Search Results (468)

Background: Bladder cancer (BC) incidence in Greenland is lower than in other Nordic countries, yet mortality is disproportionately high, suggesting delayed detection. Cystoscopy is the diagnostic gold standard to detect BC, but access in Greenland is often limited by geographic and logistical challenges, underscoring the need for more accessible diagnostic tools. Objectives: This study evaluated the performance of the urinary biomarker test Xpert^® Bladder Cancer Detection (XBCD) among patients referred for cystoscopy within the Greenlandic healthcare system. Methods: In this prospective observational study, 198 patients referred for urological evaluation due to hematuria or other urologic symptoms were recruited from five Greenlandic towns. All participants provided a urine sample for XBCD testing prior to cystoscopy, which served as the reference standard. Results: Among 194 patients with valid test results, seven BC cases were detected. XBCD identified five true positives and 166 true negatives, yielding a sensitivity of 71.4%, specificity of 88.8%, and a negative predictive value of 98.8%. Conclusions: In this low-prevalence setting, XBCD demonstrated potential as a triage tool to reduce the number of procedures and support earlier BC detection, although findings are limited by the small number of cancer cases. Full article

Urinary bladder neoplasms are clinically relevant in dogs and cats and are also common in humans, all of which may share exposure to environmental factors that influence disease risk. In Veterinary Medicine, however, their etiological determinants remain poorly defined. Urinary bladder neoplasia range from non-invasive lesions limited to the mucosa to invasive forms that infiltrate the muscular layer, which are more aggressive and metastatic. In dogs, invasive urothelial carcinoma (UC) represents the most frequently diagnosed type, while in cats, it is less common but displays similar biological behavior. Hematuria and dysuria are the predominant clinical signs, and although urinary bladder cancer accounts for only a small proportion of canine neoplasms, it is associated with considerable morbidity and mortality. Several risk factors have been identified, including breed, sex, age, obesity, diet, neuter status, and environmental exposures. Female dogs, especially Terrier breeds, are more susceptible, whereas in cats, males and short-haired animals are more often affected. Contact with insecticides, herbicides, and antiparasitic products is a recognized risk factor in dogs, although this association has not been consistently demonstrated in cats. Neutering and obesity appear to increase risk in dogs, and dietary patterns may offer protection, with regular vegetable consumption linked to a reduced incidence. Understanding these determinants is essential to improve early detection, guide preventive measures, and strengthen comparative oncology research. Full article

Bladder urothelial carcinoma (BUC) ranks among the most common malignant tumors of the urinary system, with alarmingly high incidence and mortality rates. Current clinical treatments face challenges such as strong chemotherapy resistance and limited response rates to immunotherapy, creating an urgent need for novel alternative therapies. Natural products, characterized by multi-targeted antitumor activity, low toxicity, and broad availability, have emerged as highly promising adjunctive or alternative strategies in cancer treatment. Extensive research has elucidated the antitumor activities of natural products, including inhibition of cancer cell proliferation, induction of apoptosis, and modulation of the immune microenvironment. What’s more, their bioactive components, such as terpenoids and polyphenols, can synergistically enhance therapeutic efficacy while reducing toxicity risks associated with traditional therapies. This review will examine the roles of terpenoids, phenolics, alkaloids, and other natural products in BUC treatment, to provide directions for future research. Full article

Active propelled micro robots (MRs) represent a transformative shift in biomedical engineering, engineered to navigate physiological environments by converting chemical, acoustic, or magnetic energy into mechanical propulsion. Unlike passive delivery systems limited by diffusion and systemic clearance, MRs offer autonomous mobility, enabling precise penetration and retention in hard-to-reach tissues. This review provides comprehensive analysis of MR technologies within urology, a field uniquely suited for microrobotic intervention due to the urinary tract’s anatomical accessibility and fluid-filled nature. We explore how MRs address critical therapeutic limitations, including the high recurrence of kidney stones and the rapid washout of intravesical bladder cancer therapies. The review categorizes propulsion mechanisms optimized for the urinary environment, such as urea-fueled nanomotors and magnetic swarms. Furthermore, we detail emerging applications, including bioresorbable acoustic robots for tumor ablation and magnetic grippers for minimally invasive biopsies. Finally, we critically assess the path toward clinical translation, focusing on challenges in biocompatibility, real-time tracking (MRI, MPI, photoacoustic imaging), and the regulatory landscape for these advanced combination products. Full article

Background and Objectives: Emerging evidence suggests that the genitourinary microbiota may influence the development and progression of urological malignancies, including bladder cancer. This study aimed to characterize the urinary microbiota at diagnosis in patients with bladder cancer and compare findings with healthy controls. Materials and Methods: Urine samples were collected from 30 patients with treatment-naïve bladder cancer and 20 age- and sex-matched healthy individuals. Microbiota composition was analyzed using 16S rRNA sequencing, and subgroup comparisons were made between muscle-invasive bladder cancer (MIBC) and non-muscle-invasive bladder cancer (NMIBC). Differentially abundant taxa were identified using linear discriminant analysis effect size (LEfSe) with an LDA threshold > 2 and p < 0.05. Results: No significant differences were observed in alpha or beta diversity between patients and controls or between MIBC and NMIBC. At the phylum level, Firmicutes was dominant in both groups but relatively more abundant in bladder cancer cases. Enterococcus was the most abundant genus in the cancer group (35.0%) and especially in MIBC (58.0%), while Lactobacillus was more prevalent in healthy controls (19.8% vs. 9.5%). At the species level, Veillonella dispar was notably enriched in MIBC cases (70.9%) compared to NMIBC (3.9%). LEfSe analysis revealed significant enrichment of Ralstonia, Microbacterium, and Facklamia in patients with bladder cancer, while Parvimonas, Sneathia, Gemella, and Acinetobacter guillouiae were more abundant in controls. Conclusions: These findings highlight preliminary microbiota differences associated with bladder cancer and tumor invasiveness; however, the results are exploratory and larger studies are required to evaluate their diagnostic or clinical relevance. Full article

The chromatin remodelling proteins DAXX and ATRX are key regulators of genome stability and epigenetic processes. Alterations in their expression have been associated with tumour stage and prognostic outcomes in various human cancer types, whereas their role in veterinary oncology has received little investigation to date. We analysed canine prostate and urinary bladder samples, including 18 prostate carcinomas (12 adenocarcinomas and 6 prostatic urothelial carcinomas), 10 non-malignant prostate tissues, 22 urinary bladder carcinomas, and 6 non-malignant bladder tissues. Nuclear expression of DAXX and ATRX was assessed using fully quantitative digital immunohistochemistry. Overall, DAXX exhibited consistently higher expression than ATRX across benign and malignant samples from the prostate and bladder. DAXX and ATRX expression demonstrated a positive correlation across all samples (ρ = 0.553, p < 0.05), suggesting coordinated regulation. They displayed organ-specific expression patterns: prostate carcinomas showed increased expression of DAXX compared with non-malignant prostate tissues (p < 0.05). In contrast, in the bladder, expression of DAXX and ATRX declined with increasing tumour grade (p < 0.05). Our findings provide new insights into the potential of DAXX and ATRX as biomarkers, offering new insights into their clinical relevance in dogs. Full article

Background/Objectives: Optimal selection for perioperative therapy in urothelial carcinoma (UC) remains uncertain. We evaluated the efficacy of neoadjuvant and/or adjuvant chemotherapy (NAC/AC) for patients with bladder cancer (BC) and upper tract UC (UTUC), examined the role of lymphovascular invasion (LVI), and considered the implications for adjuvant nivolumab. Methods: We retrospectively analyzed consecutive patients who underwent radical cystectomy or radical nephroureterectomy at a single center (July 1998–April 2021; observation to 31 March 2025). After exclusions, 252 BC and 153 UTUC patients were included. Endpoints were cancer-specific survival, progression-free survival (PFS; BC), non-urinary-tract recurrence-free survival (NUTRFS; UTUC), and overall survival (OS). Survival was estimated by Kaplan–Meier analysis and compared by log-rank tests. Results: For BC, AC did not improve the PFS or OS in the overall pT ≥ 2 population, whereas node-positive (pN+) disease derived significant benefits in both endpoints among NAC-naïve patients (PFS and OS, p = 0.002 and p = 0.008). For UTUC, AC conferred no advantage in NUTRFS or OS for the overall pT ≥ 2 population. However, NUTRFS benefits emerged in the pN+ subset (p = 0.049), although the OS was not improved. Among NAC-treated BC, the outcomes were poorest for ≥ypT3 and ypN+, whereas ypT ≤ 2 fared better. LVI was associated with adverse outcomes and was borderline higher in pN+ versus pT ≥ 2/pN− for BC (p = 0.056) and significantly higher for UTUC (p = 0.012). Conclusions: In this retrospective, single-center cohort, our exploratory analyses suggest that perioperative benefit is largely node-dependent, supporting prioritizing systemic therapy for pN+ disease and cautioning against routine AC for pT2/ypT2 without nodal involvement. After NAC, adjuvant therapy appeared most justified for ≥ypT3/ypN+. Prospective biomarker-integrated validation is warranted and, given the small and underpowered subgroups and the potential for selection and immortal time biases, these observations should be interpreted as hypothesis-generating rather than causal. Full article

Background/Objectives: Urothelial carcinoma of the bladder (UCC) is a leading cause of cancer-related death globally. Given that urine is in direct contact with the tumor, it represents a highly valuable source for non-invasive molecular analysis. Methods: This study utilized liquid biopsies from 41 UCC patients and 27 non-cancerous hematuria controls to identify novel diagnostic and prognostic biomarkers via proteomic and transcriptomic analysis. Results: Urine proved to be a reliable source, yielding a mean tumor cell fraction of 0.605 (95% CI: 0.505–0.705). We identified 11 genes with concurrent alteration at both the urinary protein and mRNA levels. Notably, four upregulated markers, CYTB, C1QC, SBP1, and ANXA4, demonstrated strong diagnostic potential, with AUC values greater than 0.70. CYTB and ANXA4 were detectable even in early-stage UCC (stages Cis, I, and II). Furthermore, we identified two proteins, CATC and SPB10, that were markedly upregulated in recurrent UCC and correlated with poor overall survival, positioning them as potential prognostic markers for recurrence risk. Conclusions: This study confirms the utility of urine as a reliable medium for detecting UCC tumor cells, offering promising markers for both early-stage diagnosis and predicting NMIBC recurrence. Full article

Lymphovascular invasion (LVI) is a potent yet underutilized prognostic marker in bladder cancer, particularly in non–muscle-invasive disease (NMIBC). We aimed to develop and internally validate a predictive nomogram to estimate the probability of LVI at initial transurethral resection of bladder tumors (TURBT), utilizing preoperative clinical parameters. In this retrospective cohort study, 413 patients with histologically confirmed urothelial carcinoma who underwent initial TURBT were included. LVI was identified histologically in 9.2% of cases. Univariate and multivariate logistic regression, in conjunction with the least absolute shrinkage and selection operator modeling, revealed eight significant predictors: papillary architecture, Box–Cox–transformed tumor size, urinary cytology classification, age ≥ 75 years, pedunculated morphology, gender, hydronephrosis, and tumor multiplicity. The resulting nomogram demonstrated excellent discriminative performance, with an AUC of 0.888 in the training cohort and 0.827 in the validation cohort, and exhibited good calibration based on weighted plots. This model facilitates individualized prediction of LVI using routinely available clinical data. Early detection of LVI may inform risk-adapted management strategies, including repeat resection, or intensified surveillance in patients with bladder cancer. The model complements existing predictive frameworks and can contribute to more personalized and effective bladder cancer care. Full article

Background: Non-muscle-invasive bladder cancer (NMIBC) represents approximately 70–75% of newly diagnosed bladder cancers and is characterized by high recurrence rates despite guideline-based management. Chronic urinary retention and bladder outlet obstruction (BOO) have been proposed as under-recognized modifiers of NMIBC outcomes through prolonged exposure to urinary carcinogens, inflammation, and altered intravesical pharmacokinetics. This narrative review qualitatively synthesizes biological and clinical evidence linking BOO-related dysfunction with NMIBC behavior and explores the emerging, but preliminary, role of Holmium Laser Enucleation of the Prostate (HoLEP) as a functional adjunct in selected patients. Methods: A narrative review was conducted according to SANRA guidelines. PubMed/MEDLINE, Embase, and Scopus were searched (January 2000–October 2025) using predefined terms for NMIBC, BOO, urinary retention, and HoLEP. Two reviewers independently screened records, with disagreements resolved by consensus. Sixty-one studies met inclusion criteria. Results: Elevated postvoid residual (PVR) (>80–100 mL) and moderate to severe lower urinary tract symptoms (LUTS) were consistently associated with higher NMIBC recurrence rates, independent of tumor stage and grade, in heterogeneous cohorts. Retention correlated with reduced efficacy of Bacillus Calmette–Guérin (BCG) and mitomycin C, likely via uneven drug distribution and a chronically inflamed urothelium. Mechanistic data support a plausible link between BOO-related inflammation, barrier dysfunction, and tumor biology, although direct biomarker correlations with PVR or pharmacokinetic studies are lacking. HoLEP provides durable relief of BOO, reduces PVR, and improves LUTS. Limited retrospective data suggest an association between HoLEP and lower recurrence, but these observations are confounded and should be viewed as hypothesis-generating. Conclusions: Chronic urinary retention and BOO appear to be modifiable functional factors that may influence NMIBC recurrence and intravesical therapy performance. HoLEP is a promising option to optimize bladder emptying in carefully selected patients, but its oncologic impact remains unproven and should be considered hypothesis-generating pending prospective, risk-adjusted studies. Full article

Background: The widespread adoption of holmium laser enucleation of the prostate (HoLEP) has led to a growing number of men subsequently diagnosed with localized prostate cancer requiring radical prostatectomy (RP). However, anatomical alterations after HoLEP may increase surgical complexity and affect outcomes. This systematic review aimed to synthesize current evidence on perioperative, oncological, and functional outcomes of RP following HoLEP. Methods: A systematic literature search was conducted in PubMed, CENTRAL, and ClinicalTrials.gov through to September 2025 in accordance with PRISMA 2020 guidelines (PROSPERO CRD420251134483). Eligible studies included patients undergoing RP after HoLEP with reported perioperative, oncologic, or functional data. Methodological quality was assessed using the ROBINS-I tool, and results were synthesized narratively. Results: Eight retrospective studies comprising 202 patients were included. RP after HoLEP was technically feasible across open, laparoscopic, and robotic approaches. Operative time and the need for bladder-neck reconstruction were increased, reflecting post-enucleation fibrosis, but major complication rates (<5%) and blood loss were comparable to primary RP. Oncological outcomes were preserved, with positive surgical margin rates of 6–20% and biochemical recurrence rates of 7–15%, similar to those of primary RP. Functional recovery, particularly urinary continence, was slower initially but generally equivalent at 12 months. Erectile function outcomes were variable but satisfactory when nerve-sparing was feasible. Conclusions: Radical prostatectomy after HoLEP is a technically demanding yet safe procedure that achieves oncologic and long-term functional outcomes comparable to primary prostatectomy. Prior HoLEP should not preclude curative surgical management of prostate cancer, provided the operation is performed by experienced surgeons in high-volume centers. Full article

Objective: To describe the clinical use of URO17^®, a noninvasive, urine-based immunocytochemistry assay targeting Keratin 17 (K17), as an adjunct to conventional diagnostic methods for urothelial carcinoma. Materials and Methods: These illustrative cases summarize the real-world use of URO17^® in diagnostic workflows for patients presenting with hematuria and those undergoing surveillance for non-muscle invasive bladder cancer (NMIBC). Urine samples were processed via standard immunocytochemistry and interpreted alongside cystoscopic, cytological, and radiographic findings. Discussion: URO17^® was used as a complementary diagnostic tool to help guide clinical management. Negative results supported deferral of invasive procedures in selected patients, while positive findings prompted further evaluation when standard tests were inconclusive. Conclusions: In the seven illustrative cases presented, URO17^® aided clinical decision-making as part of routine diagnostic and surveillance workflows. The test’s integration with existing cytology processes supports its potential role as a noninvasive adjunct for evaluating patients with suspected or recurrent urothelial carcinoma. Full article

Introduction of immune checkpoint inhibitors and targeted agents has markedly improved outcomes and extended survival in urothelial and renal cell carcinoma. However, the substantial subset of cases are treatment-resistant. Emerging strategies aim to enhance the effectiveness of immunotherapy. One area of growing interest and promise is the microbiome. The microbiome plays a complex and dynamic role in regulating the immune system, and represents a new frontier as a promising target for modulating response to immunotherapy. This review summarizes recent advances in our understanding of the microbiome, its interactions with immunotherapy, novel avenues for microbiome modification, and potential implications for the treatment of urothelial and renal cell carcinoma. Full article

The human bladder hosts a resident, low-biomass microbial community (urobiota) that has only become the subject of intense investigation in the last 15 years. The advantages that the urobiota may confer to the bladder, in contrast to the microbiota of other mucosal sites, remain to be elucidated. Alterations in the urobiota have been associated with various pathological urogenital conditions, including urinary tract infections (UTIs) and recurrent UTIs. A potential link between bladder cancer (BC), the ninth most common human cancer by incidence worldwide, and a dysbiotic urobiota is still unclear and represents an emerging field of study. In this review, we focus on recent studies that not only analyzed the urobiota of BC patients using urine specimens to identify biomarkers and microbial signatures of the disease, but also monitored therapeutic responses to therapies. We also discuss novel techniques of culturing, such as culturomics, animal models of BC, and 3D organotypic models. Furthermore, we review studies on the gut–bladder axis which, though still limited, already suggest that diet- and gut-derived bacterial metabolites can influence BC progression and individual responses to therapy. Full article