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Technique Selection for Robot-Assisted Radical Prostatectomy: A Multi-Institutional Survey in Japan 机器人辅助根治性前列腺切除术的技术选择:日本的一项多机构调查。
IF 2.2 3区 医学 Q3 UROLOGY & NEPHROLOGY Pub Date : 2026-01-14 DOI: 10.1111/iju.70347
Norihiko Masuda, Tatsuya Hazama, Toshihide Hosomi, Kazuto Imai, Toshiya Akao

Objectives

Since Japan's public insurance covered robot-assisted radical prostatectomy (RARP) in 2012, it has become standard. Despite widespread use, variability exists among surgeons in approaches, nerve-sparing, lymph node dissection (LND), and postoperative management. This study examined the practices of surgical technique selection, energy settings, and postoperative management in RARP across Japan to identify standardization opportunities.

Materials and Methods

A 50-item questionnaire was distributed between October and December 2023 to physicians performing robotic surgeries at 44 institutions affiliated with Kyoto University and other universities. The survey addressed the surgeons' experience, robotic platforms, energy settings, surgical approaches, LND, anastomosis, complication prevention, and postoperative management. Responses from 147 physicians were analyzed.

Results

All respondents used the da Vinci system, with the half of institutions performing over 50 RARP annually. Most surgeons preferred the transperitoneal approach (over 80%) and standard LND (65.7%), while 20% performed an extended pelvic lymph node dissection. Monopolar and bipolar energies were set to Effects 3 and 4, respectively. Barbed sutures were used for anastomosis in 90% of the cases with posterior wall reconstruction. Drains were placed in 70% of the cases, and catheters were removed on postoperative days 5–7 in over 90%. Variations were noted in dorsal venous complex management, nerve-sparing, hernia prevention, and imaging before catheter removal.

Conclusions

This survey revealed the diversity of RARP techniques and postoperative protocols among Japanese surgeons. While fundamental elements, such as LND templates and barbed anastomosis, have converged, significant procedural variability persists. A two-tiered educational model, which standardizes essential safety techniques while allowing case-specific flexibility, may promote consistent nationwide RARP practices.

自2012年日本公共保险覆盖机器人辅助根治性前列腺切除术(RARP)以来,它已成为标准。尽管广泛使用,但外科医生在入路、神经保留、淋巴结清扫(LND)和术后处理方面存在差异。本研究考察了日本RARP手术技术选择、能量设置和术后管理的实践,以确定标准化的机会。材料与方法:于2023年10月至12月向京都大学等44所附属机构的机器人外科医生发放了一份50题的问卷。调查涉及外科医生的经验、机器人平台、能量设置、手术入路、LND、吻合、并发症预防和术后管理。对147名医生的回答进行了分析。结果:所有的调查对象都使用了达芬奇系统,其中一半的机构每年的RARP超过50次。大多数外科医生选择经腹膜入路(超过80%)和标准LND(65.7%),而20%的外科医生选择扩大盆腔淋巴结清扫。单极和双极能量分别设置为效应3和效应4。后壁重建术90%采用倒刺缝合吻合。70%的病例放置了引流管,超过90%的病例在术后5-7天拔除了导管。在背静脉复群处理、神经保留、疝气预防和导管拔除前的影像学方面存在差异。结论:该调查揭示了日本外科医生RARP技术和术后方案的多样性。虽然基本要素,如LND模板和倒钩吻合已经趋同,但显著的程序差异仍然存在。两层教育模式使基本安全技术标准化,同时允许具体案例的灵活性,可以促进全国范围内一致的RARP实践。
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引用次数: 0
Editorial Comment to ‘Validation of the Pubo-Urethral Stump Angle as a Predictive Parameter for Elaborate Anastomotic Urethroplasty in Pelvic Fracture Urethral Injury’ “耻骨尿道残端角度作为骨盆骨折尿道损伤精细吻合尿道成形术预测参数的验证”的评论
IF 2.2 3区 医学 Q3 UROLOGY & NEPHROLOGY Pub Date : 2026-01-14 DOI: 10.1111/iju.70340
Akihiro Kanematsu
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引用次数: 0
Translational Advances in Urothelial Carcinoma: From Bench to Bedside 尿路上皮癌的转化进展:从实验到临床。
IF 2.2 3区 医学 Q3 UROLOGY & NEPHROLOGY Pub Date : 2026-01-14 DOI: 10.1111/iju.70341
Tomohiro Iwasawa, Takuya Tsujino, Shigehiro Tsukahara, Hiroshi Fukushima, Daisuke Ito, Eisuke Tomiyama, Fumihiko Urabe, the Japanese Young Urologist Basic Research Collaboration

Urothelial carcinoma (UC), encompassing both bladder cancer and upper tract UC, is a biologically heterogeneous malignancy that has long complicated patient stratification and therapeutic prediction. Recent genomic and transcriptomic analyses, however, have delineated reproducible molecular subtypes across non-muscle-invasive and muscle-invasive disease. These classification frameworks have refined biological understanding and improved both risk stratification and treatment selection. Emerging evidence also indicates that genomic alterations, such as FGFR3 mutations, may confer distinct immunologic phenotypes within specific transcriptomic contexts, thereby challenging prior assumptions. The advent of immune checkpoint inhibitors has transformed UC management, yet variable response rates underscore the complexity of the tumor microenvironment (TME). Single-cell and spatial analyses have identified immune-inflamed, -desert, and -excluded TME subtypes, with cancer-associated fibroblasts playing a key role in immune exclusion and therapeutic resistance. Liquid biopsy, particularly circulating tumor DNA, has demonstrated utility for real-time disease monitoring, minimal residual disease detection, and treatment stratification, as highlighted in trials such as IMvigor010 and IMvigor011. Urinary extracellular vesicles also represent promising non-invasive biomarkers, though further standardization is required. In addition, novel therapeutic strategies—including antibody-drug conjugates, gene therapies, and sustained-release delivery systems—are broadening treatment options across disease stages. Collectively, these translational advances mark a paradigm shift toward precision immuno-oncology in UC. Nonetheless, successful clinical implementation will require prospective validation, optimized analytical platforms, and sustained physician-scientist engagement to translate these discoveries into improved patient outcomes. This review provides a comprehensive overview of recent progress in UC translational research, with a focus on genomic and transcriptomic insights, the evolving role of immunotherapy, advances in liquid biopsy, and the development of novel therapeutics.

尿路上皮癌(UC)包括膀胱癌和上尿路癌,是一种生物学异质性的恶性肿瘤,长期以来一直使患者分层和治疗预测复杂化。然而,最近的基因组和转录组学分析已经描述了非肌肉侵袭性疾病和肌肉侵袭性疾病中可重复的分子亚型。这些分类框架完善了对生物学的理解,改进了风险分层和治疗选择。新出现的证据还表明,基因组改变,如FGFR3突变,可能在特定的转录组背景下赋予不同的免疫表型,从而挑战先前的假设。免疫检查点抑制剂的出现改变了UC的治疗方式,但不同的应答率强调了肿瘤微环境(TME)的复杂性。单细胞和空间分析已经确定了免疫炎症、沙漠和排除的TME亚型,与癌症相关的成纤维细胞在免疫排斥和治疗抵抗中起关键作用。液体活检,特别是循环肿瘤DNA,已被证明在实时疾病监测、最小残留疾病检测和治疗分层方面具有实用性,如IMvigor010和IMvigor011等试验所强调的那样。尿细胞外囊泡也代表了有前途的非侵入性生物标志物,尽管需要进一步的标准化。此外,新的治疗策略——包括抗体-药物偶联物、基因疗法和缓释给药系统——正在拓宽不同疾病阶段的治疗选择。总的来说,这些转化进展标志着UC向精确免疫肿瘤学的范式转变。然而,成功的临床实施需要前瞻性验证、优化的分析平台和持续的医学家参与,以将这些发现转化为改善的患者治疗结果。本文综述了UC转化研究的最新进展,重点是基因组学和转录组学的见解,免疫治疗的演变作用,液体活检的进展,以及新治疗方法的发展。
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引用次数: 0
Three Decades of Change in Frequency of Sexual Intercourse and Sexual Function Among Japanese Men: A Comparative National Survey 三十年来日本男性性交频率和性功能的变化:一项比较全国调查。
IF 2.2 3区 医学 Q3 UROLOGY & NEPHROLOGY Pub Date : 2026-01-14 DOI: 10.1111/iju.70344
Yoshikazu Sato, Akira Tsujimura, Masato Shirai, Haruaki Sasaki, Ko Kobayashi, Hiroki Horita, Aoki Masaharu, Nobukazu Suzuki, Shinichi Hisasue, Shinichiro Fukuhara, Koji Chiba, Tsuyoshi Yoshizawa, Hikaru Tomoe, Kazunori Kimura, Eiji Kikuchi, Eri Maeda, Atsushi Nagai, Koichi Nagao, Taiji Tsukamoto, Naoya Masumori

Objective

This study aimed to examine trends in frequency of sexual intercourse and sexual function among Japanese men over the past 30 years by comparing the Nationwide Survey conducted by the Japanese Society for Sexual Medicine in 2023 with the Sapporo Survey conducted by the Department of Urology, Sapporo Medical University, in 1991.

Methods

Three domains were analyzed: sexual intercourse, penile rigidity, and morning erections in both studies. To minimize inconsistencies, definitions were standardized. The 2023 survey included 3795 men aged 20–79 years, while the 1991 survey comprised 8893 participants for sexual intercourse, 7517 for morning erections, and 3886 for penile rigidity. Case numbers differed by item in 1991 owing to incomplete responses. The 1991 survey targeted only married individuals; comparable analyses were performed using married participants extracted from the 2023 dataset.

Results

1. Sexual intercourse: Compared with the 1991 Sapporo Survey, the proportion of men reporting sexual intercourse less than once per month was significantly higher across all age groups in the 2023 Nationwide Survey, except among men in their 20s. 2. Penile rigidity: The proportion of men with insufficient penile rigidity for penetration was significantly higher in 2023 than in 1991 across all age groups except those aged ≥ 75 years. 3. Morning erections: Men reporting complete absence of morning erections were significantly more common in 2023 across all age groups.

Conclusion

Over the past three decades, Japanese men have shown substantial declines in the frequency of sexual intercourse, penile rigidity, and the frequency of morning erections, particularly in younger and middle-aged cohorts.

目的:本研究旨在通过比较日本性医学学会于2023年进行的全国调查和札幌医科大学泌尿科于1991年进行的札幌调查,来研究过去30年日本男性性交频率和性功能的变化趋势。方法:在两项研究中分析了三个领域:性交、阴茎刚性和晨起。为了尽量减少不一致,定义被标准化了。2023年的调查包括3795名年龄在20-79岁之间的男性,而1991年的调查包括8893名性交参与者,7517名早晨勃起参与者,3886名阴茎僵硬参与者。由于答复不完整,1991年的个案数目因项目而异。1991年的调查只针对已婚人士;对从2023年数据集中提取的已婚参与者进行了可比分析。结果:1。性交:与1991年札幌调查相比,2023年全国调查中,除了20多岁的男性外,所有年龄段报告每月性交少于一次的男性比例都显著高于1991年的札幌调查。阴茎硬度:2023年阴茎硬度不足以插入的男性比例显著高于1991年,年龄≥75岁的男性除外。3. 晨勃起:在2023年,所有年龄组中报告完全没有晨勃起的男性明显更常见。结论:在过去的三十年里,日本男性在性交频率、阴茎硬度和晨起频率方面都出现了大幅下降,尤其是在年轻和中年人群中。
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引用次数: 0
Editorial Comment on “The Evolution of Prostate Multiparametric MRI and Its Application in Prostate Cancer Clinical Management” 《前列腺多参数MRI的发展及其在前列腺癌临床管理中的应用》的评论。
IF 2.2 3区 医学 Q3 UROLOGY & NEPHROLOGY Pub Date : 2026-01-14 DOI: 10.1111/iju.70353
Yoshiko Ueno
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引用次数: 0
Editorial Comment on Oligometastatic Prostate and Bladder Cancer: An Integrative Narrative Review 少转移性前列腺癌和膀胱癌:一个综合的叙事评论。
IF 2.2 3区 医学 Q3 UROLOGY & NEPHROLOGY Pub Date : 2026-01-14 DOI: 10.1111/iju.70343
Hiroshi Hirata
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引用次数: 0
Editorial Comment on “Usefulness of the Toronto Voiding Symptom Score in the Diagnosis of Occult Tethered Cord Syndrome” 关于“多伦多排尿症状评分在隐匿性脊髓栓系综合征诊断中的作用”的评论。
IF 2.2 3区 医学 Q3 UROLOGY & NEPHROLOGY Pub Date : 2026-01-12 DOI: 10.1111/iju.70349
Ismail Selvi
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引用次数: 0
Editorial Comment to “Clinical Features and Risk Factors of Enfortumab Vedotin-Induced Peripheral Neuropathy in Patients With Metastatic Urothelial Carcinoma: A Multicenter Retrospective Study (YUSHIMA Study)” 对“转移性尿路上皮癌患者的维多汀诱导周围神经病变的临床特征和危险因素:一项多中心回顾性研究(YUSHIMA研究)”的评论。
IF 2.2 3区 医学 Q3 UROLOGY & NEPHROLOGY Pub Date : 2026-01-11 DOI: 10.1111/iju.70351
Makito Miyake
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引用次数: 0
Retrospective Analysis of Vesicourethral-Anastomosis Stricture/Urethral Stricture After Robotic-Assisted Laparoscopic Radical Prostatectomy With and Without Radiotherapy 机器人辅助腹腔镜根治性前列腺切除术后膀胱尿道吻合口狭窄/尿道狭窄的回顾性分析。
IF 2.2 3区 医学 Q3 UROLOGY & NEPHROLOGY Pub Date : 2026-01-11 DOI: 10.1111/iju.70339
Kinan Massouh, Katharina Leucht, Lutz Leistritz, Marc-Oliver Grimm

Background and Objective

Vesicourethral anastomotic stenosis and/or urethral stenosis (VUAS/US) is a complication of robotic-assisted radical prostatectomy (RARP) for prostate cancer. We aimed to evaluate the incidence of VUAS/US after RARP and to identify potential risk factors.

Materials and Methods

We performed a retrospective assessment of clinical records of patients with RARP as primary prostate cancer treatment (January 2011–December 2018) and investigated associations between VUAS/US formation and radiotherapy, pT-stage, tumor margins, Gleason score, nerve-sparing, and postoperative duration of bladder catheterization. Statistical analysis was performed via uni- and multivariable cox regression; risk estimation was done with the Kaplan–Meier method and log-rank test.

Results and Limitations

809 patients were included in the study. Median clinical follow-up was 61.0 months (IQR 50.0–75.0) and 175 (22%) patients received radiotherapy. VUAS and US were recorded in 19 (2.3%) and 10 (1.2%) patients, respectively. Whereas in univariable analysis radiotherapy, pT-stage ≥ pT3a, higher Gleason score, positive tumor margins, nerve-sparing, and prolonged duration of bladder catheterization were significant risk factors, in a multivariable analysis only radiotherapy (p = 0.003) and prolonged duration of bladder catheterization (p = 0.0309) proved to be independently predictive. Estimated 5-year risk of VUAS/US formation was lower without than with radiotherapy (2.1% [95% CI: 0.9–3.3] vs. 7.3% [95% CI: 3.4–11]) and with normal compared to prolonged bladder catheterization (2.6% [95% CI: 1.4–3.8] vs. 9.9% [95% CI: 2.3–18]). Retrospectivity and the limited number of events were our major limitations.

Conclusions and Clinical Implications

Low incidence of VUAS/US in RARP. Patients undergoing radiotherapy or requiring prolonged catheterization should be explicitly informed about the risk of VUAS/US and about symptoms. Also, physicians must be aware.

背景与目的:膀胱尿道吻合口狭窄和/或尿道狭窄(VUAS/US)是机器人辅助根治性前列腺切除术(RARP)治疗前列腺癌的并发症。我们的目的是评估RARP后VUAS/US的发生率,并确定潜在的危险因素。材料和方法:我们对2011年1月至2018年12月期间接受RARP治疗的原发性前列腺癌患者的临床记录进行了回顾性评估,并研究了VUAS/US形成与放疗、pt分期、肿瘤边缘、Gleason评分、神经保留和术后膀胱置管时间之间的关系。通过单变量和多变量cox回归进行统计分析;风险估计采用Kaplan-Meier法和log-rank检验。结果与局限性:809例患者纳入研究。中位临床随访为61.0个月(IQR为50.0 ~ 75.0),175例(22%)患者接受放疗。VUAS和US分别为19例(2.3%)和10例(1.2%)。在单变量分析中,放疗的pt分期≥pT3a、较高的Gleason评分、肿瘤边缘阳性、神经保留和膀胱导尿时间延长是显著的危险因素,而在多变量分析中,仅放疗(p = 0.003)和膀胱导尿时间延长(p = 0.0309)被证明是独立的预测因素。估计未接受放疗的5年VUAS/US形成的风险(2.1% [95% CI: 0.9-3.3] vs. 7.3% [95% CI: 3.4-11])和正常膀胱导尿相比(2.6% [95% CI: 1.4-3.8] vs. 9.9% [95% CI: 2.3-18])。回顾性和有限的事件数量是我们的主要限制。结论及临床意义:RARP患者VUAS/US发生率低。接受放疗或需要长时间置管的患者应明确告知VUAS/US的风险和症状。此外,医生必须意识到这一点。
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引用次数: 0
Editorial Comment on (Abiraterone Acetate Triggers ER Stress-Mediated Androgen Receptor Suppression via PERK/ATF4/CHOP Signaling in Prostate Cancer) 在前列腺癌中,醋酸阿比特龙通过PERK/ATF4/CHOP信号触发内质网应激介导的雄激素受体抑制。
IF 2.2 3区 医学 Q3 UROLOGY & NEPHROLOGY Pub Date : 2026-01-11 DOI: 10.1111/iju.70352
Fatih Kar
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引用次数: 0
期刊
International Journal of Urology
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