European urology focus最新文献

{"title":"Five-year Follow-up of the Urodynamics for Prostate Surgery Trial; Randomised Evaluation of Assessment Methods-A Noninferiority Randomised Controlled Trial of Urodynamics.","authors":"Madeleine Clout, Amanda L Lewis, Madeleine Cochrane, Grace J Young, Paul Abrams, Peter S Blair, Christopher Chapple, Gordon T Taylor, Sian Noble, Tom Steuart-Feilding, Jodi Taylor, J Athene Lane, Marcus J Drake","doi":"10.1016/j.euf.2025.02.004","DOIUrl":"https://doi.org/10.1016/j.euf.2025.02.004","url":null,"abstract":"<p><strong>Background and objective: </strong>Lower urinary tract symptoms (LUTS) are a key indication for surgery in older men. The Urodynamics for Prostate Surgery Trial; Randomised Evaluation of Assessment Methods (UPSTREAM) study evaluated the diagnostic pathway for men considering surgery to treat LUTS and reported the outcomes at 18 mo. This long-term follow-up study reports the symptoms and rates of prostate surgery at 5 yr.</p><p><strong>Methods: </strong>UPSTREAM participants who had consented to long-term follow-up received postal questionnaires at 5 yr after randomisation (October 2019-December 2021). The primary outcome was the patient-reported International Prostate Symptom Score (IPSS, scale 0-35). Rates of surgery, derived from the National Health Service (NHS) England routine data, were a key secondary outcome. An intention-to-treat analytic approach was utilised.</p><p><strong>Key findings and limitations: </strong>At 5 yr, 211/427 (49.4%) participants in the intervention group and 204/393 (51.9%) in the routine care group completed the questionnaires, with routine data obtained for 801/820 (97.7%). The mean IPSS at 5 yr did not differ between randomised groups (adjusted difference 0.41, 95% confidence interval -1.10, 1.93), nor did the rates of surgery (0.96 [0.71, 1.28]). Urinary and sexual symptoms also showed no differences between the randomised groups. The main limitation is the reduced numbers of men in follow-up. In UPSTREAM, men were randomised to routine care diagnostic tests plus invasive urodynamics (intervention) or routine care only for LUTS. Treatment choice was made by the participants, advised by their clinicians.</p><p><strong>Conclusions and clinical implications: </strong>Five-year follow-up does not support the routine use of invasive urodynamics in reducing LUTS or rates of prostate surgery. Urodynamics should be used selectively in the evaluation of uncomplicated LUTS.</p>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143624092","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":"Suction Ureteral Access Sheaths for Renal Stone Treatment: Essential for Every Case: For.","authors":"Vineet Gauhar, Steffi Kar Kei Yuen, Daniele Castellani","doi":"10.1016/j.euf.2025.03.002","DOIUrl":"https://doi.org/10.1016/j.euf.2025.03.002","url":null,"abstract":"<p><p>The use of a flexible and navigable suction ureteral sheath in retrograde intrarenal surgery is effective for improving 30-d stone-free rate, while minimizing infectious complications.</p>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143624093","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":"Targeting the Autonomic Nervous System for Treatment of Urinary Incontinence.","authors":"Guillermo Conde-Santos, Barbara Padilla-Fernández","doi":"10.1016/j.euf.2025.02.015","DOIUrl":"https://doi.org/10.1016/j.euf.2025.02.015","url":null,"abstract":"<p><p>Urinary incontinence is a difficult condition that affects millions of people around the world. Recent research has opened the door to understanding the involvement of imbalance in the autonomic nervous system (ANS) as a cause of urge urinary incontinence (UUI) and has highlighted the therapeutic potential of targeting the sympathetic and parasympathetic pathways. This mini-review discusses current pharmacological and neuromodulation approaches that act on the ANS to restore bladder function. Future research should investigate the role of the ANS in bladder dysfunction and incontinence in more depth, and assess optimization of neuromodulation protocols and therapy combination to improve outcomes for patients with UUI. PATIENT SUMMARY: Our mini-review discusses dysfunction of the autonomic nervous system (ANS) as a possible cause of urge urinary incontinence. We describe treatments that could have an effect on incontinence by improving the balance of the ANS. Further research is needed to define the role of the ANS in tailoring treatment for individual patients.</p>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143604434","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":"Intrarenal Pressure During Ureteroscopy.","authors":"Emmeli Grøne Lykkegaard, Helene Jung","doi":"10.1016/j.euf.2025.02.010","DOIUrl":"https://doi.org/10.1016/j.euf.2025.02.010","url":null,"abstract":"<p><p>Intrarenal pressure (IRP) increases during ureteroscopy because of irrigation and scope manipulation and typically exceeds physiological levels. Elevated IRP can cause intrarenal backflow (IRB), whereby irrigation fluid and urine flow backwards into the kidney structures, increasing the risk of infectious complications and sepsis. The irrigation rate, outflow, and tool size are important variables that can affect IRP and the risk of IRB, but IRB thresholds vary based on papillary morphology indicating pressure compliance differences among patients. Recent research has shed light on IRP and the potential clinical consequences of elevated IRP. A greater focus on reducing IRP during ureteroscopy is recommended. PATIENT SUMMARY: When a small telescope is used to inspect the urinary tract up to the kidney, pressure inside the kidney increases because irrigation fluid is used. High pressure can cause fluid and urine to flow backwards into the kidney, which could lead to infection. The irrigation flow rate, drainage efficiency, size of the tools used, and the structure of a patient's kidney tissue can influence the pressure and the risk of backflow. Studies have shown the importance of controlling this pressure to reduce complications.</p>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2025-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143585080","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":"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}