{"title":"Correction to “Outcomes of BCG vs upfront radical cystectomy for high‐risk non‐muscle‐invasive bladder cancer”","authors":"","doi":"10.1111/bju.70090","DOIUrl":"https://doi.org/10.1111/bju.70090","url":null,"abstract":"","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"191 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145594207","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 systematically assess the diagnostic accuracy of renal tumour core biopsy for detecting malignancy in adults with localised renal masses.MATERIALS AND METHODSA search of the Cochrane, Embase and Medline databases and the grey literature published up to September 2024 was performed using pre-published methods. Eligible studies were published in English, reported all true- and false-positive and -negative results for localised renal tumour core biopsies in unique adult cohorts, and used surgical histology as the reference standard. Studies were excluded if they exclusively reported patients with malignant biopsy or surgical histology. Primary outcomes were biopsy sensitivity and specificity for detecting malignancy.RESULTSTwenty-one non-randomised cohorts were identified, totalling 1735 unique patients. In detecting malignancy, renal tumour core biopsy had a weighted mean sensitivity of 98% (95% confidence interval [CI] 0.96-1.00) and specificity of 94% (95% CI 0.84-1.00). Secondary outcomes were determined, including mean false-positive rate (6%), false-negative rate (2%), non-diagnostic rate on first (8%) and second biopsy attempt (9%), and concordance of tumour sub-type (92%) and Fuhrmann grade, both exact grade (60%) and simplified low/high grade (79%). Summary receiver-operating characteristic curve analysis demonstrated high test accuracy (area under the curve 0.97). Risk of bias was moderate to high for most studies.CONCLUSIONCore biopsy for renal masses in adults has high specificity and sensitivity. Excluding patients for whom biopsy will not change management, near-routine renal tumour biopsy may reduce rates of nephrectomy for ultimately benign tumours, and optimise operating theatre utilisation.
目的系统评价肾肿瘤核心活检对成人局部肾肿块恶性肿瘤的诊断准确性。材料与方法采用预发表方法检索Cochrane、Embase和Medline数据库以及截至2024年9月发表的灰色文献。符合条件的研究以英文发表，报告了独特成人队列中局部肾肿瘤核心活检的所有真阳性、假阳性和阴性结果，并使用手术组织学作为参考标准。如果研究只报道了恶性活检或手术组织学的患者，则排除研究。主要结果是活检检测恶性肿瘤的敏感性和特异性。结果共纳入21个非随机队列，共有1735例独特患者。在检测恶性肿瘤时，肾肿瘤核心活检的加权平均敏感性为98%(95%可信区间[CI] 0.96-1.00)，特异性为94% （95% CI 0.84-1.00）。确定次要结果，包括平均假阳性率（6%）、假阴性率（2%）、第一次和第二次活检未诊断率（8%）和第二次活检未诊断率（9%），肿瘤亚型（92%）和Fuhrmann分级的一致性，精确分级（60%）和简化的低/高分级（79%）。摘要接收机-工作特性曲线分析表明测试精度高（曲线下面积0.97）。大多数研究的偏倚风险为中等至高。结论成人肾包块核活检具有较高的特异性和敏感性。排除活检不能改变治疗的患者，近常规肾肿瘤活检可降低最终良性肿瘤的肾切除术率，并优化手术室利用率。
{"title":"Performance of percutaneous core biopsy in predicting renal tumour pathology: a systematic review.","authors":"Rebecca Stokes,Derek Hennessey,Ned Kinnear","doi":"10.1111/bju.70045","DOIUrl":"https://doi.org/10.1111/bju.70045","url":null,"abstract":"OBJECTIVESTo systematically assess the diagnostic accuracy of renal tumour core biopsy for detecting malignancy in adults with localised renal masses.MATERIALS AND METHODSA search of the Cochrane, Embase and Medline databases and the grey literature published up to September 2024 was performed using pre-published methods. Eligible studies were published in English, reported all true- and false-positive and -negative results for localised renal tumour core biopsies in unique adult cohorts, and used surgical histology as the reference standard. Studies were excluded if they exclusively reported patients with malignant biopsy or surgical histology. Primary outcomes were biopsy sensitivity and specificity for detecting malignancy.RESULTSTwenty-one non-randomised cohorts were identified, totalling 1735 unique patients. In detecting malignancy, renal tumour core biopsy had a weighted mean sensitivity of 98% (95% confidence interval [CI] 0.96-1.00) and specificity of 94% (95% CI 0.84-1.00). Secondary outcomes were determined, including mean false-positive rate (6%), false-negative rate (2%), non-diagnostic rate on first (8%) and second biopsy attempt (9%), and concordance of tumour sub-type (92%) and Fuhrmann grade, both exact grade (60%) and simplified low/high grade (79%). Summary receiver-operating characteristic curve analysis demonstrated high test accuracy (area under the curve 0.97). Risk of bias was moderate to high for most studies.CONCLUSIONCore biopsy for renal masses in adults has high specificity and sensitivity. Excluding patients for whom biopsy will not change management, near-routine renal tumour biopsy may reduce rates of nephrectomy for ultimately benign tumours, and optimise operating theatre utilisation.","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"14 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145559221","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}
To assess the safety and efficacy of combined ultrasonography (US) and fluoroscopy-guided percutaneous nephrolithotomy (CG-PCNL) vs pure US-guided endoscopic combined intrarenal surgery (USG-ECIRS) for treating 4–6-cm renal calculi.
Patients and methods
This prospective randomised trial was conducted in the period May 2022 to April 2025 at the Second Affiliated Hospital of Anhui Medical University and Zhongda Hospital of Southeast University. A total of 114 consecutive patients with 4–6-cm renal calculi were randomly assigned to undergo CG-PCNL or USG-ECIRS, with 57 patients per group. The primary outcomes of the study were the first stone-free rate (SFR) and tract establishment success rate, with secondary outcomes including operating time, haemoglobin drop and complication rate. The study was registered at http://www.chictr.org.cn (ChiCTR2200057865).
Results
A total of 106 patients were included in the analysis, with 53 in each group. The two groups had similar baseline characteristics. There was no significant difference in first SFR between the groups (81.1% vs 79.2%; P = 0.872). In patients with S.T.O.N.E. scores >10 or stones involving more than five calyces, SFR was markedly lower in both groups. No intergroup differences were detected in either tract establishment time or initial success rate. The operating time in the CG-PCNL group was significantly longer than that in the USG-ECIRS group (143.2 vs 93.6 min; P < 0.001). Haemoglobin drop was significantly more pronounced in the CG-PCNL group compared to the USG-ECIRS group (14.9 vs 10.3 g/L; P = 0.043). The overall incidence of complications in the CG-PCNL group was significantly higher than that in the USG-ECIRS group (18.9% vs 5.7%; P = 0.038).
Conclusions
Use of USG-ECIRS showed comparable efficacy to use of CG-PCNL in the management of 4–6-cm renal calculi, while demonstrating superior safety with fewer complications and less blood loss. However, the SFR declined for both approaches when the S.T.O.N.E. score exceeded 10 or when stones involved more than five calyces.
目的评价超声（US）联合透视引导下经皮肾镜取石术（CG - PCNL）与单纯超声引导下内镜联合肾内手术（USG - ECIRS）治疗4-6厘米肾结石的安全性和有效性。患者和方法本前瞻性随机试验于2022年5月至2025年4月在安徽医科大学第二附属医院和东南大学中大医院进行。114例连续4-6厘米肾结石患者被随机分配接受CG - PCNL或USG - ECIRS，每组57例患者。该研究的主要结果是首次结石无结石率（SFR）和尿路建立成功率，次要结果包括手术时间、血红蛋白下降和并发症发生率。本研究注册于http://www.chictr.org.cn （ChiCTR2200057865）。结果共纳入106例患者，每组53例。两组具有相似的基线特征。两组间首次SFR无显著差异（81.1% vs 79.2%; P = 0.872）。在S.T.O.N.E.评分为10分或结石累及超过5个肾盏的患者中，两组患者的SFR明显较低。两组间在通道建立时间和初始成功率方面均无差异。CG - PCNL组的手术时间明显长于USG - ECIRS组（143.2 vs 93.6 min; P < 0.001）。与USG - ECIRS组相比，CG - PCNL组的血红蛋白下降更为明显（14.9 g/L vs 10.3 g/L; P = 0.043）。CG - PCNL组的总并发症发生率显著高于USG - ECIRS组（18.9% vs 5.7%; P = 0.038）。结论：USG - ECIRS与CG - PCNL治疗4-6厘米肾结石的疗效相当，且安全性更高，并发症更少，出血量更少。然而，当S.T.O.N.E.评分超过10分或结石超过5个萼时，两种方法的SFR均下降。
{"title":"Ultrasonography and fluoroscopy-guided PCNL vs pure ultrasonography-guided endoscopic combined intrarenal surgery for 4–6-cm kidney stones","authors":"Daming Wang, Kai Yao, Ziang Li, Shaobin Xia, Haiyan Ju, Jiale Gao, Dingyong Zhang, Dongdong Xie, Guangyuan Zhang, Demao Ding","doi":"10.1111/bju.70089","DOIUrl":"10.1111/bju.70089","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To assess the safety and efficacy of combined ultrasonography (US) and fluoroscopy-guided percutaneous nephrolithotomy (CG-PCNL) vs pure US-guided endoscopic combined intrarenal surgery (USG-ECIRS) for treating 4–6-cm renal calculi.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Patients and methods</h3>\u0000 \u0000 <p>This prospective randomised trial was conducted in the period May 2022 to April 2025 at the Second Affiliated Hospital of Anhui Medical University and Zhongda Hospital of Southeast University. A total of 114 consecutive patients with 4–6-cm renal calculi were randomly assigned to undergo CG-PCNL or USG-ECIRS, with 57 patients per group. The primary outcomes of the study were the first stone-free rate (SFR) and tract establishment success rate, with secondary outcomes including operating time, haemoglobin drop and complication rate. The study was registered at http://www.chictr.org.cn (ChiCTR2200057865).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 106 patients were included in the analysis, with 53 in each group. The two groups had similar baseline characteristics. There was no significant difference in first SFR between the groups (81.1% vs 79.2%; <i>P</i> = 0.872). In patients with S.T.O.N.E. scores >10 or stones involving more than five calyces, SFR was markedly lower in both groups. No intergroup differences were detected in either tract establishment time or initial success rate. The operating time in the CG-PCNL group was significantly longer than that in the USG-ECIRS group (143.2 vs 93.6 min; <i>P</i> < 0.001). Haemoglobin drop was significantly more pronounced in the CG-PCNL group compared to the USG-ECIRS group (14.9 vs 10.3 g/L; <i>P</i> = 0.043). The overall incidence of complications in the CG-PCNL group was significantly higher than that in the USG-ECIRS group (18.9% vs 5.7%; <i>P</i> = 0.038).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Use of USG-ECIRS showed comparable efficacy to use of CG-PCNL in the management of 4–6-cm renal calculi, while demonstrating superior safety with fewer complications and less blood loss. However, the SFR declined for both approaches when the S.T.O.N.E. score exceeded 10 or when stones involved more than five calyces.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"137 2","pages":"383-389"},"PeriodicalIF":4.4,"publicationDate":"2025-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145567317","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}
Harrison Lucas, Brendan Dittmer, Paul David Anderson, Niall M. Corcoran
{"title":"Is it time to break the habit of treating preoperative asymptomatic bacteriuria?","authors":"Harrison Lucas, Brendan Dittmer, Paul David Anderson, Niall M. Corcoran","doi":"10.1111/bju.70086","DOIUrl":"10.1111/bju.70086","url":null,"abstract":"","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"137 2","pages":"260-261"},"PeriodicalIF":4.4,"publicationDate":"2025-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145568012","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":"Refining the paradigm in urinary diversion: the MOSAIC trial and roadmap for future innovation.","authors":"DuJiang Yang,GuoYou Wang","doi":"10.1111/bju.70093","DOIUrl":"https://doi.org/10.1111/bju.70093","url":null,"abstract":"","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"161 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145559214","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}
Keiran J.C. Pace, Jethro C.C. Kwong, Harkanwal Randhawa, Maximiliano Ringa, Zizo Al‐Daqqaq, Yashan Chelliahpillai, Soomin Lee, Kellie Kim, Samuel Haile, Amna Ali, Marian Wettstein, Amy Chan, Nathan Perlis, Jason Lee, Robert Hamilton, Neil Fleshner, Antonio Finelli, Munir Jamal, Frank Papanikolaou, Thomas Short, Andrew Feifer, Girish Kulkarni, Alexandre R. Zlotta
Objective To determine the risk and timing of metachronous upper tract urothelial carcinoma (UTUC) after non‐muscle‐invasive bladder cancer (NMIBC). Patients and Methods In this multi‐institutional retrospective cohort study involving academic and community hospitals, clinicopathological data were collected from patients with NMIBC treated between 2005 and 2022. Patients with prior or synchronous UTUC at NMIBC diagnosis were excluded. The primary outcome was time to metachronous UTUC, confirmed on pathology or upper tract imaging. Secondary objectives included determining the cumulative incidence of UTUC stratified by the European Association of Urology risk groups and UTUC risk factors identified using Fine and Gray regression, with all‐cause mortality as a competing risk. Results Among 3003 patients, 1158 (39%) were low‐risk, 650 (22%) intermediate‐risk, 944 (31%) high‐risk, and 251 (8%) very high‐risk. During a median (interquartile range) follow‐up of 4.9 (2.7–8.4) years, 104 patients developed UTUC. On multivariable analysis, multiple tumours were an independent predictor of UTUC (subdistribution hazard ratio 1.86, 95% confidence interval 1.24–2.80; P = 0.003). The 10‐year cumulative incidence was 2.2% for low‐risk, 4.4% for intermediate‐risk, and 6.3% for high‐ and very high‐risk patients. Routine imaging detected UTUC in 40% of low‐risk, 58% of intermediate‐risk, and 53% of high‐ and very high‐risk patients. High‐grade UTUC was found in 36% of low‐risk, 63% of intermediate‐risk, and 64% of high‐ and very high‐risk patients. The majority of UTUC cases (77%) occurred within 5 years of NMIBC. Conclusions The contemporary risk of metachronous UTUC may be lower than historical data. Our findings demonstrate that UTUC incidence is low in patients with low‐ and intermediate‐risk NMIBC and increases in the high‐ and very high‐risk groups. These results support current guideline recommendations to omit routine upper tract imaging in low‐risk NMIBC and question its utility in intermediate‐risk disease. In high‐risk patients, routine imaging remains warranted, although the optimal frequency and duration are yet to be determined.
{"title":"Risk of metachronous upper tract urothelial carcinoma following non‐muscle‐invasive bladder cancer","authors":"Keiran J.C. Pace, Jethro C.C. Kwong, Harkanwal Randhawa, Maximiliano Ringa, Zizo Al‐Daqqaq, Yashan Chelliahpillai, Soomin Lee, Kellie Kim, Samuel Haile, Amna Ali, Marian Wettstein, Amy Chan, Nathan Perlis, Jason Lee, Robert Hamilton, Neil Fleshner, Antonio Finelli, Munir Jamal, Frank Papanikolaou, Thomas Short, Andrew Feifer, Girish Kulkarni, Alexandre R. Zlotta","doi":"10.1111/bju.70085","DOIUrl":"https://doi.org/10.1111/bju.70085","url":null,"abstract":"Objective To determine the risk and timing of metachronous upper tract urothelial carcinoma (UTUC) after non‐muscle‐invasive bladder cancer (NMIBC). Patients and Methods In this multi‐institutional retrospective cohort study involving academic and community hospitals, clinicopathological data were collected from patients with NMIBC treated between 2005 and 2022. Patients with prior or synchronous UTUC at NMIBC diagnosis were excluded. The primary outcome was time to metachronous UTUC, confirmed on pathology or upper tract imaging. Secondary objectives included determining the cumulative incidence of UTUC stratified by the European Association of Urology risk groups and UTUC risk factors identified using Fine and Gray regression, with all‐cause mortality as a competing risk. Results Among 3003 patients, 1158 (39%) were low‐risk, 650 (22%) intermediate‐risk, 944 (31%) high‐risk, and 251 (8%) very high‐risk. During a median (interquartile range) follow‐up of 4.9 (2.7–8.4) years, 104 patients developed UTUC. On multivariable analysis, multiple tumours were an independent predictor of UTUC (subdistribution hazard ratio 1.86, 95% confidence interval 1.24–2.80; <jats:italic>P</jats:italic> = 0.003). The 10‐year cumulative incidence was 2.2% for low‐risk, 4.4% for intermediate‐risk, and 6.3% for high‐ and very high‐risk patients. Routine imaging detected UTUC in 40% of low‐risk, 58% of intermediate‐risk, and 53% of high‐ and very high‐risk patients. High‐grade UTUC was found in 36% of low‐risk, 63% of intermediate‐risk, and 64% of high‐ and very high‐risk patients. The majority of UTUC cases (77%) occurred within 5 years of NMIBC. Conclusions The contemporary risk of metachronous UTUC may be lower than historical data. Our findings demonstrate that UTUC incidence is low in patients with low‐ and intermediate‐risk NMIBC and increases in the high‐ and very high‐risk groups. These results support current guideline recommendations to omit routine upper tract imaging in low‐risk NMIBC and question its utility in intermediate‐risk disease. In high‐risk patients, routine imaging remains warranted, although the optimal frequency and duration are yet to be determined.","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"32 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145553624","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}
Israa Hussein, Simona Ippoliti, Alexander BCD Ng, Ranil Johann Boaz, Stefanie Croghan, Cameron Alexander, Arjun Nathan, Nikita Bhatt, Kevin Gerard Byrnes, Veeru Kasivisvanathan
<p>Despite clear guidance from the European Association of Urology (EAU) and the National Institute for Health and Care Excellence (NICE) advising against routine ureteric stenting after uncomplicated ureteroscopy (URS), stents are still widely used [<span>1, 2</span>]. Surveys report that up to 92% of urologists continue to insert stents in these circumstances, indicating a significant discrepancy between guidelines and real-world practice [<span>3</span>]. Stents are considered necessary in situations involving ureteric injury, obstruction, severe oedema, or sepsis risk. However, their use following an otherwise uncomplicated URS remains a matter of debate. Defining ‘uncomplicated URS’ is therefore crucial. Hiller et al. [<span>4</span>] proposed consensus criteria: unilateral, retrograde URS in patients with American Society of Anesthesiologists (ASA) Physical Status Classification System score <3, no anatomical abnormality, no active infection, no trauma or perforation, and no need for second-look procedures.</p><p>Despite this, practice variation persists. A Cochrane review found evidence on stenting vs omission was of very low to low-moderate certainty, with conflicting results regarding analgesic use, unplanned hospital visits, and quality of life [<span>5</span>]. Some studies suggest omitting stents reduces emergency visits and improves recovery. Yet, Bhatt et al. [<span>3</span>] showed that most urologists still use stents in the majority of uncomplicated cases, highlighting a gap between evidence and behaviour. We systematically review surgeons’ motivations for stenting after uncomplicated URS and examine patient experiences of living with and removing stents.</p><p>The review protocol was registered prospectively on the International Prospective Register of Systematic Reviews (PROSPERO: CRD42023456075). The ‘Enhancing transparency in reporting the synthesis of qualitative research’ (ENTREQ) and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed [<span>6, 7</span>]. A structured PubMed/MEDLINE search was performed to August 2023, supplemented by hand-searching reference lists. Titles and abstracts were screened independently by three reviewers, with disagreements resolved by consensus. Data were extracted and synthesised narratively. Risk of bias in qualitative studies was assessed using the Critical Appraisal Skills Programme (CASP) checklist. Included studies examined surgeon motivations for stenting after uncomplicated URS using qualitative or survey methods or reported patient experiences with indwelling ureteric stents. Eligible designs included randomised trials, surveys, interviews, and observational studies. Reviews, non-human studies, children aged <12 years, and purely quantitative papers on stenting rates without explanatory data were excluded.</p><p>In our results, four studies met the inclusion criteria: one international surgeon survey and three qualitative studies
总之，这些研究揭示了支架的重大心理和功能负担，与外科医生对常规使用的偏好形成对比。这篇综述强调了一个显著的脱节：外科医生经常支架置入简单的尿路并发症以减轻感知风险，而患者却承受着症状和心理负担。目前的EAU和NICE指南建议在无并发症的病例中不要进行常规支架植入[1,2]。然而，调查显示，大多数泌尿科医生继续这种做法，往往是出于对罕见并发症的关注，而不是基于证据的必要性。这表明外科医生的决策是由风险规避和轶事经验指导的，而不是公开的数据。患者负担相当大，高达80%的患者报告留置支架导致生活质量下降，包括疼痛、尿频、血尿和性功能障碍。心理后果包括焦虑、抑郁和减少社会参与。撤资增加了另一层压力。从健康经济影响来看，英国尿石症的管理每年花费高达3.24亿英镑，常规支架置入进一步增加了费用。成本分析证实，选择性遗漏比常规支架置入更经济。尽管有证据和指南，支架置入术的持续存在反映了坚持临床实践指南的更广泛挑战。外科医生愿意参与试验表明，他们认识到高质量的证据可以推动变革。与此同时，更好地与患者沟通风险、症状和移除手术可以改善体验，并可能减少不必要的支架植入。关于局限性，我们的综述只纳入了四项符合条件的研究，这限制了其通用性。患者的经历均来自同一研究队列。然而，综合揭示了一致的主题：外科医生优先考虑安全性，而患者面临不成比例的发病率。总之，无并发症尿路尿潴留后的常规支架置入术仍然存在，尽管指南建议不这样做。对水肿和梗阻的担忧驱动着外科医生的决策，而患者则经历着明显的疼痛、排尿困难、心理困扰和生活质量受损。弥合这一差距需要从随机对照试验中获得更多实质性证据，加强患者教育，并更新具有更明确定义的指南。将手术决策与以患者为中心的结果相一致可以减少不必要的发病率和医疗成本。没有宣布。由于没有患者和/或公众参与本综述的研究目标、方法和分发的制定，因此不需要伦理批准。尼基塔·巴特（Nikita Bhatt）和凯文·杰拉德·伯恩斯（Kevin Gerard Byrnes）构想了这项研究。协议由伊斯拉·侯赛因起草，搜索策略由林恩·梅尔和伊斯拉·侯赛因制定和起草。israel Hussein， Alexander BCD Ng和Ranil Johann Boaz进行了摘要和全文综述。israel Hussein， Alexander BCD Ng和Ranil Johann Boaz对数据提取和合成做出了贡献。伊斯拉·侯赛因和西蒙娜·伊波利蒂参与了最终手稿的撰写和编辑。感谢临床联络馆员Lyn maair在进行文献检索和医学主题标题（MeSH）术语方面的帮助。
{"title":"Ureteric stenting after uncomplicated ureteroscopy: a systematic review of surgeons’ motivations and patient experiences","authors":"Israa Hussein, Simona Ippoliti, Alexander BCD Ng, Ranil Johann Boaz, Stefanie Croghan, Cameron Alexander, Arjun Nathan, Nikita Bhatt, Kevin Gerard Byrnes, Veeru Kasivisvanathan","doi":"10.1111/bju.70063","DOIUrl":"10.1111/bju.70063","url":null,"abstract":"<p>Despite clear guidance from the European Association of Urology (EAU) and the National Institute for Health and Care Excellence (NICE) advising against routine ureteric stenting after uncomplicated ureteroscopy (URS), stents are still widely used [<span>1, 2</span>]. Surveys report that up to 92% of urologists continue to insert stents in these circumstances, indicating a significant discrepancy between guidelines and real-world practice [<span>3</span>]. Stents are considered necessary in situations involving ureteric injury, obstruction, severe oedema, or sepsis risk. However, their use following an otherwise uncomplicated URS remains a matter of debate. Defining ‘uncomplicated URS’ is therefore crucial. Hiller et al. [<span>4</span>] proposed consensus criteria: unilateral, retrograde URS in patients with American Society of Anesthesiologists (ASA) Physical Status Classification System score <3, no anatomical abnormality, no active infection, no trauma or perforation, and no need for second-look procedures.</p><p>Despite this, practice variation persists. A Cochrane review found evidence on stenting vs omission was of very low to low-moderate certainty, with conflicting results regarding analgesic use, unplanned hospital visits, and quality of life [<span>5</span>]. Some studies suggest omitting stents reduces emergency visits and improves recovery. Yet, Bhatt et al. [<span>3</span>] showed that most urologists still use stents in the majority of uncomplicated cases, highlighting a gap between evidence and behaviour. We systematically review surgeons’ motivations for stenting after uncomplicated URS and examine patient experiences of living with and removing stents.</p><p>The review protocol was registered prospectively on the International Prospective Register of Systematic Reviews (PROSPERO: CRD42023456075). The ‘Enhancing transparency in reporting the synthesis of qualitative research’ (ENTREQ) and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed [<span>6, 7</span>]. A structured PubMed/MEDLINE search was performed to August 2023, supplemented by hand-searching reference lists. Titles and abstracts were screened independently by three reviewers, with disagreements resolved by consensus. Data were extracted and synthesised narratively. Risk of bias in qualitative studies was assessed using the Critical Appraisal Skills Programme (CASP) checklist. Included studies examined surgeon motivations for stenting after uncomplicated URS using qualitative or survey methods or reported patient experiences with indwelling ureteric stents. Eligible designs included randomised trials, surveys, interviews, and observational studies. Reviews, non-human studies, children aged <12 years, and purely quantitative papers on stenting rates without explanatory data were excluded.</p><p>In our results, four studies met the inclusion criteria: one international surgeon survey and three qualitative studies ","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"137 2","pages":"238-240"},"PeriodicalIF":4.4,"publicationDate":"2025-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://bjui-journals.onlinelibrary.wiley.com/doi/epdf/10.1111/bju.70063","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145559105","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sophie Lewis, Riyad Peeraully, Eslam Ghazy, Harriet Corbett, Ian Maconochie, Simon Kenny, Rachel Harwood
Objectives To perform a systematic review to determine the effect of the duration of pain on early and late testicular survival after testicular torsion, and on the performance of diagnostic adjuncts for torsion, including the Testicular Workup for Ischemia and Suspected Torsion (TWIST) score and ultrasonography (US) performance, to inform the development of the ‘Getting it Right First Time’ (GIRFT) national testicular pain pathway for children and young people (CYP). Methods The study was registered on the International Prospective Register of Online Systematic Reviews (CRD42023412619) and four databases were searched. Study inclusion criteria: all participants aged <25 years or where data for these patients could be extracted; studies including <20% neonates and <20% of undescended testes. The decision for inclusion in the study was made independently by two reviewers and conflicts resolved by a third. A weighted random‐effects model was used for meta‐analysis and results are shown as the test statistic (95% CI). Results Included studies were used to analyse the effect of duration of pain on testicular salvage (studies = 26), on the sensitivity and specificity of the TWIST score (studies = 10), and of US (studies = 34). The TWIST score performs best in its extremes, with a sensitivity of 94.2% (95% CI 72.8–99%) and specificity 98% (95% CI 91.5–99.5%), when comparing a high‐risk score of 5–7 with a low‐risk score of 0–2. The diagnostic sensitivity and specificity of US for testicular torsion has likely improved with time, with papers published after 2010 showing a sensitivity of 94.8% (95% CI 88.3–97.8%) and specificity 97.3% (95% CI 89.4–99.4%) compared to all‐time published studies showing a sensitivity 92.6% (95% CI 87.8–95.6%) and specificity of 97.8% (95% CI 94.7–99.1%). Conclusions These findings demonstrate the up‐to‐date literature on the effect of duration of pain on salvage of torted testes and on the performance of TWIST scores and US when evaluating CYP with testicular pain. They have been used within the development of the GIRFT testicular pain pathway.
目的：通过系统回顾，确定疼痛持续时间对睾丸扭转后早期和晚期睾丸生存的影响，以及对扭转诊断辅助工具的性能的影响，包括睾丸缺血和疑似扭转检查（TWIST）评分和超声检查（US）表现，为“第一次获得正确”（GIRFT）国家儿童和青少年睾丸疼痛途径（CYP）的制定提供信息。方法在国际在线系统评论前瞻性注册（CRD42023412619）中注册，并检索4个数据库。研究纳入标准：所有年龄在25岁或可以提取这些患者数据的参与者；研究包括20%的新生儿和20%的隐睾。纳入研究的决定由两位审稿人独立做出，冲突由第三位审稿人解决。采用加权随机效应模型进行meta分析，结果显示为检验统计量（95% CI）。结果纳入的研究分析了疼痛持续时间对睾丸保留的影响（研究= 26），对TWIST评分的敏感性和特异性的影响（研究= 10），以及对US的影响（研究= 34）。当比较5-7的高风险评分和0-2的低风险评分时，TWIST评分在极端情况下表现最好，灵敏度为94.2% (95% CI 72.8-99%)，特异性为98% （95% CI 91.5-99.5%）。随着时间的推移，US诊断睾丸扭转的敏感性和特异性可能有所提高，2010年以后发表的论文显示灵敏度为94.8% (95% CI 88.3-97.8%)，特异性为97.3% (95% CI 89.4-99.4%)，而所有发表的研究显示灵敏度为92.6% (95% CI 87.8-95.6%)，特异性为97.8% （95% CI 94.7-99.1%）。结论：这些发现证实了最新文献关于疼痛持续时间对损伤睾丸抢救的影响，以及在评估伴有睾丸疼痛的CYP时TWIST评分和US的表现。它们已被用于GIRFT睾丸疼痛途径的发展。
{"title":"A systematic review and meta‐analysis to inform the management of children and young people with acute testicular pain","authors":"Sophie Lewis, Riyad Peeraully, Eslam Ghazy, Harriet Corbett, Ian Maconochie, Simon Kenny, Rachel Harwood","doi":"10.1111/bju.70080","DOIUrl":"https://doi.org/10.1111/bju.70080","url":null,"abstract":"Objectives To perform a systematic review to determine the effect of the duration of pain on early and late testicular survival after testicular torsion, and on the performance of diagnostic adjuncts for torsion, including the Testicular Workup for Ischemia and Suspected Torsion (TWIST) score and ultrasonography (US) performance, to inform the development of the ‘Getting it Right First Time’ (GIRFT) national testicular pain pathway for children and young people (CYP). Methods The study was registered on the International Prospective Register of Online Systematic Reviews (CRD42023412619) and four databases were searched. Study inclusion criteria: all participants aged <25 years or where data for these patients could be extracted; studies including <20% neonates and <20% of undescended testes. The decision for inclusion in the study was made independently by two reviewers and conflicts resolved by a third. A weighted random‐effects model was used for meta‐analysis and results are shown as the test statistic (95% CI). Results Included studies were used to analyse the effect of duration of pain on testicular salvage (studies = 26), on the sensitivity and specificity of the TWIST score (studies = 10), and of US (studies = 34). The TWIST score performs best in its extremes, with a sensitivity of 94.2% (95% CI 72.8–99%) and specificity 98% (95% CI 91.5–99.5%), when comparing a high‐risk score of 5–7 with a low‐risk score of 0–2. The diagnostic sensitivity and specificity of US for testicular torsion has likely improved with time, with papers published after 2010 showing a sensitivity of 94.8% (95% CI 88.3–97.8%) and specificity 97.3% (95% CI 89.4–99.4%) compared to all‐time published studies showing a sensitivity 92.6% (95% CI 87.8–95.6%) and specificity of 97.8% (95% CI 94.7–99.1%). Conclusions These findings demonstrate the up‐to‐date literature on the effect of duration of pain on salvage of torted testes and on the performance of TWIST scores and US when evaluating CYP with testicular pain. They have been used within the development of the GIRFT testicular pain pathway.","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"182 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145553623","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}
Andrea Folcia, Davide Perri, Luca Villa, Nicole Albanese, Daniele Robesti, Christian Corsini, Giorgio Bozzini, Ioannis Kartalas Goumas, Thiago Hota, Francesco Montorsi, Andrea Salonia, Olivier Traxer, Eugenio Ventimiglia
Objectives
To compare the stone retropulsion of an artificial model of urinary stones in vitro using the new holmium:yttrium aluminium garnet (Ho:YAG) laser generator with a very low peak power pulse modulation mode (Quanta Magneto Technology™; Quanta System, Samarate, Italy) and thulium fibre laser (TFL).
Materials and Methods
The following laser energy settings were used: 0.2 J–50 Hz, 0.4 J–25 Hz, 0.8 J–12 Hz, 1.5 J–6 Hz, and 2 J–5 Hz. A 5 × 5 × 5 mm cubic artificial stone was placed on two perpendicularly aligned metal rulers to create a V-shaped cross-sectional rail submerged in a tank filled with 0.9% saline solution, with the laser fibre in contact with the stone. The laser was activated for 5 s. Stone retropulsion was captured by a camera and assessed using video tracking software. Five repetitions were performed for each setting. Descriptive statistics investigated differences between the two lasers in stone retropulsion distance and speed at selected time points (0.35, 1, 3, and 5 s) and over the first second following laser activation.
Results
Comparable stone retropulsion distance and speed were observed between ‘Magneto’ and TFL according to tested high-energy settings. Magneto exhibited lower mean stone displacement at selected time points (all P < 0.02) and lower mean retropulsion speed over the first second following laser activation (all P < 0.01), when compared to TFL at low-energy settings (0.2 and 0.4 J).
Conclusions
Although Ho:YAG lasers are generally associated with greater stone retropulsion compared to TFL, Magneto exhibited a retropulsion performance similar to TFL. Further research is needed to clarify the retropulsion dynamics observed with Magneto at low-energy settings.
{"title":"In vitro comparison of stone retropulsion between the new holmium:yttrium aluminium garnet laser generator with a very low peak power pulse modulation mode (Magneto technology) and the thulium fibre laser","authors":"Andrea Folcia, Davide Perri, Luca Villa, Nicole Albanese, Daniele Robesti, Christian Corsini, Giorgio Bozzini, Ioannis Kartalas Goumas, Thiago Hota, Francesco Montorsi, Andrea Salonia, Olivier Traxer, Eugenio Ventimiglia","doi":"10.1111/bju.70083","DOIUrl":"10.1111/bju.70083","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To compare the stone retropulsion of an artificial model of urinary stones <i>in vitro</i> using the new holmium:yttrium aluminium garnet (Ho:YAG) laser generator with a very low peak power pulse modulation mode (Quanta Magneto Technology™; Quanta System, Samarate, Italy) and thulium fibre laser (TFL).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Methods</h3>\u0000 \u0000 <p>The following laser energy settings were used: 0.2 J–50 Hz, 0.4 J–25 Hz, 0.8 J–12 Hz, 1.5 J–6 Hz, and 2 J–5 Hz. A 5 × 5 × 5 mm cubic artificial stone was placed on two perpendicularly aligned metal rulers to create a V-shaped cross-sectional rail submerged in a tank filled with 0.9% saline solution, with the laser fibre in contact with the stone. The laser was activated for 5 s. Stone retropulsion was captured by a camera and assessed using video tracking software. Five repetitions were performed for each setting. Descriptive statistics investigated differences between the two lasers in stone retropulsion distance and speed at selected time points (0.35, 1, 3, and 5 s) and over the first second following laser activation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Comparable stone retropulsion distance and speed were observed between ‘Magneto’ and TFL according to tested high-energy settings. Magneto exhibited lower mean stone displacement at selected time points (all <i>P</i> < 0.02) and lower mean retropulsion speed over the first second following laser activation (all <i>P</i> < 0.01), when compared to TFL at low-energy settings (0.2 and 0.4 J).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Although Ho:YAG lasers are generally associated with greater stone retropulsion compared to TFL, Magneto exhibited a retropulsion performance similar to TFL. Further research is needed to clarify the retropulsion dynamics observed with Magneto at low-energy settings.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"137 2","pages":"306-311"},"PeriodicalIF":4.4,"publicationDate":"2025-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145545184","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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