Asian Journal of Urology最新文献

{"title":"Risk of reclassification and novel tools in active surveillance","authors":"Bárbara Vieira Lima Aguiar Melão ,&nbsp;Lucas Mendes Nogueira ,&nbsp;Karim A. Touijer","doi":"10.1016/j.ajur.2025.01.004","DOIUrl":"10.1016/j.ajur.2025.01.004","url":null,"abstract":"<div><h3>Objective</h3><div>Low-risk prostate cancer usually has an indolent course, and in this scenario, active surveillance (AS) is currently the preferred management, reducing overtreatment without compromising oncologic outcomes in well-selected patients. Two pillars of this strategy are patient selection and adequate monitoring strategy to detect early progression, leading to active treatment in the window of curability. The aim of this review is to assess the novel available tools and their role in AS.</div></div><div><h3>Methods</h3><div>We conducted a comprehensive review of the current literature addressing the risk of reclassification and studies evaluating traditional and emerging diagnostic and prognostic tools, including imaging modalities, biomarkers, and genomic classifiers, which could decrease reclassification rates and minimize the burden of serial exams during follow-up and, especially, the frequency of biopsies, which are still necessary to evaluate progression.</div></div><div><h3>Results</h3><div>The most significant follow-up cohorts demonstrate long-term treatment rates ranging from 30% to 45%, and 36% of low-risk prostate cancer patients have an upgrade in radical prostatectomy specimens. Despite the emergence of new diagnostic and prognostic tools, few of them have been validated or included in the assessment of eligible patients for AS. In the current guidelines, a combination of cT stage, Gleason score, prostate-specific antigen value, prostate-specific antigen density, and number of positive cores in biopsy is used to select patients for AS. However, various risk factors have been associated with the risk of reclassification, which reveals the need to incorporate better tools that may contribute to better risk stratification of patients eligible for AS.</div></div><div><h3>Conclusion</h3><div>Although AS is feasible and safe, the risk of progression is of great concern for patients and physicians, and monitoring is also an important part of the therapeutic strategy. Novel risk stratification tools are promising but need further validation to improve results and decrease the burden and anxiety that monitoring can bring to patients.</div></div>","PeriodicalId":46599,"journal":{"name":"Asian Journal of Urology","volume":"12 4","pages":"Pages 445-454"},"PeriodicalIF":2.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145686016","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Five things you need to know about prostate cancer diagnostic tests","authors":"Andrew J. Vickers,&nbsp;Hans Lilja","doi":"10.1016/j.ajur.2024.04.004","DOIUrl":"10.1016/j.ajur.2024.04.004","url":null,"abstract":"","PeriodicalId":46599,"journal":{"name":"Asian Journal of Urology","volume":"12 4","pages":"Pages 419-421"},"PeriodicalIF":2.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141399042","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinically lymph node-positive urothelial bladder cancer treated with upfront radical cystectomy: Diagnostic accuracy of MRI and long-term oncologic outcomes","authors":"Mahmoud Laymon ,&nbsp;Amr A. Elsawy ,&nbsp;Ali Elsorougy ,&nbsp;Abdelwahab Hashem ,&nbsp;Ahmed Mosbah ,&nbsp;Hassan Abol-enein ,&nbsp;Islam Mansour ,&nbsp;Ahmed S. El-Hefnawy","doi":"10.1016/j.ajur.2024.12.007","DOIUrl":"10.1016/j.ajur.2024.12.007","url":null,"abstract":"<div><h3>Objective</h3><div>This study aimed to evaluate the diagnostic accuracy of MRI in the detection of nodal metastasis in urothelial bladder cancer (UBC) and to assess the long-term oncological outcomes of upfront radical cystectomy (RC) in patients with clinical lymph node-positive (cN⁺) muscle-invasive UBC.</div></div><div><h3>Methods</h3><div>A retrospective analysis of 1053 consecutive UBC patients treated with RC between January 1, 2004 and January 31, 2014 was performed. Radiological, clinical, pathological data and survival outcomes of cN⁺ patients were collected. Cox regression analyses were used to assess the impact of the radiological, clinical, and pathological variables on survival.</div></div><div><h3>Results</h3><div>A total of 233 (22%) patients were diagnosed with cN⁺ UBC with a mean age of 57.3 (standard deviation 8.1) years, of whom 144 (62%) were found to have pathologically positive lymph nodes at final pathology. Adjuvant chemotherapy was administered to 58 (25%) patients. The sensitivity, specificity, positive predictive value, and negative predictive value of MRI to detect pathological lymph node-positive disease were 51%, 88%, 62%, and 83%, respectively. The overall accuracy was 79% with a calculated area under the curve of 70%. The median follow-up period was 17.0 (interquartile range 8.2–58.7) months. During this period, 54 (23%) patients developed local recurrence while 56 (24%) experienced distant metastasis and the estimated 1-, 3-, 5-, and 10-year recurrence-free survival for cN⁺ patients were 78%, 56%, 51%, and 48%, respectively. On multivariate analysis, advanced pT stage (pT3–4 <em>vs</em>. pT2) was the only independent predictor of recurrence-free survival.</div></div><div><h3>Conclusion</h3><div>Despite its potential in preoperative assessment of muscle-invasive UBC, MRI showed limited sensitivity for detecting node-positive disease. Notably, in patients with MRI-detected cN⁺ UBC, those who underwent upfront RC demonstrated long-term survival outcomes comparable to those treated with neoadjuvant chemotherapy followed by consolidative cystectomy in previously published studies.</div></div>","PeriodicalId":46599,"journal":{"name":"Asian Journal of Urology","volume":"12 4","pages":"Pages 520-528"},"PeriodicalIF":2.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145685612","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A new technique for ureteral reconstruction using a colonic mucosa graft in a beagle model","authors":"Xincheng Gao ,&nbsp;Yuancheng Zhou ,&nbsp;Shuaishuai Chai ,&nbsp;Ming Yang ,&nbsp;Jiawei Chen ,&nbsp;Zehao Yu ,&nbsp;Xingyuan Xiao ,&nbsp;Bing Li","doi":"10.1016/j.ajur.2024.10.005","DOIUrl":"10.1016/j.ajur.2024.10.005","url":null,"abstract":"<div><h3>Objective</h3><div>To investigate the feasibility of using a colonic mucosa graft (CMG) for ureteral reconstruction and assess histological changes following the engrafted CMG in Beagles.</div></div><div><h3>Methods</h3><div>Nine male Beagle dogs were randomly assigned to groups I, II, and III (<em>n</em>=3). Resection of half of the ureteral wall caused a ventral ureteral defect. Ureteral defects with lengths of 3 cm, 5 cm, and 10 cm were created in these groups, respectively. The CMG was harvested and used to repair the ureteral defects in an onlay fashion. After functional evaluation of the reconstructed ureter using CT urography at 3 months, 6 months, and 12 months postoperatively, one Beagle from each group was euthanized using air embolization. Ureteral diameter measurements and the CMG shrinkage rate calculations were performed. Histological analysis was conducted to assess changes in the engrafted CMG.</div></div><div><h3>Results</h3><div>All animals had no postoperative complications. CT urography showed normal renal function and a wide caliber ureter with no stricture or leakage. The ureteral diameter reconstructed by the CMG was larger than that of the proximal or distal normal ureter (<em>p</em>&lt;0.05). The mean shrinkage rate of the CMG ranged from 11% to 14%. From 3 months to 12 months postoperatively, the colonic mucosal epithelium gradually underwent metaplasia into urothelium, and smooth muscle and neovascularization gradually developed beneath the mucosa.</div></div><div><h3>Conclusion</h3><div>The novel technique of using a CMG for ureteral reconstruction is feasible. The CMG has the advantages of low shrinkage rate and minimal donor site complications. It is an ideal material for treating long ureteral strictures.</div></div>","PeriodicalId":46599,"journal":{"name":"Asian Journal of Urology","volume":"12 4","pages":"Pages 554-561"},"PeriodicalIF":2.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145685615","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Laparoendoscopic single-site robot-assisted nephroureterectomy: Comparison with the conventional multiport laparoendoscopic technique for upper tract urothelial carcinoma in the retroperitoneal approach","authors":"Wei Liu ,&nbsp;Yong Wei ,&nbsp;Xin Yang ,&nbsp;Fuyang Liu,&nbsp;Xuhui Meng,&nbsp;Rongjiang Jiang,&nbsp;Luming Shen,&nbsp;Haibing Hu,&nbsp;Qingyi Zhu","doi":"10.1016/j.ajur.2025.03.017","DOIUrl":"10.1016/j.ajur.2025.03.017","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the feasibility and safety of laparoendoscopic single-site robot-assisted nephroureterectomy (LESS-RANU) by comparing perioperative, pathological, and oncological results with the conventional multiport laparoendoscopic approach in the retroperitoneal approach for the management of urinary tract urothelial carcinoma.</div></div><div><h3>Methods</h3><div>Between January 2021 and October 2024, our center treated 56 patients with urinary tract urothelial carcinoma using either the LESS-RANU (<em>n</em>=31) or the conventional multi-port laparoscopic nephroureterectomy (LNU) (<em>n</em>=25) via the retroperitoneal approach. Data including demographic, perioperative, pathological, and oncological characteristics were collected.</div></div><div><h3>Results</h3><div>No significant differences were found in patient demographics and tumor characteristics between the two groups. No serious intraoperative complications occurred in both groups. The mean operation time, skin incision length, Visual Analog Scale pain scores, time for repositioning and follow-up duration for the LESS-RANU group and the LNU group were 138.23 min and 180.40 min, 6.48 cm and 15.40 cm, 3.23 and 4.60, 5.71 min and 30.24 min, and 10.84 months and 22.88 months, respectively (<em>p</em>&lt;0.001). There were no significant differences in other perioperative data between the two groups. Multiple linear regression identified an association of body mass index with operation time in the LESS-RANU group (<em>p</em>&lt;0.001). The mean operative time of the subsequent 15 patients was significantly lower than that of the initial 16 patients (130.33 min <em>vs.</em> 145.31 min, <em>p</em>=0.044). There were no significant differences in the pathological characteristics between the two groups. Recurrences developed in four patients: one in the LESS-RANU group and three in the LNU group.</div></div><div><h3>Conclusion</h3><div>LESS-RANU is safe and more effective compared to LNU via the retroperitoneal approach, especially for patients with low body mass index.</div></div>","PeriodicalId":46599,"journal":{"name":"Asian Journal of Urology","volume":"12 4","pages":"Pages 512-519"},"PeriodicalIF":2.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145685718","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"In vivo and in vitro experimental models for urolithiasis pathophysiology research","authors":"Ranjith R. Kumar,&nbsp;Suresh Janadri,&nbsp;Manjunatha P. Mudagal,&nbsp;Uday R. Sharma,&nbsp;Surendra Vada,&nbsp;Hari T. Babu,&nbsp;Prakash,&nbsp;Archana Bandapalli Gangireddy","doi":"10.1016/j.ajur.2024.08.006","DOIUrl":"10.1016/j.ajur.2024.08.006","url":null,"abstract":"<div><h3>Objective</h3><div>This review aims to investigate and establish potential <em>in vitro</em> and <em>in vivo</em> models for evaluating the anti-urolithiatic activity of therapeutic agents, exploring experimental approaches that can reliably simulate human stone formation and effectively assess the efficacy of anti-urolithiatic compounds.</div></div><div><h3>Methods</h3><div>Multiple <em>in vitro</em> and <em>in vivo</em> approaches were explored. <em>In vitro</em> methods included the​​ estimation of calcium oxalate by titrimetry, nucleation assays, aggregation assays, turbidimetric assays, and electron microscopy studies. Artificial stone models such as BegoStone and Ultracal 30 were fabricated to mimic the physicochemical characteristics of urinary calculi. <em>In vivo</em> models included ethylene glycol-induced, calcium oxalate/ammonium oxalate-induced, diet-induced, and infection-related models in rodents. Additionally, genetically modified animal models such as <em>TRPV5</em> knockout, <em>CLDN14</em> knockout, <em>AGXT</em> knockout, and <em>URAT1</em> overexpression mice were discussed to study molecular pathways of urolithiasis. Parameters such as urinary oxalate, calcium levels, and histopathological evaluation of kidney tissues were used to validate stone formation and dissolution processes.</div></div><div><h3>Results</h3><div><em>In vitro</em> models effectively demonstrate the processes of crystal nucleation, aggregation, and inhibition, allowing quantitative assessment of potential anti-urolithiatic activity. Electron microscopy provides detailed insights into crystal morphology and ultrastructural alterations. Artificial stones fabricated using BegoStone and Ultracal 30 closely replicate natural calculi hardness and composition, making them suitable for lithotripsy and dissolution studies. <em>In vivo</em> models successfully mimic human urolithiasis pathophysiology, particularly the ethylene glycol-induced rat model, which shows reproducible calcium oxalate crystal deposition in renal tissues. The application of genetic models highlights the role of specific transporters and enzymes in calcium and oxalate homeostasis.</div></div><div><h3>Conclusion</h3><div>A combination of <em>in vitro</em> and <em>in vivo</em> experimental models provides a comprehensive platform for evaluating the anti-urolithiatic potential of therapeutic agents. The integration of biochemical, morphological, and genetic analyses enhances the understanding of stone pathogenesis and development of novel anti-urolithiatic therapies.</div></div>","PeriodicalId":46599,"journal":{"name":"Asian Journal of Urology","volume":"12 4","pages":"Pages 486-495"},"PeriodicalIF":2.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145686022","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prostate cancer screening","authors":"Rodrigo España Navarro ,&nbsp;Daniel Antonio González-Padilla ,&nbsp;José Daniel Subiela ,&nbsp;Cora Pérez-Serrano ,&nbsp;David Olmos ,&nbsp;Sigrid V. Carlsson","doi":"10.1016/j.ajur.2024.09.003","DOIUrl":"10.1016/j.ajur.2024.09.003","url":null,"abstract":"<div><h3>Objective</h3><div>To examine the current status and future perspectives of prostate cancer (PCa) screening.</div></div><div><h3>Methods</h3><div>We conducted a narrative review of randomized controlled trials focused on PCa screening and treatment. This review specifically focused on population-based trials enrolling men at average risk of PCa.</div></div><div><h3>Results</h3><div>Prostate-specific antigen has been the cornerstone of PCa screening since its clinical introduction in the late 1980s. Four contemporary high-quality randomized controlled trials assessed the efficacy of a prostate-specific antigen-based screening program on PCa mortality. We address conflicting results and differences among these trials. In recent years, MRI has gained significance, particularly in the targeted diagnostic pathway of PCa. Four randomized controlled trials and one cohort study have evaluated its use in PCa screening programs. Additionally, three pivotal trials have investigated the impact of radical PCa treatment on mortality, indirectly evaluating the utility of screening protocols. Current positions of major society guidelines are also addressed. Risk-adapted strategies, considering combined factors, are envisioned as the future towards precision medicine.</div></div><div><h3>Conclusion</h3><div>PCa screening has demonstrated a benefit in terms of reducing PCa mortality after 10 years of follow-up. Nevertheless, its application is not without risks, so a shared decision-making process must be ensured between the patient and the clinician. Emerging tools such as MRI, genetic panels, and new biomarkers show promising opportunities to reduce these harms and the overdiagnosis of low-risk cancers. An individualized approach for each patient, based on detected risks and clinical parameters, helps guide different clinical pathways.</div></div>","PeriodicalId":46599,"journal":{"name":"Asian Journal of Urology","volume":"12 4","pages":"Pages 422-433"},"PeriodicalIF":2.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145685619","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Opportunistic salpingectomy during radical cystectomy for bladder cancer: A systematic review of the literature","authors":"Clara Cerrato ,&nbsp;Savio D. Pandolfo ,&nbsp;Pia Kraft ,&nbsp;Dicken S.C. Ko ,&nbsp;Maria Carmen Mir","doi":"10.1016/j.ajur.2025.03.008","DOIUrl":"10.1016/j.ajur.2025.03.008","url":null,"abstract":"<div><h3>Objective</h3><div>Pelvic organ-sparing surgery aims to preserve vital reproductive and sexual organs, enhancing quality of life, especially in premenopausal women. Pelvic organ preservation for female patients undergoing radical cystectomy is now emphasized for sexual and hormonal function. Recent screening studies show no survival advantage despite early diagnosis of ovarian cancer, but opportunistic salpingectomy could reduce high-grade serous carcinoma risk. The aim of this review was to analyze the incidence of metachronous or delayed ovarian cancer in patients undergoing radical cystectomy for bladder cancer.</div></div><div><h3>Methods</h3><div>PubMed, Scopus, Web of Science, ClinicalTrials.gov, and Cochrane Library were searched systematically for English-language articles up to June 2024. The selection was done first by title and abstract screening and then by full-text assessment for eligibility. This review has been registered in PROSPERO (CRD42024561902).</div></div><div><h3>Results</h3><div>This review included two retrospective studies (2211 patients). Most patients had local or regional advanced disease, with a minority having distant disease. Only one study reported direct pelvic organ involvement from urothelial cancer, with no ovarian involvement found. Among patients who had organ-sparing surgery or pelvic exenteration, only two developed ovarian cancer post-surgery. No mean follow-up time or side effects from pelvic organ removal were reported in either study.</div></div><div><h3>Conclusion</h3><div>When oncologically safe, ovarian-sparing surgery with salpingectomy should be considered in female bladder cancer patients undergoing radical cystectomy. Opportunistic salpingectomy should be encouraged during abdominal urological surgeries, with thorough pre-operative counseling guiding decisions. Further studies are needed to define the role of preventive gynecologic surgery in urologic procedures.</div></div>","PeriodicalId":46599,"journal":{"name":"Asian Journal of Urology","volume":"12 4","pages":"Pages 471-477"},"PeriodicalIF":2.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145686020","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Feasibility and safety of da Vinci single-port robot-assisted retroperitoneal redo partial nephrectomy","authors":"Gianluca Spena,&nbsp;Alessandro Izzo,&nbsp;Antonio Tufano,&nbsp;Francesco Passaro,&nbsp;Giovanni Grimaldi,&nbsp;Luigi Castaldo,&nbsp;Giuseppe Quarto,&nbsp;Dario Franzese,&nbsp;Raffaele Muscariello,&nbsp;Antonio Scarpato,&nbsp;Flavio Antonino Scarlata,&nbsp;Achille Aveta,&nbsp;Roberto Contieri,&nbsp;Savio Domenico Pandolfo,&nbsp;Riccardo Autorino,&nbsp;Sisto Perdonà","doi":"10.1016/j.ajur.2025.03.003","DOIUrl":"10.1016/j.ajur.2025.03.003","url":null,"abstract":"","PeriodicalId":46599,"journal":{"name":"Asian Journal of Urology","volume":"12 4","pages":"Pages 562-564"},"PeriodicalIF":2.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145685717","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical anatomy of accessory pudendal arteries in Japanese men: preservation techniques for robot-assisted radical prostatectomy","authors":"Yu Ozawa,&nbsp;Shin Koike,&nbsp;Keisuke Aoki,&nbsp;Keita Okamoto,&nbsp;Shu Gozu,&nbsp;Takaaki Yokoyama,&nbsp;Kei Ushijima,&nbsp;Toshiaki Kayaba,&nbsp;Sunao Nohara,&nbsp;Masumi Yamada,&nbsp;Yu Odagaki,&nbsp;Hideo Sakamoto,&nbsp;Kunihiko Yoshioka","doi":"10.1016/j.ajur.2024.12.003","DOIUrl":"10.1016/j.ajur.2024.12.003","url":null,"abstract":"<div><h3>Objective</h3><div>This study aimed to investigate the anatomy of the accessory pudendal artery (APA) in Asian men and to describe APA preservation techniques during robot-assisted radical prostatectomy (RARP).</div></div><div><h3>Methods</h3><div>APA was defined as “any artery located in the periprostatic region running parallel to the dorsal vascular complex and extending caudally toward the anterior perineum”. The anatomical variations of the APA were reviewed in 589 consecutive Japanese men who underwent conventional RARP at our institution between April 2019 and November 2023, including the number, laterality, side, size, and local distribution (apical <em>vs.</em> lateral). The apical APA emerges near the prostatic apical region, whereas the lateral APA courses along the lateral aspect of the prostate. They are further classified as the prostatic, fascial, and pubic APAs. Our APA identification and preservation techniques were described based on this classification.</div></div><div><h3>Results</h3><div>Of the 589 Japanese men, 299 (51%) men were with one or more APAs: 169 with one APA, 115 with two APAs, 14 with three APAs, and one with four APAs; and a total of 445 APAs were found. Approximately 97% of the APAs (432/445) were preserved. More lateral APAs were found than apical APAs (243/589 [41%] <em>vs.</em> 79/589 [13%]; <em>p</em>&lt;0.001). Lateral APAs had a higher proportion of large-caliber arteries than apical APAs (59/359 [16%] <em>vs.</em> 1/86 [1.2%]; <em>p</em>&lt;0.001), particularly prostatic and fascial APAs (14/59 [24%] and 40/163 [25%], respectively).</div></div><div><h3>Conclusion</h3><div>This study identified anatomical variations of APAs in Japanese men and demonstrated that nearly all could be preserved during RARP. Further research is needed to evaluate the clinical benefits of APA preservation.</div></div>","PeriodicalId":46599,"journal":{"name":"Asian Journal of Urology","volume":"12 4","pages":"Pages 496-503"},"PeriodicalIF":2.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145686021","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}