European urology focus最新文献

{"title":"Effect of TNF-α Inhibitor Therapy on Growth of the Prostate Gland","authors":"Ra'ad Al-Faouri ,&nbsp;Christina Sharkey ,&nbsp;Boris Gershman ,&nbsp;Leo L. Tsai ,&nbsp;Zongwei Wang ,&nbsp;Aria F. Olumi","doi":"10.1016/j.euf.2023.10.015","DOIUrl":"10.1016/j.euf.2023.10.015","url":null,"abstract":"<div><h3>Background</h3><div>Inflammation has been linked to the development of benign prostatic hyperplasia (BPH). SRD5A2 is a pivotal enzyme in the development and growth of the prostate gland and a critical target for BPH therapy. TNF-α regulates epigenetic changes in SRD5A2, leading to suppression of SRD5A2 gene and protein expression. It is unknown whether TNF-α inhibitor therapy affects prostate growth.</div></div><div><h3>Objective</h3><div>To evaluate the effect of TNF-α inhibitor therapy on prostate growth via analysis of measurements on serial pelvic imaging scans.</div></div><div><h3>Design, setting, and participants</h3><div>In this retrospective cohort study, we analyzed serial pelvic cross-sectional imaging (magnetic resonance imaging or computed tomography scans) for men aged ≥18 yr receiving TNF-α inhibitors. Our inclusion/exclusion criteria yielded a treatment cohort of 99 men. An age-matched cohort was constructed with the same inclusion/exclusion criteria but without TNF-α therapy (<em>n</em> = 99).</div></div><div><h3>Outcome measurements and statistical analysis</h3><div>Prostate growth on serial pelvic cross-sectional imaging was the primary outcome measure.</div></div><div><h3>Results and limitations</h3><div>There was no significant difference in total prostate volume (TPV) at baseline between the two groups. The TNF-α treatment group had a lower mean TPV on follow-up (26.21 ± 9.43 vs 32.71 ± 18.89 cm³; <em>p</em> = 0.002) and a lower median prostate growth rate (−0.01 vs 0.68 cm³/yr; <em>p</em> = 0.001). A multivariable linear regression model adjusted for age, race, initial TPV, and body mass index also revealed a significantly lower growth rate for men in the treatment group.</div></div><div><h3>Conclusion</h3><div>TNF-α inhibitor use was negatively correlated with the prostate growth rate, suggesting that inflammatory mediators regulate prostate growth.</div></div><div><h3>Patient summary</h3><div>We examined prostate growth rates in men taking TNF-α inhibitors and found that these drugs have a shrinking effect on the prostate. We conclude that TNF-α inhibitors may impede prostate growth.</div></div>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":"10 4","pages":"Pages 641-647"},"PeriodicalIF":4.8,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136160403","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":"Safety and Efficacy of Vaginal Implants in Pelvic Organ Prolapse Surgery: A Meta-analysis of 161 536 Patients","authors":"Júlia Ács ,&nbsp;Anett Szabó ,&nbsp;Péter Fehérvári ,&nbsp;Andrea Harnos ,&nbsp;Benjamin Skribek ,&nbsp;Martin Tenke ,&nbsp;Tibor Szarvas ,&nbsp;Péter Nyirády ,&nbsp;Nándor Ács ,&nbsp;Péter Hegyi ,&nbsp;Attila Majoros","doi":"10.1016/j.euf.2023.11.001","DOIUrl":"10.1016/j.euf.2023.11.001","url":null,"abstract":"<div><h3>Context</h3><div>Among the many surgical treatments for pelvic organ prolapse (POP), better results can be achieved with the use of vaginal implants. However, owing to perceived complications, vaginal implant surgeries have been restricted or banned in many countries.</div></div><div><h3>Objective</h3><div>To assess the real value of vaginal implants in POP surgery and compare the safety and efficacy of operations with and without implants.</div></div><div><h3>Evidence acquisition</h3><div>A systematic search was performed in three medical databases. Randomised controlled trials and observational studies comparing the safety and efficacy of vaginal POP surgery with implants versus native tissue were included. Safety outcomes were defined as different types of complications (functional and non-functional) and reoperations for complications. Efficacy outcomes were parameters of anatomical success and the rate of reoperations due to recurrence. A multivariate meta-analysis framework was used to estimate pooled odds ratios (ORs) with confidence intervals (CIs) with simultaneous control for study correlations and estimation of multiple correlated outcomes.</div></div><div><h3>Evidence synthesis</h3><div>We included 50 comparative studies in the analysis. Rates of reoperation for complications (OR 2.15, 95% CI 1.20–3.87), vaginal erosion (OR 14.05, 95% CI 9.07–21.77), vaginal bleeding (OR 1.67, 95% CI 1.25–2.23), and de novo stress urinary incontinence (OR 1.44, 95% CI 1.18–1.75) were significantly higher in the implant group. Rates of anatomical success (OR 3.22, 95% CI 2.06–5.0) and reoperation for recurrence (OR 0.55, 95% CI 0.36–0.85) were superior in the implant group.</div></div><div><h3>Conclusions</h3><div>POP surgeries with vaginal implants are more effective than surgeries without implants, with acceptable complication rates. Therefore, the complete prohibition of implants for POP surgeries should be reconsidered.</div></div><div><h3>Patient summary</h3><div>We compared vaginal surgery with and without implants for repair of pelvic organ prolapse. Despite higher complication rates, vaginal implants provide better long-term results overall than surgery without implants.</div></div>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":"10 4","pages":"Pages 525-534"},"PeriodicalIF":4.8,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134648698","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of Recipient Body Mass Index on Kidney Transplantation Outcomes: A Systematic Review and Meta-analysis by the Transplant Committee from the French Association of Urology","authors":"Thomas Prudhomme ,&nbsp;Lucas Bento ,&nbsp;Alexandre Frontczak ,&nbsp;Marc-Olivier Timsit ,&nbsp;Romain Boissier ,&nbsp;Transplant Committee from the French Association of Urology CTAFU","doi":"10.1016/j.euf.2023.11.003","DOIUrl":"10.1016/j.euf.2023.11.003","url":null,"abstract":"<div><h3>Context</h3><div>The impact of recipient obesity on kidney transplantation (KT) outcomes remains unclear.</div></div><div><h3>Objective</h3><div>The aim of this study was to perform a systematic review and meta-analysis to appraise all available evidence on the outcomes of KT in obese patients (body mass index [BMI] ≥30 kg/m²) versus nonobese patients (BMI &lt;30 kg/m²).</div></div><div><h3>Evidence acquisition</h3><div>A systematic review and meta-analysis was performed. Search was conducted in the MEDLINE OvidSP, Web of Science, Google Scholar, Embase, and Cochrane databases to identify all studies reporting the outcomes of KT in obese versus nonobese recipients.</div></div><div><h3>Evidence synthesis</h3><div>Fifty-two articles met the inclusion criteria. Delayed graft function and surgical complications were significantly higher in obese recipients (delayed graft function: relative risk [RR]: 1.44, 95% confidence interval [CI]: 1.32–1.57, <em>p</em> &lt; 0.01; surgical complications: RR: 1.74, 95% CI: 1.36–2.22, <em>p</em> &lt; 0.0001). Five-year patient survival (RR: 0.96, 95% CI: 0.92–1.00, <em>p</em> = 0.01), 10-yr patient survival (RR: 0.90, 95% CI: 0.84–0.97, <em>p</em> = 0.006), and 10-yr graft survival (RR: 0.87, 95% CI: 0.79–0.96, <em>p</em> = 0.01) were significantly inferior in the obese group.</div></div><div><h3>Conclusions</h3><div>KT in obese recipients was associated with lower patient and graft survival, and higher delayed graft function, acute rejection, and medical and surgical complications than nonobese recipients. In the current situation of organ shortage and increasing prevalence of obesity, ways to optimize KT in this setting should be investigated.</div></div><div><h3>Patient summary</h3><div>Compared with nonobese population, kidney transplantation in obese recipients has inferior patient and graft survival, and higher medical and surgical complications.</div></div>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":"10 4","pages":"Pages 551-563"},"PeriodicalIF":4.8,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138294983","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 Eleonora Rosato, Riccardo Lombardo, Vincenzo Li Marzi, Enrico Finazzi Agrò, Cosimo De Nunzio, and Simone Albisinni’s Letter to the Editor re: Rano Matta, Refik Saskin, Sarah Neu, et al. Predicting Mirabegron Treatment Response in Patients with Overactive Bladder: A Post Hoc Analysis of Data from Clinical Trials. Eur Urol Focus. In press. https://doi.org/10.1016/j.euf.2023.04.001","authors":"Rano Matta","doi":"10.1016/j.euf.2023.09.005","DOIUrl":"10.1016/j.euf.2023.09.005","url":null,"abstract":"","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":"10 4","pages":"Page 671"},"PeriodicalIF":4.8,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49676011","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":"Is Engineered Tissue the Future of Bladder Reconstruction: Con","authors":"Marie-Pier St-Laurent ,&nbsp;Claudia Chavez-Munoz ,&nbsp;Peter C. Black","doi":"10.1016/j.euf.2023.10.008","DOIUrl":"10.1016/j.euf.2023.10.008","url":null,"abstract":"","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":"10 4","pages":"Pages 668-669"},"PeriodicalIF":4.8,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49689522","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 and Urologist Perspectives on the Importance of Outcomes After Treatment of Hydrocele: A Multinational Survey","authors":"Angie K. Puerto Nino ,&nbsp;Gordon H. Guyatt ,&nbsp;Mikko Forss ,&nbsp;Tuomas Kilpeläinen ,&nbsp;Hydrocele Outcome Survey Investigators ,&nbsp;Kari A.O. Tikkinen","doi":"10.1016/j.euf.2023.11.012","DOIUrl":"10.1016/j.euf.2023.11.012","url":null,"abstract":"","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":"10 4","pages":"Pages 679-680"},"PeriodicalIF":4.8,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138611842","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":"Patients’ Trust in Artificial Intelligence–based Decision-making for Localized Prostate Cancer: Results from a Prospective Trial","authors":"Severin Rodler ,&nbsp;Rega Kopliku ,&nbsp;Daniel Ulrich ,&nbsp;Annika Kaltenhauser ,&nbsp;Jozefina Casuscelli ,&nbsp;Lennert Eismann ,&nbsp;Raphaela Waidelich ,&nbsp;Alexander Buchner ,&nbsp;Andreas Butz ,&nbsp;Giovanni E. Cacciamani ,&nbsp;Christian G Stief ,&nbsp;Thilo Westhofen","doi":"10.1016/j.euf.2023.10.020","DOIUrl":"10.1016/j.euf.2023.10.020","url":null,"abstract":"<div><h3>Background</h3><div>Artificial intelligence (AI) has the potential to enhance diagnostic accuracy and improve treatment outcomes. However, AI integration into clinical workflows and patient perspectives remain unclear.</div></div><div><h3>Objective</h3><div>To determine patients’ trust in AI and their perception of urologists relying on AI, and future diagnostic and therapeutic AI applications for patients.</div></div><div><h3>Design, setting, and participants</h3><div>A prospective trial was conducted involving patients who received diagnostic or therapeutic interventions for prostate cancer (PC).</div></div><div><h3>Intervention</h3><div>Patients were asked to complete a survey before magnetic resonance imaging, prostate biopsy, or radical prostatectomy.</div></div><div><h3>Outcome measurements and statistical analysis</h3><div>The primary outcome was patient trust in AI. Secondary outcomes were the choice of AI in treatment settings and traits attributed to AI and urologists.</div></div><div><h3>Results and limitations</h3><div>Data for 466 patients were analyzed. The cumulative affinity for technology was positively correlated with trust in AI (correlation coefficient 0.094; <em>p</em> = 0.04), whereas patient age, level of education, and subjective perception of illness were not (<em>p</em> &gt; 0.05). The mean score (± standard deviation) for trust in capability was higher for physicians than for AI for responding in an individualized way when communicating a diagnosis (4.51 ± 0.76 vs 3.38 ± 1.07; mean difference [MD] 1.130, 95% confidence interval [CI] 1.010–1.250; <em>t</em>₉₂₄ = 18.52, <em>p</em> &lt; 0.001; Cohen’s <em>d</em> = 1.040) and for explaining information in an understandable way (4.57 ± vs 3.18 ± 1.09; MD 1.392, 95% CI 1.275–1.509; <em>t</em>₉₂₁ = 27.27, <em>p</em> &lt; 0.001; Cohen’s <em>d</em> = 1.216). Patients stated that they had higher trust in a diagnosis made by AI controlled by a physician versus AI not controlled by a physician (4.31 ± 0.88 vs 1.75 ± 0.93; MD 2.561, 95% CI 2.444–2.678; <em>t</em>₉₂₅ = 42.89, <em>p</em> &lt; 0.001; Cohen’s <em>d</em> = 2.818). AI-assisted physicians (66.74%) were preferred over physicians alone (29.61%), physicians controlled by AI (2.36%), and AI alone (0.64%) for treatment in the current clinical scenario.</div></div><div><h3>Conclusions</h3><div>Trust in future diagnostic and therapeutic AI-based treatment relies on optimal integration with urologists as the human-machine interface to leverage human and AI capabilities.</div></div><div><h3>Patient summary</h3><div>Artificial intelligence (AI) will play a role in diagnostic decisions in prostate cancer in the future. At present, patients prefer AI-assisted urologists over urologists alone, AI alone, and AI-controlled urologists. Specific traits of AI and urologists could be used to optimize diagnosis and treatment for patients with prostate cancer.</div></div>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":"10 4","pages":"Pages 654-661"},"PeriodicalIF":4.8,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71479843","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":"New Drugs for Targeted Radionuclide Therapy in Metastatic Prostate Cancer","authors":"Kévin Hébert ,&nbsp;Paul Bodin-Cufi ,&nbsp;Cyril Fersing ,&nbsp;Emmanuel Deshayes","doi":"10.1016/j.euf.2024.07.016","DOIUrl":"10.1016/j.euf.2024.07.016","url":null,"abstract":"<div><div>Metastatic prostate cancer is a frequent and fatal disease. Targeted radionuclide therapy (TRT) has become a readily available therapeutic option since the approval of [¹⁷⁷Lu]Lu-PSMA-617. Various molecules are currently being studied for TRT in prostate cancer. We review various combinations of isotopes and vectors being used to target prostate cancer cells and optimize pharmacokinetics. Promising innovations include chemical modifications to improve biodistribution, identification of new targets, and the use of novel radioisotopes such as α emitters.</div></div><div><h3>Patient summary</h3><div>Our mini review summarizes research on targeted radioactive drugs for treatment of metastatic prostate cancer. Several promising radioactive pharmaceuticals are being evaluated in clinical trials, but more studies are necessary before these can be used in routine clinical practice.</div></div>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":"10 4","pages":"Pages 514-517"},"PeriodicalIF":4.8,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141982005","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"PARP Inhibitor Addition to Androgen Receptor Pathway Inhibitors in Metastatic Castration-resistant Prostate Cancer Should Be Limited to BRCA Mutation Carriers","authors":"Elena Castro","doi":"10.1016/j.euf.2024.08.005","DOIUrl":"10.1016/j.euf.2024.08.005","url":null,"abstract":"","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":"10 4","pages":"Pages 504-505"},"PeriodicalIF":4.8,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142132237","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":"Treatments for Patients with Metastatic Castration-resistant Prostate Cancer Who Previously Received Triplet Therapy at the Metastatic Hormone-sensitive Stage","authors":"Yohann Loriot,&nbsp;Karim Fizazi","doi":"10.1016/j.euf.2024.09.017","DOIUrl":"10.1016/j.euf.2024.09.017","url":null,"abstract":"","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":"10 4","pages":"Pages 511-513"},"PeriodicalIF":4.8,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142461410","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}