Background: Radical cystectomy with urinary diversion is the standard treatment for muscle-invasive bladder cancer. When bowel segments are used for diversion, patients are at risk for metabolic complications, particularly acidosis and electrolyte imbalances. GLP-1 receptor agonists (GLP-1 RAs) have shown renal-protective and metabolic benefits in diabetic patients. This study evaluates whether GLP-1 RA use is associated with reduced metabolic complications following radical cystectomy. Methods: A retrospective cohort study using the TriNetX US Collaborative Network was conducted. Adults (>= 18 years) who underwent radical cystectomy between 2005 and 2024 were included. Patients were stratified by GLP-1 RA exposure and matched for demographics and comorbidities. Outcomes included metabolic acidosis, potassium abnormalities, hypocalcemia, other electrolyte/acid-base disorders, and acute kidney failure occurring within 2-years of radical cystectomy. Results: After matching, 896 patients (448 per cohort) were included. GLP-1 RA use was associated with lower rates of acidosis (relative risk [RR] 1.6, 14.5% vs. 24.1%, p = 0.001), potassium abnormalities (RR 1.6, 16.8% vs. 26.7%, p = 0.005), hypocalcemia (RR 2.5, 2.4% vs. 6.0%, p = 0.009), other electrolyte/acid-base disorders (RR 1.6, 22.9% vs. 36.3%, p = 0.002), and acute kidney failure (RR 1.4, 19.8% vs. 28.0%, p = 0.04). On Cox proportional hazards modeling, GLP-1 RA use was associated with reduced incidence of acidosis (Hazard ratio (HR) 0.65, p = 0.0025), potassium abnormalities (HR 0.63, p = 0.0004), hypocalcemia (HR 0.40, p = 0.013), other electrolyte/acid-base disorders (HR 0.59, p < 0.0001), and acute kidney failure (HR 0.54, p < 0.0001). Kaplan-Meier curves showed improved event-free survival in the GLP-1 RA cohort for each of these outcomes (p for all < 0.05). Conclusion: GLP-1 RA use was associated with fewer metabolic and electrolyte complications post-cystectomy. These findings warrant further investigation into their potential protective role in mitigating these disorders.

INTRODUCTION:Non-muscle invasive bladder cancer (NMIBC) accounts for over 75% of bladder cancer cases worldwide and is associated with high recurrence rates and significant surveillance costs. Advances in diagnostic modalities, risk stratification, and bladder-preserving therapies have transformed management strategies. AREAS COVERED:This narrative review synthesizes evidence from 70 key publications identified through a comprehensive search of PubMed, MEDLINE, Embase, Scopus, and Google Scholar (2005-2025). Topics include clinical presentation, diagnostic innovations such as enhanced cystoscopy and urinary biomarkers, contemporary risk stratification models, and evolving treatment paradigms including intravesical therapy, immunotherapy, and gene therapy. NMIBC management is shifting toward precision-based, multimodal approaches that integrate molecular biomarkers, immunotherapy, and novel drug delivery systems. While early-phase trials show promise, large-scale studies and real-world data are essential to validate these strategies. Personalized surveillance using circulating and urinary tumor DNA may reduce procedural burden and improve outcomes, marking a paradigm shift toward adaptive, patient-centered care.

Recent advancements in antibody-drug conjugates, including FDA-approved therapies targeting Nectin-4 and Trop-2, have transformed the cancer treatment landscape, including upper tract urothelial carcinoma (UTUC). However, varied treatment effects and drug-associated adverse effects raise the question of whether patients should be selected based on a biomarker study to achieve optimal outcomes. A better understanding of the patterns and clinicopathological significance of Nectin-4 and Trop-2 expression in UTUC remains to be achieved. We generated tissue microarrays (TMAs) with 120 UTUC specimens from patients who underwent nephroureterectomy at our institution and evaluated the expression of Nectin-4 and Trop-2 in tumor and non-tumor tissue. Nectin-4 expression was significantly higher in both invasive and noninvasive high-grade UTUC compared to noninvasive low-grade tumors. In contrast, Trop-2 expression did not vary significantly between noninvasive low-grade and high-grade tumors. When analyzed by stage, Nectin-4 expression was significantly elevated in tumors of higher stages than in early-stage tumors, similar to Trop-2 expression. Although both Nectin-4 and Trop-2 were broadly expressed in tumor and adjacent non-tumor urothelium, a subset of patients demonstrated low expression in non-tumor tissue but high expression in tumor tissue. Nectin-4 expression, but not Trop-2, was significantly correlated with the Ki-67 index, indicating that they may have different roles in tumor proliferation. The differential expression of Nectin-4 and Trop-2 by tumor grade and stage highlights their potential relevance in guiding targeted therapy for UTUC. Notably, a subset of patients exhibits high expression in tumor tissue, accompanied by low expression in adjacent non-tumor urothelium, suggesting a favorable therapeutic index for antibody-drug conjugate therapy. These findings support the need for further biomarker-driven studies to optimize patient selection and treatment outcomes.

Objective: To examine the oncologic outcomes in patients treated for UTUC by radical nephroureterectomy (RNU) relative to their smoking history in a contemporary cohort that includes use of neoadjuvant and intravesical chemotherapy (IVC). Methods: We analyzed a multi-institutional cohort of patients treated with RNU for UTUC between 2000 and 2020. Patients were classified as never smokers, those with a < 20 pack-year smoking history, and those with a >= 20 pack-years of smoking history. Overall survival (OS), cancer-specific survival, intravesical recurrence, contralateral upper tract recurrence, and metastasis were compared. Results: One thousand seven hundred ninety-six patients were included. No significant differences in the risks of intravesical recurrence, contralateral upper tract recurrence, metastasis, or cancer-specific survival were identified based on smoking status. OS was significantly higher in the never smoking group, with hazard ratio for death of 1.38 (95% CI 1.09-1.73) for < 20 pack years smoking history and 1.34 (95% CI 1.12-1.61) for >= 20 pack years smoking history (P = .002). Rates of intravesical recurrence and OS were improved among smokers who received IVC compared to those who did not. Conclusion: Patients with a history of RNU for UTUC with any smoking history had worse OS compared to those with no smoking history, but no differences were seen in intravesical, contralateral upper tract, and extraurothelial recurrence or in cancer-specific survival. Counseling on smoking cessation remains an important element of ongoing care to optimize health outcomes in these patients.

Endoscopic management offers acceptable oncologic control in select patients with upper tract urothelial carcinoma (UTUC) while preserving renal function. Adjuvant intracavitary treatment with chemotherapy or Bacillus Calmette-Guérin (BCG) has been proposed to reduce recurrence risk. We aimed to evaluate the impact of adjuvant intracavitary treatment on ipsilateral UTUC recurrence following endoscopic management. We queried a multi-institutional cohort of patients who underwent endoscopic management for UTUC. Treatment groups were defined as no instillation, single post-operative instillation, or multiple instillations. Ipsilateral UTUC recurrence-free survival (RFS) was estimated using Kaplan-Meier curves and Cox proportional hazards models evaluated factors associated with recurrence. A total of 599 renal units, of which 43 received single instillation and 86 multiple instillations, in 334 patients treated endoscopically for UTUC were analyzed. The median follow-up time for patients without recurrence was 12 months (IQR 4–33). Multiple adjuvant instillations of any intracavitary treatment were associated with a significantly improved RFS (HR 0.52, 95

BACKGROUND:Residency positions in surgical subspecialties are highly competitive due to numerous applicants and limited positions. This study analyzes a decade of trends in applicant numbers and match rates across surgical subspecialties. METHODS:Publicly available data from 2015 to 2024 were collected from the American Urologic Association and National Resident Matching Program for Neurologic Surgery, Otolaryngology, Orthopedic Surgery, Plastic Surgery, Urology, and Vascular Surgery. Descriptive statistics, linear regression, and analysis of variance were conducted. RESULTS:Of 29,483 registered applicants, 19,535 (66.3%) matched. Otolaryngology had the highest match rate (74.5%), while Vascular Surgery had the lowest (52.7%). Registered and matched applicants varied significantly by year within each specialty. For instance, Orthopedic Surgery demonstrated particularly significant growth in both registered applicants and matched applicants. Generalized linear models also revealed significant year-specialty interactions, suggesting inconsistent trends across specialties. CONCLUSIONS:Matching into surgical specialties has grown more difficult given increased applicant numbers. Though matched applicants increased, growth is inconsistent and does not meet demand. Addressing this gap may require changes such as application process reforms or better resource distribution.

OBJECTIVE:To compare the associations of preoperative urinalysis (UA) and urine culture (UCx) findings, including concordant and discordant results, with postoperative infectious complications following common urologic procedures. PATIENTS AND METHODS:Using TriNetX adult patients who underwent radical prostatectomy, partial or radical nephrectomy, or transurethral resection of bladder tumor (TURBT) between 2006 and 2026 were identified. Patients were stratified by preoperative UA and UCx findings. Postoperative outcomes within 30-day of surgery were compared using measures of association. RESULTS:A total of 278,653 patients, including 109,605 radical prostatectomy, 79,613 partial or radical nephrectomy, and 89,435 TURBT patients, were included. Abnormal preoperative UA findings were present in 6.9% of radical prostatectomy, 11.2% of nephrectomy, and 22.1% of TURBT patients. Among patients with abnormal UA findings, only 5.9%, 7.1%, and 10.4%, respectively, also had a positive urine culture. Across all procedural cohorts, abnormal UA findings (without positive UCx) were associated with increased risks of postoperative UTI, sepsis, pyelonephritis, bacteremia, inpatient encounters, emergency department visits, and systemic antibiotic use. Among patients with abnormal UA findings, concurrently positive UCx provided limited additional prognostic information. Additionally, isolated positive UCx findings without abnormal UA demonstrated less consistent associations with adverse postoperative outcomes. CONCLUSION:Abnormal preoperative UA findings were more strongly and consistently associated with postoperative infectious complications than isolated positive UCx findings. These findings do not support omission of clinically indicated UCx but warrant prospective research on UA-guided or selective reflex UCx strategies to inform future preoperative testing practices.

Introduction Minimally invasive partial nephrectomy (MIPN), laparoscopic or robotic partial nephrectomy (RPN), is the preferred treatment for T1 renal cell carcinoma (RCC). As outpatient surgery expands across urology, its safety and feasibility in oncologic procedures, like MIPN and especially RPN, remain underexplored. Methods Using American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) data (2022-2023), we identified 8,927 adult patients who underwent RPN. Trends in outpatient MIPN, both laparoscopic and robotic approaches, were observed from 2019 to 2023. Patients who underwent RPN were then categorized by inpatient or outpatient setting. Propensity score matching was applied to balance demographic and clinical variables. Postoperative complications and readmissions were compared, and multivariate logistic regression identified predictors of adverse outcomes such as 30-day infectious complications, reoperations, and readmissions. Results Outpatient MIPN increased from 20.8% (n = 884) in 2019 to 35.5% (n = 1827) in 2023. After matching, 3,180 inpatient and 3,185 outpatient cases of RPN were analyzed. With the current patient selection criteria, outpatient RPN was associated with significantly lower rates of pneumonia, pulmonary embolism, myocardial infarction, deep vein thrombosis, septic shock, blood transfusions, reoperation, and readmissions. Logistic regression identified inpatient setting as an independent predictor of infectious complications (odds ratio (OR): 1.31), reoperation (OR: 1.92), and readmission (OR: 1.23). While outpatient surgery was associated with lower complication rates, this likely reflects the selection of healthier patients for ambulatory care rather than an intrinsic advantage of the outpatient setting. Conclusion Outpatient MIPN is increasingly utilized, and RPN demonstrates non-inferior safety compared to inpatient procedures in appropriately selected patients. However, disparities in access and limitations in surgical and oncologic data warrant further investigation. These findings support the safe expansion of outpatient RPN, emphasizing the need for standardized protocols, equitable access, and future research into long-term outcomes and individualized risk stratification.

Introduction and Objectives: Hydrocelectomy is the gold standard treatment for hydrocele. European data showed complication rates between 16% and 25%, however the rate within the United States has not been assessed. We examined the postoperative complication, emergency department visit, readmission and re-operation rates after hydrocelectomy in the United States. Methods: We performed a retrospective cohort study of 27,418 individuals who underwent hydrocelectomy in the United States between 2004 and 2024 identified through the TriNetX US Network using ICD-10 and CPT codes. Patients were excluded for age <18 years, testicular neoplasm, and orchiectomy. The primary outcome was rate of any surgical complication, emergency department (ED) visit, readmission, or reoperation within 90 days of hydrocelectomy. Statistical analysis was performed with R software and using t-tests. Results: The mean age of our cohort was 51 years. The complication group had higher proportions of older (p < 0.001), African American (p < 0.001), and patients with hypertension, diabetes, and coagulation defects (p < 0.001). The risk of complications was 13% within 90 days of surgery. The ED visit rate was 6.7%, surgical complication rate of 5.6%, readmission rate of 2.6%, and reoperation rate of 2.6%. Of surgical complications, 25% were bleeding, 13% were infection, and 63% were inflammatory or unspecified complications. The median ED visit was day 14 (IQR 6-41) and the median reoperation was at day 21 (IQR 9-38). Patients had a 9.2% rate of overall complications in the first month after surgery, after which the risk decreased. Conclusion: The rate of complications after hydrocelectomy in the United States is 13%, with 9% occurring in the first 30 days. There was a 2.8% risk of surgical intervention within 90 days. We recommend close follow-up in the first month to evaluate for developing complications, especially for patients with hypertension, diabetes, or coagulation defects.

TPS4643 Background: Padeliporfin VTP is a drug-led combination therapy consisting of IV Padeliporfin activated by a low-power near-infrared (753 nm) laser–fiber system. A non-contact cylindrical fiber positioned near the tumor provides circumferential illumination, inducing vascular occlusion and coagulative tumor necrosis while preserving tissue structure. Safety and efficacy were shown in a Phase 1 UTUC study (NCT03617003). We report emerging efficacy, durability, and safety from the ENLIGHTED Phase 3 trial in LG UTUC (NCT04620239). Methods: ENLIGHTED is an open-label Phase 3 study conducted in the US, EU, and Israel, evaluating the efficacy, durability, and safety of padeliporfin VTP in LG UTUC. Eligible patients (pts) may have new or recurrent disease, be treatment-naïve or previously treated, and have up to two biopsy-confirmed LG lesions (5–15 mm kidney or 5–20 mm ureter) without high-grade cells on instrumented cytology. VTP is performed via retrograde upper tract endoscopy under anesthesia and low-light conditions. Padeliporfin is administered IV, and an optical fiber with a 20–40 mm diffuser is positioned near the tumor through the scope, followed by 10 minutes of laser illumination. Treatment consists of an Induction Treatment Phase (ITP) of 1–3 VTP sessions at 4-week intervals until complete response (CR) or treatment failure at Primary Response Evaluation (PRE). Pts achieving CR enter a 12-month Maintenance Treatment Phase (MTP) with quarterly endoscopic surveillance and retreatment for treatable recurrences, followed by long-term follow-up up to 48 months. The primary endpoint is CR at PRE (28 ± 3 days post last ITP treatment), defined by absence of visible tumor on endoscopy and negative instrumented cytology. A total of 100 pts are to be enrolled. As of January 19, 2026, 78 pts were enrolled and 63 completed ITP. Response rates were: CR 73.0%, PR 17.7%, DR 3.2%, PD 4.8%, and stable disease 1.6%. Among pts with CR at PRE, 39.5% had completed MTP by data cutoff, with 88.2% maintaining CR in the treated area (TA) for ≥12 mos. Median Duration of Response in the TA was not reached and is ≥23.9 mos. Most pts remains in MTP or follow-up. The most common treatment-emergent adverse events were hematuria (10.6%), flank pain (8.6%), nausea (5.5%), procedural pain (4.5%), abdominal pain (4.1%), dysuria (4.1%), vomiting (3.4%), and fatigue (3.1%), all Grade 1–2 with a median duration of 5 days. 23 serious adverse events (7.7%) were reported, mostly unrelated to treatment. One Grade 3 SAE (renal colic related to VTP) resolved within 2 days. Padeliporfin VTP demonstrates favorable preliminary efficacy, durable responses, and a safety profile consistent with prior experience. Enrollment is ongoing, and final outcomes are anticipated to support regulatory approval of an organ-preserving therapy for LG UTUC. Clinical trial information: NCT04620239 .

OBJECTIVE:To evaluate the role of serum albumin in predicting surgical outcomes after radical cystectomy. METHODS:Retrospective cohort analysis of adults who underwent radical cystectomy from 2019 to 2022 within the ACS NSQIP dataset. Patients were stratified into three groups based on preoperative serum albumin: <3.0 g/dL, 3.0-3.5 g/dL, and >3.5 g/dL. Primary outcomes were surgical site infections, wound disruption, reoperation rates, prolonged hospitalization, and 30-day mortality. Regression analyses assessed the impact of hypoalbuminemia (<3.5 g/dL) on outcomes. RESULTS:In total, 6748 patients were included in the analysis. Distribution of preoperative albumin levels included 4.8% with albumin less than 3.0 gm/dL (Cohort A), 10.7% with albumin between 3.0 and 3.5 gm/dL (Cohort B), and 84.4% with albumin > 3.5 gm/dL (Cohort C). The incidence of superficial SSI (7.7%), deep SSI (2.2%), wound disruption (4.0%), unplanned reoperation (8.6%), and still in hospital at 30 days (5.5%) was significantly higher in Cohort A (p for all < 0.05). Moreover, 30-day mortality was significantly higher in Cohorts A and B, as compared to Cohort C (2.2% vs. 2.3% vs. 1.3%, p = 0.03). On multivariate logistic regression, albumin < 3.5 gm/dL was significantly associated with reoperation (OR = 1.39, p = 0.031), prolonged hospitalization (OR = 1.28, p = 0.038), and 30-day mortality (OR = 1.74, p = 0.025). CONCLUSIONS:Preoperative hypoalbuminemia is independently associated with increased morbidity and mortality following radical cystectomy. Given its modifiable nature, serum albumin should be considered a key target for preoperative optimization.

OBJECTIVE:To evaluate longitudinal trends in the Urology In-Service Examination (ISE) from 2016 to 2023 and identify changes in performance patterns over time. METHODS:Retrospective cohort analysis of aggregate ISE scores provided by the American Urological Association. Mean percent-correct scores across postgraduate years (PGY1-5) and subtopics were analyzed from 2016 to 2023. 2020 was used as a temporal marker for the onset of the COVID-19 pandemic in sub-analyses. Two-sample t tests determined statistical significance (α ≤ 0.05). RESULTS:A total of 680 scores were analyzed. Mean scores increased with PGY level (43%-46% in PGY1 to 68%-71% in PGY5) but declined over time. Linear trend analysis showed a statistically significant decline for PGY2-5, with the steepest and strongest correlation seen in PGY3-5. Subtopic declines were most notable in calculous disease (64.2% to 56.1%, P = .01) and physiology/immunology/adrenal (70.2% to 56.5%, P <.001), both affecting all PGY levels. Additional decreases were noted in pediatrics (PGY2-4), congenital anomalies/embryology/anatomy (PGY1-2, 4), and imaging (PGY3-4). In contrast, PGY1 scores in fluid & electrolytes/transplant/hypertension/vascular/nephrology improved modestly (50.5% vs 56.0%, P = .05). Performance on 217 repeated questions was stable (69.3% vs 69.7%). CONCLUSION:Mean ISE performance declined from 2016 to 2023 across all PGY levels, with the greatest decreases observed in general urology subtopics. Scores after 2020 were lower across most PGY levels and content domains, while performance on repeated questions remained stable. These trends may reflect increased examination difficulty, expanded content, changes in question composition, evolving study strategies, and variability in clinical exposure rather than diminished knowledge.