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Highlights from the 2025 American Urological Association Annual Meeting |
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| Cost-Effectiveness Analysis of 89Zr-Girentuximab PET—CT (TLX250) to Guide Management of Small Renal Masses |
| Pratik Kanabur, MD |
| Pratik Kanabur presented a cost-effectiveness analysis of 89Zr-girentuximab PET-CT (TLX250) for managing small renal masses. Using a decision analytic model, TLX250—especially when combined with biopsy for negative scans—proved to be the most cost-effective strategy, minimizing unnecessary surgeries for benign tumors while reducing the risk of missing malignancies. Overall, TLX250 offers a promising, non-invasive alternative to traditional biopsy and empiric partial nephrectomy. |
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| Should Primary, Solitary, and Small (3 cm) TaHG Tumors Be Classified as Intermediate- or High-Risk Disease? A Retrospective, International Cohort Study
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| Jethro Kwong, MD
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| Jethro Kwong presented a large international study showing that primary, solitary, small (<3 cm) Ta high-grade bladder tumors without CIS have a progression risk similar to intermediate-risk disease, not high-risk (HR). In contrast, TaHG tumors with even one additional risk factor behaved more like HR disease. These findings support classifying small, solitary TaHG tumors without CIS as intermediate-risk in clinical practice.
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| Primary Resistance to Nivolumab plus Ipilimumab Therapy Affects Second-Line Treatment Outcomes in Patients with mRCC |
| Kazuyuki Numakura, MD |
| Kazuyuki Numakura presented data showing that metastatic RCC patients with primary resistance to first-line nivolumab plus ipilimumab had significantly worse outcomes with second-line therapies. These patients often had poor IMDC risk scores and performance status before second-line treatment, and outcomes were poor regardless of which VEGFR-TKI was used. Primary resistance appears to be a key factor driving poor prognosis across treatment lines. |
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| Development and Evaluation of a Machine Learning-Based Approach for Real-Time Kidney Stone Detection and Segmentation in Robotic Flexible Ureterorenoscopy |
| Tzevat Tefik, MD, FEBU |
| Tzevat Tefik presented a machine learning model using Mask R-CNN to achieve real-time kidney stone detection and segmentation during robotic flexible ureterorenoscopy, with an AUC-ROC of 92.22% and frame processing under 450 ms. This AI-driven tool showed strong potential to enhance visualization, procedural efficiency, and surgical outcomes. Future plans include testing under more challenging conditions and expanding the dataset for broader validation. |
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| The Effect of High-Power Lasers on Renal Temperature During Intrarenal Surgery |
| Kavita Gupta, MD |
| Kavita Gupta presented a study evaluating renal temperatures during high-power laser lithotripsy. The research showed that while low-power settings were safe, high-energy modes (dusting and pop-dusting) raised temperatures above the 43°C threshold in as little as 15 seconds, posing a risk of renal injury. The Thulium Fiber Laser generated significantly higher maximum temperatures than the Holmium:YAG laser, highlighting the importance of monitoring during high-power procedures. |
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| Impact of Timing of Recurrence on Survival Outcomes: Implications for Postoperative Management in a KEYNOTE-564 Population |
| Chiara Re, MD |
| Chiara Re presented an analysis showing that in a KEYNOTE-564-like population, earlier recurrence of renal cell carcinoma after surgery is associated with worse cancer-specific and overall survival. In a study of 422 patients, about half experienced recurrence, with early, mid, and late recurrences nearly evenly split; earlier recurrence significantly worsened outcomes. Dr. Re emphasized that timing of recurrence should guide postoperative management strategies, potentially allowing more conservative approaches for those at risk of late recurrence. |
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| Upfront Cytoreductive Nephrectomy With Deferred Systemic Therapy For Metastatic Renal Cell Carcinoma |
| Bimal Bhindi, MD, CM, MSc, FRCSC, |
| Bimal Bhindi presented data from a Canadian multicenter cohort showing that selected patients with metastatic renal cell carcinoma who underwent upfront cytoreductive nephrectomy with deferred systemic therapy achieved favorable outcomes, with a median systemic therapy-free survival of 16.7 months and a median cancer-specific survival of 73.8 months. Factors like better performance status, low metastatic burden, and absence of venous tumor thrombus were associated with improved survival. |
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| Prognostic Impact of the Maximal Evaluable Lesion Size in Patients with Metastatic Renal Cell Carcinoma Treated with Nivolumab plus Ipilimumab Combination Therapy |
| Yoshie Mita, MD |
| Yoshie Mita presented a study showing that a larger maximal evaluable lesion size (MLS ≥ 35 mm) in patients with metastatic renal cell carcinoma (mRCC) treated with nivolumab plus ipilimumab was associated with significantly worse progression-free and overall survival. Multivariable analysis identified larger MLS, lower Karnofsky performance status, and non-clear cell histology as independent predictors of poorer outcomes. |
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| Comparative Assessment of Combination of Tyrosine Kinase Inhibitors with Immunotherapy Versus Dual Combination Immunotherapy as First-Line Treatment for Patients with Advanced RCC: A Multicenter Study Using the TOURS Database |
| Keita Tamura, PhD |
| Keita Tamura presented a multicenter TOURS database study comparing tyrosine kinase inhibitor (TKI) plus immunotherapy (IO) combinations versus dual IO therapy as first-line treatment for advanced RCC. The study found that IO-TKI combinations had significantly higher response rates, longer progression-free survival (16.9 vs. 8.6 months), and better overall survival compared to dual IO therapy, with fewer immune-related adverse events. |
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| Impact of Cytoreductive Nephrectomy on Immune Checkpoint Inhibitor Therapy: Treatment Outcomes of Immune Inhibitor Combination Therapies for Metastatic Renal Cell Carcinoma with Primary Kidney Tumors |
| Toshio Takagi, MD, PhD |
| Toshio Takagi presented a study comparing outcomes of ipilimumab + nivolumab (IO + IO) versus IO + TKI therapies in metastatic RCC patients with primary kidney tumors, and evaluating the role of cytoreductive nephrectomy. Both treatment types showed similar response rates, but deferred cytoreductive nephrectomy was an independent predictor of improved overall survival compared to upfront or no surgery. The study highlights that timing of surgery, rather than the type of immunotherapy combination, significantly impacts survival outcomes. |
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| Comparison of Clinical Outcomes Between Cabozantinib + Nivolumab and Lenvatinib + Pembrolizumab in Advanced RCC |
| Kazutaka Nakamura, MD |
| Kazutaka Nakamura presented a retrospective study comparing cabozantinib + nivolumab versus lenvatinib + pembrolizumab in advanced RCC, finding no significant differences in progression-free or overall survival between the regimens. Although cabozantinib + nivolumab had a higher objective response rate, this may have been influenced by more frequent deferred cytoreductive nephrectomy in the lenvatinib + pembrolizumab group. |
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