Urologic Oncology: From Diagnosis to Treatments

Dear Colleagues,

Urologic cancer research is a dynamic and critical field dedicated to unraveling the characteristics of tumors affecting the genitourinary system. Its primary aim is to develop our understanding in order to improve the management of these complex diseases.

Researchers tirelessly explore the intricate genetic and molecular mechanisms underlying the initiation and progression of urological cancers, paving the way for personalized diagnostic and therapeutic strategies. Robotic surgery has become widespread, with it already being a cornerstone in the treatment of many urologic malignancies. Continuous efforts are conducted by scientists to improve the accuracy of diagnostic tools, the efficacy and safety of medical treatments, the outcomes of surgical techniques, and ultimately, the patients' prognosis and quality of life.

In this Special Issue, we invite authors to submit papers on the recent advances and future perspectives of epidemiology, risk factors, pathophysiology, and the diagnosis and/or treatment of main urologic tumors.

Prof. Dr. Riccardo Autorino
Dr. Celeste Manfredi
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

• prostate cancer
• bladder cancer
• upper tract urothelial cancer
• testicular cancer
• renal cancer
• adrenal cancer
• penis cancer
• robotic surgery
• personalized medicine

Title: Robotic Distal Ureterectomy for High-Risk Distal Ureteral Urothelial Carcinoma: A Retrospective Multicenter Comparative Analysis (ROBUUST Collaborative Analysis)
Authors: A Veccia
Affiliation: Azienda Ospedaliera Carlo Poma: Mantova, IT
Abstract: Introduction. The role of kidney-sparing surgery (KSS) in patients with high-risk upper urinary tract urothelial carcinoma (UTUC) is controversial. The aim of this study was to assess the outcomes of robotic distal ureterectomy in patients with high-risk distal ureteral tumours. Methods. Three hundred and sixty-five patients with high-risk UTUC of the distal ureter were retrieved from the ROBUUST (ROBotic surgery for Upper Tract Urothelial Cancer Study) multicenter international (2006-2019). The study population was divided in two subgroups according to the type of surgical approach: 38 patients treated with robotic distal ureterectomy and 135 treated with robotic nephroureterectomy (RNU). Time to recurrence, defined by urinary cytology, CT scan or cystoscopy at last follow-up, was the primary endpoint. Secondary endpoint was the post-operative renal function, calculated as eGFR at last follow-up. A Mann-Whitney U test was performed to compare mean (± SD) of each outcome between the two populations. Results. In the overall population, mean age was 70.4 years (±9.3), with a mean preoperative Cr of 1.2 (±0.8) mg/dL and a mean tumour size of 3.3 (±2.1) cm. No significant difference was observed in terms of time to recurrence (13.3 months vs 14.3 months, p=0.8) between patients treated with distal ureterectomy and RNU. Post-operative eGFR, instead, was significantly better in patients treated with distal ureterectomy (63.4 mL/min/1.73m2 vs 51 mL/min/1.73m2, p=0.01). Conclusions. Within the limitations related to the retrospective study design, our findings suggest comparable outcomes in terms of time to recurrence between distal ureterectomy and RNU, and an advantage of in terms of post-operative renal function preservation. KSS might be considered as a potential option for selected high-risk patients.

Title: Outcomes of Robotic Partial Nephrectomy (RAPN) and Technology Tools Evaluation for or Hilar Masses: A Systematic Review
Authors: S D Pandolfo; A Aveta; C Imbimbo
Affiliation: Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Naples, Italy
Abstract: Purpose of review: Robot-assisted partial nephrectomy (RAPN) has become widely used for treatment of renal cell carcinoma (RCC) and it is expanding in the field of complex renal masses. The aim of this systematic review was to summarize and analyze the outcomes of RAPN for completely hilar masses and how new technologies could overcome the surgery challenge Recent findings: We reviewed the literature for prospective and retrospective studies evaluating the use of RAPN in the treatment of complete hilar masses. A comprehensive search in the PubMed, Scopus, Web of Science, and Cochrane Central Register of Controlled Trials databases was performed in December 2022 for English language papers. The primary endpoint was to evaluate the role of RAPN in the setting. Secondary endpoint was to evaluate the surgical and functional outcomes. After screening 1250 records, 13 full-text manuscripts were selected. Summary: Over the past decade, evidence supporting the use of RAPN for the most challenging NSS indications has continuously grown. Limitations remain, most studies being retrospective, often lacking a detailed and long-term reporting of functional and oncological outcomes, and only coming from high-volume centers. Nevertheless, the adoption of RAPN for this advanced indication is associated with favorable surgical outcomes with good preservation of renal function without compromising the oncological result. While a higher likelihood of complication might be expected, this indication should not be considered per se an exclusion criterion for performing a RAPN. Ultimately, a risk-adapted approach should be implemented, also considering surgical expertise. Three-dimensional reconstruction, intraoperative ultrasonography, and rainbow technique were demonstrated to be useful tools in this setting.

Title: Open vs Robotic Partial Nephrectomy: comparative trends from a wide national population-based database
Authors: A. Franco, A. Cicione, G. Tema, C. D. Nunzio, A. Tubaro, R. Lombardo*
Affiliation: Department of Urology, Sant’Andrea Hospital, La Sapienza University of Rome, Italy
Abstract: Limited data exist regarding Partial Nephrectomy clinical trends and utilization across different socioeconomic groups in the USA. Our objective was to investigate overall complication rates among open and robotic partial nephrectomy (PN), including impact of social determinants of health (SDOH) on postoperative outcomes and cost-analysis. Patients who underwent partial nephrectomy between 2011 and 2021 will be retrospectively analyzed by using PearlDiver-Mariner, an all-payer insurance claims database. International Classification of Diseases diagnosis and procedure codes will be used to identify the type of surgical operation, patient’s characteristics, postoperative complications and SDOH. Outcomes will be compared using multivariable regression models.