International Braz J Urol最新文献

{"title":"Exploring the Teleproctoring Potential of Telesurgery: The First Remote Procedures Performed Simultaneously Between Orlando and Shanghai.","authors":"Marcio Covas Moschovas, Shady Saikali, Travis Rogers, Mischa Dohler, Michael Mcdonald, Ela Patel, Jeffrey Marquinez, Ahmed Gamal, Jeffery Magnuson, Vipul Patel","doi":"10.1590/S1677-5538.IBJU.2025.0083","DOIUrl":"10.1590/S1677-5538.IBJU.2025.0083","url":null,"abstract":"<p><strong>Introduction: </strong>We performed the first study exploring telesurgery's teleproctoring potential while performing long-distance procedures between Orlando (USA) and Shanghai (China) over a distance of 13,000 km. The objective was to evaluate telesurgery's performance and teaching potential using the MicroPort® MedBot™ robotic platform and fiber-optic technology in real-time collaboration during urologic procedures.</p><p><strong>Materials and methods: </strong>We simulated a real-life scenario where surgeons could communicate and send mutual inputs during telesurgery cases. A prospective study using live porcine models was conducted on July 23-24, 2024. Surgeons in Orlando and Shanghai took turns controlling the robotic system, performing nephrectomies, pyeloplasties, and ureteroureterostomies while transferring control between locations. Latency and system performance were continuously monitored, and real-time communication between the surgeons was facilitated by fiber-optic technology.</p><p><strong>Results: </strong>Surgeons successfully completed numerous urologic procedures, including nephrectomies, pyeloplasties, and ureteroureterostomies, with seamless control transfers. Remote surgeons provided teleproctoring and assistance during the procedures. The robotic system operated without issues throughout the two-day study. The median latency was 139 milliseconds (range 137-216 ms) on the first day and 139 milliseconds (range 137-185 ms) on the second day.</p><p><strong>Conclusions: </strong>This study demonstrates the feasibility of long-distance telesurgery and highlights its potential to improve surgical outcomes, facilitate training, and offer remote assistance for complex cases. Telesurgery could play a significant role in expanding access to specialized care and enhancing robotic surgical training globally.</p>","PeriodicalId":49283,"journal":{"name":"International Braz J Urol","volume":"51 4","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12236972/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143671468","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":"Impact of Diagnosis of Urologic Cancer on Male Sexuality and Patients' Perceptions of Health Professional's Approach.","authors":"Rodrigo Barros, Angelo Maurílio Fosse, Alex Schul, Gabriel Mangas, Caio Henrique da Silva Teixeira, Tiago Ninis, João Paulo Martins Carvalho, Luciano A Favorito","doi":"10.1590/S1677-5538.IBJU.2025.9910","DOIUrl":"10.1590/S1677-5538.IBJU.2025.9910","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the impact of a urological neoplasm diagnosis on male sexuality and examine patient perceptions of healthcare professionals' engagement with sexuality at diagnosis.</p><p><strong>Materials and methods: </strong>This study included adult men diagnosed with urological neoplasms across two urology cancer centers from October 2022 to April 2024. Exclusions applied to those with prior cancer treatment, inactive sexual lives, or histories of anxiety/depression treatment. Data were retrospectively gathered from medical records and individual interviews using a semi-structured questionnaire on male sexuality, relationship dynamics, and perceptions of physicians' approach to sexuality. Analysis was conducted in RStudio using chi-square tests.</p><p><strong>Results: </strong>A cohort of 211 patients were included in this study, with an age range of 22 to 85 years (mean = 65.4). Among these patients, the diagnoses of urogenital cancer included cases of prostate (79.1%), bladder (9.9%), kidney (4.2%), testicular (3.7%), and penile (2.8%) neoplasms. Sexual activity was considered important by 90.5%, with 75.8% reporting decreased frequency post-diagnosis (99.5% were heterosexual and 72.5% were married). Anxiety or depression was reported by 46.9%, while 72% developed specific fears, primarily concerning erectile function and partner satisfaction. Only 23.2% of physicians addressed sexuality at diagnosis, with patient satisfaction significantly higher when these discussions occurred. Satisfaction levels were notably correlated with tumor site, with bladder cancer patients reporting higher satisfaction compared to those with prostate or penile cancer.</p><p><strong>Conclusions: </strong>Sexual issues extend beyond genital urological cancers, affecting patients with kidney and bladder cancers, with impacts often beginning at diagnosis. Early discussions on sexual health, combined with empathetic support, sexual education, and multidisciplinary care, are essential for the well-being of patients and their partners.</p>","PeriodicalId":49283,"journal":{"name":"International Braz J Urol","volume":"51 4","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12236979/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143671471","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":"Lateral Approach in Robotic-Assisted Radical Prostatectomy: Introducing Gaston's Technique in Brazil.","authors":"Plinio Ramos Pinto, Thiago Camelo Mourão, Jayme Quirino Caon Nobre, Rodrigo Coelho Pde Carvalho, João Pedro Soares Nunes, Walter Henriques da Costa, Richard Pierre Gaston, Stenio C Zequi","doi":"10.1590/S1677-5538.IBJU.2025.0138","DOIUrl":"10.1590/S1677-5538.IBJU.2025.0138","url":null,"abstract":"<p><strong>Introduction: </strong>Prostate cancer is one of the most common malignancies in men, significantly impacting quality of life and survival (1, 2). Radical prostatectomy remains a key treatment for localized disease, with ongoing advancements in surgical techniques (3-5). The lateral approach in robotic-assisted prostatectomy was developed by Professor Richard Gaston and has emerged as a method designed to enhance anatomical preservation and functional outcomes, aligning with the growing demand for precision in prostate cancer management (6-8).</p><p><strong>Objective: </strong>To present for the first time in Brazil the step-by-step technique and initial experience with the lateral approach to radical prostatectomy, emphasizing its safety, feasibility, and reproducibility as a novel surgical option for prostate cancer treatment.</p><p><strong>Materials and methods: </strong>This video demonstrates a lateral approach to radical prostatectomy in a 51-year-old male patient diagnosed with localized prostate cancer (Gleason 7 (3+4) in 2 out of 17 fragments). The surgical procedure was performed using a transperitoneal robotic approach, with lateral entry via the right paravesical space to optimize access and exposure of pelvic structures. Key technical steps included precise dissection of the endopelvic fascia, early identification and preservation of neurovascular bundles, and bladder neck preservation to enhance postoperative functional outcomes. Hemostasis was achieved using selective bipolar energy and clips, and urethrovesical anastomosis was performed using a running suture technique with barbed sutures.</p><p><strong>Results: </strong>The surgery was performed without complications, with an operative time of 150 minutes and estimated blood loss of 100 mL. The patient was discharged on the first postoperative day with adequate pain control. The urinary catheter was removed on the seventh postoperative day, and the patient reported complete continence from catheter removal onwards, requiring no pads. At three-month follow-up, the patient continued to report full urinary continence and satisfactory erectile function with phosphodiesterase type 5 inhibitors. His PSA levels remained undetectable at 3 and 6 months postoperatively.</p><p><strong>Conclusions: </strong>The lateral approach to radical prostatectomy represents a safe and reproducible technique for localized prostate cancer treatment. To our knowledge, this is the first reported case of this approach performed in Brazil, marking an important step in expanding surgical options for prostate cancer. Further studies are required to evaluate long-term clinical outcomes and comparative benefits.</p>","PeriodicalId":49283,"journal":{"name":"International Braz J Urol","volume":"51 4","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12236970/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144028154","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":"Systematic Review and Clinical Outcomes of new Robotic Systems in Urology.","authors":"Iulia Andras, Federico Piramide, Carlo Andrea Bravi, Fabrizio Di Maida, Filippo Turri, Edward Lambert, Mike Wenzel, Danny Darlington, Marco Paciotti, Giuseppe Basile, Christoph Wurnschimmel, Nikolaos Liakos, Gabriele Sorce, Ruben De Groote, Marcio Covas Moschovas, Paolo Dell'Oglio, Nicolae Crisan, Alexandre Mottrie, Alessandro Larcher","doi":"10.1590/S1677-5538.IBJU.2025.0007","DOIUrl":"10.1590/S1677-5538.IBJU.2025.0007","url":null,"abstract":"<p><strong>Purpose: </strong>The adoption of novel multi-port, single-port and modular robotic platforms has significantly increased in the last years. We aim to provide an overview of the preliminary clinical outcomes of the procedures performed with these new robotic systems, assessing their particular features and safety profile during the learning curve Material and methods: A systematic literature search was performed on 15th May 2023 on PubMed, Embase, Scopus and Web of Science databases, to identify original articles presenting clinical outcomes of new robotic systems for abdominal urologic surgery. The study protocol was registered on PROSPERO (CRD 42023437863).</p><p><strong>Results: </strong>Six new robotic platforms were identified. Of 2925 papers identified, 71 met our inclusion criteria: 49 on single-port system and 22 on novel multi-port systems. We found variable outcomes for the most common procedures performed with these new systems. However, all of them showed acceptable perioperative and oncologic outcomes during the learning curve and good safety profile. Functional outcomes were underreported Conclusions: The adoption of novel multi-port and single-port robotic systems in urologic surgery can offer new opportunities for enhanced precision, reduced invasiveness, and potentially improved patient outcomes. The variability in outcomes across different platforms underscores the need for continued research and standardized training.</p>","PeriodicalId":49283,"journal":{"name":"International Braz J Urol","volume":"51 4","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12236976/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143671476","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":"Sistematic Reviews About Infertility and Robotic Surgery are the Hot Topics in this Issue of International Brazilian Journal of Urology.","authors":"Luciano A Favorito","doi":"10.1590/S1677-5538.IBJU.2025.04.01","DOIUrl":"10.1590/S1677-5538.IBJU.2025.04.01","url":null,"abstract":"","PeriodicalId":49283,"journal":{"name":"International Braz J Urol","volume":"51 4","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12236973/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144023977","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":"Editorial Comment: Severity of Lower Urinary Tract Symptoms Predicts Neurologic Quality of Life in Patients With Multiple Sclerosis.","authors":"Ana Carolina Cimadon, Marcio A Averbeck","doi":"10.1590/S1677-5538.IBJU.2025.9911","DOIUrl":"10.1590/S1677-5538.IBJU.2025.9911","url":null,"abstract":"","PeriodicalId":49283,"journal":{"name":"International Braz J Urol","volume":"51 4","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12236986/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144054557","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":"Integrating Quality Management and Male Reproductive Health in Assisted Reproduction.","authors":"Fabiola C Bento, Rita C S Figueira, Sandro C Esteves","doi":"10.1590/S1677-5538.IBJU.2025.0180","DOIUrl":"10.1590/S1677-5538.IBJU.2025.0180","url":null,"abstract":"<p><p>Quality management is essential to ensure consistent, safe, and effective outcomes in assisted reproductive technology (ART) centers. However, traditional quality assessments often overlook male infertility, which contributes to nearly half of all infertility cases. This article explores the implementation of a quality management system (QMS), specifically ISO 9001, tailored to ART centers that prioritize male reproductive health. Drawing from our experience at ANDROFERT, a male-focused fertility clinic, we demonstrate how process standardization, structured workflows, and continuous improvement strategies can optimize diagnostics, microsurgical procedures, and laboratory practices. Integrating male-specific procedures-such as varicocele repair, microdissection testicular sperm extraction (micro-TESE), and vasovasostomy-into the QMS is discussed, along with performance monitoring tools, including key performance indicators and patient satisfaction metrics. Collaboration with an academic institution is essential to support education and ensure training is aligned with quality and safety protocols. Our center's dual IVF laboratories and andrology services exemplify how advanced testing, including sperm DNA fragmentation analysis and handling of surgically retrieved sperm, are seamlessly integrated into quality pathways. By embedding male reproductive health into QMS frameworks, ART centers can improve clinical outcomes, foster interdisciplinary collaboration, and enhance patient engagement. We advocate for a multidimensional approach to quality-beyond pregnancy rates-encompassing safety, effectiveness, patient-centeredness, timeliness, efficiency, and equity. This model strengthens clinical performance and ensures sustainable, evidence-based fertility care for male patients.</p>","PeriodicalId":49283,"journal":{"name":"International Braz J Urol","volume":"51 4","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12236985/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144002937","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":"Darifenacin Versus Parasacral Transcutaneous Electric Nerve stimulation for overactive bladder syndrome in patients infected with Human T-Lymphotropic Virus 1 - randomized open clinical trial.","authors":"Tatiane Souza Soares de Oliveira, José Abraão C, Cassius José Vitor Oliveira, Néviton M Castro, Edgar M Carvalho","doi":"10.1590/S1677-5538.IBJU.2024.0567","DOIUrl":"10.1590/S1677-5538.IBJU.2024.0567","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the efficacy of parasacral transcutaneous electric nerve stimulation (PTENS), in comparison to darifenacin for the reduction of OAB symptoms in patients infected with HTLV-1.</p><p><strong>Materials and methods: </strong>This proof-of-concept randomized clinical trial was carried out at the HTLV-1 Outpatient Clinic of the University Hospital. Participants included 42 HTLV-1 infected subjects with symptoms OAB. The OAB symptoms score questionnaire (OABSS) was applied before and after treatment to evaluate each group: group1-received darifenacin and group 2-treated with PTENS. Random sequences and statistical analysis were generated by SPSS statistical package, version 27 (IBM Inc™).</p><p><strong>Results: </strong>There was no difference between groups regarding demographic, socio-economic and clinical characteristics. The initial median and interquartile (IQR) range of OABSS were 11.2 (9.5 - 14.0) in G1 and 10.7 (8.0 - 12.7) in G2. There was a reduction in the frequency, nocturia and urgency in both groups. However, 5 (23.8%) of the patients in the group treated with darifenacin abandoned the therapy, while only 1 patient (4,8%) stopped PTENS.</p><p><strong>Conclusions: </strong>Both protocols used in this study were effective in treating OAB syndrome and reducing OABSS. However, therapy abandonment and adverse events were more frequent in the darifenacin group compared to the PTENS group.</p>","PeriodicalId":49283,"journal":{"name":"International Braz J Urol","volume":"51 4","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12236978/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144044983","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":"Editorial Comment: Is the Effectiveness of Self-Visualization During Flexible Cystos-copy Gender-Dependent in Patients with no Previous Cystoscopy History?","authors":"Hinpetch Daungsupawong, Viroj Wiwanitkit","doi":"10.1590/S1677-5538.IBJU.2025.0061","DOIUrl":"10.1590/S1677-5538.IBJU.2025.0061","url":null,"abstract":"","PeriodicalId":49283,"journal":{"name":"International Braz J Urol","volume":"51 4","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143659390","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":"Novel Role Of DSNB in Staging of Primary Urethral Cancer: New Standard?","authors":"Adnan Fazili, R Barry Sirard, Laura Elst, Kaat Vandermaesen, Hongzhi Xu, Maarten Albersen, Philippe E Spiess","doi":"10.1590/S1677-5538.IBJU.2025.9905","DOIUrl":"10.1590/S1677-5538.IBJU.2025.9905","url":null,"abstract":"<p><p>We describe the novel use of dynamic sentinel node biopsy (DSNB) in five patients with primary urethral squamous cell carcinoma (U-SCC) and no evidence of inguinal node disease across two centers in North America and Europe between 03/2021 and 06/2024. Each of these referral centers sees over 75 cases of penile cancer per year and approximately 10 cases of U-SCC per year. Patients underwent DSNB concomitant to surgical resection of the primary tumor (n=3), or in a deferred manner (n=2), six weeks after primary surgery. In the five DSNBs performed, clinically occult nodal metastasis was discovered in one patient. In this patient DSNB was performed after local recurrence and repeat imaging confirming cN0 status. Only one minor complication with DSNB was observed. Awaiting further investigations in larger series, this study highlights the feasibility of DSNB in primary U-SCC with clinically node negative disease.</p>","PeriodicalId":49283,"journal":{"name":"International Braz J Urol","volume":"51 3","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12052031/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143626537","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}