ObjectiveTo report long‐term oncological outcomes of patients with high‐risk non‐muscle‐invasive bladder cancer (HR‐NMIBC) undergoing bladder‐sparing therapy (BST) after bacillus Calmette–Guérin (BCG) failure.Patients and MethodsWe retrospectively reviewed patients with HR‐NMIBC treated from 2000 to 2025 with intravesical therapies after BCG failure, all of whom received salvage gemcitabine/docetaxel (Gem/Doce). Subsequent BST included valrubicin/docetaxel, sequential doxorubicin/gemcitabine alternating with mitomycin‐C/docetaxel, and gemcitabine/cabazitaxel with pembrolizumab. Kaplan–Meier analysis estimated recurrence‐free survival (RFS), progression‐free survival (PFS), cystectomy‐free survival (CFS), and cancer‐specific survival (CSS).ResultsA total of 85 patients with HR‐NMIBC were included of whom 38 (45%) were BCG‐unresponsive. The median (interquartile range) follow‐up was 86 (43–108) months from induction Gem/Doce. Following Gem/Doce initiation, RFS did not significantly decline with each successive line of salvage therapy: among patients treated with first (Gem/Doce), second, and third line salvage therapy, the 2‐year RFS was 47%, 43%, and 39%, respectively (P = 0.68). Overall, the PFS at 5 years was 81% (95% confidence interval [CI] 69–88%). PFS did not significantly decline with each successive salvage line of therapy: among patients treated with first (Gem/Doce), second, and third line salvage therapy, the 2‐year PFS was 91%, 88%, and 93%, respectively (P = 0.98). CFS and CSS were 74% (95% CI 62–83%) and 88% (95% CI 79–94%) at 5 years, respectively.ConclusionsMulti‐line BST is feasible and can yield durable bladder preservation and oncological control in select patients with HR‐NMIBC following BCG failure. Progression‐free outcomes remained favourable across successive lines of salvage therapy. These findings support the role of longitudinal BST as an alternative to radical cystectomy in carefully and appropriately selected patients.

To evaluate diagnostic practices in the United Kingdom (UK) prior to radical nephroureterectomy (RNU) for suspected upper tract urothelial carcinoma (UTUC) and assess their impact on early oncological outcomes. The audit examined compliance post-operative intravesical Mitomycin C (MMC) instillation and adjuvant chemotherapy for ≥pT2 disease. This national audit, by the British Association of Urological Surgeons (BAUS), invited all NHS hospitals performing RNU for non-metastatic UTUC. Retrospective anonymised data were collected. Outcomes included time from imaging to RNU, use of MMC, adjuvant chemotherapy, bladder recurrence, surgical margins, extravesical metastasis, and final histology. Statistical analysis used Mann-Whitney U, Chi-square/Fisher's exact test, and multivariate logistic regression. A total of 877 patients who underwent RNU across 70 hospitals were analysed (median 10 cases per hospital). Diagnostic ureteroscopy (d-URS) was performed in 61.3% of cases, delaying RNU by a median of 53 days (130 vs 77 days; P < 0.01). Voided urine cytology was recorded in 34.3%. Among patients with high-grade and/or ≥ pT1 disease, 89% had positive cytology. MMC was administered in 45.1% of ≥pT2 cases and adjuvant chemotherapy in 46%. Bladder recurrence was significantly higher in patients undergoing d-URS (26.6% vs 12.3%; P < 0.01), as were positive margins in ≥pT2 tumours (24% vs 14%; P = 0.03). Although not statistically significant, d-URS was associated with more metastases (27.2% vs 19.2%) and fewer non-UTUC diagnoses (5.5% vs 8.6%). Multivariate analysis showed that d-URS independently predicted bladder recurrence and margin positivity in ≥pT2 disease. Our audit showed that d-URS is associated with significant treatment delays, increased rates of metachronous bladder cancer recurrence, and higher surgical positive margin rates in patients with ≥pT2 disease. Compliance with MMC therapy and adjuvant chemotherapy was low. This national audit highlights the need for risk-stratified diagnostic pathways, multidisciplinary expertise, and establishment of quality performance indicators to improve care and outcomes in UTUC management in the UK.

The data that support the findings of this study are available from the corresponding author, Hinpetch Daungsupawong, upon reasonable request.

To evaluate the quality (DISCERN), understandability and actionability (Patient Education Materials Assessment Tool for Printable Materials [PEMAT-P]), readability (Flesch-Kincaid), and misinformation of patient-facing information on interstitial cystitis generated by four publicly available artificial intelligence (AI) chatbots: ChatGPT-4.0, Perplexity, ChatSonic, and Bing AI. A total of 10 queries derived from Google Trends and Hopkins Medicine content were submitted to each chatbot. Responses were evaluated by two blinded reviewers using validated tools: the DISCERN instrument (reliability/quality), PEMAT-P (understandability/actionability), and Flesch-Kincaid Grade Level (readability). Word count and citation inclusion were also recorded. Across chatbots, information quality was moderate with a median (interquartile range [IQR]) DISCERN score of 3/5 (2-3), with Perplexity performing best and Bing AI worst. Understandability was moderate (median [IQR] PEMAT-P score 75% [66.7-83.3%]), highest for ChatSonic with Hopkins Medicine-derived prompts and lowest for ChatGPT with Google Trends inputs. Actionability was consistently poor (median [IQR] score 40% [20-60%]), with ChatSonic performing best and Bing AI lowest. Responses averaged 256 words and college-level readability (median [IQR] Flesch-Kincaid score 25.4 [20.89-28.50]) across all platforms, limiting accessibility. Misinformation was minimal across all platforms. Chatbots referencing clinically curated prompts (Hopkins Medicine) scored higher in understandability and completeness than those responding to public search trends. Artificial intelligence chatbots offer generally accurate and understandable information about interstitial cystitis but lack actionable guidance and generate content at reading levels above typical patient comprehension. Enhancing readability, actionability, and personalisation may increase their utility as adjunct tools for patient education in functional urology.

ObjectiveTo evaluate sex differences in maximum storage detrusor pressure (Pdetmax storage), focusing on Pdetmax storage ≥40 cmH2O, an established risk factor for upper urinary tract damage, within the first year after spinal cord injury (SCI).Patients and MethodsA cohort of patients with neurogenic lower urinary tract dysfunction due to acute traumatic or ischaemic SCI, managed according to the European Association of Urology Guidelines on Neuro‐Urology, prospectively underwent urodynamic investigations at 1, 3, 6 and 12 months after SCI at a university SCI centre. Pearson's chi‐squared tests and multivariable regression analyses were used to compare outcomes between females and males.ResultsOf 97 patients, 34% were female. Within the first year after SCI, 9% of females presented with a Pdetmax storage ≥40 cmH2O, compared to 55% of males (P < 0.001). Females had lower Pdetmax storage than males, with a grand mean (standard deviation [SD]) of 13 (9) vs 30 (20) cmH2O (coefficient = 18 cmH2O, 95% confidence interval [CI] 13–24 cmH2O; P < 0.001). Females also had lower detrusor overactivity leak‐point pressure (DOLPP) than males, with a grand mean (SD) of 15 (4) vs 35 (21) cmH2O (coefficient = 20 cmH2O, 95% CI 11–29 cmH2O; P < 0.001). The cumulative incidence of antimuscarinic therapy and reported urinary incontinence was similar between sexes (female vs male: 55% vs 70%, P = 0.12; 53% vs 43%, P = 0.42, respectively).ConclusionsFemales rarely reached a Pdetmax storage ≥40 cmH2O during the first year after SCI and had lower Pdetmax storage and DOLPP than males. However, the prevalence of urinary incontinence was similar between the sexes, suggesting the need for a more sex‐tailored approach to patient management.

To assess the prevalence of germline pathogenic variants (gPVs) in genes associated with female breast cancer in Dutch patients with metastatic prostate cancer (mPCa). In this prospective multicentre cohort study (n = 15 centres), germline genetic testing of the genes BRCA1, BRCA2, ATM, CHEK2 and PALB2 was offered to patients with mPCa. We assessed the prevalence of gPVs and compared it to a reference population of 16 823 individuals who underwent genetic testing for non-oncological conditions. Additionally, we identified factors that increased the likelihood of carrying a gPV. A total of 779 patients with mPCa underwent germline genetic testing, of whom 46 (5.9%) had a gPV in a DNA damage repair gene. Most gPVs were found in CHEK2 (1100delC variant), ATM and BRCA2, all significantly more prevalent than in the reference population (odds ratios 2.4, 2.8 and 3.1, respectively). The prevalence of gPVs in BRCA1 and PALB2 was not significantly increased. Patients with a second primary cancer, a first- or second-degree relative with breast cancer at age < 50 years, or pancreatic cancer, or Jewish ancestry had the highest likelihood of carrying a gPV. We found that gPVs in CHEK2, ATM and BRCA2 were associated with men presenting with mPCa. Several factors increased the likelihood of carrying such a variant and, in these cases, healthcare professionals should be aware of the need to offer germline genetic testing.