Bladder cancer (BCa) is one of the most diagnosed urological malignancies. A timely and accurate diagnosis is crucial at the first assessment as well as at the follow up after curative treatments. Moreover, in the era of precision medicine, proper molecular characterization and pathological evaluation are key drivers of a patient-tailored management. However, currently available diagnostic tools still suffer from significant operator-dependent variability. To fill this gap, physicians have shown a constantly increasing interest towards new resources able to enhance diagnostic performances. In this regard, several reports have highlighted how artificial intelligence (AI) can produce promising results in the BCa field. In this narrative review, we aimed to analyze the most recent literature exploring current experiences and future perspectives on the role of AI in the BCa scenario. We summarized the most recently investigated applications of AI in BCa management, focusing on how this technology could impact physicians’ accuracy in three widespread diagnostic areas: cystoscopy, clinical tumor (cT) staging, and pathological diagnosis. Our results showed the wide potential of AI in BCa, although larger prospective and well-designed trials are pending to draw definitive conclusions allowing AI to be routinely applied to everyday clinical practice.

Background and Objectives: To date, sparse evidence exists about the impact of inflammatory serum markers in predicting perioperative complications after radical cystectomy (RC) for bladder cancer (BC). Here, we evaluated the role of the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), systemic immune-inflammation index (SII), C-reactive protein (CRP), and plasma fibrinogen in predicting perioperative morbidity and unplanned 30-days readmission after RC for BC. Materials and methods: We relied on a collaborative database of 271 patients who underwent open RC for cT1-4a N0 M0 BC between January 2012 and December 2022. Univariable and multivariable binomial logistic regression analyses were performed to assess the odds ratio (OR) with 95% confidence intervals (CI) testing the ability of each serum marker to predict postoperative complications (any-grade and major complications), and 30-days unplanned readmission. Results: The median age at RC was 73 yr (IQR 67–79). A total of 182 (67.2%) patients were male and the median BMI was 25.2 (IQR 23.2–28.4). Overall, 172 (63.5%) patients had a Charlson Comorbidity Index (CCI) greater than 2 points and 98 (36.2%) were current smokers at the time of RC. Overall, 233 (86.0%) patients experienced at least one complication after RC. Of these, 171 (63.1%) patients had minor complications (Clavien–Dindo grade 1–2) while 100 (36.9%) experienced major complications (Clavien–Dindo grade ≥ 3). According to multivariable analysis, current smoking status, high plasma fibrinogen, and preoperative anemia were independently associated with major complications (OR 2.10, 95%CI 1.15–4.90, p = 0.02), (OR 1.51, 95%CI 1.26–1.98, p = 0.09), and (OR 1.35, 95%CI 1.17–2.57, p = 0.03), respectively. Overall, 56 (20.7%) patients experienced a 30-days unplanned readmission. According to univariable analysis, high preoperative CRP and hyperfibrinogenemia were significantly associated with an increased risk of unplanned readmission (OR 2.15, 95%CI 1.15–4.16, p = 0.02; OR 2.18, 95%CI 1.13–4.44, p = 0.02, respectively). Conclusions: In our study, the preoperative immune-inflammation signature described by NLR, PLR, LMR, SII, and CRP showed a low reliability in predicting perioperative course after RC. Preoperative anemia and hyperfibrinogenemia were independent predictors of major complications. Further studies are pending in order to draw definitive conclusions.

Sentinel node biopsy (SNB) for prostate cancer (PCa) represents an innovative technique aimed at improving nodal staging accuracy. The routinary adoption of this procedure in patients undergoing radical prostatectomy (RP) might be crucial to identify candidates who could effectively benefit from extensive pelvic lymph nodal dissection (ePLND). Despite some promising results, SNB for PCa is still considered experimental due to the lack of solid evidence and procedural standardization. In this regard, our narrative review aimed to analyze the most recent literature in this field, providing an overview of both the diagnostic accuracy measures and the oncological outcomes of SNB.

Background: This study aims to evaluate the safety and efficacy of prostatic artery embolization (PAE) in elderly, multimorbid patients with benign prostatic hyperplasia (BPH). Additionally, it seeks to identify technical and clinical factors that predict clinical failure at the mid-term follow-up. Methods: We analyzed the clinical records of 175 consecutive patients who underwent PAE. Technical success was defined as achieving embolization on at least one side. Safety was assessed using the Clavien–Dindo classification. The pre-procedural international prostate symptom score (IPSS), quality of life (QoL) score, prostate volume (PV), prostate-specific antigen (PSA), maximum urinary flow rate (Qmax), and post-void residual urine (PVR) were compared with values assessed at the follow-up evaluation. Clinical failure was defined as no improvement or worsening of lower urinary tract symptoms (LUTS) based on the IPSS at the follow-up evaluation. Univariate and multivariate regression models were applied to identify predictors of clinical failure. Results: 158 patients met the inclusion criteria. The median age was 74 years (68, 79), with a median ASA score of 2 (2, 3) and a Charlson comorbidity index (CCI) of 5 (4, 7). Follow-up assessments were carried out at a median of 12 months (0, 1). IPSS decreased by −5 points (−8, 0), QoL by −1 point (−1, 0), PV by −19 cc (−26, −8), PVR by −45 cc (−25 to −80), and PSA by −1.1 ng/mL (−2.5, −0.2) (p < 0.01); while Qmax improved by 4 mL/s (2, 6) (p < 0.01). A total of 44 patients (30.3%) experienced clinical failure, which was significantly correlated with unilateral embolization (p < 0.01). Multivariate regression analysis indicated that higher CCI, elevated PVR, and the use of larger microspheres were associated with poorer clinical outcomes, with odds ratios of 2.17 (95% CI: 1.4–3.38), 1.02 (95% CI: 1.01–1.03), and 26.83 (95% CI: 4.81–149.8), respectively (p < 0.01). Conclusions: PAE is a safe and effective treatment for elderly multimorbid patients with BPH. Comprehensive pre-procedural clinical assessment, incorporating the CCI and PVR, is essential to optimize treatment outcomes.

Fluorescence confocal microscopy (FCM) represents a novel diagnostic technique able to provide real-time histological images from non-fixed specimens. As a consequence of its recent developments, FCM is gaining growing popularity in urological practice. Nevertheless, evidence is still sparse, and, at the moment, its applications are heterogeneous. We performed a narrative review of the current literature on this topic. Papers were selected from the Pubmed, Embase, and Medline archives. We focused on FCM applications in prostate cancer (PCa), urothelial carcinoma (UC), and renal cell carcinoma (RCC). Articles investigating both office and intraoperative settings were included. The review of the literature showed that FCM displays promising accuracy as compared to conventional histopathology. These results represent significant steps along the path of FCM’s formal validation as an innovative ready-to-use diagnostic support in urological practice. Instant access to a reliable histological evaluation may indeed significantly influence physicians’ decision-making process. In this regard, FCM addresses this still unmet clinical need and introduces intriguing perspectives into future diagnostic pathways. Further studies are required to thoroughly assess the whole potential of this technique.