Current Opinion in Urology最新文献

Purpose of review: The implementation of artificial intelligence (AI) in urology has the potential to enhance patient outcomes through the provision of intelligent tools, such as AI-enabled decision aids (AIDAs), which can support personalized care. The objective of this systematic review is to determine the role of AIDAs in educating and empowering patients, particularly those from underrepresented populations.

Recent findings: We conducted a comprehensive systematic review following PRISMA guidelines to explore the potential for AIDAs to address healthcare inequalities and promote patient education and empowerment. From 1078 abstracts screened, 21 articles were suitable for inclusion, all of which utilized chatbots. Three main themes of studies were identified. Fourteen studies focused on enhancing patient education, four studies investigated whether chatbots can improve the accessibility of urological literature and three studies explored chatbots role in providing lifestyle guidance. While chatbots demonstrated great potential as educational and lifestyle support tools, current research found mixed accuracy and a tendency for them to produce unreliable information. In terms of accessibility, chatbots were able to effectively enhance readability and translate literature, potentially bridging language, and literacy barriers.

Summary: Through chatbots, AIDAs show strong potential to enhance urological education and empower underrepresented communities. However, chatbots must show greater consistency in accuracy before they can be confidently relied upon in clinical contexts. Further research evaluating chatbots' efficacy in clinical settings, especially with underrepresented groups, would enable greater understanding of their role in improving patient inclusivity, empowerment, and education.

Purpose of review: Sodium-glucose cotransporter 2 inhibitors (SGLT2i), also known as flozins, are one of the modern oral antidiabetic drugs. Currently, there are sufficient number of studies devoted to the effect of flozins on various genitourinary disorders, confirming their multifaceted positive and side effects. Thus, the purpose of this review is to analyze the current literature for an up-to-date definition of the role of these drugs in urological practice, prospects for their further study, and side effects that urologists need to remember when treating patients with T2DM taking flozins.

Recent findings: Flozins (SGLT2i) are not linked to urological cancer risk, and might even lower the risk by disrupting tumor metabolism and cell cycle. Despite causing glucosuria, the resulting effect of Flozins is antilithogenic, which may be promising for patients with type 2 diabetes mellitus (T2DM) and kidney stone disease, especially regarding risk of recurrence. While the overall risk of UTI is not increased, flozins significantly increase the risk of genital mycotic infections. Flozins can worsen LUTS due to their diuretic action.

Summary: Current results of studies on the use of flozins in patients with T2DM are promising for different spectrums of genitourinary diseases caused by different pathogenetic mechanisms. However, we need future clinical trials with specific drugs and comparisons to get trustworthy results about how helpful flozins are for these patients and whether they can be used in urology.

Purpose of review: The management of localized prostate cancer (PCa) is shifting towards tissue-preserving strategies such as active surveillance and focal therapies. Intermediate-risk PCa, especially ISUP Grade Group 2 (GG2), encompasses a heterogeneous disease spectrum, complicating patient selection for conservative treatments. Cribriform architecture, a Gleason pattern 4 subtype, is associated with poorer outcomes and currently contraindicates active surveillance However, these conclusions are mainly based on retrospective data from older cohorts, raising questions about cribriform's independent prognostic value versus Gleason pattern 4 burden.

Recent findings: Cribriform pattern correlates strongly with increased Gleason pattern 4, which is linked to adverse features such as biochemical recurrence and tumour upstaging. The independent impact of cribriform remains unclear due to limited regression analyses and variable reporting. Cribriform detection on biopsy and MRI is challenging, often leading to underestimation and complicating risk stratification.

Summary: Despite current guidelines excluding cribriform-positive patients from active surveillance, emerging evidence suggests some patients with limited cribriform and low Gleason 4 percentage could be candidates for active surveillance or focal therapies. Prospective studies with standardized cribriform quantification and imaging evaluation are needed to clarify these issues.

Purpose of review: To provide expert recommendations for side effect management in patients with bladder cancer receiving intravesical-drug releasing system (iDRS) treatment and for optimizing iDRS insertion procedure success.

Recent findings: Indwelling iDRS are designed to provide sustained local exposure to therapy. In clinical trials, frequent side effects of iDRS treatment were lower urinary tract symptoms (LUTS) (e.g., dysuria, pollakiuria, micturition urgency), urinary tract infections (UTIs), and hematuria. These side effects are generally low grade, but if not properly managed, may lead to treatment interruptions or discontinuations. As data are limited, practical recommendations based on expert opinion for the management of common side effects and best practices for iDRS insertion procedures may improve treatment adherence and optimize outcomes in patients with bladder cancer receiving iDRS.

Summary: Two separate expert panels were convened to develop recommendations for side effect management with iDRS and optimizing iDRS insertion procedure success. Stepwise treatment-specific management strategies for LUTS, UTIs, and hematuria in patients receiving iDRS treatment that are familiar to practicing urologists are presented, including considerations for continuation or discontinuation of iDRS treatment. Several advanced techniques can be considered to improve iDRS insertions based on variations in patient anatomy.

Purpose of review: The expanding range of minimally invasive surgical therapies (MISTs) for benign prostatic hyperplasia (BPH) reflects a growing emphasis on individualized, anatomy-driven treatment that prioritizes symptom relief, reduced morbidity, and preservation of sexual function. This review provides a timely synthesis of MISTs, highlighting innovations in technique, key anatomical considerations, and evolving strategies for patient-centered care in the modern clinical setting.

Recent findings: Recent studies highlight the expanding role of MISTs, such as UroLift, Rezūm, the temporary implanted nitinol device, Optilume BPH, transperineal laser ablation, and prostatic stents. Each modality shows distinct performance characteristics depending on factors such as prostate volume, intravesical prostatic protrusion, bladder neck configuration, and the presence of a median lobe. Increasing attention has also been given to preserving antegrade ejaculation, which is often a high priority for younger or sexually active patients. Concurrently, new decision aid tools are in development to support shared decision-making in concordance with patient values and treatment preferences.

Summary: MISTs represent a diverse and maturing set of therapeutic options. Optimizing their use requires detailed anatomical assessment and thoughtful, individualized decision-making to align treatment with patient goals, preserve function, minimize morbidity, and reflect contemporary evidence-based standards in BPH management.

Purpose of review: To provide a comprehensive overview of existing literature on suction-assisted ureteroscopy, evaluating its effectiveness and associated complications.

Recent findings: A literature review was conducted in December 2024 using the MEDLINE, EMBASE and Scopus databases by two independent authors. To structure and address the clinical question, "Do suction devices improve outcomes in RIRS?", we employed the PICOS (Patient, Intervention, Comparison, Outcome, Study Type) model. Exclusion criteria included case reports, studies involving suction techniques outside the context of endocorporeal laser lithotripsy (ELL), non-English language articles and articles or clinical trials with fewer than 15 patients.

Summary: Among the 36 included studies, 28 studies focused on SUAS, of which seven specifically investigated SUAS with pressure measurement, three studies examined DISS, three studies evaluated SURE and two comparative studies analyzed different suction techniques. The presented results show that advancements in suction technology seem very promising and likely to shift endourological practice.

Purpose of review: This review aims to summarize the biology and clinical relevance of Nectin-4 in patients with advanced bladder cancer, with a focus on its role as a therapeutic target and predictive biomarker.

Recent findings: Nectin-4 is consistently overexpressed in advanced bladder cancer, facilitating tumor progression and survival signaling. Its cell surface localization makes it an ideal target for antibody-drug conjugates (ADCs), such as enfortumab vedotin, which has shown excellent efficacy in both first-line treatment, post platinum-based chemotherapy, and following immune checkpoint inhibitors. Recent insights highlight Nectin-4 as potential predictive biomarker and a target for advanced medical imaging strategies. Resistance mechanisms and new combination approaches are currently being investigated.

Summary: Nectin-4 is a key therapy target in patients with advanced bladder cancer, as demonstrated by the success of enfortumab vedotin. Emerging ADC technologies and Nectin-4-targeted imaging tools could improve efficacy and patient selection, redefining both diagnostic and therapeutic approaches.

Purpose of review: Ureteral stents are an integral part of daily urological clinical practice, but in case of ureteral stents inadvertently left in place or forgotten, they can lead to a range of complications. Managing retained DJ stents presents a complex challenge for urologists, involving various aspects such as surgery, legal implications, and financial factors both for the patient as for the health system. Ensuring proper follow-up of patients poses a significant challenge even in nowadays in everyday clinical urological practice as it involves efficient urologist-patient communication. In modern society, smartphones have become an essential part of daily lives, providing a convenient and reliable way to store and access information through certain applications. Is it the best way to go for stent tracking?

Recent findings: We performed a systematic review of PubMed/Medline, EMBASE, Cochrane Library and Scopus and reference lists according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. The tracking mechanisms include electronic medical records algorithms, mobile or chat applications, and computer-based applications. Prior to the implementation of a tracking system, hospitals experienced varying rates of stent loss or delayed removal, ranging from 0% to 13%. Through the implementation of a tracking mechanism, the occurrence of lost or delayed removal has been significantly reduced to 1%.

Summary: Stent tracking systems have proven to be highly effective in reducing the incidence of delayed removal of ureteral stents. Nevertheless, the widespread applicability of these systems is limited due to their primarily tailored design for institutions, while before implementing their use as a standard of care, more solid data through randomized trials is needed.

Purpose of review: Machine learning algorithms are occupying a larger space in medical and urology applications. However, typical medical physicians are not trained on these technologies and do not master the possibilities offered by these tools, to imagine their applications in the medical field. This manuscript is indented to be a guide in the use of machine learning in different urology applications, and to demystify the available machine learning and artificial intelligence algorithms. This manuscript reviews some of their applications and potential applications to the medical and urology field.

Recent findings: Multiple works are published on the use of machine learning in urology, with performance demonstrated to be noninferior to human experts on multiple occasions. However, the major part of the machine learning publications in urology applications are concentrated on diagnosis and/or prognosis. Advanced machine learning algorithms based on agentic artificial intelligence, able to perform decisions and causality-based treatment optimization, are rarely put to use in urology. The democratization of advanced machine learning technologies in the medical fields can accelerate the adoption of these techniques, and potentially improve the patient care through relevant suggestive decision making.

Summary: This work aims to demystify the machine learning tools for medical applications, facilitate decision making and adoption of the correct tools for the correct applications, and places a roadmap for the future of machine learning in the enhancement of patient care in urology.