World Journal of Urology最新文献

{"title":"Partial vs. whole-gland salvage hifu after radiotherapy failure: oncological and functional outcomes.","authors":"Cyriel Maillard, Samy Mebroukine, Thibaud Haaser, Gilles Pasticier, Grégoire Robert, Franck Bladou","doi":"10.1007/s00345-026-06831-1","DOIUrl":"10.1007/s00345-026-06831-1","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the long-term oncological and functional outcomes of whole-gland and partial-gland salvage high-intensity focused ultrasound (S-HIFU) in patients with radiorecurrent prostate cancer, for whom local recurrence after radiotherapy remains a major therapeutic challenge and radical salvage surgery is associated with substantial morbidity.</p><p><strong>Methods: </strong>We performed a retrospective single-center study including 138 patients treated with S-HIFU between August 2006 and October 2023 for biopsy-proven local recurrence without metastatic disease. Treatments consisted of whole-gland or partial-gland ablation, including hemi-gland and focal therapy. Oncological outcomes were assessed using Kaplan-Meier analyses and multivariable Cox regression models evaluating progression-free survival (PFS), metastasis-free survival (MFS), and cancer-specific survival (CSS). Postoperative complications were graded according to the Clavien-Dindo classification.</p><p><strong>Results: </strong>After a median follow-up of over five years, 5-year PFS, MFS, and CSS rates were 43.6%, 85%, and 95%, respectively. Higher pre-HIFU prostate-specific antigen (PSA) levels and ISUP grade ≥ 5 independently predicted disease progression. No significant differences in PFS or MFS were observed between whole-gland and partial-gland treatments. Acute urinary retention occurred in 33% of patients and voiding dysfunction in 39.9%, requiring surgical management in 34.1% of cases. Severe complications were significantly more frequent after whole-gland compared with partial-gland S-HIFU (48.3% vs. 29.8%, p < 0.05).</p><p><strong>Conclusion: </strong>S-HIFU represents a viable salvage option after radiotherapy failure. Our results support that partial-gland S-HIFU significantly reduces severe morbidity while maintaining comparable oncological outcomes compared to whole-gland S-HIFU in appropriately selected patients.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"44 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149115727","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 magnetic resonance imaging-based diagnostic pathway on oncologic outcomes of localised prostate cancer between primary treatment modalities: a Will-Rogers phenomenon?","authors":"Lingyue Yu, Han Jie Lee, Alvin Yuanming Lee, Jia Ling Goh, Kae Jack Tay, Henry Sun Sien Ho, Jeffrey Tuan, John Shyi Peng Yuen, Kenneth Chen","doi":"10.1007/s00345-026-06844-w","DOIUrl":"10.1007/s00345-026-06844-w","url":null,"abstract":"<p><strong>Background: </strong>The MRI pathway (pre-biopsy MRI-targeted plus saturation biopsies, MRI-Bx) outperforms transrectal ultrasound systematic prostate biopsy (TRUS-Bx) in diagnosing clinically significant prostate cancer (csPCa). However, there is a dearth of data on how this paradigm shift influences biochemical recurrence (BCR)-free survival in patients after radical prostatectomy (RP) or radiotherapy (RT). We aim to evaluate BCR-free survival in the MRI-Bx era stratified by primary treatment modalities in a large contemporary cohort.</p><p><strong>Methods: </strong>We retrospectively reviewed localised prostate cancer patients diagnosed by MRI-Bx or TRUS-Bx and treated with RP or RT between 2010 and 2021. Patients diagnosed and staged by PSMA-PET were excluded. BCR was defined as two successive prostatic specific antigen (PSA) > 0.2 ng/mL after RP or a rise of 2 ng/mL from PSA nadir after RT within 3 years. Kaplan-Meier (KM) analyses and multivariable Cox proportional hazards regression were performed for BCR-free survival.</p><p><strong>Results: </strong>A total of 1674 men included (1061 RP, 613 RT; 1075 TRUS-Bx, 599 MRI-Bx; median follow-up 38 months). Across all risk group, MRI-Bx yielded higher BCR-free survival at all timepoints in RP patients, especially in high-risk disease (3-year: 85% vs. 71%). In RT patients, MRI-Bx yielded no significant difference across all timepoints. On multivariable regression, MRI-Bx approach independently predicted BCR in RP patients (hazard ratio (HR) 0.60, 95% CI 0.40-0.90, p = 0.013) but not in RT patients (HR 0.94, 95% CI 0.31-3.85, p = 0.945) after adjusting for age, PSA, clinical T stage, Gleason grade group, adjuvant ADT and EAU risk groups. In terms of GG concordance after RP, MRI-Bx demonstrated decreased GG upgrading than TRUS-Bx group (23.1% vs. 27.4%) but increased GG downgrading (20.6% vs. 14.4%), which was statistically significant (p = 0.025).</p><p><strong>Conclusions: </strong>Patients managed via the MRI pathway exhibited improved BCR-free survival following RP, reflecting a risk migration consistent with the Will-Rogers phenomenon. This survival advantage was attenuated in the RT cohort, potentially due to difference in BCR definition and adjuvant ADT use. The risk reclassification in the RP cohort after MRI pathway adoption underscores the necessity of new risk models integrating quantitative MRI parameters to better select patients for surgery. Longer follow-up is required to determine the impact on overall and cancer-specific survival.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"44 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149115737","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":"Circulating tumour DNA and extrachromosomal DNA in prostate and bladder cancer: biology, clinical applications and future perspectives.","authors":"Jihane Elmasmoudi, Axel S Merseburger","doi":"10.1007/s00345-026-06790-7","DOIUrl":"10.1007/s00345-026-06790-7","url":null,"abstract":"<p><strong>Purpose: </strong>To critically appraise circulating tumour DNA (ctDNA) and extrachromosomal DNA (ecDNA) in prostate and bladder cancer, and to define what evidence links the two.</p><p><strong>Methods: </strong>Narrative review of search period July-September 2026, supplemented by reference-list and citation screening, covering ctDNA and ecDNA biology, detection and clinical application in prostate and urothelial cancer. The ctDNA-ecDNA interface was appraised using a five-tier evidentiary framework (copy-number gain; structural rearrangement; amplicon-graph reconstruction; phasing/optical mapping; orthogonal validation).</p><p><strong>Results: </strong>In bladder cancer, the phase 3 IMvigor011 trial validated ctDNA-guided adjuvant atezolizumab (disease-free survival [DFS] HR 0.64; overall survival [OS] HR 0.59), while persistently ctDNA-negative patients had 2-year DFS/OS of 88.4%/97.1% without adjuvant therapy. In prostate cancer, ctDNA positivity and androgen-receptor alterations are strongly prognostic (median OS 29.0 vs. 47.4 months; HR 2.0), but no prospective ctDNA-guided interventional trial exists. ecDNA is present in approximately 36% of urothelial carcinomas and drives oncogene amplification, heterogeneity, immune evasion and resistance. Evidence linking the two is indirect and asymmetric: prostate cancer offers stronger longitudinal ctDNA evidence via plasma AR-ecDNA proxy signatures, whereas bladder cancer shows stronger structural evidence from urinary sediment; no structurally validated blood ecDNA has been reported. This evidence derives predominantly from metastatic cohorts (mCRPC, post-cystectomy bladder cancer), with no established role in earlier-stage or minimal-residual-disease settings.</p><p><strong>Conclusion: </strong>ctDNA is clinically actionable in bladder cancer and prognostic in advanced prostate cancer, whereas ecDNA remains an investigational driver. Structural confirmation of ecDNA in blood, assay standardisation and prospective biomarker-stratified trials are the priorities for the field.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"44 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149115759","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":"Surrogacy of intermediate clinical endpoints for overall survival in BCG-naïve high-risk non-muscle-invasive bladder cancer.","authors":"Pietro Scilipoti, Aleksander Ślusarczyk, José Daniel Subiela, Mattia Longoni, Angelo Occhi, Paolo Zaurito, Giovanni Tremolada, Brigida Maiorano, Francesco Soria, Wojciech Krajewski, David D'Andrea, Francesco Claps, Francesco Del Giudice, Renate Pichler, Elisabeth Grobet-Jeandin, Andrea Gallioli, Luca Afferi, Riccardo Mastroianni, Giuseppe Simone, Laura S Mertens, Ekaterina Laukhtina, José Luis Rodriguez Elena, Javier Aranda, Alfonso Lafuente Puentedura, Jorge Caño Velasco, Roberto Contieri, Federico Zorzi, Giovanni Liguori, Rodolfo Hurle, Giuseppe Ottone Cirulli, Richard Naspro, Keiichiro Mori, Gautier Marcq, Piotr Radziszewski, Shahrokh F Shariat, Paolo Gontero, Morgan Rouprêt, Thomas Seisen, Francesco Montorsi, Alberto Briganti, Benjamin Pradere, Marco Moschini","doi":"10.1007/s00345-026-06840-0","DOIUrl":"10.1007/s00345-026-06840-0","url":null,"abstract":"<p><strong>Introduction: </strong>Recent trials in BCG-naïve high-risk non-muscle-invasive bladder cancer (HR-NMIBC) have added immunotherapy to BCG, often using event-free survival (EFS) as the primary endpoint. However, neither EFS nor progression-free survival (PFS) has been validated as a surrogate for overall survival (OS) in this setting.</p><p><strong>Methods: </strong>We retrospectively analyzed data from 18 international centers, including patients with BCG-naïve HR-NMIBC treated between 2001 and 2025. Adequate BCG exposure (International Bladder Cancer Group criteria) was the treatment contrast for its effects on intermediate clinical endpoints (ICEs) and OS, using a 12-month landmark approach and inverse probability of treatment weighting (IPTW). Surrogacy was assessed with: (1) adapted Prentice criteria, with time-varying ICEs in IPTW-adjusted Cox models for OS; and (2) an emulated two-stage meta-analytic framework estimating individual-level association (Kendall's τ) and pseudo-trial-level surrogacy (R²) across 500 random pseudo-trial replications.</p><p><strong>Results: </strong>Of 3384 patients, 3153 entered the landmark analysis; 2697 (85.5%) received adequate BCG. Median follow-up was 50 months (IQR 17-77). Adequate BCG was associated with improved OS (HR 0.63, 95% CI 0.47-0.83) and lower risks of PFS events (HR 0.46, 95% CI 0.37-0.58) and EFS events (HR 0.48, 95% CI 0.40-0.58). Both ICEs were independently associated with OS, but adjusting for each did not fully attenuate the BCG effect. Individual-level association with OS was strong for PFS (τ = 0.79, 95% CI 0.75-0.83) and EFS (τ = 0.71, 95% CI 0.66-0.75). Pseudo-trial-level surrogacy was moderate, with median R² of 0.60 (PFS) and 0.51 (EFS) and wide dispersion across replications, both below the prespecified threshold for adequate surrogacy (≥ 0.70).</p><p><strong>Conclusions: </strong>In this exploratory, hypothesis-generating analysis, PFS and EFS were strongly associated with OS at the individual level but failed to demonstrate robust pseudo-trial-level surrogacy. These endpoints may not fully capture treatment effects on OS, warranting caution when interpreting ICE-driven trial results in BCG-naïve HR-NMIBC.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"44 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149115562","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":"Regenerative therapies for erectile dysfunction: distinguishing treatment-associated improvement from comparative effectiveness.","authors":"Abdulkadir Ozmez, Mehmet Ozay Ozgur","doi":"10.1007/s00345-026-06821-3","DOIUrl":"10.1007/s00345-026-06821-3","url":null,"abstract":"","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"44 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149115308","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":"Bridging the PSMA PET/CT access gap in prostate cancer: evidence, barriers, and priorities for implementation.","authors":"J Gómez Rivas, L Fernández Hernández, L Turpin, A Peyrottes, M Rouprêt","doi":"10.1007/s00345-026-06816-0","DOIUrl":"10.1007/s00345-026-06816-0","url":null,"abstract":"<p><strong>Purpose: </strong>To examine the gap between evidence-based indications for PSMA PET/CT and real-world access in prostate cancer, with a focus on European implementation and country-specific experience from Spain and France.</p><p><strong>Methods: </strong>A focused narrative appraisal of published evidence, clinical guidelines, regulatory and reimbursement information, and real-world accessibility data was performed. European accessibility modelling and physician market research from Spain were incorporated to characterise implementation patterns and barriers.</p><p><strong>Results: </strong>Access to PSMA PET/CT remains heterogeneous despite its established role in higher-risk staging and biochemical recurrence. Reported barriers include reimbursement and local approval requirements, PET/CT and nuclear medicine capacity, radiopharmaceutical logistics, non-standardised referral pathways, waiting times, and institutional variation. Exploratory modelling suggested that use remains below the estimated eligible population in both staging and biochemical recurrence, with differences between countries and clinical scenarios. Spanish market research similarly indicated substantial variation. These data are exploratory implementation signals rather than population-level epidemiological estimates.</p><p><strong>Conclusion: </strong>Improving access requires guideline-based eligibility criteria, harmonised reimbursement, regional referral networks, adequate imaging and reporting capacity, reliable tracer supply, and measurable access indicators. Further research should determine whether reducing implementation gaps improves diagnostic pathways and treatment allocation.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"44 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13624002/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149082088","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":"Stone location may separate the benefit and harm of 4.7Fr ureteral stents.","authors":"Ting Ye","doi":"10.1007/s00345-026-06836-w","DOIUrl":"10.1007/s00345-026-06836-w","url":null,"abstract":"","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"44 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149082109","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":"Development and internal validation of a preoperative score for predicting postoperative residual stone after mini-percutaneous nephrolithotomy.","authors":"Hüseyin Mert Durak, Adem Sancı, Emre Hepşen, Anar Aghayev, Alper Gök","doi":"10.1007/s00345-026-06814-2","DOIUrl":"10.1007/s00345-026-06814-2","url":null,"abstract":"<p><strong>Objective: </strong>To develop and internally validate a simple preoperative scoring system for predicting postoperative residual stone after mini-percutaneous nephrolithotomy (mini-PCNL).</p><p><strong>Methods: </strong>This retrospective single-center study included 217 adult patients who underwent pure mini-PCNL between May 2024 and December 2025. Postoperative stone clearance was assessed exclusively by non-contrast computed tomography. Clinically significant residual stone was defined as any residual fragment larger than 4 mm. Patients with no residual fragment or residual fragments ≤ 4 mm were classified as having no clinically significant residual stone. Univariable and multivariable logistic regression analyses were performed to identify independent preoperative predictors of residual stone. Based on the final multivariable model, a simplified preoperative scoring system, the Mini-PCNL Residual Stone Score, was constructed. Discriminative ability was evaluated using receiver operating characteristic (ROC) analysis, and internal validation was performed with bootstrap resampling. The score was also compared with the S.T.O.N.E. nephrolithometry score and Guy's Stone Score in the same cohort.</p><p><strong>Results: </strong>Overall, 178 patients (82.0%) had no clinically significant residual stone, whereas 39 patients (18.0%) had clinically significant residual stone. Higher body mass index, greater stone number, larger stone volume, higher stone density, and the presence of a lower pole stone were independently associated with postoperative clinically significant residual stone. The Mini-PCNL Residual Stone Score ranged from 0 to 19 points and showed strong discrimination, with an AUC of 0.961. The optimal cut-off value was ≥ 10 points, corresponding to a sensitivity of 87.2% and a specificity of 93.3%. Internal validation demonstrated stable performance, with a bootstrap 95% confidence interval for the AUC of 0.929-0.986. After bootstrap correction for optimism, the optimism-corrected AUC was 0.954. In an exploratory comparison, the Mini-PCNL Residual Stone Score showed numerically higher discrimination than the S.T.O.N.E. nephrolithometry score and Guy's Stone Score.</p><p><strong>Conclusion: </strong>The Mini-PCNL Residual Stone Score is a simple and clinically applicable preoperative tool for estimating clinically significant residual stone risk after mini-PCNL. Because it is based entirely on routinely available preoperative variables, it may support individualized counseling and treatment planning. External validation in independent multicenter cohorts is needed before broader clinical use.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"44 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149082100","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":"Intraoperative positioning strategies to improve stone-free outcomes during retrograde intrarenal surgery: a systematic review and meta-analysis.","authors":"Lin Wang, Wen Huang, Bin Wan, Zhifang Luo, Xiaoyan Wen, Mei Feng, Qilei Jia","doi":"10.1007/s00345-026-06732-3","DOIUrl":"10.1007/s00345-026-06732-3","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate whether intraoperative patient positioning strategies improve stone-free outcomes and safety compared with standard lithotomy during retrograde intrarenal surgery (RIRS) for renal calculi.</p><p><strong>Methods: </strong>PubMed, Embase, Cochrane Library, Web of Science, CNKI, Wanfang, and SinoMed were searched from inception to December 2025. Comparative studies of intraoperative positioning strategies versus standard lithotomy during RIRS were included. Risk ratios (RRs) and mean differences (MDs) with 95% confidence intervals (CIs) were calculated using random-effects models where quantitative synthesis was appropriate. Subgroup analysis by stone location and exploratory sensitivity analyses according to dominant gravitational axis and CT-based outcome assessment were performed.</p><p><strong>Results: </strong>Eight studies involving 998 patients were included. Positioning strategies significantly increased the stone-free rate compared with standard lithotomy (RR 1.20, 95% CI 1.12-1.28; P < 0.001). Benefits were consistent in mixed intrarenal calculi and lower pole stones, and CT-based sensitivity analyses yielded comparable estimates. Postoperative fever did not differ significantly between groups (RR 1.15, 95% CI 0.53-2.53; P = 0.720). Operative-time and hospital-stay outcomes showed extreme heterogeneity or single-study dependency, and reintervention data were too limited for definitive conclusions.</p><p><strong>Conclusion: </strong>Intraoperative positioning strategies during RIRS may improve stone-free outcomes. However, endpoint variability, exploratory subgroup classification, limited reintervention data, and the absence of direct intrarenal pressure monitoring warrant cautious interpretation. Standardized trials with CT-based endpoints, clearly defined positioning protocols, and intrarenal pressure monitoring are needed.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"44 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149076015","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":"Multimodal comparison of 19 single-use flexible ureteroscopes: bench testing, operative video assessment, and surgeon ratings.","authors":"Engin Denizhan Demirkıran, Massimo Menozzi, Eugenio Ventimiglia, Giovanalberto Pini, Giorgio Bozzini, Davide Perri","doi":"10.1007/s00345-026-06815-1","DOIUrl":"10.1007/s00345-026-06815-1","url":null,"abstract":"<p><strong>Purpose: </strong>Single-use flexible ureteroscopes (fURSs) differ substantially in optical and mechanical properties, yet comparative evidence remains limited. We performed a multimodal in vitro and clinical assessment of 19 commercially available single-use fURSs to quantify performance variability and examine which device characteristics are associated with surgeon-reported usability.</p><p><strong>Methods: </strong>Each of 19 models was bench-tested for field of view, laser-fiber safety distance, irrigation flow, deflection, image resolution, signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and color discrimination. One surgeon used each device in three separate patients (57 procedures total) and completed a standardized questionnaire after every case; three blinded reviewers scored anonymized intraoperative video. As a secondary analysis, device-level bench metrics were related to patient-level outcomes using a permutation test with correction for multiple comparisons.</p><p><strong>Results: </strong>All domains showed marked variability (resolution 0.447-0.826 lp/mm; baseline deflection 219-312°, lowest 134° with accessories; empty-channel irrigation 27.9-39.0 mL/min; field of view 75-110°). In secondary, exploratory analysis, no bench metric showed an association with surgeon-reported or video-based outcomes surviving correction for multiple comparisons (54 tests, minimum q = 0.20).</p><p><strong>Conclusion: </strong>Contemporary single-use fURSs show substantial heterogeneity, and no single device excelled across every domain. Device selection should weigh several performance characteristics against the intended clinical scenario; whether bench performance predicts surgeon-reported usability remains unresolved and warrants larger, adequately powered studies.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"44 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149075973","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}