Uretero-enteric strictures are feared complications following cystectomy. Despite surgical advancements, particularly the rise of robot-assisted approaches, the risk factors associated with these strictures remain poorly defined. This study aimed to identify the risk factors associated with uretero-enteric anastomotic strictures after cystectomy, according to the surgical approach and type of urinary diversion (extracorporeal vs. intracorporeal). We conducted a single-center retrospective study including 340 patients who underwent cystectomy between 2016 and 2024 at Tours University Hospital. Clinical, biological, perioperative, and postoperative data were analyzed. The occurrence of a uretero-ileal anastomotic stricture was defined radiologically by a uretero-hydronephrosis ≥20 mm. We constructed and analyzed a learning curve for robotic surgery with intracorporeal urinary diversion. Strictures occurred in 60 patients (17.6%). On multivariable analysis, reduced preoperative glomerular filtration rate (odds ratio [OR] = 1.45 per 10 mL/min decrease, 95% CI [1.12-1.87], p = 0.004), elevated creatinine (OR = 1.30 per 10 µmol/L increase, 95% CI [1.05-1.61], p = 0.018), prior myocardial infarction (OR = 2.25, 95% CI [1.10-4.62], p = 0.027), and postoperative urinary tract infection (OR = 3.10, 95% CI [1.65-5.82], p < 0.001) were independent predictors. Most strictures were left-sided. Intracorporeal robotic diversion had a higher, though non-significant, stricture rate (21.5% vs. 15.2%, OR = 1.52, p = 0.12). Stricture rates fell markedly after 20 robotic cases per surgeon (23.8% vs. 12.1%). Uretero-enteric strictures are multifactorial, strongly influenced by baseline renal function, cardiovascular comorbidity, and postoperative infection. Robotic intracorporeal diversion shows a learning curve effect, underlining the importance of surgical expertise and infection prevention in reducing risk.

Artificial intelligence (AI)-assisted three-dimensional (3D) surgical platforms, integrated with augmented reality, have the potential to improve intraoperative anatomical recognition and provide surgeons with an immersive, dynamic operating environment during uro-oncological procedures. This review aims to examine the current applications of AI in robotic uro-oncology, with a particular focus on its role in facilitating intraoperative navigation during complex surgeries. A systematic literature search was performed across PubMed, the National Library of Medicine, MEDLINE, the Cochrane Central Register of Controlled Trials (CENTRAL), ClinicalTrials.gov, and Google Scholar to identify relevant studies published up to July 2025. The search strategy incorporated a predefined set of keywords, including AI, machine learning, radical prostatectomy (RP), robotic-assisted radical prostatectomy (RARP), robot-assisted partial nephrectomy (RAPN), and robot-assisted radical cystectomy (RARC). Only clinical trials, full-text peer-reviewed publications, and original research articles were included. Studies were eligible for inclusion if they evaluated or described applications of AI in RARP, RAPN, or RARC. Technological advancements have substantially transformed the field of uro-oncologic surgery. In particular, AI and AI-assisted intraoperative navigation in RARP demonstrate considerable potential to objectively assess surgical performance and predict clinical outcomes. In RAPN, the adoption of preoperative, interactive 3D virtual models for surgical planning has influenced surgical decisions, thus, enhanced precision in resection planning correlates with superior nephron-sparing outcomes and optimized selective clamping. AI applications in RARC, techniques such as augmented reality (AR) can overlay critical information on the surgical field, by facilitating navigation through complex anatomical planes and enhancing identification of critical structures. AI appears to enhance robotic uro-oncologic procedures by increasing operative precision and supporting individualised surgical treatment strategies.

Prostate-specific membrane antigen (PSMA) is a surface membrane antigen that is highly overexpressed in prostate cancer, with heterogenous expression throughout the natural history of the disease. This has generated significant interest as a potential biomarker for use in early diagnosis and treatment of prostate cancer. We reviewed the literature surrounding PSMA and its current clinical applications in diagnosing and managing early prostate cancer that is confined to the prostate and local lymph nodes. A search on PubMed, Medline, and Web of Science was performed using the following keywords: "PSMA", "Prostate Specific Membrane Antigen", "Prostate cancer", "Biomarker", "Diagnosis". We considered all available articles relevant to the topic of PSMA as a biomarker in early prostate cancer when developing this narrative review. Key articles assessing the biology of PSMA, as well as its use as a potential diagnostic and therapeutic target in early prostate cancer, were assessed. The role of PSMA PET as a potential diagnostic and risk stratification tool was assessed. The current use of antibody-drug conjugates and radioligand therapy targeting PSMA was assessed, along with any current evidence to support their use in early prostate cancer. PSMA is heavily expressed throughout the early stages of prostate cancer, and this has significant therapeutic implications. There is a growing body of evidence that shows PSMA PET can play a role in the diagnosis, risk stratification, and prognostication of localised prostate cancer. PSMA-targeted therapies such as Lu-177 currently do not have any proven benefit in treating early prostate cancer; however, this remains an area of ongoing research.

Hormonal treatment and response as a predictor of sperm retrieval prior to microdissection testicular sperm extraction (micro-TESE) are not well established in the current literature. This study aimed to investigate the hormonal response as a predictor of sperm retrieval among men with nonobstructive azoospermia (NOA). Seventy-seven consecutive patients who had testosterone levels ≤ 14 nmol/L were treated medically with an aromatase inhibitor or recombinant human chorionic gonadotropin (rec-hCG) prior to micro-TESE and were included. Thirty-four (44.2%) had unexplained NOA (UNEX), 25 (32.5%) had Klinefelter syndrome (KS), 8 (10.4%) had a history of cryptorchidism (UDT), 4 (5.2%) had microdeletion of the Azoospermia factor C (AZFc), and 6 (7.8%) were treated previously with chemotherapy. Baseline and post-treatment serum hormonal levels were documented. Pre-op testosterone levels were entered into binary logistic regressions with age, Follicle-stimulating hormone (FSH), and Luteinizing hormone (LH) levels to test for significance with sperm retrieval. We then built logistic regression models to identify predictors of successful surgical sperm retrieval (SSR). Forty-five patients (58%) had successful retrieval. In 32 patients (42%), no sperm was retrieved. Both the mean pre-op testosterone and the mean testosterone change between the two groups were significant (p = 0.02 and p = 0.011, respectively). Receiver operating characteristic (ROC) analysis demonstrated an area under the curve (AUC) of 0.785 (95%CI = 0.685-0.886, p < 0.001). The Youden index coefficient was calculated for KS and UNEX. The cut-off point for KS was established at 0.764 (sensitivity = 0.875, false positive rate [FPR] = 0.111), and 0.215 for UNEX (sensitivity = 0.438, FPR = 0.222). We also observed a correlation between age and SSR (p = 0.05). In KS patients, SSR was determined by pre-op testosterone levels irrespective of age. Pre-operative hormonal response is a predictor for SSR in NOA patients who were treated medically. This data may help during pre-operative counselling.

Artificial intelligence (AI) is transforming the diagnostic landscape of malignant tumors in the urinary system, including prostate cancer, bladder cancer, and renal cell carcinoma (RCC). By integrating imaging, pathology, and molecular data, AI enhances the precision and reproducibility of tumor detection, grading, and risk stratification. In prostate cancer, AI-assisted multiparametric Magnetic resonance imaging (MRI) and digital pathology systems improve lesion localization and Gleason scoring. For bladder cancer, deep learning-based cystoscopy and radiomics models from Computed tomography/magnetic resonance imaging (CT/MRI) enable real-time lesion segmentation and non-invasive biomarker prediction, such as Programmed Cell Death-Ligand 1 (PD-L1) expression. In RCC, AI, combined with CT/MRI and multi-omics data, aids in subtype classification and prognostic prediction, supporting personalized therapy. However, despite these promising advances, challenges such as data standardization, model generalizability, interpretability, and regulatory compliance hinder AI's clinical translation. This review outlines the current state of AI in urological cancer diagnosis and prognosis, its technological innovations, and the clinical challenges and opportunities that lie ahead.

Penile augmentation through injectable substances is becoming increasingly common. A growing number of aesthetic clinics are developing penile enlargement procedures using various injectable materials. Although these procedures are now performed in more controlled and medically supervised environments, their long-term outcomes remain poorly understood. The promotion of such medical treatments contributes to an increasing interest among adult males in self-injection as a method to alleviate psychological distress associated with penile size concerns. At the same time, access to injectable substances through unofficial or unregulated sources has become increasingly easy. Tor our knowledge, we report the first documented case of self-injection with Garamycin® (gentamicin) cream, contributing to the literature on the often multidisciplinary management of penile enlargement injections, a field still lacking well-established guidelines. This case report describes a young patient who self-injected Garamycin® into the penis for the purpose of enlargement. He presented to our urology department with worsening symptoms, including severe and poorly tolerated pain. His primary request was prompt relief of pain while preserving, as much as possible, the aesthetic appearance and functional integrity of his penis. This case required a multi-stage surgical approach to salvage the penis and preserve both its structural integrity and functional outcome. To our knowledge, this case report documents the first reported instance of Garamycin® injection performed for the purpose of penile enlargement. It provides insight into the clinical course of such penile cream injections, demonstrates that a two-stage scrotal flap can achieve both functional and aesthetic outcomes, and highlights the importance of comprehensive management particularly addressing the traumatic impact of penile deformity secondary to inflammation and/or infection, as well as the body dysmorphic concerns often associated with these cases.

Holmium laser enucleation of the prostate (HoLEP) is an established treatment for benign prostatic hyperplasia (BPH), but early postoperative dysuria and incontinence remain common concerns. The Virtual Basket (VB) mode has been proposed to reduce tissue trauma. This study evaluated whether VB use improves early postoperative recovery without compromising HoLEP efficacy. We retrospectively analyzed 168 men who underwent HoLEP between September 2023 and September 2024. Patients were categorized into three groups according to laser settings: 100 W Standard (n = 65), 100 W VB (n = 49), and 80 W VB (n = 54). The primary outcomes were postoperative dysuria and urinary incontinence at 1 and 3 months. Secondary outcomes included catheterization time, hemoglobin drop, surgical and energy efficiency, and perioperative complications. Logistic regression and receiver operating characteristic (ROC) analyses were performed to identify predictors of persistent incontinence. At 1 month, dysuria occurred more frequently in the Standard group (32.3%) than in the VB groups (15.6%) (p = 0.037). This difference was resolved within 3 months. Persistent urinary incontinence at 3 months was significantly lower in the VB groups (2.0% and 1.9%) compared with the Standard group (9.2%) (p = 0.031). Surgical efficiency was higher with Standard HoLEP (2.63 g/min vs. 1.8 g/min, p = 0.035), while energy efficiency was comparable across groups. The 100 W VB group had shorter catheterization times (p < 0.001) and less hemoglobin loss (p = 0.004). Logistic regression identified prostate volume as an independent predictor of incontinence (odds ratio [OR] = 1.018, 95% CI: 1.001-1.034, p = 0.035). ROC analysis demonstrated moderate predictive accuracy (area under curve [AUC] = 0.776). VB-HoLEP significantly reduces early dysuria and accelerates continence recovery while maintaining safety and efficacy. These findings support the routine use of VB mode to improve postoperative recovery and patient satisfaction.

The emergence of artificial intelligence (AI) and predictive modeling offers prospects for clinical, anatomical, and imaging factor combination, like radiomics, to help with stone-free status (SFS) estimation and peroperative decision-making. The goal of this study was, therefore, to define the present performance range, determine sources of heterogeneity, and determine methodological practices permitting reliable implementation by varied circumstances. We searched six bibliographic databases through 19 September 2025. Studies deriving or validating AI/predictive models for SFS after ureteroscopy were eligible. Independent dual screening, duplicate data extraction, and risk-of-bias consideration using QUADAS-AI were conducted. Five retrospective cohorts were included. Modeling approaches encompassed multivariable logistic regression, regularized/radiomics pipelines, gradient boosting, and ensembles. SFS definitions ranged from <2 mm residual (day-1 to 3 months) to ≤5 mm residual (1 month), determined by plain radiography, ultrasound, and/or CT. The pooled ratio-scale effect for stone size per 1 mm increase was 1.26 (95% CI 0.91-1.76; τ² ≈ 0.055; Q = 18.52; I² = 94.6%; prediction interval 0.03-49.45). Hydronephrosis (moderate-severe vs. mild/none) showed a pooled RR 2.72 (95% CI 0.96-7.72; τ² ≈ 0.821; Q = 65.40; I² = 96.9%; prediction interval 0.03-249.87). As continuous contrasts, stone size was larger in the non-stone-free group (SMD 1.36, 95% CI 0.85-1.86; τ² ≈ 0.096; I² = 72.9%; prediction interval -3.77 to 6.48), and HU was higher (SMD 0.64, 95% CI 0.39-0.90; τ² ≈ 0; Q = 0.73; I² = 0%; prediction interval -0.99 to 2.27). Across studies evaluating AI and predictive models for ureteroscopy, discrimination was generally acceptable to excellent, and performance appeared highest in models integrating radiomics with anatomic/clinical descriptors. However, the degree of between-study heterogeneity (population mix, outcome definitions, imaging protocols, thresholds, and follow-up windows) was sufficiently large that pooled quantitative estimates should be considered clinically uninterpretable.

Upper urinary tract urothelial carcinoma (UTUC) is a rare malignancy, particularly in the ureter, and is associated with high rates of recurrence and metastasis. Although body mass index (BMI) has been associated with prognosis in multiple cancer types, its role as a predictive factor in UTUC is still debated. This study aimed to investigate how BMI influences survival outcomes in patients with UTUC treated with radical nephroureterectomy (RNU). This multi-center retrospective analysis by the Taiwan UTUC Collaboration Group involved 2503 patients who underwent treatment across 19 hospitals from 1988 to 2022. Patients were categorized into normal (18.5 ≤ BMI < 24), overweight (24 ≤ BMI < 27), and obese (BMI ≥ 27) groups. Demographic, clinical, and pathological data were analyzed. Overall survival (OS), cancer-specific survival (CSS), disease-free survival (DFS), and intravesical recurrence-free survival (IVRFS) were assessed using Kaplan-Meier analysis and Cox proportional hazards models. The median follow-up period was 44.2 months. In multivariable analysis, overweight patients demonstrated significantly better OS compared with normal-weight patients (p = 0.033), and the obesity group showed a favorable, though not statistically significant, trend toward better OS. However, BMI was not an independent predictor of CSS, DFS, or IVRFS. Independent predictors of worse outcomes included older age, end-stage renal disease, ureteral tumor location, tumor size ≥3 cm, and high-grade urothelial carcinoma. Tumor stage and grade were comparable across BMI groups. Overweight status was associated with better OS in patients with UTUC treated with RNU, while BMI had no significant impact on CSS, DFS, or IVRFS. These findings suggest a potential protective effect of higher BMI on OS, warranting further investigation in prospective studies. However, BMI alone should not guide clinical decisions and may instead reflect broader patient health characteristics.

The external physical vibration lithecbole (EPVL) is a new device. It is clinically employed to improve the stone-free rate (SFR). However, it is not widely accepted in clinical practice due to the lack of high-level evidentiary support and a standard protocol. This study aimed to evaluate the effectiveness and safety of external physical vibration lithecbole (EPVL) as an adjunct to extracorporeal shock wave lithotripsy (ESWL) or retrograde intrarenal surgery (RIRS) for upper urinary tract stones. We systematically searched PubMed, Web of Science, Embase, the China National Knowledge Infrastructure (CNKI), and the Cochrane Library from inception to 13 January 2026, for randomized controlled trials (RCTs) comparing EPVL plus standard care with standard care alone, and we pooled relative risks (RR) with 95% confidence intervals (CI). Nine RCTs involving 1418 patients were analyzed. Compared with standard care alone, EPVL significantly increased early stone-free rates at about 1 week (RR 1.44, 95% CI 1.18-1.77, p < 0.001) and 2 weeks (RR 1.40, 95% CI 1.20-1.63, p < 0.001) after ESWL or RIRS, with greater benefit for lower-pole (RR 1.56, 95% CI 1.25-1.96, p < 0.001) and renal pelvic stones (RR 1.54, 95% CI 1.10-2.14, p = 0.01). EPVL was associated with a lower rate of overall complications (RR 0.58, 95% CI 0.46-0.73, p < 0.001); specifically, it was linked to lower risks of hematuria (RR 0.64, 95% CI 0.48-0.86, p = 0.002) and urinary tract infection-related findings (RR 0.28, 95% CI 0.14-0.57, p < 0.001). Adjunctive EPVL improves short-term stone clearance after ESWL or RIRS without adding measurable risk and may also be associated with a reduced incidence of complications. Where available, EPVL can be considered as a non-invasive option to enhance fragment clearance, particularly for lower-pole renal stones. Further multicenter trials are needed to confirm long-term outcomes and generalizability. PROSPERO CRD42024600537.