As an internationally accepted diagnostic system, the Paris classification has achieved a global breakthrough in the standardization of diagnoses in urine cytology. Based on experience over the past few years since its first publication, the new edition of the Paris classification refines the diagnostic criteria and discusses diagnostic pitfalls. While the detection of high-grade urothelial carcinoma remains the main focus, other aspects of urine cytology, including cytology of the upper urinary tract and the associated challenges, have also been addressed. Low-grade urothelial neoplasia is no longer listed as a separate category but is now included in the category \"negative for high-grade urothelial carcinoma\" (NGHUC). Essentially, the Paris classification provides an important basis for estimating the risk of malignancy and further clinical management.
UNASSIGNED: Als ein international anerkanntes Befundungssystem hat die Paris-Klassifikation einen globalen Durchbruch in der Standardisierung der Diagnosen in der Urinzytologie erzielt. Basierend auf Erfahrungen der letzten Jahre seit der Erstveröffentlichung werden in der Neuauflage die diagnostischen Kriterien präzisiert und differentialdiagnostische Schwierigkeiten ausführlicher diskutiert. Während der Nachweis eines high-grade Urothelkarzinoms nach wie vor im Vordergrund steht, werden auch weitere Aspekte der Urinzytologie, u. a. die Zytologie des oberen Harntrakts, und die damit verbundenen Herausforderungen thematisiert. Neu werden die low-grade urothelialen Neoplasien nicht mehr als eigenständige Kategorie aufgeführt, sondern in die Kategorie „negativ für high-grade Urothelkarzinom“ (NGHUC) eingeordnet. Die Paris-Klassifikation ist eine wichtige Grundlage für die Abschätzung des Malignitätsrisikos und das weitere klinische Vorgehen.

UNASSIGNED: Bladder cancer is ranked the ninth most common cancer in the world. Locally, the incidence of bladder cancer has increased tenfold over the past 26 years. Radical cystectomy (RC) is considered a gold standard management option for muscle-invasive bladder cancer (MIBC), but trimodal therapy (TMT) has shown comparable oncological outcomes in selected patients.
UNASSIGNED: This is a retrospective study in which we reviewed medical records of patients diagnosed with MIBC without nodal disease or distant metastasis (cT2N0M0) who underwent either RC or TMT. Demographic data, comorbidities, histopathological and clinical staging, neoadjuvant/adjuvant therapy, and follow-up were analyzed.
UNASSIGNED: We included a total of 31 patients in the study, with 10 patients in the TMT group and 21 patients in the RC group. There was no significant difference in recurrence between the TMT and RC groups (P = 0.58). The TMT group had a higher percentage of local recurrence (40% vs. RC 5.2%, P = 0.018) but no significant difference in metastasis (0% vs. 10%, P = 0.420). The difference in overall survival between the TMT and RC groups was not significant (P = 0.25).
UNASSIGNED: TMT may be considered an alternative option for patients unwilling to undergo RC due to related complications and prioritize a better quality of life. However, the decision should be made after considering the cost of extensive follow-ups and patient compliance with surveillance.

Urothelial carcinoma of the upper urinary tract (upper tract urothelial carcinoma, UTUC) is less common than bladder carcinoma with nearly identical risk factors and has a poorer prognosis. The standard diagnostic procedure is imaging of the upper urinary tract by computed tomography urography. In cases of diagnostic uncertainty, a diagnostic ureterorenoscopy with biopsy sampling can be performed in addition to urine cytology. Treatment depends primarily on the stage and grading of the tumor. Depending on the extent and localization, organ-preserving treatment or radical nephroureterectomy is indicated. Perioperative systemic treatment in high-risk UTUC can be performed in both neoadjuvant and adjuvant settings, although the current data on neoadjuvant chemo- and immunotherapy do not yet allow standard application. For metastatic disease, a multimodal treatment approach consisting of cisplatin-based or carboplatin-based chemotherapy, immunotherapy, and treatment with enfortumab vedotin can be considered. Salvage surgery, radiotherapy and metastasectomy are available for rare individual cases.
UNASSIGNED: Das Urothelkarzinom des oberen Harntrakts („upper tract urothelial carcinoma“, UTUC) ist bei nahezu identischen Risikofaktoren seltener als das der Harnblase und hat eine schlechtere Prognose. Standard in der Diagnostik ist die Bildgebung des oberen Harntrakts mittels computertomographischer Urographie. Bei diagnostischer Unsicherheit kann neben der Urinzytologie eine diagnostische Ureterorenoskopie mit Probenentnahme durchgeführt werden. Die Therapie hängt in erster Linie vom Stadium und Grading des Tumors ab. Je nach Ausdehnung und Lokalisation ist eine organerhaltende Therapie oder eine radikale Nephroureterektomie indiziert. Eine perioperative Systemtherapie kann beim Hochrisiko-UTUC sowohl im neoadjuvanten als auch adjuvanten Setting erfolgen, wobei die gegenwärtige Datenlage zur neoadjuvanten Chemo- und Immuntherapie noch keine Standardanwendung erlaubt. Für metastasierte Erkrankungen kommt ein multimodaler Therapieansatz aus cis- bzw. carboplatinbasierter Chemotherapie, Immuntherapie und Therapie mit Enfortumab-Vedotin, in seltenen Einzelfällen die Salvage-Operation, die Strahlentherapie oder die Metastasektomie in Betracht.

The aim of the present study was to report the case of a 58-year-old male patient with ureteral carcinoma who underwent ureteroileostomy treatment. At 2 years following surgery, six lymph node metastases (LNMs) were detected in the patient\'s para-aortic and pelvic regions using 18F-labeled fluoro-2-deoxyglucose (FDG) positron emission tomography (PET)/CT. All LNMs were treated using stereotactic body radiotherapy (SBRT; 35-40 Gy/5 fractions). At 3 months after radiotherapy, 18F-FDG-PET/CT examination revealed a complete radiological and metabolic response of all targeted treatment sites in the patient. In the 2 years following radiotherapy, another three same-dose SBRT treatments were performed on single or multiple LNMs, which were all detected in the abdomen and pelvis of the patient. Overall, a total of 11 LNMs were targeted in the patient and all exhibited complete radiological and metabolic response following treatment. The only treatment side effect reported by the patient was a slight and temporary loss of appetite. In patients with lymph node oligometastases there are two options for radiotherapy: i) Irradiation focusing on LNMs alone; and ii) prophylactic irradiation of the entire lymph node area combined with a boost on macroscopic lesions. In the patient discussed in the present study, the choice of irradiation focusing on LNMs alone made it possible to postpone systemic therapies and instead use an optimally tolerated treatment. The treatment outcome in this patient indicated that there was no radioresistance of urothelial LNMs.

While numerous current clinical trials are testing novel salvage therapies (ST) for patients with recurrent nonmuscle invasive bladder cancer (NMIBC) after bacillus Calmette-Guérin (BCG), the natural history of this disease state has been poorly defined to date. Herein, we evaluated oncologic outcomes in patients previously treated with BCG and ST who subsequently underwent radical cystectomy (RC).
We identified 378 patients with high-grade NMIBC who received at least one complete induction course of BCG (n = 378) with (n = 62) or without (n = 316) additional ST and who then underwent RC between 2000 and 2018. Oncologic outcomes were compared using the Kaplan-Meier method and Cox proportional hazards models. Sensitivity analyses were conducted stratifying by presenting tumor stage, matched 1:3 for receipt vs. no receipt of ST.
Patients receiving ST were more likely to initially present with CIS (26% vs. 17%) and less likely with T1 disease (34% vs. 50%, P = 0.06) compared to patients not treated with ST. Receipt of ST was not associated with increased risk of adverse pathology (≥pT2 or pN+) at RC (31% vs. 41%, P = 0.14). Likewise, 5-year cancer-specific survival did not significantly differ between groups on univariable Kaplan-Meier analysis (73% for ST and 74% for no ST, P = 0.7). Moreover, on multivariable analysis, receipt of ST was not significantly associated the risk of death from bladder cancer (HR 1.12; 95% CI 0.60-2.09, P = 0.7). Results were unchanged on sensitivity analysis.
These data suggest that, in carefully selected patients, ST following BCG for high grade NMIBC does not compromise oncologic outcomes for patients who ultimately undergo RC.

Upper urinary tract urothelial cell carcinoma (UTUC) is a rare entity. The incidence in Germany is approximately 2/100,000 with a ratio between women and men of 1:2.5. Most clinical signs are nonspecific, which is why early diagnosis is rarely successful. Computed tomography urography in combination with diagnostic ureterorenoscopy is currently the gold standard in the diagnostics of UTUC. Regarding surgical treatment, radical nephroureterectomy (RNU) with resection of a bladder cuff remains the method of choice, although the radical approach is developing towards laparoscopic/robotic or endourological procedures with preservation of kidney tissue. Due to the high recurrence rate (22-47%) of urothelial carcinoma inside the bladder, close follow-up after RNU is mandatory.

Objective: To investigate the incidence and clinical characteristics of urothelial carcinoma (UC) accompanied with multiple primary carcinoma (MPC). Methods: The clinical data of 121 UC patients with MPC in Peking University Third Hospital from January 2010 to May 2018 were retrospectly analyzed. Results: UC patients with MPC accounted for 9.74% (121/1 242) of all the UC patients. The ratio of male to female patients was 2.10∶1 in the total MPC patients, but it was 1∶1 in the upper urinary tract MPC subgroup. The MPC patients were more common in elderly people, whose medium age was 68 (32-93) years old. Of all the location (131 person-time) of other tumors besides UC, the digestive system tumors occurred most frequently, accounting for 41.98% (55/131), followed by the urinary and male reproductive system tumors (20.61%, 27/131) and the female reproductive system (12.21%, 16/131). The proportion of the digestive system tumors (47.37%, 9/19) was the highest in the upper urinary tract MPC, with a total number of the other primary cancer of 19 person-time. However, the proportion of the urinary and male reproductive system tumors (37.14%, 13/35) was higher in the synchronous MPC group, with a total number of the other primary cancer of 35 person-time. Some patients had a history of radiotherapy and/or chemotherapy before UC was diagnosed. We also observed 2 cases of genetically confirmed Lynch syndrome. The median overall survival (mOS) of UC patients with MPC was 132 months, and the mOS of patients with UC as the first malignancy (including synchronous MPC and UC as the first malignancy in metachronous MPC) was 120 months. The mOS of the synchronous MPC group was 84 months, which was significantly shorter than 178 months of metachronous MPC group (χ(2) =14.029, P<0.001). Conclusions: The incidence of UC accompanied with MPC is not low, and the most common sites of MPC are the digestive system and reproductive system. Therefore, screening for MPC in UC patients, especially those with personal or family history of tumors, as well as elderly patients, may help early diagnosis and treatment of MPC patients and improve their prognoses.
目的： 探讨尿路上皮癌(UC)合并其他多器官原发癌(MPC)的临床病理特征和预后。 方法： 2010年1月1日至2018年5月1日在北京大学第三医院诊治的UC合并MPC患者121例，通过查阅电子病例系统和电话随访，回顾性分析患者的流行病学特征、临床病理特征和预后。 结果： 合并MPC的UC患者占全部UC患者的9.74%(121/1 242)，男女比例为2.10∶1，在上尿路MPC亚组中男女比例为1∶1。MPC患者更常见于老年人，中位年龄为68岁。合并肿瘤共131例次，常累及器官依次为消化系统[41.98%(55/131)]、泌尿及男性生殖系统[20.61%(27/131)]和女性生殖系统[12.21%(16/131)]。上尿路MPC中，累及消化系统肿瘤比例最高[47.37%(9/19)]；但在同时性MPC组中，累及泌尿及男性生殖系统肿瘤比例最高[占37.14%(13/35)]。部分患者确诊UC前有放化疗史，确诊Lynch综合征2例。合并MPC的UC患者中位生存时间(mOS)为132个月，其中首发UC患者(包括异时性MPC中首发UC和同时性MPC)的mOS为120个月。同时性MPC组患者的mOS为84个月，短于异时性MPC组(178个月， P<0.001)。 结论： UC合并MPC发生率较高，合并消化系统和生殖系统最常见。对于确诊UC的患者，特别是有肿瘤既往史或家族史者以及老年患者，筛查MPC有助于患者的早诊早治和改善预后。.

OBJECTIVE: Bladder cancer is the sixth most common cancer in the United States, but is exceedingly rare in young patients, leading to a lack of accepted standards for diagnosis, treatment, and surveillance. We review our institutional experience with bladder urothelial neoplasms in pediatric and young adult patients summarizing presentation, treatment, and outcomes.
METHODS: Surgical pathology records at our institution were searched for cases of urothelial neoplasms among patients ≤25 years of age treated between January 1997 and September 2016. Cases submitted exclusively for pathology review were excluded. Diagnoses were confirmed based on pathologic examination using the 2004 World Health Organization classification system.
RESULTS: Thirty-four patients were identified with a mean age of 21.1 years (range 8-25 years), and median follow-up was 25.1 months (1-187 months). The male to female ratio was 1.83:1. The most common presenting symptom was hematuria (n=26; 76%). Diagnoses were invasive urothelial carcinoma (n=3), noninvasive urothelial carcinoma (n=24), PUNLMP (n=6), and urothelial papilloma (n=1). Noninvasive lesions were resected by cystoscopy, after which 12% (n=4) experienced complications (grade II or greater). One patient with stage IV invasive disease at diagnosis died, and 2 patients developed recurrences. Of those with noninvasive carcinoma, 29% (n=7) required repeat cystoscopy soon after initial TURBT at outside institutions, and 17% (n=4) had tumors downgraded from high-grade to low-grade after pathology review.
CONCLUSIONS: Hematuria is the most common sign of bladder neoplasia in children and young adults and should be investigated by cystoscopy. The majority of urothelial neoplasms in these patients are noninvasive and can be successfully treated with transurethral resection.
METHODS: Level IV (Retrospective study with no comparison group).

OBJECTIVE: To assess the results of organ-sparing endoscopic treatment of patients with tumors of the upper urinary tract (UUT).
METHODS: Twenty four patients underwent percutaneous and ureteropyeloscopic interventions for tumors of the upper urinary tract and were followed up at the Urology Clinic, I.M. Sechenov First MSMU. Retrograde removal of benign tumors of the renal pelvis and ureter (tumors sized from 5 to 35 mm), percutaneous removal of papillary carcinoma of renal pelvis of a solitary kidney, percutaneous removal of papillary carcinoma of renal pelvis of only one functioning kidney and percutaneous removal of papillary carcinoma of the lower calyx of the L-shaped kidney were performed in 21, 1, 1 and 1 patients, respectively. The patients had stage T1 papillary cancer of the upper urinary tract. There were 7 (29.2%) men and 17 (70.8%) women with mean age 64+/-5 years. Electroresection/vaporization was carried out in 18 patients, and 6 patients were treated using Holmium laser.
RESULTS: None of the endoscopic procedures required conversion to open surgery or a more extended surgical operation. There were no recurrences or impaired UUT urinary flow in patients with benign UUT tumors at different points of follow-up. In 3 cases of malignant UUT tumors no recurrences occurred during 12-20 months follow-up.
CONCLUSIONS: and discussion. Nephroureterectomy with resection of the urinary bladder is the standard radical treatment of patients with tumors of the UUT. Technological advances in endoscopic and percutaneous surgery for UUT have allowed for organ-sparing procedures in patients with neoplasms of pelvicalyceal system and ureter. The absolute indications for such organ-sparing operations now include solitary kidney or only one functioning kidney and chronic renal failure. Endoscopic resection of the tumor and renal pelvic wall within healthy tissue, including by holmium laser, with tumor stage not exceeding T1 and followed by trans-fistula chemotherapy can be regarded as an effective treatment for patients with tumors of pelvicalyceal system.

BACKGROUND: There is an ongoing debate on panurothelial changes in the upper and lower urinary tract as multifocal presentation of urothelial cancer is well recognised. Concurrent bladder cancer impacts the outcome of the upper urinary tract urothelial cancer treatment, while its detection still relies on the white light cystoscopy.
METHODS: We retrospectively reviewed all patients who underwent photodynamic diagnostic ureterorenoscopy, choosing those who had synchronous bladder biopsies. Each patient received 20 mg/kg body weight of oral 5-Aminolevulinic acid around 3-4 hours before endoscopy. All procedures were performed by a single endourologist experienced in photodynamic diagnosis and flexible ureterorenoscopy.
RESULTS: Between July 2009 and June 2013, 69 patients underwent bladder biopsies at the time of photodynamic diagnostic endoscopic inspection of the upper urinary tract. In total, 43.5% (30/69) patients were found to have bladder lesions, of which 43.3% (13/30) were proven to be carcinoma in situ. White light inspection of the bladder missed bladder cancer in 16 (23.1%) patients, of which 12 were carcinoma in situ. There were 14 bladder cancer lesions missed under white light which were concomitant to the upper urinary tract urothelial cancer. Twelve (17.4%) patients developed minor complications relevant to the photosensitizer.
CONCLUSIONS: The study raises a concern about missing small bladder cancer/carcinoma in situ lesions on the initial diagnosis or in surveillance of the upper urinary tract urothelial cancer. Higher than previously reported, the rate of concomitant bladder cancer may suggest utilisation of photodynamic diagnosis to ensure the cancer free status of the bladder, but this needs to be ratified in a multi-institutional randomised trial.