BACKGROUND AND OBJECTIVE:Outcomes after radical cystectomy (RC) for non-muscle-invasive bladder cancer (NMIBC) are generally favorable, but a subset experiences recurrence and cancer-specific mortality (CSM). Tools to identify high-risk patients remain limited. This study aimed to identify predictors of recurrence and cancer-specific and overall mortality in pathological NMIBC treated with RC. DESIGN, SETTING, AND PARTICIPANTS:Multicenter retrospective cohort of 1032 patients with pTis/pTa/pT1 N0 R0 disease who underwent RC (2000-2015) at nine centers. No patient received perioperative therapy. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS:Recurrence-free survival (RFS), cancer-specific survival (CSS), and overall survival (OS) were analyzed using Cox and competing-risks regression. Discrimination assessed by Harrell's C-index. RESULTS AND LIMITATIONS:Median follow-up 45.2 mo. Lymphovascular invasion (LVI), present in 39 patients (3.8%), was independently associated with RFS (hazard ratio [HR], 2.37; 95% confidence interval [CI], 1.29-4.38; p = 0.006) and CSS (HR, 2.59; 95% CI, 1.31-5.10; p = 0.006). Pathological stage was not associated with RFS (p = 0.074). Age predicted OS (HR 1.06; p < 0.001). LVI-positive patients had higher 10-yr CSM (35.3% vs 13.7%; p = 0.002). Discrimination was modest (C-index 0.59). Limitations include retrospective design and low LVI prevalence. CONCLUSIONS:In patients undergoing RC for pathological NMIBC, LVI identifies a small subgroup at increased risk of recurrence and CSM, while pathological stage adds little. These findings support LVI-guided surveillance and trial enrichment, but no treatment recommendations can be drawn.

Objectives: To investigate the rate and predictors of recurrence at second-look ureterorenoscopy (URS) and to assess the adequate timeframe for second-look URS in upper tract urothelial carcinoma (UTUC). Methods: This multicenter retrospective study included 179 patients who underwent endoscopic kidney-sparing surgery (KSS) and second-look URS for non-invasive UTUC between 2004 and 2017. We performed logistic and Cox proportional hazard regression analyses to investigate the association between clinical parameters and second-look recurrence, recurrence-free survival (RFS), and cancer-specific mortality. The optimal duration to second-look URS was extrapolated using restricted cubic splines. Results: Overall, 66 (36.9%) patients experienced recurrence at second-look URS. After second-look URS, further recurrence was observed in 87 (48.6%) patients during a median follow-up of 12 months. Female gender (OR [odds ratio] 2.3, 95% CI [confidence interval] 1.1–4.7, p = 0.026) and tumor size > 1 cm (OR 3.3, 95% CI 1.2–9.5, p = 0.027) were independently associated with recurrence at second look. Second-look recurrence was a strong prognostic factor for RFS (HR 5.0, 95% CI 3.1–8.0, p < 0.001). Second-look URS between 5 and 12 weeks after initial endoscopic laser ablation was an independent favorable factor for RFS (HR 0.5, 95% CI 0.3–0.9, p = 0.014). Conclusions: Early recurrence at second-look URS appears to be one of the strongest predictive factors for RFS in patients undergoing endoscopic KSS. Our results suggest that second-look URS performed within 5 to 12 weeks is associated with a lower probability of further disease recurrence. Given that this interval was derived and tested in the same cohort, this finding should be regarded as hypothesis-generating and requires external validation before being adopted as a clinical standard.

To evaluate the effect of intraoperative administration of 1 g of tranexamic acid (TXA) on perioperative and postoperative outcomes in patients receiving antithrombotic therapy undergoing endoscopic enucleation of the prostate (EEP). This multicenter, prospective, observational study included 932 patients across 30 centers (December 2024–June 2025). Patients were divided into four groups based on TXA use and continuation or discontinuation of blood thinners during EEP. The primary endpoint was bleeding complications within 30 days, defined as a composite of transfusion, clot retention, bleeding requiring restart of continuous bladder washout (CBWO), or surgical reintervention to control hemostasis. Multivariable Logistic regression analysis identified independent predictors of bleeding complications. There were 534 patients in Group 1 (stopped blood thinners, no TXA given), 316 in Group 2 (on blood thinners, no TXA given), 69 in Group 3 (stopped blood thinners, TXA given), and 13 in Group 4 (on blood thinners, TXA given). Median total operative time was longest in Group 2 (88 min [IQR 70–127]) and shortest in Group 3 (55 min [IQR 39–69]). Hemostasis time was shortest in TXA groups (p < 0.001). Transfusions occurred in 0.6–7.7

Background:Identifying and addressing long-term health and societal challenges after COVID-19 is a research priority. Objectives:To create an international, multidisciplinary COVID-19 database, and synthesise long-term outcomes, predictors and costs. Design:Systematic identification of COVID-19 data sets and meta-analysis of individual participant data on long-term outcomes after COVID-19. Setting:Contributed data were collected in clinical, community and research settings. Interventions:Interventions from original studies were included as covariates in models. Data sources:MEDLINE, Cochrane Central Register of Controlled Trials, EMBASE, Web of Science, PsycInfo® (American Psychological Association, Washington, DC, USA), Cumulative Index to Nursing and Allied Health Literature, World Health Organization Global Index Medicus, Epistemonikos, LitCOVID; World Health Organization International Clinical Trials Registry Platform; ClinicalTrials.gov and supplementary searches for studies (November 2019-November 2021) were searched for studies on > 10 people from cohort, case-control, survey or randomised controlled trial studies, across any setting, describing validated assessment instruments, symptoms, hospitalisation, discharge destination or mortality beyond 28-days after COVID-19 onset. Data were extracted by two independent reviewers. Methods:Principal investigators contributed fully anonymised individual participant data. Demography, equity and symptoms were described. Assessment instruments were mapped to the International Classification of Functioning, Disability and Health. Factors associated with outcomes at 3-6 months, 9-12 months and beyond 12 months of index infection, for n > 500 individual participant data and > 1 data set were described using ratio of difference, point estimates, odds ratio and 95% confidence interval, as appropriate. The Mixed Methods Appraisal Tool described study quality; models were appraised using a Grading of Recommendations Assessment, Development and Evaluation-informed approach; heterogeneity was described using I2. Outcome measures:Included overall perception of health, multidomain cognitive function, anxiety, depression, stress, post-traumatic stress disorder, fatigue, strength, walking ability, mobility, coping with daily life, breathlessness, mortality, later hospitalisation and health-related quality of life. Results:PRECIOUS collated 116 data sets from 40 countries (individual participant data = 62,849), comprising 20 randomised controlled trials, 13 case-control, 60 cohort 2 longitudinal, 1 survey and 20 other study types. Participants' median age was 58 years interquartile range (45-68); 34,185 (54.4%) were female; 158 unique symptoms and 137 unique assessment instruments were captured, predominantly describing International Classification of Function, Disability and Health-body functions. Women had poorer outcomes across 30/37 models, compared with men. In 15/37 models, pre-existing lung disease and increasing age were associated with poorer outcomes; hospitalisation, diabetes and chronic kidney disease were each associated with poorer outcomes in 8/37 models. Initial hospitalisation resulted in lower health-related quality of life that did not recover for up to 2 years after initial infection. Heterogeneity was low in 34/37 models; 22/37 models were of moderate and 11/37 were of low quality. Limitations:Use of secondary data limits available covariates, outcomes and time points to those included in primary data sets; evidence was primarily based on high-income countries. There was a lack of data on longer-term healthcare resource use to estimate the costs to the healthcare system. Conclusions:PRECIOUS contributes to the overall picture of long-term COVID-19 outcomes beyond the long-COVID condition and highlights poorer long-term outcomes in women and people with pre-existing comorbidities. Future work:Evidence gaps included healthcare resource use, isolation, loneliness, societal participation and return to work outcomes. Data are needed on the role of health inequity on long-term outcomes. Study registration:This study is registered as PROSPERO (CRD42020224323, IRAS ID: 293578). Funding:This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR132895) and is published in full in Health and Social Care Delivery Research; Vol. 14, No. 29. See the NIHR Funding and Awards website for further award information.

Renal cell carcinoma is the most common form of kidney cancer (more than 90 % of all oncological pathologies of the kidney). At an early stage of development, renal cell carcinoma can be asymptomatic, and this significantly complicates its diagnosis. Commonly used methods for diagnosing renal cell carcinoma do not allow for timely detection of this disease at early stages, thus it is necessary to develop effective and non-invasive methods for its diagnosis using biological macromolecules detectable in blood – biomarkers of this type of cancer. Small nucleolar RNAs are of great interest as such biological macromolecules. In this study, a SiNW biosensor was designed and manufactured for the direct detection of small nucleolar RNA SNORA77 in the blood, associated with renal cell carcinoma. The key element of the SiNW biosensor developed is a nanowire chip based on “siliconon- insulator” structures. The chip is manufactured using a technology similar to Smart Cut, and contains an array of silicon nanowires with n-type conductivity, on whose surface DNA oligonucleotide probes are covalently immobilized. To ensure the specificity of the analysis, the nucleotide sequence of the immobilized DNA probes is complementary to the target sequence of the small nucleolar RNA SNORA77. Purified buffer solutions containing various concentrations of synthetic DNA oligonucleotides, whose sequence is similar to the target detectable sequence of SNORA77, have been analyzed. Using the SiNW biosensor developed, the detection limit of SNORA77 was determined to be approximately 10–17 M. The SiNW biosensor has allowed us to detect an elevated level of SNORA77 in a sample isolated from the blood plasma of a patient with confirmed diagnosis of renal cell carcinoma in comparison with that in a control sample isolated from the plasma of a patient with a non-oncologic disease. The results of the study will be useful for further development of early diagnostic systems for renal cell carcinoma.

Objective This review aims to comprehensively evaluate the mechanisms of action of sodium-glucose cotransporter 2 inhibitors (SGLT2is), with a specific focus on their relevance to urological practice, including both potential benefits and risks. Methods A systematic literature search was conducted in February 2025 using PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature, and Google Scholar. Studies addressing the pharmacodynamics of flozins, their systemic effects, and genitourinary outcomes were included. Data were organized into mechanistic themes: tubular glucose and sodium transport, organ protection, antioxidative signaling, and potential anticancer activity. Urological effects were analyzed separately for non-oncological and oncological domains, and adverse outcomes were summarized. Results SGLT2is exert beneficial effects beyond glycemic control, including reduced intraglomerular pressure, improved endothelial function, antioxidative and anti-inflammatory activities, and modulation of cellular metabolism and proliferation. These effects translate to potential benefits in erectile dysfunction, nephrolithiasis, benign prostatic hyperplasia, and possibly genitourinary malignancies. However, flozins are associated with risks including genital mycotic infections, euglycemic ketoacidosis, and, in rare cases, severe urinary tract infections. Conflicting data exist regarding the actual risk of UTIs, with recent evidence suggesting a lower or neutral risk when used appropriately. Conclusion Flozins represent a promising therapeutic class with multifaceted benefits that extend into the field of urology. However, individualized risk assessment remains essential, and further urology-focused clinical research is needed to clarify their full utility and safety in this domain.

To evaluate the pathological adequacy of morcellated ERBT specimens using a two-round Delphi methodology and to establish expert consensus among leading pathologists worldwide. Core pathological parameters relevant for ERBT specimens were predefined, and representative high-quality digital slides of morcellated ERBT specimens were selected. These images were reviewed by an international panel of expert uropathologists with extensive experience in bladder cancer. A two-round Delphi survey was conducted, in which panelists rated the importance of predefined pathological parameters on a 5-point Likert scale. The items on which a consensus was not reached during the first round, were reviewed and rephrased for the second round involving the same responders. Consensus was defined as > 75

Minimally invasive surgical therapies (MIST) for benign prostatic hyperplasia (BPH) have an advantage over other treatment options as they preserve sexual function and may be performed even in frail patients, often under local anesthesia. However, risks of clinical failure after such procedures may be considerably higher compared to standard modalities, making it important to assess the feasibility of repeat MIST in cases requiring retreatment. A literature review was conducted in 2 databases, PubMed (Medline) and Google Scholar, with the following search query: (Aquablation OR PUL OR iTIND OR PAE OR Rezum) AND retreatment. The review only included articles that presented reoperation type (repeat MIST or conventional procedures) and its rate after MIST. Data was extracted and summarized in a tabular form. Repeat MIST as a form of retreatment is technically feasible and has been reported for all modalities except iTIND (temporary implantable nitinol device) owing to the limited number of clinical trials. However, literature is sparse with detailed information about type of retreatment procedures and their outcomes, and reported rates of retreatment are low and variable: from 0

INTRODUCTION:Minimally invasive treatments (MITs) have emerged as viable treatment options for carefully selected patients with localized disease. Their major advantage is that MITs enable the preservation of nearby healthy prostate tissue and critical structures such as the urethral sphincter and neurovascular bundles without compromising oncologic outcomes. The aim of the current review is to describe the impact of different MITs for prostate cancer (PCa) on urinary continence. MATERIALS AND METHODS:A systematic literature search was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Inclusion criteria were as follows: all clinical trials conducted and related to the urinary outcomes (UO) of PCa MITs. Exclusion criteria were as follows: any reviews, articles, conference abstracts, articles whose subject fell outside the scope of this review, or any articles published more than 5 years ago. RESULTS:In the course of the last 5 years, a total of 114 articles on MITs of PCa have been published. Among them, only 36 dealt with the UO for MITs. Brachytherapy, cryoablation, and high-intensity focused ultrasound (HIFU) seem to be the most widely used technologies, whereas irreversible electroporation, focal brachytherapy, focal cryoablation, and multi-parametric magnetic resonance imaging-ultrasound-guided (mpMRI-US-guided) HIFU seem to be the safest techniques in terms of UO. CONCLUSION:The use of MITs for treating PCa is a fast-growing option that can help preserve functional parameters and urinary continence close to their normal levels. It should be noted that although there are currently limited data available on all MITs for the treatment of PCa, the ones that have been extensively studied have shown promising results.

Optilume and Optilume BPH, a minimally invasive drug-coated balloon (DCB) combining mechanical dilation with paclitaxel delivery, offers a novel approach for treating urethral strictures and benign prostatic hyperplasia (BPH) respectively. This scoping review summarizes current evidence on their efficacy, safety, and long-term outcomes to evaluate their role in reducing recurrence and improving patient-reported and functional outcomes. Following PRISMA guidelines, a systematic search (Embase, PubMed, Cochrane, Scopus) until March 2025 identified 287 studies. Eligibility followed PICOS criteria, excluding non-English articles, reviews, and case reports. Risk of bias was assessed using Cochrane RoB 2 and MINORS tools. Data extraction focused on anatomical success, symptom improvement, complications, and retreatment rates. This review was registered at https://osf.io/vf4dw . After screening, 20 studies met inclusion criteria: 2 preclinical animal studies, 12 clinical studies on urethral strictures, and 6 on BPH. For urethral strictures, the ROBUST trials demonstrated 71.7

Background: Calcium oxalate (CaOx) stones have a lower recurrence rate compared with other stone types. However, their high prevalence results in a substantial clinical and economic burden. Calcium oxalate monohydrate (COM) and dihydrate (COD) are the main CaOx stone subtypes. The clinical significance of the presence of COM or COD is not certain. This study aims to evaluate the surgical recurrence rates and metabolic profiles of different CaOx stone subtypes. Patients and Methods: A retrospective analysis of surgically treated patients with an available stone composition analysis performed between 2013 and 2022 in a large health care provider database. Data were analyzed for as much as 5 years from the initial surgery. Demographic, metabolic, and surgical characteristics were collected. Stones were classified based on their dominant component (>50%). Patients with COM stones were compared with those with COD stones. Results: The study cohort included 16,091 patients with stone analysis. Of these, 13,018 (80.9%) had CaOx stones, classified into COM (10,891; 83.7%) and COD (2127; 16.3%) groups. Compared with COM patients, COD patients were significantly younger (p < 0.01) and had fewer comorbidities. COD patients exhibited significantly higher urine calcium levels (242 mg/day vs 156 mg/day, p < 0.01) and lower citrate levels (377 mg/day vs 402 mg/day, p = 0.03). Conversely, COM patients had higher sodium excretion (161 mg/day vs 144 mg/day, p < 0.01). The 5-year surgical recurrence rate was 47% higher in COD patients compared with COM patients (14.3% vs 9.8%; hazard ratio (HR) = 1.53, 95% confidence interval: 1.33-1.76, p < 0.001). Additionally, COD patients required more repeat surgeries on average (1.45 vs 1.34, p = 0.04). A dominant COD composition was a significant predictor for 5-year surgical recurrence (HR = 1.69, 1.38-2.07, p < 0.001). Conclusions: CaOx stone subtypes exhibit distinct metabolic characteristics and surgical recurrence rates. COD patients are more likely to experience surgical stone recurrence. Therefore, patients with a dominant COD stone composition may require a more comprehensive metabolic workup and closer follow-up.

Introduction Kidney diseases pose a serious healthcare problem because of their high prevalence, worsening of patients' quality of life, and high mortality. Patients with kidney diseases are often asymptomatic until disease progression starts. Expensive renal replacement therapy options, such as dialysis or kidney transplant, are required for end-stage kidney disease. Early diagnosis of kidney pathology is crucial for slowing down or curbing further damage. This study aimed to analyze the features of the protein composition of blood plasma in patients with the most common kidney pathologies: kidney calculus, kidney cyst, and kidney cancer.Methods The study involved 75 subjects. Proteins associated with kidney pathologies (CFB, SERPINA3, HPX, HRG, SERPING1, HBB, ORM2, and CP) were proposed. These proteins are important participants of complement and coagulation cascade activation and lipid metabolism.Results The revealed phosphorylated proteoforms (CFB, C4A/C4B, F2, APOB, TTR, and NRAP) were identified. For them, modification sites were mapped on 3D protein models, and the potential role in formation of complexes with native partner proteins was assessed.Discussion The study demonstrates that the selected kidney pathologies have a similar proteomic profile, and patients can be classified into kidney pathology groups with an accuracy of (70-80)%.

Purpose To evaluate the safety of endoscopic enucleation of the prostate (EEP) in benign prostatic hyperplasia (BPH) patients maintained on blood thinners compared to those who discontinued therapy, and to identify independent predictors of postoperative bleeding complications. Methods BPH patients on blood thinners planned for EEP were prospectively enrolled from 30 centers (December 2024-June 2025). Patients were divided into Group 1 (continued blood thinners, n = 329) and Group 2 (discontinued blood thinners, n = 603). Outcomes included bleeding complications, hospital stay, and functional results. Multivariable logistic regression identified predictors of postoperative bleeding (blood transfusion, need for restarting of continuous bladder washout, clot retention, surgical control of post-operative bleeding). Results The overall population had a median age of 70.0 years and prostate volume of 81.0 ml. Group 1 patients had higher comorbidity rates. Group 1 demonstrated significantly longer median operative times (87.0 vs. 70.0 min, p < 0.001) and increased bleeding-related complications, including continuous bladder washout restart (14.3% vs. 2.5%, p < 0.001), blood transfusion requirements (1.5% vs. 0.5%, p < 0.001), and hospital readmissions (10.0% vs. 4.1%, p < 0.001). Rates of surgical hemostasis intervention were similar (1.8% in Group 1 vs. 2.0% in Group 2, p = 0.92). No major thrombotic events occurred. Independent predictors of bleeding included longer operative time (OR 1.01, p < 0.001) and combination antiplatelet/anticoagulant therapy (OR 2.47, p = 0.04), while tranexamic acid was associated with lower odds (OR 0.18, p < 0.001). Conclusion EEP can be safely performed in patients on blood thinners with acceptable morbidity, though bleeding complications are higher. Combination therapy carries the highest risk, while tranexamic acid reduces bleeding complications.

Introduction:Anatomical endoscopic enucleation of the prostate (AEEP) is a guideline-recommended treatment for benign prostatic hyperplasia (BPH). We aimed to analyze postoperative complications and outcomes within a large real-world database. Material and methods:The Refinement in Endoscopic Anatomical enucleation of Prostate (REAP) registry includes patients who received AEEP for BPH in 8 centers worldwide from January 2020 to January 2022. Exclusion criteria included previous prostate/urethral surgery, prostate cancer, pelvic radiotherapy, and concomitant lower urinary tract surgery (internal urethrotomy, cystolithotripsy, or transurethral resection of bladder tumor). The primary outcome was postoperative incontinence; secondary outcomes included early complications (<30 days) and late complications (>30 days). Results:We analyzed 6,193 patients; the mean age was 68 years. Thulium laser was used in 37% and high-power holmium laser in 32%. Median operation time was 67 min [IQR 50-95 min]. The 2-lobe enucleation technique was utilized in 49%, and en-bloc resection was utilized in 39%. Early postoperative complications included urinary tract infection (4.7%), acute urinary retention (4.1%), post-operative bleeding requiring additional intervention (0.9%), and sepsis requiring intensive care admission (0.1%). The incidence of postoperative incontinence was 14.8%, of which 54% were stress incontinence; 84% cases resolved by 3 months. On univariate and multivariate analysis, prostate volume >100 ml was a significant predictor of postoperative incontinence. Late complications such as bulbar urethral stricture, bladder neck sclerosis, and need for redo BPH surgery each occurred in <1% of patients. Conclusions:Analysis of the real-world REAP database shows favorable safety outcomes for AEEP, with a low incidence of serious complications and postoperative incontinence beyond 3 months.

Purpose: To investigate the association of diabetes mellitus and metformin use with metabolic acidosis risk after radical cystectomy (RC) and urinary diversion for bladder cancer. Materials and Methods: This retrospective cohort study used TriNetX Research Network data. Patients undergoing RC with continent diversion or ileal conduit for bladder cancer were identified using International Classification of Diseases, 10th Revision (ICD-10) and ICD-10 Procedure Coding System (ICD-10-PCS) codes. The primary outcome was acidosis between 1 month and 3 years postsurgery. Risk ratios (RR) and odds ratios (OR) were calculated based on diabetes and metformin use, stratified by diversion type and chronic kidney disease stage. Propensity score matching balanced potential confounders. Results: We identified 1,986 patients who underwent continent diversion and 11,184 who underwent ileal conduit reconstruction. In matched analyses, diabetes patients had higher acidosis risk (continent diversion: RR 1.87, 95% confidence interval [CI] 1.39-2.51; ileal conduit: RR 1.94, 95% CI 1.66-2.27). The risk was highest for diabetes patients with metformin prescription (continent diversion: RR 2.06, 95% CI 1.63-2.61; ileal conduit: RR 2.13, 95% CI 1.84-2.47). However, among patients with diabetes, metformin use did not significantly affect acidosis rates in most analyses. Continent diversion patients had higher acidosis risk than ileal conduit patients (RR 1.89, 95% CI 1.58-2.26). Conclusion: Diabetes significantly increases metabolic acidosis risk after RC with urinary diversion, especially in continent diversion patients. While metformin may contribute to metabolic acidosis risk, its impact appears less significant than that of diabetes. Careful monitoring and appropriate metformin adjustments are crucial in this population. (c) 2025 Elsevier Inc. All rights are reserved, including those for text and data mining, AI training, and similar technologies.

Background/Objectives: Conventional transurethral resection of bladder tumor (TURBT) for non-muscle invasive bladder cancer (NMIBC) is usually performed in a piecemeal manner, leading to difficulties in accurate pathological assessment. En bloc resection of bladder tumor (ERBT) has been developed to address these limitations, offering improved specimen quality. So far, ERBT has been restricted to small bladder tumors due to difficulties in en bloc extraction of large ones (>3 cm). Recently, the morcellation technique has been proposed to facilitate the removal of large bladder tumors during ERBT. This narrative review aims to evaluate the feasibility of ERBT with subsequent morcellation for large bladder tumors, focusing on its role in tumor extraction and its impact on pathological assessment. Methods: A comprehensive literature search was conducted across multiple databases to identify studies evaluating the use of morcellation in ERBT for large bladder tumors. Inclusion criteria comprised studies reporting recurrence rates, detrusor muscle (DM) presence in pathological specimens, and perioperative complications. Additionally, we offered uropathologists a questionnaire to gather their perspectives on the use of morcellation following ERBT, focusing on its impact on pathological assessment, margin evaluation, and staging accuracy. Results: While there is limited evidence on the use of morcellation in ERBT for tumors larger than 3 cm and its impact on oncologic outcomes, morcellation has shown potential in facilitating the retrieval of large tumor specimens, ensuring clear resection margins and accurate staging. However, the learning curve for morcellation techniques and the need for specialized equipment may limit widespread adoption. Conclusions: Morcellation in ERBT for large bladder tumors represents a promising advancement in the management of these challenging cases, offering adequate pathological assessment and oncologic outcomes. Pathologists’ reviews of morcellated specimens will likely further validate the technique. Continued research and technological innovations are necessary to optimize its implementation in clinical practice.

Kidney stones have a recurrence risk of 30–50

PURPOSE OF REVIEW:Transurethral resection of bladder tumor (TURBT) remains the basis of bladder tumor diagnosis and an effective means of treating nonmuscle invasive bladder cancer (NMIBC). There are several limitations to this procedure: TURBT may cause free floating of malignant cells in the bladder and as a result re-implantation and early recurrence. Also, it does not allow the pathologist to define the correct spatial orientation of the specimen. The development of en bloc resection of bladder tumor (ERBT) has helped overcome the abovementioned key disadvantages of TURBT. However, many urologists doubt whether this approach is feasible for treating larger tumors. RECENT FINDINGS:In this review, it is shown that ERBT of large bladder tumor (>3 cm) is in fact a feasible and well tolerated method. Although there is a lack of comparative data proving its advantages over TURBT, en bloc in large tumor seems to result in better local cancer control (due to higher prevalence of detrusor specimen, lower need for re-TURBT), lower rate of relapse outside the resection area (due to lower risk of tumor cells circulation), and higher quality of pathology specimen. SUMMARY:Despite the skepticism of some surgeons, potential difficulties caused by larger tumor size may be overcome easily, and most agree that tumor size should not limit the implementation of the method in their daily practice.

Circulating tumor cells (CTCs) in prostate cancer (PCa) have been an area of interest over the past 35 years. The aim of this narrative review is to summarize data on CTC application in PCa diagnosis. Several CTC detection tools have been developed; however, most of them only assess subpopulations expressing matching biomarkers. Thus, a combined detection system might be useful, and priority should be given to creating a universal panel that covers a broad spectrum of PCa subtypes. Expression of CD82 and several other markers carries prognostic value and correlates with stage and relapse risk. In metastatic PCa, CTC detection correlates with both survival and response to therapy. AR-V7 expression by CTCs is associated with resistance to androgen receptor signaling inhibitors (ARSis), while the response to taxanes remains unaffected. OCT4 expression in CTCs is associated with higher serum LDH levels, worse radiographic progression-free survival, and overall survival. Ezrin overexpression in CTCs is associated with bone metastasis in PCa patients. HER2-positive CTC detection correlates with worse overall and progression-free survival among patients treated with ARSis. Prostate-specific membrane antigen (PSMA) expression in CTCs was associated with metastases, lower overall survival and progression-free survival, as well as poor response to chemotherapy in mCRPCa. Overall, CTC detection for PCa screening, early diagnosis, and prognosis in localized disease offers limited added value. Conversely, in metastatic PCa it shows promising results as a prognostic marker. AR-V7 expression by CTCs is a predictor of response to ARS inhibitors, while PSMA expression in CTCs is associated with metastases, poor prognosis, and suboptimal treatment response. OCT4, HER2, and ezrin in CTCs were also predictors of poor prognosis and treatment response, but the data is limited. If explored further, microRNAs could serve as a potential alternative to circulating tumor cells, as they are - in theory - able to perform the same functions.

Benign prostatic obstruction (BPO) is a common condition. Anatomical endoscopic enucleation of the prostate (EEP) is the mainstay in therapy for large glands (> 80 ml), but also feasible in smaller prostates. The original three-lobe enucleation technique has been supplemented by two-lobe and one-lobe or en-bloc techniques. One- and two-lobe techniques seem more effective in terms of surgical time and blood loss. The impact of the different techniques on functional outcomes however is unclear. To determine whether the technique used in prostate enucleation influences functional outcomes of surgery. We performed a systematic review of Medline/Pubmed and identified 124 studies, of which 10 were included for network meta-analyses. We included RCTs as well as retrospective and prospective cohort series, comparing one-lobe, two-lobe and three-lobe technique respectively. We assessed functional outcomes including post-void residual urine, Qmax (ml/s), IPSS Score and QoL Score. Additionally we compared stress and urge incontinence rates after three months. The only significantly differing result was in postoperative Qmax increase in favor of one-lobe and two-lobe compared to three-lobe technique. However, with mean differences of 0.989 and 0.749 respectively the effect was clinically negligible. There was no difference in the other functional outcomes including incontinence rates. Our approach is limited by the quality of the data, since retrospective and non-randomized trials were included due to the overall poor amount of studies on the subject. One-lobe/en-bloc, two-lobe and three-lobe technique in endoscopic enucleation of the prostate for benign prostate syndrome all improve micturition. No final conclusion concerning superiority of a specific lobe-technique in terms of functional outcomes can be drawn from the available data. Randomized controlled trials are needed.