Background: Fluoroquinolone resistance is an issue of concern amongst physicians worldwide. In urology, fluoroquinolones are often used in the treatment of acute pyelonephritis and prostatitis, as well as infections caused by multidrug‐resistant pathogens.Aims: We aim to highlight the importance of antimicrobial stewardship and the need for ongoing biomedical research to discover novel agents in our losing battle against resistant pathogens.Materials and methods: In this review, we survey the literature and summarise fluoroquinolone resistance as it pertains to pyelonephritis and prostatitis, as well as alternative treatment strategies and prevention of multidrug resistance.Results: The rise of fluoroquinolone resistance in bacteria has reduced the available treatment options, often necessitating hospital admission for intravenous antibiotics, which places an additional burden on both patients and the healthcare system. Many countries such as Australia have attempted to limit fluoroquinolone resistance by imposing strict prescribing criteria, though these efforts have not been entirely successful. Solutions to overcome resistance include prevention, combination therapy and the development of novel antimicrobial agents.Conclusions: Prevention of the proliferation of resistant organisms by antimicrobial stewardship is paramount, and urologists are obliged to be aware of responsible prescribing practices such as referring to local guidelines when prescribing. By reserving fluoroquinolones for infections in which they are truly indicated and by prescribing based on both patient and local environmental factors, we can preserve this effective resource for future use.

Epigenetics is a growing field and in bladder cancer, it is of particular interest in advanced or metastatic disease. As opposed to genetic mutations in which the nucleotide sequence itself is altered, epigenetic alterations refer to changes to the genome that do not involve nucleotides. This is of great interest in cancer research because epigenetic alterations are reversible, making them a promising target for pharmacological agents. While chemoimmunotherapy is the mainstay for metastatic disease, there are few alternatives for patients who have progressed on first- or second-line treatment. By targeting reversible epigenetic alterations, novel epigenetic therapies are important potential treatment options for these patients. A search of clinical registries was performed in order to identify and collate epigenetic therapies currently in human trials. A literature search was also performed to identify therapies that are currently in preclinical stages, whether this be in vivo or in vitro models. Twenty-five clinical trials were identified that investigated the use of epigenetic inhibitors in patients with bladder cancer, often in combination with another agent, such as platinum-based chemotherapy or pembrolizumab. The main classes of epigenetic inhibitors studied include DNA-methyltransferase (DNMT) inhibitors, histone deacetylase (HDAC) inhibitors, and histone methyltransferase (HMT) inhibitors. At present, no phase 3 clinical trials have been registered. Few trials have published results, though DNMT inhibitors have shown the most promise thus far. Many patients with advanced or metastatic bladder cancer have limited treatment options, particularly when first- or second-line chemoimmunotherapy fails. Epigenetic alterations, which are common in bladder cancer, are potential targets for drug therapies, and these epigenetic agents are already in use for many cancers. While they have shown promise in pre-clinical trials for bladder cancer, more research is needed to assess their benefit in clinical settings.

Objective: To evaluate the safety, efficacy, tolerability, and cost‐effectiveness of bedside or office‐based ureteric stent insertion. Methods: Following Preferred Reporting Items for Systematic Reviews and Meta‐Analyses‐Protocols (PRISMA‐P) and A MeaSurement Tool to Assess systematic Reviews (AMSTAR) 2 guidelines, we searched PubMed/the Medical Literature Analysis and Retrieval System Online (MEDLINE), the Excerpta Medica dataBASE (EMBASE), Google Scholar, Cochrane Central Register of Controlled Trials (CENTRAL), and Dimensions for English‐language studies from 1978 to April 2023. Inclusion criteria focused on primary ureteric stent placements outside of the operating theatre (OT). Results: A total of 15 studies involving 2072 stents were included. Success rates for correctly positioned stents in bedside or office‐based insertions ranged from 60% to 95.8%, with most studies reporting ≥80% success rates. Common failure reasons included impacted stones and difficulty identifying the ureteric orifice. Pain and tolerability were assessed using various methods, with validated tools indicating moderate pain levels, but most patients would undergo the procedure again under local anaesthesia. Complication rates were generally low, with minor complications such as haematuria or postoperative fever being the most common. Procedural costs were significantly lower in non‐OT settings, with estimates indicating savings of up to four‐fold. Conclusion: Bedside or office‐based ureteric stent insertion is a viable alternative to OT procedures, offering high success rates, manageable pain levels, low complication rates, and substantial cost savings. This approach is particularly advantageous in settings with limited OT access, highlighting its potential for broader adoption in urological practice. Future research should focus on standardising pain assessment methods and randomised studies.

Background/Objectives: Renal colic poses a significant burden on patients and healthcare systems. Negative ureteroscopy in the setting of stented patients is reported at up to 14%, resulting in unnecessary surgeries and inefficiencies. While ureteral stents have demonstrated efficacy in relieving obstruction, their exact effect on spontaneous stone passage (SSP) is unclear. Hence, a systematic evaluation of the literature was performed to identify the impact of ureteral stents on spontaneous stone passage rates. Methods: A systematic search was conducted in MEDLINE, Embase, and PubMed (January 1989–February 2025) to identify studies investigating indwelling ureteric stents and SSP. Two independent reviewers screened the abstracts and full texts, with a third resolving conflicts. Quality assessment was conducted using The Risk Of Bias In Non-randomized Studies—of Interventions (ROBINS-I) and Cochrane Risk of Bias 2 (RoB-2) tools. Results: A total of 2437 patients in 14 studies investigating SSP in stented patients were included. One included study was a randomised controlled trial, but the rest were observational (n = 13). Three studies compared stented and control groups, whereas 11 studies only investigated patients with stents. Mean/median overall stone sizes ranged from 4.7 to 7.8 mm in diameter. Overall, SSP rates with stents varied significantly, ranging from 1.7 to 42.3%, in the setting of variable stone size, location, duration of follow-up, and method of stone passage detection. When comparing stented and non-stented patients, two studies demonstrated impaired SSP rates in stented patients (13.9% vs. 26.8% and 14% vs. 20%), but only one of these differences was statistically significant. Three studies comparing patients with retrograde ureteral stents and nephrostomies found increased SSP rates in nephrostomy cohorts (p < 0.001). Conclusions: Stone passage rates with stents vary widely due to heterogeneity in study design, patient characteristics, and follow-up. Some studies suggest that stents may impair passage; however, evidence remains inconclusive due to the limited availability of high-quality comparative data. This study underscores the need for larger prospective trials to clarify the actual impact of stenting on stone passage.