European urology focus最新文献

{"title":"Single-dose Versus 3-day Antimicrobial Prophylaxis in Transurethral Resection or Photoselective Vaporization of the Prostate: A Multicenter, Randomized, Placebo Controlled Trial (CITrUS Trial).","authors":"Kathrin Bausch, Benjamin Speich, Deborah R Vogt, Lars G Hemkens, Maeve Dreher, Maciej Kwiatkowski, Svetozar Subotic, Peter Ardelt, Piet Bossard, Thomas Hermanns, Nicole Bruni, Stephen Wyler, Lukas Prause, Sarah-Charlotte Merz, Christian Engesser, Jan Roth, Andreas F Widmer, Hans-Helge Seifert","doi":"10.1016/j.euf.2025.08.009","DOIUrl":"https://doi.org/10.1016/j.euf.2025.08.009","url":null,"abstract":"<p><strong>Background and objective: </strong>Guidelines recommend single-dose antimicrobial prophylaxis (AMP) for transurethral resection (TURP) and photoselective vaporization (PVP) of the prostate. As guideline adherence is low and 3-d AMP is given frequently, we aimed to assess the noninferiority of a single dose compared with 3-d AMP by comparing the incidence of urinary tract infections (UTIs) within 30 d.</p><p><strong>Methods: </strong>A double-blind, multicenter, randomized, noninferiority trial was conducted comparing single-dose with 3-d AMP in patients assigned to TURP and PVP, assuming a 9% event rate for a clinical diagnosis of a UTI with a 4.4% noninferiority margin.</p><p><strong>Key findings and limitations: </strong>From anticipated 1574 patients, 728 were recruited and 621 randomized patients were analyzed fully. The study was preliminary stopped due to delayed recruitment and was analyzed exploratively. Following single-dose AMP, 11.0% of patients (95% confidence interval [CI] 7.9%, 15.0%; 33/300) had a clinical diagnosis of UTIs, compared with 8.5% (95% CI 5.8%, 12.1%; 26/307) receiving 3-d AMP (between-group difference 2.5% [95% CI -2.2%, 7.5%]). The rates of UTIs supported by bacteriuria were lower without any difference between groups (single-dose AMP: 3.3% [95% CI 1.8%, 6.0%]; 3-d AMP: 3.3% [95% CI 1.8%, 5.9%]; between-group difference 0.08% [95% CI -2.97%, 3.16%]). Adverse events were rare.</p><p><strong>Conclusions and clinical implications: </strong>In this randomized trial of transurethral prostate surgery patients, 11.0% of those on single-dose AMP and 8.5% on 3-d AMP were diagnosed with UTIs. The smaller than planned sample size precludes a definite interpretation favoring either group. Diagnoses of UTIs based on symptoms and bacteriuria reduced the overall rates and group differences.</p>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145052632","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: Vineet Gauhar, Olivier Traxer, Daniele Castellani, et al. Could Use of a Flexible and Navigable Suction Ureteral Access Sheath Be a Potential Game-changer in Retrograde Intrarenal Surgery? Outcomes at 30 Days from a Large, Prospective, Multicenter, Real-world Study by the European Association of Urology Urolithiasis Section. Eur Urol Focus 2024;10:975-82.","authors":"Yun Deng, Changhong Xu, Li Yang","doi":"10.1016/j.euf.2025.07.021","DOIUrl":"https://doi.org/10.1016/j.euf.2025.07.021","url":null,"abstract":"","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145039494","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":"Anxiety and Health-related Quality of Life in Men with Prostate Cancer Undergoing Focal Therapy: A Prospective Single-arm Phase 2 Trial.","authors":"Thomas Paul Scherer, Anna Gugerli Lazos, Julian Sonderer, Basil Kaufmann, Florian Alexander Schmid, Josef Jenewein, Niels J Rupp, Holger Moch, Daniel Eberli, Ashkan Mortezavi","doi":"10.1016/j.euf.2025.08.006","DOIUrl":"https://doi.org/10.1016/j.euf.2025.08.006","url":null,"abstract":"<p><strong>Background and objective: </strong>While whole-gland therapies for localized prostate cancer (PCa) offer excellent oncological outcomes, these can impact patients' quality of life (QoL) through serious side effects. Focal therapy using high-intensity focused ultrasound (HIFU) has emerged as a less invasive alternative to preserve QoL. However, data on the psychological impact of HIFU remain rare. This prospective study evaluates health-related QoL and emotional burden over 36 mo in men undergoing focal HIFU.</p><p><strong>Methods: </strong>In this prospective, single-arm, phase 2 trial (NCT02265159), 91 men with localized PCa (International Society of Urological Pathology grade group ≤3 and prostate-specific antigen ≤15 ng/ml) were treated with focal HIFU. Psychological distress and QoL were assessed at baseline and 6, 12, and 36 mo after HIFU using the following questionnaires: Memorial Anxiety Scale for Prostate Cancer (MAX-PC; PCa-specific anxiety), Hospital Anxiety and Depression Scale (HADS; anxiety and depression), and Functional Assessment of Cancer Therapy-Prostate (FACT-P; health-related QoL). Clinically significant distress was determined using established cutoffs.</p><p><strong>Key findings and limitations: </strong>The psychological burden was generally low throughout the study period. MAX-PC scores declined steadily over time. HADS anxiety and depression scores displayed a transient increase at 6 and 12 mo, but returned to baseline at 36 mo. At all time points, <3% of patients had scores above the threshold for clinically significant distress on the MAX-PC and HADS questionnaires. FACT-P scores remained stable and high, with no significant score changes in the total health-related QoL.</p><p><strong>Conclusions and clinical implications: </strong>Focal HIFU treatment for localized PCa is associated with a low psychological burden and stable, high health-related QoL. These results demonstrate the enduring impact of this organ-sparing approach on both psychological and QoL outcomes.</p>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145033050","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":"Effects of a Patient Decision Aid for Nonmetastatic Prostate Cancer Established in Routine Care: The Randomized Controlled EvEnt-PCA Trial.","authors":"Johannes Huber, Philipp Karschuck, Rainer Koch, Andreas Ihrig, Tanja Krones, Andreas Neisius, Sven von Ahn, Christian Klopf, Steffen Weikert, Michael Siebels, Nicolas Haseke, Christian Weißflog, Martin Baunacke, Peter Liske, Georgi Tosev, Thomas Benusch, Martin Schostak, Joachim Stein, Philipp Spiegelhalder, Christian Thomas, Cem Aksoy, Luka Flegar, Christer Groeben","doi":"10.1016/j.euf.2025.07.019","DOIUrl":"https://doi.org/10.1016/j.euf.2025.07.019","url":null,"abstract":"<p><strong>Background and objective: </strong>Since 2016, >21 000 patients with prostate cancer (PC) used our personalized online decision aid in routine care in Germany. We analyzed the effects of this online decision aid for men with nonmetastatic PC in a randomized controlled trial.</p><p><strong>Methods: </strong>In the randomized controlled EvEnt-PCA trial, 116 centers performed 1:1 allocation of 1115 patients with nonmetastatic PC to use an online decision aid (intervention = I) or a printed brochure (control = C). The primary outcome was treatment decision after 14 mo. The secondary endpoints were knowledge, acceptance, decisional conflict, physician-patient communication, anxiety and depression, decision regret, and quality of life.</p><p><strong>Key findings and limitations: </strong>With complete data from 1000 patients, there was no difference between the two groups in terms of primary or secondary endpoints. In the intervention group, consultation time was shorter (I: 61 min vs C: 70 min, p = 0.02), and more patients provided a summary of their preparation (I: 76% vs C: 56%, p < 0.001). Life expectancy (I: 53% vs C: 47%, p = 0.03), radiotherapy (I: 90% vs C: 84%, p = 0.005), rehabilitation (I: 69% vs C: 62%, p = 0.02), and psycho-oncology (I: 21% vs C: 16%, p = 0.07) were discussed more frequently in the intervention group. Additionally, more counseling sessions with general practitioners (I: 43% vs C: 35%, p = 0.01) and radiotherapists (I: 24% vs C: 18%, p = 0.03) were held in the intervention group.</p><p><strong>Conclusions and clinical implications: </strong>The use of the online decision aid was associated with structural improvements, for example, significantly shorter doctor-patient consultation time. Our findings suggest stronger guideline adherence in the counseling process and promotion of health literacy. Successful implementation of our online decision aid in routine care can provide an example for solving this key obstacle for shared decision-making.</p>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145029202","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 Lingyu Guo and Tian An's Letter to the Editor re: Mykyta Kachanov, Alexander E. Volk, Fabian Falkenbach, et al. Evaluation of Different National Comprehensive Cancer Network Clinical Practice Guidelines in Prostate Cancer for Germline Genetic Testing in Localized and Locally Recurrent Prostate Cancer. Eur Urol Focus. In press. https://doi.org/10.1016/j.euf.2025.05.021.","authors":"Mykyta Kachanov, Alexander E Volk, Fabian Falkenbach, Anna Möllring, Jan Hauke, Katrin Rading, Peter Frommolt, Kerstin Becker, Markus Graefen, Rita K Schmutzler, Tobias Maurer, Eric Hahnen, Lars Budäus","doi":"10.1016/j.euf.2025.08.001","DOIUrl":"https://doi.org/10.1016/j.euf.2025.08.001","url":null,"abstract":"","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144948075","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 Hao Wang and Li Yang's Letter to the Editor re: Mariana Silva-Ferreira, João A. Carvalho, Sofia Salta, et al. Diagnostic Test Accuracy of Urinary DNA Methylation-based Biomarkers for Bladder Cancer: Considerations for Further Research. Eur Urol Focus 2024;10:922-34.","authors":"Mariana Silva-Ferreira, Luísa Lopes-Conceição, Sara Monteiro-Reis, Rui Henrique, Carmen Jerónimo","doi":"10.1016/j.euf.2025.08.002","DOIUrl":"https://doi.org/10.1016/j.euf.2025.08.002","url":null,"abstract":"","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144947998","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 Outcomes of Prostatic Artery Embolisation: A Nationwide Prospective Cohort Study.","authors":"Anna Kristensen-Alvarez, Clara Lund-Frank, Hein Vincent Stroomberg, Mikkel Fode, Lars Lönn, Mikkel Taudorf, Anne-Sofie Brenøe, Gitte Maria Jørgensen, Margrethe Andersen, Lars Lund, Andreas Røder","doi":"10.1016/j.euf.2025.08.003","DOIUrl":"https://doi.org/10.1016/j.euf.2025.08.003","url":null,"abstract":"<p><strong>Background and objective: </strong>Lower urinary tract symptoms (LUTS) can severely impair quality of life in men. Prostatic artery embolisation (PAE) is a safe and effective treatment for LUTS. This study aims to assess the complications, treatment effects, and reintervention following PAE.</p><p><strong>Methods: </strong>A multicentre prospective cohort study was conducted using cross-sectional long-term questionnaires, including all PAE patients from 2017 to 2022. PAE was performed in an outpatient setting under local anaesthesia. An interventional radiologist embolises under fluoroscopic guidance, inducing ischaemia and subsequent prostate shrinkage. Adverse events (AEs) and serious adverse events (SAEs) were reported 90 d after PAE. Outcomes were evaluated by the Danish Prostate Symptom Score (DAN-PSS), transrectal ultrasound, uroflowmetry, and urinary catheter cessation. Retreatment was estimated by the Aalen-Johansen estimator.</p><p><strong>Key findings and limitations: </strong>A total of 336 patients were included; the median age was 72 yr (interquartile range [IQR] 66-76 yr), the median prostate volume was 101 cm³ (IQR 81-147 cm³), 88 (26%) were catheter dependent, and the median DAN-PSS of the remaining patients was 30 points (IQR 23-44). An SAE occurred in 26 (7.7%) patients; 132 (39%) experienced postembolisation syndrome and 106 (32%) another minor AE. At 0-6 mo of follow-up, the median DAN-PSS was 6 points (IQR 1-16) and 53/88 (60%) of catheter-dependent patients were catheter free. At >2 yr of follow-up, the median DAN-PSS was 9 points (IQR 3-21). The reintervention rates were 9.5% (95% confidence interval [CI]: 6.3-13%) at 2 yr and 18% (95% CI: 11-25%) at 5 yr. The questionnaire response rate was 79%. The limitations include a lack of proper follow-up data and no control cohort.</p><p><strong>Conclusions and clinical implications: </strong>PAE was proved to be safe, effective, and durable for selected patients in Denmark with severe LUTS, catheter dependency, and large prostates. During the 5-yr follow-up, 18% of patients required retreatment, a finding that should be interpreted in the context of their initially limited treatment options.</p>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144947988","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 Yun Deng, Changhong Xu, and Li Yang's Letter to the Editor re: Vineet Gauhar, Olivier Traxer, Daniele Castellani, et al. Could Use of a Flexible and Navigable Suction Ureteral Access Sheath Be a Potential Game-changer in Retrograde Intrarenal Surgery? Eur Urol Focus 2024;10:975-82.","authors":"Vineet Gauhar, Bhaskar K Somani","doi":"10.1016/j.euf.2025.08.004","DOIUrl":"https://doi.org/10.1016/j.euf.2025.08.004","url":null,"abstract":"","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144948025","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":"Clinical Consultation Guide: Neoadjuvant Chemotherapy for Upper Tract Urothelial Cancer.","authors":"Sean A Fletcher, Nirmish Singla, Jean Hoffman-Censits","doi":"10.1016/j.euf.2025.07.014","DOIUrl":"https://doi.org/10.1016/j.euf.2025.07.014","url":null,"abstract":"<p><p>In this Clinical Consultation Guide, we highlight prospective studies supporting the use of preoperative cisplatin-based chemotherapy in patients with upper tract urothelial carcinoma for whom extirpative surgery is planned.</p>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144947983","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: Thomas Dreyer, Simone Brandt, Fabrin Knud, et al. Use of the Xpert Bladder Cancer Monitor for Guiding Cystoscopy in High-grade Non-muscle-invasive Bladder Cancer: Results from the Randomized Controlled DaBlaCa-15 Trial. Eur Urol 2025;88:23-30.","authors":"Wei He, Maoyu Wang, Chen Zhang, Shuxiong Zeng, Chuanliang Xu","doi":"10.1016/j.euf.2025.07.022","DOIUrl":"https://doi.org/10.1016/j.euf.2025.07.022","url":null,"abstract":"","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":" ","pages":""},"PeriodicalIF":5.6,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144948056","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}