Abstract in English:

ABSTRACT Purpose: This meta-analysis compares the efficacy and safety of the Bricker and Wallace techniques, focusing on updating previously unassessed clinical outcomes to inform surgical decision-making. Material and Methods: A systematic review and meta-analysis followed PRISMA and Cochrane guidelines, with the protocol in PROSPERO (CRD42024621076). Searches in MEDLINE/PubMed, EMBASE, and Cochrane Library included Randomized Clinical Trials and cohort studies comparing both anastomosis techniques. Analyses used Odds Ratio (OR) and mean differences with a random-effects model. Results: Fourteen studies with 1,903 patients (980 Bricker; 923 Wallace) were included. No significant difference was found in overall stricture rates. However, the Bricker technique had more unilateral strictures (OR 0.47; 95% CI 0.30-0.75; p < 0.01), while the Wallace technique had lower stricture rates in patients who underwent ileal-conduit urinary diversion (OR 0.35; 95% CI 0.19-0.64; p < 0.001), and patients without prior radiotherapy (OR 0.29; 95% CI 0.14-0.61; p < 0.001). Wallace also presented reduced hydronephrosis (OR 0.37; 95% CI 0.17-0.79; p < 0.05). No significant differences were observed in patients undergoing neobladder diversion or those with bladder cancer. Conclusion: No difference in main analyses of stricture rates was found, supporting that technique choice should rely on surgeon preference and expertise. Therefore, beyond surgeon preference, the choice of technique should consider the patient's history of radiotherapy, and the type of urinary diversion planned, aiming to optimize postoperative outcomes and minimize the risk of specific complications.

Abstract in English:

ABSTRACT Objectives: In this review we will provide recommendations for surgical site infection (SSI) prophylaxis in urological diagnostic and surgical procedures. Material and Methods: We performed a narrative review of the literature in PubMed (Medline), EMBASE, LILACS, Web of Science, and Cochrane Collaboration databases using the terms "infection," "surgery," "urology," and "antibiotic prophylaxis" Results: We suggest recommendations of prophylactic antibiotic in the follow procedures: prostate biopsy, Urethrocystoscopy, Extracorporeal Shock Wave Lithotripsy (ESWL) for Urinary Stones, endoscopic ureterolithotripsy, percutaneous nephrolitothomy, Transurethral Resection of the Prostate (TURP) and Prostatic Enucleation, Transurethral Resection of Bladder Tumor (TURBT), Intravesical Botulinum Toxin Injection, surgical correction of female stress incontinence, Surgical Correction of Pelvic Organ Prolapse, urological prosthesis implantation and Open, Laparoscopic, and Robotic Urologic Surgery Conclusions: Consideration in SSI prophylaxis and the prophylactic antibiotic regimens in several urological procedures are show in this paper and will be useful to urologic practice.

Abstract in English:

ABSTRACT Purpose: Pheochromocytomas (Pheo) and paragangliomas (PGL) are catecholamine-secreting tumours, whose functionality is confirmed by elevated plasma (Pl) and/or 24-h urinary (Ur) metanephrines (MN). Relevance of prior background features were reviewed in a large cohort of patients with Pheo and PGL. Material and Methods: We reviewed clinical, hormonal, and imaging aspects of 116 patients studied prospectively: 93 Pheo; 22 PGL; one Pheo plus PGL. Results: Twenty-five % PPGL were discovered incidentally. Systemic arterial hypertension (SAH) was present in 81% (43% on stage 3), whereas 9.5% were prehypertensive and 9.5%, normotensive. SAH plus paroxysms occurred in 31 (32.9%) patients, being exclusively sustained in the remaining; 26 (28%) had resistant SAH. Orthostatic hypotension was seen in 65% of patients. Pl/Ur MN and normetanephrine (NMN) were compared to those of a positive (56 functioning PPGL) and a negative control group (654 subjects with normal MN/NMN). Total and fractionated Ur MN were elevated in 94% PPGL patients. Cut-off values of 885 mcg/24-h for Ur MN, and of 1.5 nmol/L for Pl MN identified functioning lesions with 100%/100% sensitivity and 93%/97% specificity, respectively. MRI detected 56% right-side Pheo, 25% on the left, and 19% bilateral; PGL were 56.5% (13/23) retroperitoneal and 43.5%, cervical (10/23). Right-side Pheo were larger (5.8 cm) than left-side ones (3.7 cm), but retroperitoneal (6.5 cm) and neck PGL (6.9 cm) were similar. Tumour size positively correlated with total Ur MN. Conclusions: in this large cohort of PPGL patients we highlighted relevant aspects of SAH, the frequently overlooked manifestation of orthostatic hypotension, common incidental presentation, significant tumour size/hormonal production.

Abstract in English:

ABSTRACT Purpose: This is the first series of urological conditions using the Versius Surgical System® platform in Brazil. We evaluated perioperative results, and surgeons’ learning curve in Brazilian hospitals. Materials and Methods: This prospective, multicenter study included urological surgeons certified on the Versius® platform and their respective procedures from May 2022 to August 2024. Perioperative variables included type of surgery, docking time, console time, number of bedside units (BSUs), complications according to the Clavien–Dindo classification, readmission and reoperation rates within 30 days after surgery. Surgeons were stratified according to experience in laparoscopy and robotic surgery. Results: Nineteen surgeons and 302 urological procedures were included. There was no statistically significant difference between docking time and console time when comparing obese patients (BMI > 30, p=0.507) and non-obese patients (BMI < 30, p=0.733). One hundred thirty-seven (45.4%) surgeries were performed by surgeons with experience in laparoscopy and robotics (> 5 years), and 238 surgeries (78.8%) were performed by surgeons who had more than 10 Versius® procedures. Docking time was 13.4 (SD 7.23) minutes. Nephroureterectomy was the procedure with the shortest docking (8.7 minutes, 6–13 min) and console (83.3 minutes, 38–152 min) times. Of the 10 surgeons with 10 or more procedures, 6 had shorter docking times, and 4 had shorter console times. There were four Clavien–Dindo III-IV complications within 30 days postoperatively (1.3%), and six (2%) patients required reoperation. Mean hospital stay was 2 days. Conclusion: This study is the largest Brazilian and worldwide case series of urological surgeries performed using the Versius® robotic platform. Our results demonstrate the safety and efficacy of the Versius® platform and provide real-world evidence of the surgeons’ learning curves and performance based on their prior expertise in laparoscopic and/or robotic surgery.

Abstract in English:

ABSTRACT Objective: To evaluate the sexual function of couples after surgeries to treat penile cancer. Material and Methods: Patients who underwent partial penectomy or glansectomy at a cancer center, between April 2014 and January 2024, and their partners were interviewed only once, at least six months after surgery, through individually conducted interviews. We used a semi-structured questionnaire, the Six-Item Female Sexual Function Index Scoring (FSFI-6) questionnaire to assess feminine sexual function and the Erection Hardness Score (EHS) and The International Index of Erectile Function-5 (IIEF-5) questionnaire to evaluate erectile function. Results: Fourteen couples were included in this study. Five patients underwent glansectomy and nine underwent partial penectomy. All of male patients remained sexually active post-procedure. Of the ten who completed the IIEF-5, five (50%) experienced mild erectile dysfunction. Among partners, twelve (85.7%) continued sexual activity. Of the ten partners who completed the FSFI-6, five (50%) had sexual dysfunction. The size of the penile stump was not correlated with satisfaction of the couples. Four (28.6%) patients adopted adaptive strategies, as engaging in sexual activity in a dark environment and use of silicone penile substitutes. All participants expressed dissatisfaction with the medical information provided by their doctors regarding sexuality after penile surgery. Conclusions: Many couples described sexual dysfunctions after PC surgeries. However, the majority of couples reported maintaining an active sexual life and the majority of the partners reported achieving orgasm. Unfortunately, counseling by healthcare professionals of these couples about sexual health after surgery to treat PC is inadequate.

Abstract in English:

ABSTRACT Purpose: Artificial intelligence (AI) continues to evolve as a tool in clinical decision support. Large language models (LLMs), such as ChatGPT and DeepSeek, are increasingly used in medicine to provide fast, accessible information. This study aimed to compare the performance of ChatGPT and DeepSeek in generating recommendations for the management of postprostatectomy urinary incontinence (PPUI), based on the AUA/SUFU guideline. Materials and Methods: A total of 20 questions (10 conceptual and 10 case-based) were developed by three urologists with expertise in PPUI, following the AUA/SUFU guideline. Each question was submitted in English using zero-shot prompting to ChatGPT-4o and DeepSeek R1. Responses were limited to 200 words and graded independently as correct (1 point), partially correct (0.5), or incorrect (0). Total and domain-specific scores were compared. Results: ChatGPT achieved 19 out of 20 points (95.0%), while DeepSeek scored 14.5 (72.5%; p = 0.031). In conceptual questions, scores were 9.0 (ChatGPT) and 8.0 (DeepSeek; p = 0.50). In case-based scenarios, ChatGPT scored 10.0 versus 6.5 for DeepSeek (p = 0.08). ChatGPT outperformed DeepSeek across all guideline domains. DeepSeek made critical errors in the treatment domain, such as recommending a male sling for radiated patients. Conclusion: ChatGPT demonstrated superior performance in providing guideline-based recommendations for PPUI. However, both models should be used under expert supervision, and future research is needed to optimize their safe integration into clinical workflows.

Abstract in English:

ABSTRACT Purpose: To demonstrate the feasibility and reproducibility of Ultra-long-distance, Asia to Middle East human telesurgery using low latency connectivity on multiple patients and different procedures. Methods: Five human telesurgeries were performed over six months using a multiport robotic platform with fiber-optic and 5G connection. Remote surgeon (SA) was in Shanghai, China, and patients were in Kuwait City, Kuwait 7,000 kilometers (Km) apart. Results: Case 1 was performed in December 2024. Cases 2 – 5 were performed consecutively over four days in April 2025. Three robotic assisted radical prostatectomies and two robotic assisted partial nephrectomies were performed. There were no clinical or technical issues encountered during any of the procedures. The average round-trip latency for all procedures was 166.6 milliseconds (ms) using fiber-optic broadband network with 5G network as back-up. Enhanced cybersecurity was employed with no recorded threats. There was an experienced robotic surgeon (AA) present in the operating room in Kuwait with a clear criteria for console take-over in case of emergencies. There were no reported complications. Patients were discharged on post-operative day two and three. Final pathology showed low grade, low stage disease in all patients and no evidence of disease at eight weeks follow-up. Conclusion: This study demonstrated the feasibility and reproducibility of multiple human telesurgical procedures through successful collaboration between two countries using a robotic system with telecommunication capabilities, with good outcomes and without complications. However, there is a need to establish robust international guidelines to allow globalization of telesurgery.

Abstract in English:

ABSTRACT Introduction: The need for transition from pediatric to adult health services developed from better survival rates of congenital diseases. Quality of life, Independence, and health preservation are to be considered. Perspectives on transition differ between patients, families, health professional and administrators. Methods: Non-systematic review and discussion of transition dilemas in a structured format. Results: Medical transition occurs during late adolescence/ early adulthood. Patients are expected to have increased longevity, need lifeterm follow-up and present varying degrees of complexity. Patients’ fundamental wishes may conflict with caregivers’ considerations. Technical decisions must be balanced, taking into account patient´s social, cognitive, motor and psychological conditions, and the needs of their family caregivers. Difficulties by pediatric healthcare professionals in mastering adult diseases, and challenges encountered by adult-specialized physicians in managing sequelae or ensuring continuity of care for pediatric conditions, are the rule. Patients afflicted by with chronic complex conditions may prove financially challenging. For families, transitioning from from paediatric care to adult-oriented medicine is destabilizing and distressing. The idealization of an unattainable normality is prevalent and detrimental, leading to the abandonment of therapeutic strategies deemed socially undesirable. Discussion: Transition care urgently requires planning by health administrators. Patients should be transferred to adult care only after clinical stabilization. Three models of transition have been suggested (direct transfer, protocol and age-driven; permanence under pediatric assistants control with eventual consultation with adult experts and gradual transition, permeated by a period of conjoint assistance). The last format is considered ideal.

Abstract in English:

ABSTRACT Purpose: The aim of this study was to quantitatively analyze the stromal components of the prostate (collagen, muscle fibers and elastic system fibers) during prostate development in normal human fetuses, in order to establish normal growth patterns. Materials and Methods: Twenty-one normal human fetuses, aged between 12- and 22-weeks post-conception (WPC), were studied. The fetuses were divided into three groups: G1, n = 7, 12 to 16 WPC; G2, n = 6, 17 to 19 WPC, and G3, n = 8, 20 to 22 WPC. The samples were fixed in 4% buffered formalin and processed for paraffin embedding for histochemical analysis. Five 5-micrometer-thick sections were taken from each sample and stained using histochemical techniques to identify the prostate stromal components. Histomorphometric analyses were carried out by evaluating the area density of the parameters analyzed, in percentage, using ImageJ software. Results: The quantitative analysis of collagen fibers (p = 0.0616) and elastic system fibers (p = 0.6049) showed no significant difference between groups. Smooth muscle fibers were higher in G2 (+82.38%) and G3 (+108.81%) when compared to G1, p = 0.0020. Linear regression of the entire fetal period studied (12 to 22 WPC) showed a proportional increase in muscle fibers in relation to gestational age (r2 = 0.3398; p = 0.0056). Linear regression revealed a strong negative correlation between collagen fibers and smooth muscle fibers in G3 (20 to 22 WPC) (r2 = 0.8209; p = 0.0019). Conclusions: Changes in the stromal components of the prostate are more significant from the end of the second trimester of pregnancy. Collagen fibers and elastic system fibers showed stable growth throughout the fetal period studied. The density of smooth muscle fibers increased about twofold with increasing fetal age.

Abstract in English:

ABSTRACT Introduction: Surgical treatment of epispadias has evolved significantly, from early tubularization techniques to modern penile disassembly approaches (1–3). Despite advancements, achieving urinary continence remains challenging and typically requiring multiple interventions (4). Purpose: The objective is to present complete penile disassembly (Belgrade) technique for primary epispadias repair. Patient and Method: We present a case of isolated penopubic epispadias and severe dorsal curvature in 18-month-old boy. Meticulous dissection is conducted ventrally and dorsally to isolate the urethral plate and spongiosal tissues. The Buck's fascia is incised ventrally to isolate the neurovascular bundles, followed by complete separation of the corpora cavernosa from each other and from the glans. The urethral plate is dissected free, transposed ventrally, and tubularized over a catheter. Penile straightening and lengthening are achieved through internal rotation of the corpora cavernosa and dorsal corporotomy with skin grafting. Glans reconstruction is done. Reassemble of all entities is performed, followed by penile skin reconstruction. Results: At the three-month follow-up, the patient demonstrated satisfactory voiding with a good urinary stream, without evidence of urethral fistula or stricture. The cosmetic outcome was favorable, with no signs of recurrent curvature. The patient remains under vacuum device therapy, till 12 month after sugery. Conclusion: The Belgrade approach for isolated penopubic epispadias includes radical approach with complete disassembly. This one-stage repair enables correction of all deformities – penile lengthening and strengthening, urethroplasty, glansplasty and penile skin reconstruction, with good outcomes.

Abstract in English:

ABSTRACT Purpose: While grafting procedures can be used to manage upper ureteric strictures (1), ileal interposition still has its role in the more complex cases with long or bilateral ureteric strictures. Ketamine-associated uropathy can mimic retroperitoneal fibrosis and give rise to long bilateral ureteric strictures (2, 3). The objective of the video is to present the total intracorporeal technique for bilateral ileal interposition with a U-configuration of small bowel loop. Patient and methods: A 34-year-old lady with bilateral long ureteric stricture secondary to ketamine-associated uropathy was managed with robotic reconstruction. The surgical access to retroperitoneum and exposure of bilateral ureters took reference from the single-docking robotic retroperitoneal lymph node dissection technique (4). Da Vinic Xi robotic system was used. Retroperitoneal space was accessed after incision was started behind the caecum, lifting up the root of small bowel mesentery. Bilateral ureters were exposed and the segment proximal to the stricture was identified. In the literature, different techniques of small bowel isolation have been described (5, 6). In this case, a loop of small bowel in U-configuration was prepared and the end of both limbs was anastomosed to the ureters in a side-to-end manner. The apex of the bowel loop was anastomosed to the bladder, completing the procedure. Results: The procedure took 507 minutes. Hospital stay was 8 days. Unobstructed drainage was confirmed by DTPA scan at 3 months and 15 months. UUnremarkable drainage was noted on IVU at 6 months and on CT scan at 18 months. Renal function was static at 3 years with creatinine clearance 56mL/min. The patient was symptom free at post-operative 3 years. Conclusions: Retro-caecal exposure of the retroperitoneal plane allows a convenient access to ureters. Bilateral ileal interposition can be safely performed in a minimally invasive manner with robotic technique.