Overall, the results of Vasdev's et al's study are quite impressive with promising results. One must be cautious in applying this preliminary data to clinical practice for reasons stated above. Despite these concerns, this study along with others demonstrate the advances in inquiries within the field of bladder cancer with the potential to shape management and outcomes.

Introduction:We sought to assess the comparative hospital outcomes and costs among a population-based cohort of bladder cancer patients by surgical approach and diversion.Methods: From a privately insured national database, we identified all bladder cancer patients who underwent open or robotic radical cystectomy and ileal conduit or neobladder from 2010 to 2015. The primary outcomes were length of stay, readmissions, and total health care costs at 90 days from surgery. We used multivariable logistic regression and generalized estimating equations to assess for 90-day readmission and health care costs, respectively. Results:Most patients underwent open radical cystectomy with ileal conduit (56.7%; n ¼ 1,680) followed by open radical cystectomy with neobladder (22.7%; n ¼ 672), robotic radical cystectomy with ileal conduit (17.4%; n ¼ 516), and robotic radical cystectomy with neobladder (3.1%; n ¼ 93). On multivariable analysis, patients had higher odds of 90-day readmissions for open radical cystectomy and neobladder (OR: 1.36; P ¼ .002) and robotic radical cystectomy with neobladder (OR 1.60; P ¼ .03) relative to open radical cystectomy with ileal conduit. After adjusting for patient covariates, we also found lower adjusted total 90-day health care costs for open radical cystectomy with ileal conduit

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Renal cell carcinoma (RCC) a common malignancy with potential to metastasize to visceral organs. However, it uncommonly spreads to the lower genitourinary tract. We present a man with a history of RCC status post radical nephrectomy in April 2012. He presented 8 years later with obstructive lower urinary tract symptoms and an elevated prostate specific antigen (PSA). Further imaging showed a large enhancing mass with internal blood vessels posterior to the left prostate and seminal vesicle. A prostate biopsy was performed and consistent with metastatic RCC. He was ultimately treated with immunotherapy and focal stereotactic radioablation.

objective of this study was to assess sPC detection rates of TB and TS in prospectively randomized men.METHODS: Using a noninferiority margin of 5% and a onesided alpha level of 5%, the randomization of 170 men (n[85 in each group) provides the trial with 80% power. All men underwent either TB or TS in addition to 24 systematic cores. Cancer and sPC (International Society of Urological Pathology grade group >[2) detection rates were analysed. Cancer detection rates were calculated for TS, TB, and SB at both lesion and patient level. Combination of SB þ TB or TS served as reference. The detection difference of TS and TB was estimated by the means of a generalized linear mixed (GLM) model and a t-test for independent samples. Intrapatient statistical differences in sPC detection for patient-and lesion-level were calculated using McNemar's tests with confidence intervals.RESULTS: 53 men (62%) in the TB and 69 men (81%) in the TS group harbored PC. sPC was detected in 42% of men in the TB and 67% in the TS group. SB detected 86% (in TB group) and 82% (in TS group) of men with sPC. TB detected 92% of men and 86% of lesions harboring sPC, whereas TS detected all men and 97% of sPC lesions. Comparing detection rates, TS was 8% in favor over TB (p[0.03) on patient level and 11% (p[0.04) on lesion level.CONCLUSIONS: Overall, data of this prospective randomized study demonstrate a higher sPC detection rate using a TS approach as compared to conventional TB in MRI/TRUS-fusion biopsy.