International Braz J Urol最新文献

{"title":"Artificial Intelligence and Peer Review: Preserving Integrity in the Pursuit of Efficiency.","authors":"José de Bessa, Cristiano Mendes Gomes","doi":"10.1590/S1677-5538.IBJU.2025.0538","DOIUrl":"10.1590/S1677-5538.IBJU.2025.0538","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/PMC13124166/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145132446","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":"Robotic-Assisted Retroperitoneal Lymph Node Dissection in a Challenging Post-Chemotherapy Case.","authors":"Willy Baccaglini, Gabriel Chahade Sibanto Simões, Julio Calderón, Nicolle Christofe, Luis G Medina, Paulo Priante Kayano, Gustavo Lemos, Arie Carneiro","doi":"10.1590/S1677-5538.IBJU.2025.0466","DOIUrl":"10.1590/S1677-5538.IBJU.2025.0466","url":null,"abstract":"<p><strong>Introduction: </strong>Robotic retroperitoneal lymph node dissection (RPLND) has emerged as a minimally invasive alternative for the management of testicular germ cell tumors, offering reduced morbidity and faster recovery when performed in experienced centers (1-3). However, post-chemotherapy cases remain technically demanding. We present a case of robotic RPLND performed for a bulky residual mass following systemic treatment.</p><p><strong>Methods: </strong>A 23-year-old male with no comorbidities underwent right orchiectomy for clinical stage IIC non-seminomatous germ cell tumor (60% yolk sac, 20% embryonal carcinoma, 20% post-pubertal teratoma), followed by three cycles of BEP chemotherapy. Tumor markers normalized, but imaging revealed a persistent 5.4-cm interaortocaval mass. Robotic RPLND was carried out using four robotic ports and one 12-mm assistant port. The procedure included a complete bilateral template dissection (paraaortic, interaortocaval, and paracaval), en bloc tumor removal, and meticulous sharp and blunt dissection using advanced bipolar energy.</p><p><strong>Results: </strong>Operative time was 300 minutes, with minimal blood loss (50 mL) and no intraoperative complications. The bulky lesion was successfully resected with excellent anatomical exposure, despite significant tumor adherence to the aorta. The patient was discharged on postoperative day one and resumed normal activities within two weeks. Pathology revealed teratoma in 1 of 34 resected lymph nodes. At 6-month follow-up, he remained disease-free, with normal tumor markers, preserved renal function, and no complications.</p><p><strong>Conclusion: </strong>This case demonstrates the feasibility of robotic RPLND for large post-chemotherapy residual masses. The robotic platform enables precise dissection even in challenging settings, with favorable perioperative and oncologic outcomes. Centralized expertise and standardized technique are essential to achieve optimal results (1, 4-6).</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/PMC13124171/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145071019","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 Partial Nephrectomy with and without Mixed Reality - REALITATEM study.","authors":"Dorival Manrique Duarte, Pietro Waltrick Brum, Milton Berger, Andrey Kowalski, Brasil Silva, André Kives Berger","doi":"10.1590/S1677-5538.IBJU.2025.0463","DOIUrl":"10.1590/S1677-5538.IBJU.2025.0463","url":null,"abstract":"<p><strong>Purpose: </strong>This randomized clinical trial (RCT) was developed to analyze the efficacy of using Mixed Reality (MIXREAL), the combination of virtual (VR) and augmented realities (AR), in robot-assisted partial nephrectomy (RAPN).</p><p><strong>Materials and methods: </strong>Forty-five patients with renal masses (RM) were allocated to RAPN with or without use of MIXREAL, Realitatem Group (RG) and Control Group (CG), respectively.</p><p><strong>Results: </strong>Analyses indicated statistically significant difference in ischemia time favoring RG (p = 0.045), with a mean difference of 3.8 minutes. Classically, the limit widely accepted as suitable for ischemia time is 20-25 minutes, but every 1 minute saved may reduce renal injury. Analyses also indicated statistically significant difference in decision for selective clamping favoring RG (p = 0.013); main renal artery clamping globally exposes the renal parenchyma to ischemia. The percentage of residual parenchyma after surgery is also an important variable to renal function recovery, and this study presented a trend towards the enucleation technique being facilitated in the RG. No difference was detected regarding complication rate. Despite those results, no difference was detected in both short and long-term renal function outcomes. The small sample is an important drawback.</p><p><strong>Conclusion: </strong>This RCT demonstrates the feasibility and safety of MIXREAL in RAPN, as well as its potential to support intraoperative decision-making. It represents the first RCT evaluating MIXREAL in RAPN. Larger studies with longer follow-up are needed to confirm potential functional benefits.</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/PMC13124186/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146042029","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":"Managing Robotic Radical Prostatectomy in Men with Penile Prosthesis: Surgical Tech-nique, Outcomes, and Literature Review.","authors":"Rohan Sharma, Yu Ozawa, Shady Saikali, Avaneesh Kunta, Marcio Covas Moschovas, Travis Rogers, Vipul R Patel","doi":"10.1590/S1677-5538.IBJU.2025.0467","DOIUrl":"10.1590/S1677-5538.IBJU.2025.0467","url":null,"abstract":"<p><strong>Introduction: </strong>Robotic-assisted radical prostatectomy (RARP) in patients with pre-existing inflatable penile prostheses (IPP) poses technical challenges due to the intrapelvic reservoir. With rising rates of prostate cancer and IPP use, evidence on safely performing RARP in this group is limited. This study assesses the feasibility, safety, and perioperative outcomes of RARP in men with prior IPP.</p><p><strong>Materials and methods: </strong>We retrospectively analyzed 32 prostate cancer patients with functional three-piece IPPs who underwent RARP (2016-2024), excluding those with prior pelvic radiation, malleable implants, or incomplete data. Key adaptations included tailored port placement, cold dissection near the reservoir, site-specific retraction without reservoir removal, and intraoperative deflation as needed. Perioperative, functional, and oncologic outcomes were systematically assessed.</p><p><strong>Results: </strong>Median age was 67 years (IQR 61-73). Follow up duration was 24 months from RARP. Median operative time and blood loss were 110 minutes (IQR 98-120) and 100 mL (IQR 50-120), respectively. No intraoperative prosthesis injuries occurred. Clavien-Dindo grade I-II complications were observed in 8 patients (25%). Median time to continence (≤1 pad/day) was 56 days (IQR 46-92). All IPPs remained functional postoperatively without revision. 31 patients were continent at 12 months. Pathologic pT2 disease was present in 16 (50%) patients; positive margins occurred in 4 (12.5%) patients. Biochemical recurrence was noted in 9.4% at 12-month median follow-up.</p><p><strong>Conclusion: </strong>RARP in patients with a pre-existing penile prosthesis reservoir is technically feasible and safe, with no increase in procedure-related or reservoir-specific complications.</p>","PeriodicalId":49283,"journal":{"name":"International Braz J Urol","volume":"52 1","pages":""},"PeriodicalIF":4.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12974977/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145132430","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":"Robotic Partial Cystectomy for Urachal Adenocarcinoma: Surgical Technique with Cys-toscopic Correlation.","authors":"Gabriel Chahade Sibanto Simões, Julio Calderón, Oliver Rojas Claros, Wladimir Alfer, Arie Carneiro","doi":"10.1590/S1677-5538.IBJU.2025.0446","DOIUrl":"10.1590/S1677-5538.IBJU.2025.0446","url":null,"abstract":"<p><strong>Introduction and objective: </strong>Urachal adenocarcinoma is a rare malignancy that typically arises from the bladder dome and is often diagnosed incidentally or during evaluation for hematuria (1, 2). Surgical excision remains the cornerstone of treatment (3, 4). This video demonstrates the robotic technique for partial cystectomy with en bloc urachal resection, combined with synchronized intraoperative cystoscopic imaging-an approach that has proven feasible and oncologically safe in selected cases (5-7).</p><p><strong>Materials and methods: </strong>A 74-year-old hypertensive male presented with self-limited gross hematuria. Cystoscopy revealed a lesion at the bladder dome, and transurethral resection confirmed urachal adenocarcinoma. Staging chest and abdominal CT scans showed no evidence of metastasis. Robotic partial cystectomy with urachal excision was performed using a da Vinci platform and an auxiliary 5-mm port, in line with contemporary minimally invasive techniques, including single-port surgery (8). The urachus was dissected to the umbilicus, the bladder dome excised, and the bladder closed in two layers with barbed sutures. The specimen was retrieved through the umbilical incision following concomitant umbilectomy. Intraoperative cystoscopy provided simultaneous tumor visualization via picture-in-picture overlay.</p><p><strong>Results: </strong>Operative time was 45 minutes, with an estimated blood loss of 20 mL and no complications. The patient was discharged on postoperative day one with a Foley catheter, which was removed after seven days. Pathological analysis revealed moderately differentiated urachal adenocarcinoma with a mucinous component, detrusor and perineural invasion, and negative margins. At 6-month follow-up, the patient remained asymptomatic, continent, and recurrence-free on surveillance CT.</p><p><strong>Conclusion: </strong>Robotic partial cystectomy with urachal excision is a safe and effective treatment for localized urachal adenocarcinoma. Intraoperative cystoscopy enhances anatomical correlation and may contribute to oncologic safety.</p>","PeriodicalId":49283,"journal":{"name":"International Braz J Urol","volume":"52 1","pages":""},"PeriodicalIF":4.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12974966/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145066138","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":"SP Retroperitoneal Robotic Nephrectomy via Lower Anterior Approach for Xanthogran-ulomatous Pyelonephritis in a Horseshoe Kidney.","authors":"William A Langbo, Arianna Biasatti, Carol L Feng, Taylor Stivali, Ruben Mercado Santos, Sameer Ansari, Riccardo Autorino","doi":"10.1590/S1677-5538.IBJU.2025.0383","DOIUrl":"10.1590/S1677-5538.IBJU.2025.0383","url":null,"abstract":"<p><strong>Purpose: </strong>Xanthogranulomatous pyelonephritis (XGP) represents an uncommon and challenging clinical scenario (1). XGP in a horseshoe kidney poses additional surgical complexity due to the anatomical anomaly (2). Robot-assisted radical nephrectomy (RARN) for XGP has been rarely reported (3), and single-port (SP) RARN via a retroperitoneal lower anterior approach (LAA) represents a recent innovation in the field (4). The aim of this video is to describe a case of SP RARN via LAA in a horseshoe kidney with XGP.</p><p><strong>Materials and methods: </strong>We report the case of a 51-year-old female (BMI 23 kg/m²) with XGP in a horseshoe kidney. A CT scan revealed severe left renal enlargement and hydroureteronephrosis, and a renal scan demonstrated <5% function of the left kidney, with a normal right kidney. The decision was made to proceed with SP RARN (5). Briefly, the patient was positioned in a modified supine position, and LAA was obtained via a 6-cm incision placed two fingerbreadths medial to the anterior superior iliac spine. The retroperitoneal space was bluntly developed, the large access port kit was introduced, and a 15-mm assistant port was placed through the same skin incision but via a separate fascial incision. The left renal hilum was identified, and the renal artery, vein, and ureter were ligated and transected. The isthmus was controlled using bipolar electrocautery and sharply divided. The kidney was freed and extracted.</p><p><strong>Results: </strong>Total operative time was 4.5 hours, estimated blood loss was 150 mL, and no perioperative complications occurred. The patient tolerated the procedure well and was discharged on postoperative day 1. The specimen weighed 500 g and showed a multinodular kidney with pathology consistent with XGP. The patient remained asymptomatic and complaint-free at the 3-month follow-up.</p><p><strong>Conclusions: </strong>SP RARN for XGP is feasible and can be safely performed. The LAA provides a versatile surgical approach and facilitates rapid postoperative recovery.</p>","PeriodicalId":49283,"journal":{"name":"International Braz J Urol","volume":"52 1","pages":""},"PeriodicalIF":4.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12974973/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144785783","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":"Comments on \"Use of ChatGPT in Urology and its Relevance in Clinical Practice\": To-ward a Responsible AI Framework for Middle-Income Settings.","authors":"Juan Martín Montoya Osorio","doi":"10.1590/S1677-5538.IBJU.2025.0459","DOIUrl":"10.1590/S1677-5538.IBJU.2025.0459","url":null,"abstract":"","PeriodicalId":49283,"journal":{"name":"International Braz J Urol","volume":"52 1","pages":""},"PeriodicalIF":4.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12974967/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144976065","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 Boari-flap after Orthotopic Neobladder Using the KangDuo Surgical Robot-01 System.","authors":"Guanpeng Han, Xiang Wang, Zhihua Li, Kunlin Yang, Liqun Zhou, Xuesong Li","doi":"10.1590/S1677-5538.IBJU.2025.0341","DOIUrl":"10.1590/S1677-5538.IBJU.2025.0341","url":null,"abstract":"<p><strong>Purpose: </strong>Benign ureteroenteric anastomosis stricture (BUES) is a well-recognized long-term complication following urinary diversion (1). While endourological interventions are often first-line, their success rates are limited (2, 3). Open uretero-ileal reimplantation remains the gold standard but is technically challenging and carries high complication risks (2). Robotic surgery offers a promising alternative with comparable success rates and minimally invasive benefits (4). In addition to the da Vinci® system, several new surgical robotic systems have been developed, demonstrating comparable safety and efficacy (5-7). This study reports our experience with robotic-assisted Boari-flap using the KangDuo-Surgical-Robot-01 (KD-SR-01) System in managing long-segment BUES after radical cystectomy with orthotopic neobladder.</p><p><strong>Materials and methods: </strong>A 64-year-old man developed left BUES 2.5 years after robot-assisted radical cystectomy with orthotopic neobladder. After nephrostomy drainage for 6 months, a robotic-assisted Boari-flap was performed using the KD-SR-01 system in the Trendelenburg position. Surgical steps included: neobladder mobilization, distal ureter dissection, neobladder flap creation, ureter-flap anastomosis, and flap tubularization.</p><p><strong>Results: </strong>Surgery was successful without conversion. The stricture length was 5 cm. The neobladder flap measured 5 × 3 cm (length × width). Operating time was 145 minutes, with 30 mL of blood loss. The nephrostomy tube and double-J stent were removed two months postoperatively. At three-month follow-up, the patient remained asymptomatic with stable serum creatinine. Cine magnetic resonance urography demonstrated normal ureteral peristalsis and ureteral jets. No postoperative complications occurred.</p><p><strong>Conclusions: </strong>Robotic-assisted Boari-flap after radical cystectomy with orthotopic neobladder is technically feasible. A larger cohort with longer follow-up is necessary to assess its safety and effectiveness.</p>","PeriodicalId":49283,"journal":{"name":"International Braz J Urol","volume":"52 1","pages":""},"PeriodicalIF":4.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12974970/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144976122","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":"Equation Predicts Renal Function after Nephroureterectomy to Treat Upper Tract Urothelial Carcinoma.","authors":"Kai-Sen Su, Hsiao-Jen Chung, Yen-Hwa Chang, William J S Huang, Eric Yi-Hsiu Huang","doi":"10.1590/S1677-5538.IBJU.2025.0076","DOIUrl":"10.1590/S1677-5538.IBJU.2025.0076","url":null,"abstract":"<p><strong>Purpose: </strong>A preoperative tool is warranted to predict renal function after radical nephroureterectomy, as this would optimize treatment plans and avoid postoperative end-stage renal disease. Therefore, this study aimed to develop an equation to predict postoperative renal function changes.</p><p><strong>Materials and methods: </strong>We reviewed the medical records of 487 patients who were diagnosed with upper tract urothelial carcinoma treated by unilateral radical nephroureterectomy with bladder cuff excision between 2010 and 2020. Renal function was comprehensively evaluated preoperatively using 99mTc-mercaptoacetyltriglycine renal scintigraphy. Serum creatinine was evaluated before, and 3 and 6 months postoperatively. We then developed a predictive equation using Pearson linear correlation analysis.</p><p><strong>Results: </strong>The median preoperative effective renal plasma flow was 241.30 mL/min., of which the lesion side accounted for 35.6% of the total. A predictive equation for changes in postoperative renal function was established. The preoperative lesion-side effective renal plasma flow ratio was significantly associated with an estimated glomerular filtration rate (eGFR) decline ratio at 3 months postoperatively (r = 0.613, P <0.001). Internal validation of the patients during 2021 confirmed that the equation could predict eGFR decline (r = 0.896) and radical nephroureterectomy-related cisplatin ineligibility (100%) at 3 months postoperatively.</p><p><strong>Conclusions: </strong>We established an equation that assists in predicting changes in postoperative eGFRs based on the preoperative lesion-side effective renal plasma flow ratio. This equation can also predict postoperative residual renal function.</p>","PeriodicalId":49283,"journal":{"name":"International Braz J Urol","volume":"52 1","pages":""},"PeriodicalIF":4.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12974961/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145208065","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":"ICSI with Testicular Sperm in Non-Azoospermic Men: Expert Opinion and Practical Algorithm.","authors":"Sandro C Esteves","doi":"10.1590/S1677-5538.IBJU.2025.9916","DOIUrl":"10.1590/S1677-5538.IBJU.2025.9916","url":null,"abstract":"","PeriodicalId":49283,"journal":{"name":"International Braz J Urol","volume":"52 1","pages":""},"PeriodicalIF":4.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12974962/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145066072","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}