Nephrolithiasis is a global healthcare problem with a current lifetime risk of 18.8% in men and 9.4% in women. Given the high cost of medical treatments and surgical interventions as well as the morbidity related to symptomatic stone disease, medical prophylaxis for stone recurrence is an attractive approach. Thiazide diuretics have been the cornerstone of pharmacologic metaphylaxis for more than 40 years. However, evidence for benefits and harms of thiazides in the prevention of calcium containing kidney stones in general remains unclear. In addition, the efficacy of the currently employed low dose thiazide regimens to prevent stone recurrence is not known. The NOSTONE trial is an investigator-initiated 3-year prospective, multicenter, double-blind, placebo-controlled trial to assess the efficacy of standard and low dose hydrochlorothiazide treatment in the recurrence prevention of calcium containing kidney stones. We plan to include 416 adult (≥ 18 years) patients with recurrent (≥ 2 stone episodes in the last 10 years) calcium containing kidney stones (containing ≥50% of calcium oxalate, calcium phosphate or a mixture of both). Patients will be randomly allocated to 50 mg or 25 mg or 12.5 mg hydrochlorothiazide or placebo. The primary outcome will be incidence of stone recurrence (a composite of symptomatic or radiologic recurrence). Secondary outcomes will be individual components of the composite primary outcome, safety and tolerability of hydrochlorothiazide treatment, changes in urinary biochemistry elicited by hydrochlorothiazide treatment and impact of baseline disease severity, biochemical abnormalities and stone composition on treatment response. The NOSTONE study will provide long-sought information on the efficacy of hydrochlorothiazide in the recurrence prevention of calcium containing kidney stones. Strengths of the study include the randomized, double-blind and placebo-controlled design, the large amount of patients studied, the employment of high sensitivity and high specificity imaging and the exclusive public funding support. ClinicalTrials.gov, NCT03057431 . Registered on February 20 2017.

To evaluate hyperthermic intravesical chemotherapy (HIVEC) using conductive heating and epirubicin in an optimized setting as an alternative to radical cystectomy in patients with recurrent non-muscle invasive bladder cancer (NMIBC) who have failed bacillus Calmette-Guérin (BCG) therapy. We retrospectively analyzed our prospectively recorded database of patients who underwent HIVEC between 11/2017 and 11/2022 at two Swiss University Centers. Cox regression analysis was used for univariate/multivariate analysis, and the Kaplan–Meier method for survival analysis. Of the 39 patients with NMIBC recurrence after failed BCG therapy, 25 (64%) did not recur within the bladder after a median follow-up of 28 months. The 12- and 24-month intravesical RFS were 94.8% and 80%, respectively. Extravesical recurrence developed in 14/39 (36%) of patients. Only 7/39 (18%) patients had to undergo radical cystectomy. Seven patients (18%) progressed to metastatic disease, with five of these (71%) having previously developed extravesical disease. No adverse events > grade 2 occurred during HIVEC. Device-assisted HIVEC using epirubicin in an optimized setting achieved excellent RFS rates in this recurrent NMIBC population at highest risk for recurrence after previously failed intravesical BCG therapy. Extravesical disease during or after HIVEC, however, was frequent and associated with metastatic disease and consecutively poor outcomes.

Purpose: To provide a detailed description of the Swiss Society of Urology prospective database of radical cystectomy (RC) due to bladder cancer (BC) about differences in operative outcomes between teaching and non-teaching RC. Methods: We collected the data of all RCs for BC from the register from March 2017 to March 2025, leading to 1587 cases. Afterwards, we decided about the extraction of 34 variables, e.g. operating approach and intraoperative complications. Furthermore, we determined that only complete data sets for our pre-defined variables will be included in the analysis, which led to 1304 RC cases. Results: Median patient age was 72.0 years (IQR 64.0–78.0). The majority of patients underwent open RC ( n = 838; 64.3%). More than one quarter ( n = 344; 26.4%) were teaching surgeries and there was no significant difference between both groups regarding demographic characteristics. There were no significant differences between teaching and non-teaching operative results in terms of surgical resection (R1 status; p = 0.295), duration of inpatient treatment ( p = 0.394), infection ( p = 0.023), wound healing disorders ( p = 0.484), duration of surgery ( p = 0.365), intraoperative bleeding ( p = 0.635) and intraoperative blood loss ( p = 0.074). However, in terms of the number of resected lymph nodes, blood transfusion rate, number of transfused packed red blood cells, intraoperative complications as well as the highest grade of complication during inpatient treatment teaching RC showed less favorable results, e.g. number of evaluated lymph nodes (teaching median 18.0 versus non-teaching median 20.0, p < 0.001). Conclusion: Teaching RC is safe, for a high complex procedure, according to our prospective pilot study.