European urology最新文献

{"title":"Clinical Outcomes, Genomic Heterogeneity, and Therapeutic Considerations Across Histologic Subtypes of Urothelial Carcinoma","authors":"Carissa E. Chu, Ziyu Chen, Karissa Whiting, Irina Ostrovnaya, Andrew T. Lenis, Timothy N. Clinton, Rayan Rammal, Gamze Gokturk Ozcan, Dilara Akbulut, Merve Basar, Jie-Fu Chen, Ying-Bei Chen, Anuradha Gopalan, Samson W. Fine, Satish K. Tickoo, Maria Arcila, A. Rose Brannon, Michael F. Berger, Eugene K. Cha, Alvin C. Goh, Hikmat Al-Ahmadie","doi":"10.1016/j.eururo.2025.04.008","DOIUrl":"https://doi.org/10.1016/j.eururo.2025.04.008","url":null,"abstract":"<h3>Background and objective</h3>Divergent differentiation and histologic subtypes are common findings in urothelial carcinoma (UC). Clinically relevant genomic alterations and oncogenic drivers of individual subtypes remain poorly defined. We characterized surgical outcomes and the genomic landscape of UC with aberrant histology (UCAH), with a focus on biomarkers and targetable alterations.<h3>Methods</h3>The clinical cohort comprised 3052 patients who underwent radical cystectomy (RC) with or without neoadjuvant chemotherapy. Targeted exon sequencing was performed for a genomic cohort of 1060 bladder tumors from RC or transurethral resection specimens. We characterized the frequency of oncogenic mutations and targetable alterations, and the tumor mutational burden (TMB) of each subtype. We defined the clonal relatedness of morphologically distinct regions of tumors with mixed histology.<h3>Key findings and limitations</h3>Patients with plasmacytoid, micropapillary, sarcomatoid, or mixed-histology tumors had worse cancer-specific survival than patients with pure urothelial histology. <em>ERBB2, FGFR3,</em> and <em>PTEN</em> alterations were most frequent in micropapillary, nested/squamous, and sarcomatoid UC, respectively. TMB was highest in plasmacytoid, neuroendocrine, and micropapillary tumors. Regions of mixed histology had shared clonal origins, but exceptions were observed. The retrospective design and potential for selection bias are limitations of our study.<h3>Conclusions and clinical implications</h3>UCAH tumors have distinct patterns of genomic alterations, which may be targetable via novel therapies and have implications for clinical trial inclusion. Biomarker-driven systemic therapy should be explored in patients with histologic subtypes that are associated with worse clinical outcomes.","PeriodicalId":12223,"journal":{"name":"European urology","volume":"55 1","pages":""},"PeriodicalIF":23.4,"publicationDate":"2025-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143878082","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Use of the Xpert Bladder Cancer Monitor Urinary Biomarker Test for Guiding Cystoscopy in High-grade Non–muscle-invasive Bladder Cancer: Results from the Randomized Controlled DaBlaCa-15 Trial","authors":"Thomas Dreyer, Simone Brandt, Knud Fabrin, Nessn Azawi, Juan Luis Vásquez, Andreas Ernst, Lars Dyrskjøt, Jørgen Bjerggaard Jensen","doi":"10.1016/j.eururo.2025.03.018","DOIUrl":"https://doi.org/10.1016/j.eururo.2025.03.018","url":null,"abstract":"<h3>Background and objective</h3>Urinary biomarker tests have long been suggested as a noninvasive alternative to current cystoscopy-based follow-up of high-grade non–muscle-invasive bladder cancer (NMIBC) to reduce both morbidity and costs. However, the clinical impact of urinary biomarker tests remains uncertain owing to a lack of randomized trials.<h3>Methods</h3>In this randomized noninferiority trial, we evaluated the impact of alternating a urinary biomarker test (Xpert Bladder Cancer Monitor, XBCM) with cystoscopy in the intervention arm as a method for reducing the number of cystoscopies during follow-up of patients with high-grade NMIBC. Patients in the control arm underwent cystoscopy at all follow-up visits. The primary outcome was comparison of the risk of recurrence-free survival in terms of high-grade NMIBC, muscle-invasive bladder cancer, or metastatic urothelial carcinoma between the study arms.<h3>Key findings and limitations</h3>In total, 43 high-grade recurrences were detected, 22 in the intervention arm and 21 in the control arm. The risk difference for high-grade recurrence between the study arms was 0.08% (95% confidence interval −7.2% to 7.4%). Two pTa high-grade recurrences were missed by the XBCM test. The number of cystoscopies performed was 1029 cystoscopies in the control arm and 445 in the intervention arm. An anticipatory positive effect was observed, with XBCM positivity observed before recurrences were visible on cystoscopy. The findings are limited by a lower-than-expected rate of recurrence in both study arms.<h3>Conclusions and clinical implications</h3>Alternating cystoscopy with XBCM reduced the number of follow-up cystoscopies for high-grade NMIBC without affecting detection of any recurrence. The long-term oncological safety of this strategy needs to be validated over longer follow-up.","PeriodicalId":12223,"journal":{"name":"European urology","volume":"7 1","pages":""},"PeriodicalIF":23.4,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143872229","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Follow-up for Non–muscle-invasive Bladder Cancer: Should the Guidelines Be Adapted?","authors":"J. Alfred Witjes","doi":"10.1016/j.eururo.2025.04.015","DOIUrl":"https://doi.org/10.1016/j.eururo.2025.04.015","url":null,"abstract":"No Abstract","PeriodicalId":12223,"journal":{"name":"European urology","volume":"3 1","pages":""},"PeriodicalIF":23.4,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143875995","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unmet Needs in Urological Education: The Role of the European School of Urology in Addressing and Advancing Global Knowledge","authors":"Bhaskar K. Somani, Evangelos Liatsikos","doi":"10.1016/j.eururo.2025.04.011","DOIUrl":"https://doi.org/10.1016/j.eururo.2025.04.011","url":null,"abstract":"No Abstract","PeriodicalId":12223,"journal":{"name":"European urology","volume":"34 1","pages":""},"PeriodicalIF":23.4,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143875996","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reply to Francesco Montorsi, Giuseppe Rosiello, Pietro Scilipoti, Marco Moschini, and Andrea Salonia’s Letter to the Editor re: Valeria Panebianco, Alberto Briganti, Jason Efstathiou, et al. The Role of Multiparametric Magnetic Resonance Imaging and the Vesical Imaging-Reporting and Data System (VI-RADS) in the Management of Patients with Bladder Cancer: Vision of the American College of Radiology VI-RADS Steering Committee. Eur Urol 2024;86:485–7","authors":"Valeria Panebianco, Alberto Briganti, Jason Efstathiou, Samuel Galgano, Lyndon Luk, Valdair Francisco Muglia, Bernadette Redd, Maarten de Rooij, Mitsuru Takeuchi, Sungmin Woo, J. Alfred Witjes, Hebert Alberto Vargas","doi":"10.1016/j.eururo.2025.03.022","DOIUrl":"https://doi.org/10.1016/j.eururo.2025.03.022","url":null,"abstract":"No Abstract","PeriodicalId":12223,"journal":{"name":"European urology","volume":"32 1","pages":""},"PeriodicalIF":23.4,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143866822","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Re: Darolutamide in Combination with Androgen-deprivation Therapy in Patients with Metastatic Hormone-sensitive Prostate Cancer from the Phase III ARANOTE Trial","authors":"Juan Gómez Rivas, Jesús Moreno Sierra","doi":"10.1016/j.eururo.2025.04.007","DOIUrl":"https://doi.org/10.1016/j.eururo.2025.04.007","url":null,"abstract":"No Abstract","PeriodicalId":12223,"journal":{"name":"European urology","volume":"12 1","pages":""},"PeriodicalIF":23.4,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143862262","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Longitudinal Evaluation of Clear-cell Renal Cell Carcinoma in von Hippel-Lindau Disease","authors":"W. Marston Linehan, Cathy Anne Pinto, Yanfang Liu, Kristin Choo, Rabindra Gautam, Claire Fox, Ananya Roy, Mengying Li, Rafia Bosan, Deborah Nielsen, Beth Ryan, Zoe Blake, Krista Reynolds, Alexis Rompre-Brodeur, Peter A. Pinto, Cathy Vocke, Sandeep Gurram, Mark W. Ball, Rodolfo Perini, Ramaprasad Srinivasan","doi":"10.1016/j.eururo.2025.03.002","DOIUrl":"https://doi.org/10.1016/j.eururo.2025.03.002","url":null,"abstract":"<h3>Background and objective</h3>An understanding the natural history of von Hippel-Lindau (VHL) disease–associated renal cell carcinoma (RCC) is critical to the development of optimal clinical management approaches and interpretation of trial results for comparable populations and endpoints. Our aim was to describe the natural progression of disease in patients with VHL RCC.<h3>Methods</h3>This was a natural history study involving 244 patients with VHL with ≥10-mm renal tumor(s) who were evaluated and managed at the US National Cancer Institute between 2004 and 2020. We analyzed radiographic outcomes, renal surgeries, metastasis, sequalae of surgery, including chronic kidney disease (CKD), and mortality. Radiographic outcomes were assessed according to Response Evaluation Criteria in Solid Tumours v1.1. The primary analyses were descriptive in nature.<h3>Key findings and limitations</h3>Among 178 patients with at least three serial tumor assessments and up to 5 yr of follow-up, the rate of spontaneous tumor regression (≥30% decrease) was 1.8% (95% confidence interval [CI] 0.4–5.2%). The probability of not having disease progression in the presence of competing risks at 5 yr was 37% (95% CI 30–44%). During follow-up, 186/244 patients had one or more renal surgeries, and 108/244 had two or more. RCC metastasis was reported for 12 patients. Among patients who underwent surgery, 41% developed postprocedure CKD. Potential limitations include selection bias and misclassification of outcomes.<h3>Conclusions and clinical implications</h3>Our study demonstrates that RCC is a significant burden for VHL patients, with high rates of disease progression, surgery, and metastasis development, even in a closely monitored, multidisciplinary clinical environment, and identifies CKD as an underappreciated aspect of VHL. These findings can provide a context for the antitumor activity of new treatments for RCC.","PeriodicalId":12223,"journal":{"name":"European urology","volume":"14 1","pages":""},"PeriodicalIF":23.4,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143866815","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bladder Preservation Strategies in Muscle-invasive Bladder Cancer: Recommendations from the International Bladder Cancer Group","authors":"Shilpa Gupta, Patrick J. Hensley, Roger Li, Ananya Choudhury, Siamak Daneshmand, Bishoy M. Faltas, Thomas W. Flaig, G. Daniel Grass, Petros Grivas, Donna E. Hansel, Comron Hassanzadeh, Wassim Kassouf, Janet Kukreja, Arturo Mendoza-Valdés, Marco Moschini, Kent W. Mouw, Neema Navai, Andrea Necchi, Jonathan E. Rosenberg, Jeffrey S. Ross, Ashish M. Kamat","doi":"10.1016/j.eururo.2025.03.017","DOIUrl":"https://doi.org/10.1016/j.eururo.2025.03.017","url":null,"abstract":"<h3>Background and objective</h3>Patient-centric management necessitates providing care aligned with patients’ values, preferences, and expressed needs. Therefore, critical assessment of bladder preservation therapies (BPTs) as alternatives to radical cystectomy (RC) for muscle-invasive bladder cancer (MIBC) and practical recommendations on the optimal selection of patients for BPTs are needed urgently.<h3>Methods</h3>A global committee of bladder cancer experts was assembled to develop BPT recommendations for MIBC. Working groups reviewed the literature and drafted recommendations, which were voted on by International Bladder Cancer Group (IBCG) members using a modified Delphi process. During a live meeting in August 2023, voting results and supporting evidence were presented, and recommendations were refined based on discussions. Final recommendations achieved ≥75% agreement during the meeting, with further refinements through web conferences and e-mail discussions.<h3>Key findings and limitations</h3>Patients with newly diagnosed MIBC should be offered evaluation in a multidisciplinary setting for consideration of BPTs. The main alternative to RC is trimodal therapy (TMT), and favorable prognostic factors for TMT include unifocal cT2 stage, lack of hydronephrosis, and no multifocal carcinoma in situ (CIS). Other options should be reserved for very select patients who are ineligible for or who decline TMT or RC after thorough consideration of benefits versus risks. These include partial cystectomy (PC) for urachal adenocarcinoma and PC or radical transurethral resection alone for solitary tumors amenable to resection with adequate margins and without concomitant CIS or histologic subtypes.<h3>Conclusions and clinical implications</h3>The IBCG consensus recommendations provide practical guidance on BPTs for MIBC.","PeriodicalId":12223,"journal":{"name":"European urology","volume":"43 1","pages":""},"PeriodicalIF":23.4,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143862257","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The PUrE randomised controlled trial 1: Clinical and cost effectiveness of flexible ureterorenoscopy and extracorporeal shockwave lithotripsy for lower pole stones of ≤10 mm","authors":"Oliver Wiseman, Daron Smith, Kathryn Starr, Lorna Aucott, Rodolfo Hernández, Ruth Thomas, Steven MacLennan, Charles Terry Clark, Graeme MacLennan, Dawn McRae, Victoria Bell, Seonaidh Cotton, Zara Gall, Ben Turney, Sam McClinton","doi":"10.1016/j.eururo.2025.02.002","DOIUrl":"https://doi.org/10.1016/j.eururo.2025.02.002","url":null,"abstract":"<h3>Background and objective</h3>The European Association of Urology guidelines recommend that extracorporeal shockwave lithotripsy (ESWL) and flexible ureterorenoscopy (FURS) are equally appropriate first-line treatment options for lower pole renal stones (LPSs). We report a pragmatic multicentre, open-label, superiority randomised controlled trial (RCT) comparing FURS versus ESWL for quality of life, and clinical and cost effectiveness for LPSs of ≤10 mm—one of two RCTs that were part of the Percutaneous nephrolithotomy, flexible Ureteroscopy and Extracorporeal shockwave lithotripsy for lower pole kidney stone study (PUrE), with the other PUrE RCT 2 investigating larger stones.<h3>Methods</h3>In total, 231 and 230 patients were randomised to FURS and ESWL, respectively. The primary outcome was health status area under the curve (AUC) 12 wk after intervention using the EQ-5D-5L questionnaire. The primary economic outcome was the incremental cost per quality-adjusted life-year (QALY) gained at 12 mo after randomisation.<h3>Key findings and limitations</h3>The mean health status AUCs over 12 wk were 0.807 (standard deviation [SD] 0.205) for FURS (<em>n</em> = 164) and 0.826 (SD 0.207) for ESWL (<em>n</em> = 188); the between-group difference was 0.024 (95% confidence interval –0.004, 0.053), a small nonsignificant difference in favour of FURS adjusted for an initial baseline imbalance. Complete stone clearance was higher with FURS (72%) than with ESWL (36%). The incremental cost-effectiveness ratio between FURS and ESWL was £65 163, meaning that at a threshold value of £20 000 per QALY, ESWL has a &gt;99% chance of being cost effective.<h3>Conclusions and clinical implications</h3>PUrE RCT 1 found that there was no evidence of a difference in health status between FURS and ESWL for LPSs of ≤10 mm, with FURS leading to a higher stone-free rate. ESWL was more cost effective than FURS.","PeriodicalId":12223,"journal":{"name":"European urology","volume":"65 1","pages":""},"PeriodicalIF":23.4,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143862260","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"European Association of Urology Guidelines on the Diagnosis and Treatment of Urolithiasis","authors":"Andreas Skolarikos, Robert Geraghty, Bhaskar Somani, Thomas Tailly, Helene Jung, Andreas Neisius, Ales Petřík, Guido M. Kamphuis, Niall Davis, Carla Bezuidenhout, Michael Lardas, Giovanni Gambaro, John A. Sayer, Riccardo Lombardo, Lazaros Tzelves","doi":"10.1016/j.eururo.2025.03.011","DOIUrl":"https://doi.org/10.1016/j.eururo.2025.03.011","url":null,"abstract":"<h3>Background and objective</h3>The European Association of Urology urolithiasis guidelines provide evidence-based recommendations for the diagnosis and treatment of urinary stone disease. Given the complexity and variability of stone formation, individualised patient management is emphasised.<h3>Methods</h3>The guidelines incorporate evidence from the latest research and focus on risk assessment, imaging techniques, pharmacological management, and surgical interventions. A research librarian conducted literature searches for urolithiasis in the Cochrane Library, Medline, and Embase databases via Dialog-Datastar. The strength of recommendations is also rated.<h3>Key findings and limitations</h3>Diagnosis relies on a combination of clinical history, biochemical evaluation, and imaging, with ultrasound as the first-line modality and low-dose computed tomography as the gold standard for precise stone assessment. Stone composition and burden influence treatment decisions with algorithms primarily based on stone size, location, and composition. Nonsteroidal anti-inflammatory drugs are recommended for first-line pain management, with opioids reserved as a secondary option. Medical expulsive therapy with α-blockers may be considered for selected patients with ureteral stones. Extracorporeal shockwave lithotripsy, ureteroscopy, and percutaneous nephrolithotomy remain the primary intervention modalities, with selection based on stone characteristics and patient factors. Advances in multiplanar imaging have improved assessment of the stone burden, although further research is needed to refine predictive models. Genetic testing is recommended for high-risk patients to guide personalised treatment.<h3>Conclusions and clinical implications</h3>The guidelines provide a framework for clinical decision-making while acknowledging the need for continued advances in urolithiasis.","PeriodicalId":12223,"journal":{"name":"European urology","volume":"12 1","pages":""},"PeriodicalIF":23.4,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143862277","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}