With the rapid advancement of computer technology, artificial intelligence (AI) has demonstrated wide application prospects in the imaging diagnosis of bladder cancer (BC). By developing AI models based on radiomics or deep learning algorithms, it is possible to effectively distinguish between non-muscle-invasive and muscle-invasive BC, predict pathological grades and subtypes, biomarker expression, lymph node metastasis status, and prognosis. In addition, AI can assist in bladder or tumor segmentation, image denoising, and radiotherapy planning, markedly improving working efficiency. This article reviews the application progress of AI in BC imaging in hopes of facilitating the clinical application of AI models for BC diagnosis and treatment.

The introduction of immune checkpoint inhibitors (ICIs) and tyrosine kinase inhibitors (TKIs) has advanced perioperative systemic strategies, however, the roles of neoadjuvant and adjuvant therapy in locally advanced renal cell carcinoma (RCC) are still being explored. Phase II studies indicate that neoadjuvant therapy can reduce surgical complexity, but existing phase III trials have not confirmed reductions in recurrence risk or durable survival gains. In the adjuvant setting, only KEYNOTE-564 has established a one-year pembrolizumab regimen with an overall survival benefit, making it the sole guideline-endorsed strategy to date. The underperformance of multiple randomized controlled trials likely reflects suboptimal endpoint selection and limited sensitivity of assessment tools, along with variability in surgical quality and intrinsic tumor heterogeneity. Future research should focus on refined patient stratification, optimization of composite endpoints, and standardized surgical quality assurance, while integrating molecular subtypes and immune biomarker–based stratification within a multidisciplinary framework. Such efforts aim to build a personalized perioperative treatment paradigm, shift the field from empiricism to a biologically and evidence-driven model, and ultimately improve outcomes for locally advanced RCC.

Prostate cancer poses a major threat to the health of men globally and in China, with its disease burden continuing to increase, accompanied by significant disparities across regions, between urban and rural areas, and among different age groups. This article reviews the global and Chinese epidemiological status of prostate cancer, as well as its incidence and mortality trends, analyzes the core characteristics of the disease burden, and systematically elaborates on international and domestic early prevention and control strategies. It also identifies the challenges currently faced in prevention and treatment, and finally puts forward targeted suggestions. The aim is to provide references for promoting precise prevention and control of prostate cancer and reducing the harm caused by the disease.

To introduce a novel robotic-assisted radical cystectomy (RARC) approach for bladder cancer patients, namely the combined posterior and lateral approach-and evaluate its efficacy.

A retrospective analysis was conducted on clinical data from 21 bladder cancer patients aged 47-80 years who underwent RARC. Among them, 12 underwent the combined posterior and lateral approach, while 9 underwent the traditional lateral approach. Clinical characteristics were compared between the two groups. The key step of the combined approach involved first incising the peritoneal reflection of the bladder prior to the lateral approach to release pelvic adhesions, mobilize the posterior bladder wall, expose the lateral bladder ligaments, and gradually expose the bilateral seminal vesicles and posterior wall of the prostate along Denonvilliers’ fascia, followed by ligation of the bilateral vas deferens arteries.

All 21 patients successfully completed the surgery. Compared to the traditional lateral approach group, the combined approach group demonstrated significantly shorter ureterostomy time [295.0 (275.0, 300.0) vs 445.0 (354.5, 501.6), P=0.034] and ileal neobladder reconstruction time [330.0 (320.0, 414.0) vs 490.0 (396.0, 545.5), P=0.019]. There were no statistically significant differences between the two groups in postoperative hospital stay, postoperative creatinine levels, or postoperative complication rates (P>0.05).

The combined posterior and lateral approach for RARC offers advantages in reducing operative time and improving intraoperative exposure, making it a safe and efficient surgical technique for RARC.

To investigate the surgical learning curve of robotic-assisted radical cystectomy and orthotopic neobladder (RARC/ONB).

The clinical data of 105 RARC/ONB patients consecutively performed by a fixed medical team from March 2017 to March 2023 were retrospectively analyzed. The learning curve of RARC/ONB was analyzed by the cumulative sum (CUSUM) with the operation time as the measurement indicator. The learning stages were divided according to the inflection points of the learning curve. The perioperative data, urodynamic characteristics of the neobladder, and postoperative urinary continence of each stage of the learning curve were compared.

All 105 surgeries were successfully completed, with no cases converted to open surgery. According to CUSUM analysis, the learning curve can be divided into two stages: 59 cases in the learning and growth stage and 46 cases in the advanced mastery stage. In the advanced mastery stage, the patients had less intraoperative blood loss (P<0.001), a lower intraoperative blood transfusion rate (P=0.006), shorter total operation time, internal reconstruction time, postoperative intestinal defecation time, postoperative hospital stay, and the total hospital stay (P<0.001), and a lower incidence of complications within 90 days after surgery (P=0.039). There was no significant difference in the urodynamic data and urinary continence rate of the neobladder in the two stages 6 months after surgery (P>0.05).

RARC/ONB is a safe, effective and repeatable surgical procedure. According to CUSUM analysis, approximately 59 patients are needed to overcome the initial learning and growth stage, which can provide a reference for specialist training and technology promotion.

To evaluate the value of computed tomography (CT) morphological features, especially the "overflowing beer sign" and "angular interface", in differentiating fat-poor angiomyolipoma (fpAML) from clear cell renal cell carcinoma (ccRCC).

The clinical and CT data of 259 patients with pathologically confirmed fpAML (n=64) and ccRCC (n=195) at our hospital from January 2019 to December 2024 were retrospectively analyzed. All tumors had a maximum diameter of ≤4 cm. Univariate and multivariate logistic regression analyses were used to identify independent predictors for fpAML and ccRCC. Incremental diagnostic value of key imaging features was assessed by constructing progressive diagnostic models, and an optimal combined model was established.

Multivariate logistic regression analysis identified the overflowing beer sign (OR=25.127), non-round shape (OR=6.284), female gender (OR=3.445), and smaller maximum tumor diameter (OR=0.534) as independent predictors for fpAML (all P<0.05). The angular interface was significant in univariate analysis ( P<0.001) but was not included in the final multivariate model. Adding the "overflowing beer sign" (model 2) to the clinical model (model 1) (AUC=0.817) significantly improved its performance (AUC=0.930, P<0.001). The combined model (model 3) incorporating all independent predictors achieved the best diagnostic performance (AUC=0.940), which was superior to model 2 (P=0.023).

The "overflowing beer sign" is the most powerful independent CT predictor for differentiating fpAML from ccRCC. A combined model integrating the overflowing beer sign, tumor shape, gender, and maximum diameter can offer an efficient and reliable tool for preoperative differentiation.

To explore the application value of robot-assisted single-port laparoscopic pyeloplasty (RSLP) in the treatment of ureteropelvic junction obstruction (UPJO) in children and to preliminarily summarize experiences with RSLP in the treatment of UPJO.

The clinical data of children (≤14 years old) who underwent RSLP at our center from February 2024 to April 2025 were collected, and the efficacy of RSLP in the treatment of UPJO was analyzed.

A total of 17 children (11 on the left side, 6 on the right side) were included, and all surgeries were successfully completed without conversion to open surgery or intraoperative complications. The median age of the children was 4.0(2.5, 64.0) months, the operation time was (186±43) min, the anastomosis time of the renal pelvis and ureter was (73±20) min, the median hospital stay was 6(3, 10) d, the median postoperative hospital stay was 2(1, 3) d, and the median follow-up was 8(3, 9) months. One child (5.8%) returned to the hospital for debridement due to poor wound healing and recovered well after surgery. The hydronephrosis grade, anteroposterior diameter of the renal pelvis, and renal parenchyma thickness of children were significantly improved after surgery.

RSLP is safe and effective for the treatment of UPJO in children.

To compare the short-term clinical efficacy of fractional CO₂ laser and biofeedback electrical stimulation for mild to moderate female stress urinary incontinence (SUI).

This prospective randomized controlled trial enrolled 67 women (age ≤50 years) with mild to moderate SUI, randomly allocated to laser treatment (n=33) or biofeedback therapy (n=34). The laser group received three fractional CO₂ laser treatments at 4-6 week intervals, while the biofeedback group underwent electrical stimulation twice weekly for 12 weeks. Primary outcome was the International Consultation on Incontinence Questionnaire-Short Form (ICI-Q-SF) score, with Incontinence Quality of Life (I-QOL) score as a secondary outcome. Efficacy was assessed at 3-month follow-up.

The laser group demonstrated significant improvement in ICI-Q-SF scores from 8.00(6.00, 9.00) to 6.00(3.50, 8.50) (P<0.001), while the biofeedback group improved from 8.00(7.00, 9.00) to 7.00(5.75, 8.00) (P<0.001). I-QOL scores in the laser group increased from 80.60(67.65, 93.70) to 90.90(77.25, 96.55) (P<0.001), compared to improvement from 75.00(53.37, 78.67) to 78.40(65.90, 88.60) (P<0.001) in the biofeedback group. Both groups showed significant improvement from baseline; however, between-group comparisons revealed no statistically significant differences in treatment efficacy (P=0.923 for ICI-Q-SF; P=0.167 for I-QOL).

Both fractional CO₂ laser therapy and biofeedback electrical stimulation demonstrated significant efficacy for mild to moderate female SUI, but further research is warranted to evaluate long-term efficacy.

To investigate the impact of bladder spasm score combined with a modified PDCA cycle nursing management model on the incidence of bladder spasm in patients undergoing transurethral thulium laser enucleation of the prostate (ThuLEP).

The data of patients admitted to the Department of Urology, Shanghai East Hospital, from January 2022 to November 2024 for ThuLEP were retrospectively analyzed. Among them, 246 patients treated between January 2022 and June 2023 were assigned to the control group and received routine nursing care. A total of 278 patients treated from July 2023 to November 2024 were assigned to the observation group and underwent nursing management integrating a self-designed bladder spasm score with a modified PDCA cycle. Comparisons were made between the two groups regarding bladder spasm scores, incidence of bladder spasm, pain scores, postoperative bladder irrigation duration, the decrease in hemoglobin on the first day after the operation, postoperative hospital stay, analgesic usage rate, quality of life (QOL), anxiety scores, and nursing satisfaction.

All 524 enrolled patients successfully completed the surgery without requiring reoperation. In the control group, 69 cases (28.05%) developed postoperative bladder spasm, whereas 31 cases (11.15%) were observed in the observation group, demonstrating a statistically significant difference (P<0.05). The postoperative visual analogue scale (VAS) scores were significantly lower in the observation group [1(1, 2)] compared to the control group [3(1, 5)] (P=0.016). No significant differences were observed in postoperative bladder irrigation duration or hospital stay between the two groups (P>0.05). The bladder spasm score was significantly reduced in the observation group (5.3±2.4) versus the control group (9.5±2.7) (P=0.016). Statistically significant improvements were also noted in quality of life (QOL) scores, anxiety scores, and nursing satisfaction (P=0.006, 0.002, and 0.026, respectively).

The integrated bladder spasm score and modified PDCA cycle nursing management model effectively reduces the incidence of bladder spasm following thulium laser enucleation of the prostate, enhances patients' disease awareness, alleviates anxiety, and improves nursing satisfaction.

To explore the predictive value of machine learning models based on clinical and radiomics features for the risk of sepsis after percutaneous nephrolithotomy (PCNL), and to provide a scientific basis for early prevention and intervention in clinical practice.

A retrospective analysis was conducted on the data of 339 patients with kidney stones who underwent PCNL from January 2020 to January 2024. Patients were divided into sepsis and non-sepsis groups based on the quick sequential organ failure assessment (qSOFA) score at 24 h postoperatively. Clinical data were collected and radiomics features were extracted from CT images. After a multi-step feature selection strategy, 8 radiomics features with significant predictive value were retained. Patients were randomly divided into a training set (n=237) and a test set (n=102) at a ratio of 7:3. Eight machine learning algorithms, namely logistic regression (LR), support vector machine (SVM), k-nearest neighbors (KNN), random forest (RF), extremely randomized trees (ExtraTrees), extreme gradient boosting (XGBoost), light gradient boosting machine (LightGBM), and multi-layer perceptron (MLP), were used to construct the clinical model and radiomics model. Subsequently, the two models with the highest performance were integrated to develop a combined clinical-radiomics model for sepsis prediction, and a nomogram was established accordingly. Calibration curve was drawn to evaluate the calibration efficacy of the nomogram, and Hosmer-Lemeshow fitting analysis was used to evaluate the calibration ability of the nomogram. Decision curve analysis (DCA) was drawn to evaluate the clinical utility of the prediction model. Model performance was assessed by the area under the receiver operating characteristic (ROC) curve (AUC).

Among the 339 patients in this study, 24(7.1%) developed sepsis postoperatively. Comparisons between the two groups revealed significant differences in gender, preoperative suspicion of infectious stones, stone burden, hemoglobin, positive urine nitrite, urine white blood cells, total blood protein, globulin, and prealbumin (P<0.05). Multivariate logistic regression further showed that preoperative suspicion of infectious stones (OR=5.589, 95%CI: 1.659-18.834, P=0.005), positive urine nitrite (OR=5.312, 95%CI: 1.802-15.662, P=0.002), and total blood protein <68.1 g/L (OR=0.245, 95%CI: 0.071-0.846, P=0.026) were independent risk factors for postoperative sepsis after PCNL. Consequently, these three indicators were selected as parameters for the construction of a clinical prediction model. In the test set of the clinical model, the ExtraTrees model exhibited superior performance among the eight machine learning models, achieving an AUC of 0.743. In the test set of the radiomics model, the KNN model demonstrated the highest performance among the eight machine learning models, with an AUC of 0.878. By integrating the aforementioned clinical and radiomics model, a combined clinical-radiomics model for sepsis prediction was developed, and a corresponding nomogram was constructed. The results indicated that in the test set, the integrated model incorporating both clinical and radiomics features achieved the best diagnostic performance, with an AUC of 0.898.

The clinical-radiomics combined model based on the ExtraTrees algorithm and the KNN algorithm can effectively predict the risk of postoperative sepsis after PCNL, which is helpful for clinicians to identify high-risk patients early and intervene in a timely manner, thereby reducing the incidence of postoperative sepsis.

To summarize the safety and clinical efficacy of 3D laparoscopic lingual mucosa graft ureteroplasty for the treatment of mid-to-long-segment ureteral strictures based on membrane anatomy.

The clinical data of 8 patients who underwent 3D laparoscopic lingual mucosal ureteroplasty for the treatment of mid-to-long-segment ureteral strictures at the Sixth Affiliated Hospital of Jinan University between July 2021 and February 2025 were retrospectively analyzed. The cohort comprised 5 males and 3 females, with a median age of 47.5 (range: 19-55) years. The median ureteral stricture length was 4.25 (range: 3.0-7.0) cm. The median preoperative serum creatinine level was 84.7(range: 56.2-141.1) μmol/L. All 8 patients underwent membrane anatomy-based 3D laparoscopic lingual mucosal ureteroplasty in a single surgical position. Regular follow-up was conducted postoperatively.

All procedures were performed by the same urologist with 20 years of clinical experience, achieving a success rate of 100%. The median operative time was 240 (range: 227-410) min, the median estimated blood loss was 20 (range: 5-30) mL. The harvested lingual mucosal graft had a median length of 4.5 (range: 4.0-7.0) cm and width of 1.5 cm. The median postoperative hospital stay was 8 (range: 7-15) d. No high-grade complications (Clavien-Dindo Ⅲ-IV) occurred during or after surgery. The median follow-up time was 9 (range: 6-30) months. The median serum creatinine level at 6 months postoperation was 76.9 (range: 53.3-121.3) μmol/L; at the last follow-up, it was 73.4 (range: 52.4-128.7) μmol/L. Among the 7 patients with preoperative flank pain, 5 experienced complete resolution and 2 reported significant improvement. Two patients developed urinary tract infections (Clavien-Dindo Ⅱ), which resolved after targeted antibiotic therapy. Seven patients experienced transient mild numbness at the lingual donor site (Clavien-Dindo I), with only 1 case persisting at the final follow-up. Five patients developed mild tongue movement impairment, all of which resolved after rehabilitation training. One patient had a grade B wound healing at the drainage site (Clavien-Dindo Ⅱ), which healed completely after local debridement and dressing changes. At the final follow-up, only 1 patient showed a mild increase in serum creatinine (an increase of 7.9 μmol/L, <15.0%). In the remaining 7 patients, renal function improved compared to preoperative levels (mean decrease in serum creatinine range 2.2-64.5 μmol/L). During follow-up, the fluctuation in renal function was <10% in all patients (except for 1 patient with a decrease of approximately 55%). No patient required dialysis or developed acute kidney injury.

The use of 3D laparoscopy combined with membrane anatomy-based dissection facilitates the mobilization and exposure of the strictured ureter, reducing bleeding and collateral injury. Lingual mucosal graft ureteroplasty based on membrane anatomy effectively relieves mid-to-long-segment ureteral obstruction without serious complications, demonstrating good feasibility and safety. However, further clinical data is needed to validate its efficacy and safety.

To explore the clinical efficacy and postoperative follow-up results of high ligation of hernia sac through concealed small incision in the treatment of inguinal hernia and communicating hydrocele in children, and to provide reference for children with inguinal hernia or communicating hydrocele.

The clinical data of 820 children (a total of 896 surgical procedures) with inguinal hernia or hydrocele treated by concealed small incision surgery from December 2010 to December 2024 were retrospectively analyzed. The operation time, intraoperative blood loss, postoperative complications, recurrence rate and incision aesthetics were collected. Vancouver Scar Scale (VSS) was used to evaluate the incision scar at 1 year after operation.

The average operation time of unilateral surgery was (8.2±4.5) min, and that of bilateral procedures was (14.3±5.8) min. The intraoperative blood loss was less than 5 mL. The total incidence of postoperative complications was 0.22%(2/896). The ipsilateral recurrence rate was 0.67% (6/896), and the contralateral recurrence rate was 1.34%(12/896). One year after the operation, 685 cases were followed up. The VSS evaluation results indicated that the score of 0 (no visible trace) accounted for 67.2%, score of 1-3 (slight trace) accounted for 27.7%, and score ≥4 (visible scar) accounted for 5.1%. There was no persistent postoperative pain or cryptorchidism during the follow-up period.

High ligation of concealed small incision hernia sac has the advantages of short operation time, small trauma, fast recovery, beautiful incision and low incidence of complications. It is a safe and effective surgical method for the treatment of inguinal hernia or communicating hydrocele in children, especially for children in primary care settings or specific anesthesia contraindications.

To explore the influence of dyadic coping on psychological distress in patients undergoing androgen deprivation therapy (ADT) for prostate cancer and their spouses.

A convenience sampling method was used to select 223 patients with prostate cancer undergoing ADT and their spouses from two tertiary grade A hospitals in Guangdong Province between October 2024 and August 2025. General information questionnaires, the dyadic coping inventory, and the Kessler Psychological Distress Scale were used for assessment. An actor-partner interdependence model was established to analyze the relationship between dyadic coping and psychological distress in both partners.

The analysis of the actor-partner interdependence model showed that regarding positive coping, the patient's positive dyadic coping negatively influenced their own psychological distress (β=-0.371, P<0.05), but positively influenced the spouse's psychological distress (β=0.462, P<0.05). The spouse's positive dyadic coping negatively influenced both their own (β=-0.946, P<0.001) and the patient's psychological distress (β=-0.371, P<0.05). Regarding negative coping, the patient's negative dyadic coping did not significantly influence either their own or the spouse's psychological distress (P> 0.05). Conversely, the spouse's negative dyadic coping positively influenced both their own (β=0.465, P<0.001) and the patient's psychological distress (β=0.400, P<0.001).

Clinical nursing should implement psychosocial interventions for patients undergoing ADT and their spouses as an integrated unit. While affirming patients' positive coping efforts in alleviating their own psychological distress, emphasis should be placed on enhancing the spouse's positive coping and reducing their negative coping, so that the psychological distress of both partners can be alleviated.

To explore the effect of three-stage training mode on the training of urological endoscopic surgeons.

Forty surgeons who participated in the urological laparoscopic training course were selected as the research participants, and a before-after self-control design was used. The pass rates in basic operation skills, such as picking beans, paper cutting, threading needles, stitching and tying and laparoscopic porcine nephrectomy, as well as the confidence of completing the operation were compared before and after the training of the three-stage training model, which includes basic theory learning, simulation training and clinical practice.

After training, participants had obviously improved in the basic laparoscopic operation skills (picking beans, paper cutting, threading needles, stitching and tying) and laparoscopic porcine nephrectomy (90.0% vs 55.0%, 85.0% vs 57.5%, 82.5% vs 42.5%, 82.5% vs 35.0%, 75.0% vs 22.5%, respectively, P<0.05). After the training, the confidence score of completing the operation was significantly higher than that before the training [(4.2±0.9) vs (2.2±0.9), P<0.001].

The three-stage training model has great application value in the training of urological endoscopic surgeon, which is worthy of wider implementation.

In patients with ACTH-independent Cushing's syndrome (primarily including adrenal cortical adenomas and adenocarcinomas) following surgery, glucocorticoid replacement therapy is required due to long-term hypercortisolism-induced suppression of the hypothalamic-pituitary-adrenal (HPA) axis function. This article reviews the three-phase management strategy for this population postoperatively: the acute phase (days 0-14 postoperatively) primarily involves intravenous hydrocortisone, with transition to oral administration based on clinical and biochemical indicators; the tapering phase (2 weeks to 24 months postoperatively) employs a stepwise dose reduction regimen while monitoring symptoms and biochemical parameters; and the long-term follow-up phase (>24 months postoperatively) evaluates HPA axis recovery through ACTH stimulation tests to determine the timing of discontinuation. Additionally, medication adjustments for special populations such as children, pregnant women, and elderly patients are summarized. The aim is to provide practical references for perioperative glucocorticoid management in clinical practice.

Urothelial carcinoma (UC) represents the most common malignant neoplasm of the urinary system. Conventional diagnostic modalities, including radiographic imaging, endoscopic biopsy, and urinary cytology, are limited by radiation exposure, invasive morbidity, and inadequate sensitivity. In recent years, non-invasive urinary genomic assays have rapidly evolved, with DNA methylation, genetic mutations, and transcriptomic signatures emerging as highly promising molecular biomarkers. This systematic review examines the utility of these three classes of genomic biomarkers in UC diagnosis and post-treatment recurrence surveillance, providing a clinical reference framework.

To report a case of primary seminal vesicle adenocarcinoma (PSVA) presenting with persistent hematospermia as the initial symptom to enhance awareness of this disease.

The data of the patient with PSVA initially presenting with persistent hematospermia treated in our hospital was retrospectively analyzed, with a review of its management strategies and prognostic features based on literature. The 40-years-old patient underwent transurethral seminal vesiculoscopy at an external hospital after failed conservative treatment for persistent hematospermia. Three months postoperatively, hematospermia persisted with new-onset intermittent initial gross hematuria upon waking. The patient was transferred to our center for repeat seminal vesiculoscopy, which revealed hemorrhagic bilateral seminal vesicles and a cauliflower-like mass in the left seminal vesicle. Pathological examination of biopsied tissue confirmed seminal vesicle adenocarcinoma. Subsequent contrast-enhanced MRI and PET/CT revealed left seminal vesicle adenocarcinoma with ipsilateral pelvic lymph node metastasis. The patient underwent robot-assisted laparoscopic radical seminal vesiculectomy with prostatectomy and pelvic lymphadenectomy.

Histopathology confirmed bilateral PSVA infiltrating the prostate, with metastatic adenocarcinoma in the left external iliac lymph node. Follow-up PET/CT at 6 months postoperatively showed no recurrence. One year later, repeat PET/CT and MRI demonstrated right pelvic lymph node metastasis without local recurrence at the primary resection site. Salvage right pelvic lymphadenectomy was performed followed by adjuvant chemoradiotherapy. Follow-up PET/CT scan 1.5 years postoperatively demonstrated tumor recurrence in the right pelvic surgical bed. The patient is currently under ongoing follow-up.

PSVA is an exceptionally rare malignancy with aggressive biological behavior and poor prognosis. Clinically, it most frequently manifests with persistent hematospermia with or without concomitant hematuria as the initial symptom. Due to its exceedingly low incidence, misdiagnosis is common, necessitating heightened clinical vigilance. Radical surgical resection constitutes the cornerstone of treatment. Adjuvant therapies such as chemotherapy or radiotherapy may be considered postoperatively, though their therapeutic outcomes warrant further investigation. Postoperative recurrence remains frequent, mandating close long-term surveillance.

This article reports a case of progression after bladder-preserving multimodal therapy. A 47-year-old man was admitted with a 2-year history of bladder-preserving treatment for muscle-invasive bladder cancer (MIBC). Initial transurethral resection of bladder tumor (TURBt) in August 2022 revealed high-grade invasive urothelial carcinoma with glandular differentiation and invasion of the lamina propria, with immunohistochemistry showing Her-2 (3+) and PD-L1 combined positive score≈10. Owing to his strong preference for bladder preservation, the patient received combination therapy with disitamab vedotin plus toripalimab and underwent repeated TURBt, achieving temporary disease stabilization. In January 2025, imaging studies revealed a progressive lesion in the posterior wall of the urinary bladder with multiple pelvic/retroperitoneal lymph node metastases. Concurrently, pathology results from TURBt confirmed high-grade papillary urothelial carcinoma. Radical resection or systemic chemotherapy was recommended, but the patient refused again. In April 2025, further PET-CT demonstrated multiple enlarged lymph nodes with highly active metabolism adjacent to the left common iliac vessels and internal/external iliac vessels. And then, the patient underwent robot-assisted radical cystectomy with pelvic lymph node dissection and ileal conduit. Pathology revealed urothelial carcinoma with lamina propria invasion and lymph node metastases (ypT₁N₃M₀). Next-generation sequencing identified pathogenic mutations in TP53, EP300, KMT2A, and TERT. Multidisciplinary team discussion concluded that this patient represents a high-risk subgroup requiring multimodal systemic therapy. Given prior immune-related rash, adjuvant immunotherapy was withheld, and the patient instead received concurrent chemoradiotherapy with cisplatin, followed by consolidation chemotherapy with gemcitabine plus cisplatin, achieving stable disease on follow-up. This case highlights that bladder-preserving strategies failing with nodal metastasis warrant salvage radical cystectomy combined with systemic therapy. Early recognition of nodal metastases requires not only conventional imaging size criteria but also morphologic features and integration of molecular diagnostics, which may improve individualized management and long-term outcomes.

This article reports a challenging case of severe urinary tract infection accompanied by lymphadenopathy. The patient was admitted with a chief complaint of "cloudy urine for over four months." Imaging revealed thickening of the left ureteral wall with severe hydronephrosis of the left kidney. PET/CT demonstrated multiple metabolically active foci in the left kidney, ureter, and bladder, along with metabolically active lymph nodes in the left renal hilum and para-aortic region (SUV_max 9.8), making it difficult to differentiate between metastatic and inflammatory lymph nodes. Four urine cytology tests failed to detect cancer cells. Upon the multidisciplinary consultation on difficult cases in Guangdong Urological Association, consultation, the patient underwent laparoscopic left nephroureterectomy with para-aortic lymph node biopsy. Postoperative pathology confirmed left pyonephrosis and nephrolithiasis, ruling out malignancy. This article discusses the differential diagnostic strategies for distinguishing between lymph node metastasis from urothelial carcinoma and inflammatory lymphadenopathy.