World Journal of Urology最新文献

{"title":"Comparative survival outcomes of minimally invasive versus open radical nephroureterectomy for upper tract urothelial carcinoma in Taiwan.","authors":"I-Hsuan Alan Chen, Wei-Ming Li, Hung-Lung Ke, Yi-Huei Chang, Chao-Hsiang Chang, Yao-Chou Tsai, Chih-Chin Yu, Wun-Rong Lin, Marcelo Chen, Yi-Hsin Lu, Chia-Cheng Yu","doi":"10.1007/s00345-025-05829-5","DOIUrl":"https://doi.org/10.1007/s00345-025-05829-5","url":null,"abstract":"<p><strong>Purpose: </strong>Upper tract urothelial carcinoma (UTUC) is rare globally but accounts for 30-40% of urothelial cancers in Taiwan. Radical nephroureterectomy (RNU) with bladder cuff excision (BCE) remains the standard of care for localized or locally advanced disease. Despite the increasing adoption of minimally invasive surgical (MIS) approaches, concerns about their oncological outcomes persist. This study evaluates the comparative survival outcomes of MIS versus open RNU for UTUC using propensity-score-matched (PSM) analysis.</p><p><strong>Methods: </strong>Data from 2430 patients with UTUC, treated between 1988 and 2022 within the Taiwan UTUC Collaboration Group, were retrospectively analyzed. PSM was employed to minimize baseline differences. The primary endpoints were overall survival (OS), cancer-specific survival (CSS), and disease-free survival (DFS). Kaplan-Meier estimates, stratified log-rank tests, and Cox proportional hazards models were used to evaluate survival outcomes.</p><p><strong>Results: </strong>After PSM, 1758 patients (1172 MIS; 586 open) were included. The MIS group demonstrated significantly improved OS (OR: 0.662; p < 0.001), CSS (OR: 0.659; p = 0.002), and DFS (OR: 0.646; p < 0.001) compared to the open group. MIS was associated with superior survival despite a higher prevalence of high-grade tumors and adverse pathological features.</p><p><strong>Conclusion: </strong>MIS approaches, including laparoscopic and robotic RNU, offer oncological outcomes comparable to or better than open RNU in UTUC. These findings support the broader adoption of MIS techniques, emphasizing meticulous BCE to ensure oncological control.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"43 1","pages":"463"},"PeriodicalIF":2.9,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144745315","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":"Enhanced consent and patient counselling using virtual reality for patients undergoing shockwave lithotripsy: prospective outcomes from a university teaching hospital.","authors":"Dara Bamerni, Loretta Tear, Tanya Davis, Phoebe C J Reynolds, Amelia Pietropaolo, Bhaskar K Somani","doi":"10.1007/s00345-025-05847-3","DOIUrl":"https://doi.org/10.1007/s00345-025-05847-3","url":null,"abstract":"<p><strong>Objective: </strong>To discover the effectiveness of VR in improving patient understanding and enhancing the consent procedure for patients undergoing extracorporeal shockwave lithotripsy (SWL). The primary outcomes measured include patient knowledge, pain perception, and emotional well-being.</p><p><strong>Methods: </strong>For this prospective study (ERGO: 92019), patients with kidney stone disease (KSD) undergoing SWL were given a VR headset before their treatment. The VR glasses visually explained the SWL process (3 min) and its success and complications through an audio explanation linked to a 3D animation. The content followed the patient information leaflet (PIL) from European and British associations. Participants were provided with three questionnaires that covered pain, anxiety, and patient understanding of SWL via the VR enhanced consent (one questionnaire each).</p><p><strong>Results: </strong>100 patients completed all three questionnaires. 68 patients reported an improved understanding of SWL with VR, and the overall improvement in patient understanding was statistically significant (p < 0.001). Participants also found the VR headset significantly more helpful and accessible and felt more confident explaining the procedure. 66 participants preferred VR to current teaching methods, and 81 firmly favoured using VR for future procedures. Findings also demonstrated a positive emotional impact, with participants reporting more positive and fewer negative emotions after VR use.</p><p><strong>Conclusion: </strong>Our study showed that incorporating VR into the consent process effectively improves patient understanding and experience, with widespread approval. VR improved the psychological well-being of patients undergoing surgical procedures, highlighting the potential for VR to play a significant role in enhancing consent.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"43 1","pages":"461"},"PeriodicalIF":2.9,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144745316","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":"Predicting poor early voiding pattern after holep using maximum flow rate (Q-max) as an objective outcome.","authors":"Abdulmalik Addar, Adel Arezki, Tarek Benzouak, Abdullah Al Zahrani, Hend Alshamsi, Abdullah Alahmari, Ahmed Ibrahim, Abdulghani Khogeer, Mélanie Aubé-Peterkin, Serge Carrier, Fadl Hamouche","doi":"10.1007/s00345-025-05817-9","DOIUrl":"https://doi.org/10.1007/s00345-025-05817-9","url":null,"abstract":"<p><strong>Purpose: </strong>Holmium laser enucleation of the prostate (HoLEP) is recognized as a gold standard treatment for benign prostatic hyperplasia (BPH), providing durable improvements in quality of life and symptomatology. However, a subset of patients continues to experience suboptimal voiding outcomes postoperatively. This study aims to identify preoperative predictors of poor voiding patterns, as objectively measured by maximum urinary flow rate (Q-max), following HoLEP.</p><p><strong>Methods: </strong>We retrospectively analyzed 1121 patients who underwent HoLEP at McGill University Health Centre from January 2006 to December 2022. Inclusion required a minimum one-month follow-up with documented Q-max. Data collected included demographics, preoperative parameters (IPSS, PSA, prostate volume), operative details, and postoperative outcomes. Poor voiding was defined as a Q-max < 15 ml/sec at one month postoperatively. Bilateral stepwise regression identified candidate predictors, which were further evaluated using logistic regression.</p><p><strong>Results: </strong>The cohort had a mean age of 70.7 years (SD 8.3), mean prostate volume of 98.3 mL, and mean PSA of 6.7 ng/dL (SD 9.1). Preoperative medical therapy included alpha blockers (63.6%) and combination therapy (33%). Multivariate analysis revealed that advanced age (OR = 1.01 per year; 95% CI, 1.00-1.01; p = 0.017), diabetes mellitus (OR = 1.29; 95% CI, 1.03-1.62; p = 0.028), and preoperative combination BPH therapy (OR = 1.17; 95% CI, 1.02-1.34; p = 0.023) were independently associated with poor postoperative Q-max, whereas increased enucleated tissue weight was protective (OR = 0.998; 95% CI, 0.996-0.999; p = 0.005).</p><p><strong>Conclusions: </strong>Advanced age, diabetes mellitus, and combination BPH therapy independently predict suboptimal voiding after HoLEP, highlighting the need for tailored preoperative evaluation and management strategies.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"43 1","pages":"462"},"PeriodicalIF":2.9,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144745317","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":"Infectious complications in patients undergoing transrectal prostate-biopsy with ciprofloxacin compared to fosfomycin-trometamol.","authors":"Andreas Banner, Sebastian Ubber, Ursula Stoces, Christine Meyer, Stephan Madersbacher, Igor Grabovac","doi":"10.1007/s00345-025-05818-8","DOIUrl":"10.1007/s00345-025-05818-8","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the risk of infectious complications associated with the use of ciprofloxacin (CIP) or fosfomycin-trometamol (FMT) for antibiotic prophylaxis in patients undergoing transrectal prostate biopsy (TrBx).</p><p><strong>Methods: </strong>A retrospective, single-centre analysis was conducted, including patients who underwent TrBx from 2015 to 2023 and received CIP or FMT for antimicrobial prophylaxis. The primary endpoint was symptomatic urinary tract infections within 30 days after TrBx, and the secondary endpoint was hospitalization due to infectious complications. Logistic regression was used to assess the risk of infection, adjusted for variables such as age, prostate size and comorbidities. Hospitalization rates were compared using the chi-square test.</p><p><strong>Results: </strong>Overall, 913 patients were eligible for inclusion, of whom 491 had received CIP and 422 had received FMT. Infectious complications occurred in 38/913 (4.2%) of all patients, 12/491 (2.4%) of whom had received CIP and 26/422 (6.2%) of whom had received FMT. Multivariable analysis revealed a significantly greater risk of infectious complications with FMT (adjusted odds ratio 2.99, 95% CI 1.39-7.16, p = 0.008) compared to CIP. Hospitalization rates were similar in the CIP group (8/12, 66.6%) and FMT group (14/26, 53.5%, p = 0.7), but one death occurred due to fulminant sepsis in the FMT group.</p><p><strong>Conclusion: </strong>Compared with CIP, FMT prophylaxis is associated with a greater risk of infectious complications and should be used cautiously in routine clinical practice. Given the uncertainty of FMT's efficacy in preventing infections after TrBx, alternative antibiotic regimens should be preferred, or transitioning to the transperineal biopsy approach may further reduce infection risk and support antibiotic stewardship.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"43 1","pages":"460"},"PeriodicalIF":2.9,"publicationDate":"2025-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12296973/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144718786","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multivariable regression analysis of perioperative parameters for a novel pulsed solid-state Thulium: YAG laser with high peak power versus Holmium: YAG laser in prostate enucleation.","authors":"M F von Bargen, M Glienke, S Tonyali, A Sigle, K Wilhelm, M Schoenthaler, C Gratzke, A Miernik","doi":"10.1007/s00345-025-05756-5","DOIUrl":"10.1007/s00345-025-05756-5","url":null,"abstract":"<p><strong>Purpose: </strong>Due to its physical properties, endoscopic enucleation of the prostate (EEP) with the pulsed solid-state Thulium: YAG laser (pulsed ThuLEP) presents a promising alternative to the widely used Holmium: YAG laser (HoLEP). This study aims to compare perioperative parameters of EEP performed using a novel 100 W pulsed Thulium: YAG laser with high peak power versus a standard 100 W Holmium: YAG laser in patients with benign prostatic hyperplasia (BPH).</p><p><strong>Methods: </strong>A retrospective analysis was conducted on 312 patients undergoing laser EEP, comprising 80 pulsed ThuLEP and 232 HoLEP procedures. Outcomes were adjusted for key perioperative variables (age, American Society of Anesthesiologists score, hemoglobin, preoperative prostate volume, prostate-specific antigen levels) through multivariable regression analysis. Comparisons between the two techniques utilized adjusted means and marginal contrast analysis.</p><p><strong>Results: </strong>Baseline characteristics were comparable across groups. Pulsed ThuLEP demonstrated significantly shorter operative times, with a reduction of 6.23 min in total surgery time (p = 0.006) and 4.36 min in enucleation time (p = 0.001) compared to HoLEP. Although pulsed ThuLEP showed faster enucleation speed, it did not reach statistical significance (p = 0.095). Laser energy consumption was comparable (p = 0.191). Additionally, pulsed ThuLEP was associated with reduced hospitalization time (4.19 vs. 4.65 days, p < 0.001) and lower maximum postoperative pain scores (0.78 vs. 4.23, p < 0.001).</p><p><strong>Conclusion: </strong>The novel pulsed solid-state Thulium: YAG laser offers a viable and effective alternative to the established Holmium: YAG laser for EEP. Advantages of pulsed ThuLEP include shorter operative duration, reduced length of hospital stay, and significantly lower postoperative pain, making it a compelling option for surgical management of BPH.</p><p><strong>Trial registration: </strong>German Clinical Trials Register number: DRKS00031676.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"43 1","pages":"459"},"PeriodicalIF":2.9,"publicationDate":"2025-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12296952/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144718787","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of citrate-based nutraceutical combinations and their impact on chemolysis in the management of urinary diversion device: a randomised double-blind placebo-controlled study on improved quality of life and clinical outcomes.","authors":"Anna Ricapito, Nicola Schiavone, Marco Finati, Nicola d'Altilia, Fabrizio Palumbo, Angelo Cormio, Rossana G Iannitti, Giada Ceccarelli, Ugo G Falagario, Carlo Bettocchi, Luigi Cormio, Giuseppe Carrieri, Gian Maria Busetto","doi":"10.1007/s00345-025-05788-x","DOIUrl":"10.1007/s00345-025-05788-x","url":null,"abstract":"<p><strong>Purpose: </strong>We aimed to evaluate in a double-blind randomized placebo-controlled trial (RCT) the effectiveness of two citrate-based products in preventing ureteral stent encrustation in patients with severe urinary system damage requiring long-term stent placement and frequent replacements to prevent complications.</p><p><strong>Methods: </strong>Men and women aged 50-80, with severe urinary system damage were randomized to Product 1, Product 2 or Placebo. Efficacy points included encrustation prevention analyzed by mean normalized Kidney, Ureter and Bladder (KUB) score, ease of stent removal, and rate of emergency room (ER) visits.</p><p><strong>Results: </strong>Of 142 patients randomized (Product 1, n = 37; Product 2, n = 62; Placebo, n = 43) 142 received treatment and 138 reached 9 months of follow-up. At 3 months Product 1 was associated with significant improvements vs. Product 2 by means of mean normalized KUB (mnKUB) score (W = - 5.75, p < 0.001). At 6 months both Product 1 and Product 2 were associated with significant improvements vs. Placebo (W = - 7.05, p < 0.001) and (W=-6.55, p < 0.001) respectively. Similar results were obtained at 9 months (Product 1 vs. Placebo, W = - 4.84, p = 0.002; Product 2 vs. Placebo, W = - 4.15, p = 0.009). These outputs agree with that obtained for ease of stent removal, while no differences were found where evaluating the rate of ER visits in the three groups.</p><p><strong>Conclusion: </strong>This study emphasises the efficacy of a combination of potassium and magnesium citrates, Phillantus niruri, Ceterach officinarum and hyaluronic acid (Product 1) in managing long-term ureteral stent dependency, enhancing clinical outcomes and improving patient quality of life (QOL).</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"43 1","pages":"458"},"PeriodicalIF":2.9,"publicationDate":"2025-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144718785","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":"Post-radiation simple cystectomy for end-stage bladder in cancer survivors is not associated with occult malignancy.","authors":"Logan W Grimaud, Thomas E Schroeder, Mariela Martinez, Kiran Sury, Matthew Salvino, Brent Nosé, Austin Livingston, Aaron C Lentz, Andrew C Peterson","doi":"10.1007/s00345-025-05823-x","DOIUrl":"https://doi.org/10.1007/s00345-025-05823-x","url":null,"abstract":"<p><strong>Purpose: </strong>Cancer survivors with a history of pelvic radiation may suffer devastating side effects best managed by cystectomy. Simple cystectomy is a less morbid alternative to radical cystectomy. While safe, concern exists that it may place patients at risk for incomplete treatment of secondary bladder malignancy. We assessed the rates of malignancy found on simple, post-radiation cystectomy specimens from patients with a history of radiation therapy for pelvic malignancies.</p><p><strong>Methods: </strong>We reviewed all benign cystectomies at our institution from 2010 to 2023. Patients with a known history of urothelial cancer, cystectomy performed for malignancy, non-cancer survivorship indications (i.e. neurogenic bladder or trauma), and patients without a history of radiation were excluded. Surgical pathology was reviewed for residual and/or secondary malignancy.</p><p><strong>Results: </strong>111 patients had a history of radiation therapy and met inclusion criteria. Prostate cancer was the most common pelvic malignancy (83.8%). All patients had an end-stage bladder defined by our algorithmic assessment. No patients (0%) had evidence of urothelial malignancy on the final pathology of the post-radiation cystectomy specimen. There were no new diagnoses of secondary malignancy at the median follow-up of 30 (0.1-138) months. Of 42 patients with primary prostate cancer who had not undergone prior prostatectomy, 2 (4.8%) had residual prostate cancer in the remaining prostate on pathology.</p><p><strong>Conclusion: </strong>In this cohort, secondary bladder malignancy was not identified. Rates of residual prostate malignancy were low in patients with radiation alone. Post-radiation simple cystectomy is a reasonable option for cancer survivors undergoing extirpative surgery where oncological control is not the primary indication.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"43 1","pages":"455"},"PeriodicalIF":2.8,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144709134","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":"Vacuum-assisted mini-percutaneous nephrolithotomy is associated with lower rates of infectious complications compared to standard procedures in low-risk patients: a single-center experience.","authors":"Marco Nizzardo, Andrea Li Puma, Giorgio Graps, Fabio Ciamarra, Gianpaolo Lucignani, Valentina Parolin, Federica Passarelli, Ludovico Maria Basadonna, Fabrizio Longo, Elisa De Lorenzis, Stefano Paolo Zanetti, Emanuele Montanari, Giancarlo Albo, Luca Boeri","doi":"10.1007/s00345-025-05783-2","DOIUrl":"https://doi.org/10.1007/s00345-025-05783-2","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the impact of vacuum-assisted mini-percutaneous nephrolithotomy (vamPCNL) vs. vacuum-cleaner mPCNL (vcmPCNL) on the rate of postoperative infectious complications in a cohort of patients with low risk factors for infections.</p><p><strong>Methods: </strong>We retrospectively analysed data from 229 patients who underwent mPCNL between 01/2016 and 09/2024. Patient's demographics, stones characteristics and operative data were collected. vamPCNL and vcmPCNL were performed based on the surgeon's preference. Low-risk patients were defied as: preoperative negative urine culture, no history of previous UTIs and immune system disease, no preoperative indwelling stent or catheter, single-stage procedure. Complications were graded according to modified Clavien classification. Descriptive statistics and logistic regression models were used to identify factors associated with postoperative infectious complications.</p><p><strong>Results: </strong>Median (IQR) age and stone volume were 56 (47-66) years and 1.7 (0.8-3.6) cm³, respectively. vamPCNL and vcmPCNL were performed in 177 (77.2%) and 52 (22.8%) cases, respectively. Infectious complications occurred in 23 (10.0%) cases after surgery. Patients who developed infectious complications were more frequently female (59% vs. 32.3%, p = 0.02), had larger stone volume (p = 0.02) and higher rate of multiple stones (p = 0.02) than those who did not. Infectious complications occurred more frequently after vcmPCNL than vamPCNL (19.6% vs. 6.8%, p = 0.01) in this cohort of low-risk patients. Longer operative time (p < 0.01) and length of stay (p < 0.01) were observed in cases with infectious complications. At multivariable logistic regression analysis, vcmPCNL procedures (OR 4.1, p = 0.01) were independently associated with the risk of infectious complications post mPCNL, after accounting for stone volume. Similarly, female gender (OR 2.6, p = 0.03) emerged as a predictor for infectious complications in low-risk patients even after accounting for vcmPCNL procedures.</p><p><strong>Conclusion: </strong>In a cohort of patients with kidney stones and low-risk factors for infections, approximately 10% of participants developed infectious complications after mPCNL. Patients with infectious complications had higher stone burden and longer procedural time than those who did not, as expected. vamPCNL confirmed to be associates with lower risk of infections, compared to vcmPCNL, even in patients with low risk factors.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"43 1","pages":"457"},"PeriodicalIF":2.8,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144709135","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":"Magnetic resonance imaging-targeted biopsy and accuracy with radical prostatectomy specimens: a grading issue.","authors":"Myky Nguyen, Oualid Mouhaoui, Marie Van Eycken, Hamid El Kaddouri, Thierry Roumeguere, Alexandre Peltier, Romain Diamand","doi":"10.1007/s00345-025-05787-y","DOIUrl":"https://doi.org/10.1007/s00345-025-05787-y","url":null,"abstract":"<p><strong>Purpose: </strong>To compare the accuracy of ISUP grade groups (GG) determined from MRI-targeted and systematic biopsies with radical prostatectomy (RP) specimens using the 2014 and 2019 ISUP recommendations, and to identify predictors of upgrading.</p><p><strong>Methods: </strong>We analyzed 212 consecutive patients who underwent both MRI-targeted and systematic biopsies followed by RP at the Jules Bordet Institute from October 2019 to January 2025. GG were assigned per 2019 ISUP guidelines, using the highest Gleason score, either from the global score of MRI-targeted lesions (including perilesional cores) or from individual systematic biopsy cores. Sensitivity analyses explored an empirical update to the 2019. ISUP recommendations by excluding minor higher-grade patterns (< 5%). Accuracy was compared using McNemar's test and weighted kappa (κ) statistics. Predictors of upgrading were identified via multivariable logistic regression and CHAID analysis.</p><p><strong>Results: </strong>The 2019 ISUP recommendations improved concordance with RP specimens by 8% (CI: 0.02-0.14, p = 0.002), reduced downgrading rates by 11% (CI:0.16 - 0.06, p < 0.001) and shown upgrading in 16% of cases (n = 33/212), representing a 3% increase compared to 2014 ISUP criteria (CI: 0.0008-0.06, p = 0.03). Weighted κ-values improved between the 2014 (κ = 0.58), 2019 (κ = 0.72) and updated 2019 ISUP recommendations (κ = 0.77). PSA-level (odds ratio [OR]: 1.11, 95%CI: 1.04-1.18, p = 0.001) and number of cores with clinically significant (Cs-) PCa (OR: 0.67, 95%CI: 0.54-0.82, p < 0.001) were independent predictors of upgrading. CHAID analysis confirmed that patients with ≤ 4 positive cores had a higher risk of upgrading (20% vs. 8.2%).</p><p><strong>Conclusion: </strong>The 2019 ISUP recommendations enhance PCa grading accuracy. The number of cores with csPCa is a key predictor of upgrading and should inform treatment decisions. These findings support the integration of the 2019 ISUP guidelines into clinical practice to improve risk stratification and minimize overtreatment.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"43 1","pages":"456"},"PeriodicalIF":2.8,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144709133","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":"Decision-making algorithm for difficult intermittent self-catheterization: construction and validation using the Delphi method.","authors":"Claire Hentzen, Xavier Biardeau, Marie-Aimée Perrouin-Verbe, Kathleen Charvier, Camille Chesnel, Pierre Denys, Jean François Hermieu, Jacques Kerdraon, Benoit Peyronnet, Alain Ruffion, Christian Saussine, Jean-Marc Soler, Xavier Gamé, Gérard Amarenco","doi":"10.1007/s00345-025-05838-4","DOIUrl":"10.1007/s00345-025-05838-4","url":null,"abstract":"","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"43 1","pages":"454"},"PeriodicalIF":2.9,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12289836/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144699706","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}