Round up

STANDARD OR EXTENDED LYMPHADENECTOMY FOR MUSCLE-INVASIVE BLADDER CANCER Nonmetastatic muscle-invasive bladder cancer (T2-T4a, N0-2) patients were randomized 1:1 to undergo standard (n = 300, obturator, external, and internal iliac LN) versus extended lymphadenectomy (n = 292, addition of common iliac, presciatic, and presacral nodes).[1] Surgery was performed by 36 surgeons at 27 sites in the United States and Canada. Fifty-seven percent received neoadjuvant chemotherapy. At a median follow-up of 6.1 years, recurrence or death had occurred in 130 patients (45%) in the extended lymphadenectomy group and in 127 (42%) in the standard lymphadenectomy group. Overall survival at 5 years was comparable (59% in the extended lymphadenectomy and 63% in the standard lymphadenectomy, hazard ratio [HR] =1.13; 95% confidence interval [CI], 0.88–1.45). Adverse events of grade 3–5 occurred in 157 patients (54%) in the extended lymphadenectomy group and in 132 (44%) in the standardlymphadenectomy group; death within 90 days after surgery occurred in 19 patients (7%) and 7 patients (2%), respectively. Thus, extended lymphadenectomy did not provide any improvement in oncological parameters, while morbidity and mortality were higher. BREAK WAVE LITHOTRIPSY FOR UROLITHIASIS: RESULTS OF THE FIRST-IN-HUMAN INTERNATIONAL MULTI-INSTITUTIONAL CLINICAL TRIAL Break Wave lithotripsy (BWL) is a new technology utilizing focused ultrasound to fragment stones. This study assesses the “Break Wave Lithotripsy” device for treating urolithiasis in a daycare setting without anesthesia or sedation.[2] In this multicenter, single-arm trial with 44 patients, BWL successfully fragmented stones in 88% of cases, with 70% of patients having residual fragments ≤4 mm and 51% with fragments ≤2 mm. Forty-nine percent of patients were completely stone-free, improving to 58% with optimized therapy settings. The procedure was safe, with no serious adverse events, and 86% of patients required no or minimal analgesia. After optimizing treatment settings, fragmentation improved to 92%, and 58% of patients were stone-free. Effectiveness was lower for lower pole stones (29% stone-free), but 89% of distal ureteral stones were completely stone-free. Although BWL showed effective outcomes for stones <10 mm, certain stone locations were not treatable due to ultrasound limitations (e.g., air or bone interference). Overall, BWL is a promising, noninvasive alternative to shock wave lithotripsy, offering comparable outcomes in a clinical setting. ANTIMICROBIAL PROPHYLAXIS FOR CHILDREN WITH VESICOURETERAL REFLUX; RANDOMIZED INTERVENTION FOR CHILDREN WITH VESICOURETERAL TRAIL Randomized Intervention for Children with Vesicoureteral Reflux (RIVUR) trial examined changes in glomerular filtration rate (eGFR) in children with vesicoureteral reflux (VUR) participating in the RIVUR trial.[3,4] VUR is a common congenital anomaly that predisposes children to recurrent urinary tract infections (UTIs), potentially leading to kidney scarring and decreased kidney function. The study analyzed eGFR changes in 188 participants over 2 years, using serum creatinine measurements at enrolment and study exit. Children who experienced more than one UTI during the trial exhibited significantly lower eGFR changes than those with one or no UTIs. Children with more than 1 febrile UTI receiving a placebo had a lower net change in eGFR by 27 mL/min/1.73 m² versus those with less than or equal to 1 UTI. Multivariable analyses showed that recurrent febrile UTIs were associated with greater declines in eGFR, suggesting that multiple UTIs may result in acute kidney injury and long-term functional loss. Antibiotic prophylaxis might mitigate UTI severity and prevent associated kidney damage. The study highlights the potential for recurrent UTIs to cause kidney injury detectable through eGFR decline, even when kidney scarring on imaging (DMSA scans) is absent. While these findings are hypothesis generating due to study limitations, they emphasize the need for larger studies to explore eGFR changes and kidney injury in children with recurrent UTIs. APALUTAMIDE FOR HIGH-RISK LOCALIZED PROSTATE CANCER FOLLOWING RADICAL PROSTATECTOMY (APA-RP) With radical prostatectomy (RP) alone, 25%–50% of patients with high-risk localized prostate cancer experience biochemical recurrence (BCR) within 2 years.[5] The Apa-RP study (NCT04523207) investigated whether adding 12 months of apalutamide plus androgen deprivation therapy (ADT) improves BCR-free survival in high-risk localized prostate cancer patients after RP. The study enrolled 108 patients, most of whom had Grade Group 5 disease. High-risk patients who had RP received 12 cycles of apalutamide (240 mg daily; 28-day cycles) plus ADT. The primary endpoint was BCR-free survival. Secondary endpoints included testosterone recovery (>150 ng/dL) and safety. The BCR-free rate at 12 months (at the end of planned treatment) was 100% and significantly better than historical rates of ~75% with RP alone. The serum testosterone recovery rates to >150 ng/dL at 6 and 12 months after completion of treatment were 36% and 77%, respectively. Safety was consistent with previous studies, with 22% experiencing grade 3–4 adverse events, and no deaths occurred. While the study design was single-arm without a comparator group, the findings suggest that adding apalutamide and ADT could be an effective treatment for high-risk patients post-RP. A phase 3 trial, PROTEUS, is ongoing to evaluate this approach further. URETERAL STENT AFTER PCNL: IS LEAVING THE THREADS THROUGH THE PERCUTANEOUS TRACT SAFE AND BETTER TOLERATED? This study evaluates the safety, feasibility, and patient tolerance of removing JJ stents via exteriorized threads through the percutaneous tract following tubeless percutaneous nephrolithotomy.[6] Conducted with 52 patients randomized into two groups (threads exteriorized through the urethra or the percutaneous tract), outcomes were assessed using the validated ureteral stent symptom questionnaire. Patients in the percutaneous group demonstrated significantly fewer urinary symptoms (P = 0.008), reduced pain (P = 0.009), and better overall well-being (P = 0.042) compared to those in the urethral group. Importantly, this method showed no increased risks of infection (P = 0.603) or bleeding (P = 0.321). Moreover, percutaneous thread placement obviated the need for cystoscopy, allowing for safe stent removal in an outpatient setting within 8 days. The findings underscore that this approach enhances patient comfort and quality of life while maintaining procedural safety and efficiency. However, its application is limited to uncomplicated cases, warranting further exploration in diverse patient cohorts. RANDOMIZED TRIAL OF NO, SHORT-TERM, OR LONG-TERM ANDROGEN DEPRIVATION THERAPY WITH POSTOPERATIVE RADIOTHERAPY AFTER RADICAL PROSTATECTOMY: RESULTS FROM THE THREE-WAY COMPARISON OF RADICALS-HD (NCT00541047) The RADICALS-HD trial evaluated the optimal duration of ADT with postoperative radiotherapy (RT) in prostate cancer patients after RP.[7] RT was given as salvage in 300/492 (61%) participants and adjuvant in 192/492 (39%). These participants were randomized into three groups: no ADT (None), 6-month ADT (Short), or 24-month ADT (Long). The study’s primary focus was metastasis-free survival, with secondary outcomes including overall survival and freedom from distant metastasis. Over a median follow-up of 9 years, no significant differences were found among the 3 groups, with approximately 80% remaining metastasis-free after 10 years. While adding ADT extended the time to the initiation of salvage RT, it did not improve overall survival or reduce distant metastases significantly. There was no statistically significant difference between the groups in overall survival (overall log-rank P = 0.940) or in freedom from distant metastases (overall log-rank P = 0.768). These results suggest that long-term ADT offers limited benefit for most patients in this context, particularly those with favorable disease characteristics. ONCOLOGICAL OUTCOMES OF ORGAN-SPARING CYSTECTOMY VERSUS STANDARD RADICAL CYSTECTOMY IN MALE PATIENTS DIAGNOSED WITH BLADDER CANCER This study compared oncological outcomes of organ-sparing cystectomy (OSC) and standard radical cystectomy (SRC) in male bladder cancer patients using data from the SEER database (2004–2015).[8] SRC involves the removal of the bladder, prostate, seminal vesicles, distal ureters, and regional lymph nodes. OSC includes complete preservation of the prostate and techniques such as preserving the prostatic capsule, seminal vesicles, and neurovascular bundles. OSC mainly encompasses four surgical techniques: prostate-sparing cystectomy, capsule-sparing cystectomy, seminal-sparing cystectomy, and nerve-sparing cystectomy. Among 7,264 patients, 96.8% underwent SRC, while 3.2% received OSC. Patients with higher T stages and high-grade tumors were less likely to undergo OSC. Baseline differences between groups were adjusted using propensity score matching (PSM). Results showed that OSC was associated with worse overall survival (HR = 1.39, 95% CI 1.10–1.75, P = 0.005) and cancer-specific survival (CSS-HR = 1.39, 95% CI 1.03–1.88, P = 0.031) compared to SRC. Subgroup analyses revealed comparable outcomes for nonmuscle invasive bladder cancer and T2 stages but significantly poorer outcomes in the T3 stage. While OSC techniques preserve urinary and sexual functions, it raises concerns about oncological efficacy, particularly in advanced tumors. Limitations include sparse OSC data and a lack of surgical margin and hospital volume information. Financial support and sponsorship: Nil. Conflicts of interest: There are no conflicts of interest.

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