Penile squamous cell carcinoma (PSCC) represents a malignancy with low incidence. Despite advances in chemotherapy-based management, outcomes for patients with locally advanced and metastatic disease remain poor, with 5-year survival rates of 51% and 9%, respectively. Early diagnosis is crucial, yet psychosocial/structural barriers often delay it. Treatment strategies are stage-dependent, ranging from organ-sparing surgery and targeted radiotherapy for early-stage disease to cisplatin-based chemotherapy for locally advanced and metastatic cases. However, systemic therapies provide modest survival benefits and can expose the patient to unnecessary toxicities. Immunotherapy has emerged as a promising area, given the high expression of PD-L1 in PSCC and the significant proportion of HPV-driven tumors. Although initial results from immunotherapy-based trials are limited, preliminary trials such as HERCULES, ALPACA, PULSE, and PERICLES aim to define their role better. Similarly, combination regimens utilizing toripalimab in combination with nimotuzumab and taxane-based chemotherapy (TNT) followed by consolidative surgery are currently underway. Furthermore, the development of therapeutic HPV vaccines offers a novel strategy to enhance local antitumor immunity. Antibody–drug conjugates (ADCs) targeting HER-2, Trop-2, and Nectin-4 antigens represent another evolving therapeutic avenue that has shown preliminary promising results. As the landscape of penile cancer treatment continues to grow, incorporating these novel strategies could further improve survival outcomes and/or offer improved quality of life. This review provides a comprehensive overview of emerging systemic therapies in PSCC, underscoring ongoing research efforts to address unmet needs.

Penile cancer is a rare malignancy, with approximately 2100 cases diagnosed annually in the United States. The 5-year overall survival rate varies significantly depending on the node involvement status, at 79% in node-negative disease versus 51% for patients with inguinal metastasis. Inguinal lymph nodes are involved in micrometastatic disease in up to one out of four patients. Early inguinal lymph node dissection (ILND) has been shown to provide a survival advantage, which is why many patients undergo inguinal lymph node dissection for diagnostic and therapeutic purposes. Unfortunately, ILND is associated with high morbidity rates, which have led to potential overtreatment and decreased quality of life in the penile cancer population. Several advancements have been made to mitigate these challenges, such as dynamic sentinel node dissection, modifications to the technique or surgical templates, the introduction of minimally invasive procedures, and changes to the postoperative pathway. This manuscript examines the evolution in managing the inguinal lymph nodes in penile cancer, its associated complications, and effective strategies for their prevention and management.

Introduction: Rerouting urine flow is often required following radical cystectomy (RC). In this context, the ileal conduit (IC) has become the most common technique for urinary diversion, primarily due to its technical simplicity and suitability for patients with compromised renal function, elderly individuals, and those unable to perform self-catheterization. Objective: This review aims to highlight the complications of IC and categorize them into metabolic and surgical complications, further subdivided by timing (intraoperative, short-term, intermediate-term, and long-term) and anatomical location (uretero-ileal anastomosis, stoma, and ileal segment). Methods: A comprehensive narrative review was conducted to summarize the most common complications of IC, their clinical presentation, and management using Google Scholar, PubMed, and Embase databases to identify studies published from 1950 to 2024. Results: The morbidity associated with IC, especially when compared to continent diversions, remains a subject of debate. Notably, IC-related complications have been described with an incidence rate ranging from 39% to 67%. Conclusions: Providing a comprehensive overview of IC complications and management strategies can enhance clinical practice and improve patient outcomes.

Introduction: Pelvic organ prolapse (POP) is a condition where weakened pelvic muscles allow pelvic organs to slip down and bulge through the vaginal canal; it affects 30% of women to varying degrees. ^{1 , 2} Around 300,000 surgeries are performed each year in the United States, accounting for 10–19% of women. ² This number is expected to increase given the aging population and improvements in quality of life. ² Unfortunately, these patients have a 15.9% risk of necessitating further re-intervention due to adverse effects or failure. ³ Abdominal sacrocolpopexy is the current gold standard repair for vaginal vault prolapse and includes the placement of a mesh. Polypropylene is the most popular synthetic materials. ^{4 – 6} Intraoperative risks such as presacral bleeding, injury to the urinary system, and postoperative complications account for 3–10% of cases. ^{7 , 8} This video showcases three cases of mesh-related complications along with their respective approaches and techniques. Methods: In this study, three cases of patients who underwent abdominal re-sacrocolpopexy in 2022–2024 by a single surgeon were collected. Surgical management was individualized and depended on the type of complication the patient had suffered. Case number 1 involved a 53-year-old woman complaining of pelvic organ prolapse recurrence. Case number 2 was a 75-year-old patient who presented with vaginal discharge and spotting. Case number 3 consisted of a fistula formation between the bladder and the vagina. Results: Successful robotic approaches were achieved in all three cases, resulting in the reduction of pelvic organ prolapse, abscess removal, and repair of the fistula, respectively. In the first case, surgery was tailored to remove the previous mesh and insert a new one, but the mesh was left in place with the intention of not compromising the patient’s recovery. Estimated blood loss was 60 cc, and operating time was 2 hours and 22 minutes. The patient was discharged 24 hours postoperatively with a urethral catheter and drain, which were both removed at 72 hours. In case number 2, the mesh was removed entirely. Estimated blood loss was 10 cc, operating time was 3 hours and 6 minutes, and the patient was discharged on day 5. Before sending the patient home, the Foley catheter, ureteral stent, and Blake® drain were removed. Successful evolution was achieved for up to 4 months following surgery. In the third case, the mesh was removed entirely. Conclusion: We have successfully demonstrated the feasibility of robotic re-do sacrocolpopexy along with its technical challenges, emphasizing its need when re-intervention is imminent. Awareness of complications is crucial for preventing them, correctly choosing the appropriate management, and ensuring proper follow-up. In addition, this study has shown that transvaginal mesh excision may not always be sufficient or appropriate, potentially causing increased distress and uncertainty in patients. Authors have received and archived patient consent for video recording/publication in advance of video recording of the procedure. Runtime of video: 8 mins 21 secs.

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Background/Objectives: Needle biopsy-based molecular assays that are sensitive, cost-effective, and reproducible could improve prostate cancer (PCa) diagnosis and risk stratification. We developed a compact, biologically informed gene expression signature panel (ONECUT2, EZH2, BRCA2) for cancer detection and aggressiveness stratification. Methods: We designed and validated a multiplex real-time RT-qPCR assay for ONECUT2, EZH2, and BRCA2. Biomarker selection was guided by The Cancer Genome Atlas Prostate Adenocarcinoma (TCGA-PRAD) and Gene Expression Omnibus (GEO) cohort analyses. The assay was applied to 979 ex vivo needle biopsy cores from 255 radical prostatectomy specimens; machine-learning models (Random Forest, AdaBoost, Elastic Net) generated an RNA signature. Diagnostic and prognostic performance was assessed by the area under the receiver operating characteristic curve (AUC), model comparisons by DeLong’s test, and biochemical recurrence-free survival (BCR) by Kaplan–Meier and Cox proportional hazards analyses. Reproducibility based on sample pairs was assessed by intraclass correlation coefficients (ICC). Results: The three-gene expression signature (ONECUT2, EZH2, and BRCA2) robustly discriminated malignant from non-malignant tissue (AUC = 0.91) and identified clinically significant cancer (Gleason Grade Group [GG] ≥ 2 vs. GG 0–1, AUC = 0.89) within biopsy cores. However, it had limited performance for advanced patient-level features (e.g., pathological GG3–5, AUC = 0.63). In contrast, ONECUT2 gene-body methylation significantly stratified pathological aggressiveness (pathological GG3–5, AUC = 0.79; aggressive disease, AUC = 0.75) and demonstrated superior assay stability (methylation ICC 0.58–0.70 vs. RNA ICC 0.38–0.61). Furthermore, ONECUT2 DNA methylation significantly stratified BCR-free survival (hazard ratio = 3.90, p = 0.023), whereas the RNA signature showed a modest trend (hazard ratio = 1.88, p = 0.053). Notably, integrating DNA methylation with the three-gene expression signature (combined model) significantly improved predictive accuracy for adverse features (e.g., extraprostatic extension, ΔAUC = 0.20, p = 0.02) compared to the three-gene expression signature alone. Conclusions: While a multiplex RT-qPCR panel (ONECUT2, EZH2, and BRCA2) excels at core-level cancer detection, it lacks the resolution for aggressiveness classification. In contrast, ONECUT2 DNA methylation provides superior analytical reproducibility, robust stratification of cancer aggressiveness, and long-term recurrence risk estimation. These findings suggest that integrating transcriptional and epigenetic markers into a multimodal framework could provide complementary information to refine risk stratification in PCa.