Bladder cancer diagnosed at a young age is uncommon, but survivors often have long life expectancy, making long-term risks such as second primary malignancies (SPMs) clinically relevant. However, the incidence and patterns of SPMs in young-onset bladder cancer survivors remain poorly characterized. We aimed to quantify the risk and distribution of SPMs in this population. We conducted a retrospective cohort study using data from 17 registries in the Surveillance, Epidemiology, and End Results (SEER) program (2000–2022). Patients diagnosed with a first primary urothelial carcinoma of the bladder before age 50 were included. Follow-up for SPMs began two months after diagnosis. Standardized incidence ratios (SIRs) and absolute excess risks (AERs) were calculated overall, by sex, and by cancer site. Age-related trends were assessed using Poisson regression, and sensitivity analyses were performed. A total of 13,378 eligible patients contributed 140,014 person-years at risk to the SPM analysis. During follow-up, 1,272 SPMs were identified, excluding bladder and non-melanoma skin cancers, corresponding to a significantly elevated overall risk compared with the general U.S. population (SIR 1.67; 95

INTRODUCTION:We aimed to characterize the contemporary landscape, completion rates, and predictors of completion of clinical trials in testicular and penile cancers. METHODS:We performed a registry-based cohort analysis of ClinicalTrials.gov to identify interventional and observational trials in testicular or penile cancer initiated between January 1, 2000, and October 1, 2025. Trials withdrawn before enrollment, supportive-care or non-oncologic studies, epidemiologic investigations, and basket trials without predefined disease-specific enrollment targets were excluded. Extracted variables included trial design, enrollment targets, funding source, geographic region, and completion status. Firth's penalized logistic regression was used to assess predictors of trial completion. Kaplan-Meier and Cox proportional hazards models evaluated time to trial completion. RESULTS:Eighty-three eligible trials were identified, including 34 penile and 49 testicular cancer studies. Most trials were early-phase, non-randomized, and small. Overall completion rates were low (38% for penile cancer and 41% for testicular cancer), with no significant difference by disease site. Trials conducted outside North America were significantly more likely to complete than North American studies (adjusted odds ratio 10.21; 95% confidence interval [CI] 2.11-68.27). Time-to-event analyses similarly demonstrated faster completion among non-North American trials (multivariable hazard ratio 5.02, 95% CI 1.84-13.66). CONCLUSIONS:Clinical trials in rare urologic cancers demonstrate persistently low completion rates and substantial geographic disparities, highlighting the need for improved international collaboration and alternative trial frameworks to enhance trial feasibility and completion.

Introduction: We aimed to characterize the contemporary landscape, completion rates, and predictors of completion of clinical trials in testicular and penile cancers. Methods: We performed a registry-based cohort analysis of ClinicalTrials.gov to identify interventional and observational trials in testicular or penile cancer initiated between January 1, 2000, and October 1, 2025. Trials withdrawn before enrollment, supportive-care or non-oncologic studies, epidemiologic investigations, and basket trials without predefined disease-specific enrollment targets were excluded. Extracted variables included trial design, enrollment targets, funding source, geographic region, and completion status. Firth’s penalized logistic regression was used to assess predictors of trial completion. Kaplan-Meier and Cox proportional hazards models evaluated time to trial completion. Results: Eighty-three eligible trials were identified, including 34 penile and 49 testicular cancer studies. Most trials were early-phase, non-randomized, and small. Overall completion rates were low (38% for penile cancer and 41% for testicular cancer), with no significant difference by disease site. Trials conducted outside North America were significantly more likely to complete than North American studies (adjusted odds ratio 10.21; 95% confidence interval [CI] 2.11–68.27). Time-to-event analyses similarly demonstrated faster completion among non-North American trials (multivariable hazard ratio 5.02, 95% CI 1.84–13.66). Conclusions: Clinical trials in rare urologic cancers demonstrate persistently low completion rates and substantial geographic disparities, highlighting the need for improved international collaboration and alternative trial frameworks to enhance trial feasibility and completion.

Trimodality therapy (TMT) is an established bladder-preserving option for selected patients with muscle-invasive bladder cancer, but non-muscle-invasive recurrence remains a clinically relevant challenge. The role of intravesical bacillus Calmette–Guérin (BCG) after prior bladder-directed chemoradiation is uncertain because the available evidence is limited to small retrospective cohorts and indirect studies in previously irradiated bladders. This mini-review examines the efficacy and tolerability of BCG after TMT, the uncertain role of maintenance therapy, and the factors that should guide continued bladder preservation versus salvage cystectomy. Across available post-TMT series, BCG was feasible and durable disease control occurred in some patients; however, the small, highly selected cohorts are vulnerable to selection bias and limited statistical power, precluding definitive comparative claims or definition of an optimal induction or maintenance strategy. Careful staging is essential because radiation-related changes may complicate endoscopic assessment and pathologic interpretation. BCG may be considered when recurrence is clearly non-muscle-invasive, endoscopically manageable, and the bladder remains functional, with salvage cystectomy still feasible if treatment fails. Uncertain staging, incomplete resection, persistent or early recurrent high-risk disease, BCG-unresponsive recurrence, or poor bladder function should lower the threshold for cystectomy. Prospective studies should incorporate oncologic outcomes, treatment completion, urinary function, and cystectomy-free survival.

OBJECTIVE:Ureteroscopy (URS) is a primary treatment for ureteral calculi, but its cost-effectiveness depends on whether it is performed as a primary procedure or after pre-stenting. While pre-stenting may improve access and reduce intraoperative complications, it adds procedural costs. This study evaluates the total reimbursed expenditures associated with URS in pre-stented versus non-stented patients within the Israeli healthcare system to determine the most cost-effective strategy. METHODS:A retrospective analysis was conducted on 228 patients who underwent URS for ureteral stones between 2020 and 2021. Clinical parameters, stone characteristics, and healthcare utilization were recorded. Reimbursement costs were calculated based on emergency department visits, hospitalization, ureteric stent placement, operative time, and additional procedures. Cost-effectiveness was assessed by comparing total expenditures with clinical outcomes. RESULTS:Pre-stented patients had larger stones (8.3 ± 4.1 vs 6.7 ± 3.2 mm, p < 0.001) and longer operative times (28.0 ± 22.7 vs 21.5 ± 11.7 min, p = 0.006). Stone-free rates at 3 months were similar (89.3% vs 87.7%, p = 0.70). Primary URS resulted in significantly lower costs for distal ureter stones, while costs at other locations were not significantly different ($5932 vs $6369, p = 0.006). CONCLUSION:Primary URS and pre-stented URS yield comparable clinical outcomes. However, primary URS is more cost-effective for distal ureter stones, emphasizing the importance of economic considerations in treatment selection. These findings reflect reimbursed expenditures and not a formal cost-utility analysis.

INTRODUCTION:Chest computed tomography (CT) is commonly obtained for initial staging of testicular cancer. Since pulmonary metastases are rare in the absence of retroperitoneal disease or elevated tumor markers, a selective imaging approach may be justified, as routine chest CT can lead to unnecessary radiation exposure to the thorax. METHODS:We conducted a retrospective cohort study of men evaluated for a newly diagnosed testicular mass at a tertiary medical center between 2011 and 2025. According to institutional protocol, all patients underwent abdominal and chest CT prior to radical orchiectomy. A risk-stratified approach was then assessed, assuming that chest CT would have been omitted if both serum tumor markers and abdominal CT were negative for metastasis. The primary outcome was the false-negative rate for thoracic metastases among patients who would have been triaged to omit chest CT, and the key secondary outcome was the proportion of chest CT examinations that could have been avoided. RESULTS:Among 183 eligible patients (mean age 34.3 ± 11.1 years), 174 (95.0%) had germ-cell tumors, including 107 (61.4%) seminomas. Chest metastases were identified in 10 patients (5.5%). Nine (90%) had positive tumor markers and seven (70%) had retroperitoneal nodal involvement. Using the prespecified rule (perform chest CT if either markers or retroperitoneal nodes were abnormal), no metastatic cases would have been missed, yielding sensitivity 100% (95% confidence interval [CI]: 69.2-100.0) and negative predictive value: 100.0% (95% CI: 95.7-100). Specificity was 48.0% (95% CI: 40.3-55.7), and application of the rule would have avoided 45.4% (95% CI: 38.0-52.9) of chest CTs. CONCLUSIONS:Integrating serum tumor markers with abdominal CT before deciding on chest CT may safely reduce radiation exposure without compromising diagnostic accuracy in the workup of men with a testicular mass. External validation is warranted before clinical implementation.

The evolving landscape of metastatic prostate cancer (mPCa) necessitates a redefinition of the urologist's role, extending beyond diagnosis to active participation in therapeutic and surgical management. This review outlines evidence-based approaches to biopsy and surgical interventions across the disease spectrum. Prostate biopsy remains fundamental for diagnosis, treatment stratification, and molecular profiling, with targeted and metastatic lesion sampling improving precision oncology. For symptom relief, surgical management of bladder outlet obstruction through transurethral resection of the prostate and holmium laser enucleation of the prostate remains essential, with emerging data suggesting possible oncologic benefits when combined with systemic therapy. GreenLight photoselective vaporization may represent an alternative option, though evidence remains limited. Cytoreductive radical prostatectomy in carefully selected patients with metastatic hormone-sensitive disease may provide improved local control and delayed progression, supported by growing biological rationale but constrained by the retrospective nature of current evidence. Collectively, these findings underscore the expanding multidisciplinary role of the urologist in mPCa care, emphasizing the need for prospective studies to validate the integration of surgical approaches within systemic treatment frameworks.

OBJECTIVES:Initial treatment for Non-Muscle Invasive Bladder Cancer (NMIBC) has remained mostly unchanged in recent decades. Cryotherapy with CO2 has been commonly used in medicine for many years. In this study, we present the results of a pre-clinical study aimed at developing a novel cryoablation device to treat superficial low-grade bladder lesions. METHODS:Following initial technical and developmental studies, a rigid cryotherapy device was developed. A technical and efficacy assessment was conducted utilizing the porcine model. Overall, twenty-six ablation areas (up to four per animal) were evaluated. Following an initial routine cystoscopy, the bladder irrigation medium was replaced with CO2 insufflation, and each area was treated with 2 cycles (15 s each) of direct liquid CO2 spraying. After five days, the bladder epithelium was harvested for pathological evaluation. RESULTS:No bladder perforation was noted on pathology. The initial efficacy and usability of the device were demonstrated. Pathological evaluation of treated tissue morphology revealed focal mucosal edema and necrosis with associated surrounding reactive fibrosis, with penetration depths ranging from 0.5 to 4 mm, without profound muscularis propria damage. CONCLUSIONS:Initial results suggest the safety and feasibility of cryotherapy utilizing CO2 spraying. Pathological analysis confirms its potential in treating non-muscle invasive bladder cancer. Ongoing clinical studies aim to validate these results in human subjects, offering a potential paradigm shift in non-muscle invasive bladder treatment.

INTRODUCTION:Bladder cancer is categorized into invasive cancer, which pathologically infiltrates the muscle layer of the bladder, and non-muscle invasive bladder cancer that does not penetrate this layer. Non-muscle-invasive bladder cancer is further stratified into risk groups based on the likelihood of disease recurrence and progression. High-risk non-muscle-invasive tumors typically undergo conventional treatment with intravesical Bacillus Calmette-Guerin (BCG) instillations. However, it is anticipated that thirty to fifty percent of patients will experience treatment failure, leading to disease recurrence or progression, necessitating radical cystectomy as the subsequent therapeutic step. Extensive endeavors are underway to explore novel treatment modalities aiming to reduce the necessity for bladder removal. Diverse treatments, both systemic and local, administered directly into the bladder, have been investigated in recent years to mitigate the need for cystectomy. This review article provides an overview of current approved therapeutic options such as combined intravesical chemotherapy with gemcitabine and docetaxel, systemic therapy with pembrolizumab, intravesical therapy with nadofaragene firadenovec, and innovative investigational treatments including TAR-200 drug-releasing supplement therapy and novel viral therapy, cretostimogene grenadenorepvec.

PURPOSE:To evaluate the effect of neoadjuvant chemotherapy (NAC) on short-term complications following robotic radical cystectomy (RRC). METHODS:A retrospective review of 134 bladder cancer patients who underwent RRC. Perioperative outcomes were compared between patients who received NAC (nRRC) and those who underwent upfront RRC (uRRC). PRIMARY OUTCOME:30-day Clavien-Dindo classification score of ⩾2 (CDC ⩾ 2). SECONDARY OUTCOMES:30-day infectious complications, readmission rates, postoperative ileus, blood transfusion, and mortality. RESULTS:Of the 134 patients, 90 (67%) were in the nRRC group and 44 (33%) in the uRRC group. The total 30-day CDC ⩾ 2 complication rates and high-grade complications were comparable between the groups. Among the various outcomes assessed, only postoperative ileus showed a statistically significant difference, with lower rates in the nRRC (20% vs 38.4%, OR = 0.39, p = 0.021). Other outcomes, including 30-day readmission, infectious complications and blood transfusions, were similar. All four cases of 30-day mortality occurred in the nRRC group. CONCLUSION:NAC in the era of RRC was not associated with a statistically significant increase in overall perioperative complication rates in our cohort. NAC can likely be administered without a significant increase in perioperative complications, although confirmation in larger studies is warranted.

Introduction: Cryotherapy with CO2 is commonly used to treat superficial papillary lesions of the skin for many years. Following preliminary results in an animal model, we present our first-in-human phase 1 clinical safety trial and preliminary results in treating low-grade noninvasive papillary lesions of the bladder with cryoablation. Materials and Methods: Patients with up to 3 papillary lesions and a maximum of 10 mm in size were recruited in a single institution. Patients with previous high-grade disease and/or positive cytology were excluded. Treatment included bladder CO2 insufflation and applying liquid CO2 cryospray to each lesion in 2 cycles of 15 seconds each, with 15 seconds of thawing between cycles. Cystoscopy and treatment site biopsy were performed 4-6 weeks after treatment. Routine surveillance with office cystoscopy was performed every 3 months for 1 year thereafter. Results: 11 men and 2 women ages 59 to 79 years old were included. Overall, 24 lesions were treated. No complications were noted during treatment or follow-up. Pathological biopsy of the treatment sites 6 weeks after treatment detected residual low-grade TCC in three patients and high-grade TCC in one patient, which was attributed to suboptimal lesion freezing due to the initial learning curve in the first few patients, and misdiagnosis of high-grade disease in an additional patient. Two lesions were resected due to the inability to properly treat them with a rigid device. Overall, 20/24 of the lesions were negative for cancer on confirmatory biopsy (83%). Conclusions: Cryotherapy utilizing CO2 spraying for small low-grade NMIBC lesions is safe and feasible. Pathological analysis confirms efficacy in tumor eradication when properly selected and adequately treated by cryospray. This novel treatment may be used as an office procedure and might offer a potential paradigm shift in the treatment of low-grade non-muscle invasive bladder cancer.

Objective: We aimed to identify risk factors associated with urinary septic shock following ureteroscopy. Methods: A retrospective review was conducted on patients who underwent ureteroscopy between 2010 and 2021. Data collected included demographics and preoperative variables. Septic shock was defined as the need for vasopressors for sepsis. A comparison was made between patients who developed septic shock and a randomly selected control group (N = 115). Multivariate logistic regression was used to identify independent risk factors. Results: Of 5000 ureteroscopy procedures, 20 cases of septic shock were identified. These patients were older, had a higher median body mass index, more hypertension, higher preoperative urinary drainage, longer drainage duration and positive preoperative urine cultures. On multivariate analysis, age over 55 years, body mass index above 26 and positive preoperative urine culture were significant predictors of septic shock. Conclusion: Consistent with findings reported in previous studies, older age, higher body mass index and positive preoperative urine cultures are key risk factors for postureteroscopy septic shock. Enhanced safety measures are essential for high-risk patients.

Bladder metastasis from primary lung adenocarcinoma is an infrequent clinical entity. Due to its rarity and nonspecific presentation, it is often misdiagnosed as primary urothelial carcinoma. We report the case of a 65-year-old male with a history of metastatic lung adenocarcinoma presenting to the emergency room with sudden gross hematuria. Imaging revealed a new bladder lesion. Following transurethral resection, histopathological and immunohistochemical analysis confirmed metastatic lung adenocarcinoma (thyroid transcription factor-1-positive/cytokeratin 7-positive/cytokeratin 20 negative/GATA binding protein 3-negative or TTF-1+/CK7+/CK20-/GATA3-). The case was discussed at the Genitourinary Oncology Tumor Board, and given the prognosis of metastatic lung adenocarcinoma, the patient opted for palliative care. This case highlights the importance of considering metastatic spread to the urinary bladder in patients with advanced malignancy who develop new urinary symptoms. Accurate diagnosis through histopathology and immunohistochemistry is essential for guiding appropriate management.

Introduction Bilateral testicular germ cell tumor (BGCT) is a rare disease, occasionally considered to be more aggressive than unilateral germ cell tumors (GCT) in some reports. Among BGCT, a synchronous disease might be diagnosed at a higher stage than a metachronous disease, resulting in lower cancer-specific survival. Hence, our study aimed to perform a comparative analysis between unilateral testicular GCT, bilateral synchronous GCT, and bilateral metachronous GCT, aiming to verify the possibility that BGCT is diagnosed with a higher stage and may require more aggressive management. Material and methods In our multicenter retrospective study we reviewed medical records of 40 patients with BGCT (24 metachronous and 16 synchronous). Clinical characteristics, pathological features of the primary and secondary tumors, adjuvant treatments (chemotherapy and radiotherapy)and sperm quality were evaluated as well as cancer-specific survival and overall survival. A cohort of one-to-one matched patients with unilateral GCT were used to determine risk factors for developing BGCT. Results Patients with BGCT were slightly younger compared to those with unilateral GCT and had more advanced disease. Despite similar T-stage distribution between the two groups, nodal involvement was nearly twofold more frequent in patients with BGCT disease (42% vs 22%, p = 0.056). Additionally, although similar histological subtypes distribution at presentation among the two groups, the synchronous disease was diagnosed with a higher local T-stage (OR = 3.4), higher proportions of patients with elevated serum BHCG levels, and more frequent nodal involvement (OR = 2.2). This was later translated into an 18% higher disease-specific mortality rate. The median time to develop a contralateral tumor was 92 months. Pathological local T-stage (T2–T3) of the primary tumor predicted a shorter time interval to a diagnosis of a second contralateral tumor (HR 0.92, P < 0.05). Conclusion BGCT presents at a younger age and potentially with more advanced disease. Synchronous BGCT is diagnosed at a later stage compared to metachronous BGCT and has higher disease-specific mortality. Metachronous tumors might have a long time interval for the development of a contralateral neoplasm. The main predictor of developing an early metachronous disease is a high primary T stage.

This study assesses the impact of percutaneous nephrostomy (PCN) presence on standard intended neoadjuvant chemotherapy (NAC) quality, its related complications and outcome after radical cystectomy. We found that PCN-patients received less adequate NAC protocols, suffered from more infections and hospitalizations during the NAC period, with no difference in the postoperative outcomes after cystectomy. This finding may potentially lead to consideration of NAC avoidance and upfront cystectomy in PCN-patients. Introduction: Symptomatic hydronephrosis associated with muscle invasive bladder cancer (MIBC) necessitates percutaneous nephrostomy (PCN) insertion before neoadjuvant chemotherapy (NAC). This study assesses the impact of PCN presence on standard intended NAC quality, its related complications and outcome after radical cystectomy (RC). Materials and Methods: The study comprises a retrospective, multicenter cohort of 193 consecutive RCs performed between 2016 and 2019. Eighty (42%) of these patients received NAC and were divided in 2 comparison groups by presence (n = 26; 33%) or absence (n = 54; 67%) of PCN. Endpoints included completion of adequate NAC treatment (cisplatin-based chemotherapy for at least 4 courses), complications during NAC, post-RC complications and hospital stay. Results: Overall, patients with PCN (45/193; 23%) featured a higher referral rate to NAC (58% vs. 36%, P = .01), worse glomerular filtration rates ( P < .001) and more adverse events ( P = .04), in comparison to non-PCN patients. In the NAC cohort, PCN patients had less adequate treatment rates (54% vs. 85%, P = .005), and more infections (35% vs, 7%; P = .008) and hospitalizations (58% vs. 13%; P < .001) during chemotherapy. Post-RC outcome was similar for both comparison groups. PCN was an independent risk factor for inadequate NAC (OR = 3.9, P = .04), and infections (OR = 11.3, P = .01) and hospitalizations (OR = 7.5, P = .004) during NAC. Conclusions: PCN in MIBC patients is a significant risk factor for inadequate NAC and adverse events during treatment. This finding may quire the rationale of NAC, potentially leading to consideration of NAC avoidance and upfront RC in PCN patients. Further survival studies with long follow-up are needed for elucidating this issue.