Therapeutic Advances in Urology最新文献

{"title":"Effect of needle disinfection with different antiseptic agents on infectious complications after TRUS-guided prostate biopsy: a prospective randomized study.","authors":"Mustafa Serdar Çağlayan, Mustafa Kestel, Musa Ekici, Cemil Aydin, Muhammet İhsan Öztürk, Ahmet Taşcı, Mehmet Murat Baykam","doi":"10.1177/17562872261458100","DOIUrl":"10.1177/17562872261458100","url":null,"abstract":"<p><strong>Background: </strong>Transrectal ultrasound-guided prostate biopsy (TRUS-guided biopsy) remains widely used for the diagnosis of prostate cancer, but it is associated with a risk of infectious complications despite antibiotic prophylaxis.</p><p><strong>Objectives: </strong>To evaluate the effect of disinfecting the prostate biopsy needle with different antiseptic agents after each core sampling on post-procedural infectious complications.</p><p><strong>Design: </strong>A prospective, randomized, single-center clinical study.</p><p><strong>Methods: </strong>Between February and May 2025, 240 patients undergoing TRUS-guided prostate biopsy were randomly assigned to four groups (<i>n</i> = 60 each): no needle disinfection, povidone-iodine disinfection, 10% formalin disinfection, or 70% isopropyl alcohol disinfection after each biopsy core. All patients received standardized empirical antibiotic prophylaxis based on the institutional protocol and local antibiogram data. Prophylaxis consisted of oral cefixime initiated on the day of biopsy and continued for 5-7 days. Patients were actively followed for 30 days for febrile urinary tract infection, hospitalization, sepsis, and microbiological culture results.</p><p><strong>Results: </strong>The rate of febrile urinary tract infection was highest in the non-disinfection group (11.6%). No cases of fever, hospitalization, or sepsis were observed in the formalin group. Povidone-iodine and isopropyl alcohol disinfection were associated with lower infection rates than no disinfection, but were less effective than formalin. <i>Escherichia coli</i> was the most frequently isolated microorganism in positive cultures.</p><p><strong>Conclusion: </strong>Disinfection of the biopsy needle after each core sampling is associated with a meaningful reduction in infectious complications following TRUS-guided prostate biopsy. Among the evaluated agents, 10% formalin demonstrated the greatest protective effect; however, further multicenter studies with longer follow-up are required to confirm long-term safety and generalizability.</p><p><strong>Trial registration: </strong>This trial was prospectively registered at ClinicalTrials.gov (Identifier: NCT06836271; Local trial ID: HititUrology001).</p>","PeriodicalId":23010,"journal":{"name":"Therapeutic Advances in Urology","volume":"18 ","pages":"17562872261458100"},"PeriodicalIF":3.5,"publicationDate":"2026-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13305399/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148346282","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Renal metastasis of adenocarcinoma of the gastrointestinal tract with unknown primary site: a case report and review of the literature.","authors":"Jiacheng Li, Xiaoyuan Ren, Zhiyuan Wang, Yanxin Zhuang, Yelinaer Baoerbieke, Yishuai Zhang, Jin Zeng","doi":"10.1177/17562872261458108","DOIUrl":"10.1177/17562872261458108","url":null,"abstract":"<p><p>Cancer of unknown primary (CUP) is an aggressive malignancy with a persistently poor prognosis. Renal metastases from an occult primary adenocarcinoma are exceptionally rare and diagnostically challenging, frequently mimicking primary kidney cancer. This case report details a rare instance of metastatic adenocarcinoma to the kidney from an occult primary origin, initially misclassified as primary renal cell carcinoma. A 60-year-old male patient was admitted to our department for further evaluation of a cystic-solid right renal mass. Staging revealed synchronous extrarenal metastases. Subsequent immunohistochemical analysis indicated gastrointestinal differentiation, yet exhaustive diagnostic workup failed to identify the primary tumor site. The patient underwent radical nephrectomy followed by biomarker-guided FLOT (fluorouracil, leucovorin, oxaliplatin, and docetaxel) chemotherapy combined with camrelizumab immunotherapy, achieving a progression-free survival of approximately 7 months, accompanied by a temporary decline in tumor markers. Tumor recurrence manifested at 11 months postoperatively as pulmonary progression, at which point retrospective molecular profiling of the archived specimen revealed an <i>ERBB2</i> amplification, providing a molecular rationale for subsequent targeted therapy. This case highlights the crucial roles of multidisciplinary collaboration and molecular technology in resolving diagnostic dilemmas and identifying actionable targets in CUP. It offers two key clinical takeaways: diagnostically, a solitary kidney mass with other metastases should prompt consideration of a renal metastasis, even though primary kidney cancer is more common. Therapeutically, while the identified biomarker provided a rationale for precision therapy, the resulting clinical benefit was limited and transient. This suggests that the aggressive biology and spatial heterogeneity typical of CUP can attenuate the long-term efficacy of biomarker-guided interventions.</p>","PeriodicalId":23010,"journal":{"name":"Therapeutic Advances in Urology","volume":"18 ","pages":"17562872261458108"},"PeriodicalIF":3.5,"publicationDate":"2026-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13305525/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148346313","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predisposing factors for angioembolization in persistent hematuria after percutaneous nephrolithotomy: a retrospective analysis.","authors":"Ali Alfiel, Abdolreza Mohammadi, Mohammad Mahdi Mehrabi, Sara Ashtari, Farshid Alaedini, Fateme Guitynavard, Parsa Nikoofar, Seyed Mohammad Kazem Aghamir","doi":"10.1177/17562872261458089","DOIUrl":"10.1177/17562872261458089","url":null,"abstract":"<p><strong>Background: </strong>Hemorrhage is one of the most significant complications of percutaneous nephrolithotomy (PCNL) and may lead to clinically significant persistent hematuria requiring digital subtraction angiography (DSA) and transcatheter arterial embolization (TAE). Identifying predictors of TAE may improve perioperative planning and risk stratification.</p><p><strong>Objectives: </strong>To determine predictors of need for TAE in patients evaluated with DSA for persistent post-PCNL hemorrhage.</p><p><strong>Design: </strong>Single-center retrospective observational study.</p><p><strong>Methods: </strong>From 2021 to 2024, a total of 2947 tubeless PCNL procedures were performed at our institution. Consecutive adult patients who developed clinically significant persistent post-PCNL hemorrhage and underwent DSA were assessed. Persistent hematuria was operationally defined as severe visible hematuria persisting for >24 h despite conservative management or recurrent severe hematuria after initial stabilization. DSA referral followed predefined escalation criteria after failure of conservative measures, including hemodynamic instability, Hb drop ⩾3 g/dL within 24 h or progressive decline, transfusion requirement ⩾2 units within 24 h, and/or recurrent clot retention requiring clot evacuation and/or continuous bladder irrigation. TAE was performed only when DSA demonstrated a culprit vascular lesion.</p><p><strong>Results: </strong>The mean age of the study population was 55.1 ± 10.6 years, and 68% were male. Among the 100 patients who underwent DSA for persistent post-PCNL hemorrhage, 36 (36%) required TAE, while 64 (64%) had normal angiographic findings and were managed conservatively. On multivariable logistic regression analysis, diabetes mellitus (odds ratio (OR) 7.42), larger stone size (OR 1.27 per mm), higher stone density (OR 1.007 per Hounsfield unit), greater skin-to-stone distance (OR 1.14 per mm), and longer operative time (OR 1.18 per minute) independently predicted the need for TAE. Pseudoaneurysm was identified in 77.8% of embolized patients and arteriovenous fistula in 22.2%. Selective coil embolization achieved 100% clinical success without the need for repeat embolization, surgical exploration, or nephrectomy.</p><p><strong>Conclusion: </strong>Among patients undergoing DSA for clinically significant persistent post-PCNL hemorrhage, diabetes mellitus, larger stone size, higher stone density, greater skin-to-stone distance, and longer operative time were independently associated with the need for TAE.</p>","PeriodicalId":23010,"journal":{"name":"Therapeutic Advances in Urology","volume":"18 ","pages":"17562872261458089"},"PeriodicalIF":3.5,"publicationDate":"2026-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13305270/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148346303","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Complete pathological response in patients with bladder cancer: predictors and outcomes.","authors":"Alireza Ghoreifi, John V Dudinec, Justin M Refugia, Mazyar Zahir, Reza Nabavizadeh, Ankeet M Shah, Michael R Abern","doi":"10.1177/17562872261458110","DOIUrl":"10.1177/17562872261458110","url":null,"abstract":"<p><p>Pathologic complete response (pCR) in bladder cancer, most often defined as pT0N0 at radical cystectomy (RC) following transurethral resection of the bladder tumor with/without neoadjuvant therapy, has emerged as a powerful prognostic marker. Predicting pCR before RC and understanding its prognostic nuances are increasingly important as perioperative chemotherapy and immunotherapy evolve. In this study, we reviewed the contemporary evidence regarding definitions and clinical contexts of pCR in bladder cancer; clinical, pathological, imaging, molecular, and liquid-biopsy predictors of pCR; and outcomes and recurrence patterns in patients achieving pCR. We found out that pCR rates vary widely according to treatment regimen, patient selection, and underlying tumor biology, ranging from 5%-15% after transurethral resection alone, 25%-35% with cisplatin-based chemotherapy, and up to 40% with combination chemoimmunotherapy. However, regardless of upfront treatment modality, pCR correlates with significantly improved overall survival and recurrence-free survival. A growing body of evidence has identified predictors of pCR spanning clinical and histopathologic features, molecular and genomic alterations, particularly DNA damage response gene mutations, immune biomarkers (e.g., tumor mutational burden and immune gene expression signatures), advanced imaging with multiparametric magnetic resonance imaging and vesical imaging reporting and data system-based assessment, and circulating tumor DNA dynamics. Among these, circulating tumor DNA clearance during neoadjuvant therapy has demonstrated particularly strong predictive and prognostic value. Despite the favorable outcomes associated with pCR, recurrence risk is not negligible, especially among ypT0 patients, highlighting the importance of risk-adapted postoperative surveillance. In parallel, bladder-preserving strategies for carefully selected patients achieving a clinical complete response remain investigational, limited by imperfect concordance between clinical and pathologic response and requiring rigorous multimodal assessment and close follow-up. Collectively, contemporary data indicate that no single biomarker is sufficient to reliably predict pCR; rather, integrated multimodal models offer the greatest potential to refine neoadjuvant treatment selection, inform bladder preservation, and individualize surveillance while maintaining oncologic safety.</p>","PeriodicalId":23010,"journal":{"name":"Therapeutic Advances in Urology","volume":"18 ","pages":"17562872261458110"},"PeriodicalIF":3.5,"publicationDate":"2026-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13305378/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148346223","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of the efficacy and safety of flexible vacuum-assisted ureteral access sheath-assisted flexible ureteroscopic lithotripsy, conventional ureteral access sheath-assisted flexible ureteroscopic lithotripsy, and mini-percutaneous nephrolithotomy for 2-3 cm renal stones.","authors":"Hao Gu, Song Xue, Yonghua Lei, Bin Wu, Ke Gao","doi":"10.1177/17562872261452324","DOIUrl":"10.1177/17562872261452324","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The optimal management of 2-3 cm renal stones remains challenging because effective stone clearance must be balanced against perioperative morbidity. Mini-percutaneous nephrolithotomy (mPCNL) provides high stone-free rates (SFR) but is associated with greater procedural burden, whereas flexible ureteroscopic lithotripsy (fURL) is less invasive but may be limited by fragment clearance efficiency. A flexible vacuum-assisted ureteral access sheath (FV-UAS) has recently been introduced to facilitate fragment evacuation and improve intrarenal drainage during fURL.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To compare the efficacy and safety of FV-UAS-assisted fURL, conventional ureteral access sheath-assisted flexible ureteroscopic lithotripsy (UAS-assisted fURL), and mPCNL for the treatment of 2-3 cm renal stones, and to provide evidence for surgical decision-making in this clinical setting.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design: &lt;/strong&gt;This was a retrospective single-center comparative study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This retrospective study included 156 patients with 2-3 cm renal stones who underwent FV-UAS-assisted fURL (FV-UAS group, &lt;i&gt;n&lt;/i&gt; = 50), UAS-assisted fURL (UAS group, &lt;i&gt;n&lt;/i&gt; = 54), or mPCNL (mPCNL group, &lt;i&gt;n&lt;/i&gt; = 52) at Xi'an People's Hospital between June 2022 and December 2024. Perioperative outcomes were compared, including operative time, postoperative hemoglobin decrease, postoperative pain assessed by the visual analogue scale (VAS), postoperative length of hospital stay, total hospitalization costs, and postoperative adverse events, including fever, renal colic, urinary tract infection, and steinstrasse. SFR was assessed on postoperative day 3 and at 1 month postoperatively.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Operative time differed significantly among the three groups (FV-UAS 77.56 ± 15.04 min vs mPCNL 67.60 ± 10.44 min vs UAS 85.04 ± 15.78 min; &lt;i&gt;p&lt;/i&gt; &lt; 0.05). Postoperative hemoglobin decrease was significantly lower in the FV-UAS and UAS groups than in the mPCNL group (3.50 ± 2.40 g/L and 4.01 ± 2.14 g/L vs 13.86 ± 3.21 g/L; &lt;i&gt;p&lt;/i&gt; &lt; 0.001). The postoperative length of stay was shorter in the FV-UAS group than in the UAS group and markedly shorter than in the mPCNL group (3.04 ± 0.73 d vs 3.52 ± 0.72 d vs 6.04 ± 0.86 d; &lt;i&gt;p&lt;/i&gt; &lt; 0.05). Postoperative VAS scores were lower in the FV-UAS and UAS groups than in the mPCNL group (&lt;i&gt;p&lt;/i&gt; &lt; 0.05), with no significant difference between the two fURL groups. Regarding total hospitalization costs, the mPCNL group had the lowest costs, and the FV-UAS group had lower costs than the UAS group (&lt;i&gt;p&lt;/i&gt; &lt; 0.05). The overall adverse event rates were comparable among groups. Steinstrasse occurred in three cases, all in the UAS group. On postoperative day 3, SFRs were 94.0% (FV-UAS), 75.9% (UAS), and 80.8% (mPCNL), with the FV-UAS group higher than the UAS group (&lt;i&gt;p&lt;/i&gt; &lt; 0.05). At 1 month, SFRs were 96.0% (FV-UAS), 81.5% (UAS), and 96.2% (mPCNL), with both the FV-UA","PeriodicalId":23010,"journal":{"name":"Therapeutic Advances in Urology","volume":"18 ","pages":"17562872261452324"},"PeriodicalIF":3.5,"publicationDate":"2026-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13241613/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148199994","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"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 preoperative MRI on surgical outcomes of robot-assisted laparoscopic prostatectomy: a single-center retrospective cohort of 844 patients.","authors":"Charles Henry Rochat, Robin Schaffar, Jacques Martin Randriantsalama, Ildiko Quinodoz Szalay, Georges Antoine de Boccard, Martina Martins Favre","doi":"10.1177/17562872261452717","DOIUrl":"10.1177/17562872261452717","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Multiparametric magnetic resonance imaging (mpMRI) refines local staging in prostate cancer, but its effect on hard surgical endpoints after robot-assisted laparoscopic prostatectomy (RALP) remains uncertain.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To evaluate whether systematic preoperative mpMRI implementation was associated with improved surgical margin status and early biochemical control in a mature robotic RALP program.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design: &lt;/strong&gt;Single-center retrospective cohort study comparing two calendar periods (pre‑mpMRI era vs mpMRI era).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We included 844 consecutive men who underwent RALP for cT1-cT2 N0 M0 prostate adenocarcinoma between January 2007 and December 2019. Patients were classified into a pre-mpMRI era (2007-2012) and a post-mpMRI era (2014-2019), excluding 2013 as a transition year. From 2014, standardized 3T mpMRI interpreted by a single uroradiologist was systematically integrated into side-specific surgical planning, including nerve-sparing decisions. The primary endpoint was any positive surgical margin (PSM); the secondary endpoint was biochemical recurrence (BCR, prostate-specific antigen (PSA) ⩾ 0.2 ng/mL) within 24 months. Logistic regression (overall and stratified by pT2/pT3) assessed associations between era and PSM, with multivariable adjustment for age, PSA, tumor volume, biopsy Gleason score, D'Amico risk group, and pathological stage. BCR-free survival was analyzed with Kaplan-Meier curves, log-rank tests, and Cox models censored at 24 months.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of 844 men, 393 were operated on in 2007-2012 and 451 in 2014-2019. Compared with the pre-mpMRI era, patients in the mpMRI era were older (median 67 vs 64 years) and had larger tumor volume (3.6 vs 2.2 cc) and less favorable Gleason and D'Amico profiles, while pT distribution was similar. Margin status was available for 802 patients; PSM decreased from 25% (97/381) to 15% (65/421) in the mpMRI era (absolute reduction ~10 percentage points). In the overall cohort, surgery in the mpMRI era was associated with lower odds of PSM (adjusted odds ratio 0.51; 95% CI 0.34-0.74; &lt;i&gt;p&lt;/i&gt; &lt; 0.001). In pT2 disease, the association was directionally favorable but non-significant (adjusted odds ratio (OR) 0.71; 95% CI 0.42-1.17; &lt;i&gt;p&lt;/i&gt; = 0.20), whereas in pT3 tumors the mpMRI era was associated with a marked reduction in PSM (adjusted OR 0.35; 95% CI 0.19-0.63; &lt;i&gt;p&lt;/i&gt; &lt; 0.001). Among 807 patients with PSA follow-up, 24-month BCR-free survival was 0.896 (95% CI 0.861-0.923) in 2007-2012 and 0.846 (95% CI 0.801-0.881) in 2014-2019 (log-rank &lt;i&gt;p&lt;/i&gt; = 0.0377); the corresponding unadjusted hazard ratio for BCR was 1.55 (95% CI 1.02-2.35), which attenuated and lost significance after adjustment for age and D'Amico risk (adjusted hazard ratio 1.10; &lt;i&gt;p&lt;/i&gt; = 0.656).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;In a high-volume center with a stable, experienced robotic surgeon, the preoperative mp","PeriodicalId":23010,"journal":{"name":"Therapeutic Advances in Urology","volume":"18 ","pages":"17562872261452717"},"PeriodicalIF":3.5,"publicationDate":"2026-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13241677/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148200054","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Characteristics, treatment patterns, and outcomes of patients with metastatic prostate cancer during 2014-2022 in Pirkanmaa, Finland-an observational study.","authors":"Mikko Moisander, Olivia Hölsä, Kaisa Teittinen, Kai Kysenius, Mikko Kosunen, Leena Lehmus, Teemu J Murtola","doi":"10.1177/17562872261451289","DOIUrl":"10.1177/17562872261451289","url":null,"abstract":"<p><strong>Background: </strong>The prognosis of patients with metastatic prostate cancer (mPC) has changed profoundly in recent years. However, observational studies are required to understand the real-world outcomes of patients with mPC.</p><p><strong>Objectives: </strong>In this retrospective single-center observational study, we aimed to describe characteristics, treatments, and outcomes of patients with mPC in Pirkanmaa Hospital District (PHD), Finland, an area with a population of 0.5 million (10% of the Finnish population).</p><p><strong>Design: </strong>The incident patients with mPC treated in PHD during 2014-2022 were identified and stratified into patients with metastatic hormone-sensitive PC (mHSPC) and castration-resistant disease PC (mCRPC).</p><p><strong>Methods: </strong>Patients with mPC were identified from electronic healthcare data using diagnoses, treatments, procedures, and patient texts. Data on demographics, diagnoses, procedures, treatments, laboratory and pathology tests, and specialized healthcare contacts were collected from specialty care records. Due to changes in treatment practices over time, treatments and outcomes were analyzed in different time periods (mHSPC: 2014-2016 and 2017-2022, mCRPC: 2014-2017 and 2018-2022).</p><p><strong>Results: </strong>In total, 1083 incident patients with mPC were identified, of which 88% received treatment indicated for mPC. Out of the 795 patients with mHSPC, and 558 patients with mCRPC, 84% (<i>N</i> = 668) and 95% (<i>N</i> = 532) received treatment, respectively. The median overall survival (mOS) for all treated patients was 40.1 months. The mOS of treated patients with mHSPC increased from 32.6 months during 2014-2016 to 54.6 months during 2017-2022.</p><p><strong>Conclusion: </strong>Since the approval of enzalutamide as a first-line treatment for mCRPC, it has become the most common first-line treatment for mCRPC in PHD. Novel therapeutics, including docetaxel, enzalutamide, and abiraterone, have been adapted into clinical practice and are being used at earlier phases of the disease. Changes in treatment practices correlate with improved outcomes in patients with mHSPC in the PHD area.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov NCT05701007.</p>","PeriodicalId":23010,"journal":{"name":"Therapeutic Advances in Urology","volume":"18 ","pages":"17562872261451289"},"PeriodicalIF":3.5,"publicationDate":"2026-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13219817/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148138821","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Age-related differences in bladder function and sexual outcomes following bipolar transurethral resection of the prostate: a retrospective cohort study.","authors":"Sezgin Yeni, Aslan Demir, Hayrettin Sabuncu, Halil Emre Yildiz, Hatice Ortac","doi":"10.1177/17562872261451290","DOIUrl":"10.1177/17562872261451290","url":null,"abstract":"<p><strong>Background: </strong>Benign prostatic obstruction negatively affects bladder emptying and, if untreated, may be associated with impaired bladder emptying and related complications.</p><p><strong>Objectives: </strong>To compare postoperative outcomes of bipolar transurethral resection of the prostate (bipolar TURP) among different age groups and evaluate the effect of patient age.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Methods: </strong>We analyzed 132 male patients who underwent bipolar TURP between May 2022 and January 2024. Patients were grouped by age: Group 1 (50-60 years), Group 2 (61-70 years), and Group 3 (⩾71 years). Pre- and postoperative parameters-including prostate-specific antigen, prostate volume, uroflowmetry (maximum and average flow rates, voided volume, post-void residual), symptom duration, medication use, and International Index of Erectile Function-5 (IIEF-5) scores-were assessed at 12 months postoperatively.</p><p><strong>Results: </strong>Group 1 demonstrated significantly greater improvements in peak flow rates, post-void residual volume, and IIEF-5 scores compared with the older cohorts (<i>p</i> < 0.05). While Group 3 presented with the longest symptom duration and highest medication use at baseline, multivariate regression analysis identified advancing age as an independent predictor of more limited improvement in post-void residual volume (<i>p</i> = 0.008) and IIEF-5 scores (<i>p</i> < 0.001), while its association with ∆<i>Q</i>max reached only marginal significance (<i>p</i> = 0.050). Younger patients exhibited better postoperative preservation of erectile function and relatively improved recovery of bladder emptying.</p><p><strong>Conclusion: </strong>Patient age is associated with urinary and sexual outcomes after bipolar TURP. The strongest age-related associations were observed for postoperative recovery of bladder emptying and preservation of erectile function, whereas improvement in peak flow rate was less strongly age-dependent and should be interpreted with caution.</p><p><strong>Trial registration: </strong>Not applicable.</p>","PeriodicalId":23010,"journal":{"name":"Therapeutic Advances in Urology","volume":"18 ","pages":"17562872261451290"},"PeriodicalIF":3.5,"publicationDate":"2026-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13219814/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148138890","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Robot-assisted simple cystectomy for benign disease with medium-term follow-up: a case series.","authors":"Martina Spazzapan, Jonathan Kam, Ellen Benn, Basil Lutfi, Samuel Folkard, Marc Alain Furrer, Sachin Malde, Ramesh Thurairaja, Rajesh Nair, Prokar Dasgupta, Arun Sahai, Muhammad Shamim Khan","doi":"10.1177/17562872261451298","DOIUrl":"10.1177/17562872261451298","url":null,"abstract":"<p><strong>Background: </strong>Robot-assisted cystectomy (RAC) is well established in the management of muscle-invasive or high-grade non-muscle invasive bladder cancer, but its role in benign disease is less well described. This case series represents the largest published experience of RAC for radiation cystitis and the largest series using an intracorporeal urinary diversion technique in this context.</p><p><strong>Objectives: </strong>To evaluate perioperative outcomes and adverse events following RAC for benign indications, and to compare outcomes between patients with radiation cystitis and other benign conditions.</p><p><strong>Design: </strong>Single-centre, retrospective case series.</p><p><strong>Methods: </strong>Patients undergoing RAC for benign disease (2013-2024) were identified from a prospectively maintained database and electronic health records. Demographic, perioperative, and postoperative data were analysed using descriptive statistics. Comparative analyses were performed between patients undergoing cystectomy for radiation-related indications and those undergoing surgery for other benign indications using <i>t</i> tests, Fisher's exact tests, and Mann-Whitney <i>U</i> tests in R.</p><p><strong>Results: </strong>Seventy patients (mean age 65 years; range 23-96) underwent RAC. Indications included radiation cystitis (<i>n</i> = 34; 48.6%), other cystitis (<i>n</i> = 14; 20%), premalignant changes (<i>n</i> = 9; 12.9%), refractory overactive bladder (<i>n</i> = 8; 11.4%), neurogenic bladder (<i>n</i> = 4; 5.7%), and Fowler's syndrome (<i>n</i> = 1; 1.4%). Intracorporeal ileal conduit diversion was performed in 57 cases (81%). Mean operative time was 334 min (range 180-540). Mean blood loss was 326 ml (100-1250) in the radiation group and 300 ml (100-800) in other patients. Mean follow-up was 16 months (1-58). No significant decline in renal function was observed at 1 year in either group (<i>p</i> = 0.8). Complications occurred in 46 patients (66%) within 90 days, with 34% graded Clavien-Dindo III or higher. Fifteen patients (21%) were readmitted within 30 days, and 8 (11%) required further intervention. Limitations include the retrospective design.</p><p><strong>Conclusion: </strong>RAC is safe and feasible for benign disease with no observed differences in outcomes between radiation cystitis and other indications in our cohort. Outcomes and complication rates observed are within the published ranges for malignancy-associated radical cystectomy.</p><p><strong>Trial registration: </strong>Not applicable.</p>","PeriodicalId":23010,"journal":{"name":"Therapeutic Advances in Urology","volume":"18 ","pages":"17562872261451298"},"PeriodicalIF":3.5,"publicationDate":"2026-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13219805/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148138866","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The causal association between seven drugs and erectile dysfunction: a Mendelian randomization study.","authors":"Jian Zhan, Jing Liu, Yilan Huang, Longyang Jiang","doi":"10.1177/17562872261448350","DOIUrl":"10.1177/17562872261448350","url":null,"abstract":"<p><strong>Objective: </strong>Many studies have shown that patients develop erectile dysfunction (ED) after taking or aggravating certain drugs. However, other studies have considered such conclusions to be inaccurate. To explore the genetically predicted associations between drug treatment and ED, we used publicly available genome-wide association study (GWAS) data to evaluate the relationship between seven drug treatment regimens and ED using two-sample Mendelian randomization (MR) analysis.</p><p><strong>Design: </strong>In this study, a two-sample Mendelian randomized design was used to evaluate the causal relationship between 40 drugs and the risk of ED using publicly available pooled data from the GWAS.</p><p><strong>Methods: </strong>We employed five methods for MR analysis: MR-Egger, weighted median, inverse variance weighted (IVW), simple mode, weighted mode, MR-Egger intercept test, MR pleiotropy residual sum, and outlier global test to identify horizontal pleiotropy. Cochran's <i>Q</i> statistics were used for instrument heterogeneity tests, and the leave-one-out method was used for sensitivity analysis.</p><p><strong>Results: </strong>The results showed that simvastatin (<i>p</i> = 0.023), ramipril (<i>p</i> = 0.041), metformin (<i>p</i> = 0.00061), gliclazide (<i>p</i> = 0.015), atorvastatin (<i>p</i> = 0.037), atenolol (<i>p</i> = 0.0052), aspirin (<i>p</i> = 0.051), and simvastatin, and five other drugs were potentially associated with ED. After excluding confounding single-nucleotide polymorphisms (SNPs), the <i>p</i>-value of aspirin was slightly above 0.05, suggesting that aspirin may not have a potential causal relationship with ED, warranting further investigation to confirm this finding. No potential causal relationships were found between the remaining 33 exposures and ED.</p><p><strong>Conclusion: </strong>Genetically predicted associations suggest that there may be potential causal relationships between simvastatin, ramipril, metformin, gliclazide, atorvastatin, atenolol, and ED, which require further research.</p>","PeriodicalId":23010,"journal":{"name":"Therapeutic Advances in Urology","volume":"18 ","pages":"17562872261448350"},"PeriodicalIF":3.5,"publicationDate":"2026-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13195245/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148017414","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}