The Canadian Journal Of Urology[JOURNAL]
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200 papers
Flexible ureterorenoscopy vs. mini percutaneous nephrolithotomy for kidney stones in chronic kidney damage: a prospective study.
Günay NF, Gelmiş M, Dizdaroğlu Ç … +4 more , Esmeray A, Çağlar U, Sarılar Ö, Özgör F
Can J Urol · 2026 Apr · PMID 42086348 · Publisher ↗
OBJECTIVES: Chronic kidney disease (CKD) poses unique challenges in the management of renal stones, and high-quality evidence to guide treatment decisions is limited. This study aimed to compare the effects of flexible u...
OBJECTIVES: Chronic kidney disease (CKD) poses unique challenges in the management of renal stones, and high-quality evidence to guide treatment decisions is limited. This study aimed to compare the effects of flexible ureteroscopy (f-URS) and mini-percutaneous nephrolithotomy (m-PCNL) on perioperative outcomes and long-term renal function in patients with CKD and renal stones. METHODS: This prospective randomized study included 60 CKD patients with renal stones measuring 1-4 cm. Participants were randomized into f-URS (n = 24) and m-PCNL (n = 36) groups. Baseline demographics, stone characteristics, and perioperative parameters were recorded. Stone-free rate (SFR) was defined as the absence of any residual fragments on postoperative computed tomography (CT) at 1 month. Renal function was assessed by estimated glomerular filtration rate (eGFR), serum creatinine, and CKD stage at baseline and 6 months. A post hoc exploratory subgroup analysis was performed for patients with 10-20 mm stones. RESULTS: Stone-free rates were comparable between groups (79.2% vs. 86.1%, p > 0.05). f-URS was associated with shorter operative duration, reduced fluoroscopy time, lower hemoglobin drop, and shorter hospital stay (all p < 0.01). At 6 months, median renal function values were more favorable in the f-URS group, with higher median eGFR (44.0 vs. 51.5 mL/min, p = 0.042) and lower creatinine (1.6 vs. 1.4 mg/dL, p = 0.031), whereas the changes from baseline (ΔeGFR and Δcreatinine) did not show a statistically significant difference. In the exploratory 10-20 mm subgroup results were statistically in favor of f-URS, but these findings should not be generalized due to the small sample size and post hoc nature of the analysis. CONCLUSIONS: Both f-URS and m-PCNL achieved similar stone clearance in CKD patients. f-URS may offer advantages regarding perioperative safety and renal function preservation, but these observations require confirmation in larger studies with long-term follow-up. Treatment decisions in this high-risk population should be individualized.
Pulsed solid-state thulium: YAG laser compared to holmium: YAG laser during mini-PCNL.
Becker B, Hook S, Dapper C … +3 more , Bergmann J, Netsch C, Filmar S
Can J Urol · 2026 Apr · PMID 42086347 · Publisher ↗
BACKGROUND: Holmium: yttrium-aluminum-garnet (Ho: YAG) laser technology has long been employed for urinary stone fragmentation; however, its limitations have prompted the exploration of alternative systems such as thuliu...
BACKGROUND: Holmium: yttrium-aluminum-garnet (Ho: YAG) laser technology has long been employed for urinary stone fragmentation; however, its limitations have prompted the exploration of alternative systems such as thulium lasers. This study aims to compare a novel pulsed solid-state Thulium: YAG (Tm: YAG) laser to the standard Ho: YAG laser in Mini-percutaneous nephrolithotomy (Mini-PCNL) lithotripsy for renal calculi. METHODS: In total, 100 patients undergoing Mini-PCNL were enrolled in this clinical trial. Fifty patients treated with a holmium laser were selected from a retrospective database. These patients were compared to fifty patients who were prospectively enrolled and treated with a new thulium laser. Patient characteristics, stone parameters, operative details, and complications were recorded and analyzed statistically. RESULTS: Both groups were comparable in demographics and stone characteristics. The Tm: YAG group demonstrated significantly shorter laser-on-time (7.20 vs. 10.46 min; p < 0.05) and operative time (32.6 vs. 41.2 min; p < 0.05) compared to the Ho: YAG group. There was no difference regarding stone-free rates (SFR) at 24 h, which were 90% in the Ho: YAG group and 92% in the Tm: YAG group (p > 0.999). Intraoperative complications did not significantly differ between groups. CONCLUSION: The novel pulsed solid-state Tm: YAG laser demonstrates advantages over the Ho: YAG laser in terms of laser-on-time and operation time, while showing comparable results for stone-free rate and complications. Further clinical trials are needed to compare Tm: YAG and Ho: YAG lasers in various contexts and to evaluate the Tm: YAG laser against the thulium fiber laser (TFL) for a comprehensive understanding of each technology's advantages.
Nonlinear association between estimated glucose disposal rate and kidney stones: a cross-sectional study.
Yang Z, Jiang L, Yin S
Can J Urol · 2026 Apr · PMID 42086346 · Publisher ↗
OBJECTIVES: Kidney stone disease is increasingly prevalent and may be linked to metabolic factors such as insulin resistance, but there is currently no direct evidence connecting estimated glucose disposal rate (eGDR) to...
OBJECTIVES: Kidney stone disease is increasingly prevalent and may be linked to metabolic factors such as insulin resistance, but there is currently no direct evidence connecting estimated glucose disposal rate (eGDR) to kidney stones. This study aimed to investigate the relationship between eGDR and kidney stone prevalence. METHODS: We conducted a cross-sectional analysis utilizing data from the National Health and Nutrition Examination Survey (NHANES) from 2007-2018, including 29,753 participants aged 20 years and older. Weighted multivariable logistic regression and nonlinear models were employed to assess the relationship between eGDR and self-reported kidney stone history. RESULTS: Among participants, 9.90% reported having kidney stones. Multivariable analysis revealed that higher eGDR values were associated with decreased odds of kidney stones (odds ratio [OR] = 0.92, 95% CI: 0.89-0.94). Participants in the highest eGDR tertile demonstrated approximately half the odds of kidney stones compared to those in the lowest tertile (adjusted OR = 0.52, 95% CI: 0.43-0.64). Nonlinear analysis identified a threshold effect at eGDR = 7.95, with significant inverse associations only observed above this threshold (OR = 0.81, 95% CI: 0.71-0.92). CONCLUSIONS: This study identifies a nonlinear relationship between eGDR and kidney stones, with a threshold effect at eGDR = 7.95. The inverse association was significant only when eGDR exceeded this threshold, suggesting the potential utility of eGDR as a clinical indicator for kidney stone risk assessment. Prospective studies are needed to establish causal relationships.
Urodynamic de-obstruction and symptom improvement after thulium laser vaporization (ThuVAP): evidence from a prospective paired study.
Tammaro S, Di Fiore F, Crocetto F … +11 more , Manfredi C, Ruvolo CC, Califano G, Barone B, Arcaniolo D, Spirito L, Calace FP, Reccia P, Fusco F, De Sio M, Balsamo R
Can J Urol · 2026 Apr · PMID 42086345 · Publisher ↗
BACKGROUND: Thulium laser vaporization of the prostate (ThuVAP) is an established treatment for benign prostatic obstruction, but its impact on urodynamic parameters remains poorly defined. This study aimed to quantify t...
BACKGROUND: Thulium laser vaporization of the prostate (ThuVAP) is an established treatment for benign prostatic obstruction, but its impact on urodynamic parameters remains poorly defined. This study aimed to quantify the de-obstructive efficacy of ThuVAP through pre- and postoperative urodynamic comparisons and to assess the relationship between urodynamic improvement and symptom relief. METHODS: In a prospective single-center cohort (June 2022-June 2024), men with urodynamically confirmed obstruction underwent standardized ThuVAP with a 200-W thulium:YAG system. Baseline and 6-month invasive urodynamics and 12-month clinical follow-up were performed. The primary endpoint was the change in the bladder outlet obstruction index (BOOI); secondary endpoints included Qmax, postvoid residual volume (PVR), bladder voiding efficiency (BVE), detrusor pressures, and International Prostate Symptom Score (IPSS). RESULTS: Sixty-four patients (mean age 67 years; prostate volume 52 mL) were analyzed. BOOI decreased from 55.9 ± 17.2 to 21.3 ± 11.2 (p < 0.001), with obstructed cases dropping from 79.7% to 7.8%. Schäfer grade fell from 3.6 to 0.3 (p < 0.001). Detrusor pressure halved, Qmax rose from 7.9 to 20.8 mL/s, PVR declined from 121 to 22 mL, and BVE improved from 64% to 94% (all p < 0.001). Low compliance and involuntary detrusor contractions (IDC) decreased notably. IPSS improved from 26.2 to 3.4 (p < 0.001) and correlated with the magnitude of urodynamic de-obstruction. CONCLUSIONS: ThuVAP provides substantial, objectively verified relief of bladder outlet obstruction with consistent improvements in voiding efficiency and symptoms. The correlation between urodynamic and clinical outcomes underscores the procedure's efficacy and the utility of urodynamics in documenting therapeutic benefit.
Proximal/Distal ureteral diameter ratio as a predictor of spontaneous passage in <10 mm ureteral stones.
Üntan İ, Aldemir N
Can J Urol · 2026 Apr · PMID 42086344 · Publisher ↗
BACKGROUND: Ureteral stones are a common cause of acute renal colic, and while most small stones pass spontaneously, reliable predictors of passage are needed to optimize patient selection for conservative management. Th...
BACKGROUND: Ureteral stones are a common cause of acute renal colic, and while most small stones pass spontaneously, reliable predictors of passage are needed to optimize patient selection for conservative management. This study aims to evaluate the role of radiologic, clinical and laboratory parameters-particularly the proximal/distal (P/D) ureteral diameter ratio-in predicting spontaneous passage of <10 mm ureteral stones. MATERIALS AND METHODS: This retrospective cohort study included 277 patients diagnosed with ureteral calculi <10 mm on non-contrast computed tomography between September 2022 and September 2025. Pregnant patients, solitary kidney cases, congenital anomalies, active urinary infection, and incomplete computed tomography (CT) data were excluded. Proximal and distal ureteral diameters were measured 1 cm above and below the stone on axial CT images, and their ratio (P/D ratio) was calculated. Stones located at the ureterovesical or ureteropelvic junction were excluded from ratio analysis due to anatomic constraints. Spontaneous passage within 4 weeks was confirmed by follow-up ultrasonography in all patients. Patients were grouped into passage (n = 204) and no-passage (n = 73). Mann-Whitney U and chi-square tests were used for group comparisons. Predictive performance was assessed by receiver operating characteristic (ROC) analysis. RESULTS: The spontaneous passage rate was 73.6%. Age, sex, and body mass index did not differ significantly between groups (p ≥ 0.05). Stone size (p < 0.001), location (p = 0.003), CT Hounsfield Unit (HU) (p < 0.001), and P/D ureteral diameter ratio (p < 0.001) were significantly associated with passage. Distal and ≤5 mm stones demonstrated markedly higher spontaneous passage rates. Median HU was lower in the passage group (487.00 [348.75-707.00]) than in the no-passage group (648.00 [467.00-846.00]). The P/D ratio was significantly lower in the passage group (2.90 [2.21-3.50]) compared with the no-passage group (4.20 [3.05-5.33]). Alpha-blocker use was not associated with passage (p = 0.232). ROC analysis demonstrated that stone size (area under the curve [AUC] 0.773) and P/D ratio (AUC 0.757) were the strongest predictors, outperforming HU (AUC 0.645) and location (AUC 0.617). CONCLUSIONS: Stone size, location, HU value, and the proximal/distal ureteral diameter ratio are significant markers associated with spontaneous passage of <10 mm ureteral stones. Lower HU values, distal location, smaller stone size, and a reduced P/D ratio favor spontaneous passage. The P/D ratio, a simple and practical CT-derived measurement, showed superior discriminative ability compared with HU and may assist clinicians in selecting appropriate candidates for conservative management.
Case report: minimally invasive management of two major complications of colonic perforation and pseudoaneurysm formation following nephrostomy tube placement.
Letouche ML, Madden A, Corralles M … +2 more , Doizi S, Traxer O
Can J Urol · 2026 Feb · PMID 41800519 · Publisher ↗
BACKGROUND: We present a case of two major complications following insertion of a nephrostomy managed in a minimally invasive way. Our case is the first in the literature to describe this minimally invasive treatment tec...
BACKGROUND: We present a case of two major complications following insertion of a nephrostomy managed in a minimally invasive way. Our case is the first in the literature to describe this minimally invasive treatment technique for colon perforation in a completely asymptomatic patient. CASE DESCRIPTION: A 75-year-old female patient with a history of bilateral obstructive uropathy secondary to bilateral radiation-induced ureteric strictures attended for bilateral nephrostomy placement. The patient had a history of endometrial cancer, treated previously by total hysterectomy and bilateral salpingo-oophorectomy with adjuvant chemo-radiotherapy and brachytherapy. Her recovery had been further complicated by the development of radiation cystitis, small bowel resection, and short gut syndrome. The strictures had previously been managed with bilateral double J stents, which have now failed. A left-sided nephrostomy insertion was performed. A CT-scan prompted by a repeat deterioration in renal function revealed a right-sided hydronephrosis and suggested transcolic passage of the previously placed left-sided nephrostomy. She had remained clinically well and apyretic. A right-sided nephrostomy was inserted, and the left re-sited following a colonoscopy-guided nephrostomy removal and clip occlusion of the nephrostomy tract. The patient then developed a pseudoaneurysm, which was managed with embolization. The patient was able to return home with corrected kidney function. The three-monthly checks for changes in nephrostomy catheters did not reveal any complications. CONCLUSIONS: The patient therefore presented with two major complications of nephrostomy placement: colonic perforation and pseudoaneurysm, classified as Clavien IIIb and IIIa, respectively. Multidisciplinary management, including urologists, gastroenterologists, general surgeons, and radiologists, enabled a minimally invasive management. Minimally invasive management with endoscopic clip placement appears to be a safe alternative to directed fistula of colonic perforation.
Penile shaft reconstruction after cream self-injection: a case report.
Bollen L, Rysselinck S, Salmin JP … +1 more , Dosin G
Can J Urol · 2026 Feb · PMID 41800518 · Publisher ↗
BACKGROUND: Penile augmentation through injectable substances is becoming increasingly common. A growing number of aesthetic clinics are developing penile enlargement procedures using various injectable materials. Althou...
BACKGROUND: Penile augmentation through injectable substances is becoming increasingly common. A growing number of aesthetic clinics are developing penile enlargement procedures using various injectable materials. Although these procedures are now performed in more controlled and medically supervised environments, their long-term outcomes remain poorly understood. The promotion of such medical treatments contributes to an increasing interest among adult males in self-injection as a method to alleviate psychological distress associated with penile size concerns. At the same time, access to injectable substances through unofficial or unregulated sources has become increasingly easy. Tor our knowledge, we report the first documented case of self-injection with Garamycin® (gentamicin) cream, contributing to the literature on the often multidisciplinary management of penile enlargement injections, a field still lacking well-established guidelines. CASE DESCRIPTION: This case report describes a young patient who self-injected Garamycin® into the penis for the purpose of enlargement. He presented to our urology department with worsening symptoms, including severe and poorly tolerated pain. His primary request was prompt relief of pain while preserving, as much as possible, the aesthetic appearance and functional integrity of his penis. This case required a multi-stage surgical approach to salvage the penis and preserve both its structural integrity and functional outcome. CONCLUSIONS: To our knowledge, this case report documents the first reported instance of Garamycin® injection performed for the purpose of penile enlargement. It provides insight into the clinical course of such penile cream injections, demonstrates that a two-stage scrotal flap can achieve both functional and aesthetic outcomes, and highlights the importance of comprehensive management particularly addressing the traumatic impact of penile deformity secondary to inflammation and/or infection, as well as the body dysmorphic concerns often associated with these cases.
Unusual metastatic patterns of urologic malignancies: a case series and literature review.
Donmez K, Yorulmaz EM, Candemir E … +4 more , Ozcan S, Kose O, Gorgel SN, Akin Y
Can J Urol · 2026 Feb · PMID 41800517 · Publisher ↗
BACKGROUND: Urologic cancers typically metastasize to common organs, while spread to sites such as the heart, hand, cranial bones, penis, or tonsil is exceedingly rare. The clinical relevance and prognostic impact of the...
BACKGROUND: Urologic cancers typically metastasize to common organs, while spread to sites such as the heart, hand, cranial bones, penis, or tonsil is exceedingly rare. The clinical relevance and prognostic impact of these unusual metastases remain unclear. This case series highlights six exceptional cases, providing unique insights to support awareness and management. CASE DESCRIPTION: We retrospectively analyzed six cases of patients diagnosed with urologic cancers who developed metastases at uncommon sites. Each case was evaluated based on clinical presentation, imaging findings, histopathological confirmation, treatment course, and outcomes. Relevant literature was reviewed to contextualize findings. Among the six cases, metastatic involvement was identified in atypical locations including the right atrium (testicular cancer), hand (bladder cancer), perineum and penis (sarcomatoid bladder cancer), cranial bones (prostate cancer), penis (rectal cancer), and tonsillar region (renal pelvis rhabdomyosarcoma). Timely imaging and histopathological confirmation guided personalized treatment strategies, primarily involving surgical interventions. Despite aggressive treatments, the prognosis remained poor in most cases, reflecting the aggressive nature of these metastases. CONCLUSION: Rare metastases from urologic malignancies, although uncommon, have significant implications on patient management. Early detection through advanced imaging and aggressive multimodal interventions are pivotal for improving outcomes. Awareness of such atypical metastatic patterns is essential for clinicians managing urologic cancers.
Clear cell sarcoma of the kidney with inferior vena cava tumor thrombus in a pediatric patient: a case report.
Yin B, Long X, Wang Z … +3 more , Ning F, Wang K, He J
Can J Urol · 2026 Feb · PMID 41800516 · Publisher ↗
BACKGROUND: Clear cell sarcoma of the kidney (CCSK) is a rare and highly aggressive pediatric renal malignancy with a marked propensity for metastatic spread. Cases of CCSK associated with inferior vena cava (IVC) tumor...
BACKGROUND: Clear cell sarcoma of the kidney (CCSK) is a rare and highly aggressive pediatric renal malignancy with a marked propensity for metastatic spread. Cases of CCSK associated with inferior vena cava (IVC) tumor thrombus (IVCTT) are exceptionally uncommon in the literature. We report a case of CCSK with IVCTT in a 15-month-old male infant. CASE DESCRIPTION: We reported a case admitted in May 2020 for a 3-day history of fever and hematuria. Abdominal CT revealed an unevenly enhanced mass and low-density shadows within the IVC. The diagnosis of CCSK was confirmed via needle biopsy. The patient received 4 cycles of adjuvant chemotherapy. The initial surgery lasted 10 h with 600 mL blood loss, and primary closure was achieved. Postoperative management included 6 cycles of radiotherapy and 5 cycles of chemotherapy. In March 2022, CT detected IVCTT recurrence, requiring surgical intervention involving thrombus removal and partial IVC resection. This procedure lasted 8 h with 300 mL blood loss, followed by 5 additional chemotherapy cycles. The patient showed no sign of IVC obstruction, including varicose veins or lower limb edema, and maintained renal function throughout follow-up. However, Intracranial metastases were detected 15 months postoperatively. After the family opted against additional treatment, the patient succumbed to the disease. CONCLUSIONS: The management of CCSK associated with IVCTT should include consideration of IVC thrombectomy. In case of recurrent IVCTT with preserved collateral circulation, combined thrombus excision and partial IVC resection may be warranted.
Feasibility of water vapor thermal therapy for treating lower urinary tract symptoms in men with localized prostate cancer on active surveillance: a case series.
Babar M, Babar F, Hawks-Ladds N … +2 more , Loloi J, Ciatto M
Can J Urol · 2026 Feb · PMID 41800515 · Publisher ↗
BACKGROUND: Prostate cancer is a common malignancy, with many men on active surveillance for localized, low-risk disease also experiencing lower urinary tract symptoms (LUTS) from benign prostatic hyperplasia (BPH). Wate...
BACKGROUND: Prostate cancer is a common malignancy, with many men on active surveillance for localized, low-risk disease also experiencing lower urinary tract symptoms (LUTS) from benign prostatic hyperplasia (BPH). Water Vapor Thermal Therapy (WVTT) is a minimally invasive BPH treatment, but its safety and efficacy in this setting are unclear. CASE DESCRIPTION: We report three men with localized PCa on active surveillance who underwent WVTT for LUTS. CONCLUSIONS: WVTT appears safe and potentially effective in treating LUTS, especially in those with lower-risk disease and smaller prostate volumes. Further research is needed to confirm safety, efficacy, and optimal patient selection.
Double blind-ending ureter: diagnostic challenges and robotic-assisted surgical management-case report.
Di Mitri M, Collautti E, Bisanti C … +8 more , Zulli A, Mantovani A, Carmine AD, Baldazzi M, Piccolo RL, Coletta R, Masieri L, Lima M
Can J Urol · 2026 Feb · PMID 41800514 · Publisher ↗
BACKGROUND: Double blind-ending ureter (DBU) is an extremely rare congenital anomaly involving a duplicated ureter with no connection to the renal pelvis or bladder, making diagnosis difficult. CASE DESCRIPTION: A 10-yea...
BACKGROUND: Double blind-ending ureter (DBU) is an extremely rare congenital anomaly involving a duplicated ureter with no connection to the renal pelvis or bladder, making diagnosis difficult. CASE DESCRIPTION: A 10-year-old girl presented with recurrent abdominal pain and ultrasound evidence of left hydroureteronephrosis. Magnetic resonance imaging (MRI) and three-dimensional (3D) reconstruction revealed a 30 cm blind-ending ureter. Robotic-assisted excision (Da Vinci Xi) was performed safely, preserving adjacent structures. Histology confirmed a nonfunctional ureteral remnant. CONCLUSIONS: DBU is a rare duplication variant. Advanced imaging and robotic surgery are essential for accurate diagnosis and effective, minimally invasive treatment.
Prolonged survival and risk factors for reintervention after inflatable penile prosthesis implantation.
Zouari S, Barthe F, Morrone A … +7 more , Mendel L, Bentellis I, Vignot L, Haider R, Ahallal Y, Chevallier D, Durand M
Can J Urol · 2026 Feb · PMID 41800513 · Publisher ↗
BACKGROUND: Inflatable Penile Prosthesis (IPP) is the treatment for erectile dysfunction (ED) refractory to pharmacological therapies. Long-term data on factors associated with prosthesis survival remain unclear. This st...
BACKGROUND: Inflatable Penile Prosthesis (IPP) is the treatment for erectile dysfunction (ED) refractory to pharmacological therapies. Long-term data on factors associated with prosthesis survival remain unclear. This study aimed to analyze the long-term survival of penile prostheses and identify risk factors associated with survival without reintervention. METHODS: This is a retrospective, single-center study of patients who underwent IPP implantation between January 2014 and December 2022. Preoperative data related to the patient and the etiology of ED, as well as perioperative data, were collected. The primary outcome was survival without reintervention, defined as prosthesis revision or explantation due to mechanical dysfunction or infection. We conducted survival analyses without reintervention and searched for risk factors using a multivariate Cox model. RESULTS: In total, 33 out of 137 patients underwent reintervention (24.1%), including 24 (17.5%) prosthesis revisions and 9 (6.6%) had explantations. Median follow-up was 39 months with an interquartile range (IQR) of 9.00 to 62.00. Median survival without reintervention was 7 years. In univariate analysis, downsizing (p = 0.046) was associated with reintervention. Smoking (p = 0.003) and age (p = 0.034) were associated with prosthesis explantation. The number of implantations (p = 0.009) was associated with prosthesis revision. Multivariate analysis by the Cox model did not identify any independent predictive factors for reintervention. CONCLUSION: Smoking may play a role in infection post-IPP implantation. Primary implantations seem to be associated with better survival. Adjusting cylinder size, known as downsizing, is likely to be a proxy for the complexity of the procedure and thus linked to earlier reintervention.
Is postoperative routine thoracic imaging necessary to detect thoracic complications in patients undergoing supracostal mini percutaneous nephrolithotomy (m-PCNL) surgery?
Esmeray A, Yazili HB, Gelmis M … +5 more , Gunay NF, Dizdaroglu C, Ozgor F, Pazir Y, Caglar U
Can J Urol · 2026 Feb · PMID 41800512 · Publisher ↗
OBJECTIVES: Supracostal access during percutaneous nephrolithotomy (PCNL) increases the risk of pulmonary complications. Although routine postoperative thoracic imaging is commonly performed to detect these events, its c...
OBJECTIVES: Supracostal access during percutaneous nephrolithotomy (PCNL) increases the risk of pulmonary complications. Although routine postoperative thoracic imaging is commonly performed to detect these events, its clinical necessity remains controversial. This study aimed to assess the necessity of routine postoperative thoracic imaging for detecting pulmonary complications in patients undergoing supracostal mini percutaneous nephrolithotomy (m-PCNL) surgery. METHODS: A retrospective analysis was conducted on data from patients who underwent supracostal m-PCNL between 2017 and 2022 in a tertiary center. Excluding patients under 18, with kidney/skeletal anomalies, or active thoracic disease, 112 eligible patients were included. Patients were divided into two groups: those with routine postoperative chest X-ray (CXR) (Group 1, n = 40) and those without (Group 2, n = 72). Complications and operative data were compared between groups. RESULTS: Mean ages were 44.3 ± 11.4 (Group 1) and 42.6 ± 13.1 (Group 2), with no significant difference (p = 0.102). Stone sizes were 30.8 ± 8.6 mm (Group 1) and 24.8 ± 8.4 mm (Group 2), also not significantly different (p = 0.313). High fever occurred in 10% of Group 1 and 4% of Group 2 (p = 0.246). Minimal effusion was found in 10% of Group 1, with no treatment due to lack of symptoms. However, subsequent CXR revealed hydropneumothorax in 2.5% of cases, necessitating thoracic tube insertion. In Group 2, 5% developed postoperative respiratory symptoms, with significant pneumothorax in 1.3%, requiring thoracic tube placement. Thoracic tube insertion rates did not significantly differ between groups (Group 1: 2.5% vs. Group 2: 1.3%, p = 0.671). CONCLUSIONS: Routine postoperative thoracic imaging did not show any significant benefit in detecting pulmonary complications post-supracostal m-PCNL.
Uretero-enteric strictures after cystectomy: revealing the modifiable risk factors.
Akkad A, Bruyere F, Bourgi A
Can J Urol · 2026 Feb · PMID 41800511 · Publisher ↗
OBJECTIVES: Uretero-enteric strictures are feared complications following cystectomy. Despite surgical advancements, particularly the rise of robot-assisted approaches, the risk factors associated with these strictures r...
OBJECTIVES: Uretero-enteric strictures are feared complications following cystectomy. Despite surgical advancements, particularly the rise of robot-assisted approaches, the risk factors associated with these strictures remain poorly defined. This study aimed to identify the risk factors associated with uretero-enteric anastomotic strictures after cystectomy, according to the surgical approach and type of urinary diversion (extracorporeal vs. intracorporeal). METHODS: We conducted a single-center retrospective study including 340 patients who underwent cystectomy between 2016 and 2024 at Tours University Hospital. Clinical, biological, perioperative, and postoperative data were analyzed. The occurrence of a uretero-ileal anastomotic stricture was defined radiologically by a uretero-hydronephrosis ≥20 mm. We constructed and analyzed a learning curve for robotic surgery with intracorporeal urinary diversion. RESULTS: Strictures occurred in 60 patients (17.6%). On multivariable analysis, reduced preoperative glomerular filtration rate (odds ratio [OR] = 1.45 per 10 mL/min decrease, 95% CI [1.12-1.87], p = 0.004), elevated creatinine (OR = 1.30 per 10 µmol/L increase, 95% CI [1.05-1.61], p = 0.018), prior myocardial infarction (OR = 2.25, 95% CI [1.10-4.62], p = 0.027), and postoperative urinary tract infection (OR = 3.10, 95% CI [1.65-5.82], p < 0.001) were independent predictors. Most strictures were left-sided. Intracorporeal robotic diversion had a higher, though non-significant, stricture rate (21.5% vs. 15.2%, OR = 1.52, p = 0.12). Stricture rates fell markedly after 20 robotic cases per surgeon (23.8% vs. 12.1%). CONCLUSION: Uretero-enteric strictures are multifactorial, strongly influenced by baseline renal function, cardiovascular comorbidity, and postoperative infection. Robotic intracorporeal diversion shows a learning curve effect, underlining the importance of surgical expertise and infection prevention in reducing risk.
Efficacy of vaginal androgen combined with pelvic floor muscle training for stress urinary incontinence in postmenopausal women: a randomized-controlled trial.
Chen Y, Ren Z, Yan J … +1 more , Yu Y
Can J Urol · 2026 Feb · PMID 41800510 · Publisher ↗
OBJECTIVES: Postmenopausal women with stress urinary incontinence (SUI) exhibit low androgen expression. This study aimed to evaluate the efficacy and safety of vaginal androgen combined with pelvic floor muscle training...
OBJECTIVES: Postmenopausal women with stress urinary incontinence (SUI) exhibit low androgen expression. This study aimed to evaluate the efficacy and safety of vaginal androgen combined with pelvic floor muscle training (PFMT) in the treatment of SUI in postmenopausal women. METHODS: Postmenopausal women with SUI were recruited from Hainan West Central Hospital between January 2024 and March 2025. Participants were randomly assigned in a double-blind manner to receive either vaginal androgen cream combined with PFMT (treatment group) or a visually identical placebo cream (without androgens) combined with PFMT (control group). The vaginal cream was applied to the vaginal wall at a dose of 0.5 g per application, twice weekly for a total of 10 applications, while PFMT was conducted for 8 weeks. The clinical efficacy and safety were compared between the two groups. RESULTS: A total of 61 patients were finally enrolled, with 31 in the treatment group and 30 in the control group. At both 3-month and 6-month follow-ups, the treatment group demonstrated significantly lower values in daily pad usage (p < 0.05), 24-h pad test scores (p < 0.05), and ICIQ-UI SF scores (p < 0.05) compared to the control group. The improvement rate of urinary incontinence was significantly higher in the treatment group (p < 0.05). Compared to baseline, the treatment group showed statistically significant reductions in all three outcome measures (all p < 0.05). No severe adverse events were reported in either group during the treatment period. CONCLUSIONS: Androgen therapy combined with PFMT significantly improved the urinary incontinence remission rate in postmenopausal women with SUI, with no severe adverse effects observed. These findings suggest that androgen therapy may represent a novel therapeutic approach for SUI management in postmenopausal women. CLINICAL TRIAL REGISTRATION NUMBER: ChiCTR2300078752 in the Chinese Clinical Trial Registry.
Endocrine stimulation in men with non-obstructive azoospermia and low serum testosterone prior to micro-TESE: hormonal response as a predictor of sperm retrieval.
Barak S, Waldenberg N, Peretz A … +3 more , Bartoov R, Bar G, Dekalo S
Can J Urol · 2026 Feb · PMID 41800509 · Publisher ↗
BACKGROUND: Hormonal treatment and response as a predictor of sperm retrieval prior to microdissection testicular sperm extraction (micro-TESE) are not well established in the current literature. This study aimed to inve...
BACKGROUND: Hormonal treatment and response as a predictor of sperm retrieval prior to microdissection testicular sperm extraction (micro-TESE) are not well established in the current literature. This study aimed to investigate the hormonal response as a predictor of sperm retrieval among men with nonobstructive azoospermia (NOA). METHODS: Seventy-seven consecutive patients who had testosterone levels ≤ 14 nmol/L were treated medically with an aromatase inhibitor or recombinant human chorionic gonadotropin (rec-hCG) prior to micro-TESE and were included. Thirty-four (44.2%) had unexplained NOA (UNEX), 25 (32.5%) had Klinefelter syndrome (KS), 8 (10.4%) had a history of cryptorchidism (UDT), 4 (5.2%) had microdeletion of the Azoospermia factor C (AZFc), and 6 (7.8%) were treated previously with chemotherapy. Baseline and post-treatment serum hormonal levels were documented. Pre-op testosterone levels were entered into binary logistic regressions with age, Follicle-stimulating hormone (FSH), and Luteinizing hormone (LH) levels to test for significance with sperm retrieval. We then built logistic regression models to identify predictors of successful surgical sperm retrieval (SSR). RESULTS: Forty-five patients (58%) had successful retrieval. In 32 patients (42%), no sperm was retrieved. Both the mean pre-op testosterone and the mean testosterone change between the two groups were significant (p = 0.02 and p = 0.011, respectively). Receiver operating characteristic (ROC) analysis demonstrated an area under the curve (AUC) of 0.785 (95%CI = 0.685-0.886, p < 0.001). The Youden index coefficient was calculated for KS and UNEX. The cut-off point for KS was established at 0.764 (sensitivity = 0.875, false positive rate [FPR] = 0.111), and 0.215 for UNEX (sensitivity = 0.438, FPR = 0.222). We also observed a correlation between age and SSR (p = 0.05). In KS patients, SSR was determined by pre-op testosterone levels irrespective of age. CONCLUSION: Pre-operative hormonal response is a predictor for SSR in NOA patients who were treated medically. This data may help during pre-operative counselling.
Association of tertiary lymphoid structures and benign lymphoepithelial lesions in NIH-category IV prostatitis: pathophysiological correlations.
Dikov D, Koleva M, Simitchiev K … +3 more , Bivolarska A, Fakirova A, Sarafian V
Can J Urol · 2026 Feb · PMID 41800508 · Publisher ↗
BACKGROUND: Chronic inflammation is closely associated with the most common and socially significant prostate conditions, including benign prostatic hyperplasia (BPH), prostate cancer (PCa), and prostatitis syndromes. NI...
BACKGROUND: Chronic inflammation is closely associated with the most common and socially significant prostate conditions, including benign prostatic hyperplasia (BPH), prostate cancer (PCa), and prostatitis syndromes. NIH-category IV prostatitis (histologic prostatitis, HP) is defined as asymptomatic chronic inflammation of the prostate. The presence of lymphoid follicles, referred to as tertiary lymphoid structures (TLSs), along with benign lympho-epithelial lesions (BLELs), is among the key histological indicators of immune inflammation and can be assessed relatively easily. This study aimed to quantitatively assess TLSs and BLELs, as well as their relationship with the severity of HP. METHODS: We investigated TLSs and BLELs in 110 prostatic specimens, including inflammatory and normal tissues, within the context of common prostate pathologies such as BPH and PCa. HP was graded as low-grade (LG) or high-grade (HG) based on the severity of inflammation. RESULTS: TLSs were observed in 51 out of 110 cases (46.4%), while BLELs were identified in 78 cases (70.44%). Both TLSs and BLELs co-occurred in 45 cases (40.9%). Statistical analysis revealed a significant correlation between the presence of TLSs, BLELs (individually or combined), and HG-HP (p < 0.001). CONCLUSIONS: This study is the first to quantitatively evaluate the immunopathologic patterns in the inflamed human prostate by analyzing the presence and co-occurrence of TLSs and BLELs. Their formation, likely triggered by antigenic stimuli and external factors, indicates a chronic inflammatory microenvironment. The strong association between TLSs, BLELs, and HG-HP underscores their potential role in HP aggressiveness. These findings suggest that TLSs and BLELs may be crucial contributors to the pathophysiology and morphogenesis of NIH-category IV prostatitis. Furthermore, TLS/BLEL formation may represent a hallmark of tissue autoimmunity, reflecting the immune or autoimmune phase of this prostatitis subtype.
Initial case series and perioperative outcomes of single-port robotic radical prostatectomy: the Italian experience.
Spena G, Passaro F, Aveta A … +10 more , Contieri R, Izzo A, Quarto G, Grimaldi G, Castaldo L, Franzese D, Muscariello R, Pandolfo SD, Tufano A, Perdonà S
Can J Urol · 2026 Feb · PMID 41800507 · Publisher ↗
BACKGROUND: The Da Vinci Single-Port Robotic System (Da Vinci-SP), introduced by Intuitive (CA, USA) in 2018 in the USA and in 2024 in Europe, integrates advanced features like a flexible camera and articulating instrume...
BACKGROUND: The Da Vinci Single-Port Robotic System (Da Vinci-SP), introduced by Intuitive (CA, USA) in 2018 in the USA and in 2024 in Europe, integrates advanced features like a flexible camera and articulating instruments. It has garnered significant interest in urology. Our report presents the first described European series of Radical Prostatectomies using the Da Vinci SP at the leading Italian center, Istituto Nazionale Tumori di Napoli, IRCCS "G. Pascale" Foundation, detailing the technical differences and challenges faced by experienced multiport robotic surgeons. METHODS: Sixteen patients have been enrolled and underwent Single-Port (SP) Robot-Assisted Radical Prostatectomy (SP-RARP). Baseline characteristics of the patients were collected. We provided a step-by-step description of the surgical technique. Oncological outcomes have been evaluated and compared with magnetic resonance imaging (MRI) and biopsy results. Intraoperative, perioperative, and postoperative complications, surgical outcomes, functional outcomes, and technical issues of the new system were also documented. RESULTS: All surgeries were successfully performed without the need for conversion. An extraperitoneal approach was used for all patients. Median Console time was 110 min. No complications were reported. The estimated median blood loss was 175 cc. Discharge from the hospital was on the first post-operative day for all patients. Bladder catheter removal was on day 7 without the need for cystography. CONCLUSIONS: We presented the first European case series of SP-RARP, reporting our experience and confirming the procedure's feasibility for a highly experienced robotic surgeon. Experience with an extraperitoneal approach using the multiport (MP) platform, combined with well-conducted training for the SP system, may facilitate the transition to SP surgery. Further procedures and studies are needed to evaluate the oncological and functional outcomes.
Artificial intelligence assisted 3D in the robotic urooncology? A systematic review and narrative synthesis of current applications, challenges and future directions.
Barakat B, Al-Absi B, Hadaschik B … +3 more , Rehme C, Schakaki S, Bauer J
Can J Urol · 2026 Feb · PMID 41800506 · Publisher ↗
BACKGROUND: Artificial intelligence (AI)-assisted three-dimensional (3D) surgical platforms, integrated with augmented reality, have the potential to improve intraoperative anatomical recognition and provide surgeons wit...
BACKGROUND: Artificial intelligence (AI)-assisted three-dimensional (3D) surgical platforms, integrated with augmented reality, have the potential to improve intraoperative anatomical recognition and provide surgeons with an immersive, dynamic operating environment during uro-oncological procedures. This review aims to examine the current applications of AI in robotic uro-oncology, with a particular focus on its role in facilitating intraoperative navigation during complex surgeries. METHODS: A systematic literature search was performed across PubMed, the National Library of Medicine, MEDLINE, the Cochrane Central Register of Controlled Trials (CENTRAL), ClinicalTrials.gov, and Google Scholar to identify relevant studies published up to July 2025. The search strategy incorporated a predefined set of keywords, including AI, machine learning, radical prostatectomy (RP), robotic-assisted radical prostatectomy (RARP), robot-assisted partial nephrectomy (RAPN), and robot-assisted radical cystectomy (RARC). Only clinical trials, full-text peer-reviewed publications, and original research articles were included. Studies were eligible for inclusion if they evaluated or described applications of AI in RARP, RAPN, or RARC. RESULTS: Technological advancements have substantially transformed the field of uro-oncologic surgery. In particular, AI and AI-assisted intraoperative navigation in RARP demonstrate considerable potential to objectively assess surgical performance and predict clinical outcomes. In RAPN, the adoption of preoperative, interactive 3D virtual models for surgical planning has influenced surgical decisions, thus, enhanced precision in resection planning correlates with superior nephron-sparing outcomes and optimized selective clamping. AI applications in RARC, techniques such as augmented reality (AR) can overlay critical information on the surgical field, by facilitating navigation through complex anatomical planes and enhancing identification of critical structures. CONCLUSION: AI appears to enhance robotic uro-oncologic procedures by increasing operative precision and supporting individualised surgical treatment strategies.
Oncological outcomes of I125low dose brachytherapy in localized prostate cancer.
Chéchile Toniolo G, Jornet N, Rojas J … +4 more , Tejedor N, Carrara S, Maccagno A, Brufau T
Can J Urol · 2026 Feb · PMID 41800505 · Publisher ↗
BACKGROUND: Low-dose rate (LDR) prostate brachytherapy is a recommended treatment of localized prostate cancer in current guidelines. The study aimed to determine biochemical relapse-free survival (BRFS) in patients trea...
BACKGROUND: Low-dose rate (LDR) prostate brachytherapy is a recommended treatment of localized prostate cancer in current guidelines. The study aimed to determine biochemical relapse-free survival (BRFS) in patients treated with dynamic real-time low-dose rate (LDR) brachytherapy using Iodine 125 (I125). METHODS: We retrospectively reviewed 499 patients with localized prostate cancer treated with I125 LDR real-time brachytherapy between 2003 and 2021. The mean patient age was 65 years (range: 45-84 years). Based on the National Comprehensive Cancer Network (NCCN) risk classification, 230 patients (46.1%) were categorized as low risk, 235 (47.1%) as intermediate risk, and 34 (6.8%) as high risk. Gleason scores were distributed as follows: 3+3 in 283 cases (56.7%), 3+4 in 157 cases (31.5%), 4+3 in 46 cases (9.2%), and 4+4 in 13 cases (2.6%). The mean follow-up was 70.5 months. RESULTS: Tumor relapse was observed in 47 patients (9.4%) over a mean follow-up period of 6.26 years (SD 4.16). Local recurrence within the prostate occurred in 20 cases (4%). Patients with nadir PSA <0.2 ng/mL at 5 years of follow-up had a significantly lower incidence of tumor recurrence (3%) compared to those with a nadir PSA >0.2 ng/mL (21.9%) (p = 0.0001). Biochemical relapse-free (BRFS) rates at 5, 10 and 15 years were 96%, 91.5% and 88.9%, respectively. When stratified by NCCCN risk groups, 5-year BRFS was 96% in low risk, 98% in intermediate risk and 85% in high risk patients (p = 0.003). In multivariate analysis, only age at the time of brachytherapy (p = 0.009), initial PSA (p = 0.007) and Gleason grade (p = 0.007) were significantly associated with tumor recurrence. Cancer-specific survival and overall survival were 99.8% and 98.0%, respectively. CONCLUSIONS: LDR with I125 has excellent long-term oncological outcomes for patients with low and intermediate-risk prostate cancer, in particular, patients achieving a nadir PSA <0.2 ng/mL at 5 years post-treatment.
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