Baseline staging investigations for renal masses invariably include a CT of the chest. However, EAU guidelines have given a weak recommendation that CT chest can be omitted in incidental T1a tumours (≤4 cm) without systemic symptoms, due to the low incidence of pulmonary metastases. This study aimed to assess if a baseline staging CT chest has been clinically useful in a cohort with T1a renal tumours.
Methods
Consecutive patients with solid and cystic cT1a renal tumours were prospectively screened for eligibility to the NEST study (ISRCTN 18156881) at a single tertiary referral centre multidisciplinary team meeting (MDT). Four hundred consecutive eligible patients between 28/05/2019 and 13/01/2021 were included in this study. Electronic records were reviewed retrospectively for follow-up data. Seventeen patients with incomplete follow-up data were excluded.
Results
Of 383 included patients (63% male, median age 65 years, median tumour diameter 2.4 cm), 264 (69%) had a baseline CT chest as part of their clinical staging investigations. No thoracic renal metastases were diagnosed. Abnormalities were reported in 37/264 cases (14%), including indeterminate lung lesions in 32 patients that were deemed benign on further investigations, three synchronous primary lung tumours, one pre-existing mesothelioma and one pleural effusion related to known renal failure.
Conclusion
CT chest is of limited value in clinical staging investigations for cT1a renal tumours and has a negligible impact on subsequent renal tumour management. Rather, it triggered further investigations and follow-up for 14% of incidentalomas and ultimately detected concurrent incidental primary lung tumours in 1% of patients.
{"title":"Staging CT chest for cT1a renal masses: Does it change management?","authors":"Sanjana Ilangovan, Hannah Warren, Federica Sordelli, Thet Paing Oo, Pyae Phyo Tun, Prasad Patki, Faiz Mumtaz, Ravi Barod, Axel Bex, Maxine Tran","doi":"10.1002/bco2.70068","DOIUrl":"10.1002/bco2.70068","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Baseline staging investigations for renal masses invariably include a CT of the chest. However, EAU guidelines have given a weak recommendation that CT chest can be omitted in incidental T1a tumours (≤4 cm) without systemic symptoms, due to the low incidence of pulmonary metastases. This study aimed to assess if a baseline staging CT chest has been clinically useful in a cohort with T1a renal tumours.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Consecutive patients with solid and cystic cT1a renal tumours were prospectively screened for eligibility to the NEST study (ISRCTN 18156881) at a single tertiary referral centre multidisciplinary team meeting (MDT). Four hundred consecutive eligible patients between 28/05/2019 and 13/01/2021 were included in this study. Electronic records were reviewed retrospectively for follow-up data. Seventeen patients with incomplete follow-up data were excluded.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 383 included patients (63% male, median age 65 years, median tumour diameter 2.4 cm), 264 (69%) had a baseline CT chest as part of their clinical staging investigations. No thoracic renal metastases were diagnosed. Abnormalities were reported in 37/264 cases (14%), including indeterminate lung lesions in 32 patients that were deemed benign on further investigations, three synchronous primary lung tumours, one pre-existing mesothelioma and one pleural effusion related to known renal failure.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>CT chest is of limited value in clinical staging investigations for cT1a renal tumours and has a negligible impact on subsequent renal tumour management. Rather, it triggered further investigations and follow-up for 14% of incidentalomas and ultimately detected concurrent incidental primary lung tumours in 1% of patients.</p>\u0000 </section>\u0000 </div>","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"6 9","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://bjui-journals.onlinelibrary.wiley.com/doi/epdf/10.1002/bco2.70068","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145111353","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}
Juanita Velasquez Ospina, Ansh Bhatia, Archan Khandekar, Aravindh Rathinam, Glenn Austin, Jonathan Katz, Robert Marcovich, Hemendra N. Shah
Objectives
To evaluate demographic characteristics and the prevalence of metabolic abnormalities in patients with pure struvite stones compared to those with mixed struvite and calcium oxalate stones.
Methods
We retrospectively reviewed 3001 stone analyses performed at our institution between August 2019 and April 2024. Patients who had a 24-hour urinary stone risk profile within six months of stone analysis were included. Exclusion criteria were a history of nephrolithiasis, bladder stones, neurogenic bladder or surgery for encrusted stent removal. Demographics, comorbidities and laboratory values were extracted using a HIPAA-compliant pipeline enhanced with a large language model (LLM). Patients with pure struvite stones were compared to those with mixed calcium oxalate–struvite stones. Statistical analysis was performed using RStudio v4.1.3.
Results
Forty-one patients met the inclusion criteria: 21 with pure struvite stones and 20 with mixed stones. While pure struvite stones were more common in females, the difference was not statistically significant. Demographics and comorbidities were similar between groups. Patients with pure struvite stones showed lower urinary levels of oxalate, potassium, citrate and uric acid, though not statistically significant. However, supersaturation of brushite, calcium oxalate and sodium urate was significantly lower in the pure struvite group (P < 0.05). At least one metabolic abnormality was present in 90.5% of the pure struvite group and in all patients with mixed stones.
Conclusions
Metabolic abnormalities are highly prevalent in both pure and mixed struvite stone formers. These findings support routine metabolic evaluation in patients with infection-related stones to guide long-term management.
{"title":"Metabolic abnormalities in pure vs. mixed struvite stone formers: A retrospective comparative analysis utilising large language models for data extraction","authors":"Juanita Velasquez Ospina, Ansh Bhatia, Archan Khandekar, Aravindh Rathinam, Glenn Austin, Jonathan Katz, Robert Marcovich, Hemendra N. Shah","doi":"10.1002/bco2.70072","DOIUrl":"10.1002/bco2.70072","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To evaluate demographic characteristics and the prevalence of metabolic abnormalities in patients with pure struvite stones compared to those with mixed struvite and calcium oxalate stones.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We retrospectively reviewed 3001 stone analyses performed at our institution between August 2019 and April 2024. Patients who had a 24-hour urinary stone risk profile within six months of stone analysis were included. Exclusion criteria were a history of nephrolithiasis, bladder stones, neurogenic bladder or surgery for encrusted stent removal. Demographics, comorbidities and laboratory values were extracted using a HIPAA-compliant pipeline enhanced with a large language model (LLM). Patients with pure struvite stones were compared to those with mixed calcium oxalate–struvite stones. Statistical analysis was performed using RStudio v4.1.3.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Forty-one patients met the inclusion criteria: 21 with pure struvite stones and 20 with mixed stones. While pure struvite stones were more common in females, the difference was not statistically significant. Demographics and comorbidities were similar between groups. Patients with pure struvite stones showed lower urinary levels of oxalate, potassium, citrate and uric acid, though not statistically significant. However, supersaturation of brushite, calcium oxalate and sodium urate was significantly lower in the pure struvite group (P < 0.05). At least one metabolic abnormality was present in 90.5% of the pure struvite group and in all patients with mixed stones.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Metabolic abnormalities are highly prevalent in both pure and mixed struvite stone formers. These findings support routine metabolic evaluation in patients with infection-related stones to guide long-term management.</p>\u0000 </section>\u0000 </div>","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"6 9","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://bjui-journals.onlinelibrary.wiley.com/doi/epdf/10.1002/bco2.70072","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145111352","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}
Fredrik Liedberg, Oskar Hagberg, Christel Häggström, Firas Aljabery, Truls Gårdmark, Staffan Jahnson, Tomas Jerlström, Viveka Ströck, Karin Söderkvist, Anders Ullén, Lars Holmberg, Johannes Bobjer
Objectives
To investigate the association between waiting time and outcomes in patients with upper tract urothelial carcinomas (UTUC).
Patients and methods
We studied a population-based cohort of 858 patients in BladderBaSe 2.0 subjected to extirpative surgery for UTUC 2015–2019 in Sweden. Diagnostic waiting time (from referral to diagnosis, reference <1 week), treatment waiting time (from diagnosis to surgery, reference <5 weeks) and total waiting time (reference <10 weeks) were investigated in relation to disease-specific (DSS) and overall survival (OS) by multivariable Cox regression models. To further explore these associations, stage progression from preoperatively recorded clinical tumour stage to pathological tumour stage in the extirpated specimen was assessed by logistic regression.
Results
Total waiting time was not associated with DSS, OS or stage progression. A diagnostic waiting time between 1 and 4 weeks was associated with better DSS (HR 0.57 [95% CI 0.35–0.94]) and OS (HR 0.60 [95% CI 0.41–0.87]). In the strata of patients with UTUC in the renal pelvis, a diagnostic waiting time > 4 weeks was associated with stage progression (OR 2.44 [95% CI 1.00–5.95]), and in patients with UTUC in the ureter, a treatment waiting time between 5 and 10 weeks was associated to worse DSS (HR 2.85 (95% CI 1.03–7.89).
Conclusions
In general, shorter care pathways were linked to beneficial survival estimates, yet some estimates may be influenced by selection bias due to prioritizing short waiting times for patients with advanced and/or overt symptomatic tumours. Stage progression with increased waiting time may indicate an underlying causal mechanism.
目的探讨上尿路上皮癌（UTUC）患者等待时间与预后的关系。患者和方法我们研究了一项基于人群的队列研究，在2015-2019年瑞典UTUC期间，在BladderBaSe 2.0中接受切除手术的858例患者。通过多变量Cox回归模型研究诊断等待时间（从转诊到诊断，参考文献1周）、治疗等待时间（从诊断到手术，参考文献5周）和总等待时间（参考文献10周）与疾病特异性（DSS）和总生存期（OS）的关系。为了进一步探讨这些关联，通过逻辑回归评估切除标本从术前记录的临床肿瘤分期到病理肿瘤分期的分期进展。结果总等待时间与DSS、OS或分期进展无关。诊断等待时间在1至4周之间与更好的DSS （HR 0.57 [95% CI 0.35-0.94]）和OS （HR 0.60 [95% CI 0.41-0.87]）相关。在肾盂UTUC患者中，诊断等待时间为4周与分期进展相关（OR 2.44 [95% CI 1.00-5.95]），而在输尿管UTUC患者中，等待治疗时间为5 - 10周与更差的DSS相关(HR 2.85 （95% CI 1.03-7.89）。总的来说，较短的治疗路径与有益的生存估计有关，但由于优先考虑晚期和/或明显症状肿瘤患者的较短等待时间，一些估计可能受到选择偏倚的影响。等待时间增加的阶段进展可能表明潜在的因果机制。
{"title":"Waiting time in diagnosis and extirpative surgery and association with survival and stage progression in upper tract urothelial carcinomas","authors":"Fredrik Liedberg, Oskar Hagberg, Christel Häggström, Firas Aljabery, Truls Gårdmark, Staffan Jahnson, Tomas Jerlström, Viveka Ströck, Karin Söderkvist, Anders Ullén, Lars Holmberg, Johannes Bobjer","doi":"10.1002/bco2.70093","DOIUrl":"10.1002/bco2.70093","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To investigate the association between waiting time and outcomes in patients with upper tract urothelial carcinomas (UTUC).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Patients and methods</h3>\u0000 \u0000 <p>We studied a population-based cohort of 858 patients in BladderBaSe 2.0 subjected to extirpative surgery for UTUC 2015–2019 in Sweden. Diagnostic waiting time (from referral to diagnosis, reference <1 week), treatment waiting time (from diagnosis to surgery, reference <5 weeks) and total waiting time (reference <10 weeks) were investigated in relation to disease-specific (DSS) and overall survival (OS) by multivariable Cox regression models. To further explore these associations, stage progression from preoperatively recorded clinical tumour stage to pathological tumour stage in the extirpated specimen was assessed by logistic regression.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Total waiting time was not associated with DSS, OS or stage progression. A diagnostic waiting time between 1 and 4 weeks was associated with better DSS (HR 0.57 [95% CI 0.35–0.94]) and OS (HR 0.60 [95% CI 0.41–0.87]). In the strata of patients with UTUC in the renal pelvis, a diagnostic waiting time > 4 weeks was associated with stage progression (OR 2.44 [95% CI 1.00–5.95]), and in patients with UTUC in the ureter, a treatment waiting time between 5 and 10 weeks was associated to worse DSS (HR 2.85 (95% CI 1.03–7.89).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In general, shorter care pathways were linked to beneficial survival estimates, yet some estimates may be influenced by selection bias due to prioritizing short waiting times for patients with advanced and/or overt symptomatic tumours. Stage progression with increased waiting time may indicate an underlying causal mechanism.</p>\u0000 </section>\u0000 </div>","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"6 9","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://bjui-journals.onlinelibrary.wiley.com/doi/epdf/10.1002/bco2.70093","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145111324","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}
Muhammad Haider, Jeffrey J. Leow, Tobias Nordström, Ashkan Mortezavi, Peter Albers, Rakesh Heer, Prabhakar Rajan
Introduction
Prostate cancer (PCa) is the second most common cancer in men globally, with a rising incidence. Early detection through population-based screening by Prostate Specific Antigen (PSA) testing improves survival outcomes, at the expense of overdiagnosis and overtreatment of clinically insignificant disease. Here, we explore emerging tools for more effective PCa early detection and evaluate their potential roles for PCa screening.
Materials and Methods
Key articles on emerging adjuncts and alternatives to PSA for PCa early detection were identified.
Results
Multiparametric MRI (mpMRI) remains the gold standard modality for identifying clinically significant PCa and has been evaluated for screening. Newer imaging strategies incorporating biparametric MRI (bpMRI) or multiparametric ultrasound (mpUS) potentially offer similar accuracy to mpMRI. Saliva-derived polygenic risk scores (PRS) hold potential as a non-invasive screening tool to identify at-risk patient groups. Blood-based biomarker tests can improve risk stratification, reducing unnecessary biopsies while maintaining detection of clinically significant cancers compared to PSA alone. Urine-based biomarker tests have been examined for the early detection and risk stratification of clinically significant disease as adjuncts to PSA testing.
Conclusion
PSA is commonly used to detect early PCa, but its lack of specificity and associated overdiagnosis risk has led to controversy over its use for population-based screening. Imaging modalities such as mpMRI have reduced detection of clinically insignificant PCa, and emerging cost-effective alternatives, such as bpMRI and mpUS, show promise. Molecular biomarkers and PRS for risk stratification may help target imaging-based early detection more effectively to at-risk populations. Prospective randomised clinical trials are urgently needed to evaluate the performance of different modalities for population-wide screening. Future developments may involve technologies such as artificial intelligence and diagnostic tests that incorporate circulating tumour markers.
{"title":"Emerging tools for the early detection of prostate cancer","authors":"Muhammad Haider, Jeffrey J. Leow, Tobias Nordström, Ashkan Mortezavi, Peter Albers, Rakesh Heer, Prabhakar Rajan","doi":"10.1002/bco2.70081","DOIUrl":"10.1002/bco2.70081","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Prostate cancer (PCa) is the second most common cancer in men globally, with a rising incidence. Early detection through population-based screening by Prostate Specific Antigen (PSA) testing improves survival outcomes, at the expense of overdiagnosis and overtreatment of clinically insignificant disease. Here, we explore emerging tools for more effective PCa early detection and evaluate their potential roles for PCa screening.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Methods</h3>\u0000 \u0000 <p>Key articles on emerging adjuncts and alternatives to PSA for PCa early detection were identified.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Multiparametric MRI (mpMRI) remains the gold standard modality for identifying clinically significant PCa and has been evaluated for screening. Newer imaging strategies incorporating biparametric MRI (bpMRI) or multiparametric ultrasound (mpUS) potentially offer similar accuracy to mpMRI. Saliva-derived polygenic risk scores (PRS) hold potential as a non-invasive screening tool to identify at-risk patient groups. Blood-based biomarker tests can improve risk stratification, reducing unnecessary biopsies while maintaining detection of clinically significant cancers compared to PSA alone. Urine-based biomarker tests have been examined for the early detection and risk stratification of clinically significant disease as adjuncts to PSA testing.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>PSA is commonly used to detect early PCa, but its lack of specificity and associated overdiagnosis risk has led to controversy over its use for population-based screening. Imaging modalities such as mpMRI have reduced detection of clinically insignificant PCa, and emerging cost-effective alternatives, such as bpMRI and mpUS, show promise. Molecular biomarkers and PRS for risk stratification may help target imaging-based early detection more effectively to at-risk populations. Prospective randomised clinical trials are urgently needed to evaluate the performance of different modalities for population-wide screening. Future developments may involve technologies such as artificial intelligence and diagnostic tests that incorporate circulating tumour markers.</p>\u0000 </section>\u0000 </div>","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"6 9","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://bjui-journals.onlinelibrary.wiley.com/doi/epdf/10.1002/bco2.70081","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145101767","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}
Aidan Weitzner, Carlos Rivera Lopez, Joseph Cheaib, Michelle Higgins, Nirmish Singla
Objective
To characterize alcohol consumption and binge-drinking patterns among individuals with GU cancers (prostate, kidney, bladder and testicular) compared to a propensity-matched cohort without cancer in a large, nationally diverse population.
Materials and Methods
We conducted a retrospective, cross-sectional study utilizing data from the National Institutes of Health All of Us Research Program. Matching accounted for age, sex assigned at birth, smoking status, comorbidities and education/marital status. The primary outcome was self-reported drinking frequency. The secondary outcomes were self-reported binge-drinking frequency and Alcohol Use Disorders Identification Test (AUDIT-C) scores.
Results
Drinking and binge-drinking among individuals with GU malignancy (N = 11 522) closely resembled those of matched controls (N = 47 747), with the majority (53%) consuming at least 2–4 drinks per month. There was no significant association between GU cancer diagnosis and increased drinking frequency (OR: 0.99; p = 0.65), binge-drinking frequency (OR: 0.85; p: 0.055) or AUDIT-C (OR: 0.99; p =0.65). Individuals diagnosed with kidney cancer had reduced odds of higher alcohol use (OR: 0.76; p < 0.001) and AUDIT-C score (OR: 0.83; p < 0.001) compared to controls.
Conclusion
In this large cohort, including traditionally underrepresented minorities, alcohol use was highly prevalent among those with GU malignancies. Drinking behaviours were similar to individuals without cancer, underscoring the need for integration of lifestyle-focused interventions into survivorship care, as alcohol remains a common and modifiable behaviour with wide-ranging health implications.
目的：在全国范围内不同人群中，将GU癌（前列腺癌、肾癌、膀胱癌和睾丸癌）患者的饮酒和狂饮模式与倾向匹配的无癌人群进行比较。材料和方法我们进行了一项回顾性的横断面研究，利用了美国国立卫生研究院“我们所有人”研究项目的数据。匹配考虑了年龄、出生性别、吸烟状况、合并症和教育/婚姻状况。主要结果是自我报告的饮酒频率。次要结果是自我报告的酗酒频率和酒精使用障碍识别测试（AUDIT-C）得分。结果GU恶性肿瘤患者（N = 11 522）饮酒和酗酒与匹配对照组（N = 47 747）非常相似，其中大多数（53%）每月至少饮酒2-4次。GU癌诊断与饮酒频率增加（OR: 0.99; p =0.65）、酗酒频率增加（OR: 0.85; p: 0.055）或AUDIT-C （OR: 0.99; p =0.65）之间无显著相关性。与对照组相比，被诊断为肾癌的个体酒精使用较高的几率（OR: 0.76; p < 0.001）和AUDIT-C评分（OR: 0.83; p < 0.001）降低。结论：在这个庞大的队列中，包括传统上代表性不足的少数民族，酒精使用在GU恶性肿瘤患者中非常普遍。饮酒行为与未患癌症的个体相似，这强调了将以生活方式为重点的干预措施纳入幸存者护理的必要性，因为饮酒仍然是一种常见且可改变的行为，具有广泛的健康影响。
{"title":"Alcohol consumption among patients diagnosed with genitourinary cancers","authors":"Aidan Weitzner, Carlos Rivera Lopez, Joseph Cheaib, Michelle Higgins, Nirmish Singla","doi":"10.1002/bco2.70086","DOIUrl":"10.1002/bco2.70086","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To characterize alcohol consumption and binge-drinking patterns among individuals with GU cancers (prostate, kidney, bladder and testicular) compared to a propensity-matched cohort without cancer in a large, nationally diverse population.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Methods</h3>\u0000 \u0000 <p>We conducted a retrospective, cross-sectional study utilizing data from the National Institutes of Health <i>All of Us</i> Research Program. Matching accounted for age, sex assigned at birth, smoking status, comorbidities and education/marital status. The primary outcome was self-reported drinking frequency. The secondary outcomes were self-reported binge-drinking frequency and Alcohol Use Disorders Identification Test (AUDIT-C) scores.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Drinking and binge-drinking among individuals with GU malignancy (N = 11 522) closely resembled those of matched controls (N = 47 747), with the majority (53%) consuming at least 2–4 drinks per month. There was no significant association between GU cancer diagnosis and increased drinking frequency (OR: 0.99; p = 0.65), binge-drinking frequency (OR: 0.85; p: 0.055) or AUDIT-C (OR: 0.99; p =0.65). Individuals diagnosed with kidney cancer had reduced odds of higher alcohol use (OR: 0.76; p < 0.001) and AUDIT-C score (OR: 0.83; p < 0.001) compared to controls.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>In this large cohort, including traditionally underrepresented minorities, alcohol use was highly prevalent among those with GU malignancies. Drinking behaviours were similar to individuals without cancer, underscoring the need for integration of lifestyle-focused interventions into survivorship care, as alcohol remains a common and modifiable behaviour with wide-ranging health implications.</p>\u0000 </section>\u0000 </div>","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"6 9","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://bjui-journals.onlinelibrary.wiley.com/doi/epdf/10.1002/bco2.70086","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145101766","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Angelo Porreca, Filippo Marino, Davide De Marchi, Marco Giampaoli, Francesca Simonetti, Antonio Amodeo, Paolo Corsi, Francesco Claps, Alessandro Crestani, Gian Maria Busetto, Daniele D'Agostino, Daniele Romagnoli, Luca Di Gianfrancesco
<div> <section> <h3> Objective</h3> <p>To assess the frequency and severity of bleeding complications during and after Holmium Laser Enucleation of the Prostate (HoLEP) in patients with prostate cancer, and compare outcomes to a control group of patients without prostate cancer but with similar baseline characteristics.</p> </section> <section> <h3> Methods</h3> <p>This multicentre retrospective study included 175 consecutive patients undergoing HoLEP across 3 referral centres with a diagnosis of prostate cancer—128 with known cancer prior to surgery and 47 with incidental findings on postoperative histology. These patients were compared to 500 consecutive control patients without prostate cancer but matched for prostate volume, age, presence of indwelling catheter, comorbidities and anticoagulant/antiplatelet therapy status. Bleeding-related events analysed included intraoperative estimated blood loss, need for transfusion, clot retention, postoperative irrigation, reoperation for haemorrhage and hospital readmission within 30 days.</p> </section> <section> <h3> Results</h3> <p>The PCa group experienced significantly higher rates of intraoperative bleeding requiring intensified coagulation (18.3% vs 8.6%, <i>p</i> < 0.01), transfusion (6.3% vs 2.0%, <i>p</i> = 0.02) and clot retention (4.0% vs 1.4%, <i>p</i> = 0.04) compared to controls. Among patients with known PCa, 25.0% experienced bleeding-related complications, while the rate was 14.9% among those with incidental PCa. Patients with a known diagnosis showed higher bleeding risk than incidental cases. In multivariate analysis, both prostate cancer and anticoagulant therapy were independently associated with increased risk of bleeding complications. Antithrombotic/antiplatelet therapy significantly raised the likelihood of bleeding events (adjusted OR 2.8, 95% CI 1.6–4.7; p < 0.001), as did the presence of prostate cancer (adjusted OR 2.1, 95% CI 1.3–3.6; p = 0.004). Patients with both risk factors experienced the highest rate of bleeding (29.4%), compared to 8.1% in those without either factor (p < 0.001), indicating a synergistic effect. No significant differences were found in catheter removal time or hospital stay.</p> </section> <section> <h3> Conclusions</h3> <p>Prostate cancer—particularly when known preoperatively—is associated with a significantly increased risk of bleeding during and after HoLEP, even when controlling for baseline characteristics. Surgeons should anticipate increased vascularity and plan perioperative management accordingly to mitigate haemorrhagic complicati
目的：评估前列腺癌患者钬激光前列腺摘除术（HoLEP）期间和之后出血并发症的频率和严重程度，并将结果与基线特征相似的非前列腺癌患者的对照组进行比较。方法：这项多中心回顾性研究包括175例连续接受HoLEP的患者，来自3个转诊中心，诊断为前列腺癌，128例术前已知癌症，47例术后组织学偶然发现。这些患者与500名没有前列腺癌但在前列腺体积、年龄、留置导管存在、合并症和抗凝/抗血小板治疗状态等方面匹配的连续对照患者进行比较。分析的出血相关事件包括术中估计失血量、输血需求、血块保留、术后冲洗、出血再手术和30天内再次住院。结果：与对照组相比，PCa组术中出血需要强化凝血的比例（18.3% vs 8.6%, p p = 0.02）和血栓保留（4.0% vs 1.4%, p = 0.04）明显更高。在已知PCa患者中，25.0%出现出血相关并发症，而在偶发PCa患者中，这一比例为14.9%。已知诊断的患者出血风险高于偶发病例。在多变量分析中，前列腺癌和抗凝治疗均与出血并发症风险增加独立相关。抗血栓/抗血小板治疗显著提高出血事件的可能性（调整OR为2.8,95% CI为1.6-4.7;p）结论：前列腺癌（尤其是术前已知的前列腺癌）与HoLEP期间和之后出血风险显著增加相关，即使在控制基线特征的情况下也是如此。外科医生应预测血管的增加，并制定相应的围手术期管理计划，以减轻出血性并发症。
{"title":"Increased risk of bleeding during and after HoLEP in patients with prostate cancer: A multicentre comparative cohort study","authors":"Angelo Porreca, Filippo Marino, Davide De Marchi, Marco Giampaoli, Francesca Simonetti, Antonio Amodeo, Paolo Corsi, Francesco Claps, Alessandro Crestani, Gian Maria Busetto, Daniele D'Agostino, Daniele Romagnoli, Luca Di Gianfrancesco","doi":"10.1002/bco2.70060","DOIUrl":"10.1002/bco2.70060","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To assess the frequency and severity of bleeding complications during and after Holmium Laser Enucleation of the Prostate (HoLEP) in patients with prostate cancer, and compare outcomes to a control group of patients without prostate cancer but with similar baseline characteristics.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This multicentre retrospective study included 175 consecutive patients undergoing HoLEP across 3 referral centres with a diagnosis of prostate cancer—128 with known cancer prior to surgery and 47 with incidental findings on postoperative histology. These patients were compared to 500 consecutive control patients without prostate cancer but matched for prostate volume, age, presence of indwelling catheter, comorbidities and anticoagulant/antiplatelet therapy status. Bleeding-related events analysed included intraoperative estimated blood loss, need for transfusion, clot retention, postoperative irrigation, reoperation for haemorrhage and hospital readmission within 30 days.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The PCa group experienced significantly higher rates of intraoperative bleeding requiring intensified coagulation (18.3% vs 8.6%, <i>p</i> < 0.01), transfusion (6.3% vs 2.0%, <i>p</i> = 0.02) and clot retention (4.0% vs 1.4%, <i>p</i> = 0.04) compared to controls. Among patients with known PCa, 25.0% experienced bleeding-related complications, while the rate was 14.9% among those with incidental PCa. Patients with a known diagnosis showed higher bleeding risk than incidental cases. In multivariate analysis, both prostate cancer and anticoagulant therapy were independently associated with increased risk of bleeding complications. Antithrombotic/antiplatelet therapy significantly raised the likelihood of bleeding events (adjusted OR 2.8, 95% CI 1.6–4.7; p < 0.001), as did the presence of prostate cancer (adjusted OR 2.1, 95% CI 1.3–3.6; p = 0.004). Patients with both risk factors experienced the highest rate of bleeding (29.4%), compared to 8.1% in those without either factor (p < 0.001), indicating a synergistic effect. No significant differences were found in catheter removal time or hospital stay.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Prostate cancer—particularly when known preoperatively—is associated with a significantly increased risk of bleeding during and after HoLEP, even when controlling for baseline characteristics. Surgeons should anticipate increased vascularity and plan perioperative management accordingly to mitigate haemorrhagic complicati","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"6 9","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12441201/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145088381","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}
Alison Hiong, James Lynam, Andrew Weickhardt, Shirley Wong, Shomik Sengupta, Paul Manohar, Lih-Ming Wong, Philip Dundee, Nathan Lawrentschuk, Alison Y. Zhang, Angelyn Anton, Ajay Raghunath, Peter Gibbs, Ben Tran
Objectives
To explore Australian data on perioperative chemotherapy use and associated outcomes in muscle-invasive bladder cancer (MIBC).
Subjects and Methods
An observational study of patients with MIBC treated with neoadjuvant chemotherapy, adjuvant chemotherapy or surgery alone was conducted using data from BLADDA, a multicentre Australian urothelial cancer registry. Pathological response to neoadjuvant chemotherapy and its effect on event-free survival (EFS) and overall survival (OS) were determined. EFS and OS in patients who underwent neoadjuvant chemotherapy, adjuvant chemotherapy or surgery alone were compared using univariate and multivariable proportional hazards regression.
Results
From 2018 to 2024, 259 patients enrolled in the BLADDA registry met inclusion criteria, of which 45% received neoadjuvant chemotherapy, 23% received adjuvant chemotherapy, 1.2% received both neoadjuvant and adjuvant chemotherapy and 31% underwent surgery only. The proportion of patients treated with neoadjuvant chemotherapy increased over time. A total of 21 of 67 (31%) evaluable subjects achieved a pathological complete response, which was associated with improved EFS and OS. Excluding patients who received both neoadjuvant and adjuvant chemotherapy, the EFS hazard ratio (HR) was 0.43 (95% confidence interval [CI] 0.29–0.65, p < 0.001) for neoadjuvant chemotherapy and 0.59 (95% CI 0.38–0.94, p = 0.03) for adjuvant chemotherapy compared to surgery alone. Neoadjuvant chemotherapy was associated with prolonged OS in the univariate analysis (HR 0.43, 95% CI 0.26–0.73, p = 0.002) but not in the multivariable analysis (HR 0.59, 95% CI 0.32–1.08, p = 0.09). OS was not improved with adjuvant chemotherapy (unadjusted HR 0.76, 95% CI 0.44–1.31, p = 0.3; adjusted HR 0.86, 95% CI 0.46–1.60, p = 0.6).
Conclusion
Neoadjuvant chemotherapy use for MIBC in Australia has increased over the past decade, but it remains underutilised. This has important implications as perioperative chemo-immunotherapy emerges as a standard of care. Although a clear impact on survival in the overall population was not observed, this was potentially due to the limited sample size.
{"title":"Perioperative chemotherapy use and related outcomes in muscle-invasive bladder cancer in Australia","authors":"Alison Hiong, James Lynam, Andrew Weickhardt, Shirley Wong, Shomik Sengupta, Paul Manohar, Lih-Ming Wong, Philip Dundee, Nathan Lawrentschuk, Alison Y. Zhang, Angelyn Anton, Ajay Raghunath, Peter Gibbs, Ben Tran","doi":"10.1002/bco2.70083","DOIUrl":"10.1002/bco2.70083","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To explore Australian data on perioperative chemotherapy use and associated outcomes in muscle-invasive bladder cancer (MIBC).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Subjects and Methods</h3>\u0000 \u0000 <p>An observational study of patients with MIBC treated with neoadjuvant chemotherapy, adjuvant chemotherapy or surgery alone was conducted using data from BLADDA, a multicentre Australian urothelial cancer registry. Pathological response to neoadjuvant chemotherapy and its effect on event-free survival (EFS) and overall survival (OS) were determined. EFS and OS in patients who underwent neoadjuvant chemotherapy, adjuvant chemotherapy or surgery alone were compared using univariate and multivariable proportional hazards regression.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>From 2018 to 2024, 259 patients enrolled in the BLADDA registry met inclusion criteria, of which 45% received neoadjuvant chemotherapy, 23% received adjuvant chemotherapy, 1.2% received both neoadjuvant and adjuvant chemotherapy and 31% underwent surgery only. The proportion of patients treated with neoadjuvant chemotherapy increased over time. A total of 21 of 67 (31%) evaluable subjects achieved a pathological complete response, which was associated with improved EFS and OS. Excluding patients who received both neoadjuvant and adjuvant chemotherapy, the EFS hazard ratio (HR) was 0.43 (95% confidence interval [CI] 0.29–0.65, p < 0.001) for neoadjuvant chemotherapy and 0.59 (95% CI 0.38–0.94, p = 0.03) for adjuvant chemotherapy compared to surgery alone. Neoadjuvant chemotherapy was associated with prolonged OS in the univariate analysis (HR 0.43, 95% CI 0.26–0.73, p = 0.002) but not in the multivariable analysis (HR 0.59, 95% CI 0.32–1.08, p = 0.09). OS was not improved with adjuvant chemotherapy (unadjusted HR 0.76, 95% CI 0.44–1.31, p = 0.3; adjusted HR 0.86, 95% CI 0.46–1.60, p = 0.6).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Neoadjuvant chemotherapy use for MIBC in Australia has increased over the past decade, but it remains underutilised. This has important implications as perioperative chemo-immunotherapy emerges as a standard of care. Although a clear impact on survival in the overall population was not observed, this was potentially due to the limited sample size.</p>\u0000 </section>\u0000 </div>","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"6 9","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12436026/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145076638","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 clinical significance of a second transurethral resection of the bladder tumour (TURBT) in patients with a primary high-grade (HG) Ta non-muscle invasive bladder cancer (NMIBC), specifically selected for the initial diagnosis.
Patients and Methods
We retrospectively analysed 121 patients with primary HG Ta urothelial carcinoma treated at our institution between January 2007 and October 2024. All patients underwent an initial TURBT with the detrusor muscle present in the specimen. Patients were divided into the second TUR group (n = 48) and the non-second TUR group (n = 73). Propensity score matching was performed using age, number of tumours and Bacillus Calmette–Guerin treatment status. Outcomes included the residual tumour rate, recurrence-free survival (RFS), time to progression to muscle invasive bladder cancer (MIBC) and cancer-specific survival (CSS).
Results
Residual tumour at the initial resection site was identified in four patients (8.3%) who underwent a second TUR, with two patients (4.2%) being upstaged to T1. The median follow-up was 53 months. There were no significant differences between the two groups in RFS (p = 0.60), time to progression to MIBC (p = 0.63) or CSS (p = 0.18). These findings remained consistent in the matched cohort. Multivariate analysis revealed that a second TUR was not associated with improved RFS.
Conclusions
This is the first study to specifically address primary HG Ta bladder cancer, and it suggests that a second TUR may be omitted in selected cases, particularly when the initial resection is complete and the detrusor muscle is adequately sampled. A risk-adapted approach may help reduce unnecessary procedures without compromising oncological safety.
{"title":"Is a second TUR necessary in patients with primary high-grade Ta NMIBC, particularly in the context of initial cases?","authors":"Satoki Abe, Hiroyuki Fujinami, Naoyuki Yamanaka, Shinro Hata, Toru Inoue, Tadasuke Ando, Toshitaka Shin","doi":"10.1002/bco2.70082","DOIUrl":"10.1002/bco2.70082","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To evaluate the clinical significance of a second transurethral resection of the bladder tumour (TURBT) in patients with a primary high-grade (HG) Ta non-muscle invasive bladder cancer (NMIBC), specifically selected for the initial diagnosis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Patients and Methods</h3>\u0000 \u0000 <p>We retrospectively analysed 121 patients with primary HG Ta urothelial carcinoma treated at our institution between January 2007 and October 2024. All patients underwent an initial TURBT with the detrusor muscle present in the specimen. Patients were divided into the second TUR group (n = 48) and the non-second TUR group (n = 73). Propensity score matching was performed using age, number of tumours and Bacillus Calmette–Guerin treatment status. Outcomes included the residual tumour rate, recurrence-free survival (RFS), time to progression to muscle invasive bladder cancer (MIBC) and cancer-specific survival (CSS).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Residual tumour at the initial resection site was identified in four patients (8.3%) who underwent a second TUR, with two patients (4.2%) being upstaged to T1. The median follow-up was 53 months. There were no significant differences between the two groups in RFS (p = 0.60), time to progression to MIBC (p = 0.63) or CSS (p = 0.18). These findings remained consistent in the matched cohort. Multivariate analysis revealed that a second TUR was not associated with improved RFS.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This is the first study to specifically address primary HG Ta bladder cancer, and it suggests that a second TUR may be omitted in selected cases, particularly when the initial resection is complete and the detrusor muscle is adequately sampled. A risk-adapted approach may help reduce unnecessary procedures without compromising oncological safety.</p>\u0000 </section>\u0000 </div>","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"6 9","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://bjui-journals.onlinelibrary.wiley.com/doi/epdf/10.1002/bco2.70082","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145057931","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p>In this article, we present a practical technical tip for fenestrating the epididymal tubule during vasoepididymostomy (V-E)—a step that, to date, has rarely been described visually. Using simple illustrations, we aim to provide a clear visual guide for this crucial part of the procedure. V-E, a type of seminal-tract re-anastomosis for obstructive azoospermia, is regarded as one of the most technically demanding forms of male infertility microsurgery.<span><sup>1</sup></span> The “intussusception method” (also known as the “invagination method”), in which the fenestrated epididymal tubule is pulled into the lumen of the vas deferens for an end-to-side anastomosis, is a widely adopted approach. Notably, “longitudinal intussusception vasoepididymostomy (LIVE)”—which involves placing two double-armed needles longitudinally in the outer wall of the epididymal tubule, then incising the space between them—has been reported to be both simpler and more effective than other V-E techniques. We also actively employ the LIVE method in our practice. Chan, one of the developers of LIVE, described using a 15° ophthalmic knife to make a longitudinal incision in the outer wall of the epididymal tubule during fenestration.<span><sup>1</sup></span> However, we found it challenging to achieve a clean fenestration in a single pass, as the force applied by the microblade tip does not efficiently transmit to the soft outer wall. We suspect that, since Chan's original report, many surgeons have independently adopted minor modifications to overcome this challenge, but to our knowledge, such techniques have not been formally documented—likely due to their seemingly trivial nature.</p><p>After fenestration, the fluid leaking from the site is placed on a slide and examined immediately to confirm the presence of sufficient sperm. If no sperm are detected, a new fenestration is made slightly closer to the caput (the testicular end) of the epididymis, and the process is repeated. Fenestration sites not used for anastomosis are closed using absorbable suture and the tunica of the epididymis. Once a successful fenestration is achieved, we proceed with the standard LIVE technique: using the initially placed needles, we suture the mucosa of the vas deferens from inside to outside at four points, tying each suture to pull the epididymal tubule into the lumen of the vas deferens. Finally, we complete the anastomosis by suturing the tunica of the epididymis to the outer layer of the vas deferens with 9–0 nylon. A brief narrated video demonstrating Steps 1 and 2 and their integration into the standard LIVE workflow accompanies this article (Video 1).</p><p>Since 2015, our team has adopted this approach across multiple institutions, but some limitations of this visual technical tip should be noted. First, we did not directly compare clinical outcomes of this modification to those achieved with Chan's original LIVE method. Second, we have not quantitatively evaluated the extent to wh
{"title":"Step-by-step: A traction-based fenestration method for vasoepididymostomy","authors":"Kosuke Kojo, Masahiro Uchida, Kazumitsu Yamasaki, Jaejeong Kim, Ayumi Nakazono, Daisuke Numahata, Takazo Tanaka, Hiroyuki Nishiyama, Tatsuya Takayama, Teruaki Iwamoto","doi":"10.1002/bco2.70088","DOIUrl":"10.1002/bco2.70088","url":null,"abstract":"<p>In this article, we present a practical technical tip for fenestrating the epididymal tubule during vasoepididymostomy (V-E)—a step that, to date, has rarely been described visually. Using simple illustrations, we aim to provide a clear visual guide for this crucial part of the procedure. V-E, a type of seminal-tract re-anastomosis for obstructive azoospermia, is regarded as one of the most technically demanding forms of male infertility microsurgery.<span><sup>1</sup></span> The “intussusception method” (also known as the “invagination method”), in which the fenestrated epididymal tubule is pulled into the lumen of the vas deferens for an end-to-side anastomosis, is a widely adopted approach. Notably, “longitudinal intussusception vasoepididymostomy (LIVE)”—which involves placing two double-armed needles longitudinally in the outer wall of the epididymal tubule, then incising the space between them—has been reported to be both simpler and more effective than other V-E techniques. We also actively employ the LIVE method in our practice. Chan, one of the developers of LIVE, described using a 15° ophthalmic knife to make a longitudinal incision in the outer wall of the epididymal tubule during fenestration.<span><sup>1</sup></span> However, we found it challenging to achieve a clean fenestration in a single pass, as the force applied by the microblade tip does not efficiently transmit to the soft outer wall. We suspect that, since Chan's original report, many surgeons have independently adopted minor modifications to overcome this challenge, but to our knowledge, such techniques have not been formally documented—likely due to their seemingly trivial nature.</p><p>After fenestration, the fluid leaking from the site is placed on a slide and examined immediately to confirm the presence of sufficient sperm. If no sperm are detected, a new fenestration is made slightly closer to the caput (the testicular end) of the epididymis, and the process is repeated. Fenestration sites not used for anastomosis are closed using absorbable suture and the tunica of the epididymis. Once a successful fenestration is achieved, we proceed with the standard LIVE technique: using the initially placed needles, we suture the mucosa of the vas deferens from inside to outside at four points, tying each suture to pull the epididymal tubule into the lumen of the vas deferens. Finally, we complete the anastomosis by suturing the tunica of the epididymis to the outer layer of the vas deferens with 9–0 nylon. A brief narrated video demonstrating Steps 1 and 2 and their integration into the standard LIVE workflow accompanies this article (Video 1).</p><p>Since 2015, our team has adopted this approach across multiple institutions, but some limitations of this visual technical tip should be noted. First, we did not directly compare clinical outcomes of this modification to those achieved with Chan's original LIVE method. Second, we have not quantitatively evaluated the extent to wh","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"6 9","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://bjui-journals.onlinelibrary.wiley.com/doi/epdf/10.1002/bco2.70088","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145062641","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
James P. Daniels, Alexander Hernández-Tirado, James Mirocha, Renning Zheng, Jordan Palmer, Daniel Moreira, Stephen J. Freedland
Objectives
Most, but not all studies, suggest insulin resistance is associated with benign prostatic hyperplasia, but its impact on prostate volume (PV) changes over time remains unclear. We examined whether higher insulin resistance, measured by Homeostatic Model Assessment of Insulin Resistance (HOMA-IR), is associated with larger PV and greater prostate growth over a 4-year period.
Materials and Methods
We analysed data from the 4-year, randomized, double-blind, placebo-controlled REDUCE trial testing whether dutasteride could prevent prostate cancer. Patients underwent transrectal ultrasound measuring PV at baseline, year 2 and year 4. We calculated HOMA-IR from baseline fasting glucose and insulin, then stratified patients into quartiles within each arm (placebo vs. dutasteride). Using multivariable models, we estimated PV changes over time. We conducted a sensitivity analysis excluding patients with diabetes.
Results
Higher HOMA-IR quartiles were associated with larger PV at baseline, year 2 and year 4 in both placebo and dutasteride arms (all p < 0.001), though absolute differences were modest. PV increased in the placebo arm over 4 years, whereas it decreased in the dutasteride arm. However, there was no significant association between HOMA-IR and PV change in either arm. Results remained unchanged after excluding patients with diabetes.
Conclusion
Patients with higher HOMA-IR had modestly larger PVs at baseline, year 2 and year 4, but insulin resistance was unrelated to PV change over four years. These findings suggest that insulin resistance may be a modifiable risk factor contributing to benign prostatic enlargement, though further research is needed to determine its clinical relevance.
{"title":"Association between insulin resistance and prostate volume: A 4-year analysis from the Reduction by Dutasteride of Prostate Cancer (REDUCE) Trial","authors":"James P. Daniels, Alexander Hernández-Tirado, James Mirocha, Renning Zheng, Jordan Palmer, Daniel Moreira, Stephen J. Freedland","doi":"10.1002/bco2.70085","DOIUrl":"10.1002/bco2.70085","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Most, but not all studies, suggest insulin resistance is associated with benign prostatic hyperplasia, but its impact on prostate volume (PV) changes over time remains unclear. We examined whether higher insulin resistance, measured by Homeostatic Model Assessment of Insulin Resistance (HOMA-IR), is associated with larger PV and greater prostate growth over a 4-year period.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Methods</h3>\u0000 \u0000 <p>We analysed data from the 4-year, randomized, double-blind, placebo-controlled REDUCE trial testing whether dutasteride could prevent prostate cancer. Patients underwent transrectal ultrasound measuring PV at baseline, year 2 and year 4. We calculated HOMA-IR from baseline fasting glucose and insulin, then stratified patients into quartiles within each arm (placebo vs. dutasteride). Using multivariable models, we estimated PV changes over time. We conducted a sensitivity analysis excluding patients with diabetes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Higher HOMA-IR quartiles were associated with larger PV at baseline, year 2 and year 4 in both placebo and dutasteride arms (all p < 0.001), though absolute differences were modest. PV increased in the placebo arm over 4 years, whereas it decreased in the dutasteride arm. However, there was no significant association between HOMA-IR and PV change in either arm. Results remained unchanged after excluding patients with diabetes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Patients with higher HOMA-IR had modestly larger PVs at baseline, year 2 and year 4, but insulin resistance was unrelated to PV change over four years. These findings suggest that insulin resistance may be a modifiable risk factor contributing to benign prostatic enlargement, though further research is needed to determine its clinical relevance.</p>\u0000 </section>\u0000 </div>","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"6 9","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://bjui-journals.onlinelibrary.wiley.com/doi/epdf/10.1002/bco2.70085","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145057930","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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