The incidence of prostate cancer (PC) has risen annually. PC mortality is explained by the metastatic disease (mPC). There is an intermediate scenario in which patients have non-mPC but have initiated a metastatic cascade through epithelial–mesenchymal transition. There is indeed a need for more and better tools to predict which patients will progress in the future to non-localized clinical disease or already have micrometastatic disease and, therefore, will clinically progress after primary treatment. Biomarkers for the prediction of mPC are still under development; there are few studies and not much evidence of their usefulness. This review is focused on tissue-based genomic biomarkers (TBGB) for the prediction of metastatic disease. We develop four main research questions that we attempt to answer according to the current evidence. Why is it important to predict metastatic disease? Which tests are available to predict metastatic disease? What impact should there be on clinical guidelines and clinical practice in predicting metastatic disease? What are the current prostate cancer treatments? The importance of predicting metastasis is fundamental given that, once metastasis is diagnosed, quality of life (QoL) and survival drop dramatically. There is still a need and space for more cost-effective TBGB tests that predict mPC disease.

Bladder cancer (BC) is the tenth most common cause of cancer worldwide and is the thirteenth leading cause of cancer mortality. The non-muscle invasive (NMI) variant represents 75% of cases and has a mortality rate of less than 1%; however, it has a high recurrence rate. The gold standard of management is transurethral resection in the case of new lesions. However, this is associated with significant morbidity and costs, so the reduction of these procedures would contribute to reducing complications, morbidity, and the burden to the health system associated with therapy. In this clinical scenario, strategies such as active surveillance have emerged that propose to manage low-risk BC with follow-up; however, due to the low evidence available, this is a strategy that is underutilized by clinicians. On the other hand, in the era of biomarkers, it is increasingly known how to use them as a tool in BC. Therefore, the aim of this review is to provide to clinical practitioners the evidence available to date on AS and the potential role of biomarkers in this therapeutic strategy in patients with low-grade/risk NMIBC. This is the first review linking use of biomarkers and active surveillance, including 29 articles.

Background: New generation devices that combine high-flow insufflation with smoke aspiration using continuous gas recirculation ]so-called Insufflator/aspirator systems (IAS)] have recently been developed to generate pneumoperitoneum. The use of an IAS could have an impact on surgical compared to conventional insufflation systems (CIS). The present study aimed to compare the clinical effectiveness/safety, healthorganizational, and pathological/oncological outcomes of the CIS versus IAS during robot-assisted radical prostatectomy (RARP). Methods: Comparative retrospective cohort study including patients with non-metastatic prostate cancer treated with RARP by four expert surgeons at a robotic referral centre between January 2020 and December 2021. A CIS was used until 15 March 2021, and the IAS thereafter. Data were extracted from the Institutional Review Board-approved (#1064) retro and prospective institutional database. Results: The final analysis included 299 patients (143 CIS; 156 IAS). We found no statistically significant differences in demographic data and preoperative results, allowing adequate group comparison. The rate of complications of any degree (9.1% and 1.9%, P<0.05) and major complications (4.2% and 0.6%, P<0.05) were lower in the IAS group. Accordingly, the hospital stay was shorter in the IAS group (P<0.05); however, the small size of this statistically significant difference probably lacks clinical value (1.9±1.6 vs. 1.6±0.8 days). There was no significant difference in surgical time, bleeding, pathological findings, or oncological results. Conclusions: Data from this large group of patients showed that the rate of overall complications, the rate of major complications, and the length of stay were lower in the IAS group. Implementing the IAS in RARP patients increased the occurrence of SCE and affected our daily practice of transversus abdominis plane block. Interpretation of the results should be made with caution since the design of this study did not allow for the identification of a causal relationship.

To systematically review the most recent scientific literature regarding modern strategies for organ preservation in the treatment of non-metastatic muscle-invasive bladder cancer. Literature search was made using PubMed, Google Scholar, EMBASE, Wiley Library, and ClinicalTrials.gov following the recommendations of the Preferred Reporting Items for Systematic reviews and Meta-Analyses statement. The primary outcome was 5-year overall survival rate, which was addressed by a systematic review and meta-analysis. The risk of bias and quality of evidence were assessed according to the Cochrane Collaboration and the Grading of Recommendations, Assessment, Development and Evaluation system. The evidence is consistent in showing that 5-year survival of trimodality therapy is similar to radical cystectomy in selected patients, ranging between 29% and 73%. Patients undergoing bladder-sparing therapy were found to have better outcomes in terms of quality of life and sociability than those undergoing radical cystectomy. Immunotherapy is establishing itself as a strategy for organ-preservation treatment, showing complete response rates between 42% and 100%. However, most of these results have been obtained from ongoing clinical trials. Furthermore, there are still no studies comparing the efficacy among the different available therapies. Although radical cystectomy remains the gold standard treatment for muscle-invasive bladder cancer, its significant morbidity has prompted the exploration of alternative therapies. In this context, bladder preservation therapies, though supported by limited literature, emerge as a potential alternative that could offer comparable oncological outcomes in selected patients.

Emphysematous pyelonephritis is an acute necrotizing infection of the renal parenchyma. The management is variable, extending to total nephrectomy in severe or refractory cases. Post‐nephrectomy complications are numerous and common, necrotizing fasciitis, and sepsis being among them. We present a case of a 37‐year‐old woman with obesity and a previous left emphysematous pyelonephritis episode managed conservatively. The patient presented with a second left emphysematous pyelonephritis and underwent a left total nephrectomy. Two weeks later, the patient presented with a contralateral necrotizing fasciitis of the abdominal wall. Subsequently, the patient required several surgical debridement procedures and a vacuum‐assisted closure system treatment. Emphysematous pyelonephritis is an aggressive infectious disease that requires high suspicion in patients at risk.

Bladder cancer (BC) is the most common malignancy of the urinary tract. Approximately 75% of cases are non-muscle-invasive BC (NMIBC), while muscle-invasive BC (MIBC) and advanced tumors account for most cancer-specific mortality. Accurate assessment of tumor invasion is essential, as staging variability may lead to inappropriate treatments. Tumor invasion involves several mechanisms including extracellular matrix (ECM) remodeling mediated by metalloproteinases, angiogenesis, and cell adhesions. Masson’s trichrome staining (MTS) provides relevant information on ECM composition. This study evaluated the application of machine learning to MTS-stained bladder biopsies to predict muscle invasion. A retrospective analysis of bladder biopsy images obtained from transurethral resections and cystectomies (2022–2024). A total of 702 histological images were analyzed. A convolutional neural network (CNN) was trained to classify tumors as MIBC or NMIBC and model outputs were correlated with clinical variables. The CNN achieved an accuracy of 95.2% in the training set and 90.1% in validation. Model-derived probabilities were significantly associated with tumor grade, lesion size, and muscle invasion. Logistic regression demonstrated a strong association with invasive disease (OR = 0.07, p = 0.017). CNN-based analysis of MTS-stained bladder biopsy images enable accurate prediction of muscle invasion, with potential to improve diagnostic precision.