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Management dilemma for very high-risk non–muscle-invasive bladder cancer

The European Association of Urology (EAU) guidelines recommend upfront radical cystectomy (RC) for very high-risk (VHR) non-muscle-invasive bladder cancer (NMIBC). However, real-world adoption is limited, as most patients are reluctant to undergo immediate bladder removal. The EAU 2021 risk model...

Are urodynamics still useful?

Two major UK randomised controlled trials, UPSTREAM and FUTURE, compared comprehensive clinical assessment (CCA) alone with CCA plus urodynamics (UDS), incorporating filling cystometry and pressure–flow studies. Both trials involved patients in whom diagnostic uncertainty suggested a potential role for UDS...

Why defining and managing DUST matters in endourology

In endourology, defining ‘DUST’ and optimising its management is vital for improving stone-free rates (SFR) and reducing complications. Residual fragments, even those ≤4mm, can act as a nidus for infection, obstruction, and recurrence. Studies have shown that 30% of patients...

Is transperineal prostate biopsy without antibiotic prophylaxis the new gold standard?

Prostate cancer is the second most diagnosed malignancy among men worldwide. Despite substantial advances in MRI–guided diagnostic pathways, prostate biopsy with histopathological evaluation remains indispensable for definitive diagnosis. Historically, transrectal biopsy (TRBx) has been the standard approach; however, concerns regarding...

Digital Twins: From NASA to the clinic

Clinical practice generates an enormous amount of patient data – histories, observations, blood results, imaging and molecular biomarkers. The problem is that these data streams rarely talk to each other. Instead, we use them in isolation, when what we actually...