Victor Maximilian Schuettfort

Objective: To evaluate the concordance between clinical complete response (cCR) and pathological complete response (pCR) in muscle‐invasive bladder cancer (MIBC) to assess the surrogacy and prognostic value of cCR for guiding bladder‐sparing strategies. Methods: In this prospectively registered systematic review and meta‐analysis (CRD420251066540), we searched MEDLINE, EMBASE, and Web of Science in June 2025 for studies reporting clinical and pathological complete response rates in patients with MIBC undergoing neoadjuvant therapy followed by radical cystectomy (RC). Pooled concordance was estimated via random‐effects meta‐analysis. Risk‐of‐bias was assessed using the Risk Of Bias In Non‐randomised Studies of Interventions (ROBINS‐I). Results: Out of 1947 individual records, 10 ( n = 894) retrospective and three ( n = 181) prospective studies comprising 1075 patients were included. Restaging modalities for cCR assessment included transurethral resection of the bladder (TURB; n = 188, two studies), computed tomography ( n = 221, two studies), magnetic resonance imaging (MRI; n = 122, two studies), and fluorodeoxyglucose positron emission tomography ( n = 45). One study ( n = 56) used perioperative cystoscopy, while the remaining five studies ( n = 499) combined imaging with cystoscopy or TURB. The concordance ( n = 779, nine studies) between cCR and pCR was 0.51 (95% confidence interval [CI] 0.42–0.60), the concordance ( n = 536, seven studies) between non‐cCR and non‐pCR was 0.84 (95% CI 0.70–0.92). Most studies were rated as having moderate concerns regarding bias, and one as serious due to examiner‐dependent bias of cystoscopy‐based cCR assessment. Conclusion: Current evidence does not support relying on the current definition of cCR alone, which poorly predicts pCR, to guide treatment decisions. Ongoing trials assessing the combination of MRI plus TURB with urine and/or blood based circulating tumour DNA may help refine cCR evaluation and support the sole introduction of bladder‐sparing approaches in patients with MIBC who respond to neoadjuvant systemic therapy.

Introduction: Urethral strictures and fistulas arising after gender-affirming surgery in transmen require meticulous management strategies. This study evaluates the safety and efficacy of urethral reconstruction and patient satisfaction post-surgery. Methods: A retrospective analysis examined peri- and postoperative data from transmen undergoing urethral reconstruction for urethral fistula and/or strictures at the distal urethral anastomosis between December 2017 and April 2023. Follow-up involved clinical examinations, uroflowmetry, and voiding cystourethrography. Patient satisfaction and quality of life were assessed using USS PROM and ICIQ-S questionnaires. Results: Among 25 patients, 88% (n = 23) had urethral fistulas, and 48% (n = 12) had urethral strictures. 41% of fistula patients also had strictures, while 75% of stricture patients had concurrent fistulas. Previous surgeries for fistula or stricture repair were noted in 26% of cases. Techniques for stricture included modified flap (50%), buccal oral mucosal grafting (33%), and primary anastomosis (17%). Post-operative urethrogram revealed urethral strictures in 15% (n = 3) and urinary extravasation in an equal number. Postoperative uroflow parameters showed improvement (Qmax 18 ml/s, Qave 7.9 ml, time 37 s, volume 332 ml). Perioperative complications were low (n = 6, 24%), all grade one (Clavien-Dindo). Follow-up revealed that 33% required another surgical intervention. The mean six-item LUTS score was 6.7 (SD 3.9). Mean ICIQ-S overall satisfaction score was 8.6 (SD 1.6) and outcome score was 20 (SD 2.8). Discussion: Our study found a significant recurrence rate of urethral strictures and fistulas post-surgery. Despite this, patient satisfaction remains high and complications are generally low-grade, highlighting the importance of expert surgical intervention.

Elevated preoperative plasma level of endoglin has been associated with worse oncologic outcomes in various malignancies. The present large-scale study aimed to determine the predictive and prognostic values of preoperative endoglin with regard to clinicopathologic and survival outcomes in patients treated with radical cystectomy (RC) for nonmetastatic urothelial carcinoma of the bladder (UCB). We prospectively collected preoperative blood samples from 1036 consecutive patients treated with RC for UCB. Logistic and Cox regression analyses were undertaken to assess the correlation of endoglin levels with pathologic and survival outcomes, respectively. The AUC and C-index were used to assess the discrimination. Patients with adverse pathologic features had significantly higher median preoperative endoglin plasma levels than their counterparts. Higher preoperative endoglin level was independently associated with an increased risk for lymph node metastasis, ≥pT3 disease, and nonorgan confined disease (NOCD; all p < 0.001). Plasma endoglin level was also independently associated with cancer-specific and overall survival in both pre- and postoperative models (all p < 0.05), as well as with recurrence-free survival (RFS) in the preoperative model (p < 0.001). The addition of endoglin to the preoperative standard model improved its discrimination for prediction of lymph node metastasis, ≥pT3 disease, NOCD, and RFS (differential increases in C-indices: 10%, 5%, 5.8%, and 4%, respectively). Preoperative plasma endoglin is associated with features of biologically and clinically aggressive UCB as well as survival outcomes. Therefore, it seems to hold the potential of identifying UCB patients who may benefit from intensified therapy in addition to RC such as extended lymphadenectomy or/and preoperative systemic therapy.