Abstract in English:

ABSTRACT Leukocytospermia, defined as ≥1×106 white blood cells (WBC)/ml of semen, is a condition frequently observed in infertile men. While symptomatic leukocytospermia is often associated with genital tract infections and managed accordingly, the clinical significance of asymptomatic leukocytospermia remains uncertain—particularly in the setting of Assisted Reproductive Technology (ART). Seminal leukocytes, primarily neutrophils, play a physiological role in immune surveillance and tissue homeostasis. However, when excessively activated, they may generate high levels of reactive oxygen species (ROS), contributing to oxidative stress, sperm dysfunction, and DNA damage. This narrative review critically examines whether asymptomatic leukocytospermia adversely affects ART outcomes, including fertilization, embryo development, clinical pregnancy, and live birth rates. A synthesis of current evidence—including meta-analyses and large retrospective studies—suggests that asymptomatic leukocytospermia does not negatively impact these outcomes. Moreover, standard sperm preparation techniques and the widespread use of ICSI appear to neutralize any potential deleterious effects from seminal leukocytes. Given the absence of compelling evidence supporting its harmful impact on ART success, routine treatment of asymptomatic leukocytospermia—particularly with empiric antibiotics—is not recommended. Such interventions may disturb the natural immune balance, promote antibiotic resistance, and increase healthcare burdens without demonstrable benefit. Nonetheless, selective treatment may be justified in specific scenarios, such as recurrent implantation failure or early pregnancy loss. Further research is warranted to standardize leukocyte detection methods and to clarify the role of adjunctive therapies. Until more definitive data emerge, an individualized, evidence-based approach remains the most appropriate strategy for managing asymptomatic leukocytospermia in infertile men pursuing ART.

Abstract in English:

ABSTRACT Renal cell carcinoma (RCC) ranks among the most prevalent malignancies worldwide, with a rising incidence attributed largely to the incidental detection of small renal masses (SRMs ≤ 4 cm) through widespread abdominal imaging. Historically managed with radical nephrectomy, treatment of SRMs has evolved significantly over recent decades. Partial nephrectomy has become the standard surgical approach, while active surveillance (AS) has emerged as a viable alternative for select patients, particularly those with comorbidities or limited life expectancy. AS involves serial imaging to monitor tumor progression, reserving intervention for signs of clinical advancement. This review synthesizes oncological outcomes and current management strategies for SRMs, comparing AS with immediate intervention. A comprehensive literature search (2005–2024) was performed across PubMed, Web of Science, and Scopus, complemented by an analysis of major international guidelines (EAU, AUA, ESMO, CUA, and Latin American Renal Cancer Group). All guidelines support AS for selected patients with cT1a tumors, though criteria vary. The AUA limits AS to tumors <2 cm, while only its guidelines define clear triggers for transitioning from AS to treatment. Imaging surveillance intervals and biopsy indications also differ, with broader support for renal mass biopsy prior to ablation but more selective use during AS. This review underscores the importance of individualized decision-making in SRM management and highlights areas of consensus and divergence among contemporary guidelines.

Abstract in English:

ABSTRACT Purpose: There is a bidirectional relationship between chronic kidney disease and the incidence of renal cell carcinoma. Despite the frequency of patients with both chronic kidney disease and renal cell carcinoma, there are limited systematic reviews detailing the nuanced treatment. This review provides comprehensive insights for clinicians for managing chronic kidney disease, and renal cell carcinoma. Methods and Methods: We reviewed published literature that examined either chronic kidney disease and renal cell carcinoma or an indirect contributor of both. Results: We compare and contrast renal cell carcinoma treatment with partial and radical nephrectomies, ablative techniques, and radiation and their impact on glomerular filtration rate, recurrence rate, and contraindications. We discuss when and how to intervene with treatment with emphasis on the delicate balance between eradicating malignancy and preserving renal function. Specifically, we detail the appropriate use of renal biopsies in incidentally discovered tumors, active surveillance, and postoperative surveillance including imaging sensitivity and specificity. We offer insight into the limitations of current systemic therapy, including renal toxicity. Conclusions: Our investigation into the intricate relationship between chronic kidney disease and renal cell carcinoma has many multifaceted challenges for both patients and healthcare providers face. This comprehensive review serves as an extensive synopsis of the current literature and offers patients the best possible long-term renal-based outcomes.

Abstract in English:

ABSTRACT Purpose: The purpose of this study is to examine whether retrovesical fibromuscular structures—specifically the trapezoid interpubic ligament (TIPL)—mechanically restrict the inversion of small, non-growing bladder plates (SNGBP) in bladder exstrophy, and to evaluate bladder growth after one-stage closure with TIPL dissection, including the effect of anticholinergic therapy. Materials and Methods: Between 2004 and 2023, 15 patients with SNGBP underwent one-stage bladder closure using a modified surgical approach with TIPL dissection. The TIPL, identified as a fibromuscular structure impeding bladder plate (BP) inversion, was targeted. Postoperative bladder capacity was evaluated based on age at surgery and the use of anticholinergic therapy. Results: The TIPL was identified as the primary mechanical impediment to BP inversion. Its dissection restored tissue compliance, facilitating successful one-stage closure in all patients. In children under three years of age at the time of surgery, the mean annual bladder capacity increased by 17.76 mL. Anticholinergic therapy further enhanced bladder growth. Conclusion: TIPL dissection enables one-stage closure in SNGBP patients who were previously considered unsuitable for this method. Early intervention supports bladder development and favorable functional outcomes. These findings provide novel anatomical insights, warranting further morphological and embryological research to validate the universality of this structure and technique.

Abstract in English:

ABSTRACT Purpose: To describe the experience of five training centers with redo laparoscopic pyeloplasty (RLP) in children with restenosis of the uteropelvic junction (UPJ), assessing whether this approach increased or not postoperative complications or surgery failure. Materials and Methods: A retrospective, descriptive study was conducted, including 19 patients who underwent transperitoneal RLP at five independent training centers across 4 different countries between January 2009 and December 2017. All patients had previously undergone Anderson-Hynes dismembered pyeloplasty. Primary outcomes included postoperative complication rates and redo surgery failure. Results: There were 19 RLP out of 744 primary laparoscopic pyeloplasties. Median operative time was 150 minutes (interquartile range [IQR] 126.2-180), extended by 19 minutes when colon mobilization was performed. No cases required conversion to open surgery. A median postoperative analgesic requirement and length of stay of 5 and 4 days, respectively, were recorded. No major complications were reported except a single instance of temporary UPJ stenosis, which was managed with a nephrostomy tube and did not require further surgery. After a median follow-up of 17 months, we achieved a 100% success rate. A significant reduction in renal pelvis dilation was noted, with the median anteroposterior diameter (APD) decreasing from 43 mm preoperatively to 17 mm postoperatively (IQR 10–22). Conclusions: Our findings suggest that RLP remains a feasible approach in the management of restenosis of the UPJ even in such different healthcare settings, providing success rates as high as those described in primary pyeloplasty while maintaining a safety profile.

Abstract in English:

ABSTRACT Purpose: Approximately one-third of the children with primary monosymptomatic enuresis (PMNE) do not respond to first-line treatment. We aimed to investigate the short-term and six-month effectiveness of combining desmopressin acetate with parasacral transcutaneous electrical nerve stimulation (PTENS) in these children and adolescents. Materials and Methods: Participants aged six–17 years with PMNE were randomly assigned to receive desmopressin acetate with active or sham PTENS. Both groups participated in weekly 30-minute electrotherapy sessions for 15 weeks. The intervention group (IG) received electrotherapy at a frequency of 10 Hz and pulse width of 700 μs. A dry and wet nights calendar assessed the frequency of wet nights in the short term and six months after the intervention ended. Results: Of 66 participants, 34 were randomized to the IG. The median age was 10.3 years (8.8 – 12), and 53% were male. Intention-to-treat analysis showed a significant reduction in the frequency of wet nights after the interventions (p <0.001) in both groups, with the IG demonstrating significant improvement, immediately after the interventions (p=0.005) and after six months (p<0.001) compared to the placebo group (PG). The Kaplan-Meier survival analysis showed improvement in the IG that became more pronounced from the 15th week onwards (log-rank test, p < 0.01). Conclusions: A 15-week treatment with desmopressin acetate and PTENS significantly reduced wet nights in children and adolescents with PMNE, and this improvement was maintained six months after the interventions.

Abstract in English:

ABSTRACT Objective: To compare the outcomes of robotic-assisted partial nephrectomy (RALPN) and selective arterial embolization (SAE) for the treatment of sporadic renal angiomyolipoma (AML). Patients and methods: The outcomes of patients who were managed by RALPN (n = 191) or SAE (n = 51) for sporadic renal AML were matched (2:1) using a propensity score for analyses. The primary endpoint was therapeutic success defined as the absence of secondary treatment. Secondary endpoints were post-operative complications and renal function preservation (loss of eGFR at 6 months). Univariate and multivariate logistic regression analyses were used to predict factors associated with re-intervention. Results: Patients baseline characteristics in the matched population (RALP, n=96 vs. SAE, n=48) were balanced. LOS was shorter (mean: 4.2 vs. 3.1 days; p = 0.004) and EBL was lower (327 mL vs. 0 mL, p < 0.0001) in the SAE group. Overall (PN: 15.2% vs. AES: 11.7% p = 0.09) and Clavien-Dindo stratified (p = 0.62) complications were similar in both groups. After a comparable mean follow-up time (33 vs. 40 months, p = 0.63), there was an overall mean loss of eGFR of 7.7±26 mL/min/1.73m2 (p = 0.001). This loss was similar between the two groups (PN: 6.87±26 vs. AES: 11.56±23, p = 0.36). After adjusting for identified confounding factors including tumor size, type of primary intervention (RALPN vs SAE) was the only predictive factor for secondary intervention. Conclusion: RALPN was associated with decreased need for secondary treatment with no increase in morbidity compared with SAE.

Abstract in English:

ABSTRACT Purpose: We evaluated the possibility of using remaining penile tissue such as preserved corpora cavernosa, the remaining glans tissue with neurovascular components and the anterior urethra, after femininizing gender affirmation surgery for live donor penile transplantation. Materials and Methods: Between January 2022 and January 2024, penile dissection was performed in 31 male cadavers, aged 20-59 years (mean 42 years). The dissection with tissue preservation was based on penile disassembly principles: penile skin, part of the glans with neurovascular elements, and proximal urethra were prepared for feminizing genitoplasty while remaining penile tissue such as full corpora cavernosa, glans and anterior urethra were micro dissected and properly measured. Results: Mean penile length was 10.24 cm in the flaccid and 14.6 cm in the stretched state. The mean diameters of the deep dorsal vein and the right and left arteries were measured at 2.8 mm, 1.9 mm and 1.8 mm, respectively. Penile nerves with an anatomical distribution were found in all cases. The mean length and girth of cavernosum bodies were 19.24 cm, and 7.29 cm, respectively. The mean length of the distal urethra was 15.73 cm (range 11-21 cm), without registered anomalies. The mean volume of the glans after neoclitoris creation was 89% of total. All dissections were completed successfully, and all entities were joined again in all cadavers. Conclusions: The cadaveric study has confirmed the technical feasibility and possibilities of using all remaining penile tissue for possible live donor penile transplantation.

Abstract in English:

ABSTRACT Introduction: Retroperitoneal lymph node dissection (RPLND) is indicated for testicular cancer patients with residual masses post-chemotherapy or stage I-II non-seminomatous germ cell tumors (NSGCT) (1, 2). Open RPLND remains the standard but carries significant morbidity. The laparoscopic approach, while minimally invasive, presents notable technical challenges (3). Robotic-assisted RPLND (rRPLND) offers a minimally invasive alternative with comparable oncological outcomes (4, 5). The Da Vinci Single Port (SP) system presents new possibilities for reducing surgical morbidity (6, 7). Methods: We report a case of SP-rRPLND using a unilateral modified template and a lower anterior access (LAA) in a 41-year-old man with NSGCT (pT2, UICC Stage IB) who underwent left orchiectomy, followed by adjuvant chemotherapy. A CT scan revealed a 3.5 cm residual retroperitoneal mass in the left hilar region. The surgical procedure, performed with the Da Vinci SP system, involved a 2.5 cm McBurney incision for retroperitoneal access. Instrument configuration followed a "Camera below" setting. The unilateral left-sided modified template guided dissection from the aortic bifurcation to the renal hilum, preserving vascular structures. A 3,5 cm residual mass and para-aortic nodes were excised with the help of flexible Greena® applicator for clips. Results: Anesthetic management prioritized opioid-sparing techniques to enhance recovery. The patient received regional anesthesia, multimodal analgesia, and had an NRS pain score of 0 at discharge. The console time was 79 minutes, with minimal blood loss and no complications. The patient resumed oral intake on postoperative day 1 and was discharged on day 2. Postoperative recovery was uneventful, with no complications or need for conversion to open or laparoscopic surgery. Final histopathological examination revealed a germ cell tumor with features suggestive of immature teratoma, along with over 10 lymph nodes showing sinus histiocytosis. At six months post-RPLND, the patient remains disease-free, with a good general condition and no new symptoms. Tumor markers (AFP, β-hCG, LDH) are within normal limits, and CT imaging shows no evidence of recurrence or residual retroperitoneal masses. Renal function and hormonal profile are stable. Given prior chemotherapy exposure, cardiovascular monitoring is advised. Follow-up will continue with clinical exams and tumor markers every 3-4 months, with the next CT scan planned at 12 months, unless symptoms warrant earlier imaging. Conclusions: As far as we know this is the first reported case of SP-rRPLND in Europe. The LAA provides safe access while minimizing morbidity, potentially improving recovery (8). A unilateral approach, avoiding transperitoneal access, may further reduce morbidity (9). Future studies should validate long-term oncological outcomes and compare SP-rRPLND with multiport and open approaches. SP-rRPLND represents a promising advancement in minimally invasive testicular cancer surgery.

Abstract in English:

ABSTRACT Purpose: Ureterocalicostomy refers to the anastomosis of the lower pole calyces with the ureter after excision of the hydronephrotic lower renal pole (1, 2). Indications for ureterocalicostomy include previous failed pyeloplasty, ureteropelvic junction obstruction (UPJO) with anatomical abnormalities, such as intrarenal pelvis or short ureter (3) and proximal ureteral strictures (4). The purpose of this video is to demonstrate the technique of Robotic-Assisted Laparoscopic Ureterocalicostomy (RALUC) in a patient with UPJO and intrarenal pelvis. Materials and Methods: Preoperatively, a retrograde ureteropyelography was performed. A transperitoneal approach with the Hassan technique was used, followed by the introduction of four additional DaVinci® trocars. The first step of the procedure is dissection of the retroperitoneum, the proximal ureter and lower part of the kidney including the renal hilum. The proximal ureter is dissected below the stricture. The lower pole artery is selectively bulldogged, and the lower pole of the kidney is resected in a circular manner to get broad based access to the lowest calix. The "Garland" suture technique is used to control hemostasis of the lower pole of the kidney. Therefore, a running, "low tension", circular suture is performed along the whole renal defect. This provides sufficient parenchymal hemostasis without narrowing the access to the lower calix. The ureter is then spatulated and sutured to the lower calix. The video shows step by step the ureterocalical anastomosis in single knot technique and explains tips and tricks. Results: Total operative time was 114 minutes, while estimated blood loss was 25 mL. The JJ catheter was removed at 40 days postoperatively, while an ultrasound was performed after the JJ removal, showing no hydronephrosis. No intraoperative or postoperative complications were reported. The creatinine count and GFR after JJ removal were 92 μmoL/L and 70 ml/min, respectively. During the last follow-up the patient remained asymptomatic and had a mild chronical dilatation of the caliceal system but no hydronephrosis. Conclusions: This video demonstrates the effectiveness and repeatability of RALUC for reconstructing UPJO in patients with very narrow or intrarenal pelvis. RALUC is a feasible, safe and efficient approach for selected patients requiring reconstruction of the upper urinary tract.