BJU International最新文献

{"title":"Gleason pattern 4 length and active surveillance eligibility in Grade Group 2–4 prostate cancer","authors":"Sean A. Fletcher, Nicholas A. Pickersgill, Nate Aiken, Melissa J. Assel, Nicole Liso, Victor E. Reuter, Behfar Ehdaie, Samson W. Fine, Andrew J. Vickers","doi":"10.1111/bju.70478","DOIUrl":"https://doi.org/10.1111/bju.70478","url":null,"abstract":"Objectives To evaluate whether total Gleason pattern 4 (GP4) length provides better risk stratification than current risk group criteria for determining potential active surveillance (AS) eligibility, using oncological outcomes after radical prostatectomy (RP). Patients and Methods We identified patients with Grade Group (GG) 2–4 disease on magnetic resonance imaging (MRI)‐targeted and systematic biopsy who underwent RP. We calculated total GP4 length as the summed millimetres of GP4 in systematic cores plus the average across MRI‐targeted cores. Concordance analysis was used to evaluate how increasing GG corresponded to greater GP4 burden. We compared prediction of adverse pathology at RP and 5‐year biochemical recurrence (BCR) between risk groups and total length of GP4. Results Among 2499 patients, 1691, 694, and 114 had GG2, GG3, and GG4 disease, of whom 73%, 19%, and 15% had low amounts (<2 mm) of GP4. Patients with <2 mm of GP4, regardless of GG, had similar risks of adverse pathology (5.2% vs 5.0%) and 5‐year BCR (20% vs 21%) as those with favourable intermediate‐risk disease; if used as an AS threshold, <2 mm of GP4 would classify approximately twice as many patients as AS eligible, translating to ~50 000 men annually in the United States alone. Conclusions Total length of GP4 provides better risk stratification for AS eligibility than current favourable intermediate‐risk group criteria. Further defining the optimal method for GP4 quantification and determining the appropriate cut‐point is needed before clinical implementation.","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"22 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149086757","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":"Global trends in urological cancers: an analysis of the global burden of disease study 2023","authors":"Hanbo Lu, Yusa Zhang, Yang Zhao, Yushi Zhang","doi":"10.1111/bju.70473","DOIUrl":"https://doi.org/10.1111/bju.70473","url":null,"abstract":"Objectives Our objective was to quantify changes in the global burden of prostate, bladder, kidney and testicular cancers from 1990 to 2023 and to assess demographic contributions and characterize geographic, age‐specific and modelled risk‐attributable patterns. Materials and Methods We analysed Global Burden of Disease 2023 estimates for incidence, deaths and disability‐adjusted life‐years (DALYs). Age‐standardised incidence rates and death rates were summarised using estimated annual percentage change. We incorporated 95% uncertainty intervals (UIs), decomposed changes in counts into population growth, population ageing and age‐specific rate effects, assessed 2021–2023 changes, and repeated country rankings after excluding locations with an implied population <1 million. Results In 2023, the four cancers accounted for approximately 2.47 million incident cases, 0.88 million deaths and 18.1 million DALYs. Prostate cancer contributed 1.41 million incident cases (95% UI 1.19–1.63 million) and 469 000 deaths (95% UI 413 000–526 000). From 1990 to 2023, age‐standardised incidence rates increased for testicular cancer (estimated annual percentage change 0.98%, 95% confidence interval [CI] 0.89–1.07) and kidney cancer (0.27%, 95% CI 0.13–0.41), was stable for prostate cancer, and decreased for bladder cancer; age‐standardised death rates decreased for all four cancers. Together, population growth and ageing accounted for the most increases in incident cases, whereas declining age‐specific rates offset deaths from prostate, bladder, kidney and testicular cancers. Small‐jurisdiction leaders changed materially in the population‐threshold sensitivity analysis. In 2023, all modelled risks accounted for 34.6% (95% UI 29.7–39.8) of bladder cancer DALYs and 27.1% (95% UI 17.0–36.7) of kidney cancer DALYs but only 1.6% (95% UI −5.6 to 6.8) of prostate cancer DALYs. Conclusion The growing absolute burden of these cancers was predominantly demographic, but cancer‐specific and geographic trajectories differed. Testicular cancer added a young‐adult, rising‐incidence component to the conventional older‐age urological cancer profile. Rankings for small populations require cautious interpretation, and prevention priorities should reflect cancer‐specific risk patterns.","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"8 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149086756","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":"Real‐world radical cystectomy use in high‐risk non‐muscle‐invasive bladder cancer: a global survey","authors":"Jose Luis Dominguez Escrig, Peter Black, Junichi Inokuchi, Girish Kulkarni, Wei Qiang, Bao Yige, Lucy Andersen, Sarah Côté, Ruhee Jain, Brendan Osborne, Marie Deault‐Bonin, Siobhán Mulhern Haughey, Emilia Biondi, Laure Manuel, Jacob Skilling, Mia Unsworth, Christopher J. D. Wallis","doi":"10.1111/bju.70480","DOIUrl":"https://doi.org/10.1111/bju.70480","url":null,"abstract":"Objectives To evaluate real‐world utilisation of radical cystectomy (RC), its acceptance and limitations, and physician perspectives on RC in patients with high‐risk non‐muscle‐invasive bladder cancer (HR‐NMIBC). Patients/Subjects and Methods Data were obtained from the Adelphi Disease Specific Programme™, a multinational, cross‐sectional survey of urologists and medical oncologists treating patients with HR‐NMIBC in China, Japan, Canada, France, Germany, Italy, Spain, and the UK. Physicians reported patient demographics, clinical characteristics, treatment patterns, and patient preferences regarding HR‐NMIBC treatment and surgery. Results Overall, 359 physicians provided data for 2583 patients (mean [standard deviation] patient age, 68.9 [9.8] years; 74% male; Stage‐1 [T1] high‐grade tumours 68%). Bacillus Calmette–Guérin (BCG) was used as first‐line treatment in 58% ( <jats:italic>n</jats:italic> = 1487) of patients. Among patients with recurrent HR‐NMIBC, RC was used in 8% (62 of 802), 7% (13 of 188), and 8% (four of 52) at second line‐of‐treatment, third line‐of‐treatment, and fourth line‐of‐treatment, respectively. Physicians considered 24% of patients likely future RC candidates. Further data were collected on 825 patients who received BCG treatment. Among these patients, RC was offered to 169 (20%); 115 of these patients (68%) refused, most commonly because of quality‐of‐life concerns (87%), unwillingness to have a stoma (60%), and surgical safety concerns (37%). Conclusion Despite guideline recommendations, real‐world RC use was low, and most patients offered RC refused it because of quality‐of‐life and safety concerns. These findings highlight an unmet need for alternative and efficacious bladder‐preserving treatments for patients with BCG‐unresponsive HR‐NMIBC.","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"298 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149086761","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":"Sexual and relational challenges in men and women affected by prostate cancer: a Project SEXUS study","authors":"Ingrid Josefine Lundorff, Christian Graugaard, Mikkel Fode, Mikael Andersson, Morten Frisch","doi":"10.1111/bju.70475","DOIUrl":"https://doi.org/10.1111/bju.70475","url":null,"abstract":"Objectives To examine, in a nationally representative Danish study, a comprehensive range of sexual characteristics, dysfunctions and relational challenges among men with prostate cancer (PCa) aged ≥50 years and women married to such men, compared with unaffected men and women. Patients/Subjects and Methods We analysed baseline questionnaire data from the Project SEXUS cohort study (2017–2018) for men aged ≥50 years with ( <jats:italic>n</jats:italic> = 715) or without ( <jats:italic>n</jats:italic> = 13 883) a history of PCa, and women married to such men with ( <jats:italic>n</jats:italic> = 345) or without ( <jats:italic>n</jats:italic> = 8323) a history of PCa. In sex‐specific analyses, prevalence estimates were calculated for a broad range of sexual and relational outcomes, and logistic regression analyses yielded confounder‐adjusted odds ratios (aORs) with 95% confidence intervals (CIs). Results Compared with controls without PCa, men with a history of PCa had substantially higher odds of sexual inactivity (aOR 2.03, 95% CI 1.69–2.43), unmet sexual needs (aOR 1.89, 95% CI 1.58–2.28), poorer self‐rated sex life (aOR 1.82, 95% CI 1.46–2.28), and sexual dysfunctions, with particularly elevated odds of erectile (aOR 5.74, 95% CI 4.25–7.74), orgasmic (aOR 3.20, 95% CI 2.09–4.89), and genital pain (aOR 3.07, 95% CI 1.02–9.25) dysfunctions. Among women, sexual needs did not differ between the two groups. However, women married to men with PCa were more likely to report sexual inactivity (aOR 1.85, 95% CI 1.42–2.39), unmet sexual needs (aOR 1.77, 95% CI 1.34–2.34), and poorer marriage quality (aOR 2.84, 95% CI 1.33–6.08). Conclusion Men with PCa and women married to such men report a substantially increased burden of sexual and relational challenges, underscoring the need for survivorship care that supports sexual well‐being in both patients and their intimate partners.","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"56 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149086758","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":"Rezvilutamide in metastatic hormone‐sensitive prostate cancer: interpreting CHART trial evidence and clinical applicability in the European Association of Urology guidelines","authors":"Lan Mi, Sheng Li, Bin Huo","doi":"10.1111/bju.70452","DOIUrl":"https://doi.org/10.1111/bju.70452","url":null,"abstract":"","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"16 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149083804","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":"Oncological and continence outcomes after nerve‐sparing robot‐assisted radical prostatectomy in selected STAMPEDE‐defined high‐risk prostate cancer","authors":"Andreia Bilé‐Silva, Prabhakar Rajan, Benjamin Lamb, Mehmet Özalevli, Louise Dickinson, Justin Collins, Anand Kelkar, John Kelly, Senthil Nathan, Greg Shaw, Prasanna Sooriakumaran, Ashwin Sridhar, Zafer Tandogdu","doi":"10.1111/bju.70460","DOIUrl":"https://doi.org/10.1111/bju.70460","url":null,"abstract":"Objectives To examine the association between the nerve‐sparing (NS) technique applied during radical prostatectomy (RP) and early oncological and continence outcomes in patients with Systemic Therapy in Advancing or Metastatic Prostate Cancer: Evaluation of Drug Efficacy (STAMPEDE)‐defined high‐risk prostate cancer (PCa) undergoing robot‐assisted RP (RARP) within a structured patient‐specific surgical planning (PSSP) pathway. Patients and Methods A retrospective single‐centre cohort study of 1385 patients who underwent primary RARP between 2021 and 2022 was conducted in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement. Patients were stratified into three groups according to the number of STAMPEDE‐defined high‐risk factors: none, one, and two or more. Outcomes were compared across these cohorts and between NS‐ and non‐NS (nNS)‐ RARP, within each risk stratum. Results Overall, NS‐RARP was performed in 75.4% of patients (1044/1385). In the STAMPEDE‐defined high‐risk cohort (two or more high‐risk criteria) 57.3% (150/262) of patients underwent some sort of NS. Among those with at least two STAMPEDE‐defined risk factors, oncological outcomes were similar between NS and nNS surgery (positive surgical margin rate 21.3% vs 23.2%, <jats:italic>P</jats:italic> = 0.72; 12‐month biochemical recurrence rate 6.7% vs 5.4%, <jats:italic>P</jats:italic> = 0.9), and urinary continence rates at 3 and 12 months were also similar ( <jats:italic>P</jats:italic> = 0.2 and <jats:italic>P</jats:italic> = 0.5, respectively). However, high‐risk patients undergoing NS‐RARP used significantly fewer pads at 12 months ( <jats:italic>P</jats:italic> = 0.03). Conclusion In a contemporary RARP cohort within a PSSP pathway, NS was feasible in over half of high‐risk patients and was not associated with worse short‐term oncological outcomes. Although pad‐free continence rates were similar between NS and nNS groups, patients undergoing NS‐RARP used significantly fewer pads at 12 months, suggesting a potential functional benefit that warrants further prospective evaluation of NS strategies in selected cases.","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"481 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149083803","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 PSA test for prostate cancer screening: an abridged Cochrane review","authors":"Juan V. A. Franco, Eu Chang Hwang, Jae Hung Jung, Octavio Vaimberg, Dragan Ilic, Anne Cleves, Philipp Dahm","doi":"10.1111/bju.70455","DOIUrl":"https://doi.org/10.1111/bju.70455","url":null,"abstract":"Objectives To assess the effects of prostate cancer screening compared to no screening in men with no prior diagnosis of prostate cancer. Methods This systematic review represents an update of a prior Cochrane review from 2013, searching multiple databases up to November 2025. We included randomised controlled trials (RCTs) of prostate cancer screening vs no screening. We used standard Cochrane methods, including rating the certainty of the evidence following a Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. Results Six RCTs (789 086 participants; follow‐up 3.2–23 years) were included: five evaluated prostate‐specific antigen (PSA)‐alone screening; one evaluated PSA combined with a kallikrein panel and magnetic resonance imaging (MRI) (ProScreen). Results are based on the certainty of evidence for each outcome and are therefore mainly derived from a sensitivity analysis by risk of bias, using the European Randomised Study of Screening for Prostate Cancer (ERSPC) trial: screening likely results in a reduction in prostate cancer‐specific mortality (sensitivity analysis from ERSPC: risk ratio [RR] 0.87, 95% confidence interval [CI] 0.80–0.95; one study, 162 236 participants; moderate‐certainty evidence; minimal clinically important difference [MCID]: one per 1000 participants). Assuming a baseline risk of 16 prostate‐cancer‐related deaths per 1000, this corresponds to two fewer (95% CI three fewer to one fewer) per 1000. Based on the analysis that included all eligible trials, screening may reduce overall mortality, although the CI includes the possibility of little to no effect (RR 0.99, 95% CI 0.97–1.00; &lt;jats:italic&gt;I&lt;/jats:italic&gt; &lt;jats:sup&gt;2&lt;/jats:sup&gt; = 22%; four studies, 675 121 participants; low‐certainty evidence; MCID: one per 1000 participants). Assuming a baseline risk of 491 deaths from any cause per 1000, this corresponds to five fewer (95% CI 15 fewer to 0 fewer) per 1000. Screening may result in little to no difference in adverse events (RR 1.32, 95% CI 0.48–3.65; low certainty) or quality of life. In the ProScreen trial (60 745 participants, 3.2‐year follow‐up), combined screening probably has little to no effect on overall detection (RR 1.85, 95% CI 1.56–2.19; moderate certainty), localised detection (RR 1.88, 95% CI 1.55–2.27; moderate certainty), or advanced detection (RR 1.78, 95% CI 1.19–2.66; moderate certainty). Mortality data are not yet mature. Conclusions Screening likely reduces prostate cancer‐specific mortality and may reduce overall mortality. It may have little to no effect on adverse events (as measured by intervention‐related mortality). Study limitations, inconsistency, and imprecision reduced our confidence in the effect estimates. Interpretation of these findings is highly sensitive to the choice of MCID. Emerging alternatives, such as screening with a kallikrein panel and MRI, may have little to no effect on diagnoses of prostate cancer, but the results on mortality are not ","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"272 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149083800","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":"Three‐generation familial risks in early‐onset prostate cancer with maternal and paternal relatives","authors":"Kari Hemminki, Frantisek Zitricky, Kristina Sundquist, Jan Sundquist, Asta Försti, Akseli Hemminki, Otto Hemminki","doi":"10.1111/bju.70465","DOIUrl":"https://doi.org/10.1111/bju.70465","url":null,"abstract":"Objectives To study familial prostate cancer (PCa) between first‐degree relatives (FDRs) and second‐degree relatives (SDRs), we accessed Swedish nationwide family and cancer data that extended through three generations and thus providing a unique chance for study of familial cancer in PCa between close and distant relatives (SDRs). The specific aim was to show the usefulness of data on maternal and paternal uncles and grandfathers for risk assessment on young patients with PCa. Patients and Methods Familial relative risks (standardised incidence ratios [SIRs]) for PCa were calculated for young men (aged &lt;69 years) in the third generation when their brothers, fathers, uncles and grandparents were diagnosed with PCa (they were probands). Results Familial SIRs for two affected brothers were 4.1 but when, additionally a SDR (uncle or grandfather) was affected SIR reached 10.1. When a father was the proband, SIR was 3.1 but when, additionally a SDR was affected SIR reached 4.7, and risk increased up to 11.5 with increasing numbers of affected SDRs. Patients with affected SDRs were more numerous than those with affected FDRs. When a maternal or paternal grandfather was the only proband the SIR for both was about 1.6. Maternal and paternal uncles transmitted a risk of 1.8 and 1.5, respectively, and when two uncles were affected, the SIR climbed to about 2.0. The highest familial risk of 27 was found for affected brothers with a father and two SDRs diagnosed with PCa. Conclusions The results showed that for the young patients in the third generation the richest sources of familial probands were SDRs. The uncles belong to the generation of fathers, and they are likely to be more numerous than grandparents. Maternal and paternal SDRs are equally informative for genetic counselling and both parental lineages should be used as they provide equal familial information about the risks of PCa.","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"53 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149083802","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":"Caution in interpreting the diagnostic superiority of digital Uromonitor in NMIBC surveillance.","authors":"Jinhu Ma, Shuaipeng He, Panfeng Shang","doi":"10.1111/bju.70336","DOIUrl":"10.1111/bju.70336","url":null,"abstract":"","PeriodicalId":8985,"journal":{"name":"BJU International","volume":" ","pages":"730"},"PeriodicalIF":4.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13550795/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148136599","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":"Towards sustainable multidisciplinary renal cancer tumour boards: redesigning the referral pathway","authors":"Bhargab Ghoshal, Sarika Nalagatla, Max Roberts, Adam Mann, David Cullen, Victoria Horsfall, Andrea Da Silva, Abhishek Reekhaye, Prasad Patki, Ravi Barod, Faiz Mumtaz, Axel Bex","doi":"10.1111/bju.70451","DOIUrl":"https://doi.org/10.1111/bju.70451","url":null,"abstract":"Objectives To develop and evaluate a complexity‐stratified referral pathway aimed at improving the sustainability, efficiency and resource utilisation of specialist multidisciplinary team (SMDT) meetings within a high‐volume tertiary renal cancer service. Patients and Methods We performed a retrospective cohort study of benign and malignant renal cancer cases discussed at SMDT meetings between January and December 2023 at the Royal Free Specialist Centre for Kidney Cancer. Patient demographics, tumour characteristics, SMDT discussions and management outcomes of patients were analysed to identify protocolised lower complexity cases suitable for alternative MDT pathways. Based on these findings, dedicated Standard of Care (SoC) and Benign MDTs were developed and implemented to manage lower complexity renal cases outside the main SMDT. The impact of the revised referral structure on SMDT workload, discussion efficiency and specialist resource utilisation was subsequently evaluated. Results In 2023, 2228 patients with benign and malignant renal pathology underwent 4154 SMDT discussions. Most patients (96.3%) required under seven discussions. Patients aged &gt;70 years with renal masses &lt;2 cm frequently underwent repeated SMDT review, despite surveillance or conservative management representing the most common management recommendation. Bosniak I–II cysts were predominantly discharged, whilst Bosniak IIF cysts were mainly managed with surveillance. Following implementation of the revised referral structure incorporating SoC and Benign MDTs, cases discussed at the main SMDT decreased from a mean of 83 to 63 patients with cancer per week, whilst discussion time per patient increased by 30.8%. The revised pathway also reduced the requirement for full SMDT attendance for protocolised cases. Conclusion Complexity‐stratified MDT referral structure improved efficiency and sustainability by diverting lower complexity protocolised cases to dedicated Benign and SoC MDTs. This enabled the main SMDT to prioritise clinically complex decision making and optimise utilisation of specialist multidisciplinary expertise.","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"1 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149083801","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}