EAU-EANM-ESTRO-ESUR-SIOG Prostate Cancer Guideline Panel Consensus Statements for Deferred Treatment with Curative Intent for Localised Prostate Cancer from an International Collaborative Study (DETECTIVE Study).

Abstract: There is uncertainty in deferred active treatment (DAT) programmes, regarding patient selection, follow-up and monitoring, reclassification, and which outcome measures should be prioritised.To develop consensus statements for all domains […]

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Multiparametric Magnetic Resonance Imaging for the Detection of Clinically Significant Prostate Cancer: What Urologists Need to Know. Part 1: Acquisition.

Abstract: Acquiring multiparametric magnetic resonance images of the prostate is not a simple “push-button” approach.To show how image acquisition of prostate multiparametric Magnetic Resonance Imaging (mpMRI) can be optimized.Image protocols, […]

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Improving Estimates of Perioperative Morbidity After Radical Cystectomy Using the European Association of Urology Quality Criteria for Standardized Reporting and Introducing the Comprehensive Complication Index.

Abstract: No procedure-specific definitions in complication reporting have been universally accepted in urological surgery, and conventional classification systems do not reflect cumulative morbidity.To conduct a rigorous assessment of 30-d complications […]

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Treatment of Urinary Urgency Incontinence Using a Rechargeable SNM System: 6-month Results of the ARTISAN-SNM Study.

Sacral Neuromodulation is a guideline-recommended treatment for urinary dysfunction and fecal incontinence in patients that have failed conservative treatments. Historically, SNM has been delivered using a non-rechargeable device with an average lifespan of 4.4 years requiring surgery to replace the implanted neurostimulator (INS) due to battery depletion. Implantation of a long-lived INS can eliminate the need for replacement surgeries, potentially reducing patient surgical risks and healthcare costs. The Axonics® r-SNM® System, is a miniaturized, rechargeable Sacral Neuromodulation (r-SNM) system designed to deliver therapy for at least 15 years. The ARTISAN-SNM study is a pivotal study using r-SNM therapy to treat urinary urgency incontinence (UUI). 6-month results are presented.129 eligible UUI patients were treated. All participants were implanted with a tined lead and the r-SNM system in a non-staged procedure. Efficacy data was collected using a 3-day bladder diary, a validated quality of life questionnaire (ICIQ-OABqol), and a participant satisfaction questionnaire. Therapy responders were identified as participants with ?50% reduction in UUI episodes compared to baseline. An as treated analysis was performed in all implanted participants.At 6 months, 90% of the participants were therapy responders. The average UUI episodes per day reduced from 5.6 ± 0.3 at baseline to 1.3 ± 0.2 (mean ± standard error). Participants experienced clinically meaningful improvements of 34 points on the ICIQ-OABqol questionnaire. There were no serious device-related adverse events.The Axonics r-SNM® System is safe and effective, with 90% of participants experiencing clinically and statistically significant improvements in UUI symptoms.

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Treatment of Bladder Stones in Adults and Children: A Systematic Review and Meta-analysis on Behalf of the European Association of Urology Urolithiasis Guideline Panel.

Bladder stones (BS) constitute 5% of urinary stones. Currently, there is no systematic review of their treatment.To assess the efficacy (primary outcome: stone-free rate [SFR]) and morbidity of BS treatments.This systematic review was conducted in accordance with the European Association of Urology Guidelines Office. Database searches (1970-2019) were screened, abstracted, and assessed for risk of bias for comparative randomised controlled trials (RCTs) and nonrandomised studies (NRSs) with ?10 patients per group. Quality of evidence (QoE) was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) tool.A total of 2742 abstracts and 59 full-text articles were assessed, and 25 studies (2340 patients) were included. In adults, one RCT found a lower SFR following shock wave lithotripsy (SWL) than transurethral cystolithotripsy (TUCL; risk ratio 0.88, p=0.03; low QoE). Four RCTs compared TUCL versus percutaneous cystolithotripsy (PCCL): meta-analyses demonstrated no difference in SFR, but hospital stay (mean difference [MD] 0.82d, p<0.00001) and procedure duration (MD 9.83min, p<0.00001) favoured TUCL (moderate QoE). Four NRSs comparing open cystolithotomy (CL) versus TUCL or PCCL found no difference in SFR; hospital stay and procedure duration favoured endoscopic surgery (very low QoE). Four RCTs compared TUCL using a nephroscope versus a cystoscope: meta-analyses demonstrated no difference in SFR; procedure duration favoured the use of a nephroscope (MD 22.74min, p<0.00001; moderate QoE). In children, one NRS showed a lower SFR following SWL than TUCL or CL. Two NRSs comparing CL versus TUCL/PCCL found similar SFRs; catheterisation time and hospital stay favoured endoscopic treatments. One RCT comparing laser versus pneumatic TUCL found no difference in SFR. One large NRS comparing CL techniques found a shorter hospital stay after tubeless CL in selected cases; QoE was very low.Current available evidence indicates that TUCL is the intervention of choice for BSs in adults and children, where feasible. Further high-quality research on the topic is required.We examined the literature to determine the most effective and least harmful procedures for bladder stones in adults and children. The results suggest that endoscopic surgery is equally effective as open surgery. It is unclear whether stone size affects outcomes. Shock wave lithotripsy appears to be less effective. Endoscopic treatments appear to have shorter catheterisation time and convalescence compared with open surgery in adults and children. Transurethral surgery, where feasible, appears to have a shorter hospital stay than percutaneous surgery. Further research is required to clarify the efficacy of minimally invasive treatments for larger stones and in young children.

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Updated European Association of Urology Guidelines on Renal Cell Carcinoma: Immune Checkpoint Inhibition Is the New Backbone in First-line Treatment of Metastatic Clear-cell Renal Cell Carcinoma.

Abstract: Recent randomised trials have demonstrated a survival benefit for a front-line ipilimumab and nivolumab combination therapy, and pembrolizumab and axitinib combination therapy in metastatic clear-cell renal cell carcinoma. The […]

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