Introduction: Clinical staging based on digital rectal examination is imprecise, leading to pathological upstaging in patients with prostate cancer (PCa). Accurate preoperative assessment remains a challenge despite the use of multiparametric magnetic resonance imaging (mpMRI) and fusion-guided biopsy. This study aims to identify key predictors of upstaging in preoperative patients. Materials and Methods: A retrospective analysis of 924 patients who underwent radical prostatectomy between July 2012 and January 2025 was performed. Variables included prostate-specific antigen, prostate volume, biopsy type, MRI, body mass index and age. Upstaging was defined as ≥pT3 in patients staged clinically as cT1-2. Optimal cut-offs for continuous variables were defined statistically. Multivariable logistic regression was applied to identify independent predictors of upstaging and minor staging upgrading (MSU)-defined as any upward shift in the pathological T stage relative to the clinical T stage. Model performance was evaluated using the area under the Receiver Operating Characteristic (ROC) curve (AUC). Results: Upstaging occurred in 31.9% and MSU in 50.6% of patients. The mean age was 65 years. Cut-off values for PSA density (PSAD) were 0.29 for upstaging and 0.28 for MSU. In the full-cohort model (AUC = 0.628), PSAD (odds ratio (OR) = 2.55), age (OR = 1.04), and hypertension (HT) (OR = 1.47) were associated with upstaging. In PIRADS-based models, PIRADS 5 and PSAD predicted both upstaging (OR = 1.62 and 6.10, respectively; AUC = 0.664) and MSU (OR = 1.75 and 4.67, respectively; AUC = 0.659). MSU was also associated with HT and a lack of fusion biopsy (AUC = 0.622). Conclusions: PSAD and PIRADS 5 lesions are strong determinants of pathological upstaging and MSU in PCa. These factors should be considered in preoperative risk stratification to improve staging accuracy. Despite advances in imaging and biopsy techniques, upstaging remains a common phenomenon, underlining the need for further refinement of diagnostic protocols.

BACKGROUND AND OBJECTIVE:Patients undergoing radical cystectomy (RC) for bladder cancer may present with synchronous or metachronous upper tract urothelial carcinoma (UTUC). These scenarios may differ in oncological outcomes and surgical complexity. This study sought to compare oncologic and perioperative outcomes in patients undergoing RC and radical nephroureterectomy (RNU) for synchronous or metachronous UTUC. METHODS:Data from 23 tertiary referral centers were retrospectively collected (2002-2024). Perioperative outcomes included length of stay (LOS) and complications (Clavien-Dindo classification). Disease-free survival (DFS), cancer-specific survival (CSS) and overall survival (OS) were estimated from RC using Kaplan-Meier and landmark analysis. Multivariable Cox regression modeling identified predictors of DFS and OS and explored the impact of RNU timing on oncological outcomes. KEY FINDINGS AND LIMITATIONS:Among 177 RC patients (n = 142 [80%] males), 106 (60%) underwent RNU subsequent to RC for metachronous UTUC. Concomitant RC and RNU led to longer LOS (10 vs. 7 days, P = 0.004), and statistically significant higher rate of major complications (Clavien-Dindo ≥ IIIa, 29.6% vs. 15.1%, P = 0.03). Metachronous disease showed better 60-month DFS (69.1% vs. 47.6%), CSS (80.3% vs. 66.4%) and OS (69.2% vs. 47.6%). Histological subtype at RNU independently predicted worse DFS (HR 2.64, P = 0.01) and OS (HR 3.22, P = 0.01), while metachronous presentation predicted better DFS (HR 0.36, P < 0.001) and OS (HR 0.53, P = 0.04). Limitations include the retrospective design and a relatively limited sample size. CONCLUSIONS AND CLINICAL IMPLICATIONS:Synchronous panurothelial disease at diagnosis requiring RC and RNU is related to worse perioperative and survival outcomes compared to metachronous disease. Our results highlight the need for dedicated studies to define individualized treatment and surveillance strategies for this challenging patient population.

Robot-assisted radical prostatectomy (RARP) requires a balance between complete cancer excision and preservation of urinary continence and erectile function. Because the preservation of neurovascular bundles adjacent to the prostate surface contributes to postoperative functional recovery, intraoperative margin assessment and surgeon-guidance technologies may help refine resection and support individualized nerve-sparing decision-making. Neurovascular structure-adjacent frozen-section examination remains the most studied and clinically established method, with evidence supporting reduced positive surgical margins and broader nerve preservation, but its use is limited by cost, workflow complexity, and pathology infrastructure. Fluorescence confocal microscopy is promising but remains limited by short and apical margins; its improved accuracy for longer margins raises concerns about its reliability for routine intraoperative margin assessment. Other optical, spectroscopic, and prostate-specific membrane antigen-targeted molecular margin assessment techniques have demonstrated inconsistent diagnostic performance, with particularly low sensitivity for assessment approaches remain investigational, whereas intraoperative ultrasound, three-dimensional and augmented-reality models, fluorescence guidance, and image-enhancement systems should be viewed as surgical guidance tools rather than direct margin-assessment methods. Intraoperative technologies may improve surgical decision-making during RARP, but prospective multicenter studies with standardized oncological and functional endpoints are needed before broader adoption.

INTRODUCTION:In the majority of very high-risk and selected high-risk cases of clinically non-muscle-invasive bladder cancer (NMIBC), radical cystectomy (RC) may be performed. However, the necessity of pelvic lymph node dissection (PLND) in this clinical scenario is debated. The aim of this review was to evaluate how the presence and extent of PLND influence survival outcomes. MATERIALS AND METHODS:A systematic literature search was performed on July 6th, 2025, without language or time restrictions. Studies were considered eligible if they compared oncological outcomes between various extents of PLND during RC for NMIBC. The primary endpoint was overall survival (OS); secondary endpoints included cancer-specific survival (CSS) and recurrence-free survival (RFS). RESULTS:Nine retrospective studies comprising 20,806 patients were included. Pathological upstaging to muscle-invasive disease was observed in 19.1 %-42.0 % of patients. Seven studies evaluated OS, three CSS, and four RFS. Most studies demonstrated OS benefit associated with PLND, particularly in patients with cT1 tumors. Greater lymph node yield - especially the removal of ≥ 10 or > 20 nodes - was consistently associated with improved OS. Extended PLND was linked to better CSS and RFS in several studies. However, findings for recurrence-related outcomes were heterogeneous and endpoint definitions varied. CONCLUSIONS:PLND during RC for clinically NMIBC may be associated with improved survival, especially in patients with cT1 disease. Higher lymph node yield may further enhance oncologic benefit. These findings support the consideration of at least limited PLND during RC for clinically NMIBC. Prospective randomized studies are needed to establish definitive recommendations.

Introduction:Upper tract urothelial carcinoma (UTUC) is associated with poor survival outcomes. Therefore, providing reliable information about UTUC is crucial. Recently, chatbots powered by large language models have become a widely used information source. Our aim was to evaluate and compare responses generated by ChatGPT-4o and DeepSeek-R1 to patient-important questions regarding UTUC. Material and methods:A set of 43 questions assigned into four categories (general information, symptoms and diagnosis, treatment, prognosis) was curated. Each question was entered into DeepSeek-R1 and ChatGPT-4o. Answers were rated by two urologists using a scale from 1 (completely incorrect) to 4 (fully correct). The median score was calculated for each question. Median scores ≥3 were considered accurate. The repeatability of responses was evaluated using cosine similarity. The number of words in responses was counted. Results:The median scores for DeepSeek-R1 and ChatGPT-4o were both 3.5. There was no statistically significant difference between the scores assigned to two chatbots for all questions (p = 0.35), nor for any particular category.DeepSeek-R1 and ChatGPT-4o provided satisfactory answers for 93% and 91% of the evaluated questions, respectively. No potentially dangerous information was found. Both models consistently generated responses with moderate-high similarity (cosine similarity >0.5), except in one query. Finally, DeepSeek-R1 provided significantly longer answers than ChatGPT-4o (p <0.001). Conclusions:Both DeepSeek-R1 and ChatGPT-4o predominantly provide satisfactory responses to patient-important questions about UTUC. Artificial intelligence chatbots demonstrate potential as the first-line information sources for patients but struggle with highly specialized inquiries and thus cannot replace expert medical advice.

The comparative efficacy and safety of retrograde intrarenal surgery (RIRS) and percutaneous nephrolithotomy (PCNL) have been extensively evaluated in the general adult population; however, evidence specifically focused on older patients remains limited. Given the underrepresentation of older individuals in comparative studies and the lack of age-specific meta-analytic data, we conducted a systematic review and meta-analysis to evaluate and compare the efficacy and safety of RIRS versus PCNL in the geriatric population. A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines. Comparative studies evaluating outcomes of RIRS and PCNL in older patients were identified through comprehensive searches of PubMed/MEDLINE, Embase, Web of Science, and the Cochrane Library up to January 2026. Primary outcomes included overall, minor, and major complications, as well as stone-free rate (SFR). Subgroup analyses were performed according to the age thresholds used to define the geriatric population (≥ 60 and ≥ 65 years). Eight studies including 849 older patients (419 RIRS, 430 PCNL) were analysed. PCNL was associated with a significantly higher final SFR (OR 0.63, 95

The aim of this study was to evaluate differences in safety and efficacy outcomes of PCNL between elderly and non-elderly patients, with special focus on commonly applied age cut-off values. A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines. Comparative studies evaluating outcomes of PCNL in elderly versus non-elderly patients were identified through comprehensive searches of PubMed/MEDLINE, Embase, Web of Science, and the Cochrane Library up to February 2026. Primary outcomes included overall, minor, and major complications, as well as stone-free rate (SFR). Subgroup analyses were performed according to different age thresholds used to define elderly populations (60, 65, and 70 years). Seventeen studies encompassing 45,603 patients, including 10,745 elderly individuals, were included. When pooled across all age definitions, rates of overall complications (OR 1.20, 95

Introduction: Conservative or upfront radical management for high- and very high-risk non-muscle-invasive bladder cancer continues to be debated, particularly for cases with adverse pathological features. We aimed to compare survival outcomes among NMIBC patients treated with transurethral resection of bladder tumour (TURBT) followed by either Bacillus Calmette-Guérin (BCG), sequential BCG plus electromotive administration of mitomycin C (EMDA-MMC), or upfront radical cystectomy (RC). Materials and Methods: High- and- very high-risk NMIBC cases undergoing TURBT followed by BCG, BCG plus EMDA-MMC, or RC at two international tertiary referral centres between 2009 and 2024 were retrospectively reviewed. Recurrence-free survival (RFS), progression-free survival (PFS), and overall survival (OS) were estimated using Kaplan-Meier methods. Multivariable Cox regression models were applied to identify factors independently associated with survival outcomes. Results: A total of 1178 patients were included: 852 received BCG, 249 received BCG/EMDA-MMC, and 77 underwent upfront RC. Kaplan-Meier analysis revealed no significant differences in RFS or PFS between the BCG and BCG/EMDA-MMC groups, nor in OS between the three treatment strategies. According to multivariable analysis, concomitant carcinoma in situ (CIS) and increasing T stage at TURBT were independently associated with poorer RFS (HR 1.39; 95% CI 1.05-1.85), PFS (HR 1.95; 95% CI 1.36-2.82), and OS (HR 2.28; 95% CI 1.60-3.25). A second resection conferred a protective effect on PFS (HR 0.72; 95% CI 0.54-0.95). Treatment modality (BCG, BCG/EMDA-MMC, or upfront RC) was not significantly associated with any survival endpoint. Conclusions: In this large multicentre series of patients with high- and very high-risk NMIBC undergoing TURBT, survival outcomes were primarily influenced by clinical-pathological characteristics rather than the adjuvant treatment of choice.

(I) To determine clinicopathological determinants of metachronous Upper Tract Urothelial Carcinoma (UTUC) requiring Radical Nephroureterectomy (RNU) after Radical Cystectomy (RC). (II) To evaluate long-term survival of patients who underwent RC + RNU compared with matched RC only controls. Patients undergoing RNU for metachronous UTUC were extracted from a multi-institutional RC database. A 1:2 Propensity Score Match (PSM) was performed based on age, gender, BMI, CCI, Smoking Status, and cT stage between RC only and RC + RNU patients. Simon-Makuch plots, landmark analyses and Multivariable Cox regressions were adopted to compare survival outcomes. Of 1804 RC patients, 85 (4.7

AbstractObjectivesTo assess the impact of a positive history of venous thromboembolism (VTE) on perioperative outcomes, including length of in‐hospital stay, readmission rates, 90‐day postoperative complications, and healthcare costs in bladder cancer (BCa) patients undergoing transurethral resection of bladder tumour (TURBT) in the United States.Patients and MethodsPatients aged ≥18 years with a BCa diagnosis undergoing TURBT were identified in the Merative® Marketscan® Research de‐identified databases between 2007 and 2021. Multivariable logistic regression adjusted by relevant perioperative confounders was used to investigate the association between diagnosis of VTE before TURBT and 90‐day complication rates, new postoperative VTE events, re‐hospitalization, and total hospital expenditures (2021 US dollars). Sensitivity analyses on VTE severity (pulmonary embolism [PE], deep venous thrombosis [DVT] or superficial thrombophlebitis/phlebitis [SVT]), as well as TURBT extent (minor vs. major) were additionally examined.ResultsIn total, 139 800 patients were identified, with 5.3% having preoperative VTE, including DVT (n = 3112, 42.20%), PE (n = 2046, 27.74%) and SVT (n = 2217, 30.06%). A history of preoperative VTE predicted higher rates of any complication (adjusted odds ratio [aOR] 1.28, 95% CI 1.14–1.43) and also higher rates of infectious and haemorrhagic complications. Additionally, preoperative VTE increased the risk of novel VTE events following TURBT (aOR 17.30, 95% CI 16.05–18.65), hospital length of stay (aOR 2.23, 95% CI 1.90–2.62), readmissions (aOR 1.47, 95% CI 1.39–1.56), and hospital associated costs (aOR 1.17, 95% CI 1.12–1.23). DVT and non‐minor TURBT procedures did not increase the risk of any, infectious, or haemorrhagic complications, but other associations were maintained regardless of the severity of VTE (PE, DVT, SVT) or TURBT extent (minor/major).ConclusionsA history of VTE before undergoing transurethral procedures for BCa is associated with significantly worse perioperative outcomes and higher healthcare costs. These findings may help us to counsel on the risks of the intervention and hopefully improve our ability to mitigate such risks.

Introduction It is believed that bacteria can be involved in the formation of all types of stones. The aim of study was to assess the urinary microbiome in patients with urolithiasis. Material and methods The study group included 50 patients qualified for endoscopic treatment of urinary tract stones using: ureteroscopic lithotripsy (URSL), retrograde intrarenal surgery (RIRS), percutaneous nephrolithotripsy (PCNL), endoscopic combined intrarenal surgery (ECIRS). Before the procedure, patients were asked to collect urine and stool for analysis. Urine from the upper urinary tract and stone fragments were collected intraoperatively. The research material was subjected to 16S rRNA sequencing. The chemical composition of stones was assessed using Raman spectroscopy. Results In the urinary bladder, upper urinary tract, and kidney stone microbiomes of patients with urolithiasis the predominant bacteria identified were: Acinetobacter, Bifidobacterium, Corynebacterium, Cutibacterium, Paracoccus, Pseudomonas, Staphylococcus and Streptococcus. Further analysis showed the relative similarity of the urinary bladder and upper urinary tract microbiomes and the dissimilarity of the kidney stone microbiome. A comparison of the upper urinary tract microbiome based on the method of urine collection and a comparison of urinary bladder and upper urinary tract microbiomes based on the presence of a DJ stent prior to the procedure showed no statistically significant differences. Conclusions The microbiome of stones differs from the microbiome of urine, which may play a role in the pathogenesis of urolithiasis. Bladder urine and upper urinary tract urine microbiomes do not differ. Therefore, bladder urine can replace upper urinary tract urine in microbiome studies.

Objectives: Intravesical Bacillus Calmette-Gu & eacute;rin (BCG) therapy is a gold standard for patients with high-risk non-muscle invasive bladder cancer (NMIBC). Although a long-lasting therapeutic response is observed in most patients, BCG failure occurs in 30%-50% of patients and a progression to muscle-invasive disease is found in 10%-15%. Therefore, predicting high-risk patients who might not benefit from BCG treatment is critical. The purpose of this study was to identify, whether the presence of specific oncogenic mutations might be indicative of BCG treatment response. Methods: Nineteen high-grade NMIBC patients who received intravesical BCG were retrospectively enrolled and divided into "responders" and "non-responders" groups. Tissue samples from transurethral resection of bladder cancer were performed before starting therapy and were examined using a multigene sequencing panel. Results: Mutations in TP53, FGFR3, PIK3CA, KRAS, CTNNB1, ALK and DDR2 genes were detected. TP53 and FGFR3 were found to be the most frequently mutated genes in our cohort (31.6% and 26.3%, respectively), followed by PIK3CA (15.8%). In the BCG-responsive patient group, 90% of samples were found to have mutated genes, with almost 50% of them showing mutations in tyrosine kinase receptors and CTNNB1 genes. On the other hand, in the BCG-unresponsive group, we found mutations in 44.4% of samples, mainly in TP53 gene. Conclusions: Our findings suggest that a Next- Generation Sequencing (NGS) multigene panel is useful in predicting BCG response in patients with NMIBC.

BACKGROUND AND OBJECTIVE:Upper tract urothelial carcinoma (UTUC) is associated with poor survival. Recent studies have evaluated whether the presence of histological subtypes or divergent differentiation (HS/DD) is associated with worse UTUC prognosis. Our aim was to assess the relationship between HS/DD and clinicopathological features and oncological outcomes for patients with UTUC undergoing radical nephroureterectomy (RNU) without investigating causal pathways. METHODS:A literature search was conducted in September 2024. Patients with UTUC who underwent RNU were included. The main outcomes were differences in clinicopathological features and oncological outcomes between HS/DD and pure urothelial carcinoma (PUC) groups. KEY FINDINGS AND LIMITATIONS:We included 22 studies involving 14 407 patients in our review. HS/DD was present in 14% of tumours. In comparison to PUC, the HS/DD group had significantly higher rates of ≥pT3 stage, high-grade tumours, lymph node invasion (LNI), lymphovascular invasion (LVI), and receipt of adjuvant chemotherapy. Pooled results revealed that the HS/DD group had significantly worse cancer-specific survival (CSS) (hazard ratio [HR] 1.65, 95% confidence interval CI] 1.39-1.96), overall survival (OS; HR 1.84, 95% CI 1.52-2.22) ,and recurrence-free survival (RFS; HR 1.64, 95% CI 1.43-1.87). Intravesical RFS (IVRFS) and urothelial RFS (URFS) were comparable between the groups. CONCLUSIONS AND CLINICAL IMPLICATIONS:Our findings suggest that UTUC with HS/DD is associated with more advanced/aggressive features, such as higher pathological stage and grade, LNI, and LVI. HS/DD is associated with significantly worse CSS, OS, and RFS, but does not predict worse IVRFS or URFS. Therefore, HS/DD detection should prompt extensive treatment and closer follow-up. To improve the quality of recommendations and patient care, well-designed studies with central pathological review are needed.

Introduction:Urolithiasis is a highly prevalent disease influenced by a wide range of factors multifactorial etiology results in the formation of urinary stones with diverse mineral compositions. Accurate identification of stone constituents is crucial for effective prevention of recurrence. Gold-standard methods for stone analysis are not always readily available in clinical practice. To address this, Daudon proposed a morphological classification system aimed at identifying stone types based on their surface characteristics. However, existing literature reports suboptimal accuracy of this method, largely due to technical limitations of endoscopic equipment. The primary objective of this study was to evaluate the reliability of morphological assessment in predicting stone mineral composition. Secondary aims included the identification of factors contributing to the consistently poor accuracy reported in previous studies. Material and methods:An online quiz consisting of 20 single-choice questions was developed, each accompanied by a high-resolution image of a urinary stone and five predefined answer options. The reference stone composition for each image was determined using Fourier-transform infrared spectroscopy. Participants' performance was evaluated based on the percentage of correct responses per individual and per question. The results of specialists and residents were compared using the two-proportion Z-test, with statistical significance set at p <0.05. Results:A total of 779 responses were collected, with an overall accuracy rate of 33.7%. The most commonly selected answers were respectively oxalates, phosphates, uric acid, cystine, and infectious stones. Subgroup analysis revealed accuracy rates of 36% among attending physicians and 32% among residents, with no statistically significant difference. Notably, two participants achieved a perfect score (100%), supporting the internal validity of the test. Conclusions:Detailed analysis revealed a wide distribution of scores, ranging from participants with only one correct response to those who completed the quiz with full accuracy. These results suggest that the consistently low diagnostic accuracy reported in the literature is more likely due to limited familiarity and lack of experience with the morphological classification, rather than inherent shortcomings of the system itself. The findings highlight the need for comprehensive endourology training programs focused on improving stone morphology recognition skills.

Holmium laser enucleation of the prostate (HoLEP) is a widely used surgical treatment for benign prostatic hyperplasia (BPH), and it is associated with a low incidence of severe complications. We report a rare case of hemolytic uremic syndrome (HUS) following HoLEP in a 71-year-old male. Shortly after the surgery, the patient developed altered consciousness, jaundice, and multiorgan failure, necessitating intensive care and renal replacement therapy. HUS was identified as the underlying cause. After a month-long hospitalization, the patient showed progressive renal recovery. This report underscores the importance of early recognition, multidisciplinary management, and close follow-up in achieving favorable outcomes in rare post-HoLEP complications.

INTRODUCTION:Transurethral resection of the bladder tumor (TURBT) followed by intravesical Bacillus Calmette-Guérin (BCG) immunotherapy is a standard treatment for high-risk non muscle-invasive bladder cancer (NMIBC). However, due to potential risk of dissemination, current guidelines recommend caution when proposing BCG treatment in immunocompromised patients. Our aim was to assess the efficacy and safety of BCG treatment in immunocompromised patients. MATERIALS AND METHODS:Patients aged ≥18 with a diagnosis of bladder cancer (BC) who underwent BCG therapy in 2007-2021, were identified in the MerativeTM Marketscan® Research Commercial and Medicare databases. Multivariable Cox proportion hazard regressions adjusted by relevant confounders were performed to investigate the influence of immunosuppression on the events associated with progression and recurrence of BC, both in the unmatched cohort and after 1:2 propensity score matching (PSM). Also, subgroup analysis on progression in patients without cancer other than BC was conducted. RESULTS:Immunocompromised and immunocompetent patients had similar rates of disseminated BCG infection after intravesical immunotherapy. However, immunocompromised patients had shorter progression-free survival and higher probability of progression (aHR: 1.23, 95% CI: 1.11-1.38), as well as shorter recurrence-free survival and a higher probability of recurrence (aHR: 1.13, 95% CI: 1.05-1.20). Similar significant associations were observed in the PSM cohort. A subgroup analysis of patients without any additional oncological diagnoses beyond BC confirmed a higher likelihood of progression in the immunocompromised group (aHR: 1.34, 95% CI: 1.15-1.56). CONCLUSIONS:BCG immunotherapy is safe in immunocompromised patients. Nevertheless, the efficacy of intravesical BCG in these patients might be suboptimal thus advocating the need for appropriate counselling and a possible lower threshold to consider radical treatment.

Introduction: Absence of residual cancer in radical cystectomy (RC) specimens is a well-known positive prognostic factor for non-muscle and muscle-invasive bladder cancer (NMIBC and MIBC) in patients with or without neoadjuvant chemotherapy (NAC). Understanding the clinical and pathological features associated with a final pT0 status can provide valuable prognostic insights, serve as a surrogate marker for survival outcomes, and help identify candidates suitable for bladder-sparing strategies. Methods: Temporal trends and clinical/demographic characteristics across clinically high-/very-high-risk NMIBC or MIBC RC patients from 2009 to 2024 were explored. Subsequently, RC pT0 patients were propensity score-matched (PSM, 1:1 ratio) with the >pT0 population based on age-adjusted CCI and preoperative clinical stage (cTis-T1 vs. cT2). Multivariable regression modelling was applied to explore predictors of pT0 status stratified according to clinical NMIBC or MIBC status. Results: A total of 655 RCs performed with curative intent were included (43% for MIBC, 57% for NMIBC). Of these, 117 were pT0 at final pathological assessment (68 NMIBC and 49 MIBC). Subsequently, 228 PSM patients (114 pT0 vs. 114 >pT0) were extracted from the original cohort and stratified according to preoperative clinical stage (MIBC vs. NMIBC). In multivariable analysis, male gender was associated with an increased likelihood of pT0 status in the NMIBC cohort (adjusted odds ratio [aOR] 2.89, 95% CI 1.13-7.90). Conversely, BCG failure and concomitant CIS independently reduced the chances of achieving pT0 status (aOR: 0.40, 95% CI 0.19-0.99; aOR: 0.16, 95% CI 0.03-0.97). For MIBC patients, as expected, NAC more than doubled the chances of achieving pT0 status (aOR: 2.20, 95% CI 1.01-6.82). On the other hand, the concomitant presence of CIS reduced the likelihood of pT0 achievement (aOR 0.22, 95% CI, 0.06-0.80). In both cohorts, the presence of variant histology (VH) demonstrated a negative association with pT0 achievement; however, the estimated effect did not reach statistical significance (p = 0.09 and p = 0.08). Conclusions: Our findings suggest potentially raising the threshold for RC consideration in high-risk or very-high-risk NMIBC patients with a favourable risk profile. MIBC patients without additional risk factors (CIS and VH) are more likely to achieve a tumour-free status, particularly when adequately receiving NAC.