European urology focus最新文献

Chronic urinary infection may have implications for disease because of reactivation of toxins in the urine or damage to bladder defences. Exploration of these possibilities requires a scrupulous scientific approach.

Background and objective: Bladder cancer (BLCa) remains a prevalent malignancy with high recurrence rates and limited treatment options. In recent years, patient-derived organoids (PDOs) have emerged as a promising platform for studying cancer biology and therapeutic responses in a personalized manner. Using drug screening, PDOs facilitate the identification of novel therapeutic agents and translational treatment strategies. Moreover, their ability to model patient-specific responses to treatments holds promise for predicting clinical outcomes and guiding treatment decisions. This exploratory review aims to investigate the potential of PDOs in advancing BLCa research and treatment, with an emphasis on translational clinical approaches. Furthermore, we analyze the feasibility of deriving PDOs from minimally invasive blood and urine samples.

Methods: In addition to exploring hypothetical applications of PDOs for predicting patient outcomes and their ability to model different stages of BLCa, we conducted a comprehensive PubMed search on already published data as well as comprehensive screening of currently ongoing trials implementing PDOs in precision medicine in cancer patients irrespective of the tumor entity.

Key findings and limitations: While the research on BLCa PDOs is advancing rapidly, data on both BLCa PDO research and their clinical application are scarce. Owing to this fact, a narrative review format was chosen for this publication.

Conclusions and clinical implications: BLCa PDOs have the potential to influence the domain of precision medicine and enhance personalized cancer treatment strategies. However, standardized protocols for PDO generation, their ideal clinical application, as well as their impact on outcomes remain to be determined.

Patient summary: In this review, we discuss the current state and future needs for the use of patient-derived organoids, small three-dimensional avatars of tumor cells, in bladder cancer. Patient-derived bladder cancer organoids offer a more personalized approach to studying and treating bladder cancer, providing a model that closely resembles the patient's own tumor. These organoids can help researchers identify new treatment options and predict how individual patients may respond to standard therapies. By using minimally invasive samples such as blood and urine, patients can participate in research studies more easily, potentially leading to improved outcomes in bladder cancer treatment.

Antimicrobial peptides (AMPs) play a pivotal role in the innate immune system as a frontline defense against microbial threats. AMPs can serve as biomarkers and alternative antibiotics, overcoming mortality related to multidrug-resistant pathogens in urinary tract infections (UTIs). While the relevance of AMPs in UTIs has been validated and AMP drugs approved by the US Food and Drug Administration are in clinical use, information about their modification status, regulation, and mechanism of action remains sparse. Only a small fraction of sequences with potential AMP activity, predicted on the basis of known AMP characteristics, have been validated. Elucidation of the global profile of AMPs in the bladder, kidney, and urine under UTI conditions would facilitate an in-depth, disease-specific understanding of the innate immune system and the development of tailored AMP biomarkers and antibiotics. This mini-review focuses on a comprehensive strategy for global profiling and validation of AMPs in UTIs that incorporates AMP data repositories, prediction algorithms, and proteomics for healthy individuals and UTI patients. PATIENT SUMMARY: Short protein molecules called peptides that have antimicrobial activity show promise for the treatment of urinary tract infections. More research and testing of naturally occurring and synthetic peptides with this activity are needed to fully understand how they can help in patient care.

Urinary tract infection (UTI) is common among older individuals, especially those with frailty and comorbidity. Asymptomatic bacteriuria is also common in this group and does not require treatment. UTI diagnosis is complicated by atypical signs and symptoms such as confusion or functional decline. This necessitates a more holistic assessment according to a diagnostic algorithm that includes nonspecific symptoms to avoid overdiagnosis or underdiagnosis. Treatment strategies for UTI in older people generally align with those for younger people, with some exceptions. Prophylaxis is similar to that for postmenopausal women. However, it is crucial to carefully consider comorbidities, polypharmacy, and the risk of potential adverse events. PATIENT SUMMARY: We provide recommendations for the management of urinary tract infection (UTI) in older individuals who are frail and have multiple medical conditions. These patients may have signs and symptoms that are not typical for UTI. Treatment plans for these vulnerable patients should take interactions with other drugs and possible side effects into account.

Both the CheckMate-901 (gemcitabine-cisplatin plus nivolumab) trial and the EV-302 (enfortumab-vedotin plus pembrolizumab; EV+P) trial have shown a significant improvement in OS over standard (cis)platinum-based chemotherapy. The effect size, as well as the broader eligibility criteria for EV+P position this regimen as a compelling preferred candidate for the new standard of care in front-line mUC treatment.

Background and objective: Major urological guidelines do not currently recommend robot-assisted surgery compared with laparoscopic or open surgery due to the lack of high-quality evidence. We aimed to provide real-world data on the evolution of robotic urology and to compare its perioperative outcomes with those of laparoscopic and open surgeries.

Methods: We used the GeRmAn Nationwide inpatient Data (GRAND), provided by the Research Data Center of the Federal Bureau of Statistics (2005-2021), and performed multiple patient-level analyses. We included patients undergoing major urological surgeries and report the largest study in the field with 993 276 patients.

Key findings and limitations: An open approach was performed in 733 416 cases, a laparoscopic approach in 109 428, and a robot-assisted approach in 150 432. Overall, 442 811 (45%) patients underwent radical prostatectomy, 129 943 (13%) radical cystectomy, 192 340 (19%) radical nephrectomy, 123 648 (12%) partial nephrectomy, 56 114 (5.6%) nephroureterectomy, and 48 420 (4.9%) pyeloplasty. The number of patients undergoing robot-assisted surgery increased exponentially, while the number of patients undergoing open surgery decreased substantially throughout the past few years. Patients undergoing minimally invasive surgery displayed slightly better, but clinically insignificant, baseline characteristics. After adjusting for the major risk factors in the multivariate regression analysis, robotic versus open surgery was associated with significantly lower odds of mortality for all five major oncological surgeries and with lower odds of intensive care unit admission, transfusion, and length of hospital stay for all six major urological surgeries.

Conclusions and clinical implications: Robotic surgery is becoming the mainstay in major urological operations.

Patient summary: Patients selected for robotic surgery in Germany presented better perioperative outcomes compared to those operated with an open approach.

Urinary tract infections (UTIs) are frequently associated with lower urinary tract dysfunction (LUTD). Urodynamic investigation (UDI) is the gold standard for assessing LUTD, but its value in identifying UTI risk factors remains underexplored. Studies have shown high rates of storage and voiding dysfunction in patients with recurrent UTIs, suggesting a causal link between LUTD and UTIs. Specific UDI findings, such as low bladder capacity, high detrusor pressures, and detrusor overactivity, have been associated with greater UTI risk, especially in kidney transplant recipients and infants. However, the current evidence is limited by the lack of control groups and therapeutic interventions, making it difficult to draw definitive conclusions. Further well-designed studies are needed to determine if UDI-guided therapies can improve UTI management outcomes. PATIENT SUMMARY: Urinary infections are often linked to problems with the lower urinary tract. Tests that measure lower urinary tract function can help in identifying these issues. More research is needed to see if treating bladder problems can prevent urinary infections.

Recurrent urinary tract infections (rUTIs) are common and can significantly impact a patient's quality of life. The mainstay of treatment is antibiotic-based, which contributes to the global problem of antibiotic resistance among urinary pathogens, so many alternative therapies have been explored. In this mini-review we evaluate evidence for intravesical agents that prevent rUTI, including antibiotic and nonantibiotic options. The current evidence supports the use of intravesical agents that replenish the glycosaminoglycan layer and of aminoglycoside antibiotics as safe and effective therapies to prevent rUTI. PATIENT SUMMARY: We reviewed evidence on the use of bladder instillations to treat repeated urinary infections. Studies have shown that agents that improve the bladder surface and one specific antibiotic class are effective and safe treatments for prevention of recurrent infections.