YAU-RCC spotlight: randomized controlled trials in renal surgery. Lessons from ROBOCOP II and OpeRa.

Percutaneous cryoablation (CA) is increasingly used to manage small renal masses (SRMs) in selected patients, offering a nephron-sparing, minimally invasive alternative to surgical resection. We evaluated the safety, renal functional preservation, and short-term oncologic outcomes of CA in a high-complexity cohort at a tertiary referral center. We conducted a retrospective single-center analysis of consecutive patients treated with CA between 2020 and 2025. SRMs were defined as renal tumors ≤4 cm (cT1a). Procedures were performed under local anesthesia, primarily using combined Ultrasound and Cone-Beam Computed Tomography guidance. Primary outcomes included perioperative morbidity (Clavien-Dindo) and oncologic results (local failure, metastasis, and cancer-specific survival). Secondary outcomes focused on renal function preservation (eGFR). Seventy-one patients were included in the analysis. The cohort had a median age of 70 years and a high comorbidity burden, with a median Charlson Comorbidity Index of 5, prior renal surgery was present in 45% of patients and 13% a solitary kidney. All procedures achieved technical success. The overall complication rate was 20%, with no Clavien-Dindo grade ≥II complications. At a median follow-up of 10 months, early oncologic outcomes showed 11 patients with local failure (9 petients with residual disease, 2 patients with recurrence), reflecting the high proportion of "salvage" cases. Most failures (55%) were successfully managed with repeated CA. Metastatic progression occurred in 3% of cases, and cancer-specific mortality was 1.4%.. Median eGFR decline was 2.5 mL/min/1.73 m². CA represent a safe and effective nephron-sparing strategy for selected patients with SRMs. particularly in high-complexity cases. Despite a non-negligible local failure rate in salvage cases, cryoablation allows effective disease control while preserving renal function. These findings support CA as a valuable treatment option, although longer follow-up is needed to confirm long-term oncologic durability.

Predictors of residual fragments and hemorrhagic complications after pediatric mini-percutaneous nephrolithotomy: A retrospective cohort analysis of 371 renal units.

Digital twins in urological oncology and surgery: A review of emerging applications.

Risk factors for adverse outcomes in first-time renal parathyroid surgery: an analysis of the United Kingdom Registry of Endocrine and Thyroid Surgeons.

This video describes in detail our current technique for laparoscopic port placement in infants when using retroperitoneoscopy. More than 60 ablative and reconstructive renal surgeries have been performed since 2017 using this retroperitoneoscopic approach in infants weighing less than 10 Kg, with no conversions or complications linked to access or port placement. It is our impression that retroperitoneoscopy is very similar in smaller children, and might have some advantages such as shorter distance between entry point and target organ and more flexible abdominal wall. This video shows a combination of 5 mm and 3 mm ports, allowing use of all current types of energy devices, clip appliers and single use scissors, and also excellent vision during initial dissection. This approach has been used in our university centers for nephrectomies, hemi-nephrectomies, pyeloplaties and uretero-ureterostomies.

As an emerging interactive display technology, mixed reality(MR) allows for the integration of multi-dimensional virtual objects with the real world, enhancing the precision of surgical operations. This technology has demonstrated significant value in renal tumor surgeries, but its application in adrenal tumor surgeries remains unclear. This study aims to investigate the clinical efficacy and potential benefits of mixed reality technology in robot-assisted laparoscopic partial adrenalectomy (RALPA) for treating adrenal tumors. A total of 82 eligible patients who underwent RALPA for adrenal tumors at the Second Affiliated Hospital of Nanchang University from September 2020 to October 2024 were included in this retrospective study. The patients were divided into two groups based on their preoperative diagnosis and treatment: 32 patients in the mixed reality (MR)group and 50 patients in the traditional CT imaging (control) group. All patients received bilateral adrenal gland CT scans, both plain and enhanced. The MR group utilized CT data to create a virtual model, which was then used for surgical planning and intraoperative guidance through a 3D tablet computer and Hololens glasses. Preoperative variables and perioperative indicators were collected to evaluate surgical outcomes in both groups. Postoperative statistics indicated that the operation time for the MR group was significantly shorter than that of the control group (102.00(98.00 103.00) minutes vs. 103.50(101.00 106.75) minutes, p = 0.017). The estimated intraoperative blood loss was also lower in the MR group compared to the control group (58.50(53.00 63.00) ml vs. 77.00(72.00 86.00) ml, p < 0.001). Additionally, the recovery time for gastrointestinal function in the MR group was significantly shorter than that in the control group (28.00(26.00 30.00) hours vs. 32.00(30.00 35.00) hours, p < 0.001). While there was no significant difference in the incidence of postoperative complications between the two groups, the postoperative hospitalization duration for patients in the MR group was significantly shorter (4.00(4.00 5.00) days vs. 5.00(5.00 5.00), p = 0.004). No statistically significant difference was observed in the spectrum of potential adrenal diseases between the MR and control groups (p > 0.05). Compared to traditional CT imaging, RALPA guided by mixed reality technology may be associated with a modest reduction in surgical time, a decrease in intraoperative blood loss, and faster recovery of gastrointestinal function. However, the clinical significance of these observed differences remains limited, and the findings should be interpreted cautiously due to the retrospective study design. Prospective controlled studies are needed to confirm whether MR technology provides a true clinical advantage over conventional imaging in adrenal surgery.

Robot-assisted radical nephrectomy (RARN) has emerged as an important minimally invasive option for the surgical treatment of renal malignancies, particularly in technically demanding cases. However, the overall research landscape, major contributors, and thematic evolution of this field remain insufficiently characterised. This study was designed to characterise the global development of RARN, clarify its intellectual framework, and identify the main research hotspots. A bibliometric and visualisation analysis was performed using data retrieved from the Web of Science Core Collection. Publications indexed between 1 January 2000 and 31 December 2025 were identified through a structured search strategy focused on RARN, whereas studies on partial nephrectomy, nephroureterectomy, donor nephrectomy, and simple nephrectomy were excluded. CiteSpace, VOSviewer, Bibliometrix, and Scimago Graphica were used to assess publication trends, contributions by countries and institutions, author and journal collaborations, co-cited references, keyword co-occurrence patterns, and thematic changes. A total of 162 publications met the inclusion criteria, including 130 original articles and 32 review articles. Annual publication output remained low before 2010, then increased gradually, followed by a marked rise after 2023, reaching its highest level in 2025. The United States ranked first in publication output, citation impact, and international collaboration. China showed the most pronounced recent growth, while Italy continued to show substantial academic influence. The Chinese People's Liberation Army General Hospital was the most productive institution, and overall research output remained concentrated in a relatively small group of high-volume academic centres. Journal analysis indicated that the field was anchored mainly in established urology journals, particularly Journal of Endourology, Journal of Urology, European Urology, Urology, and BJU International. Keyword, clustering, and co-citation analyses indicated that the field progressed from an early phase focused on feasibility assessment and comparison with laparoscopy to a more differentiated stage centred on inferior vena cava tumour thrombus, complex renal masses, perioperative outcomes, and the selective application of robotic technology in challenging renal surgery. Research on RARN has expanded steadily over the past two decades, with a more marked increase in activity in recent years. However, academic influence remains largely concentrated among a relatively small number of leading countries, institutions, authors, and journals. This study provides a structured overview of the global development, major hotspots, and thematic evolution of RARN, and may offer a useful foundation for future clinical research and academic collaboration.

Dyspareunia and sexual dysfunction after transvaginal specimen extraction - A systematic review.

BACKGROUND Renal pseudoaneurysms can occur following penetrating renal trauma, renal surgery, or renal biopsy, and are a cause of delayed bleeding. However, cases occurring after blunt trauma are rare, and pseudoaneurysms may become apparent in a delayed fashion after initially negative imaging. CASE REPORT A 52-year-old man sustained trunk injuries in a motorcycle accident, including left renal injury (American Association for the Surgery of Trauma [AAST] Grade III) and splenic injury (AAST Grade IIIa or IIIb). Transcatheter arterial embolization was performed for the splenic injury, and the left kidney was managed conservatively. The patient developed fever on post-injury day 5, and computed tomography on day 6, performed to evaluate the fever source, did not demonstrate a pseudoaneurysm. Gross hematuria later worsened, with progressive anemia. On day 12 after injury, a new pseudoaneurysm was identified, and transcatheter arterial embolization was performed using n-butyl-2-cyanoacrylate and microcoils. Additionally, a ureteral stent was placed due to concomitant urinary fistula. Subsequently, fever and hematuria improved, and the patient was transferred to the urology ward on day 20 after injury. Urinary extravasation can contribute to pseudoaneurysm formation; therefore, repeat imaging and timely intervention should be considered in selected high-risk patients. CONCLUSIONS Delayed detection of renal segmental artery pseudoaneurysm should be considered after blunt renal trauma. Minimally invasive endovascular treatment is effective and kidney-sparing. Concomitant urinary extravasation and urinary fistula may contribute to delayed bleeding complications; therefore, repeat imaging and timely intervention should be considered in selected high-risk patients.

Renal surgery for localized renal cell carcinoma carries substantial risk of acute kidney injury (AKI) regardless of surgical approach. This prospective study evaluated early biohumoral markers for AKI detection after robotic renal surgery and assessed their prognostic value for 12-month functional outcomes. Adults undergoing robotic renal tumor surgery with a healthy contralateral kidney were enrolled; AKI followed KDIGO 2012 criteria. Biomarkers measured at baseline and 2/24/72 h were serum β2-microglobulin (sβ2) serum IL-6, as well as urinary β2-microglobulin (uβ2), cystatin C (uC), and α2-macroglobulin (uα2M). Kidney function at 12 months was staged according to KDOQI criteria. Among 170 patients (35 radical nephrectomy, RN; 135 partial nephrectomy, PN), 33 developed AKI, more frequently after RN (p < 0.001); baseline biomarkers levels were similar. sβ2 was significantly higher at 2/24/72 h, and at 2 h, it achieved an AUC of 0.78 (cut-off 0.17: sensitivity 82%, specificity 60%), remaining the earliest independent predictor of AKI (p = 0.015). IL-6 differed at 24 h (AUC 0.80), uC at 72 h (AUC 0.73) and uβ2 at 72 h (AUC 0.66). Clinical AKI predicted KDOQI stage progression at 12 months (p < 0.001). Bulldog clamps (mean ischemia time 17.2 ± 6.9 min) were not associated with AKI (p = 0.99) or with KDOQI stage progression (p = 0.54). RN confers a higher AKI risk than PN. sβ2 at 2 h is the earliest actionable marker, complemented by IL-6 (24 h) and uC (72 h); short warm ischemia during robotic PN appears safe. Sequential multimarker assessment may improve recognition of AKI and support timely nephroprotective strategies.

Background:Erector spinae plane block (ESPB) and quadratus lumborum block (QLB) have demonstrated efficacy in providing postoperative analgesia following abdominal surgeries. However, evidence regarding their effectiveness in pediatric renal surgeries remain limited. The present study aimed to compare the duration of postoperative analgesia between ultrasound-guided quadratus lumborum and erector spinae plane blocks in children undergoing open pyeloplasty.Methods:Sixty children undergoing pyeloplasty, aged between 6 months and 7 years were randomized to receive ultrasound guided ESPB or QLB after induction of general anesthesia. Time to first rescue analgesia, total analgesic requirement, and time to perform the block were observed.Results:The time to first rescue analgesia was 1040 ± 99 min in QLB group as compared to 889 ± 67 min in ESPB group (P < 0.001). Mean total analgesic requirement (fentanyl) in 24 hours was lower in QLB group as compared to ESPB group (1.77 ± 1.36 μg/kg and 3.9 ± 0.80 μg/kg, respectively) (P < 0.001). The mean total time to perform block was 246 ± 107 sec in QLB group and 140 ± 80 sec in ESPB group (P < 0.001).Conclusion:Ultrasound guided quadratus lumborum block provides longer duration of postoperative analgesia with lesser total analgesic requirement as compared to erector spinae plane block in children undergoing pyeloplasty, with marginally longer time to administer quadratus lumborum block.

Background/Objectives: Paediatric renal tumours, particularly Wilms tumours, have good survival outcomes following multimodal therapy; however, long-term morbidity related to nephrectomy and adjuvant treatment remains a major concern. As treatment paradigms increasingly prioritize nephron preservation and minimization of late effects, there is growing interest in technologies that can enhance intraoperative precision. Methods: A scoping review following the PRISMA guidelines was performed. We analysed articles on fluorescence for childhood renal tumours on 1 November 2025. Case reports, opinion articles, and narrative reviews were excluded. An Ovid Medline search with search terms "Kidney neoplasm" AND "Fluorescent Dyes", along with a Cochrane trials registry search for "kidney" AND "neoplasm" AND "Fluorescent Dye", was performed, along with a hand search of citations. Results: The Ovid Medline search yielded 21 results, and the Cochrane trials search gave 4 results. Following review, five papers were included, of which one was an ex vivo study and one was a randomised, controlled trial that is currently recruiting. Conclusions: There is a lack of evidence around the use of near-infrared fluorescence in paediatric renal tumour surgery. This review summarizes the key current findings and future perspectives.

ABSTRACT Renal ischemia–reperfusion (Isc-Rep) injury commonly occurs during kidney transplantation, renal vascular surgery, or traumatic hemorrhagic shock, and is marked by excessive oxidative stress and inflammation. We aimed to examine the antioxidant properties of the melatonin–curcumin combination in an experimental renal Isc-Rep model in rats. Thirty-five rats were allocated into five distinct experimental groups. While the rats in the Control (C) group did not undergo any surgical procedure, each of the rats in the remaining groups underwent 45 minutes of renal ischemia followed by 2 h of reperfusion. In all experimental groups, except the Isc-Rep group, the rats were administered an active compound immediately prior to reperfusion, namely melatonin (MEL, 20 mg/kg), curcumin (CUR, 200 mg/kg), or a combination of MEL-CUR. In all groups, histological evaluation was carried out, while apoptotic cell analyses were similarly performed by means of the TUNEL method. In addition, oxidative stress parameters (TOS, TAS, OSI), inflammatory cytokines (TNF-α, IL-6, and IL-1β), superoxide-dismutase (SOD), and malondialdehyde (MDA) activity levels were also examined. Histological evaluation demonstrated that renal Isc-Rep-induced cellular damage, tubular dilatation, and inflammation were significantly reduced in the MEL-CUR groups in comparison with the Isc-Rep group (p < 0.005). Furthermore, statistically significant differences were observed among the groups in TOS, TAS, OSI, TNF-α, IL-6, and IL-1β levels (p < 0.005). The co-administration of melatonin and curcumin resulted in greater protection against ischemia–reperfusion-induced renal damage compared with either treatment alone. Moreover, the co-administration of these antioxidant agents demonstrates greater therapeutic efficacy compared to their individua.

Objective:Retrograde intrarenal surgery (RIRS) is the first-line treatment for kidney stones between 1 and 2 cm and can serve as an alternative to percutaneous nephrolithotomy for larger stones in high-risk patients, including those with bleeding disorders, obesity, renal congenital abnormalities, or solitary kidneys. We aimed to compare the safety and efficacy of supine mini-percutaneous nephrolithotomy (PCNL) versus RIRS for the treatment of renal pelvic stones less than 2 cm.Methods:This prospective, randomized, double-blinded study included 50 patients aged >18 years, of both sexes, with renal stones <2 cm. Patients were randomized into 2 equal groups: Group A underwent supine mini-PCNL, while Group B underwent RIRS. Stone and patient characteristics, SFR, and perioperative events were compared between groups.Results:A total of 50 patients equally distributed into the 2 groups. Operative time was significantly lower in Group A than in Group B (P < .05), while fluoroscopic time was significantly higher in Group A than in Group B (P < .05). Also, hospital stay was significantly longer in Group A compared to Group B (P < .001). SFR and retreatments were comparable between both groups. Complications were also similar, with no significant differences observed.Conclusions:Supine mini-PCNL remains an effective option for achieving high stone clearance with a shorter operative time while avoiding ureteral access manipulation, while RIRS provides advantages such as reduced radiation exposure, shorter hospitalization but with a higher need for stenting and secondary procedures. Supine mini-PCNL is not inferior to RIRS in the treatment of less than 2 cm renal stones.

In the scientific nomenclature, "incidentaloma" is the medical term to describe incidentally found asymptomatic tumors. We adapted the term "incidentaloma" to describe the finding of additional pathology during laparoscopic surgery conducted for a different indication. This study aimed to highlight the role of laparoscopy in identifying and addressing hidden concurrent conditions, thereby preventing the need for further surgical interventions. Five hundred ninety-five patients undergoing laparoscopic procedures from January 2018 to January 2023 were enrolled. Patients were divided in 4 groups according to the primary pathology or anatomical district: G1 included 331 children undergoing unilateral inguinal hernia laparoscopic repair, G2 included 115 children receiving laparoscopic varicocelectomy, G3 included 40 children undergoing laparoscopic exploration for non-palpable testis, G4 included 109 children undergoing laparoscopic abdominal procedures (53 appendectomies, 10 ovarian cystectomies, 14 renal surgeries, 28 cholecystectomies, 4 esophageal surgeries). A total of 170 incidentalomas were found intraoperatively (28.6%). In G1, 126/331 (38.1%) had contralateral patent peritoneal-vaginal duct (PPVD), and 2/331 (0.6%) had ovarian cyst (n = 1) and paratubaric cyst (n = 1). In G2, incidentaloma was found in 2/115 (1.7%), including PPVD (n = 1) and omphalomesenteric duct remnant (n = 1). In G3, PPVD was discovered in 11/40 (27.5%). In G4, 19/109 (17.4%) concomitant adnexal pathologies, 4/109 (3.7%) PPVD, 2/109 (1.8%) pelvic masses, 2/109 (1.8%) subhepatic appendices, 1/109 (0.9%) Meckel's diverticulum, 1/109 (0.9%) urachal sinus were discovered intraoperatively. The incidentalomas were treated during the same surgeries in 168/170 cases (98.8%). The postoperative course was uneventful in all patients, and no postoperative complications were observed. Laparoscopy may be helpful to detect intraoperatively concomitant asymptomatic and unknown pathologies. Our results demonstrated that the incidence of incidentalomas was not negligible (28.6%) in the pediatric population. Laparoscopy allows their early treatment in most cases, thereby preventing the need for reintervention or emergency operation in case of acute onset.

Robotic surgery is a game-changing innovation in urology. Novel multiport robotic systems’s (MRS) benefits and limitations in renal surgery when compared to Da Vinci MRS need to be fully understood. This study aims to identify variations from the well-known Da Vinci MRS in terms of surgical, oncological, and functional outcomes in patients undergoing robot-assisted partial nephrectomy (RAPN). Our systematic review and meta-analysis screened Pubmed, Web of Science, and Scopus databases, analyzing data from eighteen papers. Of them, 6 studies compared RAPN outcomes in patients between the novel MRS and Da Vinci MRS. Surgical outcomes (surgical times, estimated blood loss, length of hospital stay, Clavien-Dindo grade > 2 complications rate) and oncological outcomes (positive surgical margins rate and trifecta achievement rate) were analyzed using a Sidik-Jonkman method in a random-effects model. The abovementioned eighteen studies involved and included 1204 patients (631 novel MRS and 573 Da Vinci). Six of them were comparative studies between novel MRS and Da Vinci. Meta-analysis between novel MRS and Da Vinci revealed statistically significant differences in terms of docking time (Mean Difference 1.95; 95% CI 0.41–3.5; I2 98.9%; p = 0.01) and console time (Mean Difference 16.72; 95% CI 5.1–28.4; I2 67.7%; p < 0.01). No other variations between the two systems were shown in terms of oncological or perioperative results. The present systematic review and meta-analysis demonstrates similar surgical and clinical outcomes for RAPN conducted with the novel MRS and Da Vinci robotic platform, despite the small number of included studies. Novel MRS could be used in resource-limited hospital settings as alternative to Da Vinci MRS.

Adequate lymph node sampling is essential for accurate staging and treatment planning in Wilms tumour. Both SIOP and COG protocols recommend sampling more than six lymph nodes. However, median retrieval rates remain low in both open and minimally invasive approaches. This study aimed to assess the feasibility, safety, and efficacy of intraoperative indocyanine green (ICG) fluorescence imaging for sentinel lymph node (SLN) identification in paediatric renal tumours and to contribute to the standardization of dosage and timing protocols. A two-centre prospective study (2023-2025) was conducted in Wrocław and Gdańsk involving 20 paediatric patients undergoing nephron-sparing surgery (n = 14) or nephrectomy (n = 6) for renal tumours with ambiguous lymphatic drainage. ICG (0.2ml of a 5mg/ml solution) was injected into four sites of healthy renal parenchyma, 1-2cm from the tumour margin, after kidney exposure and before vascular pedicle preparation. Near-infrared (NIR) imaging (Stryker) was used to visualise lymphatic drainage and sentinel nodes. Twenty children were included (median age 3 years, IQR 1.75-5.00). The median number of lymph nodes retrieved was 4 (IQR 3-6), with a median of 3 fluorescent nodes (IQR 1.5-4.5). Sentinel lymph node visualisation was successful in six cases (one benign renal cyst and five nephroblastomas) and failed in chromophobe carcinoma and renal cell carcinoma. No ICG-related adverse events were observed. The number of lymph nodes retrieved did not differ significantly between nephron-sparing surgery and nephrectomy; however, a higher number of fluorescent nodes was observed in the nephron-sparing group (median 3.5 vs. 1.0; p = 0.0757). Compared with historical controls, the ICG-guided cohort demonstrated a significantly higher lymph node yield (median 4.0 vs. 3.0; p = 0.00468). Operative time was significantly longer in the ICG group (median 130.5min [IQR 114.5-145.0] vs. 109.5min [IQR 91.0-112.5]; p = 0.00513), likely reflecting the initial learning curve associated with adoption of the technique. ICG fluorescence imaging is a promising adjunct for SLN mapping in paediatric renal tumours. Standardisation of injection protocols is required to improve reproducibility. The technique is safe, feasible, and may improve staging accuracy while reducing the need for repeat surgeries.

Unraveling Smooth Muscle-rich Renal Cell Carcinoma: Clinical, Oncological, Genetic, and Pathological Insights.

A0261 Functional status at admission predicts prolonged hospital stay after renal surgery: The hidden value of nursing assessments