Benjamin Parkin, Gavin Lamb, Nikolas Arestis, Anna Brown, Zack Slevin, Jane Hendry, Steve Leung, Julian Y. Keanie, James Blackmur, Sara Ramsey, Ross N. Clark, Abdel Hamed
Introduction
Aim to design and test a suitable risk-targeted imaging protocol for follow-up of complex renal cysts categorised IIF.
Patients and Methods
The Scottish Protocol was designed at a joint meeting with the Scottish Urological and Scottish Radiological societies according to published data on imaging modality, classification criteria and interval progression of Bosniak IIF renal cysts. Patients were listed prospectively to follow this protocol across five NHS health boards within Scotland. Patient data accessed between Aug 21 and Feb 22. All patients with a confirmed Bosniak IIF cyst on computerised tomography or magnetic resonance imaging after multi-disciplinary team review were included. Patients were reviewed according to progression, interval, treatment and histology.
Results
A total of 160 patients were identified with Bosniak IIF cysts. 98 (61%) were male (age range 29–97, median 67, IQR 57–75). Thirty-four patients completed the proposed 4-year follow-up. Seventeen patients advanced to treatment, with 15 patients having confirmed malignancy (9.4% of the total database). The mean time from diagnosis to intervention was 1 year and 2 months (range 34 to 1172 days). No patients developed metastatic disease during follow-up.
Conclusions
The Scottish Complex Renal Cyst Protocol provides a risk-targeted imaging framework that reliably identifies patients with progressive lesions prior to the development of advanced disease. Incidence of progression is consistent with published data of 9.4% most commonly within 2 years, and not beyond 4 years of surveillance.
{"title":"Scottish National Complex Renal Cyst Surveillance Protocol","authors":"Benjamin Parkin, Gavin Lamb, Nikolas Arestis, Anna Brown, Zack Slevin, Jane Hendry, Steve Leung, Julian Y. Keanie, James Blackmur, Sara Ramsey, Ross N. Clark, Abdel Hamed","doi":"10.1002/bco2.70094","DOIUrl":"10.1002/bco2.70094","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Aim to design and test a suitable risk-targeted imaging protocol for follow-up of complex renal cysts categorised IIF.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Patients and Methods</h3>\u0000 \u0000 <p>The Scottish Protocol was designed at a joint meeting with the Scottish Urological and Scottish Radiological societies according to published data on imaging modality, classification criteria and interval progression of Bosniak IIF renal cysts. Patients were listed prospectively to follow this protocol across five NHS health boards within Scotland. Patient data accessed between Aug 21 and Feb 22. All patients with a confirmed Bosniak IIF cyst on computerised tomography or magnetic resonance imaging after multi-disciplinary team review were included. Patients were reviewed according to progression, interval, treatment and histology.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 160 patients were identified with Bosniak IIF cysts. 98 (61%) were male (age range 29–97, median 67, IQR 57–75). Thirty-four patients completed the proposed 4-year follow-up. Seventeen patients advanced to treatment, with 15 patients having confirmed malignancy (9.4% of the total database). The mean time from diagnosis to intervention was 1 year and 2 months (range 34 to 1172 days). No patients developed metastatic disease during follow-up.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The Scottish Complex Renal Cyst Protocol provides a risk-targeted imaging framework that reliably identifies patients with progressive lesions prior to the development of advanced disease. Incidence of progression is consistent with published data of 9.4% most commonly within 2 years, and not beyond 4 years of surveillance.</p>\u0000 </section>\u0000 </div>","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"6 10","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12504850/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145260079","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The number of ureterorenoscopies in Germany is rising. Hospitals must operate economically while ensuring quality. Environmental assessment of medical procedures is gaining focus. This study aims to perform a comparative analysis of the economic and ecological aspects of single-use versus reusable ureterorenoscopes using real-world routine data, acknowledging their trade-offs between hygienic advantages, costs and environmental impacts.
Materials and Methods
A total of 210 ureterorenoscopy cases (2022/2023) at the University Hospital of Würzburg were evaluated. A simulation assessed the impact of the OPS code 5-98b.0 on DRG (diagnosis-related groups) classification and reimbursement. Economic analysis included acquisition, repair and sterilization costs, while ecological assessment considered manufacturing, waste, reprocessing, transport and repair.
Results
In 44.3% of cases, use of OPS code 5-98b.0 resulted in an upgraded DRG (L20B instead of L20C), yielding approximately €62 000 in additional revenue over 2 years. This was outweighed by roughly €147 000 in extra costs for single-use devices, assuming repair costs for reusable devices remained around €300 per case. Environmentally, single-use devices generated 42 kg more CO2 per 100 procedures.
Conclusion
Single-use ureterorenoscopes are economically justifiable only when reusable devices incur frequent repair costs. Reusable scopes perform better ecologically due to lower CO2 emissions. Instrument choice should be guided by each clinic's specific economic and environmental context.
{"title":"Green endoscopy: Economic and ecological evaluation of single-use versus reusable ureterorenoscopes","authors":"Marcel Schwinger, Charis Kalogirou","doi":"10.1002/bco2.70100","DOIUrl":"10.1002/bco2.70100","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>The number of ureterorenoscopies in Germany is rising. Hospitals must operate economically while ensuring quality. Environmental assessment of medical procedures is gaining focus. This study aims to perform a comparative analysis of the economic and ecological aspects of single-use versus reusable ureterorenoscopes using real-world routine data, acknowledging their trade-offs between hygienic advantages, costs and environmental impacts.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Methods</h3>\u0000 \u0000 <p>A total of 210 ureterorenoscopy cases (2022/2023) at the University Hospital of Würzburg were evaluated. A simulation assessed the impact of the OPS code 5-98b.0 on DRG (diagnosis-related groups) classification and reimbursement. Economic analysis included acquisition, repair and sterilization costs, while ecological assessment considered manufacturing, waste, reprocessing, transport and repair.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In 44.3% of cases, use of OPS code 5-98b.0 resulted in an upgraded DRG (L20B instead of L20C), yielding approximately €62 000 in additional revenue over 2 years. This was outweighed by roughly €147 000 in extra costs for single-use devices, assuming repair costs for reusable devices remained around €300 per case. Environmentally, single-use devices generated 42 kg more CO<sub>2</sub> per 100 procedures.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Single-use ureterorenoscopes are economically justifiable only when reusable devices incur frequent repair costs. Reusable scopes perform better ecologically due to lower CO<sub>2</sub> emissions. Instrument choice should be guided by each clinic's specific economic and environmental context.</p>\u0000 </section>\u0000 </div>","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"6 10","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12504851/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145260061","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Angelo Cormio, Vineet Gauhar, Bhaskar K. Somani, Jaisukh Kalathia, Nariman Gadzhiev, Marek Zawadzki, Mahmoud Laymon, Karl Tan, Gopal Ramdas Tak, Theodoros Tokas, Madhu Sudan Agrawal, Jean de la Rosette, Kremena Petkova, Kazumi Taguchi, Dmitriy Gorelov, Alexey G. Martov, Leonardo Gomes Lopes, Mehmet ilker Gökce, Wissam Kamal, Stefania Ferretti, Devang Desai, Yadgar Abduljabbar Shwani, Khi Yung Fong, Steffi Kar Kei Yuen, Andreas Skolarikos, Marcos Cepeda, Thomas R. W. Herrmann, Daniele Castellani
Objectives
To compare perioperative outcomes, complications and stone-free rates (SFRs) between laser and non-laser lithotripsy in suction-assisted mini-PCNL (SM-PCNL).
Subjects and Methods
This prospective multicentre study enrolled adults with normal kidneys undergoing SM-PCNL (14–22 Fr) across 30 international centres (March–November 2024). Patients were divided into laser (Group 1) and non-laser (Group 2) groups. Propensity score matching (2:1) was performed based on age, sex, Guy's score and patient position. Primary outcomes were complications and 30-day SFR assessed by CT. Multivariable logistic regression identified predictors of complete stone clearance and complications.
Results
After matching, 748 patients were analysed (Group 1: 448; Group 2: 300). Non-laser devices were associated with shorter lithotripsy (12 vs 18 min, p < 0.001) and operative times (37 vs 45 min, p < 0.001) and higher SFR (intraoperative: 91.3% vs 80.7%; 30-day: 87.7% vs 82.1%). However, transfusions (3.3% vs 0.2%), pelvic perforation and pleural injury (each 3.0%) were more common in Group 2. On multivariable analysis, single-step dilation (OR 3.05) and sheath sizes of 16.5–18 Fr (OR 1.98) or 20–22 Fr (OR 2.72) were associated with higher odds of stone-free status, while skin-to-stone distance >8 cm (OR 0.5) and combined fluoroscopy/ultrasound access (0.28) reduced this likelihood. Stone volume (OR 1.03), serial dilation with non-metal dilators (OR 2.64) and combined fluoroscopy/ultrasound access (OR 2.11) were factors associated with higher odds of complications. The lithotripsy technology had no direct bearing on complications.
Conclusions
Both laser and non-laser lithotripsy are effective in SM-PCNL. Non-laser devices improve efficiency and lasers were preferentially used with 14–18 fr access tracts.
{"title":"Comparing laser vs mechanical lithotripsy in suction mini-PCNL for kidney stone disease: A prospective multicentre study by the endourology section of EAU","authors":"Angelo Cormio, Vineet Gauhar, Bhaskar K. Somani, Jaisukh Kalathia, Nariman Gadzhiev, Marek Zawadzki, Mahmoud Laymon, Karl Tan, Gopal Ramdas Tak, Theodoros Tokas, Madhu Sudan Agrawal, Jean de la Rosette, Kremena Petkova, Kazumi Taguchi, Dmitriy Gorelov, Alexey G. Martov, Leonardo Gomes Lopes, Mehmet ilker Gökce, Wissam Kamal, Stefania Ferretti, Devang Desai, Yadgar Abduljabbar Shwani, Khi Yung Fong, Steffi Kar Kei Yuen, Andreas Skolarikos, Marcos Cepeda, Thomas R. W. Herrmann, Daniele Castellani","doi":"10.1002/bco2.70075","DOIUrl":"10.1002/bco2.70075","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To compare perioperative outcomes, complications and stone-free rates (SFRs) between laser and non-laser lithotripsy in suction-assisted mini-PCNL (SM-PCNL).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Subjects and Methods</h3>\u0000 \u0000 <p>This prospective multicentre study enrolled adults with normal kidneys undergoing SM-PCNL (14–22 Fr) across 30 international centres (March–November 2024). Patients were divided into laser (Group 1) and non-laser (Group 2) groups. Propensity score matching (2:1) was performed based on age, sex, Guy's score and patient position. Primary outcomes were complications and 30-day SFR assessed by CT. Multivariable logistic regression identified predictors of complete stone clearance and complications.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>After matching, 748 patients were analysed (Group 1: 448; Group 2: 300). Non-laser devices were associated with shorter lithotripsy (12 vs 18 min, p < 0.001) and operative times (37 vs 45 min, p < 0.001) and higher SFR (intraoperative: 91.3% vs 80.7%; 30-day: 87.7% vs 82.1%). However, transfusions (3.3% vs 0.2%), pelvic perforation and pleural injury (each 3.0%) were more common in Group 2. On multivariable analysis, single-step dilation (OR 3.05) and sheath sizes of 16.5–18 Fr (OR 1.98) or 20–22 Fr (OR 2.72) were associated with higher odds of stone-free status, while skin-to-stone distance >8 cm (OR 0.5) and combined fluoroscopy/ultrasound access (0.28) reduced this likelihood. Stone volume (OR 1.03), serial dilation with non-metal dilators (OR 2.64) and combined fluoroscopy/ultrasound access (OR 2.11) were factors associated with higher odds of complications. The lithotripsy technology had no direct bearing on complications.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Both laser and non-laser lithotripsy are effective in SM-PCNL. Non-laser devices improve efficiency and lasers were preferentially used with 14–18 fr access tracts.</p>\u0000 </section>\u0000 </div>","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"6 10","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12504910/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145260045","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}
Samantha Shekar, Megan Crumbaker, Anthony Joshua, Andrew Yam, Phillip Stricker, Carlo Yuen, David Ende, Benjamin Namdarian, James Thompson, Raji Kooner, Gordon O'Neill, Jeremy Mo, Hao-Wen Sim, George Hruby, Farshad Kasraei, Annie Ho, Jeremy De Leon
Objectives
This work aimed to report real-world outcomes from the use of SBRT to treat ADT naïve, PSMA-detected oligometastatic prostate cancer (OPCa) and to assess disease and treatment characteristics in this heterogeneous population intersect or impact treatment response.
Subjects and Methods
This retrospective single-institution study examined PSMA-PET–detected oligometastases (n = 1–5) in ADT-naïve OPCa patients, treated with metastasis-directed therapy (MDT) using SBRT delivered via MRI- or CT-guided linear accelerator. Primary endpoint was biochemical progression free survival (PSA ≥ 25% if baseline <2 ng/mL or ≥2 ng/mL from nadir if baseline ≥ 2 ng/mL, start of systemic therapy, death). Secondary endpoints included time to PSA progression, time to next intervention, ADT-free survival. Univariate and multivariate analyses were conducted for prognostic factors associated with bPFS, time to PSA progression and PSA50 response. Baseline clinical and treatment characteristics, PSA responses and local failure rates were analysed. Those with castrate-resistant disease, prior systemic therapy or interval follow-up of <6 weeks were excluded.
Results
Sixty-seven patients treated from January 2019 to August 2024 were analysed with a median follow-up of 18.8 months. Ninety-three oligometastatic lesions were treated; 55.3% were treated for nodal disease, 38.8% bone and 5% with lung disease. All lesions were PSMA-detected with median SUVmax 6.3. Median bPFS was 22.1 m; TTNI was 28.8 m. Lower initial T stage and longer duration from OPCa diagnosis to MDT were associated with prolonged bPFS. Lower T stage and PSA doubling time >3 m at MDT were associated with prolonged time to PSA progression. Median PSA fall was 68.9%; PSA 50% response was observed in 55.2%. Twenty-nine patients (43%) had a complete metabolic response after MDT. Median ADT-free survival was not reached.
Conclusions
MDT in PSMA-PET-detected OPCa can provide clinically meaningful disease control in a subset of patients. This study supports this approach but warrants continued prospective study and exploration into the castrate-resistant setting.
{"title":"Real-world clinical outcomes of oligometastatic prostate cancer using SBRT: An Australian experience","authors":"Samantha Shekar, Megan Crumbaker, Anthony Joshua, Andrew Yam, Phillip Stricker, Carlo Yuen, David Ende, Benjamin Namdarian, James Thompson, Raji Kooner, Gordon O'Neill, Jeremy Mo, Hao-Wen Sim, George Hruby, Farshad Kasraei, Annie Ho, Jeremy De Leon","doi":"10.1002/bco2.70055","DOIUrl":"10.1002/bco2.70055","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>This work aimed to report real-world outcomes from the use of SBRT to treat ADT naïve, PSMA-detected oligometastatic prostate cancer (OPCa) and to assess disease and treatment characteristics in this heterogeneous population intersect or impact treatment response.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Subjects and Methods</h3>\u0000 \u0000 <p>This retrospective single-institution study examined PSMA-PET–detected oligometastases (<i>n</i> = 1–5) in ADT-naïve OPCa patients, treated with metastasis-directed therapy (MDT) using SBRT delivered via MRI- or CT-guided linear accelerator. Primary endpoint was biochemical progression free survival (PSA ≥ 25% if baseline <2 ng/mL or ≥2 ng/mL from nadir if baseline ≥ 2 ng/mL, start of systemic therapy, death). Secondary endpoints included time to PSA progression, time to next intervention, ADT-free survival. Univariate and multivariate analyses were conducted for prognostic factors associated with bPFS, time to PSA progression and PSA50 response. Baseline clinical and treatment characteristics, PSA responses and local failure rates were analysed. Those with castrate-resistant disease, prior systemic therapy or interval follow-up of <6 weeks were excluded.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Sixty-seven patients treated from January 2019 to August 2024 were analysed with a median follow-up of 18.8 months. Ninety-three oligometastatic lesions were treated; 55.3% were treated for nodal disease, 38.8% bone and 5% with lung disease. All lesions were PSMA-detected with median SUVmax 6.3. Median bPFS was 22.1 m; TTNI was 28.8 m. Lower initial T stage and longer duration from OPCa diagnosis to MDT were associated with prolonged bPFS. Lower T stage and PSA doubling time >3 m at MDT were associated with prolonged time to PSA progression. Median PSA fall was 68.9%; PSA 50% response was observed in 55.2%. Twenty-nine patients (43%) had a complete metabolic response after MDT. Median ADT-free survival was not reached.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>MDT in PSMA-PET-detected OPCa can provide clinically meaningful disease control in a subset of patients. This study supports this approach but warrants continued prospective study and exploration into the castrate-resistant setting.</p>\u0000 </section>\u0000 </div>","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"6 10","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12488251/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145214541","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 investigate the real-world clinical use of maintenance bacillus Calmette-Guérin (mBCG) therapy for high-risk non-muscle-invasive bladder cancer (HR-NMIBC) in Japan.
Patients and methods
This multicentre, retrospective, observational study included patients who received intravesical mBCG for HR-NMIBC following transurethral resection of bladder tumours between 2000 and 2023, and who were included in the Japan Urological Oncology Group registry database. Assessments included real-world mBCG treatment duration, the completion rate of planned treatment, reasons for treatment discontinuation and mBCG effectiveness.
Results
The study included 886 patients (median [interquartile range] age 71.0 [65.0–77.0] years; male, 83.5%). The median (interquartile range) treatment duration was 11 (6–17) months, with 43.8% of patients completing the physician-determined planned treatment duration. The percentage of patients with mBCG treatment duration of 3, 6, 12, 18 and 24 months was 21.6%, 21.8%, 31.3%, 7.6% and 9.2%, respectively. Adverse events were the most common reason for mBCG discontinuation (49.1%). The recurrence-free survival, progression-free survival, overall survival and bladder preservation durations were numerically shorter in patients treated for 3 months.
Conclusions
This first comprehensive study of the real-world use of mBCG treatment for HR-NMIBC in Japan found diverse treatment patterns, with approximately 40% of patients receiving mBCG for <1 year, which is shorter than the guideline-recommended treatment duration. The results underscore the need for early and sustained adverse event management, and provide valuable reference data for optimising mBCG therapy in clinical practice.
{"title":"Real-world use of maintenance bacillus Calmette-Guérin therapy in patients with non-muscle-invasive bladder cancer in Japan: ASUKA study","authors":"Makito Miyake, Jumpei Tokumaru, Hiroshi Oi, Hiroshi Kitagawa, Kiyohide Fujimoto, Naotaka Nishiyama, Hiroshi Kitamura","doi":"10.1002/bco2.70091","DOIUrl":"10.1002/bco2.70091","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To investigate the real-world clinical use of maintenance bacillus Calmette-Guérin (mBCG) therapy for high-risk non-muscle-invasive bladder cancer (HR-NMIBC) in Japan.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Patients and methods</h3>\u0000 \u0000 <p>This multicentre, retrospective, observational study included patients who received intravesical mBCG for HR-NMIBC following transurethral resection of bladder tumours between 2000 and 2023, and who were included in the Japan Urological Oncology Group registry database. Assessments included real-world mBCG treatment duration, the completion rate of planned treatment, reasons for treatment discontinuation and mBCG effectiveness.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The study included 886 patients (median [interquartile range] age 71.0 [65.0–77.0] years; male, 83.5%). The median (interquartile range) treatment duration was 11 (6–17) months, with 43.8% of patients completing the physician-determined planned treatment duration. The percentage of patients with mBCG treatment duration of 3, 6, 12, 18 and 24 months was 21.6%, 21.8%, 31.3%, 7.6% and 9.2%, respectively. Adverse events were the most common reason for mBCG discontinuation (49.1%). The recurrence-free survival, progression-free survival, overall survival and bladder preservation durations were numerically shorter in patients treated for 3 months.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This first comprehensive study of the real-world use of mBCG treatment for HR-NMIBC in Japan found diverse treatment patterns, with approximately 40% of patients receiving mBCG for <1 year, which is shorter than the guideline-recommended treatment duration. The results underscore the need for early and sustained adverse event management, and provide valuable reference data for optimising mBCG therapy in clinical practice.</p>\u0000 </section>\u0000 </div>","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"6 10","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12488256/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145214518","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}
Kalpesh Parmar, Anshu Jha, Angel John, Aditya Manjunath, Odunayo Kalejaiye, Ali Reza Vosough, Bhaskar Somani, Joe Philip
Objective
This study evaluates the clinical outcomes of patients with suspected penile fractures who were managed conservatively after MRI excluded tunica albuginea rupture or fracture.
Methods
A retrospective review was conducted over a seven-year period, identifying patients who presented with symptoms suggestive of penile fracture. All patients who underwent MRI imaging to confirm or exclude the presence of a tunica albuginea rupture. Based on MRI findings, patients without confirmed fractures were managed conservatively, including instructions to avoid sexual activity and strenuous physical exertion. Follow-up assessments were conducted to monitor long-term complications, with a specific focus on erectile function, assessed via the International Index of Erectile Function (IIEF) and penile curvature.
Results
Of the 30 patients with suspected penile fractures, MRI excluded fractures in 63%. Among these conservatively managed patients, approximately 60% developed erectile dysfunction (ED) and 27% developed penile curvature. Even in cases without confirmed fractures, patients with contusions demonstrated significant post-injury complications.
Conclusion
MRI is effective in ruling out penile fractures, supporting the use of conservative management when fractures are not confirmed. However, conservative treatment alone is associated with a notable rate of complications, suggesting the potential benefit of early penile rehabilitation to address functional outcomes in these patients.
{"title":"Penile trauma management in absence of fracture: Long-term outcomes","authors":"Kalpesh Parmar, Anshu Jha, Angel John, Aditya Manjunath, Odunayo Kalejaiye, Ali Reza Vosough, Bhaskar Somani, Joe Philip","doi":"10.1002/bco2.70092","DOIUrl":"10.1002/bco2.70092","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>This study evaluates the clinical outcomes of patients with suspected penile fractures who were managed conservatively after MRI excluded tunica albuginea rupture or fracture.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective review was conducted over a seven-year period, identifying patients who presented with symptoms suggestive of penile fracture. All patients who underwent MRI imaging to confirm or exclude the presence of a tunica albuginea rupture. Based on MRI findings, patients without confirmed fractures were managed conservatively, including instructions to avoid sexual activity and strenuous physical exertion. Follow-up assessments were conducted to monitor long-term complications, with a specific focus on erectile function, assessed via the International Index of Erectile Function (IIEF) and penile curvature.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of the 30 patients with suspected penile fractures, MRI excluded fractures in 63%. Among these conservatively managed patients, approximately 60% developed erectile dysfunction (ED) and 27% developed penile curvature. Even in cases without confirmed fractures, patients with contusions demonstrated significant post-injury complications.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>MRI is effective in ruling out penile fractures, supporting the use of conservative management when fractures are not confirmed. However, conservative treatment alone is associated with a notable rate of complications, suggesting the potential benefit of early penile rehabilitation to address functional outcomes in these patients.</p>\u0000 </section>\u0000 </div>","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"6 10","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12477267/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145202257","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}
Sandra Schönburg, Christian Gratzke, Kurt Miller, Erik Krieger, Patrick Papp, Laura Wiemer
Objective
To investigate whether storage or voiding symptoms respond more favourably to the use of Kranus Lutera, the first app-based digital therapeutic for male lower urinary tract symptoms (LUTS), using detailed item-level analysis of the IPSS questionnaire.
Materials and Methods
The present data represent a post-hoc analysis of the results of the BEST trial, a randomized controlled study evaluating the efficiency of the digital therapy Kranus Lutera. The study period lasted 12 weeks, conducted between 04/2023 and 11/2023. We assessed the mean change from baseline to 12 weeks for each of the seven IPSS items. Voiding symptoms (items 1, 3, 5 and 6) and storage symptoms (items 2, 4 and 7) were analysed separately.
Results
Participants using the digital therapeutic demonstrated statistically significant improvements across all IPSS items. Compared to the control group, the intervention group showed a significant and clinically relevant improvement in the primary endpoint (IPSS), with an overall reduction of −7.0 points (95% CI: −8.1 to −5.9, p < 0.0001). Notably, improvements in storage symptoms were consistently larger than those in voiding symptoms. The analysis of individual IPSS questions showed the greatest changes in the overall cohort for questions 1, 2 and 7 (each p < 0.0001). Patients with the single diagnosis BPH (N40) showed the greatest score reduction in questions 2 and 5 (each p < 0.0001), patients with OAB (N32.8) in questions 2, 4 and 7 (each p < 0.0001) and patients with BPH and OAB (N40 + N32.8) in questions 2, 3 and 7 (question 2 and 3 p < 0.0001, question 7 p = 0.0015). According to the analysis of individual IPSS questions, the greatest improvements were observed in frequency, nocturia and the feeling of incomplete bladder emptying.
Conclusion
These findings suggest that a structured app-based therapeutic may exert a stronger effect on storage symptoms than voiding symptoms in men with LUTS. This study confirms the value of the digital therapy as an integral part of the standard care for patients with male LUTS.
{"title":"Differential impact of digital therapy on storage and voiding LUTS: A post-hoc IPSS analysis from the BEST randomized controlled trial","authors":"Sandra Schönburg, Christian Gratzke, Kurt Miller, Erik Krieger, Patrick Papp, Laura Wiemer","doi":"10.1002/bco2.70069","DOIUrl":"https://doi.org/10.1002/bco2.70069","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To investigate whether storage or voiding symptoms respond more favourably to the use of Kranus Lutera, the first app-based digital therapeutic for male lower urinary tract symptoms (LUTS), using detailed item-level analysis of the IPSS questionnaire.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Methods</h3>\u0000 \u0000 <p>The present data represent a post-hoc analysis of the results of the BEST trial, a randomized controlled study evaluating the efficiency of the digital therapy Kranus Lutera. The study period lasted 12 weeks, conducted between 04/2023 and 11/2023. We assessed the mean change from baseline to 12 weeks for each of the seven IPSS items. Voiding symptoms (items 1, 3, 5 and 6) and storage symptoms (items 2, 4 and 7) were analysed separately.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Participants using the digital therapeutic demonstrated statistically significant improvements across all IPSS items. Compared to the control group, the intervention group showed a significant and clinically relevant improvement in the primary endpoint (IPSS), with an overall reduction of −7.0 points (95% CI: −8.1 to −5.9, p < 0.0001). Notably, improvements in storage symptoms were consistently larger than those in voiding symptoms. The analysis of individual IPSS questions showed the greatest changes in the overall cohort for questions 1, 2 and 7 (each p < 0.0001). Patients with the single diagnosis BPH (N40) showed the greatest score reduction in questions 2 and 5 (each p < 0.0001), patients with OAB (N32.8) in questions 2, 4 and 7 (each p < 0.0001) and patients with BPH and OAB (N40 + N32.8) in questions 2, 3 and 7 (question 2 and 3 p < 0.0001, question 7 p = 0.0015). According to the analysis of individual IPSS questions, the greatest improvements were observed in frequency, nocturia and the feeling of incomplete bladder emptying.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>These findings suggest that a structured app-based therapeutic may exert a stronger effect on storage symptoms than voiding symptoms in men with LUTS. This study confirms the value of the digital therapy as an integral part of the standard care for patients with male LUTS.</p>\u0000 </section>\u0000 </div>","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"6 10","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://bjui-journals.onlinelibrary.wiley.com/doi/epdf/10.1002/bco2.70069","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145135643","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}
Julia Mühlbauer, Luise Gottstein, Luisa Egen, Caelan Haney, Alexander Studier-Fischer, Evangelia Christodoulou, Giovanni E. Cacciamani, Keno März, Lena Maier-Hein, Stephan Maurice Michel, Allison Quan, Karl-Friedrich Kowalewski
Background and Objective
Preoperative risk stratification in renal tumour surgery is essential to enable risk-adjusted postoperative patient monitoring. Machine learning (ML) models predicting major complications (MCs) and acute kidney injuries (AKIs) following partial (PN) or radical nephrectomy (RN) have not been made, nor have they been compared with traditional logistic regression models.
Design, setting and participants
A total of 963 patients who underwent PN and RN between January 2017 and March 2023 at the University Medical Center Mannheim were included. The dataset consisted of 30 variables of interest– 18 descriptive and 12 predictor variables, which allowed for 7 predictor variables per event. The dataset was pre-processed, and ML models were created for MC and AKI. The selected models included Random Forest (RF), Support Vector Machines (SVMs), Stochastic Gradient Boosting, Neural Networks (NNs) and Elastic Net Logistic Regression models (ENETs).
Results and limitations
For major complications, the NN model had the best model fitting, with an AUROC of 0.762 [95%CI 0.611–0.912], a sensitivity of 0.86 [95%CI 0.80–0.92] and a Brier score of 0.17 [95%CI 0.11–0.23]. For AKI, the best fit model was created using a NN with an AUROC of 0.717 [95%CI 0.611–0.823], a sensitivity of 0.82 [95%CI 0.74–0.90] and a Brier score of 0.24 [95%CI 0.17–0.31]. The best performing models for both outcomes outperformed the ENETs.
Conclusions
The ML models provide valuable information for preoperative risk stratification of patients undergoing renal tumour surgery. This study suggests that NNs are the most appropriate models to stratify patients regarding the occurrence of MCs and AKIs, respectively. The models are made publicly available for reproducibility.
{"title":"AI-driven preoperative risk assessment in kidney cancer surgery: A comparative feasibility study of machine learning models","authors":"Julia Mühlbauer, Luise Gottstein, Luisa Egen, Caelan Haney, Alexander Studier-Fischer, Evangelia Christodoulou, Giovanni E. Cacciamani, Keno März, Lena Maier-Hein, Stephan Maurice Michel, Allison Quan, Karl-Friedrich Kowalewski","doi":"10.1002/bco2.70080","DOIUrl":"https://doi.org/10.1002/bco2.70080","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Objective</h3>\u0000 \u0000 <p>Preoperative risk stratification in renal tumour surgery is essential to enable risk-adjusted postoperative patient monitoring. Machine learning (ML) models predicting major complications (MCs) and acute kidney injuries (AKIs) following partial (PN) or radical nephrectomy (RN) have not been made, nor have they been compared with traditional logistic regression models.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design, setting and participants</h3>\u0000 \u0000 <p>A total of 963 patients who underwent PN and RN between January 2017 and March 2023 at the University Medical Center Mannheim were included. The dataset consisted of 30 variables of interest– 18 descriptive and 12 predictor variables, which allowed for 7 predictor variables per event. The dataset was pre-processed, and ML models were created for MC and AKI. The selected models included Random Forest (RF), Support Vector Machines (SVMs), Stochastic Gradient Boosting, Neural Networks (NNs) and Elastic Net Logistic Regression models (ENETs).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results and limitations</h3>\u0000 \u0000 <p>For major complications, the NN model had the best model fitting, with an AUROC of 0.762 [95%CI 0.611–0.912], a sensitivity of 0.86 [95%CI 0.80–0.92] and a Brier score of 0.17 [95%CI 0.11–0.23]. For AKI, the best fit model was created using a NN with an AUROC of 0.717 [95%CI 0.611–0.823], a sensitivity of 0.82 [95%CI 0.74–0.90] and a Brier score of 0.24 [95%CI 0.17–0.31]. The best performing models for both outcomes outperformed the ENETs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The ML models provide valuable information for preoperative risk stratification of patients undergoing renal tumour surgery. This study suggests that NNs are the most appropriate models to stratify patients regarding the occurrence of MCs and AKIs, respectively. The models are made publicly available for reproducibility.</p>\u0000 </section>\u0000 </div>","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"6 10","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://bjui-journals.onlinelibrary.wiley.com/doi/epdf/10.1002/bco2.70080","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145135642","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}
Rodolfo Hurle, Anita Capalbo, Giovanni Lughezzani, Nicolò Maria Buffi, Francesco Sormani, Alessio Finocchiaro, Alberto Saita, Marco Paciotti, Vittorio Fasulo, Pietro Cavalli, Paolo Bianchi, Alessio Benetti, Pier Paolo Avolio, Rosanna Asselta, Giulia Soldà, Paolo Casale, Massimo Lazzeri
Objective
The contribution of germline DNA repair gene (gDRG) variants to bladder cancer (BC) susceptibility and progression is still poorly defined, particularly in European populations. This study aims to evaluate the prevalence and clinical implications of germline homologous recombination repair (HRR) gene variants in BC patients of European ancestry.
Methods
In this prospective case–control study, 75 BC patients attending follow-up at a single tertiary centre were screened for germline variants in 20 gDRGs. Patients were included regardless of disease stage and classified by pathogenicity (Class 3–5). Clinical characteristics and outcomes were compared between variant-positive and variant-negative patients.
Results
Among 75 eligible patients, 72 underwent successful germline sequencing. A total of 23 patients (30.6%) harboured at least one pathogenic, likely pathogenic, or VUS variant. The most frequently altered genes included ATM (n = 6), ATR (n = 4), BARD1 (n = 4), CHEK2 (n = 3) and PMS2 (n = 3). Eight patients (34.7%) had multiple variants, and one carried three variants. Notably, 25.8% of NMIBC and 50% of MIBC patients had gDRG variants. Moreover, 30% of patients with low-grade G1 disease harboured at least one variant. Patients with gDRG variants had a higher rate of histopathological variants (34.8% vs. 13.5%) and underwent radical cystectomy at a younger age (60 vs. 75 years, p < 0.05).
Conclusions
Germline HRR variants are prevalent in BC patients and may influence disease aggressiveness and treatment decisions. These findings support broader implementation of germline testing in BC and warrant further validation in larger cohorts.
{"title":"Germline homologous recombination repair (gHRR) variants in bladder cancer: Preliminary evidence and clinical implications","authors":"Rodolfo Hurle, Anita Capalbo, Giovanni Lughezzani, Nicolò Maria Buffi, Francesco Sormani, Alessio Finocchiaro, Alberto Saita, Marco Paciotti, Vittorio Fasulo, Pietro Cavalli, Paolo Bianchi, Alessio Benetti, Pier Paolo Avolio, Rosanna Asselta, Giulia Soldà, Paolo Casale, Massimo Lazzeri","doi":"10.1002/bco2.70077","DOIUrl":"https://doi.org/10.1002/bco2.70077","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>The contribution of germline DNA repair gene (gDRG) variants to bladder cancer (BC) susceptibility and progression is still poorly defined, particularly in European populations. This study aims to evaluate the prevalence and clinical implications of germline homologous recombination repair (HRR) gene variants in BC patients of European ancestry.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In this prospective case–control study, 75 BC patients attending follow-up at a single tertiary centre were screened for germline variants in 20 gDRGs. Patients were included regardless of disease stage and classified by pathogenicity (Class 3–5). Clinical characteristics and outcomes were compared between variant-positive and variant-negative patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 75 eligible patients, 72 underwent successful germline sequencing. A total of 23 patients (30.6%) harboured at least one pathogenic, likely pathogenic, or VUS variant. The most frequently altered genes included <i>ATM</i> (<i>n</i> = 6), <i>ATR</i> (<i>n</i> = 4), <i>BARD1</i> (<i>n</i> = 4), <i>CHEK2</i> (<i>n</i> = 3) and <i>PMS2</i> (<i>n</i> = 3). Eight patients (34.7%) had multiple variants, and one carried three variants. Notably, 25.8% of NMIBC and 50% of MIBC patients had gDRG variants. Moreover, 30% of patients with low-grade G1 disease harboured at least one variant. Patients with gDRG variants had a higher rate of histopathological variants (34.8% vs. 13.5%) and underwent radical cystectomy at a younger age (60 vs. 75 years, <i>p</i> < 0.05).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Germline HRR variants are prevalent in BC patients and may influence disease aggressiveness and treatment decisions. These findings support broader implementation of germline testing in BC and warrant further validation in larger cohorts.</p>\u0000 </section>\u0000 </div>","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"6 10","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://bjui-journals.onlinelibrary.wiley.com/doi/epdf/10.1002/bco2.70077","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145135644","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}
Publio Cesar Cavalcante Viana, Marcelo Araújo Queiroz, Fabio Oliveira Ferreira, Adriano Basso Dias, Natally Horvat, Maurício Dener Cordeiro, Claudio Bovolenta Murta, Giuliano Betoni Guglielmetti, Rafael Ferreira Coelho, Leonardo Cardili, José Pontes Jr, William Carlos Nahas, Giovanni Guido Cerri
Objective
To evaluate the diagnostic performance of multiparametric MRI (mpMRI), mpMRI combined with PSA density (PSAd) and combined biopsy (CBx) in detecting clinically significant prostate cancer (csPCa) in men undergoing active surveillance, using radical prostatectomy (RP) specimens as the reference standard.
Patients and Methods
In this prospective single-centre study, 91 patients with low-risk prostate cancer under active surveillance underwent mpMRI, PSAd measurement, CBx and ultimately RP. mpMRI was reported using PI-RADS v2.0, and PSAd was dichotomised at 0.12 ng/ml/cm3. Diagnostic accuracy was compared using ISUP grade ≥2 and ≥3 thresholds. Radical prostatectomy pathology served as the reference standard.
Results
For detecting ISUP ≥3 cancer, mpMRI combined with PSAd achieved the highest sensitivity (93.3%) and negative predictive value (94.4%). CBx demonstrated the highest specificity (88.2%) and overall diagnostic balance (Youden index = 0.348). mpMRI alone showed intermediate performance. Differences in classification between strategies were statistically significant (McNemar p < 0.001).
Conclusions
mpMRI combined with PSAd provides high sensitivity and negative predictive value for ruling out aggressive prostate cancer, supporting its use as a non-invasive triage tool in active surveillance. CBx remains the most specific method for histological confirmation. These strategies should be used complementarily to optimise decision-making in active surveillance protocols.
目的评价多参数磁共振成像（mpMRI）、mpMRI联合PSA密度（PSAd）和联合活检（CBx）对主动监测男性临床显著性前列腺癌（csPCa）的诊断价值，并以根治性前列腺切除术（RP）标本为参考标准。在这项前瞻性单中心研究中，91名低风险前列腺癌患者在主动监测下接受了mpMRI、PSAd测量、CBx和最终RP。使用PI-RADS v2.0报告mpMRI， PSAd分为0.12 ng/ml/cm3。采用ISUP分级≥2和≥3阈值比较诊断准确性。以根治性前列腺切除术病理为参考标准。结果mpMRI联合PSAd对ISUP≥3级肿瘤的检测灵敏度最高（93.3%），阴性预测值最高（94.4%）。CBx表现出最高的特异性（88.2%）和总体诊断平衡（约登指数= 0.348）。mpMRI单独显示中等表现。不同策略的分类差异有统计学意义（McNemar p < 0.001）。结论mpMRI联合PSAd对排除侵袭性前列腺癌具有较高的敏感性和阴性预测值，支持其作为主动监测的无创分诊工具。CBx仍然是组织学证实的最具体方法。这些策略应相互补充，以优化主动监测协议中的决策。
{"title":"Multiparametric MRI combined with PSA density as a noninvasive rule-out strategy in active surveillance for prostate cancer","authors":"Publio Cesar Cavalcante Viana, Marcelo Araújo Queiroz, Fabio Oliveira Ferreira, Adriano Basso Dias, Natally Horvat, Maurício Dener Cordeiro, Claudio Bovolenta Murta, Giuliano Betoni Guglielmetti, Rafael Ferreira Coelho, Leonardo Cardili, José Pontes Jr, William Carlos Nahas, Giovanni Guido Cerri","doi":"10.1002/bco2.70079","DOIUrl":"10.1002/bco2.70079","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To evaluate the diagnostic performance of multiparametric MRI (mpMRI), mpMRI combined with PSA density (PSAd) and combined biopsy (CBx) in detecting clinically significant prostate cancer (csPCa) in men undergoing active surveillance, using radical prostatectomy (RP) specimens as the reference standard.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Patients and Methods</h3>\u0000 \u0000 <p>In this prospective single-centre study, 91 patients with low-risk prostate cancer under active surveillance underwent mpMRI, PSAd measurement, CBx and ultimately RP. mpMRI was reported using PI-RADS v2.0, and PSAd was dichotomised at 0.12 ng/ml/cm<sup>3</sup>. Diagnostic accuracy was compared using ISUP grade ≥2 and ≥3 thresholds. Radical prostatectomy pathology served as the reference standard.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>For detecting ISUP ≥3 cancer, mpMRI combined with PSAd achieved the highest sensitivity (93.3%) and negative predictive value (94.4%). CBx demonstrated the highest specificity (88.2%) and overall diagnostic balance (Youden index = 0.348). mpMRI alone showed intermediate performance. Differences in classification between strategies were statistically significant (McNemar p < 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>mpMRI combined with PSAd provides high sensitivity and negative predictive value for ruling out aggressive prostate cancer, supporting its use as a non-invasive triage tool in active surveillance. CBx remains the most specific method for histological confirmation. These strategies should be used complementarily to optimise decision-making in active surveillance protocols.</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/bco2.70079","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145111343","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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