Understanding Urachal Carcinoma: What 1,901 Patient Cases Tell Us About Diagnosis, Treatment, and Survival

Table of Contents

• Key Points
• Background: What Is Urachal Carcinoma?
• How This Study Was Conducted
• Who Develops Urachal Carcinoma?
• Symptoms at Diagnosis
• How Urachal Carcinoma Is Diagnosed
• Tumor Types Under the Microscope
• Staging the Disease
• Surgical Treatment
• Does Removing the Belly Button Matter?
• Lymph Node Removal: Unclear Benefit
• Chemotherapy: What Works Best
• Survival and Recurrence Outcomes
• Clinical Implications
• Limitations of This Research
• What This Means for Patients
• Frequently Asked Questions
• Source Information

Key Points

• Urachal carcinoma is a rare cancer of a fetal remnant between the bladder and belly button, accounting for less than 1% of bladder cancers.
• In a review of 1,901 patients, removing the tumor, urachal tract, and umbilicus together improved survival and lowered recurrence in localized disease.
• Cisplatin-based chemotherapy produced the highest disease-free rates (65.73%) in the adjuvant setting and the most responses in metastatic disease.
• The estimated 5-year overall survival was 51%, with recurrence in 35% of patients and an average time to recurrence of 27.6 months.
• CT scan was the most used imaging test (69.85% of patients), while urine cytology missed the cancer about 80% of the time.

Background: What Is Urachal Carcinoma?

Urachal carcinoma (UrC) is a rare cancer that arises in the urachus, a leftover structure from fetal development. The urachus forms when the allantois (an embryonic sac) regresses into a tube connecting the urinary bladder to the umbilicus (belly button). By the end of pregnancy, this tube normally becomes a fibrous cord called the median umbilical ligament.

In about one-third of adults, however, a piece of the urachus persists as a tubular or cystic structure lined with cells. This remnant can become the starting point for urachal carcinoma. Because it has a different origin, urachal carcinoma behaves differently from ordinary bladder cancer in both its pathology and its clinical course.

The disease is rare. It accounts for less than 1% of all bladder cancer cases, and its estimated incidence is only 0.022 to 0.060 cases per 100,000 person-years. Because so few people develop it, most of what doctors know comes from case reports, small case series, or population databases with missing information. Those weak sources make it hard to build confident treatment guidelines.

Several important questions remain disputed among specialists. Does the umbilicus (belly button) always need to be removed together with the bladder tumor? When should lymph nodes be removed, and how many? Which diagnostic and prognostic criteria should be used? The goal of this systematic review and meta-analysis was to combine the available literature and answer these questions with stronger evidence.

How This Study Was Conducted

The researchers followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines and registered their study in the PROSPERO international database under the number CRD42024562424. Their research question was framed using the PICOS (Patient-Intervention-comparator-outcome-study design) approach: what is the current evidence on the clinical and epidemiological characteristics, management strategies, and cancer outcomes of urachal carcinoma?

The search strategy combined the terms "urachal carcinoma," "urachal adenocarcinoma," and "urachal cancer." The team searched PubMed/MEDLINE through September 2024. The team also checked the reference lists of included studies for additional relevant trials.

To be included, a study had to involve patients older than 18 years with urachal carcinoma, with no language restrictions. The team accepted case series, cohort studies, and randomized trials. They excluded government databases, single case reports, case series with fewer than eight patients or incomplete information, editorial letters, expert opinions, and prior literature reviews.

Two authors independently screened every record, and a third reviewer settled any disagreements. From each included study, the team extracted data on study design, patient sex, age, other medical conditions, and symptoms. The team also extracted data on urine cytology results, cystoscopy use, preoperative tumor markers, imaging methods, tissue classification, and staging. The team also extracted data on type of surgery, lymph node removal and its extent, and whether the umbilicus was removed. The team also extracted data on chemotherapy given before, after, or as salvage treatment, along with cancer outcomes.

For continuous variables reported as median and interquartile range, the researchers converted the values to mean and standard deviation. A second author cross-validated all entered data. The final analysis included a single-arm meta-analysis to estimate survival outcomes.

Who Develops Urachal Carcinoma?

The literature search retrieved 562 records. After screening titles and abstracts, 468 were excluded as irrelevant. The team then reviewed the full text of the remaining 94 studies, excluding 44 for inappropriate study design and leaving 50 studies in the final analysis.

All 50 included studies were retrospective (looking back at existing records), and together they covered 1,901 patients. The United States contributed the largest share with 715 patients (37.61%), followed by China with 364 patients (19.15%) and South Korea with 318 patients (16.73%).

The average age at first treatment was 51 years (standard deviation ±3.31 years). Men made up the majority: 1,148 of 1,794 patients with reported sex were male (63.99%), while 646 were female (36.01%).

Among the most common other medical conditions, 24% of patients had systemic arterial hypertension (high blood pressure) and 13.3% had diabetes mellitus (high blood sugar). About 200 patients (10.52%) were smokers.

Symptoms at Diagnosis

The most common symptom by far was macroscopic hematuria (visible blood in the urine), reported in 865 of 1,210 patients (45.50%). Other signs appeared much less often:

• Abdominal pain: 122 patients (6.41%)
• Palpable abdominal mass (a lump felt by the doctor): 95 patients (4.99%)
• Mucouria (mucus passing in the urine): 52 patients (2.73%)
• Dysuria (painful urination): 36 patients (1.89%)
• Lower urinary tract symptoms: 35 patients (1.84%)
• Omphalorrhoea (discharge from the belly button): 5 patients (0.26%)

This pattern matters for patients. Blood in the urine is the signal that most often brings people to medical attention, but it is also a symptom of many other urinary conditions. That overlap means the diagnosis is rarely made on symptoms alone.

How Urachal Carcinoma Is Diagnosed

Computed tomography (CT, a detailed X-ray scan) of the abdomen and pelvis was the most frequently used imaging test. Of 952 patients with reported imaging, 665 (69.85%) had a CT scan. The next most common was 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography combined with CT (PET/CT, which highlights metabolically active tissue), used in 133 patients (13.97%).

Other imaging methods were much less common:

• Ultrasonography (ultrasound): 92 patients (9.6%)
• Laparoscopy (a surgical camera performed through small incisions): 35 patients (3.67%)
• Magnetic resonance imaging (MRI): 27 patients (2.83%)

PET/CT has proven useful for spotting metastatic sites (cancer that has spread) that other scans might miss, particularly during follow-up. Still, the review authors concluded that PET/CT does not add substantial information beyond what CT already provides. CT remains the preferred and most reliable tool for initial diagnosis and staging.

Calcification (calcium deposits) inside the tumor, once reported in 50% to 70% of patients on CT, appeared in only 35.54% of patients in this review. That is a notable difference that may reflect improved imaging or broader patient selection over time.

Urine cytology (microscopic examination of urine cells) performed poorly, with an average sensitivity of only 22% (±0.19). In other words, it missed the cancer roughly four times out of five. Cystoscopy (inserting a camera into the bladder) performed much better, with an average sensitivity of 79% (±0.19).

On cystoscopy, urachal carcinoma usually appears as a protrusion in the bladder mucosa or as a lesion growing from the outside of the bladder inward toward the inner lining. That pattern contrasts with typical urothelial carcinoma, which grows from the inner surface outward. A biopsy (tissue sample) is essential, especially when the tumor is in an unusual location or the disease is advanced. Doctors must also distinguish urachal carcinoma from primary bladder adenocarcinoma and from invasive adenocarcinoma that started elsewhere in the body.

For blood-based tumor markers, the two with the highest sensitivity for urachal carcinoma were CA 19-9 at 84% (403 of 476 patients tested) and CEA (carcinoembryonic antigen) at 80% (404 of 499 patients tested). Other markers were far less useful:

• CA 125: 30% sensitivity (20 of 66 patients tested)
• CA 15-3: 6% sensitivity (3 of 50 patients tested)
• Alpha-fetoprotein: 6% sensitivity (1 of 15 patients tested)

Tumor Types Under the Microscope

Microscopic tissue examination is the cornerstone of diagnosis. Doctors most often use the criteria of Sheldon et al., Gopalan et al., and more recently Mostofi et al. These criteria require four elements: (1) the tumor must sit in the dome or front wall of the bladder; (2) the tumor's center must lie within the bladder wall; (3) there must be no extensive cystitis cystica or cystitis glandularis (two forms of bladder inflammation); and (4) there must be no known primary adenocarcinoma elsewhere in the body.

Among 1,264 patients with a reported tumor type, the most frequent was mucinous adenocarcinoma of the urachus, found in 508 patients (40.19%). That type produces mucus. The full breakdown was:

• Mucinous adenocarcinoma: 508 (40.19%)
• Enteric (intestinal-type) adenocarcinoma: 426 (33.70%)
• Mixed adenocarcinoma: 74 (5.85%)
• Signet ring cell carcinoma: 67 (5.30%)
• Urothelial carcinoma: 70 (5.54%)
• Squamous cell carcinoma: 11 (0.87%)
• Neuroendocrine carcinoma: 1 (0.08%)
• Not specified: 107 (8.47%)

Staging the Disease

Doctors used several staging systems to describe how far the cancer had grown. The Sheldon classification was the most common, applied to 1,107 patients. In that group, stage II was the most frequent at 487 patients (43.99%), followed by stage IIIa at 262 patients (23.67%) and stage IVa at 94 patients (8.49%). The full Sheldon distribution was:

• Stage I: 21 (1.90%)
• Stage II: 78 (7.05%)
• Stage IIIA: 262 (23.67%)
• Stage IIIB: 487 (43.99%)
• Stage IIIC: 62 (5.60%)
• Stage IIID: 27 (2.44%)
• Stage IVA: 94 (8.49%)
• Stage IVB: 76 (6.87%)

The Mayo classification was available for 814 patients. Here too, stage II was most common at 385 patients (47.30%), followed by stage I at 179 patients (21.99%), stage IV at 157 patients (19.29%), and stage III at 93 patients (11.43%).

The TNM (tumor-node-metastasis) system was used for 579 patients. Stage T3 (tumor growing beyond the bladder wall) was the most common at 316 patients (54.57%), followed by T2 at 148 patients (25.56%) and T4 at 84 patients (14.50%). Very few patients had minimal disease: pT0 accounted for 4 patients (0.69%) and pT1 for 27 patients (4.66%).

At the time of first diagnosis, 297 patients (15.62%) already had metastatic disease (cancer that had spread to distant organs).

Surgical Treatment

Surgery was the main treatment in 1,417 of 1,901 patients (74.54%). Radiotherapy (radiation treatment) was used as primary therapy in 37 patients (1.95%), and chemotherapy alone in 61 patients (3.21%). For 386 patients (20.31%), the primary treatment was not specified.

The standard operation today is extended partial cystectomy (removing part of the bladder) with en-bloc resection of the urachal mass, the urachal tract, and the umbilicus. The standard operation is combined with removal of the pelvic lymph nodes. Radical cystectomy (removing the whole bladder) is generally reserved for larger tumors that involve more than the upper half of the bladder. Partial cystectomy carries fewer postoperative complications and a better quality of life.

Among the 1,417 patients who had surgery, partial cystectomy was the most common approach for localized disease at 1,145 patients (80.80%). Radical cystectomy accounted for 163 patients (11.50%), and transurethral bladder resection (TURBT, removing tumor through the urine channel) for 50 patients (3.53%). The type of surgery was not specified for 59 patients (4.16%).

Regarding surgical technique, open surgery was most frequently reported at 349 patients (19.09%), followed by laparoscopic surgery (minimally invasive through small incisions) at 192 patients (10.50%) and robotic-assisted surgery at 43 patients (2.35%). A large share of studies, 1,244 patients (68.05%), did not specify the technique.

Does Removing the Belly Button Matter?

This is one of the central debates in urachal carcinoma care, and this review provides the strongest signal yet. Sheldon et al. Once found urachal tumor invasion of the navel in 7% of autopsies on patients who died of the disease. This led them to recommend removing the urachal ligament along with the bladder dome, posterior rectus fascia, and umbilicus.

Some doctors have argued that the umbilectomy (surgical removal of the belly button) can be skipped in patients with localized tumors, to preserve body image and quality of life. In this review, 360 patients (38%) across 14 studies did not have their umbilicus removed.

Five studies directly compared patients who had umbilectomy with those who did not. Four of the five found worse overall survival, cancer-specific survival, and progression-free survival in patients who did not have complete urachal removal:

• Yu et al. (2021): 12 patients had umbilectomy and 191 did not. Overall survival hazard ratio (HR, a measure of relative risk over time) was 2.491 (95% CI 0.980–6.334; p=0.005). Cancer-specific survival HR was 2.601 (95% CI 1.024–6.608; p=0.044). Recurrence-free survival HR was 2.140 (95% CI 0.918–4.990; p=0.078).
• Ashley et al. (2006): 32 patients had umbilectomy and 27 did not. Cancer-specific survival HR was 3.0 (95% CI 1.3–6.8; p=0.008).
• Siefker-Radtke et al. (2016): 19 patients had umbilectomy and 16 did not. En-bloc resection was not statistically associated with survival (p=0.09), but 13 of the 16 long-term survivors were in the group that had en-bloc resection with umbilectomy.
• Jia et al. (2020): 27 patients had umbilectomy and 12 did not. Overall survival HR was 0.141 (95% CI 0.034–0.591; p=0.007). Progression-free survival HR was 0.355 (95% CI 0.128–0.983; p=0.046). Patients who had umbilectomy lived longer (median overall survival 87 vs 48 months, p=0.03) and stayed free of progression longer (67 vs 31 months, p=0.036).
• Dhillon et al. (2015): of 29 patients who had umbilectomy, 10 died of cancer (34%) after an average of 35 months (range 13–74 months). Of 11 patients who did not, 7 died of cancer (64%) after an average of 31 months (range 12–71 months).

Before this review, the practice of removing the umbilicus with the urachal tract rested largely on Sheldon's early work. This review adds five modern studies that point in the same direction, reinforcing umbilectomy plus en-bloc resection as the standard treatment for localized urachal carcinoma.

Lymph Node Removal: Unclear Benefit

The role of lymphadenectomy (surgical removal of lymph nodes) is less clear. Across the 1,640 patients with reported data, 377 (22.98%) had lymph nodes removed, 444 (27.07%) did not, and 819 (49.94%) were not specified. When lymphadenectomy was performed, the extent was standard (obturator, external iliac, and internal iliac nodes) in 167 of 377 patients (44.2%) and extended (adding common iliac, presacral, and paravesical nodes) in 17 patients (4.5%). The extent was unspecified in 193 patients (51.2%).

On pathologic staging of the 1,147 patients with reported node status, 226 (19.7%) had positive nodes and 921 (80.3%) had negative nodes. The average number of nodes removed was 10.26 (±3.99).

Only three studies compared cancer outcomes between patients who had lymphadenectomy and those who did not, and their results conflict:

1. Duan et al. found that 7 of 35 patients who did not have lymphadenectomy (20%) developed nodal recurrence, compared with 3 of 27 who did (11.1%). However, in the authors' analysis, performing lymphadenectomy did not correlate with disease-free survival.
2. A second study compared 20 patients who had lymphadenectomy with 40 who did not. It found that lymphadenectomy predicted cancer-specific mortality on univariate analysis (p=0.02; HR 1.5, 95% CI 0.7–2.8).
3. A third study compared 18 patients who had lymphadenectomy with 16 who did not and found no positive effect on survival.

Most series have simply not evaluated whether lymphadenectomy changes outcomes, and even among those that do, the extent of node removal is often unspecified. The evidence base here remains limited and conflicting.

Chemotherapy: What Works Best

The National Comprehensive Cancer Network (NCCN) recommends chemotherapy regimens for node-positive bladder adenocarcinoma similar to those used for colorectal cancer. Specifically, FOLFOX (oxaliplatin, leucovorin, and 5-fluorouracil) and GemFLP (5-fluorouracil, leucovorin, gemcitabine, and cisplatin) are suggested options. For advanced disease, joining a clinical trial is strongly encouraged. When that is not possible, combination chemotherapy based on 5-fluorouracil (FOLFOX or GemFLP) may be used. The ITP regimen (paclitaxel, ifosfamide, and cisplatin), or dual therapy with paclitaxel plus a platinum drug, may also be used.

Chemotherapy before surgery (neoadjuvant). Only 8 patients received neoadjuvant therapy, and regimen and response data were missing for 3 of them. Among the rest: 4 cycles of gemcitabine and cisplatin were given but response data were unavailable. A 5-fluorouracil and cisplatin regimen achieved a partial response, with the patient still disease-free at the end of the study (median follow-up after surgery of 17 months). A combination of ifosfamide, docetaxel, and cisplatin was associated with disease progression.

Chemotherapy after surgery (adjuvant). A total of 190 patients (9.9%) received adjuvant therapy. Specific regimens were reported for 72% of them, covering 32 unique regimens. Cisplatin appeared in 51% of adjuvant regimens and 5-fluorouracil in 26%.

Treatment for recurrence or metastasis. Of 1,901 total patients, 93 (4.9%) received systemic treatment for recurrence or metastatic disease, using 24 distinct regimens. Cisplatin was given in 49.5% of these cases and 5-fluorouracil in 46.2%.

Treatment responses were documented for 112 patients: 65 (58%) from the adjuvant group and 47 (42%) from the metastatic or salvage treatment group. In the adjuvant group, 63% showed no disease progression. In the metastatic or recurrent group, 14.9% had a partial or complete response.

Looking at specific regimens in the adjuvant setting:

• 5-fluorouracil-based regimens: 60% of patients had no disease progression.
• Cisplatin-based regimens: 65.73% of patients remained disease-free.
• Combination of 5-fluorouracil and cisplatin: all 3 patients treated experienced no disease progression.

Cisplatin-based therapy consistently produced the best response rates in both the adjuvant and the metastatic settings.

Survival and Recurrence Outcomes

The single-arm meta-analysis estimated a 5-year overall survival rate of 51% (95% CI 0.49–0.54). In plain terms, about 1 in 2 patients were still alive five years after treatment. The confidence interval means the true value is very likely between 49% and 54%.

Tumor recurrence (the cancer coming back) was documented in 35% of cases (95% CI 0.25–0.45). Local recurrence (returning in the same area) occurred in 28% of cases (95% CI 0.18–0.38). The average time to recurrence was 27.6 months, which means most recurrences happen within roughly two to three years of primary treatment.

In the pooled analysis, 16.2% of patients presented with metastatic disease at initial diagnosis, and 16% experienced tumor recurrence after primary treatment. The most common sites of recurrence were:

• Lung: 22.8% of recurrences
• Bladder: 22.1%
• Pelvis: 15.2%

Clinical Implications

This review, the most comprehensive to date, supports several practical conclusions. First, en-bloc resection (removing the whole tumor in one piece) combined with umbilectomy offers real oncologic advantages in localized disease, improving survival and reducing recurrence. Second, cisplatin-based chemotherapy appears to produce the best responses in both the adjuvant and metastatic settings. Third, emerging alternative therapies also show potential, which is why the authors call for further research.

For patients, the message is that complete surgical removal, including the belly button and the full urachal tract, is not an optional extra step. It appears to be a core part of effective treatment. The data also show that roughly a third of patients will experience recurrence, most within about 2 to 3 years, so structured follow-up during that window is important.

Limitations of This Research

The authors are candid about the limits of their work. Every included study was retrospective, meaning the data were collected from past records rather than from a planned experiment. That design cannot prove cause and effect; it can only show associations.

Many variables had substantial missing data. Surgical technique was unspecified in 68.05% of patients, the extent of lymphadenectomy was unspecified in 51.2%, and the primary treatment was unspecified in 20.31%. Treatment response data were available for only 112 of the patients who received systemic therapy. Because of these gaps, conclusions about lymphadenectomy in particular remain uncertain and would need prospective studies to resolve.

What This Means for Patients

If you or a loved one has been diagnosed with urachal carcinoma, here is what this research suggests you should discuss with your care team:

1. Ask whether complete surgical removal is planned. The operation should remove the tumor, the urachal tract, and the umbilicus together in one piece whenever the disease is localized. This approach was linked to longer survival and lower recurrence across multiple studies.
2. Ask about cisplatin-based chemotherapy if you need drug treatment. In this review, cisplatin-based regimens produced the highest rates of remaining disease-free (65.73% in the adjuvant setting) and the best responses in metastatic disease.
3. Expect a CT scan, not just urine tests. CT was the most reliable imaging test, used in 69.85% of patients. Urine cytology missed the cancer about 80% of the time, so a negative urine test does not rule out the disease.
4. Know the marker tests that matter. CA 19-9 (84% sensitivity) and CEA (80% sensitivity) were the most useful blood markers, far outperforming CA 125, CA 15-3, and alpha-fetoprotein.
5. Plan careful follow-up for at least the first three years. The average time to recurrence was 27.6 months, and the lungs, bladder, and pelvis were the most common sites. Routine imaging during this window can catch recurrence early.
6. Ask about clinical trials if your disease is advanced. The NCCN strongly recommends trial participation for advanced urachal carcinoma, and this review highlights that emerging alternative therapies show promise.

Talk with your doctor about how these findings apply to your specific stage, tumor type, and overall health. Urachal carcinoma is rare, so care at a center experienced with this disease can make a meaningful difference.

Frequently Asked Questions

What is urachal carcinoma?

Urachal carcinoma is a rare cancer that starts in the urachus, a leftover tube from fetal development that normally becomes a fibrous cord between the bladder and the belly button. In about one-third of adults, a piece remains and can become cancerous. It accounts for less than 1% of bladder cancers, with an estimated incidence of 0.022 to 0.060 cases per 100,000 person-years.

What are the typical symptoms of urachal carcinoma?

The most common symptom is visible blood in the urine, reported in 865 of 1,210 patients (45.50%). Other signs are much less frequent: abdominal pain (6.41%), a palpable abdominal mass (4.99%), mucus in the urine (2.73%), painful urination (1.89%), lower urinary tract symptoms (1.84%), and discharge from the belly button (0.26%). Because blood in urine has many causes, diagnosis is rarely made on symptoms alone.

How is urachal carcinoma diagnosed?

CT scan of the abdomen and pelvis was the most used imaging test, performed in 665 of 952 patients (69.85%). Urine cytology missed the cancer about 80% of the time (average sensitivity 22%), while cystoscopy detected it in 79% of cases. Blood markers CA 19-9 (84% sensitivity) and CEA (80% sensitivity) were the most useful. A biopsy is essential to confirm the diagnosis.

What chemotherapy works for urachal carcinoma?

Cisplatin-based chemotherapy produced the highest response rates in both adjuvant (after surgery) and metastatic settings. In the adjuvant group, 65.73% of patients on cisplatin-based regimens remained disease-free, compared with 60% on 5-fluorouracil-based regimens. For metastatic or recurrent disease, 14.9% had a partial or complete response. The NCCN recommends regimens similar to those for colorectal cancer, such as FOLFOX or GemFLP, and encourages clinical trials for advanced disease.

What is the survival rate and recurrence risk?

The estimated 5-year overall survival rate was 51% (95% CI 0.49–0.54), meaning about 1 in 2 patients were still alive five years after treatment. Tumor recurrence was documented in 35% of cases, with local recurrence in 28%. The average time to recurrence was 27.6 months, so most recurrences happen within roughly two to three years. The most common recurrence sites were lung (22.8%), bladder (22.1%), and pelvis (15.2%).

What follow-up is needed after treatment?

Because the average time to recurrence is 27.6 months, structured follow-up for at least the first three years is important. Routine imaging during this window can catch recurrence early. The lungs, bladder, and pelvis were the most common sites of recurrence. CT scans are the preferred imaging method for initial diagnosis and staging, and may be used during follow-up. Discuss a personalized surveillance plan with your care team.

When should a patient with urachal carcinoma seek a second opinion?

A second opinion is worth seeking when the surgical plan does not include removing the umbilicus and the full urachal tract together with the tumor. Four of five studies comparing umbilectomy with no umbilectomy found worse overall, cancer-specific, and progression-free survival without it. It is also reasonable when cisplatin-based chemotherapy is not being considered for adjuvant or metastatic disease, or when lymph node removal is recommended despite conflicting evidence. A pathology review can confirm the tumor type, as mucinous adenocarcinoma is the most frequent. Diagnostic Detectives Network provides independent expert second opinions.

Source Information

Original article title: Urachal Carcinomas: A Comprehensive Systematic Review and Meta-analysis.

Authors: Caio Vinícius Suartz, Lucas Motta Martinez, Marcelo Henrique Lima Silvestre, Richard Dobrucki de Lima, Pedro Henrique Souza Brito, Ketlyn Assunção Galhardo, Roberto Iglesias Lopes, Victor Hondo Silva de Moraes, Caio Mazzonetto Teofilo de Moraes, Luana Covatti, Maria Fernanda Dias Azevedo, Lucas Schenk de Almeida, Debora Narumi Demitrol Setoue, Natália Doratioto Serrano Faria Braz, José Bessa Júnior, Fernando Korkes, Leonardo O. Reis, Kátia Ramos Moreira Leite, William Carlos Nahas, Paul Toren, and Leopoldo Alves Ribeiro-Filho

Publication: International Brazilian Journal of Urology (Int Braz J Urol), Vol. 51 (3): e20240665, May–June, 2025. doi: 10.1590/S1677-5538.IBJU.2024.0665. Submitted November 29, 2024; accepted December 28, 2024; published ahead of print January 21, 2025.

Affiliations: Department of Urology, Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada; CHU de Québec-Université Laval, Quebec City, Quebec, Canada; Divisão de Urologia, Instituto do Câncer de São Paulo, Universidade de São Paulo (USP), São Paulo, Brazil; Faculdade Israelita Albert Einstein de Ciências da Saúde (FICSAE), Hospital Israelita Albert Einstein (HIAE), São Paulo, Brazil; Universidade Estadual de Feira de Santana (UEFS), Feira de Santana, Brazil; Divisão de Urologia, Oncologia Urológica, Faculdade de Medicina do ABC (FMABC), Santo André, Brazil; Divisão de Oncologia Urológica, Divisão de UroScience, Universidade Estadual de Campinas (Unicamp), Campinas, Brazil; Divisão de ImunOncologia, Pontifícia Universidade Católica de Campinas, Campinas, Brazil.

This patient-friendly article is based on peer-reviewed research. It is intended for educational purposes and does not replace personalized medical advice from your healthcare team.