PURPOSE: Understanding the specific tumor characteristics associated with detectable circulating tumor DNA (ctDNA) in patients with renal cell carcinoma (RCC) is critical for informing future studies aiming to establish the clinical utility of such testing. We characterized the pathologic and clinical features associated with preoperatively detectable ctDNA in patients with renal masses suspicious for RCC. METHODS: Consecutive patients who underwent partial or radical nephrectomy for nonmetastatic suspected RCC (cT1b-T3) during 2022-2023 had prospectively collected tumor-informed ctDNA analyses conducted preoperatively and postoperatively. Descriptive statistics and univariate analyses were used to describe the study findings. RESULTS: Sixty-nine patients with a median age of 62 years (IQR, 51-70) and a median follow-up time of 7 months (IQR, 3-11) had 205 ctDNA samples collected for analysis. Thirty-nine (61%) had preoperative detectable ctDNA of 64 patients. Postoperative ctDNA status was available for 47 patients, and three (6%) had detectable ctDNA. Two had inferior vena cava (IVC) involvement, and one developed metastatic disease. Subgroup analysis of solely malignant RCC (n = 65) revealed that patients with preoperative detectable ctDNA had a higher pathologic stage ( P = .001), larger tumors (7 v 4.5 cm; P = .001), higher tumor complexity ( P = .022), and increased rates of tumor grades 3-4 ( P = .038). All patients with gross renal vein or IVC involvement (n = 9) and those with lymphovascular invasion (n = 6) on pathology had detectable preoperative ctDNA. On univariate analysis, high tumor complexity, larger tumors, and tumor grades 3-4 were found to be predictors of preoperatively detectable ctDNA status. CONCLUSION: Preoperative ctDNA was detectable in 61% of patients with nonmetastatic RCC, and it correlated with clinically relevant features. Clinical trials should consider incorporating both preoperative and postoperative ctDNA analyses to augment prediction of disease recurrence and to refine treatment decision making.

Placenta percreta is a rare life-threatening condition associated with high morbidity and mortality due to severe obstetric hemorrhage. It can be associated with bladder invasion which leads to hematuria. Treatment is decided on a case-to-case basis, and there have been no guidelines proposed so far. Strategies include obstetric hysterectomy, leaving the placenta in situ with postoperative methotrexate therapy and removal of the placenta with bladder reconstruction in a single stage. An unusual case of a patient with placenta percreta and bladder invasion who presented with delayed hematuria after the placenta was left in situ has been reported. The patient was managed conservatively for 10 days postdelivery after which a decision to do an obstetric hysterectomy with focal cystectomy was taken in view of persistent hematuria. An algorithm for managing cases of placenta percreta with bladder invasion has been proposed to manage these difficult situations.

Background: Robot-assisted repair of benign ureteroenteric anastomotic strictures (UAS) provides an alternative to the open approach. We aimed to report short-, medium-, and long-term outcomes for robotic repair of benign UAS, and to provide a detailed video demonstration of critical operative techniques in performing this procedure robotically. Materials and Methods: Between January 2013 and September 2022, 31 patients from seven institutions who previously underwent radical cystectomy and subsequently developed UAS underwent robotic repair of UAS. Perioperative variables were prospectively collected, and postoperative outcomes were assessed. The surgery starts with a lysis of adhesions after previous surgery. Ureters are dissected, and the level of the stricture is identified. The ureter is then divided, and the stricture is resected. Finally, the ureter is spatulated and reimplanted with Nesbit technique after stenting with Double-J stents. In cases where both ureters show strictures, Wallace technique for reimplantation can be applied. Results: After robotic or open cystectomy, 31 patients had a total of 43 UAS at a median (interquartile range) follow-up of 21 (9–43) months. Median stricture length was 2.0 (1.0–3.25) cm, operative duration was 141 (121–232) minutes, estimated blood loss was 100 (50–150) mL, and length of hospital stay was 5 (3–9) days. One (3.2%) case was converted to open and one (3.2%) intraoperative complication occurred. Seven (22.6%) patients experienced postoperative complications, including four (12.9%) Clavien–Dindo grade 3 complications. No Clavien–Dindo grade 4 or 5 complications occurred. Stricture recurrence occurred in 2 (6.5%) patients. Conclusions: These results demonstrate that robotic repair of UAS is feasible and effective approach with outcomes in line with prior open series. Patient Consent Statement: Authors have received and archived patient consent for video recording and publication in advance of video recording of procedure.

Bipolar transurethral resection of bladder tumors (bTURBT) is the standard of care technique for the management of bladder tumors; however, new techniques such as thulium laser en bloc resection of bladder tumors (TmLRBT) have been introduced as alternatives to bTURBT. In this study, detrusor muscle acquisition, perioperative outcomes and survival outcomes after TmLRBT and bTURBT were prospectively compared in patients with primary bladder tumors (1–5 cm). This prospective interventional study, conducted over ten years, involved 542 patients under a single surgeon. Inclusion criteria were a single tumor of 1–5 cm. The primary endpoint was the presence or absence of detrusor muscle. Perioperative criteria included operative time, hospital stay length, catheterization duration, bladder perforations, readmissions, and complication incidence. Recurrence-free survival (RFS) and cancer-specific survival (CSS) were analyzed using the Kaplan-Meier method with subgroup comparisons by the log-rank test. Of 449 patients, 211 underwent TmLRBT and 238 underwent bTURBT. Detrusor muscle was present in 201 (95.2%) TmLRBT patients vs 154 (64.7%) bTURBT patients (p <0.001). Complications were less frequent in the TmLRBT group (p <0.05). Hemoglobin drop (p <0.001), hospital stay (p <0.001), catheterization duration (p <0.001), and operative time (p <0.001) were all significantly lower in the TmLRBT group. Kaplan-Meier analysis showed no significant differences in RFS (p = 0.255) and CSS (p = 0.258) between the groups. TmLRBT demonstrated significantly better detrusor muscle inclusion and perioperative outcomes compared to bTURBT.