World Journal of Urology最新文献

{"title":"Thulium fiber vs. holmium: YAG lasers in urology: insights from the FDA MAUDE database.","authors":"Juanita Velasquez Ospina, Etienne Gozlan, Adam Williams, Aravindh Rathinam, Archan Khandekar, Jonathan Katz, Robert Marcovich, Hemendra N Shah","doi":"10.1007/s00345-025-05919-4","DOIUrl":"10.1007/s00345-025-05919-4","url":null,"abstract":"<p><strong>Purpose: </strong>To compare adverse events (AEs) associated with Thulium Fiber Lasers (TFLs) and Holmium: YAG (Ho: YAG) lasers reported in the FDA MAUDE database, and to examine changes in TFL-related AEs following the FDA's 2021 Class II recall.</p><p><strong>Methods: </strong>The FDA MAUDE database was searched for events between 2018 and 2024 using \"LUMENIS MOSES,\" \"LUMENIS VERSAPULSE,\" \"SOLTIVE,\" and \"TFL + {YEAR}.\" Events were classified as device, patient, staff or environmental, and graded using the Gupta system (Levels I-IV). Exclusions included non-urologic procedures, insufficient detail, or duplicates. Subgroup analyses considered prostate vs. non-prostate, TFL pre- vs. post-recall, and Ho: YAG by pulse modulation (MOSES vs. standard). Chi-square or Fisher's exact tests were used for categorical data, and Wilcoxon rank-sum tests for Gupta comparisons.</p><p><strong>Results: </strong>954 events were included (467 TFL, 487 Ho: YAG). Console malfunctions were more common with Ho: YAG (44.4%, p < 0.0001), while fiber breaks more with TFLs (57%, p < 0.0001). Patient-involving AEs occurred more with Ho: YAG (35.3%) compared to TFLs (13.5%, p < 0.0001). Most events were Level I: 83.9% TFL vs. 59.3% Ho: YAG (p < 0.0001). Level II events were higher with Ho: YAG (39.8%), and Level III with TFLs (2.1%, p = 0.0436); one Level IV event occurred (Ho: YAG group). Post FDA recall, TFL-related Level II and III events decreased significantly. Prostate vs. non-prostate stratification showed no differences. MOSES use in Ho: YAG had fewer fiber issues, but more Level II events compared to standard holmium.</p><p><strong>Conclusion: </strong>Lasers in urology appear safe, with most AEs being free of patient or staff harm and classified as minor. Post-recall improvements in TFL safety profiles suggest effective corrective action.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"43 1","pages":"593"},"PeriodicalIF":2.9,"publicationDate":"2025-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12496257/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145226118","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intravesical prostatic protrusion volume: effect on lower urinary tract symptoms and urinary flow in patients with benign prostatic enlargement.","authors":"Emre Bulbul, Omer Oztekin, Fahri Yavuz Ilki","doi":"10.1007/s00345-025-05986-7","DOIUrl":"https://doi.org/10.1007/s00345-025-05986-7","url":null,"abstract":"<p><strong>Purpose: </strong>We aimed to evaluate the effect of intravesical prostatic protrusion (IPP) in patients with benign prostatic enlargement (BPE), using three-dimensional assessment.</p><p><strong>Methods: </strong>Men presenting with lower urinary tract symptoms (LUTS) to the urology clinic of a state hospital between March 2023 and July 2025 were evaluated. Treatment-naïve 369 BPE patients aged 50-80 years were included in the study. Prostate volume (PV), IPP length, IPP transverse diameter, IPP antero-posterior diameter, and IPP volume were measured using transabdominal ultrasonography by a single radiologist. IPP volume was calculated using the following formula: length × transverse diameter × antero-posterior diameter × 0.52.</p><p><strong>Results: </strong>The International Prostate Symptom Score (p = 0.014) and IPP volume (p = 0.018) were identified as two independent predictors of low Qmax in patients with BPE. Subsequently, receiver operating characteristic curve analysis was performed for IPP volume. The optimal cut-off value was 3.65 mL, with an area under the curve of 0.823. At this cut-off value, sensitivity was 80% and specificity was 79%. In the multivariate correlation analysis, only IPP volume demonstrated an independent correlation with post-void residual volume (B = 0.211, p = 0.030). In the same analysis, parameters independently correlated with the International Prostate Symptom Score included IPP length (B = 0.219, p = 0.002), IPP antero-posterior diameter (B = 0.391, p = 0.009), and IPP volume (B = 0.188, p = 0.001).</p><p><strong>Conclusion: </strong>In addition to IPP length, a three-dimensional assessment of the intravesical prostate-incorporating its transverse and antero-posterior diameters-may be a more objective parameter for LUTS.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"43 1","pages":"588"},"PeriodicalIF":2.9,"publicationDate":"2025-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145225995","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Inlexzo (gemcitabine intravesical system): promising data but key questions remain.","authors":"Zarmeen Azhar, Zehra Sadia","doi":"10.1007/s00345-025-05955-0","DOIUrl":"https://doi.org/10.1007/s00345-025-05955-0","url":null,"abstract":"<p><p>The FDA approval of Inlexzo (gemcitabine intravesical system, formerly TAR-200) for BCG-refractory non-muscle invasive bladder cancer (NMIBC) with carcinoma in situ is a milestone achievement in bladder-sparing therapy. Outcomes from the SunRISe-1 trial showed an outstanding 3-month complete response rate of 82%, and sustainability in more than half of responders at 12 months. Yet enthusiasm must be balanced with significant cautions: lack of comparator arm, immature long-term survival data, and practical issues with indwelling intravesical delivery, risk of infection, and access in low-resource environments. While Inlexzo is promising in a population where alternatives are scarce, its place must be clarified by longer-term follow-up, randomized comparisons versus systemic and intravesical therapies, and real-world experience. Prior to that, clinicians must utilize open counseling and shared decision-making.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"43 1","pages":"586"},"PeriodicalIF":2.9,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145207919","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intelligent pressure-controlled ureteral access sheath for renal stones < 3 cm: methodological considerations and need for randomized validation.","authors":"Asim Shah, Suleman Khan, Misbah Uddin","doi":"10.1007/s00345-025-05976-9","DOIUrl":"https://doi.org/10.1007/s00345-025-05976-9","url":null,"abstract":"","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"43 1","pages":"587"},"PeriodicalIF":2.9,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145207837","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of area of deprivation index with magnetic resonance imaging (MRI) utilization for prostate cancer detection: results from a contemporary North American population.","authors":"Alessandro Bertini, Alex Stephens, Alessio Finocchiaro, Silvia Viganò, Arjun Dinesh, Elnaz Guivatchian, Nicholas Cusmano, Giovanni Lughezzani, Nicolò Buffi, Gabriele Sorce, Vincenzo Ficarra, Alberto Briganti, Andrea Salonia, Francesco Montorsi, Akshay Sood, Craig Rogers, Firas Abdollah","doi":"10.1007/s00345-025-05925-6","DOIUrl":"https://doi.org/10.1007/s00345-025-05925-6","url":null,"abstract":"<p><strong>Purpose: </strong>Since the use of Magnetic Resonance Imaging (MRI) in the initial diagnostic evaluation for prostate cancer (PCa) has considerable costs, there is concern that socioeconomic barriers may result in MRI underutilization. We examined the relationship between socioeconomic factors, measured by the Area Deprivation Index (ADI), and MRI utilization in PCa diagnostic setting using a contemporary North American population.</p><p><strong>Methods: </strong>We included all the patients aged > 40 years with a confirmed PSA > 3 ng/mL at Henry Ford Health (HFH) between 2018 and 2022. An ADI score was assigned to each patient based on their residential census block group, ranked as a percentile of deprivation relative to the national level. The higher the ADI, the more the area has a socio-economic disadvantage. MRI and biopsy status were defined as undergoing these procedures within 6 and 9 months, respectively, from their first PSA > 3 ng/mL in the time period. Univariable (UVA) and multivariable (MVA) Logistic regression models tested the impact of ADI on prostate MRI or biopsy utilization.</p><p><strong>Results: </strong>We included 18,827 patients who had a PSA > 3 ng/mL, 3759 (20%) of whom were Non-Hispanic Black. Overall, 679 (3.6%) and 1672 (8.8%) of these individuals underwent prostatic MRI and prostate biopsy, respectively. Median (IQR) age and ADI percentile were 68 (62-74) years and 58 (38-79), respectively. Patients who received MRI were more likely to be younger (66 vs. 68, p = 0.006), Non-Hispanic Black [28.0% (95%CI: 24.7%-31.5%) vs. 19.7% (95% CI 19.1%-20.3%), p < 0.0001] and to undergo PSA test in more recent median years (2021 vs. 2019, p < 0.0001), compared to those who did not undergo MRI. When stratifying the population by ADI quintiles, men in the fifth (most deprived) quintile were less likely to receive MRI (3.1% vs. 5.9%, p < 0.001), compared to those in the first (most affluent) quintile. At logistic MVA, patients living in more deprived neighborhoods (higher ADI percentile) were less likely to receive MRI before PCa diagnosis (OR: 0.90, p < 0.001). Specifically, for an increase in ADI percentile of 10 units, the relative odds of receiving MRI decreased by 10%.</p><p><strong>Conclusions: </strong>Although the overall utilization of prostate MRI remains low in this real-world study, men living in more socioeconomically deprived areas were significantly less likely to undergo MRI before PCa diagnosis. Our findings underscore the need for targeted interventions to ensure a more equitable access to advanced diagnostic tools.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"43 1","pages":"584"},"PeriodicalIF":2.9,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145186905","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Single-session bilateral vs. staged unilateral renal stone removal: comparative outcomes in a systematic review and meta-analysis.","authors":"Marco Antonio Andrade, Nathan Joseph Silva Godinho, Lucas Guimarães C R de Amorim, Matheus Pinhati, Caio Hernandes Colhado, Daniel DaJusta","doi":"10.1007/s00345-025-05959-w","DOIUrl":"10.1007/s00345-025-05959-w","url":null,"abstract":"<p><strong>Introduction: </strong>There is still controversy regarding the best approach to bilateral renal urolithiasis. Single-session bilateral (SSB) renal stone removal is considered superior due to fewer procedures and less anesthesia exposure. However, doubts persist about its effectiveness and safety compared to staged unilateral (SU) procedures, particularly concerning complications and stone-free rates (SFR). We conducted a systematic review and meta-analysis to compare outcomes of these approaches. We hypothesize that SSB procedures have similar outcomes in terms of complications and SFR with fewer interventions.</p><p><strong>Materials and methods: </strong>A meta-analysis following Cochrane and PRISMA guidelines included studies from 2002 to 2024 comparing SSB to SU procedures. Searches were conducted in PubMed, Cochrane, and EMBASE, focusing on complication rates, SFR, operative time, and additional procedures.</p><p><strong>Results: </strong>The search yielded 13 studies with a total of 836,414 patients, of which 7,854 were in the SSB group. The rate of severe complications (Clavien-Dindo grade ≥ 3) was not significantly different between SSB versus SU groups (RR 1.22; 95% CI 0.65-2.26; P = 0.53). Nevertheless, overall complication rates were notably higher for SSB procedures (RR 1.32; 95% CI 1.08-1.62; P = 0.007). SFR was similar between approaches (RR 0.89; 95% CI 0.74-1.07; P = 0.23). Importantly, SSB procedures resulted in significantly longer operative times (MD 27.93 minutes; 95% CI 7.78-48.07; P = 0.007) and had a significantly higher need for unplanned additional interventions (RR 1.65; 95% CI 1.44-1.89; P < 0.00001).The search yielded 13 studies with a total of 836,414 patients, of which 7,854 were in the SSB group. The rate of severe complications (Clavien-Dindo grade ≥ 3) was not significantly different between SSB versus SU groups (RR 1.22; 95% CI 0.65-2.26; P = 0.53). Nevertheless, overall complication rates were notably higher for SSB procedures (RR 1.32; 95% CI 1.08-1.62; P = 0.007). SFR was similar between approaches (RR 0.89; 95% CI 0.74-1.07; P = 0.23). Importantly, SSB procedures resulted in significantly longer operative times (MD 27.93 minutes; 95% CI 7.78-48.07; P = 0.007) and had a significantly higher need for unplanned additional interventions (RR 1.65; 95% CI 1.44-1.89; P < 0.00001).</p><p><strong>Conclusion: </strong>SSB procedures achieve similar SFR and severe complication rates as SU procedures but involve longer operative times and higher overall complication rates. Their advantage lies in reducing planned surgical sessions, offering fewer anesthesia exposures, though this benefit is offset by an increased need for unplanned additional procedures.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"43 1","pages":"585"},"PeriodicalIF":2.9,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145186846","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of clinical stage T3/T4 bladder cancer: a review.","authors":"Domenique Escobar, Mazyar Zahir, Chirag Doshi, Siamak Daneshmand","doi":"10.1007/s00345-025-05960-3","DOIUrl":"10.1007/s00345-025-05960-3","url":null,"abstract":"<p><strong>Introduction: </strong>Bladder cancer is a common malignancy in the United States and while the majority are non-muscle invasive at diagnosis, those with muscle-invasive and locally advanced disease can be challenging to manage. In addition, the prognosis is poorer in this group with high rates of recurrence following treatment. Clinical trials and advances in systemic therapy have helped to improve outcomes for these patients.</p><p><strong>Materials/methods: </strong>Articles were chosen for inclusion based on expert knowledge of the literature and PubMed literature searches for the relevant areas, with a focus on clinical trials. Appropriate articles were selected for inclusion by reviewing article titles, abstracts and full texts.</p><p><strong>Results: </strong>The standard of care for treatment of muscle invasive bladder cancer involves neoadjuvant chemotherapy followed by radical cystectomy. The NIAGARA trial recently changed the standard of care to include immunotherapy both in the neoadjuvant and adjuvant settings. Multiple clinical trials have assessed the potential benefit of adjuvant immunotherapy in patients with high-risk disease after radical cystectomy, leading to the approval of nivolumab in this setting. Improvements in staging and surveillance of these patients are necessary. The use of circulating tumor DNA and advances in imaging have also shown promise in prognostication and detection and monitoring of recurrence.</p><p><strong>Conclusions: </strong>Locally advanced bladder cancer is a challenging condition to manage, and while advances have been made in systemic therapy and biomarkers such as circulating tumor DNA, further investigation is needed to continue to improve outcomes for this group of patients.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"43 1","pages":"583"},"PeriodicalIF":2.9,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12479562/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145186897","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of posterior urethral valve on patient quality of life and caregiver burden.","authors":"Kaan Kahraman, Nilüfer Göknar","doi":"10.1007/s00345-025-05970-1","DOIUrl":"https://doi.org/10.1007/s00345-025-05970-1","url":null,"abstract":"<p><strong>Background: </strong>Among the wide range of congenital kidney and urinary tract anomalies, posterior urethral valve (PUV) has most devastating complications such as recurrent urinary tract infections, urinary incontinence, and chronic kidney disease. To assess the quality-of-life (QoL) of children with PUV, determine the factors contributing to reduced patient's QoL and increased caregiver burden.</p><p><strong>Methods: </strong>A total of 36 boys with PUV and 54 healthy controls aged between 4 and 18 years were included. Both groups completed the Children's Health Related Quality of Life (KINDL). Children with PUV also completed ICIQ-CLUTS incontinence questionnaire. Caregivers of PUV patients completed Impact on Family Scale (IOFS) to assess caregiver burden.</p><p><strong>Results: </strong>Boys with PUV aged between 7 and 18 years old had significantly lower total QoL scores and lower scores in physical well-being, emotional well-being, self-esteem, family interactions, social interactions and school subscales compared to healthy controls. Patients who underwent multiple surgeries had lower emotional wellbeing scores than those with a single surgery. Among PUV patients, enuresis was associated with lower physical wellbeing score, daytime incontinence with lower emotional wellbeing and urge incontinence with lower school scores. Higher lower urinary tract symptom severity was correlated higher IOFS total scores, including familial/social impact and personal strain subscales.</p><p><strong>Conclusion: </strong>Boys aged 7-18 years with PUV experience lower QoL than healthy peers. Lower urinary tract symptoms are a major contributing factor to both reduced QoL in patients and increased caregiver burden. Early and effective management of lower urinary tract symptoms may improve QoL of PUV patients and lower caregiver burden.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"43 1","pages":"582"},"PeriodicalIF":2.9,"publicationDate":"2025-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145182203","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction: Clinical and urodynamic benefit of adding antimuscarinics after a loss of efficacy of intradetrusor botulinum toxin in patients with multiple sclerosis.","authors":"Adrien Haegel, Camille Chesnel, Maëlys Teng, Magdaline Vivier, Camille Noël, Gérard Amarenco, Claire Hentzen","doi":"10.1007/s00345-025-05972-z","DOIUrl":"https://doi.org/10.1007/s00345-025-05972-z","url":null,"abstract":"","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"43 1","pages":"581"},"PeriodicalIF":2.9,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145179253","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"\"Gun-holding\" surgical posture versus conventional surgical posture in flexible ureteroscopy: a prospective randomized study.","authors":"Xiaomin Gao, Chaoyue Lu, Qing Chen, Lianguo Chen, Siyu Zhuo, Jianyu Chen, Tianle Zheng, Binhao Du, Fangyi Zhang, Zhixian Yu, Wei Chen, Xiaofeng Gao, Weifang Sun, Fanggui Shao, Yeping Li","doi":"10.1007/s00345-025-05921-w","DOIUrl":"10.1007/s00345-025-05921-w","url":null,"abstract":"<p><strong>Introduction: </strong>The ergonomic aspects of retrograde intrarenal stone surgery (RIRS) remain underexplored, despite their crucial role in minimizing musculoskeletal strain among surgeons and enhancing procedural efficiency. This study introduces a novel \"Gun-holding\" surgical posture for RIRS, aiming to improve surgeons' physical well-being and extend their operative careers.</p><p><strong>Materials and methods: </strong>From July 2023 to June 2024, a total of 60 patients were prospectively enrolled from an initial pool of 104 and were randomized into two groups: the \"Gun-holding\" surgical posture group (Group A, n = 30) and the conventional surgical posture group (Group B, n = 30). Patient demographics, clinical outcomes, ergonomic assessments, and torque analysis for surgeons were analyzed.</p><p><strong>Results: </strong>Baseline characteristics and stone burden were comparable between the two groups. Torque analysis demonstrated a higher upper limb torque ratio in Group A compared to Group B. Ergonomic evaluation revealed a significant advantage for Group A (total score: 16.1 ± 4.1 vs. 22.4 ± 9.1, P = 0.001). Group A also had a significantly shorter mean hospitalization duration (1.7 ± 0.9 days vs. 2.9 ± 1.9 days, P = 0.003). Although the mean operative time for Group A was shorter (49.9 ± 26.1 min vs. 63.0 ± 40.4 min), this difference was not statistically significant (P = 0.139). No significant differences were observed in initial stone-free status (SFS), 3-month SFR, postoperative Day 1 hemoglobin drop, or overall complication rates.</p><p><strong>Conclusion: </strong>The \"Gun-holding\" surgical posture is a feasible, efficient, and safe alternative for performing RIRS, offering significant ergonomic benefits to surgeons.</p>","PeriodicalId":23954,"journal":{"name":"World Journal of Urology","volume":"43 1","pages":"578"},"PeriodicalIF":2.9,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145150753","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}