Urethral strictures significantly impact patients’ quality of life, with endoscopic treatments such as direct vision internal urethrotomy (DVIU) and dilatation showing high recurrence rates. Drug-coated balloon (DCB) treatment, which delivers paclitaxel locally after dilation, is an innovative, minimally invasive approach aimed at reducing fibrosis and stricture recurrence. Paclitaxel’s antiproliferative and antifibrotic properties inhibit excessive collagen deposition, improving long-term outcomes. DCB treatment is now included in guidelines for managing recurrent bulbar strictures less than 3 cm in length. Recent studies, including the ROBUST trials, have demonstrated the efficacy of Optilume in improving the International Prostate Symptom Score (IPSS) and maximum urinary flow rate (Qmax). DCB has also shown a significant reduction in reintervention rates compared with endoscopic treatments in long-term studies, confirming its safety profile. However, the durability of DCB in complex or longer strictures remains uncertain, and its role as a salvage therapy post-urethroplasty requires further investigation. DCB represents a promising, cost-effective advancement in managing recurrent bulbar urethral strictures, particularly for patients unsuitable for urethroplasty. Future research should focus on refining patient selection criteria and exploring indications for other anatomical sites.

Lung carcinoma management secondary to chronic lymphocytic leukemia could be quite challenging. We report a case of a 60-year-old male with several co-morbidities, who presented with shortness of breath and persistent cough. A chest imaging showed a right pleural effusion and complete white-out of the right chest cavity. A computed tomography scan revealed consolidation of the right upper lobe with a 6-cm lesion in hilum with complete occlusion of right lobe bronchus. The patient underwent a video-assisted thoracoscopic surgery, drainage of pleural effusion and pleural and lung biopsy. Talc pleurodesis as well as a flexible bronchoscopy of the endobronchial lesion was performed. Histopathological examination showed a small B-cell lymphoma of the right pleura and an invasive non-small cell carcinoma of the right lung. Dual neoplasms are challenging in terms of diagnosing, and they usually require a multidisciplinary team for the right treatment strategy, including surgery and chemotherapy.

Introduction: Upper tract urothelial carcinoma is a rare disease with variable prognosis depending on the stage and grade at diagnosis. Current modalities are far from perfect in diagnosis and risk stratification. In this setting, there is an urgent need for diagnostic and prognostic biomarkers to overcome these limitations. Methods: We carried out a narrative review of the literature searching for research articles on diagnostic and prognostic biomarkers for upper tract urothelial carcinoma (UC) and underlined the limitations of current diagnostic modalities. Results: CT urogram (CTU) is the imaging modality of choice in suspected upper tract UC with sensitivity and specificity exceeding 90% but with limitations in smaller lesions. Urine cytology has an excellent specificity for high-grade UC but is limited by low sensitivity leading to a high number of diagnostic ureteroscopies with significant associated risks. Adjuncts such as Fluorescence In Situ Hybridization (FISH) technology and urine DNA methylation markers have shown promising results but need further validation in large cohorts of upper tract UC. Finally, circulation tumour DNA (ctDNA) is a novel approach with great potential in risk stratification and monitoring of minimal residual disease post radical surgery; however, larger prospective studies are required to validate its role similarly to the recent bladder UC trials. Conclusions: There is an urgent need for non-invasive biomarkers that can reliably replace diagnostic ureteroscopies, identify high-risk/invasive disease and select patients for radical surgery or kidney sparing procedures.