Daniel Madarshahian, Abdulrasheed Habeeb, Nimeshan Chandra-Segaran, Kesavapilla Subramonian, Keval Patel
Background
Ureteral stent insertion, crucial for managing ureteral obstructions, often results in stent-related symptoms (SRSs) adversely affecting patient quality of life. This meta-analysis compares the effectiveness of tamsulosin or mirabegron versus placebo in alleviating these symptoms.
Methods
Following PRISMA guidelines, we systematically reviewed randomized controlled trials (RCTs) comparing mirabegron or tamsulosin to placebo in managing SRSs. Data sources included PubMed, Embase, Web of Science and CENTRAL, up to November 2023. The inclusion criteria focused on studies reporting on Ureteral Stent Symptom Questionnaire (USSQ), International Prostate Symptom Score (IPSS), quality of life (QoL) assessments, analgesic usage and adverse events. Meta-analysis employed a random-effects model, assessing heterogeneity and publication bias. For assessing the risk of bias in the included randomized trials, we employed the Cochrane Collaboration's tool. This protocol was registered at the International Prospective Register of Systematic Reviews (registration number: CRD42024511842).
Results
Sixteen RCTs with 1635 patients met the inclusion criteria. Tamsulosin significantly improved body pain (MD −1.80; 95% CI −3.53 to −0.07; p = 0.04), sexual function (MD −0.63; 95% CI −1.16 to −0.10; p = 0.02) and improved quality of life score (MD −2.36; 95% CI −3.56 to −1.17; p = 0.0001), while mirabegron was more effective in reducing urinary symptoms (MD −8.71; 95% CI −15.81 to −1.61; p = 0.02), enhancing general health (MD −2.58; 95% CI −3.78 to −1.37; p < 0.0001) and reducing analgesia use (MD −1.56; 95% CI −2.70 to −0.41; p = 0.008). Both medications significantly reduced total International Prostate Symptom Score (Tamsulosin MD −8.4; 95% CI −15.63 to −1.22; p = 0.02; Mirabegron MD −6.29; 95% CI −8.50 to −4.08; p < 0.00001) without a significant rise in adverse events (tamsulosin OR 1.90; 95% CI 0.40–9.18; mirabegron p = 0.42 and OR 0.93; 95% CI 0.30–2.88; p = 0.89).
Conclusions
Tamsulosin and mirabegron effectively manage SRSs, with distinct benefits in different symptom domains. This suggests a potential for complementary therapeutic strategies. Future high-quality RCTs are needed to explore their combined efficacy.
输尿管支架置入术是输尿管梗阻治疗的关键，经常导致支架相关症状（sss）对患者的生活质量产生不利影响。本荟萃分析比较了坦索罗辛或米拉贝隆与安慰剂在缓解这些症状方面的有效性。方法遵循PRISMA指南，我们系统地回顾了比较mirabegron或tamsulosin与安慰剂治疗srs的随机对照试验（rct）。数据来源包括PubMed， Embase， Web of Science和CENTRAL，截止到2023年11月。纳入标准集中于输尿管支架症状问卷（USSQ）、国际前列腺症状评分（IPSS）、生活质量（QoL）评估、镇痛药物使用和不良事件的研究。荟萃分析采用随机效应模型，评估异质性和发表偏倚。为了评估纳入的随机试验的偏倚风险，我们使用了Cochrane协作的工具。本方案已在国际前瞻性系统评价登记册上注册（注册号：CRD42024511842）。结果16项rct共1635例患者符合纳入标准。Tamsulosin显著提高身体疼痛(MD−1.80;95%可信区间3.53−−0.07;p = 0.04),性功能(MD−0.63;95%可信区间1.16−−0.10;p = 0.02)和改善生活质量评分(MD−2.36;95%可信区间3.56−−1.17;p = 0.0001),而mirabegron更有效地降低尿症状(MD−8.71;95%可信区间15.81−−1.61;p = 0.02),提高整体健康(MD−2.58;95%可信区间3.78−−1.37;p & lt; 0.0001),减少镇痛使用(MD−1.56;95%可信区间2.70−−0.41;p = 0.008)。两种药物均显著降低国际前列腺症状评分（坦索洛新MD - 8.4, 95% CI - 15.63 - 1.22, p = 0.02；米拉比格龙MD - 6.29, 95% CI - 8.50 - 4.08, p < 0.00001），不良事件发生率无显著升高（坦索洛新OR 1.90, 95% CI 0.40-9.18；米拉比格龙p = 0.42, OR 0.93, 95% CI 0.30-2.88, p = 0.89）。结论坦索罗辛和米拉贝龙对srs有较好的治疗效果，对不同症状域疗效明显。这提示了补充治疗策略的潜力。未来需要高质量的随机对照试验来探索它们的联合疗效。
{"title":"Ureteral stent symptoms: A systematic review and meta-analysis comparing the use of mirabegron and tamsulosin","authors":"Daniel Madarshahian, Abdulrasheed Habeeb, Nimeshan Chandra-Segaran, Kesavapilla Subramonian, Keval Patel","doi":"10.1002/bco2.485","DOIUrl":"10.1002/bco2.485","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Ureteral stent insertion, crucial for managing ureteral obstructions, often results in stent-related symptoms (SRSs) adversely affecting patient quality of life. This meta-analysis compares the effectiveness of tamsulosin or mirabegron versus placebo in alleviating these symptoms.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Following PRISMA guidelines, we systematically reviewed randomized controlled trials (RCTs) comparing mirabegron or tamsulosin to placebo in managing SRSs. Data sources included PubMed, Embase, Web of Science and CENTRAL, up to November 2023. The inclusion criteria focused on studies reporting on Ureteral Stent Symptom Questionnaire (USSQ), International Prostate Symptom Score (IPSS), quality of life (QoL) assessments, analgesic usage and adverse events. Meta-analysis employed a random-effects model, assessing heterogeneity and publication bias. For assessing the risk of bias in the included randomized trials, we employed the Cochrane Collaboration's tool. This protocol was registered at the International Prospective Register of Systematic Reviews (registration number: CRD42024511842).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Sixteen RCTs with 1635 patients met the inclusion criteria. Tamsulosin significantly improved body pain (MD −1.80; 95% CI −3.53 to −0.07; <i>p</i> = 0.04), sexual function (MD −0.63; 95% CI −1.16 to −0.10; <i>p</i> = 0.02) and improved quality of life score (MD −2.36; 95% CI −3.56 to −1.17; <i>p</i> = 0.0001), while mirabegron was more effective in reducing urinary symptoms (MD −8.71; 95% CI −15.81 to −1.61; <i>p</i> = 0.02), enhancing general health (MD −2.58; 95% CI −3.78 to −1.37; <i>p</i> < 0.0001) and reducing analgesia use (MD −1.56; 95% CI −2.70 to −0.41; <i>p</i> = 0.008). Both medications significantly reduced total International Prostate Symptom Score (Tamsulosin MD −8.4; 95% CI −15.63 to −1.22; <i>p</i> = 0.02; Mirabegron MD −6.29; 95% CI −8.50 to −4.08; <i>p</i> < 0.00001) without a significant rise in adverse events (tamsulosin OR 1.90; 95% CI 0.40–9.18; mirabegron <i>p</i> = 0.42 and OR 0.93; 95% CI 0.30–2.88; <i>p</i> = 0.89).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Tamsulosin and mirabegron effectively manage SRSs, with distinct benefits in different symptom domains. This suggests a potential for complementary therapeutic strategies. Future high-quality RCTs are needed to explore their combined efficacy.</p>\u0000 </section>\u0000 </div>","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"6 9","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://bjui-journals.onlinelibrary.wiley.com/doi/epdf/10.1002/bco2.485","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145038253","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 Irenaeus, Hans Garmo, Rolf Gedeborg, Mats Ahlberg, David Robinson, Pär Stattin, Kerri Beckmann
Objectives
To investigate the impact of age and life expectancy on treatment decisions and its consequences for outcomes among men with intermediate and high-risk prostate cancer (PCa).
Materials and methods
We studied men in Prostate Cancer data Base Sweden (PCBaSe) diagnosed between 2008 and 2022 with intermediate-risk or high-risk localized or locally advanced PCa and life expectancy between 2.5 and 15 years in the absence of PCa. Estimates of life expectancy were based on age and two comorbidity indices.
Results
A total of 32 196 men were included in the analyses. Of these, 17 419 (54%) had a life expectancy between 10 and 15 years, of whom 11 147 (64%) received primary radical treatment. Age had a stronger influence than life expectancy on the selection of treatment. Around 10% of deaths within 10 years of diagnosis could potentially have been avoided if men with >10 years life expectancy, regardless of age, had received radical treatment, based on assumptions of high treatment efficacy (30% reduction in all-cause mortality) and high uptake of treatment (90%).
Conclusion
A substantial proportion of healthy older men with intermediate and high-risk PCa did not undergo radical treatment. According to our model and assumptions, 10% of deaths within 10 years of diagnosis in these men could potentially have been avoided if they had received radical treatment.
{"title":"Potential gains from radical treatment of men with prostate cancer according to life expectancy","authors":"Sandra Irenaeus, Hans Garmo, Rolf Gedeborg, Mats Ahlberg, David Robinson, Pär Stattin, Kerri Beckmann","doi":"10.1002/bco2.70076","DOIUrl":"10.1002/bco2.70076","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To investigate the impact of age and life expectancy on treatment decisions and its consequences for outcomes among men with intermediate and high-risk prostate cancer (PCa).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and methods</h3>\u0000 \u0000 <p>We studied men in Prostate Cancer data Base Sweden (PCBaSe) diagnosed between 2008 and 2022 with intermediate-risk or high-risk localized or locally advanced PCa and life expectancy between 2.5 and 15 years in the absence of PCa. Estimates of life expectancy were based on age and two comorbidity indices.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 32 196 men were included in the analyses. Of these, 17 419 (54%) had a life expectancy between 10 and 15 years, of whom 11 147 (64%) received primary radical treatment. Age had a stronger influence than life expectancy on the selection of treatment. Around 10% of deaths within 10 years of diagnosis could potentially have been avoided if men with >10 years life expectancy, regardless of age, had received radical treatment, based on assumptions of high treatment efficacy (30% reduction in all-cause mortality) and high uptake of treatment (90%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>A substantial proportion of healthy older men with intermediate and high-risk PCa did not undergo radical treatment. According to our model and assumptions, 10% of deaths within 10 years of diagnosis in these men could potentially have been avoided if they had received radical treatment.</p>\u0000 </section>\u0000 </div>","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"6 9","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://bjui-journals.onlinelibrary.wiley.com/doi/epdf/10.1002/bco2.70076","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145037720","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}
Ingolf Griebsch, Kristian Juul, Andrew Bottomley, Roya Sherafat-Kazemzadeh, Jack Pemment, Tori Brooks, Rocco Adiutori, Sonia Bothorel
Background
Radical cystectomy (RC) is a life-altering surgery primarily used to treat muscle-invasive bladder cancer (MIBC) and, occasionally, high-risk non-muscle-invasive bladder cancer (NMIBC). While this procedure can be lifesaving, it often leads to significant changes in quality of life (QOL). This review synthesizes the current quantitative and qualitative literature on QOL outcomes for RC patients, highlighting areas of impact and minimal recovery post RC.
Methods
A targeted literature review was conducted in Medline, searching for studies using qualitative methods to report patient experience and important aspects of QOL outcomes among RC patients between 2013 and 2024. A second search was performed focusing on clinical studies that reported QOLs using quantitative methods. Studies were screened based on study population and type of reported outcomes. Nine qualitative studies were selected to identify important themes related to QOL concepts. There were seven quantitative studies that were selected to extract the results of reported patient outcomes. These results were categorized using the themes identified (Sexual Functioning, Physical Functioning, Emotional Functioning, Work Functioning, Activities of Daily Living and Family-Social Functioning). Key QOL areas were examined and organized by the severity of impairment and potential for recovery.
Results
Patients experienced disease impact on sexual functioning and physical mobility as well as emotional well-being, daily living activities, work functioning and social interactions, with the first two domains most profoundly affected by RC. Emotional challenges and dependence on family support were prevalent post RC, with some gradual improvements in the second year. Qualitative findings also underscore the complex emotional and social adjustments patients undergo.
Conclusion
This review highlights the extensive impact of RC on multiple dimensions of QOL, suggesting a critical need for improved patient counselling and long-term support strategies. The findings highlight the importance of educating patients about the potential changes in QOL when considering treatment options. With shared patient and clinician decision making in specific cases of NMIBC, bladder sparing strategies may be considered, depending on the clinical contexts and patients' individual needs.
{"title":"Life after radical cystectomy: A mixed-methods targeted review of patient-reported quality of life following bladder removal","authors":"Ingolf Griebsch, Kristian Juul, Andrew Bottomley, Roya Sherafat-Kazemzadeh, Jack Pemment, Tori Brooks, Rocco Adiutori, Sonia Bothorel","doi":"10.1002/bco2.70049","DOIUrl":"10.1002/bco2.70049","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Radical cystectomy (RC) is a life-altering surgery primarily used to treat muscle-invasive bladder cancer (MIBC) and, occasionally, high-risk non-muscle-invasive bladder cancer (NMIBC). While this procedure can be lifesaving, it often leads to significant changes in quality of life (QOL). This review synthesizes the current quantitative and qualitative literature on QOL outcomes for RC patients, highlighting areas of impact and minimal recovery post RC.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A targeted literature review was conducted in Medline, searching for studies using qualitative methods to report patient experience and important aspects of QOL outcomes among RC patients between 2013 and 2024. A second search was performed focusing on clinical studies that reported QOLs using quantitative methods. Studies were screened based on study population and type of reported outcomes. Nine qualitative studies were selected to identify important themes related to QOL concepts. There were seven quantitative studies that were selected to extract the results of reported patient outcomes. These results were categorized using the themes identified (Sexual Functioning, Physical Functioning, Emotional Functioning, Work Functioning, Activities of Daily Living and Family-Social Functioning). Key QOL areas were examined and organized by the severity of impairment and potential for recovery.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Patients experienced disease impact on sexual functioning and physical mobility as well as emotional well-being, daily living activities, work functioning and social interactions, with the first two domains most profoundly affected by RC. Emotional challenges and dependence on family support were prevalent post RC, with some gradual improvements in the second year. Qualitative findings also underscore the complex emotional and social adjustments patients undergo.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This review highlights the extensive impact of RC on multiple dimensions of QOL, suggesting a critical need for improved patient counselling and long-term support strategies. The findings highlight the importance of educating patients about the potential changes in QOL when considering treatment options. With shared patient and clinician decision making in specific cases of NMIBC, bladder sparing strategies may be considered, depending on the clinical contexts and patients' individual needs.</p>\u0000 </section>\u0000 </div>","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"6 9","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://bjui-journals.onlinelibrary.wiley.com/doi/epdf/10.1002/bco2.70049","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145037748","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Angelo Cormio, Daniele Castellani, Domenico De Palma, Ruggiero Fiorella, Runeel Ratnayake, Michele Lotito, Giuseppe Albino, Ugo Giovanni Falagario, Gian Maria Busetto, Carlo Bettocchi, Giuseppe Carrieri, Luigi Cormio
Objective
To investigate the incidence, risk factors and clinical consequences of acute kidney injury (AKI) following mini-percutaneous nephrolithotomy (mini-PCNL), with particular focus on its association with postoperative infectious complications.
Materials and Methods
A retrospective analysis was conducted on 496 adult patients who underwent mini-PCNL (22 Ch) between February 2020 and April 2025. AKI was defined according to KDIGO criteria as either a ≥ 1.5-fold increase or an absolute increase of ≥0.3 mg/dl in serum creatinine within 72 hours postoperatively. Patients were stratified into AKI and non-AKI groups. Multivariable logistic regression analyses were performed to identify predictors of AKI development and infectious complications.
Results
Surgery was done in spinal anaesthesia in all cases. AKI occurred in 45 patients (9.1%). There was no difference in median surgical time (52.5 vs 55.0 minutes, p = 0.33) between groups. There was no difference between the two groups in gender distribution, median age, body mass index, baseline serum creatinine, rates of comorbidities and stone features. Patients with AKI had significantly higher rates of overall postoperative complications (24.4% vs 7.1%, p < 0.001) and longer hospital stays (4 vs 3 days, p < 0.001). Infectious complications were significantly more frequent in the AKI group, with higher median procalcitonin levels (0.21 vs 0.06 ng/ml, p = 0.03). One patient in the AKI group died from sepsis. Multivariable analysis identified previous PCNL (OR 2.51, 95% CI 1.33–4.72, p < 0.01) and higher baseline serum creatinine (OR 2.00, 95% CI 1.07–3.73, p = 0.03) as independent predictors of AKI. AKI was the only independent predictor of infectious complications (OR 3.47, 95% CI 1.04–11.58, p = 0.04).
Conclusions
The strong association between AKI and infectious complications, including potential mortality from sepsis, highlights the clinical significance of this underreported complication. Enhanced perioperative monitoring and aggressive management of infectious complications are warranted in patients who develop AKI following mini-PCNL.
目的探讨微创经皮肾镜取石术（mini-PCNL）后急性肾损伤（AKI）的发生率、危险因素及临床后果，并探讨其与术后感染并发症的关系。材料与方法对2020年2月至2025年4月期间接受mini-PCNL （22 Ch）治疗的496例成人患者进行回顾性分析。根据KDIGO标准，AKI定义为术后72小时内血清肌酐升高≥1.5倍或绝对升高≥0.3 mg/dl。将患者分为AKI组和非AKI组。进行多变量logistic回归分析以确定AKI发展和感染并发症的预测因素。结果所有病例均行脊髓麻醉手术。45例（9.1%）发生AKI。两组间中位手术时间无差异（52.5 vs 55.0分钟，p = 0.33）。两组在性别分布、中位年龄、体重指数、基线血清肌酐、合并症发生率和结石特征方面无差异。AKI患者的总体术后并发症发生率明显更高（24.4% vs 7.1%, p < 0.001），住院时间也更长（4天vs 3天，p < 0.001）。AKI组感染并发症明显更频繁，降钙素原中位水平更高（0.21 vs 0.06 ng/ml, p = 0.03）。AKI组中有1例患者死于败血症。多变量分析发现，既往PCNL （OR 2.51, 95% CI 1.33-4.72, p < 0.01）和较高的基线血清肌酐（OR 2.00, 95% CI 1.07-3.73, p = 0.03）是AKI的独立预测因子。AKI是感染并发症的唯一独立预测因子（OR 3.47, 95% CI 1.04-11.58, p = 0.04）。AKI与感染性并发症（包括脓毒症的潜在死亡率）之间的密切关联突出了这种未被报道的并发症的临床意义。对于mini-PCNL后发生AKI的患者，加强围手术期监测和积极处理感染并发症是必要的。
{"title":"Acute kidney injury as a predictor of infectious complications after mini-PCNL","authors":"Angelo Cormio, Daniele Castellani, Domenico De Palma, Ruggiero Fiorella, Runeel Ratnayake, Michele Lotito, Giuseppe Albino, Ugo Giovanni Falagario, Gian Maria Busetto, Carlo Bettocchi, Giuseppe Carrieri, Luigi Cormio","doi":"10.1002/bco2.70084","DOIUrl":"10.1002/bco2.70084","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To investigate the incidence, risk factors and clinical consequences of acute kidney injury (AKI) following mini-percutaneous nephrolithotomy (mini-PCNL), with particular focus on its association with postoperative infectious complications.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Methods</h3>\u0000 \u0000 <p>A retrospective analysis was conducted on 496 adult patients who underwent mini-PCNL (22 Ch) between February 2020 and April 2025. AKI was defined according to KDIGO criteria as either a ≥ 1.5-fold increase or an absolute increase of ≥0.3 mg/dl in serum creatinine within 72 hours postoperatively. Patients were stratified into AKI and non-AKI groups. Multivariable logistic regression analyses were performed to identify predictors of AKI development and infectious complications.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Surgery was done in spinal anaesthesia in all cases. AKI occurred in 45 patients (9.1%). There was no difference in median surgical time (52.5 vs 55.0 minutes, p = 0.33) between groups. There was no difference between the two groups in gender distribution, median age, body mass index, baseline serum creatinine, rates of comorbidities and stone features. Patients with AKI had significantly higher rates of overall postoperative complications (24.4% vs 7.1%, p < 0.001) and longer hospital stays (4 vs 3 days, p < 0.001). Infectious complications were significantly more frequent in the AKI group, with higher median procalcitonin levels (0.21 vs 0.06 ng/ml, p = 0.03). One patient in the AKI group died from sepsis. Multivariable analysis identified previous PCNL (OR 2.51, 95% CI 1.33–4.72, p < 0.01) and higher baseline serum creatinine (OR 2.00, 95% CI 1.07–3.73, p = 0.03) as independent predictors of AKI. AKI was the only independent predictor of infectious complications (OR 3.47, 95% CI 1.04–11.58, p = 0.04).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The strong association between AKI and infectious complications, including potential mortality from sepsis, highlights the clinical significance of this underreported complication. Enhanced perioperative monitoring and aggressive management of infectious complications are warranted in patients who develop AKI following mini-PCNL.</p>\u0000 </section>\u0000 </div>","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"6 9","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://bjui-journals.onlinelibrary.wiley.com/doi/epdf/10.1002/bco2.70084","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145012303","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}
Aziz NA, Ng K, Alifrangis C, Tran B, Conduit C, Liow E, et al. Therapy de-escalation for testicular cancer (THERATEST): A multi-centre observational cohort feasibility study of de-escalation therapies for good prognosis stage II germ cell tumours. BJUI Compass. 2025; 6(8):e70057. https://doi.org/10.1002/bco2.70057.
In the originally published article, Section 3.2—Secondary Objectives and Endpoints—was not presented in the correct sequence. While the content is factually accurate, the structure is disordered and several objectives are repeated or misaligned, which may confuse readers. The correct version appears below.
{"title":"Correction to “Therapy de-escalation for testicular cancer (THERATEST): A multi-centre observational cohort feasibility study of de-escalation therapies for good prognosis stage II germ cell tumours”","authors":"","doi":"10.1002/bco2.70071","DOIUrl":"10.1002/bco2.70071","url":null,"abstract":"<p>Aziz NA, Ng K, Alifrangis C, Tran B, Conduit C, Liow E, et al. <b>Therapy de-escalation for testicular cancer (THERATEST): A multi-centre observational cohort feasibility study of de-escalation therapies for good prognosis stage II germ cell tumours</b>. BJUI Compass. 2025; 6(8):e70057. https://doi.org/10.1002/bco2.70057.</p><p>In the originally published article, Section 3.2—<i>Secondary Objectives and Endpoints—</i>was not presented in the correct sequence. While the content is factually accurate, the structure is disordered and several objectives are repeated or misaligned, which may confuse readers. The correct version appears below.</p><p><b>3.2 | Secondary objectives and endpoints</b></p><p>We apologize for this error.</p>","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"6 9","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://bjui-journals.onlinelibrary.wiley.com/doi/epdf/10.1002/bco2.70071","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145012304","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 develop a novel risk score (RS) model to predict the probability of progression to castration-resistant prostate cancer (PCa) (CRPC) after intensity-modulated radiation therapy (IMRT) for patients with high- and very high-risk PCa according to the National Comprehensive Cancer Network (NCCN) risk classification, since accurate prediction of the clinical outcome of definitive radiation therapy for patients with high- and very high-risk PCa remains challenging due to its heterogeneity.
Materials and Methods
We conducted a retrospective review of 600 patients with high- and very high-risk PCa treated with IMRT at our institution. They were randomly divided into discovery (n = 300) and validation (n = 300) cohorts. A predictive RS model was created using a dataset from the discovery cohort based on the following parameters: T-stage, Gleason score, prostate-specific antigen and age at initiation of IMRT. The model was internally validated using a dataset from the validation cohort. RS was calculated using multivariable Cox regression analysis, and patients were categorized into low-risk, intermediate-risk or high-risk based on the value.
Results
The median follow-up period of the 600 patients was 9.1 (IQR: 6.1–11.6) years. The 10-year CRPC-free rates for low-, intermediate- and high-risk categories were 100.0, 90.4 and 61.4% in the discovery cohort, respectively (p < 0.001). Such differences were reproduced in the validation cohort. Specifically, those rates for low-, intermediate- and high-risk categories were 96.4, 90.7 and 74.8% in the validation cohort, respectively (p < 0.001). Harrell's C-index for this model was 0.692, being higher than that of the NCCN risk classification (0.617).
Conclusion
This RS model provided useful information to enable tailoring of the treatment intensity for this heterogeneous population.
{"title":"Development of a novel risk model to predict CRPC progression following IMRT: Implications for tailoring treatment intensity","authors":"Takashi Ogata, Rihito Aizawa, Hiroyasu Abe, Takayuki Goto, Kiyonao Nakamura, Yuki Kita, Takayuki Sumiyoshi, Kaoru Murakami, Kei Mizuno, Satoshi Morita, Takashi Kobayashi, Takashi Mizowaki","doi":"10.1002/bco2.70074","DOIUrl":"10.1002/bco2.70074","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To develop a novel risk score (RS) model to predict the probability of progression to castration-resistant prostate cancer (PCa) (CRPC) after intensity-modulated radiation therapy (IMRT) for patients with high- and very high-risk PCa according to the National Comprehensive Cancer Network (NCCN) risk classification, since accurate prediction of the clinical outcome of definitive radiation therapy for patients with high- and very high-risk PCa remains challenging due to its heterogeneity.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Methods</h3>\u0000 \u0000 <p>We conducted a retrospective review of 600 patients with high- and very high-risk PCa treated with IMRT at our institution. They were randomly divided into discovery (n = 300) and validation (n = 300) cohorts. A predictive RS model was created using a dataset from the discovery cohort based on the following parameters: T-stage, Gleason score, prostate-specific antigen and age at initiation of IMRT. The model was internally validated using a dataset from the validation cohort. RS was calculated using multivariable Cox regression analysis, and patients were categorized into low-risk, intermediate-risk or high-risk based on the value.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The median follow-up period of the 600 patients was 9.1 (IQR: 6.1–11.6) years. The 10-year CRPC-free rates for low-, intermediate- and high-risk categories were 100.0, 90.4 and 61.4% in the discovery cohort, respectively (p < 0.001). Such differences were reproduced in the validation cohort. Specifically, those rates for low-, intermediate- and high-risk categories were 96.4, 90.7 and 74.8% in the validation cohort, respectively (p < 0.001). Harrell's C-index for this model was 0.692, being higher than that of the NCCN risk classification (0.617).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This RS model provided useful information to enable tailoring of the treatment intensity for this heterogeneous population.</p>\u0000 </section>\u0000 </div>","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"6 9","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://bjui-journals.onlinelibrary.wiley.com/doi/epdf/10.1002/bco2.70074","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145012306","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}
Julien Anract, Marie Florin, Laura Larnaudie, Michael Peyromaure, Nicolas Barry Delongchamps
Objectives
To evaluate the feasibility and safety of hydrodissection of the prostato-rectal space using 10% dextrose for focal therapy of posterior prostate tumours.
Patients and methods
We included consecutive patients who underwent focal therapy for a posterior prostate tumour with a prior injection of 10% dextrose in the prostato-rectal space, between October 2024 and February 2025. The main outcomes were to evaluate the space created using this technique. As the technique used for hydrodissection was modelled on periprostatic nerve block, we analysed a cohort of patients who underwent transperineal prostate biopsies with periprostatic nerve block using 20 ml of lidocaine, to compare the prostato-rectal spaces created by 10% dextrose and by lidocaine.
Results
A total of 11 patients underwent a focal therapy with a prior 20 ml 10% dextrose hydrodissection of the prostato-rectal space. Fifteen patients who underwent prostatic biopsies using a periprostatic nerve block (20 ml of lidocaine), with similar characteristics, were included. The median prostato-rectal space created with dextrose and with lidocaine was 8.9 [8.0; 9.9] and 6.7 [6.4; 8.4] mm, respectively (p = 0,17). The prostato-rectal space decreased slower with dextrose: 0.03 mm/min vs 0.1 mm/min (p = 0,02). The prostato-rectal space was higher at the end of focal therapy procedures (7.9 vs 6.6 mm, p = 0,033), despite a longer procedure time in focal therapy (37 vs 8 min, p < 0,001). At the end of focal therapy procedures, all patients had a prostato-rectal space > 5 mm. No hydrodissection-related adverse event was observed.
Conclusions
These initial results suggest that hydrodissection of the prostate–rectal space using 20 ml 10% dextrose, injected following a standard periprostatic nerve block protocol, is feasible, reproducible and safe for a focal therapy procedure for localized posterior prostate tumours.
目的探讨10%葡萄糖对前列腺直肠间隙进行水解剖治疗前列腺后部肿瘤的可行性和安全性。患者和方法我们纳入了2024年10月至2025年2月期间连续接受前列腺后部肿瘤局灶治疗并事先在前列腺直肠间隙注射10%葡萄糖的患者。主要结果是评估使用这种技术创造的空间。由于水解剖技术以前列腺周围神经阻滞为模型，我们分析了一组接受经会阴前列腺活检并使用20毫升利多卡因进行前列腺周围神经阻滞的患者，以比较10%葡萄糖和利多卡因造成的前列腺直肠间隙。结果11例患者均行局灶性前列腺直肠间隙10%葡萄糖水解剖20ml。采用前列腺周围神经阻滞（20ml利多卡因）进行前列腺活组织检查的15例患者具有相似的特征。葡萄糖组和利多卡因组的前列腺直肠正中间隙为8.9 [8.0]；9.9]和6.7 [6.4]；8.4] mm （p = 0,17）。葡萄糖组前列腺直肠间隙缩小较慢：0.03 mm/min vs 0.1 mm/min （p = 0.02）。局灶治疗结束时，前列腺直肠间隙增大（7.9 vs 6.6 mm, p = 0,033），尽管局灶治疗的手术时间较长（37 vs 8 min, p = 0,001）。在局灶性治疗过程结束时，所有患者的前列腺直肠间隙均为5mm。未观察到与水解剖相关的不良事件。这些初步结果表明，在标准的前列腺周围神经阻滞方案下，使用20ml 10%葡萄糖对前列腺直肠间隙进行水解剖，对于局限性前列腺后肿瘤的局灶治疗是可行的、可重复的和安全的。
{"title":"Hydrodissection using 10% dextrose before focal therapy of prostate cancer: Initial experience","authors":"Julien Anract, Marie Florin, Laura Larnaudie, Michael Peyromaure, Nicolas Barry Delongchamps","doi":"10.1002/bco2.70073","DOIUrl":"10.1002/bco2.70073","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To evaluate the feasibility and safety of hydrodissection of the prostato-rectal space using 10% dextrose for focal therapy of posterior prostate tumours.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Patients and methods</h3>\u0000 \u0000 <p>We included consecutive patients who underwent focal therapy for a posterior prostate tumour with a prior injection of 10% dextrose in the prostato-rectal space, between October 2024 and February 2025. The main outcomes were to evaluate the space created using this technique. As the technique used for hydrodissection was modelled on periprostatic nerve block, we analysed a cohort of patients who underwent transperineal prostate biopsies with periprostatic nerve block using 20 ml of lidocaine, to compare the prostato-rectal spaces created by 10% dextrose and by lidocaine.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 11 patients underwent a focal therapy with a prior 20 ml 10% dextrose hydrodissection of the prostato-rectal space. Fifteen patients who underwent prostatic biopsies using a periprostatic nerve block (20 ml of lidocaine), with similar characteristics, were included. The median prostato-rectal space created with dextrose and with lidocaine was 8.9 [8.0; 9.9] and 6.7 [6.4; 8.4] mm, respectively (p = 0,17). The prostato-rectal space decreased slower with dextrose: 0.03 mm/min vs 0.1 mm/min (p = 0,02). The prostato-rectal space was higher at the end of focal therapy procedures (7.9 vs 6.6 mm, p = 0,033), despite a longer procedure time in focal therapy (37 vs 8 min, p < 0,001). At the end of focal therapy procedures, all patients had a prostato-rectal space > 5 mm. No hydrodissection-related adverse event was observed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>These initial results suggest that hydrodissection of the prostate–rectal space using 20 ml 10% dextrose, injected following a standard periprostatic nerve block protocol, is feasible, reproducible and safe for a focal therapy procedure for localized posterior prostate tumours.</p>\u0000 </section>\u0000 </div>","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"6 9","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://bjui-journals.onlinelibrary.wiley.com/doi/epdf/10.1002/bco2.70073","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144929615","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}
Daniel Jhang, Jason Groegler, Akin S. Amasyali, Hyukje Sung, Matthew Buell, Jersey Castillo, Elizabeth A. Baldwin, Mohamed Keheila, Zhamshid Okhunov, D. Duane Baldwin
Objectives
To determine whether serial 24-hour urine collections from the same patient over time result in improved stone risk parameters.
Patients and Methods
Using a 24-hour urinalysis database, 1832 tests from 688 patients collected over a 10-year period were retrospectively reviewed. Patients included in the analysis had a minimum follow-up of 2 years and at least three 24-hour urine collections. Changes in risk parameters were evaluated over time with each patient acting as their own control. Statistical analysis was performed using repeated measures ANOVA with a Greenhouse–Geisser correction and post-hoc analysis with Bonferroni correction. Significance level was set as p < 0.05.
Results
A total of 225 patients had at least three 24-hour urine collections, of which 48% were female. From the first to the second 24-hour urine collections, volume and supersaturation of CaOx, CaP and UA all significantly improved (p < 0.05). From the second to the third collection, only the supersaturation of CaP significantly improved (p < 0.05). Approximately half of the patients continued to see improvement in stone risk parameters between the second and third urine collection.
Conclusion
Serial 24-hour urine collections performed at 6-month or greater intervals were significantly associated with improvements in stone risk parameters. This study suggests that serial collections can aid in the correction of urinary stone parameters and should be considered in active stone formers.
{"title":"From collection to correction: Can serial 24-hour urine collections demonstrate improved urinary stone parameters?","authors":"Daniel Jhang, Jason Groegler, Akin S. Amasyali, Hyukje Sung, Matthew Buell, Jersey Castillo, Elizabeth A. Baldwin, Mohamed Keheila, Zhamshid Okhunov, D. Duane Baldwin","doi":"10.1002/bco2.70070","DOIUrl":"10.1002/bco2.70070","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To determine whether serial 24-hour urine collections from the same patient over time result in improved stone risk parameters.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Patients and Methods</h3>\u0000 \u0000 <p>Using a 24-hour urinalysis database, 1832 tests from 688 patients collected over a 10-year period were retrospectively reviewed. Patients included in the analysis had a minimum follow-up of 2 years and at least three 24-hour urine collections. Changes in risk parameters were evaluated over time with each patient acting as their own control. Statistical analysis was performed using repeated measures ANOVA with a Greenhouse–Geisser correction and post-hoc analysis with Bonferroni correction. Significance level was set as p < 0.05.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 225 patients had at least three 24-hour urine collections, of which 48% were female. From the first to the second 24-hour urine collections, volume and supersaturation of CaOx, CaP and UA all significantly improved (p < 0.05). From the second to the third collection, only the supersaturation of CaP significantly improved (p < 0.05). Approximately half of the patients continued to see improvement in stone risk parameters between the second and third urine collection.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Serial 24-hour urine collections performed at 6-month or greater intervals were significantly associated with improvements in stone risk parameters. This study suggests that serial collections can aid in the correction of urinary stone parameters and should be considered in active stone formers.</p>\u0000 </section>\u0000 </div>","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"6 8","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://bjui-journals.onlinelibrary.wiley.com/doi/epdf/10.1002/bco2.70070","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144905544","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}
Frédéric Panthier, Alba Sierra, Etienne Xavier Keller, Marie Chicaud, Eugenio Ventimiglia, Jia-Lun Kwok, Vincent De Coninck, Mariela Corrales, Michel Daudon, Cyril Gorny, Steeve Doizi, Laurent Berthe, Daron Smith, Olivier Traxer
Objective
To compare in vitro the ablation rates of p-Tm:YAG, TFL and Ho:YAG against synthetic and human stones.
Material and Methods
p-Tm:YAG, TFL and Low-Power (LP) Ho:YAG were compared using 270 μm core-diameter laser fibres (CDF); experiments with 200 μm(p-Tm:YAG) and 150 μm-CDF (TFL) were also included. A continuous laser emission was applied through a spiral trajectory for 20 seconds with the laser fibre tip in contact with synthetic hard (HSP) and soft stone phantoms (SSP) submerged in saline. “Dusting” settings for p-Tm:YAG(0,6 J-20 Hz-Flex Long Pulse), TFL(0,5 J-30 Hz-Short Pulse) and Ho:YAG(0,5 J-30 Hz-Long Pulse) and “Fragmentation” settings for p-Tm:YAG(1 J-15 Hz-Captive), TFL(1 J-15 Hz-Short Pulse) and Ho:YAG(1 J-15 Hz-Long Pulse) were analysed. Then, experiments for human calcium oxalate monohydrate (COM), uric acid (UA) and cystine (CYS) stones were performed with single laser pulses at 0.6 J, 0.8 J and 1.0 J for p-Tm:YAG (Captive Fragmenting mode), TFL (Short Pulse) and Ho:YAG (Long Pulse). Synthetic and human stone samples were dried before three-dimensional scanning to measure ablation rates (ARs) and ablation volume per pulse (AVP).
Results
For synthetic stones with 270 μm-CDF, the p-Tm:YAG and TFL presented similar ARs, except in Fragmentation against HSP (95,1 ± 13,6vs67 ± 14 p = 0,02, respectively). Both p-Tm:YAG and TFL achieved higher ARs than Ho:YAG in all settings. p-Tm:YAG-200 μm-CDF and TFL-150 μm-CDF presented similar ARs, except in Fragmentation against HSP(78,4 ± 8vs42,5 ± 2,6 mm3/min,p = 0,0002). Both p-Tm:YAG-200 μm-CDF and TFL-150 μm-CDF presented at least 50% higher ARs than 270 μm-Ho:YAG. For human stones with COM, TFL exhibited higher AVP compared to p-Tm:YAG and Ho:YAG across all pulse energies (258,2 ± 213vs81,7 ± 31,9vs41,5 ± 25,4 μm3 p = 0,01, respectively). Against UA, Ho:YAG demonstrated higher AVP compared to TFL and p-Tm:YAG (355,2 ± 161vs99,8 ± 76,7vs292,9 ± 203,1 μm3 p = 0,0005, respectively). For CYS, Ho:YAG presented higher AVP but without significance (99,8 ± 76,7 vs 49,3 ± 36,3 vs 38,8 ± 12,2 μm3, p = 0,09).
Conclusion
p-Tm:YAG and TFL achieved higher ARs than LP-Ho:YAG against synthetic stones in vitro. For human stones, TFL achieved the highest AVP against COM while LP-Ho:YAG delivered higher AVPs against UA and CYS, for which TFL performed worst.
{"title":"Comparison of p-Tm:YAG, TFL and Ho:YAG's in vitro ablation rates on synthetic and human stones","authors":"Frédéric Panthier, Alba Sierra, Etienne Xavier Keller, Marie Chicaud, Eugenio Ventimiglia, Jia-Lun Kwok, Vincent De Coninck, Mariela Corrales, Michel Daudon, Cyril Gorny, Steeve Doizi, Laurent Berthe, Daron Smith, Olivier Traxer","doi":"10.1002/bco2.70067","DOIUrl":"10.1002/bco2.70067","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To compare in vitro the ablation rates of p-Tm:YAG, TFL and Ho:YAG against synthetic and human stones.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>p-Tm:YAG, TFL and Low-Power (LP) Ho:YAG were compared using 270 μm core-diameter laser fibres (CDF); experiments with 200 μm(p-Tm:YAG) and 150 μm-CDF (TFL) were also included. A continuous laser emission was applied through a spiral trajectory for 20 seconds with the laser fibre tip in contact with synthetic hard (HSP) and soft stone phantoms (SSP) submerged in saline. “Dusting” settings for p-Tm:YAG(0,6 J-20 Hz-Flex Long Pulse), TFL(0,5 J-30 Hz-Short Pulse) and Ho:YAG(0,5 J-30 Hz-Long Pulse) and “Fragmentation” settings for p-Tm:YAG(1 J-15 Hz-Captive), TFL(1 J-15 Hz-Short Pulse) and Ho:YAG(1 J-15 Hz-Long Pulse) were analysed. Then, experiments for human calcium oxalate monohydrate (COM), uric acid (UA) and cystine (CYS) stones were performed with single laser pulses at 0.6 J, 0.8 J and 1.0 J for p-Tm:YAG (Captive Fragmenting mode), TFL (Short Pulse) and Ho:YAG (Long Pulse). Synthetic and human stone samples were dried before three-dimensional scanning to measure ablation rates (ARs) and ablation volume per pulse (AVP).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>For synthetic stones with 270 μm-CDF, the p-Tm:YAG and TFL presented similar ARs, except in Fragmentation against HSP (95,1 ± 13,6vs67 ± 14 p = 0,02, respectively). Both p-Tm:YAG and TFL achieved higher ARs than Ho:YAG in all settings. p-Tm:YAG-200 μm-CDF and TFL-150 μm-CDF presented similar ARs, except in Fragmentation against HSP(78,4 ± 8vs42,5 ± 2,6 mm<sup>3</sup>/min,p = 0,0002). Both p-Tm:YAG-200 μm-CDF and TFL-150 μm-CDF presented at least 50% higher ARs than 270 μm-Ho:YAG. For human stones with COM, TFL exhibited higher AVP compared to p-Tm:YAG and Ho:YAG across all pulse energies (258,2 ± 213vs81,7 ± 31,9vs41,5 ± 25,4 μm<sup>3</sup> p = 0,01, respectively). Against UA, Ho:YAG demonstrated higher AVP compared to TFL and p-Tm:YAG (355,2 ± 161vs99,8 ± 76,7vs292,9 ± 203,1 μm<sup>3</sup> p = 0,0005, respectively). For CYS, Ho:YAG presented higher AVP but without significance (99,8 ± 76,7 vs 49,3 ± 36,3 vs 38,8 ± 12,2 μm<sup>3</sup>, p = 0,09).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>p-Tm:YAG and TFL achieved higher ARs than LP-Ho:YAG against synthetic stones in vitro. For human stones, TFL achieved the highest AVP against COM while LP-Ho:YAG delivered higher AVPs against UA and CYS, for which TFL performed worst.</p>\u0000 </section>\u0000 </div>","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"6 8","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://bjui-journals.onlinelibrary.wiley.com/doi/epdf/10.1002/bco2.70067","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144869122","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}
Marcus Sondermann, Hannah Glaser, Anke Rentsch, Katharina Boehm, Roman Herout, Tobias Hölscher, Fabian Lohaus, Fabian Funer, Matthias Miederer, Christian Thomas, Sherif Mehralivand
Background and objective
Multidisciplinary tumour boards (MTBs) play a critical role in prostate cancer management, but their time-intensive nature limits accessibility. This study evaluates machine learning (ML) algorithms for automating MTB recommendations in prostate cancer patients, focusing on multi-label classification for diagnostic and therapeutic decisions.
Methods
A retrospective dataset of 1929 MTB recommendations from 2020 to 2024 was used for model development and validation at a single academic centre. Three ML algorithms—Decision Tree, Random Forest and K-Nearest Neighbours (KNN)—were trained to predict recommendations for PSMA-PET, conventional imaging, active surveillance and local therapy (radical prostatectomy or radiotherapy). Model performance was assessed using accuracy, precision, recall and F1-score.
Key findings and limitations
The Random Forest model achieved the highest overall accuracy (66.3%, 95% CI 61.7–71%) and showed stable performance across most outcome categories. Predictions for local therapy were highly accurate (F1-score: 0.99), but model performance was lower for less frequent recommendations such as PSMA-PET and active surveillance, reflecting class imbalance and recent guideline changes. Limitations include moderate overall accuracy, retrospective single-centre design and the need for extensive manual data preprocessing. In addition, a high proportion of patients were eligible for multiple treatment options, which may limit the discriminatory value of certain outcomes.
Conclusions and clinical implications
This study demonstrates the potential of ML to replicate MTB decision patterns in prostate cancer with reasonable accuracy. However, the current model requires further optimization before it can be considered for clinical application. It should be regarded as a proof-of-concept that highlights both the opportunities and the challenges of algorithm-based decision support in oncology. Future work should focus on improving model performance through multi-institutional data, prospective validation and continuous adaptation to evolving clinical guidelines.
背景与目的多学科肿瘤委员会（MTBs）在前列腺癌治疗中发挥着关键作用，但其耗时的性质限制了其可及性。本研究评估了机器学习（ML）算法在前列腺癌患者中自动推荐MTB，重点是诊断和治疗决策的多标签分类。方法采用一个学术中心的回顾性数据集，对2020年至2024年1929年的MTB建议进行模型开发和验证。三种机器学习算法——决策树、随机森林和k近邻（KNN）——被训练来预测PSMA-PET、常规成像、主动监测和局部治疗（根治性前列腺切除术或放疗）的建议。通过准确性、精密度、召回率和f1评分来评估模型的性能。随机森林模型获得了最高的总体准确率（66.3%,95% CI 61.7-71%），并且在大多数结果类别中表现稳定。局部治疗的预测非常准确（f1得分：0.99），但对于不太频繁的推荐，如PSMA-PET和主动监测，模型性能较低，反映了类别不平衡和最近指南的变化。局限性包括一般的总体准确性，回顾性的单中心设计和需要大量的人工数据预处理。此外，较高比例的患者适合多种治疗方案，这可能限制了某些结果的歧视性价值。结论和临床意义本研究证明了ML在前列腺癌中以合理的准确性复制MTB决策模式的潜力。然而，在考虑临床应用之前，目前的模型需要进一步优化。它应该被视为一个概念验证，突出了基于算法的肿瘤学决策支持的机遇和挑战。未来的工作应侧重于通过多机构数据、前瞻性验证和不断适应不断变化的临床指南来提高模型的性能。
{"title":"A machine learning algorithm for automatic tumour board recommendations in prostate cancer patients","authors":"Marcus Sondermann, Hannah Glaser, Anke Rentsch, Katharina Boehm, Roman Herout, Tobias Hölscher, Fabian Lohaus, Fabian Funer, Matthias Miederer, Christian Thomas, Sherif Mehralivand","doi":"10.1002/bco2.70066","DOIUrl":"10.1002/bco2.70066","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and objective</h3>\u0000 \u0000 <p>Multidisciplinary tumour boards (MTBs) play a critical role in prostate cancer management, but their time-intensive nature limits accessibility. This study evaluates machine learning (ML) algorithms for automating MTB recommendations in prostate cancer patients, focusing on multi-label classification for diagnostic and therapeutic decisions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective dataset of 1929 MTB recommendations from 2020 to 2024 was used for model development and validation at a single academic centre. Three ML algorithms—Decision Tree, Random Forest and K-Nearest Neighbours (KNN)—were trained to predict recommendations for PSMA-PET, conventional imaging, active surveillance and local therapy (radical prostatectomy or radiotherapy). Model performance was assessed using accuracy, precision, recall and F1-score.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Key findings and limitations</h3>\u0000 \u0000 <p>The Random Forest model achieved the highest overall accuracy (66.3%, 95% CI 61.7–71%) and showed stable performance across most outcome categories. Predictions for local therapy were highly accurate (F1-score: 0.99), but model performance was lower for less frequent recommendations such as PSMA-PET and active surveillance, reflecting class imbalance and recent guideline changes. Limitations include moderate overall accuracy, retrospective single-centre design and the need for extensive manual data preprocessing. In addition, a high proportion of patients were eligible for multiple treatment options, which may limit the discriminatory value of certain outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions and clinical implications</h3>\u0000 \u0000 <p>This study demonstrates the potential of ML to replicate MTB decision patterns in prostate cancer with reasonable accuracy. However, the current model requires further optimization before it can be considered for clinical application. It should be regarded as a proof-of-concept that highlights both the opportunities and the challenges of algorithm-based decision support in oncology. Future work should focus on improving model performance through multi-institutional data, prospective validation and continuous adaptation to evolving clinical guidelines.</p>\u0000 </section>\u0000 </div>","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"6 8","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://bjui-journals.onlinelibrary.wiley.com/doi/epdf/10.1002/bco2.70066","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144869121","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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