European urology focus最新文献

{"title":"Review of Transperineal and Transrectal Prostate Biopsy Outcomes","authors":"Evan Suzman,&nbsp;B. Malik Wahba,&nbsp;Gal Wald,&nbsp;Aayush Kaneria,&nbsp;Jim C. Hu","doi":"10.1016/j.euf.2025.07.017","DOIUrl":"10.1016/j.euf.2025.07.017","url":null,"abstract":"<div><div>More than 2 million prostate biopsies are performed annually in the USA and Europe, but there is debate over the optimal approach. The procedural time is shorter for transrectal (TR) than for transperineal (TP) biopsy, but prospective randomized trials have demonstrated that TR biopsy has a greater risk of infectious complications and inferior cancer detection rates. As a result, professional guideline recommendations are shifting in favor of TP biopsy. Nevertheless, the TR approach still accounts for the majority of biopsies performed worldwide. Barriers to TP biopsy adoption include limited training opportunities, longer procedure duration, and higher costs in comparison to TR biopsy.</div></div><div><h3>Patient summary</h3><div>A prostate biopsy is carried out for patients who have a suspicion for prostate cancer, but there is debate over the best biopsy approach. Transrectal (TR) biopsy takes less time than transperineal (TP) biopsy. Trials have shown that TR biopsy has a higher risk of infectious complications and a similar cancer detection rate. Guidelines are therefore shifting in favor of TP biopsy, although limited training opportunities, the longer procedure time, and higher costs are barriers to more widespread use of this approach.</div></div>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":"11 6","pages":"Pages 844-847"},"PeriodicalIF":5.6,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144768568","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Estimating the Carbon Emissions of a Single Prostate-specific Antigen Test: Results from a Cradle-to-grave Life Cycle Assessment","authors":"Hanna Zurl ,&nbsp;Stephan M. Korn ,&nbsp;Klara K. Pohl ,&nbsp;Zhiyu Qian ,&nbsp;Andrea Piccolini ,&nbsp;Hari S. Iyer ,&nbsp;Michael S. Leapman ,&nbsp;Sascha Ahyai ,&nbsp;Shahrokh F. Shariat ,&nbsp;Quoc-Dien Trinh ,&nbsp;Cassandra L. Thiel ,&nbsp;Stacy Loeb ,&nbsp;Alexander P. Cole","doi":"10.1016/j.euf.2025.07.006","DOIUrl":"10.1016/j.euf.2025.07.006","url":null,"abstract":"<div><h3>Background and objective</h3><div>The health care sector is a significant contributor to greenhouse gas (GHG) emissions, and assessments of the environmental impacts of health services are essential. We aimed to evaluate the environmental impact of a highly common but controversial urology-specific blood test: the prostate-specific antigen (PSA) test.</div></div><div><h3>Methods</h3><div>A cradle-to-grave life cycle assessment was performed to estimate the emissions of a single PSA test. Primary data collection included laboratory site assessment, disassembly, and weighing of materials. The primary outcome was GHG emissions in grams of carbon dioxide equivalent (CO₂e). The secondary outcome was the health impact attributed to the environmental harm of the test.</div></div><div><h3>Key findings and limitations</h3><div>A single PSA test generates an estimated total of 189.7 g of CO₂e. The majority of emissions (88.2%) were generated by the raw materials, manufacturing, production, and disposal of the blood draw equipment. Annual CO₂e emissions from PSA testing in the USA were estimated at 5 691 000 kg CO₂e, equivalent to driving 14.5 million miles, with a resulting human health impact of 6.6 disability-adjusted life years annually. This study focused on the PSA test itself, and not on emissions from staff, patient, or sample transportation; building infrastructure; or cleaning.</div></div><div><h3>Conclusions and clinical implications</h3><div>Although the carbon footprint of a single PSA test is small, the cumulative impact of the estimated total of 30 million PSA tests performed annually in the USA is substantial, especially when considering that a notable proportion of these tests may be performed on men who are unlikely to benefit.</div></div>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":"11 6","pages":"Pages 1023-1031"},"PeriodicalIF":5.6,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144768567","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Oncologic Outcomes of Template Versus Radioguided Salvage Lymph Node Dissection for Node-only Recurrent Prostate Cancer on Prostate-specific Membrane Antigen Positron Emission Tomography Scan: Results from a Multi-institutional Collaboration","authors":"Carlo Andrea Bravi ,&nbsp;Sophie Knipper ,&nbsp;Axel Heidenreich ,&nbsp;Nicola Fossati ,&nbsp;Giorgio Gandaglia ,&nbsp;Paolo Dell’Oglio ,&nbsp;Nazareno Suardi ,&nbsp;Daniar Osmonov ,&nbsp;Klaus-Peter Juenemann ,&nbsp;Jeffrey Karnes ,&nbsp;Alexander Kretschmer ,&nbsp;Lars Budäus ,&nbsp;Fabian Falkenbach ,&nbsp;Alexander Buchner ,&nbsp;Christian Stief ,&nbsp;Andreas Hiester ,&nbsp;Peter Albers ,&nbsp;Gaetan Devos ,&nbsp;Steven Joniau ,&nbsp;Hendrik Van Poppel ,&nbsp;Tobias Maurer","doi":"10.1016/j.euf.2025.05.019","DOIUrl":"10.1016/j.euf.2025.05.019","url":null,"abstract":"<div><div>In patients treated with salvage lymph node dissection (sLND) for nodal recurrence of prostate cancer, whether radioguided surgery (RGS) might improve oncologic outcomes as compared with template sLND remains unknown. This study included 259 patients who experienced a prostate-specific antigen (PSA) rise and nodal-only recurrence after radical prostatectomy and underwent pelvic sLND at 11 tertiary referral centers between 2012 and 2022. Lymph node recurrence was documented by prostate-specific membrane antigen positron emission tomography scans. The outcomes included biochemical recurrence (BCR) and clinical recurrence (CR) after sLND. The probability of freedom from each outcome was calculated using Kaplan-Meier analyses. A Cox regression analysis was used to test the hypothesis that surgical technique for sLND (template vs RGS) might be associated with oncologic outcomes. Overall, 80 (31%) and 179 (69%) patients received template and radioguided sLND, respectively. PSA level at sLND was higher in the template than in the radioguided group (median: 1.3 vs 0.6 ng/ml; <em>p</em> &lt; 0.0001), whereas the number of positive nodes on final pathology did not differ between the groups (<em>p</em> = 0.13). The first postoperative PSA level was higher in the template than in the radioguided group (median: 0.5 vs 0.1 ng/ml; <em>p</em> &lt; 0.0001). Overall, there were 181 cases of BCR and 76 cases of CR after sLND. The median follow-up for survivors was 21 mo (interquartile range: 7, 36). The 2-yr BCR-free survival rate for patients in the template versus RGS sLND group was 18% (95% confidence interval [CI]: 9%, 29%) versus 30% (95% CI: 22%, 37%). The 2-yr CR-free survival rate for the template versus RGS sLND group was 51% (95% CI: 35%, 65%) versus 73% (95% CI: 65%, 80%). On multivariable analyses, we did not find evidence of a statistically significant difference between the groups with respect to BCR after sLND (<em>p</em> = 0.7), whereas men treated with RGS had a lower risk of CR after sLND than those receiving template sLND (hazard ratio: 0.51; 95% CI: 0.29, 0.92; <em>p</em> &lt; 0.026). Results of the sensitivity analyses were generally consistent with our main findings. Our data suggest that, in men with node-recurrent prostate cancer treated with sLND, RGS may offer important surgical guidance for surgeons, and this may eventually translate into improved oncologic outcomes. Awaiting further evidence on long-term outcomes of RGS, our study represents the most solid comparative data on different techniques for sLND and provides relevant data for counseling patients with node-only recurrent prostate cancer.</div></div>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":"11 6","pages":"Pages 921-925"},"PeriodicalIF":5.6,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144882421","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term Outcomes of Prostatic Artery Embolisation: A Nationwide Prospective Cohort Study","authors":"Anna Kristensen-Alvarez ,&nbsp;Clara Lund-Frank ,&nbsp;Hein Vincent Stroomberg ,&nbsp;Mikkel Fode ,&nbsp;Lars Lönn ,&nbsp;Mikkel Taudorf ,&nbsp;Anne-Sofie Brenøe ,&nbsp;Gitte Maria Jørgensen ,&nbsp;Margrethe Andersen ,&nbsp;Lars Lund ,&nbsp;Andreas Røder","doi":"10.1016/j.euf.2025.08.003","DOIUrl":"10.1016/j.euf.2025.08.003","url":null,"abstract":"<div><h3>Background and objective</h3><div>Lower urinary tract symptoms (LUTS) can severely impair quality of life in men. Prostatic artery embolisation (PAE) is a safe and effective treatment for LUTS. This study aims to assess the complications, treatment effects, and reintervention following PAE.</div></div><div><h3>Methods</h3><div>A multicentre prospective cohort study was conducted using cross-sectional long-term questionnaires, including all PAE patients from 2017 to 2022. PAE was performed in an outpatient setting under local anaesthesia. An interventional radiologist embolises under fluoroscopic guidance, inducing ischaemia and subsequent prostate shrinkage. Adverse events (AEs) and serious adverse events (SAEs) were reported 90 d after PAE. Outcomes were evaluated by the Danish Prostate Symptom Score (DAN-PSS), transrectal ultrasound, uroflowmetry, and urinary catheter cessation. Retreatment was estimated by the Aalen-Johansen estimator.</div></div><div><h3>Key findings and limitations</h3><div>A total of 336 patients were included; the median age was 72 yr (interquartile range [IQR] 66–76 yr), the median prostate volume was 101 cm³ (IQR 81–147 cm³), 88 (26%) were catheter dependent, and the median DAN-PSS of the remaining patients was 30 points (IQR 23–44). An SAE occurred in 26 (7.7%) patients; 132 (39%) experienced postembolisation syndrome and 106 (32%) another minor AE. At 0–6 mo of follow-up, the median DAN-PSS was 6 points (IQR 1–16) and 53/88 (60%) of catheter-dependent patients were catheter free. At &gt;2 yr of follow-up, the median DAN-PSS was 9 points (IQR 3–21). The reintervention rates were 9.5% (95% confidence interval [CI]: 6.3–13%) at 2 yr and 18% (95% CI: 11–25%) at 5 yr. The questionnaire response rate was 79%. The limitations include a lack of proper follow-up data and no control cohort.</div></div><div><h3>Conclusions and clinical implications</h3><div>PAE was proved to be safe, effective, and durable for selected patients in Denmark with severe LUTS, catheter dependency, and large prostates. During the 5-yr follow-up, 18% of patients required retreatment, a finding that should be interpreted in the context of their initially limited treatment options.</div></div>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":"11 6","pages":"Pages 991-998"},"PeriodicalIF":5.6,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144947988","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors Associated with Recovery of Urinary Continence: A Multicenter Comparison of Pelvic Fascia-sparing and Standard Robotic-assisted Radical Prostatectomy","authors":"Gal Wald ,&nbsp;Evan Suzman ,&nbsp;James B. Mason ,&nbsp;Sukhjeevan Nijhar ,&nbsp;Oakley Strasser ,&nbsp;May Ting ,&nbsp;Catherine Pothier ,&nbsp;Vanessa Dudley ,&nbsp;Judy Zhong ,&nbsp;Keith J. Kowalczyk ,&nbsp;Jim C. Hu","doi":"10.1016/j.euf.2025.06.005","DOIUrl":"10.1016/j.euf.2025.06.005","url":null,"abstract":"<div><h3>Background and objective</h3><div>Pelvic fascia-sparing (PFS) approaches during robotic-assisted radical prostatectomy (RARP) may lead to faster and better recovery of urinary continence. However, direct comparisons are limited. We compared continence recovery across standard, anterior PFS (APFS), and posterior PFS (PPFS) RARP approaches.</div></div><div><h3>Methods and surgical procedure</h3><div>We conducted a multicenter retrospective study of 1155 RARP (593 standard, 332 PPFS, and 230 APFS) procedures performed between February 2012 and May 2024. Our primary outcome was urinary continence defined as the use of zero to one pad per day, identified from the Expanded Prostate Cancer Index Composite for Clinical Practice. Multivariable models evaluated the factors affecting early and long-term urinary continence.</div></div><div><h3>Key findings and limitations</h3><div>PPFS and APFS versus the standard approach were associated with improved urinary continence at 3 mo (90%, 83%, and 64%, respectively; <em>p</em> &lt; 0.001), 12 mo (96%, 89%, and 84%, respectively; <em>p</em> &lt; 0.001), and 20 mo (97%, 99%, and 90%, respectively; <em>p</em> &lt; 0.001). In adjusted analyses, PPFS (odds ratio [OR] 3.71; confidence interval [CI] 2.27–6.07; <em>p</em> &lt; 0.001) and APFS (OR 3.54; CI 1.97–6.37; <em>p</em> &lt; 0.001) were associated with improved 3-mo continence compared with standard RARP. Similar results were observed for both PFS approaches at 12 mo. Only PPFS was associated with better long-term continence (20 mo: OR 3.00; CI 1.74–5.17; <em>p</em> &lt; 0.001). However, PPFS had the highest positive surgical margins (standard: 29.5%; PPFS: 37.4%; APFS: 30.0%; <em>p</em> = 0.04). The sequential adoption of techniques from standard RARP to PPFS and then to APFS leads to disparate follow-up and sample sizes as a limitation.</div></div><div><h3>Conclusions</h3><div>PPFS and APFS were associated with better urinary continence recovery, although PPFS was found to have more positive surgical margins. Randomized trials are needed to validate our findings.</div></div><div><h3>Patient summary</h3><div>We compared the recovery rate of urinary continence after three surgical approaches with varying degrees of pelvic fascia sparing (PFS). Our findings suggest that PFS improves short- and long-term urinary continence compared with the standard approach.</div></div>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":"11 6","pages":"Pages 896-903"},"PeriodicalIF":5.6,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144667512","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Role of the Stockholm3 Test in Guiding Confirmation Biopsy Decisions for Patients with Prostate Cancer on Active Surveillance","authors":"Serdar Madendere ,&nbsp;Mert Kılıç ,&nbsp;Erhan Palaoğlu ,&nbsp;Mert Veznikli ,&nbsp;Metin Vural ,&nbsp;Ayşenur İğdem ,&nbsp;Derya Tilki ,&nbsp;Tarık Esen ,&nbsp;Derya Balbay","doi":"10.1016/j.euf.2025.06.016","DOIUrl":"10.1016/j.euf.2025.06.016","url":null,"abstract":"<div><h3>Background and objectives</h3><div>The aim of our study was to assess correlation between Stockholm3 test results, multiparametric magnetic resonance imaging (mpMRI) findings, and confirmation biopsy outcomes in a cohort of patients on active surveillance (AS) for prostate cancer (PC).</div></div><div><h3>Methods</h3><div>The study cohort comprised 26 patients on AS for International Society of Urological Pathology grade group (GG) 1 PC. Repeat MRI and confirmation biopsy following a Stockholm3 test were performed for all. We defined a Stockholm3 score cutoff of ≥15 for higher risk of clinically significant PC (csPC). The sensitivity and negative predictive value (NPV) of the Stockholm3 test and mpMRI for prediction of csPC were assessed.</div></div><div><h3>Key findings and limitations</h3><div>The median age for the study cohort was 63 yr. Median PSA was 4.6 ng/ml and the median Stockholm3 score was 17. Sixteen patients (61.5%) had lesion with a Prostate Imaging-Reporting and Data System (PI-RADS) score of ≥4 on repeat mpMRI. Confirmatory biopsy revealed benign histology in five patients (19.3%), GG 1 PC in 13 patients (50%), and GG &gt;1 PC (upgrading) in eight patients (30.7%). Using a score cutoff of ≥15 for the Stockholm3 test yielded sensitivity of 87.5% and an NPV of 90% for upgrading on confirmatory biopsy. Of 16 patients with a PI-RADS ≥4 lesion on MRI, 43.7% had csPC on confirmatory biopsy. PI-RADS ≥4 had sensitivity of 87.5% and an NPV of 90% for prediction of csPC.</div></div><div><h3>Conclusions and clinical implications</h3><div>For most of our 26 patients on AS with a Stockholm3 score of &lt;15, confirmatory biopsy revealed GG 1 and benign histology. A confirmatory biopsy should be recommended for all patients with PI-RADS ≥4 lesions irrespective of their Stockholm3 score, but could be avoided in cases with negative MRI findings and a Stockholm3 score of &lt;15.</div></div>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":"11 6","pages":"Pages 863-868"},"PeriodicalIF":5.6,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144759515","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of a Perioperative Smoking and Alcohol Cessation Intervention on Health-related Quality of Life in Patients Undergoing Radical Cystectomy: A Randomised Controlled Trial","authors":"Susanne Vahr Lauridsen ,&nbsp;Hanne Tønnesen ,&nbsp;Peter Thind ,&nbsp;Mette Rasmussen ,&nbsp;Thomas Kallemose ,&nbsp;Thordis Thomsen","doi":"10.1016/j.euf.2025.07.009","DOIUrl":"10.1016/j.euf.2025.07.009","url":null,"abstract":"<div><h3>Background and objective</h3><div>The impact of a smoking and alcohol cessation intervention on health-related quality of life (HRQoL) following radical cystectomy (RC) is unclear. This study aimed to evaluate the effect of a 6-wk perioperative smoking and/or alcohol cessation intervention on HRQoL. A secondary objective was to assess the difference in HRQoL between patients with more than two and those with fewer complications.</div></div><div><h3>Methods</h3><div>From 2014 to 2018, 104 patients referred to RC who smoked daily or consumed at least three alcohol units per day were enrolled in a multicentre randomised clinical trial. Participants were assigned to a 6-wk intensive smoking and/or alcohol cessation programme or standard care. The smoking cessation programme had five meetings in 6 wk and was based on the principles of motivational interviewing, balanced decision-making, and the transtheoretical model of change. HRQoL was assessed at baseline, and 6 and 12 mo using the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30 and BLM30 questionnaires. Linear regression models were used to analyse the association between intervention, complications, and HRQoL.</div></div><div><h3>Key findings and limitations</h3><div>There were differences in baseline demographic and lifestyle factors between groups. At the end of intervention, 51% of the intervention group and 27% of the control group quit successfully; after 12 mo, 21% and 36%, respectively, were quitters. No significant differences in HRQoL were found between the intervention and control groups. However, patients with more than two complications had significantly lower HRQoL on the QLQ-C30 scale, while no difference was observed on the BLM30 scale. A study limitation is the nonparticipation rate of 53%.</div></div><div><h3>Conclusions and clinical implications</h3><div>The cessation intervention did not impact HRQoL significantly in patients undergoing RC. However, patients with more than two complications experienced reduced HRQoL, highlighting the importance of identifying at-risk patients preoperatively.</div></div>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":"11 6","pages":"Pages 940-950"},"PeriodicalIF":5.6,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144759514","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incisional Hernia After Transperitoneal Robot-assisted Radical Prostatectomy: A Call for Greater Awareness Among Urologists","authors":"Arthur Peyrottes ,&nbsp;Charles Dariane ,&nbsp;Alexandre Colau ,&nbsp;Maxime Pattou ,&nbsp;Andrei Necsulescu ,&nbsp;Arnaud Méjean ,&nbsp;François Desgrandchamps ,&nbsp;Olivier Oberlin ,&nbsp;Guillaume Ploussard ,&nbsp;Alexandra Masson-Lecomte","doi":"10.1016/j.euf.2025.07.015","DOIUrl":"10.1016/j.euf.2025.07.015","url":null,"abstract":"<div><div>Incisional hernia (IH) is a clinically relevant yet under-reported complication of transperitoneal robot-assisted radical prostatectomy (RARP). As this approach becomes standard, identification of procedure-specific risk factors to inform prevention strategies is essential to improve surgical outcomes for prostate cancer. We conducted an analysis of patients with localised prostate cancer who underwent transperitoneal RARP with supraumbilical specimen extraction between 2020 and 2024 in three academic centres in France. The primary endpoint was IH prevalence at 1 yr. Independent predictors were identified via multivariable analysis. A total of 629 patients were included. Median age was 61 yr (interquartile range [IQR] 66–70), and median prostate-specific antigen was 6.16 ng/ml (IQR 8.18–12). According to the D’Amico classification, 8% of patients had low risk, 75% had intermediate risk, and 17% had high risk. At 1-yr follow-up, 76 patients (12.1%) had developed IH at the supraumbilical extraction site, of whom 53 (70%) underwent surgical repair. Multivariable analysis identified higher body mass index, smoking, and postoperative parietal abscess as independent risk factors for IH. IH is a relatively frequent yet often overlooked complication of RARP. The IH incidence in our study suggests underdiagnosis of this complication, with potential consequences that include bowel obstruction and chronic pain. Optimisation of fascial closure and reconsideration of the extraction site location might reduce IH risk. Systematic imaging for high-risk patients could improve early detection.</div></div><div><h3>Patient summary</h3><div>We looked at the risk of developing a hernia in the abdomen wall after robotic surgery for prostate cancer. We found that these hernias are more common than previously thought, especially in patients with obesity, smoking habits, or wound infections. A careful surgical technique and closer follow-up may help in reducing the risk of this complication and improve outcomes.</div></div>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":"11 6","pages":"Pages 912-914"},"PeriodicalIF":5.6,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144717810","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"In Patients with Muscle-invasive Bladder Cancer Undergoing Radical Cystectomy, Dynamics of Circulating Tumor DNA Following Cystectomy: Association with Patient Outcomes","authors":"Angelos Tasios ,&nbsp;Ursula Amstutz ,&nbsp;Roland Seiler ,&nbsp;Frederike Fuhlbrück ,&nbsp;Natasha Oza ,&nbsp;Nicolas Arnold ,&nbsp;George N. Thalmann ,&nbsp;Beat Roth ,&nbsp;Tobias Grob ,&nbsp;Bernhard Kiss","doi":"10.1016/j.euf.2025.06.018","DOIUrl":"10.1016/j.euf.2025.06.018","url":null,"abstract":"<div><h3>Background and objective</h3><div>Despite various novel therapeutic possibilities for patients with muscle-invasive bladder cancer (MIBC), therapy response varies highly. Circulating tumor DNA (ctDNA) represents a fraction of cell-free DNA released into the bloodstream by apoptotic cell turnover or cell death in the tumor. We investigated whether ctDNA measurements before and after radical cystectomy are associated with disease recurrence.</div></div><div><h3>Methods</h3><div>We prospectively collected plasma, tumor tissue, and germline samples before and after radical cystectomy. Seventy patients had complete data for both pre- and postsurgery analyses. Commonly mutated genes in plasma and tissue, particularly <em>TERT</em> and <em>TP53</em>, were assessed using the AVENIO ctDNA platform (research use only; Roche, Branchburg, NJ, USA) and then evaluated for a potential association with patient outcome measures, including survival and disease recurrence.</div></div><div><h3>Key findings and limitations</h3><div>In the overall study population, patients with negative ctDNA status in postsurgery plasma had significantly longer recurrence-free survival than those with positive ctDNA status (<em>p</em> = 0.01). The ctDNA positivity fell from 46% before surgery to 23% after surgery, and a positive postoperative result predicted recurrence independently. Patients who were ctDNA positive before surgery and converted to ctDNA negative after surgery showed longer survival than those remaining ctDNA positive (median survival 36 vs 18 mo).</div></div><div><h3>Conclusions and clinical implications</h3><div>Our results highlight that perioperative ctDNA status is associated with patient prognosis in MIBC.</div></div>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":"11 6","pages":"Pages 959-967"},"PeriodicalIF":5.6,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144616849","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Systematic Review and Meta-analysis on Perioperative Stenting/Dwell Time and Postoperative Outcomes in Patients Undergoing Radical Cystectomy and Urinary Diversion for Bladder Cancer","authors":"Mithun Kailavasan ,&nbsp;Alberto Martini ,&nbsp;Max Bruins ,&nbsp;Albert Carrion ,&nbsp;Richard Cathomas ,&nbsp;Eva Compérat ,&nbsp;Jason A. Efstathiou ,&nbsp;Rainer Fietkau ,&nbsp;Anna Lorch ,&nbsp;Laura S. Mertens ,&nbsp;Richard P. Meijer ,&nbsp;Paramananthan Mariappan ,&nbsp;Mathew I. Milowsky ,&nbsp;Yann Neuzillet ,&nbsp;Valeria Panebianco ,&nbsp;Michael Rink ,&nbsp;George N. Thalmann ,&nbsp;S. Sæbjørnsen ,&nbsp;Antoine G. van der Heijden","doi":"10.1016/j.euf.2025.05.024","DOIUrl":"10.1016/j.euf.2025.05.024","url":null,"abstract":"<div><h3>Background and objective</h3><div>Ureteral stents are used to protect the ureteroenteric anastomosis during radical cystectomy and urinary diversion (RCUD); however, complications can occur from its use. The objective of this study was to perform a systematic review of perioperative stenting strategies and postoperative outcomes in patients undergoing RCUD for bladder cancer.</div></div><div><h3>Methods</h3><div>This review was published via PROSPERO (CRD42024558468) and conducted following the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Medline, Medline In-Process, Embase, and the Cochrane Central Register of Controlled Trials were searched. Prospective comparative (randomised and nonrandomised) studies published until June 2024 were included. All outcomes were included in the analysis. Risk of bias assessments were undertaken.</div></div><div><h3>Key findings and limitations</h3><div>The search yielded 1516 abstracts. Six prospective comparative studies (740 patients) were included. Although there was some evidence of reduced postoperative complications (urinary leak, ureteroileal stricture, postoperative obstruction, length of stay, and readmission within 30 d) with the omission of stents during RCUD, this did not reach statistical significance (<em>n</em> = 3). No differences in postoperative complications were identified between internal and external stenting (<em>n</em> = 2). Early stent removal (5 d) was associated with reduced urinary tract infections and hospital readmission (<em>n</em> = 1). There was a high/serious risk of bias with all studies.</div></div><div><h3>Conclusions and clinical implications</h3><div>The role of perioperative stenting during RCUD in preventing ureteroenteric complications remains equivocal and does not favour one approach over another. Until further results from on-going randomised controlled trials become available, urologists should carefully consider the indications to place a ureteric stent and its retention time after RCUD.</div></div>","PeriodicalId":12160,"journal":{"name":"European urology focus","volume":"11 6","pages":"Pages 968-977"},"PeriodicalIF":5.6,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144265786","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}