Lotte G. Zuur, Katelijne C. C. de Bie, Lieke Wever, Anne-Claire Berrens, Jean-Paul A. van Basten, Harm H. E. van Melick, Maarten L. Donswijk, Daniela E. Oprea-Lager, Wouter V. Vogel, Henk G. van der Poel, André N. Vis, Pim J. van Leeuwen
Objectives
To explore the distribution of metastatic disease in pN1 patients with biochemical recurrence (BCR) assessed by Prostate-Specific Membrane Antigen-Positron-Emission/Computed Tomography (PSMA-PET/CT).
Patients and Methods
This multicentre, retrospective cohort study included 130 pN1 PCa patients with BCR (PSA ≥ 0.2 ng/ml) post-RP with ePLND (2015–2022). All were preoperatively staged as molecular imaging (mi)N0M0 and underwent restaging PSMA-PET/CT at BCR. Clinical and imaging data were analysed using Mann–Whitney U, chi-square tests and Cox regression.
Results
Median time to BCR was 9 months (IQR 3–18). Biochemical persistence (BCP) (PSA ≥ 0.1 ng/ml at first follow-up) occurred in 66/130 (51%). At restaging PSMA-PET/CT, median PSA was 0.33 ng/ml (IQR 0.24–0.65). PSMA-PET/CT identified metastases in 63/130 (48%), with 37/63 (59%) having lymph node metastases (LNMs) limited to the ePLND template – 16/37 (43%) on the ipsilateral side of the positive resected node. Additionally, 26/63 (41%) had disease beyond the nodal template (miM+). Univariate Cox regression identified BCP as a predictor for any PSMA-PET/CT-detected recurrence, while a higher ISUP grade group at RP predicted miM+ disease.
Conclusion
PSMA-PET/CT identified PSMA-expressing recurrent disease in nearly half of pN1 PCa patients at early BCR, with about half confined to the pelvis and a quarter beyond the pelvis. These anatomical patterns indicate that PSMA-PET/CT can inform risk-adapted salvage strategies, including pelvic radiotherapy for nodal recurrences and systemic treatment when disease extends beyond the pelvis.
{"title":"Anatomical distribution of disease in pN1 prostate cancer with BCR post-RP: A PSMA-PET/CT-based analysis","authors":"Lotte G. Zuur, Katelijne C. C. de Bie, Lieke Wever, Anne-Claire Berrens, Jean-Paul A. van Basten, Harm H. E. van Melick, Maarten L. Donswijk, Daniela E. Oprea-Lager, Wouter V. Vogel, Henk G. van der Poel, André N. Vis, Pim J. van Leeuwen","doi":"10.1002/bco2.70123","DOIUrl":"10.1002/bco2.70123","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To explore the distribution of metastatic disease in pN1 patients with biochemical recurrence (BCR) assessed by Prostate-Specific Membrane Antigen-Positron-Emission/Computed Tomography (PSMA-PET/CT).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Patients and Methods</h3>\u0000 \u0000 <p>This multicentre, retrospective cohort study included 130 pN1 PCa patients with BCR (PSA ≥ 0.2 ng/ml) post-RP with ePLND (2015–2022). All were preoperatively staged as molecular imaging (mi)N0M0 and underwent restaging PSMA-PET/CT at BCR. Clinical and imaging data were analysed using Mann–Whitney U, chi-square tests and Cox regression.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Median time to BCR was 9 months (IQR 3–18). Biochemical persistence (BCP) (PSA ≥ 0.1 ng/ml at first follow-up) occurred in 66/130 (51%). At restaging PSMA-PET/CT, median PSA was 0.33 ng/ml (IQR 0.24–0.65). PSMA-PET/CT identified metastases in 63/130 (48%), with 37/63 (59%) having lymph node metastases (LNMs) limited to the ePLND template – 16/37 (43%) on the ipsilateral side of the positive resected node. Additionally, 26/63 (41%) had disease beyond the nodal template (miM+). Univariate Cox regression identified BCP as a predictor for any PSMA-PET/CT-detected recurrence, while a higher ISUP grade group at RP predicted miM+ disease.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>PSMA-PET/CT identified PSMA-expressing recurrent disease in nearly half of pN1 PCa patients at early BCR, with about half confined to the pelvis and a quarter beyond the pelvis. These anatomical patterns indicate that PSMA-PET/CT can inform risk-adapted salvage strategies, including pelvic radiotherapy for nodal recurrences and systemic treatment when disease extends beyond the pelvis.</p>\u0000 </section>\u0000 </div>","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"6 12","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12690614/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145745874","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}
Herbert Lepor, Samuel Parry, Majlinda Tafa, Eli Rapoport, James S. Wysock
Objectives
To determine the performance of MRI for detecting clinically significant prostate cancer (csPCa) recurrence following focal cryo-ablation over five years of oncological surveillance.
Subjects and Methods
A total of 305 men with intermediate-risk prostate cancer undergoing focal cryo-ablation (FCA) at our referral centre between 03/2017 and 03/2024 were prospectively enrolled in an outcomes registry. Selection criteria, treatment planning and oncological surveillance were standardized. The initial surveillance protocol included MRI at six months, two, 3.5, five years, and surveillance prostate biopsy at six months, two and five years. The surveillance protocol biopsy at six months and two years was abandoned for a negative MRI in May 2019 and November 2020. Performance statistics of MRI for detecting csPCa recurrence were assessed among mandatory MRI and biopsy dyads at six months and two years. Clinically significant prostate cancer detection rates for suspicious (positive) and negative MRI included all subjects.
Results
Sensitivity, specificity, positive predictive value and negative predictive value of MRI to predict csPCa is 25%, 93%, 29% and 91%. The csPCa detection rate for positive and negative MRI was 40% and 7.0%, respectively. The area under the receiver operating characteristic curve for MRI as a predictor of csPCa was 0.60, suggesting limitations of MRI for predicting csPCa. A limitation is that a validated instrument for positive MRI was not available during the study.
Conclusions
Six-month MRI is not recommended owing to its very low csPCa detection rate. The increasing csPCa detection rates at two and five years suggest these are reasonable time points to perform MRI. Prostate biopsy should be performed on all cases with positive MRI, and can safely be deferred in most cases with negative MRI.
{"title":"MRI performance to identify clinically significant prostate cancer following focal cryo-ablation","authors":"Herbert Lepor, Samuel Parry, Majlinda Tafa, Eli Rapoport, James S. Wysock","doi":"10.1002/bco2.70120","DOIUrl":"10.1002/bco2.70120","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To determine the performance of MRI for detecting clinically significant prostate cancer (csPCa) recurrence following focal cryo-ablation over five years of oncological surveillance.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Subjects and Methods</h3>\u0000 \u0000 <p>A total of 305 men with intermediate-risk prostate cancer undergoing focal cryo-ablation (FCA) at our referral centre between 03/2017 and 03/2024 were prospectively enrolled in an outcomes registry. Selection criteria, treatment planning and oncological surveillance were standardized. The initial surveillance protocol included MRI at six months, two, 3.5, five years, and surveillance prostate biopsy at six months, two and five years. The surveillance protocol biopsy at six months and two years was abandoned for a negative MRI in May 2019 and November 2020. Performance statistics of MRI for detecting csPCa recurrence were assessed among mandatory MRI and biopsy dyads at six months and two years. Clinically significant prostate cancer detection rates for suspicious (positive) and negative MRI included all subjects.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Sensitivity, specificity, positive predictive value and negative predictive value of MRI to predict csPCa is 25%, 93%, 29% and 91%. The csPCa detection rate for positive and negative MRI was 40% and 7.0%, respectively. The area under the receiver operating characteristic curve for MRI as a predictor of csPCa was 0.60, suggesting limitations of MRI for predicting csPCa. A limitation is that a validated instrument for positive MRI was not available during the study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Six-month MRI is not recommended owing to its very low csPCa detection rate. The increasing csPCa detection rates at two and five years suggest these are reasonable time points to perform MRI. Prostate biopsy should be performed on all cases with positive MRI, and can safely be deferred in most cases with negative MRI.</p>\u0000 </section>\u0000 </div>","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"6 12","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12690215/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145745890","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}
Jae Woong Jang, Nicole Handa, Ridwan Alam, Clayton Neill, Sai Kumar, Kent T. Perry, Edward M. Schaeffer, Hiten D. Patel, Ashley E. Ross
Introduction
Ideal candidates for focal therapy (FT) for prostate cancer (PCa) have mpMRI-visible ISUP Grade Group 2–3, localized disease. Transperineal (TP) prostate biopsies provide superior positional information of PCa in the transverse axis, and possibly higher PCa detection rates—important in choosing FT modalities. Here, we describe the frequency of optimal FT candidates among a large cohort of men with proven PCa identified from MRI-guided targeted and systematic TP biopsy.
Methods
We queried the Northwestern data warehouse for men with newly diagnosed PCa who had a positive mpMRI (PI-RADS 3–5) and a TP biopsy prior to diagnosis from January 2018 to June 2024. Patients with disease optimal for FT were determined using modified FALCON consensus guidelines with emphasis on mpMRI and biopsy findings. We also explored the disparity in FT candidacy when using only target cores compared to combined target and systematic cores.
Results
We identified 1342 men diagnosed with PCa on combined targeted and systematic TP biopsy after a positive mpMRI, of which 888 men had intermediate-risk PCa. Of these 888 men, 439 patients (49.4%) had unilateral-dominant disease, while 329 patients (37%) had unilateral-dominant and anterior (106; 11.9%) or posterior-dominant (223; 25.1%) disease. Up to half of the patients considered good candidates on target cores were considered FT-ineligible on review of systematic cores.
Conclusions
FT may be considered in up to 50% of patients with intermediate risk disease, while ideal candidates for functional preservation constitute a smaller number. Review of both targeted and systematic biopsy cores is crucial in determining FT candidacy.
{"title":"Incidence of ideal candidates for focal therapy: A scoping study following the FALCON Consensus Statements","authors":"Jae Woong Jang, Nicole Handa, Ridwan Alam, Clayton Neill, Sai Kumar, Kent T. Perry, Edward M. Schaeffer, Hiten D. Patel, Ashley E. Ross","doi":"10.1002/bco2.70121","DOIUrl":"https://doi.org/10.1002/bco2.70121","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Ideal candidates for focal therapy (FT) for prostate cancer (PCa) have mpMRI-visible ISUP Grade Group 2–3, localized disease. Transperineal (TP) prostate biopsies provide superior positional information of PCa in the transverse axis, and possibly higher PCa detection rates—important in choosing FT modalities. Here, we describe the frequency of optimal FT candidates among a large cohort of men with proven PCa identified from MRI-guided targeted and systematic TP biopsy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We queried the Northwestern data warehouse for men with newly diagnosed PCa who had a positive mpMRI (PI-RADS 3–5) and a TP biopsy prior to diagnosis from January 2018 to June 2024. Patients with disease optimal for FT were determined using modified FALCON consensus guidelines with emphasis on mpMRI and biopsy findings. We also explored the disparity in FT candidacy when using only target cores compared to combined target and systematic cores.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We identified 1342 men diagnosed with PCa on combined targeted and systematic TP biopsy after a positive mpMRI, of which 888 men had intermediate-risk PCa. Of these 888 men, 439 patients (49.4%) had unilateral-dominant disease, while 329 patients (37%) had unilateral-dominant and anterior (106; 11.9%) or posterior-dominant (223; 25.1%) disease. Up to half of the patients considered good candidates on target cores were considered FT-ineligible on review of systematic cores.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>FT may be considered in up to 50% of patients with intermediate risk disease, while ideal candidates for functional preservation constitute a smaller number. Review of both targeted and systematic biopsy cores is crucial in determining FT candidacy.</p>\u0000 </section>\u0000 </div>","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"6 12","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://bjui-journals.onlinelibrary.wiley.com/doi/epdf/10.1002/bco2.70121","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145686316","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}
Serdar Turan, Cem Tugrul Gezmis, Nusret Can Cilesiz, Mehmet Uzut, Mustafa Satılmısoglu, Rifat Burak Ergul, Mustafa Bahadır Can Balcı
Objective
To evaluate the prognostic performance of the Haematuria Cancer Risk Score (HCRS) for predicting muscle-invasive bladder cancer (MIBC) in patients presenting with haematuria.
Methods
This retrospective study analysed newly diagnosed urothelial carcinoma cases identified during haematuria evaluations between 2018 and 2023. Pathological staging was based on the highest grade or stage from TUR or re-TUR specimens. HCRS was calculated using age, sex, haematuria type, and smoking status. The primary outcome was muscle-invasive disease (≥T2). Associations were examined using univariate logistic regression, and discriminatory performance was evaluated with ROC analysis and bootstrap-derived 95% confidence intervals.
Results
Among 162 patients, 45 (27.8%) had MIBC. The median HCRS was higher in patients with MIBC than in those with non-muscle-invasive disease (6.49 [6.08–6.96] vs. 6.16 [5.44–6.94]; p = 0.04). Univariate analysis showed a significant association between HCRS and MIBC (odds ratio = 1.78; 95% CI 1.03–3.06; p = 0.039). ROC analysis demonstrated limited discriminative performance (AUC = 0.60; 95% CI 0.53–0.67). At the Youden cut-off of 6.04, sensitivity was 77.8% and specificity 48.3%. An integer threshold of HCRS ≥6 yielded comparable performance, supporting clinical applicability.
Conclusions
Higher HCRS values were modestly associated with muscle invasion, although predictive performance was limited. The HCRS may support risk stratification in haematuria pathways by flagging patients at higher risk of muscle invasion—particularly when interpreted together with cystoscopy and imaging findings.
目的：评价血尿癌风险评分（HCRS）在血尿患者中预测肌肉浸润性膀胱癌（MIBC）的预后表现。方法：本回顾性研究分析了2018年至2023年在血尿评估中发现的新诊断尿路上皮癌病例。病理分期以TUR或再TUR标本的最高分级或分期为基础。HCRS根据年龄、性别、血尿类型和吸烟状况计算。主要终点为肌肉侵袭性疾病（≥T2）。使用单变量逻辑回归检验相关性，并使用ROC分析和bootstrap导出的95%置信区间评估歧视性表现。结果：162例患者中，45例（27.8%）有MIBC。MIBC患者的中位HCRS高于非肌肉侵袭性疾病患者（6.49[6.08-6.96]比6.16 [5.44-6.94];p = 0.04）。单因素分析显示HCRS与MIBC之间存在显著相关性（优势比= 1.78;95% CI 1.03-3.06; p = 0.039）。ROC分析显示有限的判别性能（AUC = 0.60; 95% CI 0.53-0.67）。在约登截止值为6.04时，敏感性为77.8%，特异性为48.3%。HCRS≥6的整数阈值可获得相当的性能，支持临床适用性。结论：较高的HCRS值与肌肉侵袭有一定的相关性，尽管预测性能有限。HCRS可以通过标记肌肉侵入风险较高的患者来支持血尿途径的风险分层，特别是当与膀胱镜检查和影像学结果一起解释时。
{"title":"Haematuria cancer risk score as a predictor of muscle-invasive bladder cancer","authors":"Serdar Turan, Cem Tugrul Gezmis, Nusret Can Cilesiz, Mehmet Uzut, Mustafa Satılmısoglu, Rifat Burak Ergul, Mustafa Bahadır Can Balcı","doi":"10.1002/bco2.70125","DOIUrl":"10.1002/bco2.70125","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To evaluate the prognostic performance of the Haematuria Cancer Risk Score (HCRS) for predicting muscle-invasive bladder cancer (MIBC) in patients presenting with haematuria.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective study analysed newly diagnosed urothelial carcinoma cases identified during haematuria evaluations between 2018 and 2023. Pathological staging was based on the highest grade or stage from TUR or re-TUR specimens. HCRS was calculated using age, sex, haematuria type, and smoking status. The primary outcome was muscle-invasive disease (≥T2). Associations were examined using univariate logistic regression, and discriminatory performance was evaluated with ROC analysis and bootstrap-derived 95% confidence intervals.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 162 patients, 45 (27.8%) had MIBC. The median HCRS was higher in patients with MIBC than in those with non-muscle-invasive disease (6.49 [6.08–6.96] vs. 6.16 [5.44–6.94]; <i>p</i> = 0.04). Univariate analysis showed a significant association between HCRS and MIBC (odds ratio = 1.78; 95% CI 1.03–3.06; <i>p</i> = 0.039). ROC analysis demonstrated limited discriminative performance (AUC = 0.60; 95% CI 0.53–0.67). At the Youden cut-off of 6.04, sensitivity was 77.8% and specificity 48.3%. An integer threshold of HCRS ≥6 yielded comparable performance, supporting clinical applicability.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Higher HCRS values were modestly associated with muscle invasion, although predictive performance was limited. The HCRS may support risk stratification in haematuria pathways by flagging patients at higher risk of muscle invasion—particularly when interpreted together with cystoscopy and imaging findings.</p>\u0000 </section>\u0000 </div>","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"6 12","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12673275/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145679488","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}
Sulaiman Goudaimy, Louis Lenfant, Christophe Vaessen, Jérôme Parra, Emmanuel Chartier-Kastler, Aurélien Beaugerie, Pierre Mozer, Quentin Dubourg, Thomas Seisen, Morgan Roupret, Ugo Pinar
Objectives
To assess the learning curve of thulium fibre laser enucleation of the prostate (THUFLEP).
Patients and methods
We conducted a retrospective study including the first 111 patients treated with THUFLEP by a single surgeon. The operator had no prior experience in prostate enucleation and performed the first two procedures under the supervision of an expert. Initial 68 cases were performed using the three-lobe technique, and the later cases were done as en bloc enucleation with early apex release (n = 43). The learning curve was analysed in terms of temporal changes in the following variables: enucleation time, morcellation time, occurrence of intraoperative complications (IOCs) and achievement of pentafecta (enucleation + morcellation <90 min, a complete enucleation without complications and stress urinary incontinence at 3 months) in four consecutive patients.
Results
A total of 111 consecutive patients were included, with a mean age of 71.5 years (SD = 10.8), a mean total PSA of 7.9 ng/ml (SD = 8.4) and a mean prostate volume of 99.1 cc (SD = 35.9). The mean enucleation and morcellation times were 65.9 min (SD = 36.2) and 15.5 min (SD = 13.5), respectively. There were 13 postoperative complications (11.7%), and only one required reoperation for clot evacuation. The pentafecta was achieved in 66 patients (59.5%) and was reached in four consecutive patients after the 38th case. Operative time reached a plateau after approximately 60 procedures. The average enucleation efficiency was 1.1 g/min (SD = 0.7), and the plateau had not yet been reached after 111 patients.
Conclusions
In our experience, we observed a learning curve of 40–60 cases for THUFLEP. This plateau was reached after a relatively long learning curve; a more structured and supervised training programme may help improve these learning curves. Lastly, the complication rate was low from the beginning of the surgical experience, and the pentafecta was achieved in more than half of the patients.
目的探讨铥纤维激光前列腺摘除（THUFLEP）的学习曲线。患者和方法我们进行了一项回顾性研究，包括由一名外科医生治疗的首批111名患者。操作者没有前列腺摘除的经验，在专家的监督下进行了前两次手术。最初的68例采用三瓣技术，随后的43例采用早期心尖释放的整体去核术。根据以下变量的时间变化来分析学习曲线：连续4例患者的去核时间、碎化时间、术中并发症（IOCs）的发生以及五感的实现（去核+碎化& 90分钟，完全去核无并发症，3个月时压力性尿失禁）。结果共纳入111例患者，平均年龄71.5岁（SD = 10.8），平均总PSA为7.9 ng/ml (SD = 8.4)，平均前列腺体积为99.1 cc （SD = 35.9）。平均去核和分块时间分别为65.9 min （SD = 36.2）和15.5 min （SD = 13.5）。术后并发症13例（11.7%），仅1例需要再次手术进行血块清除。66例患者（59.5%）达到五肛，第38例后连续4例患者达到五肛。大约60次手术后，手术时间达到平稳期。平均去核效率为1.1 g/min (SD = 0.7)， 111例患者未达到平台期。根据我们的经验，我们观察到40-60例THUFLEP的学习曲线。这个平台是在经历了相对较长的学习曲线之后达到的；一个更有组织、更有监督的培训项目可能有助于改善这些学习曲线。最后，从手术开始，并发症发生率就很低，超过一半的患者达到了五肛。
{"title":"Thulium fibre laser endoscopic enucleation of the prostate (THUFLEP) learning curve assessment: A retrospective analysis of the experience of a single surgeon","authors":"Sulaiman Goudaimy, Louis Lenfant, Christophe Vaessen, Jérôme Parra, Emmanuel Chartier-Kastler, Aurélien Beaugerie, Pierre Mozer, Quentin Dubourg, Thomas Seisen, Morgan Roupret, Ugo Pinar","doi":"10.1002/bco2.70116","DOIUrl":"https://doi.org/10.1002/bco2.70116","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To assess the learning curve of thulium fibre laser enucleation of the prostate (THUFLEP).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Patients and methods</h3>\u0000 \u0000 <p>We conducted a retrospective study including the first 111 patients treated with THUFLEP by a single surgeon. The operator had no prior experience in prostate enucleation and performed the first two procedures under the supervision of an expert. Initial 68 cases were performed using the three-lobe technique, and the later cases were done as en bloc enucleation with early apex release (<i>n</i> = 43). The learning curve was analysed in terms of temporal changes in the following variables: enucleation time, morcellation time, occurrence of intraoperative complications (IOCs) and achievement of pentafecta (enucleation + morcellation <90 min, a complete enucleation without complications and stress urinary incontinence at 3 months) in four consecutive patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 111 consecutive patients were included, with a mean age of 71.5 years (SD = 10.8), a mean total PSA of 7.9 ng/ml (SD = 8.4) and a mean prostate volume of 99.1 cc (SD = 35.9). The mean enucleation and morcellation times were 65.9 min (SD = 36.2) and 15.5 min (SD = 13.5), respectively. There were 13 postoperative complications (11.7%), and only one required reoperation for clot evacuation. The pentafecta was achieved in 66 patients (59.5%) and was reached in four consecutive patients after the 38th case. Operative time reached a plateau after approximately 60 procedures. The average enucleation efficiency was 1.1 g/min (SD = 0.7), and the plateau had not yet been reached after 111 patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In our experience, we observed a learning curve of 40–60 cases for THUFLEP. This plateau was reached after a relatively long learning curve; a more structured and supervised training programme may help improve these learning curves. Lastly, the complication rate was low from the beginning of the surgical experience, and the pentafecta was achieved in more than half of the patients.</p>\u0000 </section>\u0000 </div>","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"6 12","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://bjui-journals.onlinelibrary.wiley.com/doi/epdf/10.1002/bco2.70116","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145686109","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}
Mario Dominguez Esteban, Ester Fernandez Guzman, Enrique Ramos Barselo, Ernesto Herrero Blanco, Sergio Zubillaga Guerrero, Roberto Ballestero Diego, Alejandro Fernandez Florez, Jose Javier Gomez Roman, Jaime Garcia Herrero, Marina Sanchez Gil, Guillermo Velilla Diez, Felix Campos Juanatey, Maria Teresa Garcia Unzueta, Jose Luis Gutierrez Baños
<div> <section> <h3> Background</h3> <p>The integration of blood-based biomarkers and multiparametric magnetic resonance imaging (mpMRI) has been proposed to improve prostate cancer (PCa) diagnosis. However, few validated models combine both tools to support risk-adapted clinical decision-making.</p> </section> <section> <h3> Objective</h3> <p>The study's aim is to evaluate and internally validate a multivariable model integrating clinical, analytical and imaging parameters—including the Prostate Health Index (PHI) and mpMRI—for predicting clinically significant prostate cancer (csPCa) in biopsy-naïve men.</p> </section> <section> <h3> Design, setting and participants</h3> <p>This prospective observational study included 183 biopsy-naïve men aged 50–75 years with PSA levels of 4–10 ng/mL and/or abnormal digital rectal examination. All patients underwent PHI testing, and 47.5% received prebiopsy mpMRI. All underwent systematic biopsy; targeted cognitive fusion biopsy was performed for PIRADS ≥ 3 lesions.</p> </section> <section> <h3> Outcome measurements and statistical analysis</h3> <p>A multivariable logistic regression model was constructed using PHI, PSA density, PSA free/total ratio, PIRADS score and age. The model was internally validated with bootstrap resampling and converted into a clinical nomogram. Diagnostic accuracy (AUC, sensitivity, specificity, NPV and PPV) was assessed and compared with simplified strategies using PHI or PIRADS alone, as well as a sequential approach (PHI → PIRADS).</p> </section> <section> <h3> Results and limitations</h3> <p>The model achieved an AUC of 0.841 (95% CI 0.76–0.91), with 100% sensitivity and 66.7% specificity for csPCa in the mpMRI cohort at the optimal 17% risk threshold (65.5 points). It safely avoided 49.4% of biopsies without missing any csPCa cases. Simpler strategies using PHI or PIRADS alone showed lower efficiency, particularly in balancing sensitivity and biopsy reduction. As an additional analysis, the PHI–mpMRI nomogram by Siddiqui et al. (2023) was externally validated in our cohort, confirming robust diagnostic accuracy (AUC 0.89, 95% CI 0.82–0.95). Limitations include the modest size of the mpMRI cohort and the historical nature of recruitment (2014–2018), although PHI and mpMRI remain standard in contemporary practice.</p> </section> <section> <h3> Conclusions</h3> <p>This model accurat
背景：基于血液的生物标志物和多参数磁共振成像（mpMRI）的整合已被提出用于改善前列腺癌（PCa）的诊断。然而，很少有经过验证的模型将这两种工具结合起来，以支持适应风险的临床决策。目的：该研究的目的是评估和内部验证一个多变量模型，该模型整合了临床、分析和影像学参数，包括前列腺健康指数（PHI）和mpmri，用于预测biopsy-naïve男性的临床显著性前列腺癌（csPCa）。设计背景和参与者：这项前瞻性观察性研究包括183名年龄在50-75岁、PSA水平为4-10 ng/mL和/或直肠指检异常的biopsy-naïve男性。所有患者都进行了PHI检测，47.5%的患者接受了活检前mpMRI检查。所有患者均行系统活检；PIRADS≥3个病灶行定向认知融合活检。结果测量与统计分析：采用PHI、PSA密度、PSA游离/总比、PIRADS评分和年龄构建多变量logistic回归模型。该模型通过bootstrap重新采样进行内部验证，并转换为临床nomogram。评估诊断准确性（AUC、敏感性、特异性、NPV和PPV），并与单独使用PHI或PIRADS的简化策略以及顺序方法（PHI→PIRADS）进行比较。结果和局限性：该模型的AUC为0.841 (95% CI 0.76-0.91)，在最佳17%风险阈值（65.5点）下，mpMRI队列中csPCa的敏感性为100%，特异性为66.7%。它安全地避免了49.4%的活组织检查，没有遗漏任何csPCa病例。单独使用PHI或PIRADS的简单策略效率较低，特别是在平衡敏感性和活检减少方面。作为另一项分析，Siddiqui等人（2023）的pi - mpmri图在我们的队列中进行了外部验证，证实了强大的诊断准确性（AUC 0.89, 95% CI 0.82-0.95）。尽管PHI和mpMRI在当代实践中仍然是标准的，但其局限性包括mpMRI队列的适度规模和招募的历史性质（2014-2018年）。结论：该模型准确预测csPCa，优于单独使用PHI或PIRADS等单独工具。它的应用可以提高诊断效率，减少不必要的程序。患者总结：结合血液检查（PHI）和MRI的模型可以帮助避免不必要的前列腺活检，同时可靠地检测侵袭性癌症。
{"title":"Multivariable model integrating PHI and mpMRI for detecting csPCa in biopsy-naïve men","authors":"Mario Dominguez Esteban, Ester Fernandez Guzman, Enrique Ramos Barselo, Ernesto Herrero Blanco, Sergio Zubillaga Guerrero, Roberto Ballestero Diego, Alejandro Fernandez Florez, Jose Javier Gomez Roman, Jaime Garcia Herrero, Marina Sanchez Gil, Guillermo Velilla Diez, Felix Campos Juanatey, Maria Teresa Garcia Unzueta, Jose Luis Gutierrez Baños","doi":"10.1002/bco2.70101","DOIUrl":"10.1002/bco2.70101","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The integration of blood-based biomarkers and multiparametric magnetic resonance imaging (mpMRI) has been proposed to improve prostate cancer (PCa) diagnosis. However, few validated models combine both tools to support risk-adapted clinical decision-making.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>The study's aim is to evaluate and internally validate a multivariable model integrating clinical, analytical and imaging parameters—including the Prostate Health Index (PHI) and mpMRI—for predicting clinically significant prostate cancer (csPCa) in biopsy-naïve men.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design, setting and participants</h3>\u0000 \u0000 <p>This prospective observational study included 183 biopsy-naïve men aged 50–75 years with PSA levels of 4–10 ng/mL and/or abnormal digital rectal examination. All patients underwent PHI testing, and 47.5% received prebiopsy mpMRI. All underwent systematic biopsy; targeted cognitive fusion biopsy was performed for PIRADS ≥ 3 lesions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Outcome measurements and statistical analysis</h3>\u0000 \u0000 <p>A multivariable logistic regression model was constructed using PHI, PSA density, PSA free/total ratio, PIRADS score and age. The model was internally validated with bootstrap resampling and converted into a clinical nomogram. Diagnostic accuracy (AUC, sensitivity, specificity, NPV and PPV) was assessed and compared with simplified strategies using PHI or PIRADS alone, as well as a sequential approach (PHI → PIRADS).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results and limitations</h3>\u0000 \u0000 <p>The model achieved an AUC of 0.841 (95% CI 0.76–0.91), with 100% sensitivity and 66.7% specificity for csPCa in the mpMRI cohort at the optimal 17% risk threshold (65.5 points). It safely avoided 49.4% of biopsies without missing any csPCa cases. Simpler strategies using PHI or PIRADS alone showed lower efficiency, particularly in balancing sensitivity and biopsy reduction. As an additional analysis, the PHI–mpMRI nomogram by Siddiqui et al. (2023) was externally validated in our cohort, confirming robust diagnostic accuracy (AUC 0.89, 95% CI 0.82–0.95). Limitations include the modest size of the mpMRI cohort and the historical nature of recruitment (2014–2018), although PHI and mpMRI remain standard in contemporary practice.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This model accurat","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"6 12","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12672186/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145679476","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}
Wei Zhu, Jinghua Zhong, Kefeng Wang, Guangming Yin, Chi-Ho Leung, Nariman Gadzhiev, Mehmet Ilker Gökce, Jaisukh Kalathia, Vineet Gauhar, Guangyuan Zhang, Gang Wu, Mingyong Li, Li Fang, Shaohua Zeng, Peide Bai, Ji Li, Zhenhua Zhao, Ming Xi, Xin Mai, Xianzhong Duan, Kehua Jiang, Jianwei Cao, Xianghu Meng, Shusheng Liu, Aram Aloyan, Peng Yuan, Xiaorui Zhu, Ting Huang, Jianhui Xing, Jingzeng Du, Wenqi Wu, Jinxiang Ma, Wen Zhong, Zhijian Zhao, Yongda Liu, Chi Fai Ng, Jean de la Rosette, Bhaskar Somani, Shiyong Qi, Guohua Zeng, Steffi Kar Kei Yuen
Background
Lower pole renal stones measuring 1–2 cm remain challenging to treat. While mini-percutaneous nephrolithotomy (mini-PCNL) provides high stone-free rates (SFRs), it carries tract-related morbidity. Flexible ureteroscopy (f-URS) is less invasive but limited in SFR. The flexible and navigable suction ureteral access sheath (FANS) has shown promise in improving stone evacuation and intrarenal pressure control. We hypothesize that FANS f-URS is non-inferior to mini-PCNL for patients with 1–2 cm lower pole stones in SFR.
Study Design
The FLAME trial is an international, multicentre, randomized, non-inferiority study directly comparing FANS-f-URS with mini-PCNL in this setting.
Endpoints
The primary outcome is immediate SFR within 72 hours on low-dose CT. Secondary outcomes include SFR at 1 month, operative time, postoperative pain, hospital stay, complications (Clavien–Dindo) and quality-of-life changes.
Patients and Methods
A total of 640 adults with CT-confirmed 1–2 cm lower pole renal stones will be randomized 1:1 to undergo FANS-f-URS or mini-PCNL across 20 high-volume urology centres worldwide. Randomization is centralized and stratified by site. Radiologists and statisticians will remain blinded to allocation. Sample size was calculated assuming an 85% SFR for both arms, an 8.5% non-inferiority margin, 80% power and 15% attrition. Analyses will follow both intention-to-treat and per-protocol principles.
{"title":"Flexible ureteroscopy with a flexible and navigable suction ureteral access sheath versus mini-percutaneous nephrolithotomy for 1–2 cm lower pole renal stones: Protocol for an international, multicentre, randomized non-inferiority trial (FLAME trial)","authors":"Wei Zhu, Jinghua Zhong, Kefeng Wang, Guangming Yin, Chi-Ho Leung, Nariman Gadzhiev, Mehmet Ilker Gökce, Jaisukh Kalathia, Vineet Gauhar, Guangyuan Zhang, Gang Wu, Mingyong Li, Li Fang, Shaohua Zeng, Peide Bai, Ji Li, Zhenhua Zhao, Ming Xi, Xin Mai, Xianzhong Duan, Kehua Jiang, Jianwei Cao, Xianghu Meng, Shusheng Liu, Aram Aloyan, Peng Yuan, Xiaorui Zhu, Ting Huang, Jianhui Xing, Jingzeng Du, Wenqi Wu, Jinxiang Ma, Wen Zhong, Zhijian Zhao, Yongda Liu, Chi Fai Ng, Jean de la Rosette, Bhaskar Somani, Shiyong Qi, Guohua Zeng, Steffi Kar Kei Yuen","doi":"10.1002/bco2.70114","DOIUrl":"https://doi.org/10.1002/bco2.70114","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Lower pole renal stones measuring 1–2 cm remain challenging to treat. While mini-percutaneous nephrolithotomy (mini-PCNL) provides high stone-free rates (SFRs), it carries tract-related morbidity. Flexible ureteroscopy (f-URS) is less invasive but limited in SFR. The flexible and navigable suction ureteral access sheath (FANS) has shown promise in improving stone evacuation and intrarenal pressure control. We hypothesize that FANS f-URS is non-inferior to mini-PCNL for patients with 1–2 cm lower pole stones in SFR.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Study Design</h3>\u0000 \u0000 <p>The FLAME trial is an international, multicentre, randomized, non-inferiority study directly comparing FANS-f-URS with mini-PCNL in this setting.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Endpoints</h3>\u0000 \u0000 <p>The primary outcome is immediate SFR within 72 hours on low-dose CT. Secondary outcomes include SFR at 1 month, operative time, postoperative pain, hospital stay, complications (Clavien–Dindo) and quality-of-life changes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Patients and Methods</h3>\u0000 \u0000 <p>A total of 640 adults with CT-confirmed 1–2 cm lower pole renal stones will be randomized 1:1 to undergo FANS-f-URS or mini-PCNL across 20 high-volume urology centres worldwide. Randomization is centralized and stratified by site. Radiologists and statisticians will remain blinded to allocation. Sample size was calculated assuming an 85% SFR for both arms, an 8.5% non-inferiority margin, 80% power and 15% attrition. Analyses will follow both intention-to-treat and per-protocol principles.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Trial registration</h3>\u0000 \u0000 <p>ClinicalTrials.gov NCT07159035.</p>\u0000 </section>\u0000 </div>","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"6 12","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://bjui-journals.onlinelibrary.wiley.com/doi/epdf/10.1002/bco2.70114","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145619244","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}
Justin B. Ziemba, Amanda Jones, Hanna Stambakio, Gregory E. Tasian, Jing Huang
Objectives
To prospectively capture patient-reported outcomes in the post-operative period to better understand the quality-of-life impact of percutaneous nephrolithotomy (PNL).
Subjects and Methods
Adults undergoing PNL for renal/ureteral stones were eligible for inclusion (11/2020–8/2022). Patients prospectively completed PROMIS – Pain Intensity, Pain Interference and Ability to participate in social roles and activities in-person pre-operatively (POD 0) and via email on POD 1, 7, 14 and 30. Scores are reported as T-scores (normalized to US pop., mean = 50) with a change of 5 (0.5 SD) considered clinically significant.
Results
A total of 62 participants enrolled at POD 0 (POD 1 = 28, POD 7 = 29, POD 14 = 20, POD 30 = 23). There was a worsening of quality of life from POD 0 to POD 1 for pain intensity (median difference 7.9, p = 0.005) and pain interference (median difference 11.9, p = 0.0003), but not for the ability to participate in social roles (median difference −5.3, p = 0.07). This was also observed for POD 0 to POD 7, but only for the dimension of pain interference (median difference 7.2, p = 0.02). All three dimensions then improved until POD 30. In multivariable analysis, there were no variables associated with severe symptomatology for any of the three dimensions.
Conclusions
Pain intensity and interference sharply increase immediately post-operatively, reducing quality of life, although the ability to participate in social roles is not impacted. The absolute magnitude of this change is significant, with a final improvement at 30 days at or above baseline. Results offer meaningful insight to assist in setting expectations for patients post-operatively.
{"title":"Post-operative recovery of quality-of-life following percutaneous nephrolithotomy: The impact on pain intensity and interference and the ability to participate in social roles","authors":"Justin B. Ziemba, Amanda Jones, Hanna Stambakio, Gregory E. Tasian, Jing Huang","doi":"10.1002/bco2.70102","DOIUrl":"https://doi.org/10.1002/bco2.70102","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To prospectively capture patient-reported outcomes in the post-operative period to better understand the quality-of-life impact of percutaneous nephrolithotomy (PNL).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Subjects and Methods</h3>\u0000 \u0000 <p>Adults undergoing PNL for renal/ureteral stones were eligible for inclusion (11/2020–8/2022). Patients prospectively completed PROMIS – Pain Intensity, Pain Interference and Ability to participate in social roles and activities in-person pre-operatively (POD 0) and via email on POD 1, 7, 14 and 30. Scores are reported as T-scores (normalized to US pop., mean = 50) with a change of 5 (0.5 SD) considered clinically significant.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 62 participants enrolled at POD 0 (POD 1 = 28, POD 7 = 29, POD 14 = 20, POD 30 = 23). There was a worsening of quality of life from POD 0 to POD 1 for pain intensity (median difference 7.9, p = 0.005) and pain interference (median difference 11.9, p = 0.0003), but not for the ability to participate in social roles (median difference −5.3, p = 0.07). This was also observed for POD 0 to POD 7, but only for the dimension of pain interference (median difference 7.2, p = 0.02). All three dimensions then improved until POD 30. In multivariable analysis, there were no variables associated with severe symptomatology for any of the three dimensions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Pain intensity and interference sharply increase immediately post-operatively, reducing quality of life, although the ability to participate in social roles is not impacted. The absolute magnitude of this change is significant, with a final improvement at 30 days at or above baseline. Results offer meaningful insight to assist in setting expectations for patients post-operatively.</p>\u0000 </section>\u0000 </div>","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"6 12","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://bjui-journals.onlinelibrary.wiley.com/doi/epdf/10.1002/bco2.70102","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145619245","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}
Women with spina bifida often experience neurological impairments leading to pelvic organ dysfunction, including difficulties with bladder and bowel emptying that necessitate frequent Valsalva manoeuvres. These factors, combined with pelvic floor weakness, may increase the risk of pelvic organ prolapse (POP). This study aimed to assess the prevalence of POP in women with spina bifida, identify associated risk factors and evaluate outcomes of surgical management.
Methods
We retrospectively analysed a prospectively maintained database of women with spina bifida seen at a French referral centre from 2007 to 2024. Age under 18 and congenital perineal abnormality were exclusion criteria. The primary outcome was the presence of POP grade 2 or higher (Baden-Walker classification). Secondary outcomes included symptomatic POP requiring surgery, recurrence after surgery, use of vaginal pessaries and related symptoms.
Results
POP grade ≥2 was present in 14.8% of patients. Women with POP were older (median 44 vs. 31 years; p < 0.0001) and more frequently parous (58.5% vs. 18.3%; p < 0.0001), although 41.5% of POP cases occurred in nulliparous women. Apical prolapse was predominant (64.3%). Among 11 patients who underwent POP surgery, 54.5% experienced recurrence. Multivariate analysis identified parity (OR 5.33; p = 0.005) and lower maximum urethral closure pressure (OR 0.97; p = 0.02) as independent risk factors.
Conclusions
POP is highly prevalent in young adult women with spina bifida, including many nulliparous patients. The parity status and a low maximum urethral closure pressure could be associated with an increased risk of POP in this population. High recurrence after surgery highlights the need for information, routine screening and tailored management in this population.
{"title":"Pelvic organ prolapse is highly prevalent in women with spina bifida","authors":"Alexandre Dubois, Briac Malandain, Juliette Hascoet, Camille Haudebert, Charlène Brochard, Claire Richard, Caroline Voiry, Krystel Nyangoh Timoh, Andrea Manunta, Emmanuelle Samson, Benoit Peyronnet","doi":"10.1002/bco2.70113","DOIUrl":"10.1002/bco2.70113","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Women with spina bifida often experience neurological impairments leading to pelvic organ dysfunction, including difficulties with bladder and bowel emptying that necessitate frequent Valsalva manoeuvres. These factors, combined with pelvic floor weakness, may increase the risk of pelvic organ prolapse (POP). This study aimed to assess the prevalence of POP in women with spina bifida, identify associated risk factors and evaluate outcomes of surgical management.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We retrospectively analysed a prospectively maintained database of women with spina bifida seen at a French referral centre from 2007 to 2024. Age under 18 and congenital perineal abnormality were exclusion criteria. The primary outcome was the presence of POP grade 2 or higher (Baden-Walker classification). Secondary outcomes included symptomatic POP requiring surgery, recurrence after surgery, use of vaginal pessaries and related symptoms.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>POP grade ≥2 was present in 14.8% of patients. Women with POP were older (median 44 vs. 31 years; p < 0.0001) and more frequently parous (58.5% vs. 18.3%; p < 0.0001), although 41.5% of POP cases occurred in nulliparous women. Apical prolapse was predominant (64.3%). Among 11 patients who underwent POP surgery, 54.5% experienced recurrence. Multivariate analysis identified parity (OR 5.33; p = 0.005) and lower maximum urethral closure pressure (OR 0.97; p = 0.02) as independent risk factors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>POP is highly prevalent in young adult women with spina bifida, including many nulliparous patients. The parity status and a low maximum urethral closure pressure could be associated with an increased risk of POP in this population. High recurrence after surgery highlights the need for information, routine screening and tailored management in this population.</p>\u0000 </section>\u0000 </div>","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"6 11","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12641141/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145607422","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}
Neoadjuvant therapy with immune checkpoint inhibitors and tyrosine kinase inhibitors has been shown to reduce the tumour size and thrombus length in patients with renal cell carcinoma with venous tumour thrombus (RCC-VTT). This study aimed to evaluate the effectiveness and safety of neoadjuvant tislelizumab plus pazopanib in patients with RCC-VTT.
Patients and Methods
From November 2021 to January 2024, nine patients with RCC-VTT were included in this retrospective study. All patients received neoadjuvant tislelizumab (200 mg intravenously every 3 weeks) and pazopanib (800 mg orally once daily), followed by surgery. Key effectiveness outcomes included the objective response rate (ORR) of the primary tumour, the percentage change in VTT length and safety.
Results
Among the nine patients with RCC-VTT, the median age was 58 years (range, 39–78). Following neoadjuvant tislelizumab plus pazopanib, six patients achieved partial response in the primary tumour and three had stable disease, yielding an ORR of 66.7%. The VTT length decreased from 4.9 cm (range, 1.1–9.3 cm) to 3.8 cm (range, 0–8.1 cm), with a median reduction of 29.2% (range, −153.1% to 100.0%). Treatment-related adverse events (TRAEs) of any grade and grade 3 were reported in 88.9% and 55.6% of patients, respectively. The common TRAEs of any grade were vomiting (77.8%), fatigue (33.3%), pruritus (33.3%), weight loss (33.3%), poor appetite (33.3%), pruritus (33.3%) and hepatic impairment (33.3%). No grade 4–5 TRAEs or deaths were observed.
Conclusion
The neoadjuvant combination of tislelizumab and pazopanib effectively reduced tumour size and thrombus length, narrowing the surgical scope and potentially leading to better postoperative outcomes.
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