Hippocrates was the first physician in history to establish medicine as a science and to suggest the boundaries of physicians' behavior towards their patients. The Hippocratic Oath is applied in many healthcare systems worldwide as an ethical guide for doctors graduating from medical school. It determines modern medicine's most significant values, such as physicians' specialization to avoid harm and respect patients' privacy. In this study, we present Hippocrates' contributions to clinical medicine and his innovative ideas for the prevention, diagnosis, and treatment of disease. We also analyze his achievements in the development of the main concepts of several medical specialties, such as neurology with his approach to the treatment of epilepsy, surgery with his techniques of antisepsis, urology with his theory on stone disease, orthopedics, and acute medicine, as well as their application in modern healthcare. We have conducted a review of the available literature from PubMed and Google Scholar databases.

In this study, we assess the impact of frailty on the success rate and risk of complications of robot-assisted urological procedures and introduce effective preoperative screening tools to evaluate frail patients' fitness to tolerate robot-assisted urological surgery. We performed a search of electronic databases for available studies, published up to August 2023, investigating the outcomes of robot-assisted urological oncology procedures and their safety in frail patients. Sixteen studies were ultimately selected, investigating the implications of frailty in robot-assisted radical cystectomy, robotassisted partial nephrectomy, and robot-assisted radical prostatectomy. All the studies used the Clavien-Dindo classification of complications with serious complications considered as Clavien-Dindo 3. Frail patients significantly benefit from robot-assisted urological procedures in comparison to open surgery, with lower rates of blood transfusion and a shorter length of stay. However, they also have a higher risk of postoperative complications than non-frail patients, as well as increased rates of conversion to open, total hospital costs, and in-hospital mortality after robot-assisted procedures. Robot-assisted urological procedures can improve the postoperative recovery of frail patients in comparison to open surgery. Reliable frailty indexes such as the Johns Hopkins indicator and simplified frailty index, as well as the Geriatric 8 screening tool, should be routinely used in the preoperative assessment of frail patients to optimize surgical decision-making.

According to the guidelines of the European Association of Urology (EAU), it is recommended to exclude PSA testing when the expected remaining lifespan is less than 10 years. In this study, we provide a comprehensive analysis of the impact of prostate-specific antigen (PSA) testing on the quality of life of elderly men who are frail. We conducted a comprehensive literature review to identify publications that examine the use of PSA as a screening and prognostic tool for prostatic illnesses in frail men. Our search included the following keywords: Prostate-specific antigen, Frailty, Prostate cancer screening, Hypogonadism, and Benign Prostatic Obstruction (BPO). Prostate-specific antigen (PSA) testing can be used to identify prostate cancer in its early and treatable stages in fragile men with a life expectancy of over 15 years. Additionally, PSA testing allows for the evaluation of the effectiveness of various prostate cancer treatments and the monitoring of testosterone replacement therapy for hypogonadism. PSA is also indicative of the clinical development of patients with benign prostatic obstruction (BPO). Nevertheless, PSA is being extensively provided without individualised patient assessment, contributing to the economic strain on healthcare systems. Conducting a frailty evaluation on men to determine the potential advantages of PSA tests on their quality of life will help minimise avoidable expenses.

Background: In urology, ureteral stents are used to treat obstructive diseases. Hematuria (54%), fever, discomfort, and lower urinary system symptoms are the predominant symptoms related to ureteral stent. Aim: This article links stent symptoms to double-j width and length, as well as patient’s height, weight, and body mass index (BMI). Ureteric Stent Symptoms Questionnaire (USSQ) was used to measure ureteral stent symptoms at 1st and 4th week of stent in situ as well as the 4th week after pigtail removal. Methods: A 200-patient prospective study, where patients were allocated into four groups following ureteral stent insertion depending on the stent characteristics. Those groups were: 4.8 Fr./26 cm (Group A), 4.8 Fr./28 cm (Group B), 6 Fr/26 cm (Group C), and 6 Fr/28 cm (Group D). Results: Men comprised 53.5% of 200 patients. Participants had an average age of 49 ± 15.5 years, height of 175 ± 8.94 cm, and BMI of 23.8 ± 7.6 cm. The laboratory results were identical between groups. At the first and fourth week, groups had similar urine symptoms, pain severity, health status and occupational activities. The difference in pain location was statistically significant. Group A had 82.4% renal back pain in the first week, whereas Group B had 68.8%, Group C 31.3% and Group D 62.5 (p = 0.04). At the fourth week, 64.7% of Group A patients reported kidney front pain, compared to 100% of Group B, 93.3% of Group C, and 100% of Group D (p = 0.04). There was statistical significance in the sexual activity of the patients. 24.4% of Group C patients stopped sexual activity before stent installation, compared to 10.6%, 8.3%, and 6.4% of the other groups (p = 0.03). A moderate percentage of patients had active sexual activity at week 4 (Group A: 7.8%, Group B: 5.8%, Group C: 8.2%, Group D: 4.1%), p = 0.83. In multivariate analysis, urinary catheter group, age, weight, height, and BMI did not significantly affect urine index score (UIS), pain index score (PIS), general health (GH), quality of work (QW), and quality of sex (QS). Conclusions: Despite various attempts to establish the best ureteral stent, the effect of double-j stent physical features on stent-related symptoms remained unknown. No verdict is conceivable without adequate empirical data.

Introduction The aim of this review was to assess the outcomes of partial nephrectomy using indocyanine green (ICG) regarding ischemia time, positive surgical margins (PSM), estimated blood loss (EBL) and estimated GFR reduction while also suggesting the optimal dosage scheme. Material and methods A systematic review was performed using Medline (PubMed), ClinicalTrials.gov, and Cochrane Library (CENTRAL) databases, in concordance with the PRISMA statement. Studies in English regarding the use of indocyanine green in partial nephrectomy were reviewed. Reviews and meta-analyses, editorials, perspectives, and letters to the editors were excluded. Results Individual ICG dose was 5 mg in most of the studies. The mean warm ischemia time (WIT) on each study ranged from 11.6 minutes to 27.2 minutes. The reported eGFR reduction ranged from 0% to 15.47%. Lowest mean EBL rate was 48.2 ml and the highest was 347 ml. Positive surgical margin rates were between 0.3% to 11%. Conclusions Indocyanine green seems to be a useful tool in partial nephrectomy as it can assist surgeons in identifying tumor and its related vasculature. Thereby, warm ischemia time can be reduced and, in some cases, selective ischemia can be implemented leading to better renal functional preservation.

There has been a growing need for enhancements in healthcare delivery, especially for the improvement of surgical outcomes. Therefore, implementing consistent reporting of complications enables the evaluation of data quality and facilitates its comparison. There are currently many available reporting and grading systems each with its own set of benefits and drawbacks. In this comprehensive review, we tried to present and assess each of them by demonstrating their criteria and their strong and weak points. To sum up, it seems that there is a need for developing a new reporting and categorization system for complications that are specific to urology.

Objectives With this study we present, for the first time to the best of our knowledge, the implications of PSA tests on the lives of frail men. Methods We searched the available literature for studies analyzing the role of PSA as a screening and prognostic tool for prostatic diseases in frail men, using keywords: Prostate-specific antigen, Frailty, Prostate cancer screening, Hypogonadism and Benign Prostatic Obstruction (BPO). Results PSA in frail men with more than 15 years life expectancy can detect prostate cancer in curable stages, while it enables monitoring response to different prostate cancer treatments and follow-up of testosterone replacement for hypogonadism. PSA also predicts clinical progression of patients with BPO. However, PSA is widely being offered, without personalized patient evaluation, adding to the financial burden of healthcare systems. Conclusion A frailty assessment of men for the potential benefit of PSA tests on their quality of life can reduce unnecessary costs.

The purpose of this article is to review the effects of different types of pharmacotherapy on symptoms that affect the quality of a patient's life after stent insertion. A thorough Medline/PubMed nonsystematic review was conducted from 1987 to January 2023, using the terms: "pigtail" OR "ureteral stents" AND "lower urinary tracts symptoms" OR "LUTS" AND "pharmacotherapy" OR "drugs". Relevant studies conducted in humans and reported in English language were included. The available reviews and articles associating the use of drugs with stent-related symptoms (SRS) provide conflicting results. Most of them show a clear benefit of alpha blockers, particularly alfuzosin, on treating urinary SRS, and hence there is a strong recommendation for the use of alpha blockers for the treatment of SRS in the guidelines of the European Association of Urology. Anticholinergics and mirabegron have shown a significant benefit in dealing with irritative bladder symptoms. In contrast, the findings for combination therapies are contradictory, with some studies showing that combination therapy is no superior to monotherapy with regards to most of the subsets of the Ureteral Stent Symptom Questionnaire (USSQ), whereas others present a clear benefit of combination therapies, specifically silodosin and solifenacin, in treating stent-associated lower urinary tract symptoms (LUTS), in comparison with any other type of monotherapy or combination therapy. Many studies suggest that some categories of pharmacotherapy, such as alpha blockers, can alleviate SRS. However, there is conflicting evidence concerning most other types of medical treatment. Randomized trials with the largest number of patients are needed to investigate the effectiveness of novel approaches on SRS.

Background:In routine urological practice, pigtails are frequently utilized to relieve blockage. Early signs of pigtail problems include pain, lower urinary tract symptoms, pain, hematuria (54%) and fever. Seventy percent of patients experience irritable voiding symptoms, and 80% of patients or even more report pain interfering with everyday activities. Methods:This article's goal is to evaluate the various polymeric stents that are currently on the market. In addition, a review of their fundamental bioqualities is conducted, and a connection between their physical attributes (length, size, and composition) and stent-related issues is looked into. For this review, extensive Medline, PubMed, and literature research from 1987 to January 2023 was conducted. Lower urinary tract complaints, ureteral stents, "pigtail," "materials," "characteristics," or "properties" were the search terms employed. Results:The reviews and publications that are now accessible linking certain materials to stent-related symptoms offer contradictory conclusions, and the majority of research do not specify the precise properties of the materials utilized. The results of the studies on the relationship between stents length and diameter and symptoms connected to stents are likewise inconclusive, despite the fact that there are several studies on this topic in the literature. Conclusion:Numerous studies imply a connection between the various types and properties of the utilized stents and stent-related complaints. However, the available data did not fully support this claim, necessitating additional research.

A ureteric stricture can be treated either endoscopically or with ureteric reconstruction. The developments in robotic ureteric repair have led to similar success rates to open techniques, with the addition of decreased hospitalization duration and blood loss [1-7]. Recognition of the stricture during robotic ureteric reconstruction, however, can be challenging. In this study, we introduce the novel technique of ureteroscopic ‘tattooing’ of the ureteric lumen on the level of the stricture to subsequently recognize it during robotic ureteroureterostomy. We also compare our technique with others used for ureteric stricture identification. Our preliminary data show that this technique is easy to use and can reduce the operating time and the complication rate postoperatively. A total of four patients with benign ureteric strictures underwent robot-assisted ureteroureterostomy in a single tertiary hospital. All patients underwent preoperative MAG3 renograms and CT urograms, which showed obstruction on the side of the stricture and provided a measure of its length (<3 cm). Patients were followed up for 1 year after their procedures with MAG3 renograms at 3 and 12 months. Three patients were male and one female. All the male patients had left ureteric strictures, while the female patient had a right stricture. Long standing obstruction from impacted ureteric stones caused the stricture in two patients and multiple ureteroscopies caused it in the other two. In all the cases a retrograde ureteroscopy with a semirigid 7-Fr ureteroscope preceded the robotic ureterectomy. A retrograde study confirmed the length of the stricture in all cases. The patients were placed in a Lloyd-Davies position. The distal end of the ureteric stricture was marked with black dye with the use of a fine endoscopic injection needle (EndoTNeedle™; GI Supply, Specialty Endoscopic Products, Mechanicsburg, PA, USA) through the working channel. Initially, the needle was pushed through the mucosa. It is of utmost importance to approach the mucosa tangentially to avoid the injection of the dye outside the ureter, which can cause inflammation or the injury of surrounding organs and vessels. After insertion of the needle, the catheter was withdrawn slightly and pulled towards the lumen to ensure that the needle was directly under the mucosa. We inserted 0.5 mL of black dye on the anterior wall of the ureteric lumen (12 o’ clock position) at the distal end of the stricture. We used a permanent carbon black dye, commercially available as Spot® Ex, ready for injection with the endoscopic injection needle. In all the cases we used the needle without the sheath to be able to pass it through the working channel of the ureteroscope. Subsequently the patient was placed in the supine position with the corresponding side of the operation elevated with a wedge. The Da Vinci Xi Robotic System was used with three robotic ports. The port configuration was similar to that used in robotic pyeloplasty. The colon was mobilized and the marked ‘tattooed’ ureter was identified and mobilized extensively above and below the mark (Fig. 1). It was then incised just under the mark, opened, and 2–3 cm of ureteric segment above the mark were removed depending on the measured length of the stricture. The proximal and distal ends are spatulated. A 3–0 double ended Quill-type suture was used for end-to-end anastomosis over a 6-Ch/26-cm JJ ureteric stent. Subsequently, an omental wrap was created and a 20-Fr Robinson's drain was placed next to the anastomosis. All four patients in our study were discharged on the next day and no complications or readmissions occurred. The mean (range) operating time was 128.75 (110–150) min. The mean (range) blood loss was 45 (20–110) mL. The stent was removed 4 weeks later and a MAG3 renogram, performed at 3 months postoperatively, showed no obstruction, with improvement of the function of the kidney in three of the patients and unchanged function in the fourth patient (Table S1). The histology of the excised ureteric segment came back as benign in all patients. A subsequent MAG3 renogram at approximately 1 year after the procedure confirmed that the obstruction had resolved in all patients. No reactions or complications were observed that could be associated with the carbon black ‘tattoo’. Studies reporting ureter marking during robotic ureteroureterostomy were identified through three databases (PubMed, Cochrane and Medline). Non-English language and paediatric population studies were excluded during the initial screening. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were followed, with the following search terms used: ‘robotic’ OR ‘robot’ AND ‘ureteral stricture’ OR ‘ureteral pathologies’ OR ‘ureteral reconstruction’ OR ‘upper urinary tract reconstruction’. Comparative outcomes (success and postoperative complications) and total and subgroup analyses were performed to identify whether ureter tattooing displayed favourable outcomes in comparison to particular marking techniques, which included simultaneous ureteroscopy, the use of intra-operative intraureteric indocyanine green (ICG) and intraureteric saline injection. The search strategy identified 299 articles. Of these, 264 records were excluded during the initial screening process (not associated with the study, non-English language, paediatric), and another 28 were excluded at the full-text assessment (case reports, reviews, ureteric stricture identification technique not described). Finally, seven articles were included in this study for comparative analysis. In five studies, simultaneous ureteroscopy was used to identify the stricture intra-operatively, while in the other two studies either ICG or saline is injected via a ureteric catheter during the robotic reconstruction. Although the small number of patients did not allow statistically significant results, the preliminary data showed that our technique reduces the operating time of robotic ureteroureterostomy and demonstrates equal if not better success rates than the other techniques, with fewer complications, while also reducing the estimated blood loss and mean hospital stay. The mean follow-up period for our patients was shorter than that of other case series: 12 months vs 15 months. Several techniques have been used to facilitate the recognition of ureteric strictures during robotic reconstruction, such as intraureteric injection of ICG. This requires the insertion of a ureteric catheter to perform the injection and the patient is placed in a modified lithotomy position during the robotic reconstruction. Also, ICG may spill outside the ureter upon incision, staining the field green and making it impossible to use intravascular ICG. Intra-operative ureteroscopy, performed to identify the ureteric obstruction by recognizing the light of the ureteroscope, requires the same patient positioning and a second surgeon to perform the ureteroscopy simultaneously with the reconstruction, as well as an extra monitor and stack with a light source [1-7]. Our technique of preoperative endoscopic ‘tattooing’ with the ureteroscope does not require the insertion of a ureteric catheter. The patient is in a preferred supine position during the robotic repair, and the simultaneous use of intravascular ICG to evaluate the ureter's viability is facilitated. No endoscopic instrumentation is required during the robotic reconstruction. Although our technique is unique for robotic identification of ureteric strictures, the use of ureteric tattooing has been documented recently in patients undergoing ileal conduit diversion for future endoscopic ureteroenteric anastomoses identification [8]. The main limitations of our study are the small number of patients and the short follow-up period, which were not sufficient to fully evaluate the long-term results of our marking technique. In conclusion, the preoperative ureteroscopic ‘tattooing’ of a ureteric stricture, performed to simplify its intra-operative identification during robotic ureteroureterostomy, is a novel marking technique, with promising safety and reliability outcomes. Larger series of patients followed up for a longer period of time are required to verify the effectiveness of this technique. None declared. Table S1. Postoperative results of MAG3 renograms after robotic ureteroureterostomy at 3- and 12-month follow-up appointments. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

To evaluate the role of low intra-abdominal pressure (IAP) in improving postoperative recovery in Robotic-assisted radical cystectomy (RARC) and intracorporeal ileal conduit urinary diversion (ICUD). A retrospective case–control study of 49 bladder cancer patients offered RARC/ICUD with standard (12 mmHg, n = 24) or low IAP (8 mmHg, n = 25). Outcomes of interest included length of procedure (LoP), estimated blood loss (EBL), blood transfusion, margin positivity rates, time to first flatus (TtFF), time to first bowel movement (TtFBM), ileus and small bowel obstruction (SBO) rates, time to safe discharge (TtSD), postoperative hospital stay (PHS) and pain levels on a postoperative day (POD) 1 and 3. Perioperative complications were recorded using the Clavien-Dindo system. Demographic and baseline clinical characteristics, LoP, EBL and margin positivity rates were similar between groups. No transfusions were recorded. Median (IQR) TtFF, TtFBM and TtSD were significantly longer in Group 1 vs Group 2 (4 (1) vs 2 (1), 7 (3) vs 6 (2) and 8.5 (5.75) vs 5.0 (1), respectively). PHS and rates of postoperative ileus and SBO were lower in Group 2, however not statistically significant. Severe pain was uncommon in both groups but moderate/severe pain was significantly higher in Group 1 (95.8% vs 48% on POD1 and 62.5% vs 16% on POD3). No significant intraoperative complications were recorded and ≥ Grade 3 postoperative complications at 30 and 90 days were similar. With limitations, Low-IAP RARC can be safely offered to RARC/ICUD patients and leads to faster bowel recovery, and shorter time to safe discharge compared to standard pneumoperitoneum.

Objectives:This study aims to evaluate the effect of frailty in patients undergoing radical cystectomy (RC) for locally advanced bladder cancer.Methods:In this retrospective, single center study we evaluated 51 patients with pT4 bladder cancer treated with radical cystectomy between 2016-2020. Patient frailty was assessed with the Clinical Frailty Scale (CFS). Furthermore, six separate parameters (early mortality index within 30 days after surgery, death after one year, length of stay, respiratory complications, readmission index, total hospital charges) were also evaluated. The patients were categorized on three groups (Group 1, 2, 3) based on the CFS.Results:A total of 51 pT4 RC patients were included in the study. Mean age was 75.6 years. Early mortality rate at 30 days after surgery was low all the groups. One year mortality rate was higher in Group 2 (22%) and 3 (69%). The length of stay and the number of patients with respiratory complications were also higher in the frailer groups. 30 days readmission rate was 22% in Group 2 and 38% in Group 3.Conclusions:Preoperative frailty is associated with worse postoperative results after RC. CFS is an objective tool for patient risk stratification and can predict postoperative complications and mortality.

Dulaglutide is an injectable glucagon-like peptide-1 receptor agonist approved for the treatment of adults with type 2 diabetes. Angioedema is defined as self-limiting edema, localized in the deeper layers of the skin and mucosa. Angioedema can be hereditary or acquired which can be allergic due to reactions to foods, insect bites and stings, and latex, drug-induced, caused by physical stimuli and associated with lupus erythematosus and hypereosinophilia. Angioedema represents a rare adverse event of glucagon-like peptide-1 receptor agonists. The only glucagon-like peptide-1 receptor agonist that has been mentioned to induce angioedema in literature is exenatide. We report the first case of dulaglutide-associated angioedema in a 72-year-old male in order to point out to the clinicians this potential rare side effect of this drug and its clinical significance.

Context: The clinical effectiveness of focal therapy (FT) for localised prostate cancer (PCa) remains controversial. Objective: To analyse the evidence base for primary FT for localised PCa via a systematic review (SR) to formulate clinical practice recommendations. Evidence acquisition: A protocol-driven, PRISMA-adhering SR comparing primary FT (sub-total, focal, hemi-gland, or partial ablation) versus standard options (active surveillance [AS], radical prostatectomy [RP], or external beam radiotherapy [EBRT]) was undertaken. Only comparative studies with >= 50 patients per arm were included. Primary outcomes included oncological, functional, and quality-of-life outcomes. Risk of bias (RoB) and confounding assessments were undertaken. Eligible SRs were reviewed and appraised (AMSTAR) and ongoing prospective comparative studies were summarised. Evidence synthesis: Out of 1119 articles identified, four primary studies (1 randomised controlled trial [RCT] and 3 retrospective studies) recruiting 3961 patients and ten eligible SRs were identified. Only qualitative synthesis was possible owing to clinical heterogeneity. Overall, RoB and confounding were moderate to high. An RCT comparing vascular-targeted focal photodynamic therapy (PDT) with AS found a significantly lower rate of treatment failure at 2 yr with PDT. There were no differences in functional outcomes, although PDT was associated with worse transient adverse events. However, the external validity of the study was contentious. A retrospective study comparing focal HIFU with robotic RP found no significant differences in treatment failure at 3 yr, with focal HIFU having better continence and erectile function recovery. Two retrospective cohort studies using Surveillance, Epidemiology and End Results data compared focal laser ablation (FLA) against RP and EBRT, reporting significantly worse oncological outcomes for FLA. The overall data quality and applicability of the primary studies were limited because of clinical heterogeneity, RoB and confounding, lack of long-term data, inappropriate outcome measures, and poor external validity. Virtually all the SRs identified concluded that there was insufficient high-certainty evidence to make definitive conclusions regarding the clinical effectiveness of FT, with the majority of SRs judged to have a low or critically low confidence rating. Eight ongoing prospective comparative studies were identified. Ways of improving the evidence base are discussed. Conclusions: The certainty of the evidence regarding the comparative effectiveness of FT as a primary treatment for localised PCa was low, with significant uncertainties. Until higher-certainty evidence emerges from robust prospective comparative studies measuring clinically meaningful outcomes at long-term time points, FT should ideally be performed within clinical trials or well-designed prospective cohort studies. Patient summary: We examined the literature to determine the effectiveness of prostate-targeted treatment compared with standard treatments for untreated localised prostate cancer. There was no strong evidence showing that focal treatment compares favourably with standard treatments; consequently, focal treatment is not recommended for routine standard practice. (C) 2020 European Association of Urology. Published by Elsevier B.V. All rights reserved.

This review summarizes the current literature on the correlation between frailty and urinary tract infections (UTIs), as well as the potential causes and measures that can be taken to prevent and treat these frailty associated UTIs (FaUTIs). A narrative review of the literature was carried out using the keywords and other associated terms (catheter associated UTIs and frailty, causes of UTIs, prevention of UTIs in the frail, treatment of UTIs in the frail). As it is shown in the literature, many risk factors that are associated with frailty such as dehydration, reduced mobility and cognitive impairment, as well as other anatomical or functional abnormalities can make frail patients prone to UTIs that are also more difficult to treat. Early correction of these risk factors (for example avoiding long term catheters, increasing hydration, treating lower urinary tract obstruction or incontinence), can prevent UTIs and improve the quality of life of frail patients. Prompt and individualized antimicrobial treatment of UTIs in the frail population can result in decreasing mortality rates but also minimize unnecessary antimicrobial drug use.

Background:-Active surveillance (AS) is a strategy employed as an alternative to immediate standard active treatments for patients with low-risk localised prostate cancer (PCa). Active treatments such as radical prostatectomy and radiotherapy are associated with significant adverse effects which impair quality of life. The majority of patients with low-risk PCa undergo a slow and predictable course of cancer growth and do not require immediate curative treatment. AS provides a means to identify and monitor patients with low-risk PCa through regular PSA testing, imaging using MRI scans and regular repeat prostate biopsies. These measures enable the identification of progression, or increase in cancer extent or aggressiveness, which necessitates curative treatment. Alternatively, some patients may choose to leave AS to pursue curative interventions due to anxiety. The main benefit of AS is the avoidance of unnecessary radical treatments for patients at the early stages of the disease, hence avoiding over-treatment, whilst identifying those at risk of progression to be treated actively. The objective of this article is to provide a narrative summary of contemporary practice regarding AS based on a review of the available evidence base and clinical practice guidelines. Elements of discussion include the clinical effectiveness and harms of AS, what AS involves for healthcare professionals, and patient perspectives. The pitfalls and challenges for healthcare professionals are also discussed. Data sources: We consulted international guidelines, collaborative studies and seminal prospective studies on AS in the management of clinically localised PCa. Conclusion: AS is a feasible alternative to radical treatment options for low-risk PCa, primarily as a means of avoiding over-treatment, whilst identifying those who are at risk of disease progression for active treatment. There is emerging data demonstrating the long-term safety of AS as an oncological management strategy. Uncertainties remain regarding variation in definitions, criteria, thresholds and the most effective types of diagnostic interventions pertaining to patient selection, monitoring and reclassification. Efforts have been made to standardise the practice and conduct of AS. As data from high-quality prospective comparative studies mature, the practice of AS will continue to evolve. Implications for Nursing Practice: The practice of AS involves a multi-disciplinary team of healthcare professionals consisting of nurses, urologists, oncologists, pathologists and radiologists. Nurses play a prominent role in managing AS programmes, and are closely involved in patient selection and recruitment, counselling, organising and administering diagnostic interventions including prostate biopsies, and ensuring patients' needs are being met throughout the duration of AS. (C) 2020 Elsevier Inc. All rights reserved.

Background: Renal hematomas, although relatively rare, are potentially life-threatening complications after ureterolithotripsy. Case Presentation: We present four cases of renal hematomas that occurred in our department during the past decade (2008-2018). Unstable vital signs, increased inflammatory markers, fever, and flank pain were the commonest postoperative findings. Two patients were treated conservatively and had an uneventful recovery, whereas one patient underwent selective arterial embolization for bleeding control. The fourth patient was diagnosed with contralateral ureteral urothelial tumor and ultimately underwent contralateral radical nephroureterectomy. Conclusion: Application of safety measures during ureteroscopy may reduce the incidence of perirenal hematomas. Prompt diagnosis is based on a thorough clinical examination in combination with imaging to evaluate the location and extent of the hematoma.

Major urologic oncology procedures such as radical cystectomy (RC), radical prostatectomy (RP), radical nephroureterectomy (RNU) and radical or partial nephrectomy are the gold standard operations for the treatment of urological malignancies not suitable to be dealt with using minimal invasive procedures such as transurethral resection or other conservative approaches.However, these surgical procedures carry significant risk of complications, especially in elderly and frail patients.The purpose of this review is to highlight the use of a wide variety of preoperative frailty and health status indexes and calculators.Recent data from large population based studies confirm that these calculators can assist physicians and urologists to predict the postoperative morbidity of patients undergoing major operations.Moreover, these frailty calculators can help urologists choose the most suitable and safe treatment for every individual patient.However, the absence of widely accepted specific urologic oncology calculators to predict the association between frailty and postoperative complications emphasizes the necessity for the use of a combination of calculators.