Search

Technological advancements have revolutionized surgical methods, with laparoscopic and robotic surgeries offering significant benefits over traditional open procedures. These benefits include reduced intraoperative blood loss, shortened hospital stays, faster recovery, and improved cosmetic outcomes. However, the learning curve for laparoscopic surgery remains a challenge. Robotic systems, like the da Vinci Surgical System, address many limitations of laparoscopic surgery, including limited range of motion and tremors, and offer superior ergonomics. Despite concerns over cost and tactile feedback, innovations like telesurgery and augmented reality are enhancing robotic surgery's potential. Moreover, robotic surgery generally results in less blood loss, fewer complications, and quicker recovery compared to open surgery. Robotic surgery tends also to be less physically demanding for surgeons, reducing fatigue and musculoskeletal strain. However, research also reveals that many surgeons still experience discomfort, particularly in the neck and shoulders, emphasizing the need for ergonomic training and improved workstation setups. The review also explores the impact of pre-procedure fatigue on surgical performance, noting that fatigue can impair performance on surgical simulators, particularly among residents. Despite this, studies showed that performing consecutive surgeries in a single day does not appear to adversely affect patient outcomes. Overall, ergonomic interventions are crucial in both laparoscopic and robotic surgeries to enhance surgeon efficiency and well-being, and further research is needed to optimize these surgical methods and understand the long-term impacts of fatigue on performance and patient outcomes. [ABSTRACT FROM AUTHOR]

Introduction: Benign prostatic hyperplasia (BPH) is a prevalent urological condition leading to lower urinary tract symptoms. Minimal invasive surgical treatment (MISTs) such as Rezūm System are emerging aiming to relieve symptoms. We present results from a single centre prospective study. Methods: We prospectively followed patients undergoing Rezūm between 2021 and 2023 from a single centre. International Prostate Symptom Score (IPSS), functional outcomes (maximum urinary flow rate (Qmax) and post-void urinary residual (PVR) and International Index of Erectile Function-5 (IIEF-5) were assessed at 3, 6, 12 and 24 months. Anterograde ejaculation was assessed at 12 months follow up. Linear mixed-effects models (LMMs) for repeated measures were applied to assess differences in the IPSS, maximum flow rate (Qmax), PVR, and International Index of Erectile Function-5 (IIEF-5) from baseline (t0) to 3, 6, 12 and 24 months. Results: After adjusting for prostate volume and symptoms severity, significant differences were observed at 3, 6, 12 and 24 months for IPSS (p < 0.001), Qmax (p < 0.001), PVR (p < 0.001) and IPSS-QoL (p < 0.001) from baseline. No statistically significant changes were found in the IIEF-5 scores at 3, 6, 12 and 24 months from baseline. Anterograde ejaculation remained in 98% of patients after treatment. Conclusions: In conclusion, the study's findings indicate that patients undergoing Rezūm treatment experience sustained improvements in IPSS, Qmax, PVR and IPSS-related quality of life up to 24 months following the intervention. Anterograde ejaculation remained in 98% of patients after treatment. [ABSTRACT FROM AUTHOR]

Objectives: The quality of life in patients undergoing radical cystectomy and urinary diversion is gaining importance. Nowadays a broad consensus about the best urinary diversion does not exist. This study presents an all‐round analysis of the impact of two types of urinary diversion on life's psycho‐social aspects in patients undergoing radical cystectomy. Methods: This is an observational, single‐centre, prospective study. Eligible participants underwent radical cystectomy and urinary diversion for bladder cancer in our department from January 2020 and February 2024. Of 130 included patients, 90 (45 with Bricker's ureteroileocutaneostomy and 45 received orthotopic bladder replacement) patients were matched and the study groups were well balanced for the baseline‐matched variables. Patients completed 4 questionnaires (EORTC QLQ‐C30, PGWBI, HADS, PSQI) at three different times: before the surgical procedure, and at 3 and 12 months. Results: Time shows a statistically significant effect (p < 0.0005) on four of the five functional scales explored (Physical Functioning, Role Functioning, Emotional Functioning, Social Functioning), and for all the nine symptoms/items' scales (p < 0.0005) and the Global Health Status (p = 0.003) in EORTC QLQ‐C30. Neobladder's group shows a statistically significant improvement on the scales of Physical Functioning, Role Functioning, and Social Functioning, and for symptoms of nausea (p = 0.0027), pain (p = 0.0005), dyspnea (p = 0.012), insomnia (p = 0.004), constipation (p = 0.003). Conclusion: We do not find a better urinary diversion in absolute terms. Neobladder obtained better results only for specific items and features. The urinary diversion's choice must be made in concert by the patient, the caregiver, and health professionals with adequate counseling. [ABSTRACT FROM AUTHOR]

Simple Summary: This research examines how the loss of the Y chromosome (LoY) in men may contribute to the development and progression of certain cancers, particularly in the urinary system. Traditionally, the Y chromosome was primarily associated with male sex determination and sperm production, but recent studies suggest it plays a wider role in health and disease. LoY appears to disrupt immune function and increase genetic instability, factors that may heighten cancer risk and impact treatment outcomes. Our review highlights that LoY could serve as an early indicator of certain cancers and might help predict cancer behavior. Understanding LoY's role could lead to new diagnostic tools and treatments, especially for cancers where Y chromosome alterations are linked to poorer outcomes. Background: The Y chromosome (ChrY) is essential for male sex determination and spermatogenesis. However, recent studies have revealed its broader role in various physiological processes and disease susceptibility, including cancer. Methods: A comprehensive literature review was conducted using databases like MEDLINE, Scopus, Web of Science, and Google Scholar. The review included clinical and preclinical studies in animals and humans focusing on the role of LoY in urological tumors. Data on the frequency of LoY, its clinical implications, and underlying mechanisms were extracted and analyzed. Results: The evidence suggests that LoY is associated with an increased risk of urologic neoplasms, potentially serving as an early marker of genomic instability. Studies reveal that LoY in urologic cancers correlates with worse survival outcomes and may contribute to tumor progression. LoY may interfere with chromatin structure and epigenetic regulation, suggesting its role as a contributor to early tumorigenesis. Conclusions: LoY appears to be a structural aberration with unique biological and clinical relevance in urologic cancers, possibly serving as a biomarker for genomic instability. Further research is necessary to identify specific Y-linked genes affected by LoY, potentially informing targeted therapies and early diagnostic strategies for these cancers. [ABSTRACT FROM AUTHOR]

The world of complementary and alternative medicine (CAM) encompasses a wide range of practices, treatments, and products that fall outside the realm of conventional (mainstream) medicine. The use of complementary and CAM has become increasingly popular in Western nations. People are turning to CAM for a variety of reasons, including managing chronic diseases, relieving symptoms of various conditions, and improving their overall health and well-being. There's a growing trend of people using and showing interest in complementary and alternative medicine therapies, especially in Western countries. CAM encompasses a wide range of treatments, some offering complete alternatives to conventional medicine, while others aim to complement existing medical approaches. Urologists should stay informed about CAM to guide their patients effectively to treat patients in a modern and personalized way. The aim of review is to analyze the scenario of complimentary and alternative medicine with a specific focus in the urological field. [ABSTRACT FROM AUTHOR]

Simple Summary: New devices are being developed and proliferated worldwide to perform robotic surgery. The sharing of data resulting from performing a large number of procedures with the HugoTM RAS system aims to demonstrate its reliability and potential use in different scenarios. In our case series, this new device has proven to be reliable in performing robot-assisted radical prostatectomy. We list the solutions we applied to address the technical issues of the system and show that these did not have a significant impact on patients and procedures. Background: Robotic-assisted surgery is the gold standard for performing radical prostatectomy (RARP), with new robotic devices such as HugoTM RAS gaining prominence worldwide. Objective: We report the surgical, perioperative, and early postoperative outcomes of RARP using HugoTM RAS. Design, setting, and participants: Between April 2022 and October 2023, we performed 132 procedures using the Montsouris technique with a four-robotic-arm configuration in patients with biopsy-proven prostate cancer (PCa). Outcome measures: We collected intraoperative and perioperative data during hospitalization, along with follow-up data at predefined postoperative intervals of 3 and 6 months. Results and limitations: Lymphadenectomy was performed in 25 procedures, with a bilateral nerve-sparing technique in 33 and a monolateral nerve-sparing technique in 33 cases. The mean total surgery time was 242 (±57) min, the mean console time was 124 (±48) min, and the mean docking time was 10 (±2) min. We identified 17 system errors related to robotic arm failures, 9 robotic instrument breakdowns, and 8 significant conflicts between robotic arms. One post-operative complication was classified as Clavien–Dindo 3b. None of the adverse events, whether singular or combined, increased the operative time. Positive margins (pR1) were found in 54 (40.9%) histological specimens, 37 (28.0%) of which were clinically significant. At 3 and 6 months post-surgery, the PSA levels were undetectable in 94.6% and 92.1% of patients, respectively. Social urinary continence was regained in 86% after 6 months. Limitations of our study include its observational monocentric case-series design and the short follow-up data for functional and oncological outcomes. Conclusions: Our initial experience highlights the reliability of the HugoTM RAS system in performing RARP. Additionally, we also list problems and solutions found in our daily work. [ABSTRACT FROM AUTHOR]

Background and Objectives: To assess the potential prognostic role of the systemic immune-inflammation index (SII) in predicting oncological outcomes in a cohort of patients treated with radical cystectomy (RC). Materials and Methods: From 2016 to 2022, a retrospective monocentric study enrolled 193 patients who were divided into two groups based on their SII levels using the optimal cutoff determined by the Youden index. The SII was obtained from a preoperative blood test approximately one month before RC. Univariable and multivariable logistic regression analyses were conducted to investigate the capacity of SII to predict lymph node invasion (N), advanced pT stage (pT3/pT4), and locally advanced condition at the time of RC. Multivariable Cox regression models adjusted for preoperative and postoperative features were used to analyze the prognostic effect of SII on recurrence-free survival (RFS), cancer-specific survival (CSS), and overall survival (OS). Results: The optimal cutoff value of the SII was 640.27. An elevated SII was seen in 113 (58.5%) patients. Using the multivariable preoperative logistic regression models, an elevated SII was correlated with nodal invasion (N; p = 0.03), advanced pT stage (p = 0.04), and locally advanced disease (p = 0.005), with enhancement of AUCs for predicting locally advanced disease (p = 0.04). In multivariable Cox regression models that considered preoperative clinicopathologic factors, an elevated SII was linked to poorer RFS (p = 0.005) and OS (p = 0.01). Moreover, on multivariable Cox regression postoperative models, a high SII was linked to RFS (p = 0.004) and to OS (p = 0.01). Conclusions: In this monocentric retrospective study, higher preoperative SII values predicted worse oncological outcomes in patients with bladder cancer (BCa) who underwent RC. [ABSTRACT FROM AUTHOR]

Purpose: This analysis aimed to evaluate the clinical relevance of the presurgical systemic inflammation response index (SIRI) in individuals undergoing radical cystectomy (RC)., Methods: In this retrospective study, 228 were categorized into 2 cohorts depending on their SIRI levels using the best cut-off determined by the Youden Index. The association between SIRI and lymph node metastasis (N), advanced pT stage (pT3/pT4), and loco-regional extended state were analyzed at the time of surgery. Multivariate Cox regression analysis was performed to evaluate the impact of SIRI on time to relapse, tumor-specific survival, and survival rates. The additional medical advantage was evaluated through decision curve analysis (DCA)., Results: High and low SIRI group was obtained using the best cut-off value (1.71×10 9 /l). On multivariate logistic regression analysis, elevated SIRI was significantly associated with advanced pT stage (P = 0.003) and loco-regional extended state (P = 0.003). On multivariable Cox regression models based on presurgical clinicopathological factors, an augmented SIRI was linked to poorer relapse-free survival (RFS) (P = 0.035), with the improvement of the concordance index just for RFS. In DCAs, incorporating SIRI yielded results equal to or better than those of the model without SIRI for all outcomes models. It demonstrated improvements in net benefit at probability thresholds up to 50% for the model adjusted with preoperative factors for RFS and for postoperative factors in CSS and OS., Conclusions: SIRI is an innovative prognostic indicator and a potential biomarker that can enhance conventional medical pathological evaluation and improve the personalization of clinical treatment strategies for bladder cancer patients following RC., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2025 The Author(s). Published by Elsevier Inc. All rights reserved.)

Introduction and Objective: Radical Cystectomy (RC) is one of the most common and complex surgical procedures in urologic surgery, and benign ureteroenteric anastomosis strictures (UAS) are complications described in about 15% of patients undergoing RC with different urinary diversion (UD). The aim of this study is to evaluate and analyze risk factors related to the development of ureteral stenosis after RC., Materials and Methods: All consecutive patients who underwent RC with ileal conduit from December 2019 to December 2022 were included. According to the guidelines patients with hydronephrosis were investigates with CT-scan or Ultrasound and blood tests at 3-6-12 months and then early. UAS was confirmed with CT-scan and eventually treated with nephrostomies with (with or without descendent pyelography). Several potential risk factor releated to UAS were analyzed by univariate analysis including preoperative, intraoperative and postoperative variables., Results: In total 116 patients were included. At 30 months mean follow up, 21 patients (19%) were diagnosed with UAS. Median time from RC to diagnosis of benign UAS was 6 months (IQR: 4-9). At the univariable analysis previous abdominal surgery (OR 13.5 CI 3.4-63.4, p  < 0.001) had the strongest association with shorter time to stricture development and six-fold highest risk of UAS development (OR 6.41, IC 95%; 2.16-21.1, p  < 0.001). Also, gender, age, body mass index, lower albumin serum level, higher fibrinogen serum level showed statistically significant association ( p  < 0.05)., Conclusion: Patients with preoperative lower albumin serum level, lower albumin/fibrinogen ratio and higher fibrinogen level are more likely to develop UAS. Moreover, having a history of PAS significantly increases the risk of strictures formation., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.