European urology focus最新文献

Background and objective: Salvage lymph node dissection (sLND) in recurrent prostate cancer (PC) is still considered experimental due to limited prospective data and sparse long-term outcome reports. This study describes long-term oncological outcomes after sLND in PC patients with suspected lymph node metastases on positron emission tomography/computed tomography after primary therapy and aims to identify predictors for selecting patients who will benefit.

Methods: Biochemical response (BR), biochemical recurrence (BCR), and clinical progression (CP) were assessed in 181 patients. Kaplan-Meier estimations served for time to BCR, CP, initiating androgen deprivation therapy (ADT), and overall survival (OS). Predictors were identified using binary logistic regression and Cox regression models.

Key findings and limitations: The median follow-up was 70.1 mo (interquartile range 42.5-98.0). BR was achieved in 45% (82/181). According to Kaplan-Meier estimates, the 2-yr BCR- and CP-free survival rates were 32.4% and 51.2%, respectively. The 5-yr rates were 11.5% and 26%, respectively. At 2 yr after sLND, 83 of 181 patients had initiated ADT, while 82 remained at risk, corresponding to a Kaplan-Meier estimate of 51.5% without initiation of ADT. An incomplete BR and omission of radiotherapy (RT) after sLND were associated with increased risks of BCR (hazard ratio [HR] 3.29, p = 0.0001 and HR 1.55, p = 0.011, respectively) and CP (HR 2.83, p = 0.0001 and HR 1.59, p = 0.013, respectively). The time from initial therapy to nodal recurrence and a prostate-specific antigen (PSA) level of >2 ng/ml at sLND were associated with BCR. At the end of follow-up, 58% (105/181) had PSA levels below those at sLND. According to the Kaplan-Meier estimate, the 10-yr OS rate was 51.2%. Limitations are the retrospective design and a lack of a control group.

Conclusions and clinical implications: Despite high BCR rates, over half of the patients were ADT free after 2 yr. Selected men with a low tumour burden may benefit from sLND, particularly in a multimodal treatment setting including RT.

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: Several observational studies have claimed that the use of neuraxial anesthesia reduces the risk of recurrence after urologic cancer surgery. However, its use is associated with age, comorbidity, and cancer stage, raising concerns of confounding. We aimed to assess the published literature to evaluate causal inference reporting.

Methods: We performed a systematic review of observational studies evaluating the association between anesthesia type and oncologic outcomes in urologic cancer surgery. We used a three-point scale to describe how causal inference was recorded on seven separate reporting criteria. To explore the issue of confounding directly, we evaluated the oncologic outcomes of patients undergoing radical cystectomy at a major cancer hospital according to the type of anesthesia received.

Key findings and limitations: We retrieved 18 studies on anesthesia and recurrence after urologic cancer surgery. Reference to causality was completely absent in more than half of the papers; all but one paper failed to assess the control of confounding in the Results section or addressed causal inference in the Discussion section. An analysis of the cohort at our own institution demonstrated large differences in age, comorbidity, and cancer stage, and inconsistent findings between overall, recurrence-free, and cancer-specific survival.

Conclusions and clinical implications: Reporting of causal inference is poor for observational studies of neuraxial anesthesia in urologic cancer surgery. The current literature is beset by residual and unmeasured confounding, and randomized controlled trials appear to be the only solution to this research question. However, these are unlikely to be a research priority given the weak biologic rationale. Reporting of causal inference in the urologic literature needs dramatic improvement.

Background and objective: Complex cystic renal masses, classified using the Bosniak system, pose diagnostic and therapeutic challenges due to their variable malignant potential. This systematic review and meta-analysis aimed to assess oncological outcomes in patients with cystic renal masses managed with active surveillance (AS) or active treatment (AT), and to report transitions from AS to AT.

Methods: A systematic literature search was conducted in MEDLINE, Embase, and Cochrane Library up to October 2024, following the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Studies reporting oncological outcomes for Bosniak IIF-IV lesions were included. Eligible patients were those managed with AS or AT; most studies were retrospective observational cohort studies. Outcomes included recurrence, metastasis, cancer-specific mortality (CSM), overall survival, and transitions from AS to AT. Data were pooled using a random-effect model. Study quality and risk of bias were assessed using the Quality In Prognosis Studies tool.

Key findings and limitations: Twenty-eight studies comprising 4,175 patients were included. Of 2353 patients managed with AS, 8.3% transitioned to AT after a mean of 20.5 mo. The 5-yr recurrence rate was 3.0% (95% confidence interval [CI]: 1.0-5.0); 5-yr CSM rate was 1.0% (95% CI: 0.1-2.0). The metastasis-free survival rate was 99.6% at 5 yr in AS patients and 97.5% at 10 yr in treated patients. No new metastases were reported beyond 10 yr. Histology revealed that 26% of the resected lesions were benign. Limitations include study heterogeneity, retrospective design, and a lack of randomised comparisons.

Conclusions and clinical implications: While individualised care remains essential, AS appears to be a safe initial strategy for selected patients with cystic renal masses, particularly Bosniak IIF. These findings support reducing unnecessary surgeries and highlight the need for standardised surveillance protocols. Further prospective studies are warranted.

The antimicrobial resistance of Mycoplasma genitalium is an escalating crisis that highlights a need for closer collaboration between clinical guideline panels and regulatory bodies. We propose a approach whereby the European Medicines Agency and European Association of Urology could work together for a bridge between regulatory oversight and proactive clinical leadership.

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.