OBJECTIVE: To evaluate and compare the efficacy of mirabegron, tamsulosin, and tadalafil in improving stent-related symptoms and overall quality of life in urological patients following JJ stent insertion. METHODS: Durin...OBJECTIVE: To evaluate and compare the efficacy of mirabegron, tamsulosin, and tadalafil in improving stent-related symptoms and overall quality of life in urological patients following JJ stent insertion. METHODS: During the period from January 2022 to December 2022, 131 patients with ureteral double-J stents were randomly assigned two days post-insertion to receive either mirabegron (50 mg daily), tamsulosin (0.4 mg daily), or tadalafil (5 mg daily) for two weeks. Stent-related symptoms and health-related quality of life were assessed at baseline and at two weeks using the validated Ureteral Stent Symptom Questionnaire (USSQ). All groups completed follow-up. RESULTS: The tamsulosin group showed the greatest improvement in total USSQ score (P ≤ .001), with significantly lower urinary symptoms, general health, and sexual function scores than the mirabegron and tadalafil groups. Specifically, sexual matter scores [median (IQR)] were lowest in the tamsulosin group [5 (1)] versus tadalafil [7 (3.2)] and mirabegron [16.5 (11)] (P ≤ .001). Differences in work performance and additional problem domains were not significant. Adverse effects were mild: dizziness/hypotension (∼6% tamsulosin), palpitations/headache (∼4% mirabegron), and flushing/dyspepsia/back pain (∼10% tadalafil). No serious events occurred, and no patient discontinued therapy. CONCLUSION: In conclusion, tamsulosin produced the most comprehensive symptom relief supporting its use as first-line therapy for patients with indwelling JJ stents. Mirabegron demonstrated good safety and modest benefits in pain and storage symptoms, suggesting its use as a viable alternative for patients intolerant to standard treatments. Larger placebo-controlled trials are needed to validate these findings.
INTRODUCTION AND OBJECTIVE: Intravesical bacillus Calmette-Guérin(BCG) remains the standard treatment for high-risk non-muscle-invasive bladder cancer(NMIBC) and is also considered an option for intermediate and very hig...INTRODUCTION AND OBJECTIVE: Intravesical bacillus Calmette-Guérin(BCG) remains the standard treatment for high-risk non-muscle-invasive bladder cancer(NMIBC) and is also considered an option for intermediate and very high-risk groups. Despite over five decades of clinical use, limited information is available regarding patients' quality of life(QoL) during therapy. The objective was to evaluate QoL patients receiving BCG therapy using the Functional Assessment of Cancer Therapy-Bladder Cancer(FACT-Bl) questionnaire. MATERIALS AND METHODS: Prospective multicentre observational study from February 2022 to June 2024 in patients with NMIBC. Patients completed the FACT-Bl questionnaire before and after the induction course. The results of both questionnaires were compared with Student's t-test for paired data using IBM®SPSS-Statistics-25. RESULTS: A total of 235 patients completed both questionnaires and were analysed. 97% of the series completed BCG induction. A worsening in the physical well-being(PWB) subscale(P < 0.05) and an improvement in the emotional well-being(EWB) subscale(P < 0.05) were observed in the total series of cases, without differences in total scores. In BCG-naive patients (90%), significant deterioration was observed in PWB subscale(P < 0.05) and FACT-Bl Trial Outcome Index(TOI) (P < 0.05). Patients over 75 years showed a statistically significant improvement in EWB, while those aged ≤75 years experienced significant declines in PWB, bladder cancer subscale (BlCS), and three total scores. Limitations include exclusive use of FACT-Bl questionnaire to assess QoL and limited sample size. CONCLUSIONS: BCG induction therapy shows no significant impact on overall FACT-Bl scores but declines PWB and improves EWB subscales. Age and prior BCG exposure influence outcomes; notably, patients aged ≤75 show marked declines in PWB, BlCS and total FACT-Bl scores.
Feltes Benítez N, Couñago F, Paredes-Rubio S
… +31 more, Peleteiro Higuero P, Molina Osorio JG, Folgar Torres A, Aissati A, Mera A, Pastor Peidró JR, Garrido Botella MI, González de Dueñas M, Duque-Santana V, Torices Caballero J, Pons Sánchez A, Andreescu Yagüe J, Rodríguez Pérez A, Guardado González S, Fernández Alonso S, Lazo-Prados A, Gaztañaga Boronat M, Moreno López S, Méndez Villamón A, García Gómez R, Gil Restrepo C, Alonso Martínez P, Mesa López F, Ibáñez Villoslada C, Willisch Santamaría P, Ribeiro I, Nicolás Boluda C, Fernández López J, López Campos F, Sargos P, González Del Portillo E
INTRODUCTION: Trimodality therapy (TMT), consisting of maximal transurethral resection of the bladder tumor followed by concurrent chemoradiotherapy, is an established bladder-preserving option for selected patients with...INTRODUCTION: Trimodality therapy (TMT), consisting of maximal transurethral resection of the bladder tumor followed by concurrent chemoradiotherapy, is an established bladder-preserving option for selected patients with muscle-invasive bladder cancer (MIBC). However, contemporary multicenter real-world data are needed to better define oncological outcomes and prognostic factors in routine clinical practice. METHODS: We conducted a retrospective multicenter cohort study including 369 patients with cT2-T4aN0M0 MIBC treated with definitive TMT between 2010 and 2022. Time-to-event outcomes were measured from radiotherapy completion and estimated using the Kaplan-Meier method. Endpoints included overall survival (OS), cancer-specific survival (CSS), metastasis-free survival (MFS), and progression-free survival (PFS). Bladder-preservation outcomes included complete local response (CLR) at first assessment and salvage cystectomy. Prognostic factors were evaluated using multivariable Cox proportional hazards regression. RESULTS: Median age was 76 years (IQR 66.5-81.0), and 85.1% of patients were male. After a median follow-up of 27.4 months, OS at 1, 2, and 3 years was 85.8%, 75.7%, and 65.7%, respectively, while CSS was 90.5%, 84.7%, and 79.9%. MFS rates at 1, 2, and 3 years were 85.8%, 83.1%, and 80.6%, and corresponding PFS rates were 82.9%, 75.4%, and 71.6%. A complete local response was achieved in 63.7% of patients, and salvage cystectomy was required in 9.7%. On multivariable analysis, increasing age, poorer ECOG performance status, and lymphovascular invasion were independently associated with worse outcomes, whereas the use of modern radiotherapy techniques (IMRT/VMAT) was associated with improved survival compared with three-dimensional conformal radiotherapy. CONCLUSIONS: In this large contemporary real-world cohort, trimodality therapy achieved effective cancer control with durable bladder preservation and a low salvage cystectomy rate. While overall survival was influenced by baseline patient fitness, cancer-specific and metastasis-free outcomes remained favourable. These findings support TMT as a robust bladder-preserving strategy in routine clinical practice, provided that appropriate patient selection and high-quality radiotherapy delivery are ensured.
OBJECTIVE: To assess long-term mortality trends for male genital organ (MGO) cancers in Spain from 1999 to 2023, stratified by age group and tumour type. METHODS: A retrospective, population-based ecological study was co...OBJECTIVE: To assess long-term mortality trends for male genital organ (MGO) cancers in Spain from 1999 to 2023, stratified by age group and tumour type. METHODS: A retrospective, population-based ecological study was conducted using mortality records from the Spanish National Institute of Statistics. Deaths were classified by ICD-10 codes: penile (C60), prostate (C61), testicular (C62), and other/unspecified (C63). Age-standardised mortality rates (ASMRs) were calculated using the 2013 European Standard Population. Temporal trends were evaluated with Joinpoint regression to estimate annual percentage change (APC) and average annual percentage change (AAPC). Analyses were stratified by early-onset (<50 years) and late-onset (≥50 years) disease. RESULTS: From 1999 to 2023, 147,917 MGO-related deaths were recorded; prostate cancer comprised approximately 97%, predominantly in men aged ≥50 years. Crude mortality increased slightly over time due to population ageing, whereas prostate cancer ASMR decreased from 49.61 to 27.26 per 100,000 (AAPC -2.5%; 95% CI -2.7 to -2.3). A joinpoint in 2016 indicated a slowing decline thereafter (APC -1.3%). Testicular cancer mortality remained low and stable (AAPC -0.4%), with a minor reduction in older men but stable or slightly increasing patterns among younger men. Penile cancer mortality showed persistently low and unchanged rates (AAPC -0.8%). Early-onset prostate and penile cancer mortality was rare and exhibited stable trends. CONCLUSIONS: MGO cancer mortality in Spain is overwhelmingly driven by prostate cancer, which has declinedC markedly over 25 years but has plateaued since 2016. Mortality from testicular and penile cancers remains low with limited age-specific variability.
OBJECTIVE: To describe the main long-term endocrine sequelae in testicular cancer survivors and their clinical relevance. MATERIAL AND METHODS: A narrative review of the clinical literature on the endocrine consequences...OBJECTIVE: To describe the main long-term endocrine sequelae in testicular cancer survivors and their clinical relevance. MATERIAL AND METHODS: A narrative review of the clinical literature on the endocrine consequences of curative therapies for TC (orchiectomy, platinum-based chemotherapy, and radiotherapy) was conducted. The impact of these interventions on the hypothalamic-pituitary-gonadal (HPG) axis and other relevant endocrine systems was examined. RESULTS: The most prevalent endocrine finding was hypergonadotropic hypogonadism (primary testicular dysfunction), characterized by elevated FSH and altered testosterone levels. The etiology is multifactorial, involving the direct deficiency following orchiectomy and the toxicity of chemotherapy/radiotherapy on Leydig cells. Hypogonadism is correlated with adverse effects on quality of life, fertility, bone metabolism, and body composition. Additionally, an increased risk of osteopenia/osteoporosis and thyroid dysfunction was documented, the latter associated explicitly with mediastinal or cervical irradiation. CONCLUSIONS: CT survivors present a significant and persistent risk of chronic endocrine dysfunction. It is imperative to establish systematic endocrine surveillance, especially for symptomatic patients or those with borderline hormonal parameters, to facilitate early identification and initiate interventions such as hormone replacement therapy. This strategy is crucial for preserving functional health and quality of life in this young population.
Casanova-Martín C, Álvarez-Maestro M, Rodríguez-Serrano A
… +7 more, Gómez-Villanueva A, Aguilera-Bazán A, Serrano-Liesa M, Alonso-Dorrego JM, Ortega-Núñez MÁ, Ríos-González E, Martínez-Piñeiro Lorenzo L
INTRODUCTION AND OBJECTIVE: Ureteroileal anastomotic stricture (UAS) is a relevant complication after radical cystectomy (RC). The retrosigmoid ileal conduit (RIC) may reduce its incidence by avoiding left ureteral trans...INTRODUCTION AND OBJECTIVE: Ureteroileal anastomotic stricture (UAS) is a relevant complication after radical cystectomy (RC). The retrosigmoid ileal conduit (RIC) may reduce its incidence by avoiding left ureteral transposition. OBJECTIVE: To compare the incidence of UAS, perioperative outcomes, and length of stay between RIC and conventional urinary diversions (Bricker/Wallace). MATERIAL AND METHODS: Retrospective, single-center observational study. All patients undergoing RC with bilateral urinary diversion were included: RIC between 01/2021-12/2024 and conventional techniques between 01/2018-12/2020. Primary variable: Multivariable logistic regression was performed using: age, body mass index (BMI), prior urinary tract dilation, Charlson Comorbidity Index (CCI), Eastern Cooperative Oncology Group (ECOG) score, and surgical technique. Secondary variables: operative time, 30-day postoperative complications (grouped as minor complications [Clavien 1-2] and major complications [Clavien ≥3]), time to stricture, length of hospital stay, and follow-up time after surgery. RESULTS: Seventy-one patients were analyzed: 36 RIC and 35 controls, with comparable baseline characteristics. UAS presented an incidence of 2.8% in RIC group and 22.9% in controls; the RIC technique was associated with a lower adjusted risk (OR: 0.05; 95% CI: 0.002-0.35; P = .011). Operative time was shorter with RIC (median: 292 [IQR: 274-315] vs. 330 [308-360] min; p = 0.00025). There were no differences in major complications (11.1 vs. 17.1%; P = .51) or minor complications (33.3 vs. 42.9%; P = .41), nor in hospital stay (11.5 vs. 9 days; P = .23). The median follow-up was 18 months (RIC) and 39 months (control). CONCLUSIONS: In our series, RIC significantly reduced UAS without increasing morbidity and was associated with a shorter operative time compared with traditional techniques. The results support the anatomical consistency and reproducibility of the technique.
INTRODUCTION AND OBJECTIVE: Anabolic androgenic steroids are synthetic substances that mimic testosterone, promoting increased strength and muscle mass. Although they were initially used to achieve an increase in sports...INTRODUCTION AND OBJECTIVE: Anabolic androgenic steroids are synthetic substances that mimic testosterone, promoting increased strength and muscle mass. Although they were initially used to achieve an increase in sports performance, nowadays most users are not professional athletes. Their use can cause various adverse effects, but despite these, they continue to be used to improve aesthetic and performance aspects. The purpose of this review of reviews was to examine the effects of anabolic androgenic steroids on male erectile function and related variables. MATERIALS AND METHODS: A systematised literature review was carried out in Medline, Scopus, Pubmed, Cinahl, ScienceDirect, SPORTDiscus databases in July 2025. The search terms were 'Anabolic Androgenic Steroids', 'Erectile Dysfunction' and 'Adverse effect'. The A Measurement Tool to Assess Systematic Review (AMSTAR-2) was used to assess the methodological quality of the selected reviews. RESULTS: Six systematic reviews were valid. Assessment of methodological quality using the AMSTAR-2 scale revealed that four reviews had critically low confidence, one review had low confidence, and one review had medium confidence. Despite methodological limitations, the reviews showed common findings associating prolonged use of anabolic androgenic steroids with the reduction in hormone levels, testosterone levels and reproductive function, leading to erectile dysfunction, in young adults (28-33 years) involved in weightlifting, powerlifting or bodybuilding. CONCLUSIONS: The use of anabolic androgenic steroids appears to have a negative impact on erectile function and male reproductive health, with evidence of hypogonadism and hormonal alterations.
INTRODUCTION: The utilisation of fluoroscopy in percutaneous nephrolithotomy gives rise to concerns regarding radiation exposure, thus necessitating the exploration of alternative methodologies. This study sets out to co...INTRODUCTION: The utilisation of fluoroscopy in percutaneous nephrolithotomy gives rise to concerns regarding radiation exposure, thus necessitating the exploration of alternative methodologies. This study sets out to compare the efficacy and safety of ultrasound-guided supine mini PCNL and fluoroscopy-guided supine mini PCNL for renal stone management. METHODS: Adult patients with renal stones ≥15 mm who underwent supine mini-PCNL were retrospectively reviewed. Patients were categorized into ultrasound-guided (US-PCNL, n = 64) and fluoroscopy-guided (FL-PCNL, n = 84) groups. Clinical variables, including operative time, number of puncture attempts, fluoroscopy duration, perioperative hemoglobin change, transfusion requirement, stone-free rate, complication rate, and length of hospital stay, were analysed. Surgical outcomes between the groups were compared using independent t-test or Mann-Whitney U test as appropriate. Wilcoxon test was used for dependent variables, and Chi-square test for categorical data. RESULTS: The US-PCNL group had a significantly shorter operative time and puncture time compared to the FL-PCNL group (p < 0.05). No significant differences were found between the groups in terms of puncture attempts, tract formation rates, or stone-free rates (p > 0.05). Postoperative complications, such as fever and the need for additional interventions, were similar between groups (p > 0.05). Notably, the FL-PCNL group had a mean fluoroscopy duration of 6.3 min, while the US-PCNL group had none. CONCLUSIONS: Ultrasound-guided supine mini-PCNL offers a promising, radiation-free alternative to fluoroscopy in renal stone management. This study shows comparable outcomes between the two techniques, emphasizing the potential of ultrasound to improve patient safety in endourology.
OBJECTIVES: To present a new nomogram that uses preoperative clinical features to predict benign pathology in clinical T1a solid renal masses. MATERIALS AND METHODS: Demographic, clinical and pathologic data related to 5...OBJECTIVES: To present a new nomogram that uses preoperative clinical features to predict benign pathology in clinical T1a solid renal masses. MATERIALS AND METHODS: Demographic, clinical and pathologic data related to 579 patients diagnosed with clinical solid T1a renal mass were retrospectively collected. Univariate and multivariable logistic regression analyses were used to determine the variables related to benign pathology. Variables with statistical significance were used to develop a nomogram. RESULTS: The female-to-male ratio was 240/339, with a median age of 56 (47-64) years. 40% (232/579) of all patients had a diagnosis of hypertension or diabetes mellitus or both. All patients had solitary renal lesion with a median size of 3.0 (23-35) cm. Cystic component was noticed in 20.7% (119/579) of the lesions. Benign pathology was detected in 19.9% (115/579) of cases. On univariate analysis, female gender, age less than 60 years, absence of hypertension or diabetes mellitus, symptomatic presentation, smaller tumor size and absence of cystic component were all related to benign pathology. Female gender, age less than 60 years, smaller tumor size and absence of cystic component kept their significance on multivariable analysis. A nomogram was built depending on these variables. The model was close to the ideal and had a c-index value of 0.79. CONCLUSION: The nomogram in the present study has good predictive ability for benign pathology in T1a solid renal masses. This will help physicians and patients while making decisions related to the management paradigm.
INTRODUCTION: The choice between radical prostatectomy (RP) and radiotherapy (RT) for localized prostate cancer depends on multiple factors. The aim of this study was to describe how urologists and radiation oncologists...INTRODUCTION: The choice between radical prostatectomy (RP) and radiotherapy (RT) for localized prostate cancer depends on multiple factors. The aim of this study was to describe how urologists and radiation oncologists weigh these variables when recommending primary treatment, and to develop clinical decision support algorithms. METHODS: An online cross-sectional survey was designed for specialists in Urology and Radiation Oncology in Spain. The questionnaire was developed ad hoc and reviewed by an expert panel. Demographic data and treatment preferences were collected using a Likert scale (1-2 RP; 3 neutral; 4-5 RT) across hypothetical clinical scenarios. Clinical consensus was defined as agreement ≥75%. RESULTS: The mean age of respondents was 41.3 years (SD 10.3), with 68.5% urologists and 31.5% radiation oncologists. Overall, in young patients (<50 years) with high IPSS (≥20), intravesical prostatic protrusion, Qmax < 10 mL/sec, and elevated post-void residual (PVR), the preference for surgery was high (>75%) (p < 0.001). In contrast, in patients older than 70 years with multiple comorbidities and body mass index (BMI) >35, a preference for radiotherapy (4-5) was observed in more than 75% of cases (p < 0.001). CONCLUSIONS: Treatment preferences for localized PCa depend primarily on age, comorbidity, and urinary symptoms, with consistent differences between specialties. These findings reinforce the need to integrate shared decision-making tools and to develop clinical decision support algorithms.
Martínez Rodríguez P, Poza Fernandez A, García Fadrique G
… +6 more, Acedo González J, Montero Adriá O, Mateo Cárcel N, Marzullo Zucchet L, Gómez Palomo F, Reig Ruiz C
INTRODUCTION: Radical prostatectomy (RP) and radiotherapy (RT) are the main treatment options for localized and locally advanced (LA) prostate cancer (PCa). While erectile dysfunction and urinary incontinence have been w...INTRODUCTION: Radical prostatectomy (RP) and radiotherapy (RT) are the main treatment options for localized and locally advanced (LA) prostate cancer (PCa). While erectile dysfunction and urinary incontinence have been widely studied, there is limited evidence regarding pelvic malignancies and radiation-induced rectal or urinary toxicity. MATERIALS AND METHODS: This retrospective study involved patients with localized and LA PCa treated exclusively with RP or RT between 2010 and 2019 in our Health Department. A total of 356 patients were included: 138 treated with RP and 218 with RT. Rectal and bladder tumors, as well as urinary and gastrointestinal toxicity variables, were compared using the chi-square test (Fisher's exact test when expected frequencies were <5). Multivariate analysis was performed using logistic regression adjusted for clinical variables. Statistical significance was set at P < .05. RESULTS: Both groups were homogeneous in terms of tumor stage and smoking status. Statistically significant differences were observed between groups in the incidence of pelvic tumors [P = .032], bladder tumors [P = .033], and urinary and gastrointestinal toxicity [P < .001]. Patients treated with radiotherapy had an almost 11-fold increased risk of bladder tumors (OR: 10.61; CI: 1.42-224.98). CONCLUSIONS: In our series, patients with localized and LA PCa treated with RT presented a higher incidence of pelvic tumors and urinary/rectal toxicity compared with those treated with RP.
INTRODUCTION: Systemic inflammatory and prognostic indices are emerging biomarkers in bladder cancer. Diabetes mellitus (DM), a chronic inflammatory disease, and Bacillus Calmette-Guérin (BCG) therapy may influence these...INTRODUCTION: Systemic inflammatory and prognostic indices are emerging biomarkers in bladder cancer. Diabetes mellitus (DM), a chronic inflammatory disease, and Bacillus Calmette-Guérin (BCG) therapy may influence these indices in non-muscle invasive bladder cancer (NMIBC). OBJECTIVE: To evaluate the impact of DM and BCG therapy on inflammatory and prognostic indices in patients with NMIBC. MATERIAL AND METHOD: A retrospective study of 156 NMIBC patients was conducted. Patients were stratified by DM and BCG status (DM+/DM-; BCG+/BCG-), and into four subgroups (DM-/BCG-, DM+/BCG+, DM-/BCG+, DM+/BCG-). Laboratory and clinical parameters were compared using standard statistical tests (t-test, Chi-square, ANOVA). A P-value <.05 was considered significant. RESULTS: DM+ patients had significantly higher glucose (P = .001), HbA1c (P = .017), GKR (P = .014), and lower PNI (P = .014). Tumor recurrence was more common in DM+ (P = .021). In the BCG comparison, albumin (P = .002) and PNI (P = .009) differed. Four-group analysis showed significant differences in tumor grade, tumor recurrence, HbA1c, albumin, PNI, and MPR (all P < .05), especially between DM+/BCG+ and DM-/BCG+. CONCLUSION: DM and BCG therapy are associated with systemic inflammatory and prognostic indices in NMIBC. GKR and PNI may serve as practical, cost-effective markers for recurrence risk stratification.
INTRODUCTION: Prostate cancer (PCa) remains one of the leading public health challenges among European men. Despite technological advances, its early detection continues to be controversial due to the risk of overdiagnos...INTRODUCTION: Prostate cancer (PCa) remains one of the leading public health challenges among European men. Despite technological advances, its early detection continues to be controversial due to the risk of overdiagnosis and the limited adoption of organized screening programs. MATERIALS AND METHODS: A review was conducted of scientific literature, institutional reports, and technical documentation from the PRAISE-U project. We describe the key components of its design, implementation and lessons learned at two pilot sites in Spain (Galicia and Manresa), with a focus on personalized strategies and operational efficiency. RESULTS: Based on the European Union recommendation of 2022, the PRAISE-U project promotes a risk-based screening program that incorporates prostate-specific antigen (PSA), magnetic resonance imaging (MRI) and risk calculators (RC). Galicia and Manresa have developed screening circuits adapted to their health systems. Galicia has managed to invite 7000 of the 12,000 target men in less than a year, integrating digital tools and direct contact strategies. Manresa, from primary care, has developed a coordinated approach focused on accessibility and traceability. Both models prioritize equity, adherence and minimization of overtreatment. CONCLUSIONS: The PRAISE-U project offers an innovative and adaptable framework for PCa screening in Europe. The Spanish experience demonstrates that it is possible to implement effective and risk-focused early detection programs, provided that there is sound planning, technological tools and a collaborative approach between levels of care.
OBJECTIVE: The Urology Simulation Bootcamp Course (USBC) was developed to address the lack of a structured national programme for practical urological skills training. Feedback from urology colleagues and trainees highli...OBJECTIVE: The Urology Simulation Bootcamp Course (USBC) was developed to address the lack of a structured national programme for practical urological skills training. Feedback from urology colleagues and trainees highlighted the need for focused procedural teaching, particularly in reconstructive urology. In response, a dedicated reconstructive skills module was established within the USBC in 2015. A descriptive report of a structured educational module is presented. METHODS: The module concentrated on four key reconstructive procedures: small bowel anastomosis, stoma formation, uretero-ileal anastomosis, and repair of ureteric and bladder injuries. This hands-on training was delivered with a high faculty-to-trainee ratio, allowing one-to-one mentorship. Faculty recruitment was based on subspecialist expertise and enthusiasm for medical education, ensuring high-quality instruction and one-to-one training. Continuous evaluation and feedback from participants shaped iterative improvements to course content and delivery. Feedback was collated from 2016 onwards, which facilitated the revision of the course over subsequent iterations. RESULTS: Over eight years, 378 trainees participated in the course. Delegates consistently praised the programme, particularly the individualised mentoring and the quality of tissue models used. The evolving curriculum, informed by systematic feedback, ensured relevance and sustainability. One notable adaptation was reducing the time devoted to small bowel anastomosis in order to expand training on ureteric reimplantation and bladder repair, reflecting delegate preferences and clinical relevance. CONCLUSION: Our simulation-based approach to teaching reconstructive urological skills has demonstrated extremely positive results from the delegates consistently over the eight-year period. Focused mentorship and amendments based on feedback have been vital in ensuring a high degree of satisfaction throughout the evolution of the course.