Symptomatic fluid collections are a source of morbidity for patients after single-port (SP) robot assisted radical prostatectomy (RARP). We previously demonstrated a reduction in fluid collections by over 50

Robot-assisted surgical management of ureteral stricture is a relatively uncommon procedure with numerous techniques described. This literature review combined with expert opinion outlines the key surgical principles of ureteral reconstruction and proposes an algorithm for the robot-assisted treatment of ureteral strictures. A narrative literature review was conducted using PubMed and Cochrane databases with a predefined search strategy including terms related to ureteroplasty and upper urinary tract reconstruction. The search yielded approximately 900 results. After screening, 219 relevant studies were selected for analysis. Two authors independently reviewed all included articles, and whenever evidence was inconsistent or insufficient, consensus was reached through discussion within the full author group. Robotic ureteral reconstruction includes several techniques, with the choice of procedure guided by multiple factors. Key principles include the use of healthy tissue, creation of a tension-free anastomosis, and ensuring adequate drainage. Outcomes may be further optimized by preoperative ureteral rest, intraoperative ureteroscopy, and the use of intravenous indocyanine green (ICG). Buccal mucosa grafting has emerged as a breakthrough in minimally invasive reconstruction. The robotic approach is adept at managing standard techniques such as ureteroureterostomy, psoas hitch, Boari flap, ureteroneocystostomy, and more recently described methods such as non-transecting ureteral reimplantation and bladder flap ureteroplasty. Ileal ureter remains a good option in cases of challenging reconstructions and patients with prior radiation therapy or extensive defects. Robot- assisted ureteral reconstruction has shifted the paradigm in stricture management, allowing complex reconstructive operations to be performed with minimally invasive techniques. This expert review summarizes key surgical approaches and presents a practical algorithm to guide urologists in the management of ureteral strictures.

Introduction: Managing benign prostatic hyperplasia (BPH) cases involving prostates larger than 100 cc remains challenging due to high retreatment rates associated with minimally invasive therapies. This study compares perioperative outcomes of transurethral robotic waterjet ablation (RWA) to single-port robotic transvesical simple prostatectomy (SP) for patients with prostates larger than 100 cc. Methods: Using our institution’s prospective and retrospective databases, we identified patients who received either RWA (1st- or 2nd-generation) or SP between June 2022 and December 2025. We included only patients with prostate volumes greater than 100 cc on pre-operative cross-sectional imaging. Data were analyzed to identify differences in perioperative outcomes, including postoperative complications and incidence of postoperative irrigation for clot retention. Results: The SP (N=43) and RWA (N=74) cohorts differed significantly in terms of preoperative PVR (252.5 vs 56.5mL; p < 0.001). Median operative time was higher in the SP cohort (111 minutes) compared to the RWA cohort (58.0 minutes; p < 0.001), as was estimated blood loss (87.5 vs 25mL; p < 0.001). There was no significant difference between the cohorts in length of stay, trial of voiding, postoperative complications, or 3-month PVR ( p = 0.419), although there was a clear trade-off in continuous bladder irrigation (CBI) utilization. Conclusion: This study demonstrates that single-port robotic transvesical simple prostatectomy provides similar short-term safety and efficacy compared with robotic waterjet ablation therapy for patients with large prostates >100 cc. There are clear trade-offs between the two approaches regarding operative time and CBI utilization. Future studies should incorporate long-term functional outcomes data.

Introduction Evidence from the literature suggests that patients with more complex tumors are less likely to achieve the surgical trifecta—defined as negative margins, ischemia time under 25 minutes, and the absence of Clavien-Dindo grade III or higher postoperative complications. The purpose of this study is to compare trifecta achievement between single-port (SP) and multi-port (MP) robotic cohorts at a high-volume institution and to assess the impact of nephrometry score and demographic factors on these outcomes. Methods Our institution’s IRB-approved, prospective renal cancer database was used to identify 753 patients with renal cell carcinoma (RCC) who underwent robot-assisted partial nephrectomy (RAPN) from 2017 to 2025. Patients were stratified into cohorts based on SP and MP RAPN approach. Trifecta rates for each group were estimated using Wilson score 95% confidence intervals. Multiple logistic regression models assessed associations between trifecta achievement and surgical approach, age, sex, body mass index (BMI), nephrometry score, and tumor size. Results The SP RAPN (N = 102) cohort included fewer male patients and had lower BMI, nephrometry scores, and tumor sizes compared to the MP cohort (N = 494). Trifecta achievement did not differ significantly between the SP (76%) and MP (80%) groups ( p = 0.46). The odds of trifecta achievement were not significantly influenced by surgical platform choice (p = 0.052). Among the factors we analyzed, only nephrometry score was significantly associated with trifecta achievement, while surgical approach showed no significant association. Conclusion We conclude that experienced surgeons using the single-port platform can achieve similar trifecta outcomes during robot-assisted partial nephrectomy compared to multi-port, regardless of tumor complexity.

The purpose of this study is to compare trifecta achievement between single-port (SP) and multi-port (MP) robotic cohorts at a high-volume institution and to assess the impact of nephrometry score and demographic factors on these outcomes. Our institution’s IRB-approved, prospective renal cancer database was used to identify 753 patients with renal cell carcinoma (RCC) who underwent robot-assisted partial nephrectomy (RAPN) from 2017 to 2025. Patients were stratified into cohorts based on SP and MP RAPN approach. Trifecta rates for each group were compared between the cohorts using complete-case and multiple imputation data sets. Multiple logistic regression models assessed associations between trifecta achievement and surgical approach, age, sex, body mass index (BMI), nephrometry score, and tumor size. Alternatively, trifecta rates were stratified by the nephrometry score and the common odds ratio and heterogeneity was tested across the nephrometry score strata with Cochran–Mantel–Haenszel and Breslow–Day tests. Trifecta achievement did not differ significantly between the SP (N = 102; 76