Search Results (29)

Urachal carcinoma is a rare and aggressive malignancy for which standardized management remains limited, particularly in patients with locally advanced and node-positive disease. We report the case of a 34-year-old woman with urachal adenocarcinoma involving the bladder dome and radiographically suspicious pelvic lymph nodes who underwent robot-assisted partial cystectomy with urachal resection and extended bilateral pelvic lymph node dissection. Because there was no clinical, radiologic, or intraoperative evidence of umbilical involvement, the umbilicus was preserved after preoperative counseling and intraoperative confirmation of a negative proximal margin. Final pathology demonstrated a 4.5 cm enteric-type urachal adenocarcinoma, pT3a pN2 (2/17), with lymphovascular invasion, perineural invasion, and negative surgical margins. Immunohistochemistry and DNA- and RNA-based next-generation sequencing showed microsatellite stability, mismatch-repair proficiency, low tumor mutational burden, and no actionable genomic alteration. Given the absence of an established adjuvant standard, the multidisciplinary tumor board selected adjuvant FOLFOX as a non-standard postoperative strategy based on the overall clinicopathologic context. The patient remained continent, experienced no postoperative complications or treatment-limiting toxicity, and showed normalization of carcinoembryonic antigen and carbohydrate antigen 19-9 levels. This case provides a carefully contextualized example of transparent surgical reasoning and restrained multidisciplinary management in a rare malignancy with limited prospective evidence. Full article

Background: Urachal carcinoma is a rare malignancy comprising less than 1% of all bladder cancers. The signet-ring cell subtype is particularly aggressive and poses significant diagnostic and therapeutic challenges. Methods: A retrospective review of urachal carcinoma cases from 1989 to 2023 was conducted using data from BC Cancer and MD Anderson Cancer Center. The study analyzed 75 patients, including 28 signet-ring cell carcinoma (SRCC) cases and a control group of 47 non-SRCC cases, to compare survival patterns, treatment outcomes, and histopathological features. Results: Clinically, the SRCC subtype was associated with advanced stage at presentation (pT3/pT4) and a higher recurrence rate (82% vs. 53%; p = 0.01). Survival analysis demonstrated worse outcomes for the SRCC cohort, with a five-year cancer-specific survival (CSS) of 39% compared to 64% in the non-signet group (p = 0.053). Partial cystectomy remained the primary surgical approach for both cohorts. Adjuvant chemotherapy was administered more often in SRCC cases (86% vs. 47%). Conclusions: By providing a comprehensive multi-institutional analysis, this study establishes urachal SRCC as a distinct clinical entity with a strong independent prognostic significance. Despite aggressive multimodal management, it carries a poorer prognosis compared to urachal non-SRCC, emphasizing the need for subtype-specific therapeutic guidelines. Full article

Urothelial carcinoma (UC) of the bladder exhibits low- and high-grade papillary forms with distinct prognoses. High mobility group proteins (HMGA1, HMGA2, HMGB1) and miR-106a-5p are involved in tumor progression, but their interplay in UC remains incompletely understood. The aim of this study was to compare the expression of these parameters in low- and high-grade papillary UC. Tissue samples from 80 patients (40 low-grade and 40 high-grade) undergoing transurethral resection or cystectomy were analyzed, with control samples consisting of tumor-adjacent tissues without histopathological alterations obtained from the same patients. HMGA1, HMGA2, and HMGB1 protein expression was assessed immunohistochemically. Gene expression was quantified by real-time PCR, and miR-106a-5p levels were measured by droplet digital PCR. Statistical analysis was conducted using Statistica 13.3, applying one-way ANOVA with Tukey’s post hoc test and correlation analysis, with p < 0.05 considered significant. Expression of HMGA1 and HMGB1 was reduced in low-grade papillary urothelial carcinoma compared to control tissues, whereas both proteins were significantly increased in high-grade lesions. HMGA2 expression was minimal in low-grade tumors but partially restored in high-grade tumors. Analysis revealed the highest levels of miR-106a-5p in normal urothelium, slightly decreased in low-grade tumors, and significantly reduced in high-grade cancers. HMG proteins and miR-106a-5p demonstrate distinct expression patterns in low- versus high-grade papillary UC, which correlates with tumor aggressiveness. These molecules may serve as diagnostic and prognostic biomarkers. Their potential as therapeutic targets requires further mechanistic and translational investigation. Full article

Robotic surgery has become a cornerstone of modern urologic practice, with the da Vinci system maintaining dominance for over two decades. In recent years, however, a new generation of robotic platforms has emerged, introducing greater competition and innovation into the field. These systems aim to address unmet needs through features such as modular architectures, enhanced ergonomics, haptic feedback, and cost-containment strategies. Several platforms—including Hugo™ RAS, Versius™, Avatera™, REVO-I, Hinotori™, Senhance™, KangDuo, MicroHand S, Dexter™, and Toumai^®—have entered clinical use with early results demonstrating perioperative and short-term oncologic outcomes broadly comparable to those of established systems, particularly in procedures such as radical prostatectomy, partial nephrectomy, and radical cystectomy. At the same time, they introduce unique advantages in workflow flexibility, portability, and economic feasibility. Nevertheless, important challenges remain, including the need for rigorous comparative trials, standardized training curricula, and long-term cost-effectiveness analyses. The integration of artificial intelligence, augmented reality, and telesurgery holds the potential to further expand the role of robotics in urology, offering opportunities to enhance precision, improve accessibility, and redefine perioperative care models. This review summarizes the evolving landscape of robotic platforms in urology, highlights their clinical applications and limitations, and outlines future directions for research, training, and global implementation. Full article

The evolution of robotic surgery in urologic oncology has led to the emergence of single-port (SP) robotic systems as a potential alternative to the widely adopted multi-port (MP) platforms. This narrative review provides a comprehensive comparison between SP and MP robotic systems, the former of which received FDA approval in 2018 and CE marking in 2024, focusing on their application across radical prostatectomy, partial and radical nephrectomy, and radical cystectomy. Drawing from the most current literature, we examine perioperative outcomes, oncologic efficacy, postoperative recovery, and complication rates. The review highlights the technical challenges unique to SP surgery, including restricted triangulation, limited instrumentation, and a defined learning curve, while also emphasizing innovations such as transvesical prostatectomy and the Supine Anterior Retroperitoneal Access (SARA) approach. Additionally, we explore the potential impact of emerging technologies—such as artificial intelligence, augmented reality, and telesurgery—on the future of SP platforms. Despite early limitations, SP systems have demonstrated comparable safety and effectiveness in selected cases and may offer unique advantages in specific anatomical scenarios. Continued innovation, structured training, and robust long-term outcome data will be essential for the broader adoption and integration of SP robotic surgery in clinical practice. Full article

Partial cystectomy is a surgical bladder-sparing option for selected patients with muscle-invasive bladder cancer (MIBC), urachal adenocarcinoma and diverticular bladder tumors. Partial cystectomy hold several advantages. It allows for definite pathology and accurate staging while avoiding side effects from radiation therapy and preserves the option for salvage radical therapy (radical cystectomy or radical radiotherapy). Patients should have a CT urogram, prostatic urethral biopsy and mapping biopsies or blue light cystoscopy to rule out multifocal disease or CIS. Small solitary MIBC patients without carcinoma in situ in an area of the bladder where resection can be performed with negative margin would be the ideal candidates for partial cystectomy. Neoadjuvant systemic therapy is recommended for patients undergoing partial cystectomy. Partial cystectomy can be performed either by open or robotic approaches. When compared to radical cystectomy, partial cystectomy affords a lower complication rate and length of stay and better quality of life. Recurrence-free survival, cancer-specific survival and overall survival at 5 years is 39–67%, 62–84% and 45–70%, respectively. Following partial cystectomy, patients should have three monthly cystoscopy and urinary cytology for the first 24 months followed by 6-monthly cystoscopy for year 3 and 4 and then yearly for life. Cross-sectional imaging should be performed every 3–6 months for the first 2–3 years and then annually for 5 years. Full article

Background and Objectives: Cystic echinococcosis (CE) remains a significant health concern in endemic areas, including Romania, where hepatic hydatid cysts frequently require surgical treatment. Surgery represents the cornerstone of therapy, particularly in large, complicated, or symptomatic cysts, where medical or minimally invasive options may be insufficient. This study aims to investigate the clinical characteristics, risk factors, and postoperative evolution of patients undergoing surgical intervention for hepatic CE in a tertiary care center over a five-year period. Materials and Methods: This retrospective study examined data from 62 patients who underwent surgical procedures for hepatic CE during a 5-year period. The analysis focused on demographic parameters, cyst morphology, surgical techniques employed, and postoperative complications, with particular attention to the frequency, management, and outcomes of biliary fistulas. Results: The study cohort had an average age of 44.1 years, with a slight predominance of female patients (51.6%). The majority of cysts (62.9%) were located in the right hepatic lobe, with an average diameter of 10.9 cm. Postoperative complications were recorded in 25.8% of cases, with biliary fistulas being the most frequent (12.9%). Patients who developed biliary fistulas presented significantly larger cysts (152.13 ± 105.68 mm vs. 102.20 ± 37.86 mm, p = 0.012) and required an extended length of hospitalization, particularly in high-output cases (29 vs. 9.3 days, p = 0.045). Hospital stays and treatment expenses were notably higher among patients with biliary fistulas. Conclusions: Biliary fistulas were observed exclusively in patients who underwent partial cystectomy. This finding highlights the need for increased caution when performing partial cystectomy, especially in cases involving large or recurrent cysts, where the risk of postoperative biliary fistulas is higher. Tailoring the surgical technique based on cyst characteristics and incorporating intraoperative strategies to manage or prevent biliary leakage may help reduce morbidity. Early identification and multidisciplinary management of high-risk cases are key to improving outcomes in hepatic CE. Full article

Background: Despite numerous studies assessing LCs in urological surgical oncology, high-quality evidence and a fully structured curriculum are missing. We aimed to systematically search and review the available literature on the LCs of robot-assisted surgery in urological cancers. Methods: Medline was systematically searched up to December 2024 to retrieve studies following the Preferred Reporting Items reporting on LC in robot-assisted radical prostatectomy (RARP), robot-assisted radical cystectomy (RARC), robot-assisted radical and partial nephrectomy (RARN, RAPN), and robot-assisted radical nephroureterectomy (RANU). The results of the last five years were then compared to those of the previous years. Results: In total, 82 studies were identified, 47 of which were for prostatectomy, 9 of which were for the last 5 years. Eighteen studies referred to partial-nephrectomy, seven over the previous 5 years. Finally, 16 studies referred to radical cystectomy, 7 over the previous five years. For radical prostatectomy, LC was based on operative time (OT), estimated blood loss (EBL), length of hospital stays, complication rate, positive surgical margin (PSM), biochemical recurrence (BCR), continence, and potency with ranges of 100–400, 90–290, 200, 15–250, 50–300, 30–250, 200–500 and 200–300 cases, respectively. For partial nephrectomy, the LC was based on OT, EBL, length of hospital stay, complication rate, warm ischemia time (WIT), and trifecta, with unclear ranges for the first three categories and 20–50, 26–140, and 50–77 cases, respectively, for the rest. Finally, for radical cystectomy, the LC was based on OT, EBL, length of hospital stay, complication rate, PSM, and lymph node yield, with ranges 20–75, 88, 40–198, 16–100, no difference, and 30–50 cases, respectively. We could not identify any study assessing the LCs in RARN and RANU. Conclusions: Robot-assisted surgery does not have a standard definition of LC regardless of the type of operation, which causes heterogeneity between the studies. Nevertheless, LCs appear to be steep and continuous. Training curriculums are essential to optimize outcomes and prepare new surgeons. Full article

Background/Objectives: Delta-radiomics involves analyzing feature variations at different acquisition time-points. This study aimed to assess the utility of delta-radiomics feature analysis applied to contrast-enhanced (CE) and non-contrast-enhanced (NE) T1-weighted images (WI) in predicting the therapeutic response to chemoradiotherapy (CRT) in patients diagnosed with muscle-invasive bladder cancer (MIBC). Methods: Forty-three patients with non-metastatic MIBC (cT2–4N0M0) who underwent partial or radical cystectomy after induction CRT were, retrospectively, reviewed. Pathological complete response (pCR) to CRT was defined as the absence of residual viable tumor cells in the cystectomy specimen. Identical volumes of interest corresponding to the index bladder cancer lesions on CE- and NE-T1WI on pre-therapeutic 1.5-T MRI were collaboratively delineated by one radiologist and one urologist. Texture analysis was performed using “LIFEx” software. The subtraction of radiological features between CE- and NE-T1WI yielded 112 delta-radiomics features, which were utilized in multiple machine-learning algorithms to construct optimal predictive models for CRT responsiveness. Additionally, the predictive performance of the radiomics model constructed using CE-T1WI alone was assessed. Results: Twenty-one patients (49%) achieved pCR. The best-performing delta-radiomics model, employing the “Extreme Gradient Boosting” algorithm, yielded an area under the receiver operating characteristic curve (AUC) of 0.85 (95% confidence interval [CI]: 0.75–0.95), utilizing four signal intensity-based delta-radiomics features. This outperformed the best model derived from CE-T1WI alone (AUC: 0.63, 95% CI: 0.50–0.75), which incorporated two morphological features and one signal intensity-based radiomics feature. Conclusions: Delta-radiomics analysis applied to pre-therapeutic CE- and NE-MRI demonstrated promising predictive ability for CRT responsiveness prior to treatment initiation. Full article

Background: Bladder leiomyomas are rare benign tumors (<0.5% of all bladder tumors) arising from the bladder wall’s smooth muscle. Only 250 cases of this condition have been reported worldwide so far. While some leiomyomas present with irritative or obstructive symptoms, hematuria, or nonspecific abdominal pain, others are asymptomatic and are diagnosed incidentally. The surgical approach is based on the leiomyoma’s size and location. Given this tumor’s rarity, standardized management guidelines do not exist; however, transurethral resection of bladder tumor (TURBT), partial or radical cystectomy, or laparoscopic/robotic enucleation are viable therapeutic options. Case history: We report the case of a 64-year-old female presenting with recurrent colic and pelvic pain. An abdominal CT scan showed a 3 cm mass protruding from the posterior bladder wall toward the right vaginal fornix. A transvaginal ultrasound-guided through-cut biopsy confirmed the diagnosis of a bladder leiomyoma. Due to the tumor’s size and location, robotic enucleation was chosen to minimize the risk of bladder perforation. The mass was successfully excised via a transvesical approach. Results: The procedure was completed in 210 min without complications, with 50 mL blood loss. The patient recovered well, with resolution of symptoms and no recurrence at eighteen-month follow-up. Histopathological examination on the surgical specimen confirmed the diagnosis of bladder leiomyoma. Conclusions: This case highlights the feasibility and safety of robotic enucleation for large bladder leiomyomas, emphasizing minimal invasiveness, limited pelvic dissection, and preservation of bladder function. Further research and standardized guidelines are needed for managing this rare condition. Full article

Background: Urachal pathologies, while rare, carry a risk of malignant transformation. Robot-assisted urachal excision and partial cystectomy (RAUEPC) is a minimally invasive technique that offers potential advantages, but the available evidence remains limited. This study aims to evaluate the outcomes of RAUEPC for benign and malignant urachal pathologies through a systematic review and single-center experience. Methods: A systematic review was conducted using PubMed, Scopus, the Cochrane Library, and ScienceDirect (last search: 1 November 2024). Inclusion criteria encompassed studies reporting on RAUEPC for urachal pathologies, while non-robotic approaches and incomplete data were excluded. Risk of bias was assessed using the Newcastle-Ottawa Scale for cohort studies and the JBI Critical Appraisal Checklist for Case Reports. Descriptive statistics summarized continuous data (means, medians, 95% confidence intervals), and chi-square tests analyzed associations between categorical variables. Heterogeneity analysis was infeasible, necessitating narrative synthesis. Institutional retrospective data from three cases (2021–2024) were included for comparison. This study was registered in PROSPERO (CRD42024597785). No external funding was received. Results: A total of 44 studies (n = 145) met the inclusion criteria. Benign lesions accounted for 66.2% and malignant lesions for 33.8%. Mean operative time was 177.8 min (cumulative), 162.7 min (benign), 192.2 min (malignant), 85.33 min (institutional, 95% CI: 74.13–96.53). Mean blood loss was 85.4 mL (cumulative), 99.5 mL (benign), 72.7 mL (malignant), 216.66 mL (institutional). Mean hospital stay was 3.64 days (cumulative), 3.26 days (benign), 4.36 days (malignant), 6.33 days (institutional, 95% CI: 3.46–9.20). Complications occurred in 10.04% (cumulative), 11.82% (benign), 8.57% (malignant), with one minor event (Clavien–Dindo II) in institutional cases. No conversions to open surgery were reported. All cases achieved complete excision with no R1 resections. No recurrences were observed at 10.66-month (institutional) mean follow-up. Conclusions: RAUEPC appears to be a feasible and safe approach with promising short-term outcomes. The associations between symptoms and diagnostic methods highlight its utility. The limitations of the evidence include small sample sizes and retrospective designs. Further prospective studies are needed to validate these findings. Full article

Background/Objectives: Bladder cancer is a significant clinical problem with approximately 500,000 new cases worldwide annually. In approximately 25% of cases, disease is diagnosed at a stage of invasion of the muscle layer of the bladder. The current standard approach in this disease is preoperative chemotherapy followed by radical cystectomy. Dose-dense MVAC (ddMVAC), a two-day chemotherapy regimen, is the reference treatment protocol in this setting. The presented study evaluated the effectiveness and safety of accelerated MVAC (aMVAC) chemotherapy—a one-day regimen given before the resection of the bladder due to muscle-invasive disease. Methods: A retrospective analysis included 119 consecutive patients diagnosed with urothelial muscle-invasive bladder cancer (MIBC) who underwent preoperative chemotherapy with the aMVAC regimen. The planned treatment included 4–6 cycles of preoperative chemotherapy. The analysis of the degree of histopathological response to treatment was based on the three-grade TRG (tumor regression grade) classification. Results: A complete pathological response (TRG1) was observed in 44 patients (36.7%), and a major pathologic response (<ypT2) was achieved in 58 patients (48.7%). A reduction in the cisplatin dose was associated with a statistically significant decrease in the chance of achieving complete pathologic responses (46.1% vs. 10%, RR for TRG1 = 0.69, p = 0.00118). Patients who received at least 4 cycles (compared to ≤3 cycles) of neoadjuvant chemotherapy had a significantly higher chance of achieving a pathological response (partial or complete) to treatment (78.1% vs. 52.2%, RR 0.68, p = 0.0374). Administration of at least five cycles of chemotherapy was associated (compared to four cycles) with a significantly higher likelihood of achieving a complete pathological response (63.2% vs. 33.8%, RR = 1.71, p = 0.0221). The vast majority of adverse events were in grades 1 and 2, according to CTCAE version 5.0. Only five patients experienced grade 3–4 toxicities. The most common adverse event was anemia, which occurred in 66.3% of patients. Conclusions: Our real-world data analysis confirms the activity, safety, and feasibility of the aMVAC regimen as neoadjuvant chemotherapy in patients with urothelial MIBC. Full article

Endometriosis is a complex condition causing surgical challenges, sometimes leading to urogynecological complications, the diagnosis and treatment of which are not always obvious. We present a case of a 46-year-old woman with a history of severe endometriosis and adenomyosis who developed an oligosymptomatic vesicovaginal fistula (VVF) as a complication of surgery. The patient’s medical history included multiple surgeries for endometriosis, a cesarean section, and a laparoscopic hysterectomy. After the excision of the full-thickness infiltration of the urinary bladder, she experienced postoperative bowel obstruction treated by laparotomy. Subsequent urinary complications of bladder healing were eventually recognized as oligosymptomatic VVF. Symptoms of VVFs may vary, making a diagnosis challenging, especially when the lesion is narrow. Imaging techniques such as cystoscopy and cystography are helpful for diagnosis. The treatment options for VVFs range from surgical repair to conservative methods, like bladder catheterization, hormonal therapy, and platelet-rich plasma (PRP) injections, depending on the lesions’ size and location. In this case, the patient’s VVF was treated with PRP injections, a low-invasive method in urogynecology. PRP, known for its pleiotropic role, is increasingly used in medicine, including gynecology. The patient’s fistula closed after 6 weeks from the PRP session, highlighting the potential of this conservative treatment modality. Full article

This review provides a summary of the literature encompassing partial and total cystectomy procedures in dogs and subsequent conclusions that can be drawn. Surgical excision as a component of treatment for lower urinary tract neoplasia in dogs may enhance survival time and result in acceptable quality of life, though risk for surgical complications is substantial, particularly following total cystectomy procedures. However, for dogs with urothelial carcinoma, cystectomy is generally not considered curative and disease progression is common. Appropriate case selection and thorough preoperative discussion with owners regarding potential risks and benefits of cystectomy are imperative for successful outcomes. Full article

Enterovesical fistula (EVF) is a rare complication of Crohn’s disease (CD), characterized by recurrent urinary tract infections, fecaluria, and pneumaturia. However, most diagnostic tools have low sensitivity for EVF. Management consists of conservative and surgical approaches. Conservative treatment is usually adopted first. However, the appropriate time to consider surgery remains controversial. Herein, we report on the case of a 34-year-old male who presented with diffuse abdominal pain with fullness for one day. Enteroscopy and biopsy confirmed the diagnosis of Crohn’s disease. Contrast-enhanced computed tomography (CT) suggested a fistula between the ileum and urinary bladder; however, cystoscopy did not find an obvious tract. The patient initially received medical treatment, but the symptoms persisted with recurrent urinary tract infections and subsequent bilateral hydronephrosis. He then underwent successful fistulectomy, partial cystectomy, and two segmental resections of the small bowel with end-to-end primary sutures. No complications or symptomatic urinary tract infections were noted during 30 months of follow-up after surgery, suggesting no recurrence of EVF. Surgical intervention is warranted when medical treatment fails or complications occur. Clinical symptoms and laboratory data are often less informative for the diagnosis of EVF, and CT is the most helpful diagnostic modality. Our management strategy provides an option for such patients. Full article