European Urology Open Science最新文献

{"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}

{"title":"Copyright page","authors":"","doi":"10.1016/S2666-1683(25)00114-4","DOIUrl":"10.1016/S2666-1683(25)00114-4","url":null,"abstract":"","PeriodicalId":12254,"journal":{"name":"European Urology Open Science","volume":"75 ","pages":"Page I"},"PeriodicalIF":3.2,"publicationDate":"2025-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143874260","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":"Phenazopyridine Inhibits Bladder Mechanosensory Signalling via the Bladder Lumen","authors":"Aaron Clark,&nbsp;Georgia Bourlotos,&nbsp;Meera Elmasri,&nbsp;Luke Grundy","doi":"10.1016/j.euros.2025.04.001","DOIUrl":"10.1016/j.euros.2025.04.001","url":null,"abstract":"","PeriodicalId":12254,"journal":{"name":"European Urology Open Science","volume":"76 ","pages":"Pages 14-16"},"PeriodicalIF":3.2,"publicationDate":"2025-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143873142","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":"ProstaPilot: A Comparative Study of Biparametric Magnetic Resonance Imaging Versus Prostate-specific Antigen as a Screening Test for Prostate Cancer","authors":"Michal Staník ,&nbsp;Michal Standara ,&nbsp;David Miklánek ,&nbsp;Kateřina Hejcmanová ,&nbsp;Miloš Pacal ,&nbsp;Roman Hrabec ,&nbsp;Ondřej Ngo ,&nbsp;Karel Hejduk ,&nbsp;Jan Křístek ,&nbsp;Michal Uher ,&nbsp;Ondřej Májek ,&nbsp;Alexandr Poprach","doi":"10.1016/j.euros.2025.03.016","DOIUrl":"10.1016/j.euros.2025.03.016","url":null,"abstract":"<div><h3>Background and objective</h3><div>Our aim was to compare detection rates for clinically significant prostate cancer (csPC) between biparametric magnetic resonance imaging (bpMRI) and prostate-specific antigen (PSA) screening pathways in the Czech population, which has a high prevalence of opportunistic PSA testing (45% in the target age group).</div></div><div><h3>Methods</h3><div>Between May 2022 and May 2023, 423 men aged 50–69 yr who were enrolled via volunteer-based recruitment, underwent both PSA testing and bpMRI of the prostate. Positive results were defined as PSA ≥3 μg/l or a Prostate Imaging-Reporting and Data System score of 4-5. Those with positive tests were referred for further evaluation, including an MRI-targeted biopsy and a systematic 12-core biopsy. csPC was defined as any cancer of International Society of Urological Pathology grade group ≥2.</div></div><div><h3>Key findings and limitations</h3><div>Of the 423 men, 35 (8.3%) had at least one positive screening test. The PSA-based pathway identified 25 men (5.9%), whereas the MRI-based pathway identified 16 (3.8%) with suspicion of PC, with potential to reduce the number of biopsies required by 36%. Subsequent biopsy revealed PC in seven men (1.7%) with a positive PSA test and 14 men (3.3%) with positive MRI findings. Nonsignificant PC and csPC rates were 1.0% (<em>n</em> = 4) and 0.7% (<em>n</em> = 3) for the PSA pathway, and 1.7% and 1.7% (<em>n</em> = 7) for the MRI pathway, respectively.</div></div><div><h3>Conclusions and clinical implications</h3><div>In a highly prescreened population, bpMRI may increase the csPC detection rate while reducing the number of biopsies needed in comparison to PSA-based diagnosis. However, bpMRI may also slightly increase the detection of grade group 1 cancers.</div></div><div><h3>Patient summary</h3><div>We compared a blood test for PSA (prostate-specific antigen) and an MRI scan (magnetic resonance imaging) for detection of prostate cancer in men aged 50–69 years. We found that MRI scans may reduce the number of biopsies that need to be performed for cancer diagnosis while increasing the detection rate for cancers that are significant.</div></div>","PeriodicalId":12254,"journal":{"name":"European Urology Open Science","volume":"76 ","pages":"Pages 7-13"},"PeriodicalIF":3.2,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143859708","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":"Uncovering the Risk: Incidence of Upper Tract Urothelial Carcinoma Following Renal Transplantation in the Netherlands","authors":"Orlane J.A. Figaroa ,&nbsp;J. Bek ,&nbsp;C.D. Savci-Heijink ,&nbsp;M.M. Idu ,&nbsp;A.D. Bins ,&nbsp;R.J.A. van Moorselaar ,&nbsp;J. Baard","doi":"10.1016/j.euros.2025.03.004","DOIUrl":"10.1016/j.euros.2025.03.004","url":null,"abstract":"<div><h3>Background and objective</h3><div>Renal transplant (RTx) recipients appear to have an elevated risk of urothelial carcinoma compared with the general population. While Asia reports a high incidence of upper tract urothelial carcinoma (UTUC) following RTx, this incidence remains underinvestigated in Western countries. The main objective of this study is to determine the incidence of UTUC after RTx in the Netherlands, and to evaluate and compare the incidence and tumour characteristics with those of the general Dutch population diagnosed with UTUC.</div></div><div><h3>Methods</h3><div>A retrospective nationwide analysis was conducted using data from the Dutch Pathology Registry on patients with UTUC after RTx between 1991 and 2023. We analysed patient and tumour characteristics, and treatment details.</div></div><div><h3>Key findings and limitations</h3><div>Out of 24 270 RTx patients (1991–2023), 30 developed UTUC, showing a 0.12% cumulative incidence and a 3.7 per 100 000 person-years incidence rate. The median age at UTUC diagnosis was 59 yr, and 47% had grade 3 UTUC. The overall incidence of UTUC in the Dutch population between 1991 and 2023 is 3.3 per 100 000 using the revised European standardised rate, with a median age of 71 yr and 40% grade 3 UTUC. Given that the study is retrospective, an inevitable bias needs to be considered.</div></div><div><h3>Conclusions and clinical implications</h3><div>We found a modestly higher incidence of UTUC after RTx within the Netherlands, with patients showing a lower median age at diagnosis and a higher percentage of grade 3 tumours than the general Dutch population diagnosed with UTUC.</div></div><div><h3>Patient summary</h3><div>In this report, we evaluated the incidence of upper tract urothelial cancer in patients who received kidney transplantation. Outcomes suggest a modestly higher incidence in patients after kidney transplantation than in the general Dutch population diagnosed with upper tract urothelial cancer.</div></div>","PeriodicalId":12254,"journal":{"name":"European Urology Open Science","volume":"76 ","pages":"Pages 1-6"},"PeriodicalIF":3.2,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143838866","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":"Personalised Prostate Cancer Diagnosis: Evaluating Biomarker-based Approaches to Reduce Unnecessary Magnetic Resonance Imaging and Biopsy Procedures","authors":"Timo F.W. Soeterik ,&nbsp;Xiaobo Wu ,&nbsp;Roderick C.N. Van den Bergh ,&nbsp;Claudia Kesch ,&nbsp;Fabio Zattoni ,&nbsp;Ugo Falagario ,&nbsp;Alberto Martini ,&nbsp;Marcin Miszczyk ,&nbsp;Vittorio Fasulo ,&nbsp;Martina Maggi ,&nbsp;Veeru Kasivisvanathan ,&nbsp;Pawel Rajwa ,&nbsp;Giancarlo Marra ,&nbsp;Giorgio Gandaglia ,&nbsp;Peter K.F. Chiu ,&nbsp;EAU-YAU Prostate Cancer Working Party","doi":"10.1016/j.euros.2025.03.006","DOIUrl":"10.1016/j.euros.2025.03.006","url":null,"abstract":"<div><h3>Background and objective</h3><div>Efforts made over the last decade for the detection of prostate cancer (PCa) have revolutionised disease diagnostics, and implementation of prebiopsy magnetic resonance imaging (MRI) has received widespread acceptance. However, universal adoption of prebiopsy MRI and the benefits achieved have been limited by availability and equivocal MRI findings. This review aims to evaluate the latest evidence on the role of existing PCa risk calculators (RCs), and blood and urinary biomarkers as part of the diagnostic algorithm to improve the diagnosis of clinically significant PCa (csPCa) and reduce unnecessary MRI procedures and biopsies. We will also evaluate the potential of prostate-specific membrane antigen (PSMA) positron emission tomography (PET) to enhance sensitivity and specificity for PCa diagnosis, complement MRI, and refine biopsy strategies within the diagnostic pathway.</div></div><div><h3>Methods</h3><div>We performed a narrative review using the PubMed/MEDLINE database, which included papers published between January 2014 and June 2024. The outcome measures included rates of reduced diagnoses of nonsignificant PCa (defined as International Society of Urological Pathology [ISUP] grade group 1) cases, diagnoses of csPCa (defined as ISUP grade group ≥2) cases missed, and MRI scans and prostate biopsies avoided.</div></div><div><h3>Key findings and limitations</h3><div>In men with abnormal prostate-specific antigen (PSA) levels, further risk stratification using RCs, or blood or urine biomarkers can reduce up to 16–51% MRI scans, while missing 1–16% csPCa cases. In case of equivocal MRI results or Prostate Imaging Reporting and Data System 3 lesions, RCs or biomarkers could reduce up to 72% of biopsies, while missing only 3–13% csPCa cases. PSMA PET has emerging potential to improve csPCa prediction in combination with MRI and may further reduce unnecessary biopsies. A limitation of this study is that this is a narrative but not a systematic review.</div></div><div><h3>Conclusions and clinical implications</h3><div>RCs and biomarkers have been demonstrated to enhance the performance and efficiency of MRI in detecting csPCa in men with elevated PSA levels. PSMA PET shows promise in detecting csPCa, complementing MRI and refining biopsy indications.</div></div><div><h3>Patient summary</h3><div>In men with a suspicion of prostate cancer, magnetic resonance imaging prostate scans are effective in predicting clinically relevant cancer, but challenges including availability and equivocal scans exist. A personalised approach by adding one or more of clinical risk calculators, blood or urine biomarkers, or even novel imaging techniques such as positron emission tomography scans may improve cancer prediction further and reduce unnecessary scans and biopsies.</div></div>","PeriodicalId":12254,"journal":{"name":"European Urology Open Science","volume":"75 ","pages":"Pages 106-119"},"PeriodicalIF":3.2,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143829030","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":"Managing Preoperative Anxiety and Thromboprophylaxis in Children Undergoing Urological Procedures: An Update of the European Association of Urology/European Society for Paediatric Urology Guidelines on Paediatric Urology","authors":"Michele Gnech ,&nbsp;Lisette ’t Hoen ,&nbsp;Martin Skott ,&nbsp;Guy Bogaert ,&nbsp;Marco Castagnetti ,&nbsp;Fardod O’Kelly ,&nbsp;Josine Quaedackers ,&nbsp;Yazan F. Rawashdeh ,&nbsp;Uchenna Kennedy ,&nbsp;Allon van Uitert ,&nbsp;Yuhong Yuan ,&nbsp;Marco Capecchi ,&nbsp;Andrea Artoni ,&nbsp;Gülhan Karaöz-Bulut ,&nbsp;Niklas Pakkasjärvi ,&nbsp;Berk Burgu ,&nbsp;Anna Bujons ,&nbsp;Mesrur Selcuk Silay ,&nbsp;Christian Radmayr","doi":"10.1016/j.euros.2025.02.006","DOIUrl":"10.1016/j.euros.2025.02.006","url":null,"abstract":"<div><h3>Context</h3><div>The literature on preventative measures against anxiety and antithrombotic management in children undergoing urological procedures is still limited, resulting in a generally low level of evidence. These guidelines aim to provide a practical approach based on a consensus from the European Association of Urology (EAU)/European Society for Paediatric Urology (ESPU) Paediatric Urology Guidelines Panel.</div></div><div><h3>Objective</h3><div>The authors aim to provide the 2024 EAU/ESPU Paediatric Urology Guidelines Panel update of the chapter on perioperative management of urological procedures in children.</div></div><div><h3>Evidence acquisition</h3><div>A structured literature review was performed for all relevant publications published from the last update until April 03, 2023.</div></div><div><h3>Evidence synthesis</h3><div>The most important updates include the following: anxiety and distress should be prevented or relieved by combining measures such as premedication, distraction techniques, and presence of parents or caregivers. Clinicians should select the appropriate premedication depending on the patient’s age, underlying conditions, and psychological status. A particular focus must be placed on paediatric patients with “special needs”, including children with psychophysical disorders that impact their relational and cognitive abilities. This unique population requires carefully tailored perioperative management. The incidence of perioperative thromboembolic events in the paediatric population is generally low. Controversies still exist on whether to perform a preoperative coagulation panel test on a routine basis. Neonates and adolescents are at a higher risk of perioperative thromboembolic events than the other children. Standard perioperative antithrombotic prophylaxis is not recommended due to a lack of high-quality evidence-based data.</div></div><div><h3>Conclusions</h3><div>This paper is a summary of evidence on preventative measures against anxiety and antithrombotic management in children undergoing urological procedures.</div></div><div><h3>Patient summary</h3><div>In this summary and update of the European Association of Urology/European Society for Paediatric Urology guidelines on paediatric urology, we provide practical considerations for preventative measures against anxiety and antithrombotic management in children undergoing urological procedures.</div></div>","PeriodicalId":12254,"journal":{"name":"European Urology Open Science","volume":"75 ","pages":"Pages 133-140"},"PeriodicalIF":3.2,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143833785","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":"Robot-assisted Laparoscopic Retroperitoneal Lymph Node Dissection for Testicular and Upper Tract Urothelial Cancer—Surgical Technique and Outcomes of a Single-surgeon Series","authors":"Marc A. Furrer ,&nbsp;Benjamin C. Thomas","doi":"10.1016/j.euros.2025.03.015","DOIUrl":"10.1016/j.euros.2025.03.015","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background and objective&lt;/h3&gt;&lt;div&gt;Retroperitoneal lymph node dissection (RPLND) is essential in managing testicular and upper urinary tract urothelial cancer (UTUC). While open RPLND remains the gold standard, robot-assisted RPLND (RA-RPLND) is gaining traction in selected cases. This study aims to describe the surgical technique and our experience with RA-RPLND, and to demonstrate the peri-and postoperative safety and efficacy of this approach for the treatment of testicular cancer and UTUC.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;We analyzed the data from a single-surgeon series of 96 patients (64 testicular cancer and 32 UTUC) who underwent RA-RPLND between 2016 and 2024. The procedures included left (&lt;em&gt;n&lt;/em&gt; = 49), right (&lt;em&gt;n&lt;/em&gt; = 31), and bilateral (&lt;em&gt;n&lt;/em&gt; = 16) template dissection. Bilateral and unilateral templates were used for testicular cancer, while unilateral templates were applied to all UTUC cases involving high-grade disease in the kidney, proximal ureter, or midureter. Surgical indications, preoperative assessment, and postoperative care protocols are described. Baseline characteristics, peri- and postoperative data, and oncological outcomes were assessed. Complications were graded using the Clavien-Dindo classification.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Key findings and limitations&lt;/h3&gt;&lt;div&gt;Median length of stay was 1 (IQR 1–1) d for testicular cancer and 2.5 (IQR 2–4) d for UTUC patients. Open conversion occurred in two testicular cancer salvage cases. Major complications (Clavien-Dindo ≥3a) occurred in 9% (testicular cancer) and 13% (UTUC) of patients. Two patients died within 90 d after RA-RPLND for UTUC: one due to an acute myocardial infarction and the other due to progressive disease. Six patients (19%) with UTUC died due to progressive disease within a median follow-up of 38 (range 4–66) mo, whereas all patients with testicular cancer were still alive after a median follow-up of 46 (range 1–97) mo. Overall and cancer-specific survival rates at the end of follow-up were 78% and 69% in patients with UTUC, and 100% and 100% in patients with testicular cancer, respectively. No retroperitoneal recurrences occurred in either cohort until the end of follow-up. Limitations include the steep learning curve and nonreproducibility by surgeons without expertise in advanced robotic surgery.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions and clinical implications&lt;/h3&gt;&lt;div&gt;RA-RPLND remains a technically challenging operation, but is safe and effective in expert hands and should therefore be considered for selected patients in high-volume centers.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Patient summary&lt;/h3&gt;&lt;div&gt;In this study, we examined the outcomes after robot-assisted retroperitoneal lymph node dissection. We conclude that it is a safe and effective procedure for patients with testicular cancer and cancer of the renal pelvis and ureter when performed by experienced surgeons. Therefore, it can be a suitable choice for certain patients, depending on their individual ci","PeriodicalId":12254,"journal":{"name":"European Urology Open Science","volume":"75 ","pages":"Pages 120-132"},"PeriodicalIF":3.2,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143829031","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}