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Background and Objectives: Aquablation, a robot-assisted, heat-free resection technique, has emerged as a promising minimally invasive surgical therapy (MIST) for benign prostatic hyperplasia (BPH). Its precision and potential for preservation of sexual function distinguish it from traditional surgical options. This systematic review aimed to evaluate the safety profile of Aquablation, with emphasis on perioperative complications and functional outcomes. Materials and Methods: We systematically searched PubMed/MEDLINE, Scopus, and the Cochrane Library through June 2025 in accordance with PRISMA 2020 guidelines (PROSPERO CRD420251074479). Eligible studies included randomized and non-randomized trials of Aquablation in men with BPH, reporting adverse events by type, frequency, or severity. Risk of bias was assessed with ROB-2 and ROBINS-I tools. Results: Forty-seven studies were included, spanning randomized controlled and prospective observational designs. Most complications were minor (Clavien-Dindo grade 1–2). Bleeding was the most frequent perioperative event, with transfusion required in 1–8% of cases, more often in large prostates. Severe complications (grade ≥ 3) were uncommon and usually related to bleeding or urinary retention. Long-term sequelae such as strictures or bladder neck contracture were rare. Compared with transurethral resection of the prostate, Aquablation yielded lower rates of ejaculatory dysfunction (10% vs. 36%), with continence and erectile function largely preserved. Outcomes were comparable to holmium laser enucleation, but Aquablation demonstrated superior ejaculatory preservation. Conclusions: Aquablation demonstrates a favorable safety profile across prostate sizes, with its greatest advantage being preservation of sexual function. While bleeding remains the principal perioperative concern, life-threatening events are rare. Further independent, long-term comparative studies are warranted.

Abstract Background: In routine urological practice, pigtails are frequently utilized to relieve blockage. Early signs of pigtail problems include pain, lower urinary tract symptoms, pain, hematuria (54%) and fever. Seventy percent of patients experience irritable voiding symptoms, and 80% of patients or even more report pain interfering with everyday activities. Methods: This article's goal is to evaluate the various polymeric stents that are currently on the market. In addition, a review of their fundamental bioqualities is conducted, and a connection between their physical attributes (length, size, and composition) and stent-related issues is looked into. For this review, extensive Medline, PubMed, and literature research from 1987 to January 2023 was conducted. Lower urinary tract complaints, ureteral stents, \"pigtail,\" \"materials,\" \"characteristics,\" or \"properties\" were the search terms employed. Results: The reviews and publications that are now accessible linking certain materials to stent-related symptoms offer contradictory conclusions, and the majority of research do not specify the precise properties of the materials utilized. The results of the studies on the relationship between stents length and diameter and symptoms connected to stents are likewise inconclusive, despite the fact that there are several studies on this topic in the literature. Conclusion: Numerous studies imply a connection between the various types and properties of the utilized stents and stent-related complaints. However, the available data did not fully support this claim, necessitating additional research.

Background: The widespread adoption of holmium laser enucleation of the prostate (HoLEP) has led to a growing number of men subsequently diagnosed with localized prostate cancer requiring radical prostatectomy (RP). However, anatomical alterations after HoLEP may increase surgical complexity and affect outcomes. This systematic review aimed to synthesize current evidence on perioperative, oncological, and functional outcomes of RP following HoLEP. Methods: A systematic literature search was conducted in PubMed, CENTRAL, and ClinicalTrials.gov through to September 2025 in accordance with PRISMA 2020 guidelines (PROSPERO CRD420251134483). Eligible studies included patients undergoing RP after HoLEP with reported perioperative, oncologic, or functional data. Methodological quality was assessed using the ROBINS-I tool, and results were synthesized narratively. Results: Eight retrospective studies comprising 202 patients were included. RP after HoLEP was technically feasible across open, laparoscopic, and robotic approaches. Operative time and the need for bladder-neck reconstruction were increased, reflecting post-enucleation fibrosis, but major complication rates (<5%) and blood loss were comparable to primary RP. Oncological outcomes were preserved, with positive surgical margin rates of 6–20% and biochemical recurrence rates of 7–15%, similar to those of primary RP. Functional recovery, particularly urinary continence, was slower initially but generally equivalent at 12 months. Erectile function outcomes were variable but satisfactory when nerve-sparing was feasible. Conclusions: Radical prostatectomy after HoLEP is a technically demanding yet safe procedure that achieves oncologic and long-term functional outcomes comparable to primary prostatectomy. Prior HoLEP should not preclude curative surgical management of prostate cancer, provided the operation is performed by experienced surgeons in high-volume centers.

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.

Catheter-related bladder discomfort (CRBD) is a common and distressing complication following transurethral urologic procedures such as transurethral resection of the prostate (TURP) and transurethral resection of bladder tumors (TURBT). This prospective observational study investigated the role of preoperative, intraoperative, and postoperative factors in predicting the severity of postoperative bladder spasms. A total of 122 patients were enrolled, and bladder discomfort was assessed using the Visual Analogue Scale (VAS) during their postoperative hospital stay. Most clinical and surgical variables, including anesthesia type, procedure type, catheter type, energy modality, and patient demographics, showed no significant association with bladder discomfort severity. However, catheter balloon volume emerged as a significant predictor, with patients receiving 40 mL balloon volumes reporting higher VAS scores compared to those with smaller volumes (p = 0.003). Additionally, a weak but statistically significant correlation was found between hematocrit drop and VAS scores (rho = 0.18, p = 0.047), suggesting a possible link between intraoperative blood loss and postoperative discomfort. These findings highlight the potential for simple interventions, such as optimizing catheter balloon volume, to alleviate CRBD and enhance postoperative recovery.

Catheter-related bladder discomfort (CRBD) is a frequent postoperative complication that significantly impacts the quality of recovery in patients undergoing transurethral surgeries. It manifests as suprapubic pain, an intense urge to void, and bladder spasms due to muscarinic receptor activation. This narrative review provides a comprehensive analysis of CRBD, with a particular focus on bladder spasms in patients treated with transurethral resection of bladder tumors (TURBT) or the prostate (TURP). The review explores the underlying pathophysiology, clinical implications, and evidence-based management strategies, including pharmacological interventions such as antimuscarinics and nerve blocks, as well as non-pharmacological measures.

Fournier's gangrene is a rare and potentially life-threatening type of necrotizing fasciitis that affects the genital and perineal regions. Malignant priapism is a rare and serious medical condition characterized by persistent and painful erection of the penis that is not associated with sexual arousal or stimulation. We present a case of a 77-year-old man with concurrent Fournier's gangrene and malignant priapism. He first underwent surgical debridement to remove necrotic tissue and aspiration of blood from the corpora cavernosa. Then a palliative penectomy was performed. The patient succumbed to severe sepsis and died after 14 days of hospitalization.

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.

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.

Urolithiasis is a common condition with high recurrence rates, often driven by metabolic abnormalities, dietary habits, and systemic disorders. Metabolic evaluation plays a key role in identifying modifiable risk factors such as hypercalciuria, hyperoxaluria, hypocitraturia, and hyperuricosuria. Despite its clinical value, metabolic evaluation remains underused in practice. This narrative review highlights the rationale, methods, and therapeutic implications of metabolic assessment in patients with recurrent or high-risk stone disease. The evaluation includes medical and dietary history, physical examination, blood and urine tests, 24‑h urine collections, and stone analysis. Tailored interventions—ranging from dietary advice to pharmacologic treatments such as thiazides, potassium citrate, and allopurinol—can reduce stone recurrence and prevent complications such as chronic kidney disease. Ongoing follow-up is essential to assess treatment response and modify strategies. Adherence to current guidelines and broader implementation of metabolic workup can significantly improve patient outcomes and reduce the global burden of stone disease.