ABSTRACT Introduction Ureteral diverticula are rare urological anomalies characterized by outpouchings of the ureteral wall. Malignancy arising from these structures is exceptionally rare, with only a few cases reported. Case Presentation We report a 57‐year‐old male with high‐grade urothelial carcinoma arising from a ureteral diverticulum in the left distal ureter. The patient experienced painless gross hematuria, and computed tomography revealed a 3 cm undetermined mass near the left distal ureter. Multiple endoscopic diagnostic procedures were inconclusive, with the final diagnosis confirmed intraoperatively. The surgery involved resection of the mass, and intraoperative frozen section analysis revealed high‐grade urothelial carcinoma. A segmental ureteral resection was performed with reconstruction using a Boari flap and Psoas hitch. Final histopathology confirmed locally advanced, high‐grade pT3 urothelial carcinoma, and adjuvant chemotherapy was recommended. Conclusion This case underscores the diagnostic and management challenges of upper tract urothelial carcinoma, especially in rare cases involving ureteral diverticula.

OBJECTIVE:To assess the surgical safety, efficacy and quality of life in patients suffering from stress urinary incontinence after desobstructive surgery for benign prostatic enlargement, we analyzed data from patients treated with the Adjustable Transobturator Male System (ATOMS) at our tertiary referral center. METHODS:We retrospectively analyzed 27 patients with stress urinary incontinence (SUI) after desobstructive surgery (transurethral resection of the prostate (TUR-P): n = 17; Holmium laser enucleation of the prostate (HoLEP): n = 10) who underwent ATOMS implantation at our high-volume incontinence-surgery center between 2018 and 2024. Patients with prior prostatectomy or cancer-related surgery were excluded. Pre- and postoperative continence parameters, complications, and patient-reported outcomes were assessed using questionnaires, 24-h pad tests, and standardized instruments. The median follow-up was 32 months. RESULTS:Baseline demographics were comparable across groups. HoLEP patients had a significantly higher resected tissue weight (95.0 g vs. 26.0 g, p = 0.008) and required greater cushion volume (8.0 ml vs. 7.0 ml, p = 0.035). Complete continence rates were 64.7% (TUR-P) and 80.0% (HoLEP, p = 0.401). Postoperative pad test results (12.0 ml vs. 11.0 ml), complication rates, and satisfaction levels showed no significant differences. Explantation occurred in ~10% of patients, with high patient-reported satisfaction and willingness to recommend the implant across both groups. CONCLUSION:ATOMS implantation is a feasible, safe, and effective treatment for SUI following both TUR-P and HoLEP. Importantly, neither the type of prior surgery nor the volume of resected prostate tissue negatively impacted outcomes. These findings support the broader application of ATOMS in patients with post-BPE SUI, including those with large prostate volumes.

AIMS:To evaluate the impact of radical prostatectomy (RP) modality on functional outcomes, safety, and patient satisfaction following Adjustable Transobturator Male System (ATOMS) implantation. Incontinence after prostate treatment (IPT) is a challenging complication of RP. While ATOMS is an established option for IPT, the influence of RP approach-open RP (ORP) versus robot-assisted RP (RARP)-on outcomes has not been investigated. METHODS:We retrospectively analyzed 131 men undergoing ATOMS implantation for severe IPT after RP (11/2018-05/2024). Patients with prior incontinence surgery, non-RP-related IPT, or urgency/mixed incontinence were excluded. Propensity score matching (1:1; caliper 0.2) for age, interval from RP to ATOMS, locally advanced disease, and prior pelvic radiotherapy yielded 106 matched patients. Primary endpoints were complete continence (0 pads/day), daily pad usage, 24-h pad test, satisfaction, and device explantation. Secondary endpoints included perioperative parameters and complications. RESULTS:RARP patients achieved higher immediate complete continence rates (60.8% vs. 39.2%, p = 0.032), lower daily pad usage (1.0 vs. 2.0 pads, p = 0.048), and fewer explantations (3.8% vs. 15.0%, p = 0.046) than ORP patients. Perioperative parameters and complication rates did not differ. Long-term functional outcomes, satisfaction (84% vs. 76%), and recommendation rates (92% vs. 84.6%) were comparable. CONCLUSIONS:This first comparative analysis of ATOMS outcomes by RP modality found RARP to be associated with superior early continence and lower explantation rates, potentially reflecting improved periurethral preservation. However, long-term efficacy, safety, and satisfaction were equivalent, supporting ATOMS as an effective treatment regardless of RP approach.

INTRODUCTION:Post-prostatectomy stress urinary incontinence (SUI) significantly impairs patients' quality of life. While the artificial urinary sphincter (AUS) is considered the gold standard for managing severe SUI, a subset of patients is not suitable for this intervention. This study aimed to evaluate the clinical outcomes of patients who received an adjustable transobturator male system (ATOMS) as an alternative to AUS for the treatment of SUI. METHODS:In this single-center retrospective study, we included 25 patients who received ATOMS implantation for post-prostatectomy SUI, despite being technically eligible for AUS based on incontinence severity and pelvic floor status. Primary outcomes included pad usage, continence rates, complications, and patient-reported satisfaction. A cross-sectional follow-up was conducted in using standardized questionnaires. RESULTS:Median age was 74.0 years; 60% of patients had undergone pelvic radiotherapy. Preoperative median pad usage was 6.0/day, reduced to 3.0/day postoperatively. Social continence (≤1 pad/day) was achieved in 16%, and ≥50% reduction in pad usage in 76% of patients. Complications were mostly minor. Cross-sectional follow-up data were available for 60% of patients at a median of 42 months. Patient satisfaction was high (73.3%), and 80% would recommend the procedure. According to the PGI score, 73.3% reported "very much" or "much improved" outcomes. CONCLUSION:ATOMS represents a feasible and safe treatment alternative for patients with severe SUI who are unable or unwilling to undergo AUS implantation. Despite suboptimal continence outcomes compared to AUS, high satisfaction and acceptable complication rates support its use in appropriately selected patients.

Acute flank pain due to ureteral calculi is a common presentation in emergency departments (EDs). Decisions between conservative management and inpatient intervention remain difficult in the absence of absolute indications. This study aims to identify size-stratified predictors to assist ED decision-making in ureterolithiasis. This was a single-center retrospective study of patients presenting in the ED of a tertiary center with acute renal colic between October 2020 and November 2024. A total of 752 patients with CT-confirmed ureteral stones were included and analyzed. Receiver operating characteristic (ROC) analysis identified a 5.65-mm threshold; operationalized as 6 mm in the subsequent analyses. After size-based stratification, uni- and multivariate regression analyses were conducted to identify predictors for inpatient admission in the <6 mm subgroup and predictors for discharge in the ≥6 mm subgroup, respectively. Overall, 77

BACKGROUND AND OBJECTIVE:Prostate biopsy for histological confirmation is the standard before radical prostatectomy (RP). However, some patients refuse biopsy despite highly suspicious imaging findings. This study aimed to evaluate final pathology, assess potential active surveillance (AS) eligibility, and exploratorily evaluate perioperative outcomes and short-term oncological biochemical recurrence (BCR)-free survival after biopsy-naïve RP (bnRP). METHODS:We retrospectively analyzed a single-center cohort of patients who underwent bnRP with pT2-pT3 disease between 2019 and 2026. Final pathology was assessed, and potential AS eligibility was approximated using European Association of Urology-based low-risk and favorable intermediate-risk categories. Perioperative outcomes and short-term BCR-free survival were exploratorily compared between patients who underwent bnRP and those who underwent biopsy-confirmed RP (bcRP) using Kaplan-Meier estimation, log-rank testing, and a univariable Cox proportional hazards model. KEY FINDINGS AND LIMITATIONS:In 103 consecutive bnRP specimens, prostate cancer was confirmed in all patients. Overall, 94% had clinically significant prostate cancer (csPCa). Compared with 3081 consecutive patients who underwent bcRP, patients who underwent bnRP had fewer low-grade tumors and more locally advanced disease. Overall, 5.8% of the biopsy-naïve patients had International Society of Urological Pathology grade group 1 disease, but only one patient fulfilled the stricter AS approximation criteria. However, in total, 18% of the biopsy-naïve patients fulfilled broader AS criteria and might have warranted formal AS assessment. Exploratory analysis revealed no significant difference in short-term BCR-free survival between patients who underwent bnRP and those who underwent bcRP. CONCLUSIONS AND CLINICAL IMPLICATIONS:In our single-center observational analysis of carefully selected patients, bnRP seemed safe and was associated with a high likelihood of csPCa. Nevertheless, the retrospective approximation of AS eligibility highlights that bnRP should be performed cautiously. Exploratory perioperative and short-term oncological analyses need prospective validation.

The pulsed Thulium: YAG (p-Tm: YAG) laser represents a recent technological advancement in endourology, offering high pulse frequencies and energy levels for efficient lithotripsy. While its efficacy has been demonstrated in retrograde intrarenal surgery (RIRS) and percutaneous nephrolithotomy (PCNL), data on its application during endoscopic combined intrarenal surgery (ECIRS) remain limited. This multicenter retrospective study evaluated the safety, efficiency, and clinical performance of the p-Tm: YAG laser during ECIRS. Data were collected from 179 consecutive patients undergoing ECIRS with the p-Tm: YAG laser (Dornier Thulio®, Dornier MedTech Systems GmbH) across three European high-volume centers (September 2023–March 2024). Patient demographics, stone characteristics, peri-operative parameters, laser settings, and outcomes were analyzed. Stone-free rate (SFR) was assessed endoscopically and radiographically (2–6 weeks post-operatively). Complications were recorded. The median stone volume was 4 050 mm³ (IQR 1 690–6 845) with a median density of 1 138 HU. The mean laser energy consumption was 7.3 J/mm³. Endoscopic and radiographic SFRs were 96.6

Abstract Objectives To provide improved evidence for treatment recommendations, this study analysed real‐world data on the characteristics, treatment and prognosis of primary extragonadal germ cell tumours (EGCTs), a very rare cancer entity that shares histological features with testicular GCTs (TGCT). Materials and methods This retrospective study analysed data from 34 patients with mediastinal or retroperitoneal EGCTs treated at a high‐volume centre between 2015 and 2025. Probability of overall survival (OS) and relapse‐free survival (RFS) was assessed using Kaplan–Meier curves. Results A primary retroperitoneal and primary mediastinal GCT was diagnosed in 23 (68%) and 11 (32%) patients, respectively. Median patient age was 41.1 years, and 62% were non‐seminomatous in origin. Thirty‐three (97%) patients received chemotherapy according to the IGCCCG prognostic group, and 15 (44%) underwent surgical intervention (4 primary RPLND, 8 post‐chemotherapy RPLND, 3 secondary orchiectomy). Thirteen patients (44.9%) who completed chemotherapy experienced a relapse after a median of 0.79 years, and six of them died. In patients with primary mediastinal seminoma, 3‐year RFS and OS were 100% as compared to 71% 3‐year OS in patients with primary retroperitoneal non‐seminoma and 46% 3‐year RFS in patients with primary mediastinal non‐seminoma. Conclusion The prognosis for primary mediastinal seminoma appears favourable, while non‐seminomatous EGCT shows poorer outcomes. Additionally, primary retroperitoneal seminomas demonstrate promising survival rates, whereas primary retroperitoneal non‐seminomas demonstrate the lowest OS rates.

Objectives: Real-world data on surgical and multimodal management of upper tract urothelial carcinoma (UTUC) are limited. This study examined epidemiological trends, nephron-sparing surgery adoption, and the perioperative impact of lymphadenectomy (LND) and neoadjuvant chemotherapy (NAC). Methods: The German Nationwide Inpatient Data (GRAND) registry (2005-2023) identified UTUC patients undergoing radical nephroureterectomy (RNU), endoscopic laser destruction, or segmental ureteral resection (SUR) using OPS codes. Demographics, comorbidities, complications, and in-hospital mortality were extracted from ICD-10-GM data. Multivariable regression adjusted for baseline comorbidities assessed associations between treatment type, LND, NAC, and perioperative outcomes. Results: Among 53,427 UTUC patients, 77.3% underwent RNU, 13.8% endoscopic laser destruction, and 8.9% SUR. Endoscopic laser use rose from <10% (2005) to about 20% (2023). LND was performed in 13% of RNU cases, increasing from 1.1% to 19%. LND was associated with higher risks of transfusion (OR 1.47, 95% CI 1.37-1.57), acute kidney injury (OR 1.19, 95% CI 1.07-1.32), and ICU admission (OR 1.21, 95% CI 1.13-1.30), without affecting in-hospital mortality. NAC was given to 1.7% of patients, with a five-fold increase over time, and was associated with more transfusions (OR 1.28, 95% CI 1.07-1.52) and urinomas (OR 2.31, 95% CI 1.31-3.78), but not mortality. Conclusions: UTUC management is evolving, with growing use of endoscopic laser therapy and guideline-aligned lymphadenectomy during nephroureterectomy. Neoadjuvant chemotherapy remains underused despite acceptable perioperative safety, highlighting the need for increased awareness to optimize multimodal treatment.

We present the case of a 66-year-old patient with a biochemical recurrence of prostate cancer manifesting as an asymptomatic testicular metastasis. Two years after radical prostatectomy and salvage radiation, the prostate-specific antigen (PSA) level rose to 1.07ng/ml. PSMA PET/CT scan showed tracer accumulation in the left testicle. Inguinal orchiectomy confirmed the metastasis. After being non-detectable, the PSA level increased five months after orchiectomy, with PSMA PET/CT revealing positive iliac lymph nodes. In summary, the presented case illustrates orchiectomy as a metastasectomy. However, apart from a transient decrease in PSA, no medium-term oncological advantage could be seen.

Objetivos: Evaluar la calidad de vida relacionada con la salud (CVRS) a los seis años de la cistectomía radical en pacientes con cáncer de vejiga músculo-invasor, comparando la neovejiga ileal ortotópica (NIO) y el conducto ileal (CI). El objetivo del estudio fue analizar los efectos a largo plazo (y poco estudiados) de los tratamientos estándar para el cáncer de vejiga en la CVRS y proporcionar información sobre las diferencias en la CVRS asociadas con estos dos métodos comunes de derivación urinaria.Pacientes y métodos: Este estudio prospectivo incluyó a 39 pacientes con carcinoma urotelial tratados con NIO o CI en nuestro centro entre 03/2013 y 01/2023. Se excluyeron pacientes con histología variante, metástasis, quimioterapia neoadyuvante o enfermedades benignas como indicación para la cistectomía. La CVRS se evaluó mediante el cuestionario QLQ-C30 de la European Organization for Research and Treatment of Cancer (EORTC) en el preoperatorio y a los cuatro y seis años del postoperatorio. Los análisis estadísticos incluyeron pruebas de Chi-cuadrado, pruebas T y modelos de regresión logística.Resultados: Del total de pacientes, el 64% (25/39) fue sometido a NIO, y el 76,9% (30/39) eran varones, con una edad media de 69 años. No se observaron diferencias significativas en cuanto a buena CVRS global (ESG>70) entre la NIO y el CI a los seis años (CI: 60±22; NIO: 69±23, p=0,2). Los pacientes con CI refirieron mayor insomnio en los dos controles de seguimiento (4 años: p=0,01; 6 años: p=0,03). El estado emocional se mantuvo estable en los pacientes con NIO, pero disminuyó en los pacientes con CI del cuarto al sexto año (p=0,04).Conclusiones: La CVRS a largo plazo no mostró diferencias significativas entre la NIO y el CI durante los primeros seis años tras la cistectomía radical. Ambos métodos de derivación urinaria pueden ser opciones viables para los pacientes, con un asesoramiento personalizado basado en la CVRS de cada caso.

PURPOSE:To investigate the awareness about their occupational elevated risk for testicular cancer, we conducted a cross-sectional study among German firefighters, as studies indicate that firefighters may be at an elevated risk for developing testicular cancer. One cause may be the exposure to carcinogenic chemicals during occupation. MATERIALS AND METHODS:A survey containing 22 questions was distributed to fire stations (including career firefighters and volunteer firefighters) in Germany. Various channels were used to distribute the survey. Statistics were performed using chi-squared test, exact binomial test, or Fisher's exact test. Furthermore, hierarchical clustering was performed. RESULTS:Data for 1324 participants was analyzed. We detected a prevalence of testicular cancer of 3.6% in our cohort. Most participants demonstrate a low awareness for testicular cancer, as only 19% were aware of their elevated risk. 89% would appreciate more information regarding their elevated risk and 90% of the participants would appreciate regular check-ups. Record of service was significantly associated with an elevated risk of testicular cancer in our cohort (factor 2.87). CONCLUSION:This is the largest study to date examining the awareness and prevalence of testicular cancer among firefighters. Awareness of testicular cancer among participating firefighters is low, but the demand for regular check-ups is high. This highlights the necessity for providing special health education for firefighters.