Minerva Urology and Nephrology最新文献

{"title":"Integrating PSMA PET into urological practice: insights from a multidisciplinary Italian survey.","authors":"Matteo Bauckneht, Laura Evangelista, Luca Sofia, Marco Maccauro, Maria L DE Rimini, Marco Krengli, Andrea Mari, Riccardo Schiavina, Alberto Lapini, Paolo Andrea Zucali, Giuseppe Fornarini","doi":"10.23736/S2724-6051.26.07105-3","DOIUrl":"10.23736/S2724-6051.26.07105-3","url":null,"abstract":"","PeriodicalId":53228,"journal":{"name":"Minerva Urology and Nephrology","volume":" ","pages":"622-624"},"PeriodicalIF":5.1,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148279942","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The PROTEUS trial: envisioning the future of perioperative therapy and radical prostatectomy for high-risk prostate cancer. Official position of the Italian Society of Urology (SIU).","authors":"Giacomo Novara, Simone Albisinni, Riccardo Campi, Alessandro Larcher, Elisa DE Lorenzis, Savio D Pandolfo, Nicola Pavan, Fabio Zattoni, Fabrizio Dal Moro, Alessandro Antonelli, Vincenzo Ficarra, Andrea Minervini, Vincenzo Mirone, Bernardo Rocco, Andrea Salonia, Andrea Tubaro, Giuseppe Carrieri, Francesco Porpiglia","doi":"10.23736/S2724-6051.26.07214-9","DOIUrl":"10.23736/S2724-6051.26.07214-9","url":null,"abstract":"","PeriodicalId":53228,"journal":{"name":"Minerva Urology and Nephrology","volume":" ","pages":"447-452"},"PeriodicalIF":5.1,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148665198","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":"Global guidelines for the management of penile cancer: evaluating clinical alignment and methodological rigor.","authors":"Savio D Pandolfo, Achille Aveta, Vincenzo Iossa, Simone Cilio, Alessandro Palmieri, Pierluigi Russo, Francesco Lasorsa, Giuseppe Lucarelli, Salvatore Siracusano, Andrea Necchi, Chiara Mercinelli, Fabio Castiglione, Celeste Manfredi, Luigi Formisano, Ithaar H Derweesh, Oscar R Brouwer, Riccardo Autorino","doi":"10.23736/S2724-6051.26.06837-0","DOIUrl":"https://doi.org/10.23736/S2724-6051.26.06837-0","url":null,"abstract":"<p><strong>Background: </strong>Penile cancer (PC) is a rare malignancy with significant geographic variability in its incidence and clinical management. In the absence of large-scale trials, international guidelines serve as primary tools for therapeutic decision-making. This review aims to systematically compare current recommendations and methodological quality across three major guidelines - EAU-ASCO (2025), NCCN (2025), and ESMO (2024) - focusing on treatment strategies for primary tumors, lymph node management, systemic therapy, and follow-up protocols.</p><p><strong>Methods: </strong>A structured comparative analysis was conducted using a predefined protocol. Guideline content was independently reviewed by two uro-oncology experts across four domains. The strength of recommendation (SoR) and level of evidence (LoE) were extracted when available. Methodological rigor was evaluated using the AGREE II instrument, with two independent reviewers scoring 23 items across six domains. Domain scores were standardized and categorized as high (>70%), moderate (50-70%), or low quality (<50%). All the disagreements were solved by a senior reviewer.</p><p><strong>Results: </strong>There was substantial concordance in early-stage tumor management and the use of platinum-based chemotherapy for advanced diseases. However, discrepancies emerged in surgical margins, lymph node evaluation thresholds, and second-line systemic therapy. Follow-up strategies varied widely in structure and comprehensiveness. AGREE II appraisal revealed marked differences in guideline development quality: EAU-ASCO scored highest across all domains, followed by NCCN and ESMO. Limitations include exclusion of regional guidelines and heterogeneity in evidence grading systems.</p><p><strong>Conclusions: </strong>International PC guidelines align on core principles; however, notable divergences persist due to evidence gaps and regional practices. Evaluating both clinical content and development quality enhances understanding of guideline credibility and applicability.</p>","PeriodicalId":53228,"journal":{"name":"Minerva Urology and Nephrology","volume":"78 4","pages":"474-483"},"PeriodicalIF":5.1,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149118630","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":"YAU-RCC Insights from ASCO GU 2026: emerging advances in renal cell carcinoma management.","authors":"Giulio Francolini, Veronica Mollica, Ronan Flippot, Riccardo Campi, Daniele Amparore","doi":"10.23736/S2724-6051.26.07111-9","DOIUrl":"10.23736/S2724-6051.26.07111-9","url":null,"abstract":"","PeriodicalId":53228,"journal":{"name":"Minerva Urology and Nephrology","volume":" ","pages":"457-460"},"PeriodicalIF":5.1,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148400077","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 prospective multicenter study of Flexible ureteroscopy using different flexible and navigable suction access sheath (FANS) sizes: peri and 30-day postoperative outcomes from the global and prospective multicenter FLEXible ureteroscopy Outcomes Registry using FANS (FLEXOR-F) by the EAU section of endourology.","authors":"Vineet Gauhar, Steffi K Yuen, Bhaskar K Somani, Oriol Angerri, Denizhan Demirkiran, Khi Y Fong, Kremena Petkova, Bokye Soebhali, Dyandra Parikesit, Idrissa Sissoko, Luis Rico, Lazaros Tzelves, Giorgio Mazzon, Arman Tsaturyan, Mohamed Elshazly, Estaban Politi, Dmitry Sytnik, Tzevat Tefik, Du Jingzeng, Tsung W Chong, Volkan Sen, Cemil Aydin, Nebil Akdogan, Yiloren Tanidir, Petrisor Geavlete, Olivier Traxer, Stefania Ferretti, Daniele Castellani","doi":"10.23736/S2724-6051.26.07004-7","DOIUrl":"10.23736/S2724-6051.26.07004-7","url":null,"abstract":"<p><strong>Background: </strong>Flexible and Navigable Suction Ureteral Access Sheath (FANS) revolutionized flexible ureteroscopy for stone management. This study assessed outcomes using a standardized FANS classification across different ureteroscope-sheath combinations.</p><p><strong>Methods: </strong>We prospectively enrolled 862 adult patients from 21 centers (June-September 2025), stratifying patients into three groups: group 1 (ultra-mini: 6.3 Fr scope/<10 Fr FANS, N.=203, 23.5%), group 2 (mini: 7.5-8 Fr scope/10-12 Fr FANS, N.=446, 51.7%), and group 3 (Standard: >8 Fr scope/11-13 or 12-14 Fr FANS, N.=213, 24.7%). Stone-free rate (SFR) was classified on 30-day CT as grade A (zero residual fragment, ZRF), grade B (single RF≤2mm), grade C (single RF 2.1-4mm), grade D (single/multiple RF>4mm).</p><p><strong>Results: </strong>Age, gender, Body Mass Index, comorbidities and stone volume were similar across all groups. Overall complications occurred in 21.6% of group 3, 5.8% in group 2, and 10.8% in group 1 (P<0.001). Ureteric injury was more frequent in group 3 (15.5%) than groups 1 (2.5%) and 2 (2.2%, P<0.001). On multivariable analysis, group 3 had significantly lower odds of ZRF (OR 0.38, 95% CI 0.23-0.62, P<0.001) compared to group 1. Grades A+B SFR was 86.3%, with ZRF achieved in 76.5% overall. Group 2 demonstrated superior ZRF rates (80.5%) compared to group 1 (77.8%) and group 3 (65.4%, P<0.001). Grade D was significantly higher in group 3 (14.8%) versus group 2 (5.9%) and group 1 (4.4%).</p><p><strong>Conclusions: </strong>Ultra-mini and mini-FANS demonstrate superior safety profiles and SFRs compared to standard FANS, with mini-FANS achieving optimal outcomes.</p>","PeriodicalId":53228,"journal":{"name":"Minerva Urology and Nephrology","volume":" ","pages":"592-602"},"PeriodicalIF":5.1,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148946168","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":"Safety and functional efficacy of transperineal laser ablation in large prostates (>80 mL): a prospective single-center study.","authors":"Francesco L Conte, Marco Saladino, Luca Lambertini, Leonardo Gajo, Neliana Kucuku, Francesca Conte, Beatrice Giustozzi, Riccardo Ferretti, Simone Posanzini, Luca Mazzola, Vincenzo Salamone, Giulia Carli, Filippo Lipparini, Federica Leo, Maro Fahoum, Marco D'Ermo, Jhosep J Carmona Garcia, Fabrizio DI Maida, Gianni Vittori, Antonio A Grosso, Andrea Minervini, Andrea Mari","doi":"10.23736/S2724-6051.26.06952-1","DOIUrl":"https://doi.org/10.23736/S2724-6051.26.06952-1","url":null,"abstract":"<p><strong>Background: </strong>To evaluate the safety and functional outcomes of transperineal laser ablation (TPLA) in men with large prostates (>80 mL), with specific focus on perioperative events, catheter-related outcomes, and mid-term efficacy.</p><p><strong>Methods: </strong>Prospective single-center observational study at a tertiary referral institution. Consecutive patients undergoing TPLA between September 2022 and December 2024 were analyzed; 85 met inclusion criteria (>80 mL). Procedures were outpatient under local anesthesia (± oral benzodiazepines) with transrectal ultrasound guidance. Three-four fibers were used per case (four in 91.8%); median total energy 10,000 J (IQR 9000-12,000), energy density 105 J/mL (IQR 95-125). Follow-up until 36 months with all the patients receiving a follow-up of at least 12 months. Outcomes included IPSS, QoL, MSHQ-EjD, Qmax, PVR; complications were graded by Clavien-Dindo.</p><p><strong>Results: </strong>Median age was 67 years; baseline uroflowmetry indicated marked obstruction (Median Qmax 9 mL/s; PVR 120 mL; IPSS 16). Catheter removal failure occurred in 24.7% at day 7 and 7.1% at day 14; 3.5% remained catheter-dependent at 30 days. Overall complications were 22.4%, predominantly grade ≤ II; one intraprostatic abscess (1.2%). No transfusions, sepsis, urethral stricture, de novo erectile or ejaculatory dysfunction were observed; transient mild incontinence occurred in 1.2%. Qmax improved modestly at 3 months (+1 mL/s; P=0.04) and markedly at 6 months (+5 mL/s; P<0.0001), remaining stable thereafter. IPSS decreased significantly through 12-24 months (-10 points; P<0.0001); PVR reduction became significant from 6 months; ejaculatory scores improved; secondary HoLEP was required in 12.9%. Median follow-up was 18 months.</p><p><strong>Conclusions: </strong>In prostates >80 mL, TPLA under local anesthesia is feasible and safe, yielding delayed yet substantial improvements in LUTS and flowmetry from 6 months onward, low sphincter-related morbidity, and preserved ejaculation. TPLA may complement enucleation procedures as a volume-adapted, minimally invasive option for selected patients.</p>","PeriodicalId":53228,"journal":{"name":"Minerva Urology and Nephrology","volume":"78 4","pages":"583-591"},"PeriodicalIF":5.1,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149118402","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":"Prostatic urethral lift in young men seeking preservation of ejaculatory function and fertility-related parameters: semen analysis up to 18 months and comparative review of MIST.","authors":"Nicola D'Altilia, Silvia Secco, Francesco Guzzi, Anna Ricapito, Marco Finati, Lorenzo Mazzotta, Gian M Busetto, Carlo Bettocchi, Giuseppe Carrieri, Pasquale Annese","doi":"10.23736/S2724-6051.26.06887-4","DOIUrl":"https://doi.org/10.23736/S2724-6051.26.06887-4","url":null,"abstract":"<p><strong>Background: </strong>Minimally invasive surgical therapies (MIST) aim to relieve lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH) while preserving sexual and ejaculatory function. We prospectively assessed semen parameters up to 18 months after prostatic urethral lift (PUL) in men under 50 prioritizing ejaculation and contextualized these findings against other MIST.</p><p><strong>Methods: </strong>In this single-center cohort (N.=20), semen analyses (according to WHO 6^th edition) were performed at baseline, 6, and 18 months after PUL. Functional outcomes were prospectively collected through uroflowmetry with post-void residual (PVR) measurement, and subjective outcomes through the International Prostate Symptom Score (IPSS) questionnaire.</p><p><strong>Results: </strong>No statistically significant deterioration of semen parameters were observed (median total sperm count at timepoints: 29.5→31.0→30.5 million/mL; P=0.88), as well as for ejaculate volume and pH. Motility, vitality, and morphology remained within reference thresholds. LUTS improved durably (Qmax +67%, PVR -50%, IPSS -60%). Complications and re-treatment rates were 15% (one had prostatitis treated with antibiotic therapy, one patient required a bladder catheter for 7 days due to acute urinary retention) and 10% (one for LUTS e one for calcification of device) respectively. Notably, this series is the first to report two cases of successful paternity following PUL.</p><p><strong>Conclusions: </strong>In carefully selected young men, PUL did not result in a deterioration of the semen quality and ejaculation through 18 months while providing durable symptom relief. To our knowledge, this is the first report of successful paternity following PUL. Ejaculation-sparing MIST should be central to counseling for fertility-conscious patients.</p>","PeriodicalId":53228,"journal":{"name":"Minerva Urology and Nephrology","volume":"78 4","pages":"574-582"},"PeriodicalIF":5.1,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149118616","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The updated 2021 EAU risk groups for non-muscle-invasive bladder cancer: what have we learned four years after implementation?","authors":"Alberto Artiles Medina, Julia Aumatell, Daniel A González-Padilla, Renate Pichler, Pietro Scilipoti, Roberto Contieri, José D Subiela","doi":"10.23736/S2724-6051.26.06915-6","DOIUrl":"10.23736/S2724-6051.26.06915-6","url":null,"abstract":"","PeriodicalId":53228,"journal":{"name":"Minerva Urology and Nephrology","volume":" ","pages":"620-622"},"PeriodicalIF":5.1,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147505570","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":"CAIX-targeted PET/CT in clear cell renal cell carcinoma: a systematic review of current evidence and clinical perspectives.","authors":"Federico Garrou, Gian M Sacchetti, Lucia Leva, Matteo Manfredi, Sabrina DE Cillis, Cristian Fiori","doi":"10.23736/S2724-6051.26.07125-9","DOIUrl":"https://doi.org/10.23736/S2724-6051.26.07125-9","url":null,"abstract":"<p><strong>Background: </strong>Carbonic anhydrase IX (CAIX)-targeted PET/CT is an emerging molecular imaging approach for clear cell renal cell carcinoma (ccRCC). This systematic review aimed to summarize the clinical evidence on CAIX-targeted PET/CT for ccRCC detection and characterization.</p><p><strong>Methods: </strong>PubMed/MEDLINE, Embase, and the Cochrane Library were searched on March 29, 2026, according to PRISMA 2020. Original clinical studies evaluating CAIX-targeted PET/CT in adult patients with suspected or confirmed renal masses or metastatic/recurrent renal cell carcinoma were included. Study selection, data extraction, and QUADAS-2 quality assessment were performed independently by two reviewers. Because of substantial clinical and methodological heterogeneity, a narrative synthesis was performed.</p><p><strong>Results: </strong>Twenty studies were included, with a summed sample size of 902 patients. Antibody-based tracers, mainly ¹²⁴I- and ⁸⁹Zr-girentuximab derivatives, provided the most established evidence for localized or indeterminate renal masses, showing high specificity and encouraging diagnostic accuracy for ccRCC. Small-molecule tracers enabled same-day imaging and showed promising results in metastatic disease assessment, particularly for extra-renal lesions. Performance was influenced by tracer class, imaging timing, renal background activity, lesion site, endpoint definition, and completeness of histological verification. The main methodological concerns involved patient selection, reference standard, and flow/timing domains.</p><p><strong>Conclusions: </strong>CAIX-targeted PET/CT is a promising imaging strategy for ccRCC, with antibody-based tracers currently better supported for indeterminate renal masses and small-molecule tracers emerging for metastatic disease assessment. Further prospective multicenter validation and standardized endpoints are required. The review was not registered and received no external funding.</p>","PeriodicalId":53228,"journal":{"name":"Minerva Urology and Nephrology","volume":"78 4","pages":"498-509"},"PeriodicalIF":5.1,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149118680","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 the 10-20 mm gray zone to a 15 mm stone size cutoff for pediatric urolithiasis management: do guidelines need revisiting? . A systematic review and meta-analysis by the EAU Section of Endourology.","authors":"Selcuk Guven, Mehmet G Sonmez, Atinc Tozsin, Gernot Ortner, Burak Akgul, Nurmanbet Turaliev, Omer F Cavdar, Panagiotis Kallidonis, Theodoros Tokas, Thomas Knoll, Selcuk Silay, Muhammad I Omar, Yuhong Yuan, Kamran Ahmed, Bhaskar Somani","doi":"10.23736/S2724-6051.26.06874-6","DOIUrl":"https://doi.org/10.23736/S2724-6051.26.06874-6","url":null,"abstract":"<p><strong>Background: </strong>Pediatric urolithiasis guidelines recommend ESWL, RIRS, or PCNL for stones within the 10-20 mm range but this broad interval often complicates treatment selection. This systematic review aimed to define a clearer, evidence-based stone size cutoff to improve clinical decision-making.</p><p><strong>Methods: </strong>A systematic review and meta-analysis were performed (PROSPERO CRD420251012163) according to PRISMA 2020 guidelines. Pediatric studies published from 2014 to 2025 were searched across major databases. Eligible studies reported stone size and at least one outcome, including stone-free rate, residual fragments, retreatment, or complications. Studies without quantitative data were excluded. Early and long-term complications as well as instrumentation were analyzed. Pooled estimates were calculated using random-effects models. Risk of bias was assessed using the Newcastle-Ottawa Scale.</p><p><strong>Results: </strong>Seventy-six study arms (N.=5294) reported stone size data. The pooled mean was 16.03 mm (95% CI 14.60-17.47; I²=99.9%). Stones treated with ESWL averaged 12.29 mm, RIRS 12.49 mm And PCNL 20.16 mm, indicating PCNL was used for larger stones (P<0.001). In 113 studies reporting SFR, pooled rates were 0.801 for ESWL, 0.826 for RIRS And 0.893 for PCNL, with PCNL showing higher SFRs. Considerable heterogeneity was observed And differences in complication profiles and instrumentation were identified as important factors influencing treatment outcomes beyond stone-free rates alone.</p><p><strong>Conclusions: </strong>A 15-mm stone size threshold appears clinically meaningful and provides clearer guidance than the traditional 10-20 mm range in children. ESWL and RIRS are appropriate options for stones <15 mm, whereas PCNL is more suitable for larger stones. Beyond stone-free rates, complication profiles and instrumentation should be considered when selecting treatment. Study heterogeneity and potential publication bias remain important limitations.</p>","PeriodicalId":53228,"journal":{"name":"Minerva Urology and Nephrology","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2026-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148347287","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}