A recent Urology digest,
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Study Type: Systematic review of prospective cohort studies

Key Question: Do dietary factors influence the risk of developing urothelial (bladder) cancer?

Key Findings:

• 32 cohort studies (~2.28 million participants) assessed diverse dietary exposures (fluid, coffee, milk, tea, alcohol, fruit/vegetables, protein, fibre); most showed no consistent association with bladder cancer risk.
• Fluid intake showed a borderline inverse association in 2/4 studies; fruit and vegetable intake showed modest inverse associations in 3 studies.
• Coffee showed no association in 3/4 studies after smoking adjustment; one showed a modest increased risk.

Clinical Relevance: UK urology clinicians can reassure patients that dietary modification is unlikely to meaningfully reduce bladder cancer risk, supporting continued focus on smoking cessation and occupational exposure reduction as primary prevention strategies.

Limitations: Most included studies carried moderate risk of bias, with residual confounding—particularly incomplete adjustment for smoking—limiting causal inference.

Study Type: Narrative review

Key Question: How does upper urinary tract (UUT) physiology respond to the mechanical, thermal, chemical and pressure-related stressors imposed by modern endourological procedures, and what does this mean for defining safe practice?

Key Findings:

• UUT function depends on coordinated peristalsis, urothelial barrier integrity, pressure regulation and perfusion, all of which can be disrupted by ureteroscopy, PCNL, irrigation/intrarenal pressure, laser lithotripsy, suction devices and stents.
• Endourological interventions may alter urothelial permeability, promote intrarenal backflow, inflammation and fibrosis, with individual tissue tolerance varying by hydronephrosis, collecting-system compliance and papillary morphology.
• Current practice prioritises technical success (e.g., stone-free rates) while physiological/biological safety endpoints remain undefined.

Clinical Relevance: UK urologists performing high-volume stone surgery should recognise that technical success does not equate to biological safety, supporting a case for developing standardised physiological outcome measures to refine intraoperative pressure and energy thresholds in NHS endourology practice.

Limitations: As a narrative (non-systematic) review, it lacks a structured methodology and quantitative synthesis, limiting the strength of conclusions drawn.

Study Type: Prospective registry-based cohort study

Key Question: How does patient-reported sexual function change 12 months after curative prostate cancer treatment (surgery, radiotherapy ± ADT, or brachytherapy)?

Key Findings:

• Among 13,413 men, sexual function declined significantly across all treatment modalities, with the largest median EPIC-26 sexual function domain score reduction after radical prostatectomy (-60.0%) and smallest after brachytherapy (-40.2%).
• At 12 months, 63.6–91.8% reported poor or absent erectile function, worst after prostatectomy and EBRT+ADT.
• Sexual aid use increased post-treatment but remained low overall, suggesting underutilisation of rehabilitation strategies.

Clinical Relevance: Reinforces the need for NHS urology teams to provide robust pre-treatment counselling on sexual function outcomes across all curative modalities and to embed structured sexual rehabilitation pathways into survivorship follow-up.

Limitations: Observational registry design with international site heterogeneity limits causal inference and generalisability to UK practice patterns.

Study Type: Narrative review

Key Question: Which patients with localized prostate cancer are best suited for primary irreversible electroporation (IRE), and how should candidate selection and technique be optimised?

Key Findings:

• Best candidates: unilateral, MRI-visible, organ-confined ISUP 2–3 disease, PSA density <0.15–0.20 ng/mL/cm³, lesion ≤20 mm for reliable electrode coverage.
• In-field control of clinically significant cancer achieved in ~80–90%; 12-month in-field persistence ~16% (PRESERVE trial); out-of-field recurrence accounts for 15–25% of failures, reflecting multifocality.
• Hemi-gland IRE shows lower persistence than focal ablation (8.6% vs 25%, single-study evidence), but focal templates better preserve erectile function.

Clinical Relevance: Provides practical, risk-stratified selection criteria to guide UK urologists offering IRE within NHS focal therapy pathways, balancing oncological control against functional preservation.

Limitations: Evidence base is heterogeneous and largely derived from small, single-centre or single-study comparisons, limiting generalisability of hemi-gland versus focal outcome comparisons.

Study Type: Cross-sectional survey study

Key Question: What factors influence sexual satisfaction, function, and orgasm following genital gender-affirming surgery (vaginoplasty or vulvoplasty) in transgender and gender-diverse patients?

Key Findings:

• 295/765 (39%) responded; sexual satisfaction did not differ by age, surgery type, race/ethnicity, revision history, or anxiety, but correlated positively with GENDER-Q Orgasm, Social Acceptance, Surgery Outcome, and Body Image scores.
• Of those able to orgasm preoperatively, 80% retained this postoperatively; 29% of previously anorgasmic patients gained postoperative orgasm capacity.
• Postoperative anorgasmia was associated with older age and lower Sexual Well-Being/Surgery Outcome scores.

Clinical Relevance: Highlights the need for UK gender surgery services to incorporate structured pre- and postoperative sexual function assessment (e.g., GENDER-Q) to counsel patients and identify those at risk of poor sexual outcomes.

Limitations: Cross-sectional design with self-selected respondents (39% response rate) limits causal inference and generalisability, particularly regarding longitudinal orgasm trajectories.

Study Type: Retrospective cohort study (ML model development and internal validation)

Key Question: Can machine learning models using clinical and morphological features accurately predict dominant urinary stone composition?

Key Findings:

• Among 442 patients, dominant stone types were COM (41.0%), COD (24.9%), calcium phosphate (19.7%), uric acid (10.9%), and cystine (3.6%).
• A clinical-only model achieved good discrimination (macro-AUC up to 0.809), using stable predictors (age, hereditary disease, stone density, diameter, location).
• Adding Daudon-based morphological features substantially improved performance (macro-AUC up to 0.983 with CatBoost), with morphology ranking highly on SHAP importance.

Clinical Relevance: For NHS stone services, a validated clinical-only model could support preoperative treatment planning (e.g., anticipating uric acid or cystine stones for alternative management), while the enhanced model may aid intra-/postoperative decision-making once externally validated.

Limitations: Single-centre retrospective design without external validation limits generalisability, and the high-performing combined model depends on intra-/postoperative morphological data, restricting its use as a true preoperative tool.

Study Type: Retrospective cohort study

Key Question: Is testosterone therapy (TTH) associated with increased risk of disease progression in men on active surveillance (AS) for low- to intermediate-risk (GG1–2) prostate cancer?

Key Findings:

• Among 3,324 AS patients (79 on TTH), 38% overall progressed on biopsy; TTH was not associated with increased risk of grade progression (HR 0.99; 95% CI 0.67–1.48; p>0.9).
• TTH also showed no association with progression to definitive treatment (HR 0.94; 95% CI 0.64–1.38; p=0.8).
• Adjusted survival curves showed no clinically meaningful separation between TTH and non-TTH groups.

Clinical Relevance: Supports cautious use of testosterone therapy in symptomatic hypogonadal men on AS within UK urology practice, provided standard AS monitoring (PSA, MRI, biopsy) continues per protocol.

Limitations: Small TTH subgroup (n=79) and retrospective design limit statistical power and causal inference; longer follow-up in larger cohorts is needed.

Study Type: Retrospective cohort study (two-centre)

Key Question: Does surgical technique (anastomotic vs. buccal mucosal graft [BMG] urethroplasty) affect stricture recurrence rates in radiation-induced bulbomembranous urethral stenosis (BMUS)?

Key Findings:

• BMG urethroplasty independently associated with higher recurrence risk (HR 3.43, 95% CI 1.03–11.47; p=0.046) versus anastomotic repair.
• 10-year cumulative recurrence: 6.8% (anastomotic) vs. 20% (BMG); log-rank p=0.01.
• No significant differences in 90-day complications, patient satisfaction, erectile dysfunction, or incontinence between techniques.

Clinical Relevance: For UK urologists managing post-radiotherapy prostate cancer patients with BMUS, this supports prioritising anastomotic urethroplasty over BMG onlay when technically feasible, given comparable functional/safety outcomes but substantially lower recurrence.

Limitations: Retrospective design with technique selection likely influenced by unmeasured stenosis characteristics (selection bias), limiting causal inference.