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Introduction and Objectives. Gross hematuria is one of the urological emergencies that require immediate assessment. Our retrospective study aimed to describe the demographic and clinical characteristics of patients with hematuria and SARS-CoV-2 infection treated in a urological emergency COVID care unit and compare them to pre-COVID-19 outcomes of the same duration. Materials and Methods. Over ten months, 55 patients with hematuria and SARS-CoV-2 infection were enrolled in the study and compared to pre-COVID-19 outcomes of similar duration. Data analyzed included patient age and gender, the etiology of hematuria, treatment applied, and follow-up time. Results. According to the analysis, there were 36 men (65.5%) and 19 women (34.5%), with an average age of 64.43 years (45 - 86). In men, 15 cases (41.7%) of hematuria were related to bladder tumors, eight cases (22.2%) to prostate adenocarcinomas, five cases (13.9%) to bladder stones, five cases (13.9%) to upper tract urothelial carcinomas, and three cases (8.3%) were related to large prostate adenoma. Among women, hematuria was associated with bladder tumors in 12 cases (63.2%) and with radiation cystitis in seven cases (36.8%). Conservative treatment was successfully applied in 17 cases (30.9%) and surgical treatment was necessary for 38 patients. (61.9%). As for SARS-CoV-2 infection, 40 patients (72.7%) showed a mild to moderate form of COVID-19, 12 patients (21.8%) had a severe course of the disease, with 3 cases (5.5%) resulting in death. All data were compared with pre-pandemic outcomes of similar duration. Conclusions. Hematuria associated with SARS-CoV-2 infection impairs a patient's prognosis. With SARS-CoV-2 infection, hematuria surgery is more challenging to perform. [ABSTRACT FROM AUTHOR]

Introduction: Upper-tract urothelial carcinoma (UTUC) accounts for 5-10% of urothelial carcinomas. The 'gold standard' surgical treatment for UTUC is still represented by radical nephroureterectomy (RNU) with bladder cuff excision. The European Association of Urology guidelines recommend offering kidney-sparing surgery (KSS) as primary treatment option to patients with low-risk disease. Sometimes, there is a lack of certainty regarding the diagnosis and tratment strategy of UTUC despite all techniques available such as cystoscopy, urinary citology, and computed tomography urography (CTU) which do now always allow correct tumor staging and grading. Diagnostic ureteroscopy (d-URS) may be of crucial importance in establishing the appropriate therapeutic approach. Evidence acquisition: A systematic review of the literature using Pubmed electronic database was performed for studies evaluating the diagnostic modalities and tratment strategies in UTUC. Overall, 74 full-text articles were assessed for eligibility. After a quantitative review of the selected literature, 24 studies were considered relevant for this review. Results: CTU has a sensitivity and specificity for UTUC of 92% and 95% respectively, but is not able to detect small or flat lessions with adequate accuracy. Urine citology for UTUC has a sensitivity of around 67-76% and is considered to offer poor prediction of muscle-invasive or high-grade disease. As no technique offers a diagnosis certainty, diagnostic ureteroscopy with enhanced technical improvements and emerging technologies can allow an increase in diagnostic accuracy by distinguishing between normal tissue and low- and high-grade tumors. Conclusions: Endoscopic treatment of even large, multifocal, low grade upper urothelial carcinoma is feasible also depending on each comfort level of expertise, does not involve significant complications and has good short-term oncologic outcomes. Proper patient selection is the main key for a better outcome when treating UUTC endoscopically. A better appreciation of the diagnostic limitations may help with choosing the weapon wisely. Maybe the most important feature of all is that the patient needs to be willing to undergo a close follow up with repetead endoscopic evaluations. [ABSTRACT FROM AUTHOR]

Introduction and Objectives. Digital flexible ureteroscopy (FURS) became an important diagnostic and follow-up procedure in upper urinary tract urothelial carcinoma (UTUC). Even so, many characteristics that can suggest nature of a lesion still represent a difficult challenge. The endpoint of the trial was to determine the diagnostic accuracy of NBI assisted digital flexible ureteroscopy versus standard FURS (WL) in upper tract urothelial carcinomas. Materials and Methods. White light (WL) and NBI-assisted digital FURS were performed in 65 patients, admitted for suspicion of UTUC. The inclusion criteria consisted of unilateral hematuria during cystoscopy, abnormal urinary cytology and pyelocaliceal system filling defects according to CT results. Patients with invasive UUT according to CT results were excluded. The investigation protocol included abdominal ultrasound, cytology, contrast CT scan and cystoscopy. The endoscopic examination use digital white light flexible ureteroscopy, followed by the NBI assessment of the renal collecting system urothelium. Results. A total of 78 UTUC lesions (23 pTa, 37 pT1 and 18 CIS) were confirmed by pathology in 65 patients. pTa, pT1 and CIS tumors detection rates were determined for WL combined with NBI mode by comparison to the WL evaluation overall UTUC 78 lesions (100%) versus 67 lesions (85.9%); pTa 23 lesions (100%) versus 17 lesions (73.9%); pT1 37 lesions (100%) versus 35 lesions (94.5%) and CIS 18 lesions (100%) versus 15 lesions (83.3%). Detection rate was improved in WL combined with NBI mode when compared with standard FURS (100% versus 84.4%). A total of 11 (14.1%) UTUC tumors (6 pTa, 2 pT1 and 3 CIS) were solely observed in NBI. Targeted biopsies’ specificity Rate of false-positive results 10.3% vs. 17.8% (WL vs. WL+NBI). Conclusions. NBI was an important tool regarding detection because it is providing a significant diagnostic improvement during digital flexible ureteroscopy. [ABSTRACT FROM AUTHOR]

The management of a rare disease like upper tract urothelial carcinoma (UTUC) continues to evolve and upper urothelial tumors may benefit in certain circumstances of minimally invasive endoscopic treatment. The indications did not change much in the last decade, including single, small (<1.5 mm) low grade and low stage tumors, cases with a solitary (functional, surgical or congenital) kidney, cases with bilateral disease or renal insufficiency. In this review we will focus on new technologies to aid in optimizing diagnostic accuracy in UTUC. This will include discussions about how advances in flexible ureteroscope improved the way we reach these tumors, development of lasers that offered the means to better treat them, while new technologies as narrow band imaging (NBI) influenced the way they are diagnosed, characterized during ablation, also the way these patients are investigated during follow- up and showing directions for future research. [ABSTRACT FROM AUTHOR]

Introduction: Nephroureterectomy with perimeatal cystectomy is still the gold standard in the treatment of urothelial upper urinarytract carcinoma (UUTC). Ureteral endoscopic surgery was proposed as a complementary first step in nephroureterectomy, in order to obviate the low abdominal incision. Our goal was to establish the value of a novel method of endoscopic distal ureteral management in on step nephroureterectomy for UUTC: pluck technique by using bipolar plasma vaporization. Materials and Methods: During the last two years, we performed nephroureterectomy with pluck transurethral detachment of the intramural ureter by using bipolar plasma vaporization in 42 cases with UUTC (pTa in 16 cases, pT1 in 10 cases, pT2 in 9 cases, pT3 in 7 cases). The tumor was pyelocaliceal in 34 cases, ureteral in 7 cases, and both ureteral and pyelocaliceal in 1 case. The follow-up was performed by cystoscopy with urinary cytology, ultrasonography, intravenous urography and CT. The mean follow-up was of 14 months (range 8 to 26 months). Results: All procedures were completed successfully. The complications rate was of 4.8%: 2 cases of hematuria, one imposing an endoscopic approach and another one treated conservatively. During follow-up, 6 patients had bladder recurrences, 1 had renal fossa tumors and 1 had secondary lymph-node invasion. The disease-specific mortality rate was of 4.8%. Conclusions: The endoscopic approach of the terminal ureter with bipolar plasma vaporization as part of one-step nephroureterectomy is a safe, facile and effective method offering good oncological results. [ABSTRACT FROM AUTHOR]

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Introduction. The standard treatment for upper urinary tract urothelial cell carcinoma (UUT-UCCs) is radical nephroureterectomy with bladder cuff excision. The endoscopic treatment was introduced with promising results in selected cases. The purpose of this study was the retrospective analysis of the factors that can influence the prognosis of the patients with UUT-UCCs who underwent endoscopic treatment. Patients and method. We identified 187 patients who where diagnosed and treated for UUT-UCCs, between 1998 - 2011, in the Urology Department of "Sf. Ioan" Clinical Emergency Hospital, Bucharest. The endoscopic treatment was used in 65 cases. The indications for endoscopic treatment were imperative (41 cases) or elective (24 cases). The retrograde approach (rigid or flexible) was used in 47 cases, while the anterograde approach was preferred in 18 cases. Tumor ablation was performed using electroresection or Nd:YAG laser. The mean follow-up period was 60 months (range between 6 and 120 months). The follow-up protocol included computed tomography or intravenous urography, urinary cytology (selected cases), cystoscopy and ureteroscopy. The recurrence rates were reviewed by retrospective analysis. Results. During follow-up 31 patients (47.6%) presented upper urinary tract recurrence. In 20 cases (30.7%) bladder recurrence was present. The median time from diagnosis to first recurrence was of 12.6 months. 18 patients (27.69%) underwent subsequent nephroureterectomy. The survival rates without recurrence at 1, 3 and 5 years were 61% (40 patients), 55.3% (36 patients) and 52.3% (34 patients). The most significant prognostic factors were: history of bladder tumour, tumour location and size, tumour stage and grade. The recurrence rate for pyelocaliceal tumours was 53.84% (21 out of 39 cases) and only 45.45% (10 out of 26 cases) for ureteral tumours. The recurrence rate for low-grade tumours was 36,36% (16 out of 44 cases) and 71.42% (15 out of 21 cases) for high-grade tumours. The tumours over 1.5 cm were associated with a higher recurrence rate compared with tumours below 1.5 cm (64.2 versus 43.13%). Conclusions. Endoscopic management of UUT-UCCs offers the advantage of preserving of renal function. Laser treatment of malignant urothelial lesions in the upper urinary tract should be reserved for a selected patient. The most important prognostic factors for UUT-UCCs evolution are tumours location, size and mostly tumour grade. The patients' compliance is very important for detecting recurrences. [ABSTRACT FROM AUTHOR]

Introduction: Non-muscle invasive bladder cancer (NMIBC) still represents an important health care problem in modern urology, as it is marked by the low accuracy endoscopic diagnosis and high recurrence rates characterizing the standard white light cystoscopy (WLC) assessment. Technological development: From astronomy to gastroenterology, narrow band imaging (NBI) was developed as a reliable optical enhancement method. The principle of narrowed bandwidths vision found applicability in both telescopes and gastrointestinal carcinoma detection. Urological use: In urological practice, NBI endoscopy was proved to provide a superior visualization of the vascular architecture of malignant lesions, thus underlining the contrast with the normal urothelium. Otherwise missed (during WLC) flat or small papillary tumors were reported as solely discovered and resected in NBI mode. Clinical outcomes: Various studies confirmed the significantly improved tumor detection rates of NBI when compared to standard cystoscopy. A substantial proportion of additional pTa and CIS lesions were left behind by WLC and only found in NBI. The premises for a favorable impact over the NMIBC treatment outcomes and eventually reduced recurrence rates were generally outlined so far. Conclusions: NBI vision markedly ameliorates the bladder cancer diagnostic and generates the conditions for a more comprehensive resection to be accomplished. Future research will be required to establish the long term viability of the method. [ABSTRACT FROM AUTHOR]