BJUI compass最新文献

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.

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.

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.

Objectives

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.

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.

Objectives

To determine whether serial 24-hour urine collections from the same patient over time result in improved stone risk parameters.

Patients and Methods

Using a 24-hour urinalysis database, 1832 tests from 688 patients collected over a 10-year period were retrospectively reviewed. Patients included in the analysis had a minimum follow-up of 2 years and at least three 24-hour urine collections. Changes in risk parameters were evaluated over time with each patient acting as their own control. Statistical analysis was performed using repeated measures ANOVA with a Greenhouse–Geisser correction and post-hoc analysis with Bonferroni correction. Significance level was set as p < 0.05.

Results

A total of 225 patients had at least three 24-hour urine collections, of which 48% were female. From the first to the second 24-hour urine collections, volume and supersaturation of CaOx, CaP and UA all significantly improved (p < 0.05). From the second to the third collection, only the supersaturation of CaP significantly improved (p < 0.05). Approximately half of the patients continued to see improvement in stone risk parameters between the second and third urine collection.

Conclusion

Serial 24-hour urine collections performed at 6-month or greater intervals were significantly associated with improvements in stone risk parameters. This study suggests that serial collections can aid in the correction of urinary stone parameters and should be considered in active stone formers.

Objective

To compare in vitro the ablation rates of p-Tm:YAG, TFL and Ho:YAG against synthetic and human stones.

Material and Methods

p-Tm:YAG, TFL and Low-Power (LP) Ho:YAG were compared using 270 μm core-diameter laser fibres (CDF); experiments with 200 μm(p-Tm:YAG) and 150 μm-CDF (TFL) were also included. A continuous laser emission was applied through a spiral trajectory for 20 seconds with the laser fibre tip in contact with synthetic hard (HSP) and soft stone phantoms (SSP) submerged in saline. “Dusting” settings for p-Tm:YAG(0,6 J-20 Hz-Flex Long Pulse), TFL(0,5 J-30 Hz-Short Pulse) and Ho:YAG(0,5 J-30 Hz-Long Pulse) and “Fragmentation” settings for p-Tm:YAG(1 J-15 Hz-Captive), TFL(1 J-15 Hz-Short Pulse) and Ho:YAG(1 J-15 Hz-Long Pulse) were analysed. Then, experiments for human calcium oxalate monohydrate (COM), uric acid (UA) and cystine (CYS) stones were performed with single laser pulses at 0.6 J, 0.8 J and 1.0 J for p-Tm:YAG (Captive Fragmenting mode), TFL (Short Pulse) and Ho:YAG (Long Pulse). Synthetic and human stone samples were dried before three-dimensional scanning to measure ablation rates (ARs) and ablation volume per pulse (AVP).

Results

For synthetic stones with 270 μm-CDF, the p-Tm:YAG and TFL presented similar ARs, except in Fragmentation against HSP (95,1 ± 13,6vs67 ± 14 p = 0,02, respectively). Both p-Tm:YAG and TFL achieved higher ARs than Ho:YAG in all settings. p-Tm:YAG-200 μm-CDF and TFL-150 μm-CDF presented similar ARs, except in Fragmentation against HSP(78,4 ± 8vs42,5 ± 2,6 mm³/min,p = 0,0002). Both p-Tm:YAG-200 μm-CDF and TFL-150 μm-CDF presented at least 50% higher ARs than 270 μm-Ho:YAG. For human stones with COM, TFL exhibited higher AVP compared to p-Tm:YAG and Ho:YAG across all pulse energies (258,2 ± 213vs81,7 ± 31,9vs41,5 ± 25,4 μm³ p = 0,01, respectively). Against UA, Ho:YAG demonstrated higher AVP compared to TFL and p-Tm:YAG (355,2 ± 161vs99,8 ± 76,7vs292,9 ± 203,1 μm³ p = 0,0005, respectively). For CYS, Ho:YAG presented higher AVP but without significance (99,8 ± 76,7 vs 49,3 ± 36,3 vs 38,8 ± 12,2 μm³, p = 0,09).

Conclusion

p-Tm:YAG and TFL achieved higher ARs than LP-Ho:YAG against synthetic stones in vitro. For human stones, TFL achieved the highest AVP against COM while LP-Ho:YAG delivered higher AVPs against UA and CYS, for which TFL performed worst.

Background and objective

Multidisciplinary tumour boards (MTBs) play a critical role in prostate cancer management, but their time-intensive nature limits accessibility. This study evaluates machine learning (ML) algorithms for automating MTB recommendations in prostate cancer patients, focusing on multi-label classification for diagnostic and therapeutic decisions.

Methods

A retrospective dataset of 1929 MTB recommendations from 2020 to 2024 was used for model development and validation at a single academic centre. Three ML algorithms—Decision Tree, Random Forest and K-Nearest Neighbours (KNN)—were trained to predict recommendations for PSMA-PET, conventional imaging, active surveillance and local therapy (radical prostatectomy or radiotherapy). Model performance was assessed using accuracy, precision, recall and F1-score.

Key findings and limitations

The Random Forest model achieved the highest overall accuracy (66.3%, 95% CI 61.7–71%) and showed stable performance across most outcome categories. Predictions for local therapy were highly accurate (F1-score: 0.99), but model performance was lower for less frequent recommendations such as PSMA-PET and active surveillance, reflecting class imbalance and recent guideline changes. Limitations include moderate overall accuracy, retrospective single-centre design and the need for extensive manual data preprocessing. In addition, a high proportion of patients were eligible for multiple treatment options, which may limit the discriminatory value of certain outcomes.

Conclusions and clinical implications

This study demonstrates the potential of ML to replicate MTB decision patterns in prostate cancer with reasonable accuracy. However, the current model requires further optimization before it can be considered for clinical application. It should be regarded as a proof-of-concept that highlights both the opportunities and the challenges of algorithm-based decision support in oncology. Future work should focus on improving model performance through multi-institutional data, prospective validation and continuous adaptation to evolving clinical guidelines.

Objectives

A range of techniques have been described for robotic-assisted intracorporeal neobladder construction. The pyramid neobladder has now been performed for over 10 years. We now describe the long-term outcomes, including the impact of function preservation through nerve and prostate capsule sparing in the male population.

Subjects/Patients and Methods

All patients who underwent pyramid neobladder construction between January 2015 and December 2023 at the University College London Hospital (UK) were reviewed. Patients were selected for function preservation based on baseline sexual function/wishes, PSA ± multiparametric prostate MRI. Selected oncological, functional and patient reported outcomes were assessed.

Results

A total of 71 patients were included; 87% (61/71) were men. About 65% (40/61) underwent either nerve- or prostate capsule-sparing surgery. Median follow-up was 57.8 months (IQR 48.3). In male patients, there was no difference between the 12- and 24-month cancer specific and overall survival rates between the function sparing groups. There were no positive prostate cancer margins. Daytime continence was 75% (39/52) and 67% (6/9), and nighttime was 17% (9/52) and 11% (1/9), in men and women, respectively. There was no significant difference between the male function sparing groups (p < 0.342). About 94% of men (29/31) were sexually active before surgery, falling to 55% (17/31) after, with 76% (13/17) using treatment for erectile dysfunction. The median change in SHIM score was 4.5 (SD 5.3) in prostate capsule-sparing, 6 (SD 7.7) in nerve-sparing and 17 (SD 2.8) in standard groups.

About 45% (30/66) of patients had a significant reduction in eGFR (>10 mL/min/1.73m²). Uretero–ileal strictures were confirmed in 4.2% (3/71). About 28% (19/67) of patients reported recurrent UTIs and 7% (5/71) reported neobladder rupture.

Conclusion

Sexual function had the largest impact on quality of life and may be improved with function-sparing techniques. The burden of additional complications including neobladder rupture and urinary tract infections was also highlighted.