Urologia Internationalis最新文献

{"title":"Clinical Significance of Bladder Sensory Loss and Bladder Overdistension in Persistent Postpartum Urinary Retention.","authors":"Yavuz Güler, Mustafa Kemal Yenmez","doi":"10.1159/uin/aewag016","DOIUrl":"https://doi.org/10.1159/uin/aewag016","url":null,"abstract":"<p><strong>Objective: </strong>To explore clinical and bladder-related factors associated with postpartum urinary retention (PUR), with particular emphasis on bladder sensation and bladder overdistension.</p><p><strong>Methods: </strong>This retrospective pilot cohort study included 30 women diagnosed with PUR following vaginal or cesarean delivery. PUR was defined as inability to void within 6 hours postpartum or elevated postvoid residual volume. Persistent PUR was defined as retention requiring catheterization beyond 7 days. Patients were classified into persistent and non-persistent groups. Clinical, obstetric, and bladder-related variables were compared. Multivariable logistic regression was performed in an exploratory manner to identify factors independently associated with persistent PUR.</p><p><strong>Results: </strong>Persistent PUR was observed in 18 patients (60%). Patients with persistent PUR more frequently had epidural anesthesia, longer second stage of labor, and delayed time to first void (all p < 0.05).Absent bladder sensation was strongly associated with persistent PUR (89% vs. 8%, p < 0.001). Initial catheterization volume was significantly higher in the persistent group (median 1400 vs. 1000 mL, p < 0.001).In exploratory multivariable analysis, absent bladder sensation (OR 32.5, 95% CI 5.2-180.4) and catheterization volume >1200 mL (OR 8.4, 95% CI 2.1-33.7) were independently associated with persistent PUR. Catheterization volume demonstrated good discriminative ability (AUC ≈ 0.83) and was positively correlated with time to recovery (r = 0.63, p < 0.001), supporting its clinical relevance.</p><p><strong>Conclusion: </strong>Persistent PUR appears to be associated with impaired bladder sensation and bladder overdistension, supporting a combined neurogenic and myogenic pathophysiological mechanism. These findings highlight the importance of early postpartum bladder monitoring in preventing prolonged dysfunction.</p>","PeriodicalId":23414,"journal":{"name":"Urologia Internationalis","volume":" ","pages":"1"},"PeriodicalIF":1.2,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148819809","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transurethral versus Suprapubic Catheterization in Acute Bacterial Prostatitis: Clinical Predictors and Outcomes.","authors":"Analena Handke, Charlotte Gassen, Patricia Rausch, Christopher Orf, Henning Bahlburg, Peter Bach, Florian Roghmann, Karl Tully","doi":"10.1159/uin/aewag007","DOIUrl":"https://doi.org/10.1159/uin/aewag007","url":null,"abstract":"<p><strong>Introduction: </strong>Acute bacterial prostatitis (ABP) is a common complication in men with lower urinary tract symptoms (LUTS). While antibiotics are the mainstay of treatment, the choice between transurethral (TC) and suprapubic (SC) catheterization remains debated. This study aimed to identify factors influencing catheterization choice and its impact on clinical outcomes.</p><p><strong>Methods: </strong>We retrospectively analyzed 255 patients presenting with ABP between 01/2015 and 12/2024. Clinical- and infection-related parameters, including prostate volume, post-void residual urine (PVR), CRP levels, and presence of prostatic abscess, were assessed for associations with catheter type. We further evaluated these factors and catheterization approach regarding hospital stay, need for subsequent subvesical de-obstruction, and 30-day readmission rates.</p><p><strong>Results: </strong>Median age was 64 years, median prostate volume 52 cc. Most patients received SC (64.3%). PVR was less frequent in the TC group (21.8% vs. 34.6%, p=0.042), while high CRP was more common (68.1% vs. 54.9%, p=0.039). Prostatic abscesses occurred more often in SC patients (8.6% vs. 3.4%, p=0.119). Median hospital stay was comparable (5 days, respectively, p=0.676). TC patients had lower 30-day readmission rates (1.1% vs. 6.8%, p=0.045), whereas SC patients more frequently required subvesical de-obstruction during follow-up through 12/2024 (21.3% vs. 11.0%, p=0.038).</p><p><strong>Conclusion: </strong>SC was preferred in patients with high PVR and abscesses. TC was associated with fewer readmissions, whereas SC patients more often required subsequent subvesical de-obstruction. These findings highlight the need for prospective studies to optimize catheterization strategies in ABP.</p>","PeriodicalId":23414,"journal":{"name":"Urologia Internationalis","volume":" ","pages":"1"},"PeriodicalIF":1.2,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148798399","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence, Clinicopathological Features, and Survival Impact of Incidental Prostate Cancer in Radical Cystoprostatectomy: A Single-Center Analysis.","authors":"Emre Albayrak, Rabia Hizarci Bal, Mesut Altan, Sertaç Yazıcı","doi":"10.1159/000553544","DOIUrl":"https://doi.org/10.1159/000553544","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the incidence, clinicopathological characteristics, and impact on overall survival (OS) of incidental prostate cancer (iPCa) detected in patients undergoing radical cystoprostatectomy (RCP) for bladder cancer.</p><p><strong>Materials and methods: </strong>We retrospectively analyzed data from 395 male patients who underwent RCP for urothelial carcinoma between January 2009 and January 2022. Patients with a preoperative diagnosis of prostate cancer were excluded. iPCa was classified as clinically significant (csPCa) based on Gleason score ≥7, stage ≥pT3a, or positive surgical margins. Survival outcomes were evaluated using Kaplan-Meier methods and Multivariable Cox regression analysis to identify independent predictors of mortality.</p><p><strong>Results: </strong>Incidental prostate cancer was detected in 136 patients (34.4%). Patients with iPCa were significantly older than those without (median 66 vs. 63 years, p=0.026). The majority of tumors were organ-confined (96.3%) and clinically insignificant (80.1%). Apical tumor involvement was observed in 19.1% of cases. In univariate analysis, the presence of iPCa was associated with worse OS (median 965 vs. 1821 days, p=0.008). However, in multivariable analysis adjusting for age and tumor characteristics, iPCa was not an independent predictor of survival (HR: 1.295, p=0.077). The primary independent risk factors for mortality were advanced age, lymph node positivity, and muscle-invasive bladder cancer.</p><p><strong>Conclusion: </strong>Incidental prostate cancer is a frequent finding during radical cystoprostatectomy but is predominantly clinically insignificant and does not independently compromise overall survival. The observed survival difference in univariate analysis is primarily driven by advanced patient age rather than the prostatic malignancy itself. Management should remain conservative for low-risk cases. However, the detection of apical involvement in nearly 20% of cases warrants caution regarding prostate-sparing cystectomy techniques.</p>","PeriodicalId":23414,"journal":{"name":"Urologia Internationalis","volume":" ","pages":"1-11"},"PeriodicalIF":1.2,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148798371","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Excessive Isotonic Irrigation Fluid Absorption Mimicking Bladder Perforation during Holmium Laser Enucleation of the Prostate: A Case Series and Diagnostic Challenge.","authors":"Kazim Ceviz, Onur Enes Tunç, Mehmet Arslan, Samet Şenel, Musab Ali Kutluhan, Zeynep Nur Akçaboy, Cüneyt Özden","doi":"10.1159/uin/aewag011","DOIUrl":"10.1159/uin/aewag011","url":null,"abstract":"<p><strong>Introduction: </strong>Holmium laser enucleation of the prostate (HoLEP) is an effective surgical method for the treatment of benign prostatic obstruction. Although transurethral resection syndrome is classically associated with hypotonic irrigation fluids, complications due to fluid absorption can also occur during HoLEP when isotonic saline is used.</p><p><strong>Case presentations: </strong>We present 3 patients with large-volume benign prostatic hyperplasia (prostate volumes 113-191 mL) who developed a clinical picture mimicking bladder perforation after HoLEP. All patients developed intraoperative abdominal distension, respiratory distress, and hypoxemia. Cystoscopic and radiological evaluations excluded bladder perforation. Blood gas analysis showed hyperchloremic metabolic acidosis in all cases (pH 7.01-7.22; Cl 117-122 mmol/L). Operative times ranged from 130 to 262 min and irrigation volumes from 48 to 56 L. After supportive treatment with diuretics and ventilatory support, clinical and biochemical stabilization was achieved within 6 h. Hospital stay ranged from 5 to 10 days; no mortality occurred.</p><p><strong>Conclusion: </strong>Despite the use of isotonic saline, prolonged HoLEP procedures with high irrigation volumes can cause significant fluid absorption leading to hyperchloremic metabolic acidosis, abdominal distension, and pulmonary edema that can mimic bladder perforation. Awareness of this complication is essential for both surgeons and anesthesiologists managing patients undergoing high-volume HoLEP.</p>","PeriodicalId":23414,"journal":{"name":"Urologia Internationalis","volume":" ","pages":"1"},"PeriodicalIF":1.2,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148798383","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prediction of delayed graft function after kidney transplantation using artificial intelligence and machine learning: A Systematic Review.","authors":"Sagar Yadav, Aakash Yadav, Shubham Singh Bais, Udit Khurana, Aarti Sharma, Prasoon Jha","doi":"10.1159/uin/aewag012","DOIUrl":"https://doi.org/10.1159/uin/aewag012","url":null,"abstract":"<p><strong>Introduction: </strong>Delayed graft function (DGF) is a frequent early complication after kidney transplantation. We systematically reviewed artificial intelligence and machine learning (AI/ML) models that use routine clinical variables to predict DGF.</p><p><strong>Methods: </strong>This PROSPERO-registered review (CRD420261400263) followed PRISMA guidance. MEDLINE/PubMed, Embase, Web of Science Core Collection and Cochrane Library were searched for human studies, without date restriction. Studies that developed or validated AI/ML models for DGF prediction using routine donor, recipient, immunological, laboratory, ischaemia-time, transplant-process or perioperative variables were eligible. Results were synthesised narratively. Quality was assessed using PROBAST+AI and STREAM-URO.</p><p><strong>Results: </strong>Of 613 records, 12 studies were included. Most were retrospective deceased-donor cohorts and three used national registries. DGF incidence varied widely (12.5-56.8%). Algorithms included neural networks, logistic and penalised regression, support vector machines, random forests, gradient boosting and stacked ensembles. Reported areas under the receiver operating characteristic curve (AUCs) ranged from 0.67 to 0.99. Recurrent predictors included donor renal-function measures, donor age and body mass index, donation after circulatory death, ischaemia time, recipient body size, dialysis exposure and human leukocyte antigen matching. Calibration, decision-curve analysis and external validation were uncommon. PROBAST+AI indicated high overall risk of bias in eight studies.</p><p><strong>Conclusions: </strong>AI/ML models show promise for DGF prediction, but their incremental benefit over conventional regression remains inconsistent. Heterogeneity across transplant eras, limited model transparency, inadequate assessment of calibration and clinical utility, and the lack of robust external validation must be addressed before these models can be implemented routinely in clinical practice.</p>","PeriodicalId":23414,"journal":{"name":"Urologia Internationalis","volume":" ","pages":"1"},"PeriodicalIF":1.2,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148798344","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adjunct Low-Intensity Extracorporeal Shockwave Therapy (LiESWT) for Acute and Chronic Epididymitis: A Case Series of 11 Patients.","authors":"Georgi Tosev, Cornelius Geil-Bierschenk, Georgios Hatzichristodoulou, Johannes Huber, Philipp Karschuck, Michael Dietz, Fabian Falkenbach, Philipp Reimold","doi":"10.1159/uin/aewag018","DOIUrl":"https://doi.org/10.1159/uin/aewag018","url":null,"abstract":"<p><p>Acute and chronic epididymitis frequently presents with significant morbidity due to severe pain and inflammation. Standard management includes antibiotics and analgesics, yet persistent symptoms and complications often occur, sometimes leading to orchiectomy. Low-intensity extracorporeal shockwave therapy (LiESWT), proven effective in reducing inflammation and promoting tissue repair in various urological conditions, was evaluated as an adjunct treatment for epididymitis. Eleven men with ultrasound-confirmed acute or chronic epididymitis were treated with adjunct Li-ESWT in addition to guideline-based antibiotic therapy. All patients demonstrated rapid improvement of symptoms, including significant pain reduction and normalization of inflammatory markers, with no adverse events observed. LiESWT was well-tolerated, and analgesic requirements appeared reduced compared with typical clinical courses. Initial clinical experience suggests that LiESWT may represent a promising, safe, and effective adjunct treatment option for acute and chronic epididymitis, with the potential to enhance recovery and reduce symptom burden. A randomized, multicenter trial is planned to further evaluate its efficacy.</p>","PeriodicalId":23414,"journal":{"name":"Urologia Internationalis","volume":" ","pages":"1"},"PeriodicalIF":1.2,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148798333","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nelaton versus Malecot Nephrostomy after Supine Mini-PCNL: A Comparative Study of Removal-Related Complications and Cost.","authors":"Eser Ördek, Eren Günsay, Duran Kuru, Sadik Görür","doi":"10.1159/uin/aewag014","DOIUrl":"https://doi.org/10.1159/uin/aewag014","url":null,"abstract":"<p><strong>Introduction: </strong>Optimal nephrostomy tube selection following percutaneous nephrolithotomy (PCNL) remains controversial. Existing literature has largely emphasized overall complication rates; however, drainage-related mechanical events during catheter removal have not been adequately explored. This study aimed to compare 12 Fr Nelaton probes and re-entry Malecot nephrostomy catheters after mini-PCNL in terms of cost and early postoperative drainage-related complications.</p><p><strong>Methods: </strong>This single-center retrospective observational study included patients who underwent mini-PCNL between January 2023 and March 2026 and received either a 12 Fr Nelaton probe or a re-entry nephrostomy catheter at the end of the procedure. The primary endpoints were total per-patient cost and early postoperative complications associated with catheter removal. Secondary endpoints included stone-free rate (SFR), hemoglobin change, transfusion requirement, operative time, length of hospital stay, and overall complications.</p><p><strong>Results: </strong>A total of 230 patients were analyzed (mean age 45.8±14.7 years). Malecot catheters were used in 64.8% of cases and Nelaton probes in 35.2%. The overall complication rate was 16.5%, predominantly Clavien-Dindo Grade I-II. No significant differences were observed between the groups regarding overall complications, residual stones, transfusion requirement, hemoglobin change, infectious complications, or length of hospital stay (p>0.05). Operative time was significantly longer in the Nelaton group (p<0.05), although this difference did not affect clinical outcomes. During catheter removal, four cases of Double-J (DJ) stent migration and one case of stone migration occurred in the Malecot group, whereas no migration-related complications were observed in the Nelaton group. The per-patient cost was significantly lower in the Nelaton group.</p><p><strong>Conclusion: </strong>Malecot and Nelaton catheters yield comparable clinical outcomes following mini-PCNL. However, the Nelaton probe offers a significant cost advantage and reduces mechanical complications during catheter removal. It represents a safe and cost-effective alternative for routine cases, although further validation through larger prospective studies is warranted.</p>","PeriodicalId":23414,"journal":{"name":"Urologia Internationalis","volume":" ","pages":"1"},"PeriodicalIF":1.2,"publicationDate":"2026-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148798335","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Magnetic Resonance Imaging-Based Prediction of Positive Surgical Margins in Radical Prostatectomy: Insights from Clinical and Imaging Parameters.","authors":"Christoph Niessen, Yannick Gromes, Simon Udo Engelmann, Maximilian Haas, Sebastian Kälble, Johannes Bründl, Christian Stroszczynski, Maximilian Burger, Florian Weber, Christoph Pickl","doi":"10.1159/uin/aewag010","DOIUrl":"10.1159/uin/aewag010","url":null,"abstract":"<p><strong>Introduction: </strong>Positive surgical margins (PSM) after radical prostatectomy are associated with adverse oncological outcomes. Preoperative identification of patients at risk may improve surgical decision-making. The objective of this study was to evaluate clinical and magnetic resonance imaging (MRI)-derived predictors of PSM and to explore their potential value for preoperative risk assessment in patients undergoing robot-assisted radical prostatectomy (RARP).</p><p><strong>Methods: </strong>This retrospective, single-center study comprised 134 patients with localized prostate cancer who underwent preoperative multiparametric MRI and RARP between July 2022 and April 2024. Clinical, histopathological, and MRI-derived parameters were analyzed using univariate and multivariate logistic regression. Odds ratios (ORs), 95% confidence intervals (CIs), and p values were reported. Model performance was evaluated using receiver operating characteristic (ROC) curve analysis.</p><p><strong>Results: </strong>PSMs were present in 20.1% (27/134) of patients. In multivariate analysis, the strongest independent predictors of PSM were suspicion of extraprostatic extension (EPE) on MRI (OR: 12.62, 95% CI: 3.24-49.15; p < 0.001), urethral involvement (distance <2 mm) (OR: 8.88, 95% CI: 1.76-44.73; p = 0.008), and capsular contact length >12 mm (OR: 8.84, 95% CI: 2.44-32.03; p < 0.001). The exploratory model achieved excellent apparent discrimination (area under the curve: 0.911). Infiltration of the perineural sheath was observed in 96% of R1 compared to 70% of R0 patients (p = 0.01). Nerve-sparing surgery was not significantly associated with a different rate of PSM (p = 0.385).</p><p><strong>Conclusion: </strong>Several MRI-derived parameters, including capsular contact length, MRI-suspected EPE, and urethral proximity, were associated with an increased likelihood of PSM. Incorporating these metrics alongside clinical factors may improve risk stratification. However, prospective studies with external validation are required before routine clinical implementation.</p>","PeriodicalId":23414,"journal":{"name":"Urologia Internationalis","volume":" ","pages":"1"},"PeriodicalIF":1.2,"publicationDate":"2026-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148798403","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of Extended-Spectrum Beta-Lactamase Production and 28-Day Mortality Predictors in Urine Cultures of Hospitalized Elderly Patients.","authors":"Kerem Yilmaz, Merve Büyükkörük, Akin Ögünç Inan","doi":"10.1159/uin/aewag015","DOIUrl":"https://doi.org/10.1159/uin/aewag015","url":null,"abstract":"<p><strong>Introduction: </strong>This study aimed to evaluate the associated factors for extended-spectrum beta-lactamase (ESBL) production in Enterobacterales isolated from urine cultures of hospitalized elderly patients and to identify independent predictors of ESBL positivity and 28-day mortality.  Methods: A retrospective observational study was conducted at Soma State Hospital involving 261 patients aged 65 years and older hospitalized between January 1, 2025 and January 1, 2026. Bacterial identification and antimicrobial susceptibility testing were performed using the VITEK 2 automated system in accordance with EUCAST guidelines. Risk factors for ESBL production and mortality were determined using multivariate logistic regression models.  Results: The median age of the cohort was 81 years, and 64.0% (n = 167) of the isolates were ESBL-positive. While Escherichia coli was the most frequently isolated pathogen overall (48.7%), Klebsiella pneumoniae was the most common organism in the ESBL-positive group (53.3%). Multivariate analysis identified urinary catheter use (aOR = 2.044, 95% CI: 1.178-3.548, p = 0.011) and length of stay (LOS) ≥ 7 days (aOR = 1.905, 95% CI: 1.083-3.352, p = 0.025) as independent risk factors for ESBL positivity. Independent predictors of 28-day mortality included age (aOR= 1.082, p < 0.001), urinary catheter use (aOR = 1.941, p = 0.023) and higher CRP levels (aOR = 1.035, p = 0.036). Notably, ESBL positivity was not significantly associated with mortality (p = 0.076). ESBL-positive isolates exhibited significantly higher resistance rates across nearly all tested antibiotic classes, including ciprofloxacin and trimethoprim-sulfamethoxazole.  Conclusion: The findings highlight that urinary catheterization and prolonged hospitalization are pivotal drivers of ESBL prevalence in the geriatric population. Furthermore, advanced age, catheter use, and CRP levels independently impact mortality, underscoring the necessity of monitoring invasive device use to mitigate resistance development and improve clinical outcomes.</p>","PeriodicalId":23414,"journal":{"name":"Urologia Internationalis","volume":" ","pages":"1"},"PeriodicalIF":1.2,"publicationDate":"2026-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148798379","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How Often are druggable mutations detectable in Metastatic Castration Resistant Prostate Cancer?","authors":"Olivia Steenbock, Constantin Rieger, Julian Heidenreich, Pia Paffenholz, David Pfister, Melanie von Brandenstein, Axel Heidenreich","doi":"10.1159/uin/aewag003","DOIUrl":"https://doi.org/10.1159/uin/aewag003","url":null,"abstract":"<p><strong>Objectives: </strong>To analyze the type and frequency druggable mutations in patients with progressive metastatic castration-resistant prostate cancer (mCRPC).</p><p><strong>Patients and methods: </strong>From 2018 to 2023, 311 patients with mCRPC underwent molecular panel analysis of archived prostatectomy samples (n=96) or CT-guided biopsies of progressive metastases (n=215).Mutation analysis was performed using NGS with an 18 multiplex PCR amplicon (AR, ATM, AURKA/MYC, BRCA1/2, CDK12, CTNNB1, DLL3, ETS family, FOXA1, FOXO1, MED12, PIK3CA, PTEN, RAD51C, TP53, Wnt-Pathway). Since 2023, we applied the TSO500 panel in selected cases. The HRD score was calculated by combining BRCA1 and BRCA2 mutations (Genomic ScarScore GSS) using the HANDLE HRD Focus Panel. The data were evaluated using the following thresholds: tumor cell content ≥ 30%, GScore positive at ≥ 50, HRD positive: GScore at ≥ 50 or BRCA1/2 category 4/5 mutation. MSI-high and mutations of MSH2, MSH6, PMS2, and MLH1 were analysed. The following databases were reviewed to identify druggable mutations: OncoKB, ClinVar, JAX-CKB, COSMIC, and My Cancer Genome.</p><p><strong>Results: </strong>299/311 (96%) biopsies had sufficient DNA content for NGS. NGS was performed from prostate (31%), lymph node (30%), visceral (15%), and bone (24%) metastases with informative DNA retrival in 95%, 95%, 92%, and 85%, respectively. 157 patients (50.5%) had no or non druggable mutations, while 154 patients (49.5%) exhibited druggable mutations. HRD gene mutations and inactivating p53 mutations were observed in 66 patients (22%). 3 patients had p53 mutations with gain-of-function resulting in ATM inactivation. 50% of HRD gene mutations iwere pathogen and treated with PARPi resulting in a progression-free survival of 3-28 months. Activating AR mutations and inactivating PTEN/activating PIC3Ca mutations were found in 42 (14%) and 24 (8%) patients, respectively. Switch of treatment for AR mutation resulted in PFS of 6-9 months. Mismatch repair deficiency/MSI high mutations were identified in 3 cases who received pembrolizumab with a PFS of 4-8 months.</p><p><strong>Conclusions: </strong>NGS analysis in mCRPC reveals mutations in two-thirds of patients, of which 41% are already druggable. Only 50% of druggable mutations are based on BRCA1/2 or ATM. NGS analysis should be integrated into the diagnostic armentarium following failure of first-line systemic therapy for mCRPC.</p>","PeriodicalId":23414,"journal":{"name":"Urologia Internationalis","volume":" ","pages":"1"},"PeriodicalIF":1.2,"publicationDate":"2026-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148763886","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}