European Urology[JOURNAL]

Brassetti A, Tuderti G, Anceschi U … +18 more , Bove AM, Bologna E, Capecchi L, Chiacchio G, D'annunzio S, Ferriero M, Flammia RS, Guaglianone S, Iuculano S, Denaro C, Luzio AD, Leonardo C, Licari LC, Mastroianni R, Misuraca L, Proietti F, Sperduti I, Simone G

Eur Urol · 2026 May · PMID 42135177 · Publisher ↗

BACKGROUND AND OBJECTIVE: The sutureless (SL) purely off-clamp robotic partial nephrectomy (ocRPN) technique has been proposed to minimize postoperative functional damage. We assessed whether this approach is noninferior... BACKGROUND AND OBJECTIVE: The sutureless (SL) purely off-clamp robotic partial nephrectomy (ocRPN) technique has been proposed to minimize postoperative functional damage. We assessed whether this approach is noninferior to renorrhaphy (RR) in terms of surgical quality. METHODS: Patients with cT1-2N0M0 renal tumors were randomly assigned to SL or RR-ocRPN within a single-center, single-surgeon randomized controlled trial (NCT06846112). A covariate-adaptive 1:1 randomization algorithm ensured balance between treatment arms for age, sex, baseline renal function, and tumor surgical complexity. The primary endpoint was Trifecta achievement at discharge. A prespecified noninferiority test (margin -10%) compared Trifecta rates using one-sided testing and confidence intervals. Secondary outcomes were descriptively analyzed and compared between study arms. Recurrence-free survival (RFS) was estimated using the Kaplan-Meier method. KEY FINDINGS AND LIMITATIONS: Among 248 patients, baseline characteristics were balanced. Trifecta was achieved in 93% and 95% of cases (absolute difference -2.4%; 90% confidence interval [CI] -7.4%-2.6%), meeting the criterion for noninferiority (one-sided p = 0.006). Blood transfusions (2.4% vs 0%) and acute kidney injury (1.6% in both groups) were rare. Nine urinary fistulae occurred overall, all managed with temporary stenting; rates were higher in the SL group but not statistically significant (p = 0.08). Renal function remained stable up to 12 mo, and 1-yr RFS was 99% in all cohorts. Limitations include single-center design, surgeon expertise, and short oncologic follow-up. CONCLUSIONS AND CLINICAL IMPLICATIONS: SL-ocRPN is safe and effective and represents a feasible alternative to RR-ocRPN in selected cT1-2N0M0 renal tumors.

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Letter to the Editor: Advanced and Metastatic Prostate Cancer: ESMO Clinical Practice Guideline for Diagnosis, Treatment, and Follow-up.

De Laere B, Mortezavi A, Eklund M … +2 more , Grönberg H, ProBio Investigators

Eur Urol · 2026 May · PMID 42135176 · Publisher ↗

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PSMA-PET Total Tumor Volume Response: Ready for Prime Time or a Work in Progress?

Osborne JR, Okobi TJ, Marulanda-Corzo V … +1 more , Tagawa ST

Eur Urol · 2026 May · PMID 42128754 · Publisher ↗

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IDH1 Mutations Are Associated with Favorable Outcomes in Prostate Cancer.

Cavka L, Nandakumar S, Wu Q … +23 more , Mehta NJ, Ozay ZI, Begum A, Kundra R, Shannon E, Nazari SS, Evans MG, Smith N, Elliott A, Samueli B, Fine SW, Chen JF, Kantoff PW, Velho PI, Wang H, Sanin DE, Van Allen EM, Agarwal N, Abida W, Lotan TL, Schultz N, Antonarakis ES, Sena LA

Eur Urol · 2026 May · PMID 42128753 · Full text

Prostate cancer with isocitrate dehydrogenase 1 (IDH1) or isocitrate dehydrogenase 2 (IDH2) mutation appears to be a unique molecular subclass, but its associated clinical features have not been previously described. Her... Prostate cancer with isocitrate dehydrogenase 1 (IDH1) or isocitrate dehydrogenase 2 (IDH2) mutation appears to be a unique molecular subclass, but its associated clinical features have not been previously described. Here, we performed a retrospective analysis of clinical and molecular features of prostate cancer with IDH1 p.R132 or IDH2 p.R172 mutations. A series of 99 IDH1-mutated and 12 IDH2-mutated cases was identified using genomics databases at multiple institutions. An IDH1/2 wild-type control cohort was generated with matched clinical features at diagnosis. IDH-mutated cases frequently presented with localized disease (91%), but exhibited high tumor stage (42% T3) and grade (54% grade group 5). Compared with matched controls, patients with IDH1 mutations exhibited longer overall survival (hazard ratio [HR], 0.16; 95% confidence interval [CI], 0.04-0.68; p = 0.01), metastasis-free survival (HR, 0.22; 95% CI, 0.09-0.58; p = 0.002), and progression-free survival on hormonal therapy (HR, 0.35; 95% CI, 0.16-0.76; p = 0.036). IDH1-mutant cases were enriched for concurrent activating mutations of FOXA1 and CTNNB1 and tended to lack TMPRSS2-ERG fusions, SPOP mutations, and RB1 alterations. IDH1 mutations were associated with global transcriptional repression and evidence of metabolic and epigenetic reprogramming. These results depict IDH-mutant prostate cancer as a subtype that can present with high tumor stage and grade, but is associated with favorable outcomes.

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Reply to Francesco Montorsi, Giuseppe Rosiello, and Giorgio Gandaglia's Letter to the Editor re: Antonio Franco, Francesco Ditonno, Celeste Manfredi, et al. Systematic Review and Pooled Analysis of Functional and Sexual Outcomes of Minimally Invasive Surgical Treatments for Benign Prostatic Obstruction. Eur Urol. In press. https://doi.org/10.1016/j.eururo.2025.09.004.

Franco A, Cindolo L, De Nunzio C

Eur Urol · 2026 May · PMID 42128752 · Publisher ↗

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Re: Kitamura et al. Active Surveillance Versus Intravesical Bacillus Calmette-Guérin for High-grade T1 Bladder Cancer with Negative Second Transurethral Resection (JCOG1019). Eur Urol 2026. In press. http://dx.doi.org/10.1016/j.eururo.2026.01.008.

Basourakos SP, Shoag J, Calaway A

Eur Urol · 2026 May · PMID 42128751 · Publisher ↗

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Expanding Bevacizumab-Erlotinib Therapy Through Fumarate Hydratase Deficiency Screening and Drug Target Pathway Analysis in Papillary Morphology Metastatic Renal Cell Carcinoma.

de Nicolás-Hernández J, Valdivia C, Arenas A … +3 more , Zaballos MA, Robledo M, Rodríguez-Antona C

Eur Urol · 2026 May · PMID 42128750 · Publisher ↗

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Management of Lymph Node-Positive Renal Cell Carcinoma: Updated Recommendations from the European Association of Urology Renal Cell Carcinoma Guidelines Panel.

Capitanio U, Zondervan P, Campi R … +17 more , Kuusk T, Klatte T, Abu-Ghanem Y, Bonn S, Breen DJ, Dabestani S, Hora M, Lund L, Marconi L, Palumbo C, Pignot G, Tran M, Woodward R, Suárez C, Powles T, Bedke J, Bex A

Eur Urol · 2026 May · PMID 42120219 · Publisher ↗

Lymph node-positive renal cell carcinoma is a heterogeneous condition. Patients with bulky or multiple nodal metastases often behave like those with metastatic disease and may benefit more from upfront systemic therapy t... Lymph node-positive renal cell carcinoma is a heterogeneous condition. Patients with bulky or multiple nodal metastases often behave like those with metastatic disease and may benefit more from upfront systemic therapy than from surgery alone.

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European Association of Urology Guidelines on Urethral Strictures: Summary of the 2026 Guidelines. Update in Recommendations for Endoluminal Management of Male Anterior Urethral Strictures.

Campos-Juanatey F, Barratt R, Chan G … +12 more , Dimitropoulos K, Esperto F, Greenwell TJ, Martins FE, Osman NI, Oszczudlowski M, Ploumidis A, Riechardt S, Verla W, Waterloos M, Bezuidenhout C, Lumen N

Eur Urol · 2026 May · PMID 42115120 · Publisher ↗

BACKGROUND AND OBJECTIVE: Endoluminal treatments are frequently used for male anterior urethral strictures (USs). We aim to summarize the current evidence assessing the clinical implications for each treatment. Details o... BACKGROUND AND OBJECTIVE: Endoluminal treatments are frequently used for male anterior urethral strictures (USs). We aim to summarize the current evidence assessing the clinical implications for each treatment. Details on epidemiology, diagnosis, open surgical management, and follow-up of US are beyond the scope of this paper, and we refer the reader to the full text Guidelines (Lumen et al., 2026) [1]. METHODS: New evidence was identified using a priori criteria. Selected literature was summarized, and recommendations were developed to prioritize clinically important decisions. KEY FINDINGS AND LIMITATIONS: Direct vision internal urethrotomy (DVIU) is safe, with success rates improving for shorter, untreated bulbar US. Short recurrences after urethroplasty could be managed using DVIU. Single dilatation offers outcomes similar to those of DVIU, with reduced complications if visually controlled. Self-dilatation, urethral stents, and local corticosteroids could prolong treatment intervals but risk US worsening. Drug-coated balloon dilatation is a promising second-line endoluminal option for bulbar US. CONCLUSIONS AND CLINICAL IMPLICATIONS: Endoluminal treatments for male anterior USs are safe, offering good long-term patency rates in selected situations. They are an alternative for patients aiming for a less invasive management but with low long-term success. Discussion of individual options and tailoring male anterior US treatment-including referring for urethroplasty when indicated-should be granted.

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Open Versus Robot-assisted Kidney Transplantation in Adults with End-stage Kidney Disease (ORAKTx): A Randomised Open-label Trial.

Ortved M, Dagnæs-Hansen J, Stroomberg HV … +7 more , Vejlstrup C, Ruhnau B, Kistorp T, Karas V, Rohrsted M, Sørensen SS, Røder A

Eur Urol · 2026 May · PMID 42106277 · Publisher ↗

BACKGROUND AND OBJECTIVE: We investigated whether robot-assisted kidney transplantation (KTx) could reduce short-term surgical complications compared to open KTx. METHODS: We conducted a randomised, parallel, open-label... BACKGROUND AND OBJECTIVE: We investigated whether robot-assisted kidney transplantation (KTx) could reduce short-term surgical complications compared to open KTx. METHODS: We conducted a randomised, parallel, open-label trial at the Copenhagen University Hospital - Rigshospitalet, Denmark. Adult patients with end-stage kidney disease and no contraindication to robotic surgery, scheduled to undergo living or deceased donor KTx, were randomly assigned to receive either open or robot-assisted surgery. Primary outcomes were the 30-d post-transplant rates of vascular and major surgical complications. All participants who underwent transplantation were analysed according to assigned intervention. KEY FINDINGS AND LIMITATIONS: A total of 54 participants were assigned to robot-assisted KTx and 53 were assigned to open KTx. Fifty-three participants in each arm underwent transplantation and completed follow-up. Major surgical complications occurred in 13 patients (25%) in the open arm and in seven patients (13%) in the robotic arm (risk difference: -11%, 95% confidence interval [CI]: -26 to 3.4, p = 0.2). Vascular complications occurred in 10 patients (19%) in the open arm and in five patients (9.4%) in the robotic arm (risk difference: -9.4%, 95% CI: -23 to 3.7, p = 0.3). Limitations include single-centre design, lack of blinding, and a modest sample size. CONCLUSIONS AND CLINICAL IMPLICATIONS: ORAKTx is the first randomised trial to compare robot-assisted KTx with open KTx surgery. Although the primary endpoint was not met, the observed reduction in complications suggests a potentially meaningful decrease in postoperative morbidity with robot-assisted surgery.

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10-yr Survival and Toxicity Outcomes of Stereotactic Body Radiotherapy for Prostate Cancer: A Nonrandomized Clinical Trial.

Meier RM, Aghdam N, Beckman AC … +5 more , Woodhouse SA, Williamson SK, Mohideen N, Dombrowski JJ, Kaplan ID

Eur Urol · 2026 May · PMID 42106276 · Publisher ↗

Stereotactic body radiotherapy (SBRT) is established as standard therapy for organ-confined prostate cancer (PC) based on 5-yr phase 2-3 outcomes, but 10-yr data are lacking. Here, we report 10-yr results of a trial cond... Stereotactic body radiotherapy (SBRT) is established as standard therapy for organ-confined prostate cancer (PC) based on 5-yr phase 2-3 outcomes, but 10-yr data are lacking. Here, we report 10-yr results of a trial conducted at 21 centers. Patients were treated from January 2008 to April 2010. SBRT was delivered on a noncoplanar robotic platform with real-time motion management, to a total dose of 40 Gy in five fractions. Adjuvant hormone therapy was not allowed. Late toxicities (>90 d) were assessed with Common Terminology Criteria for Adverse Events version 3 (CTCAE v3). Biochemical failure is defined as nadir+2. Relapses are defined as biochemical or clinical failure or salvage/systemic PC therapy. Out of 310 evaluable patients, median age 68 yr; 172 were low-risk (LR), and 138 patients were intermediate-risk (IR). Median follow-up was 9 yr. Ten-yr cumulative grade 3 gastrointestinal (GI) or genitourinary (GU) toxicities were 1.4% and 1.5% in the LR and IR cohorts, respectively. There were no grade 4-5 events observed. Ten year grade 2+ GI and GU toxicity rates were 2.1% and 14% respectively. Overall survival in 10 yr was 84%. Overall, relapse-free survival (RFS) was 90%; 94% in the LR cohort, 86% in the IR cohort, and 92% versus 77% in the favorable vs unfavorable intermediate subgroups. In this multi-institutional trial, the 10-yr follow-up demonstrates that prostate SBRT yields minimal toxicity and favorable RFS.

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European Urology[JOURNAL]

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