European urology focus最新文献

{"title":"Mitigating the Risk of Skeletal Events in Metastatic Renal Cell Carcinoma.","authors":"Yu-Wei Chen, Rana R McKay","doi":"10.1016/j.euf.2025.04.007","DOIUrl":"https://doi.org/10.1016/j.euf.2025.04.007","url":null,"abstract":"<p><p>Bone metastases affect approximately one-third of patients with metastatic renal cell carcinoma (mRCC) and contribute to substantial skeletal complications and shorter survival. Management of these metastases requires a multidisciplinary approach combining systemic therapies, localized treatments, and supportive care. Immune checkpoint inhibitor (ICI)-based combinations, especially doublets comprising an ICI and a VEGF-targeted tyrosine kinase inhibitor, have shown significant efficacy in mRCC with bone involvement. Bone-modifying agents such as zoledronic acid and denosumab help in mitigating symptomatic skeletal-related events and enhance bone integrity, although the unique bone pathology of RCC may limit their effectiveness. Local therapies, such as surgery and stereotactic body radiotherapy, play a pivotal role in providing symptom relief and controlling localized disease, particularly in oligometastatic cases. A personalized, patient-centered strategy is essential in minimizing systemic therapy disruptions, addressing skeletal morbidity, and improving clinical outcomes. PATIENT SUMMARY: Bone metastases in patients with kidney cancer can cause severe complications such as pain, fractures, and other serious issues, reducing quality of life and survival. Treatment involves a combination of therapies, including medications, targeted radiation, surgery, and immunotherapy, tailored to each patient to manage symptoms and improve outcomes.</p>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143994492","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 Models in Partial Nephrectomy: For, but Critical Evaluation Is Key.","authors":"Ruben De Groote, Joris Vangeneugden, Pieter De Backer, Alexandre Mottrie","doi":"10.1016/j.euf.2025.04.024","DOIUrl":"https://doi.org/10.1016/j.euf.2025.04.024","url":null,"abstract":"<p><p>Three-dimensional kidney models are revolutionizing robot-assisted partial nephrectomy by enhancing surgical precision, optimizing selective clamping, and potentially improving patient outcomes. While these models offer significant advantages, their development, validation, and accessibility must be critically evaluated to ensure reliability and equitable implementation. Ongoing research and technological advances, including the integration of augmented reality, hold great promise for the future of kidney surgery.</p>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143964991","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":"An Overview of Novel Devices for Tibial Nerve Stimulation in Urinary Incontinence.","authors":"Charlotte Defour, Jakob De Wachter, Stefan De Wachter","doi":"10.1016/j.euf.2025.04.020","DOIUrl":"https://doi.org/10.1016/j.euf.2025.04.020","url":null,"abstract":"<p><p>Urgency urinary incontinence (UUI) and overactive bladder (OAB) significantly impact quality of life in those who are affected. While initial treatments including lifestyle changes and pharmacotherapy often fail, second-line options such as posterior tibial nerve stimulation (TNS) offer relief. This review focuses on implantable TNS devices, a recent development in the field. Implantable TNS devices show varying degrees of effectiveness in reducing UUI episodes and improving patient quality of life. Most devices are minimally invasive and offer longer-term solutions with fewer surgical interventions in comparison to alternatives such as sacral neuromodulation and intravesical Botox injections. While results are promising, further studies are necessary to assess the efficacy and long-term outcomes of these newer devices. PATIENT SUMMARY: We reviewed new devices for nerve stimulation in the treatment of overactive bladder and urgency urinary incontinence after lifestyle changes and drugs have failed. This is an efficient and safe alternative to other options such as repeated Botox injections into the bladder.</p>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143971489","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":"Defining the Role of Surgical Resection in Metastatic Renal Cell Carcinoma: A Mini Review.","authors":"Steven M Monda, Simpa S Salami, Ulka Vaishampayan, Todd M Morgan, Udit Singhal","doi":"10.1016/j.euf.2025.04.022","DOIUrl":"https://doi.org/10.1016/j.euf.2025.04.022","url":null,"abstract":"<p><p>Ongoing advances in systemic therapy for metastatic renal cell carcinoma (mRCC) have left the role of surgical resection in this setting uncertain. In this mini review, we examine historical data and ongoing clinical trials evaluating the role of cytoreductive nephrectomy and metastasectomy in mRCC. We note that patients undergoing upfront nephrectomy may have a delayed opportunity to receive systemic therapy, which poses a significant risk, particularly for individuals with poor-risk or actively progressing disease. Although patients undergoing resection after response to systemic therapy have favorable outcomes, ongoing randomized trials will provide clarity regarding the role of deferred nephrectomy and metastasectomy in the context of current systemic regimens. PATIENT SUMMARY: In this mini review, we assess data on surgery to remove the primary tumor and its metastatic sites in kidney cancer. Drug options for metastatic kidney cancer have greatly improved, so there is a need to evaluate how surgery is used for these patients.</p>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143975353","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":"Practical Approaches to Evaluating Patients with Benign Prostatic Hyperlasia Using Home-based Tools and Apps.","authors":"Iván Schwartzmann, Bilal Chughtai","doi":"10.1016/j.euf.2025.04.021","DOIUrl":"https://doi.org/10.1016/j.euf.2025.04.021","url":null,"abstract":"<p><p>Home-based tools and apps offer a potential valuable and practical approach to evaluating patients with voiding dysfunction and complement in-clinic assessments. These technologies could improve patient convenience, enhance data collection, increase patient engagement, and personalise care. Further research is needed to address concerns and evaluate the long-term impact on patient outcomes and health care costs.</p>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143979174","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":"A Practical Guide for the Management of Toxicities Associated with Belzutifan.","authors":"Joy Li, Pooja Ghatalia","doi":"10.1016/j.euf.2025.04.019","DOIUrl":"https://doi.org/10.1016/j.euf.2025.04.019","url":null,"abstract":"<p><p>Belzutifan offers a significant therapeutic advance for von Hippel-Lindau-associated and advanced renal cell carcinoma but is associated with notable toxicities, particularly anemia and hypoxia. Effective management requires vigilant monitoring, timely interventions, and dose adjustments.</p>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143990583","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":"Preservation of Neurovascular Bundles in High-risk Prostate Cancer Patients: Long-term Oncological Outcomes from Two High-volume Tertiary Centers.","authors":"Nicola Frego, Francesco Barletta, Mario de Angelis, Stefano Resca, Enrico Vecchio, Sara Tamburini, Alessandro Pissavini, Andrea Noya Mourullo, Claudio Brancelli, Edward Lambert, Frederick D'Hondt, Ruben De Groote, Giorgio Gandaglia, Geert De Naeyer, Alberto Briganti, Francesco Montorsi, Alexandre Mottrie","doi":"10.1016/j.euf.2025.04.015","DOIUrl":"https://doi.org/10.1016/j.euf.2025.04.015","url":null,"abstract":"<p><strong>Background and objective: </strong>Preservation of neurovascular bundles (NVBs) in prostate cancer (PCa) patients undergoing radical prostatectomy (RP) has been associated with better functional outcomes. The aim of this study is to investigate the oncological impact of NVB preservation in patients with high-risk PCa.</p><p><strong>Methods: </strong>D'Amico high-risk PCa patients who underwent RP between 2002 and 2022 at two high-volume referral centers were included in the study analysis. Patients who underwent neoadjuvant and adjuvant therapy as well as those with evidence of M1 or pT4 disease were excluded. Propensity score and inverse probability of treatment weighting were used to account for a selection bias in treatment allocation. A time-to-event analysis was performed to assess the effect of NVB preservation on biochemical (BCR) and clinical (CR) recurrences.</p><p><strong>Key findings and limitations: </strong>Overall, 1551 high-risk PCa patients were included in the analysis (56.8% and 43.2% underwent preservation of NVBs vs no NVBs). After applying the inverse probability of treatment weighting, at 120 mo after RP, BCR- and CR-free survival rates were 27.1% versus 27.5% and 58.9% versus 58.4% for the preservation of NVBs versus no NVBs, respectively. In the models adjusted for pathological characteristics, age, and prostate-specific antigen density, NVB preservation was not associated with a significantly higher risk of BCR (adjusted hazard ratio [aHR]: 0.79, 95% confidence interval [CI]: 0.56-1.11, p = 0.2) and CR (aHR: 0.78, 95% CI: 0.45-1.32, p = 0.4), compared with no NVB preservation. In the subgroup analysis of pathological International Society of Urological Pathology grade 4-5 and/or pT stage 3a-3b patients, NVB preservation did not make oncological outcomes worse at both univariable and multivariable cox analyses.</p><p><strong>Conclusions and clinical implications: </strong>NVB preservation might have a limited effect on the risk of BCR and CR compared with no preservation. Nerve-sparing surgery may be attempted in selected high-risk PCa patients without compromising long-term oncological outcome.</p>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143985612","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":"Phytotherapy for the Treatment of Lower Urinary Tract Symptoms: Current Position and Unmet Needs.","authors":"Juan Justo Quintas, Stavros Gravas","doi":"10.1016/j.euf.2025.04.014","DOIUrl":"https://doi.org/10.1016/j.euf.2025.04.014","url":null,"abstract":"<p><p>Phytotherapy is considered an alternative option to medical treatment for lower urinary tract symptoms (LUTS). However, comparisons between different phytotherapeutics and the development of evidence-based recommendations are hampered by highly variable study results and the limited regulatory framework. Currently, hexanic Serenoa repens is the only agent recommended by the European Association of Urology guidelines on male LUTS. This mini review describes the current situation regarding phytotherapy for LUTS management and provides an insight into research needs for plant extracts in this setting. PATIENT SUMMARY: Our mini review discusses current evidence on plant extracts for the treatment of male lower urinary tract symptoms caused by an enlarged prostate. We highlight limitations and problems that need to be overcome to support routine use of plant extract products for these patients.</p>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143989261","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":"Lasers for Benign Prostatic Obstruction: And the Winner Is ….","authors":"Ziv Savin, Esther Garcia Rojo, Celeste Manfredi, Cecilia Maria Cracco, Javier Romero Otero, Mario Sofer","doi":"10.1016/j.euf.2025.04.016","DOIUrl":"https://doi.org/10.1016/j.euf.2025.04.016","url":null,"abstract":"<p><p>The past three decades have witnessed continuing evolution and diversification of laser technologies used for the surgical treatment of benign prostatic obstruction (BPO). These advances resulted from a better understanding of laser-tissue interactions, technical refinements, and increasing clinical experience. To date, holmium and thulium lasers are most commonly used in BPO surgery owing to their intrinsic characteristics, such as strong absorption in water and minimal tissue penetration. These laser types have also been widely assessed in clinical studies that provided strong evidence for their efficiency. This mini review describes current trends for laser applications in the treatment of BPO. PATIENT SUMMARY: Our mini review describes the different types of lasers used to remove prostate tissue in patients with a benign enlarged prostate gland that is obstructing urine flow. We highlight the advantages and disadvantages of the different techniques.</p>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143975501","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":"Impact of Lifestyle and the Microbiome on Male Lower Urinary Tract Symptoms Due to Benign Prostatic Hyperplasia.","authors":"Tommaso Cai, Tommaso Ceccato, Simone Botti, Jennifer Kranz, Paolo Verze, Gernot Bonkat, Antonio Aversa, Vito Racanelli, Truls Erik Bjerklund Johansen","doi":"10.1016/j.euf.2025.04.013","DOIUrl":"https://doi.org/10.1016/j.euf.2025.04.013","url":null,"abstract":"<p><p>Recent studies have facilitated a new understanding of how the microbiome and lifestyle contribute to the pathophysiology of prostatic diseases. This mini review explores evidence on the role of lifestyle, diet, and the microbiome in the development and progression of lower urinary tract symptoms due to benign prostatic hyperplasia (LUTS/BPH). Diet, physical activity, and the gut microbiome may influence LUTS/BPH by modulating systemic inflammation and metabolic processes. Proinflammatory diets, particularly those high in animal-based foods and low in fiber, affect systemic inflammation, leading to LUTS. Changes in the gut microbiota can alter the production of short-chain fatty acids and contribute to insulin resistance and other metabolic disturbances that may exacerbate prostate inflammation and accelerate LUTS progression. BPH development is influenced by a complex interplay of lifestyle factors, the metabolic syndrome, and the composition of the microbiota. More research into the pathophysiology of BPH is warranted to increase the evidence supporting lifestyle-based strategies in BPH prevention and management. PATIENT SUMMARY: There seems to be a link between lower urinary tract symptoms (LUTS) caused by an enlarged prostate and lifestyle, diet, and gut microbes. LUTS can be increased by factors such as a diet rich in red meat and animal protein and poor in fiber, and physical inactivity. Obesity may change the composition of microbes in the gut, which in turn increases inflammation, including in the prostate. Addressing these factors could help in preventing LUTS.</p>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2025-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143981743","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}