The role of lymph node dissection (LND) during robot-assisted nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC) remains debated, particularly in clinically node-negative (cN0) patients. This study aimed to evaluate the anatomical distribution of nodal metastases, identify predictors of lymph node positivity, and assess perioperative and oncological outcomes associated with LND. A retrospective multicenter study was conducted including 511 patients treated with RNU for UTUC at multiple high-volume international referral centers between 2019 and 2023. Among them, 218 (42.7

The EMBARK trial demonstrated improved survival with enzalutamide plus androgen deprivation therapy (ADT) in non-metastatic hormone-sensitive prostate cancer patients with high-risk biochemical recurrence (BCR), although staged using conventional imaging. Given the higher sensitivity of PSMA-PET, many of these patients could harbor metastatic disease. We retrospectively analyzed 587 patients with first BCR after radical treatment who underwent PSMA-PET. Patients were stratified according to EMBARK criteria for high-risk BCR. 169 patients (29%) met EMBARK criteria. They more often showed PSMA-PET positivity for any localization (82% vs 39%; p < 0.001) and metastatic disease (46% vs 15%; p < 0.001). Median PSA was higher and PSA doubling-time (PSADT) shorter (2.23 vs 0.43 ng/mL; 4.3 vs 9 months). Most High-risk BCR patients have a positive PSMA-PET, and many of these harbor metastatic disease at molecular imaging. Given the survival benefit from intensified systemic treatment with ARPI in this cohort, how to best combine systemic therapy with PSMA-PET guided metastases-directed-treatments remains an important future area of research.

BACKGROUND:To evaluate the feasibility and safety of robot-assisted partial nephrectomy (RAPN) performed using the Toumai® robotic system in this first European experience. METHODS:We conducted a prospective observational study including consecutive patients undergoing RAPN performed using the Toumai® robotic system at a tertiary referral robotic centre between May and December 2025. Perioperative, postoperative, functional, and pathological data were collected. RESULTS:A total of 21 RAPN procedures were performed using the Toumai® robotic system. Median patient age was 63 years, and 15 patients (71.4%) were male. Median tumour diameter was 3.2 cm. Median total operative time was 143 min, with a median console time of 90 min . No conversions to open surgery or radical nephrectomy occurred. Two robot-related technical events (9.5%) were recorded and managed intraoperatively without clinical consequences. One postoperative complication occurred (4.8%), graded as Clavien-Dindo I. No major complications, blood transfusions, or early readmissions (<30 days) were observed. Median length of hospital stay was three days. Median estimated glomerular filtration rate (eGFR) showed a minimal change at hospital discharge, with a median ΔeGFR of -2 mL/min/1.73m2 (p = 0.2). CONCLUSION:In this first European experience, RAPN performed using the Toumai® robotic system was feasible and safe. Further studies are required to confirm long-term outcomes and comparative performance.

Abstract Objective The aim of this paper is to evaluate fellowship outcomes 10 years after implementation of the European Association of Urology Robotic Section (ERUS) structured curriculum for robot‐assisted radical prostatectomy (RARP), with a focus on completion rates and reasons for non‐completion. Subjects and methods Data were obtained from institutional records and a trainee survey. The primary outcome was fellowship completion (i.e., Certificate of Excellence achievement). Secondary outcomes included reasons for non‐completion and satisfaction. Completion rates were analysed annually, with trends assessed using the Cochran–Armitage test and log‐linear regression for the Estimated Annual Percentage Change (EAPC). Comparisons before and after introduction of a procedural diary (2023) and between pandemic and non‐pandemic years used Fisher's Exact Test. Results Among 126 fellows, a total of 42 (33%) completed the fellowship by achieving the Certificate of Excellence. The trainee survey achieved a response rate of 77%, supporting the representativeness of the collected data. The main barriers to fellowship completion included limited console access (49%), insufficient programme duration (20%), logistical difficulties (20%) and COVID‐19‐related disruptions (11%). Despite these limitations, overall satisfaction with the fellowship was high (83%), with particularly strong approval of the ORSI hands‐on training week (100%). Completion rates demonstrated a progressive increase over time, rising from 20% in 2018 to 52% in 2023. The Cochran–Armitage test confirmed a statistically significant upward trend in completion rates over the study period ( p < 0.001), while log‐linear regression analysis showed a numerical but non‐significant EAPC of 13% (95% CI –0.6 to 28.6). Although 2023 represented the highest observed completion rate, this peak was not significantly different from previous years (OR 2.63, 95% CI 0.91–7.63). Conclusions The RARP ERUS Fellowship remains a benchmark in robotic training, but unsatisfactory completion rates highlight the need for improvement. Recent reforms, including the procedural diary, show promise and warrant expansion.

Objectives To evaluate whether cumulative smoking exposure and time since cessation are associated with perioperative morbidity after robot-assisted radical cystectomy (RARC).Patients and Methods We retrospectively analysed 475 patients who underwent RARC with urinary diversion at a high-volume tertiary centre between 2004 and 2024. Outcomes of interest were postoperative early complications, postoperative readmission, overall risk of postoperative morbidity according to smoking status, cumulative smoking exposure, and time since smoking cessation. Multivariable logistic regressions were performed to explore the effect of smoking status, cumulative smoking exposure, and time since smoking cessation on perioperative morbidity after RARC. The locally estimated scatterplot smoothing (LOESS) function was used to graphically explore this relationship.Results Early complications occurred in 60% of current smokers, 50% of former smokers, and 37% of never smokers. Compared with never smokers, former (odds ratio [OR] 3.83, 95% confidence interval [CI] 1.73-9.38) and current smokers (OR 6.75, 95% CI 2.85-12.40) had significantly higher odds of perioperative morbidity. Each 10 additional pack-years increased complication risk (OR 1.20, 95% CI 1.05-1.40), whereas each year since cessation reduced risk (OR 0.84, 95% CI 0.76-0.91). The LOESS curves showed a steadily increasing risk with cumulative exposure and a gradual decline following cessation.Conclusion Both lifetime smoking burden and time since cessation are strong and independent predictors of perioperative morbidity after RARC. Evaluating smoking exposure as a continuous variable improves risk stratification and provides more accurate information for preoperative counselling in patients undergoing RC.

BACKGROUND AND AIM:Percutaneous radiofrequency ablation (RFA) is an increasingly adopted treatment for small solid renal masses. However, its safety and oncological effectiveness in complex renal cysts, classified as Bosniak III and IV, remain poorly characterized. We aimed to evaluate oncological outcomes and safety of RFA in patients with Bosniak III-IV cysts. METHODS:We retrospectively identified patients who underwent ultrasound-guided percutaneous RFA for Bosniak III-IV renal cysts at our institute between June 2017 and February 2025. Clinical, radiological, histological, and functional data were collected. Technical success was defined as the absence of enhancement on intra- and postprocedural contrast-enhanced ultrasound. RESULTS:Overall, 34 patients underwent RFA for 38 cT1a complex renal cysts (mean diameter 2.11 ± 0.7 cm): 8 (21.1%) were Bosniak III and 30 (78.9%) Bosniak IV. Two patients with Bosniak III cyst were subsequently excluded from oncological analyses because of benign or nondiagnostic histology report. Technical success was achieved in 100% of cases. Postprocedural laboratory values showed Δ creatinine 0.02 mg/dL (interquartile range [IQR]: 0.01-0.05; p = 0.001), Δ estimated glomerular filtration rate -0.80 mL/min/1.73 m2 (IQR: -2.0-0.0; p = 0.001), and Δ hemoglobin -0.2 g/dL (IQR: -1.0-0.0; p = 0.001). Postprocedural complications were observed in 2/34 patients (5.8%), both involving hemorrhages, one of which required transarterial embolization (Clavien-Dindo grade III). At a median follow-up of 62.5 months (IQR: 18-72.5), local recurrence occurred in 2/32 patients (6.2%). No cases of systemic progression or cancer-specific mortality rate were observed. CONCLUSION:Ultrasound-guided RFA appears to be a safe and feasible nephron-sparing option for the management of Bosniak III-IV renal cystic lesions in selected patients.

OBJECTIVES:Complex cystic renal lesions pose a significant diagnostic challenge in the preoperative assessment of malignancy. Although percutaneous renal mass biopsy is well established for solid tumours diagnosis, its role in cystic lesions remains controversial. This systematic review aims to evaluate the diagnostic performance, safety, and clinical impact of percutaneous sampling-fine-needle aspiration (FNA) and core needle biopsy (CNB)-in Bosniak III-IV renal cysts. METHODS:A systematic review and meta-analysis were conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines [International Prospective Register of Systematic Reviews (PROSPERO) ID CRD420251124563]. PubMed/MEDLINE (Medical Literature Analysis and Retrieval System Online), Embase, Cochrane Central Register of Controlled Trials (CENTRAL), Scopus, and Web of Science were searched (1980-May 2025). Eligible studies included adult patients with Bosniak III-IV cysts undergoing FNA or CNB. Pooled diagnostic estimates were calculated using a bivariate random-effects model. RESULTS:Seven studies, including 954 patients, met the inclusion criteria. Three studies evaluated FNA, yielding a pooled sensitivity of 59% [95% Confidence Interval (CI): 14-93], specificity of 84% (95% CI: 62-94), and an overall diagnostic performance of 0.84 [Area under the curve (AUC)]. Sensitivity estimates varied widely, whereas specificity was consistently high. Four studies assessed CNB, reporting diagnostic yields between 75% and 81%. Cystic morphology was identified as the strongest independent predictor of non-diagnostic sampling, with odds ratios (OR) up to 13.9. No major complications or cases of tumour seeding were reported across the included studies. Reporting of minor complications was limited and heterogeneous, precluding a pooled analysis. CONCLUSIONS:Percutaneous sampling of Bosniak III-IV cystic renal masses is feasible but diagnostically challenging. FNA provides limited value due to high rates of non-diagnostic and false-negative results. CNB achieves higher accuracy, particularly when a solid component is present, and may be considered within a multidisciplinary setting when histological confirmation is likely to influence treatment decisions.

Vasectomy reversal is a technically demanding microsurgical procedure aimed at restoring fertility. Robot-assisted vasovasostomy (RAVV) has been introduced to enhance precision and ergonomics, but robust clinical data remain limited. We report perioperative, functional, and fertility outcomes from one of the largest single-centre series of RAVV and explore patient-related factors associated with postoperative patency. We retrospectively analysed prospectively maintained data from men undergoing bilateral RAVV at a tertiary referral centre between January 2008 and September 2025. All patients had fathered at least one biological child before undergoing vasectomy. Perioperative outcomes, semen parameters, and pregnancy rates were assessed. Functional patency was defined as a postoperative sperm concentration ≥ 1 million/mL. Associations between clinical variables and patency were explored using univariable logistic regression analyses. Sixty men underwent RAVV. Median age at surgery was 42 years (IQR 38–47), and the median interval between vasectomy and reversal was 6 years (IQR 4–9). Median operative and console times were 118 min (IQR 100–132) and 85 min (IQR 70–100), respectively. All patients were discharged on postoperative day 1. Functional patency was achieved in 56 patients (93.3