Bladder cancer (BC) is a common malignancy in the genitourinary system and the current theranostic approaches are unsatisfactory. Sensitivity and specificity of current diagnosis methods are not ideal and high recurrence and progression rates after initial treatment indicate the urgent need for management improvements in clinic. Nanotechnology has been proposed as an effective method to improve theranosis efficiency for both non-muscle invasive bladder cancer (NMIBC) and muscle invasive bladder cancer (MIBC). For example, gold nanoparticles (AuNPs) have been developed for simple, fast and sensitive urinary sample test for bladder cancer diagnosis. Nanoparticles targeting bladder cancers can facilitate to distinguish the normal and abnormal bladder tissues during cystoscopy and thus help with the complete removal of malignant lesions. Both intravenous and intravesical agents can be modified by nanotechnology for targeted delivery, high anti-tumor efficiency and excellent tolerability, exhibiting encouraging potential in bladder cancer treatment. Photosensitizers and biological agents can also be delivered by nanotechnology, intermediating phototherapy and targeted therapy. The management of bladder cancer remained almost unchanged for decades with unsatisfactory effect. However, it is likely to change with the fast-developed nanotechnology. Herein we summarized the current utility of nanotechnology in bladder cancer diagnosis and treatment, providing insights for the future designing and discovering novel nanoparticles for bladder cancer management. Graphical Abstract

The crosstalk between immunity and cancer in the regulation of tumor growth is considered a hallmark of cancer. Antitumor immunity refers to the innate and adaptive immune responses that regulate cancer development and proliferation. Tumor immune evasion represents a major hindrance to effective anticancer treatment. Extracellular vesicles (EVs) are nano‐sized and lipid‐bilayer‐enclosed particles that are secreted to the extracellular space by all cell types. They are critically involved in numerous biological functions including intercellular communication. Tumor‐derived extracellular vesicles (TEVs) can transport a variety of cargo to modulate immune cells in the tumor microenvironment (TME). This review provides the latest update about how tumor cells evade immune surveillance by exploiting TEVs. First, the biogenesis of EVs and the cargo‐sorting machinery are discussed. Second, how tumor cells modulate immune cell differentiation, activation, and function via TEVs to evade immune surveillance is illustrated. Last but not least, the novel antitumor strategies that can reverse immune escape are summarized.

The purpose of this review is to compare the effectiveness of SuperPulsed thulium fiber laser (SP TFL) and holmium:yttrium–aluminum–garnet (Ho:YAG) laser in lithotripsy, with the aim of evaluating the differences between the two in key indicators, such as lithotripsy efficiency and safety, and providing reference for clinical selection of better lithotripsy methods. By searching multiple authoritative medical databases (PubMed, Embase, and Web of Science databases) and including the results of relevant clinical studies and laboratory studies, the indexes involving SP TFL and Ho:YAG lasers in the included literature were analyzed. We found a total of 24 relevant pieces of literature. The laser parameters, such as ablation efficiency, ablation speed, operative time, dust quality, retropulsion, visibility, temperature safety, and stone-free rate, were compared between laboratory studies and clinical outcomes. Preclinical studies have shown that SP TFL has a higher rate of stone ablation, a weaker retropulsion and a lower risk of fiber breakage. The results of clinical studies showed that the two methods were comparable in the ablation rate, laser time and operative time, stone-free rate and complication. SP TFL offered better endoscopic view quality and less retropulsion. While the Ho:YAG laser remains the primary choice for endoscopic laser lithotripsy, the emergence of SP TFL offers a promising new option for the minimally invasive treatment of urinary calculi. Parameter range, retropulsion effect, laser fiber adaptability, and overall system performance demand comprehensive attention. SP TFL has a relatively short clinical application history, and further research is necessary to fully explore its long-term advantages, clinical significance, and possible limitations.

This study developed a novel technique for performing percutaneous nephrolithotomy (PCNL) in the knee-flexion prone split-leg (KF-PSL) position; this technique aimed to address the shortcomings of the traditional prone (TP) position and the PSL position. The study evaluated the safety, advantages, and feasibility of the KF-PSL position compared to the TP position. A novel technique was developed based on the common PSL position. A retrospective analysis was conducted on the data of 276 patients who underwent PCNL in either the KF-PSL or TP position between January 2022 and June 2023. Demographic and perioperative clinical data of the KF-PSL and TP groups were reviewed and compared. A total of 276 patients were divided into two groups based on the operative position. The preoperative parameters of the two groups did not differ significantly. The mean stone size (represented by the aggregation of the diameter of all the stones) was 40.03 (SD 23.89) mm. Significant differences were found in both the mean operative time (80.9 [SD 47.2] min in KF-PSL vs. 107.3 [SD 57.7] min in TP, p<0.001) and the stone-free rates (73% in KF-PSL vs. 61% in TP, p=0.046). Braden Scale scores of the two groups did not differ significantly (p=0.12). No significant difference was observed between the groups in the total complication rate (p=0.6). The KF-PSL is a promising modified position for PCNL that allows for a shorter operative time, a higher stone-free rate, and a more simplified surgical procedure compared to the TP position without compromising outcomes. It is more convenient for combined therapy, allowing access to the entire urinary tract without the need for position changes.

Background: The trifecta standard is a newly proposed criteria for evaluating the outcome of percutaneous nephrolithotomy, which take into account the capability of different PCNL techniques to fully clear renal stones and patient comfort and quality of life. Our purpose was to develop a novel nomogram to preoperatively predict the outcomes of percutaneous nephrolithotomy (PCNL) based on the new concept, trifecta. Methods: A total of 201 patients who received PCNL between June 2021 and June 2022 were included. The least absolute shrinkage and section operator (LASSO) method was used to select the optimal predictive features, and multivariable logistic regression analysis was utilized to construct a predictive model by incorporating the factors selected with the LASSO regression model. Discrimination, calibration, and clinical usefulness of the predictive model were assessed using the C-index, calibration plot, and decision curve analysis. Internal validation was assessed using bootstrapping validation. Result: Factors included in the nomogram were urine culture result, aciduria, maximum cross-sectional area (CSA) of stone, stone amount, stone density, number of affected calices, lower calyx affected, and hydronephrosis degree. The model exhibited promising discrimination with a C-index of 0.781, and internal validation exhibited a C-index value of 0.747. Decision curve analysis showed the nomogram was clinically useful when intervention was decided at the achieving trifecta possibility threshold of 14%. Conclusion: The nomogram developed exhibits a satisfactory predictive value for predicting the probability of achieving trifecta in patients undergoing PCNL. It may also assist in preoperative management to increase the probability of achieving trifecta. Trial registration: ChiCTR2200055385, June 2021, retrospectively registered.