Uro

The advent of robotic surgery has revolutionized multiple medical fields, notably in urology, gynecology, and both general and cardiovascular surgery. This article aims to explore the journey of robotic-assisted surgery (multi/single-port) in abdomen and pelvic surgeries, tracing its historical roots, examining its current landscape, and considering the potential future impact. A comprehensive review of the literature was conducted through PubMed/MEDLINE, utilizing keywords such as “robotic surgical systems,” “robotic surgery devices,” and “robotics AND urology.” Reference lists from selected articles were also explored to ensure a broad scope of understanding. The focus was on robotic systems designed for laparoscopic urological surgeries, all of which have been granted regulatory approval for clinical use. The historical trajectory of robotic surgery is traced back to the late 1980s with early systems like the Probot^®, preceding the transformative introduction of the daVinci^® system in the early 2000s. In addition to daVinci^®, the article introduces newer robotic platforms, including Senhance^®, Revo-I^®, Versius^®, Avatera^®, Hinotori^®, Edge^®, Shurui and HugoTM RAS, which are emerging as serious competitors. While daVinci^® has been the dominant force in robotic surgery for over a decade, these new systems are making significant strides with innovative designs, enhanced precision, and improved cost-efficiency. The growing competition among these platforms promises to expand their potential applications, increase accessibility, and optimize surgical outcomes across various specialties. Furthermore, as new technologies continue to evolve, there is a clear need for more extensive clinical trials and real-world data to assess their long-term impact on surgical practices, healthcare delivery, and patient outcomes. It remains to be seen how these advanced systems will integrate into healthcare infrastructures and their ultimate role in shaping the future of minimally invasive surgery. Full article

Background: Urinary tract infections (UTIs) are a leading cause of urine testing and antibiotic prescribing across healthcare settings. Despite established clinical guidelines, inappropriate practice such as unnecessary urine cultures, treatment of asymptomatic bacteriuria, suboptimal antibiotic selection, and excessive treatment duration remain common. These practices contribute to antimicrobial resistance, adverse drug events, and increased healthcare costs. Methods: This narrative review synthesises evidence from PubMed-indexed studies, including systematic reviews, randomised controlled trials, and implementation studies, to evaluate the impact of antibiotic and diagnostic stewardship interventions on UTI management. Studies assessing outcomes related to urine testing practices, antibiotic utilisation, and clinical safety were included. Discussion: The literature demonstrates that integrated stewardship interventions effectively reduce inappropriate urine testing and antibiotic use without negatively affecting patient outcomes. Diagnostic stewardship strategies such as limiting urine cultures to patients with appropriate clinical indications, implementing reflex testing algorithms, and improving result interpretation reduce downstream antibiotic overuse. When combined with antibiotic stewardship approaches including clinical decision support, audit-and-feedback, and bundled interventions, these strategies lead to sustained improvements in prescribing behaviour and care quality. Conclusions: Antibiotic and diagnostic stewardship are synergistic and essential components of optimal UTI management. Interventions targeting both diagnostic decision-making and antibiotic use can safely reduce unnecessary testing and treatment. Future stewardship efforts should prioritise integrated, multidisciplinary approaches supported by clinical decision support tools to enable real-time, sustainable improvements in UTI care across clinical settings. Full article

Background/Objective: To describe a novel dual-action pump (DAP) which is hypothesised to reduce mean intrarenal pressure (IRP) and increase irrigation flow during flexible ureterorenoscopy (fURS). The DAP incorporates a low-volume, user-controlled pumping/suctioning unit, to precisely control fluid boluses into the upper urinary tract via a ureterorenoscope and simultaneously draws out an identical volume of the delivered irrigant via a syphoning UAS. This human cadaveric study aims to assess the DAP’s impact on IRP and the irrigant flow rate compared to a traditional UAS. Methods: Twelve fresh frozen human cadaver renal units were studied in situ. An 11/13 UAS was placed under fluoroscopic guidance and a fURS was introduced. Continuous pressure was monitored. The DAP and syphoning UAS were compared to a conventional irrigation system in terms of IRP and irrigant flow at variable irrigant fluid heights and during fluid bolus administration. Results: The mean IRP was reduced by 79–141%. Maximum IRP was reduced by up to 180%. The mean irrigation flow rate was improved by 44–86%. The small sample size of 12 limits the results obtained. Conclusions: The novel DAP system shows promise in reducing intra-renal pressure and improving irrigant flow in flexible ureteroscopy. Full article

Bladder cancer (BCa) arises from the interaction between environmental exposures and the host’s immunity and microbiome. Once considered sterile, the urinary tract is now known to harbor a resident urinary microbiome (UM) that dynamically interacts with the immune system and is influenced by systemic immunomodulatory effects of the gut microbiome (GM) brought on by the emerging gut–bladder axis. Accumulating evidence links alterations in UM and GM leading to BCa development, progression, and recurrence. Loss of protective taxa (e.g., Lactobacillus, Bifidobacterium and Ruminococcus) and enrichment of pro-inflammatory or genotoxic bacteria (e.g., Fusobacterium, Acinetobacter, Prevotella and Enterobacteriaceae) are associated with immune evasion and systemic inflammation. Microbial metabolites, especially short-chain fatty acids (SCFAs), play a key role in shaping tumor immunity and show diagnostic and prognostic potential, with specific microbial signatures correlating with recurrence risk, survival, and treatment response. Therapeutically, growing evidence suggests that microbiome composition influences immunotherapy response, highlighting opportunities for microbiome-based interventions. This review aims to summarize the rationale to implement microbial modulation strategies (e.g., dietary modulation, probiotics, fecal microbiota transplantation (FMT), and emerging synbiotic or postbiotic approaches) while addressing their current limitations and future requirements in order to develop microbiome-guided therapies, diagnostics and prognostic tools for BCa. Full article

Background: Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a bothersome condition characterized by pelvic pain and lower urinary tract symptoms (LUTS). Phytotherapy can be used to treat this challenging condition. The aim of this study was to investigate the role of an oral combination of bovine colostrum, Serenoa repens extract and other anti-inflammatory elements in the treatment of CP/CPPS patients. Methods: Our study was a prospective, observational, single-arm study that enrolled patients > 18 years with a history consistent with CP/CPPS, a Chronic Prostatitis Symptom Index (CPSI) pain domain score ≥ 5 and a Meares–Stamey microbiological test negative for bacterial infection. Pelvic or genital pain was measured via the Numeric Pain Rating Scale (NPRS) and validated questionnaires. All patients were treated with an oral combination of colostrum, Serenoa repens extract and other anti-inflammatory elements for 6 months. Follow-up visits were scheduled at 3 and 6 months. Pre- and post-treatment variables were compared by means of the Wilcoxon signed-rank nonparametric test. Results: We included 42 patients in our analysis. The median (Inter-Quartile Range, IQR) age was 42 (28–51) years. Compared with baseline, after 3 months we observed a significant reduction in pain: total CPSI score of 16 (12–21) vs. 22 (17–26), p < 0.001, −6 points (−27.3%); CPSI score of “pain” domain 7 (5–9) vs. 8 (7–11), p < 0.001, −1 point (−12.5%). Moreover, quality of life improved: CPSI “quality of life” domain 6 (4–9) vs. 8 (7–10), p < 0.001. After 6 months, a significant reduction in pain was maintained: total CPSI score 19 (10–23), p < 0.001, −3 points (−13.65%); and CPSI “pain” domain 7 (4–9), p < 0.001, −1 point (−12.5%). After 6 months, a mild reduction in urinary symptoms was also reported. During the observation period, five patients discontinued treatment, two of them because of gastrointestinal intolerance. Conclusions: The daily oral administration of bovine colostrum, Serenoa repens and other anti-inflammatory elements showed a potential in improving pain and other urinary symptoms and was generally well tolerated by patients affected by CP/CPPS. Full article

Cancer cells rely on elevated ribosomal biogenesis and protein synthesis to sustain their rapid proliferation. This heightened translational demand imposes significant stress on the fidelity of protein synthesis, thereby necessitating ribosomal quality control (RQC) activation, which safeguards proteostasis by degrading incomplete nascent polypeptide chains. At present, RQC is no longer only a peripheral pathway, it is a decisive arbiter of proteostasis whose malfunction rewires the course of cancer progression. Emerging evidence suggests that RQC factors can function as pro-tumorigenic or anti-tumorigenic in a context-dependent manner across different cancer types. This review highlights mechanistic models of how translation stalling, ribosome collision, and ribotoxic stress response influence neurodegeneration, tumor progression, metastasis, stemness, and drug resistance. By framing RQC as a critical regulator of cancer fate, we will identify verifiable and experimentally tractable hypotheses for therapeutic targeting and biomarker discovery in cancer. Full article

Background/Objectives: For centuries, humans have employed animal models to progress biomedical science, to understand pathological and biological processes, and to develop and test drugs, vaccines, and surgical techniques. In the field of urology, Sampaio and his colleagues from Brazil were the pioneers in proposing that the porcine model is the most accurate representation of the human kidney. We aim to describe the relevant urinary anatomy of female Landrace pigs based on endoscopy and computed tomography (CT) scans and compare differences between the urinary anatomy of pigs and humans. Methods: Four white Landrace female pigs were used for the study: two for CT imaging and two for endoscopic assessment. CT-urograms were performed using a 64-channel tomography machine with 0.625 mm thick slices. For the endoscopic procedure, the intravaginal urethral meatus was cannulated using a cystoscope, followed by complete urethrocystoscopy. The ureteric orifices were then cannulated, and a retrograde pyelogram was performed, followed by ureterorenoscopy. The analyses were performed using SPSS (Version 28), and simulated data was created using R (version 3.5.0), with the significance set at p ≤ 0.05. The data obtained from two pigs was used to simulate an empirical data with 500 observations, using the mean and standard deviations from our n = 2 to produce a random normal distribution. Results: CT and endoscopic findings showed two multirenculate multipapillate kidneys, each receiving blood supply from a single renal artery that is further divided into cranial and caudal branches. The delayed phase of the urogram showed distal ureters passing posterior to the bladder and emptying into the bladder at the base. Urethroscopy revealed an intravaginal urethral meatus ventral to the anus, positioned midway between the mucocutaneous junction of the vulva and the cervix. Endoscopic view of the bladder neck showing patulous ureteric orifices at the bladder neck with no distinct interureteric ridge or trigone. Retrograde pyelogram showed a Group B drainage pattern in both pigs. Conclusions: While there are numerous similarities between the urinary systems of humans and pigs, there are important subtle differences that urologists and researchers need to be mindful of before using the porcine model for urological research and training. Full article

Background/Objectives: Stereotactic Body Radiation Therapy (SBRT) is increasingly used for localized prostate cancer (PCa), but evidence supporting its use in high-risk PCa (HRPC) remains limited. Standard management continues to favor conventional or moderately hypofractionated radiotherapy combined with long-course androgen deprivation therapy (ADT). This systematic review aimed to synthesize current data on SBRT biochemical outcomes, toxicity, and technical aspects in localized HRPC. Methods: A systematic PubMed search was conducted on 1 May 2024, following PRISMA 2020 guidelines (PROSPERO ID CRD420251235649). Studies reporting biochemical control (BC) for HRPC treated definitively with SBRT, with or without ADT, were included. Studies not meeting these criteria or including ≤10 HRPC patients were excluded. Risk of bias was assessed through qualitative appraisal of study methodology. Substantial heterogeneity across study design, SBRT schedules, cohort composition, and ADT integration precluded a meta-analysis; data were synthesized descriptively. Results: Thirty studies contributed biochemical control data after prostate SBRT for 1354 patients meeting inclusion criteria. SBRT was delivered using diverse platforms and dose-fractionation schemes, frequently in combination with ADT. Across studies, BC was generally favorable, though follow-up duration varied widely. Toxicity profiles were acceptable, with most reports describing predominantly grade 1–2 events and low rates of severe toxicity. Marked variability was observed in target volume definition, focal-boost strategies, urethra-sparing techniques, and the use of rectal spacers. Conclusions: Although current evidence is heterogeneous and largely derived from non-randomized studies, BC and toxicity outcomes are consistently promising, supporting SBRT as a potentially effective strategy for localized HRPC. Randomized prospective trials are needed to confirm these findings and refine optimal SBRT regimens and the role of ADT. This review received no funding. Full article

Objective: To evaluate the diagnostic yield of blue-light cystoscopy (BLC) compared with white-light cystoscopy (WLC) in detecting carcinoma in situ (CIS) and muscle-invasive bladder cancer (MIBC), and to assess recurrence-free survival (RFS) following BLC-HAL resection. Patients and Methods: We retrospectively analysed 238 patients undergoing BLC-HAL between July 2017 and July 2024. Seventy-two underwent primary BLC at initial resection, and 166 underwent BLC re-resection following WLC. Endpoints were CIS detection, tumour upstaging, and recurrence-free survival at 12 and 24 months using Kaplan–Meier analysis. Results: Overall, malignancy was confirmed in 113/238 patients (47%). Detection was higher in the secondary arm (55%) compared with the primary arm (29%). In the primary arm, CIS was detected in 19% and MIBC in 24%. In the secondary arm, CIS increased from 18% on WLC to 38% with BLC (p = 0.001), with 26% detected only under blue light; 10% were upstaged to MIBC (p = 0.022). Over one-third of patients were reclassified into a higher EAU NMIBC risk group. Kaplan–Meier analysis showed 12- and 24-month RFS of 71% (95% CI: 36–92%) and 67% (95% CI: 35–88%) in the primary arm, and 62% (95% CI: 49–74%) and 63% (95% CI: 43–79%) in the secondary arm. Median RFS was not reached within 24 months. Conclusions: BLC significantly enhances CIS detection and identifies MIBC and higher-risk disease not seen on WLC, directly influencing patient management. Despite improved detection, recurrence-free survival remains modest, consistent with high-risk NMIBC, supporting guideline recommendations for routine use of BLC at TURBT, particularly in suspected CIS and high-grade disease. Full article

Background/Objectives: Interest in the use of nutraceuticals and phytotherapy for the management of andrological diseases has increased markedly in recent years. In particular, growing attention has been directed toward the treatment of patients affected by erectile dysfunction (ED), male infertility, chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), and induratio penis plastica (IPP). However, several areas of uncertainty remain. This narrative review aims to examine the role of nutraceuticals and phytotherapeutic agents in the management of andrological disorders. Methods: A narrative review was conducted using PubMed, Scopus, Cochrane CENTRAL, and EMBASE to identify relevant studies published over the past 25 years. Only articles published in English and involving adult populations were included in the analysis. Results: Nutraceuticals and phytotherapeutic compounds have been extensively investigated in the current literature, and certain formulations—particularly specific combinations—have been evaluated in high-quality studies. Conversely, other compounds lack sufficient scientific evidence and therefore should not be recommended in routine clinical practice. In the management of ED, the following compounds, administered either alone or in combination, have demonstrated clinically significant effects: Panax ginseng, Tribulus terrestris, L-arginine, and Withania somnifera. L-carnitine, combined with micronutrients, antioxidants, and various traditional herbal supplements, appears to be an effective therapeutic option for male infertility and subfertility. Pollen extracts play an important role in the management of CP/CPPS, while carnitine, coenzyme Q10, silymarin, bromelain, and curcumin show promising potential in the treatment of IPP. Conclusions: Nutraceuticals and phytotherapeutic agents may provide favorable outcomes in the management of andrological diseases. Although current evidence is encouraging, larger prospective studies employing standardized protocols and treatment schedules are required to confirm long-term efficacy and to optimize therapeutic strategies. Full article

Background/Objectives: The objective of this study is to compare nerve-sparing (NS) and non-nerve-sparing (NNS) robot-assisted radical prostatectomy (RARP) techniques used to treat localized prostate cancer. Numerous studies have evaluated the impact of NS techniques on patient-reported outcomes. However, there are unaddressed methodological issues making interpretation of results difficult. Therefore, we performed a comparison of the two techniques, accounting for methodological threats, including patient selection and confounding. Methods: We sampled 120 patients with similar disease burden who underwent RARP by the same surgeon, either with NS (n = 84) or NNS (n = 36) and assessed changes in lower urinary tract (LUT) function and bother, and bowel function/bother using the Expanded Prostate Cancer Index Composite (EPIC) questionnaire and the six-item International Index of Erectile Function (IIEF-6) survey at 6 weeks and 12 months postoperatively. Multivariable linear regression models were used to adjust for differences in age, preoperative PSA levels, pathological tumor stage and Gleason-score of patients receiving either NS or NNS. Results: At 6 weeks postoperatively, the NNS group had a significantly larger decrease in LUT function compared to the NS group (−17.42; 95% Confidence Interval (CI): −31.31, −3.53; p = 0.0145). At 12 months, both groups recovered substantially, and no group differences were observed (p > 0.9). No significant differences were observed between the NS and NNS groups for the EPIC bowel subscores, whereas the IIEF-6 showed borderline significance at 12 months. Conclusions: The results suggest a small impact of NS vs. NNS RARP on important patient-reported outcomes when controlling for tumor biology, surgeon skill, and patient characteristics. These results need to be confirmed by larger studies using similar sampling strategies and design considerations. Full article

Background: The societal effects of prostate cancer are profound. Prostate surgeries remain one of the main treatment modalities in the care of prostate cancer, and one of the common complications associated with this procedure is postoperative erectile dysfunction (ED). ED can have a significant negative impact on men’s quality of life. The included articles from the last systematic review on effect of pre-operative pelvic floor muscle training (PPFMT) on ED after radical prostatectomy (RP) showed mixed findings but recommended the need for better exercise regime to witness better outcome. Therefore, this systematic review aims to provide further evidence from 2018 to understand the impact of PPFMT on postoperative ED and provide latest insights for future research. Methods: A systematic search was conducted on Medline, Embase, CINAHL, and Google Scholar from 2018 to June 2025, with the assistance of a subject-expert librarian. The inclusion criteria include articles which examine the effect of PPFMT on ED post prostatectomy from 2018 to June 2025 and have a minimum of two comparative groups (control vs. case). In addition, non-English articles were excluded from the study. The included articles were further assessed by two independent reviewers using Covidence, and disagreements were resolved by another independent reviewer. Results: A total of 344 articles were located and after removing duplicates, 250 articles remained. Following the abstract and title screening, nine articles were assessed for eligibility. Upon full-text review, three studies (two randomized control trials (RCTs) and one non-RCT) were ultimately included. The two RCTs showed no significant impact of PPFMT on post-operative ED. On the other hand, the non-RCT reported a significant difference in the post-operative ED rate in the case (5%) vs. control (48.6%) group. PPFMT was defined as ten pre-operative physiotherapy sessions in ten consecutive working days using anal biofeedback. Conclusions: The current study, since 2018, reveals mixed findings on the effect of PPFMT on postoperative ED. However, upon reviewing the evidence on the positive role of PPFMT in other fields (e.g., gynecology, general surgery), we noticed that the included studies may be lacking some major components like knowledge assessment, subjective and objective assessment, along with characteristics of sessions (number, duration, intensity, interval to surgery, and biofeedback) that play a crucial role in the effectiveness of the PPFMT in strengthening the pelvic floor muscle and improving the outcomes. Further research with robust designs is warranted. Full article

Background/Objectives: The internet is a major source of health information, including prostate cancer, but the quality of such content is inconsistent and may influence patient decision-making. This study aimed to evaluate the quality of online prostate cancer information by language, location, and user mode (“Logged off” vs. “Anonymous”) using the Google search engine. Methods: We conducted a cross-sectional, observational study between 5 and 11 December 2022, evaluating Google search results for prostate cancer information across three European cities (Basel, Munich, and Paris) and three languages (English, German, and French) in both “Logged off” and “Anonymous” user modes. A total of 900 websites (450 per mode) were retrieved and classified as: (1) university, (2) hospital, (3) governmental/medical societies, (4) industrial/commercial/NGOs, or (5) other. Website quality was assessed using the validated QUEST, which evaluates authorship, attribution, conflicts of interest, currency, and evidence. Inclusion rates and QUEST scores were compared across languages, locations, and categories using Kruskal-Wallis tests with multiple comparison adjustments. A total of 900 websites (450 per mode) were retrieved in English, German, and French from searches conducted in Basel, Munich, and Paris. Websites were classified as: (1) university, (2) hospital, (3) governmental/medical societies, (4) industrial/commercial/NGOs, or (5) other. Quality was assessed using the QUEST, which evaluates authorship, attribution, conflicts of interest, currency, and evidence. Inclusion rates and QUEST scores were compared across languages, locations, and categories using Kruskal-Wallis tests with multiple comparison adjustments. Results: Inclusion rates were high for both modes (Logged off: 86%; Anonymous: 85%). Location-based differences were significant for Basel (p = 0.04) and Paris (p = 0.02), while language-based differences were not significant. In “Logged off” mode, Category 1 achieved the highest median QUEST score (18.3), followed by 3 (17.8), while Category 2 scored lowest (14.2). Differences were significant (χ² = 50, p < 0.001), particularly between Categories 2 vs. 3 and 2 vs. 4 (p < 0.001). Similar patterns were observed in the “Anonymous” mode. Conclusions: Online prostate cancer information varies substantially in quality. French-language sites, despite high inclusion rates, were of lower quality, while English and German content more frequently met high-quality standards. University websites were the most reliable, hospital websites the least. Language, location, and site type influence the accessibility and reliability of online prostate cancer information. Full article

Despite substantial progress in the field of bladder cancer management, the disease continues to represent an important health issue characterized by increased recurrence and progression rates. This is largely attributed to cancer stem cells (CSCs), a unique cell subpopulation capable of self-renewal, differentiation and resistance to conventional anti-cancer therapies. At the same time, our understanding of cancer biology has been revolutionized by the identification of non-coding RNAs (ncRNAs), a heterogeneous group of RNA molecules that do not translate into proteins yet function as pivotal regulators of gene expression. Emerging evidence demonstrates that ncRNAs modulate key hallmarks of CSCs, including self-renewal, epithelial–mesenchymal transition and drug resistance. This review investigates the intricate interplay between ncRNAs and the core signaling pathways that underlie bladder CSC biology. Unravelling the nexus between CSCs and ncRNAs is crucial for developing novel diagnostic biomarkers, better prognostic tools and innovative therapeutic strategies for patients with bladder cancer. Full article

Diurnal enuresis can significantly affect a child’s biopsychosocial well-being; however, there is a lack of diagnostic and management algorithms on the diagnosis. The purpose of this literature review is to dissect the development of the evaluation and management of diurnal enuresis. A total of 44 articles published from January 1900 to December 2024 were chosen through literature searches in PubMed, Science Direct, Embase, and Google scholar. Search terms were “Diurnal Enuresis” or “Daytime Incontinence” as Mesh terms, and subsequent terms included “pediatrics”, “urinary bladder, overactive”, and “therapeutics”. Inclusion criteria included studies involving pediatric study subjects aged 5–18 years old with a specific diagnosis of diurnal enuresis, exclusion criteria were studies before 1900 and involving night-time wetting diagnoses. A consensus among the literature and the American Academy of Family Physicians recommends a stepwise diagnostic evaluation, including history taking followed by a focused physical exam, for diurnal enuresis has proven to be the most effective. Regarding treatment, biofeedback was shown to improve symptoms in 74% of cases in one study by Wiener, while pharmacological treatment via Mirabegron (beta 3 agonist) showed a 70% improvement in one study by Fryer, but older drugs such as oxybutynin (anticholinergics) are still preferred. A multidisciplinary approach with TENS therapy, behavioral modification, biofeedback, and pharmacology can enhance effectiveness, improve reliability, and provide more successful results while minimizing the impact of diurnal enuresis on a child’s well-being. Further research is needed to optimize pharmacologic management strategies and improve adherence to increase the likelihood of reaching treatment goals. Full article

Background/Objectives: The study aimed to find out if the patients without a reTURBT, due to changed protocol in our centre because of the COVID-19 pandemic, had presented higher rates of relapse or progression compared to patients treated by standard reTURBT protocol. Methods: A prospective study was conducted including 43 patients with high-risk T1 non-muscle invasive bladder cancer diagnosed between March 2020 and June 2021. Patients were divided into two groups: those who underwent reTURBT and those who did not, due to limitations during the COVID-19 pandemic. All patients received intravesical BCG induction therapy and were followed for 3 years. The institutional research ethics committee approved the study. Results: A total of 43 patients were included, 17 (39.5%) underwent reTURBT and 26 (60.5%) did not. No significant differences were observed in tumour characteristics between groups. Recurrence occurred in 43.8% of the reTURBT group and 15.4% of the non-reTURBT group. Tumour progression to T2G3 was observed only in the reTURBT group. Survival analysis showed no significant differences in recurrence-free survival between groups (p = 0.299). Conclusions: Omitting reTURBT in carefully selected patients did not result in significantly worse oncological outcomes; however, due to the small sample size, the study is underpowered and these findings should be interpreted with caution. Early BCG administration in the non-reTURBT group may have contributed to favourable recurrence-free survival. However, further prospective studies are needed to confirm these findings and define optimal criteria for safely omitting reTURBT. Full article

Background: Spontaneous regression of testicular cancer with retroperitoneal metastasis is a rare phenomenon and poses challenges in its diagnosis. Methods: A 33-year-old male patient presented with severe lower back pain (10/10) of 4 months’ duration, radiating to the left lower limb, refractory to NSAIDs, and significantly impaired ambulation, accompanied by nausea and vomiting. In addition to difficulty initiating urination and defecation, with weight loss of 30 kg, he was referred to the urology service of our hospital. Results: On physical examination, the left testicle showed signs of varicocele without pain. Therefore, laboratory and imaging studies were requested, highlighting elevated β-hCG (156.4 mIU/mL) and LDH (850 IU/L). Testicular ultrasound confirmed the diagnosis of left varicocele, while computed tomography of the abdomen and pelvis with contrast revealed a conglomerated retroperitoneal mass of more than 5 cm, located in the paravertebral, retrocural, paraaortic, and intercavoaortic regions. Based on these findings, primary treatment with left radical orchiectomy was chosen, which showed regression of the seminomatous tumor. Histopathological examination revealed a seminomatous germ cell tumor (pT0, pN3, M0), clinical stage IIC, with a good prognosis. Therefore, chemotherapy was initiated with four cycles of EP (etoposide 170 mg and cisplatin 35 mg). However, despite standard chemotherapy, the disease progressed until the patient died. Conclusions: Cases of testicular tumor with retroperitoneal metastasis are rare and infrequently present with clinical, testicular, and imaging findings. Therefore, histopathology, accompanied by the intentional identification of mutations associated with the TP53 gene when therapeutic failure exists. Full article

Background/Objectives: Pelvic floor disorders affect up to 30% of adult females in the United States. Misdiagnosis occurs in nearly 45% to 90% of cases. Standardized pelvic anatomical measurements could improve diagnostic accuracy and treatment planning. We aimed to evaluate pelvic anatomical variations using magnetic resonance imaging (MRI). Methods: We analyzed MRI pelvic measurements from 250 women aged 20–90 years. Exclusion criteria included prior pelvic surgery (except hysterectomy), pelvic cancer, and use of alternative imaging modalities. Key measurements included anterior vaginal wall thickness (AVWT), bladder wall thickness (BWT), vaginal epithelium to bladder urothelium (VWBU), urethral length (UL), and inter-ureteral distances. A comprehensive statistical analysis was performed, including corrections for multiple comparisons. Results: While several anatomical measurements were correlated, a comprehensive analysis was performed to identify markers for clinical diagnoses. After applying Bonferroni correction for multiple comparisons, we found no statistically significant association between any of the measured anatomical parameters and a diagnosis of incontinence. Notably, an uncorrected difference in Bladder Wall Thickness (BWT) (p = 0.041) did not hold up to rigorous testing. To further assess its clinical utility, a Receiver Operating Characteristic (ROC) curve analysis for BWT as a predictor of incontinence yielded an aArea Under the Curve (AUC) of 0.19, indicating poor predictive validity. Conclusions: In this cohort, static anatomical measurements derived from MRI, including BWT, do not appear to be reliable markers for incontinence. Our findings suggest that the pathophysiology of this disorder is likely more dependent on functional or dynamic factors rather than simple static anatomical variations. Future research should focus on standardizing dynamic imaging parameters to better assess pelvic floor function. Full article

Male infertility is a growing global concern with increasing prevalence in both developing and developed nations. While many associations between environmental factors and male infertility have been explored, the relationship between sleep deprivation and male infertility remains underexplored. This narrative review examines the reported effects of sleep deprivation on the Hypothalamic––Gonadal (HPG) axis, Hypothalamic–Pituitary–Adrenal (HPA) axis, oxidative stress, and testicular function, and their consequential effects on male infertility. Disruption of the HPG axis results in altered follicle-stimulating hormone (FSH) and luteinizing hormone (LH) levels, leading to fluctuation in testosterone levels, negatively affecting spermatogenesis and other critical reproductive processes. Activation of the HPA axis, often due to stress, elevates cortisol levels, which, in turn, suppresses gonadotropin-releasing hormone (GnRH), impairing reproductive function. Reactive oxidative species (ROS) accumulate in periods of oxidative stress and have been shown to damage sperm and reduce their quality. The blood–testis barrier (BTB) is disrupted in states of sleep deprivation, leading to decreased sperm quality. A literature review was conducted using PubMed and Google Scholar to assess peer-reviewed studies from 1990 to 2024, revealing a complex interplay between sleep deprivation and male reproductive dysfunction. While existing studies support a link between sleep disturbances and hormonal dysregulation, further research is needed to establish causal relationships and identify potential therapeutic interventions. Addressing sleep deprivation may represent a modifiable factor in improving male fertility outcomes. Full article