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Robot-assisted radical prostatectomy (RARP) has become the standard surgical procedure for localized prostate-cancer (PCa). Nerve-sparing surgery (NSS) during RARP has been associated with improved erectile function and continence rates after surgery. However, it remains unclear what are the most appropriate indications for NSS.The objective of this study is to systematically review the available parameters for selection of patients for NSS. The weight of different clinical variables, multiparametric magnetic-resonance-imaging (mpMRI) findings, and the impact of multiparametric-nomograms in the decision-making process on (side-specific) NSS were assessed.This systematic review searched relevant databases and included studies performed from January 2000 until December 2020 and recruited a total of 15 840 PCa patients. Studies were assessed that defined criteria for (side-specific) NSS and associated them with oncological safety and/or functional outcomes. Risk of bias assessment was performed.Nineteen articles were eligible for full-text review. NSS is primarily recommended in men with adequate erectile function, and with low-risk of extracapsular extension (ECE) on the side-of NSS. Separate clinical and radiological variables have low accuracy for predicting ECE, whereas nomograms optimize the risk-stratification and decision-making process to perform or to refrain from NSS when oncological safety (organ-confined disease, PSM rates) and functional outcomes (erectile function and continence rates) were assessed.Consensus exists that patients who are at high risk of ECE should refrain from NSS. Several multiparametric preoperative nomograms were developed to predict ECE with increased accuracy compared with single clinical, pathological, or radiological variables, but controversy exists on risk thresholds and decision rules on a conservative versus a less-conservative surgical approach. An individual clinical judgment on the possibilities of NSS set against the risks of ECE is warranted.NSS is aimed at sparing the nerves responsible for erection. NSS may lead to unfavorable tumor control if the risk of capsule penetration is high. Nomograms predicting extraprostatic tumor-growth are probably most helpful.

André N. Vis

Roderick C. N. van den Bergh

Henk G. van der Poel

Alexander Mottrie

Philip D. Stricker

Marcus Graefen

Vipul Patel

Bernardo Rocco

Birgit Lissenberg‐Witte

Pim J. van Leeuwen

Selection of patients for nerve sparing surgery in robot‐assisted radical prostatectomy

机器人辅助根治性前列腺切除术中保留神经手术的患者选择

Abstract Objective The objective of this study is to compare detection rates of extracapsular extension (ECE) of prostate cancer (PCa) using artificial intelligence (AI)‐generated cancer maps versus MRI and conventional nomograms. Materials and methods We retrospectively analysed data from 147 patients who received MRI‐targeted biopsy and subsequent radical prostatectomy between September 2016 and May 2022. AI‐based software cleared by the United States Food and Drug Administration (Unfold AI, Avenda Health) was used to map 3D cancer probability and estimate ECE risk. Conventional ECE predictors including MRI Likert scores, capsular contact length of MRI‐visible lesions, PSMA T stage, Partin tables, and the “PRedicting ExtraCapsular Extension” nomogram were used for comparison. Postsurgical specimens were processed using whole‐mount histopathology sectioning, and a genitourinary pathologist assessed each quadrant for ECE presence. ECE predictors were then evaluated on the patient (Unfold AI versus all comparators) and quadrant level (Unfold AI versus MRI Likert score). Receiver operator characteristic curves were generated and compared using DeLong's test. Results Unfold AI had a significantly higher area under the curve (AUC = 0.81) than other predictors for patient‐level ECE prediction. Unfold AI achieved 68% sensitivity, 78% specificity, 71% positive predictive value, and 75% negative predictive value. At the quadrant level, Unfold AI exceeded the AUC of MRI Likert scores for posterior (0.89 versus 0.82, p = 0.003), anterior (0.84 versus 0.80, p = 0.34), and all quadrants (0.89 versus 0.82, p = 0.002). The false negative rate of Unfold AI was lower than MRI in both the anterior (−60%) and posterior prostate (−40%). Conclusions Unfold AI accurately predicted ECE risk, outperforming conventional methodologies. It notably improved ECE prediction over MRI in posterior quadrants, with the potential to inform nerve‐spare technique and prevent positive margins. By enhancing PCa staging and risk stratification, AI‐based cancer mapping may lead to better oncological and functional outcomes for patients.

Alan Priester

Sakina Mohammed Mota

Kyla P. Grunden

Joshua Shubert

Shannon Richardson

Anthony Sisk

Ely R. Felker

James Sayre

Leonard S. Marks

Shyam Natarajan

Wayne G. Brisbane

Extracapsular extension risk assessment using an artificial intelligence prostate cancer mapping algorithm

人工智能前列腺癌映射算法用于评估包膜外扩展风险

Abstract Objective The objective of this study is to determine whether a sleep and health improvement programme (SHIP) to promote healthy sleep, eating and physical activity would be feasible, acceptable and have a positive impact on lifestyle behaviours for prostate cancer survivors and caregivers. Methods We recruited 50 participants for a single group 3‐month pre‐post pilot study. The SHIP intervention included (1) website about sleep, nutrition and physical activity (≥1 view/week), (2) two email newsletters with goal‐setting exercises and resources and (3) midpoint health coach call. The primary outcome was changes in validated sleep scales; secondary outcomes included changes in diet, physical activity and concentration from baseline to 3 months. Results Of 50 participants enrolled, median age was 65, 30% were Black and 8% were Hispanic. Thirty‐four patients and 7 family caregivers completed the pilot study (82%). Following the intervention, we observed a statistically significant improvement in the Sleep Hygiene Index (pre: 15, post: 13, p &lt; 0.01), and a trend toward lower Insomnia Severity Index (pre: 12, post: 9, p = 0.07). There were no statistically significant improvements in sleep quality or physical activity, but there were improvements in healthy eating (e.g., increase in cruciferous vegetables and reduction in dairy) and in fatigue‐related problems and concentration. Exit interview feedback was positive. Conclusions A web‐based sleep and healthy lifestyle programme for patients with prostate cancer and their caregivers is feasible and acceptable. A randomized controlled trial is planned to test whether a refined SHIP improves sleep and lifestyle in patients with prostate cancer and caregivers.

Stacy Loeb

Rebecca Robbins

Tatiana Sanchez‐Nolasco

Nataliya Byrne

Andrea Ruan

Adrian Rivera

Natasha Gupta

Stacey A. Kenfield

June M. Chan

Erin L. Van Blarigan

Patricia Carter

Girardin Jean‐Louis

Stephanie L. Orstad

Sleep and health improvement programme (SHIP) for patients with prostate cancer and caregivers

前列腺癌患者及护理者的睡眠与健康改善计划（SHIP）

To determine the consensus of a Dutch multidisciplinary expert panel on the diagnostic evaluation and treatment of de novo and recurrent metastatic prostate cancer (PCa) limited to non-regional lymph nodes (M1a) in daily clinical practice.The panel consisted of 37 Dutch specialists from disciplines involved in the management of M1a PCa (urology, medical and radiation oncology, radiology, and nuclear medicine). We used a modified Delphi method consisting of two voting rounds and a consensus meeting (video conference). Consensus (good agreement) was defined as the situation in which ≥ 75% of the panelists chose the same option.Consensus existed for 57% of the items. The panel agreed that prostate-specific membrane antigen positron emission tomography/computed tomography (PSMA-PET/CT) is the most appropriate standard imaging modality to identify de novo (100%) and recurrent (97%) M1a PCa. Androgen deprivation therapy (ADT) combined with radiotherapy to the prostate ± the M1a lesion(s) was most frequently considered an option for de novo M1a PCa. For M1a as recurrent disease, ADT alone, deferring treatment, or local radiotherapy to the M1a lesion(s) were judged to be the most important treatment options. However, no specific indications for treatment choice in relation to disease characteristics could be formulated.The Dutch consensus panel preferred PSMA-PET/CT as the standard diagnostic modality to detect M1a PCa. Although potential treatment options were identified, explicit recommendations could not be formulated. This might (partly) be explained by the absence of high-level clinical evidence in this subset of patients. Further research is, therefore, strongly encouraged.

Shafak Aluwini

Daniela E. Oprea‐Lager

Hilda de Barros

Niven Mehra

Herman Stoevelaar

Derya Yakar

Henk van der Poel

M1a prostate cancer: Results of a Dutch multidisciplinary consensus meeting

M1a 前列腺癌：荷兰多学科共识会议结果

To evaluate the relationship between pre-operative PSA value, 68Ga-prostate-specific-membrane-antigen (PSMA) PET performance and oncologic outcomes after salvage lymph node dissection (sLND) for biochemical recurrent prostate cancer (PCa).The study included 164 patients diagnosed with ≤2 pelvic lymph-node recurrence(s) of PCa documented on 68Ga-PSMA PET scan and treated with pelvic ± retroperitoneal sLND at 11 high-volume centres between 2012 and 2019. Pathologic findings were correlated to PSA values at time of sLND, categorized in early (<0.5 ng/ml), low (0.5-0.99 ng/ml), moderate (1-1.5 ng/ml) and high (>1.5 ng/ml). Clinical recurrence (CR)-free survival after sLND was calculated using multivariable analyses and plotted over pre-operative PSA value.Median [interquartile range (IQR)] PSA at sLND was 1.1 (0.6, 2.0) ng/ml, and 131 (80%) patients had one positive spot at PET scan. All patients received pelvic sLND, whereas 91 (55%) men received also retroperitoneal dissection. Median (IQR) number of node removed was 15 (6, 28). The rate of positive pathology increased as a function of pre-operative PSA value, with highest rates for patients with pre-operative PSA > 1.5 ng/ml (pelvic-only sLNDs: 84%; pelvic + retroperitoneal sLNDs: 90%). After sLND, PSA ≤ 0.3 ng/ml was detected in 67 (41%) men. On multivariable analyses, pre-operative PSA was associated with PSA response (p < 0.0001). There were 51 CRs after sLND. After adjusting for confounders, we found a significant, non-linear relationship between PSA level at sLND and the 12-month CR-free survival (p < 0.0001), with the highest probability of freedom from CR for patients who received sLND at PSA level ≥1 ng/ml.In case of PET-detected nodal recurrences amenable to sLND, salvage surgery was associated with the highest short-term oncologic outcomes when performed in men with PSA ≥ 1 ng/ml. Awaiting confirmatory data from prospective trials, these findings may help physicians to optimize the timing for 68Ga-PSMA PET in biochemical recurrent PCa.

Carlo A. Bravi

Axel Heidenreich

Nicola Fossati

Giorgio Gandaglia

Nazareno Suardi

Elio Mazzone

Armando Stabile

Vito Cucchiara

Daniar Osmonov

Klaus‐Peter Juenemann

R. Jeffrey Karnes

Alexander Kretschmer

Alexander Buchner

Christian Stief

Andreas Hiester

Peter Albers

Gaëtan Devos

Steven Joniau

Hendrik Van Poppel

Bernhard Grubmüller

Shahrokh Shariat

Derya Tilki

Markus Graefen

Inderbir S. Gill

Pierre I. Karakiewicz

Francesco Montorsi

Alberto Briganti

David Pfister

Combining PSA and PET features to select candidates for salvage lymph node dissection in recurrent prostate cancer

结合PSA和PET特征选择复发性前列腺癌补救性淋巴结切除术候选者

Abstract Objectives To evaluate the safety and feasibility of “en‐bloc” Holmium Laser Enucleation of the Prostate (HoLEP) with trainee involvement in patients with prostates larger than 200 cc. Patients and Methods A retrospective analysis was conducted on patients undergoing HoLEP using the “en‐bloc” technique for prostate sizes &gt; 200 cc between July‐2017 and December‐2023 at an academic teaching hospital. Perioperative data was collected, including patient demographics, clinical parameters, operative details and functional outcomes. Patients who continued to experience incontinence at 1 year were further followed up at 2 years to update their continence status. Sub‐group analysis was performed to compare outcomes between patients with preoperative prostate size of 200–300 cc and &gt; 300 cc. Results The analysis included 89 patients with a mean age of 73.12 ± 8.10 years. Preoperative prostate weight ranged from 200 to 401 cc with a median of 245 cc, and median PSA was 7.71 ng/ml. Median operative time was 218.5 minutes, and median enucleated prostate volume was 164.2 cc. Median postoperative PSA was 0.4 [0.21–0.78] ng/ml. At 1‐year follow‐up, mean IPSS was 1 ± 2.4, Qmax was 27.03 ± 11.57 ml/s and PVR was 21.6 ± 28.6 ml. Postoperative complications included blood transfusion (5.6%), acute renal injury (4.5%), urinary tract infection (2.2%), postoperative urinary retention (2.2%) and urethral stricture (5%). Although transient urinary incontinence was noted in 41.6% at 1–3‐months, complete continence was achieved in 83.3% and 96.3% at 1 and 2 years postoperatively, respectively. Subgroup analysis showed significant differences in operative time and enucleated weight between prostates 200–300 cc and &gt; 300 cc, but no significant differences in postoperative IPSS, PVR or Qmax at 3‐months. Conclusion “En‐bloc” HoLEP is a feasible and safe procedure for prostates larger than 200 cc, demonstrating favourable perioperative and functional outcomes despite the extended operative times and involvement of trainees.

Feres C. Maluf

Ansh Bhatia

Archan Khandekar

Diana M. Lopategui

Joao G. Porto

Ryan R. Chen

Jean C. Daher

Mohamadhusni Zarli

Robert Marcovich

Hemendra N. Shah

Safety and feasibility of En‐bloc holmium laser enucleation for very large prostates (&gt; 200 cc) with trainee involvement

学员参与的大体积前列腺（>200 cc）整块钬激光剜除术的安全性与可行性

Abstract Objectives To understand whether bladder outflow obstruction influences the association between traditional clinical predictive factors, particularly prostate‐specific antigen (PSA) density and clinically significant prostate cancer (csPCa). This will help facilitate effective and evidence‐based triaging of patients in rapid‐access clinics. Materials and Methods We retrospectively analysed prospectively collected data from 307 suspected prostate cancer patients who underwent diagnostic biopsy from 2019 to 2023 at a single, high‐volume, specialist cancer centre. Uroflowmetry testing generated two cohorts: patients with bladder outflow obstruction and non‐obstructed patients. The cohort characteristics between the groups were compared and logistic regression analyses were performed to assess associations between clinical predictive factors (age, PSA density, ethnicity, family history, digital rectal examination, urinary symptom severity and magnetic resonance imaging using the PI‐RADS scoring system) and clinically significant prostate cancer (csPCa) on biopsy (defined as International Society of Urological Pathology grade of greater than or equal to two). Results The obstructed group ( n = 80) had significantly larger prostates and worse symptom severity ( p &lt; 0.05). There was no significant difference between the other predictive factors or csPCa compared to the non‐obstructed ( n = 227) cohort. Multivariable logistic regression analysis showed age, PSA density, an abnormal digital rectal examination and scoring PI‐RADS 4–5 on magnetic resonance imaging were all significantly associated with csPCa in the non‐obstructed cohort ( p &lt; 0.05). Contrastingly, only symptom severity and scoring PI‐RADS 5 were significantly associated with csPCa for the obstructed patients ( p &lt; 0.05). Conclusion In the presence of bladder outflow obstruction, traditional predictive variables such as age, PSA density, digital rectal examination and scoring PI‐RADS 4 are not associated with csPCa. This study suggests that using these predictive variables to triage patients in rapid‐access clinics with a patient who has bladder outflow obstruction could lead to the overuse of invasive biopsy.

Thomas Philip Cahill

Samuel Joseph Withey

Steve Hazell

Declan Cahill

Netty Kinsella

Does bladder outflow obstruction obfuscate the traditional clinical factors that are used to assess the risk of prostate cancer at rapid‐access diagnostic clinics?

膀胱出口梗阻是否会混淆快速诊断诊所中用于评估前列腺癌风险的传统临床因素？

Abstract Objectives To assess long‐term outcomes (up to 10 cycles) of repeated intradetrusor botulinum toxin (BoNT) utilisation in multiple sclerosis (MS) and idiopathic overactive bladder (OAB). Materials and Methods This is a retrospective, international, multi‐centre, observational cohort study of patients diagnosed with MS and neurogenic OAB and treated with intradetrusor BoNT between January 2005 and January 2020 (just prior to COVID‐19 interruption). Dose, efficacy, duration of effect, International Consultation on Incontinence Questionnaire Overactive Bladder (ICIQ‐OAB) and International Consultation on Incontinence Questionnaire Urinary Incontinence (ICIQ‐UI) measures and complication rates were recorded. Comparisons were made to those with idiopathic OAB. Results Seven hundred and ninety‐two patients received intradetrusor BoNT treatment (104 had MS with neurogenic OAB and 688 had idiopathic OAB). Patients with MS were more likely to receive higher doses of BoNT in all cycles. Self‐reported efficacy ranged from 85.7 to 100% (MS) and 87.2 to 100% (idiopathic) with MS patients reporting increased efficacy in cycles 1–3 comparatively ( p &lt; 0.05). Duration of effect ranged from 4.5 to 9 months with a reduction in the MS cohort between cycles 1 and 10 (median 8 months vs. 5 months, p = 0.0156). Conclusion Patients with MS and neurogenic OAB have a good therapeutic effect from intradetrusor BoNT that is sustained over at least 10 cycles with significant reduction in the duration of action with subsequent cycles.

William Chui

Joshua Kealey

Henry H. Yao

Garson Chan

Alvaro Bazo

Richard Parkinson

Helen E. O'Connell

Johan Gani

Long‐term follow‐up of intradetrusor botulinum toxin utilisation: A comparison of patients with multiple sclerosis and idiopathic overactive bladder

长期随访膀胱内肉毒毒素使用情况：多发性硬化症患者与特发性膀胱过度活动症患者的比较

Abstract Objectives Lymphedema of the lower limbs and pubic area is a potential complication following extended pelvic lymph node dissection (ePLND) during robot‐assisted radical prostatectomy (RARP). The incidence of lymphedema after ePLND has not been systematically reported in the literature. This study aimed to determine the incidence of lymphedema, describe its clinical characteristics and identify specific risk factors in patients undergoing RARP with or without ePLND. Methods A retrospective cohort study was conducted at a tertiary referral centre between April 2016 and July 2020. Structured electronic case report forms (eCRFs) integrated into the electronic health record system were used to document intraoperative, perioperative and postoperative data. The primary endpoint was the incidence of lymphedema. Secondary endpoints included risk factors for and localization of the postoperative lymphedema. Results A total of 500 patients who underwent RARP were included, with 301 patients undergoing ePLND and 199 patients without any form of PLND. Median follow‐up period was 18 (range 3–49) months. Seventy‐eight out of 301 (26%) of patients who underwent ePLND developed lymphedema, compared to only 2 out of 199 (1%) patients without ePLND. In most patients (49/301, 16%), lymphedema was mild (grade 1), whereas 29 patients (10%) developed grade 2 lymphedema. Twenty‐six patients (9%) received decongestive lymphatic therapy. The most frequent site of lymphedema occurrence were the lower (54%) and the upper legs (40%). The number of nodes removed during RARP was identified as a risk factor for post‐operative lymphedema (OR 1.04; p &lt; 0.05). Conclusions In this cohort study, approximately one in four patients undergoing RARP with ePLND developed lower limb and/or midline oedema, whereas one in ten patients started decongestive lymphatic therapy for symptomatic lymphedema. These findings provide valuable information for patient counselling about the potential benefits and risks of ePLND.

Andries Clinckaert

Laura Ysenbaardt

Annabel Bijnens

Charlotte Van Calster

Inge Geraerts

Nele Devoogdt

Luc Bijnens

Wouter Everaerts

Post‐operative incidence of lymphedema after RARP with or without extended pelvic lymph node dissection in a cohort study

队列研究中RARP术后淋巴水肿发生率及其与扩大盆腔淋巴结切除术的关系

Abstract Objective To determine whether the position of the bolster affects the access tract (supracostal/infracostal) for a superior calyceal puncture during prone PCNL and its effect on pleural complications. Materials and Methods It was a randomized clinical trial. Patients in whom superior calyceal puncture was done were divided into two groups by systematic sampling method, group 1 (horizontal bolster) and group 2 (vertical bolster), 50 patients in each group. Standard PCNL was perfomed in all patients. Chest x‐ray was done on POD 0 (postoperative day) and POD 1 for assessment of pleural complication. NCCT KUB was done on POD 1 for assessment of stone clearance. Results In group 1, 36 patients (72%) underwent supracostal puncture and 14 patients (28%) underwent infracostal puncture while in group 2, 38 patients (76%) underwent supracostal puncture and 14 patients (28%) underwent infracostal puncture (p‐value‐ 0.820). Two patients (4%) in group 1 &amp; three patients in group 2 had pleural complications in the form of hydrothorax (p‐value‐ 0.666). Four patients in group 1 and five patients in group 2 underwent ancillary procedure for clearance of residual stones. Conclusion In our study, the orientation of the bolster either horizontal or vertical does not affect the site of puncture during prone PCNL which probably resulted in no difference in pleural complications in two groups.

Vikram Singh

Ishwar Ram Dhayal

Sanjeet Kumar Singh

Alok Srivastava

Nandan Rai

Impact of position of bolster on outcome of prone PCNL—A randomized clinical trial

俯卧位经皮肾镜取石术中支撑垫位置对手术结果的影响——一项随机临床试验

Abbreviation
Journal Impact	1.45
Quartiles(Global)	UROLOGY & NEPHROLOGY(Q3)

Publication Information	Publisher: John Wiley and Sons Inc，Publishing cycle: ，Journal Type: journal，Open Access Journals: Yes
Basic data	Year of publication: 2020，Proportion of original research papers: 0.00%，Self Citation Rate:6.20%， Gold OA Rate: 77.13%
Journal Fees	$2520Details
Average review cycle	网友分享经验：12 Weeks

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