Ureteral Research Articles

Risk factors for surgery in children with ureteropelvic junction obstruction due to antenatally detected ınfantil hydronephrosis.

Although the majority of cases with antenatally detected hydronephrosis (ANH) resolve during postnatal period; patients should be monitored for the risk of developing ureteropelvic junction obstruction (UPJO) which requires surgical intervention. We aimed to define independent risk factors for operation in whom diagnosis of UPJO was precisely proven with histopathological evidence. Medical files of 155 children (186 renal units) with anteroposterior pelvic diameter (APPD) ≥ 7mm or ≥ 1SFU (Society of Fetal Urology) grade of pelvicalyceal dilatation were retrospectively investigated. Patients who underwent pyeloplasty and whose pathological examinations of resected ureteral samples confirmed obstruction, were compared to non-interventional group in terms of demographics, serum creatinine, APPD, SFU grade, cortical thickness and diuretic renogram. Multiple regression models were used to predict independent risk factors for pyeloplasty. 155 patients (186 renal units) were recruited for the study. Pyeloplasty was performed in 50(32.2%) patients. Increased APPD, T1/2 and Tmax values with low parenchymal thickness and DRF were demonstrated in operated patients compared to those who did not. Significant decrease in APPD and T1/2 values and also significant improvement in parenchymal thickness were observed in conservatively managed group. Multivariate analysis revealed high APPD measurements and time activity curve patterns to be associated with significantly increased likelihood of surgical intervention. There is still an ongoing debate on which screening method should be used for the accurate diagnosis of UPJO or the indications for surgical intervention. Baseline APPD and diuretic renogram curve were found to be significant in predicting surgery for UPJO.

Prediction of surgical necessity in children with ureteropelvic junction obstruction using machine learning.

Hydronephrosis developing at the ureteropelvic junction due to obstruction poses clinical challenges as it has the potential to cause renal damage. This study aims to evaluate how well machine learning models such, as XGBClassifier and Logistic Regression can be used to predict the need for treatment in patients, with hydronephrosis resulting from ureteropelvic junction obstruction. Hydronephrosis was diagnosed in the medical records of patients from January 2015 to December 2020. These patients were classified into two groups: those who were not operated upon (n = 194) and those who had surgical procedures (n = 129). Details such as demographics, clinical presentations, and imaging findings were captured. XGBClassifier and Logistic Regression methods were employed to predict the requirement for an operation. The performance of the models was assessed based on ROC-AUC values, sensitivity, and specificity. The XGBClassifier algorithm gave the best prediction results with a ROC-AUC value of 0.977 and an accuracy rate of 95.4%. The Logistic Regression algorithm, on the other hand, offered the highest prediction during cross-validation. The presence of obstruction on scintigraphy, kidney size, anteroposterior diameter of the renal pelvic and parenchymal thickness observed in hydronephrotic kidney on USG have been identified as important predictive factors. In predicting the requirement for surgery in cases of hydronephrosis due to obstruction, machine learning algorithms have shown high accuracy and sensitivity rates. Consequently, clinical decision support systems based on these algorithms may lead to better care management of patients and more accurate projections concerning the need for surgical intervention. ESH/GOEK 2024/88-23/01/2024.

Accuracy of Sonographic Renal Pelvic Diameter in Assessment of Renal Function among Patients with Ureteropelvic Junction Obstruction using Scintigraphy as a Gold Standard

Accuracy of Sonographic Renal Pelvic Diameter in Assessment of Renal Function among Patients with Ureteropelvic Junction Obstruction using Scintigraphy as a Gold Standard

Does hypertension develop in children patients who underwent pyeloplasty due to unilateral ureteropelvic junction stenosis

Aims: Hypertension may develop in children with renal and cardiovascular pathologies. In our study, we aimed to investigate the prevalence of hypertension in children who underwent pyeloplasty. Methods: We retrospectively evaluated the blood pressure values measured in the postoperative period in children who were diagnosed with ureteropelvic junction stenosis and underwent pyeloplasty in the pediatric urology clinic of Ankara City Hospital between 2007 and 2020. Results: In our study, 167 patients (48 women, 123 men; mean age 3.6; 58 right, 109 left) who underwent pyeloplasty due to UPJO were evaluated. In the postoperative follow-up, hypertension was detect-ed in 5 patients (2.9%). Bilateral patients were excluded from the study. Of the 5 patients who developed hypertension, one had a pelvic ectopic kidney and one had a contralateral multicystic dysplastic kidney. All of the patients who developed hypertension had intrinsic UPJO; 3 of them were catheterized with a percutaneous nephrostomy catheter preoperatively. The mean MAG3 function was 43.3%. While the mean follow-up period of the patients was 5.6 years, it was ob-served that hypertension developed in an average of 3.5 years. In the postoperative period, there was an average increase of 1.2% in the functions of these five patients in the control scintigraphy. No patient who developed hypertension underwent a second surgical intervention. Conclusion: In cases where pyeloplasty was performed due to UPJO, blood pressure should be monitored in the postoperative period. Blood pressure should be checked, especially in advanced hydronephrotic patients with a history of percutaneous nephrostomy in the preoperative period.

Supranormal renal function in pediatric ureteropelvic junction obstruction: a multiparameter analysis to guide clinical management.

The clinical significance and optimal management of supranormal differential renal function (DRF ≥ 55%) in pediatric ureteropelvic junction obstruction (UPJO) remain debated. This study investigated supranormal DRF clinical characteristics and evaluated surgical versus conservative management outcomes to guide decision-making. We retrospectively reviewed 76 children with unilateral UPJO who underwent standardized DMSA and DTPA scans at a single center (2020-2022). Patients were stratified into: normal DRF (40-55%) with pyeloplasty (n = 38), supranormal DRF with pyeloplasty (n = 12), and supranormal DRF with observation (n = 26). Primary outcomes included changes in DRF, renal parenchymal parameters, and hydronephrosis severity. Supranormal DRF occurred in 11.1% of cases, predominantly in younger children (median 20 vs 42months, p = 0.01). Surgically managed supranormal cases demonstrated more severe hydronephrosis (75% grade 4, median APD 3.6cm) compared to conservatively managed cases (27% grade 4, median APD 2.9cm, p < 0.001). Post-pyeloplasty, supranormal kidneys showed consistent normalization of both DRF (58.2% to 51.6%, p < 0.001) and anatomical parameters. However, 77% of conservatively managed cases with less severe hydronephrosis maintained stable supranormal function without deterioration over median 14-month follow-up. Only 8% required delayed surgery for clinical progression. Supranormal DRF warrants careful evaluation, particularly when accompanied by severe hydronephrosis (grade 4 or APD ≥ 3.0cm). While early pyeloplasty effectively normalizes renal parameters in severe cases, observation may be appropriate for selected patients with less severe hydronephrosis. Treatment decisions should prioritize anatomical severity over DRF values alone.

Inception of novel equations for estimation of differential renal function changes after successful pyeloplasty in children

ABSTRACT Introduction Ureteropelvic junction obstruction is the most common cause of pediatric hydronephrosis. Anderson Hynes dismembered pyeloplasty as the standard surgical treatment in such cases. Purpose To evaluate and detect factors that affect renal function changes (improvement) after successful pyeloplasty using Tc-99 m Diethylenetriaminepentaacetic (DTPA) renography in children and to predict renal scan changes after successful pyeloplasty. Methods This retrospective study was conducted on children ≤ 18 years of age who underwent successful pyeloplasty from May 2018 to May 2022. Pelvic-abdominal ultrasonography and radioisotope scan Tc-99 m DTPA were performed in all patients. Results Postoperative group showed a significant increase in renal parenchyma thickness, split renal function, and glomerular filtration rate with a decreased renal pelvis anteroposterior diameter (p < 0.05). There was a significant correlation between each postoperative decrease in the anteroposterior diameter of the renal pelvis and the postoperative increase in parenchyma thickness with the postoperative increase in split renal function. The equation used to detect postoperative split renal function and glomerular filtration rate had a high detection rate. Conclusions Pyeloplasty resulted in significant improvements in hydronephrosis, and renal parenchymal changes in association with renal pelvis diameter can predict Postoperative increase in split renal function and glomerular filtration rate.

Enhancing predictive accuracy for urinary tract infections post-pediatric pyeloplasty with explainable AI: an ensemble TabNet approach

Ureteropelvic junction obstruction (UPJO) is a common pediatric condition often treated with pyeloplasty. Despite the surgical intervention, postoperative urinary tract infections (UTIs) occur in over 30% of cases within six months, adversely affecting recovery and increasing both clinical and economic burdens. Current prediction methods for postoperative UTIs rely on empirical judgment and limited clinical parameters, underscoring the need for a robust, multifactorial predictive model. We retrospectively analyzed data from 764 pediatric patients who underwent unilateral pyeloplasty at the Children’s Hospital affiliated with the Capital Institute of Pediatrics between January 2012 and January 2023. A total of 25 clinical features were extracted, including patient demographics, medical history, surgical details, and various postoperative indicators. Feature engineering was initially performed, followed by a comparative analysis of five machine learning algorithms (Logistic Regression, SVM, Random Forest, XGBoost, and LightGBM) and the deep learning TabNet model. This comparison highlighted the respective strengths and limitations of traditional machine learning versus deep learning approaches. Building on these findings, we developed an ensemble learning model, meta-learner, that effectively integrates both methodologies, and utilized SHAP(Shapley Additive Explanation, SHAP) to complete the visualization of the integrated black-box model. Among the 764 pediatric pyeloplasty cases analyzed, 265 (34.7%) developed postoperative UTIs, predominantly within the first three months. Early UTIs significantly increased the likelihood of re-obstruction (P < 0.01), underscoring the critical impact of infection on surgical outcomes. In evaluating the performance of six algorithms, TabNet outperformed traditional models, with the order from lowest to highest as follows: Logistic Regression, SVM, Random Forest, XGBoost, LightGBM, and TabNet. Feature engineering markedly improved the predictive accuracy of traditional models, as evidenced by the enhanced performance of LightGBM (Accuracy: 0.71, AUC: 0.78 post-engineering). The proposed ensemble approach, combining LightGBM and TabNet with a Logistic Regression meta-learner, achieved superior predictive accuracy (Accuracy: 0.80, AUC: 0.80) while reducing dependence on feature engineering. SHAP analysis further revealed eGFR and ALB as significant predictors of UTIs post-pyeloplasty, providing new clinical insights into risk factors. In summary, we have introduced the first ensemble prediction model, incorporating both machine learning and deep learning (meta-learner), to predict urinary tract infections following pediatric pyeloplasty. This ensemble approach mitigates the dependency of machine learning models on feature engineering while addressing the issue of overfitting in deep learning-based models like TabNet, particularly in the context of small medical datasets. By improving prediction accuracy, this model supports proactive interventions, reduces postoperative infections and re-obstruction rates, enhances pyeloplasty outcomes, and alleviates health and economic burdens.Level of evidence IV Case series with no comparison group.

Impact of hydronephrosis on shockwave lithotripsy outcomes for upper ureteral stones.

To investigate the effect of the degree of hydronephrosis on extracorporeal shockwave lithotripsy (SWL) success in patients who underwent SWL due to upper ureteral stones. Medical records of 878 patients who underwent SWL were retrospectively reviewed. Patients with isolated unilateral 6-10mm radiopaque upper ureteral stones above the upper border of the sacroiliac joint were included in the study. The primary endpoint of the study was the relationship between the degree of hydronephrosis with upper ureteral stones and the stone clearance time, number of SWL sessions, and success, while the secondary endpoint was the effect of the presence of severe hydronephrosis (SFU grade 3) on SWL success. The mean age of the patients was 41.3 ± 10.9years. The mean stone size was 8.2 (6-10) mm. Ureteropelvic junction stones were present in 24 (20%) patients. The mean stone clearance time was 14.6 ± 9.7days. One-month SWL success was determined as 85%. SWL success rates decreased as the degree of hydronephrosis increased (p = 0.047). Being 45years of age and older increased the risk of SWL failure by 16.25 times (OR = 16.25, p = 0.017). Increasing the stone clearance time by 1day increased the risk of SWL failure by 1.17 times (OR = 1.17, p = 0.006), and increasing the number of SWL sessions by 1 session increased the risk of SWL failure by 7.69 times (OR = 7.69, p = 0.016). The presence of severe hydronephrosis (grade 3) did not affect SWL success (OR = 5.56, p = 0.071). According to our study results, as the degree of hydronephrosis increases in 6-10mm upper ureteral stones, the number of SWL sessions increases, stone expulsion times prolong, and 1-month success rates decrease.

A novel suture-free nephroplication with 4D-printed biodegradable bag for giant hydronephrosis: initial experience from hydromechanics and clinical application.

Giant hydronephrosis as an rare condition is often caused by chronic ureteral obstruction. Nephroplication is a crucial procedure to improve urinary drainage in the kidney-sparing surgery for patients with giant hydronephrosis. However, traditional nephroplication via suturing kidney has technical difficulty and many potential risks. We devised a novel suture-free nephroplication by using a 4 dimension (4D)-printed biodegradable bag. Structures of the bag were observed by a scanning electron microscope. Hydromechanical analysis was conducted to explore the mechanism of this novel surgery. Patients with giant hydronephrosis caused by ureteropelvic junction obstruction (UPJO) were recruited. Computed tomography (CT) and renal emission computed tomography (ECT) were used to evaluate the renal morphology and function in preoperative examination and follow-up. 4D-printed biodegradable bag was fabricated using polycaprolactone (PCL). Hydromechanical analysis indicated that reduced space of renal pelvis after the nephroplication could improve urinary drainage. Finally, three patients were recruited, and underwent this novel suture-free nephroplication successfully. Postoperative CT and renal ECT performed at three months after the operation revealed significant recovery of affected kidney. Among them, the glomerular filtration rate (GFR) of affected kidneys in two patients increased from less than 10mL/min to 13.11mL/min and 14.30mL/min respectively, indicating the significant recovery of split renal function. This is a novel suture-free nephroplication for treating benign giant hydronephrosis, in which the 4D-printed biodegradable bag simplified and standardized surgical procedures significantly. Initial experience from clinical application is encouraging, suggesting that the nephrectomy for patients with benign giant hydronephrosis might be avoided. Future investigations on long-term outcomes of this new surgery are warranted.

Assessment of Outcomes andAnatomical Changes in the Upper Urinary Tract Following Flexible Ureteroscopy With a Flexible and Navigable Suction Ureteral Access Sheath: 3-Month Results From a Multicenter Study.

To study the long-term outcomes of the flexible and navigable suction ureteral access sheath (FANS) in flexible ureteroscopy (FURS). FANS has well-established efficiency and 30-day perioperative safety; however, its influence on pelvicalyceal and ureteric anatomy remains to be investigated. This was a prospective study of patients with normal renal anatomy who underwent FURS with FANS for renal stones from April 2023 to August 2024 in 16 centers worldwide. Thirty-day postoperative stone-free rate and delayed complications after 3 months were analyzed with a non-contrast CT scan and contrasted CT urogram respectively. The primary aim was to report if FANS could potentially cause pelviureteric junction, pelvicalyceal or ureteric complications. Three hundred-tenpatients were analyzed. Median age was 51; median stone volume was 1584mm3. Disposable scopes were used in 58.1%. Predominant laser energies were Thulium fiber laser (56.1%) followed by Thulium-YAG laser (20.6%). Median laser time was 14minutes, median ureteroscopy time was 30minutes, and median total operation time was 45minutes. Ureteric injury occurred in 11 patients (3.5%), of which 10 were Traxer-Thomas Grade 1. On 30-day NCCT, 63.5% of patients had zero residual fragments; overall stone-free status was seen in 95.1%. Thirty-day reintervention rate was 4.2% (13 cases). Three-month CT urogram showed ureteric stenosis in only 1 patient (0.3%) who was managed by dilatation and stenting. No other anatomical anomalies were recorded. The extremely low rates of 3-month adverse outcomes, high immediate SFR, and low 30-day reintervention rates further strengthen the evidence for safety and effectiveness of FANS.

Zinner syndrome incidentally diagnosed in a man with ureteropelvic junction stone and hydronephrosis: A case report

Zinner syndrome incidentally diagnosed in a man with ureteropelvic junction stone and hydronephrosis: A case report

Laparoscopic pyeloplasty for the management of Uretero-pelvic junction obstruction in two pediatric cases of horseshoe kidney

Laparoscopic pyeloplasty for the management of Uretero-pelvic junction obstruction in two pediatric cases of horseshoe kidney

Single-port robot-assisted pyeloplasty through supine anterior retroperitoneal access.

This video explores the technique of robot-assisted pyeloplasty using the Da-Vinci Single-Port robot through the supine anterior retroperitoneal access in a 28-year-old male with a right-sided ureteropelvic junction obstruction. The patient was placed in a supine position, with a 10°-20° elevation of the ipsilateral flank. Retroperitoneal access was obtained at the McBurney's point for the placement of the port. The standardized steps of the Anderson-Hynes pyeloplasty technique were executed. Operative time was 120 min with 10 mL of blood loss. The patient was discharged on the same day without complications. At 4-months follow-up, on the renal scan, the right kidney showed stable function with improved drainage.

Extrarenal Pyelocalyceal System or Extrarenal Calyces: A Case Series and Literature Review

ABSTRACT Extrarenal pyelocalyceal system or extrarenal calyces, a congenital anomaly, is identified when it presents with pelviureteric junction obstruction. It is elusive to preoperative diagnosis and was identified only intraoperatively in all published pediatric cases. Experience gained by managing a series of cases and a literature search has guided us to evolve a preoperative diagnostic approach, a pyelotomy technique, and a practical classification of the EPS. During the period from 2003 to 2023, four cases with six kidneys of the EPS including three kidneys of the polar extrarenal infundibulum and calyces, a variant of EPS involving only upper or lower pole of the kidney, were seen. Successful pyeloplasty was performed in five of the six kidneys for PUJO using a careful pyelotomy technique. Characteristic “garden rake” X-ray sign was seen in intravenous urogram or retrograde pyelogram, contrast-enhanced computerized tomogram, or magnetic resonance imaging (MRI) of the abdomen in three kidneys. Retrograde pyelogram, CECT, or MRI of the abdomen identified the polar variant in three kidneys. Late-onset PUJO was seen in one case. Four cases with PUJO presented with significantly reduced renal function. One showed postoperative deterioration to nonfunction despite good drainage. A preoperative diagnostic approach, a pyelotomy technique for pyeloplasty, and a classification of the EPS are evolved by the authors. Progressive loss of function and late-onset obstruction mandate a renal-sparing pyeloplasty approach and follow-up.

Spontaneous Rupture of Pelvicalyceal System in a Horseshoe Kidney Presenting as Acute Abdomen

Abstract Horseshoe kidney is the most common congenital renal fusion anomaly. It is more prone to complications such as pelviureteric junction obstruction and renal stones. Spontaneous rupture of the urinary collecting with urinoma has never been reported in a horseshoe kidney in literature. Spontaneous rupture of the renal pelvis is a rare event even in orthotopic kidneys and can be due to obstructing calculus. Spontaneous rupture in the horseshoe kidney can mimic acute abdominal conditions. We report a case of a 29-year-old man who presented in the emergency department with severe mid-abdominal pain. Contrast-enhanced computed tomography (CT) evaluation of the abdomen showed contrast extravasation outside the right pelvicalyceal system with pelviureteric junction obstruction in a horseshoe kidney with extensive collection in the subhepatic, subdiaphragmatic, and right pleural region. The patient underwent a double-J stent placement which was followed by complete healing of the urinary leak and underwent definitive open pyeloplasty after 3 months. Diagnosis and therapeutic challenges in this rare case are being discussed.

Pancake Kidney with Single Ureter in an Adult Male: An Infrequent Association

Abstract Crossed fused ectopia is the second most common renal fusion anomaly, following horseshoe kidney. Typically, it remains asymptomatic unless accompanied by additional abnormalities such as pelviureteric junction obstruction (PUJO) or vesicoureteral reflux. Pancake kidney, a rare variant of crossed fused ectopia, is an uncommon clinical finding, particularly in adults. We report a unique case of pancake kidney in an adult male with chronic kidney disease (CKD). This rare anomaly was characterized by a single ureter draining both renal units, anatomically resembling a tree with multiple branches stemming from a solitary trunk. The right renal unit exhibited gross hydronephrosis, containing approximately 100 small calculi. In addition, the lower pole of the left renal unit showed evidence of PUJO. This case highlights a rare presentation of pancake kidney associated with complex structural anomalies, CKD, and significant calculi burden. Proper identification and evaluation of such anomalies are critical for effective clinical management and prognosis.

Giant Hydronephrosis Due to Ureteropelvic Junction Obstruction in A 53-Year-Old Male: A Case Report

The hydronephrotic kidney, resulting from an uretero-pelvic junction obstruction (UPJO), presents commonly as a clinical condition, with the presence of usually no more than 1‑2 liters in the collecting system, but a very small number of cases of giant hydronephrosis (GHs) has been reported in adults. In this case report a 53-year-old male was admitted to the Vamshodaya Hospital Kolar, Karnataka, India in November 2023 with an abdominal pain since 15 days and abdominal distention since 6-months. Computed tomography was performed, finding large thin walled cystic mass in right side of abdominopelvic region (40x32x27cm) showing few incomplete septations, fluid density within lesion and causing significant mass effect and displacing the rest of the abdominal contents. Such cases are rarely presented; therefore the aim of the present case study was to document a clear case of GH resulting from UPJO.

Hydronephrosis-Induced Polycythemia with Low Erythropoietin Level: A Case Report and Literature Review

Introduction: Polycythemia is a rare condition that can be either primary or secondary. We report a case of an adolescent with progressive hydronephrosis-induced polycythemia and low erythropoietin levels, along with a thorough literature review. Report of a Case: A 17-year-old girl with epilepsy had progressively elevated hemoglobin levels and low erythropoietin levels. Initial investigations, including genetic surveys and bone marrow studies, showed no evidence of polycythemia vera or myeloproliferative disorders. Further imaging studies revealed severe hydronephrosis on the left side caused by ureteropelvic junction stenosis. Following nephroureterectomy, her hemoglobin levels gradually returned to normal. Conclusions: This case highlights the potential association between hydronephrosis and polycythemia, even with low erythropoietin levels. Renal abnormalities should be considered in the differential diagnosis of pediatric patients with polycythemia, even in the absence of elevation of erythropoietin. Further research is needed to clarify this association and its pathophysiology.

Dilema in Managing Children Born with Antenatally Detected Ureteropelvic Junction Obstruction (UPJO)

Now-a-Days, attitudes of paediatric urologists have been changed from surgical to observational regarding definite management of congenital ureteropelvic junction obstruction (UPJO), because many cases of UPJO goes away on its own before baby is born. In the last decade, this type of management trend has become progressively increased despite the lack of precise predictors of outcome. But these patients should be brought into regular follow-up by physical examinations, ultrasonography and nuclear imaging to observe resolution events. In some clinical scenario surgical intervention is inevitable such as solitary kidney or child with infection. Now-a-days, it is a good practice by the modern pediatric urologists frequently consults with the guardians about advantage and disadvantage of observational and surgical management of antenatally detected hydronephrosis due to UPJO of their babies and their future outcome. As a result guardians feel comfortable in decision making. Bangladesh J Child Health 2022; Vol 47 (2) : 54-58

Assessing Micturition, sexual function, and endoscopic outcomes one year after Aquablation: a single center prospective study.

Morphological changes in the prostatic urethra and bladder cavity resulting from Aquablation treatment are still unknown. This study aims to assess the safety and efficacy of Aquablation within one-year post-surgery, focusing on both functional and endoscopic outcomes. Prospective enrollment of patients undergoing Aquablation (10/2018-04/2023) included those with baseline International Prostate Symptom Score (IPSS) ≥ 10, prostate volume from 40 to 80 mL, and Qmax ≤ 12 mL/s. Functional outcomes were evaluated at 1, 3, 6, and 12 months using uroflowmetry (Qmax), and dedicated questionnaires. Cystoscopy at three months assessed ablation quality on a Likert scale (1-poor; 5-excellent). Measurements included cavity length post-treatment and preserved prostatic tissue length at the apex. Additional evaluations encompassed veru-montanum preservation, presence of residual fluffy tissue or mucous flaps, ureteral orifices and bladder trigone injuries. Out of 109 enrolled patients, one-year follow-up displayed significant improvements in Qmax (+ 103.08%), IPSS (-86.36%), and IPSS-QoL (-80.00%). Aquablation had no impact on erectile function and continence, preserving ejaculation in 96.3%. Of the 106 patients undergoing cystoscopy, prostatic urethra patency was satisfactory to perfect in 96.2%, with a median cavity length of 24 ± 8.2mm. Residual median lobe was found in 11.3%, without significant impact on micturition outcomes. Positive outcomes included minimal fluffy tissue and mucosal flaps, and well-preserved ureteral meatuses, verumontanum, and bladder trigone. Aquablation showed efficacy in solving urinary symptoms with minimal impact on ejaculation up to one year post-surgery. A three-month post-surgery endoscopic evaluation supports its safety, efficacy, and conformity with the ablative planning.