European urology focus最新文献

{"title":"PSA Assessment in Male LUTS/BPE – CON","authors":"François Hervé","doi":"10.1016/j.euf.2026.03.008","DOIUrl":"10.1016/j.euf.2026.03.008","url":null,"abstract":"","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":"12 4","pages":"Pages 631-632"},"PeriodicalIF":6.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147493658","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":"Bacillus Calmette-Guérin–exposed Non–muscle-invasive Bladder Cancer: Survival Benchmarks, Bladder-sparing Strategies, and Implications for Trial Design","authors":"Seyed Behzad Jazayeri,&nbsp;Renzo G. DiNatale,&nbsp;Christopher Guske,&nbsp;Christian Harrs,&nbsp;Joshua Linscott,&nbsp;Hongzhi Xu,&nbsp;Facundo Davaro,&nbsp;Lexiaochuan Wen,&nbsp;Philippe E. Spiess,&nbsp;Wade J. Sexton,&nbsp;Scott M. Gilbert,&nbsp;Logan Zemp,&nbsp;Michael A. Poch,&nbsp;Roger Li","doi":"10.1016/j.euf.2025.12.013","DOIUrl":"10.1016/j.euf.2025.12.013","url":null,"abstract":"<div><h3>Background and objective</h3><div>Intravesical recurrence after induction bacillus Calmette-Guérin (BCG) therapy is common in non–muscle-invasive bladder cancer (NMIBC), but longitudinal, real-world data using contemporary definitions of the BCG-exposed (BCG-E) phenotype remain limited, which constrains trial design. We assessed long-term clinical outcomes and clinical trajectories for a large BCG-exposed cohort treated at a single tertiary care center to establish pragmatic benchmarks to inform patient counseling, surveillance strategies, and the design and interpretation of bladder-sparing studies.</div></div><div><h3>Methods</h3><div>We conducted a retrospective cohort study for adults with histologically confirmed high-grade NMIBC treated with intravesical BCG at Moffitt Cancer Center between 1988 and 2024. Relevant clinical data were extracted from electronic medical records into a prespecified database, including detailed BCG doses and timing and features of each recurrence episode. Initial management followed contemporary standards, with subsequent intravesical therapy or radical cystectomy (RC) after shared decision-making. Patients were classified as BCG-unresponsive (BCG-UR) or BCG-E, with BCG adequacy defined as previously published. Time-to-event endpoints were analyzed using Kaplan-Meier estimates and multivariable Cox proportional-hazards models; baseline characteristics were compared using Fisher’s exact and Wilcoxon rank-sum tests.</div></div><div><h3>Key findings and limitations</h3><div>Of 1076 NMIBC patients treated with BCG, 470 were classifiable: 245 (52.1%) were BCG-E, of whom 173 (70.6%) were resistant and 72 (29.4%) experienced delayed relapse, and 225 (47.9%) were BCG-UR. In the BCG-E group, 50.2% experienced recurrence and 15.5% experienced progression; median recurrence-free survival (RFS) was 27.2 mo. The 5-yr survival rate estimates were 32.25% for RFS, 79.3% for progression-free survival (PFS), 84.5% for metastasis-free survival (MFS), and 65.0% for overall survival (OS). Recurrence was associated with worse PFS (<em>p</em> &lt; 0.001) and MFS (<em>p</em> = 0.03), but not OS (<em>p</em> = 0.2). RC was performed in 45 patients (18.4%). No consistent survival differences were observed across salvage therapies (62.0% BCG, 18.4% gemcitabine + docetaxel, 5.3% single-agent chemotherapy, 1.2% trials, 13% surveillance),. Multivariable OS estimates were computed. Addition of recurrence to the model did not improve discrimination; age and performance status were the strongest predictors of OS.</div></div><div><h3>Conclusions and clinical implications</h3><div>We present comprehensive outcomes for and an in-depth characterization of clinical trajectories in BCG-E NMIBC, for which salvage intravesical BCG is predominant and oncologic results are durable. These data provide pragmatic benchmarks for the interpretation and design of bladder-sparing trials in this setting.</div></div>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":"12 4","pages":"Pages 725-734"},"PeriodicalIF":6.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145800111","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: Alexandra Masson-Lecomte, Guillaume Grisay, Julien Van Damme, et al. Challenges in Defining Clinical Complete Response to Systemic Therapy in Muscle-invasive Bladder Cancer: Insights from the EORTC STARBURST Project. Eur Urol Oncol. In press. https://doi.org/10.1016/j.euo.2025.03.005","authors":"Marco Moschini,&nbsp;Giuseppe Rosiello,&nbsp;Giorgio Gandaglia,&nbsp;Alberto Briganti,&nbsp;Francesco Montorsi","doi":"10.1016/j.euf.2025.05.028","DOIUrl":"10.1016/j.euf.2025.05.028","url":null,"abstract":"","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":"12 4","pages":"Page 817"},"PeriodicalIF":6.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144301452","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: Guru P. Sonpavde. Role of Adjuvant Therapy in Current Perioperative Immunotherapy-based Trials in Bladder Cancer: A Justified Standard. Eur Urol Focus. In press. https://doi.org/10.1016/j.euf.2025.05.008","authors":"Lingyu Guo,&nbsp;Tian An","doi":"10.1016/j.euf.2025.06.021","DOIUrl":"10.1016/j.euf.2025.06.021","url":null,"abstract":"","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":"12 4","pages":"Page 820"},"PeriodicalIF":6.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144616852","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":"Digital Systematic Collection of Data for Patient-reported Outcome and Experience Measures Reveals Real-world Recovery Trajectories After Robot-assisted Radical Prostatectomy","authors":"Arthur Peyrottes,&nbsp;Charles Dariane,&nbsp;Laurent Brureau,&nbsp;Stéphane Lorin,&nbsp;Gilles Pasticier,&nbsp;Stéphane de Vergie,&nbsp;Thomas Bommelaere,&nbsp;Aude De Fourmestraux,&nbsp;Eric Potiron,&nbsp;Martin Sie,&nbsp;Olivier Skowron,&nbsp;Naoufel Miaadi,&nbsp;Nam-Son Vuong,&nbsp;Jean-Baptiste Beauval,&nbsp;Morgan Rouprêt,&nbsp;Antoine Faix,&nbsp;Yann Neuzillet,&nbsp;Alexandre de la Taille,&nbsp;Gaelle Fiard,&nbsp;Guillaume Ploussard","doi":"10.1016/j.euf.2025.12.006","DOIUrl":"10.1016/j.euf.2025.12.006","url":null,"abstract":"<div><h3>Background and objective</h3><div>Robot-assisted radical prostatectomy (RARP) is widely used for localised prostate cancer (PC). As surgical techniques and oncological outcomes have matured, attention has increasingly turned to patient-reported outcome measures (PROMs) and experience measures (PREMs), driven not only by interest in functional recovery but also by broader health care trends, including shared decision-making, patient empowerment, and value-based care models. Digital health platforms may facilitate this evolution, yet real-world evidence on their feasibility and impact is limited. Our objective was to assess the acceptability, feasibility, and clinical relevance of digital telemonitoring using a certified mobile health application after RARP.</div></div><div><h3>Methods</h3><div>We conducted a prospective, multicentre cohort study involving 465 patients undergoing RARP across 32 French centres. All used the Betty digital health platform for perioperative monitoring. The primary outcome was patient-reported satisfaction with perioperative care. Secondary outcomes were pain trajectories, analgesic use, urinary continence, erectile function, and correlations between satisfaction and recovery endpoints. PROM data were collected preoperatively and up to 6 mo postoperatively.</div></div><div><h3>Key findings and limitations</h3><div>The questionnaire completion rate at 6 wk was 86%. Satisfaction was high (median score 9–10), and pain and analgesic use declined steadily over 30 d. The pad-free rate was 59% at 6 wk and 78% at 6 mo. International Index of Erectile Function-5 scores remained low (median 3, interquartile range 1–5 at 6 mo). Satisfaction was correlated with lower pain at postoperative day 7 (<em>r</em> = −0.391, <em>p</em> = 0.001), lower incontinence scores (<em>r</em> = −0.324, <em>p</em> = 0.009), and less impact of incontinence (<em>r</em> = −0.420, <em>p</em> = 0.002). The main limitations are the inclusion of only app users and the absence of nerve-sparing data.</div></div><div><h3>Conclusions and clinical implications</h3><div>Certified digital telemonitoring after RARP is feasible, well accepted, and linked to high satisfaction. Early pain and continence recovery influence the patient experience. These results support the integration of structured PROM/PREM tracking into standard pathways for real-time monitoring and patient-centred care.</div></div>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":"12 4","pages":"Pages 709-716"},"PeriodicalIF":6.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145800054","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":"Anatomy of the Prostatic Urethra and Sphincters: Normal and Pathological Variants","authors":"Marco Finati,&nbsp;Alessandro Uleri,&nbsp;Melissa R. Kaufman,&nbsp;Marcus J. Drake,&nbsp;Benjamin Pradère","doi":"10.1016/j.euf.2026.06.005","DOIUrl":"10.1016/j.euf.2026.06.005","url":null,"abstract":"<div><div>The prostatic urethra and distal sphincteric complex are often overlooked compartments that influence symptoms, treatment response, and uncommon complications of benign prostatic hyperplasia (BPH). Emerging anatomical studies suggest that the prostatic urethra is a dynamic structure where differences in length, curvature, and angulation alter local hydrodynamics and contribute to symptoms inadequately predicted by prostate volume alone. Real-time imaging further suggests that the periverumontanal region is responsible for creating an antichamber in which semen accumulates and directs antegrade flow. Therefore, anatomical distortion, surgical modification, or local physiological barriers disruption in this region may alter ejaculatory mechanics or permit reflux phenomena involving urine or seminal fluid. Distal to this region, the external urethral sphincter may present anterior and lateral extensions beyond conventional landmarks. These considerations should be studied when planning obstructive surgery and may help explain atypical continence patterns, pelvic discomfort, or dysorgasmia not captured by conventional lower urinary tract symptoms.</div></div><div><h3>Patient summary</h3><div>We reviewed anatomical features of the prostatic urethra and sphincter, which are usually overlooked in standard evaluation of benign prostatic hyperplasia. Recognizing such anatomic variants may help explain unusual symptoms and improve surgical treatment.</div></div>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":"12 4","pages":"Pages 672-675"},"PeriodicalIF":6.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148293976","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":"Escaping the “PSA Test Loop”: How PSA Testing Overshadows Male LUTS Treatment and Management in Primary Care","authors":"Jessica R. Wheeler,&nbsp;Nikki Cotterill,&nbsp;Jo Worthington,&nbsp;Athene Lane,&nbsp;Matthew J. Ridd,&nbsp;Alisha Mahmud,&nbsp;Marcus J. Drake","doi":"10.1016/j.euf.2026.06.015","DOIUrl":"10.1016/j.euf.2026.06.015","url":null,"abstract":"&lt;div&gt;&lt;div&gt;Lower urinary tract symptoms (LUTS) affect up to 90% of men aged &gt;50 yrs, but few (around 10%) receive appropriate treatment. Research indicates that men with LUTS are mostly poorly informed about their urinary symptoms and view LUTS as largely unworthy of clinical attention. As a result, many men endure symptoms for lengthy periods without seeking support. In this uninformed and untreated context, men with LUTS are susceptible to anxiety about prostate cancer, fueled by widespread misconceptions about the association between prostate cancer and LUTS. Prostate cancer fear drives a sizeable proportion of male LUTS primary care consultations. This mini review examines the hitherto largely unrecognized “PSA test loop”—whereby over time, men with LUTS undergo repeated cycles of prostate-specific antigen (PSA) testing with negative results, but do not receive clinically recommended information or guidance within primary care to support their urinary symptoms. This concept arose through qualitative research, which was part of a large UK randomized controlled trial of conservative management for male LUTS [TRIUMPH study: ISRCTN11669964]. The PSA test loop is set in motion when men with LUTS attend primary care with a focus on prostate cancer and PSA testing, and when general practitioner (GP) attention subsequently shifts away from urinary symptoms and the provision of appropriate information, guidance and treatment to support male LUTS. The effect is compounded by GP consultation time constraints and by limitations in GPs’ attitudes and knowledge in relation to the self-management of male LUTS. The PSA test loop is activated when men with LUTS receive negative PSA results, often by telephone, and experience relief in relation to their prostate cancer concerns, leading them to exit primary care—without follow-up and without receiving guidance to support their untreated urinary symptoms. Over time, as symptoms persist and prostate cancer fears resurface, the cycle repeats. The TRIUMPH study has demonstrated that a structured and tailored self-management intervention can be effectively delivered in primary care, outside of GP consultation time (eg, by trained health care assistants or nurses), and can provide information, guidance, reassurance and symptom relief. We propose prioritizing self-management guidance for men with LUTS in primary care, especially following negative PSA testing, to better inform men, to alleviate untreated urinary symptoms and associated prostate cancer concerns, and to deactivate the PSA test loop cycle.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Patient summary&lt;/h3&gt;&lt;div&gt;Older men with urinary symptoms can become trapped in cycles of prostate cancer testing (prostate-specific antigen - or 'PSA' - tests), without receiving proper advice to help relieve their symptoms. We explain how this can happen and propose offering men who receive negative PSA results a follow-up appointment in primary care with a trained nurse or health care assistant","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":"12 4","pages":"Pages 658-663"},"PeriodicalIF":6.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148879657","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":"Should We Send TURP Histology for Pathological Examination?","authors":"Heikki Seikkula,&nbsp;Henrikki Santti,&nbsp;Marita Laurila,&nbsp;Kari A.O. Tikkinen,&nbsp;Tarmo Pekkarinen","doi":"10.1016/j.euf.2026.07.020","DOIUrl":"10.1016/j.euf.2026.07.020","url":null,"abstract":"<div><div>Transurethral resection of the prostate (TURP) has historically provided tissue for histological assessment as a by-product of surgery, but contemporary prostate cancer (PCa) pathways increasingly rely on risk stratification before surgery for benign prostatic obstruction. Although modern series suggest that incidental PCa detected in TURP specimens is relatively common, it is predominantly low grade and managed conservatively. Moreover, transition zone cancers, which are typically sampled by TURP, may show more favorable pathological features and recurrence outcomes than peripheral zone cancers, suggesting a lower risk of missing aggressive disease if routine TURP chip analysis is omitted. Routine processing is also resource intensive, may cause psychological harm, and is costly. These findings do not support routine histological examination of TURP chips in men with low preoperative suspicion of patient-important PCa and instead support evaluation of a risk-adapted strategy.</div></div><div><h3>Patient summary</h3><div>Transurethral resection of the prostate is an operation to remove prostate tissue blocking urine flow. Sometimes cancer is found unexpectedly in this tissue. Most such cancers are small, slow growing, and unlikely to cause harm. Avoiding routine tissue testing may reduce worry and unnecessary follow-up while still allowing patients at higher risk to undergo selective histological evaluation.</div></div>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":"12 4","pages":"Pages 668-671"},"PeriodicalIF":6.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148789980","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":"Conceptualizing the “High” Bladder Neck – Anatomic Rabbit Hole or Functional Gold Mine?","authors":"Melissa R. Kaufman,&nbsp;Hector S. Barba,&nbsp;Marcus J. Drake","doi":"10.1016/j.euf.2026.07.017","DOIUrl":"10.1016/j.euf.2026.07.017","url":null,"abstract":"<div><div>Describing a “high bladder neck” is common practice, yet it is not a standardized entity, and it lacks an evidence base in diagnostics and therapy. Recent systematic reviews report few trials, yet incision of the bladder neck remains a first-line therapy. The concept insinuates a basis for bladder outlet obstruction, so it is during voiding that such an issue should be assessed. For cystourethroscopy, the urinary tract is in the storage phase. A pressure-flow study in videourodynamics can visualize when the bladder neck is deflected into the proximal prostatic urethra by the force of bladder contraction, but this is rarely undertaken. Standard urodynamics may infer this diagnosis, but only by assuming the cause. Other forms of imaging are being evaluated, though they remain remote from delivering evidence based on therapy outcomes. Proper consensus regarding the “high bladder neck” is needed, primarily for standardization of terminology and agreement on justifiable endoscopic and imaging approaches.</div></div>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":"12 4","pages":"Pages 684-687"},"PeriodicalIF":6.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148677553","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":"Urethral Sensory Receptors in Voiding Physiology and Lower Urinary Tract Symptoms","authors":"Uchelly Philtjens,&nbsp;Tim Brits,&nbsp;Stefan De Wachter","doi":"10.1016/j.euf.2026.05.006","DOIUrl":"10.1016/j.euf.2026.05.006","url":null,"abstract":"<div><div>Voiding is not a sole action of the bladder, but a complex interaction and integration of signals from the bladder, the outlet consisting of urethra and sphincter complex, and the central nervous system. The urethra appears to be more than a simple tube that transports urine; it serves as a sensory unit that is necessary for maintaining continence and micturition. Several reflexes originating in the urethra have an influence on bladder activity, possibly through an extensive sensory web with specialised cells. In normal conditions, urethral flow and/or distension for example enable bladder contraction to prolong until complete emptying. Although the exact mechanisms remain unknown, it is believed that urethral dysfunction may be an important contributor to the pathophysiology of lower urinary tract symptoms (LUTS). In this review, we aim to give a brief insight into the role of the proximal urethra in voiding physiology and LUTS, uncovering some of its secrets.</div></div>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":"12 4","pages":"Pages 656-657"},"PeriodicalIF":6.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148005121","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}