European urology focus最新文献

The management of non-muscle-invasive bladder cancer (NMIBC) is undergoing a major paradigm shift driven by molecular biomarkers, artificial intelligence (AI), and a better understanding of the tumor microenvironment and bladder microbiome. Traditional risk stratification based on stage and grade fails to capture the biological heterogeneity of NMIBC and its variable clinical behavior. Recent evidence highlights the prognostic and dynamic value of urinary and circulating tumor DNA for detecting aggressive disease, anticipating recurrence, and guiding treatment escalation. In parallel, AI-based models that integrate clinicopathological variables and computational histology significantly outperform current guideline-based risk calculators and thus allow refined patient stratification. Furthermore, emerging data demonstrate that immune infiltration patterns and microbiome composition influence response to intravesical therapies, particularly bacillus Calmette-Guérin. Together, these advances support a unified molecular-digital framework that integrates biomarkers, AI, and immunomicrobial profiling to personalize surveillance and treatment strategies. This evolving approach hold promise for optimizing bladder preservation and improving oncological outcomes in NMIBC. PATIENT SUMMARY: Combining tumor DNA tests, artificial intelligence tools, and analysis of the immune and microbial environment in the bladder may improve assessment of risk for patients with non-muscle-invasive bladder cancer. This approach could allow more personalized treatment and follow-up.

Background and objective: Surgical treatments for benign prostatic hyperplasia (BPH) have expanded with the diffusion of minimally invasive surgical treatments (MISTs), but concerns persist regarding their long-term durability. This study aimed to provide a comprehensive, real-world description of current treatment trends, retreatment rates, and medication reinitiation up to 5 yr following MISTs and traditional procedures.

Methods: This observational retrospective fixed-cohort study was conducted using Epic Cosmos, including data of 6 450 295 patients and 420 611 procedures between 2014 and 2024. The primary outcome was procedural trend; the secondary outcomes were surgical retreatment and medication reinitiation. Analyses were descriptive and unadjusted for potential confounders due to the aggregated nature of the dataset.

Key findings and limitations: At 5 yr, retreatment rates were higher after prostatic urethral lift (PUL; 16%), transurethral needle ablation of the prostate (15%), transurethral microwave thermotherapy (17%), and Rezūm (14%), and lower after holmium laser enucleation of the prostate (HoLEP)/thulium laser enucleation of the prostate (ThuLEP; 4.4%) and simple prostatectomy (1.2%) when compared with transurethral resection of the prostate (TURP; 7.1%). Medication reinitiation at 5 yr was more common after MISTs (PUL: 21% α-blockers, 25% 5α-reductase inhibitors [5-ARIs], and 27% overactive bladder [OAB] drugs; all p < 0.001; Rezūm: 18% α-blockers, p = 0.001; 22% 5-ARIs, p = 0.05; and 23% OAB drugs, p > 0.99) and lower following traditional procedures, including HoLEP/ThuLEP-11% α-blockers (p < 0.001), 12% 5-ARIs (p < 0.001), and 21% OAB drugs (p = 0.3), and simple prostatectomy-5.4% α-blockers (p < 0.001), 6.5% 5-ARIs (p < 0.001), and 9.4% OAB drugs (p < 0.001), when compared with TURP (15% α-blockers, 17% 5-ARIs, and 23% OAB drugs). Limitations include the use of aggregated electronic health record data subject to coding errors and the inability to adjust for clinical variables such as prostate size and symptom severity.

Conclusions and clinical implications: In this large, real-world cohort, anatomical procedures such as HoLEP, ThuLEP, and simple prostatectomy were associated with the lowest long-term rates of retreatment and medication restart, whereas higher rates were observed with MISTs, particularly PUL and Rezūm. TURP remained the most performed procedure. As the use of MISTs declines after its initial uptake, future studies should clarify which patient characteristics may underlie these observed differences.

Background and objective: This aim of this international expert consensus project was to clarify the appropriate use of urodynamics (UDS) in men with bothersome lower urinary tract symptoms (LUTS) who are considering prostate surgery in light of high-quality published evidence, particularly high-certainty data from the UPSTREAM study, and expert clinical experience.

Methods: A modified version of the Delphi method was used. Postsurgical patients, catheterised patients, and patients with neurological disease were not included. Eight questions covered UDS in specific contexts; four addressed quality assurance.

Key findings and limitations: Consensus was reached on the need for UDS in any of the following circumstances: if the corrected maximum flow rate is ≥13 ml/s; if bothersome urinary urgency is present; if scores are below stated thresholds for overall symptoms or voiding symptoms; if the postvoid residual volume is considered meaningfully elevated; if there is extensive comorbidity; and if incontinence (any type) is identified. Consensus was not reached on the need for UDS in men with scores below the stated threshold for the impact on quality of life. Consensus was achieved for quality assurance in terms of cross-checking UDS pressure traces and derived indices; ensuring the trustworthiness of traces by experienced health care professionals; and review within the individual clinical context. UDS was considered important when benign prostatic obstruction (BPO) is less likely and in cases in which detrusor underactivity or overactivity is more likely. In cases with severe voiding symptoms, UDS was not considered necessary to increase confidence in recommending surgery to treat LUTS.

Conclusions and clinical implications: UDS retains an important role in men with bothersome LUTS considering surgery for presumed BPO. Our consensus recommends specific criteria to guide selective UDS use.

Background and objective: Radiomics and artificial intelligence (AI)-based imaging models offer a noninvasive approach to preoperative risk stratification in localized renal cell carcinoma (RCC), where existing prognostic tools remain limited. We conducted a systematic review and meta-analysis to evaluate their predictive performance and methodological quality for recurrence and survival outcomes.

Methods: A systematic review was conducted in PubMed and Scopus from inception through April 2025. Radiomics and AI models were assessed for prognostic accuracy regarding 5-yr fixed-time recurrence-free survival (RFS) and overall survival after surgery for localized RCC. The extracted data included model type, radiomic features, validation methods, and area under the curve (AUC). Methodological quality was assessed using the APPRAISE-AI framework. Pooled 5-yr AUCs were synthesized using a prespecified random-effect model; heterogeneity was quantified (Q and τ²) and explored using a prespecified analysis restricted to external validation-only cohorts and sensitivity analyses.

Key findings and limitations: Thirty studies (n = 17 639) were included, predominantly retrospective and computed tomography (CT) based. The most predictive and frequently retained radiomic features were from the gray-level co-occurrence matrix and shape families. A meta-analysis of 20 radiomic model cohorts showed a pooled AUC of 0.87 (95% confidence interval [CI]: 0.84-0.90) for 5-yr RFS (Q = 271.08; p < 0.001; τ² = 0.0037). External validation cohorts showed a pooled AUC of 0.86 (95% CI: 0.83-0.88; Q = 12.81; p = 0.172; τ² = 0.0004). APPRAISE-AI revealed overall moderate methodological quality (median score: 54/100), with limited adherence to TRIPOD-AI and underuse of explainability tools.

Conclusions and clinical implications: Radiomic models for localized RCC built on standardized CT protocols and robust segmentation, and incorporating shape and texture features combined with clinical variables demonstrated high prognostic accuracy. Our meta-analysis confirms that such models predict recurrence and survival outcomes accurately.

Background and objective: Treatment options for metastatic or recurrent penile squamous cell carcinoma (PSCC) progressing after first-line platinum-based chemotherapy are limited, and no standard subsequent-line systemic therapy exists. We systematically reviewed the efficacy, safety, and survival outcomes of second- and later-line systemic treatments in this setting.

Methods: A systematic review, compliant with the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, was performed across PubMed, Scopus, Embase, Medline, Web of Science, ClinicalTrials.gov, Cochrane Central Register of Controlled Trials (CENTRAL), and International Clinical Trials Registry Platform (from inception to June 2025). Eligible studies enrolled adult males receiving systemic chemotherapy, immunotherapy, or targeted therapy after progression on first-line treatment. The primary outcomes were overall (OS) and progression-free (PFS) survival; the secondary outcomes included objective response rate, disease control rate, duration of response, adverse events (AEs), and quality of life (QoL).

Key findings and limitations: Seventeen studies (seven nonrandomized trials and ten case series; 367 patients) were included. Evidence quality was low due to small cohorts, heterogeneity, and potential bias. The reported median OS ranged from 4.3 to 9.5 mo and PFS ranged from 1.3 to 4.8 mo. Targeted therapies showed the most favorable OS (6.7-9.5 months) and lowest grade 3-4 AE rates (0-30%), followed by immunotherapy and chemotherapy. Biomarker-driven benefit was observed in patients with human papillomavirus positivity, programmed death-ligand 1 expression, or actionable genomic alterations (eg, PIK3CA, RAD51, and NOTCH1). QoL data were reported in only two studies, underscoring a major evidence gap. Interpretation is limited by the absence of randomized studies, inconsistent reporting, and the inability to distinguish second-line from later-line therapies in most studies.

Conclusions and clinical implications: No standard systemic therapy exists beyond first-line treatment for metastatic or recurrent PSCC. Targeted agents and immune checkpoint inhibitors show encouraging activity in biomarker-selected subgroups. Prospective biomarker-guided trials and international collaborations are needed, while multidisciplinary management and clinical trial enrollment remain essential for optimizing outcomes for this rare malignancy.