International Journal of Urology最新文献

{"title":"Urinary Extracellular Vesicle–Associated EphA2 Predicts Intravesical Recurrence in Bladder Cancer","authors":"Mamoru Hashimoto,&nbsp;Eisuke Tomiyama,&nbsp;Lan Inoki,&nbsp;Koji Miki,&nbsp;Takahito Nakayama,&nbsp;Saizo Fujimoto,&nbsp;Shingo Toyoda,&nbsp;Takashi Kikuchi,&nbsp;Ryo Ukekawa,&nbsp;Yutaka Yamamoto,&nbsp;Takafumi Minami,&nbsp;Kazuhiro Yoshimura,&nbsp;Norio Nonomura,&nbsp;Kazutoshi Fujita","doi":"10.1111/iju.70656","DOIUrl":"10.1111/iju.70656","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To examine the clinical usefulness of EphA2 detected on urinary extracellular vesicles (uEphA2) for bladder cancer detection and for estimating the risk of intravesical recurrence after transurethral resection of bladder tumor (TURBT).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>An enzyme-linked immunosorbent assay was established to measure EphA2-positive urinary extracellular vesicles. The diagnostic cohort comprised 191 participants, including 120 patients with bladder cancer and 71 controls.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>uEphA2 concentrations were higher in patients with bladder cancer than in controls. Receiver operating characteristic analysis yielded an area under the curve of 0.679, with 46.7% sensitivity and 87.3% specificity. Among patients evaluable for post-TURBT recurrence, high uEphA2 levels were associated with shorter intravesical recurrence-free survival. This association remained significant in multivariable Cox regression analysis after adjustment for the EORTC risk score and age.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>uEphA2 showed modest diagnostic accuracy but high specificity and was independently associated with intravesical recurrence. These results support its potential use as a non-invasive urinary marker for post-TURBT risk stratification.</p>\u0000 </section>\u0000 </div>","PeriodicalId":14323,"journal":{"name":"International Journal of Urology","volume":"33 10","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13659636/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149181542","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 Prior Holmium Laser Enucleation of the Prostate on Outcomes After Robot-Assisted Radical Prostatectomy","authors":"Takato Nishino,&nbsp;Masaki Shimbo,&nbsp;Tomohiko Oguchi,&nbsp;Masayuki Sano,&nbsp;Kazutaka Narimoto,&nbsp;Kazunori Hattori,&nbsp;Fumiyasu Endo","doi":"10.1111/iju.70651","DOIUrl":"10.1111/iju.70651","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>We investigated whether prior holmium laser enucleation of the prostate (HoLEP) influences perioperative, oncologic, and continence outcomes following robot-assisted radical prostatectomy (RARP).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A total of 419 patients who underwent RARP, including 27 with prior HoLEP, were retrospectively analyzed using 1:2 propensity score matching. Urinary continence was assessed longitudinally using pad counts at scheduled intervals, with 12-month continence as the primary endpoint. Secondary endpoints included perioperative outcomes and biochemical recurrence (BCR).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>No significant differences were observed in perioperative outcomes, pathological findings, or BCR-free survival between patients with and without prior HoLEP. At 12 months, functional continence (≤ 1 pad/day) was achieved in 100.0% of patients without prior HoLEP and in 85.2% of those with prior HoLEP (<i>p</i> = 0.011). Kaplan–Meier analysis demonstrated no significant difference in time to recovery (log-rank <i>p</i> = 0.068); however, a subset of patients with prior HoLEP experienced persistent incontinence beyond 12 months. Exploratory analyses implied an association between longer adjunctive transurethral coagulation time during HoLEP and worse functional continence.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Perioperative and oncologic outcomes after RARP were generally comparable regardless of prior HoLEP in this cohort. However, persistent incontinence at 12 months may occur in a subset of patients with prior HoLEP.</p>\u0000 </section>\u0000 </div>","PeriodicalId":14323,"journal":{"name":"International Journal of Urology","volume":"33 10","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149169803","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development of an Improved Cadaveric Training Model for Endoscopic Combined Intrarenal Surgery Using Fresh-Frozen Cadavers","authors":"Keito Shiozaki,&nbsp;Yutaro Sasaki,&nbsp;Katsuhito Hori,&nbsp;Marika Atagi,&nbsp;Ryota Nakanishi,&nbsp;Keisuke Hashimoto,&nbsp;Koki Tada,&nbsp;Fumiya Kadoriku,&nbsp;Takuya Yoshioka,&nbsp;Kyotaro Fukuta,&nbsp;Yuichiro Atagi,&nbsp;Saki Kobayashi,&nbsp;Ryoei Minato,&nbsp;Ryotaro Tomida,&nbsp;Yoshito Kusuhara,&nbsp;Kunihisa Yamaguchi,&nbsp;Tomoya Fukawa,&nbsp;Hirofumi Izaki,&nbsp;Koichi Tomita,&nbsp;Junya Furukawa","doi":"10.1111/iju.70671","DOIUrl":"10.1111/iju.70671","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Endoscopic combined intrarenal surgery (ECIRS) is technically demanding and has a prolonged learning curve. Reports describing ECIRS training using fresh-frozen cadavers are limited, partly because intrarenal and pyelovenous backflow may prevent adequate hydronephrosis. This study aimed to establish an optimized ECIRS training model using fresh-frozen cadavers.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>ECIRS cadaver surgical training (ECIRS-CST) was conducted between April 2021 and October 2022 and evaluated across two periods. In the first period, standard ECIRS-CST was performed. In the second period, laparoscopic nephrectomy training with renal vein clipping was performed before ECIRS-CST to suppress pyelovenous backflow. Achievement of each ECIRS step and overall procedural completion were recorded. Participants assessed procedural realism and educational value using a custom-designed 5-point Likert-scale questionnaire.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Nine sessions were conducted in the first period and four in the second. During the first period, ultrasound-guided nephrostomy puncture frequently failed because adequate hydronephrosis could not be established, and only three sessions progressed through all ECIRS steps. In the second period, renal vein clipping enabled more consistent hydronephrosis, resulting in successful nephrostomy puncture and completion of all steps in three of four sessions. Questionnaire responses indicated that tactile feedback during puncture, ultrasonographic visualization, and endoscopic findings were comparable to those in live patients. Many participants reported difficulty in achieving sufficient hydronephrosis during the first period.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Fresh-frozen cadavers provide a realistic environment for ECIRS training; however, pyelovenous backflow limits the creation of adequate hydronephrosis. Renal vein clipping effectively addresses this limitation and provides a more reliable training model for procedural training.</p>\u0000 </section>\u0000 </div>","PeriodicalId":14323,"journal":{"name":"International Journal of Urology","volume":"33 10","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13659635/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149181614","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":"Factors Associated With Trifecta and Pentafecta Achievement in Robot-Assisted Laparoscopic Partial Nephrectomy for Highly Complex Renal Tumors","authors":"Hiroki Ishihara,&nbsp;Koichi Nishimura,&nbsp;Yuki Kobari,&nbsp;Hironori Fukuda,&nbsp;Kazuhiko Yoshida,&nbsp;Tsunenori Kondo,&nbsp;Toshio Takagi","doi":"10.1111/iju.70670","DOIUrl":"10.1111/iju.70670","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Robot-assisted laparoscopic partial nephrectomy (RAPN) for highly complex renal tumors can be challenging. However, determinants of oncological and functional outcomes after RAPN in this high-risk population remain poorly characterized.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We retrospectively evaluated the clinical data of 396 consecutive patients who underwent RAPN for cT1N0M0 renal tumors of high complexity, defined as a RENAL nephrectomy score ≥ 10. Factors associated with trifecta (negative surgical margin, warm ischemic time ≤ 25 min, and no surgical complications) and pentafecta achievement (≥ 90% estimated glomerular filtration rate preservation and no chronic kidney disease stage upgrade at 1 year postoperatively, along with trifecta achievement) were investigated.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Trifecta was achieved in 201 patients (51%). Multivariable analysis showed that right-side tumors (<i>p</i> = 0.0217), non-hilar tumors (<i>p</i> = 0.0056), shorter operating times (<i>p</i> &lt; 0.0001), and unexposed urinary systems (<i>p</i> = 0.0022) were independent factors for trifecta achievement. Among 334 patients with eligible data for pentafecta evaluation, 104 (31%) achieved pentafecta. After covariate adjustment, non-hilar tumors (<i>p</i> = 0.0449), shorter operating times (<i>p</i> = 0.0003), and unexposed urinary systems (<i>p</i> = 0.0004) were independent factors for pentafecta achievement.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Factors associated with trifecta and pentafecta achievement after RAPN were identified for highly complex renal tumors. These perioperative factors may be utilized for postoperative outcome prediction after RAPN in this challenging population.</p>\u0000 </section>\u0000 </div>","PeriodicalId":14323,"journal":{"name":"International Journal of Urology","volume":"33 10","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149165837","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":"From Biofluid Detectability to Bladder-Cancer-Specific Validation: Interpreting CTSV as a Noninvasive Biomarker","authors":"Di Zeng,&nbsp;Jin Li","doi":"10.1111/iju.70650","DOIUrl":"10.1111/iju.70650","url":null,"abstract":"","PeriodicalId":14323,"journal":{"name":"International Journal of Urology","volume":"33 10","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149167224","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":"Editorial Comments to Instructional Design for Surgical Novices Based on Cognitive Load Theory: Implications for Urologic Surgery Training","authors":"Kento Morozumi","doi":"10.1111/iju.70665","DOIUrl":"10.1111/iju.70665","url":null,"abstract":"","PeriodicalId":14323,"journal":{"name":"International Journal of Urology","volume":"33 10","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149136278","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":"Editorial Comment to “Depressive Symptom Severity Is Associated With IPSS and ICIQ-SF Scores but Not Overactive Bladder in Japanese Male Never-Smokers”","authors":"Shingo Hatakeyama","doi":"10.1111/iju.70669","DOIUrl":"10.1111/iju.70669","url":null,"abstract":"","PeriodicalId":14323,"journal":{"name":"International Journal of Urology","volume":"33 10","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149136327","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":"Quantitative Evaluation of Pharmacologic Synergy for Neoadjuvant Enfortumab Vedotin Plus Pembrolizumab in Muscle-Invasive Bladder Cancer: A Copula-Based Secondary Analysis","authors":"Riko Ikeda,&nbsp;Soichiro Yoshida,&nbsp;Wei Chen,&nbsp;Motohiro Fujiwara,&nbsp;Shugo Yajima,&nbsp;Hiroshi Fukushima,&nbsp;Yosuke Yasuda,&nbsp;Hajime Tanaka,&nbsp;Hiroyuki Sato,&nbsp;Akihiro Hirakawa,&nbsp;Yasuhisa Fujii","doi":"10.1111/iju.70667","DOIUrl":"10.1111/iju.70667","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Perioperative treatment with enfortumab vedotin (EV) plus pembrolizumab has demonstrated a high pathological complete response (pCR) rate in patients with cisplatin-ineligible muscle-invasive bladder cancer (MIBC). However, whether this therapeutic benefit reflects true pharmacologic synergy or can be explained by independent drug action (IDA) remains uncertain.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We analyzed data from EV-103 cohort H (EV monotherapy), the cisplatin-ineligible subset of PURE-01 (pembrolizumab monotherapy), and KEYNOTE-905/EV-303 (EV plus pembrolizumab). An IDA model incorporating a Gaussian copula was applied to estimate the predicted pCR rate of the combination therapy. The primary analysis assumed weak positive dependence between drug responses (correlation coefficient <i>ρ</i> = 0.24). Sensitivity analyses evaluated the observed-minus-IDA-predicted pCR difference across a continuous range of dependence assumptions (<i>ρ</i> = 0.00–0.99).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The predicted pCR rate for EV plus pembrolizumab was 53.5%, consisting of 21.4% EV-only responders, 17.1% pembrolizumab-only responders, and 15.0% dual responders. The observed pCR rate in the KEYNOTE-905/EV-303 trial was 57.1%, corresponding to an absolute difference of 3.6 percentage points compared with the model prediction. In sensitivity analyses, the posterior median observed-minus-predicted difference increased with stronger positive dependence, but the 95% credible intervals were wide and included zero across a broad range of dependence assumptions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Although modest pharmacologic synergy cannot be excluded given the uncertainty in the available data, substantial population-level pharmacologic synergy is not required to explain the high pCR observed with the combination.</p>\u0000 </section>\u0000 </div>","PeriodicalId":14323,"journal":{"name":"International Journal of Urology","volume":"33 10","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149127451","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":"Treatment-Effect Heterogeneity and a Simple Framework for Estimating Survival Benefit Associated With Local Therapy in Nonmetastatic Advanced Prostate Cancer: A Multicenter KAMU-ON Cohort Study","authors":"Hiroaki Iwamoto,&nbsp;Kouji Izumi,&nbsp;Kazuaki Machioka,&nbsp;Ren Toriumi,&nbsp;Takashi Shima,&nbsp;Masakazu Nozaki,&nbsp;Tomohiro Hori,&nbsp;Takahiro Inaba,&nbsp;Ryunosuke Nakagawa,&nbsp;Taiki Kamijima,&nbsp;Suguru Kadomoto,&nbsp;Tomoyuki Makino,&nbsp;Renato Naito,&nbsp;Hiroshi Yaegashi,&nbsp;Kazuyoshi Shigehara,&nbsp;Takahiro Nohara,&nbsp;Tohru Miyagi,&nbsp;Chikashi Seto,&nbsp;Yoshifumi Kadono,&nbsp;Atsushi Mizokami","doi":"10.1111/iju.70668","DOIUrl":"10.1111/iju.70668","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To evaluate treatment-effect heterogeneity associated with local therapy in nonmetastatic advanced prostate cancer and develop a simple hypothesis-generating framework to estimate the expected absolute survival benefit associated with local therapy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This multicentre retrospective cohort study included 1198 patients with clinical T3–4N0M0 or cN1M0 prostate cancer from the Kaga Million Uro-Oncology Network (KAMU-ON). Multivariable Cox models evaluated the association between local therapy and overall survival. Treatment-effect heterogeneity was assessed using interaction analyses. Adjusted 5 year overall survival and absolute survival benefit were estimated by <i>g</i>-computation. A simple clinical framework based on clinicopathological variables was derived from the subgroup analyses.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Local therapy was independently associated with improved overall survival (adjusted hazard ratio 0.32, 95% confidence interval 0.21–0.48; <i>p</i> &lt; 0.001). Significant treatment-effect heterogeneity was observed according to clinical T stage (<i>p</i> for interaction = 0.030). The greatest absolute survival benefits were observed in patients with clinical T3b/T4 disease (20.3 percentage points) and Grade Group 4–5 disease (17.2 percentage points). The framework stratified the estimated absolute survival benefit from 0.1 to 19.5 percentage points across score groups (<i>p</i> for interaction = 0.041; <i>p</i> for trend = 0.023).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The survival benefit associated with local therapy varied substantially across patients with nonmetastatic advanced prostate cancer. This hypothesis-generating framework may provide estimates of expected treatment benefit and support individualized treatment discussions.</p>\u0000 </section>\u0000 </div>","PeriodicalId":14323,"journal":{"name":"International Journal of Urology","volume":"33 10","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149127440","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":"Intravesical and Intraurethral Indocyanine Green for Structural Guidance During Robot-Assisted Radical Prostatectomy: An Exploratory Trial","authors":"Hiromitsu Negoro,&nbsp;Satoshi Nitta,&nbsp;Kozaburo Tanuma,&nbsp;Masanobu Shiga,&nbsp;Yoshiyuki Nagumo,&nbsp;Hiroyuki Nishiyama","doi":"10.1111/iju.70666","DOIUrl":"10.1111/iju.70666","url":null,"abstract":"&lt;p&gt;Accurate delineation of the bladder neck–prostate junction and precise apical urethral transection are technically demanding steps in robot-assisted radical prostatectomy (RARP). Bladder neck identification usually relies on intraoperative cues such as urethral catheter-balloon manipulation, prostate morphology, and bladder wall thickness, but anatomic variation can make the incision line and dissection plane indistinct. At the apex, urethral transection is critical for oncological control and functional preservation.&lt;/p&gt;&lt;p&gt;Near-infrared (NIR) fluorescence imaging using indocyanine green (ICG) is used in robotic urological surgery for applications such as neurovascular bundle angiography [&lt;span&gt;1&lt;/span&gt;]. Intraluminal ICG has been explored for urethral identification in transanal total mesorectal excision [&lt;span&gt;2, 3&lt;/span&gt;] and robot-assisted simple prostatectomy [&lt;span&gt;4&lt;/span&gt;]. Intravesical ICG has been used for bladder identification in gynecological surgery [&lt;span&gt;5&lt;/span&gt;], and a low-concentration washout study suggested the feasibility of bladder visualization [&lt;span&gt;6&lt;/span&gt;]. An ICG-coated Foley catheter has also been described for identifying the bladder neck and apical urethra in Retzius-sparing RARP [&lt;span&gt;7&lt;/span&gt;]. However, the utility of intravesical ICG for bladder neck dissection and urethral transection during standard RARP remains unclear.&lt;/p&gt;&lt;p&gt;We conducted a prospective exploratory trial in six patients undergoing RARP using the da Vinci Xi system with Firefly NIR imaging. Because intravesical ICG use was off-label, the study was conducted as specified clinical research under Japanese regulations. The intravesical concentration was empirically set at 2 mg/100 mL saline, based on prior human intravesical use and low-concentration washout data [&lt;span&gt;5, 6&lt;/span&gt;], because excessive concentrations may reduce fluorescence through quenching. After posterior seminal vesicle dissection and Retzius-space development, the endopelvic fascia was opened and ICG was instilled through the indwelling urethral catheter. The bladder was filled with 150 mL, observed immediately with the catheter clamped, and drained. From Case 2 onward, intraurethral ICG was delivered via a ureteral catheter alongside the Foley catheter, with the Foley balloon inflated by approximately 3 mL. Six different surgeons, all registered study investigators, performed one procedure each. Usefulness was scored immediately after RARP by the operating surgeon using a five-point Likert scale (1 = not useful; 5 = very useful). The primary assessment was intravesical ICG for bladder neck identification/dissection; the secondary assessment was intraurethral ICG for identifying the dorsal vein complex (DVC) transection landmark and apical urethral transection site.&lt;/p&gt;&lt;p&gt;Figure 1 summarizes representative images, patient/perioperative characteristics, and usefulness scores. ICG leakage after mucosal incision was managed by suction and saline irrigation, and no ICG-related","PeriodicalId":14323,"journal":{"name":"International Journal of Urology","volume":"33 10","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/iju.70666","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149127414","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}