European urology focus最新文献

{"title":"Disrupted Circadian Rhythm as a Mediator of Autonomic Dysregulation and Overactive Bladder in Men with Benign Prostatic Hyperplasia.","authors":"Yu-Hsiang Lin, Yu-Chen Chen, Jau-Yuan Chen","doi":"10.1016/j.euf.2025.05.001","DOIUrl":"https://doi.org/10.1016/j.euf.2025.05.001","url":null,"abstract":"<p><p>Overactive bladder (OAB) and nocturnal polyuria (NP) significantly impact quality of life, particularly in aging men with benign prostatic hyperplasia (BPH). While often managed as localized lower urinary tract issues, emerging evidence suggests a complex interplay involving systemic factors. This mini-review explores the hypothesis that BPH-induced sleep disruption, primarily via nocturia, can trigger a cascade involving central circadian dysregulation, subsequent autonomic nervous system (ANS) imbalance, and hormonal shifts (including antidiuretic hormone and testosterone) that ultimately contribute to OAB symptoms and NP. Conditions such as obstructive sleep apnea can exacerbate this cycle. Manifestations of ANS dysfunction, such as altered heart rate variability and nondipping blood-pressure patterns, are increasingly recognized in these patients. Current pharmacological treatments for OAB such as anticholinergic agents and β3-adrenoceptor agonists, may primarily address the downstream consequences of ANS dysregulation. This intricate network highlights the potential need for integrated management strategies targeting sleep, circadian health, and ANS balance alongside traditional urological approaches. PATIENT SUMMARY: Older men often experience frequent nighttime urination (nocturia) associated with an enlarged prostate gland. This review discusses how the resulting poor sleep can disrupt the body's internal clock and control of the nervous system. This disruption can worsen bladder problems such as overactive bladder and increase nighttime urine production, and can potentially affect heart rate patterns and blood pressure. This suggests that managing sleep and the body's rhythms might be important alongside standard bladder treatments for these patients.</p>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144076879","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":"Selecting Minimally Invasive Surgical Treatments for Benign Prostatic Hyperplasia: A Clinical Consultation Guide.","authors":"Peter Ka-Fung Chiu, Brian W H Siu, Cosimo De Nunzio","doi":"10.1016/j.euf.2025.04.025","DOIUrl":"https://doi.org/10.1016/j.euf.2025.04.025","url":null,"abstract":"<p><p>Optimal patient selection on the basis of prostate size, presence of a median lobe, and patient preferences is key to success for various minimally invasive surgical treatments for benign prostatic hyperplasia (BPH), including Rezūm, UroLift, a temporary implantable nitinol device, prostate artery embolization, and Optilume BPH balloon dilatation.</p>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143963905","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":"Management of Metastatic Renal Cell Carcinoma: Guideline Updates.","authors":"Regina Barragan-Carrillo, Anna Scavuzzo, Miguel Angel Jimenez-Rios, Nora Sobrevilla-Moreno","doi":"10.1016/j.euf.2025.04.001","DOIUrl":"https://doi.org/10.1016/j.euf.2025.04.001","url":null,"abstract":"<p><p>Metastatic clear-cell renal cell carcinoma (mccRCC) remains a major cause of morbidity and mortality among patients with kidney cancer. Over the past two decades, mccRCC treatment has significantly evolved with the incorporation of antiangiogenic tyrosine kinase inhibitors (TKIs) and immune checkpoint inhibitors (ICIs) as the cornerstone of systemic therapy. In response, major international guidelines have continuously updated their recommendations according to emerging evidence from clinical trials. We provide an overview of current management recommendations for mccRCC, including cytoreductive nephrectomy (CN), active surveillance (AS), first-line treatment, and subsequent-line treatment. While upfront CN is no longer recommended for unselected patients, it remains an option for carefully selected patients with a limited metastatic burden. AS can be considered for those with slow-growing, asymptomatic, low-volume disease. First-line treatment strategies now prioritize ICI based combinations tailored to patient risk factors, comorbidities, and disease characteristics. In subsequent lines, treatment sequencing remains a challenge, with ongoing research needed to refine therapeutic choices. As new evidence emerges, treatment strategies must continue to adapt, underscoring the need for ongoing updates to clinical guidelines. PATIENT SUMMARY: Clinical trials are continuously identifying new treatments for advanced kidney cancer. Our guideline provides updated treatment recommendations from international societies that are based on evidence from these trials. Personalized treatment can improve the care and outcomes for patients with advanced kidney cancer.</p>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143958410","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: Cristina Negrean, Ammar Alam, Duane Hickling, et al. Preoperative Magnetic Resonance Imaging Membranous Urethral Length as a Predictor of Urinary Continence After Radical Prostatectomy: A Systematic Review and Meta-analysis. Eur Urol Focus. In press. https://doi.org/10.1016/j.euf.2025.02.002.","authors":"Yalong Zhang, Rui Yan, Li Yang","doi":"10.1016/j.euf.2025.03.022","DOIUrl":"https://doi.org/10.1016/j.euf.2025.03.022","url":null,"abstract":"","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2025-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143959876","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: Justine Panian, Caiwei Zhong, Sharon H. Choi, et al. Efficacy of Treatments After Lenvatinib in Patients with Advanced Renal Cell Carcinoma. Eur Urol Focus. In press. https://doi.org/10.1016/j.euf.2024.11.011.","authors":"Viktor Grünwald, Thomas Powles, Thomas E Hutson, Jens Bedke, Camillo Porta, Robert J Motzer","doi":"10.1016/j.euf.2025.03.021","DOIUrl":"https://doi.org/10.1016/j.euf.2025.03.021","url":null,"abstract":"","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2025-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143998387","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 Treatment of Urinary Incontinence. Eur Urol Focus. In press. https://doi.org/10.1016/j.euf.2025.02.015.","authors":"Yu-Hsiang Lin, Yi-Kai Chang, Kuo-Jen Lin","doi":"10.1016/j.euf.2025.03.023","DOIUrl":"https://doi.org/10.1016/j.euf.2025.03.023","url":null,"abstract":"","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2025-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143959880","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":"Pelvic Floor Muscle Training with Preoperative Biofeedback in Patients with Postprostatectomy Incontinence: A Systematic Review and Meta-analysis of Randomised Clinical Trials.","authors":"Beatriz Brea-Gómez, Rocío Pazo-Palacios, Laura Pérez-Gisbert, Marie Carmen Valenza, Irene Torres-Sánchez","doi":"10.1016/j.euf.2025.04.004","DOIUrl":"https://doi.org/10.1016/j.euf.2025.04.004","url":null,"abstract":"<p><strong>Background and objective: </strong>The evidence on pelvic floor muscle training (PFMT) with preoperative biofeedback after radical prostatectomy (RP) is inconclusive. The objective was to analyse the efficacy of PFMT with preoperative biofeedback in reducing postprostatectomy incontinence.</p><p><strong>Methods: </strong>A systematic review and meta-analysis (CRD42024506285) was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. The search was performed until July 2024. We selected randomised clinical trials including adults with prostate cancer who were candidates for RP and underwent PFMT with preoperative biofeedback compared with the control group, usual care, or PFMT with postoperative biofeedback, and we assessed urinary incontinence, quality of life, or other surgery-related adverse events. Quality of evidence and risk of bias were assessed. A meta-analysis was performed.</p><p><strong>Key findings and limitations: </strong>Fourteen studies were included in the systematic review and 13 were included in the meta-analysis. Up to 3 mo following RP, the meta-analysis showed significantly lower rates of postprostatectomy incontinence (n = 485; odds ratio [OR] = 0.51; 95% confidence interval [CI] = 0.28, 0.92; p = 0.02; I² = 21%) in the preoperative biofeedback group than in the control group (ie, no intervention or usual care). Results were maintained at 3-<6 mo (n = 436; OR = 0.40; 95% CI = 0.20, 0.79; p = 0.008; I² = 49%) and at 6-<12 mo (n = 409; OR = 0.29; 95% CI = 0.10, 0.85; p = 0.02; I² = 65%) following RP. No significant changes were observed when compared with the postoperative biofeedback. No publication bias was detected. The level of evidence ranged from very low to low. Further high-quality research is required.</p><p><strong>Conclusions and clinical implications: </strong>PFMT with preoperative biofeedback reduced postprostatectomy incontinence significantly at different follow-up periods, supporting its use in clinical practice.</p>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143960545","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":"What Is the Role of Invasive Urodynamics in the Assessment of Male Lower Urinary Tract Symptoms/Benign Prostatic Hyperplasia.","authors":"Enrico Finazzi Agrò, Eleonora Rosato, Simone Pletto, Gianluca Sampogna","doi":"10.1016/j.euf.2025.04.018","DOIUrl":"https://doi.org/10.1016/j.euf.2025.04.018","url":null,"abstract":"<p><p>Invasive urodynamics (iUDS) should be selectively performed in male patients with lower urinary tract symptoms before invasive treatment for benign prostatic obstruction. Recent evidence highlights the relevance of iUDS, particularly in patients with mixed symptomatology or significant comorbidities. Parameters such as the maximum flow rate, Bladder Outlet Obstruction Index, Bladder Contractility Index play a crucial role in predicting surgical outcomes, which emphasizes the importance of meticulous patient selection to maximize therapeutic efficacy.</p>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143987651","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":"The Role of Salvage Cystectomy After Prior Trimodality Therapy: A Multinational Match-paired Analysis.","authors":"Nikolaos Pyrgidis, Gerald Bastian Schulz, Pietro Scilipoti, Francesco Pellegrino, Jozefina Casuscelli, Lazaros Tzelves, Stamatios Katsimperis, Davide Ciavarella, Maria Carmen Mir, Ioannis Sokolakis, Tobias Klatte, Alberto Ramos Belinchon, Jorge Caño Velasco, Yasuhisa Fujii, Hajime Tanaka, Soichiro Yoshida, Shunya Matsumoto, Paolo Umari, Jeremy Yuen-Chun Teoh, Chris Wong Ho Ming, Giuseppe Simone, Riccardo Mastroianni, Roman Mayr, Francesco Del Giudice, Marco Moschini","doi":"10.1016/j.euf.2025.04.028","DOIUrl":"https://doi.org/10.1016/j.euf.2025.04.028","url":null,"abstract":"<p><strong>Background and objective: </strong>Trimodality therapy (TMT) with transurethral resection followed by radiation of the urinary bladder and chemotherapy is associated with similar long-term survival rates to radical cystectomy (RC) for well-selected patients. Nevertheless, salvage RC may become necessary in 10% of patients receiving TMT. We aimed to assess the perioperative and long-term outcomes of salvage RC after prior TMT through a large multinational cohort study.</p><p><strong>Methods: </strong>We included patients with pure urothelial cancer of the urinary bladder. Patients undergoing salvage RC after prior TMT due to recurrence in the urinary bladder from 13 high-volume centers were matched with a propensity score analysis in a 1:1 ratio with patients without prior TMT undergoing primary RC. The two groups were adjusted for institution, age, histological status, American Society of Anesthesiologists score, and surgical technique (open or minimally invasive RC).</p><p><strong>Key findings and limitations: </strong>We included 118 patients (59 per group) with a median age of 73 yr (interquartile range [IQR]: 66-79). Seven patients (11%) developed severe, grade 4 or 5 perioperative complications during RC after prior TMT. The 30- and 90-d survival rates of salvage RC after prior TMT were 93% and 91%, respectively. RC in patients with prior TMT was associated with higher blood loss by 297 ml (95% confidence interval [CI]: 73-520, p = 0.010) and higher odds of admission to the intensive care unit (odds ratio: 2.8, 95% CI: 1.2-6.7, p = 0.017) than primary RC in matched patients. At a median follow-up of 10 mo (IQR: 5-34), 29 deaths occurred in patients requiring RC after prior TMT. Prior TMT was associated with worse overall survival than primary RC (hazard ratio: 1.9, 95% CI: 1.2-4.1, p = 0.032).</p><p><strong>Conclusions and clinical implications: </strong>Salvage RC after TMT and primary RC have comparable perioperative outcomes. Patients undergoing salvage RC after TMT may have worse overall survival in the long term, likely reflecting tumor biology.</p>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143973862","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":"STARLITE 1: Phase 1b/2 Study of Combined ¹⁷⁷Lu-Girentuximab plus Cabozantinib and Nivolumab in Treatment-naïve Patients with Advanced Clear-cell Renal Cell Carcinoma.","authors":"Elshad Hasanov, Lesley Flynt, Rebecca Slack Tidwell, Hyunsoo Hwang, Roserika Brooks, Lauren Michelle Wood, Travis Solley, Mashaal Syed, Aradhana M Venkatesan, Eric Jonasch","doi":"10.1016/j.euf.2025.04.003","DOIUrl":"https://doi.org/10.1016/j.euf.2025.04.003","url":null,"abstract":"<p><p>This trial is evaluating the combination of ¹⁷⁷Lu-girentuximab with nivolumab and cabozantinib to enhance the complete response rate in advanced clear-cell renal cell carcinoma (ccRCC). The aim is to activate cGAS-STING-induced antitumor immunity via targeted radioimmunotherapy damage to DNA. If successful, this approach could establish a novel paradigm that combines radiopharmaceuticals with immunotherapy and targeted therapy in ccRCC.</p>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2025-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144005127","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}