IVC segmental resection (SR) during robot-assisted radical nephrectomy and IVC thrombectomy (RARN-IVCT) is selected for wall invasion, occlusion, and collateral outflow, making direct comparison with non-segmental resection (NSR) biased. We compared the perioperative and renal safety of SR versus NSR in the overlap population. Retrospective single-center cohort at Peking University Third Hospital (2014–2025): 120 patients with RCC and Mayo level II–IV IVC thrombus undergoing RARN-IVCT, including 45 SR and 75 NSR. Overlap weighting balanced baseline variables. Primary outcomes were AKI, ΔSCr, and ΔeGFR; secondary outcomes were complications and hospital stay, with OS assessed exploratorily. After weighting, no statistically significant differences were observed in AKI, ΔSCr, ΔeGFR, complications, hospital stay, or OS. SR had lower RBC transfusion volume (mean difference − 249.63 mL, 95
Endoscopic treatment of urinary tract stones in children can be technically demanding. Preoperative ureteral stenting (prestenting) has been proposed to facilitate access and improve outcomes, yet its impact across different paediatric age groups remains unclear. This study evaluated the association between prestenting and first-session stone-free rate (SFR) in children undergoing ureterorenoscopy (URS) or retrograde intrarenal surgery (RIRS), and identified factors independently associated with prestenting. We retrospectively reviewed 126 children treated with URS or RIRS for urolithiasis between 2017 and 2025, grouped as < 2 years, 2–5 years, and 5–18 years. First-session SFRs were compared between prestented and non-prestented patients. Multivariate logistic regression was used to identify independent predictors of prestenting. Prestenting rates were highest in children < 2 years (72.0
To redefine upper urinary tract anatomy from an endoluminal, retrograde perspective and to identify key surgical landmarks and anatomical factors directly relevant to modern ureteroscopic practice, providing practical guidance in the context of evolving endourological technologies. A narrative review was conducted using PubMed/MEDLINE to identify relevant literature published from database inception to 2026. Search terms included endoscopic anatomy, ureteroscopy, urinary tract anatomy, renal collecting system, calyceal anatomy, ureteral anatomy, intrarenal pressure, ureterovesical junction, ureteropelvic junction, flexible ureteroscopy, and endourology. Original articles, reviews, classical anatomical references, and selected textbook sources were included based on relevance. Findings were qualitatively synthesized according to a predefined retrograde anatomical framework, from the urethral meatus to the renal papilla. A clinically oriented endoluminal map of the urinary tract was developed, describing the sequential anatomical landmarks encountered during ureteroscopy, including the urethra, bladder neck, trigone, ureteral orifice, ureter, ureteropelvic junction, renal pelvis, calyces, papilla, and fornix. Key anatomical factors (such as zones of resistance, ureteral narrowing, pelvicalyceal variability, perpendicular calyces, lower pole anatomy, infundibulopelvic angle, and anterior–posterior calyceal orientation) were shown to directly influence endoscopic access, scope deflection, working-channel alignment, lithotripsy efficiency, and complication risk. Practical intraoperative concepts, including bubble-guided orientation, stone relocation strategies, and the impact of miniaturized ureteroscopes and suction-enabled access sheaths, were also highlighted. This work provides a clinically relevant framework of endoluminal urinary tract anatomy tailored to contemporary ureteroscopy. Integrating functional anatomy with instrument behavior and pressure-related dynamics may improve navigation, enhance procedural efficiency, reduce complications, and support surgical training in modern endourology.
Numerous studies have compared reusable flexible ureteroscopes (RUFU) and single-use flexible ureteroscopes (SUFU). However, patients’ opinions (PO) have not yet been assessed. This study aimed to evaluate PO regarding RUFU versus SUFU. A multicenter anonymous survey was conducted among patients consulting for urolithiasis in eight French centers between September 2024 and April 2025. Participants completed a nine-item questionnaire validated by an expert panel, assessing demographic and medical characteristics, ureteroscope preferences, environmental considerations (EC), scenario-based choices, and willingness to pay. 186 patients were analyzed. Median age was 55years and 60.2
To evaluate long-term catheter-free spontaneous voiding after surgery for benign prostatic enlargement (BPE) among patients presenting with an indwelling urethral catheter (IUC), using age-matched patients undergoing surgery for lower urinary tract symptoms (LUTS) without a catheter as a clinical reference group. We retrospectively analyzed 481 patients treated for BPE at our center between January 2017 and March 2019 using open or endoscopic surgical techniques. Of 143 patients referred with an IUC, 143 age-matched patients operated on for LUTS alone were selected as a clinical reference group (total n = 286). Telephone follow-up was performed in late 2021 after a median of 2.5 years (IQR 637–1140 days). Patients with IUC had larger prostates, higher preoperative post-void residual volumes, and more positive urine cultures than patients with LUTS alone. Early postoperative retention was numerically more frequent in the IUC group, while long-term catheter dependence was 4
Childhood kidney cancer is one of the most common pediatric malignancies without comprehensive assessments of its global burden. We aimed to quantify the global burden from 1990 to 2021 and project trends to 2050. Data on incidence, mortality, and disability-adjusted life years (DALYs) for childhood kidney cancer were obtained from the Global Burden of Disease (GBD) 2021. Temporal trends were analyzed using Joinpoint regression. Spearman’s rank correlation was used to evaluate the association between disease burden and the sociodemographic index (SDI). Future burden trends were predicted with a Bayesian age–period–cohort (BAPC) model. In 2021, there were 9576 global incident cases of childhood kidney cancer, resulting in 3,063 deaths and 268,049 DALYs. From 1990 to 2021, global burden of childhood kidney cancer declined overall. However, substantial disparities persisted across regions and SDI levels. Low-SDI regions experienced disproportionately poorer prognosis, while children under five years and boys bore the greatest burden. Projections indicate continued declines in global burden through 2050. Despite overall declines in the global burden of childhood kidney cancer, substantial disparities persist across sociodemographic contexts. These findings emphasize the importance of improving early diagnosis, access to standardized treatment, and delivery of pediatric oncology care in high-burden settings.
Renal calculus is a common urological disease with increasing prevalence worldwide. Thrombomodulin (TM) is a marker of endothelial injury and has been associated with various inflammatory conditions. This study aimed to investigate the correlation between plasma thrombomodulin levels and renal calculus. A total of 805 participants were enrolled in this cross-sectional study, including 577 healthy controls and 228 renal calculus patients. General demographic data and laboratory indicators were collected from the participants. TM levels were measured by chemiluminescence immunoassay. Univariate and multivariate logistic regression models were used to analyze the correlation between TM and renal calculus, and subgroup analyses were performed. Renal calculus patients showed significantly higher TM levels compared to healthy controls (8.12 vs. 7.6 ng/mL, P = 0.0001). Multivariate analysis revealed TM remained independently associated with renal calculus after adjusting for non-inflammatory covariates (OR = 1.121, P = 0.0031), with the association persisting after additional adjustment for inflammatory markers (OR = 1.176, P = 0.0015). A dose-response trend across TM quartiles was observed, which was partially mediated by inflammatory markers.Patients with UTI and renal calculus complicated by infection showed significantly higher levels of TM, CRP, WBC, and NEU compared to those with simple renal calculus and healthy controls (P < 0.0001). Elevated plasma TM levels are significantly associated with increased prevalence of renal calculus.This association may be mediated by endothelial dysfunction and inflammatory responses, suggesting that vascular endothelial dysfunction plays a crucial role in the pathogenesis of renal calculus.
To quantitatively assess morphological alterations in benign prostatic hyperplasia (BPH) using MRI-based three-dimensional presumed circular area ratio (3D-PCAR), and to explore its correlation with International Prostate Symptom Score (IPSS). A total of 335 patients with pathologically confirmed BPH who underwent preoperative prostate MRI and completed IPSS questionnaire were retrospectively analyzed. MRI-derived volume parameters included total prostate volume (TPV), transition zone volume (TZV), and transition zone index (TZI, TZI = TZV / TPV); morphological parameters included intravesical prostatic protrusion (IPP), PCAR (axial, coronal, and sagittal), and peripheral zone thickness (PZ-thickness). Correlations between MRI-derived parameters and total IPSS, IPSS storage sub-score (IPSS-ss) and IPSS voiding sub-score (IPSS-vs) were analyzed using Pearson correlation, one-way analysis of variance (ANOVA) and multivariable regression. All MRI parameters showed significant correlations with IPSS scores (all p < 0.05). Positive correlations with IPSS were observed for IPP, TPV, TZV, TZI, and PCAR (r = 0.18–0.59), whereas PZ-thickness showed negative correlations (r = − 0.18 to − 0.24). Among the evaluated MRI-derived parameters, PCAR measurements in all three planes demonstrated moderate-to-strong correlations with IPSS (axial r = 0.485, 0.474, 0.405; coronal r = 0.592, 0.553, 0.524; sagittal r = 0.545, 0.508, 0.484, all p < 0.001) and remained significant predictors of IPSS in multivariable analyses (p < 0.05). 3D-PCAR reflects prostate sphericity and correlates with symptom severity in BPH, demonstrating potential as a novel non-invasive imaging biomarker for evaluating intraprostatic pressure and urinary symptoms.
To address the limited exploration of surgical ergonomics and instrument fit in urology, we evaluated the relationship between surgeons’ hand size, glove fit, gender, and their perceived ease of using various urologic instruments. An anonymous web-based survey was designed and distributed to members of the Endourology Society, Society of Women in Urology, and urology residency programs in the United States. It included demographics, perceived hand size/strength, ease of instrument use, and discomfort. Among 277 respondents (55
We aim to evaluate outcomes of a combined retrograde-percutaneous endourological approach for encrusted ureteral stents and identify predictors of 30-day postoperative complications. We retrospectively analyzed 82 adult patients (48.8
To evaluate the effectiveness of MediNik hydrogel for retrieval of stone fragments of varying sizes and to assess how application technique influences its performance. An in vitro experimental study was conducted using blood sample containers, natural stone fragments ranging from 0.2 to 2 mm, a 7.5 Fr single-use flexible ureteroscope, and a 2.2 Fr endoscopic basket. The MediNik system consists of a blue alginate component (K1) and a yellow calcium-based activator (K2) that interact to form a hydrogel. The evaluated parameters included K1:K2 ratios (2:1, 1:1, 1:2, and 1:3), stone fragment size (0.2–0.45 mm, 0.45–0.6 mm, 0.6–1.0 mm, 1–2 mm, and mixed fragments), application method (surface application versus delivery of K1 into the fragment mixture), and waiting time (3, 5, and 10 s). Hydrogel performance was strongly influenced by the application technique. Effective integration of the two components occurred when K1 was delivered directly into the stone fragments and K2 was subsequently applied, particularly at K1:K2 ratios of 1:1, 1:2, and 1:3. Successful retrieval was achieved across all fragment sizes, including mixed fragments. Surface application of the components alone did not consistently produce a stable hydrogel clot. Stable MediNik hydrogel clot formation was achieved at K1:K2 ratios of 1:1, 1:2, and 1:3 when K1 was applied first and followed by K2, with effective clot formation observed at waiting times of 3, 5, and 10 s. Stone fragment size did not affect clot formation. The most reliable clot suitable for basket extraction was obtained using intrafragment application of the alginate component followed by calcium binder delivery.
The safety of robot-assisted kidney transplantation (RAKT) in patients with end-stage renal disease (ESRD) who underwent an open kidney transplantation (OKT) in the past is unknown. We tested the hypothesis that intraoperative and postoperative complication rates are similar between RAKT and OKT in this patient population. This was a multicenter retrospective cohort study including 78 patients with ESRD who received RAKT or OKT from living donor between 2015 and 2023 in 7 European academic centers. All patients had received an OKT in the past. The primary outcome was to assess perioperative safety in terms of intra- and postoperative complications, described using the Clavien-Dindo classification. Secondary outcomes included dialysis-free survival (DFS), surgical reintervention-free survival (RFS) and renal function at discharge. Kaplan Meier estimates and log-rank test were used to compare DFS and RFS according to the surgical approach. Among 78 patients who previously underwent OKT, 29 (37
Ureteral stents are routinely placed following intracorporeal lithotripsy but are frequently associated with significant morbidity. We aimed to evaluate the tolerability of 4.7Fr versus 6Fr stents in a single center, patient- and assessor-blinded randomized controlled trial. Of 132 eligible patients, 124 undergoing elective ureterorenoscopy for urolithiasis were randomized 1:1 to receive a 6Fr (n = 63) or 4.7Fr (n = 61) PTFE double-J stent, left in situ for 3 weeks. Accounting for loss to follow-up, 119 participants (4.7Fr, n = 57; 6Fr, n = 62) were analyzed. The primary endpoint was postoperative ureteral stent tolerability, assessed using the International Prostate Symptom Score (IPSS) and Ureteral Stent Symptom Questionnaire (USSQ), while complications were graded using the Modified Clavien-Dindo Classification. Both groups had comparable baseline demographics and similar stone-free rates. At 3 weeks, overall mean IPSS scores were comparable (MD = − 0.7, 95
To evaluate the real-time safety profile and intrarenal pressure (IRP) dynamics of two suction-assisted ureteroscopic systems, the Direct In-Scope Suction (DISS) and Flexible and Navigable Suction (FANS) ureteral access sheath, in an ex-vivo model. Four porcine kidney-ureter units were used, harvested from two female pigs (32–34 kg). A 20G intravenous catheter was inserted into the middle calyx for continuous IRP monitoring via a pressure transducer and monitor. Each kidney underwent four experimental configurations combining 7.5 Fr PU3033AH or 9.2 Fr PU400A DISS scopes with 9.5/11.5 Fr or 12/14 Fr FANS sheaths. Irrigation was performed using a manual hand pump, and suction was applied at 100 mmHg either through the ureteroscope or sheath. Measurements included baseline and maximal IRPs, suction-induced changes, mucosal injury, and time to endoscopic stone-free status (ESFS). Sixteen experiments were completed. Activation of suction consistently reduced IRP across all settings. The The 7.5 Fr DISS + 9.5/11.5 Fr FANS configuration achieved the lowest pressures (4–12 mmHg) but caused pelvicalyceal collapse and six mucosal injuries. In contrast, the 9.2 Fr DISS + 12/14 Fr FANS combination-maintained IRP between 12 and 28 mmHg with efficient fragment evacuation and minimal collapse. Both DISS and FANS effectively maintained IRP within a safe range. Controlled, balanced suction was crucial for safety, while excessive negative pressure or prolonged manual irrigation risked collapse and mucosal injury. The 9.2 Fr DISS + 12/14 Fr FANS configuration demonstrated stable pressure control and efficient performance in this experimental model.
We aimed to evaluate the effectiveness of pelvic floor muscle training (PFMT), with or without adjunctive biofeedback or electrical stimulation, in improving erectile function (EF) in men who have undergone radical prostatectomy (RP) for prostate cancer, by examining randomized controlled trials (RCTs). PubMed, Scopus and Web of Science databases were systematically searched. Eligible studies were RCTs examining PFMT for post-RP erectile dysfunction (ED) according to predefined inclusion and exclusion criteria. The protocol was registered in PROSPERO (CRD420251162740). Twelve RCTs were included in the final analysis. PFMT-related effects on EF were inconsistent: four RCTs reported statistically significant EF benefits, one multimodal survivorship trial showed a favorable surgery-subgroup sexual-domain signal, and seven found no significant between-group EF difference. Across trials with extractable mean IIEF/IIEF-5 endpoint data, between-group differences ranged from − 0.97 to + 2.18 points, with a maximum change-score advantage of + 4.3 points. Selected favorable findings included higher 12-month potency rate after biofeedback-assisted PFMT (47.1
Endoscopic management, ureteroscopy (URS), retrograde intrarenal surgery (RIRS), and ureteric stenting, is central to the treatment of symptomatic urolithiasis. Serious complications, particularly those associated with infected obstruction, remain a clinical concern. Accurate estimation of procedure-related mortality is limited by heterogeneous reporting, selected cohorts, and incomplete capture of emergency presentations. Population-level data spanning extended time periods are therefore required to characterise mortality risk in routine practice. We performed a 10-year retrospective cohort study including all endoscopic interventions for symptomatic ureteric or renal calculi at a tertiary centre (1 January 2015–30 June 2025). Procedures were categorised as URS/RIRS or ureteric stent insertion alone. Demographic and operative variables were extracted from a complete theatre registry. All in-hospital deaths were identified through clinical records and reviewed as a structured case series. Analyses were descriptive and based on complete procedural activity across the 10-year period. A total of 3,656 procedures were performed: 3,244 (88.8
To evaluate the impact of pre-stenting duration on flexible and navigable ureteral access sheaths (FANS-UAS) placement, as well as perioperative and postoperative outcomes, in patients undergoing retrograde intrarenal surgery (RIRS). A total of 221 patients were prospectively randomized into three groups: no pre-stenting (Group 1, n = 70), pre-stenting for 2–4 weeks (Group 2, n = 74), and pre-stenting for 4–6 weeks (Group 3, n = 77). Analyses were performed according to the intention-to-treat principle. The primary outcome was successful FANS-UAS placement. Secondary outcomes included successful RIRS, stone-free rate (SFR), stone-related secondary procedures, perioperative parameters, and postoperative complications. Post hoc pairwise comparisons and multivariable logistic regression analyses were performed to identify factors associated with FANS-UAS placement success. FANS-UAS placement success differed significantly among the groups, increasing from 80.0
