Abiraterone did not break bones — in metastatic disease it prevented fractures

The edition in brief

Today's urology edition opens with a secondary analysis of two STAMPEDE trials. Androgen receptor pathway inhibitors have been reported to raise fracture risk, so this analysis linked 3,102 of 3,893 randomised patients in England to Hospital Episode Statistics and used a prespecified coding framework to identify fracture-related hospitalisation, with death as a competing risk. In metastatic disease, five-year incidence was lower with standard care plus abiraterone and prednisolone than standard care alone (22% versus 30%; sub-distribution hazard ratio 0.77, 95% CI 0.59-0.99, p=0.04), and lower again with abiraterone plus enzalutamide (28% versus 38%; SDHR 0.69, 0.54-0.88, p=0.002). No difference appeared in non-metastatic disease. A randomised trial in 185 patients with infectious upper urinary tract stones compared flexible ureteroscopy using a flexible negative-suction access sheath with a traditional sheath. Stone-free rates were higher at day one and at 30 days, white cell count, C-reactive protein and procalcitonin were lower at 6 and 24 hours, operative time and hospital stay were shorter, and the overall complication rate was lower. In 109 men after radical prostatectomy randomised to device-based or physiotherapist-guided pelvic floor training alongside resistance training, both groups improved and treatment success did not differ (52.1% overall; OR 1.19, 95% CI 0.53-2.66). Time since surgery predicted failure. And the AUA and SUO have updated the non-muscle-invasive bladder cancer guideline.