To explore Australian data on perioperative chemotherapy use and associated outcomes in muscle-invasive bladder cancer (MIBC).
An observational study of patients with MIBC treated with neoadjuvant chemotherapy, adjuvant chemotherapy or surgery alone was conducted using data from BLADDA, a multicentre Australian urothelial cancer registry. Pathological response to neoadjuvant chemotherapy and its effect on event-free survival (EFS) and overall survival (OS) were determined. EFS and OS in patients who underwent neoadjuvant chemotherapy, adjuvant chemotherapy or surgery alone were compared using univariate and multivariable proportional hazards regression.
From 2018 to 2024, 259 patients enrolled in the BLADDA registry met inclusion criteria, of which 45% received neoadjuvant chemotherapy, 23% received adjuvant chemotherapy, 1.2% received both neoadjuvant and adjuvant chemotherapy and 31% underwent surgery only. The proportion of patients treated with neoadjuvant chemotherapy increased over time. A total of 21 of 67 (31%) evaluable subjects achieved a pathological complete response, which was associated with improved EFS and OS. Excluding patients who received both neoadjuvant and adjuvant chemotherapy, the EFS hazard ratio (HR) was 0.43 (95% confidence interval [CI] 0.29–0.65, p < 0.001) for neoadjuvant chemotherapy and 0.59 (95% CI 0.38–0.94, p = 0.03) for adjuvant chemotherapy compared to surgery alone. Neoadjuvant chemotherapy was associated with prolonged OS in the univariate analysis (HR 0.43, 95% CI 0.26–0.73, p = 0.002) but not in the multivariable analysis (HR 0.59, 95% CI 0.32–1.08, p = 0.09). OS was not improved with adjuvant chemotherapy (unadjusted HR 0.76, 95% CI 0.44–1.31, p = 0.3; adjusted HR 0.86, 95% CI 0.46–1.60, p = 0.6).
Neoadjuvant chemotherapy use for MIBC in Australia has increased over the past decade, but it remains underutilised. This has important implications as perioperative chemo-immunotherapy emerges as a standard of care. Although a clear impact on survival in the overall population was not observed, this was potentially due to the limited sample size.
To evaluate the clinical significance of a second transurethral resection of the bladder tumour (TURBT) in patients with a primary high-grade (HG) Ta non-muscle invasive bladder cancer (NMIBC), specifically selected for the initial diagnosis.
We retrospectively analysed 121 patients with primary HG Ta urothelial carcinoma treated at our institution between January 2007 and October 2024. All patients underwent an initial TURBT with the detrusor muscle present in the specimen. Patients were divided into the second TUR group (n = 48) and the non-second TUR group (n = 73). Propensity score matching was performed using age, number of tumours and Bacillus Calmette–Guerin treatment status. Outcomes included the residual tumour rate, recurrence-free survival (RFS), time to progression to muscle invasive bladder cancer (MIBC) and cancer-specific survival (CSS).
Residual tumour at the initial resection site was identified in four patients (8.3%) who underwent a second TUR, with two patients (4.2%) being upstaged to T1. The median follow-up was 53 months. There were no significant differences between the two groups in RFS (p = 0.60), time to progression to MIBC (p = 0.63) or CSS (p = 0.18). These findings remained consistent in the matched cohort. Multivariate analysis revealed that a second TUR was not associated with improved RFS.
This is the first study to specifically address primary HG Ta bladder cancer, and it suggests that a second TUR may be omitted in selected cases, particularly when the initial resection is complete and the detrusor muscle is adequately sampled. A risk-adapted approach may help reduce unnecessary procedures without compromising oncological safety.
Most, but not all studies, suggest insulin resistance is associated with benign prostatic hyperplasia, but its impact on prostate volume (PV) changes over time remains unclear. We examined whether higher insulin resistance, measured by Homeostatic Model Assessment of Insulin Resistance (HOMA-IR), is associated with larger PV and greater prostate growth over a 4-year period.
We analysed data from the 4-year, randomized, double-blind, placebo-controlled REDUCE trial testing whether dutasteride could prevent prostate cancer. Patients underwent transrectal ultrasound measuring PV at baseline, year 2 and year 4. We calculated HOMA-IR from baseline fasting glucose and insulin, then stratified patients into quartiles within each arm (placebo vs. dutasteride). Using multivariable models, we estimated PV changes over time. We conducted a sensitivity analysis excluding patients with diabetes.
Higher HOMA-IR quartiles were associated with larger PV at baseline, year 2 and year 4 in both placebo and dutasteride arms (all p < 0.001), though absolute differences were modest. PV increased in the placebo arm over 4 years, whereas it decreased in the dutasteride arm. However, there was no significant association between HOMA-IR and PV change in either arm. Results remained unchanged after excluding patients with diabetes.
Patients with higher HOMA-IR had modestly larger PVs at baseline, year 2 and year 4, but insulin resistance was unrelated to PV change over four years. These findings suggest that insulin resistance may be a modifiable risk factor contributing to benign prostatic enlargement, though further research is needed to determine its clinical relevance.
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.
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).
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).
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.
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).
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.
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%).
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.
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.
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.
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.
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.
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.
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.
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).
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.
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.
3.2 | Secondary objectives and endpoints
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