Simran Gill,Runzhi Chen,Benjamin W Lamb,Caroline M Moore,James W F Catto,Jack Cuzick,Peter D Sasieni,Prabhakar Rajan
{"title":"Interventions for patients with prostate cancer on active surveillance: a narrative review.","authors":"Simran Gill,Runzhi Chen,Benjamin W Lamb,Caroline M Moore,James W F Catto,Jack Cuzick,Peter D Sasieni,Prabhakar Rajan","doi":"10.1111/bju.70005","DOIUrl":"https://doi.org/10.1111/bju.70005","url":null,"abstract":"OBJECTIVETo examine contemporary evidence supporting non-surgical interventions for patients with early prostate cancer (PCa) on active surveillance (AS).METHODSA literature search was conducted using the databases PubMed, Medline, and Embase in January 2024 to identify relevant articles published from 2011 onwards. Randomised controlled trials (RCTs) and cohort studies reporting on interventions in patients with PCa on AS were included.RESULTSSeveral studies have investigated a range of non-surgical interventions, from exercise and food supplements to androgen receptor pathway inhibitors (ARPIs). The largest RCTs of ARPIs have shown the greatest effect in delaying disease progression to aggressive PCa, however, concerns exist around toxicity, long-term oncological safety, and mortality benefit. Nutraceuticals, dietary modifications, and exercise appear to be well tolerated, but evidence of oncological benefit from large-scale RCTs is lacking. A major challenge is the lack of consensus on criteria for entry to and exit from AS as pre-biopsy magnetic resonance imaging reduces diagnosis of the lowest-risk disease. Molecular and imaging biomarkers may help refine baseline risk stratification and guide monitoring during surveillance.CONCLUSIONCurrent evidence supporting interventions for patients on AS remains largely based on small prospective cohort studies or open-label phase II trials. There is growing interest in short-term ARPIs for patients at higher risk of disease progression, while nutraceuticals, diet and exercise may have a role for long-term use in lower-risk patients. Large, well-powered RCTs with long-term outcomes testing different interventions and incorporating molecular and imaging biomarkers are warranted.","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"27 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145229162","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 growing valuable role of urology clinical nurse specialists in the United Kingdom","authors":"Derrick Tsang, Paula Allchorne, James Green","doi":"10.1111/bju.70025","DOIUrl":"https://doi.org/10.1111/bju.70025","url":null,"abstract":"","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"32 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145228740","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":"Robot-assisted partial nephrectomy using the Hugo™ RAS System: first multicentre study and Tetrafecta achievement.","authors":"Francesco Prata,Paolo Dell'Oglio,Angelo Mottaran,Riccardo Bertolo,Stefano Tappero,Pietro Piazza,Francesca Montanaro,Alessandro Veccia,Alberto Ragusa,Alberto Caviglia,Francesco Tedesco,Angelo Civitella,Andrea Iannuzzi,Tommaso Saccucci,Giovanni Muto,Aldo Massimo Bocciardi,Eugenio Brunocilla,Roberto Mario Scarpa,Alessandro Antonelli,Riccardo Schiavina,Antonio Galfano,Rocco Papalia","doi":"10.1111/bju.70009","DOIUrl":"https://doi.org/10.1111/bju.70009","url":null,"abstract":"OBJECTIVETo evaluate the perioperative outcomes and the rate of Tetrafecta achievement in robot-assisted partial nephrectomy (RAPN) cases performed using the Hugo™ robot-assisted surgery (RAS) system (Medtronic, Minneapolis, MN, USA).PATIENTS AND METHODSData from five tertiary care referral centres performing RAPN with the Hugo RAS System since October 2022 were collected. For the study purpose, a novel Tetrafecta was defined as a proxy for surgical quality. This included the coexistence of negative surgical margins, absence of intraoperative and Clavien-Dindo Grade ≥II postoperative complications, and 90-day decline in estimated glomerular filtration rate of no more than 30% from baseline.RESULTSA total of 140 patients, who underwent RAPN with the Hugo RAS system, were included. The median (interquartile range [IQR]) docking, console, and total operative times were 5 (4-7) min, 79 (45.5-135) min, and 150 (96-205) min, respectively. The median (IQR) estimated blood loss was 150 (100-300) mL. No additional port placements were required, and no conversions to open surgery occurred. Overall, postoperative complications were observed in 20.7% of cases, 5% of which were classified as major (Clavien-Dindo Grade >II). Tetrafecta was achieved in 80% of cases. Multivariate logistic regression analysis showed that R.E.N.A.L. (Radius, Exophytic/Endophytic, Nearness to collecting system or sinus, Anterior/Posterior, Location) nephrometry score (odds ratio [OR] 0.69; P = 0.01) and Hugo RAS surgical experience (OR 1.03; P = 0.02) were independent predictors of Tetrafecta achievement.CONCLUSIONSRelying on the largest multicentre series, our findings demonstrate that this novel robotic platform enables safe and effective RAPN, achieving a satisfactory Tetrafecta rate. These results would support the adoption of the Hugo RAS system to perform RAPN.","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"158 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145229002","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":"Temporal trends and clinical determinants of urinary diversion after radical cystectomy.","authors":"Francesco Pellegrino,Mario de Angelis,Pietro Scilipoti,Mattia Longoni,José Daniel Subiela,Roberto Contieri,Luca Afferi,Stefania Zamboni,Nazareno Suardi,Gennaro Musi,Stefano Luzzago,David D'Andrea,Ekaterina Laukhtina,Francesco Soria,Paolo Gontero,Francesco Del Giudice,Giuseppe Fallara,Morgan Roupret,Elisabeth Grobet-Jeandin,Arthur Baudewyns,Hajime Tanaka,Shunya Matsumoto,Yasuhisa Fujii,Flavia Proietti,Giuseppe Simone,Gerald Bastian Schulz,Nikolaos Pyrgidis,Guillaume Ploussard,Alessandro Antonelli,Riccardo Bertolo,Mathieu Roumiguie,Anne-Sophie Bajeot,Stefano Resca,Edoardo Beatrici,Edward Lambert,Alexandre Mottrie,Maria Carme Mir,Paolo Umari,Jeremy Teoh,Chris Wong,Laura S Mertens,Renate Pichler,Keiichiro Mori,Aleksander Ślusarczyk,Cédric Poyet,Simone Albisinni,Atiqullah Aziz,Alessandro Volpe,Shahrokh Shariat,Benjamin Pradere,Pierre Karakiewicz,Andrea Necchi,Matteo Ferro,Francesco Montorsi,Alberto Briganti,Marco Moschini, ","doi":"10.1111/bju.70018","DOIUrl":"https://doi.org/10.1111/bju.70018","url":null,"abstract":"OBJECTIVESTo evaluate the temporal trends in types of urinary diversion (UD) used after radical cystectomy (RC) in a large, multicentre, international cohort over the past two decades.MATERIALS AND METHODSWe analysed 6469 patients who underwent RC between 2004 and 2024 at 23 international tertiary referral centres. Trends in UD type (cutaneous ureterostomy [UCS], ileal conduit [IC], and neobladder) were assessed using estimated annual percentage change (EAPC). Multivariable analysis (MVA) models identified preoperative predictors of UD type. EAPC was applied to evaluate temporal changes in the patient characteristics associated with UD type.RESULTSOverall, 882 (14%), 3611 (56%) and 1976 patients (31%) underwent UCS, IC, and neobladder procedures, respectively. IC remained the most common UD, without significant temporal change (P = 0.1). UCS use increased from 2% to 22% (EAPC 9.9%; P < 0.001), while neobladder use declined from 41% to 19% (EAPC -2%; P = 0.009). MVA showed that older age, comorbidities, and advanced disease were associated with higher rates of UCS and lower rates of neobladder use (all P < 0.005). Neoadjuvant chemotherapy (NAC) was inversely linked to UCS, while robot-assisted RC and male sex favoured neobladder use (all P < 0.005). EAPC showed rising proportions of male patients (EAPC 6.7%), patients aged >70 years (1.2%), patients with a Charlson Comorbidity Index ≥3 (8.3%), patients who received NAC (10.4%) and patients with cT2-cN0 disease (0.5%; all P < 0.05).CONCLUSIONOver two decades, a marked increase in UCS use has been observed, alongside a decline in neobladder reconstruction. These trends coincided with a shift toward older, more comorbid patients undergoing RC. Evolving patient profiles and surgical practices underscore the need for tailored UD strategies and optimised peri-operative management.","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"63 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145229141","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}
Manish R. Bhise, Monica Arora, Ansari Yaasir Ahmed Abdul Razzaq
{"title":"Comments on ‘Transcriptome profiling of prostatic tumours from ENACT trial patients with or without enzalutamide’","authors":"Manish R. Bhise, Monica Arora, Ansari Yaasir Ahmed Abdul Razzaq","doi":"10.1111/bju.70023","DOIUrl":"https://doi.org/10.1111/bju.70023","url":null,"abstract":"","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"76 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145203517","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}
Wouter van Dort,Peter F W M Rosier,Thomas R F van Steenbergen,Bernard J Geurts,Laetitia M O de Kort
{"title":"Can unsupervised machine learning gain new insights into urodynamic pressure flow pattern analysis?","authors":"Wouter van Dort,Peter F W M Rosier,Thomas R F van Steenbergen,Bernard J Geurts,Laetitia M O de Kort","doi":"10.1111/bju.70011","DOIUrl":"https://doi.org/10.1111/bju.70011","url":null,"abstract":"OBJECTIVESTo explore the use of unsupervised machine learning (UML) to analyse segments of the pressure flow study (PFS) curve after maximum flow, and subsequently to analyse the urodynamic and patient characteristics of men in the detected clusters.SUBJECTS AND METHODSIn this study, we considered 1650 PFSs of men with lower urinary tract symptoms, without relevant interventions in the past. After datapoint reduction and normalisation of the PFS curve segments, the k-Shape clustering algorithm was used to identify different pattern clusters. Differences in patient and urodynamic characteristics among those clusters were explored.RESULTSThe UML approach identified four prominent clusters, with significantly different patient and urodynamic characteristics. Two pairs of these clusters were visually similar, and included similar urethral resistance values; however, they differed with regard to detrusor voiding contraction (DVC) and prostate size. In two clusters, the PFS curve pattern was significantly different from the commonly assumed 'normal' urethral resistance pattern in elderly men.CONCLUSIONIn males, PFS patterns are considered to be uniform in shape. However, this study shows that UML can help to identify clusters of pressure-flow urethral resistance subtype patterns in men. We found that these subtype patterns were associated with DVC strength and prostate size. This feasibility study has shown that UML clustering of urodynamic PFSs in men holds promise for improving the diagnosis of urethral resistance and DVC properties and dynamics.","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"19 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145194650","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":"External validation of the Uromonitor®-version 2 urine test as a biomarker for optimisation of non-muscle-invasive bladder cancer management.","authors":"José Rubio-Briones,Félix Guerrero Ramos,Asier Mercadé Sánchez,Ines Bezana Abadía,Ruth Martín Rodríguez,Antonio Alcaraz,Maite Miqueleiz Legaz,Fernando Lozano,Miguel Arrabal Martín,Adrián Luis Cardo,Victoria Gonzalo Rodríguez,Jorge Caño Velasco,Miriam Serrano Liesa,Cristina Ferreiro Pareja,Raquel Espílez Ortiz,Ignacio de González-Valcárcel de Torres,Daniel Sánchez Zalabardo,Cristina Esquinas,Lourdes Mengual,Angel Borque-Fernando,Luis Mariano Esteban Escaño,Joan Palou Redorta,Fred Witjes,Luis Martínez Piñeiro","doi":"10.1111/bju.70010","DOIUrl":"https://doi.org/10.1111/bju.70010","url":null,"abstract":"OBJECTIVESTo conduct an external multicentre validation to evaluate Uromonitor®-version 2 (v2; U-monitor, Porto, Portugal) as a biomarker for detecting non-muscle-invasive bladder cancer (NMIBC) recurrence in an independent patient cohort in a real-world-evidence setting and compare it to cytology.PATIENTS AND METHODSThe 'External Validation of Uromonitor as a Biomarker for Optimization of NMIBC Management by the Club Urológico Español de Tratamiento Oncológico Group' (EVALUATION-CUETO) study is a prospective, multicentre, observational study (NCT05864599) conducted in Spain. Inclusion criteria included any risk group of patients with NMIBC undergoing follow-up. The most recent (index) NMIBC tumours of any grade had to have been diagnosed within the past 3 months to 2 years. Regarding biomarkers, data from cystoscopy, cytology, and the Uromonitor-v2 test were collected. Predictive performance parameters, including accuracy, area under the curve, negative and positive predictive values (NPV, PPV), sensitivity, and specificity, were calculated.RESULTSA total of 1178 patients with a mean age of 72 years and a predominant male representation (80%) were included. Among the positive Uromonitor-v2 cases, 64 (57.66%) exhibited a TERT promoter mutation, and 59 (53.15%) harboured a FGFR3 mutation. No KRAS mutations were found. For the total population, Uromonitor-v2 demonstrated high specificity (0.93) and NPV (0.93), but low sensitivity (0.36) and PPV (0.36), indicating a limited ability to detect all recurrences and confirm positive cases. Performance varied across tumour grades, with low-grade tumours showing a low sensitivity of 0.32 and high-grade tumours achieving a higher but insufficient sensitivity of 0.44. Specificity remained consistent at 0.93 across all groups. Uromonitor-v2 achieved higher accuracy compared to cytology alone, with the combined approach further improving overall predictive performance.CONCLUSIONThe strong specificity and NPV observed across all studies suggest a role of Uromonitor-v2 as a potential tool for NMIBC follow-up, particularly in ruling out recurrence and clarifying doubtful cystoscopy results. However, the unexpectedly low sensitivity reported in this external multicentre validation suggests the need for further investigation before routine clinical implementation.","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"1 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145194648","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 role of PSMA PET/CT in staging patients with intermediate-risk prostate cancer.","authors":"Jacinta Bonaddio,Jonathon Carll,Renu Eapen,Niranjan Sathianathen,Nathan Lawrentschuk","doi":"10.1111/bju.70015","DOIUrl":"https://doi.org/10.1111/bju.70015","url":null,"abstract":"OBJECTIVETo synthesise data evaluating the diagnostic utility of prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) in intermediate-risk prostate cancer (PCa), as its role in intermediate-risk PCa remains uncertain.METHODSA systematic search was conducted for studies evaluating PSMA PET/CT in primary staging of newly diagnosed European Association of Urology (EAU)/National Comprehensive Cancer Network (NCCN) intermediate-risk, or Gleason Score 7 (International Society of Urological Pathology [ISUP] Grade Group [GG] 2-3) PCa. The primary outcome was overall positive scans (lymph nodes or distant metastases). We also secondarily analysed diagnostic accuracy measuring sensitivity, specificity, positive predictive value, and negative predictive value.RESULTSIn total, 16 studies reported positivity rates ranging from 2.2% to 50.0% in intermediate-risk PCa. A pooled analysis of 13 studies found a PSMA PET/CT positivity rate of 9% (95% confidence interval [CI] 6-11%). In ISUP GG 2 PCa, positivity ranged from 2.2% to 21.4%, compared to 13.6-33.3% in ISUP GG 3 PCa (across two studies). The overall nodal and metastatic sensitivity of PSMA PET/CT was low in intermediate-risk men, 33% (95% CI 14-60%). Limitations included small sample sizes, retrospective designs, and limited histopathological confirmation.CONCLUSIONFor primary staging in intermediate-risk PCa PSMA PET/CT showed a low yield. Limited data exist to guide its use in favourable vs unfavourable subgroups. Robust, prospective studies are needed to define its role in clinical decision-making, further prognostic benefits, and to inform future guidelines.","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"1 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145194651","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 'suction concept': everything a flexible ureteroscope should have.","authors":"Olivier Traxer,Aideen Madden,Mariela Corrales","doi":"10.1111/bju.16893","DOIUrl":"https://doi.org/10.1111/bju.16893","url":null,"abstract":"OBJECTIVETo develop an accurate 'suction concept' that should be part of every flexible ureteroscope (FU) and review recent literature on endourology's new technologies to determine if they incorporate all the features of our new concept, as several milestone developments in retrograde intrarenal surgery have led to a re-framing of innovation goals with recent focus on novel laser technology and suction techniques.METHODSA literature review on the main suction (suctioning ureteric access sheath [SUAS] or flexible and navigable SUAS [FANS], steerable ureteroscopic renal evacuation [SURE], and direct in-scope suction [DISS]) and intrarenal pressure devices during ureteroscopy was conducted from November 2010 until November 2024 using the PubMed and MEDLINE databases. We also develop the 'suction concept' using a 10-stage approach.RESULTSThe PubMed and MEDLINE searches returned 329 articles. After duplicate removal and full review of the abstracts and text gathered, 18 full-text articles, product brochures, and peer-reviewed abstract presentations were included for qualitative analysis. To better understand the main purpose of the present study, we divided the results into different sections: FANS, DISS, SURE, and single-use digital FUs with pressure sensor. We compared them to the items checklist that we created to determine if the new FUs or complementary devices fulfil our concept of 'suction'.CONCLUSIONSuction should be viewed as an integrated system and not as a support tool in endourology. The ideal FU should be anatomically flexible, have easy ureteric access, easy manipulation, excellent vision, an integrated energy system, and the five items included in fluid management, including irrigation, suction, pressure control, blockage detection, and automatic unblocking.","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"86 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145140420","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}
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