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The article discusses the evolution of medical scientific publishing and its impact on patient care. It highlights the changing roles of clinician scientists, innovative strategies in content delivery, the democratization of access to scientific knowledge, challenges in the peer-review process, and the influence of funding bodies on research. The article emphasizes the need for meaningful and inclusive metrics, the responsible use of artificial intelligence, and the importance of maintaining integrity in scientific publishing. It calls for a collective effort from the academic community to uphold the value of science and support clinician-scientist missions. [Extracted from the article]

Objectives: To evaluate the reliability of transperineal interstitial laser ablation of the prostate (TPLA) in preserving antegrade ejaculation compared to transurethral resection of the prostate (TURP). Patients and Methods: In this single‐centre, prospective, randomized, open‐label study, consecutive patients with indication for surgical treatment for benign prostatic obstruction (BPO) were enrolled between January 2020 and September 2021 (NCT04781049). Patients were randomized to one of two treatment arms: Group A: TPLA (experimental group) and Group B: TURP (reference standard group). The primary endpoint was change in ejaculatory function (assessed by the Male Sexual Health Questionnaire – Ejaculatory function domain [EJ‐MSHQ]) at 1 month after surgery. Secondary endpoints included comparison of visual analogue scale (VAS) scores, changes in sexual function (assessed using the five‐item International Index of Erectile Function [IIEF‐5]), change in International Prostate Symptom Score [IPSS], change in quality of life score, and maximum urinary flow rate [Qmax] improvement at 1–6 months, as appropriate. Results: Fifty‐one patients (26 TPLA vs 25 TURP) were analysed. No differences in the perception of pain assessed by VAS and no differences in IIEF‐5 score were found between the groups. The distribution of ejaculatory function assessed by the EJ‐MSHQ remained unmodified after TPLA (P = 0.2), while a median 30% decrease in EJ‐MSHQ score was observed after TURP (P = 0.01). Absence of antegrade ejaculation was reported in one patient in the TPLA group (vs 18 patients in the TURP group). A statistically significant difference between the treatment groups was found in terms of postoperative Qmax (TPLA vs TURP: 15.2 [interquartile range 13.5–18.3] mL/s vs 26.0 [interquartile range 22.0–48.0] mL/s; P < 0.001). Both treatments significantly improved Qmax, with a mean 23.9 mL/s improvement after TURP (95% confidence interval [CI] 17.1–30.7) vs 6.0 mL/s after TPLA (95% CI 5.0–7.0), and IPSS, with a mean decrease of 11.6 (95% CI 9.7–13.5) vs 5.8 after TPLA (95% CI.2–9.6) with respect to baseline. Conclusion: In our study, TPLA preserved ejaculatory function in 96% of cases in addition to providing significant relief from BPO. [ABSTRACT FROM AUTHOR]

This document is a reply to a letter regarding a trial comparing transperineal laser ablation (TPLA) and transurethral resection of the prostate (TURP) for benign prostatic obstruction (BPO). The authors acknowledge discrepancies between their publication and the information on ClinicalTrials.gov, as well as concerns about the reporting of sexual and voiding outcomes at different time points. They discuss the increase in maximum urinary flow rate (Qmax) with TPLA, patient satisfaction, and the continuation or discontinuation of medical management after TPLA. The authors appreciate the feedback and state that it will contribute to future improvements. [Extracted from the article]

We assessed the incidence and risks factors of bladder neck and urethral stenosis after Thulium laser enucleation of the prostate. Patients who underwent surgery at two centres were retrospectively reviewed (December 2014–June 2020). Exclusion criteria: previous urethral/prostatic surgery, pelvic irradiation, prostate cancer, neurogenic bladder, history of bladder neck and urethral stenosis, concomitant transurethral surgery, active urinary tract infection. Significant variables at univariate analysis (p < 0.05) were included in a multivariate logistic regression analysis to establish their association with bladder neck/urethral stenosis. One thousand and three patients were included. Median age was 69.0 (63.0–75.0) years. Median prostate volume was 65.0 (46.3–82.0) ml. Median follow‐up was 31 (25–75) months. Thirty patients (2.99%) developed bladder neck stenosis [median time after surgery: 15 (11–17.75) months], 50 patients (4.98%) urethral stenosis [median time after surgery: 9 (7–11) months]. Men with bladder neck and urethral stenosis had significantly smaller prostate volume (median volume 43.5 ml vs. 66.0 ml, p = 0.008, and 52.0 ml vs. 66.0 ml, p = 0.009, respectively). At multivariable analysis, short surgical time predicted for bladder neck stenosis (OR 0.973; 95% CI 0.957–0.994, p = 0.002), and re‐catheterization (OR 3.956; 95% CI 1.867–8.382, p < 0.001) for urethral stenosis, whereas prostate volume was significantly associated with a lower incidence of US (OR 0.984, 95% CI 0.972–0.998, p = 0.03). [ABSTRACT FROM AUTHOR]

Cancer genomes have been explored from the early 2000s through massive exome sequencing efforts, leading to the publication of The Cancer Genome Atlas in 2013. Sequencing techniques have been developed alongside this project and have allowed scientists to bypass the limitation of costs for whole‐genome sequencing (WGS) of single specimens by developing more accurate and extensive cancer sequencing projects, such as deep sequencing of whole genomes and transcriptomic analysis. The Pan‐Cancer Analysis of Whole Genomes recently published WGS data from more than 2600 human cancers together with almost 1200 related transcriptomes. The application of WGS on a large database allowed, for the first time in history, a global analysis of features such as molecular signatures, large structural variations and noncoding regions of the genome, as well as the evaluation of RNA alterations in the absence of underlying DNA mutations. The vast amount of data generated still needs to be thoroughly deciphered, and the advent of machine‐learning approaches will be the next step towards the generation of personalized approaches for cancer medicine. The present manuscript wants to give a broad perspective on some of the biological evidence derived from the largest sequencing attempts on human cancers so far, discussing advantages and limitations of this approach and its power in the era of machine learning. [ABSTRACT FROM AUTHOR]

A recent study published in BJU International aimed to evaluate the impact of management of the renal hilum and warm ischemia time on renal function in on-clamp cases. The study found that longer ischemia time was associated with decreased early postoperative estimated glomerular filtration rate (GFR), but no relationship between ischemia time and renal function was found in the long-term. The study also found that the off-clamp approach was associated with increased risk of intra-operative bleeding and higher blood losses and transfusion rates. However, the study should be interpreted with caution as it was retrospective and influenced by the era of expertise of the surgeons involved. Overall, the study suggests that the technique used to approach the renal hilum should be left to the surgeon's discretion. [Extracted from the article]

Objective: To describe the trend in surgical volume in urology in Italy during the coronavirus disease 2019 (COVID‐19) outbreak, as a result of the abrupt reorganisation of the Italian national health system to augment care provision to symptomatic patients with COVID‐19. Methods: A total of 33 urological units with physicians affiliated to the AGILE consortium (Italian Group for Advanced Laparo‐Endoscopic Surgery; www.agilegroup.it) were surveyed. Urologists were asked to report the amount of surgical elective procedures week‐by‐week, from the beginning of the emergency to the following month. Results: The 33 hospitals involved in the study account overall for 22 945 beds and are distributed in 13/20 Italian regions. Before the outbreak, the involved urology units performed overall 1213 procedures/week, half of which were oncological. A month later, the number of surgeries had declined by 78%. Lombardy, the first region with positive COVID‐19 cases, experienced a 94% reduction. The decrease in oncological and non‐oncological surgical activity was 35.9% and 89%, respectively. The trend of the decline showed a delay of roughly 2 weeks for the other regions. Conclusion: Italy, a country with a high fatality rate from COVID‐19, experienced a sudden decline in surgical activity. This decline was inversely related to the increase in COVID‐19 care, with potential harm particularly in the oncological field. The Italian experience may be helpful for future surgical pre‐planning in other countries not so drastically affected by the disease to date. [ABSTRACT FROM AUTHOR]

Objective: To compare outcomes of minimally invasive radical nephrectomy (MIS‐RN) and robot‐assisted partial nephrectomy (RAPN) in clinical T2a renal mass (cT2aRM). Patients and Methods: Retrospective, multicentre, propensity score‐matched (PSM) comparison of RAPN and MIS‐RN for cT2aRM (T2aN0M0). Cohorts were PSM for age, sex, body mass index, American Society of Anesthesiologists (ASA) class, clinical tumour size, and R.E.N.A.L. score using a 2:1 ratio for RN:PN. The primary outcome was disease‐free survival (DFS). Secondary outcomes included overall survival (OS), complication rates, and de novo estimated glomerular filtration rate (eGFR) <45 mL/min/1.73 m2. Multivariable (MVA) and Kaplan–Meier survival analyses (KMSA) were conducted. Results: In all, 648 patients (216 RAPN/432 MIS‐RN) were matched. There were no significant differences in intraoperative complications (P = 0.478), Clavien–Dindo Grade ≥III complications (P = 0.063), and re‐admissions (P = 0.238). The MVA revealed high ASA class (hazard ratio [HR] 2.7, P = 0.044) and sarcomatoid (HR 5.3, P = 0.001), but not surgery type (P = 0.601) to be associated with all‐cause mortality. Increasing R.E.N.A.L. score (HR 1.31, P = 0.037), high tumour grade (HR 2.5, P = 0.043), and sarcomatoid (HR 2.8, P = 0.02) were associated with recurrence, but not surgery (P = 0.555). Increasing age (HR 1.1, P < 0.001) and RN (HR 3.9, P < 0.001) were predictors of de novo eGFR of <45 mL/min/1.73 m2. Comparing RAPN and MIS‐RN, KMSA revealed no significant differences for 5‐year OS (76.3% vs 88.0%, P = 0.221) and 5‐year DFS (78.6% vs 85.3%, P = 0.630) for pT2 RCC, and no differences for 3‐year OS (P = 0.351) and 3‐year DFS (P = 0.117) for pT3a upstaged RCC. The 5‐year freedom from de novo eGFR of <45 mL/min/1.73 m2 was 91.6% for RAPN vs 68.9% for MIS‐RN (P < 0.001). Conclusions: RAPN had similar oncological outcomes and morbidity profile as MIS‐RN, while conferring functional benefit. RAPN may be considered as a first‐line option for cT2aRM. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate: (i) the neuro‐regenerative potential of chitosan membrane (CS‐Me) on acutely axotomised autonomic neurones in vitro; (ii) to exclude the possibility that a pro‐regenerative biomaterial could interfere with the proliferation activity of prostate cancer cell lines; (iii) to provide an in vivo proof of the biocompatibility and regeneration promoting effect of CS‐Me in a standardised rat model of peripheral nerve injury and repair; (iv) finally, to evaluate the tissue reaction induced by the degrading material; as previous studies have shown promising effects of CS‐Me for protection of the neurovascular bundles for potency recovery in patients that undergo nerve‐sparing radical prostatectomy (RP). Materials and Methods: Addressing aim (i), the neuro‐regenerative potential, organotypic cultures derived from primary sympathetic ganglia were cultured on CS‐Me over 3 days and neurite extension and axonal sprouting were evaluated. Addressing aim (ii), effects of CS on cancer cells, different human prostate cancer cell lines (PC3, DU‐145, LN‐Cap) were seeded on CS‐coated plates or cultured in the presence of CS‐Me dissolution products. Addressing aims (iii) and (iv), functional recovery of peripheral nerve fibres and tissue reaction with the biomaterial, CS‐Me and CS nerve guides were used to repair a median nerve injury in the rat. Functional recovery was evaluated during the post‐recovery time by the behavioural grasping test. Results: CS‐Me significantly stimulated axon elongation from autonomic ganglia in comparison to control conditions in organotypic three‐dimensional cultures. CS coating, as well as the dissolution products of CS‐Me, led to a significantly lower proliferation rate of prostate cancer cell lines in vitro. Tissue reaction towards CS‐Me and standard CS nerve guides was similar in the rat median nerve model, as was the outcome of nerve fibre regeneration and functional recovery. Conclusion: The results of this study provide the first experimental evidence in support of the clinical safety of CS‐Me and of their postulated effectiveness for improving functional recovery after RP. The presented results are coherent in demonstrating that acutely axotomised autonomic neurones show increased neurite outgrowth on CS‐Me substrate, whilst the same substrate reduces prostate cancer cell line proliferation in vitro. Furthermore, CS‐Me do not demonstrate any disadvantage for peripheral nerve repair in a standard animal model. [ABSTRACT FROM AUTHOR]

Objectives: To describe a step‐by‐step technique for robot‐assisted radical cystectomy (RARC) with pelvic lymph node dissection (PLND) performed using the da Vinci® SP™ surgical system (Intuitive Surgical Inc., Sunnyvale, CA, USA). Patients and Methods: Four consecutive patients diagnosed with urothelial carcinoma of the bladder were counselled for RARC with PLND and ileal conduit urinary diversion performed using the da Vinci SP surgical system. A 3‐cm midline incision was made 5‐cm above the umbilicus. Dissection was performed to access the abdominal cavity. Insertion of the GelPOINT® advanced access platform (Applied Medical, Rancho Santa Margarita, CA, USA) with the SP Cannula was performed through the incision made. A 12‐mm AirSeal® (SurgiQuest Inc., Milfort, CT, USA) port for the assistant was placed on the pre‐marked stoma site, where an ileal conduit urinary diversion was desired. Demographics and perioperative outcomes were collected under Institutional Review Board approval (IRB 13‐780). The surgeries were performed by reproducing the steps of the institutional approach for RARC performed with the multi‐arm robotic platform. Results: The surgeries were successfully completed. There was neither conversion to standard multi‐arm robotic or open approaches nor the need for additional port placement. The mean (range) operative time was 454 (420–496) min. Blood loss averaged 312 mL. No transfusions were required and no intraoperative complications occurred. All patients had negative surgical margins. All patients were discharged on postoperative day 5. Conclusion: From our preliminary experience, RARC with PLND and ileal conduit urinary diversion is feasible and safe using the da Vinci SP surgical system. Further comparative studies with open and multi‐arm robotic approaches are warranted. [ABSTRACT FROM AUTHOR]

Objective: To summarize the available evidence on renorrhaphy techniques and to assess their impact on peri‐operative outcomes after minimally invasive partial nephrectomy (MIPN). Materials and Methods: A systematic review of the literature was performed in January 2018 without time restrictions, using MEDLINE, Cochrane and Web of Science databases according to the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses statement recommendations. Studies providing sufficient details on renorrhaphy techniques during laparoscopic or robot‐assisted partial nephrectomy and comparative studies focused on peri‐operative outcomes were included in qualitative and quantitative analyses, respectively. Results: Overall, 67 and 19 studies were included in the qualitative and quantitative analyses, respectively. The overall quality of evidence was low. Specific tumour features (i.e. size, hilar location, anatomical complexity, nearness to renal sinus and/or urinary collecting system), surgeon's experience, robot‐assisted technology, as well as the aim of reducing warm ischaemia time and the amount of devascularized renal parenchyma preserved represented the key factors driving the evolution of the renorrhaphy techniques during MIPN over the past decade. Quantitative synthesis showed that running suture was associated with shorter operating and ischaemia time, and lower postoperative complication and transfusion rates than interrupted suture. Barbed suture had lower operating and ischaemia time and less blood loss than non‐barbed suture. The single‐layer suture technique was associated with shorter operating and ischaemia time than the double‐layer technique. No comparisons were possible concerning renal functional outcomes because of non‐homogeneous data reporting. Conclusions: Renorrhaphy techniques significantly evolved over the years, improving outcomes. Running suture, particularly using barbed wires, shortened the operating and ischaemia times. A further advantage could derive from avoiding a double‐layer suture. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the influence of surgical modifiable factors on chronic kidney disease upstaging in a contemporary cohort of patients with normal and "at‐risk" kidneys undergoing partial nephrectomy. Methods: We reviewed 778 consecutive patients with (n = 634)/without (n = 144) chronic kidney disease or risk factors for chronic kidney disease in our institutional partial nephrectomy database. Chronic kidney disease upstaging was assessed using glomerular filtration rate measurements preoperatively and at 3–12 months postoperatively. Using a multivariate logistic regression, baseline clinicodemographic factors, and the operative measurements of excisional volume loss and warm and cold ischemia time on rates of chronic kidney disease upstaging were determined. Marginal effects were used to analyze the impact of ischemia time and generate interaction curves. Results: Chronic kidney disease/risk factors for chronic kidney disease had equivalent rates of chronic kidney disease upstaging as the healthy kidney cohort (31.5% vs 38.2%, P = 0.15). Of the entire cohort, 2.8% were upstaged to stage IV–V chronic kidney disease. Multivariate analysis found a significant association between chronic kidney disease upstaging and excisional volume loss in both cohorts (no chronic kidney disease/risk factors for chronic kidney disease: odds ratio 1.63, P = 0.04; chronic kidney disease/risk factors for chronic kidney disease: odds ratio 1.42, P = 0.001). Only in the chronic kidney disease/risk factors for chronic kidney disease cohort, there was an association between ischemia type/duration and chronic kidney disease upstaging (odds ratio 1.04, P = 0.04). Warm ischemia began to predict an increased risk of chronic kidney disease upstaging at 17.6 min, which became statistically significant at 49 min. Conclusions: Chronic kidney disease upstaging is common after partial nephrectomy. Although volume loss unequivocally affects rates of upstaging irrespective of baseline renal function, warm ischemia time disproportionately influences "at‐risk" kidneys. Therefore, strong consideration should be given to minimizing volume loss and using cold ischemia when extended clamp times are anticipated in "at‐risk" kidneys. [ABSTRACT FROM AUTHOR]

Objectives: To describe the step‐by‐step techniques for robot‐assisted ureteric reimplantation performed using the Vinci SP® surgical system (Intuitive Surgical, Sunnyvale, CA, USA), including different case scenarios with an educational purpose. Materials and Methods: Three consecutive patients diagnosed with distal benign ureteric strictures were counselled for ureteric reimplantation and consented to undergo surgery performed using the da Vinci SP surgical system. Demographics and peri‐operative outcomes were collected after institutional review board approval (IRB 13‐780). Patients provided informed consent having received an explanation for the adoption of the novel platform. The first patient was a woman referred to our institution for a left distal ureteric stricture after total hysterectomy for uterine fibroids with ureteric injury. The second patient was a man with BPH and recurrent UTIs, who was diagnosed with a 1.5‐cm bladder stone and a large bladder diverticulum compressing the left distal ureter. The third patient was a man diagnosed with bilateral uretero‐enteric anastomoses stricture status after radical cystectomy with orthotopic ileal neobladder urinary diversion for bladder cancer. Results: The procedures were successfully completed. An extra port through a separate skin incision for the bedside assistant was placed for the first two procedures. In such cases, this additional port was used electively from the start of the procedure and did not represent a change in the treatment plan. Moreover, the port wound was used to accommodate the drainage. The bilateral ureteric reimplantation, however, was completed according to a pure single‐site approach (no extra ports were placed out of the GelSeal cap). The mean operating times were 165, 150 and 180 min, respectively. Blood loss was 50 mL in all cases. No intra‐operative complications occurred. Patients were discharged on postoperative days 1, 1 and 2, respectively, with normal serum creatinine levels. Neither transfusions nor major complications occurred. Conclusion: Robot‐assisted reconstructive surgery for benign distal ureteric strictures is feasible and safe using the da Vinci SP surgical system. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the ability of original tumour contact surface area (CSA) to predict postoperative complications and renal function impairment in a series of patients who underwent elective partial nephrectomy (PN) for renal masses. Materials and Methods: We analysed the clinical records of 531 consecutive patients who underwent elective PN because of a suspicion of kidney cancer at five academic, high‐volume centres between January 2014 and December 2016. Each participating centre evaluated prospectively the radiological images to evaluate the CSA and to assign a PADUA score. Several expert surgeons performed the surgical procedures in each participating centre. Binary logistic regression was used to perform both univariable and multivariable analyses to identify predictors of postoperative complications. Linear regression analysis was used to identify independent predictors of absolute change in estimated glomerular filtration rate (eGFR; ACE). Results: The median (interquartile range) CSA value was 14.2 (7.4–25.1) cm2. A total of 349 tumours (65.7%) had a CSA ≤ 20 cm2 and the remaining 182 (34.3%) had a CSA > 20 cm2. PNs were performed using an open approach in 237 (44.6%) cases, a pure laparoscopic approach in 152 cases (28.6%), and a robot‐assisted approach in the remaining 142 cases (26.7%). Multivariable analyses found that only age (odds ratio [OR] 1.037, 95% confidence interval [CI] 1.018–1.057) and PADUA score (OR 1.289, 95%CI 1.132–1.469) were independent predictors of postoperative complications. Tumour CSA (OR 1.020, 95%CI 1.010–1.030) was found to be an independent predictor of postoperative complications only when PADUA score was removed from the model. Age (from −0.639 to −0.306; P < 0.001); body mass index (from 0.267 to 1.076; P = 0.001), age‐adjusted Charlson score (from −3.193 to −0.259; P = 0.02), preoperative eGFR value (from −0.939 to −0.862; P < 0.001) and tumour CSA (from −0.260 to −0.048; P = 0.005) were found to be independent predictors of ACE. Conclusions: Tumour CSA is an independent predictor of postoperative renal function. Conversely, at multivariable analysis, PADUA score outperformed tumour CSA to predict postoperative complications after PN. The complexity of The Leslie et al. formula for calculating tumour CSA is a potential limitation with regard to its diffusion and application in clinical practice. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the ability of original tumour contact surface area (CSA) to predict postoperative complications and renal function impairment in a series of patients who underwent elective partial nephrectomy (PN) for renal masses. Materials and Methods: We analysed the clinical records of 531 consecutive patients who underwent elective PN because of a suspicion of kidney cancer at five academic, high‐volume centres between January 2014 and December 2016. Each participating centre evaluated prospectively the radiological images to evaluate the CSA and to assign a PADUA score. Several expert surgeons performed the surgical procedures in each participating centre. Binary logistic regression was used to perform both univariable and multivariable analyses to identify predictors of postoperative complications. Linear regression analysis was used to identify independent predictors of absolute change in estimated glomerular filtration rate (eGFR; ACE). Results: The median (interquartile range) CSA value was 14.2 (7.4–25.1) cm2. A total of 349 tumours (65.7%) had a CSA ≤ 20 cm2 and the remaining 182 (34.3%) had a CSA > 20 cm2. PNs were performed using an open approach in 237 (44.6%) cases, a pure laparoscopic approach in 152 cases (28.6%), and a robot‐assisted approach in the remaining 142 cases (26.7%). Multivariable analyses found that only age (odds ratio [OR] 1.037, 95% confidence interval [CI] 1.018–1.057) and PADUA score (OR 1.289, 95%CI 1.132–1.469) were independent predictors of postoperative complications. Tumour CSA (OR 1.020, 95%CI 1.010–1.030) was found to be an independent predictor of postoperative complications only when PADUA score was removed from the model. Age (from −0.639 to −0.306; P < 0.001); body mass index (from 0.267 to 1.076; P = 0.001), age‐adjusted Charlson score (from −3.193 to −0.259; P = 0.02), preoperative eGFR value (from −0.939 to −0.862; P < 0.001) and tumour CSA (from −0.260 to −0.048; P = 0.005) were found to be independent predictors of ACE. Conclusions: Tumour CSA is an independent predictor of postoperative renal function. Conversely, at multivariable analysis, PADUA score outperformed tumour CSA to predict postoperative complications after PN. The complexity of The Leslie et al. formula for calculating tumour CSA is a potential limitation with regard to its diffusion and application in clinical practice. [ABSTRACT FROM AUTHOR]

Objectives: To report a single expert robotic surgeon's step‐by‐step surgical technique for achieving local cancer control during robot‐assisted PN (RAPN) for T3 tumours. Patients and methods: Since January 2010 to December 2016, the institutional RAPN database was queried for patients who underwent transperitoneal RAPN performed by a single surgeon for tumours ≤4 mm from the collecting system at preoperative computed tomography (three points on the 'N [Nearness]' R.E.N.A.L. nephrometry‐score item) that were pT3a involving sinus fat at final pathology. Baseline characteristics, perioperative and oncological outcomes (particularly positive surgical margins, PSMs), were identified. Results: Of 1497 masses that underwent RAPN, 512 scored 3 points on the 'N' item of the R.E.N.A.L. nephrometry score assessment. In all, 24 patients had pT3a tumours involving sinus fat at final pathology and represented the analysed cohort. RAPN were performed according to the here described technique. No PSMs were reported. Trifecta achievement was 54.2%. Within a median follow‐up of 30 months, two and one patients had recurrence or metastasis, respectively. Two patients died unrelated to renal cancer. Retrospective analysis and limited follow‐up represent study limitations. Conclusion: In a selected cohort of patients with renal tumours near the sinus fat at baseline R.E.N.A.L. nephrometry score assessment and confirmed pT3a at final pathology, the described RAPN technique was able to achieve optimal local cancer control. [ABSTRACT FROM AUTHOR]

Objectives: To report 3‐year follow‐up results of the first implantations with a temporary implantable nitinol device (TIND®; Medi‐Tate Ltd., Or Akiva, Israel) for the treatment of lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH). Patients and Methods: In all, 32 patients with LUTS were enrolled in this prospective study. The study was approved by the local Ethics Committee. Inclusion criteria were: age >50 years, International Prostate Symptom Score (IPSS) ≥10, peak urinary flow (Qmax) <12 mL/s, and prostate volume <60 mL. The TIND was implanted within the bladder neck and the prostatic urethra under light sedation, and removed 5 days later in an outpatient setting. Demographics, perioperative results, complications (according to Clavien–Dindo classification), functional results, and quality of life (QoL) were evaluated. Follow‐up assessments were made at 3 and 6 weeks, and 3, 6, 12, 24 and 36 months after the implantation. The Student's t‐test, one‐way analysis of variance and Kruskal–Wallis tests were used for statistical analyses. Results: At baseline, the mean (standard deviation, sd) patient age was 69.4 (8.2) years, prostate volume was 29.5 (7.4) mL, and Qmax was 7.6 (2.2) mL/s. The median (interquartile range, IQR) IPSS was 19 (14–23) and the QoL score was 3 (3–4). All the implantations were successful, with a mean total operative time of 5.8 min. No intraoperative complications were recorded. The change from baseline in IPSS, QoL score and Qmax was significant at every follow‐up time point. After 36 months of follow‐up, a 41% rise in Qmax was achieved (mean 10.1 mL/s), the median (IQR) IPSS was 12 (6–24) and the IPSS QoL was 2 (1–4). Four early complications (12.5%) were recorded, including one case of urinary retention (3.1%), one case of transient incontinence due to device displacement (3.1%), and two cases of infection (6.2%). No further complications were recorded during the 36‐month follow‐up. Conclusions: The extended follow‐up period corroborated our previous findings and suggests that TIND implantation is safe, effective and well‐tolerated, for at least 36 months after treatment. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the feasibility and the safety of applying chitosan membrane (ChiMe) on the neurovascular bundles (NVBs) after nerve‐sparing robot‐assisted radical prostatectomy (NS‐RARP). The secondary aim of the study was to report preliminary data and in particular potency recovery data. Patients and Methods: This was a single‐centre, single‐arm prospective study, enrolling all patients with localised prostate cancer scheduled for RARP with five‐item version of the International Index of Erectile Function scores of >17, from July 2015 to September 2016. All patients underwent NS‐RARP with ChiMe applied on the NVBs. The demographics, perioperative, postoperative and complications data were evaluated. Potency recovery data were evaluated in particular and any sign/symptom of local allergy/intolerance to the ChiMe was recorded and evaluated. Results: In all, 140 patients underwent NS‐RARP with ChiMe applied on the NVBs. Applying the ChiMe was easy in almost all the cases, and did not compromise the safety of the procedure. None of the patients reported signs of intolerance/allergy attributable to the ChiMe and potency recovery data were encouraging. Conclusion: In our experience, ChiMe applied on the NVBs after NS‐RARP was feasible and safe, without compromising the duration, difficulty or complication rate of the ‘standard’ procedure. No patients had signs of intolerance/allergy attributable to the ChiMe and potency recovery data were encouraging. A comparative cohort would have added value to the study. The present paper was performed before Conformité Européene (CE)‐mark achievement. [ABSTRACT FROM AUTHOR]

Here we report the rationale and design of the study, a large, phase III RCT seeking to examine the role of renal artery clamping during pure LPN for small renal masses (ClinicalTrials.gov NCT02287987). In the on-clamp LPN arm, tumour resection and inner renorrhaphy are mandatorily done under ischaemia, whereas in the off-clamp arm the artery is left unclamped throughout the entire procedure. [Extracted from the article]

Yonsei nomogram: a predictive model of new-onset chronic kidney disease after on-clamp partial nephrectomy in patients with T1 renal tumors. The possibility of predicting renal functional outcome after surgery may influence treatment counseling, especially in patients for whom the trade-off between partial (PN) and radical nephrectomy is controversial.[1] During the last decade, a variety of prediction models have been proposed, yet no " I ideal i " one has been endorsed by the guidelines.[2] Of interest, a recent systematic literature review retrieved seven existing models created for the prediction of postoperative renal function following PN.[2] The Yonsei nomogram is among these " I magnificent seven i .". [Extracted from the article]

Finally, we should not forget that the short ischemia intervals (<20 min) scored by the cohorts who underwent global ischemia in the setting of the aforementioned trials might have prevented the investigators from identifying the functional benefit of the minimized ischemia techniques. Abbreviations & Acronyms eGFR estimated glomerular filtration rate PN partial nephrectomy RPN robotic partial nephrectomy Clamping of the renal artery has historically been included as an unmissable step during minimally invasive PN. [Extracted from the article]

Objectives To report the first clinical experience with a temporary implantable nitinol device ( TIND; Medi-Tate®) for the treatment of lower urinary tract symptoms ( LUTS) due to benign prostatic hyperplasia ( BPH). Patients and Methods In all, 32 patients with LUTS were enrolled in this prospective study, which was approved by our Institutional Ethics Committee. Inclusion criteria were: age >50 years, International Prostate Symptom Score ( IPSS) of ≥10, maximum urinary flow rate (Qmax) of ≤12 mL/s, and prostate volume of <60 mL. The TIND was implanted within the bladder neck and the prostatic urethra under light sedation, using a rigid cystoscope. The device was removed 5 days later in an outpatient setting. Demographics, perioperative results, complications (according to the Clavien system), functional results and quality of life (QoL) were evaluated. Follow-up assessments were made at 3 and 6 weeks, and 3, 6 and 12 months postoperatively. The Student's t-test, analysis of variance ( anova), Kruskall-Wallis test, and simple and multiple linear regression models were used in the statistical analyses. Results The mean patient age was 69.4 years, the mean (standard deviation, sd) prostate volume was 29.5 (7.4) mL and the Qmax was 7.6 (2.2) mL/s. The median (interquartile range, IQR) IPSS was 19 (14-23) and QoL score was 3 (3-4). All the implantations were successful, with no intraoperative complications recorded. The mean operative time ( sd) was 5.8 (2.5) min and the median ( IQR) postoperative stay was 1 (1-2) day. All but one of the devices (96%) was removed 5 days at after implantation in an outpatient setting. Four complications (12.5%) were recorded, including urinary retention (one, 3.1%), transient incontinence due to device displacement (one, 3.1%), prostatic abscess (one, 3.1%), and urinary tract infection (one, 3.1%). Multiple regression analysis failed to identify any independent prognostic factor for complications. There were statistically significant differences in the IPSS, QoL score and Qmax when comparing pre- and postoperative results at every time point. After 12 months, the median ( IQR) IPSS and QoL score were 9 (7-13) and 1 (1-2), respectively, and the mean ( sd) Qmax was 12 (4.7) mL/s. The mean variations with respect to baseline conditions at the same time points were −45% for the IPSS and +67% for Qmax. At 12 months after surgery (last follow-up visit), no patients required medical therapy or surgical procedures for BPH. Conclusion TIND implantation is a feasible and safe minimally invasive option for the treatment of BPH-related LUTS. The functional results are encouraging and the treatment significantly improved patient QoL. Further studies are required to assess durability of TIND results and to optimise the indications of such a procedure. [ABSTRACT FROM AUTHOR]

Objectives To examine differences in postoperative renal functional outcomes when comparing clampless with conventional laparoscopic partial nephrectomy ( LPN) by using renal scintigraphy, and to identify the predictors of poorer postoperative renal functional outcomes after clampless LPN. Patients and Methods Between September 2010 and September 2012, 87 patients with renal masses suitable for LPN were prospectively enrolled in the study. From September 2010 to September 2011, LPN with renal artery clamping was performed and from September 2011 to September 2012 clampless LPN (no clamping of renal artery) was performed. Patients who underwent clampless LPN were unselected and consecutive, and the procedure was performed at the end of surgeon's learning curve. Patients were divided into two groups according to warm ischaemia time ( WIT): group A, conventional LPN and group B, clampless- LPN ( WIT = 0 min). Demographic and peri-operative data were collected and analysed and functional outcomes were evaluated using biochemical markers and renal scintigraphy at baseline and at 3 months after surgery. The percentage loss of renal function, evaluated according to renal scintigraphy, was calculated. Chi-squared and Student's t-tests were carried out and regression analysis was performed. Results Group A was found to be similar to group B in all variables measured except for WIT and blood loss ( P < 0.001). The percentage reduction in renal scintigraphy values was not significantly different between the groups (reductions of 5% in group A and 6% in group B for split renal function [ SRF] and 12% in group A and 17% in group B for estimated renal plasmatic flow [ ERPF]; P = 0.587 and P = 0.083, respectively). Multivariate analysis in group B showed that the lower the baseline values of SRF and ERPF, the poorer the postoperative functional outcome of the treated kidney. Conclusions In our experience, even clampless LPN was not found to be functionally harmless. The patients who benefitted most from a clampless approach were those with the poorest baseline renal function. [ABSTRACT FROM AUTHOR]

Objectives To evaluate the efficacy of hemostatic agents, TachoSil and FloSeal, during partial nephrectomy using a large multicenter dataset. Methods Data of 1055 patients who underwent partial nephrectomy between January 2009 and December 2012 in 19 Italian centers were collected within an observational multicentric study ( RECORd Project). The decision whether or not to use hemostatic agents after renorrhaphy and the type of hemostatic agents applied was adopted according to the centers' and surgeons' preference. A Tri Match propensity score analysis was applied to balance three study groups (no hemostatic agents, TachoSil, FloSeal) for sex, age, surgical indication (elective/relative vs imperative), clinical stage ( cT1a vs cT1b), tumor exophyticity, approach (open vs minimally invasive), technique (standard partial nephrectomy vs simple enucleation), preoperative hemoglobin and creatinine. Postoperative complications and variation of hemoglobin and creatinine values between preoperative versus third postoperative day were compared. Results Tri Match analysis allowed us to obtain 66 well-balanced triplets. No differences were found in terms of outcomes between the study groups. Conclusions The present findings suggest that adding hemostatic agents to renorraphy during partial nephrectomy does not provide better surgical outcomes. [ABSTRACT FROM AUTHOR]

Objectives To present our laparoscopic partial nephrectomy ( LPN) results according to the margin, ischaemia and complications ( MIC) system recently proposed for the standardized reporting of partial nephrectomy ( PN) outcomes., To assess the role of learning curve and tumour anatomical characteristics on the outcomes by using MIC system., Patients and Methods Data were obtained from our prospectively maintained LPN database, including only patients who underwent LPN performed with vascular clamping., According to the MIC system definition, the goal of LPN was reached (i.e. MIC was achieved) when surgical margins were negative, warm ischaemia time ( WIT) was <20 min and no major complications occurred., Patients were stratified by quartiles of distribution, named LPN eras 1-4, and MIC rates in different LPN eras were compared, evaluating the impact of learning curve and tumour anatomical characteristics (as assessed by Preoperative Aspects and Dimensions Used for an Anatomical [ PADUA] score on the outcomes., Results The study population consisted of 206 patients., The overall MIC rate was 63.1%: it progressively increased along the learning curve, reaching 84.9% in LPN era 4 ( P < 0.001)., PADUA-score risk group categories were inversely correlated with MIC score ( P = 0.001)., When simultaneously considering the effects of both LPN eras and PADUA-score risk group categories, a trend towards a higher MIC rate was found in the latest series, regardless of tumour anatomical characteristics., When MIC score components were separately analysed, WIT decreased significantly from LPN era 1 to LPN era 4 ( P < 0.001) and from PADUA-score risk group categories 3 to 1 ( P = 0.001), A trend towards a decrease in the complication rate along the learning curve was observed ( P = 0.251), while LPN era and PADUA score together significantly influenced the complications rate ( P < 0.001). The positive surgical margin rate was very low (2.9% overall) and stable throughout the case study., Conclusion The MIC rate increased with surgeon's experience and decreased when complex lesions were treated., The MIC system was found to be an easy, useful and reproducible tool to report LPN data series. [ABSTRACT FROM AUTHOR]

Study Type - Therapy (case series) Level of Evidence 4 What's known on the subject? and What does the study add? New techniques and instrumentation in laparoscopy including the use of 'single-port' devices and natural orifice transluminal endoscopic surgery have been proposed to reduce the invasiveness of these procedures. The introduction of small laparoscopic instruments (<3 mm) continues to further the field. To date, mini-laparoscopic instruments have been used in many urological procedures, e.g. pyeloplasty in the paediatric population. However, data of pure mini-laparoscopic pyeloplasty (mLP) for the treatment of pelvi-ureteric junction obstruction in the adult population are lacking. In a selected adult population mLP is feasible and safe. Perioperative and 1-year functional results are comparable with those of standard LP, while cosmetic results of mLP are more appreciated by the patients. OBJECTIVE To evaluate perioperative and cosmetic results after pure mini-laparoscopic pyeloplasty (mLP) compared with standard LP (sLP) in an adult population., PATIENTS AND METHODS From April 2009 to June 2010, 12 patients underwent mLP for pelvi-ureteric junction (PUJ) obstruction (PUJO). For comparison, 24 patients that had previously undergone sLP were pooled from our institutional database., All patients were assessed preoperatively with physical examination, abdominal ultrasonography, intravenous urography or computed tomography and renal scintigraphy (RS). In all cases, an Anderson-Hynes transperitoneal approach was used., After surgery, cosmetic results were assessed using a Patient Scar Assessment Questionnaire (PSAQ), and RS measured reconstructive success at 1-year after LP., Demographic and perioperative variables were recorded. Groups were compared using chi-squared and Wilcoxon-Mann-Whitney tests ( P < 0.05 was considered significant)., RESULTS Baseline characteristics were similar between the groups. There were no differences in operative duration or blood loss. One mLP required conversion to sLP due to minor bleeding., Analgesic consumption and the pain visual analogue scale scores were not significantly different between the sLP and mLP cohorts., The average postoperative hospital stay for the mLP group was significantly shorter than that for the sLP group ( P= 0.024)., Complication and success rates between the groups were not significantly different., PSAQ scores showed that mLP patients were significantly more satisfied with their cosmetic result., CONCLUSIONS mLP appears to be safe, feasible and effective in the treatment of PUJOs., Cosmetically, mLP is better than sLP. [ABSTRACT FROM AUTHOR]

OBJECTIVE • To investigate the perioperative safety of laparoscopic partial nephrectomy (LPN) for large renal masses ( > 4 cm). PATIENTS AND METHODS • After Institutional Review Board approval, data from 100 consecutive patients who had undergone transperitoneal or petroperitoneal LPN at our institution from January 2005 to June 2009 were obtained from our prospectively maintained database. • The patients were divided into two groups according to radiological tumour size: group A (67 patients) with tumours ≤ 4 cm and group B (33 patients) with tumours >4 cm. • Demographic, perioperative and pathological data were evaluated. RESULTS • The two groups were comparable in terms of demographic data. Mean tumour size was 2.4 and 5 cm ( P = 0.0001) for groups A and B,respectively. Group B tumours were more complex, as reflected by significantly more with a central location ( P = 0.002), and by significantly more transperitoneal LPNs, pelvicalyceal repairs and longer warm ischaemia time (WIT; 19 vs 28 min). • Complications were recorded in nine group A patients (13.4%) and nine group B patients (27.2%) ( P= 0.09). • There was no difference between preoperative andpostoperative serum creatinine levels in either group, while a significant difference was found inpostoperative estimated glomerular filtration rate between groups ( P =0.004). • The incidence of carcinoma was comparable between the two groups. • The incidence of positive surgical margins (PSMs) was 3.9% in group A, whereas no PSM was recorded in group B ( P= 0.3). CONCLUSIONS• Laparoscopic partial nephrectomy for large tumours is feasible and has acceptable pathological results. However, the complication rate, in particular WIT, remains questionable. • Further studies are required to better clarify the role of LPN in the management of tumours of this size. [ABSTRACT FROM AUTHOR]

OBJECTIVES To evaluate, in a pilot prospective randomized trial, the safety, effectiveness and radiological recurrence of retroperitoneal renal cyst decortication compared with retroperitoneal decortication with wadding using perirenal pedicled fat tissue. PATIENTS AND METHODS From March 2004 to December 2007, 40 patients with simple renal cysts were enrolled and randomized; 22 (group A) had a simple retroperitoneal decortication (SRD) and 18 (group B) a decortication with wadding of the cyst using perirenal fat tissue (RDCW). The following variables were recorded: age, gender, side, size on ultrasonography/computed tomography (CT), location, operative duration, blood loss, complications, pathology, presence or absence of flank pain, hypertension, urinary tract compression or urinary infection. The primary endpoint of this trial was to evaluate and compare the efficacy of both treatments. Secondary endpoints were safety and pain, hypertension and the resolution of urinary tract obstruction. RESULTS In all, 40 cysts were treated; there were no bilateral cysts. The mean (sd) size on CT was 11.9 (1.84) cm in group A and 12.8 (1.25) cm in group B ( P = 0.1). All the procedures were completed laparoscopically and no conversion was necessary. There were no intraoperative complications. The mean (range) hospital stay was 3.4 (3–6) days. There was no statistically significant difference between the groups for all variables assessed. There was a radiological recurrence in three patients (14%) in group A, but none in group B (all successful). CONCLUSION To be completely successful, with maximum safety and to prevent recurrences in the treatment of renal cysts, RCDW is recommended when a retroperitoneal approach is chosen, especially if the cyst is located anteriorly. When symptom relief is considered, RCDW duplicates the results obtained with SRD. [ABSTRACT FROM AUTHOR]

The article discusses a case study from the University of Verona, Italy, focusing on the medical and surgical challenges of urinary bladder paraganglioma. A 44-year-old woman with a history of paravesical masses presented with symptoms such as hypertension and adrenergic symptoms. The patient underwent robot-assisted laparoscopic surgery for the removal of the bladder masses, which were confirmed to be paragangliomas. The article highlights the importance of proper preoperative care and surgical excision in the treatment of bladder paragangliomas, emphasizing the need for a correct diagnosis before invasive procedures. [Extracted from the article]

A letter to the editor is presented in response to the article on the outcome of an international multi-institutional study of patients who underwent laparoendoscopic single-site nephrourectomy for upper urinary tract urothelial carcinoma.