Tsubouchi K, Arima H, Abe M, et al. Effect of pharmacotherapy for overactive bladder on the incidence of and factors related to urinary tract infection: a systematic review and meta-analysis. J Urol. 2023;209(4):665-674.

Special thanks to Drs Ahmad Hefnawy and Omer Acar at the University of Illinois at Chicago.

With about 50 million people affected worldwide, overactive bladder is a highly prevalent clinical condition. Its management generally follows a stepwise approach in which medications such as antimuscarinics and Beta 3 agonists play important roles. Urinary tract infections have not been particularly evaluated as an adverse effect of these medications. This study was performed to better understand the relationship between antimuscarinics, Beta 3 agonists, and the development of urinary tract infections.

This meta-analysis included 33 studies with more than 35,000 patients. It was found that antimuscarinics increased the primary end point of urinary tract infections with a relative risk of 1.23 compared to placebo and also increased the risk of secondary end points including urinary retention, dysuria, or increased residual urine volume with a relative risk of 2.88 compared to placebo. Beta 3 agonists did not significantly increase the risk of either end point.

This study highlights clinically relevant differences between classes of drugs that are commonly used in the management of overactive bladder. It does have some limitations such as the heterogenous patient populations among the included studies, lack of information regarding infection severity, and that there were no direct head-to-head comparison studies between antimuscarinics and Beta 3 agonists. Nevertheless, it provides valuable insights to take into consideration while planning pharmacotherapy in patients with overactive bladder.

Couture F, Hadj-Mimoune S, Michael S, Podasca TB, Noël-Lamy M, Richard PO. Evolution of Bosniak IIF renal cysts and impact of the 2019 Bosniak classification. J Urol. 2023;209(4):694-700.

Special thanks to Drs Jason Huang and Mahmoud Mima at the University of Illinois at Chicago.

Renal cysts are one of the most common radiographic “incidentalomas” encountered by the urologist. The 2019 revised Bosniak IIF classification system was meant to reduce overdiagnosis and decrease follow-up and treatment of benign cysts. But how has this updated classification affected cysts diagnosed based on the 2005 classification system?

The authors sought to answer that question with a retrospective study at their institution in Quebec. They evaluated imaging characteristics and medical charts of 181 patients with Bosniak IIF cysts diagnosed between 2000 and 2018. Applying the 2019 criteria, 76% of these would have been downgraded to Bosniak II cysts initially, and only 1 of these progressed to a Bosniak IV cyst, a rate of 2.2%. Of the true Bosniak IIF cysts, 3 progressed during the median follow-up period of approximately 4 years, a rate of 7.0% progression.

Although these are retrospective data on a relatively modest cohort, this study provides helpful data validating the modern Bosniak IIF classification. A low but significant number of cysts may progress, but active surveillance remains a safe management option for patients.

Benidir T, Austhof E, Ward RD, et al. Impact of prostate urethral lift device on prostate magnetic resonance image quality. J Urol. 2023;209(4):752-761.

Special thanks to Drs Andrew Lai and Simone Crivellaro at the University of Illinois at Chicago.

New technology and innovation have continued to allow us to offer minimally invasive options to treat our bread and butter urological conditions. This study cautions us for when 2 new technologies interact in practice. We have seen the rise of prostatic urethral lift devices to treat benign prostatic enlargement in patients wishing to reduce the risk of retrograde ejaculation, and we have also seen the rise of prostatic magnetic resonance images in the early workup for prostate cancer. These authors observed that the presence of the urethral lift clips negatively affects image quality of the prostate, particularly in the mid-basal transition zone. It also impacts the diffusion-weighted images in one-third of the images studied. While this case series was only derived from a single institution, we as urologists should counsel our patients on the possible impact of prostate cancer detection for patients considering a urethral lift procedure.