Background: Robot-assisted radical cystectomy (RARC) is a growingly preferred minimally invasive technique for bladder extraction and urinary reconstruction. Postoperative urinary tract infections (UTIs) remain one of the most common complications. Objective: This narrative review examines the role of prophylactic antibiotics in reducing UTIs following RARC, with attention to risk factors, antimicrobial resistance patterns, and emerging non-antibiotic preventive strategies. Methodology: A literature search was conducted in PubMed, Scopus, Web of Science, and Google Scholar for English-language articles published between January 2014 and October 2025. Search terms included “urinary tract infection,” “radical cystectomy,” “antibiotic prophylaxis,” “drug resistance,” and “non-antibiotic strategies.” Clinical trials, meta analysis, and randomized controlled trials were prioritized. Key themes included UTI prevalence, bacterial resistance trends, prophylactic approaches, and the potential applicability of adjunctive non-antibiotic measures. Results: UTI incidence after RARC ranges from 14% to 39%, typically within 30 days but occasionally up to 90 days. Risk is influenced by patient factors such as age, female sex, and obesity, as well as surgical variables. Prophylactic antibiotics are associated with reduced UTI rates, though optimal duration remains uncertain. Evidence suggests short-course regimens are often effective, while extended prophylaxis may benefit selected high-risk patients. However, rising resistance, particularly to fluoroquinolones and cephalosporins, complicates empirical treatment. Conclusion: Prophylactic antibiotics after RARC reduce postoperative UTIs and related complications. However, conflicting RCT evidence and lack of consensus on duration require balancing benefits against risks of antimicrobial resistance and Clostridioides difficile infection. A comprehensive strategy—including culture-guided therapy, protocol adherence, and non-antibiotic preventive measures—may optimize outcomes.
Introduction and objectives: We conducted a prospective audit to evaluate the feasibility of suprapubic catheter self-removal and what factors can interfere with the decision of self-removal, in post RS-RARP patients. Material and methods: Forty-four patients had a SPC inserted following a RS-RARP from January 2024 until May 2024, 36 of them opted for self-removal. Feedback was obtained 4 weeks post operatively regarding catheter related symptoms and the complexity of self-removal procedure. Results: Most patients reported minimal overall pain (median = 2), with penile pain most frequently rated as none (mode = 1). Bladder cramps and overall problem perception were also low (median = 1); 65.9% of patients reported no bladder cramps, and 61.4% had no issues with SPC management. Factors such as overall pain ( p = 0.234), penile pain ( p = 0.286), and overall problem perception ( p = 0.643) did not significantly influence the decision of SPC self-removal. However, bladder cramp frequency had impacted the self-removal decision ( p = 0.029). The majority (80.6%) found self-removal easy, with only 11.1% considering it complicated. Most patients also recommended self-removal, reinforcing its overall feasibility. The perceived complexity of self-removal was associated with likelihood to recommend the procedure ( p < 0.001). Additionally, penile pain correlated with bladder cramps ( p = 0.006) and overall problem perception ( p = 0.003), suggesting discomfort in one area may reflect a broader negative experience affecting patients’ decision making regarding self-removal, as patients with higher bladder cramps were less likely to recommend self-removal ( p = 0.008). Conclusion: SPC self-removal after RS-RARP appeared feasible and acceptable in a selected group of patients supported by structured education and specialist nurse follow-up. These findings should be interpreted cautiously given the small single-center sample, absence of randomization, and use of a non-validated questionnaire. Further comparative studies are required before wider implementation can be recommended.
PURPOSE:Transgender individuals experience significant disparities in healthcare access and quality, often owing to limited provider training and awareness. This study aimed to assess the knowledge, attitudes, and clinical exposure of Mexican urologists and urology residents in relation to transgender patient care and to identify potential gaps that may affect treatment quality and access. METHODS:An anonymous survey was distributed to board-certified urologists and urology residents between April and May 2025. The questionnaire included a 5-point Likert scale to evaluate participants' knowledge, confidence, and comfort when treating transgender patients. The questions also assessed clinical experience, familiarity with gender identity and appropriate pronouns, ability to provide endocrine and surgical care, and awareness of healthcare disparities. A total of 322 responses were analyzed using descriptive statistics and t-tests to identify significant trends. RESULTS:Among the respondents, 53.7% had never attended to a transgender patient, and 71.1% were not currently caring for any. Only 15.5% reported a strong knowledge base in transgender health and only 7.4% felt confident in performing gender-affirming surgery. While 62.1% felt comfortable discussing gender identity, only 58.3% could clearly distinguish it from their sexual orientation. Urology residents reported greater comfort and awareness than certified urologists did. Less than half (48.4%) strongly supported transgender care in residency programs. CONCLUSION:There is a marked gap in transgender-related knowledge and clinical exposure between Mexican urologists and residents. These findings underscore the urgent need to integrate structured transgender health education into urological training and continuing medical education to promote equitable, competent, and inclusive care.
INTRODUCTION:Urinary bladder stones cause significant morbidity and are increasingly treated by transurethral holmium laser cystolithotripsy (TULC), a minimally invasive procedure. While spinal anesthesia is commonly used, local anesthesia is gaining interest, especially for high-risk or elderly patients. This study compares the safety, efficacy, and outcomes of TULC under local versus spinal anesthesia. METHODS:A retrospective observational study at AIIMS, Jodhpur, India (March 2023-March 2025) included 81 bladder stone patients undergoing TULC. 43 received local anesthesia and 38 spinal anesthesia. Data on demographics, stone size and number, operative time, pain scores (Visual Analogue Scale), complications, and stone clearance were analyzed. RESULTS:Both groups were comparable in age and sex. Mean stone size was smaller in the local anesthesia group (22 mm) compared to spinal anesthesia (30 mm); multiple stones were more common with spinal (26.3% vs 9.3%). Complete stone clearance was achieved in all patients. Operative time was shorter under local anesthesia (45.3 vs 55 min). Pain scores were similar (VAS 3.69 vs 3.70). Minor complications, such as hematuria and fever, occurred but resolved conservatively. No major complications or mortality were reported. Patient satisfaction was slightly lower with local anesthesia (Likert 4.05 vs 4.13). CONCLUSIONS:Holmium laser cystolithotripsy is safe and effective under both local and spinal anesthesia. Local anesthesia is a well-tolerated alternative for smaller stones, offering a quicker procedure with similar pain outcomes. Spinal anesthesia remains preferred for larger or multiple stones. Further randomized studies are needed to optimize anesthesia selection criteria.
OBJECTIVE:This study aimed to quantify the prevalence and severity of indwelling double-J (DJ) ureteral stent-related symptoms, characterize pain perception, and evaluate patient satisfaction among adult patients in a resource-limited healthcare system, while identifying demographic and clinical factors associated with symptom burden and satisfaction. METHODS:A cross-sectional study was conducted between April and December 2025 at two major urology centers. Patients who underwent DJ ureteral stenting for ureteral obstruction, predominantly due to urinary tract stones, were consecutively recruited. Data were collected using a structured, seven-part questionnaire assessing urinary symptoms, pain characteristics, quality of life, and satisfaction, supplemented by clinical information from electronic medical records. Pain intensity was measured using a visual analogue scale (VAS). RESULTS:Among 200 patients analyzed, stent-related symptoms were highly prevalent. The median stent indwelling duration was 30.0 days [IQR: 19.0-41.0]. Flank or abdominal pain was reported by 176 patients (88%), with a median severity of 6.0 on the VAS. Other frequent complaints included fatigue (74%), sleep disturbance (71.5%), urinary frequency (70.5%), dysuria (69%), hematuria (58%), and sensation of a foreign body (65.5%). Despite this substantial symptom burden, overall satisfaction was relatively high: 124 patients (62%) reported being satisfied or very satisfied, and 134 (67%) expressed willingness to undergo stenting again if medically indicated. Longer stent indwelling time was independently associated with increased flank pain (OR 1.05/day, 95% CI 1.01-1.09, p = 0.007) and satisfaction was negatively associated with comorbidities (β = -0.17, p = 0.027). CONCLUSION:DJ ureteral stents cause significant pain, urinary symptoms, and quality-of-life impairment among Palestinian patients, yet overall satisfaction remains high, reflecting recognition of their clinical necessity. These findings highlight the need for better counseling, tailored symptom management, and structured follow-up to strengthen patient-centered care.
