Société Internationale d’Urologie Journal

SIUJ, Vol. 7, Pages 31: Global Urology in an Era of Geopolitical Division

Henry H. Woo — 2026-04-21

SIUJ, Vol. 7, Pages 31: Global Urology in an Era of Geopolitical Division

Société Internationale d’Urologie Journal doi: 10.3390/siuj7020031

Authors: Henry H. Woo

It is difficult to comprehend how much the world has changed since the publication of the last Société Internationale d’Urologie Journal (SIUJ) issue in February [...]

SIUJ, Vol. 7, Pages 30: External Validation of the EAU Guidelines Bot for Urethral Stricture: Accuracy, Completeness, and Clarity Analysis

Pietro Spatafora — 2026-04-21

SIUJ, Vol. 7, Pages 30: External Validation of the EAU Guidelines Bot for Urethral Stricture: Accuracy, Completeness, and Clarity Analysis

Société Internationale d’Urologie Journal doi: 10.3390/siuj7020030

Authors: Pietro Spatafora Riccardo Lombardo Manfredi Bruno Sequi Marta Santioni Eleonora Rosato Matteo Romagnoli Sabrina De Cillis Enrico Checcucci Daniele Amparore Mauro Ragonese Nazario Foschi Valerio Santarelli Giorgia Tema Antonio Franco Antonio Luigi Pastore Bernardo Rocco Mauro Gacci Sergio Serni Giacomo Gallo Vincenzo Pagliarulo Cristian Fiori Enrico Finazzi Agrò Francesco del Giudice Alessandro Sciarra Andrea Tubaro Cosimo De Nunzio

Background/Objectives: Recently the European Association of Urology (EAU) guidelines presented the EAU Guidelines bot to assist urologists in the reading of the guidelines; however, there is a lack of up-to-date external validation. The aim of our study is to assess the accuracy, completeness, and clarity of the guidelines bot in urethral strictures. Methods: A total of 117 questions based on the EAU urethral strictures guidelines recommendations were developed. Each question was input to the EAU guidelines bot and the response was assessed by two expert urologists to assess the accuracy, completeness, and clarity. Moreover, 10 simple clinical cases were input. A 5-point Likert scale was used as a score and, in case of discrepancies, a third urologist was queried. Accuracy, completeness and clarity were assessed per chapter and per grade of recommendation. All questions and answers were recorded in an Excel file. Results: Overall 117 questions were developed. In terms of accuracy, 111/117 (95%) were defined as accurate (scores 4–5), 4/117 (3%) presented a fair accuracy (score 3), and 2/117 (2%) were deemed not accurate. In terms of completeness, 93/117 (80%) were defined as complete (scores 4–5), 22/117 (19%) presented a fair completeness (score 3), and 2/117 (2%) were deemed not complete. Finally, in terms of clarity, 104/117 (89%) were defined as clear (scores 4–5), 13/117 (11%) presented a fair clarity (score 3), and 0/109 (0%) were deemed not clear. When comparing strong and weak recommendations, no differences were recorded. Overall the answers to simple clinical cases were in line with the guidelines with good accuracy, completeness and clarity scores. Conclusions: The EAU guidelines bot represents an accurate tool for urethral stenosis guidelines. Some fine-tuning is needed to improve readability and clarity.

SIUJ, Vol. 7, Pages 29: Impact of Expedited Ureteroscopy on Emergency Department Utilisation in Stented Patients with Urolithiasis

Henry Wang — 2026-04-20

SIUJ, Vol. 7, Pages 29: Impact of Expedited Ureteroscopy on Emergency Department Utilisation in Stented Patients with Urolithiasis

Société Internationale d’Urologie Journal doi: 10.3390/siuj7020029

Authors: Henry Wang Christine Zhao Andrew Brooks Ankur Dhar Simon Bariol

Background/Objectives: Ureteric stents are commonly used in the management of urolithiasis but are associated with significant morbidity, leading to unplanned emergency department presentations and increased healthcare utilisation. This study aimed to evaluate whether reducing ureteric stent dwell time from three months to one month was associated with reduced stent-related emergency presentations. Secondary objectives were to assess post-ureteroscopy infective complications and identify predictors of emergency attendance. Methods: A retrospective cohort study was conducted across Western Sydney Local Health District, comparing patients undergoing ureteric stenting prior to ureteroscopy before (n = 189) and after (n = 244) an institutional policy change reducing time to definitive surgery from three months to one month. Patients aged ≥16 years with urolithiasis were included. Results: Following the policy change, mean waiting time for ureteroscopy decreased from 97.3 to 40.6 days. The proportion of patients presenting to the emergency department (ED) for stent-related symptoms decreased from 31.7% to 16.4% (p < 0.001), and mean presentations per patient declined from 0.60 to 0.21 (p < 0.001). Stent irritation accounted for most presentations. Using multivariable analysis, age < 50 years, immunosuppression, and positive pre-operative urine cultures were independently associated with ED attendance. Post-ureteroscopy infective complications were lower in the shortened dwell-time cohort (2.0% vs. 4.2%) but did not reach statistical significance (p = 0.26). Conclusions: Reducing routine ureteric stent dwell time from three months to one month was associated with significantly fewer stent-related emergency presentations. Shorter dwell protocols may reduce patient morbidity and healthcare utilisation and could be associated with lower rates of post-ureteroscopy infective complications.

SIUJ, Vol. 7, Pages 28: Uroflowmetry or Urethroscopy as a Surveillance Tool After End-to-End Anastomotic Urethroplasty Done for PFUI—A Blinded Study

Soumya Shivasis Pattnaik — 2026-04-20

SIUJ, Vol. 7, Pages 28: Uroflowmetry or Urethroscopy as a Surveillance Tool After End-to-End Anastomotic Urethroplasty Done for PFUI—A Blinded Study

Société Internationale d’Urologie Journal doi: 10.3390/siuj7020028

Authors: Soumya Shivasis Pattnaik Ganesh Gopalakrishnan Sistla Bobby Viswaroop Myilswamy Arul Natarajan Sridharan Marimuthu Kanagasabapathi Sangampalayam Vedanayagam Kandasami

Background/Objectives: Uroflowmetry is done in the surveillance period after End-to-end Anastomotic Urethroplasty for pelvic fracture urethral injury. But is maximum flow rate a reliable surrogate for urethral calibre in these cases? The above question laid the foundation of the study. The aim of the study was: “Is uroflowmetry alone sufficient to predict a successful outcome following urethroplasty after pelvic fracture urethral injury (PFUI)?” Methods: We conducted a prospective masked study of all patients undergoing end-to-end anastomosis (EEA) urethroplasty for PFUI from January 2017 to September 2022. The first follow-up was 4 weeks after surgery, micturating cystourethrogram (MCU) was done after urethral catheter removal and at the same time, uroflowmetry was also done. The second follow-up was 6 months after surgery, when uroflowmetry was repeated, and urethroscopy was performed. The urologist performing urethroscopy was blinded to the uroflowmetry results. Results: In total, 26 patients were included in the study. After 6 months, 1 patient had poor flow (maximum flow rate [Q max] < 10 mL/s), 7 patients had flow with Q max 10–15 mL/s, and 18 patients had normal flow (Q max > 15 mL/s). On urethroscopy, all patients had a normal and easily passable urethra. The International Prostate Symptom Score (IPSS) and quality of life (QoL) scores showed a positive correlation. The urologist performing urethroscopy and the investigator recording uroflowmetry reached different conclusions. Conclusions: A reduced peak on uroflowmetry after EEA urethroplasty in PFUI does not always indicate surgical failure. Urethroscopy enables direct visualisation of the anastomotic site and provides more detailed information than uroflowmetry. The IPSS score and quality of life are more important than Q max alone.

SIUJ, Vol. 7, Pages 27: Artificial Intelligence Chatbots as Information Sources on Testicular Cancer: Quality, Readability and Actionability

Harrison Lucas — 2026-04-19

SIUJ, Vol. 7, Pages 27: Artificial Intelligence Chatbots as Information Sources on Testicular Cancer: Quality, Readability and Actionability

Société Internationale d’Urologie Journal doi: 10.3390/siuj7020027

Authors: Harrison Lucas Brendan Dittmer Peter Stapleton Ben Tran Niall M. Corcoran Niranjan Sathianathen

Background/Objectives: Testicular cancer is one of the most common malignancies affecting young adult males. With the rise in artificial intelligence (AI) platforms, many patients seek health information online. Yet chatbot responses specific to testicular cancer remain unassessed. This study aims to evaluate the role of AI chatbots in providing patient information about testicular cancer in terms of its quality, readability and actionability. Methods: Fourteen frequently asked questions about testicular cancer were identified using Google Trends and the Cancer Council Australia website. Questions were then inputted into four different publicly accessible AI platforms: ChatSonic, Bing AI, ChatGPT 4.0 and Perplexity. Chatbot responses were recorded and evaluated using three validated instruments: DISCERN (1–5), Patient Education Materials Assessment Tool (PEMAT)-Understandability and Actionability (0–100%) and Flesch-Kincaid readability scores. Results: All platforms scored low on the DISCERN score with a median of 1 (interquartile range [IQR] 1–4). The median readability score was 34.1 (IQR 26.0–52.2), indicating a reading level suitable for college students. The median word count was 61.5 (IQR, 41.3–91.3). The overall PEMAT-Understandability was moderate (median 58.3, 50.0–66.7), whilst the PEMAT-Actionability was very poor (median 0, IQR 0–25). Conclusions: AI chatbots deliver moderately understandable information on testicular cancer, but this information is typically not actionable and is delivered at an above-average reading level. Despite this, patients may continue to use AI chatbots (AICs) to access health information. It is important that clinicians counsel patients on the benefits and downfalls of this strategy, advocating for the use of AICs as an adjunct rather than a replacement for clinician-led education.

SIUJ, Vol. 7, Pages 26: The Efficacy and Safety Profile of UroLift for Management of Benign Prostatic Hyperplasia in Australia

Harrison Lucas — 2026-04-18

SIUJ, Vol. 7, Pages 26: The Efficacy and Safety Profile of UroLift for Management of Benign Prostatic Hyperplasia in Australia

Société Internationale d’Urologie Journal doi: 10.3390/siuj7020026

Authors: Harrison Lucas David Homewood Suzanne Wallace Helen O’Connell Justin Chee Vy Tran Niall M. Corcoran Mariolyn Rajakulenthiran

Background/Objectives: For men with bothersome lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH) requiring surgical intervention, UroLift has been shown to be an effective and durable, minimally invasive method. Methods: A retrospective review was conducted for 72 patients who underwent UroLift at a single hospital in Australia between 2018 and 2025. Data regarding baseline demographics, the pre- and post-operative International Prostate Symptom Score (IPSS), maximum urinary flow rate (Qmax), the post-void residual (PVR), and complications were collected prospectively. Inclusion criteria for patients selected for UroLift were males over 50 years with a prostate volume between 20 and 70 mL, pre-operative PVR of <350 mL and Qmax and IPSSs of <15 mL/s and >12 respectively. The purpose of this study is to assess the clinical outcomes of patients treated with UroLift at our institution and compare these findings to the existing literature. Results: Complete data was available for 34 patients. Our cohort had a median age of 63.0 years (interquartile range [IQR] 58.0–69.0) and UroLift was performed using a median number of 4.05 implants per patient. Median prostate volume (mL) was 43.0 (IQR 38.0–59.0). Post-operatively, the median percentage changes in the IPSS, Qmax (mL/s) and PVR (mL) were −30.9% (IQR 5.8–−71.1, p = 0.0048), 40.1% (IQR −6.6–165.1, p = 0.0159) and −36.4% (IQR −84.6–29.8, p = 0.0232), respectively. Most patients (n = 24, 73.5%) were discharged on the same day of the UroLift procedure with the remainder (n = 9, 26.5%) being discharged on day 1 post-operatively. The median time (months) for post-operative review was 2 (IQR 0.9–3.3). Conclusions: UroLift is safe, effective, and a minimally invasive treatment option in suitable patients with bothersome LUTS requiring surgical intervention.

SIUJ, Vol. 7, Pages 25: Can Computed Tomography Findings for Kidney, Ureter and Bladder Correlate with Medical Comorbidity in Renal Colic Patients?

Lara Sharpe — 2026-04-17

SIUJ, Vol. 7, Pages 25: Can Computed Tomography Findings for Kidney, Ureter and Bladder Correlate with Medical Comorbidity in Renal Colic Patients?

Société Internationale d’Urologie Journal doi: 10.3390/siuj7020025

Authors: Lara Sharpe Basil Razi Cheryl Fung Rajni Lal Marnique Basto Henry H. Woo

Background/Objectives: Sarcopenia is a progressive skeletal muscle disorder linked to adverse outcomes. Computed Tomography (CT) can quantify skeletal muscle, while the Charlson Comorbidity Index (CCI) predicts mortality by categorising comorbidities. This study examined whether Computed Tomography of the Kidneys, Ureters, and Bladder (CT-KUB)-derived skeletal muscle measurements correlate with CCI scores in hospitalised patients. Methods: This retrospective study included all patients admitted with renal colic to the Urology Department, Blacktown Hospital and underwent cystoscopy between June 2022 and June 2025. Data were obtained from electronic medical records. CCI scores, incorporating age and comorbidities, generated 10-year survival estimates. CT-KUB scans were reviewed for psoas muscle perimeter, area, height, width and Hounsfield unit at the aortic bifurcation. Skeletal Muscle Index (SMI) was calculated as skeletal muscle area (SMA)/height2. Associations between CCI, psoas muscle metrics and outcomes (length of stay, Intensive Care Unit (ICU) admission, Emergency Department (ED) re-presentation) were assessed using Pearson’s correlations and between-group comparisons. Results: A total of 397 patients were analysed. Median Length of Stay (LOS) was 1 day (mean = 1.92, SD = 1.88). ICU admission occurred in 2.3% of patients, and 18.6% re-presented to ED within 30 days. Both CCI survival percentage and psoas muscle metrics (including SMI) were significantly associated with LOS. Lower SMA, Hounsfield unit (HU), length and perimeter were linked to higher ICU admission risk. Neither CCI nor muscle measures predicted ED re-presentation. Conclusions: CCI and CT-derived muscle metrics were independently associated with outcomes such as LOS and ICU admission. Combining these measures may improve risk stratification, warranting further prospective evaluation.

SIUJ, Vol. 7, Pages 24: Urology Training Across Borders: An International Survey of Residents’ Experiences, Perceptions, and Expectations

Andrea Alberti — 2026-04-17

SIUJ, Vol. 7, Pages 24: Urology Training Across Borders: An International Survey of Residents’ Experiences, Perceptions, and Expectations

Société Internationale d’Urologie Journal doi: 10.3390/siuj7020024

Authors: Andrea Alberti Rossella Nicoletti Anna Luisa Heinrichs Julian Peter Struck Petros Sountoulides Francesco Curto Sergio Serni Georgios Chasiotis Olumide Farinre Harshit Garg Clément Klein Gaelle Margue Amanda A. Myers Nikolaos Pyrgidis Roberto Contieri Ioana Fugaru Lazaros Tzelves Alessandro Uleri Wilbert Fana Mutomba Dimitrios Diamantidis Jean de la Rosette Maria Pilar Laguna Jack M. Zuckerman Philippe E. Spiess Henry H. Woo Stavros Gravas Mauro Gacci

Background/Objectives: Urology residency training widely varies across countries, and evidence comparing residents’ experiences at an international level is limited. This study reports the results of an international survey of urology residents from different countries worldwide, aiming to characterize training environments, educational exposure, and trainee expectations across diverse healthcare systems. Methods: A 39-item online survey was administered to urology residents during the Société Internationale d’Urologie (SIU) Regional Meeting (Florence, November 2024), assessing demographics, training exposure, educational resources, workload, satisfaction, and career perspectives. The results were compared between trainees at different postgraduate years (PGYs) to explore associations for key outcomes. Results: Overall, 208 urology residents from 21 countries completed the survey. Most residents were actively involved in research (76.4%), although confidence in independent scientific production was moderate (significantly lower among junior trainees). Surgical exposure increased with PGY, with good experience in endoscopy but limited hands-on exposure and expected autonomy in laparoscopic, robotic, and major open surgery. Despite high overall satisfaction with urology, residents described heavy workloads, inconsistent access to structured teaching and international fellowships, and a long-term shift in career expectations toward private practice. Conclusions: Urology residents worldwide report high engagement in research, strong satisfaction with their specialty choice, and interest in international mobility. Nonetheless, persistent disparities in surgical exposure, research confidence, workload, and gender representation highlight the need for competency-based curricula, structured mentorship, and improved training organization to promote equitable and high-quality urology education globally.

SIUJ, Vol. 7, Pages 23: Future Prospects for Renal Transplantation in Chad

Saleh Abdelkerim Nedjim — 2026-04-16

SIUJ, Vol. 7, Pages 23: Future Prospects for Renal Transplantation in Chad

Société Internationale d’Urologie Journal doi: 10.3390/siuj7020023

Authors: Saleh Abdelkerim Nedjim Djibrine Mahamat Djibrine Hissein Hagguir Adoumadji Kouldjim Mahamat Hissein Ali Valentin Vadandi Mahamat Ali Mahamat Ibrahim Hamat Mahamat A. G. Zalba Abhijit Patil Laurent Brureau Arvind Ganpule Ravindra Sabnis Rachid Aboutaieb Rimtebaye Kimassoum Choua Ouchemi

Chronic kidney disease (CKD) is a condition characterized by the progressive and irreversible loss of renal function, potentially leading to the need for renal replacement therapy, either dialysis or transplantation [...]

SIUJ, Vol. 7, Pages 22: Multilocular Intratesticular Cyst with Testicular Microlithiasis

Yoshihiro Ono — 2026-04-14

SIUJ, Vol. 7, Pages 22: Multilocular Intratesticular Cyst with Testicular Microlithiasis

Société Internationale d’Urologie Journal doi: 10.3390/siuj7020022

Authors: Yoshihiro Ono Yoshiyuki Miyazawa Seiji Arai Yoshitaka Sekine

An 85-year-old man presented with painless enlargement of the left scrotum [...]

SIUJ, Vol. 7, Pages 21: Dedifferentiated Liposarcoma Mimicking a Bosniak IV Cyst: A Rare Case of Radiographic Mimicry

Sepehr Niakani — 2026-04-08

SIUJ, Vol. 7, Pages 21: Dedifferentiated Liposarcoma Mimicking a Bosniak IV Cyst: A Rare Case of Radiographic Mimicry

Société Internationale d’Urologie Journal doi: 10.3390/siuj7020021

Authors: Sepehr Niakani Hend Alshamsi Rocio Roldan-Testillano Simon Gauvin Jean-François Toupin Alexis Rompré-Brodeur

Cystic renal lesions are frequently identified incidentally on imaging and range from benign cysts to malignant tumors [...]

SIUJ, Vol. 7, Pages 20: Managing the Assault on Our Email Inbox

Henry H. Woo — 2026-02-23

SIUJ, Vol. 7, Pages 20: Managing the Assault on Our Email Inbox

Société Internationale d’Urologie Journal doi: 10.3390/siuj7010020

Authors: Henry H. Woo

With the new year upon us and with many of us emerging from a short break over the holiday season, it is almost with some dread that we open the inbox of our email accounts [...]

SIUJ, Vol. 7, Pages 19: Urological Manifestations of Stevens–Johnson Syndrome/Toxic Epidermal Necrolysis and Their Management: A Scoping Review

Zoe Williams — 2026-02-23

SIUJ, Vol. 7, Pages 19: Urological Manifestations of Stevens–Johnson Syndrome/Toxic Epidermal Necrolysis and Their Management: A Scoping Review

Société Internationale d’Urologie Journal doi: 10.3390/siuj7010019

Authors: Zoe Williams Paul Kim Ashan David Canagasingham James Kovacic Andrew Shepherd Ankur Dhar Amanda Shu Jun Chung

Background/Objectives: Stevens–Johnson Syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare, potentially fatal immunological conditions that affect cutaneous and mucosal surfaces and have the potential to involve the genitourinary tract. While genital involvement is common, urological manifestations are under-recognised clinically and there is a paucity of clear, evidence-based management pathways specific to urological manifestations of SJS/TEN. To map the spectrum of urological manifestations of SJS/TEN, to describe the short- and long-term outcomes of these manifestations, and to synthesise management and prevention strategies to inform clinical practice. Methods: This was a scoping review conducted in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guideline. Data sources: Medline and PubMed articles published in English with publication date up to December 2025. Study selection: Eligible studies included case reports, case series, observational studies, clinical guidelines, and review articles describing urological manifestations, outcomes, management, or prevention strategies for patients with SJS/TEN. Articles limited to renal or isolated gynaecological involvement were excluded. Data extraction and synthesis: Articles were screened independently by two reviewers using a pre-defined data extraction template covering four domains: urological manifestations, outcomes and sequelae, management strategies, and prevention strategies. This criterion was refined after a pilot of 20 studies. Discrepancies were resolved by consensus with a third reviewer. Formal risk-of-bias assessment was not performed, consistent with scoping review methodology. Results: One hundred and four studies published between 1987 and 2025 were included in this review. Selected articles included case reports (n = 63), retrospective cohort studies (n = 23), prospective studies (n = 2), guidelines (n = 5), and summary articles (n = 11). Reported urological involvement ranged from genital cutaneous and mucosal disease including erosions, adhesions, and balanitis to urethral manifestations such as urethritis, stenosis, and strictures, as well as scarce upper urinary tract involvement including ureteric stricture and ureteric mucosal sloughing. While some manifestations resolved with supportive care, others progressed to chronic sequelae including persistent urethral strictures, voiding dysfunction, sexual dysfunction, recurrent infection, and in rare cases, obstructive uropathy. A multidisciplinary approach was recommended for all patients with SJS/TEN. Urological management centred around early and repeated urogenital examination, manual lysis of adhesions, urinary catheterisation, and timely intervention for urethral or ureteric obstruction. Long-term urological follow-up of 12 months was recommended for patients with significant urogenital involvement. Conclusions: Urological manifestations of SJS/TEN are diverse, clinically significant, and frequently under-recognised. Early urological involvement, systematic genital and urinary tract assessment, and proactive preventative measures may reduce long-term morbidity. This review provides a comprehensive synthesis of knowledge and recommendations to support urologists’ role in multidisciplinary care of patients with this pathology. This review also highlights the need for prospective research to guide further evidence-based management of urological complications of SJS/TEN.

SIUJ, Vol. 7, Pages 18: A New Light on Bladder Cancer Management: Integrating Laser Ablation into Endourological Care Pathways. Comment on Katz-Summercorn et al. Evolution of the Bladder Cancer Pathway in a Secondary Care Unit Incorporating Transurethral Laser Ablation and ‘Bladder Cancer Surgery Planning Meetings’. Soc. Int. Urol. J. 2026, 7, 17

Ashwini Kadam — 2026-02-23

SIUJ, Vol. 7, Pages 18: A New Light on Bladder Cancer Management: Integrating Laser Ablation into Endourological Care Pathways. Comment on Katz-Summercorn et al. Evolution of the Bladder Cancer Pathway in a Secondary Care Unit Incorporating Transurethral Laser Ablation and ‘Bladder Cancer Surgery Planning Meetings’. Soc. Int. Urol. J. 2026, 7, 17

Société Internationale d’Urologie Journal doi: 10.3390/siuj7010018

Authors: Ashwini Kadam Gagan Prakash

In this issue, Alexander Charles Katz-Summercorn et al [...]

SIUJ, Vol. 7, Pages 17: Evolution of the Bladder Cancer Pathway in a Secondary Care Unit Incorporating Transurethral Laser Ablation and ‘Bladder Cancer Surgery Planning Meetings’

Alexander Katz-Summercorn — 2026-02-23

SIUJ, Vol. 7, Pages 17: Evolution of the Bladder Cancer Pathway in a Secondary Care Unit Incorporating Transurethral Laser Ablation and ‘Bladder Cancer Surgery Planning Meetings’

Société Internationale d’Urologie Journal doi: 10.3390/siuj7010017

Authors: Alexander Katz-Summercorn Sherif Heba Stefanos Almpanis Shiv Kumar Pandian

Background/Objectives: Transurethral Laser Ablation (TULA) is fast evolving as a surgical procedure, especially for small or recurrent bladder tumours. It offers a safe alternative for patients who are unsuitable for general anaesthetic (GA) or who cannot obtain timely pre-operative assessments for Transurethral Resection of Bladder Tumour (TURBT). Patients are identified for TULA in ‘Bladder Cancer Surgery Planning Meetings’ (BSPMs) and this significantly reduces their cancer waiting time (CWT). Its effectiveness as a diagnostic and therapeutic tool, including its complications and costs, has been assessed. Methods: All TULA procedures performed at the Trust were studied in two cycles. The first between August 2023 and November 2024, prior to initial audit, and then up to September 2025. Case notes, operation notes, and multidisciplinary team (MDT) outcomes were retrospectively reviewed. All procedures were performed with a flexible cystoscope and ‘cold cup’ biopsies with further ablation and haemostasis using a 1470 nm diode laser at 4 watts and 400 µm laser fibre. Patients were identified for TULA based on tumour size, location, and fitness for general anaesthetic. Results: During the study period, 95 TULA procedures were performed with a follow-up period between 4 weeks and 1 year. A total of 86 patients (90.5%) had local anaesthetic (LA) ± intravenous (IV) sedation, with 50% having LA alone in the second phase of the study; of the remaining patients, 8 had GA (8.4%) and 1 (1.1%) had spinal anaesthetic. None of the cases were considered to have missed a significant finding. One case (1.1%) was complicated, with ongoing bleeding requiring bladder washout under GA. BSPMs were introduced in July 2024 and audited in the first phase of this study. A total of 24 (39%) of patients were identified for TULA. Of those, 7 (29%) were originally scheduled for TURBT and were having difficulties obtaining pre-operative assessment (POA) clearance. Cost figures were provided by the hospital’s accountants. Conclusions: TULA has been implemented with a low complication rate and appropriate sampling. In the next phase, TULA will be rolled out to an outpatient setting, performed exclusively under LA. This will lead to a significant cost reduction.

SIUJ, Vol. 7, Pages 16: Factors That Increase the Risk of Ureteric Stent Migration: A Retrospective Cohort Analysis

Sarah Lorger — 2026-02-20

SIUJ, Vol. 7, Pages 16: Factors That Increase the Risk of Ureteric Stent Migration: A Retrospective Cohort Analysis

Société Internationale d’Urologie Journal doi: 10.3390/siuj7010016

Authors: Sarah Lorger Paul Kim Sean Ong Stuart Jackson Sithum Munasinghe Gaeun Song Tanya Samtani Fatmah Alzahraa A. Y. Y. Haider Matthew Stanowski

Background/Objectives: Ureteric stents are commonly used in urological procedures. However, they can cause pain; haematuria; voiding symptoms; or stent migration. When stent migration occurs, this can cause a significant impact on the patients’ therapeutic outcomes and may warrant a repeat procedure to retrieve or replace the ureteric stent. This study aims to assess if there are any patient; stent; or operative factors that may increase the risk of stent migration. Methods: This is a single-institute, retrospective cohort study that looked at patient; stent; and operative factors for 828 ureteroscopies and or laser lithotripsy for management of ureteric or intra-renal calculi over a 2-year period. The 828 procedures comprised 655 patients, as some patients had multiple procedures. Results: From the 828 cases, there was a 2.7% incidence of stent migration; all episodes of stent migration were distal migration. Stent migration was more likely among females (odds ratio (OR) = 3.0; 95% confidence interval (CI) [1.2; 7.1]) compared to males; older aged groups (over 65 years) (OR = 2.7; 95% CI [0.9; 7.8]) compared to the young aged group (16–44 years); and those who were obese (OR = 2.1; 95% CI [0.9; 5.0]), had musculocutaneous (MSK) conditions (OR = 2.7; 95% CI [0.9; 8.3]), neurological conditions (OR = 3.3; 95% CI [1.1; 10.0]), and stent dwelling time ≥ month (OR = 2.3; 95% CI [0.9; 6.0]) compared to <1 month. There was no observed association between stent and operative factors. Conclusions: Patient factors such as sex; age; comorbidities; and weight need to be considered by urologists in conjunction with modifiable stent factors to ensure that the decisions are made on an individual basis to try and reduce the risk of stent migration.

SIUJ, Vol. 7, Pages 15: Prevalence and Predictors of Burnout in Urology Professionals in Pakistan

Mudassir Hussain — 2026-02-18

SIUJ, Vol. 7, Pages 15: Prevalence and Predictors of Burnout in Urology Professionals in Pakistan

Société Internationale d’Urologie Journal doi: 10.3390/siuj7010015

Authors: Mudassir Hussain

Background/Objectives: This study aims to assess the prevalence and predictors of burnout among urology professionals in Pakistan using a validated tool and to explore underlying causes through qualitative input. Methods: A cross-sectional survey was conducted among urology trainees, fellows, and consultants across Pakistan. Burnout was measured using the Maslach Burnout Inventory–Human Services Survey (MBI-HSS). Burnout was defined using a criterion of high emotional exhaustion or high depersonalization. Descriptive statistics and chi-square tests were used to assess associations. Thematic analysis was applied to open-ended responses. Results: A total of 183 responses were received. When using the high emotional exhaustion (EE) or depersonalization (DP) criterion, 62% was classified as experiencing burnout. Significant predictors included excessive working hours (more than 80 h per week), frequent night calls, avoidance-based coping, workplace favouritism, and discrimination. No association was found with gender, age, or designation. Thematic responses highlighted five common causes of burnout. Conclusions: Burnout is prevalent among urology professionals in Pakistan and is largely driven by modifiable factors. Interventions must target institutional support, work–life balance, and healthier coping mechanisms.

SIUJ, Vol. 7, Pages 14: Limiting the Escalation of Medical Cannabis Use. Comment on Hammad et al. Association Between Medical Cannabis Use and Substance Use Disorder in Patients with Dysuria: A Propensity-Score Matched Cohort Study Using Federated Network of Global Real-World Data. Soc. Int. Urol. J. 2026, 7, 13

Jonathan G. Tubman — 2026-02-18

SIUJ, Vol. 7, Pages 14: Limiting the Escalation of Medical Cannabis Use. Comment on Hammad et al. Association Between Medical Cannabis Use and Substance Use Disorder in Patients with Dysuria: A Propensity-Score Matched Cohort Study Using Federated Network of Global Real-World Data. Soc. Int. Urol. J. 2026, 7, 13

Société Internationale d’Urologie Journal doi: 10.3390/siuj7010014

Authors: Jonathan G. Tubman

The article by Hammad et al [...]

SIUJ, Vol. 7, Pages 13: Association Between Medical Cannabis Use and Substance Use Disorder in Patients with Dysuria: A Propensity-Score Matched Cohort Study Using Federated Network of Global Real-World Data

Muhammed A. M. Hammad — 2026-02-17

SIUJ, Vol. 7, Pages 13: Association Between Medical Cannabis Use and Substance Use Disorder in Patients with Dysuria: A Propensity-Score Matched Cohort Study Using Federated Network of Global Real-World Data

Société Internationale d’Urologie Journal doi: 10.3390/siuj7010013

Authors: Muhammed A. M. Hammad Laith E. Baqain Mohammed Shahait Gamal M. Ghoniem

Background/Objectives: To evaluate whether medical cannabis (MC) use following dysuria diagnosis is associated with increased risk of developing substance use disorder (SUD), given rising cannabis prescriptions for urologic symptoms and concerns about long-term consequences. Methods: We conducted a retrospective cohort study using the TriNetX Research Network, a federated electronic health record database with over 120 million patients. Adult patients newly diagnosed with dysuria between 2003 and 2024 were identified and stratified by subsequent cannabis exposure. MC users were defined by a cannabis-related diagnostic code within 90 days of dysuria diagnosis. Propensity score matching (PSM) was performed 1:1 by age, sex, and race. The primary outcome was a new diagnosis of SUD (cannabis, opioid, or cocaine use disorders) within 12 months. Secondary analysis included Kaplan–Meier (KM) survival estimates over 5 years. Risk ratios (RR), odds ratios (OR), and hazard ratios (HR) were calculated. OR and RR estimated the likelihood of SUD within 12 months, and HR reflected relative hazard over 5 years. Results: After excluding patients with prior SUD, the final sample included 60,544 MC patients and 98,715 general dysuria (GD) patients. The MC group had a significantly higher incidence of new SUD diagnoses (11.13%) than the GD group (2.28%), yielding a risk difference of −8.85% (95% CI: −9.11 to −8.58; p < 0.0001), relative risk 0.205, and OR 0.186. KM analysis showed lower SUD-free survival in MC (80.96%) versus GD (96.35%; log-rank p < 0.0001). MC exposure was associated with nearly fivefold increased odds of SUD within 12 months (OR = 0.186) and sixfold higher hazard over 5 years (HR = 0.163). Conclusions: Medical cannabis use after dysuria is linked to markedly increased risk and earlier onset of SUD. Careful patient selection, counseling, and monitoring are essential when prescribing MC for urologic symptoms.

SIUJ, Vol. 7, Pages 12: Large Language Models in Urology, a Cautionary Promise. Comment on Eskandar, K. Assessing ChatGPT Accuracy Across Versions for Patient and Guideline Queries in Sacral Neuromodulation. Soc. Int. Urol. J. 2026, 7, 11

Adrian Wagg — 2026-02-13

SIUJ, Vol. 7, Pages 12: Large Language Models in Urology, a Cautionary Promise. Comment on Eskandar, K. Assessing ChatGPT Accuracy Across Versions for Patient and Guideline Queries in Sacral Neuromodulation. Soc. Int. Urol. J. 2026, 7, 11

Société Internationale d’Urologie Journal doi: 10.3390/siuj7010012

Authors: Adrian Wagg

Eskandar’s evaluation of ChatGPT across software versions regarding sacral neuromodulation (SNM) is timely and pragmatic [...]

SIUJ, Vol. 7, Pages 11: Assessing ChatGPT Accuracy Across Versions for Patient and Guideline Queries in Sacral Neuromodulation

Kirolos Eskandar — 2026-02-12

SIUJ, Vol. 7, Pages 11: Assessing ChatGPT Accuracy Across Versions for Patient and Guideline Queries in Sacral Neuromodulation

Société Internationale d’Urologie Journal doi: 10.3390/siuj7010011

Authors: Kirolos Eskandar

Background/Objectives: Sacral neuromodulation (SNM) is an established therapy for refractory overactive bladder and non-obstructive urinary retention. With the rapid adoption of large language models (LLMs) such as ChatGPT, their accuracy in procedure-specific domains requires evaluation. The aim of this study was to compare the accuracy, completeness, and reproducibility of ChatGPT versions 3.5, 4.0, and 5.0 in answering patient- and guideline-based questions on SNM. Methods: Twenty questions were developed from international guidelines, device information, and common patient inquiries, covering five domains (mechanism, technique, outcomes, complications, postoperative management), two source types (frequently asked question [FAQs] vs. guideline), and three difficulty levels. These thematic domains were derived from core clinical counseling areas routinely addressed in SNM evaluation and follow-up. Each was submitted to ChatGPT versions 3.5, 4.0, and 5.0. Responses were rated independently by two urologists on a four-point accuracy scale. Combined success (Grades 1–2) and accuracy trends were compared across versions. Chi-square tests were used to assess differences across versions, Cramer’s V to measure effect size, and Cohen’s kappa to evaluate reproducibility. Results: Accuracy improved progressively across versions. Combined success rates rose from 70% in version 3.5 to 85% in 4.0 and 90% in 5.0 (p = 0.031, Cramer’s V = 0.29). Highest accuracy was observed in mechanism and procedural technique, while complication- and guideline-based questions showed lower performance. FAQ and straightforward questions were answered more reliably than guideline-based or complex ones. Reproducibility was excellent across all versions (κ = 0.81–0.91). Conclusions: ChatGPT 4.0 and 5.0 show strong potential as adjunctive tools for patient education in SNM, particularly for FAQs and procedural explanations. However, because persistent limitations were observed in guideline interpretation and complication management, clinician oversight remains essential, and these models should not be regarded as substitutes for professional clinical judgment.

SIUJ, Vol. 7, Pages 10: Rethinking Genitourinary Cancer: The Microbiome Enters the Spotlight. Comment on Tiwary et al. The Role of Genitourinary Microbiome in Male Cancer Etiology and Progression: Insights from Next-Generation Sequencing and Meta-Omics. Soc. Int. Urol. J. 2026, 7, 9

Katia Ramos Moreira Leite — 2026-02-12

SIUJ, Vol. 7, Pages 10: Rethinking Genitourinary Cancer: The Microbiome Enters the Spotlight. Comment on Tiwary et al. The Role of Genitourinary Microbiome in Male Cancer Etiology and Progression: Insights from Next-Generation Sequencing and Meta-Omics. Soc. Int. Urol. J. 2026, 7, 9

Société Internationale d’Urologie Journal doi: 10.3390/siuj7010010

Authors: Katia Ramos Moreira Leite

The microbiome refers to the collective genome of microorganisms, including bacteria, yeasts, and viruses (collectively termed microbiota), that inhabit various sites within the human body [...]

SIUJ, Vol. 7, Pages 9: The Role of Genitourinary Microbiome in Male Cancer Etiology and Progression: Insights from Next-Generation Sequencing and Meta-Omics

Pooja Tiwary — 2026-02-11

SIUJ, Vol. 7, Pages 9: The Role of Genitourinary Microbiome in Male Cancer Etiology and Progression: Insights from Next-Generation Sequencing and Meta-Omics

Société Internationale d’Urologie Journal doi: 10.3390/siuj7010009

Authors: Pooja Tiwary Krishil Oswal Ryan Varghese

Male genitourinary (mGU) malignancies, including prostate, bladder, kidney, testicular, and penile cancers, represent a clinically and epidemiologically significant subset of global cancer burden. Although well-established etiological factors such as genetic mutations, androgen signaling, and environmental exposures contribute to tumorigenesis, the underlying mechanisms remain ill-defined. Recent advances in next-generation sequencing and metagenomics technologies have facilitated a deeper understanding of the human microbiome, revealing its potential role in carcinogenesis. While the gut microbiome has been extensively studied, emerging evidence indicates that site-specific microbial communities within the genitourinary (GU) tract may significantly influence cancer susceptibility, progression, and therapeutic outcomes. Accordingly, this review aims to comprehensively summarize the current evidence examining the relationship between the GU microbiome and the development, progression, and treatment of mGU cancers. To provide the specific context, relevant publications were collected from Google Scholar, PubMed, Science Direct, Dimension AI, and EBSCO Host using specific keywords such as “bladder cancer”, “dysbiosis”, “genitourinary”, “genitourinary cancer”, “microbiome”, “pathogens”, “penile cancer”, “prostate cancer”, “renal cancer”, “testicular cancer”, “urogenital microbiome”. We did not add any limits to the publication date during the inclusion of papers. However, it is noteworthy that the initial reports, including the aforementioned keywords, have been published since 2015. Emerging evidence highlights a significant association between the dysbiosis of the GU microbiome and the development of mGU cancers. Notably, an increase in bacterial richness and species diversity has been correlated with a rapid progression of these cancers, suggesting that such features may be explored as potential candidate biomarkers. Advanced sequencing and meta-omics technologies have enabled the identification of distinct microbial signatures with emerging diagnostic, prognostic, and therapeutic potential. Despite these advancements, the understanding of the functional and mechanistic roles of microbiota, particularly within the penile and seminal environments, remains limited.

SIUJ, Vol. 7, Pages 8: Urine Biomarkers in Haematuria Evaluation: Cxbladder and the Path Ahead. Comment on Lucas et al. Evaluation of Cxbladder Compared to the Conventional Workup of Haematuria to Exclude a Diagnosis of Urothelial Carcinoma. Soc. Int. Urol. J. 2026, 7, 7

Zhijiang Zang — 2026-02-11

SIUJ, Vol. 7, Pages 8: Urine Biomarkers in Haematuria Evaluation: Cxbladder and the Path Ahead. Comment on Lucas et al. Evaluation of Cxbladder Compared to the Conventional Workup of Haematuria to Exclude a Diagnosis of Urothelial Carcinoma. Soc. Int. Urol. J. 2026, 7, 7

Société Internationale d’Urologie Journal doi: 10.3390/siuj7010008

Authors: Zhijiang Zang Edmund Chiong

Haematuria continues to be one of the most frequent and resource-intensive referrals in urology [...]

SIUJ, Vol. 7, Pages 7: Evaluation of Cxbladder Compared to the Conventional Workup of Haematuria to Exclude a Diagnosis of Urothelial Carcinoma

Harrison Lucas — 2026-02-11

SIUJ, Vol. 7, Pages 7: Evaluation of Cxbladder Compared to the Conventional Workup of Haematuria to Exclude a Diagnosis of Urothelial Carcinoma

Société Internationale d’Urologie Journal doi: 10.3390/siuj7010007

Authors: Harrison Lucas Brendan Dittmer David Homewood Suzanne Wallace Niall M. Corcoran Samantha Koschel Homayoun Zargar

Background/Objectives: Haematuria is a common presenting symptom of Urothelial Carcinoma (UC). Traditionally, the “triple workup”—comprising flexible cystoscopy, voided urine cytology and upper tract imaging is used as the standard diagnostic approach for evaluating these patients. However, these investigations can be invasive, time-consuming, and costly. Cxbladder, a urine based genomic biomarker, utilises a non-invasive, singular urine sample to calculate probability of UC based on a patient’s risk factors and gene expression. The aim of Cxbladder is to establish patients with a high probability of no UC being present, which suggests that the traditional investigations are not required. This study evaluates the performance of Cxbladder Triage compared to the standard triple workup in patients presenting with haematuria, excluding a diagnosis of UC. Methods: A prospective, observational study was conducted at a single Australian tertiary hospital. A total of 258 patients, who presented with haematuria from 2020 to 2023, underwent both a Cxbladder Triage test and standard triple workup, comprising three urine cytology samples, imaging and a flexible cystoscopy. Some patients required either a bladder biopsy or tumour resection to further diagnose and treat a suspected UC. Diagnostic accuracy was assessed using sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and the proportion of missed tumours. Results: Overall, 5.4% of patients, presenting with haematuria were diagnosed with UC (n = 14). Cxbladder Triage demonstrated a sensitivity of 92.9% (95% confidence interval [CI]: 66.0–99.8) and an NPV of 92.9% (95% CI: 66.0–99.8). This was higher than cytology alone, which recorded a sensitivity of 42.9% (CI 9.9–81.6%) and NPV of 78.9% (95% CI: 54.4–94.0) for the detection of UC. When cytology and imaging were combined to investigate UC, the sensitivity and NPV recorded were 75.0% (95% CI: 42.8–94.5) and 80.0% (95% CI: 51.9–95.8), respectively. The proportion of UC cases missed by Cxbladder Triage was 6.7% (n = 1). Conclusions: In our cohort of patients presenting with haematuria, Cxbladder Triage offers a non-invasive alternative to the traditional workup for the detection of UC, with both a high sensitivity and NPV. Cxbladder Triage offers an alternative diagnostic workup for low-risk patients, which has the potential to reduce unnecessary invasive tests, procedures, and cost to the healthcare system.

SIUJ, Vol. 7, Pages 6: Diagnostic Performance of Urinary Dipstick Test for Haematuria in Low-Risk Non-Muscle-Invasive Bladder Cancer Surveillance

Darcy Noll — 2026-02-11

SIUJ, Vol. 7, Pages 6: Diagnostic Performance of Urinary Dipstick Test for Haematuria in Low-Risk Non-Muscle-Invasive Bladder Cancer Surveillance

Société Internationale d’Urologie Journal doi: 10.3390/siuj7010006

Authors: Darcy Noll Tanishq Mathur Grace Mitchell Simon Harley

Background/Objectives: Low-risk non-muscle-invasive bladder cancer (NMIBC) is associated with extremely low rates of progression and cancer-specific mortality. Current surveillance strategies recommend yearly cystoscopic surveillance after the initial 12-month period. Cystoscopic surveillance is costly, leading bladder cancer to be one of the most economically burdensome diseases. We investigated the use of a negative urinary dipstick for haematuria (UDH) in predicting the absence of recurrence. Methods: All patients undergoing flexible cystoscopy at our institution underwent urinary dipstick testing immediately prior to their procedures. We conducted a retrospective analysis of all patients undergoing cystoscopic surveillance for known low-risk NMIBC at our institution between January 2018 and August 2024. All patients had low-risk NMIBC, as defined by American Urological Association (AUA) guidelines, at the time of flexible cystoscopy. Patient demographics, cystoscopy operation records, and subsequent biopsy results were reviewed. Results: A total of 124 patients who underwent 310 cystoscopies were included in the analysis. The overall rate of UDH positivity was 54%. The negative predictive value (NPV) and sensitivity of UDH for the absence of bladder cancer recurrence were 95.7% and 81.2%, respectively. All cases of bladder cancer recurrence with negative UDH were low-grade Ta (n = 5) or papillary urothelial neoplasm of low malignant potential (PUNLMP) (n = 1). There was no difference in the NPV and sensitivity within 12 months of diagnosis (NPV = 95.4%, sensitivity = 83.3%) and 12 months after diagnosis (NPV = 95.8%, sensitivity = 80%). Conclusions: UDH has a high NPV and sensitivity for recurrence in low-risk NMIBC. No cases of high-grade tumors or carcinoma in situ were undetected by UDH in this study. UDH shows promise as an inexpensive adjunct test that can reduce the high economic burden of surveillance of non-muscle-invasive bladder cancer.

SIUJ, Vol. 7, Pages 5: B2B: Bladder Cancer Summary

Peter C. Black — 2026-02-09

SIUJ, Vol. 7, Pages 5: B2B: Bladder Cancer Summary

Société Internationale d’Urologie Journal doi: 10.3390/siuj7010005

Authors: Peter C. Black Kilian M. Gust Paramananthan Mariappan Jeremy Y. C. Teoh Stephen B. Williams Karima Oualla Robert Jones Daniele Raggi Viktor Grünwald

The 7th Bench-to-Bedside Uro-Oncology: GU Cancers Triad Meeting, organized in conjunction with the 45th Annual Congress of the Société Internationale d’Urologie, was held on 31 October 2025, in Edinburgh, Scotland, and transmitted live on the SIU@U Congress app [...]

SIUJ, Vol. 7, Pages 4: B2B Symposium: Innovative Technologies in Bladder Cancer

Peter C. Black — 2026-02-09

SIUJ, Vol. 7, Pages 4: B2B Symposium: Innovative Technologies in Bladder Cancer

Société Internationale d’Urologie Journal doi: 10.3390/siuj7010004

Authors: Peter C. Black Gautier Marcq Sarah P. Psutka Kilian M. Gust

SIUJ, Vol. 7, Pages 3: B2B: Prostate Cancer Summary

Caroline M. Moore — 2026-02-09

SIUJ, Vol. 7, Pages 3: B2B: Prostate Cancer Summary

Société Internationale d’Urologie Journal doi: 10.3390/siuj7010003

Authors: Caroline M. Moore Alistair Grey Kara Watts Rafael Sanchez-Salas Hashim Ahmed Derya Tilki Silvia Secco John W. Davis Alan McNeill Nick James Jan Philipp Radtke

SIUJ, Vol. 7, Pages 2: B2B: Kidney Cancer Summary

Simon Tanguay — 2026-02-09

SIUJ, Vol. 7, Pages 2: B2B: Kidney Cancer Summary

Société Internationale d’Urologie Journal doi: 10.3390/siuj7010002

Authors: Simon Tanguay Viktor Grünwald Arnaud Méjean Axel Bex Amy Clifford Christian Kollmannsberger Karima Oualla

SIUJ, Vol. 7, Pages 1: B2B: Five Practice-Changing Advances on the Horizon Summary

Simon Tanguay — 2026-02-09

SIUJ, Vol. 7, Pages 1: B2B: Five Practice-Changing Advances on the Horizon Summary

Société Internationale d’Urologie Journal doi: 10.3390/siuj7010001

Authors: Simon Tanguay Kilian M. Gust Axel Bex Robert Jones Peter C. Black

SIUJ, Vol. 6, Pages 74: Work–Life Integration, Professional Stress, and Gender Disparities in the Urological Workforce: Findings from a Worldwide Cross-Sectional Study

Antonio Minore — 2025-12-18

SIUJ, Vol. 6, Pages 74: Work–Life Integration, Professional Stress, and Gender Disparities in the Urological Workforce: Findings from a Worldwide Cross-Sectional Study

Société Internationale d’Urologie Journal doi: 10.3390/siuj6060074

Authors: Antonio Minore Loris Cacciatore Luca Cindolo Stavros Gravas Jean de la Rosette Maria Pilar Laguna Zhenjie Wu Troy Gianduzzo Claudia Gonzalez Alfano Helen O’Connell Leticia Ruiz Nikolaos Liakos Carmen Gonzalez Enguita Jose Ignacio Nolazco Dean Elterman Silvia Secco

Background/Objectives: Physician burnout and mental health issues are widespread, with over 50% experiencing burnout and nearly 25% suffering from depression, trends that have worsened since 2018. High-demand specialties like urology face additional stressors, including increasing workloads and technological changes. Gender disparities further exacerbate these challenges, with female urologists reporting higher burnout and work–life balance struggles. To evaluate perceptions of work–life balance, career satisfaction, and workplace experiences among urologists worldwide, and to provide potential strategies to improve physician well-being, promote gender equity, and support the sustainability of urology. Methods: A web-based, cross-sectional survey was conducted from March to June 2025, involving urologists, residents, and fellows globally. The 30-item questionnaire covered demographics, working conditions, work–life balance, and gender-related workplace issues. Data were analyzed using descriptive statistics stratified by gender, age, role, and region. Results: We received replies from 390 doctors in urology. Work-related stress was reported by 87.4% (340). A total of 17.7% (69) felt their career progression to be fully compatible with their personal life, while 42.3% (165) perceived a significant imbalance. Female urologists experienced higher perceptions of inequality in career and work–life opportunities. Over 50% expressed willingness to reduce workload for family reasons, highlighting systemic barriers. Burnout was most prevalent among younger urologists (<50 years), with persistent gender disparities across regions. Conclusions: Work–life imbalance and burnout remain major concerns for urologists globally, especially among female and early-career physicians. Addressing these issues requires institutional policies promoting flexibility, gender equity, and targeted support. Further research is needed to develop effective interventions to sustain a resilient urological workforce.

SIUJ, Vol. 6, Pages 73: Cystolitholapaxy Without Transurethral Resection of the Prostate: Clinical Outcomes and Predictors of Subsequent Resection

Jeremy Cheng — 2025-12-18

SIUJ, Vol. 6, Pages 73: Cystolitholapaxy Without Transurethral Resection of the Prostate: Clinical Outcomes and Predictors of Subsequent Resection

Société Internationale d’Urologie Journal doi: 10.3390/siuj6060073

Authors: Jeremy Cheng Arjun Guduguntla Arveen Kalapara Jeremy Grummet Gideon Blecher

Background/Objectives: Limited data exist on the outcomes of men with bladder stones undergoing cystolitholapaxy alone versus cystolitholapaxy with concurrent transurethral resection of the prostate (TURP). Additionally, factors associated with the need for subsequent TURP in these patients are not well defined. This study aimed to compare the clinical outcomes in men undergoing cystolitholapaxy alone with those undergoing concurrent cystolitholapaxy with TURP, and determine what factors were associated with the need for subsequent TURP. Methods: A retrospective review was conducted of men undergoing cystolitholapaxy at a single Australian hospital between 2014 and 2021. Patients were grouped into cystolitholapaxy alone (Group A) and cystolitholapaxy with concurrent TURP (Group B). Clinical outcomes compared included rates of acute urinary retention (AUR), urinary tract infection (UTI), and subsequent TURP. Prostate volume (PV), stone size, and the presence of intravesical prostatic protrusion (IPP) were evaluated as potential predictors of subsequent TURP in Group A. Results: Fifty men were included in the final analysis, with a median follow-up of 50 months (interquartile range [IQR] 24–81). Baseline characteristics did not differ significantly between groups. There was no statistically significant difference in the rates of AUR (11% vs. 13%) or UTI (22% vs. 30%) between Group A and Group B, respectively. However, 41% of Group A underwent subsequent TURP, compared to 9% in Group B (p = 0.0112). Within Group A, those requiring subsequent TURP had a significantly greater PV (65 vs. 34 cc, p = 0.0059), larger stone size (3.5 vs. 2.0 cm, p = 0.0175), and a higher prevalence of IPP (82% vs. 6%, p < 0.001). Conclusions: Cystolitholapaxy alone is a viable initial treatment for bladder stones, with comparable clinical outcomes to concurrent TURP. PV, stone size, and IPP may help identify patients likely to require future TURP, enabling more tailored treatment and potential reduction in TURP-related morbidity.

SIUJ, Vol. 6, Pages 72: Strengthening Reconstructive Urology with an Aim for Capacity-Building in a Low-Middle-Income Country: A Multi-Institutional Global Surgery Collaboration Initial Report

Michael E. Chua — 2025-12-18

SIUJ, Vol. 6, Pages 72: Strengthening Reconstructive Urology with an Aim for Capacity-Building in a Low-Middle-Income Country: A Multi-Institutional Global Surgery Collaboration Initial Report

Société Internationale d’Urologie Journal doi: 10.3390/siuj6060072

Authors: Michael E. Chua R. Christopher Doiron Kurt McCammon Ellen C. Chong Marie Carmela Lapitan Joel Patrick Aldana Diosdado Limjoco Josefino Castillo Dennis Serrano Manuel See

Background/Objectives: Reconstructive urology is critically underrepresented in global surgery initiatives, despite its essential role in managing congenital and acquired urogenital conditions. In response, a multinational Global Surgery Collaborative was launched in 2022 by a faculty from the University of Toronto, aiming to enhance reconstructive urology capacity in the Philippines, among other low- to low-middle-income countries through longitudinal mentorship and skills transfer. This report presents early experience from 2022 to 2024. Methods: This collaboration delivered annual in-person surgical missions from 2022 to 2024 at two major Philippine healthcare institutions. Training focused on pediatric and adult reconstructive urologic procedures. Local mentees participated in structured preoperative planning, intraoperative teaching, and postoperative debriefing. We conducted a prospective service evaluation comprising a prospective registry of consecutive cases and paired pre/post trainee surveys. Data were collected on patient demographics and surgical metrics. Primary clinical endpoints included operative time, length of stay, and complications (Clavien–Dindo), with standardized follow-up windows. Mentee educational outcomes were assessed through pre- and post-training trainee-reported (Likert) measures, evaluating comfort and technical understanding. Statistical analysis used the Wilcoxon signed-rank test to assess changes. Results: Over three years, 33 surgical cases were performed with 45 surgical resident mentees (Post-graduate year (PGY)4–PGY6) engaged. The median patient age was 23 (inter-quartile range [IQR] 12.5–41.5) years, with 33.3% pediatric and 84.8% of cases classified as major. The complication rate was 15.1%, with only one major event (3%). Across 45 mentees, comfort increased from a median 4.0 (IQR 2.5–5.0) to 7.0 (5.5–8.0) and technique understanding from 5.0 (4.0–6.5) to 9.0 (8.0–10.0), with large Wilcoxon effects (r = 0.877 and r = 0.875; both p < 0.001). Year-by-year analyses showed the same pattern with large effects. Conclusions: In this early three-year experience (33 cases, 84.8% major), this multi-institutional collaboration longitudinal mentorship model was feasible and safe, and was associated with significant trainee-reported improvements in comfort and technical understanding. This demonstrates a replicable model for global surgery in reconstructive urology, successfully enhancing surgical skills and fostering sustainable capacity in low- and middle-income countries (LMIC) settings.

SIUJ, Vol. 6, Pages 71: The Latest Chapter for the Société Internationale d’Urologie Journal

Henry H. Woo — 2025-12-17

SIUJ, Vol. 6, Pages 71: The Latest Chapter for the Société Internationale d’Urologie Journal

Société Internationale d’Urologie Journal doi: 10.3390/siuj6060071

Authors: Henry H. Woo

I am grateful to the Société Internationale d’Urologie (SIU) Board of Directors for the opportunity to serve as the new Editor-in-Chief of the Société Internationale d’Urologie Journal (SIUJ), following a rigorous and competitive appointment process [...]

SIUJ, Vol. 6, Pages 70: Medium- to Long-Term Outcomes Following Robotic-Assisted Simple Prostatectomy

Cecile T. Pham — 2025-12-15

SIUJ, Vol. 6, Pages 70: Medium- to Long-Term Outcomes Following Robotic-Assisted Simple Prostatectomy

Société Internationale d’Urologie Journal doi: 10.3390/siuj6060070

Authors: Cecile T. Pham Allen Guo Jordan E. Cohen Patrick J. Treacy Wenjie Zhong Kayvan Haghighi Matthew W. Winter Scott Leslie

Background/Objectives: Robotic-assisted simple prostatectomy (RASP) is an increasingly popular surgical approach for prostate enucleation. The aim of this study is to evaluate the incidence of perioperative and delayed complications following RASP and the medium- to long-term urinary function outcomes. Methods: This is a multi-centre retrospective chart analysis of patients who underwent RASP between October 2016 and October 2022. Surgery was performed using a transvesical approach with a DaVinci Xi system. Patients were reviewed pre- and postoperatively at six weeks and annually thereafter. Patient characteristics, perioperative outcomes, pre- and postoperative uroflowmetry and post-void residual (PVR) measurement were assessed. Results: A total of 50 patients with mean preoperative prostate volume of 180.3 ± 48.1 underwent RASP. The mean operative time was 140.7 ± 28.7 min and hospital length of stay was 5.2 ± 2.9 days. The mean intraoperative blood loss was 247.4 ± 153.7 mL and no patients required transfusion. The mean follow-up period was 37.2 ± 18.3 months. No patients developed stress urinary incontinence. Two patients developed delayed bladder neck contracture at 44 and 63 months. There was a significant improvement in peak urinary flow rate (Qmax) (preop Qmax 10.7 mL/s vs. postop Qmax 24.2 mL/s, p < 0.05) and PVR (preop PVR 366.5 mL vs. postop PVR 42.2 mL, p < 0.05). All patients were weaned off medical therapy for benign prostatic enlargement (BPE) and no patients had recurrent lower urinary tract symptoms requiring re-operation. Conclusions: RASP is a safe and effective enucleation technique for large prostates >100 mL with excellent long-term durability of urinary function outcomes beyond 36 months.

SIUJ, Vol. 6, Pages 69: Early vs. Delayed Repair in Urethral Injuries: A Systematic Review

Kuncoro Adi — 2025-12-15

SIUJ, Vol. 6, Pages 69: Early vs. Delayed Repair in Urethral Injuries: A Systematic Review

Société Internationale d’Urologie Journal doi: 10.3390/siuj6060069

Authors: Kuncoro Adi Bacilius A. Priyosantoso

Background/Objectives: The optimal timing for definitive repair of urethral injuries, early versus delayed, remains a subject of ongoing debate. While delayed repair has traditionally been favored to allow resolution of local tissue trauma, emerging evidence suggests that early intervention may offer comparable or superior outcomes without increased risk of complications. This systematic review compares outcomes between early and delayed urethral repair across various patient populations and injury types. Methods: A systematic search of PubMed, Embase, and Scopus (through June 2025) was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Comparative studies evaluating early (within initial hospitalization or ≤1 month) versus delayed (>1–3 months post-injury) urethral repair were included. Primary outcomes were urethral stricture formation, erectile dysfunction (ED), and urinary incontinence (UI). Risk of bias was assessed using a modified Newcastle-Ottawa Scale. Results: Of 125 records screened, four retrospective cohort studies met inclusion criteria, encompassing 343 patients with anterior and posterior urethral injuries across pediatric and adult populations. Three studies found no significant difference in stricture, ED, or UI rates between early and delayed repair. One study (Chen et al., 2024) reported higher complication rates in the delayed group (stricture: 47% vs. 22%; ED: 37% vs. 3%; UI: 27% vs. 11%). Across the limited and heterogeneous studies available, no clear superiority was demonstrated between early and delayed urethral repair in terms of long-term stricture and functional outcomes. Conclusions: In carefully selected stable patients, early repair does not increase the risk of complications and may reduce catheterization time. When performed by experienced surgeons, early intervention does not increase stricture, ED, or UI risk, and may improve overall morbidity. Patient selection remains critical, but routine deferral of urethroplasty for several months should be reconsidered.

SIUJ, Vol. 6, Pages 68: SIU-ICUD: Clinical Application of Liquid and Tissue-Based Biomarkers in Prostate Cancer

Tamás Fazekas — 2025-12-10

SIUJ, Vol. 6, Pages 68: SIU-ICUD: Clinical Application of Liquid and Tissue-Based Biomarkers in Prostate Cancer

Société Internationale d’Urologie Journal doi: 10.3390/siuj6060068

Authors: Tamás Fazekas Pawel Rajwa Renu S. Eapen Derya Tilki

Several liquid-, and tissue-based markers are available to guide primary diagnosis-, active surveillance-, and treatment-related decision-making for patients with prostate cancer. Most of these tests can improve the balance of harms and benefits associated with early detection, and aid patient selection for treatment intensification. However, the costs of these tests can make their integration in routine clinical practice challenging. To date, prostate-specific antigen (PSA) is still one of the most well-known and widely utilized tumor markers worldwide, with a unique facility ranging from the diagnosis to the treatment-related follow-up of patients with prostate cancer. Future research efforts are needed to integrate biomarkers and novel imaging techniques, such as prostate magnetic resonance imaging, in the decision-making pathways. Despite the growing body of knowledge and evidence, considerable challenges remain in optimizing risk-stratification, improving patient selection and cost-efficacy in different prostate cancer (PCa)-related settings.

SIUJ, Vol. 6, Pages 67: Abstracts of the 45th Congress of the Société Internationale d’Urologie

Société Internationale d’Urologie Société Internationale d’Urologie — 2025-10-21

SIUJ, Vol. 6, Pages 67: Abstracts of the 45th Congress of the Société Internationale d’Urologie

Société Internationale d’Urologie Journal doi: 10.3390/siuj6050067

Authors: Société Internationale d’Urologie Société Internationale d’Urologie

The SIU wishes to extend its gratitude to the urologists who contributed their time to review abstract submissions for the 45th SIU Congress:Refaat Abusamra, Libya;Sanjai Addla, India;Kinju Adhikari, India;Neeraj Agarwal, United States;Madhu Agrawal, India;Sachin Agrawal, United Kingdom;Thomas Ahlering, United States;Shusuke Akamatsu, Japan;Peter Albers, Germany;Salah Albuheissi, United Kingdom;Naif Alhathal, Saudi Arabia;Bedeir Ali-El-Dein, Egypt;Murtadha Almusafer, Iraq;Anastasios Anastasiadis, Greece;Mohamed Arafa, Qatar;Amandeep Arora, India;Zeeshan Aslam, United Kingdom;Hammad Ather, Pakistan;Widi Atmoko, Indonesia;Melanie Aubé-Peterkin, QC;Riccardo Autorino, United States;Ben Ayres, United Kingdom;Puskal Kumar Bagchi, India;Ganesh Bakshi, India;Mevlana Derya Balbay, Turkey;Neil Barber, United Kingdom;John Barry, United States;Jens Bedke, Germany;Elisa Berdondini, Italy;Gajanan Bhat, India;Amit Bhattu, United States;Naeem Bhojani, Canada;N I Bhuiyan, Bangladesh;Marta Bizic, Serbia;Damien Bolton, Australia;Vincenzo Borgna, Chile;Muhammad Bulbul, Lebanon;Gian Maria Busetto, Italy;Ana Gabriela Caballero Garcia, Mexico;Adam Calaway, United States;Amparo Camacho, United States;Kevin Campbell, United States;Francesco Capelan, Switzerland;Manuel Castanheira de Oliveira, Portugal;Christine Joy Castillo, Philippines;David Castro-Diaz, Spain;Arun Chawla, India;Manohar ChikkaMoga Siddaiah, India;Archil Chkhotua, Georgia;Sung Yong Cho, Korea, Rep [...]

SIUJ, Vol. 6, Pages 66: Long-Term Patient-Reported Outcomes of Hyperbaric Oxygen Therapy for Haematuria Due to Radiation Cystitis Secondary to External Beam Radiotherapy for Pelvic Malignancy

Thomas Milton — 2025-10-21

SIUJ, Vol. 6, Pages 66: Long-Term Patient-Reported Outcomes of Hyperbaric Oxygen Therapy for Haematuria Due to Radiation Cystitis Secondary to External Beam Radiotherapy for Pelvic Malignancy

Société Internationale d’Urologie Journal doi: 10.3390/siuj6050066

Authors: Thomas Milton Darcy Noll Peter Stapleton Henry Shaw Joseph Hewitt Marcus Kha Troy Pudney Hien Le Adrian Winsor Rajinder Singh-Rai

Background/Objectives: To determine long-term patient-reported outcomes for patients undergoing hyperbaric oxygen therapy (HBO2) following external beam radiotherapy. Methods: A retrospective cohort study of all consecutive patients who underwent HBO2 for radiation cystitis in South Australia from September 2017 to March 2023 was performed. Patient-reported symptom severity, anxiety, healthcare use and transfusion requirements pre- and post-treatment were collected through telephone interview. Readmission data and procedural data was collected through both telephone interview and a state-wide electronic medical record. Jamovi was used to perform paired sample t-tests for statistical analysis. Results: There were 89 patients who underwent HBO2 for radiation cystitis with 54 completing the questionnaire. There were 85% of patients alive at the time of follow-up, with 61% of the total cohort and 74% of survivors completing the questionnaire. For those completing the questionnaire, 96% were male with all of them having prostate cancer. Median age was 74 (interquartile range [IQR] 69–78). The mean reduction in patients’ perceived symptom severity after HBO2 on a scale out of 10 was 7.9 to 2 with a difference of 5.9 (95% confidence interval [CI] 5.1–6.7, p < 0.001) and the mean reduction in perceived anxiety was 6.9 to 2.1 with a difference of 4.7 (95% CI 3.6–5.8 p < 0.001). Patients reported a reduction in family doctor visits from 2.7 to 0.76 with a mean reduction of 2 (95% CI 0.8 to 3.2, p = 0.003), emergency department presentations from 3.3 to 0.57 with a mean reduction of 2.7 (95% CI 1.4–4.1, p ≤ 0.001) and blood transfusions from 0.67 to 0.31 with a mean reduction of 0.34 (95% CI −0.44 to 1.1, p = 0.017). Ongoing haematuria was reported in 21 of the 54 patients (39%). Further treatment was required for 20 patients (25%). No patients reported any severe or ongoing adverse effects from HBO2 via the questionnaire. Conclusions: HBO2 is a safe option for recurrent haematuria due to radiation cystitis with high patient satisfaction and reduction in patient-perceived symptom severity, anxiety and healthcare utilisation. Level of evidence: 4.

SIUJ, Vol. 6, Pages 65: Spontaneous Stone Passage Rates of Ureteric Stones After Stenting for Acute Renal Colic: A Systematic Review

Sean Lim — 2025-10-21

SIUJ, Vol. 6, Pages 65: Spontaneous Stone Passage Rates of Ureteric Stones After Stenting for Acute Renal Colic: A Systematic Review

Société Internationale d’Urologie Journal doi: 10.3390/siuj6050065

Authors: Sean Lim Patrick Gordon Daryl Thompson Damien Bolton Oneel Patel Joseph Ischia

Background/Objectives: Renal colic poses a significant burden on patients and healthcare systems. Negative ureteroscopy in the setting of stented patients is reported at up to 14%, resulting in unnecessary surgeries and inefficiencies. While ureteral stents have demonstrated efficacy in relieving obstruction, their exact effect on spontaneous stone passage (SSP) is unclear. Hence, a systematic evaluation of the literature was performed to identify the impact of ureteral stents on spontaneous stone passage rates. Methods: A systematic search was conducted in MEDLINE, Embase, and PubMed (January 1989–February 2025) to identify studies investigating indwelling ureteric stents and SSP. Two independent reviewers screened the abstracts and full texts, with a third resolving conflicts. Quality assessment was conducted using The Risk Of Bias In Non-randomized Studies—of Interventions (ROBINS-I) and Cochrane Risk of Bias 2 (RoB-2) tools. Results: A total of 2437 patients in 14 studies investigating SSP in stented patients were included. One included study was a randomised controlled trial, but the rest were observational (n = 13). Three studies compared stented and control groups, whereas 11 studies only investigated patients with stents. Mean/median overall stone sizes ranged from 4.7 to 7.8 mm in diameter. Overall, SSP rates with stents varied significantly, ranging from 1.7 to 42.3%, in the setting of variable stone size, location, duration of follow-up, and method of stone passage detection. When comparing stented and non-stented patients, two studies demonstrated impaired SSP rates in stented patients (13.9% vs. 26.8% and 14% vs. 20%), but only one of these differences was statistically significant. Three studies comparing patients with retrograde ureteral stents and nephrostomies found increased SSP rates in nephrostomy cohorts (p < 0.001). Conclusions: Stone passage rates with stents vary widely due to heterogeneity in study design, patient characteristics, and follow-up. Some studies suggest that stents may impair passage; however, evidence remains inconclusive due to the limited availability of high-quality comparative data. This study underscores the need for larger prospective trials to clarify the actual impact of stenting on stone passage.

SIUJ, Vol. 6, Pages 62: Renal Decompression for Malignant Ureteric Obstruction: A Tertiary Hospital Cohort Analysis

Alex Buckby — 2025-10-21

SIUJ, Vol. 6, Pages 62: Renal Decompression for Malignant Ureteric Obstruction: A Tertiary Hospital Cohort Analysis

Société Internationale d’Urologie Journal doi: 10.3390/siuj6050062

Authors: Alex Buckby Rowan David Arman Kahokehr

Background/Objectives: Malignant ureteric obstruction is an increasingly common problem; however, its treatment remains challenging due to associated poor survival and quality of life outcomes. There is a lack of consensus on how to best manage these patients. We provide a description of the survival outcomes, renal function outcomes, complications, and prognostic factors associated with the treatment of malignant ureteric obstruction in a cohort of patients at our tertiary Urology unit. Methods: A retrospective review of prospectively identified patients treated for malignant ureteric obstruction at our tertiary Urology unit was performed. Obstruction was relieved with either retrograde insertion of a ureteric stent or percutaneous nephrostomy between the 1st of January 2018, and 31st of December 2023. Renal function, complications, and survival data were recorded. Subgroup analysis and survival analysis were performed to determine prognostic factors. Results: Eighty-four patients underwent treatment for malignant ureteric obstruction with a median survival of 197 days (3–1549 days). A total of 51% percent of patients had a stent-related complication requiring hospitalisation, resulting in a total of 966 additional days in hospital. A total of 78% of patients had improved renal function at 12 months. Factors associated with worse survival included emergency treatment of malignant ureteric obstruction, having no further oncological treatment, receiving no oncological-specific treatment for malignancy, bilateral obstruction, female gender, and poor Primary site, Laterality, serum Creatinine level, and Treatment for primary site (PLaCT) prognosis group (p =< 0.01). Conclusions: Patients with malignant ureteric obstruction have a poor prognosis despite intervention. Treatment is often futile and associated with a significant burden of complications related to ureteric stents and percutaneous nephrostomies.

SIUJ, Vol. 6, Pages 64: Nutcracker Syndrome as an Uncommon Cause of Isolated Hematuria in Adults

Oleksandr Boiko — 2025-10-21

SIUJ, Vol. 6, Pages 64: Nutcracker Syndrome as an Uncommon Cause of Isolated Hematuria in Adults

Société Internationale d’Urologie Journal doi: 10.3390/siuj6050064

Authors: Oleksandr Boiko Soledad Larburu David Lecumberri

Compression of the left renal vein between the abdominal aorta and superior mesenteric artery, known as nutcracker syndrome, can present with subtle, nonspecific symptoms that often delay diagnosis, posing a clinical challenge in daily urology practice and necessitating targeted imaging for accurate identification. We report the case of a 39-year-old patient who presented with isolated hematuria and long-standing pelvic pain and was ultimately diagnosed with nutcracker syndrome. Following the failure of endovascular therapy, the patient underwent renal autotransplantation, resulting in complete resolution of symptoms at follow-up.

SIUJ, Vol. 6, Pages 63: Effectiveness of Transurethral Bulkamid Injections as an Adjunct to the AdVance XP Sling for Male Patients with Post-Prostatectomy Incontinence

Sophie Plagakis — 2025-10-21

SIUJ, Vol. 6, Pages 63: Effectiveness of Transurethral Bulkamid Injections as an Adjunct to the AdVance XP Sling for Male Patients with Post-Prostatectomy Incontinence

Société Internationale d’Urologie Journal doi: 10.3390/siuj6050063

Authors: Sophie Plagakis Joshua Makary Thomas King Vincent Tse Lewis Chan

Background/Objectives: Bulkamid® (Axonics, Irvine, CA, USA) is a non-particulate polyacrylamide hydrogel used in the treatment of urinary incontinence. While its effectiveness is well-documented in female stress urinary incontinence (SUI), there is limited data on its role in male stress urinary incontinence, particularly post-prostatectomy incontinence (PPI). This study evaluates the efficacy of Bulkamid as a primary or adjunctive treatment for male PPI. Methods: A retrospective chart review was conducted on male patients who developed PPI and underwent Bulkamid injections between 2016 and 2021. Data collected included pre- and post-procedure pad usage, the volume of Bulkamid injected, prior and subsequent incontinence treatments, and patient-reported satisfaction. Bulkamid was injected transurethrally in four quadrants near the vesicourethral anastomosis using a rigid cystoscope. Results: Twenty-one men with a history of radical prostatectomy (six open and fifteen robotic), including four who received adjuvant radiotherapy, were included. Fifteen underwent Bulkamid injection as a primary treatment, with five (33%) requiring repeat injections due to initial improvement. Eight (54%) subsequently underwent an AdVance XP® sling placement, while two (13%) required no further treatment. Six patients received Bulkamid as an adjunct to prior incontinence surgery, with 80% of post-sling patients reporting improved continence. Bulkamid was less effective in men with detrusor overactivity or prior radiation. Conclusions: Bulkamid demonstrated a higher success rate as an adjunct to the AdVance XP sling, with 80% of men experiencing improved continence. As a primary treatment for PPI, success was modest, with only 33% achieving improvement, often requiring repeat injections or conversion to a sling. Bulkamid presents a low-risk option for select male PPI patients, particularly those with prior sling placement, but durability and long-term effectiveness remain concerns.

SIUJ, Vol. 6, Pages 61: When Bladder Cancer Treatment Strikes Back: Mycotic Aneurysms After Intravesical BCG Therapy

Sarah Blackwell — 2025-10-20

SIUJ, Vol. 6, Pages 61: When Bladder Cancer Treatment Strikes Back: Mycotic Aneurysms After Intravesical BCG Therapy

Société Internationale d’Urologie Journal doi: 10.3390/siuj6050061

Authors: Sarah Blackwell Kevin Yinkit Zhuo Andrew Jensen Balasubramanian Indrajit

Intravesical Bacillus Calmette-Guerin (BCG) remains the gold standard adjuvant therapy for intermediate and high-risk non-muscle invasive bladder cancer (NMIBC) [...]

SIUJ, Vol. 6, Pages 60: The Impact of Patient Navigators on Overactive Bladder Care: Real-World Practice Patterns from a US National Database

Ekene Enemchukwu — 2025-10-20

SIUJ, Vol. 6, Pages 60: The Impact of Patient Navigators on Overactive Bladder Care: Real-World Practice Patterns from a US National Database

Société Internationale d’Urologie Journal doi: 10.3390/siuj6050060

Authors: Ekene Enemchukwu Jennifer Miles-Thomas Nitya Abraham Diane K. Newman Marc Schwartz Kimberly Becker Ifantides Mariana Nelson Raveen Syan

Background/Objectives: We here describe the impact of navigated care on utilization patterns of pharmacologic and minimally invasive overactive bladder therapies. Methods: This retrospective observational cohort study used electronic medical record data from the Precision Point Specialty Analytics Portal in the United States. Eligible patients were adults (≥18 years) newly diagnosed and treated for non-neurogenic overactive bladder (1 January 2015 to 31 December 2019). Categorical endpoints were analyzed by chi-square test or Fisher exact test. Of 170,000 eligible patients, 8982 (≈5%) were randomly selected and stratified by navigation status (navigated: 1150 [12.8%]; non-navigated: 7832 [87.2%]). Results: Overall, 60.0% of patients were female, 69.9% were White, and 42.7% had Medicare coverage. Navigated care was more common among women, Black patients, and those covered by Medicaid/Medicare. Initial pharmacologic treatment rates were similar between navigated and non-navigated groups (anticholinergic: 57.0% vs. 57.4%; beta-3 agonist: 43.0% vs. 42.6%). Greater percentages of navigated versus non-navigated patients received minimally invasive therapy (23.8% vs. 10.8%, respectively; p < 0.0001). Discontinuation rates were lower for navigated versus non-navigated patients undergoing pharmacologic treatment (62.5% vs. 71.3%; p < 0.0001). Conclusions: Patient navigation for overactive bladder may help increase access to minimally invasive therapies and may be a tool to address treatment disparities.

SIUJ, Vol. 6, Pages 59: The Clinical Integration of ChatGPT Through an Augmented Patient Encounter in a Real-World Urological Cohort: A Feasibility Study

Shane Qin — 2025-10-20

SIUJ, Vol. 6, Pages 59: The Clinical Integration of ChatGPT Through an Augmented Patient Encounter in a Real-World Urological Cohort: A Feasibility Study

Société Internationale d’Urologie Journal doi: 10.3390/siuj6050059

Authors: Shane Qin Emre Alpay Bodie Chislett Joseph Ischia Luke Gibson Damien Bolton Dixon T. S. Woon

Background/Objectives: To evaluate the viability of using ChatGPT in a real clinical environment for patient education during informed consent for flexible cystoscopy, assessing its practicality, patient perceptions, and clinician evaluations within a urological cohort. Methods: A prospective feasibility study was conducted at a single institution involving patients with haematuria who attended an in-person clinic review with access to ChatGPT-4o mini. Using predetermined prompts regarding haematuria, we evaluated the accuracy, consistency, and suitability of the ChatGPT information. Responses were appraised for errors, omission of key information, and suitability for patient education. The functionality, usability, and quality of ChatGPT for patient education were assessed by three urologists using the Patient Education Materials Assessment Tool (PEMAT) and DISCERN tools. Readability was assessed using the Flesch–Kincaid tests. Further clinician questionnaires evaluated ChatGPT’s accuracy, reproducibility, and integration potential. Results: Ten patients were recruited, but one patient was excluded because he refused to use ChatGPT due to language barriers. All patients found ChatGPT to be useful, but most believed it could not entirely replace the doctor, especially for obtaining informed consent. There were no significant errors. The mean PEMAT score for understandability was 77.8%, and actionability was 63.8%. The mean DISCERN score was 57.7, corresponding to a ‘good’ quality score. The Flesch Reading Ease score was 30.2, with the writing level comparable to US grade level 13. Conclusions: ChatGPT offers valuable support for patient education, delivering accurate and comprehensive information. However, challenges with readability, contextual understanding, and actionability highlight the need for development and careful integration. Generative artificial intelligence (AI) should augment, not replace, clinician–patient interactions, emphasising ethical considerations and patient trust. This study provides a basis for further exploration of AI’s role in healthcare.

SIUJ, Vol. 6, Pages 58: Navigating the Future of Robotic Urological Surgery: The Hinotori System Joins the Expanding Armamentarium. Comment on Ong et al. Early Clinical Outcomes of the Novel Hinotori Robotic System in Urological Surgery—A Review of Existing Literature. Soc. Int. Urol. J. 2025, 6, 56

Kevin Lu — 2025-08-21

SIUJ, Vol. 6, Pages 58: Navigating the Future of Robotic Urological Surgery: The Hinotori System Joins the Expanding Armamentarium. Comment on Ong et al. Early Clinical Outcomes of the Novel Hinotori Robotic System in Urological Surgery—A Review of Existing Literature. Soc. Int. Urol. J. 2025, 6, 56

Société Internationale d’Urologie Journal doi: 10.3390/siuj6040058

Authors: Kevin Lu Yung-Shun Juan Wen-Jeng Wu

Over the past two decades, robotic-assisted surgery has revolutionized the field of urology, offering remarkable advancements in surgical precision, reduced perioperative morbidity, and enhanced postoperative recovery [...]

SIUJ, Vol. 6, Pages 57: Pathways for Innovation in Urology

Peter C. Black — 2025-08-20

SIUJ, Vol. 6, Pages 57: Pathways for Innovation in Urology

Société Internationale d’Urologie Journal doi: 10.3390/siuj6040057

Authors: Peter C. Black

The pages of this month’s Société Internationale d’Urologie Journal (SIUJ) feature important contributions addressing the clinical implementation of innovation and technology in Urology [...]

SIUJ, Vol. 6, Pages 55: The “Footprint” Sign in Voiding Cystourethrography Indicates Poor Renal Function in Vesicoureteral Reflux: Is It a Pop-Off Mechanism?

Hooman Kamran — 2025-08-19

SIUJ, Vol. 6, Pages 55: The “Footprint” Sign in Voiding Cystourethrography Indicates Poor Renal Function in Vesicoureteral Reflux: Is It a Pop-Off Mechanism?

Société Internationale d’Urologie Journal doi: 10.3390/siuj6040055

Authors: Hooman Kamran Negar Mohammadi Ganjaroudi Nooshin Tafazoli Mehrzad Mehdizadeh Abdol-Mohammad Kajbafzadeh

Background/Objectives: To assess the “footprint” sign in voiding cystourethrogram (VCUG) for its diagnostic and prognostic significance in indicating a “pop-off” mechanism that may reduce pressure on the contralateral kidney. Methods: A retrospective analysis included patients with a “footprint” sign or high-grade vesicoureteral reflux (VUR) in VCUG. They were categorized into two groups: those with (Group A) and those without (Group B) the “footprint” sign. Results: Among 55 patients (median age 18 months), 18 exhibited the “footprint” sign. Group A had predominantly male patients. Bilateral VUR was less common in Group A (38.9%) compared to Group B (51.4%), though not statistically significant (p-value: 0.385). The “footprint” sign was predominantly associated with the left side (77.8% in Group A). The median differential renal function (DRF) was significantly lower in kidneys with the “footprint” sign (11.5%) compared to those without (44.5%, p-value < 0.001). All patients with a DRF under 20% exhibited the “footprint” sign. Conclusions: The “footprint” sign correlates with poor renal function, suggesting a potential pop-off mechanism protecting the contralateral kidney. Management should prioritize the contralateral kidney with normal function. The “footprint” sign alone in VCUG may suffice to indicate compromised renal function, negating the need for further ipsilateral kidney assessment.

SIUJ, Vol. 6, Pages 56: Early Clinical Outcomes of the Novel Hinotori Robotic System in Urological Surgery—A Review of Existing Literature

Simone Meiqi Ong — 2025-08-19

SIUJ, Vol. 6, Pages 56: Early Clinical Outcomes of the Novel Hinotori Robotic System in Urological Surgery—A Review of Existing Literature

Société Internationale d’Urologie Journal doi: 10.3390/siuj6040056

Authors: Simone Meiqi Ong Hong Min Peng Wei Zheng So Ho Yee Tiong

Robotic-assisted surgery has gradually established its role in uro-oncological cases that demand a high level of precision, optimising surgeon ergonomics and decreasing fatigue whilst maintaining optimal clinical outcomes. With the novel Hinotori surgical robot (Medicaroid Corporation (Kobe, Hyogo, Japan)) launched in Japan back in 2019, it has now demonstrated its use case across various clinical series of different surgeries. We sought to narratively synthesise the initial feasibility of the Hinotori robotic system in urology. A systematic, comprehensive literature search was conducted across various databases from September 2024 to October 2024. Relevant keywords within the scope of this study were generated for a more accurate search. After exclusion and removal of duplicates, a total of nine articles were included for review. Among the included studies, one study reported data solely on radical prostatectomy for prostate cancer, two studies reported on robotic-assisted nephroureterectomy for renal tumours, two studies reported on partial nephrectomy performed for renal masses, two studies reported on radical nephrectomy carried out for renal malignancies and one study reported on robotic-assisted adrenalectomy for adrenal cancer. Lastly, one study collectively reported on outcomes pertaining to partial nephrectomy, partial nephrectomy, vesicourethral anastomosis and pelvic lymph node dissection in a porcine model, as well as partial nephrectomy, radical prostatectomy and pelvic lymph node dissection in cadavers. The current literature supports its non-inferiority to the well-established Da Vinci system, with no major drawbacks or concerns identified when comparing parameters such as intraoperative time, estimated blood loss (EBL), perioperative events (transfusions, conversion to open surgery), length of hospital stay and major postoperative complications. Future studies involving larger cohorts and more complex surgical cases are essential to further evaluate the efficacy and safety of the Hinotori system. The new Hinotori robotic system offers unique three-dimensional features as a non-inferior robotic platform alternative that has proven clinically safe thus far in its use. Larger scale studies and randomised trials are eagerly awaited to assess and validate more holistically its clinical utility.

SIUJ, Vol. 6, Pages 54: First Multi-Center, Real-World Study on the Temporary Implantable Nitinol Device (iTIND) for the Management of Lower Urinary Tract Symptoms Related to Benign Prostatic Obstruction

Roberto Castellucci — 2025-08-13

SIUJ, Vol. 6, Pages 54: First Multi-Center, Real-World Study on the Temporary Implantable Nitinol Device (iTIND) for the Management of Lower Urinary Tract Symptoms Related to Benign Prostatic Obstruction

Société Internationale d’Urologie Journal doi: 10.3390/siuj6040054

Authors: Roberto Castellucci Silvia Secco Alberto Olivero Feras Al Jaafari Sinan Khadhouri Alessio Faieta Cosimo De Nunzio Riccardo Lombardo Simone Morselli Dean Elterman Luca Cindolo

Background/Objectives: Lower urinary tract symptoms (LUTSs) due to benign prostatic obstruction (BPO) represent a common condition affecting aging men. Transurethral resection of the prostate represents the gold standard surgical treatment but is not without complications such as retrograde ejaculation, bleeding and urinary retention. The temporary implantable nitinol device (iTIND) is considered a minimally invasive surgical technique, designed to treat LUTS while preserving erectile and ejaculatory function. Herein we report the results of a multi-center, real-world assessment of the iTIND procedure. Methods: Data from five international centers treating LUTS with the iTIND device were collected. We recorded changes through an International Prostatic Symptom Score (IPSS) questionnaire with Quality of Life (QoL), International Index of Erectile Function (IIEF5) questionnaire, antegrade ejaculatory function, maximum flow (QMax), post voiding residual volume (PVR) and freedom from repeat intervention. Results: A total of 74 subjects were enrolled; median follow-up was 12 months. IPSS and QoL changed from a median of 23 and 4 points at baseline to 11 and 2 points, respectively, at the last follow-up. A mean improvement in Qmax and PVR from 9 mL/s and 56 mL at baseline to 13 mL/s and 40 mL was noticed at the last follow-up. Total median operative time was 10 min, and the median time of iTIND indwell time was 7 days. The median device removal time was 5 min. There were no changes in IIEF5 scores and antegrade ejaculation rate. No intraoperative complications were reported, and non-serious postoperative complications occurred in six patients (two urinary retention, two mild haematuria, two urinary tract infection). Finally, four patients underwent reoperation during the follow-up period. All procedures were performed as outpatient day cases. Conclusions: Our results confirms that treatment with the iTIND is effective and safe in terms of improving urinary symptoms and quality of life without impacting sexual function. Longer follow-up is required to better define the durability of this minimally invasive procedure.

SIUJ, Vol. 6, Pages 53: Artificial Intelligence in Urology—A Survey of Urology Healthcare Providers

Yam Ting Ho — 2025-08-12

SIUJ, Vol. 6, Pages 53: Artificial Intelligence in Urology—A Survey of Urology Healthcare Providers

Société Internationale d’Urologie Journal doi: 10.3390/siuj6040053

Authors: Yam Ting Ho Rizal Rian Dhalas Muhammad Zohair Subrata Deb Mohammed Shoaib Sandra Elmer A. H. M. Imrul Tareq Tauheed Fareed Nahid Rahman Zico Agus Rizal Ardy Hariandy Hamid Isaac A. Thangasamy Jeremy Y. C. Teoh

Background/Objectives: Artificial intelligence (AI) has been utilised in urological conditions such as urolithiasis, urogynaecology and uro-oncology. The aim of this study is to examine the attitudes and beliefs about AI technology amongst urology healthcare providers. Methods: A structured online questionnaire, created from a modified Delphi method with a panel of urologists and urology surgical trainees, was delivered through the Urological Asia Association’s annual congress. The questionnaire, with 25 items of mixed type responses (five-point Likert scale, nominal-polytomous and open-ended), acquired data regarding demographics, perception and attitudes towards general usage of AI in urological care. Results: A total of 464 respondents from 47 different countries were collected. The results showed that 83.4% of participants believed AI will improve efficiency and 18.8% believed they are knowledgeable in AI technology, with ordinal logistic regression showing both urology specialists and trainees are more likely to agree to these responses. Overall, 51.5% believed AI adoption will not replace clinical practice, and regression analysis found those with previous AI training are more likely to agree to this response. We found AI is commonly used in research, patient education and administrative tasks and identified key enablers as regulatory approval, AI clinical effectiveness and access to AI training. Conclusions: Overall attitudes and beliefs towards the use of AI in urology is positive and encouraging. AI training and education and regulatory reform needs to be addressed to allow integration of AI into clinical practice. A limitation of the study lies in its generalisability to global settings due to the demographics of the respondents.

SIUJ, Vol. 6, Pages 52: Trial of Void at Home After Green Light Laser Photosensitive Vaporisation of the Prostate: A Proof of Concept

Arjun Guduguntla — 2025-08-12

SIUJ, Vol. 6, Pages 52: Trial of Void at Home After Green Light Laser Photosensitive Vaporisation of the Prostate: A Proof of Concept

Société Internationale d’Urologie Journal doi: 10.3390/siuj6040052

Authors: Arjun Guduguntla Saad Fahd Andrew Xu Lauren Chandler Ken Chow Dennis Gyomber

Background/Objectives: Green light laser photosensitive vaporisation of the prostate (GLL-PVP) is a common procedure for bladder outlet obstruction, with a low incidence of post-operative bleeding. At Northern Health, postoperative management involved limited bladder washout with two bags of 2 L saline, spigotting, and undergoing a trial of void (TOV) the next morning. A new model of care was commenced in which patients were discharged after the two bags of washout, and the TOV occurred at home through the Hospital in the Home service. The aim of this study was to audit patient outcomes, patient satisfaction, and health service benefits of this novel program. Methods: Patients assigned to the program between March 2023 and June 2024 were analysed. Catheter removal occurred the morning after surgery, and the decision on the success of the TOV was made following an afternoon review. Results: A total of 93.3% (28/30) patients passed their TOV at home. There were no readmissions in the first 48 h postoperation, with only three emergency department (ED) presentations in this time. On a five-point rating scale, 25/25 questionnaire respondents were happy with their care, 20/25 rated the service as very good, and 5/25 rated the service as good. An extra AUD 3377.56 in revenue was generated per patient from the freed inpatient beds, which correlated to a net revenue of AUD 83,016.83 generated over the study period. Conclusions: At-home TOV after GLL-PVP is safe and feasible. There is high patient satisfaction and significant benefits to the healthcare system. This framework can additionally be adopted after other urological surgeries.

SIUJ, Vol. 6, Pages 51: PSMA PET in Favourable Intermediate-Risk Prostate Cancer? Gold Mine or Money Pit

Weiwei Shi — 2025-08-12

SIUJ, Vol. 6, Pages 51: PSMA PET in Favourable Intermediate-Risk Prostate Cancer? Gold Mine or Money Pit

Société Internationale d’Urologie Journal doi: 10.3390/siuj6040051

Authors: Weiwei Shi Jianliang Liu Nathan Lawrentschuk Marlon Perera

Background/Objectives: Since the proPSMA trial, prostate-specific membrane antigen (PSMA) positron emission tomography (PET) scan has primarily replaced conventional imaging for staging newly diagnosed prostate cancer. The objective of this commentary is to summarise the existing literature on the role of PSMA PET in staging favourable intermediate-risk prostate cancer. Methods: A literature search was conducted on Embase and Ovid MEDLINE, and three retrospective cohort studies were identified. Results: Overall, these studies demonstrated a low prevalence of nodal and distant metastases, as well as modest diagnostic performance of PSMA positron emission tomography-computed tomography (PET-CT) in this patient group. Additionally, PSMA PET did not significantly outperform existing nomograms in predicting lymph node involvement. Conclusions: Given its limited sensitivity, low yield, and cost, the routine use of PSMA PET-CT in favourable intermediate-risk prostate cancer patients is not recommended. Further prospective studies and cost-effectiveness analyses are warranted to clarify its role in this population.

SIUJ, Vol. 6, Pages 50: Intraurethral Steroid and Clean Intermittent Self-Dilatation for Lichen Sclerosus Proven Urethral Stricture Disease—A Retrospective Cohort Study

Alex Buckby — 2025-08-12

SIUJ, Vol. 6, Pages 50: Intraurethral Steroid and Clean Intermittent Self-Dilatation for Lichen Sclerosus Proven Urethral Stricture Disease—A Retrospective Cohort Study

Société Internationale d’Urologie Journal doi: 10.3390/siuj6040050

Authors: Alex Buckby Ramesh Shanmugasundaram Arman Kahokehr

Background/Objectives: Lichen sclerosus is a chronic lymphocyte-mediated inflammatory disorder with a predilection for the anogenital region. It is a common cause of urethral stricture disease in males. The gold standard treatment is considered to be surgical reconstruction; however, there are many patients who are not suitable or not willing to undergo surgery. Cutaneous lichen sclerosus restricted to the foreskin, prepuce or glans is often response to topical corticosteroids; however, the use of intraurethral corticosteroids for urethral involvement has limited research. Methods: We conducted a retrospective cohort study on 18 patients with histologically confirmed lichen sclerosus and associated urethral stricture disease. They were treated with clean intermittent self catheterisation using a hydrophilic catheter coated with 0.05% betamethasone ointment. International Prostate Symptom Score with Quality of Life scores were measured prior to treatment and at follow-up intervals. Results: There was significant improvement in International Prostate Symptom Score and Quality of Life scores at 3 months, 12 months and 24 months, with only 1 patient ceasing treatment due to intolerance. One patient required a single repeat endoscopic dilatation following a period of non-compliance with treatment. Conclusions: Intraurethral corticosteroids with clean-intermittent self-catheterisation is effective and well tolerated for treating lichen sclerosus-associated urethral stricture disease in the short to intermediate term for patients not willing to undergo urethroplasty.

SIUJ, Vol. 6, Pages 49: Barriers to Introducing New Transformative Surgical Technology in Australian Healthcare: A Comprehensive Review and Guide

Matthew Alberto — 2025-08-12

SIUJ, Vol. 6, Pages 49: Barriers to Introducing New Transformative Surgical Technology in Australian Healthcare: A Comprehensive Review and Guide

Société Internationale d’Urologie Journal doi: 10.3390/siuj6040049

Authors: Matthew Alberto Jennifer Xu Oneel Patel Damien Bolton Joseph Ischia

Background/Objectives: Introducing new transformative surgical technology involves navigating a complex process from design to implementation, often hindered by various barriers that delay the transition into clinical practice. This review critically examines the barriers, proposes a unified guide for medical device implementation in the Australian healthcare system utilising the validated Medtech Innovation Guide, and compares regulatory frameworks in Australia, the United Kingdom, and the United States of America. Methods: We conducted a literature review using MEDLINE and EMBASE with MeSH terms or emtree terms and keywords “new OR novel” AND “surgical device OR medical device OR health technology OR surgical technology OR surgical instrument OR transformative technology OR technological innovation OR technological change” AND “implementation OR adoption OR innovation adoption” AND “surgery OR surgical” AND “Australia”. We also assessed governmental websites (gov.au) and documents as well as the Royal Australasian College of Surgeons (RACS) website, policies, and position statements. Furthermore, Australian medical technology start-up companies were asked for any published roadmaps. Results: Four key stakeholder groups were identified: medical professionals, government, hospitals, and patients/consumers. Barriers include surgeon scepticism, regulatory hurdles (e.g., Australian Register of Therapeutic Goods), hospital clearance processes, and meeting patient expectations. To address these challenges, we propose a five-phase system: surgical device development (phase one), compliance with regulatory processes (phase two), research and experimentation (phase three), finalisation for product launch (phase four), and product launch and assessment (phase five). Conclusions: By following our five-phase guide, innovators may better navigate the complexities of integrating transformative surgical technologies into Australian healthcare. Although there are limitations, this approach is based on the validated Medtech Innovation Guide and may help both experienced and inexperienced practitioners better implement innovative technology; however, real-world validation is required.

SIUJ, Vol. 6, Pages 48: Is Micro-Ultrasound Ready to Become the New Standard for Prostate Cancer Diagnosis? Comment on Saitta et al. SIU-ICUD: Comprehensive Imaging in Prostate Cancer—A Focus on MRI and Micro-Ultrasound. Soc. Int. Urol. J. 2025, 6, 39

Chi-Fai Ng — 2025-06-17

SIUJ, Vol. 6, Pages 48: Is Micro-Ultrasound Ready to Become the New Standard for Prostate Cancer Diagnosis? Comment on Saitta et al. SIU-ICUD: Comprehensive Imaging in Prostate Cancer—A Focus on MRI and Micro-Ultrasound. Soc. Int. Urol. J. 2025, 6, 39

Société Internationale d’Urologie Journal doi: 10.3390/siuj6030048

Authors: Chi-Fai Ng

Prostate cancer remains one of the most prevalent malignancies among men worldwide, with early and accurate diagnosis being critical for improving outcomes [...]

SIUJ, Vol. 6, Pages 47: SIU-ICUD: Localized Prostate Cancer

Laurence Klotz — 2025-06-17

SIUJ, Vol. 6, Pages 47: SIU-ICUD: Localized Prostate Cancer

Société Internationale d’Urologie Journal doi: 10.3390/siuj6030047

Authors: Laurence Klotz

The International Consultation on Urologic Diseases (ICUD) is now 45 years old, representing an illustrious tradition [...]

SIUJ, Vol. 6, Pages 46: SIU-ICUD: Management of Lymph Node–Positive Prostate Cancer

Haitham Shaheen — 2025-06-13

SIUJ, Vol. 6, Pages 46: SIU-ICUD: Management of Lymph Node–Positive Prostate Cancer

Société Internationale d’Urologie Journal doi: 10.3390/siuj6030046

Authors: Haitham Shaheen Mack Roach Eman Essam Elsemary

Background/Objectives: The management of localized prostate cancer with regional lymph node involvement (N1M0) presents significant clinical challenges. While once considered indicative of systemic disease, improved imaging and evolving treatment paradigms have redefined node-positive disease as potentially curable. This systematic review aims to assess current evidence regarding treatment modalities and outcomes for patients with localized N1M0 prostate cancer. Methods: A systematic review was conducted to identify studies evaluating therapeutic strategies for N1M0 prostate cancer. Eligible studies included randomized controlled trials, retrospective analyses, and consensus guidelines. Treatment approaches reviewed included radical prostatectomy (RP) with pelvic lymph node dissection (PLND), whole pelvic radiotherapy (WPRT), prostate-only radiotherapy (PORT), androgen deprivation therapy (ADT), and metastasis-directed therapy (MDT), including stereotactic body radiotherapy (SBRT). Key outcomes included overall survival (OS), biochemical recurrence-free survival (bRFS), disease-free survival (DFS), and treatment-related toxicity. Results: Multimodal approaches—particularly the combination of ADT with WPRT or adjuvant radiotherapy following RP—were associated with improved survival outcomes. Patients with limited nodal burden and undetectable postoperative prostate-specific antigen (PSA) levels derived the most benefit. The use of prostate-specific antigen membrane positron-emission tomography/computed tomography (PSMA PET/CT) enhanced detection and guided MDT in oligorecurrent disease. SBRT, simultaneous integrated boost (SIB), and hypofractionated regimens demonstrated promising efficacy with acceptable toxicity profiles. Conclusions: Node-positive localized prostate cancer is optimally managed with individualized, multidisciplinary strategies. Combining systemic and locoregional treatments improves outcomes in selected patients. Ongoing prospective studies are warranted to refine patient selection, optimize treatment sequencing, and integrate novel imaging and systemic agents.

SIUJ, Vol. 6, Pages 45: SIU-ICUD: Germline Genetic Susceptibility to Prostate Cancer: Utility and Clinical Implementation

James T. Kearns — 2025-06-13

SIUJ, Vol. 6, Pages 45: SIU-ICUD: Germline Genetic Susceptibility to Prostate Cancer: Utility and Clinical Implementation

Société Internationale d’Urologie Journal doi: 10.3390/siuj6030045

Authors: James T. Kearns Annabelle Ashworth Elena Castro Rosalind A. Eeles Liesel M. FitzGerald Peter J. Hulick Stacy Loeb Christian P. Pavlovich Timothy R. Rebbeck Susan T. Vadaparampil Zhuqing Shi Huy Tran Jun Wei Jianfeng Xu Brian T. Helfand

Background/Objectives: Prostate cancer is the most common cancer among men globally and a leading cause of cancer-related death. Germline genetic evaluation is increasingly recognized as essential for men with high-risk features such as a strong family history or advanced disease. Methods: Comprehensive genetic risk assessment should integrate three components: family history (FH), rare pathogenic mutations (RPMs), and polygenic risk scores (PRS). RPMs in DNA repair genes (e.g., BRCA2, CHEK2, ATM) can inform screening, prognosis, and treatment strategies, particularly for metastatic or aggressive disease. PRS, derived from common genetic variants, provides a personalized and independent measure of prostate cancer risk and may guide decisions on screening intensity and timing. Results: Although PRS cannot yet differentiate between indolent and aggressive cancer, it has the potential to stratify men into low and high-risk categories more effectively than FH or RPMs alone. Knowledge of specific RPMs can influence treatment decisions in clinically advanced prostate cancer. Challenges in clinical implementation include limited provider awareness, underutilization of genetic counseling, and lack of diversity in genomic datasets, which can lead to misdiagnoses. Emerging technologies and digital tools are being developed to streamline genetic testing and counseling. Population-level strategies and tailored screening protocols based on genetic risk are under active investigation. Conclusions: While early evidence suggests high satisfaction with genetic testing among patients, further studies in diverse populations are needed. Integration of germline genetic information into prostate cancer management offers promising avenues for personalized screening, surveillance, and treatment, ultimately aiming to reduce morbidity and mortality.

SIUJ, Vol. 6, Pages 44: SIU-ICUD: Epidemiology of Prostate Cancer

Bárbara Vieira Lima Aguiar Melão — 2025-06-12

SIUJ, Vol. 6, Pages 44: SIU-ICUD: Epidemiology of Prostate Cancer

Société Internationale d’Urologie Journal doi: 10.3390/siuj6030044

Authors: Bárbara Vieira Lima Aguiar Melão Kelly R. Pekala Konstantina Matsoukas Ola Bratt Sigrid V. Carlsson

Background/Objectives: Prostate cancer (PCa) is the second most common malignancy among men worldwide and a leading cause of cancer-related mortality. In 2022, over 1.4 million new cases were reported globally, with a prevalence exceeding 5 million. Despite its widespread occurrence, the incidence and mortality of PCa show substantial geographic variation, influenced by factors such as genetic predisposition, healthcare access, lifestyle, and the adoption of screening programs. Regions with high PCa incidence, such as Northern America and Oceania, often have lower mortality rates due to early detection and advanced healthcare infrastructure. Conversely, areas with limited access to medical resources, such as parts of Africa and Latin America, experience higher mortality rates. Methods: This review explores non-modifiable risk factors such as age, family history, and race, emphasizing their role in PCa development and progression. Results: Modifiable factors, including diet, physical activity, alcohol consumption, and smoking, are also addressed, with evidence suggesting their potential in mitigating risk. Emerging data on medications such as 5-alpha reductase inhibitors and statins, as well as dietary supplements such as vitamins D, indicate their potential for chemoprevention, though further research is needed to solidify these findings. Healthcare disparities, especially in low- and middle-income regions, highlight the need for equitable access to diagnostic tools and treatment options. The review underscores the significance of tailored screening approaches, particularly in high-risk populations, to optimize outcomes while minimizing overdiagnosis and overtreatment. Conclusions: The review concludes with recommendations for future research, including the need for standardized screening protocols and the exploration of novel biomarkers for early detection. By synthesizing epidemiological data and current evidence, this review aims to enhance understanding of PCa risk factors, geographic disparities, and preventive strategies, ultimately contributing to improved global PCa management and outcomes.

SIUJ, Vol. 6, Pages 43: SIU-ICUD: Advances in Surgical Technique of Robotic Prostatectomy

Belén Mora-Garijo — 2025-06-11

SIUJ, Vol. 6, Pages 43: SIU-ICUD: Advances in Surgical Technique of Robotic Prostatectomy

Société Internationale d’Urologie Journal doi: 10.3390/siuj6030043

Authors: Belén Mora-Garijo Keith J. Kowalczyk

Background/Objectives: Innovations in robotic prostatectomy have transformed a highly morbid operation to a procedure with fewer complications and shorter hospital stays, yet techniques continue to evolve. Our objective is to discuss the most recent advances in robotic prostatectomy techniques designed to minimize morbidity related to urinary incontinence and erectile dysfunction. Methods: This review is adapted from a comprehensive committee chapter on published in the 3rd WUOF/SIU (World Urologic Oncology Federation/Société Internationale d’Urologie) International Consultation on Urologic Diseases on Localized Prostate Cancer. Results: This review article describes both traditional and emerging techniques in robotic prostatectomy techniques and discusses their respective outcomes. Conclusions: Improved understanding of pelvic anatomy has enabled robotic-assisted techniques to preserve key structures and enhance recovery and functional outcomes while preserving oncologic safety

SIUJ, Vol. 6, Pages 42: SIU-ICUD: Principles and Outcomes of Focal Therapy in Localized Prostate Cancer

Alessandro Marquis — 2025-06-10

SIUJ, Vol. 6, Pages 42: SIU-ICUD: Principles and Outcomes of Focal Therapy in Localized Prostate Cancer

Société Internationale d’Urologie Journal doi: 10.3390/siuj6030042

Authors: Alessandro Marquis Jonathan Olivier Tavya G. R. Benjamin Eric Barret Giancarlo Marra Claire Deleuze Lucas Bento Kae J. Tay Hashim U. Ahmed Mark Emberton Arnauld Villers Thomas J. Polascik Ardeshir R. Rastinehad

Background/Objectives: Focal therapy (FT) for prostate cancer (PCa) is an alternative to radical treatments that aims to balance cancer control and quality of life preservation in well-selected patients. Understanding its general principles and outcomes is key for its widespread adoption and proper implementation. Methods: The International Consultation on Urological Diseases nominated a committee to review the literature on FT for PCa. A comprehensive PubMed search was conducted to identify articles focused on the different aspects of FT, including patient selection, imaging techniques, treatment modalities, cancer control and safety outcomes, integration with other approaches and future perspectives. Results: FT for PCa was introduced in the 1990s with cryotherapy and high-intensity focused ultrasound (HIFU) as pioneering modalities. Though initially guided by transrectal ultrasound (TRUS) and large biopsy templates, FT implementation expanded significantly with the advent of multiparametric magnetic resonance imaging (MRI) and the validation of the index lesion concept. Appropriate patient selection is key for FT and relies on prostate-specific antigen (PSA) metrics, MRI findings and targeted biopsy information. Multiple energy sources are now available, each with specific technical characteristics. Cancer control rates vary by energy modality, tumor characteristics, and institutional experience, demonstrating comparable outcomes to radical treatments in well-selected patients. The safety profile is excellent, with high rates of urinary continence and sexual function preservation. Post-treatment surveillance integrates PSA measurements, imaging, and histological assessment. Future directions for further FT adoption include the availability of long-term data, protocol standardization and technological improvements to enhance patient selection and treatment planning and delivery. Conclusions: FT is a valuable therapeutic option for selected patients with localized PCa, demonstrating promising oncological outcomes and better functional preservation compared to radical treatments. Understanding its principles and technical aspects is essential for offering comprehensive PCa care.

SIUJ, Vol. 6, Pages 41: SIU-ICUD: Localized Prostate Cancer: Pathological Factors That Influence Outcomes and Management

Gladell P. Paner — 2025-06-07

SIUJ, Vol. 6, Pages 41: SIU-ICUD: Localized Prostate Cancer: Pathological Factors That Influence Outcomes and Management

Société Internationale d’Urologie Journal doi: 10.3390/siuj6030041

Authors: Gladell P. Paner Eva M. Compérat Samson W. Fine James G. Kench Glen Kristiansen Rajal B. Shah Steven Christopher Smith John R. Srigley Geert J. L. H. van Leenders Murali Varma Ming Zhou Mahul B. Amin

Background/Objectives: Pathological factors are integral in the risk stratification and management of localized prostate cancer. In recent years, there has been an upsurge of studies that uncovered novel approaches and have refined prognostic factors for prostate cancer in needle biopsy and radical prostatectomy (RP) specimens. Methods: We conducted a review of literature and summarized the significant recent updates on pathological factors for localized prostate cancer. Results: Innovative factors derived from the traditional Gleason grading, such as the extent of Gleason pattern 4 and presence of cribriform pattern are now recognized to significantly improve discrimination of outcome. The components and rules of Gleason grading themselves underwent modifications, and the subsequent prognostic grouping of the different grades (Grade group) have resulted in enhanced stratification of behavior more meaningful in management decision. The approaches for grade reporting in systematic or targeted needle biopsies and in RP with multifocal cancers are also being optimized. Newer tumor growth pattern-based factors such as intraductal carcinoma and atypical intraductal proliferation can have ramifications in management, especially in the background of low to intermediate risk prostate cancers. Gleason grade considerations in the different post-treatment settings and for de novo and residual prostate cancers with varying treatment effects have also been explicated. Likewise, the application of more traditional factors in tumor extent and perineural invasion in biopsy, or positive surgical margin in RP, have also evolved. Conclusions: Some of these newer pathological factors are now officially recommended in standardized pathology reporting protocols and are applied in the management decision for localized prostate cancer.

SIUJ, Vol. 6, Pages 40: SIU-ICUD: Prevention of Lethal Prostate Cancer via Modifiable Heart-Healthy Lifestyle Changes, Metrics, and Repurposed Medications

Mark A. Moyad — 2025-06-07

SIUJ, Vol. 6, Pages 40: SIU-ICUD: Prevention of Lethal Prostate Cancer via Modifiable Heart-Healthy Lifestyle Changes, Metrics, and Repurposed Medications

Société Internationale d’Urologie Journal doi: 10.3390/siuj6030040

Authors: Mark A. Moyad Raj V. Tiwari Daniel A. Galvão Dennis R. Taaffe Robert U. Newton

Background/Objectives: Primary prevention, germline, familial, or other pre- or post-diagnostic and standard treatment-elevated progression or recurrence risk and mitigating adverse events from systemic treatment are all clinical opportunities to reduce the risk of lethal prostate cancer. This review attempted to provide a practical and realistic consensus via an international committee of experts who, in general, harbor career-long experience in this discipline. Methods: A PubMed review primarily utilizing the latest meta-analyses, systematic reviews, and methodologically robust epidemiologic recent data adjusting for multiple confounding variables was conducted. The goal of this committee was to highlight tangible options for clinicians and patients. Results: Behavioral patterns and metrics known to reduce cardiovascular morbidity, mortality, and all-cause mortality (premature death) appear to prevent numerous lethal common cancers, including prostate cancer. This practical approach allows for the greatest probability of patient success since cardiovascular disease (CVD) is the primary cause of death in men with and without prostate cancer, and a notable source of morbidity and mortality in men with advanced disease due to systemic conventional treatment as well as the inflammatory contribution of cancer itself. Heart-healthy dietary patterns, exercise, healthy weight/waist circumference, eliminating tobacco, minimizing alcohol exposure, and other behaviors to reduce the risk of CVD should be prioritized. CVD-preventive medications, including aspirin, GLP-1 agonists, metformin, statins, etc., should receive attention to improve compliance for those that already qualify for these agents and to increase the probability of enhancing the quality and quantity of life. Dietary supplements do not have favorable data currently to espouse their utilization to prevent lethal prostate cancer but may have an ancillary role in mitigating some adverse effects of treatment. Conclusions: Remarkably, heart-healthy lifestyle changes, metrics, and promising repurposed medications known to reduce cardiovascular events, promote longevity, and improve mental health could simultaneously prevent lethal prostate cancer. This serendipitous association provides clinicians and their patients a higher probability of success, regardless of their prostate cancer pathway or circumstance.

SIUJ, Vol. 6, Pages 39: SIU-ICUD: Comprehensive Imaging in Prostate Cancer—A Focus on MRI and Micro-Ultrasound

Cesare Saitta — 2025-06-07

SIUJ, Vol. 6, Pages 39: SIU-ICUD: Comprehensive Imaging in Prostate Cancer—A Focus on MRI and Micro-Ultrasound

Société Internationale d’Urologie Journal doi: 10.3390/siuj6030039

Authors: Cesare Saitta Wayne G. Brisbane Hannes Cash Sangeet Ghai Francesco Giganti Adam Kinnaird Daniel Margolis Giovanni Lughezzani

Background/Objectives: The diagnostic approach to prostate cancer (PCa) has evolved from systematic biopsies to imaging-guided strategies that improve detection of clinically significant PCa (csPCa) while reducing overdiagnosis. Multiparametric magnetic resonance imaging (mpMRI) has emerged as the gold standard for pre-biopsy evaluation, while micro-ultrasound (MicroUS) offers a promising alternative with real-time imaging capabilities. Methods: We examined the principles, image interpretation frameworks (Prostate Imaging Reporting and Data System (PI-RADS) and Prostate Risk Identification using Micro UltraSound (PRI-MUS)), and clinical applications of mpMRI and MicroUS, comparing their diagnostic accuracy in biopsy-naïve patients, repeat biopsy scenarios, active surveillance, and staging. Results: mpMRI improves csPCa detection, reduces unnecessary biopsies, and enhances risk stratification. Landmark studies such as PRECISION (Prostate Evaluation for Clinically Important Disease: Sampling Using Image Guidance or Not?) and PRIME (Prostate Imaging Using MRI±Contrast Enhancement) confirm its superiority over systematic biopsy. However, mpMRI remains resource-intensive, with limitations in accessibility and interpretation variability. Conversely, MicroUS, with its high-resolution real-time imaging, shows non-inferiority to mpMRI and potential advantages in magnetic resonance imaging (MRI)-ineligible patients. It improves lesion visualization and biopsy targeting, with ongoing trials such as OPTIMUM (Optimization of prostate biopsy—Micro-Ultrasound versus MRI) evaluating its standalone efficacy. Conclusions: mpMRI and MicroUS are complementary modalities in PCa diagnosis. While mpMRI remains the preferred imaging standard, MicroUS offers an alternative, particularly in patients with MRI contraindications. Combining these techniques could enhance diagnostic accuracy, reduce unnecessary interventions, and refine active surveillance strategies. Future research should focus on integrating both modalities into standardized diagnostic pathways for a more individualized approach.

SIUJ, Vol. 6, Pages 38: SIU-ICUD: Focal Therapy for PCa — The Technique

Lara Rodriguez-Sanchez — 2025-06-07

SIUJ, Vol. 6, Pages 38: SIU-ICUD: Focal Therapy for PCa — The Technique

Société Internationale d’Urologie Journal doi: 10.3390/siuj6030038

Authors: Lara Rodriguez-Sanchez Thomas J. Polascik Kara Watts Peter Ka-Fung Chiu Mark Emberton Behfar Ehdaie Hashim U. Ahmed Andre Abreu Ardeshir R. Rastinehad Rafael Sanchez-Salas

Background/Objectives: Focal therapy (FT) and technology are closely connected. Advanced imaging allows for precise identification of the index lesion, enabling the targeted use of various thermal and non-thermal energy sources through different approaches, with specific techniques tailored to lesion location and operator expertise. This personalized approach enhances both safety and effectiveness, facilitating customized treatment planning. Methods: The International Consultation on Urological Diseases formed a committee to review the current literature on FT for prostate cancer (PCa), focusing specifically on the technique. Following in-depth discussions, the committee chose a “by lesion” approach rather than the traditional “by energy” approach to structure the review. A comprehensive PubMed search was conducted to gather relevant articles on the various energy modalities and procedural approaches used in FT for PCa. Results: Lesions in the apex, anterior, and posterior regions of the prostate can be accessed through several FT approaches, each associated with specific energy modalities and techniques. The transrectal approach utilizes high-intensity focused ultrasound (HIFU) and focal laser ablation (FLA), while the transperineal approach is compatible with energy sources such as cryotherapy, irreversible electroporation (IRE), brachytherapy, and FLA. The transurethral approach supports methods such as transurethral ultrasound ablation (TULSA). Each approach offers distinct advantages based on lesion location, treatment area, and energy modality. The choice of technique evaluated the safety and efficacy of each energy source and approach based on specific treatment areas within the prostate, highlighting the need for robust research across lesion locations and modalities, rather than focusing solely on each modality for a specific region. Conclusions: FT is rapidly advancing with new energy sources, technological improvements, and increasing operator expertise. To further optimize FT, research should prioritize evaluating the safety and effectiveness of different energy sources for various lesion locations, focusing on the treatment area rather than the energy modality itself.

SIUJ, Vol. 6, Pages 37: Extended vs. Standard Pelvic Lymph Node Dissection in Bladder Cancer Patients Undergoing Radical Cystectomy: Systematic Review and Meta-Analysis

Jordan Santucci — 2025-06-07

SIUJ, Vol. 6, Pages 37: Extended vs. Standard Pelvic Lymph Node Dissection in Bladder Cancer Patients Undergoing Radical Cystectomy: Systematic Review and Meta-Analysis

Société Internationale d’Urologie Journal doi: 10.3390/siuj6030037

Authors: Jordan Santucci Peter Stapleton Marlon Perera Nathan Lawrentschuk Declan Murphy Niranjan Sathianathen

Background/Objectives: Pelvic lymph node dissection during radical cystectomy has been established to be important for staging and therapeutic purposes. However, there is uncertainty regarding the optimal extent of nodal dissection. This study aimed to assess the impact of an extended pelvic lymphadenectomy template compared to a standard template in patients with bladder cancer undergoing radical cystectomy. Methods: We performed a systematic review and meta-analysis of randomised studies comparing extended pelvic lymph node dissection to standard pelvic lymph node dissection in patients undergoing radical cystectomy. A search of multiple databases was performed up to October 2024. The standard template was defined as including at least the obturator and internal and external iliac nodes. An extended template was defined as a standard template plus the removal of proximal nodal packets. The primary outcomes were overall survival and major Clavien–Dindo complications. Results: Two studies encompassing a total of 933 participants met the eligibility criteria. There was no observed improvement in overall survival with extended lymph node dissection compared to limited dissection [HR 0.95, 95%CI 0.66–1.4]. In addition, extended lymph node dissection was associated with an increased risk of grade ≥3 Clavien–Dindo complications compared to limited nodal dissection [RR 1.2, 95%CI 1.02–1.37]. There was also an increased risk of lymphoceles requiring intervention with extended lymphadenectomy. Conclusions: Extended pelvic lymphadenectomy does not improve oncological outcomes and is associated with increased morbidity compared to a standard template in bladder cancer patients undergoing radical cystectomy.

SIUJ, Vol. 6, Pages 36: SIU-ICUD: Screening and Early Detection of Prostate Cancer

Ola Bratt — 2025-06-04

SIUJ, Vol. 6, Pages 36: SIU-ICUD: Screening and Early Detection of Prostate Cancer

Société Internationale d’Urologie Journal doi: 10.3390/siuj6030036

Authors: Ola Bratt Mohamed Jalloh Anwar R. Padhani Paul F. Pinsky Hein Van Poppel Weranja Ranasinghe Kamran Zargar-Shoshtari Kai Zhang Anssi Auvinen

Background/Objectives: Randomised trials show that screening with prostate-specific antigen (PSA) and systematic prostate biopsies can reduce prostate cancer mortality but leads to high rates of overdiagnosis. Today, improved diagnostic methods more selectively detect potentially lethal, high-grade prostate cancer. Methods: This is a narrative review of modern diagnostic methods, ongoing trials, national policies and knowledge gaps related to screening and early detection of prostate cancer. Results: Screening intervals can be prolonged in men with PSA values below around 1 ng/mL as these men are at very low long-term risk of prostate cancer death. Overdiagnosis can be reduced by magnetic resonance imaging (MRI) and lesion-targeted prostate biopsies. Risk calculators and ancillary biomarkers can select men for further investigation and thereby reduce resource needs. These new methods are evaluated in large, randomised screening trials. The remaining knowledge gaps include optimal PSA cut-offs, screening intervals, start and stop ages, and the long-term balance between benefits and harm. Until recently, almost no national healthcare authority recommended population-based screening for prostate cancer. Now, the European Union Council recommends an evaluation of the feasibility of organised, risk-stratified screening. This has led to several pilot projects. In some other parts of the world, such as sub-Saharan Africa and the Caribbean, such initiatives are lacking despite high prostate cancer mortality rates. Conclusions: Risk-stratified prostate cancer screening including MRI and targeted biopsy reduces overdiagnosis. Results from ongoing research are needed to optimise screening protocols and to define long-term benefits and harms. Initiatives for early detection and screening are emerging across the world but are still lacking in many countries with high prostate cancer mortality.

SIUJ, Vol. 6, Pages 35: A 5-Year Follow-Up of Patient-Reported Outcome Measures Following External Beam Radiotherapy or Radical Prostatectomy in Localised Prostate Cancer

Rowan V. David — 2025-04-21

SIUJ, Vol. 6, Pages 35: A 5-Year Follow-Up of Patient-Reported Outcome Measures Following External Beam Radiotherapy or Radical Prostatectomy in Localised Prostate Cancer

Société Internationale d’Urologie Journal doi: 10.3390/siuj6020035

Authors: Rowan V. David Peter L. Stapleton Arman A. Kahokehr Jason Lee David I. Watson John Leung Michael E. O’Callaghan

Background/Objectives: Late toxicity following radiotherapy is common and compromises patient quality of life. However, the impact of toxicity on patient-reported outcome measures (PROMs) five years after prostate external beam radiotherapy (EBRT) is poorly characterised. We describe PROMs using the Expanded Prostate Cancer Index Composite (EPIC-26) five years post-EBRT compared against radical prostatectomy (RP). Methods: A prospective cohort of patients with localised prostate cancer treated from 2000 to 2020 captured by a state-level cancer registry was analysed. Multivariable mixed-effects linear modelling was performed to compare differences between EPIC-26 domains over time between ERBT and RP patients. The percentage of patients recording a decline in EPIC-26 domains compared with baseline which exceeded the minimal clinically important difference (MCID) was calculated and compared between groups. Additionally, subgroup analysis was performed on patients treated using contemporary techniques. Results: There were 1720 patients (EBRT n = 1441 vs. RP n = 279) with evaluable EPIC-26 PROMS. Patients in the EBRT group had a higher median age (74 vs. 66, p < 0.001) and National comprehensive Cancer Network (NCCN) high-risk disease (61% vs. 24%, p < 0.001). Bowel domain scores were worse after EBRT compared to RP (beta −0.46, 95% CI −1.20–−0.28, p < 0.001), with a greater proportion of patients reporting a change in symptoms that exceeded the MICD at 12 months (22 vs. 11%, p = 0.009). Moderate/big bowel bother scores were significantly higher in the EBRT cohort at baseline and all follow-up periods compared to RP (beta −8.27, 95% CI −10.21–−6.34, p < 0.001). Pad use (i.e., ≥1) per day was significantly lower amongst the EBRT group (beta 16.56, 95% CI 14.35–18.76, p < 0.001). Despite contemporary techniques, EBRT was associated with worse bowel domain scores at 12 (75 vs. 80, p < 0.05) and 60 months (75 vs. 80, p < 0.05) compared to RP; however, EBRT was associated with less pad use at 12 (4% vs. 34%, p < 0.001), 24 (10% vs. 33%, p < 0.001) and 60 months (13% vs. 33%, p = 0.15) than RP. Conclusions: There are significant differences in PROMs after local curative treatment for prostate cancer which persist to five years post-treatment, despite contemporary techniques. Understanding the associated toxicity patterns helps inform shared decision-making during pre-treatment counselling.

SIUJ, Vol. 6, Pages 34: ChatGPT vs. Gemini: Which Provides Better Information on Bladder Cancer?

Ahmed Alasker — 2025-04-21

SIUJ, Vol. 6, Pages 34: ChatGPT vs. Gemini: Which Provides Better Information on Bladder Cancer?

Société Internationale d’Urologie Journal doi: 10.3390/siuj6020034

Authors: Ahmed Alasker Nada Alshathri Seham Alsalamah Nura Almansour Faris Alsalamah Mohammad Alghafees Mohammad AlKhamees Bader Alsaikhan

Background/Objectives: Bladder cancer, the most common and heterogeneous malignancy of the urinary tract, presents with diverse types and treatment options, making comprehensive patient education essential. As large language models (LLMs) emerge as a promising resource for disseminating medical information, their accuracy and validity compared to traditional methods remain under-explored. This study aims to evaluate the effectiveness of LLMs in educating the public about bladder cancer. Methods: Frequently asked questions regarding bladder cancer were sourced from reputable educational materials and assessed for accuracy, comprehensiveness, readability, and consistency by two independent board-certified urologists, with a third resolving any discrepancies. The study utilized a 3-point Likert scale for accuracy, a 5-point Likert scale for comprehensiveness, and the Flesch–Kincaid (FK) Grade Level and Flesch Reading Ease (FRE) scores to gauge readability. Results: ChatGPT-3.5, ChatGPT-4, and Gemini were evaluated on 12 general questions, 6 questions related to diagnosis, 28 concerning treatment, and 7 focused on prevention. Across all categories, the correct response rate was notably high, with ChatGPT-3.5 and ChatGPT-4 achieving 92.5%, compared to 86.3% for Gemini, with no significant difference in accuracy. However, there was a significant difference in comprehensiveness (p = 0.011) across the models. Overall, a significant difference in performance was observed among the LLMs (p < 0.001), with ChatGPT-4 providing the most college-level responses, though these were the most challenging to read. Conclusions: In conclusion, our study adds value to the applications of Artificial Intelligence (AI) in bladder cancer education, with notable insights into the accuracy, comprehensiveness, and stability of the three LLMs.

SIUJ, Vol. 6, Pages 33: Higher Mortality Rates in Testicular Cancers in Low-Middle Income Countries—Is It True for All Low-Middle Income Countries? Comment on Majdalany et al. Challenges of Urologic Oncology in Low-to-Middle-Income Countries. Soc. Int. Urol. J. 2024, 5, 303–311

Lekha Madhavan Nair — 2025-04-18

SIUJ, Vol. 6, Pages 33: Higher Mortality Rates in Testicular Cancers in Low-Middle Income Countries—Is It True for All Low-Middle Income Countries? Comment on Majdalany et al. Challenges of Urologic Oncology in Low-to-Middle-Income Countries. Soc. Int. Urol. J. 2024, 5, 303–311

Société Internationale d’Urologie Journal doi: 10.3390/siuj6020033

Authors: Lekha Madhavan Nair Francis Vadakkumparambil James

We read the review entitled ‘Challenges of Urologic Oncology in Low-to-Middle Income Countries’ by Majdalany et al [...]

SIUJ, Vol. 6, Pages 32: The Impact of MISTs on Australian BPO Surgical Trends

David Armany — 2025-04-17

SIUJ, Vol. 6, Pages 32: The Impact of MISTs on Australian BPO Surgical Trends

Société Internationale d’Urologie Journal doi: 10.3390/siuj6020032

Authors: David Armany Lequang Vo Kathleen Lockhart Tania Hossack David Ende Simon Bariol Sriskanthan Baskaranathan Henry Woo

Background/Objectives: To evaluate the impact of Minimally Invasive Surgical Therapies (MISTs) on Australian trends for surgeries treating lower urinary tract symptoms (LUTSs) caused by benign prostatic obstruction (BPO). The recent adoption of the prostatic urethral lift (PUL) and water vapour thermal therapy (such as Rezum) into the Medicare Benefits Scheme (MBS) item schedule on the 1 March 2024 has likely had an impact on Australian surgical trends and we aim to describe their impact on the use of other commonly offered BPO-related surgeries. Methods: This study analyses population-adjusted rates of BPO-related surgeries in Australia from January 2004 to September 2024 using publicly available online Medicare Statistics and Census Data. Independent t-tests and significance levels were calculated to compare procedure rates before and after the introduction of PUL and Rezum in March 2024. Results: In total, 301,648 BPO surgical procedures were claimed under MBS in Australia from January 2004 to September 2024, with transurethral resection of the prostate (TURP) being the most common (78%). Procedure rates increased overall with significant shifts in treatment preference: TURP rates have steadily declined in Australia after peaking in 2009 (123.4 per 100,000 adult men), whilst photo-selective vaporisation of the prostate (PVP) and enucleation have risen. Following the introduction of PUL and Rezum on 1 March 2024, enucleation and simple prostatectomy rates increased, while Transurethral needle ablation (TUNA) and urethral and prostatic prosthesis (UPP) decreased. TURP rates were unaffected. Conclusions: Throughout the past two decades, BPO surgical trends in Australia have shifted, with TURP declining as PVP and enucleation have risen. The 2024 MBS listing for PUL and Rezum has boosted their uptake whilst reducing both TUNA and UPP claims. Simple prostatectomy rates remained stable.

SIUJ, Vol. 6, Pages 31: Epidemiological Insights into Erectile Dysfunction in the United States: A Google Trends Analysis

Zaid Ahmed — 2025-04-17

SIUJ, Vol. 6, Pages 31: Epidemiological Insights into Erectile Dysfunction in the United States: A Google Trends Analysis

Société Internationale d’Urologie Journal doi: 10.3390/siuj6020031

Authors: Zaid Ahmed Muhammed A. Moukhtar Hammad Jake Miller Elia Abou Chawareb Lawrence C. Jenkins Faysal A. Yafi

Background/Objectives: Erectile dysfunction (ED) significantly impacts the well-being and quality of life of millions of men. Understanding geographic patterns and associated factors influencing ED search trends can offer valuable insights for healthcare improvement and advocacy. This study investigated the correlation between Google search trends for ED and various factors across the US. Methods: Google search trends for “erectile dysfunction” were collected over a 6-year period between March 2018 and August 2024. The Google search trends provided data for individual states on a scale from 1 to 100. Search volumes were analyzed alongside the urologist-to-population ratio, percentage of the population aged 65 and older, median household income, and percentage of state residents with a bachelor’s degree or higher. Pearson correlation coefficients were used to examine the relationships between ED search volumes and these factors. Results: Higher ED search volumes were associated with a higher percentage of older adults (r = 0.4332, p = 0.001676). A negative correlation was found between ED search volume and higher education (r = −0.482, p = 0.000394). No significant correlation was found between median household income and ED search volume (r = −0.201, p = 0.164) or a greater urologist density (r = 0.0612, p = 0.6729). Conclusions: This study highlights how healthcare access and demographics influence ED search trends. States with older, less educated populations showed higher interest, while wealthier areas with more urologists had no significant correlation. These findings can guide targeted interventions to improve sexual care in underserved regions.

SIUJ, Vol. 6, Pages 30: Gender Disparity in Persian Gulf Urological Conferences Over the Past Three Years

Mohammed Adhoni — 2025-04-17

SIUJ, Vol. 6, Pages 30: Gender Disparity in Persian Gulf Urological Conferences Over the Past Three Years

Société Internationale d’Urologie Journal doi: 10.3390/siuj6020030

Authors: Mohammed Adhoni Ahmed Nassar Mohammed Shahait

Background/Objectives: Gender disparity is prevalent in urology and other surgical specialties, with under-representation of females in both academic and professional settings, including in the Persian Gulf region. To investigate female participation in Persian Gulf urological conferences over the past three years, focusing on abstract presenters, faculty, speakers, and moderators. Methods: Data were collected from three major conferences: the 34th Saudi Urological Conference (SUA), the Urological Asian Association and Emirates Urological Conference (UAA-EUSC), and the 11th Emirates Urological Conference and 18th Pan Arab Continence Society Conference (EUSC-PACSC). The gender of the presenters and faculty was identified using genderize.io, faculty images, and Google searches. Statistical analyses, including chi-square and Fisher’s exact tests, were conducted to assess gender disparities. Results: Out of 536 abstracts, 13.25% were presented by females, with significant variation across conferences (p = 0.018). Female representation was lowest in the basic sciences category (3.13%) and highest in the other category (35.29%) (p = 0.01). Abstract to publication rates did not differ significantly between genders. Male dominance was noted among faculty members (94.21% male), speakers (96.44% male), and moderators (98.98% male), with no significant gender distribution differences across roles (p = 0.1762). Conclusions: This study highlights significant gender disparities at Persian Gulf urological conferences, particularly in leadership roles and research presentations. Recommendations include promoting female leadership, supporting mentorship programs, and ensuring gender diversity in conference management and speaker line-ups to foster a more inclusive environment.

SIUJ, Vol. 6, Pages 29: The Role of Magnetic Resonance Imaging in Penile Fracture Management—A Systematic Review

Henry Wang — 2025-04-17

SIUJ, Vol. 6, Pages 29: The Role of Magnetic Resonance Imaging in Penile Fracture Management—A Systematic Review

Société Internationale d’Urologie Journal doi: 10.3390/siuj6020029

Authors: Henry Wang Shravankrishna Ananthapadmanabhan Jeremy Saad Alexander Combes Jarrah Spencer Sunny Nalavenkata Ankur Dhar

Background/Objectives: Penile fractures are a rare urological emergency, defined as the traumatic rupture of the tunica albuginea. They are classically diagnosed on clinical grounds, requiring urgent operative repair, most commonly by penile degloving. Magnetic resonance imaging (MRI) has emerged as a promising tool in the management of penile fractures. Often recommended in the setting of equivocal clinical diagnoses, MRI can help diagnose, as well as localise, the site of injury. Furthermore, it also holds potential in differentiating penile fractures from mimicking conditions, thereby possibly preventing unnecessary surgical procedures. This study is aimed at evaluating the diagnostic accuracy of MRI for penile fractures. Furthermore, it seeks to explore MRI’s effectiveness in guiding the surgical approach through precise localisation of the injury site. Methods: The PubMed, Embase, and Cochrane databases were searched from January 1995 to December 2022. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed, and a total of 246 cases from 32 studies were identified. Results: Pooled results for MRI use in penile fracture diagnosis resulted in a positive predictive value of 97.8%, a negative predictive value of 87.0%, a sensitivity of 98.6%, and a specificity of 80%. MRI can accurately guide localised incisions, due to its ability to accurately identify the exact site of injury, with no additional reported complications or conversions to degloving. Considerable heterogeneity was observed within MRI parameters and protocols used in the studies identified. Conclusions: This review suggests that MRI is an accurate imaging modality for penile fractures and should be considered as a first-line investigation for equivocal cases. Its application may refine clinical management by avoiding unnecessary surgeries in cases mimicking penile fractures and improve pre-operative planning through precise injury localisation. This study is limited by heterogeneity in MRI protocols and the small sample sizes and retrospective nature of many included studies. The future standardisation of MRI protocols could enhance its utility and reliability in the clinical setting. Additionally, further research is needed to evaluate the long-term outcomes following the repair of small fractures detected on MRI and following MRI-guided localised incisions during surgical repair. Level of Evidence: 2.

SIUJ, Vol. 6, Pages 28: Features and Management of Incidental Prostatic Lymphoma Obtained in Lower Urinary Tract Symptoms Surgery: A Systematic Review

Jeremy Cheng — 2025-04-17

SIUJ, Vol. 6, Pages 28: Features and Management of Incidental Prostatic Lymphoma Obtained in Lower Urinary Tract Symptoms Surgery: A Systematic Review

Société Internationale d’Urologie Journal doi: 10.3390/siuj6020028

Authors: Jeremy Cheng Samith Minu Alwis Nathan Papa Joseph Ischia Damien Bolton Dixon Woon

Background/Objectives: Prostatic lymphoma is a rare malignant tumour that frequently causes urinary tract obstruction. It is uncommon for patients to present with systemic features or B-symptoms. As a result, it is often diagnosed incidentally during surgical lower urinary tract symptoms (LUTS) treatment. This systematic review aims to identify any common clinical features of prostatic lymphoma diagnosed incidentally during surgical LUTS treatment and summarise disease treatment and outcomes. Methods: The study protocol was registered with Prospective Register of Systematic Reviews (PROSPERO). A search was performed across the following electronic databases: MEDLINE, Embase, Web of Science, and Cochrane Database of Systematic Reviews. Full texts of eligible studies were analysed and data were extracted. The review was performed in accordance with PRISMA guidelines. Results: A total of 24 case reports compromising 25 cases were included. The median (IQR) age was 67 (61–73) years. All patients reported LUTS as their primary complaint, and the median duration of LUTS prior to diagnosis was 17 (4–44) months. Serum prostate-specific antigen (PSA) was normal in 10 cases and prostatomegaly present on imaging in 16 cases. A total of 10 different subtypes of lymphoma were reported. Extra-prostatic involvement was reported in eight patients. Chemotherapy, with or without adjuvant radiotherapy, was the mainstay of lymphoma treatment. The majority of articles reported positive outcomes, with complete remission in 17 cases. Conclusions: Prostatic lymphoma is a difficult clinical diagnosis due to its similar presentation to benign prostatic hyperplasia (BPH). Although rare, prostatic lymphoma may need to be considered as a diagnosis in patients with an atypical presentation of BPH. Prognosis is often favourable after prompt referral to haematology or oncology.

SIUJ, Vol. 6, Pages 27: Is YouTube a Reliable Source of Information for Sacral Neuromodulation in Lower Urinary Tract Dysfunction?

Sarah Lorger — 2025-04-17

SIUJ, Vol. 6, Pages 27: Is YouTube a Reliable Source of Information for Sacral Neuromodulation in Lower Urinary Tract Dysfunction?

Société Internationale d’Urologie Journal doi: 10.3390/siuj6020027

Authors: Sarah Lorger Victor Yu Sithum Munasinghe

Background/Objectives: YouTube is an open-access video streaming platform with minimal regulation which has led to a vast library of unregulated medical videos. This study assesses the quality of information, understandability and actionability of videos on YouTube pertaining to sacral neuromodulation (SNM). Methods: The first 50 videos on YouTube after searching “sacral neuromodulation for bladder dysfunction” were reviewed. Thirty-eight of these videos met the inclusion criteria. These videos were reviewed by two Urology Registrars and the videos were scored using two standardised tools. The DISCERN tool assesses quality of information and the Patient Education Materials Assessment Tool for Audiovisual Material (PEMAT-A/V) tool assesses user understandability and accessibility. Results: Forty-two percent of videos were deemed to be poor or very poor, with 58% being fair, good or excellent according to the DISCERN standardised tool. For PEMAT-A/V the average score for understandability was 74% (43–100%) and actionability was 38% (0–100%). We found statistical significance comparing the duration of videos to the DISCERN groups (p = 0.02). We also found significance comparing the understandability of videos using the PEMAT-A/V score to the DISCERN groups (p ≤ 0.05). Conclusions: Forty-two percent of videos on SNM are of poor or very poor quality. The actionability score for consumers to seek out further information is also low at 38%. This raises concerns about the quality of information that is widely available on YouTube and how consumers will use this information when making decisions about their health.

SIUJ, Vol. 6, Pages 26: Xanthogranulomatous Prostatitis: A Systematic Review

Kenneth Keen Yip Chew — 2025-04-16

SIUJ, Vol. 6, Pages 26: Xanthogranulomatous Prostatitis: A Systematic Review

Société Internationale d’Urologie Journal doi: 10.3390/siuj6020026

Authors: Kenneth Keen Yip Chew Gerald Chin Ho Mak Eddy Lee Hao Wong

Background/Objectives: To understand the clinical characteristics, risk factors, diagnosis, treatment, and outcomes of xanthogranulomatous prostatitis. Methods: A comprehensive search was conducted across PubMed, Embase, and Medline following Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines, including case reports and case series. Study quality and risk of bias were assessed using the Oxford Centre for Evidence-Based Medicine (CEBM) document. The systematic review process aimed to gather and synthesize all available research evidence on the topic. Results: We included 24 articles reporting on 33 patients, with a median age of 64 years. The most common presenting symptoms were lower urinary tract symptoms (81.8%), and only one patient was asymptomatic. The mean prostate-specific antigen (PSA) level upon presentation was 6.5 ng/mL. Notably, 51.5% of patients were suspected of harbouring clinically significant prostate carcinoma, and only one patient had concurrent prostate adenocarcinoma. All diagnoses were based on changes associated with xanthogranulomatous prostatitis demonstrated upon histopathological examination. A variety of pathogens were isolated, including Escherichia coli, Pseudomonas aeruginosa, Proteus species, and Enterobacter species. Transurethral resection of the prostate (60.6%) was the mainstay approach to management. In total, 27.3% of patients were successfully managed with non-surgical therapy. Conclusions: The majority of patients were suspected of prostate carcinoma prior to the histopathological diagnosis of xanthogranulomatous prostatitis. One patient underwent unnecessary radical prostatectomy as a result. The management of xanthogranulomatous prostatitis includes transurethral resection of the prostate and conservative management with the use of antibiotics. This outlines the importance of following well-established protocols upon suspicion of prostate carcinoma in order to avoid unnecessary radical prostatectomy.

SIUJ, Vol. 6, Pages 25: Donald G. Skinner

Eila C. Skinner — 2025-04-16

SIUJ, Vol. 6, Pages 25: Donald G. Skinner

Société Internationale d’Urologie Journal doi: 10.3390/siuj6020025

Authors: Eila C. Skinner

I was very pleased to have the opportunity to write a short piece about Dr. Donald Skinner, a true giant in urology [...]

SIUJ, Vol. 6, Pages 24: Duplicated Kidney: A New Variant

Deepak Sabharwal — 2025-04-16

SIUJ, Vol. 6, Pages 24: Duplicated Kidney: A New Variant

Société Internationale d’Urologie Journal doi: 10.3390/siuj6020024

Authors: Deepak Sabharwal Sahil Sabharwal Sarat Sabharwal

Congenital urinary tract anomalies, including CAKUT (congenital anomalies of the kidneys and urinary tract), are common defects disrupting urinary system development [...]

SIUJ, Vol. 6, Pages 23: Approach to Pelvic Organ Prolapse: A Urological Perspective

Lysanne Campeau — 2025-02-19

SIUJ, Vol. 6, Pages 23: Approach to Pelvic Organ Prolapse: A Urological Perspective

Société Internationale d’Urologie Journal doi: 10.3390/siuj6010023

Authors: Lysanne Campeau

Pelvic organ prolapse (POP) has an estimated global prevalence of 28 [...]

SIUJ, Vol. 6, Pages 22: Mapping the Shifting Landscape of Urological Innovation

Samuel Sii — 2025-02-19

SIUJ, Vol. 6, Pages 22: Mapping the Shifting Landscape of Urological Innovation

Société Internationale d’Urologie Journal doi: 10.3390/siuj6010022

Authors: Samuel Sii David Homewood Brendan Dittmer Kalonji Nzembela Mahesha Weerakoon Jonathan S. O’Brien Damien Bolton Nathan Lawrentschuk Niall M. Corcoran Dinesh K. Agarwal

Introduction: Surgical innovation in urology has significantly transformed clinical practice, balancing the need for dissemination of novel techniques with rigorous safety and efficacy standards. Surgical innovation is influenced by regulatory standards, cost-effectiveness, and evolving publication requirements. This study examines publication trends in pioneering urological procedures and their implications on surgical innovation. Methods: This study analyzed 68 pioneering urological publications, examining the relationship between case numbers and publication trends over time. Data were collected through comprehensive database searches and analyzed using linear regression to identify correlations between publication case numbers and innovation dissemination. Results: A significant increase in the number of cases per publication was observed over time (R2 = 0.798, OR = 6.29, 95% CI: 2.57–10.02, p = 0.007). Early transformative techniques were frequently published as single-case reports or small series, whereas incremental innovations required larger case volumes, potentially delaying publication from resource-limited settings. Conclusions: This study highlights the need for a merit-based approach to evaluating surgical innovations, balancing rigorous safety standards with timely dissemination. Frameworks like IDEAL offer structured pathways for evaluating surgical innovations, ensuring robust evidence generation while maintaining flexibility for diverse practice settings. This study advocates for a reassessment of publication criteria to foster a balance between innovation, safety, and inclusivity, ultimately promoting the efficient and equitable advancement of surgical techniques.

SIUJ, Vol. 6, Pages 21: Management Down Under: An Australian Perspective on Benign Prostatic Obstruction

Kevin Yinkit Zhuo — 2025-02-18

SIUJ, Vol. 6, Pages 21: Management Down Under: An Australian Perspective on Benign Prostatic Obstruction

Société Internationale d’Urologie Journal doi: 10.3390/siuj6010021

Authors: Kevin Yinkit Zhuo Basil Razi Dane Cole-Clark Amanda Chung

Benign prostatic obstruction (BPO) typically presents with lower urinary tract symptoms (LUTS) such as nocturia and a slow urinary stream [...]

SIUJ, Vol. 6, Pages 20: B2B: Five Practice-Changing Advances on the Horizon Summary

Peter C. Black — 2025-02-18

SIUJ, Vol. 6, Pages 20: B2B: Five Practice-Changing Advances on the Horizon Summary

Société Internationale d’Urologie Journal doi: 10.3390/siuj6010020

Authors: Peter C. Black Faiz Mumtaz Simon Tanguay

The 6th Bench-to-Bedside Uro-Oncology: GU Cancers Triad Meeting, organized in conjunction with the 44th Annual Congress of the Société Internationale d’Urologie, was held on 25 October 2024, in New Delhi, India, and transmitted live on the SIU@U Congress platform [...]

SIUJ, Vol. 6, Pages 19: Pelvic Organ Prolapse and Sexual Dysfunction

Francisco E. Martins — 2025-02-18

SIUJ, Vol. 6, Pages 19: Pelvic Organ Prolapse and Sexual Dysfunction

Société Internationale d’Urologie Journal doi: 10.3390/siuj6010019

Authors: Francisco E. Martins

Introduction: This narrative review aims to investigate the intricacy of human sexuality, the prevalence and effect of pelvic organ prolapse (POP) repair on overall sexual function and dyspareunia, and the subsequent repercussions on body image self-perception and quality of life. Methods: A MEDLINE and PUBMED search was conducted for studies evaluating the effect of POP surgery on sexual function and dyspareunia in sexually active women as well as its impact on body image self-perception and QoL. We included both observational and randomized controlled studies evaluating this subject. We evaluated patients who underwent anterior and/or posterior compartment repair eventually including vaginal hysterectomy. We excluded studies including women with concomitant anti-incontinence surgical correction and/or any vaginal reconstruction with synthetic materials. Results: Women with POP are more likely to diminish sexual activity due to a perceived impact on body image and attractiveness as well as worry of incontinence. Conservative management (such as pelvic floor muscle physiotherapy or pessary use) or surgical intervention via transabdominal or transvaginal routes have been used to treat POP, but concerns remain regarding sexual consequences. Despite a post-surgical positive sexual outcome, there is an inherent risk of de novo dyspareunia regardless of the surgical technique employed with slightly higher risk for the transvaginal approach. Patient counselling prior to surgery has proved to be an important element of POP treatment. Only studies on complications of POP surgery, specifically its impact on female sexuality, dyspareunia, global quality of life, and self-perceived body image, were included and analyzed for this review. We limited our search to the international English language literature published over the last three decades and excluded all studies involving the use of synthetic material in transvaginal POP repair. Discussion and Conclusions: Although no consistent evidence was found that disorders of the pelvic floor in women have a clear adverse effect on sexuality, their anatomical correction using the patient’s native tissues is recommended. Dyspareunia reduced significantly after repair, but the rate remains higher after the transvaginal approach versus the minimally invasive (robot-assisted and laparoscopic) approach used for sacrocolpopexy.

SIUJ, Vol. 6, Pages 18: B2B: Bladder Cancer Summary

Peter C. Black — 2025-02-17

SIUJ, Vol. 6, Pages 18: B2B: Bladder Cancer Summary

Société Internationale d’Urologie Journal doi: 10.3390/siuj6010018

Authors: Peter C. Black Seth P. Lerner Mihir M. Desai Badrinath R. Konety Shilpa Gupta Amit Joshi Karima Oualla Senthil Rajappa Vineet Talwar Gagan Prakash Simon Tanguay

SIUJ, Vol. 6, Pages 15: B2B: Kidney Cancer Summary

Simon Tanguay — 2025-02-14

SIUJ, Vol. 6, Pages 15: B2B: Kidney Cancer Summary

Société Internationale d’Urologie Journal doi: 10.3390/siuj6010015

Authors: Simon Tanguay Maxine Tran Vedang Murthy Hazel Warburton Gagan Gautam Faiz Mumtaz Shilpa Gupta Peter C. Black

SIUJ, Vol. 6, Pages 17: Professor Foo Keong Tatt

Edwin Jonathan Aslim — 2025-02-14

SIUJ, Vol. 6, Pages 17: Professor Foo Keong Tatt

Société Internationale d’Urologie Journal doi: 10.3390/siuj6010017

Authors: Edwin Jonathan Aslim Angie Beng Guek See Christopher Wai Sam Cheng Lay Guat Ng Henry Sun Sien Ho John Shyi Peng Yuen

Professor Foo Keong Tatt is widely celebrated as the “Father of Urology” in Singapore[...]

SIUJ, Vol. 6, Pages 16: B2B: Prostate Cancer Summary

Gagan Prakash — 2025-02-14

SIUJ, Vol. 6, Pages 16: B2B: Prostate Cancer Summary

Société Internationale d’Urologie Journal doi: 10.3390/siuj6010016

Authors: Gagan Prakash Caroline M. Moore Franck Bladou Silvia Secco Sanjai Addla Priyamvada Maitre Senthil Rajappa Henry Woo Damien Bolton Peter C. Black Simon Tanguay

SIUJ, Vol. 6, Pages 14: The Prevalence of Multimorbidity Among Genitourinary Cancer Patients in Chile: A Retrospective Population-Based Study

Ignacio Eltit — 2025-02-12

SIUJ, Vol. 6, Pages 14: The Prevalence of Multimorbidity Among Genitourinary Cancer Patients in Chile: A Retrospective Population-Based Study

Société Internationale d’Urologie Journal doi: 10.3390/siuj6010014

Authors: Ignacio Eltit Diego Juri Iris Delgado Camila Cáceres Ignacio Rojas Mario I. Fernández

Introduction and Objectives: Multimorbidity, defined as the coexistence of two or more chronic conditions, poses significant challenges in healthcare by affecting patient outcomes and increasing costs. This study aimed to evaluate multimorbidity’s impact on patients with genitourinary cancer (GUC) in Chile, focusing on prevalent comorbidities, their combinations, and their association with hospitalization severity. Materials and Methods: A retrospective, population-based study was conducted using data from the Fondo Nacional de Salud (FONASA) in Chile, including patients with bladder, prostate, kidney, and testicular cancer between 2019 and 2021. Diagnosis-related group (DRG) data were used to analyze comorbidity prevalence, hospitalization type (elective vs. emergency), severity (moderate/major vs. minor/none), length of stay, and associated costs. Results: Among 4,028,597 hospital events, 11.6% were related to GUC, involving 18,792 patients. Multimorbidity was present in 67.3% of patients, with hypertension and diabetes being the most common comorbidities. These patients accounted for 69.1% of total GUC care costs. Hospital mortality was higher in multimorbid patients (7.5% vs. 3.7%; p < 0.001), who also had longer stays (mean 8 vs. 5 days). Most patients were admitted electively (60.3%), while 39.7% were admitted through the emergency room. Patients with multimorbidity had higher rates of moderate/major severity hospitalizations compared to those without (56.1% vs. 32.5%; p < 0.001). Conclusions: In Chile, multimorbidity among GUC patients is linked to increased costs, longer hospital stays, higher mortality, and greater hospitalization severity. Comprehensive care strategies are needed to improve outcomes and reduce healthcare system burdens.

SIUJ, Vol. 6, Pages 13: Responses of Artificial Intelligence Chatbots to Testosterone Replacement Therapy: Patients Beware!

Herleen Pabla — 2025-02-12

SIUJ, Vol. 6, Pages 13: Responses of Artificial Intelligence Chatbots to Testosterone Replacement Therapy: Patients Beware!

Société Internationale d’Urologie Journal doi: 10.3390/siuj6010013

Authors: Herleen Pabla Alyssa Lange Nagalakshmi Nadiminty Puneet Sindhwani

Background/Objectives: Using chatbots to seek healthcare information is becoming more popular. Misinformation and gaps in knowledge exist regarding the risk and benefits of testosterone replacement therapy (TRT). We aimed to assess and compare the quality and readability of responses generated by four AI chatbots. Methods: ChatGPT, Google Bard, Bing Chat, and Perplexity AI were asked the same eleven questions regarding TRT. The responses were evaluated by four reviewers using DISCERN and Patient Education Materials Assessment Tool (PEMAT) questionnaires. Readability was assessed using the Readability Scoring system v2.0. to calculate the Flesch–Kincaid Reading Ease Score (FRES) and the Flesch–Kincaid Grade Level (FKGL). Kruskal–Wallis statistics were completed using GraphPad Prism V10.1.0. Results: Google Bard received the highest DISCERN (56.5) and PEMAT (96% understandability and 74% actionability), demonstrating the highest quality. The readability scores ranged from eleventh-grade level to college level, with Perplexity outperforming the other chatbots. Significant differences were found in understandability between Bing and Google Bard, DISCERN scores between Bing and Google Bard, FRES between ChatGPT and Perplexity, and FKGL scoring between ChatGPT and Perplexity AI. Conclusions: ChatGPT and Google Bard were the top performers based on their quality, understandability, and actionability. Despite Perplexity scoring higher in readability, the generated text still maintained an eleventh-grade complexity. Perplexity stood out for its extensive use of citations; however, it offered repetitive answers despite the diversity of questions posed to it. Google Bard demonstrated a high level of detail in its answers, offering additional value through visual aids. With improvements in technology, these AI chatbots may improve. Until then, patients and providers should be aware of the strengths and shortcomings of each.

SIUJ, Vol. 6, Pages 12: Review on the Management of Female Urinary Incontinence and Anterior Vaginal Prolapse

Ronscardy F. Mondesir — 2025-02-12

SIUJ, Vol. 6, Pages 12: Review on the Management of Female Urinary Incontinence and Anterior Vaginal Prolapse

Société Internationale d’Urologie Journal doi: 10.3390/siuj6010012

Authors: Ronscardy F. Mondesir Angelica Gousse Daniel A. Boaretto Daniel Ajabshir Angelo Gousse

Objectives: We aimed to evaluate management strategies for female urinary incontinence, specifically stress urinary incontinence (SUI), and anterior vaginal prolapse (pelvic organ prolapse, POP), emphasizing diagnostic methods, treatment options, and factors influencing surgical outcomes. Methods: We conducted a thorough literature review examining diagnostic tools, including physical examinations, urodynamic testing, and pessary evaluations, alongside treatment options for SUI and POP. Both surgical interventions, such as mid-urethral sling placement and anterior colporrhaphy, and non-surgical methods, including pelvic floor exercises, were analyzed. This review assesses these approaches’ efficacy, complications, and outcomes, incorporating current clinical guidelines and evidence-based practices. Results: Evidence indicates that SUI frequently coexists with POP, with a notable proportion of cases being occult until a prolapse is reduced. Diagnostic methods such as pessary testing and urodynamic evaluations are essential in identifying masked SUI, though their predictive accuracy varies. Surgical techniques such as using mid-urethral slings are highly effective but pose risks, including voiding dysfunction and lower urinary tract injury. Long-term data emphasize the need for personalized treatment strategies, with combined procedures showing superior outcomes for the concurrent management of POP and SUI in select cases. Conclusions: Effective management of SUI and POP requires a personalized approach, factoring in the severity of a prolapse and the likelihood of postoperative incontinence. While conservative treatments are practical initial options, surgical solutions, such as mid-urethral slings and apical suspension procedures, offer robust, lasting results for advanced cases. Preoperative diagnostics, collaborative decision-making, and tailored treatment plans are essential to optimize success and minimize complications. Future research should prioritize enhancing diagnostic precision and refining surgical methods to further advance patient care.

SIUJ, Vol. 6, Pages 11: Therapeutic Options for Advanced Pelvic Organ Prolapse

Béatrice Bouchard — 2025-02-12

SIUJ, Vol. 6, Pages 11: Therapeutic Options for Advanced Pelvic Organ Prolapse

Société Internationale d’Urologie Journal doi: 10.3390/siuj6010011

Authors: Béatrice Bouchard Lysanne Campeau

Background: Advanced pelvic organ prolapse (POP) can have a significant impact on women’s health and quality of life (QoL). Several treatments, both conservative and surgical, can be offered to patients. These include vaginal pessaries, abdominal reconstructive surgeries, vaginal reconstruction, as well as obliterative procedures. Methods: This is a narrative review of the management of advanced POP using the PubMed, Google Scholar, and Cochrane databases. Results: Gellhorn pessaries are the most used space-occupying pessaries, with good long-term success rates. The only space-occupying pessaries that allow for self-management by the patient and that could be associated with prolapse reduction are cube pessaries. Laparoscopic sacrocolpopexy (L-SCP) is the gold standard for POP surgery. Other abdominal reconstructive procedures include sacrocervicopexy (SCerP) and laparoscopic lateral suspension (LLS). The two most common vaginal reconstructive techniques are sacrospinous ligament fixation (SSLF) and uterosacral ligament suspension (USLS). Both procedures have comparable success rates. Obliterative procedures include the total, Lefort, and Labhart colpocleisis. These procedures are ideal for women who do not wish to have intercourse or who cannot tolerate extensive surgical procedures. There is a general tendency towards uterine preservation when performing these surgeries. Conclusions: Several therapeutic options exist for advanced POP, and most of them are associated with good long-term success rates. Treatment should be chosen based on patient comorbidities and in the context of shared decision-making.

SIUJ, Vol. 6, Pages 10: The Performance and Role of PSMA PET Scans in Localised Prostate Cancer

Jianliang Liu — 2025-02-12

SIUJ, Vol. 6, Pages 10: The Performance and Role of PSMA PET Scans in Localised Prostate Cancer

Société Internationale d’Urologie Journal doi: 10.3390/siuj6010010

Authors: Jianliang Liu Jack Dunne Karim A. Touijer Marlon Perera Nathan Lawrentschuk

Background/Objectives: Prostate cancer (PCa) is one of the most prevalent cancers in men. While PSA testing aids in early detection, it often identifies clinically insignificant PCa (ciPCa), which may not necessitate treatment. Prostate-specific membrane antigen (PSMA) PET scans have emerged as a promising tool to evaluate of localised PCa. This review aims to assess the current evidence of using PSMA PET scans for localised PCa. Methods: Peer-reviewed publications on PSMA PET scans in localised PCa, from inception to May 2024, were retrieved from PubMed. The outcomes evaluated included diagnostic performance in identifying intraprostatic lesions, detecting csPCa (ISUP GG ≥ 2), and role peri-treatment. Results: The addition of PSMA PET/CT to MRI improved the sensitivity (from 83% to 97%) and NPV (72% to 91%) of detecting csPCa. PSMA PET helped improve risk stratification in active surveillance by identifying MRI-occult lesions in up to 29% of patients, of which up to 10% may harbour underlying unfavourable pathology. In local staging, PSMA PET/MRI outperforms MRI in identifying extra-prostatic extension (77% vs. 73%) and seminal vesicle invasion (90% vs. 87%). PSMA PET scans are also superior to MRI in nodal staging and bone scans in identifying bony metastasis. PSMA PET scans appear useful in guiding treatment of localised PCa and aiding follow-up. Conclusions: PSMA PET scans are valuable for evaluating localised PCa by improving the detection of csPCa and enhancing local staging. However, most available studies are retrospective, and long-term oncological outcomes remain underreported due to the relative novelty of PSMA PET scans.

SIUJ, Vol. 6, Pages 9: Canada-Wide Distribution of Environmental and Occupational Risk Factors for Urinary Stone Disease: Insights for Equitable Resource Allocation and Fighting Health Disparities

Mohammadali Saffarzadeh — 2025-02-12

SIUJ, Vol. 6, Pages 9: Canada-Wide Distribution of Environmental and Occupational Risk Factors for Urinary Stone Disease: Insights for Equitable Resource Allocation and Fighting Health Disparities

Société Internationale d’Urologie Journal doi: 10.3390/siuj6010009

Authors: Mohammadali Saffarzadeh Anna Black Michael Ordon Ben H. Chew Connor M. Forbes

Abstract: Objectives: This study aimed to map the distribution of nephrolithiasis’ environmental risk factors (occupational heat and heavy metal exposure and ambient seasonal temperature) and to assess the correlations of these exposures with the best estimates of the reported nephrolithiasis incidence in Canada. Methods: The regional average heat burden was defined as the mean temperature in the hottest three months of the year for 2020, 2021, and 2022. The employment rates in the top five industries with occupational heavy metal (cadmium, lead, and arsenic) and heat exposure were obtained from the Statistics Canada 2021 database. Statistical significance was calculated based on the 95% confidence interval difference from the null hypothesis. Correlation analysis was performed between our rates of nephrolithiasis risk factors and previously published estimates of the stone incidence: kidney stone interventions and acute kidney stone event rates. Results: Lower-latitude provinces had higher overall mean temperatures in 2020 to 2022, with Ontario, Manitoba, and Prince Edward Island having the highest seasonal heat burdens, in this order. Nunavut had the lowest rate of occupational heat exposure, while the remaining regions had similar rates. Yukon, the Northwest Territories, and Nunavut had significantly higher rates of occupational heavy metal exposure compared to the remaining regions. The ambient temperature and occupation heavy metal and heat exposure showed no significant correlation with the estimates of the stone incidence. Conclusions: The occupational heat exposure was relatively similar between regions. Northern Canada had higher occupational heavy metal exposure compared to other regions. Occupational exposures and temperature variations were not associated with the nephrolithiasis incidence in Canada.

SIUJ, Vol. 6, Pages 8: Hyaluronic Acid Rectal Spacer for Rectal Protection in Salvage Cystoprostatectomy

Benjamin Ngie Xiong Wong — 2025-02-12

SIUJ, Vol. 6, Pages 8: Hyaluronic Acid Rectal Spacer for Rectal Protection in Salvage Cystoprostatectomy

Société Internationale d’Urologie Journal doi: 10.3390/siuj6010008

Authors: Benjamin Ngie Xiong Wong Anne Hong Zein Alhamdani Damien Bolton Dixon Teck Sing Woon

Background: In salvage cystoprostatectomies (SCPs), rectal injuries can occur at a rate of 1% to 10%. Factors including T3 disease and prior pelvic radiation can lead to complications such as bleeding, recurrent wound infections and the need for colonic diversion. Methods: We present a male patient in his late 70s with a new diagnosis of pT2 muscle-invasive bladder cancer (MIBC). This is on a background of Stage IIB prostate cancer 10 years ago, managed with external beam radiotherapy. He patient had hyaluronic acid (HA) rectal spacer infiltration into the Denonvilliers’ space two weeks prior, for rectal protection. HA rectal spacers are easily identifiable due to their anechoic appearance on ultrasound imaging, making them easily distinguishable when injected into the Denonvilliers’ space intraoperatively. Results: The patient did not experience any symptoms related to rectal injury and had full bowel continence postoperatively. Conclusion: Although approved for use in radiation treatment for prostate cancer, their role in aiding dissection during SCP remains unexplored. We exhibit the use of HA rectal spacers for rectal protection during SCP.

SIUJ, Vol. 6, Pages 7: Utility and Practicability of Nephrometry Scoring Systems in Contemporary Clinical Practice—An International Multicentre Perspective

Brendan A. Yanada — 2025-02-12

SIUJ, Vol. 6, Pages 7: Utility and Practicability of Nephrometry Scoring Systems in Contemporary Clinical Practice—An International Multicentre Perspective

Société Internationale d’Urologie Journal doi: 10.3390/siuj6010007

Authors: Brendan A. Yanada David Homewood Brendan H. Dias Niall M. Corcoran Nathan Lawrentschuk Ravindra Sabnis Jeremy Y. C. Teoh Dinesh Agarwal

To conduct a multi-institutional international survey to determine the clinical utility and applicability of nephrometry scoring systems in contemporary clinical practice. Methods: A cross-sectional anonymous 15-item online survey was conducted on REDCap between January 2023 and May 2023. Survey invitations were sent via email within Australia and internationally to urologists who are either members of the Urological Society of Australia and New Zealand (USANZ) or the Urological Association of Asia (UAA) or who have direct professional relationships with their members. The survey underwent a trial run on REDCap with several urologists at our institution to test the technical functionality and comprehension prior to dissemination. Results: First, 158 responses were collected and analysed. Just over half (51%) responded that they use a nephrometry system in clinical practice, and the RENAL nephrometry scoring system is the most commonly used. Amongst respondents who use a nephrometry scoring system, 63% stated that it helps with counselling patients and 54% stated it serves as a decision-making tool on whether to perform a partial or radical nephrectomy. Furthermore, 54% use a nephrometry scoring system in surgical planning meetings, and 67% believe that it is helpful for research purposes. Common concerns included that they are too time-consuming to complete, they are unhelpful for treatment decision-making and they are only useful for research purposes. Conclusions: Nephrometry scoring systems are utilised by roughly one in two urologists in contemporary clinical practice. Further qualitative studies are required to better ascertain perspectives towards them and enhance their clinical applicability.

SIUJ, Vol. 6, Pages 2: Synthetic Meshes in Pelvic Organ Prolapse: A Narrative Review

Sami Lasri — 2025-02-12

SIUJ, Vol. 6, Pages 2: Synthetic Meshes in Pelvic Organ Prolapse: A Narrative Review

Société Internationale d’Urologie Journal doi: 10.3390/siuj6010002

Authors: Sami Lasri Hend Alshamsi Lysanne Campeau

Introduction: Pelvic organ prolapse is a common condition that can affect 50% of parous women. The surgical management can be divided into two approaches: A trans-vaginal and a trans-abdominal approach. In view of current controversies and discrepancies between guidelines, this review aims to scope the historically available data on synthetic meshes in the management of POP mainly on outcomes and complications of the trans-vaginal approach and the trans-abdominal approach. Methods: This study is a narrative review of the use of synthetic meshes in POP surgery. The different indications, the results, and comparisons to other surgical management were collected using MEDLINE and Google Scholar. Results: Regarding the trans-vaginal approach, 31 articles were included. The anatomical success rate is high, around 90%. However, this technique was recently considered cost-ineffective mostly because of high rates of erosions, ranging from 4 to 40% depending on the series. Obesity seems to be the most important risk factor of mesh erosion, followed by age and smoking. Regarding the trans-abdominal approach, 36 articles were included. In the literature, anatomical success is between 70 and 95%, with an erosion rate between 0 and 11%. Minimally invasive sacrocolpopexy and open sacrocolpopexy seem to be equally effective on anatomical outcomes and recurrence rates. Concomitant total hysterectomy might be effective but may be associated with more mesh erosions. Concomitant laparoscopic supracervical hysterectomy may be the preferred option for patients with cervical and uterine lesions but should not be performed for the sole purpose of reducing the occurrence of endometrial carcinoma, especially when uterine preservation seems effective and is associated with less blood loss and shorter operating time. Conclusion: Our review reports limited application for trans-vaginal repair because of high complications rates, leading countries to suspend their utilization. Our review reports a gold standard application for trans-abdominal sacrocolpopexy. The use of synthetic meshes in trans-abdominal sacrocolpopexy for POP repair provide durable cure rates with a lower rate of mesh-related complications and therefore may be considered the gold standard approach.