European urology最新文献

{"title":"Pelvic Lymph Node Dissection in Prostate Cancer: Evidence and Implications","authors":"Matthew J. Roberts, Giorgio Gandaglia, Daniela E. Oprea-Lager, Johan Stranne, Philip Cornford, Derya Tilki","doi":"10.1016/j.eururo.2025.03.004","DOIUrl":"https://doi.org/10.1016/j.eururo.2025.03.004","url":null,"abstract":"<h2>Section snippets</h2><section><section><h2>Why perform pelvic lymph node dissection?</h2>Pelvic lymph node dissection (PLND) performed during radical prostatectomy (RP) has been recommended for many years by international guidelines, including previous editions of the EAU-EANM-ESTRO-ESUR-ISUP-SIOG guidelines, for staging purposes and a potential oncological benefit. An extended PLND (ePLND) template detects more metastases than a standard template and so is recommended by the guidelines when PLND is deemed necessary. ePLND staging information can ideally assist with postoperative</section></section><section><section><h2>Patient selection for PLND</h2>Validated nomograms based on preoperative information have been used to individualise patient selection for ePLND for more than 20 yr to overcome the limitations of conventional imaging (CT, magnetic resonance imaging [MRI]) in terms of sensitivity. Different nomogram cutoffs have been proposed to maximise capture of patients who are likely to have pN1 disease while trying to avoid routine PLND in all patients. Historically, nomogram cutoff ranges of 5–7% were proposed and could result in</section></section><section><section><h2>The 2024 EAU-EANM-ESTRO-ESUR-ISUP-SIOG Guidelines Panel position</h2>The prior “strong” recommendation to perform ePLND because of its ability to accurately stage disease was revisited following review of the available evidence and consideration of risk/benefit ratio. The change in recommendation in 2024 was driven in part by the decision to recommend PSMA PET for staging assessment of patients before treatment. PSMA PET/CT is highly specific but with a negative predictive value of approximately 80% [9], [10], where most of missed metastases are low volume</section></section>","PeriodicalId":12223,"journal":{"name":"European urology","volume":"1 1","pages":""},"PeriodicalIF":23.4,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143789944","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":"A Comprehensive Systematic Review and Meta-analysis of the Role of Prostate-specific Membrane Antigen Positron Emission Tomography for Prostate Cancer Diagnosis and Primary Staging before Definitive Treatment","authors":"Elio Mazzone, Donato Cannoletta, Leonardo Quarta, David C. Chen, Alice Thomson, Francesco Barletta, Armando Stabile, Daniel Moon, Renu Eapen, Nathan Lawrentschuk, Francesco Montorsi, Shankar Siva, Michael S. Hofman, Arturo Chiti, Declan G. Murphy, Alberto Briganti, Marlon L. Perera","doi":"10.1016/j.eururo.2025.03.003","DOIUrl":"https://doi.org/10.1016/j.eururo.2025.03.003","url":null,"abstract":"&lt;h3&gt;Background and objective&lt;/h3&gt;Positron emission tomography (PET) with prostate-specific membrane antigen (PSMA) in the diagnosis and primary staging of patients with prostate cancer (PCa) has an established role, but recent summative evidence on its actual diagnostic and staging value is still missing. We aimed to collect and analyze published studies reporting the accuracy of PSMA PET for the diagnosis of clinically significant prostate cancer (csPCa) and detection of distant metastases at primary staging before definitive treatment.&lt;h3&gt;Methods&lt;/h3&gt;We performed a systematic review of the literature, by searching the PubMed/MEDLINE, Cochrane library’s CENTRAL, EMBASE, and Scopus databases, from inception to April 2024. Two coprimary outcomes were assessed: first, to evaluate the sensitivity, specificity, positive (PPV) and negative (NPV) predictive values of PSMA PET in detecting intraprostatic csPCa on a per-patient level, and second, to assess the positivity rates of metastatic disease in the primary staging, prior to definitive therapy. As a secondary outcome, the diagnostic accuracy of PET PSMA for the detection of lymph nodal invasion (LNI) was tested in a per-patient–level analysis of studies where pelvic lymph node dissection (PLND) was available as the reference standard. Positivity and detection rates were pooled using random-effect models. Preplanned subgroup analyses tested the diagnostic accuracy of PET PSMA across different study cohorts. Variation in PPV and NPV over csPCa and LNI prevalence was evaluated.&lt;h3&gt;Key findings and limitations&lt;/h3&gt;In total, 12 and 99 studies, with a total of 1533 and 18 649 participants, respectively, were included in the quantitative synthesis for intraprostatic diagnosis and staging. For intraprostatic disease, the sensitivity, specificity, PPV, and NPV of PSMA PET for csPCa were 82% (95% confidence interval [CI] 73–90%), 67% (95% CI 46–85%), 77% (95% CI 63–88%), and 73% (95% CI 56–87%), respectively. At a bivariate analysis, the diagnostic accuracy of PSMA PET estimated through a summary receiver operating characteristic curve–derived area under the curve was 84%, increasing up to 88% when combined with magnetic resonance imaging (MRI). On staging level, PSMA PET results were positive outside the prostate in 23% of the patients, with substantial variation in positivity rates between high-risk (31%) and intermediate-risk (12%) subcohorts. When using PLND as the reference standard (51 studies, 7713 patients), the sensitivity, specificity, PPV, and NPV of PSMA PET were, respectively, 54%, 94%, 77%, and 86%. With higher csPCa and LNI prevalence, a similar increase in PPV and a decrease in NPV were observed.&lt;h3&gt;Conclusions and clinical implications&lt;/h3&gt;The current updated systematic review and meta-analysis provides updated evidence on the diagnostic and staging accuracy of PSMA PET in PCa. We reported good accuracy of PSMA PET to discriminate csPCa, particularly when added to MRI, but NPV alone is insuf","PeriodicalId":12223,"journal":{"name":"European urology","volume":"183 1","pages":""},"PeriodicalIF":23.4,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143723651","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: Andreas Josefsson, Marianne Månsson, Kimia Kohestani, et al. Performance of 4Kscore as a Reflex Test to Prostate-specific Antigen in the GÖTEBORG-2 Prostate Cancer Screening Trial. Eur Urol 2024;86:223–9","authors":"Francesco Montorsi, Giorgio Gandaglia, Francesco Barletta, Alberto Briganti","doi":"10.1016/j.eururo.2025.01.029","DOIUrl":"https://doi.org/10.1016/j.eururo.2025.01.029","url":null,"abstract":"No Abstract","PeriodicalId":12223,"journal":{"name":"European urology","volume":"183 1","pages":""},"PeriodicalIF":23.4,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143713475","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":"Towards Epigenetic-based Subtyping of Bladder Cancer: DNA Methylation Predicts Molecular Subtypes of Non–muscle-invasive Bladder Cancer","authors":"Minghao Yu ,&nbsp;Anshita Goel ,&nbsp;Benjamin Tura ,&nbsp;Celina M. Whalley ,&nbsp;Kar Keung Cheng ,&nbsp;Maurice P. Zeegers ,&nbsp;Nicholas D. James ,&nbsp;Lars Dyrskjøt ,&nbsp;Douglas G. Ward ,&nbsp;Richard T. Bryan ,&nbsp;Roland Arnold","doi":"10.1016/j.eururo.2025.02.011","DOIUrl":"10.1016/j.eururo.2025.02.011","url":null,"abstract":"","PeriodicalId":12223,"journal":{"name":"European urology","volume":"87 5","pages":"Pages 579-581"},"PeriodicalIF":25.3,"publicationDate":"2025-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143675417","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 Importance of Precise Scientific Communication: Nonrandomized Trials Should Not Be Described as Phase 3, and Registrational-intent Trials Should Not Be Described as Phase 2","authors":"Brant A. Inman, Andrew J. Vickers","doi":"10.1016/j.eururo.2025.03.001","DOIUrl":"https://doi.org/10.1016/j.eururo.2025.03.001","url":null,"abstract":"No Abstract","PeriodicalId":12223,"journal":{"name":"European urology","volume":"22 1","pages":""},"PeriodicalIF":23.4,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143666380","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 Male Sexual and Reproductive Health: 2025 Update on Male Infertility","authors":"Suks Minhas ,&nbsp;Luca Boeri ,&nbsp;Paolo Capogrosso ,&nbsp;Andrea Cocci ,&nbsp;Giovanni Corona ,&nbsp;Marij Dinkelman-Smit ,&nbsp;Marco Falcone ,&nbsp;Christian Fuglesang Jensen ,&nbsp;Murat Gül ,&nbsp;Arif Kalkanli ,&nbsp;Ates Kadioğlu ,&nbsp;Juan I. Martinez-Salamanca ,&nbsp;L. Afonso Morgado ,&nbsp;Giorgio I. Russo ,&nbsp;Ege Can Serefoğlu ,&nbsp;Paolo Verze ,&nbsp;Andrea Salonia","doi":"10.1016/j.eururo.2025.02.026","DOIUrl":"10.1016/j.eururo.2025.02.026","url":null,"abstract":"<div><h3>Background and objective</h3><div>To present a summary of the updated 2025 European Association of Urology (EAU) Guidelines on Sexual and Reproductive Health (SRH) on male infertility, providing practical recommendations on the clinical work-up with a focus on diagnosis, treatment and follow-up.</div></div><div><h3>Methods</h3><div>For the 2025 SRH guidelines, new and relevant evidence was identified, collated, and appraised via a structured assessment of the literature. Databases searched included Medline, EMBASE, and the Cochrane Libraries. Recommendations within the guidelines were developed by the panel to prioritise clinically important care decisions. The strength of each recommendation was determined according to a balance between desirable and undesirable consequences of alternative management strategies, the quality of the evidence (including the certainty of estimates), and the nature and variability of patient values and preferences.</div></div><div><h3>Key findings and limitations</h3><div>Key recommendations emphasise the importance of a thorough urological assessment of all men seeking medical help for fertility problems to ensure appropriate treatment. The guidelines also stress the clinical relevance of a parallel investigation of the female partner during the diagnostic and management work-up of the infertile couple, to promote shared-decision making in terms of timing and therapeutic strategies. Furthermore, the guidelines recommend to counsel all infertile men and men with abnormal semen parameters on the associated health risks. Key changes in the male infertility guidelines for 2025 include: the addition of two new sections addressing exome sequencing and probiotic treatment; and significant update of the evidence base and recommendations for the diagnostic work-up of male infertility.</div></div><div><h3>Conclusions and clinical implications</h3><div>This overview of the 2025 SHR guidelines offers valuable insights into the diagnosis, classification, treatment and follow-up of male factor infertility and are designed for effective integration into clinical practice.</div></div>","PeriodicalId":12223,"journal":{"name":"European urology","volume":"87 5","pages":"Pages 601-616"},"PeriodicalIF":25.3,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143660313","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 Renal Cell Carcinoma: The 2025 Update","authors":"Axel Bex, Yasmin Abu Ghanem, Laurence Albiges, Stephanie Bonn, Riccardo Campi, Umberto Capitanio, Saeed Dabestani, Milan Hora, Tobias Klatte, Teele Kuusk, Lars Lund, Lorenzo Marconi, Carlotta Palumbo, Geraldine Pignot, Thomas Powles, Natasha Schouten, Maxine Tran, Alessandro Volpe, Jens Bedke","doi":"10.1016/j.eururo.2025.02.020","DOIUrl":"https://doi.org/10.1016/j.eururo.2025.02.020","url":null,"abstract":"<h3>Background and objective</h3>The European Association of Urology (EAU) renal cell carcinoma (RCC) guideline panel has updated their evidence-based guidelines and recommendations for the management of RCC. Here we present a summary of the 2025 RCC guidelines updated with standardised methodology to provide reproducible evidence for the management of RCC.<h3>Methods</h3>For the 2025 update, a literature search was performed covering the period from May 1, 2023 to May 1, 2024 using the Medline, EMBASE, and Cochrane Libraries. The data search focused on meta-analyses, systematic reviews, randomised controlled trials (RCTs), and retrospective or controlled comparator-arm studies. Evidence was synthesised as outlined for all EAU guidelines.<h3>Key findings and limitations</h3>Clinical practise recommendations were updated in all chapters of the RCC guidelines on the basis of a structured literature search. The studies included were predominantly retrospective with matched or unmatched cohorts based on single- or multi-institutional data. Several prospective studies and RCTs provided data that resulted in recommendations based on higher levels of evidence. Specifically, updates include new recommendations on stereotactic body radiotherapy for localised RCC, adjuvant therapy, systemic therapy for clear-cell RCC in later lines, other subtypes, and a new chapter on hereditary RCC.<h3>Conclusions and clinical implications</h3>The 2025 RCC guidelines have been updated by a multidisciplinary panel of experts using methodological standards to provide a contemporary evidence base for the management of RCC.","PeriodicalId":12223,"journal":{"name":"European urology","volume":"56 1","pages":""},"PeriodicalIF":23.4,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143660316","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 Upper Urinary Tract Urothelial Carcinoma: Summary of the 2025 Update","authors":"Alexandra Masson-Lecomte, Alison Birtle, Benjamin Pradere, Otakar Capoun, Eva Compérat, José L. Domínguez-Escrig, Fredrik Liedberg, Lydia Makaroff, Paramananthan Mariappan, Marco Moschini, Bhavan P. Rai, Bas W.G. van Rhijn, Shahrokh F. Shariat, Emma J. Smith, Jeremy Y.C. Teoh, Viktor Soukup, Robert Wood, Evanguelos N. Xylinas, Francesco Soria, Thomas Seisen, Paolo Gontero","doi":"10.1016/j.eururo.2025.02.023","DOIUrl":"https://doi.org/10.1016/j.eururo.2025.02.023","url":null,"abstract":"<h3>Background and objective</h3>We present a summary of the 2025 update for the European Association of Urology (EAU) guidelines for upper urinary tract urothelial carcinoma (UTUC). The aim is to provide practical recommendations on the clinical management of UTUC with a focus on diagnosis, treatment, and follow-up.<h3>Methods</h3>For the 2025 guidelines on UTUC, new and relevant evidence was identified, collated, and appraised via a structured assessment of the literature. Databases searched included Medline, EMBASE, and the Cochrane Libraries. Recommendations within the guidelines were developed by the panel to prioritise clinically important care decisions. The strength of each recommendation was determined according to a balance between desirable and undesirable consequences of alternative management strategies, the quality of the evidence (including the certainty of estimates), and the nature and variability of patient values and preferences.<h3>Key findings and limitations</h3>Key recommendations emphasise the importance of thorough diagnosis, treatment, and follow-up for patients with UTUC. The guidelines stress the importance of appropriate treatment taking into account patient values and preferences. Key updates in the 2025 UTUC guidelines include: significant changes to the recommendations for UTUC diagnosis; complete revision of the sections addressing risk stratification, ureteroscopy, and the surgical approach for radical nephroureterectomy; addition of four new recommendations, two related to kidney-sparing management of localised low-risk UTUC and a further two related to management of high-risk nonmetastatic UTUC; a review and adaptation of recommendation for UTUC follow-up; and addition of a new section addressing quality indicators for UTUC management.<h3>Conclusions and clinical implications</h3>This overview of the 2025 EAU guidelines on UTUC offers valuable insights into risk factors, diagnosis, classification, treatment, and follow-up for UTUC. The guidelines contain information on the management of individual patients according to the current best evidence and are designed for effective integration in clinical practice.","PeriodicalId":12223,"journal":{"name":"European urology","volume":"61 1","pages":""},"PeriodicalIF":23.4,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143660315","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-European Society of Paediatric Urology Guidelines on Paediatric Urology: Summary of 2024 Updates. Part II","authors":"Martin Skott, Uchenna Kennedy, Michele Gnech, Allon van Uitert, Anna Bujons, Lisette ’t Hoen, Yazan F. Rawashdeh, Mesrur Selcuk Silay, Fardod O’Kelly, Josine Quaedackers, Niklas Pakkasjärvi, Yuhong Yuan, Berk Burgu, Marco Castagnetti, Guy Bogaert, Christian Radmayr","doi":"10.1016/j.eururo.2025.02.022","DOIUrl":"https://doi.org/10.1016/j.eururo.2025.02.022","url":null,"abstract":"<h3>Background and objective</h3>We present a summary of part II of the 2024 update of the European Association of Urology (EAU)/European Society of Paediatric Urology (ESPU) guidelines on paediatric urology. The summary provides evidence-based standards for management of a number of urological conditions in the paediatric population. The aim is to provide practical recommendations for clinical management of these conditions with a focus on diagnosis, treatment, and follow-up.<h3>Methods</h3>For the guidelines update, new and relevant evidence was identified, collated, and appraised via a structured assessment of the literature. Databases searched included Medline, EMBASE, and the Cochrane Libraries. Recommendations in the guidelines were developed by the panel to prioritise clinically important care decisions. The strength of each recommendation was determined according to a balance between desirable and undesirable consequences of alternative management strategies, the quality of the evidence (including the certainty of estimates), and the nature and variability of patient values and preferences.<h3>Key findings and limitations</h3>Key recommendations emphasise the importance of thorough diagnosis, treatment, and follow-up for patients with the conditions outlines. The guidelines stress the importance of a multidisciplinary approach to treatment and the importance of shared decision-making with patients and their guardians/caregivers. The summary provides evidence-based standards for management of undescended testes, testicular tumours in prepubertal boys, acute scrotum, hypospadias, congenital penile curvature, urinary tract infections, daytime lower urinary tract conditions, urachal remnants, and transitional urology.<h3>Conclusions and clinical implications</h3>Part II of the 2024 EAU/ESPU guidelines provides updated guidance for evidence-based management of a number of paediatric urological conditions, with recommendations designed for effective integration into clinical practice.","PeriodicalId":12223,"journal":{"name":"European urology","volume":"29 1","pages":""},"PeriodicalIF":23.4,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143660351","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 Muscle-invasive and Metastatic Bladder Cancer: Summary of the 2025 Guidelines","authors":"Antoine G. van der Heijden ,&nbsp;Harman Max Bruins ,&nbsp;Albert Carrion ,&nbsp;Richard Cathomas ,&nbsp;Eva Compérat ,&nbsp;Konstantinos Dimitropoulos ,&nbsp;Jason A. Efstathiou ,&nbsp;Rainer Fietkau ,&nbsp;Mithun Kailavasan ,&nbsp;Anja Lorch ,&nbsp;Alberto Martini ,&nbsp;Laura S. Mertens ,&nbsp;Richard P. Meijer ,&nbsp;Param Mariappan ,&nbsp;Matthew I. Milowsky ,&nbsp;Yann Neuzillet ,&nbsp;Valeria Panebianco ,&nbsp;Sæbjørn Sæbjørnsen ,&nbsp;Emma J. Smith ,&nbsp;George N. Thalmann ,&nbsp;Michael Rink","doi":"10.1016/j.eururo.2025.02.019","DOIUrl":"10.1016/j.eururo.2025.02.019","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background and objective&lt;/h3&gt;&lt;div&gt;This publication represents a summary of the updated 2025 European Association of Urology (EAU) guidelines for muscle-invasive and metastatic bladder cancer (MMIBC). The aim is to provide practical recommendations on the clinical management of MMIBC with a focus on diagnosis, treatment, and follow-up.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;For the 2025 guidelines, new and relevant evidence was identified, collated, and appraised via a structured assessment of the literature. Databases searched included Medline, EMBASE, and the Cochrane Libraries. Recommendations within the guidelines were developed by the panel to prioritise clinically important care decisions. The strength of each recommendation was determined according to a balance between desirable and undesirable consequences of alternative management strategies, the quality of the evidence (including the certainty of estimates), and the nature and variability of patient values and preferences.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Key findings and limitations&lt;/h3&gt;&lt;div&gt;The key recommendations emphasise the importance of thorough diagnosis, treatment, and follow-up for patients with MMIBC. The guidelines stress the importance of a multidisciplinary approach to the treatment of MMIBC patients and the importance of shared decision-making with patients. The key changes in the 2025 muscle-invasive bladder cancer (MIBC) guidelines include the following: a new recommendation for the use of susceptible FGFR3 alterations to select patients with unresectable or metastatic urothelial carcinoma for treatment with erdafitinib; significant adaption and update of the recommendations for pre- and postoperative radiotherapy and sexual organ–preserving techniques in women; new recommendation related to radical cystectomy and extent of lymph node dissection based on the results of the SWOG trial; recommendation related to hospital volume; new recommendations for salvage cystectomy after trimodality therapy and for the management of all patients who are candidates for trimodality bladder-preserving treatment in a multidisciplinary team setting using a shared decision-making process; significant adaption and update to the recommendation for adjuvant nivolumab in selected patients with pT3/4 and/or pN+ disease not eligible for, or who declined, adjuvant cisplatin-based chemotherapy; and addition of a new recommendation for metastatic disease regarding the antibody-drug conjugate trastuzumab deruxtecan in case of HER2 overexpression; in addition, removal of the recommendations on sacituzumab govitecan as the manufacturer has withdrawn the US Food and Drug Administration approval for this product; update of the follow-up of MIBC; and full update of the management algorithms of MIBC.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions and clinical implications&lt;/h3&gt;&lt;div&gt;This overview of the 2025 EAU guidelines offers valuable insights into risk factors, diagnosis, classification, treatment, and follow-up of MIBC pa","PeriodicalId":12223,"journal":{"name":"European urology","volume":"87 5","pages":"Pages 582-600"},"PeriodicalIF":25.3,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143660314","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}