Abstract in English:

ABSTRACT Introduction: Telesurgery allows the procedures to be carried out over long distances, however due to lack of data, its feasibility has not been consolidated yet. Since it is a promising modality, it is important to illustrate the current scenario on this subject. Objective: To review the literature aiming at the surgical success rate as a primary objective, and secondly, the most important patient outcomes and the network system. Materials and Methods: In June 2024, we followed PRISMA guidelines to research trials on urological robotic surgery in humans. We used as exclusion criteria: editorials, specialist's opinions, tele-mentoring, tele-training, small procedures, non-remote surgeries, absence of interest outcomes, telesurgeries in non-humans or in cadaver. Results: Five hundred and ninety eight studies were identified with peer review and a third reviewer for divergencies, both directed by previously established inclusion and exclusion criteria, selecting 6 studies after the exclusions. We found 54 patients who underwent urological telesurgeries; all of them were accomplished with no complications or need for conversion to open surgery. Almost all the procedures were carried out in China (98.14%) and the most used robotic model was MicroHand S (83.33%). Nephrectomy was the procedure of choice (57%). Mean surgical time was 66.2 (IQR) 56.6 minutes. Intraoperative bleeding time was 68.6 ± 76.7 milliliters. Hospital stay was 5.5 (IQR) 5 days. The distance between main surgeon and the patient was between 2,581.5 (IQR) 2,871 kilometers. 5G network was used the most (98.14%). The total network latency time was 176 (IQR) 10.9 milliseconds. Conclusion: Despite its limitations, there was evidence demonstrating that robotic surgery in the genitourinary system is safe and feasible, however it is a subject that must be well discussed, and further studies must be carried out.

Abstract in English:

ABSTRACT Objective: This meta-analysis aimed to evaluate the predictive value of multiparametric magnetic resonance imaging (mpMRI), specifically T2-weighted imaging (T2WI) and apparent diffusion coefficient (ADC) maps, in the pathological grading of prostate cancer. Methods: A comprehensive literature search was conducted across multiple databases, including PubMed, the China National Knowledge Infrastructure dataset, Web of Science, Springer Link and Cochrane Library. Studies evaluating the use of mpMRI for prostate cancer grading were included. The quality of the included studies was assessed using the risk of bias tool. Meta-analyses were performed to calculate pooled areas under the curve (AUC) and prostate cancer detection rates. Results: Seven studies met the inclusion criteria, comprising 843 patients in the experimental group and 962 in the control group. The meta-analysis revealed a significant improvement in diagnostic performance with mpMRI, with a pooled mean difference in AUC of 0.10 (95% confidence interval [CI]: 0.04–0.16, p = 0.002) favouring the mpMRI group. The odds ratio for prostate cancer detection was 2.60 (95% CI: 1.57–4.29, p = 0.0002), indicating a higher detection rate with mpMRI compared with standard techniques. Substantial heterogeneity was observed among the studies (I² = 73% for AUC and 66% for detection rate). Conclusion: This meta-analysis demonstrates that mpMRI, particularly T2WI and ADC imaging, has a significant predictive value in the pathological grading of prostate cancer. The technique shows improved diagnostic accuracy and higher cancer detection rates compared with conventional methods. However, the substantial heterogeneity among studies suggests that standardisation of mpMRI protocols and interpretation criteria is needed.

Abstract in English:

ABSTRACT Objective: This systematic review and meta-analysis aim to consolidate current evidence on the diagnosis, epidemiology, and treatment of urachal carcinoma, a rare malignancy with limited data. Materials and Methods: A systematic search of PubMed/MEDLINE was conducted up to September 2024 to identify studies involving patients with urachal carcinoma, reporting clinical epidemiological characteristics, diagnostic strategies, histopathological findings, tumor staging, treatment modalities, and oncological outcomes. Extracted data were systematically synthesized, and statistical analyses, including a single-arm meta-analysis, were performed to comprehensively evaluate oncological outcomes. Results: Our study includes 1,901 cases of urachal carcinoma from 50 studies. The findings support the oncologic advantage of en-bloc resection with umbilectomy in localized disease, demonstrating improved survival outcomes and reduced recurrence rates. In the adjuvant setting, those receiving cisplatin-based therapy presented the best response, with 65.73% with no disease progression; similarly, in the metastatic disease, cisplatin-based regimens seem to have better responses in metastatic disease. The single-arm meta-analysis estimated a 5-year overall survival rate of 51% (95% CI: 0.49–0.54). Tumor recurrence was documented in 35% of cases (95% CI: 0.25–0.45), with local recurrence occurring in 28% (95% CI: 0.18–0.38), with the average time to recurrence of 27.6 months. Conclusion: Our study provides the most comprehensive review of urachal carcinoma to date, providing evidence to guide clinical decisions. It underscores the oncologic benefits of en-bloc resection with umbilectomy and specific chemotherapeutic regimens. Emerging alternative therapies also show potential, highlighting the need for further research to optimize patient outcomes.

Abstract in English:

ABSTRACT Magnetic Resonance Urography (MRU) has emerged as a powerful imaging modality in pediatric urology, offering comprehensive anatomical and functional assessment of the urinary tract without exposure to ionizing radiation. This review provides an in-depth analysis of MRU's technical aspects, clinical applications, advantages, and recent advancements. Traditional imaging techniques, such as ultrasound, voiding cystourethrography, and nuclear scintigraphy, have long been utilized for evaluating pediatric urinary tract anomalies; however, these methods have inherent limitations in anatomical resolution and functional assessment. MRU combines high-resolution anatomical imaging with dynamic functional analysis, making it particularly valuable in evaluating conditions such as hydronephrosis, ureteropelvic junction obstruction, and ectopic ureters. Advancements in MRU technology, including the use of 3T MRI for superior spatial resolution, diffusion-weighted imaging, and dynamic contrast-enhanced imaging, have enhanced its diagnostic capabilities. The ability to assess renal transit times and differential renal function allows for precise evaluation of obstructive uropathies and congenital anomalies. Despite requiring sedation in younger children and longer acquisition times, MRU has demonstrated superior accuracy compared to conventional imaging, reducing the need for multiple diagnostic studies. Recent developments in real-time MRI, faster imaging techniques, and AI-based reconstructions have further optimized MRU's efficiency and diagnostic utility. As MRU continues to evolve, its role in pediatric urology is expected to expand, potentially replacing traditional imaging modalities in select cases. This review highlights the growing significance of MRU in pediatric urinary tract evaluation, emphasizing its potential to improve clinical decision-making and patient outcomes.

Abstract in English:

ABSTRACT Purpose: This narrative review aims to provide the most updated knowledge regarding the treatment of adverse effects secondary to testosterone replacement therapy (TRT), such as gynecomastia, cardiovascular and hematologic risks, prostate health risk, and liver dysfunction risks. Materials and Methods: An extensive literature review was conducted, incorporating guidelines from the American Urological Association and the Endocrine Society. The studies determined common adverse effects and their most common methods of management. Results: TRT improves the quality of life, sexual function, and mood in hypogonadal men. Possible adverse effects associated with TRT include increased estrogen levels and gynecomastia, which are usually managed with aromatase inhibitors and tamoxifen. Cardiovascular risks from TRT include hypertension and erythrocytosis, which mandate periodic hematocrit and blood pressure monitoring; therapeutic phlebotomy is indicated if the hematocrit exceeds 52%. No significant concern regarding prostate cancer has been observed in the closely monitored patient. However, TRT should not be administered to individuals with active evidence of untreated prostate cancer, except under rare circumstances such as active surveillance for very low-risk disease. Older oral forms of TRT can affect liver function; therefore, transdermal, newer oral forms and injectables are generally favored in men with a history of liver disease. Conclusions: Monitoring and management of adverse effects are critical to maximize benefit and minimize the risks of TRT. Ongoing research will further elucidate the safety of TRT while advancing evidence-based practices in managing its associated adverse effects. Effective patient education and counseling are also essential to improve compliance and treatment outcomes.

Abstract in English:

ABSTRACT Introduction: The insidious interrelation between three key factors underscores the critical need to understand the neural control of the lower urinary tract (LUT): the complexity of its functioning, the epidemiology of conditions that can disrupt it, and the nonspecific presentation of related symptoms. This paper examines the importance of understanding neurophysiology of micturition to prevent mismanagement and reduce unnecessary procedures. Material and Methods: This review focuses on the neurophysiology of the micturition cycle, the epidemiology of major health conditions that affect it, and the nonspecific nature of lower urinary tract symptoms (LUTS) concerning underlying pathologies. The review was conducted in accordance with the guidelines of the Scale for Assessment of Narrative Review Articles (SANRA). Only articles in English were included, while case reports, editorials, and expert opinion pieces were excluded. Results: The ability of the LUT to store and release urine requires precise coordination and is mediated by a complex network involving the brain, spinal cord, peripheral ganglia, and nerves. Epidemiological data reveal a growing global burden of diseases that impact LUT functioning (LUTF). Moreover, the nonspecific nature of LUTS often leads to diagnostic challenges, and inappropriate treatment strategies. Conclusion: The interplay between the complexity of LUTF, the widespread prevalence of conditions that can disrupt it, and the nonspecific nature of related symptoms frequently complicate urological decision-making. Overlooking associated neurological factors can result in suboptimal outcomes, diminished quality of life, and serious adverse consequences. A systematic approach is crucial to minimizing the risk of misdiagnosis and mismanagement, especially when considering invasive interventions.

Abstract in English:

ABSTRACT Purpose: To compare the external validation of four existing scoring systems for encrusted ureteral stents (EUS) and their relationship with stent indwelling time, stone-free rates, multiple surgery sessions, multimodal procedures, and prolonged operation times exceeding 120 minutes in total. Materials and Methods: The data of 208 patients who underwent surgery for EUS reviewed. All EUSs were evaluated with 4 scoring systems: ESB (encrusted stone burden), FECal (forgotten, encrusted, calcified), KUB (kidney, ureter and bladder), V-GUES (visual grading for ureteral stone burden). Results: As the duration of stent indwelling time prolonged, a significant increase is observed in the scores of ESB, FECal, KUB and V-GUES systems (p<0.001). In multivariate logistic regression analysis, V-GUES score (p=0.025) and stent indwelling time (p=0.014) in stone-free rate, FECal grade (p<0.001) in multimodal procedure requirement, FECal (p=0.002) and V-GUES (p=0.032) scores in multiple surgery sessions, and stent indwelling time (p=0.019) and KUB score (p<0.001) in prolonged operation time were found to be predictors. When the area under receiver operating characterictic (ROC) curves (AUC) of the nomograms were examined, V-GUES score (AUC=0.685) in stone-free rate, FECal grade (AUC=0.780) in multimodal procedure requirement, FECal grade (AUC=0.845) in multiple surgery sessions, and KUB score (AUC=0.860) in prolonged operation time were found to be superior. Conclusions: The management of EUSs is often challenging for urologists. Although the current scoring systems for EUS differ somewhat, it is important to use scoring systems to guide the management of these patients.

Abstract in English:

ABSTRACT Objectives: Radical cystectomy (RC) is a surgical procedure associated with high rates of morbidity. The aim of the study is to provide a comparison between robotic (RARC) and open RC (ORC) in patients elected to cutaneous ureterostomy (CUS). Materials and Methods: This is a retrospective single-center cohort study performed at a high-volume institution. The study involved 64 patients undergoing RC with CUS, 42 ORC and 22 RARC. The indication for RC was based on EAU guidelines and the choice of CUS was planned due to advanced oncological stage or patient's frailty. Patient allocation to the robotic or open approach for RC was casual, determined by surgeon preference and/or the availability of a robotic operating room. The Adverse events were systematically graded utilizing the Clavien–Dindo classification system. Results: Complications of Clavien Dindo ≥ 2 occurred in 27 out of 42 (64.2%) ORC and 3/22 (13.6%) RARC (p < 0.001); complications of Clavien Dindo ≥ 3 occurred in 10/42 (23.8%) ORC and only 1/22 (4.5%) RARC, respectively (p = 0.08). Multivariable analysis revealed that robotic surgery was the only variable inversely associated with Clavien Dindo ≤ 2 complications. Conclusions: In conclusion, RARC appears to be associated with lower morbidity and reduced incidence of complications, elements that make it particularly suitable for frail patients with an elective indication for CUS.

Abstract in English:

ABSTRACT Objectives: This study, conducted by the Bladder Cancer in Latin America (BLATAM) group, aims to analyze epidemiological and therapeutic data on non-muscle invasive bladder cancer (NMIBC) in Latin American patients. It seeks to identify factors contributing to suboptimal responses to Bacillus Calmette-Guérin (BCG) therapy and assess areas for improvement in regional treatment practices. Materials and Methods: A multicenter retrospective study was carried out in collaboration with reference Urology Departments across Latin America. Data were collected using an electronic Case Report Form (CRF) from 2011 to 2021, capturing demographics, clinical presentation, treatment details, and follow-up of NMIBC patients treated with BCG. Statistical analyses included Kaplan-Meier survival analysis for relapse-free survival (RFS). Results: Data from 292 patients across five countries were analyzed, with a mean age of 70.3 years and a male prevalence of 74%. Smoking history was reported in 70.6% of patients. The mean time to the first BCG dose was 2.4 months post-TURBT, with 26.7% of patients exceeding the recommended 60-day window for induction initiation. While 84% of patients completed BCG induction, only 45.9% followed the recommended Lamm maintenance schedule. Delays in starting maintenance cycles were observed, with a median delay of over 36 days for the first cycle and 65 days for the second cycle. RFS at 1 year and 5 years for high-risk patients was 87.3% and 53.3%, respectively. Conclusions: This study highlights critical deviations from recommended NMIBC management protocols in Latin America, including delayed BCG initiation and inconsistencies in maintenance therapy. These findings emphasize the need for standardized treatment protocols and improved adherence to international guidelines, which could enhance NMIBC patient outcomes in the region. Collaborative efforts are essential to develop region-specific strategies, improve data collection, and ultimately provide better care for bladder cancer patients in Latin America.

Abstract in English:

ABSTRACT We describe the novel use of dynamic sentinel node biopsy (DSNB) in five patients with primary urethral squamous cell carcinoma (U-SCC) and no evidence of inguinal node disease across two centers in North America and Europe between 03/2021 and 06/2024. Each of these referral centers sees over 75 cases of penile cancer per year and approximately 10 cases of U-SCC per year. Patients underwent DSNB concomitant to surgical resection of the primary tumor (n=3), or in a deferred manner (n=2), six weeks after primary surgery. In the five DSNBs performed, clinically occult nodal metastasis was discovered in one patient. In this patient DSNB was performed after local recurrence and repeat imaging confirming cN0 status. Only one minor complication with DSNB was observed. Awaiting further investigations in larger series, this study highlights the feasibility of DSNB in primary U-SCC with clinically node negative disease.

Abstract in English:

ABSTRACT Background: Knowledge of the anatomy of laboratory animals is important for experimental research. Erectile dysfunction has been studied using the penises of different laboratory animals such as rats, mice, rabbits, dogs, etc. However, these animals have penises with different characteristics to the human penis. If these differences are not taken into account, the conclusions may be questionable. The Rhesus monkey (Macaca mulatta), due to its similarities to humans, could be a good model. Objective: To characterize and quantify the components of the penis of the Rhesus monkey (Macaca mulatta), qualifying it as a model for experimental studies. Methods: Ten adult Rhesus monkey penises were fixed in 10% buffered formalin and processed for paraffin embedding. Histological sections 5-μm thick were made and stained using histochemical techniques. We assessed the thickness of the tunica albuginea, and in the erectile tissue, the following parameters were analyzed: in the corpus cavernosum (CC): total area, area densities of collagen fibers, muscle fibers and elastic system fibers; in the corpus spongiosum (CS): area densities of collagen fibers, muscle fibers and elastic system fibers. Histomorphometric analyses were carried out on photomicrographs by using ImageJ software. Results: The penis of the Rhesus monkey (Macaca mulatta) has a single CC. The tunica albuginea was thicker in the dorsal region (1.11 ± 0.03 mm) than in the ventral region (0.87 ± 0.01 mm). The quantitative analysis of the CC showed the following values: total area (20.33 ± 5.67 mm²), collagen fibers (24.00 ± 4.00%), muscle fibers (31.52 ± 9.93%) and elastic system fibers (8.46 ± 3.20%). The quantitative analysis of the CS showed the following values: collagen fibers (52.50 ± 11.76%), muscle fibers (10.50 ± 6.36%) and elastic system fibers (15.07 ± 4.78%). Conclusion: The predominance of muscle tissue over connective tissue in the corpus cavernosum, similar to what is observed in humans, qualifies the Rhesus monkey penis as a good experimental model for erectile dysfunction.

Abstract in English:

ABSTRACT Introduction: Urothelial carcinomas (UC) represent the sixth most common tumor by incidence, involving the lower or upper urinary tracts (UTUC) (1). High-risk patients should be treated by nephroureterectomy with complete bladder cuff excision (2), conservative approach is reserved for low-risk UTUCs and/or imperative cases (3). Materials and Methods: We present a 70-year-old male patient, smoker, with history of urothelial carcinoma. He underwent distal ureterectomy with ileal replacement in April 2019. Since then, he has developed several UTUC recurrences bilaterally and in the bladder, which have been treated conservatively. In August 2023, CT- scan showed multiple recurrences in the left kidney and ureter. Hence, on November 2023, we performed cystoscopy, monopolar resection of bladder tumor and bilateral flexible ureteroscopy (fURS) with pulsed thulium:YAG (p-Tm:YAG) ablation of the tumors. We performed a no-touch technique fURS with Video Uretero-Renoscope FLEX-XC1 by Storz. After this, we placed an ureteral access sheath and then a biopsy by using a tipless basket. The laser fiber used was 272 μm and the laser settings were 0.8 J – 10 Hz – Long pulse Ablation (10 W). Results: The pathological results showed UTUC bilaterally and high-grade UC in the bladder. Then, he underwent intravenous therapy with enfortumab - vedotin and the follow-ups, in February 2024 and June 2024, showed no evidence of recurrences at the multiple biopsies. Conclusion: The p-Tm:YAG laser can be considered a valid alternative option for the conservative treatment of UTUCs. With that said, stringent follow-up remains a mainstay in the conservative treatment of imperative cases of UTUC.

Abstract in English:

ABSTRACT Introduction: Penile cancer is a rare but aggressive malignancy, with inguinal lymph node involvement representing a key prognostic indicator (1, 2). NCCN guidelines recommend prophylactic inguinal lymph node dissection (ILND) for intermediate-to-high-risk patients (pT1b, ≥T2) with non-palpable nodes, aiming for early staging and improved outcomes (3). The SP-approach employs a single incision and advanced robotic instrumentation to enhance maneuverability, reduce morbidity, and optimize recovery. Widely used in kidney and prostate surgery (4, 5), this is, to our knowledge, its first application for ILND in Europe. Material and Methods: This video shows a novel robotic-assisted bilateral, superficial and deep ILND using the DaVinci SP™ system. In this patient, a preoperative 3D reconstruction allowed detailed visualization of lymph nodes and surrounding structures, enabling precise dissection and an improved intraoperative orientation using Tilepro feature. Results: Compared to open techniques, robotic ILND offers similar lymph node yields with superior cosmetic outcomes and reduced postoperative pain (6). These benefits are amplified with the SP system, which excels in the constrained inguinal region by minimizing instrument interference and enhancing efficiency (7). Fewer incisions minimized risks such as wound infections and skin necrosis (8). Limitations of the SP-technique might include extended operative times, especially during the learning phase, and the absence of long-term oncological data. Additionally, complex cases requiring concurrent pelvic lymphadenectomy may necessitate repositioning the robotic system, increasing procedure time. Conclusions: SP robotic-assisted ILND can represent a significant advancement in the surgical management of penile cancer, combining oncological safety with reduced surgical morbidity. Future studies are needed to validate these findings, compare surgical outcomes, and assess long-term efficacy.