Urology

Local anaesthetic transperineal biopsy improves safety and significant cancer detection vs transrectal

This systematic review pooled 12 prospective studies including 8497 men undergoing local anaesthetic transperineal (LATP) or transrectal (TRUS) prostate biopsy. LATP significantly reduced infection risk (RR 0.68, 95% CI 0.56–0.84) and sepsis (RR 0.16, 95% CI 0.08–0.33) compared with TRUS. Urinary retention rates were similar, indicating no major trade-off in short-term obstructive complications. LATP modestly increased overall cancer detection (RR 1.07) and clinically significant cancer detection (Grade Group 2–5; RR 1.12) versus TRUS. 1

Targeted microwave ablation achieves 81% 12‑month in-field control in selected prostate cancer

The VIOLETTE phase II trial treated 76 men with a single MRI-visible ISUP Grade Group 2 lesion ≤15 mm using OBT-guided microwave ablation. At 12 months, 81% of evaluable patients were free of clinically significant cancer within the treated area. Fifteen men had clinically significant cancer at 12 months, including nine in-field recurrences, highlighting non-trivial local failure risk. Serious adverse events were rare, urinary function remained stable, but sexual and ejaculatory scores showed statistically significant declines. 2

JJ ureteric stent likely more cost-effective than nephrostomy for obstructive urolithiasis

In the STONE randomized trial of 204 patients, percutaneous nephrostomy (PCN) and JJ stent yielded similar recovery time and QALYs. Procedure costs favored PCN (€685 vs €792), but total societal costs were lower with JJ stenting (€7122 vs €8468). Higher societal costs with PCN were mainly driven by productivity loss and home care during the wait for definitive stone treatment. Cost-effectiveness analysis suggested a 0.74 probability that JJ stenting is preferable for both recovery time and QALYs at a €0 threshold. 3