Large-scale databases have become an essential resource in urologic oncology, enabling the generation of real-world evidence across broad and diverse patient populations. This narrative review aims to summarize the contribution of population-based cancer registries, hospital-based clinical registries, and administrative healthcare databases to the understanding and management of prostate, bladder, renal, and other genitourinary malignancies. Over the past decade, large database studies have provided key insights into cancer epidemiology, treatment patterns, outcomes, and healthcare disparities. These data sources complement randomized clinical trials by capturing routine clinical practice at a population level. Major findings include shifts in cancer incidence and mortality, increased adoption of active surveillance in low-risk prostate cancer, and greater use of nephron-sparing approaches in renal cell carcinoma. In addition, large-scale analyses have highlighted disparities related to patient demographics, institutional volume, and access to care. They have also contributed to evaluating the real-world effectiveness and safety of established therapies, particularly in populations often underrepresented in clinical trials. Despite their strengths—particularly large sample sizes and enhanced generalizability—big data studies remain subject to important limitations, including residual confounding, coding variability, and limited availability of granular clinical and biological information. When interpreted with appropriate methodological rigor, these observational data provide valuable evidence to support clinical decision-making, inform guideline development, and identify gaps in care. Continued improvements in data quality, analytical methods, and integration with emerging technologies are expected to further strengthen the role of real-world data in advancing urologic oncology.

Objective:The aim of this study was to evaluate the diagnostic yield and downstream clinical impact of routine preoperative chest CT in patients undergoing partial nephrectomy (PN) for localized renal cell carcinoma. Methods:We conducted a retrospective multicentre study using data from the French Urological Cancer Comprehensive Cohort (UroCCR) registry. Adult patients who underwent PN for localized renal masses between 2010 and 2024 and had preoperative chest CT within 30 days before surgery were included. The primary endpoint was the detection rate of synchronous pulmonary metastases. Secondary endpoints included characteristics of metachronous metastases and diagnostic or scheduling consequences of preoperative imaging. Results:Among 7351 patients, 6679 underwent surgery and 5016 had a preoperative chest CT. Of these, 4483 (89.4%) had clinical T1 tumours. Synchronous pulmonary metastases were identified in only 17 patients (0.38%), all with larger or higher grade tumours. These patients had significantly higher rates of positive surgical margins (17.6% vs. 6.1%, p = 0.04), but no significant difference in age, sex or comorbidity profile. Among 6075 patients with postoperative follow-up, 191 (3.14%) developed metachronous pulmonary metastases. Of these, 14 (7.3%) had a previously negative preoperative CT, with a median time to progression of 52.6 months. Importantly, 166 (3.7%) patients underwent additional, ultimately non-contributive thoracic investigations, and 2.1% experienced surgical delays due to incidental or equivocal CT findings. Conclusions:The diagnostic yield of routine preoperative chest CT in patients with clinical T1 RCC is exceedingly low (<0.5%). These data support the omission of routine chest CT in asymptomatic, low-risk cT1 RCC, potentially sparing over 95% of patients from unnecessary imaging, additional tests and surgical delays. A risk-adapted, symptom-guided strategy may optimize patient care while reducing radiation exposure and healthcare costs.

INTRODUCTION:Urinary tract infection (UTI) is an infrequent complication of diagnostic cystoscopy, with an incidence below 5%. Current guidelines are unclear and remain silent regarding the necessity of performing a urine bacterial culture (UBC) before cystoscopy. The objective of this study was to evaluate whether asymptomatic bacteriuria before cystoscopy increases the risk of UTI afterward. In addition, we aimed to identify risk factors in patient characteristics. PATIENTS AND METHODS:We included all patients who underwent diagnostic cystoscopy at our center between September 2022 and May 2023 and performed a UBC within the preceding 15 days. Patients were excluded if they had received antibiotic treatment or did not provide UBC. Data on the UTI within four weeks post-cystoscopy were collected via telephone interviews. UTIs were defined on the clinical criteria established by the U.S. Centers for Disease Control and Prevention. RESULTS:Six hundred eighteen cystoscopies were analyzed. Twenty-nine cases of UTI were reported, accounting for 4.7% of the procedures. Among these, 24 patients had sterile or polymicrobial UBC, whereas 5 had asymptomatic bacteriuria prior to cystoscopy. There was no significant association between asymptomatic bacteriuria and the occurrence of UTI (OR: 1.385, 95% confidence interval [0.513; 3.739], p = 0.52). In multivariable analysis, age was a protective factor (p = 0.01). There was an increase of UTI when the cystoscopy was performed for a suspected tumor (OR: 4.981, 95% confidence interval [1.122; 22.108], p = 0.035) or for a retention (OR: 7.910, 95% confidence interval [1.329; 47.093], p = 0.023). More UTIs occurred when cystoscopy was performed for suspected tumors (p = 0.035) or urinary retention (p = 0.023). There was a significant correlation between asymptomatic bacteriuria and consultation for urinary symptoms after (p = 0.043). CONCLUSION:We found no correlation between asymptomatic bacteriuria prior to cystoscopy and the subsequent occurrence of UTI. Routine UBC before cystoscopy appears unnecessary. Eliminating this practice could prevent the rescheduling of cystoscopies, which often leads to diagnostic delays. Moreover, it would contribute to reducing antibiotic consumption and combating antibiotic resistance.

To describe the clinical and tumor characteristics of bladder leiomyoma (BL) and to explore potential etiological factors and prognostic factors to guide management strategies. Patients with histologically confirmed BL treated at 14 hospitals between 1995 and 2025 were included. Associations between tumor characteristics, symptoms, management, and outcomes were evaluated using appropriate statistical tests and logistic regression. A p-value < 0.05 was considered significant. Among 74 patients (55.4

PURPOSE:Radical nephrectomy (RN) remains the standard treatment for cT2 renal cell carcinoma (RCC), but partial nephrectomy has emerged as a viable alternative with the development of robot-assisted approaches. However, robust comparative data between robot-assisted partial nephrectomy (RAPN) and RN for large renal tumors remain limited. MATERIALS AND METHODS:We conducted a multicenter retrospective study using prospectively collected data from the UroCCR network (NCT03293563). Patients undergoing RAPN or minimally invasive RN for cT2M0 RCC were matched 1:1 using propensity scores based on clinical and tumor characteristics. Primary outcome was 5-year disease-free survival. Secondary end points included overall survival, renal function, perioperative outcomes, complications, and trifecta achievement. RESULTS:Of 847 patients included, 250 RAPN and 250 RN were matched. The median tumor size was 8.2 cm in the RN group and 8 cm in the RAPN group. Oncologic outcomes were comparable: 5-year disease-free survival was 61% and 49% (P = .2), cancer-specific survival was 87% and 94% (P = .8), metastasis-free survival was 71% and 66% (P = .4), and overall survival was 80% and 80% (P = .5), for RAPN and RN, respectively. RAPN was associated with improved renal function preservation (median change in estimated glomerular filtration rate at 5 years: -15 vs -23 mL/min/1.73 m2), fewer chronic kidney disease stage migrations, and reduced acute kidney injury. Major complications were more frequent after RAPN (6% vs 2%, P = .04). The trifecta outcome was achieved in 46% of RAPN cases. CONCLUSIONS:RAPN is a safe and functionally superior alternative to RN for selected patients with cT2 RCC. While associated with higher perioperative morbidity, these risks are acceptable in expert centers and offset by long-term nephron-sparing benefits.

OBJECTIVES:Uretero-enteric strictures are feared complications following cystectomy. Despite surgical advancements, particularly the rise of robot-assisted approaches, the risk factors associated with these strictures remain poorly defined. This study aimed to identify the risk factors associated with uretero-enteric anastomotic strictures after cystectomy, according to the surgical approach and type of urinary diversion (extracorporeal vs. intracorporeal). METHODS:We conducted a single-center retrospective study including 340 patients who underwent cystectomy between 2016 and 2024 at Tours University Hospital. Clinical, biological, perioperative, and postoperative data were analyzed. The occurrence of a uretero-ileal anastomotic stricture was defined radiologically by a uretero-hydronephrosis ≥20 mm. We constructed and analyzed a learning curve for robotic surgery with intracorporeal urinary diversion. RESULTS:Strictures occurred in 60 patients (17.6%). On multivariable analysis, reduced preoperative glomerular filtration rate (odds ratio [OR] = 1.45 per 10 mL/min decrease, 95% CI [1.12-1.87], p = 0.004), elevated creatinine (OR = 1.30 per 10 µmol/L increase, 95% CI [1.05-1.61], p = 0.018), prior myocardial infarction (OR = 2.25, 95% CI [1.10-4.62], p = 0.027), and postoperative urinary tract infection (OR = 3.10, 95% CI [1.65-5.82], p < 0.001) were independent predictors. Most strictures were left-sided. Intracorporeal robotic diversion had a higher, though non-significant, stricture rate (21.5% vs. 15.2%, OR = 1.52, p = 0.12). Stricture rates fell markedly after 20 robotic cases per surgeon (23.8% vs. 12.1%). CONCLUSION:Uretero-enteric strictures are multifactorial, strongly influenced by baseline renal function, cardiovascular comorbidity, and postoperative infection. Robotic intracorporeal diversion shows a learning curve effect, underlining the importance of surgical expertise and infection prevention in reducing risk.

Bladder cancer remains a prevalent malignancy worldwide, with increasing attention directed toward environmental determinants-particularly those related to water. This review examines the dual role of water, acting both as a vehicle for carcinogenic contaminants and as a protective factor through adequate hydration in the pathogenesis of bladder cancer. A comprehensive synthesis of epidemiologic studies was performed, focusing on major water-related exposures, including arsenic, disinfection by-products (DBP), nitrates, per- and polyfluoroalkyl substances (PFAS), and total fluid intake. The findings were evaluated in terms of the strength of association, biological plausibility, and public health relevance. Arsenic and DBPs have been consistently linked to an increased risk of bladder cancer, supported by robust evidence from case-control and cohort studies conducted across diverse geographic regions. In contrast, associations with nitrate and PFAS exposures remain less consistent and warrant further investigation. Conversely, higher water consumption seems to confer a protective effect, likely through dilution of urinary carcinogens and increased voiding frequency. Drinking-water quality and consumption behaviors represent modifiable determinants of bladder cancer risk. Regulatory measures targeting established contaminants, together with behavioral strategies promoting adequate hydration, could substantially contribute to prevention efforts. Continued research is essential to clarify the role of emerging exposures and to inform evidence-based global water safety policies.

BACKGROUND:Intravesical mitomycin C (MMC) is widely used after transurethral resection of bladder tumor (TURBT) and as adjuvant therapy for non-muscle-invasive bladder cancer (NMIBC). Despite its favorable safety profile, many institutions continue to require systematic urine culture before each instillation, although supporting evidence is limited. OBJECTIVE:To evaluate the clinical utility of routine urine culture before intravesical MMC instillation and to assess its association with post-instillation urinary infectious complications. METHODS:We conducted a retrospective instillation-based analysis of all intravesical MMC instillations performed at our institution between June 2022 and June 2025. A total of 720 consecutive instillations performed in 78 patients were analyzed. Pre-instillation urine cultures were systematically obtained and classified as negative, polymicrobial, single-organism cultures, or two-organism cultures. The primary outcome was the occurrence of post-instillation urinary infectious complications within 30 days, defined as febrile urinary tract infection, hospitalization for urinary infection, or sepsis, bacteremia. RESULTS:Among 720 MMC instillations, 639 (88.8%) pre-instillation urine cultures were negative and 81 (11.2%) were non-negative (47 polymicrobial, 26 single-organism cultures, 8 two-organism cultures). Three urinary infectious complications (0.4%) were observed, all occurring in patients with negative pre-instillation urine cultures. No urinary infectious complications occurred in patients with positive urine cultures. CONCLUSION:In this retrospective cohort, routine pre-instillation urine culture appeared to have limited clinical utility for predicting subsequent urinary infectious complications. Although these findings support a symptom-based approach in asymptomatic patients, larger prospective studies are needed before definitive recommendations can be made. LEVEL OF EVIDENCE: 4:

MRI-guided prostate biopsies offering improved accuracy in detecting clinically significant cancer. Image fusion (IF) techniques have shown promise, but their adoption requires overcoming a learning curve. This study evaluates the impact of operator experience on prostate biopsy outcomes using the HITACHI ultrasound system. This study was conducted from September 2016 to March 2020, including 148 patients undergoing mpMRI and targeted biopsies. The patients were grouped into Early (first 50 cases), Intermediate (cases 51–100), and Late (cases 101–148) phases, based on operator experience. Biopsy outcomes, including cancer detection rates, procedure times, and false-negative rates, were analyzed across these phases. A significant learning curve was observed. In the Early phase, the detection rate for clinically significant cancers was 12

BACKGROUND:The COVID-19 pandemic disrupted healthcare systems globally, raising concerns about delayed cancer diagnosis and treatment. In France, transurethral resection of bladder tumors (TURBT) was prioritized in national urology guidelines to ensure the timely management of urothelial carcinoma. This study aimed to assess the impact of care reorganization on tumor staging, recurrence, palliative care, and mortality in bladder cancer patients from the pre-pandemic through late-pandemic periods. METHODS:We conducted a retrospective multicenter study including all patients who underwent TURBT with histologically confirmed urothelial carcinoma between April and December of 2019 (pre-pandemic), 2020 (early pandemic), 2021 (mid-pandemic), and 2022 (late pandemic) in two French institutions. TURBT indications were categorized as diagnostic, palliative, or staging. Clinical and pathological data were compared across the four periods. Statistical analyses included Chi-square tests, Estimated Annual Percentage Change (EAPC), and multivariable logistic regression adjusted for age, sex, ASA score, and center. RESULTS:A total of 790 TURBT procedures were analyzed. The proportion of muscle-invasive bladder cancer (pT ≥ 2) declined over time (18.7% in 2019 to 13.2% in 2022; p = 0.63), while superficial tumors (pTa) increased (57.2% to 65.5%). All-cause mortality significantly decreased from 38.0% in 2019 to 22.0% in 2020, 20.5% in 2021, and 19.5% in 2022 (p = 0.006). EAPC showed a significant annual decline in mortality (-24.3%, p = 0.004). In multivariable analysis, 2020, 2021, and 2022 were each associated with significantly lower odds of mortality compared to 2019. Recurrence rates remained stable across all periods (p = 0.93). Inter-hospital variation persisted in mortality and recurrence. CONCLUSIONS:Despite the pandemic, urothelial bladder cancer outcomes did not worsen through 2022. On the contrary, timely reorganization, prioritization of TURBT, and triage strategies were associated with reduced mortality and palliative care needs, highlighting the resilience of cancer care when guided by adaptive health policies.

BACKGROUND:Bladder cancer remains a significant global health concern, with immunotherapies such as Bacillus Calmette-Guérin (BCG) and immune checkpoint inhibitors (ICIs) playing pivotal roles in treatment. Emerging evidence suggests that the microbiome, encompassing both gut and urinary tract microorganisms, may influence the efficacy and outcomes of these immunotherapies. OBJECTIVE:This review aims to explore the intricate relationship between the microbiome and immunotherapy in bladder cancer, highlighting current research findings, potential mechanisms, and future therapeutic implications. METHODS:A comprehensive literature search was conducted across databases including PubMed and Scopus, focusing on studies published up to March 2025. Keywords utilized encompassed "bladder cancer", "microbiome", "immunotherapy", "BCG therapy", and "immune checkpoint inhibitors". RESULTS:The analysis indicates that specific microbial compositions are associated with varied responses to bladder cancer immunotherapies. Notably, certain gut microbiota profiles correlate with enhanced ICI efficacy, while alterations in the urinary microbiome may impact BCG treatment outcomes. Potential mechanisms involve microbial modulation of systemic and local immune responses, influencing tumor microenvironments and therapeutic effectiveness. CONCLUSION:Understanding the microbiome's role in bladder cancer immunotherapy presents a promising avenue for optimizing treatment strategies. Further research is imperative to elucidate these relationships and translate findings into clinical practice, potentially leading to microbiome-targeted interventions to improve patient outcomes.

Bladder cancer is uncommon in individuals under the age of 45, and its clinical and molecular characteristics in this population differ significantly from those observed in older patients. This systematic review aims to evaluate recurrence, progression, survival outcomes, and molecular profiles of bladder cancer in young adults. A systematic search was conducted in MEDLINE, Embase, Scopus, and CENTRAL databases for studies published between 1998 and 2024. Eligible studies included patients aged ≤ 40 years and reported outcomes such as recurrence-free survival (RFS), progression, and overall survival (OS). A total of 18 studies were included. Risk of bias was assessed using the ROBINS-I tool, and pooled estimates were calculated using random-effects meta-analysis models. Bladder cancer in young adults is predominantly non-muscle-invasive and low-grade, with high survival rates. Recurrence rates varied across studies, ranging from 0 to 35.9

To determine the value (measured by the number of post operative infections) of UC (urine culture positive or sterile) and antibiotic prophylaxis performed before partial nephrectomy (PN) for cancer to decrease the postoperative risk of infection. This study included a prospective cohort of patients who underwent PN for cancer between 2011 and 2023. Multivariate logistic regression was performed to investigate risk factors associated with the occurrence of postoperative infection episodes. Post operative infections were defined accordingly to the CDC (Center for disease control and prevention) definition (fever > 38°5 C that required antibiotics, superficial/deep wound infection requiring medical or surgical intervention, or urinary infection treated by antibiotics during the month after surgery). A propensity score was calculated. A logistic regression model weighted by the propensity score was defined. Preoperative UC was performed for 491 of the 702 patients (69.9

Objectives: There are no unanimous recommendations between urology societies regarding the performance of a urine culture before Bacillus Calmette-Guérin (BCG) instillations. The management of a positive urine culture before each instillation depends on the choice of the urologist. The objective of our study was to collect urine cultures performed before instillations and to study their impact on the risk of associated urinary tract infection (UTI) and on the risk of recurrence of bladder tumors. Patients and Methods: A retrospective analysis of induction BCG files (six instillations per cycle) associated or not with maintenance BCG (three instillations per cycle) was performed between January 2022 and January 2023. A urine culture was systematically carried out a few days before each instillation. In the event of a positive urine culture, the choice of treatment depended on the referring urologist. Demographic data, tumor characteristics, risk factors for UTI, and bacteriological data (date of urine culture, leukocyturia, hematuria, polymicrobial, sterile, and antibiotic therapy given) were collected. Results: Eighty patients were included, all with non-muscle-infiltrating bladder tumors. A total of 812 urine cultures were studied, of which 88 were positive. Among all positive urine cultures, 42 did not receive antibiotics, and yet no febrile UTI was detected. A serious infectious event was reported in two patients including one death, and no risk factor for the occurrence of a positive urine culture could be identified. Bladder tumor recurrence was identified in 17 patients, 3 of whom had positive urine culture treated with antibiotics. Conclusions: Performing urine culture before BCG instillation does not seem necessary. Antibiotic therapy for a positive urine culture could expose to a higher risk of recurrence.

Background: Post-operative urinary tract infections (UTIs) are a notable complication of radical prostatectomy, contributing to prolonged hospital stays, increased healthcare costs, and diminished patient quality of life. Despite international guideline recommendations of European Association of Urology and the French Society of Anesthesia and Intensive Care Medicine regarding the use of pre-operative urine cultures and antibiotic prophylaxis (AP) before radical prostatectomy, the role of pre-operative urine cultures in mitigating UTI risk remains uncertain. Methods: This multi-center prospective cohort study analyzed data from six French urology departments. Patients who underwent radical prostatectomy between January 2019 and June 2023, with variable inclusion periods across centers, were included if pre-operative urine cultures were performed. Patients were stratified into subgroups based on the occurrence of post-operative UTIs. Uni-variable and multi-variable logistic regressions, as well as receiver-operating characteristic (ROC) curve analysis, were used. Results: A total of 467 patients were analyzed, among whom post-operative UTIs developed in 30 patients. Among peri-operative factors, only the ASA (American Society of Anesthesiologists) score (p = 0.014) and the duration of post-operative catheterization (p = 0.001) were significantly associated with UTI occurrence in uni-variable analyses. Multi-variable logistic regression confirmed both factors as independent predictors of post-operative infections, with a model area under the ROC curve for catheterization duration of 0.789. A seven-day threshold for catheterization duration was identified as the optimal cutoff for predicting infection risk. Notably, neither pre-operative urine bacterial cultures nor AP reduced the incidence of post-operative UTIs. Conclusion: This study demonstrates that pre-operative urine cultures and prophylactic antibiotic agents do not mitigate UTI risk following radical prostatectomy, underscoring the need for optimized infection prevention tactics. The findings challenge the clinical utility of routine pre-operative urine cultures and highlight the critical roles of ASA score and post-operative catheterization duration in predicting infections.

BACKGROUND:Robot-assisted partial nephrectomy (RAPN) is a preferred technique for treating localized renal tumors due to its potential to preserve renal function. This study aimed to assess the impact of young surgeon's training on perioperative outcomes of RAPN. METHODS:This retrospective study described the outcomes of RAPN performed by surgical fellows under the supervision of experienced surgeons at a single center. A total of 298 RAPN procedures were analyzed, comparing 130 performed by fellows (Junior group) and 168 by expert surgeons (Senior group). RESULTS:While operative time (203 vs. 130minutes) and warm ischemia time (17 vs. 15minutes) were longer in Junior group, there were no significant differences in intraoperative blood loss, postoperative complications, or positive surgical margins between the two groups. CONCLUSION:These results suggest that with proper supervision, fellows can safely perform RAPN with outcomes comparable to those of more experienced surgeons. LEVEL OF EVIDENCE: 4: