Urology最新文献

{"title":"Editorial Comment on \"Gender representation and regional affluence as dual drivers of reimbursement equity in Urology\".","authors":"M Ashani Couchman","doi":"10.1016/j.urology.2026.10.018","DOIUrl":"https://doi.org/10.1016/j.urology.2026.10.018","url":null,"abstract":"","PeriodicalId":23415,"journal":{"name":"Urology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149220242","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":"Prospective feasibility study of cryobiopsy in patients with suspected upper tract urothelial carcinoma.","authors":"C Bolenz, J Schockmann, J T Klein, F Zengerling, N T Gaisa, T F E Barth, W Linzenbold, A John","doi":"10.1016/j.urology.2026.10.017","DOIUrl":"https://doi.org/10.1016/j.urology.2026.10.017","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the feasibility and specimen quality of cryobiopsy for ureterorenoscopic (URS) biopsy in suspected upper tract urothelial carcinoma (UTUC).</p><p><strong>Methods: </strong>Using a newly developed flexible cryoprobe, a total of 80 biopsies were obtained in 10 consecutive patients with renal pelvis tumors suspicious for UTUC (cryobiopsy, n = 28; forceps, n = 28; basket, n = 24). The primary endpoint was the diagnostic yield of cryobiopsy; secondary endpoints included comparison with standard instruments, feasibility, safety, and specimen quality.</p><p><strong>Results: </strong>Cryobiopsy enabled a definitive histopathological diagnosis in all patients (primary endpoint). As a secondary endpoint, the percentage of diagnostic cryosamples was significantly higher than with conventional forceps (75.0% vs. 35.7%; p=0.007) or basket biopsy (29.2%; p=0.002). The proportion of representative samples was highest with cryobiopsy (82.1%) compared with forceps (46.4%, p = 0.011) and basket biopsy (54.2%, p = 0.038). Cryobiopsies were significantly larger (mean area 18.0 mm²) than forceps (6.4 mm², p<0.001) or basket specimens (9.6 mm², p=0.008). Histological assessability was highest with cryobiopsy (score 4.8 vs. 2.9 with forceps, p = 0.031, and 3.8 with basket, p > 0.999). Postoperative hematuria occurred in six of ten patients; it was managed conservatively, and no patient required transfusion or re-intervention.</p><p><strong>Conclusions: </strong>Cryobiopsy in the renal pelvis is feasible and yielded larger, higher-quality specimens than standard instruments. Whether this improves staging, risk stratification, or treatment selection requires larger multicenter trials (trial registration number DRKS00025620).</p>","PeriodicalId":23415,"journal":{"name":"Urology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149220662","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 on \"Perioperative Morbidity of Robotic-Assisted Radical Cystectomy Versus Open Radical Cystectomy in Older Adults and the Role of Frailty as an Effect Modifier\".","authors":"Laura E Davis, Michael Wynne, Braden Millan, Hangcheng Fu","doi":"10.1016/j.urology.2026.10.019","DOIUrl":"https://doi.org/10.1016/j.urology.2026.10.019","url":null,"abstract":"","PeriodicalId":23415,"journal":{"name":"Urology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149220676","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":"Feasibility of AI-based Automated Identification of Sacral Anatomy and Lead Features During Sacral Neuromodulation Procedures.","authors":"Nicholas R Hugenberg, Abhinav Khanna, Brian J Linder","doi":"10.1016/j.urology.2026.10.011","DOIUrl":"https://doi.org/10.1016/j.urology.2026.10.011","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the ability of artificial intelligence-based modeling to identify pertinent sacral anatomy and lead characteristics on fluoroscopic imaging.</p><p><strong>Methods: </strong>An expert practitioner manually reviewed and segmented image pairs from sacral neuromodulation device placements between November 2017 and August 2022. These were used to train (n=177 lateral, 170 AP) and test (n=43 lateral, 36 AP) two semantic segmentation networks via nnUNet. A subset of this data was selected to train a model for electrode segmentation (n=201 train, n=38 test). Dice scores and subjective review were used to assess correlation between expert annotation and automated AI segmentation.</p><p><strong>Results: </strong>The AI algorithm accurately segmented pertinent anatomic landmarks in 97% (35/36) of AP images and 93% (40/43) of lateral images based on subjective binary expert review, indicating a high level of clinically acceptable segmentations. When evaluated by 3-point Likert scale, the mean (SD) score was 2.86 (0.42) for AP images and 2.77 (0.57) for lateral images. The overall Dice score for all lateral landmarks was (mean ± std) 0.759 ± 0.067, with individual landmark scores ranging from 0.524 (S2) to 0.769 (S3 hillock). The overall Dice score (integrated) for all AP landmarks was 0.711 ± 0.117, with individual landmark scores ranging from 0.633 (medial edge of foramen) to 0.745 (midline of spine). The overall Dice score (integrated) for all electrodes in the combined AP and lateral imaging dataset was 0.889 ± 0.035.</p><p><strong>Conclusions: </strong>Creating segmentation networks capable of producing high-quality annotations of the pertinent sacral anatomy and leads during sacral neuromodulation device placement is feasible. Further validation is needed prior to clinical implementation.</p>","PeriodicalId":23415,"journal":{"name":"Urology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149208248","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 on \"Contrasting reasons for early termination between industry and non-industry-led clinical trials in genitourinary oncology\".","authors":"Fady Ghali","doi":"10.1016/j.urology.2026.10.012","DOIUrl":"https://doi.org/10.1016/j.urology.2026.10.012","url":null,"abstract":"","PeriodicalId":23415,"journal":{"name":"Urology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149196875","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":"A Contemporary Analysis of Positive Surgical Margin Length and Oncologic Outcomes After Radical Prostatectomy: Results from an Institutional Registry with Long-Term Follow Up.","authors":"Chloe Shi, Eric V Li, Michael K Wang, Jamie O'Byrne, Peter Galatowitsch, Igor Frank, Matthew K Tollefson, Vidit Sharma, Paras Shah, Matthew T Gettman, R Jeffrey Karnes, Stephen A Boorjian, Abhinav Khanna","doi":"10.1016/j.urology.2026.10.004","DOIUrl":"https://doi.org/10.1016/j.urology.2026.10.004","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the impact of positive surgical margins (PSM) after radical prostatectomy (RP) and oncologic outcomes in a large institutional registry with long-term follow up and explore various methods of margin characterization. Prior studies remain limited by heterogeneous margin characterization, small cohorts, and limited follow-up.</p><p><strong>Methods: </strong>We queried our prospectively maintained institutional registry for patients who underwent RP from 1987-2023. PSM were analyzed as binary (negative/positive) and focality (negative/unifocal/multifocal). Cox proportional hazards regression models evaluated associations with oncologic outcomes. Cutpoint analysis identified an optimal threshold that differentiated outcomes by linear PSM length.</p><p><strong>Results: </strong>Among 24,855 patients with median follow-up of 10.9 years, 6454(26%) had PSM. On multivariable analysis, PSM were associated with increased risk of biochemical recurrence (BCR, HR 1.74 [1.57-1.93], p<.0001), but not metastasis-free (MFS), cancer-specific (CSS), or overall survival (OS). Unifocal (HR 1.66 [1.48-1.86]) and multifocal (HR 2.01 [1.7-2.37]) PSM were similarly associated with increased risk of BCR (p<.0001), but not MFS, CSS, or OS. Cutpoint analysis identified a threshold of 1mm. PSM length ≥1mm was associated with increased risk of BCR (HR 1.72[1.53-1.92, p<.0001), while <1mm was not.</p><p><strong>Conclusions: </strong>In this large cohort with long-term follow-up, PSMs were only associated with BCR but not with MFS, CSS, or OS. These results may inform postoperative surveillance protocols and adjuvant therapy risk stratification. Additionally, on exploratory analyses in a small subgroup of men with limited follow-up duration, PSMs shorter than 1mm did not appear to be associated with BCR, a hypothesis-generating finding which warrants further investigation in the modern era of digitized pathology.</p>","PeriodicalId":23415,"journal":{"name":"Urology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149196857","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":"Core Entrustable Professional Activities for Urology: A National Delphi Study of Academic Urology Educators.","authors":"Robert S Wang, Christopher D Jaeger, Mathew D Sorensen, Brenessa Lindeman, Gurjit Sandhu, Ara Tekian, Yoon Soo Park, Kate H Kraft","doi":"10.1016/j.urology.2026.10.009","DOIUrl":"https://doi.org/10.1016/j.urology.2026.10.009","url":null,"abstract":"<p><strong>Objective: </strong>To establish a consensus-based foundation for Entrustable Professional Activities (EPAs) in urology by identifying core urology EPAs - activities that all residents should be able to perform independently upon graduation. EPAs are a competency-based assessment framework designed help graduate medical training programs assess trainee readiness for independent practice. Although several specialties have formally incorporated EPAs into their training and certification frameworks, adoption within urology has been limited.</p><p><strong>Methods: </strong>A comprehensive list of EPAs spanning the breadth of urology practice was reviewed by a panel of academic urologists. Core EPAs for urology were identified through a three-round modified Delphi process. These were reviewed by EPA experts and consolidated into a smaller set of combined urology EPAs suitable for pilot testing and implementation. The quality of the final EPAs was assessed using EQual - an EPA rating rubric with strong validity evidence.</p><p><strong>Results: </strong>Out of a total of 242 candidate EPAs, 144 core EPAs were identified. Core designation was achieved for 100% of EPAs for initial evaluation of urologic conditions, 89% of EPAs covering medical/non-surgical management, and 33% of EPAs describing operations/procedures. Expert review, consolidation, and revision resulted in a final set of 15 urology EPAs. Average EQual rating was 4.8±0.42 (out of 5), indicating a high level of quality.</p><p><strong>Conclusions: </strong>We identified 15 EPAs representing the core professional activities of urology. These findings suggest that graduating urology residents are expected to independently evaluate and medically manage most urologic conditions, while performing a more limited range of urologic procedures.</p>","PeriodicalId":23415,"journal":{"name":"Urology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149196884","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 on \"The Only Urologist to Become a Head of State: Juscelino Kubitschek, President of Brazil\".","authors":"Fernando J Kim","doi":"10.1016/j.urology.2026.10.007","DOIUrl":"https://doi.org/10.1016/j.urology.2026.10.007","url":null,"abstract":"","PeriodicalId":23415,"journal":{"name":"Urology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149196795","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":"Diet quality and prognosis in patients with non-muscle invasive bladder cancer: the Be-Well Study.","authors":"Isaac J Ergas, Alexa Zimbalist, Reina Haque, Valerie S Lee, Janise M Roh, Kimberly L Cannavale, Zinian Wang, Ronald K Loo, David S Aaronson, Charles P Quesenberry, Lawrence H Kushi, Li Tang, Marilyn L Kwan","doi":"10.1016/j.urology.2026.10.010","DOIUrl":"https://doi.org/10.1016/j.urology.2026.10.010","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate whether diet quality around the time of diagnosis is associated with risks of recurrence and progression among individuals with non-muscle invasive bladder cancer (NMIBC).</p><p><strong>Methods: </strong>We conducted a prospective cohort study within a large integrated healthcare system. A total of 1,143 adults with newly diagnosed primary NMIBC were enrolled between 2015 and 2019. Dietary intake 12 months prior was assessed using food frequency questionnaires. Four diet quality indices were calculated-American Cancer Society guidelines, alternative Healthy Eating Index, 2020 Healthy Eating Index (HEI), Healthy Plant-Based Dietary Index-and then categorized into quartiles (Q). Recurrence and progression were determined through chart review approximately 2 years after diagnosis. Kaplan-Meier curves visualized recurrence-free survival, and multivariable-adjusted hazard ratios (HR) and 95% confidence intervals (CI) were estimated, with analyses stratified by treatment.</p><p><strong>Results: </strong>Among the 1,143 participants, 325 (28.4%) experienced recurrence and 52 (4.5%) had progression over 2 years. Higher diet quality was associated with lower recurrence risk for the HEI (Q4 vs Q1: HR=0.72; 95% CI, 0.52-0.99). In stratified analyses, lower recurrence risk was more pronounced among patients who did not receive intravesical chemotherapy mitomycin C (Q4 vs Q1 HR=0.60; 95% CI, 0.41-0.90). No associations were observed for progression.</p><p><strong>Conclusions: </strong>Of the four diet quality indices, the highest HEI quartile was associated with lower NMIBC recurrence risk, particularly among patients not treated with mitomycin C. Diet quality may be an important modifiable risk factor in NMIBC survivorship.</p>","PeriodicalId":23415,"journal":{"name":"Urology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149196860","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":"Transition Readiness and Independence Are Associated with Sexual Activity Among Adolescents and Young Adults with Congenital Urologic Conditions.","authors":"Rennen Haramaty, Irene Choi, Leeyan Nasrallah, Kali Mesdjian, Jennika Finup, Javi Santiago, Madeleine Rapisarda, Vinaya Bhatia, Walid Farhat, Kristin Ebert","doi":"10.1016/j.urology.2026.10.006","DOIUrl":"https://doi.org/10.1016/j.urology.2026.10.006","url":null,"abstract":"<p><strong>Objective: </strong>To describe sexual activity, sexual function, fertility interest, and associations with transition readiness and independence among adolescents and young adults with congenital urologic conditions.</p><p><strong>Methods: </strong>We studied patients seen in a Transitional Urology Clinic from August 2024 to August 2025. Participants completed SHIM (Sexual Health Inventory for Men) or FSFI-6 (Female Sexual Function Index-6) and TRAQ (Transition Readiness Assessment Questionnaire) assessments.</p><p><strong>Results: </strong>Thirty-seven patients were included; 29 had neurogenic bladder. Eight (21.6%) reported sexual activity and 30 (81.1%) met sexual dysfunction criteria. Sexual activity was lower in neurogenic bladder than non-neurogenic conditions (15.4% vs 57.1%, p=0.042). Sexually active participants were more likely to live independently (87.5% vs 20.0%, p=0.001), be their own legal guardians (100% vs 58.3%, p=0.035), and have higher TRAQ scores (100 vs 79, p=0.013).</p><p><strong>Conclusions: </strong>Sexual dysfunction was common among adolescents and young adults with congenital urologic conditions, regardless of neurologic status. Greater independence and higher transition readiness scores were associated with sexual activity and more favorable sexual health outcomes, suggesting that sexual health is closely linked to developmental readiness. These findings support incorporating sexual health assessment and counseling as a routine component of transitional urologic care.</p>","PeriodicalId":23415,"journal":{"name":"Urology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149184557","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}