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Our objective was to present the perioperative and oncological results of robot-assisted surgery performed in our department. In our publication, we retrospectively reviewed the data of 658 robot-assisted procedures performed between 01/02/2022 and 31/03/2024. The average operative time for radical prostatectomy with bilateral lymph node block dissection was 229 minutes, mean blood loss was 305 ml. Without lymphadenectomy, mean blood loss was 233 ml, operative time was 185 minutes. Biochemical relapse- free rate was 81.6% one year after the procedures. 165 patients underwent robot-assisted partial nephrectomy, and 48 patients underwent radical nephrectomy. We performed the first robot-assisted cystectomy with intracorporeal "neobladder" technique in Hungary. In terms of urinary diversion, we performed orthotopic bladder formation in 10 cases, Bricker bladder formation in 20 cases, and uretherocutaneostomia in 4 cases. We also performed the first robot- assisted retroperitoneal lymphadenectomy in the country. As a conclusion, using robot-assisted technology, the full spectrum of radical uro-oncological surgical procedures can be safely performed in a minimally invasive manner. Our experience and results are encouraging so far, validating the increasing domestic distribution of robotic surgery.

Introduction: Urothelial cancer can develop in the renal pelvis, ureters, bladder and the proximal urethra as urothelial tissue can be found in these organs. Upper tract urothelial carcinoma is rare but better understanding of the natural history of the disease is important because bladder recurrence often occurs after radical nephroureterectomy., Aim and Method: Our retrospective study aims to describe the general characteristics of patients treated with radical nephroureterectomy at the Department of Urology, Semmelweis University, between January 1st, 2005 and December 31st, 2016. Additionally, we aimed to identify risk factors of bladder recurrence after radical surgery., Results: 160 patients had radical nephroureterectomy and 135 of them had urothelial upper urinary tract cancer. The mean follow-up period was 32 months (SD: 30.25), bladder recurrence was diagnosed at 31 patients (23%), the average time for the recurrence was 19.6 months (SD: 29.7). Recurrence occurred significantly earlier among older patients (p = 0.007) and it was also associated with hypertonia of the patients (p = 0.035)., Conclusion: Upper tract urothelial cancer recurrence occurs earlier among older and multimorbid patients. Careful watching of these patients (frequent reminder to regular cystoscopy and control examinations) could reduce further complications. Orv Hetil. 2020; 161(21): 881-888.

Current advances in molecular techniques and bioinformatics allowed the analysis of complex molecular patterns in various cancers including muscle-invasive bladder cancer. As a consequence, in the last few years numerous gene- and protein expression-based molecular classifications have been recommended. Recently a comprehensive consensus classification for muscle-invasive urothelial bladder cancer has been published, distinguishing 6 subgroups with a potential impact on clinical decision-making. At the same time, the therapeutic landscape of muscle-invasive bladder cancer becomes increasingly differentiated as novel checkpoint inhibitors have been available for cisplatin-ineligible and/or resistant patients. Furthermore, promising results have been obtained with FGFR targeting agents. Therefore, molecular subtyping will probably have a crucial role in individualized therapeutic decision-making in bladder cancer. In the present work, we summarize the evolution, recent advances and potential therapeutic relevance of molecular subclassifications in bladder cancer. Orv Hetil. 2019; 160(42): 1647-1654.

By the emergence of modern immunotherapies with active agents like PD-1 (nivolumab, pembrolizumab) and PD-L1 immune checkpoint blockers (atezolizumab, avelumab, durvalumab), new therapeutic options have become available for the treatment of patients with locally advanced and metastatic urothelial carcinoma. According to the recent publications, they have been effective in case of progression after platinum therapy, in or after second-line and in firstline therapies for cisplatin ineligible patients, respectively. Patient survival and tumor response data are very promising; in particular stages, they seem to be more effective than the previously administered chemotherapies. Their toxicity profiles also appear to be more favorable. Immunological side effects are rare; their identification and management require preparedness and multidisciplinary thinking. Current and ongoing trials are investigating the combinations of new remedies with other immunotherapeutic agents (e.g., CTLA-4 inhibitor ipilimumab, tremelimumab) or chemotherapies as well as trying to identify biomarkers in order to further increase effectiveness. In our review, we summarize the recently published data about urothelial carcinoma therapy and give a brief overview of the ongoing clinical trials.

The molecular genetic dogma is valid that the histological variants of a given cancer represent genetic variants. Basis of this subclassification is known in clear cell renal cancer but still a mistery in prostate or bladder cancers. Meanwhile another genetic dogma developed recently that a given histological variant of a cancer can further be subdivided based on molecular characteristics. Best examples are clear cell renal cancer, adenocarcinoma of the prostate or transitional cell carcinoma of the bladder. This new knowledge helps in the differential diagnostics of cancer, and in determining prognosis, but also provides an opportunity to better tailor existing therapies even to consider novel target agents. Discovery of the molecular subtypes of cancers (such as leukemia or lung adenocarcinoma) contributed significantly to the extension of the progression-free or overall survival of cancer patients, and it is expected that it could lead to similar effects in case of urogenital cancers.

Unlabelled: Inverted papilloma of the urinary bladder is a rare entity. According to literature data, this disease is not malignant, and has low recurrence rate. Authors studied cases detected at the Urology Department and Urooncological Centrum at Semmelweis University in the last 11 years. They aimed to find out the rate of inverted papilloma recurrences, and transformations into malignant bladder cancer., Materials and Methods: Thirty patients with histologically proven inverted papilloma were followed after transurethral resection of bladder, which meant urine tests every three months, abdominal ultrasound and cystoscopy. After a year, these examinations were done in every six months., Results: Three patients presented transitiocellular carcinoma (17, 60, 92 months later) during this period. In one case, inverted papilloma and transitiocellular tumor (pTa G1) were detected. In one patient, inverted papilloma was found by control cystoscopy after transurethral resection of bladder (pT1 G2) and local chemotherapy 15 months later., Conclusions: Based on authors' experience, inverted papilloma of the urinary bladder is a benign lesion, but malignant changes or concomitant transitiocellular tumor may occur, thus follow-up is needed. Although references are not standardized, authors suggest following patients with inverted papilloma as a primary (pTa G1) bladder cancer.

Purpose: to identify the place and role of modern chemotherapy in invasive bladder cancer., Methods: overview of the important data of papers presented in the last three years., Results: Cisplatin-based chemotherapy with methotrexate-vinblastine-doxorubicin-cisplatin (M-VAC) or gemcitabine-cisplatin (GC) is the standard treatment and prolongs survival in metastatic disease. The paclitaxel-gemcitabine-cisplatin (TGC) protocol did not change standard therapy. Neoadjuvant chemotherapy before cystectomy for T2-3 disease provides a survival benefit compared with surgery alone. Adjuvant chemotherapy is less compelling, however, it is used in case of locally advanced, extravesical and/or lymph node-positive disease. The identification of patient's risk factors helps the decision of individual treatment strategy., Conclusion: Better understanding of molecular mechanisms and carcinogenetic pathways of bladder cancer and combination of old and new drugs with targeted therapy may increase the effectiveness of treatment in bladder cancer.

Introduction: The tumour of the bladder is the third most frequent urological malignancy. Muscle invasive cancer can be cured by radical cystectomy. After removing the bladder; a sufficient urinary diversion should be performed., Aim and Method: The authors introduce the operative process of the pouch and their experiences with the procedure. The analysis of results were performed retrospectively., Results: Between 1998 and 2005 the authors performed radical cystectomy in 76 patients followed by: Mainz pouch II urinary diversion. The average age of the patients was 59.8 (20-78) years. The distribution by gender was: 58 male, 18 female patients. The average pathological T stage was 2.3; 22 patients (29%) had metastatic lymph nodes. 94% of the cases were transitional cell cancers, 3 (4%) of them had adenocarcinoma and one leiomyosarcoma. Reoperation was carried out in 7 cases (9.2%) because of wound healing defects, and one patient was reoperated because of bleeding and ileus respectively. Transitionally nephrostomy was performed in 5 cases (6.5%) because of upper urinary tract dilatation due to a stricture of ureter anastomosis. The average survival period was 24.4 (1-98) months., Conclusion: Urinary diversion Mainz pouch II provides for safe, continent diversion requiring no urine bag; with an acceptable QL (quality of life). On the basis of the low number of complications and the acceptable QL; the authors consider this method as appropriate.

Purpose: To present three cases with choroidal metastases treated with transpupillary thermotherapy (TTT)., Patients and Methods: Five choroidal metastases of three patients were treated with infrared laser thermotherapy (TTT). In all cases the distorted vision, caused by serous retinal detachment joining the posterior pole metastasis, led the patients to an ophthalmologist. In our first case an intraductal breast carcinoma led to bilateral multifocal choroidal metastases. In the second case a squamous cell carcinoma of the hypopharynx caused a rapidly growing choroidal metastasis. The primary tumor of the third patient was urothelial carcinoma. The efficacy of treatment and systemic (general health) outcomes are discussed., Results: Three of the tumors regressed to a flat scar, and led to improved vision after one session of treatment, one tumor needed two sessions of treatment to regress. The metastasis from the squamous cell carcinoma grew very fast and caused an early death not allowing follow-up., Conclusions: TTT can be a safe therapeutic option for small choroidal metastases. This one-session treatment leads to tumor regression, improves vision and positively affects quality of life of the patient suffering from metastatic cancer.

M-VAC combination chemotherapy was considered as the "gold standard" of the treatment of advanced and metastatic bladder cancers. Arrival of gemcitabine or taxanes in the 90s attracted attention since their efficacy was combined with low toxicity profiles. Gemcitabine/cisplatin combination became the most frequently studied treatment modality in the past 3 years. Multicentric, multinational randomized phase-III study indicated that in bladder cancer the gemcitabine/cisplatin combination is equal to M-VAC while in the case of the former the risk to benefit ratio is lower. Accordingly, gemcitabine/cisplatin combination is a safer treatment option in advanced and metastatic bladder cancer and is a real alternative to M-VAC. In the case of patients where cisplatin cannot be administered due to poor renal function, the new drugs with better toxicity profiles provide further treatment options.

In the course of 20 years 83 patients with tumor of the bladder were treated by cystectomy. The infiltrations of the tumors were 14 pT1, 12 pT2, 44 pT3 and 13 pT4. There were metastatic regional lymph nodes in 11 cases (13%). The urinary diversions were 64 ureterosigmoidostomies, 18 ileal conduits and one cutaneous ureterostomy. The perioperative complication rate was 48% and mortality rate was 12%. The 3-year and 5-year survivals were 50% and 44.4%, respectively. Twenty three patients (28%) died as a result of cancer recurrence. Parallel with the increase in the depth of neoplastic bladder wall infiltrations increases were observed in the rates of lymph node metastates and tumorous mortality while a decrease of survival was noted. Owing to the observed significant differences in survival (3-year survivals 12/23 vs 0/4.5-year survivals 9/20 vs 0/2) and tumorous mortality (9/38 vs 4/6) of the T3a and T3b stage patients the authors think it has to be justified to separate the two patient groups as regarding therapy and prognosis. In T3a cases cystectomy is employed as monotherapy, while for T3b cases also adjuvant chemotherapy is recommended. The prognosis of tumors extending over the bladder wall is extremely poor. An exception to this in the bladder cancer infiltrating the prostate following whose extirpation authors have observed more than ten-year survivals in two cases.

Since 1988 27 patients with bladder cancer - in the T1, G1, G2 stage - have been treated by intra-cavitally applied BCG (Pasteur). The follow-up period was 12-62 months. There was no relapse in 18 cases (66%) in 4 cases (16%) increase the average relapse rate, in 5 cases the treatment was unsuccessful. These results suggest that the treatment is effective, affordable and occur few complications.

The net benefit of BCG immunotherapeutic prophylactic effect on recurrence of superficial bladder tumours was investigated. The BCG treatment group consisted of 121 stage Ta, T1 patients, while the control group, 49 patients, was treated only with transurethral resection. During 3-year follow-up recurrence rate in the control group was 55.1%, while in the BCG group in the two-and-a-half-year follow-up it was 23.9%. The yearly repeated 6-week cycles resulted in decrease of recurrence rate to 11.8%. The recurrence indexes were 2.2 and 0.6 in the control group and in the repeated treatment group respectively. A progression rate of 18.8% was recorded in the control group and 4.1% in the treatment group. Finally both clinical and investigative results were summarised and the necessity of repeated immunotherapeutic BCG courses were emphasized.

In autopsy material of the Department of Pathology at the Albert Szent-Györgyi Medical University in 16.8% of kidney cancers, in 12.5% of urinary bladder cancers and in 21.8% of prostatic cancers were second primary malignant tumours observed in the urinary system or in other organs. The cause of the relatively frequent tumour-associations can partly be explained with the high average age (72 years). The uropoetic cancers were in association with lung cancers (role of tobacco smoking?), gastrointestinal tumours (role of genetic or dietary factors?); and the prostatic carcinomas with urinary bladder cancer and hematologic malignancies. In our material testicular cancers were never associated with other malignancies.

Our 5-year experience with BCG in the tumor stage pTis, pTa and pT1, G I-II shows a lasting remission of 88.5% (73%) in 78 (26) patients treated with BCG preparation Pasteur (Connaught) after transurethral resection. A complete remission in patients with carcinoma in situ (12 patients) could be found in 92%. The local and systemic side-effects, which are of limited duration, are tolerable, well treatable and fully reversible.

Alteration of natural killer (NK) activity from the peripherial blood was examined in the patients with superficial bladder cancer during two years between 1989-1991. The natural killer cell activity in patients with superficial bladder cancer was significantly depressed that activity was found in normal controls (P less than 0.01). 23 patients received intravesical BCG immuntherapy and NK activity was detected in the same patients 72 times in different period during the therapy. The authors decided that the activity of NK cells alters in BCG therapy. Increase of NK cells activity in the most common way of this alteration but many different type of this change is possible. The lower dose BCG (120 mg) often induce augmentation of NK activity but high dose BCG (200 mg) more frequently caused depressed activity of NK cells. The authors didn't find direct connection between therapy effect and NK activity but they found significantly less NK activity (P less than 0.03) in the patients who are in relapse. According to their opinions the role of natural killer cells in the antitumor effect of BCG can not be excluded. They recommended more immunological investigations to clear up the anticancer effect of BCG immuntherapy.

The authors investigated by conventional CT 66 urological tumorous patients before radical operations, and compared with the findings of the histological investigations of the lymph nodes removed by the lymphadenectomy. The coincidence between the two investigations were 80%.

The location distribution of the primary and recurrent bladder tumours was studied in 417 patients. The authors decided that the ureteral orifices, the lateral walls are the most common places of primary superficial bladder tumours. The favoured places of the primary invasive bladder tumours are the posterior walls. They found not so much disparity between the site of primary and recurrent invasive bladder tumours, but the difference between the site of the primary and recurrent superficial bladder tumours is remarkable. They decided, according to their patients material, that the recurrent superficial bladder tumours take places more frequently on the posterior walls, the dome and the anterior walls. The explanation of this phenomenon may be the tumour cells implantation during the TUR. The authors survived all the other processes can yield the local and distant recurrent bladder tumours and understanding of this processes can result in a better understanding of the location distribution of the recurrent bladder tumours on the one hand and it can help us to avoid or decrease the recurrences on the other hand.

The authors present the case of a 74-year-old man in whom bladder tumor was detected the reason for haematuria. The histological investigation of transurethral resected pattern showed lymphocytic lymphoma. In possession of the histological finding detailed haematological examination has been carried out, the patient was without evidence of lymphoma dissemination. He received multichemotherapy (6 courses) and locoregional cytostatic therapy and complete clinical remission was detected. The authors report our experience with extranodal bladder lymphoma included diagnostic and therapeutical notes as well as a review of the relevant literature.

The authors reported their results of BCG immunotherapy in the treatment of the bladder cancer. between 1984-1989 60 superficial and 4 muscle infiltrative bladder tumors were treated. The results of 53 BCG treated superficial bladder cancer group were compared to control groups. The recurrence cases three-four times, the progressive cases eight-ten times were more in the control groups than it was found in the BCG group. They could not establish the value of BCG in the treatment of muscle infiltrative bladder cancer, because they had not appropriate number of patients and they could find only few articles in the literature. The authors surveied the last literature of BCG immuntherapy and verified that BCG had an important role in the treatment of the bladder cancer and searching the action of antitumor effect of BCG would add more useful information to cancer immunology.

The authors analyse the histopathological features and clinical behaviour of 325 superficial (Ta, T1) tumours of 232 patients with bladder cancer. Each of the tumours was treated by TUR using differentiating resection technique and multiple cold biopsy was performed in 197 patients. The recurrence and progression of superficial tumours are examined during the 3-192 months follow up time. It is stressed the role of incomplete TUR in the "recurrence" (tumour persistence). The opinion of the authors is, that superficial bladder tumours can not be considered a homogen group, there are significant differences between Ta and T1 stage in recurrence, neoplastic progression and histopathological features as well.

The authors report on experiences of treatment for superficial bladder cancer with BCG have achieved during three years. To achieve a permanent recidive prophylaxis the 6 weeks long course was repeated yearly. During the 37-12 months follow up a tumor recurrence have been observed in 10 of 49 patients (20.4%). There have not been seen any serious side-effects requering the interruption of the course or requering any antituberculotica. On the basis of their results and the torelable side-effects they recommend the local BCG treatment as a favourable possibility in prevention of bladder tumor recurrence.

During 9 years (from 1979 to 1988) the authors performed 412 multiple cold biopsies taken from 9 different points of the cancerous bladder in 263 patients. In 42 per cent of the patients the hystopathological examination of biopsy materials discovered dysplasia, carcinoma in situ or tumor of the grossly normal urothelium. The frequency of these proliferative lesions is closely connected with number, configuration, grading and depth of infiltration of overt bladder tumor. These lesions indicate the probable recurrence-rate as well as danger of the more progressive recurrence.

Subtotal cystectomy and bladder replacement from shorted-out ileocecal segment as well as uretero-ileostomy was carried out in a 25-year-old woman because of a contracted urinary bladder, consequence of a developmental disorder, i.e. colonic-type mucous membrane of the bladder. The patient is continent passes urine every 3-4 hours without residuum.