Objective: Diagnostic ureterorenoscopy is used to identify upper tract urothelial cancer before radical nephroureterectomy, especially for uncertain lesions in imaging modalities or urine cytology. However, diagnostic ureterorenoscopy can potentially cause intravesical tumor spillage and can increase intravesical recurrence rates. We aimed to investigate the impact of diagnostic ureterorenoscopy before radical nephroureterectomy, with and without biopsy, on intravesical recurrence rates of patients with upper tract urothelial cancer. Material and methods: Patients with localized upper tract urothelial cancer from 8 different tertiary referral centers, who underwent radical nephroureterectomy between 2001 and 2020, were included. Three groups were made: no URS (group 1); diagnostic ureterorenoscopy without biopsy (group 2); and diagnostic ureterorenoscopy with biopsy (group 3). Intravesical recurrence rates and survival outcomes were compared. Univariate and multivariate Cox regression analyses were performed to determine the factors that were associated with intravesical recurrence-free survival. Results: Twenty-two (20.8%), 10 (24.4%), and 23 (39%) patients experienced intravesical recurrence in groups 1, 2, and 3, respectively (P=.037) among 206 patients. The 2-year intravesical recurrence-free survival rate was 83.1%, 82.4%, and 69.2%, for groups 1, 2, and 3, respectively (P=.004). Cancer-specific survival and overall survival were comparable (P=.560 and P=.803, respectively). Diagnostic ureterorenoscopy+biopsy (hazard ratio: 6.88, 95% CI: 2.41-19.65, P < .001) was the only independent predictor of intravesical recurrence in patients with upper tract urothelial cancer located in the kidney, according to tumor location. Conclusion: Diagnostic ureterorenoscopy+biopsy before radical nephroureterectomy significantly increased the rates of intravesical recurrence in tumors located in kidney. This result suggests tumor spillage with this type of biopsy, so further studies with different biopsy options or without biopsy can be designed. Cite this article as: Culpan M, Cakici MC, Keser F, et al. Biopsy with ureterorenoscopy before radical nephroureterectomy is associated with increased intravesical recurrence in urothelial cancer located in the kidney. Turk J Urol. 2022;48(6):431-439.

Acute scrotal pain due to testicular vein thrombosis is a rare condition. Thrombosis is defined as clot formation within the blood vessels and as a result, it interrupts the blood supply of the peripheral organs. In routine urology practice, the incidence of thromboembolic diseases is <1%, and it is mostly encountered in patients at the postoperative period. Nevertheless, testicular vein thrombosis should also be remembered in the differential diagnosis of patients admitted to the emergency department due to acute scrotum. In general, conservative treatment is the first choice in treatment management, but surgical intervention may also be required in some cases. Since the available data on this subject are based on the information obtained from case reports, a standard treatment approach should be developed by examining the current treatment methods. We aim to present the case report of testicular vein thrombosis in the light of the literature, which is one of the rarely seen emergencies of urology. Keywords: acute pain; color doppler ultrasonography; venous thrombosis; testicular diseases

Background/Objectives: Adherent perinephric fat (APN) is common in laparoscopic partial nephrectomy (LPN). It is absent from the lists of recognised positive surgical margin (PSM) predictors. We tested whether APN is associated with PSM risk and whether the effect varies by resection technique. Methods: We analysed 401 International Society of Urological Pathology (ISUP)-gradable renal cell carcinomas (31 PSM events; chromophobe RCC was excluded from the primary cohort because the WHO/ISUP grade is not assignable) carried out at three centres by eight surgeons from 2013 to 2024. Nested logistic models added APN, then an APN × enucleation interaction, to a guideline-based covariate set (tumour size, ISUP grade ≥ 3, cT1b stage, centre fixed effects, surgeon-documented enucleation). Firth penalisation and a 2000-replicate bootstrap were used to limit small-sample bias; they cannot add information beyond the 31 observed events. Results: APN was an independent PSM predictor (adjusted odds ratio [OR] 2.68, 95% confidence interval [CI] 1.21 to 5.95, p = 0.02). The effect was technique-conditional: APN × enucleation interaction OR 7.83 (95% CI 1.08 to 56.92, p = 0.04), consistent in direction across estimators but imprecise in magnitude. PSM occurred in 29.4% of APN-positive enucleation cases (odds ratio 10.21, 95% CI 2.07 to 50.30; Fisher exact p = 0.003), against 5.0% in enucleoresection and 10.8% in resection. Conclusions: In this cohort the APN-to-PSM association was technique-conditional. The penalty concentrates in enucleation; the rim-retaining strata gave estimates compatible with both no association and clinically important harm (OR 0.99 and 1.96, both intervals wide). Because the interaction rests on few margin events and the technique was not randomised, this finding is hypothesis-generating: when APN is encountered intraoperatively, retaining a parenchymal rim (enucleoresection or resection) rather than enucleation may be considered, pending prospective validation.