European Urology Open Science最新文献

{"title":"Trends for Surgical Treatment of Testicular Varicocele: A German Whole-population Analysis of Inpatient Procedures from 2006 to 2021","authors":"Cem Aksoy ,&nbsp;Philipp Reimold ,&nbsp;Philipp Karschuck ,&nbsp;Subhajit Mandal ,&nbsp;Nicole Eisenmenger ,&nbsp;Christer Groeben ,&nbsp;Aristeidis Zacharis ,&nbsp;Johannes Huber ,&nbsp;Luka Flegar","doi":"10.1016/j.euros.2025.03.001","DOIUrl":"10.1016/j.euros.2025.03.001","url":null,"abstract":"<div><h3>Background and objective</h3><div>Testicular varicocele (TVC) is a common benign finding in men of all ages. Indications for TVC repair are abnormal sperm parameters and testicular pain. The optimal surgical method for TVC repair is still a matter of controversy. The aim of our study was to analyze the current situation and trends for TVC surgery in Germany.</div></div><div><h3>Methods</h3><div>The German reports for hospital quality were analyzed from 2006 to 2021. Linear regression models were applied to detect trends over time. Outpatient procedure rates were estimated.</div></div><div><h3>Key findings and limitations</h3><div>A total of 38 653 inpatient TVC surgeries were included. Total varicocelectomy procedures decreased from 3456 in 2006 to 2165 in 2021 (−37.4%; <em>p</em> &lt; 0.001). The proportion of open TVC procedures remained constant at ∼25%. The proportion of laparoscopic TVC procedures increased from 25% in 2006 to 45% in 2021 (<em>p</em> &lt; 0.001), while the sclerotherapy rate for TVC treatment decreased from 47% in 2006 to 29% in 2021 (<em>p</em> &lt; 0.001). In 2006, 543 hospitals offered TVC treatment, which decreased to 466 hospitals in 2021 (−14.2%). Among patients undergoing surgical TVC procedures in 2021, 75% were younger than 35 yr. We estimated an increase in outpatient procedures from 365 cases in 2013 to 1330 cases in 2021 (<em>p</em> &lt; 0.001). The estimation for outpatient procedures represents a study limitation.</div></div><div><h3>Conclusions and clinical implications</h3><div>Laparoscopic TVC treatment is the dominant surgical approach. However, one in three patients receives sclerotherapy for TVC in Germany. While fewer hospitals offer the treatment, we observed a trend for centralization, with an increase in high-caseload departments, as well as an increasing trend for outpatient treatment.</div></div><div><h3>Patient summary</h3><div>TVC is a collection of swollen veins in the testicle. We analyzed treatment trends in Germany for this condition from 2006 to 2021. There was an increase in the use of keyhole surgery over time, and we estimate that the percentage of day-case surgeries also increased.</div></div>","PeriodicalId":12254,"journal":{"name":"European Urology Open Science","volume":"75 ","pages":"Pages 29-36"},"PeriodicalIF":3.2,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143725200","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimizing Screening Performance for the Risk of Hyperoxaluria and Urolithiasis Using the Urinary Oxalate/Creatinine Ratio: A Retrospective Analysis","authors":"Pierre Letourneau ,&nbsp;Lara Cabezas ,&nbsp;Aurélie De Mul ,&nbsp;Nadia Abid ,&nbsp;Christelle Machon ,&nbsp;Cécile Poussineau ,&nbsp;Cécile Acquaviva ,&nbsp;Justine Bacchetta ,&nbsp;Laurence Derain-Dubourg ,&nbsp;Sandrine Lemoine","doi":"10.1016/j.euros.2025.03.003","DOIUrl":"10.1016/j.euros.2025.03.003","url":null,"abstract":"<div><h3>Background and objective</h3><div>The risk of chronic kidney disease (CKD) and nephrolithiasis increases with higher levels of oxalate excretion in 24-h urine, warranting monitoring in specific populations, especially after malabsorptive bariatric surgery. However, implementation of systematic 24-h urine collection is challenging, so there is a need for alternative screening methods.</div></div><div><h3>Methods</h3><div>Using retrospective data from patients evaluated for the risk of urolithiasis, we assessed different thresholds for the urinary oxalate/creatinine (UOx/Creat) ratio to optimize the screening performance for hyperoxaluria diagnosis and urolithiasis risk using lithogenic risk surrogates.</div></div><div><h3>Key findings and limitations</h3><div>Among 1264 patients referred for urolithiasis, 38% were excluded because urine collection was considered incomplete. The remaining 786 individuals were included in our analysis, of whom 16% exhibited hyperoxaluria. A UOx/Creat screening threshold between 35 and 45 μmol/mmol demonstrated good performance, depending on the clinical weighting for false-negative versus true-positive results and the cost/benefit ratio.</div></div><div><h3>Conclusions and clinical implications</h3><div>The UOx/Creat ratio is a promising tool in screening for hyperoxaluria-related complications. However, future research is needed to validate its performance and address the limitations identified to confirm its clinical relevance and effectiveness.</div></div><div><h3>Patient summary</h3><div>Our study shows that a simple test to measure the ratio of oxalate to creatinine in urine can help in identifying people at risk of kidney stones, especially for patients who have had weight-loss surgery. The test showed good screening performance, but more research is needed to confirm our findings.</div></div>","PeriodicalId":12254,"journal":{"name":"European Urology Open Science","volume":"75 ","pages":"Pages 20-28"},"PeriodicalIF":3.2,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143725199","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Durability of Active Surveillance for Localized Renal Masses: 3-year Outcomes in the Michigan Urological Surgery Improvement Collaborative","authors":"Yuzhi Wang ,&nbsp;Samantha Wilder ,&nbsp;Monica Van Til ,&nbsp;Mackenzie Gammons ,&nbsp;Mahin Mirza ,&nbsp;Sabrina L. Noyes ,&nbsp;Mohammad Jafri ,&nbsp;Brian Seifman ,&nbsp;Khurshid R. Ghani ,&nbsp;Alice Semerjian ,&nbsp;Craig G. Rogers ,&nbsp;Brian R. Lane ,&nbsp;for the Michigan Urological Surgery Improvement Collaborative","doi":"10.1016/j.euros.2025.02.005","DOIUrl":"10.1016/j.euros.2025.02.005","url":null,"abstract":"<div><h3>Background and objective</h3><div>In Michigan, around 50% of patients with localized renal masses of ≤7 cm (cT1RMs) are managed without immediate intervention, contradicting previous reports indicating active surveillance (AS) rates of &lt;10–20%. Questions remain regarding the durability of AS when applied so broadly. We evaluated the oncologic outcomes of patients at 1, 2, and 3 yr after the initiation of AS, including survival and delayed intervention rates, hypothesizing that these will be comparable to prior reports.</div></div><div><h3>Methods</h3><div>Between May 2017 and September 2023, data regarding 2161 (52% of 4178) patients with cT1RMs who initiated AS at Michigan Urological Surgery Improvement Collaborative (MUSIC) practices were reviewed. Factors associated with staying on AS were analyzed. Overall survival and the cumulative incidence of treatment were assessed using the Kaplan-Meier method.</div></div><div><h3>Key findings and limitations</h3><div>In total, 2161 patients from 21 practices initiated AS, including 51% with tumors of ≤2 cm, 26% with tumors of 2.1–3.0 cm, and 24% with tumors of 3.1–7.0 cm. At 36 mo, overall survival was 90%, with metastasis and death from kidney cancer in only one patient who refused intervention. The cumulative incidence rates of treatment were 6%, 11%, and 13% at 1, 2, and 3 yr, respectively, with 9.6% for ≤2 cm, 16% for 2.1–3.0 cm, and 18% for &gt;3 cm tumors at 3 yr. Limitations include the study’s retrospective review of prospectively enrolled data limiting conclusions beyond 3 yr of follow-up.</div></div><div><h3>Conclusions and clinical implications</h3><div>MUSIC practices initiate AS for &gt;50% of patients with 13% incidence of delayed intervention and &lt;1% incidence of metastasis within 3 yr, indicating that AS is a safe and durable option for many patients with cT1RMs. Further investigations into imaging protocols and longer-term outcomes of AS are warranted.</div></div><div><h3>Patient summary</h3><div>In Michigan, most patients diagnosed with localized renal masses of &lt;4 cm and some with tumors up to 7 cm in size elect active surveillance (AS), with a 13% cumulative incidence of undergoing intervention within 3 yr of detection. At 3 yr after initiating AS, the cohort had 90% overall survival and &gt;99% cancer-specific survival, indicating that AS is a safe and durable strategy.</div></div>","PeriodicalId":12254,"journal":{"name":"European Urology Open Science","volume":"75 ","pages":"Pages 11-19"},"PeriodicalIF":3.2,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143697124","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Copyright page","authors":"","doi":"10.1016/S2666-1683(25)00090-4","DOIUrl":"10.1016/S2666-1683(25)00090-4","url":null,"abstract":"","PeriodicalId":12254,"journal":{"name":"European Urology Open Science","volume":"74 ","pages":"Page I"},"PeriodicalIF":3.2,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143697368","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of Small Renal Masses <2 cm: Treatment","authors":"Andrea Minervini ,&nbsp;Antonio Andrea Grosso ,&nbsp;Fabrizio Di Maida","doi":"10.1016/j.euros.2023.12.010","DOIUrl":"10.1016/j.euros.2023.12.010","url":null,"abstract":"","PeriodicalId":12254,"journal":{"name":"European Urology Open Science","volume":"74 ","pages":"Pages 73-74"},"PeriodicalIF":3.2,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143697367","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Targeted Prostate Biopsies Overestimate International Society of Urological Pathology Grade Group, Particularly in Smaller Tumors","authors":"Lisa J. Kroon ,&nbsp;Ivo I. de Vos ,&nbsp;Charlotte F. Kweldam ,&nbsp;Monique J. Roobol ,&nbsp;Geert J.L.H. van Leenders ,&nbsp;Roderick C.N. van den Bergh ,&nbsp;Anser Prostate Cancer Network","doi":"10.1016/j.euros.2025.02.008","DOIUrl":"10.1016/j.euros.2025.02.008","url":null,"abstract":"<div><div>Compared with systematic biopsy of the prostate, magnetic resonance imaging (MRI)-targeted biopsies are associated with lower rates of upgrading and higher rates of downgrading between biopsy tissue and radical prostatectomy (RP) specimen International Society of Urological Pathology (ISUP) grade group (GG). Higher rates of downgrading could indicate overtreatment for some patients. We hypothesized that concordance rates between biopsy and RP are different per MRI tumor volume. We conducted an explorative retrospective study to identify the risk factors for downgrading, using RP specimens as the reference standard, in a large regional prostate collaboration. Among 616 patients, pathological concordance was seen in 58% and downgrading in 15%. The risk of downgrading was 18% for tumors of 0–10 mm, 14% for 10–20 mm, and 14% for &gt;20 mm. In a multivariable analysis among patients with targeted biopsy GG ≥2, with covariates including clinical tumor stage, prostate-specific antigen (PSA), maximal MRI index lesion diameter, number of positive target biopsies, and GG at targeted biopsy, the statistically significant predictors for downgrading were PSA, maximum MRI index lesion diameter, and target biopsy GG. A lower risk of downgrading was seen in larger tumors (odds ratio per millimeter 0.95, 95% confidence interval 0.91–1.00, <em>p</em> = 0.033). This study suggests that an overestimation of GG on biopsy is most common in smaller MRI lesions. This information is important in clinical decision-making, mainly in deciding on active surveillance versus active therapy or the indication for additional imaging for cancer staging.</div></div><div><h3>Patient summary</h3><div>In this report, we examined risk factors that could explain why some patients have higher pathological grading at prostate biopsy than on the whole prostate specimen after surgical removal. We found that patients with prostate biopsies that are targeted at small lesions on magnetic resonance imaging and patients who had high biopsy grading had a higher risk of having lower grading of their surgical specimens.</div></div>","PeriodicalId":12254,"journal":{"name":"European Urology Open Science","volume":"75 ","pages":"Pages 7-10"},"PeriodicalIF":3.2,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143683564","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Antiaggregant and Anticoagulant Medications on Perioperative Complications in Upper Tract Urothelial Carcinoma","authors":"Kang Liu ,&nbsp;Chris Ho-Ming Wong ,&nbsp;Hongda Zhao ,&nbsp;Chi Fai Ng ,&nbsp;Jeremy Yuen-Chun Teoh ,&nbsp;Pilar Laguna ,&nbsp;Jean de la Rosette","doi":"10.1016/j.euros.2025.02.007","DOIUrl":"10.1016/j.euros.2025.02.007","url":null,"abstract":"<div><h3>Background and objective</h3><div>Contemporary data are limited regarding the clinical practice of administering anticoagulant and antiplatelet medications (AA) perioperatively for patients with upper tract urothelial carcinoma (UTUC). Our aim was to investigate real-world AA perioperative management among patients with UTUC who underwent radical nephroureterectomy (RNU) and the impact on perioperative complications.</div></div><div><h3>Methods</h3><div>We conducted a retrospective analysis of data from the Clinical Research Office of the Endourology Society UTUC registry. Patients were stratified into two groups according to perioperative AA use in the RNU cohort. Baseline characteristics were compared between the control and AA groups and intraoperative and postoperative complications were analyzed. We also conducted subgroup analysis for patients who discontinued AA use in comparison to those who continued AA therapy. Univariable and multivariable analyses were performed to identify predictors of perioperative complications.</div></div><div><h3>Key findings and limitations</h3><div>A total of 1264 patients who underwent RNU were included in the analysis. Of these, 393 (31%) had AA treatment before RNU and 871 (69%) did not. Intraoperative complications occurred in 23 patients (5.9%) in the AA group and 41 (4.7%) in the control group. Postoperative complications occurred in 101 patients (26%) in the AA group and 182 (21%) in the control group. Multivariable logistic regression demonstrated that AA was not an independent risk factor for either intraoperative complications (odds ratio 0.93, 95% confidence interval [CI] 0.48–1.83; <em>p</em> = 0.84) or postoperative complications (odds ratio 0.93, 95% CI 0.66–1.30; <em>p</em> = 0.66).</div></div><div><h3>Conclusions and clinical implications</h3><div>Anticoagulant and antiaggregant therapy in patients undergoing RNU is safe, with no difference in the incidence of intraoperative and postoperative complications.</div></div><div><h3>Patient summary</h3><div>Our analysis for patients with cancer in the upper urinary tract showed that taking drugs to prevent blood clots before surgery to remove a kidney is safe. We found no significant differences in complication rates in comparison to patients not taking these drugs.</div><div>The Clinical Research Office of the Endourology Society UTUC registry study is registered on ClinicalTrials.gov as NCT02281188.</div></div>","PeriodicalId":12254,"journal":{"name":"European Urology Open Science","volume":"75 ","pages":"Pages 1-6"},"PeriodicalIF":3.2,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143683646","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perioperative, Oncological, and Functional Outcomes of New Multiport Robotic Platforms in Urology: A Systematic Review and Meta-analysis","authors":"Giuseppe Reitano ,&nbsp;Arianna Tumminello ,&nbsp;Umar Ghaffar ,&nbsp;Giorgio Saggionetto ,&nbsp;Alessandra Taverna ,&nbsp;Francesco Mangiacavallo ,&nbsp;Mohamed E. Ahmed ,&nbsp;Spyridon P. Basourakos ,&nbsp;Filippo Carletti ,&nbsp;Davide Minardi ,&nbsp;Massimo Iafrate ,&nbsp;Alessandro Morlacco ,&nbsp;Giovanni Betto ,&nbsp;R. Jeffrey Karnes ,&nbsp;Fabrizio Dal Moro ,&nbsp;Fabio Zattoni ,&nbsp;Giacomo Novara","doi":"10.1016/j.euros.2025.02.003","DOIUrl":"10.1016/j.euros.2025.02.003","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background and objective&lt;/h3&gt;&lt;div&gt;Robot-assisted surgery (RAS) has steadily become more prevalent in urology. The Da Vinci multiport surgical robot (DVM-SR) continues to lead the field. In recent years, new multiport surgical robots (NM-SRs) have been introduced to the market; however, their safety and efficacy remain unassessed. This study aims to give a comprehensive evaluation of the perioperative, oncological, and functional outcomes of NM-SRs and a comparison with the DVM-SR.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;A systematic search was performed in PubMed, Scopus, Web of Science, Embase, and clinicaltrial.gov to identify studies that evaluate NM-SRs in major urological surgeries assessing perioperative, functional, and oncological endpoints. A meta-analysis was performed comparing NM-SRs with the DVM-SR for safety, and functional and oncological outcomes.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Key findings and limitations&lt;/h3&gt;&lt;div&gt;Seventy-four studies involving 5487 patients were included in the review. Nine platforms were studied: Hinotori, Hugo RAS, Revo-I, Versius, Avatera, Senhance, KangDuo Surgical Robot-01, Dexter, and Toumai. NM-SRs were used to perform robot-assisted radical prostatectomy (RARP; 41 studies), partial nephrectomy (RAPN; 14 studies), radical nephrectomy (RARN; four studies), adrenalectomy (four studies), nephroureterectomy (two studies), RARN and thrombectomy (one study), colpopexy (four studies), pyeloplasty (seven studies), simple nephrectomy (four studies), simple prostatectomy (three studies), and ureteral surgery (four studies). Cystectomies with NM-SRs were described only in case reports and were excluded. The comparative analysis between NM-SRs and the DVM-SR showed similar outcomes in terms of intraoperative SATAVA grade ≥2 complications (odds ratio [OR] 0.89, 95% confidence interval [CI] 0.25, 3.1, &lt;em&gt;p&lt;/em&gt; = 0.9 for RARP and OR 0.59, 95% CI 0.11, 3.3, &lt;em&gt;p&lt;/em&gt; = 0.5 for RAPN), postoperative high-grade complications (Clavien-Dindo ≥IIIa, OR 0.85, 95% CI 0.4, 2, &lt;em&gt;p&lt;/em&gt; = 0.7 for RARP and OR 0.59, 95% CI 0.1, 3.3, &lt;em&gt;p&lt;/em&gt; = 0.6 for RAPN), and positive surgical margins (OR 0.90, 95% CI 0.72, 1.1, &lt;em&gt;p&lt;/em&gt; = 0.3 for RARP and OR 1.65, 95% CI 0.3, 9.1, &lt;em&gt;p&lt;/em&gt; = 0.6 for RAPN). For patients undergoing RARP, biochemical recurrence and urinary continence rates at 3 mo were comparable (OR 0.99 [95% CI 0.5, 1.8, &lt;em&gt;p&lt;/em&gt; = 1] and OR 0.99 [95% CI 0.77, 1.3, &lt;em&gt;p&lt;/em&gt; = 0.9], respectively). The achievement of the trifecta for RAPN appeared to be similar between the included studies on NM-SRs and the DVM-SR (OR 1.3, 95% CI 0.4, 4.4, &lt;em&gt;p&lt;/em&gt; = 0.7). The small sample size of the included studies and the preliminary nature of the results represent the major limitations.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions and clinical implications&lt;/h3&gt;&lt;div&gt;When compared with the DVM-SR, NM-SRs may offer similar safety, and oncological and functional outcomes across most surgeries for both benign and malignant diseases. Further research ","PeriodicalId":12254,"journal":{"name":"European Urology Open Science","volume":"74 ","pages":"Pages 44-70"},"PeriodicalIF":3.2,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143534472","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Copyright page","authors":"","doi":"10.1016/S2666-1683(25)00075-8","DOIUrl":"10.1016/S2666-1683(25)00075-8","url":null,"abstract":"","PeriodicalId":12254,"journal":{"name":"European Urology Open Science","volume":"73 ","pages":"Page I"},"PeriodicalIF":3.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143529863","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nephrometry Scores Based on Three-dimensional Virtual Models Improve the Accuracy of Predicting Postoperative Complications After Robotic Partial Nephrectomy: Results from a Collaborative ERUS Validation Study","authors":"Daniele Amparore ,&nbsp;Federico Piramide ,&nbsp;Paolo Verri ,&nbsp;Enrico Checcucci ,&nbsp;Alberto Piana ,&nbsp;Giuseppe Basile ,&nbsp;Alessandro Larcher ,&nbsp;Andrea Gallioli ,&nbsp;Angelo Territo ,&nbsp;Josep Maria Gaya ,&nbsp;Pietro Piazza ,&nbsp;Stefano Puliatti ,&nbsp;Antonio Andrea Grosso ,&nbsp;Andrea Mari ,&nbsp;Riccardo Campi ,&nbsp;Laura Zuluaga ,&nbsp;Ucpinar Burak ,&nbsp;Badani Ketan ,&nbsp;Sergio Serni ,&nbsp;Umberto Capitanio ,&nbsp;Francesco Porpiglia","doi":"10.1016/j.euros.2025.02.001","DOIUrl":"10.1016/j.euros.2025.02.001","url":null,"abstract":"<div><h3>Background and objective</h3><div>The aim of our study was to compare assessment of PADUA and RENAL nephrometry scores and risk/complexity categories via two-dimensional (2D) imaging and three-dimensional virtual models (3DVM) in a large multi-institutional cohort of renal masses suitable for robot-assisted partial nephrectomy (RAPN), and evaluate the predictive role of these imaging approaches for postoperative complications.</div></div><div><h3>Methods</h3><div>Patients were prospectively enrolled from six international high-volume robotic centers, calculating PADUA and RENAL-nephrometry scores and their relative categories with 2D-imaging and 3DVMs. The concordance of nephrometry scores and categories between the two approaches was evaluated using χ² tests and Cohen’s κ coefficient. Receiver operating characteristic curves were plotted to assess the sensitivity and specificity of the 3DVM and 2D approaches for predicting the occurrence of postoperative complications. Multivariable logistic analyses were conducted to identify predictors of major postoperative complications.</div></div><div><h3>Key findings and limitations</h3><div>A total of 318 patients were included in the study. There was low concordance for nephrometry scores and categories between the 3DVM and 2D assessment methods, with downgrading of PADUA and RENAL scores on 3DVM assessment in 43% and 49% of cases, and downgrading of the corresponding categories in 25% and 26%, respectively. Moreover, 3DVM assessment showed better accuracy than the 2D approach in predicting overall (<em>p</em> &lt; 0.001) and major (<em>p</em> = 0.001) postoperative complications. In line with these findings, multivariable analyses showed that 3DVM-based nephrometry scores and categories were predictive of major postoperative complications (<em>p</em> &lt; 0.001). Limitations include the risk of interobserver variability in evaluating nephrometry scores and categories, production costs for the 3DVMs, and the experience of the surgeons involved, with potential impacts on diffusion of this technology.</div></div><div><h3>Conclusions and clinical implications</h3><div>In this multi-institutional study, 3DVMs had superior accuracy to 2D images for evaluating the surgical complexity of renal masses and frequently led to downgrading. This could facilitate an increase in recommendations for kidney-sparing surgery and better identification of cases at risk of postoperative complications.</div></div><div><h3>Patient summary</h3><div>Our study shows that the use of three-dimensional models gives lower complexity scores for kidney tumors in comparison to standard two-dimensional scans. This can improve surgical planning and may boost the use of kidney-sparing techniques and better identification of cases that are more likely to have postoperative complications.</div></div>","PeriodicalId":12254,"journal":{"name":"European Urology Open Science","volume":"74 ","pages":"Pages 11-20"},"PeriodicalIF":3.2,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143453283","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}