共找到 20 条结果
暂无摘要（点击查看详情）
This work aimed to investigate the role of surgeon experience on operating time and detection rate of clinically significant prostate cancer (csPCa) in a large contemporary cohort undergoing transperineal (TP) MRI-targeted prostate biopsy. We retrospectively reviewed patients who underwent TP MRI-guided prostate biopsies between 10/2018 and 04/2024. Patients with suspicious MRI lesions (PI-RADS 3, 4 and 5) formed the study cohort. All patients underwent MRI-targeted biopsies of suspicious lesions combined with a standard 12-core systematic biopsy. Caseloads-both total and in increments of 50 cases-were calculated for each surgeon. We employed univariable and multivariable Poisson regression models to analyse biopsy duration, and logistic regression models to assess csPCa detection. Out of 3336 MRI-guided TP biopsies, 1148 (34%) involved PI-RADS 3, 1398 (42%) PI-RADS4 and 790 (24%) PI-RADS 5 as index lesions. Most patients (55%) had one suspicious lesion. The median caseload per surgeon was 63 (IQR [interquartile range]: 30-110). Biopsy duration significantly decreased after the first 50 procedures (13 min [95% CI: 10-18] to 10 min [95% CI: 8-15]) and plateaued thereafter. Multivariable Poisson regression demonstrated increased caseload independently associated with shorter biopsy duration (IRR 0.891 [95% CI: 0.833-0.899], p < 0.001). The overall csPCa detection rate was 43%, with no significant correlation to caseload. These findings were consistent across subgroup analyses based on PI-RADS score. This large, contemporary study demonstrated that biopsy duration decreased significantly after approximately 50 cases, indicating a learning curve without compromising the detection rate of csPCa.
This work aimed to evaluate the safety and efficacy of holmium laser enucleation of the prostate across different degrees of frailty using the 11-item and 5-item modified frailty indices and to compare perioperative and postoperative outcomes across multiple frailty thresholds. We retrospectively reviewed patients who underwent HoLEP at our institution between July 2017 and August 2025. Frailty was assessed using mFI-11 (cutoffs ≥0.18, ≥0.27, ≥0.36) and mFI-5 (≥0.40). Perioperative variables, functional outcomes, and postoperative complications were compared. Agreement between frailty definitions was assessed using Cohen's kappa. Logistic regression was used to evaluate complication risk. Among 857 patients, overall frailty burden was low ranging from 16.2% with mFI-11 ≥0.36 to 52.6% with mFI-11 ≥0.18, and 27.5% by mFI-5 ≥0.40. Functional outcomes improved in all groups, though patients defined as frail by mFI-11 ≥0.36 demonstrated less improvement in IPSS at 1 year and lower Qmax at select time points. Major complications were uncommon and did not demonstrate a consistent frailty gradient. Transfusion risk was higher only at mFI-11 ≥0.36. Urinary tract infection showed a dose-response relationship with increasing mFI-11, with approximately a 20% increase in odds per one-point increase. HoLEP is safe and effective across frailty definitions. Frailty cutoff selection meaningfully influences risk stratification, with mFI-11 ≥0.36 providing the most clinically informative discrimination.
This study aims to externally validate the preoperative risk evaluation for partial nephrectomy (PREP) score, recently introduced to predict the risk of major complications after partial nephrectomy based on patient characteristics, in a large multi-institutional cohort of robot-assisted partial nephrectomy (RAPN) patients. A retrospective review was performed on the IRB-approved, multi-institutional United States Kidney Cancer Data Network (US-KIDNET) to identify 10 154 patients who underwent RAPN from 2018 to 2025. Major complications were defined as Clavien-Dindo grade III-V within 30 days. Patients were assigned to risk categories for major complications based on weighted comorbidities, as defined by the PREP score, and the alignment of predicted complication rates with actual complication rates was evaluated. Discrimination was evaluated using the area under the receiver operating characteristic curve (AUC). Calibration was examined using the Hosmer-Lemeshow (HL) goodness-of-fit test. Subgroup analysis was performed by robotic platform and surgical approach. Exploratory univariate and multivariate logistic regression were performed to evaluate associations between individual PREP components and major complication rates. All computations were performed in Python (v3.8). A total of 8615 patients who underwent RAPN were included in the final validation cohort. The PREP score did not perform well in this robotic surgery cohort, with limited overall discrimination (AUC 0.547; 95% CI 0.518-0.580). On calibration, the model's predicted probabilities were not well-aligned with observed outcomes (HL χ2 = 150.2; p < 0.001). Performance did not differ significantly across robotic platform or surgical approach subgroups. In the adjusted analysis, coronary artery disease (CAD, aOR 2.22), chronic obstructive pulmonary disease (COPD, aOR 2.75), chronic kidney disease (CKD, aOR 1.48), and obesity (aOR 1.73) were independently associated with major complications, but not congestive heart failure (CHF; aOR 0.50, p = 0.36). Our real-world external validation for the PREP score demonstrates that this score does not perform well in a large, multicentre, robotic cohort. Our findings suggest that coefficient re-estimation, rather than simple recalibration, may be required.
This study aimed to evaluate subjectively and objectively the use of the slimmest scope, 7.5 Fr, on patient quality of life and outcome for upper urinary stones (UUS) treated by flexible ureteroscopy and to study the impact of ureteric stent insertion and operative techniques on patient satisfaction. Between January 2024 and October 2025, 120 cases with UUS met our inclusion criteria: stone burden > 7 mm (single or multiple), radio-opaque stone, no UTI and not more than mild hydronephrosis preoperatively. Two endoscopic techniques were encountered. An equal number of cases were operated on using a scope of 7.5 Fr (Group A) and 9.5 Fr (Group B). The comparisons of patient factors included age and body mass index (BMI). Stone size, number and laterality were analysed. Operative factors included ureteral dilatation, stent insertion and procedure duration. Post-operative stent, its duration, pain level, dark urine (possible significant haematuria) or dysuria (possible infection), retained stone or other post-operative complications were assessed. Both scope groups were demographically insignificant. The stone location and side were comparable. Operative details had a nearly insignificant comparison. Group A had a long operative time. Stent insertion was higher in Group B. Subjectively, the dark urine symptom was reported in 37 and 23 cases in Groups A and B, respectively (p < 0.05). Interestingly, 11 cases needed opioid injections for post-operative colic in Group A (p = 0.008). The stone-free rate was 89.2% and 91.7% in Groups A and B, respectively (p = 0.487). All stented cases had mild storage lower urinary symptoms. No major surgical complications were reported. Scope size has no impact on patient post-operative outcome. Interestingly, a long operative time with a small scope was observed. Ureteral dilation and stent insertion cases have urinary post-operative symptoms. A nonstent procedure is advised in noncomplicated cases (Hekal's criteria).
This study aims to investigate any differences in the levels of intra-operative (measured by an artificial intelligence device) and post-operative pain between two different abdominal insufflators (AirSeal vs Stryker) used for a low-pressure pneumoperitoneum robotic prostatectomy. A prospective randomised controlled clinical study was performed at Lister Hospital, Stevenage. The primary aim was to evaluate the feasibility of recruiting 40 patients with localised prostate cancer who underwent a robotic prostatectomy with either an AirSeal® Insufflation System (n = 20) or Stryker PneumoClear Insufflator (n = 20) for the management of low-pressure pneumoperitoneum (8 mmHg). The co-primary aim was to investigate any differences in intra-operative significant nociceptive stimulus (NOL ≥ 25 for ≥1 min) measured by the Medasense PMD-200 device, in addition to post-operative pain scoring and opioid consumption. The secondary aim of the study was to assess any differences in surgical factors (blood loss, console and total procedure time, length of stay, readmission rates, adverse events, differences in creatinine and haemoglobin and unplanned pneumo-peritoneal pressure changes). Forty patients were successfully recruited onto the RALP trial with complete 30-day follow-up. AirSeal has fewer significant nociceptive events per recorded hour than Stryker (20.7 vs. 33.5, p = 0.041). Shorter procedure times (p = 0.045), console times (p = 0.045) and blood loss (p < 0.001) were seen in the AirSeal arm of the trial. There were no statistical differences in post-operative pain scores, analgesia consumption at POD1 (p = 0.599) and at discharge (p = 0.488). There were four (n = 4) adverse effects reported with the Stryker arm of the trial (n = 3 ileus, n = 1 UTI) leading to two (n = 2) formal re-admissions. In this study, we were able to successfully recruit 40 participants with complete 30-day follow-up. There were advantageous surgical factors and lesser intra-operative nociceptive insult associated with the AirSeal insufflator. Further RCTs are planned with a larger population to investigate the true causality of this relationship.
This study aimed to evaluate the association between lesion echogenicity on micro-ultrasound (micro-US) and the presence and grade of prostate cancer. We prospectively analysed 229 prostate lesions from 181 men undergoing micro-US-guided transperineal biopsy at UCLA. Lesions were visually graded as hyperechoic, isoechoic or hypoechoic relative to the central zone, which served as an internal reference due to its consistent tissue characteristics and low malignancy risk. Biopsy targeting was confirmed by visualizing the needle tract within the lesion. The primary outcome was the detection rate of Grade Group (GG) ≥ 2 cancer across echogenicity categories. Secondary analyses included associations with PSA density and MRI-derived apparent diffusion coefficient (ADC) values, given that ADC is associated with tissue cellularity. Statistical comparisons were performed using chi-square and Kruskal-Wallis tests, with post hoc pairwise analyses where appropriate. GG ≥ 2 cancer detection rates increased with decreasing echogenicity: 22% in hyperechoic, 56.2% in isoechoic and 62.4% in hypoechoic lesions (p < 0.01). Hypoechoic lesions also exhibited a higher proportion of GG ≥ 3 cancers (p < 0.05). ADC values declined progressively from hyperechoic to hypoechoic lesions (median: 980, 851 and 751, respectively; p < 0.01), suggesting higher tissue cellularity. Regression analysis demonstrated no meaningful interaction between PRI-MUS and echogenicity. PSA density did not significantly differ among echogenicity groups. Lesion hypoechogenicity on micro-US is strongly associated with higher grade prostate cancer and lower ADC values, suggesting a link to tissue cellularity. These findings support the incorporation of echogenicity as a diagnostic marker within the micro-US PRI-MUS framework, potentially enhancing the accuracy of prostate cancer risk stratification.
The aim of this paper is to evaluate fellowship outcomes 10 years after implementation of the European Association of Urology Robotic Section (ERUS) structured curriculum for robot-assisted radical prostatectomy (RARP), with a focus on completion rates and reasons for non-completion. Data were obtained from institutional records and a trainee survey. The primary outcome was fellowship completion (i.e., Certificate of Excellence achievement). Secondary outcomes included reasons for non-completion and satisfaction. Completion rates were analysed annually, with trends assessed using the Cochran-Armitage test and log-linear regression for the Estimated Annual Percentage Change (EAPC). Comparisons before and after introduction of a procedural diary (2023) and between pandemic and non-pandemic years used Fisher's Exact Test. Among 126 fellows, a total of 42 (33%) completed the fellowship by achieving the Certificate of Excellence. The trainee survey achieved a response rate of 77%, supporting the representativeness of the collected data. The main barriers to fellowship completion included limited console access (49%), insufficient programme duration (20%), logistical difficulties (20%) and COVID-19-related disruptions (11%). Despite these limitations, overall satisfaction with the fellowship was high (83%), with particularly strong approval of the ORSI hands-on training week (100%). Completion rates demonstrated a progressive increase over time, rising from 20% in 2018 to 52% in 2023. The Cochran-Armitage test confirmed a statistically significant upward trend in completion rates over the study period (p < 0.001), while log-linear regression analysis showed a numerical but non-significant EAPC of 13% (95% CI -0.6 to 28.6). Although 2023 represented the highest observed completion rate, this peak was not significantly different from previous years (OR 2.63, 95% CI 0.91-7.63). The RARP ERUS Fellowship remains a benchmark in robotic training, but unsatisfactory completion rates highlight the need for improvement. Recent reforms, including the procedural diary, show promise and warrant expansion.
There is no information regarding challenges faced by European urology residents in starting a family. The aim of this study was to examine pregnancy and parenting experiences and policies during urology residency, identify regulatory gaps and provide recommendations for standardized European guidelines. A cross-sectional English-language electronic survey targeted urology residents and young urologists across Europe. The 44-item, self-administered survey was pilot-tested and iteratively revised with European Society of Residents in Urology (ESRU) board members. Data were collected between August and October 2024 from ESRU, the European Association of Urology (EAU) and the European School of Urology (ESU) via mailing lists and social media platforms. From 387 respondents, 237 (61%) were females and 255 (66%) were residents. Written policies on pregnancy and parenthood management were reported by 112 (29%) respondents. Formal discussions on pregnancy and parenting were reported to be absent from 319 (82%) respondents, though 228 (59%) agreed about their importance. Among 250 non-childbearing participants, parenthood was postponed due to fears of missing training opportunities in 130 (92%) female versus 76 (86%) male respondents and due to fears of missing career opportunities in 122 (86%) female versus 62 (70%) male respondents. Concerns about falling behind peers in training were present in 119 (84%) female versus 58 (66%) male respondents (p < 0.001). Across all participants, 283 (87%) and 277 (85%) supported adjusting residency working and training schedules, respectively, upon return to work to ensure the completion of residency requirements. Both male and female respondents strongly endorsed standardized European guidelines on pregnancy and parenting in urology residency. This survey highlights the significant barriers to family planning in European urology residency. Fear of career setbacks and training disruptions drives parenthood delays. Standardized policies are needed to support residents while maintaining training requirements and career progression during pregnancy and parenthood.
The aim of this study was to evaluate long-term safety, urological complication rates and quality of life (QoL) associated with urethral intermittent catheterization (IC) over a 5-year follow-up in adult, established, experienced subjects with longstanding IC use. Prospective, noninterventional, observational cohort study at three European sites. Adults (≥18 years) performing urethral IC with LoFric™ catheters for ≥6 years prior to enrolment were followed for 5 years. Outcomes included symptomatic urinary tract infections (UTIs), urethral strictures, bladder stones, prostatitis, epididymitis, patient-reported outcomes (PROs) and perception of catheters and IC. QoL, including pain and discomfort, anxiousness and depression, self-care and performing usual activities, was evaluated through the EQ 5DL questionnaire. Ninety-eight participants were enrolled (April 2015-August 2018); 49 completed 5-year follow-up (PP). Median age at inclusion was 61 years; 69% were male. Median follow-up was 5 years; mean prior LoFric use was 13 years (range 6-30). Neurological conditions comprised 51% of underlying aetiologies. Across 5 years, there were no significant changes in UTI frequency, other urological complications, EQ-5D tariff, or PRO ratings. At baseline, 59% (PP) reported ≥1 UTI in the prior 12 months versus 55% at Year 5 (p = 0.8036); mean UTIs decreased from 3.93 to 3.63 (p = 0.5434). Urethral stricture reports rose from 6% to 12% (NS). EQ-5D tariff remained stable (mean 0.86 at inclusion and Year 5). In adults with more than a decade of prior IC experience, continued use of hydrophilic LoFric catheters over an additional 5 years was associated with unchanged complication rates and stable QoL and PROs, supporting the long-term safety of IC as a bladder management strategy.
To evaluate the incidence and predictive factors of early penile prosthesis (PP) infection within a contemporary regional cohort in the North of England. A retrospective review of all PP implantations was conducted at a tertiary urology and andrology centre between 2018 and 2025, with variables including age, BMI, smoking, relevant comorbidities, pre-operative HbA1C, immunosuppressant use and device-related variables. Data were analysed using SPSS v29, with univariate logistic regression performed to identify factors of early infection (≤30 days). A p-value < 0.05 was considered statistically significant. A total of 103 patients underwent PP implantations. Mean age at implant was 59.4 ± 9.9 years. The comorbidity burden of diabetes, hypertension and dyslipidaemia was 35.0%, 49.5% and 39.8%, respectively, with mean pre-operative HbA1C at 45.6 mmol/mol. Notably, 9.7% of patients were on chronic immunosuppressive therapy. Early prosthetic infection was identified in six patients (5.8%). On univariate analysis, there was a strong association between immunosuppressant use and infection (50.0% vs 7.2%, p = 0.02; OR 12.0, 95% CI 1.7-85.0). The variables of age, BMI, diabetes, hypertension, dyslipidaemia, HbA1C and implant type were not associated with infection. In this contemporary regional study, early PP infection was identified in 5.8% of the cohort, with chronic immunosuppressant use being the dominant predictor of infection. Other metabolic, clinical and implant factors were not predictive of infection. This demonstrates immunosuppression being a persistent biological vulnerability requiring risk stratification and targeted perioperative strategies. Larger, prospective multicentre studies are required to further validate its impact and inform evidence-based infection-prevention protocols.
The objective of this study is to assess the efficacy, safety and change in quality of life associated with ICI-BCG (I + M) compared to BCG (I + M) in patients with BCG-naïve HR-NMIBC. A systematic search was run on PubMed, Embase and CENTRAL from inception to 29 October 2025. Phase 3 randomized controlled trials comparing safety, efficacy and quality of life (QOL) for patients with BCG-naïve HR-NMIBC receiving ICI-BCG (I + M) versus BCG (I + M): hazard ratios (HR) and 95% confidence interval (95% CI) for HG-RFS (high-grade recurrence free survival), odds ratio (OR) and 95% CI for Grade ≥3 treatment-related adverse events (G3 + TRAEs), and mean difference (MD) and 95% CI for changes in quality of life (QOL measured using EORTC QLQ C30). A priori defined subgroups included presence of CIS, presence of papillary tumours, age <65 or ≥65 years, male/female, and BCG strain. Pooled results indicated that ICI-BCG (I + M) was not associated with a reduction in HG-RFS (HR: 0.78; 95% CI: 0.59-1.02). However, on sensitivity analysis excluding ALBAN (for differences in trial design and patients included), ICI-BCG (I + M) was associated with a reduction in HG-RFS (HR: 0.68; 95% CI: 0.54-0.85) with an absolute risk reduction of 4.4-7.3% in 36-month HG-RFS. ICI-BCG (I + M) was associated with an increased risk of G3 + TRAEs (OR: 4.76; 95% CI: 3.01-7.53). ICI-BCG (I + M) was associated with a non-clinically significant decline in QOL (MD: -3.25; 95% CI: -5.11 to -1.39). Heterogeneity between trials was minimal (τ 2 < 1). Risk of bias was low in all included studies. This pooled analysis provides data for patient-specific counselling on the use of ICI-BCG (I + M) for BCG-naive HR-NMIBC.
The objective of this study is to evaluate the outcomes of an initial series of single-port robot-assisted ureterolysis (SP-RAU) in patients with retroperitoneal fibrosis (RPF). We prospectively collected surgical and clinical data from all consecutive patients undergoing SP-RAU at our institution between April 2016 and May 2024. The primary endpoint was the achievement of a stent-free status at 12 months. Overall, 16 patients (21 renal units) underwent SP-RAU with a minimum follow-up of 12 months. All five patients with bilateral disease were managed with a staged approach in two separate surgical sessions. RPF was idiopathic in 37% and secondary in 62% of cases. Four procedures (19%) were aborted due to extensive fibrosis or high vascular risk (one unilateral right, two unilateral left and one second-stage left unit). These patients had significantly longer preoperative stent duration (60 vs. 9 months; p = 0.006). Among the 17 completed procedures, no open conversions, intraoperative complications or transfusions occurred. Median operative time was 215 min (IQR 195-240), and median blood loss was 10 ml (IQR 10-20). Median length of stay was 11.5 h (IQR 7.8-26), with 52% of patients discharged the same day. At a median follow-up of 25 months (IQR 18-50), complete symptom resolution was achieved in 82% of renal units, whereas 64% remained stent-free at 12 months. The main limitations are the small sample size, single-surgeon experience and absence of a comparator arm. SP-RAU is a safe and feasible minimally invasive option for managing RPF. It achieves good functional success with minimal morbidity and enables same-day discharge in over half of patients. Larger multicentre studies with longer follow-up are needed to confirm these findings and establish the role of SP-RAU in the management of RPF.
This study aims to evaluate the oncological outcomes, functional recovery and overall satisfaction following cytoreductive radical prostatectomy (CRP) in patients with oligometastatic prostate cancer treated at a single tertiary-care centre. Between 2021 and 2024, 12 patients with clinically and radiologically confirmed oligometastatic prostate cancer (≤5 bone lesions, no visceral metastases) underwent open retropubic CRP after 6 months of neoadjuvant androgen deprivation therapy (ADT) and targeted radiotherapy to metastatic sites. Postoperatively, all patients received adjuvant ADT for 2 years. Perioperative details, pathological findings and functional outcomes including continence, erectile function and biochemical recurrence (BCR) were recorded prospectively and analysed with descriptive statistics. The mean age was 60 years (range 55-68), mean operative time 200 minutes and mean blood loss 550 mL. Final histopathology showed organ-confined (pT2) disease in all patients; two (16.7%) had positive surgical margins, and four (33.3%) had nodal involvement. Continence was achieved in 10 patients (83%) at 1 year, while potency was regained in all 10 who underwent nerve-sparing surgery within 12 months. No patient developed biochemical recurrence at a mean follow-up of 25 months. Ten patients (83%) reported complete satisfaction with the procedure. Cytoreductive radical prostatectomy appears to be a safe and feasible component of multimodal therapy for carefully selected patients with oligometastatic prostate cancer. In this limited series, acceptable perioperative morbidity, encouraging early oncological outcomes and good functional recovery were observed, supporting its potential role in comprehensive disease control.
This study aims to investigate the impact of high-grade complications (i.e., Clavien-Dindo Classification [CDC] Grade ≥III) on quality of life (QoL) and psychosocial distress (PD) in the early period after radical cystectomy (RC) and urinary diversion. The study relied on prospectively collected data of patients undergoing 3 weeks of inpatient rehabilitation (IR) after RC and urinary diversion (ileal conduit [IC] or ileal neobladder [INB]) between 04/2018 and 12/2019. Patients were surveyed on QoL (EORTC QLQ-C30) and PD (QSC-R10) by validated questionnaires at the beginning and the end of IR. Information about complications before the start of IR was taken from the hospital discharge letters and patient interview. Overall, 842 patients were enrolled. High-grade complications occurred in 25.5% of patients. Men (27.4% vs. 17.6%, p = 0.011) and patients with an INB (28.9% vs. 22.6%, p = 0.037) were significantly more susceptible to high-grade complications. At the beginning of IR, health-related QoL (HRQoL), role and social functioning were significantly lower in patients with a high-grade complication. Both HRQoL and the proportion of patients with high PD improved significantly during IR (p < 0.001, respectively). A multivariable linear regression analysis identified high-grade complications to significantly impact HRQoL (p = 0.013). Meanwhile, age (p = 0.001), INB (p = 0.019) and high-grade complications (p = 0.01) significantly contributed to PD. High-grade complications after RC and urinary diversion significantly impair short-term QoL and PD, warranting constant physical and psychosocial monitoring.
Perineural invasion (PNI) detected on prostate needle biopsy is a well-established indicator of adverse pathology, while the prognostic role of PNI quantification has recently been suggested. We herein aimed to determine whether PNI quantification could universally stratify risks by separately assessing subgroups of patients based on biopsy Grade Group (GG). We quantified actual PNI foci in the entire systematic sextant biopsy specimens from 840 men, including 580 (69.0%) exhibiting no PNI and evaluated long-term oncologic outcomes following radical prostatectomy. PNI was detected in 1 (n = 177; 21.1%), 2 (n = 48; 5.7%) or 3-6 (n = 35; 4.2%) of 6 biopsy sites/parts, while 1 (n = 156; 18.6%), 2 (n = 53; 6.3%) or 3-10 (n = 51; 6.1%) PNI foci were present on each biopsy. In the entire cohort, we confirmed a significantly higher risk of biochemical recurrence in patients with PNI (vs. no PNI; P < 0.001), multi-site PNI (vs. single-site PNI; P < 0.001) or multifocal PNI (vs. unifocal PNI; P < 0.001). In subgroup analyses, significant differences in the risk of postoperative recurrence between the absence vs. presence of PNI were observed only in patients with GG3 or GG4 cancer. In contrast, the prognostic distinction between single-site vs. multi-site PNI or unifocal vs. multifocal PNI was evident in patients with GG2 or GG3 cancer, but not in those with GG1 or GG4-5 cancer. In multivariable analysis, multifocal PNI, but not multi-site PNI, was independently associated with worse recurrence-free survival in the GG2 (hazard ratio 5.866, P = 0.004) and GG3 (hazard ratio 2.716, P = 0.021) groups. Meanwhile, PNI on prostatectomy was confirmed in 98.1% of biopsy PNI-positive cases but was still detected in 72.2% of biopsy PNI-negative cases. Quantification of actual PNI foci across all systematic biopsy sites may provide valuable prognostic information, particularly in patients with GG2-3 cancer. Notably, the mere presence of biopsy PNI may not universally predict poorer outcomes.
To use real-world data to determine the clinical risk factors that are predictive of metastatic disease in high-risk prostate cancer (PCa) patients undergoing staging [68Ga]Ga-Prostate-Specific Membrane Antigen (PSMA)-11 positron emission tomography combined with computed tomography (PET/CT). Subjects with newly diagnosed PCa who underwent [68Ga]Ga-PSMA-11 PET/CT between 1/2/20 and 1/4/23, with one or more of three major risk factors (prostate-specific antigen (PSA) ≥ 20, MRI T-stage ≥ 3 or International Society of Urological Pathology (ISUP) grade ≥ 3) were included. Metrics collected included [68Ga]Ga-PSMA-11 PET/CT primary index tumour maximum standardized uptake value (SUVmax), TNM stage, tumour histology, patient age, body mass index and treatment type. A total of 525 subjects were eligible for inclusion. A total of 22.1% had nodal or distant metastases on the baseline [68Ga]Ga-PSMA-11 PET/CT (11.8% with one major risk factor, 25.6% with two and 43.5% with three). All three major risk factors (PSA ≥ 20, MRI T-stage ≥ 3, ISUP grade ≥ 3) and the presence of a higher percentage of positive biopsy cores were significant independent risk factors for the presence of metastatic disease on multivariable analysis. Primary index tumour SUVmax was associated with clinical risk factors, including ISUP grade in the surgical cohort. A total of 146 (27.8%) subjects underwent a radical prostatectomy, and 379 (72.2%) received non-surgical management (including 242 (46.1%) who received curative intent radiotherapy (RT)). This study provides real-world validation of the clinical risk factors used for the ProPSMA study for [68Ga]Ga-PSMA-11 PET/CT scan eligibility, which represent significant independent risk factors for the presence of nodal or distant metastases on baseline [68Ga]Ga-PSMA-11 PET/CT.
This study aims understand the outcomes following intradetrusor onabotulinumtoxinA injections and sacral neuromodulation (SNM) in a national cohort of male Medicare beneficiaries with overactive bladder (OAB). This is a retrospective cohort study of a 100% sample of fee-for-service male Medicare beneficiaries undergoing first-time onabotulinumtoxinA injections or SNM test procedures from 2014 to 2016. The primary outcome was repeat onabotulinumtoxinA injections within 1 year of index injections and placement of implantable pulse generator (IPG) within 90 days of a SNM test procedure. Overall, 11 286 male beneficiaries were included; 31.4% who underwent onabotulinumtoxinA injections had repeat injections within 1 year and 56.0% who underwent SNM test procedures had an IPG implant within 90 days. Repeat onabotulinumtoxinA injections were less likely among men who were ≥85 years (adjusted relative risk [aRR] 0.85, 0.75-0.96) versus ages 65-74. IPG implantation was more likely following staged versus percutaneous nerve evaluation (PNE; aRR 1.57, 1.50-1.64) and among beneficiaries in the lowest versus highest of socioeconomic quartile (aRR 1.10, 1.03-1.18). Rates of repeat treatments following index onabotulinumtoxinA injections among older men were lower than those previously reported among younger, predominantly female populations, whereas rates of IPG implantation were similar. Interestingly, frailty and comorbidity were not associated with these claims-based treatment outcomes following either procedure, but certain non-clinical variables were associated with IPG implantation following SNM. While these outcomes cannot distinguish symptom improvement from discontinuation because of lack of efficacy, adverse events or patient preference, they provide important insights into real-world treatment patterns for a patient population which is under-sampled in the OAB literature.
This study aimed to evaluate the time toxicity of intravesical BCG compared to sequential intravesical gemcitabine and docetaxel (Gem/Doce) for non-muscle-invasive bladder cancer (NMIBC). After IRB approval, we retrospectively reviewed patients with NMIBC treated with BCG or Gem/Doce between 2022 and 2025 at our institution. Medical records were used to calculate time for intravesical therapy, office visits, transurethral resection of bladder tumour (TURBT) and emergency department encounters. Continuous variables were compared using the Wilcoxon rank sum test with Hodges-Lehmann estimates. Of 133 patients, 86 received BCG (65%) and 47 Gem/Doce (35%). Patients with BCG were more likely treatment naïve compared to those with Gem/Doce (77% vs 55%, p = 0.018). Median time per instillation was 179 min for BCG compared to 192 min for Gem/Doce (Hodges-Lehmann shift +27 min, 95% CI 4 to 57; p = 0.02). Median TURBT time, office visit time and emergency department visit time were similar between groups (all p > 0.05). Over the first six instillations, the cumulative difference was 306 min (+5.1 h, p < 0.001). Gem/Doce requires a greater time investment than BCG. As effective NMIBC therapies expand, time toxicity should be considered alongside oncologic outcomes.
This study aims to investigate the role of urinary microbiota in renal cell carcinoma; we analysed urinary microbiota in kidney cancer patients and explored its potential role as biomarker. Samples were collected from 49 males (28 patients planned to undergo systemic therapy and 21 healthy volunteers). Two samples were collected from each patient, one prior to treatment and one after 8 to 12 weeks of systemic therapy. Microbiota was analysed by 16S rRNA sequencing. Microbiota diversity, taxonomic composition and relative abundance were compared between groups and longitudinal samples. Amplicon sequence variant (ASV) richness was higher in renal cancer patients (p = 0.042) than controls. Beta diversity also differed between patients and controls by means of Jaccard (p = 0.001), Bray-Curtis (p = 0.008), and nonweighted UniFrac metrics (p = 0.001). Acetobacter, Lacticaseibacillus, Alloscardovia, Brevibacterium and the family Propicionibactericeae had higher relative abundance in cancer patients, while Prevotella, Microbacterium and Sphingomonas were more abundant in controls. Beta diversity differed between pretreatment and posttreatment samples (p = 0.008). After systemic treatment, we found an increased relative abundance for Prevotella, Rothia, Bradyrhizobium, Methylobacterium/Methylobrum, Porphiromonas and Fusobacterium and a decreased one for the Burkeholderia-Caballeronia-Paraburkholderia group. Higher ASV richness was predictive of poor prognosis for RCC patients (p = 0.043) but not of treatment response. Urinary microbiota in patients with renal cell carcinoma differed from controls. Changes in microbiota composition were observed after systemic treatment. Urinary microbiota should be further investigated as a potential biomarker in renal cell carcinoma.