Ricardo Almeida‐Magana, Larissa Sena Teixeira Mendes, Eoin Dinneen, Tarek Al‐Hammouri, Aiman Haider, Anna Silvanto, Alex Freeman, Nicholas Roberts, Louise Dickinson, Chun Wah So, Zafer Tandogdu, Benjamin W. Lamb, Nikhil Mayor, Mathias Winkler, Hashim Ahmed, Greg Shaw
Objectives To assess the feasibility of conducting a multicentre trial comparing NeuroSAFE with a novel technique based on confocal laser microscopy (LaserSAFE) and evaluate the diagnostic performance of LaserSAFE for real‐time surgical margin assessment. Patients and Methods This was a non‐randomised, prospective feasibility study conducted at a high‐volume academic UK centre ( ClinicalTrials.gov identifier: NCT06398470). Patients with localised prostate cancer (clinical T2–T3a N0 M0) scheduled for robot‐assisted radical prostatectomy and deemed unsuitable for bilateral intrafascial nerve sparing (NS) based on a multidisciplinary plan were included. LaserSAFE imaging was performed in the operating room after which the NeuroSAFE technique results guided NS decisions. Pathologists, blinded to NeuroSAFE and final histology, retrospectively evaluated LaserSAFE images. Diagnostic accuracy metrics and concordance between modalities were calculated. Feasibility was assessed based on recruitment rate and the ability to activate additional sites. Results A total of 20 patients were recruited at a single site within 12 months of recruitment start. However, expansion to additional centres was not feasible due to limitations in implementing the NeuroSAFE protocol. LaserSAFE achieved a sensitivity of 0.91 (95% confidence interval [CI] 0.59–1.00) and specificity of 1.00 (95% CI 0.88–1.00) for detecting positive surgical margins ≥0.5 mm. Cohen's kappa demonstrated strong agreement with NeuroSAFE and final pathology. LaserSAFE was completed within a median of 7 min, significantly shorter than the 63 min required for NeuroSAFE. Limitations include the small sample size, single‐centre setting, and lack of intraoperative decision‐making based on LaserSAFE findings. Conclusion While a multicentre study based on NeuroSAFE as a comparison was not achievable, LaserSAFE proved to be a rapid and accurate alternative for intraoperative margin assessment. These findings support the design of a larger trial in which NS decisions are informed by LaserSAFE, with a view to broadening access to real‐time margin assessment.
目的评估开展多中心试验比较NeuroSAFE与基于共聚焦激光显微镜（LaserSAFE）的新技术的可行性，并评估LaserSAFE在实时手术边缘评估中的诊断性能。患者和方法：这是一项在英国一个高容量学术中心进行的非随机、前瞻性可行性研究（ClinicalTrials.gov识别码：NCT06398470）。本研究纳入了计划接受机器人辅助根治性前列腺切除术的局限性前列腺癌患者（临床T2-T3a N0 M0），并基于多学科计划认为不适合双侧筋膜内神经保留（NS）。在手术室进行LaserSAFE成像，之后NeuroSAFE技术结果指导NS决策。病理学家对NeuroSAFE和最终组织学不知情，回顾性评估LaserSAFE图像。计算诊断准确性指标和模式之间的一致性。可行性是根据征聘率和激活其他地点的能力来评估的。结果在招募开始的12个月内，在单个地点共招募了20例患者。然而，由于实施NeuroSAFE方案的限制，扩展到其他中心是不可行的。LaserSAFE检测≥0.5 mm阳性手术切缘的灵敏度为0.91(95%可信区间[CI] 0.59-1.00)，特异性为1.00 （95% CI 0.88-1.00）。Cohen的kappa与NeuroSAFE和最终病理结果一致。LaserSAFE的平均完成时间为7分钟，明显短于NeuroSAFE所需的63分钟。局限性包括样本量小，单中心设置，以及缺乏基于LaserSAFE结果的术中决策。结论：虽然基于NeuroSAFE作为比较的多中心研究无法实现，但LaserSAFE被证明是术中边缘评估的快速和准确的替代方法。这些发现支持更大规模试验的设计，在该试验中，NS决策由LaserSAFE提供信息，以扩大实时边际评估的范围。
{"title":"The LaserSAFE technique for margin assessment during radical prostatectomy: a feasibility study","authors":"Ricardo Almeida‐Magana, Larissa Sena Teixeira Mendes, Eoin Dinneen, Tarek Al‐Hammouri, Aiman Haider, Anna Silvanto, Alex Freeman, Nicholas Roberts, Louise Dickinson, Chun Wah So, Zafer Tandogdu, Benjamin W. Lamb, Nikhil Mayor, Mathias Winkler, Hashim Ahmed, Greg Shaw","doi":"10.1111/bju.70092","DOIUrl":"https://doi.org/10.1111/bju.70092","url":null,"abstract":"Objectives To assess the feasibility of conducting a multicentre trial comparing NeuroSAFE with a novel technique based on confocal laser microscopy (LaserSAFE) and evaluate the diagnostic performance of LaserSAFE for real‐time surgical margin assessment. Patients and Methods This was a non‐randomised, prospective feasibility study conducted at a high‐volume academic UK centre ( <jats:ext-link xmlns:xlink=\"http://www.w3.org/1999/xlink\" xlink:href=\"http://clinicaltrials.gov\">ClinicalTrials.gov</jats:ext-link> identifier: NCT06398470). Patients with localised prostate cancer (clinical T2–T3a N0 M0) scheduled for robot‐assisted radical prostatectomy and deemed unsuitable for bilateral intrafascial nerve sparing (NS) based on a multidisciplinary plan were included. LaserSAFE imaging was performed in the operating room after which the NeuroSAFE technique results guided NS decisions. Pathologists, blinded to NeuroSAFE and final histology, retrospectively evaluated LaserSAFE images. Diagnostic accuracy metrics and concordance between modalities were calculated. Feasibility was assessed based on recruitment rate and the ability to activate additional sites. Results A total of 20 patients were recruited at a single site within 12 months of recruitment start. However, expansion to additional centres was not feasible due to limitations in implementing the NeuroSAFE protocol. LaserSAFE achieved a sensitivity of 0.91 (95% confidence interval [CI] 0.59–1.00) and specificity of 1.00 (95% CI 0.88–1.00) for detecting positive surgical margins ≥0.5 mm. Cohen's kappa demonstrated strong agreement with NeuroSAFE and final pathology. LaserSAFE was completed within a median of 7 min, significantly shorter than the 63 min required for NeuroSAFE. Limitations include the small sample size, single‐centre setting, and lack of intraoperative decision‐making based on LaserSAFE findings. Conclusion While a multicentre study based on NeuroSAFE as a comparison was not achievable, LaserSAFE proved to be a rapid and accurate alternative for intraoperative margin assessment. These findings support the design of a larger trial in which NS decisions are informed by LaserSAFE, with a view to broadening access to real‐time margin assessment.","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"7 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145611132","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}
The objective of this study is to address the lack of real-life study comparing the impact of the three surgical approaches for radical prostatectomy (RP), i.e., open (ORP), laparoscopic (LRP) and robot-assisted (RARP), on the occurrence of postoperative events by measuring the association between surgical approach and risk of death, transfer to an intensive care unit (ICU), or complications during hospitalisation for RP.
Patients and methods
This study used the French National Health Data System (Système National des Données de Santé [SNDS]) to study the 38 481 patients who underwent a RP in French hospitals in 2020–2021. The primary endpoint was the occurrence of any event (death, ICU admission, or complications) during hospitalisation for RP. Secondary endpoints were the occurrence of death, ICU admission, complications, and each of the complication subtypes. Outcomes were analysed by uni- and multivariable logistic regression.
Results
A RARP was associated with the lowest risk of an event during hospitalisation, followed by LRP compared with ORP (adjusted odds ratio [aOR] 0.51, 95% confidence interval [CI] 0.48–0.55; and aOR 0.63, 95% CI 0.58–0.68, respectively). RARP was associated with a reduction in the risk of most complications compared with ORP. Minimally-invasive procedures were associated with an increased risk of hernia. To the best of our knowledge, this is the first French nationwide study of its sort and limitations are related to the observational nature of our study, the use of a medico-administrative database, and the length of follow-up. To confirm the main results 30-day sensitivity analyses were performed.
Conclusions
There were significantly fewer short-term postoperative events for RARP. Additional studies with a longer follow-up period are required to investigate the medium- and long-term risks.
本研究的目的是通过测量手术入路与死亡风险、转入重症监护病房（ICU）或RP住院期间并发症之间的关系，来解决缺乏真实生活研究比较根治性前列腺切除术（RP）的三种手术入路，即开放（ORP）、腹腔镜（LRP）和机器人辅助（RARP）对术后事件发生的影响的问题。患者和方法本研究使用法国国家健康数据系统（system National des donnsamuess [SNDS]）对2020-2021年在法国医院接受RP的38481例患者进行了研究。主要终点是RP住院期间发生的任何事件（死亡、ICU入院或并发症）。次要终点为死亡发生率、ICU入院率、并发症发生率和各并发症亚型。结果通过单变量和多变量logistic回归分析。结果RARP与住院期间事件的最低风险相关，其次是LRP与ORP（调整比值比[aOR] 0.51, 95%可信区间[CI] 0.48-0.55； aOR为0.63,95%可信区间[CI] 0.58-0.68）。与ORP相比，RARP与大多数并发症的风险降低有关。微创手术与疝气风险增加相关。据我们所知，这是法国第一个此类全国性研究，其局限性与我们研究的观察性、医学管理数据库的使用以及随访时间长短有关。为了确认主要结果，进行了30天敏感性分析。结论RARP术后短期事件显著减少。需要进行更长随访期的额外研究来调查中期和长期风险。
{"title":"Comparison of short-term complications after open, laparoscopic and robot-assisted radical prostatectomy","authors":"Prescillia Nunes, François Richaud, Catherine Quantin, Christine Binquet, Luc Cormier, Anne-Sophie Mariet","doi":"10.1111/bju.70076","DOIUrl":"10.1111/bju.70076","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>The objective of this study is to address the lack of real-life study comparing the impact of the three surgical approaches for radical prostatectomy (RP), i.e., open (ORP), laparoscopic (LRP) and robot-assisted (RARP), on the occurrence of postoperative events by measuring the association between surgical approach and risk of death, transfer to an intensive care unit (ICU), or complications during hospitalisation for RP.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Patients and methods</h3>\u0000 \u0000 <p>This study used the French National Health Data System (Système National des Données de Santé [SNDS]) to study the 38 481 patients who underwent a RP in French hospitals in 2020–2021. The primary endpoint was the occurrence of any event (death, ICU admission, or complications) during hospitalisation for RP. Secondary endpoints were the occurrence of death, ICU admission, complications, and each of the complication subtypes. Outcomes were analysed by uni- and multivariable logistic regression.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A RARP was associated with the lowest risk of an event during hospitalisation, followed by LRP compared with ORP (adjusted odds ratio [aOR] 0.51, 95% confidence interval [CI] 0.48–0.55; and aOR 0.63, 95% CI 0.58–0.68, respectively). RARP was associated with a reduction in the risk of most complications compared with ORP. Minimally-invasive procedures were associated with an increased risk of hernia. To the best of our knowledge, this is the first French nationwide study of its sort and limitations are related to the observational nature of our study, the use of a medico-administrative database, and the length of follow-up. To confirm the main results 30-day sensitivity analyses were performed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>There were significantly fewer short-term postoperative events for RARP. Additional studies with a longer follow-up period are required to investigate the medium- and long-term risks.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"137 2","pages":"348-359"},"PeriodicalIF":4.4,"publicationDate":"2025-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://bjui-journals.onlinelibrary.wiley.com/doi/epdf/10.1111/bju.70076","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145611087","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}
{"title":"Correction to ‘Functional outcomes of robot‐assisted partial nephrectomy in patients with a solitary kidney’","authors":"","doi":"10.1111/bju.70095","DOIUrl":"https://doi.org/10.1111/bju.70095","url":null,"abstract":"","PeriodicalId":8985,"journal":{"name":"BJU International","volume":"1 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145599701","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":"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}
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