Objective:To evaluate the perioperative outcomes of suction mini-percutaneous nephrolithotomy (SM-PCNL) using disposable versus reusable sheaths, based on data from the global Suction Technology Utility in Mini-Percutaneous nephrolithotomy Study (STUMPS) registry. Methods:This prospective, multicenter observational study analyzed adult patients undergoing SM-PCNL using either disposable or reusable suction sheaths (14-22 Fr) between March 2024 and November 2024 across 30 centers in 21 countries. Propensity score matching was employed to balance key variables, including age, sex, Guy's stone score, stone volume, and patient position. Primary outcomes included 30-day stone-free rates, complications, and operative metrics. Multivariable logistic regression was performed to identify predictors of complete (Grade A) stone clearance. Results:Among 1524 patients, 1024 were matched for analysis (512 in each group). Both groups had comparable distributions of 30-day postoperative residual fragment grades (p=0.90), with similar stone-free rates (Grade A clearance: 80% in the reusable group vs. 81% in the disposable group). The disposable group demonstrated a significantly lower 30-day complication rate (9.4% vs. 15%; p=0.01), including fewer renal pelvic injuries and bleeding events. However, operative time was longer in this group (median 50 min vs. 44 min; p=0.02), and the reintervention rate was higher (3.3% vs. 1.0%; p=0.02). Predictors of reduced stone clearance included supine positioning, smaller sheath size, and larger stone volume. Conclusion:Both disposable and reusable sheaths yield comparable stone clearance in SM-PCNL. However, disposable sheaths are associated with fewer complications and may offer practical advantages in settings with limited reprocessing capabilities. Further randomized trials and cost-effectiveness studies are warranted to guide sheath selection in diverse clinical environments.

Background/Objectives: Urology residency training widely varies across countries, and evidence comparing residents’ experiences at an international level is limited. This study reports the results of an international survey of urology residents from different countries worldwide, aiming to characterize training environments, educational exposure, and trainee expectations across diverse healthcare systems. Methods: A 39-item online survey was administered to urology residents during the Société Internationale d’Urologie (SIU) Regional Meeting (Florence, November 2024), assessing demographics, training exposure, educational resources, workload, satisfaction, and career perspectives. The results were compared between trainees at different postgraduate years (PGYs) to explore associations for key outcomes. Results: Overall, 208 urology residents from 21 countries completed the survey. Most residents were actively involved in research (76.4%), although confidence in independent scientific production was moderate (significantly lower among junior trainees). Surgical exposure increased with PGY, with good experience in endoscopy but limited hands-on exposure and expected autonomy in laparoscopic, robotic, and major open surgery. Despite high overall satisfaction with urology, residents described heavy workloads, inconsistent access to structured teaching and international fellowships, and a long-term shift in career expectations toward private practice. Conclusions: Urology residents worldwide report high engagement in research, strong satisfaction with their specialty choice, and interest in international mobility. Nonetheless, persistent disparities in surgical exposure, research confidence, workload, and gender representation highlight the need for competency-based curricula, structured mentorship, and improved training organization to promote equitable and high-quality urology education globally.

Introduction The study compared the outcomes of retrograde intrarenal surgery (RIRS) performed as a second-line treatment following failed extracorporeal shock wave lithotripsy (SWL) with those of primary RIRS in patients with 1-2 cm lower pole kidney stones. Material and methods A total of 83 patients who underwent RIRS for 1-2 cm lower pole renal calculi between February 2019 and September 2024 were retrospectively analyzed in this single-center study. Patients were divided into two groups: those who underwent RIRS after failed SWL (n = 43) and those who underwent primary RIRS (n = 40). Preoperative demographics, stone characteristics, operative parameters, and postoperative outcomes were compared. Statistical analyses were performed using R software. Results There were no significant differences between the groups in terms of age, gender, body mass index, stone size, laterality, density, or Ito scores. The failed SWL group had significantly longer operative time (60 [55-75] vs 55 [40-66] min, p = 0.041), RIRS time (45 [37.5-55] vs 40 [30-46] min, p = 0.043), and fluoroscopy time (4 [3-7] vs 2 [2-4] s, p = 0.001). The stone-free rate was lower in the failed SWL group (79% vs 92%), but the difference was not statistically significant (p = 0.153). Postoperative urinary tract infections and complication rates were similar between groups (p >0.05). Conclusions RIRS remains an effective and safe option for managing lower pole kidney stones after failed SWL. However, previous SWL may increase procedural complexity, as reflected by longer operative and fluoroscopy times. Given the retrospective single-center design and limited sample size, the study's findings should be considered exploratory and interpreted with appropriate caution pending validation in larger, multicenter cohorts.

Ureteral stents are routinely used following endourological procedures to ensure adequate drainage and prevent obstruction. However, stent-related morbidity remains common, and optimal stent dwell time and removal methods are not well defined. This systematic review aimed to evaluate clinical and procedural factors influencing ureteral stent dwell time and the methods used for stent removal after endourological interventions. A systematic review was conducted in accordance with PRISMA guidelines and registered on PROSPERO. MEDLINE and Embase were searched from inception to October 2025. Randomized controlled trials and comparative observational studies evaluating ureteral stent dwell time and/or removal methods in adults undergoing endourological procedures were included. Risk of bias was assessed using RoB 2 and ROBINS-I tools. Thirty-two studies encompassing 4,373 patients were included. Reported stent dwell times varied widely, most commonly ranging between 10 and 14 days in uncomplicated cases, with longer durations associated with increased rates of encrustation and removal difficulty. Removal techniques included rigid cystoscopy (48.7

Accurate assessment of stone burden is fundamental in urolithiasis, as it directly influences treatment selection and prognostic evaluation. Although maximum stone diameter on non-contrast computed tomography remains the most widely used parameter, it does not adequately reflect the three-dimensional complexity of urinary calculi. This review aimed to summarize the evolution of stone burden assessment from conventional imaging-based methods to software-assisted volumetry and artificial intelligence (AI)-driven tools, with emphasis on their accuracy, reproducibility, and clinical utility. A narrative review of the literature was performed using PubMed/MEDLINE, Scopus, and Google Scholar for English-language studies published up to March 2026. Original studies, validation studies, technical reports, reviews, and guideline-related papers addressing conventional CT-based measurement, software-assisted volumetry, AI-based stone segmentation, and the clinical significance of stone volume were included. Due to heterogeneity in study design and reported outcomes, the evidence was synthesized narratively. Maximum stone diameter remains simple and widely available, but it incompletely represents true stone burden, particularly in larger or irregular stones. Formula-based ellipsoid calculations are practical yet show limited accuracy in complex geometries. Semi-automated CT-based segmentation software provides more reliable volumetric assessment, with excellent agreement with reference standards and reduced interobserver variability. AI-based approaches have further improved efficiency by enabling rapid and highly accurate automated stone detection and volume calculation. Across the reviewed literature, stone volume was consistently shown to be more clinically informative than linear dimensions for predicting spontaneous passage, stone-free rates after shockwave lithotripsy and ureteroscopy, and future symptomatic events during surveillance. Stone volume offers a more accurate and clinically meaningful estimate of stone burden than maximum stone diameter alone. The transition from formula-based methods to software-assisted and AI-driven volumetry represents an important advance in urolithiasis imaging. Wider adoption will depend on standardized imaging protocols, improved software accessibility, and validation of volume-based thresholds for routine clinical practice.

Background and ObjectiveMinimally invasive surgical therapies (MISTs) have emerged as alternative treatment options for benign prostatic obstruction (BPO), aiming to reduce morbidity while preserving functional outcomes. However, their adoption in routine clinical practice remains heterogeneous. We evaluated urologists’ perspectives on the utilization, perceived efficacy, barriers, and future role of MISTs in BPO management.MethodsA prospective, cross-sectional, web-based survey was conducted among members of the Young Academic Urologists (YAU) and the European Association of Urology (EAU) Endourology Section. The questionnaire was distributed via SurveyMonkey between January 27 and March 26, 2026. Descriptive statistics were used.ResultsA total of 77 complete responses were analyzed (response rate 55.7%). Awareness of MISTs was high; however, 29.6% of respondents did not perform any MIST procedures. Compared with medical therapy, MISTs were generally perceived as more effective for improving lower urinary tract symptoms, particularly Rezūm (73.2%) and UroLift (52.7%). Conversely, MISTs were considered less effective than conventional surgery but superior in preserving sexual function and reducing side effects. The most frequently reported barriers to adoption included limited access to training, lack of mentorship, equipment availability, and cost constraints. Most respondents anticipated increased use of MISTs over the next three years. Limitations include the survey-based design, the predominance of academic respondents, and the limited procedural experience of some participants.ConclusionsDespite recognized functional advantages, the adoption of MISTs remains limited by concerns regarding efficacy and structural barriers. Improved training, access, and long-term evidence may facilitate broader implementation in clinical practice.

IntroductionFailty refers to a state of vulnerability to stressors caused by declines in physiological reserve across multiple systems and is associated with adverse health outcomes. Despite its established importance in medical specialties, frailty assessment remains inconsistently implemented in urology. The aim of this review was to provide an overview of the concept of frailty and summarise the current evidence regarding its relevance to urological practice.MethodsA narrative literature review was performed using PubMed/MEDLINE and Google Scholar. Articles relating to frailty, geriatric and perioperative care, surgical outcomes, and urology were identified and reviewed. Findings were synthesised to provide a clinical overview relevant to healthcare professionals working in urological settings.ResultsFrailty is common among older adults and is increasingly recognised as a marker of vulnerability beyond chronological age alone. Multiple validated assessment tools are available, including the Clinical Frailty Scale and Frailty Index, although no single instrument has demonstrated clear superiority. Existing evidence suggests that frailty is associated with higher rates of postoperative complications, mortality, prolonged hospitalisation, and increased healthcare utilisation in urological patients. Studies further indicate that comprehensive geriatric assessment may identify potentially modifiable risk factors and support frailty-informed care pathways. While most published data relate to elective uro-oncological surgery, emerging evidence from acute urology suggests that integration of geriatric services may improve outcomes such as length of stay and hospital readmission.ConclusionsFrailty is highly relevant to contemporary urological practice and appears to be a stronger predictor of adverse outcomes than chronological age alone. Routine frailty assessment using simple validated tools may enhance risk stratification, perioperative planning, and shared decision-making. Wider implementation of frailty-informed care pathways and greater incorporation of frailty measures into urological research should be prioritised as the population ages.

CONTEXT:To evaluate the safety and efficacy of ureteroscopy (URS) in adults receiving systemic anticoagulant (AC) therapy, including vitamin K antagonists and direct oral anticoagulants (DOACs), compared with non-AC controls. OBJECTIVE:Using a Population, Intervention, Comparator, Outcomes (PICO) framework, we examined whether continuation, interruption, or peri-operative bridging of AC influences bleeding complications, thromboembolic events, and stone-free rates (SFR) in adults undergoing URS for stone disease. EVIDENCE ACQUISITION:A systematic review of PubMed, Embase, and Scopus identified studies reporting URS outcomes in anticoagulated patients. The review adhered to PRISMA standards and was registered with PROspective Register of Systematic Reviews (PROSPERO) (Centre for Reviews and Dissemination (CRD)420251154766). Studies limited to antiplatelet monotherapy were excluded. Random-effects meta-analysis was performed for outcomes where sufficient comparative data were available. SFR was summarised descriptively. Risk of bias was assessed using the Risk Of Bias In Non-randomized Studies - of Interventions (ROBINS-I). EVIDENCE SYNTHESIS:Eleven studies (1,516 AC patients; 20,708 controls) published between 1998 and 2024 met inclusion criteria. Anticoagulation was not associated with a statistically significant increase in overall postoperative complications (RR 1.83, 95% CI 0.95-3.52). Bleeding-related complications were variably reported across studies, with absolute event rates ranging from 0-20% in anticoagulated patients and 0-0.60% in controls. In the largest comparative cohort, bleeding occurred in 1.1% (8/702) of anticoagulated patients versus 0.40% (44/10,859) of controls. Thirty-day readmission rates did not differ significantly (RR 1.59, 95% CI 0.27-9.29). SFRs ranged between 70-97% across studies. Most studies were judged at serious risk of bias, primarily due to non-random allocation of AC strategies. CONCLUSIONS:Bleeding complications were variably reported across studies, with several observational cohorts reporting higher absolute bleeding rates in anticoagulated patients than controls, although definitions were heterogeneous and absolute event rates were low. Thromboembolic events were rare. Continuation may be justified in carefully selected high-thrombotic-risk patients.

BACKGROUND:The Ureteral Stent Symptom Questionnaire (USSQ) is the gold standard for evaluating stent-related symptoms. While validated in multiple languages, no validated Greek version currently exists. OBJECTIVE:To perform a cross-cultural adaptation, and psychometric evaluation of the Greek USSQ. METHODS:The USSQ was translated and culturally adapted following established forward-backward translation methodology. A cohort of 100 patients with temporary ureteral stents was prospectively enrolled and completed the Greek USSQ at predefined time points. Psychometric evaluation included internal consistency, test-retest reliability, construct validity, convergent validity, and responsiveness after stent removal. Comparative correlation was performed using International Prostate Symptom Score (IPSS), International Consultation on Incontinence Questionnaire Female Lower Urinary Tract Symptoms Modules (ICIQ-FLUTS), and 36-Item Short Form Health Survey (SF-36) questionnaires. RESULTS:Internal consistency was good for urinary symptoms (α = 0.82), pain (α = 0.79), work performance (α = 0.77), and general health (α = 0.74), while sexual matters demonstrated moderate consistency (α = 0.68). Test-retest reliability was strong with ICC values ranging from 0.72 to 0.86. Significant correlations were found with IPSS (ρ = 0.68, p < 0.001), ICIQ-FLUTS (ρ = 0.52, p < 0.01), and SF-36 domains (ρ = -0.55 to -0.62, p < 0.001). All domains showed statistically significant improvement following stent removal (p < 0.001). CONCLUSION:The Greek version of the USSQ demonstrates strong reliability, validity, and responsiveness, confirming its suitability for clinical and research use in evaluating ureteral stent-related symptoms in Greek-speaking populations.

Endourological practice increasingly depends on single-use devices, whose costs vary considerably across regions and health care systems. Flexible single use ureteroscopes (URS) and flexible and navigable sheaths (FANS) represent a major component of ureteroscopy-related expenditure. This study aimed to evaluate international variation in purchase and device-related acquisition cost of URS, FANS, and the cost of FANS (suction) assisted URS (URS and FANS). An international collaborative dataset compiled by the EAU Endourology Group collected information on device purchase prices for single use flexible ureteroscopes, FANS, and suction assisted URS across multiple countries. All costs were converted to Euros (€). Countries were stratified into quartiles, and global medians with interquartile ranges (IQRs) were reported. Data were obtained from 40 countries across Europe, Asia, North and South America, and the Middle East, and showed a significant global cost variation. The median price of single-use FURS was €676.7 (IQR 579–975), ranging from €310 (Romania) to €1638 (Cyprus), while FANS cost €180 (IQR 130–226), ranging from €36 to €400. Median per-procedure FANS assisted URS cost was €951.6 (range €415–1881). Lowest costs were observed in Romania, Belgium, and Germany, while highest were in Cyprus, Russia, and the United States, with up to four-fold inter-country variation, including within Europe. Substantial global variability exists in the cost of URS and FANS, influenced by healthcare policy, and economic conditions. These findings highlight the need for cost-effectiveness analyses and the development of evidence-based procurement policies to promote sustainability and equitable access in endourological practice.

BACKGROUND:Radical prostatectomy (RP) is a widely used treatment for localized prostate cancer, where achieving negative surgical margins is essential to reduce the risk of biochemical recurrence (BCR) and avoid additional treatments like radiation therapy. Positive surgical margins (PSMs) are associated with increased recurrence rates, higher costs, and patient anxiety. This review aims to evaluate real-time technologies for surgical margin assessment during RP, focusing on their clinical utility, advancements, and potential to improve intraoperative decision-making. METHODS:A non systematic review was conducted by searching PubMed/MEDLINE and Google Scholar for studies on realtime intraoperative margin assessment technologies in RP, including traditional and emerging methods. The review assessed technologies such as frozen section analysis, Confocal Laser Endomicroscopy (CLE), Fluorescence Confocal Microscopy (FCM), Optical Spectroscopy, and Augmented Reality (AR). Data from clinical trials and studies were analyzed based on their sensitivity, specificity, operational feasibility, and potential to reduce PSMs. RESULTS:Emerging technologies like CLE and FCM have shown significant potential for intraoperative tissue imaging, offering high-resolution, real-time feedback that can help identify cancerous tissue and guide surgical margins. Frozen section analysis remains the gold standard for intraoperative assessment due to its high sensitivity and specificity, but it is time-consuming and dependent on specialized pathology teams. AR, CLE, and optical spectroscopy technologies are gaining attention for their ability to provide real-time data and improve surgical precision. However, challenges such as high costs, technical complexity, and limited availability in resource-limited settings hinder broader adoption. Further clinical validation is needed to confirm their effectiveness and feasibility. CONCLUSIONS:Real-time assessment technologies offer promising advancements in reducing PSMs during RP, potentially improving both oncological and functional outcomes. While frozen section analysis remains the most widely used method, emerging technologies like CLE, FCM, AR, and optical spectroscopy show promise in enhancing surgical precision and patient outcomes. Continued innovation and large-scale clinical trials are crucial for integrating these tools into standard clinical practice and making them more accessible to a broader patient population.

To evaluate how to assess the optimal length of flexible and navigable suction ureteral access sheaths (FANS) to be used during flexible ureteroscopy (FURS) for kidney stones. A prospective multicenter study (16 centers, July 2024–January 2025) enrolled 226 adults with normal renal anatomy undergoing FURS with FANS for renal stones. Three preoperative measurements were analyzed: (1) Subjective on X-ray: T12–pubic symphysis, (2) Objective on CT: upper pole–pubic symphysis, and (3) Dynamic ureteral catheter length with retrograde pyelogram (RPG): upper pole–urethral meatus. Sheath length appropriateness (too short/correct/too long) was assessed intraoperatively using predefined criteria (complete calyceal access, ergonomics, need for ancillary techniques). Secondary outcomes included 30-day stone-free rates (SFR) and complications. Sheath length was deemed correct in 63.7

Ketamine is a potent anaesthetic drug that has been used for decades. Ketamine abuse is an increasingly common problem, particularly among young people. Over one quarter of ketamine users will have at least one bothersome urological symptom, with heavier and longer use leading to potentially irreversible damage to the lower and upper urinary tract. Hence, this study carried out a narrative review focusing on ketamine-induced uropathy pathophysiology, clinical presentation, and treatment options. It was found that ketamine uropathy is an inflammatory condition affecting predominantly the bladder but also the upper urinary tracts. A hypersensitivity reaction to the drug has been proposed as the potential pathophysiological mechanism that causes inflammatory reaction, muscle hypertrophy, and non-reversible fibrosis in the advanced stages of the disease. Abstinence from ketamine use is the cornerstone of treatment at any stage of the disease, with effective pain management and psychological support being critical to reduce ketamine seeking behaviours. For mildly symptomatic patients, minimally invasive options such as bladder instillations and intravesical Botox injections can provide symptomatic relief. For more severe cases with refractory symptoms and upper urinary tract involvement, reconstructive urological operations might be necessary, including augmentation cystoplasty, cystectomy, or ureteric reconstruction. Ongoing surveillance of the upper tracts is recommended for both groups of patients. Ketamine induced uropathy is an increasingly prevalent condition, and ketamine abuse should always be inquired about in people with unexplained lower urinary tract symptoms. Adequate information of the public regarding ketamine abuse and early consultation with a urologist might prevent irreversible damage.

Objective and background The purpose of this review is to systematically synthesize clinical studies evaluating changes in 24-hour urine parameters in patients receiving potassium citrate.Materials and methods A systematic review and multilevel analysis were conducted according to PRISMA and a registered protocol (PROSPERO CRD420261282247). Literature searches without date restriction identified studies reporting daily urine change among patients with urolithiasis taking potassium citrate therapy. The main object of analysis was the change (Δ) in each parameter between the baseline level and the state during potassium citrate therapy.Results Eight studies containing nine groups were included. The average increase in diuresis was 0.21 L/day. ΔpH and Δcitrate against the background of potassium citrate therapy across studies was +0.64 and +1.04, respectively. No consistent associations were observed for changes in uric acid (UA), sodium, calcium, magnesium, ammonium, phosphate, or sulfate, although the small number of studies and substantial between-study heterogeneity limit inference. Potassium citrate therapy was also associated with a decrease in urinary oxalate (Δoxalate −0.173 mmol/day), which should be interpreted cautiously given the limited evidence base.Conclusion Potassium citrate therapy was associated with study-level changes in the 24-hour urine profile that appeared to vary by dose and baseline metabolic phenotype. Increases in urinary pH and citrate were not observed uniformly across studies, but were broadly consistent with the delivered alkaline load within a pharmacodynamic framework. Reductions in calciuria and uricosuria appeared more evident in cohorts with underlying metabolic abnormalities, although these patterns remain hypothesis-generating. Overall, these findings support consideration of a more individualized, monitoring-based approach to potassium citrate titration rather than uniform empirical administration.

The convergence of artificial intelligence and robotic surgery is redefining the management of genitourinary cancers by enhancing diagnostic accuracy, surgical precision, and training efficiency. This narrative review explores recent advancements in artificial intelligence applications across the cancer care continuum, with a focus on prostate, kidney, and bladder malignancies. Artificial intelligence tools, particularly those based on machine learning and deep learning, have demonstrated strong performance in analyzing imaging data, segmenting tumors, predicting pathological features, and supporting clinical decision-making. Intraoperatively, artificial intelligence enables skill assessment, personalized feedback, and real-time navigation by processing data from surgical videos and robotic system sensors. Augmented reality and intraoperative modeling further enhance visualization and margin control during complex procedures. The review also discusses emerging technologies such as single-port robotic platforms, which offer advantages in confined anatomical spaces and support less invasive approaches. Additionally, the growing field of telesurgery is addressed, highlighting its feasibility for complex urologic operations across vast distances. While many of these innovations are still in early stages of clinical validation, their integration into practice has the potential to improve oncologic and functional outcomes, expand access to expert care, and foster the development of next-generation surgical strategies in urologic oncology.

Introduction Older adults represent an increasing proportion of urological patients and often present with frailty, multimorbidity, and functional decline, complicating clinical decision-making. This study explored urologists’ perspectives and practices in managing older and/or frail patients. Materials and methods An international, anonymised, cross-sectional survey based on a modified SIOG questionnaire was distributed via the EAU Young Academic Urology network and social media (February 2026). Domains included demographics, geriatric assessment practices, decision-making factors, and training perspectives. Descriptive statistics were used. Results A total of 102 urologists responded, predominantly consultants (71.6%) and based in Europe (89.2%). Routine geriatrician involvement was limited (15%), with 19.4% reporting no access. While most respondents were familiar with frailty concepts (74.5%), only 13.8% reported routine use of formal tools. Decision-making was driven primarily by comorbidity burden (78.5%), functional status (52.7%), anaesthetic assessment (50.5%), and frailty status (48.4%), whereas formal tools (5.4%) and chronological age (24.7%) were less influential. Anaesthetic opinion and anticipated recovery burden strongly influenced decisions. Most clinicians routinely discussed recovery and quality of life. Over 90% supported inclusion of frailty assessment in training. Conclusion Frailty is recognised but underutilised in urological practice. Greater integration of simple assessment tools, geriatric expertise, and targeted training is needed to improve care for older patients. Level of evidence 4.

In today’s digital age, more and more patients are turning to online platforms to gather information about medical treatments. However, the trustworthiness of this information can often be a bit shaky. This study sets out to compare the effectiveness of a video informed consent (VIC) with the traditional written informed consent (WIC) for patients preparing for Percutaneous Nephrolithotomy (PCNL). To conduct the study, we used the EAU patient information video, which was translated into Italian, including explanations of potential complications. From January 2022 to January 2024, we enrolled all PCNL patients from two different institutions. Each patient received both a WIC and a VIC regarding PCNL. Afterward, they filled out a pre-designed Likert scale questionnaire to evaluate: (1) comprehension; (2) satisfaction; and (3) simplicity, with scores ranging from 1 to 10. Additionally, we administered the State-Trait Anxiety Inventory (STAI) questionnaire to assess each patient’s anxiety levels before the procedure. We used the Mann-Whitney U test to analyze the differences in scores between the WIC and VIC (continuous variables). Our multicenter cohort included 148 patients, resulting in 296 questionnaires evaluated for both the paper and video-based consent. The average comprehension score ± standard deviation (SD) was 6.4 ± 0.68 for the WIC group, while the VIC group scored 9.0 ± 0.71. For satisfaction, the WIC group had a mean score of 6.6 ± 0.55, compared to 8.8 ± 0.9 for the VIC. The simplicity scores were 6.2 ± 0.65 for the WIC and 8.9 ± 0.45 for the VIC (all p < 0.001). The STAI results showed a significant drop in preoperative anxiety levels after patients watched the video, reflected in both the mean and median scores. video consent proved to be significantly more appreciated by patients across all evaluated areas compared to traditional consent, achieving an impressive overall satisfaction score of 8.9 out of 10, suggesting a bright future ahead.

Testicular germ cell tumors (TGCTs) are highly curable malignancies, yet their clinical management still relies heavily on conventional serum tumor markers, including alpha-fetoprotein, beta-human chorionic gonadotropin, and lactate dehydrogenase, which have limited sensitivity and specificity in several clinically relevant settings. Circulating microRNAs, particularly miR-371a-3p, have emerged as promising liquid biopsy biomarkers with potential applications across the TGCT disease continuum. This narrative review summarizes the current evidence on the biological basis, diagnostic performance, clinical utility, and limitations of circulating microRNAs in TGCTs. MiR-371a-3p demonstrates high diagnostic accuracy for viable non-teratomatous TGCTs and consistently outperforms classical serum tumor markers in primary diagnosis. Its rapid decline after effective treatment and its association with tumor burden support potential roles in chemotherapy monitoring, early relapse detection during surveillance, and the assessment of selected post-chemotherapy residual masses. However, its inability to detect teratoma remains a major biological limitation, particularly in non-seminomatous residual disease and surveillance settings. Additional barriers to implementation include assay heterogeneity, the lack of universally accepted cutoffs, the variable use of serum versus plasma, and the absence of broad regulatory approval. Emerging translational data suggest that miR-371a-3p may also contribute to tumor-microenvironment communication and cisplatin resistance, although these findings remain preclinical. Overall, miR-371a-3p represents one of the most promising biomarkers in TGCT management, but its routine clinical integration will require standardized analytical protocols and prospective validation in marker-guided decision pathways.