Bladder cancer (BCa) is one of the most diagnosed urological malignancies. A timely and accurate diagnosis is crucial at the first assessment as well as at the follow up after curative treatments. Moreover, in the era of precision medicine, proper molecular characterization and pathological evaluation are key drivers of a patient-tailored management. However, currently available diagnostic tools still suffer from significant operator-dependent variability. To fill this gap, physicians have shown a constantly increasing interest towards new resources able to enhance diagnostic performances. In this regard, several reports have highlighted how artificial intelligence (AI) can produce promising results in the BCa field. In this narrative review, we aimed to analyze the most recent literature exploring current experiences and future perspectives on the role of AI in the BCa scenario. We summarized the most recently investigated applications of AI in BCa management, focusing on how this technology could impact physicians’ accuracy in three widespread diagnostic areas: cystoscopy, clinical tumor (cT) staging, and pathological diagnosis. Our results showed the wide potential of AI in BCa, although larger prospective and well-designed trials are pending to draw definitive conclusions allowing AI to be routinely applied to everyday clinical practice.

Sentinel node biopsy (SNB) for prostate cancer (PCa) represents an innovative technique aimed at improving nodal staging accuracy. The routinary adoption of this procedure in patients undergoing radical prostatectomy (RP) might be crucial to identify candidates who could effectively benefit from extensive pelvic lymph nodal dissection (ePLND). Despite some promising results, SNB for PCa is still considered experimental due to the lack of solid evidence and procedural standardization. In this regard, our narrative review aimed to analyze the most recent literature in this field, providing an overview of both the diagnostic accuracy measures and the oncological outcomes of SNB.

Background: This study aims to evaluate the safety and efficacy of prostatic artery embolization (PAE) in elderly, multimorbid patients with benign prostatic hyperplasia (BPH). Additionally, it seeks to identify technical and clinical factors that predict clinical failure at the mid-term follow-up. Methods: We analyzed the clinical records of 175 consecutive patients who underwent PAE. Technical success was defined as achieving embolization on at least one side. Safety was assessed using the Clavien–Dindo classification. The pre-procedural international prostate symptom score (IPSS), quality of life (QoL) score, prostate volume (PV), prostate-specific antigen (PSA), maximum urinary flow rate (Qmax), and post-void residual urine (PVR) were compared with values assessed at the follow-up evaluation. Clinical failure was defined as no improvement or worsening of lower urinary tract symptoms (LUTS) based on the IPSS at the follow-up evaluation. Univariate and multivariate regression models were applied to identify predictors of clinical failure. Results: 158 patients met the inclusion criteria. The median age was 74 years (68, 79), with a median ASA score of 2 (2, 3) and a Charlson comorbidity index (CCI) of 5 (4, 7). Follow-up assessments were carried out at a median of 12 months (0, 1). IPSS decreased by −5 points (−8, 0), QoL by −1 point (−1, 0), PV by −19 cc (−26, −8), PVR by −45 cc (−25 to −80), and PSA by −1.1 ng/mL (−2.5, −0.2) (p < 0.01); while Qmax improved by 4 mL/s (2, 6) (p < 0.01). A total of 44 patients (30.3%) experienced clinical failure, which was significantly correlated with unilateral embolization (p < 0.01). Multivariate regression analysis indicated that higher CCI, elevated PVR, and the use of larger microspheres were associated with poorer clinical outcomes, with odds ratios of 2.17 (95% CI: 1.4–3.38), 1.02 (95% CI: 1.01–1.03), and 26.83 (95% CI: 4.81–149.8), respectively (p < 0.01). Conclusions: PAE is a safe and effective treatment for elderly multimorbid patients with BPH. Comprehensive pre-procedural clinical assessment, incorporating the CCI and PVR, is essential to optimize treatment outcomes.

Introduction: To systematically review the definitions, diagnostic modalities, incidence, predictive factors, and management strategies of Steinstrasse (SS), following extracorporeal shock wave lithotripsy (ESWL) and endourological procedures. Methods: A comprehensive literature search was conducted in accordance with the PRISMA guidelines across PubMed, Scopus, and Embase, identifying randomized controlled trials, prospective and retrospective observational studies, and case series published between 1986 and May 2025. Results: Forty-two studies met the inclusion criteria. The reported incidence of SS varied ranged from 1% to 23%, depending on initial stone burden, location, and treatment modality. Historical classifications, such as that proposed by Coptcoat et al., remain the most adopted linking SS morphology to clinical management. Diagnostic methods have evolved over time, from plain abdominal radiography (KUB) to non-contrast computed tomography (NCCT). Conservative management achieved spontaneous clearance in nearly half of reported cases, whereas ureterorenoscopy represents the treatment of choice in the remaining persistent cases. Recent technological advances in flexible Ureterorenoscopy (FURS), laser systems, and the use of flexible aspirating navigable ureteral access sheaths (FANS) have drawn attention to the accumulation of fine residual fragments (≤ 4 mm) and dust, potentially leading to SS-like conditions. Conclusions: Although SS has been traditionally associated with ESWL, its occurrence following FURS is an emerging concern. The present review highlights the importance of early recognition, standardized definitions, and individualized management strategies to optimize outcomes in both ESWL- and endoscopy-related SS.

Background: Endoscopic kidney-sparing surgery (eKSS) is increasingly adopted for the management of selected patients with upper tract urothelial carcinoma (UTUC). Laser energy is central to tumor ablation during eKSS; however, multiple laser platforms with distinct physical and thermal properties are currently available, and their comparative oncological and safety profiles remain poorly defined. This systematic review aims to summarize the available evidence on oncological outcomes and perioperative complications associated with laser-based endoscopic treatment of UTUC and to explore potential differences according to laser technology. Methods: A systematic literature search identified 25 eligible studies published between 1997 and 2024, including 1344 patients treated with laser-assisted eKSS. All included studies were non-randomized, predominantly retrospective, and characterized by moderate-to-serious risk of bias. Holmium:YAG, Thulium:YAG (thu:YAG, continuous-wave and pulsed), thulium fiber laser (TFL), Neodimio:YAG (Nd:YAG), diode lasers, and combination platforms were reported. Results: Ipsilateral upper tract recurrence was common across all laser categories, with weighted proportions ranging approximately from 27% to 52% and substantial inter-study heterogeneity. Progression and conversion to radical nephroureterectomy (RNU) were relatively infrequent overall, with numerically weighted proportions observed in thu:YAG-based cohorts. Major complications (Clavien–Dindo ≥ III) were rare across all laser technologies, although a trend toward a higher weighted proportions was observed in Ho:YAG- and Nd:YAG-based series. Minor complications were more frequently reported and highly heterogeneous. Conclusions: Available evidence supporting laser selection in endoscopic kidney-sparing management of UTUC is limited and largely descriptive. Thulium:YAG and TFL platforms seem to demonstrate encouraging trends toward lower progression and conversion to-radical-nephroureterectomy rates; however, these findings are derived from heterogeneous, non-comparative studies with limited follow-up. No standard laser platform can currently be recommended over others based on existing data. Prospective, comparative, and methodologically robust studies are required to determine whether laser technologies confer clinically meaningful advantages in oncological control or safety for UTUC treated with eKSS.