This study compares postoperative outcomes of radical cystectomy (RC) with ileal conduit urinary diversion (ICUD) using paediatric feeding tubes versus single-J ureteral stents. Patients underwent RC with ICUD for bladder cancer between 2011 and 2018. Prospective preoperative clinical, operative and postoperative data were collected. Postoperative complications including stricture, urine leak, urinary tract infection (UTI) and ileus were compared between patients who received 5-Fr paediatric feeding tubes or 7-Fr single-J ureteral stents during surgery. Two hundred thirty-four patients underwent RC with ICUD including 26 with paediatric feeding tubes and 208 with single-J ureteral stents; 41% had robotic cystectomy, with 36% of these undergoing intracorporeal ICUD. Both groups were comparable in age, gender, kidney function and comorbidities. No significant differences were observed between groups for rates of ileus (20% vs. 34%, p = 0.14), urine leak (4% vs. 10%, p = 0.3), uretero-ileal stricture (16% vs. 18%, p = 0.7) or overall urinary complications (20% vs. 37%, p = 0.12), except for a lower UTI rate in the feeding tube group (4% vs. 23%, p = 0.02). Median hospital stay was shorter in the feeding tube group (6 vs. 8 days, p = 0.015) with similar readmission rates compared to the stent group (p = 0.96). Using 5-Fr feeding tubes for ureteral stenting during RC with ICUD is a safe alternative to 7-Fr single-J stents, especially for patients with small ureters or delicate anatomy. Stent type showed no significant impact on postoperative urinary complications except for a lower UTI rate with feeding tubes, suggesting comparable overall outcomes between the two stent types.

Abstract ObjectivesTo examine the impact of overactive bladder (OAB) on all‐cause and cardiovascular mortality in women in a real‐world setting, and to examine the association of TyG‐related indices with OAB.MethodsData on 6580 women aged ≥20 years were collected from the National Health and Nutrition Examination Survey (NHANES) database. Kaplan–Meier curves and Cox survival analysis were used to evaluate the association between OAB and all‐cause and cardiovascular mortality. Biomarkers for metabolic syndrome were assessed for their association with OAB, including triglyceride‐glucose (TyG) and TyG‐related indices. The association between TyG‐related indices and OAB was evaluated using restricted cubic splines (RCS), receiver operating characteristic (ROC) curves and multivariate logistic regression, with propensity score matching (PSM) employed to balance confounders between OAB and non‐OAB groups.ResultsKaplan–Meier curves showed that OAB was associated with a poorer prognosis, and multivariate Cox regression analyses indicated that OAB was an independent risk factor for both all‐cause and cardiovascular mortality. RCS revealed a positive association between TyG‐related indices and OAB. Both ROC curves and multivariate logistic regression analysis indicated that TyG‐WHtR (TyG combined with waist‐to‐height ratio) was strongly associated with OAB, with a higher TyG‐WHtR associated with an increased risk of OAB. The retrospective design and selection bias may be the potential limitations.ConclusionsOAB is positively associated with all‐cause and cardiovascular mortality in women. TyG‐related indices are positively associated with OAB, with TyG‐WHtR as the most effective index.

To evaluate the effects of supervised recreational football-based exercise intervention on physical functioning, cardiovascular and metabolic health, bone strength and quality of life in men with PCa receiving ADT. Men with locally advanced or metastatic PCa undergoing ADT were allocated to a supervised recreational football-based exercise programme. Patients were invited to participate in 2-3 one-hour weekly sessions for 8months and encouraged to participate in at least 2 session/week. Outcomes were physical functioning (postural balance, agility, muscle strength and aerobic capacity), blood pressure, lipid profile (LDL-cholesterol, HDL-cholesterol, total-cholesterol and triglycerides), glucose, glycated haemoglobin (HbA1C) and high sensitivity C-reactive protein (CRP), proximal femoral and lumbar spine (L2-L4) bone mineral density (BMD) and quality of life (EORTC QLQ-C30 and QLQ-PR25). Descriptive and inferential statistical analysis was performed using the IBM® SPSS® Statistics version 29 software. From September to October 2022, 23 interested patients were screened and 12 were included and completed the supervised recreational football-based exercise programme. A significant improvement in aerobic capacity was recorded, with the patients improving the distances walked over 6minutes (580.0 vs. 537.5, p= 0.005). There was a significant reduction in systolic blood pressure from a median of 134 to 123 and a non-statistically significant decrease in diastolic blood pressure from a mean of 80 to 73 mmHg. There were no significant differences for lumbar and femoral BMD. A tendency for higher general health status post-intervention (80.6 vs. 70.8, p = 0.094) and a significant difference in the cognitive domain (83.0 vs. 100.0, p = 0.020) were recorded. Men with PCa undergoing ADT experience side effects that, when combined with the physical inactivity and poor fitness often seen in these patients, may heighten their risk of cardiovascular and metabolic complications. A recreational football-based exercise programme can be implemented to improve physical fitness, aerobic capacity, systolic blood pressure and quality of life.

ObjectiveTo assess the factors associated with the use of active surveillance (AS) in NCCN favourable intermediate‐risk (FIR) prostate cancer (PCa) patients who received the 17‐gene Genomic Prostate Score (GPS) assay.Material and MethodsContemporary data were collected from academic and large community group practices across the United States. Eligible patients had localized PCa classified as FIR per NCCN guidelines and received a GPS report between May 2017 and April 2019. Higher GPS results (scale: 0–100) were associated with a higher risk of adverse outcomes. The proportion of patients selecting AS was calculated with 95% confidence intervals. Uni‐and multivariable logistic regression analyses were performed to determine the association between AS selection and relevant covariates.ResultsThere were 324 eligible patients (Gleason Score 3 + 4, 79%; PSA 10–20 ng/ml, 19%; clinical stage T2b‐T2c, 2%; median percent positive cores, 16.7%; median GPS result, 26). The distribution of GPS results was 0–19 (23%), 20–40 (60%), and 41–100 (16%). Overall, 31% (95% CI 26%, 36%) selected AS: 58% (46%, 69%) with GPS 0–19, 27% (21%, 33%) with GPS 20–40, and 6% (1%, 16%) with GPS 41–100. In univariable models, the Gleason score, percent positive cores, PSA, and GPS results were significantly associated with AS selection. In a multivariable model, the percent positive cores and the GPS result remained significantly associated with AS selection. AS persistence was 91% (82%, 95%) at 12 months.ConclusionsThe GPS result and percent positive cores appear associated with AS use after controlling for relevant clinical variables in NCCN FIR prostate cancer patients.

ObjectiveUnscheduled admission for haematuria accounts for 15% of all urological emergencies with over 25 000 patients admitted each year in the UK. It is associated with prolonged admission and poor clinical outcomes. This systematic review aims to determine current management strategies and outcomes in these patients.MethodsA systematic search was performed in October 2023 across MEDLINE, EMBASE and Web of Science for randomised controlled trials and retrospective and prospective observational studies assessing the management of patients admitted as an emergency with haematuria. The primary outcome measure was the length of stay (LoS). Secondary outcomes included hospital readmission, mortality and health resource use.ResultsThree eligible publications with a total of 219 patients were identified. Mean length of stay was 5.8 days. The pooled mean age of unscheduled emergency haematuria was 74.8 years and 87.9% of patients were male. Bladder cancer was present in 17% of patients and, similarly, prostate cancer was present in 17% of patients.ConclusionsUnscheduled admission for haematuria is associated with long LoS. This systematic review has demonstrated a lack of data reporting outcomes of unscheduled haematuria and its management strategies. There is a need to perform large‐scale prospective studies to better understand this cohort of patients.

To assess the contemporary malignancy rate in isolated de novo red patches in the bladder and associated risk factors for better selection of red patch biopsy. Patients from the IDENTIFY dataset; Patients referred to secondary care with suspected urinary tract cancer and found to have isolated de novo red patches on cystoscopy. We reported the unadjusted cancer prevalence in isolated de novo red patches that were biopsied; multivariable logistic regression was used to explore cancer-associated risk factors including age, sex, smoking, type of haematuria, LUTS, UTIs and a suspicious-looking red patch (as reported by the cystoscopist). Sub-analysis of these by clinical role and experience was performed. A total of 1110 patients with isolated de novo red patches were included. 41.5% (n = 461) were biopsied, with a malignancy rate of 12.8% (59/461), which was significantly higher in suspicious versus non-suspicious red patches (19.1% vs. 2.81%, p < 0.01). There was a significant association between bladder cancer and age (OR 1.04, 95% CI 1.01-1.07, p = 0.01), smoking history (OR 2.62, 95% CI 1.09-6.27, p = 0.03) and suspicious-looking patch (OR 6.50, 95% CI 2.47-17.1, p < 0.01). The majority of malignancies were in over 60-year-olds. Malignancy rates in suspicious versus non-suspicious red patches did not differ significantly between clinical roles or experiences.Limitations included subjectivity in classifying a suspicious patch and selection bias as not all patches were biopsied. Many patients still undergo unnecessary biopsies under general anaesthetic for isolated de novo red patches. Clinicians should consider the patient's age, smoking status and how suspicious-looking the patch is, before deciding on surveillance versus biopsy to improve cancer diagnostic yield.

Transrectal (TR) prostate biopsy is being increasingly abandoned in favour of a transperineal (TP) approach as well as a targeted biopsy only of the index lesion(s). It remains underreported how these changes could impact concordance at final pathology. We aimed to evaluate the impact of transitioning from standard transrectal (sTR) to cognitive targeted transperineal (cog-tTP) biopsy on final pathology including concordance and upgrading. Analysis of consecutive patients undergoing prostate biopsy and prostatectomy (RP) between January 2018 and May 2022 at a tertiary centre in Western Norway. There were 210 and 239 patients in the sTR and cog-tTP groups, respectively. The mean [IQR] number of biopsies decreased from 12 [4-12] to 3 [3-4] (p< 0.001). The overall rate of concordance between biopsy and final pathology was 64% in both groups (Table 3, Figure 1). 24% Twenty-four per cent (cog-tTP) versus 19% (sTR) had grade group (GG) upgrading, while 12% versus 17% were downgraded (p= 0.2). Regarding positive surgical margins (PSMs) that were >3 mm in extension, there were only 3.3% and 2.1% in the sTR and cog-tTP groups, respectively (p= 0.4). For surgical outcomes associated with RP, no differences in terms of postoperative complications between the groups were found (cog-tTP:10% vs. sTR:6%, p= 0.10). Transitioning from sTR biopsy to targeted cog-tTP biopsy does not compromise concordance at final pathology nor does it increase the risk of tumour upgrading.

To determine predictors of treatment success and complications following intradetrusor onabotulinumtoxinA injections among a large cohort of nursing home (NH) residents, representing one of the most frail and vulnerable populations in the United States. This is a retrospective cohort study of long-stay NH residents who underwent onabotulinumtoxinA injections between 2014 and 2016. Residents were identified using the Minimum Data Set (MDS) linked to Medicare claims. Frailty was measured using the Claims-based Frailty Index and socioeconomic status using the Area Deprivation Index (ADI; higher ADI = increasing social deprivation). The primary outcome was treatment success, defined as repeat onabotulinumtoxinA injection within 1year of index injection. Secondary outcomes included 30-day complications and urinary retention, defined as new indwelling urinary catheters identified on the MDS at 3 months. OnabotulinumtoxinA injections were performed in 1683 NH residents. Mean age was 78.2years, 74% were female and 22.8% had an indwelling urinary catheter at baseline. A total of 38.4% of residents had ≥1 30-day complication and 14.6% had a new catheter at 3months. Repeat injections were performed in 34.3% of residents within 1year. Repeat injections were more likely among residents who were female [adjusted relative risk (aRR) 1.29; 95% CI 1.08-1.54] and who had a baseline catheter (aRR 1.30; 95% CI 1.11-1.52). Residents who were ≥85 years (aRR 0.78; 95% CI 0.64-0.96) and those in the lowest quartile ADI (aRR 0.75; 95% CI 0.61-0.93) were less likely to undergo repeat injections. Among this population of NH residents, who are by definition frail and comorbid, rates of repeat onabotulinumtoxinA injections are comparable to retrospective analyses of younger adults and independent of frailty and comorbidity. Based on these findings, surgeons should consider the entire clinical picture when evaluating patients for onabotulinumtoxinA injections and should not necessarily exclude those who are frail or comorbid from this potentially quality-of-life-improving therapy.

IntroductionUreteral stricture disease (UTSD) poses significant challenges in reconstructive urology, with recent advances highlighting disparities in healthcare outcomes based on race and ethnicity. This study investigates the impact of race and ethnicity on clinical outcomes following ureteral reconstruction.MethodsWe conducted a single‐centre prospective analysis of 233 patients who underwent ureteral reconstruction for UTSD from 2014 to 2023. Patient demographics, clinical characteristics, surgical details and outcomes were collected. Patients were stratified by race (White vs. non‐White) and ethnicity (Hispanic vs. non‐Hispanic). Statistical analyses included Kruskal–Wallis, Mann–Whitney U tests, ANOVA, Kaplan–Meier analysis and multivariate logistic regression.ResultsOur cohort included 233 patients who underwent ureteroplasty with 108 (46.4%) non‐White patients, and 71 (30.5%) were Hispanic. No significant differences were found in recurrence rates, complications, or stricture‐free survival between racial and ethnic groups. Prior reconstructions were more prevalent among non‐White patients (26.9% vs. 16.0%; p = 0.043). Unadjusted and adjusted regressions showed significant associations between non‐White race (unadjusted β = 0.76, p = 0.008; adjusted β = 0.82, p = 0.008) and Hispanic ethnicity (unadjusted β = 0.70, p = 0.025; adjusted β = 0.79, p = 0.020) with increased stricture lengths.ConclusionThis study highlights that although recurrence and complication rates do not significantly differ by race or ethnicity, disparities exist in clinical presentations, with non‐White and Hispanic patients presenting with longer stricture lengths and higher body mass index. These findings underscore the need for targeted interventions to address underlying disparities in healthcare delivery and access.

We aim to determine the prognostic significance of glutathione S-transferase Pi 1 DNA methylation (mGSTP1) in two independent prostate cancer cohorts with long-term clinical follow-up data. We first re-examined a published, in-house whole genome bisulphite sequencing (WGBS) prostate cancer dataset, derived from radical prostatectomy (RP) tissue (n = 15) with median follow-up 19.5years, to confirm and visualise the association between mGSTP1 and patient mortality. To validate prognostic significance, we used a quantitative methylation-specific head-loop (MS-HL) assay to measure mGSTP1 levels in a larger, independent cohort (n = 186), and performed univariable and multivariable Cox survival analysis. Re-analysis of WGBS data showed a significant increase in mGSTP1 in RP samples from patients with lethal versus non-lethal disease. Subsequent analysis in the larger cohort using the MS-HL assay confirmed that mGSTP1 was detectable in 97% of RP samples, validating the diagnostic potential of mGSTP1. Univariable Cox survival analysis revealed a significant association between mGSTP1 levels and biochemical recurrence and metastatic relapse free survival, with a near-significant association with prostate cancer specific mortality. Notably, multivariable Cox models demonstrated that mGSTP1 did not add independent prognostic value beyond standard clinicopathological features. Our study supports the importance of DNA methylation as a tissue-based prostate tumour biomarker. GSTP1 methylation is well established as a diagnostic marker, and in this study, we find that GSTP1 methylation levels are also associated with disease prognosis. Further research is required into the clinical utility of prognostic methylation markers and their functional role in disease progression.