Therapeutic Advances in Urology最新文献

{"title":"Contralateral recurrent upper-tract urothelial carcinoma after curative surgery: a multicentre retrospective cohort study.","authors":"Yao-Lin Kao, I-Hsuan Alan Chen, Chia-Cheng Yu, Chao-Hsiang Chang, Hsi-Chin Wu, Ching-Chia Li, Wen-Jeng Wu, Yao-Chou Tsai, Chih-Chin Yu, Chung-You Tsai, Pai-Yu Cheng, Chao-Yuan Huang, Chien-Hui Ou","doi":"10.1177/17562872261419593","DOIUrl":"10.1177/17562872261419593","url":null,"abstract":"<p><strong>Background: </strong>Contralateral recurrence of upper-tract urothelial carcinoma (UTUC) presents a clinical challenge, with limited evidence regarding optimal surgical management.</p><p><strong>Objective: </strong>To compare oncological outcomes among patients with contralateral UTUC recurrence managed by second nephroureterectomy (NUR) or nephron-sparing surgery (NSS), relative to those undergoing primary NUR.</p><p><strong>Design: </strong>A multicentre retrospective cohort study.</p><p><strong>Methods: </strong>In this multicentre retrospective cohort, 3159 patients diagnosed with UTUC between 2018 and 2024 in the Taiwanese UTUC Registry were analysed. Patients undergoing curative-intent surgery were grouped as follows: unilateral UTUC treated with primary NUR; contralateral recurrence treated with a second NUR; and contralateral recurrence managed with nephron-sparing surgery (NSS; segmental ureterectomy or endoscopic ablation). NUR was performed via open, laparoscopic, or robotic-assisted approaches. Outcomes included overall survival (OS), cancer-specific survival (CSS) and bladder recurrence-free survival (BRFS). Propensity score-based overlap weighting adjusted for baseline differences.</p><p><strong>Results: </strong>After adjustment, both second NUR and NSS achieved OS, CSS, and BRFS comparable to primary NUR. Tumour biology, including stage, lymphovascular invasion and multifocality, exerted greater prognostic impact than contralateral recurrence status or surgical modality. While the rarity of contralateral recurrence limited statistical power, particularly for CSS and in the NSS subgroup, the consistency of effect estimates supports the robustness of the observed trends.</p><p><strong>Conclusion: </strong>In this multicentre real-world cohort, second NUR and NSS for contralateral UTUC recurrence demonstrated broadly comparable survival outcomes to primary NUR, though the limited number of NSS cases and corresponding statistical power preclude firm conclusions.</p>","PeriodicalId":23010,"journal":{"name":"Therapeutic Advances in Urology","volume":"18 ","pages":"17562872261419593"},"PeriodicalIF":3.5,"publicationDate":"2026-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12901921/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146202630","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":"Digital twins in urology: a vision for the future of urological practice.","authors":"Carlotta Nedbal, Sanjeev Madaan, Ghulam Nabi, Bhaskar Kumar Somani","doi":"10.1177/17562872261419592","DOIUrl":"10.1177/17562872261419592","url":null,"abstract":"<p><p>Digital twins, dynamic, patient-specific virtual replicas of physical systems are gaining momentum across various medical fields. Their capacity to simulate and predict biological behavior offers unprecedented opportunities for personalized care. While their utility has been demonstrated in oncology, their application in urology remains nascent, and there is still a significant gap in literature findings. This review explores the theoretical framework, current evidence, and future potential of digital twins technology in managing urological conditions such as urolithiasis, benign prostatic hyperplasia (BPH), and nonmuscle invasive bladder cancer. A narrative literature review, guided by SANRA criteria, was conducted using PubMed and Scopus databases to identify relevant studies on the application of digital twins in healthcare, with a focus on urology and related fields. Additional sources from AI, imaging, and computational modelling were incorporated to support technological and theoretical concepts. Real-world use cases and clinical scenarios were constructed to illustrate the conceptual application of digital twins in endourology. Although limited in number, preliminary studies have shown promising results in uro-oncology, particularly for prostate and renal cancers. No models have yet been developed for benign urological diseases. Hypothetical applications in endourology include personalized procedural planning, dynamic follow-up, prediction of obstruction or recurrence, and real-time intraoperative guidance. Integration of imaging, functional data, and AI algorithms could create continuously adaptive simulations to support decision-making and improve treatment outcomes. However, barriers such as data complexity, cost, lack of validation frameworks, and clinician trust persist. Digital twins hold transformative potential for the future of urology, promising to personalize care across diagnosis, treatment, and surveillance. While the path to clinical integration is challenged by technical, ethical, and infrastructural hurdles, collaborative efforts and real-world validation studies are critical to realizing their full potential in clinical practice.</p>","PeriodicalId":23010,"journal":{"name":"Therapeutic Advances in Urology","volume":"18 ","pages":"17562872261419592"},"PeriodicalIF":3.5,"publicationDate":"2026-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12891402/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146182588","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":"Construction and validation of a prediction model for cystitis glandularis using serological markers combined with histological indexes to predict recurrence risk.","authors":"Yuhang Wang, Xuhao Liu, Tailai Zhou, Chuyang Huang, Yong Li, Yuzhong Yan, Minfeng Chen","doi":"10.1177/17562872261419577","DOIUrl":"10.1177/17562872261419577","url":null,"abstract":"<p><strong>Background: </strong>Cystitis glandularis (CG) is a chronic inflammatory condition of the bladder characterized by a high recurrence rate, imposing a substantial burden on patients. The mechanisms underlying recurrence remain unclear.</p><p><strong>Objectives: </strong>This study aims to identify markers associated with CG recurrence and develop a predictive model for recurrence risk.</p><p><strong>Design: </strong>Retrospective cohort study of patients with confirmed recurrence based on outpatient visits or readmissions were included in this study, which was subsequently divided into training and test set.</p><p><strong>Methods: </strong>Patients diagnosed with CG from four hospitals between 2013 and 2023 were retrospectively included and followed for one year. Recurrence was defined as the appearance of new nonneoplastic lesions on cystoscopy after complete resection of the primary disease. A total of 161 patients were divided into a training set (<i>n</i> = 98) from XiangYa Hospital and a test set (<i>n</i> = 63) from Shaoyang Central Hospital, the Second Affiliated Hospital of South China University, and the First People's Hospital of Changde City. Cox regression analysis was performed in the training set to identify serological indicators associated with recurrence, which were further validated at the histological level by immunohistochemistry. A prognostic model was then constructed using LASSO regression, and its predictive performance was evaluated using receiver operating characteristic (ROC) curves. A nomogram was also developed for clinical application.</p><p><strong>Results: </strong>Among 161 patients followed for 12 months, the recurrence rate was 49.6% (<i>n</i> = 80). Univariate and multivariate Cox regression analyses revealed that serological eosinophil and basophil counts were significantly associated with CG recurrence, with histological validation confirming their relevance. The LASSO-based risk model demonstrated good predictive ability, with an area under the ROC curve exceeding 0.75.</p><p><strong>Conclusion: </strong>Serological indicators, specifically eosinophil and basophil counts, are closely linked to CG recurrence. A risk score model based on these markers was developed, providing effective prediction of recurrence in clinical practice.</p>","PeriodicalId":23010,"journal":{"name":"Therapeutic Advances in Urology","volume":"18 ","pages":"17562872261419577"},"PeriodicalIF":3.5,"publicationDate":"2026-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12891399/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146182556","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":"Advances in the diagnosis and treatment of oligoasthenozoospermia based on epigenetic regulation.","authors":"Han-Bin Zhao, Wan-Yu Ba, Wen-Bo Zhu, Guang-Zhao Wang, Zu-Long Wang, Shi-Qi Wang","doi":"10.1177/17562872251414924","DOIUrl":"10.1177/17562872251414924","url":null,"abstract":"<p><p>Male infertility accounts for a substantial proportion of global infertility, yet its molecular basis remains incompletely defined. Emerging evidence implicates epigenetic dysregulation in impaired spermatogenesis and abnormal sperm function. We synthesize genomic, transcriptomic, and single-cell studies to clarify how DNA methylation, histone modifications, and noncoding RNAs contribute to oligoasthenozoospermia. We also appraise single-cell RNA sequencing, single-cell assay for transposase-accessible chromatin using sequencing, and integrative multi-omics for resolving cell-type and stage-specific regulation. These approaches resolve germ-cell lineages, map gene-regulatory networks, and link chromatin states with transcription across spermatogenesis. Finally, we discuss translational implications for diagnostics, biomarkers, and therapeutic strategies, including antioxidant regimens, varicocele management, and assisted reproductive technologies outcomes. In conclusion, integrating epigenetics with single-cell technologies has enhanced our understanding of male germ cell development and identified potential research directions to improve reproductive health.</p>","PeriodicalId":23010,"journal":{"name":"Therapeutic Advances in Urology","volume":"18 ","pages":"17562872251414924"},"PeriodicalIF":3.5,"publicationDate":"2026-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12861375/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146107402","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":"Association between components of metabolic syndrome and risk of urinary stone recurrence: a single-center case-control study.","authors":"Ying Feng, Chao Du, Jinbo Hu, Wenhui Tan, Jianjun Wu, Yunyun Yang","doi":"10.1177/17562872251410865","DOIUrl":"10.1177/17562872251410865","url":null,"abstract":"<p><strong>Background: </strong>Urolithiasis is a prevalent urological condition with high recurrence rates. Increasing evidence links metabolic syndrome (MetS) and its components to urinary stone disease, but the relationship between MetS and stone recurrence, including the roles of stone composition, residual fragments, urinary biochemistry, and lifestyle factors, remains underexplored.</p><p><strong>Objectives: </strong>To investigate the association between MetS components and urinary stone recurrence in a retrospective cohort, with emphasis on stone composition, surgical residual fragments, urinary biochemical parameters, and lifestyle factors.</p><p><strong>Design: </strong>A single-center retrospective case-control study.</p><p><strong>Methods: </strong>We enrolled 542 patients with urinary stones (2019-2020) and followed them for up to 5 years (median follow-up 48 months). Baseline demographic, metabolic, lifestyle, urinary biochemical, surgical, and stone composition data were collected. Kaplan-Meier and Cox regression analyses were used to evaluate recurrence-free survival and independent predictors of recurrence.</p><p><strong>Results: </strong>During follow-up, 211 patients (39%) experienced recurrence. The prevalence of MetS was significantly higher in the recurrence group (46.9% vs 28.7%). Cox regression identified hypertension (hazard ratio (HR) 1.31, 95% CI 1.04-1.65), hyperglycemia (HR 1.29, 1.01-1.64), hypertriglyceridemia (HR 1.38, 1.08-1.77), and residual fragments (HR 1.89, 1.47-2.43) as independent predictors. Stone composition analysis revealed higher recurrence in uric acid (52.3%), struvite (59.3%), and cystine (63.6%) stones compared with calcium oxalate (34.0%). Adverse urinary profiles (low pH, hypocitraturia, hyperuricosuria) and lifestyle factors (low fluid intake, high salt, high animal protein) were also associated with recurrence. Kaplan-Meier analysis showed shorter recurrence-free survival in patients with MetS (log-rank <i>p</i> < 0.001).</p><p><strong>Conclusion: </strong>MetS and its components are independently associated with a higher risk of urinary stone recurrence. Stone composition, residual fragments, urinary biochemistry, and lifestyle factors further modify recurrence risk. These findings underscore the importance of comprehensive risk stratification and metabolic management in patients with urolithiasis.</p><p><strong>Trail registration: </strong>Not applicable.</p>","PeriodicalId":23010,"journal":{"name":"Therapeutic Advances in Urology","volume":"18 ","pages":"17562872251410865"},"PeriodicalIF":3.5,"publicationDate":"2026-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12861378/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146107387","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":"Cost-effectiveness of novel antiandrogens for the treatment of nmCRPC patients in the Chinese healthcare system.","authors":"Wenjuan Yang, Bei Zheng, Mengyue Zhou, Ying Li, Lulu Zheng, Jun Zhu, Meiling Zhang","doi":"10.1177/17562872251414928","DOIUrl":"10.1177/17562872251414928","url":null,"abstract":"<p><strong>Background: </strong>Novel androgen receptor inhibitors (ARIs) have been recommended for patients with high-risk nonmetastatic castration-resistant prostate cancer (nmCRPC).</p><p><strong>Objective: </strong>The present study aims to evaluate the cost-effectiveness of darolutamide, enzalutamide, apalutamide, and bicalutamide when combined with androgen deprivation therapy (ADT) for treating nmCRPC in the context of national drug price negotiations in China.</p><p><strong>Design: </strong>A cost-effectiveness analysis.</p><p><strong>Methods: </strong>A Markov model was developed to assess the cost-effectiveness of first-line therapy (darolutamide, enzalutamide, apalutamide, and bicalutamide) combined with ADT in nmCRPC patients, as well as second-line treatment options receiving chemotherapy after disease progression. The model included three health states: progression-free survival, progression survival, and death. The transfer probability per period was calculated using a Log-normal distribution. Drug costs were obtained from national price negotiations and relevant medical institutions, and health state utility values were obtained from the literature. Uncertainty was addressed through one-way sensitivity, probabilistic sensitivity, and scenario analyses.</p><p><strong>Results: </strong>Compared with bicalutamide plus ADT, apalutamide, darolutamide, and enzalutamide provided incremental benefits of 3.52, 4.96, and 3.86 quality-adjusted life years (QALYs), respectively. This resulted in incremental cost-effectiveness ratios (ICERs) of $117,261, $166,618, and $238,170 in nmCRPC patients. Specifically, the ICERs of apalutamide, darolutamide, and enzalutamide were $33,357/QALY, $33,600/QALY, and $61,740/QALY, respectively.</p><p><strong>Conclusion: </strong>Compared with bicalutamide plus ADT, apalutamide plus ADT and darolutamide plus ADT are more cost-effective under the willingness-to-pay threshold of $38,223/QALY. Nonetheless, enzalutamide plus ADT is not cost-effective compared with bicalutamide plus ADT.</p>","PeriodicalId":23010,"journal":{"name":"Therapeutic Advances in Urology","volume":"18 ","pages":"17562872251414928"},"PeriodicalIF":3.5,"publicationDate":"2026-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12847669/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146086938","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":"Modern approaches to BPH management: expert insights and the latest evidence from the 2024 International Functional and Reconstructive Urology Update.","authors":"Vincent Hou, Sasha J Vereecken, Karen M Doersch, Kevin C Zorn, Garrett D Pohlman, Granville L Lloyd","doi":"10.1177/17562872251414925","DOIUrl":"https://doi.org/10.1177/17562872251414925","url":null,"abstract":"","PeriodicalId":23010,"journal":{"name":"Therapeutic Advances in Urology","volume":"18 ","pages":"17562872251414925"},"PeriodicalIF":3.5,"publicationDate":"2026-01-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12835500/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146094175","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":"Incidence of urinary infections and urosepsis after ureteroscopy for stone disease: a systematic review of literature.","authors":"Arianna Pischetola, Thomas Hughes, Robert Geraghty, Mohammed Boulmani, Bhaskar K Somani","doi":"10.1177/17562872251412050","DOIUrl":"10.1177/17562872251412050","url":null,"abstract":"<p><strong>Background: </strong>Ureteroscopy (URS) and laser lithotripsy are commonly used to treat kidney and ureteric stones. Post-operative infections, including urinary sepsis, can be a potentially serious complication of URS. We aimed to systematically review the incidence and predictors of post-ureteroscopy infections and sepsis.</p><p><strong>Design: </strong>Systematic review conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines and registered prospectively with PROSPERO (CRD420251102349).</p><p><strong>Data sources and methods: </strong>Only studies in the English language with over 500 patients were included. The Population, Intervention, Comparison, Outcome (PICO) framework for this study examined inpatients with stone disease who underwent ureteroscopy to investigate the incidence of urinary infections and urosepsis.</p><p><strong>Results: </strong>Nineteen studies published between 2015 and 2024 were included, totalling 939,860 patients undergoing ureteroscopy for urolithiasis. Patient demographics varied, with a mean age range of 41.3-59.1 years and a male predominance (63.9%). Laser lithotripsy was the primary modality used, with a mean operative time of 53.4 min.The overall incidence of post-operative infectious complications was 7.8%, ranging from 0.8% to 18.2%. Fever (0.0%-16.2%) and urinary tract infections were the most commonly reported (0.0-12.3%), followed by sepsis (0.0%-7.0%) and septic shock (up to 1.9%). Identified risk factors included female gender, positive pre-operative urine cultures, pre-operative double-J stent placement, patient comorbidities and prolonged operative times.</p><p><strong>Conclusion: </strong>Infectious complications predominate among post-ureteroscopy complications. Key factors for post-ureteroscopy infections included female gender, patient comorbidities, positive pre-operative cultures and longer operative times, highlighting the need for targeted management strategies to reduce complications.</p>","PeriodicalId":23010,"journal":{"name":"Therapeutic Advances in Urology","volume":"18 ","pages":"17562872251412050"},"PeriodicalIF":3.5,"publicationDate":"2026-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12816510/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146019664","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":"A case of retroperitoneal giant leiomyoma and literature review.","authors":"Zhuocheng Lai, Xiaojun Shi, Qiong Wang, Samir Lalani, Yiwei Wang, Yang Lian, Zaosong Zheng, Weiyu Huang, Shiyu Pang, Wanlong Tan","doi":"10.1177/17562872251414923","DOIUrl":"10.1177/17562872251414923","url":null,"abstract":"<p><p>Retroperitoneal fibroids are a rare condition that is often misdiagnosed preoperatively. It typically occurs in women with a history of hysterectomy or myomectomy for benign uterine smooth muscle tumors. In this case report, we present the case of a 50-year-old woman who presented with discomfort in the right perineal area. Imaging showed a large retroperitoneal tumor. The patient underwent robotic-assisted laparoscopic surgery to remove the mass, which was confirmed by histopathological analysis to be a uterine smooth muscle tumor of undetermined malignant potential (STUMP). The patient had no recurrence during the 2-year follow-up. The overall prognosis of STUMP is favorable, but more rigorous and long-term follow-up is required to monitor potential recurrence. Our case highlights that retroperitoneal masses in women with prior uterine fibroid surgery should raise suspicion for retroperitoneal fibroids. Robot-assisted laparoscopic surgery may be a safe and feasible minimally invasive option.</p>","PeriodicalId":23010,"journal":{"name":"Therapeutic Advances in Urology","volume":"18 ","pages":"17562872251414923"},"PeriodicalIF":3.5,"publicationDate":"2026-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12816555/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146019642","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":"Real-world use of enfortumab vedotin in metastatic urothelial carcinoma: efficacy, safety, and risk stratification.","authors":"Martina Catalano, Sara Bartoli, Alessia Salfi, Mirko Bonalda, Lorenzo Della Seta, Alexandra Paulet, Francesco Bloise, Federico Paolieri, Luca Galli, Michele Sisani, Laura Doni, Armando Perrella, Lorenzo Antonuzzo, Giandomenico Roviello","doi":"10.1177/17562872251412927","DOIUrl":"10.1177/17562872251412927","url":null,"abstract":"<p><strong>Background: </strong>Enfortumab vedotin (EV), an antibody-drug conjugate targeting Nectin-4, has demonstrated efficacy in advanced urothelial carcinoma (UC) following platinum-based chemotherapy and immune checkpoint inhibitor (ICI) therapy. However, real-world evidence on its effectiveness and safety remains limited.</p><p><strong>Methods: </strong>We conducted a multicenter retrospective study across Italian oncology centers to evaluate EV in patients with metastatic UC (mUC) who had progressed after prior platinum-based chemotherapy and ICI. The primary endpoints were progression-free survival (PFS) and overall survival (OS). Secondary endpoints included objective response rate (ORR), disease control rate (DCR), and safety. We also assessed prognostic factors, including a composite index (HERO score) based on baseline hemoglobin and neutrophil-to-lymphocyte ratio (NLR).</p><p><strong>Results: </strong>Fifty-three patients were included (median age 72 years; 41.5% ⩾75 years). The ORR was 34.0% (all partial responses), with a DCR of 58.5%. Median PFS and OS were 6.1 and 9.7 months, respectively. Multivariate analysis identified NLR ⩾ 4 and lung metastases as independent predictors of inferior PFS, while NLR ⩾ 4 remained independently associated with worse OS. Dose reductions and peripheral neuropathy were associated with improved outcomes. The HERO score significantly stratified patients by PFS and OS (<i>p</i> = 0.017 and <i>p</i> < 0.001, respectively). EV was generally well tolerated, with most adverse events being low-grade.</p><p><strong>Conclusion: </strong>In this real-world cohort, EV confirmed its efficacy and manageable safety profile in mUC. The HERO score may provide a simple tool for risk stratification in clinical practice, though prospective validation is needed.</p>","PeriodicalId":23010,"journal":{"name":"Therapeutic Advances in Urology","volume":"18 ","pages":"17562872251412927"},"PeriodicalIF":3.5,"publicationDate":"2026-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12812194/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146004284","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}