Yash Khanna, Vidyasagar Chinni, Kavitha Gnanasambantham, Eldho Paul, Richard O'Sullivan, Zita E. Ballok, Andrew Ryan, Shakher Ramdave, Dinesh Sivaratnam, Patrick Bowden, Mario Guerrieri, Weranja K.B. Ranasinghe, Mark Frydenberg
To analyse the utility of adding multiparametric magnetic resonance imaging (mpMRI) with 68Ga-prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) in detection of local recurrence (LR) and distant recurrence (DR) in patients with biochemical recurrence (BCR), by describing detection rates over time since radical prostatectomy (RP), describing detection rates at differing prostate-specific antigen (PSA) intervals, and identifying clinicopathological factors that predict detection of recurrence on imaging.
{"title":"Does addition of multiparametric MRI to PSMA PET/CT improve diagnostic accuracy for biochemical recurrence after radical prostatectomy?","authors":"Yash Khanna, Vidyasagar Chinni, Kavitha Gnanasambantham, Eldho Paul, Richard O'Sullivan, Zita E. Ballok, Andrew Ryan, Shakher Ramdave, Dinesh Sivaratnam, Patrick Bowden, Mario Guerrieri, Weranja K.B. Ranasinghe, Mark Frydenberg","doi":"10.1111/bju.70115","DOIUrl":"https://doi.org/10.1111/bju.70115","url":null,"abstract":"To analyse the utility of adding multiparametric magnetic resonance imaging (mpMRI) with <sup>68</sup>Ga-prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) in detection of local recurrence (LR) and distant recurrence (DR) in patients with biochemical recurrence (BCR), by describing detection rates over time since radical prostatectomy (RP), describing detection rates at differing prostate-specific antigen (PSA) intervals, and identifying clinicopathological factors that predict detection of recurrence on imaging.","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"57 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145919793","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}
Cian M Hehir, Gavin G Calpin, Orla Cullivan, Gordon R Daly, Gavin P Dowling, Niall F Davis
Objective: To critically evaluate the existing evidence base surrounding the efficacy of preoperative 5-alpha reductase inhibitor (5ARI) administration in the reduction of perioperative complication rates in transurethral resection of prostate (TURP).
Methods: In April 2025, a systematic search of on-line databases was conducted to identify randomised controlled trials (RCTs) that compared surgical outcomes and complication rates in patients undergoing TURP for benign prostatic hyperplasia (BPH) who were treated preoperatively with 5ARI (finasteride or dutasteride) as compared to placebo/none. The efficacy of preoperative finasteride was evaluated through outcomes related to blood loss, rate of blood transfusion, and operative time. The physiological mechanism of 5ARI treatment was evaluated through microvessel density (MVD) and vascular endothelial growth factor (VEGF) expression of the resected specimen.
Results: A total of 30 RCTs met the inclusion criteria for this meta-analysis in which a total of 2974 patients underwent TURP for BPH (1464 5ARI: 1410 Control). Intraoperative blood loss was significantly lower among 5ARI-treated patients (Z = 6.37, mean difference [MD] = -82.58 mL, 95% confidence interval [CI] -107.98 to -57.18; P < 0.001), which was reflected in a significantly lesser haemoglobin drop on the first postoperative day (Z = 6.84, MD = -0.90 g/dL, 95% CI-1.16 to -0.64; P < 0.001). The MVD was significantly lower in resected specimens from 5ARI-treated patients (MD = -6.18 vessels/mm3, P < 0.001), whilst expressing significantly less VEGF (MD = -3.25, P < 0.001). Patients treated with 5ARI required blood transfusion less frequently than controls (odds ratio 0.31, P < 0.001). The use of 5ARI was associated with shorter operative time (MD = -3.47 min, P = 0.02) and lower volume of irrigation agents (MD = -2.07 L, P < 0.001).
Conclusion: Preoperative administration of 5ARIs significantly reduces intraoperative blood loss and risk of requiring blood transfusion in patients undergoing TURP for BPH. Even short durations (2 weeks) of 5ARI therapy can significantly reduce prostate vascularity.
{"title":"The role of 5-alpha reductase inhibitors in transurethral resection of the prostate: a meta-analysis of randomised controlled trials.","authors":"Cian M Hehir, Gavin G Calpin, Orla Cullivan, Gordon R Daly, Gavin P Dowling, Niall F Davis","doi":"10.1111/bju.70117","DOIUrl":"https://doi.org/10.1111/bju.70117","url":null,"abstract":"<p><strong>Objective: </strong>To critically evaluate the existing evidence base surrounding the efficacy of preoperative 5-alpha reductase inhibitor (5ARI) administration in the reduction of perioperative complication rates in transurethral resection of prostate (TURP).</p><p><strong>Methods: </strong>In April 2025, a systematic search of on-line databases was conducted to identify randomised controlled trials (RCTs) that compared surgical outcomes and complication rates in patients undergoing TURP for benign prostatic hyperplasia (BPH) who were treated preoperatively with 5ARI (finasteride or dutasteride) as compared to placebo/none. The efficacy of preoperative finasteride was evaluated through outcomes related to blood loss, rate of blood transfusion, and operative time. The physiological mechanism of 5ARI treatment was evaluated through microvessel density (MVD) and vascular endothelial growth factor (VEGF) expression of the resected specimen.</p><p><strong>Results: </strong>A total of 30 RCTs met the inclusion criteria for this meta-analysis in which a total of 2974 patients underwent TURP for BPH (1464 5ARI: 1410 Control). Intraoperative blood loss was significantly lower among 5ARI-treated patients (Z = 6.37, mean difference [MD] = -82.58 mL, 95% confidence interval [CI] -107.98 to -57.18; P < 0.001), which was reflected in a significantly lesser haemoglobin drop on the first postoperative day (Z = 6.84, MD = -0.90 g/dL, 95% CI-1.16 to -0.64; P < 0.001). The MVD was significantly lower in resected specimens from 5ARI-treated patients (MD = -6.18 vessels/mm<sup>3</sup>, P < 0.001), whilst expressing significantly less VEGF (MD = -3.25, P < 0.001). Patients treated with 5ARI required blood transfusion less frequently than controls (odds ratio 0.31, P < 0.001). The use of 5ARI was associated with shorter operative time (MD = -3.47 min, P = 0.02) and lower volume of irrigation agents (MD = -2.07 L, P < 0.001).</p><p><strong>Conclusion: </strong>Preoperative administration of 5ARIs significantly reduces intraoperative blood loss and risk of requiring blood transfusion in patients undergoing TURP for BPH. Even short durations (2 weeks) of 5ARI therapy can significantly reduce prostate vascularity.</p>","PeriodicalId":8985,"journal":{"name":"BJU International","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145916736","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}
Stefanie M Croghan,Kevin Byrnes,Arjun Nathan,Christoph Schregel,Cameron E Alexander,Veeru Kasivisvanathan,Matthew B K Shaw,David Walker,Hari Ratan,Wai Gin Lee,Alistair Rogers,Daron Smith
{"title":"Are we far from getting it right? Contemporary practices in culturing urine pre-ureteroscopy.","authors":"Stefanie M Croghan,Kevin Byrnes,Arjun Nathan,Christoph Schregel,Cameron E Alexander,Veeru Kasivisvanathan,Matthew B K Shaw,David Walker,Hari Ratan,Wai Gin Lee,Alistair Rogers,Daron Smith","doi":"10.1111/bju.70101","DOIUrl":"https://doi.org/10.1111/bju.70101","url":null,"abstract":"","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"11 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145907804","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}
Stefano Puliatti, Natali Rodriguez Peñaranda, Marco Amato, Ruben De Groote, Rui Farinha, Brendan Bunting, Ben van Cleynenbreugel, Alexandre Mottrie, Anthony G Gallagher
Objective: To evaluate the cost-effectiveness of proficiency-based progression (PBP) training compared to conventional surgical training approaches, and to determine whether PBP training implementation is economically justified when scaled to large numbers of trainees.
Methods: Economic analysis was performed using data from the prospective, randomised, and blinded Orsi Surgical Skills E-learning Trial (OSSET; ClinicalTrials.gov identifier: NCT04541615) at ORSI Academy (Belgium), where 47 medical trainees without prior robotic surgery experience were randomised into four groups, each with progressively reduced adherence to the PBP methodology. All trainees completed simulation-based training on a validated bladder-urethra anastomosis model, ranging from full PBP training with metric-based assessment and proficiency benchmarks (Group 1) to a traditional apprenticeship model (Group 4). The primary outcome was training cost, evaluated per trainee and based on programme scalability (12-500 trainees), including expenses for accommodation, laboratory time, and metric development. Cost equivalence points and scalability thresholds were identified to compare the financial impact of the four training strategies.
Results: The PBP training was more expensive than conventional methods for small cohorts (e.g. €14 139 vs €7067 per trainee for 12 trainees), but became significantly more cost-effective beyond 25 trainees (equivalence point). At 500 trainees, total PBP training cost was €1.69 million compared to €3.53 million for conventional training, a 110% cost advantage. All differences were statistically significant (P < 0.001).
Conclusions: We conclude that PBP training is significantly more effective and becomes increasingly cost-efficient as the number of trainees increases. These findings support its integration into high-volume national training programmes, offering a scalable and economically sustainable alternative to apprenticeship-based surgical education.
{"title":"Randomised trial on the economic impact of proficiency-based progression vs conventional robotic surgical training.","authors":"Stefano Puliatti, Natali Rodriguez Peñaranda, Marco Amato, Ruben De Groote, Rui Farinha, Brendan Bunting, Ben van Cleynenbreugel, Alexandre Mottrie, Anthony G Gallagher","doi":"10.1111/bju.70130","DOIUrl":"https://doi.org/10.1111/bju.70130","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the cost-effectiveness of proficiency-based progression (PBP) training compared to conventional surgical training approaches, and to determine whether PBP training implementation is economically justified when scaled to large numbers of trainees.</p><p><strong>Methods: </strong>Economic analysis was performed using data from the prospective, randomised, and blinded Orsi Surgical Skills E-learning Trial (OSSET; ClinicalTrials.gov identifier: NCT04541615) at ORSI Academy (Belgium), where 47 medical trainees without prior robotic surgery experience were randomised into four groups, each with progressively reduced adherence to the PBP methodology. All trainees completed simulation-based training on a validated bladder-urethra anastomosis model, ranging from full PBP training with metric-based assessment and proficiency benchmarks (Group 1) to a traditional apprenticeship model (Group 4). The primary outcome was training cost, evaluated per trainee and based on programme scalability (12-500 trainees), including expenses for accommodation, laboratory time, and metric development. Cost equivalence points and scalability thresholds were identified to compare the financial impact of the four training strategies.</p><p><strong>Results: </strong>The PBP training was more expensive than conventional methods for small cohorts (e.g. €14 139 vs €7067 per trainee for 12 trainees), but became significantly more cost-effective beyond 25 trainees (equivalence point). At 500 trainees, total PBP training cost was €1.69 million compared to €3.53 million for conventional training, a 110% cost advantage. All differences were statistically significant (P < 0.001).</p><p><strong>Conclusions: </strong>We conclude that PBP training is significantly more effective and becomes increasingly cost-efficient as the number of trainees increases. These findings support its integration into high-volume national training programmes, offering a scalable and economically sustainable alternative to apprenticeship-based surgical education.</p>","PeriodicalId":8985,"journal":{"name":"BJU International","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145892069","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}
Koushikk S Ayyappan, Richard Menzies‐Wilson, Amir Mashia Jaafari, Hasan Al‐Sattar, Ben Turney
Objectives To evaluate the physical properties of seven ureteroscopes (URSs) and compare the maximal angle of deflection (MAD) when used with flexible and navigable suction access sheaths (FANSs) of varying sizes. Materials and Methods Seven commercial URSs (ranging from 6.3 to 9.5 F in size) were evaluated for outer diameter, irrigation flow rate, image resolution, colour reproduction and MAD. MAD was measured under three conditions: standalone URS deflection without the FANS; standard deflection of the FANS while positioned at the URS tip; and advanced FANS deflection, with the URS fully deflected beyond the FANS, and the FANS advanced. For each URS type, standalone deflection was repeated five times, and FANS deflections were repeated four times to calculate an average. FANS sizes of 10/12 F, 11/13 F and 12/14 F (ClearPetra) were tested. Results The HugeMed URS had the smallest scope diameter (6.3 F) and the lowest flow (20 mL/min), while the Endoso URS had the highest flow (32 mL/min). All the URSs had similar resolutions except the MacroLux, Seegen and Endoso URSs, which were noticeably superior in this respect. Colour reproduction was best with the MacroLux and Endoso URSs. Without a FANS, the standalone mean MAD across all URS types was 293°. Standard deflection with FANS significantly decreased the MAD (up to a 49% reduction), whereas advanced deflection maintained the MAD (up to 269°). Larger FANS, especially the 12/14‐F size, tended to reduce deflection. The MacroLux URS maintained the highest MAD across all FANS sizes, followed by the Seegen and Urotech devices. Conclusion Ureteroscope deflection significantly varied by model. Use of a FANS reduced deflection angles, especially with larger sheaths. However, advancing the FANS over a deflected scope preserved deflection angles. Overall, the MacroLux URS showed the best deflection with FANS, whereas the Seegen, Endoso and Urotech URSs showed a balance between flow rate, optics and deflection. These findings could inform clinicians in their selection of a URS for endourology procedures.
{"title":"Benchtop comparison of seven ureteroscopes: evaluating physical properties and deflection with flexible and navigable suction access sheaths","authors":"Koushikk S Ayyappan, Richard Menzies‐Wilson, Amir Mashia Jaafari, Hasan Al‐Sattar, Ben Turney","doi":"10.1111/bju.70124","DOIUrl":"https://doi.org/10.1111/bju.70124","url":null,"abstract":"Objectives To evaluate the physical properties of seven ureteroscopes (URSs) and compare the maximal angle of deflection (MAD) when used with flexible and navigable suction access sheaths (FANSs) of varying sizes. Materials and Methods Seven commercial URSs (ranging from 6.3 to 9.5 F in size) were evaluated for outer diameter, irrigation flow rate, image resolution, colour reproduction and MAD. MAD was measured under three conditions: standalone URS deflection without the FANS; standard deflection of the FANS while positioned at the URS tip; and advanced FANS deflection, with the URS fully deflected beyond the FANS, and the FANS advanced. For each URS type, standalone deflection was repeated five times, and FANS deflections were repeated four times to calculate an average. FANS sizes of 10/12 F, 11/13 F and 12/14 F (ClearPetra) were tested. Results The HugeMed URS had the smallest scope diameter (6.3 F) and the lowest flow (20 mL/min), while the Endoso URS had the highest flow (32 mL/min). All the URSs had similar resolutions except the MacroLux, Seegen and Endoso URSs, which were noticeably superior in this respect. Colour reproduction was best with the MacroLux and Endoso URSs. Without a FANS, the standalone mean MAD across all URS types was 293°. Standard deflection with FANS significantly decreased the MAD (up to a 49% reduction), whereas advanced deflection maintained the MAD (up to 269°). Larger FANS, especially the 12/14‐F size, tended to reduce deflection. The MacroLux URS maintained the highest MAD across all FANS sizes, followed by the Seegen and Urotech devices. Conclusion Ureteroscope deflection significantly varied by model. Use of a FANS reduced deflection angles, especially with larger sheaths. However, advancing the FANS over a deflected scope preserved deflection angles. Overall, the MacroLux URS showed the best deflection with FANS, whereas the Seegen, Endoso and Urotech URSs showed a balance between flow rate, optics and deflection. These findings could inform clinicians in their selection of a URS for endourology procedures.","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"41 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145847523","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}
Attilio Barretta, Pietro Piazza, Calogero Catanzaro, Angelo Mottaran, Massimiliano Presutti, Amelio Ercolino, Fontanella Luca, Silvia Li Volsi, Francesco Romei, Fabrizio Scisciolo, Irene Corsini, Luca Muratori, Stefania La Rezza, Francesca Giunchi, Michelangelo Fiorentino, Cristian Vincenzo Pultrone, Hussam Dababneh, Francesco Chessa, Lorenzo Bianchi, Riccardo Schiavina
Objectives To evaluate the utility of routine intra‐operative frozen section analysis (iFSA) of distal ureteric margins during radical cystectomy (RC) for bladder cancer (BCa), focusing on diagnostic accuracy and oncological outcomes in a high‐volume tertiary centre. Patients and Methods We retrospectively identified 1081 patients with BCa treated with RC (2010–2024). Bilateral iFSA of the distal ureters was performed in all cases. Patients were stratified according to final distal ureteric margin status (positive vs negative); if positive, additional resections were attempted intra‐operatively. Diagnostic concordance between iFSA and final pathology was calculated. Kaplan–Meier curves were used to assess 5‐year upper urinary tract recurrence (UUTR) free‐survival, overall survival (OS), and cancer‐specific survival (CSS). Univariable logistic regression and multivariable logistic regression (MLR) models identified variables associated with positive margins. Results Overall, 139 patients (12.9%) had positive distal ureteric margins at iFSA. The sensitivity and specificity of FSA were 98.6% and 99.5%, respectively. In MLR models, hydronephrosis (odds ratio [OR] 1.75, P = 0.014), T3–T4 stage (OR 2.48, P = 0.003), bladder carcinoma in situ (CIS; OR 7.94, P < 0.001) and trigonal tumour location (OR 4.85, P < 0.001) were independently associated with positive distal ureteric margins at iFSA. Positive margins were associated with increased risk of UUTR (5‐year UUTR‐free survival: 58% vs 78%; P = 0.038), worse OS (5‐year OS: 48% vs 67%; P = 0.039), and worse CSS (5‐year CSS: 60% vs 75%; P = 0.0018). Conclusion Our study showed that iFSA of distal ureteric margins during RC for BCa provided excellent diagnostic performance and enabled cancer‐free anastomosis. Our findings support iFSA, especially in patients with bladder CIS, trigonal tumours, or hydronephrosis, to guide intra‐operative decisions and tailor postoperative surveillance.
目的评估输尿管远端边缘常规术中冷冻切片分析（iFSA）在膀胱癌（BCa）根治性膀胱切除术（RC）中的实用性，重点关注高容量三级中心的诊断准确性和肿瘤预后。患者和方法我们回顾性研究了1081例接受RC治疗的BCa患者（2010-2024）。所有病例均行输尿管远端双侧iFSA。根据最终输尿管远端缘状态（阳性与阴性）对患者进行分层；如果阳性，则在术中尝试进一步切除。计算iFSA与最终病理的诊断一致性。Kaplan-Meier曲线用于评估5年上尿路复发（UUTR）无复发生存、总生存（OS）和癌症特异性生存（CSS）。单变量逻辑回归和多变量逻辑回归（MLR）模型确定了与正边际相关的变量。结果总体而言，139例（12.9%）患者输尿管远端边缘iFSA阳性。FSA的敏感性为98.6%，特异性为99.5%。在MLR模型中，肾积水（比值比[OR] 1.75, P = 0.014）、T3-T4期（比值比[OR] 2.48, P = 0.003）、原位膀胱癌（比值比[CIS] 7.94, P < 0.001）和三角肿瘤位置（比值比[OR] 4.85, P < 0.001）与iFSA输尿管远端边缘阳性独立相关。阳性切缘与UUTR风险增加（5年无UUTR生存率：58% vs 78%； P = 0.038）、更差的OS（5年OS: 48% vs 67%； P = 0.039）和更差的CSS（5年CSS: 60% vs 75%； P = 0.0018）相关。结论：本研究表明，输尿管远端边缘的iFSA在BCa的RC中具有良好的诊断性能，并且可以实现无癌吻合。我们的研究结果支持iFSA，特别是在膀胱CIS、三角肿瘤或肾积水患者中，指导术中决策和定制术后监测。
{"title":"Is there still a role for ureteric frozen section analysis during radical cystectomy?","authors":"Attilio Barretta, Pietro Piazza, Calogero Catanzaro, Angelo Mottaran, Massimiliano Presutti, Amelio Ercolino, Fontanella Luca, Silvia Li Volsi, Francesco Romei, Fabrizio Scisciolo, Irene Corsini, Luca Muratori, Stefania La Rezza, Francesca Giunchi, Michelangelo Fiorentino, Cristian Vincenzo Pultrone, Hussam Dababneh, Francesco Chessa, Lorenzo Bianchi, Riccardo Schiavina","doi":"10.1111/bju.70125","DOIUrl":"https://doi.org/10.1111/bju.70125","url":null,"abstract":"Objectives To evaluate the utility of routine intra‐operative frozen section analysis (iFSA) of distal ureteric margins during radical cystectomy (RC) for bladder cancer (BCa), focusing on diagnostic accuracy and oncological outcomes in a high‐volume tertiary centre. Patients and Methods We retrospectively identified 1081 patients with BCa treated with RC (2010–2024). Bilateral iFSA of the distal ureters was performed in all cases. Patients were stratified according to final distal ureteric margin status (positive vs negative); if positive, additional resections were attempted intra‐operatively. Diagnostic concordance between iFSA and final pathology was calculated. Kaplan–Meier curves were used to assess 5‐year upper urinary tract recurrence (UUTR) free‐survival, overall survival (OS), and cancer‐specific survival (CSS). Univariable logistic regression and multivariable logistic regression (MLR) models identified variables associated with positive margins. Results Overall, 139 patients (12.9%) had positive distal ureteric margins at iFSA. The sensitivity and specificity of FSA were 98.6% and 99.5%, respectively. In MLR models, hydronephrosis (odds ratio [OR] 1.75, <jats:italic>P</jats:italic> = 0.014), T3–T4 stage (OR 2.48, <jats:italic>P</jats:italic> = 0.003), bladder carcinoma <jats:italic>in situ</jats:italic> (CIS; OR 7.94, <jats:italic>P</jats:italic> < 0.001) and trigonal tumour location (OR 4.85, <jats:italic>P</jats:italic> < 0.001) were independently associated with positive distal ureteric margins at iFSA. Positive margins were associated with increased risk of UUTR (5‐year UUTR‐free survival: 58% vs 78%; <jats:italic>P</jats:italic> = 0.038), worse OS (5‐year OS: 48% vs 67%; <jats:italic>P</jats:italic> = 0.039), and worse CSS (5‐year CSS: 60% vs 75%; <jats:italic>P</jats:italic> = 0.0018). Conclusion Our study showed that iFSA of distal ureteric margins during RC for BCa provided excellent diagnostic performance and enabled cancer‐free anastomosis. Our findings support iFSA, especially in patients with bladder CIS, trigonal tumours, or hydronephrosis, to guide intra‐operative decisions and tailor postoperative surveillance.","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"33 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145836131","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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