Objective: To explore the diagnostic value of biparametric magnetic resonance imaging (bp-MRI) combined with tumor contact length (TCL) for identifying muscle-invasive bladder cancer (MIBC) among lesions scored 3 on the vesical imaging-reporting and data system (VI-RADS). Materials and Methods: This single-center retrospective study enrolled patients with pathologically confirmed bladder urothelial carcinoma and a preoperative VI-RADS overall score of 3 (October 2022–October 2025). Two radiologists independently assessed biparametric VI-RADS score and TCL. Inter-observer agreement was evaluated. Based on the postoperative pathology, patients were divided into nonmuscle-invasive bladder cancer (NMIBC) and MIBC groups. Diagnostic performance of individual indicators and combined models (logistic regression and clinical rule) was assessed using receiver operating characteristic analysis. Bootstrap validation (1000 resamples) was performed. Results: One hundred and three patients (46 NMIBC, 57 MIBC) were included. Inter-observer agreement was excellent for biparametric VI-RADS (weighted Kappa = 0.82) and TCL (intraclass correlation coefficient = 0.91). TCL and biparametric score was significantly higher in the MIBC group (both P < 0.001). TCL alone (cutoff >2.5 cm) yielded an area under the curve (AUC) of 0.708; for the biparametric score alone (cutoff >3), AUC was 0.743. The combined logistic model (bp-MRI + TCL) achieved the highest AUC of 0.821 (optimism-corrected AUC of 0.798), sensitivity of 96.5%, and specificity of 65.2%. Proposed clinical rule (downgrade biparametric score 3-2 if TCL ≤2.5 cm) achieved an AUC of 0.814 (sensitivity 91.2% and specificity 69.6%). Multiparametric model (including dynamic contrast-enhanced) was not superior (AUC 0.810, P > 0.05). Conclusion: Integrating TCL with biparametric VI-RADS score improved the diagnostic accuracy for muscle invasion in VI-RADS 3 lesions. The simple clinical rule (TCL ≤2.5 cm downgrades the score to 2) showed promising efficacy and may assist in preliminary decision-making, pending external validation.
Introduction:Two-dimensional (2D) imaging has traditionally guided surgical planning for partial nephrectomy (PN). However, it has limitations in depicting complex renal anatomy. Three-dimensional (3D) CT reconstructions may enhance spatial understanding, but evidence of their added value remains limited. This study evaluates the role of 3D reconstruction in preoperative planning. Materials and Methods:This was a prospective, observational, single-center cohort study conducted between June 2021 and October 2023. Patients with cT1 renal masses planned for robotic PN willing for additional 3D reconstruction were enrolled. Preoperative predictions were made first with 2D computed tomography and then with combined 2D+3D reconstructions across seven parameters: Sinus dissection, selective clamping, margin status, warm ischemia (<30 min), pelvicalyceal system (PCS) entry, venous clamping, and vascular injury. Predictions were compared with intraoperative findings. Results:Fifty-four patients with cT1 renal masses were included in the study. The median age of the patients was 49 years, and most tumors were solitary (90.7%) and of moderate complexity (64.8%). Trifecta outcomes were achieved in 92.6%. Incorporating 3D reconstruction resulted in consistent descriptive improvements in predictive accuracy of 3.7%-9.2%, although statistical significance was not reached. McNemar's test demonstrated statistically significant discordance between 2D+3D-based prediction and intraoperative findings for warm ischemia time (11 patients), PCS entry (21 patients), and major vascular injury (7 patients). Nevertheless, predictive accuracy and Cohen's kappa values favored combined imaging. Conclusion:Integration of 3D reconstruction with 2D improved the accuracy of preoperative prediction of intraoperative events, thereby supporting more informed preoperative planning. Further studies with larger sample size are warranted to identify tumor complexity subsets that derive the greatest benefit and the impact on the learning curve of PN.
Introduction: Polyacrylamide hydrogel (PAHG) injection is a minimally invasive treatment option for female stress incontinence, but reported effectiveness and durability vary across studies. This study aims to evaluate the effectiveness, safety, and retreatment rates of PAHG injection for female SUI through a systematic review and meta-analysis. Methods: A systematic review and meta-analysis were conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines and registered in PROSPERO (CRD420261328968). Literature was retrieved from electronic databases, such as PubMed, ProQuest, EuroPMC, and EBSCO, from database inception through February 2026. Cohort studies assessing PAHG injection for SUI were systematically reviewed. Random-effects models were used, heterogeneity was assessed with I2, and meta-regression examined age and follow-up as moderators. Publication bias was evaluated using funnel plots and Egger’s test. Results: Thirteen studies, including 1797 patients, were analyzed. The pooled responder rate was 72% (95% confidence interval [CI] 64%–78%; I2 = 87%). A greater mean age was significantly associated with higher response rates (P = 0.04). Four studies reporting International Consultation on Incontinence Questionnaire outcomes demonstrated a pooled mean reduction of −6.65 points (95% CI: −8.52 to −4.78; I2 = 92.8%). The pooled repeat injection rate was 16% (95% CI: 10%–27%; I2 = 94%). Follow-up duration did not significantly influence retreatment rates (P = 0.85). No evidence of publication bias was detected for the primary outcome (P = 0.96). Conclusion: PAHG injection is a minimally invasive treatment associated with clinically meaningful symptom improvement and a favorable safety profile in women with SUI. However, given the single-arm design of the included studies and substantial heterogeneity, these findings should be interpreted with caution.
Introduction:Erectile dysfunction (ED) is a common and multifactorial complication after pelvic fracture urethral injury (PFUI), yet objective characterization of ED severity and penile Doppler findings remains limited. We aimed to describe ED severity categories and penile Doppler findings in men with PFUI undergoing anastomotic urethroplasty. Methods:We performed a retrospective analysis of a prospectively maintained database. Among 110 men who underwent anastomotic urethroplasty for PFUI between September 2022 and September 2023, 97 with complete preoperative penile Doppler ultrasound and standardized Sexual Health Inventory for Men assessment were included. Pelvic fractures were classified using the Young-Burgess system. All patients received tadalafil 5 mg daily for 6 months. Postoperative Doppler was not performed. Results:The median age was 29.5 years with a median follow-up of 11 months. Urethroplasty success rate was 85%(83/97). Preoperatively, 56 out of 97 patients had ED (42 mild/moderate; 14 severe). Penile Doppler abnormalities were nearly universal: 93 had cavernosal, and 83 had dorsal artery insufficiency. Postoperatively, 13 out of 41 men developed de novo ED, while 13 out of 56 improved by at least one severity category. Among 76 patients with complete fracture data, greater fracture severity was associated with worse postoperative ED, and worsening erectile function was more frequent among patients with urethroplasty failure. Conclusions:ED and penile Doppler abnormalities are highly prevalent after PFUI. ED severity correlated with pelvic injury severity, supporting the concept that ED reflects global trauma burden rather than isolated vascular pathology. Given the retrospective design and routine postoperative use of PDE5 inhibitors, these findings should be considered descriptive and hypothesis-generating.
Introduction: The objective of this study was to evaluate the feasibility and clinical outcomes of single-stage dorsal onlay urethroplasty using thigh-harvested split-thickness skin grafts (STSGs) for the treatment of panurethral strictures. Methods: Between July 2019 and November 2023, 17 patients with urethral strictures ≥8 cm underwent single-stage dorsal onlay STSG urethroplasty at a single center. Grafts were harvested using an electric dermatome. Follow-up included uroflowmetry at 1, 6, 12, 24, and 36 months, alongside 5-item International Index of Erectile Function (IIEF-5) and International Prostate Symptom Score quality of life questionnaires at 48 months. Results: The mean patient age was 55.6 years, and the median stricture length was 10 cm. Etiology was primarily iatrogenic (70.6%), followed by lichen sclerosus (23.5%) and infection (5.9%). Median operative time and hospital stay were 249 min (interquartile ranges [IQR]: 79) and 5 days (IQR: 2.5), respectively. The overall complication rate was 11.8%. Median Qmax remained stable over time: 22.3 mL/s at 1 month, 25 mL/s at 6 months, 22 mL/s at 12 months, and 19 mL/s at 48 months. At the 3-year assessment, the median post-void residual measured by bladder scan and confirmed with uroflowmetry was 30 mL (IQR: 30). At 48 months, median IIEF-5 was 23 (IQR: 12), indicated preserved erectile function. One recurrence occurred within 24 months, with five total recurrences by 48 months. Regarding patient satisfaction (Likert scale), 14 out of 17 patients reported being “satisfied” or “very satisfied.” Conclusions: Single-stage panurethroplasty with STSG is a feasible, effective, and durable surgical option for long-segment strictures. Larger studies are needed to validate these findings.
Ephemeral urocolpos, characterized by urine accumulation in the vagina, is a rare presentation of vesicovaginal reflux, often resolving spontaneously. Its transient nature necessitates dynamic pre- and postvoid imaging. Transabdominal ultrasound of an 18-year-old obese female with intermittent postvoid urinary dribbling suggested urocolpos by demonstrating an anechoic fluid collection in the vagina that increased in size postvoid, with subsequent near-complete resolution, highlighting its transient nature. The magnetic resonance imaging corroborated this with postvoid T2-hyperintense (urine signal) vaginal distension. The computed tomography voiding cystourethrogram showed contrast reflux into the vagina during micturition, without structural anomaly or fistulous tract. Conservative management (voiding retraining) led to symptom resolution.
Introduction: Although robotic and open cystectomies have similar parastomal hernia (PSH) rates, the robotic approach offers perioperative advantages. PSH nevertheless remains a clinically and economically significant complication, and evidence on prophylactic mesh use in robot-assisted radical cystectomy (RARC) with ileal conduit (IC) formation is limited. This feasibility study reports short-term outcomes following mesh insertion, focusing on postoperative complications, including mesh-related infection and ileus. Methods: This retrospective, single-center, observational cohort study evaluates the use of prophylactic funnel mesh made of polyvinylidene fluoride (PVDF) during RARC with IC formation through a comprehensive assessment. This technique has been implemented routinely within our center. Results: From August 2023 to September 2024, 22 consecutive patients (41% of females) underwent RARC with IC formation. One robotic cystectomy was for a benign cause, whereas seven patients had bladder cancer stage T1, 11 – T2, 2 – T3, and 1 – T4. The average operating time was 310 ± 61 min. Perioperatively, 23% of patients had a Clavien–Dindo Class ≤2 ileus. After a median follow-up of 16 months, there was 1 (4.5%) clinical/radiological instance of PSH (Clavien–Dindo Class 3b) and 1 (4.5%) instance of mesh-related infection (Clavien–Dindo Class 2). Conclusions: Placement of PVDF funnel mesh during RARC with IC formation appears feasible and was associated with a low rate of mesh-related complications in this series. Although only one PSH occurred during short-term follow-up, these results should be interpreted cautiously, given the small sample size and limited duration. Longer-term evaluation is required to determine the true effectiveness of this approach in preventing PSH.
We describe a robotic technique for bilateral ureteral reconstruction using a U-shaped ileal interposition in the setting of retroperitoneal fibrosis and vascular encasement. A 77-year-old man with chronic kidney disease, prior orchiectomy with retroperitoneal radiation for testicular cancer, radical prostatectomy, and spine surgery, presented with retroperitoneal fibrosis, bilateral mid-ureteral strictures, and nephrostomy dependence. After adhesiolysis, both ureters were identified at the pelvic brim, dissected off the great vessels, and proximally spatulated. A 25-cm ileal segment was isolated, configured in a U-shape, and anastomosed to the bladder dome at its apex. Each ureter was reimplanted mucosa-to-mucosa to a separate ileal limb over double-J stents, with additional single-J stents placed across the vesico-ileal anastomosis.
Bladder neck contracture (BNC) is a recognized complication after transurethral resection of prostate (TURP) (0.5%–10%). While endoscopic treatment is first-line, obliterative BNC not amenable to guidewire passage often recurs. We report a 66-year-old male with BNC 1 year after TURP, initially managed with suprapubic cystostomy (SPC). As the contracture was complete, robotic-assisted Y-V plasty was performed. The bladder was mobilised, fibrotic tissue excised, and a vascularised anterior flap was advanced under cystoscopic and indocyanine green guidance. Recovery was uneventful. At 1 year, the patient had Qma × 22 mL/s, minimal residual urine, and full continence. Robotic Y-V plasty offers a durable, single-stage solution for refractory obliterative BNC.
Telesurgery, the use of robotic systems to perform operations remotely, represents a growing frontier in minimally invasive surgery. We report a rare and pioneering case of a 16-month-old male with left pelviureteric junction obstruction. The child underwent robotic-assisted pyeloplasty performed via a telesurgical approach. The procedure was completed successfully without intraoperative or postoperative complications. The child recovered uneventfully. To our knowledge, this is among the youngest reported cases of robotic-assisted pyeloplasty performed via SSI Mantra Robotic system (Sudhir Srivastava Innovations Pvt. Ltd., India. It highlights the feasibility of telerobotic interventions in urology.
Background: Giggle incontinence (GI) is a rare type of urinary incontinence that affects children and adolescents, impacting their quality of life by causing social isolation, reduced self-confidence, and low self-esteem. To counteract the symptoms of GI, various treatment approaches have been described, but there is a dearth of reporting on their effectiveness. Objective: This review aims to synthesize evidence on the management of GI in the adolescent population, focusing on pharmacological and nonpharmacological interventions. Methods: Ascoping review was conducted using the Joanna Briggs Institute methodology and Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for scoping reviews guidelines, along with the Population, Concept, Context framework, to perform a comprehensive search across major databases and gray literature. Treatment outcomes and follow-up data were extracted. Results: Of the 72 records, 9 studies met the inclusion criteria, in which the commonly used interventions were pharmacologic (mainly methylphenidate [MPH]) and nonpharmacologic (biofeedback, behavioral modifications). Studies explored the effectiveness of these interventions and found positive outcomes. Follow-up showed a significant effect of both the types of interventions. Conclusions: GI remains under-recognized in the adolescent population despite its effects on psychological and urological health. A multidisciplinary approach targeting the GI can help improve outcomes. This review provides insights about the use of various nonpharmacological therapies, such as biofeedback and behavioral therapy, and pharmacological therapies in the form of MPH to improve GI. Nonpharmacological approaches are low-risk and can be adapted as the primary treatment. Future research with planned methodology to compare the treatment efficacy is needed to improve the outcomes.
Introduction:Androgen deprivation therapy (ADT), widely used in men with advanced prostate cancer, has been implicated in cognitive decline. Evidence from Western cohorts remains inconsistent, with limited long-term and India-specific data. Methods:We conducted a prospective, observational case-control study between July 2021 and December 2024 with a minimum 36-month follow-up. Men initiating ADT (luteinizing hormone-releasing hormone analogues or bilateral orchidectomy) were compared with a control cohort (benign prostatic hyperplasia or postradical prostatectomy without ADT). Groups were matched for age, baseline Addenbrooke's cognitive examination III (ACE-III) score, G8 frailty score, and gait speed. Cognitive assessments were performed every 6 months using the culturally validated Hindi ACE-III tool. The primary outcome was the change in total ACEII score over 36 months; secondary outcomes included domain-wise changes and correlations with frailty and gait speed. Results:Sixty men were enrolled (30 per group); 21 men received ADT, and 23 served as controls, completing follow-up. Over 36 months, both groups showed modest declines in cognition, with a mean decline of -2.30 ± 1.13 for the ADT group and -1.87 ± 1.62 for the control group (P = 0.638). Domain-wise changes (attention, memory, fluency, language, and visuospatial) were small and statistically similar. Stratified analyses by frailty (G8 ≤ 14 vs. >14) and gait speed (≤0.6 m/s vs. >0.6 m/s) revealed parallel trajectories in both groups, with no effect of ADT. Conclusions:In this 36-month prospective study using a culturally validated tool, ADT was not associated with accelerated global or domain-specific cognitive decline compared to a matched cohort without ADT. These findings suggest that in appropriately selected patients, ADT can be administered without undue concern for disproportionate cognitive deterioration.
Ureteroinguinal hernia represents a rare anatomical anomaly with potential for significant clinical consequences. Most cases are incidentally diagnosed via imaging or during herniorrhaphy. This report documents a rare presentation of an obstructive ureteric calculus within the herniated segment of the native ureter in a 71-year-old man, outlining imaging signs, operative findings, and therapeutic strategy.
This video uses a picture-in-picture demonstration of the procedural hand movements and the endoscopic view to illustrate a reproducible technique for using prostatic urethral lift to treat an obstructive median lobe (OML) in patients with benign prostatic hyperplasia. The challenge with this procedure is in safely manipulating the median lobe without injuring it. This technique was utilized for three patients who presented with worsening urinary symptoms despite adequate medical therapy. Postoperative recovery, in this series of patients, was uneventful with significant improvements in the quality of life (6 to 1), International Prostate Symptoms Score (28 to 7), and Qmax (9.7 ml/s to 12.7 ml/s) metrics.
