Bladder cancer is the commonest malignancy of the urinary tract. In this review, we look at the latest developments in the diagnosis and management of this condition. Cystoscopy and urine cytology are the most important tools in the diagnosis and follow-up of bladder cancer. Various alternatives have been investigated, either to reduce the frequency of cystoscopy, or improve its sensitivity for detection of tumors. These include urine-based markers and point-of-care tests. Narrow-band imaging and photodynamic diagnosis/blue-light cystoscopy have shown promise in improving detection and reducing recurrence of bladder tumors, by improving the completion of bladder resection when compared with standard resection in white light. The majority of patients with a new diagnosis of bladder cancer have non-muscle-invasive bladder cancer, which requires adjuvant intravesical chemotherapy and/or immunotherapy. Recent developments in post-resection intravesical regimens are discussed. For patients with muscle-invasive bladder cancer, both laparoscopic radical cystectomy and robot-assisted radical cystectomy have been shown to reduce peri-operative morbidity, while being oncologically equivalent to open radical cystectomy in the medium term. Bladder-preserving strategies entail resection and chemoradiation, and in selected patients give equivalent results to surgery. The development, advantages, and disadvantages of these newer approaches are also discussed.

Objective: To determine whether to use ¹⁸ F ‐fluorodeoxyglucose positron emission tomography ( FDG PET ) scans in the preoperative staging of bladder cancer ( BC ). Patients and Methods: In all, 233 patients with muscle‐invasive BC ( MIBC ) or high‐risk non‐ MIBC being considered for radical cystectomy ( RC ) between 2005 and 2011 had FDG‐PET and computed tomography ( CT ) of the chest, abdomen and pelvis to assess for pelvic lymph node ( LN ) involvement or distant metastases. Sensitivity and specificity for detecting pelvic LN involvement was determined by comparing the results of the scans to the histopathology reports in patients undergoing RC . These parameters for distant metastases were determined from biopsy results or follow‐up imaging. In patients who did not undergo RC , follow‐up imaging was used to evaluate the sensitivity and specificity. Patients were excluded from analysis if they either had neoadjuvant chemotherapy or had <10 LNs removed at lymphadenectomy. Results: The PET scan was able to detect metastatic disease outside of the pelvis with a sensitivity of 54% compared with 41% for the staging CT ( N = 207). Both scans had similar specificities of 97% and 98%. There were 13 PET avid lesions not visualised on the corresponding staging CT scans. These proved to be metastatic BC (six patients), a synchronous primary colonic cancer (one), colonic adenomas (one), basal cell tumour of the parotid gland (one) and inflammatory lesions (four). The sensitivity and specificity of the CT scans for pelvic LN involvement was 45% and 98%, respectively ( N = 93). Using a combination of the PET and CT scan, the sensitivity for detecting metastatic disease in LNs increased to 69% with a 3% reduction in specificity to 95%. Conclusions: PET when used in conjunction with a standard CT scan provides a small improvement in preoperative staging of BC . However, this advantage is not significant enough to justify the additional cost. Hence we recommend use of dual imaging only in highly selected patients.

Objectives: To assess face, content and construct validity of the RobotiX Mentor virtual reality simulator, to assess its acceptability as a robotic surgery training tool and feasibility of its use, and to develop a supplementary training curriculum. Subjects and Methods: This prospective, observational and comparative study recruited novice (n=20), intermediate (n=15), and expert (n=11) robotic surgeons as participants from institutions across the United Kingdom and at the 30th European Association of Urology Annual Meeting. Each participant completed nine surgical tasks across two modules on the simulator, followed by a questionnaire to evaluate subjective realism (face validity), task importance (content validity), feasibility, and acceptability. Outcome measures of novice, intermediate, and expert groups were compared using Mann-Whitney U-tests to assess construct validity. Results: Construct validity was demonstrated in a total of 17/25 performance evaluation metrics (p2mm deep (p=0.033), average distance from suture target (p=0.015), and number of suture breakages (p=0.038). Participants determined both the simulator console and psychomotor tasks as highly realistic (mean: 3.7/5) and very important for surgical training (4.5/5), with system pedals (4.2/5) and knot tying task (4.6/5) scoring highest respectively. The simulator was also rated as an acceptable (4.3/5) tool for training and its use highly feasible (4.3/5). Conclusion: Construct, face, and content validity were established for the RobotiX Mentor and feasibility and acceptability of incorporation into surgical training was ascertained. The RobotiX Mentor shows potential as a valuable tool for training and assessment of trainees in robotic skills. Investigation of concurrent and predictive validity is necessary to complete validation and evaluation of learning curves would provide insight into its value for training.

Purpose: To report short- and medium-term oncological and functional outcomes of the first robotic-assisted laparoscopic radical cystectomy (RARC) series from the UK. Materials and methods: Thirty patients underwent RARC between 2004 and 2007 at our unit. We report oncological and functional outcomes of this procedure in 20 patients (17 ileal conduit and three Studer Pouches), who have completed at least 6 months of follow up. Results: There were 17 men and three women, median age 66 years (range 38–77 years). Median operating time was 330 min (range 295–510 min), and median blood loss 150 ml (range 100–1150 ml). There were two major complications (10%); a port site bleed and a rectal injury. The median follow up of this cohort is 23 months (range 7–44 months). One patient died of distant metastases at 8 months, and another developed a right ureteric tumour at 7 months. None of the patients had local pelvic or port site recurrence. The overall and disease-free survival are 95% and 90% respectively. Functional complications included a neovesico-urethral stricture at 3 months, a left upper ureteric stricture at 6 months and an incisional hernia at 12 months. Conclusion: Robotic-assisted laparoscopic radical cystectomy is an emerging minimally invasive procedure which at short- to medium-term follow up, in our experience, is oncologically and functionally equivalent to open radical cystectomy.