Journal of robotic surgeryBartosz Brzoszczyk, Marcin Jarzemski, Rafał Brzóska, Bartosz Roś, Łukasz Mielczarek, Rafał Bogdan Drobot, Mateusz Władysław Jobczyk, Maciej Wojciech Przudzik, …
Robot-assisted surgery (RAS) has expanded rapidly in Poland, but its integration into resident education remains uncertain. In a nationwide anonymous 35-question survey sent to 390 Polish urology residents, 156 completed it (40.0%). Among respondents, 110 (70.5%) reported RAS availability in their training centre; 56 (35.9%) reported robotic training access, 43 (27.6%) a robotic course, 46 (29.5%) simulator availability, 76 (48.7%) assistant participation, and 16 (10.3%) a supervised robotic procedure or procedural step. All respondents with training access were in RAS centres. Among these 110 respondents, course attendance (aOR 5.38, 95% CI 2.05-14.14) and simulator availability (aOR 3.90, 95% CI 1.54-9.89) were associated with access. Training access was associated with assistant participation (aOR 6.66, 95% CI 3.06-14.50), higher current and expected self-rated skill (common aORs 12.30 and 12.15), and at least satisfactory training satisfaction (aOR 17.01, 95% CI 6.35-45.57). All 16 such reports occurred among residents with access; in an exploratory conditional Firth model, each additional residency year was associated with this outcome (aOR 2.11, 95% CI 1.30-3.97). Items were independent, not sequential stages. Institutional adoption exceeded reported training access and supervised participation. Broad survey content makes participation driven solely by robotics interest less likely, but the 40.0% completion proportion, self-report, unmeasured trainee selection, and rare supervised outcome limit inference.
Urologie (Heidelberg, Germany)Julia Nebe, Friedrich Moll, Matthis Krischel
This article highlights the life and work of the urologist Elsbet Forßmann (1906-1993), who was remembered for a very long time as the "brave and understanding wife" of Nobel Prize laureate Werner Forßmann (1904-1979) and draws attention to the widespread invisibility of women in the culture of memory of the field. But she was far more than that. After completing her training under Karl Heusch (1894-1986) at the Rudolf Virchow Hospital in Berlin from 1933-1934, she was one of the first two female physicians to earn board certification in urology in the postwar period. Building on broad surgical training, her clinical practice covered the "entire spectrum of urology," and she remained dedicated to her specialty throughout her life. As the mother of six children, she temporarily ensured her family's financial security after 1945 with her rural medical practice in Bad Kreuznach; her husband, Werner Forßmann, also worked at this practice. Elsbet Forßmann is thus undoubtedly one of the pioneers in the history of urology in the Federal Republic of Germany. As a figure long reduced in public and professional discourse to the role of the "wife of the Nobel laureate," an examination of Forßmann's life is inextricably linked to questions of gendered attributions within cultures of scientific recognition and professional memory within the histories of scientific disciplines. This article demonstrates how selectively disciplinary memory functions and how social background, gender, and the structural conditions of scientific recognition influence visibility and cultures of recognition in academia. This examination of Elsbet Forßmann's biography can thus also be seen as a contribution to a culture of critical and reflective remembrance within the field of urology.
World journal of urologyTheo Clark, Samuel Murphy, Solomon Bracey, Ali Talyshinskii, Arman Tsaturyan, Steffi Kar Kei Yuen, Carlotta Nedbal, Selcuk Guven, Vineet Gauhar, Frederic Panth…
BACKGROUND: Patients with urological conditions often undergo recurrent computed tomography (CT) imaging, which results in cumulative radiation exposure which can be deleterious. Artificial intelligence (AI)- based technologies, including Deep Learning Image Reconstruction (DLIR), have emerged as a potential strategy to reduce radiation dose in CT imaging while maintaining image quality. This systematic review aimed to quantify the benefits of AI-based techniques in urological CT imaging. METHODS: A systematic search of Ovid MEDLINE, Embase, and Scopus was conducted. Studies assessing AI-based techniques in urological CT were included. Primary outcomes of interest were radiation dose metrics (CTDIvol, DLP, effective dose), with other outcomes of interest including image quality metrics along with diagnostic performance of AI techniques. RESULTS: Eleven studies met the inclusion criteria. All studies demonstrated a radiation dose reduction aided with AI techniques, with most reporting reductions of 60-80%. Consistently, Image quality was maintained or improved, with reduced image noise and increased signal-to-noise ratio. Limited evidence from diagnostic studies showed at-least comparable performance between AI-based reconstruction and conventional iterative reconstruction, but with unclear superiority at equivalent dose levels. CONCLUSION: AI-based techniques show a clear ability to allow radiation dose reduction in urological CT imaging, whilst maintaining or improving image quality. However, the current evidence base is limited by a lack of diagnostic outcomes, and further research into AI techniques is required in order to quantify their clinical effectiveness.
UrolithiasisAmelia Pietropaolo, Hayder Alhusseinawi, Boyke Soebhali, Johan Cabrera, Azimdjon Tursunkulov, Deepak Ragoori, Fabio C Vincentini, Gaston M Astroza, Kremena Pet…
Endourological practice increasingly relies on single-use devices, the costs of which vary considerably across regions and healthcare systems. Flexible single-use ureteroscopes (FURS) and flexible and navigable suction ureteral access sheaths (FANS) represent a substantial proportion of ureteroscopy-related expenditure. To mitigate these costs, some centres have adopted reuse strategies aimed at reducing per-procedure expenses. The aim of this study was to evaluate international variation in the purchase prices and real-world per-procedure costs of FURS and FANS, and to assess the economic impact of device reuse strategies. An international collaborative study coordinated by the Young Academic Urologists (YAU) and European Association of Urology (EAU) Endourology Groups was conducted across 40 countries. Endourologists provided real-world procurement data regarding purchase prices, utilization patterns, and equipment-related procedural cost of single-use FURS and FANS between March 2025 and January 2026. All costs were converted to Euros (€). In centres adopting institution-validated reuse protocols, weighted per-procedure costs were calculated by dividing device acquisition costs by the number of effective uses. Countries were stratified according to cost quartiles to assess global variability. Data were collected from 40 countries across Europe, Asia, North and South America, and the Middle East. The median purchase cost of single-use FURS was €676.7 (IQR €579.0-975.0), ranging from €310 in Romania to €1638 in Cyprus. When adjusted for reuse practices, the median equipment-related procedural cost decreased to €425.0 (IQR €216.4-611.2), with values ranging from €92 in Brazil to €1343 in Ireland. The median purchase cost of FANS was €180 (IQR €130-226), ranging from €36 in Uzbekistan to €400 in the United States. Weighted per-procedure costs decreased to a median of €130.5 (IQR €77.5-182.2). The combined equipment cost of FURS and FANS for suction-assisted ureteroscopy ranged from €139.2 in Uzbekistan to €1691 in the United States (USA). Countries adopting cost-conscious reuse strategies achieved substantial reductions in per-procedure expenditure despite high initial acquisition costs. Marked international variability exists in the procurement and equipment-related procedural cost of FURS and FANS, with up to fourfold differences observed between countries. Reuse strategies substantially reduce equipment-related expenditure and may improve the economic sustainability of ureteroscopy. These findings highlight the importance of considering regional cost structures and resource utilization when evaluating the value of emerging endourological technologies.
Journal of medical Internet researchWentong Yang, Ting Xu, Junjie Wei, Wentao Zheng, Wenbo Yan, Jingkai Wang, Guangdi Chu, Haitao Niu
BACKGROUND: Since its release in November 2022, generative AI (GenAI) tools, including ChatGPT, have gained widespread attention across various sectors, including medical education. OBJECTIVE: This study seeks to examine the effectiveness and feasibility of GenAI tools (ChatGPT o3‑mini [OpenAI] and DeepSeek R1) in enhancing urology teaching outcomes for medical undergraduates. METHODS: We assessed the accuracy of responses from ChatGPT o3-mini and DeepSeek R1 to authoritative urology multiple-choice questions. Then, a randomized controlled trial was performed to compare the learning outcomes of students using ChatGPT o3-mini and DeepSeek R1 with those using traditional learning methods. Additionally, a questionnaire was designed to survey medical undergraduates' perspectives on the application of AI in urology education. RESULTS: DeepSeek R1 demonstrated higher accuracy than ChatGPT o3-mini in answering urology-related multiple-choice questions. In the test following the self-study period, the DeepSeek R1 group surpassed both the control and ChatGPT o3-mini groups in total scores across various question types. Despite the superior scores in the ChatGPT o3-mini group, statistical significance was not achieved relative to the control group. Survey results revealed that most students had a positive attitude toward AI-assisted learning, believing it could effectively enhance medical education. CONCLUSIONS: DeepSeek-assisted self-study was associated with higher posttest scores than traditional internet-based learning, whereas ChatGPT showed numerically higher but nonsignificant results. These findings offer evidence-based insights into the embedding of GenAI within medical education frameworks, providing guidance for educators in developing teaching strategies and for institutions in formulating relevant policies.
Medical sciences (Basel, Switzerland)Zenon Pogorelić, Andrea Cvitković Roić
BACKGROUND: Pediatric urology has traditionally relied on anatomical classifications, standardized diagnostic pathways, and disease-specific treatment algorithms. However, children with the same anatomical diagnosis may have substantially different risks of disease progression, renal injury, complications, and need for intervention. Personalized and precision medicine aim to integrate clinical, imaging, functional, biological, genomic, and longitudinal information to support individualized risk assessment and decision-making. METHODS: This narrative review was based on a targeted literature search of PubMed/MEDLINE, Scopus, Embase and Web of Science databases. Search terms included combinations of "personalized medicine," "precision medicine," "risk stratification," "pediatric urology," "biomarkers," "genomics," and "artificial intelligence," together with terms related to major pediatric urological conditions. Additional relevant publications were identified from reference lists of key articles. The literature was narratively synthesized according to its relevance to individualized risk assessment and clinical decision-making. RESULTS: Current evidence supports an evolving role for individualized risk assessment in vesicoureteral reflux, antenatal hydronephrosis and ureteropelvic junction obstruction, congenital anomalies of the kidney and urinary tract, hypospadias, undescended testes, and disorders of sex development. Biomarkers, genomic testing, advanced imaging, and artificial intelligence may provide additional information for phenotyping and outcome prediction. However, most predictive and AI-based models remain insufficiently validated, with limitations related to external validation, calibration, reproducibility, clinical utility, and generalizability. Longitudinal reassessment is particularly important because risk may change with growth, disease progression, and treatment response. CONCLUSIONS: Personalized pediatric urology should move beyond diagnosis-based algorithms toward dynamic, risk-adapted decision-making. The goal is not to increase the number of investigations or interventions, but to identify which child is most likely to benefit from additional testing, surveillance, or treatment. Future implementation will depend on robust validation of predictive models and demonstration that personalized approaches improve clinically meaningful outcomes.
Current urology reportsGary W Chien, Kirk A Tamaddon, Ramin Davidoff
PURPOSE OF REVIEW: This review examines how the clinical skills, professional traits, and developmental pathways of practicing urologists can translate into broader institutional leadership roles, addressing the persistent underrepresentation of surgeons and urologists in health system decision-making. RECENT FINDINGS: National data show that physician chief executives remain uncommon and that urologists are rarely represented in senior institutional roles. Yet urology draws from a highly competitive applicant pool and is associated with personality traits, longitudinal patient relationships, and operational habits that align closely with institutional leadership. National data further illustrate how physicians commonly reach durable leadership roles through progressive responsibility, visible institutional service, and sustained operational engagement. Urologists already exercise many competencies required for institutional leadership, including triage under uncertainty, multidisciplinary coordination, regulatory awareness, high-stakes communication, and long-term relationship-building. Intentional pathways built through mentorship, leadership development, visible service, and progressive administrative responsibility can help urologists extend their impact beyond the operating room and strengthen surgical representation in organizational leadership.
Journal of nuclear medicine : official publication, Society of Nuclear MedicineBoris Hadaschik, Oliver Sartor
Theranostics, particularly PSMA-targeted imaging and radiopharmaceutical therapy, is rapidly transforming the field of urooncology. This article reviews the clinical integration of PSMA PET/CT in diagnosis, treatment planning, and patient selection for 177Lu-PSMA-617 therapy, which has demonstrated survival benefits and favorable safety profiles in metastatic castration-resistant prostate cancer. As evidence expands into earlier disease stages, PSMA radiopharmaceutical therapy is emerging as a key systemic treatment modality. The article emphasizes the importance of multidisciplinary care and the evolving role of nuclear medicine as both a diagnostic and a therapeutic partner. It also highlights current challenges and regional disparities in access, encouraging thoughtful, patient-centered adaptation of theranostic advances.
Archives of gynecology and obstetricsLena Löffler, Lisa Jörgens, Stefanie Mache, Daniela Ohlendorf, Doris Klingelhöfer, Koji Matsuo, Jenny Jaque, Isabelle Marie Kramer, Dörthe Brüggmann
INTRODUCTION: Most medical graduates and specialists of obstetrics and gynecology (OB/GYN) in Germany are female, and numbers of female urology specialists are rising. However, the number of women in higher academic positions does not correlate with this increase. This study analyzes female academic career advancement on a spatial and temporal scale in Germany using the Brüggmann-Groneberg (BG) Index. The academic BG Index relates female-to-male (f:m) ratios in chair positions of state universities while representing lower career levels. It is updated in this study from 2013 (OB/GYN) and 2015 (urology) onwards, while a modified clinical BG (BGclin) Index, introduced here for the first time, assesses career progression ratios in leadership positions in clinical medicine. METHODS: The gender distribution among medical students, OB/GYN and urology specialists, clinical leaders, and academic chair holders was obtained from governmental and non-governmental sources. The f:m ratios of the populations were assessed and used in the BG indices which were calculated for five time points (2004, 2009, 2014, 2019 and 2024) and across Germany to identify spatial-temporal trends. RESULTS: F:m ratios among hospital specialists increased in OB/GYN (0.847 to 2.388) and urology (0.13 to 0.361) from 2004 to 2024. In contrast to urology, significant changes in the distribution of male and female chair holders toward gender equality could be observed in OB/GYN. Simultaneously, the academic BG Index rose from 0.045 to 0.099 in OB/GYN and from 0 to 0.084 in urology. The BGclin Index slightly decreased in OB/GYN (0.108 to 0.102) and increased in urology (0.086 to 0.114). No spatial trend could be observed. DISCUSSION: This study demonstrates persistent gender imbalance in German academic and clinical leadership positions in OB/GYN and urology. The academic and BGclin Indices indicate stagnation and/or decline in gender parity, emphasizing the need for targeted career development programs. Furthermore, a spatial analysis revealed an absence of spatial patterns in German chair holder positions. The continued use of these indices will prove a helpful tool to assess and document changes in the upcoming years.
World journal of urologySarah Razavi, Emeka Udedibia, Kristin L Chrouser, Hamid Norasi, M Susan Hallbeck, Madeline C Snipes, Jeet Bhavsar, David Hoenig, Zeph Okeke
INTRODUCTION: To address the limited exploration of surgical ergonomics and instrument fit in urology, we evaluated the relationship between surgeons' hand size, glove fit, gender, and their perceived ease of using various urologic instruments. METHODS: An anonymous web-based survey was designed and distributed to members of the Endourology Society, Society of Women in Urology, and urology residency programs in the United States. It included demographics, perceived hand size/strength, ease of instrument use, and discomfort. RESULTS: Among 277 respondents (55% female, mean age 43.0 ± 11.4), 26% reported glove fit issues-more common in females (32% vs. 16%, p < 0.001). Nearly half (49%) reported hand size impacted their ability to use instruments and 52.73% reported having to make intraoperative adjustments in order to use the instruments effectively. Female urologists found all surgical instruments harder to use compared to their male counterparts (p < 0.05). Overall, 40% of respondents reported using some form of intervention to address discomfort and/or injury related to surgical instrument use (47% of females vs. 34% of males; p < 0.05). Female urologists and urologists with smaller hands reported significantly more discomfort using the flexible ureteroscope, disposable flexible ureteroscope, nephroscope, stapler, Ligasure, laparoscopic right angle, Trilogy™ and ShockPulse™ (p < 0.05). CONCLUSIONS: Our findings suggest that currently available urologic instruments do not fit a large subset of urologists. Industry collaboration is needed to address ergonomic disparities.
JMIR formative researchMohamed Eldaneen, Shaza Hendy, Omar Ramadan, Panagiotis Nikolinakos, Asif Muneer, Hussain M Alnajjar, Karl H Pang
BACKGROUND: Recent advances in AI, particularly large language models, have generated growing interest in their application to medical education and examination preparation. However, the accuracy, reasoning quality, and adherence to clinical guidelines of these tools in postgraduate urology assessments remain unclear. OBJECTIVE: This study aimed to evaluate the performance of 3 AI tools, ChatGPT (GPT-4.0), Claude (version 4.5), and AMBOSS, on European Board of Urology (EBU)-style multiple-choice questions, with a particular focus on accuracy, insight, concordance, and adherence to European Association of Urology (EAU) guidelines. METHODS: A total of 200 single-best-answer questions from the EBU In-Service Assessment workbook (2021-2022) were input into each AI model. Models were prompted to select an answer and provide an explanation. Two urologists with post-Fellowship of the Royal College of Surgeons (FRCS) training independently assessed the outputs. Accuracy was defined as correct answer selection. Concordance was defined as the logical alignment between the answer and its explanation. Insight was evaluated across 3 domains-nonobvious deduction, discriminative reasoning, and clinical validity-and was graded as low, moderate, or high. RESULTS: ChatGPT demonstrated the highest accuracy (171/200, 85.5%), compared to Claude and AMBOSS (both 159/200, 79.5%; P=.14). Concordance was also significantly higher for ChatGPT (190/200, 95%) than for Claude (176/200, 88%) and AMBOSS (152/200, 76%; P<.001). Nonobvious deduction was predominantly low to moderate across all models, reflecting the recall-based nature of many questions. ChatGPT and Claude showed stronger discriminative reasoning, while AMBOSS demonstrated limited exclusion of alternative options. Clinical validity was high overall, with ChatGPT showing the greatest consistency with EAU guidelines. There was substantial agreement between the 2 reviewers (weighted κ coefficient >0.61). CONCLUSIONS: AI tools can achieve high accuracy on EBU-style assessments; however, differences in reasoning quality and guideline adherence are evident. ChatGPT demonstrated superior performance across all evaluated domains, supporting its role as a potential adjunct in postgraduate urology education.
International journal of urology : official journal of the Japanese Urological AssociationSachiyo Nishida, Naoya Masumori
BACKGROUND: The rapid adoption of robot-assisted surgery has fundamentally altered urology training pathways. Although robotic platforms may reduce workload in experienced surgeons, these benefits may not extend to novice trainees. Apparent technical fluency during supervised console participation may conceal cognitive demands related to system control, anatomical interpretation, procedural sequencing, tissue handling, and team communication. OBJECTIVES: This review examined how cognitive load theory (CLT) can inform instructional design for novice trainees in robot-assisted urologic surgery. METHODS: A narrative review of the literature on CLT, surgical education, and urological training was conducted using PubMed and Google Scholar. The articles were selected based on their relevance to cognitive load management, surgical training, and video-based learning. KEY FINDINGS: CLT distinguishes intrinsic load arising from task complexity, extraneous load arising from avoidable features of instruction or the environment, and cognitive resources devoted to schema construction. In novice trainees, unfamiliar interfaces and the simultaneous demands of console operation and procedural decision-making may consume much of the available working memory capacity. CLT-informed strategies-including procedural segmentation, signaling, pre-training, part-task practice, scaffolded supervision, cognitive aids, and simulation-may help align task demands with trainee expertise. A practical framework can structure instruction before surgery, provide brief prioritized guidance during surgery, and use focused debriefing afterward. CONCLUSIONS: CLT provides a useful framework for robotic surgical education, but the current evidence is heterogeneous and not specific to all urologic settings. Prospective studies should determine whether CLT-informed training improves learning, proficiency, and patient outcomes.
Investigative and clinical urologyJung Hyun Shin, Hye Jin Byun, Young Ju Lee, Ju Hyun Shin, Mi Mi Oh
PURPOSE: To evaluate career satisfaction, mentorship experience, work-life balance, and perceptions of gender discrimination among female urology residents and specialists in Korea. MATERIALS AND METHODS: A nationwide cross-sectional survey was conducted among female urologists, including residents and board-certified specialists. The questionnaire assessed demographic characteristics, mentorship experience, career satisfaction, personal life satisfaction, work-related stress, and experiences of gender discrimination. RESULTS: A total of 41 respondents participated, including 11 residents and 30 specialists. Most specialists (63.3%) practiced in tertiary or secondary hospitals, and 21 (70.0%) specialized in female urology or voiding dysfunction. Only 9.1% of residents and 33.3% of specialists reported substantial mentorship during training, with the most common barrier being the absence of experts in the desired field. While 60.0% of specialists and 54.5% of residents stated they would choose urology again, 56.7% and 45.5%, respectively, would not recommend the specialty to their children. Residents reported higher work-related stress (median, 7 vs. 5, p>0.05), whereas personal life satisfaction was similar between groups (median, 6 vs. 7, p>0.05). All residents reported workload adjustments, whereas 95.0% of specialists reported unchanged duties. Approximately one-third experienced gender discrimination, mainly during residency, most often from colleagues or patients, and 81.6% perceived male preference in employment. CONCLUSIONS: Female urologists in Korea demonstrate strong professional dedication but there remain challenges related to mentorship scarcity, gender bias, and work-life imbalance. Efforts to strengthen mentorship and promote equitable workplace policies are essential to enhance satisfaction and retention among women in urology.
Journal of surgical educationNiccola B Lynch, Eric S Giannaris, Austin Kinley, Jonah Samuel, Yoon Soo Park, Sean O Hogan, Kate H Kraft, Wesley A Mayer, Gina M Badalato
OBJECTIVE: To examine national trends in urology resident surgical autonomy using Accreditation Council for Graduate Medical Education (ACGME) case log data. DESIGN: A retrospective cohort analysis of ACGME case logs for all graduating urology residents from 2013 to 2023. Resident-defined operative role ("assistant," "surgeon," or "teaching assistant") was used as a proxy for surgical autonomy, and an autonomy score was calculated for each resident. Trends over time were evaluated using mixed-effects regression, and differences by procedure subtype, ERAS geographic region, and sex were assessed using analysis of variance. SETTING: A novel national database encompassing all urology residency programs across the United States. PARTICIPANTS: Graduating urology residents who completed ACGME-accredited urology residency programs between 2013 and 2023. A total of 3391 residents across 145 programs met inclusion criteria. RESULTS: Mean case number per resident increased from 1243 in 2013 to 1404.6 in 2023 (p < 0.001). Mean autonomy score declined significantly over the study period from 92% in 2013 to 85% in 2023 (p < 0.001). Autonomy varied significantly according to procedure subtype, with oncology demonstrating the lowest autonomy at 78%, and endourology and general urology demonstrating the highest autonomy at 94% and 93%, respectively (p < 0.001). Autonomy varied significantly by ERAS geographic region (p < 0.001) and sex, with males reporting higher autonomy scores than females (p < 0.001). CONCLUSIONS: This national cohort analysis demonstrates a significant and sustained decline in urology resident self-reported surgical autonomy, with variation according to procedure subtype, geographic region, and sex. These findings are concerning and highlight the importance of re-evaluating and prioritizing autonomy within urology residencies.
World journal of urologyFurkan Guldibi, Umit Ozdemir, Mahmut Calıskan, Omer Faruk Cavdar, Erkan Arslan, Daniele Castellani, Vineet Gauhar, Bhaskar K Somani, Selcuk Guven, Theodoros To…
PURPOSE: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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.
Seminars in nuclear medicineKhanyisile Hlongwa, Anita Brink, Stuart More
Paediatric nephro-urology imaging plays a central role in the evaluation of congenital renal abnormalities, with renal scintigraphy remaining the reference standard for functional assessment of drainage, differential renal function, and cortical integrity. Despite advances in ultrasound and cross-sectional imaging, nuclear medicine techniques continue to provide unique quantitative and physiological information that directly influences clinical decision-making. Recent developments include improved standardisation of paediatric renography protocols, optimised use of 99mTc-labeled radiopharmaceuticals such as [99mTc]Tc-MAG3, [99mTc]Tc-EC and [99mTc]Tc-DMSA, and increasing incorporation of hybrid SPECT/CT imaging for problem-solving in equivocal cases. Interpretation of diuretic renography has also evolved, with greater emphasis on integrated analysis rather than reliance on single quantitative indices. Paediatric renal scintigraphy, however, remains prone to interpretative pitfalls due to developmental renal physiology, technical variability, and overlapping imaging appearances between obstructive and non-obstructive systems. False-positive obstruction, misinterpretation of drainage patterns, and challenges in cortical defect characterisation remain significant issues. This review summarises current advances in paediatric renal scintigraphy, highlights optimised imaging protocols, and discusses common interpretative pitfalls with strategies to improve diagnostic accuracy in clinical practice.
The Canadian journal of urologyLucas B Vergamini, Pedro Z Padovani, Nicholas Choi, Wilson R Molina, Donald Neff, David A Duchene, Emily Elliott, Colby Souders, Maxton Thoman, Bristol B Whiles
OBJECTIVES: In September 2024, Hurricane Helene caused extensive infrastructure damage in the United States, including severe disruption to a major Baxter sterile irrigation fluid manufacturing facility in North Carolina, leading to a nationwide shortage of sterile irrigation fluids used in surgical procedures. The objective of this study was to evaluate the impact of the nationwide sterile irrigation fluid shortage on urologic practice across the United States (U.S.). METHODS: A descriptive, cross-sectional Research Electronic Data Capture (REDCap) survey was distributed to U.S. urologists. The questionnaire captured provider demographics, procedure delays, and practice/procedure modifications. RESULTS: Ninety-five surgeons responded. Overall, 76.8% reported an impact on practice, and 47% were directed by hospitals to cancel or reschedule cases. Over one-third rescheduled more than 10 procedures, with a median delay of two months. Benign prostatic hyperplasia (BPH) treatments and percutaneous nephrolithotomy (PCNL) were the most affected. About 36% noted a negative impact on physician-patient relationships. Nearly half (45.7%) modified outpatient procedures, primarily cystoscopies, using syringe irrigation or requesting patients arrive with full bladders. RESULTS: Surgical adjustments (40.4%) included switching from holmium laser enucleation of the prostate (HoLEP) to simple prostatectomy and reducing resident involvement. Postoperatively, increased catheter traction was used to limit irrigation. Twenty-nine urologists planned to retain conservation measures such as smaller fluid bags or reduced pressurized irrigation. At survey completion, 32.6% still experienced effects of the fluid shortage. CONCLUSIONS: The 2024 national fluid shortage significantly disrupted U.S. urology practice, especially endourology cases. Urologists adopted a range of clinical and surgical strategies, some of which may persist, underscoring the need for systemic preparedness to mitigate future shortages.
MedicineYaxiong Tang, Yun Tan, Gang Chen, Cheng Ren
BACKGROUND: To systematically compare the research landscape, thematic hotspots, and evolutionary trajectories of urology education in China and globally between 2015 and 2024, and provide evidence-based insights for optimizing urology residency training and clinical teaching reform. METHODS: We searched for urology education papers published between 2015 and 2024 in Chinese databases (China National Knowledge Infrastructure (CNKI), Wanfang, VIP, Chinese dissertation database, National Urology Education Symposium proceedings) and international databases (Web of Science Core Collection, PubMed, ProQuest dissertation database, American Urological Association (AUA)/European Association of Urology ) annual meeting proceedings). Bibliometric methods were applied for keyword co-occurrence, cluster analysis, and burst detection using VOSviewer 1.6.19, CiteSpace 6.4.R1, and Bibliometrix 4.1.0. The validated Medical Education Research Study Quality Instrument (MERSQI) was used for quality control. Literature screening followed an adapted Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 statement. RESULTS: We identified a total of 8217 records from all databases. After screening and quality evaluation, 1563 studies were finally included in the bibliometric analysis (1137 from China, 426 from other countries). Annual publication volume showed steady growth in both regions (average annual growth: 6.2% in China, 6.6% globally). Four core clusters were identified in Chinese studies: teaching methodology innovation, technology-assisted instruction, standardized residency training optimization, and professionalism cultivation, reflecting a practice-oriented problem-solving paradigm. Four clusters were identified in international studies: interprofessional education (IPE), continuing professional development. simulation training system construction, and nontechnical skills training, reflecting a theory-driven system-building paradigm. The mean MERSQI score was 6.2 for Chinese studies and 9.7 for international studies, indicating a substantial gap in methodological rigor. CONCLUSIONS: Urology education research has expanded rapidly worldwide over the past decade, with distinct developmental paths between China and Western countries. Future efforts in China should prioritize localized adaptation of educational technologies, construction of standardized specialty education systems, and improvement of research methodology to advance high-quality urology workforce development.
Current urology reportsSteven C Campbell, Samuel K Luketich, Stanley Kandzari
The urology workforce is aging, with a median provider age of 54 years and approximately one-third over the age of 65. With growing workforce shortages and increasing age-related urologic disease, the need for urologists will continue to increase. Although initiatives such has residency expansion, increased use of advanced practice providers, and alternative certification pathways are being implemented, continued contributions and engagement from senior urologists is becoming increasingly important. These "Seniorologists" can offer refined clinical judgement, mentorship, communication skills, professionalism, and fundamentals of medicine such as the physical exam. Although changes in cognitive and physical performance may limit some "Seniorologists", these changes vary widely and each individual should be considered on an individual basis. Self-monitoring, ongoing education, objective evaluation, and appropriate scope of clinical responsibilities can be implemented for quality and patient safety. Capable "Seniorologists" should be supported by institutions while allowing for flexibility in workload and practice scope. As clinical responsibilities are reduced, "Seniorologists" can contribute to the field of urology through teaching, mentoring, and leadership. This type of support benefits the trainees and colleagues, the patients, and the field of urology as a whole. In an era of growing workforce shortages despite growing demands, experienced "Seniorologists" remain an invaluable asset whose continued engagement will help shape the future of urology and change patient care.
World journal of urologyAmelia Pietropaolo, Hayder Alhusseinawi, Boyke Soebhali, Johan Cabrera, Azimdjon Tursunkulov, Deepak Ragoori, Fabio C Vincentini, Gaston M Astroza, Kremena Pet…
BACKGROUND AND OBJECTIVE: Endourological practice increasingly depends on single-use devices, whose costs vary considerably across regions and health care systems. Flexible single use ureteroscopes (URS) and flexible and navigable sheaths (FANS) represent a major component of ureteroscopy-related expenditure. This study aimed to evaluate international variation in purchase and device-related acquisition cost of URS, FANS, and the cost of FANS (suction) assisted URS (URS and FANS). METHODS: An international collaborative dataset compiled by the EAU Endourology Group collected information on device purchase prices for single use flexible ureteroscopes, FANS, and suction assisted URS across multiple countries. All costs were converted to Euros (€). Countries were stratified into quartiles, and global medians with interquartile ranges (IQRs) were reported. RESULTS: Data were obtained from 40 countries across Europe, Asia, North and South America, and the Middle East, and showed a significant global cost variation. The median price of single-use FURS was €676.7 (IQR 579-975), ranging from €310 (Romania) to €1638 (Cyprus), while FANS cost €180 (IQR 130-226), ranging from €36 to €400. Median per-procedure FANS assisted URS cost was €951.6 (range €415-1881). Lowest costs were observed in Romania, Belgium, and Germany, while highest were in Cyprus, Russia, and the United States, with up to four-fold inter-country variation, including within Europe. CONCLUSIONS: Substantial global variability exists in the cost of URS and FANS, influenced by healthcare policy, and economic conditions. These findings highlight the need for cost-effectiveness analyses and the development of evidence-based procurement policies to promote sustainability and equitable access in endourological practice.
UrolithiasisSanguinetti Horacio, Castellani Danielle, Johnson Brett, Maheshwari Pankaj N, Quarrier Scott, Ghani Khurshid
The relative use of shock wave lithotripsy (SWL) has declined with the expansion of endourological techniques, although SWL remains widely available. Contemporary international data on SWL utilization, technical delivery, operator models, outcome assessment, and artificial intelligence (AI)-based tools are limited. This study evaluated current SWL practice patterns among urologists involved in stone disease management. A cross-sectional web-based survey was developed by the Kidney Stones Pillar of the FUTURE collaborative group and distributed through the Endourological Society network and X platform between February and April 2026. The questionnaire assessed SWL utilization, decision-making, technical parameters, operator profile, follow-up, outcome definitions, and AI use. Results were summarized using item-level denominators. Exploratory subgroup analyses compared respondents with higher (> 15%) versus lower/no (≤ 15%) SWL utilization. A total of 156 responses from 36 countries were analyzed. Overall, 121/156 (77.6%) respondents used SWL in ≤ 15% of stone cases, including 26/156 (16.7%) who did not currently use SWL. Among 144 respondents for whom the temporal-trend question was applicable, 89/144 (61.8%) perceived a decrease in SWL use over the preceding three years. Higher SWL utilization was associated with in-house SWL availability [30/35 (85.7%) vs. 59/121 (48.8%), p < 0.001]. Electromagnetic lithotripters were most common [66/129 (51.2%)], and 100/126 (79.4%) respondents reported equipment aged ≥ 6 years. AI access remained limited, with 107/130 (82.3%) reporting no access and 11/130 (8.5%) reporting clinical use. Among respondents to this international survey, SWL was used in a minority of stone cases and was commonly perceived to have decreased over the preceding three years. Considerable variability was observed in patient selection, treatment delivery, operator models, training, and outcome assessment, while access to AI-based tools remained limited.
Current urology reportsAli Bourgi, Emmanuel Rusch, Pierre Bigot, Franck Bruyère
PURPOSE OF REVIEW: Large-scale databases have become an essential resource in urologic oncology, enabling the generation of real-world evidence across broad and diverse patient populations. This narrative review aims to summarize the contribution of population-based cancer registries, hospital-based clinical registries, and administrative healthcare databases to the understanding and management of prostate, bladder, renal, and other genitourinary malignancies. RECENT FINDINGS: Over the past decade, large database studies have provided key insights into cancer epidemiology, treatment patterns, outcomes, and healthcare disparities. These data sources complement randomized clinical trials by capturing routine clinical practice at a population level. Major findings include shifts in cancer incidence and mortality, increased adoption of active surveillance in low-risk prostate cancer, and greater use of nephron-sparing approaches in renal cell carcinoma. In addition, large-scale analyses have highlighted disparities related to patient demographics, institutional volume, and access to care. They have also contributed to evaluating the real-world effectiveness and safety of established therapies, particularly in populations often underrepresented in clinical trials. Despite their strengths-particularly large sample sizes and enhanced generalizability-big data studies remain subject to important limitations, including residual confounding, coding variability, and limited availability of granular clinical and biological information. When interpreted with appropriate methodological rigor, these observational data provide valuable evidence to support clinical decision-making, inform guideline development, and identify gaps in care. Continued improvements in data quality, analytical methods, and integration with emerging technologies are expected to further strengthen the role of real-world data in advancing urologic oncology.
Topics in spinal cord injury rehabilitationCristina Sadowsky, Megan Torrance
The recently (2024) launched American Spinal Injury Association (ASIA) e-learning module UroSTeP: Urology course is getting a modern upgrade with artificial intelligence (AI)-based clinical cases developed to refine and cement knowledge acquisition. AI-based learning is not only accepted but is also required nowadays, and the conservatism of medicine is traditionally not conducive to early adoption. Here, we try to explain why and how it can be done.
Pediatric surgery internationalTharanendran Heera, Ramesh Babu, M Vijay Anand, Abirami Anbarasu, Latha Ravichandran, Lingadevi Thanasekaran
BACKGROUND AND AIMS: The utility of virtual reality (VR) in surgical planning, education and counselling has not been fully evaluated so far. The present study aims to address this gap in exploring usefulness of VR reconstruction in pediatric urology. METHODS: All patients who underwent VR reconstruction over the last one year (2023-24) were included. Contrast enhanced CT scan/ MRI images were obtained at 1-mm thickness. A VR model and a 3D environment were created (Immersive view5.0; Immersive Touch Inc. 910). The usefulness was assessed by three independent surgeons on a Likert scale (1-5) on the following headings: anatomical delineation, haptic tools, pre-surgical planning, student teaching and patient counselling. Inter class correlation (ICC) analysis was performed using SPSS. RESULTS: Among 275 patients managed, 20 cases underwent VR reconstruction in view of the complex anatomy. The diagnoses were bilateral Wilms Tumor 1; pelvic kidney UPJO 1; horse shoe kidney 1; malrotated UPJO 1, duplication anomalies 8, recto urethral fistula 1; exstrophy variants 3, complex urolithiasis 2, vaginal atresia 1, and renal trauma with urinoma 1. Among the study population 18/20 underwent surgical treatment; two were managed conservatively (renal trauma-1; renal cyst - 1). The mean usefulness score was: anatomical delineation 3.9, haptic tools 3.1, surgical planning 3.6, student training 4.2 and patient counselling 4.1. ICC for individual measures was 0.893 (95% CI 0.792-0.952; p < 0.001). CONCLUSIONS: VR reconstruction is as a valuable adjunct in enhancing anatomical understanding, and improving education and communication. Selection of ideal cases for VR will make this novel tool cost-effective.
Revista brasileira de enfermagemCristiane Feitosa Salviano, Gisele Martins
OBJECTIVES: to describe the communication strategies used by urology specialists to obtain information directly from children. METHODS: a qualitative study with professionals who had been treating children with urinary and intestinal symptoms for at least one year. Semi-structured interviews were carried out, and thematic analysis was conducted and mediated by NVIVO version 12.0. RESULTS: fourteen specialist professionals were interviewed. From their statements, three thematic categories emerged: (1) Verbal communication, with adaptation of language, use of simple terms and analogies; (2) Nonverbal communication, with visual resources such as drawings, scales and voiding diaries; (3) Play and playful strategies, such as the use of dolls to demonstrate positioning on the toilet, dramatizations and games to facilitate verbal expression of symptoms. FINAL CONSIDERATIONS: language adaptation, photo-elicitation, and playful tools prove to be effective communication strategies within pediatric urology. These strategies are low-cost, and can be developed and adapted to clinical practice.
JAMA network openWalter Hsiang, Darren Chau, Joy Barrett, Lindsay Van Winkle, Arnav Supur, Angela Kim, Bao Nguyen, Patrick Hoang, Marshall Stoller
IMPORTANCE: For uninsured or out-of-network patients, uncertainty regarding the expected prices for urology appointments presents a meaningful barrier to timely evaluation. Although price variation for hospital-based services is well documented, self-pay price information in the ambulatory urology setting remains uncharacterized. OBJECTIVE: To quantify self-pay appointment prices and characterize the availability and structure of financial assistance programs (discounts and payment plans) in urology clinics nationwide. DESIGN, SETTING, AND PARTICIPANTS: This national, cross-sectional, audit study was conducted from July 1 through August 31, 2025, at outpatient urology clinics across all 50 US states. A random sample of up to 30 urology clinics per state was selected from a nationwide directory, totaling 1150 clinics. Clinics in closed or membership-restricted health systems were excluded. Researchers used a standardized script to pose as family members of uninsured patients calling for a kidney stone consultation. Calls were limited to 5 minutes and were conducted with front-office staff and/or billing personnel. MAIN OUTCOMES AND MEASURES: The primary outcome was the self-pay price for a new patient appointment, adjusted for regional cost-of-living variability. Secondary outcomes included the availability and specific terms of financial assistance programs. RESULTS: Among 1150 urology clinics, 865 (75.2%) provided a self-pay price. The national median (IQR) self-pay price was $265 ($208-$361). Compared with private practices, academic (odds ratio [OR], 0.28; 95% CI, 0.16-0.47; P < .001) and hospital-based (OR, 0.42; 95% CI, 0.28-0.65; P < .001) clinics were associated with lower odds of providing self-pay price information. Conversely, hospital-based (OR, 2.64; 95% CI, 1.57-4.44; P < .001) and academic (OR, 1.65; 95% CI, 1.01-2.69; P = .04) clinics were associated with higher odds of offering financial assistance. However, specific terms were often unspecified for discounts (76 [27.9%]) and payment plans (313 [75.8%]). CONCLUSIONS AND RELEVANCE: In this national cross-sectional study of 1150 urology clinics, most clinics provided self-pay appointment prices, although substantial price transparency gaps remained; hospital-based and academic clinics were associated with lower odds of providing self-pay prices but higher odds of offering financial assistance programs. Ambiguous financial assistance terms may limit the ability of self-pay patients to navigate self-pay prices, suggesting a need for standardized disclosure to improve access to urologic care.
World journal of urologyMuhannad Aljoulani, Arianna Pischetola, Jia-Lun Kwok, Ali Talyshinskii, Steffi Yuen, Vineet Gauhar, Daniele Castellani, Federico Zorzi, Stefano Moretto, Giovan…
BACKGROUND AND OBJECTIVE: Outpatient retrograde ureteral stenting under local anesthesia (LA) is increasingly adopted to reduce anesthetic risk, resource use, and procedural delays. However, success rates and tolerance vary across benign and malignant obstruction. This systematic review evaluated technical success, safety, pain and tolerance, and clinical predictors of failure to inform patient selection and procedural planning. METHODS: Following PRISMA 2020 statement, MEDLINE, Embase, Scopus, and Web of Science were searched from inception to October 2025. Twenty studies involving adults undergoing ureteral stent insertion or exchange under LA in outpatient, office-based, or bedside settings were included. Data were synthesized using random-effects meta-analysis with logit transformation. Predictors of success and failure were assessed qualitatively and quantitatively where feasible. KEY FINDINGS AND LIMITATIONS: Across 1,945 patients (2,871 ureteral units), pooled technical success was 89% (95% CI 86-92%), highest for stone-related obstruction (94%) and lowest for malignant ureteral obstruction (82%). Overall complications ranged from 2 to 14%, with major events (Clavien-Dindo ≥ II) occurring in < 5%. Pain scores were modest (VAS 3.1-4.6), and 87-90% of patients were willing to undergo repeat LA stenting. Independent predictors of technical failure included bladder trigone or distal ureteric invasion, severe hydronephrosis, and poor performance status (ECOG ≥ 2). Limitations include heterogeneity in outcome definitions, lack of multivariable modelling in most studies, and short-term follow-up. CONCLUSIONS AND CLINICAL IMPLICATIONS: LA ureteral stenting is safe, effective, and well tolerated in carefully selected patients. Predictors of failure offer a practical framework to guide decision-making between outpatient LA stenting, operating-room stenting, and percutaneous drainage. Standardized reporting and prospective validation of risk models are needed.
BMC urologyFelix Seelemeyer, Rouvier Al-Monajjed, Jan Philipp Radtke, Stephan Nüesch, Jan Herden, Sassan Nazari, Ruben Gößmann
BACKGROUND AND OBJECTIVE: Flexible cystoscopy is integral to outpatient urology, particularly for surveillance of non-muscle-invasive bladder cancer. Real-world economic data comparing reusable (RU) and single-use (SU) cystoscopes in German outpatient practice are scarce. We evaluated procedure-level costs and multidisciplinary user perceptions under routine conditions. METHODS: A micro-costing analysis was performed in a German outpatient urology centre (337 cystoscopies/year). Capital investment (5-year amortisation), maintenance, reprocessing, consumables, and labour were included. Baseline and full-equipment replacement scenarios were modelled, and break-even thresholds calculated. A standardised survey of 13 physicians and 25 nursing staff from five practices assessed technical performance and workflow domains (5-point Likert scale). Groups were compared using Mann-Whitney U tests with Cliff's delta. RESULTS: Mean per-procedure cost was €27.25 for RU and €179.00 for SU. RU became cost-effective beyond 67 procedures annually; this threshold increased to 265 procedures when modelling full equipment renewal (€43,050). Physicians rated RU superior for manoeuvrability (p = 0.02) and SU superior for logistics (p = 0.02), with no differences in image quality, ergonomics, diagnostic confidence, or overall impression. Nursing staff favoured SU across all domains (all p < 0.001), particularly reprocessing workload and reliability. Limitations include single-centre design, evaluation of one device per category, context-specific reimbursement structures, and absence of primary environmental or patient-reported outcomes. CONCLUSIONS: In high-volume outpatient settings, RU cystoscopes are economically advantageous. However, SU devices offer substantial workflow benefits. Device selection should be context-specific, integrating case volume, infrastructure, and multidisciplinary perspectives.
Journal of robotic surgeryPanpan Jiao, Siyu Chen, Jianwei Yang, Li Wang, Kun Cheng, Xiaoqiang Si, Li Yang
To systematically characterize global publication trends, collaboration patterns, intellectual foundations, research hotspots, and emerging frontiers in artificial intelligence (AI)-enhanced robotic and robot-assisted surgery in urology. Publications were retrieved from the Web of Science Core Collection (WoSCC) using a topic search strategy that included three keyword groups: robot-assisted surgery, urologic diseases or procedures, and AI-related technologies. English-language articles and reviews were included. Meeting abstracts, conference proceedings, editorials, letters, non-English publications, studies unrelated to urologic robotic surgery, and studies without substantive AI or intelligent algorithmic content were excluded. RStudio was used for descriptive statistics and annual publication trend visualization. VOSviewer was used for auxiliary bibliometric network construction and visualization. CiteSpace was used to construct collaboration networks, co-citation networks, keyword co-occurrence maps, cluster maps, timeline and time-zone maps, and citation burst maps. A total of 401 records were initially retrieved, and 253 publications were finally included after screening by document type, language, and topical relevance. These comprised 199 articles (78.66%) and 54 reviews (21.34%). Publications in this field began in 2004 and increased rapidly after 2018, reaching a peak of 53 publications in 2025. Because 2026 was an incomplete retrieval year, only 23 publications were recorded. Italy, the United States, the Netherlands, China, and Japan were the leading contributing countries. The University of Turin, Azienda Ospedaliero-Universitaria San Luigi Gonzaga, IRCCS Fondazione del Piemonte per l'Oncologia, the Netherlands Cancer Institute, and Leiden University Medical Center were the most productive institutions. Keyword clustering showed that the major research hotspots included renal cell carcinoma, augmented reality, image-guided surgery, indocyanine green, machine learning, registration, deep learning, and bladder cancer. AI-enhanced robotic surgery in urology has evolved from early research on registration, navigation, and image-guided surgery toward a surgical intelligence stage characterized by augmented reality, three-dimensional reconstruction, machine learning-based prediction, deep learning-based segmentation, surgical video understanding, and skill assessment. Future studies should prioritize multicenter standardized datasets, sharing of intraoperative video and robotic platform data, model interpretability, prospective validation, and integration into real-world clinical workflows.
World journal of urologyAngelo Cormio, Carlo Giulioni, Federico Falsetti, Vineet Gauhar, Steffi Kar-Kei Yuen, Stefano Mancon, Eugenio Ventimiglia, Angelo Cafarelli, Begona Ballesta Ma…
PURPOSE: Men with benign prostatic enlargement (BPE) frequently present with concomitant bladder stones (BS), yet the optimal surgical strategy remains debated. This systematic review and meta-analysis aimed to compare perioperative and postoperative outcomes of concomitant BPE/BS surgery against BS treatment alone. METHODS: Following the 2020 PRISMA framework, a comprehensive search was conducted on 9 March 2026. Binary outcomes were pooled using the Cochran-Mantel-Haenszel method and reported as odds ratios (OR) with 95% confidence intervals (CI). Continuous outcomes were assessed using inverse variance with 95% CI. Risk of bias was assessed with RoB 2 and ROBINS-I. RESULTS: Seven comparative studies involving over 500 patients were included. Quality assessment revealed some concerns in the overall risk of bias for the single randomized trial, while non-randomized studies showed moderate (3 studies) and high overall risk of bias (3 studies). Concomitant surgery was associated with a significantly lower odds of BS recurrence (OR 0.18, 95% CI 0.10-0.33, p < 0.00001) and better urinary symptoms at last follow-up (mean IPSS difference - 3.09 points, p < 0.00001) compared with BS surgery alone. Minor complications (Clavien 1-2) were more frequent in the concomitant surgery group (OR 4.35, p < 0.0001), while major complications and stone-free rates did not differ significantly, though the comparison was likely underpowered for major complications. The rate of subsequent BPE surgical procedure in patients who had BS surgery alone ranged from 10% to 41%. CONCLUSION: Concomitant BPE and BS surgery substantially reduces stone recurrence and improves lower urinary tract symptoms without meaningfully increasing serious perioperative risk, supporting its adoption in selected cases when BS is related to BPE with bladder outlet obstruction.
World journal of urologyBurak Akgul, Selcuk Guven, Gernot Ortner, Hakan Akdere, Bhaskar Somani, Vineet Gauhar, Steffi Kar Kei Yuen, Panagiotis Kallidonis, Thomas Rw Herrmann, Udo Nage…
PURPOSE: 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. METHODS: 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. RESULTS: 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% of respondents did not use a structured stent-tracking system and 71.8% had never used a validated symptom-assessment tool such as the USSQ. Exploratory subgroup analyses identified differences according to geographic region, institution type, and endourological training background in selected aspects of stent management, including pre-stenting duration, long-term stent exchange protocols, pharmacologic management, and follow-up systems. CONCLUSION: International ureteral stent practices show substantial variability. Although core practices were broadly comparable across regions, important gaps remain in stent tracking and symptom assessment, highlighting opportunities to improve patient safety and standardize care.
Urologiia (Moscow, Russia : 1999)V Popov S, G Guseinov R, V Sivak K, S Bunenkov N, V Perepelitsa V, I Sengirbaev D, A Lelyavina T
INTRODUCTION: Artificial intelligence (AI) is one of the most innovative and promising fields of modern technology, exerting a significant impact on various areas of medicine, including urology. AI is increasingly being used not only for the diagnosis of urological conditions, but also for their treatment and prognostic assessment. The literature search was performed in the electronic databases PubMed, Web of Science, Scopus, CyberLeninka, and eLibrary. The inclusion criteria were original studies on the application of AI methods in urology and literature reviews on the topic. The exclusion criteria were preliminary studies and conference abstracts. The broad potential of AI methods in various fields of urology has been demonstrated. Machine learning and deep learning algorithms show high accuracy in diagnosing urological diseases based on laboratory and imaging data. AI models can assist surgeons in operative planning and intraoperative navigation. AI has also shown potential in predicting recurrences and complications based on the analysis of clinical data. Successful examples of AI implementation have been reported in urooncology, nephrology, and andrology. Future directions for improving AI models and integrating them into clinical practice are discussed. CONCLUSION: Artificial intelligence demonstrates high efficacy across various fields of urology from image analysis to surgical navigation. However, its implementation requires addressing issues of ethics and system validation. With the proper approach, the integration of AI and physicians expertise can significantly improve disease diagnosis and patient treatment. Further research in this area is promising and may lead to breakthroughs in urological practice.
International journal of urology : official journal of the Japanese Urological AssociationRikiya Taoka, Nozomi Hayakawa, Tomokazu Kimura, Eiji Kikuchi, Kosuke Iwatani, Minoru Kato, Takashi Matsumoto, Hajime Tanaka, Takeshi Sano, Takuto Hara, Hideo F…
OBJECTIVE: This study aimed to develop a nationwide, consensus-based surgical checklist to standardize transurethral resection of bladder tumor procedures and documentation. METHODS: In 2025, the Japanese Society of Urologic Oncology convened a working group of 20 bladder cancer specialist urologists to develop a national surgical checklist for transurethral resection of bladder tumors. A 12-member steering committee reviewed available evidence and proposed 30 candidate items. Using a modified Delphi approach, all members rated each item online, with consensus predefined as ≥ 75% agreement. Iterative revisions incorporating public comments and external expert input produced the final checklist. RESULTS: The final checklist comprised 22 items across four sections: (i) preoperative patient and tumor information (recurrence status; upper tract urothelial carcinoma; urine cytology; clinical Tumor-Node-Metastasis staging; performance status; factors affecting surgery/anesthesia); (ii) surgical and anesthetic planning (surgical intent; resection technique; adjunctive imaging modality; additional biopsies; anesthesia method; obturator reflex prophylaxis); (iii) intraoperative tumor and resection information (tumor number; index tumor morphology; index tumor size; findings suggestive of carcinoma in situ; extent of tumor resection; detrusor muscle visible; muscle invasion suspected); and (iv) complications and adjuvant therapy (urethral stricture; intraoperative complications; immediate single instillation). An additional section provides two bladder diagrams: a male/general-use version with lower urinary tract annotations and a female-specific version, both designed for mapping tumor location, characteristics, and operative findings. CONCLUSIONS: This checklist provides a practical framework to standardize transurethral resection of bladder tumor practice and documentation and support safe, high-quality care, warranting prospective evaluation of feasibility, adherence, and quality indicators/outcomes.
Archivio italiano di urologia, andrologia : organo ufficiale [di] Societa italiana di ecografia urologica e nefrologicaAlberto Trinchieri, Rodofo Montironi
Systems of digital pathology are used to enhance diagnostic consistency and reduce workload. They cannot replace pathologists but can serve as tireless and intelligent assistants. Artificial intelligence (AI) excels at high-volume and repetitive tasks, freeing pathologists to focus on complex cases and final diagnostic decisions. The other advantages of digitization include reducing interobserver variability, use as second reader tools and for triage negative biopsies. Digital images can be used for remote consultation, external quality assessment, and education. Despite these favorable results, it must be kept in mind that AI is merely a tool to assist in pathological diagnosis and treatment that cannot replace human expertise. Ethical and legal implications must be considered in order to establish legal frameworks and ensure transparency and ethical use of AI-based tools.
World journal of urologySelcuk Erdem, Daniele Amparore, Chiara Re, Samed Verep, Umberto Capitanio, Alessandro Larcher, Eduard Roussel, Tobias Klatte, Riccardo Bertolo, Stijn Muselaers…
BACKGROUND AND OBJECTIVE: Renal cell carcinoma (RCC) is a common manifestation in Von-Hippel Lindau (VHL) syndrome, accounting for almost 30% of the patients. However, since VHL syndrome is relatively rare, there are no clear guidelines regarding the approach to VHL patients with RCC. This article aims to provide evidence-based insights for diagnosis, treatment, and surveillance in VHL patients with RCC. METHODS: The articles indexed between 1977 and 2025 in PubMed was searched. Only articles in English were included. RESULTS: Renal cysts are quite common in VHL patients and these cysts predispose for RCC. VHL patients are characterized with early-onset, multifocal and/or bilateral, recurrent and clear cell subtype RCC. Patients should be monitored at regular intervals. Due to recurrent characteristics of RCC, nephron-sparing surgeries should be prioritized with the aim of life-long kidney function preservation, whenever it is feasible. Focal treatments should be considered in patients for whom surgery is not suitable. In addition, belzutifan treatment has shown promising results in selected patients. CONCLUSION: In VHL patients with RCC, kidney function should be preserved whenever possible to ensure a long and high-quality life. Since these patients may develop lesions in other organs beyond kidney, surveillance with multidisciplinary approach in tertiary centers should be recommended.
The Canadian journal of urologyTyler Overholt Daniel, David Thole, Randy Casals, Anthony Atala, Steve Hodges, Marc Colaco
OBJECTIVES: Day of surgery cancellations present several workflow challenges that result in delay of care for patients and revenue loss for physicians. This study aimed to further understand same-day pediatric urology surgical cancellations, and the authors assessed identifiable trends for quality improvement over a one-year time period. METHODS: Same-day surgical cancellations were prospectively identified at a single tertiary care center, Atrium Health Wake Forest Baptist, from 01 October 2022 to 30 September 2023. Reasons for cancellation were recorded per the parent/legal guardian and categorized as an avoidable or unavoidable cause. Demographic data, surgical rescheduling, and lost operating room time were also recorded. Descriptive and bivariate analyses were performed as indicated. RESULTS: Of 2351 scheduled cases, 51 (2.2%) were cancelled the day of surgery. The most common cancellation type was a complete no-show with no reason provided from the family (39.2%). Of those with reported reasons, 54.8% were cancelled for avoidable causes. Of those cancelled, 66.7% were for patients of a minority race, with 11.8% of families indicating a need for translation services during visits. There was no difference in terms of race/ethnicity, distance lived from the hospital, or surgical type when comparing cancellation reason (p > 0.05). Only 51.0% of cases were rescheduled with a median delay of 38 days. A total of 59.3 h of operating room time was lost due to these cancellations. CONCLUSIONS: Same-day cancellations were identified in 2.2% of planned pediatric urology cases over a one-year period, with the majority of patients cancelled for avoidable reasons. Of cancelled cases, only 51.0% were rescheduled by the family, with a median delay of over one month. Additionally, 2/3rd of patients identified as a minority race, with 11.8% requiring translation services. This represents a vulnerable population who may require additional counseling for optimal patient and provider outcomes.
World journal of urologyVineet Gauhar, Deepak Ragoori, Mallikarjuna Chiruvella, Steffi Kar-Kei Yuen, Olivier Traxer, Bhaskar Somani, Daniele Castellani
OBJECTIVE: Flexible ureteroscopy (F-URS) with suction technology has become a minimally invasive surgery for the management of renal stones. While the Flexible and Navigable Suction Ureteral Access Sheath (FANS) and Direct In-Scope Suction (DISS) ureteroscopes individually have proven benefits and restrictions, there is no dedicated research if integrating both these technologies can complement the limitations of each to improve suction F-URS outcomes. This audit introduces the Flexible Integrated Retrograde Suction-Ureteroscopy Technique (FIRST) procedure, which integrates FANS with a DISS ureteroscope, and compares its outcomes against DISS combined with a conventional ureteral access sheath (C-UAS). METHODS: This prospective audit enrolled 64 adult patients undergoing F-URS with a DISS ureteroscope between August 2024 and October 2025 at 2 institutions. Patients were allocated to DISS with FANS (Group 1, n = 37) or DISS with C-UAS (Group 2, n = 27) based on surgeon discretion and device availability. The primary outcome was 30-day stone-free rate (SFR) assessed by non-contrast CT scan (single fragment up to 2 mm). Secondary outcomes included perioperative complications, renal function, and 3-month residual fragment rate, and the surgeon-reported ergonomics of procedures. RESULTS: Despite significantly greater stone burden in Group 1, the FIRST procedure achieved a superior 30-day SFR of 83.8% versus 70.4% in Group 2, with zero-residual-fragment status in 72.9% versus 48.1% of patients, respectively (p < 0.001). At three months, zero residual fragments were detected in all patients in Group 1 compared to 22.2% in Group 2 (p < 0.01), translating into zero reinterventions in Group 1. Surgeon-reported ergonomics, intraoperative visibility, and simultaneous DISS-laser manipulation were rated significantly superior in Group 1. Overall 30-day complication rates were comparable between groups (18.9% vs. 22.2%), with no high-grade (Clavien ≥ 3) complications and preserved renal function in either cohort. CONCLUSIONS: The FIRST procedure using this integrated suction technique can potentially give 100% SFR with significantly improved ergonomics with negligible complications. These findings support further investigation of the integrated FIRST procedure in routine and anatomically complex renal stone disease.
Current urology reportsEric S Giannaris, Aaron M Brant, Joseph P Alukal
PURPOSE OF REVIEW: To review recent evidence on effective mentorship practices in urology fellowship training, with emphasis on mentorship qualities, structured programs, and equity considerations. RECENT FINDINGS: While few studies have examined mentorship specifically within urology fellowship, available evidence suggests that effective mentorship is dynamic and characterized by accessibility, alignment with mentee goals, and reciprocal engagement. Access to formal mentorship may reduce burnout and improve trainee well-being. Structured surgical mentorship programs have been associated with shortened learning curves and successful surgical outcomes. Diversity-focused initiatives have demonstrated success in improving representation in urology, yet disparities in mentorship access remain for women and underrepresented groups. Mentorship in urology fellowship can improve trainee well-being, foster career development, and support equitable representation. Collaborative efforts across subspecialty societies to expand structured mentorship models and establish standardized evaluation may strengthen training outcomes and reduce disparities in mentorship access and quality.
Archivos espanoles de urologiaCarolina de la Pinta, Alberto Artiles Medina
Artificial intelligence (AI) is redefining modern medicine and urology. Its applications range from natural language processing (NLP) systems that streamline clinical documentation and reduce administrative burden to generative AI models capable of producing actionable data to support clinical decision-making and enable precision treatment selection. In Spain, the healthcare system has undergone an accelerated digital transformation, during which AI has evolved from an experimental concept to an operational component of routine clinical practice. This review provides an overview of the current implementation of AI in urology in Spain, highlighting actively deployed AI-based systems across different centers. The review is based on a structured search of publicly available information from news databases, institutional repositories, and independent monitoring initiatives focused on AI adoption in the Spanish healthcare system. These tools demonstrate substantial clinical benefits in areas such as diagnostic imaging, automated coding, digital pathology, radiotherapy planning, and patient follow-up. Their integration has improved diagnostic accuracy, optimized workflow efficiency, reduced reporting times, and facilitated more personalized treatment approaches. At the international level, the steadily growing number of Food and Drug Administration (FDA)- and CE-approved AI tools further illustrates the expanding clinical adoption of AI in urology. Overall, these advances indicate that AI has become a cornerstone of precision medicine, rather than a distant future prospect.
Current opinion in urologyAli Talyshinskii, Bhaskar Kumar Somani
PURPOSE OF REVIEW: Self-assembling peptide (SAP) hydrogels represent a novel class of synthetic biomaterials with growing relevance in surgery. Among them, the ion-complementary peptide RADA16 has gained attention as an athermal, transparent, and biocompatible hemostatic agent. While its use is increasingly reported in multiple surgical specialties, evidence specific to urology remains fragmented. This review aims to summarize the physicochemical properties, mechanisms of action, and current clinical evidence for RADA16-based hydrogels, with a particular focus on urological applications. RECENT FINDINGS: RADA16 rapidly self-assembles into a transparent, extracellular-matrix-like nanofibrillar hydrogel upon exposure to physiological fluids, providing effective local hemostasis without reliance on the coagulation cascade. Preclinical and clinical data from other surgical fields demonstrate rapid bleeding control, favorable safety, and potential regenerative effects. Emerging urological evidence suggests that RADA16 is effective in managing hemorrhagic cystitis, radiation-induced hematuria, and bleeding during prostate surgery, including robot-assisted radical prostatectomy and benign prostate surgery. Beyond hemostasis, RADA16 may support wound healing and promotion of re-epithelialization. However, the current evidence base is limited by small sample sizes, lack of comparative studies, heterogeneous methodologies, and short follow-up. SUMMARY: RADA16-based hydrogels represent a promising adjunctive hemostatic option in urology, offering technical advantages such as transparency, absence of thermal injury, minimal swelling, and applicability in confined or high-risk settings. Robust prospective, comparative, and cost-effectiveness studies are required to define its definitive role in routine urological practice.