BJU International最新文献

{"title":"Comparative effectiveness of apalutamide-, abiraterone-, and enzalutamide-based doublets in mHSPC.","authors":"Anikó Katalin Valikovics, Dániel Bacsó, Nadeen Samaien, Isabel Pinto Amorim das Virgens, Mahmoud Obeidat, Gergely Bánfi, Boris Hadaschik, Péter Hegyi, Péter Nyirády, Tibor Szarvas","doi":"10.1111/bju.70438","DOIUrl":"https://doi.org/10.1111/bju.70438","url":null,"abstract":"<p><strong>Background and objective: </strong>Treatment of metastatic hormone-sensitive prostate cancer (mHSPC) has evolved from androgen-deprivation therapy (ADT) alone to combination therapy with androgen receptor pathway inhibitors. Although apalutamide (APA), abiraterone (ABI), and enzalutamide (ENZA) improve outcomes when added to ADT, direct comparative trials between androgen receptor pathway inhibitor-based doublets are lacking.</p><p><strong>Methods: </strong>Our systematic search was conducted on 22 September 2025, in PubMed, Embase, and the Cochrane Library databases. Studies including patients with mHSPC treated with APA, ABI, or ENZA plus ADT were eligible if they contained real-world data and reported at least one outcome: overall survival (OS), PSA50, PSA90, PSA ≤0.2 ng/mL, time to castration-resistant prostate cancer, biochemical progression-free survival, grade ≥3 adverse events, or treatment discontinuation (TDC). Pooled hazard ratios (HRs) and odds ratios (ORs) were calculated using inverse variance random-effects models.</p><p><strong>Key findings and limitations: </strong>In total, 17 retrospective studies comprising 18 626 patients were included. Compared with ABI, APA was associated with improved OS (HR 1.27; 95% confidence interval [CI] 1.09-1.47; P = 0.002), PSA90 (OR 0.70; 95% CI 0.54-0.91; P = 0.019), PSA <0.2 ng/mL (OR 0.49; 95% CI 0.25-0.95; P = 0.039), and castration-resistant prostate cancer (HR 1.40; 95% CI 1.05-1.88; P = 0.023). APA also demonstrated higher PSA90 response rates than ENZA (OR 0.67; 95% CI 0.5-0.9; P = 0.017). TDC due to adverse events was lower with ABI than with APA (OR 0.56; 95% CI 0.37-0.86; P = 0.029), with no significant difference between ENZA and APA (P = 0.10).</p><p><strong>Conclusions and clinical implications: </strong>In real-world settings, APA-based doublets were associated with more favourable efficacy outcomes with ABI, whereas ABI- and ENZA-based regimens were associated with lower TDC rates. ABI and ENZA demonstrated comparable efficacy and safety profiles, supporting individualized ARPI selection in mHSPC.</p>","PeriodicalId":8985,"journal":{"name":"BJU International","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148863289","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comment on 'Novel MRI-US fusion with advanced annotation in focal cryoablation for prostate cancer: medium-term outcomes and learning curve insights'.","authors":"Longtu Ma, Rui Lu, Zhilong Dong","doi":"10.1111/bju.70197","DOIUrl":"10.1111/bju.70197","url":null,"abstract":"","PeriodicalId":8985,"journal":{"name":"BJU International","volume":" ","pages":"508-509"},"PeriodicalIF":4.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13458641/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147364066","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bladder preservation with systemic therapy alone: are we losing sight of survival?","authors":"Alec Zhu, Pierre-Etienne Gabriel, John P Sfakianos","doi":"10.1111/bju.70441","DOIUrl":"https://doi.org/10.1111/bju.70441","url":null,"abstract":"","PeriodicalId":8985,"journal":{"name":"BJU International","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148863324","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Kidney stones composition prediction using artificial intelligence ( KiSCAI) study","authors":"Louise Duffaut, Pietro Scilipoti, Zine‐Eddine Khene, Steeve Doizi, Vincent Frochot, Laurent Berthe, Federico Zorzi, Nicola Nannola, Carlos Gonzalez Gonzalez, Jean Philippe Haymann, Emmanuel Letavernier, Michel Daudon, Olivier Traxer, Marie Chicaud, Frédéric Panthier","doi":"10.1111/bju.70442","DOIUrl":"https://doi.org/10.1111/bju.70442","url":null,"abstract":"Objectives To develop and validate explainable machine learning (ML) models predicting urinary stone composition from routinely available clinical variables and standardised morphological features, and to quantify the incremental value of morphology. Patients and Methods This retrospective cohort study included consecutive patients undergoing endourological treatment or spontaneous stone expulsion, with laboratory analysis showing a major component exceeding 50% of stone composition, between 2019 and 2024. The outcome was dominant stone composition, classified into five categories: calcium oxalate monohydrate (COM), calcium oxalate dihydrate (COD), calcium phosphate, uric acid, and cystine. Predictors included demographics, comorbidities, stone metrics, procedural details, and Daudon‐based morphological descriptors. Data were split into stratified training and validation cohorts (80% and 20%, respectively). Predictor stability was assessed using repeated‐resampling multiclass Least Absolute Shrinkage and Selection Operator (LASSO). Multiple supervised classifiers (logistic regression, support vector machine, random forest, ExtraTrees, Adaptive Boosting [AdaBoost] variants, Extreme Gradient Boosting [XGBoost], Categorical Boosting [CatBoost]) were fine‐tuned using GridSearch. Discrimination was assessed using macro‐averaged one‐vs‐rest area under the curve (AUC) and accuracy. Explainability relied on SHapley Additive exPlanations (SHAP). Results Among 442 patients (median age 51 years; 67% male), stone composition was COM in 41.0% ( <jats:italic>n</jats:italic> = 181), COD in 24.9% ( <jats:italic>n</jats:italic> = 110), calcium phosphate in 19.7% ( <jats:italic>n</jats:italic> = 87), uric acid in 10.9% ( <jats:italic>n</jats:italic> = 49), and cystine in 3.6% ( <jats:italic>n</jats:italic> = 16). LASSO stability highlighted reproducible predictors, including age, hereditary disease type, stone density, maximal diameter, and location. Clinical‐only models achieved good discrimination (macro‐AUC up to 0.809). Adding morphological features markedly improved performance, with ensemble models achieving excellent discrimination in validation (macro‐AUC up to 0.983 with CatBoost). Morphological variables ranked among the strongest contributors on SHAP. Conclusions A clinical‐only model can predict the major stone component and may support preoperative decision‐making. Performance further improved when morpho‐constitutional features were added, confirming Daudon's classification as the ground truth; however, this combined model relies on intra‐ and postoperative descriptors and is best regarded as an intra‐ or postoperative decision‐support tool rather than a preoperative one. External prospective validation is needed before clinical implementation.","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"9 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148858719","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sexual satisfaction, sexual function, and orgasm after gender‐affirming vaginoplasty and vulvoplasty","authors":"Harland V. Harrison, Geolani W. Dy, Daniel Dugi, Blair Peters, Jyoti Chouhan, Mallery Jenna Robinson, Jade Johnson, R. Craig Sineath","doi":"10.1111/bju.70391","DOIUrl":"https://doi.org/10.1111/bju.70391","url":null,"abstract":"Objectives To examine sexual satisfaction, function, and orgasm following genital gender‐affirming surgeries (GGAS) among transgender and gender‐diverse (TGD) patients; we used the GENDER‐Q, a validated instrument for TGD individuals seeking gender‐affirming care that enables a more comprehensive evaluation of sexual experience. Patients and Methods Our cross‐sectional survey was distributed via e‐mail to patients; surveys were completed in May 2025. The primary outcome was sexual satisfaction measured by the GENDER‐Q Sexual Well‐Being scale. Secondary outcomes measured the relationship between ability to orgasm and orgasm changes pre‐ and postoperatively with identity, sexual wellness, social acceptance, body image, mental health, and surgical outcomes. Results Of 765 eligible individuals, 295 (39%) responded; 103 (35%) underwent vulvoplasty and 192 (65%) underwent vaginoplasty. In all, 89% were transgender women, and 80% were at least 1‐year postoperative. Sexual satisfaction did not differ by age, surgery type, race/ethnicity, revision history, timing of first postoperative orgasm, or anxiety symptomology. Higher sexual satisfaction was associated with postoperative orgasm and absence of orgasm‐related pain and correlated positively with higher scores on the GENDER‐Q Orgasm, Social Acceptance, Surgery Outcome, and Body Image scales. In all, 80% of participants able to orgasm preoperatively reported postoperative orgasm, while 29% who did not experience orgasm preoperatively achieved orgasm postoperatively. Inability to orgasm postoperatively was associated with older age and lower Sexual Well‐Being and Surgery Outcome scores. Conclusion These findings underscore the multifactorial nature of sexual well‐being after GGAS and highlight the value of assessing sexual function before and after surgery. Longitudinal studies are needed to further characterize sexual health trajectories following GGAS.","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"5 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148842809","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sexual function after prostate cancer surgery or radiotherapy in an international registry.","authors":"Y Hess-Busch, C Darr, L Püllen, M Al-Nader, M Wahl, A V Bailey, H Wilhalme, J Lee, B Hadaschik, J Hess","doi":"10.1111/bju.70431","DOIUrl":"https://doi.org/10.1111/bju.70431","url":null,"abstract":"<p><strong>Objectives: </strong>Our objective was to evaluate patient-reported sexual function (SF) outcomes and sexual aid use 12 months after curative treatment for prostate cancer (PC).</p><p><strong>Patients & methods: </strong>This prospective registry-based cohort study analysed men with localized or locally advanced PC enrolled in the TrueNTH Global Registry. Patients with baseline and 12-month patient-reported outcome measures after radical prostatectomy (RP), external beam radiotherapy (EBRT) ± androgen-deprivation therapy (ADT), or brachytherapy (BT) were included. SF was assessed using the EPIC-26 sexual function domain score (SFDS). Baseline and 12-month EPIC-26 SFDS were compared by treatment group, with additional analyses among RP patients examining outcomes by intent to nerve spare and sexual aid use. Linear regression, adjusted for age, National Comprehensive Cancer Network risk group, baseline SFDS, and intent to nerve spare was used to identify predictors of 12-month SFDS among surgery patients.</p><p><strong>Results: </strong>Overall, 13 413 men were analysed (RP 85.2%, EBRT only 9.1%, EBRT+ADT 4.3%, BT 1.3%). SF declined significantly across all modalities. Median SFDS reduction was greatest after RP (-60.0%) and smallest after BT (-40.2%). At 12 months, poor or absent erectile function was reported by 63.6-91.8% of patients, highest after RP and EBRT+ADT. Sexual aid use increased after treatment but remained low overall. Given the retrospective design and non-representative sites in an international registry setting, these findings should be interpreted as associational rather than causal because of the potential for unmeasured confounding and cross-country heterogeneity in treatment selection.</p><p><strong>Conclusion: </strong>All curative PC treatments were associated with substantial deterioration in SF. These findings support enhanced pre-treatment counselling and early integration of proactive management and structured sexual rehabilitation into survivorship care.</p>","PeriodicalId":8985,"journal":{"name":"BJU International","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148817144","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction to \"Active surveillance for patients with prostate cancer aged ≥75 years: the Prostate Cancer Research International: Active Surveillance (PRIAS)-JAPAN study\".","authors":"","doi":"10.1111/bju.70437","DOIUrl":"https://doi.org/10.1111/bju.70437","url":null,"abstract":"","PeriodicalId":8985,"journal":{"name":"BJU International","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148817125","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Identifying the ideal candidate for irreversible electroporation in localized prostate cancer: a comprehensive narrative review from the EAU Section of Endourology.","authors":"Raffaele La Mura, Giuseppe Maiolino, Julien Anract, Massimo Valerio, Clement Orczyk, Ben Vanneste, Federico Zorzi, João Paulo Barbosa de Oliveira, Juan Ignacio Martínez-Salamanca, Eric Barret","doi":"10.1111/bju.70436","DOIUrl":"https://doi.org/10.1111/bju.70436","url":null,"abstract":"<p><strong>Background and objective: </strong>Irreversible electroporation (IRE) is an emerging non-thermal focal therapy for localized prostate cancer (PCa), offering tissue-selective ablation with functional preservation. This review aimed to delineate the 'ideal' candidate for primary IRE and provide practical guidance.</p><p><strong>Methods: </strong>A narrative review (2014-2025) of primary IRE for localized PCa was conducted, including prospective series, multicentre registries, comparative studies, and systematic reviews. We synthesized baseline characteristics, lesion features, ablation strategy, oncologic/functional outcomes, and complications, focusing on cancer control and safety.</p><p><strong>Results: </strong>The best outcomes were reported in men with magnetic resonance imaging-visible, organ-confined intermediate-risk (International Society for Urological Pathology [ISUP] 2-3) PCa, typically presenting a single dominant unilateral index lesion characterized by multiparametric MRI and biopsy. Contemporary series show in-field ablation of clinically significant cancer in ~80-90% with high functional preservation. The main limitation is out-of-field recurrence (~15-25% of failures), reflecting PCa multifocality. In-field persistence at 12 months was ~16% in the PRESERVE trial. Lesion size is a key practical constraint; current evidence and electrode geometry favour targets generally ≤20 mm. Limited comparative evidence, largely from a single study, suggests better oncologic control with hemi-gland IRE (clinically significant PCa persistence 8.6%) versus focal ablation (25%), whereas focal IRE better preserves erectile function.</p><p><strong>Conclusions and clinical implications: </strong>Primary IRE appears safe and effective in selected localized PCa. The ideal candidate has unilateral MRI-visible, organ-confined ISUP 2-3 disease, prostate-specific antigen density <0.15-0.20 ng/mL/cm³, and a lesion small enough for reliable electrode coverage. Hemi-gland templates may improve oncologic reliability, whereas focal ablation maximizes functional outcomes.</p><p><strong>Patient summary: </strong>IRE is a focal, non-thermal treatment for localized PCa that can control the treated lesion while usually preserving urinary continence and often erectile function. Cancer can still occur elsewhere in the prostate after treatment, so follow-up is essential.</p>","PeriodicalId":8985,"journal":{"name":"BJU International","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148817190","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The physiology of the upper urinary tract in endourological times – a narrative review","authors":"Emmeli Grøne Lykkegaard, Anne Sofie Peetz Brandt, Louise Faurholt Øbro, Helene Jung","doi":"10.1111/bju.70434","DOIUrl":"https://doi.org/10.1111/bju.70434","url":null,"abstract":"Objective To synthesise current knowledge of upper urinary tract (UUT) physiology in the context of contemporary endourology, with particular emphasis on the interacting biological stressors associated with endourological intervention and the tissue responses they provoke. Patients and Methods A narrative review of the literature was conducted using PubMed/MEDLINE. Relevant experimental, translational and clinical studies examining UUT physiology, tissue injury and biological responses to ureteroscopy, percutaneous nephrolithotomy, irrigation and intrarenal pressure, laser lithotripsy, suction‐assisted technologies, intracavitary therapies and ureteral stents were considered. Results The UUT is a biologically active organ whose function depends on coordinated peristalsis, urothelial barrier integrity, pressure regulation and preserved tissue perfusion. Contemporary endourological procedures expose the UUT to interacting mechanical, pressure‐related, parenchymal, thermal and chemical stressors that may influence urothelial permeability, intrarenal backflow, inflammation, tissue repair and fibrosis. Tissue tolerance appears to vary considerably between individuals and may be influenced by factors including hydronephrosis, collecting‐system compliance and papillary morphology. Despite these biological effects, current outcome assessment remains predominantly focused on technical success, while physiological and biological safety endpoints remain poorly defined. Conclusion Future advances in endourology should integrate physiological and biological outcome measures alongside traditional surgical metrics. Improved understanding of UUT physiology and tissue responses may help define evidence‐based thresholds and support endourological treatment that is both technically effective and biologically safe.","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"159 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148809933","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diet and risk of bladder cancer: a systematic review of epidemiological evidence.","authors":"Keiichiro Miyajima, Marcin Miszczyk, Navid Roessler, Shota Inoue, Paweł Rajwa, Akihiro Matsukawa, Fumihiko Urabe, Keiichiro Mori, Takafumi Yanagisawa, Pierre I Karakiewicz, Jeremy Yuen-Chun Teoh, Alberto Briganti, Lin Yang, Eva Schernhammer, Takahiro Kimura, Shahrokh F Shariat","doi":"10.1111/bju.70435","DOIUrl":"https://doi.org/10.1111/bju.70435","url":null,"abstract":"<p><strong>Purpose: </strong>Although tobacco use and occupational exposures are established risk factors for urothelial cancer (UC), the influence of dietary factors remains uncertain. We conducted a systematic review to synthesize evidence from prospective cohort studies examining associations between dietary exposures and UC incidence.</p><p><strong>Methods: </strong>A comprehensive literature search of MEDLINE, Embase, and Web of Science (May 2025) was performed to identify prospective studies evaluating dietary factors with UC incidence. The risk of bias was assessed using standard tools (CRD420251043101).</p><p><strong>Results: </strong>From 6253 records screened, 32 prospective cohort studies were included, encompassing 2 277 677 participants. Investigated exposures included fluid intake (four studies, n = 562 038), coffee (four, n = 1 013 624), milk (three, n = 613 141), tea (three, n = 532 949), alcohol (three, n = 694 585), fruits (three, n = 597 753), vegetables (three, n = 555 685), protein (two, n = 469 339), fibre (two, n = 466 577), and cruciferous vegetables (two, n = 1 071 313). Only one study specifically assessed upper tract urothelial carcinoma (n = 80 388). Two studies suggested a borderline inverse association between high fluid intake and bladder cancer (BC) risk (upper 95% confidence interval >0.95), whereas two others found no such association. Three of four coffee studies reported no significant association after adjustment for smoking; one reported a modest increased risk. Fruit and vegetable intake showed modest inverse associations with BC risk in three studies. Most included studies were at moderate risk of bias, and residual confounding-particularly by smoking-remains a concern.</p><p><strong>Conclusion: </strong>Available evidence does not support a strong or consistent association between dietary factors and BC incidence. Although a healthy diet is beneficial for overall well-being, patients should be informed that dietary modifications alone are unlikely to meaningfully alter their BC risk.</p>","PeriodicalId":8985,"journal":{"name":"BJU International","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148808004","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}