Renal cell carcinoma （RCC），one of the most prevalent malignancies in the urinary system，underscores the critical role of pathological diagnosis in disease management and treatment strategy formulation. With the vigorous development of artificial intelligence，particularly the notable breakthroughs of deep learning in medical image processing，intelligent pathological diagnosis for RCC has emerged as a forefront research area. This article systematically reviews the latest advancements in RCC intelligent pathological diagnosis，detailing the current applications of artificial intelligence in histological subtype discrimination，pathological type differentiation，nuclear grade determination，prognosis evaluation，and gene mutation prediction. Despite the achievements made，clinical adoption of RCC intelligent pathological diagnosis faces several challenges，including incomplete coverage of pathological types，limited dataset sizes，low data standardization，insufficient algorithm generalizability，and the absence of prospective external clinical validations. Moving forward，research should prioritize addressing these existing issues while focusing on enhancing model interpretability，building RCC pathological foundation models，and developing multimodal RCC-specific foundation models. These efforts aim to advance the maturity and extensive application of RCC intelligent pathological diagnosis technologies，ultimately providing more personalized，precise，and efficient diagnostic and treatment options for RCC patients.

Prostate cancer is one of the most common malignant tumors among men，and its incidence is on an upward trend worldwide. The accurate prognosis prediction of prostate cancer patients is a crucial reference for formulating personalized treatment plans and long-term management，but currently there is a lack of objective，accurate，and standardized tools. In recent years，the application of artificial intelligence technology in the medical field has become increasingly extensive，especially in the prognostic prediction of prostate cancer. It has shown tremendous potential.Representative research achievements include the identification of imaging features in multiparametric magnetic resonance through machine learning models，which can achieve an accuracy rate for patient prognosis prediction that exceeds the Prostate Imaging Reporting and Data System （PI-RADS）. Additionally，through machine learning models，the identification of pathological sections can achieve an accuracy rate for patient prognosis prediction that surpasses the traditional Gleason scoring system. This article aims to review the current state of artificial intelligence in the prognostic prediction of prostate cancer，discuss the existing problems in its development，and look forward to future development trends.

Objective

To investigate the clinical and imaging features of inflammatory myofibroblastic tumor of urinary bladder （IMTUB），aiming to improve the clinical diagnosis and treatment of this rare disease.

Methods

The clinic data of 4 cases IMTUB confirmed by pathology from December 2008 to July 2023 were retrospectively analyzed，and related literatures were reviewed.

Results

All cases were presented with severe urinary irritation while two of them complained gross hematuria. It can be described as clear submucosal border lesions grow in an expansive way and annular or delayed enhancement on contrast-enhanced CT. MRI showed slightly higher signal intensity on T2WI，enhancement of lesions was obvious after enhancement. Partial cystectomy was performed to completely remove the tumor in all cases.

Conclusions

IMTUB is a rare benign tumor with low malignant potential and is easily misdiagnosed as a malignant bladder tumor. It should be strongly suspect to IMTUB while the lesions on CT or MR appear to the following features，including the submucosal polyps grow in a nodular expansive way，annular enhancement sign or delayed contrast enhancement sign. In addition，routine biopsy of bladder tumors is necessary for this type of tumor to clarify the nature and avoid misdiagnosis. Partial cystectomy is a good choice to cure this disease which has a good prognosis.

Objective

To explore the application effect of tracking methodology combined with Failure Mode and Effects Analysis （FMEA） in patients undergoing bladder infusion chemotherapy.

Methods

A total of 5436 patients who underwent transurethral resection of bladder tumors in the First Affiliated Hospital of Navy Military Medical University from May 2020 to May 2021 and subsequently received bladder instillation chemotherapy in the outpatient department were included. The intervention method is to conduct nursing risk assessment of patients through the application of tracking methodology combined with FMEA，and establish plans and implement improvement measures. This study used convenience sampling method to select 646 patients who implemented improvement measures （observation group） and 531 patients who did not implement measures （control group）. By comparing the risk priority index （RPN），satisfaction with nursing quality indicators，and annual incidence of adverse events between two groups of patients，evaluate whether the nursing plan benefits patients undergoing bladder infusion chemotherapy.

Results

Compared with patients without intervention，the application of tracking methodology combined with FMEA mode resulted in varying degrees of decrease in RPN scores before，during，and after bladder infusion therapy. The difference between the implementation group and the control group was statistically significant （P＜0.001）； Pre operation education，patient privacy protection，nurse service attitude，operating room conditions，proficiency in operating techniques，post operation condition observation，ability to handle adverse reactions，out of hospital guidance，patient satisfaction with the entire operation process，and treatment effectiveness all showed significant improvements compared to the control group （P＜0.001）； The incidence of adverse events decreased from 3.58% （not implemented） to 0.77% （implemented），and the incidence of adverse reactions was significantly lower than that of the control group，with statistical significance （P=0.001）.

Conclusions

The combination of tracking methodology and FMEA mode can effectively improve the weak links in the process of bladder perfusion chemotherapy，ensure the safety of bladder perfusion chemotherapy，reduce the incidence of adverse events，and improve the satisfaction of nursing indicators. It is a beneficial nursing attempt that is worth learning and promoting.

Objective

To explore the learning curve and share surgical experiences of modified trans-umbilical single-port laparoscopic ligation of patent processus vaginalis by single surgeon in a primary hospital.

Methods

A retrospective analysis was conducted on the clinical data of 25 children，who underwent modified trans-umbilical single-port laparoscopic ligation of patent processus vaginalis by single surgeon in the Urology department of Kashgar People's Hospital，from July 2023 to January 2024.The learning curve was generated using cumulative sum analysis （CUSUM） method based on cumulative number of surgical cases and the unilateral repair time. After the number of surgical cases required to enter the vertex of the learning curve was determined，the differences between the learning and completion stage were compared.

Results

18 male and 7 female pediatric patients were included in the study，with 21 unilateral and 4 bilateral deficiencies. All surgeries were successfully completed without any additional operating channels or conversion to open surgery. Five cases preoperatively diagnosed as unilateral lesion were identified to have a contralateral patent processus vaginalis intraoperatively and received simultaneous repair surgery. The best fitting model for the CUSUM learning curve was a cubic curve with the equation:y= 0.02x³-1.079x²+14.732x+0.529 （x is the number of surgical cases），which had a high fitting coefficient R²=0.938. The fitting curve crossed the vertex when accumulating to the 9th case，which was recognized as the cut point for dividing the curve into learning stage and the completion stage. No significant difference was found between the two groups in terms of intraoperative blood loss，postoperative pain score，appearance score，and postoperative hospital stay，while the unilateral repair time in the completion stage was significantly shorter than that in the learning stage ［（16±5） min vs （28±5） min，P＜0.001］. There were no significant complications in both groups after 1 month of follow-up.

Conclusions

The modified transumbilical single-port laparoscopic ligation of patent processus vaginalis is safe and effective. The technique can be proficiently mastered after accumulating 9 surgical experiences，which is suitable for application and promotion in grassroots hospitals.

Objective

To evaluate the safety and efficacy of single-port percutaneous nephroscopic unroofing of renal cysts and traditional laparoscopic unroofing of renal cysts.

Methods

The clinical data of patients with renal cyst from January 2019 to December 2021 were analyzed retrospectively. Single-port percutaneous nephroscopic unroofing of renal cysts was performed in 14 cases and laparoscopic unroofing in 39 cases. There was no significant difference in gender，age，BMI between the two groups （P＞0.05），as well as the size and position of cysts （P＞0.05）. The treatment-related endpoints of the two groups were compared，including hospital stay，operation time，intraoperative blood loss，postoperative drainage，postoperative length of stay and postoperative painkiller use. In addition，the adverse effect and follow-up of the two groups were evaluated.

Results

The operations of 53 patients in both groups were completed successfully. The hospital stay in single-port group was less than those in the laparoscopy group，but there was no significant difference between the two groups ［（4.1±1.4） d vs （5.9±2.0） d，P=0.056］. No significant differences were found between the two groups in operation time ［80.5（36.0） min vs 63.0（37.0） min］，intraoperative blood loss ［7.5（8.0） ml vs 10.0（0.0） ml］，postoperative drainage ［0.0（50.0） ml vs 0.0（30.0） ml］ and painkiller use ［2.0（2.0）vs 1.0（4.0） times］. The postoperative length of stay in single-port group was significantly shorter than that in laparoscopy group ［（2.4±0.5） d and （3.1±0.8） d，P=0.002］. There were no obvious adverse reactions in the single-port group，but 2 cases in the laparoscopy group. Twelve cases in single-port group and 17 cases in laparoscopy group were followed up，and the imaging examination of 29 cases showed complete disappearance or more than 50% volume reduction of renal cysts，no recurrence cases in both groups.

Conclusions

The effect of single-port percutaneous nephroscopic unroofing of renal cyst is similar to that of laparoscopic renal cyst unroofing，which is safe and feasible，and it has a certain advantage in postoperative length of stay.

Objective

To introduce the application of real-time ultrasound-guided the outof-plane and the in-plane percutaneous renal calyx puncture techniques based on electromagnetic tracking and surgical navigation system.

Methods

35 cases of renal calculi undergoing percutaneous nephrolithotomy in Shenzhen Longgang District Sixth People's Hospital from September 2016 to July 2018 were analyzed. There were 25 males and 15 females，the median age of them was 44（29-70） years. BMI was 24.5（18.5-32.5） kg/m². Percutaneous nephrolithotomy was conducted by the SonixGPS^TM ultrasound equipment with electromagnetic tracking and navigation system produced by Ultrasonix of Canada. Under the guidance of electromagnetic tracking puncture needle，three-dimensional intraoperative navigation and real-time ultrasound guidance，two percutaneous calyceal puncture methods were used to establish the surgical channel by puncture the skin outside or inside the ultrasonic-image plane of ultrasonic transducer.According the different puncture methods，the cases were divided into two groups，20 cases in the outof-plane puncture group and 15 cases in the in-plane puncture group.

Results

The median successful time of puncture in the out-of-plane puncture group and the in-plane puncture group was 4.0（3.0-9.0）minutes and 6.0（3.0-18.0） minutes，respectively，and the difference was significant difference （P＜0.05）.The puncture success rates were 95.0%（19/20） and 93.3%（14/15），with no significance （P＞0.05）. Among the 35 cases，29 cases was achieved with the precise puncture effect of one-time puncture attempt and only 1 case had surgical complications with the highest grade of Clavien-Dindo classification Ⅲa.

Conclusion

The real-time ultrasound-guided the out-of-plane puncture method based on electromagnetic tracking and surgical navigation system has shorter puncture time and easier operation. When the intercostal space is not wide enough，the in-plane puncture method can still be used for precise puncture.

Objective

To investigate the clinical efficacy of holmium laser lithotripsy of bladder lithiasis between F8.0/9.8 ureteroscopy combined with 21 F cystoscope sheath and plasma electroscope.

Methods

A retrospective study was performed on 112 bladder lithiasis patients admitted from January 2016 to May 2023 in the Urology department of Xinrongqi Hospital. According to different surgical methods，the patients were divided into two groups，including 58 cases in the 21 F cystoscope sheath combined with 8.0/9.8 F ureteroscopy （cystoscope sheath group） and 54 cases in the plasma electroscope（electroscope group）. Operation time，intraoperative flush volume，surgical field satisfaction，length of hospital stay，hospitalization cost，postoperative hematuria duration，urethral pain score，stone clearance rate were compared between the two groups.

Results

There was no significant difference in the preoperative general information between the two groups （P＞0.05）. Compared with plasma electroscope group，cystoscope sheath group showed shorter operation time，higher surgical field satisfaction，less intraoperative flushing，lower hospitalization costs，shorter postoperative hematuria duration and low pain score and higher stone clearance rate （P＜0.05）. There was no significant difference in the length of hospital stay between the two groups （P＞0.05）.

Conclusions

21 F cystoscope sheath combined with 8.0/9.8 F ureteroscopy is safe and effective surgical methods for bladder lithiasis patients using holmium laser lithotripsy. Compared with plasma electroscope，21 F cystoscope sheath combined with 8.0/9.8 F ureteroscopy has the characteristics of higher surgical efficiency，lower hospitalization cost，less surgical trauma，strong operability，better clinical application value and can be popularized widely.

Objective

To investigate the clinicopathologic features，diagnosis，differential diagnosis，treatment and prognosis of dedifferentiated liposarcoma of spermatic cord.

Methods

The clinical data of two patients with dedifferentiated liposarcoma of spermatic cord diagnosed in the First Affiliated Hospital of Zhengzhou Universitywere retrospectively analyzed and the related literature was reviewed.

Results

Both patients presented with right groin masses. Case 1 underwent excision of groin lesion and radical excision of right testicle. No recurrence was observed during 6 months'follow-up. Case 2 was admitted to a local health center for tumor biopsy，but no further treatment was given after pathological diagnosis in our hospital. At present，one year follow-up has been conducted and local progress has been found.

Conclusions

Dedifferentiated liposarcoma of spermatic cord is rare and often presents as painless mass in one groin or abnormal enlargement of the scrotum on one side. Detailed preoperative physical examination and imaging examination are necessary and need to be combined with histopathology，immunohistochemistry and genetic testing to confirm the diagnosis. Surgical resection is the preferred treatment，which can be supplemented with chemoradiotherapy and molecular targeted therapy if necessary. Close follow-up should be conducted after radical resection.

Objective

To compare the clinical effect and complication between anatomical microscopical varicocele ligation and conventional microscopical varicocele ligation for the treatment of varicocele.

Methods

The clinical data of 80 patients with varicocele admitted to Qingdao Municipal Hospital from August 2020 to April 2022 were analyzed. All patients received microscopic varicocele ligation，they were divided into anatomical and conventional group according to different surgical methods.The conventional group underwent surgery in a conventional manner. The anatomical group innovatively dissected the "posterior and lateral spaces of spermatic cord" and used two rubber strips to improve the actual surgical level. The number of ligated vein branches，perioperative complications，operation time，numeric rating scale （NRS），quality of semen after 6 months operation，and recurrence rate were compared between the two groups.

Results

Compared with the conventional group，the operation time in anatomical group was significantly reduced （P＜0.05）. The number of branches of internal spermatic vein ligation in the anatomical group was significantly less than that in the conventional group （P＜0.05）.There were no significant differences in the incidence of perioperative complications，recurrence rate，degree of relief of scrotal pain and the improvement of sperm quality between the two groups （P＞0.05）.

Conclusions

The spermatic vein ligation under the anatomical microscope can effectively improve the patient's sperm quality and clinical symptoms，and can significantly reduce the operation time，the number of operative ligation of spermatic vein and the learning curve，which provides a new idea for microscopic treatment of varicocele in the future.

Objective

Based on two-dimensional transperineal pelvic floor ultrasound images obtained during the Valsalva maneuver，this study aims to develop a deep learning artificial intelligence model to assist in the clinical grading diagnosis of female stress urinary incontinence （SUI）.

Methods

All patients underwent transperineal pelvic floor ultrasound examination within one month of their initial visit. According to the International Consultation on Incontinence Questionnaire-Short Form （ICI-QSF），the SUI patients were divided into three groups: mild （S1），moderate （S2），and severe （S3）. Baseline information and ultrasound images of the patients were collected，and midsagittal plane images of the pelvic floor during the Valsalva maneuver were selected. After preprocessing，the regions of interest（ROI） were semi-automatically segmented using computer algorithms. A transfer learning approach was applied using a ResNet50 model pretrained on ImageNet. The data were randomly divided into a training set and a test set in an 8∶2 ratio，with five-fold cross-validation performed on the training set. After model training，performance was evaluated using a confusion matrix and the area under the receiver operating characteristic curve （AUC）. Finally，gradient-weighted class activation mapping （Grad-CAM） was used to generate heatmaps to visually demonstrate the areas of interest identified by the model.

Results

A total of 282 patients were included in the study，comprising 167 patients with SUI and 115 non-SUI patients（S0）. The model achieved an accuracy of 84.1% in the training set and 83.9% in the test set. The AUC values in the training set were as follows: non-SUI 0.89 （95%CI: 0.78-0.97），mild SUI 0.96 （95%CI: 0.90-1.00），moderate SUI 0.92 （95%CI: 0.81-1.00），and severe SUI 0.93 （95%CI: 0.84-0.98）. In the test set，the AUC values were non-SUI 0.88 （95%CI: 0.77-0.98），mild SUI 0.91 （995%CI: .80-0.99），moderate SUI 0.92 （95%CI: 0.80-1.00），and severe SUI 0.88 （95%CI: 0.75-0.98）.

Conclusion

The grading diagnostic artificial intelligence model based on two-dimensional transperineal pelvic floor ultrasound images during the Valsalva maneuver shows potential to become an objective basis for the grading diagnosis of SUI patients.

Objective

To explore the influencing factors of stress urinary incontinence （SUI）after transvaginal mesh （TVM） surgery in patients with pelvic organ prolapse （POP） and construct a column chart prediction model.

Methods

A retrospective collection of clinical data was conducted on 180 patients who underwent transvaginal mesh due to POP stage II-IV admitted to the Suzhou High-tech Zone People's Hospital from May 2019 to May 2021. The degree of prolapse was evaluated using the POP-Q staging method of the International Association for Urinary Control. Patients were divided into SUI group（51 cases） and N-SUI group （129 cases） based on whether they had SUI after TVM surgery. Multivariate logistic regression analysis was conducted to identify the influencing factors of SUI after TVM surgery.Introduce the factors that affect postoperative SUI in TVM into R3.6.3 software and RMS package，and construct a column chart model for predicting the risk of postoperative SUI in TVM. Draw a calibration curve，which is the receiver operating characteristic （ROC） curve，to evaluate the model.

Results

Among the 180 POP patients，51 cases （28.33%） developed SUI after TVM surgery，the proportion of vaginal delivery，preoperative urodynamic examination occult SUI （UDS-OSUI），parity ≥2，and preoperative UDS urethral obstruction in the SUI group was significantly higher than that in the N-SUI group，and the proportion of combined anti UI surgery was lower than that in the N-SUI group （P＜0.05）. Multivariate logistic regression analysis showed that combined anti UI surgery was a protective factor for concurrent SUI （P＜0.05），while vaginal delivery，preoperative UDS-OSUI，parity≥2，and preoperative UDS urethral obstruction were independent risk factors for concurrent SUI （P＜0.05）. The column chart model shows that vaginal delivery increases the weight by 74.9 points，preoperative UDS-OSUI increases the weight by 100 points，parity ≥2 increases the weight by 75.1 points，preoperative UDS urethral obstruction increases the weight by 82.5 points，and no combined anti UI surgery increases the weight by 92.2 points. The H-L fitting test shows that，χ²=4.072，P=0.771. The slope of the calibration curve approaches 1. ROC curve was used to evaluate model discrimination，with an area under the curve of 0.875 （95%CI: 0.817-0.919），and sensitivity and specificity of 74.51% and 83.72%，respectively.

Conclusion

Vaginal delivery，preoperative UDSOSUI，parity ≥2，preoperative UDS urethral obstruction，and combined anti UI surgery are all influencing factors of postoperative SUI in TVM. The column chart prediction model constructed in this study has high value in the evaluation of SUI and may be used for personalized prediction of SUI.

Objective

To evaluate the pain during and after urodynamic examination of women using 2% lidocaine gel and lubricant gel.

Methods

A randomized，controlled，double-blind study was conducted. During the examination，female patients who received urodynamic examination were randomly divided into 2% lidocaine gel group and lubricant gel group. Neither the patient nor the examining physician knows the type of gel. Patients self-reported their pain levels before the start of the examination，after the cotton swab examination，and 30 minutes after the placement of the urinary dynamic catheter. The pain was evaluated using the Wong Baker Pain Scale，with a score range of 0-10 points. After the examination is completed，the patient will use the Likert scale to assess the extent of pain compared to expectations. The examining physician scores the patient's impression of pain during the examination process after the examination is completed.

Results

A total of 75 patients were included in the study，including 38 patients in the 2% lidocaine gel group and 37 patients in the lubricant gel group. The pain scores of patients in the 2% lidocaine gel group were lower than those in the lubricant gel group after swab examination and placement of urodynamic catheter （P＜0.001）. There was no significant difference in the average pain scores between the two groups 30 minutes after the examination was completed （P＞0.05）.Both groups of patients believed that the pain during the examination was milder than expected. The examination physician's perception of pain during the examination was that the 2% lidocaine gel group was lower than the lubricant group （P＜0.001）.

Conclusion

2% lidocaine gel can alleviate the pain of catheter insertion and swab examination in urodynamic examination.

Objective

To investigate the expression of RDM1 in prostate cancer and its role in prostate cancer progress.

Methods

The TCGA database，prostate cancer tissues and cell lines were used to analyze the expression of RDM1 in prostate cancer. Survival analysis and COX regression confirmed the correlation between RDM1 and the prognosis of prostate cancer patients. Enrichment analysis，CCK8，cell flow cytometry，plate cloning experiment，EdU staining and Western Blotting experiment were used to analyze the role and mechanism of RDM1 in prostate cancer cells.

Results

The expression of RDM1 was significantly increased in prostate cancer and was positively correlated with poor prognosis of patients.In addition，RDM1 is an independent risk factor affecting the overall survival time of prostate cancer patients. Functionally，RDM1 enhanced the ability of proliferation in prostate cancer cells. Mechanistically，RDM1 promotes the G₀/G₁ to the S phase by upregulating the expression of CDK4，ultimately promoting the proliferation of prostate cancer cells.

Conclusion

RDM1 is highly expressed in prostate cancer and can promote the proliferation of prostate cancer cells. It is expected to become a novel target for prostate cancer treatment.

Objective

To explore the differences and specific mechanisms of the killing effect of oncolytic virus M1 on different prostate cancer cells.

Methods

The survival rate of 13 different prostate cancer cells treated with M1 virus at different titers （0，0.001，0.01，0.1，1，10 PFU/CELL） for 48 hours was detected by MTT assay. Detection of gene expression in 13 different prostate cancer cells through transcriptome sequencing. Spearman/Person correlation analysis on the correlation between cell survival rate and gene expression level. Verify the correlation analysis results through protein labeling （Western Blot） and gene silencing （siRNA）.

Results

The MTT assay showed that there were differences in the survival rates of 13 different prostate cancer cells under the same titer of M1 virus. Correlation analysis revealed that the MAPK14 gene was a key factor affecting the differential killing effect of M1 virus on different prostate cancer cells. Western blot showed that compared with the control group，the expression level of MAPK14 in siRNA group cells was significantly downregulated. The MTT assay showed that compared with the control group，the survival rate of cells in the siRNA group was significantly reduced under M1 virus infection （P＜0.05）.

Conclusion

MAPK14 is a key factor affecting the killing effect of M1 virus on prostate cancer cells. Targeted inhibition of MAPK14 can enhance the killing effect of M1 virus on prostate cancer cells.

Robot assisted radical prostatectomy is one of the main treatment methods for prostate cancer patients，and positive margins are a common adverse prognostic factor after surgery and an urgent problem that surgeons need to solve. This article reviews the definition，clinical significance，influencing factors，and treatment of positive margins in robot assisted radical prostatectomy.

This article reports a case of bladder cancer，who was admitted to the Second Affiliated Hospital of Nanjing Medical University due to "painless gross hematuria over two months". The color Doppler ultrasound of the urinary system showed that patient suffered from strong echoes in bladder，bilateral kidney stones，and mild right hydronephrosis. Further computed tomography （CT） confirmed the suspicious bladder-occupying lesion. Urinary tract cytology showed that dysmorphic cells were detected in urine-based smears and did not exclude tumors. A diagnosis of bladder cancer was considered，cystoscopy was performed and confirmed to be muscle invasive bladder cancer.After clarifying the indications for surgery，improving preoperative examination，and excluding contraindications，transpneumatic bladder route robot-assisted single-port laparoscopic bladder tumor resection and transurethral flexible ureteroscopic holmium laser lithotripsy with double kidney stones were performed under general anesthesia on August 8，2023. The machince preparation time was 15 min，the robotic operation time was 34 min，the time of transurethral flexible ureteroscopic holmium laser lithotripsy with double kidney stones was 181 min and the total operation time of the patient was 230 min. The intraoperative blood loss was about 20 ml.There were no complications during the operation. The patient recovered well after surgery. The results showed that single port robot-assisted laparoscopic partial cystectomy via pneumatic bladder approach is efficient，simple，delicate，safe，and the curative effect is positive.

Emphysematous pyelonephritis （EPN） is a rare infectious disease of the renal parenchyma characterized by extensive necrosis of the renal parenchyma with gas accumulation in the renal parenchyma and perirenal tissues. Emphysematous cystitis is characterized by the presence of gas in and around the bladder wall，which is more rare and often associated with emphysematous pyelonephritis. We report a case of emphysematous pyelonephritis and emphysematous cystitis in a female patient. Despite the presence of septic shock，acute renal insufficiency，hyponatremia，and thrombocytopenia，the patient was cured and discharged after conservative treatment with percutaneous puncture drainage combined with medical treatment. Combined with the literature，we discuss the clinical manifestations，pathogenesis and treatment principles of this type of disease.

This article reports a case with high-grade invasive urothelial carcinoma of the bladder. The patient was diagnosed as bladder cancer with multiple lymph node metastasis and penis metastasis two years ago. On June 22，2022，he was treated with Gemcitabine+Cisplatin （GC） combined with Lirilumab after diagnostic transurethral resection of bladder tumor（TURBT）. On November 23，2022，a follow-up examination revealed multiple lesions in the bladder involving the muscular layer. Immune maintenance therapy was continued，along with pelvic radiotherapy. In June 2023，immunotherapy was temporarily suspended due to hypothyroidism and later resumed. On December 4，2023，multiple lymph node metastases were still found during the follow-up examination. After a multidisciplinary consultation on difficult cases in Guangdong Urological Association，it is recommended that the patient be treated with Disitamab Vedotin combined with Toripalimab q2w for 6 cycles. After treatment，the patient's transurethral resection and biopsy did not show any cancer lesions，and the lymph nodes were significantly reduced or disappeared compared to before.Therefore，for advanced urothelial carcinoma with isolated metastatic lesions，based on evidence-based medicine，selecting first-line treatment options that include immunotherapy in combination with radiotherapy can further benefit.After the progress of first-line treatment，the immune "re-challenge" can still benefit，and the combination of immune and antibody conjugated drugs is an optional solution.