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

Ureteral stents are widely used following ureteroscopy (URS), yet several aspects of their management remain non-standardized despite contemporary EAU and AUA guideline recommendations. This study evaluated contemporary international practices and identified gaps in ureteral stent use among endourologists. A cross-sectional international survey consisting of 58 items across nine domains was distributed via social media, major urological meetings, and the EAU Endourology Section. Only fully completed responses were analyzed. Descriptive statistics were used, with continuous variables reported as medians and categorical variables as frequencies and percentages. A total of 121 respondents from 48 countries were included. Stent placement remained common after uncomplicated ureteroscopy and was nearly universal in complicated cases. Pre-stenting was applied selectively, most commonly after failed ureteroscopy and for ureteral dilatation. A 6 Fr stent and polyurethane material were the preferred choices. Stent-related symptoms were frequent, with urgency and frequency predominating, followed by hematuria. Pharmacologic management varied, and conservative treatment was commonly used for post-stenting infections. Notably, 45

Multiparametric MRI (mpMRI) has reshaped prostate cancer diagnosis. However, Multiparametric MRI (mpMRI) often underestimates the tumor extent. Perilesional biopsy (PB) helps avoid excessive numbers of systematic biopsy (SB) cores. Nevertheless, there are concerns about the potential misses of contralateral clinically significant prostate cancer (csPCa). Despite ongoing research, a lack of high-quality studies remains. This scoping review examined the impact of PB in detecting csPCa, as well as the potential advantages and drawbacks of perilesional sampling compared to TB and systematic biopsy (SB) approaches. We conducted a PRISMA-based systematic search in Pubmed, Scopus, and WOS. We identified 77 articles, and nineteen PB studies were selected. Fourteen studies utilized an MRI-TRUS fusion software. Ten applied a sector-based or quadrant-based definition of perilesional sampling, and 8 adopted a precise mm-based definition, within a 5 mm or a ≤ 10 mm perilesional margin. We discovered a significant methodological diversity, particularly in terms of direct comparisons. Included studies recorded a wide range of csPCa detection rates (35%-99%). There were contradictory findings regarding the impact of PB on the detection rates of csPCa. Adding PB to TB decreased the detection of insignificant prostate cancer, the number of biopsy cores, and the upgrading rates in radical prostatectomy specimens. Six and 13 studies were rated as high- and moderate-risk of overall bias according to the ROBINS-I framework. Perilesional sampling during prostate biopsy is a promising yet immature strategy for detecting csPCa. The heterogeneity of methods and the lack of a standardized protocol hinder widespread adoption.

Background and objective Percutaneous nephrolithotomy (PCNL) is a common urological procedure recommended as first-line treatment for large renal calculi. This systematic review aimed to determine the mortality associated with PCNL in managing kidney stone disease (KSD). Methods In line with the Preferred Reporting Items for Systematic reviews and Meta-analyses guidelines, a literature search was conducted across Medline, Embase, CINAHL, and the Cochrane Library. The inclusion criteria included English articles of adult and paediatric patients that reported on mortality from PCNL. The extracted data included patient demographics, comorbidities, number of mortalities, and cause of mortality. Key findings and limitations Sixty-five articles were included, which reported on 634 844 patients over a time period spanning from 1983 to 2024. A total of 2777 mortalities were identified. The overall weighted proportion mortality rate for adult studies, excluding selected patient cohorts, was 0.24%. The overall weighted proportion paediatric mortality rate was 0.6%, and mortality rates for other specific patient subgroups varied. Where the cause of death was reported, the most common causes of death in patients were sepsis (35.6%), myocardial infarction (23.3%), haemorrhage (12.2%), and pulmonary embolism (11.1%). Conclusions and clinical implications Mortality rates from PCNL have remained stable and low over the lifetime of the procedure, with a slight reduction in reported mortality rates over time, despite increasing prevalence of KSD and patient comorbidities. Reporting of mortalities from PCNL has increased in recent years, with the most common causes of mortality identified being sepsis, myocardial infarction, and haemorrhage. Careful patient selection, with the identification and mitigation of risk factors, is vital in reducing the risk of mortality from PCNL.

Background: Active surveillance (AS) is an established management strategy for patients with low- and favorable intermediate-risk prostate cancer (PCa). Accurately distinguishing indolent from aggressive disease and identifying progression during follow-up remain significant clinical challenges. Artificial intelligence (AI) has appeared as a promising approach to enhance risk stratification and support clinical decision-making. Our aim was to evaluate the role of AI-based decision support systems in patient selection and monitoring during AS for PCa, as well as their potential to guide timely transition to definitive treatment. Methods: A scoping review was conducted in accordance with Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) 2020 guidelines. The review protocol was prospectively registered in PROSPERO (CRD420261358519). Literature searches in PubMed and Scopus were performed, applying filters for English-language studies published within the past 5 years. Of 133 records identified, 24 studies met the inclusion criteria after screening and eligibility assessment. Results: Most included studies were retrospective and used machine learning (ML) or deep learning (DL) techniques on clinical, radiological, and histopathological data. AI models demonstrated stronger predictive performance than traditional statistical methods, with reported area under the curve (AUC) values ranging from 0.74 to 0.96. Radiomics-based models derived from magnetic resonance imaging (MRI) facilitated non-invasive characterization of tumor aggressiveness, while DL algorithms applied to biopsy whole-slide images improved grading accuracy and progression prediction. Multimodal models that integrated heterogeneous data sources consistently outperformed single-modality approaches. Finally, longitudinal models including serial prostate-specific antigen (PSA) measurements and imaging data enabled dynamic risk assessment and customized monitoring during AS. Conclusion: AI-based models show considerable potential to improve patient selection and predict progression in AS for PCa, potentially reducing overtreatment and unnecessary biopsies. However, current evidence is limited by retrospective study designs, lack of external validation, and variability in AS protocols. Prospective multicenter studies and enhanced model explainability are necessary before routine clinical implementation. Level of evidence: Not applicable.

Ureteral stents are essential in routine urologic practice for maintaining urinary drainage and preventing obstruction. Traditional stents are often associated with pain, urinary symptoms, encrustation, infection, and the need for secondary removal procedures. In theory, an “ideal” ureteral stent would address these challenges. This scoping review summarizes contemporary advancements in ureteral stent technology, including innovations in material and design, functional mechanisms, coating systems, and drug elution. An electronic literature search was performed on MEDLINE, EMBASE, Web of Science, and Cochrane Library using MeSH terms from inception to August 2025. Screening and data extraction were performed by two independent reviewers. All studies reporting on technological innovations and advancements in ureteral stent design aimed at improving clinical outcomes and reducing patient morbidity were included. Of the 1407 identified studies, 62 were included in the final review. The included studies were categorized into the following specific categories: stent material, design, and positioning, anti-reflux mechanisms, biodegradable stents, stent removal innovations, stent coatings and drug-eluting systems. Despite substantial advancements in stent technology, no universal “ideal” stent exists. Contemporary advancements in ureteral stent technology span across multiple domains, including innovations in stent material and design, anti-reflux mechanisms, biodegradable systems, stent coatings, and drug-eluting systems. Future ureteral stent development is anticipated to focus on patient-specific customization. Continued translational research and clinical validation are required to integrate many of these ureteral stent innovations into routine urological practice.

Background Ureteric stenting is a common procedure performed to provide temporary drainage for an obstructed or infected kidney, helping to relieve blockage or back pressure. Patients, their relatives, and the general public rely on internet websites and Artificial Intelligence Large Language Models (AI LLMs) such as ChatGPT to obtain relevant information about the procedure, seek advice and guidance, and make informed decisions. We evaluated and compared the quality and readability of websites and information generated by both AI LLMs.Methods Four ureteric stent-related search terms were entered into Google, Yahoo, and Bing search engines. The top 20 websites for each search term were collected, with duplicates excluded. Patient information leaflets were generated by ChatGPT, Gemini, DeepSeek, and Google AI. The quality of the sources was assessed using the DISCERN and JAMA Benchmark scores, with readability measured by the Flesch Reading Ease Score (FRES) and the Flesch-Kincaid Grade Level (FKGL).Results Fifty-seven websites and seven AI LLM sources were included, with mean DISCERN scores of 41.5 (±11.2) and 44.3 (±4.19), mean JAMA Benchmark scores of 2.04 (±1.00) and 2.14 (±1.07), mean FRES of 57.1 (±13.6) and 57.0 (±9.71), and mean FKGL scores of 8.08 (±2.24) and 8.27 (±1.50), respectively. No significant differences were observed between websites, and the AI LLM produced information leaflets, with no association between search ranking and quality or readability.Conclusions There is a general shortage of high-quality, accessible information about ureteric stents in both website and AI sources. As reliance on AI LLMs to gather data from patients grows, efforts should be made to enhance the quality and readability of resources available. This will help ensure that misinformation is minimised and achieve patient education, supporting shared decision-making and a stronger physician-patient relationship throughout the process.

Ureteral stents are widely used to maintain upper urinary tract drainage in diverse clinical scenarios; however, guidance on selecting the optimal stent configuration remains limited. This narrative review evaluates the clinical relevance of ureteral stent design, size, material composition, and surface coating technologies to support evidence-based device selection in routine practice. A focused narrative literature review was conducted using the PubMed, Scopus, and Web of Science databases, supplemented by cross-referencing key publications. Studies addressing the structural characteristics, biomaterial properties, and coating technologies of ureteral stents, as well as their clinical implications, were appraised thematically. Conventional double-J stents remain the most used configuration. However, several modifications—including loop-tail, extraction-string, magnetic-tip, and multilength designs—have been introduced to improve positioning accuracy and patient comfort. Alternative stent types, such as mono-J, suture, anti-reflux, grooved, and tumor stents, offer scenario-specific advantages in selected indications. Material composition, particularly silicone and polyurethane-based platforms, significantly influences flexibility, handling characteristics, resistance to encrustation, and patient tolerance. Surface engineering strategies—including lubricating, antimicrobial, anti-fouling, and drug-eluting coatings—aim to reduce infection, biofilm formation, and stent-related symptoms, although clinical evidence remains heterogeneous. Structural parameters such as diameter and length are key determinants of symptom burden and quality of life. Optimal ureteral stent selection requires individualized evaluation of device design, material properties, size, and coating technologies. No single stent configuration demonstrates universal superiority across all clinical scenarios; therefore, indication-specific selection remains essential to optimize drainage efficiency and minimize complications.

Objective:The introduction of a flexible and navigable suction ureteral access sheath (FANS-UAS) has further enhanced retrograde intrarenal surgery (RIRS) by improving kidney stone clearance and reducing operative challenges. However, evidence for its use in the pediatric population remains sparse. Thus, this systematic review focuses on the current evidence on the use of a FANS-UAS during RIRS in children with renal stones. Methods:A systematic search of PubMed, Cochrane Library, and Google Scholar was conducted in May 2025 following the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines and PROSPERO registration (CRD420251049140). Studies were included if they reported original data on the use of a suction ureteral access sheath (UAS) during RIRS in pediatric patients (<18 years). Data on patient demographics, stone characteristics, surgical outcomes, and complications were extracted and analyzed descriptively. Results:Out of 49 screened studies, three met the inclusion criteria, including 74 pediatric patients. A FANS-UAS was used in all cases, with 97% utilizing 10/12 Fr UAS and 91% employing a 7.5 Fr flexible ureteroscope. The pooled stone-free rate was 99%, with complications limited to minor ureteral injury (4.1%) and Clavien-Dindo Grade I/II events (9.5%). One study showed the superiority of a FANS-UAS over a conventional UAS in operative time and initial stone-free rate. However, the evidence was limited by small sample sizes and heterogeneity. Conclusion:RIRS with a FANS-UAS a is a safe and effective option for managing pediatric urolithiasis, including large and multiple stones. Nevertheless, current evidence is based on a small number of studies with limited generalizability. Further prospective research is needed to validate these findings, to explore the role of suction, and to investigate various UAS and endoscope configurations.

The term "gold standard" is widely used in benign prostatic obstruction (BPO) surgery to describe established procedures such as transurethral resection of the prostate (TURP) and, more recently, holmium laser enucleation of the prostate (HoLEP). This article argues that the term no longer reflects contemporary practice, where treatment should be individualised according to patient characteristics, priorities, and surgical expertise. Describing a single procedure as the gold standard risks oversimplifying decision-making and overlooking the growing range of effective evidence-based options. More precise terms, such as "preferred treatment" or "reference standard" in a defined clinical context, better reflect modern guideline-based care and support shared decision-making.

BackgroundRadical prostatectomy remains a key curative treatment for localized prostate cancer which has undergone continuous transformation. Recent developments in robot-assisted and single-port surgery have followed the concept of minimizing morbidity while maintaining oncologic safety. Furthermore, the integration of artificial intelligence and novel diagnostic tools have transformed the modern surgical workflow. Therefore, the aim of this study is to give an overview of the evolution of surgical techniques, functional and oncological outcomes, and available surgeon-assisting concepts.MethodsWe conducted a non-structured review to summarize the evolution of radical prostatectomy techniques and recent developments in surgeon-assisting tools. Relevant English-language publications were identified through a targeted PubMed search using predefined keywords related to, laparoscopic, robot-assisted, Retzius-sparing, and single-port approaches. Key studies, systematic reviews, and meta-analyses were used and synthesized to provide a comparative overview. Furthermore, studies focusing on integration of artificial intelligence, novel diagnostic tools and targeted surgery are discussed.ResultsLaparoscopic surgery aims to reduce morbidity yet is technically demanding. Robotic-assisted approaches improve visualization and precision, leading to faster recovery and earlier continence recovery. Newer Retzius-sparing and single-port techniques show promising functional results, though evidence is still limited. Novel diagnostic tools including image overlay, targeted surgery, and fast and accurate intraoperative pathological assessment of resection margins are increasingly shaping modern radical prostatectomy.ConclusionRadical prostatectomy has evolved into a minimally invasive, technology-driven procedure with improved recovery and functional outcomes. Advances in robotics, imaging, and artificial intelligence enhance surgical precision. Ongoing innovation and long-term data will define the future of prostate surgery.

Double-J (DJ) ureteral stents are essential for managing urinary tract obstruction, infection, and perioperative drainage, but up to 80

In this scoping review, we mapped the available clinical evidence on the use of double-J (DJ) ureteral stents in pediatric patients across reconstructive, stone-related, and other endourological indications, synthesizing contemporary data on techniques, sizing, dwell time, removal strategies, outcomes, and emerging technologies. A scoping review was conducted in accordance with the PRISMA Extension for Scoping Reviews (PRISMA-ScR). The review protocol was prospectively registered in PROSPERO (CRD420251147003). PubMed, Scopus, Cochrane Library, and Web of Science were searched without date limits to 9 September 2025. Original clinical studies on double-J (DJ) ureteral stents in children were screened, data were extracted into a harmonized database, and risk of bias was appraised using RoB 2, ROBINS-I, or the Joanna Briggs Institute checklist as appropriate. Fifty studies (2003–2025) were included. In reconstruction, internal DJ and externalized stents achieved similar success after pyeloplasty; externalized options commonly enabled office removal without general anesthesia (GA) but often increased length of stay and/or operating time. During ureteroneocystostomy for vesicoureteral reflux, routine stenting was associated with worse adjusted short-term outcomes; these findings are consistent with selective use. In stone disease, routine pre-stenting before ureteroscopy or extracorporeal shock-wave lithotripsy did not improve stone-free rates and increased infectious morbidity; when performed, a short dwell time ( 2 weeks) was adequate. Across indications, modifiable drivers of morbidity included prolonged dwell, bilateral placement, and multiple lifetime stents. Practical aids included the “Age + 10 cm” length rule and strategies that reduce GA exposure (e.g., stent-on-string with disciplined protocols). Magnetic DJ systems showed high outpatient retrieval success with familiar complication profiles, while anti-biofilm/anti-encrustation coatings remain promising but require pediatric clinical validation. Pediatric ureteral stenting practices vary widely across indications. The mapped literature suggests broadly comparable success between internal and externalized stents in reconstruction, while highlighting the importance of dwell time, anesthesia exposure, and individualized decision-making. In stone disease, routine pre-stenting does not appear to confer consistent benefit. Overall, careful patient selection, planned dwell duration, and structured follow-up remain central to optimizing outcomes, while prospective multicenter studies are needed to strengthen the evidence base.

Purpose Patients with long-term ureteral stents need regular change, traditionally under General Anesthesia (GA). We present a hybrid model where patients are risk-stratified for anticipated technical difficulty: (1) local anesthesia (LA) in the outpatient cystoscopy suite as day procedures, or (2) GA/ Monitored Anesthesia Care (MAC) in operating room (OR). Methods A retrospective review was conducted of ureteral stent changes between 2021 and 2025, using a risk-stratified model: lower-risk as outpatient LA in ambulatory cystoscopy suite, and higher-risk under GA/MAC in the OR. Results A total of 569 stent changes were performed: 348 (61%) under LA in cystoscopy suite, and 221 (39%) under GA/MAC in OR. LA cystoscopy suite stent change patients were older (75 vs. 69 years, p < 0.01), with higher ASA grade (ASA 3/4 = 79 vs. 66%, p < 0.01). There were similar proportions of males (43 vs. 48%) and bilateral ureteral stent changes (15 vs. 16%) (all p > 0.05). Under LA, 335 (96.3%) stent changes were successful, compared with 220 (99.5%) in OR (p < 0.05). Complication rates were similar (3.74 vs. 5.45%, p = 0.35), with most complications being urinary tract infections managed conservatively (Clavien 1/2). Conclusion A hybrid ureteral stent change model with selected ureteral stent changes performed under LA in the ambulatory cystoscopy suite instead of the OR, is a feasible and safe option. Advantages include avoiding risks of general anesthesia and reducing the duration of hospital stay as an ambulatory day case. LA stent change has cost-savings, conserves hospital resources and can be considered for older and higher ASA risk patients.

Objective This review aims to comprehensively evaluate the mechanisms of action of sodium-glucose cotransporter 2 inhibitors (SGLT2is), with a specific focus on their relevance to urological practice, including both potential benefits and risks. Methods A systematic literature search was conducted in February 2025 using PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature, and Google Scholar. Studies addressing the pharmacodynamics of flozins, their systemic effects, and genitourinary outcomes were included. Data were organized into mechanistic themes: tubular glucose and sodium transport, organ protection, antioxidative signaling, and potential anticancer activity. Urological effects were analyzed separately for non-oncological and oncological domains, and adverse outcomes were summarized. Results SGLT2is exert beneficial effects beyond glycemic control, including reduced intraglomerular pressure, improved endothelial function, antioxidative and anti-inflammatory activities, and modulation of cellular metabolism and proliferation. These effects translate to potential benefits in erectile dysfunction, nephrolithiasis, benign prostatic hyperplasia, and possibly genitourinary malignancies. However, flozins are associated with risks including genital mycotic infections, euglycemic ketoacidosis, and, in rare cases, severe urinary tract infections. Conflicting data exist regarding the actual risk of UTIs, with recent evidence suggesting a lower or neutral risk when used appropriately. Conclusion Flozins represent a promising therapeutic class with multifaceted benefits that extend into the field of urology. However, individualized risk assessment remains essential, and further urology-focused clinical research is needed to clarify their full utility and safety in this domain.

BACKGROUND:Pediatric urolithiasis guidelines recommend ESWL, RIRS, or PCNL for stones within the 10-20 mm range but this broad interval often complicates treatment selection. This systematic review aimed to define a clearer, evidence-based stone size cutoff to improve clinical decision-making. METHODS:A systematic review and meta-analysis were performed (PROSPERO CRD420251012163) according to PRISMA 2020 guidelines. Pediatric studies published from 2014 to 2025 were searched across major databases. Eligible studies reported stone size and at least one outcome, including stone-free rate, residual fragments, retreatment, or complications. Studies without quantitative data were excluded. Early and long-term complications as well as instrumentation were analyzed. Pooled estimates were calculated using random-effects models. Risk of bias was assessed using the Newcastle-Ottawa Scale. RESULTS:Seventy-six study arms (N.=5294) reported stone size data. The pooled mean was 16.03 mm (95% CI 14.60-17.47; I2=99.9%). Stones treated with ESWL averaged 12.29 mm, RIRS 12.49 mm And PCNL 20.16 mm, indicating PCNL was used for larger stones (P<0.001). In 113 studies reporting SFR, pooled rates were 0.801 for ESWL, 0.826 for RIRS And 0.893 for PCNL, with PCNL showing higher SFRs. Considerable heterogeneity was observed And differences in complication profiles and instrumentation were identified as important factors influencing treatment outcomes beyond stone-free rates alone. CONCLUSIONS:A 15-mm stone size threshold appears clinically meaningful and provides clearer guidance than the traditional 10-20 mm range in children. ESWL and RIRS are appropriate options for stones <15 mm, whereas PCNL is more suitable for larger stones. Beyond stone-free rates, complication profiles and instrumentation should be considered when selecting treatment. Study heterogeneity and potential publication bias remain important limitations.

Double J stents (DJS) are vital tools in endourological surgery and have a variety of indications. Their main function is to facilitate urinary drainage. Despite their many benefits, they do have drawbacks, chiefly their effect on quality of life (QoL). With the ongoing development of DJS, as well as ever-changing guidance regarding their placement, decision making regarding DJS can be difficult for clinicians to navigate. We therefore give an up-to-date summary of DJS indications and summarise the data concerning their frequency of insertion. A narrative review of the literature was undertaken. A focused search of PubMed MEDLINE was performed with search terms including "stent frequency”, "stent indication”, “stenting”, “endourology”, “ureteroscopy”, and “percutaneous nephrolithotomy”, on all papers from 1983 to 2025 to identify key studies, systematic reviews, and meta-analyses relating to indications and frequency of DJS. There are numerous indications for DJS placement. These can be categorised into elective and emergency indications. Elective indications include prior to, or following, ureteroscopy (URS), percutaneous nephrolithotomy (PCNL) or extracorporeal shockwave lithotripsy (ESWL). Other elective indications include, but are not limited to, chronic ureteric obstruction and reconstructive urology. Emergency decompression of the urinary tract with DJS remains a mainstay of management of patients with ureteric obstruction. The frequency of DJS placement following URS ranges from 64 to 86