INTRODUCTION:Testicular torsion (TT) is a surgical emergency in which prompt intervention is critical for testicular salvage. Delays in care remain common and may occur both before and after hospital presentation. OBJECTIVE:To identify clinical and non-clinical predictors of orchiectomy in patients with TT and determine whether pre-hospital or in-hospital delays have the greater impact on testicular salvage. STUDY DESIGN:We retrospectively reviewed all TT cases from 2017 to 2024 at a metropolitan tertiary care center. Demographic and process variables were collected, including time intervals throughout emergency and operative management. Univariate and multivariate logistic regression were used to identify predictors of orchiectomy, and a logistic regression spline model was constructed to characterize the relationship between time to presentation and orchiectomy risk. RESULTS:Among 109 patients, 34 % underwent orchiectomy. On multivariate analysis, only pre-hospital symptom duration predicted orchiectomy: 6-24 h (OR 11.7, 95 % CI 2.1-94.0, p = 0.009) and >24 h (OR 430.7, 95 % CI 21.9-21031.6, p < 0.001). The spline model estimated a 50 % probability of orchiectomy at approximately 23 h after symptom onset. Weekend or nighttime admissions, hospital transfer, and triage-to-OR time were not associated with orchiectomy. Median in-hospital time from ED triage to OR start was 4.1 h (IQR 3.2-4.8) and there was no significant differences between orchiopexy and orchiectomy groups (p = 0.068). DISCUSSION:Pre-hospital delay was the primary driver of orchiectomy risk, whereas in-hospital workflow factors had no statistically significant impact on outcomes. While continued efforts to optimize triage efficiency for patients with suspected TT remain important, our findings suggest that educational initiatives promoting early symptom recognition and prompt emergency department presentation may offer greater potential for improving testicular salvage than further in-hospital process refinements. CONCLUSION:Although streamlining in-hospital triage for patients with suspected TT remains important, targeting pre-hospital delays through patient, parental, and provider education may offer even greater opportunities to improve testicular salvage.

INTRODUCTION:Understanding decision-making and post-donation experiences in living kidney donors informs more effective pre-donation counseling and follow-up care. This study examined factors influencing donation decisions and post-operative experiences among patients who underwent laparoscopic donor nephrectomy (LDN) or single port robotic-assisted donor nephrectomy (SPRDN). METHODS:We conducted a retrospective survey of patients who underwent LDN or SPRDN by a single surgeon between 2013 and 2024 using a study-specific questionnaire. Participants rated pre-donation factors based on importance in their decision to donate. Responses were analyzed based on donor age, sex and relationship to recipient. Donors then reported on their post-donation experiences, and responses were analyzed by surgical approach. RESULTS:Sixty-eight patients completed the survey (44% response rate). Donors rated long-term renal function and personal fulfillment as the most important factors when deciding to donate. Additionally, female donors prioritized personal fulfillment significantly more than male donors and younger donors were significantly more concerned about post-operative complications and recovery than older donors. After donation, most donors reported increased happiness and minimal quality-of-life impact, though nearly half expressed greater caution in daily activities. Notably, SPRDN donors were significantly more likely to report faster-than-expected recovery compared to LDN donors. CONCLUSIONS:Donors prioritize long-term kidney health and personal fulfillment when considering donation, underscoring the need to address these concerns during preoperative counseling. Following donation, ongoing lifestyle education is essential to address persistent post-donation caution and ensure long-term donor well-being. SPRDN is as a promising alternative for LKD, potentially enhancing the donor experience through faster recovery.

Recent studies have shown comparable outcomes between robotic and laparoscopic donor nephrectomy. Since its FDA approval in 2018, the da Vinci single-port (SP) robotic surgical system has been used for a variety of urologic robotic cases, including more recently, SP robotic donor nephrectomy (SP RDN). We evaluated the outcomes of SP RDN at our institution and discussed the surgical steps and operative considerations when performing SP RDN. 51 donors underwent SP RDN from 9/1/2020 to 7/1/2024 at our institution. Patients were placed in modified flank position and the robotic platform was docked following a 7 cm Pfannenstiel incision and a 12 mm umbilical assistant port placement. Surgical steps included 1) medial reflection of colon and accessing the retroperitoneum, 2) splenic mobilization, 3) exposure of gonadal and renal vein, 4) ligation of adrenal, gonadal, and lumbar vein, 5) dissection of renal hilum, 6) mobilization of upper pole of kidney, 7) lateral and posterior mobilization of kidney, 8) mobilization and ligation of ureter, 9) extraction preparation, 10) ligation of renal artery and vein, 11) kidney extraction. Mean operative, extraction, and warm ischemia times as well as hemoglobin change and length of stay were in line with current literature. Postoperatively, mean donor eGFR ranged was 67.21 mL/min/1.73m2 at 2-weeks and 70.1 mL/min/1.73m2 at 1-year. Recipient post-op eGFR was 62.9 mL/min/1.73m2 by postoperative day 3 and 59.3 mL/min/1.73 m at 1-year. Postoperative 30-day emergency department visit and hospital readmissions were both 1.9 % (1/51). Clavien-Dindo II-IV complications occurred in 9.8 % of patients. Overall, SP RDN is a novel approach to donor nephrectomy, which provides excellent visualization and degrees of freedom that allow surgeons to tackle complex vascular anatomy while reducing number of laparoscopic incisions.

We evaluated trends, predictors, and outcomes of unplanned open conversion for patients with upper tract urothelial carcinoma (UTUC) undergoing robotic radical nephroureterectomy (R-RNU) or laparoscopic RNU (L-RNU). The National Cancer Database was queried from 2010 to 2020 for patients with non-metastatic UTUC treated with RNU. Trends in surgical approach and conversion were evaluated. Demographics and outcomes including lymph node dissection, lymph node yield, positive surgical margins (PSM), prolonged length of stay (PLOS) (≥ 90th percentile), unplanned readmission (UR), and 30- and 90-day mortality were compared between converted and unconverted cases. Multivariate logistic regression evaluated predictors of conversion and whether conversion predicted adverse clinical outcomes. 25,523 cases were included (robotic = 40.4

OBJECTIVE To evaluate the statistical fragility of randomized controlled trials (RCTs) outcomes cited by the American Urological Association (AUA) and European Association of Urology (EAU) nephrolithiasis management guidelines using the fragility index (FI), reverse fragility index (rFI), and fragility quotient (FQ). METHODS Two-armed RCTs with at least one dichotomous outcome cited by the AUA and EAU were identified. FI was calculated using a 2 x 2 contingency table, adjusting events until statistical significance was lost (P >=.05). rFI was determined by modifying nonsignificant outcomes until significance was achieved (P < .05). FQ was calculated by dividing FI by sample size. RESULTS A total of 1210 outcomes from 138 RCTs were analyzed. The median FI for AUA-cited studies was 4 (IQR 3-6) with an FQ of 0.05 (0.03-0.09), while for EAU-cited studies, median FI was 5 (3-7) with an FQ of 0.04 (0.02-0.06). Over 62% of outcomes required fewer than five event reversals to alter significance. No significant difference in FI (P = .375) or FQ (P = .080) was found between AUA and EAU studies. With respect to median publication year, FI significantly increased in EAU studies published after 2015 (P = .001), and FQ in AUA studies was significantly higher after 2006 (P = .004). In 11.8% of AUA and 14.2% of EAU outcomes, loss to follow-up exceeded the FI. CONCLUSION RCTs cited in AUA and EAU nephrolithiasis guidelines demonstrate statistical fragility. The findings underscore the limitations of P-values as a sole measure of evidence strength. Future research should incorporate FI, rFI, and FQ to enhance clinical decision-making. UROLOGY 202: 46-53, 2025. (c) 2025 Elsevier Inc. All rights are reserved, including those for text and data mining, AI training, and similar technologies.

The internet is a primary source of health information, our study addresses the need to assess the credibility, readability, and reliability of Spanish-language medical websites concerning nephrolithiasis. With the Spanish-speaking population in the United States rapidly approaching 20