BJU International最新文献

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What are we missing? Identifying clinically significant prostate cancer among patients with low PSA: the utility of the free-to-total PSA ratio. 我们错过了什么？在低PSA患者中识别具有临床意义的前列腺癌：自由-总PSA比值的效用。

IF 4.5 2区医学 Q1 UROLOGY & NEPHROLOGY

BJU International

Pub Date : 2025-12-08 DOI: 10.1111/bju.70110

Daniel Crisafi,Jeffrey Jiang,Damien Bolton,Joseph Ischia,Dixon T S Woon

引用次数: 0

Urologic chronic pelvic pain syndrome 3-year symptom trajectories: the Multidisciplinary Approach to the Study of Chronic Pelvic Pain (MAPP) Symptom Patterns Study 泌尿系统慢性盆腔疼痛综合征3年症状轨迹：多学科方法研究慢性盆腔疼痛（MAPP）症状模式研究。

IF 4.4 2区医学 Q1 UROLOGY & NEPHROLOGY

BJU International

Pub Date : 2025-12-02 DOI: 10.1111/bju.70087

Catherine S. Bradley, Mengying You, Wensheng Guo, Niloofar Afari, Priyanka Gupta, Karl J. Kreder, John N. Krieger, H. Henry Lai, Susan K. Lutgendorf, Bruce D. Naliboff, Siobhan Sutcliffe, Frank Tu, David A. Williams, Tara McWilliams, Larissa Rodriguez, J. Richard Landis, for the Multidisciplinary Approach to the Study of Chronic Pelvic Pain (MAPP) Research Network

Objectives

To characterise 3-year pelvic pain and urinary symptom trajectories and to identify baseline factors associated with urologic chronic pelvic pain syndrome (UCPPS) improvement.

Patients and Methods

The Trans-Multidisciplinary Approach to the Study of Chronic Pelvic Pain (MAPP) Symptom Patterns Study was a multicentre, prospective cohort study of UCPPS, including interstitial cystitis/bladder pain syndrome and chronic prostatitis/chronic pelvic pain syndrome. Patients completed four weekly run-in assessments, baseline visit, and quarterly visits up to 3 years, providing clinical and patient-reported data. A functional clustering approach, applied separately to Pelvic Pain Severity (PPS) and Urinary Symptom Severity (USS) longitudinal change scores, was used to generate symptom trajectory clusters dichotomised as Group 0 ‘improvers’ vs Groups 1–3 ‘non-improvers’. Logistic regression models explored baseline factors associated with improvement and included run-in period average and baseline scores to adjust for regression to the mean effects.

Results

A total of 545 patients (66% female) were followed for a median (interquartile range) of 34 (23–35) months. Four trajectory clusters were identified for each of PPS and USS, consistent with moderate improvement (Group 0), slight improvement (Group 1), no change (Group 2), and slight worsening (Group 3). In all, 18% and 19% of patients were in the moderately improved PPS and USS groups, respectively, representing 30% of patients overall. Female sex, better sleep, and less opioid use were associated with PPS improvement (Group 0); younger age and baseline cystoscopic treatment were associated with USS improvement (Group 0).

Conclusion

In all, 30% of patients with UCPPS demonstrated improvement in pain and/or urinary symptoms over 3 years. Baseline factors associated with improvement may represent markers of a milder or localised phenotype and/or treatment effects.

目的：描述3年盆腔疼痛和泌尿症状轨迹，并确定与泌尿系统慢性盆腔疼痛综合征（UCPPS）改善相关的基线因素。患者和方法：跨学科方法研究慢性盆腔疼痛（MAPP）症状模式研究是一项多中心、前瞻性队列研究UCPPS，包括间质性膀胱炎/膀胱疼痛综合征和慢性前列腺炎/慢性盆腔疼痛综合征。患者完成了为期3年的4次每周磨合评估、基线访问和季度访问，提供了临床和患者报告的数据。功能聚类方法分别应用于盆腔疼痛严重程度（PPS）和泌尿症状严重程度（USS）纵向变化评分，用于生成症状轨迹聚类，分为0组“改善者”和1-3组“非改善者”。逻辑回归模型探讨了与改善相关的基线因素，并包括磨合期平均值和基线得分，以调整回归到平均效应。结果：共有545例患者（66%为女性）被随访，中位（四分位数范围）为34（23-35）个月。分别为PPS和USS确定了四个轨迹组，分别为中度改善（0组）、轻度改善（1组）、无变化（2组）和轻度恶化（3组）。总的来说，18%和19%的患者分别属于中度改善的PPS组和USS组，占总患者的30%。女性、更好的睡眠和更少的阿片类药物使用与PPS改善相关（0组）；年龄较小和基线膀胱镜治疗与USS改善相关（0组）。结论：总的来说，30%的UCPPS患者在3年内表现出疼痛和/或泌尿系统症状的改善。与改善相关的基线因素可能代表轻度或局部表型和/或治疗效果的标志。

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引用次数: 0

Transition to a digital perioperative pathway for robot‐assisted radical prostatectomy: impact on patient outcomes and adherence 机器人辅助根治性前列腺切除术向数字化围手术期路径的过渡：对患者预后和依从性的影响

IF 4.5 2区医学 Q1 UROLOGY & NEPHROLOGY

BJU International

Pub Date : 2025-12-02 DOI: 10.1111/bju.70102

Bogdan Adrian Buhas, Alessandro Uleri, Olga Katzendorn, Ambroise Salin, Marine Lesourd, Christophe Almeras, Guillaume Loison, Christophe Tollon, Benjamin Pradère, Jean‐Baptiste Beauval, Bernard Malavaud, Guillaume Ploussard

Objectives To test whether prehabilitation (PreHab), delivered digitally or as digital + on‐site, improves early continence after robot‐assisted radical prostatectomy (RARP) vs no PreHab, and to evaluate implementation by quantifying programme uptake after transitioning from an on‐site programme to a digital pathway. Patients and Methods Two‐centre, high‐volume, non‐randomised before–after consecutive cohort over 3 years ( N = 350; Control = 204; PreHab = 146). PreHab combined pelvic floor muscle training, structured education, and optimisation via a smartphone pathway with or without a 1‐day class. Primary outcome: 6‐week continence (0–1 pad/day). Secondary outcomes: same‐day discharge (SDD), complications (Clavien–Dindo Grade ≥III), 30‐day unplanned visits and readmissions, postoperative physiotherapy, satisfaction (0–10 visual analogue scale), and continence at 6 and 12 months. Group comparisons used chi‐square/Fisher's and Mann–Whitney U ; multivariable logistic regression provided adjusted estimates. Results For the PreHab vs Control cohorts: 6‐week continence 84.2% vs 67.6% ( P = 0.003); SDD 47.3% vs 35.3% ( P = 0.025); high‐grade complications 2.1% vs 7.4% ( P < 0.001); mean (standard deviation) satisfaction score 9.4 (0.7) vs 8.4 (1.3) ( P < 0.001). Readmissions 3.4% vs 7.8% ( P = 0.086) and unplanned visits 3.4% vs 6.4% ( P = 0.218) were not different. Continence remained higher with PreHab at 6 months 97.7% vs 84.3% ( P < 0.001) and 12 months 99.2% vs 93.6% ( P = 0.004). Adjusted analyses showed lower odds of 6‐week incontinence (odds ratio 0.43, 95% confidence interval 0.22–0.85; P = 0.015). Uptake rose from 26.6% (on‐site era) to 48.2% and 68.7% across successive digital periods ( P < 0.001). Effects did not differ by delivery mode. Conclusions Prehabilitation, regardless of delivery mode, improves early continence vs no PreHab without compromising safety; digitisation increased programme uptake, indicating that digital PreHab is an effective and scalable option.

目的：测试预康复（PreHab），以数字化或数字化+现场方式提供，是否能改善机器人辅助根治性前列腺切除术（RARP）后的早期尿失禁，并通过量化从现场方案过渡到数字途径后的方案摄取来评估实施情况。患者和方法：两中心、大容量、非随机、前后连续队列超过3年（N = 350；对照= 204;PreHab = 146）。PreHab结合了盆底肌肉训练、结构化教育和通过智能手机途径进行的优化，有或没有1天的课程。主要终点：6周尿失禁（0-1次/天）。次要结局：同一天出院（SDD）、并发症（Clavien-Dindo分级≥III）、30天计划外就诊和再入院、术后物理治疗、满意度（0-10视觉模拟量表）以及6个月和12个月的尿失禁。组间比较采用卡方/Fisher’s和Mann-Whitney U；多变量逻辑回归提供了调整后的估计。PreHab组与对照组的结果：6周尿失禁84.2% vs 67.6% (P = 0.003)；SDD 47.3% vs 35.3% (P = 0.025)；高级别并发症2.1% vs 7.4% (P < 0.001)；平均（标准差）满意度评分9.4 (0.7)vs 8.4 (1.3) （P < 0.001）。再入院3.4% vs 7.8% (P = 0.086)，计划外就诊3.4% vs 6.4% （P = 0.218）无差异。PreHab组6个月的尿失禁率为97.7%比84.3% (P < 0.001)， 12个月的尿失禁率为99.2%比93.6% （P = 0.004）。校正分析显示6周尿失禁的几率较低（优势比0.43,95%可信区间0.22-0.85;P = 0.015）。在连续的数字时代，采用率从26.6%（现场时代）上升到48.2%和68.7% （P < 0.001）。效果没有因递送方式而异。结论：与不使用预康复相比，无论哪种交付方式，预康复在不影响安全性的情况下都能改善早期尿失禁；数字化增加了项目的吸收，表明数字化PreHab是一种有效且可扩展的选择。

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引用次数: 0

Deep learning-based classification of acute scrotum using single ultrasound images 基于深度学习的急性阴囊单超声图像分类

IF 4.4 2区医学 Q1 UROLOGY & NEPHROLOGY

BJU International

Pub Date : 2025-12-01 DOI: 10.1111/bju.70091

Sahyun Pak, Sung Gon Park, Jong Keun Kim, Seong Ho Lee, Won Ki Lee, Cheol Young Oh, Ji Young Woo, Sung Tae Cho, Young Goo Lee

Objective

To develop a deep learning model for differential diagnosis of acute scrotum using single ultrasound (US) images.

Patients and Methods

We analysed 1172 patients with acute scrotal pain evaluated by Doppler US at four hospitals. From each case, we selected a representative axial colour Doppler US image. We trained a binary classification model to distinguish torsion from non-torsion using an EfficientNet architecture. The dataset was split 70% for training and 30% for validation. We addressed class imbalance with data augmentation and class weighting. Class Activation Mapping was used to interpret model decisions.

Results

The model achieved robust performance: accuracy 97%, precision 98%, sensitivity 97%, and F1 score 97%. Class activation mapping heatmaps localised decision-making to pathologically critical regions, including absent testicular blood flow and whirlpool signs. In a 20-patient prospective pilot study, the system correctly identified both surgically confirmed torsion cases, with one non-torsion case misclassified as torsion.

Conclusions

A deep learning model demonstrated promising diagnostic performance in differentiating acute scrotal emergencies using single US images. Its feasibility was preliminarily assessed in a small pilot study. These findings support further investigation, with larger and more balanced multicentre studies required to establish clinical utility and effective workflow integration.

目的建立用于急性阴囊超声单张影像鉴别诊断的深度学习模型。患者与方法我们分析了4家医院1172例经多普勒超声评估的急性阴囊疼痛患者。从每个病例中，我们选择了具有代表性的轴向彩色多普勒超声图像。我们训练了一个二元分类模型来区分扭矩和非扭矩。数据集分成70%用于训练，30%用于验证。我们通过数据增强和类加权来解决类不平衡问题。类激活映射用于解释模型决策。结果该模型具有良好的鲁棒性，准确率97%，精密度98%，灵敏度97%，F1评分97%。类激活映射热图将决策定位到病理关键区域，包括睾丸血流量缺失和漩涡体征。在一项20例患者的前瞻性先导研究中，该系统正确识别了两例手术证实的扭转病例，其中一例非扭转病例被错误地归类为扭转。结论：深度学习模型在使用单个超声图像鉴别急性阴囊急症方面表现出良好的诊断性能。在一项小型试点研究中初步评估了其可行性。这些发现支持进一步的研究，需要更大、更平衡的多中心研究来建立临床效用和有效的工作流程整合。

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引用次数: 0

Analysis of upper tract urothelial carcinoma in the Asian population. 亚洲人群上尿路上皮癌的分析。

IF 4.5 2区医学 Q1 UROLOGY & NEPHROLOGY

BJU International

Pub Date : 2025-12-01 DOI: 10.1111/bju.70038

Shane Qin,Kylie Lim,Jake Tempo,Joseph Ischia,Damien Bolton,Neil Fleshner,Jaime O Herrera-Cáceres,Zachary Klaassen,Hanan Goldberg,Thenappan Chandrasekar,Omar Alhunaidi,Guan Hee Tan,Greg Nason,Khaled Ajib,Girish Kulkarni,Dixon Woon

引用次数: 0

Comment on 'Robot-assisted partial nephrectomy using the Hugo™ RAS system: first multicentre study'. 评论“使用Hugo™RAS系统的机器人辅助部分肾切除术：首次多中心研究”。

IF 4.5 2区医学 Q1 UROLOGY & NEPHROLOGY

BJU International

Pub Date : 2025-11-30 DOI: 10.1111/bju.70100

Longtu Ma,Long Cheng,Zhilong Dong

引用次数: 0

Comment on ‘Feasibility of randomisation to radical prostatectomy or standard care in patients with metastatic prostate cancer’ 对“转移性前列腺癌患者根治性前列腺切除术或标准治疗随机化的可行性”的评论

IF 4.5 2区医学 Q1 UROLOGY & NEPHROLOGY

BJU International

Pub Date : 2025-11-28 DOI: 10.1111/bju.70097

Kun Zhao, Zhongze Zhou, Zhilong Dong

引用次数: 0

Impact of perioperative nutrition on recovery after radical cystectomy: a randomised trial 围手术期营养对根治性膀胱切除术后恢复的影响：一项随机试验

IF 4.5 2区医学 Q1 UROLOGY & NEPHROLOGY

BJU International

Pub Date : 2025-11-28 DOI: 10.1111/bju.70094

Mohammed Lotfi Amer, Ahmed Rabie Amer, Sameh Fawzy Elnasharty, Abdallah Atef Homouda, Asmaa Badr Eldin Opoda, Sohair Mostafa Soliman, Mohamed Hassan Radwan, Mohamed Abou Farha, Mohamed Elbendary Elnady

Objective To assess the effect of structured perioperative nutritional optimisation on complication rates, recovery metrics, and body composition in patients undergoing radical cystectomy (RC) with urinary diversion. Patients and Methods In this prospective, randomised controlled trial, 74 patients scheduled for RC were allocated to either a nutritional optimisation group (NOG, n = 37) receiving individualised pre‐ and postoperative dietary interventions, or a standard care group (SCG, n = 37). Protocol included immunonutrition, caloric/protein adjustment, and close clinical and laboratory monitoring. The primary endpoint was overall complication rates within 30 days. Secondary endpoints included time to gastrointestinal recovery, length of hospital stay, wound healing time, nutritional markers, and body composition measurements. Results Baseline characteristics were comparable between the groups. Although the overall complication rate was lower in the NOG (54%) than SCG (68%), the difference was not statistically significant ( P = 0.236). Nutritional optimisation significantly accelerated gastrointestinal recovery; time to flatus (mean [SD] 39.6 [10.2] vs 64.8 [12.4] h, P < 0.001) and stool passage (mean [SD] 63.4 [12.1] vs 84.2 [13.8] h, P = 0.002) were shorter in the NOG. Length of stay (mean [SD] 7.78 [1.13] vs 10.59 [3.67] days, P = 0.002) and wound healing time (mean [SD] 14.22 [0.92] vs 15.5 [0.88] days, P < 0.001) were also significantly improved. The NOG maintained higher skeletal muscle mass and phase angle measurements at 30 days postoperatively ( P ≤ 0.007). Conclusions Structured perioperative nutritional optimisation significantly improved gastrointestinal recovery, reduced hospital stay, accelerated wound healing, and preserved skeletal muscle mass in patients undergoing RC.

目的探讨结构性围手术期营养优化对根治性膀胱切除术（RC）伴尿分流患者并发症发生率、恢复指标和体成分的影响。在这项前瞻性、随机对照试验中，74名计划进行RC的患者被分配到营养优化组（NOG, n = 37）和标准护理组（SCG, n = 37），分别接受个性化的术前和术后饮食干预。方案包括免疫营养，热量/蛋白质调整，密切的临床和实验室监测。主要终点是30天内的总并发症发生率。次要终点包括胃肠道恢复时间、住院时间、伤口愈合时间、营养指标和身体成分测量。结果两组间基线特征具有可比性。虽然NOG组的总并发症发生率（54%）低于SCG组（68%），但差异无统计学意义（P = 0.236）。营养优化显著加速胃肠恢复；NOG组的排气时间（平均[SD] 39.6[10.2]比64.8 [12.4]h, P < 0.001）和排便时间（平均[SD] 63.4[12.1]比84.2 [13.8]h, P = 0.002）更短。住院时间（平均[SD] 7.78 [1.13] vs 10.59[3.67]天，P = 0.002）和伤口愈合时间（平均[SD] 14.22 [0.92] vs 15.5[0.88]天，P < 0.001）也显著改善。术后30天NOG骨骼肌质量和相位角测量值保持较高（P≤0.007）。结论：有组织的围手术期营养优化显著改善了RC患者的胃肠道恢复，缩短了住院时间，加速了伤口愈合，并保留了骨骼肌质量。

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引用次数: 0

Authors’ reply to: comment on ‘Feasibility of randomisation to radical prostatectomy or standard care in patients with metastatic prostate cancer’ 作者回复：关于“转移性前列腺癌患者根治性前列腺切除术或标准治疗随机化的可行性”的评论

IF 4.5 2区医学 Q1 UROLOGY & NEPHROLOGY

BJU International

Pub Date : 2025-11-28 DOI: 10.1111/bju.70098

Lies Van den Eynde, Piet Ost, Nicolaas Lumen

引用次数: 0

Cystoscopic application of RADA16 peptide for refractory haematuria from radiation cystitis 膀胱镜下RADA16肽在放射性膀胱炎难治性血尿中的应用

IF 4.5 2区医学 Q1 UROLOGY & NEPHROLOGY

BJU International

Pub Date : 2025-11-28 DOI: 10.1111/bju.70075

Jonathan Kam, Yasmin Abu‐Ghanem, Francesco Del Guidice, Youssef Ibrahim, Elsie Mensah, Rajesh Nair, Muhammad Shamim Khan, Ramesh Thurairaja

Objective To present a novel technique for cystoscopic application of RADA16, a self‐assembling peptide that promotes both haemostasis and healing within the irradiated bladder, and describe its efficacy for intractable haematuria from radiation cystitis. Patients and Methods A total of 15 patients who had failed standard treatment for haematuria from radiation cystitis were offered this novel treatment at Guy's Hospital, London and Cleveland Clinic London, UK between February and October 2024. A standard saline cystoscopy was performed under general anaesthetic and the bladder emptied. CO 2 insufflation of the bladder was performed and the RADA16 deployed over the area of radiation telangiectasia. This was left for 5 min and then the gas evacuated from the bladder. Patients were followed up for a minimum of 3 months for complications and re‐bleeding. Results In all, 14 of the 15 patients had significant reduction in their bleeding at 6 weeks. One patient with ongoing bleeding proceeded to salvage cystectomy. Two patients required further cystodiathermy and RADA16 application within 3 months. No other modified Clavien–Dindo ≥III complications occurred within 3 months. Patients who had a follow‐up cystoscopy within 3 months of application showed significant regression of the radiation‐induced telangiectasia with no evidence of bladder scarring or ureteric orifice obstruction. Conclusions Cystoscopic application of RADA16 shows promise for treating intractable haematuria from radiation cystitis. It is the first treatment option that potentially provides both haemostasis as well as promoting bladder healing and regression of radiation‐induced telangiectasia.

目的介绍一种膀胱镜下应用RADA16的新技术，RADA16是一种促进放射膀胱内止血和愈合的自组装肽，并描述其对放射膀胱炎引起的顽固性血尿的疗效。患者和方法在2024年2月至10月期间，共有15名放射性膀胱炎血尿标准治疗失败的患者在伦敦盖伊医院和英国伦敦克利夫兰诊所接受了这种新颖的治疗。在全身麻醉下进行标准生理盐水膀胱镜检查并排空膀胱。膀胱内注入二氧化碳，RADA16部署在辐射毛细血管扩张的区域。放置5分钟，然后气体从膀胱排出。对患者进行至少3个月的并发症和再出血随访。结果15例患者中有14例在6周时出血明显减少。一名持续出血的患者进行了膀胱切除术。2例患者在3个月内需要进一步的膀胱热疗和RADA16应用。3个月内未发生其他改良Clavien-Dindo≥III并发症。在应用3个月内进行随访膀胱镜检查的患者显示放射引起的毛细血管扩张明显消退，无膀胱瘢痕或输尿管口梗阻的证据。结论膀胱镜下应用RADA16治疗放射性膀胱炎所致顽固性血尿有较好的疗效。这是第一种既能止血又能促进膀胱愈合和放疗引起的毛细血管扩张的治疗选择。

{"title":"Cystoscopic application of RADA16 peptide for refractory haematuria from radiation cystitis","authors":"Jonathan Kam, Yasmin Abu‐Ghanem, Francesco Del Guidice, Youssef Ibrahim, Elsie Mensah, Rajesh Nair, Muhammad Shamim Khan, Ramesh Thurairaja","doi":"10.1111/bju.70075","DOIUrl":"https://doi.org/10.1111/bju.70075","url":null,"abstract":"Objective To present a novel technique for cystoscopic application of RADA16, a self‐assembling peptide that promotes both haemostasis and healing within the irradiated bladder, and describe its efficacy for intractable haematuria from radiation cystitis. Patients and Methods A total of 15 patients who had failed standard treatment for haematuria from radiation cystitis were offered this novel treatment at Guy's Hospital, London and Cleveland Clinic London, UK between February and October 2024. A standard saline cystoscopy was performed under general anaesthetic and the bladder emptied. CO 2 insufflation of the bladder was performed and the RADA16 deployed over the area of radiation telangiectasia. This was left for 5 min and then the gas evacuated from the bladder. Patients were followed up for a minimum of 3 months for complications and re‐bleeding. Results In all, 14 of the 15 patients had significant reduction in their bleeding at 6 weeks. One patient with ongoing bleeding proceeded to salvage cystectomy. Two patients required further cystodiathermy and RADA16 application within 3 months. No other modified Clavien–Dindo ≥III complications occurred within 3 months. Patients who had a follow‐up cystoscopy within 3 months of application showed significant regression of the radiation‐induced telangiectasia with no evidence of bladder scarring or ureteric orifice obstruction. Conclusions Cystoscopic application of RADA16 shows promise for treating intractable haematuria from radiation cystitis. It is the first treatment option that potentially provides both haemostasis as well as promoting bladder healing and regression of radiation‐induced telangiectasia.","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"59 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145611103","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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