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ABSTRACT Purpose: To summarize current evidence on the etiology, diagnostic approach, management strategies, and outcomes of micropenis in children and adolescents. Materials and Methods: A narrative review was performed using PubMed/MEDLINE (October 2025) with the search terms (Micropenis OR Microphallus OR "Small Penis") AND (Children OR Youth OR Adolescents). From 707 records screened, 36 studies were selected based on methodological quality and relevance to clinical practice. Results: Micropenis is a clinical sign frequently associated with underlying endocrinopathies, particularly Congenital Hypogonadotropic Hypogonadism (CHH). Accurate diagnosis relies on standardized Stretched Penile Length (SPL) assessment, recently optimized by the Stretched Penile Length INdicator Technique (SPLINT). Use of population-specific SPL nomograms is critical for diagnostic reliability. Testosterone therapy remains the primary treatment modality and demonstrates greatest efficacy in early infancy, promoting significant penile growth and generally favorable functional outcomes. Spontaneous catch-up growth during puberty has been reported in select cases. Current evidence supporting surgical interventions in children and adolescents is limited, heterogeneous, and associated with inconsistent long-term results; thus, surgery should not be considered first-line therapy. High-quality long-term outcome data and randomized placebo-controlled trials are lacking. Conclusions: Standardized SPL measurement and appropriate nomogram use are essential for accurate diagnosis. Early hormonal therapy, especially in CHH-associated micropenis, appears to yield optimal functional and psychosocial outcomes. Expectant management may be appropriate in selected clinical scenarios. Surgical techniques remain controversial, with insufficient evidence to recommend routine use. Further well-designed prospective studies, including randomized placebo-controlled trials, are needed to define long-term outcomes and guide clinical decision-making.

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ABSTRACT Purpose: To perform a systematic review and meta-analysis evaluating the efficacy and safety of preoperative silodosin in improving ureteroscopy (URS) outcomes for ureterolithiasis. Materials and Methods: PubMed, EMBASE and Cochrane Central were systematically searched for studies comparing preoperative silodosin with placebo or ‘no preoperative silodosin’ in patients undergoing URS for ureteral stones. Primary outcomes included ureteral wall injury, analgesia use, fever, haematuria, stone-free rate (SFR), operative time, and complications. Statistical analysis was performed using Review Manager 5.1.7. Study quality and risk of bias were assessed per Cochrane guidelines. Results: Nine studies, including eight randomized clinical trials, including 960 patients were analysed; 450 (46.8%) received silodosin. Compared to controls, silodosin significantly reduced ureteral injuries (RR 0.30; 95% CI: 0.18–0.49; p < 0.00001) and operative time (MD −17.72 minutes; 95% CI: −24.72 to −10.72; p < 0.00001). It also lowered analgesia needs (RR 0.35; 95% CI: 0.16–0.75; p = 0.007), with trends toward reduced fever (RR 0.67; 95% CI: 0.36–1.22; p = 0.19) and haematuria (RR 0.57; 95% CI: 0.32–1.02; p = 0.06). In studies with ≥10 days of preoperative use, silodosin significantly improved SFR (RR 1.17; 95% CI: 1.10–1.26; p < 0.00001). Conclusions: Preoperative silodosin reduces ureteral injuries, operative time, and complications, supporting its use to improve safety and efficiency of URS for ureterolithiasis.

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ABSTRACT Purpose: This is a systematic review and meta-analysis of the outcomes of transperineal prostate laser ablation (TPLA) in men with benign prostatic enlargement. Materials and Methods: Pubmed, Embase, Scopus, and Cochrane Library databases were searched from inception to July 2024. Random-effects model was employed to compute mean differences for continuous endpoints. Heterogeneity was evaluated by prediction interval and I-squared statistics. Results were reported following the PRISMA guidelines. Results: Seventeen studies involving 777 patients with mean age of 62 to 80 years were included. Over 12-month follow-up, TPLA decreased the International Prostate Symptom Score (MD −12.62; 95% CI −14.87 to −10.37; p<0.001; I2 = 90%), post-void residual (MD −73.24 mL; 95% CI −96.91 to −49.57; p<0.001; I2 = 89%), and prostate volume (MD −21.23 mL; 95% CI −32.65 to −9.81; p<0.001; I2 = 84%). TPLA increased the maximum urinary flow rate (MD 6.32 mL/s; 95% CI 4.69 to 7.95; p<0.001; I2 = 81%). Ejaculatory and erectile functions were not impacted. Compared to TURP, TPLA was associated with ejaculatory function preservation, shorter operating time and length of stay. Risk of bias for the non-randomized studies was moderate, and low for the randomized studies. Conclusions: TPLA demonstrated favorable outcomes for BPE without a negative impact on sexual function. This minimally invasive treatment was found to have advantages over TURP, such as, ejaculatory function preservation, reduced operative time, and shorter hospital stay. Evidence for this MIST is emerging but remains predominantly retrospective with short follow-up, highlighting the need for further comparative prospective studies.

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ABSTRACT Purpose: This randomized clinical trial (RCT) was developed to analyze the efficacy of using Mixed Reality (MIXREAL), the combination of virtual (VR) and augmented realities (AR), in robot-assisted partial nephrectomy (RAPN). Materials and Methods: Forty-five patients with renal masses (RM) were allocated to RAPN with or without use of MIXREAL, Realitatem Group (RG) and Control Group (CG), respectively. Results: Analyses indicated statistically significant difference in ischemia time favoring RG (p = 0.045), with a mean difference of 3.8 minutes. Classically, the limit widely accepted as suitable for ischemia time is 20-25 minutes, but every 1 minute saved may reduce renal injury. Analyses also indicated statistically significant difference in decision for selective clamping favoring RG (p = 0.013); main renal artery clamping globally exposes the renal parenchyma to ischemia. The percentage of residual parenchyma after surgery is also an important variable to renal function recovery, and this study presented a trend towards the enucleation technique being facilitated in the RG. No difference was detected regarding complication rate. Despite those results, no difference was detected in both short and long-term renal function outcomes. The small sample is an important drawback. Conclusion: This RCT demonstrates the feasibility and safety of MIXREAL in RAPN, as well as its potential to support intraoperative decision-making. It represents the first RCT evaluating MIXREAL in RAPN. Larger studies with longer follow-up are needed to confirm potential functional benefits.

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ABSTRACT Purpose: Posterior bulboprostatic excision and primary anastomosis (EPA) is considered standard of care for obliterative or disruptive pelvic fracture urethral injuries (PFUIs), yet validated patient-reported outcomes (PROMs) in this setting remain limited. We aimed to evaluate long-term reintervention-free survival (RFS) and PROMs following EPA. Patients and Methods: This retrospective study included male patients undergoing transperineal bulboprostatic EPA for PFUI between 2014 and 2024 at a tertiary reconstructive referral center. Data collected included trauma etiology, comorbidities, prior interventions, operative details, and follow-up duration. Co-primary endpoints were RFS estimated by Kaplan-Meier analysis, and PROMs assessed using validated instruments. Results: Seventy patients (median age 48 years) underwent EPA. Initial management included suprapubic catheter (77%), endoscopic (21%), or open realignment (1.4%). Median operative time was 77 minutes; median follow-up was 53 months. RFS was 87% at 2 years and 84% at 5 years. PROMs—available in 53% of patients at median 71 months—included moderate voiding/incontinence symptoms (median LUTS score 6; ICIQ-UI SF 7), severe erectile dysfunction (IIEF-EF 7), preserved ejaculatory function (MSHQ-Ej 24), high satisfaction (ICIQ-S 21; global satisfaction 9), and negligible decision regret (median 0). Limitations include retrospective design and incomplete PROM data (53% response rate). Conclusions: Bulboprostatic EPA offers durable anatomical success and high long-term patient satisfaction despite persistent functional impairments largely linked to initial trauma. Most patients expressed minimal regret and willingness to repeat the procedure. These outcomes reinforce EPA's role as the standard of care in PFUI management.

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ABSTRACT Purpose: There is currently no validated instrument in Brazil specifically designed to assess the quality of life (QoL) of patients with ureteral stones. The Cambridge Ureteral Stone Patient-Reported Outcome Measure (CUSP) is a self-administered questionnaire that evaluates the QoL impact of ureteral stones over the preceding seven days. This study aimed to translate, culturally adapt, and validate the CUSP for Brazilian Portuguese (Br-CUSP) for clinical and research applications. Materials and Methods: The CUSP questionnaire was translated into Portuguese according to Guillemin's cross-cultural adaption guidelines. Patients with and without ureterolithiasis completed both the Br-CUSP and SF-12 questionnaires. Psychometric validation included assessment of internal consistency, test-retest reliability, convergent validity, and discriminant validity. Results: A total of 156 participants completed both questionnaires. No inconsistencies emerged during univariate analysis. Confirmatory factor analysis supported the six-factor model with satisfactory fit indices. All factor loadings exceeded 0.50. Internal consistency was high across all domains (Cronbach's α = 0.72 - 0.98; McDonald's ω = 0.73 - 0.98). Test-retest reliability demonstrated strong temporal stability. Inter-domain correlations (Spearman's p = 0.45 - 0.82) supported structural coherence. Convergent validity was confirmed through inverse correlations with SF-12 scores. Discriminant validity was demonstrated by significant score differences between patients with and without ureteral stone, with large effect sizes. Conclusions: The Brazilian Cambridge Ureteral Stone Patient-Reported Outcome Measure is a valid, reliable tool for assessing health-related quality of life in Brazilian patients with ureteral stones. Its implementation can enhance both clinical assessment and research into patient-centered outcomes in urolithiasis.

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ABSTRACT Purpose: No validated tool specifically assesses health-related quality of life (HRQoL) in Brazilian patients with kidney stones. The Cambridge Renal Stone Patient-Reported Outcome Measure (CReSP) is a self-administered questionnaire that evaluates the impact of kidney stones on patients’ QoL over the preceding seven days. This study aimed to translate the CReSP into Portuguese, validate it, and compare it with the validated generic SF-12 questionnaire. Materials and Methods: The CReSP questionnaire was translated into Portuguese following Guillemin's guidelines. Patients with and without kidney stones completed the Brazilian version of the CReSP (Br-CReSP) and SF-12 questionnaires. Internal consistency, test-retest reliability, discriminant validity, and convergent validity with SF-12 components were evaluated. Logistic regression assessed the discriminant capacity of Br-CReSP and SF-12 components for nephrolithiasis. Results: One hundred patients completed both questionnaires. Internal consistency was high across all domains and the total score (Cronbach's α = 0.92). Test-retest reliability demonstrated strong correlations for all domains and the total score (ICC = 0.94). Discriminant validity was evidenced by significant differences between patients with and without kidney stones, with large effect sizes. Convergent validity was shown by significant inverse correlations between the Br-CReSP and SF-12 (p < 0.001). The Br-CReSP outperformed PCS-12 and MCS-12 in predicting nephrolithiasis (AUC = 0.91 vs. 0.84 and 0.73, respectively). Conclusions: The validated Br-CReSP outperforms SF-12 in assessing HRQoL in Brazilian patients with kidney stones.

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ABSTRACT Purpose: To describe the surgical technique and evaluate the clinical outcomes of robot-assisted reduction pyeloplasty for adult giant hydronephrosis (GH) secondary to ureteropelvic junction obstruction (UPJO). Materials and Methods: Between May 2019 and August 2024, 18 adult patients with GH caused by UPJO underwent robot-assisted laparoscopic reduction pyeloplasty. Patients’ characteristics, perioperative variables, and clinical outcomes were prospectively recorded. Three-dimensional (3D) reconstructions generated from CTU were used for preoperative planning and intraoperative navigation. The surgical technique was described, and outcomes were assessed. Results: All procedures were completed successfully with no conversions to open surgery. The median (range) operative time was 153 (77-241) minutes, with a median (range) estimated blood loss of 20 (10-100) mL. No intraoperative complications were observed. During a median (range) follow-up of 10 (6-40) months, all patients achieved complete symptomatic relief and significant reduction in hydronephrosis. Renal parenchymal thickness improved significantly after surgery (11.9 ± 3 mm vs 9.2 ± 4.4 mm, P=0.0207). Split renal function [38.7 (15.4-48.7) vs 25.7 (3.6-53.5), P=0.0131] showed significant improvement after surgery, which was consistent in patients in poorly functioning kidney subgroup [26.0 (19.2-24.6) vs 21.9 (11.6-24.6), P=0.0273]. Conclusion: Our results show that robot-assisted reduction pyeloplasty is a safe and effective option for managing GH, facilitating significant improvement in renal functional outcomes, even in patients with borderline renal function.

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ABSTRACT Purpose: Focal cryotherapy is a minimally invasive treatment for localized prostate cancer (PCa), but its oncological outcomes, particularly in relation to baseline Gleason Grade Group (GG), remain understudied. This study evaluates its efficacy and the impact while radical of baseline Gleason score on recurrence-free survival. Materials and Methods: A retrospective analysis included 111 patients with localized PCa treated with focal cryotherapy between 2014 and January 2024. Patients with prior treatments or follow-up <12 months were excluded. All patients underwent MRI and transperineal biopsy, and cryotherapy was performed using the Visual ICE Cryoablation System. Confirmatory biopsies were recommended at 12–24 months post-treatment. Recurrence was classified as either in-field (treated or adjacent areas) or out-field (non-adjacent areas). Any recurrence-free survival was defined as the absence of positive biopsy or additional treatment. Radical treatment-free survival was defined as the absence of whole-gland treatment (e.g., radical prostatectomy, radiotherapy), androgen deprivation therapy, metastasis, or death. Outcomes were compared between patients with baseline GG 1 and GG >1. Results: Median follow-up was 35 months (IQR 24–49). Confirmatory biopsies were performed in 78% of patients (n=87), revealing in-field recurrence in 10% and out-field recurrence in 23%. There were no statistically significant differences between ISUP 1 and ISUP >1 groups in terms of protocol biopsy positivity for either in-field recurrence (HR 0.41; 95% CI 0.09–1.9) or out-field recurrence (HR 0.77; 95% CI 0.3–1.98). At three-years, the rates of any recurrence-free and radical treatment-free survival were 63% and 85%, respectively, with no significant variation by baseline GG. Conclusion: Focal cryotherapy provides favorable short-term oncological outcomes in localized PCa, with no significant differences in recurrence-free survival based on baseline Gleason score.

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ABSTRACT Background: There are no reports comparing penile length with foot-length between normal and anencephalic fetuses. Aim: To compare the penile length with foot-length in fetuses with anencephaly and without anomalies. Materiais and methods: We studied 32 fetuses without anomalies, aged 11-22 weeks post-conception (WPC) and 13 anencephalic fetuses, aged 13-19 WPC. We evaluated penile free portion length and width, penile root length and width and total penile length with a digital caliper and the aid of computer programs (Image Pro and Image J). The Shapiro-Wilk test was employed to ascertain the normality of the data and to compare quantitative data between normal vs. anencephalic fetuses. Simple linear correlations were calculated for penile measurements according to foot-length. Outcomes: This is a morphometric study of human fetuses using a standardized technique to measure the penis in human fetuses. Results: Total penile length varied from 4.69 to 29.77mm (mean =15.67) in normal fetuses and from 7.49 to 18.46mm (mean=11.48) in anencephalic fetuses without significant differences. The linear regression analysis indicated that the total penile length has a strong and significant correlation with the foot length in the control group (r2=0.8505, p<0.001) and a moderate correlation of total penile length and foot length in the anencephalic group (r2=0.6813; p=0.0032) and the penile body and root width increased significantly and positively with fetal foot length in normal and anencephalic fetuses. Clinical Implications: This study may suggest a correlation between foot size and penis size in human fetuses during the 2nd gestational trimester of development. Strengths & Limitations: Sample size was small; however, anencephalic fetuses are rare, so observations of a small sample are still relevant. Conclusions: Penile length increased significantly and positively when correlated with foot length during the 2nd trimester of gestational development. We can suggest that foot size can be considered an indicator of penis size in human fetuses.

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ABSTRACT Introduction: Rectovesical fistula (RVF) is a rare complication after robot-assisted radical prostatectomy (RARP) (1), often requiring complex surgery (2). Robotic systems provide dexterity and visualization for deep pelvic procedures (3, 4). We report the first RVF repair using the Hugo™ RAS System. Materials and Methods: A 76-year-old male developed fecaluria one week after catheter removal following RARP. MRI revealed a 1.3 cm fistulous tract between the bladder and rectum. Initial management included transurethral and suprapubic catheters, plus a loop colostomy. Robotic repair was performed five months later. Trocar placement, adapted to the stoma, included four robotic and two assistant ports. Posterior bladder wall dissection allowed removal of two joined catheters. The posterior bladder wall, urethrovesical anastomosis dehiscence, and a 1 cm anterior rectal defect were repaired. Fibrotic tissue and residual clip were removed. A peritoneal flap was interposed between the bladder and rectum, and a new bladder neck and vesicourethral anastomosis were created using barbed sutures. Intraoperative testing confirmed integrity, and a bladder catheter was placed. Results: The postoperative course was uneventful, with patient discharge on day 4. The bladder catheter was removed after 3 weeks. At the 2-month follow-up, urinary function was normal with good continence. Ultrasound confirmed good bladder filling and no post-void residual. Cystoscopy showed a well-healed urethrovesical anastomosis without fistula. Colostomy reversal is pending. Conclusions: This case demonstrates the feasibility and effectiveness of the Hugo™ RAS System for RVF repair post-RARP. Robotic surgery can manage complex defects with favorable outcomes (5). Robotic platforms may expand telesurgery, allowing patients to undergo procedures locally with expert surgeons operating remotely (6).

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ABSTRACT Introduction: Robotic retroperitoneal lymph node dissection (RPLND) has emerged as a minimally invasive alternative for the management of testicular germ cell tumors, offering reduced morbidity and faster recovery when performed in experienced centers (1–3). However, post-chemotherapy cases remain technically demanding. We present a case of robotic RPLND performed for a bulky residual mass following systemic treatment. Methods: A 23-year-old male with no comorbidities underwent right orchiectomy for clinical stage IIC non-seminomatous germ cell tumor (60% yolk sac, 20% embryonal carcinoma, 20% post-pubertal teratoma), followed by three cycles of BEP chemotherapy. Tumor markers normalized, but imaging revealed a persistent 5.4-cm interaortocaval mass. Robotic RPLND was carried out using four robotic ports and one 12-mm assistant port. The procedure included a complete bilateral template dissection (paraaortic, interaortocaval, and paracaval), en bloc tumor removal, and meticulous sharp and blunt dissection using advanced bipolar energy. Results: Operative time was 300 minutes, with minimal blood loss (50 mL) and no intraoperative complications. The bulky lesion was successfully resected with excellent anatomical exposure, despite significant tumor adherence to the aorta. The patient was discharged on postoperative day one and resumed normal activities within two weeks. Pathology revealed teratoma in 1 of 34 resected lymph nodes. At 6-month follow-up, he remained disease-free, with normal tumor markers, preserved renal function, and no complications. Conclusion: This case demonstrates the feasibility of robotic RPLND for large post-chemotherapy residual masses. The robotic platform enables precise dissection even in challenging settings, with favorable perioperative and oncologic outcomes. Centralized expertise and standardized technique are essential to achieve optimal results (1, 4–6).

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ABSTRACT Introduction: Suction ureteral access sheaths (FANS, S-UAS) are reshaping retrograde intrarenal surgery (RIRS) by improving stone-free rates and reducing complications compared to traditional UAS (1–5). Since their use requires significant technical adjustments with limited standardization, we present an instructional video detailing setup, operative choreography, and troubleshooting. Methods: Single-center instructional case from a tertiary unit. Index patient: 67-year-old man with a 25-mm right pelvic stone (1560 HU; ~3500 mm³). Preoperative considerations included selective prior stenting and off-label α-blockers. We typically use 10/12 or 11/13 Fr suction UAS with 7.5–8.5 Fr flexible ureteroscopes. Setup: pressurized irrigation to the ureteroscope; lateral suction port connected to a labeled collector cup via a vacuum regulator, creating a closed-loop, pressure-aware system. Under fluoroscopy, the sheath is positioned above the ureteropelvic junction (UPJ) with careful advancement into the target calyx. Laser strategy combines dusting and fragmentation with suction. Fragments are evacuated through coordinated suction bursts and slow scope withdrawal. Final inspection defines stent placement and dwell. Results: Operative time was 115 min, with 25 min of laser use. POD-1 CT confirmed stone-free status. The patient was discharged after 24 h, and the double-J stent with string was removed on day 5. The high-definition video illustrates connections, target pressures, inflow/outflow rules, and provides concise troubleshooting algorithms for common issues: impassable UPJ (use as conventional UAS), friction/kinks, clogging, and system collapse (increase inflow, reduce suction, or reopen outflow). Conclusion: A standardized suction-UAS technique is feasible and reproducible, optimizing visualization, fragment clearance, pressure control, and safety during RIRS for large stones (6–8). Standardization videos such as this may enhance training, support wider adoption, and improve consistency of outcomes.