INTRODUCTION:Peyronie's disease causes penile curvature and painful erections, potentially impairing quality of life; surgical grafts are employed to correct curvature and restore penetrative sexual function. OBJECTIVES:This study aimed to summarize the evidence on perioperative and functional outcomes of surgical grafting procedures for Peyronie's disease. METHODS:A systematic review was conducted following the PRISMA guidelines. Databases including PubMed, EMBASE, Scopus, Google Scholar, and the Cochrane Library were searched up to April 1, 2023. Eligible studies included retrospective or prospective reports on patients aged 18 years or older treated with various graft materials, including vein, dermal, buccal mucosa, small intestinal submucosa, human cadaveric, and bovine pericardium. Quality was assessed using the JBI Critical Appraisal Checklist. Due to data heterogeneity and a lack of comparative studies, no quantitative synthesis was performed. The systematic review was registered on PROSPERO-CRD42024508997. The review focused on perioperative outcomes, erectile function changes, and complication rates associated with different graft materials. RESULTS:Out of 521 articles identified from 1933 to 2023, 71 studies involving 2692 patients met the inclusion criteria. Six studies were prospective, and the remainder were retrospective. Quality assessment revealed a high or severely high risk of bias across all included studies. Erectile function worsened in 0%-70% of patients, with complication rates ranging from 0% to 50%. No comparative studies among graft types were identified. CONCLUSION:Various graft materials offer reliable perioperative and functional outcomes for Peyronie's disease; however, further comparative studies are essential.

BACKGROUND:Radical cystectomy with pelvic lymph node dissection (PLND) remains the standard treatment for muscle-invasive bladder cancer (MIBC). Neoadjuvant chemotherapy (NAC) improves survival, and recent immunochemotherapy trials have reported complete pathological responses in up to 60% of patients, increasing interest in bladder-sparing strategies. However, the ability to accurately identify patients without residual pelvic lymph node metastases after NAC remains limited. OBJECTIVE:To evaluate the association between pathological response in the bladder and pelvic lymph node status after NAC in patients with MIBC undergoing radical cystectomy (RC) and PLND. DESIGN, SETTING, AND PARTICIPANTS:This retrospective, multi-institutional cohort study included 751 patients with MIBC treated with NAC followed by RC and PLND between 2000 and 2021 across 26 institutions. INTERVENTION:Neoadjuvant chemotherapy followed by RC and PLND. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS:The primary outcome was residual lymph node involvement (ypN+). Multivariable logistic regression was used to identify factors associated with ypN+. RESULTS AND LIMITATIONS:Overall, 175 patients (23%) achieved a complete pathological response in the bladder (ypT0), 102 (14%) were downstaged to non-muscle-invasive disease (ypTa/ypTis/ypT1), and 185 (25%) had residual lymph node involvement. On multivariable analysis, cN+ disease before NAC was associated with higher odds of ypN+ (OR 1.97, 95% CI 1.32-2.94), whereas ypT0 (OR 0.11, 95% CI 0.05-0.21) and ypTa/ypTis/ypT1 (OR 0.24, 95% CI 0.12-0.47) were associated with lower odds of ypN+. Notably, 5% of ypT0 and 10% of downstaged patients harboured residual lymph node metastases. Limitations include potential selection bias and centre-level variability in surgical and pathological assessment, which may affect the generalizability of the findings. CONCLUSIONS:Current clinical and radiological variables cannot reliably exclude residual pelvic lymph node disease, even in patients achieving ypT0-1. Novel imaging techniques and liquid biomarkers require validation before bladder-sparing approaches can be safely expanded.

OBJECTIVE:To achieve an international expert consensus among surgeons on the indications, contraindications, and perioperative management of feminising genital surgery (FGS) for assigned-male-at-birth (AMAB) individuals, using a Delphi process. METHODS:A two-round on-line Delphi survey (May-July 2025) followed by a final consensus meeting (September 2025) was conducted among 27 urological surgeons specialised in gender-affirming genital surgery. The survey explored eligibility criteria, risk factors, hormone therapy, counselling, and perioperative care. Consensus was defined a priori as ≥75% agreement or disagreement, with descriptive statistics summarising results. RESULTS:In all, 26 experts (96%) completed Round 1, and 24 (89%) completed Round 2. Consensus was achieved on 63 of 68 statements. Advanced age alone was not a contraindication but should be evaluated alongside comorbidities. Body mass index >24.9 kg/m2, diabetes, smoking, and cardiovascular disease were identified as significant risk factors for postoperative complications. Major psychiatric disorders and spinal cord injury were relative contraindications for FGS. Previous pelvic surgery or radiotherapy, as well as Charlson Comorbidity Index ≥3, were considered relative contraindications for vaginoplasty only. No consensus was reached on the timing of hormone therapy interruption or re-initiation. Preoperative counselling was essential for adherence to wound care and dilation protocols and for addressing complications such as infection, thromboembolism, bleeding, and bowel injury. Experts recommended genital hair removal, enoxaparin prophylaxis, postoperative dressings and catheterization for 3-5 days, and pelvic rehabilitation before and after surgery. A dilation protocol of three daily 30-min sessions was advised. FGS improved quality of life even in older or comorbid patients, although healing and function may be less optimal. CONCLUSION:This study presents the first international Delphi consensus on indications and perioperative management of FGS in AMAB individuals, emphasising individualised, comorbidity-based assessment, structured counselling, and multidisciplinary care. Unresolved issues regarding hormone therapy require further study.

OBJECTIVE:To establish international expert consensus on indications, contraindications, risk factors, and complication management in masculinising genital surgery (MGS) for assigned female at birth individuals, addressing the current lack of evidence-based selection criteria. METHODS:A two-round Delphi study was conducted between May and July 2025 using an on-line platform, followed by a final consensus meeting in September 2025. A total of 27 internationally recognised urologists with ≥5 years of independent experience in gender-affirming genital surgery were invited; response rates were 96% and 89% in rounds one and two, respectively. In all, 83 statements related to metoidioplasty and phalloplasty were evaluated using a Likert scale. Consensus was pre-defined as ≥75% agreement or disagreement. RESULTS:Consensus was achieved on 75 of 83 statements. No strict upper age limit was recommended for metoidioplasty or phalloplasty; however, advanced age and comorbidities were recognised as risk factors for prolonged healing and severe complications. A body mass index >24.9 kg/m2, diabetes mellitus, smoking, and cardiovascular disease were identified as relevant risk factors. A Charlson Comorbidity Index ≥3 was considered a relative contraindication for phalloplasty but not metoidioplasty. Multidisciplinary preoperative assessment was strongly endorsed. No consensus was reached regarding perioperative testosterone suspension. In urethral complications, staged reconstruction with a 6-month interval and consideration of perineostomy in high-risk patients were preferred. Penile prosthesis re-implantation was considered acceptable after one failure but discouraged after multiple complications. CONCLUSIONS:This international Delphi consensus provides structured, expert-based guidance for patient selection and complication management in MGS, emphasising individualised risk assessment, multidisciplinary evaluation, and cautious surgical planning in older or comorbid patients.

PURPOSE OF REVIEW:Outcome assessment after urethral stricture surgery remains inconsistent, with success traditionally defined by anatomical patency or absence of reintervention. Growing recognition of discordance between objective findings and patient experience has made it necessary to re-evaluate how outcomes are measured. This review explores contemporary approaches to defining success and highlights the need for standardized, patient-centered endpoints. RECENT FINDINGS:Current literature shows that anatomical and objective functional measures alone fail to capture the complexity of postoperative recovery. Patient-reported outcome measures have gained increasing importance, revealing persistent urinary symptoms, sexual dysfunction, and quality-of-life impairment despite technically successful reconstruction. Functional outcomes such as storage symptoms, ejaculatory changes, and perceived penile alterations are increasingly recognized as key determinants of satisfaction. Emerging composite outcomes aim to integrate anatomical, functional, and patient-reported domains into a unified framework. SUMMARY:Outcome evaluation in urethral stricture surgery is shifting toward multidimensional assessment that prioritizes patient perception alongside traditional metrics. Standardized composite endpoints may improve comparability across studies, support shared decision-making, and better align surgical success with patient expectations.

Iatrogenic urethral strictures represent a relevant complication following endoscopic surgical treatment for benign prostatic hyperplasia, potentially leading to significant morbidity and impaired quality of life. Despite advances in endoscopic technologies, urethral trauma related to prolonged operative time and large-caliber instruments remains a concern. The optimal management of urethral strictures secondary to surgery is still debated, and high-quality evidence comparing endoscopic and open reconstructive approaches is lacking. This systematic review aimed to evaluate the efficacy and safety of contemporary treatments for iatrogenic urethral strictures following endoscopic management of benign prostatic hyperplasia. A systematic review was conducted according to PRISMA guidelines and registered in PROSPERO (CRD42024604611). MEDLINE, Embase, and the Cochrane Library were searched from 2000 to June 2025. Studies reporting outcomes of endoscopic or open surgical treatments for urethral strictures following benign prostatic hyperplasia surgery were included. Data extraction focused on patient characteristics, stricture features, treatment modality, success rates, complications, and follow-up. Due to substantial heterogeneity, a meta-analysis was not performed. Eleven studies comprising a total of 610 patients were included. Of these, 443 (73

Background: We investigated the predictive role of prostatic morphology on preoperative multiparametric magnetic resonance imaging for post-prostatectomy urinary incontinence. Methods: Patients who underwent robot-assisted radical prostatectomy between February 2018 and October 2021 and who were not previously incontinent, did not undergo radiotherapy, hormone therapy, or transurethral resection of the prostate, and who had a follow-up longer than 12 months were selected. For each patient, a radiology physician evaluated the preoperative magnetic resonance imaging, measuring prostatic and membranous urethral length, classifying prostatic apex according to the Lee Type, and estimating the presence of the median lobe and its intravesical protrusion. Multivariate logistic regression models evaluated the influence of anatomic features measured in magnetic resonance imaging on urinary continence recovery, defined as daily pad usage less than or equal to one, considering age, body mass index, prostate volume, International Prostatic Symptoms Score, the usage of a nerve sparing technique, and the International Society of Urological Pathology classification. Results: A total of 95 patients who underwent robot-assisted radical prostatectomy were enrolled. Median age, median body mass index, and median PSA density were respectively 66 years (62, 70), 26.12 kg/m2 (23.88, 28.09), and 0.16 ng/mL/cc (0.10, 0.26). Patients with urinary continence ranged from 32 (33.7%) at baseline to 93 (97.8%) after one year from surgery. At preoperative magnetic resonance, Lee Type was almost equally distributed, but Type C was less represented (18 patients, 18.9%) and Type D was more frequent (31 patients, 32.2%). Median prostatic urethral length, median membranous urethral length, and median intravesical prostatic protrusion were respectively 36 mm (31, 42), 15 mm (13, 16), and 0 mm (0, 0). Multivariate logistic regression models showed no statistical significance, except for Lee Type C and A comparison at vesical catheter removal after surgery (OR 0.17; 95% CI 0.04-0.71; p-value 0.01). Conclusions: The results of this study showed that patients who had Lee Type C might have higher probability of early urinary continence recovery, but no further statistically significant correlations were found.

Background:Mpox primarily presents with systemic and cutaneous symptoms. However, it can also lead to urological complications, necessitating specialized attention. The aim of this scoping review is to summarize the current evidence regarding the urological manifestations of Mpox, possible complications, and available treatments. Methods:An electronic systematic search of the current literature was conducted through the Medline and NCBI PubMed and Scopus databases on 18th August 2024. Our study search and inclusion criteria were in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. 9 The search terms and keywords used were: "monkeypox; Mpox" (MeSH Terms), combined with different terms: "urology", "kidney", "ureter", "bladder", "prostate", "genitals", "penis", "testicles", "urethra", in all different possible combinations. Results:A total of 32 articles included in the scoping review. A total of 116 patients were included, all males. The genitals were the most interested organs, associated with urethritis, while bladder and kidneys seemed to be not impacted by the disease. Patients were usually young, with a mean age of 36 years [31.5-40 years]. The most prevalent risk factor was sexual intercourse in the days/weeks before the appearance of symptoms. All patients had a molecular confirmatory diagnosis by a polymerase chain reaction (PCR) test. Five articles out of 32 (15.6%) reported the need for surgical debridement of penile and genital lesions due to their clinical worsening. However, in most reports, patients experienced spontaneous resolution of the lesions and symptoms. Conclusion:Awareness of Mpox and timely diagnosis are crucial for ensuring appropriate treatment and reducing the need for surgical management and the possible risk of long-term sequelae. Collaboration among dermatologists, infectious disease specialists, and urologists is pivotal to effectively managing Mpox patients.

Urethral complications following urethral lengthening in transgender men, such as strictures and fistulas, are common and frequently necessitate secondary surgical interventions. These surgeries vary significantly in their techniques and are evaluated with considerable heterogeneity, making a synthesized presentation of their outcomes valuable for guiding clinical management. This systematic review included 14 studies selected through a database search (Medline, Embase, Web of Science) that reported urethral complications after urethral lengthening. Among the 595 patients considered, 76% underwent phalloplasty and 24% underwent metoidioplasty. Our findings highlight that staged urethroplasty techniques demonstrated the lowest recurrence rates (0–25%), particularly in the management of long strictures in the pendulous urethra. In contrast, one-stage urethroplasties—especially those performed without augmentation—were associated with high recurrence rates, reaching approximately 50%, even when buccal mucosa grafts were used for augmentation. Patient-reported outcomes were documented in only one-third of the included studies, underscoring the limited functional evaluation of urethroplasty outcomes following phalloplasty. The considerable variability in urethroplasty techniques, types of genital reconstruction, and reporting standards highlights the need for more comprehensive and standardized outcome assessments. Future studies will be essential in advancing our understanding and optimizing the management of these complex cases.

Bladder cancer (BC) ranks among the tenth most common cancers globally, and its management remains a significant challenge for both patients and clinicians in terms of care delivery and decision-making process. The integration of artificial intelligence (AI) tools-primarily machine learning and deep learning methods-into the current BC workflow offers an opportunity for a more personalized approach to treatment. This article provides a brief overview of AI applications across different steps of BC management (ie, detection, grading, staging, risk stratification, treatment, and outcome prediction), highlighting its potential to contribute to individualized management strategies. Despite significant advances, major barriers still impede broad applications of AI in BC clinical workflows. Overcoming these obstacles is critical to realize the full potential of AI-driven personalization of BC care in the coming decade. PATIENT SUMMARY: Our mini review summarizes how artificial intelligence (ie, a machine's ability to mimic human intelligence to perform tasks involving decision-making and problem-solving) has been applied to the management of bladder cancer, and whether it could lead to more precise treatment for patients diagnosed with this disease. Although several promising applications have been developed, more studies are necessary before these can be used in routine clinical practice.

OBJECTIVES:To compare the predictive performance of the World Health Organization (WHO) 1973, WHO 2004/2022, the three-tier (low grade [LG]/Grade 1 [G1]-G2, high grade [HG]/G2, and HG/G3), and four-tier (LG/G1, LG/G2, HG/G2, and HG/G3) hybrid grading systems in Ta non-muscle-invasive bladder cancer (NMIBC), by evaluating recurrence-free survival (RFS) and progression-free survival (PFS). PATIENTS AND METHODS:This retrospective multicentre study included 1233 patients with pTa NMIBC treated with transurethral resection of bladder tumour, eventually followed by intravesical instillations as determined by their physicians, between 2010 and 2023, across 18 Italian hospitals. Pathologists graded resected tissues using the WHO 1973, WHO 2004/2022 classifications, and hybrid three-tier (LG, HG/G2, HG/G3) and four-tier (LG/G1, LG/G2, HG/G2, HG/G3) systems. Kaplan-Meier curves estimated RFS and PFS. Discriminative performance was assessed using Harrell's concordance index (C-index). RESULTS:Among 1233 patients with pTa NMIBC, 890 were classified as LG and 343 as HG according to the WHO 2004/2022 grading system, while 586, 405, and 242 were categorised as G1, G2, and G3, respectively, under the WHO 1973 system. With a median (interquartile range) follow-up of 26 (14-48) months, 418 patients experienced recurrence, including 184 with HG recurrence and 42 who progressed to MIBC. The C-index values for RFS were 0.60, 0.56, 0.57, and 0.61 for the WHO 1973, WHO 2004/2022, hybrid three-tier, and four-tier grading systems, respectively. For progression, the C-index values were 0.80, 0.74, 0.75, and 0.81 across the same systems, underscoring the superior predictive capacity of the four-tier classification. Nonetheless, the low number of MIBC progression events limits the robustness of these analyses. CONCLUSION:Our findings highlight the superior prognostic accuracy of the four-tier hybrid classification in predicting recurrence and progression in patients with stage Ta NMIBC. By combining strengths from the WHO 1973 and 2004/2022, this hybrid model shows promise as tool for enhancing NMIBC patient management in clinical practice.

The introduction of novel robotic platforms has expanded surgical options for robot-assisted radical prostatectomy (RARP). However, comparative outcomes with da Vinci multiport (MP) system remain unclear. This systematic review and network meta-analysis aimed to compare perioperative, early oncological, and functional outcomes of RARP performed with novel robotic platforms versus the da Vinci MP system. A systematic literature search was conducted in PubMed, Scopus, and Embase (updated December 22, 2024) following PRISMA guidelines. Eligible studies compared RARP performed with alternative robotic platforms versus da Vinci MP, reporting perioperative, oncological, or functional outcomes. A network meta-analysis was conducted using a random-effects model. Outcomes were expressed as mean differences for continuous variables and odds ratios (OR) for dichotomous variables, with 95

We describe the first experience of Retzius-sparing robot-assisted radical prostatectomy (RS-RARP) performed with the Versius robotic system (CMR Surgical, Cambridge, UK). Five patients underwent RS-RARP at ASST Grande Ospedale Metropolitano Niguarda (Milan, Italy) between May 2023 and December 2023. All procedures were completed with no complications or need for conversion. No arms collision or technical failure of the system was recorded. The median operative time was 244 minutes (interquartile range [IQR]: 190-300). Median length of stay was three days. Our initial experience suggests that RS-RARP with the Versius robotic system is a feasible procedure. This novel platform provides a flexible system environment that can be easily tailored to all types of surgery. However, some arrangements are still necessary, warranting future investigations in larger series.

Background: Prostate-specific membrane antigen (PSMA)-PET imaging has significantly improved prostate cancer (PCa) staging, yet its interpretation remains challenging, even for experienced specialists. No prior study has assessed urologists’ ability to interpret PSMA-PET. Methods: We conducted a multicenter prospective study involving 63 urologists from eight Italian institutions. Participants evaluated 20 PSMA-PET scans of high-risk PCa cases, with no clinical information provided. Proficiency was defined as correctly identifying at least two of three staging components (T, N, M) in ≥75% of cases. Associations between performance and factors such as hierarchy (resident vs. consultant), institution type, surgical volume, and multidisciplinary team (MDT) presence were analyzed using univariable and multivariable logistic regression. Results: Only one participant achieved full staging proficiency, while 44% reached the ≥75% threshold for partial (almost correct) staging. Urologists from centers with ≥300 PCa diagnoses per year demonstrated better T and M stage identification. Institutions with ≥150 robot-assisted radical prostatectomies (RARPs) per year and those with MDTs showed higher accuracy in M staging. No significant predictors of proficiency emerged in the multivariable analysis, although hierarchy and surgical volume approached significance for nodal metastasis detection. Conclusion: PSMA-PET interpretation is complex for urologists, with particular challenges in T and M staging. High institutional case volumes and MDT involvement may enhance interpretation skills. Structured training programs and increased exposure to multidisciplinary imaging discussions are essential to optimize urologists’ diagnostic proficiency and ultimately improve patient care.

Treatment success after urethral reconstruction remains poorly standardized, resulting in heterogeneous outcome reporting and limited comparability across studies. To address this gap, we aimed to establish a consensus-based, reproducible definition of surgical success through the development of a novel outcome framework: the stricture-fecta. A two-round Delphi process was conducted under the auspices of the European Association of Urology (EAU) Young Academic Urologists—Trauma and Reconstructive Urology Working Party. A total of 113 international experts in urethral reconstruction were invited to assess the potential outcome criteria using a 9-point Likert scale. Consensus was defined as a rating of 7–9 by ≥70% and 1–3 by ≤15% of respondents. Eighty-seven (77%) experts completed round 1, and 65 (75%) participated in round 2. The final consensus identified three core criteria: (1) freedom from stricture retreatment; (2) no significant impact on continence or sexual function, assessed with validated instruments; and (3) patient satisfaction. The stricture-fecta represents a step toward standardized outcome reporting in urethral reconstruction, akin to the trifecta metrics in urological oncology. Its adoption may improve data quality, facilitate multicenter collaboration, and support more transparent, patient-centered evaluations of surgical success. Patient summary This study developed a clear and simple way to measure success after surgery to fix narrowing of the urethra, a condition that affects urination and quality of life. Experts agreed that success means no need for further treatment, and no negative effects on bladder control or sexual function, and that patients feel satisfied with the results. The use of this approach will help doctors compare outcomes better and improve care for patients undergoing urethral surgery.