BJU International最新文献

{"title":"Artificial intelligence for predicting BCG response in non-muscle-invasive bladder cancer: a systematic review","authors":"Ludovica Cella, Roberto Contieri, Marco Paciotti, Vittorio Fasulo, Alessandro Uleri, Pier Paolo Avolio, Laura S. Mertens, Benjamin Pradere, Sisto Perdonà, Alberto Saita, Massimo Lazzeri, Paolo Casale, Giovanni Lughezzani, Rodolfo Hurle, Nicolò Maria Buffi","doi":"10.1111/bju.70404","DOIUrl":"10.1111/bju.70404","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To systematically identify, appraise and synthesise artificial intelligence (AI) and machine-learning (ML) models that predict treatment response and clinical outcomes after intravesical bacillus Calmette–Guérin (BCG) in non-muscle-invasive bladder cancer (NMIBC), a setting in which current risk calculators underperform, and identifying non-responders has become urgent as alternatives to BCG enter practice.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>PubMed, EMBASE and Web of Science were searched through April 2026 following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines (International Prospective Register of Systematic Reviews [PROSPERO] number CRD420261376808). Studies developing or validating AI/ML models for BCG-associated outcomes with a quantitative performance metric were included. Risk of bias was assessed with the Prediction model Risk Of Bias ASsessment Tool (PROBAST). Evidence was synthesised along a clinically oriented framework: AI as a perceptual tool (extracting signal from histology or imaging) or integrative tool (re-weighting clinicopathological, molecular, or urinary variables).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 15 studies (>24 900 patients) were included: seven perceptual, eight integrative. By input data, six used digital pathology, two radiomics, two genomics/transcriptomics, four clinicopathological markers, and one urinary biomarkers. The digital-pathology Computational Histology Artificial Intelligence (CHAI) platform, validated across 12 international centres, stratified high-grade recurrence (hazard ratio [HR] 2.08), progression (HR 3.87) and BCG-unresponsive disease (HR 2.31), and was the only model providing a first signal of predictive value, demonstrating a significant BCG vs gemcitabine/docetaxel interaction (<i>P</i> = 0.029). Integrative models PROGRxN-BCa (concordance index [C-index] 0.79) and DeepSurv (C-index 0.881) outperformed standard calculators but with modest gains (ΔC-index 0.05–0.10). Only 40% of studies performed external validation, none prospectively; five were at high risk of bias.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Perceptual AI, particularly digital pathology, has the highest external validation and provides the only biomarker with a first signal of predictive value for BCG vs alternatives, increasingly relevant in the context of the global BCG shortage. Integrative models such as PROGRxN-BCa and DeepSurv outperform standard calculators with incremental gains and are freely accessible. Prospective validation, systematic calibration reporting and treatment-by-bi","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"138 5","pages":"786-797"},"PeriodicalIF":4.1,"publicationDate":"2026-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148754563","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":"Bladder washing cytology in the initial evaluation of patients with neuro-urological disorders: to do or not to do?","authors":"Fabienne Lehner,&nbsp;Sarah Dugas,&nbsp;Veronika Birkhäuser,&nbsp;Oliver Gross,&nbsp;Lorenz Leitner,&nbsp;Ulrich Mehnert,&nbsp;Lara Stächele,&nbsp;Collene E. Anderson,&nbsp;Thomas M. Kessler","doi":"10.1111/bju.70422","DOIUrl":"10.1111/bju.70422","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To evaluate if bladder washing cytology (BWC) provides a diagnostic benefit in the initial evaluation of patients with neuro-urological disorders.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Patients and Methods</h3>\u0000 \u0000 <p>This prospective cross-sectional study investigated a consecutive series of patients with lower urinary tract symptoms referred for neuro-urological evaluation at our department of neuro-urology who underwent urethro-cystoscopy (UC) and BWC from 2018 to 2023.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 581 neurological patients, 274 (47.2%) were females. Tumour-suspicious findings leading to surgical intervention were detected in 17 (2.9%) by UC alone and in three (0.5%) by BWC but unsuspicious UC, respectively. Overall, relevant histological findings after transurethral bladder surgery (TUBS) were detected in eight (1.4%, 95% confidence interval [CI] 0.6–2.7%) patients: keratinising squamous metaplasia (two) and non-muscle-invasive urothelial carcinoma (six), all were initially identified by UC. Three patients refused surgery, two of whom had positive BWC without suspicious lesion in UC. Sensitivity and specificity of BWC referenced to UC alone were 0% (95% CI 0.0–36.9%) and 99.7% (95% CI 98.7–99.9%), respectively. Adding BWC to UC increased costs by 22.8% without improving tumour detection. The main study limitation was the lack of true positives in BWC.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Bladder washing cytology in addition to UC is not justified in the initial evaluation of patients with neuro-urological disorders as decision making regarding TUBS is based on UC findings. Moreover, omission of BWC saves relevant costs without compromising patient safety.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"138 5","pages":"860-866"},"PeriodicalIF":4.1,"publicationDate":"2026-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/bju.70422","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148763249","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":"Digital advances for multicentre studies – the British Urology Researchers in Surgical Training (BURST) experience","authors":"Nikki Kerdegari,&nbsp;Feargus Hosving-Jervis,&nbsp;Veeru Kasivisvanathan,&nbsp;Kevin Byrnes,&nbsp;Kevin Gallagher,&nbsp;Sinan Khadhouri,&nbsp;Nikita Bhatt","doi":"10.1111/bju.70447","DOIUrl":"10.1111/bju.70447","url":null,"abstract":"&lt;p&gt;The UK National Institute for Health and Care Research (NIHR) spent £578.21 million funding research programmes to improve patient outcomes in 2024/2025 [&lt;span&gt;1&lt;/span&gt;]. Despite considerable investment, &gt;40% of UK trials fail to achieve their intended recruitment [&lt;span&gt;2&lt;/span&gt;]. Collaborative multicentre research is valuable in the evolving research landscape. It can answer questions that traditional trials cannot. A large network of international collaborating sites allows a shorter time to sufficient power, whilst maintaining methodological robustness. The collaborative model increases accessibility in participation, overcoming barriers such as financial constraints, geography, and lack of infrastructure. The increased sample sizes, data granularity and diversity of participants create the potential to give high certainty answers to research questions whilst meeting the needs of increasingly diverse and complex patient populations.&lt;/p&gt;&lt;p&gt;A barrier to multicentre studies is the logistical challenge of coordinating many parties. With over a decade of experience, and in partnership with database developers, the British Urology Researchers in Surgical Training (BURST) collaborative has evolved to adopt innovations to improve site participation and streamline data entry whilst maintaining high data quality. This has resulted in large-scale, meaningful outputs. In the IDENTIFY study (ClinicalTrials.gov identifier: NCT03548688), 10 896 patients from 110 hospitals were recruited in 12 months [&lt;span&gt;3&lt;/span&gt;]. In the RESECT study (NCT05154084), an embedded cluster randomised controlled trial was enabled, randomising 220 sites in 18 months and collecting data about 19 505 transurethral resection of bladder tumour cases from 230 sites across all phases of the study in 27 months [&lt;span&gt;4&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Research Electronic Data Capture (REDCap) is a locally hosted, non-commercial data management platform accessible from a web browser and widely used internationally. BURST uses REDCap for site registration, data entry, and data management for the study team. The experience for participating sites is improved by simplifying the registration process and self-service of input, such as surgeon demographic data.&lt;/p&gt;&lt;p&gt;Applications (apps) can be connected to REDCap on top of its core database structure. We have made use of this functionality to build study-specific apps, developed using ‘Shiny’ (an R web app framework), which are distributed to relevant users. Apps include: The RESECT surgical performance feedback dashboard, an authorship and participant certificate management app and a data quality app (Figs S1–S3). The data quality app was developed during RESECT and refined for our most recent study the ‘Ward AdmiSsion of Haematuria: an Observational mUlticentre sTudy’ (WASHOUT). The app automatically extracts data in real-time and on-demand, processes and standardises it, and presents site-specific data quality reports to users. This automated data qu","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"138 5","pages":"747-749"},"PeriodicalIF":4.1,"publicationDate":"2026-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/bju.70447","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148987866","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":"Small- and large-calibre ureteroscopes: an updated systematic review and meta-analysis","authors":"Francesco Di Bello,&nbsp;Paolo Verri,&nbsp;Alejandra Bravo-Balado,&nbsp;Paula Izquierdo,&nbsp;Lucio Fila,&nbsp;Andres K. Kanashiro,&nbsp;Rozalba Gogaj,&nbsp;Elizabeth Wells,&nbsp;Olivier Traxer,&nbsp;Oriol Angerri,&nbsp;Esteban Emiliani","doi":"10.1111/bju.70394","DOIUrl":"10.1111/bju.70394","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To systematically review and meta-analyse the available evidence comparing perioperative outcomes between small- (≤6.3/7.5 F) and large-calibre (≥7.5/9.8 F) ureteroscopes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A literature search of MEDLINE/PubMed, and Scopus was performed prior to March 2026 according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The endpoints of interest were stone-free rates (SFRs), overall complications, and operative time. Study quality and risk of bias were evaluated using the Newcastle–Ottawa Scale and the Revised Cochrane Risk of Bias Tool for Randomised Trials for non-randomised and randomised studies. Sensitivity analyses were completed on studies reporting flexible ureteroscopes only, 7.5- vs &gt;7.5-F ureteroscopes, and on randomised controlled trials (RCTs).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Eight studies were included in the meta-analysis. Of those, four were RCTs while four were retrospective. Specifically, three studies compared 6.3- vs 7.5-F ureteroscopes, one 6.3- vs 8.5-F ureteroscopes, one 6- vs 7.5-F ureteroscopes, while three compared 7.5- vs &gt;7.5-F ureteroscopes. Within the meta-analysis comparing 6.3- vs 7.5-F ureteroscopes, the small-calibre ureteroscopes were associated with a risk ratio [RR] for SFR of 0.99 (95% confidence interval [CI] 0.92–1.06), of 1.08 (95% CI 0.77–1.51) for overall complications, and a standardised mean difference in operative time of −14.5 min (95% CI −33.4 to 3.3 min). These results were virtually confirmed by all sensitivity analyses. No differences in the above outcomes were recorded for the comparison between 7.5- vs &gt;7.5-F ureteroscopes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Within the present meta-analysis, the small-calibre ureteroscopes achieved comparable outcomes to large-calibre ureteroscopes. To overcome the substantial heterogeneity and residual confounding across studies, well-designed and adequately powered RCTs are required.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"138 5","pages":"769-776"},"PeriodicalIF":4.1,"publicationDate":"2026-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148596187","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":"Spontaneous stone passage prediction in acute ureteric colic using radiomics and machine learning","authors":"Frederic Panthier,&nbsp;Zine-Eddine Khene,&nbsp;Daniela Velinova,&nbsp;Laurent Berthe,&nbsp;Hugh Crawford-Smith,&nbsp;Sian Allen,&nbsp;Olivier Traxer,&nbsp;Clare Allen,&nbsp;Daron Smith","doi":"10.1111/bju.70408","DOIUrl":"10.1111/bju.70408","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Objectives&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;To predict spontaneous stone passage (SSP) in uncomplicated acute ureteric colic (AC) using non-contrast computed tomography (NCCT)-based radiomics and machine learning (ML).&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Patients and Methods&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;This retrospective single-centre study included consecutive patients presenting with stone-related uncomplicated AC between January 2022 and March 2024, confirmed by NCCT. Initial and 4-week follow-up clinical and imaging data were collected, including SSP status. After anonymisation, a semi-automated density-based stone segmentation was performed using 3DSlicer. Radiomic features were extracted (PyRadiomics_v3.1.1). Significant features were selected using the Least Absolute Shrinkage and Selection Operator (LASSO) method. After data splitting (training [80%]–validation [20%]), nine ML models were trained with hyperparameter fine-tuning to predict SSP on the validation set. The primary performance metric was the area under the curve (AUC).&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;A total of 428 patients were included, with a median (interquartile range [IQR]) age of 45 (32–56) years. Most ureteric stones were solitary, with a median (IQR) maximum stone diameter (MSD) of 5.3 (4.1–6) mm and stone volume of 68.8 (22–78.1) mm&lt;sup&gt;3&lt;/sup&gt;. The majority of the stones were proximal rather than distal: 59.6%, were located in the upper ureter, 9.1%, in the middle, and 30.8% in the lower ureter. A pelvic phlebolith was present in 50.9% of cases. The overall SSP rate was 47.9%. Following LASSO selection, seven radiomic features were used for model training and validation: image-original_mean (mean value of all voxels), image-original_maximum (maximum voxel value), original_glrlm_RunEntropy (heterogeneity in grey level run lengths), original_gldm_DependenceVariance (structure irregularity), original_gldm_LargeDependenceEmphasis (voxel homogeneity), original_gldm_LargeDependenceHighGreyLevelEmphasis (homogenous regions with high voxel intensity), original_gldm_LargeDependenceLowGreyLevelEmphasis (homogenous regions with low voxel intensity), along with SSP status. The random forest algorithm achieved the best performance of all tested models with an AUC of 0.79 (95% confidence interval 0.68–0.88) on the validation set (accuracy = 0.72, F1-score = 0.72, sensitivity = 0.69, specificity = 0.76).&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusion&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Predicting SSP in uncomplicated AC is feasible using radiomics features extracted from NCCT. Hybrid models, including the stone location could improve their performance. External validation is required, and developing an automated ureteric st","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"138 5","pages":"841-851"},"PeriodicalIF":4.1,"publicationDate":"2026-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148726385","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":"AI-based anatomical recognition for bladder neck dissection in robot-assisted radical prostatectomy","authors":"Shinnosuke Fujiwara,&nbsp;Keishiro Fukumoto,&nbsp;Masashi Takeuchi,&nbsp;Yuichiro Konnai,&nbsp;Yota Yasumizu,&nbsp;Nobuyuki Tanaka,&nbsp;Toshikazu Takeda,&nbsp;Kazuhiro Matsumoto,&nbsp;Takeo Kosaka,&nbsp;Hirofumi Kawakubo,&nbsp;Masaru Ishida,&nbsp;Yuko Kitagawa,&nbsp;Mototsugu Oya","doi":"10.1111/bju.70390","DOIUrl":"10.1111/bju.70390","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To develop an artificial intelligence (AI) system for anatomical recognition that can automatically identify key anatomical structures during bladder neck dissection in robot-assisted radical prostatectomy (RARP), a critical yet technically demanding step.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Methods</h3>\u0000 \u0000 <p>We constructed an AI model and evaluated its accuracy using 210 RARP videos from two institutions. A total of 1353 frames of bladder neck dissection were extracted from 25 videos, and the boundaries of the prostate, bladder and retrotrigonal layer were annotated. The DeepLabV3+ model was employed in developing the anatomical recognition AI model. An active learning approach was applied by iteratively retraining the model using frames with poor initial performance. The model was further evaluated using 202 independent test frames derived from seven surgeons. Segmentation performance was evaluated using the intersection over union (IoU) and Dice similarity coefficient.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The IoU of the initial AI model was 0.41 for the prostate and 0.44 for the bladder. The retrained model demonstrated improved segmentation performance, with final IoU values of 0.75 and 0.68, respectively. In an independent test dataset derived from seven surgeons, segmentation performance for the prostate and bladder was maintained.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>We developed an AI system for anatomical recognition and improved its accuracy by using retraining processes. The retrained AI model demonstrated high accuracy, and its use is anticipated to support surgeons and aid in the education of novice surgeons.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"138 5","pages":"852-859"},"PeriodicalIF":4.1,"publicationDate":"2026-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/bju.70390","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148589029","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":"Symptom-guided reduction of BCG dwell time: findings from the north-REG randomized trial","authors":"Lene Munk,&nbsp;Josephine Maria Hyldgaard,&nbsp;Vanaja Kumasegaram,&nbsp;Rikke Vilsbøl Milling,&nbsp;Simone Buchardt Brandt,&nbsp;Juan Luis Vásquez,&nbsp;Knud Fabrin,&nbsp;Gitte Wrist Lam,&nbsp;Lasse Bro,&nbsp;Sigurður Gudjonsson,&nbsp;Viveka Ströck,&nbsp;Tomas Jerlsström,&nbsp;Tomas Thiel,&nbsp;Maria Skydt Lindgren,&nbsp;Jørgen Bjerggaard Jensen,&nbsp;Charlotte Graugaard-Jensen","doi":"10.1111/bju.70396","DOIUrl":"10.1111/bju.70396","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To evaluate the impact of personalized dwell-time (DT) reductions on symptom prevalence and systemic toxicities in patients undergoing Bacillus Calmette–Guérin (BCG) instillation for non-muscle invasive bladder cancer (NMIBC).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Within a multinational randomized controlled trial (North-REG Dwell Time Study [NCT04701151]), 225 patients provided daily electronic patient-reported outcomes data during BCG induction and maintenance cycles. Participants were randomized 1:1, stratified by clinical site, sex, and concomitant carcinoma in situ, to either a standard care arm (control) or an intervention arm. Toxicity was analysed using a ‘worst-day’ principle to capture peak symptom burden. All patients initially received a standard 120-min DT. In the intervention group, algorithm-guided DT reductions (to 60 or 30 min) were triggered by real-time symptom severity, whereas the control group maintained a 120-min DT.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>At baseline, 69% vs. 71% (control vs. intervention) of participants reported pre-existing symptoms, primarily lower urinary tract symptoms such as pollakiuria and urgency. During induction, the intervention group experienced significantly lower rates of urgency at week 3 (34% vs. 47%, <i>P</i> = 0.04) and week 6 (32% vs. 49%, <i>P</i> = 0.01). Significant reductions were also observed during maintenance at week 9 for systemic symptoms (30% vs. 61%, <i>P</i> &lt; 0.001) and fatigue (22% vs. 47%, <i>P</i> = 0.001). Total adherence to the 15-instillation protocol was 38% in the intervention group and 40% in the control group.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Daily electronic patient-reported outcomes monitoring revealed that patients with NMIBC have a high baseline symptom burden prior to BCG therapy. Symptom-guided DT reductions may reduce local urgency and systemic toxicity and improve treatment tolerability. However, treatment completion does not seem to be affected.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"138 5","pages":"831-840"},"PeriodicalIF":4.1,"publicationDate":"2026-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/bju.70396","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148648192","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":"In vitro evaluation of the new holmium:yttrium-aluminium-garnet laser with Magneto technology on behalf of the Progress and Collaboration in Endourology (PACE) group","authors":"Adèle Martin-Illac,&nbsp;Marie Chicaud,&nbsp;Marie-Lou Letouche,&nbsp;Stefano Moretto,&nbsp;Federico Zorzi,&nbsp;Alejandra Bravo-Balado,&nbsp;Carlos Altez Fernandes,&nbsp;Alberto Quarà,&nbsp;Aideen Madden,&nbsp;Letizia Maria Ippolita Jannello,&nbsp;Jorge Peña Lueza,&nbsp;Razvan Ionut Popescu,&nbsp;Luigi Candela,&nbsp;Frederic Panthier,&nbsp;Olivier Traxer,&nbsp;Steeve Doizi,&nbsp;Stessy Kutchukian","doi":"10.1111/bju.70425","DOIUrl":"10.1111/bju.70425","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To evaluate the following characteristics of the holmium:yttrium-aluminium-garnet (Ho:YAG) laser with Magneto technology: pulse shape, shape and duration of the laser-induced vapour bubble (VB), power loss over time, and the risk of fibre fracture (RFF).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A 150 W Ho:YAG generator was characterised <i>in vitro</i> with Magneto technology. The pulse shape was measured using an oscilloscope. The pulse duration was measured to calculate the peak power (PP) using both a 200- and 550-μm laser fibre (LF). VB were evaluated with a 200-μm fibre using a high-speed camera (8000 frames/s). Power loss over time was obtained at the fibre tip before and after 30 s, then 1 min of continuous laser activation in saline solution and in contact with BegoStone® (BEGO GmbH &amp; Co., Bremen, Germany). Power loss was evaluated using LFs with core diameters of 200, 365, and 550 μm. RFF was tested after 5 min of continuous laser activation or until LF fracture with different laser settings and LF bending radii (0.45, 0.6, 0.9 cm) using a 200-μm LF.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The Ho:YAG laser with the Magneto technology possesses a quasi-rectangular waveform with extended pulse durations ranging between 0.7 and 1.7 ms and limited PPs between a mean (standard deviation) of 513.4 (23.3) to 1149.7 (6.9) W that increase proportionally with power. However, multiple spikes were observed within each pulse, precluding a perfectly linear plateau. Regarding VB, it was significantly wider with the 550-μm LF compared to the 200-μm LF. Conversely, the VB duration was significantly longer with the 200-μm LF. A consistent initial power loss was observed in normal saline of 13–28.0% across all LF diameters, which progressed during continuous activation of up to 1 min. This power degradation was more pronounced on synthetic BegoStone. No LF fractures were observed under the tested experimental conditions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The new Ho:YAG laser with Magneto technology appears to be a promising compromise between conventional Ho:YAG and thulium fibre laser, owing to its pulse profile with a limited PP.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"138 5","pages":"877-885"},"PeriodicalIF":4.1,"publicationDate":"2026-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148754564","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":"Active surveillance for intermediate-risk prostate cancer: a systematic review and pooled analysis","authors":"Alessandro Uleri,&nbsp;Ludovica Cella,&nbsp;Thibaut Long-Depaquit,&nbsp;Federica Sordelli,&nbsp;Alba Farré,&nbsp;Victor Caballero,&nbsp;Josep Comet,&nbsp;Pawel Rajwa,&nbsp;Romain Diamand,&nbsp;Bertrand Tombal,&nbsp;Morgan Roupret,&nbsp;Veeru Kasivisvanathan,&nbsp;Michael S. Leapman,&nbsp;Guillaume Ploussard,&nbsp;Michael Baboudjian","doi":"10.1111/bju.70388","DOIUrl":"10.1111/bju.70388","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Active surveillance (AS) is the preferred management for individuals with low-risk prostate cancer (PCa), but its role in intermediate-risk (IR) disease remains underreported. Given growing interest and published data, we performed an updated systematic review and meta-analysis to evaluate AS outcomes in selected patients with Gleason Grade Group (GG) 1–2 IR PCa.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PROSPERO CRD420251138532). PubMed/MEDLINE, Embase, and Web of Science databases were searched for studies published up to September 2025 reporting outcomes of AS in IR PCa. Primary outcomes were AS discontinuation-free survival and GG ≥3 upgrade-free survival.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In total, 18 studies, including 3783 selected patients with IR PCa, were analyzed. Pooled AS discontinuation-free survival rates were 70% (95% confidence interval [CI] 62–78) at 3 years, 63% (95% CI 58–68) at 5 years, and 53% (95% CI 38–67) at 10 years. In analyses restricted to GG 2 cohorts, corresponding pooled estimates were 72% at 3 years, 56% at 5 years, and 40% at 10 years. GG ≥3 upgrade-free survival was 84% (95% CI 76–92) at 3 years and 78% (95% CI 65–91) at 5 years in all cohorts and 92% (95% CI 86–98) and 87% (95% CI 78–95) at 3 and 5 years in cohorts screened using multiparametric magnetic resonance imaging. No significant difference in AS discontinuation was observed between biopsy GG 1 and 2 (hazard ratio 1.08; 95% CI 0.86–1.35). Limitations include moderate risk of bias and heterogeneity across AS protocols.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Although long-term data are lacking, particularly regarding robust oncological outcomes, growing evidence suggests that AS appears oncologically safe in well-selected patients. Magnetic resonance imaging will play a key role in the appropriate selection and follow-up of patients.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"138 5","pages":"759-768"},"PeriodicalIF":4.1,"publicationDate":"2026-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148589022","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":"Comparative accuracy of imaging modalities for differentiating malignant small testicular masses","authors":"Yajat Dua, Anusha Maheshwari, Marlon Perera, Declan Murphy, Nathan Lawrentschuk, Niranjan Sathianathen","doi":"10.1111/bju.70492","DOIUrl":"https://doi.org/10.1111/bju.70492","url":null,"abstract":"Objectives To synthesise evidence comparing the diagnostic performance of imaging modalities in differentiating malignant from benign small testicular masses. Patients and Methods A Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA)‐compliant search of PubMed, Scopus, Cochrane and Web of Science databases up to 6 May 2026 identified 11 studies comprising 707 patients with small testicular masses (predominantly &lt;2 cm) who underwent imaging prior to a histopathological or, where unavailable, a mixed clinical/radiological follow‐up reference standard. Diagnostic accuracy measures for six modalities (brightness‐mode [B‐Mode] ultrasonography [US], colour doppler US [CDUS], contrast‐enhanced US [CEUS], magnetic resonance imaging [MRI], strain elastography [SE] and strain ratio [SR]) were synthesised using a Bayesian bivariate hierarchical summary receiver operating characteristic model. Results The CEUS demonstrated the most reliable discriminatory ability with a pooled sensitivity of 91% and pooled specificity of 81%, yielding the highest diagnostic odds ratio of 46. B‐Mode US remains a valid screening test with the highest sensitivity of 96% but a specificity of only 39%. CDUS showed a pooled sensitivity of 69% and a specificity of 81%. MRI had a pooled sensitivity of 91% and a specificity of 38%. SE demonstrated a pooled sensitivity of 87% and a specificity of 56%. Finally, SR reported the lowest sensitivity at 74% and a specificity of 50%. CEUS demonstrated significantly higher specificity than B‐Mode US (ratio 1.9, 95% posterior interval [PI] 1.2–4.4) and MRI (ratio 1.8, 95% PI 1.0–5.2). Conclusion The CEUS demonstrates the highest combined sensitivity and specificity for differentiating benign from malignant testicular masses, significantly outperforming conventional B‐Mode US and MRI in specificity. CEUS represents a compelling decision‐making tool to support testis‐sparing strategies and reduce unnecessary orchidectomies for indeterminate small testicular masses.","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"11 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149140456","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}