When patients with congenital genitourinary conditions transition to adult care, they encounter multiple challenges, including management of multiple complex medical needs, understanding and navigating the healthcare system, and reconciling their condition with their social and psychological development. These issues translate directly into inferior short-term and long-term health outcomes, including increased emergency room visits after 18 years of age, persistent bothersome urinary symptoms, reduced quality of life and lack of appropriate urological management into adulthood. Conversely, smooth care transition enables improved age-appropriate subspecialty care and eases the burden of care on paediatric care providers. Transitional urology aims to aid adolescents and young adults, particularly those with complex healthcare needs, in successfully transitioning from paediatric to adult care. Transitional urology is one of the top ten highest-priority research topics in urology, but the existing body of research regarding transitional care remains relatively small. Knowledge and understanding of this patient population, including models of care, quantitative assessment of transition, stakeholder perspectives, common clinical challenges and barriers to establishing and maintaining transitional care programmes, can inform transitional care. Avenues of future transitional urology research include outcomes-based studies for specific pathologies, comparisons of different care implementation models, creation and evaluation of training opportunities and validation of resources created for non-urologic care team members. An idealized transition schema is proposed as both an example and guide to ground recommendations and data.
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This study aimed to evaluate global research trends in robotic surgery in andrology using a bibliometric approach. A comprehensive search was conducted in the Web of Science Core Collection using predefined keywords related to robotic-assisted techniques and andrological procedures. Publications between 2003 and 2025 were included. After applying eligibility criteria, 69 studies (37 articles and 32 reviews) were analyzed. Bibliometric analyses were performed using Biblioshiny and VOSviewer to assess publication output, citation patterns, leading sources, countries, authors, and collaborative networks. The results demonstrated fluctuations in annual scientific production, with the highest number of publications recorded in 2014. Citation trends varied across publication years. Publications were primarily concentrated in leading peer-reviewed journals in the fields of urology, andrology, and robotic surgery, reflecting the specialized and interdisciplinary nature of the field. The United States ranked first in both publication output and citation impact, while Turkey exhibited the highest collaborative strength based on total link strength. Keyword analysis identified vasovasostomy, microsurgery, varicocelectomy, and male infertility as the dominant research themes. Co-authorship and co-citation analyses indicated that the field is shaped by a limited number of influential authors and core studies. In conclusion, robotic surgery in andrology represents a steadily expanding research area characterized by increasing scientific output and evolving collaboration patterns. From a clinical perspective, the concentration of current evidence may limit its generalizability to broader practice. Future multicenter studies evaluating procedure-specific outcomes, functional results, pain relief, complications, long-term durability, and cost-effectiveness may further clarify the role of robotic techniques in andrology.
Ureteral strictures (USTs) are increasingly common. While some can be managed endoscopically, many cases require reconstructive surgery. Autologous tissue substitutes (ATSs) are a promising option in this setting. The aim of our systematic review was to map surgical techniques and outcomes for ureteral reconstruction using various ATS options. We conducted a systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Three databases were searched for studies on ATS ureteroplasty. Seventeen studies (559 patients) reporting on buccal mucosa grafts (BMGs), lingual mucosa grafts (LMGs), appendiceal techniques, vesical mucosa grafts (VMGs), and reconfigured intestinal segments were included. Owing to substantial clinical heterogeneity for graft types, surgical techniques, outcome definitions, and follow-up protocols, a quantitative meta-analysis was not feasible. A narrative synthesis was therefore used to report technical aspects and outcomes. The most common UST causes were iatrogenic and stone-related. In most of the studies included, more than one-third of the patients enrolled had a history of ureteral repair. Short-term success rates were 85-100% for BMGs/LMGs, 85-93% for appendiceal techniques, and 100% in the single VMG series, but definitions of success varied widely across the studies. BMGs/LMGs were most frequently used for shorter strictures (<5 cm), whereas appendiceal techniques were used for longer defects (up to 7.5 cm). Limitations include the retrospective nature of most studies, heterogeneous reporting of outcomes, and short follow-up, which precluded meta-analysis and long-term assessment of efficacy. ATSs are a viable option for ureteral reconstruction. Graft choice should be tailored to the stricture length and location. These techniques require specialised expertise but can prevent more morbid procedures. This review looked at use of a patient's own tissue (eg, from the inside of the cheek or the appendix) to repair the tube draining urine from the kidney to the bladder when it is blocked by a narrow segment. Results show that these techniques work very well and can often prevent the need for more invasive surgery. The type of tissue chosen depends on the exact nature and location of the blockage.
Posterior urethral valves are the leading cause of congenital bladder outlet obstruction in boys and can result in long-term lower urinary tract dysfunction and reduced quality of life. Sexual and reproductive consequences in this population are poorly described and understood. The purpose of this systematic review (SR) was to assess the long-term sexual functions and fertility outcomes in patients treated in the pediatric age for posterior urethral valve (PUV). A SR was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. MEDLINE, Embase, and Scopus were searched for studies reporting sexual or reproductive outcomes in individuals with a history of PUV. The primary outcomes were prevalence and nature of sexual dysfunctions and fertility issues. Risk of bias was assessed using ROBINS-I or the Newcastle-Ottawa Scale, as appropriate. Eleven studies (2 non-randomized comparative studies and 9 case series) including 2723 individuals met the inclusion criteria. Most patients exhibited preserved erectile function, ejaculatory function was variably reported with most individuals described normal ejaculation. Semen analysis, reported in 7 studies, revealed normal parameters in approximately half of the cohorts, though abnormalities were noted in patients with renal impairment or complex urological histories. Paternity rates varied widely (6%-58%) and were lower in individuals with renal dysfunction or urinary incontinence. Only one study used validated tools to assess quality of life, showing negative impact in domains related to continence and renal status. Most males treated for PUV during childhood reach adulthood with preserved sexual and reproductive potential. Given the heterogeneity and methodological limitations of the current literature, prospective studies using standardized outcome measures are needed to better define long-term risks and inform clinical follow-up.
Infertility is often viewed as a couple-centric issue; however, male infertility significantly contributes to reproductive challenges. While infertility screening is increasingly discussed in partnered contexts, limited evidence exists specifically regarding infertility screening for unmarried men. This protocol outlines a scoping review that aims to explore the scope and nature of evidence related to infertility screening in unmarried men. This scoping review will adhere to a comprehensive 14-step methodological framework, incorporating the established Arksey and O'Malley methodology, enhanced by Tricco and Peters. It will follow the PRISMA-ScR guidelines. A combination of thesaurus and free-text search methods will be employed, connecting keywords within each concept. Databases including Web of Science (ISI), PubMed, Scopus, and search engines like Google Scholar, will be searched. To ensure rigor, the selection process will be conducted using the established PCCT framework (population, concept, context, and study type). This review will consider quantitative, qualitative, and mixed-methods studies, as well as grey literature from any geographical location and setting, focusing on infertility screening concepts for unmarried men. The extracted data will be synthesized and presented through diagrams and tables, accompanied by a narrative summary. This scoping review will summarize the evidence on infertility screening in unmarried men, highlighting diverse types of screening, potential benefits and harms, and knowledge gaps. It aims to guide future research and improve the understanding of the reproductive health needs of unmarried men worldwide.
Benign prostatic hyperplasia (BPH) is one of the most prevalent urological conditions. Holmium laser enucleation of the prostate (HoLEP) has emerged as a durable, effective, and minimally invasive treatment option for men with BPH. Despite the success of HoLEP in men with BPH, it is not without postoperative side effects, both sexual and non-sexual. This narrative review compiles existing evidence of side effects associated with HoLEP. The review mostly covers sexual side effects but also discusses some non-sexual side effects. There can be significant overlap between sexual and non-sexual side effects; thus, both were included. A search of the medical literature was carried out in PubMed and Medline, focusing on original research and systematic reviews on HoLEP and its sexual side effects. Due to the nature of BPH and HoLEP, sexual side effects are significant considerations in patients undergoing HoLEP. Multiple studies have shown the commonality of retrograde ejaculation (RE) and ejaculatory dysfunction after HoLEP. Other studies have shown some effect on the orgasm itself, but overall unchanged sexual satisfaction. HoLEP is a durable, effective, and safe option for men with BPH. It has high rates of RE, which can affect sexual health and orgasmic function. However, the effects typically are not largely impactful to the overall sexual health and satisfaction of men.
This umbrella review aimed to summarize and provide a general evaluation of the effectiveness of current treatments for erectile dysfunction (ED) and assess the quality of evidence. This umbrella review available in PubMed, Web of Science, the Cochrane Library, and Embase, covering studies published up to October 2025, was conducted. The International Index of Erectile Function (IIEF) or its simplified version and the erectile hardness score (EHS) were used as endpoints to evaluate the effectiveness of the treatments. Of 1191 studies, 23 published meta-analyses were extracted, yielding 42 summary effects on IIEF (n = 20), the international index of erectile function-5 (IIEF-5) (n = 9), the international index of erectile function-erectile function (IIEF-EF) (n = 6), and EHS (n = 7) on 36 interventions. All meta-analyses were analyzed via the AMSTAR-2, of which 13 (56.5%) were rated as critically low quality, 7 (30.5%) were rated as low quality, 2 (8.7%) were rated as moderate quality, and 1 (4.3%) was rated as high quality. Of the 42 summary effects, only two studies were rated as high-quality and moderate-quality respectively, whereas 47.6% (n = 20) and 47.6% (n = 20) were rated low and very low, respectively. The current evidence base for ED treatments is predominantly of low or very low quality. While statistically significant improvements in ED were observed with both pharmacological and nonpharmacological interventions, these findings should be interpreted with caution due to the limited number of patients and the subjective nature of outcome indicators. The treatment landscape for ED is increasingly diverse, yet the reliability of the evidence is poor. Further well-designed studies on single treatments and high-quality meta-analyses of intertreatment comparisons are urgently recommended.
Patient-derived organoids (PDOs) and organotypic slice tissues have emerged as promising platforms to model prostate cancer (PCa) in three dimensions (3D), preserving tumor architecture and molecular features. Their relevance as translational tools for precision oncology, however, remains incompletely defined. To systematically assess the feasibility, molecular fidelity, and translational applications of 3D models in PCa. We conducted a comprehensive systematic literature review (PROSPERO CRD42025643117) in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies published until December 2024 were screened across PubMed, EMBASE, and Web of Science. Original studies involving human-derived PCa 3D models were included. Data were extracted on organoid generation efficiency, molecular profiling, biomarker exploration, and drug testing outcomes. Success rates for PDO establishment varied widely (15-90%), influenced by sample type, disease stage, and matrix conditions. Long-term expansion beyond 5-10 passages was achieved in a minority of models, particularly from radical prostatectomy. Despite these limitations, PDOs showed high genomic, transcriptomic, and epigenetic concordance with patient tumors, including key alterations in androgen receptor (AR) signaling, Tumor Protein (TP) 53, Phosphatase and TENsin homolog (PTEN), Phosphoinositide-3-Kinase/Protein Kinase B (PI3K/AKT), and neuroendocrine markers. Organoids retained intratumoral heterogeneity and were suitable for single-cell sequencing. Biomarker studies identified Enhancer of Zest Homolog 2 (EZH2), SeCretoGranin 2 (SCG2), Human Epidermal Growth factor receptor 3 (HER3), and methylation patterns as relevant for subtype classification. Drug screening recapitulated known therapeutic responses and highlighted actionable resistance mechanisms, including differential sensitivity to androgen receptor pathway inhibitors, taxanes, poly(adenosine diphosphate-ribose)-polymerase inhibitors, and PI3K/AKT-targeted therapies. However, the lack of microenvironment components and the time-intensive nature of organoid establishment remain key limitations. Prostate cancer 3D models offer a relevant, patient-specific platform to study tumor biology, predict drug responses, and identify novel biomarkers. While standardization and scalability challenges persist, organoids have a strong potential for integration into precision oncology pipelines.
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Urolithiasis is increasingly common, with rising rates driven by obesity, diabetes and metabolic syndrome. Patients with cancer have additional, unique risks of stone formation owing to effects on fluid and electrolyte balance, systemic cancer therapies, tumour lysis syndrome and anatomical alterations after urinary diversion or nephrectomy. Moreover, urolithiasis itself has been linked to increased rates of renal cell carcinoma, urothelial carcinoma and bladder cancer, potentially mediated by chronic inflammation, recurrent infections and shared metabolic or environmental factors. Management in this setting is complex and must be individualized. Percutaneous nephrolithotomy achieves the highest stone-free rates in patients with altered urinary tract anatomy, whereas retrograde intrarenal surgery and shock wave lithotripsy have more selective roles. Preventive strategies focus on thorough metabolic evaluation, hydration optimization and addressing cancer-specific risk factors such as hypercalcaemia, acidosis and chronic urinary stasis. Despite these insights, data on the epidemiology, mechanistic underpinnings and optimal management of urolithiasis in patients with cancer remain limited. Prospective studies are needed to clarify causal relationships, refine preventive strategies and develop evidence-based treatment algorithms for this growing and complex population.
Androgen signalling is the primary driver of male sexual differentiation in mammals, directing masculinization during a crucial fetal window. In male fetuses, high levels of fetal androgens, mainly from the testes, promote male reproductive tract development through androgen receptor activation, whereas low levels of androgens in female fetuses enable the development along the female pathway. This androgen-centric view of reproductive development has long dominated the field, casting oestrogens as passive bystanders. However, both historical and emerging evidence challenges this narrative, pointing to an active role of oestrogens in shaping reproductive development through complex, tissue-specific interactions with androgen pathways. Oestrogen receptors are expressed in developing reproductive tissues of both sexes, and disruptions in oestrogen signalling - shown in genetic and pharmacological models - can lead to reproductive abnormalities. Oestrogens might counteract androgen action at the tissue level and modulate androgen receptor expression, independently of effects on androgen production. Moreover, combined exposure to anti-androgens and oestrogenic compounds can amplify developmental disruptions, underscoring the importance of hormonal crosstalk. These findings question the adequacy of an androgen-only model, especially when assessing endocrine disruptors. Understanding the role of oestrogens is essential for interpreting normal development and chemical risks. Reproductive differentiation seems to depend on the integrated balance between androgen and oestrogen pathways, rather than on isolated signals.
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