BJU International最新文献

{"title":"Comment on: ‘Residents surgical training using metrics for transurethral resection of bladder tumours’","authors":"Pietro Diana, Andrea Gallioli, Marco Paciotti, Alex Mottrie, Nicolòmaria Buffi, Alberto Breda","doi":"10.1111/bju.16853","DOIUrl":"https://doi.org/10.1111/bju.16853","url":null,"abstract":"","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"9 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144578379","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":"Natural history of treated and untreated renal oncocytoma: a systematic review and meta‐analysis","authors":"Francesco Edwards, Jack B. Fanshawe, Joana Neves, Michael Aitchison, Soha El‐Sheikh, Archie Hughes‐Hallett, Ahmed Marous, Faiz Mumtaz, John Withington, Prasad Patki, Ravi Barod, Pedro Silva, Rebecca Varley, Wilson To, Axel Bex, Hannah Warren, Maxine G.B. Tran","doi":"10.1111/bju.16832","DOIUrl":"https://doi.org/10.1111/bju.16832","url":null,"abstract":"IntroductionCurrent guidelines recommend active surveillance, surgery, and ablation all as acceptable management strategies for renal oncocytoma, but there is growing concern about overtreatment. Our aim was to report the natural history of treated and untreated renal oncocytoma to inform clinical guidelines and shared decision‐making.MethodsA systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta‐analyses (PRISMA). We systematically reviewed MEDLINE, EMBASE, CENTRAL and <jats:ext-link xmlns:xlink=\"http://www.w3.org/1999/xlink\" xlink:href=\"http://clinicaltrials.gov\">Clinicaltrials.gov</jats:ext-link> from inception to 18 August 2023. Studies that reported outcomes during follow‐up for adult patients with treated and untreated histologically confirmed renal oncocytoma were included. The Joanna Briggs Institute tool was used to assess risk of bias for included studies. We present a narrative review and meta‐analysis.ResultsThere are no reports of distant metastases or disease‐related death for oncocytoma on active surveillance. Most oncocytomas on surveillance show limited growth (&lt;2 mm/year) and minimal renal function decline (−1 mL/min/1.73m<jats:sup>2</jats:sup>/year). A significant minority (14%) transition to active treatment, most often for tumour growth. Concordance between biopsy and surgical pathology was high (89%). Metastatic oncocytoma and disease‐related death after treatment was negligible, and exclusively in reports using historic diagnostic criteria defined prior to the World Health Organisation 1998 classification, and therefore likely including eosinophilic renal cell carcinomas.ConclusionActive surveillance of oncocytoma is oncologically safe and allows patients to avoid the risk of morbidity and mortality with treatment. Imaging surveillance after active treatment can be safely omitted. The literature would benefit from prospective cohort studies of oncocytomas on surveillance, reporting surveillance protocols, and clinical outcomes including reasons for transition to active treatment.","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"10 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144577703","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":"A meta-analysis of Retzius-sparing and hood-technique robot-assisted radical prostatectomy.","authors":"Siyu Huang,David C Chen,Liang Qu,Nathan Papa,Kirby Qin,Ahmed Adam,Damien Bolton,Brian D Kelly,Declan G Murphy,Nathan Lawrentschuk,Marlon L Perera","doi":"10.1111/bju.16847","DOIUrl":"https://doi.org/10.1111/bju.16847","url":null,"abstract":"OBJECTIVESTo compare Retzius-sparing (RS-) robot-assisted radical prostatectomy (RARP), hood-technique RARP and standard RARP, assessing functional, oncological and peri-operative outcomes.METHODSA systematic review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. The primary outcome was postoperative perfect continence rate (0 pad/day) at different time points over 12 months. Secondary outcomes included postoperative social continence, positive surgical margins (PSMs), biochemical recurrence at 12 months, and other peri-operative measures. A meta-analysis was conducted to assess RS-RARP vs standard RARP. A further exploratory meta-analysis was performed to compare the hood technique against standard RARP.RESULTSThe meta-analyses included 26 studies comparing RS-RARP vs standard RARP and four studies assessing hood-technique RARP vs standard RARP, covering a total of 5512 patients. In comparison with standard RARP, RS-RARP demonstrated a significantly higher rate of perfect continence at 0 months (risk ratio [RR] 2.28, 95% confidence interval [CI] 1.42-3.66), 1 month (RR 2.94, 95% CI 1.24-6.98), 3 months (RR 1.85, 95% CI 1.21-2.84), 6 months (RR 1.20, 95% CI 1.04-1.38) and 12 months (RR 1.30, 95% CI 1.03-1.63) after surgery. The hood technique also demonstrated a statistically favourable perfect continence outcome at 6 months post-surgery (RR 1.52, 95% CI 1.13-2.04).CONCLUSIONSBoth RS-RARP and hood-technique RARP are associated with a higher continence rate in the early period after surgery. However, there is limited evidence to suggest significant differences between these techniques in the long term. A direct comparison between hood-technique RARP and RS-RARP as well as quality data on long-term outcomes are needed to determine which technique provides superior functional outcomes.","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"43 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144578744","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":"Degree of contrast enhancement improves prediction of new baseline glomerular filtration rate following radical nephrectomy.","authors":"Jayant Siva,Anne Wong,Kieran Lewis,Carlos Munoz-Lopez,Eran N Maina,Nityam Rathi,Akira Kazama,Angelica Bartholomew,Nicholas Heller,Jason M Scovell,Rebecca A Campbell,Nima Almassi,Robert Abouassaly,Samuel C Haywood,Christopher J Weight,Steven C Campbell","doi":"10.1111/bju.16846","DOIUrl":"https://doi.org/10.1111/bju.16846","url":null,"abstract":"OBJECTIVESTo assess the accuracy of PVA+, a model integrating differential degree of enhancement (DOE) with parenchymal volume analysis (PVA), for predicting new baseline glomerular filtration rate (NBGFR) following radical nephrectomy (RN), and to assess PVA+ vs PVA alone in patients with hydronephrosis, where disruptions in the parenchymal volume/function relationship may impact prediction accuracy.PATIENTS AND METHODSA total of 485 RN patients (2006-2021) with preoperative contrast-enhanced computed tomography were included. The predicted NBGFR was estimated to be 1.25 (GFRpreRN x split renal function [SRF]contralateral), with 1.25 representing the average renal functional compensation following RN in adults. For PVA, SRF was determined with differential parenchymal volumes, whereas for PVA+ the differential DOE was also incorporated. Parenchymal volumes and DOE were measured using semi-automated software from the venous phase vs non-contrast images. The accuracy of predicted vs observed NBGFR was compared using a 15% threshold.RESULTSOverall, PVA+ accurately predicted NBGFR for 76% (r = 0.86) of the cases, compared to 72% for PVA alone (r = 0.84, both P < 0.05). PVA+ was particularly advantageous in patients with hydronephrosis or renal vein thrombosis (RVT; 68% vs 50% accuracy for PVA+ vs PVA alone; P < 0.01). Similarly, PVA+ was superior in patients with infiltrative renal masses (IRMs) compared to PVA alone (55% vs 40%; P < 0.01).CONCLUSIONAccurate prediction of NBGFR following RN is essential for counselling patients for whom RN is being considered vs partial nephrectomy. PVA+ was superior to PVA alone for NBGFR prediction, particularly in patients with hydronephrosis, RVT and IRMs. Requiring only routine contrast-enhanced preoperative imaging, PVA+ improves peri-operative decision-making for patients with localised renal masses, particularly in cases where the parenchymal volume/function relationship might be distorted.","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"148 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144547827","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":"Guideline of guidelines: a critical appraisal of the evidence for PSA retesting intervals.","authors":"Kiana K Collins, Pradeep S Virdee, Nia Roberts, Jason L Oke, Brian D Nicholson","doi":"10.1111/bju.16809","DOIUrl":"https://doi.org/10.1111/bju.16809","url":null,"abstract":"<p><strong>Objectives: </strong>To summarise the recommendations for prostate-specific antigen (PSA) retesting intervals and to evaluate the evidence cited by each guideline by conducting a systematic review of clinical practice guidelines.</p><p><strong>Methods: </strong>We searched PubMed and the Turning Research into Practice (TRIP) database for guidelines written in English and developed or updated in 2013-2024. Guideline quality assessment was performed using the AGREE II tool. We narratively synthesised results.</p><p><strong>Results: </strong>Eleven guidelines were included. Ten (91%) recommended PSA retesting intervals of approximately 2 to 4 years. A total of 37 studies were referenced as evidence for the recommended intervals across the 11 guidelines. Five of these studies (14%) had the objective of determining PSA retesting intervals. Fourteen studies (38%) analysed single PSA test results. Five guideline recommendations partially aligned with the evidence referenced and five did not align.</p><p><strong>Conclusions: </strong>Generally, for asymptomatic patients aged ≥50 years with PSA levels between 1 and 3 ng/mL, most guidance recommended a retesting interval of 2-4 years, with the possibility to extend the interval to 4-10 years for patients with a PSA value <1 ng/mL. Until research generates direct evidence for PSA retesting intervals for both asymptomatic and symptomatic patients, clinicians and patients engaging in shared decision-making should be aware that current guidelines lack direct evidence for recommended PSA retesting intervals.</p>","PeriodicalId":8985,"journal":{"name":"BJU International","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144558944","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 primary tumour site surgery in metastatic UTUC: a systematic review and meta-analysis.","authors":"Ludovica Cella,Stefano Moretto,Roberto Contieri,Alessandro Uleri,Pier Paolo Avolio,Andrea Piccolini,Benedetto Calabrese,Vittorio Fasulo,Rodolfo Hurle,Massimo Lazzeri,Alberto Saita,Laura S Mertens,Bas W G van Rhijn,Benjamin Pradere,Alexander P Cole,Thomas Seisen,Paolo Casale,Giovanni Lughezzani,Nicolò Maria Buffi,Marco Paciotti","doi":"10.1111/bju.16836","DOIUrl":"https://doi.org/10.1111/bju.16836","url":null,"abstract":"OBJECTIVETo assess the impact of primary tumour surgery on survival outcomes in patients with metastatic upper urinary tract urothelial carcinoma (mUTUC) by conducting a systematic review and meta-analysis.METHODSA systematic search was conducted using the PubMed/Medline, Embase, Web of Science, and Cochrane Library databases for studies published up to January 2025, using the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Eligible studies included adult patients (≥18 years) diagnosed with mUTUC (cM+ excluding cN + M0). The intervention assessed was primary tumour surgery, compared to non-surgical management, including chemotherapy, immunotherapy, radiation therapy, or best supportive care. Key outcomes measured were surgical/peri-operative outcomes, progression-free survival (PFS), cancer-specific survival (CSS) and overall survival (OS).RESULTSTen eligible retrospective studies were identified. Most reported a significant improvement in survival outcomes (PFS, CSS and OS) for patients undergoing primary tumour surgery compared to systemic therapy (STx) alone. Surgery was notably associated with superior OS both for STx plus consolidative surgery (hazard ratio [HR] 0.66, 95% confidence interval [CI] 0.55-0.81) and cytoreductive surgery plus STx (HR 0.73, 95% CI 0.68-0.78). The most favourable outcomes were observed in younger patients and those with a single metastatic site.CONCLUSIONSSurgery may improve survival outcomes in mUTUC compared to non-surgical options. However, the current evidence is mainly derived from retrospective studies with potential selection bias. Prospective studies are needed to confirm these findings and establish criteria for selecting patients who could benefit from surgical intervention.","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"22 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144547826","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‐driven streamlining of prostate cancer multidisciplinary team recommendations in a tertiary NHS centre in the UK","authors":"Ahmed Khattak, Danny Ruta, Vivek Patkar, Rick Popert, Jonathan Makanjuola, Martha Martin, Lesedi Ledwaba‐Chapman, Kate Dodgson, Robert Oldroyd, Jonathan Noel, Paul Cathcart, Simon Hughes, Ben Challacombe, Deborah Josephs, Deborah Enting, Elias Pintus, Ruth McCarthy, Majid Kazmi","doi":"10.1111/bju.16845","DOIUrl":"https://doi.org/10.1111/bju.16845","url":null,"abstract":"ObjectivesTo evaluate the effectiveness of a rules‐based artificial intelligence (AI) clinical decision support system (CDSS) called the PROState AI Cancer‐Decision Support (PROSAIC‐DS) in streamlining the prostate cancer multidisciplinary team (MDT) pathway by identifying patients meeting standard of care (SoC) guidelines for reduced discussion in MDT meetings.Subjects/Patients and MethodsThis study consisted of two phases. Phase one involved a retrospective concordance analysis of 287 patients referred to the prostate MDT at King's College Hospital over a 2‐year period. In phase two, a prospective analysis included 416 patients from Guy's Hospital over another 2‐year period. Clinical treatment recommendations were independently reviewed by a panel of urologists and oncologists to establish a ‘ground truth.’ Concordance between the medical recommendations and those generated by the PROSAIC‐DS was assessed.ResultsIn phase one, the overall concordance between the clinicians’ recommendations and the PROSAIC‐DS was 92% (95% confidence interval [CI] 88.1–94.7%), compared to just 53% (95% CI 47–59%) with historic MDT outputs (<jats:italic>P</jats:italic> &lt; 0.01). In phase two, the PROSAIC‐DS achieved an 85.6% concordance (95% CI 81.6–88.9%) with the MDT recommendations for 355 evaluable cases (<jats:italic>P</jats:italic> &lt; 0.01). Notably, using a machine learning‐derived decision tree enabled the identification of 93 patients for streamlined management, demonstrating a 97.8% concordance in this subgroup (<jats:italic>P</jats:italic> &lt; 0.01).ConclusionThe implementation of the PROSAIC‐DS into the prostate cancer MDT pathway allowed 33.8% of patients to bypass MDT discussions with high treatment concordance. This study showcases the potential for AI‐based solutions to improve clinical workflow and patient management in oncology, thus addressing the workload challenges faced by MDTs.","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"33 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144533162","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":"Flexible and navigable suction access sheaths: what size stone particles can be cleared?","authors":"Richard Menzies‐Wilson, Jessica Williams, Koushikk Ayyappan, Thijs Ruiken, Candace Rhodes, Ben Turney","doi":"10.1111/bju.16844","DOIUrl":"https://doi.org/10.1111/bju.16844","url":null,"abstract":"ObjectivesTo perform benchtop experiments on flexible and navigable suction (FANS) ureteric access sheaths (UASs) to determine the clearance capabilities for various stone sizes when paired with different‐sized ureteroscopes.MethodsQuartz stones were used as a surrogate for renal stones. Stone samples were created to simulate the range of particle sizes produced by ‘dusting’ a 1‐cm calcium oxalate monohydrate stone. The stone mixture was introduced into an open vial at a 30° angle in aliquots every 3 min over the course of 30 min, mimicking their gradual production by lasertripsy. This benchtop model focused on the effects of geometry (between FANS access sheath and ureteroscope) and suction, excluding complex fluid flow. An 11/13‐F ClearPetra® FANS UAS with an indwelling ureteroscope was free to move in the vial and targeted visible stones. The vial was intermittently filled to 40 mL with water and emptied using 200‐mmHg suction. The experiment had two arms: (1) a permanently indwelling ureteroscope in the FANS UAS to mimic continuous lasering with aspiration and (2) intermittent withdrawal of the ureteroscope to mimic pausing lasering to clear larger fragments through the empty FANS sheath lumen. Three ureteroscope sizes were used: 9.5‐F (Lithovue™), 7.5 F (PUSEN) and 6.3 F (Hugemed). The experiment was performed three times for each ureteroscope.ResultsWith a permanently indwelling 9.5‐F ureteroscope, the FANS UAS cleared 64% of the overall stone mass but became blocked after an average of 21 min. Intermittent withdrawal of the ureteroscope cleared all stones. With indwelling 7.5‐F and 6.3‐F ureteroscopes, the FANS UAS did not become blocked and completely cleared stones of up to 500 μm and 2 mm, respectively.ConclusionsWithout withdrawing the ureteroscope (potentially allowing continuous lasertripsy), it is possible to continuously aspirate small fragments alongside a 7.5‐F and a 6.3‐F ureteroscope in an 11/13‐F FANS UAS. Intermittent withdrawal of either of the ureteroscope from the FANS UAS allows complete stone clearance.","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"5 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144520343","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":"Is pelvic floor loading in female runners associated with post‐run changes in pelvic floor morphometry or function?","authors":"Marie‐Eve Berube, Stefan Niederauer, Ryan Graham, Robert Hitchcock, Linda McLean","doi":"10.1111/bju.16842","DOIUrl":"https://doi.org/10.1111/bju.16842","url":null,"abstract":"ObjectivesTo investigate whether, among female runners, transient changes in pelvic floor morphometry, pelvic floor muscle (PFM) function, or pad weight gain observed after a standardised running protocol are associated with the exposure of the pelvic floor to loading during the run.MethodsAdult female runners with (<jats:italic>n</jats:italic> = 19) and without (<jats:italic>n</jats:italic> = 19) running‐induced stress urinary incontinence (RI‐SUI) completed a 37‐min treadmill‐based running protocol with a pressure sensor placed in the posterior fornix of the vagina and a triaxial accelerometer adhered to the pelvis, and an incontinence pad adhered to their undergarment. Pelvic morphometry and PFM function were assessed before and after the run using transperineal ultrasonography and intra‐vaginal dynamometry. Urine leakage volume was estimated based on incontinence pad weight gain. Separate linear regression models were used to evaluate the associations between variables representative of pelvic floor load exposure (posterior fornix sensor pressure [PFSP] and pelvic accelerations) and changes in pelvic morphometry, PFM function, and incontinence pad weight observed after the run.ResultsAfter the run, the levator hiatus was larger and the bladder neck sat lower in the pelvis, but there were no significant differences in PFM active or passive forces measured using dynamometry. These changes were not different between those with and those without RI‐SUI. Higher pelvic accelerations were associated with greater reductions in passive PFM stiffness after the run (<jats:italic>R</jats:italic><jats:sup>2</jats:sup> = 20%–27%), but not with changes in pelvic morphometry. No associations were found between any measures of pelvic floor load exposure and changes in PFM force‐generating capacity. Among runners with RI‐SUI, greater pad weight gain occurred among those who ran with slower vector accelerations (<jats:italic>R</jats:italic><jats:sup>2</jats:sup> = 0.27).ConclusionThe magnitude of pelvic floor loading experienced during running does not appear to influence the transient loss in static pelvic organ support observed after running nor urine leakage volume.","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"37 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144520346","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":"Renal clearance of fluorescent agents can compromise image-guided surgery along the urinary tract.","authors":"Anne-Claire Berrens,Tessa Buckle,Matthias N van Oosterom,Leon J Slof,Belle M Melsert,Jakko A Nieuwenhuijzen,Esther M K Wit,Pim J van Leeuwen,Henk G van der Poel,Fijs W B van Leeuwen","doi":"10.1111/bju.16804","DOIUrl":"https://doi.org/10.1111/bju.16804","url":null,"abstract":"OBJECTIVESTo study the effect of renally cleared fluorescent agents on image-guided surgery along the urinary tract by using the renally cleared, non-tumour-specific, fluorescent dye fluorescein.SUBJECTS AND METHODSSixteen patients who underwent robot-assisted radical prostatectomy (RARP) with lymph node dissection received an intradermal injection of fluorescein. The slow-release of the fluorescein from the skin into the lymph- and bloodstream were used as a pharmacokinetic model for slow release from receptor-targeted agents. The presence of fluorescein in the urine and the surgical dissection planes around the prostate (representative of cancer margins) during RARP were evaluated. Suction, gauze and irrigation were used to try and reduce fluorescent background signals according to standard operating protocol.RESULTSFluorescein was detected in the urine in the bedside catheter bag after a median of 1.3 h after agent administration and in the surgical field after opening the bladder neck as part of RARP (median of 2.4 h after injection). Suction and application of gauze helped to reduce contamination, but suction combined with irrigation with lukewarm NaCl 0.9% was shown to be most effective. Fluorescein accumulation was seen in the tissue surrounding the bladder neck in 80% of patients.CONCLUSIONSRenally excreted fluorescent agents risk contamination of the surgical field and possible dissection margins along the urinary tract, a feature that, without proper counter measures, could compromise the accuracy of intra-operative imaging by creating false-positive findings. A clear example of this was the observed bladder neck staining with fluorescein.","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"277 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144521214","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}