International Braz J Urol最新文献

{"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":4.3,"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":"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":4.3,"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":"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":4.3,"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}

{"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":4.3,"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":"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":4.3,"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":"Focal Cryotherapy in Prostate Cancer. Does Gleason Impact Results?","authors":"Kinga Mate, Pedro de Pablos-Rodríguez, Marta Burbano Herraiz, Mario Hassi Román, Paula Pelechano Gómez, Ana Calatrava Fons, Maria Isabel Martín García, Jessica Patiño Aliaga, Manel Beamud Cortés, Álvaro Gómez-Ferrer Lozano, Jose Luis Dominguez Escrig S, Cristina Gutierrez Castañé, Victor Rodríguez Part, Juan Luis Casanova Ramón Borja","doi":"10.1590/S1677-5538.IBJU.2025.0289","DOIUrl":"10.1590/S1677-5538.IBJU.2025.0289","url":null,"abstract":"<p><strong>Purpose: </strong>Focal cryotherapy is a minimally invasive treatment for localized prostate cancer (PCa), but its oncological outcomes, particularly in relation to baseline Gleason Grade Group (GG), remain understudied. This study evaluates its efficacy and the impact while radical of baseline Gleason score on recurrence-free survival.</p><p><strong>Materials and methods: </strong>A retrospective analysis included 111 patients with localized PCa treated with focal cryotherapy between 2014 and January 2024. Patients with prior treatments or follow-up < 12 months were excluded. All patients underwent MRI and transperineal biopsy, and cryotherapy was performed using the Visual ICE Cryoablation System. Confirmatory biopsies were recommended at 12-24 months post-treatment. Recurrence was classified as either in-field (treated or adjacent areas) or out-field (non-adjacent areas). Any recurrence-free survival was defined as the absence of positive biopsy or additional treatment. Radical treatment-free survival was defined as the absence of whole-gland treatment (e.g., radical prostatectomy, radiotherapy), androgen deprivation therapy, metastasis, or death. Outcomes were compared between patients with baseline GG 1 and GG >1.</p><p><strong>Results: </strong>Median follow-up was 35 months (IQR 24-49). Confirmatory biopsies were performed in 78% of patients (n=87), revealing in-field recurrence in 10% and out-field recurrence in 23%. There were no statistically significant differences between ISUP 1 and ISUP >1 groups in terms of protocol biopsy positivity for either in-field recurrence (HR 0.41; 95% CI 0.09-1.9) or out-field recurrence (HR 0.77; 95% CI 0.3-1.98). At three-years, the rates of any recurrence-free and radical treatment-free survival were 63% and 85%, respectively, with no significant variation by baseline GG.</p><p><strong>Conclusion: </strong>Focal cryotherapy provides favorable short-term oncological outcomes in localized PCa, with no significant differences in recurrence-free survival based on baseline Gleason score.</p>","PeriodicalId":49283,"journal":{"name":"International Braz J Urol","volume":"52 2","pages":""},"PeriodicalIF":4.3,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13124189/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146042054","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":"Robot-assisted Repair of Rectovesical Fistula after Radical Prostatectomy using the Hugo™ RAS System.","authors":"Lara Herrero López, Andrea Noya Mourullo, Sara Tamburini, Edoardo Beatrici, Nicola Frego, Simone Morra, Florencio Manuel Marin Martinez, Geert De Naeyer, Ruben De Groote, Edward Lambert, Frederiek D'Hondt, Alexandre Mottrie","doi":"10.1590/S1677-5538.IBJU.2025.0405","DOIUrl":"10.1590/S1677-5538.IBJU.2025.0405","url":null,"abstract":"<p><strong>Introduction: </strong>Rectovesical fistula (RVF) is a rare complication after robot-assisted radical prostatectomy (RARP) (1), often requiring complex surgery (2). Robotic systems provide dexterity and visualization for deep pelvic procedures (3, 4). We report the first RVF repair using the Hugo™ RAS System.</p><p><strong>Materials and methods: </strong>A 76-year-old male developed fecaluria one week after catheter removal following RARP. MRI revealed a 1.3 cm fistulous tract between the bladder and rectum. Initial management included transurethral and suprapubic catheters, plus a loop colostomy. Robotic repair was performed five months later. Trocar placement, adapted to the stoma, included four robotic and two assistant ports. Posterior bladder wall dissection allowed removal of two joined catheters. The posterior bladder wall, urethrovesical anastomosis dehiscence, and a 1 cm anterior rectal defect were repaired. Fibrotic tissue and residual clip were removed. A peritoneal flap was interposed between the bladder and rectum, and a new bladder neck and vesicourethral anastomosis were created using barbed sutures. Intraoperative testing confirmed integrity, and a bladder catheter was placed.</p><p><strong>Results: </strong>The postoperative course was uneventful, with patient discharge on day 4. The bladder catheter was removed after 3 weeks. At the 2-month follow-up, urinary function was normal with good continence. Ultrasound confirmed good bladder filling and no post-void residual. Cystoscopy showed a well-healed urethrovesical anastomosis without fistula. Colostomy reversal is pending.</p><p><strong>Conclusions: </strong>This case demonstrates the feasibility and effectiveness of the Hugo™ RAS System for RVF repair post-RARP. Robotic surgery can manage complex defects with favorable outcomes (5). Robotic platforms may expand telesurgery, allowing patients to undergo procedures locally with expert surgeons operating remotely (6).</p>","PeriodicalId":49283,"journal":{"name":"International Braz J Urol","volume":"52 2","pages":""},"PeriodicalIF":4.3,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13124194/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145071003","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":"Large Language Models and the \"Centaur Model\" in Urological Training in Latin America.","authors":"Juan Martín Montoya Osorio","doi":"10.1590/S1677-5538.IBJU.2025.0632","DOIUrl":"10.1590/S1677-5538.IBJU.2025.0632","url":null,"abstract":"","PeriodicalId":49283,"journal":{"name":"International Braz J Urol","volume":"52 2","pages":""},"PeriodicalIF":4.3,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13124170/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146042057","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":"Robot-assisted Reduction Pyeloplasty with 3D Image Navigation for Adult Giant Hydro-nephrosis: Technique and Clinical Outcomes.","authors":"Hao Dong, Pan Song, Zhihua Li, Xiang Wang, Kunlin Yang, Xuesong Li","doi":"10.1590/S1677-5538.IBJU.2025.0525","DOIUrl":"10.1590/S1677-5538.IBJU.2025.0525","url":null,"abstract":"<p><strong>Purpose: </strong>To perform a systematic review and meta-analysis evaluating the efficacy and safety of preoperative silodosin in improving ureteroscopy (URS) outcomes for ureterolithiasis.</p><p><strong>Materials and methods: </strong>PubMed, EMBASE and Cochrane Central were systematically searched for studies comparing preoperative silodosin with placebo or 'no preoperative silodosin' in patients undergoing URS for ureteral stones. Primary outcomes included ureteral wall injury, analgesia use, fever, haematuria, stone-free rate (SFR), operative time, and complications. Statistical analysis was performed using Review Manager 5.1.7. Study quality and risk of bias were assessed per Cochrane guidelines.</p><p><strong>Results: </strong>Nine studies, including eight randomized clinical trials, including 960 patients were analysed; 450 (46.8%) received silodosin. Compared to controls, silodosin significantly reduced ureteral injuries (RR 0.30; 95% CI: 0.18-0.49; p < 0.00001) and operative time (MD -17.72 minutes; 95% CI: -24.72 to -10.72; p < 0.00001). It also lowered analgesia needs (RR 0.35; 95% CI: 0.16-0.75; p = 0.007), with trends toward reduced fever (RR 0.67; 95% CI: 0.36-1.22; p = 0.19) and haematuria (RR 0.57; 95% CI: 0.32-1.02; p = 0.06). In studies with ≥10 days of preoperative use, silodosin significantly improved SFR (RR 1.17; 95% CI: 1.10-1.26; p < 0.00001).</p><p><strong>Conclusions: </strong>Preoperative silodosin reduces ureteral injuries, operative time, and complications, supporting its use to improve safety and efficiency of URS for ureterolithiasis.</p>","PeriodicalId":49283,"journal":{"name":"International Braz J Urol","volume":"52 2","pages":""},"PeriodicalIF":4.3,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13124163/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146042026","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: Safety and efficacy of vibegron in pediatric patients with treatment-resistant nocturnal enuresis: a multicenter retrospective study","authors":"Luciano A Favorito","doi":"10.1590/S1677-5538.IBJU.2025.9923","DOIUrl":"10.1590/S1677-5538.IBJU.2025.9923","url":null,"abstract":"","PeriodicalId":49283,"journal":{"name":"International Braz J Urol","volume":"52 2","pages":""},"PeriodicalIF":4.3,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13124182/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146042006","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}