Augmented reality and related extended-reality technologies have been increasingly investigated in urology to support procedures characterized by complex three-dimensional anatomy and limited intraoperative visualization. This review synthesizes recent original evidence on augmented reality/extended-reality applications in urology across clinical practice and training, with a focus on procedural planning, intraoperative guidance, and educational outcomes. A total 25 studies were identified. In Endourology, randomized studies in percutaneous nephrolithotomy (58-175 patients) showed improved anatomical understanding, shorter renal access times (50-60% reduction), changes in access strategy in 30% of cases, higher stone-free rates, and fewer intermediate-grade complications, with inconsistent effects on operative duration and fluoroscopy exposure using augmented reality/extended-reality applications.In robotic urology, most evidence concerns oncological surgery. Feasibility and comparative studies in robot-assisted partial nephrectomy (20-105 patients) confirmed rapid augmented reality co-registration and acceptable perioperative safety. In radical prostatectomy, comparative and randomized data (92-133 patients) suggested lower positive surgical margin rates at preserved neurovascular bundles and improved early continence recovery, without consistent differences in short-term oncological outcomes. Applications to pelvic lymph node dissection and highly complex renal surgery remain exploratory.Educational and training applications represent the most mature domain, with randomized and validation studies (12-43 trainees) consistently demonstrating improved technical performance, procedural efficiency, and reduced cognitive workload using immersive or mixed-reality platforms, including remote training solutions. Current augmented reality/extended-reality applications in urology show reproducible benefits in anatomical understanding, procedural planning, and selected technical steps, particularly in endourology and surgical training. Clinical outcome evidence remains heterogeneous and largely limited to short-term or surrogate endpoints, while broader adoption is constrained by technical robustness, workflow integration, and scalability. Ongoing randomized studies and advances in automation and artificial intelligence-driven registration are expected to better define the role of augmented reality/extended-reality in routine urological practice.
Background/Objectives: Despite extensive research on nurses' knowledge and attitudes toward pain management globally, limited evidence exists regarding the actual implementation of multimodal pain management practices among Vietnamese nurses. This study aimed to (1) assess nurses' implementation of pharmacological and non-pharmacological postoperative pain management interventions, (2) examine the relationships among knowledge, attitude, and practice (KAP), and (3) identify predictors of competent practice with attention to the relative contributions of formal training versus clinical experience. Methods: A cross-sectional survey was conducted among 230 nurses working in Urology Departments from two tertiary public hospitals in Ho Chi Minh City, Vietnam, between April and June 2024, focusing on postoperative pain management. Pain management knowledge, attitudes, and practices were assessed using validated instruments. Independent samples t-tests compared trained versus untrained nurses. Multiple linear regression identified predictors of practice competency. Effect sizes (Cohen's d) quantified the magnitude of training effects. Results: Nurses demonstrated moderate-to-good competency, with pharmacological interventions (M = 3.74) implemented more consistently than non-pharmacological interventions (M = 3.48, p < 0.001). Trained nurses significantly outperformed untrained nurses across all domains with large effect sizes (Cohen's d = 1.34-1.54). A clear hierarchy emerged in non-pharmacological practice: environmental (M = 4.01) > physical (M = 3.69) > cognitive-behavioral (M = 3.27) > spiritual (M = 2.60). Strong KAP correlations were observed (r = 0.70-0.85, p < 0.001). Prior training was the strongest predictor of both pharmacological (β = 1.31, p < 0.001) and non-pharmacological practice (β = 0.58, p < 0.001), while clinical experience showed no significant effect (p > 0.40). Conclusions: This study provides evidence that formal training-not clinical experience-is strongly associated with competent postoperative pain management practice among Vietnamese nurses, with large effect sizes demonstrating practical significance. The strong KAP relationships support targeted educational interventions addressing knowledge gaps to improve practice. These findings have implications for nursing education research in Vietnam and similar healthcare settings.
Background/Objectives: Platelet-rich plasma (PRP) is an autologous blood-derived biologic enriched in platelets and bioactive mediators. In urology and sexual medicine, PRP has been promoted for erectile dysfunction (ED) and a growing range of urogenital disorders on the premise that it may support angiogenesis, neuroregeneration, immune modulation, and tissue remodeling. However, clinical uptake has outpaced high-quality evidence, while heterogeneity in PRP preparation, characterization, and delivery limits interpretability and reproducibility. This structured narrative review aims to critically integrate mechanistic, preclinical, and clinical evidence regarding PRP use in ED, Peyronie's disease (PD), stress urinary incontinence (SUI), interstitial cystitis/bladder pain syndrome (IC/BPS), and selected emerging indications. We further aim to identify sources of heterogeneity and propose an actionable minimum reporting framework (PRP-Uro Checklist) to guide future research. Methods: A structured search of PubMed/MEDLINE was conducted for studies published between 2021 and 2025. The relevant literature on PRP use in ED, PD, SUI, IC/BPS, and related indications was included for critical narrative synthesis. Emphasis was placed on PRP classification and preparation variables, outcome measure validity, and sources of heterogeneity across studies. Results: Mechanistic and preclinical evidence supports PRP's potential to modulate nerve repair, angiogenesis, extracellular matrix remodeling, and immune polarization through a complex secretome of growth factors, cytokines, and extracellular vesicles (EVs). Clinical evidence suggests that intracavernosal PRP may improve erectile function in selected populations, but effect size, durability, and superiority over placebo remain uncertain due to small trials, substantial placebo effects, short follow-up, and incomplete biologic characterization. Evidence for PRP in PD, SUI, and IC/BPS remains preliminary and is derived largely from small cohorts, proof-of-concept studies, or uncontrolled designs, although early findings suggest potential symptom benefit and acceptable short-term tolerability. Across indications, inconsistent PRP reporting, particularly the absence of absolute platelet dose, leukocyte quantification, activation method, and standardized treatment protocols, represents a major barrier to reproducibility and evidence synthesis. Conclusions: PRP is biologically plausible and appears broadly safe, but its role in urology and sexual medicine remains investigational and is not yet supported by guideline-level evidence. To enhance reproducibility and interpretation, we propose a Minimum PRP Reporting Checklist for Urology and Sexual Medicine Trials (PRP-Uro Checklist). Future progress requires rigorous standardized reporting, indication-specific biologic characterization, rigorously designed sham-controlled trials, clinically meaningful endpoints, and longer-term follow-up.
To develop a structured framework for integrating artificial intelligence into urology residency programs in order to optimize workflow, enhance clinical training, and support resident well-being. A review informed by a qualitative needs assessment was conducted to identify inefficiencies in urology residency training through available literature and online resources. Commercially available and FDA-approved artificial intelligence platforms were reviewed and mapped to these identified domains. Applications were categorized into workflow optimization, educational support, performance assessment, and resident wellness. Urology-specific use cases were then developed, and corresponding cost estimates were derived based on current clinical practice. Artificial intelligence applications in urology residency include personalized learning assistants, interview preparation platforms, and wellness monitoring tools. These tools offer targeted learning, real-time feedback, and proactive stress management. Reported benefits include increased efficiency, adaptive education, and improved readiness for assessments, while limitations include privacy concerns, variable accuracy, and limited specialty-specific validation. Artificial intelligence technologies hold considerable promise for streamlining urology residency training. Implementing artificial intelligence solutions could improve efficiency, educational quality, and resident satisfaction. Future research should focus on real-world implementation, trainee feedback, and long-term outcomes. Cost estimates vary widely across domains, allowing programs to select tools aligned with their specific needs and resources.
Population ageing is changing everyday urological practice. The number of older adults is increasing, and urology already treats a patient population that is, on average, older than the general population. Consequently, older adults with urolithiasis represent a core part of contemporary endourological practice. Given this, a focused review of the available evidence is valuable to inform clinical practice. A peak in stone disease can occur in older adults who may also be less likely to present with the classical features of renal colic. As such, delayed or missed diagnosis may carry greater clinical consequences. Although the literature remains relatively limited, ureteroscopy, shock wave lithotripsy, and percutaneous nephrolithotomy remain feasible options in appropriately selected older adults. In this group in particular, broader health associations merit consideration, as the presence of urolithiasis in older adults may reflect overall health status in later life. The burden of urolithiasis in older adults is increasing and now represents a routine component of everyday clinical practice. Clinical presentation may differ from that seen in younger "index" patients, and complications may have a greater impact on recovery and function. Management should therefore be individualized, taking into account comorbidity, frailty, functional status, and the patient's own priorities.
The intersection between urology and plastic surgery represents an important collaborative frontier in modern reconstruction. Defects involving the genitourinary and perineal regions frequently require the coordinated expertise of both specialties to restore urinary continuity, soft-tissue coverage, sexual function, and aesthetics. Despite the expanding scope of this reconstructive collaboration that spans oncological, traumatic, congenital, and gender-affirming care, no formal designation has been defined to unify these efforts. This review introduces the concept of "uroplastics," a reconstructive field that integrates the principles and techniques of urology and plastic surgery under a shared philosophy of restoring both form and function. Drawing a parallel to the evolution of other blended specialties, such as neuroplastics, oncoplastics, and orthoplastics, uroplastics seeks to codify existing interdisciplinary practice into a coherent framework. Three collaborative models are identified across the literature: consultative, concurrent, and integrated. Each represents a progressive stage of interaction, from reactive consultation to fully integrated reconstructive programs and research partnerships. Representative studies demonstrate that early, structured collaboration improves wound healing, functional outcomes, and patient satisfaction in complex genitourinary reconstruction. Beyond the operating room, the formalization of uroplastics has implications for education, institutional design, and translational research, including advances in microsurgery, robotics, and tissue engineering. Its formal recognition as a collaborative reconstructive discipline will strengthen multidisciplinary training, accelerate innovation, and ultimately improve outcomes for patients requiring comprehensive genitourinary reconstruction.
Thermal ablation offers a safer, less invasive, and more cost-effective curative-intent treatment for selected patients with primary and metastatic liver tumours than surgery; when done with appropriate technique, ablation can deliver similar oncological outcomes. However, effectiveness in routine practice varies because structured training, planning, and procedural governance remain scarce. These international multidisciplinary, multi-society guidelines-formally endorsed by the European Society of Surgical Oncology, the Cardiovascular and Interventional Radiological Society of Europe, and the Society of Interventional Oncology-define key domains contributing to procedural difficulty and practice variation in liver tumour thermal ablation. A Delphi consensus initiative held in Innsbruck, Austria, engaged 72 experts across three iterative rounds of scoring across 135 statements grouped into five domains: credentialing, indications, approach, procedural factors, and safety measures. Consensus was achieved for 94 (70%) of 135 statements. The least invasive route-typically percutaneous-should be prioritised, and margin adequacy was reaffirmed as the principal technical goal. Procedural difficulty was considered context-dependent, shaped by tumour factors, institutional infrastructure, and operator experience. Organ displacement techniques were endorsed to maintain safety and expand treatable indications. Complex ablations should be done by experienced operators (more than 100 previous cases), with programmes underpinned by structured training, multidisciplinary team participation, and routine audit. Future efforts should develop and validate practical tools such as difficulty scoring systems, standardised procedural reporting templates, and comprehensive training curricula to improve consistency, standardisation, and clinical outcomes globally.
Since the rise of freely accessible pornographic streaming websites, pornography consumption has become widespread and normative worldwide. In Flanders, early exposure-before age 13-has tripled over the past decade, and frequent use, particularly among young men, is common. While pornography consumption may support body satisfaction, self-exploration, and self-esteem, evidence on its effects on sexual development and sexual well-being remains limited. Public debates are polarized, swinging between moral panic and denial of potential risks. Care providers and helplines increasingly report young people struggling with pornography-related concerns, such as self-perceived porn-induced sexual dysfunctions. Adolescents and young adults from diverse backgrounds express a clear need for guidance in navigating sexually explicit media, particularly when communication with parents, teachers, or health care providers is difficult. This project aims to generate evidence-based insights into the complex relationships between pornography consumption, sexual development, and sexual well-being among young people. By producing actionable knowledge, it seeks to inform education, prevention, and care practices that help adolescents and young adults navigate sexually explicit media in ways that promote healthy and inclusive sexual well-being within Flanders' ethnically and sexually diverse society. The project consists of four interconnected work packages: (1) examining pornography in relation to societal norms and inequalities, (2) exploring pornography within family-based sexual development, (3) investigating pornography's role in health care contexts, and (4) developing evidence-based pornography literacy tools for education and prevention. A mixed methods approach will combine systematic scoping reviews, a nationally representative survey, laboratory studies, qualitative interviews and focus groups, and co-creation with key societal stakeholders. The project received funding from Research Foundation - Flanders in 2024, and researchers were appointed between September and November 2024. Scoping reviews began in January 2025 and concluded in October 2025. A large-scale survey will be conducted between January and March 2026, followed by subsequent stages of analysis, dissemination, and valorization, concluding in 2028. Although empirical results are not yet available, the project will deliver new evidence on how pornography consumption shapes sexual development and sexual well-being across diverse contexts. It will produce practical outputs for education, health care, and policy, and contribute to reducing stigma and misinformation around pornography use. By addressing pornography as a multifaceted social and sexual phenomenon, this multidisciplinary research will advance scientific understanding and promote more inclusive, evidence-based approaches to sexual health education, care, and policy.
The 2026 European Association of Urology and American Society of Clinical Oncology (EAU-ASCO) guideline update reflects significant developments in the diagnosis and management of penile cancer. This review summarises the key changes and contrasts them with previous recommendations, with particular focus on staging, treatment, quality of life and emerging personalised approaches. The summary is based on a critical appraisal of the full 2026 guideline and its underpinning systematic reviews, with comparison to earlier versions. Recommendations were informed by structured literature assessment and expert panel consensus, incorporating evaluation of benefits and harms, evidence uncertainty and patient values. Major updates include refined pathological risk stratification, routine ultrasound (US)-guided nodal assessment, and broader guidance on organ-preserving surgery. There is support for selective genomic testing and clearer, restructured algorithms are introduced, including newly developed flow diagrams for nodal management, alongside an expanded evidence base for systemic therapy. Greater emphasis is placed on survivorship, centralisation of care and rationalisation of follow-up. However, many recommendations remain informed by retrospective data and expert consensus, reflecting the rarity of the disease and limited prospective evidence. The updated guideline promotes more nuanced selection of organ-preserving strategies, earlier detection of regional lymphatic disease, and holistic palliative care, while reinforcing the central role of shared decision-making. The new guidance for penile cancer aims to improve care, personalise treatment and better address quality of life, while acknowledging that further research is still needed.
To evaluate the educational validity of two bench-top simulators for Transurethral Resection of the Prostate (TURP) and Transurethral Resection of Bladder Tumor (TURB), focusing on their realism, ergonomics, and relevance for structured endourology training. Fourteen expert endourologists from multiple European centers assessed both simulators during the European Association of Urology Residents Education Programme (EUREP) 2025. Face validity and content validity were evaluated using 4-point Likert questionnaires. Item-level (I-CVI) and scale-level (S-CVI/Ave) content validity indices were calculated for all items and adjusted for core procedural skills. Experts rated both simulators highly for anatomical realism, tissue handling, and overall utility (mean scores > 3.5/4). The TURP simulator achieved an adjusted S-CVI/Ave of 0.92 and the TURB simulator 0.97, indicating excellent consensus on their educational adequacy for key procedural steps. Non-modeled features such as bleeding, obturator reflex, and energy modulation received low ratings, reflecting inherent limitations of bench-top simulation. Both models were considered effective for practicing instrument handling and resection depth control in a risk-free, standardized environment. The TURP and TURB simulators demonstrated strong face and content validity for core resection training. Their modular, non-biological, and reproducible design supports safe, structured skill acquisition and competency assessment in endourology curricula, offering a practical bridge between theoretical learning and clinical performance.
The European Association of Urology (EAU) produces an annual guidelines document based on the most recent evidence for the diagnosis, treatment, and follow-up of testicular cancer (TC). To summarize the 2026 version of the EAU Guidelines on TC and highlight the main changes compared to the previous version. A multidisciplinary team of clinicians with specific expertise in the disease (urologists, medical oncologists, radiation oncologists, and pathologists) reviewed the results of a comprehensive appraisal of the published literature on the topic since the last Guidelines update paper in 2023. Recommendations based on the highest available level of evidence are presented across TC stages, histologies and prognostic categories regarding diagnosis, primary management, detection and treatment of relapse and survivorship care. Areas of lack of strong recommendation consensus are highlighted. The 2026 version of the EAU Guidelines on TC collates the highest available scientific evidence to standardize the management of patients with TC.
A thorough examination of the patient is a crucial component of providing high-quality care and is regarded as best practice in the assessment of female patients presenting with lower urinary tract symptoms (LUTS). Nevertheless, anecdotal reports suggest that pelvic examinations are infrequently performed in the outpatient setting, raising important questions regarding adherence to established standards of care. To explore the practices and attitudes of urologists toward pelvic examination for patients with LUTS. In this qualitative, mixed-methods study, a structured 9-question survey about digital rectal and pelvic examination practices was distributed between November 19, 2023, and May 19, 2024, to urologists and urology trainees via the Urological Society of Australia and New Zealand newsletter across Australia and New Zealand. The end of the survey invited clinicians to participate in a semistructured interview to further discuss their responses. The primary outcomes were urologist-reported responses to the survey assessing the numbers and percentages of male and female clinicians who routinely performed pelvic and digital rectal examinations for patients with LUTS at their initial appointment and qualitative semistructured interview responses to identify themes associated with clinician attitudes toward pelvic examinations. Of 553 consultant urologists and 100 urology trainees sent the survey, 74 participants responded, a response rate of 11.8%. A total of 74 clinicians (46 [62.2%] male), comprising 63 urologists and 11 urology trainees, completed the survey. While 89.1% (95% CI, 80.1%-98.1%) of male clinicians and 92.9% (95% CI, 83.3%-100.0%) of female clinicians consistently performed digital rectal examinations for male patients presenting with LUTS, only 8.7% (95% CI, 5.5%-16.8%) of male clinicians routinely conducted pelvic examinations for female patients compared with 85.7% (95% CI, 72.8%-92.9%) of female clinicians (P < .001). In total, 10 semistructured interviews were conducted. Two major themes were identified: fear, including medicolegal reprimand, clinician and patient discomfort or reluctance, and failure to recognize pathology; and barriers to pelvic examinations, including perceived poor utility, limited access to chaperones, and concerns for patient discomfort. Findings of this study suggested that male clinicians were less likely than female clinicians to perform pelvic examination for female patients who presented with LUTS. Barriers to pelvic examination need to be addressed to enable female patients to receive optimal care. Focused training may help prevent unnecessary operative procedures and improve patient outcomes.
Digital twin technology represents a transformative approach in healthcare, creating virtual replicas of physical entities that enable real-time data integration, predictive modelling, and personalised treatment strategies. In urology, this emerging technology offers unprecedented opportunities to optimise patient care through simulation-based decision-making. This narrative review comprehensively examines current applications of digital twin technology in urology, evaluates its clinical utility across various urological conditions, and identifies key challenges limiting its widespread implementation. A comprehensive search was conducted across PubMed, Web of Science, and Scopus databases for literature published between January 2020 and January 2026. Search terms included digital twin, virtual twin, urology, uro-oncology, prostate cancer, renal surgery, and bladder dysfunction. Studies focusing on the development, validation, and clinical implementation of digital twins in urological practice were included. Digital twin technology demonstrates significant potential in uro-oncology for treatment planning, surgical navigation, and disease progression monitoring. Key applications include patient-specific tumour growth simulation in prostate cancer, three-dimensional anatomical modelling for partial nephrectomy, and bladder function prediction in outlet obstruction. Integration with artificial intelligence enhances predictive accuracy and enables real-time surgical guidance. Digital twin technology represents a paradigm shift towards precision urology, though challenges in data integration, computational requirements, validation, and ethical considerations must be addressed before routine clinical implementation. Future developments should focus on standardisation, regulatory frameworks, and prospective clinical validation studies.
Penile prostheses have undergone significant evolution over the past five decades, becoming vital treatments for erectile dysfunction (ED) and essential tools in gender-affirming surgeries. Advances in design, functionality, and materials have contributed to better patient outcomes and device performance. This review provides a comprehensive analysis of penile prosthesis systems, emphasizing their roles in treating ED and supporting gender-affirming procedures. The review also highlights recent technological advancements and evaluates the affordability and accessibility of these devices. Data for this review were systematically collected from databases, including Web of Science, PubMed, ResearchGate, Scopus, and Springer Nature, to ensure comprehensive coverage of the field. Additionally, the latest information on inflatable penile prostheses (IPPs) was gathered from product websites and patent documentation. A comparative analysis of semi-rigid, malleable, and inflatable penile prostheses was conducted, focusing on affordability, pricing, durability, and patient-centric features. Inflatable penile prostheses (IPPs) remain the gold standard for ED treatment due to their superior functionality, including user-controlled rigidity and a more natural appearance in both erect and flaccid states. Despite higher costs compared to semi-rigid and malleable prostheses, IPPs offer enhanced patient satisfaction and quality of life. Advances in IPP designs have improved durability and reduced mechanical failure rates, while novel activation mechanisms, such as remote control and magnetic induction, are emerging as promising enhancements. While two recent patents have entered the clinical pipeline, focusing on improved durability and activation, one additional patent demonstrates potential for future adoption. However, their impact on clinical practice will depend on further research and validation. Emerging technologies and innovative designs in penile prostheses promise to enhance ED treatment and gender-affirming surgeries. This review provides valuable insights into current trends, comparative analyses, and future directions for clinicians, researchers, and engineers in the field.
As the exstrophy-epispadias complex (EEC) has not only physical, but also complex psychological consequences, further research is required to understand these in greater detail. This study aimed to test hypotheses concerning the association between shame, disclosure, friendship quality and life satisfaction among individuals with EEC, in order to identify specific areas for potential patient support. During the pre-registered study, data were collected online and anonymously via an Instagram account and four support groups in Germany and Switzerland. This cross-sectional survey incorporated the "Chronic Illness-related Shame Scale", four subscales of the "McGill Friendship Questionnaire", and the "Short Scale to Measure General Life Satisfaction", with minor modifications. The disclosure scale was self-created and tested using exploratory factor analysis. The reliability of the scales ranged from acceptable to very good. For hypothesis testing, Pearson correlation and linear regressions were performed (α = 0.05). To examine sex differences, t-tests were conducted. 106 adults (47 men, 58 women, 1 divers or no answer) completed the questionnaire. On average, shame was reported in the lower to mid-range of the scale, while disclosure, friendship quality, and life satisfaction were reported at moderate to high levels. In line with the hypotheses, the analyses revealed significant negative correlations between EEC-related shame and social support and intimacy within the best friendship, life satisfaction, and the propensity to disclose EEC with approach goals, thus indicating an association between lower levels of shame and more positive social factors. Additionally, in affected friendships, a positive correlation between disclosure with approach goals and positive feelings, social support, and reliable alliance was found. Contrary to expectations, men reported a marginally insignificant tendency to experience more EEC-related shame than women. Women scored higher than men in terms of friendship quality and disclosure. In EEC, the level of shame and disclosure appears to be important in friendships. Furthermore, shame seems to play an important role in life satisfaction. Men, in particular, may be vulnerable in relation to most of these constructs. The results are largely consistent with previous research. Limitations of this study are especially the predominance of support groups and the underrepresentation of men. The findings suggest the need for practical support. The study emphasized the importance of psychosocial factors in EEC. Future research should continue to focus on psychosocial aspects of EEC, with a particular emphasis on health services research.
Outcome assessment in genital gender-affirming surgery (gGAS) has long been a heterogenous practice. Although two core outcome sets (COS) for masculinizing and feminizing gGAS have been previously established, the absence of standardized and validated outcome measurement instruments (OMIs) limits consistent reporting. The second phase of the GenderCOS project aimed to identify, evaluate, and recommend OMIs to standardize outcome assessment and facilitate adoption of the COS in gGAS research, ultimately enabling comparability and evidence synthesis. The project followed the Core Outcome Measures for Effectiveness Trials (COMET) initiative standards and the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guideline for selecting OMIs for a COS. Phase 2 of the GenderCOS project was conducted from September 2024 to June 2025. Potential OMIs were identified through systematic reviews: PROSPERO: CRD42022347400 (inception to September 2023) and CRD42020223430 (inception to November 2020), clinical guidelines, and international expert consultations. All instruments relevant to at least one core outcome underwent quality and feasibility assessment. Consensus on the most appropriate OMIs and essential supplementary information was achieved through an international consensus process involving professional experts across multiple disciplines. A total of 380 potential OMIs were identified through systematic searches. After domain- and COS- matching, 152 patient-reported outcome measures (PROMs) and 53 clinical OMIs were evaluated on quality and feasibility aspects. The consensus process among professional experts in gender-care, resulted in measurement recommendations for 19 of the 20 unique core outcomes. These recommendations endorse the use of validated PROMs for the included patient-reported outcomes (PROs) and adherence to existing clinical guidelines for clinical outcomes and adverse events. For the remaining outcome relating to feminizing gGAS, a measurement recommendation was made for the subgroup that underwent vaginoplasty only. Development of an OMI suitable for all feminizing gGAS is also recommended. The GenderCOS provides the first consensus-based standardized measurement framework for core outcomes in gGAS. Its modular structure and inclusion of validated instruments enable harmonized reporting, data synthesis and evidence-based improvement in gGAS research. None received.
Catheter-associated urinary tract infections (CAUTI) are among the most common healthcare-associated infections, particularly in hospitalised patients requiring prolonged catheterisation. Despite standard protocols, preventable lapses in catheter care and clinical practices contribute to the incidence of these infections. This study aimed to identify significant risk factors and develop a point-based CAUTI Risk Scoring System for early prediction and intervention. A prospective observational study was conducted over six months at a tertiary care hospital, including 100 catheterized adult inpatients. Demographic data, Clinical variables, and catheter practices were documented. CAUTI was confirmed by urine culture. A risk stratification model was developed by assigning weighted scores to statistically significant variables, categorising patients into low, moderate, and high CAUTI risk groups. A domain-wise heatmap visually represented the novelty and interdisciplinary relevance of the study's contributions across ten clinical research domains. Among the 26% of study participants who had CAUTI overall, the important procedural predictors were open-type drainage systems (p < 0.00001), kinking of catheter tubing (p < 0.00001), and raised urobag placement (p < 0.00001). Clinical risk variables included diabetes mellitus (p = 0.00001), catheter duration greater than 7 days (p = 0.0043), female sex (p = 0.0023), and immobility (p = 0.0014). Strong early signals included turbid urine (p = 0.00004) and unexplained fever (p = 0.00001). A cumulative risk rating system placed patients into low (0-3), moderate (4-6), and high-risk (≥7) categories. This study presents the first validated CAUTI Risk Scoring System, including clinical, procedural, and early bedside indicators. The scoring tool enables proactive intervention and serves as a necessary adjunct to infection prevention plans in hospital environments.
To provide insight into real-world surveillance practices for patients with low-risk (LR), intermediate-risk (IR), and (very) high-risk (HR) non-muscle invasive bladder cancer (NMIBC). Cystoscopy surveillance patterns were analysed using real-world data from two population-based cohort studies in the Netherlands, comparing practices to guideline recommendations by risk group. As bladder cancer-related symptoms may prompt diagnostic investigations beyond routine follow-up, we evaluated the occurrence of such symptoms and the use of various diagnostics including cystoscopy in a subset of patients with available data. In total, 2791 primary and recurrent tumours were included in the analyses. Among patients with LR NMIBC, 37.6% were monitored more intensively than recommended. The average number of cystoscopies in the first follow-up year was 1.3 (range 0-4). IR NMIBCs were generally monitored in accordance with guideline recommendations. However, adherence declined over the years following diagnosis, dropping from 78.1% to 59.3%. The proportion of patients with IR NMIBCs who were monitored less than recommended increased from 21.7% to 39.8%. Most HR NMIBCs (88.2%) were monitored less than recommended, though adherence improved over time. In-depth analysis of 204 tumours revealed that next to cystoscopy, cytology was frequently employed, increasing with risk group (LR: 50.0%, IR: 52.3%, HR: 88.9%). Imaging (25-65%) and biopsies (25-85%) were also commonly performed. Surveillance patterns varied especially among IR NMIBCs. Symptoms were reported in approximately one third of bladder tumours during follow-up but did not appear to affect surveillance patterns. Our findings demonstrate substantial deviations from recommended NMIBC surveillance practices, with cystoscopy overuse in LR disease and underuse in HR cases. Surveillance of IR NMIBC was particularly heterogenous, using varying diagnostic investigations. These insights highlight the need to refine NMIBC surveillance schedules to improve patient outcomes and optimise healthcare resource allocation.
Ileal conduit diversion is currently the most commonly used urinary diversion method for patients undergoing radical cystectomy. Because intestinal reconstruction is involved, perioperative enteral nutrition intake is limited, placing patients at risk of malnutrition and affecting postoperative recovery and quality of life. Whole-process perioperative nutritional management is of great significance for promoting rapid postoperative recovery in such patients. This study aims to explore the effects of whole-process nutritional management intervention based on the information-knowledge-attitude-practice (IKAP) theory on nutritional status and quality of life in patients undergoing radical cystectomy for bladder cancer. A total of 69 patients who underwent radical cystectomy with ileal conduit diversion for bladder cancer in the Department of Urology, Third Xiangya Hospital of Central South University, between January 2022 and December 2024 were included. Patients were grouped according to admission time. Patients admitted between January 2022 and October 2023 were assigned to the control group (n=34) and received routine perioperative nutritional support for radical cystectomy with ileal conduit diversion. Patients admitted between November 2023 and December 2024 were assigned to the intervention group (n=35) and received whole-process nutritional management based on IKAP theory. Nutritional Risk Screening 2002 (NRS2002) score, Onodera's prognostic nutritional index (OPNI), and the third edition Chinese version of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTCQLQ-C30) were compared between the 2 groups at 3 time points: day 1 after admission, 1 day before discharge, and 1 month after discharge. The incidence of postoperative related complications between the two groups was also compared. In both groups, the NRS2002 score at 1 month after discharge was lower than that at 1 day before discharge, and the intervention group had lower scores than the control group, with statistically significant differences (all P<0.05). The OPNI at 1 month after discharge was significantly higher than that at 1 day before discharge in both groups, and the intervention group had higher values than the control group, with statistically significant differences (all P<0.05). There was no statistically significant difference in the incidence of postoperative related complications between the 2 groups (all P>0.05). The EORTCQLQ-C30 scores in the intervention group were higher than those in the control group at 1 day before discharge and 1 month after discharge, with statistical significant differences (both P<0.05). Whole-process nutritional management based on IKAP theory can improve the nutritional status and prognosis of patients undergoing radical cystectomy with ileal conduit diversion and improve their quality of life. 目的: 回肠通道术是目前临床最为常用的根治性膀胱全切患者的尿流改道方式，因涉及肠道重建，围术期肠内营养摄入受限，患者存在营养不良风险，影响术后患者的康复及生活质量。围术期全程营养管理对促进此类患者术后快速康复具有重要意义。本研究旨在探讨基于信息-知识-信念-行为(information- knowledge-attitude-practice，IKAP)理论的全程营养管理干预对膀胱癌根治术患者营养状况及生活质量的影响。方法: 纳入2022年1月至2024年12月中南大学湘雅三医院泌尿外科收治的69例因膀胱癌行根治性膀胱全切加回肠通道术的患者。根据入院的先后顺序对患者进行分组，2022年1月至2023年10月收治的患者为对照组(n=34)，给予常规的根治性膀胱全切加回肠通道术围手术期营养支持;2023年11月至2024年12月收治的患者为干预组(n=35)，给予基于IKAP理论的全程营养管理。比较2组患者在入院第1天、出院前1 d、出院后1个月3个时间点的营养风险筛查(Nutrition Risk Screening 2002，NRS2002)评分、小野寺预后营养指数(Onodera’s prognostic nutritional index，OPNI)及第3版中文版欧洲癌症研究与治疗组织生活质量量表(European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30，EORTCQLQ-C30)评分，并比较2组患者术后相关并发症的发生率。结果: 2组患者出院后1个月的NRS2002评分均低于出院前1 d，且干预组低于对照组，差异均有统计学意义(均P<0.05)。2组患者出院后1个月的OPNI均较出院前1 d明显升高，且干预组高于对照组，差异均有统计学意义(均P<0.05)。2组患者术后相关并发症发生率的差异均无统计学意义(均P>0.05)。干预组患者在出院前1 d、出院后1个月的EORTCQLQ-C30评分均高于对照组，差异均有统计学意义(均P<0.05)。结论: 基于IKAP理论的全程营养管理能改善根治性膀胱切除加回肠通道术患者的营养状况及预后，提高其生活质量。.
Immune-based combination therapies have become the standard first-line treatment for metastatic renal cell carcinoma (mRCC) and have positively impacted survival outcomes in phase III clinical trials. However, these trials are conducted in highly selected populations and controlled settings, which may limit the generalizability of toxicity profiles to routine clinical practice. Real-world data are therefore essential to better characterize the incidence and determinants of severe adverse events (AEs) associated with immune-based combinations. We conducted a multinational, retrospective analysis of the ARON-1 registry, of patients with mRCC who received first-line immune-based combination therapy across 17 countries. The primary endpoint was to evaluate the real-world incidence of grade 3-4 (G3-G4) AEs. Logistic regression analyses were performed to identify clinical factors associated with toxicity. Overall survival (OS) was assessed using Kaplan-Meier methods, with landmark analyses to explore the association between G3-G4 AEs and survival outcomes. Among 2, 401 patients receiving immune-based combinations, 1, 921 (80%) had complete data on grade 3-4 AEs and were included in the analysis. G3-G4 AEs occurred in 34% (n=653). Pembrolizumab plus lenvatinib was associated with the highest incidence of high-grade AEs, whereas nivolumab plus ipilimumab showed the lowest. Older age and female sex were independently associated with an increased risk of G3-G4 toxicity. Although the occurrence of severe AEs was associated with improved OS in unadjusted analyses, this association was non-significant in the 6-month landmark analyses. In this large, multinational real-world cohort, the incidence of G3-G4 adverse events in patients with mRCC treated with immune-based combinations was lower than that reported in pivotal clinical trials, underscoring meaningful differences between trial and routine practice settings. Patient- and regimen-specific factors significantly influenced toxicity risk. These findings highlight the complementary role of real-world evidence in informing toxicity management and support individualized treatment strategies to optimize outcomes in everyday clinical practice.