BJU International最新文献

{"title":"Flexible and navigable suction access sheaths: balancing sheath and scope size for desired flows.","authors":"Richard Menzies-Wilson,Jessica Williams,Thijs Ruiken,Candace Rhodes,Ben Turney","doi":"10.1111/bju.16865","DOIUrl":"https://doi.org/10.1111/bju.16865","url":null,"abstract":"OBJECTIVETo study the effects of ureteroscope diameter, 'flexible and navigable suction' access sheaths (FANS) diameter, and irrigation pressure on intrarenal pressure (IRP) and irrigation fluid flow rates in ex vivo porcine kidneys; these benchtop data were compared against mathematical modelling results.MATERIALS AND METHODSFresh ex vivo porcine kidneys and ureters were used. The tip of an 11/13- or 10/12-F ClearPetra® FANS was placed within the renal pelvis. Either a 9.5-F Boston Scientific LithoVue™, 7.5-F PUSEN PU3033, or 6.3-F HugeMed HU30M ureteroscope was inserted through the sheath. Irrigation pressures of 0, 50, 100, 150 and 200 mmHg were applied. No suction was applied. The corresponding steady state IRP and flow rate was recorded. This was replicated in three separate porcine kidneys. Benchtop data were compared to mathematical model predictions. The maximum flow rates that could be achieved with an IRP ≤30 mmHg were extrapolated.RESULTSThe FANS and ureteroscope geometries affect outflow resistance. Lower outflow resistances, allow higher irrigation pressures and flow rates to be used whilst maintaining an IRP ≤30 mmHg (without suction). Whilst keeping IRP ≤30 mmHg with an 11/13-F FANS: ~700 mmHg irrigation (~120 mL/min) could be used with a 6.3-F ureteroscope; ~300 mmHg irrigation (flow rate ~65 mL/min) could be used with a 7.5-F ureteroscope; ~100 mmHg irrigation (~15 mL/min) could be used with a 9.5-F ureteroscope.CONCLUSIONSUsing a FANS in the renal pelvis potentially allows for higher irrigation pressures whilst maintaining a low IRP (without the need for suction). With intraoperative monitoring of IRP, irrigation pressure could be increased to achieve flow rates up to 24 times higher than those achievable with gravity irrigation (120 vs ~5 mL/min).","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"154 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145140306","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 computer vision model for automated kidney stone segmentation and evaluation of its performance vs surgeons.","authors":"Daiwei Lu,Ekamjit S Deol,Tatsuki Koyama,Ipek Oguz,Nicholas L Kavoussi","doi":"10.1111/bju.70001","DOIUrl":"https://doi.org/10.1111/bju.70001","url":null,"abstract":"OBJECTIVESTo develop a computer vision model that segments stones to improve visualisation during ureteroscopy (URS) and to compare model performance to that of experts.MATERIALS AND METHODSWe collected 136 videos of URS for intrarenal kidney stone treatment. Frames were extracted at 3 frames per second (FPS) and manually annotated. The video dataset was split into training (75%), validation (5%) and testing (20%) subsets. Model performance was evaluated for stone localisation, laser ablation, and final evaluation of remaining fragments based on area under the receiver-operating curve, binary cross-entropy loss and Dice similarity coefficient (DSC). Model performance was compared to the manual annotations of five board-certified urologists through pairwise comparison of frame-by-frame segmentation accuracy.RESULTSThe final dataset consisted of 21 718 frames from 38 fibreoptic and 98 digital videos. Overall, the model showed excellent performance: DSC 0.97 (interquartile range [IQR] 0.91, 0.99) and could segment at 30 FPS. Performance was similar for both fibreoptic (0.97 [IQR 0.91, 0.99]) and digital scopes (0.97 [IQR 0.92, 0.99]). Additionally, the model demonstrated good performance during stone localisation (0.98 [IQR 0.93, 0.99]) and stone laser ablation (0.96 [IQR 0.89, 0.97]), with slightly worse performance during evaluation of residual fragments (0.91 [IQR 0.50, 0.97]). Model performance was comparable to the five expert surgeons overall. In a head-to-head comparison, the model significantly outperformed three of the five experts and performed similarly to the other two.CONCLUSIONThe computer vision model demonstrates good performance for task-specific stone segmentation evaluation during URS. The segmentation performance of the model was similar to the segmentation performance of expert surgeons, demonstrating the feasibility of its real-time intra-operative utilisation.","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"41 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145133962","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 benefits of PCNL combined with ureterorenoscopy compared to isolated PCNL in urolithiasis (PRECISE): a multicentre randomised controlled trial protocol.","authors":"Chris A Suijker,Riemer A Kingma,Dirk Bakker,Ward Goossens,Jaap Poerink,Antoinette D I van Asselt,Inge M van Oort,Stijn Roemeling, ","doi":"10.1111/bju.70008","DOIUrl":"https://doi.org/10.1111/bju.70008","url":null,"abstract":"BACKGROUNDPercutaneous nephrolithotomy (PCNL) often fails to achieve complete stone clearance with a single procedure. Residual fragments, irrespective of size, are associated with increased stone-related morbidity and a higher likelihood of re-intervention. Endoscopic combined intrarenal surgery (ECIRS), which integrates PCNL with retrograde ureterorenoscopy, may improve stone-free rates and reduce morbidity. However, given the potential for increased risks and greater resource utilisation, a comprehensive randomised controlled trial is warranted. The 'PRECISE' trial is designed to compare ECIRS and PCNL in terms of efficacy, safety, stone-related morbidity, and resource utilisation.STUDY DESIGNThe PRECISE is a prospective, non-blinded, randomised, parallel-group, multicentre interventional trial involving patients eligible for percutaneous kidney stone surgery. Patients will be randomised in a 1:1 ratio to undergo either ECIRS or standard PCNL.ENDPOINTSThe primary endpoint is the Grade A (0 mm) stone-free rate on postoperative computed tomography (CT) at 4 weeks. Secondary radiological endpoints include Grade B (≤2 mm) and Grade C (≤4 mm) stone-free rates at 4 weeks, stone volume reduction, 1-year stone-free rates, and radiation exposure. Additional outcomes include complications, operative duration, stone-related events (SREs), health-related quality of life (HRQoL), cost differences, cost-effectiveness and environmental impact, assessed up to 5 years postoperatively.PATIENTS AND METHODSAdults (aged ≥18 years) eligible for percutaneous kidney stone surgery, where retrograde access is feasible, will be recruited. The main exclusion criteria comprise papillary calcifications, renal transplant procedures, and (suspected) pregnancy. A total of 350 patients (175 per arm) will be recruited. Follow-up includes CT imaging with clinical consultations at 4 weeks and 1 year to evaluate radiological outcomes, complications, SREs, and HRQoL. Telephone interviews at 3 and 5 years will assess long-term SREs and HRQoL. We aim to retrospectively evaluate cost differences, cost-effectiveness, and environmental impact.TRIAL REGISTRATIONThe PRECISE study: an investigation into combined kidney stone surgery, Dutch Trial Registry, NL-009577.","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"15 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145133959","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":"Distribution of serum PSA in Chinese men: a preliminary community-based study.","authors":"Yang Zhenyu,Yu Yang,Gu Bin,Pan Chunwu,Jiang Feng,Zhang Dingguo,Xia Qier,Li Jun,Ling Le,Zhao Dandan","doi":"10.1111/bju.70007","DOIUrl":"https://doi.org/10.1111/bju.70007","url":null,"abstract":"","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"39 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145140419","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":"Safe pressures for suction ureteric access sheaths: in vitro conversion of pressures to flow.","authors":"Jordan Santucci,Matthew Alberto,Niranjan Sathianathen,Anne Hong,Damien Bolton,Greg Jack","doi":"10.1111/bju.70012","DOIUrl":"https://doi.org/10.1111/bju.70012","url":null,"abstract":"OBJECTIVETo convert suction pressure settings into practical, size-specific operating limits for suction ureteric access sheaths (sUAS).MATERIALS AND METHODSUsing an 8.7-F flexible ureteroscope with a standard 3.9-F working channel, we measured irrigation inflow at various pressures with no instrument, 270-μm laser fibre, and 1.9-F basket. Outflow was measured using 10/12-, 11/13-, and 12/14-F sUAS with suction applied via Neptune 3™ (Stryker, Kalamazoo, MI, USA) at 30-s intervals and pressures ranging from 50 to 300 mmHg. Inflow and outflow were matched by linear interpolation deriving conservative size- and instrument-specific suction pressure limits for all evaluated sUAS configurations.RESULTSUreteroscope irrigation inflow ranged from 30 to 130 mL/min as irrigation pressure irrigation increased from 50 cmH20 (gravity) to 300 mmHg. Working channel instruments reduced inflow: mean (± 2 × the standard error of the mean) change of -57.1% (1.6%) for the 1.9-F basket and -42.1% (2.1%) for the 270-μm laser fibre vs no instrument. Negative pressure via sUAS generated outflow as slow as 5 mL/min (10/12-F sUAS, 50 mmHg suction) and as fast as 700 mL/min (12/14-F sUAS, 300 mmHg suction). Outflow and negative pressure were linearly related (R2 0.94-0.99). Increased scope-to-sheath ratio (SSR) reduced irrigation outflow. Fully opening the valve significantly reduced outflow by 70.8% on average. The 40-cm sUAS modestly increased outflow by 13.3% on average compared to 50-cm sUAS of same diameter. Suction of 50-80 mmHg was ideal for maintaining flow equilibrium with 11/13- and 12/14-F sUAS. The small diameter and high SSR (0.87) of the 10/12-F sUAS required greater negative pressures (150-300 mmHg) to maintain flow equilibrium.CONCLUSIONSSuction pressures as low as 50-80 mmHg are sufficient for majority of sUAS cases. Increasing irrigation inflow with pressure bag systems may counter excessive sUAS outflow; however, introducing instruments can negate this effect.","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"73 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145133961","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":"MRI in combination with Technetium-99m-sestamibi single-photon emission CT/CT: a novel diagnostic algorithm to maximise the characterisation of small renal masses.","authors":"Alessandro Bertini,Giuseppe Basile,Francesco Prato,Riccardo Zurrida,Giulio Imperiale,Giorgio Brembilla,Roberto Bertini,Giuseppe Rosiello,Andrea Salonia,Alessandro Larcher,Arturo Chiti,Francesco Montorsi,Francesco De Cobelli,Umberto Capitanio","doi":"10.1111/bju.70002","DOIUrl":"https://doi.org/10.1111/bju.70002","url":null,"abstract":"","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"1 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145116624","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":"Paleoproteomic study of blood residues shows that Voltaire (1778) died of perforated bladder squamous cell cancer with peritoneal extension.","authors":"Philippe Charlier,Yann Neuzillet,Romain Le Gendre,Jean Armengaud","doi":"10.1111/bju.70003","DOIUrl":"https://doi.org/10.1111/bju.70003","url":null,"abstract":"","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"23 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145103450","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":"Feasibility of randomisation to radical prostatectomy or standard care in patients with metastatic prostate cancer.","authors":"Lies Van den Eynde,Piet Ost,Wesley Verla,Wouter Everaerts,Karen Fransis,Pieter Uvin,Filip Ameye,Thomas Van Erps,Valérie Fonteyne,Charles Van Praet,Nicolaas Lumen","doi":"10.1111/bju.70006","DOIUrl":"https://doi.org/10.1111/bju.70006","url":null,"abstract":"OBJECTIVETo evaluate the feasibility of randomising patients with newly diagnosed metastatic prostate cancer (mPCa) to cytoreductive radical prostatectomy (cRP) plus systemic standard of care (SOC) vs SOC alone in Belgian centres.PATIENTS AND METHODSThis is a phase II, multicentre, prospective, randomised, open-label feasibility trial. Patients with newly diagnosed mPCa were screened across six centres from August 2018 to August 2024. The aim was to randomise 86 patients to either cRP with pelvic lymphadenectomy plus systemic SOC or SOC alone (including radiotherapy in low-volume disease). Eligible patients had an Eastern Cooperative Oncology Group Performance Status of 0-1 and were considered suitable candidates for local treatment. The primary endpoint was the feasibility of randomisation, assessed by the randomisation rate (randomised/eligible).RESULTSA total of 325 patients with newly diagnosed mPCa were screened, of whom 170 (52%) were eligible. The main reasons for ineligibility included unresectable tumours (42% [65/155]) and inadequate surgical fitness (37% [58/155]). Among eligible patients, 75% were excluded (127/170), mostly due to patient refusal (68% [86/127]) and inclusion in competing studies (21% [27/127]). A total of 43 patients were randomised: 21 to cRP and 22 to SOC, yielding a randomisation rate of 25% (43/170). Randomisation rates were lower than anticipated, limiting feasibility in the present trial setting.CONCLUSIONRandomising men with newly diagnosed mPCa to RP plus SOC vs SOC alone proved challenging in this Belgian trial. Major barriers to recruitment included limited surgical eligibility and patient refusal. Targeted recruitment strategies or alternative trial designs should be considered.","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"4 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145089851","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":"Incidence and risk factors for postoperative vaginal events following radical cystectomy for bladder cancer: a nationwide population-based study.","authors":"Elin Kalén,Charlotte Ginstman,Fredrik Liedberg,Oskar Hagberg,Martin Holmbom,Tomas Jerlström,Staffan Jahnson,Truls Gårdmark,Viveka Ströck,Lars Holmberg,Christel Häggström,Firas Aljabery","doi":"10.1111/bju.70004","DOIUrl":"https://doi.org/10.1111/bju.70004","url":null,"abstract":"OBJECTIVETo estimate the probability of vaginal events (diagnosis and/or surgery) following radical cystectomy (RC) and explore possible risk factors in a nationwide population-based observational registry based study.PATIENTS AND METHODSWomen undergoing RC for urinary bladder cancer in Sweden, from 1 January 1997 to 31 December 2019, were identified within national registries. Women with any postoperative vaginal event (PVE), either a diagnosis or surgical repair related to a vaginal complication, were identified using diagnostic and treatment codes. The probability of developing a PVE was estimated based on the cumulative incidence proportion using a competing risk model. Additionally, a multivariable Cox proportional hazards model was used to explore the risk factors for PVEs. Subgroup analysis was performed in patients operated from 2011 to 2019, where additional perioperative variables were registered.RESULTSThe study encompassed 1914 women with a median age of 69 years at the time of bladder cancer diagnosis. The 5-year cumulative risk of PVEs in the entire cohort was 11% (95% confidence interval [CI] 9.5-12.5%). Subgroup analysis showed that robot-assisted RC and a body mass index (BMI) >30 kg/m2 were more often associated with PVEs after RC (hazard ratio [HR] 2.82, 95% CI 1.81-4.40; and HR 1.71, 95% CI 1.05-2.79, respectively).CONCLUSIONSA clinically relevant cumulative incidence of PVEs following RC was identified. An association between robot-assisted RC or high BMI with increased risk of a PVE indicate the need for further studies on risk assessment of vaginal complications.","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"233 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145089850","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":"Male sex is a risk factor for detrusor pressure jeopardising the upper urinary tract in patients with spinal cord injury.","authors":"Veronika Birkhäuser,Collene E Anderson,Marko Kozomara,Martin W G Brinkhof,Oliver Gross,Lorenz Leitner,Martina D Liechti,Ulrich Mehnert,Lara Stächele,Thomas M Kessler","doi":"10.1111/bju.16925","DOIUrl":"https://doi.org/10.1111/bju.16925","url":null,"abstract":"OBJECTIVETo evaluate sex differences in maximum storage detrusor pressure (Pdetmax storage), focusing on Pdetmax storage ≥40 cmH2O, an established risk factor for upper urinary tract damage, within the first year after spinal cord injury (SCI).PATIENTS AND METHODSA cohort of patients with neurogenic lower urinary tract dysfunction due to acute traumatic or ischaemic SCI, managed according to the European Association of Urology Guidelines on Neuro-Urology, prospectively underwent urodynamic investigations at 1, 3, 6 and 12 months after SCI at a university SCI centre. Pearson's chi-squared tests and multivariable regression analyses were used to compare outcomes between females and males.RESULTSOf 97 patients, 34% were female. Within the first year after SCI, 9% of females presented with a Pdetmax storage ≥40 cmH2O, compared to 55% of males (P < 0.001). Females had lower Pdetmax storage than males, with a grand mean (standard deviation [SD]) of 13 (9) vs 30 (20) cmH2O (coefficient = 18 cmH2O, 95% confidence interval [CI] 13-24 cmH2O; P < 0.001). Females also had lower detrusor overactivity leak-point pressure (DOLPP) than males, with a grand mean (SD) of 15 (4) vs 35 (21) cmH2O (coefficient = 20 cmH2O, 95% CI 11-29 cmH2O; P < 0.001). The cumulative incidence of antimuscarinic therapy and reported urinary incontinence was similar between sexes (female vs male: 55% vs 70%, P = 0.12; 53% vs 43%, P = 0.42, respectively).CONCLUSIONSFemales rarely reached a Pdetmax storage ≥40 cmH2O during the first year after SCI and had lower Pdetmax storage and DOLPP than males. However, the prevalence of urinary incontinence was similar between the sexes, suggesting the need for a more sex-tailored approach to patient management.","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"177 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145083583","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}