Background Managing high-burden multiple renal stones remains a significant challenge. While retrograde intrarenal surgery (RIRS) is common, it often requires multiple stages for large stone burdens. Objectives To evaluate the comparative outcomes, specifically efficacy and safety, of Ultramini-endoscopic combined intrarenal surgery (ECIRS) using a 12 Fr percutaneous sheath versus RIRS for high-burden multiple renal stones. Design Single-center retrospective propensity score-matched (PSM) cohort study. Methods We reviewed adult patients with high-burden multiple renal stones (≥3 stones, largest stone length >10 mm) who underwent Ultramini-ECIRS or RIRS between January 2020 and November 2024. PSM yielded 49 patients per group, balanced for stone area, length, density, and the presence of lower calyx stones. The primary outcome was the one-month stone-free rate (SFR), defined as the absence of residual fragments >4 mm. Assessment was performed via computed tomography (CT) for radiolucent stones and plain radiography (KUB) or CT for radiopaque stones. Results Ultramini-ECIRS was associated with significantly higher primary SFR (81.6% vs. 34.7%; OR: 12.50; 95% CI: 2.96–52.77; p <0.001) and final SFR (85.7% vs. 51.0%; OR: 5.25; 95% CI: 1.80–15.29; p <0.001). The stone reduction rate was also higher in the Ultramini-ECIRS group (97.5% vs. 71.6%, p <0.001). Subgroup analysis of lower calyx stones demonstrated a consistent clearance advantage for the combined approach. No significant differences were observed in operative time, hospital stay, hemoglobin decrease, or renal function changes. The incidence of postoperative Clavien–Dindo grade II or higher complications was comparable between Ultramini-ECIRS and RIRS group (24.5% vs. 36.7%, p =0.188). Conclusion In this propensity score-matched cohort, Ultramini-ECIRS was associated with higher single-session SFR compared to RIRS for selected high-burden multiple renal stones with a comparable safety profile. These results suggest a potential role for Ultramini-ECIRS in managing complex stone distributions, particularly those involving the lower calyx. Further prospective randomized trials are warranted to further validate these findings.
Background Cabozantinib is a treatment for metastatic renal cell carcinoma (mRCC), typically recommended at a 60 mg daily starting dose. However, a lower dose is often used in clinical practice to improve tolerability. Objectives This study investigates the impact of cabozantinib starting dose on survival and safety in a real-world cohort from Southwest Finland. Design and Methods This study utilized electronic healthcare data from the Hospital District of Southwest Finland, including adult patients with mRCC initiating cabozantinib monotherapy between March 2018 and December 2021. Patients were stratified by treatment line (first-line [1L] or second/later line [2L+]) and starting dose (40 mg or 60 mg daily). Outcomes assessed were overall survival (OS), time to next treatment (TTNT), and safety (CTCAE v5.0). Results Of 71 patients, 34 (48%) received cabozantinib as 1L and 37 (52%) as 2L+ treatment. Median OS was 24 months for 1L and 10 months for 2L+, with no significant difference between starting doses. Median follow-up was 16 months (IQR 9.9, 23.4) for 1L and 9 months (IQR 3.6, 16.5) for 2L+. Median treatment duration was 11 months (IQR 4.3, 15.8) for 1L and 6 months (IQR 3.0, 10.0) for 2L+. At 8 months, 86% of 1L and 92% of 2L+ patients did not start the next treatment line. Dose reduction or schedule modification was needed for 79% of patients starting 1L cabozantinib at 60mg daily, compared to 45% at 40mg. Diarrhea and hand-foot syndrome were more common than elevated liver enzymes, with grade 3 adverse events being rare. Conclusion This study suggests that no statistically significant difference in survival outcomes was observed between patients starting cabozantinib at 40 mg versus 60 mg, while fewer dose modifications and adverse events were observed with the lower starting dose.
Background Total pelvic exenteration (TPE) is an extensive procedure with a high complication rate, and often in conjunction with chemotherapy or radiotherapy or both, is the only chance of cure in patients with locally advanced or recurrent pelvic malignancy. There is a relative paucity of data reported related to complications from the urinary tract reconstruction. Objectives The aim of this report is to perform the first systematic review of complications relating to urinary tract reconstruction as part of TPE. Design Systematic Review in accordance with PRISMA guidelines. Data Sources and Methods A systematic review was conducted using Pubmed/Medline for English language published articles reporting urinary tract complications following TPE in studies reporting on at least 10 patients and between 1990-2023. Risk of bias assessment was conducted using ROBINS-I and Newcastle-Ottawa assessment tools. The quality of evidence was assessed using GRADE. Results In total, 2031 articles were screened with 19 included in the final review. Overall, 1566 patients underwent TPE. The age range of the cohort was 15-92. There were 779 urological complications (49.7 %), with some patients having multiple complications. The most common complications observed were UTI/pyelonephritis (n=216) uretero-enteric anastomotic leakages (n=125), hydronephrosis (n=83) and stricture (n=75). Of the 14 studies reporting results for specific urinary diversions, the use of continent diversion, as compared to incontinent diversion, was worse or comparable for all complications. The overall certainty of evidence is low due to imprecisions and inconsistency in the recording of results. Conclusion Urinary complication rates for TPE are high overall. Continent diversions were generally associated with higher rates of complications compared to incontinent. There is a clear need for reporting of urological complications in a consistent and standardised way in future TPE publications. Registration This review was registered on the PROSPERO website (CRD42021212093).
Background UGN-101 is indicated for patients with low-grade upper tract urothelial carcinoma (LG-UTUC). Objective Evaluate long-term duration of response (DoR) in patients with complete response (CR) following UGN-101 treatment in the Phase 3 Olympus trial. Design Non-interventional, observational, long-term follow-up study (BL007). Methods Patients who remained event-free 12 months after achieving CR at 3 months in Olympus were eligible. Patients were monitored for up to 5 years or until recurrence, progression, or death. DoR was assessed using Kaplan–Meier methods. Results In Olympus, estimated median DoR among all 41 patients who achieved a CR at 3 months was 47.8 months; median follow-up: 28.1 months (95% confidence interval [CI], 13.1, 60.1). As of March 21, 2025, 75% (15/20) of patients in BL007 were event-free. The median follow-up for the 20 patients in BL007 was 53.3 months (95% CI: 27.9, 72.8), with median DoR not estimable (NE) (95% CI: 43.5, NE). There was no progression to high-grade disease. Conclusion UGN-101 demonstrated durable responses in patients with LG-UTUC, with sustained disease control over extended follow-up, supporting its role as a kidney-sparing treatment option.
Background Clinically significant prostate cancer (csPCa) detection is critical to guide treatment while minimizing unnecessary invasive procedures. Noninvasive tools to assist clinical risk stratification require thorough exploration. Objectives To develop and validate an explainable machine learning model integrating PSMA PET/CT quantitative features and serum biomarkers for predicting csPCa, and to explore its potential for clinical decision-making and biopsy decision-making. Design A dual-center retrospective diagnostic study utilizing patient cohorts consecutively enrolled from prior registered prospective clinical trials. Methods We retrospectively analyzed a development cohort (n=340), a temporally independent internal validation cohort (n=93), and an external validation cohort (n=126). Nine machine-learning algorithms were compared and the best model selected. Diagnostic performance was assessed by AUC, sensitivity and specificity; a prespecified PSA gray-zone subgroup (4-20 ng/mL; n=197) was analyzed separately. Clinical decision rate was defined as the proportion of patients classified as low or high risk under predefined high thresholds (PPV or NPV ≥97.5%). SHAP was used for model interpretability. Results Among all candidate models, XGBoost demonstrated the best performance. The model achieved AUCs of 0.96 (95% CI: 0.94–0.98) in the training cohort, 0.96 (95% CI: 0.93–1.00) in the testing cohort, 0.90 (95% CI: 0.83–0.96) in the temporally independent internal validation cohort, and 0.93 (95% CI: 0.88–0.97) in the external validation cohort. In the PSA gray-zone subgroup, the model maintained high diagnostic discrimination, with corresponding AUCs of 0.94 (95% CI: 0.90–0.98), 0.96 (95% CI: 0.91–1.00), 0.88 (95% CI: 0.80–0.96), and 0.87 (95% CI: 0.79–0.96), outperforming individual imaging and serological indicators. Under predefined threshold, the XGBoost supported potential clinical decision rate was 51.6% to 62.1% of patients across cohorts while maintaining reliable predictive performance. Conclusions An XGBoost model combining PSMA PET/CT metrics and serum indices showed superior diagnostic accuracy and expanded clinical decision performance compared with conventional indicators, including in the PSA gray zone. These findings are encouraging and hypothesis-generating; however, rigorous prospective validation remains mandatory before any clinical translation or therapeutic application.
