Reporting and Grading of Complications in Urological Surgery: Current Trends and Future Perspectives.

There has been a growing need for enhancements in healthcare delivery, especially for the improvement of surgical outcomes. Therefore, implementing consistent reporting of complications enables the evaluation of data quality and facilitates its comparison. There are currently many available reporting and grading systems each with its own set of benefits and drawbacks. In this comprehensive review, we tried to present and assess each of them by demonstrating their criteria and their strong and weak points. To sum up, it seems that there is a need for developing a new reporting and categorization system for complications that are specific to urology.

Sleep Quality and Urinary Incontinence in Prostate Cancer Patients: A Data Analytics Approach with the ASCAPE Dataset.

BACKGROUND: The ASCAPE project aims to improve the health-related quality of life of cancer patients using artificial intelligence (AI)-driven solutions. The current study employs a comprehensive dataset to evaluate sleep and urinary incontinence, thus enabling the development of personalized interventions. METHODS: This study focuses on prostate cancer patients eligible for curative treatment with surgery. Forty-two participants were enrolled following their diagnosis and were followed up at baseline and 3, 6, 9, and 12 months after surgical treatment. The data collection process involved a combination of standardized questionnaires and wearable devices, providing a holistic view of patients' QoL and health outcomes. The dataset is systematically organized and stored in a centralized database, with advanced statistical and AI techniques being employed to reveal correlations, patterns, and predictive markers that can ultimately lead to implementing personalized intervention strategies, ultimately enhancing patient QoL outcomes. RESULTS: The correlation analysis between sleep quality and urinary symptoms post-surgery revealed a moderate positive correlation between baseline insomnia and baseline urinary symptoms (r = 0.407, p = 0.011), a positive correlation between baseline insomnia and urinary symptoms at 3 months (r = 0.321, p = 0.049), and significant correlations between insomnia at 12 months and urinary symptoms at 3 months (r = 0.396, p = 0.014) and at 6 months (r = 0.384, p = 0.017). Furthermore, modeling the relationship between baseline insomnia and baseline urinary symptoms showed that baseline insomnia is significantly associated with baseline urinary symptoms (coef = 0.222, p = 0.036). CONCLUSIONS: The investigation of sleep quality and urinary incontinence via data analysis through the ASCAPE project suggests that better sleep quality could improve urinary disorders.

Artificial Intelligence in Urologic Robotic Oncologic Surgery: A Narrative Review.

With the rapid increase in computer processing capacity over the past two decades, machine learning techniques have been applied in many sectors of daily life. Machine learning in therapeutic settings is also gaining popularity. We analysed current studies on machine learning in robotic urologic surgery. We searched PubMed/Medline and Google Scholar up to December 2023. Search terms included "urologic surgery", "artificial intelligence", "machine learning", "neural network", "automation", and "robotic surgery". Automatic preoperative imaging, intraoperative anatomy matching, and bleeding prediction has been a major focus. Early artificial intelligence (AI) therapeutic outcomes are promising. Robot-assisted surgery provides precise telemetry data and a cutting-edge viewing console to analyse and improve AI integration in surgery. Machine learning enhances surgical skill feedback, procedure effectiveness, surgical guidance, and postoperative prediction. Tension-sensors on robotic arms and augmented reality can improve surgery. This provides real-time organ motion monitoring, improving precision and accuracy. As datasets develop and electronic health records are used more and more, these technologies will become more effective and useful. AI in robotic surgery is intended to improve surgical training and experience. Both seek precision to improve surgical care. AI in ''master-slave'' robotic surgery offers the detailed, step-by-step examination of autonomous robotic treatments.

Emerging Trends in AI and Radiomics for Bladder, Kidney, and Prostate Cancer: A Critical Review.

This comprehensive review critically examines the transformative impact of artificial intelligence (AI) and radiomics in the diagnosis, prognosis, and management of bladder, kidney, and prostate cancers. These cutting-edge technologies are revolutionizing the landscape of cancer care, enhancing both precision and personalization in medical treatments. Our review provides an in-depth analysis of the latest advancements in AI and radiomics, with a specific focus on their roles in urological oncology. We discuss how AI and radiomics have notably improved the accuracy of diagnosis and staging in bladder cancer, especially through advanced imaging techniques like multiparametric MRI (mpMRI) and CT scans. These tools are pivotal in assessing muscle invasiveness and pathological grades, critical elements in formulating treatment plans. In the realm of kidney cancer, AI and radiomics aid in distinguishing between renal cell carcinoma (RCC) subtypes and grades. The integration of radiogenomics offers a comprehensive view of disease biology, leading to tailored therapeutic approaches. Prostate cancer diagnosis and management have also seen substantial benefits from these technologies. AI-enhanced MRI has significantly improved tumor detection and localization, thereby aiding in more effective treatment planning. The review also addresses the challenges in integrating AI and radiomics into clinical practice, such as the need for standardization, ensuring data quality, and overcoming the "black box" nature of AI. We emphasize the importance of multicentric collaborations and extensive studies to enhance the applicability and generalizability of these technologies in diverse clinical settings. In conclusion, AI and radiomics represent a major paradigm shift in oncology, offering more precise, personalized, and patient-centric approaches to cancer care. While their potential to improve diagnostic accuracy, patient outcomes, and our understanding of cancer biology is profound, challenges in clinical integration and application persist. We advocate for continued research and development in AI and radiomics, underscoring the need to address existing limitations to fully leverage their capabilities in the field of oncology.

Surgical techniques to preserve continence after robot-assisted radical prostatectomy.

Radical prostatectomy significantly impacts the inherent anatomy of the male pelvis and the functional mechanisms of urinary continence. Incontinence has a considerable negative influence on the quality of life of patients, as well as their social and psychological wellbeing. Numerous surgical techniques have been demonstrated to support the preservation of continence during robot-assisted radical prostatectomy (RARP). In this in-depth analysis, we give a general summary of the surgical techniques used in RARP and their impact on incontinence rates.

Radiation protection measures during endourological therapies.

Objective: The objective of this narrative review was to search the existing literature for studies reporting measures to minimize radiation use during endoscopic management of stone disease and present ways of reducing the exposure of both patients and operating room staff. Methods: A literature review in PubMed was performed to identify studies describing protocols or measures to reduce radiation received during endourological procedures from January 1970 to August 2022. Eligible studies were those that reported outcomes for ureteroscopy or percutaneous nephrolithotripsy regarding measures to minimize radiation doses used intraoperatively, performed either in real-life theatres or using phantoms. Both comparative and non-comparative studies were deemed eligible. Results: Protection can be achieved initially at the level of diagnosis and follow-up of patients, which should be done following an algorithm and choice of more conservative imaging methods. Certain protocols, which follow principles for minimized fluoroscopy use should be implemented and urologists as well as operating room staff should be continuously trained regarding radiation damage and protection measures. Wearing protective lead equipment remains a cornerstone for personnel protection, while configuration of the operating room and adjusting X-ray machine settings can also significantly reduce radiation energy. Conclusion: There are specific measures, which can be implemented to reduce radiation exposure. These include avoiding excessive use of computed tomography scans and X-rays during diagnosis and follow-up of urolithiasis patients. Intraoperative protocols with minimal fluoroscopy use can be employed. Staff training regarding dangers of radiation plays also a major role. Use and maintenance of protective equipment and setting up the operating room properly also serve towards this goal. Machine settings can be customized appropriately and finally continuously monitoring of exposure with dosimeters can be adopted.

Acceptance of Artificial Intelligence in Supporting Cancer Patients.

ASCAPE Project is a study aiming to implement the advances of Artificial Intelligence (AI), to support prostate cancer survivors, regarding quality of life issues. The aim of the study is to determine characteristics of patients who accepted to join ASCAPE project. It results that participants of the study mainly originate from higher-educated societies that are better informed about the potential benefits of AI in medicine. Therefore, efforts should be focused on eliminating patients' reluctancy by better informing them on the potential benefits of AI.

Post Radical Prostatectomy Erectile Dysfunction. A Single Centre Experience.

INTRODUCTION: This study aims to determine the effects of radical retropubic prostatectomy on post-operative erectile function. MATERIALS & METHODS: A total of 50 patients were included in this study, diagnosed with localized prostate cancer, and underwent nerve-sparing radical retropubic prostatectomy. All patients completed the International Index of Erectile Function (IIEF-5) questionnaire pre-operatively and on the third, sixth, and twelfth post-operative month and completed a self-reporting of their satisfaction with their sexual performance. Patients with a history of severe heart disease, were on erectile dysfunction medication, or had a score of 7 or less on the IIEF-5 questionnaire, were excluded from the study. RESULTS: Pre-operatively it was observed that the lower the IIEF-5 score, the higher the biopsy Gleason score. Post-operatively, 16 patients stated that erectile function had returned to the pre-operative IIEF-5 category. In contrast, only 13 of them stated they were happy with their sexual performance on the self-reporting scale. The rest reported dissatisfaction despite returning to their pre-operative erectile function status. IIEF-5 scores were also different when compared amongst the four age groups, with scores indicating that younger age is related to higher IIEF-5 scores. At the 3-month follow-up, no statistically significant difference was observed between age groups. Finally, patients younger than 64 reported significantly less deterioration in post-operative erectile function. CONCLUSION: Post-radical prostatectomy erectile dysfunction remains one of the most pressing issues in prostate cancer therapy. A higher Gleason score has a more significant impact on pre-operative ED, and at the same time, the best post-operative ED results are observed in younger patients. Finally, patients need extensive follow-up, therapy, and pre-and post-operative psychological support to have the best possible erectile function.

Anthropometric characteristics and relationship with non-muscle invasive bladder cancer in Greece: A case-control study.

BACKGROUND: Risk factors like smoking, radiation, chronic infections and exposure to occupational chemicals are strongly associated with occurrence of bladder cancer. Association between increased body weight and bladder cancer has been controversial. The aim of this case-control study is to evaluate association of anthropometric characteristics on bladder cancer incidence in Greek population. METHODS: This case-control study was conducted at a tertiary hospital in Greece with cases being patients with bladder cancer diagnosed within the last 2 years and controls patients admitted to hospital for reason other than cancer and not related to common risk factors related to bladder cancer. Anthropometric characteristics like weight, height, body mass index, waist and hip circumference were measured. Analyses was done with R (Vienna, Austria). RESULTS: Comparison between groups showed that patients with bladder cancer had higher weight, BMI and waist circumference compared to controls. However, multivariate, binomial logistic regression showed that only age (OR 1.03, 95% CI: 1-1.05, p = 0.02), no use of smoke (OR 0.12, 95% CI: 0.07-0.23, p < 0.001) and occupation related to bladder cancer (OR 7.45, 95% CI: 2.53-27.93, p < 0.001) significantly predicted the incidence of bladder cancer. CONCLUSIONS: Bladder cancer incidence is strongly linked with specific risk factors such as smoking, occupation with exposure to chemicals and smoke, increasing age, radiation and chronic infections. Several studies have shown a weak association between anthropometric characteristics and bladder cancer, although most studies in European populations did not confirm these findings. Similarly in our case-control study in a Greek population, we found potential relationship between increased weight/BMI and waist circumference with bladder cancer, but the association disappeared in multivariate analysis.

Outcomes from treatment of metastatic renal-cell carcinoma following failure of first-line anti-VEGF/VEGFR therapy: real-life evidence on the change of the treatment paradigm.

Recently approved agents for post-vascular endothelial growth factor/post-vascular endothelial growth factor receptor (VEGF/VEGFR) inhibitors treatment of metastatic renal-cell carcinomas (mRCC), such as axitinib, nivolumab, and cabozantinib were shown to improve prognosis and substituted everolimus in this setting. We studied practice patterns, efficacy, and tolerability of these agents in a real-world series of Greek patients. We included patients with mRCC who received everolimus, axitinib, or nivolumab after progression on first-line anti-VEGF/VEGFRs therapy. Patients were stratified into three groups. Group A received nivolumab with or without cabozantinib at some point in their disease. Group B received axitinib but without nivolumab or cabozantinib. Group C received only everolimus among the four approved agents. Overall, 131 patients were included in the analysis. Everolimus and nivolumab were mainly used in the second line, while axitinib and cabozantinib were mostly used in the third and fourth lines. Median overall survival (OS) from first-line initiation was 8.7 [95% confidence interval (CI), 4-not reached], 3.6 (95% CI, 2-6), and 2.1 years (95% CI, 1.4-2.6) for Group A, B, and C, respectively ( P < 0.001). Median OS from the initiation of second-line therapy was 3.5, 2.7, and 1.3 years, respectively ( P < 0.001). There was no impact of first-line agent or treatment timing on survival. International Metastatic Renal Cell Carcinoma Database Consortium risk stratification was associated with OS. Toxicities observed were within expected frequencies. Grade ≥3 events were rare. Adoption of modern standards in everyday treatment of mRCC results in prolongation of survival. Real-world datasets are the new landmarks of survival for future research.

CT of the urinary tract revisited.

Computed tomography (CT) of the abdomen is usually appropriate for the initial imaging of many urinary tract diseases, due to its wide availability, fast scanning and acquisition of thin slices and isotropic data, that allow the creation of multiplanar reformatted and three-dimensional reconstructed images of excellent anatomic details. Non-enhanced CT remains the standard imaging modality for assessing renal colic. The technique allows the detection of nearly all types of urinary calculi and the estimation of stone burden. CT is the primary diagnostic tool for the characterization of an indeterminate renal mass, including both cystic and solid tumors. It is also the modality of choice for staging a primary renal tumor. Urolithiasis and urinary tract malignancies represent the main urogenic causes of hematuria. CT urography (CTU) improves the visualization of both the upper and lower urinary tract and is recommended for the investigation of gross hematuria and microscopic hematuria, in patients with predisposing factors for urologic malignancies. CTU is highly accurate in the detection and staging of upper tract urothelial malignancies. CT represents the most commonly used technique for the detection and staging of bladder carcinoma and the diagnostic efficacy of CT staging improves with more advanced disease. Nevertheless, it has limited accuracy in differentiating non-muscle invasive bladder carcinoma from muscle-invasive bladder carcinoma. In this review, clinical indications and the optimal imaging technique for CT of the urinary tract is reviewed. The CT features of common urologic diseases, including ureterolithiasis, renal tumors and urothelial carcinomas are discussed.

The effects of method of anaesthesia on the safety and effectiveness of Radical Retropubic Prostatectomy.

OBJECTIVE: The aim of this study is to determine if patients undergoing radical retropubic prostatectomy with localized prostate cancer under combined (epidural-spinal) anaesthesia have any benefit over patients undergoing the procedure under general anaesthesia. MATERIAL AND METHODS: Patients with clinically localised prostate cancer, scheduled for radical retropubic prostatectomy, were allocated to undergo the operation under either general anaesthesia (GA) or under combined (epidural-spinal) (CESA) anaesthesia. Several parameters were recorded both preoperatively (medical history, biometric data, PSA, biopsy Gleason score) and postoperatively (blood pressure, heart rate, haemoglobin levels, operation time and total hospital stay). In addition, mean arterial pressure, change in heart rate, total blood loss, blood transfusions, SAS score, intravenous fluid administration and operation time were also noted down intraoperatively. Patient pain levels and total satisfaction were evaluated using appropriate questionnaires. At the 12-month follow-up, biochemical recurrence using PSA levels and urinary continence status were evaluated. RESULTS: A total of 60 patients were included (30 in each group). Intraoperatively, mean MAP and heart rate change was higher in the GA group (MAP+7,46, HR+27) and mean SAS was higher in the CESA group (+0.93). The time needed for patients' recovery was faster (-3.5 min) and hospitalization was shorter for patients in the CESA group (-0.6 days). Intraoperative blood loss, time for induction and duration of operation were not significantly different. Mean postoperative drop of haemoglobin was greater in the GA group (+0.56) while blood transfusions, VAS pain scores and amount of intravenous fluids did not differ significantly between the two groups. No complications were reported. Patient satisfaction and urinary continence were comparable between the groups and there were no cases of biochemical recurrence. CONCLUSIONS: Radical retropubic prostatectomy can safely be performed under combined (spinal epidural anaesthesia, with possible benefits of lower blood loss, less post-operative complications and earlier discharge. Both procedures have equal oncological and functional outcomes at the 12-month follow-up.

Risk for Arterial Thromboembolic Events (ATEs) in Patients with Advanced Urinary Tract Cancer (aUTC) Treated with First-Line Chemotherapy: Single-Center, Observational Study.

Arterial thromboembolism has been associated with cancer or its treatment. Unlike venous thromboembolism, the incidence and risk factors have not been extensively studied. Here, we investigated the incidence of arterial thromboembolic events (ATEs) in an institutional series of advanced urinary tract cancer (aUTC) treated with cytotoxic chemotherapy. The ATE definition included peripheral arterial embolism/thrombosis, ischemic stroke and coronary events. A total of 354 aUTC patients were analyzed. Most patients (95.2%) received platinum-based chemotherapy. A total of 12 patients (3.4%) suffered an ATE within a median time of 3.6 months from the start of chemotherapy. The most frequent ATE was ischemic stroke (n = 7). Two ATEs were fatal. The 6-month and 24-month incidence were 2.1% (95% confidence interval [CI]: 0.9-4.1) and 3.6% (95% CI: 1.9-6.2), respectively. Perioperative chemotherapy increased the risk for ATE by 5.55-fold. Tumors other than UTC and pure non-transitional cell carcinoma histology were also independent risk factors. No association with the type of chemotherapy was found. Overall, ATEs occur in 4.6% of aUTC patients treated with chemotherapy and represent a clinically relevant manifestation. Perioperative chemotherapy significantly increases the risk for ATE. The role of prophylaxis in high-risk groups should be prospectively studied.

Cluster Analysis Assessment in Proposing a Surgical Technique for Benign Prostatic Enlargement.

Benign prostatic enlargement (BPE) is a common disease in men over 50 years old. The phenotype of patients with BPE is heterogenous, regarding both baseline patient characteristics and disease-related parameters. Treatment can be either medical-conservative or surgical. A great variety of surgical techniques are available for surgical management, with three of the most common being monopolar transurethral resection of the prostate (mTUR-P), bipolar transurethral resection of the prostate (bTUR-P), and bipolar transurethral vaporization of the prostate (bTUVis). The selection of each one of these depends on surgeon reasoning, equipment availability, patient characteristics, and preferences. Since all of these techniques are available in our Urology Department, and surgeons are skilled to perform each one of them, we performed a clustering analysis according to patient pre-operative characteristics, using the k-means algorithm, to compare clustering-related technique assignment with the real-life technique used.

Artificial intelligence supporting cancer patients across Europe-The ASCAPE project.

INTRODUCTION: Breast and prostate cancer survivors can experience impaired quality of life (QoL) in several QoL domains. The current strategy to support cancer survivors with impaired QoL is suboptimal, leading to unmet patient needs. ASCAPE aims to provide personalized- and artificial intelligence (AI)-based predictions for QoL issues in breast- and prostate cancer patients as well as to suggest potential interventions to their physicians to offer a more modern and holistic approach on cancer rehabilitation. METHODS AND ANALYSES: An AI-based platform aiming to predict QoL issues and suggest appropriate interventions to clinicians will be built based on patient data gathered through medical records, questionnaires, apps, and wearables. This platform will be prospectively evaluated through a longitudinal study where breast and prostate cancer survivors from four different study sites across the Europe will be enrolled. The evaluation of the AI-based follow-up strategy through the ASCAPE platform will be based on patients' experience, engagement, and potential improvement in QoL during the study as well as on clinicians' view on how ASCAPE platform impacts their clinical practice and doctor-patient relationship, and their experience in using the platform. ETHICS AND DISSEMINATION: ASCAPE is the first research project that will prospectively investigate an AI-based approach for an individualized follow-up strategy for patients with breast- or prostate cancer focusing on patients' QoL issues. ASCAPE represents a paradigm shift both in terms of a more individualized approach for follow-up based on QoL issues, which is an unmet need for cancer survivors, and in terms of how to use Big Data in cancer care through democratizing the knowledge and the access to AI and Big Data related innovations. TRIAL REGISTRATION: Trial Registration on clinicaltrials.gov: NCT04879563.

Denonvilliers' Fascia: The Prostate Border to the Outside World.

The fascial structure around the prostate has been a controversial issue for several decades, but its role in radical prostatectomy is crucial to achieving successful nerve-sparing surgery. One of the fasciae surrounding the prostate is Denonvilliers' fascia, forming its posterior border with the rectum and enclosing along its layers several fibers of the neurovascular bundle. This review focuses on embryological and anatomical points of Denonvilliers' fascia, aiming to provide a summary for the operating general surgeons and urologists of this area.

Metachronous Bilateral Testicular Plasmacytoma After an Initial Soft Tissue, Extramedullary Plasmacytoma.

Testicular plasmacytoma is a rare extramedullary manifestation of plasma cell dyscrasia. We report a case of a 53-year-old man who presented with a metachronous testicular lesion originating from a soft tissue plasmacytoma of the oral cavity. He underwent radical orchiectomy and a year later, presented with testicular plasmacytoma in the contralateral testis. He received induction chemotherapy, autologous stem cell transplantation with high dose melphalan and maintenance with lenalidomide, as he refused orchiectomy and achieved complete remission. However, six months post-transplant, he relapsed with localized disease in his testis, received second-line chemotherapy, after refusing orchiectomy and still remains in partial remission and alive.

The use and applicability of machine learning algorithms in predicting the surgical outcome for patients with benign prostatic enlargement. Which model to use?

OBJECTIVES: Artificial intelligence (AI) is increasingly used in medicine, but data on benign prostatic enlargement (BPE) management are lacking. This study aims to test the performance of several machine learning algorithms, in predicting clinical outcomes during BPE surgical management. METHODS: Clinical data were extracted from a prospectively collected database for 153 men with BPE, treated with transurethral resection (monopolar or bipolar) or vaporization of the prostate. Due to small sample size, we applied a method for increasing our dataset, Synthetic Minority Oversampling Technique (SMOTE). The new dataset created with SMOTE has been expanded by 453 synthetic instances, in addition to the original 153. The WEKA Data Mining Software was used for constructing predictive models, while several appropriate statistical measures, like Correlation coefficient (R), Mean Absolute Error (MAE), Root Mean-Squared Error (RMSE), were calculated with several supervised regression algorithms - techniques (Linear Regression, Multilayer Perceptron, SMOreg, k-Nearest Neighbors, Bagging, M5Rules, M5P - Pruned Model Tree, and Random forest). RESULTS: The baseline characteristics of patients were extracted, with age, prostate volume, method of operation, baseline Qmax and baseline IPSS being used as independent variables. Using the Random Forest algorithm resulted in values of R, MAE, RMSE that indicate the ability of these models to better predict % Qmax increase. The Random Forest model also demonstrated the best results in R, MAE, RMSE for predicting % IPSS reduction. CONCLUSIONS: Machine Learning techniques can be used for making predictions regarding clinical outcomes of surgical BPRE management. Wider-scale validation studies are necessary to strengthen our results in choosing the best model.

Referral for "Neoadjuvant Chemotherapy" for Muscle-Invasive Bladder Cancer to a Multidisciplinary Board: Patterns, Management and Outcomes.

BACKGROUND: Utilization of neoadjuvant chemotherapy for the treatment of muscle invasive bladder cancer in everyday practice differs from that of clinical trials. We describe the patterns of referral for "neoadjuvant chemotherapy", treatment and outcomes in a multidisciplinary tumor board. METHODS: This was an observational study. Patients referred for neoadjuvant chemotherapy received 4 cycles of dose-dense gemcitabine/cisplatin and were then assessed for definitive local therapy. Patients had a minimum follow-up of 2 years. Primary objective was a 3-year disease-free survival rate. RESULTS: Forty-six patients (clinical stages II: 28, IIIA: 9, IIIB: 4, IVA: 3, missing: 2) were included. Following chemotherapy, 30 underwent radical cystectomy, 8 radiotherapy and 8 no further therapy. Pathological downstaging was observed in 14 (46.6%) of the 30 patients who underwent radical cystectomy; clinical TNM staging was correlated with disease-free survival in the whole population, while clinical and pathological stages, as well as pathological downstaging, were correlated with disease-free survival in patients undergoing radical cystectomy. Three-year disease-free survival rates for the whole cohort and for patients undergoing radical cystectomy were 67.3% (95% confidence interval [CI]: 51-79.2) and 65.2 (95% CI: 44.9-79.6), respectively. CONCLUSION: Real-world muscle invasive bladder cancer patients who receive neoadjuvant chemotherapy are characterized by more advanced diseases and less frequent radical surgery than those included in clinical trials. Nevertheless, outcomes were comparable and, therefore, offering patients with stage II-IVA muscle invasive bladder cancer neoadjuvant chemotherapy after assessment by multidisciplinary tumor boards should be strongly encouraged.

Association of obesity and other anthropometric characteristics with bladder cancer risk: a systematic review and meta-analysis of longitudinal cohort studies.

PURPOSE: The purpose of this systematic review and meta-analysis was to evaluate the potential associations between anthropometric characteristics and bladder cancer risk, synthesizing longitudinal cohort studies. METHODS: Literature search across MEDLINE, EMBASE, Scopus, Google Scholar and Cochrane Central was performed up to December 31, 2019 and data abstraction was performed independently by two authors. Random-effects (DerSimonian-Laird) models were used to estimate pooled relative risks (RR) and 95% confidence intervals (95%CI); subgroup analyses were performed in geographical region, mean age, publication year, length of follow-up, sample size, method of body mass index (BMI) estimation and adjustment for smoking. RESULTS: 27 studies were included (88 593 bladder cancer cases in a total cohort of 49 647 098 subjects). Increased bladder cancer risk was noted in overweight men (pooled RR=1.12, 95%CI: 1.04-1.21) but not in overweight women. Both obese men (pooled RR=1.14, 95%CI: 1.06-1.22) and women (pooled RR=1.19, 95%CI: 1.02-1.38) showed increased risk. Interestingly, height increase per 5 cm did not seem to affect risk of bladder cancer in men (pooled RR=1.03, 95%CI: 0.99- 1.06) and women (pooled RR=1.02, 95%CI: 0.97-1.06). Larger waist circumference was associated with bladder cancer risk in men (pooled RR=1.18, 95%CI: 1.09-1.26) but not women. CONCLUSION: Bladder cancer risk seems to be related with obesity overall and central obesity in men. In contrast to other cancer types, height does not seem to affect risk, but more studies are needed to extract safe conclusions.