World Journal of Urology最新文献

{"title":"Efficacy and safety of antegrade ureteroscopic lithotripsy versus retrograde ureteroscopic lithotripsy in the treatment of upper ureteric stones measuring > 10 mm in maximum dimension and/or impacted stones: randomized comparative study.","authors":"Mohamed Wishahi, Mohammad Attaby, Rafik El Halaby, Ahmad G Elbaz, Mohamed Hasan","doi":"10.1007/s00345-026-06445-7","DOIUrl":"https://doi.org/10.1007/s00345-026-06445-7","url":null,"abstract":"<p><strong>Objective: </strong>To compare efficacy and safety of antegrade flexible ureteroscopic lithotripsy (fURSL) in treating proximal ureteric stone ˃ 10 mm in maximum diameter including impacted stones with the retrograde approach.</p><p><strong>Patients and materials: </strong>This randomized prospective comparative study conducted at high-volume hospitals in urology departments in Ain Shams university and Theodor Bilharz Research Institute from March 2022 to December 2025 and included 100 patients all having upper ureteric stone larger than 10 mm (˃10 mm) in maximum diameter. Patients were randomized into 2 groups; the antegrade fURSL (group A) and retrograde fURSL (group B). For stone disintegration flexible ureteroscope and holmium laser were used . Renal access tract was achieved in antegrade group in prone position. All patients had double J stent fixed at end of procedure.</p><p><strong>Results: </strong>Group A patients had higher stone-free-rate (SFR) than group B (92% Vs 74%) showing statistical significance (P = 0.027). This gap in SFR increases with focusing on subgroups of impacted stones (94.12% Vs 64.5%, P = 0.004). Group B patients required a significantly higher proportion of auxiliary treatment (18% Vs 4%, P = 0.02). Group B had significantly shorter operative and fluoroscopy times than group A (P <0.0001) and had significantly shorter hospital stay (P = 0.015). Mean hemoglobin drop in group A was higher than in group B with no statistical significance, no signs of bleeding were recorded nor the need for blood transfusion. Overall complications were higher in group B than in group A (P = 0.028). Complications rate was significantly related to failure of insertion of ureteral access sheath (UAS) in retrograde approach with odds ratio 14.7.</p><p><strong>Conclusion: </strong>Antegrade fURSL is safe and effective modality to treat upper ureteric stones ˃10 mm mm in maximum diameter with higher SFR, less auxiliary procedures needed and favorable post-operative adverse events profile. Antegrade approach efficacy is augmented when focusing on treating impacted stones.</p><p><strong>Clinical trial registration: </strong>ClinicalTrials.gov ID NCT07362784.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"44 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147843568","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 factors for post-renal transplant ureteral stenosis: a survival analysis in a contemporary cohort.","authors":"Nicolás Sierrasesumaga Martín, Juan Ramón Torrecilla Garcia-Ripoll, Miguel Pascual Samaniego, Sergio Martin Martin, Esther Valsero Herguedas, Raúl Calvo González, Fatima Castroviejo Royo, Laura Pesquera Ortega, Antonio José Alonso Villalba, María Consuelo Conde Redondo, Jesus Calleja Escudero","doi":"10.1007/s00345-026-06452-8","DOIUrl":"https://doi.org/10.1007/s00345-026-06452-8","url":null,"abstract":"<p><strong>Purpose: </strong>Ureteral stenosis remains a significant urological complication after kidney transplantation. This study aimed to identify independent risk factors for the development of post-transplant ureteral stenosis and to evaluate their temporal impact using survival analysis in a contemporary cohort.</p><p><strong>Methods: </strong>A retrospective single-center cohort study was conducted, including 342 deceased donor kidney transplant recipients between 2014 and 2024. The primary endpoint was the time to radiologically confirmed ureteral stenosis within the first post-transplant year. Univariate analysis and Kaplan-Meier survival curves were used to identify associated factors. A multivariable Cox proportional hazards model was constructed to determine independent predictors, adjusting for clinically relevant variables.</p><p><strong>Results: </strong>The incidence of ureteral stenosis was 11.1% (n = 38). Multivariable Cox regression identified urinary fistula as the strongest associated factor (Hazard Ratio [HR]: 8.28; 95% CI: 3.87-17.72; p < 0.001), drastically reducing median stenosis-free survival to 188.9 days. Diabetes mellitus showed a borderline association with stenosis (HR: 2.41; 95% CI: 1.02-5.72; p = 0.046). Conversely, the prophylactic use of a double-J stent was an independent protective factor, reducing the risk of stenosis by 72% (HR: 0.28; 95% CI: 0.11-0.73; p = 0.009). Postoperative urinary tract infection showed a non-significant trend (HR: 1.89; p = 0.079).</p><p><strong>Conclusion: </strong>Urinary fistula was the strongest predictor of ureteral stenosis, underscoring the importance of its prevention. Routine prophylactic double-J stenting appeared to be an effective protective strategy. Diabetes mellitus showed a borderline association with stenosis and may identify a subgroup requiring closer postoperative urological surveillance; this finding should be interpreted cautiously and confirmed in larger studies.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"44 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147843570","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":"Outcomes of the novel EXIME prostate stent: initial experience in a South African setting.","authors":"Daniel Da Silva Ferreira, Chris Christofides, Ahmed Adam","doi":"10.1007/s00345-026-06439-5","DOIUrl":"10.1007/s00345-026-06439-5","url":null,"abstract":"<p><strong>Purpose: </strong>Urinary retention due to Benign Prostatic Hyperplasia (BPH) is a frequent and serious urological emergency. This study evaluated the efficacy and clinical outcomes of the EXIME temporary prostatic stent as an alternative to traditional catheterisation.</p><p><strong>Methods: </strong>A prospective study including 50 male patients presenting with BPH-related urinary retention or those awaiting definitive surgery was performed. The EXIME stent was inserted as an outpatient for a one-month indwelling period. Primary endpoints included voiding efficacy and ease of use. Secondary outcomes assessed sexual function restoration, pain and bacterial colonisation rates.</p><p><strong>Results: </strong>Spontaneous voiding was achieved in all 50 patients with a median maximum flow rate (Qmax) of 17.8 ml/s [IQR 12.9-21.7] and a median post-void residual (PVR) of 20 ml [IQR 10-37]. A significant restoration of sexual activity was observed, with a resumption rate of 88% among previously sexually active men (p < 0.001). Surrogate markers for bacterial colonisation improved with dipstick nitrite positivity dropping from 26% pre-insertion to 0% at removal (p < 0.001). Procedurally, 90% of insertions were graded as extremely easy to easy (VAS 1-3) and 84% of patients reported only minimal to uncomfortable pain (VAS 1-3). The failure rate was 4% with only two early removals documented.</p><p><strong>Conclusion: </strong>This study represents the first clinical experience on this novel innovation on the continent of Africa, demonstrating a safe, effective, and well-tolerated alternative to traditional catheterization by providing immediate symptom relief and improved outcomes regarding sexual function and bacterial colonisation thus supporting its use in the management of BPH-related urinary retention.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"44 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13139204/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147821054","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":"Face and content validation of TURP and TURB simulation models: an EAU European School of Urology (ESU) Lower Urinary Tract Endoscopy Working Group Study.","authors":"Tarik Emre Sener, Tiago Ribeiro de Oliveira, Engin Denizhan Demirkiran, Davide Perri, Sergio Pereira, Juan Pablo Caballero, Luis Osorio, Ioannis Goumas Kartalas, Rodrigo Ramos, Afonso Sousa Castro, Daniel Oliveira Reis, Marco Paciotti, Paramananthan Mariappan, Pietro Diana, Laurian Dragos, Domenico Veneziano, Chandra Shekhar Biyani, Bhaskar Somani, Evangelos Liatsikos","doi":"10.1007/s00345-026-06441-x","DOIUrl":"10.1007/s00345-026-06441-x","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the educational validity of two bench-top simulators for Transurethral Resection of the Prostate (TURP) and Transurethral Resection of Bladder Tumor (TURB), focusing on their realism, ergonomics, and relevance for structured endourology training.</p><p><strong>Materials and methods: </strong>Fourteen expert endourologists from multiple European centers assessed both simulators during the European Association of Urology Residents Education Programme (EUREP) 2025. Face validity and content validity were evaluated using 4-point Likert questionnaires. Item-level (I-CVI) and scale-level (S-CVI/Ave) content validity indices were calculated for all items and adjusted for core procedural skills.</p><p><strong>Results: </strong>Experts rated both simulators highly for anatomical realism, tissue handling, and overall utility (mean scores > 3.5/4). The TURP simulator achieved an adjusted S-CVI/Ave of 0.92 and the TURB simulator 0.97, indicating excellent consensus on their educational adequacy for key procedural steps. Non-modeled features such as bleeding, obturator reflex, and energy modulation received low ratings, reflecting inherent limitations of bench-top simulation. Both models were considered effective for practicing instrument handling and resection depth control in a risk-free, standardized environment.</p><p><strong>Conclusions: </strong>The TURP and TURB simulators demonstrated strong face and content validity for core resection training. Their modular, non-biological, and reproducible design supports safe, structured skill acquisition and competency assessment in endourology curricula, offering a practical bridge between theoretical learning and clinical performance.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"44 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13139298/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147820882","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":"Clinical and procedural factors influencing ureteral stent dwell time and removal methods after endourological procedures: a systematic review.","authors":"Stamatios Katsimperis, Ioannis Manolitsis, Lazaros Lazarou, Theodoros Tokas, Yuhong Yuan, Begoña Ballesta Martinez, Amelia Pietropaolo, Patrick Juliebø-Jones, Senol Tonyali, Rifat Burak Ergül, Bhaskar Somani, Lazaros Tzelves, Andreas Skolarikos","doi":"10.1007/s00345-026-06436-8","DOIUrl":"https://doi.org/10.1007/s00345-026-06436-8","url":null,"abstract":"<p><strong>Introduction: </strong>Ureteral stents are routinely used following endourological procedures to ensure adequate drainage and prevent obstruction. However, stent-related morbidity remains common, and optimal stent dwell time and removal methods are not well defined. This systematic review aimed to evaluate clinical and procedural factors influencing ureteral stent dwell time and the methods used for stent removal after endourological interventions.</p><p><strong>Methods: </strong>A systematic review was conducted in accordance with PRISMA guidelines and registered on PROSPERO. MEDLINE and Embase were searched from inception to October 2025. Randomized controlled trials and comparative observational studies evaluating ureteral stent dwell time and/or removal methods in adults undergoing endourological procedures were included. Risk of bias was assessed using RoB 2 and ROBINS-I tools.</p><p><strong>Results: </strong>Thirty-two studies encompassing 4,373 patients were included. Reported stent dwell times varied widely, most commonly ranging between 10 and 14 days in uncomplicated cases, with longer durations associated with increased rates of encrustation and removal difficulty. Removal techniques included rigid cystoscopy (48.7%), flexible cystoscopy (19.9%), extraction strings (23.5%), and device-assisted methods (7.9%). Less invasive approaches, particularly flexible cystoscopy and extraction-string removal, were consistently associated with reduced pain scores and improved patient comfort, although extraction strings carried a small risk of premature dislodgement.</p><p><strong>Conclusions: </strong>While practice patterns vary, the evidence suggests that a 10-14 day dwell time might be the optimal window to balance healing with the prevention of encrustation. Less invasive removal approaches, particularly flexible cystoscopy and extraction-string techniques, were generally associated with lower pain scores and high procedural success rates in selected patients. While these methods are safe and better tolerated, extraction strings carried a small, reproducible risk of premature dislodgement. High-quality prospective studies are needed to define determinant-based, individualized stent management strategies.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"44 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147821629","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":"Flexible and navigable suction ureteral access sheath combined with flexible ureteroscopy for proximal impacted ureter stones: a retrospective case series.","authors":"Yan Wang, Dongdong Guo, Tao Wang, Xinyu Zhai, Cheng Ma, Dongliang Xu, Chuanmin Chu","doi":"10.1007/s00345-026-06447-5","DOIUrl":"https://doi.org/10.1007/s00345-026-06447-5","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the technical feasibility and clinical outcomes of flexible and navigable suction ureteral access sheath (FANS) combined with flexible ureteroscopy (fURS) for proximal impacted ureter stones (PIUS) and identify predictors of residual fragments (RF).</p><p><strong>Methods: </strong>This single-center retrospective study included 45 patients with PIUS who underwent FANS-fURS (August 2023-February 2025). The surgical procedure involved FANS deployment, laser lithotripsy, and real-time suction-assisted fragment clearance. Stone-free status (SFS) was assessed at 30 days postoperatively, with Grades B-D defined as RF. Multivariate logistic regression analyzed predictors of RF.</p><p><strong>Results: </strong>The median age was 55 years (IQR: 41.5-61.5), with 71.1% male. Postoperative SFS were Grade A (40.00%), B (51.11%), C (6.67%), and D (2.22%). Multivariate analysis identified larger sheath size as protective against RF (OR: 0.061, P = 0.025), while larger stone diameter (OR: 1.593, P = 0.031) and higher polyp occupancy within the lumen (OR: 1.919, P = 0.040) increased RF risk. Median operative time was 42 min (IQR: 33.5-65.0).</p><p><strong>Conclusion: </strong>The combination of FANS and fURS demonstrated high efficacy in managing PIUS, achieving favorable stone clearance rates. Sheath size, stone diameter, and polyp occupancy within the lumen are significant predictors of RF, which can help optimize surgical strategy.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"44 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147820875","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":"Single-port robotic ileal ureter reconstruction: feasibility, technique, and early outcomes.","authors":"Wattanachai Ratanapornsompong, Sutthirat Sarawong, Jeffery S Lin, Amr Elbakry, Lee C Zhao","doi":"10.1007/s00345-026-06416-y","DOIUrl":"https://doi.org/10.1007/s00345-026-06416-y","url":null,"abstract":"<p><strong>Purpose: </strong>Ileal ureter interposition is a well-established option for complex ureteral strictures. While minimally invasive approaches have evolved, the application of the single-port (SP) robotic platform for ileal ureter reconstruction has not been previously reported. This study presents the first clinical series evaluating the feasibility, technique, and early outcomes of SP robotic ileal ureter reconstruction.</p><p><strong>Methods: </strong>We retrospectively reviewed a prospectively maintained database of patients who underwent SP robotic ileal ureter substitution between September 2019 and November 2024 by a single surgeon. Demographic, perioperative, and functional data were analyzed. Surgical success was defined as freedom from reintervention, absence of radiographic obstruction, and stable renal function. Pre- and postoperative renal function was compared using paired statistical analysis.</p><p><strong>Results: </strong>Seventeen patients underwent SP robotic ileal ureter reconstruction (29% male), with a mean age of 54 years. Radiation-induced strictures accounted for 70.6% of cases. Unilateral reconstruction was performed in 8 (47.1%), while 8 (47.1) required bilateral reconstruction with V-shaped or reverse-7 configurations, including bladder augmentation in selected cases. One patient (5.9%) underwent unilateral ileal ureter with bladder neck reconstruction. The median ileal segment length was 25 cm. Mean operative time was 308 min, and median blood loss was 70 mL. One intraoperative complication (5.9%) occurred. Postoperative complications were observed in 47%, with 11.8% classified as Clavien-Dindo grade IIIa. Renal function remained stable (preoperative eGFR 56.4 vs. postoperative 57.5 mL/min/1.73 m², p = 0.803). At a median follow-up of 20.5 months, the overall success rate was 94.1%.</p><p><strong>Conclusions: </strong>Single-port robotic ileal ureter reconstruction is a feasible and effective technique for complex ureteral strictures, achieving high early success with acceptable morbidity.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"44 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147821026","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":"Size matters: not all scopes are created equal! A flow rate reality check for single-use flexible ureteroscopes.","authors":"Arman Tsaturyan, Arkadya Musayelyan, Hayk Grigoryan, Sergey Fanarjyan, Arthur Grabsky, Armen Muradyan, Mher Mkhitaryan, Steffi Kar Kei Yuen, Vineet Gauhar, Evangelos Liatsikos, Panagiotis Kallidonis, Etienne Xavier Keller, Marco Lattarulo, Pier Paolo Prontera, Olivier Traxer, Bhaskar Somani, Amelia Pietropaolo","doi":"10.1007/s00345-026-06411-3","DOIUrl":"https://doi.org/10.1007/s00345-026-06411-3","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the irrigation flow parameters of a 3.6Fr working channel in single-use flexible ureteroscopes with empty and without an instrument in the straight and flexed tip positions.</p><p><strong>Materials and methods: </strong>An in-vitro experimental study including 8 single-use flexible ureteroscopes of varying size ranging from 6.3Fr to 9.0Fr in diameter and marketed as having a 3.6Fr working channel. The evaluation was performed under three different conditions: (1) With empty working channel, (2) With a 272 μm laser fiber (3) With a 2.2Fr nitinol basket. The trials were performed with the distal tip of the scope in a straight position and with right and left complete deflection.</p><p><strong>Results: </strong>The maximal and minimal irrigation flow rates of 37.0 and 26.5 ml/min were observed with the 7.5Fr HU30S and with 6.3Fr HU30M HugeMed, respectively. The 6.3Fr HU30M scope was associated with statistically significant worse irrigation flow rates compared to 7.5Fr HU30S and 9.0HU30 scopes under all conditions. Deflection of the scopes affected the flow rates in up to 11% with empty channel, with minimal or no effect with laser fiber and basket inserted.</p><p><strong>Conclusion: </strong>We found that the novel 6.3Fr HU30M flexible ureteroscope featuring a 3.6Fr working channel was associated with significantly reduced irrigation flows compared to 7.5Fr HU30S and 9.0Fr HU30 scopes regardless of the channel occupancy. Presence of larger diameter working instruments significantly reduced the flow rates, regardless of the ureteroscope used. Deflection of the scope tip does impact flow rates, particularly with empty working channel.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"44 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147782764","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":"Management of lower urinary tract symptoms before prostate cancer radiotherapy: a call for innovative strategies.","authors":"Jennifer Le Guevelou, Julien Anract, Charles Dariane, Matthijs Scheltema, Rui Bernardino, Lorenzo Bianchi, Veeru Kasivisvanathan, Mattia Sibona, Andrea Mari, Marc Sapoval, Marcin Miszczyk, Pawel Rajwa, Tom Boeken, Giancarlo Marra","doi":"10.1007/s00345-026-06427-9","DOIUrl":"10.1007/s00345-026-06427-9","url":null,"abstract":"<p><p>Benign prostatic hyperplasia (BPH) is the main cause of lower urinary tract symptoms (LUTS) in aging men. As the incidence of prostate cancer (PCa) increases with age, coexistence of BPO and PCa is a frequent issue. Radical prostatectomy might be considered as the best option for patients presenting with severe obstructive symptoms, allowing to simultaneously treat both diseases. However, not all patients are eligible or prefer surgery, therefore a large number of patients are referred to receive PCa radiotherapy (RT). Preexisting LUTS represent a well-known risk factor to develop severe genito-urinary (GU) toxicity. While improving urinary function before starting irradiation appears to be crucial, the development of new minimally invasive surgical therapies (MIST) for BPH creates new opportunities for treatment personalization in RT patients with LUTS.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"44 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13132912/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147782644","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":"Time to rethink routine histopathology after adult circumcision? Long-term oncological outcomes from an 11-year cohort.","authors":"Ghulam Mustafa Nandwani, Mubeshar Hassan, Devanand Lohana, Prasad Bollina","doi":"10.1007/s00345-026-06432-y","DOIUrl":"https://doi.org/10.1007/s00345-026-06432-y","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate whether routine histopathological examination of the prepuce following adult circumcision without clinical suspicion of malignancy influences patient management and healthcare resource utilisation, and to report circumcision frequency and long-term oncological outcomes.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted of all adult circumcisions performed between January 2015 and December 2025. Patients aged ≥ 15 years undergoing circumcision for symptomatic phimosis, paraphimosis, or recurrent balanitis were included. Cases with suspected malignancy or known premalignant lesions were excluded. Demographic, operative, histopathological, and follow-up data were extracted from electronic records. Median follow-up was 85 months. Cost analysis was based on an estimated histopathology cost of £226 per specimen.</p><p><strong>Results: </strong>Of 1,648 listed patients, 1,523 met the inclusion criteria (median age 44 years). Phimosis was the primary indication (98.2%). Lichen sclerosus was identified in 62% of specimens, while incidental penile intraepithelial neoplasia (PeIN) was detected in 0.5%. No invasive carcinomas were identified. All PeIN cases were managed with circumcision alone, and no progression or additional intervention was required at a median follow-up of 81 months. Eliminating routine histopathology would have saved 304.6 consultant hours and £344,198 over 11 years (£31,291 annually).</p><p><strong>Conclusions: </strong>In the absence of clinical suspicion, routine histopathological examination of the prepuce rarely detects clinically significant malignancy or alters management. A selective, risk-adapted approach may optimise resource utilisation while maintaining oncological safety.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"44 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13133191/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147821241","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}