To evaluate recurrence rates and functional outcomes after drug-coated balloon (DCB) dilation (Optilume®) compared to standard endoscopic treatment in patients with posterior urethral stenosis. In this retrospective cohort study, we evaluated postoperative outcomes of patients who underwent either DCB dilation or standard endoscopic treatment for posterior urethral stenosis (vesicourethral anastomotic stenosis and bladder neck contracture). Recurrence-free survival (RFS) was recorded. Multivariate analysis was conducted to identify factors leading to improved RFS. Additionally, functional outcomes were analysed in the DCB group. A total of 141 patients were included in the study. Of these, 65 underwent DCB dilation, while 76 received standard treatment. Cohorts were matched in age, initial treatment and history of radiotherapy (each p>0.05). Patients treated with DCB demonstrated significantly improved RFS compared to standard treatment group (p=0.013). Multivariate analysis confirmed treatment modality as a significant predictor of RFS (HR 0.40, 95% CI 0.19-0.87, p=0.021). Functional analysis in the DCB group showed a reduction in post-void residual volume (55 mL vs. 0 mL, p<0.001) and an increase in maximum urinary flow rate (Qmax: 9 mL/s vs. 22 mL/s, p=0.001). In conclusion, this study demonstrates that Optilume® DCB dilation may be an effective treatment option for posterior urethral stenosis. These findings support the continued study of DCB as a promising, minimally invasive and safe alternative for managing posterior urethral stenosis. Long term studies including standardized follow-up intervals and parameters are warranted to validate these results and assess durability beyond the follow-up period.

Objective: To provide a comprehensive review, analysis and critique of guidelines from various oncological and urological organisations regarding the use pelvic lymph node dissection (PLND) in men undergoing radical prostatectomy (RP) for primary treatment of prostate cancer (PCa). Methods: PubMed, Google Scholar and the official webpages of major urological and oncological societies were searched for PCa guidelines. Guidelines were assessed for recommendations and opinions regarding the use of PLND. A total of 15 guidelines were identified and included for this review. Results: There is consensus amongst guidelines that an extended template (ePLND), is the preferred templated when PLND is to be undertaken. The majority of guidelines acknowledge the lack of proven oncological benefit from PLND, and that the largest benefit is from improved staging information. However, there is significant divergence between the guidelines about which patients should undergo PLND. Some guidelines advocate for the abandonment of PLND altogether, whilst others adopt a risk‐stratified approach, suggesting that patients should be offered PLND based on nomograms or clinical risk stratification. Conclusion: Whilst ePLND is recommended by some guidelines for select patients undergoing RP, it remains a contentious topic with significant discordance between guidelines regarding patient selection. Given the lack of proven oncological benefit and significant morbidity from the procedure, careful selection is required. It is uncertain as to how pathological findings on PLND will change management given recent trends towards salvage rather than adjuvant radiotherapy, and improved preoperative staging with prostate‐specific membrane antigen‐positron emission tomography/computed tomography.

Background/Objectives: Accurate preoperative discrimination between benign and malignant testicular masses remains challenging. Lesion size has been suggested as a predictor, but robust cutoffs and the role of contralateral biopsy remain uncertain. Methods: We retrospectively analyzed a prospectively maintained single-center database of 387 patients treated for testicular lesions between December 2013 and November 2024. Patients with malignant non-germ cell histologies or prior systemic GCT therapy were excluded. Lesion size was evaluated as a predictor of malignancy using ROC analysis, logistic regression, and predefined cutoffs (5, 8, 10, 15 mm). Associations between contralateral biopsy results and clinical variables were assessed using uni- and multivariable analyses. Results: Of 387 patients, 284 (73.4%) had malignant GCTs. Malignant lesions were significantly larger than benign ones (median 25.0 vs. 5.5 mm, p < 0.001). Lesion size showed good discrimination between benign and malignant lesions (AUC 0.829, 95% CI 0.784–0.874), with a Youden-derived optimal cutoff of 12.5 mm. Internal bootstrap validation (2000 resamples) yielded a median optimal cutoff of 12.5 mm (95% percentile interval 7.45–19.5 mm), indicating uncertainty regarding the exact threshold. Among 360 patients with complete clinical and tumor-marker data, combining lesion size with age, AFP, β-HCG, and LDH significantly improved discrimination compared with lesion size alone (AUC 0.863 vs. 0.818; DeLong p = 0.003). Contralateral biopsy was performed in 249 patients, with 7 (2.8%) positive for GCNIS. Younger age was associated with contralateral GCNIS, while tumor size, serum markers, and histology were not predictive. Multivariable analysis showed no significant predictors. Conclusions: Lesion size is a strong predictor of malignant histology, although the optimal size threshold remains subject to uncertainty. Combining lesion size with readily available clinical and biochemical parameters may further improve preoperative risk stratification. Contralateral GCNIS was rare and not reliably predicted, supporting individualized biopsy strategies.