Background: Accurate staging of prostate cancer (PCa) is essential for determining the appropriate treatment and predicting outcomes. This study is comparing the effectiveness of Gallium‐68 Prostate‐Specific Membrane Antigen Positron Emission Tomography/Computed Tomography (Ga‐68 PSMA PET/CT) and multiparametric MRI (mpMRI) in preoperative locoregional staging and localizing PCa.Methods: A retrospective analysis was conducted on 78 patients who underwent both mpMRI and Ga‐68 PSMA PET/CT scans before surgery. The imaging was reviewed by radiologists and nuclear medicine specialists and compared with the final histopathology, which was reviewed by an experienced uropathologist.Results: mpMRI demonstrated higher sensitivity in detecting extraprostatic extension (EPE) and bladder neck invasion (BNI) compared to Ga‐68 PSMA PET/CT (83% vs. 44% and 29% vs. 17%, respectively). Conversely, Ga‐68 PSMA PET/CT showed higher sensitivity in detecting seminal vesicle invasion (SVI) and lymph node metastasis (LNM) (75% vs. 55% and 50% vs. 30%, respectively). When both methods were combined, sensitivity increased in detecting both EPE and SVI. The index tumor localization in mpMRI and Ga‐68 PSMA PET/CT was found to be in complete agreement with histopathological findings at 36.4% and 41.8%, respectively. When both imaging methods were combined, the agreement with histopathology in predicting index tumor localization reached 72.1%.Conclusion: Both mpMRI and Ga‐68 PSMA PET/CT provide valuable and complementary information for tumor localization and locoregional staging. While mpMRI showed higher sensitivity in detecting EPE, Ga‐68 PSMA PET/CT demonstrated superior performance in detecting LNM and SVI. The combined use of these imaging modalities enhance accuracy of index tumor localizations.

Postchemotherapy retroperitoneal lymph node dissection (PC-RPLND) plays an important role in the management of advanced germ cell testicular tumors. Bilateral template lymph node dissection is considered a standard treatment in postchemotherapy residual masses; however, modified unilateral templates have gained acceptance in patients with unilateral residual disease. In this study, we aimed to demonstrate the perioperative and oncological outcomes of the patients with advanced testicular cancer who underwent unilateral modified template PC-RPLND in our center. This is a retrospective study in which patients who underwent PC-RPLND in a referred center between 2004 and 2021 were investigated. All patients had three or four cycles of chemotherapy and retroperitoneal residual masses. Data were retrospectively collected from medical, operative, radiology, and pathology records and analyzed. A total of 57 patients underwent PC-RPLND. The mean age was 32.7±8.1 years (19-50). According to the disease stage at presentation, there were 39 patients with stage 2 and 18 patients with stage 3. The average tumor size after chemotherapy was 57.6±2.7 mm (25-117). The overall complication rate was 35% (20/57 patients). No grade 4 and 5 complications were observed. Pathologic review demonstrated the presence of teratoma in 28 (49.1%) patients, fibrosis and/or necrosis in 15 (26.3%) patients, and viable germ cell tumor in 14 (24.5%) patients. The mean follow-up was 69.4 months (8-201). During follow-up after surgery, 14 (24.5%) deaths occurred due to advanced disease. PC-RPLND is a major component of the management of advanced testicular germ cell cancer. Our study demonstrated that modified unilateral template is an effective and safe procedure in the postchemotherapy setting for selected patients.

OBJECTIVE: Wound dehiscence is associated with high morbidity and mortality. This study aimed to analyze the risk factors and comorbidities in the patients undergoing radical cystectomy with early postoperative wound dehiscence.METHODS: In all, 539 patients with bladder cancer who underwent radical cystectomy and urinary diversion at a single center between January 2008 and January 2022 were included in the study. The data related to the demographics, medical history, and perioperative clinical features were reviewed. Univariate and multivariate regression analysis was performed to identify risk factors for wound dehiscence.RESULTS: The mean age of the patients was 64.2 years (22-91). The mean body mass index was 26.4 kg/m2 (18.7-35.4). Wound dehiscence was observed in 43 (7.9%) of 539 patients. The patients with wound dehiscence had significantly higher mean BMI (27.8 vs. 26.3, p=0.006), ASA scores (p=0.002), history of chronic obstructive pulmonary disease (30.2 vs. 14.3%, p=0.006), diabetes mellitus (44.2 vs. 17.9%, p=0.003), previous abdominal surgery (18.6 vs. 7.7%, p=0.014), and postoperative ileus (58.1 vs. 16.9%, p=0.006). In the multivariable regression model, diabetes mellitus (odds ratio [OR] 4.9, 95%CI 2.3-10.1; p<0.001), postoperative ileus (OR 8.1, 95%CI 4.1-16.5; p<0.001), and chronic obstructive pulmonary disease (OR 2.6, 95%CI 1.2-5.7; p=0.013) were independent predictors of abdominal wound dehiscence following radical cystectomy. CONCLUSION: Diabetes mellitus, chronic obstructive pulmonary disease, and postoperative ileus were strongly associated with abdominal wound dehiscence following radical cystectomy. Both potential preventive and therapeutic interventions may decrease the risk of wound dehiscence.

Objective: The coronavirus disease 2019 (COVID-19) pandemic disrupted all routine health care services and resulted in a significant reconfiguration of urologic cancer services and care pathways across the globe. This study aimed to retrospectively determine the pandemic’s impact on the urologic oncological surgery outcomes at a high-volume referral center. Materials and methods: We compared the number and histopathological outcomes of urologic oncological procedures in a referral center coded during the pandemic and data of the period before the pandemic as control. Data were extracted from patient files and hospital records. The pathological examination included a complete histopathological staging according to TNM stage. Results: A total of 683 patients were included in the study, 424 (62%) of which were operated in the pre-pandemic period. There was a 39% decline in urologic oncological surgical activity in the pandemic, mostly in renal and prostate cancer. The mean tumor size was larger in renal cancer patients who underwent surgery during the pandemic (5.6 cm vs 4.5 cm, p=0.002). During the pandemic, more lymph node involvement was seen after radical cystectomy and prostatectomy (50% vs 27.8%, p=0.024 and 12.5% vs 4.5%, p=0.026, respectively). No differences in terms of main pathologic features were observed in patients undergoing radical orchiectomy. Conclusion: COVID-19 appeared to adversely effect oncologic outcomes in patiens undergone surgery for prostate and bladder cancer. Tumor development induced by a delay in diagnosis may cause severe consequences for patients. Reprioritizion of non-deferrable urologic oncological seems crucial.

Prostate cancer (PCa) remains a leading cause of cancer-related mortality among men. Although prostate-specific antigen (PSA) is a key biomarker, its diagnostic and prognostic limitations necessitate the identification of novel markers. Urotensin-2 (UT-2), a potent vasoactive peptide, has been implicated in the pathogenesis of several malignancies, but its role in prostate cancer remains underexplored. This study aimed to evaluate plasma UT-2 levels across disease stages in PCa and assess its potential as a biomarker for metastatic disease. This cross-sectional study included 147 male patients: 100 with metastatic PCa and 47 controls (comprising benign prostatic hyperplasia [BPH], localized, and locally advanced PCa). Plasma UT-2 levels were quantified using ELISA. Statistical analyses included analysis of variance, Kruskal–Wallis, and receiver operating characteristic (ROC) curve analysis to assess UT-2’s discriminative ability and its correlation with clinical parameters such as Gleason score, ISUP grade, and PSA. UT-2 levels were significantly elevated in metastatic PCa patients (mean: 2.03 ± 0.91 ng/mL) compared to control groups (BPH: 1.42 ± 0.61 ng/mL; localized: 1.46 ± 0.71 ng/mL; locally advanced: 1.41 ± 0.76 ng/mL; P = .002). ROC analysis demonstrated a moderate discriminatory ability for metastasis (AUC = 0.70, 95% CI: 0.61–0.79), with a cutoff of 1.269 ng/mL yielding 81% sensitivity and 53% specificity. No significant associations were observed between UT-2 levels and Gleason score, ISUP grade, PSA levels, or metastatic site. This is the first clinical study to evaluate plasma UT-2 levels in PCa patients. Elevated UT-2 levels in metastatic cases, independent of traditional prognostic markers, suggest its potential utility in identifying systemic disease burden. While not suitable as a standalone diagnostic tool, UT-2 may serve as a complementary biomarker within a multiparameter panel to improve prognostication and risk stratification in PCa. Further prospective and longitudinal studies are warranted to validate its prognostic significance.

Introduction: Iatrogenic ureteral injuries following ureterorenoscopic (URS) stone surgery are significant complications that can occur despite the preserved structure of the urinary tract. This study aimed to evaluate the demographic characteristics, types of injuries, timing of diagnosis, and outcomes of treatment methods in patients with iatrogenic ureteral injury after URS. Materials and Methods: Patients with iatorogenic ureteral injury during URS were included based on retrospective data collected from 19 centers across Turkey between November 2010 and December 2022. Demographics, location, and grade of injury, time of diagnosis, and success rates of endourological or reconstructive surgical interventions were analyzed. Surgical success was defined as the absence of postoperative complications and no need for further surgical intervention. Results: Of the 105 patients, 65 were males and 40 females, with a median age of 48 years (20–86). Injuries occurred in the distal ureter in %60, mid-ureter in %18.1, and proximal ureter in %21.9 of cases. Laceration accounted for %64.7 of the injuries, whereas %35.3 occurred during laser use. Diagnosis was made intraoperatively in %21 and postoperatively in %79 of patients, with a median time to postoperative diagnosis of 30 days (1–720). Higher body mass index was associated with lower primary surgical success ( p = 0.049). The most common initial treatment was ureteral stent placement. Reconstructive surgeries had lower rates of secondary interventions or complications compared to endourological procedures ( p = 0.045). Among patients necessitating a second surgery, those who underwent reconstructive surgery had significantly lower tertiary intervention or complication rates ( p < 0.001). Nephrectomy was required in six patients because of renal atrophy. Conclusion: Early diagnosis is crucial in iatrogenic ureteral injuries after URS. Elevated BMI may negatively affect surgical outcomes. Although endourological approaches are commonly used initially, reconstructive surgeries offer more durable outcomes, especially in severe injuries or failed primary treatments, underscoring the need for individualized management strategies.