The objective of this study is to evaluate the outcomes of an initial series of single-port robot-assisted ureterolysis (SP-RAU) in patients with retroperitoneal fibrosis (RPF). We prospectively collected surgical and clinical data from all consecutive patients undergoing SP-RAU at our institution between April 2016 and May 2024. The primary endpoint was the achievement of a stent-free status at 12 months. Overall, 16 patients (21 renal units) underwent SP-RAU with a minimum follow-up of 12 months. All five patients with bilateral disease were managed with a staged approach in two separate surgical sessions. RPF was idiopathic in 37% and secondary in 62% of cases. Four procedures (19%) were aborted due to extensive fibrosis or high vascular risk (one unilateral right, two unilateral left and one second-stage left unit). These patients had significantly longer preoperative stent duration (60 vs. 9months; p = 0.006). Among the 17 completed procedures, no open conversions, intraoperative complications or transfusions occurred. Median operative time was 215 min (IQR 195-240), and median blood loss was 10ml (IQR 10-20). Median length of stay was 11.5h (IQR 7.8-26), with 52% of patients discharged the same day. At a median follow-up of 25 months (IQR 18-50), complete symptom resolution was achieved in 82% of renal units, whereas 64% remained stent-free at 12 months. The main limitations are the small sample size, single-surgeon experience and absence of a comparator arm. SP-RAU is a safe and feasible minimally invasive option for managing RPF. It achieves good functional success with minimal morbidity and enables same-day discharge in over half of patients. Larger multicentre studies with longer follow-up are needed to confirm these findings and establish the role of SP-RAU in the management of RPF.

The objective of this study is to compare the use of lymph node surgery and complication rates before and after centralization of penile cancer (PeCa) surgery in Sweden. In January 2015, curative surgical care for PeCa was centralized to the Skåne University Hospital in Malmö and the Örebro University Hospital in Örebro. All 1079 patients with invasive PeCa in the Swedish National Penile Cancer Register (NPECR) diagnosed between 2009 and 2020 were included, 458 before and 621 after centralization. The proportion of patients subjected to lymph node surgery 2009-2014 versus 2015-2020 was compared using Pearson's Chi-squared test. Odds ratios (ORs) for complications were calculated using a logistic regression model adjusting for age, nodal stage and extent of penile surgery. Continuous variables were presented as medians and compared using Wilcoxon's rank sum test. Before centralization, 270/458 (59%) of patients were subjected to lymph node surgery compared to 474/621 (76%) after 2014. Overall complication rate for patients undergoing such surgery was unaltered before and after centralization. The incidence of any complications increased after Dynamic Sentinel Lymph Node Biopsy from 18% (22/122) to 36% (91/256), corresponding to an adjusted OR of 1.89 (95% confidence interval [CI] 1.09-3.27). For lymphocele, lymphedema or infection after modified or radical inguinal or pelvic lymphadenectomy, the adjusted OR was 0.47 (95% CI 0.29-0.75) after centralization. The register-based setting is a study limitation. The proportion of men undergoing lymph node surgery increased, and the risk of lymphocele, lymphedema and infection after inguinal and pelvic lymph node surgery decreased after centralization of PeCa care.

To provide improved evidence for treatment recommendations, this study analysed real-world data on the characteristics, treatment and prognosis of primary extragonadal germ cell tumours (EGCTs), a very rare cancer entity that shares histological features with testicular GCTs (TGCT). This retrospective study analysed data from 34 patients with mediastinal or retroperitoneal EGCTs treated at a high-volume centre between 2015 and 2025. Probability of overall survival (OS) and relapse-free survival (RFS) was assessed using Kaplan-Meier curves. A primary retroperitoneal and primary mediastinal GCT was diagnosed in 23 (68%) and 11 (32%) patients, respectively. Median patient age was 41.1 years, and 62% were non-seminomatous in origin. Thirty-three (97%) patients received chemotherapy according to the IGCCCG prognostic group, and 15 (44%) underwent surgical intervention (4 primary RPLND, 8 post-chemotherapy RPLND, 3 secondary orchiectomy). Thirteen patients (44.9%) who completed chemotherapy experienced a relapse after a median of 0.79 years, and six of them died. In patients with primary mediastinal seminoma, 3-year RFS and OS were 100% as compared to 71% 3-year OS in patients with primary retroperitoneal non-seminoma and 46% 3-year RFS in patients with primary mediastinal non-seminoma. The prognosis for primary mediastinal seminoma appears favourable, while non-seminomatous EGCT shows poorer outcomes. Additionally, primary retroperitoneal seminomas demonstrate promising survival rates, whereas primary retroperitoneal non-seminomas demonstrate the lowest OS rates.

This study aims understand the outcomes following intradetrusor onabotulinumtoxinA injections and sacral neuromodulation (SNM) in a national cohort of male Medicare beneficiaries with overactive bladder (OAB). This is a retrospective cohort study of a 100% sample of fee-for-service male Medicare beneficiaries undergoing first-time onabotulinumtoxinA injections or SNM test procedures from 2014 to 2016. The primary outcome was repeat onabotulinumtoxinA injections within 1 year of index injections and placement of implantable pulse generator (IPG) within 90 days of a SNM test procedure. Overall, 11 286 male beneficiaries were included; 31.4% who underwent onabotulinumtoxinA injections had repeat injections within 1 year and 56.0% who underwent SNM test procedures had an IPG implant within 90 days. Repeat onabotulinumtoxinA injections were less likely among men who were ≥85 years (adjusted relative risk [aRR] 0.85, 0.75-0.96) versus ages 65-74. IPG implantation was more likely following staged versus percutaneous nerve evaluation (PNE; aRR 1.57, 1.50-1.64) and among beneficiaries in the lowest versus highest of socioeconomic quartile (aRR 1.10, 1.03-1.18). Rates of repeat treatments following index onabotulinumtoxinA injections among older men were lower than those previously reported among younger, predominantly female populations, whereas rates of IPG implantation were similar. Interestingly, frailty and comorbidity were not associated with these claims-based treatment outcomes following either procedure, but certain non-clinical variables were associated with IPG implantation following SNM. While these outcomes cannot distinguish symptom improvement from discontinuation because of lack of efficacy, adverse events or patient preference, they provide important insights into real-world treatment patterns for a patient population which is under-sampled in the OAB literature.

[This corrects the article DOI: 10.1002/bco2.70058.].

To compare oncological outcomes after extended pelvic lymph node dissection (PLND) versus limited in patients with high-risk prostate cancer (PCa) undergoing curative external beam radiation therapy (EBRT). From 3627 men with PCa at a single centre between 2000 and 2013, 167 with high-risk, age ≤75, Gleason score 6-10, clinical stage T1-T3, PSA < 100 ng/ml, no distant metastases (M1) and node-negative at the obturator fossa, underwent PLND before curative EBRT. Of these, 90 received limited, and 77 underwent extended PLND. Mean follow-up (SD) was 14.9 yr (5.8) for the limited and 12.3 yr (3.3) for the extended PLND. Primary endpoint was biochemical recurrence (BCR), secondary M1, cancer-specific mortality (CSM), overall mortality (OM). HR, KM and Cox regression models adjusted for age and Cambridge prognostic group (CPG) score. RR, RD at 11 yr. Extended PLND was associated with a significantly lower risk for BCR (HR: 0.51, 95% CI: 0.31-0.86, p =0.01) (RR: 0.43, 95% CI: 0.26-0.69, p = 0.001), lower risk of M1 (HR: 0.22, 95% CI: 0.08-02.65, p = 0.006) (RR: 0.26, 95% CI: 0.09-0.73, p = 0.004) and lower CSM compared with limited PLND (HR: 0.31, 95% CI: 0.08-0.65 p= 0.035) (RR 0.27, 95% CI: 0.08-0.91, p= 0.028). OM did not differ significantly. Extended PLND prior to curative ERBT shows reductions in BCR, M1 and CSM long-term outcomes following extended versus limited PLND. Extended PLND can be considered in cases with high-risk PCa prior to curative EBRT.

ObjectivesThe purpose of this study is to investigate the impact of Glucagon‐like peptide‐1 receptor agonists (GLP‐1RAs) use on 90‐day postoperative outcomes and overall survival following partial nephrectomy (PN) for renal cell carcinoma (RCC), where type 2 diabetes mellitus (T2DM) is a common comorbidity.Materials and MethodsThe TriNetX database was used to retrospectively identify T2DM patients who underwent PN. Patients prescribed GLP‐1RAs were identified and matched in a 1:1 ratio with control patients who were not prescribed GLP‐1RAs based on baseline characteristics, comorbidities, metformin and insulin prescription, and renal function laboratory values. For 90‐day postoperative adverse events, risk difference, risk ratio and odds ratio with 95% confidence intervals were calculated. Kaplan–Meier analysis, log‐rank tests and multivariable Cox Proportional Hazards model were performed to measure the effect of GLP‐1RAs use on overall survival.ResultsUse of GLP‐1RAs was associated with lower odds of acute kidney injury (odds ratio [OR] = 0.712), arrhythmia (OR = 0.725), readmission (OR = 0.8) and ileus (OR = 0.336) compared to the non‐GLP‐1RAs group (p < 0.05 for each). Kaplan–Meier analysis and log‐rank tests demonstrated improved 2‐year (p = 0.002) and 3‐year (p = 0.001) overall survival among patients prescribed GLP‐1RAs compared to those who were not.ConclusionUse of GLP‐1RAs was associated with reduced incidence of 90‐day postoperative complications, such as acute kidney injury, arrhythmia, readmission and ileus, potentially contributing to improved overall survival. These results align with ongoing studies investigating the broader benefits of the use of GLP‐1RAs.

To measure the effects of varying configurations of nephroscope sheath, irrigation, instruments, and suction on intrarenal pressure (IRP) during percutaneous nephrolithotomy (PCNL). Kidney and ureter 3D printed models from a deidentified patient's CT scan were placed in a plaster and foam mould, simulating the torso of a prone patient. An Amplatz sheath was inserted into the kidney model. Fourteen different rigid nephroscope sheath (RNS), irrigation, instrument and suction configurations were compared. IRP was measured in a retrograde fashion. Comparisons were performed using the Wilcoxon Signed-Rank test followed by Bonferroni correction. The mean IRP with and without the RNS was 19.1 and 14.7 mm Hg, respectively (p< 0.001). Using the inflow port of the RNS for irrigation created a lower IRP (19.1 mm Hg) compared to the outflow port (32.7 mm Hg; p< 0.001). Addition of suction to all working scenarios significantly reduced IRP (p< 0.001). Insertion of instruments did not significantly alter IRP. In situations where the IRP should be low, removal of the RNS, irrigating through the inflow port, and frequent use of suction maintain the lowest pressures. If temporary increases in IRP are necessary to improve visualisation in the setting of bleeding, irrigating through the outflow port, minimising drainage and use of the RNS can be used to raise IRP.

MRI-targeted biopsies (TBx) combined with systematic biopsies (SBx) have traditionally been recommended for patients with unilateral MRI-suspicious prostate cancer (PCa) lesions. Recent European Association of Urology (EAU) guidelines propose that, in cases with a solitary lesion, TBx with perilesional sampling may suffice, potentially omitting contralateral SBx. The clinical impact of this omission remains uncertain. This study evaluates how omitting contralateral SBx affects pathological grading, EAU risk classification, and estimated lymph node involvement (LNI). We conducted a retrospective cohort study (2016-2024) including 190 biopsy-naïve men diagnosed with PCa via TBx and bilateral SBx for a single, unilateral MRI-visible lesion. Outcomes were re-evaluated using only TBx and ipsilateral SBx, simulating omission of contralateral SBx. Changes in ISUP grade, EAU risk group, and LNI probability using the Briganti 2019, Amsterdam-Brisbane-Sydney (ABS), and Memorial Sloan Kettering Cancer Center (MSKCC) nomograms were assessed. Furthermore, we compared cancer detection rates for TBx alone versus TBx plus ipsilateral SBx. ISUP grading changed in 14 of 190 patients (7.4%) when contralateral SBx was omitted; two patients (1.1%) had clinically significant PCa (ISUP 2) detected solely in contralateral cores. In seven patients (3.7%), only ISUP 1 cancer was found in contralateral SBx, meaning no diagnosis would have been made without those cores. EAU risk classification changed in five patients (2.6%). LNI estimates were affected minimally: One patient (0.5%) dropped below the Briganti 7% threshold, and one patient (1.2%) no longer met the 8% ABS threshold. The MSKCC model showed a statistically significant 8% increase in patients above the 7% ePLND threshold when contralateral SBx was omitted (p= 0.0023). Ipsilateral SBx substantially improved detection of higher-grade disease: sensitivity for ISUP ≥3 increased from 82% with TBx alone to 98% when combined with ipsilateral SBx. Omitting contralateral SBx in patients with unilateral MRI lesions had limited effect on grading, risk classification, and LNI estimates. However, ipsilateral SBx adds significant diagnostic value compared with TBx alone and should be retained. These findings support a more targeted diagnostic approach in patients with a unilateral lesion on MRI in a primary diagnostic setting.

ObjectivesTo assess treatment outcomes and evaluate patient selection criteria for cytoreductive partial nephrectomy (CRPN) in a unique cohort of metastatic renal cell carcinoma (mRCC) patients.MethodsA retrospective review of mRCC patients who underwent CRPN between 1995 and 2023 at a single institution was performed. Clinical characteristics, perioperative outcomes, longitudinal imaging reports and overall survival data were analysed.ResultsSeventy‐three patients with mRCC were included. Forty per cent of patients had prior radical nephrectomy, and 44% had prior metastasectomy. The median tumour size was 4 cm (IQR 2.7, 5.5). Median follow‐up among patients who survived was 6.7 years (IQR 3.4, 9.6). Median overall survival was 6.1 years (95% CI 4.6 to 7.8). Complications occurred in 22% of patients within 30 days post‐surgery. eGFR stabilized at 3 months after surgery, and no patients required dialysis. Larger tumour size was associated with a higher risk of cancer‐specific death (HR 1.19, 95% CI 1.07 to 1.31, p < 0.001). Higher pathologic stage and grade were associated with significantly higher risks of cancer‐specific death (HR 2.78, 95% CI 0.83 to 9.36, p = 0.10 and HR 1.45, 95% CI 0.64 to 3.29, p = 0.4, respectively).ConclusionCRPN was performed effectively as a component of integrated medical and surgical management for highly selected mRCC patients. Preservation of renal function in patients with a solitary kidney or with an intact contralateral kidney was achieved with acceptable surgical morbidity and oncologic outcomes.