Ejaculatory dysfunction represents a major drawback of conventional endoscopic surgery for benign prostatic hyperplasia (BPH), substantially affecting postoperative quality of life. Ejaculation-sparing (ES) endoscopic techniques have been developed to preserve ejaculatory function while maintaining effective relief of lower urinary tract symptoms (LUTS). A systematic review and meta-analysis of randomized controlled trials was conducted in accordance with the PRISMA 2020 guidelines. Adult men undergoing ES endoscopic prostate surgery were compared with those treated using standard endoscopic techniques. Primary outcomes included preservation of antegrade ejaculation, Male Sexual Health Questionnaire–Ejaculatory Dysfunction (MSHQ-EjD) scores, and semen volume. Secondary outcomes comprised erectile function, urinary flow parameters, symptom scores, operative time, and postoperative complications. Eight randomized trials, including 562 patients, were analyzed. ES techniques were associated with a substantially higher likelihood of preserving antegrade ejaculation compared with conventional surgery (OR 15.11, 95

Men with benign prostatic enlargement (BPE) frequently present with concomitant bladder stones (BS), yet the optimal surgical strategy remains debated. This systematic review and meta-analysis aimed to compare perioperative and postoperative outcomes of concomitant BPE/BS surgery against BS treatment alone. Following the 2020 PRISMA framework, a comprehensive search was conducted on 9 March 2026. Binary outcomes were pooled using the Cochran-Mantel-Haenszel method and reported as odds ratios (OR) with 95

Optilume and Optilume BPH, a minimally invasive drug-coated balloon (DCB) combining mechanical dilation with paclitaxel delivery, offers a novel approach for treating urethral strictures and benign prostatic hyperplasia (BPH) respectively. This scoping review summarizes current evidence on their efficacy, safety, and long-term outcomes to evaluate their role in reducing recurrence and improving patient-reported and functional outcomes. Following PRISMA guidelines, a systematic search (Embase, PubMed, Cochrane, Scopus) until March 2025 identified 287 studies. Eligibility followed PICOS criteria, excluding non-English articles, reviews, and case reports. Risk of bias was assessed using Cochrane RoB 2 and MINORS tools. Data extraction focused on anatomical success, symptom improvement, complications, and retreatment rates. This review was registered at https://osf.io/vf4dw . After screening, 20 studies met inclusion criteria: 2 preclinical animal studies, 12 clinical studies on urethral strictures, and 6 on BPH. For urethral strictures, the ROBUST trials demonstrated 71.7

Dear Editor, For a few decades, urinary tract infections (UTIs) have been classified according to the dichotomy "uncomplicated" and "complicated"...

Objective:To evaluate the clinical effectiveness and safety of outpatient versus inpatient flexible ureterorenoscopy (FURS) using the flexible and navigable suction access sheath (FANS). Methods:Conducted across 25 global centers between July 2023 and March 2024, this study included patients undergoing retrograde intrarenal surgery stratified by surgical setting. All patients were counseled for FURS with FANS as an outpatient procedure unless otherwise planned earlier. The primary outcome was stone-free rate defined as zero residual fragments or a single fragment of ≤2 mm on a 30-day non-contrast CT scan. The secondary outcome was complication rates. Outpatient status applied to any patient observed for less than 24 h postoperatively. No fixed criteria were assigned for outpatient care. Results:Seven hundred and four patients were included, with 356 undergoing outpatient surgery and 348 receiving inpatient care. Operative, lasing, and ureteroscope times were significantly shorter in the outpatient group (p<0.001 in all three), despite the larger stone burden in the outpatient group. A significantly higher number of patients had intraoperative residual fragments in the inpatient group. The outpatient group achieved a significantly higher 100% stone-free rate (67% vs. 53%, p<0.001). A significantly greater proportion of the outpatient cohort underwent placement of an overnight ureteral catheter (p<0.001), which was subsequently removed at discharge, whereas the majority of the inpatient group received a double-J stent (p<0.001). Reintervention and intraoperative complication rates were comparable between groups. Postoperative complications were fewer in outpatient patients: fever (0.84% vs. 3.2%, p=0.02). The multivariate analysis identified postoperative double-J stent positioning as the factor associated with lower odds of having postoperative fever requiring antibiotics (odds ratio 0.282, 95% confidence interval 0.109-0.729, p=0.009). Conclusion:Outpatient FURS with FANS demonstrates excellent outcomes, with a low rate of minor complications. These findings support the broader adoption of outpatient RIRS in patients with kidney stones and normal renal anatomy, provided that patient selection and intraoperative planning are appropriately optimized.

Partial nephrectomy (PN) has become the standard of treatment for most T1 renal masses and is suitable for selected T2 renal cortical masses. In this setting, the management of complex renal masses (CRM) requires a thorough understanding of the potential risks and benefits of both PN and radical nephrectomy (RN). Indeed, thanks to the advent of robotic surgery, indications of PN have expanded to include larger tumors and CRM, despite the associated surgical complexity and oncologic risks. The decision-making process for CRM treatment with PN or RN is complex. Thus, the current review aims to explore the decision-making essentials for patients with CRM, identify research gaps, and address the clinical challenge of determining the most suitable surgical approach. Current evidence suggests that while PN offers a clear advantage in renal tissue preservation, it may carry higher perioperative risks compared to RN. However, these risks should be balanced with the long-term benefits of renal function preservation. In conclusion, further high-quality, prospective studies are needed to better define the comparative effectiveness of PN vs . RN to guide clinical decision-making for CRM.

This study aims to compare and organize recommendations from the most eminent international guidelines on the staging and treatment of lymph node (LN) involvement in penile cancer (PC). Early recognition and appropriate management of nodal disease remain the cornerstone of care, influencing both survival and treatment-related morbidity. This study compares and organize recommendations form the most eminent international guidelines—including NCCN, ESMO-EURACAN, and EAU-ASCO—on the staging and treatment of lymph node involvement in penile cancer. Open inguinal LN dissection (ILND) remains the standard treatment for not superficial cancers and its morbidity has driven interest in minimally invasive surgical approaches, such as video-endoscopic inguinal lymphadenectomy (VEIL), including its robot-assisted variant (RA-VEIL). Their role is well defined in clinically node-negative (cN0) patients but remains investigational in node-positive (cN+) cases. For cN3 disease and pelvic node involvement, multimodal strategies including chemotherapy, surgery, and radiotherapy are required. The variability among guidelines underscores the need for collaborative efforts and high-quality prospective trials to refine and standardize treatment recommendations.

Dear Editor, Prostate cancer (PCa) remains one of the most common malignancies among men worldwide, representing a major healthcare burden both in terms of morbidity and economic cost...

Monkeypox is an emerging zoonotic viral disease caused by the Monkeypox virus, traditionally confined to central and west Africa, which has recently spread to other regions worldwide, making it a global health concern...

INTRODUCTION:Benign prostatic hyperplasia (BPH) is a common urological disease that is strongly associated with the aging process and can lead to lower urinary tract symptoms (LUTS). LUTS due to BPH can significantly affect the quality of life of many patients. Among the treatments available for BPH to improve symptoms and functional outcomes, drug therapy and surgical therapy are the options of choice. However, for most patients with symptomatic BPH, medical management remains the cornerstone of treatment. Pharmacologic interventions are often preferred as a first approach, being less invasive compared to surgery. Although the medical treatment of BPH is currently defined by the algorithms of international guidelines, the need for a more personalized approach is increasingly recognized given the wide and heterogeneous range of therapeutic options available. MATERIALS AND METHODS:A review of medical therapy for BPH was conducted using relevant articles in PubMed, Scopus, and the Cochrane Central Register of Controlled Trials. In this review, all drug treatments currently available on the international market whose efficacy is scientifically proven are reviewed and described (phytotherapy, alpha-blockers, muscarinic receptor antagonists, 5-alpha-reductase inhibitors, combination therapies, etc.). RESULTS:A total of 17 randomized clinical trials were selected for review. Further, 75 studies were included for analysis and discussion. CONCLUSIONS:As the treatment landscape continues to evolve, tailoring therapy to individual patient needs and preferences is likely to become increasingly important to ensure that treatment strategies are both effective and meet patient expectations.

To the Editor, Bladder cancer is one of the most common cancers in humans, representing the 7th and 17th type of neoplasm in both genders. Its incidence and mortality are quite heterogeneous in different countries and are due to different risk factors, quality and prevalence of healthcare and the possibility of early diagnosis and treatment of the tumor and its potential recurrences [...].

To the Editor, In recent years, alternative solutions have been proposed to obtain effective results comparable to TURP, which is currently considered the gold standard, and laser vapo-enucleation techniques (1, 2), but with the possibility of maintaining sexual functions. In recent years there has been a growing trend towards ejaculation preservation. Although the results of TURP (3), and most laser enucleation techniques are undoubted in the Benign Prostatic Hyperplasia (BPH) and Lower Urinary Tract Symptoms (LUTS) management, they often lack in the preservation of ejaculation. All the alternative recently proposed interventions (Rezum, AquaBeam, Urolift, TPLA, i-TIND, LEST) are procedures considered by some authors to be promising in both managing BPO and preserving sexual functions. However, all these methods are limited by a lack of long-term follow-up that would evaluate the efficacy over time, possible complications related to the method and the correct patient selection for a specific method. The aim of this letter is to summarize the available evidence and provide clinicians with practical recommendations on the use of the brand new minimally invasive techniques for the management of BPO. [...]

You have accessJournal of UrologyCME1 Apr 2023MP59-04 HOLMIUM LASER ENUCLEATION OF THE PROSTATE FOR VERY LARGE BENIGN PROSTATIC HYPERPLASIA (>200 ML): LONG TERM OUTCOME OF A LARGE SERIES. Matteo Tallè, Francesco Mengoni, Roberto Orciani, Donato Dente, and Angelo Cafarelli Matteo TallèMatteo Tallè More articles by this author , Francesco MengoniFrancesco Mengoni More articles by this author , Roberto OrcianiRoberto Orciani More articles by this author , Donato DenteDonato Dente More articles by this author , and Angelo CafarelliAngelo Cafarelli More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003312.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Patients presenting with very large prostates (>200 ml of total volume) are a challenge to both patients and surgeons. Nowadays, although the efficacy and the less invasiveness of HoLEP compared to open techniques has been proven, still high level evidences for the best treatment of large prostates are limited. Aim of the study is to evaluate the short and long term outcomes of patients with very large prostates (>200 cc) in the largest series available so far. METHODS: Clinical data were collected in a prospective maintained database, we performed 183 HoLEP procedures on prostates greater than 200 gr in 86 months. We reported patient preoperative, intraoperative, postoperative outcomes and complications. Surgical technique: we used a Gilling modified technique with a three-lobe enucleation with a high power 120 W Holmium laser (Lumenis Pulse). Morcellation is conducted with a 7 gr/min morcellator (Lumenis VersaCut) together with basket for removal of the small prostate chips, in order to reduce operating time. Patients results were collected in a proper database Patients with limited follow-up and with data unavailable were excluded. RESULTS: We collected retrospectivally data of consecutive male patients who underwent HoLEP from July 2015 to September 2022 (86 months). There were 183 patients with a mean preoperative gland size of 218.9 cc (200-366 cc). Mean operative (145 min) and enucleation time (83 min) .Enucleation efficiency was greater for glands ≥300 cc (4.5 cc/min). Mean length of stay was 2.2±days and catheter duration was 2.8±days. Mean haemoglobin loss was (3,6 gr/dl, SD 0,1 - 6 gr/dl). 7 cases required blood transfusion (3.8%). 52 patients (28.4%) had indwelling catheter before surgery for urinary retention; this population experienced higher incidence of post-operative UTI and fever (42% vs 13%; p=0.001) Mean variation of Qmax was+14 ml/s (p<0,05) and IPSS score -16 points (p<0.05) at long term follow-up, these results stayed stable for during time with a mean follow 24 months (range 2-86) 3 (7.1%) patient required retreatment of BPH at last follow-up. CONCLUSIONS: HoLEP for giant prostate is a minimally invasive option with low morbidity and good post-operative outcomes. These data support the feasibility of HoLEP regardless the size of the prostate and suggest that HoLEP could become the “gold standard” approach for prostate >200 cc. Source of Funding: 1) World Journal of Urology © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e807 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Matteo Tallè More articles by this author Francesco Mengoni More articles by this author Roberto Orciani More articles by this author Donato Dente More articles by this author Angelo Cafarelli More articles by this author Expand All Advertisement PDF downloadLoading ...

Introduction: Perioperative complications, especially intraoperative adverse events (iAEs), carry significant potential for long-term sequelae in a patient’s postoperative course. These events represent a substantial gap in contemporary surgical literature, with only a fraction of publications reporting intraoperative complications as outcomes of interest. To date, there is no universal standard for comprehensively reporting intraoperative complications in surgical practice and literature beyond the systems developed for grading individual events. We aim to establish a set of best-practice criteria for iAE reporting known as the Intraoperative Complication Assessment and Reporting with Universal Standards (ICARUS) Guidelines. Methods and analysis: We will generate the ICARUS reporting guidelines using the EQUATOR Network development framework and the SQUIRE Guidelines. The initial step involves an umbrella review and meta-analysis of systemic reviews (SRs) assessing the perioperative adverse events of common surgeries. Measures for assessing, collecting, grading, and reporting the iAEs will be merged into a comprehensive list of criteria. Using a modified Delphi methodology, a team of expert surgeons (≥ 200 inpatient procedures/years) will contribute to and evaluate the proposed reporting guidelines. The panel will evaluate both the clinical usefulness and quality assessment and improvement utility of each criterion using a 5-point Likert. We expect multiple survey rounds until consensus regarding the utility of the guidelines is reached. Dissemination: We plan to share then validate the newly developed guidelines within each surgical field. Dissemination will involve publicly shared guidelines, simultaneous journal publications, conference presentations, encouragement for journal endorsement, and application for inclusion in the Equator Network database. The study team plans to continue collecting feedback for future extension of the intraoperative reporting guidelines. Highlights: Intraoperative adverse events are underreported and lack homogeneity in surgical literature We aim to use a modified Delphi methodology to develop the consensus-based, intraoperative complications assessment and reporting with universal standards (ICARUS) guidelines We will disseminate the ICARUS guidelines through journal publications and presentations at national and international meetings; journals and professional organizations will be encouraged to endorse the ICARUS guidelines

Purpose: The coronavirus disease 2019 (COVID-19) pandemic has put a substantial burden on the Italian healthcare system, resulting in the restructuring of hospitals to care for COVID-19 patients. However, this has likely impacted access to care for patients experiencing other conditions. We aimed to quantify the impact of COVID-19 on access to care for patients with urgent/emergent urological conditions throughout Italy. Materials and Methods: A questionnaire was sent to 33 urological units in the AGILE consortium, asking clinicians to report on the number of urgent/emergent urological patients seen and/or undergoing surgery over a 3-week period during the peak of the COVID-19 outbreak and a reference week prior to the outbreak. ANOVA and linear regression models were used to quantify these changes. Results: Data from 27 urological centres in Italy showed a decrease from 956 patients/week seen just prior to the outbreak to 291 patients/week seen by the end of the study period. There was a difference in the number of patients with urgent/emergent urological disease seen within/during the different weeks (all p values < 0.05). A significant decrease in the number of patients presenting with haematuria, urinary retention, urinary tract infection, scrotal pain, renal colic, or trauma and urgent/emergent cases that required surgery was reported (all p values < 0.05). Conclusion: In Italy, during the COVID-19 outbreak there has been a decrease in patients seeking help for urgent/emergent urological conditions. Restructuring of hospitals and clinics is mandatory to cope with the COVID-19 pandemic; however, the healthcare system should continue to provide adequate levels of care also to patients with other conditions.

OBJECTIVE:To describe the trend in surgical volume in urology in Italy during the coronavirus disease 2019 (COVID-19) outbreak, as a result of the abrupt reorganisation of the Italian national health system to augment care provision to symptomatic patients with COVID-19.METHODS:A total of 33 urological units with physicians affiliated to the AGILE consortium (Italian Group for Advanced Laparo-Endoscopic Surgery; www.agilegroup.it) were surveyed. Urologists were asked to report the amount of surgical elective procedures week-by-week, from the beginning of the emergency to the following month.RESULTS:The 33 hospitals involved in the study account overall for 22 945 beds and are distributed in 13/20 Italian regions. Before the outbreak, the involved urology units performed overall 1213 procedures/week, half of which were oncological. A month later, the number of surgeries had declined by 78%. Lombardy, the first region with positive COVID-19 cases, experienced a 94% reduction. The decrease in oncological and non-oncological surgical activity was 35.9% and 89%, respectively. The trend of the decline showed a delay of roughly 2 weeks for the other regions.CONCLUSION:Italy, a country with a high fatality rate from COVID-19, experienced a sudden decline in surgical activity. This decline was inversely related to the increase in COVID-19 care, with potential harm particularly in the oncological field. The Italian experience may be helpful for future surgical pre-planning in other countries not so drastically affected by the disease to date.

BACKGROUND:To report the perioperative and early functional outcomes of patients undergoing Robot-assisted radical cystectomy (RARC) with totally intracorporeal urinary diversion performed by a single surgeon after a modified modular training.METHODS:The surgeon (A.P.) attained a 30-days modified modular training at a referring Center mentored by a worldwide-recognized robotic surgeon (P.W.). The training program consisted of: 1) e-learning based on 10 hours of theoretical lessons made by the mentor; 2) video-session concerning the different steps of the procedure, 3) step-by-step in vivo modular training. Demographics, intraoperative data and post-operative complications were recorded for each patient.RESULTS:Twenty-four consecutive patients were prospectively evaluated. Median age was 68.5 years (IQR 59-75). Thirteen (54.2%) and 11 (45.8%) patients received RARC with orthotopic neobladder (ONB) and ileal conduit (IC), respectively. Overall mean (±SD) operative time was 392 (± 34.8) minutes. The median number of lymph node retrieved was 30 (IQR 24-42), the mean intraoperative estimated blood loss (EBL) was 403 mL (±60) with average hospitalization of 7.8 days (±2.2). All procedures were completed successfully without open conversion. A statistically significant difference in terms of overall operative time (OT) and urinary diversion operative time (UDOT) was found in favor of IC group compared to ONB group (P=0.002). Overall complication rate was 33%, 7 out of 9 (88%) were graded as minor (Clavien 1-2). Two (22%) major complications (Clavien 3-5) occurred solely on ONB group.CONCLUSIONS:Robot-assisted radical cystectomy with totally intracorporeal urinary diversion is a challenging procedure with a steep learning curve. An adequate modular training with an experienced mentor and a skilled robotic team could be essential to reach these optimal results. Further studies investigating the impact of modular learning curve and a dedicated menthorship on operative and functional outcomes after RARC are needed.