BJUI compass最新文献

{"title":"3D anatomical digital twins: New generation virtual models to navigate robotic partial nephrectomy","authors":"Daniele Amparore,&nbsp;Alberto Piana,&nbsp;Federico Piramide,&nbsp;Sabrina De Cillis,&nbsp;Enrico Checcucci,&nbsp;Cristian Fiori,&nbsp;Francesco Porpiglia","doi":"10.1002/bco2.453","DOIUrl":"https://doi.org/10.1002/bco2.453","url":null,"abstract":"<p>Objective 3D virtual models have gained interest in urology, particularly in the context of robotic partial nephrectomy. From these, newly developed “anatomical digital twin models” reproduce both the morphological and anatomical characteristics of the organs, including the texture of the tissues they comprise. The aim of the study was to develop and test the new digital twins in the setting of intraoperative guidance during robotic-assisted partial nephrectomy (RAPN). Patient and Methods The production path of the 3D model-digital twin of an organ begins with a phantom of virtual elements, including the kidney's parenchyma, vessels, tumour and collecting system. Textures are created from intraoperative robotic surgery images using machine learning algorithms. The result is a 3D model - digital twin that replicates the organ's shape and appearance. Two surgeons, one experienced and one young, used both the standard 3D model and the digital twin in four surgical phases: identifying the organ and its boundaries, dissecting the vascular pedicle, isolating the neoplastic lesion and identifying the renal pelvis and ureter. Results 4 patients, 2 per each surgeon harbouring a low and intermediate complexity (PADUA 6 and 8) renal masses respectively, underwent RAPN. From the assessment made by the surgeons at the end of each procedure, the 3D digital twin models were found to be superior to their standard counterparts both in terms of concordance with real anatomy and in usefulness to guide the identification of the tumour, vascular pedicle and ureter, while they did not demonstrate significant advantages in identifying the kidney and its margins. Conclusions The new 3D digital twin models represent a step forward towards the personalization of virtual reconstructions. Approaching real anatomy more closely, they offer the surgeons a perceived higher degree of concordance with the intraoperative environment, making it easier to identify the structures of interest during the surgical procedure.</p>","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"6 3","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/bco2.453","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143581940","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":"Comparing GreenLight PVP and HoLEP beyond 5 years: A systematic review of long-term functional outcomes and reoperation rates","authors":"Arthur Yim,&nbsp;Matthew Alberto,&nbsp;Xingqi Yan,&nbsp;Damien Bolton,&nbsp;Lih-Ming Wong,&nbsp;Kapil Sethi","doi":"10.1002/bco2.483","DOIUrl":"https://doi.org/10.1002/bco2.483","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>This study aimed to compare long-term (≥ 5 years) functional outcomes and reoperation rates following holmium laser enucleation of prostate (HoLEP) vs GreenLight photoselective vaporisation of prostate (GLPVP).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>MEDLINE, Embase and Cochrane databases were searched from inception to December 2023. Included were randomised controlled trials (RCTs), cohort studies and case series studying HoLEP and/or GLPVP, where functional outcomes and reoperation rates were reported. Studies with &lt;5-year follow-up were excluded. Evidence was synthesised as a comparison across all parameters. Quality of evidence was assessed with the Newcastle–Ottawa Scale.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 3047 records identified, 25 were eligible, including two RCTs, two cohort studies, one cross-sectional study and 20 case series. Twenty-three studies focused on HoLEP or GLPVP, whilst two were comparative studies. HoLEP demonstrated long-term durability of outcomes and low reoperation rates (mean 4.1%, range 2.0%–6.3%) at a mean follow-up of 7.3 years. GLPVP also had durable outcomes at 5-year follow-up, but inconclusive evidence for improvements at 10 years. Reoperation rates were also higher (mean 12.6%, range 3.8%–33.3%). This is in keeping with findings of comparative studies, where HoLEP demonstrated greater improvements in all functional parameters except PVR, and lower reoperation rates. Findings are limited by patient attrition, lack of comparative studies and long-term data beyond 10 years. Three studies examined the 180-W GLPVP model at 5 years showed superior durability to earlier 80-W/120-W models.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Current evidence suggests that HoLEP provides significantly greater functional improvements and a lower reoperation rate when compared with the GLPVP 80-W/120-W model at 5-year follow-up. The 180-W model is comparable with HoLEP based on limited data at 5 years, but there is a lack of data beyond 10 years for longer-term functional outcomes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"6 2","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/bco2.483","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143431366","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":"Testosterone levels at diagnosis: A key predictor of overall survival among patients with prostate cancer","authors":"Ilkka Jussila,&nbsp;Juha P. Ahtiainen,&nbsp;Eija K. Laakkonen,&nbsp;Pirjo Käkelä,&nbsp;Maisa Parviainen,&nbsp;Heikki Pohjolainen,&nbsp;Jarno Aaltonen,&nbsp;Ninamaria Onni,&nbsp;Koskimaa Mikko,&nbsp;Teemu J. Murtola,&nbsp;Heini Huhtala,&nbsp;Heikki Seikkula","doi":"10.1002/bco2.484","DOIUrl":"https://doi.org/10.1002/bco2.484","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Objective</h3>\u0000 \u0000 <p>The exact relationship between testosterone levels at diagnosis and prostate cancer (PCa) prognosis remains inadequately explored. The objective was to determine whether serum testosterone levels at the time of PCa diagnosis are associated with overall survival.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Patients and Methods</h3>\u0000 \u0000 <p>The study cohort involved 2544 PCa patients, divided into three groups; normal (&gt;10.4 nmol/L), grey zone (8.0–10.4 nmol/L) and low (2.0–8.0 nmol/L) serum testosterone groups. Survival outcomes were analysed using Kaplan–Meier curves and Cox regression models.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The analysis revealed an increased risk of death among patients with low testosterone levels compared to those with normal levels in uni- (HR = 1.67, 95% CI: 1.37–2.05, <i>p</i> &lt; 0.001) and multivariable-adjusted (HR = 1.58, 95% CI: 1.24–1.98, <i>p</i> &lt; 0.001) analysis. Sensitivity analysis on patients with normal glucose metabolism revealed similar results (HR = 1.93, CI: 1.48–2.51, <i>p</i> &lt; 0.001), as well as after stratified with age below 70 years (HR = 1.55, 95% CI: 1.02–2.36, <i>p</i> &lt; 0.001) and over 70 years (HR = 1.83, 95% CI: 1.46–2.28, <i>p</i> &lt; 0.001.) There was no difference in survival between the grey zone compared to other testosterone groups. The retrospective design limits our ability to infer causality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Low testosterone at the time of PCa diagnosis is an independent predictor of overall survival. Findings highlight the potential of testosterone for prognostic evaluation in PCa.</p>\u0000 </section>\u0000 </div>","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"6 2","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/bco2.484","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143431271","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":"Expert consensus on Rezūm™: Indications, surgical technique and postoperative care","authors":"Emilio López Alcina,&nbsp;Manuel Fernández Arjona,&nbsp;Ester Fernández Guzmán,&nbsp;Jorge Rioja Zuazu,&nbsp;Iván Schwartzman Jochamowitz","doi":"10.1002/bco2.491","DOIUrl":"https://doi.org/10.1002/bco2.491","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Lower urinary tract symptoms associated to benign prostatic hyperplasia (LUTS/BPH) is a growing condition in males associated to a high clinical, economic and humanistic burden. Currently, there is a wide range of therapeutic options, both pharmacological and surgical. In recent years, several minimally invasive therapies have emerged, but they still have limitations. In this context, water vapour thermal therapy (WVTT), Rezüm™, is a new minimally invasive surgical technique with a low retreatment rate and the ability to preserve sexual function. The objective of this study is to establish recommendations for the correct execution of WVTT, as well as to define the ideal patient profile for the intervention.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A literature search was conducted in PubMed, without date limitations, using the terms ‘benign prostatic hyperplasia’, ‘benign prostatic enlargement’, ‘prostatic hyperplasia’, ‘bph’, ‘Rezūm’, ‘water vapour thermal therapy’, ‘quality of life’ and ‘HRQOL’. A systematic review of the evidence was conducted and subsequently discussed in a face-to-face meeting with a panel of five experts in the field of urology. The aspects addressed were classified into patient profile, pre-intervention, intervention and post-intervention.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The search returned 172 results, ultimately leading to the analysis of 49 articles. Evidence and expert opinion showed that WVTT could be a good option for patients with moderate to severe symptomatology, no age restriction, Qmax &lt;15 mL/s and prostate volume greater than 30 cm³, but not necessarily less than 80 cm³. Low retreatment rate and low impact on erectile capacity and ejaculatory function were also demonstrated.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>WVTT is considered a safe treatment option, even as a first-line approach for certain patient profiles. However, further research is needed in areas where evidence and clinical experience remain limited, including postoperative catheter management, anaesthesia, antibiotic prophylaxis and follow-up care for patients after the procedure.</p>\u0000 </section>\u0000 </div>","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"6 2","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/bco2.491","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143424053","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":"Method to determine the nadir PSA following partial gland ablation","authors":"Nelson N. Stone,&nbsp;Vassilios Skouteris,&nbsp;Rendi Shu,&nbsp;Richard G. Stock,&nbsp;Ben GL Vanneste","doi":"10.1002/bco2.496","DOIUrl":"https://doi.org/10.1002/bco2.496","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>The objective of this study is to propose a novel method of determining the nadir PSA (nPSA) for men with prostate cancer treated by partial gland ablation (PGA).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Methods</h3>\u0000 \u0000 <p>Two cohorts of men were analyzed to develop a formula for the nPSA in men undergoing PGA. First, 123 men with a suspicion of prostate cancer underwent transperineal mapping biopsy (TPMB) and found to have benign pathology. Their prostate-specific antigen (PSA) was compared to the prostate volume using curve estimation regression analysis. Second, the contribution of PSA from an ablated region was determined by using a surrogate of 545 men who had whole-gland brachytherapy followed by prostate biopsy. Biopsy results were compared to radiation dose (calculated as the biological equivalent dose) levels in men who were free from biochemical failure. The nPSA was then calculated by using the PSA density (PSAD) for the untreated volume plus the PSA from the post-brachytherapy patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The PSAD with the highest <i>R</i>² (0.80, <i>p</i> &lt; 0.001) for the 123 men who had TPMB and a negative biopsy was 0.12 ng/mL². In the brachytherapy patients, five 20 Gy dose groups were analyzed from ≤140 to ≥220 Gy, which demonstrated a progressive decrease in the positive biopsy rate to 1.5% at the highest dose (<i>p</i> = 0.036). PSA was &lt;0.2 ng/mL in 98.2% of these men. If brachytherapy was used for PGA and a dose of ≥ 220 Gy was delivered to the ablation zone, the nPSA could be calculated from the remaining untreated volume as: the [(pretreatment PV)–treated volume] ×0.12 ng/mL².</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>A method for determining the nPSA following PGA using brachytherapy was developed. The formula relies on complete ablation of the treated volume, which resulted in no PSA contribution from that component. Other forms of ablative energy should yield similar results. Further clinical validation of this concept is warranted.</p>\u0000 </section>\u0000 </div>","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"6 2","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/bco2.496","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143404583","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":"How to clean a catheter: Development of an intervention for intermittent catheter reuse","authors":"Sandra Wilks,&nbsp;Margaret Macaulay,&nbsp;Jacqui Prieto,&nbsp;Miriam Avery,&nbsp;Catherine Bryant,&nbsp;Debbie Delgado,&nbsp;Cathy Murphy,&nbsp;Nicola Morris,&nbsp;Mandy Fader","doi":"10.1002/bco2.487","DOIUrl":"https://doi.org/10.1002/bco2.487","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Objectives</h3>\u0000 \u0000 <p>Much intermittent catheterisation (IC) is carried out using single-use catheters. Waste and costs could be reduced by cleaning and reusing catheters, but is it safe to do so? To answer these questions of safety and sustainability, clinical trials are needed. In this study, we developed a user-tested catheter cleaning method and training materials for use in a clinical trial.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Focus groups selected candidate cleaning methods and developed draft instructions. Users then home tested these methods on uncoated, plastic-based catheters, which were cleaned and reused up to 28 times. Reused and cleaned catheters were analysed using advanced microbiological analysis methods. The refined cleaning method was further tested by a naïve user panel. Additionally, a silicone catheter designed for reuse was tested in the laboratory and for user acceptability. User panel feedback was gathered throughout testing and thematically analysed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Twenty-six IC users were recruited to three user panels. Focus groups identified soap and water (SW) and soap and water plus a 15-minute soak in a chlorine-based cleaning solution (SW-Cl) as the preferred cleaning methods. User testing (≤3 reuses) and laboratory analysis showed SW alone to be less effective than SW-Cl: bacteria were detected in 23/120 (19%) male and 56/108 (52%) female SW samples versus 16/228 (7%) and 16/201 (8%) for SW-Cl. Bacteria were detected in only 1/240 (&lt;0.5%) of catheter samples after 8–≥28 reuses with the SW-Cl method. Naïve user panel results were similar. The silicone catheter was acceptable to users and had comparable laboratory results using SW-Cl. User panel feedback informed refinement and simplification of the SW-Cl cleaning method and instructions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>A chlorine-based method for cleaning catheters, which effectively removed bacteria from catheters reused multiple times, has been developed, tested and refined by users, and captured in an instruction booklet and video for inclusion in a clinical trial.</p>\u0000 </section>\u0000 </div>","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"6 2","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/bco2.487","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143112065","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":"Sociodemographic landscape of suspected prostate cancer referrals and diagnoses across North East London","authors":"Muhammad Haider,&nbsp;Jeffrey J. Leow,&nbsp;James S. A. Green,&nbsp;Chamkhor Dhillon,&nbsp;Angela S. Wong,&nbsp;Yin Zhou,&nbsp;Sara Paparini,&nbsp;Benjamin W. Lamb,&nbsp;Prabhakar Rajan,&nbsp;for the North East London Cancer Alliance Urology Expert Reference Group","doi":"10.1002/bco2.495","DOIUrl":"https://doi.org/10.1002/bco2.495","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>The objective of this study is to identify healthcare inequities in referrals and diagnoses of suspected prostate cancer (PCa) in an ethnically diverse and socially deprived large urban region.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Retrospective cohort study of 2-Week Wait (2WW) suspected PCa patients (<i>n</i> = 12 947) referred to two acute NHS Trusts in North East London (NEL) from February 2019 to August 2023. Sociodemographics, diagnosis and pretreatment staging data were collected from patient records. We examined referral and diagnosis statistics, age at referral, radiological T-stage at diagnosis, levels of deprivation by ethnicity and the impact of COVID-19 pandemic lockdowns on proportion of referrals and diagnoses by ethnicity and T-stage at diagnosis. Uni- and multivariable logistic regression was performed to identify predictors of locally advanced (T-stage ≥T3) disease.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of all referrals, 22% were diagnosed with PCa. There were no statistically significant differences in referrals, diagnoses or T-stage of PCa by ethnicity during COVID lockdown versus non-lockdown periods (<i>p</i> &gt; 0.05). Compared to men from any other ethnicity, Black men (from Black British, Black African and Black Caribbean ethnic groups) were diagnosed at a younger age (mean = 65 years), had the highest age-adjusted PCa incidence rate of 149 per 100 000 person-years, were from the most deprived backgrounds, and were diagnosed with the highest proportion of localised PCa (74%). Multivariable analysis of a patient subgroup revealed age bands 71–80 years (OR 2.01, 95% CI 1.31–3.07) and &gt;80 (OR 4.27, 95% CI 2.25–8.08) as independent positive predictors of locally advanced PCa, and Black ethnicity as an independent predictor of localised disease (OR 0.66, 95% CI 0.43–1.00). Limitations of this study include the exclusion of PCa cases diagnosed outside the 2WW pathway, as well as missing data on Prostate-Specific Antigen (PSA) levels, distant radiological staging and histopathological findings.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>We identify disparities in PCa incidence, stage and age at presentation, as well as socio-economic deprivation among Black men in NEL. Targeted efforts are needed to mitigate these healthcare inequities.</p>\u0000 </section>\u0000 </div>","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"6 2","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/bco2.495","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143112064","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":"Impact of pre-stenting and bladder dranaige on intrapelvic pressure during retrograde intrarenal surgery","authors":"Sezgin Yeni,&nbsp;Hakan Kilicarslan,&nbsp;Gokhan Ocakoglu,&nbsp;Burhan Coskun,&nbsp;Mehmet Cagatay Cicek,&nbsp;Kadir Omur Gunseren,&nbsp;Ismet Yavascaoglu,&nbsp;Onur Kaygisiz","doi":"10.1002/bco2.490","DOIUrl":"https://doi.org/10.1002/bco2.490","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>This study aims to assess the effect of pre-stenting and bladder drainage on intrapelvic pressure (IP) during Retrograde Intrarenal Surgery (RIRS).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Eighty-five consecutive patients were prospectively enrolled and meticulously recorded in a data form. Forty-two patients meeting the inclusion criteria after applying exclusion factors. The patients were divided into two groups: Group 1 (21 patients with preoperative JJ stents) and Group 2 (21 patients without preoperative JJ stents). IP was measured during RIRS, and the impact of various factors, including pre-stenting, bladder drainage and hydronephrosis (HN) grade, on IP was analysed through univariate and multiple linear regression.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The perioperative mean highest IP (78 ± 18.2 mmHg vs. 110 ± 23.9 mmHg), median lowest IP (29 mmHg vs. 42 mmHg) and median overall IP (41 mmHg vs. 69 mmHg) were significantly lower in Group 1 compared to Group 2 (all p &lt; 0.001). Multivariate analysis showed that pre-stenting and mild HN (Grade 0–1) were independent predictors of reduced IP.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Pre-stenting led to a significant reduction in IP during RIRS, likely due to passive ureteral dilation. Additionally, bladder drainage with urethral catheter further decreased IP. These findings suggest that pre-stenting and bladder drainage should be considered as strategies to reduce IP during RIRS, potentially improving surgical outcomes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"6 2","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/bco2.490","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143112123","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":"Retzius-sparing radical prosatectomy: First 200 Australian cases","authors":"Troy Richard John Gianduzzo,&nbsp;Philip Ellard Dundee","doi":"10.1002/bco2.489","DOIUrl":"https://doi.org/10.1002/bco2.489","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>The objective of this study is to report the first multi-centred Australian series of 200 cases of Retzius-sparing radical prostatectomy (RSRP).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Patients and methods</h3>\u0000 \u0000 <p>Between April 2017 and June 2024, 200 RSRP procedures (197 robotic, three laparoscopic) were performed separately by the authors in five centres across two Australian cities (Melbourne, Victoria and Brisbane, Queensland). Data were collected prospectively with ethics committee approval (UCH-HREC 2019.01.279) at weeks 1, 4–6, and three-monthly. Exclusion criteria included prostate size &gt;80 cc, significant middle lobe, large anterior tumour, previous TURP or any clinical factor deemed to make RSRP unsuitable. These criteria were relaxed as experience was gained.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Median (interquartile range) age, body mass index and PSA were 65 (60–70) years, 26 (25–29) kg/m² and 5.2 (4.0–7.0) ng/mL. Low, intermediate and high D'Amico risk groups were 3.5%, 75.0% and 21.5%, respectively. Median (interquartile range) skin-to-skin operative time was 163 (125–210) min and blood loss 200 (100–350) mL. There were 17 (8.5%) Clavien–Dindo grade 1–2 complications and 8 (4%) grade 3 complications. Final pT stage was 60.5% pT2 and 39.5% pT3. The overall positive surgical margins (PSM) rate was 14.5% including 3.3% pT2 and 29.1% pT3. At 1 week post catheter removal 53.5% were pad-free, increasing to 58.5% and 65.0% at 4 and 6 weeks, then 79.5%, 84.6%, 88.2% and 91.3% at 3, 6, 9 and 12 months, respectively. When a security pad is included, 71.5% and 85.5% of men were continent at 4 and 6 weeks, then 94%, 96%, 96% and 97% at 3, 6, 9 and 12 months, respectively. Three men required a suburethral sling and one an artificial urinary sphincter. Ninety of 140 (60.4%) preoperatively potent men were potent at 12 months with or without phosphodiesterase-5 inhibitors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>RSRP provides excellent early continence and can be introduced safely with good oncological results by experienced minimally- invasive surgeons.</p>\u0000 </section>\u0000 </div>","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"6 2","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/bco2.489","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143112122","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":"Impact of prostate cancer screening in European ancestry un-affected men with germline DNA repair pathogenic variants","authors":"Vittorio Fasulo,&nbsp;Giuseppe Chiarelli,&nbsp;Giuseppe Garofano,&nbsp;Carla Barbara Ripamonti,&nbsp;Monica Barile,&nbsp;Paolo Bianchi,&nbsp;Emanuela Morenghi,&nbsp;Alessio Benetti,&nbsp;Muhannad Aljoulani,&nbsp;Alessio Finocchiaro,&nbsp;Marco Paciotti,&nbsp;Pier Paolo Avolio,&nbsp;Edoardo Beatrici,&nbsp;Paola Arena,&nbsp;Alberto Saita,&nbsp;Rodolfo Hurle,&nbsp;Federica Maura,&nbsp;Giorgio Da Rin,&nbsp;Rosanna Asselta,&nbsp;Anita Capalbo,&nbsp;Giulia Soldà,&nbsp;Paolo Casale,&nbsp;Nicolò Maria Buffi,&nbsp;Giovanni Lughezzani,&nbsp;Massimo Lazzeri","doi":"10.1002/bco2.424","DOIUrl":"https://doi.org/10.1002/bco2.424","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Objective</h3>\u0000 \u0000 <p>Prostate cancer (PCa) is a significant global health concern, ranking as the second most prevalent cancer among men worldwide. Genetic factors, particularly germline pathogenic variants (PVs) in DNA repair genes (DRGs), play a crucial role in PCa predisposition. Our study aimed to assess patients' adherence to a targeted PCa screening program targeting high-risk individuals with DRG PVs and evaluate the potential reduction in biopsy and MRI rates by employing our screening protocol.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a prospective ongoing trial evaluating targeted PCa screening in men with documented PVs in DRGs. Screening involved annual assessment of medical history, physical examination, prostate-specific antigen (PSA) testing, Prostate Health Index (PHI), and multiparametric magnetic resonance imaging (mpMRI) when indicated. Descriptive statistics were used to analyse patient characteristics, and adherence to screening was evaluated at three time points: baseline (T0), one year (T1), and two years (T2) from enrolment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Key Findings and Limitations</h3>\u0000 \u0000 <p>A total of 101 high-risk individuals were enrolled, with a median age of 52 years. Adherence to screening was high, with 72.3% of patients attending the first annual follow-up (T1) and 100% attending the second follow-up (T2). Despite elevated PSA levels in some patients, no PCa was detected during the study period. However, our screening protocol demonstrated the potential in reducing unnecessary biopsies and MRIs, particularly in patients with elevated PSA but low PHI values. Limitations include the ongoing nature of the study, small sample size, and lack of non-carrier controls.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions and Clinical Implications</h3>\u0000 \u0000 <p>Our findings described a new PCa screening strategy integrated with genetic risk factors. The incorporation of PHI shows promise in improving the efficiency of diagnostic procedures while minimizing unnecessary interventions. High adherence among high-risk individuals underscores the potential effectiveness of targeted screening programs.</p>\u0000 </section>\u0000 </div>","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"6 3","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/bco2.424","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143581984","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}