Current Urology Reports最新文献

Purpose of review: Postoperative prolapse recurrence is not uncommon, despite advances in surgical options and techniques. There is no consensus on the optimal approach to guide counseling and management for patients with recurrent prolapse following surgical repair.

Recent findings: Risk factors for postoperative prolapse recurrence include patient factors, pelvic floor factors, and surgical approach. There are various definitions for prolapse recurrence, including anatomic measures and patient reported symptoms. The highest rate of prolapse recurrence is seen within two years of initial surgery. Retreatment for prolapse requires shared decision-making, considering the patient's symptomatology, anatomy, comorbidities, and long-term goals. There is limited data regarding the long-term success of reoperation for pelvic organ prolapse. Anatomic and patient factors that affect surgical re-treatment outcomes for recurrent prolapse are not well understood. Standardized definitions of prolapse recurrence and more long-term data are necessary to inform evidence-based treatment decisions.

Purpose of review: This contemporary review paper analyzes the impact of fluid reduction in overactive bladder and associated factors related to nephrolithiasis.

Recent findings: Historically, overactive bladder and nephrolithiasis have been considered separate urologic pathologies. However, patients with OAB symptoms often restrict fluid intake to prevent episodes of urinary incontinence with resultant supersaturated urine, which precipitates nephrolithiasis formation. Coexistent pathologies promote the relationship between overactive bladder and nephrolithiasis, including urinary tract infection-related urolithiasis, bladder stones secondary to voiding dysfunction, and genitourinary syndrome of menopause. Overactive bladder and nephrolithiasis are profoundly impacted by fluid intake. The approach to overactive bladder should aim to optimize quality of life primarily by managing symptoms to avoid patient-imposed fluid intake restriction. By promoting patient confidence to consume the recommended daily fluid intake, nephrolithiasis formation risk is reduced. Eradication of other coexistent pathologies will further reduce overactive bladder symptoms and decrease stone formation.

Purpose of review: To summarize the evolution and future of technologies and techniques that assist in providing good functional outcomes during nerve-sparing robot-assisted radical prostatectomy.

Recent findings: Recent data underscore the value of preoperative optimization, including structured weight loss and pharmacologic interventions such as GLP-1 receptor agonists, in facilitating safer and more precise nerve-sparing. Advances in imaging and surgical planning, including 3D modeling and augmented reality, have enhanced anatomic visualization and margin control. Intraoperative adjuncts such as frozen section analysis (NeuroSAFE), nerve mapping and fluorescence guidance are being evaluated to minimize neural injury. Next-generation robotic systems incorporating haptic feedback and intraoperative penile oxygen monitoring may provide real-time functional assessment. Early series suggest these technologies can improve early continence and potency recovery, though long-term validation is needed. The future of nerve-sparing prostatectomy lies in a precision-based, multimodal framework that integrates advanced imaging, intraoperative functional assessment, and patient-specific rehabilitation strategies. While robotic surgery has established a new benchmark for anatomic preservation hold promise for improving both oncologic and quality-of-life outcomes. Rigorous validation and standardized reporting will be critical to moving these innovations from investigational use into routine practice.

Purpose of review: Urosymphyseal Fistula (USF) is a rare, often debilitating condition in which the urinary tract fistulizes with the pubic bone, resulting in recurrent pubic osteomyelitis (POM) from urinary tract seeding. These injuries commonly arise in the setting of pelvic radiation and are generally preceded by instrumentation of the lower urinary tract for obstruction. USFs tend to be recognized only after patients fail to recover from multiple lower urinary tract infections, resulting in repeat hospital readmissions. While fistula closures with urinary tract reconstruction have been described, treatment of USF is often complex and is best treated via urinary diversion with pubic bone debridement in the setting of preoperative optimization and long-term postoperative antibiotic regimens. The general understanding of USF presentation, work-up, and management is largely based on retrospective reviews with small sample sizes and case reports. Here we review the etiology, diagnosis, and considerations when providing care for this complex condition and propose a management algorithm to guide care.

Recent findings: Recent data on USF remain limited, with the literature dominated by small, retrospective case series and single-institution reviews. Most published studies report on cohorts of fewer than 30 patients, often focusing on men with a history of pelvic radiotherapy and subsequent urethral manipulation for prostate cancer. There is a notable absence of formal guidance from professional societies regarding standardized preoperative evaluation, diagnostic criteria, antimicrobial regimens, surgical techniques, or follow-up protocols for this condition. The literature published in the past 18 months continues to be sparse, with fewer than 10 new publications identified, underscoring the rarity of the condition and the ongoing need for multicenter studies and consensus guidelines. The presentation of USF can be quite subtle initially, and thus its diagnosis is nuanced and requires providers maintain a low threshold for further evaluation in high-risk patients with pelvic pain and refractory urinary tract infections. Here, we propose a comprehensive management pathway, informed by the current data, data from relevant related disease processes and institutional experience, that begins with contrast-enhanced imaging, preoperative medical optimization, and early involvement of infectious disease and surgical subspecialists to support perioperative and intraoperative planning and management. Ultimately, long durations of culture-directed antibiotics as well as surgical debridement with cystectomy, pubectomy, and urinary diversion is the most definitive method for cure of this condition. Long-term, high-volume studies on management and outcomes in these patients have yet to be performed.

Purpose of review: The review aims to understand how well patients follow dietary recommendations to prevent kidney stone recurrence and to identify strategies that can enhance their compliance with these dietary guidelines.

Recent findings: The review found that adherence to dietary prevention measures for nephrolithiasis is generally low, with only about 30% of patients following recommendations. Factors affecting adherence include education, comorbidities, and misconceptions. Strategies to improve adherence include clear communication, tailored plans, and the use of technology like mHealth and telemedicine. This mini review assesses patient adherence to dietary prevention measures for nephrolithiasis and explores methods to maintain or improve it. The review identifies factors affecting adherence, such as limited education, poverty, and misconceptions about the disease. It emphasizes the importance of clear communication, tailored dietary plans, and regular monitoring by healthcare providers to enhance patient compliance and improve health outcomes.

Purpose of review: Robot-assisted partial nephrectomy (RAPN) has become the gold standard for treating localized renal cell carcinoma (RCC) in high-volume centres. However, increasing tumor complexity demands refined preoperative planning tools. This review summarizes current evidence regarding the use of three-dimensional virtual models (3DVM) in RAPN, focusing on their clinical applications, outcomes and future perspectives.

Recent findings: 3DVMs are generated from contrast-enhanced CT scans through segmentation and reconstruction, enabling interactive anatomical visualization. These models provide functional tools such as perfusion territory mapping, volumetric renal function prediction and nephrometry-based complexity stratification. Integration with augmented reality (AR) platforms allows real-time intraoperative navigation. Comparative studies and meta-analyses demonstrate that 3DVM-guided RAPN is associated with reduced warm ischemia time (WIT), lower estimated blood loss (EBL), higher trifecta/pentafecta achievement and improved postoperative renal function, particularly in complex tumors. Additionally, 3DVM enhance surgical education and patient counselling. 3DVM represent a pivotal advancement in personalized urologic surgery. By improving anatomical comprehension, surgical precision, and planning of selective ischemia strategies, they contribute to superior intraoperative and functional outcomes in RAPN. Although promising, broader implementation requires standardization, cost-effectiveness validation and further multicentre prospective studies.

Purpose of review: This manuscript provides a comprehensive review of the risks of radiation exposure in endourology and highlights strategies to ensure the health and safety of endourologists during pregnancy.

Recent findings: Recent studies have measured radiation exposure to endourologists during fluoroscopic procedures, underscoring the role of protective measures such as lead shielding, low-dose fluoroscopy, and pulsed imaging to significantly reduce radiation doses. Adherence to these strategies enables endourologists to safely perform fluoroscopic procedures throughout pregnancy while staying within recommended exposure limits. This review outlines the latest research on radiation exposure in endourology with a focus on exposure risks during pregnancy. Major findings include insights into potential stochastic and dose-dependent effects of radiation exposure on pregnant endourologists and their fetuses as well as effective dose-reduction strategies to mitigate these risks. Further research is needed to improve individual understanding of exposure risks and establish standardized institutional and policy frameworks for radiation safety during pregnancy.

Purpose of review: This narrative review summarizes the evolution of the artificial urinary sphincter (AUS) and its role in treating male stress urinary incontinence (SUI). This review discusses the history of AUS and changes that have helped drive current and future developments in AUS innovation.

Recent findings: Recent AUS models have addressed many shortcomings of prior devices designed for the treatment of SUI. However, the need for manual pumping as well as the risks of erosion, infection, and malfunction remain areas of concern, prompting innovative transformations to AUS development. The AUS is the gold standard and most effective treatment for male SUI. Currently available devices have limitations, especially in patients with reduced manual dexterity and cognition. Additionally, there are inherent risks for urethral erosion and device failure. Despite the efficacy and success of modern-day AUS devices, there is still opportunity for innovation in the AUS market. This includes the advent of electronic assisted devices as well as adjustable and variable pressure mechanisms to create dynamic artificial sphincters that minimize complications while maximizing patient outcomes.

Purpose of review: To provide a primer for how augmented reality (AR)-guided surgical technology works at a fundamental level and discuss recent advances and limitations in a rapidly advancing field, including studies aiming to reduce current issues limiting wider adoption.

Recent findings: Among the studies published within the last five years, AR-guided technologies have advanced from pre-operative planning to intraoperative use in procedures including robot-assisted radical prostatectomy, percutaneous nephrolithotomy, and renal transplantation. Artificial intelligence (AI) and deep learning techniques have allowed for development of automatic registration to address challenges with soft tissue deformation. Subspecialities which may benefit from further AR/MR adoption include reconstructive and andrology, which were underrepresented in our review. Augmented reality refers to the process of superimposing digital information (e.g., preoperative imaging) on top of the physical world. Along with its interactive counterpart, mixed reality (MR), AR has become an area of sustained research interest in the urological surgery space. This technology has significant implications for surgical accuracy, efficiency, and medical education. As a result, it is critical for clinicians to both be aware of advancements in the field and understand the basics of this technology. We discuss articles published from March 2021 to February 2025, across a range of urologic procedures and applications, and discuss how recent trends point to a shift towards higher-powered, prospective studies incorporating intraoperative usage of AR/MR.