This Week in Urology — Oct 23, 2026
Generated Oct 23, 2026 · 10:58
The week's practice-changing Urology research, summarized for clinicians.
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Validation of Cxbladder Triage Plus in Australian patients with haematuria: the AUSSIE study.
In 691 Australian haematuria patients, the Cxbladder Triage Plus urine test showed 89 percent sensitivity and 99 percent negative predictive value, though it missed six tumours including one invasive cancer.
BJU International · 2026 · PubMed
This week’s papers
- 01
Transient apnoea for motion control during flexible ureteroscopic lithotripsy: a randomised trial.
Protocolised transient apnoea improved laser lithotripsy efficiency and shortened operative time versus standard or low tidal-volume ventilation, but did not improve stone-free rates and frequently stopped early for bradycardia or hypotension.
Yu J et al. · BJU International · 2026
From the briefingIn BJU International, Yu and colleagues ran a single-centre, three-arm randomised trial of 150 adults with a single renal or proximal ureteric stone between 10 and 20 millimetres, comparing regular ventilation, small tidal-volume ventilation, and protocolised transient apnoea during flexible ureteroscopic laser lithotripsy [1]. Apnoea followed five minutes of pre-oxygenation with 100 percent oxygen, capped at nine minutes. Stone ablation efficiency rose by roughly a quarter with apnoea compared with either ventilation strategy, total operative time fell by about seven minutes, and surgeons rated targeting stability noticeably higher. Stone-free rates at one day and one month, however, did not differ between groups, so the benefit is intraoperative rather than in clearance. The physiological cost deserves attention: the median apnoea lasted about five minutes, and nearly every patient resumed ventilation before the nine-minute ceiling, most often for falling heart rate or blood pressure. No patient desaturated below 90 percent and there were no serious complications, but this is one centre with tight anaesthetic protocols, and the authors frame it as a brief motion-control option under continuous monitoring rather than a routine change.
Written by AI from the published abstract, for healthcare professionals. Not medical advice; check the paper before acting on it.
- 02
Does bespoke metabolic investigation reduce urinary stone recurrence? A narrative review.
Fluid, dietary and targeted drug therapy each reduce stone recurrence, but evidence that 24-hour-urine-directed therapy beats empirical therapy is limited to high-risk, recurrent and post-procedural stone formers.
Wiseman OJ, Turney BW · BJU International · 2026
From the briefingAlso in BJU International, Wiseman and Turney's narrative review asks whether bespoke metabolic investigation reduces recurrence [2]. Their synthesis finds that increased fluid intake roughly halves recurrence, that a normal-calcium, low-sodium, lower animal-protein diet achieves a similar reduction in hypercalciuric calcium oxalate formers, and that potassium citrate appears to cut risk by about three quarters. They are candid that the rigorous NOSTONE trial found no significant thiazide benefit, and that evidence for 24-hour-urine-directed therapy over empirical therapy is confined to high-risk patients. The case for individualised work-up is strongest in recurrent, high-risk and post-procedural stone formers, which is largely where current guidance already sits.
Written by AI from the published abstract, for healthcare professionals. Not medical advice; check the paper before acting on it.
- 03
Early apical release versus conventional (non-early apical release) holmium laser enucleation of the prostate: a systematic review and meta-analysis of postoperative urinary incontinence and functional outcomes.
Across five studies of 2,821 men, early apical release during HoLEP roughly halved stress incontinence up to four months, with no difference by six to twelve months and comparable functional outcomes.
Mansour I et al. · Prostate Cancer and Prostatic Diseases · 2026
From the briefingIn Prostate Cancer and Prostatic Diseases, Mansour and colleagues pooled five studies with 2,821 men comparing early apical release with conventional holmium laser enucleation of the prostate [3]. Early apical release roughly halved the risk of stress incontinence at four to six weeks and again at three to four months, but by six to twelve months there was no difference. Symptom scores, flow rates, and operative times were comparable, and early minor complications were somewhat more frequent with the modification. With only five studies, mostly observational, this supports early apical release as a way to shorten the period of transient leakage rather than to change long-term continence.
Written by AI from the published abstract, for healthcare professionals. Not medical advice; check the paper before acting on it.
- 04
Intraoperative performance errors predict patient outcomes in robot-assisted radical prostatectomy.
In video-scored nerve-sparing robotic prostatectomies, cases ending in erectile dysfunction at one year had substantially more surgical errors, particularly during neurovascular bundle dissection, supporting objective performance assessment.
Graefen M et al. · BJU International · 2026
From the briefingIn BJU International, Graefen and colleagues took a different angle, scoring video recordings of 100 bilateral nerve-sparing robotic prostatectomies by seven experienced surgeons, with an age-matched subgroup of 66 preoperatively potent men [4]. Trained raters agreed closely with one another. Cases ending in erectile dysfunction at twelve months contained about 43 percent more total errors and about two thirds more errors during neurovascular bundle dissection, even though patient characteristics were similar. The sample is small and the design associative, but it adds weight to the idea that objective video-based performance metrics capture something clinically meaningful, with obvious implications for training and credentialing debates.
Written by AI from the published abstract, for healthcare professionals. Not medical advice; check the paper before acting on it.
- 05
Circulating Immune and Cancer Driver Gene Biomarkers Precede Prostate Cancer Diagnosis by over 10 yr.
Large-scale plasma proteomics in the EPIC cohort identified immune, angiogenesis and driver-gene proteins associated with prostate cancer arising over a decade later, though external replication was incomplete.
Huang Z et al. · European Urology · 2026
From the briefingIn European Urology, Huang and colleagues profiled more than six thousand plasma proteins in baseline samples from the EPIC cohort, comparing 982 men who later developed prostate cancer with a subcohort of 1,573 [5]. Higher levels of KLK3, the gene product measured as PSA, were associated with more than double the risk per standard deviation, as expected, but other proteins also emerged, including seven linked to aggressive disease and twelve associated with cancers diagnosed more than fifteen years after blood draw. Circulating products of driver genes such as KRAS and NRAS were tied to future aggressive disease. Replication in a second cohort was only partial, so these are candidate risk markers, not tests.
Written by AI from the published abstract, for healthcare professionals. Not medical advice; check the paper before acting on it.
- 06
Risk-stratified Prostate Cancer Screening in 2026: Blood- and Urine-based Biomarkers.
Combining MRI with blood and urine biomarkers such as PHI, 4Kscore, Stockholm3 and SelectMDx underpins risk-adapted prostate screening pathways designed to reduce unnecessary biopsy and overdiagnosis.
Stangl-Kremser J, Salami SS · European Urology Focus · 2026
From the briefingFor what is clinically available now, Stangl-Kremser and Salami in European Urology Focus review blood- and urine-based biomarkers for risk-stratified screening [6], covering the Prostate Health Index, 4Kscore, Stockholm3, and urine assays such as SelectMDx and MyProstateScore 2.0. Their argument is that combining these tools with MRI is the backbone of modern pathways aimed at clinically significant cancer while reducing unnecessary biopsy, with large trials still under way.
Written by AI from the published abstract, for healthcare professionals. Not medical advice; check the paper before acting on it.
- 07
Development and Validation of the JIKEI-YAYOI Score for Predicting Castration Resistance in Metastatic Castration-Sensitive Prostate Cancer Treated With ARSI-Based Doublet Therapy.
A simple externally validated score using Grade Group, disease extent, haemoglobin and LDH stratified three-year castration-resistance risk from about 11 to 93 percent in metastatic castration-sensitive prostate cancer.
Urabe F et al. · International Journal of Urology · 2026
From the briefingAt the other end of the disease spectrum, Urabe and colleagues in the International Journal of Urology developed the JIKEI-YAYOI score for men with metastatic castration-sensitive disease on androgen receptor pathway inhibitor doublet therapy [7]. Built from Grade Group, extent of disease on bone scan, haemoglobin and lactate dehydrogenase in 388 patients and externally validated in 451, the score showed reasonable discrimination, with predicted three-year castration-resistance risk ranging from about one in ten to over nine in ten. It is retrospective and Japanese, so generalisability to other populations and to triplet therapy remains open.
Written by AI from the published abstract, for healthcare professionals. Not medical advice; check the paper before acting on it.
- 08
Validation of Cxbladder Triage Plus in Australian patients with haematuria: the AUSSIE study.
In 691 Australian haematuria patients, the Cxbladder Triage Plus urine test showed 89 percent sensitivity and 99 percent negative predictive value, though it missed six tumours including one invasive cancer.
Buhariwalla V et al. · BJU International · 2026
From the briefingIn BJU International, the AUSSIE study led by Buhariwalla tested the Cxbladder Triage Plus urine assay prospectively in 691 Australian patients referred for cystoscopy with visible or non-visible haematuria [8]. Just under eight percent of patients had a confirmed tumour. The test detected about nine in ten cancers, and its negative predictive value was 99 percent, with roughly three quarters of patients testing negative. Six tumours were missed, five of them low-grade Ta lesions but one a T3b urachal adenocarcinoma, a reminder that a negative result is not zero risk. The positive predictive value was modest at about 27 percent, though more than three times that of the 2025 American Urological Association risk criteria. This is observational, industry-relevant validation, and it strengthens the case for urine biomarkers in reducing cystoscopy among low-risk patients without settling whether cystoscopy can safely be omitted. Two real-world studies in the International Journal of Urology follow.
If you only have time for one paper this week, make it the AUSSIE validation of Cxbladder Triage Plus in BJU International [8]. It reopens the question of whether every patient with haematuria needs immediate cystoscopy, while its missed invasive tumour shows exactly where the limits of that argument lie.
Written by AI from the published abstract, for healthcare professionals. Not medical advice; check the paper before acting on it.
- 09
Oncological Outcomes and Safety Profiles of Adjuvant Nivolumab in Muscle-Invasive Urothelial Carcinoma.
Real-world adjuvant nivolumab gave similar disease-free survival in bladder and upper tract urothelial carcinoma, with high eosinophil counts predicting recurrence and adrenal insufficiency more frequent than expected.
Katayama S et al. · International Journal of Urology · 2026
From the briefingKatayama and colleagues reviewed 97 patients on adjuvant nivolumab after surgery for muscle-invasive disease, about a third with upper tract tumours [9]. Disease-free survival at six months was about 62 percent and did not differ between bladder and upper tract primaries, despite worse kidney function in many patients after nephroureterectomy. A higher baseline eosinophil count roughly doubled the risk of recurrence. Adrenal insufficiency occurred in eight percent and hypophysitis in four percent, higher than the authors expected, with serious events appearing anywhere from three to eighteen months into therapy.
Written by AI from the published abstract, for healthcare professionals. Not medical advice; check the paper before acting on it.
- 10
Changes in Treatment Patterns and Survival Outcomes Across Therapeutic Eras in Metastatic Urothelial Carcinoma: A Multicenter Real-World Study.
Median overall survival in metastatic urothelial carcinoma rose from about 13 months in the chemotherapy era to roughly 20 to 22 months in the immunotherapy eras in a 727-patient real-world cohort.
Tomioka S et al. · International Journal of Urology · 2026
From the briefingTomioka and colleagues, in a 727-patient cohort spanning two decades of first-line treatment for metastatic disease, found median overall survival rose from about 13 months in the chemotherapy era to about 20 months in the pembrolizumab era and about 22 months in the avelumab maintenance era [10]. The two immunotherapy eras did not differ significantly from each other, and as an era comparison it cannot isolate the effect of any single drug, particularly as enfortumab vedotin sequences entered practice.
Written by AI from the published abstract, for healthcare professionals. Not medical advice; check the paper before acting on it.
The full briefing
This AudioScholar briefing is generated by artificial intelligence for healthcare professionals and trainees. It is not medical advice.
Welcome to This Week in Urology. This week we're covering 10 notable papers spanning stone and surgical technique, biomarker-driven risk stratification in prostate and bladder cancer, and real-world systemic therapy for urothelial carcinoma. Let's dive in.
We start with stones, where one paper looks at what happens inside the kidney during lithotripsy and another asks what happens after the patient goes home. In BJU International, Yu and colleagues ran a single-centre, three-arm randomised trial of 150 adults with a single renal or proximal ureteric stone between 10 and 20 millimetres, comparing regular ventilation, small tidal-volume ventilation, and protocolised transient apnoea during flexible ureteroscopic laser lithotripsy [1]. Apnoea followed five minutes of pre-oxygenation with 100 percent oxygen, capped at nine minutes. Stone ablation efficiency rose by roughly a quarter with apnoea compared with either ventilation strategy, total operative time fell by about seven minutes, and surgeons rated targeting stability noticeably higher. Stone-free rates at one day and one month, however, did not differ between groups, so the benefit is intraoperative rather than in clearance. The physiological cost deserves attention: the median apnoea lasted about five minutes, and nearly every patient resumed ventilation before the nine-minute ceiling, most often for falling heart rate or blood pressure. No patient desaturated below 90 percent and there were no serious complications, but this is one centre with tight anaesthetic protocols, and the authors frame it as a brief motion-control option under continuous monitoring rather than a routine change. Also in BJU International, Wiseman and Turney's narrative review asks whether bespoke metabolic investigation reduces recurrence [2]. Their synthesis finds that increased fluid intake roughly halves recurrence, that a normal-calcium, low-sodium, lower animal-protein diet achieves a similar reduction in hypercalciuric calcium oxalate formers, and that potassium citrate appears to cut risk by about three quarters. They are candid that the rigorous NOSTONE trial found no significant thiazide benefit, and that evidence for 24-hour-urine-directed therapy over empirical therapy is confined to high-risk patients. The case for individualised work-up is strongest in recurrent, high-risk and post-procedural stone formers, which is largely where current guidance already sits.
Two papers this week speak to how surgical technique and surgical performance translate into function. In Prostate Cancer and Prostatic Diseases, Mansour and colleagues pooled five studies with 2,821 men comparing early apical release with conventional holmium laser enucleation of the prostate [3]. Early apical release roughly halved the risk of stress incontinence at four to six weeks and again at three to four months, but by six to twelve months there was no difference. Symptom scores, flow rates, and operative times were comparable, and early minor complications were somewhat more frequent with the modification. With only five studies, mostly observational, this supports early apical release as a way to shorten the period of transient leakage rather than to change long-term continence. In BJU International, Graefen and colleagues took a different angle, scoring video recordings of 100 bilateral nerve-sparing robotic prostatectomies by seven experienced surgeons, with an age-matched subgroup of 66 preoperatively potent men [4]. Trained raters agreed closely with one another. Cases ending in erectile dysfunction at twelve months contained about 43 percent more total errors and about two thirds more errors during neurovascular bundle dissection, even though patient characteristics were similar. The sample is small and the design associative, but it adds weight to the idea that objective video-based performance metrics capture something clinically meaningful, with obvious implications for training and credentialing debates.
Prostate cancer risk stratification is our third theme, spanning discovery science, a review of available tools, and a prognostic score for advanced disease. In European Urology, Huang and colleagues profiled more than six thousand plasma proteins in baseline samples from the EPIC cohort, comparing 982 men who later developed prostate cancer with a subcohort of 1,573 [5]. Higher levels of KLK3, the gene product measured as PSA, were associated with more than double the risk per standard deviation, as expected, but other proteins also emerged, including seven linked to aggressive disease and twelve associated with cancers diagnosed more than fifteen years after blood draw. Circulating products of driver genes such as KRAS and NRAS were tied to future aggressive disease. Replication in a second cohort was only partial, so these are candidate risk markers, not tests. For what is clinically available now, Stangl-Kremser and Salami in European Urology Focus review blood- and urine-based biomarkers for risk-stratified screening [6], covering the Prostate Health Index, 4Kscore, Stockholm3, and urine assays such as SelectMDx and MyProstateScore 2.0. Their argument is that combining these tools with MRI is the backbone of modern pathways aimed at clinically significant cancer while reducing unnecessary biopsy, with large trials still under way. At the other end of the disease spectrum, Urabe and colleagues in the International Journal of Urology developed the JIKEI-YAYOI score for men with metastatic castration-sensitive disease on androgen receptor pathway inhibitor doublet therapy [7]. Built from Grade Group, extent of disease on bone scan, haemoglobin and lactate dehydrogenase in 388 patients and externally validated in 451, the score showed reasonable discrimination, with predicted three-year castration-resistance risk ranging from about one in ten to over nine in ten. It is retrospective and Japanese, so generalisability to other populations and to triplet therapy remains open.
Our final theme is urothelial carcinoma, from haematuria triage to adjuvant and metastatic treatment. In BJU International, the AUSSIE study led by Buhariwalla tested the Cxbladder Triage Plus urine assay prospectively in 691 Australian patients referred for cystoscopy with visible or non-visible haematuria [8]. Just under eight percent of patients had a confirmed tumour. The test detected about nine in ten cancers, and its negative predictive value was 99 percent, with roughly three quarters of patients testing negative. Six tumours were missed, five of them low-grade Ta lesions but one a T3b urachal adenocarcinoma, a reminder that a negative result is not zero risk. The positive predictive value was modest at about 27 percent, though more than three times that of the 2025 American Urological Association risk criteria. This is observational, industry-relevant validation, and it strengthens the case for urine biomarkers in reducing cystoscopy among low-risk patients without settling whether cystoscopy can safely be omitted. Two real-world studies in the International Journal of Urology follow. Katayama and colleagues reviewed 97 patients on adjuvant nivolumab after surgery for muscle-invasive disease, about a third with upper tract tumours [9]. Disease-free survival at six months was about 62 percent and did not differ between bladder and upper tract primaries, despite worse kidney function in many patients after nephroureterectomy. A higher baseline eosinophil count roughly doubled the risk of recurrence. Adrenal insufficiency occurred in eight percent and hypophysitis in four percent, higher than the authors expected, with serious events appearing anywhere from three to eighteen months into therapy. Tomioka and colleagues, in a 727-patient cohort spanning two decades of first-line treatment for metastatic disease, found median overall survival rose from about 13 months in the chemotherapy era to about 20 months in the pembrolizumab era and about 22 months in the avelumab maintenance era [10]. The two immunotherapy eras did not differ significantly from each other, and as an era comparison it cannot isolate the effect of any single drug, particularly as enfortumab vedotin sequences entered practice.
If you only have time for one paper this week, make it the AUSSIE validation of Cxbladder Triage Plus in BJU International [8]. It reopens the question of whether every patient with haematuria needs immediate cystoscopy, while its missed invasive tumour shows exactly where the limits of that argument lie.
Here is what this week's evidence adds up to in Urology. First, motion control through transient apnoea makes ureteroscopic lithotripsy faster in a single randomised trial, but without better stone clearance and with frequent haemodynamic stops, so its role remains niche. Second, technique and performance matter for function after prostate surgery: early apical release shortens early incontinence on pooled observational data, and video-scored errors track with erectile outcomes in a small cohort. Third, prostate cancer risk prediction is moving toward multimodal models, from discovery-stage proteins detectable a decade ahead to a validated clinical score in metastatic castration-sensitive disease, though most of these tools still need broader validation. Fourth, urine biomarkers now show very high negative predictive value for haematuria triage in a prospective cohort, yet guidelines have not adopted them as a replacement for cystoscopy. And finally, real-world data suggest adjuvant nivolumab performs similarly in upper tract and bladder tumours, with endocrine toxicity possibly more common than trials implied.
That's your roundup for This Week in Urology. The full transcript and references are available on the episode page. This is an AI-curated summary — for clinical decisions, always consult primary sources and current guidelines. See you next week.
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