After radical cystectomy, fracture risk roughly doubled in women, with no rise in bone treatment

The edition in brief

A nationwide Swedish register study compared 2,908 patients who had radical cystectomy with urinary diversion (2011–2019) with 13,669 matched referents. Women had about double the risk of femoral fracture (HR 1.97) and any fracture (HR 2.06), and men a higher risk of any fracture (HR 1.51), yet initiation of bone-specific drug therapy did not increase. Metabolic acidosis and malabsorption after diversion are plausible contributors, and the gap in bone assessment is the practical message. A reconstructed individual-patient meta-analysis of three phase 3 trials (2,590 patients) found that adding a checkpoint inhibitor to BCG induction and maintenance improved event-free survival in BCG-naive high-risk NMIBC (HR 0.77), but not with induction-only BCG, and severe adverse events rose from 6.1% to 24.5%; overall survival data are immature. In a single-centre study of 66 men with PI-RADS 3 lesions and a high-risk feature, PSMA PET/MRI-targeted biopsy found more clinically significant cancer than MRI-targeted biopsy (15% vs 6%), and a negative PET would have spared 68% a biopsy without missing significant cancer. A randomised trial of 100 stone patients found a sulfonic acid-coated stent halved encrustation and reduced stent symptoms. The pearl covers stent registers.