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ABSTRACT Objective: To analyze the role of surgical treatment in pediatric adrenal neuroblastoma and the operative methods employed according to staging and risk stratification based on patient-related and tumor biological factors. Materials and Methods: A narrative literature review was conducted through a structured search of the PubMed/MEDLINE, Scopus, and Web of Science databases. Studies published in English between 2020 and 2025 were included, while classical references were used to contextualize staging and risk stratification systems. Letters, editorials, case reports, and studies not providing specific insight into the topic were excluded. Results: Surgical treatment represents a key component in the management of pediatric adrenal neuroblastoma. Staging and risk stratification determine both the timing of surgery and its role in achieving local disease control. In low-risk neuroblastoma, surgery alone may be curative. In intermediate-risk patients, neoadjuvant chemotherapy precedes resection, reducing surgical complexity and facilitating tumor removal. In high-risk patients, tumor resection exceeding 90% may contribute to improved overall survival (OS). Image-Defined Risk Factors (IDRFs) are essential for staging and surgical planning, as they define the anatomical relationship between the tumor and adjacent vascular and organ structures. Surgical approaches include open surgery and minimally invasive surgery, the latter being appropriate in carefully selected cases. Conclusion: Surgical treatment remains fundamental in pediatric adrenal neuroblastoma, and operative strategies should be guided by clinical, biological, and radiologic parameters to achieve maximal oncologic safety.

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ABSTRACT Purpose: The landscape of ureteroscopy has been transformed by rapid advancements in laser technology. The transition from the standard Holmium:YAG (Ho:YAG) to Thulium Fiber Laser (TFL) and emerging hybrid technologies (Magneto/Tm:YAG) creates decisional uncertainty. This review analyzes the physical principles, safety, and clinical outcomes of available lasers, proposing a context-based decision-making framework. Materials and methods: A literature review using PubMed and Embase (2014-2025) yielded 1,902 records. Search terms included "holmium laser nephrolithotripsy," "thulium fiber laser," and "ureteroscopy laser." Fourteen seminal high-quality studies were selected for expert narrative synthesis, focusing on ablation efficiency, stone-free rates (SFR), complications, and cost-effectiveness. Results: Literature heterogeneity, particularly inconsistent SFR definitions and imaging modalities, challenges comparative analysis. Clinically, TFL demonstrates superior ablation speeds and dusting capabilities compared to standard Ho:YAG, with equivalent safety. However, High-Power Ho:YAG remains unmatched in versatility for complex stones. Emerging pulsed Tm:YAG and Magneto Cyber Ho systems theoretically combine peak power with dusting efficiency but require further validation. Economically, TFL and High-Power systems demand significantly higher capital investment than Low-Power alternatives. Conclusions: No universally superior laser exists; selection must be guided by institutional context. We propose a four-scenario framework: (1) Low-Power Ho:YAG is ideal for cost-sensitive, low-volume centers; (2) High-Power Ho:YAG is the standard for high-volume centers treating complex cases; (3) TFL is the choice for maximizing operative efficiency and dusting; and (4) Emerging Hybrid Technologies suit academic centers driving innovation. Future studies must prioritize standardized reporting to solidify the evidence base.

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ABSTRACT The ureterovesical junction (UVJ) is a specialized anatomical and functional unit responsible for maintaining unidirectional urinary flow from the ureter into the bladder. Dysfunction at this junction may lead to vesicoureteral reflux (VUR), obstruction, recurrent infections, and potential renal damage. The aim of this review is to present a narrative overview of the historical evolution in the understanding of the UVJ and to summarize key surgical principles, techniques, and contemporary controversies in its management. A narrative analysis of historical anatomical literature, landmark surgical innovations, and contemporary management strategies for UVJ pathology was performed. Emphasis was placed on seminal contributors and the evolution of surgical techniques. Early anatomical descriptions established the importance of the intramural ureter and trigonal anatomy. With the advent of cystography, VUR became recognized as a major pediatric urologic condition. Despite technological advances, the fundamental surgical principles governing UVJ reconstruction remain unchanged: adequate submucosal tunnel length, preservation of vascularity, and tension-free reimplantation. Ongoing advances in minimally invasive surgery and biomaterials continue to refine management strategies.

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ABSTRACT Purpose: This study aims to compare safety, complications, and procedural characteristics of commonly used circumcision devices in neonates and early infants. Methods: We searched PubMed, EMBASE, Web of Science, and SCOPUS through January 2026 for randomized controlled trials comparing infant circumcision devices (Plastibell™, Mogen™, ShangRing™, AccuCirc™) in infants ≤3 months. The primary outcome was total adverse events; secondary outcomes included bleeding, infection, redundant skin, adhesions, parental satisfaction, and procedure time. A random-effects network meta-analysis estimated relative effects with 95% confidence intervals (CI), using Gomco™ or Mogen™ as reference devices. Analyses were performed in R. Results: Ten trials including 3,984 infants from Africa, the Middle East, and the United States were analyzed. No device differed significantly from Gomco™ in total adverse events: Plastibell™ (risk ratios, [RR] 1.53, 95% CI 0.56–4.21), ShangRing™ (RR 2.70, 95% CI 0.31–23.66), Mogen™ (RR 3.83, 95% CI 0.97–15.17), and AccuCirc™ (RR 9.62, 95% CI 0.24–388.45). Plastibell™ was associated with a higher infection risk versus Gomco™ (RR 4.25, 95% CI 1.43–12.65). No significant differences were observed in bleeding, redundant skin, adhesions, or parental satisfaction. Mogen™ and ShangRing™ had shorter procedure times than Gomco™ (mean difference [MD] −3.29 minutes, 95% CI −4.82 to −1.76; MD −3.39 minutes, 95% CI −6.11 to −0.67). Conclusions: Neonatal circumcision devices demonstrate generally comparable safety profiles, though Plastibell™ carries elevated infection risk. Mogen™ and ShangRing™ offer procedural efficiency advantages. Device selection should prioritize provider expertise, infection control capabilities, and programmatic efficiency requirements alongside safety considerations.

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ABSTRACT Purpose: The 2019 Briganti nomogram is widely used to guide the indication for pelvic lymph node dissection (LND) at the time of radical prostatectomy in patients with localized prostate cancer. Although previously validated, its generalizability across distinct clinical settings remains uncertain. Materials and methods: We conducted a multicentre external validation of the nomogram in 481 patients from three French academic institutions (Centre A n=198, Centre B n=183 and Centre C n=100). Discrimination, calibration, and clinical utility were assessed. Spared LNDs and missed lymph node invasions (LNIs) were evaluated across risk thresholds. Results: The overall area under the receiver operating characteristics curve (AUC) was 0.733 but varied across centres (0.580-0.768). Calibration was acceptable overall but showed systematic overestimation in low-prevalence centres. At the 7% recommended threshold, the proportion of spared LNDs ranged from 51% to 76%, while missed LNIs ranged from 0% to 8.9%. Decision curve analysis revealed that the optimal threshold differed between centres. Conclusions: These results underscore the need for local validation and population-specific threshold adjustment before clinical implementation. Fixed thresholds may lead to under- or overtreatment depending on institutional case mix. Nomogram-based decision-making should be individualized based on local performance and patient-centred risk tolerance.

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ABSTRACT Purpose: Post-prostatectomy vesicourethral anastomotic stenosis (VUAS) affects up to 5% of patients. A subset of cases remains refractory to endoscopic treatment, significantly impacting quality of life in the long-term. This study presents 15-year follow-up data on patients undergoing open reanastomosis for refractory or obliterative VUAS. Patients and Methods: We included patients who underwent transperineal vesicourethral reanastomosis from 2009–2023. The procedure was often staged, with artificial urinary sphincter (AUS) implantation three months later. Co-primary endpoints included retreatment-free survival (RFS) and patient-reported outcome measures (PROMs). RFS was analyzed with Kaplan-Meier estimators, and PROMs were evaluated per scoring manuals. Additionally, we conducted a scoping review of all studies reporting outcomes following complex VUAS reconstruction. Results: Among 46 patients with VUAS, prior endoscopic interventions included dilation (17%), incision (61%), and resection (80%). Median time from prostatectomy to reanastomosis was 23 months (IQR 16–42). At a median follow-up of 80 months (IQR 41–149), RFS rates were 91% at two years and 88% at five years. 30 patients (65%) required staged AUS implantation for stress urinary incontinence. PROMs, assessed in 28 patients (61%), indicated restored voiding function, absence of fecal incontinence, high treatment satisfaction, and low decision regret. Limitations include the absence of preoperative PROMs for baseline comparisons. The scoping review revealed varying success rates ranging from 60% to 92% and a significant underuse of validated PROMs. Conclusions: Transperineal reanastomosis offers an effective and lasting solution for treating recurrent or obliterative VUAS, with encouraging long-term results and favorable patient-reported outcomes, underscoring its critical role in salvage posterior urethral reconstruction after prostatectomy.

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ABSTRACT Purpose: Retroperitoneal robot-assisted partial nephrectomy (RRPN) has achieved widespread acceptance worldwide. However, the complications and discomfort associated with tubes cannot be overlooked. Consequently, we have initiated Tubeless RRPN (TLRRPN). This approach eliminates the need for tracheal intubation, central venous catheterization, urinary catheters, or abdominal drainage. Materials and Methods: From 2024-07 to 2025-06, a total of 78 patients underwent RRPN at our center. Following a 1:1 propensity scores matching process, we compared 14 patients who underwent TLRRPN with 14 matched patients receiving Traditional RRPN (TRRPN). Anesthetic management and surgical procedures were systematically detailed, and perioperative outcomes were comprehensively assessed. Results: All 28 patients underwent successful R0 tumor resection, with no conversions or major complications reported in either group. Patients who received TLRRPN resumed oral intake and ambulation significantly earlier (1.03 hours vs. 22.20 hours and 1.03 hours vs. 30.55 hours, p < 0.001), experienced a shorter postoperative hospital stay (26.00 hours vs. 91.43 hours, p < 0.001), and incurred lower overall costs. No anesthesia- or surgery-related complications were observed, and postoperative pain was significantly reduced in the TLRRPN group compared to the TRRPN group. Conclusions: TLRRPN is a safe, efficient, innovative, cost-effective, and selective surgical procedure. This operation fundamentally reduces the adverse effects associated with tubes in patients and significantly facilitates rapid recovery.

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ABSTRACT Introduction: Robot-assisted radical prostatectomy (RARP) continues to evolve with surgical approaches aimed at preserving continence-related anatomy and optimizing postoperative recovery (1). Transvesical RARP has gained increasing interest, particularly with the advent of single-port platforms (2, 3). Building on our prior experience with clipless techniques and functional outcome optimization (4), we evaluated a multiport transvesical approach. Objective: To describe, step-by-step, a clipless transvesical RARP technique and to report its feasibility and early functional and oncologic outcomes. Materials and Methods: An intravesical, line-of-sight technique was employed, with abdominal trocars positioned similarly to conventional transperitoneal RARP. The surgical sequence included: posterior release; longitudinal cystotomy with suspension sutures; semicircumferential bladder neck incision; bilateral clipless lateral dissection (blunt and sharp); anterior and apical release with dorsal venous complex control; urethral transection; urethrovesical anastomosis using two 3-0 barbed sutures; and single-layer cystotomy closure. Three consecutive patients with localized prostate cancer and moderate prostate volumes were included. Results: All procedures were completed as planned. Perioperative morbidity was low; one Clavien–Dindo grade II complication was managed conservatively. Early continence was observed in all patients, including at the first postoperative evaluation (45 days). One patient (Case 3) presented with a focal apical positive surgical margin on final pathology; prostate-specific antigen levels were undetectable in all cases during early follow-up. The approach was technically feasible and familiar to surgeons experienced in anterior RARP. Larger prostate volume may limit intravesical working space and apical visualization. Conclusions: We describe a reproducible clipless transvesical RARP performed using a multiport platform, addressing a body of literature predominantly focused on single-port systems. The technique demonstrated encouraging early functional outcomes in carefully selected patients (5); however, larger prostate volumes and longer follow-up are required to further define its oncologic and functional durability. This video complements our previous publication on alternative RARP approaches supporting anterior-preserving strategies (6).

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ABSTRACT Purpose: Late radiation-induced genitourinary and gastrointestinal complications after multimodal treatment for pelvic malignancies frequently require complex reconstructive surgery, often necessitating both urinary and fecal diversion (1). In this setting, a colonic segment may provide an effective option for urinary diversion while avoiding bowel anastomosis (2, 3). Minimally invasive robotic approaches have increasingly expanded the feasibility of these complex reconstructions and may reduce morbidity, particularly in frail or previously irradiated patients (4–7). We describe a single-stage robot-assisted sigmoid colon conduit urinary diversion in a patient with a pre-existing loop colostomy. Materials and Methods: A 46-year-old woman with prior pelvic chemoradiation developed a rectovaginal fistula requiring loop colostomy, followed by bilateral distal ureteral strictures, radiation cystitis, recurrent pyelonephritis, and a large parastomal hernia. After failed conservative management and preoperative nephrostomy placement, a single-stage robot-assisted procedure was performed. The operation included adhesiolysis, parastomal hernia repair, conversion of the loop to a terminal colostomy, and construction of a sigmoid colon urinary conduit. Ureterointestinal anastomoses were completed intracorporeally under indocyanine green fluorescence guidance. Results: The procedure was completed robotically without intraoperative complications. Total operative time was 95 minutes, with an estimated blood loss of 100 mL. Oral intake resumed on postoperative day 1, and the patient was discharged on day 3. At 6-month follow-up, renal function was preserved, with no recurrent infections or evidence of ureteral obstruction. Conclusion: Robot-assisted sigmoid colon conduit is a safe and reproducible option for urinary diversion in selected patients requiring concomitant bowel diversion, avoiding bowel anastomosis and reducing reconstructive morbidity.

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ABSTRACT Purpose: Single Port (SP) Robotic Extraperitoneal approach enhances maneuverability in the narrow extraperitoneal space while preserving peritoneal integrity (1, 2). First reports show reduced postoperative pain, fewer gastrointestinal complications and shorter hospital stay compared to multiport or open techniques (3-5). Recent experiences with robotic ureteral reconstruction have further supported the feasibility of advanced reconstructive procedures in selected patients (6-8) but literature on SP platform remains limited (9, 10), therefore we present this innovative technique. Materials and Methods: We report the case of a 44-year-old female (BMI 29.1 kg/m2), with medical history of fibromyalgia, who presented with right-sided back pain and nausea. CT-urogram showed severe right hydroureteronephrosis with a distal ureteral stricture and diffuse ureteral thickening, without a clear obstructing lesion. Diagnostic ureteroscopy revealed luminal narrowing due to wall thickening, without papillary masses. Biopsies and urine cytology were negative for urothelial carcinoma. A double-J stent was placed, and SP robotic distal ureterectomy with ureteral reimplantation was scheduled. Results: Low Anterior Access (LAA) was obtained through a 4-cm incision at the McBurney point. The retroperitoneal space was bluntly developed to identify the psoas muscle as anatomical landmark; the ureter was dissected caudally and resected at the level of the stricture. The bladder was then reached for cystotomy and ureteral reimplantation. Operative time was 160 minutes. No complications occurred and the patient was discharged on postoperative day 1. Final pathology revealed endometriosis. The ureteral stent was removed after 4 weeks; at 3-month follow-up the patient was asymptomatic, renal function was normal, and CT scan showed no right hydroureteronephrosis. Conclusion: Robotic SP extraperitoneal approach appears safe, feasible, and promising for ureteral reconstruction, combining retroperitoneal access with SP system dexterity and potentially reducing postoperative morbidity and hospital stay.