Introduction: VI-RADS (Vesical Imaging-Reporting and Data System) is a standardized scoring system developed to assess the likelihood of muscle-invasive bladder cancer (MIBC) using multiparametric magnetic resonance imaging (mpMRI). Our aim was to report our 3-year experience in using mpMRI to differentiate MIBC from non-muscle invasive bladder cancer (NMIBC). All radiological reports were generated using the VI-RADS score. Materials and methods: Patients with finding of ⩾15 mm suspicious bladder cancer at Ultrasound, CT scan or flexible cystoscopy underwent mpMRI before transurethral resection of bladder tumor (TURBT). We used a 5-point VI-RADS score, derived using T2-weighted MRI, diffusion-weighted imaging, and dynamic contrast enhancement. All examinations were performed on a 1.5 T scanner. In these 3 years images were analyzed by dedicated genitourinary radiologists and all TURBT were performed by expert urologists adhering to the European guidelines’ recommendations in order to strive for high-quality resections. Accuracy was determined using histopathology as the reference standard. Results: A total of 90 patients were analyzed, both primary and recurrent. Overall accuracy of the complete mpMRI protocol was 87% in differentiating NMIBC from MIBC. Better accuracy was achieved for ⩾25 mm (92%) and lateral wall sided (91%) lesions, while a lower one was recorded for dome tumors (86%). Hematuria, cytology, class of risks, focality and patients’ features did not impact on results. No differences were recorded for histological variants. Conclusions: mpMRI with VI-RADS showed good diagnostic performance in differentiating muscle-invasive from non-muscle-invasive bladder cancer in a real-world clinical setting. Further prospective studies with larger cohorts are warranted to confirm these findings.
Purpose: Using radical retropubic prostatectomy (RRP) specimens as the reference standard, we assessed whether PI-RADS 4–5 lesions in the transitional zone (TZ) and peripheral zone (PZ) differ in their association with clinically significant prostate cancer (csPCa), whether the composition of non-csPCa lesions differs by zone, and whether multiparametric MRI (mpMRI) lesion size predicts pathological upstaging. Materials and methods: Preoperative mpMRI data from 55 patients (108 lesions) undergoing RRP were retrospectively analyzed. A single experienced radiologist scored lesions using PI-RADS v2.1; each was correlated with the specimen by anatomical compartment. PI-RADS 4–5 lesions were classified as (A) csPCa (ISUP Grade Group ⩾ 2), (B) ISUP GG1, or (C) no neoplastic correlate within the corresponding compartment. Upstaging was defined as clinical T2a/T2b to surgical ⩾T2c, or clinical T2c to surgical ⩾T3a. Results: csPCa was identified in 25.9% (7/27) of TZ PI-RADS 4–5 lesions versus 70.0% (35/50) in the PZ ( p < 0.001). Maximum lesion diameter was larger in patients with upstaging (18.7 ± 7.6 vs 11.8 ± 2.8 mm; p = 0.0003); the AUC was 0.808 (95% CI 0.694–0.922) and the Youden-selected cut-off was ⩾13 mm (sensitivity 87.9%, specificity 61.9%, OR = 11.78). After adjustment for age and PSA, lesion size remained the only significant predictor (aOR = 1.294 per mm, p = 0.003), and the association persisted when the endpoint was restricted to extraprostatic extension (per 10 mm: OR = 4.96, 95% CI 1.90–16.92). Among non-csPCa lesions, 11 of 20 in the TZ had no neoplastic correlate versus 1 of 15 in the PZ ( p = 0.004). Conclusion: Larger mpMRI lesion size was associated with pathological upstaging, an association that persisted after adjustment and under a stricter endpoint; the ⩾13 mm threshold is exploratory pending external validation. Most TZ PI-RADS 4–5 lesions were non-csPCa, and lesions lacking a neoplastic correlate were more frequent in the TZ, although this comparison rested on a single such lesion in the PZ and is hypothesis-generating
Background: Robot-assisted radical cystectomy (RARC) is a growingly preferred minimally invasive technique for bladder extraction and urinary reconstruction. Postoperative urinary tract infections (UTIs) remain one of the most common complications. Objective: This narrative review examines the role of prophylactic antibiotics in reducing UTIs following RARC, with attention to risk factors, antimicrobial resistance patterns, and emerging non-antibiotic preventive strategies. Methodology: A literature search was conducted in PubMed, Scopus, Web of Science, and Google Scholar for English-language articles published between January 2014 and October 2025. Search terms included “urinary tract infection,” “radical cystectomy,” “antibiotic prophylaxis,” “drug resistance,” and “non-antibiotic strategies.” Clinical trials, meta analysis, and randomized controlled trials were prioritized. Key themes included UTI prevalence, bacterial resistance trends, prophylactic approaches, and the potential applicability of adjunctive non-antibiotic measures. Results: UTI incidence after RARC ranges from 14% to 39%, typically within 30 days but occasionally up to 90 days. Risk is influenced by patient factors such as age, female sex, and obesity, as well as surgical variables. Prophylactic antibiotics are associated with reduced UTI rates, though optimal duration remains uncertain. Evidence suggests short-course regimens are often effective, while extended prophylaxis may benefit selected high-risk patients. However, rising resistance, particularly to fluoroquinolones and cephalosporins, complicates empirical treatment. Conclusion: Prophylactic antibiotics after RARC reduce postoperative UTIs and related complications. However, conflicting RCT evidence and lack of consensus on duration require balancing benefits against risks of antimicrobial resistance and Clostridioides difficile infection. A comprehensive strategy—including culture-guided therapy, protocol adherence, and non-antibiotic preventive measures—may optimize outcomes.
Introduction and objectives: We conducted a prospective audit to evaluate the feasibility of suprapubic catheter self-removal and what factors can interfere with the decision of self-removal, in post RS-RARP patients. Material and methods: Forty-four patients had a SPC inserted following a RS-RARP from January 2024 until May 2024, 36 of them opted for self-removal. Feedback was obtained 4 weeks post operatively regarding catheter related symptoms and the complexity of self-removal procedure. Results: Most patients reported minimal overall pain (median = 2), with penile pain most frequently rated as none (mode = 1). Bladder cramps and overall problem perception were also low (median = 1); 65.9% of patients reported no bladder cramps, and 61.4% had no issues with SPC management. Factors such as overall pain ( p = 0.234), penile pain ( p = 0.286), and overall problem perception ( p = 0.643) did not significantly influence the decision of SPC self-removal. However, bladder cramp frequency had impacted the self-removal decision ( p = 0.029). The majority (80.6%) found self-removal easy, with only 11.1% considering it complicated. Most patients also recommended self-removal, reinforcing its overall feasibility. The perceived complexity of self-removal was associated with likelihood to recommend the procedure ( p < 0.001). Additionally, penile pain correlated with bladder cramps ( p = 0.006) and overall problem perception ( p = 0.003), suggesting discomfort in one area may reflect a broader negative experience affecting patients’ decision making regarding self-removal, as patients with higher bladder cramps were less likely to recommend self-removal ( p = 0.008). Conclusion: SPC self-removal after RS-RARP appeared feasible and acceptable in a selected group of patients supported by structured education and specialist nurse follow-up. These findings should be interpreted cautiously given the small single-center sample, absence of randomization, and use of a non-validated questionnaire. Further comparative studies are required before wider implementation can be recommended.
PURPOSE:Transgender individuals experience significant disparities in healthcare access and quality, often owing to limited provider training and awareness. This study aimed to assess the knowledge, attitudes, and clinical exposure of Mexican urologists and urology residents in relation to transgender patient care and to identify potential gaps that may affect treatment quality and access. METHODS:An anonymous survey was distributed to board-certified urologists and urology residents between April and May 2025. The questionnaire included a 5-point Likert scale to evaluate participants' knowledge, confidence, and comfort when treating transgender patients. The questions also assessed clinical experience, familiarity with gender identity and appropriate pronouns, ability to provide endocrine and surgical care, and awareness of healthcare disparities. A total of 322 responses were analyzed using descriptive statistics and t-tests to identify significant trends. RESULTS:Among the respondents, 53.7% had never attended to a transgender patient, and 71.1% were not currently caring for any. Only 15.5% reported a strong knowledge base in transgender health and only 7.4% felt confident in performing gender-affirming surgery. While 62.1% felt comfortable discussing gender identity, only 58.3% could clearly distinguish it from their sexual orientation. Urology residents reported greater comfort and awareness than certified urologists did. Less than half (48.4%) strongly supported transgender care in residency programs. CONCLUSION:There is a marked gap in transgender-related knowledge and clinical exposure between Mexican urologists and residents. These findings underscore the urgent need to integrate structured transgender health education into urological training and continuing medical education to promote equitable, competent, and inclusive care.
