BJU International最新文献

{"title":"Comparative 30-day life cycle assessment of bladder drainage strategies","authors":"Arthur Peyrottes,&nbsp;Thibaut Long-Depaquit,&nbsp;Marc Fourmarier,&nbsp;Benjamin Pradere,&nbsp;Benoit Peyronnet,&nbsp;Laurent Zieleskiewicz,&nbsp;Alessandro Uleri,&nbsp;Jean-Nicolas Cornu,&nbsp;Vincent Misrai,&nbsp;Richard Mallet,&nbsp;Michael Baboudjian,&nbsp;the French Sustainability Task Force from the Association Française d'Urologie","doi":"10.1111/bju.70304","DOIUrl":"10.1111/bju.70304","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To identify the most environmentally sustainable urinary drainage strategies commonly used to manage bladder outlet obstruction and also to highlight actionable levers for reducing the footprint of urinary drainage in clinical practice.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Methods</h3>\u0000 \u0000 <p>We conducted a comparative life cycle assessment of three urinary drainage strategies (i.e., indwelling urinary catheter, clean intermittent self-catheterisation [CISC], and temporary urethral stent) over a 30-day period, in accordance with International Organization for Standardization (ISO) 14040 and ISO 14044 standards. Primary data were collected via device disassembly and manufacturer consultation, with secondary data from the Ecoinvent version 3.9 database (Ecoinvent, Zurich, Switzerland). Impacts were modelled using the Environmental Footprint 3.0 method across 13 categories. Sensitivity analyses tested care delivery parameters and reusable catheters for CISC.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The mean climate change impact over 30 days was 96.5 kg CO₂ equivalents (CO₂-eq; 95% confidence interval [CI] 58.8–162) for indwelling catheterisation, 39.8 kg CO₂-eq (95% CI 31.2–53.3) for disposable CISC catheters, and 16.1 kg CO₂-eq (95% CI 8.4–29.2) for the stent. Indwelling catheterisation consistently showed the highest impact, CISC intermediate, and the stent the lowest. Relative to catheterisation, the stent reduced climate impact by 83%, fossil resource use by 83%, and water consumption by 92%. Reusable CISC catheters showed a comparable profile to the stent. Sensitivity analyses confirmed that home nurse travel, device replacement frequency, and patient autonomy substantially influenced overall impact. Limitations include the mono-country design.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Device choice and care delivery models critically affect the environmental footprint of urinary drainage strategies. This study provides further strong arguments for promoting existing alternatives to the indwelling urinary catheter.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"138 2","pages":"285-296"},"PeriodicalIF":4.1,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/bju.70304","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147866885","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":"Spontaneous miscarriage after intracytoplasmic sperm injection with frozen sperm of patients with testicular germ cell tumour","authors":"Haru Hamada,&nbsp;Akifumi Ijuin,&nbsp;Tomonari Hayama,&nbsp;Naoki Tsuchiya,&nbsp;Sumiko Sueyoshi,&nbsp;Misaki Toda,&nbsp;Ai Miyakoshi,&nbsp;Mayuko Kurumizaka,&nbsp;Marina Saito,&nbsp;Yuki Oike,&nbsp;Hiroe Ueno,&nbsp;Shinnosuke Kuroda,&nbsp;Kazumi Takeshima,&nbsp;Teppei Takeshima,&nbsp;Shin Saito,&nbsp;Ryoko Asano,&nbsp;Taichi Mizushima,&nbsp;Yasushi Yumura,&nbsp;Hideya Sakakibara,&nbsp;Etsuko Miyagi,&nbsp;Miki Tanoshima,&nbsp;Mariko Murase","doi":"10.1111/bju.70332","DOIUrl":"10.1111/bju.70332","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To clarify the impact of chromosomal aberrations on the offspring of patients with testicular germ cell tumour (TGCT) by evaluating the outcomes of intracytoplasmic sperm injection (ICSI).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Patients and Methods</h3>\u0000 \u0000 <p>Under the ethical review of Yokohama City University, 12 patients with TGCT and 25 with non-TGCT cancer who had cryopreserved sperm for ICSI for fertility preservation between 1 April 2014 and 31 March 2023 were enrolled. For 198 oocytes from the TGCT group, 480 oocytes from the non-TGCT group, fertilisation, embryo viability, pregnancy, and spontaneous miscarriage rates were examined.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Females who received ICSI from patients with TGCT showed a significantly higher spontaneous miscarriage rate than those who received ICSI from patients with non-TGCT cancer (43.8% vs 9.1%, respectively, <i>P</i> &lt; 0.05), with no significant between-group difference in the pregnancy rate. In the TGCT group, three cases of recurrent pregnancy loss and recurrent implantation failure were reported. The high spontaneous miscarriage rate in the TGCT group can be attributed to chromosomal abnormalities or DNA fragmentation in the sperm of patients with TGCT.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Natural conception may be an option for patients who have completed TGCT treatment and have adequate sperm. However, when semen parameters do not recover sufficiently, assisted reproductive technologies may be considered, including, where possible, the use of post-treatment sperm not affected by TGCT rather than pre-treatment sperm collected during tumour-bearing state. In selected cases, pre-implantation genetic testing for aneuploidy may also be considered.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"138 2","pages":"315-323"},"PeriodicalIF":4.1,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/bju.70332","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148148523","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":"Simulation-based assessment in laparoscopic urology: Model design and validation challenges","authors":"Arianna Pischetola,&nbsp;Willem M. Brinkman,&nbsp;Juan Gómez Rivas","doi":"10.1111/bju.70288","DOIUrl":"10.1111/bju.70288","url":null,"abstract":"&lt;p&gt;Simulation-based training has become a central component of urological education, driven by patient safety imperatives, reduced operative exposure, surgeon burnout, and the transition from time-based to competency-based training models [&lt;span&gt;1&lt;/span&gt;]. In Europe, this shift has been operationalised through structured initiatives such as the European Basic Laparoscopic Urological Skills (E-BLUS) programme and subsequent standardisation efforts led by the European School of Urology (ESU), which emphasise objective assessment and portability across training locations [&lt;span&gt;2, 3&lt;/span&gt;]. As simulation increasingly informs progression and credentialing decisions, attention has moved beyond simulator availability towards the validity and interpretability of simulator-derived assessment scores. Contemporary validity frameworks emphasise that assessment scores must be supported by coherent evidence for their intended use, including content relevance, internal structure and reliability, and relationships to external measures. Within surgical simulation, this re-frames validation away from demonstrating realism alone and towards determining whether observed performance metrics can meaningfully discriminate levels of expertise and inform educational decisions. However, in practice assessment approaches remain heterogeneous, particularly beyond basic skills training, with substantial variability in model design, outcome metrics, and reporting standards as task complexity increases across training levels.&lt;/p&gt;&lt;p&gt;Effective simulation-based assessment requires models capable of accurate and reliable measurement. Across contemporary laparoscopic simulators, functional fidelity, that is, features that directly task execution, appears to be more influential than surface realism. Design elements such as realistic tissue–instrument interaction, visual cues for bleeding or leakage, and stable camera perspectives are consistently associated with improved discrimination of technical performance. Model geometry and materials are most effective when informed by task analysis of critical procedural steps and common errors, allowing graded progression, reuse, and feasibility within constrained training environments [&lt;span&gt;4, 5&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Measurement strategies underpin assessment credibility. Most simulation-based assessments combine process metrics, such as completion time or motion efficiency, with variable inclusion of product-based outcomes that better reflect clinical priorities, including haemostasis, repair integrity, and precision of closure. While automated capture through virtual platforms or video-based tracking can enhance reproducibility, automation alone does not compensate for poorly defined metrics or inconsistent scoring frameworks. Standardised tools, including task-specific checklists and anchored global rating scales, remain essential for converting observation into reliable scores. Importantly, rater reliability should be treated as a design re","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"138 2","pages":"184-185"},"PeriodicalIF":4.1,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/bju.70288","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147663823","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":"Precision by recognition: smarter firing for better lithotripsy","authors":"Arkadiusz Miernik,&nbsp;Heinrich-Otto Teichmann","doi":"10.1111/bju.70339","DOIUrl":"10.1111/bju.70339","url":null,"abstract":"&lt;p&gt;Laser lithotripsy has become faster, finer, and more efficient, but not necessarily more discriminating. In contemporary retrograde intrarenal surgery, especially using dusting-oriented thulium fibre laser systems, the surgeon often works in a mobile liquid environment where visibility is intermittently degraded by bubbles, dust, and mucosal proximity. Under these conditions, the clinically relevant question is not only how effectively the laser ablates stone, but whether it can be prevented from firing if the stone is no longer truly in front of the fibre or out of reach of the laser. In this context, Traxer et al. [&lt;span&gt;1&lt;/span&gt;] report about a timely pre-clinical study of StoneSense™ (IPG Medical, Marlborough, MA, USA), a thulium fibre laser platform that uses back-reflected light to gate laser emission in real time. This technology operates on the physical principle of optical reflection spectroscopy, utilising the surgical laser fibre to continuously analyse the spectral signature of back-reflected light-emitting diode (LED) light from the target. The system instantly differentiates between urinary stones and soft tissue, automatically halting laser emission if it detects healthy mucosa or a fibre-to-target distance &gt;2 mm.&lt;/p&gt;&lt;p&gt;The potential attraction of such a system is obvious. Off-target lasing is inefficient at best and potentially injurious at worst. During laser fragmentation, only a fraction of delivered energy contributes to ablation. The remainder dissipates into the ambient fluid as heat [&lt;span&gt;2&lt;/span&gt;]. A platform that inhibits emission if the fibre tip is directed at tissue or too far from the target therefore could improve safety without materially sacrificing efficacy. That proposition is especially relevant to thulium fibre laser lithotripsy, whose high-frequency, low-pulse-energy settings favour fine dusting but can also encourage prolonged pedal activation and release of heat [&lt;span&gt;1, 2&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Optical stone-tissue discrimination is not new. Over the past decade, groups working largely with holmium:yttrium-aluminium-garnet (YAG) have shown that fibre-based optical feedback allows to distinguish stone from tissue, earlier by autofluorescence and later by additional reflected-light information [&lt;span&gt;3&lt;/span&gt;]. Automated feedback-controlled systems then progressed to &lt;i&gt;ex vivo&lt;/i&gt; and porcine validation, with reductions in total delivered energy and less visible lesions. Small series about automatic beam blocking have now also appeared [&lt;span&gt;4, 5&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;The conceptual advance of StoneSense is less complex but still important: it implements conditional laser firing in a thulium fibre laser platform by spectral recognition of reflected-light rather than by a pure fluorescence-based approach [&lt;span&gt;1, 3&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;The present study has several strengths. It is not confined to a bench-top optical demonstration but links a sensing technology to surgical endpoints that matter to endourologists: stone ","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"138 2","pages":"182-183"},"PeriodicalIF":4.1,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/bju.70339","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148136535","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":"Oligoprogressive renal cell carcinoma: What is the role of surgery?","authors":"Chiara Re,&nbsp;William H.J. Ince,&nbsp;Leo Bickley,&nbsp;James P. Blackmur,&nbsp;Mouhamad H. Ismail,&nbsp;Justicia Kyeremeh,&nbsp;Teele Kuusk,&nbsp;Eva Mendes Serrao,&nbsp;James O. Jones,&nbsp;Grant D. Stewart","doi":"10.1111/bju.70281","DOIUrl":"10.1111/bju.70281","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To provide an overview of the biological mechanism and pattern of oligoprogression in renal cell carcinoma (RCC) and the most updated role of surgery in this setting, highlighting scientific gaps and informing future implications.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A non-systematic search of PubMed/MEDLINE was performed in August 2025 including guidelines, reviews, and original studies. Additional sources were identified through manual reference screening.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Oligoprogression in RCC likely arises from clonal evolution dynamics, with spatially confined subclone mutations and microenvironmental niches yielding differential responses to treatment. Complete metastasectomy may offer a survival benefit, spare patients toxic side effects of systemic therapy, and offers the possibility of histopathological and molecular characterisation of residual disease. Surgery is also particularly important in delayed cytoreductive nephrectomy as the site of oligoprogression. However, this must be weighed against non-negligible surgical morbidity and complication rates. International guidelines recognise the role of surgical resection in the metastatic setting but emphasise low evidence levels and careful patient selection requirements.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Limited evidence derived from the oligometastatic context constrains optimal patient selection and timing strategies in oligoprogressive RCC. Following the establishment of consensus over definitions and research gaps, future research integrating molecular biomarkers, novel imaging tracers, and multicentre collaborative studies will be essential to develop evidence-based surgical management protocols for this increasingly common clinical scenario.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"138 2","pages":"219-228"},"PeriodicalIF":4.1,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/bju.70281","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147663854","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":"Pre-clinical evaluation of a laser system with emission control based on stone vs soft tissue recognition","authors":"Olivier Traxer,&nbsp;Federico Zorzi,&nbsp;IIya V. Yaroslavsky,&nbsp;Anastasia Kovalenko,&nbsp;Viktoriya Andreeva,&nbsp;James Childs,&nbsp;Alexey G. Martov,&nbsp;Gregory Altshuler","doi":"10.1111/bju.70301","DOIUrl":"10.1111/bju.70301","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To evaluate the feasibility and performance of the StoneSense™ module (SSM; IPG Medical, Marlborough, MA, USA), a prototype real-time target recognition unit integrated into a IPG Thulium Fiber Laser (TFL).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Methods</h3>\u0000 \u0000 <p>The SSM analyses the spectral signature of back reflected light-emitting diode (LED) light from the target, stopping laser energy emission when incoming signal is originating from tissue or when the fibre-to-target distance is larger than pre-defined threshold (typically, ≥2–4 mm). The <i>ex vivo</i> tests were conducted on artificial BegoStone phantoms ((Bego GmbH &amp; Co. KG, Bremen, Germany) embedded in porcine kidney tissue using energy settings of 0.1–2 J and 5–100 Hz at two fibre-scanning speeds (1 and 3 mm/s) through a translation stage movement. Human urinary stones were subsequently tested at 2 and 5 mm/s with setting of 0.5 J × 20 Hz. The <i>in vivo</i> trial was conducted by lithotripsy of pre-implanted human stones in porcine urinary tract. Primary outcome measures included ablation efficiency as well as specificity and sensitivity of stone recognition.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Soft tissue ablation was completely prevented in all the <i>ex vivo</i> trials while maintaining high lithotripsy efficiency. Mean stone ablation reduction was 2.75% and 3% at fibre scanning speeds of 1 and 3 mm/s, respectively. The system achieved 100% sensitivity and up to 98% specificity in inhibiting laser emission to soft tissue. <i>In vivo</i>, complete dusting with fragments &lt;500 μm was achieved for all studied stone types without observable mucosal injury. Specificity ranged from 85% to 100%, while sensitivity ranged from 90% to 100%.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Integration of back reflected-light-spectra-based laser emission control into a TFL-based lithotripsy system is feasible and effective. The SSM enables precise real-time stone recognition, minimises unnecessary lasing, and preserves dusting efficiency.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"138 2","pages":"267-275"},"PeriodicalIF":4.1,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/bju.70301","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148136586","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":"Guideline of guidelines: pelvic lymph node dissection at time of radical prostatectomy","authors":"Jonathon Carll,&nbsp;Jonathan Walbaum,&nbsp;Carlos Delgado,&nbsp;Elena Berg,&nbsp;Declan G. Murphy,&nbsp;Marlon Perera,&nbsp;Ahmed Adam,&nbsp;John Yaxley,&nbsp;Nathan Lawrentschuk","doi":"10.1111/bju.70277","DOIUrl":"10.1111/bju.70277","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To provide a comprehensive review, analysis and critique of guidelines from various oncological and urological organisations regarding the use pelvic lymph node dissection (PLND) in men undergoing radical prostatectomy (RP) for primary treatment of prostate cancer (PCa).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>PubMed, Google Scholar and the official webpages of major urological and oncological societies were searched for PCa guidelines. Guidelines were assessed for recommendations and opinions regarding the use of PLND. A total of 15 guidelines were identified and included for this review.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>There is consensus amongst guidelines that an extended template (ePLND), is the preferred templated when PLND is to be undertaken. The majority of guidelines acknowledge the lack of proven oncological benefit from PLND, and that the largest benefit is from improved staging information. However, there is significant divergence between the guidelines about which patients should undergo PLND. Some guidelines advocate for the abandonment of PLND altogether, whilst others adopt a risk-stratified approach, suggesting that patients should be offered PLND based on nomograms or clinical risk stratification.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Whilst ePLND is recommended by some guidelines for select patients undergoing RP, it remains a contentious topic with significant discordance between guidelines regarding patient selection. Given the lack of proven oncological benefit and significant morbidity from the procedure, careful selection is required. It is uncertain as to how pathological findings on PLND will change management given recent trends towards salvage rather than adjuvant radiotherapy, and improved preoperative staging with prostate-specific membrane antigen-positron emission tomography/computed tomography.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"138 2","pages":"208-218"},"PeriodicalIF":4.1,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/bju.70277","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147666922","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":"Active surveillance for intermediate risk prostate cancer: the Manitoba Prostate Center experience","authors":"Steven Lu,&nbsp;Connor Roque,&nbsp;Jeff Saranchuk,&nbsp;Ardalan E. Ahmad","doi":"10.1111/bju.70318","DOIUrl":"10.1111/bju.70318","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To report long-term oncological outcomes of men with intermediate-risk prostate cancer managed with active surveillance at a single centre.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Subjects/Patients and Methods</h3>\u0000 \u0000 <p>We retrospectively analysed a prospectively maintained Manitoba Prostate Centre active surveillance database. Included were men with disease classed per National Comprehensive Cancer Network risk categories: very low-, low-, favourable intermediate-, and unfavourable intermediate-risk prostate cancer managed with surveillance (2004–2023). Active surveillance involved serial prostate-specific antigen testing, digital rectal exam, and confirmatory/surveillance biopsies. Outcomes were treatment-free survival, metastasis-free survival, prostate cancer–specific survival, overall survival, and biopsy grade progression. Kaplan–Meier estimated survival; Cox regression evaluated variables associated with outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 561 men, the median age was 65 years (interquartile range 59–69) and the median follow-up was 4.4 years. Overall, 256 men (45.6%) transitioned to definitive treatment. Five-year treatment-free survival declined stepwise by risk group: 84.8% in very low-risk, 61.4% in low-risk, 50.0% in favourable intermediate-risk, and 21.4% in unfavourable intermediate-risk disease (<i>P</i> &lt; 0.001). On multivariable analysis, older age, higher prostate-specific antigen density, and grade group ≥2 were independently associated with earlier treatment. Metastatic progression and prostate cancer–specific mortality were rare across the cohort, with higher event rates observed among patients with unfavourable intermediate-risk disease.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In this real-world active surveillance cohort, the likelihood of remaining on surveillance differed substantially by baseline risk, with unfavourable intermediate-risk disease associated with earlier transition to treatment and higher risks of disease progression. Older age, higher prostate-specific antigen density, and grade group ≥2 were independently associated with discontinuation of active surveillance. Despite less intensive surveillance protocols, rates of metastatic progression and prostate cancer–specific mortality remained low, particularly among patients with low-risk and favourable intermediate-risk disease, supporting active surveillance as a viable management strategy in carefully selected men beyond low-risk disease.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"138 2","pages":"297-305"},"PeriodicalIF":4.1,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/bju.70318","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147970143","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":"Diagnostic and prognostic utility of PSMA-PET/CT in node-metastatic prostate cancer","authors":"Nicholas A. Pickersgill,&nbsp;Rebecca Yu,&nbsp;Emily A. Vertosick,&nbsp;Sean A. Fletcher,&nbsp;Nicole Liso,&nbsp;Jonas Kluckert,&nbsp;Oguz Akin,&nbsp;Behfar Ehdaie,&nbsp;Vincent P. Laudone,&nbsp;James A. Eastham,&nbsp;Andrew J. Vickers,&nbsp;Karim A. Touijer,&nbsp;Christoper D. Gaffney","doi":"10.1111/bju.70280","DOIUrl":"10.1111/bju.70280","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To measure the sensitivity of prostate-specific membrane antigen-positron emission tomography/computed tomography (PSMA-PET/CT) for detecting lymph node involvement (LNI) in patients undergoing radical prostatectomy (RP) and extended pelvic lymph node dissection (PLND) and to evaluate whether PSMA nodal status independently predicts oncological outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Patients and Methods</h3>\u0000 \u0000 <p>We identified patients with localised or locoregional prostate cancer who underwent PSMA-PET/CT followed by RP (2021–2024) at a high-volume centre and had pathologically confirmed LNI (pN1) on PLND. We evaluated the sensitivity of PSMA-PET/CT for detecting pN1 disease. Associations between PSMA-PET/CT and biochemical recurrence (BCR), any radiographic recurrence, and distant recurrence were evaluated using Cox regression models.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Overall, PSMA-PET/CT detected LNI in 24 of 79 patients with pN1 disease, a sensitivity of 30% (95% confidence interval [CI] 21–42%). PSMA-positive nodal disease (clinical N1 [cN1]) was significantly associated with BCR (hazard ratio [HR] 2.34, 95% CI 1.26–4.36; <i>P</i> = 0.009), radiographic recurrence (HR 4.23, 95% CI 1.86–9.58; <i>P</i> &lt; 0.001), and distant radiographic recurrence (HR 5.81, 95% CI 1.79–18.8; <i>P</i> = 0.002). The 1-year risk of BCR approached 90% for those with cN1 disease. Median metastatic focus size was larger in cN1 vs cN0 patients (1.1 vs 0.3 cm; <i>P</i> &lt; 0.001). Limitations include relatively short follow-up.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Due to low sensitivity, PSMA-PET/CT without evidence of nodal disease does not obviate the need for PLND. However, PSMA-avid nodal disease portends a nearly inevitable short interval recurrence and radiographic progression, supporting treatment intensification.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"138 2","pages":"250-256"},"PeriodicalIF":4.1,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147810846","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":"Intraoperative surgical anatomy through the eyes of artificial intelligence: the silent tutor","authors":"Thineskrishna Anbarasan","doi":"10.1111/bju.70337","DOIUrl":"10.1111/bju.70337","url":null,"abstract":"&lt;p&gt;Computer vision applications have been explored for detecting the surgical phase and anatomical landmarks in robot-assisted radical prostatectomy (RARP), but their impact on surgeons’ performance remains under-evaluated. In an attempt to address this, Muto et al. [&lt;span&gt;1&lt;/span&gt;] show that exposure to a deep-learning-based bladder neck segmentation model improved the speed and quality of annotation of the bladder and prostate during bladder neck dissection by novice surgeons. The artificial intelligence (AI) segmentation model has the potential to be applied at scale, enabling trainees to rapidly review surgical anatomy without expert annotation. This could facilitate the development of a digital repertoire of surgical cases with AI-guided anatomical overlays, accessible to trainees at their discretion. Video-based educational tools have been shown to be effective in acquiring surgical skills [&lt;span&gt;2&lt;/span&gt;]. However, further work is needed to develop methods for measuring skill acquisition using validated, objective outcomes and to determine whether integrating other technologies, such as virtual and augmented reality, can further enhance learning.&lt;/p&gt;&lt;p&gt;The models in this study were sensitive to cues from surgical instruments and the Foley catheter, to varying degrees, when segmenting anatomical boundaries. This instrument bias has also been observed in anatomical segmentation models for laparoscopic cholecystectomy [&lt;span&gt;3&lt;/span&gt;]. Therefore, a diverse dataset from multiple institutions with different instrument set-ups will be required to reduce this bias and improve generalisability. An important limitation to scaling the development of surgical segmentation models is the need for expert-annotated ground truth data, particularly when considering 1-s interval frames, which is infeasible at scale. To address this, the authors adopted an active learning strategy in which, instead of all frames, only those with high entropy, resulting in higher uncertainty in the model's predictions, were selected for annotation and iterative learning. Such an approach has also been shown to be efficient, with a reduced annotation burden, for a supervised learning model in cataract surgery [&lt;span&gt;4&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;The development of an AI segmentation tool provides an opportunity to assess the machine attention map, that is, the pixels that contribute most to the model's decision. Expert surgeons showed no significant change in annotation time following exposure to the segmentation model in this study, likely reflecting an already optimised cognitive workflow. It would be interesting to determine whether the machine attention map shares similarities with areas in the surgical field that experts focus on. A deep learning network trained to classify Crohn's lesions from video capsule endoscopy images showed that, with increased training, the machine's attention map approaches that of expert gastroenterologists, as measured by visual gaze tracking [&lt;span&gt;5&lt;/spa","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"138 2","pages":"181-182"},"PeriodicalIF":4.1,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/bju.70337","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148136588","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}