INTRODUCTION:Biochemical recurrence (BCR) after radical prostatectomy occurs in 20-40% of patients. Prostate-specific membrane antigen (PSMA) PET/computed tomography (CT) is the preferred imaging modality for recurrence, but detection rates decline at low prostate-specific antigen (PSA) levels. The role of PSA kinetics in postradical prostatectomy BCR remains unclear. We evaluated the association between PSA kinetics and PSMA PET/CT positivity in postradical prostatectomy BCR. MATERIALS AND METHODS:We retrospectively analyzed postradical prostatectomy patients (2013-2024) who developed BCR and underwent 68Ga-PSMA PET/CT. Patients with prior therapy, PSA persistence, inadequate follow-up, or non-PSMA imaging were excluded. Clinicopathological and PSA kinetic variables were compared between groups. Logistic regression assessed associations with PET positivity, and receiver operating characteristic (ROC) analysis identified exploratory cut-offs. RESULTS:Of 973 men who underwent radical prostatectomy, 64 met the inclusion criteria. Nineteen (29.7%) had positive and 45 (70.3%) had negative scans. Baseline characteristics were comparable. Median PSA at imaging was 0.30 ng/ml. PET-positive patients had higher PSA velocity (PSAV) (0.58 vs. 0.27 ng/ml/year; P = 0.020) and shorter PSA doubling time (PSADT) (3.23 vs. 5.80 months; P = 0.009). On univariable analysis, PSAV [odds ratio (OR): 3.31, P = 0.027), PSADT (OR: 0.86, P = 0.050), and PSA at imaging (OR: 10.68, P = 0.032) were associated with PET positivity. ROC analysis showed moderate discrimination for PSADT (AUC: 0.71) and PSAV (AUC: 0.69). CONCLUSION:Shorter PSADT and higher PSAV predicted PSMA PET positivity in men with BCR after radical prostatectomy. Exploratory cut-offs of PSADT less than 3.9 months and PSAV more than 0.54 ng/ml/year were identified but require external validation.

Abstract Background: Intradiverticular bladder tumors (IDBTs) are rare urothelial malignancies arising within bladder diverticula and pose unique diagnostic and therapeutic challenges due to altered anatomy and absence of the muscularis propria. Materials and Methods: We retrospectively reviewed the institutional bladder cancer database for IDBTs managed between 2010 and 2024. Clinical presentation, imaging findings, cystoscopic features, histopathology, management strategies, and outcomes were analyzed. Results: All patients were male, with a median age of 70 years. Hematuria was the most common presenting symptom (80%). Tumors were predominantly high-grade urothelial carcinomas arising from lateral (40%), posterior wall (20%), or bladder base (20%) diverticula. Management included transurethral resection (60%), partial cystectomy with diverticulectomy (20%), and radical cystectomy (20%) based on the tumor extent and patient factors. At a median follow-up of 14 months, all patients remained disease-free. Conclusion: IDBTs are uncommon but clinically significant tumors that frequently exhibit aggressive behavior and staging uncertainty. Early recognition and individualized surgical management are critical for optimal outcomes.

Small renal masses (SRMs), defined as renal tumors < 4 cm, are increasingly detected due to the widespread use of imaging modalities. Data from India regarding the clinical characteristics and outcomes of SRMs remain limited. This multi-institutional study led by the Society of Genitourinary Oncologists aims to delineate the demographic, radiological, and pathological profiles of SRMs in the Indian population and evaluate management outcomes following partial nephrectomy. A retrospective analysis was conducted across multiple tertiary care centers in India from January 2013 to December 2022. Patients aged ≥ 18 years with SRMs undergoing partial nephrectomy were included. Data on demographics, clinical presentation, radiology (including RENAL nephrometry score), intraoperative factors, postoperative outcomes, and histopathology were analyzed. Statistical associations between renal scores, BMI, tumor stage, and histologic type were assessed. A total of 432 patients were analyzed, with a male predominance (76.6

Introduction & Objectives Biochemical recurrence (BCR) after radical prostatectomy (RP) occurs in approximately 20–40%. PSMA PET/CT is the preferred imaging modality for detecting recurrence; however, detection rates decline sharply when PSA is < 1 ng/mL, leading to more negative scans, added costs and radiation exposure. PSA kinetics, which reflect tumour aggressiveness, have been correlated with PET positivity in mixed cohorts, but their role in post-prostatectomy BCR exclusively remains unclear. Our study aimed to evaluate the association between PSA kinetics and PSMA PET/CT positivity in post-RP BCR and to define clinically relevant kinetic cut-offs to improve imaging yield. Materials & Methods A retrospective analysis of post-RP patients (2013–2024) who developed BCR and underwent 68Ga-PSMA PET/CT was performed. Patients with prior therapy, PSA persistence, inadequate follow-up, or non-PSMA imaging were excluded. Institutional Ethics Committee approval was obtained prior to data collection. Baseline, pathological, and PSA kinetic parameters were compared between PET-positive and PET-negative cohorts. Logistic regression was used to assess correlation between PSA kinetics and PET positivity, and ROC analysis identified optimal cut-offs. Results A total of 973 men underwent RP during the study period. After applying the inclusion and exclusion criteria, 64 patients were included in final analysis. The median age was 67 years. 19 patients (29.7%) had positive scans, while 45 (70.3%) had negative scans. Baseline and pathological characteristics were comparable between the two groups. Median PSA at the time of imaging was 0.58 ng/mL. PSA kinetics differed significantly between groups. PET-positive patients had higher PSA velocity (1.50 ± 2.20 vs 0.39 ± 0.42 ng/mL/year, p = 0.02) and shorter doubling time (4.40 ± 4.03 vs 8.68 ± 7.91 months, p = 0.009). On univariate analysis, PSA velocity (PSAV) (OR 3.31, 95% CI 1.14–9.58, p = 0.027), PSA doubling time (PSADT) (OR 0.86, 95% CI 0.75–1.00, p = 0.050), and PSA at imaging (OR 10.68, 95% CI 1.23–93.11, p = 0.032) were significant predictors of PET positivity. On ROC analysis, PSA-DT and PSAV showed good discriminatory power (AUC 0.71 and 0.69, respectively) with optimal cut-offs of 3.8 months and 0.5 ng/mL/year respectively. Conclusion Patients with PSA-DT < 4 months or PSAV > 0.5 ng/mL/year are more likely to have positive scans. Integration of PSA kinetics into imaging decisions can improve the yield. However, prospective studies with large sample size are needed for validation.

Abstract Primary vaginal malignant melanoma is an extremely rare and aggressive cancer, accounting for less than 3% of melanomas involving the female genital tract. Due to its nonspecific presentation, diagnosis is often delayed, and no standardized treatment protocol exists. A 63-year-old postmenopausal woman presented with persistent vaginal discharge, anorexia, and weight loss. Clinical evaluation and biopsy of a vaginal lesion revealed malignant melanoma. Magnetic resonance imaging demonstrated vaginal and urethral involvement. Histopathology revealed malignant melanoma, positive for S-100, SOX-10, vimentin, and focal HMB-45. Following a multidisciplinary evaluation, she underwent total abdominal hysterectomy, bilateral salpingo-oophorectomy, total vaginectomy, urethrectomy, and Mitrofanoff (appendicovesicostomy) urinary diversion. Histopathology confirmed melanoma with a Breslow thickness of 4 mm and negative margins. She received adjuvant pelvic radiotherapy and was trained in clean intermittent self-catheterization (CISC). At 33 months post-treatment, the patient remains disease-free and functionally independent, with successful CISC. This case emphasizes the role of individualized surgical planning and continent urinary reconstruction following urethrectomy in the management of locally advanced vaginal melanoma. A multidisciplinary approach and individualized intervention are essential to optimize outcomes in such rare gynecologic malignancies.

Introduction:Two-dimensional (2D) imaging has traditionally guided surgical planning for partial nephrectomy (PN). However, it has limitations in depicting complex renal anatomy. Three-dimensional (3D) CT reconstructions may enhance spatial understanding, but evidence of their added value remains limited. This study evaluates the role of 3D reconstruction in preoperative planning. Materials and Methods:This was a prospective, observational, single-center cohort study conducted between June 2021 and October 2023. Patients with cT1 renal masses planned for robotic PN willing for additional 3D reconstruction were enrolled. Preoperative predictions were made first with 2D computed tomography and then with combined 2D+3D reconstructions across seven parameters: Sinus dissection, selective clamping, margin status, warm ischemia (<30 min), pelvicalyceal system (PCS) entry, venous clamping, and vascular injury. Predictions were compared with intraoperative findings. Results:Fifty-four patients with cT1 renal masses were included in the study. The median age of the patients was 49 years, and most tumors were solitary (90.7%) and of moderate complexity (64.8%). Trifecta outcomes were achieved in 92.6%. Incorporating 3D reconstruction resulted in consistent descriptive improvements in predictive accuracy of 3.7%-9.2%, although statistical significance was not reached. McNemar's test demonstrated statistically significant discordance between 2D+3D-based prediction and intraoperative findings for warm ischemia time (11 patients), PCS entry (21 patients), and major vascular injury (7 patients). Nevertheless, predictive accuracy and Cohen's kappa values favored combined imaging. Conclusion:Integration of 3D reconstruction with 2D improved the accuracy of preoperative prediction of intraoperative events, thereby supporting more informed preoperative planning. Further studies with larger sample size are warranted to identify tumor complexity subsets that derive the greatest benefit and the impact on the learning curve of PN.

Introduction:Existing retrospective evidence suggests cytoreductive nephrectomy (CN) may benefit patients suffering metastatic renal cell carcinoma, but optimal patient selection criteria are unclear. We evaluated outcomes following CN to identify factors influencing survival to guide patient selection. Methods:We retrospectively reviewed patients who underwent CN from January 2011 to December 2023. Data on demographics, treatment, and survival outcomes were analyzed. Kaplan-Meier estimates calculated progression-free survival (PFS) and overall survival (OS). Cox regression models identified prognostic factors. Results:Of 1346 surgeries performed for RCC during the study period, 63 were performed with cytoreductive intent. Median (IQR) age was 57 (50-65) years, and 79.4% were male. Median PFS was 13.0 (95% confidence interval [CI], 2.5-23.5) months. Diabetes mellitus (DM) (hazard ratio [HR] 2.4, 95% CI 1.1-5.5, P = 0.03) and presentation with systemic symptoms (SS) (HR 3.0, 95% CI 1.4-6.7, P = 0.01) were associated with shorter PFS. Median OS was 54.0 (95% CI, 22.7-85.3) months. Multiple metastatic sites (HR 4.5, 95% CI 1.4-14.3, P = 0.01), rhabdoid differentiation (RD) (HR 3.5, 95% CI 1.1-10.9, P = 0.03), sarcomatoid differentiation (SD) (HR 4.3, 95% CI 1.2-16.1, P = 0.03), and DM (HR 5.4, 95% CI 1.8-16.0, P < 0.01) predicted worse OS. Conversely, year of diagnosis ≥ 2019 was associated with better PFS (HR 0.9, 95% CI 0.8-0.9, P = 0.03) and OS (HR 0.7, 95% CI 0.6-0.8, P < 0.01). Conclusion:The presence of a single site of metastasis is associated with better OS after CN and can serve as a useful criterion to select patients that are most likely to derive benefit from CN. Presentation with SS, RD/SD, and DM predicts poorer outcomes, informing decision-making for CN in metastatic renal cell carcinoma.

INTRODUCTION:Robotic-assisted partial nephrectomy (RPN) is increasingly recognized as an effective treatment for small renal masses. This study aims to highlight the therapeutic benefits of RPN for both small and relatively larger renal masses in the Indian population. METHODS:A retrospective chart review was conducted on patients who underwent RPN using the da Vinci surgical system between September 2010 and September 2022 across 14 centers located in various cities of India, including Ahmedabad, Bengaluru, Chandigarh, Chennai, Delhi, Gurugram, Hyderabad, Kochi, and Nadiad. Data on demographics, medical history, clinical characteristics, and perioperative, functional, and oncological outcomes were extracted from medical records and analyzed statistically. RESULTS:A total of 1,267 patients were included in the study, with 757 in the T1a tumor group and 510 in the T1b+T2 tumor group. In terms of baseline characteristics, the two groups showed a significant difference (p < 0.001) in renal nephrometry score (RENAL score). The mean operating room time (201.31 ± 77.57 vs. 191.06 ± 74.51; p = 0.0021) and warm ischemia time (25.21 ± 8.08 vs. 22.51 ± 7.95; p < 0.001) were significantly higher in the T1b+T2 tumor groups. Other outcomes were comparable, namely, length of hospital stay (4.21 ± 2.47 vs. 4.05 ± 2.30 days; p = 0.2459), postoperative complications (3.33% vs. 2.11%; p = 0.181), conversion rates (0% vs. 0%), and surgical margins (3.04 vs. 4.31%, p = 0.229). There was no difference in recurrence rates, and no significant differences were observed in the functional outcomes between the two groups. CONCLUSION:RPN provides encouraging surgical, oncological, and functional outcomes for both T1a and T1b+T2 renal masses, enabling nephron-sparing surgery and early recovery of renal function.

Introduction:Despite level 1 evidence supporting neoadjuvant chemotherapy (NACT) followed by radical cystectomy (RC) for muscle-invasive bladder cancer (MIBC), its adoption is hindered by concerns about toxicity and detrimental impact on post-RC complications. We retrospectively reviewed post-RC complications at a tertiary care hospital, particularly assessing impact of NACT. Methods:Data from the institutional bladder cancer database were retrieved for patients aged ≥18 with MIBC (≥American Joint Committee on Cancer Clinical Stage T2), treated with RC between May 2013 and July 2023. Exclusions were nonurothelial histology, salvage cystectomy, and palliative intent. Data abstracted included patient characteristics, NACT administration, surgery, and outcomes. Patients were divided into two groups based on NACT and compared. Complications were categorized as early (≤30 days) or late (31-90 days) and graded. Statistical analysis set significance at P < 0.05. Results:Of 154 patients who underwent RC, 33 were excluded due to non-MIBC, nonurothelial histology, or salvage cystectomy. The 121 patients analyzed had a mean age of 64 years and a Charlson Comorbidity Index (CCI) of 4.9. Among them, 61 received NACT and 60 did not. There was no significant difference between the NACT+RC and RC-only groups in overall complication rates (85.3% vs. 75.0%, P = 0.16) or in major complications (50.8% vs. 58.3%, P = 0.41). CCI >5 predicted major complications, while NACT did not. Conclusion:In our study of MIBC patients managed at a tertiary care institute in India, NACT administration did not increase postoperative complications.

Background:Prostate cancer is the second most common malignancy globally amongst men. While prostate-specific antigen (PSA) screening aids in early detection, prostate biopsy remains the diagnostic gold standard. However, the biopsy practices vary widely across various Indian centers. This study aimed to evaluate the current biopsy techniques, indications, complications, and diagnostic yield across multiple institutions. Methods:A prospective, multi-center observational study was conducted from June 14, 2023, to June 14, 2024, under the Urological Society of India Collaborative Research Committee. Data from 2479 patients across 43 institutions were collected using a standardized template. Men aged ≥40 years undergoing initial or repeat biopsies were included. Variables included demographics, PSA levels, imaging, biopsy route and technique, antibiotic prophylaxis, pain scores, complications, and histopathology. Analysis was performed using SPSS v23. Results:Elevated PSA was the primary indication of biopsy in 95.2% of the patients (median: 19.8 ng/ml). The transrectal route was used in 91.8% of the patients whereas the transperineal was used in 6.4%. Multiparametric magnetic resonance imaging was performed in 45%, with targeted cores in 15.6% of the patients. PIRADS 5 lesions had a cancer detection rate (CDR) of 81.4%, while PIRADS 2 had CDR of 23.1%; no cancers were found in PIRADS 2 lesions in repeat biopsy settings. Adenocarcinoma was diagnosed in 61% of the patients. Transrectal biopsies had a higher CDR (61.3% vs. 47.2%; P < 0.05) but also higher infection rates (3.3% vs. 0%; P = 0.03). Overall complication rate was 11%, with hematuria >1 day being the most common (6.5%) complication. Conclusion:This large, multi-institutional study highlights significant variability in prostate biopsy practices in India and emphasizes the need for standardized training to improve the diagnostic outcomes and safety.

Immunoglobulin G4-related disease (IgG4-RD) is a systemic fibro-inflammatory condition first recognized in 2001, primarily associated with autoimmune pancreatitis, and later identified in various organ systems. The peculiar tendency to form tumefactive lesions mimics infiltrative malignancy, leading to misdiagnosis and inappropriate treatment. Involvement of the urinary tract and its presentation to urologists remain uncommon, with only a limited number of published case reports. We report our experience with IgG4-RD, elucidating the clinical presentations, diagnostic dilemmas, and subsequent management of four patients. Each case was initially presented as a diagnostic challenge, necessitating multidisciplinary discussion. Presentations included renal pelvic masses (unilateral and bilateral), a suprarenal mass, and a retroperitoneal mass causing bilateral hydroureteronephrosis. In all cases, initial imaging raised the suspicion of malignancy, prompting aggressive surgical interventions, including nephroureterectomy, nephrectomy, and partial nephrectomy. Subsequent histopathological evaluation confirmed the diagnosis of IgG4-related disease. IgG4-RD in the urinary tract is uncommon often mimicking malignancy. Early suspicion and minimally invasive biopsy for accurate tissue diagnosis, along with multidisciplinary evaluation, is crucial for diagnosing IgG4-related disease involving the urinary tract and avoiding unnecessary extirpative surgery.

Introduction:Recently, the Prostate Imaging Reporting and Data System - 3 lesions (PI-RADS 3) have been sub classified into "3a" - lesions with a volume of <0.5 mL and "3b" - lesions exceeding 0.5 mL, whereas the prostate-specific antigen density (PSAD) is an established adjunct tool for predicting clinically significant prostate cancer (csPCa). The objective of this study was to evaluate the association between the volume of PI-RADS 3 lesions and PSAD in diagnosing csPCa and to assess the sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) when PSAD is combined with the lesion volume. Methods:This retrospective single-center study reviewed the data of transperineal prostate biopsies performed under transrectal ultrasound guidance from January 2018 to December 2023. csPCa was defined as a Gleason score >= 3 + 4. Patients were divided into two groups based on the PIRADS-3 subclassification and PSAD. Results:Out of the 108 PIRADS-3 lesions, 17 patients had csPCa. All the patients with PIRADS-3a (n = 37) had clinically insignificant tumors or benign conditions. Receiver operating characteristic curve analysis for predicting csPCa showed that the (Area under the curve) AUC values of PSAD, prostate volume, and prostate-specific antigen were 0.899, 0.746, and 0.381, respectively. 16 csPCa patients in PIRADS-3b category had PSAD >= 0.29 ng/ml2, whereas 1 patient had PSAD <0.29 ng/ml2. Sensitivity, specificity, PPV, and NPV of PIRADS-3b lesions were 100%, 40.66%, 23.94%, and 100%, respectively, and it became 94.12%, 74.07%, 53.33%, and 97.56%, respectively, when PSAD was added to PIRADS-3b lesions. Conclusion:The combination of lesion volume of the PI-RADS 3 lesion and PSAD improved the PPV and specificity of detecting csPCa.

Abstract Chondrosarcomas are the second-most common bone tumors and are known to occur in the pelvis. However, invasion into the urinary bladder is rare. We report a rare case of a primary chondrosarcoma invading the urinary bladder and the prostate requiring wide excision with cystoprostatectomy and reconstruction. On initial evaluation, a 48-year-old male patient presented with obstructive lower urinary tract symptoms and was suspected to have a prostate mass. He underwent a transurethral resection biopsy of the mass at an outside hospital which showed features of a chondrosarcoma. Further imaging by magnetic resonance imaging scan at our hospital showed a large 9.5 cm × 8.3 cm mass arising from the right pubic bone, infiltrating the urinary bladder and the prostate. Metastatic workup was negative. He underwent wide local excision of the mass, cystoprostatectomy, and diversion with an ileal conduit. The orthopedic team and plastic surgery teams were involved. Reconstruction was done using recon plates and prolene mesh placement to fill the empty cavity. He had a surgical site infection in the postoperative period which required multiple debridements and gracilis flap interposition. He recovered well and was discharged on the postoperative day 20. Final histopathology showed a well-differentiated chondrosarcoma with negative surgical margins. Primary chondrosarcomas are rare and infiltration into the urinary bladder is uncommon. Surgical treatment with negative margins is the mainstay of treatment. These tumors are resistant to chemotherapy and radiotherapy.

Summary The 2022 WHO classification of urinary tract tumors identifies several less common subtypes of invasive urothelial carcinoma, all of which are classified as high-grade. Reporting the percentage of divergent differentiation or specific subtypes is recommended whenever feasible. The role of neoadjuvant and adjuvant chemotherapy in these histologies is still uncertain, as prospective data are limited. This chapter emphasizes the histologic traits of divergent differentiation and bladder cancer subtypes outlined in the latest WHO classification, along with updates on their clinical characteristics.

Introduction:There is an unmet need for high-quality data for Robot-assisted partial nephrectomy (RAPN) in the Indian population. Indian study group on partial nephrectomy (ISGPN) is a consortium of Indian centers contributing to the partial nephrectomy (PN) database. The current study is a descriptive analysis of perioperative and functional outcomes following RAPN. Methods:For this study, the retrospective ISGPN database was reviewed, which included patients who underwent RAPN for renal masses at 14 centers across India from September 2010 to September 2022. Demographic, clinical, radiological, perioperative, and functional data were collected and analyzed. Ethics approval was obtained from each of the participating centers. Results:In this study, 782 patients were included, and 69.7% were male. The median age was 53 years (interquartile range [IQR 44-62]), median operative time was 180 min (IQR 133-240), median estimated blood loss was 100 mL (IQR 50-200), mean warm ischemia time was 22.7 min and positive surgical margin rates were 2.5%. The complication rate was 16.2%, and most of them were of minor grade. Trifecta and pentafecta outcomes were attained in 61.4% and 60% of patients, respectively. Conclusions:This is the largest Indian multi-centric study using the Indian Robotic PN Collaborative database to evaluate the outcomes of robot-assisted PN, and has proven its safety and efficacy in the management of renal masses.

PURPOSE:To compare diagnostic accuracy in localization and detection of extraprostatic extension (EPE), seminal vesicle invasion (SVI), lymph node involvement (LNI) between PSMA PET MRI and multiparametric MRI (mpMRI) in carcinoma prostate. METHODS:We did a prospective study of consecutive men with biopsy-proven prostate cancer who underwent radical prostatectomy between July'2020 and Dec'2021 at our institution. Patients underwent PSMA PET MRI imaging. MpMRI findings were inferred separately by another radiologist who was blinded to the PSMA PET findings. PIRADS > 2 and any standardized uptake value (SUV) were considered positive. Findings were mapped to a 30-region anatomical grid and compared with pathology. The uro-pathologist also marked the presence of the tumor onto the same anatomical grid. The presence of EPE, SVI, and LVI was noted. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS:The significance in difference: McNemar test. SUVmax and Gleason score: Kruskal-Wallis test. RESULTS:Seventy-five men (mean age 65) with an average PSA of 21.5 ng/ml were included. The sensitivity of PSMA PET MRI for localization was higher [63.6 vs 41.9] (p < 0.001) while specificity was similar [81.5 vs 83.2] (p 0.103). The former had a higher sensitivity to detect SVI [85.7 vs 57.10] (p = 0.03). No difference in the detection of EPE or LNI was noted. SUVmax > 7 was associated with high-risk disease (Gleason score >/= 7). LIMITATIONS:non-randomized nature, higher risk population. CONCLUSION:Ga-PSMA PET MRI improved the localization of prostate cancer and better detection of SVI. Further studies are required. It can act as a single-stop investigation for the primary staging of prostate cancer.

Objectives In this study, we evaluated the risk factors for urinary retention after freehand transrectal ultrasound (TRUS) guided transperineal prostate biopsy (TPB). Patients and Methods Data from 102 cases of freehand TPB at a single institution were retrospectively collected and analyzed. All patients underwent magnetic resonance imaging (MRI)-TRUS cognitive fusion TPB using a transperineal needle guide, with systematic biopsies from 10 prostate sectors and additional MRI-guided targeted biopsies. Exclusions comprised patients with coagulation abnormalities, prior prostate surgeries including biopsy, active urinary tract infection, or a lack of pre-biopsy multiparametric MRI. Results 14/102 (13.72%) had urinary retention and required urethral catheterization for voiding difficulty or discomfort along with a bladder volume of ≥500 ml. Patients with retention exhibited significantly larger prostate volumes (median 75 cc vs. 40 cc; P < 0.05). Receiver operating curve analysis revealed a prostate volume threshold of 57.5 cc and a core number cutoff of 23 for predicting post-TPB urinary retention, with sensitivities of 78.57% and 85.71%, specificities of 75% and 82.95%, positive predictive values of 33.33% and 44.44%, and negative predictive values of 95.75% and 97.33%, respectively, whereas the number of biopsy cores correlated positively with the development of urinary retention (median 25 vs. 22; P < 0.05). Urinary retention was independent of the patient’s age, comorbidities, presenting prostate-specific antigen levels, prebiopsy severity of lower urinary tract symptoms, and use of alpha-blockers. Conclusion Patients with larger prostates and higher number of biopsy cores are at a higher risk of postfreehand TPB urinary retention and should receive appropriate counselling. Targeted biopsies alone, rather than a full template, may help mitigate urinary retention in these high-risk groups.

Objective Retroperitoneal lymph node dissection (RPLND) is a recommended surgical treatment for nonseminomatous germ cell testicular cancer (NSGCT), in post-chemotherapy residual retroperitoneal lymphnode masses. In this video, we present our novel surgical approach, termed robot-assisted supine extraperitoneal RPLND (RASE-RPLND), for managing retroperitoneal lymph metastasis in NSGCT. Patients and surgical procedure A 32-year-old married gentleman who was initially diagnosed to have NSGCT of left testicle and Stage T1N2M0S2, received four cycles of BEP chemotherapy, showed a residual para-aortic lymph node measuring 3.5 × 2.4 cm on follow up and was planned for RPLND. He underwent RASE-RPLND and the retroperitoneum was approached from the right flank and dissection was done across the midline to the opposite side to clear all residual lymph nodular masses. The entire paracaval, interaortocaval, and para-aortic lymph nodes were removed according to the standard bilateral template. Postganglionic sympathetic efferent fibers were preserved. Following sufficient vascular control, a portion of the left renal vein was resected along with the nodal mass, and the vein was subsequently repaired using prolene suture. Patient was discharged after 48 h. Results We performed 13 cases of RASE-RPLND in post-chemotherapy patients, with a mean age of 27.8 ± 6.64 years and BMI of 22.8 ± 2.26Kg/m2. All cases involved NSGCT. The median operative time was 350 min with 180 ml mean blood loss. One patient required preoperative IVC filter placement, and two cases needed conversion due to adhesions and pneumoperitoneum. A renal vein injury was repaired intraoperatively. Postoperatively, lymphocele was the most common complication, managed conservatively. Conclusion Nerve-sparing RPLND via the RASE approach in a post-chemotherapy setting shows favourable outcomes, including minimal bowel handling, managing intra-operative challenging situations and, early post-operative recovery. Complicated vascular reconstruction is possible with this approach.

You have accessJournal of UrologyCME1 Apr 2023PD22-05 IS PRE OPERATIVE PSMA (PROSTATE SPECIFIC MEMBRANE ANTIGEN) PET/CT A RELIABLE PREDICTOR OF PELVIC LYMPH NODE METASTASIS IN INTERMEDIATE AND HIGH RISK LOCALISED PROSTATE CANCER:A MULTI CENTRE RETROSPECTIVE ANALYSIS Kishore Ta, Dinesh Cherian, Deepak Kaddu, Bikramjit Sodhi, Ravi Chandran, and Ginil Kumar Pooleri Kishore TaKishore Ta More articles by this author , Dinesh CherianDinesh Cherian More articles by this author , Deepak KadduDeepak Kaddu More articles by this author , Bikramjit SodhiBikramjit Sodhi More articles by this author , Ravi ChandranRavi Chandran More articles by this author , and Ginil Kumar PooleriGinil Kumar Pooleri More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003295.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Functional imaging techniques have been incorporated into conventional anatomical imaging to help improve identification of metastasis in normal sized nodes The primary objective of this study was to retrospectively analyse the percentage of patients “negative for metastasis” on 68Ga PSMA PETCT that translated to absent pelvic node metastasis on histopathology (Negative predictive value-NPV). The secondary objective was to analyse if pathological T stage and biopsy ISUP grades influenced the NPV of the PSMA PET CT. METHODS: A total of 217 biopsy-proven, treatment-naive, intermediate and high-risk (D’Amico classification) localised prostate cancer patients from two institutions were included in the study. All the patients had undergone a pre operative PSMA PET/ CT assessment of their pelvic lymph nodes and the patients “negative for metastasis” underwent Robotic assisted radical prostatectomy with extended pelvic lymph node dissection-ePLND. RESULTS: 49/217 patients had positive nodes despite PSMA PET/CT showing no evidence of lymph node metastasis,of which 27(55.10%) of them were obese. Thus the negative predictive value(NPV) was 77.42%. The NPV of PSMA PET CT in patients with intermediate risk prostate cancer was 86.9% compared to 71.43% in patients with high risk prostate cancer. As the ISUP biopsy grade increased the NPV decreased from 94.12% in ISUP 1 to 44.83%(p<0.0001) in ISUP 5.On retrospective analysis, all intermediate risk patients with a

Bioengineered 3D models that can mimic patient-specific pathologies in vitro are valuable tools for developing and validating anticancer therapeutics. In this study, microfibrillar matrices with unique structural and functional properties were fabricated as 3D spherical and disc-shaped scaffolds with highly interconnected pores and the potential of the newly developed scaffolds for developing prostate cancer model has been investigated. The newly developed scaffolds showed improved cell retention upon seeding with cancer cells compared to conventional electrospun scaffolds. They facilitated rapid growth and deposition of cancer-specific extracellular matrix through-the-thickness of the scaffold. Compared to the prostate cancer cells grown in 2D culture, the newly developed prostate cancer model showed increased resistance to the chemodrug Docetaxel regardless of the drug concentration or the treatment frequency. A significant reduction in the cell number was observed within one week after the drug treatment in the 2D culture for both PC3 and patient-derived cells. Interestingly, almost 20%-30% of the cancer cells in the newly developed 3D model survived the drug treatment, and the patient-derived cells were more resistant than the tested cell line PC3. The results from this study indicate the potential of the newly developed prostate cancer model for in vitro drug testing.