Background Flexible ureteroscopy (FURS) has become a standard treatment for upper urinary tract stones. However, stone evacuation efficiency remains a concern. Novel suction evacuation ureteral access sheaths (FANS-UAS) with bendable tips may improve outcomes. Objective To compare the feasibility and efficacy of suction evacuation ureteral access sheath versus standard ureteral access sheath during FURS for upper urinary tract stone lithotripsy. MethodsThis prospective randomized comparative study was conducted from April 2024 to April 2025 at Tanta University Hospital. Seventy patients with upper urinary tract stones <= 20 mm were randomly allocated into two groups: Group A (n = 35) using suction evacuation UAS (ClearPetra 11/13 Fr) and Group B (n = 35) using standard UAS (11/13 Fr). Primary endpoint was 1-month NCCT stone-free rate. Secondary endpoints included immediate stone free rate, operative time, surgeon satisfaction, and complications. Results Of the 70 randomized patients, 60 were included in the per-protocol analysis (29 in Group A and 31 in Group B). Regarding the primary endpoint, Group A achieved a significantly superior one-month NCCT stone-free rate compared to Group B (93% vs 71%, p = 0.043). Concerning secondary endpoints, Group A demonstrated significantly higher immediate stone clearance rates assessed by both endoscopic vision (86% vs 61%, p = 0.029) and C-arm fluoroscopy (97% vs 74%, p = 0.015). Additionally, Group A had a significantly shorter mean operative time compared to Group B (77.59 +/- 9.32 vs 87.74 +/- 12.51 min, p = 0.001). Surgeon satisfaction scores were significantly higher in Group A across all assessed domains, including visualization, fragmentation, maneuverability, and suction (all p < 0.001). No significant differences were observed between the two groups regarding complications, hospital stay, or pain scores. Conclusions Suction evacuation ureteral access sheaths with bendable tips significantly improve operative efficiency, immediate and one-month stone-free rates, and surgeon satisfaction compared to standard sheaths, while maintaining similar safety profiles.

Introduction The aim of the study was to evaluate the accuracy of responses from three common artificial intelligence (AI) tools-ChatGPT, Claude, and DeepSeek-to patient enquiries regarding lower urinary tract symptoms (LUTS), comparing these responses to European Association of Urology (EAU) 2025 guidelines. As patients increasingly turn to large language models (LLMs), it is crucial to assess their reliability. Material and methods Prospective face-to-face and telephone general urology clinics were conducted between April and May 2025, during which consented patients were asked to state the questions they would submit to an AI tool if they were to enquire about their LUTS. These questions were submitted to ChatGPT (GPT-4), Claude (Sonnet 4.0), and DeepSeek (V3), and the responses were summarised and compared against the EAU guidelines. Each response was categorised as correct, missing key elements from the guidelines, or incorrect/misleading. Results Sixteen patients participated in the study, and following removal of duplicate questions, a total of 13 were included for analysis. These questions covered symptom causation, diagnostic workup and management of LUTS. All models provided correct information in 92.3% of their responses when compared to the EAU guidelines. However, 92.3-100% of answers omitted key elements from the guidelines, and 30.8-92.3% contained incorrect or misleading content. Conclusions Current LLMs provide readily accessible guidance on LUTS; however, their unsupervised use in clinical decision-making remains a concern and may be considered premature.

BACKGROUND:Proficiency based progression (PBP) is a very effective method of training and has been adopted by the European Robotic Surgical Section (ERUS) for robotic skills training. No study has addressed whether all learners can be trained to the proficiency benchmark. In this study, we evaluated: 1) if all trainees reached a quantitatively defined proficiency benchmark for a robotic suturing and knot tying anastomosis task; and 2) the number of training trials required. METHODS:In a multi-center, prospective, randomized, study, 48 participants were randomized to: 1) a PBP group that received e-learning on the ORSI chicken anastomosis task with the requirement to reach the proficiency benchmark before starting practical training; 2) e-learning group, received the exact same curriculum as group 1, but with no proficiency requirement on the e-learning; 3) traditional group received the exact same curriculum in face-to-face lectures; 4) the apprenticeship group received a conventional preparation. RESULTS:All participants, except five in group 4, demonstrated the proficiency benchmark. Group 1 took ~6 trials (~3 hours); group 2 required 14% longer, group 3, 103% (P<0.001) and in group 4, 58% of trainees demonstrated the benchmark but took 162% (P<0.001) longer. This was a small-scale but robust study with substantial effect sizes. CONCLUSIONS:All PBP trainees demonstrated the proficiency benchmark in comparison to 58% of conventional trained group. As adherence to the PBP methodology decreased, the efficiency of proficiency demonstration significantly reduced.

In patients who have undergone previous prostate biopsies, surgeons are worried that enucleation may be challenging due to potential adhesions, hematoma, and fibrosis between adenoma and prostatic capsule. Therefore, we aimed in this study to evaluate the impact of previous prostate biopsy on the technique of bipolar transurethral enucleation of the prostate (B-TUEP) and also, to detect the ideal time interval between biopsy and enucleation of the prostate. The data of 125 patients who underwent (B-TUEP) were retrospectively reviewed. Patients were stratified into two groups; group A (no previous biopsy) (n = 93) and group B (n = 32) had undergone previous prostate biopsy. Enucleation time, overall operative time, enucleation efficacy and complications were compared in both groups. The median age of our patients was 67 (56–76). The enucleation and overall operative time (OT) were significantly longer in group B than in group A (p < 0.001). The overall post-operative complications rate was higher in group B (40.6

Purpose To compare the erectile and urinary functions of ventral and dorsal onlay buccal mucosal graft (BMG) urethroplasty in the management of proximal bulbar urethral strictures (PBUS) in sexually active men. Patients and methods We retrospectively included patients with primary non-traumatic PBUS who were treated with (BMG) urethroplasty at our department between March 2019 and March 2023 either ventral or dorsal approaches. Patients were assessed at 3- and 12-months postoperatively for urinary and erectile functions. Results133 patients were identified and underwent either ventral repair (n = 60, group I) or dorsal repair (n = 73, group II). There was no significant difference in baseline urinary and sexual function between both groups (p > 0.05). Overall, the success rate was 91.7% in Group I and 90.4% in Group II (p = 0.801). Transient ED (at 3 months) was detected in 5% and 25% (p = 0.002), while permeant ED (at 12 months) was 1.7% and 13.7% (p = 0.012) in group I and group II, respectively. Group I had significantly higher mean IIEF scores; 28.2 and 28.4 at 3 months (p < 0.001) and 12 months (p < 0.001); compared to Group II; 22.1 and 24.4, respectively. Conclusion The ventral approach had better erectile functional outcomes compared to the dorsal approach in the management of non-traumatic PBUS in sexually active men. This might be related to less urethral mobilization and no dissection of the intercrural space during ventral onlay graft urethroplasty.

BACKGROUND:Fragile patients with indwelling bladder catheter (IBC) represent a category at high risk of morbidity and overall quality of life decline. The goal for these patients is to remove the bladder catheter and avoid surgical stress, complications and long hospitalisation. Prostatic artery embolisation (PAE) has been developed as a minimally invasive procedure for the treatment of benign prostatic obstruction (BPO)-related lower urinary tract symptoms. We evaluated the results of PAE in patients unfit for surgery with IBC. METHODS:We retrospectively reviewed data on fragile patients unfit for surgery due to comorbidities with IBC secondary to BPO who underwent PAE in three centres. Our objective was to remove urinary catheter and maintain patients free from bladder catheter. We divided patients into two groups: Those with successful (Group A) or unsuccessful (Group B) procedure after 1 year. RESULTS:A total of 74 patients with IBC receiving PAE were included. No PAE failure occurred due to tortuous or atherosclerotic vessels. After 1 year, 49 patients (66.20%) were without bladder catheter. We found no differences in age (75.30 vs 78.70), Charlson comorbidity index (6.00 vs 6.60), prostate volume (94.70 vs 94.70), hospital stay (1.90 vs 3.90 days), catheterisation time after the procedure (17.20 vs 20.80 days) or complication rate (11.20% vs 8.30%) between Groups A and B. One patient developed postembolisation partial penile necrosis, two had penile skin ischemia (conservatively managed), and four developed urinary tract infection following the procedure. The history of IBC was longer in Group B than in Group A (9.70 vs 6.20 months, p = 0.018). Multivariate logistic regression confirmed a significant reduction in the probability of unsuccessful procedure based on an increased postoperative catheterisation time (odds ratio = 0.91; 95% confidence interval: 0.83-0.99). CONCLUSIONS:PAE is a minimally invasive surgical treatment for BPO. This procedure should be considered in elderly and fragile patients, based on its favourable safety profile. In our series, PAE was a safe procedure for patients with IBC affected by BPO. In our experience, the success of this treatment is correlated with postoperative catheterisation. Patient's selection and counselling are key for optimising the results.

OBJECTIVE To describe our own approach using buccal mucosal grafting and to assess the outcome of this approach. MATERIALS AND METHODS A total of 42 patients underwent ventral onlay BMG by a single surgeon between 2017 and 2022. A longitudinal incision along the length of the urethra was made through the anterior vaginal wall and the periurethral fascia was incised to create 2 flaps. This ventral urethrotomy ran from the meatus into the proximal healthy urethra above the level of the stricture. A buccal mucosal graft was harvested and sutured to the margins of the urethral mucosa itself and the flaps of periurethral fascia. The vaginal wall was then closed. RESULTS The mean age of the patients was 53.6 +/- 12.8 years. There were no perioperative or postoperative complications. At a mean follow-up of 38.1 months, 41 patients (98%) were stricture free. Peak flow rate improved from a mean of 7.7 +/- 3.2 mL/s preoperatively to 25.9 +/- 5.9 mL/s postoperatively. No patient developed incontinence. One patient developed a recurrent urethral stricture which was treated by redo urethroplasty. CONCLUSION The surgical technique applied has proved efficiency. The ventral BMG preserves the urethral sphincter and so avoids postoperative incontinence. The use of periurethral fascia represents good vascular and mechanical support for the graft. UROLOGY 193: 194-200, 2024. (c) 2024 Elsevier Inc. All rights are reserved, including those for text and data mining, AI training, and similar technologies.

Abstract Background Despite the fact that prostate abscess (PA) is a serious condition, no standardized guidelines are available on the best methods for its drainage. The goal of the current study is to compare the outcomes of the three modalities of prostate abscess (PA) drainage: transrectal ultrasound (TRUS) guided aspiration (TRA), transperineal aspiration (TPA), and transurethral de-roofing (TUD). Methods The records of 66 patients diagnosed with PAs were collected between 2015 and 2022 and divided into 3 groups according to the technique of abscess drainage that was used. Group A included 26 patients treated by TRA; Group B included 28 patients treated by TUD; and Group C included 12 patients treated by TPA. The three groups were compared based on demographic data, drainage success, recurrence, complications, and hospital stay. Results The mean abscess size (cm) was 4.8 ± 1, 5.7 ± 1, and 5.4 ± 1.3 cm in groups A, B, and C, respectively. Central abscesses were detected in 35 patients (53%), peripheral in 21 patients (31.8%), and both central and peripheral in 10 patients (15.2%). The most common clinical presentation was lower urinary tract symptoms (LUTS) in 45 patients (68.18%), followed by fever in 40 patients (60.6%). The mean abscess size (cm) was 4.8 ± 1, 5.7 ± 1, and 5.4 ± 1.3 cm in groups A, B, and C, respectively. Recurrence of the abscess occurred in three (11.5%), one (3.6%), and one (8.3%) patients in groups A, B, and C, respectively (p = 0.496). The mean hospital stay was 4.8 ± 1.7, 5 ± 1.8, and 4.5 ± 1.3 days in groups A, B, and C, respectively (p = 0.763). When compared to the other two groups, the TUD group had a higher rate of complications (32.1%). Conclusion A TRUS-guided transrectal and transperineal aspiration of PA were comparable to TUD technique regarding the recurrence rate and hospitalization period; however, the safety profile was in favor of the aspiration groups.

This study investigated the effect of Urtica dioica roots etheric extract (UDEE) on oxidative stress, and urine obstruction with histopathological examinations of prostatic and renal tissues,and suggests computational methods as a complementary method, to make a hypothesis on the overall effect of UDEE in the treatment of benign prostatic hyperplasia (BPH).Gas chromatography/mass spectrometry was utilised to characterise UDEE.BPH was induced in rats through daily subcutaneous injections of testosterone propionate. Rats were also orally administered UDEE or a vehicle. After four weeks, prostate weight, urine output, and biochemical markers were evaluated. UDEE treatment demonstrated significant regression of prostatic enlargement, improved biochemical and histopathological characteristics, and regulation of antioxidant activity levels. Phytosteroids stand out, act by inhibiting 5α-reductase and aromatase. This study provides an insight into treatment of BPH, demonstrating safety of this compound towards the kidney compared to finasteride without severe side effects.

Objective: To evaluate the outcomes of ventral onlay buccal mucosal graft urethroplasty (VOBMGU) in bulbomembranous urethral strictures after transurethral resection of the prostate. Methods: After approval of the institutional ethical committee, we retrospectively examined the database of patients diagnosed with post-TURP urethral stricture (PTS) and treated by VOBMGU from January 2020 to January 2022. The patients were evaluated by retrograde urethrogram and voiding cystourethrogram. Follow-up evaluation included assessment of lower urinary tract symptoms, physical examination, uroflowmetry (Q-max and International Prostate Symptom Score) 3, 6, and 12 months of follow-up. Results: A total of 30 patients underwent VOBMGU for bulbomembranous PTS were included. The median age of the patients was 63.5 (11.25). The median stricture length was 3.5 (1.5) cm. During follow-up, the mean Q-max significantly increased to 21.1 +/- 5.5 mL/s (P < .0001), 20.1 +/- 5.4 mL/s (P < .001), and 19.1 +/- 5.3 mL/s (P < .003) at 3, 6, and 12 months, respectively. IPSS significantly decreased to 8.93 +/- 6.37 at the 12-month follow-up mark (P < .0001). Three patients developed stricture recurrence and two patients developed postoperative urinary incontinence. Conclusion: VOBMGU in cases of bulbomembranous urethral PTS offered excellent functional outcomes with low stricture recurrence and minimal risk of incontinence. Further prospective studies are warranted to confirm the results. (c) 2024 Elsevier Inc. All rights reserved.

The metaverse refers to a collective virtual space that combines physical and digital realities to create immersive, interactive environments. This space is powered by technologies such as augmented reality (AR), virtual reality (VR), artificial intelligence (AI) and blockchain. In healthcare, the metaverse can offer many applications. Specifically in surgery, potential uses of the metaverse include the possibility of conducting immersive surgical training in a VR or AR setting, and enhancing surgical planning through the adoption of three-dimensional virtual models and simulated procedures. At the intraoperative level, AR-guided surgery can assist the surgeon in real time to increase surgical precision in tumour identification and selective management of vessels. In post-operative care, potential uses of the metaverse include recovery monitoring and patient education. In urology, AR and VR have been widely explored in the past decade, mainly for surgical navigation in prostate and kidney cancer surgery, whereas only anecdotal metaverse experiences have been reported to date, specifically in partial nephrectomy. In the future, further integration of AI will improve the metaverse experience, potentially increasing the possibility of carrying out surgical navigation, data collection and virtual trials within the metaverse. However, challenges concerning data security and regulatory compliance must be addressed before the metaverse can be used to improve patient care.

BACKGROUND:Histopathological examination, a cornerstone in diagnosing cancer, faces challenges due to its time-consuming nature. This review explores the potential of ex-vivo fluorescent confocal microscopy (FCM) in urology, addressing the need for real-time pathological assessment, particularly in prostate cancer. This systematic review aims to assess the applications of FCM in urology, including its role in prostate cancer diagnosis, surgical margin assessment, and other urological fields. METHODS:Following Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, a systematic search of PubMed and SCOPUS was conducted, focusing on English written original articles published after January 1, 2018, discussing the use of FCM in urological practice. The search included keywords related to FCM and urological terms. The risk of bias assessment was performed using Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool. RESULTS:A total of 17 relevant studies were included in the review that focuses on three main urological issues: prostate cancer (15 articles), bladder cancer (1 article), and renal biopsy (1 article). FCM exhibited significant promise in diagnosing prostate cancer. These studies reported an accuracy range of 85.33% to 95.1% in distinguishing between cancerous and non-cancerous prostate tissues. Moreover, FCM proved valuable for assessing surgical margins in real-time during radical prostatectomy, reducing the need for frozen section analysis. In some investigations, researchers explored the integration of artificial intelligence (AI) with FCM to automate diagnostic processes. Concerning bladder cancer, FCM played a beneficial role in evaluating urethral and ureteral margins during radical cystectomy. Notably, it showed substantial agreement with conventional histopathology and frozen section examination. In the context of renal biopsy, FCM demonstrated the potential to differentiate normal renal parenchyma from cancerous tissue, although the available evidence is limited in this area. The main limitation of the current study is the scarcity of data regarding the topic of interest. CONCLUSIONS:Ex-vivo FCM holds promise in urology, particularly in prostate cancer diagnosis and surgical margin assessment. Its real-time capabilities may reduce diagnostic delays and patient stress. However, most studies remain experimental, requiring further research to validate clinical utility.

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Surgical Therapy & New Technology III (MP46)1 May 2024MP46-20 THE SAFETY AND EFFICACY OF ADDITION OF GENTAMICIN ON IRRIGATION FLUID IN PREVENTION OF POST-TRANSURETHRAL RESECTION OF THE PROSTATE INFECTIOUS COMPLICATIONS: A PROSPECTIVE RANDOMIZED DOUBLE BLINDED PLACEBO CONTROLLED TRIAL Ahmed Zoeir, Ayman Mousa, Hussein Mamdoh, Talaat Zaghloul, Tarek Gameel, Maged Ragab, Mohamed Abo-Elenein, Mansour R. Fotouh, and Ahmed Eissa Ahmed ZoeirAhmed Zoeir , Ayman MousaAyman Mousa , Hussein MamdohHussein Mamdoh , Talaat ZaghloulTalaat Zaghloul , Tarek GameelTarek Gameel , Maged RagabMaged Ragab , Mohamed Abo-EleneinMohamed Abo-Elenein , Mansour R. FotouhMansour R. Fotouh , and Ahmed EissaAhmed Eissa View All Author Informationhttps://doi.org/10.1097/01.JU.0001008668.53858.38.20AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Infectious complications after transurethral resection of the prostate (TURP) is common and their reported incidence varies widely. The specific incidence of postoperative bacteriuria has been reported to be 7.6–26%. The prevention of postoperative infectious complications is important and only a few studies have evaluated the risk factors. The objectives: to evaluate the safety and efficacy of adding gentamicin on irrigation fluid in prevention of post-TURP infectious complications. METHODS: After the ethical committee approval, 220 patients scheduled for TURP for the management of urinary retention or LUTS were included and divided into two groups; "Group A" included 110 patients who had undergone TURP with addition of one ampoule of gentamicin 80 mg (2ml) /3L of irrigation solution (the first 9 Liters during resection and the first 6 Liters during post-operative irrigation) and "Group B" included 110 patients who had underwent TURP with addition of normal saline (2 ml) as a placebo on the irrigation solution. Determination of Gentamicin in human serum using HPLC/UV after Chemical Derivatization was done using the method of Barends et al (Barends, Brouwers, & Hulshoff, 1987). Both groups were compared as regards the demographic data, post-operative pyuria and bacteruria (1 week after removal of urethral catheter), fever, and/or sepsis. RESULTS: The demographic data were comparable in both groups. The mean operative time was 58.95±7.92 and 58.58±8.90 minutes in groups A and B, respectively. No significant changes between pre-and post-operative serum creatinine in both groups. The applied method could not detect any amount of gentamicin in the serum of the tested patients. These results indicated that gentamicin was either not absorbed or was circulating in the blood stream with concentrations lower than the limit of quantitation (that could be neglected and wouldn't induce neither therapeutic effect nor side effects). Post-operative pyuria (1 week after urethral catheter) occurred in 8.2 % in group A versus 20.9% in group B (P=0.007). Post-operative bacteruria was observed in 7 patients (6.3 %) in group A versus 22 patients (20 %) in group B (p value<0.001). febrile UTI occurred in 3 patients in group A versus 7 patients in group B. Sepsis occurred in two patients in group B. CONCLUSIONS: The addition of gentamicin on the irrigation solution during and after TURP is safe and significantly associated with reduction of postoperative pyuria, bacteruria and febrile UTI. Further studies are needed to confirm our findings. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e761 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Ahmed Zoeir More articles by this author Ayman Mousa More articles by this author Hussein Mamdoh More articles by this author Talaat Zaghloul More articles by this author Tarek Gameel More articles by this author Maged Ragab More articles by this author Mohamed Abo-Elenein More articles by this author Mansour R. Fotouh More articles by this author Ahmed Eissa More articles by this author Expand All Advertisement PDF downloadLoading ...

INTRODUCTION:Donor nephrectomy (DN) is a unique surgical procedure in urological practice, as it involves exposing a healthy individual to the potential risks of surgery. This type of surgery exhibits heterogeneity in terms of approach (open, laparoscopic, or robotic), each with its unique set of advantages and disadvantages. Consequently, there is currently a lack of universally agreed upon clear guidelines. In these settings, this study aims to evaluate transplantation surgeons' knowledge through a real-life survey and compare it with data from published randomized controlled trials (RCTs). EVIDENCE ACQUISITION:The study is divided into two parts, with the first part focusing on the outcomes of the real-life survey designed to assess surgeons' knowledge about different DN approaches and their real-world practices during the surgery. The second part involves a systematic review and meta-analysis of RCTs, specifically examining the outcomes of different surgical approaches to DN. The systematic review followed the PRISMA Guidelines and involved a search of PubMed and Web of Science for RCTs comparing the outcomes of different DN approaches. The risk of bias was assessed using the RoB-2 tool. The random effect model was mainly used to assess the mean difference of the included studies. EVIDENCE SYNTHESIS:The study was conducted between July 2021 and January 2022 and surveyed 50 surgeons, of which 35 participants (70%) completed the survey. Regarding various approaches to DN, 97.14% of surgeons reported having experience with live DN, and 45.72% performed over 15 cases per year. The most performed approach was pure laparoscopic DN (68.57%). Pure laparoscopic DN was the preferred approach for 77.42% of respondents. The review process resulted in 335 articles, of which 35 were eligible for inclusion in the systematic review. In summary, most studies found that laparoscopic approaches, including standard, hand-assisted, LESS-DN, and mini-LDN, resulted in less postoperative pain, better cosmetic, and quicker recovery times compared to open approaches. The main limitation of the current study is the heterogeneity of the included studies. CONCLUSIONS:The study provides valuable insights into the practices of renal transplantation surgeons, offering a comprehensive comparison to level 1 studies (RCTs) in the field. It underscores the continued significance of ODN in contemporary practice, particularly in light of recommendations from the EAU guidelines on renal transplantation. This reaffirms the need to consider the advantages and disadvantages of various approaches, including factors such as cost, postoperative pain, and cosmetic outcomes. While robotic-assisted DN holds promise, their adoption remains variable, potentially due to limited robust evidence.

Background: The ectopic pelvic kidney, a common renal anomaly, is often smaller and malformed, with a shorter and sometimes tortuous ureter (1). Muscle -invasive bladder cancer (MIBC), constituting 15-25% of bladder cancer cases (2), mandates radical cystectomy with a 50% 5 -year survival rate (2). Despite the growing use of robot -assisted radical cystectomy (RARC) (3, 4), there is limited data on its application in ectopic kidneys. Only one RARC case has been reported (5), in contrast to numerous open radical cystectomies (1, 6) involving an ectopic kidney. Patient and methods: After being diagnosed with T2 high-grade urothelial carcinoma, the 66 -year -old patient, previously treated with multiple transurethral resections and adjuvant BCG therapy, received neoadjuvant chemotherapy. Preoperative staging CT revealed a 2.6 x 2.2 cm bladder neoformation and an ectopic right pelvic kidney. Results: Using the da Vinci Surgical System, radical cystectomy with ileal conduit (sec Wallace II) and lymphadenectomy were performed. During the demolition phase, the shorter right ureter was dissected with care to avoid damage to the renal pedicle. The reconstructive phase included intracorporeal urinary diversion (ICUD) and uretero-ileal anastomosis, facilitated by the favorable position of the kidney. The 8 -hour console surgery resulted in minimal blood loss. Discharged on day 16 due to COVID-19, the patient exhibited positive outcomes. A 2 -month CT follow-up revealed no cancer recurrence, metastasis, hydronephrosis, and complete regression of the lymphocele. Imaging follow-up continues without postoperative adjuvant chemotherapy. Conclusion: Robotic surgery with intracorporeal urinary diversion holds potential for right -sided pelvic kidney cases, but additional studies are necessary for validation.

BACKGROUND: Percutaneous nephrolithotomy (PCNL) could be performed in both prone and supine positions. Each position has its own advantages and disadvantages. "Learning curve" is a graph that represents progress of a skill against the time needed to master the technique. We hypothesized that supine PCNL might have a shorter learning curve by novice urologists compared to prone PCNL based on the findings of previous studies assessing the learning curve of both techniques. The aim of this study is to assess the learning curve of prone and supine PCNL among novice urologists to detect which is easier for the beginners. METHODS: One hundred and fifty patients undergoing PCNL for renal stones were included and divided into two groups; Group A included 75 patients undergoing supine PCNL and Group B included 75 patients undergoing prone PCNL. Subsequently, each group was subdivided into three subgroups of 25 patients to allow the evaluation of the learning curve of the two novice surgeons as regards: operative time, fluoroscopy time, stone free rate, and complications. RESULTS: The mean operative time in group A decreased from of 111.813.91 minutes to 84.2 +/- 15.86 minutes, and thereafter, decreased to 78.4 +/- 12.97 minutes in the three consecutive subgroups. Similarly, in group B, the mean operative time decreased from 122 +/- 23.76 minutes to 110.2 +/- 17.05 minutes, and thereafter, further decreased to 82 +/- 15.34 minutes. The operative time plateau was reached after 25 and 50 cases in groups A and B, respectively. The overall stone free rate, and complications were comparable in both groups. CONCLUSIONS: Both supine and prone PCNL are safe and effective; however, supine PCNL may be associated with significantly shorter learning curve.