The edition · Urology
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.
The edition in brief
Two findings today reverse an assumption. A randomised trial in 185 patients with infectious upper urinary tract stones compared flexible ureteroscopy using a flexible negative-suction ureteral access sheath against a traditional sheath. The suction group had lower white cell count, C-reactive protein and procalcitonin at both six and 24 hours after surgery, higher stone-free rates on day one and at 30 days, shorter operating time, shorter stay, better quality of life and a lower overall complication rate. Ureteral stricture at three months did not differ. Separately, a secondary analysis within the STAMPEDE platform linked 3,102 English patients to hospital episode data and found that abiraterone-based intensification did not increase fracture-related hospitalisation as earlier meta-analyses had suggested. In metastatic disease it reduced it: five-year incidence 22% versus 30% with abiraterone added (subdistribution hazard ratio 0.77, 95% CI 0.59 to 0.99) and 28% versus 38% with abiraterone plus enzalutamide (0.69, 0.54 to 0.88). There was no difference in non-metastatic disease. A meta-analysis of 5 randomised trials and 721,607 participants followed for 11 to 23 years found high-certainty evidence that PSA-based screening reduces prostate cancer-specific mortality among those who engage in it, with a larger relative reduction the longer the follow-up — while stating that this does not by itself justify population screening. The AUA and SUO have updated their non-muscle-invasive bladder cancer guideline, and Class II recalls have been issued for mirabegron tablets and for sildenafil and tadalafil compounding powders.
Negative-suction access sheath lowered the inflammatory response after infected stone surgery
A flexible negative-suction ureteral access sheath lowered white cell count, CRP and procalcitonin at six and 24 hours and raised stone-free rates in infected upper tract stones — the population most at risk of post-operative sepsis.
PSA screening now has high-certainty evidence — and still does not settle the policy question
High-certainty evidence from 5 trials and 721,607 men followed 11 to 23 years shows PSA-based screening reduces prostate cancer death among those screened — which changes the counselling conversation without settling whether to screen a population.
Abiraterone reduced fracture hospitalisation in metastatic disease rather than causing it
Abiraterone-based intensification did not raise fracture hospitalisation and in metastatic disease reduced it, from 30% to 22% at five years — fracture risk is not a reason to withhold it.
Mirabegron and compounding-grade sildenafil and tadalafil recalled; new AUA guideline for NMIBC
Class II recalls affect mirabegron 25 mg tablets and bulk sildenafil and tadalafil compounding powder; separately, the AUA and SUO have revised NMIBC risk stratification and their statements on intravesical therapy and BCG maintenance.
Real-world data ranks the mHSPC doublets — with the usual caveat
Real-world data across 18,626 patients favoured apalutamide over abiraterone on survival and PSA response but favoured abiraterone on tolerability — retrospective evidence that should not override cost, comorbidity or a stable regimen.
Drain the obstructed infected kidney today; the stone can wait a month
In an obstructed infected kidney, decompress within hours and treat the stone weeks later — and send a culture from the collecting system, not just the bladder.
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