International Braz J Urol最新文献

{"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}

{"title":"Applied Anatomy of Bulbospongiosus Muscle: a Narrative Review.","authors":"William Lannes, Jorge L Alves-Pereira, Eduardo M Ribeiro, Edilaine F Alves, Luciano A Favorito","doi":"10.1590/S1677-5538.IBJU.2025.9917","DOIUrl":"10.1590/S1677-5538.IBJU.2025.9917","url":null,"abstract":"<p><p>This review aims to provide a comprehensive analysis of the anatomy of the bulbospongiosus muscle (BSM) in males, highlighting its morphological features, anatomical variations, and clinical implications in ejaculatory process and urethral surgery. We analyzed papers published in the past 70 years in the databases of Pubmed, Embase and Scielo. We excluded case reports, editorials and opinions of specialists. Studies were excluded if they lacked clear anatomical descriptions of the BSM, if full-text access was unavailable, or if they were published in languages other than Portuguese, English, or Spanish. The BSM is part of the superficial muscular layer of the perineum The perineal arteries provide vascular supply to BSM and, toward the end of their path, give rise to several posterior scrotal branches that supply the skin and dartos muscle of the scrotum. The deep branch of pudendal nerve is primarily muscular and innervates the superficial transverse perineal, bulbospongiosus, ischiocavernosus, deep transverse perineal, and sphincter muscles of the membranous portion of the urethra. This revision concluded that the BSM is a paired skeletal striated muscle that originates from the perineal body enveloping the bulbar portion of the urethra. Stimulation of the dorsal nerve of the penis leads to BSM contraction that provides an indication of anatomic sacral nerve pathway integrity. BSM has some important clinical applications. The bulbar urethral stricture causes minimal alterations in the structure of the BSM during the surgical procedure and the BSM is highly sensitive to androgen and could be used in common androgenic activity evaluation.</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/PMC12974980/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145208035","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":"Fourteen-Year Analysis of Percutaneous Nephrolithotripsy Outcomes: Evolution of Technique and Future Perspectives.","authors":"Fabio C Vicentini, Carlos A Batagello, Giovanni S Marchini, Fabio C M Torricelli, Artur Brito, Alexandre Danilovic, Guilherme Gentile, Henrique Lepine, Priscila Kuriki Mota, Daniel Beltrame Ferreira, Rodrigo Perrella, David Cohen, Claudio B Murta, Valter Cassao, Joaquim A Claro, William Nahas, Eduardo Mazzucchi","doi":"10.1590/S1677-5538.IBJU.2025.0403","DOIUrl":"10.1590/S1677-5538.IBJU.2025.0403","url":null,"abstract":"<p><strong>Purpose: </strong>The treatment of kidney stones has undergone continuous evolution. Despite the evolution of retrograde intrarenal surgery, percutaneous nephrolithotomy (PNL) remains the gold standard treatment for large and complex stones. We aimed to evaluate and analyze the temporal evolution of the results of the PNLs conducted at two teaching hospitals.</p><p><strong>Results: </strong>Data from 2660 patients were studied between 2009 and 2022. The rate of complex stones (Guy's 3 and 4) was 55.3%. Supine position was used in 82.1% of the cases. In 74.7% of cases, only 1 puncture was performed. The median surgery time was 120 min (15-240 min). The overall complication rate was 12.2%, the transfusion rate was 4.5%, and the success rate was 59.8%. Regarding temporal evolution, the use of the supine position increased from 73% in 2009 to 100% in 2022 (p < 0.001). The use of nephrostomy dropped from 81.8% to 26.5% (p<0.001), the median duration of surgery dropped from 145 to 130 min, the median time of use of fluoroscopy went from 12 to 8 min, the rate of blood transfusions dropped from 11.5% to 2.8% (p= 0.009), and the complication rate dropped from 18.2% to 12% (p= 0.002), while the average length of stay dropped from 81.8 hours to 50 hours.</p><p><strong>Conclusions: </strong>PNL is an effective surgical option for treating complex kidney stones. The implementation of several technical aspects, along with the standardization of the procedure, led to a significant improvement in most outcomes, reducing complication rates but leaving room for technique improvements in terms of success rates.</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/PMC12974981/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144976105","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 Radical Prostatectomy in the Brazilian Unified Health System (SUS): A Landmark in Surgical Public Health.","authors":"Leonardo O Reis","doi":"10.1590/S1677-5538.IBJU.2025.9918","DOIUrl":"10.1590/S1677-5538.IBJU.2025.9918","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/PMC12974975/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145304130","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":"Survival Without Reintervention of Second Artificial Urinary Sphincter Implants in Men: A National Healthcare Data System-Based Study in France.","authors":"Elliot Tokarski, Yoann Taillé, Emmanuel Chartier-Kastler, Bertrand Lukacs, Thomas Seisen, Morgan Roupret, Aurélien Beaugerie, Eric Vicaut, Pierre C Mozer, Louis Lenfant","doi":"10.1590/S1677-5538.IBJU.2025.0374","DOIUrl":"10.1590/S1677-5538.IBJU.2025.0374","url":null,"abstract":"<p><strong>Purpose: </strong>Artificial urinary sphincter (AUS) is the gold standard treatment for severe male stress urinary incontinence (SUI). While survival outcomes after primary implantation are now well established, the prognosis following reintervention remains poorly understood. We aimed to assess long-term reintervention-free survival after a second AUS implantation and to compare outcomes between device replacement and reimplantation after removal.</p><p><strong>Materials and methods: </strong>We performed a nationwide, population-based, retrospective cohort study including all men aged ≥18 years in France who underwent a second AUS implantation between 2006 and 2018 for SUI following prostate cancer or benign prostatic hyperplasia treatment. AUS procedures were identified through a unique device identifier. Of 5,132,311 eligible men, 8,475 received a first AUS and 1,619 a second AUS: 1,165 after device replacement and 454 after reimplantation following removal. The primary outcome was reintervention-free survival, estimated by Kaplan-Meier analysis. Secondary outcomes included replacement and removal rates. Predictors of reintervention were identified using multivariable Cox regression.</p><p><strong>Results: </strong>Median follow-up was 53 months (IQR 26-81). Reintervention-free survival after second AUS was 81% (95% CI 79-83) at 2 years, 68% (95% CI 65-71) at 5 years, and 61% (95% CI 57-64) at 10 years. Device replacement achieved significantly better survival than reimplantation after removal (p <0.001). Notably, only 21% of patients whose first AUS was removed underwent reimplantation.</p><p><strong>Conclusions: </strong>Second AUS implantation provides durable long-term outcomes, approaching those of primary implants. The indication for reintervention critically influences prognosis, with replacement outperforming reimplantation after removal. The low reimplantation rate after AUS removal provides a clinically relevant piece of information to counsel patients requiring device removal.</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/PMC12974964/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145066238","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":"Gender Affirming Revision Vaginoplasty Utilizing Decellularized Fish Skin Xenograft: Surgical Technique and Outcomes.","authors":"Seyed Sajjad Tabei, Alex J Xu, Rachel Pope, Kyle Scarberry, Kirtishri Mishra, Shubham Gupta","doi":"10.1590/S1677-5538.IBJU.2025.0340","DOIUrl":"10.1590/S1677-5538.IBJU.2025.0340","url":null,"abstract":"<p><strong>Purpose: </strong>Tissue availability for revision vaginoplasty in trans feminine individuals is often limited, creating challenges in cases with prior surgery or inadequate local tissue. While not yet extensively studied in genital reconstruction, Kerecis SurgiClose®, a decellularized fish skin xenograft, has shown promise as a skin substitute in other surgical contexts, including burn care and chronic wound management. This study aims to describe the surgical technique and evaluate the short-term clinical outcomes of revision vaginoplasty using decellularized fish skin xenograft (FSXRV) in trans feminine individuals.</p><p><strong>Materials and methods: </strong>A retrospective review of 27 trans feminine patients who underwent FSXRV between February 2023 and December 2024 was conducted. Data on preoperative characteristics, intraoperative details, and postoperative outcomes were collected from electronic medical records and analyzed.</p><p><strong>Results: </strong>The median age was 36 years, and the median BMI was 27 kg/m². Median postoperative follow-up was 261 days. Indications for FSXRV included loss of neovaginal depth (81.5%), proximal introital narrowing (14.8%), and devitalized neovaginal grafts (3.7%). The xenograft was applied in various configurations and anatomical locations using either a perineal-only or combined perineal-robotic approach. No intraoperative or major (Clavien-Dindo ≥II) complications occurred within 30 days postoperatively. Five patients (18.5%) underwent subsequent canal revision after FSXRV. Positive outcomes were reported in 74% of patients using the Patient Global Impression of Improvement scale.</p><p><strong>Conclusion: </strong>Fish skin xenograft revision vaginoplasty demonstrated early safety and feasibility for revision neovaginal lining and appeared to reduce reliance on autologous grafts or flaps in complex revision settings.</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/PMC12974968/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144976067","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}