Muhammad Imran, Wayne G. Brisbane, Li-Ming Su, Jason P. Joseph, Wei Shao
Objective
This study aimed to evaluate the diagnostic accuracy of artificial intelligence (AI)–enhanced micro-ultrasound (micro-US) for detecting clinically significant prostate cancer (csPCa) in men referred for prostate biopsy.
Patients and Methods
We retrospectively analysed 145 men undergoing micro-US-guided biopsy (79 with csPCa, 66 without). Deep features were extracted from 2D micro-US slices using a self-supervised convolutional autoencoder and classified with a random forest model under fivefold cross-validation. Patients were considered csPCa-positive if ≥8 consecutive slices were predicted positive. Diagnostic performance was assessed against biopsy pathology using receiver operating characteristic (ROC) analysis.
Results
The AI–micro-US model achieved an area under the ROC curve (AUC) of 0.871. At a fixed threshold, sensitivity was 92.5% and specificity 68.1%, outperforming a clinical model based on prostate-specific antigen (PSA), digital rectal examination (DRE), age, and prostate volume (AUC 0.753; sensitivity 96.2%, specificity 27.3%).
Conclusion
AI-enhanced micro-US reduces false positives from conventional screening tools while preserving high sensitivity. It shows promise as a point-of-care alternative to MRI, integrating risk stratification and biopsy guidance into a single platform.
{"title":"AI-enhanced micro-ultrasound improves detection of clinically significant prostate cancer at biopsy","authors":"Muhammad Imran, Wayne G. Brisbane, Li-Ming Su, Jason P. Joseph, Wei Shao","doi":"10.1002/bco2.70133","DOIUrl":"https://doi.org/10.1002/bco2.70133","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>This study aimed to evaluate the diagnostic accuracy of artificial intelligence (AI)–enhanced micro-ultrasound (micro-US) for detecting clinically significant prostate cancer (csPCa) in men referred for prostate biopsy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Patients and Methods</h3>\u0000 \u0000 <p>We retrospectively analysed 145 men undergoing micro-US-guided biopsy (79 with csPCa, 66 without). Deep features were extracted from 2D micro-US slices using a self-supervised convolutional autoencoder and classified with a random forest model under fivefold cross-validation. Patients were considered csPCa-positive if ≥8 consecutive slices were predicted positive. Diagnostic performance was assessed against biopsy pathology using receiver operating characteristic (ROC) analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The AI–micro-US model achieved an area under the ROC curve (AUC) of 0.871. At a fixed threshold, sensitivity was 92.5% and specificity 68.1%, outperforming a clinical model based on prostate-specific antigen (PSA), digital rectal examination (DRE), age, and prostate volume (AUC 0.753; sensitivity 96.2%, specificity 27.3%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>AI-enhanced micro-US reduces false positives from conventional screening tools while preserving high sensitivity. It shows promise as a point-of-care alternative to MRI, integrating risk stratification and biopsy guidance into a single platform.</p>\u0000 </section>\u0000 </div>","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"7 2","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://bjui-journals.onlinelibrary.wiley.com/doi/epdf/10.1002/bco2.70133","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146136102","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, Steffi Kar Kei Yuen, Khi Yung Fong, Deepak Ragoori, Laurian Dragos, Mohamed Omar, Luigi Cormio, Guohua Zeng, Wei Zhu, Shusheng Liu, Thomas R. W. Herrmann, Bhaskar K. Somani, Chi Fai Ng, Mohamed Elshazly, Vineet Gauhar
Objective
This study aims to evaluate the safety, efficacy and clinical outcomes of elective flexible ureteroscopy using flexible and navigable suction ureteral access sheaths (FANS) in patients with upper tract infectious stones following initial management of systemic urinary tract infections (UTIs).
Materials and Methods
We conducted a multicentre prospective analysis of patients with infectious ureteral or kidney stones (struvite or calcium carbonate-apatite) who underwent flexible ureteroscopy using FANS between March 2024 and March 2025. All patients had prior systemic UTI management with a minimum 6-week interval before definitive stone treatment. Stone-free rate was assessed at 30 days using a CT scan.
Results
The cohort included 144 patients (median age 51 years, 70.1% female) with a median stone diameter of 1.9 cm. 20.1% had initially received only antibiotic treatment, whereas 79.9% had also received emergency drainage. Forty-seven patients (32.6%) had emphysematous pyelonephritis at initial presentation. Median operative time was 40 min with a 1-day hospital stay. Notable findings included zero cases of sepsis and a 29.9% rate of postoperative fever requiring extended antibiotics up to 2 weeks. Zero residual fragments were achieved in 48.6% and a single fragment up to 2 mm in 43.8% of patients (92.4% combined stone-free rate). Renal function improved at 30 days (median creatinine decrease −15 μmol/L) and 3 months (−18 μmol/L). Fever rate was 29.8% in the emphysematous pyelonephritis subgroup.
Conclusions
Elective flexible ureteroscopy using FANS for upper tract infectious stones is feasible for its excellent safety profile with no sepsis cases and high stone-free rates. FANS technology appears to offer significant advantages in this challenging patient population by mitigating postoperative sepsis due to debris aspiration, reduction of pyelovenous backflow of contaminated irrigation fluids and improved stone fragment evacuation.
{"title":"Elective flexible ureteroscopy with suction sheaths for infectious stones in prior UTI patients","authors":"Angelo Cormio, Daniele Castellani, Steffi Kar Kei Yuen, Khi Yung Fong, Deepak Ragoori, Laurian Dragos, Mohamed Omar, Luigi Cormio, Guohua Zeng, Wei Zhu, Shusheng Liu, Thomas R. W. Herrmann, Bhaskar K. Somani, Chi Fai Ng, Mohamed Elshazly, Vineet Gauhar","doi":"10.1002/bco2.70151","DOIUrl":"10.1002/bco2.70151","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>This study aims to evaluate the safety, efficacy and clinical outcomes of elective flexible ureteroscopy using flexible and navigable suction ureteral access sheaths (FANS) in patients with upper tract infectious stones following initial management of systemic urinary tract infections (UTIs).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Methods</h3>\u0000 \u0000 <p>We conducted a multicentre prospective analysis of patients with infectious ureteral or kidney stones (struvite or calcium carbonate-apatite) who underwent flexible ureteroscopy using FANS between March 2024 and March 2025. All patients had prior systemic UTI management with a minimum 6-week interval before definitive stone treatment. Stone-free rate was assessed at 30 days using a CT scan.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The cohort included 144 patients (median age 51 years, 70.1% female) with a median stone diameter of 1.9 cm. 20.1% had initially received only antibiotic treatment, whereas 79.9% had also received emergency drainage. Forty-seven patients (32.6%) had emphysematous pyelonephritis at initial presentation. Median operative time was 40 min with a 1-day hospital stay. Notable findings included zero cases of sepsis and a 29.9% rate of postoperative fever requiring extended antibiotics up to 2 weeks. Zero residual fragments were achieved in 48.6% and a single fragment up to 2 mm in 43.8% of patients (92.4% combined stone-free rate). Renal function improved at 30 days (median creatinine decrease −15 μmol/L) and 3 months (−18 μmol/L). Fever rate was 29.8% in the emphysematous pyelonephritis subgroup.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Elective flexible ureteroscopy using FANS for upper tract infectious stones is feasible for its excellent safety profile with no sepsis cases and high stone-free rates. FANS technology appears to offer significant advantages in this challenging patient population by mitigating postoperative sepsis due to debris aspiration, reduction of pyelovenous backflow of contaminated irrigation fluids and improved stone fragment evacuation.</p>\u0000 </section>\u0000 </div>","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"7 2","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12869839/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146127708","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}
Evan Seibly, Ali Albaghli, Kyu Park, Elizabeth A. Baldwin, Ala'a Farkouh, Katya Hanessian, Nicole Mack, Cliff De Guzman, Toby Clark, Matthew Buell, Rose Leu, Kanha Shete, Sikai Song, Akin S. Amasyali, Zham Okhunov, D. Duane Baldwin
Objectives
To measure the effects of varying configurations of nephroscope sheath, irrigation, instruments, and suction on intrarenal pressure (IRP) during percutaneous nephrolithotomy (PCNL).
Materials and Methods
Kidney and ureter 3D printed models from a deidentified patient's CT scan were placed in a plaster and foam mould, simulating the torso of a prone patient. An Amplatz sheath was inserted into the kidney model. Fourteen different rigid nephroscope sheath (RNS), irrigation, instrument and suction configurations were compared. IRP was measured in a retrograde fashion. Comparisons were performed using the Wilcoxon Signed-Rank test followed by Bonferroni correction.
Results
The mean IRP with and without the RNS was 19.1 and 14.7 mm Hg, respectively (p < 0.001). Using the inflow port of the RNS for irrigation created a lower IRP (19.1 mm Hg) compared to the outflow port (32.7 mm Hg; p < 0.001). Addition of suction to all working scenarios significantly reduced IRP (p < 0.001). Insertion of instruments did not significantly alter IRP.
Conclusion
In situations where the IRP should be low, removal of the RNS, irrigating through the inflow port, and frequent use of suction maintain the lowest pressures. If temporary increases in IRP are necessary to improve visualisation in the setting of bleeding, irrigating through the outflow port, minimising drainage and use of the RNS can be used to raise IRP.
目的：探讨经皮肾镜取石术（PCNL）中不同配置的肾镜鞘、冲洗、器械和吸引器对肾内压（IRP）的影响。材料和方法：将患者CT扫描的肾脏和输尿管3D打印模型放入石膏和泡沫模具中，模拟俯卧患者的躯干。将Amplatz鞘插入肾脏模型。比较了14种不同的刚性肾镜鞘、灌洗、器械及吸液配置。IRP以逆行方式测量。比较采用Wilcoxon Signed-Rank检验，然后采用Bonferroni校正。结果：带RNS和不带RNS的平均IRP分别为19.1和14.7 mm Hg （p p p）。结论：在IRP应较低的情况下，去除RNS、通过流入口冲洗、频繁使用吸痰可保持最低压力。如果需要暂时增加IRP以改善出血情况下的视觉效果，则可以通过流出口冲洗，减少引流和使用RNS来提高IRP。
{"title":"Does instrumentation and irrigation configuration affect intrarenal pressure during PCNL?","authors":"Evan Seibly, Ali Albaghli, Kyu Park, Elizabeth A. Baldwin, Ala'a Farkouh, Katya Hanessian, Nicole Mack, Cliff De Guzman, Toby Clark, Matthew Buell, Rose Leu, Kanha Shete, Sikai Song, Akin S. Amasyali, Zham Okhunov, D. Duane Baldwin","doi":"10.1002/bco2.70164","DOIUrl":"10.1002/bco2.70164","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To measure the effects of varying configurations of nephroscope sheath, irrigation, instruments, and suction on intrarenal pressure (IRP) during percutaneous nephrolithotomy (PCNL).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Methods</h3>\u0000 \u0000 <p>Kidney and ureter 3D printed models from a deidentified patient's CT scan were placed in a plaster and foam mould, simulating the torso of a prone patient. An Amplatz sheath was inserted into the kidney model. Fourteen different rigid nephroscope sheath (RNS), irrigation, instrument and suction configurations were compared. IRP was measured in a retrograde fashion. Comparisons were performed using the Wilcoxon Signed-Rank test followed by Bonferroni correction.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The mean IRP with and without the RNS was 19.1 and 14.7 mm Hg, respectively (<i>p</i> < 0.001). Using the inflow port of the RNS for irrigation created a lower IRP (19.1 mm Hg) compared to the outflow port (32.7 mm Hg; <i>p</i> < 0.001). Addition of suction to all working scenarios significantly reduced IRP (<i>p</i> < 0.001). Insertion of instruments did not significantly alter IRP.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>In situations where the IRP should be low, removal of the RNS, irrigating through the inflow port, and frequent use of suction maintain the lowest pressures. If temporary increases in IRP are necessary to improve visualisation in the setting of bleeding, irrigating through the outflow port, minimising drainage and use of the RNS can be used to raise IRP.</p>\u0000 </section>\u0000 </div>","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"7 2","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12869112/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146127728","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}
André B. Silva, Bruno R. Lebani, Eduardo R. Pinto, Luciano T. Silva, Denise S. Gouveia, Hudson de Lima, Marcia E. Girotti, Milton Skaff, Fernando G. Almeida
Objective
The weight of adenoma removed during benign prostatic hyperplasia (BPH) surgery is commonly used as a surgical landmark. During endoscopic procedures, prostatic tissue is exposed to heat generated by electric current, resulting in tissue vaporization that may affect the final specimen weight. This study aimed to quantify tissue loss due to vaporization during TURP, comparing monopolar and bipolar techniques.
Materials and Methods
Surgical specimens from 32 patients undergoing open simple prostatectomy were analysed. After enucleation, adenomas were weighed and then completely resected in vitro simulating TURP using monopolar or bipolar energy. The weight of the resected fragments was measured to estimate tissue loss associated with each energy source and compared with preoperative MRI-estimated transition zone volumes.
Results
Mean patient age was 68.2 ± 5.75 years. There was a strong correlation between MRI-estimated transition zone weight and enucleated specimen weight (97.5 ± 40.1 g vs. 90.5 ± 38 g; r = 0.998, p < 0.001). Of the 32 enucleated adenomas, 16 were resected in vitro using monopolar energy and 16 using bipolar energy. After in vitro resection of the adenoma, a significant decrease in the enucleated specimen weight was observed (from 90.5 ± 38 g to 64.25 ± 25.6 g; p < 0.001). Overall, the mean decrease in weight after resection was 26.3 g, corresponding to a 29% reduction. Bipolar resection showed a greater reduction in tissue weight compared to monopolar resection, with a decrease of 36.8% and 19.4%, respectively (p < 0.001).
Conclusion
The weight of the adenoma removed during surgical treatment of BPH differs depending on the technique used and, therefore, cannot be used comparatively between techniques. Resection surgeries result in tissue vaporization and dehydration, reducing adenoma weight by approximately 28%. Adenoma volume determination by MRI shows a strong correlation with the volume to be removed during surgery.
目的：良性前列腺增生（BPH）手术中切除腺瘤的重量通常被用作手术标志。在内窥镜检查过程中，前列腺组织暴露在电流产生的热量下，导致组织蒸发，这可能会影响最终的标本重量。本研究旨在通过比较单极和双极技术，量化TURP过程中由于蒸发造成的组织损失。材料与方法：对32例开放性单纯性前列腺切除术患者的手术标本进行分析。去核后，称量腺瘤，然后用单极或双极能量模拟体外TURP完全切除。测量切除碎片的重量以估计与每个能量源相关的组织损失，并与术前mri估计的过渡区体积进行比较。结果：患者平均年龄68.2±5.75岁。mri估计的转移区重量与去核标本重量之间有很强的相关性（97.5±40.1 g vs 90.5±38 g; r = 0.998, p p p）。结论：手术治疗BPH时切除的腺瘤重量因技术的不同而不同，因此不能在技术之间进行比较。切除手术导致组织蒸发和脱水，使腺瘤重量减少约28%。MRI测定的腺瘤体积与手术中要切除的体积有很强的相关性。
{"title":"The impact of vaporization on adenoma weight in benign prostatic hyperplasia surgery","authors":"André B. Silva, Bruno R. Lebani, Eduardo R. Pinto, Luciano T. Silva, Denise S. Gouveia, Hudson de Lima, Marcia E. Girotti, Milton Skaff, Fernando G. Almeida","doi":"10.1002/bco2.70171","DOIUrl":"10.1002/bco2.70171","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>The weight of adenoma removed during benign prostatic hyperplasia (BPH) surgery is commonly used as a surgical landmark. During endoscopic procedures, prostatic tissue is exposed to heat generated by electric current, resulting in tissue vaporization that may affect the final specimen weight. This study aimed to quantify tissue loss due to vaporization during TURP, comparing monopolar and bipolar techniques.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Methods</h3>\u0000 \u0000 <p>Surgical specimens from 32 patients undergoing open simple prostatectomy were analysed. After enucleation, adenomas were weighed and then completely resected in vitro simulating TURP using monopolar or bipolar energy. The weight of the resected fragments was measured to estimate tissue loss associated with each energy source and compared with preoperative MRI-estimated transition zone volumes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Mean patient age was 68.2 ± 5.75 years. There was a strong correlation between MRI-estimated transition zone weight and enucleated specimen weight (97.5 ± 40.1 g vs. 90.5 ± 38 g; <i>r</i> = 0.998, <i>p</i> < 0.001). Of the 32 enucleated adenomas, 16 were resected in vitro using monopolar energy and 16 using bipolar energy. After in vitro resection of the adenoma, a significant decrease in the enucleated specimen weight was observed (from 90.5 ± 38 g to 64.25 ± 25.6 g; <i>p</i> < 0.001). Overall, the mean decrease in weight after resection was 26.3 g, corresponding to a 29% reduction. Bipolar resection showed a greater reduction in tissue weight compared to monopolar resection, with a decrease of 36.8% and 19.4%, respectively (<i>p</i> < 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The weight of the adenoma removed during surgical treatment of BPH differs depending on the technique used and, therefore, cannot be used comparatively between techniques. Resection surgeries result in tissue vaporization and dehydration, reducing adenoma weight by approximately 28%. Adenoma volume determination by MRI shows a strong correlation with the volume to be removed during surgery.</p>\u0000 </section>\u0000 </div>","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"7 2","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12872109/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146127689","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}
Joshua Yi Min Tung, Rachel Shu-En Lau, Edmund Pek Siang Teo, Kit Mun Chow, Julene Hui Wun Ong, Timothy Siliang Lu, Weiren Chen, Jingqiu Li, Xinyan Yang, Alvin Yuanming Lee, Yu Guang Tan, Kae Jack Tay, Sue Ping Thang, Winnie Wing Chuen Lam, Yan Mee Law, Henry Sun Sien Ho, Christopher Wai Sam Cheng, John Shyi-Peng Yuen, Kenneth Chen
Introduction
Prostate-Specific Membrane Antigen Positron Emission Tomography Computed Tomography (PSMA PET/CT) has shown a higher diagnostic accuracy in prostate cancer imaging when compared to conventional modalities, with improved sensitivity and specificity rates when combined with multiparametric prostate Magnetic Resonance Imaging (mpMRI). We evaluated the cost-effectiveness of a combined PSMA PET/CT and mpMRI biopsy-free diagnostic approach for clinically significant prostate cancer (csPCa).
Method
A decision tree model was designed to compare two diagnostic strategies for csPCa in men with raised Prostate Specific Antigen (PSA)—the first with conventional mpMRI followed by transperineal prostate biopsy versus a second biopsy-free, PSMA PET/CT plus mpMRI combined imaging strategy. We evaluated the impact of each strategy on costs and Quality-Adjusted-Life-Years (QALYs). Willingness-to-pay thresholds were set at 1× and 3× Gross Domestic Product (GDP). One-way sensitivity analysis and probabilistic sensitivity analyses were performed.
Results
A combined mpMRI and PSMA PET/CT diagnostic strategy was 0.04 QALY more effective but SGD$4088.03 more expensive than the conventional mpMRI and biopsy strategy. The incremental cost-effective ratio (ICER) was SGD$92782.87 per quality-adjusted life year (QALY). In the combined imaging strategy, 3.5% of the cohort had a missed diagnosis of prostate cancer versus 13.9% in the conventional mpMRI and biopsy strategy. Probabilistic analyses showed that the combined imaging strategy was cost-effective at willingness-to-pay thresholds of SGD$121160 and SGD$363480, respectively.
Conclusion
Combined mpMRI and PSMA PET/CT for csPCa diagnosis are a cost-effective strategy in terms of health utility over the conventional approach for diagnosing csPCa in men with raised PSA, potentially reducing the need for invasive diagnostic procedures.
{"title":"Cost-effectiveness analysis of a biopsy-free diagnostic strategy for prostate cancer using mpMRI and PSMA-PET/CT","authors":"Joshua Yi Min Tung, Rachel Shu-En Lau, Edmund Pek Siang Teo, Kit Mun Chow, Julene Hui Wun Ong, Timothy Siliang Lu, Weiren Chen, Jingqiu Li, Xinyan Yang, Alvin Yuanming Lee, Yu Guang Tan, Kae Jack Tay, Sue Ping Thang, Winnie Wing Chuen Lam, Yan Mee Law, Henry Sun Sien Ho, Christopher Wai Sam Cheng, John Shyi-Peng Yuen, Kenneth Chen","doi":"10.1002/bco2.70172","DOIUrl":"10.1002/bco2.70172","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Prostate-Specific Membrane Antigen Positron Emission Tomography Computed Tomography (PSMA PET/CT) has shown a higher diagnostic accuracy in prostate cancer imaging when compared to conventional modalities, with improved sensitivity and specificity rates when combined with multiparametric prostate Magnetic Resonance Imaging (mpMRI). We evaluated the cost-effectiveness of a combined PSMA PET/CT and mpMRI biopsy-free diagnostic approach for clinically significant prostate cancer (csPCa).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>A decision tree model was designed to compare two diagnostic strategies for csPCa in men with raised Prostate Specific Antigen (PSA)—the first with conventional mpMRI followed by transperineal prostate biopsy versus a second biopsy-free, PSMA PET/CT plus mpMRI combined imaging strategy. We evaluated the impact of each strategy on costs and Quality-Adjusted-Life-Years (QALYs). Willingness-to-pay thresholds were set at 1× and 3× Gross Domestic Product (GDP). One-way sensitivity analysis and probabilistic sensitivity analyses were performed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A combined mpMRI and PSMA PET/CT diagnostic strategy was 0.04 QALY more effective but SGD$4088.03 more expensive than the conventional mpMRI and biopsy strategy. The incremental cost-effective ratio (ICER) was SGD$92782.87 per quality-adjusted life year (QALY). In the combined imaging strategy, 3.5% of the cohort had a missed diagnosis of prostate cancer versus 13.9% in the conventional mpMRI and biopsy strategy. Probabilistic analyses showed that the combined imaging strategy was cost-effective at willingness-to-pay thresholds of SGD$121160 and SGD$363480, respectively.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Combined mpMRI and PSMA PET/CT for csPCa diagnosis are a cost-effective strategy in terms of health utility over the conventional approach for diagnosing csPCa in men with raised PSA, potentially reducing the need for invasive diagnostic procedures.</p>\u0000 </section>\u0000 </div>","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"7 2","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12872110/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146127738","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}
Stijn M. van den Bosch, Daniël L. van den Kroonenberg, Bram W. van Bruggen, Katelijne C. C. de Bie, Auke Jager, Arnoud W. Postema, Daniela E. Oprea-Lager, Ivo G. Schoots, Jorg R. Oddens, Andre N. Vis
<div> <section> <h3> Background and Objective</h3> <p>MRI-targeted biopsies (TBx) combined with systematic biopsies (SBx) have traditionally been recommended for patients with unilateral MRI-suspicious prostate cancer (PCa) lesions. Recent European Association of Urology (EAU) guidelines propose that, in cases with a solitary lesion, TBx with perilesional sampling may suffice, potentially omitting contralateral SBx. The clinical impact of this omission remains uncertain. This study evaluates how omitting contralateral SBx affects pathological grading, EAU risk classification, and estimated lymph node involvement (LNI).</p> </section> <section> <h3> Methods</h3> <p>We conducted a retrospective cohort study (2016–2024) including 190 biopsy-naïve men diagnosed with PCa via TBx and bilateral SBx for a single, unilateral MRI-visible lesion. Outcomes were re-evaluated using only TBx and ipsilateral SBx, simulating omission of contralateral SBx. Changes in ISUP grade, EAU risk group, and LNI probability using the Briganti 2019, Amsterdam–Brisbane–Sydney (ABS), and Memorial Sloan Kettering Cancer Center (MSKCC) nomograms were assessed. Furthermore, we compared cancer detection rates for TBx alone versus TBx plus ipsilateral SBx.</p> </section> <section> <h3> Key Findings</h3> <p>ISUP grading changed in 14 of 190 patients (7.4%) when contralateral SBx was omitted; two patients (1.1%) had clinically significant PCa (ISUP 2) detected solely in contralateral cores. In seven patients (3.7%), only ISUP 1 cancer was found in contralateral SBx, meaning no diagnosis would have been made without those cores. EAU risk classification changed in five patients (2.6%). LNI estimates were affected minimally: One patient (0.5%) dropped below the Briganti 7% threshold, and one patient (1.2%) no longer met the 8% ABS threshold. The MSKCC model showed a statistically significant 8% increase in patients above the 7% ePLND threshold when contralateral SBx was omitted (<i>p</i> = 0.0023). Ipsilateral SBx substantially improved detection of higher-grade disease: sensitivity for ISUP ≥3 increased from 82% with TBx alone to 98% when combined with ipsilateral SBx.</p> </section> <section> <h3> Conclusion and Clinical Implications</h3> <p>Omitting contralateral SBx in patients with unilateral MRI lesions had limited effect on grading, risk classification, and LNI estimates. However, ipsilateral SBx adds significant diagnostic value compared with TBx alone and should be retained. These findings support a more targeted diagnostic approach in patients with a unilateral lesion on MRI in
{"title":"Omission of contralateral biopsies in unilateral MRI-suspicious prostate cancer has minimal impact on clinical risk assessment","authors":"Stijn M. van den Bosch, Daniël L. van den Kroonenberg, Bram W. van Bruggen, Katelijne C. C. de Bie, Auke Jager, Arnoud W. Postema, Daniela E. Oprea-Lager, Ivo G. Schoots, Jorg R. Oddens, Andre N. Vis","doi":"10.1002/bco2.70154","DOIUrl":"10.1002/bco2.70154","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Objective</h3>\u0000 \u0000 <p>MRI-targeted biopsies (TBx) combined with systematic biopsies (SBx) have traditionally been recommended for patients with unilateral MRI-suspicious prostate cancer (PCa) lesions. Recent European Association of Urology (EAU) guidelines propose that, in cases with a solitary lesion, TBx with perilesional sampling may suffice, potentially omitting contralateral SBx. The clinical impact of this omission remains uncertain. This study evaluates how omitting contralateral SBx affects pathological grading, EAU risk classification, and estimated lymph node involvement (LNI).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a retrospective cohort study (2016–2024) including 190 biopsy-naïve men diagnosed with PCa via TBx and bilateral SBx for a single, unilateral MRI-visible lesion. Outcomes were re-evaluated using only TBx and ipsilateral SBx, simulating omission of contralateral SBx. Changes in ISUP grade, EAU risk group, and LNI probability using the Briganti 2019, Amsterdam–Brisbane–Sydney (ABS), and Memorial Sloan Kettering Cancer Center (MSKCC) nomograms were assessed. Furthermore, we compared cancer detection rates for TBx alone versus TBx plus ipsilateral SBx.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Key Findings</h3>\u0000 \u0000 <p>ISUP grading changed in 14 of 190 patients (7.4%) when contralateral SBx was omitted; two patients (1.1%) had clinically significant PCa (ISUP 2) detected solely in contralateral cores. In seven patients (3.7%), only ISUP 1 cancer was found in contralateral SBx, meaning no diagnosis would have been made without those cores. EAU risk classification changed in five patients (2.6%). LNI estimates were affected minimally: One patient (0.5%) dropped below the Briganti 7% threshold, and one patient (1.2%) no longer met the 8% ABS threshold. The MSKCC model showed a statistically significant 8% increase in patients above the 7% ePLND threshold when contralateral SBx was omitted (<i>p</i> = 0.0023). Ipsilateral SBx substantially improved detection of higher-grade disease: sensitivity for ISUP ≥3 increased from 82% with TBx alone to 98% when combined with ipsilateral SBx.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion and Clinical Implications</h3>\u0000 \u0000 <p>Omitting contralateral SBx in patients with unilateral MRI lesions had limited effect on grading, risk classification, and LNI estimates. However, ipsilateral SBx adds significant diagnostic value compared with TBx alone and should be retained. These findings support a more targeted diagnostic approach in patients with a unilateral lesion on MRI in ","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"7 2","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12869837/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146127683","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}
Lila G. McGrath, Hailey W. Holck, Anthony J. Teixeira, Mallie C. Roley, Saeed Dupree, Ferdous Ahmed, Kris E. Gaston, Justin T. Matulay, Stephen B. Riggs, Peter E. Clark, Ornob P. Roy
Objectives
To investigate how patient-specific factors, including race and socioeconomic status, impact time to treatment initiation (TTI) for patients with small renal masses (SRMs).
Materials and Methods
We retrospectively reviewed 275 patients with SRMs ≤ 4 cm at Atrium Health Carolinas Medical Center who underwent treatment for their renal mass. TTI was defined by the time between office visit (TTI-OV) or between initial imaging (TTI-Imaging) and procedure date. Statistical analysis was employed to determine patient-specific factors associated with TTI.
Results
We found that TTI was significantly associated with race as Black patients experienced longer TTI than non-Hispanic White patients (OV: HR = 0.637, 95% CI [0.479–0.848], p = 0.0048; Imaging: HR = 0.541, 95% CI [0.402–0.727], p = 0.0002). TTI, however, was not significantly associated with socioeconomic status as defined by Area Deprivation Index, income or insurance status. TTI-OV was also significantly associated with procedure year, and TTI-Imaging was associated with procedure year, Charlson Comorbidity Index (CCI) and tumour size when first seen on imaging. On multivariable analysis, TTI-Imaging was not independently associated with race (p = 0.1775), suggesting procedure year, CCI and tumour size are more significant predictors of TTI.
Conclusion
Black patients experienced a treatment delay from initial clinical presentation to procedure, but treatment delays from initial imaging identification to procedure may be tied more strongly to clinical factors.
目的：探讨患者特异性因素，包括种族和社会经济地位，如何影响小肾肿块（SRMs）患者的治疗开始时间（TTI）。材料和方法：我们回顾性分析了在心房健康卡罗来纳医疗中心接受肾肿块治疗的275例srm≤4 cm的患者。TTI的定义是门诊就诊（TTI- ov）或初次成像（TTI- imaging）与手术日期之间的时间。采用统计分析确定与TTI相关的患者特异性因素。结果：我们发现TTI与种族显著相关，黑人患者的TTI时间比非西班牙裔白人患者长（OV: HR = 0.637, 95% CI [0.479-0.848], p = 0.0048；影像学：HR = 0.541, 95% CI [0.402-0.727], p = 0.0002）。然而，TTI与由地区剥夺指数、收入或保险状况定义的社会经济地位没有显著相关性。TTI-OV也与手术时间显著相关，TTI-Imaging与手术时间、Charlson合并症指数（CCI）和首次成像时肿瘤大小相关。在多变量分析中，TTI- imaging与种族没有独立相关性（p = 0.1775），这表明手术年份、CCI和肿瘤大小是TTI更重要的预测因素。结论：黑人患者经历了从最初的临床表现到手术的治疗延迟，但从最初的影像学识别到手术的治疗延迟可能与临床因素联系更紧密。
{"title":"Racial and socioeconomic disparities from time of diagnosis to treatment for small renal masses","authors":"Lila G. McGrath, Hailey W. Holck, Anthony J. Teixeira, Mallie C. Roley, Saeed Dupree, Ferdous Ahmed, Kris E. Gaston, Justin T. Matulay, Stephen B. Riggs, Peter E. Clark, Ornob P. Roy","doi":"10.1002/bco2.70115","DOIUrl":"10.1002/bco2.70115","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To investigate how patient-specific factors, including race and socioeconomic status, impact time to treatment initiation (TTI) for patients with small renal masses (SRMs).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Methods</h3>\u0000 \u0000 <p>We retrospectively reviewed 275 patients with SRMs ≤ 4 cm at Atrium Health Carolinas Medical Center who underwent treatment for their renal mass. TTI was defined by the time between office visit (TTI-OV) or between initial imaging (TTI-Imaging) and procedure date. Statistical analysis was employed to determine patient-specific factors associated with TTI.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We found that TTI was significantly associated with race as Black patients experienced longer TTI than non-Hispanic White patients (OV: HR = 0.637, 95% CI [0.479–0.848], p = 0.0048; Imaging: HR = 0.541, 95% CI [0.402–0.727], p = 0.0002). TTI, however, was not significantly associated with socioeconomic status as defined by Area Deprivation Index, income or insurance status. TTI-OV was also significantly associated with procedure year, and TTI-Imaging was associated with procedure year, Charlson Comorbidity Index (CCI) and tumour size when first seen on imaging. On multivariable analysis, TTI-Imaging was not independently associated with race (p = 0.1775), suggesting procedure year, CCI and tumour size are more significant predictors of TTI.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Black patients experienced a treatment delay from initial clinical presentation to procedure, but treatment delays from initial imaging identification to procedure may be tied more strongly to clinical factors.</p>\u0000 </section>\u0000 </div>","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"7 2","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12868985/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146127686","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}
The objective of this study is to evaluate the safety and efficacy of Rezūm water vapour energy therapy (WAVE) in Japanese patients with benign prostatic hyperplasia (BPH) continuing antithrombotic therapy and to validate the Okayama University Modified Clavien-Dindo classification (OU-mCD) for perioperative hematuria.
Patients and Methods
We retrospectively analysed 80 consecutive patients who underwent WAVE from August 2023 to July 2024, including 37 (46.2%) continuing antithrombotic therapy perioperatively. Hematuria within 30 days was graded using conventional Clavien-Dindo classification and the OU-mCD, a novel classification focusing on intervention necessity. We assessed clinically significant hematuria (Grade ≥ Ib), catheter-free rate, prostate volume reduction and haemoglobin change.
Results
Clinically significant hematuria occurred in 21.6% (8/37) of patients continuing antithrombotic therapy versus 4.7% (2/43) without (p = 0.038). All 10 Grade ≥ Ib cases occurred during hospitalization with the catheter in place and were managed conservatively with continuous bladder irrigation (median 1 day); none required transfusion or surgical reintervention. Only one patient required temporary drug discontinuation. Treatment efficacy did not differ by antithrombotic status: 86.2% achieved PVR < 50 ml with 44% mean prostate volume reduction. Multivariate analysis identified antithrombotic therapy as the sole independent risk factor for Grade ≥ Ib hematuria (OR 5.46, 95% CI 1.06–28.16, p = 0.042).
Conclusion
WAVE can be safely performed with continued antithrombotic therapy. Whereas Grade ≥Ib hematuria occurred in 25% of antiplatelet/anticoagulant users (vs. 5% without), 75% had no significant bleeding, and all complications were managed conservatively without transfusion. The OU-mCD provides precise complication stratification. These findings suggest outpatient procedures may be feasible with appropriate patient selection.
{"title":"Safety and efficacy of Rezūm water vapour energy therapy in BPH patients receiving antithrombotic therapy: A Japanese single-centre experience","authors":"Takatoshi Moriwake, Yusuke Tominaga, Satoshi Katayama, Haruki Kaku, Ichiro Tsuboi, Kasumi Yoshinaga, Tomoaki Yamanoi, Tatsushi Kawada, Takuya Sadahira, Takehiro Iwata, Shingo Nishimura, Kensuke Bekku, Yasuhiro Katayama, Motoo Araki","doi":"10.1002/bco2.70170","DOIUrl":"10.1002/bco2.70170","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>The objective of this study is to evaluate the safety and efficacy of Rezūm water vapour energy therapy (WAVE) in Japanese patients with benign prostatic hyperplasia (BPH) continuing antithrombotic therapy and to validate the Okayama University Modified Clavien-Dindo classification (OU-mCD) for perioperative hematuria.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Patients and Methods</h3>\u0000 \u0000 <p>We retrospectively analysed 80 consecutive patients who underwent WAVE from August 2023 to July 2024, including 37 (46.2%) continuing antithrombotic therapy perioperatively. Hematuria within 30 days was graded using conventional Clavien-Dindo classification and the OU-mCD, a novel classification focusing on intervention necessity. We assessed clinically significant hematuria (Grade ≥ Ib), catheter-free rate, prostate volume reduction and haemoglobin change.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Clinically significant hematuria occurred in 21.6% (8/37) of patients continuing antithrombotic therapy versus 4.7% (2/43) without (<i>p</i> = 0.038). All 10 Grade ≥ Ib cases occurred during hospitalization with the catheter in place and were managed conservatively with continuous bladder irrigation (median 1 day); none required transfusion or surgical reintervention. Only one patient required temporary drug discontinuation. Treatment efficacy did not differ by antithrombotic status: 86.2% achieved PVR < 50 ml with 44% mean prostate volume reduction. Multivariate analysis identified antithrombotic therapy as the sole independent risk factor for Grade ≥ Ib hematuria (OR 5.46, 95% CI 1.06–28.16, <i>p</i> = 0.042).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>WAVE can be safely performed with continued antithrombotic therapy. Whereas Grade ≥Ib hematuria occurred in 25% of antiplatelet/anticoagulant users (vs. 5% without), 75% had no significant bleeding, and all complications were managed conservatively without transfusion. The OU-mCD provides precise complication stratification. These findings suggest outpatient procedures may be feasible with appropriate patient selection.</p>\u0000 </section>\u0000 </div>","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"7 2","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12864163/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146121236","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}
Mohamed A. Soltan, Tamer E. Helmy, Mohamed E. Dawaba, Mohamed Abou El-Ghar, Ahmed Shokeir
Objectives
While early outcomes after pyeloplasty are well-documented, long-term split renal function (SRF) stability, particularly beyond puberty, remains unclear. This study evaluates SRF after prepubertal pyeloplasty and identifies factors associated with late deterioration.
Methods
A retrospective review included paediatric patients who underwent pyeloplasty between 2000 and 2025. Exclusion criteria were solitary kidney, missing imaging, congenital anomalies or prior pyeloplasty. Patients were categorised into two groups: Group 1 (no deterioration) and Group 2 (late deterioration after puberty), based on ≥5% decrease in SRF. Clinical, surgical and imaging parameters were compared among groups using Chi-square, Fisher's exact and Mann–Whitney U tests, with multivariate logistic regression to identify predictors of late deterioration.
Results
Out of 1493 patients, 191 were included: 152 (79.6%) in Group 1 and 39 (20.4%) in Group 2. Group 2 patients were younger at surgery, had more frequent renal pelvis reduction and persistent hydronephrosis at 1-year follow-up (p < 0.001). Multivariate analysis identified renal pelvis reduction (odds ratio [OR] = 9.82, 95% confidence interval [CI]: 3.551–37.799, p < 0.001) and non-resolution of hydronephrosis (OR = 4.811, 95% CI: 1.766–13.1, p = 0.002), as late deterioration predictors. Older age at surgery (OR = 0.958, 95% CI: 0.942–0.975, p < 0.001) and higher final SRF (OR = 0.905, 95% CI: 0.855–0.958, p < 0.001) were protective against deterioration.
Conclusion
SRF may deteriorate after puberty despite initial post-operative stability. Renal pelvis reduction, persistent hydronephrosis at 1 year and younger age at surgery are associated with increased risk of deterioration.
目的：虽然肾盂成形术后的早期结果有充分的文献记载，但长期的分裂肾功能（SRF）稳定性，特别是在青春期之后，仍不清楚。本研究评估青春期前肾盂成形术后的SRF，并确定与晚期恶化相关的因素。方法：回顾性分析2000年至2025年间接受肾盂成形术的儿科患者。排除标准为孤立肾、影像缺失、先天性异常或既往肾盂成形术。根据SRF下降≥5%，将患者分为两组：1组（无恶化）和2组（青春期后恶化）。采用卡方检验、Fisher’s exact检验和Mann-Whitney U检验比较各组的临床、手术和影像学参数，并采用多变量logistic回归来确定晚期恶化的预测因素。结果：共纳入1493例患者191例，其中组1 152例（79.6%），组2 39例（20.4%）。2组患者手术时更年轻，在1年随访时出现更频繁的肾盂缩小和持续性肾积水（p p p = 0.002），作为晚期恶化的预测因素。手术年龄较大（OR = 0.958, 95% CI: 0.942-0.975, p p）结论：尽管初始术后稳定，但SRF可能在青春期后恶化。肾盂缩小、1岁时持续肾积水和手术年龄较低与恶化风险增加相关。
{"title":"Post-pubertal stability of split renal function after pyeloplasty performed in childhood","authors":"Mohamed A. Soltan, Tamer E. Helmy, Mohamed E. Dawaba, Mohamed Abou El-Ghar, Ahmed Shokeir","doi":"10.1002/bco2.70159","DOIUrl":"10.1002/bco2.70159","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>While early outcomes after pyeloplasty are well-documented, long-term split renal function (SRF) stability, particularly beyond puberty, remains unclear. This study evaluates SRF after prepubertal pyeloplasty and identifies factors associated with late deterioration.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective review included paediatric patients who underwent pyeloplasty between 2000 and 2025. Exclusion criteria were solitary kidney, missing imaging, congenital anomalies or prior pyeloplasty. Patients were categorised into two groups: Group 1 (no deterioration) and Group 2 (late deterioration after puberty), based on ≥5% decrease in SRF. Clinical, surgical and imaging parameters were compared among groups using Chi-square, Fisher's exact and Mann–Whitney <i>U</i> tests, with multivariate logistic regression to identify predictors of late deterioration.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Out of 1493 patients, 191 were included: 152 (79.6%) in Group 1 and 39 (20.4%) in Group 2. Group 2 patients were younger at surgery, had more frequent renal pelvis reduction and persistent hydronephrosis at 1-year follow-up (<i>p</i> < 0.001). Multivariate analysis identified renal pelvis reduction (odds ratio [OR] = 9.82, 95% confidence interval [CI]: 3.551–37.799, <i>p</i> < 0.001) and non-resolution of hydronephrosis (OR = 4.811, 95% CI: 1.766–13.1, <i>p</i> = 0.002), as late deterioration predictors. Older age at surgery (OR = 0.958, 95% CI: 0.942–0.975, <i>p</i> < 0.001) and higher final SRF (OR = 0.905, 95% CI: 0.855–0.958, <i>p</i> < 0.001) were protective against deterioration.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>SRF may deteriorate after puberty despite initial post-operative stability. Renal pelvis reduction, persistent hydronephrosis at 1 year and younger age at surgery are associated with increased risk of deterioration.</p>\u0000 </section>\u0000 </div>","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"7 2","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12863991/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146121210","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}
Sam Kwon, Fiona Wardrop, Diego Gonzalez, Francis Ryan, Liza Khutsishvili, Rollins Turner, Mohammad Ghassab Deameh, Michael J. Whalen
Objectives
The purpose of this study is to investigate the impact of Glucagon-like peptide-1 receptor agonists (GLP-1RAs) use on 90-day postoperative outcomes and overall survival following partial nephrectomy (PN) for renal cell carcinoma (RCC), where type 2 diabetes mellitus (T2DM) is a common comorbidity.
Materials and Methods
The TriNetX database was used to retrospectively identify T2DM patients who underwent PN. Patients prescribed GLP-1RAs were identified and matched in a 1:1 ratio with control patients who were not prescribed GLP-1RAs based on baseline characteristics, comorbidities, metformin and insulin prescription, and renal function laboratory values. For 90-day postoperative adverse events, risk difference, risk ratio and odds ratio with 95% confidence intervals were calculated. Kaplan–Meier analysis, log-rank tests and multivariable Cox Proportional Hazards model were performed to measure the effect of GLP-1RAs use on overall survival.
Results
Use of GLP-1RAs was associated with lower odds of acute kidney injury (odds ratio [OR] = 0.712), arrhythmia (OR = 0.725), readmission (OR = 0.8) and ileus (OR = 0.336) compared to the non-GLP-1RAs group (p < 0.05 for each). Kaplan–Meier analysis and log-rank tests demonstrated improved 2-year (p = 0.002) and 3-year (p = 0.001) overall survival among patients prescribed GLP-1RAs compared to those who were not.
Conclusion
Use of GLP-1RAs was associated with reduced incidence of 90-day postoperative complications, such as acute kidney injury, arrhythmia, readmission and ileus, potentially contributing to improved overall survival. These results align with ongoing studies investigating the broader benefits of the use of GLP-1RAs.
{"title":"GLP-1RA use improves outcomes post partial nephrectomy in T2DM patients with RCC: A TriNetX study","authors":"Sam Kwon, Fiona Wardrop, Diego Gonzalez, Francis Ryan, Liza Khutsishvili, Rollins Turner, Mohammad Ghassab Deameh, Michael J. Whalen","doi":"10.1002/bco2.70169","DOIUrl":"10.1002/bco2.70169","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>The purpose of this study is to investigate the impact of Glucagon-like peptide-1 receptor agonists (GLP-1RAs) use on 90-day postoperative outcomes and overall survival following partial nephrectomy (PN) for renal cell carcinoma (RCC), where type 2 diabetes mellitus (T2DM) is a common comorbidity.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Methods</h3>\u0000 \u0000 <p>The TriNetX database was used to retrospectively identify T2DM patients who underwent PN. Patients prescribed GLP-1RAs were identified and matched in a 1:1 ratio with control patients who were not prescribed GLP-1RAs based on baseline characteristics, comorbidities, metformin and insulin prescription, and renal function laboratory values. For 90-day postoperative adverse events, risk difference, risk ratio and odds ratio with 95% confidence intervals were calculated. Kaplan–Meier analysis, log-rank tests and multivariable Cox Proportional Hazards model were performed to measure the effect of GLP-1RAs use on overall survival.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Use of GLP-1RAs was associated with lower odds of acute kidney injury (odds ratio [OR] = 0.712), arrhythmia (OR = 0.725), readmission (OR = 0.8) and ileus (OR = 0.336) compared to the non-GLP-1RAs group (<i>p</i> < 0.05 for each). Kaplan–Meier analysis and log-rank tests demonstrated improved 2-year (<i>p</i> = 0.002) and 3-year (<i>p</i> = 0.001) overall survival among patients prescribed GLP-1RAs compared to those who were not.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Use of GLP-1RAs was associated with reduced incidence of 90-day postoperative complications, such as acute kidney injury, arrhythmia, readmission and ileus, potentially contributing to improved overall survival. These results align with ongoing studies investigating the broader benefits of the use of GLP-1RAs.</p>\u0000 </section>\u0000 </div>","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"7 2","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12863992/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146121154","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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