Background Data on longitudinal bladder cancer (BC) costs are scarce. Objective To assess the economic burden of non–muscle-invasive bladder cancer (NMIBC) by progression risk groups in France over a 1-yr and 5-yr time horizon after initial diagnosis. Design, setting, and participants We used data from the French national prospective COhort to study BLAdder CancEr (COBLAnCE) cohort. A total of 1101 patients diagnosed with a primary NMIBC between 2012 and 2018 were linked with the French National Healthcare System Database. Patients were classified into four risk groups according to the 2021 European Association of Urology risk stratification. Resources used included all BC-related hospitalizations, follow-up visits to urology and oncology clinics and related prescriptions, BC-related imaging procedures, transportation, and sick leaves. Costs were estimated from the perspective of the French health care system over the 5 yr after BC diagnosis. Outcome measurements and statistical analysis Across risk groups, mean per-patient cost ranged from €5838 to €20 678 and €11 697 to €40 519 over 1 yr and 5 yr, respectively. Surgical hospital stays accounted for 60% of costs in the first year. Over 5 yr, intravesical treatments, surveillance visits, and imaging were major cost drivers, especially among patients at lower risk of progression. Results and limitations Although claims databases are comprehensive, the economic burden of NMIBC may be underestimated owing to potential incomplete coding. Conclusions To our knowledge, this is the first national cohort study to provide robust cost estimates for patients with NMIBC stratified according to progression risk groups. These real-world data are particularly awaited for the economic evaluation of emerging treatments in patients with NMIBC.
Background and objective Chronic neurogenic urinary retention often requires assisted emptying and remains challenging to treat. We evaluated whether electrical pudendal nerve stimulation (EPNS) improves bladder emptying and compared short-term outcomes with a standard sacral neuromodulation (SNM) test stimulation strategy. Methods In this prospective, multicenter, assessor-masked study, 70 adults with chronic refractory neurogenic nonobstructive urinary retention received either EPNS (12 sessions over 4 wk) or a standard 4-wk continuous SNM test phase using a percutaneously placed S3 lead. The primary outcome was the percentage change from baseline in postvoid residual urine volume (PVR) at 4 wk. Secondary outcomes included changes in International Consultation on Incontinence Questionnaire–Lower Urinary Tract Symptoms and Quality of Life scores. Analyses used linear mixed models; propensity score matching was prespecified as a sensitivity analysis. Key findings and limitations At 4 wk, the adjusted PVR improvement rate was 68% with EPNS versus 51% with SNM (between-group difference 17 percentage points; 95% confidence interval 5–29; p = 0.008). Improvements in symptom and quality of life scores also favored EPNS (p < 0.001 for both). Limitations include nonrandom treatment allocation and short follow-up. Conclusions and clinical implications Outpatient EPNS produced clinically meaningful short-term improvements in bladder emptying and patient-reported outcomes without implantation, supporting consideration of EPNS as an initial step in a stepped neuromodulation pathway for neurogenic urinary retention.
Context Kidney transplantation (KT) is the treatment of choice for end-stage kidney disease, but technical success depends on thorough preoperative evaluation. Imaging may detect vascular calcifications, anatomic abnormalities, or incidental findings that influence surgical planning. However, recommendations remain heterogeneous, and the optimal imaging strategy is unclear. Objective To assess the role of preoperative abdominopelvic imaging in adult candidates for KT and its impact on surgical decision-making and outcomes. Evidence acquisition Following Preferred Reporting Items for Systematic reviews and Meta-Analyses 2020 guidelines, PubMed/MEDLINE and Embase were searched (January 2000–August 2025) for studies reporting preoperative imaging in candidates for KT. Included modalities were Doppler ultrasound (DUS), contrast-enhanced ultrasound, noncontrast computed tomography (NCCT), computed tomography angiography, magnetic resonance imaging, and plain abdominal x-ray. Outcomes included detection of surgically relevant abnormalities, changes in surgical planning, and exclusion from transplantation. Evidence synthesis Thirteen studies (eight prospective, five retrospective; 20–470 patients) were included. Imaging findings modified surgical strategy in up to 24% of cases and led to exclusion from KT in 2.0–29%. Vascular calcifications were identified in 14–20% with DUS and up to 90% with NCCT. Age, diabetes, and dialysis duration were common criteria for imaging. Data heterogeneity and limited sample sizes restricted firm conclusions. Conclusions Preoperative imaging can support surgical planning in KT, although the current evidence base remains limited. Although prospective studies are needed and are likely challenging to perform, a structured expert consensus could serve as a useful interim step to encourage more consistent imaging practices and help inform future multicentric research.
Adolescents and young adults with childhood-onset lower urinary tract symptoms (LUTS) face significant challenges transitioning from paediatric to adult urological care, a period often marked by disrupted care continuity, reduced adherence, and psychosocial stress. This transition remains poorly studied in urology. STREAMWAY aims to explore adolescents' perceptions, attitudes, and lived experiences during this phase. This exploratory qualitative study uses semi-structured interviews, supplemented by validated questionnaires, in participants aged 16–25 years with childhood LUTS currently undergoing or having recently completed transition to adult care. The primary endpoint is to map perceptions and experiences of transition, identifying barriers and facilitators to transition success. Secondary endpoints include current urinary symptoms, sleep quality, quality of life, bowel and genitourinary symptoms, and adverse childhood experiences. Approximately 20 participants will be enrolled. Data collection includes pre-interview completion of urological care timelines and growth curves, followed by a 60-minute semi-structured interview and validated questionnaires (ICIQ-MLUTS/FLUTS, ICIQ-LUTSqol, PSQI, EQ-5D-5L, ACE-IQ, CCCS, GUPI). Qualitative data will undergo thematic and interpretative phenomenological analysis; quantitative data will be analysed descriptively, with integration of both findings.
Background and objective:Photodynamic diagnosis (PDD) is used during transurethral resection of bladder tumors (TURBT) to improve detection of non-muscle-invasive bladder cancer (NMIBC). Emerging evidence suggests that PDD may also influence immune activation. We investigated whether PDD is associated with immune-related changes in tumors and urine from patients with NMIBC receiving Bacillus Calmette-Guérin (BCG) immunotherapy. Methods:We retrospectively analyzed paired pre- and post-BCG samples from 156 patients with NMIBC with detailed clinical data. PDD exposure was determined from medical records and defined as PDD use within 100 days before BCG induction. PDD status was linked to existing multi-omics data, including urine proteomics (Olink), tumor ribonucleic acid (RNA) sequencing, and imaging mass cytometry (IMC) for spatial immune profiling. Findings and limitations:Urine proteomics showed post-BCG upregulation of immune-related proteins, including programmed death-1 and vascular endothelial growth factor receptor-2, in PDD-exposed patients. In contrast, RNA sequencing suggested increased post-BCG infiltration of multiple immune cell populations (B cells, T cells, cytotoxic cells, and mast cells) in No PDD patients but not in PDD-exposed patients. Consistently, IMC indicated increased infiltration of cluster of differentiation (CD)4⁺, CD8⁺, and natural killer cells post-BCG in No PDD exposed patients, with minimal changes in PDD-exposed patients. The exploratory design and potential confounding limit causal interpretation, and no clear association with clinical outcomes was demonstrated. Conclusions and clinical implications:This exploratory and biologically focused study suggests that while PDD appears to modulate the local urinary proteome, no clear shifts in tumor immune cell infiltration were observed. These findings do not support a consistent effect of PDD on the tumor immune microenvironment, and no association with clinical outcomes was observed. Determining whether the added benefit of PDD stems purely from enhanced diagnostics or includes a direct immunomodulatory effect warrants further investigation.
Background and objective:Treatment decision-making in older patients with bladder cancer (BC) is complicated by frailty and comorbidities. Comprehensive geriatric assessment (CGA) may support this process. This study evaluated the impact of CGA on treatment selection and identified CGA-prompted interventions in older patients with high-risk non-muscle-invasive BC (NMIBC) or muscle-invasive BC (MIBC). Design setting participants and intervention:Patients aged ≥70 yr or aged <70 yr and deemed frail were referred for CGA after multidisciplinary team (MDT) discussion. Outcomes were discussed at a subsequent MDT meeting, and changes in treatment plans were recorded. The impact of CGA was defined as (1) modification of proposed treatment, (2) assessment of functional status because of concerns about resilience for treatment, or (3) guidance among multiple treatment options. Medical records were examined for CGA-prompted interventions. Overall survival (OS) was described according to CGA impact. Results and limitations:Among 201 patients (79% male, median age 76 yr), CGA influenced treatment selection in 19% (n = 38). In the impact group, CGA resulted in treatment de-escalation in 25 of the 38, assessed resilience in 7 of the 38, and guided selection among multiple options in 6 of the 38 patients. A total of 443 patient-specific interventions were generated, especially medication adjustments (22%), paramedical consultations (20%), and monitoring recommendations (18%). Compared with the no-impact group, patients in the impact group had poorer physical and cognitive performance and received best supportive care more frequently. Observed median OS was 8.4 versus 40.3 mo in MIBC and 19.4 versus not reached in NMIBC, likely reflecting underlying frailty and treatment selection. Conclusions:CGA contributed to treatment selection in 1 in 5 patients, leading to de-escalation in frailer patients and supporting decisions when resilience or treatment choice was uncertain, demonstrating its potential to optimise treatment strategies.
Background:Dietary patterns with anti-inflammatory properties have been linked to lower risks of several chronic diseases and some cancers, but their impact on survival after cancer is less well understood. Objective:We assessed whether a higher prediagnostic Anti-Inflammatory Diet Index (AIDI) score was associated with all-cause mortality after urologic cancer diagnosis, with urologic cancer-specific mortality evaluated as a secondary end point. Design setting and participants:In the Cohort of Swedish Men and the Swedish Mammography Cohort, incident urologic cancers and deaths were identified through Swedish registers. AIDI was derived from food-frequency questionnaires (1997; 2009 in a subset) and defined as the assessment at least 2 yr before diagnosis, preferentially 2009 when available. Follow-up ran from diagnosis to death, emigration, or December 31, 2020. Outcome measurements and statistical analysis:Cox models estimated hazard ratios (HRs) per 1 standard deviation (SD) higher AIDI, adjusting for demographic factors, lifestyle, comorbidities, and total energy intake. Fine-Gray models assessed urologic cancer-specific mortality while accounting for death from other causes as a competing event. Results and limitations:Among 7686 patients with valid AIDI, 6609 had complete covariate data, including 4990 patients with prostate cancer. During follow-up, 3281 deaths occurred, including 1435 urologic cancer deaths. Each 1-SD higher AIDI was associated with lower all-cause mortality (HR = 0.91, 95% confidence interval [CI] = 0.88-0.95). Evidence for an association with urologic cancer-specific mortality was weak and borderline in cause-specific Cox models (HR = 0.95, 95% CI = 0.90-1.00) and was attenuated in competing-risk analysis (subdistribution HR = 0.97, 95% CI = 0.92-1.02). Conclusions:Higher prediagnostic AIDI was associated with lower all-cause mortality after urologic cancer diagnosis. Whether this reflects a causal effect of diet or residual confounding, healthy-lifestyle clustering, health care engagement bias, or differences in competing noncancer mortality requires further study.
Introduction:The superior diagnostic capabilities of novel imaging modalities such as multiparametric prostate magnetic resonance imaging MRI (mpMRI) and prostate-specific membrane-antigen positron emission tomography/computed tomography (PSMA PET/CT) might provide data for consideration of a prostate biopsy-omitting approach in a selected subgroup of patients with prostate cancer. Methods:Patients who underwent radical prostatectomy (RP) for prostate cancer between December 2015 and December 2024 were retrospectively evaluated, and only patients who underwent mpMRI and PSMA PET/CT were included in the study. After recording patient characteristics (age, prostate-specific antigen [PSA], PSA density [PSAD]), mpMRI characteristics (Prostate Imaging Reporting And Data System [PI-RADS] score, number of lesions, size of the index lesion), and PSMA PET characteristics (prostatic SUVmax ≥12 = PRIMARY 5), adverse pathology (≥pT3a or pN1 or GG≥3) rates at RP were investigated. Multivariable logistic regression analysis was performed to determine the independent predictors of adverse pathology. Results:The median age and serum PSA of 413 patients included in the study were 64.9 years (interquartile range [IQR]: 58.3-69.9) and 7.0 ng/dl (IQR: 4.9-9.4). The RP pathology revealed that 248 out of 413 patients (60%) had adverse features (58 out of 413 had GG4 or 5 disease). The multivariable analysis revealed that age, serum PSAD, PI-RADS-5 score on mpMRI, and prostatic SUVmax ≥12 (PRIMARY-5) on PSMA PET were independent predictors of adverse pathology. Based on these results, the combination of PSAD, MRI, and PSMA PET has consistently resulted in adverse pathology: PSAD >0.15 ng/ml/cc AND PI-RADS-5 AND PRIMARY 5. Conclusions:A combination of serum PSAD, PI-RADS score on mpMRI, and PRIMARY score on PSMA PET/CT has consistently resulted in adverse pathology, indicating consideration of a biopsy-omitting approach if further studies endorse these findings.
Background and objective:While oxybutynin is the most efficacious oral antimuscarinic treatment to reduce incontinence episodes in patients with an overactive bladder, oxybutynin is often discontinued due to significant side effects. This is hypothesized to be caused by its metabolite. The purpose of the study was to determine whether intravaginal oxybutynin administration leads to fewer anticholinergic side effects than oral oxybutynin. Additionally, the pharmacokinetics (PK), safety, and tolerability were compared. Methods:The study had a single-blind, placebo-controlled, three-way cross-over design in 24 healthy women. Participants randomly received repeatedly 2.5 mg intravaginal oxybutynin via the MedRing, 5 mg oral oxybutynin, and placebo. Anticholinergic side effects were assessed with the NeuroCart test battery. Additionally, quantitative electro-encephalography (qEEG), salivary flow, dry mouth symptoms, pharmacokinetics, safety, and tolerability were assessed. Key findings and limitations:Neither intravaginal nor oral oxybutynin demonstrated a significant effect on the adaptive tracking test compared to placebo. However, both oxybutynin administration routes resulted in broad qEEG amplitude decreases. Participants reported less dry mouth symptoms, and the saliva weight was significantly higher after intravaginal oxybutynin (estimated difference, 0.51 g [95% confidence interval, 0.16-0.87], p = 0.006). Intravaginal oxybutynin led to a ∼10-fold lower metabolite/parent ratio and was generally safe and well-tolerated.Limitations include the lack of measured cognitive effect in this population, and the ultimately single-blind study conduct because of subtle differences in the appearance of the ring. Conclusions and clinical implications:This study provides a solid basis for intravaginal oxybutynin via the MedRing as an alternative route of administration. Intravaginal oxybutynin could be considered an alternative to reduce side effect-related discontinuation rates.
Background:Pathogenic and likely pathogenic (P/LP) germline variants in cancer susceptibility genes (CSGs) are detected in 5-10% of patients with prostate cancer, but their clinical impact in high-risk disease remains unclear. Objective:This study aimed to assess the prevalence of P/LP variants in CSGs among patients with high-risk prostate cancer and their association with oncologic outcomes in patients treated with radiotherapy. Methods:We conducted a retrospective study of 600 men with high-risk prostate cancer. Germline DNA was analyzed using a 19-gene panel, and gene-level variant prevalence was compared with non-cancer control cohorts using Fisher's exact test. Time-to-event analyses were performed in the 390 patients treated with radiotherapy as primary curative intent. The primary endpoint was overall survival (OS), assessed by Kaplan-Meier and multivariable Cox regression. Secondary endpoints included biochemical recurrence, distant metastasis, prostate cancer-specific mortality (PCSM), and second primary malignancies, analyzed using cumulative incidence functions and Fine-Gray competing-risk models. Key findings and limitations:P/LP variants were identified in 8.0% of patients (n = 48). CHEK2, ATM, and BRCA2 variants were significantly enriched in patients compared with non-cancer control cohorts. BRCA1/BRCA2 carriers had worse OS (10-yr OS rate: 19% vs 57%; p = 0.021) and higher cumulative incidence of biochemical recurrence events (10-yr cumulative incidence: 57% vs 28%; p = 0.048), distant metastases (57% vs 18%; p = 0.004) and PCSM (33% vs 4.3%; p = 0.001) compared with non-carriers. CHEK2 carriers showed heterogeneous family cancer histories and a higher incidence of second primary malignancies (47% vs 15%; p = 0.003). ATM carriers showed no metastatic progression or PCSM during follow-up. Limitations include the single-institution design and small gene-specific subgroups. Conclusions and clinical implications:Germline P/LP variants are prevalent in high-risk prostate cancer and define gene-specific subgroups with distinct oncologic outcomes, supporting the role of germline genetic testing in risk stratification and treatment decision-making.
