Purpose: Urinary bladder neoplasms are among the most prevalent urologic cancers. Historically, these tumors have been treated with conventional transurethral resection of bladder tumors (cTURBT), which has widely recognized limitations and potential complications. Accordingly, alternative approaches have been explored. In this study, we implemented low-power holmium laser en bloc resection of bladder tumors (HoEBRBTs) and evaluated its safety, effectiveness, and practicality. Materials and Methods: A total of 100 individuals participated in this observational study. Fifty individuals underwent low-power HoEBRBTs, and the remaining 50 underwent conventional TURBT. The study was approved by the institutional ethics committee, and written informed consent was obtained from all participants. Intraoperative and postoperative data were collected. Results: During TURBT, 10 patients experienced obturator reflex; no such events occurred in the holmium laser en bloc resection of bladder tumor (HoEBRBT) group. In the TURBT group, 2 patients had bladder perforations, whereas none occurred in the HoEBRBT group. One patient in the TURBT group required postoperative clot evacuation, and no patients in the HoEBRBT group required clot evacuation. The mean catheterization duration was 2.78±1.02 days in the TURBT group and 1.78±0.68 days in the HoEBRBT group. The mean hospital stay was 3.24±0.59 days in the TURBT group and 2.48±0.54 days in the HoEBRBT group. Detrusor muscle was present in 78% of specimens in the TURBT group and 92% of specimens in the HoEBRBT group. Conclusion For non–muscle-invasive bladder cancer, low-power holmium laser en bloc resection appears to be safe, with a low risk of complications. The higher rate of detrusor muscle-positive specimens suggests that the technique is feasible and effective.

DNA methylation is one of the most extensively characterized epigenetic alterations in cancer and provides a biologically stable, analytically tractable foundation for biomarker development. In genitourinary (GU) oncology, the early occurrence, clonal maintenance, and chemical stability of aberrant cytosine-phosphate-guanine methylation enable reliable detection in tissue, urine, and plasma, supporting its use in liquid biopsybased diagnostics and surveillance. Recent advances have enabled clinical evaluation of DNA methylation assays across multiple GU malignancies. Among these, urothelial carcinoma has progressed furthest toward clinical translation: urine-based methylation tests have demonstrated high diagnostic accuracy and reproducibility and, in selected settings, have achieved regulatory approval or guideline incorporation for surveillance. In renal cell carcinoma, genome-wide plasma and urine methylome profiling has shown feasibility for early detection and prognostic stratification, although clinical implementation remains investigational. In prostate cancer, tissue-based methylation assays support repeat-biopsy decision-making, whereas urine- and plasma-based tests contribute to detection of clinically significant disease, molecular subtyping, and treatment-response monitoring. Despite strong analytical performance, broad clinical adoption of DNA methylation biomarkers remains constrained by limited prospective validation, interlaboratory variability, and incomplete evidence of cost-effectiveness in real-world care pathways. Economic modeling suggests that these assays could reduce invasive procedures and surveillance costs, but these findings require confirmation in prospective studies. Given the accessibility of urine as a noninvasive biospecimen and ongoing integration with machine-learning and multiomic frameworks, DNA methylation profiling is well positioned to complement conventional diagnostics and advance precision detection, surveillance, and prognostication in GU cancers.

Purpose: Radiotherapy (RT) remains a cornerstone of curative treatment for localized and locally advanced prostate cancer. However, dose escalation to improve tumor control is often constrained by the proximity of the rectum, which increases the risk of gastrointestinal (GI) and genitourinary toxicities. Biodegradable rectal spacers inserted between the prostate and rectum have emerged as an effective approach to reduce rectal radiation exposure. This guideline provides evidence-based recommendations on indications, contraindications, procedural standards, and clinical management for biodegradable rectal spacer insertion during prostate cancer RT. Materials and Methods: This guideline was developed by a multidisciplinary expert panel through a systematic review of the literature, analysis of international guidelines (National Comprehensive Cancer Network, European Association of Urology, American Society for Radiation Oncology), and expert consensus among radiation oncologists, radiologists, and urologists with clinical experience in spacer insertion. The strength of each recommendation and the level of evidence were classified according to the modified GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) system. Results: Spacer insertion is conditionally recommended (Grade C, Level I) for patients receiving definitive external-beam RT without rectal invasion. It reduces the high-dose rectal irradiation volume (V70–75) by >50%, decreases acute GI toxicity, and helps maintain bowel-related quality of life. However, the benefit for late severe toxicity (grade 2 or higher) remains debated in recent meta-analyses. Contraindications include rectal invasion, anatomical inaccessibility, infection, and material hypersensitivity. Procedures should be performed under local anesthesia in a sterile environment by trained physicians. Short-course antibiotics and simulator-based training, including completion of multiple supervised cases, are advised. Conclusion Biodegradable rectal spacer insertion is clinically validated and effective in reducing acute rectal toxicity. Although pivotal trials demonstrated a favorable procedural safety profile, real-world postmarket data include reports of rare but severe procedural complications. This guideline provides standardized recommendations tailored to Korean clinical practice while remaining consistent with international standards, emphasizing the importance of operator training and careful patient selection.

Purpose: Complications associated with retroperitoneal lymph node dissection (RPLND) have primarily been described from single-center data. These historical single-center studies often lack standardized reporting preventing combined cohort analysis. Therefore, we describe and discuss the complications associated with RPLND from a prospectively maintained, validated, national database. Materials and Methods: The National Surgical Quality Improvement Program (NSQIP) database was queried for 30-day postoperative complications following RPLND for testicular cancer from 2005–2018, which comprised the cohort for analysis. Complications were subcategorized by organ systems and by Clavien-Dindo classification grade (I–II [low], III–V [high]). A subanalysis of large (>5 cm) retroperitoneal masses was evaluated as a surrogate for postchemotherapy RPLND. Associations with patient and perioperative variables were analyzed with logistic regression. Results: A total of 375 patients met inclusion criteria. Seventy-four patients (19.7%) experienced at least one postoperative complication for a total of 125 complications. The median hospital length of stay was 5 (interquartile range, 4–7) days. Hospital readmission occured in 32 patients (8.5%). There were 52 patients (13.9%) who underwent RPLND for large masses, with a 34.6% complication rate. The most common organ system complications included blood transfusions (11.7%), wound dehiscence/infection (4%), and pulmonary (2.3%). The majority of complications were of low Clavien-Dindo classification grade (12% vs. 3.5%). On univariable analysis, smoking, disseminated cancer, steroid use, older age, low albumin, low hematocrit, low platelet counts, and longer operative times were significantly associated with the occurrence of any complication. Smoking, low hematocrit, and longer operative times remained significant on multivariable analysis. Conclusion In the NSQIP database, complication rates following RPLND are predominantly of low Clavien-Dindo classification grade and are higher than some previously published single-center series. Increased rates were associated with smoking, unfavorable preoperative blood counts, and longer operative times.

Purpose: Radical cystectomy (RC) is associated with substantial postoperative morbidity, and unplanned readmission remains common despite advances in perioperative management. However, the association between postoperative readmission due to complications and oncologic outcomes after RC for bladder cancer has not been clearly defined. We evaluated the impact of postoperative readmission on overall survival (OS) and cancer-specific survival (CSS) after RC for bladder cancer. Materials and Methods: We retrospectively analyzed 3,972 patients who underwent RC for bladder cancer in a multicenter cohort. Postoperative readmission was defined as unplanned hospitalization within 90 days postsurgery due to surgery-related complications. Survival outcomes were assessed using the Kaplan-Meier method and compared using the log-rank test. Univariable and multivariable Cox proportional hazards regression analyses were performed to identify independent predictors of OS and CSS. Results: Among the study population, 916 patients (23.1%) experienced postoperative readmission. Baseline and perioperative characteristics were generally comparable between patients with and without readmission. Kaplan-Meier analyses demonstrated significantly worse OS and CSS among patients who experienced postoperative readmission (both log-rank p<0.001). In multivariable analyses adjusting for clinicopathological factors, postoperative readmission remained independently associated with worse OS (hazard ratio [HR], 1.654; 95% confidence interval [CI], 1.464–1.868; p<0.001) and CSS (HR, 1.761; 95% CI, 1.509–2.055; p<0.001). Conclusion Postoperative readmission within 90 days after RC was independently associated with inferior long-term oncologic outcomes. These findings suggest the importance of strategies aimed at preventing postoperative complications and subsequent readmission.

Purpose: This study evaluated the feasibility of radical nephrectomy and thrombectomy without cardiopulmonary bypass (CPB) in patients with renal cell carcinoma (RCC) and level IV venous tumor thrombus, compared with CPB-assisted surgery. Materials and Methods: This retrospective cohort study analyzed patients with RCC and level IV venous tumor thrombus who underwent surgery at a single center between 2014 and 2020. Feasibility of non-CPB surgery was assessed by comparing perioperative safety-related outcomes, overall survival (OS), and progression-free survival (PFS) between the non-CPB and CPB groups. Perioperative outcomes included operative time, blood loss, severe complications (Clavien-Dindo classification grade ≥III), intensive care unit (ICU) stay, and mortality. Kaplan-Meier analysis and generalized Wilcoxon tests were used to compare survival outcomes. Results: A total of 16 patients met eligibility criteria: 5 underwent surgery without CPB, and 11 underwent CPB-assisted surgery. Median operative time was similar between the CPB and non-CPB groups (490 minutes vs. 480 minutes, p=0.650). Compared with the CPB group, blood loss was lower in the non-CPB group (4000 mL vs. 1080 mL, p=0.333). Severe complications occurred in 36.4% of CPB patients and 0% of non-CPB patients (p=0.245). ICU stay was comparable between the non-CPB and CPB groups (2 days vs. 3 days, p=0.356). OS did not differ significantly between groups (p=0.180), whereas PFS was longer in the non-CPB group (p=0.041). Conclusions Radical nephrectomy and thrombectomy without CPB appears feasible and may be associated with lower perioperative morbidity and blood loss without compromising oncologic outcomes. Non-CPB surgery should be considered in selected patients with level IV venous tumor thrombus when technically feasible.

Purpose: Kidney cancer mortality in the United States exhibits persistent racial, ethnic, and geographic disparities, yet regional patterning of these disparities over time remains incompletely characterized. We conducted a retrospective analysis using national mortality data to examine differences in kidney cancer mortality between U.S. Mexico border and non-border regions from 2000 through 2020. Materials and Methods: Death records were obtained from CDC WONDER, and kidney cancer deaths were identified using ICD 10 code C64 as the underlying cause of death. We evaluated C64 to C65 in sensitivity analyses, including C65 separately. We compared demographics, age adjusted mortality rates, and temporal trends by border residence. Multivariable logistic regression assessed demographic patterning of deaths across regions, and Joinpoint regression evaluated changes in age adjusted mortality trends over time. Results: A total of 279,117 kidney cancer related deaths were recorded nationally. Hispanic decedents were disproportionately represented among border state deaths (22.9% vs 2.8% in non-border states). Border states accounted for 67.4% of Hispanic C64 deaths. Age distribution and racial composition of decedents differed between border and non-border regions (all p<0.001). In multivariable analyses, Hispanic ethnicity was strongly associated with border state residence among decedents, independent of age and race. Joinpoint regression identified multiple periods of change in mortality trends, with statistically significant increases in non-border regions and less precise segment estimates in border regions. Conclusion Kidney cancer deaths among Hispanic decedents show substantial geographic concentration in U.S. Mexico border states. These findings support surveillance strategies and interventions that incorporate geographic context in efforts to reduce kidney cancer mortality disparities.

Purpose: Prostatic extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma) is an exceptionally rare malignancy that often mimics benign prostatic conditions. Its nonspecific symptoms and the frequent absence of abnormalities on prostate-specific antigen (PSA) testing or digital rectal examination contribute to delayed or incidental diagnosis. This review summarizes the published literature on prostatic MALT lymphoma and integrates an illustrative case from our institution. Materials and Methods: A PubMed literature search was conducted on 29 November 2025 using predefined free-text terms related to prostatic MALT lymphoma. Human studies published in English were included. A total of 24 articles were screened, of which 10 met eligibility criteria. Given the rarity of the condition and heterogeneity across reported cases, a narrative synthesis was performed. One case from Hospital Professor Doutor Fernando Fonseca was analyzed separately and incorporated into the results. Results: A total of 25 patients were identified. Clinical presentation was dominated by lower urinary tract symptoms, and nearly half of reported PSA values were within the normal range. Histology consistently demonstrated centrocyte-like B-cell infiltrates with variable lymphoepithelial lesions and a characteristic CD20-positive/BCL2-positive immunophenotype. Most patients presented with localized Ann Arbor stage I disease. Local therapies, including transurethral resection of the prostate or radiotherapy, achieved durable complete remissions, whereas systemic chemotherapy was reserved for disseminated disease. The illustrative case showed typical features of localized prostatic MALT lymphoma and achieved complete remission after low-dose radiotherapy, remaining disease-free at 9 months. Conclusion Prostatic MALT lymphoma is an indolent but highly treatable malignancy when recognized early. Awareness of its nonspecific presentation and characteristic histopathologic profile is essential for timely diagnosis. Organ-preserving treatment strategies offer excellent outcomes in localized disease.

Purpose: Androgen deprivation therapy (ADT) is widely used to treat prostate cancer (PC). However, ADT has been associated with various adverse events (AEs) affecting the liver and kidneys. We aimed to evaluate the risk of liver- and kidney-related AEs after ADT. Materials and Methods: This retrospective cohort study used data from the National Health Insurance Database of Korea from 2007 to 2022 and included patients diagnosed with PC between 2013 and 2017. Patients who received ADT were matched 1:1 with those who did not using propensity score matching in the liver and kidney cohorts. Cox proportional hazards models were used to estimate adjusted hazard ratios (HRs) and 95% confidence intervals (CIs). Results: The study included 9,877 and 16,834 patients in the liver and kidney cohorts, respectively. The risk of hepatitis was higher among ADT users (adjusted HR [aHR], 1.27; 95% CI, 1.04–1.54), and the risk was even greater among patients aged ≥70 years (aHR, 1.37; 95% CI, 1.09–1.72). Longer ADT duration was associated with an increased risk of hepatitis (aHR, 1.32; 95% CI, 1.06–1.65). ADT use was not significantly associated with the risk of acute kidney injury (AKI) or chronic kidney disease (CKD) (AKI: aHR, 1.22; 95% CI, 0.92–1.64; CKD: aHR, 1.16; 95% CI, 0.97–1.38). Conclusion In patients with PC, ADT, particularly when used for an extended duration, was associated with an increased risk of hepatitis, but not with kidney-related AEs. Close monitoring for liver AEs is recommended in patients undergoing long-term ADT.