Scandinavian Journal of Urology (SJU) is an international, non-profit journal that publishes online with Open Access. SJU aims to be a leading forum for clinical urologists, publishing high-quality original urological research. Contributions from all parts of the world are welcome. ´The journal is owned by the Acta Chirurgica Scandinavica society.
As from Volume 59 (2024) all published articles, unless otherwise specified, are published under CC-BY license, allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material, with the condition of proper attribution to the original work.
Validation of the Stockholm3 test for prostate cancer detection in a nationwide Finnish private primary care cohort
Objective: The Stockholm3 test combines clinical variables and biomarkers to improve the diagnosis of clinically significant prostate cancer (csPCa). We aimed to validate and compare its performance to prostate-specific antigen (PSA)-based decision-making. Material and methods: We conducted a prospective observational cohort study at a nationwide Finnish private primary care provider between July 2017 and February 2018. We included 1,379 men scheduled for PSA tests, excluding 74 men with missing PSA results or previously diagnosed prostate cancer. The clinical assessment was based on the PSA value and other clinical parameters, with clinicians unaware of the Stockholm3 result. We compared PSA-based decision-making with counterfactual Stockholm3 reflex testing. Results: Among the 1,305 men, the median age was 58 (interquartile range [IQR]: 51–64). PSA was ≥3 ng/mL in 209/1,305 (16%) men and above the age-specific reference limit in 119/1,305 (9%) men. Among men with PSA ≥1.5 ng/mL, a Stockholm3 Risk Score ≥15% would have selected 44% fewer men for further diagnostic evaluation than PSA ≥3 ng/mL (117/469 vs. 209/469). Over 6 years of registry-based follow-up, men with a Stockholm3 Risk Score ≥15% despite PSA below the age-specific reference limit represented a clinically relevant subgroup with subsequent csPCa diagnoses. The main limitation of this study was its observational design. Conclusions: The hypothetical clinical implementation of Stockholm3 reflex testing would have reduced referrals, helped standardise decision-making, and identified a different group of men for further diagnostic evaluation.
Copyright (c) 2026 Henrikki Santti, Mika Matikainen, Kristina Hotakainen https://creativecommons.org/licenses/by/4.0
Early intradetrusor injection of Onabotulinumtoxin A in patients with subacute spinal cord injury: The SCIBOT study
Objectives: The aim of this study was to examine if early intradetrusor injections of onabotulinumtoxin A (BTX) permanently prevent the development of neurogenic detrusor overactivity (NDO) in patients with spinal cord injury (SCI). Materials and methods: Double-blinded randomised controlled trial. Patients with a sensorimotor complete subacute traumatic suprasacral SCI received intradetrusor injection of BTX or placebo at baseline (within 12 weeks after injury) and 3 months later. Urodynamic and clinical evaluation was performed at baseline, at 3 months, at 12 months and at long-term follow-up after >24 months. The primary endpoint was occurrence of NDO with contractions above 40 cmH2O. The secondary endpoints included comparisons of urodynamic parameters, as well as clean intermittent catheterisation (CIC) frequency, occurrence of urinary incontinence, and quality of life (QOL) evaluated by questionnaires. Results: Nine patients were included, with four in the placebo group and five patients in the BTX group. Two patients in the placebo group but none in the BTX group developed NDO with contractions above 40 cmH2O. Regarding the secondary outcome variables, there were lower maximum detrusor pressure, less frequent CIC, less incontinence, and better QOL in the BTX group at >24 months follow up. Although there was a trend toward better outcome measures, none of the differences were statistically significant. No adverse events were related to BTX in either group. Conclusion: Intradetrusor injection of BTX in patients with SCI during the subacute phase seems to be safe and may be beneficial, but further studies are needed.
Copyright (c) 2026 Ole Jacob Nilsen, Thomas Glott, Henriette Veiby Holm, Célia Duarte Cruz, Lars Frich https://creativecommons.org/licenses/by/4.0
Letter to the Editor regarding ‘Histopathological assessment practices in adult male circumcision and detection of lichen sclerosus: a retrospective single-centre study’
Copyright (c) 2026 Ahmet Murat Bayraktar https://creativecommons.org/licenses/by/4.0
Detection of prostate cancer by magnetic resonance imaging before biopsy – real-world evidence from a nationwide cohort study
Objective: Magnetic resonance imaging (MRI) improves prostate cancer detection, but some tumours may be undetectable. This study assessed prostate cancer detection in biopsy-naïve men undergoing first-time prostate MRI. Material and methods: In this nationwide Danish cohort (2018–2022), men aged ≥ 40 years undergoing first-time prostate MRI were classified as MRI-positive if biopsied within 30 days, and MRI-negative if not. This served as a proxy for the radiology report findings. One-year cumulative incidence of prostate cancer diagnosis in the Danish Prostate Cancer Registry, repeated MRI, biopsy and mortality was estimated by MRI-status (positive/negative) and prostate-specific antigen (PSA) level, using the Aalen–Johansen estimator. Occurrence of high-grade cancer was also assessed. Results: Among 10,777 men, 40% were MRI-positive and 60% MRI-negative. The cumulative incidence of prostate cancer was higher in the MRI-positive than the MRI-negative men during 1-year follow-up (63% vs. 5% at PSA levels 2–3.9 µg/L), increasing with higher PSA levels (91% vs. 38% at PSA levels ≥ 20 µg/L). At 1 year, repeated MRI occurred in 21% of MRI-positive men and 9% of MRI-negative men; the subsequent 1-year biopsy incidence was 15% among MRI-negative men. Mortality was comparable between MRI-positive and MRI-negative men (1% vs. 1%). The risk of high-grade prostate cancer at the time of diagnosis was 80% in MRI-positive and 74% in the MRI-negative men. Conclusions: Among biopsy-naïve men undergoing first-time prostate MRI, MRI-positive status strongly predicts prostate cancer, even in men with low PSA. In MRI-negative men with PSA < 4.0 µg/L, prostate cancer risk remains low within the 2-year follow-up.
Copyright (c) 2026 Amalie H Simoni, Anne Ording, Jakob N. Hedegaard, Michael Borre, Søren P. Johnsen, Henrik Møller https://creativecommons.org/licenses/by/4.0
Paediatric stone treatment in the Nordic countries – a multicentre study from the Scandinavian Collaboration Group for Urinary Stones
Objective: To explore differences and similarities in paediatric stone treatment between hospitals in the Nordic countries. Material and methods: A retrospective review of the medical records was performed for children receiving stone treatment in nine Nordic hospitals between January 2014 and December 2023. Variables of interest included diagnostic imaging, treatment modalities, complication rates and stone free rates (SFR). Results: Five hundred and sixty two treatments among 319 children were included; 117 girls and 202 boys with a median age of 10 years (interquartile range 5 – 14). Preoperative diagnostic imaging with computed tomography was performed in 442 cases (79%), and 120 patients (21%) were diagnosed with ultrasound, MRI or X-ray. In 150 cases (27%), stones treated were located in the ureter only and in 412 cases (73%) in the renal pelvis ± ureter. Ureteroscopic stone treatment (URS) was performed in 248 (44%), shock wave lithotripsy (SWL) in 242 (43%) and percutaneous lithotripsy (PCNL) in 72 cases (13%). The distribution of treatment modalities varied considerably between hospitals. URS treatments increased, and SWL procedures declined throughout the study period. A follow-up consultation was carried out in 505 cases (90%). Overall SFR after each session across treatment modalities and location was 49%. The SFRs after URS was 68%, SWL 30% and PCNL 61% and significantly higher after URS compared to SWL, p < 0.001. Postoperative complications leading to readmission occurred in 10% of patients. Conclusion: The study reveals differences in preferred treatment modalities and results between the hospitals. Standardising diagnostics, treatment and follow-up could improve outcomes for children with kidney stone disease.
Copyright (c) 2026 Øyvind Ulvik, Line Vigrestad, Dan Helgø, Stein Øverby, Kristian Stritesky Larssen, Pertti Nurminen, Jóhann Páll Ingimarsson, John Åkerlund, Rita Ferrito, Tomas Thiel https://creativecommons.org/licenses/by/4.0
Optilume® for panurethral stricture: the good, the bad, and the ridiculous
Copyright (c) 2026 Lukas Andrius Jelisejevas, Gennadi Tulchiner, Peter Rehder https://creativecommons.org/licenses/by/4.0
Sweden’s nationwide transition to transperineal prostate biopsy: implications for implementation across Europe
Copyright (c) 2026 Matthias May, Christian Gilfrich, Uwe-Bernd Liehr, Steffen Lebentrau https://creativecommons.org/licenses/by/4.0
Histopathological assessment practices in adult male circumcision and detection of lichen sclerosus: a retrospective single-centre study
Objective: To investigate histopathological assessment practices following medical circumcision, analyse the prevalence of lichen sclerosus (LS) and assess the management of circumcised LS patients. Material and methods: This retrospective study was conducted at Umeå University Hospital. A total of 416 patients aged ≥18 years who underwent medical circumcision between 2016 and 2023 were included. The variables investigated were the frequency of histopathological diagnosis of preputial tissue, pre- and post-surgery treatment, further management and the prevalence of LS. Results: The mean (standard deviation [SD]) age of included patients was 47 (21) years. Before circumcision, 34% (141/416) of the study population had received treatment with potent or ultrapotent topical corticosteroids. A pre-operative diagnosis of LS was set in 4.8% (20/416) of the patients. Histopathological analysis of circumcised material was performed in 44% (183/416) of cases. Amongst these, LS was confirmed in 60% (110/183). Amongst the patients with histologically confirmed LS, 13% (14/110) received a recorded diagnosis of LS. A total of 15% (16/110) of the patients with LS were either referred to a dermatovenereologist and/or received treatment with an ultrapotent topical corticosteroid. Conclusions: LS appears to be both underdiagnosed and not adequately treated in patients undergoing medical circumcision. Less than half of the circumcised specimens were analysed, which means a risk of missing LS and potential dysplastic changes. Most patients with LS did not receive adequate diagnosis and treatment after surgery. Failure to diagnose LS limits patient awareness, follow-up and appropriate care, factors that may contribute to disease progression and increased cancer risk.
Copyright (c) 2026 Jenny Engman, Wilma Håkansson, Nirina Andersson, Johan Svensson, Elisabet Nylander, Amir Sherif, Maja af Klinteberg https://creativecommons.org/licenses/by/4.0
Impact of asymptomatic bacteriuria on the outcomes and tolerability of Bacillus Calmette–Guérin immunotherapy
Objective: To determine whether asymptomatic bacteriuria (ABU) prior to Bacillus Calmette-Guérin (BCG) immunotherapy has an impact on the oncological results and overall tolerability of BCG treatment in patients with non-muscle-invasive bladder cancer (NMIBC). Materials and methods: We analyzed retrospectively all patients who received ≥ 1 BCG instillations as treatment of NMIBC in Helsinki University Hospital and Turku University Hospital during 2009–2018. Patients submitted urine specimen 1–7 days prior to the initiation of BCG therapy. ABU was classified as having any positive urine culture but no dysuria or fever. Our primary endpoints were 5-yr recurrence-free survival and progression-free survival. Discontinuation rate of BCG therapy was a secondary endpoint. Results: We identified 795 patients, of whom 154 (19%) had ABU prior to the first BCG instillation. The 5-yr recurrence-free survival rates in the uninfected and bacteriuric groups were 63% (95% confidence interval [CI]: 59–67%) vs. 69% (95% CI: 62–78%), respectively (hazard ratio [HR] 0.83, 95% CI 0.60–1.14). The 5-yr progression-free survival rates were 88% (95% CI: 86–90%) vs. 89% (95% CI: 84–94%), respectively (HR 0.86, 95% CI 0.50–1.49). The 3-yr discontinuation-free survival rates were 51% (95% CI: 47–54%) vs. 51% (95% CI: 44–60%), respectively (HR 0.98, 95% CI 0.75–1.28). Conclusion: ABU did not significantly affect BCG immunotherapy outcomes. Intravesical BCG during ABU is safe, with similar discontinuation rates, indicating very similar treatment tolerability.
Copyright (c) 2026 Antti Nummi, Pertti Nurminen, Olli Kesti, Mikael Högerman, Otto Ettala, Peter J. Boström, Antti Kaipia, Jukka Sairanen, Riikka Järvinen https://creativecommons.org/licenses/by/4.0
The Swedish national guidelines on prostate cancer: recurrent, metastatic and castration resistant disease
Objective: This article presents a summary of the 2025 Swedish prostate cancer guidelines, focusing on recurrence after local treatment, metastatic disease, and castration-resistant prostate cancer. Results: The 2025 Swedish guidelines introduce several important updates. Prostate specific membrane antigen (PSMA)-PET/CT is recommended only when PSA exceeds 0.2 µg/L, and reporting should follow the defined PSMA-RADS-scale. PSMA-PET/CT is preferred over lymph-node dissection for staging. A strong recommendation is issued for radiotherapy to the primary tumour in all oligometastatic men with a life expectancy > 5 years, whereas metastasis-directed therapy is restricted to clinical trials. Systemic treatment pathways now prioritise androgen receptor pathway inhibitors (ARPI) plus androgen deprivation therapy (ADT), with triple therapy (including docetaxel) used more selectively. Pathway-specific staging algorithms have been revised. The oly (ADP-ribose) polymerase inhibitor (PARPi) section has expanded, with broader genomic-based selection and integration into treatment sequencing. Two new chapters and an appendix address cardiovascular risk assessment before ARPI or chemotherapy. Supportive care is substantially strengthened. Compared with the EAU-EANM-ESTRO-ESUR-ISUP-SIOG Guidelines on Prostate Cancer 2025, the Swedish guidelines 2025 applies PSMA-PET/CT more conservatively, restricts PSMA-guided nodal salvage therapy, and issues a more universal recommendation for local radiotherapy in oligometastatic disease. The Swedish guidelines 2025 prioritise ARPI + ADT and limit triple therapy and PARPi combinations due to regulatory and reimbursement constraints. PARPi are largely reserved for BRCA1/2-mutated disease. The Swedish guidelines 2025 provide a more comprehensive framework for rehabilitation and survivorship. Conclusions: The 2025 Swedish prostate cancer guidelines introduce multiple new recommendations and differ in several aspects from the European guidelines.
Copyright (c) 2026 Johan Stranne, Elin Axen, Ola Bratt, Stefan Carlsson, Jon Kindblom, Kimia Kohestani, Anna Kristiansen, Ingela Franck Lissbrant, Gabriel Moise, Elinor Nemlander, David Robinsson, Christian Torbrand, Elin Trägårdh, Jonas Wallström, Camilla Wennerberg, Camilla Thellenberg Karlsson https://creativecommons.org/licenses/by/4.0
Early recurrence after primary TURBT for non-muscle-invasive bladder cancer in Iceland: the critical role of surgical quality
Introduction: Transurethral resection of bladder tumor (TURBT) is the standard treatment for non-muscle-invasive bladder cancer (NMIBC), but early recurrences remain frequent. The objective of this study was to standardize TURBT management at our institution through the implementation of a treatment protocol designed to reduce early recurrence after primary TURBT. Material and methods: All patients with newly diagnosed NMIBC who underwent primary TURBT at Landspítali University Hospital between 2013–2015 (control) and 2017–2019 (intervention) were included. The treatment protocol restricted procedures to four surgeons, mandated blue-light cystoscopy, routine postoperative bladder irrigation, and guideline-based instillation therapy. The primary endpoint was recurrence rate at first follow-up cystoscopy; secondary endpoints included adherence to protocol measures and recurrence-free survival. Results: A total of 133 control and 138 intervention patients were included. Baseline characteristics were comparable. After implementation, bladder irrigation increased from 46 to 90%, blue-light cystoscopy was used in 59% of intervention cases, and instillation therapy rates rose (Mitomycin-C: 0–49% in intermediate-risk; Bacillus Calmette-Guérin (BCG):35–63% in high-risk patients). Early recurrence rates remained comparable (15% vs. 16%). Early recurrence varied markedly between surgeons (11–40%) and correlated strongly with detrusor muscle presence. No significant difference in recurrence-free survival was observed, though a trend toward lower recurrence was seen in the intervention group after adjusting for risk factors. Conclusion: Implementation of a standardized TURBT protocol improved adherence to recommended measures but did not reduce early recurrence. Marked inter-surgeon variability highlights surgical quality as the key determinant of early recurrence in non-muscle-invasive bladder cancer.
Copyright (c) 2026 Oddur Björnsson, Guðmundur Geirsson, Árni Stefán Leifsson, Sigfús Þór Nikulásson, Sigurður Guðjónsson https://creativecommons.org/licenses/by/4.0
Application of the International Bladder Cancer Group prediction model for recurrence-free survival on a national cohort of primary intermediate risk non-muscle invasive bladder cancer
The International Bladder Cancer Group (IBCG) has proposed a prognostic model for intermediate risk (IR) non-muscle invasive bladder cancer (NMIBC) for clinical decision-making. We applied the IBCG IR model in a population-based Swedish setting in patients with primary IR NMIBC diagnosed 2013–2014 in BladderBaSe 2.0. Patients were stratified into low-risk (unifocal and tumour size < 3 cm) and intermediate-risk (multiple and/or tumour size ≥ 3 cm) for estimation of 1- and 3-year recurrence-free survival (RFS). Among 710 patients with IR NMIBC, 329 (46%) and 381 (54%) were categorized as low- and intermediate-risk, respectively. Probabilities of disease recurrence or death at 1 and 3 years in low-risk patients were 19% (95% confidence interval [CI]: 15–23) and 41% (95% CI: 35–46), versus 27% (95% CI: 22–31) and 45% (95% CI: 40–50) in the intermediate-risk group. In a sensitivity analysis including only patients receiving serial adjuvant instillations (n = 152) the corresponding probabilities at 1 and 3 years were 19% (95% CI: 10–28) and 33% (95% CI: 22–43) versus 15% (95% CI: 7–23) and 31% (95% CI: 20–41), respectively. Thus, no clinically meaningful difference in recurrence-free survival was observed between International Bladder Cancer Group low- and intermediate-risk groups in this population-based primary non-muscle invasive bladder cancer setting.
Copyright (c) 2026 Denis Mesinovic, Johannes Bobjer, Oskar Hagberg, Firas Aljabery, Truls Gårdmark, Staffan Jahnson, Tomas Jerlström, Henrik Kjölhede, Per-Uno Malmström, Viveka Ströck, Karin Söderkvist, Anders Ullén, Lars Holmberg, Christel Häggström, Fredrik Liedberg https://creativecommons.org/licenses/by/4.0
Risk of Achilles tendon rupture following single-dose ciprofloxacin use in transrectal prostate biopsies
Purpose: To assess the risk of Achilles tendon rupture (ATR) following single-dose ciprofloxacin prophylaxis for transrectal prostate biopsy. Methods: Using the Prostate Cancer data Base Sweden (PCBaSe 5.0), we analysed 44,959 prostate biopsy exposures versus 662,520 non-exposures to assess the risk of ATR. Prostate biopsy served as a proxy for quinolone use, with single-dose ciprofloxacin being the recommended and most extensively documented prophylaxis in Sweden for this procedure. The outcome was ATR in men who underwent a biopsy compared to those who did not. Results: The incidence rate of ATR was 60.46 per 100,000 person-years in the no-biopsy group, compared to 62,77 per 100,000 person-years in the biopsy group. The multivariable analysis yielded a hazard ratio of 0.98 (95% confidence interval [CI]: 0.83–1.15). Conclusions: Transrectal prostate biopsy was not associated with an elevated risk of Achilles tendon rupture. This provides some evidence against single-dose ciprofloxacin being a relevant risk factor for this outcome, but there is remaining uncertainty related to study limitations.
Copyright (c) 2026 Michaela Runnaes, Erik Lampa, Johan Styrke, Karl-Johan Lundström https://creativecommons.org/licenses/by/4.0
Complications and clinical outcomes of retroperitoneal lymph node dissection for testicular cancer in a centralized population-based cohort in Sweden: insights from SWENOTECA
Objective: Retroperitoneal lymph node dissection (RPLND) for testicular germ cell cancer is a complex procedure associated with postoperative complications and long-term morbidity, best performed by experienced surgeons at high-volume centers. This study evaluates surgical outcomes of RPLND in a centralized population-based cohort. Methods: This is a retrospective analysis of a prospective multicenter cohort of all RPLNDs in Sweden between 2018 and 2022. 217 patients (175 nonseminomas and 42 seminomas) underwent unilateral or bilateral primary RPLND or post-chemotherapy RPLND. Primary outcomes were complications, loss of ejaculation, and histopathology. Results: Intraoperative complications occurred in 8% of unilateral and 0% of bilateral templates in primary RPLND, and in 0 and 8% in post-chemotherapy RPLND, most commonly renal injury. Postoperative complications rate was significantly higher with bilateral templates in post-chemotherapy RPLND (49% vs 18%, p < 0.01). Clavien-Dindo ≥ IIIb complications occurred in 2 (primary) and 3% (post-chemotherapy), respectively. Loss of ejaculation was numerically more common after bilateral templates (primary: 60% vs 31%, p = 0.07; post-chemotherapy: 53% vs 38%, p = 0.09). Viable cancer was found in 95% of seminomas and 52% of nonseminomas for primary RPLND and in nonseminoma post-chemotherapy RPLND, 11% viable cancer, 50% teratoma, and 39% benign nodes. Robotic surgery did not increase complications or loss of ejaculation. Conclusions: RPLND demonstrated low complication rates and rare serious events. Bilateral templates were associated with increased loss of ejaculation. Robotic surgery was safe, and prior chemotherapy did not preclude laparoscopy. Post-chemotherapy RPLND showed more teratoma and viable cancer, and fewer benign findings than previously reported.
Copyright (c) 2026 Anna Thor, Anna Grenabo Bergdahl, Armin Abniki, Axel Gerdtsson, Ingrid Glimelius, Martin Hellström, Anna K. Jansson, Berglind Johannsdottir, Torgrim Tandstad, Gabriella Cohn-Cedermark, Anders Kjellman, Per-Olof Lundgren https://creativecommons.org/licenses/by/4.0
Clinical application of transurethral resection/electrocautery for urethral hemangiomas: two centers retrospective cohort study
Background: We aimed to evaluate the safety and efficacy of transurethral resection/electrocautery for the treatment of urethral hemangiomas. Methods: A retrospective analysis was conducted on clinical data from patients who underwent transurethral resection/electrocautery for urethral hemangiomas at two medical institutions between August 2018 and July 2025. Perioperative data, short-term and long-term complications, and tumor recurrence were assessed. Results: In total, 42 patients were included in this study. All patients successfully underwent surgical treatment without any intraoperative complications and residual tumor. The procedures were completed in a median operative length of 10 min (interquartile range [IQR]: 10–15 min) and a median blood loss volume of 20 mL (IQR: 10–20 mL). Most patients (n = 39, 92%) presented multiple lesions, with a median size of 4 mm (IQR: 3–4 mm). The lesion range of the 31 patients (74%) was more than one-half of the circumferential diameter in cystourethroscopy. Postoperative complications occurred in five patients (12%), primarily consisting of difficult urination (n = 4, 10%) and gross hematuria (n = 1, 2%). The median follow-up times were 12.0 months (IQR: 8.0–38.5 months), and one patient developed recurrence 4 months after surgery. Long-term complications, such as urethral stricture, urinary incontinence, and retrograde ejaculation, were observed. Conclusion: Transurethral resection/electrocautery provides a safe, effective, and feasible treatment for urethral hemangiomas, delivering swift hemostasis with very low rates of complications and recurrence. Although this study included the largest sample size currently available worldwide, the findings still need additional validation.
Copyright (c) 2026 Jian-Feng Huang, Rong-Hua Wu, Jin-Chun Qi, Tao Guo, Fan He, Yan-Yang Jin, Liang Liu https://creativecommons.org/licenses/by/4.0
Number of risk factors versus infection after transrectal prostate biopsy: a nationwide population-based study
Objective: It is unknown how risk factors for infection after transrectal prostate biopsy interact. We designed a study to evaluate this. Methods: We identified biopsy procedures from 2006 to 2020 in the Swedish nationwide database PCBaSe. Primary outcome was post-biopsy infection, defined as a dispensed prescription of a urinary tract antibiotic and secondary outcome was inpatient care for infection both within 30 days. Risk factors were age, diabetes, medical treatment of lower urinary tract symptoms (LUTSs), prostate enlargement, immunosuppressives, corticosteroids, and defined antibiotic exposure during the past 1–12 months. When analysing risk in men with several risk factors clinically related factors were grouped as urinary tract infection (UTI)-antibiotics, treatment of LUTS, immunosuppressives including corticosteroids, and diabetes. Logistic regression was used to calculate odds ratios (ORs) with 95% confidence intervals (CI). Results: A total of 139,056 transrectal prostate biopsy procedures were analysed. The grouped risk factors were significantly associated with post-biopsy infection (multivariable ORs: 1.22–1.72). Infection increased with number of risk factors; none: 4.0% (95% CI: 3.8–4.1), one: 6% (95% CI: 5.9–6.4), two: 10% (95% CI: 9.3–11), and three or four: 12% (95% CI: 9.8–14); inpatient care increased from 2.0% (95% CI: 1.9–2.1) to 3.1% (95% CI: 2.2–4.4). Conclusion: Infection risk after transrectal prostate biopsy incrementally increases with the number of risk factors. Clinical Implications: The transrectal biopsy route should be used with caution for patients with several risk factors for post-biopsy infections. Patient Summary: Diabetes, urinary symptoms, previous urinary infection, and immune suppressing medication increase the risk of infection after a prostate biopsy through the rectum. Patients with many of these conditions have a particularly high risk. What does the study add? We used nationwide register data to estimate the infection risk after transrectal prostate biopsy by the number of these risk factors: diabetes, medical treatment of lower urinary tract symptoms, immunosuppressives including corticosteroids, and use of urinary tract antibiotics the past year. The risk incrementally increased from 4.0% in men with no risk factor to 12% in those with 3 or 4. Take Home Message: Infection after transrectal prostate biopsy increases with number of risk factors: diabetes, medical treatment of lower urinary tract symptoms, immunosuppressives including corticosteroids, and use of urinary tract antibiotics the past year, from 4.0% (none) to 12% (3 or 4).
Copyright (c) 2026 Joakim Örtegren, Olof Elvstam, Kimia Kohestani, Henrik Kjölhede, Johan Styrke, Pär Stattin, Anders Berglund, Ola Bratt https://creativecommons.org/licenses/by/4.0
Testicular torsion Point-based Assessment and Imaging tool - identifying Need for Surgical exploration (TPAINS): a clinical algorithm for detecting testicular torsion
Objective: Testicular torsion (TT) is a medical emergency, difficult to identify solely through clinical evaluation. This study aims to develop an assessment algorithm with a safe lower threshold for complementary ultrasound. Material and methods: Males between 1 and 30 years of age assessed for suspected TT during the years 2019 – 2023 were retrospectively included. Clinical assessments were conducted by primarily nonurologists and ultrasounds by radiologists. An assessment algorithm named Testicular torsion Point-based Assessment and Imaging tool - identifying Need for Surgical exploration (TPAINS) was developed based on symptoms showing significant correlation with TT. Results: Of the 417 patients included, 68 (16%) were surgically explored and 33 (8%) diagnosed with TT. Six symptoms showing a significant association with TT were combined for the development of the algorithm TPAINS. With a cut-off value of ≥2 points, TPAINS showed a sensitivity of 100% (confidence interval, CI: [90, 100]), specificity 54% (CI [49 – 59]), and an AUC-value of 0.89 (95% CI [84 – 94]). Conclusions: This study concludes that symptom-based evaluation, together with a low threshold for ultrasound, is a promising approach for the detection of TT. The developed algorithm, TPAINS, includes an ultrasound assessment and focuses on safe lower thresholds for further clinical actions – hoping for a reduced rate of unnecessary surgical explorations.
Copyright (c) 2026 Nathalie Dahlgren, Gustav Sundström, Charlotta Nilsson, Magnus Wagenius https://creativecommons.org/licenses/by/4.0
Long-term effects of testosterone therapy on prostate volume and LUTS in hypogonadal men: a retrospective study
Introduction: Up to 20% of aging men have low serum testosterone (late-onset hypogonadism [LOH]), and approximately 80% develop benign prostatic enlargement (BPE) with increasing age. Both age and prostate size are linked to lower urinary tract symptoms (LUTS). This study aimed to evaluate the effect of testosterone replacement therapy (TRT) on prostate volume and LUTS in men with LOH. Materials and methods: From 2004 to 2017, 511 men underwent annual checkups including physical examination, transrectal ultrasound, bladder scanning, serum Prostate-Specific Antigen (s-PSA), and serum testosterone and questionnaires on LUTS and LOH symptoms. None had prior treatments affecting prostate size or LUTS at baseline. During the annual follow-ups, 167 men (33%) were diagnosed with symptomatic LOH and received TRT. A longitudinal statistical model was used to compare periods with and without treatment regarding prostate growth, post-void residual urine, IPSS (International Prostate Symptom Score), quality of life (QoL), and s-PSA. Results: Participants contributed 3745 visits (median 7 per man), including 904 (24%) after testosterone initiation. TRT was associated with a mean increase in prostate growth rate of 0.22 mL/year compared with untreated periods (p = 0.023). No significant differences were observed in LUTS, QoL, or s-PSA between treated and untreated periods Conclusion: In ageing males with late-onset hypogonadism, testosterone replacement therapy was linked to a small but statistically significant increase in prostate growth rate without measurable effects on urinary symptoms.
Copyright (c) 2026 Peter Ströberg, Ramin Ghaffarpour, Börje Ljungberg, Johan Svensson https://creativecommons.org/licenses/by/4.0
Thermal imaging in the diagnosis of acute testicular pain – results of a feasibility pilot study
Objective: This study aimed to evaluate the feasibility of thermal imaging for the diagnosis of acute testicular pain. Pain is usually caused by infection, inflammation or torsion of the testis or testicular appendage. Diagnosis is based on examination, laboratory tests, and Doppler ultrasound (DU), which is investigator dependent and may cause delays. Thermal imaging is a fast and noninvasive method for measuring surface temperature. Materials and methods: Our 3-month pilot study investigated the feasibility of thermal imaging for the diagnosis of acute testicular pain. Eighteen consecutive patients were examined using a thermal camera. Results: Two patients had testicular torsion (group 1), two had torsion of the testicular appendage (group 2), four had bacterial epididymitis (group 3), and 10 had inflammatory epididymitis (group 4). The mean ± standard deviation (SD) temperature differences between symptomatic and a reference asymptomatic testicles were −0.65 ± 0.57°C (range, −1.1 to −0.2°C), −0.15 ± 0.21°C (range, −0.3 to 0.0°C), +0.65 ± 0.25°C (range, +0.4 to +1.0°C), and +0.39 ± 0.87°C (range, −1.0 to +1.8°C) in groups 1, 2, 3, and 4, respectively. Conclusions: Thermal imaging is a feasible, noninvasive method for evaluating acute testicular pain. It may serve as a rapid diagnostic tool, but its clinical value must be confirmed in large prospective trials.
Copyright (c) 2026 Lasse Hirvonen, Konrad Sopyllo, Juhani Rantakallio, Ilkka Paaso, Mika Raitanen https://creativecommons.org/licenses/by/4.0
Radical cystectomy practice patterns in the Nordic countries: results from the prospective NorCys study
Background: Muscle invasive bladder cancer (MIBC) is an aggressive disease with a high mortality rate. Radical cystectomy (RC) is the standard treatment for MIBC and selected non-muscle invasive bladder ­cancer (NMIBC) cases. The NorCys-study (NCT04523038, NCT04537221 and NCT04523025) aims to validate biomarkers predicting RC outcomes. This report describes RC practice patterns across the Nordic countries. Materials and Methods: This prospective, multi-institutional study included bladder cancer patients undergoing RC with or without preoperative chemotherapy in all five Nordic countries from 5/2020 to 1/2025. Clinical and pathological data were collected prospectively into REDCap database and analysed using descriptive statistics, Wilcoxon rank sum and Pearson’s Chi-squared tests. Results: A total of 1,642 patients from 15 centres were enrolled. Of these, 35% (531) had clinical NMIBC (T1-Tis-Ta), and 65% (999) had cT2-4 disease. Preoperative chemotherapy was administered to 398/929 (43%) cT2-4 or node-positive patients. The most common neoadjuvant chemotherapy (NAC) regimens were gemcitabine – cisplatin (GC) (275/475 [58%]) and dose-dense methotrexate, vinblastine, doxorubicin and cisplatin (dd-MVAC) (144/475 [30%]). Robot-assisted RC was the most common surgical approach administered in 886 of 1,472 (60%) cases, with variation between centres. Ileal conduit was the predominant diversion method in 1,375 out of 1,465 cases (94%). Median surgical time was 322 min, blood loss was 300 mL and hospital stay was 9 days. Final pathology demonstrated pT0 in 29%, ≥pT2 in 43% and lymph node metastases 203 (17%). Conclusion: This study reports current RC practices amongst Nordic countries. Patient cohorts did not differ between countries, and although the practices were generally similar, some differences were noted in chemotherapy regimens, the use of robotic-assisted surgery and rates of early RC.
Copyright (c) 2026 Tiia Venhomaa, Ilkka Nikulainen, Johannes Bobjer, Mats Bläckberg, Lasse Bro, Simone Buchardt Brandt, Otto Ettala, Knud Fabrin, Sigurdur Gudjonsson, Erik Skaaheim Haug, Mikael Högerman, Josephine M. Hyldgaard, Tomas Jerlström, Peter Kirrander, Ilmari Koskinen, Gitte Lam, Markku J. Leskinen, Fredrik Liedberg, Astrid Helene Livbjerg, Heikki Seikkula, Katharina Skovhus, Viveka Ströck, Grazvydas Tuckus, Ville Virta, Marie-Louise Vrang, Jørgen Bjerggaard Jensen, Peter J. Boström https://creativecommons.org/licenses/by/4.0
Nationwide population-based longitudinal data on magnetic resonance imaging of the prostate and subsequent prostate biopsy results
Background and aim: Magnetic resonance imaging (MRI) is crucial for prostate cancer (Pca) diagnosis, risk stratification, and treatment planning. However, large-scale observational studies require structured MRI data, which are often only obtainable from free-text reports. We aimed to extract information from narrative prostate MRI reports and to describe subsequent biopsy outcomes in a nationwide population-based cohort. Methods: We identified 108,361 prostate MRI examinations in Prostate Cancer database Sweden with extended treatments and endpoints data (PCBase Xtend) performed in 2015–2023. A rule-based text recognition algorithm was created and used to extract Prostate Imaging Reporting and Data System (PI-RADS) score and prostate volume from free-text MRI reports. Extracted data were validated against manually extracted information in the National Prostate Cancer Register (NPCR). We examined biopsy rates and Gleason score according to PI-RADS, Prostate Specific Antigen (PSA) density, and calendar year. Results: The proportion of reports with identifiable PI-RADS scores increased from 38% in 2015–2016 to 83% in 2022–2023, with excellent agreement with NPCR data (correlation coefficient r = 0.94). Extracted prostate volumes correlated well with those in NPCR (r = 0.88). Biopsy rates decreased for PI-RADS 3 lesions over time, particularly in men with PSA density < 0.15 ng/ml/ml, while the proportion of men with PI-RADS 5 lesions who underwent biopsy increased. Almost all prostate cancers in men with PI-RADS 3 lesions were Gleason 6 or 7 (3+4). Gleason 9–10 was almost exclusively found in PI-RADS 5 lesions. Conclusions: Automated extraction of information from unstructured MRI reports is feasible and accurate. The observed temporal trends reflecting increasing quality and standardization of prostate MRI support its use in large-scale epidemiological research.
Copyright (c) 2026 Eugenio Ventimiglia, Rolf Gedeborg, Marcus Westerberg, Paolo Zaurito, Fredrik Jäderling, Pär Stattin, Hans Garmo https://creativecommons.org/licenses/by/4.0
Treatment with CernitinTM of induced urinary bladder inflammation downregulates relevant pro-inflammatory biomarkers – an experimental in vivo rodent model
Objective: Chronic inflammation of the urinary bladder is associated with the bladder pain syndrome. The treatment alternatives in humans are far from satisfactory and need further attention. Well-established preclinical models have shown that pro-inflammatory cytokines contribute to the progress of the inflammatory response behind pain and hyperalgesia. Previously presented results indicate that treatment with CernitinTM pollen extracts active pharmaceutical ingredients (APIs) (Cernitin GBX and Cernitin T60) significantly alleviated pain in cyclophosphamide-induced urinary bladder inflammation in a rodent model through downregulation of PGD2 and cyclooxygenase-2 (COX-2) mediators when compared to the vehicle alone. The objective was to extend the original study by exploring the correlation between the two APIs and cytokines expression and to identify a possible biomarker pattern. Material and method: The Olink® Target 48 Mouse Cytokine assay was conducted on the homogenised tissue extracts of the bladder wall with induced inflammation from a previous study to identify the potential impacts on protein biomarkers. Results: The test revealed that treatment with the APIs significantly downregulated the cytokines interleukin (IL)-1α, IL-2, IL-4, IL-6, and with trend to significance the biomarkers IL-12 α, β, CCL4 and fibroblast growth factor 21 when administered in combination (GBX+T60) or each component alone, compared to vehicle controls. Conclusion: This study identified seven cytokines that were significantly or markedly reduced. The results suggest that CernitinTM APIs impact a series of key pro-inflammatory biomarkers demonstrating an ability to restrain inflammation. Therefore, they warrant further investigation as potential therapeutic candidates
Copyright (c) 2026 Nishtman Dizeyi, Celine Augé, Philippe Lluel, Magnus Grabe https://creativecommons.org/licenses/by/4.0
Uptake of doublet and triplet therapy for men with de novo metastatic castration-sensitive prostate cancer. Population-based study
Purpose: In randomised clinical trials, doublet and triplet therapy improved survival compared to standard androgen deprivation therapy (ADT) in men with de novo metastatic castration-sensitive prostate cancer (mCSPC). Guidelines recommend doublet therapy since 2020 and triplet therapy since 2022. The aim of this study was to assess the uptake of upfront doublet and triplet therapy at a population level and assess trends in survival for all men with mCSPC. Methods: We included men registered with de novo mCSPC in 2016–2024 in the National Prostate Cancer Register of Sweden. We estimated the annual proportion of men with de novo mCSPC who upfront received doublet therapy (ADT plus androgen receptor pathway inhibitor [ARPI] or docetaxel) or triplet therapy (ADT plus docetaxel and ARPI). Kaplan–Meier curves were used to estimate 3-year overall survival. Results: In 9294 men diagnosed with de novo mCSPC, the use of upfront doublet therapy increased from 19% in 2016 to 66% in 2024, and the use of triplet therapy rose from 4% in 2021 to 17% in 2024. Uptake was highest among men below age 65 years, of whom 46% received doublet and 48% received triplet therapy in 2024. Three-year survival increased from 51% (95% CI: 49–52%) in 2016–2018 to 61% (95% CI: 58–64%) in 2022–2024. Among men below age 65, survival increased from 69% (95% CI: 65–73) in 2019–2021 to 77% (95% CI: 71–84) in 2022–2024. Conclusions: The uptake of doublet and triplet therapy increased substantially during the study period, in particular among men below age 65. In parallel, 3-year overall survival increased in all men diagnosed with de novo mCSPC. These data provide support for the benefit of upfront doublet or triplet therapy in clinical practice.
Copyright (c) 2026 Paolo Zaurito, Rolf Gedeborg, Hans Garmo, Eugenio Ventimiglia, Mats Alhberg, Pär Stattin, Marcus Westerberg https://creativecommons.org/licenses/by/4.0
Risk of infectious complications after transperineal prostate biopsy compared to transrectal biopsy: nationwide population-based cohort study in Sweden
Objective: Prostate biopsy is associated with a risk of significant infectious complications including sepsis. We investigated the risk of infections after transrectal (TR) biopsy compared to transperineal (TP) biopsy. Materials and methods: Men who had undergone prostate biopsy and diagnosed with prostate cancer were identified in the National Prostate Cancer Register (NPCR) of Sweden. Linkage with Swedish health care registers provided information on hospitalization, antibiotic prescriptions and comorbidities. Rate ratios for hospitalization, for infections, after TR and TP biopsies over day 1–7, 1–14, and 1–30 were estimated with Poisson regression. Filled prescriptions for urinary tract related antibiotics were also assessed. Results: Thirty-one thousand two hundred twenty-two men underwent biopsy between 1 January 2020 and 31 December 2023. 87% underwent TR and 13% TP biopsy. Hospitalization occurred in 0.6% of men (n = 24) after TP biopsy and 2.0% (n = 548) after TR biopsy. Rate ratios for hospitalization in the TR group compared to TP were 8.0 (95% confidence interval [CI]: 4.0–16.2) for day 1–7, 6.2 (3.2–11.9) for day 1–14, and 4.1 (2.4–6.8) for day 1–30. Filled antibiotic prescriptions were found for 4.5% of men (n = 187) after TP biopsy and 6.9% (n = 1,883) after TR biopsy. For antibiotic prescriptions, the rate ratios were 2.3 (1.8–2.9) for day 1–7 as well as day 1–14, and 1.6 (1.3–1.9) for day 1–30. Conclusions: A transrectal prostate biopsy was associated with a significantly higher risk of post-biopsy infectious complications compared to transperineal biopsy. These findings support the use of transperineal biopsy.
Copyright (c) 2026 Jesper Bonnedahl, Karl-Johan Lundström, Erik Lampa, David Robinson, Johan Stranne, Stefan Carlsson, Magnus Wagenius, Adam Linder, Joakim Örtegren, Anders Andreasson, Martin Holmbom, Pär Stattin, Johan Styrke https://creativecommons.org/licenses/by/4.0
Introduction of a modified surgical approach for ProACT balloon placement: a retrospective cohort study
Objective: To compare adjustable continence balloons (ProACT) implanted above the pelvic floor with or without subsequent placement of a third balloon (AP) with a modified technique placing balloons below the pelvic floor (BP). Materials and methods: We retrospectively compared 38 men who underwent the BP procedure and 38 men who received the AP technique. Primary outcome was continence (≤1 pad/day or <8 ml/24 h leakage). Secondary outcomes included operative time, complications, number of balloon filling visits, and satisfaction. Results: Median age was 75.5 years (BP) and 70.5 years (AP) (p < 0.0001). Groups were comparable in preoperative incontinence severity. Median surgical time was 15 min (BP) versus 20 min (AP) (p = 0.034). Early retention occurred in 18.4% (BP) versus 0% (AP) (p = 0.012). A third balloon was inserted in 39.4% of AP patients, and median number of fillings (6 vs. 10, p = 0.0006) was lower in BP group. Late complications consisting of migration, erosion, and balloon puncture were similar (23.7% BP vs. 36.8% AP, p = 0.32). Continence was achieved in 52.6% (BP) and 57.9% (AP) (p = 0.64), and satisfaction was reported by 71.1% (BP) and 57.9% (AP) (p = 0.34). On multivariate analyses, surgical method did not predict outcomes, and Cox regression shoved that BP was associated with a non-significant hazard of revision (HR: 1.60; 95% confidence interval [CI]: 0.53–4.85; p = 0.40). Conclusions: ProACT placement below the pelvic floor yielded similar continence but reduced operative time and postoperative visits, at the cost of more early retention.
Copyright (c) 2026 Jakob Klint Axelsen, Lars Boesen, Rasmus Bisbjerg, Nis Nørgaard, Helene Reif Andersen, Mikkel Fode https://creativecommons.org/licenses/by/4.0
Plasma and urine biomarker algorithm versus systematic biopsy for prostate cancer detection in elderly men: a randomised trial with early termination for futility
Objective: This study aimed to compare test sensitivity for detecting aggressive prostate cancer and test specificity (measured by reduction in prostate biopsies) between algorithm-triage and standard systematic biopsy in elderly men with suspected prostate cancer. Methods: This randomised controlled trial enrolled men ≥ 70 years old suspected of prostate cancer and randomised them 1:1 to algorithm-triage or standard systematic biopsies. The algorithm arm used a 10-gene mRNA panel from urine and plasma samples, integrated with clinical characteristics and PSA measurements to predict prostate cancer with International Society of Urological Pathology grade group ≥ 2. Patient-reported outcomes measures were collected using the Functional Assessment of Cancer Therapy-Prostate (FACT-P) scores or subdomains throughout a 24-month follow-up. ClinicalTrials.gov: NCT04079699. Results: A total of 202 men were included between October 2019 and September 2021. The study was terminated early due to algorithm underperformance. The algorithm-triage arm detected fewer indolent cancers (7.9% vs. 19%, absolute difference −10.9 percentage points, 95% confidence interval [CI]: −21.0 to −1.0 pp, P = 0.039) but also fewer clinically significant cancers (26% vs. 40%, absolute difference −13.9 percentage points, 95% CI: −27.6 to −0.1 pp, P = 0.051) compared to systematic biopsy. Patient-reported outcomes showed no significant between-group differences in FACT-P scores or subdomains throughout 24-month follow-up (differences 0.1–2.2 points, all P > 0.05), indicating comparable quality of life. Conclusion: The biomarker-based algorithm-triage reduced biopsy numbers but also detected fewer ­clinically significant prostate cancers. Quality of life was comparable between approaches.
Copyright (c) 2026 Torben Brøchner Pedersen, Charlotte Aaberg Poulsen, Martin Lund, Maher Albitar, Louise Dorner Østergaard, Søren Feddersen, Lars Lund, Mads Hvid Poulsen https://creativecommons.org/licenses/by/4.0
From recommendation to requirement: why multidisciplinary governance and centralization must become global standards in penile cancer care
Copyright (c) 2026 Matthias May, Christian Gilfrich, Ingmar Wolff, Steffen Lebentrau https://creativecommons.org/licenses/by/4.0
Consequences of different definitions of disease progression in observational studies of men with advanced prostate cancer
Introduction and objectives: Definitions of prostate specific antigen progression for men with prostate cancer on androgen deprivation therapy (ADT) are mainly derived from randomised trials, and their applicability to the clinical practice remains uncertain. This study aimed to assess how different PSA-based definitions of progressions while on ADT affect estimates of progression, treatment initiation, and outcomes in men with prostate cancer. Methods: Using data from the Prostate Cancer database of Sweden with extended treatments and endpoints data (PCBase Xtend), we identified 3718 men who initiated ADT between 2009 and 2022 and who had longitudinal PSA and treatment data. PSA progression was defined according to four modified guideline-based definitions ranging from the European Association of Urology (EAU) that has the most stringent criteria for progression to our previously used and less stringent definition (PCBase). We analysed cumulative incidence of PSA progression, treatment for castration resistant prostate cancer before and after PSA progression, and prostate cancer-specific mortality, accounting for competing risks. Results: ADT was prescribed as the primary treatment in 52% of included men. The number of men with PSA progression ranged by definition from 1047 men (28%, EAU) to 2378 men (64%, PCBase) at 10 years after initiation of ADT. Earlier progression was observed with less stringent criteria, with a difference in median time to progression of 3 months (PCBase vs EAU). Despite variation in incidence proportion of PSA progression, the proportion of men treated within 5 years after progression was similar (45–52%), as was prostate cancer-specific mortality (26–27%) across definitions. Conclusion: While definitions of PSA progression significantly impacted estimated incidence proportion of disease progression, they had limited influence on treatment initiation and long-term mortality. These findings suggest that in the clinical practice, decisions are guided by factors other than formal progression criteria. PSA-based definitions can be useful in observational studies if supported by sensitivity analyses.
Copyright (c) 2026 Eugenio Ventimiglia, Marcus Westerberg, Paolo Zaurito, Miranda Tiago Bonde, David Robinson, Rolf Gedeborg, Pär Stattin, Hans Garmo https://creativecommons.org/licenses/by/4.0
In pathological T2-prostate cancers a positive surgical margin is associated with adverse psychological outcomes
Objective: A positive surgical margin (PSM) after radical prostatectomy (RP) is considered an adverse surgical feature, but the clinical implications have been debated. Further motive to aim for negative margins (NSM) may be patient anxiety due to PSM, but studies on psychological consequences are lacking. We explored associations between psychological factors and PSM on a consecutive group of men after RP. Material and methods: Men with suspected prostate cancer were invited to a study on psychological factors. Patient reported outcome measurement questionnaires were collected before diagnosis, and at 6, 12 and 24 months from those who underwent RP. Multivariable mixed models and post hoc pairwise comparisons were used to explore associations between PSM and psychological outcomes. Results: In total, 387 men had RP and 94 (24%) had PSM. General psychological outcomes were not associated with margin status. At 12 months, men with PSM considered their personal risk of recurrence 6% (30% vs. 24%) points higher and had clinical fear of recurrence (FoR) 14% (47% vs. 33%) more often than men with NSM. In adjusted and stratified analyses, men with pathological (p-)T2-stage and NSM had less FoR than the rest of the sample. In pT3-disease, PSM had no additional impact on FoR. A limitation was the small size of the pT2 group with PSM and the lack of information on how patients were informed. Conclusions: After RP, PSM was associated with higher FoR, particularly in men with pT2-cancer. Improved counselling and further research into causes and mitigation of FoR, is warranted.
Copyright (c) 2026 Rasmus Nilsson, Tor Åge Myklebust, Thomas Næss-Andresen, Tomm Bernklev, Hege Kersten, Erik ­Skaaheim Haug https://creativecommons.org/licenses/by/4.0
Lower urinary tract symptoms in adults treated for vesico-ureteral reflux in childhood, compared to healthy controls
Objective: To compare lower urinary tract (LUT) symptoms in young adults with previous vesico-ureteral reflux (VUR) and healthy controls. VUR is associated with LUT dysfunction in childhood but less is known regarding long-term prognosis. Methods: A questionnaire was sent to 483 patients treated for VUR between 1993 and 2003 and a control group of 640 healthy young adults. Presence of LUT symptoms was compared by multivariable logistic regression, expressed as odds ratios (OR) and 95% confidence intervals (CI), adjusting for age, sex and body mass index. Results: The study group response rate was 45.8% versus 41.9% in the controls. There was a female predominance in both groups (77.9% and 74.3%). Overall, 45.7% of the VUR group and 36.6% of the controls reported current LUT symptoms, with unspecified LUT symptoms being significantly more common (OR = 3.86, 95% CI 1.33–11.20), especially in individuals receiving single treatment, and women without a pregnancy history. A larger proportion of those with VUR reported childhood incontinence than controls (20.4% vs. 5.6%, OR = 3.86, 95% CI 1.53–9.79). There were no significant differences in pyelonephritis during adulthood, yet individuals in the VUR group tended to have a higher micturition frequency than controls. Conclusion: Bladder dysfunction related to VUR during early childhood seems to improve with age, yet voiding difficulties and a higher micturition frequency appeared to remain more common in adults, predominantly females, with previous reflux than in healthy controls.
Copyright (c) 2026 Thora S. Olafsdottir, Sofia Tjernlund, Göran Läckgren, Nele Brusselaers, Tryggve Nevéus https://creativecommons.org/licenses/by/4.0
Copyright (c) 2026 Per-Uno Malmström, Eugen Y.H. Wang https://creativecommons.org/licenses/by/4.0
Long-term oncological outcomes of pelvic lymph node dissection during radical prostatectomy
Purpose: Lymph node dissection during radical prostatectomy (RP) remains under debate due to an unclear impact on oncological outcomes. Here, we investigate long-term oncological events after RP +/- pelvic lymph node dissection (PLND). Methods: All patients who had an RP from 2006 to 2021 (N=15,515) in the Danish Prostate Registry were included. Cumulative incidence of biochemical failure (BF), subsequent treatment, and prostate cancer-specific death by the Aalen Johansen estimator from the time of RP were compared for men without lymph nodes removed (pNx), without positive lymph nodes (pN0), and with lymph node invasion (pN1). Area under the curve (AUC) of the receiver operating characteristic was used to determine the added value of PLND for outcome discrimination. Results: The 15-year incidences of BF were pNx = 22% (95% confidence interval [95CI]: 20–23), pN0 = 37% (95CI: 35–39), and pN1 = 70% (95CI: 65–76). Fifteen-year incidences of subsequent treatment were 19% (95CI: 18–20), 31% (95CI: 29–33), and 84% (95CI: 79–89) for men with pNx, pN0, and pN1. Fifteen-year risk of prostate cancer-specific death was 2.1% (95CI: 1.6–2.6), 5.5% (95CI: 4.6–6.5), and 25% (95CI: 18–32) for men with pNx, pN0, and pN1. The AUC for the 10-year BF increased from 74% (95CI: 72–77) to 76% (95CI: 73–78) with the addition of pN0/pN1 in the model. The main limitation was the inability to differentiate the number of malignant nodes removed. Conclusion: Men with positive lymph nodes after PLND faced a high risk of BF, subsequent treatment, and prostate cancer-specific death. As the addition of PLND did not substantially improve the discriminative ability, the added benefit of PLND is likely limited. The side effects of PLND should be considered in relation to its possible advantages.
Copyright (c) 2026 Rikke Groth Olsen, William Birk Rich, Klaus Brasso, Andreas Røder, Lars Konge, Flemming Bjerrum, Hein Vincent Stroomberg https://creativecommons.org/licenses/by/4.0