Minerva Urology and Nephrology最新文献

{"title":"Office-based transperineal laser ablation in patients with large prostates (≥80 mL): real-world evidence of safety and efficacy from a prospective single center cohort.","authors":"Paolo Polverino, Luisa Moscardi, Mattia Lo Re, Corso Caneschi, Giulio R Resta, Beatrice Giustozzi, Francesca Conte, Salvatore Granata, Alessio Pecoraro, Riccardo Campi, Vincenzo Li Marzi, Agostino Tuccio, Sergio Serni, Francesco Sessa","doi":"10.23736/S2724-6051.26.06687-5","DOIUrl":"https://doi.org/10.23736/S2724-6051.26.06687-5","url":null,"abstract":"<p><p>Transperineal laser ablation (TPLA) is emerging as a minimally invasive, office-based treatment for benign prostatic obstruction, but there is still a lack of evidence regarding its results in large prostates. The aim of this work was to evaluate safety, feasibility, and functional outcomes of TPLA in patients with prostate volume ≥80 mL. Data from consecutive patients undergoing TPLA April 2021 and February 2025 were prospectively collected in a dedicated institutional database, queried to select those patients with a prostate volume ≥80 mL who underwent TPLA. All procedures were performed under local anesthesia in an outpatient setting. A total of 234 patients underwent TPLA during the study period. Of these, 43 met the inclusion criteria for prostate volume and were included in the analysis. At the time of the surgery, 5 patients (12%) had an indwelling catheter and 36 (84%) were on medical therapy for BPO. Preoperative median prostate volume was 96 mL. At a median 12-month follow-up, uroflowmetry and symptom scores improved significantly, with preserved sexual and ejaculatory function. No major complications occurred. The catheter was successfully removed in 3 out of 5 (60%) patients with an indwelling catheter before TPLA. A total of four patients (9%) required additional surgical intervention during follow-up time. Our findings suggest that TPLA may be a safe and effective alternative to conventional surgery even in large prostates, warranting further validation through larger and comparative studies.</p>","PeriodicalId":53228,"journal":{"name":"Minerva Urology and Nephrology","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147595993","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":"Effectiveness of hyaluronic acid in the treatment of Peyronie's disease in the light of the European Urology Guidelines: the real-world experience.","authors":"Alessandro Zucchi, Giuseppe Maiolino, Matteo Pacini, Giada Macrì, Juan I Martínez Salamanca, Giuseppe Dachille, Antonio Vitarelli, Vincenzo Ficarra, Antonio L Pastore, Luca Lepri, Carlo Porrozzi, Riccardo Bartoletti, Fabrizio Scroppo","doi":"10.23736/S2724-6051.25.06662-5","DOIUrl":"10.23736/S2724-6051.25.06662-5","url":null,"abstract":"<p><strong>Background: </strong>Peyronie's disease (PD) is a progressive fibrotic disorder of the tunica albuginea that impairs penile anatomy, sexual function, and quality of life. With no approved pharmacological treatments in Europe after the withdrawal of collagenase Clostridium histolyticum (CCH), intralesional hyaluronic acid (HA) has emerged as a potential option. This study aims to assess the clinical effectiveness of HA in PD, focusing on patient-reported outcomes via the Peyronie's Disease Questionnaire (PDQ).</p><p><strong>Methods: </strong>This prospective observational study included patients treated with weekly intralesional HA injections for 8 weeks, combined with penile modeling and daily tadalafil. Inclusion required a penile curvature >30° and at least one episode of penetrative intercourse within the past 3 months. Penile curvature, IIEF-5, and PDQ scores were assessed at baseline and after 3 months.</p><p><strong>Results: </strong>Sixty-six patients were included. Total PDQ scores improved from 61.5 (50.0-67.0) to 40.0 (26.8-49.0; P<0.001), with a mean reduction of -19.9±9.7. Specifically, all three domains of the PDQ questionnaire (Penile Pain, Penile Deformity, and Symptom Bother) showed a significant improvement (P<0.001). No adverse events were recorded.</p><p><strong>Conclusions: </strong>Intralesional HA injections are safe and effective in improving patient's reported symptoms and subsequently quality of life in PD patients. This therapy may represent a valuable alternative in real-world clinical practice, especially in Europe where other pharmacological options are lacking.</p>","PeriodicalId":53228,"journal":{"name":"Minerva Urology and Nephrology","volume":" ","pages":"275-282"},"PeriodicalIF":4.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145783617","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":"Real-world comparison of the effectiveness and safety of immune-based combinations in elderly patients with advanced renal cell carcinoma (ARON-1 study).","authors":"Marco Maruzzo, Alexandr Poprach, Sebastiano Buti, Aristotelis Bamias, Roubini Zakopoulou, Ugo DE Giorgi, Jakub Kucharz, Luigi Formisano, Thomas Buttner, Paolo A Zucali, Haoran Li, Lorena Incorvaia, Ray M Kopp, Carlo Messina, Jindrich Kopecky, Giuseppe Fornarini, Johannes Landmesser, Sara E Rebuzzi, Cecilia Nasso, Andre P Fay, Dipen Bhuva, Alvaro Pinto, Tomas Buchler, Renate Pichler, Ravindran Kanesvaran, Andrey Soares, Francesco Massari, Fernando S Monteiro, Idemar A Dos Santos Filho, Camillo Porta, Umberto Basso, Matteo Santoni","doi":"10.23736/S2724-6051.25.06360-8","DOIUrl":"https://doi.org/10.23736/S2724-6051.25.06360-8","url":null,"abstract":"<p><strong>Background: </strong>Nowadays, systemic treatment with immune-based combinations for metastatic renal cell carcinoma (mRCC) is the gold standard. However, the benefit of these treatments in patients aged ≥70 years is uncertain. Thus, we evaluate the effectiveness and safety of first-line immune-based combinations in elderly patients with mRCC.</p><p><strong>Methods: </strong>We retrospectively collected data from mRCC patients who were treated with immune-based combinations in first-line setting at 75 hospitals from 23 countries. Patients were assessed for overall survival (OS), overall response rate (ORR) and severe adverse events (SAEs). The statistical analysis encompassed the Fisher's Exact Test, the Kaplan-Meier methodology, the log-rank test, as well as univariate and multivariate Cox proportional hazards regression models.</p><p><strong>Results: </strong>Of the 1990 mRCC patients included in this analysis, 739 patients were aged ≥70 years. Median OS was 41 months for patients aged <70 years and 30.1 months in patients aged ≥71 years (P<0.001). The age was a prognostic factor in both univariate and multivariate analysis. There was no difference in ORR (52% versus 44%, P=0.262). There was no statistical difference in incidence SAEs as well as dose reductions or treatment discontinuation between elderly and young patients.</p><p><strong>Conclusions: </strong>This large real-world study with mRCC patients substantiates the effectiveness and safety of first-line immune-based combination treatments in elderly patients. Nonetheless, this population has a lower survival in comparison to younger patients.</p>","PeriodicalId":53228,"journal":{"name":"Minerva Urology and Nephrology","volume":"78 2","pages":"210-221"},"PeriodicalIF":4.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147789028","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 monorchid patients with previous testis cancer: the role of frozen sections and the real possibility of testis sparing surgery in a large retrospective series.","authors":"Sebastiano Nazzani, Ruggero Darisi, Mario Catanzaro, Tullio Torelli, Alberto Macchi, Silvia Stagni, Antonio Tesone, Carlo Silvani, Matteo Facco, Susanna Garbagnati, Francesco P Costa, Rodolfo Lanocita, Tommaso Cascella, Melanie Claps, Patrizia Giannatempo, Matteo Zimatore, Marco Barella, Biagio Paolini, Davide Biasoni, Barbara Avuzzi, Emanuele Montanari, Nicola Nicolai","doi":"10.23736/S2724-6051.25.06301-3","DOIUrl":"10.23736/S2724-6051.25.06301-3","url":null,"abstract":"<p><strong>Background: </strong>The role of surgical exploration and frozen sections (FSs) in monorchid patients with testicular nodules is still not well defined. We tested the role of surgical exploration and FSs in monorchid patients and the impact on the chance of testis sparing surgery (TSS).</p><p><strong>Methods: </strong>We identified 81 consecutive monorchid patients with testicular nodules between 2008 and 2024 candidates to surgical exploration and FSs. The statistical significance of differences in medians and proportions was tested with the Wilcoxon rank sum and Chi-square tests. Multivariable logistic regression models (MLRMs) were used.</p><p><strong>Results: </strong>Testicular lesions number was available in 61 patients and was one in 35 (57.4%) of those, two in 15 (24.6%), three in 7 (11.5%) and more than three in 4 (6.5%). Median larger lesion size was 12 mm (IQR 9-20 mm). FSs were performed in 59 (73%) patients and showed germ-cell tumor (GCT) in 53 (65.4%). Orchidectomy was performed in 68 patients (84%). In 55 of 56 patients (98.3%) definitive histology confirmed FSs. Thirteen (16%) had TSS including 7 patients with seminomatous GCT, of those none had disease relapse at follow-up. At MLRMs older age was associated with lower probability of GCT (Odds Ratio 0.91, Confidence Interval 0.84-0.99, P value 0.03).</p><p><strong>Conclusions: </strong>FSs are feasible and reliable in monorchid patients following a history of GCT. Nonetheless, TSS is rarely performed, as most of these patients actually have GCT. The few ones who had TSS had excellent oncological results.</p>","PeriodicalId":53228,"journal":{"name":"Minerva Urology and Nephrology","volume":" ","pages":"203-209"},"PeriodicalIF":4.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146054965","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":"Utility of the Guy's Stone Score on real world outcomes of suction mini-PCNL in 1527 adult patients with normal collecting system anatomy. A prospective multicenter study from the EAU section of Endourology and Asian Urological Society of Endoluminal Surgery and Technology collaboration.","authors":"Vineet Gauhar, Steffi K Yuen, Marek Zawadzki, Ee J Lim, Takaki Innoue, Kazumi Taguchi, Khi Y Fong, Jaisukh Kalathia, Gopal R Tak, Mohamed A Lakmichi, Yadgar A Shwani, Karl Tan, Chinnakhet Ketsuwan, Wissam Kamal, Nitesh Kumar, Amish Mehta, Chin T Heng, Mahmoud Laymon, Mohamed Omar, Rajiv H Kalbit, Chu-Ann Chai, Vaddi C Mohan, Nariman Gadzhiev, Vigen Malkhasyan, Marcos Cepeda Delgado, Abu Baker, Morshed Salah, Guohua Zeng, Kemal Sarica, Carlo Giulioni, Thomas R Herrmann, Bhaskar K Somani, Daniele Castellani","doi":"10.23736/S2724-6051.25.06632-7","DOIUrl":"10.23736/S2724-6051.25.06632-7","url":null,"abstract":"<p><strong>Background: </strong>Guy's Stone Score (GSS) has proven to be the most reliable and valuable tool for predicting the success rate and potential complications after percutaneous nephrolithotomy (PCNL) This study aims to assess the impact of GSS on perioperative outcomes, complications and stone-free rates (SFR) in adult patients undergoing suction mini-percutaneous (SM)-PCNL for kidney stone(s).</p><p><strong>Methods: </strong>Data from 1527 adult patients with normal renal anatomy who underwent prone or supine SM-PCNL across 21 countries were analyzed. Patients were stratified by GSS (1-4) based on preoperative CT imaging. The primary outcome was 30-day SFR, assessed by non-contrast CT, defined as zero fragment. Secondary outcomes included peri- and postoperative complications. Multivariate analysis identified predictors of SFR and complications.</p><p><strong>Results: </strong>Despite increased complexity, SM-PCNL was frequently utilized for GSS 3 and 4 cases, often requiring multiple tracts and advanced access techniques. Complication rates, including bleeding and infectious events, were low but significantly higher in GSS 3 and 4 groups. SFR decreased with increasing GSS, with GSS 1 achieving the highest rates and GSS 4 the lowest. Multivariate analysis identified stone volume (OR 0.96), and GSS 2 (OR 0.53), 3 (OR 0.27) and 4 (OR 0.46) as independent predictors of lower odds of zero residual fragment compared to GSS 1, while sheath size 16-18 Fr (OR 1.72) and <18 Fr (OR 4.48) with higher odds compared to sheath size <16 Fr. GSS 2 (OR 2.22), 3 (OR 4.97) and 4 (OR 4.01) compared to GSS 1 and mechanical lithotripsy (OR 1.65) were associated with higher odds of all complications compared to laser lithotripsy.</p><p><strong>Conclusions: </strong>GSS effectively predicts perioperative outcomes following suction mini-PCNL. Increasing stone complexity is associated with reduced SFR and higher complication rates, underscoring the importance of preoperative risk stratification, tailored surgical planning and a proper informed consent for the patient in complex cases.</p>","PeriodicalId":53228,"journal":{"name":"Minerva Urology and Nephrology","volume":" ","pages":"265-274"},"PeriodicalIF":4.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146004643","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":"MRI prostate tumor volume predicts the need for systematic biopsies in patients undergoing MRI-targeted biopsy.","authors":"Hanna Zurl, Stefan Embacher, Helmut Schöllnast, Emina Talakic, Stephanie Schöpfer-Schwab, Klara Pohl, Lukas Scheipner, Samra Jasarevic, Julia Altziebler, Anna Mangge, Sebastian Mannweiler, Jakob Riedl, Uros Bele, Conrad Leitsmann, Marianne Leitsmann, Georg Hutterer, Sascha Ahyai, Johannes Mischinger","doi":"10.23736/S2724-6051.25.06375-X","DOIUrl":"10.23736/S2724-6051.25.06375-X","url":null,"abstract":"<p><strong>Background: </strong>Combined transrectal mpMRI-TRUS targeted (TB) and systematic biopsy (SB) is widely used to diagnose prostate cancer (PCa). However, SB may be omitted in a subset of patients with minimal risk of missing clinically significant prostate cancer (csPCa) in TB alone. We aimed to identify clinical characteristics predicting the need for SB in men undergoing TB.</p><p><strong>Methods: </strong>In this retrospective cohort study, 879 patients underwent combined TB and SB. Cases where csPCa was missed by TB but detected by SB were identified. Logistic regression analysis was used to identify clinical predictors for SB necessity, including digital rectal examination, prior negative biopsy, age, prostate-specific antigen (PSA), prostate volume, PSA density, mpMRI tumor volume (MTV), number of mpMRI lesions, PI-RADS score, and mpMRI tesla.</p><p><strong>Results: </strong>In 80 (9.1%) cases csPCa was missed by TB and detected by SB only. Median MTV was 0.75 cm³ (IQR 0.43-1.41 cm³). Multivariable logistic regression analysis revealed MTV as the only significant predictor of csPCa missed by TB alone (OR=0.52, 95% CI 0.36, 0.75, P<0.001). A larger MTV was inversely associated with the risk of missing csPCa in TB alone. In patients with an MTV greater than 1.36 cm³, the rate of missing csPCa with TB alone was ≤5%.</p><p><strong>Conclusions: </strong>MTV is a promising predictor to identify patients who may not require a concomitant SB when undergoing TB. However, this finding needs to be validated in external cohorts before being applied in clinical practice.</p>","PeriodicalId":53228,"journal":{"name":"Minerva Urology and Nephrology","volume":" ","pages":"222-231"},"PeriodicalIF":4.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146004648","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":"Evolution of survival outcomes in robot-assisted radical cystectomy over 20 years of experience in a high-volume tertiary robotic center.","authors":"Stefano Resca, Simone Morra, Nicola Frego, Sara Tamburini, Marco Ticonosco, Alessandro Pissavini, Andrea N Mourullo, Francesco Barletta, Edward Lambert, Frederiek D'Hondt, Ruben DE Groote, Geert DE Naeyer, Alexandre Mottrie","doi":"10.23736/S2724-6051.26.06722-4","DOIUrl":"https://doi.org/10.23736/S2724-6051.26.06722-4","url":null,"abstract":"<p><strong>Background: </strong>Radical cystectomy (RC) is the gold standard for muscle-invasive and recurrent high-risk non-muscle-invasive bladder cancer (BCa). Over time, robot-assisted radical cystectomy (RARC) has gained adoption. Despite technological advancements, survival differences may persist between patients treated in earlier versus recent years. This study examines temporal variations in overall survival (OS) among patients undergoing robotic-assisted radical cystectomy (RARC) at a high-volume tertiary robotic center, comparing a historical cohort (2003-2016) with a contemporary one (2017-2024).</p><p><strong>Methods: </strong>Data from patients undergoing RARC at AZORG Hospital (Aalst, Belgium) between July 2003 and March 2024 were analyzed. Three experienced surgeons performed all procedures. Baseline characteristics were compared, Kaplan-Meier plots illustrated OS, and Cox regression models evaluated overall mortality (OM). An 18-month landmark analysis minimized immortal time bias.</p><p><strong>Results: </strong>Overall, 358 BCa patients underwent RARC (53% historical vs. 47% contemporary). The 3-year OS was 85% for the historical cohort vs. 93% for the contemporary cohort (P=0.001). Multivariable Cox regression showed that treatment in the contemporary cohort was an independent predictor of lower OM (hazard ratio [HR]: 0.52, 95% CI: 0.34-0.83; P=0.006), with further reduction after the 18-month landmark analysis (HR: 0.42, 95% CI: 0.19-0.92; P=0.03). Higher pathological T stage (pT3-4) was associated with increased OM before (HR: 3.9, 95% CI: 2.19-6.95; P<0.001) and after landmark analysis (HR: 2.25, 95% CI: 1.08-4.68; P=0.03). Grade 3-4 Clavien-Dindo complications predicted higher OM before (HR: 2.02, 95% CI: 1.27-3.22; P=0.003), but not after landmark analysis (HR: 2.04; 95% CI: 0.99-4.18; P=0.052).</p><p><strong>Conclusions: </strong>Patients treated between 2017-2024 had significantly lower OM, with a 50% reduction in mortality risk compared to 2003-2016. Advancements in surgical techniques and perioperative care likely contributed to improved OS. However, pathological T stage remained a strong predictor of OM, highlighting the need for enhanced early detection and disease management despite technological progress.</p>","PeriodicalId":53228,"journal":{"name":"Minerva Urology and Nephrology","volume":"78 2","pages":"249-256"},"PeriodicalIF":4.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147788824","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":"Pharmacology, efficacy and safety of different extracts of Serenoa repens in patients with lower urinary tract symptoms and benign prostatic hyperplasia: a narrative review.","authors":"Cosimo DE Nunzio, Riccardo Lombardo, Antonio Franco, Beatrice Turchi, Antonio Cicione, Mauro Gacci, Stavros Gravas","doi":"10.23736/S2724-6051.26.06657-7","DOIUrl":"https://doi.org/10.23736/S2724-6051.26.06657-7","url":null,"abstract":"<p><p>Aim of this review is to evaluate the pharmacological efficacy and safety of Serenoa repens extracts in managing lower urinary tract symptoms (LUTS) and benign prostatic hyperplasia (BPH). Using PubMed, Web of Science, and the Cochrane database, we identified studies published until November 2023 reporting effect of Serenoa repens extracts on LUTS and BPH. All studies were included in the literature search. The most relevant studies were selected to identify the effects of different extracts of serenoa repens in terms of pharmacology, efficacy and safety. Hexanic extract of Serenoa repens (HESr), presents important anti-inflammatory, antiproliferative, and antiandrogenic activities proven through various in vitro, in vivo, and clinical trials. The current phytotherapeutic landscape is very heterogeneous and limited by the lack of a regulatory framework for herbal substances. There is a clear disparity in the qualitative and quantitative composition of extracts due to varied extractive processes, affecting the therapeutic efficacy. Several studies (prospective randomized clinical trials) demonstrated the clinical efficacy of HESr compared to placebo and other pharmacological treatments. Particularly, HESr improves nocturia and Qmax. Other extraction techniques, such as alcoholic and CO<inf>2</inf> need further RCT to better define their efficacy. The review identifies the critical role of Serenoa repens extract in managing LUTS in patients with BPH. Particularly the evidence suggests significant in vitro and in vivo differences in terms of inflammation reduction, symptoms relief and flow improvement depending on the extraction technique.</p>","PeriodicalId":53228,"journal":{"name":"Minerva Urology and Nephrology","volume":"78 2","pages":"177-190"},"PeriodicalIF":4.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147788994","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":"Soft ureteral stents significantly reduce stent-related symptoms compared to firm ureteral stents: a prospective, randomized trial.","authors":"Orel Hemo, Asaf Shvero, Dorit E Zilberman, Oleksander Chepeliuk, Zohar Dotan, Nir Kleinmann","doi":"10.23736/S2724-6051.25.06622-4","DOIUrl":"10.23736/S2724-6051.25.06622-4","url":null,"abstract":"<p><strong>Background: </strong>Double-J stents are commonly inserted following ureteroscopy and stone lithotripsy, potentially leading to various urinary and pain-related symptoms and affecting patients' quality of life. This study aimed to compare the impact of soft and firm silicone stents on stent-related symptoms in patients undergoing ureteroscopy and stone lithotripsy.</p><p><strong>Methods: </strong>After receiving institutional ethical committee approval (SMC 0119-23), we conducted a prospective, randomized, single-blinded trial between 2023-2024. Patients undergoing ureteroscopy and stone lithotripsy were randomized into two groups: those receiving a soft polymer stent (Universa^®, Cook Medical, Bloomington, IN, USA) or a firm polymer stent (Percuflex^®, Boston Scientific, Marlborough, MA, USA). Symptoms were assessed using the Ureteral Stent Symptoms questionnaire (USSQ), completed upon stent removal, 14 days postoperatively. The primary outcome was the USSQ index score, with secondary outcomes including individual USSQ domain scores.</p><p><strong>Results: </strong>A total of 120 patients completed the questionnaire. The soft-stent group (N.=60) demonstrated significantly lower USSQ index scores (26 vs. 73, P<0.001) and improved outcomes across all USSQ sub-domains (P<0.001) compared to the firm-stent group. A multiple regression model confirmed that using firm stent material independently resulted in higher USSQ index scores (P<0.001) relative to soft stent. Intraoperative and postoperative complication rates were similar between groups.</p><p><strong>Conclusions: </strong>Using soft ureteral stents results in fewer stent-related symptoms compared to firm stents, offering superior quality of life while maintaining a comparable safety profile. Based on these findings, when placing a ureteral stent following ureteroscopy and stone lithotripsy, a soft stent is recommended.</p>","PeriodicalId":53228,"journal":{"name":"Minerva Urology and Nephrology","volume":" ","pages":"257-264"},"PeriodicalIF":4.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146108504","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":"Detrimental effect of delayed or incomplete BCG protocols administration after trans-urethral tumor resection in patients with non-muscle-invasive bladder cancer: a systematic review.","authors":"Ettore DI Trapani, Arturo Lo Giudice, Elio Mazzone, Paolo Dell'oglio, Gabriele Sorce, Stefano Luzzago, Francesco A Mistretta, Giovanni LA Croce, Mattia Piccinelli, Dario DI Trapani, Marco Moschini, Antonio Galfano, Francesco Montorsi, Alberto Briganti, Firas Abdollah, Ottavio DE Cobelli, Gennaro Musi","doi":"10.23736/S2724-6051.26.06594-8","DOIUrl":"https://doi.org/10.23736/S2724-6051.26.06594-8","url":null,"abstract":"<p><strong>Introduction: </strong>Bacillus Calmette-Guérin (BCG) immunotherapy remains the standard treatment for high-risk non-muscle-invasive bladder cancer (NMIBC). While the European Association of Urology (EAU) guidelines recommend initiating BCG treatment no later than 4-6 weeks following transurethral resection of bladder tumors (TURBT), delays in BCG administration are not uncommon due to factors such as pathological assessment timelines, patient-related issues, healthcare system limitations, and drug shortages. This systematic review aims to evaluate the impact of delayed BCG therapy or unconventional schedules on oncological outcomes, trying to establish the best treatment option for these patients.</p><p><strong>Evidence acquisition: </strong>A comprehensive literature search was conducted across multiple databases (PubMed, Scopus, Web of Science) for studies published from January 2010 to the present. After screening 262 publications, relevant prospective and retrospective studies, systematic reviews, and meta-analyses were included.</p><p><strong>Evidence synthesis: </strong>We retrieved 14 manuscripts evaluating different BCG schedule or doses. Only two papers specifically referred to the delay in the treatment of high risk NMIBC. The findings highlight that the delays in initiating the BCG therapy beyond 6 weeks are associated with worse recurrence-free survival (RFS), progression-free survival (PFS), and cancer-specific survival (CSS) rates. However, evidence on the progression to MIBC or metastatic disease remains inconclusive, with only a few studies suggesting a potential impact. Despite these delays, even reduced dose or shortened BCG regimens appear to offer some level of protection against disease progression.</p><p><strong>Conclusions: </strong>This review emphasizes the importance of adhering to standard BCG treatment schedules to minimize the risk of recurrence and suggests that, in cases of unavoidable delay, strict endoscopic follow-up is crucial and an optimal treatment in case of cancer relapse must be offered. Further prospective studies are needed to conclusively determine the long-term effects of delayed therapy.</p>","PeriodicalId":53228,"journal":{"name":"Minerva Urology and Nephrology","volume":"78 2","pages":"170-176"},"PeriodicalIF":4.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147788765","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}