Matthew Kwon,Asaad Ahmad,Natalie Lott,Alison Blatt
OBJECTIVETo undertake a systematic review and meta-analysis to evaluate the efficacy, safety, and clinical applicability of intravesical instillations for preventing recurrent urinary tract infections (rUTIs).METHODSPubMed/MEDLINE, Embase, Cochrane CENTRAL, Scopus, and Web of Science were searched from January 2000 to April 2025 for randomised and observational studies of intravesical instillations in rUTI treatment. The primary outcome was UTI recurrence, expressed as incidence rate ratio (IRR) or risk ratio (RR). Random-effects meta-analyses were performed for three intervention families: aminoglycosides, hyaluronic acid (HA) monotherapy, and HA with chondroitin sulphate (HA + CS) combined therapy. Subgroup analyses examined population type and antibiotic used; sensitivity analyses included leave-one-out re-estimation. Other agents were narratively synthesised.RESULTSTotal of 25 studies were included. Aminoglycoside instillations produced a marked reduction in recurrence (pooled IRR 0.23, 95% confidence interval [CI] 0.15-0.37; P < 0.001), with consistent benefit across neurogenic and non-neurogenic populations and across gentamicin and amikacin. HA monotherapy was also effective (pooled RR 0.15, 95% CI 0.05-0.43; P = 0.011), although heterogeneity was high. HA + CS combined therapy showed favourable results in individual studies but an imprecise pooled effect (RR 0.41, 95% CI 0.04-4.77; P = 0.465). Narrative evidence for heparin, povidone-iodine and fosfomycin suggested potential benefit, but methods and outcome definitions were inconsistent. Serum aminoglycoside levels were undetectable where measured, and adverse events were mild and infrequent.CONCLUSIONIntravesical instillations appear safe and effective for preventing rUTIs in select patients. The strongest evidence supports aminoglycosides while HA offers a non-antibiotic alternative. HA + CS requires further study. Larger, high-quality randomised trials with standardised outcomes are needed to optimise protocols and patient selection.
目的通过系统回顾和荟萃分析，评价膀胱内滴注预防复发性尿路感染（rUTIs）的有效性、安全性和临床适用性。方法检索spubmed /MEDLINE、Embase、Cochrane CENTRAL、Scopus和Web of Science从2000年1月到2025年4月的随机观察性膀胱内滴注治疗rUTI的研究。主要终点是UTI复发率，用发病率比（IRR）或危险比（RR）表示。对三个干预家族进行随机效应荟萃分析：氨基糖苷类、透明质酸（HA）单一治疗和透明质酸与硫酸软骨素（HA + CS）联合治疗。亚组分析检查了人群类型和抗生素使用情况；敏感性分析包括留一重估。其他药剂是叙述合成的。结果共纳入25项研究。氨基糖苷滴注显著降低复发率（合并IRR 0.23, 95%可信区间[CI] 0.15-0.37; P < 0.001），在神经源性和非神经源性人群以及庆大霉素和阿米卡星中均有一致的获益。HA单药治疗也有效（合并RR 0.15, 95% CI 0.05-0.43; P = 0.011），尽管异质性很高。HA + CS联合治疗在个别研究中显示出良好的结果，但不精确的合并效应（RR 0.41, 95% CI 0.04-4.77; P = 0.465）。肝素、聚维酮碘和磷霉素的叙事证据提示潜在的益处，但方法和结果定义不一致。血清氨基糖苷水平在测量时无法检测到，不良事件轻微且罕见。结论经膀胱内滴注预防rUTIs安全有效。最有力的证据支持氨基糖苷类，而透明质酸提供了一种非抗生素替代品。HA + CS有待进一步研究。需要更大规模、高质量、结果标准化的随机试验来优化方案和患者选择。
{"title":"Intravesical therapy for recurrent urinary tract infection: a systematic review and meta-analysis.","authors":"Matthew Kwon,Asaad Ahmad,Natalie Lott,Alison Blatt","doi":"10.1111/bju.70252","DOIUrl":"https://doi.org/10.1111/bju.70252","url":null,"abstract":"OBJECTIVETo undertake a systematic review and meta-analysis to evaluate the efficacy, safety, and clinical applicability of intravesical instillations for preventing recurrent urinary tract infections (rUTIs).METHODSPubMed/MEDLINE, Embase, Cochrane CENTRAL, Scopus, and Web of Science were searched from January 2000 to April 2025 for randomised and observational studies of intravesical instillations in rUTI treatment. The primary outcome was UTI recurrence, expressed as incidence rate ratio (IRR) or risk ratio (RR). Random-effects meta-analyses were performed for three intervention families: aminoglycosides, hyaluronic acid (HA) monotherapy, and HA with chondroitin sulphate (HA + CS) combined therapy. Subgroup analyses examined population type and antibiotic used; sensitivity analyses included leave-one-out re-estimation. Other agents were narratively synthesised.RESULTSTotal of 25 studies were included. Aminoglycoside instillations produced a marked reduction in recurrence (pooled IRR 0.23, 95% confidence interval [CI] 0.15-0.37; P < 0.001), with consistent benefit across neurogenic and non-neurogenic populations and across gentamicin and amikacin. HA monotherapy was also effective (pooled RR 0.15, 95% CI 0.05-0.43; P = 0.011), although heterogeneity was high. HA + CS combined therapy showed favourable results in individual studies but an imprecise pooled effect (RR 0.41, 95% CI 0.04-4.77; P = 0.465). Narrative evidence for heparin, povidone-iodine and fosfomycin suggested potential benefit, but methods and outcome definitions were inconsistent. Serum aminoglycoside levels were undetectable where measured, and adverse events were mild and infrequent.CONCLUSIONIntravesical instillations appear safe and effective for preventing rUTIs in select patients. The strongest evidence supports aminoglycosides while HA offers a non-antibiotic alternative. HA + CS requires further study. Larger, high-quality randomised trials with standardised outcomes are needed to optimise protocols and patient selection.","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"101 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147483695","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Joost van Drumpt, Diederik Baas, Katja Aben, Arno van Leenders, Lambertus Kiemeney, Michiel Sedelaar, Peter Mulders, Jean‐Paul van Basten, Inge van Oort, Berdine Heesterman, Diederik Somford
{"title":"Response to ‘Letters to the Editor’ comments on the paper ‘Impact of positive surgical margins on biochemical recurrence and metastases after radical prostatectomy’","authors":"Joost van Drumpt, Diederik Baas, Katja Aben, Arno van Leenders, Lambertus Kiemeney, Michiel Sedelaar, Peter Mulders, Jean‐Paul van Basten, Inge van Oort, Berdine Heesterman, Diederik Somford","doi":"10.1111/bju.70242","DOIUrl":"https://doi.org/10.1111/bju.70242","url":null,"abstract":"","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"27 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147478003","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Matthijs Duijn, Aline M. Tijans, R. Jeroen A. van Moorselaar, Marjoleine F. Broekema, Marleen E. de Lange, Emiel D. Post Uiterweer, Marilyne M. Lange, Naomi Donner, Markus V. Starink, Antoinette Hollestelle, Liselotte P. van Hest, Femke Struik, Patricia J. Zondervan
{"title":"Clinical characteristics and follow‐up of 77 patients with pathogenic fumarate hydratase variants","authors":"Matthijs Duijn, Aline M. Tijans, R. Jeroen A. van Moorselaar, Marjoleine F. Broekema, Marleen E. de Lange, Emiel D. Post Uiterweer, Marilyne M. Lange, Naomi Donner, Markus V. Starink, Antoinette Hollestelle, Liselotte P. van Hest, Femke Struik, Patricia J. Zondervan","doi":"10.1111/bju.70257","DOIUrl":"https://doi.org/10.1111/bju.70257","url":null,"abstract":"","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"11 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147478005","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Aleksander Ślusarczyk,Pietro Scilipoti,Roberto Contieri,Wojciech Krajewski,Francesco Claps,José Daniel Subiela,Laura S Mertens,Keiichiro Mori,Elisabeth Grobet-Jeandin,Jorge Caño Velasco,Karl Tully,Francesco Soria,Pedro Del Olmo Duran,Alfonso Lafuente Puentedura,Renee A G Lijnen,Mattia Longoni,Gautier Marcq,Andrea Mari,Ekaterina Laukhtina,Luca Afferi,Simone Albisinni,Andrea Gallioli,Francesco Del Giudice,Stephen A Boorjian,Alberto Briganti,Shahrokh F Shariat,Paolo Gontero,Piotr Radziszewski,Marco Moschini,Benjamin Pradere, ,
OBJECTIVETo validate International Bladder Cancer Group (IBCG) definitions of Bacillus Calmette-Guérin (BCG)-unresponsive and BCG-exposed non-muscle-invasive bladder cancer (NMIBC) and assess prognostic heterogeneity across various BCG-failure types.PATIENTS AND METHODSFrom a multicentre international cohort of 3806 BCG-treated patients, 591 who developed high-grade NMIBC recurrence following BCG between 2003 and 2024 were included. Progression-free survival (PFS) was the primary endpoint; cancer-specific (CSM) and overall mortality (OM) were secondary endpoints. Cumulative incidence functions, competing-risk models and multivariable Cox regression were used.RESULTSPatients with BCG-unresponsive and BCG-exposed disease showed similar PFS, CSM, and OM (all P > 0.05). When stratified into five subgroups, prognosis varied: 5-year progression rates were 29% for BCG-unresponsive, 32.5% for late relapse (between 6 and 24 months) after adequate BCG, 30% for BCG-exposed with inadequate BCG (<24 months from induction), 6.2% for BCG-resistant, and 14% for very late relapse (>24 months since last BCG) (P < 0.01). In multivariable analysis, BCG-exposed after inadequate BCG (subdistribution hazard ratio [sHR] 3.42, 95% confidence interval [CI] 1.33-8.84), late relapse (sHR 3.74, 95% CI 1.59-8.78), and BCG-unresponsive (sHR 2.34, 95% CI 1.00-5.44) were associated with higher progression risks compared to very late relapse. Limitations include retrospective design and treatment heterogeneity.CONCLUSIONSUnder IBCG definitions, BCG-unresponsive and BCG-exposed NMIBC have similarly poor outcomes. A refined classification reveals prognostic heterogeneity, with late relapses after adequate BCG demonstrating outcomes comparable to BCG-unresponsive, and very late relapses conferring better prognosis.
目的验证国际膀胱癌组织（IBCG）对卡介苗（BCG）无反应和暴露于BCG的非肌肉浸润性膀胱癌（NMIBC）的定义，并评估不同BCG衰竭类型的预后异质性。患者和方法：来自3806例BCG治疗患者的多中心国际队列，其中591例在2003年至2024年期间发生BCG后高度NMIBC复发。无进展生存期（PFS）是主要终点；癌症特异性（CSM）和总死亡率（OM）是次要终点。采用累积关联函数、竞争风险模型和多变量Cox回归。结果bcg无应答和bcg暴露患者的PFS、CSM和OM表现相似（P < 0.05）。当被分为5个亚组时，预后各不相同：BCG无应答者的5年进展率为29%，BCG充足后晚期复发（6至24个月）者的5年进展率为32.5%，BCG暴露者（距最后一次BCG 24个月）的5年进展率为30% （P < 0.01）。在多变量分析中，BCG暴露不足（亚分布风险比[sHR] 3.42, 95%可信区间[CI] 1.33-8.84）、晚期复发（sHR 3.74, 95% CI 1.59-8.78）和BCG无应答（sHR 2.34, 95% CI 1.00-5.44）与晚期复发相比具有更高的进展风险。局限性包括回顾性设计和治疗异质性。结论根据IBCG的定义，bcg无反应和bcg暴露的NMIBC具有相似的不良结局。精细化的分类揭示了预后的异质性，充分卡介苗后的晚期复发显示出与卡介苗无反应的结果相当，而非常晚的复发赋予了更好的预后。
{"title":"Refining BCG-failure classifications in non-muscle-invasive bladder cancer.","authors":"Aleksander Ślusarczyk,Pietro Scilipoti,Roberto Contieri,Wojciech Krajewski,Francesco Claps,José Daniel Subiela,Laura S Mertens,Keiichiro Mori,Elisabeth Grobet-Jeandin,Jorge Caño Velasco,Karl Tully,Francesco Soria,Pedro Del Olmo Duran,Alfonso Lafuente Puentedura,Renee A G Lijnen,Mattia Longoni,Gautier Marcq,Andrea Mari,Ekaterina Laukhtina,Luca Afferi,Simone Albisinni,Andrea Gallioli,Francesco Del Giudice,Stephen A Boorjian,Alberto Briganti,Shahrokh F Shariat,Paolo Gontero,Piotr Radziszewski,Marco Moschini,Benjamin Pradere, , ","doi":"10.1111/bju.70231","DOIUrl":"https://doi.org/10.1111/bju.70231","url":null,"abstract":"OBJECTIVETo validate International Bladder Cancer Group (IBCG) definitions of Bacillus Calmette-Guérin (BCG)-unresponsive and BCG-exposed non-muscle-invasive bladder cancer (NMIBC) and assess prognostic heterogeneity across various BCG-failure types.PATIENTS AND METHODSFrom a multicentre international cohort of 3806 BCG-treated patients, 591 who developed high-grade NMIBC recurrence following BCG between 2003 and 2024 were included. Progression-free survival (PFS) was the primary endpoint; cancer-specific (CSM) and overall mortality (OM) were secondary endpoints. Cumulative incidence functions, competing-risk models and multivariable Cox regression were used.RESULTSPatients with BCG-unresponsive and BCG-exposed disease showed similar PFS, CSM, and OM (all P > 0.05). When stratified into five subgroups, prognosis varied: 5-year progression rates were 29% for BCG-unresponsive, 32.5% for late relapse (between 6 and 24 months) after adequate BCG, 30% for BCG-exposed with inadequate BCG (<24 months from induction), 6.2% for BCG-resistant, and 14% for very late relapse (>24 months since last BCG) (P < 0.01). In multivariable analysis, BCG-exposed after inadequate BCG (subdistribution hazard ratio [sHR] 3.42, 95% confidence interval [CI] 1.33-8.84), late relapse (sHR 3.74, 95% CI 1.59-8.78), and BCG-unresponsive (sHR 2.34, 95% CI 1.00-5.44) were associated with higher progression risks compared to very late relapse. Limitations include retrospective design and treatment heterogeneity.CONCLUSIONSUnder IBCG definitions, BCG-unresponsive and BCG-exposed NMIBC have similarly poor outcomes. A refined classification reveals prognostic heterogeneity, with late relapses after adequate BCG demonstrating outcomes comparable to BCG-unresponsive, and very late relapses conferring better prognosis.","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"31 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147483697","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objectives To validate urinary myelin basic protein (uMBP) as a mechanism‐based diagnostic and prognostic biomarker for paediatric overactive bladder‐dry (OAB‐dry) in children with 25‐hydroxyvitamin D (25[OH]D) levels of <35 ng/mL, and to explore whether vitamin D supplementation (VDS) targets a reversible neuromyelination pathway. Patients and Methods This three‐phase study comprised: (i) discovery of candidate biomarkers via urinary proteomics; (ii) diagnostic validation in a cross‐sectional cohort ( n = 216); and (iii) a 12‐week multicentre randomised controlled trial (RCT, n = 180). Children with OAB‐dry and 25(OH)D level of <35 ng/mL were randomised (1:1) to receive high‐dose VDS (2400 IU/day) plus standard urotherapy (SU) or solifenacin (5 mg/day) plus SU. The primary outcome was the change in daily voiding frequency. We evaluated the interaction between baseline uMBP/creatinine ratio (uMBP/Cr) and treatment response and performed moderated mediation analysis to assess the mechanistic role of uMBP/Cr reduction. Results The uMBP/Cr was significantly elevated in paediatric OAB‐dry with vitamin D levels of <35 ng/mL and showed a strong negative correlation with 25(OH)D levels ( ρ = −0.69, P < 0.001). It achieved an area under the curve of 0.80 for diagnosing paediatric OAB with 25(OH)D levels of <35 ng/mL. In the RCT, VDS + SU demonstrated superior efficacy compared to solifenacin + SU in reducing voiding frequency (adjusted difference: 2.7 voids/day, P < 0.001). Importantly, baseline uMBP/Cr significantly modified the treatment effect: higher baseline levels predicted a greater reduction in symptoms with VDS + SU ( Ptrend < 0.001). Furthermore, the reduction in uMBP/Cr during treatment mediated 35.2% of the therapeutic benefit of VDS on voiding frequency, supporting a treatment mechanism involving myelin restoration. Conclusion Urinary MBP serves as a predictive biomarker for a distinct ‘neuro‐vulnerable’ paediatric OAB‐dry subtype, characterised by 25(OH)D levels of <35 ng/mL. These findings position uMBP as a potential tool for precision treatment stratification and suggest that paediatric OAB may represent a sentinel sign of underlying neural axis vulnerability associated with low vitamin D status.
{"title":"Is urinary myelin basic protein the key to understanding the role of vitamin D supplementation in paediatric overactive bladder‐dry? Results from a three‐stage clinical investigation","authors":"Hongsong Chen, Zhicheng Zhang, Zihan Ye, Qiang Zhang, Ting Zhang, Nini An, Yichen Huang, Hongcheng Song, Shengde Wu, Deying Zhang, Xing Liu, Guanghui Wei","doi":"10.1111/bju.70228","DOIUrl":"https://doi.org/10.1111/bju.70228","url":null,"abstract":"Objectives To validate urinary myelin basic protein (uMBP) as a mechanism‐based diagnostic and prognostic biomarker for paediatric overactive bladder‐dry (OAB‐dry) in children with 25‐hydroxyvitamin D (25[OH]D) levels of <35 ng/mL, and to explore whether vitamin D supplementation (VDS) targets a reversible neuromyelination pathway. Patients and Methods This three‐phase study comprised: (i) discovery of candidate biomarkers via urinary proteomics; (ii) diagnostic validation in a cross‐sectional cohort ( <jats:italic>n</jats:italic> = 216); and (iii) a 12‐week multicentre randomised controlled trial (RCT, <jats:italic>n</jats:italic> = 180). Children with OAB‐dry and 25(OH)D level of <35 ng/mL were randomised (1:1) to receive high‐dose VDS (2400 IU/day) plus standard urotherapy (SU) or solifenacin (5 mg/day) plus SU. The primary outcome was the change in daily voiding frequency. We evaluated the interaction between baseline uMBP/creatinine ratio (uMBP/Cr) and treatment response and performed moderated mediation analysis to assess the mechanistic role of uMBP/Cr reduction. Results The uMBP/Cr was significantly elevated in paediatric OAB‐dry with vitamin D levels of <35 ng/mL and showed a strong negative correlation with 25(OH)D levels ( <jats:italic>ρ</jats:italic> = −0.69, <jats:italic>P</jats:italic> < 0.001). It achieved an area under the curve of 0.80 for diagnosing paediatric OAB with 25(OH)D levels of <35 ng/mL. In the RCT, VDS + SU demonstrated superior efficacy compared to solifenacin + SU in reducing voiding frequency (adjusted difference: 2.7 voids/day, <jats:italic>P</jats:italic> < 0.001). Importantly, baseline uMBP/Cr significantly modified the treatment effect: higher baseline levels predicted a greater reduction in symptoms with VDS + SU ( <jats:italic>P</jats:italic> <jats:sub>trend</jats:sub> < 0.001). Furthermore, the reduction in uMBP/Cr during treatment mediated 35.2% of the therapeutic benefit of VDS on voiding frequency, supporting a treatment mechanism involving myelin restoration. Conclusion Urinary MBP serves as a predictive biomarker for a distinct ‘neuro‐vulnerable’ paediatric OAB‐dry subtype, characterised by 25(OH)D levels of <35 ng/mL. These findings position uMBP as a potential tool for precision treatment stratification and suggest that paediatric OAB may represent a sentinel sign of underlying neural axis vulnerability associated with low vitamin D status.","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"17 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147478007","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Adree Khondker,Numan Baydilli,Edoardo Bindi,Quinten Bogaerts,Muhammet Irfan Donmez,Christa Gernhold,Rianne J M Lammers,Beatriz B Marco,Ugo Maria Pierucci,Yesica Quiroz,Ismail Selvi,Vasileios Tatanis,Lisette A 't Hoen,
{"title":"Subjectivity in paediatric urological imaging: a European Association of Urology-Young Academic Urologists (EAU-YAU) reliability study with consensus datasets.","authors":"Adree Khondker,Numan Baydilli,Edoardo Bindi,Quinten Bogaerts,Muhammet Irfan Donmez,Christa Gernhold,Rianne J M Lammers,Beatriz B Marco,Ugo Maria Pierucci,Yesica Quiroz,Ismail Selvi,Vasileios Tatanis,Lisette A 't Hoen, ","doi":"10.1111/bju.70237","DOIUrl":"https://doi.org/10.1111/bju.70237","url":null,"abstract":"","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"11 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147471552","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hugo W Schuil,Nora Hendriks,Ruben G Duijnhoven,Bart C H Oskam,Tom J H Arends,Diederick Duijvesz,Alexander D Horsch,Bart van der Heij,Irene M Tjiam,Hans van Overhagen,Armand B G N Lamers,Otto M van Delden,Wout A Scheepens,Jamie M A Drossaerts,Frank C H d'Ancona,Steven Boering,Janneke I M van Uhm,Rutger W van der Meer,J Herman van Roijen,Martin de Kiefte,Ad J M Hendrikx,Saskia Weltings,Rob C M Pelger,Harrie P Beerlage,Barbara M A Schout,Guido M Kamphuis
OBJECTIVETo compare the effects of percutaneous nephrostomy (PCN) and JJ ureteric stent (JJ) for urinary tract decompression in patients with obstructive urolithiasis on health-related quality of life (HRQoL), pain scores, urinary symptoms, and patient satisfaction.PATIENTS AND METHODSIn 11 hospitals, 204 patients with obstructive urolithiasis were randomised to JJ or PCN placement. Patient-reported outcome measures (PROMs) were assessed until stone passage, surgical removal, or at 3 months.RESULTSBoth PCN and JJ effectively improved HRQoL index scores (PCN: pre-decompression 0.70, 1 day post-decompression 0.82, P = 0.003; JJ: pre 0.59, post 0.85, P < 0.001), pain scores (PCN: pre 4.9, post 1.3, P < 0.001; JJ: pre 5.5, post 1.3, P < 0.001), and achieved patient satisfaction (score at discharge PCN: 7.9; JJ: 8.2), with no significant differences between interventions in overall HRQoL (generalised estimating equation [GEE] P = 0.7) or mean daily pain scores (GEE P = 0.4). PCN led to more self-care difficulties (patients reporting no problems: PCN 74%, JJ 91%, P = 0.023), while JJ recipients reported more urinary symptoms and higher peak pain intensity (pain score PCN: 2.3, JJ: 3.7, between groups P = 0.018). Despite symptoms, more JJ recipients preferred the same intervention in future (60%), than PCN recipients (31%) (P < 0.001). Survey-based data collection may introduce response bias (response rate 59%).CONCLUSIONIn patients with obstructive urolithiasis, urinary decompression with PCN and JJ improved HRQoL and pain comparably. JJ causes more urinary symptoms and peak pain but allows better self-care. Baseline self-care and urinary symptoms should guide shared decision-making. Drainage duration should be minimised.
目的比较经皮肾造口术（PCN）和JJ输尿管支架术（JJ）对梗阻性尿石症患者健康相关生活质量（HRQoL）、疼痛评分、泌尿系统症状和患者满意度的影响。患者和方法在11家医院，204例梗阻性尿石症患者被随机分配到JJ或PCN放置组。评估患者报告的预后指标（PROMs），直至结石排出、手术切除或3个月。RESULTSBoth PCN和JJ有效改善HRQoL指数评分(PCN: pre-decompression 0.70, 1天post-decompression 0.82, P = 0.003; JJ:前0.59,0.85,P < 0.001),疼痛评分(PCN: pre - 4.9, 1.3, P < 0.001; JJ:前5.5,1.3,P < 0.001),取得了患者满意度(放电PCN得分:7.9;JJ: 8.2),与整体干预HRQoL之间没有显著差异(广义估计方程(GEE) P = 0.7)或意味着每天疼痛评分(哎呀P = 0.4)。PCN导致更多的自我照顾困难（患者报告无问题：PCN占74%，JJ占91%，P = 0.023），而JJ接受者报告更多的泌尿系统症状和更高的峰值疼痛强度（疼痛评分PCN: 2.3, JJ: 3.7，组间P = 0.018）。尽管有症状，JJ受体（60%）比PCN受体（31%）更倾向于未来同样的干预措施（P < 0.001）。基于调查的数据收集可能会引入反应偏差（回复率59%）。结论梗阻性尿石症患者行PCN和JJ尿路减压可显著改善患者HRQoL和疼痛。JJ会引起更多的泌尿系统症状和疼痛高峰，但可以更好地自我照顾。基线自我保健和泌尿系统症状应指导共同决策。应尽量缩短排水时间。
{"title":"Patient-reported outcome measures of percutaneous nephrostomy vs JJ stent in obstructive urolithiasis: results of the STent Or NEphrostomy (STONE) randomised controlled trial.","authors":"Hugo W Schuil,Nora Hendriks,Ruben G Duijnhoven,Bart C H Oskam,Tom J H Arends,Diederick Duijvesz,Alexander D Horsch,Bart van der Heij,Irene M Tjiam,Hans van Overhagen,Armand B G N Lamers,Otto M van Delden,Wout A Scheepens,Jamie M A Drossaerts,Frank C H d'Ancona,Steven Boering,Janneke I M van Uhm,Rutger W van der Meer,J Herman van Roijen,Martin de Kiefte,Ad J M Hendrikx,Saskia Weltings,Rob C M Pelger,Harrie P Beerlage,Barbara M A Schout,Guido M Kamphuis","doi":"10.1111/bju.70249","DOIUrl":"https://doi.org/10.1111/bju.70249","url":null,"abstract":"OBJECTIVETo compare the effects of percutaneous nephrostomy (PCN) and JJ ureteric stent (JJ) for urinary tract decompression in patients with obstructive urolithiasis on health-related quality of life (HRQoL), pain scores, urinary symptoms, and patient satisfaction.PATIENTS AND METHODSIn 11 hospitals, 204 patients with obstructive urolithiasis were randomised to JJ or PCN placement. Patient-reported outcome measures (PROMs) were assessed until stone passage, surgical removal, or at 3 months.RESULTSBoth PCN and JJ effectively improved HRQoL index scores (PCN: pre-decompression 0.70, 1 day post-decompression 0.82, P = 0.003; JJ: pre 0.59, post 0.85, P < 0.001), pain scores (PCN: pre 4.9, post 1.3, P < 0.001; JJ: pre 5.5, post 1.3, P < 0.001), and achieved patient satisfaction (score at discharge PCN: 7.9; JJ: 8.2), with no significant differences between interventions in overall HRQoL (generalised estimating equation [GEE] P = 0.7) or mean daily pain scores (GEE P = 0.4). PCN led to more self-care difficulties (patients reporting no problems: PCN 74%, JJ 91%, P = 0.023), while JJ recipients reported more urinary symptoms and higher peak pain intensity (pain score PCN: 2.3, JJ: 3.7, between groups P = 0.018). Despite symptoms, more JJ recipients preferred the same intervention in future (60%), than PCN recipients (31%) (P < 0.001). Survey-based data collection may introduce response bias (response rate 59%).CONCLUSIONIn patients with obstructive urolithiasis, urinary decompression with PCN and JJ improved HRQoL and pain comparably. JJ causes more urinary symptoms and peak pain but allows better self-care. Baseline self-care and urinary symptoms should guide shared decision-making. Drainage duration should be minimised.","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"17 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147471551","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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