PURPOSE:Retroperitoneal robot-assisted partial nephrectomy (RRPN) has achieved widespread acceptance worldwide. However, the complications and discomfort associated with tubes cannot be overlooked. Consequently, we have initiated Tubeless RRPN (TLRRPN). This approach eliminates the need for tracheal intubation, central venous catheterization, urinary catheters, or abdominal drainage. MATERIALS AND METHODS:From 2024-07 to 2025-06, a total of 78 patients underwent RRPN at our center. Following a 1:1 propensity scores matching process, we compared 14 patients who underwent TLRRPN with 14 matched patients receiving Traditional RRPN (TRRPN). Anesthetic management and surgical procedures were systematically detailed, and perioperative outcomes were comprehensively assessed. RESULTS:All 28 patients underwent successful R0 tumor resection, with no conversions or major complications reported in either group. Patients who received TLRRPN resumed oral intake and ambulation significantly earlier (1.03 hours vs. 22.20 hours and 1.03 hours vs. 30.55 hours, p <0.001), experienced a shorter postoperative hospital stay (26.00 hours vs. 91.43 hours, p < 0.001), and incurred lower overall costs. No anesthesia- or surgery-related complications were observed, and postoperative pain was significantly reduced in the TLRRPN group compared to the TRRPN group. CONCLUSIONS:TLRRPN is a safe, efficient, innovative, cost-effective, and selective surgical procedure. This operation fundamentally reduces the adverse effects associated with tubes in patients and significantly facilitates rapid recovery.
Purpose: Post-prostatectomy vesicourethral anastomotic stenosis (VUAS) affects up to 5% of patients. A subset of cases remains refractory to endoscopic treatment, significantly impacting quality of life in the long-term. This study presents 15-year follow-up data on patients undergoing open reanastomosis for refractory or obliterative VUAS. Patients and Methods: We included patients who underwent transperineal vesicourethral reanastomosis from 2009-2023. The procedure was often staged, with artificial urinary sphincter (AUS) implantation three months later. Co-primary endpoints included re-treatment-free survival (RFS) and patient-reported outcome measures (PROMs). RFS was analyzed with Kaplan-Meier estimators, and PROMs were evaluated per scoring manuals. Additionally, we conducted a scoping review of all studies reporting outcomes following complex VUAS reconstruction. Results: Among 46 patients with VUAS, prior endoscopic interventions included dilation (17%), incision (61%), and resection (80%). Median time from prostatectomy to reanastomosis was 23 months (IQR 16-42). At a median follow-up of 80 months (IQR 41-149), RFS rates were 91% at two years and 88% at five years. 30 patients (65%) required staged AUS implantation for stress urinary incontinence. PROMs, assessed in 28 patients (61%), indicated restored voiding function, absence of fecal incontinence, high treatment satisfaction, and low decision regret. Limitations include the absence of preoperative PROMs for baseline comparisons. The scoping review revealed varying success rates ranging from 60% to 92% and a significant underuse of validated PROMs. Conclusions: Transperineal reanastomosis offers an effective and lasting solution for treating recurrent or obliterative VUAS, with encouraging long-term results and favorable patient-reported outcomes, underscoring its critical role in salvage posterior urethral reconstruction after prostatectomy.
Purpose: The 2019 Briganti nomogram is widely used to guide the indication for pelvic lymph node dissection (LND) at the time of radical prostatectomy in patients with localized prostate cancer. Although previously validated, its generalizability across distinct clinical settings remains uncertain. Materials and methods: We conducted a multicentre external validation of the nomogram in 481 patients from three French academic institutions (Centre A n=198, Centre B n=183 and Centre C n=100). Discrimination, calibration, and clinical utility were assessed. Spared LNDs and missed lymph node invasions (LNIs) were evaluated across risk thresholds. Results: The overall area under the receiver operating characteristics curve (AUC) was 0.733 but varied across centres (0.580-0.768). Calibration was acceptable overall but showed systematic overestimation in low-prevalence centres. At the 7% recommended threshold, the proportion of spared LNDs ranged from 51% to 76%, while missed LNIs ranged from 0% to 8.9%. Decision curve analysis revealed that the optimal threshold differed between centres. Conclusions: These results underscore the need for local validation and population-specific threshold adjustment before clinical implementation. Fixed thresholds may lead to underor overtreatment depending on institutional case mix. Nomogram-based decision-making should be individualized based on local performance and patient-centred risk tolerance.
INTRODUCTION:Concomitant bladder neck incision (BNI) with posterior urethral valve ablation (VA) was proposed to mitigate the long-term sequela of posterior urethral valve (PUV) and reduce the reoperation rates. This study aimed to investigate the short-term outcomes of concomitant BNI and VA, particularly short-term reoperation rates. PATIENTS AND METHODS:Patients with PUV and bladder neck hypertrophy on preoperative imaging were randomized to undergo VA only or VA with concomitant BNI. Surgical reoperation within one year was the primary endpoint. Renal function, UTI, hydronephrosis and VUR improvement at one year were secondary endpoints. RESULTS:Sixty-three patients were included in the final analysis, 33 in VA group (group A) and 30 in concomitant BNI and VA group (group B). After one year of follow-up, the reoperation rate was similar [5(15.2%) in group A and 3(10%) in group B, p=0.18]. The median (IQR) nadir serum creatinine was lower in group B [0.2 (0.1-0.3) vs. 0.2 (0.2-0.4) mg/dL in group A, p=0.049]. The last follow-up serum creatinine median (IQR) eGFR [107 (89.5-163) in group A vs. 139(102-165) mL/min/1.73 m2 in groups B, p=0.37], and febrile UTI rates were not different between the two groups. Hydronephrosis improved/ resolved in 27 (40.9%) renal units in group A vs. 33 (55%) renal units in group B (p=0.286). Vesicoureteral reflux improved/ resolved in 23(34.8%) and 12 (20%) renal units in group A and B, respectively (p=0.074). CONCLUSION:Concomitant BNI with VA does not confer a lower short-term reoperation rate or better upper urinary tract outcomes compared to VA only.
Introduction: Robot-assisted radical prostatectomy (RARP) continues to evolve with surgical approaches aimed at preserving continence-related anatomy and optimizing postoperative recovery (1). Transvesical RARP has gained increasing interest, particularly with the advent of single-port platforms (2, 3). Building on our prior experience with clipless techniques and functional outcome optimization (4), we evaluated a multiport transvesical approach. Objective: To describe, step-by-step, a clipless transvesical RARP technique and to report its feasibility and early functional and oncologic outcomes. Materials and Methods: An intravesical, line-of-sight technique was employed, with abdominal trocars positioned similarly to conventional transperitoneal RARP. The surgical sequence included: posterior release; longitudinal cystotomy with suspension sutures; semicircumferential bladder neck incision; bilateral clipless lateral dissection (blunt and sharp); anterior and apical release with dorsal venous complex control; urethral transection; urethrovesical anastomosis using two 3-0 barbed sutures; and single-layer cystotomy closure. Three consecutive patients with localized prostate cancer and moderate prostate volumes were included. Results: All procedures were completed as planned. Perioperative morbidity was low; one Clavien-Dindo grade II complication was managed conservatively. Early continence was observed in all patients, including at the first postoperative evaluation (45 days). One patient (Case 3) presented with a focal apical positive surgical margin on final pathology; prostate-specific antigen levels were undetectable in all cases during early follow-up. The approach was technically feasible and familiar to surgeons experienced in anterior RARP. Larger prostate volume may limit intravesical working space and apical visualization. Conclusions: We describe a reproducible clipless transvesical RARP performed using a multiport platform, addressing a body of literature predominantly focused on single-port systems. The technique demonstrated encouraging early functional outcomes in carefully selected patients (5); however, larger prostate volumes and longer follow-up are required to further define its oncologic and functional durability. This video complements our previous publication on alternative RARP approaches supporting anterior-preserving strategies (6).
ABSTRACT Objective: To evaluate patterns and imaging-based predictors of positive surgical margins (PSMs) in patients with high-risk prostate cancer (PCa) undergoing nerve-sparing (NS) robot-assisted radical prostatectomy (RARP). Materials and Methods: We retrospectively analyzed 1,235 consecutive patients with high-risk PCa treated with RARP between 2022 and 2024 at a high-volume tertiary referral center. Among them, 533 patients underwent preoperative multiparametric MRI (mpMRI) reviewed by two expert uro-radiologists and MRI–ultrasound fusion biopsy. A per-side analysis was performed to identify predictors of ipsilateral PSMs in cases where neurovascular bundle (NVB) preservation was attempted. Biochemical recurrence (BCR) was assessed, and multivariable logistic regression was used to determine independent predictors of PSMs. Results: Overall, 36.1% of patients underwent non–nerve-sparing surgery, 49.5% unilateral NS, and 14.4% bilateral NS. Nerve sparing was performed on 418 surgical sides, with ipsilateral PSMs detected in 90 (21.5%). Sides with and without PSMs showed comparable nerve-sparing techniques (intra- vs interfascial) and similar 3-year BCR-free survival rates (68% vs. 69%) at a median follow-up of 36 months, although earlier biochemical failure at lower PSA thresholds was more frequent in PSM-positive sides. On multivariable analysis, larger prostate volume, apical tumor location, peripheral zone involvement, greater lesion diameter, and extracapsular extension on mpMRI were independently associated with an increased risk of ipsilateral PSMs. Conclusions: Nerve-sparing RARP may be feasible in carefully selected high-risk PCa patients. The integration of mpMRI-based predictors can enhance patient selection, optimizing the balance between oncologic safety and functional preservation. Prospective studies are warranted to validate these findings and minimize selection bias.
ABSTRACT Objective: To assess long-term changes in renal volume and function after laparoscopic partial nephrectomy using 3D modeling and to identify key predictors. Patients and Methods: This retrospective study included 187 patients who underwent laparoscopic partial nephrectomy between October 2012 and January 2023. Patients underwent the same cross-sectional imaging both pre- and postoperatively, with a minimum follow-up of one year. Pre- and postoperative volumes were reconstructed with 3D Slicer software. Results: The median age of the patients was 58 years. The median Radius-Exophytic-Nearness-Anterior-Location (RENAL) score was 7. The median tumor volume was 15.8 cm³. The median warm ischemia time was 14 minutes, and the median surgical time was 80 minutes. The mean tumor-free renal parenchymal volume before surgery was 168,87 ± 40,91 cm³, which decreased to a mean operated renal parenchymal volume of 137.6 ± 41.7 cm³ at 5 years postoperatively. The estimated glomerular filtration rate (eGFR) declined from a median value of 90.6 to 75.9 mL/min/1.73 m² over the same period. The predictors of renal function decline were parenchymal volume loss, age, female gender, diabetes mellitus, and tumor-to-parenchyma contact surface area. Factors affecting parenchymal volume loss included age, RENAL score, comorbidities, Surface-Intermediate-Base (SIB) score, and operative time. Conclusions: While the most influential factor on renal function in the early postoperative period was the preserved renal volume, diabetes mellitus (DM) emerged as the primary determinant of long-term functional outcomes. Tumor resection technique and operative time are modifiable factors influencing parenchymal volume preservation. Enucleation-based approaches may enhance parenchymal preservation without compromising oncological outcomes.
ABSTRACT Purpose: The combination of systematic biopsy (SB) and MRI-targeted biopsy (TB) is the current approach for prostate cancer (PCa) diagnosis; however, the clinical benefit of including SB remains controversial. This study aimed to determine whether SB adds value beyond TB in detecting clinically significant prostate cancer (csPCa) in men with suspicious lesions. Materials and Methods: Retrospective, single-center study conducted between January 2019 and September 2023. It enrolled men with suspicious lesions identified on multiparametric MRI (PI-RADS≥3) who had undergone combined biopsy (TB+SB). Sociodemographic and clinical data were secondarily collected. csPCa was defined when ISUP≥2. Results: This study included 997 men with a median age of 68 years, of whom 497 had a negative prior biopsy. The TB+SB approach identified 53.0% of PCa and 36.8% of csPCa cases. TB alone significantly outperformed SB in identifying csPCa, with detection rates of 34.8% vs. 10.3%, respectively, missing only 4.8% of PCa diagnosis—most of which were low-grade tumors. SB contributed marginally, identifying additional csPCa cases in 1.4% of patients. In patients with a prior negative biopsy, the addition of SB to TB only accounted for 12.5% of PCa diagnosis. Limitations include the study single-center design, restricting generalizability, and the lack of whole-mount prostatectomy for histological confirmation. Conclusions: In conclusion, SB adds limited diagnostic value, with TB alone being sufficient for detecting csPCa cases in patients with MRI-visible lesions. The results suggest that SB may be safely omitted in selected patients to reduce biopsy burden and lead to better clinical outcomes.
ABSTRACT Purpose: Ejaculatory alterations are among the most frequent sexual side effects of α1-adrenergic antagonists. Although often attributed to retrograde ejaculation, recent evidence indicates that tamsulosin primarily disrupts seminal emission, occasionally leading to transient azoospermia. This study evaluated the frequency, timing, and reversibility of ejaculatory and seminal changes following a single oral dose of 0.8 mg tamsulosin in healthy men. Materials and Methods: Thirty-one healthy male volunteers (aged 18–45 years) underwent a baseline semen analysis, followed by six additional collections at 1–3 week intervals. Each collection was performed at a different post-dose time point, spaced every 4 hours, to construct a 24-hour post-administration profile. Semen parameters were assessed according to WHO criteria, and post-ejaculatory urine was examined to detect retrograde ejaculation. Temporal variations were analyzed using repeated-measures ANOVA, with effect sizes estimated by Cohen's d. Results: Seminal volume decreased significantly in 93.6% of participants, with aspermia in 80.7%, peaking 12 h after ingestion (p<0.001, d=2.05). Sperm concentration declined markedly, with azoospermia in 80.7% (p<0.001, d=1.59) and normalized after wash-out in 2 days. No retrograde ejaculation was observed. Adverse effects were mild and self-limited. A single 0.8 mg dose of tamsulosin caused a consistent, time-dependent disruption of seminal emission, producing transient azoospermia rather than retrograde ejaculation. Conclusions: A single 0.8 mg dose of tamsulosin transiently suppressed seminal emission, leading to reversible azoospermia within 12 hours most recovered by 24h, and all recovered within 48h. Its predictable, reversible effect supports caution in men seeking conception and further exploration as an on-demand male contraceptive model.
ABSTRACT Infertility affects millions worldwide and is increasingly recognized as a major public-health concern. Despite advances in reproductive medicine, the lack of a unified global framework has contributed to substantial heterogeneity in clinical practice, particularly in the evaluation and management of male infertility. In 2025, the World Health Organization (WHO) issued its first comprehensive Guideline for the Prevention, Diagnosis, and Treatment of Infertility, establishing a global, evidence-based standard applicable across diverse resource settings. Notably, the guideline integrates male reproductive health throughout prevention, diagnosis, and treatment pathways, reinforcing the essential role of paternal factors in reproductive outcomes. This review summarizes the development, scope, and methodological foundations of the WHO guideline, including its use of systematic evidence synthesis, the GRADE framework, and structured consensus processes. Particular emphasis is placed on male-focused recommendations and good practice statements on lifestyle risk modification, sexually transmitted infections, standardized semen analysis, diagnostic algorithms, unexplained infertility, antioxidant supplementation, and varicocele repair. The review also clarifies the guideline's public-health scope and delineates areas that remain within the domain of specialty practice. Finally, we discuss dissemination, implementation challenges, and research priorities, highlighting persistent evidence gaps in male reproductive biology, sperm function, and clinically meaningful treatment outcomes. By aligning public-health principles with contemporary understanding of male physiology, the WHO guideline provides a global foundation for equitable and systematic infertility care.
PURPOSE:To assess factors associated with patients' self-assessed pain scores during prostate biopsy (PBx) performed exclusively under local anesthesia (LA). MATERIALS AND METHODS:Consecutive patients who underwent MRI followed by a transperineal (TP) or transrectal (TR) PBx under LA were prospectively assessed. Race and ethnicity were self-reported according to NIH standards. Socioeconomic status was assessed using the Distressed Community Index (DCI). Pain was evaluated with a visual analog scale (0-10) after the procedure. Univariable and multivariable linear regression analyses were performed to correlate clinical parameters related to pain. RESULTS:A total of 419 patients underwent TP (77%) or TR (23%) PBx. Overall, 14% of patients were Asian, 5% Black, 17% Latino, 12% Others, and 53% White. Of the cohort, 20% of Black and 27% of Latino patients were most distressed (DCI 80-100) compared with 4% of Asian, 9% of Other, and 5% of White patients (p<0.001). The median (IQR) self-assessed pain levels were higher for Black 5 (2-5) and Latino 4 (3-5) compared to Asian 3 (2-4), Other 3 (2-5), and White 3 (2-4) patients (p=0.01). On multivariable analysis, younger patients, Black or Latino patients, and the number of lesions on MRI were independent predictors for pain levels. CONCLUSIONS:PBx under LA alone are generally well tolerated; however, there is a subset of patients who experience more pain, including Black and Latino, younger patients, and those with more MRI suspicious lesions. Discussion of these pain risk factors is important for patients when choosing to have a biopsy performed under LA versus sedation.
Male hypogonadism is a prevalent and clinically relevant condition with substantial effects on reproductive, metabolic, skeletal, and psychosocial health. Rising obesity rates, metabolic syndrome, and anabolic-androgenic steroid use have increased the frequency of functional hypogonadism in Brazil. Despite advances in diagnosis and treatment, clinical practice remains heterogeneous and access to standardized recommendations is limited. This joint position statement from the Department of Female Endocrinology, Andrology and Transgenderism (DEFAT) of the Brazilian Society of Endocrinology and Metabolism (SBEM), the Brazilian Society of Urology (SBU), and the Brazilian Association for Sexual Medicine and Health (ABEMSS) provides practical, evidence-based guidance for the evaluation and management of male hypogonadism in Brazil. The document outlines diagnostic criteria, including morning total testosterone confirmation and assessment of gonadotropins, and emphasizes recognition of functional etiologies such as obesity-related hypogonadism. Therapeutic recommendations include testosterone replacement therapy for confirmed organic hypogonadism, preferential use of long-acting intramuscular or transdermal formulations, and fertility-preserving strategies (SERMs, hCG, aromatase inhibitors) when indicated. The statement also addresses monitoring protocols, safety considerations, and the management of adverse effects. This is the first multidisciplinary Brazilian guideline harmonizing endocrine, urological, and sexual medicine perspectives to support national clinical practice. This consensus aims to promote consistent clinical decision-making, reduce underdiagnosis and overtreatment, and ensure safe, individualized care aligned with international principles and adapted to the national context.
ABSTRACT Purpose: Multifocal ureteral strictures pose significant challenges for reconstructive surgery due to their segmental distribution and the need to preserve the ureteral blood supply (1, 2). Robotic-assisted surgery, owing to its precision and minimally invasive advantages, has increasingly become a preferred approach (3). Although the da Vinci surgical system has long dominated this field, several novel robotic platforms have recently emerged with comparable safety and efficacy (4, 5). This study reports our experience with robotic-assisted laparoscopic buccal mucosal graft ureteroplasty combined with ureteral reimplantation for complex ureteral stricture repair using the modular Carina™ robotic surgical system. Materials and Methods: A 32-year-old man presented with a one-month history of flank pain and was found to have both proximal and distal ureteral strictures. Using the modular Carina™ robotic system, the procedure was performed as follows: dissection of the proximal stricture, longitudinal ureterotomy, posterior augmented anastomosis, harvesting of buccal mucosa for ventral onlay grafting; followed by dissection of the distal ureteral stricture and bladder wall and completion of a side-to-side ureterovesical anastomosis. Results: The procedure was completed successfully without conversion, with a total operative time of 272 minutes. The patient was discharged on postoperative day 7. Histopathological examination revealed granulomatous inflammation, and anti-tuberculosis therapy was initiated. The double-J stent and nephrostomy tube were removed 2 months postoperatively. During an 8-month follow-up, the patient's symptoms resolved, imaging demonstrated improvement of hydronephrosis, renal function remained stable, and no postoperative complications were observed. Conclusions: Robotic-assisted reconstructive surgery for complex ureteral strictures using the modular Carina™ robotic system is technically feasible. However, larger studies with longer follow-up are required to validate these preliminary findings.
PURPOSE:To analyze the renal length in patients submitted to computed tomography (CT scans) and compare it according to age, gender, laterality and body parameters like height, weight and Body Mass Index (BMI). Methods and Methods: We analyzed 74 patients (148 kidneys) submitted to CT scans and evaluated renal length in centimeters, gender, height, weight and BMI. The abdominal CT scans acquisition and image analysis was done using 16 and 64 slice multidetector computed tomography (MDCT) scanners to perform multiplanar reconstructions (MPR) and measure the kidney length (KL) in coronal plane. The statistical analysis was performed with the GraphPad Prism software (Version 9.2.0). RESULTS:The 74 patients analyzed (28 Males/37.83% and 46 females/62.17%) presented mean age of 54.1 years-old, right kidney length between 8.4 to 13.1cm (mean=10.79) and left kidney length between 8.3 to 13.1cm (mean=10.97). The kidney length on both sides was significantly greater in male sex (p<0.001). The length of the left kidney was significantly greater than that of the right kidney (p=0.017). The linear regression analysis showed non-significant correlation between both right kidney length and positive correlations between kidney length and BMI, weight and height. CONCLUSIONS:CT scan accurately assessed renal length. We observed that renal length was greater in males and in the left side. Weight, age, height and body mass index showed a positive correlation with kidney length.
ABSTRACT Introduction: Focal therapy with high-intensity focused ultrasound (HIFU) has emerged as a treatment option for selected patients with localized prostate cancer; however, disease recurrence requiring salvage intervention remains a recognized challenge (1–5). Salvage radical prostatectomy is technically demanding due to post-ablative tissue changes, which may compromise oncologic and functional outcomes (6,7). Herein, we describe the surgical technique and clinical outcomes of salvage robotic-assisted radical prostatectomy (RARP) performed using a single-port (SP) transvesical approach following HIFU. Materials and Methods: The index case was a 57-year-old man with a history of right hemigland HIFU for ISUP Grade Group 2 prostate cancer. During routine surveillance four years after HIFU, his PSA rose to 3.64 ng/mL, prompting repeat biopsy. Biopsy confirmed clinically significant recurrent prostate cancer both within and outside the prior treatment field, with bilateral involvement. Preoperatively, the patient reported satisfactory erectile function, with a Sexual Health Inventory for Men (SHIM) score of 25/25. After informed consent, salvage transvesical SP-RARP was performed. Dissection was carried out with anticipation of post-ablation tissue changes, and bilateral nerve-sparing was incorporated to optimize functional outcomes. Results: The procedure was completed in 82 minutes without placement of additional ports and without intraoperative complications. Estimated blood loss was 75 mL. The patient was discharged home the same day (4.3 hours postoperatively). Foley catheter removal on postoperative day 6 was followed by immediate urinary continence. Erectile function remained satisfactory at 3 months, indicating preservation of baseline functional outcomes. Final pathology demonstrated pT3b ISUP Grade Group 2 prostate cancer with evidence of prior ablation and negative surgical margins. At the most recent follow-up (12 months), PSA remained undetectable, with no biochemical recurrence. Conclusion: Transvesical SP-RARP appears to be a safe and effective salvage option following focal ablative therapy for prostate cancer. Leveraging the advantages of single-port robotic technology (8,9), this approach may facilitate outpatient surgery while maintaining favorable functional and oncologic outcomes.
PURPOSE:To evaluate oncological and functional outcomes of minimally invasive partial and radical nephrectomy (MIS-PN vs. MIS-RN) in patients with pT3aN0M0 renal cell carcinoma (RCC). MATERIALS AND METHODS:We performed a multicenter retrospective study of patients with pT3aN0M0 RCC treated with MIS-PN or MIS-RN. The primary outcome was recurrence-free survival (RFS). Secondary outcomes included de novo eGFR <60 mL/min/ 1.73 m2 (CKD-S) and <45 mL/min/ 1.73 m2 (CKD-S3b) at the new baseline (1-12 month postoperatively), as well as CKD-S at the latest follow-up (>1 year postoperatively). A 1:2 ratio propensity score matching (PSM) was applied to balance covariates, and inverse probability weighting (IPW) served as sensitivity analysis. Survival curves were estimated using the Kaplan-Meier method, and multivariable analyses (MVA) were performed to identify predictors of oncological and functional outcomes. RESULTS:A total of 303 patients were enrolled (113 MIS-PN/190 MIS-RN) with a median follow-up of 39.0 months (IQR 26.8-52.9). After PSM (66 MIS-PN/54 MIS-RN), no significant difference in RFS was observed between two groups (p=0.23). MVA revealed that surgical approach was not an independent predictor of RFS (HR: 1.00, p=1.00). Among patients with available new baseline eGFR after PSM (41 MIS-PN/37 MIS-RN), MIS-RN was independently associated with a higher risk of CKD-S (OR: 7.96, p=0.03). Among patients with available the latest follow-up eGFR after PSM (41 MIS-PN/37 MIS-RN), MIS-RN remained an independent predictor of CKD-S at the latest follow-up (OR: 7.98, p=0.03). IPW analysis yielded consistent results. Additionally, IPW identified MIS-RN as an independent risk factor for CKD-S3b at the new baseline (OR: 18.29, p<0.01). CONCLUSION:MIS-PN provided comparable mild term oncologic outcomes to MIS-RN while offering superior renal function preservation. MIS-PN may be a viable option for selected T3a RCC patients when nephron preservation is indicated.
