Search Results (97)

Background: Patients with end-stage renal disease (ESRD) undergoing radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC) represent a uniquely high-risk population. While prior studies have demonstrated worse postoperative outcomes among dialysis-dependent patients, no study has systematically compared oncological outcomes between peritoneal dialysis (PD) and hemodialysis (HD) modalities following RNU. This multicenter study evaluates whether dialysis modality (peritoneal dialysis versus hemodialysis) acts as an independent prognostic factor following radical nephroureterectomy. Methods: Using the Taiwan UTUC Collaboration Group Registry—a multicenter, nationwide database comprising 21 tertiary and regional medical centers —we identified 350 ESRD patients who underwent RNU for UTUC between September 1988 and December 2023. Patients were categorized by dialysis modality at the time of surgery: 310 on HD and 40 on PD. Propensity score overlap weighting was applied to account for baseline differences. Multivariate Cox proportional hazards and Fine-Gray competing risk regression models were utilized to evaluate overall survival (OS), cancer-specific survival (CSS), progression-free survival (PFS), and non-UTUC mortality. Results: After overlap weighting, PD was independently associated with significantly worse OS (HR = 2.34, 95% CI 1.29–4.25, p = 0.005) and PFS (HR = 2.06, 95% CI 1.16–3.66, p = 0.013) compared to HD and exhibited a trend toward worse CSS in univariate analysis (log-rank p = 0.094). Survival curve divergence between PD and HD was most pronounced from 12 to 24 months post-surgery onward. Notably, this survival disadvantage persisted despite PD patients being significantly younger (mean age 58.8 vs. 65.1 years) and receiving adjuvant chemotherapy more frequently (20.0% vs. 6.5%). PD was also independently associated with higher non-UTUC mortality on multivariate competing risk analysis (sHR = 2.17, 95% CI 1.22–3.88, p = 0.009). Conclusions: In this first multicenter systematic comparison of PD versus HD patients undergoing RNU for UTUC, PD modality was independently associated with worse OS and PFS and exhibited a trend toward worse CSS in univariate analysis, compared to HD. This survival disadvantage persists despite favorable baseline characteristics and higher rates of adjuvant chemotherapy. We hypothesize these outcomes may be driven by a dual vulnerability: impaired systemic tumor control and elevated non-cancer mortality following surgical disruption of the peritoneal environment. To mitigate these risks, prioritizing minimally invasive or retroperitoneal surgical approaches to preserve peritoneal integrity, combined with modality-specific multidisciplinary surveillance, is recommended. Full article

Background: Retroperitoneoscopic laparoscopic adrenalectomy (RLA) is widely adopted for benign adrenal lesions due to its direct access and minimal bowel interference. However, expanding indications to larger tumors and complex anatomies increase technical difficulty because of the confined retroperitoneal space and obscured hilar landmarks. Current predictive models mainly focus on transperitoneal approaches and lack specificity for RLA. This study aimed to develop and internally validate a preoperative nomogram for predicting RLA-specific surgical difficulty. Methods: All patients undergoing RLA from April 2024 to February 2025 at a single center were included. Operative time and postoperative hemoglobin (Hb) reduction were used as surrogate markers of difficulty. Patients were classified into high- and standard-risk groups. Univariate and multivariate analyses were performed to identify predictors of difficult RLA and develop a composite difficulty score. Results: Tumor position (between the upper renal pole and renal pedicle: OR 8.819, 95% CI 3.981–21.462, p < 0.001) and pheochromocytoma (PHEO) pathology (OR 34.881, 95% CI 3.841–4719.428, p < 0.001) were the strongest independent predictors of high surgical difficulty, whereas tumor size (≥40 mm: OR 3.926, p = 0.071) showed limited predictive value. The composite score demonstrated excellent discrimination, with an optimism-corrected area under the curve (AUC) of 0.828 (95% CI 0.796–0.835). The nomogram showed robust calibration, and a cutoff score ≥ 2 yielded a negative predictive value of 0.940. Conclusions: This study developed an RLA-specific nomogram incorporating tumor size, position, and pathology. The tumor–renal pedicle relationship was more predictive of surgical difficulty than tumor size alone, providing risk stratification to guide surgical planning, optimize patient selection, and enhance safety as RLA indications expand. External validation is required to confirm its generalizability. Full article

Background: Primary plantar hyperhidrosis is a disabling condition characterized by excessive plantar sweating and impaired quality of life. Lumbar sympathectomy is reserved for patients with symptoms refractory to conservative treatment, but minimally invasive techniques remain technically heterogeneous. This study describes a modified retroperitoneoscopic lumbar sympathectomy and reports its preliminary perioperative outcomes. Methods: A single-center case series included consecutive patients who underwent modified retroperitoneoscopic lumbar sympathectomy for primary plantar hyperhidrosis between June 2019 and May 2024. The technique combined ultrasound-guided retroperitoneal access, indocyanine green (ICG)-assisted creation of the retroperitoneal working space, and temporary selective clamping of the lumbar sympathetic trunk with an intraoperative assessment of plantar temperature and perfusion before definitive clipping. Results: Forty-five patients underwent 81 procedures, including 35 bilateral procedures (70 sides), 10 unilateral procedures, and one unilateral reoperation for recurrent symptoms. All patients resumed oral intake and ambulation on the day of surgery and were discharged within 24 h according to institutional protocol. No intraoperative or postoperative complications were observed and resolution of plantar sweating in subsequent follow-ups was achieved. Conclusions: Modified retroperitoneoscopic lumbar Sympathetic Chain Selective Clamping appears to be a feasible and safe technique for the surgical treatment of primary plantar hyperhidrosis. These technical refinements may facilitate retroperitoneal access and intraoperative confirmation of the target sympathetic level. Larger comparative studies with standardized outcomes and longer follow-up are needed to confirm the durability and clinical value of this approach. Full article

Low back pain (LBP) is one of the most common causes of medical consultation worldwide and is typically attributed to degenerative spinal disorders. However, a subset of patients presents with LBP related to extra-spinal conditions, including disorders of the lumbar plexus. These conditions are often underrecognized and may mimic lumbar radiculopathy, leading to delayed diagnosis or inappropriate management. The lumbar plexus, formed by the anterior rami of L1–L4 nerve roots, lies deep within the psoas muscle and can be affected by a wide range of pathological processes, including traumatic, compressive, inflammatory, infectious, and neoplastic conditions. A targeted literature search of the PubMed/MEDLINE database was performed to identify relevant English-language articles on lumbar plexus disorders, their imaging features, and diagnostic strategies published from inception to June 2026; representative imaging examples were selected from the co-authors’ clinical archives. The review summarizes the relevant anatomy, clinical presentation, and key imaging features of the most common plexus pathologies, including retroperitoneal tumors, psoas hematomas, inflammatory plexopathies, and iatrogenic injuries. Advances in imaging techniques, particularly magnetic resonance imaging (MRI) and magnetic resonance neurography (MRN), have significantly improved the ability to visualize the lumbar plexus and detect pathological changes involving peripheral nerves and surrounding structures. Additionally, a practical diagnostic imaging approach is proposed to assist radiologists and clinicians in recognizing lumbar plexus involvement in patients with atypical low back pain. Full article

Objectives: Renal ischemia–reperfusion (I/R) injury is one of the most important pathological triggers of acute kidney injury. This study aimed to investigate the protective effects of meloxicam, a selective cyclooxygenase-2 (COX-2) inhibitor, against renal I/R injury through specific cell death pathways including inflammation, apoptosis, necroptosis, and the MAPK/ERK pathway, which is potentially linked to regulated cell death mechanisms such as ferroptosis. Methods: Male Wistar Albino rats weighing 280–300 g were used in the study and were divided into four groups: Sham, IR (40 min ischemia + 120 min reperfusion), Meloxicam + IR, and Meloxicam + IR1. Bilateral renal ischemia was induced for 40 min via a retroperitoneal approach under anesthesia. Meloxicam was administered intravenously at a dose of 1 mg/kg at the initiation of reperfusion in the Meloxicam + IR group, whereas in the Meloxicam + IR1 group, the same dose was administered 1 h after the onset of reperfusion. Total reperfusion time was 120 min in both groups. Renal function parameters (BUN and creatinine) and oxidative stress markers (TAS and TOS) were measured. Inflammatory cytokines (IL-6, IL-1β, and IL-10), the glomerular filtration injury marker Cystatin C, the tubular injury marker KIM-1, the apoptotic marker Caspase 3, the necroptosis markers RIPK3 and MLKL, and MAPK signaling pathway alterations (ERK1/2 and pERK1/2 levels) associated with cellular survival and death signaling were evaluated. Results: Most notably, meloxicam markedly modulated apoptosis, the expression of necroptosis markers RIPK3 and MLKL, and the activation of pERK1/2, a key node in MAPK signaling that is regulatory in cell survival and cell death processes. The drug also suppressed pro-inflammatory cytokines (IL-6 and IL-1β) while preserving anti-inflammatory IL-10 levels. Furthermore, improvements were observed in the levels of KIM-1, a marker of tubular injury, and Cystatin C, a marker of glomerular filtration impairment. Consequently, meloxicam administration significantly reduced the elevated serum creatinine and TOS levels observed in the IR group, although serum BUN levels remained without notable alteration. Conclusions: The findings of this study suggest that meloxicam may extend beyond its role as a classical anti-inflammatory agent, potentially offering biochemical and functional protection against renal I/R injury in association with the modulation of specific cell death mechanisms, including necroptosis and apoptosis, as well as the MAPK signaling pathway. Full article

Background: Giant retroperitoneal schwannomas with vertebral body erosion are exceedingly rare, and the decision regarding spinal instrumentation following tumor resection remains controversial in the absence of established guidelines. A 25% vertebral body involvement threshold has been proposed as an indication for fixation, yet this criterion does not account for bone quality or the potential biological adaptation of bone to chronic mechanical loading. Case Presentation: A 56-year-old man presented with bilateral gluteal pain and urinary urgency secondary to a giant retroperitoneal lumbar schwannoma (97 × 67 mm) with 36.6% erosion of the L5 vertebral body, confirmed by CT-guided biopsy (S100+, SOX10+, Ki-67 < 5%). Despite erosion exceeding the proposed instrumentation threshold, complete tumor resection was performed via an anterior laparotomic approach without spinal fixation, based on the absence of clinical or radiological signs of instability and the integrity of the intervertebral disc and posterior ligamentous complex. Intraoperative neurophysiological monitoring guided sacrifice of the tumor-origin root. The postoperative course was uneventful, with complete resolution of symptoms and no new complaints or neurological deficits at one-year follow-up. Conclusions: Post-hoc Hounsfield Unit measurements on pre-operative CT demonstrated markedly elevated bone density at the eroded L5 vertebral body (480 HU) compared with the adjacent L4 vertebra (317 HU), consistent with compensatory sclerosis induced by chronic mechanical compression. Pre-operative HU assessment may represent a valuable, readily available adjunct to anatomical erosion criteria in the surgical decision-making process for giant schwannomas with vertebral body involvement. Full article

Adrenal tumors are increasingly diagnosed due to widespread use of cross-sectional imaging and an aging population, making adrenalectomy a progressively more common surgical procedure. Over the past three decades, adrenal surgery has undergone a paradigm shift from open adrenalectomy to minimally invasive (MI) techniques, with laparoscopic adrenalectomy becoming the standard approach for most benign and selected malignant adrenal tumors. More recently, retroperitoneoscopic and robotic approaches have expanded the armamentarium available to adrenal surgeons, allowing for tailored, patient-specific surgical strategies. This review summarizes current evidence on MI adrenalectomy techniques, including transperitoneal and retroperitoneal laparoscopic approaches, hand-assisted adrenalectomy, and robotic adrenalectomy, with particular emphasis on their role in pheochromocytoma and adrenocortical carcinoma. In addition, evolving ancillary technologies such as laparoscopic ultrasound, indocyanine green fluorescence imaging, artificial intelligence, and virtual and augmented reality are reviewed, highlighting their potential to enhance intraoperative decision-making, safety, and surgical precision. Current controversies, including the role of preoperative alpha-blockade, partial versus total adrenalectomy in hereditary pheochromocytoma, the oncologic adequacy of MI surgery for adrenocortical carcinoma, and the selective use of lymph node dissection, are discussed. Available evidence supports MI adrenalectomy as a safe and effective approach in carefully selected patients when performed by experienced surgeons in high-volume centers. Technological innovations continue to refine surgical planning, execution, and training, suggesting that the future of adrenal surgery will increasingly rely on precision-guided, personalized, and data-driven strategies. This review offers a timely and comprehensive synthesis of the evolving landscape of MI adrenalectomy, uniquely integrating current evidence across the full spectrum of surgical techniques with a critical appraisal of emerging ancillary technologies while addressing unresolved clinical controversies relevant to contemporary surgical practice. Full article

Background/Objectives: Acute pancreatitis is a prevalent pathology with increasing incidence. Despite advances in treatment, some patients still present a severe clinical course with high morbidity and mortality rates. We evaluated the association between implementation of a step-up-based management strategy and clinical outcomes in patients with severe acute pancreatitis (SAP) treated at a tertiary referral center. Method: A retrospective observational study was conducted, including patients treated for SAP at a tertiary care center. Clinical outcomes, including mortality, morbidity, and length of hospital stay, were compared between two periods: Period A (1998–2010, classical treatment) and Period B (2011–2021, step-up approach). A subanalysis on minimally invasive techniques was also performed for Period B. Results: In total, 116 patients were included (39 Period A; 77 Period B). Pancreatic fistulas were reduced in Period B (15.38% vs. 5.33%; p = 0.088), as was mortality (30.76% vs. 18.67%; p = 0.15). Open surgeries decreased significantly in Period B (71.9% vs. 16.9%; p = 0.043), as did the mean hospital stay (60.5 ± 28 vs. 33.08 ± 28 days; p < 0.001). When comparing endoscopy management versus Video-Assisted Retroperitoneal Debridement (VARD), the rate of pancreatic fistulas was higher in the VARD group (0% vs. 57.1%; p < 0.01). Patients requiring VARD presented with larger collections (710 cc vs. 1737.9 cc; p = 0.03) and fewer procedures (4.2 ± 2.3 vs. 1.5 ± 0.5; p = 0.002). Conclusions: The step-up management in patients with SAP was associated with a decrease in open surgical approches and length of stay. VARD was performed in patients with higher volume collections and was associated with fewer interventions than patients treated by endoscopic necrosectomy; however, the incidence of pancreatic fistulas was higher. Full article

Background and Clinical Significance: Retroperitoneal urinomas are uncommon complications that can arise following trauma, particularly in the context of congenital anomalies such as pyeloureteral duplication. These conditions pose significant diagnostic and therapeutic challenges, requiring a comprehensive and multidisciplinary approach to ensure optimal patient outcomes. Case Presentation: Here, we report the case of a 22-year-old male who presented to the emergency department with right lumbar and flank pain, nausea, and abrasions following a fall from a height. Initial imaging revealed a right-sided retroperitoneal urinoma and a rare congenital anomaly: complete pyeloureteral duplication with the upper pole draining into the right seminal vesicle. The patient underwent two surgical interventions, including the insertion of a ureteral stent and reimplantation of the ureter using a latero-terminal U trans U technique. Conclusions: This case highlights the complexity of managing traumatic retroperitoneal urinomas associated with congenital anomalies such as complete pyeloureteral duplication. It emphasizes the importance of timely surgical intervention to prevent complications and improve patient outcomes. Full article

Background: Endometrial cancer is the most common gynecologic malignancy in developed countries. Sentinel lymph node (SLN) mapping has emerged as a less invasive alternative to systematic lymphadenectomy and is increasingly incorporated into surgical staging algorithms. Vaginal natural orifice transluminal endoscopic surgery (vNOTES) provides transvaginal access to the retroperitoneum and may facilitate SLN mapping while potentially reducing postoperative morbidity, including lower extremity lymphedema (LEL). Objective: This study aimed to evaluate the feasibility of vNOTES hysterectomy with bilateral salpingo-oophorectomy (BSO) and retroperitoneal SLN mapping and to report early postoperative lymphedema outcomes in patients with newly diagnosed endometrial cancer. Methods: This retrospective cohort study included 113 patients who underwent vNOTES-assisted hysterectomy with BSO and SLN mapping using methylene blue dye at a tertiary referral center between January 2022 and January 2023. Lymphedema was evaluated using the Gynecologic Cancer Lymphedema Questionnaire at 6 and 12 months postoperatively, supported by clinical examination. Descriptive statistical analyses were performed to summarize clinical characteristics and symptom profiles. Results: The mean patient age was 55.0 ± 10.5 years and the mean BMI was 30.94 ± 2.54 kg/m². Endometrioid adenocarcinoma was the most common histological subtype (75.5%), and most tumors were grade 1 (57.1%). SLN mapping was successful in 102 of 113 patients (overall detection rate 90.3%), with bilateral detection in 79.6% and unilateral detection in 10.6% of cases. Limb swelling was reported in 4.1% of patients, while only one patient (1.0%) met the criteria for self-reported mild lymphedema. No clinical signs of inguinal lymphedema were detected. Conclusions: vNOTES hysterectomy combined with retroperitoneal SLN mapping was associated with a low incidence of postoperative lower extremity lymphedema in this single-arm cohort. These findings suggest that vNOTES-assisted SLN mapping may represent a feasible minimally invasive approach for nodal assessment in selected patients with endometrial cancer. Prospective comparative studies are required to confirm these findings and to evaluate long-term oncologic and lymphatic outcomes. Full article

Background and Clinical Significance: Plasmablastic lymphoma (PBL) is a rare and highly aggressive B-cell neoplasm most often associated with immunodeficiency. Transformation of chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) into PBL is exceptionally uncommon, particularly in immunocompetent individuals. This paper describes a rare synchronous SLL-to-PBL transformation and summarizes current knowledge on synchronous and metachronous cases reported in the literature. Case Presentation A midle-aged immunocompetent patent presented with generalized lymphadenopathy and lumbar pain. Concurrent biopsies of an axillary lymph node and a retroperitoneal mass were obtained. Diagnostic evaluation included immunohistochemistry; fluorescent in situ hybridization (FISH); PCR-based assessment of IGH, IGK, and IGL loci; and next-generation sequencing (NGS) of IGHV to assess clonal relatedness. The patient was treated with six cycles of Dara-CHOP, followed by autologous stem cell transplantation and maintenance therapy with daratumumab and ibrutinib. The axillary node showed SLL (CD20+, CD5+, CD23+), while the retroperitoneal mass demonstrated classic features of PBL (CD138+, MUM1+, MYC+, Ki-67 ~100%, CD20−). FISH detected MYC rearrangement in the PBL component. PCR and NGS confirmed identical IGHV1-69 rearrangements, establishing clonal relatedness and Richter transformation. A review of published cases shows that both synchronous and metachronous CLL/SLL-to-PBL transformations are exceedingly rare. The patient achieved partial metabolic remission after treatment and remains in sustained metabolic response 24 months after diagnosis. Conclusions: This case highlights a rare example of synchronous CLL/SLL-to-PBL transformation in an immunocompetent patient. Integration of detailed molecular diagnostics enabled early recognition and guided a personalized treatment approach incorporating CD38-targeted therapy and BTK inhibition, resulting in an excellent long-term clinical outcome. Full article

Background: Retroperitoneal leiomyosarcomas are aggressive malignancies. Complete surgical resection with negative margins is crucial to decrease the risk of recurrence but can be risky due to vascular involvement. The aim of our study was to evaluate the different approaches to IVC and renal vein management and their impact on postoperative complications. Methods: We performed a retrospective review of patients who underwent surgery for retroperitoneal leiomyosarcoma with IVC and/or renal vein involvement at our institution from 2016 to 2024. Patients were stratified by intraoperative vascular management, including ligation only versus varying forms of vascular reconstruction. Postoperative complications, including bleeding, transfusions, the need for acute and chronic hemodialysis, and thromboembolic events, were recorded. Chi-squared tests were used to compare rates of postoperative complications by vascular management. A p-value of 0.05 was considered statistically significant. Results: We identified 60 patients at our institution who underwent surgery for leiomyosarcoma with IVC and/or renal vein involvement. Ten patients underwent IVC ligation alone due to thrombosis, thirty-six had IVC replacement, and fourteen had patch angioplasty. In the entire cohort, twenty-six patients (43.3%) experienced an adverse event after surgery. When looking at postoperative adverse events by IVC management, we did not find any statistically significant differences among rates of adverse events by group. There were also no statistically significant differences in complications following renal vein ligation versus renal vein reconstruction. Conclusions: Patients with leiomyosarcoma with IVC and/or renal vein involvement have several options for intraoperative vascular management. Our data demonstrates that there are no statistically significant differences in rates of complications among the different groups. Full article

Background/Objectives: Pleural mesothelioma (PM) frequently recurs despite multimodal therapy. Here, we aimed to retrospectively evaluate the safety and potential clinical benefit of radiofrequency ablation (RFA) for recurrent PM. Methods: Fourteen consecutive patients underwent CT-guided RFA between July 2019 and June 2025. The cohort comprised 13 men and 1 woman, with a median age of 69 (range, 54–77) years. All patients had previously received systemic therapy, and 12 had undergone surgery. Seven patients (50%) presented with multiple lesions, and 25 tumors (median diameter 1.8 cm; range, 0.5–7.0 cm) were treated in 23 sessions. Outcomes assessed were local tumor control, complications, and survival. Local progression and overall survival were estimated using Kaplan–Meier analysis. Adverse events were classified according to the Society of Interventional Radiology guidelines. Results: Technical success was achieved in all sessions. Two tumors showed local recurrence, corresponding to 1- and 2-year local progression rates of 10.6%. Seven patients showed distant metastases, most of whom subsequently received systemic therapy. Three patients died, two from disease progression and one from treatment-related gastrointestinal perforation during therapy for an unrelated cancer. The overall survival rates were 100%, 100%, and 60% at 1, 3, and 5 years, respectively. Major and minor complications occurred in one case each (4.3%): a refractory skin ulcer and retroperitoneal hematoma, respectively. Conclusions: RFA was technically feasible and generally well tolerated and helped achieve encouraging local control and survival in patients with recurrent PM, warranting further evaluation of RFA as a complementary approach in multimodal treatment strategies. Full article

Robotic retroperitoneal lymph node dissection (R-RPLND) represents an evolution in the surgical management of testicular germ cell tumors, offering reduced morbidity compared with open approaches. However, this procedure remains technically challenging, particularly after chemotherapy, due to dense fibrosis and distortion of the retroperitoneal anatomy. We report a case of an unrecognized intraoperative thermal injury causing a partial transection of the proximal ureter presenting postoperatively as a urinary fistula following R-RPLND for residual mass resection, along with a focused review of the contemporary literature on procedure-related complications. A review of large series highlights severe complications (Clavien–Dindo ≥ III) occurring in 6–12% of cases, with ureteral injuries occurring in up to 6%, often identified after surgery. This case underscores the importance of meticulous dissection, awareness of altered anatomy, and prompt intervention when unexpected events arise during R-RPLND. Full article

Background and Objectives: Radiomics and artificial intelligence (AI) offer emerging quantitative tools for enhancing the diagnostic evaluation of testicular cancer. Conventional imaging—ultrasound (US), magnetic resonance imaging (MRI), and computed tomography (CT)—remains central to management but has limited ability to characterize tumor subtypes, detect occult nodal disease, or differentiate necrosis, teratoma, and viable tumor in post-chemotherapy residual masses. This systematic review summarizes current advances in radiomics and AI for both primary tumors and retroperitoneal disease. Materials and Methods: A systematic search of PubMed, Scopus, and Web of Science identified studies applying radiomics or AI to testicular tumors, retroperitoneal lymph nodes and post-chemotherapy residual masses. Eligible studies included quantitative imaging analyses performed on ultrasound, MRI, and CT, with optional integration of clinical or molecular biomarkers. Eighteen studies met inclusion criteria and were evaluated with respect to methodological design, diagnostic performance, and translational readiness. Results: Across modalities, radiomics demonstrated encouraging discriminatory capacity, with accuracies of 74–82% for ultrasound, 80.7–97.9% for MRI, and 71.7–85.3% for CT. CT-based radiomics for post-chemotherapy residual masses showed moderate ability to distinguish necrosis/fibrosis, teratoma, and viable germ-cell tumor, though heterogeneous methodologies and limited external validation constrained generalizability. The strongest performance was observed in multimodal approaches: integrating radiomics with clinical variables or circulating microRNAs improved accuracy by up to 12% and 15%, respectively, mirroring gains reported in other oncologic radiomics applications. Persisting variability in segmentation practices, acquisition protocols, feature extraction, and machine-learning methods highlights ongoing barriers to reproducibility. Conclusions: Radiomics and AI-enhanced frameworks represent promising adjuncts for improving the noninvasive evaluation of testicular cancer, particularly when combined with clinical or molecular biomarkers. Future progress will depend on standardized imaging protocols, harmonized radiomics pipelines, and multicenter prospective validation. With continued methodological refinement and clinical integration, radiomics may support more precise risk stratification and reduce unnecessary interventions in testicular cancer. Full article