European urology focus最新文献

{"title":"A Systematic Review and Meta-analysis on Perioperative Stenting/Dwell Time and Postoperative Outcomes in Patients Undergoing Radical Cystectomy and Urinary Diversion for Bladder Cancer.","authors":"Mithun Kailavasan, Alberto Martini, Max Bruins, Albert Carrion, Richard Cathomas, Eva Compérat, Jason A Efstathiou, Rainer Fietkau, Anna Lorch, Laura S Mertens, Richard P Meijer, Paramanathan Mariappan, Mathew I Milowsky, Yann Neuzillet, Valeria Panebianco, Michael Rink, George N Thalmann, S Sæbjørnsen, Toine van der Heijden","doi":"10.1016/j.euf.2025.05.024","DOIUrl":"https://doi.org/10.1016/j.euf.2025.05.024","url":null,"abstract":"<p><strong>Background and objective: </strong>Ureteral stents are used to protect the ureteroenteric anastomosis during radical cystectomy and urinary diversion (RCUD); however, complications can occur from its use. The objective of this study was to perform a systematic review of perioperative stenting strategies and postoperative outcomes in patients undergoing RCUD for bladder cancer.</p><p><strong>Methods: </strong>This review was published via PROSPERO (CRD42024558468) and conducted following the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Medline, Medline In-Process, Embase, and the Cochrane Central Register of Controlled Trials were searched. Prospective comparative (randomised and nonrandomised) studies published until June 2024 were included. All outcomes were included in the analysis. Risk of bias assessments were undertaken.</p><p><strong>Key findings and limitations: </strong>The search yielded 1516 abstracts. Six prospective comparative studies (740 patients) were included. Although there was some evidence of reduced postoperative complications (urinary leak, ureteroileal stricture, postoperative obstruction, length of stay, and readmission within 30 d) with the omission of stents during RCUD, this did not reach statistical significance (n = 3). No differences in postoperative complications were identified between internal and external stenting (n = 2). Early stent removal (5 d) was associated with reduced urinary tract infections and hospital readmission (n = 1). There was a high/serious risk of bias with all studies.</p><p><strong>Conclusions and clinical implications: </strong>The role of perioperative stenting during RCUD in preventing ureteroenteric complications remains equivocal and does not favour one approach over another. Until further results from on-going randomised controlled trials become available, urologists should carefully consider the indications to place a ureteric stent and its retention time after RCUD.</p>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144265786","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Re: Alessandro Uleri, Thibaut Long Depaquit, Alba Farré, et al. Thulium Fiber Versus Holmium: Yttrium-aluminum-garnet Laser for Endoscopic Enucleation of the Prostate: A Systematic Review and Meta-analysis. Eur Urol Focus 2024;10:914-21.","authors":"Francesco Montorsi, Paolo Capogrosso, Federico Dehò, Giorgio Gandaglia, Alberto Briganti, Andrea Salonia","doi":"10.1016/j.euf.2025.04.011","DOIUrl":"https://doi.org/10.1016/j.euf.2025.04.011","url":null,"abstract":"","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2025-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144247183","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prostate Pathway Embedded Comparative Trial: Outcomes from the Pilot Phase of the Imperial Prostate 3-PROState Pathway Embedded Comparative Trial.","authors":"Edward James Bass, Francesca Rawlins, Taimur Shah, Natalia Klimowska-Nassar, Thiagarajah Sasikaran, Puja Jadav, Emma Cullen, Matyas Szigeti, Francesca Fiorentino, Matt R Sydes, Matt Winkler, Nimalan Arumainayagam, Alvan Pope, Heminder Sokhi, Mariam Nasseri, Hashim Uddin Ahmed","doi":"10.1016/j.euf.2025.05.007","DOIUrl":"https://doi.org/10.1016/j.euf.2025.05.007","url":null,"abstract":"<p><strong>Background and objective: </strong>Rapid innovations in prostate cancer diagnosis and treatment have led to the adoption of innovative trial designs. The Imperial Prostate 3-PROState Pathway Embedded Comparative Trial (IP3-PROSPECT) aims to explore the feasibility and acceptability of a cohort multiple randomised controlled trial (cmRCT) design within the prostate cancer pathway.</p><p><strong>Methods: </strong>Eligible participants were approached at the point of referral for a clinical suspicion of prostate cancer and were invited to join the cohort, agreeing in principle to future randomisations, without knowledge of the details of those interventions. Patients completed patient-reported outcome measure (PROM) questionnaires at baseline and follow-up visits, providing valuable insights into their experiences following prostate cancer diagnosis.</p><p><strong>Key findings and limitations: </strong>IP3-PROSPECT recruited 139 participants from 384 individuals approached across four sites, meeting the primary endpoint with an approach rate of 35.3%. Recruitment outcomes demonstrated the feasibility of recruiting patients to the cmRCT cohort within the prostate cancer pathway, with high completion rates for PROM questionnaires observed throughout the study visits. Participants and health care professionals expressed favourable views towards the design, acknowledging its potential advantages over traditional trial designs. Sufficient interventions that span the prostate pathway so that the potential large number of participants could be involved in answering research questions as well as the need to optimise recruitment strategies were identified.</p><p><strong>Conclusions and clinical implications: </strong>IP3-PROSPECT provides valuable insights into the feasibility and acceptability of implementing a cmRCT design within the prostate cancer pathway. Future research will evaluate the effectiveness of the cmRCT design in generating comparative effectiveness data for prostate cancer interventions.</p>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144233619","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient Values, Preferences, and Expectations for Managing Symptoms Due to Benign Prostate Obstruction.","authors":"Sachin Malde, Marcus J Drake, Kari A O Tikkinen","doi":"10.1016/j.euf.2025.05.018","DOIUrl":"https://doi.org/10.1016/j.euf.2025.05.018","url":null,"abstract":"<p><p>An exploration of a patient's values and preferences is an essential component of the shared decision-making (SDM) process. For the management of symptomatic benign prostate enlargement, for which there are numerous treatment options that differ in their risks, benefits, and trade-offs, it is important to empower patients so that they are able to play an active role in decisions on their treatment. The goal is to ensure that choices reflect an individual's needs, desires, and values, thereby promoting satisfaction and minimising later regret. Preferences for the management of male lower urinary tract symptoms vary widely and are shaped by various factors, including age, symptom severity, and level of sexual activity at baseline. Patient decision aids can support SDM by helping patients to choose treatments that align with what matters most to them. To fully integrate SDM into clinical practice, decision aids should be included in clinical guidelines and kept up to date. In this context, patients need clear, honest information about outcomes that matter to them, such as symptom relief, the likelihood of catheterisation, sexual and continence function, and perioperative risks. Ultimately, the success of management should be defined by the patient. PATIENT SUMMARY: Treatment for an enlarged prostate causing urinary symptoms should be personalised. Patients should discuss their individual preferences with their urologist before deciding which treatment is likely to suit them best.</p>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144233618","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Options Other than General Anaesthesia for Surgical Procedures for Bladder Outlet Obstruction.","authors":"Basil Razi, Dane Cole-Clark, Ben Dreyer, Feras Al Jaafari, Mark Rochester","doi":"10.1016/j.euf.2025.05.013","DOIUrl":"https://doi.org/10.1016/j.euf.2025.05.013","url":null,"abstract":"<p><p>An increasing number of procedures are available for treatment of bladder outlet obstruction. Minimally invasive surgical treatments include prostatic urethral lift (UroLift), water vapour therapy (Rezūm), the temporary implanted nitinol device, and transperineal laser ablation. Longer patient waiting lists, wider patient choice, patient comorbidities, and interest in conducting procedures in outpatient settings have placed a focus on options other than a general anaesthetic (GA). Non-GA options for BOO include various instillations or injections of local anaesthetic and methods for sedation. This review summarises the non-GA options available for surgical treatments for bladder outlet obstruction. PATIENT SUMMARY: This mini review looks at surgical treatment options for an enlarged prostate causing urinary blockage that do not require a general anaesthetic. We summarise the anaesthetic options available and review which are suitable for various surgical procedures.</p>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144233617","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intrarenal Fluid Temperature During Laser Lithotripsy: A Mini Review by the European Association of Urology Endourology Section.","authors":"Felipe Pauchard, Mariela Corrales, Davide Perri, Daniele Robesti, Arman Tsaturyan, Bhaskar K Somani, Ioannis Kartalas Goumas, Olivier Traxer, Eugenio Ventimiglia","doi":"10.1016/j.euf.2025.05.009","DOIUrl":"https://doi.org/10.1016/j.euf.2025.05.009","url":null,"abstract":"<p><p>Laser lithotripsy involves thermal risks due to heat generated in the surrounding fluid. The concept of thermal dose, which accounts for both temperature and exposure duration, provides a more nuanced understanding of tissue tolerance than fixed temperature thresholds, considering both the magnitude of the temperature increase and the length of exposure to each specific temperature. The concept of a thermal safety distance defines the spatial extent of potential damage, supporting safe power limits of 10 W in the ureter and 20 W in the kidney. Importantly, the type of laser (holmium:YAG, thulium fiber, or thulium:YAG) does not independently affect the rise in temperature, which is primarily driven by the amount of energy absorbed by water in the surrounding tissue. Temperature-related tissue injury can be mitigated by optimizing the flow of the irrigation fluid and the laser power settings and activation patterns. PATIENT SUMMARY: Laser treatment for stones in the kidney or ureter generates heat, which can harm adjacent tissues. The use of low-power settings and proper fluid flow helps in reducing this risk.</p>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144233616","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prostatic Stents for the Management of Lower Urinary Tract Symptoms Due to Benign Prostatic Obstruction.","authors":"Keiran J C Pace, David-Dan Nguyen, Tiange Li, Bilal Chugtai, Kevin C Zorn, Naeem Bhojani, Dean S Elterman","doi":"10.1016/j.euf.2025.05.017","DOIUrl":"https://doi.org/10.1016/j.euf.2025.05.017","url":null,"abstract":"<p><p>Prostatic stents offer a minimally invasive alternative for the management of benign prostatic obstruction. Efficacy has been demonstrated for stents that have already been approved, and investigational stents show promise. Long-term safety, durability, and patient selection are key factors for widespread adoption. Ongoing trials will define the future clinical role of these devices.</p>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144224858","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Re: Guillermo Conde-Santos, Barbara Padilla-Fernández. Targeting the Autonomic Nervous System for Urinary Incontinence Treatment. Eur Urol Focus. In press. https://doi.org/10.1016/j.euf.2025.02.015.","authors":"Hao-Wei Chen, Wei-Chung Tsai, Yu-Hsiang Lin, Yu-Chen Chen","doi":"10.1016/j.euf.2025.04.012","DOIUrl":"https://doi.org/10.1016/j.euf.2025.04.012","url":null,"abstract":"","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144215377","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Strategies for Treatment De-escalation in Metastatic Renal Cell Carcinoma.","authors":"Shuchi Gulati, Lorenzo Nardo, Primo N Lara","doi":"10.1016/j.euf.2025.05.014","DOIUrl":"https://doi.org/10.1016/j.euf.2025.05.014","url":null,"abstract":"<p><p>Immune checkpoint inhibitors (ICIs) and targeted therapies have revolutionized the management of metastatic renal cell carcinoma (mRCC). Currently, the frontline standard of care for patients with mRCC involves the provision of systemic ICI-based combination therapy with no clear guidelines on holding or de-escalating treatment, even with a complete or partial radiological response. Treatments usually continue until disease progression or unacceptable toxicity, frequently leading to overtreatment, which can elevate the risk of toxicity without providing a corresponding increase in therapeutic efficacy. In addition, the ongoing use of expensive antineoplastic drugs increases the financial burden on the already overstretched health care systems and on patients and their families. De-escalation strategies could be designed by integrating contemporary technologies, such as circulating tumor DNA, and advanced imaging techniques, such as computed tomography (CT) scans, positron emission tomography CT, magnetic resonance imaging, and machine learning models. Treatment de-escalation, when appropriate, can minimize treatment-related toxicities, reduce health care costs, and optimize the patients' quality of life while maintaining effective cancer control. This paper discusses the advantages, challenges, and clinical implications of de-escalation strategies in the management of mRCC. PATIENT SUMMARY: In this report, we describe the burden of overtreatment in patients who are never able to stop treatments for metastatic kidney cancer. We discuss the application of the latest technology that can help in making de-escalation decisions.</p>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144224859","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adjuvant Therapy for Renal Cell Carcinoma After Metastatectomy: A Focus on Therapy Intensification.","authors":"Michael Serzan","doi":"10.1016/j.euf.2025.05.005","DOIUrl":"https://doi.org/10.1016/j.euf.2025.05.005","url":null,"abstract":"<p><p>Adjuvant therapy for patients with completely resected metastases in renal cell carcinoma remains a clinical conundrum. Owing to the high risk of disease recurrence, several clinical trials are investigating treatment intensification with combination regimens aimed at improving efficacy and limiting toxicity.</p>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144141939","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}