Pierre Allainguillaume, Coralie Uthe-Spencker, Laura Larnaudie, Mathilde Sibony, Anthony Kanbar, Albert Semaan, Nicolas Barry Delongchamps, Michael Peyromaure, Julien Anract
Objectives
This study aimed to perform a risk analysis of any prostate cancer (Pca) and of clinically significant prostate cancer (csPCa) in a contemporary cohort of prostatic biopsies.
Materials and Methods
We conducted a retrospective analysis of patients who underwent prostate biopsies in our centre between December 2020 and December 2022. We calculated Pca and csPCa rate (ISUP grade ≥2). Univariate and multivariate regression models were constructed to assess independent predictive factors for Pca and csPCa. We used χ2 automatic interaction detection (CHAID) for decision tree analysis.
Results
We included 255 patients in the analysis, of whom 69.8% had positive biopsies for Pca and 36.9% for csPCa. Multivariate analysis found PSA density (PSAd) (OR = 1.001) (1.000; 1.001), PIRADS score (OR = 1.393) (1.234; 1.571) as independent predictive factors of csPCa. For the detection of any PCa, CHAID analysis revealed that patients with PIRADS score ≤4 doubled the risk of negative biopsies (from 22.6% to 54.3%) when the prostate volume was >46 mL.
Conclusion
For patients with a PIRADS ≤4, a large prostate volume (>46 mL) was a predictor of negative biopsies, independently of PSAd. MRI interpretation and targeting in these patients should therefore be performed with particular caution.
{"title":"Risk factors of negative prostate biopsies: A CHAID decision tree analysis","authors":"Pierre Allainguillaume, Coralie Uthe-Spencker, Laura Larnaudie, Mathilde Sibony, Anthony Kanbar, Albert Semaan, Nicolas Barry Delongchamps, Michael Peyromaure, Julien Anract","doi":"10.1002/bco2.70162","DOIUrl":"10.1002/bco2.70162","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>This study aimed to perform a risk analysis of any prostate cancer (Pca) and of clinically significant prostate cancer (csPCa) in a contemporary cohort of prostatic biopsies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Methods</h3>\u0000 \u0000 <p>We conducted a retrospective analysis of patients who underwent prostate biopsies in our centre between December 2020 and December 2022. We calculated Pca and csPCa rate (ISUP grade ≥2). Univariate and multivariate regression models were constructed to assess independent predictive factors for Pca and csPCa. We used <i>χ</i><sup>2</sup> automatic interaction detection (CHAID) for decision tree analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We included 255 patients in the analysis, of whom 69.8% had positive biopsies for Pca and 36.9% for csPCa. Multivariate analysis found PSA density (PSAd) (OR = 1.001) (1.000; 1.001), PIRADS score (OR = 1.393) (1.234; 1.571) as independent predictive factors of csPCa. For the detection of any PCa, CHAID analysis revealed that patients with PIRADS score ≤4 doubled the risk of negative biopsies (from 22.6% to 54.3%) when the prostate volume was >46 mL.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>For patients with a PIRADS ≤4, a large prostate volume (>46 mL) was a predictor of negative biopsies, independently of PSAd. MRI interpretation and targeting in these patients should therefore be performed with particular caution.</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/PMC12863419/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146115123","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 D. Cabral, Margaret Gannon, Gregory Raster, David J. Nusbaum, David Bouhadana, Adel Arezki, Aalya Hamouda, Anouk Leathead, Ilan Ohana, Rosie Foucault, Iman Sadri, Jeffrey A. Sioufi, Nick Lee, Tarek Benzouak, Liam Murad, Nicholas J. Corsi, John Klein, Inderjit Singh, James Kearns, Cecilia Chang, Juan Justo Quintas, Kevin C. Zorn, Tiago Rodrigues, Shawn H. Marhamati, Brian T. Helfand, Alexander P. Glaser
Objective
The purpose of this study is investigate the clinical outcomes of men with benign prostatic hyperplasia (BPH) and bladder stones treated concomitantly with Aquablation and bladder stone removal in an international, multi-institutional cohort.
Patients and Methods
We performed a retrospective analysis of men who underwent Aquablation between 2018 and 2024. Patients were divided into two cohorts: men with bladder stones and those without. Outcomes assessed included baseline demographics and variables (medication use, prostate volume, prior BPH surgery), operative characteristics (OR time, transfusion requirement, complications), and functional outcomes were measured by the International Prostate Symptom Score (IPSS), peak urinary flow rate (Qmax) and PVR at regular intervals over 24 months.
Results
A total of 1885 men were analysed, including 60 men with bladder stones and 1825 without. Patients with bladder stones had higher rates of prior BPH surgery (15% vs. 5.5%, p = 0.015) and pre-operative urinary retention (28.3% vs. 14.8%, p = 0.004) as well as larger prostate volumes (98.6 ml vs. 77 ml, p < 0.0001). Total operative time was longer in the bladder stone group (76.5 mins vs. 55.0 mins, p < 0.001), but there were no significant differences in Aquablation time or bleeding complications including transfusions. There was also no difference in improvements in IPSS, Qmax and PVR post-operatively.
Conclusion
This study demonstrates that Aquablation is safe and effective in the management of BPH regardless of concomitant bladder stone treatment.
目的：本研究的目的是在一项国际、多机构队列研究中，探讨男性良性前列腺增生（BPH）和膀胱结石联合水溶术和膀胱结石去除术的临床结果。患者和方法：我们对2018年至2024年间接受水消融的男性进行了回顾性分析。患者被分为两组：有膀胱结石的男性和没有膀胱结石的男性。评估的结果包括基线人口统计学和变量（药物使用，前列腺体积，既往BPH手术），手术特征（OR时间，输血需求，并发症），功能结果通过国际前列腺症状评分（IPSS），峰值尿流率（Q max）和PVR在24个月内定期测量。结果：共分析了1885例男性，其中膀胱结石60例，无膀胱结石1825例。膀胱结石患者既往BPH手术发生率（15% vs. 5.5%, p = 0.015）和术前尿潴留（28.3% vs. 14.8%, p = 0.004）较高，前列腺体积（98.6 ml vs. 77 ml， p p Q max和术后PVR）较大。结论：本研究表明，无论是否伴有膀胱结石治疗，水消融治疗前列腺增生是安全有效的。
{"title":"Outcomes of Aquablation in BPH with bladder stones: Analysis of the ICARUS database","authors":"Joshua D. Cabral, Margaret Gannon, Gregory Raster, David J. Nusbaum, David Bouhadana, Adel Arezki, Aalya Hamouda, Anouk Leathead, Ilan Ohana, Rosie Foucault, Iman Sadri, Jeffrey A. Sioufi, Nick Lee, Tarek Benzouak, Liam Murad, Nicholas J. Corsi, John Klein, Inderjit Singh, James Kearns, Cecilia Chang, Juan Justo Quintas, Kevin C. Zorn, Tiago Rodrigues, Shawn H. Marhamati, Brian T. Helfand, Alexander P. Glaser","doi":"10.1002/bco2.70156","DOIUrl":"10.1002/bco2.70156","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>The purpose of this study is investigate the clinical outcomes of men with benign prostatic hyperplasia (BPH) and bladder stones treated concomitantly with Aquablation and bladder stone removal in an international, multi-institutional cohort.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Patients and Methods</h3>\u0000 \u0000 <p>We performed a retrospective analysis of men who underwent Aquablation between 2018 and 2024. Patients were divided into two cohorts: men with bladder stones and those without. Outcomes assessed included baseline demographics and variables (medication use, prostate volume, prior BPH surgery), operative characteristics (OR time, transfusion requirement, complications), and functional outcomes were measured by the International Prostate Symptom Score (IPSS), peak urinary flow rate (<i>Q</i><sub>max</sub>) and PVR at regular intervals over 24 months.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 1885 men were analysed, including 60 men with bladder stones and 1825 without. Patients with bladder stones had higher rates of prior BPH surgery (15% vs. 5.5%, <i>p</i> = 0.015) and pre-operative urinary retention (28.3% vs. 14.8%, <i>p</i> = 0.004) as well as larger prostate volumes (98.6 ml vs. 77 ml, <i>p</i> < 0.0001). Total operative time was longer in the bladder stone group (76.5 mins vs. 55.0 mins, <i>p</i> < 0.001), but there were no significant differences in Aquablation time or bleeding complications including transfusions. There was also no difference in improvements in IPSS, <i>Q</i><sub>max</sub> and PVR post-operatively.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This study demonstrates that Aquablation is safe and effective in the management of BPH regardless of concomitant bladder stone treatment.</p>\u0000 </section>\u0000 </div>","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"7 2","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12856958/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146108708","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}
Matthew Playfair, J. Andrew McClure, Chris Bailey, Blayne Welk
Introduction
While earlier decompression after spinal cord injury (SCI) is linked to better motor recovery, its impact on bladder and sexual function remains unexplored. Our objective was to determine if time to surgical decompression is associated with bladder and sexual function.
Methods
We conducted a retrospective cohort study using the prospectively collected Canadian Rick Hansen SCI Registry. Primary exposure was time to surgical decompression. Primary outcome was abnormal bladder function defined by use of catheters or any incontinence at 1-year. Secondary outcomes were sexual function and motor score. Adjusted logarithmic regression models were used.
Results
One thousand thirty-eight participants met inclusion criteria. Median time to surgical decompression was 25 (IQR17–50) hours, and 46% (475/1038) had early decompression (<24 h). There were 63% (650/1038) who had evidence of abnormal bladder function at 1-year. On multivariate regression, time to decompression was not significantly related to abnormal bladder function (OR 1.00, 95% CI 1.00–1.01, p = 0.38); older age (OR 1.13, 95% CI 1.03–1.23, p = 0.01) and worse ASIA score (ASIA A OR 16.35, p < 0.01, ASIA B OR 5.12, p < 0.01 and ASIA C OR 2.23, p < 0.01 all relative to ASIA D) were significantly associated with abnormal bladder function. These results were similar in several sensitivity analyses. Time to decompression was also not significantly associated with sexual function or motor score at 1-year.
Conclusions
A shorter time to surgical decompression after SCI was not associated with improved bladder or sexual function outcomes; however, older age and a more complete injury were significant predictors.
虽然脊髓损伤（SCI）后早期减压与更好的运动恢复有关，但其对膀胱和性功能的影响尚不清楚。我们的目的是确定手术减压时间是否与膀胱和性功能有关。方法：我们采用前瞻性收集的加拿大Rick Hansen SCI注册表进行回顾性队列研究。主要暴露时间为手术减压时间。主要结局是1年内使用导尿管或任何失禁所定义的膀胱功能异常。次要结果是性功能和运动评分。采用调整后的对数回归模型。结果：1338名受试者符合纳入标准。手术减压的中位时间为25 （IQR17-50）小时，46%（475/1038）患者早期减压（p = 0.38）；老年（OR 1.13, 95% CI 1.03-1.23, p = 0.01）和较差的ASIA评分（ASIA A OR 16.35, p p p）结论：脊髓损伤后较短的手术减压时间与膀胱或性功能的改善无关；然而，老年和更完整的损伤是显著的预测因素。
{"title":"The impact of the timing of spinal decompression on urinary and sexual function after acute spinal cord injury","authors":"Matthew Playfair, J. Andrew McClure, Chris Bailey, Blayne Welk","doi":"10.1002/bco2.70163","DOIUrl":"10.1002/bco2.70163","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>While earlier decompression after spinal cord injury (SCI) is linked to better motor recovery, its impact on bladder and sexual function remains unexplored. Our objective was to determine if time to surgical decompression is associated with bladder and sexual function.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a retrospective cohort study using the prospectively collected Canadian Rick Hansen SCI Registry. Primary exposure was time to surgical decompression. Primary outcome was abnormal bladder function defined by use of catheters or any incontinence at 1-year. Secondary outcomes were sexual function and motor score. Adjusted logarithmic regression models were used.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>One thousand thirty-eight participants met inclusion criteria. Median time to surgical decompression was 25 (IQR17–50) hours, and 46% (475/1038) had early decompression (<24 h). There were 63% (650/1038) who had evidence of abnormal bladder function at 1-year. On multivariate regression, time to decompression was not significantly related to abnormal bladder function (OR 1.00, 95% CI 1.00–1.01, <i>p</i> = 0.38); older age (OR 1.13, 95% CI 1.03–1.23, <i>p</i> = 0.01) and worse ASIA score (ASIA A OR 16.35, <i>p</i> < 0.01, ASIA B OR 5.12, <i>p</i> < 0.01 and ASIA C OR 2.23, <i>p</i> < 0.01 all relative to ASIA D) were significantly associated with abnormal bladder function. These results were similar in several sensitivity analyses. Time to decompression was also not significantly associated with sexual function or motor score at 1-year.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>A shorter time to surgical decompression after SCI was not associated with improved bladder or sexual function outcomes; however, older age and a more complete injury were significant predictors.</p>\u0000 </section>\u0000 </div>","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"7 2","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12858374/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146108729","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 aim of this study is to evaluate the impact of ureteric stent diameter on stent-related symptoms and early urological complications in kidney transplant recipients.
Patients and Methods
A single-centre randomised controlled trial that enrolled 70 kidney transplant recipients to receive either a 4.8 Fr or 6 Fr ureteric stent allocated at a 1:1 ratio was conducted. Stent-related symptoms and patient-reported outcomes were assessed using the Ureteral Stent Symptom Questionnaire (USSQ) and a visual analogue scale (VAS) for pain. Early postoperative complications—including urinary leakage, ureteric obstruction and urinary tract infection (UTI)—were recorded.
Results
The 4.8 Fr stents were associated with significantly fewer stent-related symptoms and lower USSQ scores than 6 Fr stents (47.0 ± 4.5 vs. 53.9 ± 4.2; p < 0.001). Patients who received a 4.8 Fr stent experienced lower pain intensity than those who received a 6 Fr stent (VAS 1.4 ± 0.7 vs. 2.2 ± 0.8; p < 0.001). Rates of urinary leakage, ureteric obstruction and UTI were comparable between the two groups.
Conclusion
The 4.8 Fr ureteric stents reduce stent-related symptoms and postoperative pain while demonstrating a similar early safety profile to 6 Fr stents. These findings support the use of smaller-calibre stents to improve postoperative comfort following kidney transplantation.
{"title":"Impact of ureteric stent diameter on stent-related symptoms and early outcomes after kidney transplantation: A randomised controlled trial","authors":"Ratchanon Wongtreeratanachai, Yada Phengsalae, Nuttapon Arpornsujaritkun, Surasak Kantachuvesiri, Kittinut Kijvikai, Kun Sirisopana, Wisoot Kongchareonsombat, Premsant Sangkum, Chinnakhet Ketsuwan","doi":"10.1002/bco2.70166","DOIUrl":"10.1002/bco2.70166","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>The aim of this study is to evaluate the impact of ureteric stent diameter on stent-related symptoms and early urological complications in kidney transplant recipients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Patients and Methods</h3>\u0000 \u0000 <p>A single-centre randomised controlled trial that enrolled 70 kidney transplant recipients to receive either a 4.8 Fr or 6 Fr ureteric stent allocated at a 1:1 ratio was conducted. Stent-related symptoms and patient-reported outcomes were assessed using the Ureteral Stent Symptom Questionnaire (USSQ) and a visual analogue scale (VAS) for pain. Early postoperative complications—including urinary leakage, ureteric obstruction and urinary tract infection (UTI)—were recorded.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The 4.8 Fr stents were associated with significantly fewer stent-related symptoms and lower USSQ scores than 6 Fr stents (47.0 ± 4.5 vs. 53.9 ± 4.2; <i>p</i> < 0.001). Patients who received a 4.8 Fr stent experienced lower pain intensity than those who received a 6 Fr stent (VAS 1.4 ± 0.7 vs. 2.2 ± 0.8; <i>p</i> < 0.001). Rates of urinary leakage, ureteric obstruction and UTI were comparable between the two groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The 4.8 Fr ureteric stents reduce stent-related symptoms and postoperative pain while demonstrating a similar early safety profile to 6 Fr stents. These findings support the use of smaller-calibre stents to improve postoperative comfort following kidney transplantation.</p>\u0000 </section>\u0000 </div>","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"7 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12832192/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146055249","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 evaluate the efficacy and safety of adding 0.1% tranexamic acid (TXA) to irrigation fluid in reducing perioperative blood loss during mini-percutaneous nephrolithotomy (mini-PCNL).
Patients and Methods
In this prospective, randomised study, 40 patients undergoing mini-PCNL were allocated to receive irrigation fluid containing either 0.1% TXA (n = 20) or distilled water (placebo; n = 20). The outcomes assessed included changes in haemoglobin, estimated blood loss, operative duration, irrigation volume, length of hospital stay, transfusion requirements, stone clearance and TXA-related adverse events.
Results
Baseline characteristics were comparable between the two groups. The TXA group had significantly less haemoglobin decline (0.5 g/dl vs. 1.5 g/dl) and lower estimated blood loss (91.7 ml vs. 169.0 ml) compared with the placebo group (both p < 0.05). Operative time and hospital stay were also shorter in the TXA group (p < 0.05). Transfusion rate and irrigation volume were lower in the TXA group, while stone clearance rates were comparable between the groups (90% vs. 85%; p = 0.633). No TXA-related adverse events were observed.
Conclusion
The addition of 0.1% TXA to irrigation fluid during mini-PCNL significantly reduces perioperative blood loss and appears to be safe in this pilot cohort, without increasing complications observed in the study.
目的：评价灌洗液中加入0.1%氨甲环酸（TXA）减少微型经皮肾镜取石术（mini-PCNL）围术期出血量的疗效和安全性。患者和方法：在这项前瞻性随机研究中，40名接受mini-PCNL的患者被分配接受含有0.1% TXA （n = 20）或蒸馏水（安慰剂，n = 20）的冲洗液。评估的结果包括血红蛋白的变化、估计失血量、手术时间、冲洗量、住院时间、输血需求、结石清除和txa相关不良事件。结果：两组患者的基线特征具有可比性。与安慰剂组相比，TXA组血红蛋白下降（0.5 g/dl vs. 1.5 g/dl）和估计失血量（91.7 ml vs. 169.0 ml）显著减少（p p p = 0.633）。未观察到与txa相关的不良事件。结论：在mini-PCNL期间，在灌洗液中添加0.1%的TXA可显著减少围手术期出血量，并且在该试点队列中似乎是安全的，没有增加研究中观察到的并发症。
{"title":"Effect of tranexamic acid irrigation on perioperative blood loss during mini-percutaneous nephrolithotomy: A pilot double-blind randomised controlled trial","authors":"Ornnicha Prohsoontorn, Kun Sirisopana, Surawach Piyawannarat, Yada Phengsalae, Premsant Sangkum, Wisoot Kongchareonsombat, Chinnakhet Ketsuwan","doi":"10.1002/bco2.70157","DOIUrl":"10.1002/bco2.70157","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To evaluate the efficacy and safety of adding 0.1% tranexamic acid (TXA) to irrigation fluid in reducing perioperative blood loss during mini-percutaneous nephrolithotomy (mini-PCNL).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Patients and Methods</h3>\u0000 \u0000 <p>In this prospective, randomised study, 40 patients undergoing mini-PCNL were allocated to receive irrigation fluid containing either 0.1% TXA (<i>n</i> = 20) or distilled water (placebo; <i>n</i> = 20). The outcomes assessed included changes in haemoglobin, estimated blood loss, operative duration, irrigation volume, length of hospital stay, transfusion requirements, stone clearance and TXA-related adverse events.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Baseline characteristics were comparable between the two groups. The TXA group had significantly less haemoglobin decline (0.5 g/dl vs. 1.5 g/dl) and lower estimated blood loss (91.7 ml vs. 169.0 ml) compared with the placebo group (both <i>p</i> < 0.05). Operative time and hospital stay were also shorter in the TXA group (<i>p</i> < 0.05). Transfusion rate and irrigation volume were lower in the TXA group, while stone clearance rates were comparable between the groups (90% vs. 85%; <i>p</i> = 0.633). No TXA-related adverse events were observed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The addition of 0.1% TXA to irrigation fluid during mini-PCNL significantly reduces perioperative blood loss and appears to be safe in this pilot cohort, without increasing complications observed in the study.</p>\u0000 </section>\u0000 </div>","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"7 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12819009/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146020501","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}
Reza Lahiji, Lorenzo Storino Ramacciotti, Ernie Morton, Edouard H. Nicaise, Adam Braunschweig, Gregory Palmateer, Benjamin Schmeusser, Dattatraya Patil, Maxwell Richardson, Frank Glover, Ethan Kearns, Aaron Lay, Mohammad Hajiha, Viraj A. Master, Kenneth Ogan
Background
The relationship between body composition and lithogenic urine parameters remains poorly defined. This study aimed to evaluate associations between computerized tomography (CT)-derived body composition metrics and 24-h urine findings.
Methods
Stone-forming patients in our Nephrolithiasis Database who underwent 24-h urine testing and CT within 120 days were retrospectively reviewed. Skeletal muscle index (SMI), visceral adipose tissue index (VATI), subcutaneous adipose tissue index (SATI) and skeletal muscle density (SMD) were calculated from segmented L3 axial images. Spearman correlations and multivariable logistic regression tested associations between body composition and 24-h urine markers.
Results
Among 443 patients, all body composition metrics demonstrated numerous correlations with 24-h urine marker values on Spearman analysis. After adjusting for confounders, higher SMI quartiles were associated with increased odds of elevated urine volume (OR 2.13–2.71), hyperoxaluria (OR 2.11), hyperuricosuria (OR 2.60) and hypernatriuria (OR 2.70). Higher VATI was associated with reduced odds of elevated urine volume (OR 0.44), SATI with elevated sodium excretion (OR 2.35–2.38) and higher SMD with decreased odds of elevated oxalate (OR 0.50) and hypocitraturia (OR 0.41).
Conclusions
CT-derived body composition metrics show distinct and clinically meaningful relationships with 24-h urine profiles. Muscle mass, adipose distribution and muscle quality each influence lithogenic risk, supporting incorporation of body composition assessment into metabolic evaluation of stone-forming patients.
{"title":"Computerized tomography-derived body composition metrics are associated with 24-h urine lithogenic parameters","authors":"Reza Lahiji, Lorenzo Storino Ramacciotti, Ernie Morton, Edouard H. Nicaise, Adam Braunschweig, Gregory Palmateer, Benjamin Schmeusser, Dattatraya Patil, Maxwell Richardson, Frank Glover, Ethan Kearns, Aaron Lay, Mohammad Hajiha, Viraj A. Master, Kenneth Ogan","doi":"10.1002/bco2.70152","DOIUrl":"10.1002/bco2.70152","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The relationship between body composition and lithogenic urine parameters remains poorly defined. This study aimed to evaluate associations between computerized tomography (CT)-derived body composition metrics and 24-h urine findings.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Stone-forming patients in our Nephrolithiasis Database who underwent 24-h urine testing and CT within 120 days were retrospectively reviewed. Skeletal muscle index (SMI), visceral adipose tissue index (VATI), subcutaneous adipose tissue index (SATI) and skeletal muscle density (SMD) were calculated from segmented L3 axial images. Spearman correlations and multivariable logistic regression tested associations between body composition and 24-h urine markers.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 443 patients, all body composition metrics demonstrated numerous correlations with 24-h urine marker values on Spearman analysis. After adjusting for confounders, higher SMI quartiles were associated with increased odds of elevated urine volume (OR 2.13–2.71), hyperoxaluria (OR 2.11), hyperuricosuria (OR 2.60) and hypernatriuria (OR 2.70). Higher VATI was associated with reduced odds of elevated urine volume (OR 0.44), SATI with elevated sodium excretion (OR 2.35–2.38) and higher SMD with decreased odds of elevated oxalate (OR 0.50) and hypocitraturia (OR 0.41).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>CT-derived body composition metrics show distinct and clinically meaningful relationships with 24-h urine profiles. Muscle mass, adipose distribution and muscle quality each influence lithogenic risk, supporting incorporation of body composition assessment into metabolic evaluation of stone-forming patients.</p>\u0000 </section>\u0000 </div>","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"7 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12805417/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145999961","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}
Markus Angerer, Alexander C. Harms, Christian Wülfing, Klaus-Peter Dieckmann
Objectives
This work aimed to document four new cases with giant testicular germ cell tumour (GCT) and to evaluate their relative incidence and clinical characteristics based on a literature survey. Despite the well-established trend over time towards declining tumour sizes in testicular GCTs, giant testicular tumours (>15 cm in diameter) are still reported in present times.
Patients, Methods
GCT patients treated during 2010–2025 were retrospectively evaluated with tabulating the following data: size of primary tumour (mm), age (years), histology, side and clinical stage (CS). The following parameters were calculated: relative frequency of giant GCTs; median tumour size in all GCTs and in various subgroups. A literature survey was conducted to identify previously published giant testicular GCTs followed by a descriptive evaluation of those cases.
Results
Four (0.5%) giant GCTs were identified among 860 GCT patients, two seminomas and two nonseminomas, all having CS3 disease, two of whom were cured. The median tumour size was 32 mm in all GCTs, and 30 mm and 35 mm in seminomas (n = 541) and nonseminomas (n = 319), respectively. Median tumour size was significantly smaller in CS1 cases than in those with CS > 1 (32 mm vs. 38 mm). Of the 40 cases identified with the literature survey, 24 were nonseminomas, 62% were left-sided, median age was 36 years, and 80% were cured. Diagnostic delay is the most frequent cause of excessive tumour growth.
Conclusions
Giant testicular tumours are observed in 0.5% of all GCT patients while the median tumour size of 32 mm observed herein is consistent with current reports. In most cases of giant GCT, personal misapprehension of the swelling, lack of knowledge or shame appears to be the key element causing diagnostic delay and consequently, extraordinary tumour growth. Information campaigns including individuals from socioeconomically underprivileged groups could help to increase men's awareness of genital diseases.
目的：通过文献调查，分析4例新发巨大睾丸生殖细胞瘤（GCT）的发病率及临床特点。尽管随着时间的推移，睾丸gct的肿瘤大小呈下降趋势，但目前仍有巨大的睾丸肿瘤（直径约为15厘米）的报道。方法：对2010-2025年期间接受治疗的GCT患者进行回顾性评估，列出以下数据：原发肿瘤大小（mm）、年龄（岁）、组织学、侧方和临床分期（CS）。计算了以下参数：巨型gct的相对频率；所有gct和不同亚组的中位肿瘤大小。进行文献调查以确定先前发表的巨睾丸gct，然后对这些病例进行描述性评估。结果：在860例GCT患者中发现4例（0.5%）巨大GCT， 2例精原细胞瘤和2例非精原细胞瘤，均为CS3疾病，其中2例治愈。所有gct的中位肿瘤大小为32 mm，精原细胞瘤（n = 541）和非精原细胞瘤（n = 319）的中位肿瘤大小分别为30 mm和35 mm。CS1患者的中位肿瘤大小明显小于CS bbb1患者（32 mm vs 38 mm）。在文献调查确定的40例病例中，24例为非精原细胞瘤，62%为左侧，中位年龄为36岁，80%治愈。诊断延误是肿瘤过度生长的最常见原因。结论：在所有GCT患者中，有0.5%的患者存在巨大睾丸肿瘤，而本研究中所观察到的中位肿瘤大小为32 mm，与目前的报道一致。在大多数巨大的GCT病例中，个人对肿胀的误解，缺乏知识或羞耻似乎是导致诊断延误的关键因素，因此，肿瘤生长异常。包括社会经济地位低下群体的个人在内的宣传运动有助于提高男子对生殖疾病的认识。
{"title":"Giant testicular germ-cell tumours—An analysis of relative incidence and clinical features based on a clinical case series and a survey of the literature","authors":"Markus Angerer, Alexander C. Harms, Christian Wülfing, Klaus-Peter Dieckmann","doi":"10.1002/bco2.70118","DOIUrl":"10.1002/bco2.70118","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>This work aimed to document four new cases with giant testicular germ cell tumour (GCT) and to evaluate their relative incidence and clinical characteristics based on a literature survey. Despite the well-established trend over time towards declining tumour sizes in testicular GCTs, giant testicular tumours (>15 cm in diameter) are still reported in present times.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Patients, Methods</h3>\u0000 \u0000 <p>GCT patients treated during 2010–2025 were retrospectively evaluated with tabulating the following data: size of primary tumour (mm), age (years), histology, side and clinical stage (CS). The following parameters were calculated: relative frequency of giant GCTs; median tumour size in all GCTs and in various subgroups. A literature survey was conducted to identify previously published giant testicular GCTs followed by a descriptive evaluation of those cases.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Four (0.5%) giant GCTs were identified among 860 GCT patients, two seminomas and two nonseminomas, all having CS3 disease, two of whom were cured. The median tumour size was 32 mm in all GCTs, and 30 mm and 35 mm in seminomas (<i>n</i> = 541) and nonseminomas (<i>n</i> = 319), respectively. Median tumour size was significantly smaller in CS1 cases than in those with CS > 1 (32 mm vs. 38 mm). Of the 40 cases identified with the literature survey, 24 were nonseminomas, 62% were left-sided, median age was 36 years, and 80% were cured. Diagnostic delay is the most frequent cause of excessive tumour growth.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Giant testicular tumours are observed in 0.5% of all GCT patients while the median tumour size of 32 mm observed herein is consistent with current reports. In most cases of giant GCT, personal misapprehension of the swelling, lack of knowledge or shame appears to be the key element causing diagnostic delay and consequently, extraordinary tumour growth. Information campaigns including individuals from socioeconomically underprivileged groups could help to increase men's awareness of genital diseases.</p>\u0000 </section>\u0000 </div>","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"7 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12795782/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145971572","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}
Andrea Lopez Sanmiguel, Yash S. Khandwala, Emily A. Vertosick, Daniel Barbakoff, Roya Ghavamian, Jonathan A. Coleman, Mark Dawidek, Andrew J. Vickers, A. Ari Hakimi, Paul Russo
Objectives
To assess treatment outcomes and evaluate patient selection criteria for cytoreductive partial nephrectomy (CRPN) in a unique cohort of metastatic renal cell carcinoma (mRCC) patients.
Methods
A retrospective review of mRCC patients who underwent CRPN between 1995 and 2023 at a single institution was performed. Clinical characteristics, perioperative outcomes, longitudinal imaging reports and overall survival data were analysed.
Results
Seventy-three patients with mRCC were included. Forty per cent of patients had prior radical nephrectomy, and 44% had prior metastasectomy. The median tumour size was 4 cm (IQR 2.7, 5.5). Median follow-up among patients who survived was 6.7 years (IQR 3.4, 9.6). Median overall survival was 6.1 years (95% CI 4.6 to 7.8). Complications occurred in 22% of patients within 30 days post-surgery. eGFR stabilized at 3 months after surgery, and no patients required dialysis. Larger tumour size was associated with a higher risk of cancer-specific death (HR 1.19, 95% CI 1.07 to 1.31, p < 0.001). Higher pathologic stage and grade were associated with significantly higher risks of cancer-specific death (HR 2.78, 95% CI 0.83 to 9.36, p = 0.10 and HR 1.45, 95% CI 0.64 to 3.29, p = 0.4, respectively).
Conclusion
CRPN was performed effectively as a component of integrated medical and surgical management for highly selected mRCC patients. Preservation of renal function in patients with a solitary kidney or with an intact contralateral kidney was achieved with acceptable surgical morbidity and oncologic outcomes.
目的：评估转移性肾癌（mRCC）患者的治疗结果和患者选择标准。方法：回顾性分析1995年至2023年间在一家机构接受CRPN治疗的mRCC患者。分析临床特征、围手术期结果、纵向影像报告和总体生存数据。结果：纳入73例mRCC患者。40%的患者既往行根治性肾切除术，44%既往行转移性肾切除术。中位肿瘤大小为4cm （IQR为2.7,5.5）。存活患者的中位随访时间为6.7年（IQR 3.4, 9.6）。中位总生存期为6.1年（95% CI 4.6 - 7.8）。22%的患者在术后30天内出现并发症。术后3个月eGFR稳定，无患者需要透析。较大的肿瘤大小与较高的癌症特异性死亡风险相关（相对危险度1.19,95% CI 1.07至1.31,p = 0.10，相对危险度1.45,95% CI 0.64至3.29,p = 0.4）。结论：CRPN作为高度选定的mRCC患者内科和外科综合治疗的一个组成部分是有效的。在单侧肾或对侧肾完整的患者中，肾脏功能得以保存，手术发病率和肿瘤预后均可接受。
{"title":"Long-term outcomes after cytoreductive partial nephrectomy for metastatic renal cell carcinoma","authors":"Andrea Lopez Sanmiguel, Yash S. Khandwala, Emily A. Vertosick, Daniel Barbakoff, Roya Ghavamian, Jonathan A. Coleman, Mark Dawidek, Andrew J. Vickers, A. Ari Hakimi, Paul Russo","doi":"10.1002/bco2.70122","DOIUrl":"10.1002/bco2.70122","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To assess treatment outcomes and evaluate patient selection criteria for cytoreductive partial nephrectomy (CRPN) in a unique cohort of metastatic renal cell carcinoma (mRCC) patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective review of mRCC patients who underwent CRPN between 1995 and 2023 at a single institution was performed. Clinical characteristics, perioperative outcomes, longitudinal imaging reports and overall survival data were analysed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Seventy-three patients with mRCC were included. Forty per cent of patients had prior radical nephrectomy, and 44% had prior metastasectomy. The median tumour size was 4 cm (IQR 2.7, 5.5). Median follow-up among patients who survived was 6.7 years (IQR 3.4, 9.6). Median overall survival was 6.1 years (95% CI 4.6 to 7.8). Complications occurred in 22% of patients within 30 days post-surgery. eGFR stabilized at 3 months after surgery, and no patients required dialysis. Larger tumour size was associated with a higher risk of cancer-specific death (HR 1.19, 95% CI 1.07 to 1.31, <i>p</i> < 0.001). Higher pathologic stage and grade were associated with significantly higher risks of cancer-specific death (HR 2.78, 95% CI 0.83 to 9.36, <i>p</i> = 0.10 and HR 1.45, 95% CI 0.64 to 3.29, <i>p</i> = 0.4, respectively).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>CRPN was performed effectively as a component of integrated medical and surgical management for highly selected mRCC patients. Preservation of renal function in patients with a solitary kidney or with an intact contralateral kidney was achieved with acceptable surgical morbidity and oncologic outcomes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"7 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12795982/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145971613","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}
Lymph node metastasis status is the strongest predictive factor for penile cancer survival. In penile cancer patients with suspected lymph node involvement, inguinal lymph node dissection (ILND) extends disease-free survival. Though video-endoscopic ILND (VEILND) has demonstrated superior surgical outcomes to open ILND (OILND) in the short term, its oncological efficacy long term is unproven. We present our long-term oncological follow-up of our previously published ILND cohort.
Methods
A prospectively collected institutional database was used to determine the outcome in 42 consecutive patients treated for penile cancer in a tertiary referral centre between 2008 and 2015. Overall survival and cancer-specific survival (CSS) were calculated using Kaplan–Meier curves and compared via log-rank tests.
Results
Forty-two patients underwent 68 ILND (35 OILND vs. 33 VEILND). Thirteen out of 42 patients were alive at a mean follow-up of 12.5 years. Overall survival for OILND and VEILND was 36.4% and 30.0% at 10 years. There was no significant difference between the survival curves (p = 0.91). CSS was equivalent (p = 0.87). Ten-year CSS was 75.3% (OILND) and 65.5% (VEILND). When stratified by nodal status, CSS for OILND was 77.8%, 83.3%, 50% and 66.7% (N0, N1, N2 and N3) compared with VEILND which were 100%, 75%, 75% and 40% respectively at 8 years. Thus, there was no significant difference in CSS between patients undergoing VEILND and OILND stratified by nodal status. Moreover, inguinal or pelvic nodal recurrence rate was equivalent in both groups, occurring in 5/22 OILND and 4/20 VEILND (p = 1.00) patients.
Conclusion
To our knowledge, we present the first European report of long-term follow-up demonstrating the oncological safety of VEILND. VEILND has comparable outcomes of recurrence, overall survival and CSS, with significantly reduced complication rates and length of stay, in penile cancer at a median follow-up of 104 months (range 2–213 months).
{"title":"Video-endoscopic versus open inguinal lymphadenectomy: Long-term oncological outcomes in penile cancer","authors":"Ranya Kumar, Krishna Sethia, Vivekanandan Kumar","doi":"10.1002/bco2.70153","DOIUrl":"10.1002/bco2.70153","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Lymph node metastasis status is the strongest predictive factor for penile cancer survival. In penile cancer patients with suspected lymph node involvement, inguinal lymph node dissection (ILND) extends disease-free survival. Though video-endoscopic ILND (VEILND) has demonstrated superior surgical outcomes to open ILND (OILND) in the short term, its oncological efficacy long term is unproven. We present our long-term oncological follow-up of our previously published ILND cohort.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A prospectively collected institutional database was used to determine the outcome in 42 consecutive patients treated for penile cancer in a tertiary referral centre between 2008 and 2015. Overall survival and cancer-specific survival (CSS) were calculated using Kaplan–Meier curves and compared via log-rank tests.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Forty-two patients underwent 68 ILND (35 OILND vs. 33 VEILND). Thirteen out of 42 patients were alive at a mean follow-up of 12.5 years. Overall survival for OILND and VEILND was 36.4% and 30.0% at 10 years. There was no significant difference between the survival curves (<i>p</i> = 0.91). CSS was equivalent (<i>p</i> = 0.87). Ten-year CSS was 75.3% (OILND) and 65.5% (VEILND). When stratified by nodal status, CSS for OILND was 77.8%, 83.3%, 50% and 66.7% (N0, N1, N2 and N3) compared with VEILND which were 100%, 75%, 75% and 40% respectively at 8 years. Thus, there was no significant difference in CSS between patients undergoing VEILND and OILND stratified by nodal status. Moreover, inguinal or pelvic nodal recurrence rate was equivalent in both groups, occurring in 5/22 OILND and 4/20 VEILND (<i>p</i> = 1.00) patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>To our knowledge, we present the first European report of long-term follow-up demonstrating the oncological safety of VEILND. VEILND has comparable outcomes of recurrence, overall survival and CSS, with significantly reduced complication rates and length of stay, in penile cancer at a median follow-up of 104 months (range 2–213 months).</p>\u0000 </section>\u0000 </div>","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"7 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12774794/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145936611","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}
Zorawar Singh, Dylan Brown, Justin James, Atieh D. Ashkezari, Manish A. Vira, Arun Rai
Introduction
The diagnosis of small renal masses is becoming increasingly common. Management recommendations are shifting from radical nephrectomy (RN) toward nephron-sparing options such as partial nephrectomy (PN), thermal ablation (TA), and active surveillance (AS). This study aims to present current treatment trends in the USA for treating clinical stage T1 renal cell carcinoma in the largest series to date. Additionally, we sought to identify predictors linked to the receipt of ablative treatments.
Methods
We conducted a retrospective cohort study using the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) 22 Registries from 2000 to 2021. Adults (≥18 years) with unilateral, primary cT1 renal cortical renal cell carcinoma were included. Treatments analysed were RN, PN, and ablative therapies (radiofrequency, cryoablation, and laser). Annual trends were assessed, and multinomial logistic regression identified demographic and clinical predictors of treatment selection.
Results
A total of 86 642 patients were included. Between 2000 and 2021, PN increased from 16% to 57% and ablation from 1% to 11%, while RN decreased from 84% to 33% (p < 0.001). Overall, 6138 ablative treatments were performed, with the majority (n = 5623, 92%) conducted on renal masses <4 cm. The most substantial growth was for tumours <2 cm, with a 17.2% increase in ablation compared to a 3.4% increase for masses >4 cm. Among ablative techniques, cryoablation's utilization increased most dramatically from 0% to 7% during the study period. Multivariable analysis indicated that predictors for choosing ablation over RN included older age, later year of diagnosis, smaller tumours, and higher income. Conversely, Hispanic ethnicity, marital status, and non-classic RCC subtypes were linked to a higher likelihood of receiving RN versus ablation.
Conclusion
Over the past two decades, PN and ablation have increasingly replaced RN in the management of cT1 renal masses, particularly for tumours <4 cm. As technology advances, ablation is likely to expand further, reinforcing the shift toward nephron-sparing strategies.
肾小肿块的诊断越来越普遍。治疗建议正从根治性肾切除术（RN）转向保留肾的选择，如部分肾切除术（PN）、热消融（TA）和主动监测（as）。这项研究的目的是在迄今为止最大的系列研究中，展示美国治疗临床T1期肾细胞癌的当前治疗趋势。此外，我们试图确定与接受消融治疗相关的预测因素。方法：我们使用美国国家癌症研究所的监测、流行病学和最终结果（SEER） 22个登记处，从2000年到2021年进行了一项回顾性队列研究。包括单侧原发性cT1肾皮质肾细胞癌的成人（≥18岁）。分析的治疗方法包括RN、PN和消融治疗（射频、冷冻消融和激光）。评估年度趋势，多项逻辑回归确定治疗选择的人口学和临床预测因素。结果：共纳入86 642例患者。2000年至2021年间，4 cm肾肿块的PN从16%增加到57%，消融从1%增加到11%，而RN从84%下降到33% （p n = 5623, 92%）。在消融技术中，冷冻消融的使用率在研究期间从0%急剧上升到7%。多变量分析表明，选择消融而非RN的预测因素包括年龄较大、诊断年份较晚、肿瘤较小和收入较高。相反，西班牙裔、婚姻状况和非经典RCC亚型与接受RN比消融的可能性更高有关。结论：在过去的二十年中，在处理cT1肾肿块，特别是肿瘤方面，PN和消融越来越多地取代了RN
{"title":"The decline of radical nephrectomy: Contemporary trends in the treatment of T1 renal cell carcinoma","authors":"Zorawar Singh, Dylan Brown, Justin James, Atieh D. Ashkezari, Manish A. Vira, Arun Rai","doi":"10.1002/bco2.70148","DOIUrl":"10.1002/bco2.70148","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>The diagnosis of small renal masses is becoming increasingly common. Management recommendations are shifting from radical nephrectomy (RN) toward nephron-sparing options such as partial nephrectomy (PN), thermal ablation (TA), and active surveillance (AS). This study aims to present current treatment trends in the USA for treating clinical stage T1 renal cell carcinoma in the largest series to date. Additionally, we sought to identify predictors linked to the receipt of ablative treatments.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a retrospective cohort study using the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) 22 Registries from 2000 to 2021. Adults (≥18 years) with unilateral, primary cT1 renal cortical renal cell carcinoma were included. Treatments analysed were RN, PN, and ablative therapies (radiofrequency, cryoablation, and laser). Annual trends were assessed, and multinomial logistic regression identified demographic and clinical predictors of treatment selection.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 86 642 patients were included. Between 2000 and 2021, PN increased from 16% to 57% and ablation from 1% to 11%, while RN decreased from 84% to 33% (<i>p</i> < 0.001). Overall, 6138 ablative treatments were performed, with the majority (<i>n</i> = 5623, 92%) conducted on renal masses <4 cm. The most substantial growth was for tumours <2 cm, with a 17.2% increase in ablation compared to a 3.4% increase for masses >4 cm. Among ablative techniques, cryoablation's utilization increased most dramatically from 0% to 7% during the study period. Multivariable analysis indicated that predictors for choosing ablation over RN included older age, later year of diagnosis, smaller tumours, and higher income. Conversely, Hispanic ethnicity, marital status, and non-classic RCC subtypes were linked to a higher likelihood of receiving RN versus ablation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Over the past two decades, PN and ablation have increasingly replaced RN in the management of cT1 renal masses, particularly for tumours <4 cm. As technology advances, ablation is likely to expand further, reinforcing the shift toward nephron-sparing strategies.</p>\u0000 </section>\u0000 </div>","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"7 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12765420/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145907227","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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