A recent Urology digest,
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Study Type: Retrospective international multicentre cohort study (21 centres, 15 countries; n=716).

Key Question: Is operative time associated with postoperative complications after PCNL in patients aged ≥70, and is there a clinically useful threshold?

Key Findings:

• 30-day complication rates: overall 16.8%, major 6.8%, infectious 6.8%.
• Operative time ≥95 min (ROC-derived) was independently associated with overall (OR 3.37, 95% CI 2.16–5.26), major (OR 2.63, 1.35–5.10), and infectious complications (OR 3.79, 1.90–7.57); the relationship was non-linear, rising steeply beyond ~90–100 min.
• Non-papillary puncture predicted all complication types; positive preoperative urine culture predicted infectious complications.

Clinical Relevance: Supports a pragmatic ~90–100 min intraoperative checkpoint to consider staging or terminating PCNL in older patients, alongside optimising urine culture status and puncture technique.

Limitations: Retrospective design means operative time may be a marker of case complexity or surgeon factors rather than an independent causal driver, and the threshold lacks prospective validation.

Study Type: Reconstructed individual patient data analysis with simulation modelling of six single-arm registrational trials.

Key Question: How do differences in response assessment protocols (biopsy timing, retreatment policy, CR definition) affect reported efficacy across BCG-unresponsive CIS trials?

Key Findings:

• Reclassifying re-induction patients as non-responders reduced 12-month CR for NAI + BCG (44% to 33%) and cretostimogene (45% to 38%).
• Adjusting for an 11% cystoscopy/cytology false-negative rate (derived from the nadofaragene trial) lowered pembrolizumab 12-month CR to 17% (P = 0.07) and NAI to 29% (P = 0.4), both non-significant versus the reference.
• Under mandatory biopsy protocols, TAR-200 reached 12-month CR of 45%, exceeding the reference (P < 0.01).

Clinical Relevance: Headline CR rates cannot be compared directly across agents, which matters when NHS clinicians and commissioners are weighing options for BCG-unresponsive CIS in the absence of head-to-head data.

Limitations: The false-negative adjustment relies on a single trial's data, and indirect comparisons of reconstructed data from single-arm trials remain vulnerable to residual population differences.

Study Type: Preclinical animal study (two independent rat cohorts, n=30 each; sham-controlled) with ex vivo imaging validation.

Key Question: Can collagen-specific photoacoustic imaging detect and map regional bladder wall remodelling in a rat model of partial bladder outlet obstruction?

Key Findings:

• pBOO increased bladder mass and bladder-to-body mass ratio at 4 and 8 weeks (P<0.05); 8-week voiding showed more frequent small-volume voids despite preserved mean, maximum and total voided volumes.
• Remodelling was spatially heterogeneous: the midsection showed the greatest collagen accumulation (raised hydroxyproline and matrix gene expression), but even greater detrusor expansion, lowering the collagen-to-muscle ratio.
• Ex vivo PA collagen density correlated with histological collagen-to-muscle ratio (r=0.75).

Clinical Relevance: If translated, noninvasive PA imaging could allow early, longitudinal detection of obstruction-related bladder remodelling in men with BOO, though human application is distant.

Limitations: PA validation was ex vivo in female rats using a surgical obstruction model, so in vivo feasibility, tissue-depth limits and human applicability remain unproven.

Study Type: Retrospective multicentre diagnostic accuracy and recurrence analysis (two tertiary centres, 2006–2025; 133 patients, 256 URS assessments)

Key Question: Can CT urography and urinary cytology safely replace routine surveillance ureteroscopy after endoscopic kidney-sparing surgery (eKSS) for UTUC?

Key Findings:

• Combined CT and/or cytology: sensitivity 35.5%, specificity 75.0%, NPV 48.0% (95% CI 40.4–55.7). This avoided 69.2% of URS but missed 64.5% of recurrences.
• Cytology alone: sensitivity 11%, specificity 97%. CT alone: sensitivity 27%, specificity 78%. Requiring both positive: sensitivity 2.8%.
• Recurrence rates remained stable at roughly 0.3 events/person-year across years 1–4 in both low-risk and high-risk groups, with no decline over time.

Clinical Relevance: Non-invasive surveillance cannot substitute for endoscopic follow-up after eKSS, so UK units should continue scheduled URS, including beyond year 2, rather than de-escalating on the basis of imaging and cytology.

Limitations: Retrospective design with URS as the reference standard, restricted to tertiary centres, with reported analysis starting from the third URS, which may limit generalisability.

Study Type: Cross-sectional review of registered trials (ClinicalTrials.gov, 1994–2025).

Key Question: How often are patient-reported outcomes (PROs) incorporated as endpoints in interventional NMIBC trials?

Key Findings:

• Only 21 of 94 trials (22%) included PROs; 3% as primary and 20% as secondary endpoints, with little change over time.
• EORTC QLQ-C30 (48%) and QLQ-NMIBC24 (43%) were the most frequently used tools among PRO-incorporating trials.
• PRO trials had larger planned enrolment (median 166 vs 46, P = 0.002); RCT design showed a trend only (62% vs 41%, P = 0.057). Funding source did not differ.

Clinical Relevance: Trial evidence informing NMIBC treatment decisions (including intravesical therapy) rarely captures patient experience, limiting shared decision-making and NICE/NHS value assessments that increasingly weigh quality of life.

Limitations: Registry-based analysis depends on the completeness of ClinicalTrials.gov entries, so PRO use may be under-reported; the study also cannot assess PRO quality or reporting in publications.

Study Type: Retrospective cohort study (SEER database, 2004–2021) with propensity score matching and competing risks regression.

Key Question: Does a delay of more than 3 months from diagnosis to nephrectomy increase cancer-specific mortality in pT1b-2 N0M0 renal cell carcinoma?

Key Findings:

• Of 16,322 patients, 18% (3,023) had surgery >3 months after diagnosis. After 1:1 matching, 60-month CSM was 7.6% vs 5.9% for delayed vs timely surgery; delay independently predicted 1.3-fold higher CSM (P = 0.02).
• Dose-response pattern: ~1.3-fold higher CSM at 3–6 months and 1.6-fold at >6 months.
• Effect was consistent across grades but not seen in non-clear cell histology.

Clinical Relevance: Supports prioritising clear cell RCC for timely surgery within NHS pathways, where capacity pressures and backlogs may push waits beyond 3 months.

Limitations: Retrospective SEER data with pathological (not clinical) staging introduces selection and immortality bias, and the abstract's matching figures are internally inconsistent (e.g., 100% vs 23% of matched patients), so the reported numbers should be verified against the full text.

Study Type: Retrospective real-world cohort study (EV + P, n = 322; pembrolizumab monotherapy comparator cohort, n = 232)

Key Question: Are pretreatment tumour NECTIN4 RNA expression and tumour mutational burden (TMB) associated with outcomes in metastatic urothelial carcinoma treated with first-line enfortumab vedotin plus pembrolizumab?

Key Findings:

• NECTIN4-high vs low: OS HR 0.67 (95% CI 0.46-0.98; median 21.5 vs 14.2 months); ORR 67.4% vs 41.9%. Independent on multivariable analysis (adjusted OS HR 0.62, 95% CI 0.41-0.93).
• TMB-high vs low: OS HR 0.57 (95% CI 0.33-0.96); ORR 69.2% vs 52.6%.
• Double-low (NECTIN4-low and TMB-low) tumours fared worst (OS HR 0.61 favouring either marker high). NECTIN4 showed no significant association with outcomes on pembrolizumab alone.

Clinical Relevance: With EV + P now standard first-line therapy in the UK, this suggests a potential predictive biomarker, though it is not yet actionable for treatment selection.

Limitations: Retrospective design without prospective validation, and no defined thresholds or testing platform accessible in routine NHS practice.

Study Type: Multicentre RCT (5 US centres; 178 enrolled, 133 analysed for primary outcome)

Key Question: Does stone-free rate after RIRS dusting differ between pulse-modulated Ho:YAG and thulium fibre laser for intrarenal stones 5-20 mm?

Key Findings:

• Zero-fragment stone-free rate on CT at 6-12 weeks was near-identical: 52.9% (36/68) Ho:YAG vs 52.3% (34/65) TFL (p=0.942).
• No significant differences in procedure time, laser time, laser efficiency, or complication rates.
• Baseline demographics and stone parameters were balanced between arms.

Clinical Relevance: Supports choosing between these lasers on availability, cost and surgeon preference, which is pertinent to NHS procurement decisions; the roughly 50% zero-fragment rate also informs patient counselling after dusting.

Limitations: No power calculation, effect size or confidence intervals are reported in the abstract, and a 45-patient gap between enrolment and analysis is unexplained, so equivalence cannot be firmly concluded.