Introduction: Chest computed tomography (CT) is commonly obtained for initial staging of testicular cancer. Since pulmonary metastases are rare in the absence of retroperitoneal disease or elevated tumor markers, a selective imaging approach may be justified, as routine chest CT can lead to unnecessary radiation exposure to the thorax. Methods: We conducted a retrospective cohort study of men evaluated for a newly diagnosed testicular mass at a tertiary medical center between 2011 and 2025. According to institutional protocol, all patients underwent abdominal and chest CT prior to radical orchiectomy. A risk-stratified approach was then assessed, assuming that chest CT would have been omitted if both serum tumor markers and abdominal CT were negative for metastasis. The primary outcome was the false-negative rate for thoracic metastases among patients who would have been triaged to omit chest CT, and the key secondary outcome was the proportion of chest CT examinations that could have been avoided. Results: Among 183 eligible patients (mean age 34.3 ± 11.1 years), 174 (95.0%) had germ-cell tumors, including 107 (61.4%) seminomas. Chest metastases were identified in 10 patients (5.5%). Nine (90%) had positive tumor markers and seven (70%) had retroperitoneal nodal involvement. Using the prespecified rule (perform chest CT if either markers or retroperitoneal nodes were abnormal), no metastatic cases would have been missed, yielding sensitivity 100% (95% confidence interval [CI]: 69.2–100.0) and negative predictive value: 100.0% (95% CI: 95.7–100). Specificity was 48.0% (95% CI: 40.3–55.7), and application of the rule would have avoided 45.4% (95% CI: 38.0–52.9) of chest CTs. Conclusions: Integrating serum tumor markers with abdominal CT before deciding on chest CT may safely reduce radiation exposure without compromising diagnostic accuracy in the workup of men with a testicular mass. External validation is warranted before clinical implementation.

Purpose: To evaluate the effect of neoadjuvant chemotherapy (NAC) on short-term complications following robotic radical cystectomy (RRC). Methods: A retrospective review of 134 bladder cancer patients who underwent RRC. Perioperative outcomes were compared between patients who received NAC (nRRC) and those who underwent upfront RRC (uRRC). Primary outcome: 30-day Clavien-Dindo classification score of ⩾2 (CDC ⩾ 2). Secondary outcomes: 30-day infectious complications, readmission rates, postoperative ileus, blood transfusion, and mortality. Results: Of the 134 patients, 90 (67%) were in the nRRC group and 44 (33%) in the uRRC group. The total 30-day CDC ⩾ 2 complication rates and high-grade complications were comparable between the groups. Among the various outcomes assessed, only postoperative ileus showed a statistically significant difference, with lower rates in the nRRC (20% vs 38.4%, OR = 0.39, p = 0.021). Other outcomes, including 30-day readmission, infectious complications and blood transfusions, were similar. All four cases of 30-day mortality occurred in the nRRC group. Conclusion: NAC in the era of RRC was not associated with a statistically significant increase in overall perioperative complication rates in our cohort. NAC can likely be administered without a significant increase in perioperative complications, although confirmation in larger studies is warranted.

Introduction: Peyronie’s disease is a fibrotic disorder of the tunica albuginea that causes penile curvature and sexual dysfunction. Plication surgery is a standard treatment for men with preserved erectile function; however, non-absorbable sutures may lead to palpable and bothersome nodules. Objective: The aim of the study was to compare surgical and patient-reported outcomes between absorbable and non-absorbable sutures in penile plication surgery. Methods: This retrospective study included 48 patients who underwent plication surgery between 2013 and 2023 and completed long-term follow-up. Twenty-nine (60.4%) received absorbable sutures and 19 (39.6%) non-absorbable sutures. Mean follow-up was 8.4 ± 2.9 vs. 4.0 ± 1.2 years (p < 0.001). Primary outcomes were surgical success (no residual curvature) and bothersome nodularity, both self-reported. Univariate and multivariable logistic regression identified predictors of these outcomes. Results: Surgical success rates were comparable (62.1% vs. 63.2%; p = 0.94). Bothersome nodularity was significantly less frequent with absorbable sutures (6.8% vs. 36.8%; p = 0.02). On multivariable analysis, non-absorbable sutures remained the strongest predictor of bothersome nodularity (adjusted OR 18.0; 95% CI 1.36–642; p = 0.057), while no independent predictors of surgical success were identified. Conclusion: Absorbable sutures reduce bothersome nodularity without compromising surgical outcomes, suggesting improved postoperative comfort with comparable efficacy.