Urology[JOURNAL]
Sun
200 papers
Complex Renal Cysts in a Challenging Patient: Balancing Oncologic Risk and Renal Preservation.
Lopez Imizcoz F, Ruiz J, Rosiere N … +10 more , Blain O, Arenas I, Imaz F, Alberti DW, Flores P, Cadario M, Formia I, Pacheco L, Felizzia G, Weller S
Urology · 2026 Jun · PMID 42263915 · Publisher ↗
Abstract loading — click title to view on PubMed.
Emergency management of ureteral stones with SWL: is there any advantage over elective approach?
Guzel R, Kanberoglu AF, Yildirim S … +2 more , Simsek G, Sarica K
BMC Urol · 2026 Jun · PMID 42260532 · Full text
INTRODUCTION: The optimal timing of extracorporeal shock wave lithotripsy (ESWL) for ureteral stones remains unclear. This study aimed to compare the clinical and radiological outcomes of emergency versus elective ESWL i...
INTRODUCTION: The optimal timing of extracorporeal shock wave lithotripsy (ESWL) for ureteral stones remains unclear. This study aimed to compare the clinical and radiological outcomes of emergency versus elective ESWL in patients presenting with ureteral calculi. METHODS: In this retrospective study, 66 patients who underwent ESWL at our institution between June 2023 and December 2024 were included. Patients were categorized into emergency (n = 32) and elective (n = 34) ESWL groups. All procedures were performed using a Modulith SLK Inline lithotripter (Storz Medical, Switzerland) with up to 3,000 shocks per session at 60-90 shocks per minute under NSAID analgesia. Demographic characteristics, stone-related parameters (size, volume, density), procedural variables (session number, duration), stone-free (SF) rates, post-procedural emergency visits, and infectious complications were analyzed. Stone-free status was assessed 7 days after the final ESWL session. RESULTS: There were no significant differences between the emergency and elective groups regarding age, sex, body mass index (BMI), or comorbidities. Stones in the emergency ESWL group were significantly larger (8.2 ± 2.65 mm vs. 7.7 ± 1.74 mm; p = 0.023) while stone volume was similar. The number of ESWL sessions and total procedure duration did not differ significantly. Stone-free rates were comparable between groups (65.6% vs. 67.6%; p = 0.862). Post-treatment emergency department visits (31.3% vs. 20.6%; p = 0.322) and infectious complications (15.6% vs. 5.9%; p = 0.199) did not differ significantly. CONCLUSION: Emergency ESWL was associated with stone-free rates comparable to elective ESWL in carefully selected patients, despite a larger mean stone size in the emergency ESWL group. However, the numerically higher infectious complication rate in the emergency group warrants cautious interpretation. These findings suggest that emergency ESWL may represent a feasible early treatment option for selected patients with symptomatic ureteral stones.
Immunotherapy in bladder cancer: a systematic review of clinical trials and therapeutic advances.
Alasker A, Alghafees M, Nammor T … +6 more , Alanazi N, Alferayan T, Almanie A, Alrashed M, Almarzouq Y, Alammari A
BMC Urol · 2026 Jun · PMID 42260513 · Full text
BACKGROUND: Bladder cancer poses significant morbidity, mortality, and healthcare burdens globally. While non-muscle-invasive bladder cancer often initially responds to intravesical Bacillus Calmette-Guérin, many patient...
BACKGROUND: Bladder cancer poses significant morbidity, mortality, and healthcare burdens globally. While non-muscle-invasive bladder cancer often initially responds to intravesical Bacillus Calmette-Guérin, many patients become unresponsive to Bacillus Calmette-Guérin, resulting in recurrence or progression. Emerging immunotherapies, including checkpoint inhibitors (Pembrolizumab, Atezolizumab, Durvalumab), intravesical gene therapies (Nadofaragene Firadenovec, Cretostimogene Grenadenorepvec), and novel cytokine-based therapies, present promising alternatives. This systematic review thoroughly synthesizes existing clinical evidence from phase 2 and 3 trials, critically assessing immunotherapeutic options for bladder cancer treatment. METHODS: A comprehensive search was systematically conducted across four databases: PubMed, Cochrane, Web of Science and Scopus strictly adhering to PRISMA guidelines and retrospectively registered. Included studies evaluated immunotherapies in non-muscle-invasive bladder cancer and selected muscle-invasive bladder cancer populations. Two reviewers independently performed study screening, data extraction, and risk-of-bias assessments using the Cochrane Risk-of-Bias tool. Results were synthesized both qualitatively, incorporating detailed comparative analyses and robust statistical descriptions. RESULTS: A total of 778 studies were initially identified. Intravesical Cretostimogene Grenadenorepvec demonstrated the highest complete response [1] rate (75.2%), with impressive durability (83% maintaining response ≥ 12 months). Intravesical Nadofaragene Firadenovec also exhibited notable efficacy (CR 53.4%, median duration 9.69 months). Nogapendekin Alfa Inbakicept combined with Bacillus Calmette-Guerin achieved a robust CR (71%) and a remarkably sustained response (median 26.6 months). Systemic Pembrolizumab showed moderate efficacy (43.5% 12-month disease-free survival) but raised significant toxicity concerns (14% grade ≥ 3 adverse events). Intravesical therapies consistently provided superior cystectomy avoidance (≥ 89% at 12 months) compared to systemic treatments. Safety profiles significantly favored intravesical therapies, which had predominantly mild (grade 1-2) adverse events, while systemic therapies reported notable severe toxicities and treatment-related fatalities. CONCLUSIONS: Intravesical immunotherapies, particularly Nogapendekin Alfa Inbakicept and Bacillus Calmette-Guerin and Nadofaragene, demonstrate superior efficacy, significant response durability, and favorable safety profiles in treating bladder cancer compared to systemic checkpoint inhibitors, which display moderate efficacy and notable safety concerns. These findings strongly support prioritizing intravesical therapies in non-muscle-invasive bladder cancer management, especially for patients who are unresponsive to Bacillus Calmette-Guerin. Future research should focus on head-to-head randomized controlled trials and biomarker-driven patient selection to optimize clinical outcomes.
AirSeal versus conventional insufflation in robot-assisted radical prostatectomy: effects on operative efficiency, pain, and perioperative outcomes.
Aykanat IC, Muduroglu M, Mese SK … +7 more , Ozkan A, Gurbuz A, Koseoglu E, Kordan Y, Balbay MD, Esen T, Canda AE
BMC Urol · 2026 Jun · PMID 42260479 · Full text
BACKGROUND: Robot-assisted radical prostatectomy (RARP) requires a stable pneumoperitoneum to maintain optimal surgical conditions. The AirSeal Intelligent Flow System has been developed to provide continuous pressure re...
BACKGROUND: Robot-assisted radical prostatectomy (RARP) requires a stable pneumoperitoneum to maintain optimal surgical conditions. The AirSeal Intelligent Flow System has been developed to provide continuous pressure regulation and smoke evacuation; however, its clinical impact during RARP remains incompletely defined. OBJECTIVE: To compare perioperative, oncological, and postoperative recovery outcomes between the AirSeal system and conventional insufflation systems during RARP. METHODS: We retrospectively analyzed patients who underwent RARP at a high-volume tertiary center in a retrospective before-and-after cohort design. Patients were stratified according to the insufflation system used during surgery: conventional insufflation system (CIS) or the AirSeal system. Demographic characteristics, perioperative parameters, pathological outcomes, postoperative complications (Clavien-Dindo), postoperative pain scores and opioid consumption were evaluated. RESULTS: A total of 749 patients were included (CIS: 398; AirSeal: 351). Baseline demographic and clinical characteristics were comparable between the groups. Operative time was significantly shorter in the AirSeal group (183 ± 77.7 vs. 217.4 ± 73.0 min; p < 0.001). Estimated blood loss, transfusion rates, and length of hospital stay were similar between the groups. Pathological stage distribution differed between the groups, with a higher proportion of locally advanced disease (≥pT3) in the AirSeal cohort (49.3% vs 39.2%; p = 0.005). However, other oncological outcomes, including pathological ISUP grade distribution, lymph node involvement, and positive surgical margin rates, were comparable. Overall postoperative complication rates were similar between the groups; however, high-grade complications (Clavien-Dindo ≥III) occurred less frequently in the AirSeal group. Postoperative pain scores at 1, 6, and 24 hours were significantly lower in the AirSeal group (all p < 0.001), postoperative morphine consumption at 24 hours was also significantly reduced (p < 0.001). CONCLUSIONS: Use of the AirSeal insufflation system during RARP was associated with shorter operative times, lower postoperative pain scores, and less frequent high-grade complications. Positive surgical margin rates and lymph node involvement were comparable between the groups. However, given the retrospective before-and-after design, differences in surgical periods and pneumoperitoneum pressure between the groups, these findings should be considered observational and hypothesis-generating.
Feasibility and preliminary safety of urologic telesurgery using Chinese surgical systems: a single-center exploratory case series.
Xu T, Wang Z, Qi A … +4 more , Guo M, Wang J, Guo P, Wang Z
BMC Urol · 2026 Jun · PMID 42260478 · Full text
PURPOSE: Telesurgery offers a solution to the uneven distribution of surgical resources by enabling telesurgery through surgical robotic systems. This study aimed to describe the technical feasibility and preliminary sho...
PURPOSE: Telesurgery offers a solution to the uneven distribution of surgical resources by enabling telesurgery through surgical robotic systems. This study aimed to describe the technical feasibility and preliminary short-term safety of urologic telesurgery using Chinese surgical systems (CSS). METHODS: This single-center exploratory descriptive case series evaluated urologic telesurgery using CSS between January 2023 and October 2025. A total of 6 consecutive eligible telesurgeries were included: 3 robot-assisted radical prostatectomies (RARP) and 1 robot-assisted partial nephrectomy (RAPN) were performed with the Edge MP1000 (MP1000) system, and 1 RAPN and 1 robot-assisted radical cystectomy (RARC) were performed with the KangDuo SR-2000 (KD-SR-2000) system. Six locally performed RARP cases using the da Vinci Xi (DV-Xi) system during the same study period were retrospectively collected as a limited contextual reference for the RARP subgroup. The primary outcome was technical success, defined as completion without conversion. Secondary descriptive outcomes included perioperative safety events, 30-day Clavien-Dindo complications (CDC), network performance, and, in the RARP subgroup, positive surgical margin (PSM) rate, estimated blood loss (EBL), operative time, suture-per-stitch time, and 4-week urinary continence recovery after catheter removal. RESULTS: All six telesurgeries were completed without intraoperative conversion or major complications. In the RARP subgroup, remote MP1000 procedures were summarized alongside locally performed DV-Xi procedures as a limited contextual reference. PSM rate and early urinary continence recovery showed no obvious unfavorable signal in this small contextual cohort, whereas operative time and suture-per-stitch time were longer, and EBL was numerically higher, in remote procedures. Mean Network round-trip latency for telesurgery ranged from 6.13 ± 0.71 ms (Harbin-Harbin, 2 km) to 54.12 ± 0.58 ms (Harbin-Hangzhou, 2200 km), with no frame loss. CONCLUSION: In this small selected case series, urologic telesurgery using CSS was technically feasible and preliminary safety under stable telecommunication conditions.
Preoperative superselective transarterial ICG-lipiodol embolization for endophytic renal tumors in robot-assisted partial nephrectomy: a preliminary feasibility report.
Hsieh CC, Chiang TY, Tseng WH … +4 more , Liu CL, Wu RH, Huang SK, Chiu AW
BMC Urol · 2026 Jun · PMID 42260455 · Full text
Partial nephrectomy for small, anatomically complex renal tumors presents significant navigational challenges. This study aims to evaluate the synergistic hemostatic and navigational utility and surgical outcomes of preo...
Partial nephrectomy for small, anatomically complex renal tumors presents significant navigational challenges. This study aims to evaluate the synergistic hemostatic and navigational utility and surgical outcomes of preoperative superselective indocyanine green (ICG) embolization during retroperitoneal robot-assisted partial nephrectomy (RAPN). We retrospectively reviewed 32 patients who underwent retroperitoneal RAPN for small renal masses (< 4 cm). Patients were stratified by preoperative intervention: 9 patients (28.1%) received superselective transarterial delivery of an ICG-lipiodol mixture with coil embolization 3 h prior to surgery, while 23 patients (71.9%) underwent standard RAPN. A uniform main renal artery clamping protocol was maintained across both cohorts to evaluating the combined utility of ICG. Strikingly, the ICG cohort consisted entirely of completely endophytic tumors (E3 component: 100% vs. 13%, p < 0.001). Despite this extreme anatomical complexity, the ICG group demonstrated significantly shorter median operative time (90.0 vs. 100.2 min, p = 0.049) and lower median estimated blood loss (100 vs. 350 mL, p = 0.039). Consequently, the perioperative blood transfusion rate was lower in the ICG group (11.1% vs. 60.9%, p = 0.018). Median warm ischemia time (16.48 vs. 16.78 min, p = 0.900) and postoperative renal function changes at day 1, 6 months, and 1 year were comparable between groups. No gastrointestinal or embolization-related complications were observed. Our preliminary experience demonstrates that preoperative superselective ICG embolization serves as a feasible and safe adjunct during RAPN for completely endophytic tumors. By providing a synergistic combination of direct local hemostasis and real-time fluorescent navigation, this tailored approach facilitates precise tumor localization. While these initial findings suggest potential perioperative advantages, they should be interpreted as exploratory signals awaiting further validation in larger, well-balanced cohorts.
An expanded paternal legacy: epididymal mRNAs are transmitted to the embryo.
Warkiani ME, Goss DM
Nat Rev Urol · 2026 Jun · PMID 42259963 · Publisher ↗
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Impact of preoperative MRI on surgical outcomes of robot-assisted laparoscopic prostatectomy: a single-center retrospective cohort of 844 patients.
Rochat CH, Schaffar R, Randriantsalama JM … +3 more , Szalay IQ, de Boccard GA, Favre MM
Ther Adv Urol · 2026 · PMID 42253847 · Full text
BACKGROUND: Multiparametric magnetic resonance imaging (mpMRI) refines local staging in prostate cancer, but its effect on hard surgical endpoints after robot-assisted laparoscopic prostatectomy (RALP) remains uncertain....
BACKGROUND: Multiparametric magnetic resonance imaging (mpMRI) refines local staging in prostate cancer, but its effect on hard surgical endpoints after robot-assisted laparoscopic prostatectomy (RALP) remains uncertain. OBJECTIVES: To evaluate whether systematic preoperative mpMRI implementation was associated with improved surgical margin status and early biochemical control in a mature robotic RALP program. DESIGN: Single-center retrospective cohort study comparing two calendar periods (pre‑mpMRI era vs mpMRI era). METHODS: We included 844 consecutive men who underwent RALP for cT1-cT2 N0 M0 prostate adenocarcinoma between January 2007 and December 2019. Patients were classified into a pre-mpMRI era (2007-2012) and a post-mpMRI era (2014-2019), excluding 2013 as a transition year. From 2014, standardized 3T mpMRI interpreted by a single uroradiologist was systematically integrated into side-specific surgical planning, including nerve-sparing decisions. The primary endpoint was any positive surgical margin (PSM); the secondary endpoint was biochemical recurrence (BCR, prostate-specific antigen (PSA) ⩾ 0.2 ng/mL) within 24 months. Logistic regression (overall and stratified by pT2/pT3) assessed associations between era and PSM, with multivariable adjustment for age, PSA, tumor volume, biopsy Gleason score, D'Amico risk group, and pathological stage. BCR-free survival was analyzed with Kaplan-Meier curves, log-rank tests, and Cox models censored at 24 months. RESULTS: Of 844 men, 393 were operated on in 2007-2012 and 451 in 2014-2019. Compared with the pre-mpMRI era, patients in the mpMRI era were older (median 67 vs 64 years) and had larger tumor volume (3.6 vs 2.2 cc) and less favorable Gleason and D'Amico profiles, while pT distribution was similar. Margin status was available for 802 patients; PSM decreased from 25% (97/381) to 15% (65/421) in the mpMRI era (absolute reduction ~10 percentage points). In the overall cohort, surgery in the mpMRI era was associated with lower odds of PSM (adjusted odds ratio 0.51; 95% CI 0.34-0.74; < 0.001). In pT2 disease, the association was directionally favorable but non-significant (adjusted odds ratio (OR) 0.71; 95% CI 0.42-1.17; = 0.20), whereas in pT3 tumors the mpMRI era was associated with a marked reduction in PSM (adjusted OR 0.35; 95% CI 0.19-0.63; < 0.001). Among 807 patients with PSA follow-up, 24-month BCR-free survival was 0.896 (95% CI 0.861-0.923) in 2007-2012 and 0.846 (95% CI 0.801-0.881) in 2014-2019 (log-rank = 0.0377); the corresponding unadjusted hazard ratio for BCR was 1.55 (95% CI 1.02-2.35), which attenuated and lost significance after adjustment for age and D'Amico risk (adjusted hazard ratio 1.10; = 0.656). CONCLUSION: In a high-volume center with a stable, experienced robotic surgeon, the preoperative mpMRI era has been linked to better surgical outcomes, particularly for patients with more pT3 disease. While this temporal association supports a potential contribution of systematic preoperative mpMRI to surgical precision, residual temporal confounding cannot be excluded. Early BCR-free survival within 24 months did not differ significantly between eras after adjustment for baseline risk. In the future, more precise 3D MRI mapping could further enhance the preservation of neurovascular bundles without compromising the oncological prognosis. TRIAL REGISTRATION: Not applicable (retrospective analysis of routinely collected clinical data).
Comparison of the efficacy and safety of flexible vacuum-assisted ureteral access sheath-assisted flexible ureteroscopic lithotripsy, conventional ureteral access sheath-assisted flexible ureteroscopic lithotripsy, and mini-percutaneous nephrolithotomy for 2-3 cm renal stones.
Gu H, Xue S, Lei Y … +2 more , Wu B, Gao K
Ther Adv Urol · 2026 · PMID 42253846 · Full text
BACKGROUND: The optimal management of 2-3 cm renal stones remains challenging because effective stone clearance must be balanced against perioperative morbidity. Mini-percutaneous nephrolithotomy (mPCNL) provides high st...
BACKGROUND: The optimal management of 2-3 cm renal stones remains challenging because effective stone clearance must be balanced against perioperative morbidity. Mini-percutaneous nephrolithotomy (mPCNL) provides high stone-free rates (SFR) but is associated with greater procedural burden, whereas flexible ureteroscopic lithotripsy (fURL) is less invasive but may be limited by fragment clearance efficiency. A flexible vacuum-assisted ureteral access sheath (FV-UAS) has recently been introduced to facilitate fragment evacuation and improve intrarenal drainage during fURL. OBJECTIVES: To compare the efficacy and safety of FV-UAS-assisted fURL, conventional ureteral access sheath-assisted flexible ureteroscopic lithotripsy (UAS-assisted fURL), and mPCNL for the treatment of 2-3 cm renal stones, and to provide evidence for surgical decision-making in this clinical setting. DESIGN: This was a retrospective single-center comparative study. METHODS: This retrospective study included 156 patients with 2-3 cm renal stones who underwent FV-UAS-assisted fURL (FV-UAS group, = 50), UAS-assisted fURL (UAS group, = 54), or mPCNL (mPCNL group, = 52) at Xi'an People's Hospital between June 2022 and December 2024. Perioperative outcomes were compared, including operative time, postoperative hemoglobin decrease, postoperative pain assessed by the visual analogue scale (VAS), postoperative length of hospital stay, total hospitalization costs, and postoperative adverse events, including fever, renal colic, urinary tract infection, and steinstrasse. SFR was assessed on postoperative day 3 and at 1 month postoperatively. RESULTS: Operative time differed significantly among the three groups (FV-UAS 77.56 ± 15.04 min vs mPCNL 67.60 ± 10.44 min vs UAS 85.04 ± 15.78 min; < 0.05). Postoperative hemoglobin decrease was significantly lower in the FV-UAS and UAS groups than in the mPCNL group (3.50 ± 2.40 g/L and 4.01 ± 2.14 g/L vs 13.86 ± 3.21 g/L; < 0.001). The postoperative length of stay was shorter in the FV-UAS group than in the UAS group and markedly shorter than in the mPCNL group (3.04 ± 0.73 d vs 3.52 ± 0.72 d vs 6.04 ± 0.86 d; < 0.05). Postoperative VAS scores were lower in the FV-UAS and UAS groups than in the mPCNL group ( < 0.05), with no significant difference between the two fURL groups. Regarding total hospitalization costs, the mPCNL group had the lowest costs, and the FV-UAS group had lower costs than the UAS group ( < 0.05). The overall adverse event rates were comparable among groups. Steinstrasse occurred in three cases, all in the UAS group. On postoperative day 3, SFRs were 94.0% (FV-UAS), 75.9% (UAS), and 80.8% (mPCNL), with the FV-UAS group higher than the UAS group ( < 0.05). At 1 month, SFRs were 96.0% (FV-UAS), 81.5% (UAS), and 96.2% (mPCNL), with both the FV-UAS and mPCNL groups higher than the UAS group ( < 0.05). CONCLUSION: For 2-3 cm renal stones, FV-UAS-assisted fURL was associated with less hemoglobin decrease, lower postoperative pain, and shorter hospital stay than mPCNL, and showed advantages over UAS-assisted fURL in operative time and hospitalization costs, while achieving a 1-month SFR comparable to mPCNL. FV-UAS-assisted fURL may represent a safe and effective minimally invasive alternative for 2-3 cm renal stones. TRIAL REGISTRATION: Not applicable.
Association between CYP2C19 gene polymorphisms and analgesic response to meperidine in emergency department patients with renal colic: a prospective observational study.
Baykara Sayili S, Koseler A, Erdur B
BMC Urol · 2026 Jun · PMID 42252451 · Full text
BACKGROUND: Renal colic is a urologic emergency that presents with characteristic severe pain and is mostly seen in emergency services. The preferred medications are NSAIDs, paracetamol and opioids, but considering the s...
BACKGROUND: Renal colic is a urologic emergency that presents with characteristic severe pain and is mostly seen in emergency services. The preferred medications are NSAIDs, paracetamol and opioids, but considering the severity of pain, opioid analgesics should be advised. The aim of this study is to determine the relationship between meperidine efficacy and CYP2C19 gene polymorphisms. METHODS: This prospective observational study was conducted between 01.07.2017 and 01.10.2018 in the Pamukkale University Faculty of Medicine Emergency Department. Our study subjects included 203 patients with renal colic and 102 individuals presenting with abdominal pain but not diagnosed with renal colic were included only for genetic frequency analysis; this group was not included in the intervention safety/efficacy analyses. 203 patients were given 100 mg of meperidine and observed 60 min later, and vital signs, laboratory values, etc., were recorded. RESULTS: The age and sex distributions were similar between the case and control groups. There was no statistically significant difference between the sexes in visual analog scale (VAS) scores at any time (0.min-15.min-30.min-60.min). The normal-activity/rapid metabolizer groups had significantly lower 30- and 60-min VAS scores than did the moderate-activity groups. The percentages of VAS decreases at 30 and 60 min from baseline were significantly greater in the normal-activity rapid metabolizer group than in the moderate-activity group. This study revealed that the efficacy of the drug was not affected by age, sex or stone location. The VAS score decreased significantly at all time intervals. Additionally, the decrease in the VAS score between 0 and 15 min after drug administration was similar in each genotype group, but after 30 min, it was remarkable for the CYP2C19 1/1 genotype. During follow-up, 11 patients had drug-related adverse events (most commonly nausea and dizziness). No serious events occurred, and no additional interventions or hospitalizations were required. CONCLUSIONS: This study suggested that the effectiveness of meperidine in treating renal colic may be influenced by the genetic polymorphism of CYP2C19 in the patient. The pain response was markedly reduced in individuals with the CYP2C19 *1/*1 genotype. The age, sex, and stone localization groups were seemingly comparable with respect to the efficacy of meperidine. It is advisable to consider the genetic profile in individualized treatment approaches, with the aim of increasing drug efficacy and optimizing dose adjustments.
Editorial Comment on "The Relationship Between Burnout, Perfectionism, and Grit in Urology".
Patel MK, El-Arabi AM
Urology · 2026 Jun · PMID 42251908 · Publisher ↗
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Tubo-ovarian Deflection During Robotic Ureteral Reimplantation for Vesicoureteral Reflux in Girls.
Schwarztuch Gildor O, Shaked Y, Bakaleyschik P … +3 more , Itshak A, Vainrib M, Neheman A
Urology · 2026 Jun · PMID 42251907 · Publisher ↗
OBJECTIVE: To evaluate the feasibility, safety, and outcomes of medial tubo-ovarian deflection (MTOD), a maneuver involving division of the round ligament to enhance distal ureteral access, compared with standard robotic...
OBJECTIVE: To evaluate the feasibility, safety, and outcomes of medial tubo-ovarian deflection (MTOD), a maneuver involving division of the round ligament to enhance distal ureteral access, compared with standard robotic-assisted laparoscopic extravesical ureteral reimplantation (RALUR-EV), in female children with vesicoureteral reflux. METHODS: We reviewed female patients who underwent RALUR-EV for primary vesicoureteral reflux (VUR) from 2017 to 2025, dividing into Control (2017-2020) and MTOD (2021-2025) groups. We compared operative metrics, complications, and radiographic outcomes and used multivariable regression to assess MTOD's effect on operative time. RESULTS: Thirty-five patients were included (MTOD: n = 11; Control: n = 24). Ipsilateral VUR grades were similar between cohorts (P = .331). MTOD was feasible and performed in all cases. Operative time was shorter in the MTOD group (80 vs 120 minutes, P = .031). In multivariable regression, MTOD was identified as a predictor of shorter operative time (β = (-45), 95% CI [-88, -2.5], P = .047). No cases of high-grade persistent VUR (grades III-V) occurred in either group. No cases of de novo reflux were observed in the MTOD group. CONCLUSION: MTOD is a safe, feasible, and reproducible adjunct maneuver that enhances distal ureteral exposure during RALUR-EV in female children and is associated with shorter operative time.
Diagnostic value of PSA-based markers in prostate cancer: a retrospective analysis stratified by body mass index.
Yang T, Zhang Q, Liu Z … +3 more , Tian J, Hu X, Lv Z
BMC Urol · 2026 Jun · PMID 42251295 · Full text
OBJECTIVE: Body mass index (BMI) influences the accuracy of prostate-specific antigen (PSA) in prostate cancer (PCa) diagnostic performance. This study investigates the effect of BMI on conventional PSA-based markers and...
OBJECTIVE: Body mass index (BMI) influences the accuracy of prostate-specific antigen (PSA) in prostate cancer (PCa) diagnostic performance. This study investigates the effect of BMI on conventional PSA-based markers and evaluates a novel age-adjusted PSA density parameter (A-PSAD) to optimize diagnostic performance strategies across different BMI groups. RESULTS: The cohort comprised 307 low-BMI (91 PCa, 216 benign) and 356 high-BMI (109 PCa, 247 benign) patients. In the low-BMI group, A-PSAD yielded the highest diagnostic efficacy (AUC = 0.714), outperforming PSAD (0.685) and total PSA (TPSA, 0.588). In the high-BMI group, A-PSAD also demonstrated superior performance (AUC = 0.793) compared to PSAD (0.774) and TPSA (0.613). A-PSAD's overall diagnostic value was significantly higher than conventional markers across both groups (P < 0.01). Furthermore, LASSO regression identified four optimal predictive variables for the low-BMI group and seven for the high-BMI group; A-PSAD consistently emerged as a core independent predictor in both. CONCLUSION: BMI significantly modulates the diagnostic efficacy of PCa diagnostic performance indicators. A-PSAD demonstrates robust, superior diagnostic value across varying BMI categories, serving as a promising primary diagnostic performance tool to optimize individualized pre-biopsy risk stratification.
Perioperative complications of laparoscopic sacrohysteropexy versus sacrocolpopexy with subtotal hysterectomy for pelvic organ prolapse.
Alanazi S, Alshammari N, Jrais A … +4 more , Alharbi N, Alsaadoon M, Alanazi Y, Alsahabi J
BMC Urol · 2026 Jun · PMID 42249363 · Full text
BACKGROUND: Pelvic organ prolapse (POP) affects 23.4% of women in Saudi Arabia. Laparoscopic sacrocolpopexy is the established surgical gold standard; however, whether concomitant hysterectomy confers additional perioper...
BACKGROUND: Pelvic organ prolapse (POP) affects 23.4% of women in Saudi Arabia. Laparoscopic sacrocolpopexy is the established surgical gold standard; however, whether concomitant hysterectomy confers additional perioperative risk remains debated. METHODS: This retrospective cohort study included 179 women who underwent laparoscopic sacrocolpopexy with subtotal hysterectomy (n = 119) or laparoscopic sacrohysteropexy (n = 60) at two tertiary referral centers in Riyadh, Saudi Arabia, between 2009 and 2024. Intraoperative and postoperative complications, perioperative hemoglobin change, and hospital stay duration were compared between groups. RESULTS: The sacrocolpopexy group was significantly older (P = 0.004). Organ injury occurred in 0.6% of cases overall. Blood transfusion was required exclusively in the sacrohysteropexy group (3.3% vs. 0.0%, P = 0.045). Both groups demonstrated a statistically significant postoperative hemoglobin decline - sacrocolpopexy: 124.52 ± 15.07 to 110.60 ± 13.77 g/L; sacrohysteropexy: 125.27 ± 13.20 to 110.29 ± 12.18 g/L (P < 0.001) - with no significant between-group difference (P = 0.747) and neither decline reaching clinical significance. Sacrohysteropexy was associated with shorter hospitalization (44.6% vs. 24.6% discharged within two postoperative days, P = 0.012). Reoperation rates and symptom resolution were comparable between groups. CONCLUSIONS: No significant between-group differences in perioperative morbidity were detected. Sacrohysteropexy was associated with shorter hospital stay; however, the clinical relevance of the higher transfusion rate is uncertain, given the small event count. Given baseline group non-comparability and the retrospective design, these results should be regarded as exploratory. The surgical approach should be individualized based on patient characteristics and the surgeon's expertise. Prospective randomized trials are warranted.
Epigenetic modulation of prostate cancer disparities in men with African ancestry.
Craddock J, Hayes VM
Nat Rev Urol · 2026 Jun · PMID 42249067 · Publisher ↗
Prostate cancer disproportionately affects men of African ancestry, yet the molecular mechanisms underlying these disparities remain poorly defined. Genomic studies have begun to reveal ancestry-linked risk alleles and s...
Prostate cancer disproportionately affects men of African ancestry, yet the molecular mechanisms underlying these disparities remain poorly defined. Genomic studies have begun to reveal ancestry-linked risk alleles and somatic alterations, but the role of epigenetic dysregulation is only emerging. Drawing on multi-ancestral comparative analyses, with emphasis on cohorts from sub-Saharan Africa, we speculate that germline and somatic variation converge in epigenetic machinery genes to drive tumour evolution. African tumours harbour a heightened burden and diversity of both inherited and acquired variants, supporting a model of 'oncogenic cooperation' whereby germline diversity interacts with somatic mutations to broaden the range of pathogenic interactions. Limited yet complementary methylation analyses reveal tumour-specific and ancestry-specific reprogramming of promoters, enhancers and heterochromatin, suggesting that African tumours might be epigenetically primed for aggressive phenotypes. Chromatin remodelling defects emerge as potentially under-recognized disparity drivers, promoting genomic instability, altered gene regulation and therapeutic resistance. Collectively, these findings support a genome-epigenome-environment model in which inherited susceptibility, somatic variation and environmentally reinforced epigenetic reprogramming converge to shape aggressive African-associated prostate cancer. However, current insights are limited by European-centred baselines, under-representation of African cohorts and platform mismatches. Reducing prostate cancer health disparities requires equitable prostate cancer genomics and epigenomic research efforts that embrace the rich African ancestral population identifier.
Art, science and clinical urology with a Capitol AUA.
Fenner A
Nat Rev Urol · 2026 Jun · PMID 42249066 · Publisher ↗
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Corrigendum to "Comparison of Functional and Patient-reported Outcomes Following Non-transecting Anastomotic Urethroplasty for Lengthy (>2 cm) Versus Short (≤2 cm) Bulbar Urethral Strictures" [Urology 210(2026)126-130].
Findlay BL, Moring N, Miller AJ … +5 more , Fadel A, Pinkhasov AM, Nicholas Warner J, Anderson KT, Viers BR
Urology · 2026 Jun · PMID 42248717 · Publisher ↗
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Association of Prior Urethroplasty and Technique With Outcomes After Artificial Urinary Sphincter Implantation: A Systematic Review and Meta-analysis.
Deameh MG, Mohamed H, Abdelshafi A … +2 more , Mohamed T, Ramez M
Urology · 2026 Jun · PMID 42248334 · Publisher ↗
Artificial urinary sphincter (AUS) implantation is the standard treatment for moderate-to-severe stress urinary incontinence, but outcomes may be influenced by prior urethral reconstruction. To evaluate the impact of pri...
Artificial urinary sphincter (AUS) implantation is the standard treatment for moderate-to-severe stress urinary incontinence, but outcomes may be influenced by prior urethral reconstruction. To evaluate the impact of prior urethroplasty and transecting versus non-transecting urethroplasty techniques on outcomes following artificial urinary sphincter implantation. A systematic search of PubMed, Scopus, and Web of Science was conducted from inception through January 2026. It included comparative studies of artificial urinary sphincter outcomes in patients with or without prior urethroplasty, and of transecting and non-transecting urethroplasty techniques. Primary outcomes were urethral erosion and device explantation; secondary outcomes included continence, mechanical failure, and postoperative infection. Four studies involving 533 patients were analyzed. Prior urethroplasty was associated with a significantly higher risk of device explantation compared to no history of urethroplasty (RR 2.05, 95% CI 1.08-3.89), confirmed by pooled hazard ratio analysis (HR 2.95, 95% CI 1.45-6.02), but showed no statistically significant increase in erosion, infection, or mechanical failure. Transecting urethroplasty was associated with significantly higher risks of both erosion (RR 2.34, 95% CI 1.30-4.21) and explantation (RR 2.38, 95% CI 1.59-3.57) compared to non-transecting urethroplasty, with consistent findings on time-to-event analysis. Prior urethroplasty, especially with transecting techniques, links to higher AUS erosion and explantation rates. Continence outcomes stay favorable, but these findings are observational and need prospective studies to clarify how urethroplasty methods affect AUS outcomes.
Digital tracking of ureteral stents with the stentless application: clinical outcomes in 200 patients.
Giurgiu L, Buzoianu MM, Medan PA … +9 more , Andras I, Dobrotă F, Peia R, Vranău SP, Medan Ș, Rus B, Ognean R, Coman I, Crișan N
BMC Urol · 2026 Jun · PMID 42243855 · Full text
BACKGROUND AND OBJECTIVES: Ureteral double-J stents (UDJS) are frequently placed in urologic practice for a range of indications, including ureteral obstruction, strictures, stone disease, peri- and post-ureteroscopy, an...
BACKGROUND AND OBJECTIVES: Ureteral double-J stents (UDJS) are frequently placed in urologic practice for a range of indications, including ureteral obstruction, strictures, stone disease, peri- and post-ureteroscopy, and following ureteral reconstruction or reimplantation. Recent studies suggest that approximately 13% of inserted stents become overdue or neglected, which can lead to serious, potentially life-threatening complications. We therefore aimed to develop a smartphone application to track patients with UDJS and reduce the incidence of overdue indwelling ureteral stents. MATERIALS AND METHODS: For the development of the application, we worked with a specialized team of programmers. To facilitate universal access to the complete patient database, a cloud-based database was implemented. The application was designed to send a Short Message Service (SMS) to the patients and their general practitioner to remind the timing for UDJS extraction. We prospectively enrolled a total of 200 patients who underwent UDJS insertion for any indication by six urologists from June 2023, to March 2024. The patients were divided into two groups: the first group was monitored using the Stentless mobile application, while the second group was monitored using an electronic patient registry. The two groups were compared with respect to stent overdue times and complete loss-to-follow-up rates. RESULTS: In this study, a total of 200 patients were enrolled non-randomly and assigned to one of the study groups. 100 patients assigned to group 1 (mobile application group) and 100 to group 2 (electronic registry group). Among these, 187 patients (93.5%) underwent unilateral ureteral stent placement, while 13 patients (6.5%) required bilateral stent placements. The study also included patients with long-term indwelling stents, with the maximum stent replacement interval extending up to 360 days. The median indwelling time across the cohort was 17 days (range 14-360), reflecting the inclusion of long-term stents. In group 1, no patients missed their scheduled stent removal appointments, corresponding to an LTFU rate of 0% and no overdue removals. In group 2, four patients failed to attend their scheduled appointments (p = 0.121). These patients were identified through the electronic patient registry and subsequently contacted for follow-up. The delay in stent removal among these four patients was (7, 10, 13, and 60 days) beyond the planned appointment date. Notably, one patient from group 2 presented with an encrusted stent requiring two flexible ureteroscopy procedures for removal. Ultimately, all ureteral stents were successfully removed in an office-based setting, ensuring complete management for all participants. CONCLUSIONS: By notifying the patient and general practitioner with a mobile phone text message automatically transmitted from the application, there is the potential to increase patient compliance, reduce the rate of those who have a UDJS and fail to return for follow-up, respectively to reduce the rate of patients presenting for complications due to stent encrusting.
Efficacy and safety of optical navigation system versus conventional fluoroscopy in sacral neuromodulation electrode implantation: a prospective randomized controlled trial.
Ziqin Z, Xin S, Yinjun G … +4 more , Tingting L, Weilin F, Jin H, Jianwei LV
BMC Urol · 2026 Jun · PMID 42243833 · Full text
BACKGROUND: Precise Stage I electrode implantation is critical for the success of sacral neuromodulation (SNM); however, conventional fluoroscopy-guided puncture is limited by reliance on bony landmarks and significant r...
BACKGROUND: Precise Stage I electrode implantation is critical for the success of sacral neuromodulation (SNM); however, conventional fluoroscopy-guided puncture is limited by reliance on bony landmarks and significant radiation exposure. This study evaluated the clinical value of an optical navigation system (ONS) combined with multimodal image fusion for SNM electrode implantation. METHODS: A prospective, single-blind, randomized controlled trial was conducted between March 2024 and June 2025. Eighty patients with refractory lower urinary tract dysfunction (including neurogenic bladder, overactive bladder, and interstitial cystitis/bladder pain syndrome) undergoing SNM were randomly assigned (1:1) to receive either ONS-assisted puncture (experimental group, n = 40) or conventional X-ray guidance (control group, n = 40). The primary outcome was the conversion rate to Stage II permanent implantation. Secondary outcomes included the number of puncture attempts, puncture time, total operative time, radiation dose, minimum effective voltage, and perioperative complications. RESULTS: Baseline characteristics were comparable between groups. The Stage II conversion rate was significantly higher in the ONS group than in the control group (87.5% vs. 62.5%, P < 0.05). Patients in the ONS group required fewer median puncture attempts [2.0 (2.0, 2.2) vs. 5.0 (4.0, 7.0), P < 0.01] and shorter puncture time [7.5 (5.8, 10.2) min vs. 16.0 (12.0, 25.0) min, P < 0.01]. Intraoperative radiation exposure was substantially reduced in the ONS group [145.5 (108.4, 202.3) mGy vs. 473.3 (354.5, 635.2) mGy, P < 0.01]. Furthermore, the minimum effective voltage was significantly lower in the ONS group [1.8 (1.8, 2.5) V vs. 2.8 (1.8, 3.0) V, P = 0.010], suggesting superior electrode-neural positioning accuracy. No surgical complications occurred in either group. CONCLUSIONS: ONS combined with multimodal image fusion significantly improves the precision of SNM electrode implantation, reduces surgical trauma and radiation exposure, and increases Stage II conversion rates. This technique demonstrates stable clinical efficacy across various etiologies of refractory lower urinary tract dysfunction and represents a valuable navigation tool warranting broader clinical adoption. TRIAL REGISTRATION: Chinese Clinical Trial Registry #ChiCTR2500098093 3/3/2025.
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