Background The AirSeal® Intelligent Flow System (IFS) is a valveless insufflation system that provides stable pneumoperitoneum and continuous smoke evacuation. While its safety and efficacy have been demonstrated in urologic surgery, evidence regarding its impact on perioperative outcomes in robotic-assisted partial nephrectomy (RAPN) remains limited. Objectives To compare perioperative outcomes, postoperative complications, and opioid use between RAPN performed with AirSeal® versus conventional insufflation. Design Retrospective comparative study using a prospectively maintained single-center database. Methods We analyzed 208 consecutive patients who underwent elective RAPN at a tertiary care center between 2013 and 2023. Patients were divided into two groups based on the insufflation system used: AirSeal® (n=86) and conventional insufflation (n=122). Baseline demographics, operative characteristics, and postoperative outcomes—including operative time, estimated blood loss, length of hospital stay, complications (Clavien-Dindo classification), trifecta achievement, renal function, and postoperative opioid use—were compared. Statistical analyses included chi-square tests, independent t-tests, and univariate linear regression. Results Baseline demographic, functional, and oncologic characteristics were comparable between groups. Use of AirSeal® was associated with significantly shorter operative time (−30.83 minutes, p<0.001), reduced estimated blood loss (−81.42 cc, p=0.003), and shorter hospital stay (−1.09 days, p<0.001). There were no significant differences in postoperative complications, trifecta achievement, renal functional outcomes, or postoperative opioid use between the two groups. Conclusion The use of AirSeal® in RAPN is associated with improved perioperative efficiency, including shorter operative time, reduced blood loss, and shorter hospitalization, without compromising safety or functional outcomes. Further prospective and multicenter studies are warranted to validate these findings and assess cost-effectiveness.
Retained encrusted ureteral stents represent a complex urologic problem, particularly in patients with limited healthcare access. We present a 28-year-old undocumented female with a 10-month retained ureteral stent who developed massive right-sided encrustation, including a 3 cm proximal renal stone near the renal pelvis and a 5-6 cm bladder stone, classified as FECal Grade IV-V. A single-session combined approach consisting of robot-assisted cystolithotomy, intraoperative ureteroscopy with stent exchange, and robot-assisted pyelolithotomy was performed successfully. Intraoperative ureteroscopy between operative phases confirmed ureteral clearance and enabled immediate stent placement without repositioning delay. This case supports the use of combined robotic approaches for high-grade disease and illustrates how structural barriers drive late presentation and increased surgical complexity.
High-risk non–muscle invasive bladder cancer poses therapeutic challenges, with significant rates of recurrence and progression with standard intravesical bacillus Calmette-Guérin (BCG) therapy. Current surveillance strategies lack accurate risk stratification models to predict individual treatment response and personalized treatment options. Simultaneously, there are no well-validated alternatives to replace the current gold-standard approach based on clinical and pathologic features. This review examines emerging biomarkers and advanced technologies with the potential to enhance patient selection and personalize intravesical therapy in HR-NMIBC. Artificial intelligence(AI)-driven histopathologic tools, such as the computer histological AI biomarker, have demonstrated the ability to identify non-responders to standard therapy using whole-slide digital pathology images. In parallel, radiomics-enhanced imaging has shown promise in assessing tumor biology and immune microenvironment features predictive of BCG responsiveness. Liquid biopsy, especially urine tumor DNA analysis, is now available in the arsenal to detect minimal residual disease, stratify recurrence risk, and predict treatment response even before clinical or radiographic evidence of recurrence. Tissue-based genomic profiling has also revealed molecular alterations associated with treatment resistance, though additional validation is needed. Together, these next-generation biomarkers may represent a pivotal shift toward precision oncology in bladder cancer and their incorporation into NMIBC future clinical guidelines is both anticipated and necessary.
Background People living with HIV (PLWH) are increasingly undergoing endourological procedures, including mini-percutaneous nephrolithotomy (mini-PCNL) and retrograde intrarenal surgery (RIRS), but comparative evidence on postoperative infectious outcomes is limited. Objectives This study aims to compare short-term postoperative outcomes between PLWH and HIV-negative patients undergoing mini-PCNL or RIRS, focusing on postoperative urosepsis and exploring factors associated with urosepsis among PLWH. Design A single-center, retrospective cohort study. Methods Consecutive adult patients who underwent mini-PCNL or RIRS between July 2023 and January 2025 were grouped by HIV status. The primary outcome was postoperative urosepsis during the index hospitalization. Secondary outcomes included stone-free status and length of stay. Results A total of 708 patients were included (70 PLWH and 638 HIV-negative). Postoperative urosepsis occurred in 8/70 (11.4%) PLWH and 45/638 (7.1%) HIV-negative patients, with no significant difference between groups (p=0.13). Stone-free status was achieved in 66/70 (94.3%) PLWH and 586/638 (91.8%) HIV-negative patients (p=0.48). Other outcomes, including total hospitalization time, postoperative hospital stay, and preoperative antibiotic exposure, did not differ significantly between groups (all p>0.05). Among PLWH, exploratory univariable analyses showed that female sex, positive preoperative urine culture, and clinically higher-risk HIV disease group (acute HIV infection or AIDS) were associated with higher odds of postoperative urosepsis. CD4+ T-cell count <400 cells/µL showed a higher but statistically non-significant estimated odds. Conclusion Short-term postoperative outcomes following mini-PCNL or RIRS did not differ significantly between PLWH and HIV-negative patients. Exploratory univariable analyses suggested that female sex, positive preoperative urine culture, and clinically higher-risk HIV disease group were associated with postoperative urosepsis among PLWH. These findings should be interpreted cautiously because of the limited number of PLWH and urosepsis events.
Muscle-invasive bladder cancer (MIBC) remains associated with high recurrence and mortality despite radical cystectomy and cisplatin-based neoadjuvant chemotherapy (NAC). For decades, perioperative therapy was defined by platinum-based regimens, which improve survival but are limited to fewer than half of patients due to comorbidities. Recent advances in the past year have redefined this landscape. Multiple pivotal phase III trials have demonstrated the efficacy of immune checkpoint inhibitors (ICIs) in both neoadjuvant and adjuvant settings. The phase III trials, KEYNOTE-905/EV-303 and KEYNOTE-B15/EV-304 have established perioperative enfortumab vedotin plus pembrolizumab as a new standard of care for neoadjuvant therapy. Parallel translational research has identified biomarkers that may refine patient selection and optimize therapy. PD-L1 expression, DNA damage repair gene alterations, molecular subtyping, and circulating tumor DNA (ctDNA) have all emerged as predictive and prognostic tools. Liquid biopsy approaches may guide adjuvant therapy decisions and facilitate real-time monitoring of minimal residual disease. This review synthesizes the evolving role of perioperative therapies in MIBC, from the historical reliance on cisplatin-based chemotherapy to the transformative integration of immunotherapy, ADCs, and biomarker-guided approaches. Together, these advances represent a significant progress in perioperative bladder cancer care, heralding a shift toward individualized, biomarker-driven strategies that promise improved survival and broader treatment applicability.
Background Neurogenic urinary incontinence represents a major therapeutic challenge in patients with a history of severe pelvic trauma, where extensive scarring and distorted anatomy limit conventional surgical options. Despite its clinical relevance, published data on continence-preserving treatments for this subgroup remain scarce, and many patients are managed with permanent catheterization or urinary diversion. Objective Our aim was to describe a novel technique for artificial urinary sphincter implantation using an alternative cuff placement strategy around the bladder outlet and to evaluate associated clinical outcomes. Design Single-center retrospective cohort study evaluating feasibility, safety, and long-term outcomes of a novel surgical technique. Methods We provide a standardized, step-by-step description of the novel operating technique and retrospectively analyzed 12 consecutive paraplegic male patients who underwent artificial urinary sphincter implantation using this approach. Demographic, functional, and patient-reported outcomes were assessed. Results Twelve consecutive patients underwent successful implantation of an artificial urinary sphincter using the CATPUB (Combined Anterior Transmembranous Posterior Urethral Bulbar) technique between 2008 and 2025. No serious perioperative complications were observed during a follow-up of up to 15 years (median 35 months). Conclusions CATPUB cuff placement provides a safe and effective continence-preserving option for male paraplegic patients with neurogenic urinary incontinence following severe pelvic trauma and may represent a valuable alternative when conventional bladder neck cuff placement is not feasible.
Background Several scoring systems have been developed to predict stone-free rates (SFR) after retrograde intrarenal surgery (RIRS), but their clinical utility remains limited. The pelvic stone angle (PSA) has recently been proposed as a novel anatomical parameter for evaluating lower pole stones. Objectives To evaluate the predictive value of PSA for stone-free outcomes after RIRS and compare the performance of PSA-integrated scoring systems with existing nephrolithometric models. Design Retrospective single-center cohort study. Methods A total of 198 patients who underwent RIRS between April 2018 and October 2023 were retrospectively reviewed. Patients with lower pole stones were included. Preoperative non-contrast computed tomography was used to evaluate PSA, stone burden, and other anatomical parameters. Stone-free status was assessed one month postoperatively. Four scoring systems (MS-ReSC, R.I.R.S., RUSS, and T.O.HO.) were analyzed, with PSA replacing the conventional infundibulopelvic angle where applicable. Predictive performance was evaluated using area under the receiver operating characteristic curve (AUC). Results The T.O.HO. score demonstrated the highest predictive performance for stone-free status with an AUC of 0.7080, followed by the R.I.R.S. score with PSA (0.6525), MS-ReSC (0.6147), and RUSS with PSA (0.6121). Among the evaluated models, only the T.O.HO. score showed a statistically significant improvement compared with RUSS (p = 0.0445). No statistically significant differences in overall accuracy were observed among the scoring systems. Lower pole stone burden, stone multiplicity, CT attenuation values, and multifocal stones were significantly associated with postoperative stone-free outcomes. Conclusion PSA is a practical and reliable anatomical parameter for predicting stone-free outcomes after RIRS. Integration of PSA into existing scoring systems maintained comparable predictive performance and may improve reproducibility in modern endourological practice. Although the T.O.HO. score demonstrated the best overall performance, further large-scale prospective multicenter studies are required to validate PSA-based scoring systems.
Background Informed consent in outpatient urology remains challenging, with patients often demonstrating limited understanding and experiencing anxiety prior to procedures such as flexible cystoscopy. Virtual reality (VR) has emerged as a potential tool to enhance patient education and engagement. Objectives To evaluate the effectiveness of virtual reality (VR) as a tool for enhancing informed consent and patient counselling in individuals undergoing flexible cystoscopy, by assessing its impact on patient understanding, emotional response, pain perception, and overall satisfaction. Design This single-arm prospective study was conducted from July to October 2025 at our university teaching hospital. Methods This single-arm prospective study was conducted from July to October 2025 at our university teaching hospital. Adult patients undergoing flexible cystoscopy were recruited to assess the impact of a VR-enhanced consent process. Participants viewed a 3-minute VR module via headset, featuring interactive 3D anatomical models and narrated explanations based on British Association of Urological Surgeons (BAUS) and European Association of Urology (EAU) patient information materials, outlining the procedure, expected outcomes, and potential risks. To evaluate the intervention, patients completed three validated questionnaires before and after the VR session: a 4-point Likert-scale Procedure Understanding Questionnaire, a Visual Analogue Scale (VAS) for pain, and the State-Trait Anxiety Inventory (STAI) to measure emotional state. Results 101 patients were included in the study. VR significantly improved patient comprehension, with mean scores rising for understanding (3.03 to 3.81, p <0.001), ability to explain (2.87 to 3.68, p <0.001), and accessibility (2.93 to 3.65, p <0.001). Reported difficulties decreased (1.59 to 1.22, p <0.001), while nervousness did not reach significance (2.17 to 1.93, p =0.034). STAI scores demonstrated significant improvements in positive emotional states including calmness, satisfaction, and self-confidence, alongside reductions in tension, worry, indecisiveness, and confusion. Pain perception of cystoscopy declined but was not statistically significant (VAS, 3.57 to 3.34, p =0.132). Patient evaluation revealed strong preference for VR over traditional consent materials, with most rating the content positively. Conclusion VR-enhanced counselling was associated with improved patient understanding, reduced anxiety, and lowered perceived pain during flexible cystoscopy. Patients strongly preferred VR over conventional information, supporting its use as a practical adjunct to routine outpatient consent.
Background In the era of precision prostate cancer diagnostics, the role of emerging imaging modalities requires redefinition within integrated diagnostic pathways. Micro-ultrasound (mUS) has emerged as a potential alternative to multiparametric magnetic resonance imaging (mpMRI) for targeted prostate biopsy; however, comparative evidence remains methodologically heterogeneous. Objectives We aimed to re-evaluate the comparative detection performance of mUS versus mpMRI-targeted biopsy for clinically significant prostate cancer (csPCa), with particular attention to contemporary evidence and study design considerations. Design Systematic review with meta-analysis. Data sources and methods A systematic review of PubMed/MEDLINE, Web of Science, ScienceDirect, and the Cochrane databases was conducted up to February 28, 2026, in accordance with the PRISMA guidelines to identify studies comparing mUS- and mpMRI-targeted prostate biopsies. Study quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool. The primary outcome was the pooled detection ratio (DR) for csPCa, defined as the ratio of detection rates between mUS- and mpMRI-targeted biopsy. Results Fifteen studies comprising 2,512 patients were included. mUS-targeted biopsy detected csPCa in 654/2181 participants, compared to 691/2391 with mpMRI-targeted biopsy. The pooled DR for csPCa detection was 1.06 (95% CI 0.97–1.15; p=0.20), indicating no significant difference between modalities. Similarly, detection of clinically insignificant prostate cancer did not differ significantly (DR 0.89, 95% CI 0.72–1.10; p=0.28). Across studies, heterogeneity in design and potential within-patient correlations were identified as important contextual factors influencing interpretation. The inclusion of the OPTIMUM randomized trial provided complementary evidence from independently assigned diagnostic pathways, supporting the overall consistency of findings. Conclusion No statistically significant difference was observed between mUS-targeted and mpMRI-targeted biopsies in the detection of clinically significant prostate cancer. Beyond a binary comparison, these findings support a shift toward integrated diagnostic pathways in which mUS may serve as a complementary or alternative tool depending on the clinical context. Further prospective and methodologically robust studies are needed to refine its role in precision prostate cancer diagnostics.
Third kidney transplantation is rare and technically challenging because of exhausted iliac fossae, dense adhesions, and increased vascular risks. Robot-assisted kidney transplantation (RAKT) has emerged as a minimally invasive alternative, although its role in complex retransplantation remains uncertain. We report a 41-year-old man with two failed deceased-donor kidney transplants who underwent robot-assisted third kidney transplantation using the da Vinci Xi system. Vascular anastomoses were performed under continuous intra-abdominal hypothermic perfusion, and uretero-ureterostomy was selected because severe pelvic adhesions precluded bladder reconstruction. Immediate graft function was achieved, with serum creatinine decreasing to 62 μmol/L on postoperative day 2 and remaining stable thereafter. This case demonstrates that robot-assisted third kidney transplantation is feasible in carefully selected patients and suggests that robotic techniques may expand surgical options for complex kidney retransplantation.
Background Given the complexity of radical nephroureterectomy (RNU), simplifying the procedure is particularly important. Objective To compare perioperative and oncological outcomes, this study evaluated a novel one-position bladder cuff resection (nRNU) against the conventional ureteral pluck technique (UPT) for distal ureter excision in RNU, a procedure traditionally requiring patient repositioning. Design A multicenter retrospective cohort study comparing two approaches to bladder cuff management. Methods This study evaluated patients with upper urinary tract urothelial carcinoma (UTUC) who underwent laparoscopic RNU between January 2015 and November 2024. Participants were stratified into two groups: a nRNU group and a UPT group. Data on baseline characteristics, perioperative outcomes, and oncological results were collected. Results In this study, 169 patients were enrolled according to predefined inclusion and exclusion criteria, of whom 135 underwent nRNU and 34 underwent UPT. Baseline demographic and clinicopathological characteristics were well balanced between the two groups. Perioperative outcomes indicated significantly shorter operative time and reduced postoperative hospital stay in the nRNU group compared with the UPT group (operative time: 207.74 ± 50.29 min vs 256.91 ± 60.17 min, p < 0.001; postoperative hospital stay: 6 [5, 7] days vs 13.5 [12, 16] days, p < 0.001). Regarding oncological outcomes, the nRNU group exhibited a lower rate of bladder tumour recurrence than the UPT group (p = 0.006). No significant between-group difference was observed in the incidence of distant metastasis. Conclusion and Registration Our findings suggest that the novel one-position approach to RNU is associated with an accelerated postoperative recovery process, as evidenced by reduced duration of hospitalisation and a lower incidence of subsequent bladder tumour recurrence.This study, as part of the novel one-position RNU series, have been registered with the Chinese Clinical Trial Registry (registration No. ChiCTR2400090932).
Background: Prostate cancer is one of the most common malignancies in men worldwide. Radical prostatectomy is an effective curative treatment, but a noticeable number of men are ultimately found to have clinically insignificant disease, such as a Gleason score of 3 plus 3, on final histopathology. This suggests that some patients may undergo unnecessary surgery. The widespread adoption of multiparametric MRI has improved tumour detection and targeted biopsy accuracy, yet its potential role in preventing overtreatment is not fully understood. Because some low-risk tumours demonstrate low conspicuity on MRI, we hypothesised that specific MRI features, particularly low lesion conspicuity and PI-RADS 3 or lower, may be associated with final Grade Group 1 pathology in men undergoing radical prostatectomy. Objectives: The purpose of this study was to assess whether pre-operative multiparametric MRI can help identify men with potentially indolent prostate cancer and reduce unnecessary radical prostatectomies. We focused on MRI features such as PI-RADS 3 or lower, low lesion conspicuity and overall imaging quality to see how strongly they relate to final Grade Group 1 in men who were selected for surgery. Design: Retrospective single-centre cohort study. Methods: We reviewed 400 consecutive men who underwent robot-assisted radical prostatectomy for presumed clinically significant prostate cancer. Final pathology identified 13 men with Grade Group 1 disease. Pre-operative mpMRI examinations were reassessed for PI-RADS category, lesion location, lesion conspicuity and overall image quality to determine whether imaging features were associated with low-risk pathology. Results: Analyses showed that certain MRI characteristics were frequently associated with Gleason 3 plus 3 pathology. Several patients who proceeded to surgery had inconspicuous, equivocal or low probability MRI lesions such as PI-RADS 2 or 3 that lacked features typically associated with clinically significant cancer. Recognising these signatures may refine patient selection and support broader use of active surveillance. Conclusion: Assessment of MRI appearance, lesion conspicuity and PI-RADS category may improve selection for surgery and reduce overtreatment. MRI-based identification of low-grade prostate cancer could help avoid unnecessary prostatectomies and the associated morbidity while preserving oncologic safety.
Background: YouTube is widely used by patients seeking information about robot-assisted radical prostatectomy (RARP), but the reliability, transparency, and counseling coverage of RARP-related videos remain variable, particularly in a fragmented and search-driven digital environment. Objectives: To evaluate the quality, reliability, transparency, and patient-oriented counseling coverage of YouTube videos on RARP and identify underrepresented topics relevant to shared decision-making. Design: Cross-sectional observational study. Methods: YouTube was searched on February 16, 2026, using “robotic radical prostatectomy,” “RARP prostate,” and “da Vinci prostatectomy” in incognito mode. After duplicate removal and eligibility assessment, 174 videos were included. Video characteristics, uploader type, target audience, and format were recorded. Educational quality, reliability, and transparency were assessed using the Global Quality Scale (GQS), modified DISCERN, and Journal of the American Medical Association (JAMA) benchmark criteria. Counseling-related coverage was assessed using a 15-item RARP-specific checklist designed to evaluate key patient-centered domains rather than stand-alone adequacy. Non-parametric tests and Spearman correlations were used. Results: Among 174 videos, 93.7% targeted patients. Median duration was 3.09 min (interquartile range (IQR), 1.92–5.91), and median view count was 1658 (IQR, 371–9747). Educational quality and reliability were low to moderate (median GQS 2 (IQR, 2–3); modified DISCERN 2 (IQR, 2–3)). Transparency was limited (median JAMA 2 (IQR, 1–2)), with only 10.9% achieving JAMA ⩾3. Clinically important counseling topics were frequently underrepresented, including postoperative prostate-specific antigen follow-up (84.5%), complications/complication rates (55.2%), erectile dysfunction (40.8%), urinary continence outcomes (39.7%), and recovery timeline (31.6%). Transparency differed by uploader type ( p < 0.001), whereas quality and counseling coverage did not differ by uploader source. Popularity metrics showed no meaningful correlation with GQS. Conclusion: YouTube provides accessible and highly searchable information on RARP; however, the reliability, transparency, and coverage of key counseling-related topics vary considerably across videos. While short-form or highly specialized content may help address specific patient questions, important topics related to complications, functional outcomes, and postoperative follow-up are frequently underrepresented. Development of patient-centered and platform-adapted educational frameworks may improve the balance, transparency, and practical value of YouTube-based patient education in RARP. Trial registration: Not applicable.
Background: Lower caliceal stones (LCS) account for 25%–36% of all renal stones. Flexible ureteroscopic lithotripsy (FURL) is first-line treatment for LCS, but its stone-free rate (SFR) is significantly affected by renal anatomy and stone characteristics. Currently, there is a lack of specific, convenient scoring systems for predicting SFR of LCS after FURL. Objectives: To assess the factors influencing the SFR of LCS after FURL, and establish a practical, convenient, and accurate scoring system. Design: A single-center retrospective cohort study. Methods: A total of 149 patients who underwent FURL between September 2020 and December 2022 were divided into two groups based on the results of NCCT of the kidney performed 1 month after surgery: Group A (stone clearance group) with 112 patients and Group B (residual stone group) with 37 patients. Variables with p values less than 0.1 from univariate analysis were incorporated into binary unconditional multivariate logistic regression analysis. The degree of correlation was assessed based on the odds ratio of independent risk factors. The optimal cutoff value for the early warning scoring system was determined using the Youden index. Results: According to binary unconditional multivariate logistic regression analysis, stone length ( p = 0.003), stone CT value ( p = 0.043), infundibulopelvic angle (IPA; p = 0.031), infundibular width (IW; p = 0.043), calyceal pelvic height (CPH; p = 0.006), and renal pelvis morphology ( p = 0.036) were identified as independent risk factors. Each factor was assigned one point based on OR values, resulting in a total score of six points. The area under the ROC curve was 0.859, and the cutoff value was 1.5. Internal validation was performed via bootstrap resampling (1000 iterations). The optimism-corrected AUC was 0.842 (95% CI: 0.797–0.913). When the total score was less than 2, the overall SFR was 96.20%; however, when the total score was ⩾2, this rate significantly decreased to 49.32%. Conclusion: Stone length, stone CT value, renal pelvis shape, IPA, IW, and CPH were identified as independent factors influencing the SFR of LCS after FURL. Each factor was assigned a score of 1, resulting in a prediction scoring system with a total score of six points. A total score exceeding two was associated with a significantly reduced SFR. FURL was strongly recommended for scores of 0–1, used with caution for scores of 2–3, and not routinely recommended for scores 4–6.
Demand has increased in recent years to develop and implement strategic approaches for improving functional outcomes following pelvic surgery. Intraoperative neurophysiological monitoring represents one such possible approach for this field. It involves generating neuronal activity within the nerve supply of pelvic organs and structures, conventionally using an external electrical current, and conjunctively recording neuronally mediated functional responses, which then, in real time, guides the surgical dissection in a manner that maximizes nerve preservation. A central aspect of this methodology is the creation of a neuronal stimulus. As such, sacral neurostimulation is proposed, strategically exploiting the neuroregulatory influence of the sacral spinal cord in pelvic physiology. While resembling sacral neuromodulation, a distinct methodology designed for long-term reprogramming of neural circuits, sacral neurostimulation aims to produce more immediate nerve signaling effects. Several technical options in this mode of neurostimulation are described, in which stimulatory electrodes are applied transspinally or peripherally to the neural pathways of the sacral spinal cord. These options can be categorized as surgical, percutaneous, and transcutaneous techniques. Ongoing studies in this field may reveal the most applicable techniques and optimal parameters for inducing erections and other neuronally mediated functional responses in the pelvic region as well. In turn, sacral neurostimulation may contribute toward applying neurophysiological monitoring during pelvic surgeries as a potential advance for improving postoperative functional outcomes. This narrative review serves to present the novelty of sacral neurostimulation for intraoperative induction of penile erection and its possible use in intraoperative neurophysiological monitoring for pelvic surgery.
Background:Triplet therapy with androgen deprivation therapy (ADT), docetaxel, and androgen receptor pathway inhibitors (ARPIs), either darolutamide or abiraterone, is one of the standard treatments for metastatic hormone-sensitive prostate cancer (mHSPC); however, no randomized trial has directly compared both ARPIs within this regimen. Given practical and financial constraints, a head-to-head randomized trial directly comparing these ARPIs may be unlikely. Objective:To compare the real-world effectiveness of darolutamide- versus abiraterone-based triplet therapy in patients with mHSPC. Design:Retrospective cohort study using a multinational electronic health record network. Methods:We conducted a retrospective cohort study using the TriNetX research network. Patients with mHSPC treated with darolutamide- or abiraterone-based triplet therapy were identified and balanced using propensity-score matching. The primary outcome was overall survival (OS), and the secondary outcome was time to next treatment (TTNT), defined by treatment switch. Prespecified subgroup analyses focused on age, cardiometabolic comorbidities, and polypharmacy-related medication use. Results:Among 1607 eligible patients, 1252 were included after propensity score matching (626 per group). Darolutamide-based triplet therapy was associated with longer OS compared with abiraterone (hazard ratio (HR) 0.42). A favorable difference in TTNT was also observed (HR 0.66). These associations were consistent across clinically relevant subgroups, including patients aged ⩾65 years and those with ischemic heart disease or diabetes mellitus. In polypharmacy-enriched subgroups, darolutamide-based therapy was consistently associated with more favorable OS and TTNT. Conclusion:In this large real-world analysis, darolutamide-based triplet therapy was associated with longer OS and TTNT compared with abiraterone-based triplet therapy in patients with mHSPC, particularly among older individuals and those with comorbidities. These findings are hypothesis-generating, suggesting that ARPI selection within triplet therapy may have clinically relevant implications, supporting the need for prospective studies.
Background: Transrectal ultrasound-guided prostate biopsy (TRUS-guided biopsy) remains widely used for the diagnosis of prostate cancer, but it is associated with a risk of infectious complications despite antibiotic prophylaxis. Objectives: To evaluate the effect of disinfecting the prostate biopsy needle with different antiseptic agents after each core sampling on post-procedural infectious complications. Design: A prospective, randomized, single-center clinical study. Methods: Between February and May 2025, 240 patients undergoing TRUS-guided prostate biopsy were randomly assigned to four groups ( n = 60 each): no needle disinfection, povidone-iodine disinfection, 10% formalin disinfection, or 70% isopropyl alcohol disinfection after each biopsy core. All patients received standardized empirical antibiotic prophylaxis based on the institutional protocol and local antibiogram data. Prophylaxis consisted of oral cefixime initiated on the day of biopsy and continued for 5–7 days. Patients were actively followed for 30 days for febrile urinary tract infection, hospitalization, sepsis, and microbiological culture results. Results: The rate of febrile urinary tract infection was highest in the non-disinfection group (11.6%). No cases of fever, hospitalization, or sepsis were observed in the formalin group. Povidone-iodine and isopropyl alcohol disinfection were associated with lower infection rates than no disinfection, but were less effective than formalin. Escherichia coli was the most frequently isolated microorganism in positive cultures. Conclusion: Disinfection of the biopsy needle after each core sampling is associated with a meaningful reduction in infectious complications following TRUS-guided prostate biopsy. Among the evaluated agents, 10% formalin demonstrated the greatest protective effect; however, further multicenter studies with longer follow-up are required to confirm long-term safety and generalizability. Trial registration: This trial was prospectively registered at ClinicalTrials.gov (Identifier: NCT06836271; Local trial ID: HititUrology001).
