This Week in Urology — Sep 11, 2026

Welcome to This Week in Urology. This week we're covering 10 notable papers spanning advanced prostate cancer systemic therapy and molecular imaging, the surgical management of bladder outflow obstruction and stone disease, and a set of studies that challenge long-standing perioperative habits. Let's dive in.

We'll start with advanced prostate cancer, where two papers reframe how we counsel and stratify patients. In European Urology, Gray and colleagues report a secondary analysis of two STAMPEDE platform trials looking specifically at fracture-related hospitalisation, using linked national hospital records for just over three thousand men in England [1]. This matters because meta-analyses have suggested androgen receptor pathway inhibitors increase fracture risk, and that concern shapes bedside conversations. What they found runs the other way. In metastatic disease, five-year fracture-related hospitalisation was lower with standard of care plus abiraterone and prednisolone than with standard of care alone, at about 22 percent versus 30 percent, roughly a quarter reduction in risk. In the comparison that added enzalutamide to abiraterone, the effect was similar in direction, with about 28 percent versus 38 percent. In high-risk non-metastatic disease there was no significant difference either way. The authors' interpretation is that better control of metastatic bone disease outweighs any skeletal harm from deeper androgen suppression. The important caveats are that only hospitalised fractures were captured, there was no baseline bone mineral density, and bone-protective therapy use over time wasn't accounted for. Still, the practical message is that fear of fractures is not a reason to withhold treatment intensification in metastatic disease. Alongside that, European Urology Focus published a PROMISE registry analysis from Civan and colleagues on more than five hundred men with non-metastatic castration-resistant disease who underwent PSMA-PET [2]. Conventional imaging called them non-metastatic; PSMA-PET found distant disease in about two thirds of them, and visceral disease in about one in twenty. Over a median follow-up of more than four years, total tumour volume above a cutoff of 7.8 millilitres was associated with roughly two and a half times the risk of death, and simply having any distant metastatic finding on PSMA-PET carried a substantially worse survival. This is retrospective, and the cutoff is data-derived and needs validation, but it argues that PSMA-PET volume is prognostic information we are currently discarding in this disease state.

Turning to benign prostatic obstruction, three papers approach the same problem from different angles. In European Urology Focus, Hu and colleagues report a prospective cohort of 105 sexually active men undergoing transurethral vaporization with a 450 nanometre blue laser [3]. Median prostate volume was 44 millilitres and median operating time 25 minutes. Symptom scores fell from 24 to 8 and peak flow rose from 9 to 25 millilitres per second, with erectile function scores unchanged at twelve months. Ejaculate volume halved, but complete anejaculation occurred in under 3 percent of men, and there were no new cases of erectile dysfunction or incontinence. Transient haematuria affected about a third of patients and one man needed reoperation for haemostasis. This is a single-arm cohort with no comparator, so it establishes feasibility rather than superiority, but it adds to the ejaculation-preserving options worth discussing with younger men. Complementing that, in the World Journal of Urology, Segal and colleagues asked whether men who present already in retention with an indwelling catheter can expect to void again after surgery [4]. Comparing 143 catheterised men with 143 age-matched men operated for symptoms alone, and following up by telephone after a median of two and a half years, they found that despite larger prostates, higher residual volumes and more positive urine cultures at baseline, long-term catheter dependence was only about 4 percent in the catheterised group versus 2 percent in the reference group. Early postoperative retention was numerically more common, but durable catheter-free voiding was the norm. That's a useful figure to quote when counselling a catheterised patient who assumes surgery won't help. And on the platform question, also in the World Journal of Urology, Wallace and colleagues interrogated the national surgical quality database for 2022 and 2023, comparing single-port with multiport prostatectomy [5]. Among more than twelve thousand radical prostatectomies, single-port cases were about five times more likely to be discharged the same day and had meaningfully shorter length of stay, with a shorter stay also seen in simple prostatectomy. Thirty-day complications did not differ significantly, though with only 167 single-port radical cases the study was underpowered for small differences. The authors are appropriately cautious that this may reflect the practices of enthusiastic early-adopting centres as much as the platform itself.

In stone disease, two papers address how we improve clearance. A Bayesian network meta-analysis in the World Journal of Urology from Hinojosa-Gonzalez and colleagues pooled seventeen comparative studies and more than three and a half thousand patients with renal stones up to two centimetres, comparing flexible aspiration navigable sheaths and direct in-scope suction against conventional access sheaths [6]. Aspirating sheaths roughly two and a half times the odds of being stone-free at thirty days, with shorter operative time, less postoperative fever and lower odds of sepsis. Direct in-scope suction pointed the same way but with far fewer patients and much wider uncertainty, and performance clearly differed between specific devices, with one system showing no significant benefit at all. So the technology category matters less than the particular sheath. In children, Karabacak and colleagues reviewed 126 paediatric endourological cases and found that preoperative stenting was associated with a higher first-session stone-free rate only in those under two years of age, where every prestented child was rendered stone-free compared with fewer than half of those without a stent [7]. There was no benefit in the two-to-five or five-to-eighteen year groups, and no significant difference overall. This is small and retrospective, but it supports a selective, age-driven approach rather than routine prestenting.

Finally, two papers that should change perioperative routines. In European Urology Focus, Carl and colleagues report PAUSE-URO, a prospective single-arm study of 480 consecutive patients on direct oral anticoagulants undergoing elective urological surgery, using a standardised protocol of pausing the drug for either two or four days depending on renal function and procedural risk, then restarting on the first postoperative day at reduced dose for ten days [8]. Clinically relevant urological bleeding occurred in about 4 percent of patients, well below the prespecified safety threshold of 8 percent, major bleeding in under 1 percent, and there were no deaths, strokes or systemic emboli, with single cases of venous thromboembolism and acute coronary syndrome. It's single-centre and uncontrolled, and the authors flag more bleeding after endourological procedures, but it gives a defensible, bridging-free template pending randomised data. And in the same journal, Rice and colleagues report a systematic review and meta-analysis of six studies and more than six thousand patients asking whether screening for asymptomatic bacteriuria before cystoscopy prevents infection [9]. It did not. The pooled estimate favoured screening numerically but was not statistically significant, with substantial heterogeneity, and hospitalisation was rare in both arms. Certainty of evidence was low. Given the cost, the procedural delays and the antibiotic exposure involved, the authors conclude routine screening before cystoscopy should not be performed. One more practice-pattern signal, from European Urology Focus: Lee and colleagues used the Surveillance, Epidemiology, and End Results database to track primary retroperitoneal lymph node dissection in marker-negative non-seminomatous germ cell tumours from 2007 to 2022 [10]. In stage I, use fell from about 16 percent to under 3 percent; in stage IIb, from roughly half to under a third. Ten-year cancer-specific mortality was low and did not differ between primary surgery and chemotherapy. The concern the authors raise is not that surgery is being wrongly abandoned, but that falling volumes threaten the surgical expertise needed to offer it well.

If you only have time for one paper this week, make it the meta-analysis on screening for asymptomatic bacteriuria before cystoscopy [9]. It addresses one of the highest-volume decisions in urology, and the answer, stop doing it routinely, is immediately actionable in every clinic.

Here are the key takeaways from this week in Urology. First, abiraterone-based intensification did not increase fracture-related hospitalisation and in metastatic disease was associated with fewer such admissions, so skeletal fear should not drive undertreatment. Second, PSMA-PET tumour volume and the presence of distant disease carry strong prognostic weight in so-called non-metastatic castration-resistant disease. Third, men presenting with an indwelling catheter usually achieve durable catheter-free voiding after surgery, and blue laser vaporization preserved erectile function and antegrade ejaculation in the large majority of men in a prospective cohort. Fourth, aspirating ureteroscopy sheaths improve stone-free rates and reduce infectious complications, but the specific device matters; and in children, prestenting helps mainly under two years of age. And fifth, two perioperative habits deserve revision: a standardised pause-and-restart protocol for direct oral anticoagulants appears safe without bridging, and routine urine culture before cystoscopy does not prevent infection.

That's your roundup for This Week in Urology. The full transcript and references are available on the episode page in your AudioScholar library. This is an AI-curated summary — for clinical decisions, always consult primary sources and current guidelines. See you next week.

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