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}
Mario Bitar, Roseanne Ferreira, Sagi Shprits, Omar Buksh, Naeem Bhojani, Bilal Chughtai, Kevin C. Zorn, Dean Elterman
Objective To present large‐scale safety outcomes, with a particular focus on postoperative bleeding following Aquablation for benign prostatic hyperplasia. Patients and Methods Patients who underwent Aquablation between 2019 and 2024 across Asia, Europe, and North America were assessed to evaluate trends in treated prostate sizes, which were visualised using density plots. A corporate prospective database was maintained, incorporating case recordings and data collected by on‐site company representatives. In addition, the incidence of postoperative bleeding—defined as transfusion or surgical takeback for haemostatic fulguration—was analysed using data from the United States Food and Drug Administration (FDA) Manufacturer and User Facility Device Experience (MAUDE) database and procedure counts by the manufacturer. Results A total of 70 270 Aquablation procedures were evaluated over the period from 2019 to 2024. The mean (standard deviation) prostate volume was 87.3 (42.4) mL, with a maximum recorded size of 1189 mL. Density plot analysis of prostate volumes demonstrated consistent utilisation of Aquablation across the full range of prostate sizes throughout all years studied. The overall rate of blood transfusion or return to the operating room for haemostatic fulguration was 0.2%, indicating a favourable safety profile across a very wide range of prostate sizes. Conclusions Aquablation has been consistently utilised across a broad spectrum of prostate sizes, with a low overall rate of transfusion or return to the operating room for bleeding control. These findings highlight the procedure's broad applicability and favourable safety profile in real‐world practice from 2019 to 2024.
{"title":"Aquablation for benign prostatic hyperplasia: real‐world prostate size relevance and bleeding events across 6 years","authors":"Mario Bitar, Roseanne Ferreira, Sagi Shprits, Omar Buksh, Naeem Bhojani, Bilal Chughtai, Kevin C. Zorn, Dean Elterman","doi":"10.1111/bju.70118","DOIUrl":"https://doi.org/10.1111/bju.70118","url":null,"abstract":"Objective To present large‐scale safety outcomes, with a particular focus on postoperative bleeding following Aquablation for benign prostatic hyperplasia. Patients and Methods Patients who underwent Aquablation between 2019 and 2024 across Asia, Europe, and North America were assessed to evaluate trends in treated prostate sizes, which were visualised using density plots. A corporate prospective database was maintained, incorporating case recordings and data collected by on‐site company representatives. In addition, the incidence of postoperative bleeding—defined as transfusion or surgical takeback for haemostatic fulguration—was analysed using data from the United States Food and Drug Administration (FDA) Manufacturer and User Facility Device Experience (MAUDE) database and procedure counts by the manufacturer. Results A total of 70 270 Aquablation procedures were evaluated over the period from 2019 to 2024. The mean (standard deviation) prostate volume was 87.3 (42.4) mL, with a maximum recorded size of 1189 mL. Density plot analysis of prostate volumes demonstrated consistent utilisation of Aquablation across the full range of prostate sizes throughout all years studied. The overall rate of blood transfusion or return to the operating room for haemostatic fulguration was 0.2%, indicating a favourable safety profile across a very wide range of prostate sizes. Conclusions Aquablation has been consistently utilised across a broad spectrum of prostate sizes, with a low overall rate of transfusion or return to the operating room for bleeding control. These findings highlight the procedure's broad applicability and favourable safety profile in real‐world practice from 2019 to 2024.","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"2 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145759788","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}
Abderrahim-Oussama Batouche,Eugen Czeizler,Timo-Pekka Lehto,Andrew Erickson,Tolou Shadbahr,Teemu D Laajala,Joona Pohjonen,Tuomas Mirtti,Antti S Rannikko
OBJECTIVETo determine the likelihood of definitive treatment and risk of post-treatment recurrence for patients with Gleason Grade Group (GG) 2 cancer diagnosed using targeted biopsies relative to men with GG1 cancer diagnosed using systematic biopsies.MATERIALS AND METHODSWe performed a retrospective study using a large tertiary centre registry (the HUS Acamedic data lake) to retrieve data on prostate cancer (PCa) diagnosis, treatment, and cancer recurrence. We included patients with either GG1 PCa detected by systematic biopsies (n = 3317) or GG2 PCa detected with targeted biopsies (n = 554) between 1993 and 2019. We assessed the risk of curative treatment and recurrence after treatment. Kaplan-Meier curves were used to estimate treatment- and recurrence-free survival, and Cox proportional hazards regression was used to evaluate the risk of post-treatment recurrence.RESULTSPatients with systematic biopsy-detected GG1 cancer had a significantly longer median time to treatment (31 months) than those with targeted biopsy-detected GG2 cancer (4 months; P < 0.0001). Risk of recurrence after curative treatment was similar in the two groups, with the upper bound of the 95% confidence interval (CI) excluding any significant difference (hazard ratio 1.04, 95% CI 0.75-1.43; P = 0.83).CONCLUSIONMen diagnosed with GG2 PCa based on MRI-targeted biopsy had a similar risk of recurrence after treatment compared to men with GG1 disease diagnosed using systematic biopsy, although they were more likely to undergo curative treatment. These findings suggest that at least a portion of the apparent increase in GG2 diagnoses in the MRI era may reflect reclassification rather than more aggressive disease. Improved risk stratification is needed to identify which men with MRI-era GG2 cancer may be suitable for active surveillance.
目的：相对于采用系统活检诊断为GG1癌的男性，采用靶向活检诊断为Gleason Grade Group (GG) 2癌的患者确定治疗的可能性和治疗后复发的风险。材料和方法我们使用一个大型三级中心登记处（HUS学术数据湖）进行了一项回顾性研究，以检索前列腺癌（PCa）的诊断、治疗和癌症复发的数据。我们纳入了1993年至2019年间通过系统活检检测到GG1型前列腺癌（n = 3317）或通过靶向活检检测到GG2型前列腺癌（n = 554）的患者。我们评估了治愈治疗和治疗后复发的风险。Kaplan-Meier曲线用于估计无治疗和无复发生存期，Cox比例风险回归用于评估治疗后复发风险。结果系统活检检测到GG1癌患者的中位治疗时间（31个月）明显长于靶向活检检测到GG2癌患者（4个月，P < 0.0001）。两组治愈后复发的风险相似，95%置信区间（CI）上界排除任何显著差异（风险比1.04,95% CI 0.75-1.43; P = 0.83）。结论与系统活检诊断为GG1的男性相比，基于mri靶向活检诊断为GG2的男性治疗后复发的风险相似，尽管他们更有可能接受根治性治疗。这些发现表明，在MRI时代GG2诊断的明显增加中，至少有一部分可能反映了重新分类，而不是更具侵袭性的疾病。需要改进风险分层，以确定哪些患有mri时代GG2癌的男性可能适合进行主动监测。
{"title":"Comparable recurrence risk for MRI-detected Gleason Grade Group (GG) 2 and systematic biopsy-detected GG1 prostate cancer.","authors":"Abderrahim-Oussama Batouche,Eugen Czeizler,Timo-Pekka Lehto,Andrew Erickson,Tolou Shadbahr,Teemu D Laajala,Joona Pohjonen,Tuomas Mirtti,Antti S Rannikko","doi":"10.1111/bju.70109","DOIUrl":"https://doi.org/10.1111/bju.70109","url":null,"abstract":"OBJECTIVETo determine the likelihood of definitive treatment and risk of post-treatment recurrence for patients with Gleason Grade Group (GG) 2 cancer diagnosed using targeted biopsies relative to men with GG1 cancer diagnosed using systematic biopsies.MATERIALS AND METHODSWe performed a retrospective study using a large tertiary centre registry (the HUS Acamedic data lake) to retrieve data on prostate cancer (PCa) diagnosis, treatment, and cancer recurrence. We included patients with either GG1 PCa detected by systematic biopsies (n = 3317) or GG2 PCa detected with targeted biopsies (n = 554) between 1993 and 2019. We assessed the risk of curative treatment and recurrence after treatment. Kaplan-Meier curves were used to estimate treatment- and recurrence-free survival, and Cox proportional hazards regression was used to evaluate the risk of post-treatment recurrence.RESULTSPatients with systematic biopsy-detected GG1 cancer had a significantly longer median time to treatment (31 months) than those with targeted biopsy-detected GG2 cancer (4 months; P < 0.0001). Risk of recurrence after curative treatment was similar in the two groups, with the upper bound of the 95% confidence interval (CI) excluding any significant difference (hazard ratio 1.04, 95% CI 0.75-1.43; P = 0.83).CONCLUSIONMen diagnosed with GG2 PCa based on MRI-targeted biopsy had a similar risk of recurrence after treatment compared to men with GG1 disease diagnosed using systematic biopsy, although they were more likely to undergo curative treatment. These findings suggest that at least a portion of the apparent increase in GG2 diagnoses in the MRI era may reflect reclassification rather than more aggressive disease. Improved risk stratification is needed to identify which men with MRI-era GG2 cancer may be suitable for active surveillance.","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"14 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145752610","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 'Male sex is a risk factor for detrusor pressure jeopardising the upper urinary tract after spinal cord injury'.","authors":"Longtu Ma,Rui Lu,Zhilong Dong","doi":"10.1111/bju.70107","DOIUrl":"https://doi.org/10.1111/bju.70107","url":null,"abstract":"","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"57 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145752747","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}
Matthias May,Anton Kravchuk,Ralph M Wirtz,Thorsten H Ecke,Axel Heidenreich
{"title":"Expanding the evidence base for Uromonitor®: updated pooled performance across eight cohorts.","authors":"Matthias May,Anton Kravchuk,Ralph M Wirtz,Thorsten H Ecke,Axel Heidenreich","doi":"10.1111/bju.70113","DOIUrl":"https://doi.org/10.1111/bju.70113","url":null,"abstract":"","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"170 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145752614","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":"Response to: ‘Expanding the evidence base for Uromonitor®: updated pooled performance across eight cohorts’","authors":"José Rubio‐Briones","doi":"10.1111/bju.70114","DOIUrl":"https://doi.org/10.1111/bju.70114","url":null,"abstract":"","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"6 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145731055","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}
Collene E. Anderson, Veronika Birkhäuser, Martin W. G. Brinkhof, Thomas M. Kessler
{"title":"RE: Comment: ‘Male sex is a risk factor for detrusor pressure jeopardising the upper urinary tract in patients with spinal cord injury’","authors":"Collene E. Anderson, Veronika Birkhäuser, Martin W. G. Brinkhof, Thomas M. Kessler","doi":"10.1111/bju.70106","DOIUrl":"https://doi.org/10.1111/bju.70106","url":null,"abstract":"","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"98 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145711403","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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