BJUI Compass

To describe a novel RoboSling technique performed at the time of robot‐assisted radical prostatectomy (RARP) and its utility for enhancing urinary function recovery postoperatively.
The surgical technique involves harvesting a vascularised, fascial flap from the peritoneum on the posterior aspect of the bladder. Following completion of prostatectomy, the autologous flap is tunnelled underneath the bladder and incorporated into the rectourethralis and vertical longitudinal detrusor fibres at the posterior bladder neck with a modified Rocco suture. After urethra‐vesical anastomosis is completed, the corners of the flap are hitched up to Cooper's ligament bilaterally with V‐Loc sutures, tensioned and secured creating a bladder neck sling. A prospective, longitudinal cohort study was performed of 193 consecutive patients undergoing RARP between December 2016 and September 2019. The first 163 patients underwent standard RARP, and the last 30 patients had the RoboSling technique performed concurrently. Continence outcomes were the primary outcomes assessed using pad number and Expanded Prostate Cancer Composite (EPIC)‐urinary domain questionnaire. Operative time (OT), estimated blood loss (EBL), complications and oncological outcomes were secondary outcomes.
The two groups were comparable for demographics and clinicopathological variables. At 3 months, zero pad usage (p= 0.005) and continence rates, defined as EPIC score ≥ 85 (p= 0.007), were both higher in the RoboSling group. EBL, complication rate and positive surgical margin rate did not differ between the two groups. Superior zero pad usage was observed at 1 year in the RoboSling group (p= 0.029). The RoboSling technique added on average 16 min to OT.
The RoboSling procedure at the time of RARP was associated with earlier return to continence without negatively impacting other postoperative outcomes. This improvement in continence outcomes was maintained long term.

Scott Leslie

Stuart Jackson

Mark Broe

Danielle C. van Diepen

Christina Stanislaus

Daniel Steffens

George McClintock

Sia Kim

Nicola Jeffery

Jeremy Fallot

Nariman Ahmadi

Arthur Vasilaras

Paul Sved

Lewis Chan

Ruban Thanigasalam

Improved early and late continence following robot‐assisted radical prostatectomy with concurrent bladder neck fascial sling (RoboSling)

机器人辅助根治性前列腺切除术后同期膀胱颈筋膜吊带（RoboSling）改善早期和晚期控尿效果

The objective of this study is to evaluate the prevalence and the importance of preperitoneal vas deferens (VD) infiltration in high‐risk prostate cancer (PCa).
In this prospectively designed study, we included 332 high‐risk PCa patients with a Briganti score >5%, who were treated by robot‐assisted radical prostatectomy between July 2017 and February 2022 at the Urology Department, SLK Kliniken Heilbronn. In addition to the standard histological analysis of the distal VD, which was attached to the prostate specimen, we analysed the infiltration status of preperitoneal VD in this cohort. The preperitoneal VD, which represents the middle part of ductus deferens and extends between the internal inguinal ring and obturator fossa, was resected during extended pelvic lymphadenectomy. Distal and preperitoneal VD status was registered together with preoperative and postoperative disease characteristics. Descriptive analysis methods and logistic regression analysis were used.
Briganti score of the target cohort had a median value of 19%, while 235 patients (70.8%) of the group demonstrated a locally advanced disease. The Grade Group at prostatectomy specimen was at least 3 for 286 patients (86.1%). Distal VD infiltration was found in 20 patients (6%) and preperitoneal VD infiltration in two patients (0.6%). Distal VD infiltration was not associated with an increased possibility for positive surgical margins or nodal status among pT3b patients, while both patients with preperitoneal VD infiltration were characterized by highly aggressive disease in locally advanced stage and bilateral distal VD infiltration.
PCa extension along VD may reach a more proximal point of VD than the reported from the existing data infiltration of VD adjacent to seminal vesicles. This rare manifestation of PCa local extension may be the intermediate step to the rare cases of recurrence in the testicles. However, more robust data are needed to confirm the aforementioned hypothesis. Distal VD infiltration seems to have no additional prognostic value among patients with infiltrated seminal vesicles.

Ali Serdar Gözen

Antonios Koudonas

Samet Senel

Maurizio Colecchia

Jens Rassweiler

Preperitoneal vas deferens infiltration in high‐risk prostate cancer

高危前列腺癌的前腹膜输精管浸润

A prospective cohort study comparing peri‐ and postoperative outcomes for patients with predominantly anterior prostate cancer (APC) identified preoperatively against non‐anterior prostate cancer (NAPC) treated via robotic‐assisted radical prostatectomy (RARP).
Of the 757 RARP's completed between January 2016 and April 2018, two comparative cohorts for anterior and an equivalent group of non‐anterior prostate tumours each consisting of 152 patients were compared against each other. Data were collected on the following variables: patient age; operating consultant; preoperative PSA, ISUP grade, degree of nerve sparing; tumour staging; presence and location of positive surgical margins; PSA density, postoperative ISUP grade; treatment paradigm and postoperative PSA, erectile function, and continence outcomes with 2‐year follow‐up.
APCs were found to have significantly lower ISUP grading postoperatively; increased diagnosis via active surveillance over new diagnosis; more frequently undertaken bilateral nerve‐sparing and long‐term poorer continence outcomes at 18 and 24 months postoperatively (p< 0.05). Pre‐ and post‐op PSA levels, erectile function, PSA density, positive surgical margins (PSM), age and tumour staging showed no significant differences between the APC and NAPC cohorts (p> 0.05).
The lower ISUP grading could indicate APC as overall being less aggressive than NAPC, whereas the poorer long‐term continence outcomes require further investigating. The non‐significant differences amongst tumour staging, PSA density, preoperative PSA levels and PSM rates suggest that APC may not be as significant as predicted in diagnostic evaluation. Overall, this study provides useful information on the growing literature of anterior prostate cancer. Being the largest comparative cohort study to date on APC post‐RARP, these results indicate the true characteristics of anterior tumours and their functional outcomes to help improve education, patient expectations and management.

Reyan Saghir

Beth Russell

Francesca Kum

Raef Darwish

Jude Deane

Christopher Allen

Hira Rizwi

Noman Saghir

Nikhil Mayor

Paul Cathcart

Prokar Dasgupta

Rick Popert

Christian Brown

Ben Challacombe

Clinical outcomes of anterior prostate cancers treated with robotic assisted radical prostatectomy

机器人辅助根治性前列腺切除术治疗前列腺癌的临床结果

Abstract Introduction Ureteral stricture disease (UTSD) poses significant challenges in reconstructive urology, with recent advances highlighting disparities in healthcare outcomes based on race and ethnicity. This study investigates the impact of race and ethnicity on clinical outcomes following ureteral reconstruction. Methods We conducted a single‐centre prospective analysis of 233 patients who underwent ureteral reconstruction for UTSD from 2014 to 2023. Patient demographics, clinical characteristics, surgical details and outcomes were collected. Patients were stratified by race (White vs. non‐White) and ethnicity (Hispanic vs. non‐Hispanic). Statistical analyses included Kruskal–Wallis, Mann–Whitney U tests, ANOVA, Kaplan–Meier analysis and multivariate logistic regression. Results Our cohort included 233 patients who underwent ureteroplasty with 108 (46.4%) non‐White patients, and 71 (30.5%) were Hispanic. No significant differences were found in recurrence rates, complications, or stricture‐free survival between racial and ethnic groups. Prior reconstructions were more prevalent among non‐White patients (26.9% vs. 16.0%; p = 0.043). Unadjusted and adjusted regressions showed significant associations between non‐White race (unadjusted β = 0.76, p = 0.008; adjusted β = 0.82, p = 0.008) and Hispanic ethnicity (unadjusted β = 0.70, p = 0.025; adjusted β = 0.79, p = 0.020) with increased stricture lengths. Conclusion This study highlights that although recurrence and complication rates do not significantly differ by race or ethnicity, disparities exist in clinical presentations, with non‐White and Hispanic patients presenting with longer stricture lengths and higher body mass index. These findings underscore the need for targeted interventions to address underlying disparities in healthcare delivery and access.

Dhruv Puri

Eric Cho

Kian Ahmadieh

Nishant Garg

Cesar Delgado

Benjamin Cedars

Michael Witthaus

Michael Pan

Jill C. Buckley

Impact of race and ethnicity on clinical outcomes and recurrence post‐ureteral reconstruction

种族和民族对输尿管重建后临床结果和复发的影

Historically, direct visual internal urethrotomy (DVIU) and balloon dilation (BD) have been preferred as first line interventions for certain urethral strictures. Urethroplasty is considered the gold standard following failed primary intervention; however, no recommendations exist for intervention following a failed urethroplasty.1 Thus far, DVIU and BD have been shown to display comparable outcomes as primary treatments in terms of freedom from recurrent stricture, time to recurrence, and complications.2 In this research letter, we provide evidence that in the case of secondary interventions following failed urethroplasty, BD shows significantly improved 3-year outcomes compared to DVIU. Urethral strictures are fairly common with a prevalence of 229–627 per 100 000 males.3 They typically impact men over the age of 65 and increase the risk for UTIs and incontinence. While some studies have compared the success of DVIU versus BD as primary interventions, reported success rates are highly variable with 32%–96% for DVIU and 35%–84% for BD.2, 4, 5 Conversely, urethroplasty has a high reported success rate of 96%, though is a more complicated procedure requiring longer recovery and a skilled surgeon.1 Due to the low frequency of recurrence following urethroplasty, recommendations for subsequent reoperations with DVIU or BD have not been adequately studied. Given the prevalence of urethral strictures and increasing use of urethroplasty, it is important to study the success of subsequent DVIU and BD. We performed a retrospective review using TriNetX (TriNetX, Inc., Cambridge, MA, USA), a clinical research platform that collects and stores over 125 million patients' electronic health record data, to determine whether urethroplasty patients with subsequent DVIU or BD had a higher chance of recurrent stricture. We are unaware of another study that directly compares success rates of DVIU versus BD as secondary interventions following urethroplasty. Cohorts were constructed for both DVIU following urethroplasty and BD following urethroplasty. Patient ages ranged from 21 to 90, and exclusion criteria included benign prostatic hyperplasia, neurogenic bladder and bladder neck contracture. Specific inclusion and exclusion criteria can be found in Appendix S1. Given the small sample sizes, cohorts were not matched for comorbidities. Outcomes were defined as ≥1 instance of urethral stricture or stenosis, or retention of urine between 1 month and 3 years after DVIU or BD. Outcomes were assessed with Kaplan–Meier, hazard ratios (HR) and log-rank tests to determine significance (p < 0.05), and a Kaplan–Meier curve was generated. DVIU (N = 45) had a significantly higher probability (p = 0.0353) of recurrent urethral stricture compared to BD (N = 25), with respective 3-year incidence probabilities of 95.15% and 69.05% (Figure 1). DVIU had a median survival of 99 days while BD had a median survival of 355 days. DVIU had an increased hazard compared to BD with a HR of 1.901 (95% CI: 1.034, 3.497). For both cohorts, the median time between initial urethroplasty and subsequent salvage intervention was comparable, with 177 days for DVIU and 153 days for BD. In conclusion, for patients experiencing recurrent urethral stricture post-urethroplasty, BD appears to have better 3-year outcomes compared to DVIU. Additionally, the data suggest that in the short term, BD may provide longer lasting symptom relief before recurrence of urethral stricture. Primary limitations of this study are attributed to the use of electronic health record data including: completeness and accuracy of medical records, loss to follow-up and billing code restrictions. Additionally, the heterogeneity of cohorts formed through TriNetX and not a single institution's data will have significant influence and cannot be ignored—this is of particular note given the highly surgeon and hospital-dependent outcomes of complex procedures such as urethroplasties. Lastly, due to the nature of TriNetX, we were unable to fully characterize strictures' length and location, type of urethroplasty or type of balloons used in BD. Future studies should prioritize larger sample sizes and consider a prospective randomized controlled trial to incorporate more granular data on strictures and interventional techniques, as the results of this research could change clinical management of urethral strictures. Appendix S1.: ICD and CPT Codes Used in Cohort Construction. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

David Gilbert

Anastasia Christ

Kyle Barclay

Shubham Gupta

Kirtishri Mishra

Efficacy of direct visual internal urethrotomy versus balloon dilation to treat recurrent urethral stricture following failed urethroplasty

直接可视内尿道切开术与球囊扩张术治疗尿道狭窄复发的效果比较：基于尿道成形术失败的病例

Abstract Objectives The objective of this study is to evaluate preoperative factors associated with cardiopulmonary bypass (CPB) utilization and outcomes for patients with renal cell carcinoma (RCC) and tumour thrombus (TT). Radical nephrectomy with thrombectomy is a standard treatment for patients with RCC and associated TT. Morbidity and mortality rates tend to correlate with aggressiveness of tumour and TT level. Methods Patients undergoing radical nephrectomy with thrombectomy (2006–2023) were retrospectively identified. Inclusion criteria included RCC histology and preoperative imaging available for thrombus‐level categorization based on the Mayo Clinic grading system. Logistic regression assessed predictors for utilizing CPB, and Cox regression identified factors associated with survival. Results A total of 72 patients with RCC and associated TT were identified. The median age was 67 years. RCC‐related symptoms were present in 83%, and 28% had Levels 3 and 4 thrombi. Eleven patients (15.3%) had undergone neoadjuvant therapy, and 81% had clear‐cell RCC. CPB was utilized in eight (11.1%) cases. The median tumour size was 10.5 cm. Metastatic disease was greater in the CPB cohort (75% vs. 28%, p = 0.008). All cases performed on CPB were Levels 3 and 4 thrombi (100% vs. 19% in the non‐CPB group, p &lt; 0.001). CPB cases had significantly longer operative time, and hospital stays and rates of Clavien ≥ 3 complications. On multivariate analysis, metastatic disease was a predictor of CPB utilization. Median survival was 74 and 25 months in the non‐CPB and CPB cohorts, respectively ( p = 0.01). Pulmonary disease and metastatic disease with CPB utilization were significantly associated with worse survival on multivariate analysis. Conclusions Surgical extirpation of kidney tumours with associated TT remains the standard of care among patients with locally advanced RCC. CPB can be utilized to increase the feasibility of resection for high‐level thrombi. Preoperative planning and cooperation among surgical teams are key given the perioperative morbidity and mortality.

Chalairat Suk‐Ouichai

Mitchell M. Huang

Clayton Neill

Christopher K. Mehta

Ashley E. Ross

Shilajit D. Kundu

Kent T. Perry

Duc T. Pham

Hiten D. Patel

Utilization of cardiopulmonary bypass at radical nephrectomy for renal cell carcinoma with tumour thrombus

根治性肾切除术中使用体外循环治疗伴有瘤栓的肾细胞癌的利用

Abstract Objectives The objective of this study is to evaluate the diagnostic performance of perineal access cannulas tethered to a biplanar ultrasound probe in cognitive transperineal prostate biopsies of targets identified by multiparametric magnetic resonance imaging (mpMRI) by comparing the results of the PrecisionPoint (PP) Transperineal Access System with the double‐freehand (DFH) technique. Patients and methods All patients who underwent cognitive transperineal prostate biopsy of mpMRI targets using the PP or DFH technique between November 2020 and September 2023 were enrolled. All data related to mpMRI target biopsies were stratified by technique, visibility in transrectal ultrasound and analysed by comparing PP versus DFH. A standardised anaesthesia protocol with 1% mepivacaine was used in all biopsies. The tolerability of the procedures was assessed using a visual analogue scale (VAS). Results The number of mpMRI targets sampled was 166 in PP and 242 in DFH. In target biopsies, the PP system was associated with better diagnostic performance for clinically significant prostate cancer (Gleason score ≥3 + 4) compared to DFH for both ultrasound‐visible targets (61.4% vs. 48.0%) and non‐visible targets (41.4% vs. 14.9%) ( p = 0.02). A higher rate of positive cores was obtained from targets sampled with PP (57.7% vs. 49.6%, p = 0.0002). The PP system was associated with the retrieval of significantly longer cores ( p &lt; 0.0001). There was no significant difference between the techniques regarding pain reported during the biopsy, with a median VAS of 2.7/10, although the PP device required a lower amount of anaesthetic in the periprostatic planes (4.3 ± 2.0 mL vs. 5.9 ± 1.9 mL, p &lt; 0.0001). Conclusion The PrecisionPoint Transperineal Access System enabled more precise and higher quality biopsies, resulting in improved histological characterisation of prostate cancer compared to the DFH approach. The use of a perineal cannula did not increase the pain perceived by patients and also required less local anaesthetic during the biopsy.

Luca Orecchia

Stefano Germani

Gaia Colalillo

Angelica Fasano

Matteo Ricci

Eleonora Rosato

Anastasios D. Asimakopoulos

Simone Albisinni

Enrico Finazzi Agrò

Guglielmo Manenti

Roberto Miano

Prospective per‐target analysis of the added value of the PrecisionPoint Transperineal Access System in cognitive prostate biopsy of MRI targets

前瞻性每目标分析PrecisionPoint经会阴入路系统在MRI目标认知前列腺活检中的附加价值

Abstract Objective The aim of this study was to assess the precision and safety of targeted microwave ablation (TMA) using organ‐based tracking (OBT) fusion, in patients with intermediate risk prostate cancer. Patients and method We conducted a prospective, multicentric trial. Eligible patients had a prostate‐specific antigen (PSA) &lt; 20 ng/mL, a magnetic resonance imaging (MRI)‐visible index tumour of Gleason score 3 + 4, with largest axis ≤15 mm and distant of at least 5 mm from the rectum and apex. TMA was performed with microwave needle applicator using OBT fusion, with a transperineal or a transrectal approach. In this interim analysis, we evaluated precision, safety, urinary and sexual outcomes, and PSA density kinetics. Results At this point, 37 patients were treated in five centres. Median (interquartile range) age is 68 (63–72) years. Baseline median prostate volume and PSA are of 45 (34–57) mL and 8 (6.2–10.8) ng/mL, respectively. Median largest tumour axis on T2W MRI is of 11 mm (10–13). Patients were treated under general anaesthesia or conscious IV sedation in an outpatient setting. Anaesthesia had a median duration of 78 (66–90) min. A median number of 3 (2–4) 12‐W ablations of 2 to 5 min were performed per patient. After a median follow‐up of 6 (2.4–10) months, we observed 58 adverse events (AE) in 22 patients. These were of Common Terminology Criteria for Adverse Events (CTCAE) grade 1, 2 and 3 in 43 (74%), 13 (22%) and 2 (4%) cases. Six (15%) patients had an acute urinary retention, five of which considered as severe AE because of rehospitalisation. We did not observe any significant difference in International Prostate Symptom Score (IPSS), Male Sexual Health Questionnaire‐ejaculatory dysfunction (MSHQ‐EjD) and International Index of Erectile Function (IIEF5) from baseline to last follow‐up. Median PSA density evolved from 0.2 (0.1–0.3) at baseline to 0.1 (0.07–0.16) at 12 months. Conclusions These preliminary results suggest that TMA using OBT fusion is precise and safe in patients with intermediate risk localised prostate cancer. Further inclusions and follow‐up are needed to assess oncological outcome.

Nicolas Barry Delongchamps

Alexandre Peltier

Eric Potiron

Franck Bladou

Julien Anract

Romain Diamand

Grégoire Robert

Aurel Messas

Roland Van Velthoven

Targeted microwave ablation of localised prostate cancer: Initial results of VIOLETTE trial

局部前列腺癌靶向微波消融术：VIOLETTE试验的初步结果

短名
Journal Impact	1.45
国际分区	UROLOGY & NEPHROLOGY(Q3)

涉及主题	医学内科学生物遗传学癌症病理外科计算机科学泌尿科数学前列腺癌放射科前列腺统计心理学内分泌学解剖
出版信息	出版商: John Wiley and Sons Inc，出版周期: ，期刊类型: journal，开源期刊: 是
基本数据	创刊年份: 2020，原创研究文献占比: 0.00%，自引率:6.20%， Gold OA占比: 77.13%
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Improved early and late continence following robot‐assisted radical prostatectomy with concurrent bladder neck fascial sling (RoboSling)

Preperitoneal vas deferens infiltration in high‐risk prostate cancer

Clinical outcomes of anterior prostate cancers treated with robotic assisted radical prostatectomy

Impact of race and ethnicity on clinical outcomes and recurrence post‐ureteral reconstruction

Efficacy of direct visual internal urethrotomy versus balloon dilation to treat recurrent urethral stricture following failed urethroplasty

Utilization of cardiopulmonary bypass at radical nephrectomy for renal cell carcinoma with tumour thrombus

Prospective per‐target analysis of the added value of the PrecisionPoint Transperineal Access System in cognitive prostate biopsy of MRI targets

Impact of race and ethnicity on clinical outcomes and recurrence post‐ureteral reconstruction

Efficacy of direct visual internal urethrotomy versus balloon dilation to treat recurrent urethral stricture following failed urethroplasty

Targeted microwave ablation of localised prostate cancer: Initial results of VIOLETTE trial