To evaluate the clinical significance of a second transurethral resection of the bladder tumour (TURBT) in patients with a primary high-grade (HG) Ta non-muscle invasive bladder cancer (NMIBC), specifically selected for the initial diagnosis.
Patients and Methods
We retrospectively analysed 121 patients with primary HG Ta urothelial carcinoma treated at our institution between January 2007 and October 2024. All patients underwent an initial TURBT with the detrusor muscle present in the specimen. Patients were divided into the second TUR group (n = 48) and the non-second TUR group (n = 73). Propensity score matching was performed using age, number of tumours and Bacillus Calmette–Guerin treatment status. Outcomes included the residual tumour rate, recurrence-free survival (RFS), time to progression to muscle invasive bladder cancer (MIBC) and cancer-specific survival (CSS).
Results
Residual tumour at the initial resection site was identified in four patients (8.3%) who underwent a second TUR, with two patients (4.2%) being upstaged to T1. The median follow-up was 53 months. There were no significant differences between the two groups in RFS (p = 0.60), time to progression to MIBC (p = 0.63) or CSS (p = 0.18). These findings remained consistent in the matched cohort. Multivariate analysis revealed that a second TUR was not associated with improved RFS.
Conclusions
This is the first study to specifically address primary HG Ta bladder cancer, and it suggests that a second TUR may be omitted in selected cases, particularly when the initial resection is complete and the detrusor muscle is adequately sampled. A risk-adapted approach may help reduce unnecessary procedures without compromising oncological safety.
{"title":"Is a second TUR necessary in patients with primary high-grade Ta NMIBC, particularly in the context of initial cases?","authors":"Satoki Abe, Hiroyuki Fujinami, Naoyuki Yamanaka, Shinro Hata, Toru Inoue, Tadasuke Ando, Toshitaka Shin","doi":"10.1002/bco2.70082","DOIUrl":"10.1002/bco2.70082","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To evaluate the clinical significance of a second transurethral resection of the bladder tumour (TURBT) in patients with a primary high-grade (HG) Ta non-muscle invasive bladder cancer (NMIBC), specifically selected for the initial diagnosis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Patients and Methods</h3>\u0000 \u0000 <p>We retrospectively analysed 121 patients with primary HG Ta urothelial carcinoma treated at our institution between January 2007 and October 2024. All patients underwent an initial TURBT with the detrusor muscle present in the specimen. Patients were divided into the second TUR group (n = 48) and the non-second TUR group (n = 73). Propensity score matching was performed using age, number of tumours and Bacillus Calmette–Guerin treatment status. Outcomes included the residual tumour rate, recurrence-free survival (RFS), time to progression to muscle invasive bladder cancer (MIBC) and cancer-specific survival (CSS).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Residual tumour at the initial resection site was identified in four patients (8.3%) who underwent a second TUR, with two patients (4.2%) being upstaged to T1. The median follow-up was 53 months. There were no significant differences between the two groups in RFS (p = 0.60), time to progression to MIBC (p = 0.63) or CSS (p = 0.18). These findings remained consistent in the matched cohort. Multivariate analysis revealed that a second TUR was not associated with improved RFS.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This is the first study to specifically address primary HG Ta bladder cancer, and it suggests that a second TUR may be omitted in selected cases, particularly when the initial resection is complete and the detrusor muscle is adequately sampled. A risk-adapted approach may help reduce unnecessary procedures without compromising oncological safety.</p>\u0000 </section>\u0000 </div>","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"6 9","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://bjui-journals.onlinelibrary.wiley.com/doi/epdf/10.1002/bco2.70082","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145057931","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p>In this article, we present a practical technical tip for fenestrating the epididymal tubule during vasoepididymostomy (V-E)—a step that, to date, has rarely been described visually. Using simple illustrations, we aim to provide a clear visual guide for this crucial part of the procedure. V-E, a type of seminal-tract re-anastomosis for obstructive azoospermia, is regarded as one of the most technically demanding forms of male infertility microsurgery.<span><sup>1</sup></span> The “intussusception method” (also known as the “invagination method”), in which the fenestrated epididymal tubule is pulled into the lumen of the vas deferens for an end-to-side anastomosis, is a widely adopted approach. Notably, “longitudinal intussusception vasoepididymostomy (LIVE)”—which involves placing two double-armed needles longitudinally in the outer wall of the epididymal tubule, then incising the space between them—has been reported to be both simpler and more effective than other V-E techniques. We also actively employ the LIVE method in our practice. Chan, one of the developers of LIVE, described using a 15° ophthalmic knife to make a longitudinal incision in the outer wall of the epididymal tubule during fenestration.<span><sup>1</sup></span> However, we found it challenging to achieve a clean fenestration in a single pass, as the force applied by the microblade tip does not efficiently transmit to the soft outer wall. We suspect that, since Chan's original report, many surgeons have independently adopted minor modifications to overcome this challenge, but to our knowledge, such techniques have not been formally documented—likely due to their seemingly trivial nature.</p><p>After fenestration, the fluid leaking from the site is placed on a slide and examined immediately to confirm the presence of sufficient sperm. If no sperm are detected, a new fenestration is made slightly closer to the caput (the testicular end) of the epididymis, and the process is repeated. Fenestration sites not used for anastomosis are closed using absorbable suture and the tunica of the epididymis. Once a successful fenestration is achieved, we proceed with the standard LIVE technique: using the initially placed needles, we suture the mucosa of the vas deferens from inside to outside at four points, tying each suture to pull the epididymal tubule into the lumen of the vas deferens. Finally, we complete the anastomosis by suturing the tunica of the epididymis to the outer layer of the vas deferens with 9–0 nylon. A brief narrated video demonstrating Steps 1 and 2 and their integration into the standard LIVE workflow accompanies this article (Video 1).</p><p>Since 2015, our team has adopted this approach across multiple institutions, but some limitations of this visual technical tip should be noted. First, we did not directly compare clinical outcomes of this modification to those achieved with Chan's original LIVE method. Second, we have not quantitatively evaluated the extent to wh
{"title":"Step-by-step: A traction-based fenestration method for vasoepididymostomy","authors":"Kosuke Kojo, Masahiro Uchida, Kazumitsu Yamasaki, Jaejeong Kim, Ayumi Nakazono, Daisuke Numahata, Takazo Tanaka, Hiroyuki Nishiyama, Tatsuya Takayama, Teruaki Iwamoto","doi":"10.1002/bco2.70088","DOIUrl":"10.1002/bco2.70088","url":null,"abstract":"<p>In this article, we present a practical technical tip for fenestrating the epididymal tubule during vasoepididymostomy (V-E)—a step that, to date, has rarely been described visually. Using simple illustrations, we aim to provide a clear visual guide for this crucial part of the procedure. V-E, a type of seminal-tract re-anastomosis for obstructive azoospermia, is regarded as one of the most technically demanding forms of male infertility microsurgery.<span><sup>1</sup></span> The “intussusception method” (also known as the “invagination method”), in which the fenestrated epididymal tubule is pulled into the lumen of the vas deferens for an end-to-side anastomosis, is a widely adopted approach. Notably, “longitudinal intussusception vasoepididymostomy (LIVE)”—which involves placing two double-armed needles longitudinally in the outer wall of the epididymal tubule, then incising the space between them—has been reported to be both simpler and more effective than other V-E techniques. We also actively employ the LIVE method in our practice. Chan, one of the developers of LIVE, described using a 15° ophthalmic knife to make a longitudinal incision in the outer wall of the epididymal tubule during fenestration.<span><sup>1</sup></span> However, we found it challenging to achieve a clean fenestration in a single pass, as the force applied by the microblade tip does not efficiently transmit to the soft outer wall. We suspect that, since Chan's original report, many surgeons have independently adopted minor modifications to overcome this challenge, but to our knowledge, such techniques have not been formally documented—likely due to their seemingly trivial nature.</p><p>After fenestration, the fluid leaking from the site is placed on a slide and examined immediately to confirm the presence of sufficient sperm. If no sperm are detected, a new fenestration is made slightly closer to the caput (the testicular end) of the epididymis, and the process is repeated. Fenestration sites not used for anastomosis are closed using absorbable suture and the tunica of the epididymis. Once a successful fenestration is achieved, we proceed with the standard LIVE technique: using the initially placed needles, we suture the mucosa of the vas deferens from inside to outside at four points, tying each suture to pull the epididymal tubule into the lumen of the vas deferens. Finally, we complete the anastomosis by suturing the tunica of the epididymis to the outer layer of the vas deferens with 9–0 nylon. A brief narrated video demonstrating Steps 1 and 2 and their integration into the standard LIVE workflow accompanies this article (Video 1).</p><p>Since 2015, our team has adopted this approach across multiple institutions, but some limitations of this visual technical tip should be noted. First, we did not directly compare clinical outcomes of this modification to those achieved with Chan's original LIVE method. Second, we have not quantitatively evaluated the extent to wh","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"6 9","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://bjui-journals.onlinelibrary.wiley.com/doi/epdf/10.1002/bco2.70088","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145062641","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
James P. Daniels, Alexander Hernández-Tirado, James Mirocha, Renning Zheng, Jordan Palmer, Daniel Moreira, Stephen J. Freedland
Objectives
Most, but not all studies, suggest insulin resistance is associated with benign prostatic hyperplasia, but its impact on prostate volume (PV) changes over time remains unclear. We examined whether higher insulin resistance, measured by Homeostatic Model Assessment of Insulin Resistance (HOMA-IR), is associated with larger PV and greater prostate growth over a 4-year period.
Materials and Methods
We analysed data from the 4-year, randomized, double-blind, placebo-controlled REDUCE trial testing whether dutasteride could prevent prostate cancer. Patients underwent transrectal ultrasound measuring PV at baseline, year 2 and year 4. We calculated HOMA-IR from baseline fasting glucose and insulin, then stratified patients into quartiles within each arm (placebo vs. dutasteride). Using multivariable models, we estimated PV changes over time. We conducted a sensitivity analysis excluding patients with diabetes.
Results
Higher HOMA-IR quartiles were associated with larger PV at baseline, year 2 and year 4 in both placebo and dutasteride arms (all p < 0.001), though absolute differences were modest. PV increased in the placebo arm over 4 years, whereas it decreased in the dutasteride arm. However, there was no significant association between HOMA-IR and PV change in either arm. Results remained unchanged after excluding patients with diabetes.
Conclusion
Patients with higher HOMA-IR had modestly larger PVs at baseline, year 2 and year 4, but insulin resistance was unrelated to PV change over four years. These findings suggest that insulin resistance may be a modifiable risk factor contributing to benign prostatic enlargement, though further research is needed to determine its clinical relevance.
{"title":"Association between insulin resistance and prostate volume: A 4-year analysis from the Reduction by Dutasteride of Prostate Cancer (REDUCE) Trial","authors":"James P. Daniels, Alexander Hernández-Tirado, James Mirocha, Renning Zheng, Jordan Palmer, Daniel Moreira, Stephen J. Freedland","doi":"10.1002/bco2.70085","DOIUrl":"10.1002/bco2.70085","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Most, but not all studies, suggest insulin resistance is associated with benign prostatic hyperplasia, but its impact on prostate volume (PV) changes over time remains unclear. We examined whether higher insulin resistance, measured by Homeostatic Model Assessment of Insulin Resistance (HOMA-IR), is associated with larger PV and greater prostate growth over a 4-year period.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Methods</h3>\u0000 \u0000 <p>We analysed data from the 4-year, randomized, double-blind, placebo-controlled REDUCE trial testing whether dutasteride could prevent prostate cancer. Patients underwent transrectal ultrasound measuring PV at baseline, year 2 and year 4. We calculated HOMA-IR from baseline fasting glucose and insulin, then stratified patients into quartiles within each arm (placebo vs. dutasteride). Using multivariable models, we estimated PV changes over time. We conducted a sensitivity analysis excluding patients with diabetes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Higher HOMA-IR quartiles were associated with larger PV at baseline, year 2 and year 4 in both placebo and dutasteride arms (all p < 0.001), though absolute differences were modest. PV increased in the placebo arm over 4 years, whereas it decreased in the dutasteride arm. However, there was no significant association between HOMA-IR and PV change in either arm. Results remained unchanged after excluding patients with diabetes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Patients with higher HOMA-IR had modestly larger PVs at baseline, year 2 and year 4, but insulin resistance was unrelated to PV change over four years. These findings suggest that insulin resistance may be a modifiable risk factor contributing to benign prostatic enlargement, though further research is needed to determine its clinical relevance.</p>\u0000 </section>\u0000 </div>","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"6 9","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://bjui-journals.onlinelibrary.wiley.com/doi/epdf/10.1002/bco2.70085","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145057930","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Daniel Madarshahian, Abdulrasheed Habeeb, Nimeshan Chandra-Segaran, Kesavapilla Subramonian, Keval Patel
Background
Ureteral stent insertion, crucial for managing ureteral obstructions, often results in stent-related symptoms (SRSs) adversely affecting patient quality of life. This meta-analysis compares the effectiveness of tamsulosin or mirabegron versus placebo in alleviating these symptoms.
Methods
Following PRISMA guidelines, we systematically reviewed randomized controlled trials (RCTs) comparing mirabegron or tamsulosin to placebo in managing SRSs. Data sources included PubMed, Embase, Web of Science and CENTRAL, up to November 2023. The inclusion criteria focused on studies reporting on Ureteral Stent Symptom Questionnaire (USSQ), International Prostate Symptom Score (IPSS), quality of life (QoL) assessments, analgesic usage and adverse events. Meta-analysis employed a random-effects model, assessing heterogeneity and publication bias. For assessing the risk of bias in the included randomized trials, we employed the Cochrane Collaboration's tool. This protocol was registered at the International Prospective Register of Systematic Reviews (registration number: CRD42024511842).
Results
Sixteen RCTs with 1635 patients met the inclusion criteria. Tamsulosin significantly improved body pain (MD −1.80; 95% CI −3.53 to −0.07; p = 0.04), sexual function (MD −0.63; 95% CI −1.16 to −0.10; p = 0.02) and improved quality of life score (MD −2.36; 95% CI −3.56 to −1.17; p = 0.0001), while mirabegron was more effective in reducing urinary symptoms (MD −8.71; 95% CI −15.81 to −1.61; p = 0.02), enhancing general health (MD −2.58; 95% CI −3.78 to −1.37; p < 0.0001) and reducing analgesia use (MD −1.56; 95% CI −2.70 to −0.41; p = 0.008). Both medications significantly reduced total International Prostate Symptom Score (Tamsulosin MD −8.4; 95% CI −15.63 to −1.22; p = 0.02; Mirabegron MD −6.29; 95% CI −8.50 to −4.08; p < 0.00001) without a significant rise in adverse events (tamsulosin OR 1.90; 95% CI 0.40–9.18; mirabegron p = 0.42 and OR 0.93; 95% CI 0.30–2.88; p = 0.89).
Conclusions
Tamsulosin and mirabegron effectively manage SRSs, with distinct benefits in different symptom domains. This suggests a potential for complementary therapeutic strategies. Future high-quality RCTs are needed to explore their combined efficacy.
输尿管支架置入术是输尿管梗阻治疗的关键，经常导致支架相关症状（sss）对患者的生活质量产生不利影响。本荟萃分析比较了坦索罗辛或米拉贝隆与安慰剂在缓解这些症状方面的有效性。方法遵循PRISMA指南，我们系统地回顾了比较mirabegron或tamsulosin与安慰剂治疗srs的随机对照试验（rct）。数据来源包括PubMed， Embase， Web of Science和CENTRAL，截止到2023年11月。纳入标准集中于输尿管支架症状问卷（USSQ）、国际前列腺症状评分（IPSS）、生活质量（QoL）评估、镇痛药物使用和不良事件的研究。荟萃分析采用随机效应模型，评估异质性和发表偏倚。为了评估纳入的随机试验的偏倚风险，我们使用了Cochrane协作的工具。本方案已在国际前瞻性系统评价登记册上注册（注册号：CRD42024511842）。结果16项rct共1635例患者符合纳入标准。Tamsulosin显著提高身体疼痛(MD−1.80;95%可信区间3.53−−0.07;p = 0.04),性功能(MD−0.63;95%可信区间1.16−−0.10;p = 0.02)和改善生活质量评分(MD−2.36;95%可信区间3.56−−1.17;p = 0.0001),而mirabegron更有效地降低尿症状(MD−8.71;95%可信区间15.81−−1.61;p = 0.02),提高整体健康(MD−2.58;95%可信区间3.78−−1.37;p & lt; 0.0001),减少镇痛使用(MD−1.56;95%可信区间2.70−−0.41;p = 0.008)。两种药物均显著降低国际前列腺症状评分（坦索洛新MD - 8.4, 95% CI - 15.63 - 1.22, p = 0.02；米拉比格龙MD - 6.29, 95% CI - 8.50 - 4.08, p < 0.00001），不良事件发生率无显著升高（坦索洛新OR 1.90, 95% CI 0.40-9.18；米拉比格龙p = 0.42, OR 0.93, 95% CI 0.30-2.88, p = 0.89）。结论坦索罗辛和米拉贝龙对srs有较好的治疗效果，对不同症状域疗效明显。这提示了补充治疗策略的潜力。未来需要高质量的随机对照试验来探索它们的联合疗效。
{"title":"Ureteral stent symptoms: A systematic review and meta-analysis comparing the use of mirabegron and tamsulosin","authors":"Daniel Madarshahian, Abdulrasheed Habeeb, Nimeshan Chandra-Segaran, Kesavapilla Subramonian, Keval Patel","doi":"10.1002/bco2.485","DOIUrl":"10.1002/bco2.485","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Ureteral stent insertion, crucial for managing ureteral obstructions, often results in stent-related symptoms (SRSs) adversely affecting patient quality of life. This meta-analysis compares the effectiveness of tamsulosin or mirabegron versus placebo in alleviating these symptoms.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Following PRISMA guidelines, we systematically reviewed randomized controlled trials (RCTs) comparing mirabegron or tamsulosin to placebo in managing SRSs. Data sources included PubMed, Embase, Web of Science and CENTRAL, up to November 2023. The inclusion criteria focused on studies reporting on Ureteral Stent Symptom Questionnaire (USSQ), International Prostate Symptom Score (IPSS), quality of life (QoL) assessments, analgesic usage and adverse events. Meta-analysis employed a random-effects model, assessing heterogeneity and publication bias. For assessing the risk of bias in the included randomized trials, we employed the Cochrane Collaboration's tool. This protocol was registered at the International Prospective Register of Systematic Reviews (registration number: CRD42024511842).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Sixteen RCTs with 1635 patients met the inclusion criteria. Tamsulosin significantly improved body pain (MD −1.80; 95% CI −3.53 to −0.07; <i>p</i> = 0.04), sexual function (MD −0.63; 95% CI −1.16 to −0.10; <i>p</i> = 0.02) and improved quality of life score (MD −2.36; 95% CI −3.56 to −1.17; <i>p</i> = 0.0001), while mirabegron was more effective in reducing urinary symptoms (MD −8.71; 95% CI −15.81 to −1.61; <i>p</i> = 0.02), enhancing general health (MD −2.58; 95% CI −3.78 to −1.37; <i>p</i> < 0.0001) and reducing analgesia use (MD −1.56; 95% CI −2.70 to −0.41; <i>p</i> = 0.008). Both medications significantly reduced total International Prostate Symptom Score (Tamsulosin MD −8.4; 95% CI −15.63 to −1.22; <i>p</i> = 0.02; Mirabegron MD −6.29; 95% CI −8.50 to −4.08; <i>p</i> < 0.00001) without a significant rise in adverse events (tamsulosin OR 1.90; 95% CI 0.40–9.18; mirabegron <i>p</i> = 0.42 and OR 0.93; 95% CI 0.30–2.88; <i>p</i> = 0.89).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Tamsulosin and mirabegron effectively manage SRSs, with distinct benefits in different symptom domains. This suggests a potential for complementary therapeutic strategies. Future high-quality RCTs are needed to explore their combined efficacy.</p>\u0000 </section>\u0000 </div>","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"6 9","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://bjui-journals.onlinelibrary.wiley.com/doi/epdf/10.1002/bco2.485","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145038253","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sandra Irenaeus, Hans Garmo, Rolf Gedeborg, Mats Ahlberg, David Robinson, Pär Stattin, Kerri Beckmann
Objectives
To investigate the impact of age and life expectancy on treatment decisions and its consequences for outcomes among men with intermediate and high-risk prostate cancer (PCa).
Materials and methods
We studied men in Prostate Cancer data Base Sweden (PCBaSe) diagnosed between 2008 and 2022 with intermediate-risk or high-risk localized or locally advanced PCa and life expectancy between 2.5 and 15 years in the absence of PCa. Estimates of life expectancy were based on age and two comorbidity indices.
Results
A total of 32 196 men were included in the analyses. Of these, 17 419 (54%) had a life expectancy between 10 and 15 years, of whom 11 147 (64%) received primary radical treatment. Age had a stronger influence than life expectancy on the selection of treatment. Around 10% of deaths within 10 years of diagnosis could potentially have been avoided if men with >10 years life expectancy, regardless of age, had received radical treatment, based on assumptions of high treatment efficacy (30% reduction in all-cause mortality) and high uptake of treatment (90%).
Conclusion
A substantial proportion of healthy older men with intermediate and high-risk PCa did not undergo radical treatment. According to our model and assumptions, 10% of deaths within 10 years of diagnosis in these men could potentially have been avoided if they had received radical treatment.
{"title":"Potential gains from radical treatment of men with prostate cancer according to life expectancy","authors":"Sandra Irenaeus, Hans Garmo, Rolf Gedeborg, Mats Ahlberg, David Robinson, Pär Stattin, Kerri Beckmann","doi":"10.1002/bco2.70076","DOIUrl":"10.1002/bco2.70076","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To investigate the impact of age and life expectancy on treatment decisions and its consequences for outcomes among men with intermediate and high-risk prostate cancer (PCa).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and methods</h3>\u0000 \u0000 <p>We studied men in Prostate Cancer data Base Sweden (PCBaSe) diagnosed between 2008 and 2022 with intermediate-risk or high-risk localized or locally advanced PCa and life expectancy between 2.5 and 15 years in the absence of PCa. Estimates of life expectancy were based on age and two comorbidity indices.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 32 196 men were included in the analyses. Of these, 17 419 (54%) had a life expectancy between 10 and 15 years, of whom 11 147 (64%) received primary radical treatment. Age had a stronger influence than life expectancy on the selection of treatment. Around 10% of deaths within 10 years of diagnosis could potentially have been avoided if men with >10 years life expectancy, regardless of age, had received radical treatment, based on assumptions of high treatment efficacy (30% reduction in all-cause mortality) and high uptake of treatment (90%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>A substantial proportion of healthy older men with intermediate and high-risk PCa did not undergo radical treatment. According to our model and assumptions, 10% of deaths within 10 years of diagnosis in these men could potentially have been avoided if they had received radical treatment.</p>\u0000 </section>\u0000 </div>","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"6 9","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://bjui-journals.onlinelibrary.wiley.com/doi/epdf/10.1002/bco2.70076","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145037720","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ingolf Griebsch, Kristian Juul, Andrew Bottomley, Roya Sherafat-Kazemzadeh, Jack Pemment, Tori Brooks, Rocco Adiutori, Sonia Bothorel
Background
Radical cystectomy (RC) is a life-altering surgery primarily used to treat muscle-invasive bladder cancer (MIBC) and, occasionally, high-risk non-muscle-invasive bladder cancer (NMIBC). While this procedure can be lifesaving, it often leads to significant changes in quality of life (QOL). This review synthesizes the current quantitative and qualitative literature on QOL outcomes for RC patients, highlighting areas of impact and minimal recovery post RC.
Methods
A targeted literature review was conducted in Medline, searching for studies using qualitative methods to report patient experience and important aspects of QOL outcomes among RC patients between 2013 and 2024. A second search was performed focusing on clinical studies that reported QOLs using quantitative methods. Studies were screened based on study population and type of reported outcomes. Nine qualitative studies were selected to identify important themes related to QOL concepts. There were seven quantitative studies that were selected to extract the results of reported patient outcomes. These results were categorized using the themes identified (Sexual Functioning, Physical Functioning, Emotional Functioning, Work Functioning, Activities of Daily Living and Family-Social Functioning). Key QOL areas were examined and organized by the severity of impairment and potential for recovery.
Results
Patients experienced disease impact on sexual functioning and physical mobility as well as emotional well-being, daily living activities, work functioning and social interactions, with the first two domains most profoundly affected by RC. Emotional challenges and dependence on family support were prevalent post RC, with some gradual improvements in the second year. Qualitative findings also underscore the complex emotional and social adjustments patients undergo.
Conclusion
This review highlights the extensive impact of RC on multiple dimensions of QOL, suggesting a critical need for improved patient counselling and long-term support strategies. The findings highlight the importance of educating patients about the potential changes in QOL when considering treatment options. With shared patient and clinician decision making in specific cases of NMIBC, bladder sparing strategies may be considered, depending on the clinical contexts and patients' individual needs.
{"title":"Life after radical cystectomy: A mixed-methods targeted review of patient-reported quality of life following bladder removal","authors":"Ingolf Griebsch, Kristian Juul, Andrew Bottomley, Roya Sherafat-Kazemzadeh, Jack Pemment, Tori Brooks, Rocco Adiutori, Sonia Bothorel","doi":"10.1002/bco2.70049","DOIUrl":"10.1002/bco2.70049","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Radical cystectomy (RC) is a life-altering surgery primarily used to treat muscle-invasive bladder cancer (MIBC) and, occasionally, high-risk non-muscle-invasive bladder cancer (NMIBC). While this procedure can be lifesaving, it often leads to significant changes in quality of life (QOL). This review synthesizes the current quantitative and qualitative literature on QOL outcomes for RC patients, highlighting areas of impact and minimal recovery post RC.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A targeted literature review was conducted in Medline, searching for studies using qualitative methods to report patient experience and important aspects of QOL outcomes among RC patients between 2013 and 2024. A second search was performed focusing on clinical studies that reported QOLs using quantitative methods. Studies were screened based on study population and type of reported outcomes. Nine qualitative studies were selected to identify important themes related to QOL concepts. There were seven quantitative studies that were selected to extract the results of reported patient outcomes. These results were categorized using the themes identified (Sexual Functioning, Physical Functioning, Emotional Functioning, Work Functioning, Activities of Daily Living and Family-Social Functioning). Key QOL areas were examined and organized by the severity of impairment and potential for recovery.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Patients experienced disease impact on sexual functioning and physical mobility as well as emotional well-being, daily living activities, work functioning and social interactions, with the first two domains most profoundly affected by RC. Emotional challenges and dependence on family support were prevalent post RC, with some gradual improvements in the second year. Qualitative findings also underscore the complex emotional and social adjustments patients undergo.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This review highlights the extensive impact of RC on multiple dimensions of QOL, suggesting a critical need for improved patient counselling and long-term support strategies. The findings highlight the importance of educating patients about the potential changes in QOL when considering treatment options. With shared patient and clinician decision making in specific cases of NMIBC, bladder sparing strategies may be considered, depending on the clinical contexts and patients' individual needs.</p>\u0000 </section>\u0000 </div>","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"6 9","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://bjui-journals.onlinelibrary.wiley.com/doi/epdf/10.1002/bco2.70049","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145037748","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Angelo Cormio, Daniele Castellani, Domenico De Palma, Ruggiero Fiorella, Runeel Ratnayake, Michele Lotito, Giuseppe Albino, Ugo Giovanni Falagario, Gian Maria Busetto, Carlo Bettocchi, Giuseppe Carrieri, Luigi Cormio
Objective
To investigate the incidence, risk factors and clinical consequences of acute kidney injury (AKI) following mini-percutaneous nephrolithotomy (mini-PCNL), with particular focus on its association with postoperative infectious complications.
Materials and Methods
A retrospective analysis was conducted on 496 adult patients who underwent mini-PCNL (22 Ch) between February 2020 and April 2025. AKI was defined according to KDIGO criteria as either a ≥ 1.5-fold increase or an absolute increase of ≥0.3 mg/dl in serum creatinine within 72 hours postoperatively. Patients were stratified into AKI and non-AKI groups. Multivariable logistic regression analyses were performed to identify predictors of AKI development and infectious complications.
Results
Surgery was done in spinal anaesthesia in all cases. AKI occurred in 45 patients (9.1%). There was no difference in median surgical time (52.5 vs 55.0 minutes, p = 0.33) between groups. There was no difference between the two groups in gender distribution, median age, body mass index, baseline serum creatinine, rates of comorbidities and stone features. Patients with AKI had significantly higher rates of overall postoperative complications (24.4% vs 7.1%, p < 0.001) and longer hospital stays (4 vs 3 days, p < 0.001). Infectious complications were significantly more frequent in the AKI group, with higher median procalcitonin levels (0.21 vs 0.06 ng/ml, p = 0.03). One patient in the AKI group died from sepsis. Multivariable analysis identified previous PCNL (OR 2.51, 95% CI 1.33–4.72, p < 0.01) and higher baseline serum creatinine (OR 2.00, 95% CI 1.07–3.73, p = 0.03) as independent predictors of AKI. AKI was the only independent predictor of infectious complications (OR 3.47, 95% CI 1.04–11.58, p = 0.04).
Conclusions
The strong association between AKI and infectious complications, including potential mortality from sepsis, highlights the clinical significance of this underreported complication. Enhanced perioperative monitoring and aggressive management of infectious complications are warranted in patients who develop AKI following mini-PCNL.
目的探讨微创经皮肾镜取石术（mini-PCNL）后急性肾损伤（AKI）的发生率、危险因素及临床后果，并探讨其与术后感染并发症的关系。材料与方法对2020年2月至2025年4月期间接受mini-PCNL （22 Ch）治疗的496例成人患者进行回顾性分析。根据KDIGO标准，AKI定义为术后72小时内血清肌酐升高≥1.5倍或绝对升高≥0.3 mg/dl。将患者分为AKI组和非AKI组。进行多变量logistic回归分析以确定AKI发展和感染并发症的预测因素。结果所有病例均行脊髓麻醉手术。45例（9.1%）发生AKI。两组间中位手术时间无差异（52.5 vs 55.0分钟，p = 0.33）。两组在性别分布、中位年龄、体重指数、基线血清肌酐、合并症发生率和结石特征方面无差异。AKI患者的总体术后并发症发生率明显更高（24.4% vs 7.1%, p < 0.001），住院时间也更长（4天vs 3天，p < 0.001）。AKI组感染并发症明显更频繁，降钙素原中位水平更高（0.21 vs 0.06 ng/ml, p = 0.03）。AKI组中有1例患者死于败血症。多变量分析发现，既往PCNL （OR 2.51, 95% CI 1.33-4.72, p < 0.01）和较高的基线血清肌酐（OR 2.00, 95% CI 1.07-3.73, p = 0.03）是AKI的独立预测因子。AKI是感染并发症的唯一独立预测因子（OR 3.47, 95% CI 1.04-11.58, p = 0.04）。AKI与感染性并发症（包括脓毒症的潜在死亡率）之间的密切关联突出了这种未被报道的并发症的临床意义。对于mini-PCNL后发生AKI的患者，加强围手术期监测和积极处理感染并发症是必要的。
{"title":"Acute kidney injury as a predictor of infectious complications after mini-PCNL","authors":"Angelo Cormio, Daniele Castellani, Domenico De Palma, Ruggiero Fiorella, Runeel Ratnayake, Michele Lotito, Giuseppe Albino, Ugo Giovanni Falagario, Gian Maria Busetto, Carlo Bettocchi, Giuseppe Carrieri, Luigi Cormio","doi":"10.1002/bco2.70084","DOIUrl":"10.1002/bco2.70084","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To investigate the incidence, risk factors and clinical consequences of acute kidney injury (AKI) following mini-percutaneous nephrolithotomy (mini-PCNL), with particular focus on its association with postoperative infectious complications.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Methods</h3>\u0000 \u0000 <p>A retrospective analysis was conducted on 496 adult patients who underwent mini-PCNL (22 Ch) between February 2020 and April 2025. AKI was defined according to KDIGO criteria as either a ≥ 1.5-fold increase or an absolute increase of ≥0.3 mg/dl in serum creatinine within 72 hours postoperatively. Patients were stratified into AKI and non-AKI groups. Multivariable logistic regression analyses were performed to identify predictors of AKI development and infectious complications.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Surgery was done in spinal anaesthesia in all cases. AKI occurred in 45 patients (9.1%). There was no difference in median surgical time (52.5 vs 55.0 minutes, p = 0.33) between groups. There was no difference between the two groups in gender distribution, median age, body mass index, baseline serum creatinine, rates of comorbidities and stone features. Patients with AKI had significantly higher rates of overall postoperative complications (24.4% vs 7.1%, p < 0.001) and longer hospital stays (4 vs 3 days, p < 0.001). Infectious complications were significantly more frequent in the AKI group, with higher median procalcitonin levels (0.21 vs 0.06 ng/ml, p = 0.03). One patient in the AKI group died from sepsis. Multivariable analysis identified previous PCNL (OR 2.51, 95% CI 1.33–4.72, p < 0.01) and higher baseline serum creatinine (OR 2.00, 95% CI 1.07–3.73, p = 0.03) as independent predictors of AKI. AKI was the only independent predictor of infectious complications (OR 3.47, 95% CI 1.04–11.58, p = 0.04).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The strong association between AKI and infectious complications, including potential mortality from sepsis, highlights the clinical significance of this underreported complication. Enhanced perioperative monitoring and aggressive management of infectious complications are warranted in patients who develop AKI following mini-PCNL.</p>\u0000 </section>\u0000 </div>","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"6 9","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://bjui-journals.onlinelibrary.wiley.com/doi/epdf/10.1002/bco2.70084","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145012303","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Aziz NA, Ng K, Alifrangis C, Tran B, Conduit C, Liow E, et al. Therapy de-escalation for testicular cancer (THERATEST): A multi-centre observational cohort feasibility study of de-escalation therapies for good prognosis stage II germ cell tumours. BJUI Compass. 2025; 6(8):e70057. https://doi.org/10.1002/bco2.70057.
In the originally published article, Section 3.2—Secondary Objectives and Endpoints—was not presented in the correct sequence. While the content is factually accurate, the structure is disordered and several objectives are repeated or misaligned, which may confuse readers. The correct version appears below.
{"title":"Correction to “Therapy de-escalation for testicular cancer (THERATEST): A multi-centre observational cohort feasibility study of de-escalation therapies for good prognosis stage II germ cell tumours”","authors":"","doi":"10.1002/bco2.70071","DOIUrl":"10.1002/bco2.70071","url":null,"abstract":"<p>Aziz NA, Ng K, Alifrangis C, Tran B, Conduit C, Liow E, et al. <b>Therapy de-escalation for testicular cancer (THERATEST): A multi-centre observational cohort feasibility study of de-escalation therapies for good prognosis stage II germ cell tumours</b>. BJUI Compass. 2025; 6(8):e70057. https://doi.org/10.1002/bco2.70057.</p><p>In the originally published article, Section 3.2—<i>Secondary Objectives and Endpoints—</i>was not presented in the correct sequence. While the content is factually accurate, the structure is disordered and several objectives are repeated or misaligned, which may confuse readers. The correct version appears below.</p><p><b>3.2 | Secondary objectives and endpoints</b></p><p>We apologize for this error.</p>","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"6 9","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://bjui-journals.onlinelibrary.wiley.com/doi/epdf/10.1002/bco2.70071","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145012304","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
To develop a novel risk score (RS) model to predict the probability of progression to castration-resistant prostate cancer (PCa) (CRPC) after intensity-modulated radiation therapy (IMRT) for patients with high- and very high-risk PCa according to the National Comprehensive Cancer Network (NCCN) risk classification, since accurate prediction of the clinical outcome of definitive radiation therapy for patients with high- and very high-risk PCa remains challenging due to its heterogeneity.
Materials and Methods
We conducted a retrospective review of 600 patients with high- and very high-risk PCa treated with IMRT at our institution. They were randomly divided into discovery (n = 300) and validation (n = 300) cohorts. A predictive RS model was created using a dataset from the discovery cohort based on the following parameters: T-stage, Gleason score, prostate-specific antigen and age at initiation of IMRT. The model was internally validated using a dataset from the validation cohort. RS was calculated using multivariable Cox regression analysis, and patients were categorized into low-risk, intermediate-risk or high-risk based on the value.
Results
The median follow-up period of the 600 patients was 9.1 (IQR: 6.1–11.6) years. The 10-year CRPC-free rates for low-, intermediate- and high-risk categories were 100.0, 90.4 and 61.4% in the discovery cohort, respectively (p < 0.001). Such differences were reproduced in the validation cohort. Specifically, those rates for low-, intermediate- and high-risk categories were 96.4, 90.7 and 74.8% in the validation cohort, respectively (p < 0.001). Harrell's C-index for this model was 0.692, being higher than that of the NCCN risk classification (0.617).
Conclusion
This RS model provided useful information to enable tailoring of the treatment intensity for this heterogeneous population.
{"title":"Development of a novel risk model to predict CRPC progression following IMRT: Implications for tailoring treatment intensity","authors":"Takashi Ogata, Rihito Aizawa, Hiroyasu Abe, Takayuki Goto, Kiyonao Nakamura, Yuki Kita, Takayuki Sumiyoshi, Kaoru Murakami, Kei Mizuno, Satoshi Morita, Takashi Kobayashi, Takashi Mizowaki","doi":"10.1002/bco2.70074","DOIUrl":"10.1002/bco2.70074","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To develop a novel risk score (RS) model to predict the probability of progression to castration-resistant prostate cancer (PCa) (CRPC) after intensity-modulated radiation therapy (IMRT) for patients with high- and very high-risk PCa according to the National Comprehensive Cancer Network (NCCN) risk classification, since accurate prediction of the clinical outcome of definitive radiation therapy for patients with high- and very high-risk PCa remains challenging due to its heterogeneity.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Methods</h3>\u0000 \u0000 <p>We conducted a retrospective review of 600 patients with high- and very high-risk PCa treated with IMRT at our institution. They were randomly divided into discovery (n = 300) and validation (n = 300) cohorts. A predictive RS model was created using a dataset from the discovery cohort based on the following parameters: T-stage, Gleason score, prostate-specific antigen and age at initiation of IMRT. The model was internally validated using a dataset from the validation cohort. RS was calculated using multivariable Cox regression analysis, and patients were categorized into low-risk, intermediate-risk or high-risk based on the value.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The median follow-up period of the 600 patients was 9.1 (IQR: 6.1–11.6) years. The 10-year CRPC-free rates for low-, intermediate- and high-risk categories were 100.0, 90.4 and 61.4% in the discovery cohort, respectively (p < 0.001). Such differences were reproduced in the validation cohort. Specifically, those rates for low-, intermediate- and high-risk categories were 96.4, 90.7 and 74.8% in the validation cohort, respectively (p < 0.001). Harrell's C-index for this model was 0.692, being higher than that of the NCCN risk classification (0.617).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This RS model provided useful information to enable tailoring of the treatment intensity for this heterogeneous population.</p>\u0000 </section>\u0000 </div>","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"6 9","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://bjui-journals.onlinelibrary.wiley.com/doi/epdf/10.1002/bco2.70074","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145012306","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Julien Anract, Marie Florin, Laura Larnaudie, Michael Peyromaure, Nicolas Barry Delongchamps
Objectives
To evaluate the feasibility and safety of hydrodissection of the prostato-rectal space using 10% dextrose for focal therapy of posterior prostate tumours.
Patients and methods
We included consecutive patients who underwent focal therapy for a posterior prostate tumour with a prior injection of 10% dextrose in the prostato-rectal space, between October 2024 and February 2025. The main outcomes were to evaluate the space created using this technique. As the technique used for hydrodissection was modelled on periprostatic nerve block, we analysed a cohort of patients who underwent transperineal prostate biopsies with periprostatic nerve block using 20 ml of lidocaine, to compare the prostato-rectal spaces created by 10% dextrose and by lidocaine.
Results
A total of 11 patients underwent a focal therapy with a prior 20 ml 10% dextrose hydrodissection of the prostato-rectal space. Fifteen patients who underwent prostatic biopsies using a periprostatic nerve block (20 ml of lidocaine), with similar characteristics, were included. The median prostato-rectal space created with dextrose and with lidocaine was 8.9 [8.0; 9.9] and 6.7 [6.4; 8.4] mm, respectively (p = 0,17). The prostato-rectal space decreased slower with dextrose: 0.03 mm/min vs 0.1 mm/min (p = 0,02). The prostato-rectal space was higher at the end of focal therapy procedures (7.9 vs 6.6 mm, p = 0,033), despite a longer procedure time in focal therapy (37 vs 8 min, p < 0,001). At the end of focal therapy procedures, all patients had a prostato-rectal space > 5 mm. No hydrodissection-related adverse event was observed.
Conclusions
These initial results suggest that hydrodissection of the prostate–rectal space using 20 ml 10% dextrose, injected following a standard periprostatic nerve block protocol, is feasible, reproducible and safe for a focal therapy procedure for localized posterior prostate tumours.
目的探讨10%葡萄糖对前列腺直肠间隙进行水解剖治疗前列腺后部肿瘤的可行性和安全性。患者和方法我们纳入了2024年10月至2025年2月期间连续接受前列腺后部肿瘤局灶治疗并事先在前列腺直肠间隙注射10%葡萄糖的患者。主要结果是评估使用这种技术创造的空间。由于水解剖技术以前列腺周围神经阻滞为模型，我们分析了一组接受经会阴前列腺活检并使用20毫升利多卡因进行前列腺周围神经阻滞的患者，以比较10%葡萄糖和利多卡因造成的前列腺直肠间隙。结果11例患者均行局灶性前列腺直肠间隙10%葡萄糖水解剖20ml。采用前列腺周围神经阻滞（20ml利多卡因）进行前列腺活组织检查的15例患者具有相似的特征。葡萄糖组和利多卡因组的前列腺直肠正中间隙为8.9 [8.0]；9.9]和6.7 [6.4]；8.4] mm （p = 0,17）。葡萄糖组前列腺直肠间隙缩小较慢：0.03 mm/min vs 0.1 mm/min （p = 0.02）。局灶治疗结束时，前列腺直肠间隙增大（7.9 vs 6.6 mm, p = 0,033），尽管局灶治疗的手术时间较长（37 vs 8 min, p = 0,001）。在局灶性治疗过程结束时，所有患者的前列腺直肠间隙均为5mm。未观察到与水解剖相关的不良事件。这些初步结果表明，在标准的前列腺周围神经阻滞方案下，使用20ml 10%葡萄糖对前列腺直肠间隙进行水解剖，对于局限性前列腺后肿瘤的局灶治疗是可行的、可重复的和安全的。
{"title":"Hydrodissection using 10% dextrose before focal therapy of prostate cancer: Initial experience","authors":"Julien Anract, Marie Florin, Laura Larnaudie, Michael Peyromaure, Nicolas Barry Delongchamps","doi":"10.1002/bco2.70073","DOIUrl":"10.1002/bco2.70073","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To evaluate the feasibility and safety of hydrodissection of the prostato-rectal space using 10% dextrose for focal therapy of posterior prostate tumours.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Patients and methods</h3>\u0000 \u0000 <p>We included consecutive patients who underwent focal therapy for a posterior prostate tumour with a prior injection of 10% dextrose in the prostato-rectal space, between October 2024 and February 2025. The main outcomes were to evaluate the space created using this technique. As the technique used for hydrodissection was modelled on periprostatic nerve block, we analysed a cohort of patients who underwent transperineal prostate biopsies with periprostatic nerve block using 20 ml of lidocaine, to compare the prostato-rectal spaces created by 10% dextrose and by lidocaine.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 11 patients underwent a focal therapy with a prior 20 ml 10% dextrose hydrodissection of the prostato-rectal space. Fifteen patients who underwent prostatic biopsies using a periprostatic nerve block (20 ml of lidocaine), with similar characteristics, were included. The median prostato-rectal space created with dextrose and with lidocaine was 8.9 [8.0; 9.9] and 6.7 [6.4; 8.4] mm, respectively (p = 0,17). The prostato-rectal space decreased slower with dextrose: 0.03 mm/min vs 0.1 mm/min (p = 0,02). The prostato-rectal space was higher at the end of focal therapy procedures (7.9 vs 6.6 mm, p = 0,033), despite a longer procedure time in focal therapy (37 vs 8 min, p < 0,001). At the end of focal therapy procedures, all patients had a prostato-rectal space > 5 mm. No hydrodissection-related adverse event was observed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>These initial results suggest that hydrodissection of the prostate–rectal space using 20 ml 10% dextrose, injected following a standard periprostatic nerve block protocol, is feasible, reproducible and safe for a focal therapy procedure for localized posterior prostate tumours.</p>\u0000 </section>\u0000 </div>","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"6 9","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://bjui-journals.onlinelibrary.wiley.com/doi/epdf/10.1002/bco2.70073","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144929615","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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