European urology focus最新文献

Background and objective: There is an established association between secondary bladder cancers (SBCs) and radiotherapy (RT) for prostate cancer (PC), which remains a significant concern. Our aim was to update the evidence on SBC incidence across different RT modalities and to compare oncological outcomes for patients diagnosed with SBC to those diagnosed with primary bladder cancer (PBC).

Methods: We searched MEDLINE, Scopus, and Web of Science for studies on SBC following PC. Pairwise meta-analyses were conducted to compare SBC incidence in terms of odds ratios (ORs) between RT modalities (external beam radiation therapy [EBRT], brachytherapy [BT], and BT + EBRT) and PBC incidence after radical prostatectomy (RP). SBC incidence data are presented as proportions, and pairwise meta-analyses were used to compare overall survival (OS) between SBC and PBC using hazard ratios (HRs).

Key findings and limitations: Thirty-one studies (n = 576 341) were included. All RT modalities significantly increased the risk of SBC in comparison to RP at all time points investigated. BT alone had similar long-term SBC risk in comparison to EBRT (OR 0.56, 95% confidence interval [CI] 0.25-1.23 at 10 yr; OR 0.51, 95% CI 0.24-1.06 at 15 yr). There was no significant difference in OS between SBC and PBC in the overall cohort. However, among patients requiring radical cystectomy (RC), SBC resulted in a significant decrease in OS in comparison to PBC (HR 1.55, 95% CI 1.06-2.26; p = 0.02).

Conclusions and clinical implications: All RT modalities increased the risk of SBC at each post-RT time point investigated. SBC patients requiring RC have worse survival than those with PBC. Our results highlight the need for ongoing surveillance and early detection. Despite the rarity of SBC, clinicians should monitor bladder symptoms in PC patients after RT. These data need to be included in the shared decision-making process with patients regarding therapeutic decisions to raise awareness of SBC in this setting.

For selected endourological interventions, local anesthesia provides an alternative to general anesthesia and can avoid complications and reduce turnover times and health care costs. Virtual reality (VR) has emerged as a promising nonpharmacological adjunct with potential to improve local anesthesia tolerability. This mini-review examines the role of VR during urological procedures under local anesthesia. Ten studies were included from 559 screened articles. For more invasive procedures, VR use was often associated with significant pain and anxiety reductions, while other studies reported minimal effects. VR effectiveness varied according to the invasiveness of the procedure, patient anxiety, and VR content. While VR shows potential in urology, further research is needed to confirm its effectiveness across various interventions. PATIENT SUMMARY: We reviewed studies on the use of virtual reality to reduce pain and anxiety during urological procedures. The current evidence shows promise, but more studies in urology are needed in this emerging field.

We analyzed data for a cohort of 111 patients with EMBARK-like biochemical recurrence (BCR) of prostate cancer (prostate-specific antigen [PSA] doubling time ≤9 mo, PSA ≥1 ng/ml) after radical prostatectomy and localized oligorecurrence on prostate-specific membrane antigen (PSMA)-based imaging. All patients underwent PSMA-radioguided surgery (RGS). At PSMA-RGS, the median PSA was 1.95 ng/ml (interquartile range [IQR] 1.36-3.20) ng/ml and the median PSA doubling time was 4.0 mo (IQR 2.5-5.5). Clavien-Dindo grade >IIIa complications occurred in nine of 111 patients (8.1%). A complete biochemical response (cBR; PSA decline ≤0.2 ng/ml after PSMA-RGS) was observed in 53 patients (47.7%). In the cBR group (equivalent to the treatment suspension criterion in EMBARK), estimated survival rates at 2 yr were 49.9% (95% confidence interval [CI] 37.2-67.1%) for BCR-free survival and 65.2% (95% CI 52.2-81.4%) for treatment-free survival. A relevant proportion of our PSMA-RGS cohort with localized oligorecurrence on PSMA-based imaging fulfilled the EMBARK criteria. PSMA-RGS yielded meaningful biochemical responses that translated to long-lasting treatment-free periods. PATIENT SUMMARY: For some patients with prostate cancer and no evidence of metastasis on conventional imaging but high risk of metastatic progression, modern molecular imaging identifies small cancer deposits that can be removed via targeted surgery. This surgery led to a significant decrease in PSA (prostate-specific antigen) levels, which allowed a longer break from further treatment.

Dysbiosis may hinder effective tumor immunity and reduce the efficacy of therapies such as immune checkpoint blockade (ICB) in renal cell carcinoma (RCC). CBM588, a product containing live Clostridium butyricum, has shown promise in enhancing ICB effectiveness in metastatic RCC in terms of response rates and progression-free survival. Further research to confirm these findings should take factors such as diet and microbiome composition into account and include predictive biomarkers for patient selection.

After identifying a urinary microbiota, new insights have emerged into how urinary tract infections (UTIs) develop and recur in women. This review explores factors influencing the urinary microbiome, and its role in UTI susceptibility and recurrence. Age, menopausal status, estrogen, and prior UTIs can impact the urinary microbiome significantly, with estrogen promoting predominance of beneficial Lactobacillus species in women. Study of the urinary microbiome has identified anaerobic bacteria as emerging uropathogens, as well as microbiome species that are markers of recurrent UTI susceptibility. UTIs also impact microbiome functions, including disrupting microbiome scaffolding sites (ie, glycosaminoglycans) and enriching antibiotic resistance genes. A clear link is becoming established between the natural flora of the human urinary tract and UTI susceptibility, which is also impacted by aging and the menopausal transition. Deepening this understanding can lead to the development of a new generation of UTI therapeutic and preventative strategies aimed at modulating the urinary microbiome. PATIENT SUMMARY: A clear link is becoming established between the natural flora of the human urinary tract and urinary tract infection (UTI) susceptibility, which is also impacted by aging and the menopausal transition. Deepening this understanding can lead to the development of a new generation of UTI therapeutic and preventative strategies aimed at modulating the urinary microbiome.

Advancements in microbiome research reveal its impact on cancer treatment outcomes, particularly in renal cell carcinoma (RCC). While immune checkpoint inhibitors (ICIs) have improved survival in metastatic RCC, composition of the gut microbiome has the potential to influence their efficacy. Antibiotic-induced microbiome disruptions correlate with diminished outcomes, while strains such as Akkermansia muciniphila, Clostridium butyricum, and others enhance immune responses and progression-free survival. Some prebiotics such as inulin gel can alter the gut flora to overcome the resistant strains occurring in response to immune therapy. This mini-review explores microbiome-targeted interventions, such as pre/probiotics and fecal microbiota transplantation, for overcoming ICI resistance. Although promising, prospective randomized trials are needed to standardize clinical applications and optimize microbiome-targeted treatments. The standard use of gut-modulating therapy cannot be recommended at present outside of clinical trials. A double-blind placebo-controlled randomized trial of ICI ± gut modulating therapy is being planned in frontline therapy of advanced RCC (BIOFRONT trial by the Southwest Oncology Group).

Microbiome research has the potential to provide valuable information regarding the complex relationship between microbial communities and the human body. To help facilitate the translation of this potentially revolutionary research to clinical medicine, common guidelines and best practices are necessary. These guidelines should be based on the key findings of recent research in the field and address the primary areas of discrepancy in the previously published literature. Based on this review's findings, future microbiome research should adopt a consistent and clear approach to nomenclature, using standardized terminology to mitigate confusion. Additionally, only sample collection methods proven to reduce the risk of contamination should be utilized. While sample storage often creates difficulty in microbiome research, there are proven techniques that can improve results. With the wide array of research methodologies in the literature, standardization of metadata collection, kits, and analysis software could also be beneficial. Finally, documentation and records are critical in ensuring reproducibility, as is the case with all basic research. This brief review provides a foundation for evidence-based guidelines in microbiome research. PATIENT SUMMARY: This report outlines general guidelines and best practices for conducting microbiome research, which could significantly advance the field of medicine.

Benign prostatic hyperplasia is a prevalent condition leading to male lower urinary tract symptoms (mLUTS), particularly in aging populations. Current management strategies-spanning watchful waiting, pharmaceutical therapy, and surgical interventions such as transurethral resection of the prostate-face significant limitations, including side effects, low adherence, and patient hesitancy toward invasive treatments. First-line interventional therapy (FIT) emerges as a novel paradigm bridging the gap between medications and surgery. FIT aims to provide effective, minimally invasive symptom relief with rapid recovery, minimal side effects, and preserved treatment adaptability. Recent advancements in minimally invasive surgical therapies (MISTs) highlight potential; yet existing MIST procedures often fall short of meeting the FIT criteria. An ideal FIT would integrate outpatient feasibility, durability, and patient-centered outcomes, addressing both urologist and patient expectations. By reimagining treatment pathways, FIT has the potential to revolutionize mLUTS management, shifting the standard of care toward early, effective, and patient-friendly interventions, ultimately improving quality of life and long-term bladder health. PATIENT SUMMARY: In this report, we explored new treatment options for men with urinary symptoms caused by an enlarged prostate. We found that many men avoid surgery due to its risks and side effects, while medications often have limited success and unwanted effects. We suggest a new type of treatment, called first-line interventional therapy, which could provide faster symptom relief with fewer risks and quicker recovery, offering a better option for many patients.