The edition · Urology
ESBL complicated UTI: oral fosfomycin step-down was non-inferior to staying on IV
A Korean trial supports switching improving patients to oral fosfomycin and sparing carbapenems, while an ENZAMET biomarker study and a SEER analysis of surgical delay sharpen two cancer decisions.
The edition in brief
Today's urology edition opens on kidney cancer timing. A SEER analysis of 16,322 patients with pT1b–2 renal cell carcinoma found that waiting more than three months from diagnosis to nephrectomy was associated with higher five-year cancer-specific mortality (7.6% vs 5.9% after matching), with a larger effect beyond six months and no effect in non-clear-cell tumours. A biomarker analysis of the ENZAMET trial found an artificial-intelligence pathology classifier separated men with metastatic hormone-sensitive prostate cancer who gained from enzalutamide (HR 0.50) from those with little evidence of benefit (HR 1.04). A multicentre database of 1,887 men found waterjet ablation after previous failed BPH surgery gave outcomes and complication rates similar to first-time treatment. The pearl covers selecting patients for oral step-down in complicated UTI. The edition closes on a randomised non-inferiority trial of 299 adults with complicated UTIs caused by ESBL-producing Enterobacterales: after improvement on 3 to 7 days of intravenous therapy, switching to oral fosfomycin 3 g daily gave clinical cure in 92.8% against 95.2% on continued intravenous carbapenem or β-lactam/β-lactamase inhibitor, meeting non-inferiority, with similar microbiological cure and safety.
Waiting over three months for nephrectomy linked to higher kidney cancer mortality
For larger localised renal cancers, aim for surgery within three months of diagnosis; delays beyond that were linked to higher cancer-specific mortality.
An AI pathology classifier picked out who gained from enzalutamide in ENZAMET
An AI slide classifier identified men most likely to benefit from enzalutamide, but it needs validation before it changes treatment.
Waterjet ablation after failed BPH surgery performed like first-time treatment
Waterjet ablation after failed BPH surgery gave outcomes similar to first-time treatment in this series, making it a reasonable salvage option where available.
Who is ready for oral step-down in complicated UTI
Step down to oral antibiotics once the patient is afebrile and stable, the source is controlled, and a susceptible oral option exists.
Oral fosfomycin step-down for ESBL complicated UTI met non-inferiority
In improving patients with ESBL complicated UTI, consider stepping down to oral fosfomycin to spare carbapenems, with susceptibility confirmed where possible.
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