Maria Florencia Frascheri, Pablo Contreras, Dmitry Enikeev, Arman Tsaturyan, Giorgio Bozzini, Bhaskar K Somani
{"title":"Small tools, big impact and redefining endourology: the paradigm shift of ureteroscopy for large stones and percutaneous nephrolithotomy for small stones - a literature review.","authors":"Maria Florencia Frascheri, Pablo Contreras, Dmitry Enikeev, Arman Tsaturyan, Giorgio Bozzini, Bhaskar K Somani","doi":"10.1097/MOU.0000000000001283","DOIUrl":"10.1097/MOU.0000000000001283","url":null,"abstract":"<p><strong>Purpose of review: </strong>We aim to review the evolving paradigm in endourology, where technology has led us to manage small stones with ureteroscopy (URS) and large stones with miniaturized percutaneous nephrolithotomy (mPCNL) techniques. We analyse recent literature, their findings, emerging trends and newer technologies that are helping redefine modern day endourology in pushing these boundaries.</p><p><strong>Recent findings: </strong>A significant trend is the use of smaller devices to treat larger stones via ureteroscopy, and to treat smaller stones via percutaneous nephrolithotomy (PCNL). Improved laser technologies, smaller single use ureteroscopes and nephroscopes, suction access sheaths, all play a key role in this.The use of suction sheaths and vacuum assisted devices allows to control intrarenal pressure and help in reducing infectious and other complications whilst improving the stone-free rate (SFR). The treatment choice often depends on surgical expertise and available resources, guided by anatomical factors, stone composition and patient-specific considerations.</p><p><strong>Summary: </strong>The management of kidney stone disease has undergone a paradigm shift. While ureteroscopy is being done for larger renal stones, miniaturised PCNL is being done for small stones. This has been driven by a surge in technology, but a tailored and patient-centred approach is needed, and must be helped by guidelines and a multidisciplinary approach.</p>","PeriodicalId":11093,"journal":{"name":"Current Opinion in Urology","volume":" ","pages":"347-353"},"PeriodicalIF":2.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143779314","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Chiara Mercinelli, Chiara Carli, Rosanna Di Vita, Maria Oliveri, Luca Galli, Andrea Necchi
{"title":"Immunotherapy toxicities in genito-urinary cancers: insights and challenges for clinicians.","authors":"Chiara Mercinelli, Chiara Carli, Rosanna Di Vita, Maria Oliveri, Luca Galli, Andrea Necchi","doi":"10.1097/MOU.0000000000001295","DOIUrl":"10.1097/MOU.0000000000001295","url":null,"abstract":"<p><strong>Purpose of review: </strong>The advent of immunotherapy has completely transformed cancer treatment, particularly in genitourinary malignancies, where immune checkpoint inhibitors (ICIs) are now a cornerstone in bladder and kidney cancer management. However, their use introduces a distinct spectrum of immune-related adverse events (irAEs), necessitating a thorough understanding of their incidence, mechanisms, and management. This review explores the safety profile of ICIs in genitourinary cancers, addressing their impact in both localized and metastatic settings.</p><p><strong>Recent findings: </strong>Recent studies highlight the diverse nature of irAEs, which can affect multiple organ systems with varying severity. While ICIs have demonstrated durable responses, their toxicity profile differs significantly from conventional therapies, requiring vigilant monitoring and prompt intervention. Notably, combination therapies, such as PD-1/PD-L1 inhibitors with CTLA-4 blockade or chemotherapy, may increase the risk of severe irAEs. Emerging data suggest that preexisting autoimmune conditions and specific patient subgroups may be more susceptible to toxicity, emphasizing the need for individualized risk assessment.</p><p><strong>Summary: </strong>This review highlights the need for continuous monitoring, effective management strategies, and further research to better understand the mechanisms of irAEs and improve the well tolerated use of immunotherapy in genitourinary cancers. Clinicians should be aware of the incidence of immunotherapy-related adverse events in order to early identify them.</p>","PeriodicalId":11093,"journal":{"name":"Current Opinion in Urology","volume":" ","pages":"461-466"},"PeriodicalIF":2.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143984947","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Differences in lasers and laser technologies: what does a clinician need to know?","authors":"Andrey Morozov, Vladislav Skossyrskiy, Diana Babaevskaya, Vineet Gauhar, Dmitry Enikeev","doi":"10.1097/MOU.0000000000001264","DOIUrl":"10.1097/MOU.0000000000001264","url":null,"abstract":"<p><strong>Purpose of review: </strong>This review focuses on recent advancements in laser technologies used in urology, particularly in enucleation, vaporization, lithotripsy, and focal laser ablation (FLA). The growing use of the thulium fiber laser (TFL) and the development of pulsed thulium lasers (p-Tm:YAG) highlight the relevance of this review, as these innovations aim to improve precision and outcomes in urological procedures.</p><p><strong>Recent findings: </strong>Recent studies have shown the advantages of TFL in achieving precise tissue ablation, reduced retropulsion offered by the Moses technology in holmium lasers, and the potential of pulsed thulium lasers for more precise control of the effects on tissues. Additionally, FLA is gaining traction for its ability to treat localized prostate cancer with minimal collateral damage. These technologies not only optimize procedural accuracy but also reduce complications, making them safer for high-risk patients, including those receiving anticoagulants.</p><p><strong>Summary: </strong>The advancements in laser technology, including TFL, Moses technology, and pulsed thulium lasers, are improving outcomes in urological surgeries by increasing precision, reducing operative time, and minimizing complications. FLA represents a promising alternative for minimally invasive cancer treatments. Ongoing research should focus on optimizing laser parameters and exploring broader clinical applications.</p>","PeriodicalId":11093,"journal":{"name":"Current Opinion in Urology","volume":" ","pages":"354-359"},"PeriodicalIF":2.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143001821","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Genetics of male infertility.","authors":"Christian Corsini, Edoardo Pozzi, Andrea Salonia","doi":"10.1097/MOU.0000000000001287","DOIUrl":"10.1097/MOU.0000000000001287","url":null,"abstract":"<p><strong>Purpose of review: </strong>The aim of this study was to outline the role of genetic abnormalities, including chromosomal anomalies, single-gene mutations, epigenetic changes, and mitochondrial DNA (mtDNA) defects, in male factor infertility.</p><p><strong>Recent findings: </strong>Recent advances in genetic research have brought incredible new perspectives to understanding male infertility, thanks in large part to next-generation sequencing. Chromosomal abnormalities like Klinefelter syndrome and Y chromosome microdeletions remain key contributors, with new insights into their variable presentations and impact on sperm retrieval. Advanced discoveries in genes such as CFTR and ADGRG2 have reframed our approach to conditions like CBAVD, while epigenetic disruptions and mitochondrial DNA mutations are revealing previously unrecognized mechanisms behind impaired spermatogenesis and sperm motility. Rare copy number variations and genetic syndromes like Kallmann and Noonan further underscore the complex interplay between systemic disorders and male fertility.</p><p><strong>Summary: </strong>The field of genetic infertility is rapidly evolving, offering new insights into the molecular mechanisms behind impaired spermatogenesis and fertility. These findings highlight the importance of integrating genetic testing into infertility evaluations to guide personalized management strategies.</p>","PeriodicalId":11093,"journal":{"name":"Current Opinion in Urology","volume":" ","pages":"489-496"},"PeriodicalIF":2.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143779307","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Cost-effectiveness of serum, urine, and tissue-based prostate cancer biomarkers.","authors":"Veerain K Gupta, Brian D Cortese, Ruchika Talwar","doi":"10.1097/MOU.0000000000001293","DOIUrl":"10.1097/MOU.0000000000001293","url":null,"abstract":"<p><strong>Purpose of review: </strong>Prostate cancer remains a leading malignancy among men in the United States. While prostate-specific antigen (PSA) screening improves early detection, it also leads to over-diagnosis and over-treatment. Biomarkers offer a promising solution for risk stratification and guiding treatment decisions. This review examines the cost-effectiveness of serum, urine, and tissue-based biomarkers to assess their impact on healthcare expenditures and clinical decision-making.</p><p><strong>Recent findings: </strong>Serum-based biomarkers like 4Kscore and PHI reduce unnecessary biopsies and healthcare costs. Urine-based biomarkers, including SelectMDx and ExoDx Prostate IntelliScore (EPI), have shown potential to optimize prostate cancer detection while being more cost-effective than some serum-based alternatives. Tissue-based biomarkers, such as OncotypeDx and Decipher, help in treatment selection, though their economic impact varies. Economic analyses suggest that biomarkers can enhance clinical decision-making while reducing healthcare expenditures, but real-world validation remains limited.</p><p><strong>Summary: </strong>Prostate cancer biomarkers improve risk stratification and may lower healthcare costs. However, variations in cost-effectiveness, reimbursement policies, and guideline recommendations limit widespread adoption. Prospective studies are needed to validate real-world cost savings and refine biomarker integration into clinical practice. Addressing financial and policy challenges is essential to ensure equitable access and maximize their impact on prostate cancer management.</p>","PeriodicalId":11093,"journal":{"name":"Current Opinion in Urology","volume":" ","pages":"412-417"},"PeriodicalIF":2.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143957259","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Orla Cullivan, Sorcha O'Meara, Cian M Hehir, Rob Geraghty, Olivier Traxer, Bhaskar Somani, Niall F Davis
{"title":"Flexible versus rigid ureteroscopy in the management of proximal ureteric calculi: a systematic review and meta-analysis from EAU Endourology comparing perioperative outcomes and complication rates.","authors":"Orla Cullivan, Sorcha O'Meara, Cian M Hehir, Rob Geraghty, Olivier Traxer, Bhaskar Somani, Niall F Davis","doi":"10.1097/MOU.0000000000001311","DOIUrl":"https://doi.org/10.1097/MOU.0000000000001311","url":null,"abstract":"<p><strong>Purpose of review: </strong>Urolithiasis is a common condition, with an increasing prevalence. Rigid ureteroscopy (rURS) and flexible ureteroscopy (fURS) are two management approaches for proximal ureteric calculi. The aim of this systematic review and meta-analysis was to compare perioperative outcomes in rURS versus fURS in the management of proximal ureteric calculi.</p><p><strong>Recent findings: </strong>This systematic review was conducted according to PRISMA guidelines. Systematic search of online databases was performed in November 2024. A combination of MeSH and free text terms were applied. Primary outcome was stone free status. Secondary outcomes included operative time, complication rates, and hospital stay. Six studies met inclusion criteria, in which a total of 1085 patients underwent ureteroscopy (fURS, n = 537 versus rURS, n = 548). Five studies were retrospective comparative, one was prospective randomized comparative. FURS use was associated with significantly superior stone free rates (92%) when compared with rURS (84.5%) (P < 0.001). Secondary outcomes of complication rates (P = 0.17), length of stay (P = 0.39), and operative time (P = 0.08) did not reach statistical significance.</p><p><strong>Summary: </strong>Both rURS and fURS have acceptable stone clearance and complication rates for managing proximal ureteric calculi. Regarding stone clearance, fURS is superior to rURS, both interventions are comparable with regards to complications, operative time, and hospital stay.</p>","PeriodicalId":11093,"journal":{"name":"Current Opinion in Urology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144474208","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Davide Perri, Jean-Baptiste Roche, Bogdan Petrut, Giorgio Bozzini
{"title":"Bladder diverticula management - conservative and surgical outcomes: a narrative review from EAU endourology.","authors":"Davide Perri, Jean-Baptiste Roche, Bogdan Petrut, Giorgio Bozzini","doi":"10.1097/MOU.0000000000001307","DOIUrl":"https://doi.org/10.1097/MOU.0000000000001307","url":null,"abstract":"<p><strong>Purpose of review: </strong>Standardized treatment of bladder diverticula is not defined. The majority of evidence comes from single-centre case series and high-quality studies are lacking.</p><p><strong>Recent findings: </strong>Surgery is the preferred option to treat a symptomatic bladder diverticulum. Robot-assisted surgery has progressively replaced open approach, either with an extravesical or transvesical or transdiverticular technique, with favourable outcomes. Endoscopic treatment may represent a valid alternative mainly in old and frail patients. In case of intradiverticular tumour, some concerns arise on the optimal management between transurethral resection, partial and radical cystectomy. Pathological evaluation may underestimate the oncological status given the lack of muscular layer in the diverticular wall.</p><p><strong>Summary: </strong>Surgical diverticulectomy is considered the reference option for symptomatic diverticula. Robotics should be the preferred approach whenever available. Whatever the technique used (extravesical, transvesical, transdiverticular), good outcomes have been reported. Alternatively, endoscopic incision of diverticular neck and fulguration of the mucosa may be considered for selected patients. The relationship between bladder diverticula and bladder cancer is unclear and the choice between transurethral resection, partial or radical cystectomy should be based on multiple factors, starting from tumour stage and grade. However, evidence comes mainly from limited, heterogeneous case-series. Further studies are needed to properly assess the management of these patients.</p>","PeriodicalId":11093,"journal":{"name":"Current Opinion in Urology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144474207","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ali Talyshinskii, Carlotta Nedbal, Bhaskar K Somani
{"title":"Urological impact of flozins (SGLT2 inhibitors): an EAU Endourology review of risks, side effects and clinical considerations.","authors":"Ali Talyshinskii, Carlotta Nedbal, Bhaskar K Somani","doi":"10.1097/MOU.0000000000001306","DOIUrl":"https://doi.org/10.1097/MOU.0000000000001306","url":null,"abstract":"<p><strong>Purpose of review: </strong>Sodium-glucose cotransporter 2 inhibitors (SGLT2i), also known as flozins, are one of the modern oral antidiabetic drugs. Currently, there are sufficient number of studies devoted to the effect of flozins on various genitourinary disorders, confirming their multifaceted positive and side effects. Thus, the purpose of this review is to analyze the current literature for an up-to-date definition of the role of these drugs in urological practice, prospects for their further study, and side effects that urologists need to remember when treating patients with T2DM taking flozins.</p><p><strong>Recent findings: </strong>Flozins (SGLT2i) are not linked to urological cancer risk, and might even lower the risk by disrupting tumor metabolism and cell cycle. Despite causing glucosuria, the resulting effect of Flozins is antilithogenic, which may be promising for patients with type 2 diabetes mellitus (T2DM) and kidney stone disease, especially regarding risk of recurrence. While the overall risk of UTI is not increased, flozins significantly increase the risk of genital mycotic infections. Flozins can worsen LUTS due to their diuretic action.</p><p><strong>Summary: </strong>Current results of studies on the use of flozins in patients with T2DM are promising for different spectrums of genitourinary diseases caused by different pathogenetic mechanisms. However, we need future clinical trials with specific drugs and comparisons to get trustworthy results about how helpful flozins are for these patients and whether they can be used in urology.</p>","PeriodicalId":11093,"journal":{"name":"Current Opinion in Urology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144149651","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mariela Corrales, Matthias Boeykens, Alba Sierra Del Rio, Eugenio Ventimiglia, Amelia Pietropaolo, Bhaskar Somani, Olivier Traxer
{"title":"The role of suction devices in enhancing outcomes of retrograde intrarenal surgery: a narrative review by the YAU urolithiasis and section of EAU endourology.","authors":"Mariela Corrales, Matthias Boeykens, Alba Sierra Del Rio, Eugenio Ventimiglia, Amelia Pietropaolo, Bhaskar Somani, Olivier Traxer","doi":"10.1097/MOU.0000000000001304","DOIUrl":"https://doi.org/10.1097/MOU.0000000000001304","url":null,"abstract":"<p><strong>Purpose of review: </strong>To provide a comprehensive overview of existing literature on suction-assisted ureteroscopy, evaluating its effectiveness and associated complications.</p><p><strong>Recent findings: </strong>A literature review was conducted in December 2024 using the MEDLINE, EMBASE and Scopus databases by two independent authors. To structure and address the clinical question, \"Do suction devices improve outcomes in RIRS?\", we employed the PICOS (Patient, Intervention, Comparison, Outcome, Study Type) model. Exclusion criteria included case reports, studies involving suction techniques outside the context of endocorporeal laser lithotripsy (ELL), non-English language articles and articles or clinical trials with fewer than 15 patients.</p><p><strong>Summary: </strong>Among the 36 included studies, 28 studies focused on SUAS, of which seven specifically investigated SUAS with pressure measurement, three studies examined DISS, three studies evaluated SURE and two comparative studies analyzed different suction techniques. The presented results show that advancements in suction technology seem very promising and likely to shift endourological practice.</p>","PeriodicalId":11093,"journal":{"name":"Current Opinion in Urology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144119160","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Exploring the impact of artificial intelligence-enabled decision aids in improving patient inclusivity, empowerment, and education in urology: a systematic review by EAU endourology.","authors":"Solomon Bracey, Nasif Bhuiyan, Amelia Pietropaolo, Bhaskar Somani","doi":"10.1097/MOU.0000000000001301","DOIUrl":"https://doi.org/10.1097/MOU.0000000000001301","url":null,"abstract":"<p><strong>Purpose of review: </strong>The implementation of artificial intelligence (AI) in urology has the potential to enhance patient outcomes through the provision of intelligent tools, such as AI-enabled decision aids (AIDAs), which can support personalized care. The objective of this systematic review is to determine the role of AIDAs in educating and empowering patients, particularly those from underrepresented populations.</p><p><strong>Recent findings: </strong>We conducted a comprehensive systematic review following PRISMA guidelines to explore the potential for AIDAs to address healthcare inequalities and promote patient education and empowerment. From 1078 abstracts screened, 21 articles were suitable for inclusion, all of which utilized chatbots. Three main themes of studies were identified. Fourteen studies focused on enhancing patient education, four studies investigated whether chatbots can improve the accessibility of urological literature and three studies explored chatbots role in providing lifestyle guidance. While chatbots demonstrated great potential as educational and lifestyle support tools, current research found mixed accuracy and a tendency for them to produce unreliable information. In terms of accessibility, chatbots were able to effectively enhance readability and translate literature, potentially bridging language, and literacy barriers.</p><p><strong>Summary: </strong>Through chatbots, AIDAs show strong potential to enhance urological education and empower underrepresented communities. However, chatbots must show greater consistency in accuracy before they can be confidently relied upon in clinical contexts. Further research evaluating chatbots' efficacy in clinical settings, especially with underrepresented groups, would enable greater understanding of their role in improving patient inclusivity, empowerment, and education.</p>","PeriodicalId":11093,"journal":{"name":"Current Opinion in Urology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144076669","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}