European urology focus最新文献

{"title":"Impact of Metastatic Hormone-sensitive Prostate Cancer Treatments on Health-related Quality of Life: A Systematic Review and Network Meta-analysis","authors":"Tessa van Elst,&nbsp;Pedro Lopez,&nbsp;Laurien M. Buffart,&nbsp;Jose A.E. Custers,&nbsp;Lieke Wever,&nbsp;Jippe C. de Bie,&nbsp;Peter F.A. Mulders,&nbsp;Haiko J. Bloemendal,&nbsp;Jean-Paul A. van Basten,&nbsp;Niven Mehra","doi":"10.1016/j.euf.2025.12.001","DOIUrl":"10.1016/j.euf.2025.12.001","url":null,"abstract":"<div><h3>Background and objective</h3><div>In metastatic hormone-sensitive prostate cancer (mHSPC), health-related quality of life (HRQoL) is key for personalised treatment decisions. We compared the impact of different mHSPC treatment strategies on HRQoL, tackling a previously unaddressed challenge in comparing the outcomes across different patient-reported outcome measures (PROMs).</div></div><div><h3>Methods</h3><div>A systematic review was conducted of prospective studies reporting HRQoL outcomes of androgen deprivation therapy (ADT) alone or with placebo, radiotherapy, abiraterone, apalutamide, enzalutamide, and/or docetaxel in mHSPC (CRD42021227902). Databases were searched in April 2022 and April 2024. HRQoL domains across different PROMs were harmonised using the Wilson and Cleary model. A frequentist network meta-analysis (NMA) compared 12-mo treatment effects using standardised mean differences (SMDs) with 95% confidence intervals (CIs). Statistical significance was defined as <em>p</em> &lt; 0.05.</div></div><div><h3>Key findings and limitations</h3><div>Of the 24 articles included, nine were analysed in the NMA (eight trials, <em>n</em> = 6248). ADT + abiraterone resulted in significantly less pain than ADT + placebo (SMD: –0.22, 95% CI [–0.33; –0.10], <em>p</em> &lt; 0.001), ADT + apalutamide (SMD: –0.17, 95% CI [–0.31; –0.02], <em>p</em> = 0.022), and ADT + enzalutamide (SMD: –0.23, 95% CI [–0.37; –0.09], <em>p</em> = 0.001). Less fatigue was observed with ADT + abiraterone versus ADT + enzalutamide (SMD: –0.45, 95% CI [–0.88; –0.02], <em>p</em> = 0.041). ADT + abiraterone showed significantly better physical functioning than ADT + enzalutamide (<em>p</em> = 0.015) and ADT + placebo (<em>p</em> = 0.032). Both were also associated with significantly worse general health perception than ADT alone, ADT + docetaxel, and ADT + radiotherapy. General health perception and overall quality of life were significantly better with ADT + abiraterone than with ADT + enzalutamide, ADT + apalutamide, and ADT + placebo (<em>p</em> &lt; 0.001). The limitations include heterogeneity (0–76%) and few eligible trials.</div></div><div><h3>Conclusions and clinical implications</h3><div>HRQoL outcomes differ across treatment strategies for mHSPC. At 12 mo, ADT + abiraterone yielded the most favourable HRQoL profile.</div></div>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":"12 4","pages":"Pages 769-784"},"PeriodicalIF":6.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145741201","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":"ARAMON, a phase 2 open-label trial of darolutamide monotherapy in patients with biochemical recurrence or oligometastatic castration-sensitive prostate cancer after radical prostatectomy or primary radiotherapy","authors":"Andrew L. Laccetti,&nbsp;Matthew R. Smith,&nbsp;Howard I. Scher,&nbsp;Sepehr Nowfar,&nbsp;David Einstein,&nbsp;Benjamin Martin,&nbsp;Patrick Adorjan,&nbsp;Manjari Dissanayake,&nbsp;Frank Verholen,&nbsp;Xin Gao","doi":"10.1016/j.euf.2026.02.005","DOIUrl":"10.1016/j.euf.2026.02.005","url":null,"abstract":"<div><h3>Background and objective</h3><div>Darolutamide is an androgen receptor inhibitor (ARI) with low blood–brain barrier penetration, potentially resulting in low reactive testosterone increases and less feminizing adverse events (AEs). In the phase 2, open-label, ARAMON trial (NCT05526248), change in serum testosterone after darolutamide monotherapy was investigated in patients with biochemical recurrence (BCR) or oligometastatic castration-sensitive prostate cancer (CSPC).</div></div><div><h3>Methods</h3><div>Eligible patients had CSPC, prostate-specific antigen (PSA) ≥0.2 ng/mL after radical prostatectomy or ≥2 ng/mL after primary radiotherapy, PSA doubling time ≤20 months, &lt;5 asymptomatic metastatic lesions, and serum testosterone &gt;150 ng/dL. Patients received darolutamide 600 mg twice daily for 52 weeks. Primary endpoint was change in serum testosterone from baseline to week 12. Secondary endpoints included testosterone change from baseline to weeks 24 and 52, PSA response, and safety.</div></div><div><h3>Key findings and limitations</h3><div>At baseline (<em>n</em> = 23), median (interquartile range) age was 74 years (67–79) and PSA 6.0 ng/mL (3.9–9.1). Mean percent increase in serum testosterone from baseline was 53% at week 12 and 48% at week 52. At week 52, 65% of patients had PSA &lt;0.2 ng/mL. Darolutamide had a favorable safety profile. Most AEs were grade 1/2, including feminizing AEs, occurring mainly during the first 6 months. Trial limitations include a single-arm, open-label design and small sample size.</div></div><div><h3>Conclusions and clinical implications</h3><div>In patients with CSPC, darolutamide monotherapy moderately increased testosterone from baseline to week 12, remaining stable through week 52. High PSA response rates were observed, and the safety profile was consistent with those expected with ARI monotherapy.</div></div><div><h3>Clinical trial registration</h3><div>ClinicalTrials.gov identifier: NCT05526248.</div></div>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":"12 4","pages":"Pages 743-751"},"PeriodicalIF":6.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147316763","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":"Postvoided Residual/Bladder Emptying: A Mini Review","authors":"Cosimo De Nunzio,&nbsp;Riccardo Lombardo,&nbsp;Marcus J. Drake","doi":"10.1016/j.euf.2026.05.021","DOIUrl":"10.1016/j.euf.2026.05.021","url":null,"abstract":"<div><div>Postvoid residual (PVR) urine volume is widely used in the evaluation of patients with lower urinary tract symptoms (LUTS) and benign prostatic obstruction (BPO), yet its clinical role remains debated. This mini review critically appraises current evidence on the definition, pathophysiology, measurement, and clinical utility of PVR. PVR reflects impaired bladder emptying and is influenced by multiple mechanisms, including bladder outlet obstruction, detrusor underactivity, and altered sensory function. However, its diagnostic accuracy for identifying specific conditions is limited by high interindividual variability, lack of standardized cutoffs, and weak diagnostic accuracy for any specific condition. Recently, the PVR ratio has been introduced and may overcome the diagnostic limitations of PVR. Clinically, PVR is useful for monitoring medical and surgical treatment outcomes and disease. Overall, PVR should be interpreted as a dynamic parameter within a broader clinical and urodynamic assessment framework.</div></div><div><h3>Patient summary</h3><div>We reviewed how physician use a simple test that measures how much urine remains in the bladder after voiding. We found that this test alone is not very reliable for diagnosing the cause of urinary symptoms, but it can still be helpful in monitoring how patients respond to treatment. Overall, it should be used together with other clinical assessments rather than on its own.</div></div>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":"12 4","pages":"Pages 680-683"},"PeriodicalIF":6.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148162419","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":"“Pro/ ‘Yes’ for PSA Testing Before BPO Surgical Therapy” Ignoring PSA in BPE is Not Progress; It’s Clinical Blindness","authors":"Selcuk Guven,&nbsp;Thomas RW Herrmann","doi":"10.1016/j.euf.2026.04.006","DOIUrl":"10.1016/j.euf.2026.04.006","url":null,"abstract":"<div><div>Although traditionally linked to prostate cancer screening, prostate-specific antigen (PSA) serves as a multifaceted clinical marker in men with lower urinary tract symptoms. PSA reflects prostate biology, predicts disease progression, and guides treatment decisions in benign prostatic enlargement. As a dynamic biomarker, changes in PSA over time indicate treatment response and disease course. PSA also facilitates oncological assessment, as enucleation reduces benign glandular interference and establishes a more reliable baseline for detecting incidental or future malignancy. Consequently, the clarity of PSA interpretation depends on the treatment approach, with complete adenoma removal yielding a more distinct clinical signal than tissue-ablative methods. PSA should be considered a continuous biomarker throughout the care pathway.</div></div>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":"12 4","pages":"Pages 628-630"},"PeriodicalIF":6.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147812643","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":"Propensity Score–matched Analysis of 30-day Outcomes of Suction Versus Nonsuction Mini Percutaneous Nephrolithotomy from a Real-World Multicenter Prospective Study: Collaboration Between the European Association of Urology Endourology Section and the Asian Urological Society of Endoluminal Surgery and Technology","authors":"Steffi Kar Kei Yuen,&nbsp;Gregory Xiang Wen Pek,&nbsp;Thomas Herrmann,&nbsp;Daniele Castellani,&nbsp;Khi Yung Fong,&nbsp;Jaisukh Kalathia,&nbsp;Wei Zhu,&nbsp;Gopal Ramdas Tak,&nbsp;Marcos Cepeda,&nbsp;Nariman Gadzhiev,&nbsp;Vigen Malkhasyan,&nbsp;Maher Al Hadithi,&nbsp;Rajesh Kukreja,&nbsp;Arun Chawla,&nbsp;Madhu Sudan Agrawal,&nbsp;Chandra Mohan Vaddi,&nbsp;Takaaki Inoue,&nbsp;Venkatsubramaniam Dhandapani,&nbsp;Nebil Akdogan,&nbsp;Tzevat Tefik,&nbsp;Vineet Gauhar","doi":"10.1016/j.euf.2025.12.011","DOIUrl":"10.1016/j.euf.2025.12.011","url":null,"abstract":"<div><h3>Background and objective</h3><div>This study compares 30-d perioperative outcomes between suction mini percutaneous nephrolithotomy (S-mPCNL) and nonsuction mPCNL (NS-mPCNL).</div></div><div><h3>Methods</h3><div>This prospective multicenter study involved 20 surgeons from 14 countries. The primary outcome was the 30-d stone free rate (SFR) on computed tomography. Propensity score matching (PSM) was used to adjust for baseline differences between the two groups. Multivariable logistic regression was used to evaluate factors associated with 100% SFR and the overall complication rate.</div></div><div><h3>Key findings and limitations</h3><div>PSM for 1915 patients (1534 S-mPCNL, 381 NS-mPCNL) yielded a cohort of 664 S-mPCNL and 309 NS-mPCNL cases for analysis. Baseline and stone characteristics were well matched. The 30-d 100% SFR (grade A) was high in both groups and did not significantly differ (85% vs 87%; odds ratio [OR] 0.97, 95% confidence interval [CI] 0.63–1.49; <em>p</em> = 0.9). The S-mPCNL group had a shorter median operative time (43 vs 57 min), higher intraoperative SFR according to visual inspection or fluoroscopy (82% vs 70%), and lower blood transfusion rate (1.3% vs 3.6%). There was no between-group difference in infectious complications. Multivariable analysis revealed that stone volume (OR 0.93, 95% CI 0.87–0.99; <em>p</em> = 0.021) and single-step dilatation (OR 3.28, 95% CI 1.85–5.81; <em>p</em> &lt; 0.001) were significantly associated with grade A SFR. Limitations include variability in practice.</div></div><div><h3>Conclusions and clinical implications</h3><div>Suction during mPCNL improves intraoperative stone clearance rates and reduces the operative time, with no significant difference in 30-d SFR or infectious complications. Both S-mPCNL and NS-mPCNL achieve high rates of zero residual fragments.</div></div>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":"12 4","pages":"Pages 717-724"},"PeriodicalIF":6.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145800094","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":"Aligning Terminology and Assessment in Male Lower Urinary Tract Symptoms: A Comparison of Guideline Perspectives","authors":"D. Carolina Ochoa,&nbsp;Lucía Diéguez,&nbsp;Paulina Bueno,&nbsp;Andrew Gammie,&nbsp;Nikki Cotterill,&nbsp;Tufan Tarcan,&nbsp;Hashim Hashim","doi":"10.1016/j.euf.2026.08.004","DOIUrl":"10.1016/j.euf.2026.08.004","url":null,"abstract":"<div><div>The International Continence Society (ICS) report on the terminology for adult male lower urinary tract and pelvic floor symptoms and dysfunction provides the terminology to categorise patients based on their symptoms, signs, and study findings. It is designed to standardise communication among health care professionals involved in the care of men with lower urinary tract symptoms (LUTS). The 2026 European Association of Urology Guidelines on Non-neurogenic Male Lower Urinary Tract Symptoms and the 2026 American Urological Association Guideline on the Management of Lower Urinary Tract Symptoms Attributed to Benign Prostatic Hyperplasia are key references in the diagnosis and treatment of male patients with LUTS. The purpose of this paper is to examine how these prominent guidelines align with ICS terminology, which is considered the gold standard for the communication of male LUTS.</div></div>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":"12 4","pages":"Pages 688-694"},"PeriodicalIF":6.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148812472","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":"Straining to Pass Urine in Men with Lower Urinary Tract Symptoms","authors":"Paulina Bueno Garcia-Reyes,&nbsp;D. Carolina Ochoa,&nbsp;Abdulmalik Alkhamis,&nbsp;Marcus J. Drake","doi":"10.1016/j.euf.2026.06.001","DOIUrl":"10.1016/j.euf.2026.06.001","url":null,"abstract":"<div><div>Straining to void is widely regarded as a clinical indicator of bladder outlet obstruction (BOO) in men with lower urinary tract symptoms (LUTS). However, the physiological significance of this behaviour remains poorly understood. This review examines the role of straining during the voiding cycle and evaluates current evidence regarding its relationship with BOO. Straining represents a voluntary increase in intra-abdominal pressure that may occur at different stages of micturition. Studies comparing patient-reported straining with urodynamic findings demonstrate poor correlation, and the prevalence of the symptom does not differ significantly between obstructed and unobstructed individuals. Furthermore, straining may persist after surgical relief of obstruction, suggesting that it may represent behavioural or compensatory mechanisms rather than mechanical obstruction. Overall, available evidence indicates that straining is a non-specific finding with limited diagnostic value for BOO and should be interpreted alongside objective urodynamic assessment.</div></div><div><h3>Patient summary</h3><div>We reviewed research on why some people strain when passing urine. Straining can occur in people with and without bladder outlet blockage and may simply reflect a habit or a way of to help the bladder empty. This means that straining alone is not a reliable sign of obstruction.</div></div>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":"12 4","pages":"Pages 664-667"},"PeriodicalIF":6.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148271086","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":"Natural History of Patients Eligible for PROTEUS Diagnosed with Prostate Cancer and Treated with Radical Prostatectomy Without Perioperative Systemic Treatment","authors":"Benedikt Hoeh,&nbsp;Giovanni Mazzucato,&nbsp;Pierre Tennstedt,&nbsp;Jonas Ekrutt,&nbsp;Felix Preisser,&nbsp;Lars Budäus,&nbsp;Tobias Maurer,&nbsp;Markus Graefen,&nbsp;Derya Tilki,&nbsp;Philipp Mandel,&nbsp;Thomas Steuber","doi":"10.1016/j.euf.2026.05.002","DOIUrl":"10.1016/j.euf.2026.05.002","url":null,"abstract":"<div><div>The ongoing PROTEUS study aims to evaluate the effectiveness of perioperative Apalutamide combined with androgen-deprivation therapy in improving oncological outcomes for a specifically defined high-risk prostate cancer (PCa) group who were treated with radical prostatectomy (RP). Interestingly, the PROTEUS inclusion criteria did not rely on established risk categories such as the European Association of Urology (EAU) or the National Comprehensive Cancer Network (NCCN) high-risk classification. Consequently, little is known about the natural course of patients eligible for PROTEUS who were diagnosed with high-risk PCa and treated with RP without receiving any neoadjuvant systemic treatment. To address this knowledge gap, this analysis included 701 patients eligible for PROTEUS who have undergone RP, revealing that a significant proportion did not fit into the established high-risk classifications (EAU high-risk: 58.2% and NCCN high-risk: 53.1%). Event-free survival (EFS) rates at 36 and 60 mo of the overall cohort of patients eligible for PROTEUS were 57.6% (95% confidence interval [CI]: 53.9–61.7) and 45.9% (95% CI: 41.9–50.4), respectively. Notably, patients solely eligible for PROTEUS criteria exhibited more favorable EFS rates than those who also met EAU and/or NCCN high-risk criteria. This study highlights the need to enhance treatment strategies for patients with high-risk PCa and suggests potential implications for future research based on PROTEUS data. The results aim to inform clinical practices and the understanding the natural history and its outcomes of patients eligible for PROTEUS who were diagnosed with PCa and underwent RP without neoadjuvant systemic treatment.</div></div>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":"12 4","pages":"Pages 695-699"},"PeriodicalIF":6.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148420161","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":"Consolidative Surgery for Advanced Upper Urinary Tract Urothelial Carcinoma After Enfortumab Vedotin and/or Immune Checkpoint Inhibitors","authors":"Satoru Taguchi,&nbsp;Michinori Shimizu,&nbsp;Ibuki Tsuru,&nbsp;Jun Kamei,&nbsp;Shigenori Kakutani,&nbsp;Yoichi Mori,&nbsp;Takashi Murata,&nbsp;Yuta Yamada,&nbsp;Haruki Kume","doi":"10.1016/j.euf.2026.03.006","DOIUrl":"10.1016/j.euf.2026.03.006","url":null,"abstract":"<div><div>Upper urinary tract urothelial carcinoma (UTUC) is a rare malignancy with a poor prognosis in advanced disease. With the advent of novel systemic therapies, including enfortumab vedotin (EV) and immune checkpoint inhibitors (ICIs), deep and durable responses can now be achieved, potentially enabling consolidative surgery with curative intent. However, evidence supporting this approach in advanced UTUC remains scarce. We report a case series of five patients with advanced UTUC who underwent consolidative surgery after EV and/or ICI therapy. All patients achieved sufficient disease control with systemic therapy to allow surgical consolidation, including cases in which the primary tumor showed regrowth and metastatic lesions had nearly or completely resolved during systemic therapy. Consolidative surgery was successfully performed with negative surgical margins in all cases. At a median follow-up of 12 (6–30) mo after surgery, all five patients remained alive, with no evidence of disease, and three patients achieved complete discontinuation of systemic therapy. These findings suggest that consolidative surgery after modern systemic therapy, including EV and/or ICIs, may provide durable disease control and treatment-free survival in selected patients with advanced UTUC.</div></div>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":"12 4","pages":"Pages 805-809"},"PeriodicalIF":6.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147722209","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":"Seeking a Credible Basis for Prostatic Obstruction as the Reversible Cause of Other Lower Urinary Tract Dysfunctions","authors":"Marcus J. Drake,&nbsp;Kari A.O. Tikkinen","doi":"10.1016/j.euf.2026.07.004","DOIUrl":"10.1016/j.euf.2026.07.004","url":null,"abstract":"<div><div>Lower urinary tract symptoms (LUTS) and various lower urinary tract dysfunctions (LUTDs) often coexist because their prevalence increases with ageing. In men, benign prostatic obstruction (BPO) is often proposed as a cause of other “secondary” LUTDs. However, causality of BPO in LUTDs, other than voiding LUTS and acute urinary retention, is probably indirect, if present at all. Indirect mechanisms complicate the inference of causality and may reduce the chance of reversibility. BPO is not a unifying explanation for LUTD, but one possible aetiological factor among many age-related, metabolic, neurological, behavioural, and anatomical factors. This mini-review discusses how to evaluate whether associations between BPO and LUTD are causal, reversible, and relevant to treatment decisions. The Bradford Hill viewpoints (strength, consistency, specificity, temporality, biological gradient, plausibility, coherence, experiment, and analogy) remain a useful framework for considering whether observed associations may be causal. However, the potential surgical setting of BPO adds two additional dimensions. First, is BPO needed to maintain the phenotype, such that treating BPO should bring resolution of the secondary problem? Second, if causation appears to apply at a population level, how confidently can that inference be applied to the individual man considering surgery? Association should not be mistaken for causation, causation should not be mistaken for reversibility, and reversibility should not be mistaken for sufficient net benefit for the individual man considering surgery.</div></div>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":"12 4","pages":"Pages 676-679"},"PeriodicalIF":6.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148577531","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}