Alternative, non-invasive, cost-effective methods to complement or serve as substitutes to current standard of care (SOC) procedures in non-muscle invasive bladder cancer (NMIBC) follow-up, are needed. Uromonitor® is a urine biomarker test detecting bladder cancer (BC) recurrence through the screening of TERT, FGFR3 and KRAS hotspot mutations. The aim of the current study is to assess Uromonitor® performance comparing it to the current SOC methods. 528 NMIBC surveillances from 439 patients were enrolled in the study. All subjects underwent SOC methods and provided a urine sample for Uromonitor® analysis before undergoing cystoscopy. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated for recurrence and compared to the gold-standard cystoscopy plus trans-urethral resection (TURBT) histopathology. Uromonitor® displayed a sensitivity of 87% (74-95, 95% CI), with only 6 out of 47 recurrences failing to be detected, a specificity of 99% (98-100) PPV of 93% (82-98) and a NPV of 99% (97-99). Cystoscopy showed a total of 22 (32%) false positives not confirmed by TURBT, while Uromonitor® presented only three positive tests where no lesions were found. Overall recurrence rate was 8.9% (n=47) among 528 total screenings. Sensitivity, specificity, PPV and NPV values for Uromonitor® remained high across all NMIBC grades and stages. Uromonitor® represents a reliable tool in the detection of NMIBC recurrence in patients undergoing routine surveillance, regardless of stage and grade. To our knowledge, this is the largest single-center study assessing Uromonitor®´s performance, thus validating its usefulness in clinical practice.

Bladder cancer (BC) is an increasingly frequent cancer worldwide, being currently the sixth most frequent tumor and the thirteenth leading cause of cancer death. Among all BC cases, pathologists have identified several histomorphologies different from the conventional urothelial carcinoma. Although rare, these histologic variants have a distinct growth pattern, an altered cell differentiation and an unusual clinical behavior, especially concerning clinical presentation at diagnosis, response to the standard treatment and prognosis. Therefore, an updated review of this topic should be useful to aid clinicians in a better evidence-based decision-making. This chapter aims to summarize the current literature on the most common histologic variants regarding their epidemiology, clinical presentation at diagnosis, treatment options and prognosis. This includes both non-muscle invasive BC and muscle invasive BC as well as metastatic disease. A special focus will be placed on the role of neoadjuvant chemotherapy and early cystectomy and its prognostic implications.

Background: Renal tumors in solitary kidneys require treatments that optimize both oncological and functional outcomes. Robot-assisted partial nephrectomy (RAPN) offers a balance between these needs and reduced morbidity. This study investigates the oncologic and functional outcomes of RAPN in solitary-kidney patients. Methods: We analyzed data from 1852 patients with cT1-T4N0M0 renal cell carcinoma treated by RAPN from January 2018 to June 2022. The cohort included patients with solitary kidneys based on preoperative characteristics, tumor staging and perioperative outcomes using the Trifecta criteria. Results: Of the study participants, 39 had solitary kidneys. Fifteen patients (38.6%) had an ASA score > 2, indicating a higher preoperative risk. The median PADUA score was 7 (IQR 8–9). Moreover, 28 (71.8%) patients had a chronic kidney disease stage > 2. Trifecta success was achieved in 26 (66.6%) of the cases. During a median follow-up of 36 months, tumor recurrence was observed in 12 patients (30.7%), with local recurrences in 4 (10.2%) and systemic recurrences in 8 (20.5%). A higher ASA score and global ischemic clamping were independent predictors of renal function decline at the third postoperative day and Trifecta failure. Only a higher ASA score significantly predicted a significant long-term decline in renal function. Nucleolar grade at pathological stage was the only factor significantly associated with tumor recurrence. Conclusions: RAPN is as an effective treatment for renal tumors in solitary kidneys, balancing oncological control and renal function preservation. Global ischemia and patient physical status are the most important factors influencing outcomes and highlight the importance of patient selection and tailored surgical strategies.