Abstract
Welcome to the September issue of the Journal of Clinical Urology (JCU). This comes after the special 80th BAUS anniversary issue, which was also printed for the BAUS 2025 annual meeting and had very good feedback. We have now more or less cleared the backlog of articles and will have more special issues planned for next year.
We are, of course, waiting for the BAUS endourology and oncology meetings which are under preparations at the time of writing this editorial.
This issue of JCU has a variety of articles on all aspects of urology. There is a systematic review on surgical versus medical castration in the treatment of metastatic prostate cancer. Fifteen studies on 63,682 participants show that surgical castration appears to be a safe, feasible and efficacious alternative to medical castration, with evidence to suggest a potential survival benefit and limited evidence of a financial benefit in the treatment of these men. Another paper looks at the implementation of a consultant-supervised triage process to avoid unnecessary multiparametric magnetic resonance imaging (mpMRI) or clinic appointments before a patient received a diagnosis or reassuring test.
There are a few endourology articles starting with transitioning from a mobile to an on-site extracorporeal shockwave lithotripsy service from Scotland, with data showing increased treatment capacity, a higher stone clearance rate and shorter waiting times with the latter, and overall, a better service and potential to cut costs in the long term. The second paper looks at the ‘Trifecta’ consisting of achieving stone-free rate, without postoperative complications and in a single surgical session. The authors conclude that miniaturisation of percutaneous nephrolithotomy (PCNL) tract was better in achieving trifecta, with mini and ultra-mini techniques. The trifecta rate calculated was slightly higher in the ultra-mini (65%), followed by the Mini-15Fr group (55%) and then standard PCNL (50%). The third paper is a retrospective study on investigating raised white cells, sepsis and antibiotic administration in obstructive urolithiasis. The authors conclude that leucocytosis alone is not a reliable marker of sepsis with obstructing ureteric stones. Septic patients are more likely to have severe diabetes with larger stones, and female patients with multiple calculi are more likely to re-present with sepsis. Finally, the last paper concludes that drainage of irrigation through the ureteral access sheath has an impact on the results of primary retrograde intrarenal surgery.
There are other papers covering different topics of interest. One of the papers looks at the role of embolisation in the management of giant renal angiomyolipomas (AMLs) and concludes that selective embolisation is an effective intervention for giant AMLs with comparable outcomes to nephron-sparing surgery and nephrectomy and should be considered a suitable management option for giant renal AMLs. The second paper looks at the current perioperative and surgical management of bladder paraganglioma and suggests a meticulous perioperative optimisation under the care of an experienced multidisciplinary team. There is also a randomised control trial with three arms, vardenafil, tamsulosin and combination for management of lower urinary tract symptoms secondary to benign prostatic hyperplasia (BPH), with data suggesting that the combination therapy is more effective in improving lower urinary tract symptoms (LUTS) than monotherapy. A retrospective study from the Scottish Renal Cancer Consortium analysed a large cohort of cT1a renal cancer patients and found a low risk of isolated metastases outside the abdomen. The authors suggest that in the absence of intra-abdominal metastases, computed tomography (CT) chest or pelvic imaging at diagnosis may be safely omitted, reducing radiation exposure and optimising resource use.
Two other interesting papers include the role of ChatGPT in sitting for the Fellowship of the Royal College of Surgeons (FRCS) Urology examination and whether artificial intelligence (AI) will get certified. ChatGPT scored 35% overall in Part 1 multiple choice questions (MCQs), and while its performance improved slightly in Part 2 Viva, its performance raised some concerns on answering questions with ChatGPT failing to pass the exams. The second paper looks at nurse-led urinary tract infection (UTI) service and concludes that a well-run, protocol-driven nurse-led UTI clinic provides consistent care to women with recurrent UTIs with more than 80% of patients successfully discharged at 6 months, reducing pressure on consultant clinics.
This issue has papers that will appeal to all urologists and covers a wide range of general day-to-day urology, and I hope you enjoy reading this. As always, I am grateful to BAUS office, SAGE, section editors and reviewers for making JCU a success.