PURPOSE: To evaluate the activity and safety of nivolumab with nab-paclitaxel as neoadjuvant therapy, followed by radical cystectomy (RC) and postsurgical adjuvant nivolumab in patients with muscle-invasive bladder cancer (MIBC). PATIENTS AND METHODS: Eligible patients had an Eastern Cooperative Oncology Group performance status of ≤1 and a T2-4aN0-1M0 stage with >50% urothelial carcinoma histology and were ineligible for or refused cisplatin-based chemotherapy. Patients received four cycles of nivolumab 360 mg once every 3 weeks + nab-paclitaxel 125 mg/m ² once on days 1 and 8, every 3 weeks, followed by RC, and then adjuvant nivolumab 360 mg once every 3 weeks × 13 cycles. The primary end point was the pathologic complete response (CR) rate (ypT0N0). Secondary end points were major pathologic response (ypT≤1N0), safety, event-free survival (EFS), and overall survival. RESULTS: Thirty-one patients were enrolled from December 2021 to June 2023; 19 (61.3%) had a cT2 stage, two (6.5%) had N1 stage, and 16 (51.6%) had a variant histology. Five patients (16.1%) received less than four full courses of neoadjuvant treatment because of treatment-related adverse events (TRAEs). Grade 3/4 TRAEs occurred in eight patients (25.8%). Twenty-eight patients underwent RC, and three refused RC after evidence of clinical CR and received a redo transurethral resection of the bladder tumor (reTURBT). The trial met its primary end point: 10 patients (32.3%; 95% CI, 16.7 to 51.4) achieved an ypT0N0 response. By including those who underwent reTURBT, 22 (70.9%; 95% CI, 55 to 87) achieved an ypT≤1N0-x response. After a median follow-up of 12 months (range, 5-22), two patients had a disease relapse after surgery. The 12-month EFS was 89.8% (95% CI, 79.5 to 100). CONCLUSION: To our knowledge, the first results from NURE-Combo trial suggest that this combination could expand the therapeutic opportunities of immune-chemotherapy in patients with MIBC.

Background: In patients treated with partial nephrectomy, prior evidence showed that peri-operative outcomes, such as complications and ischemia time, improved as a function of the surgical experience of the surgeon, but data on functional outcomes after surgery are still scarce. Methods: We retrospectively analyzed data of 4011 patients with a single, unilateral cT1a-b renal mass treated with laparoscopic or robot-assisted partial nephrectomy. The operations were performed by 119 surgeons at 22 participating institutions between 1997 and 2022. Multivariable models investigated the association between surgical experience (number of prior operations) and acute kidney injury (AKI) and recovery of at least 90% of baseline estimated glomerular filtration rate (eGFR) 1 yr after partial nephrectomy. The adjustment for case mix included age, Body Mass Index, preoperative serum creatinine, clinical T stage, PADUA score, warm ischemia time, pathologic tumor size, and year of surgery. Results: A total of 753 (19%) and 3258 (81%) patients underwent laparoscopic and robot-assisted partial nephrectomy, respectively. Overall, 37 (31%) and 55 (46%) surgeons contributed only to laparoscopic and robotic learning curves, respectively, whereas 27 (23%) contributed to the learning curves of both approaches. In the laparoscopic group, 8% and 55% of patients developed AKI and recovered at least 90% of their baseline eGFR, respectively. After adjusting for confounders, we did not find evidence of an association between surgical experience and AKI after laparoscopic partial nephrectomy (odds ratio [OR]: 0.9992; 95% confidence interval [CI]: 0.9963, 1.0022; p = 0.6). Similar results were found when 1-year renal function was the outcome of interest (OR: 0.9996; 95% CI: 0.9988, 1.0005; p = 0.5). Among patients who underwent robot-assisted partial nephrectomy, AKI occurred in 11% of patients, whereas 54% recovered at least 90% of their baseline eGFR. On multivariable analyses, the relationship between surgical experience and AKI after surgery was not statistically significant (OR: 1.0015; 95% CI: 0.9992, 1.0037; p = 0.2), with similar results when the outcome of interest was renal function one year after surgery (OR: 1.0001; 95% CI: 0.9980, 1.0022; p = 0.9). Virtually the same findings were found on sensitivity analyses. Conclusions: In patients treated with laparoscopic or robot-assisted partial nephrectomy, our data suggest that the surgical experience of the operating surgeon might not be a key determinant of functional recovery after surgery. This raises questions about the use of serum markers to assess functional recovery in patients with two kidneys and opens the discussion on what are the key steps of the procedure that allowed surgeons to achieve optimal outcomes since their initial cases.

Hereditary renal cell carcinoma (H-RCC) accounts for 5–8% of kidney cancers and has important clinical implications. However, H-RCC is frequently underdiagnosed, and genetic counselling is underutilised in clinical practice. This review provides an overview of the main H-RCC syndromes and offers a step-by-step clinical guide to support clinicians in the identification, counselling, and management of affected individuals. A nonsystematic search of PubMed/MEDLINE was performed in June 2024 and updated in February 2025, covering guidelines, consensus statements, and original studies. Additional sources were identified via manual reference screening. Although H-RCC syndromes may present with overlapping features, they vary significantly in genetics, histology, and aggressiveness. While referral criteria for genetic testing in RCC are outlined in multiple international guidelines, certain criteria are still debated. Genetic counselling is essential both before and after testing. Pretest counselling ensures informed consent and helps patients to understand the implications of results. Post-test counselling discusses medical and psychological implications, and guides cascade testing for at-risk relatives. Mainstream genetic testing led by clinicians other than genetic specialists is increasingly adopted, but adequate training and structured collaboration with genetics services are required. Clinical management differs across syndromes: while aggressive entities such as FH-associated RCC warrant prompt surgical intervention, others such as clear-cell RCC associated with von Hippel-Lindau disease benefit from active surveillance, with nephron-sparing approaches typically recommended when the largest tumour reaches a threshold of 3 cm to balance oncological control and renal preservation. The main limitation of this review is its nonsystematic design. Genetic assessment is a key component of RCC management. Enhancement of clinician awareness and fostering of multidisciplinary collaboration are key to improving care and outcomes. For patients with kidney cancer, genetic risk assessment and testing are crucial for improving patient care, guiding surveillance, and offering tailored treatments to those who might have a hereditary form of cancer. Collaboration among different specialists is vital to provide the best care for patients with hereditary kidney cancer syndromes.

Article: Current management of patients affected by benign prostatic hyperplasia: a multi-institutional study from a contemporary large Italian cohort - Minerva Urology and Nephrology 2025 Feb 06 - Minerva Medica - Journals

Background: Localised renal cell carcinoma (RCC) is usually treated surgically, with post‐operative imaging‐based surveillance to monitor for recurrence. However, surveillance practices vary widely, and patients often lack a clear understanding of their risk of recurrence and follow‐up care. The PREDICT Kidney tool has been developed to enhance risk communication by providing individualised recurrence and mortality risk estimates. The tool uses the Leibovich score augmented with English national data to provide a personalised risk assessment of cancer recurrence and death from other causes, presented in both numerical and visual formats.Study Design: A multicentre, prospective feasibility study of incorporating the PREDICT Kidney risk communication tool into the first follow‐up consultation for localised RCC patients post‐surgery.Endpoints: Patient uptake into the study, completeness of data collection, consultation duration, the acceptability of the tool to both patients and clinicians, clinician adherence to the study “best‐practice” guide, variability in tool usage across clinicians and sites and patient‐level clinical outcomes including subjective and objective comprehension of risk of recurrence and follow‐up, perceived risk of cancer recurrence, risk conviction, satisfaction with the information provided on risk of recurrence and follow‐up, and fear of cancer recurrence.Patients and Methods: We aim to recruit 60 patients from three hospitals in England and Scotland. Patients treated with surgery for primary localised clear‐cell RCC awaiting their first follow‐up appointment will be invited to take part. Participants will be allocated into two groups: standard care and standard care supplemented with the use of the PREDICT Kidney tool. Data will be collected through questionnaires, audio/video recordings of consultations and interviews with a subset of patients and clinicians. The study period is planned from September 2024 to July 2025. The findings will guide the design of a future randomised controlled trial to evaluate the tool's efficacy in clinical settings.