This study aimed to understand clinical pathways for patients with high-risk non-muscle-invasive bladder cancer (HR-NMIBC) from diagnosis to follow-up and to identify opportunities to improve care. A cross-sectional survey was conducted via structured online interviews with consented NHS healthcare professionals (HCPs) from the United Kingdom (UK) between June and September 2025. Topics surveyed included MDT structures/roles, diagnostic timelines, adjuvant treatment, radical cystectomy (RC) decision making, current bladder-sparing treatment and clinical trial access. Quantitative data were analysed descriptively. Qualitative responses were analysed thematically. Seventy HCPs were included and reported that typically; 88.5% of patients achieve diagnosis within 6-8 weeks of referral, and 11.4% reported delays beyond 8 weeks. BCG maintenance duration and completion rates varied. Following BCG induction, a median (IQR) of 20.0% (5.0-32.5%) and 60.0% (40.0-70.0%) of patients completed ≥2 or ≤1years of maintenance, respectively; 1.0% (1.0-2.0%) failed to complete induction. For BCG-unresponsive HR-NMIBC, HCPs reported that a mean (SD) proportion of 53.4 (18.1)% of patients tend to be eligible for and consent to RC, 22.0 (12.6)% tend to be eligible but decline RC and 24.6 (14.9)% tend to be ineligible. Bladder-sparing options remain limited, with 60% of HCPs regarding further BCG as the most appropriate option. All respondents agreed that adherence to quality performance indicators (QPIs) and a national bladder cancer audit would be beneficial. Insufficient specialist nurse capacity to meet foreseeable demands of HR-NMIBC patient care was reported by 70% (n = 49) of HCPs. Results reveal variability in real-world HR-NMIBC care within the NHS. Delays in diagnosis, inconsistent BCG maintenance duration, lack of evidence-based alternatives to BCG and a lack of bladder-sparing treatment and trial options in the BCG-unresponsive setting were identified. Findings highlight unmet needs in relation to MDT resourcing, diagnostic efficiency, trial access, QPI adherence and a national bladder cancer audit.

Treatment of upper tract urothelial carcinoma (UTUC) depends on risk stratification and tumour characteristics. Kidney-sparing surgery (KSS) is preferred for low-risk disease, whereas radical nephroureterectomy (RNU) is the standard for high-risk UTUC. Intravesical recurrences (IVR) are common after both treatment modalities, but their impact on survival remains unclear. To assess the IVR rate and cumulative hazard following UTUC treatment and oncological outcomes based on the presence of IVR during follow-up. Second, the relation between UTUC and IVR tumour grade in patients treated with endoscopic KSS (eKSS). A single-centre study, including non-metastatic UTUC patients treated between 2010 and 2023. Analysis was performed in a cohort of patients without a history of bladder cancer. In total 164 patients were selected; 85 treated with eKSS, 79 by RNU. Overall, 91 patients (55%) developed an IVR, 53 (62%) after eKSS and 38 (48%) after RNU, during a median follow-up of 33 months (IQR 11-72). eKSS-treated patients showed a significantly higher cumulative hazard for IVR (HR 0.6, 95% CI 0.42-0.95, p = 0.02). The CSS and MFS were comparable between patients with or without IVR during follow-up. In patients treated by eKSS, we found IVR upgrading in 24% of patients treated with eKSS. Patients treated by eKSS showed a higher cumulative hazard of IVR, without an impact on oncological outcomes. These findings support the use of kidney-sparing approaches in well-selected cases and highlight the need for proper follow-up including the bladder and evaluate IVR preventive measures as intravesical instillations.

Isolated retroperitoneal lymph-node (RPLN) recurrence after radical nephrectomy (RN) for renal cell carcinoma (RCC) is uncommon, and optimal management remains undefined. This study reports contemporary outcomes of retroperitoneal lymph-node dissection (RPLND) for isolated nodal recurrence, including in patients previously treated with stereotactic ablative body radiotherapy (SABR) or systemic therapy. A retrospective review was performed of all patients undergoing RPLND for isolated nodal recurrence of RCC between July 2023 and October 2024. Clinical, operative, and pathologic variables were collected, and postoperative complications were graded using the Clavien-Dindo system. Recurrence-free survival (RFS) was calculated from RPLND to recurrence or last follow-up. Eight patients met inclusion criteria. Median age at RPLND was 59.5years, and six were male. The median interval from RN to RPLND was 29 months. Median operative time was 255 min, estimated blood loss 300 mL, and hospital stay 6.5days. One patient experienced postoperative complication (Clavien-Dindo IIIa). All specimens confirmed malignancy with negative margins. After a median follow-up of 18 months, three patients (37.5%) recurred, with a mean RFS of 15.3months. RPLND is a safe and viable option for isolated nodal recurrence of RCC, offering complete resection and oncologic outcomes comparable to historical data, and may serve as an important component of multimodal management.

To evaluate the incidence and predictive factors of early penile prosthesis (PP) infection within a contemporary regional cohort in the North of England. A retrospective review of all PP implantations was conducted at a tertiary urology and andrology centre between 2018 and 2025, with variables including age, BMI, smoking, relevant comorbidities, pre-operative HbA1C, immunosuppressant use and device-related variables. Data were analysed using SPSS v29, with univariate logistic regression performed to identify factors of early infection (≤30 days). A p-value < 0.05 was considered statistically significant. A total of 103 patients underwent PP implantations. Mean age at implant was 59.4 ± 9.9years. The comorbidity burden of diabetes, hypertension and dyslipidaemia was 35.0%, 49.5% and 39.8%, respectively, with mean pre-operative HbA1C at 45.6mmol/mol. Notably, 9.7% of patients were on chronic immunosuppressive therapy. Early prosthetic infection was identified in six patients (5.8%). On univariate analysis, there was a strong association between immunosuppressant use and infection (50.0% vs 7.2%, p = 0.02; OR 12.0, 95% CI 1.7-85.0). The variables of age, BMI, diabetes, hypertension, dyslipidaemia, HbA1C and implant type were not associated with infection. In this contemporary regional study, early PP infection was identified in 5.8% of the cohort, with chronic immunosuppressant use being the dominant predictor of infection. Other metabolic, clinical and implant factors were not predictive of infection. This demonstrates immunosuppression being a persistent biological vulnerability requiring risk stratification and targeted perioperative strategies. Larger, prospective multicentre studies are required to further validate its impact and inform evidence-based infection-prevention protocols.

This study aimed to externally validate the European Association of Urology (EAU) biochemical recurrence (BCR) risk stratification in a North American population after radical prostatectomy (RP) and radiation therapy (RT), where validation remains lacking despite prior European and Asian validation. We identified all patients with BCR after RP or RT between 1995 and 2023 from a North American institutional database and classified them by EAU criteria. Primary outcome was prostate cancer-specific mortality (CSM). We calculated Harrell's concordance indices (C-index) and used competing-risk regression to assess associations between EAU risk groups and CSM, comparing performance to multivariable models including age, clinical stage, Gleason grade, PSA doubling time and time to BCR. Among the 940 patients (646 RP, 294 RT; 40.5% African American), 563 (59.9%) had low-risk and 377 (40.1%) high-risk BCR. The 10-year cumulative incidence of CSM was 3.6% versus 12% for low-risk versus high-risk RP patients and 18.4% versus 49.5% for low-risk versus high-risk RT patients. EAU high-risk BCR was associated with increased CSM in both groups (RP: HR 2.83, 95% CI 1.47-5.46; RT: HR 3.98, 95% CI 2.43-6.53). The EAU classification showed moderate discrimination (Harrell's C-index 0.62 for RP, 0.69 for RT). Multivariable models including clinical variables demonstrated a Harrell's C-index of 0.76 for both RP and RT. This first North American validation confirms moderate EAU discriminative ability. For RP patients, low 10-year CSM in low-risk BCR (3.6%) supports surveillance. However, low-risk RT BCR showed substantial CSM (18.4%), exceeding high-risk RP (12%), suggesting current criteria inadequately stratify risk after RT.

ObjectivesThis study aimed to evaluate the potential of plasma‐based proton magnetic resonance spectroscopy (1H‐MRS) for non‐invasive discrimination between clear cell renal cell carcinoma (ccRCC), benign renal masses (angiomyolipoma and oncocytoma) and healthy controls by identifying disease‐specific metabolic signatures.Patients and MethodsWe performed 1H‐MRS metabolic profiling of human plasma samples from 30 individuals divided into three cohorts: ccRCC (n = 10, all biopsy‐confirmed, nonmetastatic T3 tumours), benign renal masses (n = 10, angiomyolipoma or oncocytoma) and healthy controls (n = 10). Multivariate and univariate statistical analyses were conducted to evaluate group separation and identify differentially abundant metabolites. Metabolite set enrichment analysis was used to identify significantly perturbed metabolic pathways associated with each state.ResultsWe observed altered metabolic plasma profiles in ccRCC patients compared to normal controls and benign patients. We detected significantly increased concentrations of hydroxybutyrate (normal vs. ccRCC, p = 0.008), glucose (normal vs. ccRCC, p = 0.020), (benign vs. ccRCC, p = 0.009), creatinine (normal vs. ccRCC, p = 0.015), (benign vs. ccRCC, p = 0.014) in ccRCC patients' plasma compared to normal controls and benign renal masses plasma. We also found that acetate and myoinositol were significantly elevated in benign (normal vs. benign, p = 0.0002) and ccRCC (normal vs. ccRCC, p = 0.0001) plasma compared to normal controls plasma. Pathway enrichment analysis revealed alterations in fatty acid biosynthesis, amino acid metabolism, nitrogen handling and glycolysis‐related pathways consistent with ccRCC‐associated metabolic reprogramming.ConclusionThis pilot study demonstrates that plasma 1H‐MRS can detect metabolic alterations associated with ccRCC and benign renal masses. These findings support the feasibility of using metabolomic profiling as a non‐invasive diagnostic tool for renal mass characterization. Larger validation studies are warranted to confirm diagnostic accuracy and explore utility in clinical decision‐making.

ObjectivesThis study aims to investigate the impact of high‐grade complications (i.e., Clavien‐Dindo Classification [CDC] Grade ≥III) on quality of life (QoL) and psychosocial distress (PD) in the early period after radical cystectomy (RC) and urinary diversion.Patients and MethodsThe study relied on prospectively collected data of patients undergoing 3 weeks of inpatient rehabilitation (IR) after RC and urinary diversion (ileal conduit [IC] or ileal neobladder [INB]) between 04/2018 and 12/2019. Patients were surveyed on QoL (EORTC QLQ–C30) and PD (QSC–R10) by validated questionnaires at the beginning and the end of IR. Information about complications before the start of IR was taken from the hospital discharge letters and patient interview.ResultsOverall, 842 patients were enrolled. High‐grade complications occurred in 25.5% of patients. Men (27.4% vs. 17.6%, p = 0.011) and patients with an INB (28.9% vs. 22.6%, p = 0.037) were significantly more susceptible to high‐grade complications. At the beginning of IR, health‐related QoL (HRQoL), role and social functioning were significantly lower in patients with a high‐grade complication. Both HRQoL and the proportion of patients with high PD improved significantly during IR (p < 0.001, respectively). A multivariable linear regression analysis identified high‐grade complications to significantly impact HRQoL (p = 0.013). Meanwhile, age (p = 0.001), INB (p = 0.019) and high‐grade complications (p = 0.01) significantly contributed to PD.ConclusionHigh‐grade complications after RC and urinary diversion significantly impair short‐term QoL and PD, warranting constant physical and psychosocial monitoring.

ObjectiveThis study aimed to investigate whether a machine‐learning model improves the assessment of postsurgical recurrence‐free survival in patients with non‐metastatic clear cell renal cell carcinoma (ccRCC) compared with a Cox proportional hazards (CPH) approach.Patients and MethodsPatients undergoing curative surgery for non‐metastatic ccRCC between 2010 and 2018 were identified from the DaRenCa Study‐3, a nationwide register‐based cohort study. Three recurrence prediction models were developed: an extreme gradient boosting (XGBoost) model, a feature‐matched CPH model and a pathology‐based CPH model. The data set was divided into training and test cohorts. Missing data were addressed using multiple imputation for the CPH models, whereas XGBoost handled missing values inherently. Model performance was evaluated using the concordance index (C‐index) with 1000 bootstrap resamples. The XGBoost model was also compared with the Leibovich nomogram.ResultsAmong 2782 patients, with a median follow‐up of 7.3 years, 13.7% developed a recurrence. In the test cohort, the XGBoost model showed higher discrimination than both CPH models. Compared with the best performing pathology‐based CPH model, XGBoost demonstrated a paired bootstrap difference in Uno's C‐index of 0.022 (95% CI 0.005–0.038). The model also identified a subgroup of patients with a very low risk of recurrence (<3% after 10 years) and demonstrated improved clinical risk stratification, with clearer separation between risk groups, higher hazard ratios between groups and larger differences in 5‐year recurrence‐free survival compared with established models. This improved risk stratification could reduce follow‐up imaging by approximately 11% compared with current EAU guideline recommendations. Limitations include the retrospective design and lack of external validation.ConclusionThe XGBoost model provided improved prediction of recurrence compared with CPH models and the Leibovich nomogram, supporting more precise risk stratification. With external validation, this approach may help reduce unnecessary imaging after surgery.

ObjectivesTo investigate the potential of the Haematuria Cancer Risk Score (HCRS) to improve the real‐world investigation pathway for suspected bladder cancer.Materials and methodsData were retrospectively analysed for all consecutive patients referred with suspected urinary tract cancer on a faster diagnostic pathway to five UK institutions between January and April 2025. The HCRS cut‐off score of ≥82 was used to define a ‘HCRS high risk’ population. The co‐primary outcomes were the ability to calculate HCRS in the referred population from the information provided by primary care and the cancer detection rate.ResultsIn total, 1944 referrals were received, median age of 71 years (IQR 61–78), 1186/1944 (61%) were male, and 1586/1944 (82%) had sufficient information to calculate the HCRS. Of the cohort with HCRS scores, overall 165/1586 (10%) had bladder cancer. The HCRS was ≥82 in 176/437 (40%) of those with non‐visible haematuria (NVH); in total, 6/176 (3%) had bladder cancer; and using HCRS in the NVH group alone, no case of muscle‐invasive bladder cancer (MIBC) would have been missed. The HCRS was ≥82 in 1062/1149 (92%) with visible haematuria (VH), of whom 150/1062 (14%) had bladder cancer. Adopting a strategy of using HCRS and upper tract imaging in combination for the whole cohort would have resulted in two cases of NMIBC being missed for the NVH cohort and one case of NMIBC being missed for the VH cohort. No cases of MIBC or upper tract urothelial cancer would have been missed.ConclusionHCRS is a simple innovation, which demonstrates clear potential when combined with upper tract imaging to improve current UK risk stratification to determine which patients referred with haematuria need flexible cystoscopy.

IntroductionUrethroplasty remains the gold standard treatment of recurrent urethral stricture disease (USD). While the literature extensively discusses urethroplasty outcomes in various contexts, there remains a need for focussed exploration into its efficacy, specifically in cases arising from transurethral resection of the prostate (TURP)‐related strictures.ObjectivesTo evaluate and compare different anterior urethroplasty techniques and their effectiveness in a large homogenous cohort of USD secondary to TURP.Materials and methodsA multicentre retrospective cohort study was conducted in three reconstructive urology centres in Poland, which are the referral centres for USD repair. This included patients who underwent urethral reconstruction surgery between 2015 and 2022 because of urethral stricture secondary to TURP. In all patients, the stricture was diagnosed and evaluated prior to urethroplasty by retrograde urethrography and/or voiding cystourethrography. Basic demographic and medical data including the length and localisation of the stricture, as well as details about performed urethral reconstruction and follow‐up data regarding the recurrence of the stricture and reintervention were recorded. The primary outcome was re‐intervention‐free survival after urethroplasty. Statistical analysis was performed using STATA 18 (StataCorp).ResultsOne hundred forty‐seven patients underwent urethroplasty because of recurrent anterior USD secondary to TURP with a mean age of 69 years. Ninety‐nine patients (67%) had a bulbar stricture, 35 (24%) had a penile urethra stricture, while 13 patients (9%) were diagnosed with penobulbar stricture. The mean length of the stricture was 24 mm, and it was significantly different among different localisations (penile – 30 mm, bulbar – 16 mm, penobulbar – 67 mm; p < 0.05). Half of the patients (73–50%) were treated with anastomotic urethroplasty (including transecting and non‐transecting techniques), 60 (41%) with augmentation urethroplasty, seven (5%) with substitution urethroplasty and seven (5%) underwent perineal or penile urethrostomy. Follow‐up data were available for 138 patients (94%). In the median follow‐up of 19.5 months, 19 patients (13.8%) had another procedure because of the recurrence of USD. Longer stricture length was independently associated with an increased risk of recurrence. Around 103/120 patients (85.8%) were overall satisfied with the treatment.ConclusionsUSD secondary to TURP can present with various clinical manifestations, with short bulbar strictures being the most common location. The outcomes of urethroplasty are highly favourable, resulting in high levels of patient satisfaction, but do not depend on surgical technique.