BMC Urology最新文献

{"title":"Largest pediatric scrotal lipoma with perineal extension: a rare case expanding the anatomic spectrum and diagnostic pitfalls.","authors":"Ahmed Abdelmohsen","doi":"10.1186/s12894-026-02240-z","DOIUrl":"10.1186/s12894-026-02240-z","url":null,"abstract":"<p><strong>Background: </strong>Scrotal lipomas are exceptionally rare in children, with only a few cases reported worldwide and most measuring less than 7 cm. Giant pediatric scrotal lipomas with multi-compartmental perineal extension have not been previously described. This case presents the largest documented pediatric scrotal lipoma, with an analytic framework for understanding diagnostic pitfalls and rare visual documentation of surgical anatomy.</p><p><strong>Case presentation: </strong>A 5-year-old boy presented with six months of progressive left scrotal swelling clinically consistent with a large hydrocele. Ultrasound suggested heterogeneous fatty tissue, while MRI performed elsewhere was interpreted as omental herniation. Standard inguinal exploration for presumed hydrocele revealed a normal testis without a hernia or fluid collection, prompting intraoperative diagnostic reassessment. Subsequent scrotal exploration identified a well-encapsulated lipoma measuring 14 × 12 × 7 cm, located between the dartos and scrotal skin with deep extensions to the pubic arch, penile root, and pelvic floor. Complete excision was achieved while preserving all neurovascular structures. Histopathology confirmed mature lipoma. At one-year follow-up, the patient remained asymptomatic with symmetric testes and no recurrence.</p><p><strong>Conclusions: </strong>This case demonstrates how ultra-rare pediatric conditions can closely mimic common scrotal diseases, leading to diagnostic anchoring despite supportive imaging. It documents, to the best of our knowledge, the largest pediatric scrotal lipoma to date and the only case with extensive perineal extension. Intraoperative diagnostic flexibility, combined with meticulous anatomical dissection, enables safe and complete excision with excellent functional outcomes.</p>","PeriodicalId":9285,"journal":{"name":"BMC Urology","volume":"26 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13390228/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148547894","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":"Durable complete metabolic response to enfortumab vedotin plus pembrolizumab in metastatic upper tract urothelial carcinoma: a case report.","authors":"Melike Dönmez Tekin, Atike Pınar Erdoğan, Mustafa Şahbazlar, Mustafa Faraşat, Fatma Seher Pehlivan, Ferhat Ekinci","doi":"10.1186/s12894-026-02264-5","DOIUrl":"10.1186/s12894-026-02264-5","url":null,"abstract":"<p><strong>Background: </strong>Upper tract urothelial carcinoma (UTUC) accounts for approximately 5-10% of urothelial malignancies and is frequently associated with advanced stage and aggressive clinical behavior. In metastatic disease, platinum-based chemotherapy has historically represented standard first-line therapy; however, long-term outcomes remain limited. The combination of enfortumab vedotin and pembrolizumab has recently demonstrated superior survival outcomes compared with platinum-based chemotherapy in advanced urothelial carcinoma. Nevertheless, the depth and durability of response following early discontinuation of antibody-drug conjugate therapy remain incompletely characterized.</p><p><strong>Case presentation: </strong>A 38-year-old woman with advanced UTUC developed metastatic progression involving liver, lymph nodes, peritoneum, ovary, and bone following platinum-based chemotherapy and surgery. She received three cycles of enfortumab vedotin plus pembrolizumab. Cross-sectional imaging demonstrated near-complete radiologic response with resolution of hepatic metastases and marked regression of thoracic and abdominal lymphadenopathy. Enfortumab vedotin was discontinued because of treatment-related peripheral neuropathy and dermatologic toxicity, and pembrolizumab monotherapy was continued. At the sixth cycle of pembrolizumab, FDG PET/CT revealed complete metabolic response. The patient remains progression-free for more than eight months after documentation of complete metabolic response.</p><p><strong>Conclusion: </strong>This case demonstrates sustained complete metabolic response following short-course enfortumab vedotin combined with pembrolizumab in metastatic UTUC and highlights the potential for durable disease control despite early discontinuation of enfortumab vedotin.</p>","PeriodicalId":9285,"journal":{"name":"BMC Urology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13670588/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148535386","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":"Surgical complications, functional outcomes and associated factors among men underwent transurethral resection of the prostate at Benjamin Mkapa Hospital, Tanzania.","authors":"Gerald P Mwing'a, Emmanuel Tairo, Hindu Ibrahim Hussein, Edward Msokwa, Shemsa Said Khatib, Sanuni Ally Kessy, Said Mawji, Okoa Sukunala, Vitus Kajerero, Remigius Rugakingira, Joseph Elisha, Angelina M Lutambi, Basiliana Emidi, Monica Kessy, Alphonce Chandika, Abel Makubi","doi":"10.1186/s12894-026-02214-1","DOIUrl":"10.1186/s12894-026-02214-1","url":null,"abstract":"<p><strong>Introduction: </strong>Transurethral resection of the prostate (TURP) is the gold standard surgical treatment for moderate to severe lower urinary tract symptoms due to benign prostatic hyperplasia. However, data on surgical complications and functional adverse outcomes in Tanzania remain limited. This study assessed the incidence and factors associated with surgical complications and described functional adverse outcomes following TURP at Benjamin Mkapa Hospital (BMH).</p><p><strong>Methods: </strong>A retrospective cohort study was conducted using routinely collected data from men aged ≥ 40 years who underwent TURP at BMH between 2021 and 2023 with at least one year of follow-up. Patients with prior prostate or urethral surgery, neurogenic bladder, or incidental prostate cancer were excluded. Logistic regression was used to estimate crude and adjusted odds ratios (ORs) with 95% confidence intervals (CIs).</p><p><strong>Results: </strong>Among 705 men (mean age 69 ± 8.9 years), 67 (9.50%) developed surgical complications, and 76 (10.78%) had functional adverse outcomes. Overall, 132 (18.72%) had at least one recorded outcome, noting that the two categories were not mutually exclusive and functional adverse outcomes may include pre-existing conditions due to a lack of baseline assessment. Ejaculatory dysfunction (10.35%) was the most common functional adverse outcome, while urethral stricture (4.54%) was the most frequent surgical complication. Late complications (6.80%) were more common than early complications (2.98%). Hypertension (aOR = 2.06, 95% CI: 1.20-3.53) and diabetes (aOR = 4.81, 95% CI: 2.36-9.80) were independently associated with higher odds of surgical complications, while prostate size < 80 cm³ was protective (aOR = 0.58, 95% CI: 0.33-0.93).</p><p><strong>Conclusion: </strong>Surgical complication rates following TURP at BMH were comparable to international reports. Hypertension, diabetes, and larger prostate size were associated with higher odds of surgical complications. Functional adverse outcomes were common but should be interpreted cautiously because baseline functional status was not systematically assessed.</p>","PeriodicalId":9285,"journal":{"name":"BMC Urology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13663214/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148520016","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":"Upregulation of osteopontin expression in prostatic stromal cells via the interaction with prostatic epithelial cells contribute to inflammation-related prostatic fibrosis.","authors":"Xing-Sheng Yao, Heng Zhang, Xiao-Hu Tang, Yan-Dong Wang, Yi-Qi Ruan, Mu-Xia Luo, Lei Tang, Ye Tian, Ying Cao","doi":"10.1186/s12894-026-02258-3","DOIUrl":"10.1186/s12894-026-02258-3","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to investigate the role of osteopontin (OPN) in promoting prostatic fibrosis through inflammation.</p><p><strong>Methods: </strong>OPN expression in the prostates of BPH patients was detected using immunohistochemistry, and its correlation with inflammatory grade, preoperative IPSS, and the percentage of collagen fiber was evaluated, respectively. RNA sequencing (RNA-Seq) identified differentially expressed genes (DEGs) in Spp1-OE WPMY-1 cells. A non-contact co-culture system of BPH-1 and WPMY-1 cells (with or without rhOPN treatment), Spp1-shRNA, or Spp1-OE WPMY-1 cells was established to assess WPMY-1 cells mRNA expression of PTGS2, CXCL1, CCL2, and Spp1 by RT-PCR.</p><p><strong>Results: </strong>The expression of OPN in prostate stromal cells was significantly higher in the symptomatic BPH (S-BPH) group, the IPSS 20-35 (severe symptom) group, and the Moderate + Severe inflammation group compared to the asymptomatic BPH (A-BPH) group, the IPSS 8-19 (moderate symptom) group, and the No + Mild inflammation group. Furthermore, OPN expression was positively correlated with preoperative IPSS and the percentage of collagen fibers in S-BPH patients. RNA-Seq identified some DEGs between Vector and Spp1-OE WPMY-1 cells, which are closely related to inflammation and fibrosis. In vitro experiments demonstrated that the expression of PTGS2, CXCL1, CCL2, and Spp1 significantly increased in WPMY-1 cells co-cultured with BPH-1 cells, particularly following treatment with rhOPN. Spp1-shRNA WPMY-1 cells co-cultured with BPH-1 cells exhibited reduced expression of PTGS2, CXCL1, and CCL2, whereas Spp1-OE WPMY-1 cells co-cultured with BPH-1 cells showed an increased expression of these genes.</p><p><strong>Conclusions: </strong>OPN may be involved in the occurrence of prostatic inflammation and fibrosis. The upregulation of OPN expression in prostatic stromal cells may contribute to prostatic fibrosis by interacting with prostatic epithelial cells to exacerbate inflammatory processes.</p>","PeriodicalId":9285,"journal":{"name":"BMC Urology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13663079/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148497137","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":"Sperm morphology indices as exploratory screening tools for elevated DNA fragmentation: a single-centre correlation and threshold derivation study.","authors":"Abhishek Ramakrishnan, Peter Osvath, Rudolf Gesztelyi, Csaba Csikos, Bela Juhasz, Aniko Pósa, Miklos Szücs","doi":"10.1186/s12894-026-02261-8","DOIUrl":"10.1186/s12894-026-02261-8","url":null,"abstract":"<p><strong>Background: </strong>Sperm morphology assessment remains a routine component of semen analysis, yet its relationship with sperm DNA fragmentation at the level of individual morphological indices is incompletely characterised. This study evaluated correlations between the Teratozoospermia Index (TZI), Sperm Deformity Index (SDI), and Multiple Anomalies Index (MAI) with the DNA Fragmentation Index (DFI), deriving exploratory thresholds to identify men at risk of elevated DNA fragmentation (DFI > 20%).</p><p><strong>Methods: </strong>A retrospective analysis was conducted on 135 semen samples from men aged 20-55 years attending a university andrology centre. Morphology was assessed on Papanicolaou-stained smears; TZI, SDI, and MAI were calculated manually. DNA fragmentation was measured using the GC-SCD-20 kit. Pearson correlation and receiver operating characteristic (ROC) analysis with Youden-optimised thresholds were performed.</p><p><strong>Results: </strong>All three indices showed statistically significant, weak positive correlations with DFI: TZI (r = 0.263, p = 0.001), SDI (r = 0.290, p = 0.004), and MAI (r = 0.371, p < 0.001). ROC analysis demonstrated modest discriminatory performance: AUC values of 0.645, 0.620, and 0.680 respectively. At thresholds of TZI > 1.85, SDI > 2.42, and MAI > 2.53, sensitivity ranged from 82% to 90% with specificity of 44-53%.</p><p><strong>Conclusion: </strong>TZI, SDI, and MAI correlate weakly but significantly with DFI and demonstrate a high-sensitivity, low-specificity screening profile. These thresholds are exploratory, derived from a single cohort, and require prospective validation in larger independent studies before clinical application. They should be regarded as adjunctive tools within routine semen analysis and cannot substitute for direct DNA fragmentation testing.</p>","PeriodicalId":9285,"journal":{"name":"BMC Urology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13663195/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148497017","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":"Caecal volvulus around the mesentery of ileal neobladder: a case report.","authors":"Chinedu Okoli, Andrew Eksi, Damien Carter","doi":"10.1186/s12894-026-02164-8","DOIUrl":"10.1186/s12894-026-02164-8","url":null,"abstract":"<p><strong>Background: </strong>Caecal volvulus occurring in the setting of ileal neobladder reconstruction is rare. We report a case of caecal volvulus occurring after urinary reconstruction to highlight the diagnostic challenges and surgical management.</p><p><strong>Case presentation: </strong>We report the case of a 61‑year‑old male who presented with clinical features consistent with small bowel obstruction. Cross‑sectional imaging demonstrated a dilated small bowel with a transition point adjacent to the neobladder and mesenteric crowding suggestive of an internal hernia. The patient underwent exploratory laparotomy, which identified torsion of the caecum around the mesentery of the neobladder. The caecum was then decompressed through an appendectomy and a stapled partial caecectomy was performed followed by closure of the mesenteric defect.</p><p><strong>Conclusion: </strong>Caecal volvulus should be considered in patients presenting with acute bowel obstruction after ileal neobladder reconstruction. Awareness of this should prompt early diagnosis and timely intervention to prevent bowel ischemia and reduce morbidity.</p>","PeriodicalId":9285,"journal":{"name":"BMC Urology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13660335/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148469260","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":"Evaluation of the predictive accuracy of scoring systems for retrograde intrarenal surgery in a pediatric population.","authors":"Muhammet Cicek, Ayberk Iplikci, Mammad Khalilov, Ilkin Hamid-Zada, Mesrur Selcuk Silay, Asif Yildirim","doi":"10.1186/s12894-026-02259-2","DOIUrl":"10.1186/s12894-026-02259-2","url":null,"abstract":"<p><strong>Background: </strong>To assess the predictive accuracy of the retrograde intrarenal surgery (R.I.R.S.) nomogram and Resorlu-Unsal Score (RUSS) in pediatric patients undergoing RIRS.</p><p><strong>Methods: </strong>This retrospective study included 91 children (≤ 15 years) treated with RIRS between 2016 and 2024. Demographic, anatomical, and stone-related data were analyzed. Stone-free status (SFS) was defined as residual fragments < 2 mm at 4 weeks. Predictive factors were assessed by multivariate binary logistic regression analysis, and scoring systems were evaluated with Receiver Operating Characteristic (ROC) curve analysis.</p><p><strong>Results: </strong>SFS was achieved in 53 patients, while 38 had residual fragments. Independent predictors included stone diameter ≥ 15 mm, infundibulopelvic angle ≤ 30°, renal infundibular length ≥ 25 mm, and multiple stones. Both scoring systems showed high predictive performance: the R.I.R.S. nomogram achieved an AUC of 0.911 (95% CI: 0.855-0.967) and RUSS an AUC of 0.876 (95% CI: 0.806-0.947); formal comparison by DeLong's test showed no statistically significant difference (p = 0.337). R.I.R.S. score ≤ 6 provided optimal sensitivity (94.3%) and specificity (73.7%).</p><p><strong>Conclusions: </strong>Stone size and anatomy significantly affect RIRS outcomes in children. Both the R.I.R.S. nomogram and RUSS demonstrated high predictive performance, with no statistically significant difference between their AUC values on formal comparison. Either scoring system may support preoperative assessment, though clinical decisions should be individualized.</p>","PeriodicalId":9285,"journal":{"name":"BMC Urology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13660325/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148469273","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":"Bladder augmentation and bladder neck reconstruction in bladder exstrophy patients: a single center experience.","authors":"M Abada, A Khairi, S Shehata, M Abouheba, A Oshiba","doi":"10.1186/s12894-026-02173-7","DOIUrl":"10.1186/s12894-026-02173-7","url":null,"abstract":"<p><strong>Background: </strong>Bladder augmentation with gastrointestinal tissue accompanied by bladder neck repair are important tools for pediatric surgeons in the management of children with Bladder exstrophy for urinary incontinence. The goal of bladder augmentation is to create a reservoir with an adequate functional capacity with low end-filling pressure. The aim of this study is to evaluate the efficacy, safety, and outcomes of ileocystoplasty with modified Young-Dees-Leadbetter bladder neck reconstruction and continent catheterizable channel in children born with bladder exstrophy at Pediatric Surgery Unit, Children's Hospital, Faculty of Medicine, Alexandria University, Egypt.</p><p><strong>Patients and methods: </strong>This prospective study included 20 patients with bladder exstrophy after successful bladder closure and who had small bladder capacity less than 100 ml with incontinence and needed augmentation cystoplasty and bladder neck reconstruction.</p><p><strong>Results: </strong>As regards daytime continence, 16 patients (80%) were dry between clean intermittent catheterization CIC sessions, while 4 patients (20%) were wet between clean intermittent catheterization at resting time. During stress, 14 patients (70%) were dry, while 6 patients (30%) were wet (4 of them were wet at resting time). Reflux resolution (100%), and significant improvement in bladder capacity (mean increase from 60.2 ml to 348.5 ml, p < 0.001).</p><p><strong>Conclusion: </strong>For patients with bladder exstrophy, bladder augmentation and bladder neck reconstruction remain crucial for maintaining continence and enhancing their quality of life.</p>","PeriodicalId":9285,"journal":{"name":"BMC Urology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13378153/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148454688","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":"Two versus four weeks ureteral stenting prior to flexible ureteroscopy after failed primary ureteral access sheath insertion: a randomized trial.","authors":"Baher Salman, Atef Badawy, Mohamed El-Shazly, Ammar Alorabi, Mohamed Elgharbawy","doi":"10.1186/s12894-026-02244-9","DOIUrl":"10.1186/s12894-026-02244-9","url":null,"abstract":"<p><strong>Background: </strong>During Flexible ureteroscopy; Failed primary placement of the ureteral access sheath (UAS) or backloading of flexible ureteroscopy occurred in up to 22% of patients who required ureteric stent insertion for some time. This study was conducted to compare the outcomes of two versus four weeks of preoperative ureteral stenting in patients with failed primary ureteral access undergoing flexible ureteroscopy (FURS).</p><p><strong>Patients and methods: </strong>This single-blind, randomized controlled trial included 60 patients with upper and/or renal stones < 20 mm who had failed primary access during FURS between April 2024 and October 2025. Patients were randomized into 2 groups to insert a ureteral double-J stent for either 2 weeks (n = 30) or 4 weeks (n = 30) before the definite FURS. The primary endpoint was successful insertion of a 10/12 Fr ureteral access sheath (UAS). Secondary outcomes included stone-free rate (SFR) (assessed by a postoperative 4-week CTUT), operative time, complications, and stent-related symptoms (assessed by the Ureteral Stent Symptom Questionnaire (USSQ)).</p><p><strong>Results: </strong>Baseline demographic and clinical characteristics were comparable between groups. Successful UAS insertion was achieved in 90% of the 2-week group and 93.3% of the 4-week group with no difference between groups (p = 0.64). No significant differences were found between groups regarding postoperative 4-week NCCT SFR (80.0% vs. 73.3%, p = 0.54), operative time (55 vs. 48.5 min, p = 0.44), or complication rates. Ureteric injuries were minor (6.7% in each group). Stent-related symptoms measured by USSQ did not significantly differ (p = 0.24).</p><p><strong>Conclusion: </strong>In this randomized trial, no statistically significant differences were observed between 2-week and 4-week preoperative stenting regarding UAS insertion success, stone-free rate, operative time, or complication rates. These findings suggest that prolonging stent dwell time beyond 2 weeks may not provide a substantial additional benefit in this patient population.</p><p><strong>Trial registration: </strong>The trial was retrospectively registered in 12/2024 on clinicaltrials.gov under the number: NCT06761378.</p>","PeriodicalId":9285,"journal":{"name":"BMC Urology","volume":"26 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13374341/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148469304","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 ureteral reconstruction combined with trans-trocar flexible ureteroscopy using a flexible and navigable suction ureteral access sheath: a case report and technical note.","authors":"Chaoyue Ji, Jianxing Li, Weiguo Hu, Gang Zhang","doi":"10.1186/s12894-026-02238-7","DOIUrl":"10.1186/s12894-026-02238-7","url":null,"abstract":"<p><strong>Background: </strong>Simultaneous management of upper urinary tract stricture and renal calculi remains a technical challenge in minimally invasive urology. Conventional hybrid techniques combining robotic reconstruction with standard flexible ureteroscopy often face limitations such as impaired visualization, irrigation fluid leakage, and difficulty in managing a substantial stone burden. We report a refined hybrid technique that integrates a flexible and navigable suction ureteral access sheath (FANS) directly into the robot-assisted ureteral reconstructive workflow.</p><p><strong>Case presentation: </strong>A 49-year-old male patient presenting with a 1-cm middle-to-upper ureteral stricture and a concomitant lower-calyceal stone cluster (aggregate size: 18 × 16 × 12 mm; approximal density: 550 HU) underwent a refined hybrid procedure using the da Vinci Xi system following failed retrograde intrarenal surgery. Intraoperatively, a 12/14 Fr FANS (40 cm) was introduced through an assistant trocar and utilized for 40 min to facilitate thulium fiber laser lithotripsy (1.2 J/10 Hz; active lasing time: 15 min), enabling direct fragment evacuation. Stone-free status was initially confirmed via kidney-ureter-bladder radiography on postoperative day 2. At the 14-month follow-up, abdominal CT demonstrated significant resolution of hydronephrosis and confirmed no recurrence of stones or ureteral obstruction.</p><p><strong>Conclusions: </strong>The trans-trocar FANS-assisted hybrid approach is a feasible and efficient single-session strategy for complex upper urinary tract pathology. The core innovation lies in the functional integration of suction-assisted endourology into robotic reconstructive surgery.</p>","PeriodicalId":9285,"journal":{"name":"BMC Urology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13647558/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148444474","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}