Central European Journal of Urology最新文献

{"title":"Feasibility and safety of robot-assisted radical prostatectomy following laser enucleation of the prostate.","authors":"Mehmet Yilmaz, Mustafa Karaaslan, Mehmet Emin Şirin, Halil Çağrı Aybal, Muhammed Emin Polat, Zeynep Akdagcik, Mustafa Yigit Ozdemir, Tuncay Toprak, Arkadiusz Miernik","doi":"10.5173/ceju.2025.0123","DOIUrl":"https://doi.org/10.5173/ceju.2025.0123","url":null,"abstract":"<p><strong>Introduction: </strong>The aim of this study was to systematically review the available evidence on the feasibility and safety of robot-assisted radical prostatectomy (RARP) in patients with prostate cancer following laser enucleation of the prostate (LEP).</p><p><strong>Material and methods: </strong>A systematic search was conducted using PubMed (MEDLINE) and Web of Science online databases until 31 July 2025 with the search terms (\"HoLEP\" OR \"endoscopic enucleation\" OR \"laser enucleation of the prostate\" OR \"ThuLEP\" OR \"ThuFLEP\" OR \"EEP\" OR \"LEP\") AND (\"robot assisted radical prostatectomy\" OR \"robotic assisted radical prostatectomy\" OR \"RARP\") by incorporating the PICO formula (population, intervention, comparison, outcome).</p><p><strong>Results: </strong>Three studies were identified. Continence rates and recovery times differed between patients with prior LEP and those who were LEP-naïve. In one study, postoperative incontinence rates were significantly different between the prior HoLEP and HoLEP-naïve groups (74.0% vs 22.0%, p <0.001), whereas in the other two studies there was no significant difference between groups. Erectile function was documented in 2 studies, which exhibited no statistically significant differences between the prior-LEP group and LEP-naïve group. Complication rates across the studies remained relatively low (7.0-9.0%). Biochemical recurrence and positive surgical margins between the previous LEP and LEP naïve groups were comparable.</p><p><strong>Conclusions: </strong>In patients undergoing RARP after LEP, complications are low and the oncological outcomes are promising, similar to patients who are LEP-naïve. It is essential for surgeons to counsel patients on the potential for prolonged recovery, particularly in regard to continence and sexual function.</p>","PeriodicalId":9744,"journal":{"name":"Central European Journal of Urology","volume":"78 4","pages":"532-539"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12924079/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147269806","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Late relapse of testicular germ cell tumor: An individual patient data meta-analysis of disease characteristics, treatments, and oncological outcomes.","authors":"Mehdi Kardoust Parizi, Nirmish Singla, Siamak Daneshmand, Axel Heidenreich, Aditya Bagrodia, Vitaly Margulis, Akihiro Matsukawa, Ichiro Tsuboi, Shahrokh F Shariat","doi":"10.5173/ceju.2025.0069","DOIUrl":"10.5173/ceju.2025.0069","url":null,"abstract":"<p><strong>Introduction: </strong>Late relapse (LR) of testicular germ cell tumor (TGCT) is a relatively rare event with limited data to help refine evidence-based decision-making. This individual patient data meta-analysis aims to analyze disease characteristics, treatment modalities, and factors affecting oncological outcomes of TGCT patients suffering from LR.</p><p><strong>Material and methods: </strong>A systematic search and individual patient data gathering was performed. The primary end points were disease-free survival (DFS) and cancer-specific survival (CSS).</p><p><strong>Results: </strong>A total of 12 studies, comprising 240 patients, were selected for review. In multivariable analysis, surveillance as primary management of TGCT was associated with a higher risk of retroperitoneal LR (OR = 10.08, 95% CI: 2.34-43.31). On univariable analyses, longer time to LR, LR multiplicity, and chemotherapy (as the sole treatment of LR) were significantly associated with worse DFS and CSS, while pure teratoma at LR, teratoma element at LR, surgery (as the sole treatment of LR), and surgery-based combination treatment of LR were significantly associated with better DFS and CSS. Salvage chemotherapy for LR was associated with worse DFS and CSS compared to first-line chemotherapy in multivariable cox regression analysis (HR = 13.03, 95% CI: 1.13-150.25). Two decision-tree models are proposed to help shared decision making regarding chemotherapy-based vs surgery-only and surgery-based versus combination treatments; the accuracies of these models were 0.94 and 0.88.</p><p><strong>Conclusions: </strong>Available data suggest a benefits to surgery alone or surgery-based combination therapy compared to chemotherapy alone for LR of TGCT. We propose decision-tree models to help clinical decision-making in TGCT patients with LR.</p>","PeriodicalId":9744,"journal":{"name":"Central European Journal of Urology","volume":"78 3","pages":"289-304"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12663810/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145647206","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treatment patterns for urolithiasis and renal colic-like pain symptoms in Poland: The POLSTONE Study.","authors":"Jakub Szymanski, Pawel Rajwa, Wojciech Krajewski, Piotr Bryniarski, Przemyslaw Dudek, Piotr Chlosta, Mikolaj Przydacz","doi":"10.5173/ceju.2025.0112","DOIUrl":"10.5173/ceju.2025.0112","url":null,"abstract":"<p><strong>Introduction: </strong>The aim of this study was to determine population-level treatment patterns for urolithiasis and renal colic-like pain symptoms in Poland.</p><p><strong>Material and methods: </strong>We used data from POLSTONE, a survey representative of the entire Polish population stratified by age, sex, and place of residence. We identified and evaluated non-surgical and surgical treatment patterns for urolithiasis and renal colic-like pain symptoms.</p><p><strong>Results: </strong>In this nationally representative survey of 10,029 Polish adults, the lifetime prevalence of urolithiasis was 12.85% (n = 1,289) and 43.05% (n = 4,317) reported renal colic-like pain symptoms. Ultrasound was the most used diagnostic method for urolithiasis (73.78%; n = 951), followed by computed tomography (22.11%; n = 285). Conservative treatment predominated in the management of urolithiasis, with 58.73% (n = 757) of patients receiving prescription drugs and 29.87% (n = 385) using over-the-counter medications. Among surgical interventions, transurethral procedures were most frequent (13.42%; n = 173), followed by shockwave lithotripsy (11.48%; n = 148), laparoscopic or open surgery (6.75%; n = 87), and percutaneous nephrolithotripsy (6.05%; n = 78). Physicians gave preventive advice to 88.98% (n = 1,147) of respondents who had urolithiasis, most often recommending increased fluid intake (58.65%; n = 756). For renal colic-like pain, medications were the mainstay of treatment, with nearly 90% of patients reporting satisfaction. Some treatment patterns varied by age, sex, and/or residence, highlighting the influence of sociodemographic factors on care.</p><p><strong>Conclusions: </strong>This study offers the first in-depth, population-level evaluation of how urolithiasis and renal colic-like pain symptoms are treated in Poland. The results can guide healthcare policy, support cost-effectiveness studies, and inform targeted strategies for management of urolithiasis and renal colic-like pain symptoms.</p>","PeriodicalId":9744,"journal":{"name":"Central European Journal of Urology","volume":"78 3","pages":"385-393"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12663812/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145647434","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"<i>In vivo</i> endoscopic cryobiopsy of urothelial tumors in the upper urinary tract and bladder: A feasibility pilot study in humans.","authors":"Jan Łaszkiewicz, Łukasz Nowak, Wojciech Tomczak, Joanna Chorbińska, Maciej Kaczorowski, Agnieszka Hałoń, Tomasz Szydełko, Wojciech Krajewski","doi":"10.5173/ceju.2025.0132","DOIUrl":"10.5173/ceju.2025.0132","url":null,"abstract":"<p><strong>Introduction: </strong>Biopsy of the upper tract urothelial carcinoma (UTUC) often provides low-quality or non-diagnostic material. Cryobiopsy may improve the quality of UTUC samples. Our aim was to assess the feasibility of <i>in vivo</i> endoscopic cryobiopsy of UTUC and bladder cancer (BC).</p><p><strong>Material and methods: </strong>Cryobiopsies were performed using the ERBECRYO® device and ø 1.1 mm flexible cryoprobes. Adult patients with UTUC/BC undergoing diagnostic/therapeutic endoscopic procedures were included. The cryoprobes were introduced in the proximity of the tumors and activated. The tissue samples were avulsed from the tumor, extracted and placed in a fixative.</p><p><strong>Results: </strong>Six males were included. Out of these, 4 had UTUC, while 2 had BC. The median age was 68 years. Transurethral procedures were performed in 4 patients, percutaneous in 1 and combined in 1. Cryobiopsies were conducted using cystoscopes (n = 2), rigid ureterorenoscopes (n = 2), nephroscopes (n = 1) and without endoscope, through the ureteral access sheath (n = 1). Mean obtained sample size was 6.2 × 4.7 × 3.0 mm. All the specimens allowed for a histopathologic evaluation; no crushing artifacts were reported, lamina propria was present in 4 specimens, and muscularis propria was present in 1. Bleeding from the sample bed was subjectively significantly less intense than after conventional biopsies, and the procedure was found to be less challenging than standard methods.</p><p><strong>Conclusions: </strong>Cryobiopsy represents a promising advancement in the endoscopic diagnosis of UTUC. Our pilot study demonstrates its feasibility in human <i>in vivo</i> settings. Further comparative research is warranted to establish its role in routine practice.</p>","PeriodicalId":9744,"journal":{"name":"Central European Journal of Urology","volume":"78 3","pages":"263-270"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12663819/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145647496","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Modified posterior reconstruction and vesicourethral anastomosis in robot-assisted radical prostatectomy and its impact on anastomosis stricture rate and clips migration.","authors":"Piotr Kania, Markijan Kubis, Jakub Biedrzycki, Paweł Marczuk","doi":"10.5173/ceju.2024.0239","DOIUrl":"10.5173/ceju.2024.0239","url":null,"abstract":"","PeriodicalId":9744,"journal":{"name":"Central European Journal of Urology","volume":"78 2","pages":"252-253"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12379979/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144944528","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development of a predictive risk score for 1-year intravesical recurrence after radical nephroureterectomy for upper tract urothelial carcinoma.","authors":"Rıdvan Kayar, Kemal Kayar, İlker Artuk, Samet Demir, Emre Erdoğan, Emre Tokuc, Metin Öztürk","doi":"10.5173/ceju.2025.0191","DOIUrl":"https://doi.org/10.5173/ceju.2025.0191","url":null,"abstract":"<p><strong>Introduction: </strong>The study aims to develop and internally validate a novel risk stratification model specifically designed to predict 1-year intravesical recurrence (IVR) following radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC), integrating readily available clinicopathologic parameters.</p><p><strong>Material and methods: </strong>We retrospectively analyzed 87 patients who underwent RNU for UTUC between 2012 and 2024. Patients were stratified according to IVR status at 12 months postoperatively. Univariate and LASSO logistic regression analyses were conducted to identify independent predictors. A simplified risk score was derived from regression coefficients. Model performance was assessed using area under the ROC curve (AUC), calibration plots, and bootstrap validation. Clinical utility was evaluated with decision curve analysis (DCA).</p><p><strong>Results: </strong>One-year IVR occurred in 34 patients (39.1%). Seven independent predictors were identified: tumor multifocality, ureteral tumor location, history of non-muscle-invasive bladder cancer, chronic kidney disease, preoperative ureteroscopy, intravesical bladder cuff excision, and positive surgical margins. The final model showed excellent discriminative performance (AUC = 0.854) and good calibration. Patients were stratified into low (0-2 points), intermediate (3-5), and high-risk (6-9) groups, with IVR rates of 11.1%, 53.7%, and 80.0%, respectively (p for trend <0.001). DCA demonstrated a favorable net benefit across a wide range of thresholds.</p><p><strong>Conclusions: </strong>We present a novel, internally validated scoring system that integrates routine clinicopathologic parameters to predict early IVR following RNU for UTUC. This tool may support urologists in implementing risk-adapted cystoscopic surveillance protocols and identifying candidates for early intravesical therapy. External validation is warranted prior to clinical implementation.</p>","PeriodicalId":9744,"journal":{"name":"Central European Journal of Urology","volume":"78 4","pages":"453-461"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12924064/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147269765","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of preoperative pelvic floor muscle strength and endurance on urinary continence after radical prostatectomy: a sub-analysis of a randomized clinical trial.","authors":"Daimantas Milonas, Laimonas Siupsinskas, Pavelas Zachovajevas, Brigita Zachovajeviene","doi":"10.5173/ceju.2025.0018","DOIUrl":"10.5173/ceju.2025.0018","url":null,"abstract":"<p><strong>Introduction: </strong>To assess the impact of preoperative pelvic floor muscle (PFM) strength on urinary incontinence (UI) after radical prostatectomy (RP).</p><p><strong>Material and methods: </strong>A total of 127 men who underwent surgical treatment for clinically localized prostate cancer in a tertiary university hospital were included in a sub-analysis. PFM strength (cmH₂O) and endurance (s) were measured using a perineometer on the day before and at 1, 3, and 6 months after surgery. UI volume was measured using an 8-hour pad test. The primary outcome was continence, defined as 0-5 grams of urine during the 8-hour pad test at 6 months post-RP. The association between baseline PFM strength and continence was analyzed using Spearman's correlation coefficient, receiver-operating characteristic analysis, and logistic regression analysis.</p><p><strong>Results: </strong>At 6 months post-RP, 45 of 127 (35.4%) men were continent. UI showed a strong negative (r = -0.7; p <0.001) association with preoperative PFM strength and a medium negative (r = -0.55; p <0.001) association with PFM endurance. PFM strength (odds ratio [OR] = 1.16, p <0.0001), PFM endurance (OR 1.6, p <0.0001), and preoperative prostate-specific antigen (OR = 0.87, p = 0.03) were the most significant predictors of continence in the univariate regression analysis. In the multivariate analysis, only PFM strength remained a significant predictor (OR = 1.13, p <0.001) of UI. The thresholds for PFM endurance and strength were 9.6 seconds and 98.9 cmH₂O, respectively.</p><p><strong>Conclusions: </strong>Preoperative PFM strength and endurance demonstrated significant associations with postoperative UI. Objectively measured preoperative PFM conditions could help identify patients at increased risk of UI after RP.</p>","PeriodicalId":9744,"journal":{"name":"Central European Journal of Urology","volume":"78 3","pages":"339-346"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12663820/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145647436","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficiency and safety of microscopic cluster ligation of the internal spermatic veins: A prospective matched case-control study.","authors":"Wang Jingkai, Xu Peng, Wang Hailuo, Zhang Ruoran, Pang Kun","doi":"10.5173/ceju.2024.0163","DOIUrl":"10.5173/ceju.2024.0163","url":null,"abstract":"<p><strong>Introduction: </strong>The aim of this study was to evaluate the surgical efficacy and safety of microscopic cluster ligation of the spermatic vein (MCLSV), and to compare the similarities and differences between MCLSV and microscopic traditional branch ligation of the spermatic vein (MTBLSV).</p><p><strong>Material and methods: </strong>A prospective matched case-control study of 91 patients with bilateral varicocele was conducted. Participants underwent microscopic bilateral spermatic vein ligation and were randomly assigned by computer to undergo MCLSV on one side and MTBLSV on the other. The operative outcomes of the two techniques were compared.</p><p><strong>Results: </strong>The operative time of MCLSV was significantly lower than that of MTBLSV (p <0.001). Postoperative day 1 VAS scores at the operative site in MCLSV were significantly lower than MTBLSV (p <0.05). There was no significant difference between the two groups in the number of spermatic vein ligations, the number of internal spermatic arteries and lymphatics, complications, occurrence of foreign body sensation of wire knots, improvement of scrotal pain and distant recurrence (p >0.05).</p><p><strong>Conclusions: </strong>Compared with MTBLSV, MCLSV can significantly shorten surgical time, improve surgical efficiency, and alleviate postoperative perineal pain and discomfort in patients while ensuring surgical safety and effectiveness.</p>","PeriodicalId":9744,"journal":{"name":"Central European Journal of Urology","volume":"78 3","pages":"429-433"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12663800/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145647445","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cuff downsizing in the treatment of non-mechanical persistent or recurrent stress urinary incontinence: narrative review.","authors":"Michał Skrzypczyk, Łukasz Białek, Yulian Mytsyk, Alexandre Dubois, Jakub Dobruch, Benoit Peyronnet","doi":"10.5173/ceju.2025.0028","DOIUrl":"10.5173/ceju.2025.0028","url":null,"abstract":"<p><strong>Introduction: </strong>Stress urinary incontinence (SUI) is a common complication following radical prostatectomy, affecting up to 60.0% of men. The artificial urinary sphincter (AUS) has been the gold standard for treating severe SUI since its introduction in 1973. Despite its efficacy, long-term complications such as device failure and recurrent incontinence are relatively common, often necessitating revision surgeries. This review focuses on cuff downsizing as a revision strategy for non-mechanical AUS failure.</p><p><strong>Material and methods: </strong>A literature review was conducted using PubMed/Medline, covering studies published between January 2000 and December 2023. Key words included: \"artificial urinary sphincter\", \"cuff downsizing\", \"urethral atrophy\", \"non-mechanical failure\" and \"male urinary incontinence revision\". Inclusion criteria were studies addressing cuff downsizing as a primary revision for non-mechanical failures. Only English-language studies were reviewed. We analyzed the timing of revisions, follow-up duration, and outcomes such as continence rates, complication rates, and device survival.</p><p><strong>Results: </strong>Six retrospective studies involving 206 patients were included in the present review. Cuff downsizing was performed as the sole intervention in 3 studies and in combination with other approaches in the remaining 3 studies. The median cuff size decreased from 4.5 cm preoperatively to 4.0 cm postoperatively, with 8.0-12.0% of patients receiving a cuff downsized by more than 1.0 cm. Across all studies, continence rates after revision surgery ranged from 52.0% to 90.0% based on patient-reported outcome measures (PROMs). Device survival rates varied from 64.0% to 95.0%, with infection and urethral erosion being the leading causes of device explantation.</p><p><strong>Conclusions: </strong>Cuff downsizing is a reasonable revision strategy for non-mechanical AUS failure, offering similar continence outcomes and complication rates compared to alternative techniques.</p>","PeriodicalId":9744,"journal":{"name":"Central European Journal of Urology","volume":"78 3","pages":"413-418"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12663815/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145647449","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reclassification of prostate cancer on first confirmatory prostate biopsy in men under active surveillance: A systematic review and meta-analysis.","authors":"Benjamin M Mac Curtain, Killian Daly, Gavin Calpin, Eoin Collins, Avinash Deshwal, Olwyn Lynch, Wanyang Qian, Aaron O'Mahony, Hugo C Temperley, Reuben D Mac Curtain, Diarmaid Moran, John A O Kelly, Catherine Dowling","doi":"10.5173/ceju.2025.0011","DOIUrl":"10.5173/ceju.2025.0011","url":null,"abstract":"<p><strong>Introduction: </strong>Prostate cancer is typically diagnosed following prostate biopsy. In low-risk and selected favourable intermediate-risk disease, active surveillance is the treatment strategy of choice. In these men, a confirmatory biopsy performed. We report on the rates of risk upgrading at biopsy confirmatory that may represent a need to pursue further treatment in lieu of active surveillance.</p><p><strong>Material and methods: </strong>We performed a systematic review and meta-analysis of pooled reclassification rates of men on active surveillance at first confirmatory biopsy, in line with PRISMA recommendations. PubMed, EMBASE, and Cochrane central registry for clinical trials were searched until June 2024. Stata was used to pool reclassification rates at first confirmatory biopsy.</p><p><strong>Results: </strong>Seventeen studies from 9 countries comprising 6,039 patients were included. Transrectal biopsy was the most common biopsy method for confirmatory biopsy. Weighted pooled rates of upgrading on first confirmatory biopsy were 20% with a 95% confidence interval of 19-21%.</p><p><strong>Conclusions: </strong>Approximately 20% of men undergoing active surveillance were upgraded at confirmatory biopsy. This may alter the management of these patients, and it highlights the importance of a confirmatory biopsy.</p>","PeriodicalId":9744,"journal":{"name":"Central European Journal of Urology","volume":"78 2","pages":"125-136"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12379824/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144944514","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}