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Renal cell carcinoma is the third type of urologic cancer and has a poor prognosis with 30% of metastatic patients at diagnosis. The antiangiogenics and targeted immunotherapies led to treatment remodeling emphasizing the role of the tumour microenvironment. However, long-term responses are rare with a high rate of resistance. New strategies are emerging to improve the efficacy and the emerging drugs are under evaluation in ongoing trials. With the different treatment options, there is an urgent need to identify biomarkers in order to predict the efficacy of drugs and to better stratify patients. Owing to the limitations of programmed death-ligand 1 (PD-L1), the most studied immunohistochemistry biomarkers, and of the tumor mutational burden, the identification of more reliable markers is an unmet need. New technologies could help in this purpose.

Background Only a few studies have compared the outcomes of robotic partial nephrectomy (RPN) and open partial nephrectomy (OPN). This study aimed to compare perioperative and oncologic outcomes of RPN and OPN. Methods The data of all patients who underwent partial nephrectomy from 2006 to 2014 in six academic departments of urology were retrospectively collected. Perioperative outcomes were compared between OPN and RPN patients. Cancer-specific survival (CSS) and recurrence-free survival (RFS) were estimated using the Kaplan–Meier method and compared using the log-rank test. Results The study included 1800 patients: 937 who underwent RPN and 863 who underwent OPN. The patients in the robotic group had smaller tumors (33.1 vs. 39.9 mm; p  < 0.001) but comparable RENAL scores (6.8 vs. 6.7; p  = 0.37). The complication rate was higher in the OPN group (28.6 vs. 18 %; p  < 0.001). The OPN patients had greater estimated blood loss (359.5 vs. 275 ml; p  < 0.001) and more frequent hemorrhagic complications (12.1 vs. 6.9 %; p  < 0.001). The robotic approach was associated with a shorter warm ischemia time (WIT 15.7 vs. 18.6 min; p  < 0.001) and a shorter hospital of stay (4.7 vs. 10.1 days; p  < 0.001). In the propensity score-weighted analysis, the inverse probability of treatment weighting adjusted odds ratio for the risk of complication after OPN versus RPN was 2.11 (95 % confidence interval, 1.53–2.91; p  < 0.001). After a median postoperative follow-up period of 13 months for OPN and 39 months for RPN ( p  < 0.001), CSS and RFS were similar in the two groups. In the multivariate analysis, RPN showed an impact on the occurrence of a complication but had no effect on WIT or RFS. Conclusion In this study, RPN was less morbid than OPN, with lower complications, less blood loss, and a shorter hospital of stay. The intermediate-term oncologic outcomes were similar in the two groups.

We aim to explore the feasibility of robot-assisted supratrigonal cystectomy and augmentation cystoplasty (RA-SCAC) for the management of adult neurogenic lower urinary tract dysfunction and to compare the functional and surgical outcomes of an intracorporeal and extracorporeal approach. A retrospective review of all patients who underwent robot-assisted supratrigonal cystectomy and augmentation cystoplasty was performed. Data was collected on age, body mass index, American Society of Anaesthesiologists (ASA) score, type and duration of neurological disease, previous abdominal surgery and renal function. Bladder diary, urodynamics and validated symptom score results were recorded at baseline and repeated postoperatively. Intraoperative details included type of diversion, concomitant surgery, duration of surgery, blood loss and conversion to open. Postoperative surgical recovery was also reviewed. The primary endpoint was the rate of major postoperative complications defined as any complication Clavien-Dindo grade ≥3 occurring within the first 90 days postoperatively. There were 26 patients in total; 7 performed extracorporeally and 19 intracorporeally. Mean age was 41.5, mean BMI 24.4 and majority were ASA score 2 (61.5%). Twelve (46.1%) patients had spinal cord injury and 6 (23.1%) spina bifida. Seven (26.9%) had a concomitant procedure including bladder neck artificial urinary sphincter (AUS) insertion, bladder neck fascial sling or creation of a continent catheterisable channel. The surgical outcomes were analysed separately for those that had RA-SCAC only versus RA-SCAC with a concomitant procedure. The operative time was shorter in the intracorporeal group, and the length of stay was similar in both groups. The total number of major postoperative complications was low (n = 3; 11.5%). All urodynamic parameters significantly improved at 6 months in the intracorporeal group. Median number of urinary incontinence episodes per 24 h decreased significantly in both groups at 3 months but the continence status and ICIQ-UI SF demonstrated statistical significance in the intracorporeal group only. In conclusion, robot-assisted supratrigonal cystectomy and augmentation cystoplasty is feasible in adult neurological patients, favouring an intracorporeal approach. Plain language summary Robot-assisted supratrigonal cystectomy and augmentation cystoplasty for adult neurogenic lower urinary tract dysfunction and a comparison of different surgical techniques Neurological disease in the adult population can cause lower urinary tract dysfunction and may require surgical intervention when less invasive treatments have failed. Augmentation cystoplasty has traditionally been performed as an open operation and can be associated with significant peri-operative morbidity due to its surgical complexity. We reviewed the records of 26 patients who underwent this operation using a minimally invasive robot-assisted approach. We compared two different surgical techniques (intracorporeal versus extracorporeal diversion) and looked at both the functional and surgical outcomes to assess its feasibility in this patient group. Our findings suggest that a robot-assisted approach is safe and feasible and that when performed, an intracorporeal diversion is preferential.

Purpose of ReviewPost-prostatectomy overactive bladder (OAB) is a common and challenging condition to manage. The aim of the present report was to review the recent evidences regarding OAB symptoms that develop in men after prostatectomy and how to manage them.Recent FindingsThe prevalence of OAB after radical prostatectomy may range from 15.2 to 37.8%. Recent studies have highlighted the role of the urethrogenic mechanism (facilitation of the urethrovesical reflex due to stress urinary incontinence (SUI)) in the genesis of post-prostatectomy OAB in a significant proportion of patients. Several other pathophysiological factors such as iatrogenic decentralization of the bladder, defunctionalized bladder due to severe SUI, detrusor underactivity, or bladder outlet obstruction might be involved. The evaluation should aim to identify the underlying mechanism to tailor the treatment, which could range from SUI surgery, to fixing a urethral stricture, improving bladder emptying or using the conventional spectrum of OAB therapies. There is a paucity of data for OAB therapies specific to post-prostatectomy patients, with the exception of solifenacin, tolterodine, and botulinum toxin. There is currently no data on how preoperative management or surgical technique may prevent post-prostatectomy OAB.

PurposeNeurogenic bladder associated with spina bifida disease remains a major cause for mortality or morbidity due to kidney damages. However, we currently do not know which urodynamic findings are associated with an higher risk of upper tract damages in spina bifida patients. The objective of the present study was to evaluate urodynamic findings associated with functional kidney failure and/or with morphological kidney damages.MethodsA large single-center restrospective study was conducted in our national referral center for spina bifida patients using our patients’ files. All urodynamics curves were assessed by the same examinator. Functional and/or morphological evaluation of the upper urinary tract were done at the same moment as the urodynamic exam (between 1 week before and 1 month after). Kidney function was assessed using creatinine serum levels or 24 h urinary creatinine levels (creatinine clearance) for walking patients, or with the 24 h urinary creatinine level for wheelchair‐users.ResultsWe included 262 spina bifida patients in this study. Fifty-five patients had a poor bladder compliance (21.4%) and 88 of them had detrusor overactivity (33.6%). Twenty patients had a stage 2 kidney failure (eGFR < 60 ml/min) and 81 patients out of 254 (30.9%) had an abnormal morphological examination. There were three urodynamic findings significantly associated with UUTD: bladder compliance (OR = 0.18; p = 0.007), Pdetmax (OR = 14.7; p = 0.003) and detrusor overactivity (OR = 1.84; p = 0.03).ConclusionIn this large series of spina bifida patients, maximum detrusor pressure and bladder compliance are the main urodynamic findings determinants of UUTD risk.

IntroductionThe optimal management of the urethra in patients planned for radical cystectomy (RC) remains unclear. We sought to evaluate the impact of urethrectomy on perioperative and oncological outcomes in patients treated with RC for non-metastatic urothelial carcinoma of the bladder (UCB).Materials and methodsWe assessed the retrospective data from patients treated with RC for UCB of five European University Hospitals. Associations of urethrectomy with progression-free (PFS), cancer-free (CSS), and overall (OS) survivals were assessed in univariable and multivariable Cox regression models. We performed a subgroup analysis in patients at high risk for urethral recurrence (UR) (urethral invasion and/or bladder neck invasion and/or multifocality and/or prostatic urethra involvement).ResultsA total of 887 non-metastatic UCB patients were included. Among them, 146 patients underwent urethrectomy at the time of RC. Urethrectomy was performed more often in patients with urethral invasion, T3/4 tumor stage, CIS, positive frozen section analysis of the urethra, and those who received neoadjuvant chemotherapy, underwent robotic RC, and/or received an ileal conduit urinary diversion (all p < 0.001). Estimated blood loss and the postoperative complication rate were comparable between patients who received an urethrectomy and those who did not. Urethrectomy during RC was not associated with PFS (HR 0.83, p = 0.17), CSS (HR 0.93, p = 0.67), or OS (HR 1.08, p = 0.58). In the subgroup of 276 patients at high risk for UR, urethrectomy at the time of RC decreased the risk of progression (HR 0.58, p = 0.04).ConclusionIn our study, urethrectomy at the time of RC seems to benefit only patients at high risk for UR. Adequate risk assessment of UCB patients’ history may allow for better clinical decision-making and patient counseling.

PurposeTo compare the perioperative and functional outcomes between 180_W XPS GreenLight photoselective vaporization (PVP) and 532-nm GreenLight laser enucleation of the prostate (GreenLEP) in the surgical management of benign prostatic obstruction (BPO).MethodsRetrospective review of a prospectively maintained international database of patients managed with GreenLight laser surgery (PVP or GreenLEP) was performed. To adjust for potential baseline confounders, propensity-score matching (PSM) was applied at a ratio of 1:1 to compare the perioperative and functional outcomes between the groups.ResultsA total of 2,420 patients were included. 1,491 (61.6%) underwent PVP and 929 (38.4%) underwent GreenLEP. Before PSM analysis, patients in the vaporization group were older (p < 0.001), had a lower PSA and prostate volume at baseline (p < 0.001). Using estimated propensity scores, 78 patients in the PVP group were matched 1:1 to the patients in the GreenLEP group. The incidence of overall postoperative complications was comparable between the two groups (19 vs. 16%, p = 0.06). However, after PSM, PVP was found to be associated with a higher rate of overall complications (33 vs. 11%, p = 0.001). At 3 months and at last follow-up the I-PSS, Qmax and PSA had similarly decreased in the two groups with a greater improvement in the GreenLEP group (all p < 0.05).ConclusionsPVP and GreenLEP are two efficient and safe techniques for treating BPO. However, PVP was associated with longer operative time and higher risk of reoperation on a midterm follow-up compared to GreenLEP.

Introduction: In recent years, several preliminary reports have suggested that the robot-assisted approach may decrease the surgical morbidity of artificial urinary sphincter (AUS) implantation in female patients with stress urinary incontinence (SUI). However, for now, only short-term outcomes have been reported. The present study aimed to report the 5-year outcomes of robot-assisted AUS implantation in female patients.Patients and methods: All female patients who underwent a robot-assisted AUS implantation between January 2014 and September 2019 at a single academic center were included in a retrospective study. All robot-assisted female AUS implantations performed after September 2019 were excluded to ensure a 5-year minimum follow-up duration. The indication for AUS implantation was SUI due to intrinsic sphincter deficiency. The primary endpoint was the explantation-free survival and revision-free survival.Results: Forty-two patients were included. The median age was 66 years (28-84), and 83.8% of the patients had a history of previous anti-incontinence procedure. After a median follow-up of 64 months (16-110), 8 patients were lost to follow-up before the 5-year time point. The 5-year estimated revision-free survival was 89.2 and the 5-year estimated explantation-free survival was 88%. Five AUS explantations were needed (11.9%), and six revisions were required (14.3%). The median time to explantation was 14 months. Four explantations (80%) occurred within the first 18 months, and all of them within the first 27 months. Thirty patients (71.42%) had a complete or improved continence with a complete continence rate of 59.52% and an improved continence rate of 11.9%. There were 10 intraoperative complications (23.8%): 5 bladder injuries and 5 vaginal injuries. Thirteen patients had postoperative complications (30.9%), but only two were Clavien grade ⩾3.Conclusion: The 5-year outcomes of robot-assisted AUS implantation seem to confirm the promising short-term outcomes that have been reported so far, although revision rates increased with time, which warrants further investigation.

PURPOSE: To compare the outcomes of patients undergoing robotic YV plasty for bladder neck contracture (BNC) vs. vesico-urethral anastomotic stricture (VUAS). METHODS: A retrospective study included male patients who underwent robotic YV plasty for BNC after endoscopic treatment of BPH or VUAS between August 2019 and March 2023 at a single academic center. The primary assessed was the patency rate at 1 month post-YV plasty and during the last follow-up visit. RESULTS: A total of 21 patients were analyzed, comprising 6 in the VUAS group and 15 in the BNC group. Patients with VUAS had significantly longer operative times (277.5 vs. 146.7 min; p = 0.008) and hospital stay (3.2 vs. 1.7 days; p = 0.03). Postoperative complications were more common in the VUAS group (66.7% vs. 26.7%; p = 0.14). All patients resumed spontaneous voiding postoperatively. Five patients (23.8%) who developed de novo stress urinary incontinence had already an AUS (n = 1) or required concomitant AUS implantation (n = 3), all of whom were in the VUAS group (83.3% vs. 0%; p < 0.0001). The proportion of patients improved was similar in both groups (PGII = 1 or 2: 83.3% vs. 80%; p = 0.31). Stricture recurrence occurred in 9.5% of patients in the whole cohort, with no significant difference between the groups (p = 0.50). Long-term reoperation was required in three VUAS patients, showing a statistically significant difference between the groups (p = 0.05). CONCLUSION: Robotic YV plasty is feasible for both VUAS and BNC. While functional outcomes and stricture-free survival may be similar for both conditions, the perioperative outcomes were less favorable for VUAS patients.