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Percutaneous cryoablation (CA) is increasingly used to manage small renal masses (SRMs) in selected patients, offering a nephron-sparing, minimally invasive alternative to surgical resection. We evaluated the safety, renal functional preservation, and short-term oncologic outcomes of CA in a high-complexity cohort at a tertiary referral center. We conducted a retrospective single-center analysis of consecutive patients treated with CA between 2020 and 2025. SRMs were defined as renal tumors ≤4 cm (cT1a). Procedures were performed under local anesthesia, primarily using combined Ultrasound and Cone-Beam Computed Tomography guidance. Primary outcomes included perioperative morbidity (Clavien-Dindo) and oncologic results (local failure, metastasis, and cancer-specific survival). Secondary outcomes focused on renal function preservation (eGFR). Seventy-one patients were included in the analysis. The cohort had a median age of 70 years and a high comorbidity burden, with a median Charlson Comorbidity Index of 5, prior renal surgery was present in 45% of patients and 13% a solitary kidney. All procedures achieved technical success. The overall complication rate was 20%, with no Clavien-Dindo grade ≥II complications. At a median follow-up of 10 months, early oncologic outcomes showed 11 patients with local failure (9 petients with residual disease, 2 patients with recurrence), reflecting the high proportion of "salvage" cases. Most failures (55%) were successfully managed with repeated CA. Metastatic progression occurred in 3% of cases, and cancer-specific mortality was 1.4%.. Median eGFR decline was 2.5 mL/min/1.73 m². CA represent a safe and effective nephron-sparing strategy for selected patients with SRMs. particularly in high-complexity cases. Despite a non-negligible local failure rate in salvage cases, cryoablation allows effective disease control while preserving renal function. These findings support CA as a valuable treatment option, although longer follow-up is needed to confirm long-term oncologic durability.

This study compared the efficacy of three combined treatment regimens (biofeedback electrical stimulation [BES] combined with pelvic floor muscle training [PFMT], acupuncture combined with PFMT, and a triple therapy regimen of acupuncture, BES, and PFMT) in addressing urinary incontinence (UI) and sexual dysfunction in patients with postpartum pelvic floor dysfunction (PFD), with the aim of exploring the clinical advantages of the triple therapy regimen. This study was designed as a randomized controlled trial, with blinding applied to both the evaluators and the data analysts. A total of 203 postpartum women with PFD were enrolled and randomly assigned to Group A (BES+ PFMT, n = 65), Group B (acupuncture + PFMT, n = 68), and Group C (acupuncture + BES + PFMT, n = 64). Pelvic floor EMG, muscle strength, MUCP, and MFR were measured at baseline and 6 months post-treatment. Leakage volume was assessed by 1-hour pad test. UI was evaluated using ICI-Q-SF and IIQ-7, and sexual function using FSFI and PISQ-31. Adverse events were recorded throughout treatment. All groups showed significant improvement in EMG, muscle strength, MUCP, MFR, FSFI, and PISQ-31 scores, alongside reductions in leakage volume, ICI-Q-SF, and IIQ-7 scores. Improvements were most significant in Group C. No significant difference was found between Groups A and B after treatment. Adverse event rates did not differ significantly among groups. Compared to dual-therapy approaches, triple-therapy (acupuncture + BES + PFMT) enhances postpartum pelvic floor rehabilitation, effectively improving UI and sexual function in patients with PFD.

The aim of this study is to compare the clinical outcomes of cystoscopy and laser resectoscope used during transurethral cystolithotripsy (TUC) and to evaluate the efficacy and reliability of these two endoscopic instruments. This study included patients who underwent transurethral bladder stone (BS) surgery between 2022 and 2025. Patients were categorized into cystoscope and laser resectoscope groups according to the endoscopic instrument used. Lithotripsy was performed using a holmium laser in all cases. Demographic characteristics, stone-related parameters, perioperative variables, and clinical outcomes were analyzed comparatively. Statistical analyses were performed using appropriate tests, and a p value <0.05 was considered statistically significant. A total of 80 patients were included (Group 1: cystoscope, n=40; Group 2: laser resectoscope, n=40). No significant differences were found between groups regarding age, body mass index (BMI), number of stones, or stone size (p>0.05). Operation and lithotripsy times were significantly shorter in the laser resectoscope group (29 vs. 45 min; 18 vs. 23 min, respectively; p<0.001). Stone visualization quality was higher in this group, and mucosal bleeding was significantly less frequent (p=0.014). No significant differences were observed regarding hospital stay, catheterization duration, or overall complication rates. Comparable stone-free and safety outcomes were achieved with TUC performed using either a cystoscope or a laser resectoscope. However, the laser resectoscope provided shorter operative times, improved visualization, and reduced mucosal injury, indicating that it is an effective and reliable alternative for TUC.

Primary Ewing sarcoma of the kidney is an exceptionally rare and highly aggressive malignancy. Its clinical, radiologic, and pathologic features often overlap with other renal tumors, making early diagnosis particularly challenging. A young adult presented with acute abdominal pain. Contrast-enhanced CT revealed a cystic-solid right renal mass with active intratumoral bleeding. The patient underwent emergency surgical management, followed by a second radical procedure due to uncertain resection margins. Histopathological examination demonstrated sheets of small round blue cells, and immunohistochemistry showed diffuse CD99 and NKX2.2 positivity. Fluorescence in situ hybridization confirmed an EWSR1 gene rearrangement, establishing the diagnosis of Ewing sarcoma. Postoperatively, the patient received a VAC 4-cycle sequential IE 2-cycle adjuvant chemotherapy regimen. This case highlights the diagnostic difficulty and rapid progression of renal Ewing sarcoma. Accurate diagnosis relies on integrated imaging, histopathology, immunoprofiling, and molecular testing. Early recognition and multidisciplinary decision-making are essential for optimizing outcomes in this rare tumor entity.

Chronic prostatitis/chronic pelvic pain syndrome CP/CPPS is a relatively common disease and shows an association with urogenital infections. Tuft cells in general have been identified at various entry points into the body (respiratory tract, gastrointestinal tract, and urogenital tract) and are seen as guardians against invading threats. Urethral tuft cells utilizing canonical taste transduction cascade to detect of microbial products and initiating reflex micturition and neurogenic inflammation as a protective mechanism in response. Impaired chemoreception of the T2R38 taste receptor predisposes individuals to upper respiratory tract infections. Therefore, it is very likely that impaired chemoreception has a comparable effect on bacterial urogenital infections, whereas non-bacterial urogenital infections should remain unaffected. The aim of this study was to investigate the influence of TAS2R38 receptor functionality, as measured by a taste test, on the clinical presentation of patients with chronic abacterial prostatitis type III. From 2016 to 2025 a total of 252 patients with diagnosed CP/CPPS received a comprehensive andrological work-up including a taste test for the functionality of the TAS2R38 receptor. Complete semen analysis was performed according to WHO 2021 recommendations including the determination of inflammatory parameters in the ejaculate as well as microbiological examination of first-void urine, post-prostate massage urine and ejaculate. The proportion of tasters was 55.95%, while non-tasters accounted for 44.05%. No significant differences could be found between tasters and non-tasters with CP/CPPS with regard to symptom burden measured using questionnaires, various ejaculate parameters, prostate-specific antigen, and microbiological results. Only seminal elastase and serum CRP levels showed a significant difference, but with higher values in the taster group, which, in view of our initial hypothesis, is more likely a statistical coincidence. The results of our studies show that the taste status of TAS2R38 in patients with chronic abacterial prostatitis type III had no association with symptom severity, the ejaculate parameters examined, or the serum levels of PSA and CRP.

Digital transformation of European healthcare is progressing rapidly, yet implementation in outpatient specialist care remains uneven. In Germany, office-based urologists face distinct structural, regulatory, and economic challenges. We assessed digital infrastructure, tool utilization, perceived barriers, and investment behavior, including age-related differences. We conducted a nationwide cross-sectional survey (April-July 2024) among private practice urologists in Germany using a 35-item questionnaire structured along three dimensions of digital adoption (infrastructure, functional use, physician attitudes). Items were adapted from two previously published, peer-reviewed German urology surveys, and pretested with 12 urologists prior to launch. A total of 189 valid responses (response rate: 17.4%) were analyzed using descriptive statistics, chi-squared tests, and prespecified multivariable logistic regression adjusting for age, gender, practice size, years in practice, and region. Self-reported digital familiarity was high (66.1% familiar or very familiar), yet infrastructure remained traditional: 92.6% used on-site servers and only 7.4% any cloud component. Telemedicine was rarely used (61.9% never), while 49.2% used health apps or DiGAs. Adjusted analyses confirmed that age <55 years (adjusted odds ratio [aOR]: 2.93, 95% CI: 1.56-5.52, p < 0.001) and shorter time in practice (aOR: 0.78 per +5 years, 95% CI: 0.65-0.94, p = 0.009) independently predicted DiGA use and revealed that telemedicine adoption was driven primarily by practice size (aOR: 1.16 per additional full-time equivalent, 95% CI: 1.05-1.29, p = 0.005) rather than age. Most practices planned to invest less than EUR 30,000 over 5 years. Digitalization in outpatient urology remains primarily administrative. High familiarity does not translate into clinical transformation, and adoption is constrained by structural rather than generational barriers. Targeted funding, interoperable systems, and clear reimbursement frameworks are needed to enable clinically meaningful digital integration.

Peyronie's disease is a fibrotic disorder of the tunica albuginea that causes penile curvature and sexual dysfunction. Plication surgery is a standard treatment for men with preserved erectile function; however, non-absorbable sutures may lead to palpable and bothersome nodules. The aim of the study was to compare surgical and patient-reported outcomes between absorbable and non-absorbable sutures in penile plication surgery. This retrospective study included 48 patients who underwent plication surgery between 2013 and 2023 and completed long-term follow-up. Twenty-nine (60.4%) received absorbable sutures and 19 (39.6%) non-absorbable sutures. Mean follow-up was 8.4 &#xb1; 2.9 vs. 4.0 &#xb1; 1.2 years (p < 0.001). Primary outcomes were surgical success (no residual curvature) and bothersome nodularity, both self-reported. Univariate and multivariable logistic regression identified predictors of these outcomes. Surgical success rates were comparable (62.1% vs. 63.2%; p = 0.94). Bothersome nodularity was significantly less frequent with absorbable sutures (6.8% vs. 36.8%; p = 0.02). On multivariable analysis, non-absorbable sutures remained the strongest predictor of bothersome nodularity (adjusted OR 18.0; 95% CI 1.36-642; p = 0.057), while no independent predictors of surgical success were identified. Absorbable sutures reduce bothersome nodularity without compromising surgical outcomes, suggesting improved postoperative comfort with comparable efficacy.

Recurrent urinary tract infections (rUTIs), a prevalent condition among women, substantially impair quality of life, underscoring the need for effective and safe preventive treatments. This study evaluated the efficacy, safety, and bacterial resistance rates of methenamine hippurate versus low-dose nitrofurantoin for rUTI prevention in women, to guide clinical prophylaxis choices. We conducted a retrospective propensity score-matched cohort study involving female rUTI patients from our urology clinic between June 2021 and February 2024. After 1:1 matching, fifty patients each constituted the methenamine hippurate (MH) group and the low-dose nitrofurantoin (NFT) group . The treatment and follow-up period was 12 months, with assessments at 3, 6, and 12 months. A non-inferiority margin of &#x394;=0.5 episodes per person-year was defined. The primary endpoint was the 12-month symptomatic UTI recurrence rate. Secondary outcomes encompassed urine culture positivity, pathogen profile, antibiotic resistance, asymptomatic bacteriuria, international prostate symptom score (IPSS), quality of life score (SF-36), direct costs, compliance, and adverse events. After propensity score matching (PSM), initial analysis showed no significant differences in the baseline characteristics between the two groups (P>0.05). The 12-month recurrence rates were 18.00% for MH and 20.00% for NFT, confirming non-inferiority (P=0.765). Urine culture positivity and pathogen profiles did not differ significantly. Notably, the MH group showed no detectable resistance, compared to 28.57% resistance in the NFT group (P=0.022), and a reduced rate of asymptomatic bacteriuria (8.00% vs. 22.00%; P=0.037). Compliance was similar between groups. At 12 months, MH resulted in significantly improved IPSS and SF-36 scores (P<0.001). Although drug costs were higher with MH, total management costs for recurrences and adverse events were lower (P<0.001), with fewer reported adverse events (P<0.05). Methenamine hippurate demonstrates noninferiority to low-dose nitrofurantoin for preventing rUTIs in women, with reduced resistance, adverse events, and asymptomatic bacteriuria. Despite higher cost, its superior long-term benefit supports its use as an alternative in NFT-intolerant or high-risk patients.

Endourological management of upper urinary tract stones has increased substantially, with ureteroscopy (URS) and percutaneous nephrolithotomy (PNL) now representing standard treatment modalities. Concurrently, the prevalence of type 2 diabetes mellitus (T2DM) and the use of sodium-glucose cotransporter 2 inhibitors (SGLT2is) are rising. While SGLT2is provide established cardiovascular and renal benefits, their impact on perioperative outcomes in endourological stone surgery remains unclear. In this retrospective single-centre cohort study, all patients undergoing URS, PNL, or endoscopic combined intrarenal surgery between January 2024 and February 2025 were included. Patients were stratified into non-diabetic controls (n = 150), T2DM without SGLT2i (n = 49), and T2DM with SGLT2i (n = 48). Outcomes included in-hospital complications (Clavien-Dindo), postoperative urinary tract infection (UTI)/urosepsis, and UTIs within 4 weeks after discharge. Multivariable logistic regression adjusted for age, BMI, comorbidity, preoperative urine culture, operative time, and procedure type. Overall in-hospital complication rates were significantly higher in SGLT2i-treated patients, driven predominantly by minor, noninfectious events, while infectious outcomes remained comparable between groups. In multivariable analysis, SGLT2i therapy independently predicted in-hospital complications (p = 0.026). Preoperative urine culture status was the only independent predictor of postoperative UTI (p = 0.011). SGLT2i therapy in patients with T2DM undergoing endourological stone surgery was associated with increased minor in-hospital complications but not with higher perioperative infectious risk. Preoperative urine culture status remained the key determinant of postoperative UTI. Prospective multicentre studies are warranted to confirm these findings and optimize perioperative risk stratification in diabetic stone patients.

This study aimed to evaluate the therapeutic efficacy of hip muscle training combined with pelvic floor biofeedback electrical stimulation (BES) in postpartum patients with stress urinary incontinence (SUI) and identify predictors of treatment outcomes. A total of 142 SUI patients were randomly allocated to a control group (n = 71, pelvic floor muscle training [PFMT] + BES) or an observation group (n = 71, PFMT + BES + hip muscle training). Outcomes included therapeutic efficacy, pelvic floor muscle strength (GRRUG criteria), and incontinence symptoms (International Consultation on Incontinence Questionnaire-Short Form [ICI-Q-SF]). Univariate and multivariate logistic regression analyses were performed to identify predictors of treatment success. The observation group exhibited a significantly higher total efficacy rate (94.4% vs. 74.6%, p = 0.001) and a greater proportion of grade III or higher pelvic floor muscle strength (88.7% vs. 70.4%, p = 0.007). Post-intervention, the observation group demonstrated superior improvements in leakage frequency, urine volume, and quality of life impact (all p < 0.001). Univariate analysis identified parity, delivery mode, gestational weight gain, fetal weight, episiotomy, bladder neck mobility, SUI severity, and intervention type as significant predictors (p < 0.05). Multivariate analysis confirmed gestational weight gain <17.5 kg, absence of episiotomy, reduced bladder neck mobility, mild SUI, and combined therapy as independent protective factors (all p < 0.05). The integration of hip muscle training with pelvic floor BES significantly improves SUI symptoms and pelvic floor function. This biomechanically synergistic approach provides a novel framework for personalized postpartum rehabilitation.

To evaluate the need for structured feedback in urological residency training, we compared two assessment tools - Global Rating Scale (GRS) and Global Assessment of Urological Endoscopic Skills (GAUES) - during the 2024 Endo-Workshop of the German Society of Residents in Urology (GeSRU). The workshop included simulation training on ureterorenoscopy (URS), transurethral resection of the bladder (TURB), and transurethral resection of the prostate (TURP). Feedback was provided using GRS and GAUES. An online survey assessed the need for structured feedback. Descriptive statistics and Spearman correlation were used. Among 15 participants, 53% were female, and 60% were early-stage residents. All expressed a desire for feedback, though only 73% had previously received unstructured feedback. Mean scores on GRS were 26 (URS), 28 (TURB), and 25 (TURP); on GAUES: 32, 37, and 33 (max 58). GRS and GAUES scores correlated positively (URS: &#x3c1; = 0.85; TURB: 0.5; TURP: 0.54). Post-workshop, 93% rated structured feedback as helpful. Most participants found GAUES (86%) and GRS (79%) specific and useful for training. Structured assessments like GRS and GAUES show strong potential to improve endourological training. GAUES demonstrates value as a task-specific tool. Continuous evaluation of such tools is essential for high-quality surgical education and patient care.

The aim of the study was to prospectively evaluate patient and clinician reported outcomes of voiding function, pain levels and patient satisfaction of transgender women preoperatively (t0), 6 months (t1), and 12 months (t2) after gender-affirming surgery (GAS) with penile inversion vaginoplasty. Transgender women undergoing two-stage GAS at our tertiary care center were included (02/2020-01/2023). Voiding function (male lower urinary tract symptoms [MLUTS]), pain (visual analogue scale) and patients reported outcome measures were assessed. Clinical outcomes and complications were evaluated. A regression analysis was performed to identify possible risk factors for deterioration in voiding function. Fifty-three patients with an average age of 40.27 &#xb1; 14.43 years were included. Complications were mostly minor (Clavien-Dindo Classification grade I/II). Meatal stenosis occurred in 3 patients (6.38%). MLUTS voiding and incontinence complaints were low and did not change up to 12 months postoperatively (voiding symptoms p = 0.16, incontinence symptoms p = 0.32). The same applies to frequency and nocturia (p = 0.54 and p = 0.32, respectively). Pain intensity increased between t0 and t1 (p = 0.003). Pelvic pain was reported by 71% (t1) and 47% (t2). Patient satisfaction with the functional and cosmetical result was high and increased between t1 and t2, even though not significantly (p = 0.71 and p = 0.18). Age, pain intensity, and localization had no significant influence on postoperative voiding function in the regression analysis (all p > 0.05). Gender-affirming penile inversion vaginoplasty is a safe procedure regarding complications with high patient satisfaction and no significant changes in postoperative voiding function up to 12 months postoperatively.

Chronic kidney disease (CKD) is a significant concern following renal tumor surgery, impacting long-term renal function and patient outcomes. This study investigated the potential of computed tomography (CT)-based radiomics as a quantitative imaging approach to predict postoperative CKD in kidney tumor patients. We included adult patients with renal tumor surgery treated at our center between 2012 and 2022. Preoperative retrospective CT-imaging data were analyzed, and radiomic features were extracted from tumor lesions and renal parenchyma. Machine learning models were trained to predict postoperative new-onset CKD based on clinical information and radiomics. Model performance was assessed using five-fold cross-validation on the training set (n = 65) and on a separate test set (n = 17). Model performance was primarily evaluated using the receiver operating characteristic curve, with the area under the curve (AUC) serving as the principal summary metric. The study cohort comprised n = 82 patients, of whom n = 25 (30%) developed postoperative new-onset CKD. The best models achieved a mean validation AUC of 0.74 [95% CI: 0.60-0.86] for solely radiomics, 0.83 [0.73-0.93] with clinical information only, and 0.80 [0.67-0.91] on radiomics and clinical parameters, respectively (p > 0.05). For the test dataset, AUCs were 0.62 [95% CI: 0.29-0.92], 0.77 [0.50-0.98], and 0.80 [0.52-1.00], respectively (p > 0.05). Preoperative CT-based radiomic features in combination with clinical information can serve as a noninvasive predictor of postoperative CKD in renal tumor patients undergoing surgical resection. While prospective and external validation is needed, this approach facilitated clinical decision-making and enabled personalized treatment strategies in patients with renal tumors.

Residual lower pole fragments are a common limitation of ureteroscopy, yet the optimal patient positioning to minimize stone migration remains undefined. This study aimed to evaluate the impact of Trendelenburg (head tilt) and lateral body roll (body tilt) on stone migration within the kidney using physics-based simulation. Three-dimensional collecting system models were generated from delayed-phase CT urograms using RadiAnt&#x2122;. These hollowed models and an open-source stone model were imported into NVIDIA Isaac Sim&#x2122; (physics-based simulator). Stones were placed in the upper pole and subjected to gravity and a random contact force directed toward renal pelvis to simulate stone migration during laser fragmentation. Five angles (0&#xb0;, 5&#xb0;, 10&#xb0;, 15&#xb0;, 20&#xb0;) of head tilt and body tilt, independently and in combination, were tested with 100 simulations per configuration to evaluate lower pole migration. Stone migration between sides was compared with a Mann-Whitney U test. Two-way analysis of variance (ANOVA) assessed head tilt and body tilt effects, with paired t tests and Pearson's correlation quantifying their impact. From 20 CTs, 20 left and 18 right collecting systems were extracted. Average lower pole migration was 14.0 &#xb1; 5.5 (left) vs. 13.2 &#xb1; 5.4 (right), with no significant difference (U = 120,568, p = 0.056). Two-way ANOVA revealed significant effects of head tilt (F = 929.99, p < 0.0001) and body tilt (F = 513.42, p < 0.0001), without interaction (p = 0.37). Paired t test showed no difference between tilt types (p = 0.056). Increased head tilt and body tilt correlated with reduced lower pole migration (r = -0.744 and -0.552, p < 0.0001). Simulation findings suggest combined head and body tilt can reduce stone migration to the lower pole but challenge the convention of one ideal angle. These adjustments may improve stone clearance during ureteroscopy.

Objective Evaluate long-term effectiveness, safety and tolerability of OM-89 (Uro-Vaxom&#xae;), an oral immunostimulant derived from bacterial lysates of Escherichia coli, in the prophylactic management of recurrent urinary tract infections (rUTIs) in women in a real-world outpatient gynecology setting. Methods Retrospective, multicenter observational study based on data from women with a diagnosis of rUTI who received a single 90-day cycle of OM-89 therapy. Data were collected from medical records at the Mexican Institute for Infectious Diseases in Obstetrics and Gynecology (IMIGO) clinic in Monterrey, Mexico, between January 2023 and March 2024.. Primary outcomes included time to UTI recurrence, number of UTI episodes post-treatment, and use of antibiotics to treat a UTI. Secondary outcomes included recurrence-free interval and incidence of adverse events. Results A total of 208 women with recurrent UTIs were included. 72.1% received a single OM-89 90-day cycle, while 27.9% underwent two or more 90-day cycles. The mean recurrence-free interval after one OM-89 cycle was 5.3 &#xb1; 2.6 years, and 4.6 &#xb1; 2.5 years for those with OM-89 multiple cycles. Post-treatment bacterial cultures revealed a significant reduction in bacterial resistance 72.4% of urine samples and 37.0% of vaginal samples (p < 0.001). Conclusion A single 90-day course of OM-89 was associated with a long term reduction in UTI recurrences and antibiotic use in women with rUTIs. These findings support its use as a safe and effective non-antibiotic preventive strategy in clinical practice. Keywords: Recurrent urinary tract infections, OM-89, Uro-Vaxom&#xae;, oral immunotherapy, antibiotic stewardship, women's health, E. coli, resistance.

Active surveillance (AS) is the guideline-recommended management strategy for low-risk and favorable intermediate-risk prostate cancer (PCa). However, conventional risk stratification remains limited in predictive accuracy. Robust real-world evidence on the clinical utility of the Cell Cycle Risk (CCR; Prolaris&#xae;) score within European healthcare settings is currently scarce. We performed a retrospective single-center study of 60 localized PCa patients who underwent CCR testing at a tertiary academic urologic center between 2021 and 2025. We analyzed indications for testing, CCR treatment recommendations, and adherence rates using descriptive statistics. Median patient age was 62 years, median PSA level was 5.76 ng/ml. Overall, 13.3% of biopsy cores were positive, and 93.3% of patients had a Gleason score (GS) of 6. CCR testing was performed after initial diagnosis in 61.7% of patients and during ongoing AS in 38.3%. Following CCR testing, definitive therapy was recommended in 21.7% of patients, with an adherence rate of 53.8%, whereas continued AS was recommended in 78.3% of patients, with an adherence rate of 87.2%. CCR testing demonstrated high adherence rates, particularly for AS recommendations in the real-world setting. These findings support Prolaris&#xae; as a complementary decision aid for AS patient selection and management.

Surgical video-based learning has rapidly shifted to unregulated open-access platforms. This study evaluates the consumption habits, clinical impact, and content selection criteria of urologists across different career stages to understand the risks of this transition. A cross-sectional survey was conducted among 133 urologists stratified as residents, specialists, and academic urologists. Platform preferences, practice modifications, and selection criteria were assessed using Likert scales. Differences between groups were analyzed using chi-square and Kruskal-Wallis tests with post hoc pairwise comparisons. Open-access platforms (YouTube) were the primary source for 84.0% of the cohort, with no significant difference between groups (p: 0.351). A total of 37.4% reported modifying their surgical technique based on online videos. This rate did not differ significantly between residents (34.9%), specialists (48.0%), and academic urologists (35.0%) (p: 0.477). In adjusted analysis, career stage was not independently associated with technique modification, whereas higher weekly operative workload was associated with a greater likelihood of reporting modification. However, a significant divergence emerged in selection criteria: residents prioritized "surgeon's reputation" significantly less than specialists (p: 0.012) and academic urologists (p: 0.007). Additionally, the clarity of patient consent in online videos was rated universally low. The "YouTube era" appears to have a tangible influence on clinical practice across different seniority levels. However, potential differences in credibility assessment may exist as residents may rely more heavily on unregulated content without systematically evaluating author expertise. These findings highlight the potential value of incorporating digital literacy and source evaluation skills into residency curricula to support more informed engagement with online surgical content.

This study aims to compare the safety and efficacy of the pressure-controlling ureteral access sheath (PCUAS) and the tip-flexible suctioning ureteral access sheath (FSUAS) for treating renal stones &#x2264;3 cm. A total of 292 patients with renal stones were prospectively enrolled across three centers from June 2022 to October 2024. Participants were randomized into PCUAS and FSUAS groups in a 1:1 ratio. Data compared between groups included demographic information, position placement time, ureteroscopy time, sheath placement time, operation time, stone-free rate, postoperative hospitalization duration, intraoperative complications, and sheath placement success rate. There was no statistically significant difference in preoperative data between the two groups (P > 0.05). Of the 292 patients, ureteral access sheaths (UAS) placement was successful in 268 patients during the first stage, while 19 patients required a second stage after ureteral stent placement. Five patients were converted to percutaneous nephrolithotomy (PCNL) due to failed UAS placement. The PCUAS group had better fever and pain score outcomes than the FSUAS group (P < 0.05). Conversely, the FSUAS group had shorter position placement time, ureteroscopy time, and higher stone-free rate at 1 d and 1 month postoperatively (P < 0.05). The remaining indices showed no statistical significance between the groups. Both PCUAS and FSUAS have distinct advantages regarding safety and efficacy. Combining the benefits of both techniques could further improve the safety and effectiveness of flexible ureteroscopic lithotripsy for renal stones.

Primary malignant tumors of the epididymis are extremely rare and are associated with a poor prognosis. Since the first description by Scholl in 1928, fewer than 100 cases have been reported . Because presentations are nonspecific and misdiagnosis is common, clinical suspicion remains essential. Standardized diagnostic and therapeutic protocols are lacking, and there is no systematic evaluation of available treatment modalities. This report describes a 52-year-old man who presented with left testicular swelling and pain. Imaging initially suggested epididymitis. He underwent radical orchiectomy, and histopathology confirmed primary epididymal adenocarcinoma (PEA). Pathological staging was pT2 N1 M0, S0 .A subsequent laparoscopic retroperitoneal lymph node dissection (RPLND) identified metastasis in 1 of 10 nodes. The patient declined adjuvant chemotherapy; therefore, postoperative radiotherapy (50 Gy in 25 fractions to the pelvic and para-aortic regions) was administered. The patient has remained disease-free for ten years of follow-up, indicating a clinical cure. This case represents one of the longest reported follow-ups for node-positive PEA. It highlights that an aggressive multimodal strategy-integrating radical orchiectomy, RPLND for pathologic staging and potential therapeutic benefit, and adjuvant radiotherapy when chemotherapy is declined-can be curative. This long-term survival outcome provides a management framework for this orphan disease, though validation in larger cohorts is needed.