Marco Bandini

Objective: To systematically evaluate surgical outcomes of urethroplasty for bulbomembranous urethral strictures developing after endoscopic surgery for benign prostatic hyperplasia (BPH), focusing on patency, urinary continence, and erectile function. Patients and Methods: A pre‐registered systematic review (International Prospective Register of Systematic Reviews [PROSPERO] identifier: CRD420261374244) was performed following the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) 2020 guidelines. PubMed and the Excerpta Medica database (EMBASE) were searched for observational studies reporting urethroplasty outcomes in ≥10 patients with post‐BPH bulbomembranous, membranous, or proximal bulbar strictures. Risk of bias was assessed using the Risk Of Bias In Non‐randomised Studies of Interventions (ROBINS‐I). Random‐effects meta‐analysis with logit back‐transformation and Hartung‐Knapp‐Sidik‐Jonkman correction pooled proportions of patency and urinary incontinence (UI), stratified by technique. Results: A total of 11 studies comprising 669 patients were identified, of which nine (417 patients) were included in the primary quantitative analysis. All studies were retrospective or prospective observational cohorts with moderate‐to‐serious risk of bias. Definitions of patency and continence were heterogeneous across studies. The overall pooled patency rate, predominantly defined as freedom from re‐intervention rather than objectively confirmed anatomical patency, was 90% (95% confidence interval [CI] 85–93%), with moderate heterogeneity ( Q = 11.22). Subgroup analysis by technique yielded patency rates of 87% (95% CI 76–93%) for ventral onlay buccal mucosal graft (BMG) (four studies), 94% (95% CI: 87–97%) for anastomotic urethroplasty (three studies), and 91% (95% CI 83–95%) for dorsal onlay BMG (one study). The pooled UI rate was 5% (95% CI 3–10%), with moderate heterogeneity ( Q = 11.38). Sensitivity analysis excluding studies incorporating simple prostatectomy cases (two studies) yielded consistent results. Erectile function data were insufficient for pooled analysis; the two studies reporting Sexual Health Inventory for Men scores documented no significant deterioration. Conclusions: Urethroplasty for bulbomembranous strictures following BPH surgery achieves high, heterogeneously defined patency—predominantly freedom from re‐intervention—with low de novo UI in experienced centres. The heterogeneous, non‐comparative evidence precludes technique‐specific recommendations; prospective, standardised studies are needed to refine patient selection.

Objectives: To investigate the rate and predictors of recurrence at second-look ureterorenoscopy (URS) and to assess the adequate timeframe for second-look URS in upper tract urothelial carcinoma (UTUC). Methods: This multicenter retrospective study included 179 patients who underwent endoscopic kidney-sparing surgery (KSS) and second-look URS for non-invasive UTUC between 2004 and 2017. We performed logistic and Cox proportional hazard regression analyses to investigate the association between clinical parameters and second-look recurrence, recurrence-free survival (RFS), and cancer-specific mortality. The optimal duration to second-look URS was extrapolated using restricted cubic splines. Results: Overall, 66 (36.9%) patients experienced recurrence at second-look URS. After second-look URS, further recurrence was observed in 87 (48.6%) patients during a median follow-up of 12 months. Female gender (OR [odds ratio] 2.3, 95% CI [confidence interval] 1.1–4.7, p = 0.026) and tumor size > 1 cm (OR 3.3, 95% CI 1.2–9.5, p = 0.027) were independently associated with recurrence at second look. Second-look recurrence was a strong prognostic factor for RFS (HR 5.0, 95% CI 3.1–8.0, p < 0.001). Second-look URS between 5 and 12 weeks after initial endoscopic laser ablation was an independent favorable factor for RFS (HR 0.5, 95% CI 0.3–0.9, p = 0.014). Conclusions: Early recurrence at second-look URS appears to be one of the strongest predictive factors for RFS in patients undergoing endoscopic KSS. Our results suggest that second-look URS performed within 5 to 12 weeks is associated with a lower probability of further disease recurrence. Given that this interval was derived and tested in the same cohort, this finding should be regarded as hypothesis-generating and requires external validation before being adopted as a clinical standard.

Representativeness of study participants

Supplementary Figure 1: Study flow-chart. Supplementary Figure 2: Kaplan-Meier curves of event-free survival according to tertile-split tumor mutational burden. Supplementary Figure 3. Kaplan-Meier curves of recurrence-free survival according to the molecular subtype. Supplementary Figure 4: PD-L1 staining values (CPS percentages) according to molecular subtypes, split by the three subtyping classifiers GSC/Decipher, Consensus classification, and TCGA.

Surgical safety outcomes in PURE-01 trial

Updated adverse events observed in ITT population