To provide a detailed description of the Swiss Society of Urology prospective database of radical cystectomy (RC) due to bladder cancer (BC) about differences in operative outcomes between teaching and non-teaching RC. We collected the data of all RCs for BC from the register from March 2017 to March 2025, leading to 1587 cases. Afterwards, we decided about the extraction of 34 variables, e.g. operating approach and intraoperative complications. Furthermore, we determined that only complete data sets for our pre-defined variables will be included in the analysis, which led to 1304 RC cases. Median patient age was 72.0 years (IQR 64.0–78.0). The majority of patients underwent open RC (n = 838; 64.3

Introduction:Radical cystectomy or trimodal therapy are treatment options for non-metastatic bladder cancer. However, there is limited evidence guiding post-treatment follow-up regimens, resulting in variations in care. Objective:A Swiss consensus meeting aimed to identify gaps in follow-up strategies and subsequently tailoring follow-up protocols after curative treatment for bladder cancer. Methods:A consensus meeting including participants from urology, oncology, radiation oncology, neuro-urology, international advisors, and patient representatives was held. 19 pre-formulated questions addressing follow-up duration, frequency, and modalities after radical cystectomy or trimodal therapy for bladder cancer were discussed and voted by participants. Results:42 experts from 22 institutions participated in the meeting. Agreement was reached on several important elements of oncological and functional follow-up like risk-adapted follow-up and regular usage of patient reported outcome measures (PROMs) and 3 novel personalized follow-up schedules were suggested, balancing oncological surveillance, and monitoring functional complications. Conclusion:We agreed on 3 newly developed Swiss follow up schedules for patients with bladder cancer who underwent cystectomy or trimodal therapy with curative intent; these protocols include stage-specific recommendations for type and timing of investigations to detect relapse combined with balanced measures to monitor functional complications such as PROMS and specific clinical examinations. These protocols will be evaluated in a prospective national multicentric cohort study.

PURPOSE:To provide a detailed description of the Swiss Society of Urology prospective database of radical cystectomy (RC) due to bladder cancer (BC) about differences in operative outcomes between teaching and non-teaching RC. METHODS:We collected the data of all RCs for BC from the register from March 2017 to March 2025, leading to 1587 cases. Afterwards, we decided about the extraction of 34 variables, e.g. operating approach and intraoperative complications. Furthermore, we determined that only complete data sets for our pre-defined variables will be included in the analysis, which led to 1304 RC cases. RESULTS:Median patient age was 72.0 years (IQR 64.0-78.0). The majority of patients underwent open RC (n = 838; 64.3%). More than one quarter (n = 344; 26.4%) were teaching surgeries and there was no significant difference between both groups regarding demographic characteristics. There were no significant differences between teaching and non-teaching operative results in terms of surgical resection (R1 status; p = 0.295), duration of inpatient treatment (p = 0.394), infection (p = 0.023), wound healing disorders (p = 0.484), duration of surgery (p = 0.365), intraoperative bleeding (p = 0.635) and intraoperative blood loss (p = 0.074). However, in terms of the number of resected lymph nodes, blood transfusion rate, number of transfused packed red blood cells, intraoperative complications as well as the highest grade of complication during inpatient treatment teaching RC showed less favorable results, e.g. number of evaluated lymph nodes (teaching median 18.0 versus non-teaching median 20.0, p < 0.001). CONCLUSION:Teaching RC is safe, for a high complex procedure, according to our prospective pilot study.

Purpose: Performing restaging transurethral bladder resection (reTURB) for high-risk non-muscle invasive bladder cancer (NMIBC) reduces the risk of recurrence and tumour understaging. Management of residual high-grade papillary Ta or T1 after reTURB has changed this last 10 years in international recommendations. This study aimed to compare the recurrence free survival according to the different management procedures performed. Materials and methods: Patients who underwent reTURB for initial high-risk NMIBC between 2011 and 2020 were included. Patients with residual high-grade papillary Ta or T1 tumour after reTURB were divided into two groups: BCG instillations upfront versus BCG following a third-look resection (3TURB). Patient and tumour characteristics, BCG instillations, recurrence-free survival were retrospectively analysed. Results: A total of 162 high-risk patients were included. Sixty-one (37.7%) had residual high-grade papillary Ta or T1 at reTURB: 35 (21.6%) had BCG instillations upfront, 18 (11.2%) had a 3TURB and 8 (5%) had other management. The mean follow-up was 34.2 weeks +/- 20.2. Recurrence-free survival was significantly better in patients who underwent BCG instillations upfront (P < 0.0043). Recurrence after BCG therapy following reTURB was significantly lower in patients with no residual NMIBC at 6 (92.5% vs. 72.4%, P < 0.004) and 12 months (85% vs. 67.3%, P < 0.03). Conclusions: The efficacy of intravesical BCG is compromised in case of residual tumour following TURB. The role of a 3TURB following a positive reTURB is not yet determined. This study has confirmed that residual tumor following reTURB is a negative predictive factor but could not demonstrate the value of a 3TURB compared to upfront BCG. (c) 2023 Elsevier Masson SAS. All rights reserved.

Optimal follow-up strategies following trimodal treatment for muscle invasive bladder cancer play a crucial role in detecting and managing relapse and side-effects. This article provides a comprehensive summary of the patterns and risk factors of relapse, functional outcomes, and follow-up protocols. A systematic literature search on PubMed and review of current guidelines and institutional follow-up protocols after trimodal therapy were conducted. Out of 200 identified publications, 43 studies (28 retrospective, 15 prospective) were selected, encompassing 7447 patients (study sizes from 24 to 728 patients). Recurrence rates in the urinary bladder varied between 14–52

Background: The day of surgery admission (DOSA) has been practiced in surgery for decades, with reports dating as far back as 1909. DOSA policy has potential benefits for the health system and the patient, especially when there is a shortage of health-care resources. Objective: This study aims to compare DOSA and standard prior admission (D-1) among patients who underwent major urological operations. Methods: This retrospective study enrolled a total of 206 patients who did not meet the criteria for day care surgery admission. The patients were divided into two groups: those admitted on the same day of surgery and those admitted the day before surgery. Among the participants, 111 (53.8%) were admitted on the same day, while 95 (46.2%) were admitted the day before surgery. We collected data from the electronic health records of these patients, documenting various variables, including patient demographics, type of surgery, admission type and date, intervention date, length of stay, complications, Clavien–Dindo score, and American Society of Anesthesiologists (ASA) score. Results: We included a total of 206 patients who were admitted for operations in the urology department. The mean age was 70.5 years, and the majority was males (83.5%). Endoscopic procedures were the most common interventions (68%). The most ASA score for the enrolled patients was 2 (56.2%). DOSA was done for 53.8% of the patients, whereas the remaining patients were admitted 1 day before elective surgery. DOSA patients were significantly younger ( P = 0.025), had a higher proportion of ASA score 1 (12.7%) and ASA score 3 (26.4%), had significantly fewer postoperative complications ( P = 0.002), and had statistically significantly a shorter length of stay ( P < 0.001) compared to D-1 admission patients. Conclusion: In our study, DOSA patients were younger, had a lower prevalence of comorbidities, utilized anticoagulants less frequently, experienced fewer complications, and had significantly shorter hospital stays. Since the DOSA policy is safe and has a lower financial and economic burden on the health-care system, we recommend more urological and surgical centers to implement it.

To describe the practice of robotic-assisted partial nephrectomy (RAPN) in France and prospectively assess the late complications and long-term outcomes. Prospective, multicenter (n = 16), observational study including all patients diagnosed with a renal tumor who underwent RAPN. Preoperative, intraoperative, postoperative, and follow-up data were collected and stored in the French research network for kidney cancer database (UroCCR). Patients were included over a period of 12 months, then followed for 5 years. In total, 466 patients were included, representing 472 RAPN. The mean tumor size was 3.4 ± 1.7 cm, most of moderate complexity (median PADUA and RENAL scores of 8 [7–10] and 7 [5–9]). Indication for nephron-sparing surgery was relative in 7.1

EDITORIAL article Front. Surg., 02 August 2023Sec. Genitourinary Surgery Volume 10 - 2023 | https://doi.org/10.3389/fsurg.2023.1253985

EDITORIAL article Front. Surg., 21 November 2023Sec. Genitourinary Surgery Volume 10 - 2023 | https://doi.org/10.3389/fsurg.2023.1260951

En los últimos 40 años y desde la descripción inicial de la prostatectomía radical moderna, los conocimientos sobre la anatomía quirúrgica prostática han aumentado considerablemente, amplificados por la visión novedosa que aporta la técnica laparoscópica, el aumento del número de urólogos interesados en la cirugía oncológica prostática y el incremento del número de pacientes operados. Cada situación quirúrgica y cada etapa se han descrito para formar un corpus de conocimientos anatómicos inmenso, pero no siempre fácil de utilizar por el urólogo, con las técnicas quirúrgicas disponibles en la actualidad.

La BipolEP est l’un des traitements disponibles pour la prise en charge chirurgicale de l’hypertrophie bénigne de la prostate (HBP). L’objectif de cette vidéo était de décrire la technique de la BipolEP en monobloc. Les étapes clés de la BipolEP en monobloc sont présentées chez un patient âgé de 65 ans, sans antécédents médicaux particuliers, qui présentait des symptômes du bas appareil urinaire prédominant sur la phase vidange, réfractaires à un traitement médical par alpha-bloquants. À l’examen clinique, la prostate était souple. L’échographie retrouvait une prostate de 60 cm 3 . Score IPSS à 22 ; QoL à 5 ; Qmax : 9,2. L’intervention débute par une ouverture de la muqueuse en amont du veru montanum et dissection jusqu’à laisser apparaître le plan d’énucléation sous la face postérieure de la zone transitionnelle. La muqueuse est ouverte du côté gauche (puis droit) avec ouverture du plan d’énucléation du lobe latéral gauche (puis droit). Énucléation progressive bilatérale jusqu’en position antérieure. Jonction des 2 plans d’énucléation antérieurs par section des fibres muqueuses au niveau du sphincter au contact de l’adénome afin de préserver la continence. Poursuite de l’énucléation antérieure jusqu’à ouverture de la muqueuse vésicale. Énucléation complète de la face antérieure. Énucléation latérale gauche, droite, puis de la face postérieure de l’adénome jusqu’au col vésical. L’adénome est refoulé en position intravésicale. Morcellation de l’adénome en réplétion vésicale. L’énucléation endoscopique de la prostate en monobloc devient progressivement dominante par rapport aux techniques en plusieurs lobes. Elle pourrait apporter un gain de temps, limiter les forces de traction sur la zone apicale antérieure et, par conséquent, limiter l’incontinence postopératoire.

Increased diagnoses of silent prostate cancer (PCa) have led to overtreatment and consequent functional side effects. Focal therapy (FT) applies energy to a prostatic index lesion treating only the clinically significant PCa focus. We analysed the potential predictive factors of FT failure. We collected data from patients who underwent robot-assisted radical prostatectomy (RARP) in two high-volume hospitals from January 2017 to January 2020. The inclusion criteria were: one MRI-detected lesion with a Gleason Score (GS) of ≤7, ≤cT2a, PSA of ≤10 ng/mL, and GS 6 on a random biopsy with ≤2 positive foci out of 12. Potential oncological safety of FT was defined as the respect of clinicopathological inclusion criteria on histology specimens, no extracapsular extension, and no biochemical, local, or metastatic recurrence within 12 months. To predict FT failure, we performed uni- and multivariate logistic regression. Sixty-seven patients were enrolled. The MRI index lesion median size was 11 mm; target lesions were ISUP grade 1 in 27 patients and ISUP grade 2 in 40. Potential FT failure occurred in 32 patients, and only the PSA value resulted as a predictive parameter (p < 0.05). The main issue for FT is patient selection, mainly because of multifocal csPCa foci. Nevertheless, FT could represent a therapeutic alternative for highly selected low-risk PCa patients.

Purpose Pathological evaluation of pelvic lymph node (LN) dissection (PLND) is important for management of cystectomy patients. However, challenges such as unclear interobserver variability of LN counting remain. Here, we assess interobserver variability of LN measures and their clinical utility, with a focus on variant histology. Methods We retrieved radical cystectomy cases with PLND between 2010 and 2016 and reevaluated pathological parameters; number of total and metastatic LN, LN density (LND), length of metastatic LN and metastases, extranodal extension (ENE). Results We report 96 patients: median age of 71a, 34 cases pN+, 36 cases with any extent of variant histology, median follow-up 10 months. Perivesical LN were only rarely identified, but frequently metastatic (4/9). Variant histology (34 cases) frequently exhibited LN metastasis (53% of pN+ cases). Interobserver variance was poor for total LN (kappa = 0.167), excellent for positive LN (0.85) and pN staging (0.96), and mediocre for LND (0.53). ROC analysis suggests that both LND and the sum of LN metastasis length may predict outcome (AUC 0.83 and 0.75, respectively). Conclusion Our study confirms the notion of LND as a prognostic measure, but cautions due to strong interobserver variance of LN counts. The sum length of LN metastases could be a measure that is independent of LN counts. We find that microscopically identified perivesical LN merit particular attention. In summary, our study highlights current challenges in pathological reporting of PLND, confirms previous observations and forms a basis for further studies.

Los tumores del pene son los tumores urogenitales menos frecuentes; en ellos predomina el carcinoma epidermoide. Los tumores no epiteliales son excepcionales. Afectan mayoritariamente a los varones, no circuncidados, entre la quinta y la séptima décadas de la vida. Los tumores se desarrollan principalmente en el glande y el prepucio, y su diagnóstico se basa en la biopsia. Las pruebas de imagen son esencialmente necesarias si existe duda sobre una posible extensión local hacia el cuerpo esponjoso y los cuerpos cavernosos, así como para buscar una posible afectación ganglionar inguinal. Las dos exploraciones esenciales para evaluar la extensión local son la resonancia magnética y la eco-Doppler. Los primeros puntos de paso ganglionares son inguinales. Si se palpa una adenopatía inguinal, están indicadas la tomografía computarizada (TC) abdominopélvica y la tomografía por emisión de positrones acoplada a TC (PET-TC) con 18-fluoro-desoxi-glucosa (18-FDG). En caso de tumor peneano con riesgo de extensión ganglionar sin que se palpe adenopatía, se recomienda el estudio del ganglio centinela. El pronóstico de los tumores localizados es muy bueno. En cambio, es malo si existe extensión ganglionar.

Renal oncocytoma is an uncommon tumor that exhibits numerous features which are characteristic but not necessarily unique. Percutaneous biopsy is a safe method of diagnosis. However, differentiation from other tumor subtypes often requires sophisticated analysis and is not universally feasible. This is why, surgical management can be considered as a first-line treatment or after surveillance. Potential triggers for change in management are: tumor size >3 cm, stage progression, kinetics of size progression (>5 mm/y), and clinical change in patient or tumor factors. Long-term follow-up data are lacking and greater centralization should be considered to reach adequate management.

Faire le point sur la caractérisation par l’imagerie des tumeurs testiculaires. Analyse de la littérature (PubMed, Medline, langue anglaise et française) des études urologiques et radiologiques portant sur la nature et la caractérisation des tumeurs testiculaires. À l’écho-Doppler, la taille de la ou des lésions, la présence de microlithes/microlithiases/calcifications, l’architecture vasculaire en Doppler couleur sont des éléments sémiologiques importants pour orienter vers la bénignité ou la malignité. D’autres techniques comme l’IRM multiparamétrique, l’élastographie ultrasonore, l’échographie de contraste améliorent la caractérisation, mais sont toujours en évaluation. Les tumeurs à cellules de Leydig (TCL), tumeurs hypoéchogènes vascularisées, le plus souvent bénignes, sont maintenant mieux identifiées. Les tumeurs éteintes ou « burned-out » tumeur sont des pièges diagnostiques car elles apparaissent comme des lésions ou plages hypo/avasculaires d’allure cicatricielles. Si l’écho-Doppler reste l’examen de référence, la combinaison avec les autres techniques ultrasonores ou par IRM améliorent la caractérisation. To state about testicular tumors characterization using imaging findings. Literature review (PubMed, Medline, in French and English) of urological and radiological studies dealing with testicular tumors nature and characterization. At Color Doppler, the size, the presence of microlithts/microlithiasis/macrocalcifications, the vascular architecture are major semiological findings to suggest the benign or the malignant nature of the lesion. Other techniques like multiparametric MRI, contrast-enhanced sonography, sonographic elastography improve the caracterisation, but are still in evaluation. Leydig cell tumors (LCT), vascularized hypoechoic tumors, usually benign, are now better identified. Burned-out tumors are diagnostic traps because they appear as hypo/avascular scar-like lesions. Doppler ultrasound remains the reference examination. The combination with other ultrasound or MRI techniques improves the characterization.

In this study we compared the short-term outcomes for laparoscopic partial nephrectomy after selective embolization (LPNE) in a hybrid operating room with those for robot-assisted partial nephrectomy (RAPN). We found that oncological and functional outcomes were comparable between the 2 techniques. We conclude that LPNE is an interesting alternative to RAPN in the treatment of localized renal tumors. Background: Partial nephrectomy (PN) is the standard treatment for localized renal tumors. Laparoscopic PN (LPN) after selective embolization of tumor (LPNE) in a hybrid operating room has been developed to make LPN easier and safer. The aim of this study was to compare outcomes of LPNE and robot-assisted PN (RAPN). Patients and Methods: All patients who underwent an LPNE at Angers University Hospital between May 2015 and April 2017, and a RAPN at Diaconesses Croix Saint Simon hospital between October 2014 and April 2017 were prospectively included. The functional outcomes were evaluated using the change of estimated glomerular filtration rate (eGFR) at 1 month, and the oncological outcomes were evaluated using the positive surgical margin (PSM) rate. Results: Fifty-seven patients underwent LPNE and 48 underwent RAPN. There was no difference between oncological and functional outcomes, with 2 PSM (4.4%) in the LPNE group and 4 PSM (10.3%) in the RAPN group (P= .32), and a mean change in eGFR at 1 month of 5.5% for LPNE and 8.3% for RAPN (P = .17). The mean surgical time was shorter in the LPNE group (150 vs. 195 minutes; P < .001), and mean estimated blood loss was less in the LPNE group (185 vs. 345 mL; P= .04). Conclusion: The short-term oncological and functional outcomes for LPNE were comparable with those for RAPN. A longer follow-up and a larger cohort of patients would be necessary to verify the benefits of LPNE, which appears to be a very interesting alternative to RAPN. (C) 2018 Elsevier Inc. All rights reserved.

Help in management of non-palpable testicular tumors. French Urologic Association Genital cancer committee's Edit.To review their characterization at imaging findings of non-palpable testicular tumors.Literature review (PubMed, Medline) of urological and radiological studies dealing with testicular tumors using keywords: non-palpable/incidental testicular tumors; color Doppler ultrasound; US elastography; magnetic resonance imaging; contrast enhanced sonography; partial surgery.Color Doppler is the basic exam. The size, the presence of microlithts/microlithiasis/macrocalcifications, the vascular architecture are major semiological findings to suggest the benign or the malignant nature of the lesion. Other techniques like multiparametric MRI, contrast-enhanced sonography, sonographic elastography are still in evaluation. The frequency of benign tumors such as Leydig cell tumors lead to preservation management, through improved characterization, monitoring or tumorectomy.Non-randomized study - a very few prospective studies.The era of total orchiectomy for any uncertain testicular lesion is over. We try the challenge of characterization, and define management's algorithms based on the suspected nature of the tumors.

Background. - Help in management of non-palpable testicular tumors. French Urologic Association Genital cancer committee's Edit. Objectives. - To review their characterization at imaging findings of non-palpable testicular tumors. Documentary sources. Literature review(PubMed, Medline) of urological and radiological studies dealing with testicular tumors using keywords: non-palpable/incidental testicular tumors; color Doppler ultrasound; US elastography; magnetic resonance imaging; contrast enhanced sonography; partial surgery. Results. - Color Doppler is the basic exam. The size, the presence of microlithts/microlithiasis/macrocalcifications, the vascular architecture are major semiological findings to suggest the benign or the malignant nature of the lesion. Other techniques like multi parametric MRI, contrast-enhanced sonography, sonographic elastography are still in evaluation. The frequency of benign tumors such as Leydig cell tumors lead to preservation management, through improved characterization, monitoring or tumorectomy. Limits. - Non-randomized study a very few prospective studies. Conclusion. - The era of total orchiectomy for any uncertain testicular lesion is over. We try the challenge of characterization, and define management's algorithms based on the suspected nature of the tumors. (C) 2018 Elsevier Masson SAS. All rights reserved.