Urologic Oncology-seminars and Original Investigations最新文献

{"title":"CDKL1 facilitates tumorigenesis and metastasis of bladder urothelial carcinoma by activating SIRT1/Wnt/β-catenin signaling.","authors":"Huajun Tan, Yun Zhang, Yongqi Long, Linfei Shu, Guoqiu Zheng, Yuqi Li, Xiangmeng Yi, Lei Chen, Zhijun Han, Fan Yang","doi":"10.1016/j.urolonc.2026.08.004","DOIUrl":"https://doi.org/10.1016/j.urolonc.2026.08.004","url":null,"abstract":"<p><p>Bladder urothelial carcinoma (BUC) is a common malignancy characterized by high recurrence and progression, and patients with advanced disease often have poor outcomes due to therapeutic resistance and limited targeted treatment options. In this study, we investigated the role of cyclin-dependent kinase-like 1 (CDKL1) in BUC progression. CDKL1 was markedly upregulated in BUC tissues, and elevated CDKL1 expression was significantly associated with unfavorable patient survival. Functional assays demonstrated that CDKL1 depletion suppressed BUC cell proliferation, migration, and invasion in vitro and inhibited tumor growth in vivo. Mechanistically, CDKL1 interacted with sirtuin 1 (SIRT1), promoting SIRT1-mediated deacetylation of β-catenin, which activated β-catenin/TCF4 signaling. Activation of the β-catenin/TCF4 complex effectively rescued the inhibitory effects of CDKL1 knockdown on BUC cell proliferation and metastasis. These findings indicate that CDKL1 promotes BUC tumorigenesis and metastasis through activation of the Wnt/β-catenin/TCF4 signaling pathway via SIRT1-dependent β-catenin deacetylation, highlighting CDKL1 as a potential therapeutic target for BUC.</p>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148971461","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advancing clinical trials for rare renal cell carcinoma subtypes: Consensus statements from the International Kidney Cancer Symposium North America 2025 think tank.","authors":"Pavlos Msaouel, Salvatore La Rosa, Edwin Jason Abel, Laurence Albiges, Pedro C Barata, Stephanie A Berg, David A Braun, James Brugarolas, Matthew T Campbell, Marie I Carlo, Katie Coleman, Nicholas G Cost, Arighno Das, Arpita Desai, Nazli Dizman, Daniela Drago, Minas Economides, Daniel M Geynisman, Meghan Griffith, Tasha Hall, Elizabeth P Henske, Eric Jonasch, Prateek Khanna, Ritesh R Kotecha, Amy Luckenbaugh, Jodi K Maranchie, Viraj Master, Allison M May, Robert J Motzer, Moshe C Ornstein, Michael V Ortiz, Sumanta K Pal, Jose R Perez, Brian Rini, Daniel D Shapiro, Brian M Shuch, Adam E Singer, Eric A Singer, Walter M Stadler, Michael Staehler, Nizar M Tannir, Ulka N Vaishampayan, Wenxin Xu, Wesley Yip, Niki M Zacharias, Martin H Voss","doi":"10.1016/j.urolonc.2026.07.035","DOIUrl":"10.1016/j.urolonc.2026.07.035","url":null,"abstract":"<p><strong>Purpose: </strong>Rare renal cell carcinoma (RCC) subtypes present unique challenges for clinical trial design and drug development. This consensus initiative aimed to provide actionable expert guidance on advancing preclinical and clinical development of rational therapeutic strategies for non-clear cell RCC variants, including papillary, chromophobe, MiT family/translocation, collecting duct, renal medullary carcinoma, and fumarate hydratase-deficient RCC.</p><p><strong>Methods: </strong>A modified Delphi method was employed to develop consensus statements among a multidisciplinary panel of 46 experts in urologic oncology, medical oncology, radiation oncology, molecular biology, genetics, and biostatistics, with representatives from pharmaceutical industry, regulatory affairs, and patient advocacy. Over multiple rounds, including an in-person meeting on November 13, 2025, 20 initial statements were proposed, evaluated, refined, and voted on. Consensus was defined a priori as a median Likert score ≥8 out of 10.</p><p><strong>Results: </strong>Twenty final consensus statements were endorsed across 5 thematic domains: (1) Trial Design and Endpoints; (2) Perioperative Trials; (3) Operations and Accrual; (4) Biology-driven and Histology/molecular Strategy Trials; and (5) Preclinical Efforts, Target Identification, and Early Signal Testing. Key recommendations include prioritizing histology-specific trial designs over pooled \"non-clear cell\" approaches, adopting innovative single-arm and adaptive designs for ultra-rare subtypes, leveraging patient advocacy collaborations and natural history registries, and pursuing mechanism-informed therapeutic development.</p><p><strong>Conclusions: </strong>These recommendations provide a framework to guide researchers, cooperative groups, regulatory bodies, and pharmaceutical industry partners in advancing evidence generation and therapeutic development for patients with rare kidney cancer variants.</p>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13625684/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148956915","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Corrigendum to \"A 2-center review of histopathology of variants of upper urinary tract urothelial carcinoma and their impact on clinical outcomes\" [Urologic Oncology: Seminars and Original Investigations 42 (2024) 333.e15-333.e20].","authors":"Nicola Giudici, Anna Schoch, Vera Genitsch, Antonio Rodriguez-Calero, George Thalmann, Roland Seiler","doi":"10.1016/j.urolonc.2026.08.021","DOIUrl":"https://doi.org/10.1016/j.urolonc.2026.08.021","url":null,"abstract":"","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148956964","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidental bladder cancer detected by routine cystoscopy before robot-assisted radical prostatectomy: A multicenter retrospective study.","authors":"Masakazu Nozaki, Ryunosuke Nakagawa, Yoshifumi Kadono, Yoshiki Koketsu, Taiki Kamijima, Hiroshi Kano, Tomoyuki Makino, Renato Naito, Hiroaki Iwamoto, Hiroshi Yaegashi, Kazuyoshi Shigehara, Takahiro Nohara, Kouji Izumi, Takao Nishikawa, Tomochika Shinagawa, Hiroki Yamauchi, Masayuki Takata, Masanori Kono, Kazuto Komatsu, Atsushi Mizokami","doi":"10.1016/j.urolonc.2026.08.018","DOIUrl":"https://doi.org/10.1016/j.urolonc.2026.08.018","url":null,"abstract":"<p><strong>Introduction: </strong>To evaluate the role of routine cystoscopy before robot-assisted radical prostatectomy (RARP) in detecting incidental bladder cancer (BC) and to identify clinical factors associated with BC detection.</p><p><strong>Methods: </strong>In this retrospective study conducted at 2 institutions, we included 918 patients who underwent routine cystoscopy before RARP between August 2014 and March 2025. We assessed incidental BC detection, detection of intermediate- or high-risk nonmuscle-invasive BC (NMIBC), and cystoscopy-related events, including urinary tract infection (UTI) and changes in planned prostate cancer (CaP) treatment.</p><p><strong>Results: </strong>Incidental BC was detected in 18 of 918 patients (1.96%), including 8 cases of intermediate- or high-risk NMIBC. Increasing age was significantly associated with BC detection (odds ratio [OR] per 1-year increase, 1.13; 95% confidence interval [CI], 1.02-1.25). Patients aged ≥70 years had a higher BC detection rate (3.2%; OR, 3.96; 95% CI, 1.29-12.1). Nine patients switched to alternative CaP treatments, including radiotherapy and/or androgen deprivation therapy. Among the 9 patients who underwent RARP after bladder tumor resection, the median interval from cystoscopy to RARP was 10.8 months, with no clinically evident CaP progression before RARP. During a median follow-up of 34.6 months, no BC recurrence or dissemination-suggestive recurrence was identified. UTI occurred in 6 patients (0.7%).</p><p><strong>Conclusion: </strong>Routine cystoscopy before RARP identified previously unrecognized BC, including clinically significant lesions. Older age was associated with BC detection; however, this finding should be regarded as hypothesis-generating. Further prospective studies are needed to determine whether age-based or risk-adapted cystoscopy strategies are appropriate before RARP.</p>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148945761","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cryoablation for localized prostate cancer: Feasibility in large prostates.","authors":"Jamie Michael, Kathryn Fink, Vivian Wan, Clayton Neill, Yutai Li, Jae W Jang, Ridwan Alam, Ashley E Ross","doi":"10.1016/j.urolonc.2026.08.011","DOIUrl":"https://doi.org/10.1016/j.urolonc.2026.08.011","url":null,"abstract":"<p><strong>Introduction and objectives: </strong>Prostate volume may influence the technical feasibility of focal therapy and increase failure rates. In this study, we aimed to characterize the outcomes of patients undergoing primary focal therapy with cryoablation, and evaluate the effectiveness of this approach in larger glands.</p><p><strong>Methods: </strong>We retrospectively identified men who underwent focal therapy as primary treatment for localized prostate cancer at our institution. Treatment failure was defined as clinically significant prostate cancer on post-treatment biopsy (GG2-5) or need for subsequent therapy. Kaplan Meier survival curves were generated to compare event free survival between patients with large glands (defined as >60 grams) and small glands (<60 grams).</p><p><strong>Results: </strong>Seventy-two patients underwent primary focal therapy for localized prostate cancer, all with cryoablation, with a median follow up time of 21.2 months (IQR 6.8, 68.3). Gland size ranged from 17 to 177 grams. In total, 16 (22.2%) experienced treatment failure, at a median of 20 months (IQR 12, 30) after treatment. Of the 16 failures, 12 were biopsy-proven (4 in-field, 1 near-field, 7 out-of-field). Gland size was not associated with treatment failure or toxicity in this small cohort. Among 18 patients with prostate volume >60 grams, 5 (27.8%) failed. Failure free survival did not differ between large and small glands (P = 0.70). Only 1 complication occurred in the population (Clavien grade I hematuria managed with observation, prostate volume 59 grams).</p><p><strong>Conclusions: </strong>Focal therapy with cryoablation is feasible among patients with larger gland size with low complication rates and no significant difference in treatment failure rates compared to men with smaller prostates in this small cohort.</p>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148945772","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Calendar-time bias in a TriNetX study of GLP-1 receptor agonists, SGLT2 inhibitors and bladder cancer survival.","authors":"Joshua Wang","doi":"10.1016/j.urolonc.2026.08.019","DOIUrl":"https://doi.org/10.1016/j.urolonc.2026.08.019","url":null,"abstract":"","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148931224","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Epidemiological trends in penile cancer and the evolving role of dynamic sentinel lymph node biopsy.","authors":"Cian M Hehir, Lorraine Scanlon, Gavin G Calpin, Ivor M Cullen","doi":"10.1016/j.urolonc.2026.07.025","DOIUrl":"https://doi.org/10.1016/j.urolonc.2026.07.025","url":null,"abstract":"<p><strong>Introduction: </strong>Penile cancer (PeCa) is a rare but aggressive malignancy with growing global incidence. The most influential prognostic factor in PeCa is the presence of nodal metastasis. Current imaging modalities lack the diagnostic accuracy to reliably detect micro-metastasis in PeCa. Since 2015, Dynamic Sentinel Lymph Node Biopsy (DSLNBx) emerged as a means of accurately detecting nodal metastases in PeCa. The impact of DSLNBx on overall and cancer-specific survival years remains to be established in the Irish population.</p><p><strong>Methods: </strong>Population based data was obtained from The National Cancer Registry of Ireland (NCRI) on all patients diagnosed with PeCa between 1994 and 2021. Log-rank Mantel-Cox analysis was applied to assess survival benefit associated with DSLNBx.</p><p><strong>Results: </strong>A total of 866 patients were diagnosed with PeCa in Ireland between 1994 and 2021 with population standardized incidence incrementing from 1.68 to 2.80 cases/100,000 males/year during this period. The most common histological subtype was squamous cell carcinoma (92.8%) followed by melanoma (2.7%), basal cell carcinoma (0.7%). Surgical excision constituted mainstay treatment (86.2%). DSLNBx was performed in 8% of cases of which 13% had node positive disease. Those who underwent DSLNBx were found to have a statistically significant increase in overall survival rate, χ² (1) = 4.067, P = 0.044. Cancer specific survival rate correlated positively in those who underwent DSLNBx also, but this did not reach statistical significance.</p><p><strong>Conclusion: </strong>PeCa has growing incidence in Ireland. DSLNBx offers a means of accurately assessing presence of nodal metastasis whilst incurring minimal morbidity which has been associated with improved overall survival on univariate analysis.</p>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148913628","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perioperative and survival outcomes of synchronous vs. metachronous upper tract urothelial carcinoma among bladder cancer patients treated with radical cystectomy and nephroureterectomy: Results from an International Multicenter Collaborative Study-On behalf of the Young Academic Urology (YAU) Urothelial Working Group.","authors":"Roberta Corvino, Giuseppe Basile, Valerio Santarelli, Vincenzo Asero, Ettore De Berardinis, Alessandro Sciarra, Luigi Vittori, Yasmin Abu-Ghanem, Rajesh Nair, Muhammad Shamim Khan, Ramesh Thurairaja, Ravi Barod, Wojciech Krajewski, Jan Laszkiewicz, Simone Albisinni, Keiichiro Mori, Felix Guerrero-Ramos, David D'Andrea, Andrea Gallioli, Ekaterina Laukhtina, Agata Suleja, Elisabeth Grobet-Jeandin, Andrea Mari, Laura S Mertens, Marco Moschini, Mario De Angelis, Pietro Scillipoti, Francesco Soria, Alessandro Bosio, Jeremy Teoh, Francesco Claps, Antonio Amodeo, Aleksander Ślusarczyk, Roberto Contieri, Daniel Subiela, Ana Tagalos, Karl H Tully, Renate Pichler, Alessandro Antonelli, Riccardo Bertolo, Alessandro Veccia, Sarah Malandra, Rodolfo Hurle, Francesco Sormani, Felice Crocetto, Roman Mayr, Angelo Porreca, Giuseppe Simone, Gabriele Tuderti, Bernardo Rocco, Alchiede Simonato, Franco Alchiede Simonato, Gautier Marcq, Paolo Gontero, Zhe Tian, Pierre Karakiewicz, Benjamin I Chung, Benjamin Pradere, Francesco Del Giudice","doi":"10.1016/j.urolonc.2026.08.007","DOIUrl":"https://doi.org/10.1016/j.urolonc.2026.08.007","url":null,"abstract":"<p><strong>Background and objective: </strong>Patients undergoing radical cystectomy (RC) for bladder cancer may present with synchronous or metachronous upper tract urothelial carcinoma (UTUC). These scenarios may differ in oncological outcomes and surgical complexity. This study sought to compare oncologic and perioperative outcomes in patients undergoing RC and radical nephroureterectomy (RNU) for synchronous or metachronous UTUC.</p><p><strong>Methods: </strong>Data from 23 tertiary referral centers were retrospectively collected (2002-2024). Perioperative outcomes included length of stay (LOS) and complications (Clavien-Dindo classification). Disease-free survival (DFS), cancer-specific survival (CSS) and overall survival (OS) were estimated from RC using Kaplan-Meier and landmark analysis. Multivariable Cox regression modeling identified predictors of DFS and OS and explored the impact of RNU timing on oncological outcomes.</p><p><strong>Key findings and limitations: </strong>Among 177 RC patients (n = 142 [80%] males), 106 (60%) underwent RNU subsequent to RC for metachronous UTUC. Concomitant RC and RNU led to longer LOS (10 vs. 7 days, P = 0.004), and statistically significant higher rate of major complications (Clavien-Dindo ≥ IIIa, 29.6% vs. 15.1%, P = 0.03). Metachronous disease showed better 60-month DFS (69.1% vs. 47.6%), CSS (80.3% vs. 66.4%) and OS (69.2% vs. 47.6%). Histological subtype at RNU independently predicted worse DFS (HR 2.64, P = 0.01) and OS (HR 3.22, P = 0.01), while metachronous presentation predicted better DFS (HR 0.36, P < 0.001) and OS (HR 0.53, P = 0.04). Limitations include the retrospective design and a relatively limited sample size.</p><p><strong>Conclusions and clinical implications: </strong>Synchronous panurothelial disease at diagnosis requiring RC and RNU is related to worse perioperative and survival outcomes compared to metachronous disease. Our results highlight the need for dedicated studies to define individualized treatment and surveillance strategies for this challenging patient population.</p>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148897938","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"FOXD1 upregulates DARS2-mediated glycolysis to drive cisplatin resistance in bladder cancer.","authors":"Xianyong Li, Mingqiang Su, Jingxian Luo, Dengjun Han, Liangliang Qing, Dayong Zhang, Sheng Liu, Junfa Liu, Guangqing Fu","doi":"10.1016/j.urolonc.2026.07.027","DOIUrl":"https://doi.org/10.1016/j.urolonc.2026.07.027","url":null,"abstract":"<p><strong>Background: </strong>Chemotherapy remains the most effective systemic treatment for bladder cancer (BLCA), with cisplatin as the primary agent. However, the frequent development of cisplatin resistance limits its clinical efficacy. Forkhead box D1 (FOXD1) is implicated in BLCA progression, yet its role in mediating cisplatin resistance remains unexplored.</p><p><strong>Methods: </strong>FOXD1 expression and its correlation with patient prognosis in BLCA were analyzed using the TCGA database. Cisplatin-resistant BLCA cell lines (T24-R and HT-1376-R) were established by treatment with gradient concentrations of cisplatin. qRT-PCR and Western blot were performed to detect the expression levels of FOXD1, β-catenin, and Aspartyl-tRNA Synthetase 2 (DARS2). Cell viability, proliferation, cell cycle, and apoptosis were assessed using CCK-8, colony formation assays, and flow cytometry. Co-IP was performed to examine the interaction between FOXD1 and β-catenin. Glycolysis levels in BLCA cells were determined using specific assay kits.</p><p><strong>Results: </strong>FOXD1 was highly expressed in BLCA tissues and correlated with poor prognosis. Knockdown of FOXD1 inhibited proliferation and cell cycle progression, promoted apoptosis, and enhanced cisplatin sensitivity in T24-R cells, while reducing β-catenin nuclear translocation and DARS2 expression. Overexpression of FOXD1 exerted the opposite effects on HT-1376-R cells and increased DARS2 expression, which were reversed by β-catenin knockdown. Moreover, knockdown of TCFs/LEF suppressed DARS2 expression. DARS2 was enriched in the glycolysis pathway. Its overexpression promoted glycolysis, proliferation, and cell cycle progression, while inhibiting apoptosis and cisplatin sensitivity in HT-1376-R cells-effects were reversed by 2-DG.</p><p><strong>Conclusion: </strong>FOXD1 facilitates β-catenin nuclear translocation and upregulates DARS2 to enhance glycolysis, thereby promoting cisplatin resistance in BLCA. These findings identify the FOXD1/β-catenin/DARS2 axis as a potential therapeutic target for overcoming cisplatin resistance in BLCA clinically.</p>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148897831","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intraoperative indocyanine green fluorescence guidance to reduce ureteroenteric anastomotic strictures during robot-assisted radical cystectomy. A systematic review and meta-analysis.","authors":"Emmanuel Oberdá Nominato, Arthur Ávila Reis Roncarati Miranda, Maria Eduarda Martins Fernandes, Victor Lima Amaral, Angélica Steckelberg Pimenta Macedo, Kenzo Higashi Lima, Marcelo Albuquerque Barbosa Martins, Guilherme Canabrava Rodrigues Silva","doi":"10.1016/j.urolonc.2026.08.003","DOIUrl":"https://doi.org/10.1016/j.urolonc.2026.08.003","url":null,"abstract":"<p><p>Ureteroenteric anastomotic stricture (UAS) is a clinically relevant complication of robot-assisted radical cystectomy (RARC), primarily driven by ureteral ischemia. Indocyanine green (ICG) fluorescence has been proposed to identify ischemic segments prior to anastomosis. This systematic review and meta-analysis aimed to evaluate UAS incidence with ICG versus no ICG during RARC. PubMed, Embase, and Cochrane were searched up to February 2026. Eligible studies were comparative observational studies on adults undergoing RARC exclusively. Random-effects models were used to pool risk ratios (RR) and mean differences (MD) with 95% confidence intervals. Four observational studies were included (n = 886 patients; 1,739 ureters): 369 (41.6%) underwent ICG - guided assessment and 517 (58.4%) standard assessment without ICG. Pooled analysis showed no statistically significant reduction in UAS per ureter (RR 0.31, 95% CI 0.08-1.16; P = 0.08; I² = 76.4%). Sensitivity analysis excluding the highest-bias study eliminated heterogeneity and shifted results in favor of ICG (RR 0.20, 95% CI 0.09-0.46; I² = 0%), suggesting that the primary pooled estimate is unstable and heavily influenced by between-study heterogeneity. No significant differences were observed in ureteral excision length, node positivity, or operative time. Current evidence is limited to non-randomized studies with serious risk of bias and very low certainty. The instability of the pooled estimate highlights the inadequacy of the current evidence base and the need for prospective randomized studies to define the true clinical benefit of ICG. PROSPERO: CRD420261322254.</p>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148888685","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}