European Urology Open Science最新文献

{"title":"Copyright page","authors":"","doi":"10.1016/S2666-1683(26)00072-8","DOIUrl":"10.1016/S2666-1683(26)00072-8","url":null,"abstract":"","PeriodicalId":12254,"journal":{"name":"European Urology Open Science","volume":"86 ","pages":"Page I"},"PeriodicalIF":4.5,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147612402","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":"First Prospective Multicenter Evaluation of Robotic-assisted Partial Nephrectomy Using the DEXTER Robotic Surgery System","authors":"Damien Thillou ,&nbsp;Xavier Durand ,&nbsp;Humphrey Robin ,&nbsp;Aurélien Forgues ,&nbsp;Nadia Ali Benali ,&nbsp;Damien Emeriau ,&nbsp;Guillaume Hugues","doi":"10.1016/j.euros.2026.02.001","DOIUrl":"10.1016/j.euros.2026.02.001","url":null,"abstract":"<div><h3>Background and objective</h3><div>Robot-assisted partial nephrectomy (RAPN) is a standard treatment for small renal tumors due to its precision and nephron-sparing properties. The DEXTER Robotic Surgery System is an open, sterile, compact, three-arm multiport system. This study evaluated the intraoperative and early postoperative safety and clinical performance of DEXTER in RAPN.</div></div><div><h3>Methods</h3><div>A prospective observational study was conducted at two hospitals in France. Seven surgeons performed surgeries using DEXTER. The primary endpoints were major complications (Clavien-Dindo grades III–V) and procedural success rate. The secondary endpoints included perioperative outcomes and 30-d follow-up assessment.</div><div>Key findings and limitations</div><div>Thirty-three patients with a median age of 70 yr (interquartile range [IQR] 60–74) and a body mass index of 26.2 kg/m² (IQR 23.7–31.2) were enrolled. The clampless technique was used in six cases. When full (22 cases) or selective (five cases) clamping was applied, the median warm ischemia time was 20 min (IQR 14–25). All procedures were completed without conversion to open or laparoscopic surgery. Three Clavien-Dindo grade III events occurred. The median estimated blood loss was 300 ml (IQR 100–600), with no blood transfusions. The skin-to-skin operative time was 170 min (IQR 137–200), and the length of hospital stay was 2 d (IQR 2–3). Limitations included the lack of a learning curve assessment due to a low case load per surgeon, and reduced comparability due to a short follow-up time and lack of a control group.</div></div><div><h3>Conclusions and clinical implications</h3><div>RAPN with DEXTER is feasible, and the study supports its short-term safety, even during the initial cases. Further studies are needed to assess its long-term performance.</div></div><div><h3>Patient summary</h3><div>This is a prospective, multicenter cohort study of patients who underwent robot-assisted partial nephrectomy with the DEXTER Robotic Surgery System. During the study, all procedures were completed successfully without any conversions to open or laparoscopic surgery. The results support the short-term safety and feasibility, and highlight the ease of implementation of DEXTER. Further studies are needed to assess its long-term performance.</div></div>","PeriodicalId":12254,"journal":{"name":"European Urology Open Science","volume":"85 ","pages":"Pages 118-125"},"PeriodicalIF":4.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147303735","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-evaluating Treatments for Advanced Urothelial Carcinoma Using Restricted Mean Survival Time: A Systematic Review and Network Meta-analysis","authors":"Shugo Yajima ,&nbsp;Wei Chen ,&nbsp;Kohei Hirose ,&nbsp;Akihiro Hirakawa ,&nbsp;Kenji Tanabe ,&nbsp;Motohiro Fujiwara ,&nbsp;Hiroshi Fukushima ,&nbsp;Hajime Tanaka ,&nbsp;Hitoshi Masuda ,&nbsp;Yasuhisa Fujii ,&nbsp;Soichiro Yoshida","doi":"10.1016/j.euros.2026.01.013","DOIUrl":"10.1016/j.euros.2026.01.013","url":null,"abstract":"<div><h3>Background and objective</h3><div>The proportional hazards (PH) assumption may not hold for immune checkpoint inhibitor (ICI) trials because of delayed treatment effects. We assessed PH validity in trials of first-line treatment in advanced urothelial carcinoma (UC) and compared treatments using restricted mean survival time (RMST).</div></div><div><h3>Methods</h3><div>We conducted a systematic review and network meta-analysis (NMA) of phase 2/3 randomized controlled trials published between 2015 and 2025 evaluating ICIs or antibody-drug conjugates. Seven trials involving 5321 patients with ten treatment comparisons were analyzed. Individual patient data were reconstructed from Kaplan-Meier curves. The PH assumption was tested using Schoenfeld residuals (<em>p</em> &lt; 0.05 indicating violation). RMST-based NMA was performed at 6-mo intervals up to 36 mo.</div></div><div><h3>Key findings and limitations</h3><div>The PH assumption was violated in 50% of overall survival (OS) comparisons and 60% of progression-free survival comparisons. ICI monotherapy regimens demonstrated a significant early detriment at 12 mo in comparison to chemotherapy (PD-1 inhibitors: −0.8 mo, <em>p</em> = 0.007; PD-L1 inhibitors: −0.9 mo, <em>p</em> &lt; 0.001) that was completely masked by nonsignificant hazard ratios. Enfortumab vedotin + pembrolizumab was associated with a superior RMST benefit of 5.7 mo (95% confidence interval 3.3–8.1) at the 36-mo time point. Study limitations include the sparse network structure and heterogeneous patient eligibility criteria across trials.</div></div><div><h3>Conclusions and clinical implications</h3><div>Half of modern UC trials violate PH assumptions, with time-dependent treatment effects that can be obscured by traditional analyses. RMST analysis quantifies the magnitude and clinical impact of early ICI monotherapy detriment that is not captured by nonsignificant hazard ratios. Enfortumab vedotin plus pembrolizumab demonstrated the largest RMST benefit in this analysis, although this finding is based on a single pivotal trial and requires validation in additional studies and real-world settings. These findings support the value of RMST analysis as a complementary approach for evaluating time-dependent treatment effects in immunotherapy trials.</div></div><div><h3>Patient summary</h3><div>We analyzed clinical trials of treatments for advanced bladder cancer and found that traditional statistical methods may miss important treatment patterns. Our analysis shows that immunotherapy alone may perform worse than chemotherapy initially, but the treatment effect improves over time. The combination of enfortumab vedotin and pembrolizumab provides the best outcomes for patients at all time points.</div></div>","PeriodicalId":12254,"journal":{"name":"European Urology Open Science","volume":"85 ","pages":"Pages 60-70"},"PeriodicalIF":4.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146190609","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":"Anatomical Variation of the Pudendal Nerve and Related Structures","authors":"Junjie Yang ,&nbsp;Katie E. Webb ,&nbsp;Emma V. Carrington ,&nbsp;Emma M. Cullen ,&nbsp;Alex Digesu ,&nbsp;Karel Everaert ,&nbsp;Ahmed Ibrahim ,&nbsp;Harriet Kemp ,&nbsp;Alison Mears ,&nbsp;Jalesh N. Panicker ,&nbsp;Marcus J. Drake","doi":"10.1016/j.euros.2026.01.015","DOIUrl":"10.1016/j.euros.2026.01.015","url":null,"abstract":"<div><h3>Background and objective</h3><div>The pudendal nerve (PN) typically arises from sacral roots S2–S4 and gives rise to three main branches: inferior rectal, perineal, and dorsal genital nerves. However, conditions such as pudendal neuralgia and persistent genital arousal disorder exhibit great variability in clinical course and therapeutic responses. Anatomical variation of the PN may contribute to this variability by placing the nerve or its branches in vulnerable positions that lead to compression or traction. This scoping review examined PN anatomical variations to gain a better understanding of their role in pathophysiology and clinical outcomes.</div></div><div><h3>Methods</h3><div>A scoping review was conducted according to the Preferred Reporting of Items for Systematic Reviews and Meta-Analyses-Extension for Scoping Reviews (PRISMA-ScR) guidelines to answer the following research question: What are the anatomical variations of the PN and related structures along its route? Searches were conducted in the MEDLINE and EMBASE databases, with manual screening. Studies on human anatomical investigations of PN variations, regardless of method, were included.</div></div><div><h3>Key findings and limitations</h3><div>The review revealed substantial anatomical diversity in nerve roots, trunk, branches, and related structures, for which detailed schematic illustrations were developed. Limitations include methodological heterogeneity across studies, the predominance of elderly cadaver specimens, and lack of formal quality assessment.</div></div><div><h3>Conclusions and clinical implications</h3><div>Anatomical variation is a key factor in the development and persistence of PN-related conditions. An understanding of this variability is critical for diagnosis, surgical planning, and effective management. This review challenges assumptions of “typical anatomy” and offers context for refinement of decompression techniques and therapeutic strategies.</div></div><div><h3>Patient summary</h3><div>Our study shows that one of the nerves in the pelvis, called the pudendal nerve, varies between individuals. This could explain why standard treatments do not work in some patients and could help doctors to better understand these conditions.</div></div>","PeriodicalId":12254,"journal":{"name":"European Urology Open Science","volume":"85 ","pages":"Pages 71-81"},"PeriodicalIF":4.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146190598","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":"Posteriorly Augmented Anastomotic Ureteroplasty with Lingual Mucosal Onlay Grafts: 8-year Multi-institutional Experience in 61 Cases","authors":"Yuancheng Zhou ,&nbsp;Shuaishuai Chai ,&nbsp;Kangxiang Xu ,&nbsp;Xincheng Gao ,&nbsp;Wang Wang ,&nbsp;Manshun Dong ,&nbsp;Ruoyu Li ,&nbsp;Chaoqi Liang ,&nbsp;Bing Li ,&nbsp;Xingyuan Xiao","doi":"10.1016/j.euros.2026.01.007","DOIUrl":"10.1016/j.euros.2026.01.007","url":null,"abstract":"<div><h3>Background and objective</h3><div>Management of long proximal ureteral strictures remains a significant challenge. Posteriorly augmented anastomotic ureteroplasty with lingual mucosal onlay grafts (PAAU-LMG) is a novel technique used for treating obliterated or diseased ureteral segments. This study aims to evaluate the long-term effectiveness of PAAU-LMG in a multi-institutional cohort of patients with long, complex proximal ureteral strictures.</div></div><div><h3>Methods</h3><div>This retrospective study involved data for 61 patients treated with PAAU-LMG at three centers between April 2017 and December 2024. Perioperative and follow-up data were collected. Surgical success is defined by the absence of clinical symptoms, no stricture on imaging, and no severe complications. A descriptive statistical analysis was performed.</div></div><div><h3>Key findings and limitations</h3><div>Of the 61 patients, 18 underwent laparoscopic surgery and 43 underwent robotic surgery. PAAU-LMG was performed in 45 (73.77%) cases, 16 (26.23%) cases underwent PAAU-LMG with ureteral dorsal adventitia “fold” technique. The reconstructed ureter was covered with perirenal fat in four cases (6.56%) and with omentum in 57 cases (93.44%). The median (range) stricture length was 3.60 (1.50–9.00) cm, operative time was 140 (84–306) min, estimated blood loss was 50 (10–400) ml, and postoperative hospital stay was 6 (4–10) d. No open conversions and intraoperative complications occurred. At a median (range) follow-up of 32 (7–98) mo, the overall success rate was 100% (61/61). The main limitation is the lack of a control group.</div></div><div><h3>Conclusions and clinical implications</h3><div>PAAU-LMG is a safe, effective, and feasible treatment for selected patients with long obliterated or diseased proximal ureteral strictures.</div></div><div><h3>Patient summary</h3><div>We evaluated the long-term follow-up outcomes of posteriorly augmented anastomotic ureteroplasty with lingual mucosal onlay grafts (PAAU-LMG), in which the diseased ureter was excised and reanastomosed primarily on the dorsal side, and a lingual mucosal graft was placed on the ventral side. For patients with obliterated or diseased ureter stricture, PAAU-LMG is a safe and feasible alternative with satisfactory outcome.</div></div>","PeriodicalId":12254,"journal":{"name":"European Urology Open Science","volume":"85 ","pages":"Pages 9-15"},"PeriodicalIF":4.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146075951","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":"Discrepancies Between Global Consensus and Local Implementation in the Management of Advanced Prostate Cancer","authors":"Niven Mehra ,&nbsp;Daniela E. Oprea-Lager ,&nbsp;Addy C.M. van de Luijtgaarden ,&nbsp;Jochem R.N. van der Voort van Zyp ,&nbsp;Shafak Aluwini ,&nbsp;Herman J. Stoevelaar ,&nbsp;Roderick C.N. van den Bergh","doi":"10.1016/j.euros.2025.12.020","DOIUrl":"10.1016/j.euros.2025.12.020","url":null,"abstract":"<div><div>The biennial Advanced Prostate Cancer Consensus Conference (APCCC) provides expert-based recommendations on clinical topics for which high-level evidence is lacking. These consensus statements reflect the views of a worldwide panel of more than 100 specialists. There may be discrepancies in local implementation because of context-specific factors. To explore this for the Dutch situation, a national multidisciplinary panel of 34 specialists used a stepwise approach to evaluate selected APCCC 2024 questions. After individual voting, results were discussed in a plenary meeting with partial revoting. Discordance with APCCC consensus was observed for 35% of the questions. Items with the greatest disagreement were revisited in an online follow-up meeting. National deviations were largely regarded justified because of several contextual factors, including wider clinical adoption of prostate-specific membrane antigen positron emission tomography/computed tomography in the Netherlands. Our approach may provide an adequate means of identifying barriers for local compliance with the international consensus recommendations.</div></div><div><h3>Patient summary</h3><div>International experts established consensus statements on the treatment of advanced prostate cancer for topics with unclear evidence. Dutch specialists reviewed these recommendations to determine which ones fit best with local care.</div></div>","PeriodicalId":12254,"journal":{"name":"European Urology Open Science","volume":"85 ","pages":"Pages 126-129"},"PeriodicalIF":4.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147325201","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":"Deep Learning Artificial Intelligence and Restriction Spectrum Imaging for Patient-level Detection of Clinically Significant Prostate Cancer on Biparametric Magnetic Resonance Imaging","authors":"Yuze Song ,&nbsp;Mariluz Rojo Domingo ,&nbsp;Christopher C. Conlin ,&nbsp;Deondre D. Do ,&nbsp;Madison T. Baxter ,&nbsp;Anna Dornisch ,&nbsp;George Xu ,&nbsp;Aditya Bagrodia ,&nbsp;Tristan Barrett ,&nbsp;Mukesh Harisinghani ,&nbsp;Gary Hollenberg ,&nbsp;Sophia Kamran ,&nbsp;Christopher J. Kane ,&nbsp;Dimitri A. Kessler ,&nbsp;Joshua Kuperman ,&nbsp;Kanglung Lee ,&nbsp;Michael A. Liss ,&nbsp;Daniel J.A. Margolis ,&nbsp;Paul M. Murphy ,&nbsp;Nabih Nakrour ,&nbsp;Tyler M. Seibert","doi":"10.1016/j.euros.2026.01.014","DOIUrl":"10.1016/j.euros.2026.01.014","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background and objective&lt;/h3&gt;&lt;div&gt;Our aim was to evaluate whether combining the maximum restriction score derived from restriction spectrum imaging (RSIrs&lt;sub&gt;max&lt;/sub&gt;) with deep learning (DL) models can enhance patient-level detection of clinically significant prostate cancer (csPCa) in comparison to Prostate Imaging-Reporting and Data System (PI-RADS) or RSIrs&lt;sub&gt;max&lt;/sub&gt; alone.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;A total of 1892 patients from seven institutions who underwent imaging between January 2016 and March 2024 were included on the basis of magnetic resonance imaging (MRI) findings and biopsy-confirmed prostate cancer diagnosis. Two DL architectures, 3D-DenseNet and 3D-DenseNet+RSI (incorporating RSIrs&lt;sub&gt;max&lt;/sub&gt;), were developed and trained using biparametric MRI and RSI data using a leave-one-center-out validation approach. RSI is a rapid sequence that requires only 2–3 min to acquire. Model performance was evaluated in a biopsy-confirmed subset of 876 patients, with subgroup analyses stratified by site and scanner vendor. Receiver operating characteristic (ROC) and precision recall curves and forest plots (I&lt;sup&gt;2&lt;/sup&gt; for heterogeneity) were generated, and the area under the ROC curve (AUC) and sensitivity, were compared, as well as specificity at fixed sensitivity of 0.90. Calibration, decision-curve, and reclassification analyses (net reclassification improvement and integrated discrimination improvement) were performed. Codes used in developing the DL model are available on GitHub (&lt;span&gt;&lt;span&gt;https://github.com/ESONG1999/Deep-learning-AI-and-RSI-for-patient-level-detection-of-csPCa-on-MRI&lt;/span&gt;&lt;svg&gt;&lt;path&gt;&lt;/path&gt;&lt;/svg&gt;&lt;/span&gt;).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Key findings and limitations&lt;/h3&gt;&lt;div&gt;Neither RSIrs&lt;sub&gt;max&lt;/sub&gt; nor the best DL model combined with RSIrs&lt;sub&gt;max&lt;/sub&gt; significantly outperformed PI-RADS interpretation by expert radiologists. However, when combined with PI-RADS, both approaches significantly improved patient-level csPCa detection, with AUCs of 0.78 (95% confidence interval [CI] 0.75–0.81; &lt;em&gt;p&lt;/em&gt; &lt; 0.001) for RSIrs&lt;sub&gt;max&lt;/sub&gt; + PI-RADS and 0.80 (95% CI 0.77–0.82; &lt;em&gt;p&lt;/em&gt; &lt; 0.001) for the best DL model + PI-RADS, versus 0.75 (95% CI 0.71–0.78) for PI-RADS alone. The absolute gain in specificity at fixed sensitivity of 0.90 was 0.04 (95% CI 0.04–0.04) for RSIrs&lt;sub&gt;max&lt;/sub&gt; + PI-RADS, and 0.03 (95% CI 0.03–0.04) for DL + PI-RADS.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions and clinical implications&lt;/h3&gt;&lt;div&gt;Both RSIrs&lt;sub&gt;max&lt;/sub&gt; and the best DL model demonstrated comparable performance to PI-RADS alone. Addition of either model to PI-RADS significantly enhanced patient-level detection of csPCa in comparison to PI-RADS alone. Limitations include biopsy as an imperfect reference, the exclusion of hip implant cases, lack of external calibration, limited RSI availability, and missing case-level information for individual radiologists and their expertise.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Patient summary&lt;/h3&gt;&lt;di","PeriodicalId":12254,"journal":{"name":"European Urology Open Science","volume":"85 ","pages":"Pages 49-59"},"PeriodicalIF":4.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146190606","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":"Perineural Invasion in Radical Prostatectomy Specimens and Its Association with Biochemical Recurrence and Survival in Prostate Cancer: A Systematic Review and Meta-analysis","authors":"Jakub Karwacki ,&nbsp;Karolina Klasen ,&nbsp;Laura Wojdyło ,&nbsp;Maciej Kaczorowski ,&nbsp;Adam Gurwin ,&nbsp;Agnieszka Hałoń ,&nbsp;Paweł Rajwa ,&nbsp;Fabio Zattoni ,&nbsp;Michael Baboudjian ,&nbsp;Takafumi Yanagisawa ,&nbsp;Patryk Patrzałek ,&nbsp;Wojciech Krajewski ,&nbsp;Tomasz Szydełko ,&nbsp;Bartosz Małkiewicz","doi":"10.1016/j.euros.2026.01.018","DOIUrl":"10.1016/j.euros.2026.01.018","url":null,"abstract":"<div><h3>Background and objective</h3><div>Perineural invasion (PNI) in prostate cancer (PC) has been linked to adverse oncological outcomes. The objective of this study was to evaluate the association between PNI identified in radical prostatectomy (RP) specimens and survival outcomes.</div></div><div><h3>Methods</h3><div>A systematic literature search was conducted in December 2024 using PubMed (MEDLINE), Embase, Scopus, and Web of Science Core Collection databases. We included studies reporting on PNI in RP specimens and its association with primary endpoints (biochemical recurrence [BCR] or BCR-free survival) and/or secondary endpoints (cancer-specific survival [CSS], overall survival, recurrence-free survival, disease-free survival [DFS], or metastasis-free survival).</div></div><div><h3>Key findings and limitations</h3><div>A total of 58 studies met the inclusion criteria. A meta-analysis of 40 studies (27 030 patients) demonstrated that PNI was associated with BCR (pooled hazard ratio [HR] 1.40, 95% confidence interval [CI] 1.28–1.52; <em>p</em> &lt; 0.001). Further analyses showed that PNI was linked to worse CSS (<em>n</em> = 903; pooled HR 2.9, 95% CI 1.1–8.1; <em>p</em> = 0.048). The association with DFS was not statistically significant (<em>n</em> = 1008; pooled HR 1.8, 95% CI 0.7–4.3; <em>p</em> = 0.1). The main limitation is the reliance on predominantly retrospective studies with small samples and high risk of bias.</div></div><div><h3>Conclusions</h3><div>Our findings indicate that PNI identified in RP specimens is associated with higher risk of BCR, as well as worse CSS, which underscores its relevance as a prognostic factor in PC.</div></div><div><h3>Patient summary</h3><div>We found that detection of cancer cells around nerves, which is called perineural invasion (PNI), in specimens after surgery to remove the prostate, is linked to a higher chance of worse survival outcomes in prostate cancer. Men with PNI were more likely to experience biochemical recurrence and had worse cancer-specific survival. PNI may help in identifying patients at higher risk after surgery who could benefit from closer follow-up or additional treatment. However, more high-quality studies are needed to confirm its role in guiding long-term care.</div></div>","PeriodicalId":12254,"journal":{"name":"European Urology Open Science","volume":"85 ","pages":"Pages 99-110"},"PeriodicalIF":4.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146190610","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":"Histology-specific Prognostic Impact of Microscopic Positive Surgical Margins in Renal Cell Carcinoma: Implications for Postoperative Surveillance","authors":"Giacomo Musso ,&nbsp;Margaret F. Meagher ,&nbsp;Mai Dabbas ,&nbsp;Giuseppe Garofano ,&nbsp;Natalie Birouty ,&nbsp;Kit L. Yuen ,&nbsp;Benjamin Baker ,&nbsp;Cesare Saitta ,&nbsp;Dattatraya Patil ,&nbsp;Kazutaka Saito ,&nbsp;Yosuke Yasuda ,&nbsp;Hajime Tanaka ,&nbsp;Francesco Montorsi ,&nbsp;Alberto Briganti ,&nbsp;Andrea Salonia ,&nbsp;Umberto Capitanio ,&nbsp;Alessandro Larcher ,&nbsp;Giuseppe Rosiello ,&nbsp;Yasuhisa Fujii ,&nbsp;Viraj A. Master ,&nbsp;Ithaar H. Derweesh","doi":"10.1016/j.euros.2026.01.009","DOIUrl":"10.1016/j.euros.2026.01.009","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background and objective&lt;/h3&gt;&lt;div&gt;Microscopic positive surgical margins (m-PSM) have been associated with adverse outcomes after surgery in renal cell carcinoma (RCC). However, their role in survival outcomes across RCC histologies remains unclear. Our aim was to evaluate the prognostic impact of m-PSM in clear-cell RCC (ccRCC) versus non–clear-cell RCC (nccRCC).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;We retrospectively analyzed data for 8270 patients who underwent partial (PN) or radical nephrectomy (RN) for RCC. Patients were grouped as ccRCC or nccRCC (including papillary and chromophobe RCC). Outcomes included overall survival (OS), cancer-specific survival (CSS), and recurrence-free survival (RFS). Kaplan-Meier analysis and multivariable Cox regression (CoxPH) were used to assess associations between m-PSM and survival endpoints according to histology.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Key findings and limitations&lt;/h3&gt;&lt;div&gt;Of the 307/8270 patients (3.7%) with m-PSM, 231/6649 (3.5%) were in the ccRCC cohort and 76/1621 (4.7%) in the nccRCC cohort. Patients with m-PSM were more likely to have higher comorbidity, higher pathological grade, locally advanced disease, and PN. Median follow-up was 75 mo (interquartile range 36–126). In ccRCC, m-PSM was negatively associated with OS (5-yr rate: 69% vs 79% for negative margin group; &lt;em&gt;p&lt;/em&gt; = 0.003), CSS (5-yr rate: 79% vs 87%; &lt;em&gt;p&lt;/em&gt; = 0.004), and RFS (5-yr rate: 70% vs 89%; &lt;em&gt;p&lt;/em&gt; = 0.015). On multivariable CoxPH models, m-PSM remained statistically associated with OS (hazard ratio [HR] 1.77, &lt;em&gt;p&lt;/em&gt; = 0.008), CSS (HR 2.01, &lt;em&gt;p&lt;/em&gt; = 0.027), and RFS (HR 2.83, &lt;em&gt;p&lt;/em&gt; = 0.013). In nccRCC, OS and CSS did not differ by margin status, whereas m-PSM was associated with RFS (5-yr rates: 79% vs 94%; &lt;em&gt;p&lt;/em&gt; = 0.002). At CoxPH, m-PSM was associated with recurrence (HR 2.87, &lt;em&gt;p&lt;/em&gt; = 0.024). Limitations include low event numbers in nccRCC and incomplete data on surgical technique detail and adjuvant therapies.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions and clinical implications&lt;/h3&gt;&lt;div&gt;In ccRCC, m-PSM showed consistent associations with overall, cancer-specific and recurrence-free survival. By contrast, in nccRCC, m-PSM was statistically associated with recurrence, while no statistically significant association was observed with OS or CSS within the available follow-up. These findings highlight histology-specific associations between margin status and postoperative outcomes, and further research should focus on investigating the prognostic role of positive surgical margins in the non-clear cell setting.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Patient summary&lt;/h3&gt;&lt;div&gt;We looked at the presence of a microscopic margin positive for tumor after surgery for kidney cancer (KC) and its association with survival. Positive margins were associated with survival outcomes in clear-cell KC, but not in less common histological KC subtypes. Our results provide subtype-specific information on outcomes for these patients after surger","PeriodicalId":12254,"journal":{"name":"European Urology Open Science","volume":"85 ","pages":"Pages 41-48"},"PeriodicalIF":4.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146164693","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":"Machine Learning-based Radiomic Model for Early Diagnosis of Male Urethral Injury in Pelvic Fracture Patients","authors":"Yongdong Pan ,&nbsp;Yubo Gu ,&nbsp;Ruihang Zhang ,&nbsp;Tianzheng Hao ,&nbsp;Jianwen Huang ,&nbsp;Weidong Zhu ,&nbsp;Guoping Song ,&nbsp;Lujie Song","doi":"10.1016/j.euros.2025.12.015","DOIUrl":"10.1016/j.euros.2025.12.015","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background and objective&lt;/h3&gt;&lt;div&gt;Pelvic fracture urethral injury (PFUI) is serious and requires prompt diagnosis. Traditional diagnostic methods, which rely on clinical evaluation and invasive imaging, are subjective and can cause delays. This study aims to utilize machine learning and radiomics to improve the accuracy and efficiency of PFUI diagnosis.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;A retrospective analysis was conducted using computed tomography (CT) imaging data from male patients with pelvic fractures, including 100 cases in the PFUI group and 105 cases in the non-PFUI group. First, the key pelvic bony structures such as the iliac and pubic bones were segmented using the TotalSegmentator tool. Then, two physicians performed interactive correction of fracture areas using the 3D-Slicer tool. Radiomic features, including multidimensional data such as texture, shape, and wavelet transformations, were extracted via PyRadiomics. Core biomarkers were identified using three machine learning–based feature selection methods: random forest (using the Boruta algorithm), least absolute shrinkage and selection operator regression, and support vector machine recursive feature elimination. These consensus features were used to develop a radiomic nomogram (Nomo-score) prediction model. Additionally, clinical variables were combined with these key radiomic features to evaluate the changes in model performance.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Key findings and limitations&lt;/h3&gt;&lt;div&gt;Patients in the PFUI group were significantly more likely to present with bilateral pubic ramus fractures (78% vs 61%, &lt;em&gt;p&lt;/em&gt; = 0.013) and Tile B2 type fractures (15% vs 1.9%, &lt;em&gt;p&lt;/em&gt; = 0.002) than those in the non-PFUI group. The combination of multiple models identified six core wavelet domain features, and the constructed nomogram demonstrated excellent performance in the validation cohort (C-index = 0.85). The Nomo-score of the nomogram was significantly higher in the PFUI group than in the non-PFUI group (&lt;em&gt;p&lt;/em&gt; &lt; 0.05 in both the training and the validation set), with a decision curve analysis confirming its clinical advantage. After combining clinical variables with radiomic features, the combined model demonstrated the best generalization capability (validation area under the curve: 0.94, 95% confidence interval: 0.86–1.00, accuracy: 91.97%, specificity: 90.24%). Indeed, the research was conducted as a single-center retrospective analysis, and the lack of multicenter external validation may restrict the generalizability of the model.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions and clinical implications&lt;/h3&gt;&lt;div&gt;The machine learning model based on pelvic CT radiomics can predict the risk of PFUI. The combined model is the optimal approach for implementation. In the future, it can be integrated into emergency imaging workflows.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Patient summary&lt;/h3&gt;&lt;div&gt;This study developed a machine learning model using pelvic computed tomography images to diagnose urethr","PeriodicalId":12254,"journal":{"name":"European Urology Open Science","volume":"85 ","pages":"Pages 30-40"},"PeriodicalIF":4.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146164047","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}