We aim to determine if ureteral rest is necessary prior to distal ureteral reconstruction with reimplantation with or without psoas hitch and/or Boari flap. We retrospectively reviewed all patients who underwent ureteral reimplantation at a single institution from December 2016 to April 2023. We included all reimplantation techniques, including psoas hitch and Boari flap. Patients were stratified based on if they had ureteral rest, defined as the absence of a ureteral stent for at least 4 weeks prior to the operation. Patient demographics, stricture characteristics, and perioperative outcomes were compared between the two groups. Patients were scheduled for 3 and 12 month postoperative ultrasounds to assess for stricture recurrence. Renal scintigraphy was used if significant or worsening hydronephrosis was seen. Our cohort consisted of 50 patients, among whom 29 (58%) underwent ureteral rest before reimplantation. Demographics, stricture characteristics, and use of psoas hitch and/or Boari flap were comparable between the two groups. Stricture etiology was significantly different in patients with and without ureteral rest ( = 0.002). The cohort without ureteral rest had a higher percentage of radiation-induced ureteral injury (47.6%), while the cohort with ureteral rest had a higher percentage of iatrogenic ureteral injury (75.9%). Other/idiopathic causes were split relatively evenly. Median follow-up for the cohort was 8.6 months (interquartile range: 4.6-17.4 months). Postoperatively, there were no significant differences in 30-day complication rate, postoperative hydronephrosis, or stricture recurrence rate. Our data suggest that ureteral rest does not confer an advantage for distal ureteral reconstruction. Thus, operation should not be delayed in order to achieve ureteral rest when reimplantation is expected.

Data on complications following holmium laser enucleation of the prostrate (HoLEP) are primarily single-center experiences. Although postoperative urethral stricture rates are well described in the literature, secondary urinary incontinence surgeries (UIS) are poorly characterized. We aimed to quantify the incidence of long-term complications, notably UIS, following HoLEP using a large national dataset. We retrospectively reviewed a limited dataset from the TriNetX Research Network Database, which carries clinical data of 104 US academic medical centers and health care organizations. A search query between 1 year prior to and 2 years after HoLEP identified patients of interest from 45 providers. The following diagnoses and procedures were queried: HoLEP, urinary incontinence, anti-spasmodic prescription, artificial urethral sphincter (AUS), male sling, cystourethroscopy with injection for chemodenervation, injection of urethral bulking material, meatotomy/meatoplasty, urethrotomy, transurethral resection of bladder neck contracture, urethroplasty, and urinary retention. Of the 11,559 patients that underwent HoLEP, 2391 (20.7%) were diagnosed with urinary incontinence, and 1921 (16.6%) were prescribed urinary antispasmodics in the year preceding the surgical procedure. The risk of short-term incontinence in the first 3 months following the surgical procedure was 1185 (10.3%). This decreased to 551 (4.8%) between 1 and 2 years after the surgical procedure. Thirteen (0.1%) underwent insertion of an AUS or sling placement, 90 (0.8%) had cystoscopy with chemodenervation, and 10 (0.10%) underwent urethral bulking in the 2 years following HoLEP. The same dataset shows 209 (1.8%) patients required surgical treatment of postoperative urethral stricture disease, excluding bladder neck contracture, in the 24 months following HoLEP. Data from a large national database show a low rate (4.8%) of persistent urinary incontinence beyond 1 year following HoLEP and an expected low rate of urinary incontinence procedures.

To investigate the safety and feasibility of non-papillary puncture in total ultrasound (US)-guided standard size access percutaneous nephrolithotomy (PCNL) for patients with complex renal stones. We retrospectively reviewed the charts of complex renal stones (Guy's scoring system 3-4) patients who had undergone standard size access PCNL in our department from January 2019 to October 2023 ( = 422). Renal abnormalities, history of PCNL and pyelolithotomy/nephrolithotomy, and multiple tracts PCNL were excluded. Two hundred A total of 218 eligible patients were finally enrolled. These patients were allocated to two groups according to puncture site: papillary (Group 1, = 182) and non-papillary (Group 2, = 36). All procedures were guided by total US. Single standard access (22-24 F) was achieved in all patients. Relevant patient characteristics, operative variables, and postoperative data were collected and analyzed, with a focus on the stone-free rate (SFR) and bleeding complications. Successful percutaneous renal puncture was achieved in all patients. Patients' basic characteristics (gender, age, body mass index, stone size, surgical side) were similar between the two groups. The SFRs in the papillary puncture group were significantly higher than the non-papillary puncture group (81.3% 69.4%, = 0.03). Hemoglobin loss in Group 2 is much more significant than in Group 1 (18.4 ± 5.4 g/L 10.4 ± 4.7 g/L, = 0.02). Overall non-severe complication (Clavien-Dindo Grade 1-2) rates were significantly lower in Group 1 ( = 0.02, 0.03). The operative duration, transfusion rate, severe complication rate, and renal function changes show no significant difference between the two groups. US-guided PCNL through a standard-access tract is necessary for renal papilla puncture. Non-papillary puncture increases bleeding volume and reduces SFR, and should be avoided in complex stones whenever possible.

To evaluate the safety and efficacy of a novel combined retrograde intrarenal surgery (RIRS) technique utilizing a tip-bendable suction ureteral access sheath (S-UAS) and ±20° gravity-assisted (Trendelenburg/reverse Trendelenburg) supine positioning for treating renal stones ≥3 cm. A retrospective multicenter study (3 centers) was conducted in 73 patients between October 2023 and January 2025 with renal stones ≥3 cm. A two-phase surgical approach was employed: initial lithotripsy in 20° Trendelenburg position, followed by fragment evacuation in 20° reverse Trendelenburg using S-UAS suction. All procedures utilized flexible ureteroscopy and a 12/14F S-UAS. Perioperative variables-including operative time, hemoglobin drop, need for second-stage procedures, 3-month stone-free rate (SFR), and complications (fever, subcapsular hematoma, and septic shock) graded by the Clavien-Dindo system-were recorded. A total of 73 patients (mean stone size ∼34 mm) were included. Mean operative time was 125 ± 39 minutes. A second-stage RIRS was required in 32.9% of cases. The overall SFR at 3 months was Grade A (60.3%), Grade B (90.4%), and Grade C (97.3%) after one or two sessions. Postoperative fever occurred in 12.3% and subcapsular hematoma in 1.4% of patients; one patient (1.4%) developed urosepsis (septic shock, Clavien IVa) requiring intensive care unit care. No patients had long-term sequelae or required open surgery. On subgroup analysis, patients with high stone density (≥700 Hounsfield units) had higher second-stage RIRS rate. RIRS with a tip-bendable suction sheath combined with gravity-assisted supine positioning (±20° Trendelenburg/Reverse Trendelenburg) for renal stones appears to be a feasible option for managing stones >3 cm and may be particularly suitable for lower-density calculi. Further studies are needed to validate its effectiveness and safety in broader populations.

This study aims, for the first time, to assess and quantify the environmental impact of ureteroscopy. We conducted a life cycle assessment of flexible ureteroscopy for lithiasis in four different centers, with objective of comparing their respective impacts, determining the most environmentally unsustainable steps of the procedure, and comparing the toll of different medical devices, such as single-use and reusable flexible ureteroscopes (SUFU and RFU). In order to identify eco-designed approaches and to suggest recommendations for sustainable and eco-responsible strategies. For each step of the procedure, we collected the reference of every medical device, their quantities, composition, transport, and disposal methods. Reusable devices' impacts were divided by their lifespans, with sterilization processes included. Data analysis was carried out by Agence Primum non nocere-an independent company specialized in sustainable development-using SimaPro 9.5 with the Ecoinvent 3.9 database and assessing 18 environmental impacts. The steps with the highest environmental cost were equipment installation, surgical staff attire, calculi exploration, and patient setup. There was no clear overall difference between SUFU and RFU regarding global warming, though differences were more significant in certain specific impact categories. Reusable laser fibers exhibit significantly lower environmental impacts compared with single-use fibers. The absence of transparency regarding production data from manufacturers constitutes a significant limitation to our study. We recommend designing optimized ureteroscopy packs, promoting the use of reusable fabric attire, using RFU sterilized with the low-temperature hydrogen peroxide method, prioritizing SUFU with a recycling program, revising disinfection protocols, and increasing waste valorization in operative rooms. We further recommend a hybrid approach to increase the lifespan of reusable ureteroscopes.

Ureteroscopy (URS) is the most commonly performed surgery for the management of renal stones. Post-URS sepsis has been reported to be around 5%, but most studies rely on purchased datasets or electronic medical record (EMR) data that pull data based on billing codes of sepsis without clinical verifications. This study aims to evaluate the true incidence of sepsis using the Sepsis-3 criteria at a single tertiary care institution. A retrospective review was conducted on all URS procedures at a single tertiary care institution from 2021 to 2022, including both Medicare and private insurance patients ≥18 years old. The EMR was queried for URS procedure codes and readmission within 30 days post-procedure with a sepsis diagnosis code. All other procedures, including URS during percutaneous nephrolithotomy, were excluded. Each identified case was evaluated for sepsis using the Sepsis-3 criteria, including sequential organ failure assessment (SOFA) and quick SOFA (qSOFA). A total of 1316 patients underwent URS. Nineteen patients were identified with a sepsis diagnosis, giving an initial post-URS sepsis rate of 1.44%. After EMR verification, 5 patients were excluded, leaving 14 (1.06%) patients with a diagnosis code of sepsis. Using Sepsis-3 criteria, only 6 (0.44%) met the diagnosis. This retrospective review identified only 0.44% of patients with a true post-URS sepsis within 30 days using Sepsis-3 criteria. The difference in our rate from the initial query and current literature highlights the need for accurate clinical diagnosis and documentation of sepsis.

In patients with residual kidney stone fragments after treatment, ultrasonic propulsion (UP) reduced risk of relapse by 70% over 5 years compared with untreated controls. This study presents a second, independent trial of UP to reduce relapse of stone-related events at 1 year follow-up. In this multicenter, open-label, randomized, controlled trial, 24 adults with residual fragments ≤5 mm at least 4 weeks after operation an for kidney stones were enrolled. Using block randomization (4), participants were randomized to treatment ( = 12) with UP or observation ( = 12). The primary outcome was relapse, defined as a symptomatic stone event necessitating medical attention or operation within 1 year of enrollment. The cumulative incidence of relapse was estimated using the Kaplan-Meier method. Log-rank test was used to compare the treatment (UP) and control (observation) groups. The trial was conducted from April 2024 to June 2025. Fragments remained a median of 6 months after procedure before study enrollment. Median (interquartile range) follow-up was 358 (342-365) days. There were no relapse events in the treatment group, whereas 50% of the control group had a relapse event (6/12, < 0.005). The restricted mean time-to-relapse in the control group was 105 ± 48 days. Removal of residual stone fragments by UP reduced relapse of symptomatic stone events and need for operation in the year after intervention, compared with observation.

Focal ablative therapy is an alternative treatment option for selected patients with prostate cancer. Despite growing interest, its initial adoption in the United States has been limited, and its real-world utilization remains insufficiently characterized at the national level. With recent expansions in Medicare coverage, we aimed to use national claims data to analyze the utilization patterns and regional variability in ablative therapies across the United States. We analyzed 100% Medicare claims data to identify patients newly diagnosed with prostate cancer from 2019 to 2023 who underwent ablative therapies, including high-intensity focused ultrasound, cryoablation, and laser ablation. Regional variability was assessed by hospital referral regions, which are designed to capture regional health care markets. We conducted descriptive analyses to examine the uptake of ablative therapies across sociodemographic and clinical variables, including metro, urban, or rural residence (from most to least densely populated areas), United States region, age, race, Medicare/Medicaid eligibility factors, year of diagnosis, and comorbidities. We identified 5462 Medicare beneficiaries newly diagnosed with prostate cancer who underwent ablative therapies from 2019 to 2023, with a median age of 73 years. Most patients were White (84.9%) and had multiple comorbidities (81.1%). Ablative therapies were more commonly performed in metro areas (78.8%) and the South region (39.6%), with utilization rates varying across 306 hospital referral regions from 0% to 6.13% of newly diagnosed prostate cancer cases. Cryotherapy (74.9%) and high-intensity focused ultrasound (24.3%) were the most frequently used ablation techniques. Despite expanded insurance coverage, ablative therapies remain infrequently used for prostate cancer, with substantial regional variations in their adoption. These findings highlight the need for continued data collection and outcomes evaluation to define the optimal use of ablative therapy in prostate cancer care.

To provide a comprehensive overview of the efficacy and safety of ECIRS procedures in a tertiary referral hospital. All ECIRS cases at a tertiary referral center for urolithiasis (Amsterdam UMC) between January 2018 and September 2023 were retrospectively reviewed. Predicted complexity of the operation was stated in Guy's stone score (GSS). Primary outcome was the stone-free rate (SFR) as determined by fragments <4 mm on noncontrast computed tomography (NCCT) at 6 weeks postoperatively. Secondary outcomes included endoscopic SFR and complication rate. A total of 261 ECIRS procedures were included. Mean age was 54 years, and 58% of patients had a GSS of III or IV. Endoscopic SFR was 80%; however, NCCT showed a radiological SFR of 54%, with SFRs of 78%, 55%, 63%, and 40% for GSS I, II, III, and IV, respectively. Postoperative complications occurred in 23% of cases, with major complications (Clavien-Dindo grade ≥3) in 3.8%. Systemic inflammatory response syndrome developed in 8.0%, and a blood transfusion was administered in 3.8% of patients. ECIRS is an effective and safe option for the management of complex renal stones, although complete stone clearance was not achieved in all patients in this selected referral population. Endoscopic and radiological SFRs differ significantly, highlighting the impact of imaging modality on outcome interpretation. A higher GSS correlates with a lower SFR and a higher chance of complications.

This study investigates the efficacy of an innovative anatomical enucleation prostate technique, utilizing a low-energy pulsed thulium:YAG laser emission, to spare the ventral urethral plate (or "lissosphincter") and the ejaculatory hoods in 50 patients with high-volume benign prostatic hyperplasia (BPH). The primary aim was to assess its impact on preserving antegrade ejaculation while obtaining relief from obstruction. In this prospective study, 50 patients were evaluated using the following validated instruments: the International Prostate Symptom Index (IPSS), Quality of Life (QoL) score, and Male Sexual Health Questionnaire Ejaculatory Dysfunction Short Form (MSHQ-EjD SF). Assessments were performed preoperatively and at 6 months postoperation. : Significant improvements were observed postoperatively in functional outcomes: IPSS decreased from 20.42 to 5.76, and QoL score improved from 4.2 to 1.2 (both < 0.001, if significant). Mean Qmax significantly increased from 8.11 mL/min preoperatively to 20.6 mL/min at 6 months ( < 0.001), accompanied by a significant reduction in postvoid residual (PVR) volume. Crucially, antegrade ejaculation was preserved. While MSHQ-EjD SF analysis indicated a nonsignificant reduction in semen volume (Item 3), other parameters, including ejaculation frequency (Item 1), strength of expulsion (Item 2), and bother/satisfaction (Item 4), were not significantly modified, but the patients were satisfied. The ejaculation-sparing pulsed thulium:YAG laser anatomical enucleation technique shows promising results for preserving antegrade ejaculatory function (70% preservation rate) while achieving effective relief of cervico-prostatic obstruction. However, these preliminary findings from a limited cohort require validation through larger, randomized controlled studies with longer follow-up before establishing this technique as a standard approach for ejaculation preservation in BPH operations.

The flexible and navigable suction sheath (FANS) is designed for the effective treatment of renal stones of various sizes. This study aimed to assess and compare the safety and postoperative outcomes at 30 days following FANS treatment for stones smaller and larger than 20 mm. From January to December 2024, patients undergoing retrograde intrarenal surgery performed with FANS were prospectively recruited and divided into two groups based on stone diameter (Group 1: DMAX <20 mm, Group 2: DMAX ≥20 mm). Baseline, perioperative, and follow-up characteristics were analyzed. Stone-free rate (SFR) was evaluated with a non-contrast CT scan at 1-month. Statistical analysis was performed using the unpaired Student's -test and chi-squared test with Yates' correction. A total of 140 patients were enrolled, with 77 having stones <20 mm and 63 having stones ≥20 mm. While a significant difference in stone diameters was observed, no discrepancies were noted regarding the mean stone density between the two groups, thus minimizing the potential for bias. No major Clavien-Dindo complications occurred in either group without differences in hospital length of stay, but Group 1 reported lower visual analogue scale pain. No significant differences in Grade A, B, and C SFR (all > 0.05) and re-intervention ( = 0.58) were observed, suggesting similar efficacy for both stone sizes. This study demonstrates that the FANS as a valuable tool for enhancing patient safety and outcomes in managing larger stones, achieving adequate SFR, and reducing the need for re-intervention without major complications. In the future, FANS may effectively change the indications for stone's treatment according to diameter.

Ureteral injury is a clinical concern during placement of a ureteral access sheath (UAS). Herein, we identify factors contributing to the clinically successful passage of 16F UASs using a previously established safe force threshold of ≤6 Newtons (N). UAS force sensor measurements were recorded during ureteroscopic procedures in 250 renal units (238 patients). If 6 N was reached during insertion of the UAS, the surgeon was advised to downsize from a 16F UAS to a smaller sheath. In each case, a post-ureteroscopic lesion scale (PULS) grade was recorded. A 16F UAS was safely deployed in 145 (58%) renal units with a mean maximum force of 5.5 N. Two renal units sustained a high-grade ureteral injury (PULS 3), both of which had forces of deployment ≥8 N. Independent favorable factors for passage of a 16F UAS included: presence of a preoperative indwelling ureteral stent (76.5% passage) (OR: 3.049, 0.002) and a course of oral antibiotics within 6 weeks of the procedure with or without an associated urinary tract infection (68.4% and 59.6% passage) (OR: 3.133, = 0.002 and 2.046, = 0.034). Preoperative tamsulosin was not of benefit. Adherence to a force threshold of ≤6 N during UAS passage resulted in safe passage of a 16F UAS in 58% of 250 renal units; when adhering to the recommended ≤6 N force threshold, there were no PULS 3 injuries. A preexisting indwelling ureteral stent and administration of antibiotics within 6 weeks of the procedure independently favored safe passage of a 16F UAS.

Precise and efficient application of force on tissue is a core competency of surgical practice, ingrained into surgeons' hands through years of training. To date, safe force thresholds have only begun to be evaluated for urologic tissues. We introduce , an emerging discipline within Urology, by conducting the first comprehensive synthesis of force-related data across urologic procedures. We aim to define force thresholds that inform safe practice, enhance surgical technique, and guide future innovation. A Preferred Reporting Items for Systematic Reviews and Meta-Analyses compliant scoping review was registered with International Prospective Register of Systematic Reviews and conducted using PubMed, Cochrane Library, and Scopus. Two independent reviewers screened studies evaluating surgical mechanical force applied to human GU. Data were categorized by organ, instrument, and procedure. Study quality and bias were assessed using the Newcastle-Ottawa Scale and Cochrane Risk-of-Bias tool. Among 4988 studies identified (1974-2024), only 36 met our Urology-focused inclusion criterion; these studies involved 741 patients and 46 tissue specimens. Force data were reported for the fascia ( = 2), kidney ( = 5), prostate ( = 10), ureter ( = 9), urethra ( = 5), and vagina ( = 5). Ureteral studies identified 6-8 Newtons (N) as a safety threshold. Prostate studies focused on brachytherapy and cancer localization, with needle insertion forces ranging from 2 to 9 N depending on tissue type and needle gauge. Other organs showed wide variability and limited data. Only seven studies were randomized controlled trials; the mean quality score was 6.3, indicating an overall low level of quality among the force studies. This is the first comprehensive review defining surgical force thresholds across urologic tissues to support integration of force-aware technologies into practice and education. Future work should focus on standardizing force application to improve outcomes, especially as force-sensing tools are developed and artificial intelligence-guided platforms become more widely available.

Robot-assisted radical prostatectomy (RARP) is the most common surgical approach in the management of localized prostate cancer. Early evidence suggests that single-port (SP) RARP is a safe and feasible alternative to the conventional multiport (MP) RARP. We compared the perioperative and functional outcomes of SP MP RARP performed by a single high-volume robotic surgeon, assessing the efficacy of SP RARP in an academic setting. We retrospectively analyzed data from 145 consecutive patients who had undergone SP RARP performed by a single surgeon after the initial adoption of this technique. Continence and potency were evaluated at 3 and 6 months postoperatively. After propensity score matching (PSM), outcomes were compared with a historical cohort of patients who had undergone MP RARP performed by the same surgeon. The median estimated blood loss (EBL) was 200 mL (100-300), and the median operative time (OT) was 210 minutes (180-240). Most patients showed intermediate Gleason risk (3 + 4, = 99, 68.3%; 4 + 3, = 30, 20.7%). When compared with the MP cohort after PSM, there were no differences in EBL and a positive surgical margin rate ( = 0.749 and 0.194, respectively). SP RARP patients showed longer OT ( = 0.007) and lower early continence rate after operation (3 months, 47.2% 65.9%, = 0.003; 6 months, 55.3% 82.9%, < 0.001) compared with patients who underwent MP RARP. The majority of the SP RARP patients were discharged on the day of operation. In this single-surgeon series, EBL and surgical margin positivity rate were similar between the SP and MP groups. However, OT was longer, and early continence rates were worse in the SP group. These findings suggest that SP RARP may yield suboptimal functional outcomes in the initial phase of the learning curve.

This study aimed to prospectively compare the impact of suprapubic catheter (SPC) urethral catheter (UC) drainage on perioperative complications and functional outcomes after transperineal whole-gland prostate cryoablation for localized prostate cancer. Between October 2021 and December 2024, 67 patients underwent whole-gland prostate cryoablation at our institution; 52 were eligible for analysis, of whom 19 received an SPC and 33 a UC in a nonrandomized manner based on surgeon preference. Perioperative data were prospectively collected, including catheterization time, urinary retention, infections, and voiding outcomes at 12 months. Comparative analyses were performed, and logistic regression was used to identify predictors of post-treatment urinary retention. The SPC group had a significantly longer median time to effective voiding trial than the UC group (50 20 days, = 0.022). Urinary retention necessitating transurethral operation occurred more frequently in the SPC group (26.3% 9.1%), although this did not reach statistical significance ( = 0.124). Seminal tract infections were observed exclusively in the SPC group (15.8%, = 0.044). No significant differences were observed in incontinence and 12-month voiding outcomes. Multivariable logistic regression with backward selection did not identify any independent predictors of higher odds of urinary retention. Compared with UC, the use of SPC after prostate cryoablation was associated with longer catheterization time and a higher rate of both urinary retention requiring operation and seminal tract infections. Although SPC may improve comfort, its use should be carefully individualized based on patient risk factors.

Benign prostatic hyperplasia (BPH) represents a common condition in aging males. For prostates exceeding 80 g, robotic-assisted simple prostatectomy (RASP) and transurethral prostate enucleation have emerged as leading treatments. This study aimed to comprehensively compare outcomes between these approaches. We conducted a systematic review and Bayesian network meta-analysis of randomized controlled trials and cohort studies. Outcomes included changes in urinary flow rate, International Prostate Symptom Score (IPSS), complication rates, operative bleeding, operative time, hospitalization duration, and catheterization period. Robotic interventions were classified as single-port (SP) or multiport with transvesical (TV), transperitoneal, or transcapsular techniques. Enucleation methods included holmium laser (HoLEP), thulium laser, bipolar, and GreenLight laser vapo-enucleation. We included data from 25 studies with 3924 patients. Network meta-analysis showed no significant difference in overall complication rates between RASP and enucleation techniques, though RASP had the highest surface under the cumulative ranking curve scores in the SP approaches, particularly the SPTV approach. Both RASP and enucleation approaches showed similar improvements in urinary flow rates. RASP approaches, particularly SPTV, had the highest decrease in IPSS, but the changes were not statistically significant. Despite longer operative times and Foley catheterization durations for RASP, blood loss was comparable to enucleation techniques. Our results suggest that robotic approaches have similar performance to HoLEP when managing large prostates. However, robotic approaches may have slight differences including improved symptom scores, lower incontinence rates, longer operative times, and longer hospital stays. In this study, we compared two modern surgical approaches for treating enlarged prostates over 80 g-robotic surgery and laser/electrical techniques that remove prostate tissue through the urethra. We found both approaches work equally well for improving urinary flow, with similar bleeding risks, though the robotic approach may better reduce urinary symptoms but requires longer surgery and hospital stays. This information helps doctors and patients choose the most suitable treatment option for large prostate enlargement.

Bladder outlet obstruction (BOO) and urinary retention were recognized contributing factors to bladder cancer (BCa) recurrence and progression due to prolonged urothelial exposure to carcinogens, chronic inflammation, and incomplete bladder emptying. Holmium laser enucleation of prostate (HoLEP) is a minimally invasive and highly effective procedure that completely removes obstructive prostatic tissue, thus resolving BOO. To explore the HoLEP impact on BCa recurrence and progression by improving voiding dynamics and reducing post-void residual (PVR). We carried out a retrospective case-control study, based on a multicenter prospectively maintained database, on 100 consecutive male patients (cases) with a first diagnosis of non-muscle-invasive bladder cancer, with BOO and urinary retention and treated with HoLEP (in case of at least 3-months of timor-free status). The cases were compared with 200 patients (controls) with same baseline characteristics but not treated with HoLEP. We evaluated PVR, International Prostatic Symptoms Score-IPSS, BCa recurrence and progression rates. The -Test, χ2-test, logistic correlations, multivariate analysis were applied to evaluate the association between the BOO resolution and urinary retention by HoLEP and BCa recurrence and progression. Patients treated with HoLEP showed a significant PVR reduction compared with controls ( < 0.01). The HoLEP group demonstrated statistically significant improvements in IPSS scores, indicating better urinary symptom control. The rates of recurrence and progression were significantly lower in the HoLEP-treated group ( < 0.01). Multivariate analysis identified the BOO resolution by HoLEP as an independent predictor of reduced BCa recurrence (odds ratio 0.65, 95% CI 0.45-0.85, < 0.001). The control group exhibited persistently elevated PVR and higher rates of BCa recurrence and progression. Urinary retention could represent a prognostic factor of treatment response, and its active treatment by HoLEP should be considered as an important therapeutic step in the clinical management of patients with BCa.

Traditionally, robot-assisted kidney transplant (RAKT) is performed using a transperitoneal approach, with patient in steep Trendelenburg position, leading to potential concerns for cardio-respiratory, bowel, and ocular complications. To circumvent these, we evaluated the feasibility, technical aspects, and outcomes of an extraperitoneal approach (EP-RAKT) and compared it with the transperitoneal approach (TP-RAKT). We reviewed our prospective database of patients who underwent RAKT with extraperitoneal approach between June 2023 and May 2024. This cohort was propensity matched in a 12 ratio with patients who underwent RAKT with transperitoneal approach for confounding variables (age, sex, BMI, graft kidney GFR, and graft number of vessels). Clinical parameters were recorded for all patients, including their demographic profile, radiological parameters, operative details and postoperative outcomes, and the cohorts were compared for intraoperative and postoperative outcomes. During our study period, 10 patients underwent EP-RAKT and were propensity matched with 20 patients with similar characteristics who underwent TP-RAKT. The mean duration of postoperative ileus (1.3 vs. 2.9 days), mean drain output (131 vs. 786 mL), and mean postoperative pain score (Visual Analog Scale score 10.2 vs. 14.8) were shorter for the extraperitoneal when compared with transperitoneal approach. No statistical differences were observed between the two groups for blood loss, rewarm ischemia time, vascular anastomosis time, or graft function. Patients in EP-RAKT group had more consistent tacrolimus levels in the therapeutic range in early postoperative period. However, the mean total operative time (288 ± 35.2 vs. 240 ± 28.2 minutes) and the mean time spent in port placement and bed preparation (50.8 ± 8.4 vs. 28.3 ± 6.1 minutes) were longer in EP-RAKT vs TP-RAKT. EP-RAKT is a safe and feasible procedure, with similar graft function and reduced early postoperative complications compared with TP-RAKT, albeit with higher operative times.

Single-use (SU) flexible ureteroscopes have been widely adopted as standard-of-care. However, there are few head-to-head studies comparing SU scopes in real-world clinical scenarios. Further complicating these comparisons is the fast pace of incremental improvement and evolution of SU scopes. We compared usability and video quality for SU ureteroscopes in a real-world clinical scenario to provide information for prospective users. Nine SU and one reusable ureteroscope were compared (Boston Scientific LithoVue, LithoVue Elite, Cook Ascend, Dornier Axis, OTU WiScope, Pusen Uscope, Becton Dickinson Aptra, Richard Wolf digital ureteroscope, Storz Flex-XC1, Olympus URF-V2). First, faculty and residents performed ureteroscopy and reviewed scopes with the University of Wisconsin Flexible Ureteroscopy Evaluation Instrument (image quality, deflection, control, irrigation, access, working channel, and satisfaction; 1-5 scale). Second, using a novel video quality evaluation instrument, blinded reviewers rated resolution, contrast, color, sharpness, glare, depth perception, distortion, and overall quality on a 1-5 scale. Multivariate analysis of variance and analysis of variance analyses were conducted. 167 hands-on and 162 video evaluations were completed. Internal consistency was demonstrated (Cronbach's α > 0.90 for all cases). Flex-XC1 and LithoVue Elite had the highest image quality ( < 0.05). Ascend had superior ureteroscopic access ( < 0.05). Uscope ranked lowest in image quality, working channel function, and satisfaction ( < 0.05). LithoVue Elite and Ascend had the highest satisfaction scores (4.64, 4.60, < 0.05). Flex-XC1 and URF-V2 had the highest resolution, contrast, and overall quality ( < 0.05). Flex-XC1 led in color and sharpness ( < 0.05), while Uscope was rated poorly for image resolution, contrast, sharpness, and overall image quality ( < 0.05). This study is the largest head-to-head comparison to date, providing real-world data for urologists who are prospective purchasers and users of SU ureteroscopes. In the hands-on evaluation, users preferred Cook Ascend, Boston Scientific LithoVue Elite, and Storz Flex-XC1. The Flex-XC1 was rated higher in most categories in video quality evaluation.

Ureteral stents are commonly used after ureteroscopic lithotripsy (URS) to prevent obstruction, but often cause stent-related symptoms (SRS), which can impact patients' quality of life. The Ureteral Stent Symptoms Questionnaire (USSQ) is a validated tool for assessing these symptoms. This study aimed to compare the SRS of three ureteral stents: conventional Double-J (cDJ, Tria), soft DJ (sDJ, Tria Soft), and loop-tail (LT, Polaris Loop), using the Japanese version of the USSQ. In this multicenter, prospective cohort study, 96 patients undergoing URS for upper urinary tract stones were enrolled and evenly assigned to one of the three stent groups. The USSQ was administered at baseline, 2 and 14 days after stent placement, and 2 weeks after stent removal. The primary end point was the USSQ score on postoperative day 14. The secondary end points included USSQ scores on day 2, postremoval, and score changes over time. Statistical analysis was performed using paired and unpaired -tests, with < 0.05 considered significant. On day 14, the LT group showed significantly better general health index scores than the cDJ group ( < 0.001), whereas the sDJ group showed a favorable trend ( = 0.054). The LT group had worse scores in the sexual matters domain ( = 0.011), although all groups scored low. There were no significant between-group differences in urinary symptoms, pain, or work performance. The LT and sDJ groups had significantly better general health index scores than the cDJ group on day 2 and after removal. Urinary symptoms and pain were highest early poststenting and improved significantly over time ( < 0.001). The Polaris Loop stent significantly reduced SRS compared with the Tria stent, whereas the Tria Soft stent showed a favorable trend toward improvement. Because SRS is a major patient concern, general health should be considered alongside urinary and pain symptoms when selecting an optimal stent.