European urology focus最新文献

The management of high-grade renal trauma has shifted towards conservative strategies; however, failure of nonoperative management may result in significant morbidity. We systematically reviewed articles reporting on management outcomes published up to August 2025. Among 11 studies involving 746 patients, conservative management was attempted for 89% of grade 4 injuries and 51% of grade 5 injuries, with failure rates for conservative treatment ranging from 4% to 38% across studies. One study identified perinephric hematoma rim distance and intravascular contrast extravasation as potential predictors of treatment failure, although these findings require validation. While most grade 4 injuries can be managed conservatively, grade 5 injuries often require intervention. PATIENT SUMMARY: We looked at conservative treatments for kidney injuries. Most patients with grade 4 injuries can be successfully treated without surgery, whereas grade 5 injuries often need a surgical procedure.

Background and objective: Direct-to-consumer (DTC) telemedical platforms facilitate the discreet management of sensitive medical conditions, including erectile dysfunction. We aimed to use a large dataset to generate a head-to-head comparison on the efficacy, onset of action, and adverse events (AEs) of phosphodiesterase type 5 inhibitors (PDE5is).

Methods: Data for this retrospective cohort study were obtained from a data pool of 132 100 patients treated with sildenafil, tadalafil, or vardenafil. Efficacy, onset of action, and AEs collected by digital questionnaires were used as the primary endpoints. Group comparisons between intermediate/high and low doses of the respective PDE5is were performed for AEs (sildenafil, tadalafil, and vardenafil) and efficacy as well as onset of action (sildenafil vs tadalafil).

Key findings and limitations: Medium (50 mg) and high (100 mg) doses of sildenafil improved patient satisfaction (mean change in score ± standard deviation [SD] 2.534 ± 1.3 vs 2.235 ± 1.4, p < 0.0001) and sexual performance (mean change in score ± SD for hardness: 2.245 ± 1.2 vs 2.105 ± 1.3, p < 0.0001, and for maintenance: 2.264 ± 1.2 vs 2.120 ± 1.3, p < 0.0001), compared with similar doses of tadalafil (10 and 20 mg). Sildenafil (35.0%, 3572/10 201) and tadalafil (33.9%, 2225/6564) revealed similar AE rates (d = 0.011, 95% confidence interval [CI]: -0.0037 to 0.0257, p = 0.1424), but vardenafil revealed higher rates (47.4%, 268/565) than sildenafil (d = -0.124, 95% CI: -0.166 to -0.082, p < 0.0001). Nasal congestion was the most common AE across all PDE5is concerning medium/high doses. Sildenafil was less likely to cause reflux compared with tadalafil (5.3%, 536/10 201 vs 8.0%, 523/6564; d = -0.027, 95% CI: -0.035 to -0.019, p < 0.0001). Conversely, tadalafil was less associated with flushing (7.3%, 438/10 201 vs 152/6564; d = 0.02, 95% CI: 0.014-0.025, p < 0.001). Limitations include a relatively healthy patient population.

Conclusions and clinical implications: PDE5i usage is associated with distinct efficacy and AE profiles in a large real-world dataset guiding treatment recommendations for urologists. Future DTC data might be used to complement clinical trial data.

Novel therapeutic options are needed to extend disease control and survival for patients with metastatic castration-resistant prostate cancer (mCRPC) after docetaxel. Cohort G of the phase 1b/2 KEYNOTE-365 study evaluated the efficacy and safety of vibostolimab coformulated with pembrolizumab in participants with docetaxel-pretreated mCRPC. Eligible participants with mCRPC whose disease progressed following docetaxel received vibostolimab 200 mg coformulated with pembrolizumab 200 mg intravenously every 3 wk for up to 35 cycles. Primary endpoints were the prostate-specific antigen (PSA) response rate, the objective response rate (ORR) according to Response Evaluation Criteria in Solid Tumors (RECIST) v1.1 by blinded independent central review, and safety. Forty participants received the study treatment. The median follow-up was 10.2 mo (interquartile range 9.5-12.2). The confirmed PSA response rate in the overall cohort was 18% (95% confidence interval [CI] 7.3-33%). The ORR in the subgroup with RECIST-measurable disease (n = 29) was 6.9% (95% CI 0.80-23%). Treatment-related adverse events (TRAEs) occurred in 25 participants (63%); pruritus (25%), nausea (10%), and rash (7.5%) were the most common. Grade 3-5 TRAEs occurred in nine participants (23%). One treatment-related death (due to pulmonary embolism) occurred. Vibostolimab coformulated with pembrolizumab had limited antitumor activity in participants with mCRPC previously treated with docetaxel. The AE profile was manageable and consistent with the profiles of each agent. PATIENT SUMMARY: There is a need for new treatments for patients with metastatic prostate cancer that no longer responds to hormone therapy. We looked at whether a combination of two immunotherapy drugs called vibostolimab and pembrolizumab has antitumor activity with manageable side effects in a group of these patients who had already received chemotherapy. We found that this combination had limited antitumor activity, with side effects as expected for the two drugs individually. The KEYNOTE-365 trial is registered on ClinicalTrials.gov as NCT02861573.

Background and objective: The optimal patient position for percutaneous nephrolithotomy (PCNL) remains a matter of debate. Our aim was to evaluate the association between prone versus supine positioning and perioperative and postoperative outcomes of suction mini-PCNL.

Methods: In this prospective multicenter observational study, we analyzed data for 1534 patients treated in 30 centers between March and November 2024. Outcomes included the stone-free rate (SFR) assessed via 30-d computed tomography, and complication rates. Multivariable analysis was used to assess the effect of prone positioning on stone-free status (zero fragments) and overall complications, with adjustment for other covariates.

Key findings and limitations: There were 653 patients (43%) in the prone group and 881 (57%) in the supine group. Patient demographics were similar between the groups, except for body mass index. In terms of Guy's stone score, the prone group had a higher proportion of score 1 stones (60% vs 47%) and the supine group a higher proportion of score 4 stones (6.9% vs 3.2%). Median stone volume did not differ significantly, at 1636 mm³ in the supine group and 1725 mm³ in the prone group (p = 0.7). The prone group had more frequent use of spinal anesthesia (68% vs 29%; p < 0.001), fluoroscopy-only guidance (86% vs 61%; p < 0.001), and supracostal access (36% vs 22%; p < 0.001). Surgical time, pain scores, hospital length of stay, and readmission rates were similar between the groups. Zero-fragment stone-free rates were comparable (85% prone vs 81% supine; p = 0.052). Prone position was associated with higher rates of blood transfusion (2.8% vs 0%; p < 0.001), renal pelvic perforation (2.8% vs 0.23%; p < 0.001), and pneumothorax (1.5% vs 0%; p < 0.001). Multivariable analysis revealed that prone positioning was not significantly associated with grade A stone-free status (odds ratio 0.92, 95% confidence interval [CI] 0.66-1.29; p = 0.6) or the overall complication rate (odd ratio 0.87, 95% CI 0.59-1.28; p = 0.5). The nonrandomized study design may have introduced selection bias and limited our ability to establish causal relationships between variables.

Conclusions and clinical implications: Both prone and supine positioning for PCNL achieved excellent SFRs with acceptable safety profiles.

Background and objective: Treatment options have evolved for metastatic castration-resistant prostate cancer (mCRPC). The aim of our study was to examine real-world (RW) treatment patterns and survival for individuals with mCRPC via a systematic literature review of RW observational studies.

Methods: Electronic databases (PubMed, Embase, and the Cochrane Library) and key conferences (2022-2025) were systematically searched for reports published between January 2015 and June 2025 on treatment patterns and RW overall survival (OS) in mCRPC.

Key findings and limitations: From 7727 articles retrieved, 45 studies met the inclusion criteria. Most studies were from the USA. Bone metastases were present in ≥80% and visceral metastases in ≤28% of cases at mCRPC diagnosis. Androgen receptor pathway inhibitors (ARPIs) were the first-line treatment most frequently used for mCRPC (≥50% in most studies). Chemotherapy was the second most common first-line mCRPC treatment and was more common in Europe and Oceania than in the USA. Use of radiopharmaceuticals, olaparib, and sipuleucel-T in first-line mCRPC was low in most studies (<10%). ARPI-to-ARPI from the first to the second line was the most common sequence in the US studies. Median RW OS was ≤34 mo from either mCRPC diagnosis or initiation of first-line mCRPC treatment in most studies.

Conclusions and clinical implications: The findings showed that ARPIs are the most frequent first- and second-line treatments in mCRPC, and back-to-back ARPI sequencing is also common practice, especially in the USA, despite the availability of therapies beyond ARPIs. The findings highlight the need to optimize treatment beyond systemic hormone therapy in this setting.

Background and objective: An artificial urinary sphincter (AUS) is a gold standard treatment for moderate to severe male stress urinary incontinence (SUI). The objective of this study was to evaluate whether self-reported toileting behaviors are associated with quality of life (QOL) following AUS implantation.

Methods: Artificial Urinary Sphincter Clinical Outcomes (AUSCO) is a prospective, multicenter study evaluating the AMS 800 AUS in men with primary SUI. A total of 115 participants were implanted at 17 sites, with follow-up at 3, 6, and 12 mo. Patients with predominant overactive bladder symptoms were preoperatively excluded from participation. Participants reported on incontinence events (voiding diaries), toileting habits, device use, and satisfaction. QOL was assessed via questionnaires such as the Incontinence Quality of Life (I-QOL), Incontinence Impact Questionnaire (IIQ-7), and EQ-5D-5L.

Key findings and limitations: Of the participants, 94% achieved ≥50% reduction in pad weight and 92% reported satisfaction at 12 mo. Significant improvements were observed in I-QOL, IIQ-7, and EQ-5D-5L scores (p < 0.001). Reduction in pad weight and ease of device use were strong predictors of both satisfaction and QOL improvement. Voiding diary-based stress and urgency incontinence events declined significantly, but changes in toileting habits (eg, sitting vs standing and urinal vs stall use) were minimal and not associated with satisfaction. Postvoid dribbling persisted in 68% of patients at 12 mo, despite an improvement from baseline (p = 0.02). Functional limitations in self-care and mobility predicted more difficulty in using the device.

Conclusions and clinical implications: AUS implantation results in high satisfaction and substantial improvements in continence and QOL at 1 yr. Ease of use and effectiveness are key drivers of satisfaction, while toileting behaviors appear largely unchanged following implant. These findings offer valuable insights to guide preoperative counseling and patient selection.

Background and objective: Socioeconomic disparities in opportunistic prostate-specific antigen (PSA) testing for prostate cancer (PCa) are well known. To explore whether the introduction of organised prostate cancer testing (OPT) was associated with reduced disparities, we compared associations between socioeconomic status and PSA testing among invited and ineligible men.

Methods: A register- and population-based cohort study was conducted including all men in Stockholm County invited to OPT in 2022-2023 (OPT invitees, aged 50 yr, born in 1972-1973) and a concurrently ineligible control group (OPT ineligible, aged 52-53 yr, born in 1969-1971). A sensitivity analysis included men aged 50-51 yr in 2017-2018 (born in 1966-1968). Associations with PSA testing were analysed using logistic regression, with educational level, civil status, income, and birth country/region as socioeconomic indicators. Z tests compared associations between cohorts.

Key findings and limitations: A total of 33 754 OPT invitees and 76 535 OPT-ineligible men were included. PSA testing was higher among OPT invitees (39%) than among OPT-ineligible men (13%) across all socioeconomic strata. In adjusted models, higher education was associated with increased testing among OPT invitees (odds ratio [OR] 1.88, 95% confidence interval [CI] 1.73-2.06), but not among OPT-ineligible men (OR 1.03, 95% CI 0.94-1.12; p < 0.001). Income was associated with increased testing in both groups, particularly among OPT-ineligible men (OR 3.56, 95% CI 3.28-3.87 compared to 2.18, 95% CI 2.01-2.37; p = 0.006). Being born outside the Nordic countries was associated with lower uptake among OPT invitees. The sensitivity analysis aligned with the main findings. Limitations include potential residual confounding.

Conclusions and clinical implications: While OPT increased PSA testing overall, socioeconomic disparities persisted. Targeted strategies are needed to ensure equitable participation.