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}
Joseph B. John, Robert Feasey, Ranan Dasgupta, Tim W.R. Briggs, John S. McGrath, William K. Gray
Objectives To investigate the associations between how reusable flexible cystoscopes (FCs) are managed during their functioning lifetime and their longevity. Patients and Methods This was an exploratory retrospective analysis of administrative data collected by a medical supplies company (KARL STORZ Endoscopy (UK) Ltd) on FC usage linked at a National Health Service (NHS) hospital trust level to data from NHS England's Hospital Episodes Statistics dataset on the number of FCs performed each year in the NHS in England. Number of uses before failure (defined as user‐determined need for FC return to the supplier) were analysed descriptively and using a negative binomial regression model. Results Data were available for 1918 FCs across 70 hospitals. The median (interquartile range) number of uses and min of use before failure were 58 (20–147.75) and 706.5 (208.25–1718), respectively. Eighty‐five percent of returned FCs were exchanged (i.e. replaced with a new FC), at a median of 66 uses. The two most common reasons for failure – damage to the working channel and control handle housing – were observed in 76.3% and 63.8% of returned FCs, respectively. A greater number of uses before failure was significantly associated with recency, same‐site same‐complex decontamination, on‐site endoscopic specialist availability, decontamination in a general endoscopy unit, and drying cabinet or bowl storage rather than vacuum packaging. Top‐quintile‐volume units were associated with a significantly higher number of uses before failure, however, there was otherwise no clear independent volume–longevity association. Conclusion This exploratory analysis generates mechanistically plausible hypotheses regarding factors that could promote FC longevity. These findings are of relevance as we seek to understand how to optimise the cost, resilience and environmental sustainability of healthcare. A prospectively designed study could investigate whether there is a causal link between the key factors identified and longevity of FC usage.
{"title":"Factors associated with flexible cystoscope longevity: an analysis of supplier and health service datasets","authors":"Joseph B. John, Robert Feasey, Ranan Dasgupta, Tim W.R. Briggs, John S. McGrath, William K. Gray","doi":"10.1111/bju.70133","DOIUrl":"https://doi.org/10.1111/bju.70133","url":null,"abstract":"Objectives To investigate the associations between how reusable flexible cystoscopes (FCs) are managed during their functioning lifetime and their longevity. Patients and Methods This was an exploratory retrospective analysis of administrative data collected by a medical supplies company (KARL STORZ Endoscopy (UK) Ltd) on FC usage linked at a National Health Service (NHS) hospital trust level to data from NHS England's Hospital Episodes Statistics dataset on the number of FCs performed each year in the NHS in England. Number of uses before failure (defined as user‐determined need for FC return to the supplier) were analysed descriptively and using a negative binomial regression model. Results Data were available for 1918 FCs across 70 hospitals. The median (interquartile range) number of uses and min of use before failure were 58 (20–147.75) and 706.5 (208.25–1718), respectively. Eighty‐five percent of returned FCs were exchanged (i.e. replaced with a new FC), at a median of 66 uses. The two most common reasons for failure – damage to the working channel and control handle housing – were observed in 76.3% and 63.8% of returned FCs, respectively. A greater number of uses before failure was significantly associated with recency, same‐site same‐complex decontamination, on‐site endoscopic specialist availability, decontamination in a general endoscopy unit, and drying cabinet or bowl storage rather than vacuum packaging. Top‐quintile‐volume units were associated with a significantly higher number of uses before failure, however, there was otherwise no clear independent volume–longevity association. Conclusion This exploratory analysis generates mechanistically plausible hypotheses regarding factors that could promote FC longevity. These findings are of relevance as we seek to understand how to optimise the cost, resilience and environmental sustainability of healthcare. A prospectively designed study could investigate whether there is a causal link between the key factors identified and longevity of FC usage.","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"23 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145812925","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}
Marco Tozzi, Giuseppe Fallara, Matteo Ferro, Francesco Chierigo, Roberto Bianchi, Hussain M. Alnajjar, Karl H. Pang, Asif Muneer
Objective To compare and summarise the most up to date international guidelines and major recommendations for the management of small testicular masses (STMs). Methods A systematic search was conducted in PubMed, EMBASE, Scopus, Google Scholar, and the Cochrane Library up to 1 November 2024. The latest editions of five international guidelines were included in the review: the European Association of Urology 2025; the National Comprehensive Cancer Network 2024; the American Urological Association 2023; the Canadian Urological Association 2022; and the European Society for Medical Oncology 2018. The Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool was applied by two authors (M.T. and G.F.) to assess the quality of these guidelines. Results Emerging evidence supports testis‐sparing surgery (TSS) as a viable option for managing STMs, showing acceptable oncological outcomes and preservation of gonadal function in select patients. The shared indications for TSS include indeterminate STMs identified on ultrasonography with negative tumour markers, particularly in the case of a solitary testis or of bilateral tumours. Where intra‐operative frozen section analysis is available, and confirms a benign lesion, a radical orchidectomy could be avoided. Conclusion Consensus across guidelines favours TSS in suitable cases, balancing oncological control with functional outcomes and informed patient decisions.
{"title":"Guideline of guidelines: management of small testicular masses","authors":"Marco Tozzi, Giuseppe Fallara, Matteo Ferro, Francesco Chierigo, Roberto Bianchi, Hussain M. Alnajjar, Karl H. Pang, Asif Muneer","doi":"10.1111/bju.70131","DOIUrl":"https://doi.org/10.1111/bju.70131","url":null,"abstract":"Objective To compare and summarise the most up to date international guidelines and major recommendations for the management of small testicular masses (STMs). Methods A systematic search was conducted in PubMed, EMBASE, Scopus, Google Scholar, and the Cochrane Library up to 1 November 2024. The latest editions of five international guidelines were included in the review: the European Association of Urology 2025; the National Comprehensive Cancer Network 2024; the American Urological Association 2023; the Canadian Urological Association 2022; and the European Society for Medical Oncology 2018. The Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool was applied by two authors (M.T. and G.F.) to assess the quality of these guidelines. Results Emerging evidence supports testis‐sparing surgery (TSS) as a viable option for managing STMs, showing acceptable oncological outcomes and preservation of gonadal function in select patients. The shared indications for TSS include indeterminate STMs identified on ultrasonography with negative tumour markers, particularly in the case of a solitary testis or of bilateral tumours. Where intra‐operative frozen section analysis is available, and confirms a benign lesion, a radical orchidectomy could be avoided. Conclusion Consensus across guidelines favours TSS in suitable cases, balancing oncological control with functional outcomes and informed patient decisions.","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"28 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145812924","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}
Objective To compare intravesical gemcitabine/docetaxel (Gem/Doce) vs standard‐of‐care bacillus Calmette–Guérin (BCG) in intermediate‐/high‐risk non‐muscle‐invasive bladder cancer (NMIBC), as patient‐reported physical‐psychological quality of life (QoL) and cost‐effectiveness estimation are pivotal to evaluate adjuvant intravesical treatments yet are rarely evaluated head‐on. Patients and Methods In a prospective per‐protocol analysis (Gem/Doce 39 patients; BCG 44 patients), survival endpoints (recurrence‐free survival [RFS], progression‐free survival [PFS]) and National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE)‐graded adverse events (AEs) were recorded. QoL was assessed at baseline, post‐induction, and at 6 and 12 months using the European Organisation for Research and Treatment of Cancer Quality‐of‐Life Questionnaire‐30‐item core (EORTC QLQ‐C30) and 24‐item QLQ‐NMIBC (QLQ‐NMIBC24) and mapped to the EuroQoL five Dimensions five Levels (EQ‐5D‐5L) using an Indian tariff to estimate quality‐adjusted life years (QALYs). Direct medical costs were recorded, and incremental cost‐effectiveness ratios (ICERs) were calculated per QALY and recurrence/progression outcomes. Results Patients receiving Gem/Doce achieved higher 1‐year RFS (94.74% vs 75%, hazard ratio 0.44; P = 0.02) and PFS (100.00% vs 93.19%, P = 0.09). The AEs were fewer with Gem/Doce (12.82% vs 34.10%, P = 0.028); Grade 3 events occurred only with BCG (4.65%). Gem/Doce showed significantly higher global health, physical/role/emotional functioning and sexual health scores at 6–12 months, with reduced fatigue, urinary symptoms and intravesical‐treatment problems. Mean QALYs improved with Gem/Doce (0.8807 vs 0.7198), and with an ICER of ₹504 000 Indian Rupees ($6072 United States Dollars) per QALY – well within India's willingness‐to‐pay threshold and far below international benchmarks. Additional gains included +1.38 recurrence‐free months overall and +2.82 in high‐risk patients, achieved at acceptable incremental cost, indicating pragmatic cost profile against avoided recurrences and QoL gains. Conclusions Sequential Gem/Doce delivered optimal short‐term survival outcomes, favourable patient‐reported QoL and safety profile, and attractive cost per avoided recurrence/progression compared with BCG, supporting its adoption as a clinically and economically viable alternative in resource‐constrained NMIBC care.
目的比较膀胱内注射吉西他滨/多西他赛（Gem/Doce）与标准护理卡介苗（BCG）治疗中/高风险非肌肉侵袭性膀胱癌（NMIBC），因为患者报告的生理-心理生活质量（QoL）和成本-效果评估是评估辅助膀胱内治疗的关键，但很少进行正面评估。在一项前瞻性的按方案分析（Gem/Doce 39例患者；BCG 44例患者）中，记录了生存终点（无复发生存期[RFS]、无进展生存期[PFS]）和国家癌症研究所不良事件通用术语标准（CTCAE）分级不良事件（ae）。使用欧洲癌症研究和治疗组织生活质量问卷- 30项核心（EORTC QLQ‐C30）和24项QLQ‐NMIBC （QLQ‐NMIBC24）对基线、诱导后、6个月和12个月的生活质量进行评估，并使用印度关税来估计质量调整生命年（QALYs），将其映射到EuroQoL的五个维度五个水平（EQ‐5D‐5L）。记录直接医疗费用，并根据QALY和复发/进展结果计算增量成本-效果比（ICERs）。结果Gem/Doce组患者获得了更高的1年RFS （94.74% vs 75%，风险比0.44;P = 0.02）和PFS （100.00% vs 93.19%, P = 0.09）。Gem/Doce组ae较低（12.82% vs 34.10%, P = 0.028）；3级事件仅发生在卡介苗组（4.65%）。Gem/Doce在6-12个月时显示出更高的整体健康、身体/角色/情感功能和性健康评分，同时减少了疲劳、泌尿系统症状和膀胱内治疗问题。Gem/Doce （0.8807 vs 0.7198）的平均质量aly有所改善，每个质量aly的ICER为504000印度卢比（6072美元），远远低于印度的支付意愿阈值，远低于国际基准。额外的收益包括总体+1.38个无复发月和高风险患者+2.82个无复发月，在可接受的增量成本下实现，表明实际的成本概况与避免复发和生活质量的收益。与BCG相比，顺序Gem/Doce提供了最佳的短期生存结果，有利的患者报告的生活质量和安全性，每避免复发/进展的成本具有吸引力，支持其作为资源受限的NMIBC治疗的临床和经济上可行的替代方案。
{"title":"Quality of life and cost‐effectiveness of intravesical gemcitabine/docetaxel vs BCG in BCG ‐naïve non‐muscle‐invasive bladder cancer","authors":"Aviral Srivastava, Sameer Trivedi, Ujwal Kumar, Yashasvi Singh, Lalit Kumar, Sahil Data, Anil Kumar, Satya Narayan Sankhwar","doi":"10.1111/bju.70126","DOIUrl":"https://doi.org/10.1111/bju.70126","url":null,"abstract":"Objective To compare intravesical gemcitabine/docetaxel (Gem/Doce) vs standard‐of‐care bacillus Calmette–Guérin (BCG) in intermediate‐/high‐risk non‐muscle‐invasive bladder cancer (NMIBC), as patient‐reported physical‐psychological quality of life (QoL) and cost‐effectiveness estimation are pivotal to evaluate adjuvant intravesical treatments yet are rarely evaluated head‐on. Patients and Methods In a prospective per‐protocol analysis (Gem/Doce 39 patients; BCG 44 patients), survival endpoints (recurrence‐free survival [RFS], progression‐free survival [PFS]) and National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE)‐graded adverse events (AEs) were recorded. QoL was assessed at baseline, post‐induction, and at 6 and 12 months using the European Organisation for Research and Treatment of Cancer Quality‐of‐Life Questionnaire‐30‐item core (EORTC QLQ‐C30) and 24‐item QLQ‐NMIBC (QLQ‐NMIBC24) and mapped to the EuroQoL five Dimensions five Levels (EQ‐5D‐5L) using an Indian tariff to estimate quality‐adjusted life years (QALYs). Direct medical costs were recorded, and incremental cost‐effectiveness ratios (ICERs) were calculated per QALY and recurrence/progression outcomes. Results Patients receiving Gem/Doce achieved higher 1‐year RFS (94.74% vs 75%, hazard ratio 0.44; <jats:italic>P</jats:italic> = 0.02) and PFS (100.00% vs 93.19%, <jats:italic>P</jats:italic> = 0.09). The AEs were fewer with Gem/Doce (12.82% vs 34.10%, <jats:italic>P</jats:italic> = 0.028); Grade 3 events occurred only with BCG (4.65%). Gem/Doce showed significantly higher global health, physical/role/emotional functioning and sexual health scores at 6–12 months, with reduced fatigue, urinary symptoms and intravesical‐treatment problems. Mean QALYs improved with Gem/Doce (0.8807 vs 0.7198), and with an ICER of ₹504 000 Indian Rupees ($6072 United States Dollars) per QALY – well within India's willingness‐to‐pay threshold and far below international benchmarks. Additional gains included +1.38 recurrence‐free months overall and +2.82 in high‐risk patients, achieved at acceptable incremental cost, indicating pragmatic cost profile against avoided recurrences and QoL gains. Conclusions Sequential Gem/Doce delivered optimal short‐term survival outcomes, favourable patient‐reported QoL and safety profile, and attractive cost per avoided recurrence/progression compared with BCG, supporting its adoption as a clinically and economically viable alternative in resource‐constrained NMIBC care.","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"1 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145812926","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}
Mathias Sørstrand Æsøy, Patrick Juliebø‐Jones, Peder Gjengstø, Christian Beisland, Øyvind Ulvik
Objective To compare operative time and clinical outcomes between high‐power (HP) and low‐power (LP) thulium fibre laser (TFL) ureteroscopic (URS) lithotripsy for renal stones. Patients and methods Single‐centre, randomised trial (1:1) at Haukeland University Hospital, Norway. Adults undergoing day‐case URS for 8–25 mm renal stones were enrolled. A total of 150 cases were included. Patients were randomised to URS lithotripsy with TFL using HP (16–18 W, selected for thermal safety during sheathless URS) or LP (4–6 W). The primary endpoint was operative time. The secondary endpoints were stone‐free rate (SFR) on 3‐month non‐contrast computed tomography (Grade A: no residuals; Grade B: ≤2 mm; Grade C: ≤4 mm; Grade D: >4 mm), laser metrics, performance measures, and complications according to the Clavien–Dindo Classification. Groups were compared using appropriate parametric and non‐parametric tests (two‐sided α = 0.05). Results A ureteric access sheath was not used in any case, reflecting routine practice at our centre. The operative time did not differ between arms: median (interquartile range) HP 48 (36–62) vs LP 54 (42–65) min ( P = 0.12). HP used more energy (12 vs 7 kJ, P < 0.001) with shorter active laser time (13 vs 24 min, P < 0.001), but laser operating time was similar. SFRs favoured LP compared to HP: Grade A, 63% vs 44% ( P = 0.02); Grade B, 77% vs 56% ( P = 0.008). The Grade C SFR was similar between arms. LP was also associated with better surgeon‐rated endoscopic visibility and fewer minor postoperative complications (11% vs 37%, P < 0.001). Major complications (Clavien–Dindo Grade ≥III) were uncommon and similar between arms. Conclusion Using HP did not shorten the operative time. LP improved SFRs for Grade A/B and reduced minor postoperative morbidity, supporting LP as the default TFL strategy for sheathless URS lithotripsy.
目的比较高功率（HP）和低功率（LP）铥纤维激光输尿管镜（URS）碎石治疗肾结石的手术时间和临床效果。患者和方法挪威豪克兰大学医院的单中心随机试验（1:1）。接受8-25毫米肾结石尿路治疗的成人被纳入研究。共纳入150例。患者被随机分配到使用HP （16-18 W，选择用于无鞘URS期间的热安全）或LP （4-6 W）进行尿路碎石和TFL。主要终点为手术时间。次要终点是3个月非对比计算机断层扫描的无结石率（SFR） （A级：无残留；B级：≤2mm； C级：≤4mm； D级：≤4mm）、激光指标、性能指标和根据Clavien-Dindo分类的并发症。采用适当的参数检验和非参数检验对各组进行比较（双侧α = 0.05）。结果所有病例均未使用输尿管导管套，反映了我中心的常规做法。两组手术时间无差异：中位（四分位数范围）HP 48 (36-62) vs LP 54 (42-65) min （P = 0.12）。HP使用的能量更多（12 vs 7 kJ, P < 0.001），有效激光时间更短（13 vs 24 min, P < 0.001），但激光工作时间相似。与HP相比，SFRs更倾向于LP: A级，63% vs 44% (P = 0.02)；B级：77% vs 56% （P = 0.008）。两组间的C级SFR相似。LP还与更好的外科医生评价的内窥镜可视性和更少的术后轻微并发症相关（11%对37%，P < 0.001）。主要并发症（Clavien-Dindo分级≥III）不常见，两组间相似。结论HP的使用并没有缩短手术时间。LP改善了A/B级患者的sfr，并减少了轻微的术后发病率，支持LP作为无鞘尿路碎石术的默认TFL策略。
{"title":"Watt's the difference? A randomised trial of high‐ vs low‐power ureteroscopic thulium fibre laser lithotripsy","authors":"Mathias Sørstrand Æsøy, Patrick Juliebø‐Jones, Peder Gjengstø, Christian Beisland, Øyvind Ulvik","doi":"10.1111/bju.70123","DOIUrl":"https://doi.org/10.1111/bju.70123","url":null,"abstract":"Objective To compare operative time and clinical outcomes between high‐power (HP) and low‐power (LP) thulium fibre laser (TFL) ureteroscopic (URS) lithotripsy for renal stones. Patients and methods Single‐centre, randomised trial (1:1) at Haukeland University Hospital, Norway. Adults undergoing day‐case URS for 8–25 mm renal stones were enrolled. A total of 150 cases were included. Patients were randomised to URS lithotripsy with TFL using HP (16–18 W, selected for thermal safety during sheathless URS) or LP (4–6 W). The primary endpoint was operative time. The secondary endpoints were stone‐free rate (SFR) on 3‐month non‐contrast computed tomography (Grade A: no residuals; Grade B: ≤2 mm; Grade C: ≤4 mm; Grade D: >4 mm), laser metrics, performance measures, and complications according to the Clavien–Dindo Classification. Groups were compared using appropriate parametric and non‐parametric tests (two‐sided <jats:italic>α</jats:italic> = 0.05). Results A ureteric access sheath was not used in any case, reflecting routine practice at our centre. The operative time did not differ between arms: median (interquartile range) HP 48 (36–62) vs LP 54 (42–65) min ( <jats:italic>P</jats:italic> = 0.12). HP used more energy (12 vs 7 kJ, <jats:italic>P</jats:italic> < 0.001) with shorter active laser time (13 vs 24 min, <jats:italic>P</jats:italic> < 0.001), but laser operating time was similar. SFRs favoured LP compared to HP: Grade A, 63% vs 44% ( <jats:italic>P</jats:italic> = 0.02); Grade B, 77% vs 56% ( <jats:italic>P</jats:italic> = 0.008). The Grade C SFR was similar between arms. LP was also associated with better surgeon‐rated endoscopic visibility and fewer minor postoperative complications (11% vs 37%, <jats:italic>P</jats:italic> < 0.001). Major complications (Clavien–Dindo Grade ≥III) were uncommon and similar between arms. Conclusion Using HP did not shorten the operative time. LP improved SFRs for Grade A/B and reduced minor postoperative morbidity, supporting LP as the default TFL strategy for sheathless URS lithotripsy.","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"23 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145807511","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}
Jonas Mennes,Murat Akand,Rodrigue Benijts,Loïc Baekelandt,Wouter Everaerts,Maarten Albersen,Hendrik Van Poppel,Frank Van der Aa,Steven Joniau
OBJECTIVETo assess the oncological impact of prophylactic urethrectomy (PU) on recurrence, metastasis, and survival outcomes, as PU was historically performed alongside radical cystectomy (RC) in men but has become rare with the increasing use of orthotopic neobladder substitution and uncertain survival benefits.PATIENTS AND METHODSA total of 1028 patients underwent RC at a single tertiary referral center between 1996 and 2022. Among them, 581 males who received either incontinent urinary diversion or continent cutaneous diversion were identified. A propensity score matching was performed to minimise selection bias, yielding a cohort of 332 patients, of whom 166 underwent PU and 166 did not. Kaplan-Meier survival analysis was conducted to evaluate recurrence-free survival (RFS), urethral recurrence-free survival (URFS), cancer-specific survival (CSS), and overall survival (OS) at multiple time points postoperatively. Differences in survival outcomes between the two groups were assessed using the log-rank test.RESULTSA trend toward improved CSS was observed in the PU group; however, the difference was not significant, and no notable variation was found in RFS. At 10 years, URFS was higher in the PU group (97.9% vs 90.9%, P = 0.05), but after matching, this difference (98.2% vs 95.9%) was no longer significant. A significant improvement in OS was observed among patients who underwent PU, with a 10-year survival rate of 47.3% compared to 27.5% in those who did not receive the procedure (P = 0.002). Independent predictors of OS included age ≥80 years (P = 0.013), Charlson Comorbidity Index score ≥3 (P = 0.002), pathological N-stage ≥N1 (P < 0.001), positive surgical margins (P < 0.001), and performing PU (P = 0.015).CONCLUSIONSPatients undergoing PU had significantly improved OS at 2-, 5-, and 10-year follow-up compared to those who did not. No significant differences were found in CSS and RFS. While PU was associated with a reduced risk of urethral recurrence at 10 years, this advantage was no longer significant after adjusting for confounders. The procedure may be most beneficial for select patients, particularly those with prostatic urethral involvement.
目的评估预防性尿道切除术（PU）对复发、转移和生存结果的肿瘤学影响，因为PU历来与根治性膀胱切除术（RC）一起在男性中进行，但随着原位新膀胱替代术的使用越来越多，且生存效益不确定，PU已变得罕见。患者和方法1996年至2022年间，共有1028名患者在单一三级转诊中心接受了RC。其中581例男性行尿失禁改道或皮肤改道。为了尽量减少选择偏差，进行了倾向评分匹配，产生了332例患者，其中166例接受了PU， 166例未接受PU。采用Kaplan-Meier生存分析评估术后多个时间点的无复发生存（RFS）、尿道无复发生存（URFS）、癌症特异性生存（CSS）和总生存（OS）。使用log-rank检验评估两组间生存结果的差异。结果PU组有改善CSS的sa趋势；但差异不显著，RFS无显著差异。10年时，PU组的URFS较高（97.9% vs 90.9%, P = 0.05），但配对后，这一差异（98.2% vs 95.9%）不再显著。接受PU治疗的患者的OS有显著改善，10年生存率为47.3%，而未接受PU治疗的患者为27.5% （P = 0.002）。OS的独立预测因子包括年龄≥80岁（P = 0.013）、Charlson合并症指数评分≥3分（P = 0.002）、病理n分期≥N1 （P < 0.001）、手术切缘阳性（P < 0.001）和行PU （P = 0.015）。结论：与未接受PU治疗的患者相比，接受PU治疗的患者在2年、5年和10年随访时的OS显著改善。CSS和RFS无显著差异。虽然PU与10年尿道复发风险降低相关，但在调整混杂因素后，这一优势不再显著。该手术可能对特定的患者最有利，特别是那些前列腺尿道受累的患者。
{"title":"Prophylactic urethrectomy at the time of radical cystectomy for bladder cancer: does it really have an effect on oncological outcomes?","authors":"Jonas Mennes,Murat Akand,Rodrigue Benijts,Loïc Baekelandt,Wouter Everaerts,Maarten Albersen,Hendrik Van Poppel,Frank Van der Aa,Steven Joniau","doi":"10.1111/bju.70096","DOIUrl":"https://doi.org/10.1111/bju.70096","url":null,"abstract":"OBJECTIVETo assess the oncological impact of prophylactic urethrectomy (PU) on recurrence, metastasis, and survival outcomes, as PU was historically performed alongside radical cystectomy (RC) in men but has become rare with the increasing use of orthotopic neobladder substitution and uncertain survival benefits.PATIENTS AND METHODSA total of 1028 patients underwent RC at a single tertiary referral center between 1996 and 2022. Among them, 581 males who received either incontinent urinary diversion or continent cutaneous diversion were identified. A propensity score matching was performed to minimise selection bias, yielding a cohort of 332 patients, of whom 166 underwent PU and 166 did not. Kaplan-Meier survival analysis was conducted to evaluate recurrence-free survival (RFS), urethral recurrence-free survival (URFS), cancer-specific survival (CSS), and overall survival (OS) at multiple time points postoperatively. Differences in survival outcomes between the two groups were assessed using the log-rank test.RESULTSA trend toward improved CSS was observed in the PU group; however, the difference was not significant, and no notable variation was found in RFS. At 10 years, URFS was higher in the PU group (97.9% vs 90.9%, P = 0.05), but after matching, this difference (98.2% vs 95.9%) was no longer significant. A significant improvement in OS was observed among patients who underwent PU, with a 10-year survival rate of 47.3% compared to 27.5% in those who did not receive the procedure (P = 0.002). Independent predictors of OS included age ≥80 years (P = 0.013), Charlson Comorbidity Index score ≥3 (P = 0.002), pathological N-stage ≥N1 (P < 0.001), positive surgical margins (P < 0.001), and performing PU (P = 0.015).CONCLUSIONSPatients undergoing PU had significantly improved OS at 2-, 5-, and 10-year follow-up compared to those who did not. No significant differences were found in CSS and RFS. While PU was associated with a reduced risk of urethral recurrence at 10 years, this advantage was no longer significant after adjusting for confounders. The procedure may be most beneficial for select patients, particularly those with prostatic urethral involvement.","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"167 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145807876","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}
Hilin Yildirim,Melinda S Schuurman,Harm H E van Melick,Adriaan D Bins,Patricia J Zondervan,Katja K H Aben
{"title":"Trends in treatment and survival of older vs younger patients with renal cancer between 2011 and 2022.","authors":"Hilin Yildirim,Melinda S Schuurman,Harm H E van Melick,Adriaan D Bins,Patricia J Zondervan,Katja K H Aben","doi":"10.1111/bju.70116","DOIUrl":"https://doi.org/10.1111/bju.70116","url":null,"abstract":"","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"35 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145807875","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}
扫码关注我们
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号