Introduction/Background: Large-volume benign prostatic hyperplasia (≥80 mL) requires complete anatomical removal of the adenoma. Robot-assisted or minimally invasive simple prostatectomy (RASP/MISP) and anatomic endoscopic enucleation of the prostate (AEEP) have both emerged as minimally invasive alternatives to open simple prostatectomy, but their comparative perioperative performance in very large glands remains incompletely defined. Objective: To systematically review and quantitatively synthesize the perioperative outcomes and complications of RASP/MISP versus AEEP in the surgical management of large-volume BPH. Methodology: Following PRISMA 2020, PubMed, Embase, Scopus and the Cochrane Library were searched from inception to 7 June 2026 for randomized and non-randomized comparative studies of RASP/MISP versus AEEP in men with mean or median prostate volume ≥ 80 mL reporting at least one perioperative or functional outcome and at least one Clavien-Dindo grade ≥ III complication. Continuous outcomes were pooled as mean differences (MD) and dichotomous outcomes as risk ratios using random-effects models (REML with Knapp-Hartung adjustment); heterogeneity was assessed with I2. Risk of bias was evaluated with the Newcastle-Ottawa Scale and ROBINS-I, and certainty of evidence with GRADE. Publication bias and leave-one-out sensitivity analyses were performed where the number of studies permitted. Results: Five comparative cohort studies published between 2017 and 2025 were included, comprising 271 patients treated with RASP/MISP and 998 treated with AEEP. AEEP was associated with a significantly shorter catheterization time (pooled MD 5.95 days; 95% CI 1.98-9.92; p = 0.014) and a shorter hospital stay (pooled MD 2.73 days; 95% CI 1.07-4.39; p = 0.010), both with high heterogeneity (I2 99.0% and 96.1%, respectively). Perioperative hemoglobin drop tended to favor AEEP without reaching significance (pooled MD 0.65 g/dL; 95% CI -0.33 to 1.63; p = 0.103), and transfusion risk was lower but not statistically significant (pooled RR ≈ 0.46; 95% CI 0.18-1.15). PSA reduction was substantial and broadly equivalent between techniques. Functional outcomes (IPSS, QoL, Qmax, PVR) improved comparably with both approaches. Leave-one-out analyses confirmed that the catheterization and length-of-stay advantages of AEEP were robust, and no evidence of publication bias was detected. Certainty of evidence was low to moderate, reflecting the observational designs. Leave-one-out analyses indicated that the catheterization and length-of-stay differences were not driven by any single study; publication bias could not be assessed reliably because fewer than ten studies contributed to any outcome. Certainty of evidence was low to moderate, reflecting the observational designs, the small number of studies, and substantial between-study heterogeneity, and the findings should be regarded as hypothesis-generating. Conclusions: In large-volume BPH, AEEP and RASP/MISP achieve comparable functional improvement and adenoma debulking, but AEEP offers superior perioperative efficiency, with markedly shorter catheterization and hospital stay and at least comparable safety. RASP/MISP remains a valuable option where robotic infrastructure is available but high-volume enucleation expertise is lacking. These findings, drawn from observational evidence of low-to-moderate certainty, support AEEP as the more resource-efficient minimally invasive option for very large glands and underline the need for randomized comparative trials.

INTRODUCTION:Pyeloplasty is a common reconstructive procedure in urology, traditionally involving internal stenting to enhance drainage and healing. However, conventional Double-J (DJ) stents are associated with complications such as discomfort, infection, and migration. MATERIALS AND METHODS:This prospective pilot study evaluates the feasibility and clinical outcomes of using the JFil® stent, an alternative designed for improved patient tolerance and reduced complications, in robot-assisted Anderson-Hynes pyeloplasty. Four patients underwent the procedure with intraoperative JFil® stent placement. Outcomes were assessed through follow-up imaging, renal function tests, and a stent-specific symptom questionnaire. RESULTS:Results showed no peri- or postoperative complications of Clavien-Dindo ≥ grade III and improved postoperative kidney function. The questionnaire scores indicated minimal postoperative discomfort. CONCLUSION:While the study's small sample size limits generalizability, findings support the JFil® stent as a promising alternative in pyeloplasty. Further research with larger cohorts is recommended to validate these results.

To improve the prediction of relapse for clinical stage I seminoma, we aimed to validate the Boormans model (incorporating tumor size, rete testis invasion, and lymphovascular invasion) against the conventional classification (tumor size > 4 cm/rete testis invasion). Consecutive cSI seminoma patients managed with active surveillance after orchidectomy across multiple centers were retrospectively analyzed (1994-2024). Part of the data was provided by the prospective Swiss-Austrian-German Testicular Cancer Cohort Study Group. The primary outcome was relapse. Among the 1025 patients, 116 (11.3%) relapsed during a median follow-up of 45 months (95% CI 42-48). In the descriptive multivariable analysis, TS (HR 1.03, 95% CI 1.01-1.04) and RTI (HR 2.73, 95% CI 1.83-4.06) were found to be independent predictors of relapse. The Boormans model classified 645 (62.9%) men as low-, 356 (34.7%) as intermediate-, and 24 (2.3%) men as high-risk candidates. The 5-year relapse risk was 0.07 (95% CI 0.04-0.09), 0.24 (0.19-0.29), and 0.35 (0.10-0.53) for the low-, intermediate-, and high-risk groups, respectively. The Boormans model outperformed the conventional model (C-index 0.66 vs. 0.61; Δ0.06, p < 0.001). Despite improved discrimination, clinical utility was limited across risk-adapted treatment scenarios compared with the conventional model. The Boormans model demonstrated superior discrimination but limited gains in clinical utility. Integrating novel biomarkers may enable more accurate, risk-adapted management.

Benign prostatic obstruction (BPO) is a common condition. Anatomical endoscopic enucleation of the prostate (EEP) is the mainstay in therapy for large glands (> 80 ml), but also feasible in smaller prostates. The original three-lobe enucleation technique has been supplemented by two-lobe and one-lobe or en-bloc techniques. One- and two-lobe techniques seem more effective in terms of surgical time and blood loss. The impact of the different techniques on functional outcomes however is unclear. To determine whether the technique used in prostate enucleation influences functional outcomes of surgery. We performed a systematic review of Medline/Pubmed and identified 124 studies, of which 10 were included for network meta-analyses. We included RCTs as well as retrospective and prospective cohort series, comparing one-lobe, two-lobe and three-lobe technique respectively. We assessed functional outcomes including post-void residual urine, Qmax (ml/s), IPSS Score and QoL Score. Additionally we compared stress and urge incontinence rates after three months. The only significantly differing result was in postoperative Qmax increase in favor of one-lobe and two-lobe compared to three-lobe technique. However, with mean differences of 0.989 and 0.749 respectively the effect was clinically negligible. There was no difference in the other functional outcomes including incontinence rates. Our approach is limited by the quality of the data, since retrospective and non-randomized trials were included due to the overall poor amount of studies on the subject. One-lobe/en-bloc, two-lobe and three-lobe technique in endoscopic enucleation of the prostate for benign prostate syndrome all improve micturition. No final conclusion concerning superiority of a specific lobe-technique in terms of functional outcomes can be drawn from the available data. Randomized controlled trials are needed.

Background: To retrospectively investigate scatter radiation (SCR) exposure among staff in the endourology operating theatre. Methods: During surgeries under fluoroscopic guidance, five professional groups (urological surgeon [US], surgical nurse [SN], assistant surgical nurse [ASN], anaesthetist [A], and anaesthesia care [AC]) wore real-time dosimeters (Philips DoseAware System) on their head and chest over lead aprons between July 2023 and February 2024. The SCR data were analysed and correlated with procedural and patient factors. Results: In total, 249 procedures were performed, including 86 retrograde intrarenal surgeries and 10 percutaneous nephrolithotomies. Median SCR exposure was 38.81, 17.20, 7.71, 11.58, 0.63, 0.23, 0.12, and 0.15 Microsievert (µSv) for US chest (USC), US head (USH), SN chest (SNC), SN head (SNH), A chest (AC), AC chest (ACC), ASN chest (ASNC), and ASN head (ASNH), respectively. There was a significant correlation between DAP and SCR doses detected by USC, USH, SNC, SNH, AC, and ACC dosimeters (p < 0.05). The median chest-to-eye conversion factor (CECF) was 2.11 for the US and 0.71 for the SN. Conclusions: This study, using real-time dosimetry, is among the first to assess staff occupational SCR exposure in endourology. It highlights a substantial SCR exposure, indicating an occupational health hazard that warrants further investigation.

Objective: The objective of this study was to prospectively assess the extent to which magnetic resonance imaging (MRI) can differentiate malignant from benign lesions of the testis. Materials and Methods: All included patients underwent multiparametric testicular MRI, including diffusion-weighted imaging (DWI) and subtraction dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI). Subsequently, all patients underwent a histopathological examination via orchiectomy or testicular biopsy/partial resection. The Kolmogorov–Smirnov test, t-test, Mann–Whitney U test, Fisher’s exact test, and logistic regression were applied for statistical analysis. Results: We included 48 male patients (median age 37.5 years [range 18–69]) with testicular tumors. The median tumor size on MRI was 2.0 cm for malignant tumors and 1.1 cm for benign tumors (p < 0.05). A statistically significant difference was observed for the type (type 0-III curve, p < 0.05) and pattern of enhancement (homogeneous, heterogeneous, or rim-like, p < 0.01) between malignant and benign tumors. The minimum apparent diffusion coefficient (ADC) value was 0.9 for benign tumors and 0.7 for malignant tumors (each ×103 mm2/s, p < 0.05), while the mean ADC was 0.05. The mean ADC value was significantly lower for malignant tumors; the mean ADC value was 1.1 for benign tumors and 0.9 for malignant tumors (each ×103 mm2/s, p < 0.05). The sensitivity, specificity, positive predictive value, and negative predictive value of multiparametric MRI for differentiating malignant from benign testicular lesions were 94.3%, 76.9%, 91.7%, and 83.3%, respectively. The surgical procedures performed included orchiectomy (n = 33; 71.7%) and partial testicular resection (n = 11; 23.9%). Histopathology (HP) revealed malignancy in 35 patients (72.9%), including 26 with seminomas and 9 with non-seminomatous germ cell tumors (NSGCTs). The HP was benign in 13 (27.1%) patients, including 5 with Leydig cell tumors. Conclusions: Malignant and benign tumors differ in MRI characteristics in terms of the type and pattern of enhancement and the extent of diffusion restriction, indicating that MRI can be an important imaging modality for the accurate diagnosis of testicular lesions.

In der Akutdiagnostik bei Verdacht auf Nephroureterolithiasis sollte die Sonographie die Untersuchungsmodalität der Wahl darstellen. Bei Verdacht auf Urolithiasis, unklarem Flankenschmerz mit Fieber oder bei einer Einzelniere sollte darauffolgend immer eine Nativ-CT (Computertomographie) durchgeführt werden. Bei Schwangeren kann bei nicht eindeutigen Sonographiebefunden auf eine Magnetresonanztomographieuntersuchung zurückgegriffen werden. Wird die Indikation zur Harnableitung gestellt, sollte eine retrograde Darstellung im Rahmen der Harnableitung durchgeführt werden. Diese oder die CT eignen sich auch zur präinterventionellen Bildgebung vor Stoßwellenlithotripsie, perkutaner Nephrolithotomie oder Ureteroskopie. Eine postinterventionelle Bildgebung ist nicht immer notwendig, und oft ist hier die Sonographie ausreichend. Bei einem konservativen Therapieprozedere kann die Abdomenleeraufnahme zur Verlaufskontrolle zu Rate gezogen werden.

OBJECTIVES:To determine the safety and oncological advantages of en bloc resection of bladder tumour (ERBT) vs conventional transurethral resection of bladder tumour (cTURBT) in terms of resection quality, staging quality, and safety. PATIENTS AND METHODS:We conducted a single-blinded randomised controlled trial at seven European hospitals with the following inclusion criteria: first diagnosis of non-muscle-invasive bladder cancer, no singular carcinoma in situ, and tumour size >4.3 mm. Patients were randomised intraoperatively in a 1:1 ratio to either the ERBT or cTURBT group. Outcome analysis was performed using the chi-square test, t-test, and multivariate regression analysis. RESULTS:A total of 97 patients were randomised into the study (cTURBT = 40, ERBT = 57). A switch to cTURBT was necessary in two patients (3.5%) and 11.5% of the screened patients were preoperatively excluded for ERBT. There was no difference in the specimen presence of detrusor muscle with 73.7% in cTURBT and 67.3% in ERBT specimens (P = 0.69). There were no significant differences in mean operative time (ERBT 27.6 vs cTURBT 25.4 min, P = 0.450) or mean resection time (ERBT 16.3 vs cTURBT 15.5 min, P = 0.732). Overall the complication rate did not differ significantly (ERBT 18.2% vs cTURBT 7.5%, P = 0.142). Bladder perforations occurred significantly more often in the ERBT group (ERBT seven vs cTURBT none, P = 0.020). R0 status was reported more often after ERBT, whilst a second resection was significantly less frequent after ERBT (P = 0.018). Recurrence rates were comparable for both techniques after 6 months of follow-up. CONCLUSION:The feasibility of ERBT is higher than previously reported. Whereas other perioperative and safety parameters are comparable to cTURBT, bladder perforations occurred significantly more often in the ERBT group and raised safety concerns. This is why this trial was terminated.

Background: The selection of suitable patients for the surgical treatment of benign prostatic obstruction (BPO) is a challenge in persons ≥75 years of age. Methods: After a systematic literature search of PubMed, 22 articles were included in this review. Clinical and functional parameters were evaluated statistically. Results: The mean age of the patients was ≥79 years. The mean duration of postoperative catheterization ranged between 2 (d) (ThuLEP, thulium laser enucleation of the prostate) and 4.4 days (TURP, transurethral resection of the prostate). Complication rates ranged between 6% (HoLAP, holmium laser ablation of the prostate) and 34% (PVP, photoselective vaporization of the prostate); the maximum rate of severe complications was 4% (TURP). The mean postoperative maximal urinary flow (Qmax) in mL/sec. ranged between 12.9 mL/sec. (HoLAP) and 19.8 mL/sec (Hol-TUIP, holmium laser transurethral incision of the prostate). The mean quality of life (QoL) score fell from 4.7 ± 0.9 to 1.8 ± 0.7 (HoLEP), from 4.1 ± 0.4 to 1.9 ± 0.8 (PVP), from 5.1 ± 0.2 to 2.1 ± 0.2 (TURP), and from 4 to 1 (ThuVEP, thulium laser vapoenucleation of the prostate). Pearson’s correlation coefficient (r) revealed a positive linear correlation between age and inferior functional outcome (higher postoperative International Prostate Symptom Score (IPSS) [r = 0.4175]), higher overall complication rates (r = 0.5432), and blood transfusions (r = 0.4474) across all surgical techniques. Conclusions: This meta-analysis provides the summary estimates for perioperative and postoperative functional outcome and safety of endoscopic treatment options for BPO in patients ≥ 75 years of age. Of particular importance is that all surgical techniques significantly improve the postoperative quality of life of patients in this age group compared to their preoperative quality of life.

To evaluate the early learning curve of BipolEP (Bipolar Enucleation of the Prostate). We conducted a retrospective, multicenter analysis of surgical and functional outcomes of patients treated with BipolEp for BPO (benign prostatic obstruction). We evaluated the first 20 cases of BipolEp performed by four different surgeons in three different countries. The following baseline parameters were obtained: age, IPSS, indwelling catheter, transrectal measured prostate volume, post void residual volume (PVR) and uroflowmetry. The learning curve was analysed based on perioperative parameters and the influence of perioperative parameters was correlated with the sequence of BipolEp cases. 84 BipolEp operations performed by 4 different surgeons in their early learning curve were studied. Mean prostate volume was 75 ml, 39

Zusammenfassung Bei steigender Lebenserwartung gibt es zunehmend ältere (≥ 80 Jahre) PatientInnen mit der Diagnose eines muskelinvasiven Blasenkarzinoms. Therapie der Wahl ist die radikale Zystektomie mit Harnableitung (mit neoadjuvanter Chemotherapie, sofern belastbar). Die Auswahl der richtigen Harnableitung in Abwägung von Morbidität gegenüber Funktionalität und Lebensqualität stellt eine Herausforderung dar. Das kalendarische Alter allein ist nicht entscheidend. Wegweisend ist v. a. eine adäquate präoperative Begutachtung mit Blick auf medizinische Besonderheiten sowie physische und kognitive Einschränkungen. Standardmäßig wird bei älteren PatientInnen das Ileum-Conduit als inkontinente Harnableitung eingesetzt, da der Eingriff eine geringere Komplexität und Operationsdauer als eine kontinente Harnableitung aufweist. Fitte PatientInnen mit adäquater Lebenserwartung und ausreichender Compliance können jedoch auch im hohen Alter Kandidaten für kontinente Harnableitungen sein. Die Ureterokutaneostomie mit Harnleiterschienendauerversorgung ist eine wichtige Alternative für multimorbide PatientInnen mit hohem perioperativem Risiko. Wichtig ist v. a. eine gute präoperative Aufklärung, sodass PatientInnen eine informierte Entscheidung treffen können.

Uretero-neocystostomy (UNC) is the gold-standard for distal-ureter repair. Whether the surgery should be conducted minimally invasive (laparoscopic (LAP), robotic RAL)) or open remains unanswered by the literature. Retrospective analysis of surgical outcome of patients treated with UNC for distal ureteral stenosis (January 2012 - October 2021). Patient demographics, estimated blood loss (EBL), surgical technique, operative time, complications and length of hospital stay (LOS) were recorded. During the follow-up period, patient underwent renal ultrasound and kidney function tests. Success was defined as relieve of symptoms or no findings of obstruction needing urine drainage. 60 patients were included (9 RAL, 25 LAP, 26 open). The different cohorts were similar of age, gender, American Society of Anesthesiologists (ASA) score, body-mass index and history of prior treatment of the ureter. No intraoperative complications were detected in all groups. There was no conversion to open surgery in the RAL group, whereas one was found in the LAP arm. Six patients had a recurrent stricture, but with no significant difference between the cohorts. EBL was not different between the groups. LOS was significantly lower in the RAL + LAP group compared to open (7 vs. 13 days, p = 0.005) despite significantly longer operating times (186 vs. 125.5 min, p = 0.005). Minimal invasive UNC, especially RAL, is a feasible and safe surgical method and provides similar results in terms of success rates in comparison to open approach. A shorter LOS could be detected. Further prospective studies need to be done.

Preoperative homeostasis of sex hormones in testicular germ cell tumor (TGCT) patients is scarcely characterized. We aimed to explore regulation of sex hormones and their implications for histopathological parameters and prognosis in TGCT using a data-driven explorative approach. Pre-surgery serum concentrations of luteinizing hormone (LH), follicle-stimulating hormone (FSH), testosterone (T), estradiol (E2) and prolactin were measured in a retrospective multicenter TGCT cohort (n = 518). Clusters of patients were defined by latent class analysis. Clinical, pathologic and survival parameters were compared between the clusters by statistical hypothesis testing, Random Forest modeling and Peto-Peto test. Cancer tissue expression of sex hormone-related genes was explored in the publicly available TCGA cohort (n = 149). We included 354 patients with pure seminoma and 164 patients with non-seminomatous germ cell tumors (NSGCT), with a median age of 36 years. Three hormonal clusters were defined: 'neutral' (n = 228) with normal sex hormone homeostasis, 'testicle' (n = 91) with elevated T and E2, low pituitary hormones, and finally 'pituitary' subset (n = 103) with increased FSH and LH paralleled by low-to-normal levels of the gonadal hormones. Relapse-free survival in the hormonal subsets was comparable (p = 0.64). Cancer tissue expression of luteinizing hormone- and follicle-stimulating hormone-coding genes was significantly higher in seminomas, while genes of T and E2 biosynthesis enzymes were strongly upregulated in NSGCT. Substantial percentages of TGCT patients are at increased risk of sex hormone dysfunction at primary diagnosis before orchiectomy. TGCT may directly influence systemic hormonal homeostasis by in-situ synthesis of sex hormones.

Background: Our aim was to evaluate the effect of COVID-19 infection on male fertility and sexual function. Methods: Thirty-one patients were investigated over a mean follow-up of 90 days (22–527) after a COVID-19 infection. Erectile dysfunction (ED), blood tests for sexual hormones, semen analysis including analysis of oxidative stress (OS), as well as COVID-19 antibody titer and the nasal COVID-19 PCR test were evaluated pre- and post-infection. Results: Five patients reported a mild de novo ED (16.13%). One patient had a de novo positive mixed antiglobulin reaction test after the infection. We found no significant difference between pre-COVID-19 and post-COVID-19 spermiogram parameters (p = 0.815). OS showed no significant association with COVID-19 infection, but with pathological spermiogram categories, sperm concentration, total sperm count, testis volume, FSH and testosterone. Conclusion: COVID-19 infection does not appear to affect sperm quality and OS negatively in the intermediate term. Further investigations will be needed to assess the potential long-term effects of the infection and vaccination on male sexual function and fertility.

Neoadjuvant chemotherapy is a well-established concept in muscle-invasive bladder cancer with known advantages in overall survival. Phase II trials show encouraging response rates for neoadjuvant immunotherapy before radical surgery in urothelial cancer. There is no recommendation for neoadjuvant therapy in upper tract urothelial carcinoma before nephroureterectomy. Our aim was to assess the available data on neoadjuvant chemotherapy and immunotherapy before nephroureterectomy in patients with high-risk upper tract urothelial carcinoma in terms of pathological downstaging and oncological outcomes. Two investigators screened PubMed/Medline for comparative trials in the English language. We identified 368 studies and included eleven investigations in a systematic review and meta-analysis for neoadjuvant chemotherapy and control groups. There were no comparative trials investigating immunotherapy in this setting. All 11 studies reported on overall pathological downstaging with a significant effect in favor of neoadjuvant chemotherapy (OR 5.17; 95%CI 3.82; 7.00). Pathological complete response and non-muscle invasive disease were significantly higher in patients receiving neoadjuvant chemotherapy (OR 12.07; 95%CI 4.16; 35.03 and OR 1.62; 95%CI 1.05; 2.49). Overall survival and progression-free survival data analysis showed a slight benefit for neoadjuvant chemotherapy. Our results show that neoadjuvant chemotherapy is effective in downstaging in upper urinary tract urothelial carcinoma. The selection of patients and chemotherapy regimens are unclear.

Transurethral resection of bladder tumors (TURBT) is the standard of care for the diagnostics and primary treatment of bladder tumors. These are removed by fragmentation using loop diathermy. The resection area is coagulated for hemostasis. An important aspect is always a complete resection with an adequate amount of detrusor muscle in the specimen. Postoperative intravesical instillation of single-shot chemotherapy has been proven to reduce recurrence rates. Methods for improved tumor visualization (particularly photodynamic diagnostics) are used to enhance tumor detection rates particularly in multifocal tumors or carcinoma in situ (CIS). Thus, recurrence and progression rates can be reduced. Depending on the histological examination of the TURBT specimen, follow-up treatment for non-muscle invasive bladder tumors are adjuvant instillation treatment using chemotherapy or Bacillus Calmette-Guerin (BCG), second look TURBT and early cystectomy or for muscle invasive bladder tumors, radical cystectomy or (oncologically subordinate) trimodal treatment with renewed TURBT, radiotherapy and chemotherapy are indicated. Possible complications of TURBT include bleeding with bladder tamponade, extraperitoneal or intraperitoneal bladder perforation and infections of the urogenital tract.

Abstract Purpose: To compare oncological, peri-, and postoperative outcomes of robot-assisted with those of laparoscopic partial nephrectomy. Patients and Methods: Thirty patients with low- or moderate-complexity renal tumors (R.E.N.A.L. nephrometry scoring) were randomized in a single-blind manner and operated on by the robot-assisted (n = 13) or laparoscopic (n = 17) approach. The primary outcome was oncological safety, based on the residual tumor (R) classification. Secondary outcome parameters were perioperative and postoperative results. The open-source R statistical software was used for statistical analysis. Results: Oncological outcomes did not differ significantly between the two surgical methods (p = 0.58). Operating time (p = 0.105), ischemia time (p = 0.884), overall length of hospital stay (p = 0.664), postoperative pain, and preoperative and in-hospital renal function scores were similar. Creatinine levels differed significantly six months postoperatively (robotic: 0.9 mg/dl versus laparoscopic: 1.1 mg/dl; p= 0.014). Intraoperative blood loss was significantly greater in the laparoscopic group (400 ml versus 168 ml; p = 0.028), which was also reflected in postoperative hemoglobin levels (13.8 mg/dl versus 12.5 mg/dl; p = 0.012). Peri- or postoperative complications did not differ significantly (p = 0.355). Subgroup analysis revealed significantly more frequent complications in patients with moderate-complexity tumors treated by laparoscopic surgery (p = 0.021). Conclusions: The oncological outcome in regard to the R status was similar in both groups. Intraoperative blood loss, postoperative renal function, and complications all benefited from robot-assisted surgery. Trial registration: The study was registered on ClinicalTrials.gov (NCT03900364; 03/04/2019).

Background: In Bacillus Calmette–Guérin (BCG) refractory non-muscle-invasive bladder cancer (NMIBC), radical cystectomy is the gold standard. The advent of immune checkpoint inhibitors (CPIs) has permanently changed the therapy landscape of bladder cancer (BC). This article presents a systematic review of immune-modulating (IM) therapies (CPIs and others) in BCG-refractory NMIBC. Methods: In total, 406 articles were identified through data bank research in PubMed/Medline, with data cutoff in October 2021. Four full-text articles and four additional congress abstracts were included in the review. Results: Durvalumab plus Oportuzumab monatox, Pembrolizumab, and Nadofaragene firadenovec (NF) show complete response (CR) rates of 41.6%, 40.6%, and 59.6% after 3 months, with a long-lasting effect, especially for NF (12-month CR rate of 30.5%). Instillations with oncolytic viruses such as NF and CG0070 show good efficacy without triggering significant immune-mediated systemic adverse events. Recombinant BCG VPM1002BC could prove to be valid as an alternative to BCG in the future. The recombinant pox-viral vector vaccine PANVAC™ is not convincing in combination with BCG. Interleukin mediating therapies, such as ALT-803, are currently being studied. Conclusion: CPIs and other IM agents now offer an increasing opportunity for bladder-preserving strategies. Studies on different substances are ongoing and will yield new findings.

Background En bloc tumor resection of bladder tumors (ERBT) is a novel alternative procedure to conventional resection of bladder tumor (cTURBT), which might help to address common problems of the standard method, such as inadequate detrusor muscle in specimens, high re-resection rates and high recurrence rates. Objective To analyze current data on ERBT in efficacy and safety compared to cTURBT. Data sources: PubMed. Study selection Two independent authors identified trials based on keywords and inclusion criteria. A third author was consulted in case of discrepancies. Screening keywords: ERBT, en bloc transurethral resection of bladder tumor, TURBT en bloc. A meta-analysis of 13 studies was performed. The effect size was estimated based on odds ratios and mean differences including their corresponding two-sided 95% confidence intervals. Data synthesis The analyzed studies comprised a homogenous collective in terms of tumor size, tumor multiplicity and tumor stage. Operation time did not significantly differ between the methods. Differences were observed in hospitalization and catheterization time in favor of ERBT. Reported complications did not show clear differences. There was significantly more detrusor muscle in the specimens in the ERBT group. No significant differences were found in recurrence up to 2 years of follow-up. Conclusion ERBT is a safe alternative to conventional TURBT with promising features regarding effective resection of detrusor muscle. More standardized data on recurrence rates, different resection modalities and resection margin results are needed.