European urology focus最新文献

{"title":"Preoperative Magnetic Resonance Imaging Membranous Urethral Length as a Predictor of Urinary Continence After Radical Prostatectomy: A Systematic Review and Meta-analysis.","authors":"Cristina Negrean, Ammar Alam, Duane Hickling, Humberto R Vigil, Luke T Lavallée, Ranjeeta Mallick, Risa Shorr, Anathea S Flaman, Matthew McInnes, Nicola Schieda, Rodney Henry Breau","doi":"10.1016/j.euf.2025.02.002","DOIUrl":"https://doi.org/10.1016/j.euf.2025.02.002","url":null,"abstract":"<p><strong>Background and objective: </strong>The evidence regarding membranous urethral length (MUL) and urinary continence after radical prostatectomy is inconsistent. The primary objective of this review was to evaluate the association between MUL and postprostatectomy continence.</p><p><strong>Methods: </strong>Multiple databases were searched up to August 31, 2024. Studies evaluating the association between magnetic resonance imaging (MRI)-measured MUL and urinary continence at 12 mo after prostatectomy were included. Published abstracts were excluded. The pooled association between longer MUL and continence was evaluated using a meta-analysis with random effects. The risk of bias was assessed using Quality In Prognosis Studies (QUIPS) tool. Certainty of evidence was determined using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach (PROSPERO protocol: CRD42023483229).</p><p><strong>Key findings and limitations: </strong>Thirty studies (11 239 patients) were included. The risk of bias was low in most studies for measurement, confounding, and statistical analysis/reporting. The median MUL between studies ranged from 10.4 to 17.3 mm. Longer MUL (usually dichotomized at the median) was associated with a greater probability of continence (15 studies, 4025 patients; pooled risk ratio [RR] 1.30, 95% confidence interval [CI] 1.18, 1.44; p < 0.0001, I² = 80%). After excluding high risk of bias studies, the association between longer MUL and continence remained significant (pooled RR 1.18, 95% CI 1.08, 1.29; p = 0.003). The certainty of the association between MUL and continence was moderate. No publication bias was evident. The results are limited by a high risk of attrition bias.</p><p><strong>Conclusions and clinical implications: </strong>Longer preoperative MRI-measured MUL is associated with better urinary continence 12 mo after radical prostatectomy, regardless of the continence definition and assessment method. MUL measurement techniques should be standardized, and MUL should be incorporated in prognostic models.</p>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143585204","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 Implantation of an Artificial Urinary Sphincter for Females with Stress Urinary Incontinence: State of the Art and Future Perspectives.","authors":"Maria Lucia Gallo, Martina Moriconi, Kevin Elkrieff, Georges Abi Tayeh, Véronique Phé","doi":"10.1016/j.euf.2025.02.012","DOIUrl":"https://doi.org/10.1016/j.euf.2025.02.012","url":null,"abstract":"<p><p>While artificial urinary sphincter (AUS) represents the gold standard for treatment for male stress urinary incontinence (SUI), this same tool has not yet gained equivalent popularity for the same condition in female patients. This may be related to the apparent technical difficulties and perceived risk of complications traditionally related to the open approach. Use of robotic surgery could drive a paradigm shift in female SUI treatment thanks to better ergonomics and visibility. Results reported in the literature show that robot-assisted AUS placement is feasible, safe, and effective for female SUI. Comparative studies suggest superiority to the open approach in terms of intraoperative complications and functional outcomes. Novel technological advances may further facilitate AUS implantation and contribute to diffusion of this technique. PATIENT SUMMARY: This mini-review summarises research results for robot-assisted implantation of artificial urinary sphincter in female patients with stress incontinence. This approach is safe and effective and seems to provide advantages in comparison to traditional open surgery.</p>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143585206","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 Biopsy: The Transperineal Approach is Better!","authors":"Fabio Zattoni, Giacomo Novara, Fabrizio Dal Moro, Zafer Tandogdu","doi":"10.1016/j.euf.2025.02.011","DOIUrl":"https://doi.org/10.1016/j.euf.2025.02.011","url":null,"abstract":"<p><p>Transperineal prostate biopsy offers advantages over transrectal biopsy in terms of cancer detection in specific prostate areas, potential use of larger-gauge needles for tissue sampling, a lower risk of severe infectious complications such as sepsis, and lower use of antibiotic prophylaxis, aligning with antibiotic stewardship policies and reducing the risk of antimicrobial resistance and gut microbiome changes.</p>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143556407","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":"Sacral Neuromodulation in Multiple Sclerosis: The NEMISIS Study.","authors":"Harry J Kendall, Armelle Knops, Oliver Gerlach, John P F A Heesakkers","doi":"10.1016/j.euf.2025.02.009","DOIUrl":"https://doi.org/10.1016/j.euf.2025.02.009","url":null,"abstract":"<p><p>Recent studies have shown promising sacral neuromodulation (SNM) results in neurogenic overactive bladder caused by multiple sclerosis. In the first half of 2025 we aim to start including patients in a multicentre, randomised controlled trial to test the hypothesis that SNM has a therapeutic benefit in this setting.</p>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143556409","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":"Telesurgery: Challenges, Ethical Considerations, and Opportunities in the Robotic Surgery Era.","authors":"Marcio Covas Moschovas, Mischa Dohler, Vipul Patel","doi":"10.1016/j.euf.2025.02.016","DOIUrl":"https://doi.org/10.1016/j.euf.2025.02.016","url":null,"abstract":"<p><p>Telesurgery can revolutionize health care by facilitating remote surgical interventions and expanding access to underserved regions. Its success depends on robust communication networks, latency management, and ethical oversight, which require collaboration between surgeons, engineers, and stakeholders to ensure safe, efficient, and equitable implementation.</p>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143556410","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 Biopsy: The Transperineal Approach Is Better!","authors":"Fabio Zattoni, Giacomo Novara, Fabrizio Dal Moro, Zafer Tandogdu","doi":"10.1016/j.euf.2025.02.014","DOIUrl":"https://doi.org/10.1016/j.euf.2025.02.014","url":null,"abstract":"<p><p>Transperineal prostate biopsy offers advantages over transrectal biopsy in terms of cancer detection in specific prostate areas, potential use of larger-gauge needles for tissue sampling, a lower risk of severe infectious complications such as sepsis, and lower use of antibiotic prophylaxis, aligning with antibiotic stewardship policies and reducing the risk of antimicrobial resistance and gut microbiome changes.</p>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143556408","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":"Artificial Intelligence for Endoscopic Stone Surgery: What's Next? An Overview from the European Association of Urology Section of Endourology.","authors":"Carlotta Nedbal, Giovanni Cacciamani, Pieter De Backer, Chady Ghnatios, Zine-Eddine Khene, Peter Kronenberg, Tzevat Tefik, Ben Turney, Oliver Traxer, Bhaskar K Somani, Frederic Panthier","doi":"10.1016/j.euf.2025.02.013","DOIUrl":"https://doi.org/10.1016/j.euf.2025.02.013","url":null,"abstract":"<p><p>Technology has driven the evolution of endourology over the past decades. Endoscopic stone surgery could benefit greatly from integration of artificial intelligence to refine diagnostics and enhance training and postoperative care. However, ethical, accessibility, and cost challenges need to be addressed to realise the full potential of artificial intelligence in this setting. PATIENT SUMMARY: Our mini-review describes current and future applications of artificial intelligence (AI) for telescopic surgery for stones in the urinary tract. It is likely that AI-driven devices will be used from diagnosis to surgery, but ethical issues need to be clearly defined before AI can be widely used in clinical practice.</p>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143556406","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":"Antimuscarinics or β3 Adrenoreceptor Agonists: Which Should Be the First Step?","authors":"Maria Lucia Gallo, Mikołaj Przydacz, Véronique Phé","doi":"10.1016/j.euf.2025.02.006","DOIUrl":"https://doi.org/10.1016/j.euf.2025.02.006","url":null,"abstract":"<p><p>Antimuscarinics are historically considered the cornerstone for pharmacological treatment of overactive bladder syndrome (OAB). The more recent introduction of β3 adrenoreceptor agonists has increased the range of therapeutic possibilities, but it is still not possible to determine a priori which drug class should be used first. Considering the comparable effectiveness in terms of symptom improvement, the choice should take into account the different tolerability profile of these drugs according to the patient's clinical features (age, neurologic disease and comorbidities, and risk factors for adverse events). In the absence of specific characteristics that guide the choice towards one of these drug classes, shared decision-making with the patient that takes into account their personal values, preferences, and expectations should be undertaken. PATIENT SUMMARY: We provide recommendations on choice of the first drug type to use in treating overactive bladder. Two drug classes with similar effectiveness but different side effects are available. The decision on which medication to use first should take into account the patient's characteristics and their personal values, preferences, and expectations.</p>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143531457","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":"Use of Interactive Three-dimensional Modeling for Partial Nephrectomy in the 3DPN Study.","authors":"Jens-Uwe Stolzenburg, Sigrun Holze, Anja Dietel, Toni Franz, Phuc Ho Thi, Doreen Trebst, Nicole Köppe-Bauernfeind, Miroslav Bačák, Theodoros Spinos, Evangelos Liatsikos, Clara Steiner","doi":"10.1016/j.euf.2025.02.003","DOIUrl":"https://doi.org/10.1016/j.euf.2025.02.003","url":null,"abstract":"<p><p>Virtual interactive three-dimensional modeling is a novel visualization tool that could improve preoperative surgery planning and intraoperative navigation. The 3DPN trial seeks to assess its value for robot-assisted partial nephrectomy in comparison to conventional computed tomography imaging in a multicenter randomized controlled setting.</p>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143515199","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 Radiotherapy After Radical Cystectomy for Muscle-invasive Bladder Cancer: A Phase 2 Trial-Results of Secondary Endpoints.","authors":"Flor Verghote, Elke Rammant, Piet Dirix, Charles Van Praet, Charlien Berghen, Sara Junius, Nick Liefhooghe, Leen Noé, Piet Ost, Karel Decaestecker, Geert Villeirs, Alexander Decruyenaere, Kathia De Man, Sofie Verbeke, Daan De Maeseneer, Valérie Fonteyne","doi":"10.1016/j.euf.2025.02.005","DOIUrl":"https://doi.org/10.1016/j.euf.2025.02.005","url":null,"abstract":"<p><strong>Background and objective: </strong>Patients with muscle-invasive bladder cancer (MIBC) who develop a recurrence after radical cystectomy (RC) have poor outcomes. This study aims to evaluate the safety and efficacy of adjuvant radiotherapy (ART) in mitigating pelvic recurrences in high-risk MIBC patients. We report on survival outcomes, health-related quality of life (HRQoL), and hematological toxicity for these patients.</p><p><strong>Methods: </strong>A multicentric phase 2 trial was conducted from August 2014 to October 2020, in which 72 high-risk MIBC patients received ART after RC. High risk was defined by the presence of one or more of the following criteria: pT3 stage and lymphovascular invasion, pT4 stage, fewer than ten lymph nodes removed, positive lymph nodes, and positive surgical margins. Using intensity-modulated radiotherapy, patients with pelvic lymph nodes ± cystectomy bed (in case of a positive surgical margin) received 50 Gy in 25 fractions. Outcomes were local relapse-free rate (LRFR), clinical relapse-free survival (CRFS), overall survival (OS) (Kaplan-Meier statistics), HRQoL (European Organisation for Research and Treatment of Cancer QLQ-C30/QLQ-BLM30 surveys), and hematological toxicity (Common Terminology Criteria for Adverse Events grading).</p><p><strong>Key findings and limitations: </strong>The median follow-up of patients without a recurrence was 39 mo. At 2 and 5 yr, LRFRs were 81% (95% confidence interval [CI] 71-91%) and 79% (95% CI 68-89%), CRFS rates were 32% (95% CI 21-42%) and 20% (95% CI 11-30%), and OS rates were 48% (95% CI 36-59%) and 34% (95% CI 22-45%), respectively. At the end of ART, several symptoms worsened, most returning to baseline within the first few months. Diarrhea showed the greatest deterioration, recovering to baseline score only partially. Hematological toxicity of incidence grade ≥2 included lymphopenia (75%), neutropenia (2%), thrombopenia (2%), and anemia (17%). Limitations include the single-arm design and the limited availability of blood samples and surveys.</p><p><strong>Conclusions and clinical implications: </strong>ART after RC is well tolerated and leads to a favorable local control rate, supporting its use in clinical practice.</p>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143457412","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}