The edition · Urology
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.
The edition in brief
Today's urology desk leads with functional outcomes after radical prostatectomy from the New Zealand registry: 4889 men, 2844 open and 2045 robotic, assessed with EPIC-26 at 12 months. Robotic surgery scored higher in every domain, and the adjusted differences exceeded the minimal clinically important threshold for urinary incontinence (6.9 points, 95% CI 4.6 to 9.2) and sexual function (11.4 points, 9.1 to 13.7). Zero pad use was 65.1 versus 54.4 per cent and two or more pads 3.9 versus 10.0 per cent. An updated network meta-analysis of 23 trials and 18,689 men with metastatic hormone-sensitive prostate cancer found no triplet regimen significantly improved overall survival over an androgen receptor pathway inhibitor plus androgen deprivation in all-comers; docetaxel added to that combination did improve survival in high-volume disease (HR 0.76, 95% CI 0.61 to 0.95, high certainty). A Japanese national survey of 3100 children aged 6 to 15 found daytime lower urinary tract symptoms in 17.5 per cent, nocturnal enuresis in 5.1 per cent and chronic functional constipation in 14.0 per cent, with enuresis commoner in boys and falling with age. The practice-changer is a Bayesian network meta-analysis of 17 studies and 3657 patients: flexible aspiration navigable sheaths gave a higher 30-day stone-free rate than conventional access sheaths for renal stones of 2 cm or less (OR 2.5, 95% credible interval 2.0 to 3.1) with lower odds of postoperative sepsis (OR 0.40, 0.12 to 0.97), while performance varied substantially by device.
Robotic prostatectomy, measured by the men who had it
Robotic prostatectomy carries clinically meaningful advantages in continence and sexual function at 12 months in registry practice — quote the pad rates, not the scores.
Triplet therapy in mHSPC: the survival gain is in high-volume disease
Add docetaxel to ARPI plus ADT for high-volume metastatic hormone-sensitive disease, and not as a default for everyone.
One child in six has daytime urinary symptoms
Ask about bowels first in any child with daytime urinary symptoms — functional constipation was present in one in seven in this population.
Send the stone, and ask for the analysis back
Send every stone for composition analysis and book the follow-up for when the result will be back.
Suction ureteroscopy: higher stone-free rates, less sepsis, and device matters
Use a flexible aspiration sheath for sub-2 cm renal stones where you have one, and judge the device on its own data rather than on the category.
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