European Association Of Urology Research Articles

Clinical and pathological predictors of persistent T1 HG at second resection.

T1 high-grade (HG) non-muscle invasive bladder cancer (NMIBC) has a significant risk of recurrence and progression, and the European Association of Urology recommends a second transurethral resection of the bladder (ReTUR). Stage at ReTUR has been shown to be a reliable predictor of survival, therefore, we sought to assess clinical and pathological predictors associated with the persistence of T1 at ReTUR in our retrospective multicentric cohort. This is a retrospective multicentric study of T1 HG patients at transurethral resection of the bladder (TURB) who underwent subsequent ReTUR. All histological samples were sub-classified according to Rete Oncologica Lombarda (ROL) T1 sub-staging system. One hundred and sixty-six patients were enrolled. Forty-four (26.5%) had T1 HG tumor at ReTUR while 93 (56%) had residual tumor of any stage. Lesion size was significantly greater in T1 HG patients at ReTUR, as well as the prevalence of multifocality. The multivariable logistic regression model showed lesion dimension and multifocality as predictors of T1 HG at ReTUR, after adjusting for significant covariables (CIS and detrusor muscle presence). ROL sub-staging system was not a significant predictor, but ROL2 prevalence was higher in the T1 HG at ReTUR group. Lesion size and multifocality were independent predictors of T1 HG persistence at ReTUR, and patients at risk should be promptly identified and treated accordingly. Our results could help physicians make patient-tailored decisions by identifying those most likely to benefit from a second resection.

Performance of the OncoUrine test on the predictive capacity of non-muscle-invasive bladder cancer patients who are candidates for repeated transurethral resection.

e16595 Background: According to European Association of Urology (EAU) guidelines, repeated transurethral resection of bladder tumor (re-TURBT) is recommended in a large percentage of high-risk non–muscle-invasive bladder cancers (NMIBC) due to possibility of incomplete initial TURBT. But so far, no diagnostic tests able to improve patients’ stratification exist to reduce negative biopsy ratio of re-TURBT. To evaluate the value of the OncoUrine test for the predictive capacity of biopsy findings on re-TURBT, a prospective multi-center clinical trial was designed. Methods: This was a blinded, observational, prospective multicenter study (NCT05112523). Between December 2020 and September 2022, patients with a confirmed diagnosis of high-risk NMIBC at three study centers were enrolled. The inclusion criteria were ≥age 22 years old, prepare for re-TURBT following EAU guidelines, able to produce 100 ml of morning urine, and able to consent. Urine samples were collected from the enrolled patients for the OncoUrine tests before re-TURBT, and the test results were compared with the pathological results to calculate the performance. High-throughput sequencing of 17 genes and methylation analysis for ONECUT2 CpG sites were combined as a liquid biopsy test panel named OncoUrine. Results: Out of 109 patients enrolled, 93 were eligible for the performance analysis. In 33 cases, residual tumors were confirmed while the remaining 60 patients was found to have a result of negative pathological section. In the overall OncoUrine test results, variants from 11 genes showed positive mutations. TERT C228T, TP53, TERT C250T, ERBB2 and PIK3CA were on the top 5 of the list with other mutations from FGFR3, KRAS, HRAS, ERBB3, ERCC2, U2AF1, and ROHA. The sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) of the OncoUrine test for predicting pathological diagnosis were 81.8% (27/33), 81.7% (49/60), 89.1% (49/55), and 71.1% (27/38), respectively. Conclusions: Even for high-risk patients for whom re-TURBT is currently recommended, the OncoUrine test can accurately differentiate between cases with incomplete primary surgeries and those with no residual tumors. An interventional clinical trial is needed to further confirm the clinical value of this urine-based biopsy method on improving the selections of NMIBC patients. Clinical trial information: NCT05112523 .

EDITORIAL COMMENT

Prostate biopsy is one of the most common ambulatory urological procedures with more than 4000 performed daily in Europe and the USA. The European Association of Urologists (EAU) strongly recommended that transperineal prostate biopsy is used rather than transrectal biopsy due to the lower risk of infectious complications. 1 Mottet N van den Bergh RCN Briers E et al. EAU-EANM-ESTRO-ESUR-SIOG guidelines on prostate cancer-2020 update. Part 1: screening, diagnosis, and local treatment with curative intent. Eur Urol. 2021; 79: 243-262https://doi.org/10.1016/j.eururo.2020.09.042 Abstract Full Text Full Text PDF PubMed Scopus (931) Google Scholar However, despite clear evidence of the superiority of transperineal biopsy in terms of infectious complications, the majority of urologists remain more familiar with the transrectal biopsy.

International Society of Urological Pathology (ISUP) Consensus Conference on Current Issues in Bladder Cancer. Working Group 1: Comparison of Bladder Cancer Grading System Performance.

Grade is a key prognostic factor in determining progression in nonmuscle invasive papillary urothelial carcinomas. The 2 most common grading methods in use worldwide are the World Health Organization (WHO) 2004 and 1973 schemes. The International Society of Urological Pathology (ISUP) organized the 2022 consensus conference in Basel, Switzerland on current issues in bladder cancer and tasked working group 1 to make recommendations for future iterations of bladder cancer grading. For this purpose, the ISUP developed in collaboration with the European Association of Urology a 10-question survey for their memberships to understand the current use of grading schemes by pathologists and urologists and to ascertain the areas of potential improvements. An additional survey was circulated to the ISUP membership for their opinion on interobserver variability in grading, reporting of urine cytology, and challenges encountered in grade assignment. Comprehensive literature reviews were performed on bladder cancer grading prognosis and interobserver variability along with The Paris System for urine cytology. There are notable differences in practice patterns between North American and European pathologists in terms of used grading scheme and diagnosis of papillary urothelial neoplasm of low malignant potential. Areas of common ground include difficulty in grade assignment, a desire to improve grading criteria, and a move towards subclassifying high-grade urothelial carcinomas. The surveys and in-person voting demonstrated a strong preference to refine current grading into a 3-tier scheme with the division of WHO 2004 high grade into clinically relevant categories. More variable opinions were voiced regarding the use of papillary urothelial carcinoma with low malignant potential.

Peering through the PSMA PET Lens: The Role of the European Association of Urology Biochemical Recurrence Risk Groups after Radical Prostatectomy.

(1) Background: The European Association of Urology (EAU) biochemical recurrence (BCR) risk grouping relies on data from historical cohorts that used conventional imaging techniques. In the era of PSMA PET/CT, we compared the patterns of positivity in the two risk groups and provided insight into positivity predictive factors. (2) Methods: Data from 1185 patients who underwent 68Ga-PSMA-11PET/CT for BCR was analyzed, out of which 435 patients treated initially treated by radical prostatectomy were included in the final analysis. (3) Results: A significantly higher rate of positivity in the BCR high-risk group was observed (59% vs. 36%, p < 0.001). BCR low-risk group demonstrated more local (26% vs. 6%, p < 0.001) and oligometastatic (100% vs. 81%, p < 0.001) recurrences. The BCR risk group and PSA level at the time of PSMA PET/CT were independent predictive factors of positivity. (4) Conclusions: This study confirms that the EAU BCR risk groups have different rates of PSMA PET/CT positivity. Even with a lower rate in the BCR low-risk group, oligometastatic disease was 100% in those with distant metastases. Given the presence of discordant positivity and risk classification, integrating PSMA PET/CT positivity predictors into risk calculators for BCR might improve patient classification for subsequent treatment options. Future prospective studies are still needed to validate the above findings and assumptions.

Comparison of holmium laser, bipolar and conventional monopolar transurethral resection of bladder tumour in primary non-muscle invasive bladder cancer.

To compare the efficiency and safety profile of conventional monopolar, bipolar plasmakinetic and holmium laser techniques for transurethral resection of bladder tumour. The prospective comparative study was conducted from July 2019 to May 2021 after approval from the ethicsreview committee of Kafrelsheikh University, Egypt, and comprised patients of either gender with primary non muscle invasive bladder cancer who qualified for transurethral resection of bladder tumour. The patients were stratified into low-risk group A, intermediate risk group B and high-risk group C in accordance with the guidelines of the European Association of Urology. Comprehensive cystoscopy and panendoscopy were done in all cases. Once panendoscopy was done, tumour resection was performed with monopolar resectoscope in group A, plasmakinetic resectoscope in group B and holmium laser in group C). Data was collected at preoperative, peroperative, postoperative and follow-up stages. Data was analysed using SPSS 21. Of the 84 patients, 67(79.76%) were males and 17(20.23%) were females. There were 27(32.14%) patients in group A; 21(77.8%) males and 6(22.2%) females withy mean age 60.63±11.76 years. Group B had 32(38%) patients; 26(81.2%) males and 6(18.8%) females with mean age 65.34±7.55 years. Group C had 25(29.76%) patients; 20(80%) males and 5(20%) females with mean age 59.48±12.6 years. The mean follow-up period was 12.97±2.70 months in group A, 12.81±2.75 monthsin group B and 13.48±3.3 monthsin group C. Visualised complete resection was done in 23(85.8%) group A patients, 29(90.6%) group B patients and 24(96%) group C patients(p=0.018). Visualised complete resection, tumour multiplicity, tumour size, catheter duration, and hospital stay were significant predictors (p<0.05). Survival analysis showed 26(96.3%), 30(93.75%) and 25(100%) cases in groups A, B and C, respectively. Bipolar plasmakinetic and holmium laser techniques were found to be more effective and safer than the conventional monopolar technique for transurethral resection of bladder tumour in patients with primary non-muscle invasive bladder cancer.

(175) Readability Assessment of Online Men's Health Education Materials from the Sexual Medicine Society of North America, Urology Care Foundation, and European Association of Urology

Abstract Introduction The use of online health information by patients has gained considerable attention during the last decade. With this attention has come exponential adoption towards online resources. Existing literature has shown that a significant majority of patient education materials (PEM) available online exceed the literacy and comprehension of the audience reading them. The National Institute of Health (NIH) and American Medical Association (AMA) advocate the dissemination of accessible and readable resources targeted towards a fifth to seventh grade reading level. As the rise of mens health and sexual health continues to grow, understanding what resources may currently exist and how they meet or fail to meet patients needs is of growing concern. Objective We aimed to evaluate the readability of online patient resources from the Sexual Medicine Society of North America (SMSNA), American Urological Association and European Urological Association websites. Methods Content published under the web-section “SMSNA: For Patients - conditions and topics” portal (n=16) were reviewed. Identical topics published online via Urology Care Foundation (ie AUA; n=8) and the European Association of Urology (ie EAU; n=8) were also reviewed. Readability and estimated educational level required for understanding was assessed using validated readability and English language assessment tools including the Flesh Reading Ease score, Flesch Kincade, Gunning Fog, Simple Measure of Gobbledygook (SMOG), Coleman-Liau and Automated Readability index. Results SMSNA online patient education materials (PEM), on average, are written at a college sophomore reading level (14th grade). This is 6.5 and 8 grade levels higher than the average U.S. adult and recommended reading levels for PEM, respectively. Comparable AUA and EAU resources were an average of 10th (p&amp;lt;0.05) and 12th (p=0.854) grade reading levels, respectively. Conclusions Men’s sexual health PEM’s published online are written at an advanced reading level, most notably the SMSNA compared to equivalent professional sources. This could pose a barrier to patient understanding and impact patients’ engagement and health decision-making. One proposed mitigatory strategy is for PEM to provide improved readability, and appropriate user-friendly language to facilitate easier and inclusive understanding, outreach and educational support. Disclosure No

Definition and Diagnosis of Oligometastatic Bladder Cancer: A Delphi Consensus Study Endorsed by the European Association of Urology, European Society for Radiotherapy and Oncology, and European Society of Medical Oncology Genitourinary Faculty

BackgroundIn contrast to other cancers, the concept of oligometastatic disease (OMD) has not been investigated in bladder cancer (BC). ObjectiveTo develop an acceptable definition, classification, and staging recommendations for oligometastatic BC (OMBC) spanning the issues of patient selection and the roles of systemic therapy and ablative local therapy. Design, setting, and participantsA European consensus group of 29 experts, led by the European Association of Urology (EAU), the European Society for Radiotherapy and Oncology (ESTRO), and the European Society of Medical Oncology (ESMO), and including members from all other relevant European societies, was established. Outcome measurements and statistical analysisA modified Delphi method was used. A systematic review was used to build consensus questions. Consensus statements were extracted from two consecutive surveys. The statements were formulated during two consensus meetings. Agreement levels were measured to determine if consensus was achieved (≥75% agreement). Results and limitationsThe first survey included 14 questions and the second survey had 12. Owing to a considerable lack of evidence, which was the major limitation, definition was limited in the context of de novo OMBC, which was further classified as synchronous OMD, oligorecurrence, and oligoprogression. A maximum of three metastatic sites, all resectable or amenable to stereotactic therapy, was proposed as the definition of OMBC. Pelvic lymph nodes represented the only “organ” not included in the definition of OMBC. For staging, no consensus on the role of 18F-fluorodeoxyglucose positron emission tomography/computed tomography was reached. A favourable response to systemic treatment was proposed as the criterion for selection of patients for metastasis-directed therapy. ConclusionsA consensus statement on the definition and staging of OMBC has been formulated. This statement will help to standardise inclusion criteria in future trials, potentiate research on aspects of OMBC for which consensus was not achieved, and hopefully will lead to the development of guidelines on optimal management of OMBC. Patient summaryAs an intermediate state between localised cancer and disease with extensive metastasis, oligometastatic bladder cancer (OMBC) might benefit from a combination of systemic treatment and local therapy. We report the first consensus statements on OMBC drawn up by an international expert group. These statements can provide a basis for standardisation of future research, which will lead to high-quality evidence in the field.

International Opinions on Grading of Urothelial Carcinoma: A Survey Among European Association of Urology and International Society of Urological Pathology Members

BackgroundGrade of non–muscle-invasive bladder cancer (NMIBC) is an important prognostic factor for progression. Currently, two World Health Organization (WHO) classification systems (WHO1973, categories: grade 1–3, and WHO2004 categories: papillary urothelial neoplasm of low malignant potential [PUNLMP], low-grade [LG], high-grade [HG] carcinoma) are used. ObjectiveTo ask the European Association of Urology (EAU) and International Society of Urological Pathology (ISUP) members regarding their current practice and preferences of grading systems. Design, setting, and participantsA web-based, anonymous questionnaire with ten questions on grading of NMIBC was created. The members of EAU and ISUP were invited to complete an online survey by the end of 2021. Thirteen experts had previously answered the same questions. Outcome measurements and statistical analysisThe submitted answers from 214 ISUP members, 191 EAU members, and 13 experts were analyzed. Results and limitationsCurrently, 53% use only the WHO2004 system and 40% use both systems. According to most respondents, PUNLMP is a rare diagnosis with management similar to Ta-LG carcinoma. The majority (72%) would consider reverting back to WHO1973 if grading criteria were more detailed. Separate reporting of WHO1973-G3 within WHO2004-HG would influence clinical decisions for Ta and/or T1 tumors according the majority (55%). Most respondents preferred a two-tier (41%) or a three-tier (41%) grading system. The current WHO2004 grading system is supported by a minority (20%), whereas nearly half (48%) supported a hybrid three- or four-tier grading system composed of both WHO1973 and WHO2004. The survey results of the experts were comparable with ISUP and EAU respondents. ConclusionsBoth the WHO1973 and the WHO2004 grading system are still widely used. Even though opinions on the future of bladder cancer grading were strongly divided, there was limited support for WHO1973 and WHO2004 in their current formats, while the hybrid (three-tier) grading system with LG, HG-G2, and HG-G3 as categories could be considered the most promising alternative. Patient summaryGrading of non–muscle-invasive bladder cancer (NMIBC) is a matter of ongoing debate and lacks international consensus. We surveyed urologists and pathologists of European Association of Urology and International Society of Urological Pathology on their preferences regarding NMIBC grading to generate a multidisciplinary dialogue. Both the “old” World Health Organization (WHO) 1973 and the “new” WHO2004 grading schemes are still used widely. However, continuation of both the WHO1973 and the WHO2004 system showed limited support, while a hybrid grading system composed of both the WHO1973 and the WHO2004 classification system may be considered a promising alternative.

EARLY-STAGE TESTICULAR CANCER MANAGEMENT REFERRING TO EUROPEAN ASSOCIATION OF UROLOGY (EAU) GUIDELINES: A SURVEY IN INDONESIA

Objective: This study aimed to determine the management of early-stage testicular cancer among urologists in Indonesia by using a survey. Material &amp; Methods: This research was a descriptive-analytic study using a survey method through a Google-forms questionnaire distributed to urologists throughout Indonesia who were willing to participate. Data were collected from September 1 to 30, 2021. Results: Of the total respondents, 15 (14.2%) respondents were consultant urologic oncologists, and 90 (85.71%) respondents were non-consultant urologists or consultant urologists non-oncology. There was no difference in the treatment given by consultant uro-oncologists and non-consultant urologists/consultant urologists non-oncology in the management of surveillance of stage IA-IB seminoma (66.7% vs. 55.6%, p-value = 0.207), chemotherapy of stage IIA-IIB seminoma (100.0% vs. 90.0%, p-value = 0.080), surveillance of stage I non-seminoma cancers (46.7% vs. 41.1%, p-value = 0.304), and chemotherapy of stage IIA and IIB non-seminoma cancers (80% vs. 91.1%, p-value = 0.193). Conclusion: In general, as many as 84.4% of oncology consultant urologists and 83.7% of non-consultant urologists/consultant urologists non-oncology have performed initial diagnostic examinations, treatment, and follow-up following testicular cancer management guidelines according to the European Association of Urology 2021.

Primum Non Discernere: Glass Ceilings and Female Representation at the European Association of Urology and European Society for Paediatric Urology Annual Meetings, 2012–2022

BackgroundThe term glass ceiling coined by Loden in 1978 is commonly used to describe difficulties faced by minorities and women when trying to move into senior roles. ObjectiveTo analyse trends and patterns for female representation at the European Association of Urology (EAU) and European Society for Paediatric Urology (ESPU) annual general meetings over the past decade. Design, setting, and participantsWe used objective data on female representation in the roles of chairs, moderators, and lecture speakers at the EAU and ESPU meetings from 2012 to 2022. Outcome measurements and statistical analysisWe evaluated gender based representation in paediatric urology sessions at the EAU and ESPU meetings, collecting data on the overall number of sessions, lectures, symposiums, abstract/poster sessions, and courses, and analysed the male/female ratio. Data were derived from printed and digital programmes for the relevant meetings. Results and limitationsDuring the period from 2012 to 2022, the percentage female representation varied from 0% (2012) to a maximum of 35% (2022) at EUA paediatric urology sessions, and from 13.5% (2014) to a maximum of 32% (2022) at ESPU meetings. Both associations show clear progression towards equality. ConclusionsFemale representation at EAU and ESPU meetings has risen over the years, reaching 35% and 32%, respectively, in 2022, which is in line with the number of female members. We hope that this motivates a move towards the equality objectives for 2030. A clear and fundamental societal change is needed, with fair and more consistent institutional policies and framework commitments in the areas of science, medicine, and global health. Gender equality and diversity taskforces are essential to achieve these goals. Patient summaryWe analysed the male/female ratio for participants in annual meetings held by the European Association of Urology and the European Society for Paediatric Urology. From a low level in 2012, the ratio increased to over 30% in 2022, in line with the female membership of the societies. Focus on fair and consistent policies is needed to ensure that women are well represented in medicine.

Comment on: "Accuracy of the European Association of Urology (EAU) NMIBC 2021 scoring model in predicting progression in a large cohort of HG T1 NMIBC patients treated with BCG".

Comment on: "Accuracy of the European Association of Urology (EAU) NMIBC 2021 scoring model in predicting progression in a large cohort of HG T1 NMIBC patients treated with BCG".

A narrative review on surgical treatment options for male stress urinary incontinence.

Stress urinary incontinence (SUI) can occur due to a variety of etiologies. For male patients specifically, SUI is typically thought of as iatrogenic secondary to intrinsic sphincter deficiency occurring after prostate surgery. Given the noted negative impact that SUI can have on a man's quality of life, multiple treatment options have been developed to improve symptoms. However, there is no "One-Size-Fits-All" approach to management of male SUI. In this narrative review, we sought to highlight some of the various procedures and devices available to treat men with bothersome SUI. This narrative review gathered primary resources through Medline search, and secondary resources by cross-referencing citations used in articles of interest. We started our investigation by searching for previous systematic reviews on male SUI and treatments for male SUI. Furthermore, we reviewed societal guidelines, such as the American Urological Association and Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction guidelines and the recently published European Urological Association guidelines. Our review focused on English-language full-length manuscripts when available. We present multiple surgical options for men with SUI. This review focuses on surgical options including 5 fixed male slings, 3 adjustable male slings, 4 artificial urinary sphincters (AUS), and an adjustable balloon device. This review includes treatment options from across the globe, although not all included devices are available in the United States. A great variety of treatment options exist for men with SUI, although not all Federal Drug Administration (FDA) approved. Shared decision making is paramount to generate the greatest satisfaction for patients.

Clomiphene citrate therapy for testosterone deficiency: a proposed clinical care pathway.

Several testosterone (T) therapy options are currently available, including oral, intranasal, transdermal (gel, patches), intramuscular, and subcutaneous agents. The practice guidelines of some professional societies, including the American Urological Association and the European Association of Urology but not all international societies,1,2 suggest treating with aromatase inhibitors or selective estrogen receptor modulators for men with infertility. However, selective estrogen receptor modulators (ie, clomiphene citrate [CC]) may be a reasonable alternative for men experiencing low T with infertility or a wish to maintain their fertility.3 In clinical practice, CC—a nonsteroidal triphenylethylene derivative distantly related to diethylstilbestrol and a selective estrogen receptor modulator—is also used as an effective treatment for men with low T to improve T levels and T deficiency symptoms. CC is an oral agent that acts centrally. CC is a mixture of enclomiphene (62%), which is a trans isomer with pure antiestrogen effect, and zuclomiphene (38%), which is a cis isomer that has a mixed action with a predominant estrogen receptor agonistic property. It selectively binds to estrogen receptors primarily in the hypothalamus to produce a partial estrogen agonist effect resulting in an estrogenic negative feedback inhibition, thus increasing the hypothalamic gonadotropin-releasing hormone pulse frequency and, as a result, elevating luteinizing hormone (LH) secretion to stimulate the gonads to increase sexual hormones—for men, the Leydig cells to raise T levels.4 In vitro data have also suggested that CC has a pituitary site of action where it causes an increase in the gonadotropin response to gonadotropin-releasing hormone.5

Development, Validation, and Clinical Utility of a Six-gene Signature to Predict Aggressive Prostate Cancer

BackgroundMolecular signatures in prostate cancer (PCa) tissue can provide useful prognostic information to improve the understanding of a patient’s risk of harbouring aggressive disease. ObjectiveTo develop and validate a gene signature that adds independent prognostic information to clinical parameters for better treatment decisions and patient management. Design, setting, and participantsExpression of 14 genes was evaluated in radical prostatectomy (RP) tissue from an Irish cohort of PCa patients (n = 426). A six-gene molecular risk score (MRS) was identified with strong prognostic performance to predict adverse pathology (AP) at RP or biochemical recurrence (BCR). The MRS was combined with the Cancer of the Prostate Risk Assessment (CAPRA) score, to create a molecular and clinical risk score (MCRS), and validated in a Swedish cohort (n = 203). Outcome measurements and statistical analysisThe primary AP outcome was assessed by the likelihood ratio statistics and area under the receiver operating characteristics curves (AUC) from logistic regression models. The secondary time to BCR outcome was assessed by likelihood ratio statistics and C-indexes from Cox proportional hazard regression models. Results and limitationsThe six-gene signature was significantly (p < 0.0001) prognostic and added significant prognostic value to clinicopathological features for AP and BCR outcomes. For both outcomes, both the MRS and the MCRS increased the AUC/C-index when added to European Association of Urology (EAU) and CAPRA scores. Limitations include the retrospective nature of this study. ConclusionsThe six-gene signature has strong performance for the prediction of AP and BCR in an independent clinical validation study. MCRS improves prognostic evaluation and can optimise patient management after RP. Patient summaryWe found that the expression panel of six genes can help predict whether a patient is likely to have a disease recurrence after radical prostatectomy surgery.

EAU Congress Interview: Arnulf Stenzl

EAU Congress Interview: Arnulf Stenzl

Antibiotics in the Treatment of Uncomplicated Cystitis: A Google Trends Analysis

Introduction: Using Google Trends (GT) data, the trend variations for the most common antibiotics used to treat uncomplicated cystitis were analyzed by time and region since 2004. Methods: GT was used to create a “line-graph” that shows how interest in a topic in certain locations has grown or decreased over time. The relative search volume, which is displayed on a scale of 0–100, was used to index the search values for specific phrases. Nitrofurantoin (NFN), fosfomycin (FOS), trimethoprim (TMP), pivmecillinam (PIV), and cefadroxil are among the antibiotics recommended by the European Association of Urology (EAU) and the American Urological Association for the treatment of uncomplicated cystitis. Using the “global” inquiry category, the data was searched “worldwide” from 1 February 2004 to 31 December 2021. Results: In the regression analysis, all antibiotics exhibited positive trends (p < 0.05). With a steady rise in popularity, NFN is the most popular antibiotic today. Search trend for cefadroxil stayed nearly stable until 2012, the rate of rise in the last 10 years increased, and cefadroxil is the second most popular antibiotic. In the previous 5 years, there was a decline in interest in TMP. In recent years, there was an increase in the trends for FOS and PIV. Conclusion: Clinicians and patients all around the world increasingly use the web to search for antibiotic therapies for uncomplicated cystitis. Antibiotics used to treat uncomplicated cystitis have various trends in different continents throughout the world. The web trends seem to be compatible with daily use.

Androgen Deprivation Therapy in Current Clinical Practice: Challenges and Future Perspective

Androgen deprivation therapy (ADT) has been used for many years for treating advanced prostate cancer (PCa) and remains the backbone of treatment. Luteinising hormone-releasing hormone (LHRH) receptor agonists are the most widely used ADT drugs. However, newer options, including gonadotropin releasing hormone (GnRH) receptor antagonists such as degarelix and relugolix, may be clinically more beneficial for some patients. GnRH antagonists reduce serum testosterone levels more rapidly than LHRH agonists, without an initial testosterone surge or subsequent microsurges. This article summarises a symposium delivered on 11th March 2023 at the 38th European Association of Urology (EAU) Annual Congress in Milan, Italy, where speakers from three different disciplines described challenges and future perspectives for ADT in current clinical practice. Kurt Miller, Urologist, Charité University Hospital, Berlin, Germany, described the evolution of ADT in the treatment of PCa, from early reports of the benefits of surgical castration to the recent development of oral treatment for chemical castration. Miller explained the acceleration in progress in ADT research over recent years, with the development of novel drugs, drug sequences, and combinations, which have transformed outcomes in PCa. Alberto Bossi, Radiation Oncologist, Amethyst Group, Institut Gustav Roussy (IGR), Paris, France, next described current challenges with ADT management, including outstanding questions about the personalisation of ADT. Finally, Patrick Davey, Consultant Cardiologist, Northampton General Hospital, UK, spoke about ways to maintain a healthy heart on hormone treatment, and noted that cardiovascular safety is a major challenge in the use of ADT. The meeting was chaired by Heather Payne, Consultant Clinical Oncologist, University College Hospital, London, UK, who introduced the speakers and co-ordinated a question-and-answer session at the end of the symposium.

Verity of male sexual disorder videos on social media platforms

: Male sexual disorders remain taboo, particularly in a developing country like India. The affected census is under-depicted as of privacy issues, unawareness about the disease complex, a phobia about being affected, and many more counting on it, with advancing digitalization and many friendly social media platform, the affected individual logs onto the cybernet for perception, and here comes the role of content reliability.: In April 2022, we seek the most accountable social media platforms - with keywords of "Male Sexual Disorders", "Erectile Dysfunction", "Premature Ejaculation" and "Male sex Problems" using BuzzSumo, an online analytic tool. The collected content was evaluated by two urology residents on ground of European Association of Urology(EAU) Guidelines 2022, and for discrepancies, the final decision was established by a senior specialist.: Out of 191 included videos, 62.3% were videos uploaded by specialist and their mean duration was 7.2 minutes. 67.53% of uploaded videos explained general information (n=129, 67.53%) and provide information about diagnosis (28.7%) and treatment (78.01%), among which maximum videos favored medical management (97.9%). 158 inclusion videos (82.72%) were following EAU guidelines. In excluded videos, videos on alternative medicines shared maximum number (45.63%). Videos with animation and sound were more appealing based on views and likes, although the contribution of animated videos was rather less in number (25.65%). : The content with delusive information, small size samples, and individual opinion are having more luring appeasement. so, this study firms its ground by stressing verity of content and need for scrutiny by medical community.

Unilateral Pelvic Lymph Node Dissection in Prostate Cancer Patients Diagnosed in the Era of Magnetic Resonance Imaging-targeted Biopsy: A Study That Challenges the Dogma.

Bilateral extended pelvic lymph node dissection at the time of radical prostatectomy is the current standard of care if pelvic lymph node dissection is indicated; often, however, pelvic lymph node dissection is performed in pN0 disease. With the more accurate staging achieved with magnetic resonance imaging-targeted biopsies for prostate cancer diagnosis, the indication for bilateral extended pelvic lymph node dissection may be revised. We aimed to assess the feasibility of unilateral extended pelvic lymph node dissection in the era of modern prostate cancer imaging. We analyzed a multi-institutional data set of men with cN0 disease diagnosed by magnetic resonance imaging-targeted biopsy who underwent prostatectomy and bilateral extended pelvic lymph node dissection. The outcome of the study was lymph node invasion contralateral to the prostatic lobe with worse disease features, ie, dominant lobe. Logistic regression to predict lymph node invasion contralateral to the dominant lobe was generated and internally validated. Overall, data from 2,253 patients were considered. Lymph node invasion was documented in 302 (13%) patients; 83 (4%) patients had lymph node invasion contralateral to the dominant prostatic lobe. A model including prostate-specific antigen, maximum diameter of the index lesion, seminal vesicle invasion on magnetic resonance imaging, International Society of Urological Pathology grade in the nondominant side, and percentage of positive cores in the nondominant side achieved an area under the curve of 84% after internal validation. With a cutoff of contralateral lymph node invasion of 1%, 602 (27%) contralateral pelvic lymph node dissections would be omitted with only 1 (1.2%) lymph node invasion missed. Pelvic lymph node dissection could be omitted contralateral to the prostate lobe with worse disease features in selected patients. We propose a model that can help avoid contralateral pelvic lymph node dissection in almost one-third of cases.