The edition · Urology
An acute kidney signal with androgen deprivation, and a shift in stone surgery
Plus the 2026 advanced prostate cancer guideline amendment, how ileal and colonic neobladders compare, and the haematuria that always needs referral.
The edition in brief
Today's urology edition opens on a safety signal. A meta-analysis of 72,980 patients found androgen deprivation therapy was associated with higher odds of acute kidney injury (odds ratio 1.34), driven by GnRH agonists rather than orchiectomy — a reminder to watch renal function and nephrotoxic co-exposures in men on ADT. The AUA/SUO advanced prostate cancer guideline was amended for 2026, updating imaging, germline and somatic testing, and the management of biochemically recurrent and metastatic hormone-sensitive disease. A meta-analysis of neobladder reconstruction found ileal pouches gave better nighttime continence and fewer early complications, while sigmoid pouches voided more spontaneously, supporting individualised choice. A clinic pearl reaffirms that visible painless haematuria always warrants referral to exclude urothelial cancer. The practice-changer: a meta-analysis of 2,347 patients found suction-assisted flexible ureteroscopy matched mini-percutaneous nephrolithotomy for stone clearance of 2-to-3 cm stones with fewer complications and shorter stays, challenging the guideline default of percutaneous surgery for larger renal stones.
Androgen deprivation therapy linked to acute kidney injury
Monitor renal function in men on androgen deprivation therapy, especially GnRH agonists, and be cautious with nephrotoxic co-exposures.
Advanced prostate cancer guideline amended for 2026
Use the 2026 AUA/SUO amendment, not the 2023 version, when evaluating and treating biochemically recurrent and metastatic hormone-sensitive prostate cancer.
Ileal and colonic neobladders trade continence against voiding
Individualise neobladder choice after cystectomy: ileum for nighttime continence and smoother early recovery, sigmoid for more spontaneous voiding.
Treat visible painless haematuria as cancer until proven otherwise
Refer every episode of visible painless haematuria for cystoscopy and upper-tract imaging to exclude urothelial cancer.
Suction ureteroscopy matched mini-PCNL for larger renal stones
For selected 2-to-3 cm renal stones, suction-assisted flexible ureteroscopy is a viable primary alternative to mini-percutaneous nephrolithotomy, with fewer complications and shorter stays.
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