Introduction: Botulinum neurotoxin A (BoNT-A) is a treatment option for neurogenic lower urinary tract dysfunctions (NLUTD) and idiopathic overactive bladder (OAB) in adults. Recently, its use has gained popularity in paediatric urology. Transitional urology deals with adolescents affected by congenital urological issues, who mature into adulthood. The aim of this systematic review was to update the current knowledge on the use of BoNT-A in children and adolescents. Methods: A comprehensive search in PubMed, Scopus, and Web of Science databases was performed from articles published up to September 2024. Both prospective and retrospective single-cohort or comparative studies evaluating outcomes of interest were included. These consisted of the amelioration of urinary incontinence (UI), continence rates, improvement of urodynamic parameters (maximum detrusor pressure during voiding, maximum bladder capacity, and bladder compliance), and type and prevalence of adverse/side effects. Qualitative and quantitative data syntheses were provided. Moderators and meta-regression analyses were carried out as well. Results: Forty-one full-text manuscripts were selected of which 26 focused on children with NLUTD, 13 on idiopathic OAB, and two on both conditions. Overall, 1521 patients were included of whom 715 were male, 646 female, and 160 of unknown sex. Mean age varied between 5.6 and 15.6 years. No studies specifically focused on transitional urology, despite patients up to at least 17 years of age being included. Several differences existed in design, type, dose, way of administration, outcomes measured and follow-up time; however, all studies independently showed an improvement of UI and urodynamic parameters with no major side/adverse events. Pooled analysis showed a mean rate of improvement in UI scores/episodes of 75.87% within a period of 3–6 months following BoNT-A treatment. Meta-regression analyses demonstrated a significant correlation between dryness rate and both patients’ age (negative) and bladder compliance (positive). Conclusions: Several uncontrolled or comparative studies provided significative evidence of the clinical benefit and safety of BoNT-A administration in children in terms of UI relief and improvement of urodynamic parameters, with neurogenic aetiologies being the most investigated conditions. A reduced bladder compliance was identified as one of the potential predictors of poor response to BoNT-A. Moreover, the earlier the treatment was started the higher the success rate that was reached in terms of dryness/urinary continence achievement.

Background and Objectives: We sought to investigate whether the 2012 Briganti nomogram may represent a potential prognostic factor of prostate cancer (PCa) progression after surgical treatment beyond European Association of Urology (EAU) risk categories. Materials and Methods: From January 2013 to December 2021, data on PCa patients treated with robot-assisted radical prostatectomy at a single tertiary referral center were extracted. The 2012 version of the Briganti nomogram assessing the risk of pelvic lymph node invasion was used. Here, the nomogram score was evaluated both as a continuous and a categorical variable. The association between variables and disease progression after surgery was evaluated through Cox regression models. Results: Overall, 1047 patients were identified. According to the EAU classification system, 297 (28.4%) patients were low-risk, 527 (50.3%) intermediate-risk, and 223 (21.3%) high-risk. The median (interquartile range) 2012 Briganti nomogram score within the investigated population was 3% (2–8%). Median (95% Confidence Interval [CI]) follow-up was 95 (91.9–112.4) months. Disease progression occurred in 237 (22.6%) patients, who were more likely to have an increasing 2012 Briganti nomogram score (Hazard Ratio [HR]: 1.03; 95%CI: 1.01–1.81; p = 0.015), independently of unfavorable issues at clinical presentation. Moreover, the nomogram score stratified according to tertiles (<3% vs. 3–8% vs. ≥8%) hold significance beyond EAU risk categories: accordingly, the risk of disease progression increased as the score increased from the first (reference) to the second (HR: 1.50; 95%CI: 1.67–3.72; p < 0.001) up to the third (HR: 3.26; 95%CI: 2.26–4.72; p < 0.001) tertile. Conclusions: Beyond EAU risk categories, the 2012 Briganti nomogram represented an independent predictor of PCa progression after surgery. Likewise, as the nomogram score increased so patients were more likely to experience disease progression. Accordingly, it may allow further stratification of patients within each risk category to modulate appropriate treatment paradigms.

Objectives To evaluate the index density (Id) of the percentage of biopsy positive cores (BPC), Id-BPC, as a prognostic factor of prostate cancer (PCa) progression after predicting unfavorable pathology in patients treated with robot-assisted radical prostatectomy (RARP) eventually associated with extended pelvic lymph node dissection. Design Data from 1047 patients undergoing RARP were collected between January 2013 and December 2021. Methods Id-BPC was defined as the ratio of BPC (%) to prostate volume (mL). Unfavorable pathology in the surgical specimen was defined as tumor grade group greater than 1 and/or non-organ confined disease. Disease progression was defined as biochemical recurrence and/or loco-regional recurrence and/or metastatic occurrence. Associations with the risk of unfavorable pathology and disease progression were evaluated by logistic regression and Cox proportional hazards model (univariate and multivariate analysis), respectively. Results Unfavorable pathology was detected in 930 (88.8%) cases. Disease progression occurred in 160 (15.3%) patients after a mean (95% CI) follow-up of 89.0 (86.6-91.3) months. After adjusting for all clinical variables, patients with higher Id-BCR were more likely to have unfavorable pathology in the surgical specimen (odds ratio = 1.566; 95% CI: 1.029 – 2.383; p < 0.001). As Id-BCR increased, patients were more likely to experience disease progression, even when adjusting for clinical variables (hazard ratio = 1.587; 95% CI: 1.306 – 1.929; p < 0.0001), as well as unfavorable pathology (hazard ratio = 1.365; 95% CI: 1.166 – 1.597; p < 0.0001). The impact of Id-BPC on PCa progression was stronger than that of BPC, particularly after predicting unfavorable pathology. Conclusions Id-BCR is an independent prognostic factor of unfavorable pathology and disease progression in PCa patients undergoing surgical treatment with curative intent. As Id-BPC increases, patients have a higher probability of experiencing unfavorable pathology in the surgical specimen and disease progression. Id-BCR is a clinical marker of PCa biology.

Background/Objectives: Prostate cancer (PCa) is prevalent among men over 70. Treatment may involve interventions like radical prostatectomy. The objective of this study was to investigate the combination of adverse pathology patterns on PCa progression through the Briganti 2012 nomogram and EAU risk classes in elderly patients treated with robotic surgery. Methods: A cohort of 1047 patients treated from January 2013 to December 2021 was categorized as being older if aged 70 or above. The adverse pathology risk scores were ranked from zero to three. These scores were then analyzed for correlations with the Briganti 2012 nomogram via EAU risk groups and for PCa progression. Results: Overall, older age was detected in 287 patients who had higher rates of adverse pathology features combined into a pattern risk score of 3. Within each age group, the adverse pathology risk score patterns were positively predicted by the Briganti 2012 nomogram across EAU prognostic groups. After a median (95% CI) follow-up period of 95 months, PCa progression occurred in 237 patients, of whom 68 were elderly and more likely to progress as adverse pathology patterns increased, particularly for a risk score of 3 (p < 0.0001), which was almost three times higher than that in younger patients (p < 0.0001). Conclusions: Managing PCa in elderly patients is challenging due to their increasing life expectancy. The Briganti 2012 nomogram effectively predicts disease progression in this population. Elderly prostate cancer patients have higher severe pathology rates predicted independently by the Briganti 2012 nomogram, with nearly triple the risk of progression compared to that in younger cases, necessitating tailored treatment approaches.