Nat Rev Urol
· 2026 May · PMID 42103924
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Patient outcomes after robotic surgery vary widely, often reflecting differences in surgical performance. Artificial intelligence (AI) offers new ways to address this variability, with applications spanning automated ski...Patient outcomes after robotic surgery vary widely, often reflecting differences in surgical performance. Artificial intelligence (AI) offers new ways to address this variability, with applications spanning automated skills assessment and feedback, intraoperative guidance and autonomous surgery. The most credible short-range advances of AI in this space consist in generating assistive systems that enhance perception, anticipate risks and standardize feedback while remaining under surgeon control. Results from early studies suggest that AI can influence decision-making, reduce errors and shorten learning curves, particularly in areas such as augmented navigation, anatomy recognition, error detection and telesurgery support. Long-term directions include emerging vision-language-action interfaces capable of programming task-specific support through natural language. In addition to technical performance, translation of AI into clinical practice will require robust datasets, systems designed around human users, regulatory alignment and clear accountability. Ultimately, the measure of surgical AI will be patient outcomes, including reduced complications, fast proficiency acquisition and improved outcome consistency across diverse settings.
OBJECTIVE: To delineate the natural clinical trajectory and cumulative incidence of conservative management failure in children with primary vesicoureteral reflux (VUR) and a history of urinary tract infection (UTI), to...OBJECTIVE: To delineate the natural clinical trajectory and cumulative incidence of conservative management failure in children with primary vesicoureteral reflux (VUR) and a history of urinary tract infection (UTI), to identify independent risk factors, and to develop a prognostic nomogram for personalized risk stratification. METHODS: This retrospective study included 145 children with primary VUR and a history of UTI undergoing conservative management. We evaluated clinical data, maximum ureteral diameter (MUD), VUR grade, and immuneinflammatory markers. Multivariate Cox regression identified independent predictors of surgical intervention. A prognostic nomogram was constructed and validated using ROC curves, calibration plots, and decision curve analysis (DCA). RESULTS: The cohort primarily consisted of infants (median age: 8.4 months). Over a median follow-up of 26.5 months, 38.6% of patients failed conservative management. Cumulative surgical rates were 22.1% at 1 year and 29.0% at 2 years. Platelet-to-lymphocyte ratio (PLR) >81.5 (HR = 2.763), MUD >7.5 mm (HR = 2.397), and high-grade VUR (HR = 2.091) were independent predictors of failure. The nomogram achieved AUCs of 0.782 (1-year) and 0.715 (2-year), with reasonable calibration and potential clinical net benefit. CONCLUSION: During follow-up, 38.6% of children with VUR and a history of UTI underwent surgical intervention. Integrating PLR, MUD, and VUR grade, our nomogram may serve as an adjunctive tool for personalized risk stratification and for supporting shared decision-making regarding early surgical intervention, pending external validation.
INTRODUCTION: Tranexamic acid (TXA) is an antifibrinolytic agent with demonstrated benefits in various surgical procedures, including urological surgeries. However, its effect on radical cystectomy (RC) remains uncertain...INTRODUCTION: Tranexamic acid (TXA) is an antifibrinolytic agent with demonstrated benefits in various surgical procedures, including urological surgeries. However, its effect on radical cystectomy (RC) remains uncertain, largely due to limited data from an earlier meta-analysis that combined RC with substantially different urological procedures, as well as conflicting results from two recently published meta-analyses specifically evaluating the impact of TXA on RC. METHODS: This systematic review and meta-analysis was registered in PROSPERO (CRD42024628394) and conducted following PRISMA and Cochrane guidelines. Randomized controlled trials (RCTs) and observational studies comparing TXA versus no TXA in patients undergoing RC. Primary endpoints included perioperative blood transfusion (PBT) and venous thromboembolism (VTE). Random-effects models with Hartung-Knapp-Sidik-Jonkman (HKSJ) adjustment were used to calculate pooled risk ratios (RR) and 95% confidence intervals (CI). RESULTS: Three studies (one RCT and two propensity-score matched observational studies) involving 1,344 patients (673 TXA; 671 control) were included. The pooled analysis for PBT showed a non-significant reduction in risk (RR 0.69; 95% CI 0.25-1.86; p = 0.25; I2 = 81%). Similarly, the risk of VTE was not significantly different between groups, although a potential trend toward increased risk was noted (RR 1.60; 95% CI 0.80-3.17; p = 0.10; I2 = 0%). CONCLUSIONS: Current evidence is underpowered to confirm the efficacy or safety of TXA during radical cystectomy. While no significant benefit or harm was identified, the wide confidence intervals necessitate further large-scale randomized trials to provide definitive clinical guidance.
The understanding of oligometastatic prostate cancer has advanced substantially in the past two decades, reshaping both diagnostic and therapeutic paradigms. The advent of next-generation imaging, particularly prostate-s...The understanding of oligometastatic prostate cancer has advanced substantially in the past two decades, reshaping both diagnostic and therapeutic paradigms. The advent of next-generation imaging, particularly prostate-specific membrane antigen PET-CT, has improved staging accuracy, enabling patients with limited metastatic burden who might benefit from intensified local and metastasis-directed approaches to be identified. Results from randomized phase II trials support the use of metastasis-directed therapy in patients with metachronous oligometastatic prostate cancer. However, evidence for metastasis-directed therapy in de novo presentations remains preliminary but encouraging. In parallel, prostate-directed treatments such as radiotherapy and cytoreductive radical prostatectomy are under active investigation, although the role of these approaches in the era of intensified systemic therapy is yet to be fully defined. Although interest around oligometastatic prostate cancer is growing, several issues are currently unsettled, including a unified definition of oligometastatic prostate cancer; the inclusion of biological information in patient selection; optimal treatment sequencing, including the integration and duration of systemic therapy; and appropriate clinical end points.
OBJECTIVE: To evaluate patient preferences for intermediate-risk prostate cancer treatment and determine how these preferences vary across demographic groups using a discrete choice experiment. METHODS: We recruited pati...OBJECTIVE: To evaluate patient preferences for intermediate-risk prostate cancer treatment and determine how these preferences vary across demographic groups using a discrete choice experiment. METHODS: We recruited patients with intermediate-risk prostate cancer from a single-center urology clinic. In this survey, we included 8 attributes with 3-4 levels each to capture the full spectrum of prostate cancer treatment outcomes. We estimated patient preferences using a conditional logit model. We conducted a latent class analysis to identify patient subgroups with distinct choice behavior patterns. We used a multivariable linear probability model to assess the association between patient demographic characteristics and latent class membership. RESULTS: A total of 88 patients completed the survey. In our primary analysis, patients had a significant preference towards avoiding bowel symptoms, erectile dysfunction, use of a catheter, or frequent trips to the facility. Bowel symptoms were considered the most important of all attributes, while urinary symptoms did not significantly influence patients' choices. Patients placed a low weight on facing prolonged travel times or undergoing a major surgery. Latent class analysis revealed 2 groups based on survey response patterns: (1) patients averse to surgery and catheter and (2) patients averse to erectile and bowel symptoms. Older patients and racial and ethnic minorities were more likely to be members of the surgery and catheter-focused class. CONCLUSION: Overall, patients appear to prioritize avoiding bowel and sexual side effects after prostate cancer treatment. However, a subset of older patients may have strong preferences against surgery or the prolonged use of a catheter.
Radiation-induced ureteral stricture (RIUS) is a rare but refractory late complication of pelvic radiotherapy, driven by severe fibrosis and microvascular injury that undermines the effectiveness of conventional interven...Radiation-induced ureteral stricture (RIUS) is a rare but refractory late complication of pelvic radiotherapy, driven by severe fibrosis and microvascular injury that undermines the effectiveness of conventional interventions such as balloon dilation, ureteral stenting, and reconstructive surgery. This review summarizes the pathophysiological basis of treatment resistance in RIUS and critically appraises current management strategies. Beyond its clinical relevance, RIUS is discussed as a paradigmatic model of advanced fibrotic ureteral disease, offering broader insights into the limitations of purely mechanical approaches. We further examine emerging biologically oriented strategies, including mesenchymal stem cell-derived extracellular vesicle-based regenerative therapies, next-generation ureteral stents incorporating advanced biomaterials, and drug-eluting stent platforms for localized antifibrotic and antimicrobial delivery. Although largely investigational, these approaches collectively signal a conceptual shift from palliative drainage toward biologically informed, restorative management of RIUS and related refractory ureteral strictures.
OBJECTIVE: To evaluate the association between motor vehicle accident (MVA) fatalities and the incidence of genitourinary (GU) injuries using national trauma and fatality data from 2012-2022. Motor vehicle fatalities rep...OBJECTIVE: To evaluate the association between motor vehicle accident (MVA) fatalities and the incidence of genitourinary (GU) injuries using national trauma and fatality data from 2012-2022. Motor vehicle fatalities represent the second-leading accidental cause of death in the United States. Motor vehicle crashes represent the most common cause of genitourinary injuries. Despite the decrease in motor vehicle accident (MVA) fatality rate over the past century, there has been no evaluation of relationships between fatality trends and incidence of genitourinary injuries. METHODS: Data were obtained from the National Trauma Database over an 11-year period (2012-2022). ICD-9 and ICD-10 codes were used to identify patients who sustained genitourinary injury(-ies) in motor vehicle-related accidents. Injury and patient-related demographic data were reviewed. National traffic fatality data were obtained from the National Highway Traffic Safety Administration. Descriptive statistics were performed per year; polynomial (quadratic) regression was then used to evaluate temporal trends. RESULTS: Demographics were similar year-by-year with a male predominance (range over time = 63.9%-66.1%), and median ages in the thirties (range over time = 31-33). The most common genitourinary injury across all years was renal injuries. On polynomial regression, there was a strong positive correlation between motor vehicle fatalities and genitourinary injuries (adjust R = 0.733, P = .002). CONCLUSION: The frequency of genitourinary injuries has a positive correlation with motor vehicle fatalities. Given the predominance of blunt renal injuries in the MVA setting future efforts at improving motor vehicle safety should consider further protection from blunt trauma to the trunk.
OBJECTIVE: To elucidate the association of endogenous circulating testosterone and its related substances with the onset and severity of stress urinary incontinence (SUI) in postmenopausal women. PATIENTS AND METHODS: A...OBJECTIVE: To elucidate the association of endogenous circulating testosterone and its related substances with the onset and severity of stress urinary incontinence (SUI) in postmenopausal women. PATIENTS AND METHODS: A comparative analysis of clinical data was conducted on postmenopausal women with SUI who visited our hospital between January 2021 and October 2025, along with age-matched healthy postmenopausal controls recruited during the same period. Participants were stratified by age and body mass index (BMI). Venous blood samples were collected from all subjects, and serum levels of testosterone, sex hormone-binding globulin (SHBG), dehydroepiandrosterone (DHEA), and androstenedione were measured using chemiluminescence immunoassay. After adjusting for age, BMI, hypertension, delivery mode, hysterectomy status, and occupation, multivariate logistic regression analysis was performed to determine the relationship between SUI in postmenopausal women and serum testosterone and its related substances. RESULTS: Serum testosterone levels were significantly lower in SUI patients compared to healthy controls (1.05 ± 0.60 vs 1.76 ± 0.93; P < .05), while no significant differences were observed in SHBG, DHEA, or androstenedione levels between groups (P > .05). Decreased serum testosterone levels not only showed a negative correlation with SUI severity in postmenopausal women, but also emerged as a potential risk factor for SUI (OR = 5.627, 95%CI = 3.360-9.424, P = .001). In contrast, SHBG, DHEA, and androstenedione showed no significant correlation (P > .05). CONCLUSION: The findings of this study suggest that low serum testosterone levels are associated with an increased likelihood of SUI in postmenopausal women.
BACKGROUND: Repeat transurethral resection of bladder tumor (TURBT) is recommended in selected patients with newly diagnosed bladder cancer to improve staging accuracy and detect residual disease, but it also increases m...BACKGROUND: Repeat transurethral resection of bladder tumor (TURBT) is recommended in selected patients with newly diagnosed bladder cancer to improve staging accuracy and detect residual disease, but it also increases morbidity and treatment burden. The Vesical Imaging-Reporting and Data System (VI-RADS) has shown high accuracy for predicting muscle invasion, whereas its role in identifying patients who undergo repeat TURBT remains unclear. This study evaluated the clinical value of VI-RADS for predicting repeat TURBT status in primary bladder cancer. METHODS: This single-center prospective observational study included 59 patients with newly diagnosed primary bladder tumors who underwent preoperative multiparametric magnetic resonance imaging and initial TURBT. VI-RADS scores were assigned by an experienced radiologist blinded to pathological findings. Associations between VI-RADS and clinicopathological variables were examined using Spearman's correlation analysis. Diagnostic performance for predicting repeat TURBT status was assessed by receiver operating characteristic analysis. Univariable and multivariable logistic regression models were used to identify independent predictors of undergoing repeat TURBT. RESULTS: Repeat TURBT was performed in 31 patients (52.5%). Higher VI-RADS categories were more frequently observed among patients who underwent repeat TURBT, whereas lower categories predominated in the single-TURBT group. Among patients undergoing repeat TURBT, residual malignancy was identified in 66.7% of VI-RADS 4 lesions and 88.9% of VI-RADS 5 lesions. VI-RADS correlated significantly with tumor grade, invasion depth, tumor size, and number of surgical procedures. ROC analysis showed modest discriminatory ability for predicting repeat TURBT status (AUC 0.635, 95% CI 0.491-0.778; p = 0.066). At a cutoff of VI-RADS ≥ 3, sensitivity was 70.4% and specificity was 59.4%. In multivariable analysis, only invasion depth at initial TURBT independently predicted repeat TURBT. CONCLUSIONS: VI-RADS was associated with pathological tumor severity and with repeat TURBT status, but it did not independently predict undergoing repeat TURBT. These findings support VI-RADS as an adjunctive preoperative tool rather than a stand-alone determinant for repeat resection decisions.
OBJECTIVE: To evaluate whether clinical or urodynamic response to Botox reduces progression to definitive surgery (bladder augmentation/incontinent diversion) in children with myelomeningocele (MMC). METHODS: We performe...OBJECTIVE: To evaluate whether clinical or urodynamic response to Botox reduces progression to definitive surgery (bladder augmentation/incontinent diversion) in children with myelomeningocele (MMC). METHODS: We performed a retrospective cohort study of children with MMC treated with intravesical Botox at a tertiary pediatric center. Demographics, urodynamics, bladder morphology, vesicoureteral reflux (VUR), and treatment characteristics were collected. "Botox effect" was defined as clinical or urodynamic improvement after initial injection. The primary outcome was progression to augmentation or incontinent diversion. Time-to-event analyses used Kaplan-Meier and Cox regression. RESULTS: Eighty-three patients were included (median follow-up 4.8 years). Twenty-five patients (30.1%) progressed to augmentation or diversion. Five-year freedom from progression was 73.9%. Patients demonstrating a Botox effect had lower progression to augmentation or diversion compared with non-responders (5-year freedom from progression: 81.4% vs 45.8%, P<.001). On multivariable analysis, Botox effect was independently protective against progression (HR 0.23, 95% CI 0.09-0.60), while presence of VUR was associated with increased risk (HR 4.69, 95% CI 1.79-12.29). Receipt of multiple Botox injections was also associated with improved outcomes. CONCLUSION: In children with MMC, favorable initial response to Botox is strongly associated with reduced progression to augmentation or diversion. Future prospective studies with standardized definitions of response and long-term follow-up are needed to better define which patients derive durable benefit from Botox and to refine treatment strategies.
OBJECTIVE: To investigate the dynamics between both patient-level Medicaid status and facility-level Medicaid share and receipt of guideline-concordant care for localized PCa. METHODS: Using the National Cancer Database,...OBJECTIVE: To investigate the dynamics between both patient-level Medicaid status and facility-level Medicaid share and receipt of guideline-concordant care for localized PCa. METHODS: Using the National Cancer Database, we identified a cohort of individuals aged 21-64 diagnosed with localized PCa from 2014 to 2021. The primary outcome was receipt of guideline-concordant management, defined as active surveillance for "low risk," and either radical prostatectomy or androgen deprivation therapy and radiation therapy for "unfavorable intermediate" and "high risk" PCa. We evaluated the association between Medicaid insurance status, a facility's share of Medicaid-insured patients, and their association with guideline-concordant care using random effects logistic regression, accounting for clustering of patients within facilities. RESULTS: At the patient level, Medicaid insurance was associated with higher odds of guideline-concordant care among the subset with low-risk PCa (OR 1.25, 95% CI 1.12-1.40, P<.01) but lower odds in the high-risk subsets (OR 0.67, IQR 0.62-0.73 P<.01), reflecting less definitive treatment overall in this group. Similarly, higher facility Medicaid share was independently associated with guideline-concordant care for patients with low-risk disease (OR 1.39, IQR 1.26-1.55, P<.01) but inversely associated for those with high-risk disease (OR 0.86, IQR 0.82-0.91, P<.01). CONCLUSION: Medicaid insurance and higher facility-level Medicaid share were associated with greater use of guideline-concordant care in low-risk disease and lower use in unfavorable intermediate- and high-risk disease, indicating risk-dependent differences in treatment intensity and alignment with guideline-based care.