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Robotic flexible ureteroscopy (RFURS) has emerged as a novel approach to address the ergonomic challenges and technical limitations of conventional flexible ureteroscopy (FURS) for renal stone management. While FURS remains a cornerstone in treating nephrolithiasis, prolonged procedures contribute to surgeon fatigue, musculoskeletal strain, and increased radiation exposure. Despite growing adoption, the literature lacks a synthesis of the clinical benefits, cost-effectiveness, and long-term outcomes of RFURS compared to conventional approaches. The objective of our study is to synthesize the existing evidence in the literature and produce a comprehensive systematic review of RFURS. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we searched PubMed, Embase, and Cochrane (inception: June 2025) for clinical studies on RFURS. Meta-analysis used random-effects models for pooled estimates of stone-free rates (SFRs), operative times and complications. The risk of bias was assessed by the Newcastle-Ottawa Scale and the Cochrane risk tool. Twelve studies (706 patients) were included. RFURS achieved a pooled SFR of 87.4% (95% confidence interval (CI): 82.7-92.0%), comparable to conventional FURS. Pooled operative time was 94.7 minutes (95% CI: 78.9-110.5), longer than conventional FURS. Complication rates were 10.6% (95% CI: 5.1-16.1%) similar to conventional FURS. Ergonomics were superior, with reduced surgeon fatigue and radiation exposure. Learning curves vary according to the robot platforms and early proficiency is noted among experienced endoscopists. Cost-effectiveness data were limited. RFURS demonstrates non-inferior efficacy and safety to conventional FURS, with enhanced ergonomics and manageable learning curves. High heterogeneity and limited cost data necessitate larger comparative studies.

 This study aimed to analyze and evaluate the effectiveness and safety of Rezum (water vaporization of the prostate), a minimally invasive treatment for managing lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH), with a focus on postoperative outcomes.  Methodology: Seventy-three patients meeting the inclusion criteria were enrolled in the study at Leicester General Hospital (University Hospitals of Leicester NHS (UHL), NHS trust), Leicester, England, from 1 August 2023 to 31 August 2024. In this prospective cohort study, the following variables were recorded: name, date of birth, date of admission, pre-/postoperative International Prostate Symptom Score (IPSS), pre-/postoperative Quality of Life Score (QOLS), pre-/postoperative International Index of Erectile Function (IIEF-5), prostate size, urodynamics, prostate-specific antigen (PSA) level, Rezum injections, anesthesia, post-procedure side effects and symptoms on follow-up, recommendations to family and friends, and status on discharge. To assess the procedure outcomes, these variables were analyzed using IBM SPSS Statistics, version 23 (IBM Corp., Armonk, NY), and the results were depicted in the form of graphs, charts, and tables.  Results: In our study, the mean preoperative IPSS was 22.6 ± 7.5, reduced to 12.8 ± 9.4, showing a 27% improvement. The highest pre-procedure QOLS was five (n=19, 26.4%), compared to three (n=21, 29.2%) after Rezum, representing a 33.3% improvement. Preoperative assessment of erectile function, as measured by the IIEF-5 with a maximum possible score of 25, revealed a mean score of 15.1 ± 1.1. Post-operative evaluation indicated a slight decline, with the mean score decreasing to 14.7 ± 4.03, reflecting a 1.5% reduction in erectile function. The reduction in symptomatic LUTS showed a statistically significant improvement with injections targeting the left side and the median lobe (p = 0.002). Furthermore, a statistically significant correlation was observed between Rezum injections targeting the median lobe and post-procedure quality of life (p = 0.003).  Through this single-center retrospective cohort, we concluded that Rezum is a minimally invasive outpatient procedure that offers safe and effective treatment for LUTS. It has a low side-effect profile and preserves sexual function. Further long-term studies are recommended.

The treatment of urolithiasis is changing with the development of new technological tools and laser technologies. In this study, we aimed to compare the operation types and laser lithotripsy settings used in 1-2 cm lower calyceal stones and the effect of these settings on success. Place & duration of study: Amasya University Faculty of Medicine, Şerefeddin Sabuncuoğlu Training and Research Hospital Department of Urology, Mustafa Kemal University Faculty of Medicine, between March 2019 and June 2021. A total of 263 patients who underwent retrograde intrarenal surgery (RIRS) (n = 155) and mini percutaneous nephrolithotomy (mPCNL) (n = 108) for the treatment of lower pole kidney stones between 2019 and 2021 were analyzed. Laser settings between 0.2-0.8 joules & 10-20 Hz were defined as high frequency using low-pulse energy (HiFr-LoPE), and settings between 1-2 joules & 5-10 Hz were defined as low frequency using high-pulse energy (LoFr-HiPE). The operation types according to laser settings were compared in terms of operative time, fluoroscopy duration, length of hospital stay, stone clearance rate, clinically insignificant residual fragment (CIRF), and complication rate. The operation time and fluoroscopy time were significantly longer in the mPCNL group (p<0.001 and p<0.001, respectively). While the stone density was similar between groups (group 1 = 1039.00 (IQR = 930.00-1222.00) vs group 2 = 1101.00 (IQR = 900.00-1238.00); p = 0.406), the stone size was significantly higher in the mPCNL cohort (100.00 (IQR = 90.00 - 117.00) vs. 190.00 (IQR = 170.00-218.00), p<0.001). The stone-free rates (SFR) were similar between groups (p = 0.1011). Additionally, the required energy (J/mm ) was higher in the mPCNL group (23.70 (IQR=21.41-25.92) and 25.21 (IQR=24.29-26.19) p<0.001). For further analysis, subgroup analysis based on stone size 1.5 cm was performed and showed that there is no significant difference in terms of total energy, required energy, and stone-free rate between groups in patients with stone size below 1.5 cm (p = 0.589, p = 0.210, and p = 0.845, respectively). However, operation time, total energy, and required energy were significantly higher in the mPCNL group in patients with stone size above 1.5 cm (p <0.001, p <0.001, and p <0.001, respectively). The most common low-grade (grade I and grade II) complications were seen (22 and 8, respectively), and the grade of complications was similar between groups (p = 0.233). The laser technologies have added a significant contribution to urinary stone treatment. The required energy and laser time may provide crucial information for preoperative planning. The bigger stones require greater energy for fragmentation, and the percutaneous approach is advantageous when planning the treatment of this stones.

Locally advanced prostate cancers (LAPC) are a clinical dilemma due to their biological heterogeneity and multiple algorithmic treatment options. Recent years have seen a great deal of progress in management, both in established methods and new modalities. This had led to a necessity to systematically map out existing evidence. This scoping review intends to systematically integrate and summarize the zeitgeist research in the area of the care of LAPC to advance the available knowledge, discuss emergent management strategies, and identify evidence needs in different healthcare settings. A scoping review was undertaken following the Joanna Briggs Institute methodology and reported following the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. A primary study search was conducted on six electronic databases (MEDLINE, Embase, Scopus, Web of Science, CINAHL Plus, and Cochrane Library) and gray literature sources published between 2013 and April 2025. The Population-Concept-Context (PCC) framework guided the eligibility. Data were plotted and thematically synthesized into six key domains: hormonal therapy, radiotherapy innovations, surgical strategies, new systemic therapies, imaging improvements, and real-life evidence. Six studies were included, consisting of a randomized controlled trial, an observational study, and a diagnostic review. The main themes were the benefits of multimodal treatment, the impact of prostate-specific membrane antigen (PSMA) positron emission tomography (PET) imaging and genomic profiling, and the role of second-generation androgen receptor inhibitors and regional disparities in access to treatments. Combination therapies showed oncologic benefits, but raised concerns about patients' quality-of-life outcomes. The management of LAPC is moving to a related precision-based, multimodal paradigm. Although current knowledge supports more aggressive and individualized therapy, there are still data gaps in long-term outcomes, global uptake, and patient-reported measures. Future research needs to be based on inclusive longitudinal studies that span between clinical innovation and real-world application.

Urinary incontinence (UI) is a common condition that impacts society. A transobturator tape (TOT) sling is one of the most widely used surgical options in the treatment of stress incontinence. This study aimed to investigate the incidence and types of postoperative complications, as well as the reoperation rate, in women undergoing TOT sling surgery. A retrospective cohort study was conducted involving 194 women submitted to a TOT sling between 2010 and 2020 at São José do Rio Preto Base Hospital, a university hospital in the state of São Paulo, Brazil. Demographic characteristics, type of UI, preoperative urodynamic data, postoperative complications, and the need for reoperation were collected. The data were entered into a spreadsheet in MS Excel. IBM SPSS Statistics for Windows, version 23.0 (released 2014, IBM Corp., Armonk, NY) and GraphPad Instat (version 3.10, released 2009, GraphPad, California, USA) programs were used for the statistical analysis. The mean patient age was 56.4 years, and 68% of the sample had stress UI alone. The success rate was 77%, whereas 31% had clinical or surgical complications, such as de novo urgency and postoperative stress UI, mesh extrusion, urinary obstruction, and acute urinary retention. Only four patients (2%) required reoperation. The epidemiological findings (average age and prevalence of comorbidities, such as hypertension (36.6%) and diabetes (14.4%)) match the expected profile for women with UI. The overall complication rate was compatible with rates described in the literature, with a predominance of conservatively manageable clinical complications. Although 7.8% of the patients required intervention for surgical complications, the procedure proved safe and effective, even in a teaching environment. TOT sling proved to be a safe, effective option for the treatment of stress UI, even in a training scenario. Most postoperative complications were managed clinically, and the reoperation rate was low. Despite the proven efficacy of the procedure, the monitoring of clinical complications is necessary to minimize the impact on the quality of life of patients.

Objective This study aimed to assess whether the hinotori™ surgical system (Medicaroid Corporation, Kobe, Japan), during its early clinical adoption, could achieve perioperative outcomes in robot-assisted sacrocolpopexy (RASC) for pelvic organ prolapse (POP) comparable to those of the established da Vinci® system (Intuitive Surgical, Sunnyvale, CA, USA). Materials and methods This single-center retrospective study included 23 patients who underwent RASC between September 2023 and December 2024. Eleven patients underwent surgery with the hinotori™ system (h-RASC), and twelve with the da Vinci® system (d-RASC). Operative time, console time, and stepwise procedural durations were evaluated. Results Patient characteristics were comparable between groups. Although console time showed no significant difference, operative time tended to be longer in the h-RASC group (275 vs. 242 minutes; p = 0.056), without reaching statistical significance. The time from robot roll-in to console start (16 vs. 7 minutes; p = 0.004) and posterior mesh fixation (16 vs. 12 minutes; p = 0.001) was significantly longer with the hinotori™ system. Other perioperative outcomes were similar. Conclusion RASC using the hinotori™ system produced comparable perioperative outcomes to those of the da Vinci® system, although some procedural delays were observed during the initial implementation period.

The horseshoe kidney is the most common renal fusion anomaly, and its unique anatomical configuration and aberrant vasculature present significant surgical challenges, particularly in malignant conditions such as urothelial carcinoma. We report a case of robot-assisted right nephroureterectomy with the da Vinci Xi® Surgical System (Intuitive Surgical Inc., Sunnyvale, CA) in a patient with right lower ureteral cancer associated with a horseshoe kidney. The procedure was completed robotically using the da Vinci Xi® system in 207 minutes with minimal blood loss. The pathological diagnosis was high-grade urothelial carcinoma (pT2) with negative surgical margins and one positive lymph node near the ureteral tumor (N1). The postoperative course was uneventful, and no recurrence was observed at 24 months. This case demonstrates the safety and efficacy of robot-assisted surgery for upper tract urothelial carcinoma (UTUC) in patients with complex renal anomalies such as a horseshoe kidney.

This report presents the case of a 62-year-old male who presented with a two-month history of right flank pain and decreased appetite. Clinical evaluation revealed a palpable, non-tender mass in the right flank, while laboratory tests demonstrated mild anemia (hemoglobin 9.3 g/dL) with otherwise normal renal function. Contrast-enhanced computed tomography of the abdomen showed a large, heterogeneous mass arising from the lower pole of the right kidney, containing mixed densities, fatty components, and coarse calcifications. The initial differential diagnosis included angiomyolipoma. Following multidisciplinary discussion, the patient underwent radical nephrectomy. Gross examination revealed a lobulated, yellowish tumor with areas of necrosis and hemorrhage. Histopathological analysis confirmed the diagnosis of dedifferentiated liposarcoma, characterized by spindle cell proliferation with moderate nuclear atypia and mature adipocytes. Immunohistochemistry showed strong nuclear positivity for MDM2 and p16, supporting the diagnosis. The tumor was staged as pT3aNxM0. Postoperative follow-up was arranged to monitor for recurrence. This case highlights the diagnostic challenge posed by rare renal tumors with fatty components and emphasizes the importance of including dedifferentiated liposarcoma in the differential diagnosis. Early surgical intervention remains essential to optimize outcomes, given the tumor's limited response to adjuvant therapies.

Varicocele is a common, correctable cause of male infertility, often associated with impaired spermatogenesis. Microsurgical subinguinal varicocelectomy is considered the gold standard for varicocele repair, with documented benefits on semen quality, particularly sperm count. The objective of this study was to evaluate the effect of microsurgical varicocelectomy on sperm count in infertile men diagnosed with clinical varicocele. This prospective observational study was conducted at the Institute of Kidney Diseases, Hayatabad Medical Complex, Peshawar, Pakistan, over six months (October 1, 2024, to March 31, 2025). A total of 100 male patients aged between 20 to 45 years with clinical Grade I-III varicocele and abnormal semen parameters were enrolled. Patients underwent microsurgical subinguinal varicocelectomy after baseline semen analysis. A follow-up semen analysis was performed three months postoperatively. Pre- and postoperative sperm counts were compared using paired t-tests. Subgroup analysis was performed based on varicocele grade and laterality. The mean preoperative sperm count was 12.5 ± 6.8 million/mL, which significantly increased to 20.2 ± 8.1 million/mL postoperatively (p < 0.001). Patients with Grade III varicocele showed the highest improvement (22.6 ± 9.1 million/mL, p = 0.003). No significant difference was observed based on laterality (p = 0.087). Microsurgical varicocelectomy significantly improves sperm count in men with clinical varicocele, particularly in higher-grade cases. It should be considered an effective first-line intervention in the management of varicocele-associated male infertility.

Preoperative obstructive pyelonephritis (OP) increases the risk of febrile urinary tract infection (fUTI) after ureteroscopic lithotripsy (URSL). This study aimed to investigate the effect of a history of OP treated without drainage on post‑URSL fUTI. We retrospectively reviewed the medical records of 343 consecutive patients who underwent URSL at three institutions between January 2021 and April 2024. Risk factors for post‑URSL fUTI were analyzed, and frequencies were compared among patients with a history of OP treated without drainage, those with a history of OP treated with ureteral stent (US) placement, and those without a history of OP. Of the 343 patients, 29 (8.5%) developed post‑URSL fUTI. Multivariate logistic regression analysis revealed that a history of OP (p < 0.001) and preoperative positive urine culture (p = 0.043) were independent risk factors for post‑URSL fUTI. The incidence of post‑URSL fUTI was significantly higher in patients with OP treated with drainage than in those without a history of OP (p < 0.001). Moreover, the incidence of post‑URSL fUTI in patients with OP treated without drainage was significantly higher than that in patients treated with US placement (p = 0.030). In this study, the incidence of post‑URSL fUTI in patients with OP treated without drainage was significantly higher than that in those treated with US placement. A history of OP treated without drainage might represent the highest risk factor for post‑URSL fUTI. Therefore, calculous pyelonephritis probably should be managed with drainage to mitigate this risk.