European Urology Open Science最新文献

{"title":"Impact of H1 Antihistamines on Bacillus Calmette-Guérin–treated Non–muscle-invasive Bladder Cancer","authors":"Kang Liu ,&nbsp;Alex Qinyang Liu ,&nbsp;Hongda Zhao ,&nbsp;Chris Ho-Ming Wong ,&nbsp;Peter Ka-Fung Chiu ,&nbsp;Chi-Fai Ng ,&nbsp;Jeremy Yuen-Chun Teoh","doi":"10.1016/j.euros.2025.11.001","DOIUrl":"10.1016/j.euros.2025.11.001","url":null,"abstract":"<div><h3>Background and objective</h3><div>Concomitant H1 antihistamine (H1-AH) administration is associated with better survival outcomes for patients with metastatic urothelial carcinoma receiving immunotherapy. However, the role of H1-AHs among patients with non–muscle-invasive bladder cancer (NMIBC) treated with adjuvant intravesical bacillus Calmette-Guérin (BCG) immunotherapy has not been explored. Our aim was to investigate the impact of H1-AH use on survival outcomes for patients with BCG-treated NMIBC.</div></div><div><h3>Methods</h3><div>We conducted a territory-wide retrospective observational study. Patients with NMIBC who received intravesical immunotherapy with a single BCG strain in Hong Kong from 2001 to 2020 were identified. H1-AH prescription data were recorded. Overall survival (OS), cancer-specific survival (CSS), recurrence-free survival (RFS), and progression-free survival (PFS) outcomes were compared between H1-AH and control groups using the Kaplan-Meier method and multivariable Cox regression.</div></div><div><h3>Key findings and limitations</h3><div>Our analysis included 2028 patients with NMIBC who received intravesical BCG immunotherapy. Of these, 1539 patients (76%) had a H1-AH prescription at baseline and 489 (24%) never received any H1-AH prescription during the study period. Median follow-up was 11.0 yr. Kaplan-Meier analysis revealed that the H1-AH group had better CSS (<em>p</em> = 0.017) and PFS (<em>p</em> = 0.001). Subgroup analysis by H1-AH timing (before or during BCG therapy) showed that concomitant H1-AH treatment during intravesical BCG immunotherapy was associated with better CSS (<em>p</em> = 0.002) and PFS (<em>p</em> = 0.005). Multivariable Cox regression results demonstrated that concomitant H1-AH treatment was associated with better OS (hazard ratio [HR] 0.69, 95% confidence interval [CI] 0.58–0.82), CSS (HR 0.44, 95% CI 0.30–0.65), RFS (HR 0.81, 95% CI 0.67–0.98), and PFS (HR 0.64, 95% CI 0.45–0.91).</div></div><div><h3>Conclusions and clinical implications</h3><div>Concomitant H1-AH treatment was associated with better OS, CSS, RFS, and PFS for patients with NMIBC receiving adjuvant intravesical BCG.</div></div><div><h3>Patient summary</h3><div>The treatment for non–muscle-invasive bladder cancer (NMIBC) typically includes a solution of BCG (bacillus Calmette-Guérin) instilled into the bladder. We found better survival outcomes (overall survival, cancer-specific survival, recurrence-free survival, and progression-free survival) for patients who took a H1 antihistamine during their BCG treatment for intermediate-risk or high-risk NMIBC. More research is needed to confirm our results.</div></div>","PeriodicalId":12254,"journal":{"name":"European Urology Open Science","volume":"83 ","pages":"Pages 23-29"},"PeriodicalIF":4.5,"publicationDate":"2025-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145616056","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Single-port Robotic Prostatectomy with Neuraxial Anesthesia and Virtual Reality Support: Combining Technologies To Minimize Surgical Impact","authors":"Daniele Amparore ,&nbsp;Gabriele Bignante ,&nbsp;Enrico Checcucci ,&nbsp;Alessandra Saliva ,&nbsp;Paolo Alessio ,&nbsp;Gabriele Volpi ,&nbsp;Michele Sica ,&nbsp;Saverio Liguori ,&nbsp;Michele Ortenzi ,&nbsp;Stefano Zuccolin ,&nbsp;Stefano Alba ,&nbsp;Alessandro Cerutti ,&nbsp;Francesco Porpiglia","doi":"10.1016/j.euros.2025.11.003","DOIUrl":"10.1016/j.euros.2025.11.003","url":null,"abstract":"<div><div>Minimally invasive surgery continues to evolve to reduce the surgical and anesthetic burden for patients. We present the first prospective pilot case series to assess the feasibility and safety of combining extraperitoneal single-port robot-assisted radical prostatectomy (SP-RARP) with neuraxial anesthesia and intraoperative virtual reality (VR) support. Ten consecutive patients with low-risk prostate cancer underwent SP-RARP under combined spinal-epidural anesthesia and immersive VR distraction offered by the HypnoVR device to enhance patient comfort and reduce anxiety during surgery. Dedicated questionnaires focused on intraoperative HypnoVR tolerability and the patient experience. Data for perioperative parameters and anxiety trends were collected. All procedures were successfully completed without conversion to general anesthesia. Hemodynamic stability was maintained, with only two transient hypotensive episodes managed pharmacologically. Median operative time was 90 min and median hospital stay was 2 d, with no intraoperative or postoperative complications. Pain scores remained negligible (Visual Analog Scale 0/10) and no involuntary movements were reported. Nine patients (90%) completed surgery wearing the HypnoVR visor; most reported better comfort and lower anxiety. State-Trait Anxiety Inventory scores significantly decreased from before surgery to the 24-h postoperative assessment, and Health-Information Technology Usability Evaluation Scale scores confirmed high usability. The study demonstrates that SP-RARP under neuraxial anesthesia combined with VR is safe, feasible, and well accepted, and supports further investigation to validate the impact of this approach on recovery and patient-centered outcomes.</div></div>","PeriodicalId":12254,"journal":{"name":"European Urology Open Science","volume":"83 ","pages":"Pages 30-35"},"PeriodicalIF":4.5,"publicationDate":"2025-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145616104","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes After Initial Noninterventional Management of Clinical Stage cT1b Renal Masses","authors":"Banna Hussain ,&nbsp;Jack Considine ,&nbsp;Yuzhi Wang ,&nbsp;Brian R. Lane ,&nbsp;Sami Wilder ,&nbsp;Mohit Butaney ,&nbsp;Stephanie Daignault-Newton ,&nbsp;Monica Van Til ,&nbsp;Abena Osei ,&nbsp;Mackenzie Gammons ,&nbsp;Mahin Mirza ,&nbsp;Alice Semerjian ,&nbsp;Craig G. Rogers ,&nbsp;Amit K. Patel ,&nbsp;Michigan Urological Surgery Improvement Collaborative","doi":"10.1016/j.euros.2025.09.008","DOIUrl":"10.1016/j.euros.2025.09.008","url":null,"abstract":"<div><h3>Background and objective</h3><div>Localized renal masses 4.1–7.0 cm in size (cT1bRMs) are typically treated with partial or radical nephrectomy. Utilization and results of initial nonsurgical approaches for cT1bRMs are unclear. Our primary objective was to evaluate overall (OS) and metastasis-free (MFS) survival after initiating surveillance for cT1bRMs.</div></div><div><h3>Methods</h3><div>We retrospectively examined initial management and subsequent follow-up of all patients diagnosed with cT1bRMs (from May 2017 to November 2024) in the Michigan Urological Surgery Improvement Collaborative (MUSIC). Patients were stratified by intervention versus surveillance at 90 d following initial consultation. Patients initiating surveillance were further stratified as those with continued surveillance versus delayed intervention (DI) at least 90 d after initiating surveillance. The 3-yr estimated rates of DI, OS, MFS, and cancer-specific survival (CSS) were reported.</div></div><div><h3>Key findings and limitations</h3><div>Of 1134 patients with cT1bRMs, 297 were initiated on surveillance (26%), including 207 (70%) with solid, 47 (16%) with Bosniak III/IV, and 43 (14%) with indeterminate lesions. In a multivariable analysis, the predictors of surveillance included Charlson Comorbidity Index ≥2 versus 0 (odds ratio [OR] 1.43, 95% confidence interval [CI] 0.97–2.13), nonsolid tumor type (Bosniak III/IV cyst: OR 8.03, 95% CI 4.58–14; indeterminate: OR 5.42, 95% CI 2.86–10.3), and benign findings on a renal mass biopsy (OR 24.0, 95% CI 9.07–63). For the 297 surveilled cT1bRM patients, the cumulative incidence of DI at 2 yr was 27%, and the rates of MFS, CSS, and OS were, respectively, 91%, 96%, and 84% at 3 yr after initiating surveillance. A subset analysis excluding cystic, indeterminate, and biopsy-proven benign tumors found the cumulative incidence of DI at 2 yr to be 35%, with MFS and OS rates to be 95% and 78%, respectively, at 3 yr. In a multivariable analysis, initial surveillance was not associated with OS (vs immediate treatment; hazard ratio [HR] 1.47, 95% CI 0.83–2.63), with age as the only significant factor (HR 1.31, 95% CI 1.16–1.48). Limitations include the study’s observational and retrospective nature.</div></div><div><h3>Conclusions and clinical implications</h3><div>The MUSIC data support active surveillance for select patients with cT1bRMs.</div></div><div><h3>Patient summary</h3><div>In this report, we looked at the outcomes of surveilling larger (cT1b) renal masses in a large population in Michigan. We found that watching instead of treating cT1b renal masses immediately in older people with more medical conditions did not change survival or cause the cancer to spread compared with people who were treated immediately. We conclude that surveillance for cT1b cancer is an option that should be considered for all patients but implemented selectively.</div></div>","PeriodicalId":12254,"journal":{"name":"European Urology Open Science","volume":"83 ","pages":"Pages 15-22"},"PeriodicalIF":4.5,"publicationDate":"2025-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145570816","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prospective Evaluation of Blood-based and Microbiological Early Indicators of In-hospital Infectious Complications After Open Cystectomy","authors":"Benedikt Ebner,&nbsp;Judith Hirsch,&nbsp;Annkathrin Holz,&nbsp;Lennert Eismann,&nbsp;Julian Hermans,&nbsp;Nikolaos Pyrgidis,&nbsp;Marc Kidess,&nbsp;Marie Semmler,&nbsp;Isabel Brinkmann,&nbsp;Can Aydogdu,&nbsp;Michael Chaloupka,&nbsp;Maria Apfelbeck,&nbsp;Andrea Katharina Lindner,&nbsp;Philipp Weinhold,&nbsp;Christian G. Stief,&nbsp;Yannic Volz ,&nbsp;Gerald B. Schulz","doi":"10.1016/j.euros.2025.10.019","DOIUrl":"10.1016/j.euros.2025.10.019","url":null,"abstract":"<div><h3>Background and objective</h3><div>In-hospital infectious complications after cystectomy are understudied, with no reliable predictive tools. The aim of our study was to (1) comprehensively and prospectively evaluate these complications, (2) compare results between ileal conduit (IC) and ileal neobladder (NB) groups, and (3) evaluate the suitability of interleukin-6 (IL-6) and procalcitonin (PCT) levels and culture results for wound drainage fluid (WDF) as early indicators of infection.</div></div><div><h3>Methods</h3><div>We monitored in-hospital complications among patients undergoing cystectomy and analyzed IL-6 and PCT levels and WDF cultures on the first postoperative day. Statistical analysis included logistic regression and Spearman correlation analysis. The trial was registered on ClinicalTrials.gov as NCT05153694.</div></div><div><h3>Key findings and limitations</h3><div>From December 2021 to October 2024, 205 patients underwent open cystectomy in our department, of whom 186 consented to participate (66% IC, 34% NB). The median patient age was 71.6 yr and 80% were male. During their inpatient stay, 47% of patients developed fever and 44% received additional intravenous antibiotics. We found no significant differences between the IC and NB groups regarding postoperative fever, additional antibiotic use, positive blood cultures, the incidence of complications by Clavien-Dindo grade, Comprehensive Complication Index scores, or the incidence of wound infection or other infections. Microbial growth was detected in 13% of WDF samples; <em>Escherichia coli</em> and <em>Enterococcus</em> spp. were the most prevalent bacteria. We observed little to no correlations between IL-6 or PCT levels or WDF culture results and infectious complications.</div></div><div><h3>Conclusions and clinical implications</h3><div>Our prospective study revealed unexpectedly high incidence of in-hospital infections among cystectomy patients, with no significant differences between IC and NB groups. IL-6 and PCT levels and WDF culture results on the first postoperative day were not suitable as early indicators of infectious complications after open cystectomy.</div></div><div><h3>Patient summary</h3><div>We looked at infectious complications during their hospital stay for patients undergoing surgical removal of their bladder. We found no difference in the rate of infectious complications between two common surgical procedures that create a new pathway for urine to leave the body. We also found that levels of the markers interleukin-6 and procalcitonin, and bacterial culture results for wound drainage fluid were not helpful in predicting infectious complications for these patients.</div></div>","PeriodicalId":12254,"journal":{"name":"European Urology Open Science","volume":"83 ","pages":"Pages 1-8"},"PeriodicalIF":4.5,"publicationDate":"2025-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145536863","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Randomised Clinical Trial Comparing Two Biopsy Templates and Follow-up Schedules for Men on Active Surveillance for Low-risk Prostate Cancer: SAMS","authors":"David Robinson ,&nbsp;Jovana Maljkovic ,&nbsp;Anna Genell ,&nbsp;Stefan Carlsson ,&nbsp;Erik Holmberg ,&nbsp;Ola Bratt","doi":"10.1016/j.euros.2025.10.024","DOIUrl":"10.1016/j.euros.2025.10.024","url":null,"abstract":"<div><h3>Background and objective</h3><div>Neither the number nor location of biopsy cores or follow-up schedules for active surveillance of prostate cancer are based on evidence from randomised trials. We therefore initiated a study that compared two follow-up schedules in this setting. The main endpoint was decision to initiate curative treatment within 5 yr from randomisation.</div></div><div><h3>Methods</h3><div>Men aged 40–75 yr with low-risk prostate cancer (grade group 1, T1c/T2a, ≤33% positive biopsy cores, prostate-specific antigen [PSA] ≤13 μg/l, PSA density ≤0.2 μg/l/cm³) diagnosed with the previous 6 mo were randomly allocated to a standard confirmatory systematic biopsy and standard follow-up, or an extended confirmatory systematic biopsy and less intense follow-up.</div></div><div><h3>Key findings and limitations</h3><div>Data for 328 men were available for analysis. After 5 yr, 42% in the standard arm and 36% in the experimental arm received treatment with curative intent (<em>p</em> = 0.51). In first year, more men in the experimental arm were treated, but after 4 yr the treatment rate in the standard arm surpassed that in the experimental arm. Compliance with scheduled biopsies decreased over time. The trial started when magnetic resonance imaging (MRI) was not used for active surveillance in Sweden. Inclusion was stopped before the target of 500 men was reached.</div></div><div><h3>Conclusions and clinical implications</h3><div>Use of an extended confirmatory biopsy may allow for less intensive surveillance of low-risk prostate cancer in a setting without routine use of MRI. This approach has the potential to reduce the burden of repeat biopsies without compromising the effectiveness of disease monitoring.</div></div><div><h3>Patient summary</h3><div>For men with low-risk prostate cancer, use of a more extensive initial biopsy followed by less intensive monitoring resulted in similar 5-year treatment rates as for standard monitoring. This suggests that follow-up with fewer scheduled biopsies can be considered without affecting the overall quality of surveillance when MRI (magnetic resonance imaging) is not available.</div></div>","PeriodicalId":12254,"journal":{"name":"European Urology Open Science","volume":"82 ","pages":"Pages 208-214"},"PeriodicalIF":4.5,"publicationDate":"2025-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145568842","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Oncological Results After Accidental Tumor Incision During Partial Nephrectomy","authors":"Markus Varpela ,&nbsp;Sara Tornberg ,&nbsp;Harry Nisen ,&nbsp;Tuomas Mirtti ,&nbsp;Petrus Järvinen","doi":"10.1016/j.euros.2025.11.002","DOIUrl":"10.1016/j.euros.2025.11.002","url":null,"abstract":"<div><h3>Background and objective</h3><div>Incising or breaking a tumor during surgery for renal cell carcinoma (RCC) is considered an adverse event. The aim of our study was to examine oncological outcomes for patients with accidental tumor incision (ATI) during partial nephrectomy (PN) for cT1 RCC.</div></div><div><h3>Methods</h3><div>We conducted a retrospective single-center study of patients who underwent open, laparoscopic, or robot-assisted PN for cT1a–b RCC. The cohort was divided into groups with and without ATI during PN. The Kaplan-Meier method and a log-rank test were used to estimate and compare recurrence-free survival (RFS) and cancer-specific survival (CSS) for the two groups.</div></div><div><h3>Key findings and limitations</h3><div>Among 813 patients, ATI was recorded for 103 cases (13%). Disease recurrence during follow-up occurred in 15 patients in the ATI group and 15 in the group without ATI. RFS differed significantly between the groups according to Kaplan-Meier analysis (<em>p</em> &lt; 0.001) during median follow-up of 52 mo. ATI was associated with larger tumor diameter and higher RENAL score. The difference in CSS between the groups was not statistically significant (<em>p</em> = 0.8). Limitations of the study include the possibility of ATI cases being missed if not reported by the surgeon.</div></div><div><h3>Conclusions and clinical implications</h3><div>Our results demonstrate that ATI during PN is associated with greater risk of disease recurrence in T1 RCC, even though there was no significant difference in CSS over intermediate follow-up. Clinicians should take intraoperative precautions to minimize ATI and consider extended surveillance for patients in whom ATI occurs. Further research is warranted to explore preventative strategies and the long-term impact of ATI on survival.</div></div><div><h3>Patient summary</h3><div>We looked at cancer control outcomes after accidental incision into a tumor (ATI for short) during partial kidney removal for kidney cancer. The rate of cancer recurrence was higher in the group with ATI than in the group without ATI.</div></div>","PeriodicalId":12254,"journal":{"name":"European Urology Open Science","volume":"83 ","pages":"Pages 9-14"},"PeriodicalIF":4.5,"publicationDate":"2025-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145536862","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Radical Prostatectomy Combined with Prostate Specific Membrane Antigen–radioguided Lymph Node Dissection is Associated with Longer Treatment-free Survival for Patients with Primary Lymph Node–positive Prostate Cancer","authors":"Philipp Korn ,&nbsp;Flemming Lischewski ,&nbsp;Helena Staehler ,&nbsp;Matthias Eiber ,&nbsp;Tobias Maurer ,&nbsp;Thomas Horn ,&nbsp;Jürgen E. Gschwend ,&nbsp;Matthias M. Heck","doi":"10.1016/j.euros.2025.10.018","DOIUrl":"10.1016/j.euros.2025.10.018","url":null,"abstract":"<div><h3>Background and objective</h3><div>The optimal treatment for patients with prostate cancer with primary lymph node metastases (LNMs) is still a matter of debate. Radical prostatectomy (RP) combined with prostate-specific membrane antigen (PSMA)-radioguided surgery (RGS) may be a helpful technique in removal of LNMs detected on preoperative PSMA positron emission tomography (PET) in comparison to conventional lymph node dissection (LND). The aim of our retrospective analysis was to determine whether addition of PSMA-RGS at primary radical prostatectomy (RP) is associated with longer survival.</div></div><div><h3>Methods</h3><div>^99mTechnetium-PSMA-I&amp;S was administered preoperatively to facilitate LND during RP in the RGS group. Standard descriptive statistics were used to outline differences in patient characteristics. To address imbalance of covariates, we created matched samples using exact matching before assessing survival outcomes using Cox regression analyses.</div></div><div><h3>Key findings and limitations</h3><div>Matched samples were created for a cohort comprising 46 patients who underwent RP with RGS, and 42 patients who underwent RP without RGS, with matching according to LNM distribution, number of LNMs on preoperative PSMA PET scans, and surgical margin status. Multivariate Cox regression revealed an association between longer treatment-free survival (TFS) and PSMA RGS (hazard ratio [HR] 0.53, 95% confidence interval [CI] 0.30–0.94). A higher number of positive lymph nodes (HR 1.29, 95% CI 1.07–1.56) and positive surgical margins (HR 1.86, 95% CI 1.06–3.25) were associated with shorter TFS. The main limitations are the retrospective design and small sample size.</div></div><div><h3>Conclusions and clinical implications</h3><div>Addition of PSMA-RGS at primary RP was associated with longer TFS for patients with limited PSMA PET–positive locoregional LNMs.</div></div><div><h3>Patient summary</h3><div>We looked at whether a technique to label and detect lymph node metastases during prostate cancer surgery is linked to better cancer control for patients whose preoperative scans showed limited spread to the lymph nodes. We found that this approach may lead to better cancer control after surgery and a longer time before additional treatment is needed.</div></div>","PeriodicalId":12254,"journal":{"name":"European Urology Open Science","volume":"82 ","pages":"Pages 201-207"},"PeriodicalIF":4.5,"publicationDate":"2025-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145517100","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Integrative Diagnostic Model Combining Urinary Biomarkers and Clinical Parameters to Improve Diagnostic Performance in Interstitial Cystitis/Bladder Pain Syndrome","authors":"Yu-Chen Chen ,&nbsp;Jing-Hui Tian ,&nbsp;Hann-Chorng Kuo","doi":"10.1016/j.euros.2025.10.021","DOIUrl":"10.1016/j.euros.2025.10.021","url":null,"abstract":"<div><h3>Background and objective</h3><div>Interstitial cystitis/bladder pain syndrome (IC/BPS) is a chronic condition characterized by pelvic pain and urinary symptoms that overlap with other urological disorders, making diagnosis challenging. Current diagnostic approaches are often subjective and inconsistent. This study develops and internally validates a multivariable diagnostic prediction model that combines urinary biomarkers and clinical parameters to improve the diagnostic accuracy for IC/BPS.</div></div><div><h3>Methods</h3><div>Data from 385 participants (344 IC/BPS patients and 41 controls) who underwent cystoscopic hydrodistension and videourodynamic studies were analyzed. Urine samples were analyzed for inflammatory cytokines and oxidative stress markers using multiplex and enzyme-linked immunosorbent assays. Clinical parameters included bladder pain (visual analog scale [VAS]) and functional bladder capacity (3-d voiding diary). The participants were randomly divided into training (70%) and testing (30%) sets. Logistic regression with stepwise selection was used to develop diagnostic models.</div></div><div><h3>Key findings and limitations</h3><div>Urinary 8-hydroxy-2′-deoxyguanosine (8-OHdG) showed the highest discriminative ability among individual biomarkers (area under the receiver operating characteristic curve [AUROC] = 0.838). The two-marker model combining 8-OHdG and tumor necrosis factor-alpha (TNF-α) yielded AUROC values of 0.958 (training) and 0.952 (testing). The final integrative model incorporating 8-OHdG, TNF-α, and VAS achieved near-perfect diagnostic performance (AUROC = 0.997 in training and 0.997 in testing), with 96% accuracy, 96% sensitivity, and 92% specificity.</div></div><div><h3>Conclusions and clinical implications</h3><div>This integrative, noninvasive diagnostic model demonstrates excellent diagnostic performance and offers a scalable, objective, and patient-friendly alternative to traditional invasive testing. Incorporation of urinary oxidative stress and inflammatory biomarkers into clinical pain scores may facilitate earlier and more accurate IC/BPS diagnosis in routine practice.</div></div><div><h3>Patient summary</h3><div>We found that combination of specific urine markers with pain scores can diagnose interstitial cystitis/bladder pain syndrome accurately, without invasive tests. This diagnostic model reduces reliance on patients’ subjective symptom reporting, helping doctors confirm the disease earlier and more confidently, while making the diagnostic process more comfortable for patients.</div></div>","PeriodicalId":12254,"journal":{"name":"European Urology Open Science","volume":"82 ","pages":"Pages 192-200"},"PeriodicalIF":4.5,"publicationDate":"2025-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145517102","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical and Pathological Features Associated with Chromophobe Renal Cell Carcinoma Recurrence: Analysis from a Nationwide Cohort","authors":"Arthur Peyrottes ,&nbsp;Edouard Auclin ,&nbsp;Marc-Olivier Timsit ,&nbsp;Nicolas Branger ,&nbsp;Nicolas Doumerc ,&nbsp;Thibaut Waeckel ,&nbsp;Pierre Bigot ,&nbsp;Louis Surlemont ,&nbsp;Sophie Knipper ,&nbsp;Géraldine Pignot ,&nbsp;Frank Bruyère ,&nbsp;Alexis Fontenil ,&nbsp;Bastien Parier ,&nbsp;Cécile Champy ,&nbsp;Morgan Rouprêt ,&nbsp;Jean-Jacques Patard ,&nbsp;François Henon ,&nbsp;Gaëlle Fiard ,&nbsp;Julien Guillotreau ,&nbsp;Jean-Baptiste Beauval ,&nbsp;François Audenet","doi":"10.1016/j.euros.2025.10.023","DOIUrl":"10.1016/j.euros.2025.10.023","url":null,"abstract":"<div><h3>Background and objective</h3><div>Chromophobe renal cell carcinoma (chRCC) is a rare renal malignancy with a generally favourable prognosis. However, a subset of patients experiences recurrence, which remains poorly characterised. This study aims to identify the clinicopathological factors associated with recurrence in chRCC, describe the timing and anatomical patterns of recurrence, and develop a predictive model to guide surveillance strategies.</div></div><div><h3>Methods</h3><div>We conducted a multicentre retrospective cohort study using data from the French UroCCR database, including patients treated surgically for nonmetastatic chRCC between 2010 and 2024. Clinicopathological features, recurrence-free survival (RFS), cancer-specific survival, and overall survival were analysed. Kaplan-Meier survival curves and multivariable Cox proportional-hazard models were used to assess prognostic factors.</div></div><div><h3>Key findings and limitations</h3><div>Among the included 683 patients, 43 (6.3%) developed recurrence, with median RFS of 142 mo (95% confidence interval [CI] 121–not reached). Local recurrence was observed in 30 patients, while 18 developed distant metastases, predominantly in the retroperitoneal lymph nodes and lungs. Male sex (hazard ratio [HR] 3.1, 95% CI 1.27–7.54, <em>p</em> = 0.01), locally advanced disease (HR 1.94, 95% CI 1.02–3.84, <em>p</em> = 0.05), positive surgical margins (HR 3.03, 95% CI 1.4–6.56, <em>p</em> = 0.005), and lymphovascular invasion (HR 2.08, 95% CI 1.01–4.38, <em>p</em> = 0.05) were independently associated with recurrence. Limitations include the absence of a central pathological review and of standardised recurrence management strategies across centres.</div></div><div><h3>Conclusions and clinical implications</h3><div>This study provides novel insights into the recurrence patterns of chRCC, highlighting the key prognostic factors. The proposed predictive model was designed to aid clinicians in identifying high-risk patients, optimising follow-up intensity, and guiding therapeutic decisions.</div></div><div><h3>Patient summary</h3><div>We studied a rare kidney cancer type, called chromophobe renal cell carcinoma (chRCC), to understand why some patients experience recurrence. We found that being male, having advanced disease, or some aggressive pathological characteristics increased the risk of cancer coming back. Our results suggest that doctors should monitor certain patients more closely after surgery. This research may help improve long-term follow-up and treatment plans for patients with chRCC. While certain factors are associated with a higher risk of recurrence, it is important to note that chromophobe renal cell carcinoma generally has a favourable prognosis, and the absolute risk of recurrence remains low for most patients.</div></div>","PeriodicalId":12254,"journal":{"name":"European Urology Open Science","volume":"82 ","pages":"Pages 185-191"},"PeriodicalIF":4.5,"publicationDate":"2025-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145517225","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Validation of Artificial Intelligence–enhanced Stimulated Raman Histopathology for Intraoperative Margin Assessment During Robot-assisted Radical Prostatectomy: Preliminary Results from the ROBOSPEC Study","authors":"Arif Özkan ,&nbsp;Karl-Moritz Schröder ,&nbsp;Peter Bronsert ,&nbsp;Julia Franz ,&nbsp;Maximilian Glienke ,&nbsp;August Sigle ,&nbsp;Jürgen Beck ,&nbsp;Martin Werner ,&nbsp;Christian Gratzke ,&nbsp;Jakob Straehle ,&nbsp;Samir S. Taneja ,&nbsp;Miles P. Mannas ,&nbsp;Nikolaos Liakos","doi":"10.1016/j.euros.2025.10.022","DOIUrl":"10.1016/j.euros.2025.10.022","url":null,"abstract":"<div><h3>Background and objective</h3><div>Stimulated Raman histology (SRH) offers promising near–real-time tissue visualization for intraoperative pathology assessment. We present preliminary results from the ROBOSPEC study, with a focus on the accuracy of results obtained via an integrated artificial intelligence (AI) tool.</div></div><div><h3>Methods</h3><div>ROBOSPEC is a prospective, single-arm pilot study involving patients with prostate cancer undergoing robot-assisted radical prostatectomy (RARP). Probes from the RP specimens from the first 18 patients with intermediate-risk or high-risk prostate cancer were collected bilaterally from the dorsolateral sides of the prostate and examined with frozen section with hematoxylin and eosin staining (cryo-HE), SRH imaging (NIO laser imaging system, Invenio Imaging, Santa Clara, CA, USA). A previously published New York University AI algorithm (NYU-AI) that is based on the Inception-ResNet-v2 CNN architecture was used to generate three-color overlays to assist in interpretation. SRH images were reviewed by blinded urologists using this AI-enhanced output.</div></div><div><h3>Key findings and limitations</h3><div>NYU-AI identified positive surgical margins in 22% of patients, with no statistically significant difference in comparison to cryo-HE (<em>p</em> &gt; 0.05). Patient-based analysis yielded sensitivity and a negative predictive value (NPV) of 1.0, specificity of 0.93, and a positive predictive value of 0.75. Sample-based analysis showed similar performance, with specificity of 0.97 and identical sensitivity and NPV. These findings indicate strong diagnostic agreement between NYU-AI and conventional intraoperative pathology. Limitations of the study include the small patient cohort, the single-center design, previous training of the NYU-AI tool on prostate biopsy and periprostatic surgical-bed samples, and the lack of testing of interobserver agreement.</div></div><div><h3>Conclusions and clinical implications</h3><div>Our preliminary findings support the potential of SRH with NYU-AI for intraoperative detection of positive surgical margins during RARP. Implementation of this technique should be further discussed after more studies have been conducted.</div></div><div><h3>Patient summary</h3><div>We looked at an artificial intelligence program using a method called stimulated Raman histology to assess the cancer status of the cutting margin during robot-assisted surgery to remove the prostate. Our preliminary results show that this method could be an alternative to the current standard as it provides accurate and faster results.</div></div>","PeriodicalId":12254,"journal":{"name":"European Urology Open Science","volume":"82 ","pages":"Pages 178-184"},"PeriodicalIF":4.5,"publicationDate":"2025-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145517101","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}