World Journal of Urology最新文献

{"title":"The effect of race/ethnicity on systemic chemotherapy in urothelial carcinoma patients exposed to radiotherapy.","authors":"Mario de Angelis, Carolin Siech, Francesco Di Bello, Natali Rodriguez Peñaranda, Jordan A Goyal, Zhe Tian, Nicola Longo, Felix K H Chun, Salvatore Micali, Fred Saad, Shahrokh F Shariat, Letizia Maria Ippolita Jannello, Mattia Longoni, Gennaro Musi, Giorgio Gandaglia, Marco Moschini, Francesco Montorsi, Alberto Briganti, Pierre I Karakiewicz","doi":"10.1007/s00345-025-05767-2","DOIUrl":"10.1007/s00345-025-05767-2","url":null,"abstract":"<p><strong>Introduction: </strong>Based on prospective trials' result, it is unknown whether race/ethnicity affects the magnitude of cancer-specific survival differences after trimodal therapy (TMT) versus external beam radiation therapy alone (EBRT) for urothelial carcinoma for urinary bladder (UCUB). We addressed this knowledge gap.</p><p><strong>Materials and methods: </strong>Within the Surveillance, Epidemiology, and End Results database (2004-2020), we identified patients with cT2-T4aN0M0 UCUB treated with either TMT or EBRT. We focused on the four most prevalent race/ethnicities: Caucasians, Hispanics, African American (AAs) and Asian/Pacific Islanders (APIs). Cumulative incidence plots and multivariable competing risks regression (CRR) models addressed cancer specific mortality (CSM) after additional adjustment for other-cause mortality (OCM) and standard covariates.</p><p><strong>Results: </strong>Of 3249 patients, 2643 (81%) were Caucasians versus 254 (8%) AAs versus 209 (7%) Hispanics versus 143 (4%) APIs. Compared to EBRT, TMT rates were higher in Caucasians (81%) and APIs (81%), lower in AAs (75%) and lowest in Hispanics (69%). In Caucasians, five-year CSM rates were 41.6% after TMT versus 49.0% after EBRT and TMT independently predicted lower CSM (HR: 0.70, p < 0.001). In AAs, Hispanics and APIs, TMT did not predict CSM differences (p = 0.1, 0.2 and p = 0.06, respectively).</p><p><strong>Conclusion: </strong>For Caucasians UCUB patients, TMT is strongly associated with significantly lower CSM. However, this observation cannot be generalized non-Caucasian subgroups, where TMT did not predict lower CSM relative to EBRT.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"43 1","pages":"403"},"PeriodicalIF":2.8,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144529929","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 the PI-QUAL MRI quality score on histopathological up-staging from MRI fusion biopsy to final prostatectomy specimen.","authors":"Maximilian Haack, Mohamad Turkman, Tobias Jorg, Lukas Müller, Gregor Duwe, Lisa Johanna Frey, Maximilian Peter Brandt, Axel Haferkamp, Hendrik Borgmann, Robert Dotzauer","doi":"10.1007/s00345-025-05755-6","DOIUrl":"10.1007/s00345-025-05755-6","url":null,"abstract":"<p><strong>Purpose: </strong>The qualitative heterogeneity of multiparametric MRI (mpMRI) poses significant challenges for the diagnostic pathway of prostate cancer (PCa). The Prostate Imaging Quality Score (PI-QUAL) is a novel tool for the qualitative assessment of mpMRI. Aim of this study was to evaluate the impact of PI-QUAL on consistency of radiological to pathological T-stage.</p><p><strong>Methods: </strong>Patients undergoing MRI-TRUS fusion biopsy and radical prostatectomy (RP) from 01/2016 to 03/2024 were retrospectively included. PI-QUAL was determined by two expert radiologists and categorised: inadequate (1-2), sufficient (3) and optimal (4-5). Primary endpoint was upstaging from locally confined disease in mpMRI (mrT ≤ 2) to advanced in RP-specimen (pT ≥ 3a). Variables were compared using analysis of variance and χ² or Fisher's exact test. Uni- and multivariate binary regression identified independent predictors.</p><p><strong>Results: </strong>Of 349 patients included, 18 had PI-QUAL 1-2, 44 PI-QUAL 3 and 287 PI-QUAL 4-5. Patient characteristics, PI-RADS scores and biopsy counts were balanced between these groups. Upstaging from mrT ≤ 2 to pT ≥ 3a was significantly more frequent in PI-QUAL 1-2 (22.4%) and PI-QUAL 3 (22.7%) compared to PI-QUAL 4-5 (10.8%) (p = 0.031). Suboptimal mpMRI harbours an increased risk of upstaging (HR 2.22; 95% CI 1.05-4.71; p = 0.037). Optimal mpMRI quality independently predicts higher PI-RADS grading (PI-RADS ≥ 4) (HR 2.27; 95% CI 1.02-5.00; p = 0.043).</p><p><strong>Conclusion: </strong>PI-QUAL (≤ 3) significantly influences PI-RADS grading and predicts for upstaging from radiological to pathological staging. In case of suboptimal image quality, repetition of mpMRI should be considered.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"43 1","pages":"404"},"PeriodicalIF":2.8,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12208975/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144529927","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":"Contemporary results of En Bloc holep for large prostates.","authors":"Alexandre Iscaife, Moises Rodríguez Socarrás, Thalita Bento Talizin, Willian Carlos Nahas, Julio Fernandez Del Alamo, Vanesa Cuadros Rivera, Fernando Gómez Sancha, Moisés Rodríguez Socarrás","doi":"10.1007/s00345-025-05765-4","DOIUrl":"https://doi.org/10.1007/s00345-025-05765-4","url":null,"abstract":"<p><strong>Background and purpose: </strong>The aim of this study was to compare patients undergoing En Bloc HoLEP with early apical release and sphincter preservation, accordingly to prostate size regarding perioperative data and postoperative evolution.</p><p><strong>Materials and methods: </strong>754 patients were studied and divided into 2 groups: prostate ≤ 120 g (644 patients) and prostate ≥ 120 g, (110 patients). Surgeries were performed by a single surgeon (Fernando Gómez Sancha) using a 150 W high power Holmium laser (Quanta SpA, Samarate, Italy), The technique was En-Bloc with early apical release and sphincter preservation. Prostate volume, PSA, Q max, IPSS among other parameters were assessed before surgery and 3, 6 and 12 months after the procedure. Urinary incontinence (UI) was defined as any leakage reported by patients; classified by duration (< 1 month, 1-3 months, and > 3 months) and type (urge, stress, or mixed).</p><p><strong>Results: </strong>The mean age was 67.2 years 67.2 years (± 8,4). Enucleation time was longer in the larger prostate group (40.0 vs. 25.0 min, p < 0.0001), as well as morcellation time (13.0 vs. 5.0 min, p < 0.0001). Enucleation (3.1 vs. 1.9 g/min, p < 0.0001) and morcellation efficiency (7.7 vs. 1.5 g/min, p = 0.0015) were higher in the large prostate group. At 6 months the incidence of STUI was extremely low without difference between groups (0.9% vs. 0.15%, p = 0.27).</p><p><strong>Conclusion: </strong>In conclusion, the study shows that the En-Bloc technique with early release and sphincter preservation has excellent continence results and low complication rates even for prostates larger than 120 g. Technical refinement and care with apical enucleation should be one of the fundamental axes of the training and development of surgeons in performing HoLEP, especially in large prostates.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"43 1","pages":"401"},"PeriodicalIF":2.8,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144529926","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":"Novel non-invasive intrarenal pressure monitoring devices in flexible ureteroscopy: an in-vitro comparative study.","authors":"Steffi Kar Kei Yuen, Zixiao Chen, Skyler Yuen, Alex Qinyang Liu, Chi-Ho Leung, Ivan Ching Ho Ko, Chi Kwok Chan, Bhaskar Somani, Thomas Herrmann, Helene Jung, Theodoros Tokas, Stefanie Croghan, Olivier Traxer, Peter Ka Fung Chiu, Ben Chew, Jeremy Yuen Chun Teoh, Vineet Gauhar, Zheng Li, Chi Fai Ng","doi":"10.1007/s00345-025-05761-8","DOIUrl":"10.1007/s00345-025-05761-8","url":null,"abstract":"<p><strong>Purpose: </strong>Intrarenal pressure monitoring is emerging as an important tool in flexible ureteroscopy. Novel non-invasive intrarenal pressure monitoring devices are introduced. We evaluated the pressure readings simultaneously across four novel non-invasive intrarenal pressure monitoring devices against the urodynamic system.</p><p><strong>Materials and methods: </strong>Two IRP monitoring single-use flexible ureteroscopy: LithoVue Elite^™ (Boston Scientific Corporation, Marlborough, MA, USA); ZebraScope^™ (Happiness Works Medical Instruments Co., Ltd, Anhui, China); two intelligent intrarenal system integrated with irrigation and suction via flexible and navigable suction ureteral access sheath: i-MIMERsys^™ (ZSR Biomedical Technology Co., Ltd, Dongguan, China); Tidor^™ (YiGao Medical Technology Co., Ltd, Zhejiang, China) were tested against MMS/Laborie Nexam Pro Urodynamic System (Laborie Medical Technologies Corporation, Portsmouth, USA).</p><p><strong>Results: </strong>The degree of agreement between measurements from urodynamic system and the experimented device was demonstrated by Bland-Altman plots and intraclass correlation coefficients (ICCs). Compared to the urodynamic system, the average difference ± standard deviation of LithoVue Elite™ was 0.26 ± 1.75mmHg; ZebraScope™ 3.22 ± 1.86mHg, i-MIMERsys™ 0.96 ± 2.26mmhg; Tidor™ 1.09 ± 2.57mmHg. Pressure measured by LithoVue Elite™, ZebraScope™, i-MIMERsys™ and Tidor™ to urodynamic system showed excellent ICCs of 0.975 (p < 0.001), 0.915(p = 0.016), 0.955(p < 0.001) and 0.937(p < 0.001) respectively.</p><p><strong>Conclusion: </strong>Pressure recordings from four novel non-invasive intrarenal monitoring devices, namely flexible ureteroscopes-LithoVue Elite^™, ZebraScope^™; and intelligent IRP monitoring systems via flexible and navigable suction ureteral access sheaths - i-MIMERsys^™, Tidor^™. were comparable to that of urodynamic system. This in-vitro study verifies that such non-invasive devices provide reliable data for monitoring intrarenal pressure changes.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"43 1","pages":"402"},"PeriodicalIF":2.8,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12209378/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144529928","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":"Correction to: Pulsed Thulium: YAG laser for the management of Urolithiasis: a systematic review from the EAU section of endourology.","authors":"Panagiotis Kallidonis, Theodoros Spinos, Selcuk Guven, Vasileios Tatanis, Angelis Peteinaris, Evangelos Liatsikos, Olivier Traxer, Bhaskar Somani","doi":"10.1007/s00345-025-05600-w","DOIUrl":"https://doi.org/10.1007/s00345-025-05600-w","url":null,"abstract":"","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"43 1","pages":"400"},"PeriodicalIF":2.8,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144508661","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 comparative meta-analysis on bilateral same-session and unilateral retrograde intrarenal surgery for kidney stones.","authors":"Henrique L Lepine, Fabio Carvalho Vicentini, Alexandre Danilovic, Wilson R Molina, Lucas B Vergamini, Giovanni S Marchini, Fabio C M Torricelli, Carlos A Batagello, William C Nahas, Eduardo Mazzucchi","doi":"10.1007/s00345-025-05673-7","DOIUrl":"10.1007/s00345-025-05673-7","url":null,"abstract":"<p><strong>Purpose: </strong>To compare the safety and efficacy of bilateral same-session retrograde intrarenal surgery (B-RIRS) and unilateral retrograde intrarenal surgery (U-RIRS) for treating renal stones, focusing on stone-free rates (SFR), complications, retreatment rates, operative time, and hospital stay.</p><p><strong>Materials and methods: </strong>A systematic review was conducted following PRISMA guidelines. Seven comparative studies met the inclusion criteria. Primary outcomes included SFR and complications (minor: Clavien-Dindo I-II; major: III-V); secondary outcomes comprised retreatment rates, operative time, and hospital stay. Random-effects models were used to generate pooled odds ratios (OR) for categorical outcomes and mean differences (MD) for continuous variables. Subgroup analyses compared adult-only populations with elderly-inclusive cohorts.</p><p><strong>Results: </strong>A total of 1,218 patients from seven studies were analyzed. Overall, B-RIRS showed no statistically significant difference in SFR (OR 0.73; 95% CI, 0.43-1.23) compared to U-RIRS, yet subgroup analyses indicated that elderly populations tended to have lower SFR with bilateral procedures. B-RIRS was associated with higher minor (OR 2.55; 95% CI, 1.33-4.90) and major complications (OR 3.16; 95% CI, 1.38-7.24), increased retreatment needs (OR 2.46; 95% CI, 1.48-4.08), and longer operative times (MD 24.99 min; 95% CI, 17.48-32.50). Hospital stay was similar between groups.</p><p><strong>Conclusions: </strong>Although B-RIRS facilitates management by reducing multiple anesthesia exposures and maintaining similar SFRs, it appears to be linked with increased complication and retreatment rates, especially in elderly or comorbidity-heavy populations. Carefully selected patients may see more comparable complications. Future randomized trials are needed to confirm these subgroup findings, standardize stone-free definitions, and refine selection criteria for bilateral same-session RIRS.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"43 1","pages":"394"},"PeriodicalIF":2.8,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144498192","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":"Non-conventional diagnostic tools for lower urinary tract symptoms and bladder outlet obstruction in men: a perspective review.","authors":"Minore Antonio, Cacciatore Loris, Secco Silvia, Gacci Mauro, Thomas R W Herrmann, De Nunzio Cosimo, Kuang Wayne, Cornu Jean Nicolas, Cindolo Luca","doi":"10.1007/s00345-025-05777-0","DOIUrl":"https://doi.org/10.1007/s00345-025-05777-0","url":null,"abstract":"<p><p>Introduction Assessing male lower urinary tract symptoms (LUTS) due to Benign outlet obstruction (BOO) remains a challenge in urology due to the limitations of conventional diagnostic methods, which are often invasive, time-consuming, and inefficient. Objective Given these limitations, this review explores emerging non-conventional diagnostic approaches for evaluating benign male LUTS. Methods: A broad literature search was performed in November 2024 regarding the assessment of male LUTS exploiting tools different than UDS. The search strategy was implemented across Scopus, PubMed, and Web of Science.Results Ultrasonography, along with surrogate diagnostic methods such as detrusor wall thickness and intravesical prostatic protrusion, remains a key tool in the outpatient setting. Additionally, alternative methods, including near-infrared spectroscopy (NIRS), condom catheter testing, and penile cuff pressure analysis, are being investigated with the latter, showing potential as a non-invasive alternative to urodynamics, pending further future validations. Biomarkers, such as PSA, adiponectin, neural growth factor and miRNA are gaining interest in the scientific community as additional diagnostic frameworks to enhance diagnostic accuracy. Moreover, advancements in computational modeling and artificial intelligence (AI) are poised to revolutionize LUTS diagnostics. Computational modeling, though still in its early stages, offers valuable insights into anatomical and flow dynamics, providing objective parameters for assessing obstruction severity and the need for surgical intervention. Although it has not yet integrated in the current clinical practice, AI, in particular, may offer the potential to integrate diverse data sources, including diagnostic tests and patient-reported symptoms, to create more reliable predictive models for bladder outlet obstruction. Conclusion Given the rapid development and the large economic interest of machine learning, it is expected to play a pivotal role in the future of LUTS assessment, offering faster and more accurate diagnostic tools.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"43 1","pages":"395"},"PeriodicalIF":2.8,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144498197","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":"From laser-on time to lithotripsy duration: improving the prediction of lithotripsy duration with 'Kidney Stone Calculator' using artificial intelligence.","authors":"Frédéric Panthier, Laurent Berthe, Chady Ghnatios, Francisco Chinesta, Stessy Kutchukian, Steeve Doizi, François Audenet, Laurent Yonneau, Thierry Lebret, Marc-Olivier Timsit, Arnaud Mejean, Luigi Candela, Catalina Solano, Mariela Corrales, Marie Chicaud, Olivier Traxer, Daron Smith","doi":"10.1007/s00345-025-05771-6","DOIUrl":"10.1007/s00345-025-05771-6","url":null,"abstract":"<p><strong>Introduction: </strong>\"Kidney Stone Calculator\" (KSC) helps to plan flexible ureteroscopy, providing the stone volume (SV) and an estimated duration of laser lithotripsy (eLD). eLD is calculated from in vitro ablation rates and SV. KSC's accuracy has been demonstrated with a mean difference between eLD and effective LD (EfLD) of 18.8%. We aimed to reduce the eLD-efLD difference using Machine Learning (ML).</p><p><strong>Methods: </strong>From the prospective multicenter KSC database, demographic and peri-operative data were anonymously extracted: SV, stone location, maximum density, anatomy, surgical expertise, ureteral access sheath, basket use, laser source, fiber diameter and settings, eLD and efLD. After normalization and splitting (training (80%), test (20%)), significant variables influencing the difference between eLD and efLD were selected through multiple linear regression (MLR). Six types of ML models were subsequently evaluated to minimize the mean absolute error (MAE) between eLD and efLD on the test group.</p><p><strong>Results: </strong>125 patients were included. After normalization and MLR, MAE were significantly influenced by 14 variables (including diverticulum location, surgical expertise, laser sources, laser fiber diameters, 5 Hz frequency, 1.5 J pulse energy and eLD). eLD had the greatest positive impact on the eLD-efLD difference (2.45 (2.16-2.73), p < 0.0001)). Above the various tested ML models, the Bayesian \"Automatic-Relevance-Determination\" and Dense Neural Networks respectively presented the lowest and highest MAE on the test group (3.9% and 6.8%). Results did not differ among models overall (p = 0.93) and two by two.</p><p><strong>Conclusion: </strong>The difference between KSC's eLD and efLD can be five-fold reduced using ML and Artificial Intelligence, including clinically impactful factors such as the surgical technique or expertise. A clinical inference could help to externally validate our findings.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"43 1","pages":"396"},"PeriodicalIF":2.8,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144498196","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":"Comparing ventral and dorsal oral mucosal graft urethroplasty in female urethral stricture: a systematic review and meta-analysis.","authors":"Mazhar Ortac, M Firat Ozervarli, Rifat Burak Ergul, Arda Tunc Aydinoglu, Mevlut Melih Bicer, Teresa Olsen Ekerhult, Senol Tonyali, Assoc Prof","doi":"10.1007/s00345-025-05773-4","DOIUrl":"10.1007/s00345-025-05773-4","url":null,"abstract":"<p><strong>Purpose: </strong>Reconstructive surgical options have become an alternative for female urethral stricture. Dorsal and ventral methods using oral mucosa grafts have been described, but their superiority over each other has not been evaluated. In this meta-analysis, the outcomes of dorsal and ventral techniques with oral mucosa graft in female urethroplasty have been compared.</p><p><strong>Material and method: </strong>A systematic search of Pubmed, Scopus and Web of Science databases was performed according to the Preferred Reporting Items For Systematic Review And Meta-Analysis statement. Manuscripts published until February 2025 that reported the use of dorsal or ventral surgical approaches with oral mucosa grafts in female urethroplasty included. Success, determined based on the recurrence rate, was analyzed and compared between both groups. Complications were presented in both groups to evaluate the safety of the surgical technique.</p><p><strong>Results: </strong>A total of 320 studies were identified, with 25 meeting the inclusion criteria. The meta-analysis, including four comparative cohort studies, showed no significant difference in surgical success between the dorsal (62/69 patients) and ventral (93/103 patients) techniques (OR = 0.84, 95% CI: 0.30-2.36, p = 0.74). In the pooled analysis combining both comparative and non-comparative studies, the success rates for the dorsal and ventral techniques were 92.1% (95% CI: 89.1-95.1) and 95.5% (95% CI: 92.8-98.2), respectively, with no significant heterogeneity. A total of 4 cases of stress urinary incontinence complications were reported in the ventral approach, while 2 cases were reported using the dorsal approach. The majority of the studies (21 out of 25) provided Level 4 evidence, with only two randomized controlled trials reaching Level 2.</p><p><strong>Conclusion: </strong>This meta-analysis confirms that both dorsal and ventral approaches are effective for treating female urethral stricture, with high success rates. There was no statistically significant difference in success rates between the ventral and dorsal approaches. Surgical approach selection should depend on patient factors and surgeon expertise to achieve optimal outcomes.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"43 1","pages":"397"},"PeriodicalIF":2.8,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12202565/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144498194","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":"Single-use versus reusable flexible ureterorenoscopes with FANS: a multicenter propensity-matched analysis of outcomes in a large series from the EAU-Endourology Section and FANS Collaborative Group.","authors":"Carlo Giulioni, Daniele Castellani, Federico Falsetti, Naeem Bhojani, Ben Hall Chew, Steffi Kar Kei Yuen, Anil Shrestha, Pablo Contreras, Sundaram Palaniappan, Tsung Wen Chong, Angelo Cafarelli, Wei Zhu, Guohua Zeng, Yi Tan Quan, Jia-Lun Kwok, Khi Yung Fong, Amelia Pietropaolo, Thomas Herrmann, Olivier Traxer, Bhaskar Kumar Somani, Vineet Gauhar","doi":"10.1007/s00345-025-05769-0","DOIUrl":"10.1007/s00345-025-05769-0","url":null,"abstract":"<p><strong>Objective: </strong>This study compares the clinical outcomes of single-use and reusable flexible ureterorenoscopes (fURS) in retrograde intrarenal surgery (RIRS) with flexible and navigable suction access sheath (FANS).</p><p><strong>Methods: </strong>A multicenter prospective analysis included 704 patients who underwent RIRS with FANS between July 2023 and March 2024. Patients were stratified into two groups: those treated with single-use fURS (Group 1, n = 263) and those with reusable fURS (Group 2, n = 441). Propensity score matching (PSM) was used to reduce confounding in the statistical comparisons. The primary outcomes were stone-free rate (SFR) and complication rates, assessed through pre- and postoperative non-contrast computed tomography (NCCT) scans. Statistical analyses were performed using R software, with p < 0.05 considered significant.</p><p><strong>Results: </strong>After propensity score matching, 226 patients per group were well-balanced across baseline characteristics (ASMD < 0.1). Group 1 was associated with shorter laser (p = 0.001) and operative times (p = 0.048), and more frequent use of larger sheaths (p < 0.001). Complication rates were low and comparable between groups. Group 1 achieved higher 100% stone free status (65.5% vs. 55.8%, p = 0.012), though overall stone-free rates were similar. Reintervention rates did not differ significantly. Lasing and exit strategy did not differ between the two groups. On multivariate analysis, single-use scope use (OR 1.659, p = 0.018) and 10-12 Fr UAS (OR 1.749, p = 0.043) were significantly associated with complete stone clearance.</p><p><strong>Conclusion: </strong>Our study findings indicate that FANS is a safe and effective technique irrespective of the type of scope used. However, as FANS offers the potential to achieve a truly 100% stone-free status, this outcome is more likely when using single-use scopes in combination with 10/12 sheaths. Given that stone volume is a significant determinant of stone-free outcomes, surgeons may consider selecting the scope type to tailor the procedure according to stone complexity.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"43 1","pages":"399"},"PeriodicalIF":2.8,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144498200","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}