BJU International最新文献

{"title":"Computed tomography-derived extracellular volume fraction is associated with high-grade recurrence in non-muscle-invasive bladder cancer treated with intravesical gemcitabine and docetaxel","authors":"Mohamad Abou Chakra,&nbsp;Issa Alsamarah,&nbsp;Helen Y. Hougen,&nbsp;Yousef Zakharia,&nbsp;James A. Brown,&nbsp;Amanda A. Myers,&nbsp;Kathryn A. Marchetti,&nbsp;Grant M. Henning,&nbsp;Sarah L. Mott,&nbsp;Igor Duquesne,&nbsp;Bogdan Adrian Buhas,&nbsp;Michael A. O'Donnell","doi":"10.1111/bju.70319","DOIUrl":"10.1111/bju.70319","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To evaluate whether extracellular volume (ECV) fraction derived from contrast-enhanced computed tomography (CT) is associated with recurrence risk in patients with treatment-naïve high-risk non-muscle-invasive bladder cancer (HR-NMIBC) receiving intravesical gemcitabine/docetaxel (Gem/Doce) therapy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Patients and Methods</h3>\u0000 \u0000 <p>This retrospective cohort study, conducted at a tertiary referral centre, included 103 patients with HR-NMIBC treated with intravesical Gem/Doce between 2012 and 2024. All patients underwent pre-resection contrast-enhanced CT with an equilibrium phase (~3 min post-injection). Tumour ECV fraction (%) was calculated using the formula: ECV = (ΔHUtumour/ΔHUaorta) × (1 − haematocrit) × 100, where Δ Hounsfield units (HU) represents the change in attenuation between non-contrast and equilibrium phases. Regions of interest were manually placed in the tumour and abdominal aorta, and haematocrit values obtained within ±10 days were used. Associations between clinical variables, ECV, and recurrence were evaluated using Cox proportional hazards models, with discrimination assessed by Uno's C-statistic.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The median (interquartile range) follow-up was 17 (10–25) months. High-grade recurrence-free survival (HG-RFS) was 76% at 12 months and 69% at 24 months. CT-derived ECV was the only variable significantly associated with HG-RFS (hazard ratio 1.05, 95% confidence interval 1.03–1.08), demonstrating strong discrimination (C-statistic, 0.81; <i>P</i> &lt; 0.01). A 15% threshold offered the best sensitivity–specificity trade-off (~70% each) for predicting HG-RFS at 12 and 24 months. Patients with ECV ≤15% had markedly better HG-RFS than those with ECV &gt;15% at 24 months (88% vs 41%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The CT-derived ECV is a practical, first-of-its-kind imaging biomarker associated with recurrence risk and useful for risk stratification in patients with HR-NMIBC treated with intravesical Gem/Doce, a regimen increasingly used in the setting of global Bacillus Calmette-Guérin shortages and intolerance. ECV can be rapidly quantified from routine contrast-enhanced CT using standard picture archiving and communication system (PACS) tools, without additional imaging or proprietary software, making it a feasible metric for integration into risk-adapted management pending large-scale validation with extended follow-up.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"138 2","pages":"306-314"},"PeriodicalIF":4.1,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148041149","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":"Clinical outcomes of BCG-treated patients with high-risk non-muscle-invasive bladder cancer according to pre- and post-2021 European Association of Urology risk classifications","authors":"Tian Ye,&nbsp;Benjamin Tura,&nbsp;Ben Abbotts,&nbsp;Maurice P. Zeegers,&nbsp;K. K. Cheng,&nbsp;Nicholas D. James,&nbsp;Richard T. Bryan","doi":"10.1111/bju.70247","DOIUrl":"10.1111/bju.70247","url":null,"abstract":"&lt;p&gt;Bladder cancer is the sixth most common cancer diagnosis in males in the European Union, with &gt;70% of cases attributed to non-muscle-invasive bladder cancer (NMIBC). Postoperative intravesical therapy remains a cornerstone of treatment, positioning NMIBC among the most financially burdensome malignancies [&lt;span&gt;1&lt;/span&gt;]. To inform adjuvant treatment recommendations and surveillance schedules for NMIBC patients, since 2002 the European Association of Urology (EAU) has proposed patient stratification by prognostic risk groups. Accordingly, patients from the high-risk groups are recommended BCG instillations (if not radical cystectomy [RC]). However, the risk stratification is underpinned by studies lacking BCG-treated patients. In 2021, a Very High-Risk group (VHR-NMIBC) was added into the EAU guidelines as a result of the progression score model by Sylvester et al. [&lt;span&gt;2&lt;/span&gt;]. We investigated the clinical outcomes of pre-2021 High-Risk NMIBC (HR-NMIBC) patients treated with BCG and re-classified them according to 2021 risk groups.&lt;/p&gt;&lt;p&gt;Patients with pre-2021 HR-NMIBC and treated with BCG were identified from the Bladder Cancer Prognosis Programme (BCPP, ethics approval 06/MRE04/65), a prospective cohort study recruiting newly-diagnosed treatment-naïve patients from 10 hospitals in the West Midlands (UK) from 2005 to 2011 [&lt;span&gt;3&lt;/span&gt;]. Patient eligibility criteria included: primary Ta/T1 urothelial carcinomas of the urinary bladder, with or without concomitant carcinoma &lt;i&gt;in situ&lt;/i&gt; (CIS); primary NMIBC treated with complete transurethral resection of bladder tumour (TURBT) and subsequent BCG (at least five instillations); minimum follow-up of 3 months; no RC within 3 months from primary TURBT; high-risk group (HR-NMIBC) patients according to the 2020 EAU guidelines; patients with missing parameters only if the risk group would not change; and patients who completed at least one follow-up cystoscopy after induction BCG instillations. Exclusion criteria: CIS without concomitant papillary tumour; previous history of muscle-invasive disease; concomitant upper tract urothelial carcinoma; concomitant variant pathologies; immediate RC (&lt;3 months) for NMIBC; patients treated with simultaneous chemotherapy instillation, systemic chemotherapy, radiation as well as other anti-tumour treatments; less than five intravesical instillation doses of BCG; and disease recurrence before the 3-month cystoscopy.&lt;/p&gt;&lt;p&gt;The primary outcome for the present study was progression-free survival (PFS), defined as time from TURBT to the date of: increase in stage to ≥T2, metastasis, or death from bladder cancer. The secondary endpoint was recurrence-free survival (RFS), recorded as time from TURBT to date of first bladder recurrence. Patients without a record of recurrence or progression were censored upon RC (as primary treatment for HR-NMIBC) or the date of their last follow-up visit. Kaplan–Meier curves for recurrence and progression were plotted to p","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"138 2","pages":"229-231"},"PeriodicalIF":4.1,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/bju.70247","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147495194","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":"Reducing complexity in International Bladder Cancer Group intermediate-risk non-muscle-invasive bladder cancer stratification: a three-factor approach","authors":"Jayant Siva,&nbsp;Can Aydogdu,&nbsp;Nicholas Heller,&nbsp;Rishi Jonnalagadda,&nbsp;Patrick J. Hensley,&nbsp;Gabriela M. Diaz,&nbsp;Sean McSweeney,&nbsp;Rebecca Campbell,&nbsp;Nima Almassi,&nbsp;Reza Alaghehbandan,&nbsp;Christopher J. Weight,&nbsp;Ashish M. Kamat,&nbsp;Laura Bukavina","doi":"10.1111/bju.70269","DOIUrl":"10.1111/bju.70269","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To evaluate whether a simplified risk model preserves the prognostic performance of the International Bladder Cancer Group (IBCG) five-factor risk stratification model in intermediate-risk (IR) non-muscle-invasive bladder cancer (NMIBC).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Patients and Methods</h3>\u0000 \u0000 <p>We performed a multicentre retrospective analysis of 2822 patients with IR NMIBC treated with transurethral resection of bladder tumour and intravesical therapy between 2005 and 2025. Multivariable Cox regression identified independent predictors of recurrence and progression. A simplified risk model was constructed using significant variables and compared with the full IBCG model using recurrence and progression rates, area under the curve analysis, and likelihood ratio testing.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 2822 patients with IR NMIBC were included. When classified using the full IBCG model, 1143 (41%) were in the IR-low, 1535 (54%) IR-intermediate, and 144 (5%) IR-high-risk groups. On multivariable analysis, only multifocality, early recurrence, and failure of intravesical therapy independently predicted oncological outcomes. Using these factors, patients were stratified as IR-low (no factors), IR-intermediate (one factor), or IR-high (two or more factors). Under the simplified model, 1535 (54%) patients were classified as IR-low, 906 (32%) as IR-intermediate, and 381 (14%) as IR-high. The 3-year recurrence and progression rates increased stepwise across simplified risk groups. Discriminative performance of the simplified model was comparable to the full model across all metrics, with no meaningful loss of discrimination.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Three variables captured the most prognostic signal in this cohort without loss of discrimination compared with the full model. This simplified model is an internally validated refinement, with planned external validation to confirm generalisability and to ensure that simplified thresholds do not alter the clinically important IR-high subgroup used in care and trials.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"138 2","pages":"244-249"},"PeriodicalIF":4.1,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/bju.70269","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147585573","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":"Multiparametric MRI in prostate cancer active surveillance: results from the Miami Active Surveillance Trial (MAST) trial","authors":"Seyed Hossein Hosseini Sharifi,&nbsp;Adam Williams,&nbsp;Jonathan T. Ryan,&nbsp;Tarek Ajami,&nbsp;Omri Falik Nativ,&nbsp;Sunwoo Han,&nbsp;Isildinha M. Reis,&nbsp;Nachiketh Soodana-Prakash,&nbsp;Archan Khandekar,&nbsp;Sanjaya Swain,&nbsp;Oleksandr N. Kryvenko,&nbsp;Radka Stoyanova,&nbsp;Alan Pollack,&nbsp;Patricia R. Castillo,&nbsp;Bruno Nahar,&nbsp;Chad R. Ritch,&nbsp;Bruce Kava,&nbsp;Mark L. Gonzalgo,&nbsp;Dipen J. Parekh,&nbsp;Sanoj Punnen","doi":"10.1111/bju.70303","DOIUrl":"10.1111/bju.70303","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To examine the role of multiparametric magnetic resonance imaging (mpMRI) in enhancing prostate cancer (PCa) detection and selecting candidates for active surveillance (AS), given that its utility in monitoring disease progression remains unclear.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Patients and Methods</h3>\u0000 \u0000 <p>The Miami Active Surveillance Trial (MAST) is a prospective trial of men undergoing serial mpMRI and biopsies on AS for PCa. Participants had annual mpMRI with MRI-targeted and systematic biopsies at confirmatory (12–18 months) and subsequent intervals (12, 24, and 36 months). Grade progression was defined as an upgrade from Grade Group (GG) 1 to GG ≥2 or GG 2 to GG ≥3. The performance of MRI was evaluated at baseline (prior to confirmatory biopsy) and on subsequent biopsies for association with grade progression. Fine and Gray competing-risk models evaluated MRI for predicting grade progression after controlling for risk factors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 205 men, 79 (38.5%) had grade progression at the conclusion of the trial (36 months), with 40 (19.5%) men having grade progression at confirmatory biopsy, and the remaining 39 (2.0–9.8%/year) progressing on subsequent biopsies. A Prostate Imaging-Reporting And Data System (PI-RADS) score of 4 or 5 (vs no suspicious lesions or PI-RADS 1 and 2) on baseline MRI (prior to confirmatory biopsy) was an independent predictor of grade progression on confirmatory biopsy (Gray's test <i>P</i> &lt; 0.001), with volume progression treated as a competing risk. At 36 months, MRI-only surveillance would have avoided 45% of biopsies but missed 32% of progression events.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Pre-confirmatory biopsy MRI independently predicted grade progression on confirmatory and subsequent biopsies during AS; however, false positives and negatives still occur highlighting the need for periodic biopsy of the prostate.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"138 2","pages":"276-284"},"PeriodicalIF":4.1,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/bju.70303","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147833050","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":"Clinical complete response as a surrogate for pathological response in bladder cancer: a systematic review and meta-analysis","authors":"Navid Roessler,&nbsp;Marcin Miszczyk,&nbsp;Paolo Gontero,&nbsp;Alessandro Dematteis,&nbsp;Keiichiro Miyajima,&nbsp;Shota Inoue,&nbsp;Katharina Oberneder,&nbsp;Markus von Deimling,&nbsp;Victor M. Schuettfort,&nbsp;Malte W. Vetterlein,&nbsp;Bernadett Szabados,&nbsp;Pawel Rajwa,&nbsp;Pierre I. Karakiewicz,&nbsp;Jeremy Yuen-Chun Teoh,&nbsp;Margit Fisch,&nbsp;Shahrokh F. Shariat","doi":"10.1111/bju.70214","DOIUrl":"10.1111/bju.70214","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To evaluate the concordance between clinical complete response (cCR) and pathological complete response (pCR) in muscle-invasive bladder cancer (MIBC) to assess the surrogacy and prognostic value of cCR for guiding bladder-sparing strategies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In this prospectively registered systematic review and meta-analysis (CRD420251066540), we searched MEDLINE, EMBASE, and Web of Science in June 2025 for studies reporting clinical and pathological complete response rates in patients with MIBC undergoing neoadjuvant therapy followed by radical cystectomy (RC). Pooled concordance was estimated via random-effects meta-analysis. Risk-of-bias was assessed using the Risk Of Bias In Non-randomised Studies of Interventions (ROBINS-I).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Out of 1947 individual records, 10 (<i>n</i> = 894) retrospective and three (<i>n</i> = 181) prospective studies comprising 1075 patients were included. Restaging modalities for cCR assessment included transurethral resection of the bladder (TURB; <i>n</i> = 188, two studies), computed tomography (<i>n</i> = 221, two studies), magnetic resonance imaging (MRI; <i>n</i> = 122, two studies), and fluorodeoxyglucose positron emission tomography (<i>n</i> = 45). One study (<i>n</i> = 56) used perioperative cystoscopy, while the remaining five studies (<i>n</i> = 499) combined imaging with cystoscopy or TURB. The concordance (<i>n</i> = 779, nine studies) between cCR and pCR was 0.51 (95% confidence interval [CI] 0.42–0.60), the concordance (<i>n</i> = 536, seven studies) between non-cCR and non-pCR was 0.84 (95% CI 0.70–0.92). Most studies were rated as having moderate concerns regarding bias, and one as serious due to examiner-dependent bias of cystoscopy-based cCR assessment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Current evidence does not support relying on the current definition of cCR alone, which poorly predicts pCR, to guide treatment decisions. Ongoing trials assessing the combination of MRI plus TURB with urine and/or blood based circulating tumour DNA may help refine cCR evaluation and support the sole introduction of bladder-sparing approaches in patients with MIBC who respond to neoadjuvant systemic therapy.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"138 2","pages":"186-195"},"PeriodicalIF":4.1,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/bju.70214","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147465295","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":"Gynaecomastia secondary to transdermal oestradiol used for androgen deprivation therapy: informed reality vs subjective fear","authors":"Carly Sears, Robert Watson, Eric Brown, Badra Abbas, Paul Schellhammer, Richard Wassersug","doi":"10.1111/bju.70374","DOIUrl":"https://doi.org/10.1111/bju.70374","url":null,"abstract":"Objectives To provide information that can aid patients with prostate cancer (PCa) and their uro‐oncologists in shared decision‐making discussions about androgen deprivation therapy (ADT), with transdermal oestradiol (tE2) as one option. We do so by summarising recent literature on breast growth in genetic males undergoing treatment with exogenous E2. Based on the amount of breast development observed in this population, we estimate the maximum amount of breast growth that patients with PCa can expect, if they elect tE2 for ADT. We also present data on risks and management of mastalgia associated with tE2. Methods We summarise findings from five studies involving a total of 480 trans women (i.e., genetic males) undergoing gender‐affirming hormone treatment with exogenous oestrogen. Results Exogenous E2 typically induces less than an A‐cup size among trans women. The majority of breast growth occurs within the first year of treatment. We present this evidence to illustrate that the degree of gynaecomastia patients with PCa can expect if they elect tE2 for ADT is quite modest. This information can allay the often‐heightened concern patients with PCa and their uro‐oncologists may have regarding gynaecomastia induced by tE2 when used for ADT. Conclusion Development of breast tissue in genetic males taking exogenous E2 tends to be mild and typically results in less than A‐cup size. Mastalgia in the form of breast and nipple sensitivity is common with E2 treatment in patients with PCa but is transient in most cases, responds to topical anti‐inflammatory agents, and can be managed with neurectomy in severe cases. This information can help clinicians provide accurate counselling and mitigate misconceptions that may dissuade patients from considering tE2 for their ADT.","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"42 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148432074","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":"Mental health disorders following nephrectomy for renal cell carcinoma: a national study","authors":"Baris Esen, Reza Lahiji, Dattatraya Patil, Susan Mumford, Kelsey R. Landrum, Reza Nabavizadeh, Mohammad Hajiha, Valentina Grajales, Nazih Khater, Shreyas S. Joshi, Vikram M. Narayan, Kenneth Ogan, Viraj A. Master","doi":"10.1111/bju.70383","DOIUrl":"https://doi.org/10.1111/bju.70383","url":null,"abstract":"","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"29 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148415540","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":"Function drives 1‐year decision regret in radical prostatectomy: a multicentre prospective study","authors":"Christopher Hirtsiefer, Emma Kümmel, Anna Vogelgesang, Fabian Falkenbach, Mona Kafka, Annemarie Uhlig, Tim Nestler, Cem Aksoy, Iva Simunovic, Johannes Huber, Isabel Heidegger, Markus Graefen, Marianne Leitsmann, Christian Thomas, Martin Baunacke","doi":"10.1111/bju.70382","DOIUrl":"https://doi.org/10.1111/bju.70382","url":null,"abstract":"Objectives To identify contemporary drivers of postoperative decision regret 1 year after radical prostatectomy (RP). Patients and Methods In this prospective, multicentre study, patients undergoing robot‐assisted RP (RARP) or retropubic open RP (ORP) for localised prostate cancer at seven centres in Germany and Austria (2022–2024) completed questionnaires preoperatively and at 1 year postoperatively. Decision regret was assessed using the Decision Regret Scale (DRS). Functional outcomes were measured with European Organisation for Research and Treatment of Cancer quality of life questionnaire – 25‐item prostate cancer specific (EORTC QLQ‐PR25) symptom scores at 1 year postoperatively. Multivariable logistic regression identified predictors of high surgical decision regret (DRS score ≥10). Sensitivity was tested via propensity score matching (PSM). Results A total of 419 patients completed the surveys (58% RARP, 42% ORP) at 1 year postoperatively. Surgical decision regret was low (mean [SD] DRS score 9.0 [15.4]). Erectile dysfunction was the outcome that most patients self‐reported as worse than expected (54% [221/404]), followed by urinary incontinence (23% [96/414]) and oncological cure (10% [39/397]) in a questionnaire on their retrospective perception. The ORP patients reported higher regret regarding surgical approach than RARP patients (mean [SD] DRS score 11.3 [17.1] vs 7.4 [13.9], <jats:italic>P</jats:italic> = 0.02). In a multivariate analysis, high urinary symptom burden (odds ratio [OR] 2.4, <jats:italic>P</jats:italic> = 0.009) and impaired sexual functioning (OR 2.8, <jats:italic>P</jats:italic> = 0.002) independently predicted high surgical decision regret whereas surgical approach and prostate‐specific antigen recurrence did not. Sensitivity analyses via PSM confirmed these independent predictors. Conclusions Surgical decision regret after RP is primarily driven by postoperative functional outcomes rather than oncological results or surgical approach. Optimising functional recovery and managing patient expectations are key strategies to reduce regret in prostate cancer surgery.","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"14 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148414960","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 ‘Active surveillance for intermediate risk prostate cancer: the Manitoba Prostate Center experience’","authors":"Yang Xu, Dejun Hu, Yuanfeng Ruan","doi":"10.1111/bju.70369","DOIUrl":"https://doi.org/10.1111/bju.70369","url":null,"abstract":"","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"53 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148414959","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":"Prostate morcellation devices: a systematic review and meta-analysis of clinical outcomes and efficiency.","authors":"Stessy Kutchukian,Pietro Scilipoti,Mikael Abi Abdallah,Astrid La Rosa,Tristan Filler,Frédéric Panthier,Marie Chicaud,Stefano Moretto,Steeve Doizi","doi":"10.1111/bju.70362","DOIUrl":"https://doi.org/10.1111/bju.70362","url":null,"abstract":"OBJECTIVETo systematically evaluate the efficiency and safety of different prostate morcellators used during prostate enucleation for benign prostatic hyperplasia (BPH).METHODSA systematic review was performed according to the Preferred Reporting Items for Systematic Review and Meta-analyses guidelines. PubMed/Medline, Scopus, and Web of Science were searched for studies published between October 2012 and May 2025. Studies reporting clinical outcomes of morcellators used during prostate enucleation were included. Primary outcome was morcellation efficiency (g/min). Secondary outcomes included intraoperative complications, device malfunction, and cost when available. Risk of bias (RoB) was assessed using the Risk Of Bias In Non-randomised Studies of Interventions (ROBINS-I), RoB 2 tool, and European Association of Urology case-series criteria. Random-effects meta-analyses and multilevel meta-regression adjusted for prostate volume were conducted.RESULTSA total of 22 studies comprising 5980 patients were included, most undergoing holmium laser enucleation of the prostate. The most frequently evaluated devices were the Piranha™ (Richard Wolf GmbH, Knittlingen, Germany) and Lumenis VersaCut™ (Lumenis Ltd., Yokneam, Israel; 12 and 13 studies, respectively), followed by DrillCut™ (Karl Storz SE & Co. KG, Tuttlingen, Germany), MultiCut™ (Asclepion Laser Technologies GmbH, Jena, Germany), and Cyber Blade™ (Quanta System SpA, Milan, Italy) systems. Unadjusted weighted mean morcellation efficiency was 7.80 g/min (95% confidence interval [CI] 6.26-9.34 g/min) for Piranha, 4.70 g/min (95% CI 3.61-5.79 g/min) for VersaCut, 5.90 g/min (95% CI 3.16-8.64 g/min) for DrillCut, and 9.59 g/min (95% CI 4.78-14.39 g/min) for MultiCut. In volume-adjusted meta-regression using Piranha as reference, VersaCut remained significantly less efficient (-2.75 g/min; 95% CI -4.58 to -0.92 g/min; P = 0.003), with an even greater difference in prostates >70 mL (-4.34 g/min). Bladder mucosal injury was the most frequently reported complication; however, relatively rare across all devices. Meta-analysis demonstrated a significantly higher risk with VersaCut compared to Piranha (risk ratio 3.22, 95% CI 1.81-5.71), with low heterogeneity.CONCLUSIONThis systematic review provides a contemporary clinical benchmark of the efficiency and safety of currently available prostate morcellators. Oscillating blade systems, particularly the Piranha morcellator, demonstrated higher morcellation efficiency and a more favourable safety profile than reciprocating blade devices, with the largest performance differences observed in patients with larger prostates.","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"8 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148408123","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}