Evidence is something that many people get stressed about when approaching FRCS(Urol) Part 2. Trying to remember every key paper should not be your priority — as we have explained in the Part 2 Revision Guide, practising how to speak and articulate answers in a structured fashion is far more important.
That said, having a solid grasp of the landmark trials and key evidence across each station topic will help you deliver confident, well-supported answers. We have compiled this quick-reference guide of papers that we kept in mind prior to the exam.
This is not an exhaustive list — by all means build your own — but if you are comfortable with all of the evidence below, you will certainly be heading in the direction of an 8.
Randomised controlled trial demonstrating that a single postoperative dose of intravesical mitomycin C (MMC) reduces the risk of a bladder tumour within the first year following nephroureterectomy for UTUC. The absolute risk reduction was 11%, the relative risk reduction was 40%, and the number needed to treat (NNT) to prevent one bladder tumour was 9.
PubMed →Multicentre observational study examining the diagnostic pathway for UTUC. Key findings: patients undergoing diagnostic ureteroscopy (URS) took a median of 53 days longer to reach definitive surgery. Diagnostic URS lowered the risk of a T0 nephroureterectomy specimen by only 3.4% (8.6% without URS vs 5.2% with URS). Diagnostic URS more than doubled the risk of subsequent bladder recurrence (12% to 26%), irrespective of whether a biopsy was performed. In patients with suspected T2+ disease on imaging, diagnostic URS was an independent predictor of early metastatic disease.
PubMed →Multicentre, international prospective observational study of over 10,000 patients presenting with haematuria. The adjusted prevalence of bladder cancer was 25% and UTUC was 1%. Unadjusted rates: visible haematuria (VH) — bladder cancer ~22%, UTUC 1.5%; non-visible haematuria (NVH) — bladder cancer ~5%, UTUC 0.25%. Independent risk factors for malignancy included age, visible haematuria, male sex, and smoking history.
BJUI →PHOTO was a pragmatic RCT comparing photodynamic diagnosis (PDD) with white-light TURBT for intermediate- and high-risk bladder cancer. No benefit in recurrence-free survival was demonstrated. This contradicts earlier systematic reviews.
PubMed →The most recent Cochrane review of PDD-guided TURBT states low certainty that PDD may help reduce recurrence; however, PHOTO remains the only RCT.
Cochrane →Meta-analysis of approximately 8,000 patients demonstrating a 50% risk of residual/persistent disease and almost 10% risk of upstaging in T1 tumours at re-resection. Supports routine re-TURBT for high-grade T1 disease.
PubMed →Systematic review of approximately 2,000 patients examining single-dose intravesical MMC following TURBT. Demonstrated a decrease in 5-year recurrence rate from 59% to 44% (a 35% relative reduction). Notably, this benefit was not seen in patients with an EORTC recurrence score of 5 or more.
PubMed →Meta-analysis demonstrating an approximately 50% reduction in recurrence with BCG compared with TURBT alone for non-muscle-invasive bladder cancer.
PubMed →Meta-analysis showing a 30% reduction in recurrence with BCG compared to intravesical MMC, particularly with BCG maintenance therapy.
PubMed →Meta-analysis demonstrating a 30% reduction in progression with BCG maintenance therapy. Some conflicting evidence exists, including a Cochrane review questioning the magnitude of this benefit.
PubMed →Meta-analysis of BCG versus MMC for carcinoma in situ (CIS). Complete response was achieved in 50% with MMC versus 70% with BCG. Of those achieving complete response, approximately 50% may recur or progress. In BCG-refractory patients (disease present at 3 months), approximately 50% will achieve complete response with a further course of BCG.
PubMed →Ongoing trial programme evaluating TAR-200, an intravesical gemcitabine-releasing device. Early data in BCG-unresponsive patients who refused radical cystectomy showed complete response rates of approximately 80%. Results from multiple arms are awaited.
PubMed →Meta-analysis demonstrating a 5% absolute improvement in 5-year overall survival with neoadjuvant platinum-based chemotherapy prior to radical cystectomy for muscle-invasive bladder cancer.
PubMed →Randomised controlled trial comparing robot-assisted radical cystectomy (RARC) with open radical cystectomy (ORC). RARC was non-inferior to ORC for 2-year progression-free survival. Operative outcomes (blood loss, length of stay) favoured RARC.
PubMed →Randomised phase II trial comparing immediate versus deferred cytoreductive nephrectomy (CN) in metastatic RCC patients receiving sunitinib. Although underpowered, the deferred CN arm showed improved overall survival, suggesting that an initial period of systemic therapy can identify patients most likely to benefit from surgery.
PubMed →Non-inferiority RCT comparing sunitinib alone versus cytoreductive nephrectomy followed by sunitinib in intermediate- and poor-risk metastatic RCC. Sunitinib alone was non-inferior, challenging the role of cytoreductive nephrectomy as standard of care for all patients with metastatic disease.
PubMed →Phase III RCT of adjuvant pembrolizumab versus placebo following nephrectomy for clear-cell RCC at high risk of recurrence. Pembrolizumab significantly improved disease-free survival and overall survival, establishing adjuvant immunotherapy as a standard of care in this setting.
PubMed →RCT comparing partial versus radical nephrectomy for small (< 5 cm) renal tumours. No difference in overall or cancer-specific survival. Partial nephrectomy associated with nephron preservation but a higher complication rate. Supports nephron-sparing surgery for small renal masses.
PubMed →RCT examining the role of extended lymph node dissection at the time of radical nephrectomy. No survival benefit was demonstrated for routine lymph node dissection, although the study may have been underpowered for node-positive patients.
PubMed →American RCT of PSA + DRE screening annually versus standard care. No significant improvement in prostate cancer mortality at 10 years, but a 22% increase in diagnosis. Limited by relatively short follow-up and significant contamination of the control arm (approximately 50% had PSA testing).
PubMed →European randomised screening study using a PSA-based protocol. Demonstrated a significant reduction in prostate cancer mortality with lower contamination of the control arm. NNS of 570 and NNT of 18 overall; lower in the longer-followed Rotterdam section (NNI 246, NND 14). Limited by a pre-MRI era with sextant systematic biopsy. Subgroup data suggest that if PSA < 1, < 1% had a PSA > 3 at 4 years, with a cancer detection rate of ~1% at 8 years, supporting 8-yearly testing for those with PSA < 1 (though unproven).
PubMed →Population-based RCT showing similar results to ERSPC. Prostate cancer mortality was 0.67 of the non-screening group for men aged 55–59 at randomisation, representing a significant reduction.
PubMed →Classic framework for evaluating screening programmes. Ten criteria: (1) important health problem, (2) accepted treatment, (3) facilities for diagnosis and treatment, (4) recognisable latent stage, (5) suitable test, (6) test acceptable to population, (7) well-understood natural history, (8) agreed policy on whom to treat, (9) balanced cost of case-finding, diagnosis and treatment, (10) case-finding should be a continuing process.
PMC →Targeted PSA screening in BRCA1 and BRCA2 carriers. BRCA2 carriers had a higher incidence of clinically significant prostate cancer at a younger age, supporting earlier screening in this population.
PubMed →Retrospective analysis of stored blood samples from men under 50. PSA measured prior to age 50 was predictive of subsequent development of prostate cancer, supporting baseline PSA measurement for risk stratification.
PMC →Genetic screening study in approximately 6,000 men using common germline variants from saliva samples to generate a polygenic risk score. Of 745 high-risk participants (score in 90th percentile), MRI and biopsy found prostate cancer in 40%, of which half were intermediate or high risk. Many had low PSA and/or low PI-RADS scores, suggesting genetic screening may identify cancers missed by conventional pathways.
JCO →£42m prostate cancer screening trial co-funded by Prostate Cancer UK and NIHR, comparing bpMRI screening, PSA screening, genetic risk-based screening, and standard of care. Stage 1 will recruit 16,000 men; stage 2 up to 300,000 men. First men recruited in November 2025. The biggest prostate cancer screening trial in over two decades.
NIHR →Landmark study in biopsy-naïve men with clinical suspicion of prostate cancer (abnormal DRE or raised PSA). All men underwent mpMRI, TRUS biopsy, and transperineal (TP) template biopsy. On TP mapping, 70% had cancer and 50% was clinically significant. MRI had a sensitivity and NPV of approximately 90% for clinically significant disease. MRI could reduce unnecessary biopsies by approximately 25%. Limitations: TP biopsy performed before TRUS, no MRI-targeted biopsies, two radiologists per scan.
PubMed →RCT comparing MRI-targeted biopsy (with option to avoid biopsy if MRI negative) versus standard TRUS biopsy. MRI-targeted pathway detected 12% more clinically significant prostate cancer and 13% less clinically insignificant cancer.
PubMed →Prospective study where men underwent both systematic biopsy (with TRUS targets) and MRI-targeted biopsy. Similar detection rates from both approaches; best results achieved with combined systematic + targeted biopsy. Limited by performing systematic biopsy first.
PubMed →Prospective study evaluating MRI-targeted biopsy following systematic biopsy. Similar detection rates from both; fewer clinically insignificant cancers in the targeted group. Omitting systematic biopsy carried a 4% risk of missing clinically significant prostate cancer.
PubMed →Comparison of biparametric (bpMRI) versus multiparametric MRI (mpMRI) for prostate cancer detection. No difference in the proportion of scans scored PI-RADS ≥ 3. Dynamic contrast enhancement (DCE) identified approximately 6% more lesions, corresponding to an absolute improvement in clinically significant prostate cancer detection of only 0.4%. bpMRI was considered non-inferior.
UroToday →Landmark RCT randomising men to active monitoring, radical radiotherapy, or radical prostatectomy. At 15 years, overall survival was equivalent across all three arms. Metastases and clinical progression were lower in the treatment arms than in the active monitoring arm. However, 75% of men in the monitoring arm eventually received some form of treatment. Limitations: unfiltered cohort from the pre-MRI era; active monitoring protocol not representative of modern active surveillance.
PubMed →RCT randomising men to observation versus radical prostatectomy. At 10 years, no survival benefit was seen for men with low-risk disease (PSA < 10). In those with PSA > 10, radical prostatectomy appeared to improve survival, but the study was underpowered for this subgroup and the cohort was relatively elderly.
PMC →RCT examining adjuvant versus salvage radiotherapy after radical prostatectomy. No benefit to immediate adjuvant radiotherapy was demonstrated (progression defined as PSA > 0.4 or > 2.0 at any time). Potentially underpowered in the high-risk cohort, leaving open the argument for adjuvant radiotherapy in ISUP 4/5, pT3 with positive margins.
Lancet →Large adaptive platform trial comparing standard of care (SOC) with multiple interventions in men with newly diagnosed metastatic, node-positive, or high-risk node-negative prostate cancer. Key findings: (1) zoledronic acid and celecoxib — no benefit; (2) docetaxel — significant survival benefit; (3) abiraterone — significant survival benefit; (4) docetaxel vs abiraterone showed no significant difference; (5) radiotherapy to the prostate in M1 disease benefited only low-volume disease; (6) abiraterone + enzalutamide combination was not more effective; (7) abiraterone (2 years) + ADT + radiotherapy established as new standard for high-risk non-metastatic disease (T3–4, ISUP 4/5, PSA > 40, or N1).
STAMPEDE Publications →RCT demonstrating that adding docetaxel to ADT improved overall survival in men with metastatic hormone-sensitive prostate cancer (mHSPC), particularly those with high-volume disease (defined as visceral metastases or ≥ 4 bone lesions with ≥ 1 beyond the axial skeleton).
PubMed →RCT showing that ADT + radiotherapy + abiraterone improved progression-free survival and castration-resistance-free survival, but not overall survival, in men with low-volume mHSPC.
PubMed →Retrospective audit of 904 men undergoing radical orchidectomy for testicular cancer, assessing the safety of simultaneous testicular prosthesis insertion. The study demonstrated that concurrent prosthesis insertion is safe, with a low complication rate and no adverse effect on oncological outcomes.
BJUI →Multicentre trial evaluating chemo/radiation/surgery combinations for advanced penile cancer. Two arms: (1) neoadjuvant arm randomising intermediate-risk disease to surgery alone, neoadjuvant chemotherapy + surgery, or neoadjuvant chemoradiotherapy; (2) for those requiring inguinal lymph node dissection (ILND), adjuvant chemoradiotherapy ± PLND (without NAC) versus PLND and observation (for those who had NAC).
ClinicalTrials.gov →Phase II trial evaluating cemiplimab (PD-1 inhibitor; PD-L1 is upregulated in 40–60% of penile cancers) in combination with standard of care platinum-based chemotherapy followed by maintenance cemiplimab in locally advanced or metastatic penile carcinoma. Demonstrated safety and a 50% response rate with cemiplimab + cisplatin.
JCO →Phase II trial evaluating cemiplimab as first-line monotherapy in advanced penile carcinoma. Showed it is safe and a viable option in patients not suitable for cisplatin.
JCO →RCT comparing trimethoprim-sulfamethoxazole prophylaxis versus placebo for vesicoureteral reflux (VUR) in children. Antibiotic prophylaxis reduced recurrent UTIs (with greater effect in those with febrile infections and bladder-bowel dysfunction). However, it did not reduce renal scarring and did increase antibiotic resistance.
PubMed →Multicentre study comparing medical management versus ureteric reimplantation for VUR. Renal growth, UTI rates, and scarring rates were similar between groups. However, febrile UTIs were more common in the medical group (20% vs 10%).
PubMed →Classic observational study describing the natural history of preputial development. At age 6, 60% had preputial adhesions and 8% had phimosis, reducing to 3% and 1% respectively by age 16–17. Supports a conservative approach in childhood.
PubMed →Study demonstrating that approximately 50% of boys referred to secondary care for circumcision avoided surgical intervention with a course of topical clobetasol 0.05% cream.
PubMed →Multicentre study demonstrating no increased risk of testicular atrophy, reoperation, or anaesthetic complications with early orchidopexy (< 1 year of age). Supports early surgical intervention for undescended testes.
PubMed →Consensus statement: if an undescended testis (UDT) is still not in the scrotum after 3 months of age, the GP must refer for further advice. Boys should be assessed by a urologist by 6 months of age. Surgery is recommended between 6 and 18 months.
BAPU →Getting It Right First Time guidance on testicular torsion: emphasises awareness, minimising interhospital transfer, considering point-of-care ultrasound to reduce negative exploration, and appropriate follow-up after orchidopexy or orchidectomy.
GIRFT →Collaborative study examining the role of ultrasound in the assessment of acute scrotal presentations. Highlights the potential for ultrasound to delay surgical exploration and emphasises clinical decision-making in suspected torsion.
PubMed →Emergency urology relies heavily on consensus guidelines and best-practice statements rather than large randomised trials. The EAU Guidelines on Urological Trauma provide the most comprehensive evidence-based framework for managing urogenital injuries.
Multicentre observational trial of over 2,500 patients examining spontaneous stone passage rates. Overall passage rates: < 5 mm — 90%; 5–7 mm — 50%; > 7 mm — 30%. By location: lower ureter 90%/60%/50%; mid-ureter 80%/50%/40%; upper ureter 70%/30%/15%. Sepsis rate in conservatively managed stones was 0.6%. Inflammatory markers, hydronephrosis, and MET use were not significantly associated with passage. 20% were lost to follow-up.
PubMed →RCTs demonstrating that stone clearance from the lower pole is poor with ESWL, especially for stones > 10 mm. URS was more effective than ESWL; PCNL was the most effective (70% vs 45% SFR for URS, though not statistically significant). Now somewhat outdated in the context of modern flexible URS and miniaturised PCNL equipment.
PubMed (LP I) →UK RCT comparing placebo versus tamsulosin versus nifedipine for conservatively managed ureteric stones. No significant difference in stone passage between groups. However, the study may not have been powered to detect benefit in specific subgroups. A subsequent large RCT (Ye et al.) found benefit for distal stones > 5 mm, and a 2018 Cochrane review supported increased clearance with MET for larger stones (> 5 mm).
PubMed →RCT comparing flexible URS (FURS) versus ESWL for lower pole stones ≤ 10 mm. Complete stone clearance was significantly higher with FURS (72%) than ESWL (36%).
PubMed →Systematic review demonstrating that stone size is not reliable for predicting symptoms but does predict the risk of requiring intervention.
PubMed →Historic study reporting a 28% all-cause mortality rate in patients with untreated staghorn calculi. More contemporary series show disease-specific mortality of < 10% and a similar rate of renal failure or need for dialysis (~10%).
PubMed →RCT comparing ESWL versus URS for ureteric stones. ESWL was non-inferior, although there were issues with crossover from the intention-to-treat analysis, and patients whose stones passed spontaneously before treatment were excluded. EAU guidelines quote a 29% re-intervention rate for ESWL versus 12% for URS.
PubMed →The most widely studied UTI vaccine. Contains whole heat-inactivated bacteria (E. coli, Klebsiella pneumoniae, Enterococcus faecalis, Proteus vulgaris) administered as a daily sublingual spray. Observational and some randomised data suggest significant reduction in UTI recurrence.
PubMed →Multicentre RCT (Harding et al.) demonstrating that methenamine hippurate was non-inferior to daily low-dose antibiotics in preventing recurrent UTI in adult women. Supports methenamine as a non-antibiotic prophylaxis option.
PubMed →A Cochrane review showed no clear benefit, but subsequent meta-analyses have shown potential protective effects. No consensus on optimal dose or formulation.
PubMed →Cochrane review evaluating D-mannose for preventing or treating urinary tract infections in adults and children. Limited evidence; no definitive benefit demonstrated, although other systematic reviews and meta-analyses have shown some benefit from limited-quality evidence.
Cochrane →Evidence is less relevant in this station. See Potential Scenarios for Imaging & Technology for more information on what can be covered in this station.
Phase II trial demonstrating that combination solifenacin + mirabegron was superior to placebo or solifenacin alone for overactive bladder (OAB) symptoms.
PubMed →Two phase III RCTs in patients with neurogenic detrusor overactivity (NDO) due to MS or spinal cord injury. Patients were randomised to onabotulinumtoxinA 200 or 300 units versus placebo. No significant difference between 200 and 300 units. Both active doses showed significant improvement in urinary incontinence and quality of life versus placebo.
PubMed →RCT comparing onabotulinumtoxinA (200 units) versus sacral nerve stimulation (SNS) for refractory urgency urinary incontinence. Botox was slightly more effective and improved quality of life more than SNS. Intermittent self-catheterisation was required in 8% of the Botox group, with higher UTI rates. SNS required revision in 3% of patients.
PubMed →The American Spinal Injury Association (ASIA) Impairment Scale classifies spinal cord injuries from A (complete) to E (normal). Essential for understanding neurogenic bladder management.
ASIA →Comprehensive guideline for urological management of patients with spinal cord injury, covering initial assessment, investigation, and long-term management of the neuropathic bladder.
BJUI →World Health Organisation classification system for vesicovaginal fistulae, grading by size, location, and complexity. Used to guide surgical approach and predict outcomes.
WHO →RCT comparing Burch colposuspension (CS) with autologous fascial sling (AFS) for stress urinary incontinence. Higher success rates in the AFS group, but with increased morbidity (UTI, urge incontinence, voiding dysfunction). At 5 years, continence rates were 25% (CS) vs 30% (AFS), with satisfaction rates of 75% vs 85%.
PubMed →RCT comparing male sling versus artificial urinary sphincter (AUS) for post-prostatectomy incontinence. Similar overall continence rates, though AUS performed better in the severe incontinence subgroup. Higher patient satisfaction with AUS.
PubMed →BPH is often one of the most evidence-heavy topics given the rapidly evolving landscape of surgical interventions.
Landmark autopsy study describing the age-related prevalence of histological BPH. Prevalence increases with age, reaching approximately 50% by age 50 and over 80% by age 80.
PubMed →Community-based longitudinal study of urinary symptoms and flow rates in men. Demonstrated that LUTS increase with age and that there is significant overlap between BPH symptoms and other causes of LUTS.
PubMed →RCT comparing placebo, doxazosin, finasteride, and combination therapy for BPH. Combination therapy was significantly superior to either monotherapy for reducing clinical progression. Finasteride reduced the risk of acute urinary retention and need for surgery.
PubMed →Long-term RCT of finasteride versus placebo. Finasteride reduced the risk of acute urinary retention by 57% and the need for BPH-related surgery by 55% over 4 years. Placebo arm provides useful natural history data.
PubMed →RCT comparing dutasteride, tamsulosin, and combination therapy for BPH. Combination was superior to monotherapy for reducing symptoms, clinical progression, acute urinary retention, and BPH-related surgery. Unlike MTOPS, the placebo arm is not available for natural history data.
PubMed →Trial evaluating alfuzosin for acute urinary retention. Alfuzosin improved the rate of successful trial without catheter (TWOC).
PubMed →RCT comparing urodynamics-based management versus routine care before surgery for LUTS. Paper 1: adding urodynamics to clinical assessment did not improve symptom outcomes after surgery. Paper 2: urodynamics did change management in a significant proportion but did not lead to better outcomes.
PubMed →Multiple meta-analyses confirm monopolar TURP as a durable and effective standard for surgical management of BPH. Bipolar TURP shows comparable efficacy with a lower risk of TUR syndrome.
PubMed →Meta-analyses demonstrate that HoLEP is at least as effective as TURP with reduced blood loss, shorter catheterisation time, and lower retreatment rates, particularly for larger prostates. Considered the gold standard for enucleation.
PubMed →Pivotal RCT for the UroLift prostatic urethral lift system. Demonstrated significant improvement in LUTS with preservation of sexual function. Durability data show a retreatment rate of approximately 13% at 5 years.
PubMed →RCT of Rezum water vapour therapy for BPH. Demonstrated significant improvement in IPSS and quality of life with preservation of sexual function. Retreatment rate approximately 4–5% at 5 years.
PubMed →Multicentre RCT for the temporarily implanted nitinol device (iTIND) for BPH. Results outstanding/awaited.
NIHR →Series of RCTs evaluating aquablation (robot-assisted waterjet ablation) for BPH. WATER I (30–80 mL): non-inferior to TURP with improved ejaculatory outcomes. WATER II (80–150 mL): effective for large prostates. WATER III and OPEN WATER provide longer-term and expanded data.
PubMed →RCT comparing GreenLight photoselective vaporisation of the prostate (PVP) versus TURP. GreenLight was non-inferior to TURP at 2 years with shorter catheterisation time and hospital stay.
PubMed →Prospective UK registry of prostate artery embolisation (PAE). Showed symptom improvement but inferior to TURP in functional outcomes. Role as an alternative for those unfit for surgery.
PubMed →Two phase III RCTs evaluating collagenase Clostridium histolyticum (CCH) for Peyronie's disease. Patients treated with CCH experienced a mean reduction in penile curvature of 17.0 degrees (34%) compared to 9.3 degrees (18%) in the placebo group (p < 0.0001).
PubMed →Initial systematic review suggesting varicocele repair was not effective for subfertility. However, subsequent meta-analyses and RCTs have shown improved fertility rates following varicocele treatment. A 2021 Cochrane review found that microsurgical varicocelectomy probably improves pregnancy rates.
PubMed →ROBUST I: 5-year results for drug-coated balloon (Optilume) showing functional success of 60% (IPSS improvement > 50% without retreatment). ROBUST III (Optilume vs dilatation): repeat intervention required in 75% of dilatation patients versus 25% of Optilume patients.
PubMed →RCT comparing urethroplasty versus urethrotomy for urethral stricture. Both improved voiding symptoms. Urethroplasty was more durable with a 50% lower risk of re-intervention. Limited by only 2-year follow-up.
PubMed →Study showing no difference between dilatation and urethrotomy for stricture outcomes. Risk of recurrence increased with stricture length: 40% for < 2 cm, 50% for 2–4 cm, and 80% for > 4 cm. Supports primary urethroplasty for longer strictures.
PubMed →This guide is intended as a concise reference to help you recall the key evidence across the major FRCS(Urol) Part 2 station topics. It is not a comprehensive literature review, rather suggestions of key papers you can use to try and get your answers from a 6 or 7 to an 8.
The most important thing you can do in preparation for the exam is practise articulating your answers in a structured, fluent, and confident manner. Evidence is the icing on the cake, but should never be relied upon as a substitute for a solid answer that shows your clear clinical reasoning.
Where possible, try to understand the key messages and limitations of each trial, rather than memorising raw statistics. Examiners are far more impressed by a candidate who can critically appraise a paper and apply its findings to a clinical scenario than one who can recite numbers without context.
If you think we've missed out a critical paper that could help others, let us know and we'll get it added (support@urobank.co.uk).
We wish you the very best in your exam preparation and hope this guide proves useful. Good luck!
Want to read more about preparing for Part 2? Check out our Part 2 Revision Guide or our suggested practice scenarios.
Haven't passed Part 1 yet? Check out our Part 1 Revision Guide.
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