International Braz J Urol最新文献

{"title":"Robotic-Assisted Laparoscopic Buccal Mucosal Graft Ureteroplasty and Ureteral Reim-plantation for Repair of Complex Ureteral Strictures Using the Modular Carina™ System.","authors":"Wencong Han, Zhihua Li, Zhenyu Li, Guanpeng Han, Zheng Zhang, Kunlin Yang, Xuesong Li","doi":"10.1590/S1677-5538.IBJU.2025.0660","DOIUrl":"10.1590/S1677-5538.IBJU.2025.0660","url":null,"abstract":"<p><strong>Purpose: </strong>Multifocal ureteral strictures pose significant challenges for reconstructive surgery due to their segmental distribution and the need to preserve the ureteral blood supply (1, 2). Robotic-assisted surgery, owing to its precision and minimally invasive advantages, has increasingly become a preferred approach (3). Although the da Vinci surgical system has long dominated this field, several novel robotic platforms have recently emerged with comparable safety and efficacy (4, 5). This study reports our experience with robotic-assisted laparoscopic buccal mucosal graft ureteroplasty combined with ureteral reimplantation for complex ureteral stricture repair using the modular Carina™ robotic surgical system.</p><p><strong>Materials and methods: </strong>A 32-year-old man presented with a one-month history of flank pain and was found to have both proximal and distal ureteral strictures. Using the modular Carina™ robotic system, the procedure was performed as follows: dissection of the proximal stricture, longitudinal ureterotomy, posterior augmented anastomosis, harvesting of buccal mucosa for ventral onlay grafting; followed by dissection of the distal ureteral stricture and bladder wall and completion of a side-to-side ureterovesical anastomosis.</p><p><strong>Results: </strong>The procedure was completed successfully without conversion, with a total operative time of 272 minutes. The patient was discharged on postoperative day 7. Histopathological examination revealed granulomatous inflammation, and anti-tuberculosis therapy was initiated. The double-J stent and nephrostomy tube were removed 2 months postoperatively. During an 8-month follow-up, the patient's symptoms resolved, imaging demonstrated improvement of hydronephrosis, renal function remained stable, and no postoperative complications were observed.</p><p><strong>Conclusions: </strong>Robotic-assisted reconstructive surgery for complex ureteral strictures using the modular Carina™ robotic system is technically feasible. However, larger studies with longer follow-up are required to validate these preliminary findings.</p>","PeriodicalId":49283,"journal":{"name":"International Braz J Urol","volume":"52 3","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13124168/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146127046","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Start of a Robotic Kidney Transplant Program: Institutional Step-by-Step Technique.","authors":"Alessandro Antonelli, Rostand Emmanuel Nguefouet Momo, Paola Donato, Gabriele Ugolini, Giovanni Corghi, Simone Priolo, Cristina Buttazzoni, Francesco Nacchia, Riccardo Bertolo","doi":"10.1590/S1677-5538.IBJU.2025.0532","DOIUrl":"10.1590/S1677-5538.IBJU.2025.0532","url":null,"abstract":"<p><strong>Purpose: </strong>To report our institutional technique for robot-assisted kidney transplantation (RAKT) (1, 2) in a detailed, step-by-step manner.</p><p><strong>Materials and methods: </strong>This is a case of RAKT from a living donor successfully performed at our institution. A 29-year-old male with end-stage renal disease secondary to focal segmental glomerulosclerosis, undergoing hemodialysis with a baseline serum creatinine of 1035 μmol/L at admission, received a left kidney donated by his 55-year-old mother. Preoperative evaluation confirmed one HLA mismatch (0-0-1) and ABO compatibility, making the patient suitable for living donation.</p><p><strong>Results: </strong>The procedure was performed using the da Vinci Xi robotic system (Intuitive, Sunnyvale, CA, USA). The recipient was placed in a 23° Trendelenburg position. Four robotic ports were aligned above the umbilicus, and two additional ports were used for the assistant. Graft introduction was performed via a 7-cm Pfannenstiel incision using an Alexis O Wound Protector-Retractor with Laparoscopic Cap (Applied Medical, Rancho Santa Margarita, CA, USA). Following robotic living donor nephrectomy, extracorporeal bench preparation was performed (warm ischemia time = 4 min; cold ischemia time = 239 min). RAKT was then completed with intracorporeal vasculares anastomoses using 5-0 Gore-Tex sutures (warm ischemia time = 45 min), and ureteral reimplantation according to the Lich-Gregoire technique, performed with 4/0 monofilament suture (3). The surgery was uneventful, with excellent graft reperfusion and no perioperative complications. Postoperative renal Doppler ultrasound and radionuclide renal scan were normal. Serum creatinine and eGFR at discharge were 1.45 mg/dL and 62 mL/min, respectively (4).</p><p><strong>Conclusions: </strong>Our experience confirms the feasibility and safety of RAKT with a living donor in a selected setting, supporting further integration of robotic assistance into renal transplantation programs.</p>","PeriodicalId":49283,"journal":{"name":"International Braz J Urol","volume":"52 3","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13124192/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146126983","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Minimally Invasive Partial versus Radical Nephrectomy for Non-metastatic pT3a Renal Cell Carcinoma: a Multicenter Matched Cohort Study.","authors":"Xiangpeng Zou, Zhenhua Liu, Yunhan Luo, Peimin Zhou, Longbin Xiong, Zhoujie Sun, Xuesong Li, Peng Hong, Kangbo Huang, Chunsen Yang, Zhaohui Zhou, Yulu Peng, Xin Luo, Junhang Luo, Xin Yao, Shengjie Guo, Pei Dong, Hui Han, Fangjian Zhou, Shudong Zhang, Wei Yu, Zhiling Zhang","doi":"10.1590/S1677-5538.IBJU.2025.0500","DOIUrl":"10.1590/S1677-5538.IBJU.2025.0500","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate oncological and functional outcomes of minimally invasive partial and radical nephrectomy (MIS-PN vs. MIS-RN) in patients with pT3aN0M0 renal cell carcinoma (RCC).</p><p><strong>Materials and methods: </strong>We performed a multicenter retrospective study of patients with pT3aN0M0 RCC treated with MIS-PN or MIS-RN. The primary outcome was recurrence-free survival (RFS). Secondary outcomes included de novo eGFR <60 mL/min/ 1.73 m2 (CKD-S) and <45 mL/min/ 1.73 m2 (CKD-S3b) at the new baseline (1-12 month postoperatively), as well as CKD-S at the latest follow-up (>1 year postoperatively). A 1:2 ratio propensity score matching (PSM) was applied to balance covariates, and inverse probability weighting (IPW) served as sensitivity analysis. Survival curves were estimated using the Kaplan-Meier method, and multivariable analyses (MVA) were performed to identify predictors of oncological and functional outcomes.</p><p><strong>Results: </strong>A total of 303 patients were enrolled (113 MIS-PN/190 MIS-RN) with a median follow-up of 39.0 months (IQR 26.8-52.9). After PSM (66 MIS-PN/54 MIS-RN), no significant difference in RFS was observed between two groups (p=0.23). MVA revealed that surgical approach was not an independent predictor of RFS (HR: 1.00, p=1.00). Among patients with available new baseline eGFR after PSM (41 MIS-PN/37 MIS-RN), MIS-RN was independently associated with a higher risk of CKD-S (OR: 7.96, p=0.03). Among patients with available the latest follow-up eGFR after PSM (41 MIS-PN/37 MIS-RN), MIS-RN remained an independent predictor of CKD-S at the latest follow-up (OR: 7.98, p=0.03). IPW analysis yielded consistent results. Additionally, IPW identified MIS-RN as an independent risk factor for CKD-S3b at the new baseline (OR: 18.29, p<0.01).</p><p><strong>Conclusion: </strong>MIS-PN provided comparable mild term oncologic outcomes to MIS-RN while offering superior renal function preservation. MIS-PN may be a viable option for selected T3a RCC patients when nephron preservation is indicated.</p>","PeriodicalId":49283,"journal":{"name":"International Braz J Urol","volume":"52 3","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13124172/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146126971","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Care of Patients with Male Hypogonadism: A Joint Position Statement from the Brazilian Society of Endocrinology and Metabolism (SBEM), the Brazilian Society of Urology (SBU), and the Brazilian Association for Sexual Medicine and Health (ABEMSS).","authors":"Alexandre Hohl, Leonardo Lopes, Marcelo Fernando Ronsoni, Eduardo P Miranda, Tayane Muniz Fighera, Fernando Nestor Facio, Lucas Bandeira Marchesan, Luiz Otavio Torres","doi":"10.1590/S1677-5538.IBJU.2025.0610","DOIUrl":"10.1590/S1677-5538.IBJU.2025.0610","url":null,"abstract":"<p><p>Male hypogonadism is a prevalent and clinically relevant condition with substantial effects on reproductive, metabolic, skeletal, and psychosocial health. Rising obesity rates, metabolic syndrome, and anabolic-androgenic steroid use have increased the frequency of functional hypogonadism in Brazil. Despite advances in diagnosis and treatment, clinical practice remains heterogeneous and access to standardized recommendations is limited. This joint position statement from the Department of Female Endocrinology, Andrology and Transgenderism (DEFAT) of the Brazilian Society of Endocrinology and Metabolism (SBEM), the Brazilian Society of Urology (SBU), and the Brazilian Association for Sexual Medicine and Health (ABEMSS) provides practical, evidence-based guidance for the evaluation and management of male hypogonadism in Brazil. The document outlines diagnostic criteria, including morning total testosterone confirmation and assessment of gonadotropins, and emphasizes recognition of functional etiologies such as obesity-related hypogonadism. Therapeutic recommendations include testosterone replacement therapy for confirmed organic hypogonadism, preferential use of long-acting intramuscular or transdermal formulations, and fertility-preserving strategies (SERMs, hCG, aromatase inhibitors) when indicated. The statement also addresses monitoring protocols, safety considerations, and the management of adverse effects. This is the first multidisciplinary Brazilian guideline harmonizing endocrine, urological, and sexual medicine perspectives to support national clinical practice. This consensus aims to promote consistent clinical decision-making, reduce underdiagnosis and overtreatment, and ensure safe, individualized care aligned with international principles and adapted to the national context.</p>","PeriodicalId":49283,"journal":{"name":"International Braz J Urol","volume":"52 3","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13124176/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146183099","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Single-dose Tamsulosin Induces Reversible Azoospermia and Ejaculatory Dysfunction Suggesting Potential for on-demand Male Contraception.","authors":"Leonardo Seligra Lopes, Julia Domingues Candelaria, Felipe Placco Araujo Glina, Thais Ventura Feitosa, Bruna Bizio Parra de Oliveira, Willy Roberto Camargo Baccaglini, Erik Montagna, Caio Parente Barbosa, Jose de Bessa, Sidney Glina","doi":"10.1590/S1677-5538.IBJU.2025.0601","DOIUrl":"10.1590/S1677-5538.IBJU.2025.0601","url":null,"abstract":"<p><strong>Purpose: </strong>Ejaculatory alterations are among the most frequent sexual side effects of α₁-adrenergic antagonists. Although often attributed to retrograde ejaculation, recent evidence indicates that tamsulosin primarily disrupts seminal emission, occasionally leading to transient azoospermia. This study evaluated the frequency, timing, and reversibility of ejaculatory and seminal changes following a single oral dose of 0.8 mg tamsulosin in healthy men.</p><p><strong>Materials and methods: </strong>Thirty-one healthy male volunteers (aged 18-45 years) underwent a baseline semen analysis, followed by six additional collections at 1-3 week intervals. Each collection was performed at a different post-dose time point, spaced every 4 hours, to construct a 24-hour post-administration profile. Semen parameters were assessed according to WHO criteria, and post-ejaculatory urine was examined to detect retrograde ejaculation. Temporal variations were analyzed using repeated-measures ANOVA, with effect sizes estimated by Cohen's d.</p><p><strong>Results: </strong>Seminal volume decreased significantly in 93.6% of participants, with aspermia in 80.7%, peaking 12 h after ingestion (p<0.001, d=2.05). Sperm concentration declined markedly, with azoospermia in 80.7% (p<0.001, d=1.59) and normalized after wash-out in 2 days. No retrograde ejaculation was observed. Adverse effects were mild and self-limited. A single 0.8 mg dose of tamsulosin caused a consistent, time-dependent disruption of seminal emission, producing transient azoospermia rather than retrograde ejaculation.</p><p><strong>Conclusions: </strong>A single 0.8 mg dose of tamsulosin transiently suppressed seminal emission, leading to reversible azoospermia within 12 hours most recovered by 24h, and all recovered within 48h. Its predictable, reversible effect supports caution in men seeking conception and further exploration as an on-demand male contraceptive model.</p>","PeriodicalId":49283,"journal":{"name":"International Braz J Urol","volume":"52 3","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13124190/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147345519","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors Affecting Preserved Renal Volume and Function After Laparoscopic Partial Ne-phrectomy: A Long-Term 3D Volumetric Analysis.","authors":"Onur Kalaycı, Ender Özden, Murat Gülşen, İlkay Çamlıdağ, Ertuğrul Köse, Mehmet Necmettin Mercimek, Yakup Bostancı, Yarkın Kamil Yakupoğlu, Şaban Sarıkaya","doi":"10.1590/S1677-5538.IBJU.2025.0665","DOIUrl":"10.1590/S1677-5538.IBJU.2025.0665","url":null,"abstract":"<p><strong>Objective: </strong>To assess long-term changes in renal volume and function after laparoscopic partial nephrectomy using 3D modeling and to identify key predictors.</p><p><strong>Patients and methods: </strong>This retrospective study included 187 patients who underwent laparoscopic partial nephrectomy between October 2012 and January 2023. Patients underwent the same cross-sectional imaging both pre- and postoperatively, with a minimum follow-up of one year. Pre- and postoperative volumes were reconstructed with 3D Slicer software.</p><p><strong>Results: </strong>The median age of the patients was 58 years. The median Radius-Exophytic-Nearness-Anterior-Location (RENAL) score was 7. The median tumor volume was 15.8 cm³. The median warm ischemia time was 14 minutes, and the median surgical time was 80 minutes. The mean tumor-free renal parenchymal volume before surgery was 168,87 ± 40,91 cm³, which decreased to a mean operated renal parenchymal volume of 137.6 ± 41.7 cm³ at 5 years postoperatively. The estimated glomerular filtration rate (eGFR) declined from a median value of 90.6 to 75.9 mL/min/1.73 m² over the same period. The predictors of renal function decline were parenchymal volume loss, age, female gender, diabetes mellitus, and tumor-to-parenchyma contact surface area. Factors affecting parenchymal volume loss included age, RENAL score, comorbidities, Surface-Intermediate-Base (SIB) score, and operative time.</p><p><strong>Conclusions: </strong>While the most influential factor on renal function in the early postoperative period was the preserved renal volume, diabetes mellitus (DM) emerged as the primary determinant of long-term functional outcomes. Tumor resection technique and operative time are modifiable factors influencing parenchymal volume preservation. Enucleation-based approaches may enhance parenchymal preservation without compromising oncological outcomes.</p>","PeriodicalId":49283,"journal":{"name":"International Braz J Urol","volume":"52 3","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13124191/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147345517","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transperineal Laser Ablation for Treatment of Lower Urinary Tract Symptoms in Benign Prostate Enlargement: A Systematic Review and Meta-analysis.","authors":"Iago Zang Pires, Marília Oberto da Silva Gobbo, Alexandre Yamada Fujimura, Tanize Louize Milbradt, Renan Yuji Ura Sudo, Mable Pereira, Nilson Marquardt, Gustavo Franco Carvalhal, Márcio Augusto Averbeck","doi":"10.1590/S1677-5538.IBJU.2025.0423","DOIUrl":"10.1590/S1677-5538.IBJU.2025.0423","url":null,"abstract":"<p><strong>Purpose: </strong>This is a systematic review and meta-analysis of the outcomes of transperineal prostate laser ablation (TPLA) in men with benign prostatic enlargement.</p><p><strong>Materials and methods: </strong>Pubmed, Embase, Scopus, and Cochrane Library databases were searched from inception to July 2024. Random-effects model was employed to compute mean differences for continuous endpoints. Heterogeneity was evaluated by prediction interval and I-squared statistics. Results were reported following the PRISMA guidelines.</p><p><strong>Results: </strong>Seventeen studies involving 777 patients with mean age of 62 to 80 years were included. Over 12-month follow-up, TPLA decreased the International Prostate Symptom Score (MD -12.62; 95% CI -14.87 to -10.37; p<0.001; I2 = 90%), post-void residual (MD -73.24 mL; 95% CI -96.91 to -49.57; p<0.001; I2 = 89%), and prostate volume (MD -21.23 mL; 95% CI -32.65 to -9.81; p<0.001; I2 = 84%). TPLA increased the maximum urinary flow rate (MD 6.32 mL/s; 95% CI 4.69 to 7.95; p<0.001; I2 = 81%). Ejaculatory and erectile functions were not impacted. Compared to TURP, TPLA was associated with ejaculatory function preservation, shorter operating time and length of stay. Risk of bias for the non-randomized studies was moderate, and low for the randomized studies.</p><p><strong>Conclusions: </strong>TPLA demonstrated favorable outcomes for BPE without a negative impact on sexual function. This minimally invasive treatment was found to have advantages over TURP, such as, ejaculatory function preservation, reduced operative time, and shorter hospital stay. Evidence for this MIST is emerging but remains predominantly retrospective with short follow-up, highlighting the need for further comparative prospective studies.</p>","PeriodicalId":49283,"journal":{"name":"International Braz J Urol","volume":"52 2","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13124165/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146041680","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The use of Silodosin in Ureterolithiasis is the Hot Topic in this Number of International Brazilian Journal of Urology.","authors":"Luciano A Favorito","doi":"10.1590/S1677-5538.IBJU.2026.02.01","DOIUrl":"10.1590/S1677-5538.IBJU.2026.02.01","url":null,"abstract":"","PeriodicalId":49283,"journal":{"name":"International Braz J Urol","volume":"52 2","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13124179/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146040929","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Why Open Testicular Mapping (OTEM) Should Precede, and Often Replace, Micro-TESE in Nonobstructive Azoospermia.","authors":"Felipe Placco Araujo Glina, Marcelo Vieira, Eduardo Mazucato, Sidney Glina","doi":"10.1590/S1677-5538.IBJU.2025.0582","DOIUrl":"10.1590/S1677-5538.IBJU.2025.0582","url":null,"abstract":"","PeriodicalId":49283,"journal":{"name":"International Braz J Urol","volume":"52 2","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13124195/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146042078","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Posterior Bulboprostatic Excision and Primary Anastomosis for Pelvic Fracture Urethral Injury: Long-term Objective and Patient-reported Outcomes.","authors":"Jakob Klemm, Max C Wagner, Robert J Schulz, Navid Roessler, Margit Fisch, Roland Dahlem, Malte W Vetterlein","doi":"10.1590/S1677-5538.IBJU.2025.0509","DOIUrl":"10.1590/S1677-5538.IBJU.2025.0509","url":null,"abstract":"<p><strong>Purpose: </strong>Posterior bulboprostatic excision and primary anastomosis (EPA) is considered standard of care for obliterative or disruptive pelvic fracture urethral injuries (PFUIs), yet validated patient-reported outcomes (PROMs) in this setting remain limited. We aimed to evaluate long-term reintervention-free survival (RFS) and PROMs following EPA.</p><p><strong>Patients and methods: </strong>This retrospective study included male patients undergoing transperineal bulboprostatic EPA for PFUI between 2014 and 2024 at a tertiary reconstructive referral center. Data collected included trauma etiology, comorbidities, prior interventions, operative details, and follow-up duration. Co-primary endpoints were RFS estimated by Kaplan-Meier analysis, and PROMs assessed using validated instruments.</p><p><strong>Results: </strong>Seventy patients (median age 48 years) underwent EPA. Initial management included suprapubic catheter (77%), endoscopic (21%), or open realignment (1.4%). Median operative time was 77 minutes; median follow-up was 53 months. RFS was 87% at 2 years and 84% at 5 years. PROMs-available in 53% of patients at median 71 months-included moderate voiding/incontinence symptoms (median LUTS score 6; ICIQ-UI SF 7), severe erectile dysfunction (IIEF-EF 7), preserved ejaculatory function (MSHQ-Ej 24), high satisfaction (ICIQ-S 21; global satisfaction 9), and negligible decision regret (median 0). Limitations include retrospective design and incomplete PROM data (53% response rate).</p><p><strong>Conclusions: </strong>Bulboprostatic EPA offers durable anatomical success and high long-term patient satisfaction despite persistent functional impairments largely linked to initial trauma. Most patients expressed minimal regret and willingness to repeat the procedure. These outcomes reinforce EPA's role as the standard of care in PFUI management.</p>","PeriodicalId":49283,"journal":{"name":"International Braz J Urol","volume":"52 2","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13124180/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146042072","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}