Non-muscle-invasive bladder cancer (NMIBC) accounts for approximately 75% of newly diagnosed bladder cancers and is particularly prevalent in men. Guidelines stratify patients into risk categories based on disease characteristics as patients often recur or progress to muscle-invasive disease. Most guidelines recommend transurethral resection of bladder tumor (TURBT) followed by up to 3 years of Bacillus Calmette-Guerin (BCG) therapy for high-risk (HR) patients. For very HR patients or those who recur after BCG, radical cystectomy (RC) is recommended. This study aimed to describe the profile of individuals with HR-NMIBC, alongside treatment patterns and outcomes across Europe, North America, and Japan. Data were extracted from the Adelphi Disease Specific Program for 1,864 patients initially diagnosed with HR-NMIBC and 273 with very HR-NMIBC. First-line treatment was mainly intravesical BCG, however, less than half of patients received the guideline recommended maintenance BCG and none received RC. Second-line treatment options were similar to first-line, with RC usage still rare. While TURBT+BCG was shown to be the current standard of care, the underutilization of full guideline recommended treatment alongside the relatively high number of recurrences highlights the need for novel therapeutic approaches, either in combination with BCG therapy, or as alternative first-line treatments. High-risk non-muscle-invasive bladder cancer (NMIBC) is a type of cancer that has not spread into the bladder wall’s muscle layer but is likely to spread or return after treatment. This study looked at characteristics of people with high-risk NMIBC in Europe, North America, and Japan. It also evaluated what treatments patients received. Researchers conducted a survey with doctors and patients with high-risk NMIBC to collect this information. Patient characteristics were similar across regions: 75% male with an average age of 71 years; two out of 10 patients were in full- or part-time employment, another eight out of 10 were current or ex-smokers. Disease characteristics, including symptoms and tumor stage of included patients were representative of the general high-risk NMIBC population. Typical care was similar across regions. Most patients underwent transurethral resection of bladder tumor (TURBT) followed by insertion of Bacillus Calmette-Guérin (BCG) into the bladder. TURBT is a procedure that removes cancer cells from the bladder’s inner layers to leave the rest of the bladder intact, BCG is a live vaccine that stimulates the immune system to attack cancer cells. Fewer than half of patients continued BCG treatment for the recommended one-year maintenance period. Few patients underwent radical cystectomy, a procedure that consists in removing the bladder and nearby tissue affected by cancer. Many patients’ cancer returned within 1 year despite receiving recommended treatments. There is therefore a need for new treatments that reduce the risk of cancer returning or growing and that improve quality of life for these patients.
Robot-assisted surgery has been widely adopted in urology, particularly as the mainstream approach for radical prostatectomy. Despite the advantages of robotic systems in surgical precision and complication control, postoperative sexual dysfunction-mainly erectile dysfunction-remains a core issue affecting patients' quality of life. Currently, a systematic visualization analysis of research trends and the intellectual structure of this topic is lacking. Therefore, this study uses bibliometric methods based on the Web of Science Core Collection to delineate the global research landscape, evolving hotspots, and emerging frontiers in the association between robot-assisted radical prostatectomy and sexual function outcomes, aiming to provide references for clinical practice and future research. We retrieved literature from the Web of Science Core Collection on the association between robot-assisted radical prostatectomy and postoperative sexual function outcomes, covering the period from 2007 to 2025. Subsequently, a series of bibliometric and visualization analyses were performed using CiteSpace (version 6.4.R1), VOSviewer (version 1.6.20), and the Bibliometrix R package (version 5.0). CiteSpace was primarily employed for country collaboration network analysis; VOSviewer was mainly used to construct keyword co-occurrence networks and journal co-citation networks; and the Bibliometrix R package was applied to generate global country collaboration world maps and to conduct annual publication output analyses. A total of 218 eligible publications were included in this bibliometric analysis, involving 1,320 authors, 414 institutions, and 39 countries, published across 73 journals and citing 3,941 references. Annual publication output fluctuated over the study period (2007-2025) but displayed a consistent upward trajectory, peaking in 2024. The United States led all countries in both publication volume (77 papers) and total citations (3,399), followed by Italy, Japan, and South Korea, while Australia achieved the highest average citations per paper. The United States also served as the central hub in the international collaboration network, with Europe and North America remaining the core research regions and Asian countries showing steadily growing contributions. Regarding institutional contributions, the most productive institutions were primarily concentrated in the United States, followed by Europe and Asia. European Urology emerged as the most influential journal in terms of total citations and average citations per article, and occupied a central position within the co-citation network. Menon, Mani, and Montorsi, Francesco were the most prolific authors, while Honda, Masashi achieved the highest average citations per article. Keyword co-occurrence analysis revealed three major research clusters: foundational surgical techniques, postoperative urinary and sexual function outcomes with comparative studies, and nerve-sparing techniques with quality of life assessments. Erectile dysfunction and urinary incontinence emerged as the most prominent outcome-specific terms, confirming their dominant positions as the primary functional outcomes of concern, while penile rehabilitation and urinary continence also appeared with lower frequencies. Co-citation analysis identified the systematic reviews by Ficarra V et al. (2012) as the most highly cited references, and the co-citation network was categorized into three major research lineages: oncologic outcomes, functional health-related quality of life, and surgical safety with comprehensive outcome assessment. This study presents the first bibliometric and visualization analysis of the literature on sexual function outcomes after robot-assisted radical prostatectomy (RARP) using the Web of Science Core Collection (2007-2025). The findings reveal a steady increase in annual publication output, with a peak observed in 2024, indicating growing global research attention to this topic. The United States emerged as the dominant contributor in terms of both publication volume and citation impact, followed by Italy and other European and Asian countries. European Urology was identified as the most influential journal, while the systematic reviews by Ficarra V et al. (2012) constituted the intellectual cornerstone of the co-citation network. Keyword analysis demonstrated that research hotspots have progressively shifted from early descriptions of surgical complications toward robotic technique optimization, nerve-sparing, functional recovery, and quality of life assessment. Notably, erectile dysfunction and urinary incontinence were the most prominent outcome-specific terms, reflecting their clinical significance as primary concerns after RARP. Despite the leadership of a small group of high-impact authors and institutions, international collaborative research remains insufficient, particularly across regions.Key limitations include database and language restrictions, citation and synonym biases, author/institution disambiguation challenges, and the inherent inability of bibliometric methods to assess clinical evidence quality. Future research should prioritize multicenter prospective studies, standardized patient-reported outcome measures, and strengthened cross-regional and interdisciplinary collaboration to advance individualized functional preservation strategies.
The comparative real-world adverse event (AE) reporting profiles of enzalutamide, olaparib, and lutetium Lu-177 vipivotide tetraxetan remain incompletely characterized in prostate cancer. As sequential and combination strategies continue to evolve, understanding post-marketing AE reporting patterns in broader clinical populations is important. This study aimed to characterize time-dependent AE reporting profiles and descriptively summarize sparse reports involving concomitant use of all three agents using a large pharmacovigilance database. We performed a retrospective disproportionality analysis of the FDA Adverse Event Reporting System (FAERS) database from each drug's approval date through the third quarter of 2025. Reports were included when the drug of interest was listed as the primary suspect drug and prostate cancer was recorded as the therapeutic indication. Signal detection used four algorithms: reporting odds ratio (ROR), proportional reporting ratio (PRR), multi-item gamma Poisson shrinker (MGPS), and Bayesian confidence propagation neural network (BCPNN). Stratified analyses by age and time-to-onset were conducted, and reports involving concomitant use of all three agents were summarized descriptively. A total of 8,341 enzalutamide, 217 olaparib, and 486 lutetium Lu-177 vipivotide tetraxetan primary-suspect reports with prostate cancer as the indication were included. Distinct AE reporting patterns were observed across the three individual-drug cohorts. Olaparib showed a strong disproportionality signal for anaemia (ROR 8.77), whereas lutetium Lu-177 vipivotide tetraxetan was characterized by signals for dry mouth (ROR 18.08) and thrombocytopenia. Time-to-onset analysis showed that many reported AEs occurred within the first 90 days after treatment initiation. Seven reports involved concomitant use of all three agents; this subset was too sparse to support reliable signal detection or inference regarding drug-drug interaction. This study provides a comparative overview of post-marketing AE reporting patterns for three major prostate cancer therapies. The findings were broadly consistent with established toxicity profiles and suggested that early treatment may represent an important period for clinical observation. Because reports involving concomitant use of all three agents were extremely sparse, no reliable conclusions regarding drug-drug interaction, additive toxicity, or synergistic toxicity can be drawn. Prospective studies are needed to characterize the safety of emerging multi-agent treatment strategies. Interpretation of cross-drug comparisons should additionally account for substantial inter-cohort differences in reporter type and reporting country.
Robot-assisted radical prostatectomy (RARP) has become an increasingly discussed surgical option for patients with high-risk or locally advanced prostate cancer. Nevertheless, how publications, knowledge structures, and research priorities have developed in this area remains insufficiently clarified. This study aimed to characterize the bibliometric profile and clinically oriented evidence domains of RARP for this patient population, with emphasis on oncologic safety, functional outcomes, lymph-node management, and multimodal treatment. Publications were retrieved from the Web of Science Core Collection. Eligible records included English-language original articles and reviews with official publication years up to 2025. After database filtering and manual screening, 643 records were retained, including 596 original articles and 47 review articles. Bibliometric assessment, data processing, and graphical visualization were performed using R, Bibliometrix, VOSviewer, CiteSpace, and Scimago Graphica. We analyzed publication trajectories, geographic and institutional contributions, author activity, journal distribution, citation links, reference co-citation patterns, keyword networks, thematic clusters, burst keywords, and longitudinal topic changes. Scientific output increased progressively from 2003 to 2025, with publication activity becoming more pronounced in the most recent period. In terms of national contribution, the United States showed the strongest overall performance in both publication output and citation impact, whereas Italy, the Netherlands, Japan, China, and several other countries also made substantial contributions. At the institutional level, the Netherlands Cancer Institute, Vita-Salute San Raffaele University, and the University of Verona represented major contributors. BJU International, European Urology, World Journal of Urology, Journal of Endourology, and Journal of Robotic Surgery were identified as key journals for disseminating research in this area. Keyword and co-citation findings indicated a gradual transition from early surgical experience, learning-curve assessment, and technical feasibility toward research on oncologic outcomes, lymph-node management, functional recovery, and multimodal treatment, alongside increasing attention to magnetic resonance imaging, pathological grading, and predictive factors. Research activity concerning robot-assisted radical prostatectomy for high-risk and locally advanced prostate cancer has expanded consistently over the past 20 years and has progressively shifted toward an integrated clinical research framework centered on oncologic safety, functional outcomes, lymph-node management, and multimodal treatment. Diagnostic and risk-assessment themes have increasingly supported patient selection, staging, and treatment planning within this framework. Future investigations incorporating harmonized definitions, longer follow-up, prospective multicenter designs, and consistent reporting of oncologic, functional, nodal, and treatment-sequencing outcomes are needed to define more precisely the clinical role of RARP in this patient population.
Outpatient retrograde ureteral stenting under local anesthesia (LA) is increasingly adopted to reduce anesthetic risk, resource use, and procedural delays. However, success rates and tolerance vary across benign and malignant obstruction. This systematic review evaluated technical success, safety, pain and tolerance, and clinical predictors of failure to inform patient selection and procedural planning. Following PRISMA 2020 statement, MEDLINE, Embase, Scopus, and Web of Science were searched from inception to October 2025. Twenty studies involving adults undergoing ureteral stent insertion or exchange under LA in outpatient, office-based, or bedside settings were included. Data were synthesized using random-effects meta-analysis with logit transformation. Predictors of success and failure were assessed qualitatively and quantitatively where feasible. Across 1,945 patients (2,871 ureteral units), pooled technical success was 89% (95% CI 86-92%), highest for stone-related obstruction (94%) and lowest for malignant ureteral obstruction (82%). Overall complications ranged from 2 to 14%, with major events (Clavien-Dindo ≥ II) occurring in < 5%. Pain scores were modest (VAS 3.1-4.6), and 87-90% of patients were willing to undergo repeat LA stenting. Independent predictors of technical failure included bladder trigone or distal ureteric invasion, severe hydronephrosis, and poor performance status (ECOG ≥ 2). Limitations include heterogeneity in outcome definitions, lack of multivariable modelling in most studies, and short-term follow-up. LA ureteral stenting is safe, effective, and well tolerated in carefully selected patients. Predictors of failure offer a practical framework to guide decision-making between outpatient LA stenting, operating-room stenting, and percutaneous drainage. Standardized reporting and prospective validation of risk models are needed.
To describe the spectrum of robotic surgical techniques used for removal of synthetic midurethral slings (MUS) in different mesh-related complications and to report perioperative and functional outcomes in a tertiary referral setting. Robotic MUS removal has recently emerged as an alternative approach; however, data regarding its indications, technical aspects and outcomes remain limited. We analyzed a prospectively maintained database of all female patients who underwent robotic MUS removal at a single tertiary referral center between August 2022 and July 2025. Indications for surgery included pain, mesh exposure, or patient request for complete removal. Depending on the indication and shared decision-making process, either complete removal of all remaining mesh components or partial removal of the extruded segment was planned. Patients with preoperative stress urinary incontinence (SUI) were offered concomitant robotic autologous fascial sling placement, whereas those without preoperative SUI underwent pubourethral ligament plication. Outcomes assessed included postoperative complications (Clavien-Dindo classification), pain evaluated using a visual analog scale (VAS), continence outcomes, Patient Global Impression of Improvement (PGI-I), and need for reintervention. Seventy patients were included. The planned extent of mesh excision was achieved in all patients; complete removal of all remaining mesh components was performed in 74 cases and partial removal in 6 cases. Median operative time was 160 min, and median length of hospital stay was 3 days (range 0-21). Major complications (Clavien-Dindo ≥ III) occurred in 6 patients (8.6%). At last follow-up, 62 patients (88.6%) reported symptom improvement, including 49 (70%) with PGI-I scores of 1-2. Stress urinary incontinence remained a relevant postoperative concern, and 11 patients (15.7%) ultimately required additional continence treatment. Robotic MUS removal is a feasible approach associated with high rates of patient-reported symptom improvement. However, continence outcomes should be interpreted cautiously given the heterogeneity of the population and the frequent use of concomitant anti-incontinence procedures.
To evaluate the incidence and predictive factors of transient and persistent urinary incontinence following ThuFLEP. We included consecutive patients who underwent ThuFLEP between March 2023 and July 2024. The primary endpoint was transient urinary incontinence at 3 months. Secondary outcomes included stress urinary incontinence(SUI), urge urinary incontinence(UUI), and persistent incontinence at 12 months. Uni- and multivariate logistic regression analyses were performed to identify predictors of 3-month incontinence. A total of 213 patients were included(mean age 71.9 ± 8.1years; mean prostate volume 93.3 ± 33.9 cc). Mean operative time was 96.1 ± 44.0 minutes, and mean total laser energy delivered was 94.6 ± 38.6 kJ. At 3months, overall urinary incontinence was reported in 44 patients (20.7%), including SUI in 9.9%, UUI in 8.0%, and mixed incontinence in 2.8%. At 12months, overall incontinence significantly decreased to 6.6%(p < 0.01), with persistent SUI and UUI rates of 2.3% each. Multivariate analysis identifiedtotal laser energy as an independent predictor of transient urinary incontinence (OR 1.015 per kJ, 95% CI 1.002-1.03, p = 0.025). Prostate volume,enucleation technique and surgeon experience were not independently associated with incontinence." ThuFLEP was associated with favorable long-term continence outcomes, with most postoperative urinary incontinence being transient and resolving within 12 months. Higher laser energy delivery is an independent and potentially modifiable predictor of early urinary incontinence. Optimization of energy use and surgical technique, particularly during the learning curve, may improve early functional recovery after ThuFLEP.
The role of ureteral access sheath (UAS) during flexible ureteroscopy (fURS) remains undecided in the era of direct in-scope suction (DISS), which subserves dust and debris removal with active intrarenal pressure control. This study aims to evaluate the utility of UAS on perioperative outcomes in patients undergoing DISS-assisted fURS. This prospective, multicentre study analysed data from an international registry of patients who underwent successful fURS with DISS at 16 centres across 14 countries between May and December 2025. Patients were grouped based on whether UAS was used. All participants had one non-contrast CT scans (NCCT) before and at 30 days post operatively. 100% Stone-free rate (SFR) was defined as zero residual fragment (ZFR) on NCCT in bone window (Grade A) or overall stone free (OSF) was Grade A + B where grade B reported a single RF of 2 mm. The study recorded perioperative outcomes, immediate Clavien-Dindo complications and new anatomical anomalies on 3 month imaging. Multivariable logistic regression identified factors that predicted SFR and complications. A total of 540 patients were divided into Group1 undergoing DISS without UAS 296 (54.8%), and Group2 had DISS with UAS 244 (45.2%). ZRF Grade A (Group1vs Group2) was 72.6% vs. 70% and OSF (grade A + B) was 95.9% vs. 88.9% (p = 0.011) respectively but no significant differences in planned re-intervention. Group2 cohort including larger stone burden (12.0 vs. 10.0 mm, p = 0.016), multiplicity higher pre-stenting (57.0% vs. 15.2%, p < 0.001) and more complex cases, operative time was significantly longer in this cohort (64 vs. 39 min, p < 0.001). Although OSF (Grade A + B) rates were high in both groups, they were significantly higher in the non-UAS cohort compared with the UAS cohort (95.9% vs. 88.9%, p = 0.011). Fever > 38.C was significantly higher in Group 2(11.5 vs. 2.7%, p < 0.001) as was 30 day any cause re-admission (7% vs. 15, p < 0.001) with zero sepsis case. Multivariate analysis did not reveal any specific association for ZRF but the use of UAS (OR 6.52, 3.52-12.41, p < 0.001) and pre-stenting (OR 2.63, 1.44-4.90, p,0.002) increases the odds for 30 day complications. DISS with UAS (conventional or Flexible and Navigable Suction access sheath FANS) is preferred in fURS for larger, multiple, or complex stones. Non-UAS DISS is a safe, effective option for smaller, simpler cases, showing high ZRF and OSF rates with fewer low grade complications. Dusting with simultaneous aspiration removes fragments efficiently, may extend operative times, and can reduce post-operative stenting without increasing readmissions or infection risk. These results support tailoring DISS management to individual cases.
Ureteral stents are widely used following ureteroscopy (URS), yet several aspects of their management remain non-standardized despite contemporary EAU and AUA guideline recommendations. This study evaluated contemporary international practices and identified gaps in ureteral stent use among endourologists. A cross-sectional international survey consisting of 58 items across nine domains was distributed via social media, major urological meetings, and the EAU Endourology Section. Only fully completed responses were analyzed. Descriptive statistics were used, with continuous variables reported as medians and categorical variables as frequencies and percentages. A total of 121 respondents from 48 countries were included. Stent placement remained common after uncomplicated ureteroscopy and was nearly universal in complicated cases. Pre-stenting was applied selectively, most commonly after failed ureteroscopy and for ureteral dilatation. A 6 Fr stent and polyurethane material were the preferred choices. Stent-related symptoms were frequent, with urgency and frequency predominating, followed by hematuria. Pharmacologic management varied, and conservative treatment was commonly used for post-stenting infections. Notably, 45% of respondents did not use a structured stent-tracking system and 71.8% had never used a validated symptom-assessment tool such as the USSQ. Exploratory subgroup analyses identified differences according to geographic region, institution type, and endourological training background in selected aspects of stent management, including pre-stenting duration, long-term stent exchange protocols, pharmacologic management, and follow-up systems. International ureteral stent practices show substantial variability. Although core practices were broadly comparable across regions, important gaps remain in stent tracking and symptom assessment, highlighting opportunities to improve patient safety and standardize care.
Men with benign prostatic enlargement (BPE) frequently present with concomitant bladder stones (BS), yet the optimal surgical strategy remains debated. This systematic review and meta-analysis aimed to compare perioperative and postoperative outcomes of concomitant BPE/BS surgery against BS treatment alone. Following the 2020 PRISMA framework, a comprehensive search was conducted on 9 March 2026. Binary outcomes were pooled using the Cochran-Mantel-Haenszel method and reported as odds ratios (OR) with 95% confidence intervals (CI). Continuous outcomes were assessed using inverse variance with 95% CI. Risk of bias was assessed with RoB 2 and ROBINS-I. Seven comparative studies involving over 500 patients were included. Quality assessment revealed some concerns in the overall risk of bias for the single randomized trial, while non-randomized studies showed moderate (3 studies) and high overall risk of bias (3 studies). Concomitant surgery was associated with a significantly lower odds of BS recurrence (OR 0.18, 95% CI 0.10-0.33, p < 0.00001) and better urinary symptoms at last follow-up (mean IPSS difference - 3.09 points, p < 0.00001) compared with BS surgery alone. Minor complications (Clavien 1-2) were more frequent in the concomitant surgery group (OR 4.35, p < 0.0001), while major complications and stone-free rates did not differ significantly, though the comparison was likely underpowered for major complications. The rate of subsequent BPE surgical procedure in patients who had BS surgery alone ranged from 10% to 41%. Concomitant BPE and BS surgery substantially reduces stone recurrence and improves lower urinary tract symptoms without meaningfully increasing serious perioperative risk, supporting its adoption in selected cases when BS is related to BPE with bladder outlet obstruction.
The relationship between the triglyceride-glucose index (TyG) and the risk of kidney stone formation has not been fully explored in the current literature. Although an association between the TyG index, associated indices, and kidney stone formation has been reported, this link remains unconfirmed. Clarifying this relationship is crucial for both individual health and public health decision-making. Additionally, the TyG index and its related indices are gaining recognition for their emerging utility as valuable biomarkers in epidemiological studies of kidney stones. The main objective of this research is to assess the correlation between the TyG index, associated indices, and the prevalence of kidney stones. Furthermore, we seek to investigate the potential broader implications of this association for public health policy and clinical practice. We conducted a cross-sectional study involving a representative sample of 12,159 participants from the US population. For data analysis, logistic regression combined with smooth curve fitting techniques was employed to precisely evaluate the relationship between the TyG index and kidney stone prevalence. The predictive capability of TyG and its derived indices for kidney stone risk was comprehensively assessed using AUC, NRI, and IDI. To examine the robustness of our findings under different assumptions, we conducted a sensitivity analysis. The overall prevalence of kidney stone disease was 9.9%, comprising 54.84% of males and 45.16% of females. Compared with the group without a history of kidney stones, the group with a history of kidney stones exhibited significantly elevated triglyceride-glucose indices and related indicators. In the fully adjusted model, compared with the first tertile (T1) group, the risk of developing kidney stones increased in the third tertile (T3) group, with odds ratios (ORs) and 95% confidence intervals (CI) of TyG was 1.23 (0.99-1.54), triglyceride glucose-waist circumference (TyG-WC) was 1.93 (1.55-2.41), triglyceride glucose-body mass index (TyG-BMI) was 1.87 (1.51-2.31), triglyceride glucose-waist to height ratio (TyG-WHtR) was 1.66 (1.31-2.11), triglyceride glucose-weight-adjusted waist index (TyG-WWI) was 1.57 (1.23-2.00), and triglyceride glucose-a body shape index (TyG -ABSI) was 1.29 (1.04-1.60) respectively. Restricted cubic spline (RCS) analysis indicated that kidney stones' risk increased with rising TyG and its derived indices. Subsequent subgroup analyses revealed no significant interactions in most subgroups (all P > 0.05). Results from the three sensitivity analyses aligned with those of the primary analysis, reinforcing its robustness. Our investigation revealed that TyG and its derived indices had a significant link to the prevalence of kidney stones in the US adult population. Future research could involve designing and conducting longitudinal or cohort studies to validate further associations and possibilities.
Transcutaneous tibial nerve stimulation (TTNS) has emerged as an attractive treatment option for the management of overactive bladder (OAB) symptoms. This review summarizes the clinical and real-world evidence supporting the efficacy, safety, and patient-reported outcomes of TTNS in OAB. A comprehensive search of the PubMed database was conducted in December 2025 using the keyword "transcutaneous tibial nerve stimulation." This search identified 623 records, which were screened by title for relevance to the objectives of this narrative review. All eligible articles were included. A total of 28 prospective studies published between 2011 and 2025 met the inclusion criteria. Across prospective studies, TTNS was associated with improvements in urgency, frequency, and urgency urinary incontinence, with a mean responder rate of 72.2%, according to each study's outcome measures. Compared with sham, TTNS demonstrated significant benefit in studies including patients with non-neurogenic OAB. Evidence in neurogenic bladder disorders was limited and heterogeneous. TTNS was also found to be non-inferior to percutaneous tibial nerve stimulation in one randomized controlled trial (RCT). In comparisons with anticholinergics, TTNS was generally less effective in symptom reduction but markedly better tolerated. TTNS is a safe, simple, patient-friendly and non-invasive neuromodulation option for lower urinary tract symptoms management. Improvement of symptoms is observed in over two third of cases, with minimal adverse events and excellent tolerability. Long term studies are warranted to further evaluate treatment persistence, as well as well-designed RCTs vs other treatment options to refine the role of TTNS in the therapeutic armamentarium.
Upper tract urothelial carcinoma (UTUC) is a rare malignancy arising from the renal pelvis or ureter and is often diagnosed at an advanced stage. Prognosis depends strongly on tumor stage and grade, but remains poorer than that of bladder urothelial carcinoma. This review article summarizes current evidence on the management of locally advanced but resectable UTUC, focusing on perioperative systemic therapy, clinical guideline recommendations, and emerging therapeutic strategies. In high risk cases, radical nephroureterectomy (RNU) with bladder cuff excision is the surgical state of the art. To reduce relapse rates, perioperative systemic therapy is gaining increasing importance. Neoadjuvant platinum-based chemotherapy (+/- durvalumab) has shown promising rates of pathological downstaging, however, high level evidence is still lacking. In contrast, evidence for adjuvant therapy is stronger. Adjuvant platinum-based chemotherapy should be offered to patients with pT2-pT4 or pN+ disease within 90 days after RNU. Immune checkpoint inhibitors show activity in perioperative settings, but potential benefits in UTUC subgroups remain unclear. There are ongoing trials combining immunotherapy, chemotherapy, or targeted agents. Molecular profiling and novel strategies, such as mRNA vaccines and antibody-drug conjugates, may enable more personalized approaches and reshape the therapeutic landscape of UTUC. Management of locally advanced but resectable UTUC is evolving rapidly, driven by advances in perioperative systemic therapies and a growing understanding of the disease's molecular biology. However, prognosis remains poor, underscoring the need to further improve treatment options.
This studyaims to systematically elucidate the mechanisms underlying hematologic toxicity in 225Ac-PSMA-617 treatment for metastatic castration-resistant prostate cancer (mCRPC), establish a clinical risk stratification framework, and propose an integrated management strategy to optimize the therapeutic safety margin and efficacy. By integrating and analyzing existing clinical and mechanistic research evidence, a "triple-hit" toxicity mechanism model was proposed. Based on this, key risk factors were identified, risk stratification criteria were established, and a structured clinical management pathway encompassing prevention, monitoring, and intervention was developed. The hematologic toxicity of 225Ac-PSMA-617. results from the synergistic effects of direct α-particle damage, tumor microenvironment(TME)-mediated bone marrow function hijacking, and cumulative depletion of bone marrow reserve. Based on this, we established baseline bone marrow tumor burden, prior treatment history, and hematopoietic function as core risk factors, and proposed stratification criteria for low, intermediate, and high-risk groups along with corresponding differential monitoring and intervention strategies. A thorough understanding of the triple-hit mechanism and implementation of risk stratification management facilitate safer and more effective application of 225Ac-PSMA-617 in the treatment of mCRPC. Future efforts should focus on expanding the therapeutic window of this therapy through individualized dosing, optimization of combination therapies, and development of multidimensional biomarkers.
Haemorrhagic radiation cystitis is a challenging complication of pelvic radiotherapy, with limited high-quality evidence to guide management and no established standard of care. We explored the real-world potential and safety of intravesical RADA16 (PuraStat) for the treatment of persistent severe haematuria secondary to radiation cystitis. This exploratory prospective observational study included consecutive patients with clinically significant haematuria following radiotherapy, treated with intravesical RADA16 across two NHS Trusts. The primary outcome was resolution of visible haematuria. Secondary outcomes included healthcare utilisation (hospital admissions, length of stay, emergency department attendances) and safety. Patients were followed for a minimum of 90 days. Ten consecutive patients (mean age 79.6 yr; 90% male) were included. Nine of the ten patients had complete resolution of visible haematuria during follow-up. One patient reported minimal, self-limiting haematuria occurring intermittently, which had subsided by the one-year follow-up. No procedure-related adverse events were observed. Unplanned healthcare utilisation was reduced to zero in all patients following treatment. Follow-up cystoscopic assessment suggested improvement in bladder lesions. Limitations include the small sample size, single-arm design, and limited follow-up in some patients. Intravesical RADA16 shows potential in relation to safety and feasibility for the treatment of haemorrhagic radiation cystitis. In the present exploratory study RADA16 was associated with resolution of haematuria in the majority of patients and elimination of unplanned hospital attendances although these findings must be interpreted with caution owing to the small sample size, short and variable follow-up, and lack of control group. However, these findings support further evaluation in larger, controlled studies to confirm efficacy, durability, and optimal treatment protocols. We observed patients undergoing a new treatment for bleeding in the bladder that can occur after radiotherapy. Most patients stopped having visible bleeding after treatment, and none needed to return to hospital unexpectedly. This treatment may offer a simple and safe alternative to more invasive procedures, but larger studies are needed to confirm these results.
To compare perioperative and functional outcomes of standard holmium, Moses 1.0, and Moses 2.0 laser enucleation performed at an academic center with trainee involvement. We retrospectively reviewed men undergoing HoLEP between June 2022 and May 2024. Patients were grouped by laser platform: standard holmium, Moses 1.0, or Moses 2.0. Baseline demographics, perioperative data, complications, and functional outcomes up to six months were analyzed using analysis of variance or Kruskal-Wallis tests. Among 389 patients (standard holmium 206; Moses 1.0 126; Moses 2.0 57), baseline characteristics were similar. Median operative times were 95, 105, and 100 min for standard holmium, Moses 1.0, and Moses 2.0, respectively (p = 0.25), and median prostate weights were comparable (84 g, 85 g, 79 g; p = 0.44). Hospital stay was slightly longer with Moses lasers (1.6 vs. 1.4 days, p < 0.001), though this difference is unlikely to be clinically significant. Objective measures of bleeding-postoperative hemoglobin drop (1.7-2.0 g/dL) and transfusion rates (0-1.6%)-did not differ significantly between groups. Postoperative catheter duration, hospital stay, and complication rates were also comparable. Functional outcomes improved in all groups through 6 months, with no intergroup differences. HoLEP is safe and effective across conventional holmium, Moses 1.0, and Moses 2.0 platforms, with comparable perioperative and functional outcomes. Although the literature suggests that Moses 2.0 may facilitate same-day discharge, its absence should not limit HoLEP availability, and platform selection may reasonably reflect institutional resources and surgeon preference.
Aquablation is a semi-automated, ejaculation-sparing surgical option for treatment of benign prostatic hyperplasia (BPH). While previous studies have demonstrated that approximately 50 cases are required to achieve surgical competence in prostate laser enucleation, objective evaluations of Aquablation learning curve remain limited. The aim of this study was to assess Aquablation learning curve using cumulative sum (CUSUM) method, based on operative parameters and postoperative outcomes. We retrospectively analyzed data from 80 patients who underwent Aquablation by a single surgeon with prior experience in prostate resection and enucleation (01/2024 - 07/2025). Patient demographics, including prostate volume (PV) and comorbidities, were recorded. Operative parameters were collected. Patient evaluations were conducted at baseline, 3, 6 months postoperatively, including uroflowmetry and assessment using the International Prostate Symptom Score (IPSS). Ejaculation preservation was assessed. Trifecta was defined as preserved ejaculation, IPSS < 8, and maximum urinary flow rate (Qmax) > 15 mL/s at 6 months. Descriptive statistics, linear regression analyses, and CUSUM method were applied. Median (interquartile range [IQR]) prostate volume and baseline IPSS-total score were 60 (45-78) mL and 21 (14-27). Median total operative time was 39 (31-47) minutes. Postoperative complications occurred in 18 patients (22.5%). Median IPSS-total score and Qmax improved significantly at 3- and 6-month follow-up visits (p < 0.01). Antegrade ejaculation was preserved in 81.2% of patients at 6-month follow-up. Trifecta at 6 months was achieved in 49 patients (61.2%). CUSUM analysis demonstrated that learning curve for setup and ablation tissue time reached plateau after 14 cases, while coagulation time stabilized after 21 procedures. CUSUM charts for trifecta achievement revealed an initial learning phase requiring 18 cases to achieve stable performance, subsequently maintained. Aquablation is a reproducible, ejaculation-sparing surgical option for BPH, with procedural efficiency and stable functional outcomes achieved after approximately 12-21 cases. Aquablation offers a faster acquisition of technical proficiency due to its high degree of automation and standardized planning, leading to a rapid integration into clinical practice.
To evaluate the diagnostic accuracy of intravesical prostatic protrusion (IPP) for detecting bladder outlet obstruction (BOO) in men with lower urinary tract symptoms (LUTS) attributed to benign prostatic hyperplasia (BPH), using urodynamic studies as the reference standard. A systematic review and meta-analysis was performed in accordance with PRISMA-DTA guidance. Studies were included if they evaluated IPP in adult men with LUTS attributed to BPH and defined BOO using urodynamic criteria, specifically BOO index > 40. Data were extracted to construct 2 × 2 diagnostic tables. Pooled sensitivity and specificity were estimated using a bivariate random-effects model, and overall diagnostic performance was assessed using a summary receiver operating characteristic curve. A random-effects model was also used to estimate the association between IPP > 10 mm and BOO. Ten studies including 1253 men met inclusion criteria. Greater IPP was associated with increased odds of urodynamically confirmed BOO, with a pooled odds ratio of 2.67 (95% CI, 1.48-4.79; I² = 94.6%). The 95% prediction interval ranged from 0.32 to 22.49, indicating substantial between-study variability and uncertainty regarding the association in future populations. Diagnostic meta-analysis across study-defined IPP thresholds of approximately 10-12 mm demonstrated a pooled sensitivity of 71.0% and specificity of 75.5% for detecting BOO. The area under the summary receiver operating characteristic curve was 0.795, consistent with moderate overall diagnostic accuracy. Available evidence suggests that IPP is associated with urodynamically confirmed BOO and that a threshold of approximately 10 mm may provide moderate diagnostic accuracy. However, the certainty of these findings is limited by the observational design, relatively small sample sizes, methodological heterogeneity, and unclear risk of bias in several included studies. IPP may therefore be useful as an adjunct to other clinical findings but should not replace urodynamic evaluation when diagnostic certainty is required.
To describe the clinical and tumor characteristics of bladder leiomyoma (BL) and to explore potential etiological factors and prognostic factors to guide management strategies. Patients with histologically confirmed BL treated at 14 hospitals between 1995 and 2025 were included. Associations between tumor characteristics, symptoms, management, and outcomes were evaluated using appropriate statistical tests and logistic regression. A p-value < 0.05 was considered significant. Among 74 patients (55.4% female, median age 60 years [IQR, 42.25-70.00]), 48.6% were asymptomatic at diagnosis, and 66.2% presented with at least one metabolic syndrome criterion. Tumors had a median size of 21.0 mm [IQR 13.50-35.00] and were most frequently endovesical (48.6%), followed by intramural (35.1%) and extravesical (16.2%) patterns; tumor size and location were not associated with preoperative symptoms but significantly influenced surgical management (p = 0.002). Transurethral bladder resection was the most common treatment (62.2%), followed by partial cystectomy (23.0%) and bladder excision (9.5%), with 68.8% of them performed laparoscopically. Early postoperative complications occurred in 8.1% of patients. Over a median follow-up of 14.3 months [IQR 2.3-48.0], recurrence occurred in 5.4% and persistent or worsening symptoms in 17.6% of patients. Initial LUTS were predictive of both recurrence and persistent postoperative symptoms (OR = 2.02 [1.20-4.61] and 2.38 [1.53-4.55], respectively). This study represents the largest cohort of BL to date. The high proportion of asymptomatic cases suggests that its true incidence is underestimated. While recurrence was uncommon, persistent LUTS remained a concern among initially symptomatic patients, supporting a personalized, conservative therapeutic approach whenever feasible. Further studies are needed to clarify the biological mechanisms underlying BL and to optimize its management.
Neurogenic bladder (NB) frequently leads to bladder fibrosis, yet the underlying mechanisms remain unclear. Piezo1, a mechanosensitive ion channel, has been implicated in fibrotic processes. This study investigated whether Piezo1 promotes macrophage-to-myofibroblast transition (MMT) and contributes to bladder fibrosis in NB. A mouse NB model was established via spinal cord injury. Bladder tissues were analyzed by HE and Masson staining, immunohistochemistry, qRT-PCR, and Western blot to assess fibrosis and Piezo1 expression. Immunofluorescence colocalization and flow cytometry were used to evaluate MMT. In vitro, RAW264.7 macrophages were treated with TGF-β1, the Piezo1 agonist Yoda1, the Piezo1 inhibitor GsMTx4, or Piezo1 siRNA, followed by assessment of MMT and fibrosis-related protein expression. Piezo1 expression was significantly upregulated in NB bladder tissues, correlating with increased collagen deposition and fibronectin expression. Immunofluorescence revealed colocalization of macrophage markers (CD68, F4/80) with α-SMA, indicating MMT in NB tissues. In vitro, TGF-β1-induced MMT was enhanced by Yoda1 and attenuated by GsMTx4 or Piezo1 knockdown, as confirmed by immunofluorescence and flow cytometry. Similarly, Piezo1 activation increased the expression of fibrosis-related proteins (Fibronectin, Collagen I, α-SMA), whereas Piezo1 inhibition suppressed their expression. Piezo1 is a critical regulator of macrophage-to-myofibroblast transition and promotes bladder fibrosis in neurogenic bladder. Targeting Piezo1 may represent a potential therapeutic strategy to mitigate fibrosis and preserve bladder function in NB patients.