ABSTRACT Objective: To evaluate patterns and imaging-based predictors of positive surgical margins (PSMs) in patients with high-risk prostate cancer (PCa) undergoing nerve-sparing (NS) robot-assisted radical prostatectomy (RARP). Materials and Methods: We retrospectively analyzed 1,235 consecutive patients with high-risk PCa treated with RARP between 2022 and 2024 at a high-volume tertiary referral center. Among them, 533 patients underwent preoperative multiparametric MRI (mpMRI) reviewed by two expert uro-radiologists and MRI–ultrasound fusion biopsy. A per-side analysis was performed to identify predictors of ipsilateral PSMs in cases where neurovascular bundle (NVB) preservation was attempted. Biochemical recurrence (BCR) was assessed, and multivariable logistic regression was used to determine independent predictors of PSMs. Results: Overall, 36.1% of patients underwent non–nerve-sparing surgery, 49.5% unilateral NS, and 14.4% bilateral NS. Nerve sparing was performed on 418 surgical sides, with ipsilateral PSMs detected in 90 (21.5%). Sides with and without PSMs showed comparable nerve-sparing techniques (intra- vs interfascial) and similar 3-year BCR-free survival rates (68% vs. 69%) at a median follow-up of 36 months, although earlier biochemical failure at lower PSA thresholds was more frequent in PSM-positive sides. On multivariable analysis, larger prostate volume, apical tumor location, peripheral zone involvement, greater lesion diameter, and extracapsular extension on mpMRI were independently associated with an increased risk of ipsilateral PSMs. Conclusions: Nerve-sparing RARP may be feasible in carefully selected high-risk PCa patients. The integration of mpMRI-based predictors can enhance patient selection, optimizing the balance between oncologic safety and functional preservation. Prospective studies are warranted to validate these findings and minimize selection bias.

Objective: To evaluate the early oncological outcomes of patients treated with robot-assisted radical prostatectomy for prostate cancer with multiple PIRADS lesions at baseline mpMRI in a tertiary referral center. Methods: Data of consecutive patients undergoing robot-assisted radical prostatectomy between 2020 and 2022 at a high-volume tertiary referral center were prospectively collected. mpMRI data was evaluated by two expert uro-radiologists at our center. All patients received an MRI-ultrasound fusion biopsy. Results: Overall, 286 patients with multiple PIRADS lesions treated with robot-assisted radical prostatectomy at a tertiary referral center were included. Unilateral and bilateral nerve-sparing were achieved in 63 (22.3%) and 124 (43.1%) patients, respectively. Median age was 69 years (IQR: 64-72), while median Charlson Comorbidity Index was 3 (IQR: 2-4). The presence of two PIRADS lesions was found in the 81.8% of cases, while 18.2% presented with three or more. Bilateral lesions were observed in 67.4% of cases. The dominant lesion was PIRADS 4 in 57.3% and PIRADS 5 in 32.3% of cases, with a median diameter of 12 mm (IQR: 10-17). Pathological upstaging to pT3 occurred in 61% of patients. Overall, 9.8% of cases exhibited positive surgical margins (PSMs), most of them single and limited in extent. Postoperative major complications were recorded in 6.3% of patients. At a median follow-up of 18 months (IQR: 6-29), biochemical recurrence (BCR) occurred in 8% of patients. Patients with PIRADS 5 lesions experienced shorter BCR-free survival compared to those with PIRADS 3-4. On multivariable Cox regression, PIRADS 5 independently predicted biochemical recurrence (HR: 2.52; 95% CI: 1.10-5.80; p = 0.029), after adjustment for age, number of lesions, and nerve-sparing status, with the performance of nerve-sparing not associated with an increased risk of recurrence, including in patients with multifocal disease. Conclusions: Nerve-Sparing Robot-Assisted Radical Prostatectomy in patients with multiple PIRADS lesions achieves encouraging short-term oncologic outcomes, with biochemical recurrence-free survival exceeding 84% at 3 years, despite high rates of multifocality and pathological upstaging.

OBJECTIVE:To provide an updated national overview of the clinical management of congenital and acquired penile curvature (PC) in Italy, evaluating current diagnostic and therapeutic practices among Italian urologists. MATERIALS AND METHODS:A 23-item anonymous digital survey was distributed by the Italian Society of Urology (SIU) to 2034 affiliated urologists between 2024 and 2025. The survey includes demographic data, diagnostic approaches, and treatment strategies for PC, including Peyronie's disease (PD). Participants were categorized by practice setting and geographic region. SPSS software was used to conduct descriptive and comparative analyses. RESULTS:Overall, 442 urologists had completed the survey (response rate: 21.7%). Most participants were affiliated either with university hospitals (34.6%) or public non-university hospitals (32.8%). The major incidence of PD cases, as reported by 310 (70.1%) respondents, were in patients between 45-60 years old and the most frequent presentation was a dorsal curvature (223 responses, 50.5%). The routine clinical practice, as reported by respondents, includes anamnestic data with photographs collection and penile ultrasound (in 261 (59%) and 188 (42.5%) of respondents, respectively), while penile dynamic CCDU was mainly used in patients with erectile dysfunction. In regard to therapeutic strategies, 142 (32.8%) of urologists used Clostridium Collagenase Histolyticum (CCH) for intralesional therapy; a similar proportion used verapamil/nicardipine, despite limited supporting evidence. Interestingly, surgical approaches varied widely: tunica plication was preferred in non-complex cases by 169 (38.2%), while penile prosthesis was offered in complex cases by 129 (29.2%) urologists. Finally, penile prosthesis implantation was offered in patients with severe ED unresponsive to pharmacological therapy, regardless of penile curvature only by 176 respondents (39.8%), meanwhile, 177 respondents considered penile prothesis only for severe PC over >60 degrees associated with ED. CONCLUSIONS:This nationwide survey reveals a significative heterogeneity in PC and PD management in Italy, with frequent reliance on off-label treatments and variable adherence to international guidelines. Economic limitations and regional differences appear to be a primary factor influencing clinical decisions and clinical practice. These findings underline the need for a major dissemination of evidence-based guidelines associated with national healthcare strategies aimed at standardized care and improving patient outcomes.

INTRODUCTION:Vesicoureteral reflux (VUR) may have long lasting effects on affected individuals, especially in females. Its intertwined relationship with urinary tract infection (UTI) has been well documented and there is a further risk during pregnancy where UTIs are more problematic. OBJECTIVE:To analyze existing data within the literature to identify factors associated with pregnancy-related complications in women with a history of VUR in childhood. METHODS:PubMed, MEDLINE, Embase, and the Cochrane Library databases were searched to identify all published reports of pregnancy outcomes in women with a history of VUR in childhood up to January 2024 (PROSPERO Registration ID: CRD42024550470). Selection criteria included all English-language original articles reporting pregnancy outcomes (maternal and fetal morbidities) in pregnant patients with a history of VUR in childhood. After screening and eligibility assessment, 17 articles met the PICO inclusion criteria. RESULTS:The search yielded 1060 papers, of which 17 remained after exclusions, and assessed 2349 women with a history of VUR in childhood,1167 pregnant women and a total of 2206 pregnancies. Compared with the general obstetric population, the results showed an increased rate of pregnancy-related complications (particularly febrile urinary tract infection, gestational hypertension, pre-eclampsia) in the presence of renal scarring, even if the women had undergone anti-reflux surgery in childhood, but not persistent low-grade VUR. CONCLUSION:Despite the lack of larger prospective randomized controlled trials with long-term follow-up, based on the findings of this systematic review, we conclude that close monitoring during pregnancy should be recommended in the presence of persistent high-grade VUR or in women with renal scarring, even if VUR has resolved.

Background and Objective: The incidence of stone disease in children has risen worldwide, leading to the development of more treatment options. Percutaneous nephrolithotomy (PCNL) is often the preferred approach in many pediatric cases. This systematic review aims to assess the effectiveness and safety of PCNL in children, as well as to identify future directions for improving procedural outcomes. Methods: For this systematic review a comprehensive electronic search was conducted in PubMed and EMBASE in August 2023. The search included patients younger than 18 with renal stones requiring any modality of PCNL, as well as to establish the deficiencies in the reports of outcomes. The search strategy adhered to PRISMA guidelines, and quality assessments were performed using the Cochrane tool and MINORS tool. Key Findings and Limitations: Regardless of age, PCNL is safe and efficient in children, with stone-free rate above 85% and complication rate below 7%. However, neither the definition of stone free nor the way of reporting complications is homogeneous among studies. In addition, aspects such as diagnostic imaging, antibiotic prophylaxis, postoperative drainage, metabolic study, or follow-up are not systematically or uniformly reported in the studies. Conclusions and Clinical Implications: PCNL maintains its efficiency and safety even when the working tract caliber is reduced. However, the lack of standardization when describing pre-, peri-, and postoperative aspects creates a gap that does not allow grouping outcomes and highlights the lack of clear guidelines when implementing this surgical procedure.

Undescended testis (UDT, cryptorchidism) is the most frequent genital anomaly in boys. However, its treatment varies widely throughout the world. This second part of our roundtable discussion aims to continue to ask global experts to express their attitudes towards several case scenarios of UDT in order to explore the rationale for their clinical decisions. As the European Association of Urology - Young Academic Urologists Pediatric Urology Working Group, we believe that this roundtable series will facilitate colleagues all over the world to reflect and improve their practices regarding the treatment of UDT.

INTRODUCTION:Consensus for Enhanced Recovery After Surgery (ERAS) in pediatrics has been achieved in neonatal intestinal surgery, yet it is not widely utilized in pediatric urology. We investigated the application of ERAS guidelines in pediatric urology, and determined its effects given the available level of evidence supporting the ERAS protocol in children. EVIDENCE ACQUISITION:A systematic literature review including series providing adoption of fast-track recovery protocols for pediatric urology procedures was carried out. Main outcome measures were study characteristics, adherence to the 19 ERAS items, complication rates and length of hospital stay. Sub-group analysis by surgery type (hypospadias versus major surgery) was performed. EVIDENCE SYNTHESIS:Nine series with data from 1272 surgical pediatric cases were included. An enhanced recovery pathway was applied in 67.3% of the reports. Two series included patients undergoing hypospadias repair and ERAS items were insufficiently reported. Studies including children undergoing major procedures mentioned a median of 15 ERAS items, yet applied a median of 11 items. Median compliance rate was 88.9% (range 50-100). More ERAS guideline items were reported (applied or mentioned) in the most recently published studies. CONCLUSIONS:There is limited reporting and use of the ERAS guidelines in urologic surgery particularly in hypospadias repair; whilst in major surgery in children, adherence and compliance rates vary widely. In more recent series there was an increase in ERAS items that have been mentioned and applied. Future research is needed to identify barriers and to overcome them in order to fully adopt and benefit from the ERAS pathway.

Objective To identify any self-reported differences or attitudes towards certification, publication, or practice patterns between adult urology and paediatric general surgery-trained paediatric urology providers. There are no known published differences in clinical/operative/research outcomes in either group. Methods An 18-item cross-sectional survey was compiled through the EAU Young Academic Urologists (YAU) office and disseminated to a trans-Atlantic convenience sample of current practising paediatric urologists. This was created using a mini-Delphi method to provide current semi-quantitative data relating to current opinions and attitudes of this cohort. Results A total of 228 respondents completed the survey, with female respondents representing 37% and 34% for urology and paediatric general surgery, respectively. Nearly 90% overall respondents felt that a full 2-year paediatric fellowship program was very important and 94% endorsed a collaborative dedicated paediatric urology on call service, with 92% supporting the joint development of transitional care. Urology managed higher numbers of bedwetting ( p = 0.04), bladder bowel dysfunction ( p = 0.02), endourological procedures ( p = 0.04), and robotics ( p = 0.04). Paediatric general surgery managed higher numbers of laparoscopic reconstruction ( p = 0.03), and posterior urethral valve ablation ( p = 0.002). Conclusion This study represents the first time that a cross-sectional cohort of paediatric urologists from different training backgrounds were compared to assess their productivity, practice patterns and attitudes. Paediatric urology is in a unique position to have two contributing specialities, with the ability to provide optimal transitional and lifelong care. We believe that there should be a strong emphasis on collaboration and to remove any historically-created barriers under policies of equity, diversity and inclusivity.

Introduction Ureteropelvic Junction Obstruction (UPJO), is a major cause of pathological hydronephrosis in children. Minimally invasive surgery (MIS), including laparoscopic pyeloplasty (LP) and robot-assisted laparoscopic pyeloplasty (RALP), has gained popularity due to its known advantages. LP faces technical difficulties and a steep learning curve. RALP has overcome these limitations, making it safer and more effective for children. The study aims to assess the safety and effectiveness of LP and RALP in infants weighing <= 15 kg. Materials and methods This is a retrospective analysis (2010-2022). The study included pediatric patients who had a confirmed diagnosis of UPJO and weighed <= 15 kg. The patients were divided into two groups: LP and RALP. The study evaluated preoperative, intraoperative, perioperative, and follow-up data, including complications. Success was defined as no worsening of hydronephrosis on postoperative ultrasound in the first year of follow-up. Results The total patients were 94: 42 in the LP group, and 52 in the RALP group. The median age at the intervention was 17.5 months (LAP group) versus 29 months (RALP group) (p = 0.01). The median weight at the time of intervention was 9.5 Kg (LP group), and 11.6 Kg (RALP group) (p = 0.44). The median operative time was significantly longer in the LP group: 245 min versus 125.5 min in the RALP group (p = 0.001). The median length of hospitalization was comparable: 4.3 days (LP group) and 3.5 days (RALP group) (p = 0.42). No intraoperative complications were reported in either group. There were no statistically significant differences regarding postoperative complications. During follow-up, all patients remained asymptomatic, with no episodes of urinary tract infection or abdominal pain, and none of them had a recurrence of UPJ obstruction. Consequently, the two techniques are equally effective and safe in the short term. Discussion Both procedures offer excellent outcomes with comparable postoperative complications. LOS was similar for both groups, with no intraoperative complications or conversions, and a non-significant increase in postoperative complications. A notable finding was the significant difference in operation times between the procedures, emphasizing the importance of reduced surgical time in pediatric patients for minimizing anesthetic and intubation durations. Conclusion For the absence of intra- and postoperative complications and recurrences, RALP is as effective as LP in pyeloplasty in children weighing 15 kg or less. This finding reinforces the idea that RALP can be safely executed, benefiting from its advanced technology and the learning curve, for patients of any age regarding pyeloplasty for UPJO.

EDITORIAL article Front. Pediatr., 17 April 2023Sec. Pediatric Urology Volume 11 - 2023 | https://doi.org/10.3389/fped.2023.1195301

Undescended testis (UDT, cryptorchidism) is the most common congenital anomaly of the genital tract. Despite its high incidence, the management of UDT varies between specialties (urology, pediatric surgery, pediatric urology, pediatric endocrinology). Therefore, as the European Association of Urology - Young Academic Urologists Pediatric Urology Working Group, we requested experts around the world to express their own personal approaches against various case scenarios of UDT in order to explore their individual reasoning. We intended to broaden the perspectives of our colleagues who deal with the treatment of this frequent genital malformation.

We thank the editorial board of the Journal of Pediatric Urology and the reviewers who have provided great input in order to bring out a comprehensive manuscript [1]. The initial idea behind this study was firstly, to highlight the national, international and even intercontinental differences on the management of undescended testis (UDT) and learn the mentalities of each other. Given that UDT has the highest incidence among genital abnormalities, there has been an excessive amount of data available in the literature regarding UDT.

Objective:The incidence of Wilms'tumor(WT)among adult individuals accounts for less than 1％ of kidney cancer cases,with a prognosis usually less favorable when compared to younger individuals and an overall survival rate of 70％for the adult patients versus 90％ for the pediatric cases.The diagnosis and treatment of WT are complex in the preoperative setting;neoadjuvant chemotherapy(NAC)or robotic surgery has rarely been described.This study aimed to review the literature of robotic surgery in WT and report the first adult WT man-agement using both NAC and robotic strategy. Methods:We reported a case of WT managed in a multidisciplinary setting.Furthermore,ac-cording to Preferred Reporting Items for Systematic reviews and Meta-Analyses recommenda-tions,a systematic review of the literature until August 2020 of WT treated with a robotic approach was carried out. Results:A 33-year-old female had a diagnosis of WT.She was scheduled to NAC,and according to the clinical and radiological response to a robotic radical nephrectomy with aortic lymph nodes dissection,she was managed with no intraoperative rupture,a favorable surgical outcome,and a follow-up of 25 months,which did not show any recurrence.The systematic review identified a total number of 230 cases of minimally invasive surgery reported in the literature for WT.Of these,approximately 15 patients were carried out using robotic surgery in adolescents while none in adults.Moreover,NAC has not been administered before mini-mally invasive surgery in adults up until now. Conclusion:WT is a rare condition in adults with only a few cases treated with either NAC or minimally invasive approach so far.The advantage of NAC followed by the robotic approach could lead to favorable outcomes in this complex scenario.Notwithstanding,additional cases of adult WT need to be identified and investigated to improve the oncological outcome.

Introduction Complex urological anomalies often require continued care as patients reach adulthood. Adequate transition for adolescents with ongoing urological care needs is critical to allow for seam-less care in adult hospitals. Studies have shown that this can lead to improved patient and parental satisfaction, and lower utilisation of unplanned inpatient beds and emergency department visits. There is currently no ESPU-EAU consensus on the adequate mechanism and very few individual pa-pers examining the role of urological transition for these patients in a European setting. This study aimed to identify current practice patterns in paediatric urologists providing adolescent/transi-tional care, to assess their opinions towards formal transition and to look for variations in care. This has implications for long-term patient health and specialist care. Methods An 18-item cross-sectional survey was compiled and pre-approved through the EAU-EWPU and ESPU board offices prior to dissemination to all registered ordinary members affiliated with the ESPU. This was created using a mini-Delphi method through the EWPU research meetings to provide current semi-quantitative data relating to current opinions and attitudes of this cohort. Results A total of 172 respondents (55% paediatric general surgery; 45% urology) across 28 countries completed the survey. The majority of respondents were in practice >10 years and spent >80% time in paedi- atric urology. There was no formal transition process according to 50% respondents and over half of those that did have less than 1/month, with <10% using validated questionnaires. More than two-thirds re- spondents continued to provide care after transi- tion, as >70% units had no designated corresponding adult service. Furthermore, 93% paediatric believe formal transition service to be very important, using a multidisciplinary framework. A pareto chart demonstrated 10 specific conditions to be of most interest in transition to adulthood. Conclusion This is the first study to assess the requirements of paediatric urologists for adequate transitional care, however due to the nature of the survey's distribu- tion, this was a non-scientific poll based on a con- venience sample of respondents. It is critical that dual-trained or adult-trained urologists with a spe- cific interest in paediatric urology work with current paediatric urologists in a multidisciplinary fashion to facilitate early transition based on the adolescent's developmental and biopsychosocial requirements. National urological and paediatric surgical societies need to make transitional urology a priority. The ESPU and EAU should collaboratively consider developing transitional urology guidelines to allow framework by which this can occur.

OBJECTIVE To evaluate strategies that are followed after pediatric renal trauma during the recovery stage, with an emphasis on mobility and involvement in subsequent sporting activities. Renal trauma is the most common urogenital trauma in children. The American Association for the Surgery of Trauma (AAST) scale is most commonly used to stratify the severity of injury. There is no consensus in the existing literature with respect to the recovery stage following renal trauma. METHODS A survey was constructed by the European Association of Urology (EAU) - Young Academic Urologists (YAU) Pediatric Urology Working Group and then made digitally available on SurveyMonkey. The survey consists of 15 questions exploring relevant factors and timing to start again with mobility and activity. RESULTS In total 153 people responded, of whom 107 completed the entire survey. The presence of pain and severity of trauma were acknowledged as most important factors to commence mobilization, whereas presence of hematuria was identified as an additional factor for sporting activity. Regardless of severity of trauma a minimum of 90% of respondents recommend return to noncontact sports within 12 weeks. For contact sports, a minimum of 33% of respondents advised > 12 weeks minimum before starting again. A small number of respondents would never allow sporting activities again. CONCLUSION The time to allow sporting activity shows high variation among the respondents, some even restricting sporting activities completely. This survey highlights the need for a standardized protocol based on multicenter follow-up data. UROLOGY 183: 199-203, 2024. (c) 2023 The Author(s). Published by Elsevier Inc. This is an open access article under the CC BY license.

Background: The term glass ceiling coined by Loden in 1978 is commonly used to describe difficulties faced by minorities and women when trying to move into senior roles. Objective: To analyse trends and patterns for female representation at the European Association of Urology (EAU) and European Society for Paediatric Urology (ESPU) annual general meetings over the past decade. Design, setting, and participants: We used objective data on female representation in the roles of chairs, moderators, and lecture speakers at the EAU and ESPU meetings from 2012 to 2022. Outcome measurements and statistical analysis: We evaluated gender based represen-tation in paediatric urology sessions at the EAU and ESPU meetings, collecting data on the overall number of sessions, lectures, symposiums, abstract/poster sessions, and courses, and analysed the male/female ratio. Data were derived from printed and digital programmes for the relevant meetings. Results and limitations: During the period from 2012 to 2022, the percentage female representation varied from 0% (2012) to a maximum of 35% (2022) at EUA paedi-atric urology sessions, and from 13.5% (2014) to a maximum of 32% (2022) at ESPU meetings. Both associations show clear progression towards equality. Conclusions: Female representation at EAU and ESPU meetings has risen over the years, reaching 35% and 32%, respectively, in 2022, which is in line with the number of female members. We hope that this motivates a move towards the equality objectives for 2030. A clear and fundamental societal change is needed, with fair and more consistent institutional policies and framework commitments in the

Nowadays, the mass production of insects is promoted not only for their nutritional value, but also for their ability to convert agri-food by-products into high valuable derived products. In the present work, the potential production of carotenoid-rich larvae of black soldier fly,Hermetia illucens (BSFL), was evaluated by rearing them on different agri-food by-products. The carotenoid concentration in BSFL was highly correlated with the carotenoid content of the substrates (R=0.882). Among the different substrates, tomato and carrot by-products allowed to obtain BSFL with a total carotenoid content 230% higher than the amount detected in the BSFL grown in the control diet. Furthermore, the killing method played a key role in the preservation of the BSFL carotenoid content, with dry heating resulting in a significantly higher total carotenoid content compared to blanching and freezing. These results clearly support the valorisation of agri-food by-products for the production of BSFL naturally rich in carotenoids for specific feed and food purposes.