European urology最新文献

{"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}

{"title":"Re: [177Lu]Lu-PSMA-617 plus Enzalutamide in Patients with Metastatic Castration-resistant Prostate Cancer (ENZA-p): An Open-label, Multicentre, Randomised, Phase 2 Trial","authors":"Juan Gómez Rivas, Jesús Moreno Sierra","doi":"10.1016/j.eururo.2025.04.006","DOIUrl":"https://doi.org/10.1016/j.eururo.2025.04.006","url":null,"abstract":"No Abstract","PeriodicalId":12223,"journal":{"name":"European urology","volume":"1 1","pages":""},"PeriodicalIF":23.4,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143862282","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":"Robot-assisted Single-docking Approach for Level III Inferior Vena Cava Tumor Thrombectomy: Surgical Technique and Outcomes","authors":"Shengzheng Wang, Gaurab Pokhrel, Jinshan Cui, Shuanbao Yu, Yafeng Fan, Zhaowei Zhu, Jin Tao, Xuepei Zhang","doi":"10.1016/j.eururo.2025.04.001","DOIUrl":"https://doi.org/10.1016/j.eururo.2025.04.001","url":null,"abstract":"<h3>Background and objective</h3>Robot-assisted tumor thrombectomy (RATT) for level III inferior vena cava (IVC) tumor thrombus is an emerging but complex approach with limited reports. Variability in docking strategies, renal artery management, surgical exposure, and vascular control complicates adoption. We evaluated the safety, feasibility, and outcomes of RATT for level III IVC using a single-docking technique.<h3>Methods</h3>This retrospective study included 15 patients who underwent RATT for level III IVC tumor thrombus at a tertiary center between 2019 and 2023. A novel strategy, including early division of the renal artery, IVC control, and tumor thrombectomy, was completed robotically without redocking. Distal repositioning of the IVC clamp was carried out when indicated. Median follow-up was 24 mo. Exclusion criteria were unresectable metastasis and severe comorbidities.<h3>Key findings and limitations</h3>All surgeries were successfully completed using a single-docking technique. The median operative time was 225 min (range 140–375), and median blood loss was 400 ml (range: 200–2000). Twelve patients (80%) required intraoperative transfusions. The median IVC occlusion time was 14 min (range 8–25). Segmental IVC resection was performed in seven patients, with angioplasty reconstruction in two cases. Complications occurred in 73.3% (11/15), including three Clavien-Dindo grade IIIb events. At median follow-up of 24 mo, five patients had died and one had developed liver metastasis. Limitations include the small cohort size and the single-surgeon experience.<h3>Conclusions and clinical implications</h3>Single-docking RATT for level III IVC tumor thrombus is a feasible and reproducible technique. Standardization of key surgical steps enhances procedural efficiency and addresses challenges in vascular control. This technique offers a viable alternative to multistage procedures in selected cases. Further validation with extended follow-up in multicenter studies is required.","PeriodicalId":12223,"journal":{"name":"European urology","volume":"43 1","pages":""},"PeriodicalIF":23.4,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143857824","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 Systematic Review of Novel Intravesical Approaches for the Treatment of Patients with Non–muscle-invasive Bladder Cancer","authors":"Saum Ghodoussipour, Trinity Bivalacqua, Richard T. Bryan, Roger Li, M. Carmen Mir, Joan Palou, Sarah P. Psutka, Debasish Sundi, Mark D. Tyson, Brant A. Inman","doi":"10.1016/j.eururo.2025.02.010","DOIUrl":"https://doi.org/10.1016/j.eururo.2025.02.010","url":null,"abstract":"<h3>Background and objective</h3>Intravesical therapy is central to managing non–muscle-invasive bladder cancer (NMIBC); yet, recurrence and progression remain common, underscoring the need for new treatments. This systematic review evaluates clinical trials of novel intravesical therapies for all risk categories of NMIBC.<h3>Methods</h3>A comprehensive literature search was conducted to identify the clinical trials assessing the effectiveness, safety, and tolerability of intravesical therapies for NMIBC. The search focused on studies published from 2020 to 2024, including trials on bacillus Calmette-Guérin (BCG)-unresponsive/refractory disease as well as on BCG-naïve and intermediate-risk patients. Mechanisms of action and drug delivery methods were summarized. No statistical syntheses were performed due to limited comparative data.<h3>Key findings and limitations</h3>Out of 2998 studies identified, 36 reported on efficacy and safety, and six provided patient-reported outcomes (PROs). Intravesical therapies included BCG-based therapies, chemotherapy combinations, chemical-drug conjugates, thermogels, hyperthermic chemotherapy, osmotic pumps, and gene therapy. Initial response rates ranged from 42% to 85% for BCG-unresponsive/refractory patients and from 65% to 100% for treatment-naïve patients. The 12-mo recurrence-free survival rates ranged from 22% to 83% and 39% to 92%, respectively. Progression and severe toxicity (grade ≥3) were rare (0–17% and 0–20%, respectively). PROs were stable. The limitations included early-phase studies, heterogeneous outcome assessments, and a need for research on long-term durability, comparative effectiveness, quality of life, and cost.<h3>Conclusions and clinical implications</h3>This systematic review highlights the promising efficacy and tolerability of novel intravesical therapies for NMIBC. However, further research is needed to refine treatment strategies and assess long-term outcomes, quality of life, and economic factors. Future studies should include multiarm, multistage designs with a focus on patient-centered outcomes.","PeriodicalId":12223,"journal":{"name":"European urology","volume":"23 1","pages":""},"PeriodicalIF":23.4,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143849391","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":"Renal Neoplasia in Birt-Hogg-Dubé Syndrome: Integrated Histopathologic, Bulk, and Single-cell Transcriptomic Analysis","authors":"Sounak Gupta, Surendra Dasari, Rachel R. Warren, Wei Shen, Rhianna M. Urban, Melissa L. Stanton, Christine M. Lohse, Megan A. Holdren, Megan F. Hoenig, Beth A. Pitel, Stephanie A. Smoley, Stefan W. Nelson, Nate R. Torell, Autumn C. Moon, Leah M. Nelson, Joaquin J. Garcia, Peter C. Lucas, Kevin C. Halling, Benjamin R. Kipp, Stephen A. Boorjian, Bradley C. Leibovich","doi":"10.1016/j.eururo.2025.03.012","DOIUrl":"https://doi.org/10.1016/j.eururo.2025.03.012","url":null,"abstract":"<h3>Background and objective</h3>It is unclear whether historically diagnosed “hybrid tumors” in patients with Birt-Hogg-Dubé syndrome (BHD) represent unique tumors or a hybrid between oncocytoma and chromophobe renal cell carcinoma (Ch-RCC), and existing diagnostic criteria are ambiguous. We aimed to understand the spectrum of <em>folliculin</em> gene (<em>FLCN)</em> alterations, outcomes for BHD patients with kidney tumors, and the biology of <em>FLCN</em>-mutated tumors (FMTs) to refine diagnostic algorithms.<h3>Methods</h3>Germline testing for <em>FLCN</em> alterations and outcomes for 20 BHD patients with 84 kidney tumors were evaluated. Renal tumors were profiled for histopathology and analyzed using a combination of next-generation sequencing, bulk/single-cell transcriptomic analysis, and immunohistochemistry (IHC).<h3>Key findings and limitations</h3>Ninety unique germline <em>FLCN</em> variants in 234 unrelated families included rare deletion events (14/234, 6%), including those of the promoter region. Most patients (17/19, 90%) met the National Comprehensive Cancer Network criteria for germline testing. Almost all cases represented indolent FMTs (<em>n</em> = 81), with metastases seen in two (of three) nonconventional renal cell carcinoma patients. FMTs showed a gene expression profile distinct from both oncocytoma and Ch-RCC characterized by four distinct <em>L1CAM</em>^–/<em>FOXI1</em>⁺ and two <em>L1CAM</em>⁺/<em>FOXI1</em>^– cell populations that showed <em>GPNMB</em> overexpression. IHC panels that include L1CAM, SOX9, and GPNMB can be a reliable screen for conventional FMTs. Limitations include the absence of external transcriptomic datasets to avoid batch effects.<h3>Conclusions and clinical implications</h3>Our results highlight the gaps in current clinical germline testing strategies for BHD, which should include promoter deletion events. Multimodal molecular profiling results can be translated into routine clinical practice using IHC biomarkers to improve the diagnosis of BHD and to separate indolent “conventional” FMTs from “nonconventional tumors,” which may be clinically aggressive.","PeriodicalId":12223,"journal":{"name":"European urology","volume":"64 1","pages":""},"PeriodicalIF":23.4,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143849462","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: Adjuvant Pembrolizumab versus Observation in Muscle-invasive Urothelial Carcinoma","authors":"Khrishanthne Sambasivan, Natasha Chaudhury, Sola Adeleke","doi":"10.1016/j.eururo.2025.04.005","DOIUrl":"https://doi.org/10.1016/j.eururo.2025.04.005","url":null,"abstract":"No Abstract","PeriodicalId":12223,"journal":{"name":"European urology","volume":"67 1","pages":""},"PeriodicalIF":23.4,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143841296","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: Determinants of Late Metastases in Renal Cell Carcinoma","authors":"Ziyang Xu, Wenbin Jiang, Youqi Qiu, Li Liu, Jianming Guo","doi":"10.1016/j.eururo.2025.04.004","DOIUrl":"https://doi.org/10.1016/j.eururo.2025.04.004","url":null,"abstract":"No Abstract","PeriodicalId":12223,"journal":{"name":"European urology","volume":"68 1","pages":""},"PeriodicalIF":23.4,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143841297","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: Johann S. de Bono, Meng He, Chen Shi, et al. Final Overall Survival and Molecular Data Associated with Clinical Outcomes in Patients Receiving Ipatasertib and Abiraterone in the Phase 3 IPATential150 Trial. Eur Urol. In press. https://doi.org/10.1016/j.eururo.2024.12.015","authors":"Felix Melchior, Andreas Pircher, Isabel Heidegger","doi":"10.1016/j.eururo.2025.02.031","DOIUrl":"https://doi.org/10.1016/j.eururo.2025.02.031","url":null,"abstract":"No Abstract","PeriodicalId":12223,"journal":{"name":"European urology","volume":"26 1","pages":""},"PeriodicalIF":23.4,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143837507","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}