Urology
An alpha-blocker before catheter removal raised trial-without-catheter success by about 25 points
A meta-analysis of eight trials supports starting an alpha-blocker in men with BPH-related retention. Long-term PSA screening trials now show a prostate cancer mortality benefit with high certainty, and a probiotic E. coli strain showed an early, non-significant signal in recurrent UTI.
After a negative prostate MRI, PSA density sorted who needed another look
In Göteborg-2, men with PSA density below 0.10 had less than half the seven-year risk of significant cancer after a clear MRI; a membranous urethral length model predicted near-continence but not pad-free continence; and a local-anaesthetic device handled small bladder recurrences in clinic.
Abiraterone intensification did not raise fracture admissions in STAMPEDE, and lowered them in metastatic disease
A secondary analysis of two STAMPEDE trials eases a common worry about adding abiraterone to ADT; complete response rates in BCG-unresponsive CIS trials are not comparable as published; and PSMA-guided biopsy is well tolerated.
In 267,133 patients with microhaematuria, 1.5% had bladder cancer at two years — and the guideline's risk tiers barely separated them
A Veterans Affairs cohort shows why age, sex, smoking and red-cell count should shape who gets cystoscopy, ADT is associated with a third more acute kidney injury, and ileal and colonic neobladders trade night continence for spontaneous voiding.
ASTRO endorses trimodal bladder preservation as an alternative to cystectomy for selected muscle-invasive disease; most men lose erectile function after curative prostate treatment
A new radiation oncology guideline sets out bladder preservation, a 13,000-man registry quantifies sexual function loss after prostatectomy and radiotherapy, the ProBIOPSY consensus standardises targeted biopsy, thulium and holmium enucleation come out level, and the first randomised trial of robotic kidney transplantation misses its primary endpoint.
Prehabilitation before radical prostatectomy lowered the odds of early incontinence
Sixteen randomised trials support starting pelvic floor and exercise training before surgery; EAU restructures its infection guidelines and updates biopsy prophylaxis; testosterone was not linked to progression on active surveillance; and Stockholm3 could spare a fifth of surveillance biopsies.
Ejaculation-sparing prostate surgery raised the odds of keeping antegrade ejaculation nearly sevenfold, with no loss of urinary benefit
A meta-analysis backs ejaculation-sparing BPH techniques, NRG-GU005 finds five-fraction SBRT kinder on bowel function and continence but no better at disease control, a real-world pooling compares mHSPC doublets, and intermittent enzalutamide caused gynaecomastia in 42%.
Suction sheaths raise stone-free rates and cut sepsis
A Bayesian network meta-analysis of 3657 patients puts flexible aspiration sheaths ahead of conventional ureteroscopy for stones under 2 cm — with lower odds of postoperative sepsis. Plus what a national registry says about open versus robotic prostatectomy, and where triplet therapy in mHSPC actually earns its toxicity.
With two decades of follow-up, PSA screening does reduce prostate cancer deaths
Five trials and 721,607 men, at high certainty — and the authors still stop short of endorsing population screening; plus the 2026 EAU update on metastatic disease, a urine test that beat MRI on active surveillance, and frailty as the missed variable before an artificial sphincter.
PSA density after a negative MRI could cut repeat scans by 60% and biopsies by 46%
A pre-specified Göteborg-2 analysis puts a number on what a negative MRI actually buys you, and on what a density-guided follow-up would cost in delayed diagnoses. Also: Cochrane finds HoLEP's only proven advantage over TURP is transfusion, and anastomotic repair beats buccal graft after radiotherapy strictures.
Abiraterone did not break bones — in metastatic disease it prevented fractures
Linked hospital data from 3,102 STAMPEDE patients found five-year fracture hospitalisation lower with abiraterone, not higher: 22% against 30%. Plus a suction access sheath that changed the numbers on infected stones, a device-versus-physiotherapist trial in post-prostatectomy incontinence, and the 2026 NMIBC guideline.
Bladder cancer followed microhaematuria in 1.5% of 267,133 patients, and the AUA risk tiers barely discriminated
A guideline classification performing at an AUC of 0.52, the EAU's new five-tier localised prostate cancer system, salvage radiotherapy outcomes that did not follow socioeconomic disadvantage, and a Class II recall of compounding-grade sildenafil.
ASTRO guideline: trimodal therapy is an alternative to cystectomy for selected muscle-invasive bladder cancer
The ASTRO bladder cancer radiotherapy guideline closes the edition. Before it: sexual function a year after prostate cancer treatment, recurrences during bladder-sparing surveillance, thulium fibre against holmium enucleation, and an FDA supplement for a generic tadalafil.
80 Gy with long-term ADT cut 10-year progression by 44% in high-risk prostate cancer
GETUG AFU 18 finally shows a durable benefit from dose escalation alongside hormones; a blinded Indian trial favours thinner stents after ureteroscopy; and testosterone therapy did not speed progression on active surveillance.
Gynaecomastia on enzalutamide has nothing to do with the testosterone
Forty-two per cent of men on intermittent enzalutamide monotherapy developed gynaecomastia, and neither peak testosterone nor how long it stayed up predicted who. Plus a Class II recall on compounding-grade tadalafil, and a four-arm stone trial worth reading carefully.
Suction changes what a flexible ureteroscopy achieves
A Bayesian network meta-analysis of 3,657 patients puts aspiration sheaths well ahead of conventional access for stones under 2 cm, including on sepsis; an FDA recall hits sildenafil and tadalafil compounding powder; and one in six schoolchildren has daytime urinary symptoms.
A recall on the raw material, and a urine test that sees recurrence four months early
The EAU has rewritten its relapsing and metastatic prostate cancer guidance; the first randomised comparison of robotic and open kidney transplantation misses its endpoint but points somewhere; and urine tumour DNA finds BCG failures before cystoscopy does.
Cochrane on HoLEP: one advantage over TURP survives the randomised evidence, and it is transfusion
Fifty-two trials and 6,242 men, and at 12 months HoLEP and TURP look alike on symptoms, quality of life, major adverse events, re-treatment and erectile function. Transfusion is the exception, RR 0.19. Plus a randomised trial of PSMA PET-guided biopsy, machine learning for stone composition, a tadalafil ingredient recall, and where the guidelines now agree on lutetium-177.
A suction sheath changed the numbers in infected stone surgery
185 patients randomised: lower white cell count, CRP and procalcitonin at six and 24 hours, higher stone-free rates, shorter operating time and fewer complications with a flexible negative-suction access sheath. Plus PSA screening reaches high-certainty evidence at 11 to 23 years, and abiraterone turns out to reduce fractures in metastatic disease, not cause them.
Leaving the renal bed unsutured met its noninferiority margin — in one surgeon's hands
A 248-patient randomised trial of sutureless against renorrhaphy in purely off-clamp robotic partial nephrectomy found Trifecta rates of 93% and 95%, within the prespecified margin. Plus mitomycin-C given before the resection rather than after, frailty as the missing variable in continence surgery, a compounding-grade API recall, and the ProBIOPSY consensus.
A urine test beat MRI at deciding who needs a surveillance biopsy, and two of three checkpoint inhibitors added to BCG worked
MyProstateScore 2.0 avoided nearly two-thirds of unnecessary active surveillance biopsies while missing 3% of significant upgrades, durvalumab and sasanlimab improved outcomes with BCG while atezolizumab did not, and triplet therapy in metastatic hormone-sensitive disease still has no overall survival advantage in unselected patients.
Mirabegron tablets recalled over a nitrosamine impurity
An ongoing Class II FDA recall covers mirabegron extended-release 25 mg tablets after an out-of-specification result for N-nitroso mirabegron, the EAU has restructured its urological infections guidelines around a new UTI classification, and adding tolterodine to tamsulosin improved distal ureteral stone expulsion from 66.7% to 83.3%.
Lutetium-PSMA moves earlier: a survival-pathway win in hormone-sensitive prostate cancer
The phase 3 PSMAddition trial adds 177Lu-PSMA-617 to standard treatment in metastatic hormone-sensitive prostate cancer and slows progression, dose-escalated radiotherapy earns a 10-year edge in high-risk disease, and a network meta-analysis sorts the overactive-bladder drugs — as one of them is recalled for a nitrosamine impurity.
PSMA radioligand therapy moves earlier: PSMAddition meets its endpoint in hormone-sensitive disease
Adding lutetium-177 PSMA-617 to ADT and an androgen receptor pathway inhibitor cut radiographic progression by 28% in metastatic hormone-sensitive prostate cancer, dose-escalated radiotherapy shows a widening benefit at ten years, and a smaller ureteric stent is more comfortable but falls out more often.