BJUI compass最新文献

{"title":"Does orchidopexy for testicular torsion affect long-term fertility parameters in males: A systematic review.","authors":"Avula Aishwarya Rao, Muhammad Shariq Rahemtoola, Hassaan Aziz, Peter Grice, Mohamed Mubarak, Ian Pearce, Theodora Stasinou, Vaibhav Modgil","doi":"10.1002/bco2.70287","DOIUrl":"10.1002/bco2.70287","url":null,"abstract":"<p><strong>Objectives: </strong>The aim of this study is to investigate long-term fertility outcomes following orchidopexy performed for testicular torsion.</p><p><strong>Patients and methods: </strong>This systematic review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and was registered with the International Prospective Register of Systematic Reviews (PROSPERO: CRD420251152057). A literature search was conducted from June 2025 to October 2025 across Scopus, PubMed, Web of Science and the StarPlus Library (University of Sheffield). Studies reporting on male patients with a history of testicular torsion who underwent orchidopexy were included. Eligible study designs comprised case reports/series, cohort studies, case-control studies and randomised controlled trials. Studies involving cryptorchidism, orchidectomy or no intervention following exploration, as well as systematic reviews, meta-analyses, editorials, book chapters, conference proceedings/posters, reviews and commentaries, were excluded.</p><p><strong>Results: </strong>Seventeen articles with 324 patients analysed fertility and hormonal outcomes following detorsion with orchidopexy. Primary outcomes were classified as fertility parameters and semen analysis. Reported pregnancy rates were high, ranging from 90.2% to 91.3% with reported time to pregnancy of 6.6 to 8.9 months. Six studies reported semen parameters with sperm count (11.2-235.4 × 10), motility (51.6-67%) and morphology (3.6-28%) generally within reported reference ranges, although substantial variability existed between studies. Secondary outcomes included hormonal analysis and anti-sperm antibody prevalence. Five studies reported hormonal follicle-stimulating hormone (FSH) and luteinising hormone (LH) levels, eight studies reported testosterone levels and two reported inhibin B levels. Anti-sperm antibodies (ASA) were described in two studies, with positive ASA ranging from 20% to 27.2%. The reported follow-up duration across nine studies was 0.12-11.8 years, although none reported fertility outcomes longitudinally.</p><p><strong>Conclusion: </strong>This review suggests that fertility potential is generally preserved following testicular detorsion with orchidopexy, with the majority of studies reporting favourable semen profiles and pregnancy outcomes. However, the small number of heterogeneous studies and limited long-term data highlight the need for larger, standardised studies to better define the long-term impact of testicular torsion on fertility.</p>","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"7 10","pages":"e70287"},"PeriodicalIF":2.0,"publicationDate":"2026-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13678274/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149225522","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Decision regret after partial nephrectomy for benign small renal masses: The importance of preoperative counselling","authors":"Sarika Nalagatla,&nbsp;Aqua Asif,&nbsp;Bhargab Ghoshal,&nbsp;Maria Yacoub,&nbsp;Samuel Davis,&nbsp;Maria Bahhadi-Harbo,&nbsp;Abhishek Reekhaye,&nbsp;Manar Malki,&nbsp;Muddassar Hussain,&nbsp;Neil Barber","doi":"10.1002/bco2.70289","DOIUrl":"https://doi.org/10.1002/bco2.70289","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Objectives&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;This study aimed to evaluate decision regret following robot-assisted laparoscopic partial nephrectomy (RALPN) for benign small renal masses (SRMs) in patients who did not undergo preoperative renal mass biopsy (RMB) and to assess factors associated with regret and satisfaction with treatment decision-making.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Patients and Methods&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;We conducted a mixed methods study combining retrospective clinical data with prospective patient-reported outcomes at a high-volume renal cancer centre. Patients who underwent RALPN for indeterminate SRMs ≤4 cm between January 2010 and July 2025 without preoperative RMB and were subsequently found to have benign histology were identified from a prospectively maintained renal cancer database. Participants completed a standardised questionnaire incorporating the validated Decision Regret Scale (DRS). Significant regret was defined as DRS ≥ 25. Decision regret was evaluated in relation to patients' recollection of counselling and perceived quality of preoperative information.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Of 1480 RALPN procedures performed during the study period, 167 patients met the eligibility criteria. Contact was established with 108 patients, of whom 104 agreed to participate and 58 completed the questionnaire. Median age was 66 years, and median tumour size was 30 mm. No Clavien-Dindo Grade ≥III complications occurred. Most patients recalled being informed that the lesion could be benign (79.3%). Discussion of RMB was recalled by 55.2% of respondents, whereas 29.3% reported no recollection of biopsy discussion. Overall decision regret was low, with a mean DRS of 13.8 (95% confidence interval [CI] 10.3–17.4), although 27.6% demonstrated clinically significant regret (DRS ≥ 25). Despite benign histology, 87.9% believed surgery had been the correct decision and only 29.3% would retrospectively have preferred RMB before surgery. Lower regret scores were observed in patients who recalled detailed RMB discussion and reported higher perceived quality of preoperative counselling.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusion&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Most patients undergoing RALPN for benign small renal masses reported low decision regret despite ultimately benign pathology. Although over one-quarter of patients demonstrated clinically significant regret, the majority remained satisfied with their treatment decision and believed surgery had been the correct choice. Comprehensive counselling regarding diagnostic uncertainty and the potential role of renal m","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"7 10","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/bco2.70289","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149206140","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"En bloc stapler versus separate clip ligation for renal hilar control during robotic-assisted nephrectomy: A retrospective comparative cohort study","authors":"Ibrahim A. Khalil,&nbsp;Fatima A. Al-Jassim,&nbsp;Yaser M. Ata,&nbsp;Humam Emad Rajha,&nbsp;Abdulhamed Mansour,&nbsp;Ibrahim Al-Emadi,&nbsp;Khalid Al-Jalham,&nbsp;Khalid Al Rumaihi","doi":"10.1002/bco2.70297","DOIUrl":"https://doi.org/10.1002/bco2.70297","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>This study aimed to compare en bloc endovascular stapler ligation (ENBLOC) with separate clip ligation (CLIPS) for renal hilar control during robotic-assisted nephrectomy, with emphasis on perioperative safety.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Patients and methods</h3>\u0000 \u0000 <p>This single-centre retrospective cohort included 193 consecutive adults undergoing robotic-assisted radical nephrectomy, simple nephrectomy or nephroureterectomy between January 2018 and December 2025. Patients were classified as CLIPS (<i>n</i> = 66) or ENBLOC (<i>n</i> = 127). Primary safety outcomes were intraoperative complications, postoperative complications and postoperative arteriovenous fistula (AVF) formation. Operative, renal functional and oncological outcomes were secondary or exploratory. Procedure-specific subgroup analyses were also performed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Baseline characteristics were largely comparable, except for ASA III–IV status was more frequent in the CLIPS group (27.3% vs. 16.5%, <i>p</i> = 0.029). Operative time (206.5 vs. 218.0 min, <i>p</i> = 0.26), estimated blood loss (median 100 mL in both groups, <i>p</i> = 0.37) and transfusion rates (1.5% vs. 5.5%, <i>p</i> = 0.19) did not differ significantly. Intraoperative complications occurred in 3/66 (4.5%) CLIPS and 8/127 (6.3%) ENBLOC patients (OR 1.41, 95% CI 0.36–5.51; absolute risk difference 1.8 percentage points, 95% CI − 4.8 to 8.3; <i>p</i> = 0.752). Postoperative complications occurred in 5/66 (7.6%) and 9/127 (7.1%) patients, respectively (<i>p</i> = 0.91). No AVF was identified during follow-up. Exploratory subgroup analyses did not identify additional statistically significant between-group differences, although estimates were limited by small sample sizes and sparse events.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>En bloc stapler ligation was not associated with statistically significant differences in the evaluated safety outcomes compared with separate clip ligation. However, the observational design and limited number of events preclude conclusions regarding equivalence, and clinically relevant differences cannot be excluded.</p>\u0000 </section>\u0000 </div>","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"7 10","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/bco2.70297","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149206077","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Baseline Patient and Tumour Characteristics Associated with Mental Health in Men Undergoing Active Surveillance for Prostate Cancer","authors":"Beth Russell,&nbsp;Mia Tazi,&nbsp;Harriet Wylde,&nbsp;Alan Francis,&nbsp;Christian P. Pavlovich,&nbsp;Michael Peacock,&nbsp;Daan Nieboer,&nbsp;Lionne D. F. Venderbos,&nbsp;Prokar Dasgupta,&nbsp;Mieke Van Hemelrijck","doi":"10.1002/bco2.70293","DOIUrl":"https://doi.org/10.1002/bco2.70293","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>This study aims to examine how patient demographics and clinical characteristics relate to mental well-being in men with prostate cancer (PCa) on active surveillance (AS).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Subjects and Methods</h3>\u0000 \u0000 <p>We analysed data from the GAP3 database, established in 2014. The study included men from three cohorts who completed baseline self-reported well-being assessments using either the Memorial Anxiety Scale for Prostate Cancer (MAX-PC, <i>n</i> = 488) or the Functional Assessment of Cancer Therapy–Prostate Emotional Well-being Score (FACT-P EWB, <i>n</i> = 497). MAX-PC scores were categorised as mild (&lt;9), moderate (9–27) or high anxiety (≥27), while FACT-P EWB scores were divided into tertiles (≤18, 19–20 and ≥21; higher scores indicate better emotional well-being). Descriptive statistics and ordinal logistic regression were used to examine associations between baseline characteristics and questionnaire scores.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among the men across three cohorts, 488 completed the MAX-PC and 497 the FACT-P EWB. In the chi2 analysis for the MAX-PC cohort, anxiety levels were significantly associated with baseline BMI, ethnicity, marital status, education, family history of PCa, PSA levels, T stage, smoking status, Charlson Comorbidity Index and erectile dysfunction (all <i>p</i> &lt; 0.001). Ordinal logistic regression showed that a family history of prostate cancer was associated with higher anxiety (OR = 1.94, 95% CI: 1.26–3.00). In contrast, no significant associations were observed in the FACT-P EWB cohort.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Our findings highlight several baseline demographic and clinical factors associated with disease-specific anxiety in men with PCa on AS. These results underscore the importance of routine psychosocial elements and of considering lifestyle and psychosocial factors when evaluating the supportive care needs of men considering or pursuing PCa AS.</p>\u0000 </section>\u0000 </div>","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"7 10","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/bco2.70293","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149205930","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between human immunodeficiency virus diagnosis and risk of penoscrotal conditions in adult males: A propensity-matched retrospective cohort study","authors":"Hossein A. Zolfaghari,&nbsp;Melissa Nanotkar,&nbsp;Juan Riestra,&nbsp;Aleksandar Popovic,&nbsp;Diba Atar,&nbsp;Amjad Alwaal","doi":"10.1002/bco2.70291","DOIUrl":"10.1002/bco2.70291","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>This study aimed to examine the temporal association between human immunodeficiency virus (HIV) diagnosis and subsequent development of penoscrotal conditions including priapism, phimosis, epididymo-orchitis, testicular torsion and paraphimosis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Patients and methods</h3>\u0000 \u0000 <p>A propensity-matched retrospective cohort study was conducted using the TriNetX database. Adult males with HIV (B20) were matched 1:1 to controls on age and race. Outcomes were assessed over a 10-year follow-up period using the Cox proportional hazards model.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Following matching, cohort sizes ranged from 48 615 to 65 423 patients per group. HIV diagnosis was associated with significantly increased rates of priapism (HR 1.892, 95% CI 1.115–3.210, <i>p</i> = 0.0162), phimosis (HR 2.364, 95% CI 1.631–3.428, <i>p</i> &lt; 0.0001) and epididymo-orchitis (HR 2.346, 95% CI 2.116–2.602, <i>p</i> &lt; 0.0001). No significant association was observed for testicular torsion (HR 1.579, 95% CI 0.756–3.295, <i>p</i> = 0.2200). Paraphimosis could not be evaluated in the corrected analysis due to insufficient data.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>HIV diagnosis was associated with significantly elevated rates of priapism, phimosis and epididymo-orchitis, while no significant association was observed for testicular torsion. These findings are hypothesis-generating, and prospective studies with more granular clinical data are needed to confirm and characterize these associations.</p>\u0000 </section>\u0000 </div>","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"7 10","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13662735/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149198209","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"NEITHER study: NICE versus EAU inconsistent triage, expenses and reliability in non–high-risk non-muscle invasive bladder cancer surveillance","authors":"Youssef Ibrahim,&nbsp;Luis Ribeiro,&nbsp;Michelle Heelan,&nbsp;Martina Spazzapam,&nbsp;Findlay Macaskill,&nbsp;Kiyara Fernando,&nbsp;Adham Ahmed,&nbsp;Ahmed Hussien,&nbsp;Mohammed Gad,&nbsp;Soumitra Chakravarti,&nbsp;Sara Mokbel,&nbsp;Rajesh Nair,&nbsp;Ramesh Thurairaja,&nbsp;Muhammad Shamim Khan,&nbsp;Yasmin Abughanem,&nbsp;Elsie Mensah","doi":"10.1002/bco2.70283","DOIUrl":"https://doi.org/10.1002/bco2.70283","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>This study aimed to quantify discrepancies in non–high-risk non–muscle-invasive bladder cancer (NMIBC) stratification between the National Institute for Health and Care Excellence (NICE) and the European Association of Urology (EAU) guidelines, compare discriminative performance for predicting recurrence, estimate potentially missed recurrences under shorter surveillance and calculate per-patient surveillance costs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Patients and methods</h3>\u0000 \u0000 <p>This is a retrospective cohort study of patients undergoing transurethral resection of bladder tumour (TURBT) at a UK tertiary centre (2018–2020). Patients with low- or intermediate-risk NMIBC who completed 5-year follow-up or experienced recurrence were included. Each patient was stratified according to both NICE and EAU (WHO 1973) guidelines. Outcomes included recurrence rate, discriminative accuracy (Harrell's C-index), proportion of recurrences occurring beyond NICE discharge timepoints and surveillance cost based on NHS reference prices.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of the 158 eligible patients (78% male; mean age 68 years), 40% were assigned different risk categories depending on guideline applied. NICE classified significantly more patients as low risk than EAU (31.1% vs. 12.7%; <i>p</i> &lt; 0.001). Overall, 5-year recurrence was 48.7%, with no significant difference in recurrence rates between corresponding risk groups under each guideline. NICE demonstrated superior discrimination (C-index 0.605 vs. 0.511; <i>p</i> = 0.006). Among NICE low-risk patients, 45% of recurrences occurred between Years 2 and 5—beyond the recommended 1-year discharge point. Mean per-patient surveillance cost was £1412 under NICE versus £3525 under EAU, representing a 60% reduction.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>NICE can reduce cost with comparable discrimination efficiency to EAU guidelines, but risks missed recurrences; a hybrid NICE–EAU approach may offer the optimal balance.</p>\u0000 </section>\u0000 </div>","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"7 10","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/bco2.70283","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149205763","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does gadolinium truly enhance the active surveillance of men with prostate cancer?","authors":"Abinav Udaiyar,&nbsp;Navid Jabalameli,&nbsp;Soroush Rais-Bahrami","doi":"10.1002/bco2.70296","DOIUrl":"https://doi.org/10.1002/bco2.70296","url":null,"abstract":"&lt;p&gt;Active surveillance (AS) is the preferred management of low-risk prostate cancer (PCa) and has expanded to some favourable intermediate-risk cases, and multiparametric MRI (mpMRI) plays a significant role in monitoring patients who are on surveillance. However, widespread adoption of serial mpMRI is challenging because of resource constraints and increased demand for prostate MRI. Biparametric MRI (bpMRI) omits the gadolinium-based dynamic contrast-enhanced (DCE) phase, retaining only the T2-weighted and diffusion-weighted sequences that carry most of the diagnostic signal.&lt;/p&gt;&lt;p&gt;In this setting, we eagerly read the paper by Rivera López and colleagues, which asked a simple but impactful question: Can the DCE sequence be safely dropped from surveillance MRI?&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; Most published bpMRI versus mpMRI comparisons have been small, single-centre, unblinded and retrospective, without MRI quality assurance&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt;; this study represents single-centre and retrospective data as well but brings a mature AS database, biopsy-verified endpoints and a matched control cohort. Among 129 men on AS, and a 68-man biopsied subgroup matched to 68 mpMRI controls, bpMRI performed comparably to mpMRI: Grade reclassification occurred in 29% vs. 25% (&lt;i&gt;p&lt;/i&gt; = 0.7); extreme reclassification to GG ≥ 3 was identical at 7.3%, and no difference was found in PI-RADS lesion stability. This is a timely, pragmatic contribution since bpMRI in the biopsy-naïve setting is now supported by Level 1 evidence from the prospective, multicentre PRIME trial, with early evidence of its benefit developing for over a decade.&lt;span&gt;&lt;sup&gt;2, 3&lt;/sup&gt;&lt;/span&gt; However, the role of bpMRI during AS, where imaging is repeated sometimes several times over consecutive years, still lacks robust data.&lt;/p&gt;&lt;p&gt;Within PI-RADS v2.1, DCE only contributes to the scoring by upgrading an equivocal peripheral zone diffusion finding from PI-RADS 3 to PI-RADS 4.&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt; In AS programmes that biopsy every PI-RADS ≥3 lesion, this does not change clinical practice since the lesions found are biopsied in either scenario. The study is built on this rationale: Every patient had a prior mpMRI localizing known disease, and all PI-RADS 3–5 lesions are targeted at the time of surveillance biopsy, so the incremental yield of gadolinium use for mpMRI in their AS programme should be minimal.&lt;/p&gt;&lt;p&gt;The stakes go beyond convenience. Men on AS accumulate serial contrast exposures, and trace gadolinium is retained with all agents, although no adverse clinical effect has been demonstrated. The case for omission rests less on toxicity, which remains unsettled, than on proportionality: An agent that alters no management decision should not be given repeatedly across potentially a decade of surveillance in a low-risk patient population. Dropping the contrast also shortens scans, removes intravenous access, improves throughput and lowers costs, which may widen access to surveillance im","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"7 10","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/bco2.70296","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149146359","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Natural history of artificial urinary sphincter cuff erosion in males: Experience from two tertiary centres in the United Kingdom","authors":"Loufopoulos Ioannis,&nbsp;Pace Keith,&nbsp;Toia Bogdan,&nbsp;Kapriniotis Konstantinos,&nbsp;Papaefstathiou Efstathios,&nbsp;Newman Thomas,&nbsp;Barratt Rachel,&nbsp;Nobrega Richard,&nbsp;Noah Anthony,&nbsp;Gresty Helena,&nbsp;Sharma Davendra,&nbsp;Greenwell Tamsin,&nbsp;Seth Jai,&nbsp;Ockrim Jeremy","doi":"10.1002/bco2.70277","DOIUrl":"https://doi.org/10.1002/bco2.70277","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>This study aimed to describe the natural history of urethral cuff erosion (UCE) following artificial urinary sphincter (AUS) implantation, including the incidence of urethral stricture and fistula formation, and the outcomes of salvage AUS reimplantation, based on the experience of two UK tertiary centres.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and methods</h3>\u0000 \u0000 <p>Data collected prospectively from 2016 to 2024 was analysed retrospectively. Demographics, characteristics and outcomes of AUS re-implantation were analysed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 273 AUS implantation were performed during the study period. Fifty had device explantation for UCE. Median age at explantation was 73 years. Median time from implantation to erosion was 32 months. About 12% had a history of neurogenic bladder and 58% pelvic irradiation. The most significant cause of acute erosion was traumatic catheterisation (44%).</p>\u0000 \u0000 <p>Following explantation, nine developed urethral stricture (18%), while five patients had urethro-cutaneous fistulae (10%). Twelve individuals underwent salvage AUS re-implantation with 6 (50%) requiring further explantation (50%) within 8 months. Of the remaining 38 patients, 17 continued with pad use alone and 21 underwent alternative conservative management including long-term catheterisation, convene drainage, penile clamp or urethral bulking. Four patients (8%) ultimately required urinary diversion, two following primary explantation and two following failed salvage reimplantation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Overall, 18% of males having AUS implantation had UCE and explantation of the device. The vast majority of them had a history of pelvic irradiation or catheterisation for stricture disease (76%). The main risk for UCE was traumatic catheterisation. About 18% of explanted cases developed urethral stricture and 10% urethra-cutaneous fistulae. Only 24% of these patients had attempted salvage AUS re-implantation, with one half resulting in further early UCE/infection and removal.</p>\u0000 </section>\u0000 </div>","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"7 10","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/bco2.70277","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149146358","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prostate MRI vascular markers and erectile function after nerve-sparing prostatectomy","authors":"Abdullah Al-Mitwalli,&nbsp;Matthew Megson,&nbsp;Dalia Mohammed,&nbsp;Ahmed Al-Nowfal,&nbsp;Conrad Von Stempel,&nbsp;Wai Gin Lee,&nbsp;David Ralph,&nbsp;Zafer Tandogdu","doi":"10.1002/bco2.70295","DOIUrl":"https://doi.org/10.1002/bco2.70295","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Objectives&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;To determine whether preoperative multiparametric magnetic resonance imaging (mpMRI)-derived vascular markers are associated with baseline and postoperative erectile function (EF) and change in EF in men undergoing bilateral nerve-sparing robot-assisted radical prostatectomy (RARP).&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Patients and Methods&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;A secondary retrospective imaging analysis was undertaken using prospectively collected cohort data. Men undergoing bilateral nerve-sparing RARP with a preoperative International Index of Erectile Function—erectile function domain score (IIEF-6) and preoperative mpMRI incorporating dynamic contrast-enhanced sequences were included. MRI-detected accessory pudendal artery (APA), prostate enhancement ratio (PER) and corporal enhancement ratio (CER) were assessed by two expert uro-radiologists. Associations with EF outcomes were examined using correlation analyses and univariable and multivariable linear regression.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Seventy-one patients (mean age 60 years) met inclusion criteria; APA was identified in 31 (43.6%). APA presence was associated with higher baseline IIEF-6 scores (mean 24.1 vs. 20.0, &lt;i&gt;p&lt;/i&gt; = 0.043). Baseline IIEF-6 demonstrated moderate negative correlation with PER (&lt;i&gt;ρ&lt;/i&gt; = −0.30, &lt;i&gt;p&lt;/i&gt; = 0.014) and moderate positive correlation with CER (&lt;i&gt;ρ&lt;/i&gt; = 0.30, &lt;i&gt;p&lt;/i&gt; = 0.018). On multivariable analysis, APA presence (&lt;i&gt;β&lt;/i&gt; = 5.20, &lt;i&gt;p&lt;/i&gt; = 0.019), PER (&lt;i&gt;β&lt;/i&gt; = −0.049, &lt;i&gt;p&lt;/i&gt; = 0.017) and CER (&lt;i&gt;β&lt;/i&gt; = 0.040, &lt;i&gt;p&lt;/i&gt; = 0.049) independently predicted baseline EF. Increasing age independently predicted lower baseline IIEF-6 (&lt;i&gt;β&lt;/i&gt; = −0.34, &lt;i&gt;p&lt;/i&gt; = 0.017), while higher body mass index correlated with poorer 24-month IIEF-6 scores (&lt;i&gt;ρ&lt;/i&gt; = −0.27, &lt;i&gt;p&lt;/i&gt; = 0.046). Bilateral intrafascial/intra-interfascial nerve-sparing techniques were associated with superior 24-month EF outcomes (mean 16.8 vs. 10.5, &lt;i&gt;p&lt;/i&gt; = 0.028). No MRI-derived marker predicted 24-month EF or EF change.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusion&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Preoperative mpMRI-derived vascular markers, particularly APA identification, independently correlate with baseline EF in men undergoing BNS RARP, supporting a contributory vascular component in post-prostatectomy ED. Prospective studies are warranted to determine whether intraoperative vascular preservation strategies, guided by preoperative MRI vascular mapping, influence functional recovery and can be integrated into surgical planning pathways.&lt;/p&gt;\u0000 &lt;/section","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"7 10","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/bco2.70295","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149146031","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A systematic review and meta-analysis on the safety and efficacy of Aquablation","authors":"Kimberley Chan,&nbsp;Nico Christian Grossmann,&nbsp;Matthew Feyissa,&nbsp;Jeremy Nettleton,&nbsp;Philip Charlesworth,&nbsp;Neil Barber,&nbsp;Jeremy Teoh,&nbsp;Ben Challacombe,&nbsp;Garrett Pohlman,&nbsp;Evangelos Liatsikos,&nbsp;Dean Elterman,&nbsp;Nikhil Vasdev","doi":"10.1002/bco2.70292","DOIUrl":"10.1002/bco2.70292","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>This work aimed to evaluate the efficacy and safety of Aquablation for the treatment of benign prostatic enlargement.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A systematic review was conducted in accordance with PRISMA 2020 guidelines (PROSPERO CRD420261401865). A comprehensive PubMed search identified prospective studies and randomised controlled trials published up to January 2026. Studies including ≥30 patients reporting clinical outcomes of Aquablation were included. Guidelines, case reports, review articles, letters, retrospective studies with pooled data were excluded. Primary outcomes were International Prostate Symptom Score, maximum flow rate, postvoid residual and sexual function. Secondary outcomes included perioperative parameters and complications. Random-effects meta-analysis using DerSimonian–Laird was performed for outcomes reported in three or more studies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Fifteen studies comprising 1580 patients were included. Mean age and prostate volume were 67.0 years and 82.1 cc, respectively. Aquablation significantly improved urinary outcomes, with a pooled IPSS reduction of −15.80 at 6 months (95% confidence interval [CI] −17.88 to −13.73; <i>I</i>² = 97.8%), sustained to 36 months. <i>Q</i>_max increased by 11.0 mL/s (95% CI 8.93–13.02; <i>I</i>² = 95.1%), while PVR decreased by 103.8 mL (95% CI −139.5 to −68.0; <i>I</i>² = 98.1%) at 6 months. Ejaculatory dysfunction occurred in 7.4% of patients, with no reported erectile dysfunction. The transfusion rate was 2.5%, with lower rates observed using focal bladder neck cautery. Most complications were low grade.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Aquablation provides durable and significant improvements in urinary outcomes with a favourable safety profile and low rates of sexual dysfunction, supporting its role as an effective surgical option for BPE.</p>\u0000 </section>\u0000 </div>","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"7 10","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13645495/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149139432","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}