Urological Practice Research Articles

Venoocclusive erectile dysfunction: up-to-date review and clinical guide

Erectile dysfunction (ED) is one of the most frequently reasons for patient presentation in the urological practice. Despite fundamental progress in the understanding of ED pathophysiology, there are some vascular forms of ED where the diagnostic and therapeutic pathway is not clear (cavernous venous insufficiency).What is the right procedure when venous leakage is suspected? How important are venous ligation surgery and radiological interventions?Narrative literature review of the available sources on cavernous venous insufficiency.The reasons for venous cavernous insufficiency are heterogenous. The most effective and reliable therapy option is penile prothesis implantation. Venous ligation surgery or radiological interventions are not reliable options, because of the risk of recurrence.Patients with venous cavernous insufficiency are candidates for penile prosthesis implantation. In this group of patients, vascular interventions may be performed as options for clinical study.

Implementing and Optimizing Universal Germline Genetic Testing for Patients with Prostate Cancer in Clinical Practice Consider.

To advocate for universal germline genetic testing (UGGT) in prostate cancer and provide practical recommendations for its implementation. Although guidelines for germline genetic testing (GGT) in prostate cancer have progressed, usage remains limited and inconsistent due to barriers including access, cost, and variable guideline adherence. These issues prevent some patients with germline pathogenic/likely pathogenic variants from benefiting from risk assessment, precision therapies (e.g., PARP inhibitors, PD-1 inhibitors) and potential clinical trials. Despite these benefits, studies indicate that GGT use remains low, especially in prostate cancer care. The PROCLAIM trial (Shore et al., 2023) highlighted that nearly half of patients with pathogenic variants are missed under NCCN guidelines, particularly impacting non-white patients and those with incomplete family history data. Additional racial and socioeconomic disparities further hinder access and variant interpretation accuracy. Given these challenges, UGGT for all prostate cancer patients has been proposed to improve care equity and decision-making. In March 2024, prostate cancer experts convened to discuss strategies for UGGT implementation. The outcome of that meeting includes recommendations for integrating UGGT into oncology and urology practices and have been outlined in this paper. To maximize the benefits while mitigating the potential risks of UGGT, it is essential to address implementation details, including careful gene panel selection, VUS reporting and management, appropriate genetics follow-up, and seamless integration of test reports into EMRs for accessibility by patients and providers.

Pathogenetic features of functional disorders in the remaining kidney during the early postoperative period of radical nephrectomy

Relevance. Despite the widespread introduction of organ-preserving operations into urological practice, the number of radical nephrectomies has continued to increase. The results of modern research show that the initial stages of diseases of the remaining kidney are already formed at the earliest possible time after radical nephrectomy; therefore, adequate management of the postoperative period is a key factor in the prevention of diseases of the single kidney. However, this approach should be based on a detailed understanding of the mechanisms of adaptive restructuring of the body, which have a key effect on the morphology and function of a single kidney.Objective. To study the features of adaptive body reactions and the dynamics of the functional state of a single kidney following radical nephrectomy.Materials and methods. In the early postoperative period, the clinical and laboratory parameters of 85 patients who underwent radical nephrectomy for renal cell carcinoma in the T2-T3N0M0 stage were studied. The control group comprised 25 patients who underwent similar operations for the same indications within a period of 1.5–12 months. The metabolism of adrenaline, histamine, and serotonin, indicators of psychological and emotional states, vegetative-vascular status, and nitrogen excretion and filtration functions of the remaining kidney were studied.Results. Radical nephrectomy, as well as the period of conscious expectation, is the cause of a stress syndrome that occurs due to an imbalance of the studied biogenic amines, accompanied by disorders of psychological and emotional health and vegetative-vascular disorders observed at least during the 2 weeks of the postoperative period. In addition, the filtration capacity of a single kidney is impaired, and it persists for 14 days at follow-up. Correlation analysis made it possible to establish reliable links between the imbalance of biogenic amine and anxiety levels and the severity of autonomic vascular disorders, which adversely affect kidney filtration.Conclusions. The results of this study indicate the need for pharmacological subsidies during the postoperative period of radical nephrectomy, which makes it possible to offset the negative impact of stress syndrome on the outcome of surgical treatment.

Adherence to american urological association (AUA) vasectomy guidelines: a systematic review of current practice among healthcare providers.

Vasectomy, a common male sterilization procedure, has seen a surge in popularity following the 2022 reversal of Roe v. Wade. The American Urological Association (AUA) vasectomy guidelines provide essential guidance for providers, outlining best practices for the procedure. We reviewed studies that examined adherence to the AUA vasectomy guidelines with regard to pre-procedure counseling, surgical technique, and post vasectomy semen analysis (PVSA) practice, as well as studies evaluating the impact of these guidelines on urology and non-urology practices. A total of five studies were identified that assessed adherence to the guidelines. Only one of these studies evaluated adherence to all three aspects of the guidelines. The remaining four studies focused solely on the practice of PVSA. Overall, urologists exhibited greater adherence to the guidelines compared to other healthcare providers. However, the adherence rates were still suboptimal. Five additional studies were included that evaluated the use of home-based PVSA, which is not part of the AUA guidelines. Conflicting results were found regarding the test compliance. While the studies evaluating home-based PVSA may raise the question of including this approach in the guidelines panel discussion, it is important to consider the potential benefits and drawbacks before incorporating it as an option in future guidelines.

Monitoring of prostate-specific antigen in men with benign prostate enlargement receiving 5-alpha reductase inhibitors: a non-interventional, cross-sectional study of real-world practice of urologists in Spain and Brazil

BackgroundInconsistent monitoring of prostate-specific antigen in patients receiving 5-alpha reductase inhibitors for lower urinary tract symptoms/benign prostate enlargement may affect prostate cancer outcomes. This study evaluated real-world practice among urologists treating patients receiving 5-alpha reductase inhibitors.MethodsThis non-interventional, cross-sectional study collected data from urologists in Spain (N = 100) and Brazil (N = 100) via a self-reporting questionnaire and patient record forms. Endpoints included: frequency/methodology of prostate-specific antigen monitoring, concerns about the effect of 5-alpha reductase inhibitors on prostate-specific antigen monitoring, triggers of prostate biopsy, and concerns when switching 5-alpha reductase inhibitor formulation.ResultsOver half of urologists monitored prostate-specific antigen every 6 months (Spain 59%, Brazil 58%). Preferred methods were the “doubling rule” (Spain 66%, Brazil 41%) and “increase from nadir” (Spain 28%, Brazil 43%). A minority of urologists monitored unadjusted values (Spain 3%, Brazil 11%) or did not monitor prostate-specific antigen (Spain 1%, Brazil 3%). Most urologists ranked the potential for 5-alpha reductase inhibitors to mask prostate cancer as their top concern (Spain 65%, Brazil 56%). The most selected trigger for prostate biopsy was “if doubled (adjusted) prostate-specific antigen level after 6 months of treatment is > 4 ng/mL” (Spain 39%, Brazil 37%). Many urologists were moderately/very concerned about the effect on prostate-specific antigen when switching 5-alpha reductase inhibitor formulation.ConclusionsAn unmet need exists for standard guidance and continuous education to support optimal monitoring and interpretation of prostate-specific antigen in patients with lower urinary tract symptoms/benign prostate enlargement treated with 5-alpha reductase inhibitors.

Academician Nikolai Alekseevich Lopatkin (1924–2013) (on the 100th anniversary of his birth)

An outstanding urological surgeon and nephrologist, a talented scientist and teacher, a major healthcare organizer, the founder of the largest domestic school of urologists and nephrologists, Hero of Socialist Labor (1978), Academician of the USSR Academy of Medical Sciences (1974) and the Russian Academy of Medical Sciences (1992), Honored Scientist of the Russian Federation (1998), three-time laureate of the USSR State Prize (1971, 1984, 1990), laureate of the USSR Council of Ministers Prize (1981), chief urologist of the USSR and Russian Ministry of Health, Chairman of the All-Union and Russian Societies of Urologists (1972–2012), Professor Nikolai Alekseevich Lopatkin was born on February 18, 1924 in Moscow into a doctor’s family. In 1941, he entered the 1st Moscow Medical Institute named after I. M. Sechenov, from which in 1943 he was transferred to the 2nd Moscow Medical Institute named after N. I. Pirogov. In 1947, he graduated from the Faculty of Medicine and was enrolled in residency at the Department of Faculty Surgery of the 2nd Moscow Medical Institute, which he successfully completed in 1950 and was elected to the position of assistant of the Department. In 1953, he defended his candidate’s dissertation and in the same year was transferred to the Department of Urology of the 2nd MMI, where under the supervision of the Professor A. Ya. Pytel, he worked as the assistant, Associate Professor and Professor of the Department, and in 1967, he was elected the head of the Department of Urology and Surgical Nephrology. In 1959, he defended his doctoral dissertation “Renal Angiography”. He introduced general anesthesia with tracheal intubation and artificial ventilation into urological practice, as well as numerous cutting-edge methods of diagnosing and treating urological diseases. In 1958, together with A. Ya. Pytel, he was the first in our country to use the “artificial kidney” apparatus, and later took direct part in organizing hemodialysis departments in urological clinics in the USSR. In 1972, Nikolai Alekseevich organized the All-Union Society of Urologists of the USSR, which he headed until 1991, and was the chairman of the Russian Society of Urologists until 2012. For many years, he served as the chief urologist of the USSR Ministry of Health. On the initiative of N. A. Lopatkin, the Research Institute of Urology of the USSR Ministry of Health was created in Moscow, which he headed from 1979 to 2007. Nikolai Alekseevich was the author and co-author of more than 800 scientific and scientific-practical works, including 40 monographs, manuals and textbooks. Under his supervision, 25 doctoral and about 50 candidate dissertations were defended. Academician N.A. Lopatkin died on September 16, 2013 and was buried at the Vagankovo Cemetery in Moscow.

Evidence-Based Framework for Surgical Irrigation Fluid Stewardship and Endoscopic Case Prioritization During Fluid Shortages.

The US supply disruption of surgical irrigation fluids in September 2024 prompted the need for fluid conservation and potential deferral of urology procedures. We characterized fluid use in common endoscopic procedures to articulate recommendations for irrigation fluid stewardship and case prioritization during fluid shortages. We reviewed case volumes and irrigation fluid use for endoscopic urological procedures at our institution during January-September 2024. We convened a panel of high-volume urologists and used a 3-step modified Delphi method to determine consensus recommendations for fluid stewardship and case prioritization. Among 6155 cases, the procedures consuming the highest mean per-case fluid volumes were prostate enucleation (26.6 L), transurethral resection of the prostate (16.7 L), percutaneous nephrolithotomy (12.4 L), and robotic water-jet prostate ablation (10.9 L). These 4 procedures comprised 17% of all cases but consumed 42% of total fluid volume. To prioritize procedures for potential deferral, procedures were stratified into 3 fluid tiers based on fluid consumption and 3 urgency tiers based on clinical indication. Combining both fluid and urgency tiers, we identified 5 procedural priority levels in which lower priority cases that consume more fluid and treat less urgent indications are deferred first. Finally, we defined 4 fluid stewardship principles addressing patient and trainee needs. Among endoscopic urology cases, the 4 most fluid-intensive procedures consume 42% of surgical irrigation fluid. A case prioritization framework that accounts for fluid consumption and clinical urgency can help urology practices navigate potential case deferrals. Fluid stewardship principles may optimize fluid conservation to minimize adverse impact on patients and trainees.

The COVID-19 pandemic and Urology - reflecting on successful initiatives and lessons in Australia.

To summarise the impact of the coronavirus disease 2019 (COVID-19) pandemic on urological practice globally with a focus on Australian initiatives, as the pandemic resulted in radical changes in healthcare infrastructure and policies. We conducted a literature review of the Medical Literature Analysis and Retrieval System Online (MEDLINE), Excerpta Medica dataBASE (EMBASE) and Web of Science medical databases. The key terms used to conduct our search algorithm comprised of 'COVID', 'wait list or wait time or delay', 'urology', 'surgery' and 'outcomes', and generated 231 articles. Abstracts were reviewed for relevance and 40 studies selected for full-text review. Society position statements and government level press release statements were identified through citation tracking and additionally included. The halt on elective surgical services during the pandemic was deemed necessary to curb infection rates and conserve healthcare resources. However, it resulted in extended wait times and large surgical backlogs with major downstream effects. Australia fared favourably with regards to infection rates compared to international populations consequent upon strict border control, vaccine mandates, and stringent lockdowns. However, similar trends were noted in both oncological and non-oncological urology service reduction, resulting in significant concerns regarding the long-term sequelae of delayed surgery and missed appointments upon patient clinical outcome. Initiatives including collaborative partnerships between public and private hospital sectors, government-funded programmes and adoption of telehealth were successfully established as part of Australia's efforts to stabilise our healthcare system in response to the pandemic. Australia's pandemic efforts have highlighted the escalating imbalance between increasing demand from a growing and ageing population on an already over-burdened system with finite resources. The additional strain of managing post-COVID-19 pandemic fallout in this context provides further challenges for clinicians and healthcare administrators alike. Collaboration by all stakeholders must continue in order to seek innovative solutions to maximise efficiency of healthcare service utilisation, so that quality universal healthcare provision may continue in the future.

Varicocele management in Tunisia: Overview of practices and comparison with latest international guidelines.

Varicocele has a detrimental effect on testicular growth and spermatogenesis, hence the importance of its management. This management remains controversial among Tunisian urologists; diagnostic and therapeutic choices tend to vary from one urologist to another. The aim of this survey is to evaluate the practices of Tunisian urologists regarding varicocele management compared to the latest international guidelines. A cross-sectional study was conducted among Tunisian urologists, members of the Tunisian Association of Urology, using a computerized questionnaire available online. The response rate was 51.6%. Approximately 80% of Tunisian urologists reported that they diagnose and manage patients with varicocele at least once a week. Half of the Tunisian urologists use a grading system for classification. Over 75% of Tunisian urologists believe that scrotal ultrasound and semen analysis should be systematically requested. Half of them consider treatment starting from Dubin and Amelar grade 2, while the other half treat from Dubin and Amelar grade 3. The majority agreed that the results of varicocele repair are controversial, with 10% never performing bilateral varicocele repair. The vast majority planned surgical treatment (95%), with sub-inguinal approach and magnification used in only 16% of cases; 25% never froze sperm before varicocele repair. Recent recommendations had clear messages to promote in terms of diagnosis, therapeutic indications, and modalities. This work highlights the existence of gaps between recommendations on certain aspects of varicocele management, suggesting a review of continuous medical education modalities regarding this pathology in particular.

THE RATIO OF UROLOGISTS FOR EACH REGENCY AND CITY IN EAST JAVA INDONESIA AND THE INDICATORS AFFECTING THEIR DISTRIBUTION

Objective: Research on the distribution of urology in Indonesia, especially in East Java, has not been widely discussed. There are still several areas in East Java that do not have a urologist at all. We try to find out the factors underlying this distribution through several indicators. Material & Methods: Data from all hospitals in East Java were compiled with data of urologists in East Java obtained from the Indonesian Urological Association, supplemented by information from social media and the telephone of the hospital operator. The number of urologists and hospitals with urology services is then correlated with the human development index, the education index, purchasing power index, health index, and regional minimum wage. Results: The ratio of urologists in each district and city in East Java is not evenly distributed, and likewise with the hospitals that provide urology services in each district and city in East Java. The ratio of urologists and the number of hospitals providing urology services are significantly related to the human development index, the education index, the purchasing power index, the health index, and the regional minimum wage. Conclusion: The location of a urologist's practice is related to the development of an area, which in this study is assessed through indicators of human development, education, health, and economy. Keywords: Urologist Ratio, East Java, Urology.

Enhancing stone expulsion: The efficacy of combined medical therapy with tamsulosin and dexamethasone in renal colic patients

Background: Ureteral stones are a common aspect of daily urologic practice, affecting 10%–15% of people worldwide over their lifetime. This study aimed to assess the efficacy of combined medical expulsive therapy (MET) with intravenous dexamethasone and oral tamsulosin compared to tamsulosin alone in the frequency and duration of distal ureteral stone expulsion. Materials and Methods: This prospective, double-blind, randomized controlled trial with 1:1 balanced randomization was conducted from September 2022 to March 2023 at Al-Zahra Hospital, a tertiary care facility affiliated with Isfahan University of Medical Sciences. Of 213 patients admitted to our center with acute renal colic, 134 had distal ureteral stones and were assessed. Among them, 105 patients were eligible and included in the trial and were randomly assigned into the intervention group (n = 52) and control group (n = 53). Data from four patients in the case group were omitted from the analysis due to the drop-out from the study. Results: Mean initial stone size was 6.5 ± 1.2 mm in the intervention, and 6.3 ± 1.0 mm in the control groups, which was not statistically significant (P = 0.488). Gender was comparable between both groups (P = 0.196), whereas the distribution of BMI (27.2 ± 4.0 vs. 29.8 ± 3.9 kg/m2, P = 0.001) and age (41.5 ± 12.9 vs. 47.9 ± 16.2 years, P = 0.031) was not in balance. In total, 43 patients had expelled the stone by the end of the 2 weeks, resulting in an overall expulsion rate of 42.5%. Specifically, 28 (58.3%) patients in the intervention group and 15 (28.3%) patients in the control group had expelled the stone, a difference that was statistically significant (P = 0.002). The time to stone expulsion did not exhibit a significant difference between the intervention and control groups (9.8 vs. 5.4 days, respectively). However, it is noteworthy that the variability in the time to stone expulsion in the tamsulosin + dexamethasone group was considerably smaller than that in the control group, as indicated by the smaller standard deviation in the former (1.0 vs. 3.8 days, respectively). Conclusion: Adding dexamethasone to standard MET with tamsulosin for distal ureterolithiasis appears to increase the stone expulsion rate, although it did not significantly shorten the expulsion time.

Risk of childlessness in help-seeking men with Peyronie's disease-A Swedish longitudinal study.

Peyronie's disease (PD) is a disorder of the penis that is associated with poor mental health, lowered psychosocial- and sexual wellbeing, which may increase the risk of childlessness in men affected by the disorder. Although this is an issue of significant clinical importance, it has not been addressed in research to date. We conducted a longitudinal cohort study based on data from Swedish national registers utilizing a large sample of help-seeking men with PD, along with matched subjects from the general population. We assessed the probability and odds ratio of childlessness, modeled with logistic regressions, and offspring rate ratio, modeled with Poisson regression. We found that the probability of childlessness was somewhat lowered for men with PD aged between 35 and 71 years at end of follow-up. Men with PD aged 35 or less showed slightly elevated probabilities of childlessness. Specifically, odds ratios for childlessness were between 0.5 and 1.0 for men aged above 35, and between 1 and 1.5 for men aged less than 35, although the confidence intervals for increased odds partly included the null. Analyses of men's rate of offspring showed similar pattern, with higher rate ratios for older men and lower for younger men. Although more research is needed, the findings of this study suggest that clinical urological practice may be enhanced by a proactive discussions about the potential issue of childlessness in younger men with PD.

Emerging strategies in tackling antimicrobial resistance in urology: Narrative review and expert opinion

Urinary tract infections (UTIs) are highly prevalent and frequently treated with antibiotics, making antimicrobial stewardship (AMS) crucial in this field to benefit both individual patients and society. This narrative review examines recent advancements in managing urinary tract infections, focusing on AMS and antimicrobial resistance (AMR). AMS is essential in urology, where antibiotics are frequently prescribed for UTI. AMS promotes optimal antibiotic use to improve patient outcomes, control AMR, and safeguard public health. Key AMS practices in urology include selecting antibiotics at the appropriate dose and duration, especially for uncomplicated UTIs, asymptomatic bacteriuria, and catheter-associated infections. Following evidence-based guidelines, such as those from EAU and the IDSA, helps prioritize narrow-spectrum antibiotics and discourage empirical broad-spectrum use. Regular audits and feedback on antibiotic use help align practices with AMS goals, reducing inappropriate prescriptions. Multidisciplinary AMS teams, including urologists, microbiologists, and pharmacists, enhance treatment precision and antibiotic optimization in complex cases. Reassessing antibiotic therapy based on culture results after 48–72 h enables clinicians to refine treatment, minimizing unnecessary broad-spectrum use and strengthening AMS efforts in urology. In conclusion, addressing AMR in urology requires a careful approach that combines evidence-based antibiotic use, attention to local resistance patterns, and patient-specific factors. Non-antibiotic strategies for recurrent UTI prevention, judicious catheter management, and tailored treatment for complex infections are key AMS components. Emerging technologies in diagnostics and precision medicine offer tools for targeted, personalized therapy, enhancing AMS efforts, and helping to reduce reliance on broad-spectrum antibiotics.

Radiomics in urolithiasis: a systematic review of current applications, limitations and future directions.

The above analysis of studies available in the international literature shows that the use of radiomics in urolithiasis is a rapidly developing area in medical science. From the total number of studies included in this review, it is evident that mainly diagnostic applications that are associated with radiological diagnostics are close to implementation in urological practice, while in many studies the authors argued that the function of their proposed model can be further optimized after entering more data. Texture analysis of stone images has significantly improved the accuracy of kidney stone type prediction. Such advances in medical imaging technologies and machine learning are likely to be more widely used in routine clinical management of urolithiasis in the near future. However, there is still room for further improvement of machine learning algorithms to improve the sensitivity and specificity of automatic classification methods. Keywords: urolithiasis, radiomics, texture analysis, machine learning, artificial intelligence.

Emerging Use of Social Media in Clinical Urology Practice in the 21st Century: Survey Study.

Social media (So-Me) platforms are valuable resources for health care professionals and academics to discover, discuss, and distribute current advances in research and clinical practices, including technology trends. This study aims to assess the role of So-Me in urological practice in Saudi Arabia. It explores the influence of digital platforms on patient interaction, professional communication, decision-making, and education. The survey was conducted among 145 urologists from July 2021 to July 2022 following institutional review board approval. A questionnaire designed using the SurveyMonkey platform examined urologists' knowledge of So-Me. The survey was conducted using the CHERRIES (Checklist for Reporting Results of Internet E-Surveys) guidelines and was open for 17 weeks. Data analysis was performed using SPSS 21.0. Of the 145 participants, 70% (n=102) were Saudi Arabians. The most common age groups were 30-40 (n=68, 46.8%) and 41-50 (n=61, 42.2%) years, with a gender distribution of 44.8% (n=65) women and 55.2% (n=80) men. A total of 61.5% (n=89) of urologists reported using So-Me accounts for professional purposes, with 54.9% (n=80) sharing health-related information. Social media enhanced patient connections beyond clinic visits for 55.8% (n=81) of respondents, while 57.2% (n=83) used it to provide educational resources. Additionally, 56.5% (n=82) believed So-Me facilitated patient feedback and improved their practice. In terms of professional communication, 60.6% (n=88) of urologists agreed that So-Me facilitated collaboration with colleagues, while 63.3% (n=92) used it to stay updated on the latest advances in urology. Furthermore, 62% (n=90) followed professional societies or journals on So-Me, and 63.3% (n=92) used it for continuing medical education. A majority (n=94, 64.7%) reported that So-Me influenced treatment decisions based on new research findings, and 85.3% (n=124) learned about novel technologies and treatment options through these platforms. Regression analysis showed a significant positive correlation between gender and social media usage patterns (R=0.653, R2=0.426), indicating that approximately 42.6% of the differences in usage patterns can be attributed to gender. However, the Pearson χ2 analysis showed that gender did not significantly affect most aspects of social media use, except information sharing and participating in online discussions (both P<.05). This study highlights the widespread use of So-Me among urologists in Saudi Arabia, underscoring its role in enhancing patient interaction, professional development, and clinical decision-making. Strategically designed health care programs using social media could improve and modernize professional and patient-centered care in Saudi Arabia through legislative assistance and guidelines.

Observations and Reflections from Sub-Saharan Africa. Comment on Shahait, M. Urology Practice in Low- to Middle-Income Countries. Soc. Int. Urol. J. 2024, 5, 374–375

Observations and Reflections from Sub-Saharan Africa. Comment on Shahait, M. Urology Practice in Low- to Middle-Income Countries. Soc. Int. Urol. J. 2024, 5, 374–375

Oncological Safety of MRI-Informed Biopsy Decision-Making in Men With Suspected Prostate Cancer

The magnetic resonance imaging (MRI) pathway for diagnosing clinically significant prostate cancer (csPCa; defined as International Society of Urological Pathology grade group ≥2) uses multiparametric MRI (mpMRI) for prostate biopsy (PB) decision-making. However, the intermediate impact on patient outcomes in men with negative MRI results avoiding PB and men with positive MRI results without PCa remains unknown. To assess the feasibility and safety of a community-based MRI diagnostic strategy in men with suspected PCa using 3-year active monitoring. This multisite, longitudinal cohort trial took place across 54 community-based urology practices and 2 radiology imaging centers at a referral academic institution in Berlin, Germany. Eligible participants aged 18 to 75 years with clinically suspected PCa were enrolled between September 2016 and December 2017 and monitored for 3 years. Final analysis was reported on December 23, 2023. Participants underwent 3-T mpMRI. Men with findings suspected to be PCa were recommended for targeted PB (diagnostic phase). Men with negative mpMRI results or positive mpMRI results with benign findings at PB were systematically monitored for 3 years (monitoring phase). Clinical visits were recommended every 6 months. The total proportion of men avoiding PB and those with csPCa. A total of 593 men (median [IQR] age, 64 [58-70] years) underwent mpMRI, with 286 (48%) having negative MRI results, 261 (44%) avoiding PB initially, and 242 (41%) avoiding PB over 3 years. csPCa was detected in 161 (27%) men after immediate PB, increasing to 172 (29%) men after 3 years. Seven men with negative MRI results were diagnosed with PCa by immediate PB (including 4 cases of csPCa), while 279 entered monitoring. Three-year monitoring was completed by 233 (84%) men, with 7 diagnoses of csPCa. Of 307 men with positive MRI results, 58 (19%) showed no PCa after immediate PB, of which 41 (71%) completed monitoring and 4 (7%) were diagnosed with csPCa. In this cohort study, men with negative mpMRI results avoiding biopsy were not at elevated risk of csPCa. The study confirms the oncological safety of the prebiopsy MRI strategy of avoiding an immediate PB after negative MRI results when a programmatic safety net is in place.

Assessment of Urological Knowledge and Practice Among Emergency and Primary Health Care Physicians

Assessment of Urological Knowledge and Practice Among Emergency and Primary Health Care Physicians

Artificial Intelligence in Urology: New Technologies with Major Potential

&lt;p dir="ltr"&gt;&lt;span&gt;The present paper described how Artificial intelligence (AI) is revolutionizing urology, with applications in diagnosis, treatment planning, and patient monitoring. This review highlights AI's role in key urological areas, such as cancer detection, robotic-assisted surgeries, and personalized patient care. These advancements significantly enhance clinical decision-making and treatment outcomes. Thus, we can clearly state that AI has immense potential to redefine urological practice, fostering accuracy, efficiency, and patient-centered care. However, the integration of these technologies requires addressing challenges like data security, ethical concerns, and regulatory validation. Future efforts should focus on developing robust, evidence-based AI tools to ensure their safe and effective deployment in clinical settings.&lt;/span&gt;&lt;/p&gt;&lt;div&gt;&lt;span&gt;&lt;br /&gt;&lt;/span&gt;&lt;/div&gt;

The evolving landscape of urological practice: beyond distances.

The evolving landscape of urological practice: beyond distances.