European urology focus最新文献

{"title":"European Association of Urology Guidelines on Renal Transplantation: Update 2024.","authors":"Oscar Rodríguez Faba, Romain Boissier, Klemens Budde, Arnaldo Figueiredo, Vital Hevia, Enrique Lledó García, Heinz Regele, Rhana Hassan Zakri, Jonathon Olsburgh, Carla Bezuidenhout, Alberto Breda","doi":"10.1016/j.euf.2024.10.010","DOIUrl":"https://doi.org/10.1016/j.euf.2024.10.010","url":null,"abstract":"<p><strong>Background and objective: </strong>The European Association of Urology (EAU) Panel on Renal Transplantation released an updated version of the renal transplantation (RT) guidelines. This report aims to present the 2024 EAU guidelines on RT.</p><p><strong>Methods: </strong>A broad and comprehensive scoping exercise covering all areas of RT guidelines published between May 31, 2020 and April 1, 2023 was performed. Databases covered by the search included Medline, Embase, and the Cochrane Libraries. Previous guidelines were updated, and levels of evidence and grades of recommendation were assigned.</p><p><strong>Key findings and limitations: </strong>It is strongly recommended to offer pure or hand-assisted laparoscopic/retroperitoneoscopic surgery for living donor nephrectomy. One should not base decisions regarding the acceptance of a donor organ on histological findings alone, since this might lead to an unnecessary high rate of discarded grafts. For the ureterovesical anastomosis, a Lich-Gregoir-like extravesical technique protected by a ureteral stent is the preferred technique. A list of RT patients with a history of appropriately treated low-stage/grade renal cell carcinoma or prostate cancer should be made without additional delay. In the potential donor kidney, the main surgical tumoral approach is ex vivo tumor excision and finally transplantation. It is also strongly recommended to perform initial rejection prophylaxis with a combination therapy of a calcineurin inhibitor (preferably tacrolimus), mycophenolate, steroids, and an induction agent (either basiliximab or antithymocyte globulin). The long version of the guidelines is available at the EAU website (www.uroweb.org/guidelines).</p><p><strong>Conclusions and clinical implications: </strong>These abridged EAU guidelines present updated information on the clinical and surgical management of RT for incorporation into clinical practice.</p><p><strong>Patient summary: </strong>The European Association of Urology has released the renal transplantation guidelines. Implementation of minimally invasive surgery for organ retrieval and the latest evidence on transplant surgery as well as on immunosuppressive regimens are key to minimizing rejection and achieving long-term graft survival.</p>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2024-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142568303","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":"Gender Demographics in Urology in Europe: Trend Analysis over a 10-year Period.","authors":"Alba Sierra, Rita Pagés, Mriganka Sinha, Patrick Juliebø-Jones, Judith Bosschieter, Marie-Claire Rassweiler, Etienne Xavier Keller, Frederic Panthier, Vincent de Connick, Francesco Esperto, Manuela Hunziker, Christian Beisland, Patricia Zondervan, Carlotta Nedbal, Geraldine Pignot, Amelia Pietropaolo, Maria Ribal, Bhaskar K Somani","doi":"10.1016/j.euf.2024.10.008","DOIUrl":"https://doi.org/10.1016/j.euf.2024.10.008","url":null,"abstract":"<p><strong>Background and objective: </strong>We analysed gender trends for urology trainees and consultants across nine European countries (Spain, UK, Netherlands, Norway, Germany, France, Belgium, Italy, and Switzerland) over a 10-yr period (2012-2022) to gain insight into gender dynamics in urology and determine if there is increasing representation of women in the profession. This information will help in the development of more effective strategies to promote gender equality.</p><p><strong>Methods: </strong>Data from the past decade were collected, encompassing trainee and consultant records nationally. The project focused on gender demographics within the field of urology, looking at trends in the nine countries. Information was obtained from national registries and supplemented with additional data sources where necessary.</p><p><strong>Key findings and limitations: </strong>Our results reveal significant variations in gender composition of urology trainees, displaying a slight increase in the presence of female trainees across most countries. This trend was particularly remarkable in Spain and Belgium where the proportion of female urologists exceeded 50%, indicating a potential generational shift within the field. Furthermore, among consultants, there was a global annual increase of 6.7% in female representation, with notable rises in the UK, France, Swiss and Belgium. These trends were also reflected in the membership affiliation data of the European Association of Urology during the same timeframe.</p><p><strong>Conclusions and clinical implications: </strong>The observed growth in female trainees and consultants offers valuable insights for educational and workforce planning. It is important to understand the evolving dynamics in the field of urology, especially for trainee demographics. Furthermore, the potential engagement of this with more countries could provide a comprehensive view of urology trends across Europe and worldwide.</p><p><strong>Patient summary: </strong>We looked at the proportion of urology trainees and consultants who are women across Europe. We found that overall, the percentage of females in these roles increased from 2012 to 2022, especially for urology trainees, but there are differences by country. Even if these trends continue, it will take many years before there is equal representation of men and women doctors in urology.</p>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142544632","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":"Urology Malpractice Litigation and Complaints Referred to the General Medical Council: A UK-based analysis of Trends, Demographics, and Outcomes over the Last Two Decades.","authors":"Abhinav Tiwari, Jenni Lane, Bhaskar K Somani","doi":"10.1016/j.euf.2024.10.007","DOIUrl":"https://doi.org/10.1016/j.euf.2024.10.007","url":null,"abstract":"<p><strong>Background and objective: </strong>Surgical specialties account for a significant proportion of malpractice litigation claims and complaints to the regulatory body. The aim of our study was to analyse trends and outcomes for urology malpractice claims and complaints to the General Medical Council (GMC) in the UK over the last two decades.</p><p><strong>Methods: </strong>Data were requested from the GMC and NHS Resolution under the Freedom of Information Act 2000. This included the number of malpractice claims in urology, including damages paid, and annual complaints about urologists to the GMC since 2006. For complaints to the GMC, demographics, case outcomes, and reasons for complaints were also provided.</p><p><strong>Key findings and limitations: </strong>Over the study period, there was a 2.9-fold increase in successful (settled or closed) malpractice claims (from 2006-2007 to 2022-2023) and a 1.5-fold increase in complaints to the GMC about urologists (from 2007 to 2024). There were 2511 successful malpractice claims, resulting in a total payout of £145 million. The GMC received 1118 complaints regarding 1045 urologists, of which 26.0% (291/1118) were investigated, 2.4% (27/1118) resulted in a hearing, and 0.5% (6/1118) resulted in the doctor involved being erased from the medical register. Demographic distributions, including gender, ethnicity, and place of medical qualification, for the group involved in complaints differed significantly in comparison to the overall urologist population.</p><p><strong>Conclusions and clinical implications: </strong>The numbers of successful urological malpractice claims and complaints to the regulatory body and associated costs have risen. A small proportion of complaints to the GMC led to a medicolegal hearing and subsequent erasure of the doctors involved from the medical register.</p><p><strong>Patient summary: </strong>We analysed trends and outcomes for malpractice claims and complaints in urology over the last two decades in the UK. The numbers of successful urological malpractice claims and complaints and associated costs have risen, with a small proportion of doctors removed from the medical register.</p>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142544633","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":"Long-term Relapse and Survival in Clinical Stage I Testicular Teratoma.","authors":"Julian Chavarriaga, Roderick Clark, Eshetu G Atenafu, Lynn Anson-Cartwright, Padraig Warde, Peter Chung, Philippe L Bedard, Di Maria Jiang, Martin O'Malley, Susan Prendeville, Michael Jewett, Robert J Hamilton","doi":"10.1016/j.euf.2024.10.004","DOIUrl":"https://doi.org/10.1016/j.euf.2024.10.004","url":null,"abstract":"<p><strong>Background and objective: </strong>Studies in metastatic nonseminomatous germ-cell tumor (NSGCT) suggest that the presence of teratomatous elements in the primary tumor is a risk factor for poor survival. Many guidelines have extrapolated this observation and recommend adjuvant retroperitoneal lymph-node dissection (RPLND) even for clinical stage I (CSI) teratoma confined to the testicle. Our objective was to assess relapse-free survival (RFS), cancer-specific survival (CSS), overall survival (OS) among patients with CSI pure teratoma in comparison to CSI NSGCT.</p><p><strong>Methods: </strong>Patients with CSI NSGCT managed with surveillance between 1980 and 2023 were identified in the prospectively maintained Princess Margaret Cancer Centre database. We compared cases with pure teratoma with or without somatic transformation in the primary tumor to all other nonteratomatous NSGCTs.</p><p><strong>Key findings and limitations: </strong>A total of 774 patients with CSI NSGCT were identified, including 63 (8.1%) with pure teratoma and/or somatic transformation in the primary tumor. Median follow-up was 61 mo. The pure teratoma group had superior RFS at 6 yr (85.2% vs 67.9%; p = 0.008). There were no significant differences in 6-yr CSS (100% vs 99.1%; p = 0.92) or OS (97.4% vs 98.1%; p = 0.33). Limitations include the single-center setting and the limited follow-up (median 61 mo), hindering the ability to detect late relapses.</p><p><strong>Conclusions and clinical implications: </strong>CSI pure teratoma managed with surveillance is associated with a low risk of relapse overall and significantly lower risk of relapse in comparison to other CSI NSGCTs. No patients with CSI teratoma in the study population died of testicular cancer. Guidelines should be revised to include surveillance as a preferred approach for CSI teratoma.</p><p><strong>Patient summary: </strong>We compared survival rates after testicle removal in clinical stage I testicular cancer for two different tumor types. We found that cancer-specific and overall survival rates were similar for pure teratoma tumors and nonseminoma tumors, and that the recurrence rate was lower for pure teratoma tumors. Our results support surveillance as a suitable option after surgery for patients with clinical stage I testicular teratoma.</p>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142497700","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":"Robot-assisted Radical Prostatectomy with the Hugo RAS and da Vinci Surgical Robotic Systems: A Systematic Review and Meta-analysis of Comparative Studies.","authors":"Filippo Marino, Stefano Moretto, Francesco Rossi, Francesco Pio Bizzarri, Carlo Gandi, Giovanni Battista Filomena, Filippo Gavi, Pierluigi Russo, Marco Campetella, Angelo Totaro, Francesco Pierconti, Nicolò Lentini, Roberta Pastorino, Emilio Sacco","doi":"10.1016/j.euf.2024.10.005","DOIUrl":"https://doi.org/10.1016/j.euf.2024.10.005","url":null,"abstract":"<p><strong>Background and objective: </strong>The introduction of the Hugo RAS system represents a recent innovation in robotic surgery. The potential benefits and limitations of this system and its integration into clinical practice in urology have yet to be fully delineated. Our objective was to assess surgical, early oncological, and functional outcomes in studies comparing robot-assisted radical prostatectomy (RARP) performed with the new Hugo RAS system and the well-established da Vinci surgical system.</p><p><strong>Methods: </strong>We conducted a systematic review and meta-analysis using PubMed, Web of Science, Scopus, and Embase databases. Eligible studies compared RARP outcomes in adult males between the Hugo RAS and da Vinci systems. The main endpoints were analyzed using a random-effects model, including perioperative outcomes (surgical times, estimated blood loss, length of hospital stay, Clavien-Dindo grade ≥2 complications), oncological outcomes (positive surgical margins and postoperative prostate-specific antigen), and functional outcomes (continence status and erectile function).</p><p><strong>Key findings and limitations: </strong>Nine studies involving 1185 patients (478 Hugo RAS and 707 da Vinci) were included. Significant differences in pooled baseline characteristics included higher body mass index for the da Vinci cohort (p = 0.035) and a higher rate of palpable disease in the Hugo RAS cohort (p = 0.036). Docking time was significantly longer for the Hugo RAS, with a median difference of 6.1 min (95% confidence interval 3.9-8.2; I² = 68.6%; p < 0.001; three studies). Overall, there were no significant differences in perioperative, oncological, and functional outcomes between the two systems.</p><p><strong>Conclusions and clinical implications: </strong>Despite the preliminary nature of the evidence, this systematic review and meta-analysis show comparable surgical and clinical outcomes for RARP performed with the Hugo RAS system and the da Vinci robotic platform.</p><p><strong>Patient summary: </strong>We reviewed studies comparing the use of two different surgical robots for removal of the prostate. The results suggest that surgical and clinical outcomes with the new Hugo RAS robot are comparable to those with the established da Vinci robot for this procedure.</p>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142497701","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":"Comparison of Apixaban Versus Enoxaparin for Venous Thromboembolism Prevention After Radical Cystectomy: The CARE Trial.","authors":"Katharine F Michel, Michelle Slinger, Hanna Stambakio, Ruchika Talwar, Amy N Luckenbough, Max Kates, Sunil H Patel, Luke J Keele, Trinity J Bivalacqua","doi":"10.1016/j.euf.2024.10.002","DOIUrl":"https://doi.org/10.1016/j.euf.2024.10.002","url":null,"abstract":"<p><p>CARE is a pragmatic randomized clinical trial designed to compare adherence, satisfaction, patient out-of-pocket costs, and venous thromboembolism (VTE) rates between apixaban and enoxaparin prescribed as VTE prophylaxis on discharge after radical cystectomy.</p>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142497698","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":"Outpatient Robotic Urological Surgery: An Evidence-based Analysis.","authors":"Angelo Orsini, Francesco Lasorsa, Gabriele Bignante, Michele Marchioni, Luigi Schips, Giuseppe Lucarelli, Francesco Porpiglia, Jihad H Kaouk, Simone Crivellaro, Riccardo Autorino","doi":"10.1016/j.euf.2024.10.003","DOIUrl":"https://doi.org/10.1016/j.euf.2024.10.003","url":null,"abstract":"<p><strong>Background and objective: </strong>One of the primary advantages of minimally invasive surgery is the shorter hospitalization time, which can potentially allow \"outpatient\" (OP) procedures. The recent advent of single-port (SP) robotics has further fueled the debate on this topic. We sought to provide an evidence-based analysis of the safety, feasibility, and advantages of robotic urological surgery in the OP setting.</p><p><strong>Methods: </strong>A literature search in PubMed was conducted in June 2024 to identify studies on the feasibility and safety of OP robotic urological surgery. Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria and the Population, Intervention, Comparator, Outcome model were used to select retrospective and prospective studies. Data collected included patient characteristics, operative outcomes, same-day discharge (SDD), and complication and readmission rates. Study quality was assessed using the Newcastle-Ottawa Scale. Data analysis and synthesis were performed using Review Manager and GraphPad Prism.</p><p><strong>Key findings and limitations: </strong>For 3291 patients in noncomparative studies, we found SDD rates of 46.17% for multiport (MP) robot-assisted radical prostatectomy (RARP), 77.35% for SP-RARP, 93.1% for robot-assisted radical or partial nephrectomy, and 93.3% for adrenalectomy. Among comparative studies involving 4130 patients, we found that the OP setting is feasible and safe. Comparison of overall complications between OP and inpatients (IP) settings revealed a relative risk (RR) of 0.66 (95% confidence interval [CI] 0.48-0.91; p = 0.01) favoring OP. The risk of readmission was lower risk for OP than for IP surgery (RR 0.53, 95% CI 0.33-0.85; p = 0.008). Comparison of MP-RARP and SP-RARP revealed that OP protocols are more easily achievable with SP-RARP (44.20% vs 79.59%; p < 0.001).</p><p><strong>Conclusions and clinical implications: </strong>OP robotic urological surgery is feasible and safe in selected patients and can enhance satisfaction and reduce costs. SP robotics could promote wider adoption of SDD protocols. Strict case selection minimizes complications. Differences in health care systems should be considered in future evaluations.</p><p><strong>Patient summary: </strong>We examined the feasibility and safety of same-day hospital discharge after robot-assisted surgery for urology operations. We found that this option can be safely offered and may be even more viable if the use of robots allowing surgery through a single keyhole incision becomes more widespread.</p>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2024-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142461408","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":"Reply to Arun Joshi, Lazaros Tzelves, Zafer Tandogdu, Patrick Juliebø-Jones, and Bhaskar Somani's Letter to the Editor re: Christian Moro, Charlotte Phelps, Vineesha Veer, et al. Cranberry Juice, Cranberry Tablets, or Liquid Therapies for Urinary Tract Infection: A Systematic Review and Network Meta-analysis. Eur Urol Focus. In press. https://doi.org/10.1016/j.euf.2024.07.002.","authors":"Christian Moro, Charlotte Phelps, Vineesha Veer, Mark Jones, Paul Glasziou, Justin Clark, Kari A O Tikkinen, Anna Mae Scott","doi":"10.1016/j.euf.2024.09.014","DOIUrl":"10.1016/j.euf.2024.09.014","url":null,"abstract":"","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2024-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142375354","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":"Survival Rates in Trimodal Therapy Versus Radiotherapy in Urothelial Carcinoma of Urinary Bladder.","authors":"Mario de Angelis, Carolin Siech, Francesco Di Bello, Natali Rodriguez Peñaranda, Jordan A Goyal, Zhe Tian, Nicola Longo, Felix K H Chun, Stefano Puliatti, Fred Saad, Shahrokh F Shariat, Giorgio Gandaglia, Marco Moschini, Armando Stabile, Francesco Montorsi, Alberto Briganti, Pierre I Karakiewicz","doi":"10.1016/j.euf.2024.09.013","DOIUrl":"10.1016/j.euf.2024.09.013","url":null,"abstract":"<p><strong>Background and objective: </strong>Trimodal therapy (TMT) provided significant survival advantage relative to external beam radiation therapy (EBRT) alone in prospective trials. However, the magnitude of survival benefit has not been validated in population-based studies. The objective of this study is to determine whether TMT is associated with lower cancer-specific mortality (CSM) rates relative to EBRT.</p><p><strong>Methods: </strong>Within the Surveillance, Epidemiology, and End Results database (2004-2020), we identified patients with cT2-T4aN0M0 urothelial carcinoma of urinary bladder (UCUB) treated with either TMT or EBRT. Cumulative incidence plots and multivariable competing risk regression (CRR) models addressed CSM after additional adjustment for other-cause mortality and standard covariates. The same methodology was repeated according to stage and age categories.</p><p><strong>Key findings and limitations: </strong>Of 4471 patients, 3391 (76%) underwent TMT versus 1080 (24%) EBRT. TMT rates increased over time in the overall cohort (estimated annual percent change [EAPC]: 1.8%, p < 0.001) as well as in organ-confined (OC) stage (EAPC: 1.7%, p < 0.001), but not in non-organ-confined (NOC) stage (p = 0.051). In the overall cohort, 5-yr CSM rates were 43.6% in TMT versus 52.7% in EBRT. In multivariable CRR models, TMT was an independent predictor of lower CSM (hazard ratio [HR]: 0.76, p < 0.001). In OC patients, 5-yr CSM rates were 42.0% in TMT versus 51.9% in EBRT (p < 0.001). In multivariable CRR models, TMT was an independent predictor of lower CSM (HR: 0.74, p < 0.001). Conversely, in NOC patients, TMT did not achieve independent predictor status (p = 0.3).</p><p><strong>Conclusions and clinical implications: </strong>In this population-based study, relative to EBRT, TMT is associated with lower CSM in OC stage, but not in NOC UCUB patients.</p><p><strong>Patient summary: </strong>In this report, we investigated the survival benefit of administering systemic chemotherapy in addition to radiotherapy in patients who are candidates for bladder-sparing strategies. We found that the combination of systemic chemotherapy and radiotherapy leads to improved cancer-specific survival compared with radiotherapy alone in patients with organ-confined urothelial carcinoma. We conclude that among patients who are candidates for bladder-sparing strategies, following transurethral resection, the combination of radiotherapy and chemotherapy (namely, trimodal therapy) should always be offered in those with organ-confined urothelial carcinoma.</p>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2024-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142375355","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":"Mirabegron Versus Placebo and Other Therapeutic Modalities in the Treatment of Patients with Overactive Bladder Syndrome-A Systematic Review.","authors":"Anirban Dey, Georgios Georgiadis, Justin Umezurike, Yuhong Yuan, Fawzy Farag, James N'Dow, Muhammad Imran Omar, Charalampos Mamoulakis","doi":"10.1016/j.euf.2024.09.012","DOIUrl":"https://doi.org/10.1016/j.euf.2024.09.012","url":null,"abstract":"<p><strong>Background and objective: </strong>The prevalence of overactive bladder (OAB) increases with age. Mirabegron and other drugs are used for the management of patients with OAB. To evaluate mirabegron versus other treatments for overactive bladder syndrome (OAB).</p><p><strong>Methods: </strong>This randomised controlled trial (RCT)-based systematic review (CRD42020200394) was conducted following the 2020 Preferred Reporting Items for Systematic Reviews and Meta-analyses statement, with standards reported in the Cochrane Handbook for Systematic Reviews of Interventions.</p><p><strong>Key findings and limitations: </strong>We included 28 RCTs (n = 27 481 adults), comparing the following: mirabegron 25 mg versus placebo (n = 8798; six RCTs): significant changes in urgency urinary incontinence (mean difference [MD] -0.41, 95% confidence interval [CI] -0.56 to -0.26), total incontinence (MD -0.47, 95% CI -0.63 to -0.30), and nocturia (MD -0.10, 95% CI -0.17 to -0.02), and mirabegron 50 mg versus placebo (n = 14 933; 12 RCTs): significant changes in urgency urinary incontinence (MD -0.41, 95% CI -0.52 to -0.31), urgency (MD -0.49, 95% CI -0.64 to -0.33), total incontinence (MD -0.44, 95% CI -0.55 to -0.33), favouring mirabegron 25/50 mg; mirabegron 50 mg versus tolterodine 4 mg (n = 8008; five RCTs): significant changes in micturition (MD -0.16, 95% CI -0.31 to -0.02) and overall adverse events (AEs; odds ratio [OR] 0.71, 95% CI 0.59-0.86), favouring mirabegron 50 mg; mirabegron 50 mg versus solifenacin 5 mg (n = 8911; four RCTs): significant changes in voided volume/micturition in millilitres (MD -7.77, 95% CI -12.93 to -2.61), favouring mirabegron 50 mg; and mirabegron 50 mg versus oxybutynin 73.5 mg (n = 302; one RCT): significant changes in overall AEs (OR 0.02, 95% CI 0.00-0.16), favouring mirabegron 50 mg.</p><p><strong>Conclusions and clinical implications: </strong>Mirabegron is effective, safe, and well tolerated. Coadministration with anticholinergics provides an advantageous additive effect without a higher occurrence of side effects.</p><p><strong>Patient summary: </strong>Mirabegron is effective, safe, and well tolerated for treating overactive bladder. When used in conjunction with anticholinergic medications, it provides extra benefits without causing more side effects.</p>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2024-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142344350","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}