PURPOSE:To evaluate the impact of intraoperative Doppler ultrasound (IDU) during microsurgical subinguinal varicocelectomy (MSV) on surgical outcomes, complication rates, and reproductive parameters. MATERIALS AND METHODS:A systematic review and meta-analysis were conducted in accordance with PRISMA and MOOSE guidelines (PROSPERO: CRD420250656066). A comprehensive literature search was performed in PubMed and Scopus up to December 2024. Studies enrolling men with varicocele (Population) who underwent MSV with IDU (Intervention) were compared with those who underwent MSV without IDU (Comparison). Primary outcomes included fertility outcomes (pregnancy rates, sperm parameters), pain resolution, and postoperative complications (recurrence, hydrocele, testicular atrophy). Secondary outcomes included operative time, number of preserved arteries, ligated veins, and preserved lymphatic vessels. Statistical analyses used fixed- or random-effects models depending on heterogeneity. RESULTS:Seven studies involving 1,044 patients were included. While no differences were found in sperm concentration or morphology, progressive sperm motility improved significantly with (mean difference [MD] 12.10%; 95% confidence interval [CI] 3.47 to 20.72; p=0.006). Pregnancy rates were similar between groups. Two studies assessed postoperative pain; both showed improvement, with one reporting higher complete pain resolution using Doppler, but heterogeneity prevented meta-analysis. No significant difference was observed in varicocele recurrence, hydrocele formation, or testicular atrophy. Intraoperative Doppler significantly reduced operative time in unilateral varicocelectomy (MD -5.90 minutes; 95% CI -9.78 to -2.02; p=0.003) but not in bilateral cases. IDU improved arterial preservation (MD 0.44 arteries per patient; 95% CI 0.32 to 0.57; p<0.0001) and led to more veins being ligated (MD 1.06 veins; 95% CI 0.80 to 1.33; p<0.0001). CONCLUSIONS:IDU enhances surgical precision by improving arterial identification and vein ligation, while reducing operative time in unilateral varicocelectomy. It significantly enhances sperm motility but shows no effect on pregnancy or complication rates.

To study the global practice of SWL, its comparative results with other treatment options, and potential future advances that may boost its clinical relevance. A global cross-sectional survey was conducted amongst members of Société Internationale d’Urologie (SIU). The survey was distributed amongst urologist and urology trainees and captured data on demographics of participants, the use of Shock Wave Lithotripsy (SWL), Ureteroscopy (URS), and Percutaneous Nephrolithotomy (PCNL) in the management of urinary stones. The survey was translated into seven languages. The survey was conducted through the SurveyMonkey platform. We used descriptive statistics where all analyses were conducted using SAS Version 9.4 (Cary, North Carolina, USA). 3,761 urologists across 108 countries replied to the survey. Most participants were from Asia (50.1%), general urologists with over 20 years of clinical practice (61.5%) and coming from High Income countries (84.6%). Most hospitals were equipped with SWL equipment from Dornier (28.1%) or Siemens (17.7%). While 62.7% of the SWL providers received specific SWL training during residency, SWL treatment is usually performed by specialized technicians (48.1%). Higher volume stone centers perform equally SWL and URS while lower volume stone centers balance between SWL, URS and PCNL. Shockwave lithotripsy (SWL) remains widely available but its position in urinary stone management has transformed in favor of ureteroscopy (URS). Advances in robotics, artificial intelligence, and improved training programs may strengthen SWL’s position as a valuable treatment option in the future.

BACKGROUND:The optimal management of the distal ureter and bladder cuff during radical nephroureterectomy (RNU) for patients with upper tract urothelial carcinoma (UTUC) is uncertain. Endoscopic techniques are less invasive but may compromise oncological control. OBJECTIVE:To compare oncological outcomes of formal transvesical/extravesical (Tr/Ex) bladder cuff excision versus endoscopic distal ureter management in patients undergoing RNU for UTUC. DESIGN, SETTING, AND PARTICIPANTS:We conducted a retrospective analysis of patients included in the Clinical Research Office of the Endourological Society (CROES) UTUC registry, which prospectively collects data from participating centers worldwide. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS:The primary endpoint was recurrence-free survival (RFS); secondary endpoints were intravesical recurrence (IVR) and overall survival (OS). RFS and OS were assessed using Kaplan-Meier methods and Cox regression, whereas IVR was analyzed using competing-risk methods, including Gray's test and Fine-Gray regression. Multivariable adjustment was applied for the primary endpoint RFS. In the matched cohort, an exploratory interaction analysis was performed by adding a treatment-by-primary-tumor-location interaction term to the multivariable Cox model. RESULTS AND LIMITATIONS:Of 1255 patients, 1109 underwent Tr/Ex resection and 146 received endoscopic management. Propensity score matching yielded 258 matched patients (129/group) with good balance in measured baseline covariates, representing a restricted overlap subset. In the matched cohort, Kaplan-Meier analysis showed better RFS with Tr/Ex than with endoscopic management (log-rank p = 0.034). Univariable Cox analysis yielded a hazard ratio (HR) for recurrence of 0.47 (95% confidence interval [CI], 0.23-0.96; p = 0.039), whereas the adjusted Cox model showed a similar but nonsignificant association (HR, 0.49; 95% CI, 0.22-1.10; p = 0.085). OS was similar between groups (HR, 0.96; 95% CI, 0.32-2.89; p > 0.9). In competing-risk analyses treating death without prior IVR as a competing event, the cumulative incidence of IVR did not differ significantly between groups (Gray's test p = 0.064). Fine-Gray regression likewise showed a nonsignificant association between treatment group and IVR (Tr/Ex vs endoscopic: subdistribution hazard ratio [sHR], 0.48, 95% CI, 0.22-1.05; p = 0.067). In an exploratory interaction analysis, the estimated HR for Tr/Ex versus endoscopic management was 0.64 (95% CI, 0.23-1.75; p = 0.382) in renal pelvic tumors and 0.39 (95% CI, 0.09-1.71; p = 0.212) in ureteral tumors; however, no statistically significant treatment-by-location interaction was observed (HR for interaction, 0.61; 95% CI, 0.10-3.68; p = 0.590). CONCLUSION:In the matched cohort, Tr/Ex management was associated with longer RFS on Kaplan-Meier analysis, but the adjusted HR favored Tr/Ex without reaching statistical significance. For intravesical recurrence, competing-risk analyses showed no statistically significant difference between groups. No significant interaction by primary tumor location was observed. REGISTRATION:NCT02281188.

Despite well-defined standards for urethral stricture management, significant practice variations persist. This survey assessed guideline adherence among Turkish urologists. An online SurveyMonkey survey was sent to Turkish Urological Association members, open October 10–17, 2021, with two reminders. Data were centrally collected and analyzed using descriptive statistics. Of 2,078 members, 222 (11

Combined criteria have been used in many facets of urologic surgical care in the management of urological cancer. We aimed to validate the prognostic ability of a pentafecta related to the outcomes of radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC). Data were obtained from the Clinical Research Office of the Endourology Society Urothelial Carcinomas of the Upper Tract (CROES-UTUC) registry, a prospective multinational database. Non-metastatic UTUC patients treated with RNU were included. We adopted a pentafecta criteria of (1) negative surgical margin; (2) en bloc resection of the bladder cuff; (3) absence of major complications; (4) template-based lymph node dissection performed per European Association of Urology guidelines; and (5) absence of recurrence (urothelial and/or distant recurrence) within 12 months. Outcomes were pentafecta achievement rates and oncological outcomes, including overall survival (OS) and recurrence-free survival (RFS). Kaplan–Meier survival analyses with log-rank were performed on survival outcomes. Multivariate Cox regression was performed to identify confounders, and logistic regression was performed to identify factors that confounded the pentafecta achievement rate. Overall, 1049 cases were analyzed, and pentafecta was achieved in 504 patients (48.0

Objectives:To compare perioperative outcomes, complications and stone-free rates (SFRs) between laser and non-laser lithotripsy in suction-assisted mini-PCNL (SM-PCNL). Subjects and Methods:This prospective multicentre study enrolled adults with normal kidneys undergoing SM-PCNL (14-22 Fr) across 30 international centres (March-November 2024). Patients were divided into laser (Group 1) and non-laser (Group 2) groups. Propensity score matching (2:1) was performed based on age, sex, Guy's score and patient position. Primary outcomes were complications and 30-day SFR assessed by CT. Multivariable logistic regression identified predictors of complete stone clearance and complications. Results:After matching, 748 patients were analysed (Group 1: 448; Group 2: 300). Non-laser devices were associated with shorter lithotripsy (12 vs 18 min, p < 0.001) and operative times (37 vs 45 min, p < 0.001) and higher SFR (intraoperative: 91.3% vs 80.7%; 30-day: 87.7% vs 82.1%). However, transfusions (3.3% vs 0.2%), pelvic perforation and pleural injury (each 3.0%) were more common in Group 2. On multivariable analysis, single-step dilation (OR 3.05) and sheath sizes of 16.5-18 Fr (OR 1.98) or 20-22 Fr (OR 2.72) were associated with higher odds of stone-free status, while skin-to-stone distance >8 cm (OR 0.5) and combined fluoroscopy/ultrasound access (0.28) reduced this likelihood. Stone volume (OR 1.03), serial dilation with non-metal dilators (OR 2.64) and combined fluoroscopy/ultrasound access (OR 2.11) were factors associated with higher odds of complications. The lithotripsy technology had no direct bearing on complications. Conclusions:Both laser and non-laser lithotripsy are effective in SM-PCNL. Non-laser devices improve efficiency and lasers were preferentially used with 14-18 fr access tracts.

To evaluate the impact of tumour location on the survival outcomes of patients with upper tract urothelial carcinoma (UTUC) after radical nephroureterectomy (RNU). Patients with ureteral urothelial carcinoma (UUC) or renal pelvic urothelial carcinoma (RPUC) of the Clinical Research Office of the Endourology Society (CROES)-UTUC registry were analyzed. Study outcomes included overall survival (OS), cancer-specific survival (CSS), intravesical recurrence-free survival (IRFS), and progression-free survival (PFS), which were compared using Kaplan–Meier method with log-rank test. Propensity score matching (PSM) was performed to balance the differences in tumour features between the two groups. The UUC and RPUC groups consisted of 309 (41.9

Prostate cancer (PCa) management poses challenges due to treatment-related morbidities associated with conventional therapies. Focal therapy (FT) is emerging as a promising alternative for intermediate-risk PCa, aiming to selectively target localized cancerous lesions while preserving healthy tissue. This review explores emerging FT modalities for PCa treatment, focusing on transrectal MRI-guided focused ultrasound surgery (MRgFUS), transurethral ultrasound ablation (TULSA), focal laser ablation (FLA), and histotripsy. A comprehensive literature search was conducted to identify studies and clinical trials related to FT. Relevant articles were selected and data were synthesized to provide insights into the efficacy and feasibility of MRgFUS, TULSA, FLA, and histotripsy for FT. MRgFUS utilizes transrectal high-intensity focused ultrasound under MRI guidance to selectively ablate cancerous tissue, demonstrating positive outcomes in oncologic control and preservation of urinary and sexual function. TULSA employs transurethral delivery of high-intensity ultrasound energy under MRI guidance, showing promising results for whole gland treatment. FLA benefits from precise ablation, indicating effectiveness in tumor destruction while preserving quality-of-life. Histotripsy, a mechanical ablation method, exhibits promise by inducing tissue fractionation through bubble activity, offering advantages such as tissue selectivity and real-time treatment monitoring. Emerging FT modalities present promising alternatives for the management of localized PCa, offering personalized treatment. Further research and clinical trials are warranted to establish the long-term efficacy of these techniques in PCa management.

OBJECTIVE:To investigate the implementation and adherence of (inter)national guidelines (GLs) on non-muscle-invasive bladder cancer (NMIBC) across continents. SUBJECTS AND METHODS:An international, inter-lingual survey was designed to capture the practice of diagnosis and treatment of NMIBC globally, including questions designed to evaluate compliance to GLs. An invitation was sent to members of the Société Internationale d'Urologie (SIU). We assessed the adherence to GLs in relation to age, working environment, subspecialities, gender, and years of experience. RESULTS:A total of 3595 urologists took part in the survey and 2319 provided information about their compliance to European Association of Urology (EAU), American Urological Association (AUA), and other (inter)national GLs. The survey comprised 92% males including >50% in clinical practice for >15 years; 57% were in general practice, whereas 17% were qualified uro-oncologist and 8% endourologist. The majority were in academic practice and most (60%) performed <5 transurethral resection of bladder tumour/month. GLs were followed in 42-70% of cases when taking bladder biopsies. The majority followed the EAU GLs (40%) followed by national GLs modified from the AUA, EAU or similar GLs (31%), or national GLs by their own societies (14%). Low participation from the Americas may limit the applicability of findings to that region; future studies should engage more diverse North American samples to enhance generalisability. CONCLUSION:The EAU GLs were mostly preferred in NMIBC diagnosis and treatment across all continents. General adherence to the GLs was inconsistent, with notable variances among the different regions. As GLs provide the best evidence-based knowledge, it is advised to adhere to them more consistently in daily clinical practice.

BACKGROUND:The growing use of smartphones offers a key opportunity to monitor BPO/LUTS through well-designed medical apps. The primary objective of the study was to assess the feasibility and acceptability of a mobile app (MyBPHCare) for men with lower urinary tract symptoms (LUTS). Secondary objectives included medical adherence using electronic reminders and compliance of treatment with current guidelines. METHODS:This was an observational cohort pilot study conducted in Greece, Türkiye, and Italy. Patients with LUTS, treatment-naïve or under treatment, older than 40 years were eligible. Patients received standard care according to physician's practice and duration of follow-up was 6 months. Standard questionnaires, diagnostic tools, medication, and follow-up visits were employed. Feasibility, acceptance, and satisfaction were assessed using a standardized, translated and validated app rating user questionnaire (uMARS). Patients' adherence to treatment and physicians' with guidelines were also recorded. RESULTS:From a total of 157 patients, 68.15% filled in the uMARS questionnaire. All uMARS mean scores ranged between "Acceptable" and "Good": App Quality (3.43), Engagement (3.21), Functionality (3.47), Aesthetics (3.37), and Information (3.68). 96.3% of the participants would recommend using the app. Recorded adherence to medication was 47.85%, while a discrepancy between guidelines and real-life practice was found. CONCLUSIONS:MyBPHCare app is a possibly feasible application for virtually monitoring men with LUTS with good acceptance from the patients.

Background:Lower pole renal stones measuring 1-2 cm remain challenging to treat. While mini-percutaneous nephrolithotomy (mini-PCNL) provides high stone-free rates (SFRs), it carries tract-related morbidity. Flexible ureteroscopy (f-URS) is less invasive but limited in SFR. The flexible and navigable suction ureteral access sheath (FANS) has shown promise in improving stone evacuation and intrarenal pressure control. We hypothesize that FANS f-URS is non-inferior to mini-PCNL for patients with 1-2 cm lower pole stones in SFR. Study Design:The FLAME trial is an international, multicentre, randomized, non-inferiority study directly comparing FANS-f-URS with mini-PCNL in this setting. Endpoints:The primary outcome is immediate SFR within 72 hours on low-dose CT. Secondary outcomes include SFR at 1 month, operative time, postoperative pain, hospital stay, complications (Clavien-Dindo) and quality-of-life changes. Patients and Methods:A total of 640 adults with CT-confirmed 1-2 cm lower pole renal stones will be randomized 1:1 to undergo FANS-f-URS or mini-PCNL across 20 high-volume urology centres worldwide. Randomization is centralized and stratified by site. Radiologists and statisticians will remain blinded to allocation. Sample size was calculated assuming an 85% SFR for both arms, an 8.5% non-inferiority margin, 80% power and 15% attrition. Analyses will follow both intention-to-treat and per-protocol principles. Trial registration:ClinicalTrials.gov NCT07159035.

Background: Urinary incontinence (UI) and depression are prevalent conditions affecting millions globally and are significantly associated with various demographic, health, and socio-economic factors. This study examines the associations between UI and depression over a 14-year period using nationwide data. Methods: We analyzed cross-sectional data from the Turkish Health Studies Surveys conducted in seven different years between 2008 and 2022, including 125,276 participants aged 15 and older and excluding those with incomplete key health data. Variables included chronic conditions, BMI, depression severity (assessed by PHQ-8), socio-economic status, and lifestyle factors. Univariable and multivariable logistic regression models were used to investigate associations between UI and various risk factors over time. Results: The prevalence of UI and depression fluctuated over the 14 years, with a significant increase observed in 2014. Multivariate analysis confirmed a strong and consistent association between UI and depression across genders and age groups, even after adjusting for confounders. Higher depression severity increased the odds of experiencing UI. Age, multiple comorbidities, higher BMI, and lower socio-economic status were associated with an increased likelihood of UI. Obesity was a significant risk factor for UI in females but not in males. Urban living and higher education levels were inversely associated with UI. The simultaneous rise in UI and depression in 2014 may be linked to socio-economic changes during that period. Conclusions: The findings suggest a robust link between UI and depression, influenced by a complex interplay of health, demographic, and socio-economic factors, needing prospective studies to further investigate the causal pathway of these associations.

Urolithiasis represents one of the most common urologic diseases, and its incidence demonstrates, globally, an increasing trend. The application of preventive measures is an established strategy to reduce urolithiasis-related morbidity, and it is based mostly on the adaptation of lifestyle factors and pharmacotherapy. Furthermore, other research areas demonstrate promising results, such as the research on the microbiome. In the current review, we searched for the latest data on lifestyle–based prevention and microbiome alterations in urolithiasis patients. The majority of the proposed lifestyle measures are already included in the urological guidelines, while additional factors, such as vitamin D supplementation, seem to have a putative positive effect. From the microbiome studies, several microbial composition patterns and metabolic pathways demonstrated an inhibiting or promoting role in lithogenesis. Up to the present, stone prevention has not shown satisfying results, which suggests that lifestyle measures are not adequate. Moreover, microbiome studies are prone to bias, since microbes are strongly affected by numerous clinical factors, while the analysis procedures are not standardized yet. Analysis standardization and data pooling from extensive registration of clinical and microbiome data are essential steps in order to improve the existing prevention strategy with targeted microbiome manipulations.

Background:The evidence supporting personalized surveillance strategies for upper-tract urothelial carcinoma (UTUC) remains limited. This study seeks to explore how smoking habits influence the oncological outcomes of UTUC. Methods:Data on disease characteristics from UTUC patients were gathered prospectively. Recurrence-free survival was the primary outcome measured. Patients were stratified based on smoking status for Kaplan-Meier and multivariable Cox regression analyses. Results:A total of 1952 patients were involved, including 684 (35%) patients who never smoked, 572 (29%) that were ex-smokers, and 696 (36%) that were current smokers. For female patients, most of them were nonsmokers (n = 328). Current smokers were significantly younger and had higher American Society of Anesthesiologist (ASA) scores and Charlson Comorbidity Index. A total of 19.9% (n = 236) of patients developed tumor recurrence. Kaplan-Meier analyses showed that smoking status was associated with a greater likelihood of urothelial carcinoma recurrence (p = 0.011) and intravesical recurrence (p = 0.021). The multivariable Cox regression analysis identified the smoking status as an independent risk factor for urothelial carcinoma recurrence (p = 0.046). When compared with former smokers, current smokers showed a higher urothelial carcinoma recurrence (p = 0.016) and intravesical recurrence (p = 0.006). Conclusion:Smoking at the time of diagnosis was significantly associated with an increased risk of tumor recurrence in the bladder but not significantly in the upper urinary tract. This study confirms that cumulative smoking exposure accelerates the risk of tumor recurrence and underlines the importance of smoking cessation. Trial registration:NCT02281188.

Background and objective:Contemporary data are limited regarding the clinical practice of administering anticoagulant and antiplatelet medications (AA) perioperatively for patients with upper tract urothelial carcinoma (UTUC). Our aim was to investigate real-world AA perioperative management among patients with UTUC who underwent radical nephroureterectomy (RNU) and the impact on perioperative complications. Methods:We conducted a retrospective analysis of data from the Clinical Research Office of the Endourology Society UTUC registry. Patients were stratified into two groups according to perioperative AA use in the RNU cohort. Baseline characteristics were compared between the control and AA groups and intraoperative and postoperative complications were analyzed. We also conducted subgroup analysis for patients who discontinued AA use in comparison to those who continued AA therapy. Univariable and multivariable analyses were performed to identify predictors of perioperative complications. Key findings and limitations:A total of 1264 patients who underwent RNU were included in the analysis. Of these, 393 (31%) had AA treatment before RNU and 871 (69%) did not. Intraoperative complications occurred in 23 patients (5.9%) in the AA group and 41 (4.7%) in the control group. Postoperative complications occurred in 101 patients (26%) in the AA group and 182 (21%) in the control group. Multivariable logistic regression demonstrated that AA was not an independent risk factor for either intraoperative complications (odds ratio 0.93, 95% confidence interval [CI] 0.48-1.83; p = 0.84) or postoperative complications (odds ratio 0.93, 95% CI 0.66-1.30; p = 0.66). Conclusions and clinical implications:Anticoagulant and antiaggregant therapy in patients undergoing RNU is safe, with no difference in the incidence of intraoperative and postoperative complications. Patient summary:Our analysis for patients with cancer in the upper urinary tract showed that taking drugs to prevent blood clots before surgery to remove a kidney is safe. We found no significant differences in complication rates in comparison to patients not taking these drugs.The Clinical Research Office of the Endourology Society UTUC registry study is registered on ClinicalTrials.gov as NCT02281188.