Explore the vast range of titles available.

Inverted urothelial papilloma (IUP) is an uncommon benign urothelial tumor characterized by an endophytic growth pattern. While it most commonly affects older male patients, we report the case of a young female patient with a bladder lesion located on the right lateral wall, an exceptionally rare clinical presentation in terms of age, sex, and tumor location. Such unusual presentations offer valuable learning opportunities and remind clinicians to consider rare benign entities in the differential diagnosis of bladder tumors. Accurate differentiation from urothelial carcinoma (UC) remains essential due to overlapping histological features. We emphasize the critical role of imaging, histopathology, and immunohistochemistry in reaching a definitive diagnosis, while highlighting the potential of emerging methods to enhance clinical decision-making. As radiomics and artificial intelligence (AI) continue to advance, they may significantly influence diagnostic approaches and future therapeutic strategies.

Laser disintegration of urinary stones is a cornerstone of urolithiasis treatment in the modern era. Despite the wide clinical use of stone lasers, basic and advanced technological achievements and developments are difficult to comprehend and interpret by the average urologist. A descriptive analysis of laser production and stone disintegration mechanisms was performed. We focused on physics of modern types of lithotripters, the construction of laser fibers, laser parameters, new modes, settings, and lithotripsy techniques. The main principle of laser emission remains the same since the first emitting laser was produced. Peak power density and short interaction time lead to photothermal effects responsible for stone disintegration. Modern lithotripters such as Holmium: YAG (low/high power, Moses technology) and thulium fiber laser show basic construction differences with the physical properties of the latter being superior, at least in in vitro studies. By adjusting lasing parameters, a wide spectrum of stone ablation from fragmentation to dusting can be achieved. New technology allows for the production of real dust. Knowledge of laser fiber construction and physical properties are useful in marketing and clinical use. Urologists should understand the physical and physiological background of the lasers used in their everyday practice for stone fragmentation. Cite this article as: Tzelves L, Somani B, Berdempes M, Markopoulos T, Skolarikos A. Basic and advanced technological evolution of laser lithotripsy over the past decade: An educational review by the European Society of Urotechnology Section of the European Association of Urology. Turk J Urol 2021; 47(3): 183-92.

IntroductionThe role of medical expulsive treatment (MET) is controversial. Fragility index is an additional metric to assess randomized controlled trials (RCTs) outcome validity and indicates how many patients would be required to convert a trial from being statistically significant, to not significant. The larger is the FI, the better the trial’s data. The aim of this study is to assess FI of RCTs regarding MET for ureteral stones.Materials and methodsA systematic literature search was performed. RCTs, reporting stone expulsion as a dichotomous outcome, showing statistical significance were eligible. FI (the number of patients needed to change from a non-event to event group, to lose statistical significance) and Fragility quotient (FI divided by total sample size), were calculated while Pearson’s correlation and Mann–Whitney U test were used as appropriate.ResultsThirty-six RCTs were eligible, with median FI = 3.5 and fragility quotient = 0.042, median sample size = 81, median journal impact factor = 1.73 and median reported p value = 0.008. In 33.3% of the studies, number of patients lost during follow-up was larger than FI, while in 13.89% of the studies, FI was 0, indicating use of inappropriate statistical method. Pearson’s correlation showed significant positive association between FI and sample size (r = 0.981), number of events (r = 0.982) and impact factor (r = 0.731), while no association was found with p value or publication year.ConclusionsIn this analysis, a calculated FI of 3.5 indicates that findings from RCTs on MET for ureteral stones are fragile and should be interpreted in combination with clinical thinking and expertise.

Urolithiasis is a common clinical condition with frequent recurrences. Advances in knowledge of pathophysiological mechanisms permit the categorization of patients to low and high risk for recurrence, with specific metabolic abnormalities diagnosed in the second category. Follow-up is essential for patients with urolithiasis and consists of both imaging and metabolic follow-up with urine studies. No formal guidelines or solid evidence currently exists regarding frequency and type of follow-up studies to be performed in each category. This review aims to summarize existing evidence regarding follow-up, in order to guide clinicians on how and when to follow-up urolithiasis patients according to existing clinical scenario.

Testicular cancer is the most common neoplasm in men aged 15-45 years old, with several established risk factors such as cryptorchidism, age, and family history. We report a case of a 44-year-old man with a history of cryptorchidism who presented with lesions in his right testis, a large retroperitoneal mass, and diffuse nodal lesions in his lungs. He underwent radical orchiectomy that showed testicular cancer and was immediately inducted into systemic therapy based on bleomycin, etoposide, and cisplatin. Two weeks later, his monozygotic twin brother, also reporting cryptorchidism at a young age, presented with a painless mass in his left testis. He underwent radical orchiectomy that revealed testicular cancer and received adjuvant chemotherapy. The first patient, after two cycles of chemotherapy, suffered from an episode of massive hematochezia and died while his brother remains relapse-free.

Gangrenous cystitis is considered a life-threatening but rather rare clinical entity due to the widespread use of antibiotics. We herein report a case of a 78-year-old female with gangrenous cystitis secondary to a spontaneous expanded hematoma of the lesser pelvis who underwent partial cystectomy followed by bilateral ureterostomies with no favorable outcome.

Percutaneous nephrolithotomy (PCNL) is the gold standard procedure for treatment of large stones and complex kidney disorders, but its morbidity remains the highest among stone treatment procedures. In pursuit of minimizing complication rates, surgeons have developed different variations of the classic prone position in which PCNL is usually performed; one among them is supine position. In this study, we review the literature and present all available evidence on different variations in positioning during PCNL, in an effort to identify if there is a position that can minimize the morbidity of this procedure.

Urachal cancer is a rare and aggressive type of cancer, frequently characterized by a lack of prominent symptoms. We herein report a case of a 50-year-old female with mucin-producing adenocarcinoma originating from the urachus who underwent partial cystectomy and the patient remains disease-free for 30 months after treatment.

Renal cell carcinoma represents approximately 3% of all cancers, with the highest incidence occurring in the western world. Around 33% of the patients experience metastatic disease at diagnosis. Since the approval of the first targeted therapy, the treatment of metastatic renal cell carcinoma (mRCC) has positively changed, but the surgical treatment of the primary tumor, and metastases if possible, is sometimes crucial in selected patients controlling the burden of cancer sites with the intention to improve survival. We, herein, report on a case of a young male patient presented in the emergency room with gross hematuria which underwent transdiaphragmatic nephrectomy with synchronous pulmonary and anterior thoracic wall mass metastasectomy with a single thoracic incision due to mRCC. Achieving a full response in patients with mRCC is extremely rare only with medical treatment. The role of complete surgical metastasectomy is questioned, but there are several studies that support its efficacy in achieving metastases free status prolonged overall survival and better quality of life. The therapeutic treatment plan for these patients should be discussed within dedicated multidisciplinary cancer centers and focus on each patient individually and they should be offered a closed follow-up strategy.

Penile abscess is a urological entity rarely described in the literature. It has been associated with injection therapy for erectile dysfunction, penile instrumentation, trauma and priapism. Identified risk factors include immunosuppresion and pre-existing local or distant infection. Common causal microorganisms include Staphylococcus aureus, Streptococci and Bacteroides. We herein report on a case of penile abscess in a 37-year-old patient occurring after sexual trauma and presenting with bacteremia.