{"title":"Use of MRI in the diagnosis of bladder cancer: a health economic analysis.","authors":"Niranjan Sathianathen,Marlon Perera,Joseph Ischia,Nathan Lawrentschuk,Damien Bolton","doi":"10.1111/bju.70243","DOIUrl":"https://doi.org/10.1111/bju.70243","url":null,"abstract":"","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"4 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147471550","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}
{"title":"Comment on 'Considerations on positive surgical margin thresholds and clinical implications after radical prostatectomy'.","authors":"Xiao-Hong Sun,Shun Wan","doi":"10.1111/bju.70241","DOIUrl":"https://doi.org/10.1111/bju.70241","url":null,"abstract":"","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"8 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147471555","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}
{"title":"Comment on 'Impact of positive surgical margins on biochemical recurrence and metastases after radical prostatectomy'.","authors":"Kishankumar Mahida,Snehal Rajendra Jagtap","doi":"10.1111/bju.70244","DOIUrl":"https://doi.org/10.1111/bju.70244","url":null,"abstract":"","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"88 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147471556","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}
{"title":"Alternate-day administration of intravesical gemcitabine and docetaxel to improve clinic utilisation.","authors":"John R Heard,Michael Ahdoot","doi":"10.1111/bju.70240","DOIUrl":"https://doi.org/10.1111/bju.70240","url":null,"abstract":"","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"1 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147471558","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}
Katharina Beyer, Lionne D. F. Venderbos, Olivier Exertier, Philipp Karschuk, Monique J. Roobol, Deborah Maskens, Michael Jewett
Objective To explore the perspectives of healthcare professionals (HCPs) on what enables or hinders shared decision‐making (SDM) in everyday small renal masses (SRM) management. Subjects and Methods A systematic literature search was conducted, which informed a structured discussion guide. Subsequently, qualitative research was undertaken with HCPs involved in the management of SRM across the Netherlands, Germany, and the UK. Results In total, 30 HCPs participated in the study, comprising semi‐structured interviews and a focus group (the Netherlands 10 HCPs; Germany 11; UK nine). While SDM was consistently viewed as important and the concept could be explained, actual implementation varied substantially across countries. In the UK and the Netherlands, patients were typically offered, and HCPs discussed all major treatment options supported by nurse involvement. In Germany, SDM was often constrained: not all major treatment options were always presented, often influenced by resource limitations and financial incentives favouring surgery. Across all countries, key barriers to SDM included clinician bias, variable patient engagement, and time constraints. Facilitators to SDM were highlighted to be clear communication, visual aids, and audio‐recording consultations. Conclusions Shared decision‐making is widely valued but inconsistently delivered and is heavily shaped by national structures. Tackling the identified barriers and leveraging known facilitators are key to making SDM a reality in SRM care.
{"title":"Empowering choices: insights from healthcare professionals on shared decision‐making in kidney cancer","authors":"Katharina Beyer, Lionne D. F. Venderbos, Olivier Exertier, Philipp Karschuk, Monique J. Roobol, Deborah Maskens, Michael Jewett","doi":"10.1111/bju.70177","DOIUrl":"https://doi.org/10.1111/bju.70177","url":null,"abstract":"Objective To explore the perspectives of healthcare professionals (HCPs) on what enables or hinders shared decision‐making (SDM) in everyday small renal masses (SRM) management. Subjects and Methods A systematic literature search was conducted, which informed a structured discussion guide. Subsequently, qualitative research was undertaken with HCPs involved in the management of SRM across the Netherlands, Germany, and the UK. Results In total, 30 HCPs participated in the study, comprising semi‐structured interviews and a focus group (the Netherlands 10 HCPs; Germany 11; UK nine). While SDM was consistently viewed as important and the concept could be explained, actual implementation varied substantially across countries. In the UK and the Netherlands, patients were typically offered, and HCPs discussed all major treatment options supported by nurse involvement. In Germany, SDM was often constrained: not all major treatment options were always presented, often influenced by resource limitations and financial incentives favouring surgery. Across all countries, key barriers to SDM included clinician bias, variable patient engagement, and time constraints. Facilitators to SDM were highlighted to be clear communication, visual aids, and audio‐recording consultations. Conclusions Shared decision‐making is widely valued but inconsistently delivered and is heavily shaped by national structures. Tackling the identified barriers and leveraging known facilitators are key to making SDM a reality in SRM care.","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"5 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147465294","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}
Navid Roessler, Marcin Miszczyk, Paolo Gontero, Alessandro Dematteis, Keiichiro Miyajima, Shota Inoue, Katharina Oberneder, Markus von Deimling, Victor M. Schuettfort, Malte W. Vetterlein, Bernadett Szabados, Pawel Rajwa, Pierre I. Karakiewicz, Jeremy Yuen‐Chun Teoh, Margit Fisch, Shahrokh F. Shariat
Objective To evaluate the concordance between clinical complete response (cCR) and pathological complete response (pCR) in muscle‐invasive bladder cancer (MIBC) to assess the surrogacy and prognostic value of cCR for guiding bladder‐sparing strategies. Methods In this prospectively registered systematic review and meta‐analysis (CRD420251066540), we searched MEDLINE, EMBASE, and Web of Science in June 2025 for studies reporting clinical and pathological complete response rates in patients with MIBC undergoing neoadjuvant therapy followed by radical cystectomy (RC). Pooled concordance was estimated via random‐effects meta‐analysis. Risk‐of‐bias was assessed using the Risk Of Bias In Non‐randomised Studies of Interventions (ROBINS‐I). Results Out of 1947 individual records, 10 ( n = 894) retrospective and three ( n = 181) prospective studies comprising 1075 patients were included. Restaging modalities for cCR assessment included transurethral resection of the bladder (TURB; n = 188, two studies), computed tomography ( n = 221, two studies), magnetic resonance imaging (MRI; n = 122, two studies), and fluorodeoxyglucose positron emission tomography ( n = 45). One study ( n = 56) used perioperative cystoscopy, while the remaining five studies ( n = 499) combined imaging with cystoscopy or TURB. The concordance ( n = 779, nine studies) between cCR and pCR was 0.51 (95% confidence interval [CI] 0.42–0.60), the concordance ( n = 536, seven studies) between non‐cCR and non‐pCR was 0.84 (95% CI 0.70–0.92). Most studies were rated as having moderate concerns regarding bias, and one as serious due to examiner‐dependent bias of cystoscopy‐based cCR assessment. Conclusion Current evidence does not support relying on the current definition of cCR alone, which poorly predicts pCR, to guide treatment decisions. Ongoing trials assessing the combination of MRI plus TURB with urine and/or blood based circulating tumour DNA may help refine cCR evaluation and support the sole introduction of bladder‐sparing approaches in patients with MIBC who respond to neoadjuvant systemic therapy.
{"title":"Clinical complete response as a surrogate for pathological response in bladder cancer: a systematic review and meta‐analysis","authors":"Navid Roessler, Marcin Miszczyk, Paolo Gontero, Alessandro Dematteis, Keiichiro Miyajima, Shota Inoue, Katharina Oberneder, Markus von Deimling, Victor M. Schuettfort, Malte W. Vetterlein, Bernadett Szabados, Pawel Rajwa, Pierre I. Karakiewicz, Jeremy Yuen‐Chun Teoh, Margit Fisch, Shahrokh F. Shariat","doi":"10.1111/bju.70214","DOIUrl":"https://doi.org/10.1111/bju.70214","url":null,"abstract":"Objective To evaluate the concordance between clinical complete response (cCR) and pathological complete response (pCR) in muscle‐invasive bladder cancer (MIBC) to assess the surrogacy and prognostic value of cCR for guiding bladder‐sparing strategies. Methods In this prospectively registered systematic review and meta‐analysis (CRD420251066540), we searched MEDLINE, EMBASE, and Web of Science in June 2025 for studies reporting clinical and pathological complete response rates in patients with MIBC undergoing neoadjuvant therapy followed by radical cystectomy (RC). Pooled concordance was estimated via random‐effects meta‐analysis. Risk‐of‐bias was assessed using the Risk Of Bias In Non‐randomised Studies of Interventions (ROBINS‐I). Results Out of 1947 individual records, 10 ( <jats:italic>n</jats:italic> = 894) retrospective and three ( <jats:italic>n</jats:italic> = 181) prospective studies comprising 1075 patients were included. Restaging modalities for cCR assessment included transurethral resection of the bladder (TURB; <jats:italic>n</jats:italic> = 188, two studies), computed tomography ( <jats:italic>n</jats:italic> = 221, two studies), magnetic resonance imaging (MRI; <jats:italic>n</jats:italic> = 122, two studies), and fluorodeoxyglucose positron emission tomography ( <jats:italic>n</jats:italic> = 45). One study ( <jats:italic>n</jats:italic> = 56) used perioperative cystoscopy, while the remaining five studies ( <jats:italic>n</jats:italic> = 499) combined imaging with cystoscopy or TURB. The concordance ( <jats:italic>n</jats:italic> = 779, nine studies) between cCR and pCR was 0.51 (95% confidence interval [CI] 0.42–0.60), the concordance ( <jats:italic>n</jats:italic> = 536, seven studies) between non‐cCR and non‐pCR was 0.84 (95% CI 0.70–0.92). Most studies were rated as having moderate concerns regarding bias, and one as serious due to examiner‐dependent bias of cystoscopy‐based cCR assessment. Conclusion Current evidence does not support relying on the current definition of cCR alone, which poorly predicts pCR, to guide treatment decisions. Ongoing trials assessing the combination of MRI plus TURB with urine and/or blood based circulating tumour DNA may help refine cCR evaluation and support the sole introduction of bladder‐sparing approaches in patients with MIBC who respond to neoadjuvant systemic therapy.","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"189 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147465295","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}
OBJECTIVESTo develop an international consensus on technical principles, training requirements, patient selection, and procedural best practices for retroperitoneal single-port (SP) robotic urological surgery through a structured Delphi methodology.METHODSA five-step modified Delphi process was conducted in accordance with ACcurate COnsensus Reporting Document (ACCORD) guidelines. A total of 32 statements were formulated by a steering committee of expert robotic surgeons and distributed to an international panel of 16 urologists from five countries. Consensus was defined as ≥70% agreement with <15% disagreement using a 9-point Likert scale. Statements without consensus after the first round were discussed, revised, and re-voted during an in-person meeting (Naples, Italy, July 2025). Internal reliability was evaluated with Cronbach's α, and inter-rater concordance with Kendall's W.RESULTSA total of 14 experts participated in Round I and 12 in Round II. Consensus was achieved for 22 of 32 statements (69%), primarily addressing general principles, surgeon training, patient selection, access techniques, and perioperative management. Agreement was highest for the need for structured and proctored training (92.9%), suitability of low-complexity renal tumours as index cases (78.6%), and feasibility of the lower anterior access to enhance recovery (84%). No consensus was reached on absolute contraindications, specimen extraction protocols, or standardised criteria for platform selection in obese patients. Reliability of expert ratings was excellent across rounds (Cronbach's α = 0.98 and 0.92).CONCLUSIONSThis Delphi study provides the first international consensus defining principles and technical considerations for retroperitoneal SP robotic surgery. These consensus recommendations represent a key step toward standardisation and safer clinical adoption of SP retroperitoneal surgery, while highlighting areas needing further evidence.
{"title":"Defining standards for retroperitoneal single-port (SP) robotic surgery: the Advancing Retroperitoneal International SP Excellence (ARISE) international Delphi consensus.","authors":"Gianluca Spena,Roberto Contieri,Marco Paciotti,Achille Aveta,Alberto Briganti,Nicolò Maria Buffi,Ruben De Groote,Paolo dell'Oglio,Antonio Galfano,Paolo Gontero,Alessandro Izzo,Jihad Kaouk,Senthil Nathan,Francesco Porpiglia,Giuseppe Simone,Zhenjie Wu,Simone Crivellaro,Riccardo Autorino,Sisto Perdonà","doi":"10.1111/bju.70213","DOIUrl":"https://doi.org/10.1111/bju.70213","url":null,"abstract":"OBJECTIVESTo develop an international consensus on technical principles, training requirements, patient selection, and procedural best practices for retroperitoneal single-port (SP) robotic urological surgery through a structured Delphi methodology.METHODSA five-step modified Delphi process was conducted in accordance with ACcurate COnsensus Reporting Document (ACCORD) guidelines. A total of 32 statements were formulated by a steering committee of expert robotic surgeons and distributed to an international panel of 16 urologists from five countries. Consensus was defined as ≥70% agreement with <15% disagreement using a 9-point Likert scale. Statements without consensus after the first round were discussed, revised, and re-voted during an in-person meeting (Naples, Italy, July 2025). Internal reliability was evaluated with Cronbach's α, and inter-rater concordance with Kendall's W.RESULTSA total of 14 experts participated in Round I and 12 in Round II. Consensus was achieved for 22 of 32 statements (69%), primarily addressing general principles, surgeon training, patient selection, access techniques, and perioperative management. Agreement was highest for the need for structured and proctored training (92.9%), suitability of low-complexity renal tumours as index cases (78.6%), and feasibility of the lower anterior access to enhance recovery (84%). No consensus was reached on absolute contraindications, specimen extraction protocols, or standardised criteria for platform selection in obese patients. Reliability of expert ratings was excellent across rounds (Cronbach's α = 0.98 and 0.92).CONCLUSIONSThis Delphi study provides the first international consensus defining principles and technical considerations for retroperitoneal SP robotic surgery. These consensus recommendations represent a key step toward standardisation and safer clinical adoption of SP retroperitoneal surgery, while highlighting areas needing further evidence.","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"79 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147461755","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}
Max C Wagner,Jakob Klemm,Navid Roessler,Robert J Schulz,Dejan K Filipas,Margit Fisch,Roland Dahlem,Malte W Vetterlein
OBJECTIVESTo evaluate long-term outcomes of open urorectal fistula (URF) repair, including URF recurrence, need for re-intervention, and patient-reported outcomes.PATIENTS AND METHODSThis retrospective study included men undergoing open URF repair between 2014 and 2024. Data collected encompassed comorbidities, prostate cancer treatment history, prior URF interventions, and intraoperative details. Endpoints were: (i) URF recurrence-free survival, (ii) re-intervention-free survival (no further disease-related procedures), and (iii) validated patient-reported outcome measures (PROMs). Kaplan-Meier estimators were used for survival analyses; PROMs were scored according to standard protocols.RESULTSA total of 29 patients underwent open URF repair. The median (interquartile range [IQR]) age was 68 (61-71) years, body mass index was 26 (23-28) kg/m2, and the time from prostatectomy to URF repair was 10 (4-13) months. Five patients (17%) had prior pelvic radiotherapy; 13 (45%) underwent redo repairs. Presenting symptoms included rectal urine leakage (48%), pneumaturia (24%), recurrent infections (21%), dysuria (21%), and faecaluria (10%). Transperineal repair was performed in 26 patients (90%) and transabdominal repair in three (10%). The median (IQR) operating time was 90 (80-107) min. The median follow-up was 50 months for recurrence and 58 months for re-intervention. The 5-year URF recurrence-free and any disease-related re-intervention-free survival estimates were 96% and 75%, respectively. The median (IQR) six-item lower urinary tract symptoms score from the Urethral Stricture Surgery PROM was 4 (2-8), International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form sum score was 11 (6-15), Wexner faecal incontinence score was 3 (1-9), International Consultation on Incontinence Questionnaire-Satisfaction outcome score was 21 (18-23), and Decision Regret Scale score was 0 (0-10), indicating restored voiding function, moderate urinary incontinence, mild faecal incontinence, high patient satisfaction, and negligible decisional regret.CONCLUSIONOpen URF repair achieves durable URF closure with favourable long-term outcomes, even in complex cases. Patient satisfaction is high, while moderate urinary incontinence persists in some, likely reflecting underlying disease. Voiding and faecal continence remain largely preserved.
{"title":"Long-term patient-reported outcomes of open urorectal fistula repair after prostate cancer treatment.","authors":"Max C Wagner,Jakob Klemm,Navid Roessler,Robert J Schulz,Dejan K Filipas,Margit Fisch,Roland Dahlem,Malte W Vetterlein","doi":"10.1111/bju.70233","DOIUrl":"https://doi.org/10.1111/bju.70233","url":null,"abstract":"OBJECTIVESTo evaluate long-term outcomes of open urorectal fistula (URF) repair, including URF recurrence, need for re-intervention, and patient-reported outcomes.PATIENTS AND METHODSThis retrospective study included men undergoing open URF repair between 2014 and 2024. Data collected encompassed comorbidities, prostate cancer treatment history, prior URF interventions, and intraoperative details. Endpoints were: (i) URF recurrence-free survival, (ii) re-intervention-free survival (no further disease-related procedures), and (iii) validated patient-reported outcome measures (PROMs). Kaplan-Meier estimators were used for survival analyses; PROMs were scored according to standard protocols.RESULTSA total of 29 patients underwent open URF repair. The median (interquartile range [IQR]) age was 68 (61-71) years, body mass index was 26 (23-28) kg/m2, and the time from prostatectomy to URF repair was 10 (4-13) months. Five patients (17%) had prior pelvic radiotherapy; 13 (45%) underwent redo repairs. Presenting symptoms included rectal urine leakage (48%), pneumaturia (24%), recurrent infections (21%), dysuria (21%), and faecaluria (10%). Transperineal repair was performed in 26 patients (90%) and transabdominal repair in three (10%). The median (IQR) operating time was 90 (80-107) min. The median follow-up was 50 months for recurrence and 58 months for re-intervention. The 5-year URF recurrence-free and any disease-related re-intervention-free survival estimates were 96% and 75%, respectively. The median (IQR) six-item lower urinary tract symptoms score from the Urethral Stricture Surgery PROM was 4 (2-8), International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form sum score was 11 (6-15), Wexner faecal incontinence score was 3 (1-9), International Consultation on Incontinence Questionnaire-Satisfaction outcome score was 21 (18-23), and Decision Regret Scale score was 0 (0-10), indicating restored voiding function, moderate urinary incontinence, mild faecal incontinence, high patient satisfaction, and negligible decisional regret.CONCLUSIONOpen URF repair achieves durable URF closure with favourable long-term outcomes, even in complex cases. Patient satisfaction is high, while moderate urinary incontinence persists in some, likely reflecting underlying disease. Voiding and faecal continence remain largely preserved.","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"85 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147447002","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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