Lower pole renal stones measuring 1–2 cm remain challenging to treat. While mini-percutaneous nephrolithotomy (mini-PCNL) provides high stone-free rates (SFRs), it carries tract-related morbidity. Flexible ureteroscopy (f-URS) is less invasive but limited in SFR. The flexible and navigable suction ureteral access sheath (FANS) has shown promise in improving stone evacuation and intrarenal pressure control. We hypothesize that FANS f-URS is non-inferior to mini-PCNL for patients with 1–2 cm lower pole stones in SFR.
The FLAME trial is an international, multicentre, randomized, non-inferiority study directly comparing FANS-f-URS with mini-PCNL in this setting.
The primary outcome is immediate SFR within 72 hours on low-dose CT. Secondary outcomes include SFR at 1 month, operative time, postoperative pain, hospital stay, complications (Clavien–Dindo) and quality-of-life changes.
A total of 640 adults with CT-confirmed 1–2 cm lower pole renal stones will be randomized 1:1 to undergo FANS-f-URS or mini-PCNL across 20 high-volume urology centres worldwide. Randomization is centralized and stratified by site. Radiologists and statisticians will remain blinded to allocation. Sample size was calculated assuming an 85% SFR for both arms, an 8.5% non-inferiority margin, 80% power and 15% attrition. Analyses will follow both intention-to-treat and per-protocol principles.
ClinicalTrials.gov NCT07159035.
To prospectively capture patient-reported outcomes in the post-operative period to better understand the quality-of-life impact of percutaneous nephrolithotomy (PNL).
Adults undergoing PNL for renal/ureteral stones were eligible for inclusion (11/2020–8/2022). Patients prospectively completed PROMIS – Pain Intensity, Pain Interference and Ability to participate in social roles and activities in-person pre-operatively (POD 0) and via email on POD 1, 7, 14 and 30. Scores are reported as T-scores (normalized to US pop., mean = 50) with a change of 5 (0.5 SD) considered clinically significant.
A total of 62 participants enrolled at POD 0 (POD 1 = 28, POD 7 = 29, POD 14 = 20, POD 30 = 23). There was a worsening of quality of life from POD 0 to POD 1 for pain intensity (median difference 7.9, p = 0.005) and pain interference (median difference 11.9, p = 0.0003), but not for the ability to participate in social roles (median difference −5.3, p = 0.07). This was also observed for POD 0 to POD 7, but only for the dimension of pain interference (median difference 7.2, p = 0.02). All three dimensions then improved until POD 30. In multivariable analysis, there were no variables associated with severe symptomatology for any of the three dimensions.
Pain intensity and interference sharply increase immediately post-operatively, reducing quality of life, although the ability to participate in social roles is not impacted. The absolute magnitude of this change is significant, with a final improvement at 30 days at or above baseline. Results offer meaningful insight to assist in setting expectations for patients post-operatively.
Women with spina bifida often experience neurological impairments leading to pelvic organ dysfunction, including difficulties with bladder and bowel emptying that necessitate frequent Valsalva manoeuvres. These factors, combined with pelvic floor weakness, may increase the risk of pelvic organ prolapse (POP). This study aimed to assess the prevalence of POP in women with spina bifida, identify associated risk factors and evaluate outcomes of surgical management.
We retrospectively analysed a prospectively maintained database of women with spina bifida seen at a French referral centre from 2007 to 2024. Age under 18 and congenital perineal abnormality were exclusion criteria. The primary outcome was the presence of POP grade 2 or higher (Baden-Walker classification). Secondary outcomes included symptomatic POP requiring surgery, recurrence after surgery, use of vaginal pessaries and related symptoms.
POP grade ≥2 was present in 14.8% of patients. Women with POP were older (median 44 vs. 31 years; p < 0.0001) and more frequently parous (58.5% vs. 18.3%; p < 0.0001), although 41.5% of POP cases occurred in nulliparous women. Apical prolapse was predominant (64.3%). Among 11 patients who underwent POP surgery, 54.5% experienced recurrence. Multivariate analysis identified parity (OR 5.33; p = 0.005) and lower maximum urethral closure pressure (OR 0.97; p = 0.02) as independent risk factors.
POP is highly prevalent in young adult women with spina bifida, including many nulliparous patients. The parity status and a low maximum urethral closure pressure could be associated with an increased risk of POP in this population. High recurrence after surgery highlights the need for information, routine screening and tailored management in this population.
Neoadjuvant therapy with immune checkpoint inhibitors and tyrosine kinase inhibitors has been shown to reduce the tumour size and thrombus length in patients with renal cell carcinoma with venous tumour thrombus (RCC-VTT). This study aimed to evaluate the effectiveness and safety of neoadjuvant tislelizumab plus pazopanib in patients with RCC-VTT.
From November 2021 to January 2024, nine patients with RCC-VTT were included in this retrospective study. All patients received neoadjuvant tislelizumab (200 mg intravenously every 3 weeks) and pazopanib (800 mg orally once daily), followed by surgery. Key effectiveness outcomes included the objective response rate (ORR) of the primary tumour, the percentage change in VTT length and safety.
Among the nine patients with RCC-VTT, the median age was 58 years (range, 39–78). Following neoadjuvant tislelizumab plus pazopanib, six patients achieved partial response in the primary tumour and three had stable disease, yielding an ORR of 66.7%. The VTT length decreased from 4.9 cm (range, 1.1–9.3 cm) to 3.8 cm (range, 0–8.1 cm), with a median reduction of 29.2% (range, −153.1% to 100.0%). Treatment-related adverse events (TRAEs) of any grade and grade 3 were reported in 88.9% and 55.6% of patients, respectively. The common TRAEs of any grade were vomiting (77.8%), fatigue (33.3%), pruritus (33.3%), weight loss (33.3%), poor appetite (33.3%), pruritus (33.3%) and hepatic impairment (33.3%). No grade 4–5 TRAEs or deaths were observed.
The neoadjuvant combination of tislelizumab and pazopanib effectively reduced tumour size and thrombus length, narrowing the surgical scope and potentially leading to better postoperative outcomes.
To develop a predictive model for symptomatic postoperative febrile urinary tract infections (UTIs) in children undergoing open reimplantation for vesicoureteral reflux (VUR) and evaluate the association with VUR recurrence.
This multicentre retrospective study included children with unilateral VUR (grades III–V) who underwent open Cohen or Lich-Gregoir reimplantation (2010–2022), had recurrent febrile UTIs, and ≥1 year follow-up. Analyses used 10-pooled multiple imputation, with complete case for sensitivity. Full and Least Absolute Shrinkage and Selection Operator (LASSO) Weibull regression models with centre clustering, bootstrapping, and 10-fold cross-validation identified predictors. Prediction used demographic, clinical, procedural and antibiotic factors. The non-scaled LASSO model informed the nomogram, evaluated using C-indices, calibration and decision curve analysis (DCA). UTI and VUR recurrence were analysed via cumulative incidence.
A total of 404 children (median age 8 (6–9) years; follow-up 2.3 (2.0–3.3) years, 233 complete-case) were analysed. Median preoperative febrile UTIs were four, 74.5% had antibiotic resistance and median postoperative prophylaxis was two days. The 3-year cumulative incidence of postoperative UTI was 27.2% (95% CI: 22.9–31.6). LASSO-significant predictors included operative time (HR 1.10, 95% CI 1.03–1.16); in sensitivity analyses, prior injection (HR 2.08, 95% CI 1.88–2.30) and postoperative antibiotic duration (HR 0.81, 95% CI 0.69–0.97) were also significant. The nomogram included preoperative fever, antibiogram resistance, renal defect, VUR phase, prior injection, surgical indication, catheterization, hospitalization and stenting. The model performed well (C-indices = 0.743; calibration slope = 1), with DCA supporting clinical utility for 10–40% predicted risk. Recurrent VUR grade ≥II after 12 months (3.3%–12.7% at 1–3 years, n = 273) did not increase UTI risk.
Children with unilateral dilating VUR remained at risk of postoperative febrile UTIs. The nomogram can assist in identifying high-risk children for targeted interventions, but requires external validation and refinement.
To compare the outcomes of open versus robotic ureteral reimplantation procedures at a single centre.
The charts of all patients with ureteral strictures who underwent open ureteral reimplantation between 2005 and 2024, and those who underwent robotic reimplantation between 2013 and 2024, were retrospectively reviewed, and the outcomes of the two approaches were compared.
Eighty patients were included in the final analysis: 45 in the open surgery group and 35 in the robotic group. After a median follow-up duration of 16,5 months for the open group and 10 months for the robotic group, the stricture recurrence rate was similar in both groups (6,8% vs. 8.6%; p = 0.99). In terms of long-term complications, there were similar rates of symptomatic reflux (4.4% vs. 5.7%; p = 0.99) and flank pain (8.9% vs. 8.6%; p = 0.99) between both groups. There were more recurrent urinary tract infections in the open group (17.8% vs. 8.6%) and more de novo lower urinary tract symptoms in the robotic group (11.4% vs. 2.2%), but these differences were not statistically significant (p = 0.33 and p = 0.16, respectively). Overall, 30 patients (38%) had at least one long-term complication (35.6% vs 40%; p = 0.82). The only variable significantly associated with the risk of stricture recurrence was radiotherapy (OR = 11.2; p = 0.01).
The robotic approach appears to be non-inferior to the open approach in terms of stricture recurrence while being associated with a shorter length of hospital stay and lower estimated blood loss. More importantly, the present series raises questions regarding the long-term consequences of ureteral reimplantation and confirms the higher risk of failure in radiated patients.
Preoperative EAU guideline criteria stratify Upper tract urinary carcinomas (UTUC) into low- and high-risk groups. Depending on this classification, high-risk patients may receive simultaneous lymphadenectomy (LAD) during robot-assisted radical nephroureterectomy (RANU). This study examines the reliability of such stratification, focusing on oncological outcomes.
In 60 patients with UTUC who underwent RANU, 38 were stratified as low-risk (63%) and 22 as high-risk (37%) based on preoperative EAU guideline criteria. LAD was performed solely in the high-risk group.
In the low-risk group, 19 patients (50%) had non-muscle-invasive (Ta, Tis-T1) disease, 7 (18%) had muscle-invasive, locally confined (T2) disease and 12 (32%) had locally advanced (T3/4) disease. In the high-risk group, results were 11 (50%), 3 (14%) and 8 (36%), with no statistical differences observed. Follow-up (6 to 60 months) showed no significant differences in cancer-specific (p = 0.3) and overall survival (p = 0.8) between groups. Limitations: the small sample size and the retrospective nature. Conclusions and Clinical Implications: The current EAU guideline-based preoperative criteria for UTUC risk stratification demonstrated limited accuracy in identifying high-risk patients undergoing RANU, potentially excluding some patients from receiving LAD.
We think that improved preoperative staging and risk stratification tools are needed to better manage patients with upper urinary tract urothelial carcinoma undergoing surgical treatment.
The aim of this study is to evaluate the clinical efficacy of glans tunnel urethroplasty using a pedicled penile flap or lower lip mucosa for glans penis urethral stricture.
A retrospective analysis was conducted on 41 patients with urethral stricture at the glans penis who visited our hospital from January 2021 to July 2025. Causes include iatrogenic factors (including prostate hyperplasia surgery, transurethral resection of bladder lesions and catheterisation), a history of hypospadias repair and penile lichen sclerosus (LS), including 14 cases of urethral meatus stricture and 27 cases of navicular fossa stricture. The length of the stricture was 2.0 (1.0, 3.0) cm, the maximum flow rate (Qmax) was (7.24 ± 3.47) ml/s, the International Prostate Symptom Score (IPSS) was (17.49 ± 5.29), and the International Index of Erectile Function - 5 (IIEF-5) was 14.0 (9.00, 21.00) points. Surgery preserved glans integrity, incised the ventral stenotic urethra and reconstructed the defect with a flap or mucosa graft. A F16/18 indwelling catheter was removed after 3 weeks. Pre- and post-operative uroflowmetry, IPSS and IIEF-5 evaluations were conducted.
All post-operative outcomes were assessed at 12–23 months (median 20, IQR 19–21). Postoperative Qmax increased to 23.61 ± 4.54 ml/s, and the IPSS decreased to 9.02 ± 3.57 (both P < 0.001 vs. pre-op). The IIEF-5 score (14.71 ± 6.48) points showed no significant change. No recurrence, glans dehiscence, fistula, infection or ischaemia occurred.
Glans tunnel urethroplasty maintaining glans integrity effectively treats urethral meatal and navicular fossa strictures, balancing function and aesthetics.
The study aims to review the safety of performing robotic-assisted radical prostatectomy (RARP) in patients with a body mass index (BMI) > 35 kg/m2 in a high-volume robotic centre.
A prospective database of all patients who underwent RARP between December 2015 and October 2024 was reviewed. Propensity score matching was done preoperatively on age, prostate-specific antigen, ISUP grade and T stage. Matched cohort analysis was conducted comparing outcomes in 89 patients with BMI ≥ 35 kg/m2 and those with BMI 18–25 kg/m2. Outcomes included operational time, estimated blood loss (EBL), positive surgical margins (PSM), complications, length of stay, continence and erectile function at 12 months.
Console time was significantly longer in the high-BMI group (146 ± 48 min vs. 129 ± 44 min, p = 0.02). EBL was also greater (median 350 ml vs. 200 ml, p < 0.001). However, there was no significant difference in hospital stay (median 3 days for both groups, p = 0.86), nerve sparing rates or PSM. Patients in the obese cohort experienced more complications although this was not statistically significant. At 12 months post-operatively, continence was comparable between the groups. Median pad use was 1/day (interquartile range [IQR] 0–2) in the obese cohort versus 0/day (IQR 0–1) in the non-obese cohort (p = 0.09). Pad-free status was achieved in 48.3% compared with 61.8% respectively (p = 0.06). Erectile function recovery found 14.8% regaining function in the obese cohort compared with 18.0% in the non-obese cohort (p = 0.82).
This matched cohort analysis demonstrates that obese patients undergoing RARP experience longer operative times and increased EBL. These factors do not adversely impact functional or oncological outcomes. The incidence of post-operative complications remained low and comparable with patients with a normal BMI. With appropriate surgical expertise, high BMI alone should not be considered a contraindication to RARP.
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