Pub Date : 2025-03-03DOI: 10.1016/j.euros.2025.02.003
Giuseppe Reitano , Arianna Tumminello , Umar Ghaffar , Giorgio Saggionetto , Alessandra Taverna , Francesco Mangiacavallo , Mohamed E. Ahmed , Spyridon P. Basourakos , Filippo Carletti , Davide Minardi , Massimo Iafrate , Alessandro Morlacco , Giovanni Betto , R. Jeffrey Karnes , Fabrizio Dal Moro , Fabio Zattoni , Giacomo Novara
<div><h3>Background and objective</h3><div>Robot-assisted surgery (RAS) has steadily become more prevalent in urology. The Da Vinci multiport surgical robot (DVM-SR) continues to lead the field. In recent years, new multiport surgical robots (NM-SRs) have been introduced to the market; however, their safety and efficacy remain unassessed. This study aims to give a comprehensive evaluation of the perioperative, oncological, and functional outcomes of NM-SRs and a comparison with the DVM-SR.</div></div><div><h3>Methods</h3><div>A systematic search was performed in PubMed, Scopus, Web of Science, Embase, and clinicaltrial.gov to identify studies that evaluate NM-SRs in major urological surgeries assessing perioperative, functional, and oncological endpoints. A meta-analysis was performed comparing NM-SRs with the DVM-SR for safety, and functional and oncological outcomes.</div></div><div><h3>Key findings and limitations</h3><div>Seventy-four studies involving 5487 patients were included in the review. Nine platforms were studied: Hinotori, Hugo RAS, Revo-I, Versius, Avatera, Senhance, KangDuo Surgical Robot-01, Dexter, and Toumai. NM-SRs were used to perform robot-assisted radical prostatectomy (RARP; 41 studies), partial nephrectomy (RAPN; 14 studies), radical nephrectomy (RARN; four studies), adrenalectomy (four studies), nephroureterectomy (two studies), RARN and thrombectomy (one study), colpopexy (four studies), pyeloplasty (seven studies), simple nephrectomy (four studies), simple prostatectomy (three studies), and ureteral surgery (four studies). Cystectomies with NM-SRs were described only in case reports and were excluded. The comparative analysis between NM-SRs and the DVM-SR showed similar outcomes in terms of intraoperative SATAVA grade ≥2 complications (odds ratio [OR] 0.89, 95% confidence interval [CI] 0.25, 3.1, <em>p</em> = 0.9 for RARP and OR 0.59, 95% CI 0.11, 3.3, <em>p</em> = 0.5 for RAPN), postoperative high-grade complications (Clavien-Dindo ≥IIIa, OR 0.85, 95% CI 0.4, 2, <em>p</em> = 0.7 for RARP and OR 0.59, 95% CI 0.1, 3.3, <em>p</em> = 0.6 for RAPN), and positive surgical margins (OR 0.90, 95% CI 0.72, 1.1, <em>p</em> = 0.3 for RARP and OR 1.65, 95% CI 0.3, 9.1, <em>p</em> = 0.6 for RAPN). For patients undergoing RARP, biochemical recurrence and urinary continence rates at 3 mo were comparable (OR 0.99 [95% CI 0.5, 1.8, <em>p</em> = 1] and OR 0.99 [95% CI 0.77, 1.3, <em>p</em> = 0.9], respectively). The achievement of the trifecta for RAPN appeared to be similar between the included studies on NM-SRs and the DVM-SR (OR 1.3, 95% CI 0.4, 4.4, <em>p</em> = 0.7). The small sample size of the included studies and the preliminary nature of the results represent the major limitations.</div></div><div><h3>Conclusions and clinical implications</h3><div>When compared with the DVM-SR, NM-SRs may offer similar safety, and oncological and functional outcomes across most surgeries for both benign and malignant diseases. Further research
{"title":"Perioperative, Oncological, and Functional Outcomes of New Multiport Robotic Platforms in Urology: A Systematic Review and Meta-analysis","authors":"Giuseppe Reitano , Arianna Tumminello , Umar Ghaffar , Giorgio Saggionetto , Alessandra Taverna , Francesco Mangiacavallo , Mohamed E. Ahmed , Spyridon P. Basourakos , Filippo Carletti , Davide Minardi , Massimo Iafrate , Alessandro Morlacco , Giovanni Betto , R. Jeffrey Karnes , Fabrizio Dal Moro , Fabio Zattoni , Giacomo Novara","doi":"10.1016/j.euros.2025.02.003","DOIUrl":"10.1016/j.euros.2025.02.003","url":null,"abstract":"<div><h3>Background and objective</h3><div>Robot-assisted surgery (RAS) has steadily become more prevalent in urology. The Da Vinci multiport surgical robot (DVM-SR) continues to lead the field. In recent years, new multiport surgical robots (NM-SRs) have been introduced to the market; however, their safety and efficacy remain unassessed. This study aims to give a comprehensive evaluation of the perioperative, oncological, and functional outcomes of NM-SRs and a comparison with the DVM-SR.</div></div><div><h3>Methods</h3><div>A systematic search was performed in PubMed, Scopus, Web of Science, Embase, and clinicaltrial.gov to identify studies that evaluate NM-SRs in major urological surgeries assessing perioperative, functional, and oncological endpoints. A meta-analysis was performed comparing NM-SRs with the DVM-SR for safety, and functional and oncological outcomes.</div></div><div><h3>Key findings and limitations</h3><div>Seventy-four studies involving 5487 patients were included in the review. Nine platforms were studied: Hinotori, Hugo RAS, Revo-I, Versius, Avatera, Senhance, KangDuo Surgical Robot-01, Dexter, and Toumai. NM-SRs were used to perform robot-assisted radical prostatectomy (RARP; 41 studies), partial nephrectomy (RAPN; 14 studies), radical nephrectomy (RARN; four studies), adrenalectomy (four studies), nephroureterectomy (two studies), RARN and thrombectomy (one study), colpopexy (four studies), pyeloplasty (seven studies), simple nephrectomy (four studies), simple prostatectomy (three studies), and ureteral surgery (four studies). Cystectomies with NM-SRs were described only in case reports and were excluded. The comparative analysis between NM-SRs and the DVM-SR showed similar outcomes in terms of intraoperative SATAVA grade ≥2 complications (odds ratio [OR] 0.89, 95% confidence interval [CI] 0.25, 3.1, <em>p</em> = 0.9 for RARP and OR 0.59, 95% CI 0.11, 3.3, <em>p</em> = 0.5 for RAPN), postoperative high-grade complications (Clavien-Dindo ≥IIIa, OR 0.85, 95% CI 0.4, 2, <em>p</em> = 0.7 for RARP and OR 0.59, 95% CI 0.1, 3.3, <em>p</em> = 0.6 for RAPN), and positive surgical margins (OR 0.90, 95% CI 0.72, 1.1, <em>p</em> = 0.3 for RARP and OR 1.65, 95% CI 0.3, 9.1, <em>p</em> = 0.6 for RAPN). For patients undergoing RARP, biochemical recurrence and urinary continence rates at 3 mo were comparable (OR 0.99 [95% CI 0.5, 1.8, <em>p</em> = 1] and OR 0.99 [95% CI 0.77, 1.3, <em>p</em> = 0.9], respectively). The achievement of the trifecta for RAPN appeared to be similar between the included studies on NM-SRs and the DVM-SR (OR 1.3, 95% CI 0.4, 4.4, <em>p</em> = 0.7). The small sample size of the included studies and the preliminary nature of the results represent the major limitations.</div></div><div><h3>Conclusions and clinical implications</h3><div>When compared with the DVM-SR, NM-SRs may offer similar safety, and oncological and functional outcomes across most surgeries for both benign and malignant diseases. Further research ","PeriodicalId":12254,"journal":{"name":"European Urology Open Science","volume":"74 ","pages":"Pages 44-70"},"PeriodicalIF":3.2,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143534472","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-21DOI: 10.1016/j.euros.2025.02.001
Daniele Amparore , Federico Piramide , Paolo Verri , Enrico Checcucci , Alberto Piana , Giuseppe Basile , Alessandro Larcher , Andrea Gallioli , Angelo Territo , Josep Maria Gaya , Pietro Piazza , Stefano Puliatti , Antonio Andrea Grosso , Andrea Mari , Riccardo Campi , Laura Zuluaga , Ucpinar Burak , Badani Ketan , Sergio Serni , Umberto Capitanio , Francesco Porpiglia
Background and objective
The aim of our study was to compare assessment of PADUA and RENAL nephrometry scores and risk/complexity categories via two-dimensional (2D) imaging and three-dimensional virtual models (3DVM) in a large multi-institutional cohort of renal masses suitable for robot-assisted partial nephrectomy (RAPN), and evaluate the predictive role of these imaging approaches for postoperative complications.
Methods
Patients were prospectively enrolled from six international high-volume robotic centers, calculating PADUA and RENAL-nephrometry scores and their relative categories with 2D-imaging and 3DVMs. The concordance of nephrometry scores and categories between the two approaches was evaluated using χ2 tests and Cohen’s κ coefficient. Receiver operating characteristic curves were plotted to assess the sensitivity and specificity of the 3DVM and 2D approaches for predicting the occurrence of postoperative complications. Multivariable logistic analyses were conducted to identify predictors of major postoperative complications.
Key findings and limitations
A total of 318 patients were included in the study. There was low concordance for nephrometry scores and categories between the 3DVM and 2D assessment methods, with downgrading of PADUA and RENAL scores on 3DVM assessment in 43% and 49% of cases, and downgrading of the corresponding categories in 25% and 26%, respectively. Moreover, 3DVM assessment showed better accuracy than the 2D approach in predicting overall (p < 0.001) and major (p = 0.001) postoperative complications. In line with these findings, multivariable analyses showed that 3DVM-based nephrometry scores and categories were predictive of major postoperative complications (p < 0.001). Limitations include the risk of interobserver variability in evaluating nephrometry scores and categories, production costs for the 3DVMs, and the experience of the surgeons involved, with potential impacts on diffusion of this technology.
Conclusions and clinical implications
In this multi-institutional study, 3DVMs had superior accuracy to 2D images for evaluating the surgical complexity of renal masses and frequently led to downgrading. This could facilitate an increase in recommendations for kidney-sparing surgery and better identification of cases at risk of postoperative complications.
Patient summary
Our study shows that the use of three-dimensional models gives lower complexity scores for kidney tumors in comparison to standard two-dimensional scans. This can improve surgical planning and may boost the use of kidney-sparing techniques and better identification of cases that are more likely to have postoperative complications.
{"title":"Nephrometry Scores Based on Three-dimensional Virtual Models Improve the Accuracy of Predicting Postoperative Complications After Robotic Partial Nephrectomy: Results from a Collaborative ERUS Validation Study","authors":"Daniele Amparore , Federico Piramide , Paolo Verri , Enrico Checcucci , Alberto Piana , Giuseppe Basile , Alessandro Larcher , Andrea Gallioli , Angelo Territo , Josep Maria Gaya , Pietro Piazza , Stefano Puliatti , Antonio Andrea Grosso , Andrea Mari , Riccardo Campi , Laura Zuluaga , Ucpinar Burak , Badani Ketan , Sergio Serni , Umberto Capitanio , Francesco Porpiglia","doi":"10.1016/j.euros.2025.02.001","DOIUrl":"10.1016/j.euros.2025.02.001","url":null,"abstract":"<div><h3>Background and objective</h3><div>The aim of our study was to compare assessment of PADUA and RENAL nephrometry scores and risk/complexity categories via two-dimensional (2D) imaging and three-dimensional virtual models (3DVM) in a large multi-institutional cohort of renal masses suitable for robot-assisted partial nephrectomy (RAPN), and evaluate the predictive role of these imaging approaches for postoperative complications.</div></div><div><h3>Methods</h3><div>Patients were prospectively enrolled from six international high-volume robotic centers, calculating PADUA and RENAL-nephrometry scores and their relative categories with 2D-imaging and 3DVMs. The concordance of nephrometry scores and categories between the two approaches was evaluated using χ<sup>2</sup> tests and Cohen’s κ coefficient. Receiver operating characteristic curves were plotted to assess the sensitivity and specificity of the 3DVM and 2D approaches for predicting the occurrence of postoperative complications. Multivariable logistic analyses were conducted to identify predictors of major postoperative complications.</div></div><div><h3>Key findings and limitations</h3><div>A total of 318 patients were included in the study. There was low concordance for nephrometry scores and categories between the 3DVM and 2D assessment methods, with downgrading of PADUA and RENAL scores on 3DVM assessment in 43% and 49% of cases, and downgrading of the corresponding categories in 25% and 26%, respectively. Moreover, 3DVM assessment showed better accuracy than the 2D approach in predicting overall (<em>p</em> < 0.001) and major (<em>p</em> = 0.001) postoperative complications. In line with these findings, multivariable analyses showed that 3DVM-based nephrometry scores and categories were predictive of major postoperative complications (<em>p</em> < 0.001). Limitations include the risk of interobserver variability in evaluating nephrometry scores and categories, production costs for the 3DVMs, and the experience of the surgeons involved, with potential impacts on diffusion of this technology.</div></div><div><h3>Conclusions and clinical implications</h3><div>In this multi-institutional study, 3DVMs had superior accuracy to 2D images for evaluating the surgical complexity of renal masses and frequently led to downgrading. This could facilitate an increase in recommendations for kidney-sparing surgery and better identification of cases at risk of postoperative complications.</div></div><div><h3>Patient summary</h3><div>Our study shows that the use of three-dimensional models gives lower complexity scores for kidney tumors in comparison to standard two-dimensional scans. This can improve surgical planning and may boost the use of kidney-sparing techniques and better identification of cases that are more likely to have postoperative complications.</div></div>","PeriodicalId":12254,"journal":{"name":"European Urology Open Science","volume":"74 ","pages":"Pages 11-20"},"PeriodicalIF":3.2,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143453283","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-21DOI: 10.1016/j.euros.2025.02.002
Yi-Ju Chou , Chia-Lun Chang , Yao-Chou Tsai
Background and objective
Indocyanine green-guided sentinel lymph node dissection (ICG-SLND) has demonstrated good diagnostic accuracy for lymph node metastasis in prostate cancer. This study aims to perform a meta-analysis of the diagnostic accuracy of ICG-SLND at both the per-patient and the per-node level.
Methods
We conducted a literature search on PubMed and Embase for relevant studies published up to June 2024. The inclusion criteria were prostate cancer patients undergoing radical prostatectomy, ICG-SLND, and subsequent extended pelvic lymph node dissection (ePLND). Data were extracted to calculate the pooled sensitivity and negative predictive value (NPV) at both the per-patient and the per-node level.
Key findings and limitations
Our search identified 13 relevant studies, comprising a total of 748 patients. All studies were assessed as having a low risk of bias. At the per-patient level, the pooled sensitivity of ICG-SLND for diagnosing lymph node metastasis was 0.87 (95% confidence interval [CI]: 0.77–0.92), with a pooled NPV of 0.95 (95% CI: 0.90–0.98). At the per-node level, the pooled sensitivity was 0.53 (95% CI: 0.45–0.62), and the pooled NPV was 0.98 (95% CI: 0.97–0.98). Significant heterogeneity was observed in the per-node level sensitivity, NPV, and sentinel lymph node detection rate outcomes. The primary limitation is the lack of investigation into the impact of ICG-SLND on survival outcomes.
Conclusions and clinical implications
The per-patient level sensitivity of ICG-SLND for diagnosing lymph node metastases is 87%, which better represents the diagnostic accuracy of ICG-SLND than the per-node level sensitivity. As ePLND has demonstrated a positive impact on oncologic outcomes, ICG-SLND cannot yet be recommended as the standard lymph node dissection approach. The significant heterogeneity observed in the pooled results highlights the need for further research to determine the optimal injection methods.
Patient summary
Indocyanine green–guided sentinel lymph node dissection (ICG-SLND) has demonstrated favorable performance for diagnosing lymph node metastases in prostate cancer. The per-patient level sensitivity of ICG-SLND provides better diagnostic performance than its per-node level sensitivity. However, further research is needed for ICG-SLND to be recommended as the standard approach for lymph node dissection.
{"title":"Diagnostic Accuracy of Indocyanine Green–stained Sentinel Lymph Nodes in Prostate Cancer Patients: A Systematic Review and Meta-analysis","authors":"Yi-Ju Chou , Chia-Lun Chang , Yao-Chou Tsai","doi":"10.1016/j.euros.2025.02.002","DOIUrl":"10.1016/j.euros.2025.02.002","url":null,"abstract":"<div><h3>Background and objective</h3><div>Indocyanine green-guided sentinel lymph node dissection (ICG-SLND) has demonstrated good diagnostic accuracy for lymph node metastasis in prostate cancer. This study aims to perform a meta-analysis of the diagnostic accuracy of ICG-SLND at both the per-patient and the per-node level.</div></div><div><h3>Methods</h3><div>We conducted a literature search on PubMed and Embase for relevant studies published up to June 2024. The inclusion criteria were prostate cancer patients undergoing radical prostatectomy, ICG-SLND, and subsequent extended pelvic lymph node dissection (ePLND). Data were extracted to calculate the pooled sensitivity and negative predictive value (NPV) at both the per-patient and the per-node level.</div></div><div><h3>Key findings and limitations</h3><div>Our search identified 13 relevant studies, comprising a total of 748 patients. All studies were assessed as having a low risk of bias. At the per-patient level, the pooled sensitivity of ICG-SLND for diagnosing lymph node metastasis was 0.87 (95% confidence interval [CI]: 0.77–0.92), with a pooled NPV of 0.95 (95% CI: 0.90–0.98). At the per-node level, the pooled sensitivity was 0.53 (95% CI: 0.45–0.62), and the pooled NPV was 0.98 (95% CI: 0.97–0.98). Significant heterogeneity was observed in the per-node level sensitivity, NPV, and sentinel lymph node detection rate outcomes. The primary limitation is the lack of investigation into the impact of ICG-SLND on survival outcomes.</div></div><div><h3>Conclusions and clinical implications</h3><div>The per-patient level sensitivity of ICG-SLND for diagnosing lymph node metastases is 87%, which better represents the diagnostic accuracy of ICG-SLND than the per-node level sensitivity. As ePLND has demonstrated a positive impact on oncologic outcomes, ICG-SLND cannot yet be recommended as the standard lymph node dissection approach. The significant heterogeneity observed in the pooled results highlights the need for further research to determine the optimal injection methods.</div></div><div><h3>Patient summary</h3><div>Indocyanine green–guided sentinel lymph node dissection (ICG-SLND) has demonstrated favorable performance for diagnosing lymph node metastases in prostate cancer. The per-patient level sensitivity of ICG-SLND provides better diagnostic performance than its per-node level sensitivity. However, further research is needed for ICG-SLND to be recommended as the standard approach for lymph node dissection.</div></div>","PeriodicalId":12254,"journal":{"name":"European Urology Open Science","volume":"74 ","pages":"Pages 34-43"},"PeriodicalIF":3.2,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143453282","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-21DOI: 10.1016/j.euros.2025.01.014
Frédéric D. Birkhäuser, Thomas von Rütte, Felix Moltzahn, Philipp Huber, Pascal Zehnder
Background and objective
During laparoscopic pyeloplasty, double-J ureteral stents are routinely placed to protect the anastomosis from urinary leakage. However, no consensus exists on the optimal double-J ureteral stent indwelling time. This study aims to evaluate the impact of a short compared to a long double-J ureteral stent indwelling time on long-term functional outcomes ans complications following minimally invasive pyeloplasty.
Methods
A prospective randomized single-surgeon series compared 2- versus 6-wk indwelling time. Renal scintigraphy was performed preoperatively, and at 6 and 24 mo postoperatively. Diuretic renography was performed 3 mo postoperatively. From year 2 to 5, patients were followed mainly with interviews.
Key findings and limitations
The median follow-up was 66 (range 29–104) mo. Preoperatively, all 82 patients were symptomatic and renal scintigraphy revealed an obstruction. Diuretic renography documented regular morphology and kinetics in all patients at 3 mo. Six months postoperatively, renal scintigraphy detected unobstructed drainage in 84% of patients in group A (2 wk) and in 95% of patients in group B (6 wk; p = 0.237). At 2 yr, the rate of unobstructed drainage increased to 97% in group A and 96% in group B (p = 0.962). In patients with scintigraphically delayed tracer transportation, additional diuretic renography proved regular morphology and contrast media kinetics. No stent-related complications and urinary leakage were observed. All patients were asymptomatic at the last follow-up.
Conclusions and clinical implications
Our long-term data demonstrate that 2 wk of double-J ureteral stenting following pyeloplasty provides similar functional outcome to 6 wk of stenting. Furthermore, no stent-related complications occurred. This finding may safely be applied to all pyeloplasty patients.
Patient summary
Without comprising overall functional success or increasing the rate of complications, patients following minimally invasive pyeloplasty benefit from a short double-J stent indwelling time.
{"title":"A Short Double-J Ureteral Stent Indwelling Time Is Safe and Effective Following Minimally Invasive Pyeloplasty: Long-term Results from a Prospective Randomized Controlled Trial","authors":"Frédéric D. Birkhäuser, Thomas von Rütte, Felix Moltzahn, Philipp Huber, Pascal Zehnder","doi":"10.1016/j.euros.2025.01.014","DOIUrl":"10.1016/j.euros.2025.01.014","url":null,"abstract":"<div><h3>Background and objective</h3><div>During laparoscopic pyeloplasty, double-J ureteral stents are routinely placed to protect the anastomosis from urinary leakage. However, no consensus exists on the optimal double-J ureteral stent indwelling time. This study aims to evaluate the impact of a short compared to a long double-J ureteral stent indwelling time on long-term functional outcomes ans complications following minimally invasive pyeloplasty.</div></div><div><h3>Methods</h3><div>A prospective randomized single-surgeon series compared 2- versus 6-wk indwelling time. Renal scintigraphy was performed preoperatively, and at 6 and 24 mo postoperatively. Diuretic renography was performed 3 mo postoperatively. From year 2 to 5, patients were followed mainly with interviews.</div></div><div><h3>Key findings and limitations</h3><div>The median follow-up was 66 (range 29–104) mo. Preoperatively, all 82 patients were symptomatic and renal scintigraphy revealed an obstruction. Diuretic renography documented regular morphology and kinetics in all patients at 3 mo. Six months postoperatively, renal scintigraphy detected unobstructed drainage in 84% of patients in group A (2 wk) and in 95% of patients in group B (6 wk; <em>p</em> = 0.237). At 2 yr, the rate of unobstructed drainage increased to 97% in group A and 96% in group B (<em>p</em> = 0.962). In patients with scintigraphically delayed tracer transportation, additional diuretic renography proved regular morphology and contrast media kinetics. No stent-related complications and urinary leakage were observed. All patients were asymptomatic at the last follow-up.</div></div><div><h3>Conclusions and clinical implications</h3><div>Our long-term data demonstrate that 2 wk of double-J ureteral stenting following pyeloplasty provides similar functional outcome to 6 wk of stenting. Furthermore, no stent-related complications occurred. This finding may safely be applied to all pyeloplasty patients.</div></div><div><h3>Patient summary</h3><div>Without comprising overall functional success or increasing the rate of complications, patients following minimally invasive pyeloplasty benefit from a short double-J stent indwelling time.</div></div>","PeriodicalId":12254,"journal":{"name":"European Urology Open Science","volume":"74 ","pages":"Pages 28-33"},"PeriodicalIF":3.2,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143453284","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-21DOI: 10.1016/j.euros.2025.02.004
Marc Kidess , Troya Ivanova , Julian Hermans , Leo Stadelmeier , Marina Hoffmann , Nikolaos Pyrgidis , Julian Marcon , Michael Chaloupka , Ricarda M. Bauer , Christian G. Stief , Yannic Volz
Background and objective
Urology is characterized by continuous innovation. The inception of robot-assisted radical prostatectomy (RP) marked a pivotal technological advance and further advances in digital treatment options for stress urinary incontinence (SUI) are emerging. Our aim was to assess patient willingness to receive an electronic artificial urinary sphincter (eAUS) implant and identify associated concerns.
Methods
Patients who received a first AUS implant (AMS800 system) for post-RP SUI from March 2013 to December 2023 were included. An anonymous survey was used to collect data on demographics, current AUS satisfaction, daily technology use, interest in an eAUS, and concerns about potential eAUS technical malfunctions. Data were analyzed using SPSS, with significance set at p < 0.05.
Key findings and limitations
Out of 345 patients, 208 (60.2%) completed the questionnaire. The majority were aged 71–80 yr (51.7%) and had a university education (37.7%). Satisfaction with their AUS was high: 79.8% of the respondents were satisfied, 88.9% were satisfied with its handling, and 89.4% would choose an AUS implant again. Notably, 60.4% showed interest in an eAUS, with younger respondents and those who use technology on a daily basis expressing greater interest. Preferred control methods included remote-based (78.4%) and smartphone-based (60.0%) options. Concerns about system malfunction (66.4%), connection loss (65.9%), and battery issues (60.0%) were prevalent.
Conclusions and clinical implications
There was significant patient interest in an eAUS in our survey, especially among younger individuals and those who use technology daily. Despite high satisfaction with current AUS devices, addressing potential technical malfunctions and patient concerns is crucial for broader acceptance of an eAUS. Patient concerns about technological malfunctions seem to outweigh worries about medical issues.
Patient summary
Urology is becoming more advanced with technologies like robotic surgery and electronic artificial urinary sphincters (eAUS). According to our survey, most patients are happy with their current sphincters and are open to eAUS, especially younger patients who are familiar with technology. However, patients are concerned about system malfunctions and connection loss. More research is needed to address technical issues and patient concerns.
{"title":"Next-generation Solutions: Are Patients Ready for Electronic Artificial Urinary Sphincters for Male Incontinence?","authors":"Marc Kidess , Troya Ivanova , Julian Hermans , Leo Stadelmeier , Marina Hoffmann , Nikolaos Pyrgidis , Julian Marcon , Michael Chaloupka , Ricarda M. Bauer , Christian G. Stief , Yannic Volz","doi":"10.1016/j.euros.2025.02.004","DOIUrl":"10.1016/j.euros.2025.02.004","url":null,"abstract":"<div><h3>Background and objective</h3><div>Urology is characterized by continuous innovation. The inception of robot-assisted radical prostatectomy (RP) marked a pivotal technological advance and further advances in digital treatment options for stress urinary incontinence (SUI) are emerging. Our aim was to assess patient willingness to receive an electronic artificial urinary sphincter (eAUS) implant and identify associated concerns.</div></div><div><h3>Methods</h3><div>Patients who received a first AUS implant (AMS800 system) for post-RP SUI from March 2013 to December 2023 were included. An anonymous survey was used to collect data on demographics, current AUS satisfaction, daily technology use, interest in an eAUS, and concerns about potential eAUS technical malfunctions. Data were analyzed using SPSS, with significance set at <em>p</em> < 0.05.</div></div><div><h3>Key findings and limitations</h3><div>Out of 345 patients, 208 (60.2%) completed the questionnaire. The majority were aged 71–80 yr (51.7%) and had a university education (37.7%). Satisfaction with their AUS was high: 79.8% of the respondents were satisfied, 88.9% were satisfied with its handling, and 89.4% would choose an AUS implant again. Notably, 60.4% showed interest in an eAUS, with younger respondents and those who use technology on a daily basis expressing greater interest. Preferred control methods included remote-based (78.4%) and smartphone-based (60.0%) options. Concerns about system malfunction (66.4%), connection loss (65.9%), and battery issues (60.0%) were prevalent.</div></div><div><h3>Conclusions and clinical implications</h3><div>There was significant patient interest in an eAUS in our survey, especially among younger individuals and those who use technology daily. Despite high satisfaction with current AUS devices, addressing potential technical malfunctions and patient concerns is crucial for broader acceptance of an eAUS. Patient concerns about technological malfunctions seem to outweigh worries about medical issues.</div></div><div><h3>Patient summary</h3><div>Urology is becoming more advanced with technologies like robotic surgery and electronic artificial urinary sphincters (eAUS). According to our survey, most patients are happy with their current sphincters and are open to eAUS, especially younger patients who are familiar with technology. However, patients are concerned about system malfunctions and connection loss. More research is needed to address technical issues and patient concerns.</div></div>","PeriodicalId":12254,"journal":{"name":"European Urology Open Science","volume":"74 ","pages":"Pages 21-27"},"PeriodicalIF":3.2,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143453366","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-20DOI: 10.1016/j.euros.2025.01.018
Yang Fan , Jun Dong , Hanfeng Wang , Qiang Zu, Kan Liu, Jie Zhu, Baojun Wang, Qingbo Huang, Yu Gao, Xin Chen, Jianming Zhao, Xiaowei Hao, Qiang Zhu, Shuang Huang, Xin Ma, Xu Zhang
Background and objective
Bench surgery (BenS) with kidney autotransplantation serves as an alternative to nephron-sparing surgery (NSS) for patients harboring high-complexity renal tumors that are ineligible for in situ partial nephrectomy (PN). However, the experience of BenS with robot-assisted kidney autotransplantation (RAKAT) has been scarce in such cases. Here, we describe the operative techniques, and functional and oncological outcomes of BenS with RAKAT.
Methods
We reviewed prospectively followed 12 patients with complex solitary or bilateral kidney tumors who underwent robot-assisted nephrectomy (RAN) with BenS and RAKAT at our institution from January 2018 to May 2021 and all surgical procedures were performed by the same surgical team. The surgical, functional, and oncological outcomes were assessed.
Key findings and limitations
All surgical margins were negative. The median operative time was 480 min, and the median console times of RAN and RAKAT were 100 and 161 min, respectively. The median warm ischemia, cold ischemia, and rewarming times were 3, 178, and 55 min, respectively. The median estimated blood loss was 100 ml. Three patients presented grade IV complications, including one case of septic shock resolved with antibiotics and supportive care, and two cases with delayed graft function resolved with temporary dialysis. The median percentage of ipsilateral estimated glomerular filtration rate preserved at 3 mo was 51.1%. Two patients had progressing disease at a median follow-up of 70 mo.
Conclusions and clinical implications
BenS with RAKAT is an alternative strategy for the treatment of high-complexity renal tumors that are unsuitable for in situ PN. Larger prospective studies with longer follow-up are required to further assess the findings.
Patient summary
We evaluated the outcomes of bench surgery (BenS) with robot-assisted kidney autotransplantation (RAKAT), in which the diseased kidney is removed, undergo partial nephrectomy (PN) extracorporeally, and is transplanted back robotically. We found that for patients with complex solitary or bilateral kidney tumors who are not eligible for in situ PN, BenS with RAKAT is a safe and feasible alternative of nephron-sparing surgery with acceptable functional and oncological outcomes.
{"title":"Bench Surgery with Robot-assisted Kidney Autotransplantation for Complex Kidney Tumors: Technique and Outcomes from a Single Center","authors":"Yang Fan , Jun Dong , Hanfeng Wang , Qiang Zu, Kan Liu, Jie Zhu, Baojun Wang, Qingbo Huang, Yu Gao, Xin Chen, Jianming Zhao, Xiaowei Hao, Qiang Zhu, Shuang Huang, Xin Ma, Xu Zhang","doi":"10.1016/j.euros.2025.01.018","DOIUrl":"10.1016/j.euros.2025.01.018","url":null,"abstract":"<div><h3>Background and objective</h3><div>Bench surgery (BenS) with kidney autotransplantation serves as an alternative to nephron-sparing surgery (NSS) for patients harboring high-complexity renal tumors that are ineligible for in situ partial nephrectomy (PN). However, the experience of BenS with robot-assisted kidney autotransplantation (RAKAT) has been scarce in such cases. Here, we describe the operative techniques, and functional and oncological outcomes of BenS with RAKAT.</div></div><div><h3>Methods</h3><div>We reviewed prospectively followed 12 patients with complex solitary or bilateral kidney tumors who underwent robot-assisted nephrectomy (RAN) with BenS and RAKAT at our institution from January 2018 to May 2021 and all surgical procedures were performed by the same surgical team. The surgical, functional, and oncological outcomes were assessed.</div></div><div><h3>Key findings and limitations</h3><div>All surgical margins were negative. The median operative time was 480 min, and the median console times of RAN and RAKAT were 100 and 161 min, respectively. The median warm ischemia, cold ischemia, and rewarming times were 3, 178, and 55 min, respectively. The median estimated blood loss was 100 ml. Three patients presented grade IV complications, including one case of septic shock resolved with antibiotics and supportive care, and two cases with delayed graft function resolved with temporary dialysis. The median percentage of ipsilateral estimated glomerular filtration rate preserved at 3 mo was 51.1%. Two patients had progressing disease at a median follow-up of 70 mo.</div></div><div><h3>Conclusions and clinical implications</h3><div>BenS with RAKAT is an alternative strategy for the treatment of high-complexity renal tumors that are unsuitable for in situ PN. Larger prospective studies with longer follow-up are required to further assess the findings.</div></div><div><h3>Patient summary</h3><div>We evaluated the outcomes of bench surgery (BenS) with robot-assisted kidney autotransplantation (RAKAT), in which the diseased kidney is removed, undergo partial nephrectomy (PN) extracorporeally, and is transplanted back robotically. We found that for patients with complex solitary or bilateral kidney tumors who are not eligible for in situ PN, BenS with RAKAT is a safe and feasible alternative of nephron-sparing surgery with acceptable functional and oncological outcomes.</div></div>","PeriodicalId":12254,"journal":{"name":"European Urology Open Science","volume":"74 ","pages":"Pages 1-10"},"PeriodicalIF":3.2,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143444519","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-20DOI: 10.1016/j.euros.2025.01.013
Fabian J. Aschwanden , Luca Afferi , Lukas Kandler , Adrian P. Marty , Philipp Baumeister , Agostino Mattei , Marko Kozomara , Christian D. Fankhauser
Background and objective
Urology residency programs often lack consistent feedback mechanisms and tracking of an individual’s progress. Competency-based medical education, using entrustable professional activities (EPAs), offers a solution but faces challenges in implementation. The aim of this study was to implement and assess a smartphone application for real-time EPA assessments in urology residency programs.
Methods
A mobile application was introduced to 13 urology residents and ten supervisors at a Swiss training institution. Assessment characteristics were analyzed using descriptive statistics. Agreement between trainees and supervisors on task complexity and supervision levels was evaluated using Cohen’s and Fleiss’ κ metrics.
Key findings and limitations
Over a period of 7 mo, 246 EPA assessments were recorded, of which 214 assessments were completed, representing a completion rate of 86%. Procedural EPAs accounted for 92% of the assessments, and nonprocedural EPAs for 8%. Cohen’s κ indicated moderate agreement for task complexity (κ = 0.56) and supervision levels (κ = 0.55). Higher agreement was observed when trainees were rated competent in supervising others (κ = 0.71). Limitations include the focus on procedural tasks and the small sample size.
Conclusions and clinical implications
A mobile application can effectively facilitate real-time EPA assessments in urology training, promoting frequent feedback conversations and efficient tracking of resident progress. However, greater emphasis on nonprocedural EPAs is needed.
Patient summary
We tested a mobile phone app that provides real-time feedback to urology residents and found that it enhanced their training experience. While the app effectively tracks progress in carrying out procedures, more focus is needed on developing nonprocedural skills such as patient counseling.
{"title":"Mobile-based Assessment of Entrustable Professional Activities in Urology Training: Implementation and Outcomes","authors":"Fabian J. Aschwanden , Luca Afferi , Lukas Kandler , Adrian P. Marty , Philipp Baumeister , Agostino Mattei , Marko Kozomara , Christian D. Fankhauser","doi":"10.1016/j.euros.2025.01.013","DOIUrl":"10.1016/j.euros.2025.01.013","url":null,"abstract":"<div><h3>Background and objective</h3><div>Urology residency programs often lack consistent feedback mechanisms and tracking of an individual’s progress. Competency-based medical education, using entrustable professional activities (EPAs), offers a solution but faces challenges in implementation. The aim of this study was to implement and assess a smartphone application for real-time EPA assessments in urology residency programs.</div></div><div><h3>Methods</h3><div>A mobile application was introduced to 13 urology residents and ten supervisors at a Swiss training institution. Assessment characteristics were analyzed using descriptive statistics. Agreement between trainees and supervisors on task complexity and supervision levels was evaluated using Cohen’s and Fleiss’ κ metrics.</div></div><div><h3>Key findings and limitations</h3><div>Over a period of 7 mo, 246 EPA assessments were recorded, of which 214 assessments were completed, representing a completion rate of 86%. Procedural EPAs accounted for 92% of the assessments, and nonprocedural EPAs for 8%. Cohen’s κ indicated moderate agreement for task complexity (κ = 0.56) and supervision levels (κ = 0.55). Higher agreement was observed when trainees were rated competent in supervising others (κ = 0.71). Limitations include the focus on procedural tasks and the small sample size.</div></div><div><h3>Conclusions and clinical implications</h3><div>A mobile application can effectively facilitate real-time EPA assessments in urology training, promoting frequent feedback conversations and efficient tracking of resident progress. However, greater emphasis on nonprocedural EPAs is needed.</div></div><div><h3>Patient summary</h3><div>We tested a mobile phone app that provides real-time feedback to urology residents and found that it enhanced their training experience. While the app effectively tracks progress in carrying out procedures, more focus is needed on developing nonprocedural skills such as patient counseling.</div></div>","PeriodicalId":12254,"journal":{"name":"European Urology Open Science","volume":"73 ","pages":"Pages 71-76"},"PeriodicalIF":3.2,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143445679","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-18DOI: 10.1016/j.euros.2025.01.017
Ursina Rigonalli , Silvan Sigg , Seraina Von Moos , Philipp Baumeister , Agostino Mattei , Christian D. Fankhauser , Andres Affentranger
Urinary retention is a common urological emergency requiring catheterization. However, follow-up management remains poorly defined, particularly regarding post-obstruction hyperdiuresis (POHD), which may lead to complications such as hypovolemia and electrolyte disturbances. Our mini review of PODS identified nine relevant studies involving 665 patients. POHD occurred in 15–78% of cases, with a mean duration of 2–5 d. Risk factors included serum creatinine >105 μmol/l (odds ratio [OR] 4.83, 95% confidence interval [CI] 1.14–20.44; p = 0.032) and greater bladder volume (OR per 100-ml increment: 1.21, 95% CI 1.06–1.40; p = 0.006). Complications included hematuria (11–55%), hyponatremia (22–28%), and hypotension (9%), most of which were self-limiting. Data on management were sparse; one randomized controlled trial showed no significant difference in complications between rapid and gradual decompression. The lack of standardized protocols underscores the need for further prospective studies to optimize patient outcomes.
Patient summary
After relief of urinary obstruction, an increase in urination is common. Complications such as blood in the urine, electrolyte imbalances, and dehydration may occur but typically resolve on their own without additional treatment.
{"title":"Prevalence and Clinical Implications of Post-obstruction Hyperdiuresis Among Patients with Urinary Retention: A Mini Review","authors":"Ursina Rigonalli , Silvan Sigg , Seraina Von Moos , Philipp Baumeister , Agostino Mattei , Christian D. Fankhauser , Andres Affentranger","doi":"10.1016/j.euros.2025.01.017","DOIUrl":"10.1016/j.euros.2025.01.017","url":null,"abstract":"<div><div>Urinary retention is a common urological emergency requiring catheterization. However, follow-up management remains poorly defined, particularly regarding post-obstruction hyperdiuresis (POHD), which may lead to complications such as hypovolemia and electrolyte disturbances. Our mini review of PODS identified nine relevant studies involving 665 patients. POHD occurred in 15–78% of cases, with a mean duration of 2–5 d. Risk factors included serum creatinine >105 μmol/l (odds ratio [OR] 4.83, 95% confidence interval [CI] 1.14–20.44; <em>p</em> = 0.032) and greater bladder volume (OR per 100-ml increment: 1.21, 95% CI 1.06–1.40; <em>p</em> = 0.006). Complications included hematuria (11–55%), hyponatremia (22–28%), and hypotension (9%), most of which were self-limiting. Data on management were sparse; one randomized controlled trial showed no significant difference in complications between rapid and gradual decompression. The lack of standardized protocols underscores the need for further prospective studies to optimize patient outcomes.</div></div><div><h3>Patient summary</h3><div>After relief of urinary obstruction, an increase in urination is common. Complications such as blood in the urine, electrolyte imbalances, and dehydration may occur but typically resolve on their own without additional treatment.</div></div>","PeriodicalId":12254,"journal":{"name":"European Urology Open Science","volume":"73 ","pages":"Pages 68-70"},"PeriodicalIF":3.2,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143429784","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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