Urology

RAPN reduces chronic morbidity versus open partial nephrectomy with preserved 2-year outcomes

This randomized phase 2 trial assigned 50 patients with localized RCC to robot-assisted or open partial nephrectomy. At 2 years, overall survival was 100% in both groups, with a single nodal recurrence after RAPN. Mean eGFR was similar between arms, indicating no renal penalty for RAPN. Chronic operative-site pain and flank bulge were significantly more frequent after open surgery than RAPN. Health-related quality of life remained high and comparable, supporting RAPN as a morbidity-sparing standard option. 1

Ablation offers T1a RCC control comparable to resection with shorter stays

This Danish registry study included 1862 adults with T1a RCC treated by ablation, partial resection, or nephrectomy. Adjusted progression risk did not differ significantly between ablation and resection (HR 1.46, 95% CI 0.60–3.56). Local recurrence was most frequent after ablation but was manageable with additional procedures. Distant metastases occurred most often after nephrectomy. Hospital stay and early hospital contacts were lowest after ablation, suggesting fewer short-term complications. 2

Residual T1 at re-TURB after BCG identifies a highly adverse T1HG NMIBC subgroup

Among 1403 T1 high-grade NMIBC patients receiving adequate BCG, 38.8% had residual disease at re-TURB and 17.7% had persistent T1. Persistent T1 was associated with much lower 5-year high-grade recurrence-free and progression-free survival versus T0/Ta. Five-year cancer-specific mortality increased from 6–7% in T0/Ta to 23% with residual T1. On multivariable analysis, residual T1 independently predicted worse high-grade recurrence, progression, and cancer-specific mortality. Cure modeling showed reduced cure fractions, supporting early radical strategies for high- and very high-risk patients with persistent T1. 3

Ipilimumab+nivolumab induction plus CRT achieves high bladder-intact survival in MIBC

The INDIBLADE phase 2 trial treated 50 patients with stage II/III MIBC using induction ipilimumab plus nivolumab followed by chemoradiotherapy. At median 28.7 months follow-up, estimated 2-year bladder-intact event-free survival was 78%, meeting the primary endpoint. Two-year overall survival was 96%, indicating strong systemic control with this bladder-sparing strategy. Grade 3–4 immune-related adverse events occurred in 24% and CRT-related events in 7%, reflecting manageable toxicity. Undetectable ctDNA after induction immunotherapy was associated with better bladder-intact event-free survival, supporting ctDNA-guided risk adaptation. 4