BJUI compass最新文献

{"title":"Multiparametric MRI combined with PSA density as a noninvasive rule-out strategy in active surveillance for prostate cancer","authors":"Publio Cesar Cavalcante Viana,&nbsp;Marcelo Araújo Queiroz,&nbsp;Fabio Oliveira Ferreira,&nbsp;Adriano Basso Dias,&nbsp;Natally Horvat,&nbsp;Maurício Dener Cordeiro,&nbsp;Claudio Bovolenta Murta,&nbsp;Giuliano Betoni Guglielmetti,&nbsp;Rafael Ferreira Coelho,&nbsp;Leonardo Cardili,&nbsp;José Pontes Jr,&nbsp;William Carlos Nahas,&nbsp;Giovanni Guido Cerri","doi":"10.1002/bco2.70079","DOIUrl":"10.1002/bco2.70079","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To evaluate the diagnostic performance of multiparametric MRI (mpMRI), mpMRI combined with PSA density (PSAd) and combined biopsy (CBx) in detecting clinically significant prostate cancer (csPCa) in men undergoing active surveillance, using radical prostatectomy (RP) specimens as the reference standard.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Patients and Methods</h3>\u0000 \u0000 <p>In this prospective single-centre study, 91 patients with low-risk prostate cancer under active surveillance underwent mpMRI, PSAd measurement, CBx and ultimately RP. mpMRI was reported using PI-RADS v2.0, and PSAd was dichotomised at 0.12 ng/ml/cm³. Diagnostic accuracy was compared using ISUP grade ≥2 and ≥3 thresholds. Radical prostatectomy pathology served as the reference standard.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>For detecting ISUP ≥3 cancer, mpMRI combined with PSAd achieved the highest sensitivity (93.3%) and negative predictive value (94.4%). CBx demonstrated the highest specificity (88.2%) and overall diagnostic balance (Youden index = 0.348). mpMRI alone showed intermediate performance. Differences in classification between strategies were statistically significant (McNemar p &lt; 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>mpMRI combined with PSAd provides high sensitivity and negative predictive value for ruling out aggressive prostate cancer, supporting its use as a non-invasive triage tool in active surveillance. CBx remains the most specific method for histological confirmation. These strategies should be used complementarily to optimise decision-making in active surveillance protocols.</p>\u0000 </section>\u0000 </div>","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"6 9","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://bjui-journals.onlinelibrary.wiley.com/doi/epdf/10.1002/bco2.70079","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145111343","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":"Staging CT chest for cT1a renal masses: Does it change management?","authors":"Sanjana Ilangovan,&nbsp;Hannah Warren,&nbsp;Federica Sordelli,&nbsp;Thet Paing Oo,&nbsp;Pyae Phyo Tun,&nbsp;Prasad Patki,&nbsp;Faiz Mumtaz,&nbsp;Ravi Barod,&nbsp;Axel Bex,&nbsp;Maxine Tran","doi":"10.1002/bco2.70068","DOIUrl":"10.1002/bco2.70068","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Baseline staging investigations for renal masses invariably include a CT of the chest. However, EAU guidelines have given a weak recommendation that CT chest can be omitted in incidental T1a tumours (≤4 cm) without systemic symptoms, due to the low incidence of pulmonary metastases. This study aimed to assess if a baseline staging CT chest has been clinically useful in a cohort with T1a renal tumours.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Consecutive patients with solid and cystic cT1a renal tumours were prospectively screened for eligibility to the NEST study (ISRCTN 18156881) at a single tertiary referral centre multidisciplinary team meeting (MDT). Four hundred consecutive eligible patients between 28/05/2019 and 13/01/2021 were included in this study. Electronic records were reviewed retrospectively for follow-up data. Seventeen patients with incomplete follow-up data were excluded.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 383 included patients (63% male, median age 65 years, median tumour diameter 2.4 cm), 264 (69%) had a baseline CT chest as part of their clinical staging investigations. No thoracic renal metastases were diagnosed. Abnormalities were reported in 37/264 cases (14%), including indeterminate lung lesions in 32 patients that were deemed benign on further investigations, three synchronous primary lung tumours, one pre-existing mesothelioma and one pleural effusion related to known renal failure.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>CT chest is of limited value in clinical staging investigations for cT1a renal tumours and has a negligible impact on subsequent renal tumour management. Rather, it triggered further investigations and follow-up for 14% of incidentalomas and ultimately detected concurrent incidental primary lung tumours in 1% of patients.</p>\u0000 </section>\u0000 </div>","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"6 9","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://bjui-journals.onlinelibrary.wiley.com/doi/epdf/10.1002/bco2.70068","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145111353","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":"Metabolic abnormalities in pure vs. mixed struvite stone formers: A retrospective comparative analysis utilising large language models for data extraction","authors":"Juanita Velasquez Ospina,&nbsp;Ansh Bhatia,&nbsp;Archan Khandekar,&nbsp;Aravindh Rathinam,&nbsp;Glenn Austin,&nbsp;Jonathan Katz,&nbsp;Robert Marcovich,&nbsp;Hemendra N. Shah","doi":"10.1002/bco2.70072","DOIUrl":"10.1002/bco2.70072","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To evaluate demographic characteristics and the prevalence of metabolic abnormalities in patients with pure struvite stones compared to those with mixed struvite and calcium oxalate stones.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We retrospectively reviewed 3001 stone analyses performed at our institution between August 2019 and April 2024. Patients who had a 24-hour urinary stone risk profile within six months of stone analysis were included. Exclusion criteria were a history of nephrolithiasis, bladder stones, neurogenic bladder or surgery for encrusted stent removal. Demographics, comorbidities and laboratory values were extracted using a HIPAA-compliant pipeline enhanced with a large language model (LLM). Patients with pure struvite stones were compared to those with mixed calcium oxalate–struvite stones. Statistical analysis was performed using RStudio v4.1.3.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Forty-one patients met the inclusion criteria: 21 with pure struvite stones and 20 with mixed stones. While pure struvite stones were more common in females, the difference was not statistically significant. Demographics and comorbidities were similar between groups. Patients with pure struvite stones showed lower urinary levels of oxalate, potassium, citrate and uric acid, though not statistically significant. However, supersaturation of brushite, calcium oxalate and sodium urate was significantly lower in the pure struvite group (P &lt; 0.05). At least one metabolic abnormality was present in 90.5% of the pure struvite group and in all patients with mixed stones.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Metabolic abnormalities are highly prevalent in both pure and mixed struvite stone formers. These findings support routine metabolic evaluation in patients with infection-related stones to guide long-term management.</p>\u0000 </section>\u0000 </div>","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"6 9","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://bjui-journals.onlinelibrary.wiley.com/doi/epdf/10.1002/bco2.70072","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145111352","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":"Waiting time in diagnosis and extirpative surgery and association with survival and stage progression in upper tract urothelial carcinomas","authors":"Fredrik Liedberg,&nbsp;Oskar Hagberg,&nbsp;Christel Häggström,&nbsp;Firas Aljabery,&nbsp;Truls Gårdmark,&nbsp;Staffan Jahnson,&nbsp;Tomas Jerlström,&nbsp;Viveka Ströck,&nbsp;Karin Söderkvist,&nbsp;Anders Ullén,&nbsp;Lars Holmberg,&nbsp;Johannes Bobjer","doi":"10.1002/bco2.70093","DOIUrl":"10.1002/bco2.70093","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To investigate the association between waiting time and outcomes in patients with upper tract urothelial carcinomas (UTUC).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Patients and methods</h3>\u0000 \u0000 <p>We studied a population-based cohort of 858 patients in BladderBaSe 2.0 subjected to extirpative surgery for UTUC 2015–2019 in Sweden. Diagnostic waiting time (from referral to diagnosis, reference &lt;1 week), treatment waiting time (from diagnosis to surgery, reference &lt;5 weeks) and total waiting time (reference &lt;10 weeks) were investigated in relation to disease-specific (DSS) and overall survival (OS) by multivariable Cox regression models. To further explore these associations, stage progression from preoperatively recorded clinical tumour stage to pathological tumour stage in the extirpated specimen was assessed by logistic regression.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Total waiting time was not associated with DSS, OS or stage progression. A diagnostic waiting time between 1 and 4 weeks was associated with better DSS (HR 0.57 [95% CI 0.35–0.94]) and OS (HR 0.60 [95% CI 0.41–0.87]). In the strata of patients with UTUC in the renal pelvis, a diagnostic waiting time &gt; 4 weeks was associated with stage progression (OR 2.44 [95% CI 1.00–5.95]), and in patients with UTUC in the ureter, a treatment waiting time between 5 and 10 weeks was associated to worse DSS (HR 2.85 (95% CI 1.03–7.89).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In general, shorter care pathways were linked to beneficial survival estimates, yet some estimates may be influenced by selection bias due to prioritizing short waiting times for patients with advanced and/or overt symptomatic tumours. Stage progression with increased waiting time may indicate an underlying causal mechanism.</p>\u0000 </section>\u0000 </div>","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"6 9","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://bjui-journals.onlinelibrary.wiley.com/doi/epdf/10.1002/bco2.70093","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145111324","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":"Emerging tools for the early detection of prostate cancer","authors":"Muhammad Haider,&nbsp;Jeffrey J. Leow,&nbsp;Tobias Nordström,&nbsp;Ashkan Mortezavi,&nbsp;Peter Albers,&nbsp;Rakesh Heer,&nbsp;Prabhakar Rajan","doi":"10.1002/bco2.70081","DOIUrl":"10.1002/bco2.70081","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Prostate cancer (PCa) is the second most common cancer in men globally, with a rising incidence. Early detection through population-based screening by Prostate Specific Antigen (PSA) testing improves survival outcomes, at the expense of overdiagnosis and overtreatment of clinically insignificant disease. Here, we explore emerging tools for more effective PCa early detection and evaluate their potential roles for PCa screening.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Methods</h3>\u0000 \u0000 <p>Key articles on emerging adjuncts and alternatives to PSA for PCa early detection were identified.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Multiparametric MRI (mpMRI) remains the gold standard modality for identifying clinically significant PCa and has been evaluated for screening. Newer imaging strategies incorporating biparametric MRI (bpMRI) or multiparametric ultrasound (mpUS) potentially offer similar accuracy to mpMRI. Saliva-derived polygenic risk scores (PRS) hold potential as a non-invasive screening tool to identify at-risk patient groups. Blood-based biomarker tests can improve risk stratification, reducing unnecessary biopsies while maintaining detection of clinically significant cancers compared to PSA alone. Urine-based biomarker tests have been examined for the early detection and risk stratification of clinically significant disease as adjuncts to PSA testing.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>PSA is commonly used to detect early PCa, but its lack of specificity and associated overdiagnosis risk has led to controversy over its use for population-based screening. Imaging modalities such as mpMRI have reduced detection of clinically insignificant PCa, and emerging cost-effective alternatives, such as bpMRI and mpUS, show promise. Molecular biomarkers and PRS for risk stratification may help target imaging-based early detection more effectively to at-risk populations. Prospective randomised clinical trials are urgently needed to evaluate the performance of different modalities for population-wide screening. Future developments may involve technologies such as artificial intelligence and diagnostic tests that incorporate circulating tumour markers.</p>\u0000 </section>\u0000 </div>","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"6 9","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://bjui-journals.onlinelibrary.wiley.com/doi/epdf/10.1002/bco2.70081","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145101767","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":"Alcohol consumption among patients diagnosed with genitourinary cancers","authors":"Aidan Weitzner,&nbsp;Carlos Rivera Lopez,&nbsp;Joseph Cheaib,&nbsp;Michelle Higgins,&nbsp;Nirmish Singla","doi":"10.1002/bco2.70086","DOIUrl":"10.1002/bco2.70086","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To characterize alcohol consumption and binge-drinking patterns among individuals with GU cancers (prostate, kidney, bladder and testicular) compared to a propensity-matched cohort without cancer in a large, nationally diverse population.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Methods</h3>\u0000 \u0000 <p>We conducted a retrospective, cross-sectional study utilizing data from the National Institutes of Health <i>All of Us</i> Research Program. Matching accounted for age, sex assigned at birth, smoking status, comorbidities and education/marital status. The primary outcome was self-reported drinking frequency. The secondary outcomes were self-reported binge-drinking frequency and Alcohol Use Disorders Identification Test (AUDIT-C) scores.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Drinking and binge-drinking among individuals with GU malignancy (N = 11 522) closely resembled those of matched controls (N = 47 747), with the majority (53%) consuming at least 2–4 drinks per month. There was no significant association between GU cancer diagnosis and increased drinking frequency (OR: 0.99; p = 0.65), binge-drinking frequency (OR: 0.85; p: 0.055) or AUDIT-C (OR: 0.99; p =0.65). Individuals diagnosed with kidney cancer had reduced odds of higher alcohol use (OR: 0.76; p &lt; 0.001) and AUDIT-C score (OR: 0.83; p &lt; 0.001) compared to controls.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>In this large cohort, including traditionally underrepresented minorities, alcohol use was highly prevalent among those with GU malignancies. Drinking behaviours were similar to individuals without cancer, underscoring the need for integration of lifestyle-focused interventions into survivorship care, as alcohol remains a common and modifiable behaviour with wide-ranging health implications.</p>\u0000 </section>\u0000 </div>","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"6 9","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://bjui-journals.onlinelibrary.wiley.com/doi/epdf/10.1002/bco2.70086","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145101766","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":"Increased risk of bleeding during and after HoLEP in patients with prostate cancer: A multicentre comparative cohort study","authors":"Angelo Porreca,&nbsp;Filippo Marino,&nbsp;Davide De Marchi,&nbsp;Marco Giampaoli,&nbsp;Francesca Simonetti,&nbsp;Antonio Amodeo,&nbsp;Paolo Corsi,&nbsp;Francesco Claps,&nbsp;Alessandro Crestani,&nbsp;Gian Maria Busetto,&nbsp;Daniele D'Agostino,&nbsp;Daniele Romagnoli,&nbsp;Luca Di Gianfrancesco","doi":"10.1002/bco2.70060","DOIUrl":"10.1002/bco2.70060","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Objective&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;To assess the frequency and severity of bleeding complications during and after Holmium Laser Enucleation of the Prostate (HoLEP) in patients with prostate cancer, and compare outcomes to a control group of patients without prostate cancer but with similar baseline characteristics.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Methods&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;This multicentre retrospective study included 175 consecutive patients undergoing HoLEP across 3 referral centres with a diagnosis of prostate cancer—128 with known cancer prior to surgery and 47 with incidental findings on postoperative histology. These patients were compared to 500 consecutive control patients without prostate cancer but matched for prostate volume, age, presence of indwelling catheter, comorbidities and anticoagulant/antiplatelet therapy status. Bleeding-related events analysed included intraoperative estimated blood loss, need for transfusion, clot retention, postoperative irrigation, reoperation for haemorrhage and hospital readmission within 30 days.&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;The PCa group experienced significantly higher rates of intraoperative bleeding requiring intensified coagulation (18.3% vs 8.6%, &lt;i&gt;p&lt;/i&gt; &lt; 0.01), transfusion (6.3% vs 2.0%, &lt;i&gt;p&lt;/i&gt; = 0.02) and clot retention (4.0% vs 1.4%, &lt;i&gt;p&lt;/i&gt; = 0.04) compared to controls. Among patients with known PCa, 25.0% experienced bleeding-related complications, while the rate was 14.9% among those with incidental PCa. Patients with a known diagnosis showed higher bleeding risk than incidental cases. In multivariate analysis, both prostate cancer and anticoagulant therapy were independently associated with increased risk of bleeding complications. Antithrombotic/antiplatelet therapy significantly raised the likelihood of bleeding events (adjusted OR 2.8, 95% CI 1.6–4.7; p &lt; 0.001), as did the presence of prostate cancer (adjusted OR 2.1, 95% CI 1.3–3.6; p = 0.004). Patients with both risk factors experienced the highest rate of bleeding (29.4%), compared to 8.1% in those without either factor (p &lt; 0.001), indicating a synergistic effect. No significant differences were found in catheter removal time or hospital stay.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusions&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Prostate cancer—particularly when known preoperatively—is associated with a significantly increased risk of bleeding during and after HoLEP, even when controlling for baseline characteristics. Surgeons should anticipate increased vascularity and plan perioperative management accordingly to mitigate haemorrhagic complicati","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"6 9","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12441201/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145088381","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":"Perioperative chemotherapy use and related outcomes in muscle-invasive bladder cancer in Australia","authors":"Alison Hiong,&nbsp;James Lynam,&nbsp;Andrew Weickhardt,&nbsp;Shirley Wong,&nbsp;Shomik Sengupta,&nbsp;Paul Manohar,&nbsp;Lih-Ming Wong,&nbsp;Philip Dundee,&nbsp;Nathan Lawrentschuk,&nbsp;Alison Y. Zhang,&nbsp;Angelyn Anton,&nbsp;Ajay Raghunath,&nbsp;Peter Gibbs,&nbsp;Ben Tran","doi":"10.1002/bco2.70083","DOIUrl":"10.1002/bco2.70083","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To explore Australian data on perioperative chemotherapy use and associated outcomes in muscle-invasive bladder cancer (MIBC).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Subjects and Methods</h3>\u0000 \u0000 <p>An observational study of patients with MIBC treated with neoadjuvant chemotherapy, adjuvant chemotherapy or surgery alone was conducted using data from BLADDA, a multicentre Australian urothelial cancer registry. Pathological response to neoadjuvant chemotherapy and its effect on event-free survival (EFS) and overall survival (OS) were determined. EFS and OS in patients who underwent neoadjuvant chemotherapy, adjuvant chemotherapy or surgery alone were compared using univariate and multivariable proportional hazards regression.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>From 2018 to 2024, 259 patients enrolled in the BLADDA registry met inclusion criteria, of which 45% received neoadjuvant chemotherapy, 23% received adjuvant chemotherapy, 1.2% received both neoadjuvant and adjuvant chemotherapy and 31% underwent surgery only. The proportion of patients treated with neoadjuvant chemotherapy increased over time. A total of 21 of 67 (31%) evaluable subjects achieved a pathological complete response, which was associated with improved EFS and OS. Excluding patients who received both neoadjuvant and adjuvant chemotherapy, the EFS hazard ratio (HR) was 0.43 (95% confidence interval [CI] 0.29–0.65, p &lt; 0.001) for neoadjuvant chemotherapy and 0.59 (95% CI 0.38–0.94, p = 0.03) for adjuvant chemotherapy compared to surgery alone. Neoadjuvant chemotherapy was associated with prolonged OS in the univariate analysis (HR 0.43, 95% CI 0.26–0.73, p = 0.002) but not in the multivariable analysis (HR 0.59, 95% CI 0.32–1.08, p = 0.09). OS was not improved with adjuvant chemotherapy (unadjusted HR 0.76, 95% CI 0.44–1.31, p = 0.3; adjusted HR 0.86, 95% CI 0.46–1.60, p = 0.6).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Neoadjuvant chemotherapy use for MIBC in Australia has increased over the past decade, but it remains underutilised. This has important implications as perioperative chemo-immunotherapy emerges as a standard of care. Although a clear impact on survival in the overall population was not observed, this was potentially due to the limited sample size.</p>\u0000 </section>\u0000 </div>","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"6 9","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12436026/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145076638","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":"Is a second TUR necessary in patients with primary high-grade Ta NMIBC, particularly in the context of initial cases?","authors":"Satoki Abe,&nbsp;Hiroyuki Fujinami,&nbsp;Naoyuki Yamanaka,&nbsp;Shinro Hata,&nbsp;Toru Inoue,&nbsp;Tadasuke Ando,&nbsp;Toshitaka Shin","doi":"10.1002/bco2.70082","DOIUrl":"10.1002/bco2.70082","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To evaluate the clinical significance of a second transurethral resection of the bladder tumour (TURBT) in patients with a primary high-grade (HG) Ta non-muscle invasive bladder cancer (NMIBC), specifically selected for the initial diagnosis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Patients and Methods</h3>\u0000 \u0000 <p>We retrospectively analysed 121 patients with primary HG Ta urothelial carcinoma treated at our institution between January 2007 and October 2024. All patients underwent an initial TURBT with the detrusor muscle present in the specimen. Patients were divided into the second TUR group (n = 48) and the non-second TUR group (n = 73). Propensity score matching was performed using age, number of tumours and Bacillus Calmette–Guerin treatment status. Outcomes included the residual tumour rate, recurrence-free survival (RFS), time to progression to muscle invasive bladder cancer (MIBC) and cancer-specific survival (CSS).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Residual tumour at the initial resection site was identified in four patients (8.3%) who underwent a second TUR, with two patients (4.2%) being upstaged to T1. The median follow-up was 53 months. There were no significant differences between the two groups in RFS (p = 0.60), time to progression to MIBC (p = 0.63) or CSS (p = 0.18). These findings remained consistent in the matched cohort. Multivariate analysis revealed that a second TUR was not associated with improved RFS.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This is the first study to specifically address primary HG Ta bladder cancer, and it suggests that a second TUR may be omitted in selected cases, particularly when the initial resection is complete and the detrusor muscle is adequately sampled. A risk-adapted approach may help reduce unnecessary procedures without compromising oncological safety.</p>\u0000 </section>\u0000 </div>","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"6 9","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://bjui-journals.onlinelibrary.wiley.com/doi/epdf/10.1002/bco2.70082","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145057931","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":"Step-by-step: A traction-based fenestration method for vasoepididymostomy","authors":"Kosuke Kojo,&nbsp;Masahiro Uchida,&nbsp;Kazumitsu Yamasaki,&nbsp;Jaejeong Kim,&nbsp;Ayumi Nakazono,&nbsp;Daisuke Numahata,&nbsp;Takazo Tanaka,&nbsp;Hiroyuki Nishiyama,&nbsp;Tatsuya Takayama,&nbsp;Teruaki Iwamoto","doi":"10.1002/bco2.70088","DOIUrl":"10.1002/bco2.70088","url":null,"abstract":"&lt;p&gt;In this article, we present a practical technical tip for fenestrating the epididymal tubule during vasoepididymostomy (V-E)—a step that, to date, has rarely been described visually. Using simple illustrations, we aim to provide a clear visual guide for this crucial part of the procedure. V-E, a type of seminal-tract re-anastomosis for obstructive azoospermia, is regarded as one of the most technically demanding forms of male infertility microsurgery.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; The “intussusception method” (also known as the “invagination method”), in which the fenestrated epididymal tubule is pulled into the lumen of the vas deferens for an end-to-side anastomosis, is a widely adopted approach. Notably, “longitudinal intussusception vasoepididymostomy (LIVE)”—which involves placing two double-armed needles longitudinally in the outer wall of the epididymal tubule, then incising the space between them—has been reported to be both simpler and more effective than other V-E techniques. We also actively employ the LIVE method in our practice. Chan, one of the developers of LIVE, described using a 15° ophthalmic knife to make a longitudinal incision in the outer wall of the epididymal tubule during fenestration.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; However, we found it challenging to achieve a clean fenestration in a single pass, as the force applied by the microblade tip does not efficiently transmit to the soft outer wall. We suspect that, since Chan's original report, many surgeons have independently adopted minor modifications to overcome this challenge, but to our knowledge, such techniques have not been formally documented—likely due to their seemingly trivial nature.&lt;/p&gt;&lt;p&gt;After fenestration, the fluid leaking from the site is placed on a slide and examined immediately to confirm the presence of sufficient sperm. If no sperm are detected, a new fenestration is made slightly closer to the caput (the testicular end) of the epididymis, and the process is repeated. Fenestration sites not used for anastomosis are closed using absorbable suture and the tunica of the epididymis. Once a successful fenestration is achieved, we proceed with the standard LIVE technique: using the initially placed needles, we suture the mucosa of the vas deferens from inside to outside at four points, tying each suture to pull the epididymal tubule into the lumen of the vas deferens. Finally, we complete the anastomosis by suturing the tunica of the epididymis to the outer layer of the vas deferens with 9–0 nylon. A brief narrated video demonstrating Steps 1 and 2 and their integration into the standard LIVE workflow accompanies this article (Video 1).&lt;/p&gt;&lt;p&gt;Since 2015, our team has adopted this approach across multiple institutions, but some limitations of this visual technical tip should be noted. First, we did not directly compare clinical outcomes of this modification to those achieved with Chan's original LIVE method. Second, we have not quantitatively evaluated the extent to wh","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"6 9","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://bjui-journals.onlinelibrary.wiley.com/doi/epdf/10.1002/bco2.70088","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145062641","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}