{"title":"Comment on 'Impact of perioperative nutrition on recovery after radical cystectomy: a randomised trial'.","authors":"Longtu Ma, Zeming Qiu, Zhilong Dong","doi":"10.1111/bju.70160","DOIUrl":"https://doi.org/10.1111/bju.70160","url":null,"abstract":"","PeriodicalId":8985,"journal":{"name":"BJU International","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146117488","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}
Elizabeth Day, Francesco Pio Bizzarri, Elizabeth Waine, Rebecca Martin, Adam W. Nelson, Alexandra J. Colquhoun, Helena Burden, Benjamin Ayres, Vishwanath Hanchanale, Jonathan Aning, James Douglas, Niyati Lobo
Objective To characterise contemporary practice patterns in female radical cystectomy (RC) across the UK and Ireland, focusing on preoperative counselling, operative strategies, and postoperative care. Subjects and Methods A 36‐item survey was distributed to consultant urologists performing RC, identified via the British Association of Urological Surgeons (BAUS) and Cancer Alliances. The questionnaire addressed surgeon demographics, preoperative assessment and counselling, operative decision‐making including organ‐ and nerve‐sparing techniques, and survivorship care. Responses were analysed descriptively; group comparisons were made using the Wilcoxon rank‐sum and Fisher's exact tests. Results A total of 64 surgeons responded (56.1% [64/114]), representing 41 cystectomy centres (70.7% [41/58]). Preoperative assessment of sexual activity (68.8%) and menopausal status (78.1%) was common, whereas sexual orientation (15.6%) and prolapse (26.6%) were rarely addressed. Female surgeons were significantly more likely to enquire about menopausal status ( P = 0.025). Counselling on sexual dysfunction (98.4%) and vaginal shortening (96.9%) was routine, but other complications, including prolapse (68.8%), menopause (82.8%), or fistula (6.3%), were inconsistently discussed. Organ‐sparing practice varied: 28.1% rarely or never performed organ preservation, citing oncological concerns. High‐volume centres were more likely to offer organ‐sparing RC ( P = 0.013). Over half reported inadequate access to female‐specific rehabilitation services, with most centres lacking formal pathways for vaginal complications. Conclusions Female RC practice across the UK and Ireland is heterogeneous, with clear gaps in preoperative counselling, uptake of organ‐sparing techniques, and survivorship care. There is an urgent need for standardised, evidence‐based pathways and consensus guidance to optimise outcomes for female patients.
{"title":"Contemporary practice patterns in female radical cystectomy: results of a UK and Ireland survey","authors":"Elizabeth Day, Francesco Pio Bizzarri, Elizabeth Waine, Rebecca Martin, Adam W. Nelson, Alexandra J. Colquhoun, Helena Burden, Benjamin Ayres, Vishwanath Hanchanale, Jonathan Aning, James Douglas, Niyati Lobo","doi":"10.1111/bju.70159","DOIUrl":"https://doi.org/10.1111/bju.70159","url":null,"abstract":"Objective To characterise contemporary practice patterns in female radical cystectomy (RC) across the UK and Ireland, focusing on preoperative counselling, operative strategies, and postoperative care. Subjects and Methods A 36‐item survey was distributed to consultant urologists performing RC, identified via the British Association of Urological Surgeons (BAUS) and Cancer Alliances. The questionnaire addressed surgeon demographics, preoperative assessment and counselling, operative decision‐making including organ‐ and nerve‐sparing techniques, and survivorship care. Responses were analysed descriptively; group comparisons were made using the Wilcoxon rank‐sum and Fisher's exact tests. Results A total of 64 surgeons responded (56.1% [64/114]), representing 41 cystectomy centres (70.7% [41/58]). Preoperative assessment of sexual activity (68.8%) and menopausal status (78.1%) was common, whereas sexual orientation (15.6%) and prolapse (26.6%) were rarely addressed. Female surgeons were significantly more likely to enquire about menopausal status ( <jats:italic>P</jats:italic> = 0.025). Counselling on sexual dysfunction (98.4%) and vaginal shortening (96.9%) was routine, but other complications, including prolapse (68.8%), menopause (82.8%), or fistula (6.3%), were inconsistently discussed. Organ‐sparing practice varied: 28.1% rarely or never performed organ preservation, citing oncological concerns. High‐volume centres were more likely to offer organ‐sparing RC ( <jats:italic>P</jats:italic> = 0.013). Over half reported inadequate access to female‐specific rehabilitation services, with most centres lacking formal pathways for vaginal complications. Conclusions Female RC practice across the UK and Ireland is heterogeneous, with clear gaps in preoperative counselling, uptake of organ‐sparing techniques, and survivorship care. There is an urgent need for standardised, evidence‐based pathways and consensus guidance to optimise outcomes for female patients.","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"216 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146098414","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":"Methodological clarifications of perioperative nutritional outcomes: a response to Ma et al.","authors":"Mohammed Lotfi Amer,Sameh Fawzy Elnasharty","doi":"10.1111/bju.70158","DOIUrl":"https://doi.org/10.1111/bju.70158","url":null,"abstract":"","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"2 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146073268","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 determine the short-term oncological results and safety of the ProFocal Laser Therapy for Prostate Tissue Ablation (PFLT-PC) trial, the first phase II clinical trial of ProFocal® (Medlogical Innovations, Sydney, Australia), a novel, cooled laser focal therapy (cLFT) device for prostate cancer (PCa) treatment.PATIENTS AND METHODSMen with localised PCa, prostate-specific antigen (PSA) level ≤15 ng/mL, T stage ≤T2c, International Society of Urological Pathology (ISUP) score 2-3 concordant with multiparametric magnetic resonance imaging (mpMRI) visible disease were recruited for this trial (Australian and New Zealand Clinical Trial Registry [ACTRN]12618001774213p) at Nepean Hospital, Australia. The cLFT was performed under general anaesthesia as a day procedure. Primary outcome was adequacy of tissue ablation assessed by mpMRI within 72 h and biopsy at 3 months. Secondary outcomes of functional measures were assessed using validated questionnaires (International Prostate Symptom Score, Sexual Health Inventory for Men [SHIM], Expanded Prostate cancer Index Composite [EPIC], 12-item Short-Form Health Survey). Complications and adverse events within 90 days were reported using Clavien-Dindo classification grading.RESULTSA total of 100 patients were recruited. The median (interquartile range [IQR]) age was 66 (60-72) years, PSA level 5.9 (3.9-7.6) ng/mL, prostate volume 39 (30-51) mL and MRI lesion volume 0.84 (0.57-1.2) mL. The median (IQR) treatment time was 60 (47-70) min. In all, 84% had no ISUP Grade Group ≥2 PCa in their 3-month treatment zone biopsies. Erectile dysfunction was reported in 12% of the men, with a 15% mean decline in the SHIM and EPIC-sexual domains scores. There was a 4.5% decrease on EPIC-urinary domain scores. There was no decline in any other functional measures. This study's main limitations were the absence of a control group and the short follow-up.CONCLUSIONSThe PFLT-PC trial demonstrates that at 3 months, cLFT using the ProFocal device provides an 84% treatment success with low morbidity.
{"title":"Focal therapy using a novel cooled laser device for prostate cancer: early trial results.","authors":"Jonathan Kam,Bishoy Hanna,Stuart Jackson,Stephen McCombie,George McClintock,Matthew J Roberts,Jeremy Teoh,Mohan Arianayagam,Bertram Canagasingham,Ahmed Saeed Goolam,Nicola Jeffery,Matthew Winter,Mohamed Khadra,Raymond Ko,Nicholas Mehan,Isaac Thangasamy,Celi Varol","doi":"10.1111/bju.70150","DOIUrl":"https://doi.org/10.1111/bju.70150","url":null,"abstract":"OBJECTIVESTo determine the short-term oncological results and safety of the ProFocal Laser Therapy for Prostate Tissue Ablation (PFLT-PC) trial, the first phase II clinical trial of ProFocal® (Medlogical Innovations, Sydney, Australia), a novel, cooled laser focal therapy (cLFT) device for prostate cancer (PCa) treatment.PATIENTS AND METHODSMen with localised PCa, prostate-specific antigen (PSA) level ≤15 ng/mL, T stage ≤T2c, International Society of Urological Pathology (ISUP) score 2-3 concordant with multiparametric magnetic resonance imaging (mpMRI) visible disease were recruited for this trial (Australian and New Zealand Clinical Trial Registry [ACTRN]12618001774213p) at Nepean Hospital, Australia. The cLFT was performed under general anaesthesia as a day procedure. Primary outcome was adequacy of tissue ablation assessed by mpMRI within 72 h and biopsy at 3 months. Secondary outcomes of functional measures were assessed using validated questionnaires (International Prostate Symptom Score, Sexual Health Inventory for Men [SHIM], Expanded Prostate cancer Index Composite [EPIC], 12-item Short-Form Health Survey). Complications and adverse events within 90 days were reported using Clavien-Dindo classification grading.RESULTSA total of 100 patients were recruited. The median (interquartile range [IQR]) age was 66 (60-72) years, PSA level 5.9 (3.9-7.6) ng/mL, prostate volume 39 (30-51) mL and MRI lesion volume 0.84 (0.57-1.2) mL. The median (IQR) treatment time was 60 (47-70) min. In all, 84% had no ISUP Grade Group ≥2 PCa in their 3-month treatment zone biopsies. Erectile dysfunction was reported in 12% of the men, with a 15% mean decline in the SHIM and EPIC-sexual domains scores. There was a 4.5% decrease on EPIC-urinary domain scores. There was no decline in any other functional measures. This study's main limitations were the absence of a control group and the short follow-up.CONCLUSIONSThe PFLT-PC trial demonstrates that at 3 months, cLFT using the ProFocal device provides an 84% treatment success with low morbidity.","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"77 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146056496","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}
INTRODUCTION AND OBJECTIVESLuminal Index magnetic resonance imaging (LI-MRI) is a novel technique that has recently been proposed for prostate cancer (PCa) characterisation. It is based on multi-echo T2-weighted sequences and requires <10 min to be performed. However, evidence on its diagnostic performance in the diagnostic evaluation of PCa is lacking. The 'Comparison of diagnostic accuracy of Luminal Index and standard of care MRI for Accelerated deTEction of prostate cancer' (CLIMATE) trial aims to compare the diagnostic accuracy of LI-MRI and standard of care (SOC) MRI (multiparametric or biparametric MRI) for the detection of clinically significant PCa (csPCa).TRIAL DESIGNThe CLIMATE trial is a prospective, multicentre, paired, non-randomised comparative trial of LI-MRI and SOC MRI targeted biopsy in participants with clinically suspected PCa.ENDPOINTSThe primary endpoint of the trial is to compare the per-participant diagnostic accuracy of LI-MRI and SOC MRI for csPCa using targeted biopsies as the standard of reference.PATIENTS AND METHODSAdult men (aged ≥18 years) with clinical suspicion of PCa and no prior PCa diagnosis or treatment will be invited. Each participant will undergo LI-MRI and SOC MRI in a single scan session, with each test interpreted without knowledge of the other test images or results. LI-MRI and SOC MRI will be reported on a 1-5 scale for suspicion of tumour (Likert scale or Prostate Imaging-Reporting and Data System). Targeted biopsies will be taken for any suspicious lesions detected, defined as MRI score of ≥3.TRIAL REGISTRATIONClinicalTrials.gov Registry (NCT05020522).
{"title":"The 'Comparison of diagnostic accuracy of Luminal Index and standard of care MRI for Accelerated deTEction of prostate cancer' (CLIMATE) trial protocol.","authors":"Tarek Al-Hammouri,Giorgio Brembilla,Mrishta Brizmohun,Juel Tuazon,Joey Clemente,Manju Mathew,Ingrid Potyka,Chris Brew-Graves,Julia Markus,Francesco Giganti,Tom Parry,Aiman Haider,Sue Mallett,Tim Dudderidge,Tristan Barrett,Gerhardt Attard,Caroline Moore,Shonit Punwani, ","doi":"10.1111/bju.70108","DOIUrl":"https://doi.org/10.1111/bju.70108","url":null,"abstract":"INTRODUCTION AND OBJECTIVESLuminal Index magnetic resonance imaging (LI-MRI) is a novel technique that has recently been proposed for prostate cancer (PCa) characterisation. It is based on multi-echo T2-weighted sequences and requires <10 min to be performed. However, evidence on its diagnostic performance in the diagnostic evaluation of PCa is lacking. The 'Comparison of diagnostic accuracy of Luminal Index and standard of care MRI for Accelerated deTEction of prostate cancer' (CLIMATE) trial aims to compare the diagnostic accuracy of LI-MRI and standard of care (SOC) MRI (multiparametric or biparametric MRI) for the detection of clinically significant PCa (csPCa).TRIAL DESIGNThe CLIMATE trial is a prospective, multicentre, paired, non-randomised comparative trial of LI-MRI and SOC MRI targeted biopsy in participants with clinically suspected PCa.ENDPOINTSThe primary endpoint of the trial is to compare the per-participant diagnostic accuracy of LI-MRI and SOC MRI for csPCa using targeted biopsies as the standard of reference.PATIENTS AND METHODSAdult men (aged ≥18 years) with clinical suspicion of PCa and no prior PCa diagnosis or treatment will be invited. Each participant will undergo LI-MRI and SOC MRI in a single scan session, with each test interpreted without knowledge of the other test images or results. LI-MRI and SOC MRI will be reported on a 1-5 scale for suspicion of tumour (Likert scale or Prostate Imaging-Reporting and Data System). Targeted biopsies will be taken for any suspicious lesions detected, defined as MRI score of ≥3.TRIAL REGISTRATIONClinicalTrials.gov Registry (NCT05020522).","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"28 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146044619","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}
Christopher Kniep, Tobias Maurer, Ben Frederik Hartwieg, Philipp Mandel, Mike Wenzel, Fabian Falkenbach, Kristian Krpina, Lars Budäus, Alexander Haese, Georg Salomon, Thomas Steuber, Markus Graefen, Derya Tilki, Felix Preisser
Objective To evaluate the diagnostic performance of different staging modalities and oncological outcomes in patients with intermediate‐risk (IR) prostate cancer (PCa) undergoing radical prostatectomy (RP) with pelvic lymph node dissection (PLND). Patients and Methods Patients with IR PCa who underwent RP and PLND between 2015 and 2021 were retrospectively analysed. Patients who had received neoadjuvant hormone therapy were excluded. The effectiveness of computed tomography (CT), magnetic resonance imaging (MRI), and prostate‐specific membrane antigen‐positron emission tomography (PSMA‐PET) in detecting lymph node invasion (LNI) was assessed. Kaplan–Meier analysis was used to evaluate biochemical recurrence‐free and metastasis‐free survival. Results Among 8043 patients with IR PCa undergoing RP with PLND, 624 (7.8%) had LNI. PSMA‐PET was performed in 400 patients: six true positives, 40 false negatives, 14 false positives, and 340 true negatives. CT was used in 2079 patients: two true positives, 228 false negatives, seven false positives, and 1842 true negatives. MRI was performed in 148 patients: one true positive, 11 false negatives, and 136 true negatives, with no false positives. Sensitivity was highest for PSMA‐PET (13%), followed by MRI (8.3%) and CT (0.9%). Negative predictive values were 92.5% for MRI, 89.5% for PSMA‐PET, and 89% for CT. Patients with negative PSMA‐PET findings had significantly better biochemical recurrence‐free and metastasis‐free survival than those with suspicious findings on PSMA‐PET. Conclusions All evaluated staging modalities demonstrated limited sensitivity in detecting LNI in patients with IR PCa, including PSMA‐PET. Given the poor diagnostic performance of conventional imaging, such methods may be omitted in this setting. PSMA‐PET may still be considered selectively, as it provides modest sensitivity and prognostic value, although its role remains limited.
{"title":"Diagnostic accuracy and outcomes of lymph node staging in intermediate‐risk prostate cancer","authors":"Christopher Kniep, Tobias Maurer, Ben Frederik Hartwieg, Philipp Mandel, Mike Wenzel, Fabian Falkenbach, Kristian Krpina, Lars Budäus, Alexander Haese, Georg Salomon, Thomas Steuber, Markus Graefen, Derya Tilki, Felix Preisser","doi":"10.1111/bju.70155","DOIUrl":"https://doi.org/10.1111/bju.70155","url":null,"abstract":"Objective To evaluate the diagnostic performance of different staging modalities and oncological outcomes in patients with intermediate‐risk (IR) prostate cancer (PCa) undergoing radical prostatectomy (RP) with pelvic lymph node dissection (PLND). Patients and Methods Patients with IR PCa who underwent RP and PLND between 2015 and 2021 were retrospectively analysed. Patients who had received neoadjuvant hormone therapy were excluded. The effectiveness of computed tomography (CT), magnetic resonance imaging (MRI), and prostate‐specific membrane antigen‐positron emission tomography (PSMA‐PET) in detecting lymph node invasion (LNI) was assessed. Kaplan–Meier analysis was used to evaluate biochemical recurrence‐free and metastasis‐free survival. Results Among 8043 patients with IR PCa undergoing RP with PLND, 624 (7.8%) had LNI. PSMA‐PET was performed in 400 patients: six true positives, 40 false negatives, 14 false positives, and 340 true negatives. CT was used in 2079 patients: two true positives, 228 false negatives, seven false positives, and 1842 true negatives. MRI was performed in 148 patients: one true positive, 11 false negatives, and 136 true negatives, with no false positives. Sensitivity was highest for PSMA‐PET (13%), followed by MRI (8.3%) and CT (0.9%). Negative predictive values were 92.5% for MRI, 89.5% for PSMA‐PET, and 89% for CT. Patients with negative PSMA‐PET findings had significantly better biochemical recurrence‐free and metastasis‐free survival than those with suspicious findings on PSMA‐PET. Conclusions All evaluated staging modalities demonstrated limited sensitivity in detecting LNI in patients with IR PCa, including PSMA‐PET. Given the poor diagnostic performance of conventional imaging, such methods may be omitted in this setting. PSMA‐PET may still be considered selectively, as it provides modest sensitivity and prognostic value, although its role remains limited.","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"101 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146032724","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Joost van Drumpt,Tim Govers,Ricardo Almeida-Magana,Diederik Baas,Aiman Haider,Michiel Sedelaar,Greg Shaw,Diederik Somford
OBJECTIVETo determine whether current intraoperative margin assessment (IOMA) techniques (such as Neurovascular Structure Adjacent Frozen-section Examination [NeuroSAFE] or confocal laser microscopy [CLM]) used during radical prostatectomy (RP) to enhance nerve-sparing surgery (NSS) while reducing positive surgical margins (PSMs) justify their extra costs, this study assessed their cost-effectiveness.METHODSA decision analytical model assessed health outcomes and costs associated with NeuroSAFE and CLM (using the Histolog® Scanner) compared to bilateral, unilateral, and non-NSS. Outcomes were calculated in quality-adjusted life years (QALYs), with a cost-effectiveness threshold of €50 000 per QALY. NSS reduced erectile dysfunction and incontinence probabilities. However, when extraprostatic extension was present but not identified pre- or intraoperatively, NSS resulted in a PSM, increasing the risk of biochemical recurrence (BCR) and development of metastases.RESULTSThe NeuroSAFE and CLM were cost-effective strategies compared to non-IOMA strategies. NeuroSAFE was most cost-effective if NeuroSAFE and CLM were used in an equal number of patients. However, if NeuroSAFE was used in >8% fewer patients compared to CLM, CLM was most cost-effective. Sensitivity analyses highlighted the impact of PSMs on cost-effectiveness. In hospitals with higher RP volumes (>160 per year), CLM had lower costs per procedure than NeuroSAFE.CONCLUSIONSIntraoperative margin assessment during RP is a cost-effective intervention. The choice to implement NeuroSAFE or CLM should be guided by both surgical volume and available capacity, as the more labour-intensive nature of NeuroSAFE may limit its use and reduces its cost-effectiveness compared with CLM.
{"title":"The cost-effectiveness of intraoperative margin assessment strategies during radical prostatectomy.","authors":"Joost van Drumpt,Tim Govers,Ricardo Almeida-Magana,Diederik Baas,Aiman Haider,Michiel Sedelaar,Greg Shaw,Diederik Somford","doi":"10.1111/bju.70121","DOIUrl":"https://doi.org/10.1111/bju.70121","url":null,"abstract":"OBJECTIVETo determine whether current intraoperative margin assessment (IOMA) techniques (such as Neurovascular Structure Adjacent Frozen-section Examination [NeuroSAFE] or confocal laser microscopy [CLM]) used during radical prostatectomy (RP) to enhance nerve-sparing surgery (NSS) while reducing positive surgical margins (PSMs) justify their extra costs, this study assessed their cost-effectiveness.METHODSA decision analytical model assessed health outcomes and costs associated with NeuroSAFE and CLM (using the Histolog® Scanner) compared to bilateral, unilateral, and non-NSS. Outcomes were calculated in quality-adjusted life years (QALYs), with a cost-effectiveness threshold of €50 000 per QALY. NSS reduced erectile dysfunction and incontinence probabilities. However, when extraprostatic extension was present but not identified pre- or intraoperatively, NSS resulted in a PSM, increasing the risk of biochemical recurrence (BCR) and development of metastases.RESULTSThe NeuroSAFE and CLM were cost-effective strategies compared to non-IOMA strategies. NeuroSAFE was most cost-effective if NeuroSAFE and CLM were used in an equal number of patients. However, if NeuroSAFE was used in >8% fewer patients compared to CLM, CLM was most cost-effective. Sensitivity analyses highlighted the impact of PSMs on cost-effectiveness. In hospitals with higher RP volumes (>160 per year), CLM had lower costs per procedure than NeuroSAFE.CONCLUSIONSIntraoperative margin assessment during RP is a cost-effective intervention. The choice to implement NeuroSAFE or CLM should be guided by both surgical volume and available capacity, as the more labour-intensive nature of NeuroSAFE may limit its use and reduces its cost-effectiveness compared with CLM.","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"64 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146015122","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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