BACKGROUND/OBJECTIVES:Bladder carcinoma (BC) is strongly associated with tobacco exposure, a major shared risk factor for several smoking-related diseases (SRDs), including pulmonary disorders and coronary atherosclerosis. However, the prevalence of SRDs in patients with high-grade (HGBC) or muscle-invasive bladder carcinoma (MIBC) has not been systematically investigated. We aimed to evaluate SRD prevalence and to assess the potential role of chest high-resolution computed tomography (HRCT) in a population with histologically confirmed HGBC or MIBC. METHODS:We retrospectively analyzed 166 patients with histologically confirmed HGBC/MIBC who underwent staging HRCT. SRDs-including emphysema, suspicious pulmonary nodules, airway disease, interstitial lung disease (ILD), and coronary artery calcifications (CAC)-were assessed. Associations between smoking status and SRDs were evaluated using binary logistic regression, and odds ratios (OR) with 95% confidence intervals (CI) were calculated. RESULTS:Overall, 60.2% of patients had at least one SRD. Smokers showed a significantly higher SRD prevalence than non-smokers (p < 0.05). Pulmonary SRDs were observed in 31.9% of patients, with emphysema being most strongly associated with smoking (p < 0.01). Suspicious pulmonary nodules (Lung-RADS ≥ 3) were detected in 6.6% of patients, more commonly among smokers (72.7%), though the difference was not statistically significant. Histological confirmation, available for 45% of these nodules, revealed primary lung cancers rather than metastatic bladder carcinoma in all verified cases. CONCLUSIONS:Patients with HGBC/MIBC demonstrate a high prevalence of SRDs, supporting the integration of chest HRCT into staging protocols. HRCT may enable early detection of clinically relevant comorbidities and help identify candidates for lung cancer screening.

OBJECTIVES:To evaluate the utility of routine intra-operative frozen section analysis (iFSA) of distal ureteric margins during radical cystectomy (RC) for bladder cancer (BCa), focusing on diagnostic accuracy and oncological outcomes in a high-volume tertiary centre. PATIENTS AND METHODS:We retrospectively identified 1081 patients with BCa treated with RC (2010-2024). Bilateral iFSA of the distal ureters was performed in all cases. Patients were stratified according to final distal ureteric margin status (positive vs negative); if positive, additional resections were attempted intra-operatively. Diagnostic concordance between iFSA and final pathology was calculated. Kaplan-Meier curves were used to assess 5-year upper urinary tract recurrence (UUTR) free-survival, overall survival (OS), and cancer-specific survival (CSS). Univariable logistic regression and multivariable logistic regression (MLR) models identified variables associated with positive margins. RESULTS:Overall, 139 patients (12.9%) had positive distal ureteric margins at iFSA. The sensitivity and specificity of FSA were 98.6% and 99.5%, respectively. In MLR models, hydronephrosis (odds ratio [OR] 1.75, P = 0.014), T3-T4 stage (OR 2.48, P = 0.003), bladder carcinoma in situ (CIS; OR 7.94, P < 0.001) and trigonal tumour location (OR 4.85, P < 0.001) were independently associated with positive distal ureteric margins at iFSA. Positive margins were associated with increased risk of UUTR (5-year UUTR-free survival: 58% vs 78%; P = 0.038), worse OS (5-year OS: 48% vs 67%; P = 0.039), and worse CSS (5-year CSS: 60% vs 75%; P = 0.0018). CONCLUSION:Our study showed that iFSA of distal ureteric margins during RC for BCa provided excellent diagnostic performance and enabled cancer-free anastomosis. Our findings support iFSA, especially in patients with bladder CIS, trigonal tumours, or hydronephrosis, to guide intra-operative decisions and tailor postoperative surveillance.

BACKGROUND:Solid organ transplant recipients (SOTRs) face higher cancer risk because of immunosuppressive therapy used to prevent organ rejection. We hypothesized that SOTRs treated with radical cystectomy (RC) and pelvic lymph-node dissection (PLND) for bladder cancer (UBC) might have worse survival outcomes compared to non-SOTRs. This study aims to assess survival outcomes of SOTRs treated with RC and PLND for UBC compared to non-SOTRs. METHODS:A retrospective analysis of 645 patients treated with RC and PLND for UBC, originating from our multicenter cooperation program (2002-2022), stratified in two groups according to previous solid organ transplantation. Co-primary endpoints were OS and CSS, assessed using mixed-effects Cox-analysis. Secondary endpoints included postoperative complications, readmission-rates, operation time, estimated blood loss and length of stay. RESULTS:Of the 361 patients analyzed (median follow-up: 17 months), 23 were SOTRs. SOTRs exhibited lower 12-month (70% vs. 80%) and 24-month (36% vs. 68%) OS-rates compared to non-SOTRs (P=0.011). Corresponding CSS-rates were also lower for SOTRs at 12 (81% vs. 85%) and 24 months (55% vs. 76%) (P=0.016). Multivariable Cox-regression identified a prior solid organ transplant (OR:5.2; P=0.002), higher pathologic-stage (OR:3.8; P=0.03 for pT2, OR:3.6; P=0.04 for pT3, OR:4.5; P=0.03 for pT4), and administration of "any systemic treatment" (OR:0.3; P=0.001) as OS predictors. For CSS, predictors were a prior solid organ transplant (OR:3.0; P=0.03), higher pathologic-stage (OR:9.8; P=0.04 for pT3, OR:13; P=0.02 for pT4), and administration of "any systemic treatment" (OR:0.4; P=0.03). CONCLUSIONS:Solid organ transplant recipients undergoing RC and PLND for urinary UBC have worse survival outcomes compared to non-SOTRs. Our findings may impact patient counseling, follow-up, and planning future clinical trials.

Robot-assisted nephroureterectomy (RANU) has demonstrated equal oncological outcomes and better perioperative outcomes compared to open and laparoscopic procedures for treating upper tract urothelial carcinoma (UTUC). However, RANU is still limited by technical difficulties like patient positioning, port placement, transitioning between anatomical regions and cost-effectiveness issues. The new surgical robot HUGO RAS increasing competition may spread the robotic approach also for this procedure. We aimed to demonstrate the feasibility of single docking RANU using HUGO RAS platform along with the description of our setting. We reported the first RANU performed in Europe at IRCCS Sant'Orsola Hospital (Bologna, Italy) using the HUGO™ Robot-Assisted Surgery (RAS) System. Our main goal was to demonstrate the technical feasibility of RANU with HUGO™ RAS along with its safety in terms of perioperative outcomes and complications. We also aimed to describe our surgical setup. We collected patient's characteristics, intraoperative and perioperative complications, docking time, operative time, clashing of the instruments, or technical errors of the system. The procedure was performed in a 78-year-old male with a clinically organ-confined high risk UTUC. No need for conversion to open/laparoscopic surgery was required. No intraoperative complications, instrument clashes or failure of the system that compromised the completion of the surgery were recorded. Docking, total operative, and console times were 7, 185 and 130 minutes, respectively. RANU with the HUGO™ RAS System is a feasible and safe procedure in terms of perioperative outcomes and complications. Our setup allowed a rapid docking procedure and a smoothly completion of the surgery.

Aims: To compare the oncological outcomes of patients with high-risk localized prostate cancer undergoing nerve-sparing and non-nerve-sparing robot-assisted radical prostatectomy (RARP). Methods: Between November 2002 and December 2018, we prospectively recorded the data of patients undergoing RARP for high-risk localized prostate cancer (PCa) at our tertiary referral center. NSS (nerve-sparing surgery) was carefully offered on the basis of the preoperative clinical characteristics of the patients and an intraoperative assessment. The patients were stratified into two groups: nerve-sparing and non-nerve-sparing groups (yes/no). Radical prostatectomies were performed by 10 surgeons with a robot-assisted technique using a daVinci® surgical system. The primary oncological outcome evaluated was biochemical recurrence (BCR). The secondary oncological outcomes assessed were positive surgical margins (PSMs) and cancer-specific survival (CSS). Results: A total of 779 patients were included in the study: 429 (55.1%) underwent NSS while 350 (44.9%) underwent non-NSS. After a mean (±SD) follow-up of 192 (±14) months, 328 (42.1%) patients developed BCR; no significant difference was found between the NSS and non-NSS groups (156 vs. 172; p = 0.09). Both our univariable and multivariable analyses found that the nerve-sparing approach was not a predictor of BCR (p > 0.05). Kaplan–Mayer survival curves for BCR showed no significant difference among the non-NSS, unilateral NSS, and bilateral NSS groups (log rank test = 0.6). PSMs were reported after RARPs for 254 (32.6%) patients, with no significant difference between the NSS and non-NSS group (143 vs. 111; p = 0.5). In the subgroup of 15 patients who died during the follow-up period, mean (±SD) CSS was 70.5 (±26.1) months, with no significant difference between the NSS and non-NSS groups (mean CSS: 70.3 vs. 70.7 months). Conclusions: NSS does not appear to negatively impact the oncological outcomes of patients with high-risk PCa. Randomized clinical trials are needed to confirm our promising findings.

Nerve-sparing vs. non nerve sparing surgery (NSS vs. non-NSS) is associated with improved functional outcomes in prostatectomy patients. The aim of the present study is to compare the oncological outcomes of patients with high-risk localized prostate cancer undergoing nerve-sparing and non nerve-sparing robot-assisted radical prostatectomy (RARP). Between November 2002 and December 2018, we prospectively recorded data of patients undergoing RARP for high-risk localized prostate cancer (PCa). NSS (nerve-sparing surgery) was offered based on preoperative clinical characteristics of patients and intraoperative assessment. Patients were stratified into 2 groups according to NSS. The primary outcome was biochemical recurrence (BCR), while positive surgical margin (PSM) and cancer-specific survival (CSS) were secondary outcomes. Logistic regression was used to investigate predictive factors. A total of 779 patients were included in the study, 429 (55.1%) underwent NSS while 350 (44.9%) underwent a non-NSS. After a mean (±SD) follow-up of 192 (±14) months, 328 (42.1%) patients developed BCR, no significant difference was found between NSS and non-NSS group (156 vs. 172; p=0.09). Both univariable and multivariable analysis found that nerve-sparing approach was not a predictor of BCR (p>0.05). NSS vs. non-NSS was not associated with worse oncological outcomes in patients with high-risk PCa