Urology Evidence Evolution

5 evidence evolution narratives tracing how landmark trials and guideline updates reshaped urology practice.

Prostate Cancer Active Surveillance

Watching wisely

Treat-all → Epstein criteria → ProtecT (2016) → expanded → MRI-guided → Gleason reclassification

Beyond TURP

TURP gold standard → laser (HoLEP/PVP) → UroLift (LIFT) → Rezum → Aquablation (WATER)

Smaller instruments, better outcomes

Open → SWL → ureteroscopy → miniPCNL → size-based algorithms → metabolic prevention

New rungs on the ladder

Antimuscarinics only → mirabegron (SCORPIO/ARIES) → combination → SNM → PTNS → dementia risk

De-escalation works

RPLND for all stage I → surveillance → risk-adapted (MRC TE08) → carboplatin single (MRC TE19) → de-escalation