Search Results (74)

Background: Upper tract urothelial carcinoma (UTUC) is a rare and aggressive malignancy with limited prognostic tools to predict disease progression. Due to its low incidence, the molecular pathogenesis of UTUC remains poorly understood, and few studies have explored transcriptomic profiling in this setting. Identifying gene expression biomarkers associated with progression may help improve risk stratification and guide postoperative management. Methods: In this study, we applied a machine learning approach to gene expression data from radical nephroureterectomy (RNU) specimens of 17 consecutive patients with pT2 or pT3 UTUC treated at our institution. RNA was extracted from formalin-fixed paraffin-embedded tissues and sequenced using the Ion AmpliSeq™ Transcriptome Human Gene Expression Kit on an Illumina HiSeq 2500 platform. Differential gene expression was assessed using DESeq2, and results were visualized with volcano plots. Predictive power was evaluated through logistic regression and receiver operating characteristic (ROC) analysis. Gene Ontology enrichment analysis was used to explore biological pathways. Results: A total of 76 genes were differentially expressed between progressive and non-progressive patients. A random forest classifier identified ten key genes with prognostic potential. Validation with logistic regression yielded an area under the ROC curve (AUC) of 0.88, indicating high discriminative ability. These genes were associated with immune regulation, cell cycle control, and tumor progression. Conclusions: This pilot study demonstrates the potential of integrating machine learning with transcriptomic analysis to identify prognostic biomarkers in UTUC. Further validation in larger, independent cohorts is needed to confirm these findings and support their clinical application. Full article

Background/Objectives: Upper tract urothelial carcinoma (UTUC) is a rare and biologically distinct subset of urothelial malignancies, comprising approximately 5–10% of urothelial cancers. UTUC presents unique diagnostic and therapeutic challenges, with both a higher likelihood of invasive disease at presentation and a less favorable prognosis compared to urothelial carcinoma of the bladder. Current treatment strategies for UTUC are largely derived from bladder cancer studies, underscoring the need for UTUC-directed research. This review provides a comprehensive overview of UTUC, encompassing diagnostic approaches, systemic and intraluminal therapies, surgical management, and future directions. Methods: A narrative review was conducted synthesizing evidence from guideline-based recommendations, retrospective and prospective clinical studies, and ongoing trials focused on UTUC. Results: Neoadjuvant cisplatin-based chemotherapy is increasingly preferred in UTUC due to the risk of postoperative renal impairment that may preclude adjuvant cisplatin use. Surgical management includes kidney-sparing approaches and radical nephroureterectomy (RNU), with selection guided by tumor risk and patient comorbidities. While endoscopic management (EM) preserves renal function, it carries a higher recurrence and surveillance burden; RNU remains standard for high-risk cases. Systemic therapy for advanced and metastatic UTUC mirrors that of bladder urothelial carcinoma. Enfortumab vedotin (EV) plus pembrolizumab showed superior efficacy over chemotherapy in the EV-302 trial, with improved response rate, progression-free survival, and overall survival across subgroups, including UTUC. For patients ineligible for EV, the CheckMate-901 study supported first-line chemoimmunotherapy with gemcitabine, cisplatin, and nivolumab. Further systemic therapy strategies include maintenance avelumab post-chemotherapy (JAVELIN Bladder 100), targeted therapies such as erdafitinib (THOR trial), and trastuzumab deruxtecan (DESTINY-PanTumor02) in FGFR2/3-altered and HER2-positive disease, respectively. Conclusions: Historically, the therapeutic landscape of UTUC has been extrapolated from bladder cancer; however, ongoing research specific to UTUC is deriving more precise regimens involving the use of immune checkpoint inhibitors, antibody–drug conjugates, and biomarker-driven therapies. Full article

Background/Objectives: Upper tract urothelial carcinoma (UTUC) is often complicated by intravesical recurrence and cancer progression following radical nephroureterectomy (RNU). Identifying reliable prognostic biomarkers remains crucial for optimizing postoperative surveillance. The goal of this study was to assess the prognostic value of the De Ritis ratio (AST/ALT) in predicting bladder recurrence and oncologic outcomes in patients with clinically localized UTUC undergoing RNU. Methods: This retrospective study analyzed 87 patients treated with RNU between 2018 and 2025. Preoperative De Ritis ratios were calculated, and an optimal cut-off value of 1.682 was determined using ROC analysis. Recurrence-free survival (RFS), cancer-specific survival (CSS), and overall survival (OS) were analyzed using the Kaplan–Meier and Cox regression methods. Logistic regression was used to identify independent predictors of bladder recurrence. Results: A high De Ritis ratio was significantly associated with increased bladder recurrence and worse RFS and CSS, but not OS. Multivariate analysis confirmed that an elevated De Ritis ratio, current smoking, positive surgical margins, and synchronous bladder cancer were the independent predictors of bladder recurrence. The De Ritis ratio demonstrated strong discriminatory performance (AUC: 0.807), with good sensitivity and specificity for predicting recurrence. Conclusions: The De Ritis ratio is a simple, cost-effective preoperative biomarker that may aid in identifying UTUC patients at higher risk for intravesical recurrence and cancer-specific mortality. Incorporating this ratio into clinical decision-making could enhance risk stratification and guide tailored follow-up strategies. Full article

Objectives: Upper urinary tract urothelial cell carcinoma (UTUC) in kidney transplant recipients (KTRs) presents distinct clinical challenges due to the complexities of managing both cancer and the long-term immunosuppressive therapy required to preserve graft function. UTUC in this population often presents at advanced stages, contributing to poorer outcomes compared to immunocompetent individuals. Methods: This systematic review (SR) evaluates the incidence, clinical presentation, treatment approaches, and survival outcomes of UTUC in KTRs, based on 16 retrospective studies including 526 patients. Results: The present study highlights a predominance of female patients (ranging from 50% to 91.6%) and significant variability in time to diagnosis (from 7 to 181 months post-transplant). Tumor characteristics also showed considerable heterogeneity, with high-grade and advanced-stage (T3–T4) tumors being more common. The standard treatment for UTUC in KTRs remains radical nephroureterectomy (RNU), with additional resection of the bladder (TURB) when bladder cancer (BC) coexists. Survival outcomes vary significantly, with 5-year overall survival (OS) rates ranging from 16.7% to 90.9%, strongly influenced by tumor stage at diagnosis. This SR further reports high rates of bladder recurrence (18.8% to 61.2%) and challenges in balancing effective cancer treatment with graft preservation. The variability in immunosuppressive regimens across studies complicates the assessment of their role in UTUC progression. The limitations of the current evidence include small sample sizes, retrospective designs, and inconsistent follow-up durations. Conclusions: This SR underscores the need for tailored treatment strategies and improved long-term surveillance. Future research should focus on prospective studies with larger cohorts, exploring the impact of immunosuppression and novel therapies on UTUC outcomes in KTRs. Full article

Background and Objectives: Upper tract urothelial carcinoma (UTUC) is one of the most underdiagnosed but, at the same time, one of the most lethal cancers. In this review article, we investigated the application of artificial intelligence and novel technologies in the prompt identification of high-grade UTUC to prevent metastases and facilitate timely treatment. Materials and Methods: We conducted an extensive search of the literature from the Pubmed, Google scholar and Cochrane library databases for studies investigating the application of artificial intelligence for the diagnosis of UTUC, according to the PRISMA guidelines. After the exclusion of non-associated and non-English studies, we included 12 articles in our review. Results: Artificial intelligence systems have been shown to enhance post-radical nephroureterectomy urine cytology reporting, in order to facilitate the early diagnosis of bladder recurrence, as well as improve diagnostic accuracy in atypical cells, by being trained on annotated cytology images. In addition to this, by extracting textural radiomics features from data from computed tomography urograms, we can develop machine learning models to predict UTUC tumour grade and stage in small-size and especially high-grade tumours. Random forest models have been shown to have the best performance in predicting high-grade UTUC, while hydronephrosis is the most significant independent factor for high-grade tumours. ChatGPT, although not mature enough to provide information on diagnosis and treatment, can assist in improving patients’ understanding of the disease’s epidemiology and risk factors. Computer vision models, in real time, can augment visualisation during endoscopic ureteral tumour diagnosis and ablation. A deep learning workflow can also be applied in histopathological slides to predict UTUC protein-based subtypes. Conclusions: Artificial intelligence has been shown to greatly facilitate the timely diagnosis of high-grade UTUC by improving the diagnostic accuracy of urine cytology, CT Urograms and ureteroscopy visualisation. Deep learning systems can become a useful and easily accessible tool in physicians’ armamentarium to deal with diagnostic uncertainties in urothelial cancer. Full article

Upper tract urothelial carcinoma (UTUC) is a rare malignancy, representing only 5–10% of urothelial carcinoma. The mainstay of treatment for high-risk patients is radical nephroureterectomy. Given the aggressive behavior of this disease, additional treatments could be required perioperatively in terms of chemotherapy (CHT), either in a neoadjuvant or adjuvant setting. On the other hand, low-risk and selected cases can be managed with kidney-sparing surgery (KSS). The ROBotic surgery for Upper tract Urothelial cancer STudy (ROBUUST) is an ongoing international, multicenter registry of patients undergoing surgery for UTUC. After conducting a literature search in February 2025 using the MEDLINE (via PubMed) and Embase databases, we identified 14 studies based on the ROBUUST data analyses. There are several key topics concerning UTUC that remain under debate and were therefore addressed in these studies, focusing on preoperative evaluation and planning, surgical techniques and intraoperative procedures, additional perioperative treatments, and outcomes. The ROBUUST registry has served as a valuable source for a growing body of investigations focusing on various aspects of UTUC treatment planning, decision-making, and outcomes, providing innovative tools and enabling large-scale, novel analyses. Full article

Urinary actinomycosis is a rare condition, often mimicking a urinary tract tumor. Due to its low prevalence, it can be challenging to diagnose and may be mistaken for malignancies. A 33-year-old female patient with a history of type 2 Diabetes Mellitus and recurrent urinary tract infections presented to the emergency room with right renal fossa pain radiating to the right hypochondrium, fever with chills, nausea, and vomiting. Physical examination revealed a positive Giordano sign and tenderness at the ipsilateral middle and upper ureteral points. A contrast-enhanced CT scan showed a mass infiltrating the distal third of the right ureter, causing retrograde dilatation and hydronephrosis. Additionally, a liver injury with both liquid and solid components was observed. Therefore, given the suspicion of a urothelial tumor, a diagnostic cystoscopy and ureteroscopy were performed. Using interventional radiology, an abscessed liver lesion was drained, yielding purulent fluid. The histopathological examination revealed no evidence of malignancy. However, due to the strong suspicion of upper urinary tract urothelial carcinoma, a right radical nephroureterectomy with bladder cuff excision and retroperitoneal lymphadenectomy was performed. Histopathological examination ultimately confirmed urinary actinomycosis. Consequently, antibiotic therapy with oral amoxicillin 2 g every 12 h was initiated, leading to a good clinical response. Despite its low incidence, urinary actinomycosis should be considered as a differential diagnosis in cases suspected of urothelial tumors in the upper urinary tract. Increased awareness of this rare condition may help prevent unnecessary surgical interventions. Full article

Background: Radical nephroureterectomy (RNU) is the standard treatment for upper tract urothelial carcinoma (UTUC). Minimally invasive techniques like robotic (RARNU) and laparoscopic (LRNU) RNU offer potential benefits over open surgery, but their comparative oncologic outcomes are debated. Methods: This retrospective, multicenter study analyzed 2037 Taiwanese patients undergoing RNU between 2010 and 2022. Missing data was addressed using multiple imputations. Overlap weighting was applied to balance patient characteristics between the RARNU and LRNU groups. Survival outcomes were compared using Kaplan-Meier analysis and Cox regression. Results: After excluding the missing data, 405 patients underwent RARNU, and 1262 underwent LRNU. After adjusting for baseline differences, both groups showed comparable rates of surgical complications, residual tumor, UTUC-related mortality, and disease recurrence. The median follow-up was similar (52.4 vs. 51.6 months, p = 0.91). Using Kaplan-Meier survival curve analysis, overall survival, cancer-specific survival, and disease-free survival were similar between the two groups. Conclusions: This study shows that RARNU for UTUC has comparable oncological and perioperative outcomes to pure LRNU. RARNU may be easier for surgeons to adopt, particularly those with limited laparoscopic experience. 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: Upper tract urothelial carcinoma (UTUC) often presents with aggressive behaviour, demanding accurate preoperative assessment to guide management. Radiomics-based approaches have shown promise in extracting quantitative features from imaging, yet few studies have explored whether perirenal fat (PRF) radiomics can augment tumour-only models. Methods: A retrospective cohort of 103 UTUC patients undergoing radical nephroureterectomy was analysed. Tumour regions of interest (ROI) and concentric PRF expansions (10–30 mm) were segmented from computed tomography (CT) scans. Radiomic features were extracted using PyRadiomics, filtered by correlation and intraclass correlation coefficients, and integrated with clinical variables (e.g., age, BMI, multifocality). Multiple machine learning models, including MLPClassifier and CatBoost, were evaluated via repeated cross-validation. Performance was assessed using the area under the ROC curve (AUC), sensitivity, specificity, F1-score, and DeLong tests. Results: The best tumour grade model (AUC = 0.961) merged tumour-derived features with a 10 mm PRF margin, exceeding PRF-only (AUC = 0.900) and tumour-only (AUC = 0.934) approaches. However, the improvement over tumour-only was not always statistically significant. For stage prediction, combining tumour and 15 mm PRF features yielded the top AUC of 0.852, surpassing the tumour-alone model (AUC = 0.802) and outperforming PRF-only (AUC ≤ 0.778). PRF features provided an additional predictive value for both grade and stage models. Conclusions: Integrating PRF radiomics with tumour-based analyses enhances predictive accuracy for UTUC grade and stage, suggesting that the tumour microenvironment contains complementary imaging cues. These findings, pending external validation, support the potential for radiomics-driven risk stratification and personalised treatment planning in UTUC. Full article

(1) Background: Upper tract urothelial carcinoma (UTUC) is typically managed through radical nephroureterectomy (RNU) or local ablation (LA). Compared to RNU, LA offers nephron-sparing benefit for select patients but may present increased recurrence risk. This study primarily compares long-term differences between LA and RNU in chronic kidney disease (CKD) progression, estimated glomerular filtration rate (eGFR) decline, all-cause mortality, and need for dialysis. (2) Methods: A retrospective cohort study was conducted using the TriNetX database, examining patients with UTUC treated with RNU (n = 2007) or LA (n = 4172). Propensity score matching balanced both cohorts (n = 1965 per group). Risk ratios and hazard ratios with 95% confidence intervals were calculated over 10 years. (3) Results: At 10 years, LA preserved higher mean eGFR (53.49 vs. 46.72; p < 0.001) and lower mean creatinine (1.56 vs. 1.66; p = 0.017). However, LA held a higher incidence of end-stage renal disease (ESRD) (3.6% vs. 2.2%, p = 0.008) and all-cause mortality (26.7% vs. 23.5%, p = 0.016). There was no significant difference in rates of dialysis (p = 0.79). (4) Conclusions: RNU did not carry an increased risk of ESRD, advanced stages of CKD, need for renal dialysis, or overall mortality compared with LA. LA may delay but not totally prevent renal dysfunction when compared to RNU, and exhibits a more gradual timeline. Full article

Background: The objective of the present study was to evaluate the impact of dialysis on patients with upper tract urothelial carcinoma (UTUC) who are undergoing surgical intervention, as well as to identify predictive factors linked to contralateral recurrence. Methods: A retrospective review was conducted on patients who underwent radical nephroureterectomy (RNU) for non-metastatic UTUC at our institution from 2000 to 2013. The contralateral recurrence rate was calculated using the Kaplan–Meier method, and multivariate logistic regression analysis was employed to examine the relationship between clinicopathological characteristics and contralateral recurrence. Results: A total of 593 patients were included in this analysis, of which 31 (5.8%) experienced metachronous recurrence on the contralateral side. Kaplan–Meier analysis indicated a statistically significant reduction in the contralateral recurrence-free survival rate among female patients (p = 0.040), those with a prior history of bladder cancer (p < 0.001), individuals presenting with multiple tumors (p = 0.011), patients with advanced chronic kidney disease (CKD) (p < 0.001), and those requiring postoperative dialysis (p < 0.001). In contrast, preoperative hemodialysis status did not show a significant correlation with contralateral recurrence (p = 0.08). The multivariate analysis identified a history of bladder cancer (hazard ratio (HR), 3.19; 95% confidence interval (CI), 1.2–8.4; p = 0.018), the necessity for new hemodialysis postoperatively (HR, 5.34; 95% CI, 1.3-25.6; p = 0.034), and advanced CKD (HR, 2.52; 95% CI, 1.4–4.9; p = 0.021) as independent risk factors associated with an increased rate of contralateral recurrence. Conclusions: In conclusion, advanced CKD, a history of bladder cancer, and the initiation of new dialysis following surgery were identified as independent prognostic indicators for contralateral recurrence in patients with initial unilateral UTUC undergoing RNU. It is recommended that patients exhibiting these three adverse characteristics undergo rigorous monitoring of the contralateral upper urinary tract throughout the follow-up period. Full article

Objective: Nephroureterectomy (NU) is a challenging multi-quadrant surgical procedure that involves intra–infra- and retroperitoneal dissection. The introduction of the da Vinci Xi platform has further improved the minimally invasive approach. With the Xi robotic system, single docking for multi-quadrant dissection is now feasible and increasingly popular. Herein, we redefined the surgical technique by optimizing minimal port usage, maximizing template visualization, and utilizing the Xi platform’s retargeting system, based on our experience with 15 patients. Methods: This single-center cohort study was based on the experience of a single surgeon with 15 patients who underwent robotic radical nephroureterectomy (RRNU) between 2019 and 2024, performed via the one docking, three-port technique. Patient data were retrospectively collected and analyzed from the medical records. Results: The cohort’s median age was 79 years, with male predominance of 80%. The median operative time was 133 min, with 60% of procedures completed within 150 min; longer times (>150 min) were due to additional intraoperative non-robotic procedures. Median blood loss was 100 mL, with two patients requiring intraoperative blood transfusion. Lymph node dissection (LND) in six patients did not significantly affect the overall operative time. The intraoperative and major postoperative complication rates (Clavien-Dindo grade > III) were 13.3%. Conclusions: The use of three robotic ports combined with the Xi platform’s camera-hop feature is a safe and effective technique for multi-quadrant, minimally invasive procedures, particularly in RRNU. This approach facilitates procedural goals and reduces overall operative time. Full article

Background: The da Vinci single-port (SP) platform is emerging as the latest innovation in minimally invasive surgery and its utilization in treating urologic malignancies continues to expand. Methods: A search was conducted in PubMed, MEDLINE, and ScienceDirect. The final set includes 40 academic articles. Results: Research on single-port surgery for genitourinary cancer is still an emerging topic. We divided the topic into the following categories: radical prostatectomy, radical cystectomy, nephrectomy, and nephroureterectomy. Conclusions: The single-port platform provides urologists with another tool to tackle more complex surgical cases and pathologies with the added improvements of decreased length of stay and increased pain tolerance for patients. Full article

Background: Upper tract urothelial carcinoma (UTUC) presents significant challenges in prognostication due to its rarity and complex anatomy. This study introduces a novel approach integrating perirenal fat (PRF) radiomics with clinical factors to enhance prognostic accuracy in UTUC. Methods: The study retrospectively analyzed 103 UTUC patients who underwent radical nephroureterectomy. PRF radiomics features were extracted from preoperative CT scans using a semi-automated segmentation method. Three prognostic models were developed: clinical, radiomics, and combined. Model performance was assessed using concordance index (C-index), time-dependent Area Under the Curve (AUC), and integrated Brier score. Results: The combined model demonstrated superior performance (C-index: 0.784, 95% CI: 0.707–0.861) compared to the radiomics (0.759, 95% CI: 0.678–0.840) and clinical (0.653, 95% CI: 0.547–0.759) models. Time-dependent AUC analysis revealed the radiomics model’s particular strength in short-term prognosis (12-month AUC: 0.9281), while the combined model excelled in long-term predictions (60-month AUC: 0.8403). Key PRF radiomics features showed stronger prognostic value than traditional clinical factors. Conclusions: Integration of PRF radiomics with clinical data significantly improves prognostic accuracy in UTUC. This approach offers a more nuanced analysis of the tumor microenvironment, potentially capturing early signs of tumor invasion not visible through conventional imaging. The semi-automated PRF segmentation method presents advantages in reproducibility and ease of use, facilitating potential clinical implementation. Full article