BJU International最新文献

Like most journals, BJUI relies on the hard work and dedication of its peer reviewers and we are grateful to them all. Each month the Editorial Team nominates peer reviewers whose reviews have stood out for their quality and timeliness and those selected as the best are highlighted on this page in recognition of their exceptional work.

Dr. Zhuo Tony Su is a urology resident physician at the Johns Hopkins Brady Urological Institute and an incoming urologic oncology fellow at the National Cancer Institute of the National Institutes of Health. Dr. Su obtained his Bachelor of Science degree in physics and biology with Cum Laude and distinction honours from Yale University and Doctor of Medicine degree from the Johns Hopkins University School of Medicine. His research interests include improving risk stratification in urologic cancers including the use of decision modelling, novel molecular imaging, and artificial intelligence-based diagnostics, identifying modifiable risk factors of disease progression in favourable-risk prostate cancer, and assessing the financial burden of care in urologic oncology and cost-effectiveness of new treatment options such as emerging immunotherapies for bladder cancer. Dr. Su has first-authored publications in leading journals including JAMA Oncology, European Urology, Journal of the Journal of the National Comprehensive Cancer Network (JNCCN), JAMA Network Open, Journal of the National Cancer Institute (JNCI), Journal of Urology, BJU International, and Cancer. He has served as an editorial board member/associate editor for 4 research journals and performed invited peer-reviews for over 40 journals including Annals of Internal Medicine, Modern Pathology, BJU International, and Urologic Oncology: Seminars and Original Investigations.

Alison Tree was appointed as a consultant clinical oncologist at the Royal Marsden hospital in 2014, specialising in urological malignancies.

She is the GU editor for the International Journal of Radiation Oncology Biology and Physics, the lead journal globally dedicated to radiation-related research.

She is chair of the MR Linac Consortium Steering Committee and teaches on several ESTRO and ASTRO courses. She is Chief Investigator of the TRAP, DELINEATE, HERMES, DESTINATION 1 and 2 and PACE C trials. She is the joint lead of the Cancer Research UK Radiation Research Centre of Excellence at The ICR/Royal Marsden.

Her research has received funding from Prostate Cancer UK, Cancer Research UK, the Rosetrees Trust, the JP Moulton foundation, Accuray and Elekta. Her current research interests include technical radiotherapy improvements in localised prostate cancer, oligometastatic and oligoprogressive disease.

Objective: To determine whether subcutaneous local anaesthesia (LA) infiltration at perineal puncture sites reduces immediate postoperative pain after transperineal (TP) prostate biopsy performed under general anaesthesia (GA).

Methods: In this two-centre, patient-blinded, randomised, placebo-controlled trial, men undergoing TP prostate biopsy under GA (GATP biopsy) were allocated 1:1 to receive either 20 mL 0.5% bupivacaine or 20 mL normal saline, infiltrated subcutaneously into the perineal skin at the conclusion of biopsy. The primary endpoint was the proportion of patients reporting moderate-to-severe pain (visual analogue scale [VAS] score > 3) 30 min postoperatively. Secondary endpoints included the Short-Form McGill Pain Questionnaire (SF-MPQ) and opioid use in recovery.

Results: Of 150 men randomised, 140 were included in the modified intention-to-treat analysis. Moderate-to-severe pain occurred in 22.5% of controls and 8.7% of patients receiving LA (absolute risk reduction 13.8%, 95% confidence interval 2.1-25.6; P = 0.035; number needed to treat = 7). The median VAS and SF-MPQ scores were 0 in both groups. Opioid administration did not differ significantly (10% control vs 19% LA; P = 0.15). In an exploratory post hoc subgroup, the benefit of LA infiltration was greater among men undergoing >20-core biopsy (34.1% vs 10.6%). No significant complications occurred.

Conclusion: Subcutaneous LA infiltration significantly reduces immediate moderate-to-severe pain following GATP biopsy. Although overall pain scores were low, a clinically meaningful subset benefitted from this simple, low-cost, and safe intervention. These findings also have relevance to contemporary TP prostate biopsy under LA workflows, supporting the concept that superficial infiltration may provide additive value alongside established block-based analgesic protocols.

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.