Abstract Objective The aim of this study was to evaluate the diagnostic yield and downstream clinical impact of routine preoperative chest CT in patients undergoing partial nephrectomy (PN) for localized renal cell carcinoma. Methods We conducted a retrospective multicentre study using data from the French Urological Cancer Comprehensive Cohort (UroCCR) registry. Adult patients who underwent PN for localized renal masses between 2010 and 2024 and had preoperative chest CT within 30 days before surgery were included. The primary endpoint was the detection rate of synchronous pulmonary metastases. Secondary endpoints included characteristics of metachronous metastases and diagnostic or scheduling consequences of preoperative imaging. Results Among 7351 patients, 6679 underwent surgery and 5016 had a preoperative chest CT. Of these, 4483 (89.4%) had clinical T1 tumours. Synchronous pulmonary metastases were identified in only 17 patients (0.38%), all with larger or higher grade tumours. These patients had significantly higher rates of positive surgical margins (17.6% vs. 6.1%, p = 0.04), but no significant difference in age, sex or comorbidity profile. Among 6075 patients with postoperative follow‐up, 191 (3.14%) developed metachronous pulmonary metastases. Of these, 14 (7.3%) had a previously negative preoperative CT, with a median time to progression of 52.6 months. Importantly, 166 (3.7%) patients underwent additional, ultimately non‐contributive thoracic investigations, and 2.1% experienced surgical delays due to incidental or equivocal CT findings. Conclusions The diagnostic yield of routine preoperative chest CT in patients with clinical T1 RCC is exceedingly low (<0.5%). These data support the omission of routine chest CT in asymptomatic, low‐risk cT1 RCC, potentially sparing over 95% of patients from unnecessary imaging, additional tests and surgical delays. A risk‐adapted, symptom‐guided strategy may optimize patient care while reducing radiation exposure and healthcare costs.

Partial nephrectomy can lead to complications such as urinary fistulas, with an incidence ranging from 1 to 17

INTRODUCTION:Intravesical instillations of mitomycin C, epirubicin, and BCG are considered as the standard of care for most patients with non-muscle invasive bladder cancer (NMIBC). These guidelines aim to optimize intravesical instillations in order to improve their efficacy and decrease morbidity. MATERIAL:An analysis of good practice, available regulations, and published guidelines was conducted through an online literature search in French and English using Medline® and Embase®, up to December 2025. The following keywords were used: "BCG"; "Mitomycin C"; "Epirubicin"; "Bladder"; "Complication"; "Toxicity"; "Adverse reaction"; "Prevention"; "Treatment". RESULTS:Information should be given to the patient by the attending physician before the first intravesical instillation. A medical examination to detect specific contraindications is also mandatory to select appropriate therapy. Intravesical instillations should be delivered in health-care centers where urological endoscopic procedures are performed routinely. Screening for or treating asymptomatic bacteriuria prior to intravesical chemotherapy or BCG instillation is not recommended. In the presence of a clinically apparent urinary tract infection, instillations should be postponed. Intravesical instillation can only be delivered after a bladder catheter has been inserted without any injury to the lower urinary tract. The pharmaceutical agent should be retained in the bladder for 2h. Finally, voiding within 6h after intravesical instillation should be done in the seated position and the patient should drink at least 2L of water per day for 2 days. CONCLUSION:The delivery of intravesical instillations of mitomycin C, epirubicin and BCG should follow a standardized procedure for better efficacy and lower morbidity.

INTRODUCTION:Intravesical instillations of BCG are recommended for the treatment of high-risk non-muscle invasive bladder cancer. However, their prolonged use remains limited by potentially serious adverse events (AEs) or complications. The aim of this article is to provide updated recommendations for the diagnosis and management of AEs or complications of intravesical BCG instillations. MATERIALS:A review of the literature was performed using Medline (http://www.ncbi.nlm.nih.gov) and Embase (http://www.embase.com), and the following MeSH keywords or a combination of keywords: "Bladder"; "BCG"; "Complication"; "Toxicity"; "Adverse events"; "Prevention"; "Treatment". RESULTS:AEs or complications of BCG included genitourinary and systemic symptoms. The most common complications (cystitis, moderate fever) should be treated symptomatically and may require BCG adjustment to allow patients to have the most complete BCG course possible. Serious complications are rare but must be identified promptly because of their life-threatening nature. Their management is based on a combination of anti-tubercular treatment, anti-inflammatory drugs, and permanent discontinuation of BCG. CONCLUSION:The management of AEs during BCG therapy requires early identification, rational and effective treatment if necessary, and discussions about the continuation of BCG therapy in each situation.

PURPOSE:Radical nephrectomy (RN) remains the standard treatment for cT2 renal cell carcinoma (RCC), but partial nephrectomy has emerged as a viable alternative with the development of robot-assisted approaches. However, robust comparative data between robot-assisted partial nephrectomy (RAPN) and RN for large renal tumors remain limited. MATERIALS AND METHODS:We conducted a multicenter retrospective study using prospectively collected data from the UroCCR network (NCT03293563). Patients undergoing RAPN or minimally invasive RN for cT2M0 RCC were matched 1:1 using propensity scores based on clinical and tumor characteristics. Primary outcome was 5-year disease-free survival. Secondary end points included overall survival, renal function, perioperative outcomes, complications, and trifecta achievement. RESULTS:Of 847 patients included, 250 RAPN and 250 RN were matched. The median tumor size was 8.2 cm in the RN group and 8 cm in the RAPN group. Oncologic outcomes were comparable: 5-year disease-free survival was 61% and 49% (P = .2), cancer-specific survival was 87% and 94% (P = .8), metastasis-free survival was 71% and 66% (P = .4), and overall survival was 80% and 80% (P = .5), for RAPN and RN, respectively. RAPN was associated with improved renal function preservation (median change in estimated glomerular filtration rate at 5 years: -15 vs -23 mL/min/1.73 m2), fewer chronic kidney disease stage migrations, and reduced acute kidney injury. Major complications were more frequent after RAPN (6% vs 2%, P = .04). The trifecta outcome was achieved in 46% of RAPN cases. CONCLUSIONS:RAPN is a safe and functionally superior alternative to RN for selected patients with cT2 RCC. While associated with higher perioperative morbidity, these risks are acceptable in expert centers and offset by long-term nephron-sparing benefits.

Background: In low-burden countries such as France, whole-genome sequencing (WGS) is increasingly used for tuberculosis (TB) surveillance, but with a focus on drug resistance or to retrospectively confirm transmission. Applying WGS to all TB cases, however, generates large volumes of data, requiring automated tools for timely interpretation and thus triggering real-time alerts to TB control centres. Methods: Since November 2016, all clinical M. tuberculosis isolates diagnosed in eight hospitals from three cities of Auvergne-Rhône-Alpes in France have undergone WGS. In July 2023, an automated pipeline for anti-TB drug resistance prediction and unbiased detection of transmission clusters based on single nucleotide polymorphism (SNP) distances was implemented. Epidemiological, microbiological, and clinical data were collected. Index cases were stratified by their level of extra-household transmission (EHT), and statistical analyses were performed to identify associated factors. Findings: Among 1,152 TB patients diagnosed between 2016 and 2025, 75 clusters involving 247 patients (21·4%) were identified. All resistant isolates were detected by WGS using the WHO catalogue of mutations. Routine WGS enabled real-time alerts for TB control centres, leading to expanded field investigations, including community spill over, nosocomial transmissions, and school outbreak. Classical indicators of contagiousness (smear results, cavitary disease) were not associated with EHT level; but lower TB severity indices and longer duration of symptoms were associated with higher EHT level. Interpretation: Systematic WGS supports timely identification of drug resistance and transmission events and provides new insights into contagiousness factors. The approach described herein provides a concrete solution for integrating Mtb WGS data into routine practice, with an automated pipeline that allows direct interpretation by clinical microbiologists, without the need for bioinformaticians at each step.

SUMMARY Background In low-burden countries such as France, whole-genome sequencing (WGS) is increasingly integrated into routine tuberculosis (TB) surveillance to improve case management and transmission monitoring. However, applying WGS to all TB cases generates large volumes of data, requiring automated tools for timely interpretation and outbreak response. Methods Since November 2016, all clinical M. tuberculosis isolates diagnosed in eight hospitals from three cities of Auvergne-Rhône-Alpes in France have undergone WGS. In July 2023, an automated pipeline for anti-TB drug resistance prediction and unbiased detection of transmission clusters based on SNP distances was implemented. Epidemiological, microbiological and clinical data were collected, with contact duration classified as household, frequent, or occasional. Index cases were stratified by their level of extra-household transmission (EHT), and statistical analyses were performed to identify associated factors. Findings Among 1,152 TB patients diagnosed between 2016 and 2025, 75 clusters involving 247 patients (21·4%) were identified. WGS reliably detected resistance to first-line anti-TB drugs, leveraging the WHO mutation catalogue. Routine WGS enabled real-time alerts for TB control centres, leading to expanded field investigations, including community spillover, nosocomial transmissions, and school outbreak. Classical indicators of contagiousness (smear results, cavitary disease) were not associated with EHT level. Instead, lower TB severity indices and longer duration of symptoms were linked to higher EHT level. Interpretation Systematic WGS supports timely identification of drug resistance and transmission events and provides new insights into contagiousness factors. The automated pipeline enables direct interpretation by clinical microbiologists, facilitating real-time public health action. In this study, we demonstrate how, with the appropriate pipeline, WGS offered a time- and cost-effective solution for routine TB management. Funding This work was supported by SHAPE-Med@Lyon, a French government grant managed by the French National Research Agency under the France 2030 program (reference ANR-22-EXES-0012). RESEARCH IN CONTEXT Evidence before this study A systematic literature search was conducted using PubMed up to October 2025, with the following keywords: “tuberculosis” AND “whole genome sequencing” AND “contact tracing” OR “population based” OR “genomic surveillance” OR “investigation”. The review encompassed studies addressing the use of whole-genome sequencing (WGS) for tuberculosis (TB) surveillance, transmission cluster detection, and integration into routine epidemiological practice. Most published studies have focused on using WGS to retrospectively confirm or refute transmission events or to distinguish relapse from reinfection and therefore have not used genomic data to trigger real-time alerts to TB control centres. Even in the rare studies adopting a more proactive approach, the operational integration of WGS into routine diagnostic workflows is not described. No prospective study has provided a clear framework for the real-time use of WGS by clinical microbiologists to enable routine implementation and direct public health action. Added value of this study To our knowledge, this is the first study presenting the implementation of an automated WGS pipeline that enables unbiased detection of TB transmission clusters, based on single nucleotide polymorphism (SNP) distance, in routine surveillance across multiple hospitals. It shows how WGS data can be directly interpreted by clinical microbiologists for anti-TB drugs susceptibility prediction as well as facilitating real-time notification of TB control centres and immediate field investigations. By integrating genomic, epidemiological and clinical data, this comprehensive approach provides new insights into the factors associated with extra-household transmission and moves beyond the retrospective use of WGS, establishing its role as a proactive tool in TB diagnosis and public health practice. Implications of all the available evidence These findings highlight the need for national and international guidelines to evolve and support the widespread integration of WGS into routine TB management. The adoption of automated pipelines, such as the one presented herein, would not only enhance epidemiological surveillance but also streamline resistance detection and species identification, providing a time- and cost-effective all-in-one tool. Broad implementation of WGS-based approaches could significantly improve public health responses and the overall management of TB.

BACKGROUND AND OBJECTIVE:Prostate biopsies remain a key step in the diagnosis of prostate cancer and are performed either via a transrectal (TR) or a transperineal (TP) route. In general, the approaches are considered to provide similar diagnostic power. However, infectious complications appear to differ in favour of the TP approach. Furthermore, antibiotic prophylaxis is felt to have limited additional value in a TP biopsy, which aligns with antimicrobial stewardship principles. Urology association guidelines have provided conflicting recommendations on the best approach for a prostate biopsy. This systematic review aims to compare the infectious complications and antibiotic usage of the two approaches. METHODS:A systematic review and meta-analysis were performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines after registration with PROSPERO (CRD42024513309). MEDLINE, Embase, Scopus, and Web of Science were searched for articles published until April 1, 2025. Randomised controlled trials (RCTs) assessing infectious complications (fever, urinary tract infection, and hospitalisation with infectious complications) following a prostate biopsy were included. The risk of bias was assessed with the RoB 2 tool, and statistical analyses included visualisation through funnel and forest plots and assessing the publication bias via Egger's regression test. KEY FINDINGS AND LIMITATIONS:Ten RCTs were included in the analysis, encompassing 4188 prostate biopsies. Of seven studies reporting hospitalisation for infectious complications, the TP route showed significantly lower odds (odds ratio 0.23, 95% confidence interval [CI] 0.10-0.54; graphical abstract), reducing hospitalisation risk by 77% compared with the TR route. Postinterventional fever occurred less frequently, with an odds ratio of 0.68 (95% CI 0.52-0.89). There was no statistically significant difference in infectious complications after a TP biopsy with or without antibiotics. All TR route biopsies utilised antibiotic prophylaxis. The small number of eligible studies and the high risk of bias, as well as sparse data on bias in most studies, limit the power of our manuscript. CONCLUSIONS AND CLINICAL IMPLICATIONS:TP biopsy is associated with a lower admission risk due to postprocedural infection compared with TR biopsy. TP biopsy seems to be a safe procedure without antibiotics in patients without risk factors, advocating for enhanced antimicrobial stewardship in urology.

Local recurrence after partial nephrectomy with negative margins (R0) remains a clinical concern in the management of non-metastatic renal cell carcinoma (RCC). We aimed to quantify its incidence and to identify independent predictors of recurrence in a large, contemporary, multicenter cohort. We retrospectively analyzed 2,438 patients from the UroCCR database who underwent R0 nephron-sparing surgery for cT1–cT3a/N0/M0 RCC between 2007 and 2022 across 24 French centers. The primary endpoint was histologically confirmed local recurrence (tumor bed or ipsilateral renal recurrence). Fine‑and‑Gray competing‑risk regression, with death treated as a competing event, was applied to determine independent predictors. After a median follow-up of 66 months (IQR:26–86), local recurrence occurred in 97 patients (3.9

OBJECTIVE:To compare outcomes of nephrectomy for left-sided (n = 70) vs right-sided (n = 118) renal tumours with caval thrombi. METHODS:In this retrospective analysis (June 2008-February 2023), we evaluated peri-operative variables, 30-day complications, estimated glomerular filtration rate (eGFR), and survival rates. RESULTS:Patients in the left-sided renal tumour group experienced significantly longer operating times (240 vs 193 min; P < 0.001), greater blood loss (1700 vs 1000 mL, P = 0.042), and more complications (53% vs 35%, P = 0.015). Postoperative renal function was worse in the left-sided vs the right-sided renal tumour group, with lower immediate postoperative eGFR (P = 0.035) and a higher dialysis rate (17% vs 6.8%, P = 0.026). However, overall survival and recurrence-free survival were similar (P = 0.8 and P = 0.43, respectively). CONCLUSIONS:Left-sided renal tumours with caval thrombi present a higher risk of complications and acute kidney injury requiring dialysis, potentially due to left renal vein ischaemia during surgery and anatomical proximity to the superior mesenteric artery. Thorough preoperative planning and limited clamping time are essential.

To determine the value (measured by the number of post operative infections) of UC (urine culture positive or sterile) and antibiotic prophylaxis performed before partial nephrectomy (PN) for cancer to decrease the postoperative risk of infection. This study included a prospective cohort of patients who underwent PN for cancer between 2011 and 2023. Multivariate logistic regression was performed to investigate risk factors associated with the occurrence of postoperative infection episodes. Post operative infections were defined accordingly to the CDC (Center for disease control and prevention) definition (fever > 38°5 C that required antibiotics, superficial/deep wound infection requiring medical or surgical intervention, or urinary infection treated by antibiotics during the month after surgery). A propensity score was calculated. A logistic regression model weighted by the propensity score was defined. Preoperative UC was performed for 491 of the 702 patients (69.9

Background and objective: A renal mass biopsy (RMB) is not systematically recommended before surgical excision of a renal mass, although it has demonstrated elevated accuracy in determining renal masses with low morbidity. Our aim was to determine the diagnostic accuracy of an RMB, the clinical and tumoral factors associated with RMB practice, and the impact of an RMB on renal cell carcinoma management in a contemporary prospective national registry-UroCCR (2010-2021). Methods: We identified all patients with a single renal mass (pT1-4 N0-2 M0 or benign) who were treated surgically and stratified them according to the erformance of a prior RMB. Patients treated by active surveillance, percutaneous ablative treatment, or stereotaxic radiotherapy were excluded. Diagnostic accuracy of an RMB was determined in the RMB group. Clinical and tumoral factors associated with the practice of RMBs were analyzed using logistic regression. Key findings and limitations: In total, 9283 patients were included, who presented 1594 tumors (17%) with a prior RMB. RMBs were 92.4% contributive. The correlation between an RMB and excision in the determination of benign/malignant disease, histological subtype, and grade are, respectively, 96.9%, 86.4%, and 52.6%. The impact of an RMB versus no prior RMB was determined according to the rate of surgical excision for benign lesion and the rate of partial nephrectomy (63.9% vs 57.8%; p < 0.001). Conclusions and clinical implications: An RMB is performed rarely when its diagnostic performance is high. A prior RMB significantly changes the management of localized renal masses, with fewer surgical procedures for benign renal masses and conservative treatment in a higher proportion of patients. Patient summary: In a large and contemporary registry, we demonstrated that a renal mass biopsy has excellent diagnostic accuracy, significantly reduces renal surgery for benign masses and low-grade/stage renal cell carcinoma, and increases conservative surgical excision. (c) 2025 The Author(s). Published by Elsevier B.V. on behalf of European Association of Urology. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

To assess the effect of single-dose perioperative antibiotic prophylaxis (PAP) on surgical site infection (SSI) rates and related outcomes in elective scrotal or inguinal testicular surgery. Retrospective cohort study of patients who underwent elective clean scrotal or inguinal testicular surgery. Patients were stratified by PAP administration: single-dose PAP versus no PAP. Outcomes were SSI incidence, overall complications and severity (Clavien-Dindo classification and Comprehensive Complication Index [CCI]), length of stay, and readmission rates. Univariable regression analysis identified SSI risk factors in non-PAP patients. Between 09/2018 and 09/2022, 105 (59

Multiple myeloma (MM) is the second most common blood malignancy, with several lines of evidence supporting an inherited genetic component. Here, we sequenced 177 affected individuals from 128 families, and 170 early-onset MM cases diagnosed before 55 years of age. Samples were identified and collected through nationwide efforts in France, Sweden, and Greece. We focused on rare germline protein truncating and likely deleterious missense variants in genes harboring variants in at least two families showing variant-disease segregation, and in additional index (≥2) and/or early-onset (≥2) cases. We identified likely pathogenic variants in ATM (N = 12), ANGPTL6 (N = 5), and FBXW9 (N = 6). Additionally, we detected variants in previously reported MM predisposition genes, including DIS3, EP300, and KDM1A. Our results represent the largest sequencing study on familial and early-onset MM to date, and further illuminate the constitutional genetic basis of MM.

Schistosomiasis, known as bilharzia, is a parasitic disease caused by trematodes of the genus Schistosoma, found primarily in Africa and pockets of the Middle East. Southern Europe seems to be a breeding ground for urogenital schistosomiasis emergence. Ten and five years have passed since the first and the last cases of urogenital schistosomiasis were identified in Corsica (patients who have bathed in the Cavu and/or Solenzara rivers between 2013 and 2019). Through a literature review, the authors aimed to clarify the epidemiological, clinical and diagnostic particularities of urinary schistosomiasis acquired in Corsica. LEVEL OF EVIDENCE: 4.

OBJECTIVES:We performed next generation sequencing in two affected-sibling pairs of atypical femur fractures (AFF) and in unrelated cases of AFF to identify genetic variants of bisphosphonates (BP)-associated AFF. METHODS:A whole exome sequencing (WES) was performed in two sisters with BP-associated AFF and their healthy brother naïve to BP treatment (family A). After bioinformatic filtering, the intrafamilial segregation was analysed. Then, we performed targeted sequencing of 62 genes, including 36 genes containing variants predicted to be damaging and segregating with the phenotype in both sisters of the family A, and 26 candidate genes for osteogenesis imperfecta (OI), hypophosphatasia and the mevalonate pathway. The targeted sequencing was performed on the family A, and on 47 unrelated participants and another affected sibling pair (family B) from the Quebec AFF Registry. 100 healthy controls recruited in same geographic area than patients were genotyped for rare variants. RESULTS:Sixty-three rare and deleterious variants were detected by the WES and shared by the two affected sisters of the family A. Among those variants, a rare likely pathogenic variant (p.Leu3fs) of the WNT1 gene, already linked to OI and early onset osteoporosis, was also shared by a third individual, an unrelated case with BP-associated AFF. The pair of siblings of family B carried a novel variant (p.Glu1323fs) in the COL1A2 gene, linked to OI. One unrelated case had a novel variant in the FDFT1 gene, involved in the mevalonate pathway. These rare variants were not found in 100 healthy controls. CONCLUSION:Some BP-associated AFFs may occur in the setting of clinically undiagnosed underlying genetic disorders predisposing to osteoporosis and fractures, such as OI.