European Urology Open Science最新文献

{"title":"Ultralow Prostate-specific Antigen Nadir After Apalutamide: Outcomes in Synchronous Versus Metachronous Metastatic Hormone-sensitive Prostate Cancer","authors":"Mike Wenzel ,&nbsp;Thomas Steuber ,&nbsp;Carolin Siech ,&nbsp;Maximilian Kriegmair ,&nbsp;Benedikt Hoeh ,&nbsp;Derya Tilki ,&nbsp;Axel S. Merseburger ,&nbsp;Felix K.H. Chun ,&nbsp;Philipp Mandel","doi":"10.1016/j.euros.2025.05.001","DOIUrl":"10.1016/j.euros.2025.05.001","url":null,"abstract":"<div><div>As an ultralow prostate-specific antigen (PSA) nadir (≤0.02 ng/ml) after apalutamide treatment for metastatic hormone-sensitive prostate cancer (mHSPC) was associated with the best oncological outcomes, the question arises as to whether this holds true for both synchronous and metachronous mHSPC. We addressed this knowledge gap using data from the FRAMCAP (Frankfurt Metastatic Cancer of the Prostate) database. In a cohort of 75 patients with synchronous mHSPC treated with apalutamide, 35% experienced a PSA decline to ≤0.02 ng/ml. Analysis of time to castration-resistant prostate cancer (CRPC) and overall survival (OS) revealed significant differences by PSA nadir category (<em>p</em> &lt; 0.01). In a cohort of 33 patients with metachronous mHSPC treated with apalutamide, 52% experienced a PSA decline to ≤0.02 ng/ml. Analysis of CRPC revealed significant differences by PSA nadir category (<em>p</em> = 0.02). Although there were no significant differences in OS among the PSA nadir categories (<em>p</em> = 0.3), the best numerical OS outcome was observed for PSA ≤0.02 ng/ml. For the overall group of patients achieving PSA ≤0.02 ng/ml, there were no significant difference in time to CRPC and OS between synchronous and metachronous mHSPC.</div></div><div><h3>Patient summary</h3><div>Apalutamide is a drug for treatment of metastatic prostate cancer that is sensitive to hormone treatment. We found that a decrease in PSA (prostate-specific antigen) to a very low level of ≤0.02 ng/ml after apalutamide treatment can predict good cancer control. This applies to patients with metastasis when they are first diagnosed and to patients who develop metastasis after their diagnosis of prostate cancer. This level of ≤0.02 ng/ml can be used in discussing prognosis and treatment options with these patients.</div></div>","PeriodicalId":12254,"journal":{"name":"European Urology Open Science","volume":"77 ","pages":"Pages 19-22"},"PeriodicalIF":3.2,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144196444","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical and Genomic Landscape of FGFR3 Alterations Across Different Stages of Urothelial Cancer","authors":"Maximilian Haas ,&nbsp;Roman Mayr ,&nbsp;Danijel Sikic ,&nbsp;Bernd Wullich ,&nbsp;Niklas Klümper ,&nbsp;Philipp Erben ,&nbsp;Ralph Wirtz ,&nbsp;Christian Bolenz ,&nbsp;Florian Roghmann ,&nbsp;Robert Stöhr ,&nbsp;Veronika Bahlinger ,&nbsp;Arndt Hartmann ,&nbsp;Maximilian Burger ,&nbsp;Johannes Breyer ,&nbsp;Markus Eckstein ,&nbsp;BRIDGE Consortium e.V","doi":"10.1016/j.euros.2025.04.005","DOIUrl":"10.1016/j.euros.2025.04.005","url":null,"abstract":"<div><h3>Background and objective</h3><div>Our aim was to provide a comprehensive analysis of the prevalence of potentially targetable activating <em>FGFR3</em> alterations and their impact on oncological outcomes across different urothelial carcinoma (UC) stages.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed clinical data and <em>FGFR3</em> results for 1509 formalin-fixed, paraffin-embedded tissue specimens. Actionable activating <em>FGFR3</em> mutations were assessed using a well-established multiplex SNaPshot polymerase chain reaction approach. <em>FGFR3</em> fusion testing was performed with a Qiagen Therascreen kit.</div></div><div><h3>Key findings and limitations</h3><div>In the study population of 1509 patients, 202 (13%) had stage pTa, 380 (25%) had stage pT1, 258 (17%) had localized muscle-invasive bladder cancer (MIBC), 556 (37%) had locally advanced MIBC, 91 (6.0%) had metastatic UC of the bladder (mUCB), and 22 (1.5%) had metastatic upper tract UC (mUTUC). Of the <em>FGFR3</em> alterations detected in 373 patients (25%), 104 (52%) were in stage pTa, 158 (42%) were in pT1, 42 (16%) were in localized MIBC, 53 (9.5%) were in locally advanced MIBC, nine (9.9%) were in mUCB, and seven (32%) were in mUTUC. <em>FGFR3</em> alterations were associated with better progression-free survival and overall survival in the overall population (<em>p</em> &lt; 0.001), but not in subgroup analyses for different disease stages. Study limitations include the retrospective design and heterogeneous patient cohort.</div></div><div><h3>Conclusions and clinical implications</h3><div><em>FGFR3</em> alterations occur at a stage-dependent frequency and are more prevalent in lower tumor stages. We were unable to demonstrate an independent prognostic effect of <em>FGFR3</em> alterations on oncological outcomes after adjusting for tumor stage.</div></div><div><h3>Patient summary</h3><div>We analyzed a protein called fibroblast growth factor receptor 3 (FGFR3) in patients with cancer of the urinary tract. We found that more aggressive tumors had fewer genetic changes in FGFR3 in comparison to less aggressive tumors. However, genetic changes in FGFR3 were not related to survival for these patients.</div></div>","PeriodicalId":12254,"journal":{"name":"European Urology Open Science","volume":"77 ","pages":"Pages 1-9"},"PeriodicalIF":3.2,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144178205","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ureteroscopy for Urolithiasis in Pregnancy: Outcomes of a Multicentre Study on Behalf of the European Association of Urology Section of Endourology","authors":"Patrick Juliebø-Jones ,&nbsp;Vineet Gauhar ,&nbsp;Smita De ,&nbsp;Øyvind Ulvik ,&nbsp;Yiloren Tanidir ,&nbsp;Nebil Akdogan ,&nbsp;Cemil Aydi ,&nbsp;Pablo Contreras ,&nbsp;Maria Florencia Frascheri ,&nbsp;Javier Pizzarello ,&nbsp;Deepak Ragoori ,&nbsp;Lazaros Tzelves ,&nbsp;Peder Gjengstø ,&nbsp;Mathias Sørstrand Æsøy ,&nbsp;Albert El Hajj ,&nbsp;Elsayed Desouky ,&nbsp;Alejandro Bautista-Perez-Gavilan ,&nbsp;Vigen Malkhasyan ,&nbsp;Olivier Traxer ,&nbsp;Christian Beisland ,&nbsp;Bhaskar K. Somani","doi":"10.1016/j.euros.2025.05.003","DOIUrl":"10.1016/j.euros.2025.05.003","url":null,"abstract":"<div><h3>Background and objective</h3><div>In patients with stone disease during pregnancy, surgical management in the form of ureteroscopy (URS) can be indicated. However, there remains a relatively limited pool of published data. The objective was to perform a multicentre and international study evaluating the safety and outcomes of URS in pregnancy.</div></div><div><h3>Methods</h3><div>A retrospective study was performed across 12 tertiary endourology centres for patients undergoing URS during pregnancy over the past 10 yr. Data were collected on demographics, diagnostic imaging, operative findings, and intra- and postoperative complications. Follow-up data on stone-free rate (SFR) and pregnancy outcomes were also obtained.</div></div><div><h3>Key findings and limitations</h3><div>A total of 146 females underwent URS, and the median age was 28 yr (interquartile range [IQR] 24–32). The majority were in the 2nd trimester (58%), were not presented (74%), and had the surgery performed by an endourologist (81%). Ultrasound was the most popular diagnostic imaging modality. Anaesthesia type was as follows: general (62%), spinal (23%), and sedation (15%). The negative URS rate was 48%. The median operative time was 35 min (IQR 35–45), and 77% were discharged within 24 h. The early and late complication rates were 11% and 2.8%, respectively. Regarding the former, there were two intensive care admissions (Clavien IV). In patients in whom a stone was found at URS, the SFR in terms of zero fragments was 65% and it was 78% for residual fragments of ≤2 mm based on postpartum imaging follow-up.</div></div><div><h3>Conclusions and clinical implications</h3><div>In the setting of a tertiary centre, URS can be performed safely during pregnancy with a low risk of major complications. Future studies are needed to investigate how the diagnostic algorithm can be improved to result in a lower rate of negative URS.</div></div><div><h3>Patient summary</h3><div>Managing kidney disease in pregnancy is recognised to be challenging as the surgeon must deliver safe care for both the mother and the unborn child. This is even more so the case when surgery to remove a stone is indicated. This study found that performing surgery using a method called ureteroscopy is safe, but it is recommended to be performed in an expert centre.</div></div>","PeriodicalId":12254,"journal":{"name":"European Urology Open Science","volume":"76 ","pages":"Pages 65-70"},"PeriodicalIF":3.2,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144124088","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Re: Ben-Max de Ruiter, Jan E. Freund, C. Dilara Savci-Heijink, et al. Prospective Analysis of Confocal Laser Endomicroscopy for Assessment of the Resection Bed for Bladder Tumor. Eur Urol Open Sci 2025;71:57–62","authors":"Roberto Contieri,&nbsp;Giovanni Lughezzani,&nbsp;Alessandro Uleri","doi":"10.1016/j.euros.2025.03.019","DOIUrl":"10.1016/j.euros.2025.03.019","url":null,"abstract":"","PeriodicalId":12254,"journal":{"name":"European Urology Open Science","volume":"76 ","pages":"Pages 56-57"},"PeriodicalIF":3.2,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144089510","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Virtual Interactive 3D Modeling to Improve Outcomes in Robot-Assisted Partial Nephrectomy: Clinical Trial Protocol for the Multicenter, Randomized 3DPN Study","authors":"Sigrun Holze ,&nbsp;Clara Steiner ,&nbsp;Anja Dietel ,&nbsp;Toni Franz ,&nbsp;Phuc Ho Thi ,&nbsp;Nicole Köppe-Bauernfeind ,&nbsp;Miroslav Bačák ,&nbsp;Meinhard Mende ,&nbsp;Jens-Uwe Stolzenburg","doi":"10.1016/j.euros.2025.04.004","DOIUrl":"10.1016/j.euros.2025.04.004","url":null,"abstract":"<div><div>3DPN is a prospective, multicenter, randomized, controlled, two-armed open trial with planned recruitment of 370 patients in ten centers over a period of 24 mo. The trial is evaluating the value of virtual interactive 3D modeling for robot-assisted partial nephrectomy (RAPN) by assessing clinical outcomes, patient understanding, and surgeon confidence. Patients aged ≥18 yr with kidney tumors ≤7 cm who have contrast-enhanced computed tomography (CT) scans available and for whom RAPN with a da Vinci Surgical System is planned are eligible for the study. Using 1:1 randomization, patients are assigned to either the 3D model–based RAPN arm or the 2D CT scan–based RAPN arm.</div><div>This trial is registered on ClinicalTrials.gov as NCT06056505.</div></div>","PeriodicalId":12254,"journal":{"name":"European Urology Open Science","volume":"76 ","pages":"Pages 58-64"},"PeriodicalIF":3.2,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144089511","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Harnessing Advanced Imaging Technologies in Robotic Urological Surgery Requires Specialized and Structured Training","authors":"Enrico Checcucci ,&nbsp;Stefano Puliatti ,&nbsp;Gabriele Volpi ,&nbsp;Gabriele Bignante ,&nbsp;Francesco Porpiglia ,&nbsp;Riccardo Campi ,&nbsp;Daniele Amparore","doi":"10.1016/j.euros.2025.04.006","DOIUrl":"10.1016/j.euros.2025.04.006","url":null,"abstract":"<div><div>In recent years, the integration of advanced technologies in surgery has transformed health care, with urology consistently pioneering these innovations. Unlike the structured drug development process, surgical advancements follow a distinct pathway, exemplified by the Innovation, Development, Exploration, Assessment, and Long-term follow-up (IDEAL) framework, which supports safe, evidence-based innovation. Complementary technologies, including three-dimensional (3D) models and augmented reality (AR), have emerged as transformative tools in robotic urological surgery, particularly for complex cases. These technologies enhance surgical planning, intraoperative navigation, and postoperative outcomes, especially in kidney and prostate cancer surgeries. Despite growing adoption, structured training programs tailored to 3D and AR applications remain underdeveloped. To address this gap, we conducted an online survey of participants from the 12th Techno Urology Meeting (2024) to evaluate the current use and training needs for these technologies. Among 126 respondents, the majority utilized 3D models (64.5%) and AR (40.3%) in clinical practice, highlighting their role in robotic partial nephrectomy and radical prostatectomy. Respondents overwhelmingly emphasized the need for dedicated multidisciplinary courses with hands-on training and proficiency-based progression methodologies. This study underscores the necessity of structured, technology-specific training to maximize the potential of 3D models and AR in robotic urology, offering critical insights for advancing surgical education and improving patient care outcomes.</div></div><div><h3>Patient summary</h3><div>This study highlights the increasing integration of advanced technologies such as three-dimensional models and augmented reality in urological surgery, and emphasizes the growing demand for proper training to maximize their potential. While demonstration of their direct impact on surgical precision and outcomes would require a different study design, this analysis primarily underscores the need to establish comprehensive training programs to ensure safer and more effective care for patients.</div></div>","PeriodicalId":12254,"journal":{"name":"European Urology Open Science","volume":"76 ","pages":"Pages 51-55"},"PeriodicalIF":3.2,"publicationDate":"2025-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143928243","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Strategies and Techniques for Ileourethral Approximation During Robotic Intracorporeal Neobladder Reconstruction: An International Survey and Video Collection, in Collaboration with the European Association of Urology Robotic Urology Section Scientific Working Group","authors":"Maria Chiara Sighinolfi ,&nbsp;Simone Assumma ,&nbsp;Peter Wiklund ,&nbsp;Richard Gaston ,&nbsp;Andrea Minervini ,&nbsp;Alex Mottrie ,&nbsp;Reza Mehrazin ,&nbsp;Abdullah Erdem Canda ,&nbsp;Enrico Panio ,&nbsp;Filippo Gavi ,&nbsp;Luca Sarchi ,&nbsp;Tommaso Calcagnile ,&nbsp;Filippo Turri ,&nbsp;Fabrizio Di Maida ,&nbsp;Luca Lambertini ,&nbsp;Hubert Jhon ,&nbsp;Rafael Coelho ,&nbsp;Abolfazi Hosseini ,&nbsp;Kris Maes ,&nbsp;Anup Kumar ,&nbsp;Bernardo Rocco","doi":"10.1016/j.euros.2025.03.018","DOIUrl":"10.1016/j.euros.2025.03.018","url":null,"abstract":"<div><h3>Background and objective</h3><div>The use of robotic-assisted radical cystectomy (RARC) with intracorporeal urinary diversion has increased rapidly in the past decade. The approximation of the ileum toward the urethral stump could be a demanding step. Whereas the techniques for reconstruction have been described in detail, a comprehensive depiction of strategies to facilitate neobladder-urethral approximation is lacking. This manuscript and video collection provide a summary of the techniques and maneuvers suggested by RARC surgeons.</div></div><div><h3>Methods and surgical procedure</h3><div>This is a cross-sectional study in collaboration with the European Association of Urology Robotic Urology Section (ERUS) Scientific Working Group that evaluates strategies for ileourethral approximation and anastomosis from surgeons performing RARC with an intracorporeal neobladder. To this purpose, a survey was developed by a single institution with input from experts. The survey included questions on caseload, types of diversions, ileal approximation, and techniques and strategies for overcoming challenges in an ileourethral anastomosis. Responders were recruited among experts from scientific societies and were asked to rate the importance of these tricks on a Likert scale. A video collection was developed thereafter.</div></div><div><h3>Key findings and limitations</h3><div>Twenty-one surgeons were involved, with five of them having an individual caseload of &gt;300 cases. The Studer (<em>n</em> = 9) and Bordeaux (<em>n</em> = 9) reconstructions were most used; four operators declared the use of more than one type of diversion. Ileourethral approximation is considered a demanding part of intracorporeal neobladder reconstruction for 86% of participant surgeons. It is perceived as difficult in approximately one out of four surgical cases. Ten surgeons reported at least one conversion to ileal conduit due to impossible ileal descent. The posterior reconstruction was ranked as a useful trick to aid in an ileourethral anastomosis for ten surgeons (48%); a reduction in the Trendelenburg position by nine (43%), the use of small incisions in the mesentery was useful for six (29%) and opening the ileal segment before the anastomosis for five (24%) surgeons.</div></div><div><h3>Conclusions</h3><div>Some strategies and techniques are available to facilitate ileal descent toward the pelvis to achieve a tension-free ileourethral anastomosis. The knowledge and application of these tricks are important to cope with this demanding step and make intracorporeal neobladder reconstruction easier and safer.</div></div><div><h3>Patient summary</h3><div>The robotic realization of a neobladder through an intracorporeal approach could be demanding. The associated video presents some surgical strategies to make this step easier and safer, to ensure the achievement of a tension-free neobladder-urethral anastomosis.</div></div>","PeriodicalId":12254,"journal":{"name":"European Urology Open Science","volume":"76 ","pages":"Pages 45-50"},"PeriodicalIF":3.2,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143906813","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of a Single Intravesical Instillation of Mitomycin C on the Intravesical Recurrence Rate After Ureteroscopy for Upper Tract Urothelial Carcinoma: The SINCERE Prospective Multicenter Registry Study","authors":"Orlane Figaroa ,&nbsp;Ranan Dasgupta ,&nbsp;Nora Hendriks ,&nbsp;Guido Kamphuis ,&nbsp;Jorg Oddens ,&nbsp;Jeroen van Moorselaar ,&nbsp;Adriaan Bins ,&nbsp;Joyce Baard","doi":"10.1016/j.euros.2025.03.017","DOIUrl":"10.1016/j.euros.2025.03.017","url":null,"abstract":"<div><h3>Background</h3><div>Upper tract urothelial carcinoma (UTUC) is a rare malignancy, accounting for 5–10% of all urothelial carcinomas (UCs). Radical nephroureterectomy (RNU) has been the standard treatment, but kidney-sparing surgery (KSS) via ureteroscopy (URS) is now recommended for low-risk cases. KSS is associated with a higher rate of intravesical recurrence (IVR). The SINCERE study is evaluating whether a single postoperative intravesical instillation of mitomycin C (SI-MMC) after URS can reduce the IVR rate.</div></div><div><h3>Study design</h3><div>This is a prospective multicenter registry study enrolling patients with nonmetastatic UTUC undergoing URS followed by SI-MMC. Data will be compared to a historical control cohort without adjuvant MMC. Patients are aged ≥18 yr with no history of bladder cancer or contralateral UTUC. The study is following the principles of the Declaration of Helsinki and has received ethics approval.</div></div><div><h3>Primary and secondary outcomes</h3><div>The primary outcome is total IVR and time to IVR. The secondary outcome is evaluation of predictive variables for IVR in patients with UTUC after endoscopic treatment.</div></div><div><h3>Discussion</h3><div>Given the high recurrence rate after URS, the study aim is to provide evidence regarding MMC use to reduce IVR and address the current lack of robust data for this strategy. The study has potential to change clinical practice by demonstrating the efficacy of SI-MMC in preventing IVR after URS for UTUC.</div></div>","PeriodicalId":12254,"journal":{"name":"European Urology Open Science","volume":"76 ","pages":"Pages 17-22"},"PeriodicalIF":3.2,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143882081","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development of the CAMUS Intra- and Postoperative Risk and Difficulty Estimation Indices Risk Prediction Tool for Estimating Peri- and Postoperative Outcomes, Including Surgical Difficulty, in Major Urological Surgery—A Protocol for a Delphi Study","authors":"Christopher Soliman ,&nbsp;Patrick Y. Wuethrich ,&nbsp;Jochen Walz ,&nbsp;Niall M. Corcoran ,&nbsp;Nathan Lawrentschuk ,&nbsp;Anna Walde ,&nbsp;Marc A. Furrer","doi":"10.1016/j.euros.2025.04.002","DOIUrl":"10.1016/j.euros.2025.04.002","url":null,"abstract":"<div><div>This protocol will outline the development of the CAMUS Intra- and Postoperative Risk and Difficulty Estimation Indices (IPRADES), a tool designed to predict perioperative outcomes and surgical complexity in major urological procedures. Its objective will be to enhance preoperative planning and risk stratification by systematically evaluating a range of patient-, organ-, and surgery-specific factors. The study will be conducted in three phases. Firstly, expert consensus will be established through a Delphi survey involving experienced high-volume surgeons to identify key parameters influencing surgical difficulty and complications. Secondly, data will be collected from the CAMUS Collaboration database and augmented with additional parameters from a prospective open cystectomy database. Thirdly, using this extensive dataset, a nomogram will be developed to evaluate the association between the identified parameters and postoperative complications, as well as to quantify their predictive values. Each parameter will be assigned a weighted significance, which will be integrated into the final risk prediction model. Statistical analyses will incorporate multivariable regression models to identify predictors of complications and mortality. The model’s performance will be evaluated through c-statistics, Hosmer-Lemeshow tests, and Brier scores, with internal validation performed via dataset splitting and bootstrap resampling. Additionally, the study will compare the predictive accuracy of universal versus procedure-specific models. The tool will not only account for patient and surgical factors, but also incorporate the influence of surgeon experience and learning curves on surgical outcomes. A web-based calculator will be developed to facilitate seamless integration into daily clinical practice, providing real-time risk assessments. Following validation, the CAMUS IPRADES tool will refine surgical planning, optimise resource allocation, and enhance patient counselling. By delivering data-driven risk assessments, it will further enable surgeon and institutional benchmarking, thereby contributing to education, training, and clinical research. Ultimately, this tool will play a pivotal role in advancing the quality and safety of urological surgeries.</div></div>","PeriodicalId":12254,"journal":{"name":"European Urology Open Science","volume":"76 ","pages":"Pages 23-37"},"PeriodicalIF":3.2,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143882083","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Revisiting Uric Acid Stone Dissolution Kinetics: Insights for Optimizing Medical Therapy","authors":"Paz Lotan ,&nbsp;Michael Mastai ,&nbsp;Yitzhak Mastai ,&nbsp;Sapir Shekef Aloni ,&nbsp;Itay Sagy ,&nbsp;Bezalel Sivan ,&nbsp;Abd E. Darawsha ,&nbsp;David Lifshitz","doi":"10.1016/j.euros.2025.04.003","DOIUrl":"10.1016/j.euros.2025.04.003","url":null,"abstract":"<div><h3>Background and objective</h3><div>Urine alkalinization, the mainstay of uric acid (UA) stone dissolution medical therapy, relies on old in vitro studies and expert opinions. Moreover, the effects of lowering urine UA concentration in patients without hyperuricosuria have rarely been investigated. We revisited the UA dissolution kinetics to determine the optimal alkalinization target and evaluate the effect of reducing urine UA saturation below normal levels.</div></div><div><h3>Methods</h3><div>Ultraviolet-visible spectrophotometry was employed to analyze the dissolution kinetics of intact and grounded stones in artificial urine solution at various pH levels and UA concentrations. Crystal structures of precipitates were examined by X-ray diffraction.</div></div><div><h3>Key findings and limitations</h3><div>The average dissolution rate increased fourfold when the pH rose from 6–6.5 to 6.5–7 and ninefold when it reached 7–7.2, with the optimal level being at 7.2. At pH 7.4, the rate dropped significantly, and hydroxyapatite crystals precipitated. Grounded stones dissolved 10-fold faster than intact stones at each pH level. Lowering of the urine UA concentration enhanced the dissolution rate only at pH &gt;6.5 and after reducing the concentrations by 55% of the normal level. The artificial urine, buffering solution, and model could only partially mimic the in vivo urine environment.</div></div><div><h3>Conclusions and clinical implications</h3><div>The in vitro study of UA dissolution kinetics offers valuable insights for improving medical therapy in patients with UA nephrolithiasis. Our study confirms alkalinization as the key factor for dissolution and supports expert recommendations. Specifically, by maintaining urine pH &gt;6.5, preferably 7–7.2, and increasing stone surface area, dissolution can be optimized. Reduction of UA concentrations in patients without hyperuricosuria enhances dissolution only after sufficient alkalinization.</div></div><div><h3>Patient summary</h3><div>In this report, we used contemporary laboratory methods to refine the optimal pH target of urine alkalinization, the mainstay medical therapy for uric acid stone dissolution. We found the dissolution rate to increase mainly at pH levels above 6.5, with the optimal pH being 7.2. Additionally, increasing the stone surface area by fragmentation increased the dissolution further, implicating a potential second-line option when initial treatment is unsuccessful. Finally, we confirmed the expert-based recommendation on the lack of effectiveness of allopurinol treatment without adequate alkalinization in patients who have normal uric acid urinary excretion.</div></div>","PeriodicalId":12254,"journal":{"name":"European Urology Open Science","volume":"76 ","pages":"Pages 38-44"},"PeriodicalIF":3.2,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143882082","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}