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Introduction We present a case of simultaneous robot‐assisted radical nephroureterectomy (RANU) and robot‐assisted radical cystectomy (RARC) for muscle‐invasive bladder cancer with concomitant upper urinary tract urothelial carcinoma. Case presentation A 59‐year‐old Japanese man was diagnosed with right ureteral cancer and muscle‐invasive bladder cancer. We performed RANU and RARC simultaneously; three of the ports used for RANU were diverted to RARC. Console times for RANU and RARC were 66 and 207 minutes, respectively. Total operative time was 386 minutes. The intraoperative blood loss was estimated 255 ml. The patient was discharged on postoperative day 18 without complications. Conclusion We reported our experience with simultaneous RANU and RARC for muscle‐invasive bladder cancer with concomitant right ureteral cancer. To the best of our knowledge, this is the first report of its kind in Japan.

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Objectives The purpose of this study was to develop a new composite score to accurately predict postoperative delirium (POD) after major urological cancer surgery. Methods Our retrospective analysis included, in total, 449 consecutive patients who experienced major urological cancer surgery and a preoperative geriatric functional assessment at our institution (development cohort). Geriatric functional assessments included Geriatric 8, Instrumental Activities of Daily Living, and mini‐cognitive assessment instrument (Mini‐Cog). Multivariate analysis was used to identify factors related to POD and combined to create a predictive score. The composite score was externally validated using a cohort of 92 consecutive pancreatic cancer patients who underwent pancreaticoduodenectomy and a preoperative geriatric functional assessment (validation cohort). The predictive accuracy and performance of the composite score were evaluated using the area under the receiver operating characteristic curves (AUC) and calibration plots. Results In multivariate analysis of a development cohort, the following factors were significantly associated with POD: a Mini‐Cog score of <3 (odds ratio [OR] = 9.5; p < 0.001), disability in the responsibility for medication (OR = 4.1; p = 0.03), and the preoperative use of benzodiazepine (OR = 6.4; p < 0.001). The composite score of these three factors showed excellent discrimination in predicting POD, with AUC values of 0.819 and 0.804 in development and validation cohorts, respectively. Calibration plots showing predicted probability and actual observation in both cohorts showed good agreement. Conclusions A combined model of Mini‐Cog, a disability in the responsibility for medication, and preoperative benzodiazepine use showed excellent discriminative power in predicting POD.