World Journal of Urology最新文献

{"title":"A prognostic model for survival of patients with metastatic upper tract urothelial carcinoma with first-line systemic therapy.","authors":"Siming Li, Jinchang Wei, Huayan Xu, Xiaowen Wu, Juan Li, Li Zhou, Xieqiao Yan, Bixia Tang, Lu Si, Chuanliang Cui, Zhihong Chi, Jun Guo, Xinan Sheng","doi":"10.1007/s00345-025-05592-7","DOIUrl":"https://doi.org/10.1007/s00345-025-05592-7","url":null,"abstract":"<p><strong>Purpose: </strong>Upper tract urothelial carcinoma (UTUC) presents distinct clinicopathological, molecular features, and biological behaviors compared to urothelial bladder carcinoma (UBC). Currently, no prognostic model exists for metastatic UTUC (mUTUC). This study aimed to develop a prognostic model for patients with mUTUC receiving first-line systemic therapy.</p><p><strong>Patients and methods: </strong>A total of 476 patients with mUTUC who received first-line systemic therapy were included and retrospectively analyzed. Patients were randomly assigned to development and validation cohorts in a 3:1 ratio, with potential prognostic factors recorded prospectively. Univariate analyses identified clinical and laboratory factors significantly associated with median overall survival (mOS) in the development cohort, followed by multivariate analyses to determine independent prognostic factors. These factors were utilized to develop a prognostic model. Internal validation was conducted using the validation cohort.</p><p><strong>Results: </strong>The number of metastatic organs, Eastern Cooperative Oncology Group Performance Status (ECOG PS), time to distant metastasis (TTDM), white blood cell (WBC) count and alkaline phosphatase (ALP) were identified as independent prognostic factors for mUTUC. Patients were stratified into three risk categories: favorable (0 risk factors, mOS 65.0 months, 95% confidence interval [CI] 35.5-94.6]), intermediate (1 risk factor, mOS 32.0 months, 95% CI 25.8-38.2), and poor (2 + risk factors, mOS 16.0 months, 95% CI 12.1-19.9) (P < 0.001). The model's concordance statistic (c-statistic) was 0.71.</p><p><strong>Conclusion: </strong>We developed and validated a prognostic model to estimate survival of patients with mUTUC receiving first-line systemic therapy. This model is applicable to real-world clinical practice and may inform the design of future clinical trials.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"43 1","pages":"206"},"PeriodicalIF":2.8,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143765261","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Robot-assisted partial nephrectomy and robot-assisted radical prostatectomy using the Chinese surgical systems KangDuo-SR-2000 and EDGE MP1000 versus the Da Vinci Xi system: a prospective, single-center, non-randomized clinical trial.","authors":"Pengyu Guo, Honglei Wang, Zixing Wang, Tao Xu, Jianzhang Li, Yangyang Xu, Dexin Ding, Changfu Li, Lichen Teng, Hui Chen, Yongsheng Chen, Zhongjie Qiao, Muyang Cao, Chen Du, Hongwei Li, Ziqi Wang, Wanhai Xu","doi":"10.1007/s00345-025-05593-6","DOIUrl":"https://doi.org/10.1007/s00345-025-05593-6","url":null,"abstract":"<p><strong>Purpose: </strong>This study aims to compare the safety and efficacy of robot-assisted partial nephrectomy (RAPN) and robot-assisted radical prostatectomy (RARP) using the Chinese surgical systems KangDuo-SR-2000 (KD-SR-2000) and EDGE MP1000 (MP1000) versus the Da Vinci Xi (DV-Xi) system, to explore viable alternative options to DV-Xi.</p><p><strong>Methods: </strong>This prospective, single-center, non-randomized clinical trial enrolled 261 patients who underwent RAPN or RARP from August 2023 to June 2024. All surgeries were performed by 3 surgeons. For RAPN, the primary outcome included surgical success, positive surgical margin (PSM), warm ischemia time (WIT) and conversion to open or laparoscopic surgery. The secondary outcome was estimated glomerular filtration rate (eGFR). For RARP, the primary outcome was surgical success without conversion to open or laparoscopic surgery, and the secondary outcomes included PSM and urinary continence recovery at 4 weeks post-catheter removal.</p><p><strong>Results: </strong>Baseline demographics were comparable across the KD-SR-2000 group (n = 88), EDGE MP1000 group (n = 59) and DV-Xi group (n = 114). No significant differences observed in primary and secondary outcomes. However, operation time and suture time per stitch were longer in Chinese surgical systems for both RAPN and RARP compared to DV-Xi, and estimated blood loss (EBL) is higher in RAPN. Subgroup analyses indicated that performance differences were primarily attributed to the KD-SR-2000, with no significant differences observed between the MP1000 and DV-Xi. No severe complications (Clavien-Dindo grade ≥ 3) reported in any group.</p><p><strong>Conclusions: </strong>Chinese surgical systems provide a viable alternative, demonstrating non-inferiority compared to DV-Xi.</p><p><strong>Trial registration number: </strong>ChiCTR2300074914; Registration Date: 2023-08-21.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"43 1","pages":"205"},"PeriodicalIF":2.8,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143765263","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk stratification for repeat stone surgery: the role of stone composition.","authors":"Sagi A Shpitzer, Igal Shpunt, Nadav Loebl, Leor Perl, Dmitry Enikeev, Abd E Darawsha, Yaron Ehrlich, David Lifshitz","doi":"10.1007/s00345-025-05573-w","DOIUrl":"https://doi.org/10.1007/s00345-025-05573-w","url":null,"abstract":"<p><strong>Purpose: </strong>Kidney stones have a recurrence risk of 30-50% within five years, with surgical recurrence often being the most clinically significant and burdensome. Stone composition results obtained after surgery are readily available and typically precede metabolic evaluation. However, only few, relatively small studies, correlated stone composition with surgical reccurence. This study aims to determine whether stone composition alone can reliably predict recurrent stone surgery, offering insights into personalized management strategies.</p><p><strong>Methods: </strong>A retrospective analysis of surgically treated patients with an available stone composition analysis performed between 2013 and 2020 in a large healthcare provider database. Data were analyzed for up to 5 years from the initial surgery.</p><p><strong>Results: </strong>8,561 patients underwent surgical procedures for stones and 2,097 (24.5%) had repeat surgery within 5 years. Compared to calcium oxalate stone formers, individuals forming uric acid, calcium phosphate, infection, brushite, and cystine stones were 1.5, 1.5, 1.87, 2.64, and 2.71 times more likely, respectively, to undergo a second stone surgery (p < 0.001). The median time for repeat stone surgery in cystine and infection stone formers was significantly shorter compared to calcium oxalate (p < 0.01).</p><p><strong>Conclusions: </strong>Stone composition significantly affects the 5-year surgical recurrence rates and the median time to recurrence, with non-calcium oxalate stone formers at a higher risk for recurrence. Sharing this information with patients may improve compliance with preventive strategies, including comprehensive metabolic evaluation and adherence to preventive therapy. Emphasizing this risk may help prioritize proactive management in high-risk patients.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"43 1","pages":"203"},"PeriodicalIF":2.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143754811","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A systematic review and meta-analysis of alpha-adrenergic antagonists for the treatment of pain in chronic prostatitis.","authors":"Anthony Carona, David Jacobson, Charles Hildebolt, Kevin Rowland","doi":"10.1007/s00345-025-05575-8","DOIUrl":"https://doi.org/10.1007/s00345-025-05575-8","url":null,"abstract":"<p><strong>Background: </strong>Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS) is a debilitating condition affecting 2-10% of men globally. Its symptoms, including pelvic pain, urinary problems, and reduced quality of life, vary widely. Despite extensive research, a definitive treatment remains elusive. Alpha-adrenergic antagonists are frequently used to manage urinary symptoms, while analgesics are employed for pain. However, the long-term efficacy of alpha-adrenergic antagonists for pelvic pain requires further investigation. CP/CPPS places a significant burden on healthcare systems and the economy. This systematic review aims to evaluate the effectiveness of alpha-adrenergic antagonists in reducing pain symptoms in men with CP/CPPS compared to placebo.</p><p><strong>Methods: </strong>A systematic search of randomized, placebo-controlled trials evaluating the effectiveness of alpha-adrenergic antagonists for the treatment of pain in CP/CPPS was conducted and captured all available studies (n = 680). After application of exclusion criteria, five studies were identified as suitable for inclusion.</p><p><strong>Results: </strong>Four papers consisting of five studies, containing a total of 578 participants, were evaluated. The combined effects found no difference in pain relief between treated and control subjects for the data from the five studies in the meta-analysis (P = 0.106), with the 95% CI for the random effects model containing a value of 0.00.</p><p><strong>Conclusion: </strong>In adults with CP/CPPS, alpha-adrenergic antagonists were ineffective as monotherapy to treat pain. Further studies are needed to address possible confounding variables for alpha-adrenergic antagonist efficacy. These findings suggest that alpha-adrenergic antagonists as monotherapy are not effective for pain reduction in CP/CPPS and highlight the need for further research to explore combination therapies or other treatment modalities.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"43 1","pages":"204"},"PeriodicalIF":2.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143765262","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Will artificial intelligence (AI) replace cytopathologists: a scoping review of current applications and evidence of A.I. in urine cytology.","authors":"Jingqiu Li, Tsung Wen Chong, Khi Yung Fong, Benjamin Lim Jia Han, Si Ying Tan, Joanne Tan San Mui, Li Yan Khor, Bhaskar Kumar Somoni, Thomas R W Herrmann, Vineet Gauhar, Valerie Gan Huei Li, Christopher Cheng Wai Sam, Ee Jean Lim","doi":"10.1007/s00345-025-05583-8","DOIUrl":"https://doi.org/10.1007/s00345-025-05583-8","url":null,"abstract":"<p><strong>Purpose: </strong>Urine cytology, while valuable in facilitating the detection and surveillance of bladder cancer, has notable limitations. The application of artificial intelligence (AI) in urine cytology holds significant promise for improving diagnostic accuracy and efficiency. Our scoping review aims to assess the current evidence of AI's utility in urine cytology.</p><p><strong>Method: </strong>An electronic literature research on the application of AI in the setting of urine cytology was conducted on PubMed, EMBASE, and Scopus from inception to 1st November 2024. Case reports, abstracts, and reviews were excluded from this analysis. Our search strategy retrieved 1356 articles; after excluding 142 duplicates, the remaining 1214 papers were screened by title and abstract. 31 studies entered full-article review, and a total of 16 articles were included in the final analysis.</p><p><strong>Results: </strong>The main application of AI in urine cytology diagnosis is to automate the identification and characterization of abnormal cells. It has also been utilized for risk stratification of abnormal cells, predicting histologic results from urine cytology samples, and predicting bladder cancer recurrence. Current limitation includes the need for robust training datasets and validation studies to ensure the generalizability of AI algorithms.</p><p><strong>Conclusion: </strong>In summary, AI in urine cytology, though still developing, shows significant promise in enhancing diagnostic accuracy and efficiency. Current evidence suggests that AI, as a valuable tool, could revolutionize urinary tract cancer diagnosis and management.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"43 1","pages":"200"},"PeriodicalIF":2.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143754633","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endourological treatment of ureteral strictures with the use of self-expanding stents: is it possible to completely cure the stricture endoscopically? A report on the experience with implantation of 35 stents with a two-year follow-up period; a retrospective study.","authors":"Filip Kowalski, Błażej Kuffel, Michał Późniak, Pavel Lipowski, Michal Czarnogorski, Jacek Wilamowski, Adam Ostrowski, Jan Adamowicz, Tomasz Drewa","doi":"10.1007/s00345-025-05574-9","DOIUrl":"https://doi.org/10.1007/s00345-025-05574-9","url":null,"abstract":"<p><strong>Background: </strong>The current results of endoscopic treatment of ureteral strictures are characterized by very divergent treatment results, which is due to a wide range of criteria for including patients in the analyses and different definitions of effective treatment. In this retrospect study we wanted to introduce a possibility of curing ureteral strictures depending on their type and degree with the use of self-expanding ureteral stents (SUS).</p><p><strong>Methods: </strong>33 patients with ureteral strictures received endourological treatment with the use of Allium® SUS (2 patients with SUS placed on both sides). Patients were divided into 2 groups: patients with uncomplicated strictures (Grp 1) and patients with complicated strictures (Grp 2). Uncomplicated stricture was defined as a single stricture below 2 cm. A complicated stricture was defined as a stricture over 2 cm and/or multiple strictures. The follow-up time was 24 months. All patients were scheduled for renoscintigraphy during the treatment. A full therapeutic success was defined as no tight stenosis in renoscintigraphic furosemide test after SUS explantation.</p><p><strong>Results: </strong>In Grp 1, full therapeutic success was achieved in 80% of patients, which was statistically significant (p < 0.001). Serious complications (Clavien-Dindo > 3a) occurred significantly more often in Grp 2 (p = 0.046). Renal outflow during stenting was present in 70% of the patients in Grp 2.</p><p><strong>Conclusions: </strong>A full therapeutic success of endoscopic, SUS-assisted treatment can be considered among patients with short, single ureteral stricture. In long and/or multiple strictures, SUS can be used as drainage element, but full recovery of the stricture is unlikely.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"43 1","pages":"201"},"PeriodicalIF":2.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143754809","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cost-effectiveness of nivolumab compared with surveillance for adjuvant treatment of muscle-invasive urothelial carcinoma at high risk of recurrence in France.","authors":"Sylvie Negrier, Julia Bonastre, Florian Colrat, Siguroli Teitsson, Christopher Knight, Lei Ni, Julie Chevalier, Sébastien Branchoux, Morgan Rouprêt","doi":"10.1007/s00345-025-05589-2","DOIUrl":"https://doi.org/10.1007/s00345-025-05589-2","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the cost-effectiveness of nivolumab for adjuvant treatment of adults with muscle-invasive urothelial carcinoma at high risk of recurrence (MIUC-HR) and tumour cell expression PD-L1 ≥ 1% following radical resection from the payer perspective in France.</p><p><strong>Methods: </strong>A four-state (disease-free, loco-regional recurrence, distant recurrence, death) semi-Markov model was developed to simulate health outcomes and costs in a cohort of patients with MIUC-HR and tumour cell expression PD-L1 ≥ 1% following radical resection. Health state-specific costs and quality of life-adjusted life years (QALYs) were compared between two treatment strategies (nivolumab, surveillance). The time horizon was 15 years. Clinical and utility inputs were modelled from the data obtained in the Phase III trial CheckMate 274 (#NCT02632409). Cost inputs were extracted from French sources (notably the French National Cost Study). Model outputs were life-years and QALYs overall and by health-state, total costs and cost components. The incremental cost-effectiveness ratio (ICER) and incremental cost-utility ratio (ICUR) between the two treatment strategies were calculated.</p><p><strong>Results: </strong>Life-years were 7.3 for nivolumab and 5.2 for surveillance; QALYs were 4.7 for nivolumab and 3.3 for surveillance. The between-strategy difference in QALYs was essentially accrued in the disease-free state (nivolumab: 4.2, surveillance: 2.6). Total costs were €129,150 for nivolumab and €93,031 for surveillance. The principal cost components were nivolumab acquisition (€ 44,054) and disease management (nivolumab: €29,831; surveillance: €27,233). The estimated ICER was € 17,228/LY gained and the estimated ICUR was €25,806/QALY.</p><p><strong>Conclusion: </strong>Nivolumab in the adjuvant setting is likely to be cost-effective compared to surveillance in France.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"43 1","pages":"202"},"PeriodicalIF":2.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143754807","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Use of disposable painless silicone urethral catheter during urological surgery for male patients: a randomized controlled study.","authors":"Hong-Wei Zhang, Teng Fan, Dan Shen, Zhi-Li Zhao, Hui-Fang Xi, Wei-Wei Wang, Xiu-Qin Yue, Li Li","doi":"10.1007/s00345-025-05506-7","DOIUrl":"https://doi.org/10.1007/s00345-025-05506-7","url":null,"abstract":"<p><strong>Objective: </strong>The objective of this study is to evaluate the benefits of placing a disposable, painless silicone urethral catheter in male patients undergoing urological surgery.</p><p><strong>Methods: </strong>A total of 246 male patients who were scheduled to undergo elective urological surgery under general anesthesia were randomly allocated to the observation and control groups. Patients in the observation group received a disposable, painless silicone urethral catheter connected to an analgesic pump infusing 50 mL of 2% lidocaine at 2 mL/h. The control group received a standard silicone urethral catheter post-surgery. Pain scores, the incidence and severity of catheter-related bladder discomfort (CRBD), sedation scores at 0, 1, 6, 12, and 24 h post-surgery, satisfaction scores at 24 h post-surgery, and postoperative complications were recorded.</p><p><strong>Results: </strong>The incidence of CRBD among patients in the observation group at 1, 6, and 12 h post-surgery was significantly lower than in the control group (at 1 h: 15.25% vs. 28.23%, respectively; p = 0.021; at 6 h: 8.47% vs. 20.16%, respectively; p = 0.010; at 12 h: 4.24% vs. 12.90%, respectively; p = 0.017). The severity of CRBD was also significantly lower in the observation group at 0 and 1 h post-surgery (p = 0.012 and p = 0.026, respectively). Pain and sedation scores at 1, 6, and 12 h post-surgery were significantly lower among patients in the observation group compared to those in the control group. Although there were no significant differences in postoperative complications, patients in the observation group reported significantly higher satisfaction scores (p < 0.001).</p><p><strong>Conclusions: </strong>The placement of a disposable painless silicone urethral catheter in male patients during urological surgery was effective in reducing the incidence and severity of postoperative CRBD, relieving pain, and improving patient satisfaction without clinically significant adverse reactions.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"43 1","pages":"199"},"PeriodicalIF":2.8,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143753739","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Direct-in-scope suction with a 5.1Fr large working channel ureteroscope: what stone dust size for effective evacuation during laser lithotripsy? An in vitro analysis by PEARLS and section of EAU Endourology.","authors":"Ming Chun Chan, Vineet Gauhar, Soon Hock Koh, Frédéric Panthier, Eugenio Ventimiglia, Vincent De Coninck, Stefano Moretto, Aideen Madden, Anil Shrestha, Sung Yung Cho, Esteban Emiliani, Steffi Kar Kei Yuen, Thomas R W Herrmann, Bhaskar Somani, Olivier Traxer, Etienne Xavier Keller, Jia-Lun Kwok","doi":"10.1007/s00345-025-05579-4","DOIUrl":"https://doi.org/10.1007/s00345-025-05579-4","url":null,"abstract":"<p><strong>Purpose: </strong>A novel larger 5.1Fr working channel flexible ureteroscope for Direct-In-Scope Suction (DISS) has recently been introduced. However, the optimal stone dust size for successful evacuation without working channel blockage is currently unknown.</p><p><strong>Methods: </strong>In vitro assessment of the PU400A 9.2Fr ureteroscope (Zhuhai Pusen Medical Technology Co., Ltd, China) was performed with BegoStone particle sizes ≤ 2000 μm (size range 1000-2000 μm), ≤ 1000 μm (500-1000 μm), ≤ 500 μm (250-500 μm), ≤ 250 μm (125-250 μm) and ≤ 125 μm (63-125 μm), in a kidney calyx model. This was conducted with an empty working channel, and with occupancy by 150 μm Olympus, 200 μm Quanta, 270 μm Dornier laser fibers. Primary outcome was complete suction-evacuation without working channel blockage. Secondary outcome was evacuation speed for particle sizes that did not have blockage.</p><p><strong>Results: </strong>A stone particle size upper limit of 250 μm was found to achieve complete suction-evacuation without blockage, across all working channel occupancy situations. For stone particle size of range 125-250 μm, evacuation speeds were 35, 26, 13, 11 mm³/s across empty, 150 μm Olympus, 200 μm Quanta, 270 μm Dornier laser fiber occupancy, respectively (ANOVA = p < 0.001). For stone particle size range 63-125 μm, evacuation speeds were 19, 14, 9, 8 mm³/s respectively (ANOVA = p < 0.001).</p><p><strong>Conclusion: </strong>The 5.1Fr working channel DISS ureteroscope allows a stone particle size limit of 250 μm to be suction-evacuated without blockage, even with laser fiber occupancy. With a laser fiber, a smaller 150 μm fiber size allows better particle evacuation speeds. Urologists should therefore aim for a dust particle size of ≤ 250 μm in routine DISS with the 5.1Fr working channel ureteroscope, for effective intraoperative stone evacuation.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"43 1","pages":"198"},"PeriodicalIF":2.8,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143754808","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perioperative cisplatin-based chemotherapy for muscle-invasive bladder cancer: a decision analysis.","authors":"Luca Afferi, Beate Jahn, Amar H Kelkar, Stijntje W Dijk, Zach M Feldman, Zachary J Ward, Marco Moschini, Richard Cathomas, Joaquim Bellmunt, Andrea Gallioli, Alberto Breda, Christian D Fankhauser, Agostino Mattei, Steven L Chang, Uwe Siebert","doi":"10.1007/s00345-025-05584-7","DOIUrl":"https://doi.org/10.1007/s00345-025-05584-7","url":null,"abstract":"<p><strong>Purpose: </strong>While meta-analyses of randomised studies suggest that neoadjuvant (NAC) or adjuvant (ACT) cisplatin-based chemotherapy improve overall survival in patients with muscle-invasive bladder cancer (MIBC), there are no trials comparing NAC against ACT in terms of quality-adjusted life years (QALYs) and costs. We aimed to evaluate the long-term QALYs, costs, and cost-effectiveness of different strategies for treating patients with MIBC.</p><p><strong>Methods: </strong>An individual-level state transition microsimulation model was developed for patients with urothelial non-metastatic MIBC eligible for surgery and NAC at diagnosis. Four treatment strategies were evaluated: (i) no treatment, (ii) radical cystectomy (RC) without perioperative chemotherapy, (iii) NAC followed by RC, and (iv) RC followed by ACT. Primary endpoints were QALYs and costs. Sensitivity analysis on the probability of being fit for ACT after surgery was conducted to account for the uncertainty of this parameter. The model was face-validated independently by two urologists.</p><p><strong>Results: </strong>Life-expectancy was 4.54 QALYs for ACT, 4.38 QALYs for NAC, 4.28 QALYs for RC without perioperative chemotherapy, and 2.84 QALYs for no treatment. Costs were lowest for ACT (US$45,805), compared to NAC (US$48,160), RC without perioperative chemotherapy (US$48,703), and no treatment (US$59,948). Sensitivity analysis suggested that NAC is associated with increased QALYs compared to ACT if the estimated probability of being fit for ACT is less than 38%. Limitations include the US-centric cost perspective.</p><p><strong>Conclusions: </strong>In lack of comparative studies, simulated data suggests that ACT leads to increased QALYs and is cost-effective compared to NAC.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"43 1","pages":"197"},"PeriodicalIF":2.8,"publicationDate":"2025-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143754810","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}