BJU International最新文献

{"title":"Response letter 'A study of oral metformin for the intravesical treatment of non-muscle-invasive bladder cancer'.","authors":"Jons W van Hattum, Marinka J Remmelink, Jorg R Oddens, Theo M de Reijke, Hanneke W Wilmink","doi":"10.1111/bju.70295","DOIUrl":"10.1111/bju.70295","url":null,"abstract":"","PeriodicalId":8985,"journal":{"name":"BJU International","volume":" ","pages":"351"},"PeriodicalIF":4.1,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13371384/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148210077","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":"Complications following repeated ureteroscopy for UTUC: The price to pay for nephron-sparing surgery.","authors":"Pietro Scilipoti, Angelo Occhi, Daniele Robesti, Andrea Folcia, Christian Corsini, Riccardo Ramadani, Armando Galdieri, Silvia Proietti, Guido Giusti, Eugenio Ventimiglia, Luigi Candela, Olivier Traxer, Andrea Salonia, Alberto Briganti, Francesco Montorsi, Marco Moschini, Luca Villa","doi":"10.1111/bju.70331","DOIUrl":"10.1111/bju.70331","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the safety profile of, and identify predictors of complications in patients undergoing, endoscopic conservative upper tract urothelial carcinoma (UTUC) management at a high-volume tertiary centre.</p><p><strong>Methods: </strong>We retrospectively reviewed 67 patients treated conservatively for UTUC, undergoing a total of 268 ureteroscopy (URS) procedures (2015-2025). Complications were collected via chart review and patient interviews from the first URS to last follow-up and graded according to the Clavien-Dindo classification. Univariable logistic regression was used to assess predictors of complications and ureteral stenosis (US). Cumulative incidence plots depicted time-to-complication events. Renal function was evaluated using serial estimated glomerular filtration rate measurements and analysed through individual trajectories and locally estimated scatterplot smoothed trends.</p><p><strong>Results: </strong>The median number of URS per patient was three (interquartile range 2-5). At least one complication occurred in 32 patients (47%). Clavien-Dindo I-II and IIIa-b events accounted for 87% and 13% of complications, respectively. Twelve patients (18%) developed endoscopic evidence of US; of these, three (25%) were treated endoscopically and two (16%) ultimately required radical nephroureterectomy. The 5-year cumulative incidence of any and major complications (Clavien-Dindo ≥ 3) was 62% (95% confidence interval 43-75) and 14% (95% confidence interval 2-25), respectively. On univariable analysis, the number of URS was the only variable significantly associated with both any complication (odds ratio 1.41 per URS, P = 0.012) and US (odds ratio 1.20 per URS, P = 0.042). The predicted risk of US reached 22.7% after six URS. Over 50 months, mean estimated glomerular filtration rate declined by >20 mL/min/1.73 m² in the overall cohort, whereas the mean decline was limited to ~10 mL/min/1.73 m² in patients who did not undergo RNU or require intervention for US or hydronephrosis.</p><p><strong>Conclusions: </strong>Conservative management of UTUC is associated with a cumulative risk of mostly low-grade complications. Prolonged endoscopic follow-up may increase the likelihood of US in a subset of patients. These findings support informed patient counselling and individualized surveillance planning.</p>","PeriodicalId":8985,"journal":{"name":"BJU International","volume":" ","pages":"334-342"},"PeriodicalIF":4.1,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13371851/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148136579","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":"Measuring the right quality targets in TURBT : detection bias and audit priorities","authors":"Ahmet Murat Bayraktar, Bilgi Işler","doi":"10.1111/bju.70401","DOIUrl":"https://doi.org/10.1111/bju.70401","url":null,"abstract":"","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"160 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148623934","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":"Symptom-guided reduction of BCG dwell time: findings from the north-REG randomized trial.","authors":"Lene Munk, Josephine Maria Hyldgaard, Vanaja Kumasegaram, Rikke Vilsbøl Milling, Simone Buchardt Brandt, Juan Luis Vásquez, Knud Fabrin, Gitte Wrist Lam, Lasse Bro, Sigurður Gudjonsson, Viveka Ströck, Tomas Jerlsström, Tomas Thiel, Maria Skydt Lindgren, Jørgen Bjerggaard Jensen, Charlotte Graugaard-Jensen","doi":"10.1111/bju.70396","DOIUrl":"https://doi.org/10.1111/bju.70396","url":null,"abstract":"<p><strong>Objectives: </strong>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><p><strong>Methods: </strong>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><p><strong>Results: </strong>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%, P = 0.04) and week 6 (32% vs. 49%, P = 0.01). Significant reductions were also observed during maintenance at week 9 for systemic symptoms (30% vs. 61%, P < 0.001) and fatigue (22% vs. 47%, P = 0.001). Total adherence to the 15-instillation protocol was 38% in the intervention group and 40% in the control group.</p><p><strong>Conclusion: </strong>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>","PeriodicalId":8985,"journal":{"name":"BJU International","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","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":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Oncologic outcomes of radical radiotherapy in frail patients with upper tract urothelial carcinoma","authors":"Willy Po‐Yuan Chen, Wing‐Keen Yap, Hao‐Lun Luo, Yao‐Yu Wu, Miao‐Fen Chen, Shih‐Ming Huang, Din‐Li Tsan, Po‐Hung Lin, Kai‐Jie Yu, Yu‐Hsiang Lin, I‐Hung Shao, Hung‐Cheng Kan, Po‐Jung Su, Wen‐Kuan Huang, Po‐Jui Chen, Po‐Ying Peng","doi":"10.1111/bju.70392","DOIUrl":"https://doi.org/10.1111/bju.70392","url":null,"abstract":"Objective To evaluate oncologic outcomes of high‐dose radical radiotherapy (RT) in medically frail patients with upper tract urothelial carcinoma (UTUC). Materials and Methods We retrospectively reviewed 63 patients with UTUC who received definitive RT at four major academic hospitals (2014–2021) with significant comorbidities (age‐adjusted Charlson Comorbidity Index ≥3). Patients were stratified into high‐ and low‐dose groups using a biologically effective dose (BED <jats:sub>10</jats:sub> ) cutoff of 74.3 Gy (from 63 Gy/35 fractions, assuming α/β ratio = 10). The median BED <jats:sub>10</jats:sub> was 64.8 Gy (interquartile range 60.0–72.0) in the low‐dose group and 84.0 Gy (interquartile range 78.4–86.4) in the high‐dose group. Baseline imbalances were addressed using inverse probability of treatment‐weighted (IPTW) in Cox proportional hazard models and Kaplan–Meier analyses. Results The median follow‐up was 76 months. The pelvic ureter was the most frequently involved site (57%), followed by the renal pelvis (33%) and the abdominal ureter (21%). In the IPTW‐adjusted cohort, the disease control rate was significantly higher with high‐dose RT (98% vs 62%, <jats:italic>P</jats:italic> &lt; 0.001). High‐dose RT significantly improved IPTW‐adjusted locoregional control (3‐year LRC: 51% vs 29%, <jats:italic>P</jats:italic> = 0.041), freedom from distant metastasis (3‐year FFDM: 75% vs 39%, <jats:italic>P</jats:italic> = 0.001), freedom from progression (3‐year FFP: 43% vs 25%, <jats:italic>P</jats:italic> = 0.013), and overall survival (3‐year OS: 46% vs 11%, <jats:italic>P</jats:italic> &lt; 0.001). Multivariate analysis identified higher RT dose as an independent prognosticator of improved FFP (adjusted hazard ratio [aHR] 0.96, <jats:italic>P</jats:italic> = 0.018) and OS (aHR 0.93, <jats:italic>P</jats:italic> &lt; 0.001). Furthermore, pre‐RT gross haematuria (aHR 2.63, <jats:italic>P</jats:italic> = 0.002) and age‐adjusted Charlson Comorbidity Index &gt;5 (aHR 2.85, <jats:italic>P</jats:italic> = 0.007) were associated with worse OS. Conclusion A clear dose–response relationship was observed in UTUC treated with definitive RT. High‐dose RT was associated with significantly improved survival and represents a safe alternative for medically frail patients.","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"19 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148623933","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":"Reply to Bayraktar and Işler.","authors":"Luca Orecchia, Simone Albisinni","doi":"10.1111/bju.70402","DOIUrl":"https://doi.org/10.1111/bju.70402","url":null,"abstract":"","PeriodicalId":8985,"journal":{"name":"BJU International","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148618295","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":"Retrograde intrarenal surgery with flexible and navigable suction access sheaths vs mini-percutaneous nephrolithotomy for large upper urinary tract stones: a systematic review and meta-analysis.","authors":"Han Jie Lee, Clyve Yaow, Ryan Ian Houe Chong, Sonam Kelzang, Vineet Gauhar, Steffi Kar Kei Yuen, Alvin Wei Xiang Low, Palaniappan Sundaram, Wei Zhu, Guohua Zeng, Tsung Wen Chong, Jingzeng Du","doi":"10.1111/bju.70393","DOIUrl":"https://doi.org/10.1111/bju.70393","url":null,"abstract":"<p><strong>Objective: </strong>To conduct a meta-analysis comparing the efficacy and perioperative outcomes of contemporary flexible and navigable suction access sheath-assisted retrograde intrarenal surgery (FANS-RIRS) against percutaneous nephrolithotomy (PCNL) for the management of large upper urinary tract stones, as despite technological advances in RIRS such as high-powered lasers and FANS that have substantially enhanced its performance, current guidelines continue to recommend PCNL as first-line treatment for renal stones >2cm.</p><p><strong>Methods: </strong>MEDLINE, Embase, and the Cochrane Library were searched for studies performing direct comparisons of FANS-RIRS against PCNL in adult patients until September 2025. Primary outcomes included stone-free rates (SFRs) and need for ancillary procedures. Secondary outcomes included operative time, length of postoperative hospitalisation, and postoperative complications.</p><p><strong>Results: </strong>A total of 10 studies (three randomised control trials, seven retrospective cohort studies) comprising 2347 patients were included; preoperative stone sizes were predominantly 2-3 cm. All PCNL procedures in the studies included were performed as mini-PCNL. The SFRs for FANS-RIRS were comparable with mini-PCNL across all stone sizes (odds ratio [OR] 0.90, 95% confidence interval [CI] 0.70-1.17) and stones ≥2 cm (OR 0.80, 95% CI 0.60-1.08), with low heterogeneity. Ancillary procedures rates were similar (OR 1.22, 95% CI 0.61-2.44). FANS-RIRS was associated with significantly fewer overall complications, specifically smaller haemoglobin decline, need for transfusion, and shorter hospital stay. However, mini-PCNL demonstrated shorter operative times for stones ≥2 cm. Urosepsis rates were low and similar between both groups. Limitations include predominance of Asian studies, variability of practice, and inclusion of non-randomised studies.</p><p><strong>Conclusions: </strong>Contemporary FANS-RIRS achieves SFRs comparable to mini-PCNL even for 2-3 cm stones, while offering superior safety profiles and shorter hospitalisation; this supports FANS-RIRS as a viable primary treatment in selected patients.</p>","PeriodicalId":8985,"journal":{"name":"BJU International","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148618341","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 stent‐plus‐irrigation protocol after adolescent hypospadias repair: a multicentre randomised controlled trial","authors":"Zihan Ye, Hongsong Chen, Qiang Zhang, Xingguo Luo, Zhicheng Zhang, Guanghui Wei, Li Zeng, Ning Li, Gaofeng Zhang, Wei Liu, Xing Liu","doi":"10.1111/bju.70386","DOIUrl":"https://doi.org/10.1111/bju.70386","url":null,"abstract":"Objectives To evaluate whether a stent‐plus‐irrigation protocol reduces complication rates following hypospadias repair in adolescents compared with catheter drainage alone. Patients and Methods In this multicentre randomised controlled trial, adolescents (Tanner Stage II–V) undergoing hypospadias repair were randomly assigned to either a stent‐plus‐irrigation group or a catheter‐drainage group. The catheter‐drainage group received standard urethral catheter drainage alone, whereas the stent‐plus‐irrigation group received an additional small‐calibre urethral stent positioned within the reconstructed urethra and twice‐daily saline irrigation. The primary outcome was the overall postoperative complication rate; secondary outcomes included urinary function and cosmetic outcomes. Results A total of 172 adolescents were assessed for eligibility, with 150 participants (75 in the stent‐plus‐irrigation group and 75 in the catheter‐drainage group) included in the final analysis. Compared with the catheter‐drainage group, the stent‐plus‐irrigation group demonstrated a significantly lower overall complication rate (risk ratio [RR] 0.33, 95% confidence interval [CI] 0.20–0.56; <jats:italic>P</jats:italic> &lt; 0.001), urethral fistula rate (RR 0.27, 95% CI 0.14–0.51; <jats:italic>P</jats:italic> &lt; 0.001), and surgical site infection (SSI) rate (RR 0.43, 95% CI 0.21–0.87; <jats:italic>P</jats:italic> = 0.020). Conclusions A postoperative stent‐plus‐irrigation protocol was associated with lower rates of postoperative complications, particularly urethral fistula and SSI, compared with catheter drainage alone after adolescent hypospadias repair. Because the intervention included both an additional urethral stent and saline irrigation, the independent contribution of irrigation cannot be determined in this two‐arm trial.","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"65 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148595576","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":"Small‐ and large‐calibre ureteroscopes: an updated systematic review and meta‐analysis","authors":"Francesco Di Bello, Paolo Verri, Alejandra Bravo‐Balado, Paula Izquierdo, Lucio Fila, Andres K. Kanashiro, Rozalba Gogaj, Elizabeth Wells, Olivier Traxer, Oriol Angerri, Esteban Emiliani","doi":"10.1111/bju.70394","DOIUrl":"https://doi.org/10.1111/bju.70394","url":null,"abstract":"Objective 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. Methods 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). Results 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. Conclusions 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.","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"267 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-07-28","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":"INtraVESical immunoTherapy ( INVEST ) prior to radical cystectomy for bladder cancer: trial protocol","authors":"Ruby Lister‐Whelan, Ethan Senior, Jessica Kendall, Jamie B. Oughton, Fiona Collinson, Jon Griffin, Rachel Hubbard, Steven Kennish, Aidan Noon, Derek J. Rosario, Irbaz B. Riaz, Julie Telliez, James W. F. Catto, Syed A. Hussain","doi":"10.1111/bju.70387","DOIUrl":"https://doi.org/10.1111/bju.70387","url":null,"abstract":"Background High‐risk non‐muscle‐invasive bladder cancer (HRNMIBC) has a variable prognosis, managed predominantly by local surgical resection and intravesical Bacillus Calmette–Guérin (BCG), or radical cystectomy (RC). Current treatments are poorly tolerated, have supply limitations and often fail to control the disease. Treatments overcoming these limitations are needed to improve HRNMIBC outcomes. Many novel agents have been approved in recent years (including systemic pembrolizumab, nogapendekin alfa inbakicept‐pmln, N‐803), but long‐term efficacy is unknown. Given advanced bladder cancer findings, we believe direct intravesical administration of atezolizumab may aid with managing HRNMIBC or muscle‐invasive bladder cancer in patients who are ineligible for cisplatin‐based neoadjuvant chemotherapy. Study design The INtraVESical immunoTherapy (INVEST) trial is a UK‐based, open‐label, non‐randomised, single‐centre, Phase Ib dose escalation, window of opportunity study exploring atezolizumab administration via intravesical routes (passive instillation and direct injection [sub‐urothelial]) in patients with bladder cancer with all stages undergoing RC. For both routes, an initial dose confirmation stage will determine toxicity and recommended atezolizumab dosage, followed by a dose expansion stage to further evaluate safety and toxicity at the recommended dose. Endpoints We aim to investigate safety (primary) and preliminary activity (secondary) of intravesical atezolizumab delivered by passive instillation and direct injection into the tumour/bladder wall in patients with bladder urothelial cell carcinoma prior to RC. Primary endpoints include dose limiting toxicities and adverse events. Secondary endpoints include progression‐free survival, pathological complete response rate and treatment compliance. Exploratory endpoints include pharmacokinetic profile (assessed by serum and urine concentrations at prespecified timepoints), spatial analysis of atezolizumab distribution within RC tissue by imaging mass spectrometry and overall survival. Patients and Methods Atezolizumab will be administered intravesically by either passive instillation or direct injection into the tumour/bladder wall. Cohorts will receive either 600 mg or 1200 mg doses administered as a single dose or as multiple doses (weekly for 3–6 weeks). Trial Registration International Standard Randomised Controlled Trial Number: <jats:ext-link xmlns:xlink=\"http://www.w3.org/1999/xlink\" xlink:href=\"https://www.isrctn.com/ISRCTN15842444\">ISRCTN15842444</jats:ext-link> , registered 2 December 2022.","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"35 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148595564","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}