BACKGROUND AND OBJECTIVE:The sutureless (SL) purely off-clamp robotic partial nephrectomy (ocRPN) technique has been proposed to minimize postoperative functional damage. We assessed whether this approach is noninferior to renorrhaphy (RR) in terms of surgical quality. METHODS:Patients with cT1-2N0M0 renal tumors were randomly assigned to SL or RR-ocRPN within a single-center, single-surgeon randomized controlled trial (NCT06846112). A covariate-adaptive 1:1 randomization algorithm ensured balance between treatment arms for age, sex, baseline renal function, and tumor surgical complexity. The primary endpoint was Trifecta achievement at discharge. A prespecified noninferiority test (margin -10%) compared Trifecta rates using one-sided testing and confidence intervals. Secondary outcomes were descriptively analyzed and compared between study arms. Recurrence-free survival (RFS) was estimated using the Kaplan-Meier method. KEY FINDINGS AND LIMITATIONS:Among 248 patients, baseline characteristics were balanced. Trifecta was achieved in 93% and 95% of cases (absolute difference -2.4%; 90% confidence interval [CI] -7.4%-2.6%), meeting the criterion for noninferiority (one-sided p = 0.006). Blood transfusions (2.4% vs 0%) and acute kidney injury (1.6% in both groups) were rare. Nine urinary fistulae occurred overall, all managed with temporary stenting; rates were higher in the SL group but not statistically significant (p = 0.08). Renal function remained stable up to 12 mo, and 1-yr RFS was 99% in all cohorts. Limitations include single-center design, surgeon expertise, and short oncologic follow-up. CONCLUSIONS AND CLINICAL IMPLICATIONS:SL-ocRPN is safe and effective and represents a feasible alternative to RR-ocRPN in selected cT1-2N0M0 renal tumors.

Whether cryoablation and high-intensity focused ultrasound (HIFU) provide distinct advantages in hemigland ablation for localized prostate cancer (PCa) is unresolved. A prospective FT-PCa registry (2021–2025) was analysed, identifying 258 men treated with hemigland ablation (cryoablation n = 179; HIFU n = 79). Baseline differences were addressed through inverse-probability-of-treatment weighting based on age, PSA, PSA density, ISUP, PI-RADS, lesion size,

Robot-assisted radical cystectomy (RARC) with totally intracorporeal orthotopic neobladder (i-ON) is increasingly used. Functional outcomes in women remain under-investigated due to the limited number of female patients undergoing i-ON.The aim of the present study is to identify predictors of daytime and nighttime continence recovery in female patients undergoing i-ON We retrospectively analysed our IRB-approved single-center database for female patients treated with RARC and i-ON between January 2016 and July 2022. Women receiving sex-sparing approaches were excluded. Continence status was assessed with 3-day voiding diaries. Daytime continence was defined as total dryness (0 g) and nighttime continence as pad wetness ≤50 g. Kaplan–Meier curves and log-rank tests compared recovery; Cox regression identified predictors. Thirty-five female patiens were included. Median age was 62 years (IQR 55–66) and BMI 24,5 kg/m2 (IQR 21.5–28.0). High-grade complications (Clavien ≥3) occurred in 11

PURPOSE:To report the first multicentric comparison between Hugo™ robot-assisted surgery/system (RAS) and Da Vinci® Xi for robot-assisted partial nephrectomy (RAPN). METHODS:Between October 2022 and March 2024, a total of 258 patients underwent off-clamp RAPN (Hugo RAS = 52 patients, and Da Vinci = 206 patients). Da Vinci and Hugo cases were matched in a 1:1 ratio using propensity score matching (PSM), adjusting for the Radius Exophytic Nearness Anterior Location score and renorrhaphy technique. Trifecta was defined as the coexistence of negative surgical margin status, no Clavien-Dindo grade ≥ 3 complications, and ≤ 30% estimated glomerular filtration rate (eGFR) reduction at discharge. RESULTS:After 1:1 PSM, two comparable populations of 52 patients each were selected. No intraoperative blood transfusion occurred in any group. The Hugo cohort displayed a higher rate of postoperative transfusions (7.7% vs 0%, p = 0.04). Nevertheless, perioperative complications were comparable (p = 0.32). The median length of stay (LOS) was shorter in the Da Vinci group (2 days vs 3 days, p < 0.001), as for median eGFR at discharge (74.5 mL/min/1.73m2 vs 87.3 mL/min/1.73m2, p = 0.03). No significant difference in positive surgical margins was shown between the two groups (p = 0.08). Finally, a comparable Trifecta rate was achieved for both platforms (88.5% in the Hugo RAS group and 90.4% in the Da Vinci group, p = 0.75). CONCLUSIONS:Despite the hierarchical role of Da Vinci in the robotic surgical landscape, RAPN can be safely carried out with the new Hugo RAS System, with satisfactory perioperative surgical outcomes comparable to the Da Vinci Xi System.

INTRODUCTION:The ability of time to PSA nadir (TTN) to predict early treatment failure after focal therapy for prostate cancer remains unclear. We assessed whether TTN and PSA nadir-related parameters are associated with early oncologic failure after primary cryotherapy or high-intensity focused ultrasound (HIFU). MATERIALS AND METHODS:We relied on a prospective registry of 319 men treated with primary cryotherapy (n = 221) or HIFU (n = 98). TTN was categorised as ≤6, 6-12, or >12 months. PSA nadir and nadir PSA density (nPSAD) were analysed. Treatment failure (TF) included biochemical/local recurrence, metastatic progression, or salvage therapy. Primary endpoint was early TF (≤24 months). Independent predictors were evaluated with Firth logistic regression; failure-free survival (FFS) was estimated with Kaplan-Meier analysis. RESULTS:Men selected for HIFU had slightly more favourable baseline features. Median TTN was 6 months overall but longer after cryotherapy than after HIFU (6 vs 3 months; p < 0.001). Cryotherapy achieved lower PSA nadir and nPSAD than HIFU (each p < 0.001). At a median follow-up of 26 months, overall FFS was 84.8% (82.1% after cryotherapy and 90.8% after HIFU; p = 0.046). TTN strata were associated with differences in FFS (log-rank p < 0.001). In multivariable models, TTN >12 months independently predicted early TF after cryotherapy (OR 17.5; p < 0.001). After HIFU, ablation extent was independently associated with early treatment failure. CONCLUSIONS:Delayed TTN was independently associated with early failure after cryotherapy, whereas no independent association emerged after HIFU. These findings support modality-specific interpretation of TTN when planning post-ablation follow-up.

BACKGROUND:The role of redo minimally invasive partial nephrectomy (rMIPN) for single ipsilateral renal cancer recurrences (RCRs) after prior nephron-sparing surgery (NSS) remains debated. rMIPN offers the potential for renal preservation but carries substantial surgical complexity and perioperative risk. This dual-institutional study compared perioperative, functional, and oncologic outcomes of rMIPN versus redo minimally invasive radical nephrectomy (rMIRN) for solitary ipsilateral RCRs. METHODS:From January 2004 to October 2024, 2 prospectively maintained renal cancer databases were queried for patients with solitary, localized RCRs treated with rMIPN (n = 63) or rMIRN (n = 41). Baseline demographics, operative data, renal function, and pathologic findings were retrospectively extracted. Kaplan-Meier analysis tested overall survival (OS), cancer-specific survival (CSS), and progression to stage ≥ 3b chronic kidney disease (CKD), with log-rank test comparisons. RESULTS:Baseline demographics and tumor characteristics were similar between groups. rMIPN was associated with longer hospital stay (median 3 vs. 2 days), higher complication rates (22.2% vs. 4.9%), and greater transfusion requirements (7.9% vs. 0%; all P < 0.05). At a median follow-up of 47.5 months [IQR 22.2-75], OS, CSS, and CKD progression did not differ significantly between rMIPN and rMIRN (all P > 0.05). CONCLUSIONS:rMIPN provides oncologic and functional outcomes comparable to rMIRN but at the cost of higher perioperative morbidity. Surgical selection should be individualized, weighing the potential benefits of nephron preservation against the higher surgical risks.

OBJECTIVES:Achieving both relief of urinary obstruction and preservation of ejaculatory function is a key goal of modern surgical management for benign prostatic hyperplasia (BPH). However, standardized definitions of success that integrate multiple clinical domains remain limited. This study introduces a composite definition of clinical success and explores its predictors using a multicenter dataset of minimally invasive, ejaculation-preserving procedures. METHODS:Multi-institutional data were combined, including patients who underwent urethral-sparing robot-assisted simple prostatectomy (usRASP; n = 94), Aquablation (n = 95), or Rezum (n = 308). Complete clinical success (CSS) was defined as: (1) ⩾30% International Prostatic Symptoms Score (IPSS) reduction at 12-months; (2) preserved ejaculation, based on a positive response to the Male Sexual Health Questionnaire Ejaculatory Dysfunction (MSHQ-EjD Q3); and (3) absence of ⩾Grade III Clavien-Dindo complications. Partial clinical success (PCS) was defined as the achievement of any two of the three criteria. A multivariable logistic regression analysis identified independent predictors of CCS. RESULTS:The final cohort included 497 patients. CCS rates were 66.0% (usRASP), 73.6% (Aquablation), and 68.8% (Rezum); PCS rates were 28.7%, 14.7%, and 20.1%, respectively. No significant differences were observed among groups for IPSS (p = 0.455), ejaculation rates (p = 0.07), or complication rates (p = 0.445). On multivariable analysis, prostate volume < 110 mL (OR 0.52; p = 0.034), higher MSHQ-EjD Q3 (OR 1.07; p < 0.001), and shorter catheterization time (OR 0.91; p = 0.02) independently predicted CCS at 1 year. CONCLUSIONS:This composite endpoint offers a pragmatic and clinically relevant framework for evaluating success in minimally invasive BPH surgery. Its adoption may enhance cross-technique comparisons and inform individualized treatment strategies.

To evaluate perioperative outcomes and characterize the early integration of single-port (SP) robot-assisted radical prostatectomy (RARP) in surgeons with established multi-port (MP) robotic experience. A prospectively maintained database of consecutive patients undergoing RARP between 2019 and 2025 was retrospectively analyzed. After excluding pelvic lymph node dissection cases and each surgeon’s initial MP learning curve, a propensity score–matched cohort (49 MP vs. 49 SP) was generated. The entire SP cohort (n = 98) was used to assess adoption dynamics through tertile stratification and LOESS modeling. Baseline characteristics were balanced. Perioperative outcomes were comparable, including length of stay, catheterization time, hemoglobin variation, and complication rates (all p > 0.1). Operative time was longer in the SP group (150 vs. 100 min; p < 0.001). Across sequential tertiles, operative time decreased (p = 0.04). LOESS analysis demonstrated a steep early decline within approximately the first 10–15 cases, followed by progressive stabilization, consistent with a short adaptation phase in proficient robotic surgeons. In experienced MP robotic surgeons, transition to SP-RARP preserved perioperative safety, with differences mainly confined to a transient increase in operative time. Rather than suggesting a distinct performance advantage over MP surgery, these findings define the early adaptation profile of SP integration within an already mature robotic program.