ABSTRACT Background: Combination therapy with an α1-blocker and a phosphodiesterase-5 inhibitor is widely used for benign prostatic hyperplasia (BPH), but the extent to which the benefits of tamsulosin 0.4 mg plus tadalafil 5 mg are additive versus nonadditive remains uncertain. Materials and Methods: We systematically reviewed randomized controlled trials comparing tamsulosin 0.4 mg, tadalafil 5 mg, and their fixed combination for BPH. Outcomes assessed were changes in International Prostate Symptom Score (IPSS), Qmax (maximum urinary flow rate), quality of life (QoL), and postvoid residual (PVR). A frequentist random-effects network meta-analysis (NMA) was performed, followed by component NMA (cNMA) using additive and interaction models to quantify component contributions and detect departures from additivity. Results: Sixteen trials, including 4854 participants, were analyzed. The combination achieved the greatest symptom reduction in the IPSS network, with a pooled improvement versus placebo of approximately −4.87 IPSS points (95% confidence interval [CI] −6.51 to −3.23). For Qmax, the combination improved flow versus placebo (+1.42 mL/s; 95% CI, 0.49–2.35). For IPSS-QoL, all active regimens improved patient-reported outcomes versus placebo; however, the cNMA interaction term suggested a less-than-additive effect for the combination (interaction estimate −0.55, 95% CI: −0.76 to −0.34), indicating that the QoL gain with combination was smaller than the simple sum of its components. PVR estimates were imprecise, with no consistent differences between the regimens. Conclusion: Tamsulosin–tadalafil combination therapy provides the largest overall improvement in lower urinary tract symptoms and urinary flow, whereas QoL benefits appear sub-additive, supporting the need for pragmatic step-up versus upfront combination trials that incorporate adverse events and treatment persistence.
ABSTRACT Introduction: International Society of Urological Pathology (ISUP) grade group (GG) 2 is the most common grade at radical prostatectomy (RP), yet its long-term natural history is poorly defined. We evaluated the predictors of biochemical recurrence (BCR) and the relationship between BCR, salvage treatment, and oncological outcomes. Methods: We analyzed 224 consecutive patients with confirmed GG2 prostate cancer after RP between 1999 and 2015. BCR was defined as two consecutive prostate-specific antigen ≥0.2 ng/mL. Kaplan–Meier and competing-risk analyses were performed, and predictors of BCR were assessed using multivariable Cox regression analysis. Results: Median follow-up was 209 months. BCR occurred in 91 patients (40.6%) after a median of 47 months. Ten-year BCR-free survival was 62.0%, 72.5% with negative surgical margins, and 51.9% with positive margins ( P < 0.001). Positive surgical margin (PSM) was the only independent predictor of BCR (hazard ratio: 2.29, 95% confidence interval 1.40–3.75; P = 0.001). No patient received adjuvant radiotherapy. Among 91 patients with BCR, 35 (38.5%) received no salvage treatment; after 107 months’ median follow-up from recurrence, none developed metastasis or died from prostate cancer. Metastasis developed in 8 patients (3.6%) and prostate cancer-specific death occurred in 2 (0.9%). Twenty-year metastasis-free and cancer-specific survival were 95.4% and 97.9%, respectively. Conclusions: In our cohort, PSM was the main predictor of BCR, whereas metastatic progression and prostate cancer-specific death after BCR were uncommon. Favorable outcomes were observed among recurrent patients managed without salvage treatment, although nonrandom treatment allocation and the limited number of progression events preclude causal inference.
ABSTRACT Radical nephroureterectomy with bladder cuff excision remains the gold standard for upper tract urothelial carcinoma (UTUC). While traditional approaches often mandate the removal of bladder cuff, though it does not defy the logic of removal of 1–2 cm of bladder cuff, we present a case series of 12 patients with renal pelvis and upper ureteric UTUC who had robot-assisted extravesical intramural ureterectomy without the removal of the bladder cuff. As the intramural ureter is the only blind spot for subsequent cystoscopy, all patients did well, with no recurrence at the site of the previously resected ureteric orifice, and the catheter could be removed at a median of 3 days.
ABSTRACT This video demonstrates postengraftment retrograde intrarenal surgery for managing incidental donor renal stones in a kidney transplant. We report our experience with six cases of donor-gifted stones. Results showed 100% stone clearance with minimal operative time and no complications. This technique effectively eliminates donor risk and avoids prolonged cold ischemia, offering a safe, efficient alternative to conventional stone removal.
