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 investigate whether a machine-learning model improves the assessment of postsurgical recurrence-free survival in patients with non-metastatic clear cell renal cell carcinoma (ccRCC) compared with a Cox proportional hazards (CPH) approach. Patients undergoing curative surgery for non-metastatic ccRCC between 2010 and 2018 were identified from the DaRenCa Study-3, a nationwide register-based cohort study. Three recurrence prediction models were developed: an extreme gradient boosting (XGBoost) model, a feature-matched CPH model and a pathology-based CPH model. The data set was divided into training and test cohorts. Missing data were addressed using multiple imputation for the CPH models, whereas XGBoost handled missing values inherently. Model performance was evaluated using the concordance index (C-index) with 1000 bootstrap resamples. The XGBoost model was also compared with the Leibovich nomogram. Among 2782 patients, with a median follow-up of 7.3 years, 13.7% developed a recurrence. In the test cohort, the XGBoost model showed higher discrimination than both CPH models. Compared with the best performing pathology-based CPH model, XGBoost demonstrated a paired bootstrap difference in Uno's C-index of 0.022 (95% CI 0.005-0.038). The model also identified a subgroup of patients with a very low risk of recurrence (<3% after 10 years) and demonstrated improved clinical risk stratification, with clearer separation between risk groups, higher hazard ratios between groups and larger differences in 5-year recurrence-free survival compared with established models. This improved risk stratification could reduce follow-up imaging by approximately 11% compared with current EAU guideline recommendations. Limitations include the retrospective design and lack of external validation. The XGBoost model provided improved prediction of recurrence compared with CPH models and the Leibovich nomogram, supporting more precise risk stratification. With external validation, this approach may help reduce unnecessary imaging after surgery.
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.
Reservoir placement during three-piece inflatable penile prosthesis (IPP) implantation is the step most commonly associated with serious intraoperative complications. The reservoir is traditionally positioned within the space of Retzius, where it lies in close proximity to the bladder, bowel and major pelvic vessels. Although injuries are uncommon, damage to these structures can result in significant morbidity, particularly in patients with prior pelvic surgery, radiotherapy or distorted pelvic anatomy. As prosthetic surgery expands to more complex patient populations, surgeons must be prepared to recognise and manage these complications when they occur. This review focuses on the intraoperative injuries associated with reservoir insertion during IPP surgery and provides a practical framework for their recognition and management. Bladder, bowel and vascular injuries are discussed with emphasis on intraoperative warning signs, methods of confirmation and immediate management strategies. Key principles of repair, haemorrhage control and involvement of specialist surgical teams are outlined. Guidance is also provided on intraoperative decision-making, including when reservoir relocation, staged implantation or procedure abandonment may be appropriate to minimise the risk of prosthesis infection and other complications. Alternative reservoir placement techniques are briefly discussed in the context of risk reduction, particularly for patients with hostile pelvic anatomy. However, the primary aim of this review is to provide pragmatic guidance for surgeons confronted with intraoperative complications during reservoir insertion. Early recognition, prompt management and a structured approach to intraoperative decision-making are essential to minimise morbidity and preserve the favourable functional outcomes associated with IPP surgery.
To compare prostatic urethral lift (PUL) and water vapour thermal therapy (WVTT) for benign prostatic hyperplasia (BPH) in a real-world setting, this study compares clinical management outcomes that are less thoroughly documented in current literature-such as drug-free status, complications and post-procedure readmission rates. BPH patients (age ≥50) with prostate volumes 30-80 cc who underwent either PUL or WVTT between January 2021 and December 2024 were identified. Patients were given BPH medications (alpha-blockers and/or 5-alpha reductase inhibitors) till 3 months postoperatively. The two groups were matched using a 1:3 propensity score matching; multivariable logistic regression analyses were performed on the full unmatched cohort. The primary outcome is drug-free status, defined as the cessation of alpha-blockers and 5-alpha reductase inhibitors at 6 months post-procedure. Secondary outcomes include unplanned readmission within 30 days. In total, 421 eligible patients were analysed (363 WVTT; 58 PUL). In propensity score matched analyses (174 WVTT; 58 PUL), patients were more likely to be drug-free after PUL at 6 months compared to WVTT (weighted OR: 2.62 [95% CI: 1.22-5.61], p = 0.013). The association remained significant in multivariable regression analysis (adjusted OR: 2.41 [95% CI: 1.31-4.58], p = 0.006). No statistically significant difference in 30-day readmission rates was found between the two groups in either the propensity score (p = 0.097) or multivariable analysis (p = 0.123). In this retrospective propensity-score-matched study, PUL was associated with less BPH medication use at 6 months; readmission rates were comparable for PUL and WVTT.
To develop and validate machine learning models for predicting 30-day major morbidity and mortality in patients undergoing radical cystectomy (RC) using the American College of Surgeons National Surgical Quality Improvement Project (ACS-NSQIP) and to compare performance against a logistic regression model. We identified 11 241 patients from the ACS-NSQIP database 2020-2024 who underwent radical cystectomy. Demographics and comorbidities were extracted along with targeted variables from the NSQIP RC-targeted database. The cohort was split into a training and an independent validation dataset. Predictive models were developed for logistic regression, random forest (RF) and XGBoost. Model performance was evaluated using the area under the receiver operating characteristic (ROC) curve, SHapley Additive exPlanations (SHAP) analysis, sensitivity, specificity and Brier scores. Of 11 241 patients, 2691 (23.9%) experienced at least one major complication, and 185 (1.6%) died within 30 days. Overall complications were 6365 (56.62%). Non-survivors were significantly older (72.65 ± 10.14 vs. 68.50 ± 10.32 years, p < 0.001). Patients with major morbidity had lower mean albumin levels (3.92 ± 0.56 vs. 4.01 ± 0.48, p < 0.001). Logistic regression identified high BMI (OR 1.15, p < 0.001), black race (OR 1.34, p = 0.003), Hispanic ethnicity (OR 1.37, p = 0.009), prior pelvic surgery (OR 1.15, p = 0.002) and continent diversions (OR 1.46, p = 0.001) as predictors of 30-day major morbidity, while low frailty (mFI-5 ≤ 1; OR 0.72, p = 0.001) and higher preoperative albumin (OR 0.88, p < 0.001) were protective. For 30-day mortality, increasing age (OR 1.42, p < 0.001) was the strongest risk factor. For 30-day morbidity, the XGBoost model achieved the highest AUC 0.796 (95% CI: 0.783-0.814). For 30-day mortality, the RF model showed superior discrimination with an AUC of 0.921 (95% CI: 0.908-0.934). SHAP analysis showed predictors of major morbidity were frailty, BMI and advanced age, whereas predictors of mortality were age, ASA class and preoperative creatinine levels. Decision curve analysis showed net clinical benefit for all three models. The web-based tool can be accessed and used for prediction (https://cystectomyai.streamlit.app/). We developed and validated machine learning models for 30-day major morbidity and 30-day mortality following radical cystectomy. These findings support the integration of machine learning into clinical workflows to enhance preoperative counselling and personalized risk reduction.
This study aims to validate the diagnostic accuracy of a novel urine-based DNA methylation test in patients with suspected upper tract urothelial carcinoma (UTUC) on CT urography and to assess its potential to eliminate the need for diagnostic ureterorenoscopy (URS) in selected patients, expedite treatment and identify high-grade tumours suitable for neoadjuvant chemotherapy. We prospectively collected urine samples from 46 consecutive patients with suspected UTUC in computed tomography and analysed them using the Bladder CARE™ methylation test. Test performance was evaluated against final pathology from URS biopsies and/or surgical specimens. We performed Youden Index analysis to optimise diagnostic cut-off values and assessed correlations between Bladder CARE Index (BCI) levels and tumour characteristics, particularly grade differentiation. Using the manufacturer's cut-off (BCI > 2.5), the test demonstrated 95% sensitivity, 69% specificity, 70% positive predictive value and 95% negative predictive value (NPV), significantly outperforming cytology (11% sensitivity). An optimised, study-derived cut-off (4.35) further improved specificity to 92% with sensitivity and NPV remaining ≥95%. Importantly, a higher threshold (BCI > 10) yielded 100% specificity and 100% PPV, although at the expense of sensitivity (65%). Median BCI values differed between high-grade (38.6) and low-grade tumours (9.45), suggesting utility for non-invasive grade assessment. BCI also correlated with tumour size (β = 12 mm per log10 increase, p = 0.08). This novel urine-based DNA methylation test offers high diagnostic accuracy for UTUC detection. However, clinical interpretation should be threshold dependent. While BCI values >2.5 show high sensitivity, the PPV of 70% indicates a relevant proportion of false-positive results, and diagnostic URS remains warranted in this range. In contrast, high positive values (BCI > 10) demonstrated 100% specificity and PPV and could enable direct progression to definitive surgery without diagnostic URS, avoiding procedure-related complications and expediting treatment. The correlation with tumour grade addresses a critical need for identifying candidates for neoadjuvant chemotherapy without invasive tissue diagnosis.
Transperineal prostate biopsy (TPPB) is increasingly used for prostate cancer diagnosis due to low postoperative infection rates. However, the necessity of perioperative antibiotics remains debated. Although infectious complications such as urinary tract infections (UTIs) are uncommon, acute urinary retention (AUR) is a recognized complication. This study compared infection rates between patients undergoing TPPB with versus without perioperative antibiotics and evaluated rates of AUR and its association with prostate size. We conducted a multi-institutional retrospective review of patients who underwent TPPB from 2012 to 2025. Patients were stratified by receipt of perioperative antibiotics (second- or third-generation cephalosporin) versus no antibiotics. Infection was defined as fever ≥38.3°C with or without UTI symptoms or a positive urine culture (>105 CFU) within 96 h of biopsy. AUR was defined as inability to void within 72 h requiring catheterization. Outcomes were compared based on antibiotic use and development of AUR. A total of 904 patients were included (771 antibiotics and 133 no antibiotics). Eighteen patients (2.0%) developed infection, with no significant difference based on antibiotic usage (p > 0.05). Patients who developed infection were older than those without infection (71.1 vs. 66.4 years; p < 0.01; confidence intervals [CIs] -8.3, -1.2). AUR occurred in 44 patients (4.9%). Mean prostate volume was significantly greater among patients with AUR compared to those without (77.1 vs. 52.4 ml; p < 0.01; CI -40.6, -8.8). A prostate volume threshold of 79 ml was associated with increased risk of AUR. Perioperative antibiotics did not reduce infection rates following TPPB. Larger prostate volume is associated with an increased risk of AUR after TPPB.
Urethroplasty remains the gold standard treatment of recurrent urethral stricture disease (USD). While the literature extensively discusses urethroplasty outcomes in various contexts, there remains a need for focussed exploration into its efficacy, specifically in cases arising from transurethral resection of the prostate (TURP)-related strictures. To evaluate and compare different anterior urethroplasty techniques and their effectiveness in a large homogenous cohort of USD secondary to TURP. A multicentre retrospective cohort study was conducted in three reconstructive urology centres in Poland, which are the referral centres for USD repair. This included patients who underwent urethral reconstruction surgery between 2015 and 2022 because of urethral stricture secondary to TURP. In all patients, the stricture was diagnosed and evaluated prior to urethroplasty by retrograde urethrography and/or voiding cystourethrography. Basic demographic and medical data including the length and localisation of the stricture, as well as details about performed urethral reconstruction and follow-up data regarding the recurrence of the stricture and reintervention were recorded. The primary outcome was re-intervention-free survival after urethroplasty. Statistical analysis was performed using STATA 18 (StataCorp). One hundred forty-seven patients underwent urethroplasty because of recurrent anterior USD secondary to TURP with a mean age of 69 years. Ninety-nine patients (67%) had a bulbar stricture, 35 (24%) had a penile urethra stricture, while 13 patients (9%) were diagnosed with penobulbar stricture. The mean length of the stricture was 24 mm, and it was significantly different among different localisations (penile - 30 mm, bulbar - 16 mm, penobulbar - 67 mm; p < 0.05). Half of the patients (73-50%) were treated with anastomotic urethroplasty (including transecting and non-transecting techniques), 60 (41%) with augmentation urethroplasty, seven (5%) with substitution urethroplasty and seven (5%) underwent perineal or penile urethrostomy. Follow-up data were available for 138 patients (94%). In the median follow-up of 19.5 months, 19 patients (13.8%) had another procedure because of the recurrence of USD. Longer stricture length was independently associated with an increased risk of recurrence. Around 103/120 patients (85.8%) were overall satisfied with the treatment. USD secondary to TURP can present with various clinical manifestations, with short bulbar strictures being the most common location. The outcomes of urethroplasty are highly favourable, resulting in high levels of patient satisfaction, but do not depend on surgical technique.
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 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.
This study aimed to understand clinical pathways for patients with high-risk non-muscle-invasive bladder cancer (HR-NMIBC) from diagnosis to follow-up and to identify opportunities to improve care. A cross-sectional survey was conducted via structured online interviews with consented NHS healthcare professionals (HCPs) from the United Kingdom (UK) between June and September 2025. Topics surveyed included MDT structures/roles, diagnostic timelines, adjuvant treatment, radical cystectomy (RC) decision making, current bladder-sparing treatment and clinical trial access. Quantitative data were analysed descriptively. Qualitative responses were analysed thematically. Seventy HCPs were included and reported that typically; 88.5% of patients achieve diagnosis within 6-8 weeks of referral, and 11.4% reported delays beyond 8 weeks. BCG maintenance duration and completion rates varied. Following BCG induction, a median (IQR) of 20.0% (5.0-32.5%) and 60.0% (40.0-70.0%) of patients completed ≥2 or ≤1 years of maintenance, respectively; 1.0% (1.0-2.0%) failed to complete induction. For BCG-unresponsive HR-NMIBC, HCPs reported that a mean (SD) proportion of 53.4 (18.1)% of patients tend to be eligible for and consent to RC, 22.0 (12.6)% tend to be eligible but decline RC and 24.6 (14.9)% tend to be ineligible. Bladder-sparing options remain limited, with 60% of HCPs regarding further BCG as the most appropriate option. All respondents agreed that adherence to quality performance indicators (QPIs) and a national bladder cancer audit would be beneficial. Insufficient specialist nurse capacity to meet foreseeable demands of HR-NMIBC patient care was reported by 70% (n = 49) of HCPs. Results reveal variability in real-world HR-NMIBC care within the NHS. Delays in diagnosis, inconsistent BCG maintenance duration, lack of evidence-based alternatives to BCG and a lack of bladder-sparing treatment and trial options in the BCG-unresponsive setting were identified. Findings highlight unmet needs in relation to MDT resourcing, diagnostic efficiency, trial access, QPI adherence and a national bladder cancer audit.
This study aimed to investigate the systemic immune landscape in patients experiencing urogynaecological mesh failure. The use of urogynaecological mesh was paused in the UK following an independent safety review that found ~1 in 15 women required removal due to complications. However, the mechanisms underpinning mesh failure remain largely unknown, with few studies focussing on localised tissue responses and no reports characterising systemic immune dysregulation. Serum samples collected from patients during mesh removal surgery were analysed for immunomodulatory protein content using enzyme-linked immunosorbent assay (ELISA) and multiplex Luminex Discovery Assay. Peripheral blood mononuclear cells (PBMCs) collected were cultured with or without exposure to pristine mesh, and immunomodulatory protein secretion was measured in the same way. Patient serum was also used as a migratory stimulus for healthy PBMCs to test the functionality of chemotactic proteins present. Mesh patient serum had increased chemotactic protein levels, particularly CCL2, CXCL5, CCL12 and CCL4, which had a functional effect and induced significant cell migration. Mesh patient PBMCs also secreted immunomodulatory proteins including MMP-9 and CCL2. Future studies should focus on expanding cohort numbers and including a control group of mesh patients not experiencing complications to further determine both underlying biology and mesh responses. This study characterised an altered systemic immune landscape not previously investigated in mesh failure patients. Clinically, the ability to identify phenotypic factors or develop biomarkers which predict and monitor mesh responses would help guide clinicians and patients in shared decision making.
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.
Obesity rates are rising among prostate cancer patients undergoing robotic-assisted laparoscopic prostatectomy (RALP). This review evaluates the anthropometric tools used to study this group and their correlation with surgical outcomes. Our objective is to identify which obesity metrics have been measured against clinically relevant surgical outcomes in patients undergoing RALP to enable more accurate risk stratification and improved patient counselling. Five databases (Ovid, Medline, Web of Science, Cochrane, Scopus) were systematically searched in March 2025 for studies examining obesity metrics and RALP outcomes. Inclusion criteria: English-language studies from the last 15 years with ≥15 patients undergoing transperitoneal RALP. Two independent reviewers screened articles and assessed bias using the Newcastle-Ottawa Scale. Data on anthropometric tools, patient demographics, obesity definitions and outcomes were extracted and analysed descriptively. Search strategy yielded 15 papers in total demonstrating that body mass index (BMI) is the only anthropometric tool used in surgical research to assess obese patients for relevant outcomes from RALP. Outcomes observed were categorised as functional, oncological and perioperative. Most studies examined a combination of all three. The data consistently utilises BMI to measure obesity in RALP patients, with numerous surgical outcomes explored in the literature. However, there is a paucity of studies examining alternative obesity metrics. Given the abdomino-pelvic site of prostatectomy, metrics that more accurately assess body fat distribution in this anatomical area may be more appropriate for research and clinical practice.
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.
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 aim of this study is to evaluate the feasibility and perioperative outcomes of robotic-assisted resection of selected non-genitourinary retroperitoneal tumours (RA-RTR) performed by urologists with established experience in robotic retroperitoneal lymph node dissection (RA-RPLND) within a specialised centre. A retrospective analysis was conducted of all patients undergoing RA-RPLND for testicular cancer and RA-RTR for non-genitourinary tumours between January 2022 and May 2025. Procedures for renal, adrenal and upper tract urothelial malignancies were excluded. All operations were performed using a four-port da Vinci Xi® platform. Forty-five patients were included: 27 RA-RPLND and 18 RA-RTR. RA-RTR patients were older (median 50 vs. 36 years, p = 0.024). Preoperative tumour size was larger in RA-RTR (56 mm vs. 20 mm, p < 0.001), although specimen dimensions were similar. Operative time was longer for RA-RPLND (143 vs. 90 min, p = 0.045). Estimated blood loss (40 vs. 20 mL, p = 0.077) and length of stay (1 vs. 2 days, p = 0.272) were comparable. No conversions or transfusions occurred. Complication rates did not differ (14.8% vs. 5.6%, p = 0.333), and all cases achieved negative margins. Comparable perioperative outcomes between RA-RTR and RA-RPLND indicate that these surgeries can be performed in specialised centres by urologists experienced in complex retroperitoneal surgery.
To investigate the potential of the Haematuria Cancer Risk Score (HCRS) to improve the real-world investigation pathway for suspected bladder cancer. Data were retrospectively analysed for all consecutive patients referred with suspected urinary tract cancer on a faster diagnostic pathway to five UK institutions between January and April 2025. The HCRS cut-off score of ≥82 was used to define a 'HCRS high risk' population. The co-primary outcomes were the ability to calculate HCRS in the referred population from the information provided by primary care and the cancer detection rate. In total, 1944 referrals were received, median age of 71 years (IQR 61-78), 1186/1944 (61%) were male, and 1586/1944 (82%) had sufficient information to calculate the HCRS. Of the cohort with HCRS scores, overall 165/1586 (10%) had bladder cancer. The HCRS was ≥82 in 176/437 (40%) of those with non-visible haematuria (NVH); in total, 6/176 (3%) had bladder cancer; and using HCRS in the NVH group alone, no case of muscle-invasive bladder cancer (MIBC) would have been missed. The HCRS was ≥82 in 1062/1149 (92%) with visible haematuria (VH), of whom 150/1062 (14%) had bladder cancer. Adopting a strategy of using HCRS and upper tract imaging in combination for the whole cohort would have resulted in two cases of NMIBC being missed for the NVH cohort and one case of NMIBC being missed for the VH cohort. No cases of MIBC or upper tract urothelial cancer would have been missed. HCRS is a simple innovation, which demonstrates clear potential when combined with upper tract imaging to improve current UK risk stratification to determine which patients referred with haematuria need flexible cystoscopy.
This study aimed to evaluate the functional, oncological and learning-curve outcomes of the complete urethral preservation (CUP) technique during robot-assisted radical prostatectomy in a large single-centre cohort. We retrospectively analysed patients undergoing robot-assisted radical prostatectomy (RARP) between June 2021 and August 2025 by a single high-volume surgeon. Outcomes were compared by CUP status. Continence was assessed at early (3-6 months) and late (12 months) follow-up, using a strict binary definition and with pad usage recorded separately. Oncological assessment included margin status (MS) and biochemical recurrence (BCR) over 3 years. Multivariable Cox regression assessed predictors of BCR. The learning curve was evaluated using LOESS-based probability smoothing. A total of 459 patients were included, with successful CUP achieved in 316 (68.8%). Early continence was higher in the CUP cohort than in non-CUP patients (77% vs 67%, p = 0.02), while rates were similar at 12 months (83% vs. 80%, p = 0.74). CUP patients were significantly more likely to be pad-free/security pad only at both timepoints (p = 0.019 and 0.012, respectively). Positive MS rates and locations were comparable between groups. CUP was not associated with increased BCR risk on multivariable analysis (HR 1.06, 95% CI 0.56-1.98; p = 0.90). CUP likelihood improved with experience. CUP is associated with improved early continence recovery and higher rates of pad-free status following RARP, without compromising margin status or biochemical recurrence. These findings support CUP as a safe and reproducible continence-preserving technique, with the likelihood of successful CUP increasing with surgical experience.