Renal artery pseudoaneurysm may develop after laser flexible ureteroscopy stone lithotripsy (FURSL). Typical symptoms include flank pain, persistent hematuria, delayed refractory anemia, or hemorrhagic shock in case of pseudoaneurysm rupture. This complication of laser FURSL is very rare with only five cases reported in the literature as of April 2023, of which one involved Thulium laser. We report the case of a 65-year-old man with recurrent renal lithiasis who underwent FURSL using Thulium fibered laser (TFL) for 8 mm stone of left kidney upper pole. Persistent hematuria developed postoperatively, secondary to a pseudoaneurysm from a segmental branch of the left renal artery. It was diagnosed on arteriography performed for sudden hemorrhagic shock 27 days after surgery. Selective embolization with metallic micro-coils resolved hematuria. Although laser FURSL is often uncomplicated and TFL is regarded as safe, this complication should be suspected when refractory hematuria or hemodynamic instability follows the procedure. We report this case to add support to the current literature and outline procedural risk factors and useful precautions during the procedure.

Prostate cancer (PCa) diagnosis has historically relied on the prostate-specific antigen (PSA) testing. Although the screening significantly reduces mortality rates, PSA has low specificity with risks of overdiagnosis and overtreatment. These limitations highlight the need for a more accurate diagnostic approach. Emerging technologies, such as artificial intelligence (AI), novel biomarkers, and advanced imaging techniques, offer promising avenues to enhance the accuracy and efficiency of PCa diagnosis and risk stratification. This narrative review comprehensively analyzed the current literature, focusing on new tools aiding PCa diagnosis (AI-driven image interpretation, radiomics, genomic classifiers, biomarkers, and multimodal data integration) with consideration for technical, regulatory, and ethical challenges related to clinical implementation of AI-based technologies. A literature search was performed using the PubMed and MEDLINE databases to identify relevant peer-reviewed articles published in English using the search terms “prostate cancer,” “artificial intelligence,” “machine learning,” “deep learning,” “MRI,” “histopathology,” and “diagnosis.” Articles were selected based on their relevance to AI-assisted diagnostic tools, clinical utility, and performance metrics. In addition, a separate section was developed initially to contextualize the limitations of current PSA-based screening approaches. The reviewed studies showed that AI had significant utility in prostate mpMRI interpretation (lesion detection; Gleason grading) with high accuracy and high reproducibility. For the pathologist, AI-driven algorithms improve the diagnostic accuracy of digital slide evaluation for histologic diagnosis of prostate cancer and automated Gleason score grading. Genomic tools such as the Oncotype DX test, combined with AI, could also allow for tailored and individualized risk prediction. Overall, multimodal models integrating clinical, imaging, and molecular data often outperform traditional PSA-based strategies and reduce unnecessary biopsies. Transition from PSA-centered toward AI-driven, biomarker-supported, and image-enhanced diagnosis marks a critical evolution in PCa diagnosis.

Primary urethral carcinoma (PUC) is a rare disease with frequent nodal metastasis at the time of diagnosis. Few risk factors have been established and overall prognosis remains poor. As of now, no clear therapeutic guidelines are established and management of advanced PUC often involves surgery which can have negative functional and psychological outcomes for the patient. Few authors have already reported the use of chemoradiotherapy alone to avoid surgery with some good short-term results. We report the case of a 48-year-old woman with advanced high-grade urothelial carcinoma of distal urethra associated to bilateral inguinal nodal metastasis. She was similarly and successfully treated using chemoradiotherapy exclusively without significant adverse effects. This experience reinforces benefits of a surgery-sparing management, when possible, as recommended in current guidelines.

Seminal vesicle cystadenomas (SVC) are exceedingly rare benign tumors, with only 22 cases reported in the literature up to 2018. Here, we present the case of a 40-year-old man who presented with acute urinary retention secondary to a giant pelvic mass. Radiological imaging diagnosed a retrovesical well-delimited multicystic tumor, initially suspected to arise from the left lobe of the prostate but ultimately confirmed to originate from left seminal vesicle. Despite inconclusive biopsy results and normal tumor markers, surgical removal was recommended to confirm diagnosis. The patient initially opted for conservative management but eventually underwent open surgery due to the tumor's significant enlargement on the follow-up imagery. The procedure, though challenging due to the mass's size and proximity to adjacent structures, was successfully completed with minimal blood loss and uncomplicated postoperative phase. Histopathological evaluation confirmed the diagnosis of SVC, marking the largest reported case of its kind and the first to be discovered upon investigation of an acute urinary retention. This case highlights importance of considering SVC in the differential diagnosis of pelvic masses and underscores the role of imagery and surgery together for definitive diagnosis.

Percutaneous coronary intervention is generally safe, but rare complications such as guidewire fracture can occur and may lead to thrombosis, embolism, vessel injury, or myocardial ischemia. We report the case of a 58-year-old male patient with 2-vessel coronary artery disease who underwent coronary stenting of the left anterior descending and circumflex arteries in another institution. During the index procedure, the guidewire fractured at the bifurcation between the left anterior descending artery and the first diagonal branch. One week later, the patient presented at our institution with recurrent chest pain and a second procedure was performed to retrieve the retained fragment. Real-time intravascular ultrasound imaging was used to visualize the fragment and perform targeted retrieval using a gooseneck snare introduced into the vessel. The fragment was successfully removed without altering the stent position, with uneventful follow-up. This case highlights that real-time IVUS visualization can modify procedural strategy for such complication by improving localization of retained intravascular material and allow safer percutaneous retrieval compared with fluoroscopy alone, potentially reducing the need for surgical intervention.