World Journal of Urology最新文献

{"title":"Identifying optimal candidates for active surveillance in low-grade intermediate-risk non-muscle invasive bladder cancer.","authors":"Paolo Zaurito, Pietro Scilipoti, Mattia Longoni, Mario de Angelis, Chiara Re, Leonardo Quarta, Giovanni Tremolada, Giusy Burgio, Francesco Pellegrino, Giuseppe Rosiello, Andrea Necchi, Renzo Colombo, Giorgio Gandaglia, Andrea Salonia, Francesco Montorsi, Alberto Briganti, Marco Moschini","doi":"10.1007/s00345-024-05417-z","DOIUrl":"10.1007/s00345-024-05417-z","url":null,"abstract":"<p><strong>Objective: </strong>The intermediate-risk non-muscle invasive bladder cancer (IR-NMIBC) prognostic group is heterogeneous. Growing evidence supports the role of active surveillance (AS) for patients with low-risk NMIBC, however, no clear data exists considering IR-NMIBC. The aim of the study was to assess the risk of recurrence of patients eligible for AS based on the International Bladder Cancer Group (IBCG) stratification.</p><p><strong>Methods: </strong>We retrospectively evaluated 174 LG IR-NMIBC patients who underwent transurethral resection of bladder tumor (index TURBT) from 2012 to 2023 at a tertiary referral center and fulfilled the inclusion criteria for enrollment in AS protocols at the index TURBT (≤ 5 suspicious lesions, no macrohematuria, negative urine cytology, lesions ≤ 1 cm). Patients were then stratified according to the International Bladder Cancer Group (IBCG) risk factors: frequent recurrence, early recurrence, previous instillation, and multifocality. Kaplan Meier plots and multivariable Cox regression analysis (MVA) were used to assess the risk of any and high-grade (HG) recurrence according to the number of risk factors.</p><p><strong>Results: </strong>Overall, 168 (97%) patients had a Ta low grade bladder tumor. After a median follow-up of 36 months [Interquartile range (IQR) 20-54], 75 (43%) and 32 (18%) patients experienced any- and HG recurrence, respectively. The 3-year recurrence free-survival (RFS) was 86% [95% Confidence Interval (CI) 76-98%] for patients with 0, 76% (95% CI 68-84%) for those with 1-2, and 54% (95% CI 34-84%) for those with ≥ 3 risk factors. The 3-year HG-RFS was > 90% for patients with 0 and 1-2 risk factors, compared to 76% (95% CI 58-99%) for those with ≥ 3 risk factors. At MVA, the presence of ≥ 3 risk factors was associated with a higher risk of recurrence [hazard ratio: 4.74, 95% CI 1.75-12.8, p = 0.002].</p><p><strong>Conclusion: </strong>Among patients with LG IR-NMIBC eligible for AS, those with more than 2 IBCG risk factors may not be suitable candidates due to a higher risk of developing HG recurrence. Randomized controlled trials with standardized AS protocols are necessary to validate these findings and optimize patient selection for AS in LG IR-NMIBC.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"43 1","pages":"52"},"PeriodicalIF":2.8,"publicationDate":"2024-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142910938","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":"Androgen receptor pathway inhibitors vs. docetaxel chemotherapy for metastatic hormone-sensitive and first-line castration resistant prostate cancer.","authors":"Mike Wenzel, Benedikt Hoeh, Clara Humke, Cristina Cano Garcia, Carolin Siech, Thomas Steuber, Markus Graefen, Miriam Traumann, Luis Kluth, Felix K H Chun, Philipp Mandel","doi":"10.1007/s00345-024-05388-1","DOIUrl":"10.1007/s00345-024-05388-1","url":null,"abstract":"<p><strong>Purpose: </strong>No currently available phase III trial compared docetaxel vs. androgen receptor pathway inhibitors (ARPI) regarding cancer-control outcomes in metastatic hormone-sensitive prostate cancer (mHSPC). Moreover, few is known about the effect of sequential therapies in mHSPC and subsequent metastatic castration resistant prostate cancer (mCRPC).</p><p><strong>Methods: </strong>We relied on the FRAMCAP database and compared docetaxel vs. ARPI in mHSPC patients regarding time to mCRPC (ttCRPC) and overall survival (OS). Sensitivity analyses addressed high volume mHSPC patients. Finally, sequential therapies were compared regarding progression-free survival (PFS) and OS in first-line mCRPC.</p><p><strong>Results: </strong>Of 419 included mHSPC patients, 25% received docetaxel vs. 75% ARPI. ARPI patients were significantly older (71 vs. 66 years), and harbored lower baseline PSA (38 vs. 183 ng/ml, both p ≤ 0.002). Median ttCRPC was significantly longer for ARPI than for docetaxel-treated patients (30 vs. 17 months, hazard ratio [HR]: 0.49, p < 0.001). In OS analyses, ARPI patients also exhibited significantly longer OS, relative to docetaxel patients (96 vs. 50 months, HR: 0.67, p = 0.03). After multivariable adjustment in Cox regression models, no difference between both treatments remained in both analyses (all p > 0.05). In sensitivity analyses of high volume mHSPC patients only, also no ttCRPC or OS differences were observed for ARPI vs. docetaxel (all p > 0.05). Regarding sequential therapies, no PFS and OS differences were observed for all and specifically high volume mHSPC patients, when ARPI-ARPI vs. ARPI-docetaxel vs. docetaxel-ARPI treatments were compared (all p > 0.05).</p><p><strong>Conclusion: </strong>In real-world setting, ARPI treatment performs comparable to docetaxel chemotherapy in mHSPC. Therefore, docetaxel should only be used in triplet therapy. Moreover, no differences for sequential therapies of ARPI/docetaxel combinations in first-line mCRPC were observed.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"43 1","pages":"51"},"PeriodicalIF":2.8,"publicationDate":"2024-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11682002/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142897813","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":"Letter to the editor: anticoagulation, photoselective vaporization of the prostate and safety: a propensity score-matched study.","authors":"Chenxi Wang, Huichuan Tian, Jin Shang","doi":"10.1007/s00345-024-05411-5","DOIUrl":"https://doi.org/10.1007/s00345-024-05411-5","url":null,"abstract":"","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"43 1","pages":"49"},"PeriodicalIF":2.8,"publicationDate":"2024-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142898236","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":"Comparison of three different scoring systems in predicting success of retrograde intrarenal surgery in kidney stones larger than 20 millimeters.","authors":"Ergun Alma, Mert Hamza Özbilen, Adem Altunkol, Hakan Anıl, Hakan Ercil","doi":"10.1007/s00345-024-05415-1","DOIUrl":"https://doi.org/10.1007/s00345-024-05415-1","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate stone free rate (SFR) predictivity of three different scoring systems in patients with kidney stones larger than 20 millimeters undergoing retrograde intrarenal surgery(RİRS).</p><p><strong>Methods: </strong>Digital records of a total of 166 patients were reviewed retrospectively. Epidemiological characteristics (age, gender, medical history) of the patients, stone and affected kidney characteristics (size, volume, location, density, opaque, presence of urinary system anomaly, presence of stones in different calyx, number of stones, lower pole stone, renal infundibulopelvic angle (IPA), renal infundibulopelvic length (RIL), hydronephrosis), and operative characteristics (preoperative ureteral stent, operation duration, postoperative residual fragments, hospitalization time and complications were recorded. Each patient was scored separately according to the Resorlu-Unsal Scoring System (RUSS), the modified Seoul National University Renal Stone Complexity (S-ReSC) and R.I.R.S scoring systems based on the stone characteristics seen on CT.</p><p><strong>Results: </strong>All three methods had statistically acceptable sensitivity and specificity values. Sensitivity for R.I.R.S nomogram is 62.3%, specificity is 77.1% (cut-off: 7.5 points, area under the curve (AUC):0.735, p < 0.001), sensitivity for RUSS nomogram is 60.7%, specificity is 77.9% (cut off: 2.5, AUC = 0.749, p < 0.001), sensitivity for the Modified S-ReSC nomogram was determined as 65.6% and specificity as 71.2% (cut off: 2.5, AUC = 0.743, p < 0.001). The residual stone ratio was found to be higher in the presence of lower pole stone. While the cut-off value for IPA was 44.5°, this value was calculated as 24.5 mm for RIL.</p><p><strong>Conclusion: </strong>Three scoring systems demonstrate accceptable sensitivity and specificity in predicting stone free rate(SFR) with stones ≥ 20 mm. Multivariate analysis highlighted the superiority of the R.I.R.S. scoring system for SFR predictivity. In the presence of lower pole stones, IPA and RIL are important factors in predicting surgical success.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"43 1","pages":"50"},"PeriodicalIF":2.8,"publicationDate":"2024-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142898224","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":"Physician vs. AI-generated messages in urology: evaluation of accuracy, completeness, and preference by patients and physicians.","authors":"Eric J Robinson, Chunyuan Qiu, Stuart Sands, Mohammad Khan, Shivang Vora, Kenichiro Oshima, Khang Nguyen, L Andrew DiFronzo, David Rhew, Mark I Feng","doi":"10.1007/s00345-024-05399-y","DOIUrl":"10.1007/s00345-024-05399-y","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the accuracy, comprehensiveness, empathetic tone, and patient preference for AI and urologist responses to patient messages concerning common BPH questions across phases of care.</p><p><strong>Methods: </strong>Cross-sectional study evaluating responses to 20 BPH-related questions generated by 2 AI chatbots and 4 urologists in a simulated clinical messaging environment without direct patient interaction. Accuracy, completeness, and empathetic tone of responses assessed by experts using Likert scales, and preferences and perceptions of authorship (chatbot vs. human) rated by non-medical evaluators.</p><p><strong>Results: </strong>Five non-medical volunteers independently evaluated, ranked, and inferred the source for 120 responses (n = 600 total). For volunteer evaluations, the mean (SD) score of chatbots, 3.0 (1.4) (moderately empathetic) was significantly higher than urologists, 2.1 (1.1) (slightly empathetic) (p < 0.001); mean (SD) and preference ranking for chatbots, 2.6 (1.6), was significantly higher than urologist ranking, 3.9 (1.6) (p < 0.001). Two subject matter experts (SMEs) independently evaluated 120 responses each (answers to 20 questions from 4 urologist and 2 chatbots, n = 240 total). For SME evaluations, mean (SD) accuracy score for chatbots was 4.5 (1.1) (nearly all correct) and not significantly different than urologists, 4.6 (1.2). The mean (SD) completeness score for chatbots was 2.4 (0.8) (comprehensive), significantly higher than urologists, 1.6 (0.6) (adequate) (p < 0.001).</p><p><strong>Conclusion: </strong>Answers to patient BPH messages generated by chatbots were evaluated by experts as equally accurate and more complete than urologist answers. Non-medical volunteers preferred chatbot-generated messages and considered them more empathetic compared to answers generated by urologists.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"43 1","pages":"48"},"PeriodicalIF":2.8,"publicationDate":"2024-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11680670/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142898398","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":"Oncological outcomes and prognostic implications of T1 histo-anatomic substaging in the management of high-Grade non-muscle invasive bladder cancer: results from a large single centre series.","authors":"Marco Finati, Antonio Fanelli, Francesco Cinelli, Nicola Schiavone, Ugo Giovanni Falagario, Anna Ricapito, Nicola d'Altilia, Richard Naspro, Angelo Porreca, Felice Crocetto, Biagio Barone, Ciro Imbimbo, Carlo Bettocchi, Francesca Sanguedolce, Luigi Cormio, Giuseppe Carrieri, Gian Maria Busetto","doi":"10.1007/s00345-024-05410-6","DOIUrl":"https://doi.org/10.1007/s00345-024-05410-6","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to comprehensively evaluate the prognostic value of T1 histo-anatomic substaging (T1a/T1b) for high grade (HG) non-muscle invasive bladder cancer (NMIBC) over a large single-centre cohort.</p><p><strong>Materials and methods: </strong>Patients with primary HG T1 NMIBC were identified from our Institutional database, between 2011 and 2022. Data from diagnosis to repeated transurethral resection of bladder tumour (RE-TURBT), bacillus Calmette-Guérin (BCG) treatment and follow-up were collected. Patients were stratified based on histo-anatomic landmark into T1a (invasion above the Muscularis Mucosa-MM) and T1b (into/beyond MM). Kaplan-Meier curves and multivariate Cox regression analyses were used to assess the impact of histo-anatomic substaging on recurrence-free survival (RFS), cancer-specific survival (CSS), and progression-free survival (PFS).</p><p><strong>Results: </strong>Substaging was feasible in 88% of cases. The median (IQR) follow-up was 40 (17-72) months. T1b patients had larger initial tumours (> 3 cm: 43.2% vs. 26.1%, p < 0.001), while upstaging to muscle-invasive bladder cancer (MIBC) at RE-TURBT was more frequent in T1b than in T1a (5.9% vs. 1.5%, p = 0.02). T1b patients without BCG induction had worse RFS and PFS (all p ≤ 0.02) compared to T1a, while no differences were observed in patients who received complete BCG induction. At Multivariate analysis, completing at least a BCG induction course was associated with better outcomes across all endpoints.</p><p><strong>Conclusions: </strong>Invasion of the MM in primary T1 NMIBC is associated with a higher risk of upstaging to MIBC. Patients who received full BCG induction had similar outcomes regardless of substaging, whereas T1b patients without BCG induction experienced higher recurrence and progression rates.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"43 1","pages":"47"},"PeriodicalIF":2.8,"publicationDate":"2024-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142898435","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":"The effectiveness and safety between prone position and supine position for ultrasound guided shock wave lithotripsy in proximal ureteral stones: a multi-center prospective propensity score-matching study.","authors":"Liping Shan, Gang Liu, Chengshan Ge, Hongqiang Guo, Shiyu Song, Fei Wu, Song Bai","doi":"10.1007/s00345-024-05383-6","DOIUrl":"10.1007/s00345-024-05383-6","url":null,"abstract":"<p><strong>Background: </strong>Although shock wave lithotripsy (SWL) has been considered to be effective in treating ureteral stones, a definitive conclusion remains unclear on which patient's position is the optimal option for proximal ureteral stones. The purpose of this study is to assess the ideal position of ultrasound guided SWL for the treatment of proximal ureteral stones.</p><p><strong>Methods: </strong>This prospective study was conducted in multi-center from June 2020 to December 2023. Patients who underwent SWL in prone or supine position for proximal stones were enrolled in this study. The primary outcome was stone-free rate (SFR); the secondary outcome was complete SFR, sessions of SWL, and complications. Propensity score-matched (PSM) analysis was performed.</p><p><strong>Results: </strong>Finally, 1187 patients with proximal ureteral stones were enrolled in this study; of which 50.5% (599) were treated with prone position and 49.5% (588) underwent supine position. After 1:1 PSM, the prone position group was superior in SFR (85.7% vs. 77.4%, P = 0.001), and complete SFR (83.3% vs. 75.0%, P = 0.001) compared with the supine potion group. The sessions of SWL (1.27 vs. 1.20, P = 0.092) and complications rate (all P values > 0.05) were comparable between the two groups. In addition, the prone group had shorter skin-to-stone distance (SSD) on ultrasound than the supine group (50 mm vs. 101 mm, P < 0.001).</p><p><strong>Conclusion: </strong>This multi-center prospective PSM study demonstrated that the prone position could increase the SFR and had comparable safety for ultrasound guided SWL among patients with proximal ureteral stones. Therefore, we advocate its priority application to patients with proximal ureteral stones when the prone position is possible.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"43 1","pages":"46"},"PeriodicalIF":2.8,"publicationDate":"2024-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142898598","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 novel preoperative evaluation technique for partial nephrectomy: three-dimensional extended renal tumor plane.","authors":"Liqing Xu, Xinfei Li, Yiming Zhang, Zhihua Li, Kunlin Yang, Zhongyuan Zhang, Lin Cai, Cheng Shen, Liqun Zhou, Xuesong Li","doi":"10.1007/s00345-024-05395-2","DOIUrl":"https://doi.org/10.1007/s00345-024-05395-2","url":null,"abstract":"<p><strong>Objective: </strong>To develop a three-dimensional (3D) image based extended tumor plane technique for robotic-assisted partial nephrectomy (RAPN).</p><p><strong>Methods: </strong>We prospectively enrolled patients with a local renal tumor for RAPN between March 2019 and Mar 2022. 3D virtual model was reconstructed based on the computed tomography urography. The tumor plane was extended equidistantly (10 mm) to form a virtual plane. According to the relationship between the extended plane and the collection system, patients are divided into those with no collecting system involvement, renal medulla involvement, and renal calyx involvement. The primary endpoint was trifecta achievement, which was defined as warm ischemic time ≤ 25 min, negative surgical margins, and no major perioperative complications.</p><p><strong>Results: </strong>This study enrolled a total of 215 patients. The median preoperative aspects and dimensions used for an anatomical (PADUA) score was 9 (6-15). The average warm ischemic time was 21.64 ± 9.35 min. Postoperative complications occurred in 26 (12.1%) patients, of whom 14 (6.5%) classified as major complication. The number of cases with trifecta failure was 1 (5.3%) in the no involvement group, 28 (20.6%) in the renal medullary involvement group, and 24 (40.0%) in the renal calyx involvement group (p < 0.001). Logistic regression indicated that renal calyx involvement was a risk factor for trifecta failure (OR = 2.639, 95% confidence interval [1.268-5.492], p = 0.009).</p><p><strong>Conclusions: </strong>The extended tumor plane based on three-dimensional images can is useful for the evaluation of RAPN. Determining whether the extended plane involves the collecting system, particularly the renal calyx, may impact the achievement of trifecta.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"43 1","pages":"44"},"PeriodicalIF":2.8,"publicationDate":"2024-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142877871","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":"Validation of novel grading schemes and refinement of the Leibovich risk groups for chromophobe renal cell carcinoma.","authors":"Haiyue Lin, Caiying Wang, Yun Zhao, Run Wang, Wei Xi, Ying Xiong, Li Xiao, Yi Liu, Shaoting Zhang, Chenchen Dai","doi":"10.1007/s00345-024-05394-3","DOIUrl":"10.1007/s00345-024-05394-3","url":null,"abstract":"<p><strong>Background: </strong>Traditional grading systems have proven inadequate in stratifying chRCC patients based on recurrence risk. Recently, several novel grading schemes, including three-tiered, two-tiered, and four-tiered systems, have been proposed, but their prognostic value remains controversial and lacks external validation.</p><p><strong>Materials and methods: </strong>We included 528 patients with pathologically proven chRCC (chromophobe renal cell carcinoma) from multiple medical institutions and the Cancer Genome Atlas-Kidney Chromophobe cohort. Three experienced pathologists independently reassessed the slides based on the three novel grading schemes. Survival outcomes, including disease-specific survival (DSS), recurrence-free survival (RFS), were analyzed using Kaplan-Meier methods and Cox proportional hazards regression models. The prognostic value of the original and adjusted Leibovich risk groups was compared using Harrell's C-index.</p><p><strong>Results: </strong>All grading systems demonstrated significant survival differences among their respective groups (p < 0.001 for all). However, within the four-tiered system, no significant survival disparity was observed between grade 1 and grade 2 tumors (GTG2 without necrosis) (p = 0.619 for DSS). When patients with necrosis were excluded, no survival difference was detected between CTG1 and CTG2 tumors in the three-tiered system (p = 0.870 for DSS), challenging the prognostic utility of distinguishing between these two grades. The adjusted Leibovich risk stratification (C-index = 0.840 for DSS), incorporating necrosis and tumor thrombus, demonstrated superior prognostic value compared to the original model (C-index = 0.762 for DSS), with more pronounced survival distinctions and improved predictive performance.</p><p><strong>Conclusion: </strong>Our study validates the prognostic significance of recently developed grading systems for chRCC. The observed survival difference between CTG1 and CTG2 in the three-tiered system may be attributed to varying percentages of coagulative necrosis. By integrating necrosis and tumor thrombus into the Leibovich risk groups, we enhanced the model's ability to distinguish between patients and improved its predictive performance.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"43 1","pages":"45"},"PeriodicalIF":2.8,"publicationDate":"2024-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142877842","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":"Impact of neurovascular bundle preservation on biochemical recurrence after robot-assisted radical prostatectomy for high-risk prostate cancer.","authors":"Hiroki Hagimoto, Masashi Kubota, Yoshiyuki Matsui, Takayuki Sumiyoshi, Ryoichi Saito, Takehiko Segawa, Shigeki Fukuzawa, Kenji Mitsumori, Toru Yoshida, Toshiya Akao, Yuya Sekine, Hiromitsu Negoro, Ryoma Kurahashi, Kimihiro Shimatani, Atsuro Sawada, Shusuke Akamatsu, Takashi Kobayashi, Takayuki Goto, The Daimonji Clinical Application Database Dai-Cad","doi":"10.1007/s00345-024-05363-w","DOIUrl":"https://doi.org/10.1007/s00345-024-05363-w","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate functional and oncological outcomes in patients who underwent unilateral or bilateral nerve-sparing (NS) robot-assisted radical prostatectomy (RARP) for high-risk prostate cancer.</p><p><strong>Methods: </strong>The cohort comprised 2683 patients with clinical stage T1-4, N0M0 high-risk prostate cancer who underwent RARP in Japanese tertiary care centers from August 2011 to April 2023. High risk was defined using the European Association of Urology risk stratification criteria. Patients were classified as high risk if they had clinical stage T2c-T4, a serum prostate-specific antigen concentration (PSA) of > 20 ng/dL, or an International Society of Urological Pathology (ISUP) grade of 4-5. Patients were grouped into NS and non-NS surgery groups. Propensity score matching was performed (1:1 ratio) to reduce confounding bias. The primary outcome was biochemical recurrence (BCR)-free survival (BCR-FS). The impact of NS surgery on BCR-FS was examined in the propensity score-matched cohort using Cox proportional hazards regression.</p><p><strong>Results: </strong>The propensity score-matched cohort comprised 1722 patients. In the matched cohort, median follow-up was 31.9 months. The 5-year BCR-FS was 70.2% in the NS group and 71.9% in the non-NS group (HR 1.05; 95% confidence interval, 0.85-1.29). NS surgery did not increase the risk of BCR in subgroups of patients stratified according to ISUP grade, T stage, percent cancer core involvement, and PSA.</p><p><strong>Conclusion: </strong>Neurovascular bundle preservation during RARP for high-risk prostate cancer appears feasible without increasing the BCR rate. However, the retrospective study design carries the potential influence of selection bias.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"43 1","pages":"43"},"PeriodicalIF":2.8,"publicationDate":"2024-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142873025","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}