BJU International最新文献

{"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":"10.1111/bju.70437","url":null,"abstract":"","PeriodicalId":8985,"journal":{"name":"BJU International","volume":" ","pages":"932"},"PeriodicalIF":4.1,"publicationDate":"2026-11-01","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":"Endoscopic kidney-sparing surgery for upper tract urothelial carcinoma in patients with a solitary kidney.","authors":"Pietro Scilipoti, Federico Zorzi, Carlos Gonzalez Gonzalez, Nicola Nannola, Stefano Moretto, Letizia Maria Ippolita Jannello, Ugo Gradilone, Marie Chicaud, Andrea Folcia, Angelo Occhi, Andrea Cosenza, Giuseppe Rosiello, Eugenio Ventimiglia, Luigi Candela, Francesco Montorsi, Alberto Briganti, Andrea Salonia, Marco Moschini, Steeve Doizi, Frederic Panthier, Luca Villa, Olivier Traxer","doi":"10.1111/bju.70454","DOIUrl":"10.1111/bju.70454","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate cancer control, renal function trajectories, and dialysis risk in patients with a solitary kidney treated with endoscopic kidney-sparing surgery (eKSS) for upper tract urothelial carcinoma (UTUC).</p><p><strong>Patients and methods: </strong>We conducted a retrospective multicentre cohort study including 62 consecutive patients with UTUC and a solitary kidney treated with primary eKSS between 2006 and 2024 at two tertiary referral centres. All patients underwent ureteroscopic biopsy and laser ablation followed by intensified surveillance with mandatory second-look ureteroscopy and repeat retreatment as needed. Primary endpoints were upper tract recurrence, progression, cancer-specific mortality, and dialysis dependency. Competing-risk cumulative incidence functions and linear mixed-effects models were used.</p><p><strong>Results: </strong>Median age was 71 years (interquartile range [IQR] 67-77), and baseline estimated glomerular filtration rate (eGFR) was 48 mL/min/1.73 m² (IQR 40-70). High-grade disease at initial ureteroscopy was present in 12 patients (19%). Over a median follow-up of 65 months, patients underwent a median of five ureteroscopies (IQR 3-9), and 16 (26%) ultimately underwent radical nephroureterectomy. The cumulative incidence of upper tract recurrence was 70% (95% confidence interval [CI] 58-83) at 5 years. The 5-year cumulative incidence of progression was 40% (95% CI 26-54). Cancer-specific mortality was 20% (95% CI 7.9-32) at 5 years. Dialysis dependency occurred in 32% (95% CI 18-45) at 5 years, predominantly among patients with baseline eGFR <30 mL/min/1.73 m² (hazard ratio 5.68; 95% CI 1.20-27.0, P = 0.029). Mixed-effects modelling showed a mean annual eGFR decline of 2.9 mL/min/1.73 m² (95% CI 1.2-4.6).</p><p><strong>Conclusions: </strong>In patients with UTUC and a solitary kidney, eKSS delivered within an intensive surveillance programme provided durable renal preservation with acceptable oncological outcomes. Despite frequent recurrences requiring repeated ureteroscopic interventions, cancer-specific mortality remained limited, supporting eKSS as a viable alternative to radical nephroureterectomy in imperative clinical settings.</p>","PeriodicalId":8985,"journal":{"name":"BJU International","volume":" ","pages":"894-904"},"PeriodicalIF":4.1,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148982114","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":"Generating a consensus on the follow-up of multifocal high-grade prostate intraepithelial neoplasia.","authors":"Charles Carey, Sashi S Kommu","doi":"10.1111/bju.70321","DOIUrl":"10.1111/bju.70321","url":null,"abstract":"","PeriodicalId":8985,"journal":{"name":"BJU International","volume":" ","pages":"929-930"},"PeriodicalIF":4.1,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148041191","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":"Impact of operative time on complications after PCNL in the elderly (aged ≥70 years): the Safety and Efficacy of Nephrolithotomy in Older patients undergoing PCNL (SENIOR-PCNL) study.","authors":"Łukasz Nowak, Wojciech Krajewski, Bhaskar Somani, Tomasz Szydełko, Vineet Gauhar, Steffi Kar Kei Yuen, Matthias Boeykens, Thomas Tailly, Ioannis Mykoniatis, Alba Sierra, Emre T Sener, Vincent De Coninck, Rifat Burak Ergul, Alberto Olivero, Lazaros Tzelves, Francesco Esperto, Angelis Peteinaris, Yuigi Yuminaga, Qi Hou, Patrick Juliebø-Jones, Arman Tsaturyan, Bartosz Małkiewicz, Agata Góral, Paulina Biesiadecka, Francisco Javier Lopez Vivo, Mantu Gupta, Juan Serna, Ziv Savin, Anastasios Anastasiadis, Dimitrios Memmos, Charlotte Slots, Rita Pages, Ceyhun Ozdemiroglu, Maria Florencia Frascheri, Rafael Carrasco Moreno, Eugenio Ventimiglia, Panagiotis Kallidonis, Evangelos Liatsikos, Otas Durutovic, Amelia Pietropaolo, Begoña Ballesta Martinez","doi":"10.1111/bju.70440","DOIUrl":"10.1111/bju.70440","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate the association between operative time (OT) and postoperative complications after percutaneous nephrolithotomy (PCNL) in elderly patients, and to identify a clinically meaningful OT threshold for risk stratification.</p><p><strong>Patients and methods: </strong>A retrospective international multicentre study was performed including patients aged ≥70 years who underwent PCNL between January 2014 and February 2025 across 21 centres in 15 countries. Postoperative complications within 30 days were analysed as overall, major, and infectious events. The optimal OT threshold was determined using receiver operating characteristic (ROC) analysis, whereas the association between OT and postoperative outcomes was evaluated using multivariable logistic regression and adjusted restricted cubic spline models.</p><p><strong>Results: </strong>Among 716 patients, 120 (16.8%) developed postoperative complications; 49 (6.8%) had major and 49 (6.8%) infectious complications. ROC analysis identified a common OT threshold around 95 min. An OT ≥95 min was independently associated with overall complications (odds ratio [OR] 3.37, 95% confidence interval [CI] 2.16-5.26), major complications (OR 2.63, 95% CI 1.35-5.10), and infectious complications (OR 3.79, 95% CI 1.90-7.57). The highest discriminative performance was observed for infectious complications (multivariable model area under the curve 0.77). Restricted cubic spline analysis confirmed significant non-linear associations between OT and all outcomes, with a steeper increase in adjusted complication probability beyond approximately 90-100 min. Non-papillary puncture was independently associated with all complication types, while positive preoperative urine culture predicted infectious complications.</p><p><strong>Conclusions: </strong>In elderly patients undergoing PCNL, prolonged OT was independently associated with higher odds of overall, major, and infectious postoperative complications. The relationship was non-linear, with a clinically relevant threshold around 95 min, supporting OT as a practical intraoperative marker for risk stratification and procedural planning.</p>","PeriodicalId":8985,"journal":{"name":"BJU International","volume":" ","pages":"915-926"},"PeriodicalIF":4.1,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13655189/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149011808","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":"RE: What makes a great urology sub-internship? A survey of medical students, residents, and faculty.","authors":"Roger K Khouri","doi":"10.1111/bju.70322","DOIUrl":"10.1111/bju.70322","url":null,"abstract":"","PeriodicalId":8985,"journal":{"name":"BJU International","volume":" ","pages":"931"},"PeriodicalIF":4.1,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147970162","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":"Response to the Letter by Carey and Kommu: 'Generating a consensus on the follow-up of multifocal high-grade prostate intraepithelial neoplasia'.","authors":"Juan Morote","doi":"10.1111/bju.70320","DOIUrl":"10.1111/bju.70320","url":null,"abstract":"","PeriodicalId":8985,"journal":{"name":"BJU International","volume":" ","pages":"930"},"PeriodicalIF":4.1,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148041150","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":"Artificial intelligence for predicting BCG response in non-muscle-invasive bladder cancer: a systematic review.","authors":"Ludovica Cella, Roberto Contieri, Marco Paciotti, Vittorio Fasulo, Alessandro Uleri, Pier Paolo Avolio, Laura S Mertens, Benjamin Pradere, Sisto Perdonà, Alberto Saita, Massimo Lazzeri, Paolo Casale, Giovanni Lughezzani, Rodolfo Hurle, Nicolò Maria Buffi","doi":"10.1111/bju.70404","DOIUrl":"10.1111/bju.70404","url":null,"abstract":"<p><strong>Objectives: </strong>To systematically identify, appraise and synthesise artificial intelligence (AI) and machine-learning (ML) models that predict treatment response and clinical outcomes after intravesical bacillus Calmette-Guérin (BCG) in non-muscle-invasive bladder cancer (NMIBC), a setting in which current risk calculators underperform, and identifying non-responders has become urgent as alternatives to BCG enter practice.</p><p><strong>Methods: </strong>PubMed, EMBASE and Web of Science were searched through April 2026 following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines (International Prospective Register of Systematic Reviews [PROSPERO] number CRD420261376808). Studies developing or validating AI/ML models for BCG-associated outcomes with a quantitative performance metric were included. Risk of bias was assessed with the Prediction model Risk Of Bias ASsessment Tool (PROBAST). Evidence was synthesised along a clinically oriented framework: AI as a perceptual tool (extracting signal from histology or imaging) or integrative tool (re-weighting clinicopathological, molecular, or urinary variables).</p><p><strong>Results: </strong>A total of 15 studies (>24 900 patients) were included: seven perceptual, eight integrative. By input data, six used digital pathology, two radiomics, two genomics/transcriptomics, four clinicopathological markers, and one urinary biomarkers. The digital-pathology Computational Histology Artificial Intelligence (CHAI) platform, validated across 12 international centres, stratified high-grade recurrence (hazard ratio [HR] 2.08), progression (HR 3.87) and BCG-unresponsive disease (HR 2.31), and was the only model providing a first signal of predictive value, demonstrating a significant BCG vs gemcitabine/docetaxel interaction (P = 0.029). Integrative models PROGRxN-BCa (concordance index [C-index] 0.79) and DeepSurv (C-index 0.881) outperformed standard calculators but with modest gains (ΔC-index 0.05-0.10). Only 40% of studies performed external validation, none prospectively; five were at high risk of bias.</p><p><strong>Conclusion: </strong>Perceptual AI, particularly digital pathology, has the highest external validation and provides the only biomarker with a first signal of predictive value for BCG vs alternatives, increasingly relevant in the context of the global BCG shortage. Integrative models such as PROGRxN-BCa and DeepSurv outperform standard calculators with incremental gains and are freely accessible. Prospective validation, systematic calibration reporting and treatment-by-biomarker interaction analyses, ideally embedded in trials such as the BRIDGE trial (ClinicalTrials.gov identifier: NCT05538663), remain priorities before clinical adoption.</p>","PeriodicalId":8985,"journal":{"name":"BJU International","volume":" ","pages":"786-797"},"PeriodicalIF":4.1,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148764530","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":"Intraoperative performance errors predict patient outcomes in robot‐assisted radical prostatectomy","authors":"Markus Graefen, Peter Wiklund, Claudio Brancelli, Brendan P. Bunting, Alberto Breda, Niki Rashidian, Edoardo Beatrici, Ruben De Groote, Rui Farinha, Anne Sophie Knipper, Maria Peraire Lores, Stefano Puliatti, Marco Amato, Camille Berquin, Burkhard Beyer, Carlo Andrea Bravi, Jan Hohenhorst, Elio Mazzone, Marco Paciotti, Artur Paludo, Pietro Piazza, Luca Sarchi, Anthony G. Gallagher, Alexandre Mottrie","doi":"10.1111/bju.70503","DOIUrl":"https://doi.org/10.1111/bju.70503","url":null,"abstract":"Objectives To evaluate the association between objectively assessed intraoperative surgical performance and postoperative functional outcomes following robot‐assisted radical prostatectomy (RARP). Patients/Subjects and Methods Prospectively collected data from 100 patients undergoing bilateral nerve‐sparing RARP by seven experienced robotic surgeons were analysed. To control for age‐related confounding, a subgroup of 66 subjects was selected from the initial cohort using age‐matching. These patients, all of whom were preoperatively potent, were identified from an audited outcomes registry with complete video recordings. In all, 14 trained surgeons trained to score the recordings using validated RARP‐specific metrics for procedure steps, errors, critical errors, and nerve‐sparing phase errors. Results There were no significant pre‐ or postoperative differences in demographic or clinical variables between patients with good or poor outcomes. The mean inter‐rater reliability of video assessments was high (0.91). There were no significant differences in the number of steps completed or critical errors made. Intraoperative performance in cases resulting in erectile dysfunction at 12 months was characterised by 43% more total errors and 67% more neurovascular bundle (NVB) dissection errors ( <jats:italic>P</jats:italic> &lt; 0.001) compared to cases with good functional outcomes. Age‐matched analysis confirmed differences of 31–54% ( <jats:italic>P</jats:italic> &lt; 0.001). The number of intraoperative errors, particularly during NVB dissection, was strongly associated with clinical outcomes ( <jats:italic>P</jats:italic> = 0.01–0.008). Conclusions The objectively assessed intraoperative performance of the surgeon strongly predicted the clinical outcome of the procedure at 1 year. The more errors the surgeon made the more likely the patient was to have erectile dysfunction at 12 months.","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"89 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149226382","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":"Enfortumab vedotin plus pembrolizumab in cisplatin‐eligible muscle‐invasive bladder cancer: efficacy proven, duration unclear","authors":"Massimiliano Depalma, Francesco Rossi, Matteo Ferro, Laura Bukavina, Giuseppe Di Lorenzo, Riccardo Autorino","doi":"10.1111/bju.70507","DOIUrl":"https://doi.org/10.1111/bju.70507","url":null,"abstract":"","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"75 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149226380","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":"Does bespoke metabolic investigation reduce urinary stone recurrence? A narrative review","authors":"Oliver J. Wiseman, Ben W. Turney","doi":"10.1111/bju.70500","DOIUrl":"https://doi.org/10.1111/bju.70500","url":null,"abstract":"Objective To examine whether individualised (‘bespoke’) metabolic investigation and targeted dietary and medical therapy reduces urinary stone recurrence, and whether the approach also improves health‐related quality of life (HRQOL) and lowers financial and environmental cost. Methods In this narrative review we searched PubMed/Medical Literature Analysis and Retrieval System Online (MEDLINE), the Cochrane Library and Europe PubMed Central (PMC) (January 1980 to March 2026) for randomised trials, controlled cohorts and systematic reviews on metabolic assessment and stone recurrence prevention in adults, supplemented by European Association of Urology (EAU), American Urological Association (AUA), National Institute for Health and Care Excellence (NICE) and American College of Physicians (ACP) guidance and by hand‐searching of reference lists. Results Interventions that correct a defined urinary abnormality each reduce stone recurrence. Increased fluid intake approximately halves it (relative risk [RR] 0.45–0.55); a normal calcium, reduced sodium, reduced animal protein diet achieves a similar reduction in hypercalciuric calcium‐oxalate formers (RR 0.49); and targeted pharmacotherapy lowers it further (potassium citrate RR approximately 0.25, thiazides 0.52, allopurinol 0.59), although the rigorous NOSTONE trial (ClinicalTrials.gov identifier: NCT03057431) found no significant thiazide benefit. After shockwave lithotripsy and percutaneous nephrolithotomy, medical therapy reduces stone formation and residual‐fragment regrowth. Evidence that 24‐h‐urine‐directed therapy outperforms empirical therapy is confined to high‐risk patients, in whom selective treatment yields significantly fewer stone‐related events. Stone disease impairs disease‐specific quality of life and is costly, so preventing stone recurrence is cost‐saving. Conclusions The case for bespoke prevention is strongest in recurrent, high‐risk and post‐procedural stone formers. Identifying the abnormality, correcting it, ensuring adherence and confirming the response by repeat testing offers the best chance to reduce stone recurrence and residual‐stone growth, improve HRQOL, and lower financial cost.","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"1 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149226386","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}