European Urology Open Science最新文献

{"title":"Risk Prediction Tools for Estimating Surgical Difficulty and Perioperative and Postoperative Outcomes Including Morbidity for Major Urological Surgery: A Concept for the Future of Surgical Planning","authors":"Christopher Soliman ,&nbsp;Jochen Walz ,&nbsp;Niall M. Corcoran ,&nbsp;Patrick Y. Wuethrich ,&nbsp;Nathan Lawrentschuk ,&nbsp;Marc A. Furrer","doi":"10.1016/j.euros.2025.03.012","DOIUrl":"10.1016/j.euros.2025.03.012","url":null,"abstract":"<div><div>Risk assessment plays a critical role in surgical decision-making and influences patient care, resource allocation, surgical planning, and postoperative outcomes. Accurate stratification facilitates better treatment selection and planning, and identification of teaching cases. Existing tools such as POSSUM and the Surgical Apgar Score are widely used but focus primarily on general surgery and often lack urology-specific considerations or integration of intraoperative factors. Urological surgery requires a dedicated tool that accounts for preoperative factors (eg, prostate size, tumour extent), intraoperative findings (eg, fibrosis, adhesions), and patient-specific complexities. We propose a comprehensive scoring system for risk and surgical difficulty that ranges from 0 (no risk) to 100 (procedure abandonment or death) covering five parameter categories: preoperative patient characteristics; intraoperative patient factors; preoperative organ-specific parameters; intraoperative organ-specific factors; and unexpected postoperative conditions. The aims of the proposed system are to improve surgical planning, enhance risk prediction, and identify suitable teaching cases. By incorporating surgeon-specific factors such as case volume and learning curves, the system stratifies procedures by difficulty and can facilitate comparisons between surgeons and hospitals. The system can also promote transparency in patient counselling and may improve the quality of patient consent. Once validated, the scoring system could be integrated into standard practice to improve surgical care, resource allocation, and research efforts. Despite challenges such as comprehensive data collection, this tool offers significant potential to enhance surgical outcomes and multidisciplinary decision-making.</div></div><div><h3>Patient summary</h3><div>Risk assessment is essential in helping surgeons and anaesthetists to make better decisions before, during, and after surgery. The aim of our work is to create a tool that predicts potential risks and challenges during surgery and makes it easier to prepare for these challenges. This tool can improve management of resources and surgical planning, and may ensure smooth recovery after an operation. Finally, it could also help patients and their families to understand the potential risks involved, giving them clearer information about what to expect and making the process more transparent and reassuring.</div></div>","PeriodicalId":12254,"journal":{"name":"European Urology Open Science","volume":"75 ","pages":"Pages 55-60"},"PeriodicalIF":3.2,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143790984","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":"Circulating Tumor DNA and Response to Cisplatin-based Chemotherapy in Patients with Metastatic Urothelial Carcinoma Enrolled in CALGB 90601 (Alliance)","authors":"Brendan J. Guercio ,&nbsp;Karissa Whiting ,&nbsp;Ronak H. Shah ,&nbsp;Karla V. Ballman ,&nbsp;Susan Halabi ,&nbsp;Ashley M. Regazzi ,&nbsp;Jennifer H. Milbank ,&nbsp;Dean F. Bajorin ,&nbsp;Himisha Beltran ,&nbsp;Michael J. Morris ,&nbsp;David B. Solit ,&nbsp;Michael F. Berger ,&nbsp;Gopa Iyer ,&nbsp;Venkatraman Seshan ,&nbsp;Jonathan E. Rosenberg","doi":"10.1016/j.euros.2025.03.009","DOIUrl":"10.1016/j.euros.2025.03.009","url":null,"abstract":"<div><h3>Background and objective</h3><div>Cisplatin-based chemotherapy has been a cornerstone of therapy for advanced/metastatic urothelial cancer (mUC). However, no genomic characteristics have been validated as prognostic biomarkers for this therapy. We sought to identify prognostic biomarkers using plasma cell-free (cf)DNA collected in a phase 3 cooperative group trial.</div></div><div><h3>Methods</h3><div>We analyzed pretreatment cfDNA from a cohort nested in CALGB 90601 (Alliance), a first-line trial of gemcitabine/cisplatin with bevacizumab or placebo in mUC. We examined associations between cfDNA features and overall survival (OS), progression-free survival (PFS), and treatment response.</div></div><div><h3>Key findings and limitations</h3><div>Baseline cfDNA was sequenced from 201 patients with mUC. There was no statistically significant association between alterations in DNA damage response (DDR) genes and response to cisplatin-based chemotherapy (12/24; 50% response rate in DDR+ vs 60/145; 41% response rate in DDR−; <em>p</em> = 0.4), OS (hazard ratio [HR] 0.78, 95% confidence interval [CI] 0.50–1.22; <em>p</em> = 0.3) or PFS (HR 0.77, 95% CI 0.48–1.22; <em>p</em> = 0.3), although the DDR analysis was underpowered owing to the low frequency of DDR gene alterations. Higher variant allele frequency (VAF) in circulating tumor (ct)DNA was associated with shorter OS (HR 2.51, 95% CI 1.26–5.00; <em>p</em> = 0.009) and PFS (HR 2.18, 95% CI 1.02–4.67; <em>p</em> = 0.045). Shorter OS was associated with cfDNA alterations in <em>TERT</em> (HR 1.59, 95% CI 1.15–2.19; <em>p</em> = 0.005), <em>PIK3CA</em> (HR 1.91, 95% CI 1.20–3.04; <em>p</em> = 0.006), and <em>ERBB2</em> (HR 1.64, 95% CI 1.08–2.49; <em>p</em> = 0.019).</div></div><div><h3>Conclusions and clinical implications</h3><div>Among patients with mUC treated with cisplatin-based chemotherapy, high pretreatment VAF in ctDNA and alterations in the <em>TERT</em> promoter, <em>PIK3CA</em>, and <em>ERBB2</em> were associated with poor prognosis.</div></div><div><h3>Patient summary</h3><div>We looked at the link between tumor DNA present in blood and outcomes after chemotherapy for patients with advanced bladder cancer. Higher amounts of tumor DNA in blood and mutations in specific cancer genes were linked to worse survival. The results may help in the design of new studies to improve survival for patients with advanced bladder cancer.</div><div>This trial is registered on ClinicalTrials.gov as NCT00942331.</div></div>","PeriodicalId":12254,"journal":{"name":"European Urology Open Science","volume":"75 ","pages":"Pages 80-88"},"PeriodicalIF":3.2,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143790904","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":"Targeting All Multiple Magnetic Resonance Imaging Prostate Lesions Does Not Enhance Cancer Detection: Insights from the YAU Prostate Cancer Group","authors":"Fabio Zattoni ,&nbsp;Giorgio Gandaglia ,&nbsp;Giancarlo Marra ,&nbsp;Filippo Carletti ,&nbsp;Veeru Kasivisvanathan ,&nbsp;Guillaume Ploussard ,&nbsp;Tamás Fazekas ,&nbsp;Alberto Martini ,&nbsp;Jonathan Olivier ,&nbsp;Peter K. Chiu ,&nbsp;Massimo Valerio ,&nbsp;Alessandro Marquis ,&nbsp;Paolo Gontero ,&nbsp;Hongqian Guo ,&nbsp;Junlong Zhuang ,&nbsp;Francesco Barletta ,&nbsp;Riccardo Leni ,&nbsp;Giuseppe Cirulli ,&nbsp;Alexander Kretschmer ,&nbsp;Maria Apfelbeck ,&nbsp;Giacomo Novara","doi":"10.1016/j.euros.2025.03.008","DOIUrl":"10.1016/j.euros.2025.03.008","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background and objective&lt;/h3&gt;&lt;div&gt;Although diagnostic efficacy of multiparametric magnetic resonance imaging (MRI) in identifying index lesions (ILs) in prostate cancer (PCa) patients is well established, challenges arise when multiple lesions (MLs) are present. Determination of an optimal biopsy strategy for these patients is crucial. This study aims to assess the risk of detecting PCa and clinically significant PCa (csPCa; International Society of Urological Pathology [ISUP] grade group ≥2) when targeting suspicious MRI MLs in addition to the IL.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;We included 1310 biopsy-naïve patients with only a single MRI lesion (SL) and 621 men with MLs. Patients underwent a subsequent targeted biopsy (TBx) of each lesion, along with a systematic biopsy (SBx). We compared TBx alone versus TBx + SBx and evaluated whether the presence of MLs increases the risk of PCa and csPCa using a multivariable logistic regression model (MVA), while accounting for confounders.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Key findings and limitations&lt;/h3&gt;&lt;div&gt;Overall, PCa was detected in 57.6% and 51.2% of IL-TBx for the SL and ML groups, respectively (&lt;em&gt;p&lt;/em&gt; ≤ 0.01). The rates of detection of csPCa with IL-TBx were 46.2% for the SL group and 36.1% for the ML group (&lt;em&gt;p&lt;/em&gt; &lt; 0.01). When combining all TBx and SBx procedures, PCa was detected in 63.8% for the SL group and 67.0% for the ML group (&lt;em&gt;p&lt;/em&gt; = 0.2), while csPCa was detected in 54.1% for the SL group and 48.1% for the ML group (&lt;em&gt;p&lt;/em&gt; = 0.01). SBx yielded PCa detection rates of 58.5% for the SL group and 56.7% for the ML group (&lt;em&gt;p&lt;/em&gt; = 0.5) and csPCa detection rates of 42.1% for the SL group and 38.8% for the ML group (&lt;em&gt;p&lt;/em&gt; = 0.2). ISUP upgrading targeting the 2° and 3° lesions was found in 14 (12.2%) and six (5.2%) cases, respectively. In the MVA, the presence of MLs was identified as an independent predictor of PCa (odds ratio [OR]: 0.6, 95% confidence interval [CI]: 0.5–0.8, &lt;em&gt;p&lt;/em&gt; &lt; 0.01) and csPCa (OR: 0.5, 95% CI: 0.4–0.6, &lt;em&gt;p&lt;/em&gt; &lt; 0.01) in TBx and combined TBx + SBx (PCa: OR: 0.6, 95% CI: 0.5–0.9, &lt;em&gt;p&lt;/em&gt; = 0.02, and (csPCa: OR: 0.4, 95% CI: 0.3–0.7, &lt;em&gt;p&lt;/em&gt; &lt; 0.01), respectively.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions and clinical implications&lt;/h3&gt;&lt;div&gt;Patients with MLs have a lower risk of PCa and csPCa. In case of MLs, a TBx of the IL + a concomitant SBx allows for the diagnosis of the vast majority of PCa and csPCa cases. The added value of a second TBx on the non-IL is modest, including only a 5.6% increase in the diagnosis of csPCa.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Patient summary&lt;/h3&gt;&lt;div&gt;We studied whether targeting multiple suspicious areas on prostate magnetic resonance imaging increases cancer detection. We found that patients with multiple lesions had a lower risk of prostate cancer than those with a single lesion. Targeting the largest suspicious area along with sampling the entire prostate led to the detection of most cancer cases, with littl","PeriodicalId":12254,"journal":{"name":"European Urology Open Science","volume":"75 ","pages":"Pages 61-68"},"PeriodicalIF":3.2,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143785709","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":"How Does Routine Prostate-specific Membrane Antigen Positron Emission Tomography/Computed Tomography Modify the Current Management of Prostate Cancer? A Multidisciplinary View","authors":"Daniela E. Oprea-Lager ,&nbsp;Tessa van Elst ,&nbsp;Shafak Aluwini ,&nbsp;Els Dewulf ,&nbsp;Henk van der Poel ,&nbsp;Herman Stoevelaar ,&nbsp;Chris H. Bangma ,&nbsp;Aart Beeker ,&nbsp;Steve Boudewijns ,&nbsp;Tom Budiharto ,&nbsp;Igle-Jan de Jong ,&nbsp;Kim C. de Vries ,&nbsp;Maarten L. Donswijk ,&nbsp;Jurgen J. Fütterer ,&nbsp;Paul Hamberg ,&nbsp;Linda Heijmen ,&nbsp;Robert J. Hoekstra ,&nbsp;Thomas M.A. Kerkhofs ,&nbsp;Jules Lavalaye ,&nbsp;Daphne Luijendijk-de Bruin ,&nbsp;Niven Mehra","doi":"10.1016/j.euros.2025.03.007","DOIUrl":"10.1016/j.euros.2025.03.007","url":null,"abstract":"<div><h3>Background and objective</h3><div>Prostate-specific membrane antigen positron emission tomography/computed tomography (PSMA-PET/CT) and new treatment modalities have expanded the possibilities for diagnosing and managing metastatic prostate cancer, but have also raised questions about their implementation in daily clinical practice. We sought consensus on definitions, preferred imaging modality for staging, and treatment selection in the era of next-generation imaging.</div></div><div><h3>Methods</h3><div>A modified Delphi method involved two voting rounds and a face-to-face multidisciplinary meeting with 40 Dutch prostate cancer (PCa) experts. Consensus was reached if ≥75% of the panellists chose the same option. Appropriateness was assessed by the RAND Corporation/University of California Los Angeles appropriateness method.</div></div><div><h3>Key findings and limitations</h3><div>There was consensus on performing metastatic screening with PSMA-PET/CT for unfavourable intermediate- or high-risk PCa. PSMA-PET/CT findings were considered feasible for determining treatment in synchronous metastatic hormone-sensitive prostate cancer, but there was no agreement on the validity of the CHAARTED criteria for interpreting the PSMA-PET/CT findings. If the PSMA-PET/CT findings led to upstaging after conventional imaging, 76% of panellists would opt for treatment intensification. In case of downstaging, 71% would choose for deintensification. Panellists would generally treat patients based on metastatic disease volume as per the CHAARTED criteria, except for bulky low-volume disease (LVD) and LVD with multiple (more than ten) bone metastases, all within the axial skeleton. This would be classified as LVD but treated as high-volume disease. Limitations are that the statements are largely consensus based and originate from a national (Dutch) perspective.</div></div><div><h3>Conclusions and clinical implications</h3><div>PSMA-PET/CT was considered the preferred modality for initial PCa staging, which is nowadays the standard of care in The Netherlands. The majority of panellists would incorporate PSMA-PET/CT findings for treatment planning, including intensification and deintensification, but the criteria for interpreting metastatic disease volume on PSMA-PET/CT are still uncertain.</div></div><div><h3>Patient summary</h3><div>A group of Dutch medical specialists discussed on how to diagnose metastatic hormone-sensitive prostate cancer and choose the most appropriate treatment for patients with this condition. It was concluded that imaging based on Prostate-specific membrane antigen (PSMA) positron emission tomography (PET) helps determine appropriate treatment options, with most experts supporting treatment adjustments based on PSMA-PET/computed tomography (CT) results. However, there is still some uncertainty about the criteria for interpreting the extent of metastatic disease with PSMA-PET/CT.</div></div>","PeriodicalId":12254,"journal":{"name":"European Urology Open Science","volume":"75 ","pages":"Pages 69-79"},"PeriodicalIF":3.2,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143785710","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":"Classification of Urinary Tract Infections in 2025: Moving Beyond Uncomplicated and Complicated","authors":"Gernot Bonkat ,&nbsp;Florian Wagenlehner ,&nbsp;Tommaso Cai ,&nbsp;Suzanne Geerlings ,&nbsp;José Medina-Polo ,&nbsp;Bela Köves ,&nbsp;Adrian Pilatz ,&nbsp;Laila Schneidewind ,&nbsp;Sören Schubert ,&nbsp;Rajan Veeratterapillay ,&nbsp;Kathrin Bausch ,&nbsp;Wout Devlies ,&nbsp;Lorenz Leitner ,&nbsp;Guglielmo Mantica ,&nbsp;Fabian Peter Stangl ,&nbsp;Jennifer Kranz","doi":"10.1016/j.euros.2025.03.010","DOIUrl":"10.1016/j.euros.2025.03.010","url":null,"abstract":"","PeriodicalId":12254,"journal":{"name":"European Urology Open Science","volume":"75 ","pages":"Pages 44-47"},"PeriodicalIF":3.2,"publicationDate":"2025-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143784023","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":"Development and Validation of an Algorithm for Segmentation of the Prostate and its Zones from Three-dimensional Transrectal Multiparametric Ultrasound Images","authors":"Daniel L. van den Kroonenberg ,&nbsp;Florian T. Delberghe ,&nbsp;Auke Jager ,&nbsp;Arnoud W. Postema ,&nbsp;Harrie P. Beerlage ,&nbsp;Wim Zwart ,&nbsp;Massimo Mischi ,&nbsp;Jorg R. Oddens","doi":"10.1016/j.euros.2025.03.005","DOIUrl":"10.1016/j.euros.2025.03.005","url":null,"abstract":"<div><h3>Background and objective</h3><div>Multiparametric ultrasound (mpUS) is being investigated as an alternative to magnetic resonance imaging (MRI) for detection of prostate cancer (PC). Automated prostate segmentation facilitates workflows, and zonal segmentation can aid in PC diagnosis, accounting for differences in imaging characteristics and tumor incidence. Our aim was to develop a deep learning algorithm that can automatically segment the prostate and its zones on three-dimensional (3D) contrast-enhanced ultrasound (CEUS) and conventional brightness-mode (B-mode) images (NCT04605276).</div></div><div><h3>Methods</h3><div>A total of 259 3D mpUS images were collected from men with suspicion for PC in a prospective multicenter trial to develop a computer-aided diagnosis system for PC. Manual segmentation was performed using a custom tool, and an algorithm was developed using a convolutional neural network based on the U-Net architecture.</div></div><div><h3>Key findings and limitations</h3><div>Cross-validation of the automated segmentation algorithm revealed Dice similarity coefficients (DSCs) of 0.91 (95% confidence interval [CI] 0.90–0.91) for CEUS and 0.94 (95% CI 0.93–0.94) for B-mode ultrasound for 3D prostate segmentation. Zonal segmentation was less accurate, with DSCs of 0.83 (95% CI 0.82–0.84) for CEUS and 0.86 (95% CI 0.85–0.87) for B-mode ultrasound. There was high agreement for prostate volume between automatic segmentation on CEUS and physician-estimated volumes on MRI (R² = 0.96). Qualitative assessment of prostate segmentation using a scale from 1 to 5 revealed a median grade of 5 (interquartile range [IQR] 4–5) for manual segmentation and 4 (IQR 4–5) for automated segmentation (<em>p</em> = 0.10).</div></div><div><h3>Conclusions and clinical implications</h3><div>Our deep learning algorithm demonstrated strong performance for automatic prostate and zonal segmentation from 3D CEUS and B-mode ultrasound images.</div></div><div><h3>Patient summary</h3><div>We developed a computer tool to automatically identify the prostate in three-dimensional ultrasound images. The results show high accuracy and closely match manual assessments by urologists. This tool has potential for use in a computer-aided diagnostic system for prostate cancer.</div></div>","PeriodicalId":12254,"journal":{"name":"European Urology Open Science","volume":"75 ","pages":"Pages 48-54"},"PeriodicalIF":3.2,"publicationDate":"2025-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143784024","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":"Editorial on the Abstracts from the 22nd Meeting of the Association of Academic European Urologists (AAEU)","authors":"John Heesakkers (Secretary General),&nbsp;Frans Debruyne (Honorary Communications Officer),&nbsp;Christopher Chapple (22nd AAEU Meeting President)","doi":"10.1016/j.euros.2025.01.007","DOIUrl":"10.1016/j.euros.2025.01.007","url":null,"abstract":"","PeriodicalId":12254,"journal":{"name":"European Urology Open Science","volume":"75 ","pages":"Page 43"},"PeriodicalIF":3.2,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143759798","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":"Prognostic Factors for Pregnancy and Patency Rates After Microsurgery for Obstruction of the Upper Seminal Tract: A Retrospective Single-surgeon Series of 336 Cases","authors":"Marco A. Sieber ,&nbsp;Jan Blaser ,&nbsp;Roland Seiler ,&nbsp;Dominik Abt ,&nbsp;Jennifer Blarer ,&nbsp;Adrian Sieber","doi":"10.1016/j.euros.2024.08.010","DOIUrl":"10.1016/j.euros.2024.08.010","url":null,"abstract":"<div><h3>Background and objective</h3><div>To achieve optimal results in treating vasal obstruction, microsurgery is the standard of care. However, not all vasovasostomy (VV) or vasoepididymostomy (VE) procedures lead to subsequent pregnancy. Identification of parameters that can predict success in restoring fertility is clinically relevant. We evaluated various parameters in relation to patency and pregnancy outcomes in a retrospective single-surgeon series.</div></div><div><h3>Methods</h3><div>We analysed data for 336 men with azoospermia due to vasal obstruction who underwent microsurgery to restore fertility. Seminal fluid was harvested intraoperatively from the testicular stump for analysis of gross quality. Intraoperative parameters, time to conception, patency rate, age of the female partner, and time from vasectomy to reconstruction were assessed in relation to pregnancy outcomes. Multivariable logistic regression was performed to identify independent prognostic parameters.</div></div><div><h3>Key findings and limitations</h3><div>The median age at surgery was 42 (range 27–70) yr for the men and 33 (range 19–46) yr for their female partners. The overall patency rate after surgery was 86.8% (236/272). Secondary obstruction occurred in 14/272 men (5.1%). Pregnancy was achieved in 127/258 couples (49.2%). The most significant predictor of successful treatment was the obstruction time (<em>p</em> &lt; 0.01), with significantly lower success rates for longer times since vasectomy. None of the intraoperative parameters we analysed was associated with subsequent pregnancy. The primary limitation of our study is its retrospective design.</div></div><div><h3>Conclusions and clinical implications</h3><div>Patency and pregnancy rates in our series are similar to rates reported in the literature. Pregnancy success after vasectomy reversal mainly depends on the time since vasectomy. Additional biomarkers are needed to predict postoperative pregnancy outcomes.</div></div><div><h3>Patient summary</h3><div>In our study, nearly 87% of men were fertile again after surgery to reverse a vasectomy, and about half of the couples were then able to get pregnant. The key factor for success was the time since vasectomy, with better results for shorter times. More research is needed to find reliable ways to predict if a couple will get pregnant after this surgery.</div></div>","PeriodicalId":12254,"journal":{"name":"European Urology Open Science","volume":"75 ","pages":"Pages 37-42"},"PeriodicalIF":3.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143747188","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":"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}