To understand patterns in private equity (PE) acquisition of urology practices based on the Social Vulnerability Index (SVI), a composite, area-level measurement reflecting the following themes: socioeconomic status, household characteristics, racial & ethnic minority status, and housing & transportation type. We identified PE-owned urology practices by cross-referencing multiple sources. We linked the SVI for census tracts with and surrounding a PE practice (census places). We used multilevel, multivariable logistic regression to predict the probability of PE acquisition for a census tract within a census place based on SVI and its separate themes, adjusted for urban/non-urban designation and physician office density. We identified 349 census tracts containing at least one PE practice and 11,868 census tracts in the same census places with no PE practices. There was no statistically significant association between the composite SVI measurement and PE acquisition (False Discovery Rate (FDR)-adjusted p=0.390). In exploratory analysis, we found that census tracts with lower socioeconomic status and more racial and ethnic minorities were associated with a significantly lower probability of PE acquisition, although to only a small degree (FDR-adjusted p=0.003 and p=0.002, respectively). Composite social vulnerability index was not associated with PE acquisition of urology practices.
Background/objectives: Botulinum toxin is widely used across medical specialties, with expanding indications in neurology, pain management, urology, and aesthetic medicine. Highly cited publications can reflect influential evidence and clinical priorities within healthcare. This study aimed to identify and characterize highly cited research on botulinum toxin as indicators of influential evidence within the field, with a focus on clinical trends, collaboration patterns, and healthcare-relevant applications. Methods: A bibliometric analysis was conducted using the Science Citation Index Expanded (SCI-EXPANDED) within the Web of Science Core Collection. Publications from 1991 to 2022 with ≥100 citations (TC2024 ≥ 100) were included. Data on publication characteristics, authorship, institutional and country contributions, and citation impact were extracted. Bibliometric indicators, including total publications, citations per publication, and the Y-index, were applied. Keyword and title analyses were used to identify major research themes. Results: A total of 643 highly cited articles were identified, with 118,175 citations. The United States was the leading contributor, and industry-linked research, particularly from Allergan, demonstrated high citation impact. Five major clinical themes emerged: spasticity management, dystonia and movement disorders, chronic pain, urinary disorders, and cosmetic applications. Highly cited research was predominantly produced through collaborative teams, most commonly involving two to six authors, and international collaborations were associated with higher citation impact. Conclusions: Highly cited botulinum toxin research may partially reflect evolving clinical demand and interdisciplinary use across healthcare fields. The prominence of collaborative and industry-linked research highlights the role of translational and practice-driven innovation. These findings provide insight into influential evidence and may support future research prioritization, interdisciplinary collaboration, and evidence-based decision-making in clinical and healthcare contexts.
Robot-assisted surgery has become an important component of modern urologic practice, and the emergence of alternative robotic platforms has accelerated platform diversification beyond the conventional da Vinci multiport ecosystem. However, the global research landscape and evidence evolution of emerging robotic platforms in urology remain incompletely characterized. Publications related to emerging robotic platforms in urology were retrieved from the Web of Science Core Collection from inception to May 15, 2026. After screening, 264 articles and reviews were included. CiteSpace and bibliometrix were used to analyze publication trends, geographic and institutional contributions, collaboration networks, co-cited references, journals, keyword evolution, burst terms, and thematic structure. Annual output remained limited before 2021 but increased rapidly thereafter, reaching the highest levels in 2024 and 2025. Italy, China, and Japan were the most productive countries, whereas the United States showed the highest betweenness centrality in the country collaboration network. Research activity was concentrated in several high-volume institutions, including Catholic University of the Sacred Heart, IRCCS Policlinico Gemelli, Kobe University, and Peking University. Co-cited references were mainly published after 2022, indicating a recently formed and rapidly evolving knowledge base. Keyword analyses showed that current research is centered on robotic surgery, radical prostatectomy, prostate cancer, outcomes, complications, Hugo RAS, learning curve, and partial nephrectomy. The evidence structure was uneven across procedures: robot-assisted radical prostatectomy represented the most mature application area, whereas partial nephrectomy, cystectomy, adrenalectomy, pyeloplasty, and reconstructive procedures remained largely supported by feasibility studies or early clinical cohorts. Emerging topics such as artificial intelligence, telesurgery, and virtual reality appeared as niche themes, suggesting future directions for digitally integrated robotic surgery. Overall, research on emerging robotic platforms in urology is transitioning from early feasibility reporting toward outcome assessment and platform-specific comparison, but multicenter validation, long-term follow-up, learning-curve assessment, and cost-effectiveness evidence remain insufficient.
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.
Laser treatment is rapidly becoming a staple of hypertrophic scar management, but literature reviews have identified significant heterogeneity in laser protocols. Mapping laser operative practices can help to share clinical expertise and identify new research directions. A questionnaire to characterize laser treatment techniques for hypertrophic scars was conducted. The questionnaire was developed with a multidisciplinary team of burns clinicians and researchers and translated into Spanish, Chinese and German. It was distributed internationally to burns clinicians between December 2021 and June 2023. Forty-three clinicians participated in the questionnaire. Respondents used laser to treat both immature (n = 36, 84%) and mature (n = 42, 98%) scars, with varying approaches to how soon therapy should commence post-injury, and how frequently it should be repeated. Almost all respondents used CO2 fractional ablative laser (n = 41, 95%) for scar treatment, one-third used pulsed dye laser (n = 14, 33%), and approximately one-half reported using more than one laser during a single procedure (n = 21, 49%). Respondents used scar thickness to assist with setting laser parameters (n = 29, 67%), chiefly determining this by estimation (n = 25, 58%). 60% of respondents performed scar reconstruction (n = 26), and 91% (n = 39) used adjunct therapies, such as corticosteroids, concurrently with laser treatment. Choices of anesthetic, analgesia and dressings varied widely. While there are similarities in the broad aspects of how burns clinicians use laser to treat hypertrophic scars, there are several differences in practice. These variations highlight potential research directions to optimize patient outcomes from this treatment modality.
The global population is aging rapidly, and the number of older adults with cancer is increasing worldwide. However, evidence supporting optimal pharmacotherapy for this population remains limited because older adults are frequently underrepresented in clinical trials. Therefore, we aimed to develop evidence-based clinical practice guidelines for pharmacotherapy in older adults with cancer. The Japanese Society of Medical Oncology and the Japanese Society of Clinical Oncology developed the second edition of the Clinical Practice Guidelines for Pharmacotherapy in Older Adults with Cancer in accordance with the Minds 2020 methodology, incorporating systematic reviews, the Evidence-to-Decision framework, and multidisciplinary consensus processes. The guideline addressed 17 clinical questions across hematologic and major solid tumors within a cross-organ framework. Most recommendations were classified as conditional because of the limited availability of high-quality evidence specific to older adults and the need to consider the balance between benefits and harms, patient values and preferences, treatment burden, and resource use. Only one recommendation was classified as strong. The guidelines emphasize individualized treatment approaches integrating patient characteristics, including functional status, comorbidities, life expectancy, and patient preferences, rather than relying solely on chronological age. These guidelines provide a cross-organ, pharmacotherapy-focused framework for managing older adults with cancer. Developed in the most rapidly aging society, they provide clinically relevant insights and evidence-based recommendations for oncology practice and highlight the importance of integrating geriatric principles into treatment decision-making. They also underscore the urgent need for clinical trials targeting older adults to strengthen the evidence base in geriatric oncology.
Effective communication is a core competency in healthcare, yet traditional training methods often face limitations in realism, scalability, and learner engagement. This study evaluated the perceptions of healthcare professionals regarding the use of artificial intelligence (AI)-enhanced virtual reality (VR) simulations for communication skills training in urology. A total of 45 healthcare professionals (N = 45) participated in a haematuria role-play simulation using AI-enhanced VR via Bodyswaps© software. Participants completed pre- and post-simulation questionnaires using a standard five-point Likert scale to measure perceptions of the potential of AI-VR to improve communication skills, usefulness, agreement with AI-generated feedback, realism compared to clinical practice, and overall enjoyability. Although Likert-scale responses are ordinal, they were treated as approximately interval data for statistical analysis. Descriptive statistics and one-sample t-tests against the neutral midpoint (3.0) were conducted to assess whether participant perceptions differed significantly from neutrality, with significance set at α = 0.05. Prior to the simulation, participants (n = 23, 51.11%) reported belief in the potential of AI-VR to improve communication skills by responding above the neutral midpoint (M = 3.844 ± 0.9034). Post-simulation, participants (n = 40, 88.89%) showed increased perceptions of usefulness (M = 4.636 ± 0.6851). High levels of agreement with AI-generated feedback were reported by participants (n = 35, 77.78%) (M = 4.2 ± 0.9195), and participants (n = 40, 88.89%) rated the simulation as useful (M = 4.5 ± 0.6949). Regarding realism, participants (n = 34, 73.33%) rated the simulation positively (M = 4.159 ± 0.9135), and participants (n = 41, 91.11%) found the experience enjoyable (M = 4.465 ± 0.8549). All results reached statistical significance (p < 0.0001). The findings suggest that AI-enhanced VR simulations have potential as effective and engaging tools for communication skills training in urology. The positive responses across all measured domains support further integration of immersive AI technologies into clinical education.
Penile cancer (PeCa) is a rare malignancy with substantial global variation in clinical presentation, staging practices and treatment approaches. This scoping review synthesises current evidence across key domains of PeCa management, including tumour classification, human papillomavirus (HPV) integration, organ preservation, nodal staging, systemic therapy and survivorship care. Despite recent updates in the American Joint Committee on Cancer staging system, limitations persist, particularly the absence of biologically relevant factors such as HPV status. While HPV-associated tumours may exhibit different responses to radiotherapy and systemic treatments, routine HPV testing and serotyping are not yet standardised in clinical practice. Early-stage PeCa remains amenable to organ-sparing approaches-including brachytherapy and reconstructive surgery-yet access to these modalities varies widely. Nodal management remains an area of controversy, with global inconsistencies in surgical templates and staging algorithms. Dynamic sentinel lymph node biopsy is emerging as a minimally invasive alternative but remains underused outside of high-volume centres. For node-positive disease, there is growing support for treatment intensification with chemotherapy and radiotherapy; however, prospective evidence is limited. Survivorship issues, particularly regarding psychosocial support and functional outcomes, remain poorly addressed in both research and routine care. This review identifies persistent gaps in the literature and highlights the need for international consensus-building, longitudinal data collection and equitable access to multidisciplinary care through collaborative efforts.
Teaching postoperative follow-up for renal cell carcinoma (RCC) is challenging during brief urology rotations. We evaluated a structured module based on a simplified risk model (IMDB: venous invasion, tumor size ≥ 7 cm, systemic symptoms, renal sinus fat invasion) to improve residents' knowledge and clinical decision-making. Forty residents who completed the 8-10 h module (2022-2025) were enrolled in this retrospective pre-post study. The module used a Postoperative Health Management Passport integrating lectures, simulations, outpatient practice, and debriefing. Knowledge was assessed by validated questionnaire (pre/post). Decision-making was scored on follow-up card assignments (0-15). Satisfaction was measured by 5-point Likert scale. Knowledge scores increased from 65.75 ± 5.13 to 90.88 ± 4.92 (mean gain 25.13 ± 4.00; t = 39.71, P < 0.0001). Decision-making scores: IMDB accuracy 4.52 ± 0.64, plan rationality 4.19 ± 0.65, patient education 3.93 ± 0.81. Inter-rater reliability was excellent (ICC = 0.97), pass rate 92.5% (37/40). Satisfaction was 96.1%; 100% would recommend the module. Knowledge gain did not correlate with decision-making scores (all r ≤ 0.07, P > 0.05). Second-year residents improved most (27.00 ± 4.14 points, F = 4.307, P = 0.0208). The IMDB-based module effectively enhanced residents' knowledge and decision-making. However, because the decision-making assessment showed near-ceiling performance, the absence of a significant correlation between knowledge gain and decision-making scores should be interpreted with caution; a more sensitive assessment instrument is needed to meaningfully examine this relationship in future studies. The "learn-practice-reflect" framework offers a reproducible model for integrating clinical tools into residency training.
Delayed graft function (DGF) is a commonly reported outcome in kidney transplantation research, but no single definition has been uniformly adopted. Variation in how DGF is defined, measured, and analysed may limit evidence synthesis, and affect trial design. We conducted a scoping review to map contemporary DGF outcome reporting practices in adult kidney transplantation. We conducted a scoping review using the Arksey and O'Malley framework, reported in accordance with PRISMA-ScR. MEDLINE and Embase were searched for English-language studies published from 1 January 2009 onwards. Eligible adult kidney transplant studies reported DGF as an outcome and explicitly defined it. Data were charted on study characteristics, definition type, timing, aggregation, justification, and analysis. Because some studies reported more than one definition, the unit of analysis was the individual DGF definition. 261 included sources yielded 305 DGF definitions, with 88 definitional variants across 5 main definitional families. 60 full-text records were excluded because they used DGF as an outcome without definition. Dialysis-within-7-days predominated, which accounted for 44% of definitions. Alternative dialysis-based definitions accounted for 18%, duration- or severity-stratified definitions for 21%, creatinine-based definitions for 9%, and composite clinical definitions for 9%. The first post-transplant week was the dominant time frame. Most definitions were binary (98%). Justification for authors' chosen definition was absent in 41%. Contemporary DGF reporting is dominated by binary dialysis-based definitions despite the biological and clinical heterogeneity of DGF. A standardised research endpoint designed according to a novel framework may improve validity, comparability, and future trial design.
This study aims to assess how Primary Care Physicians (PCPs) in Portugal currently approach opportunistic prostate cancer (PCa) screening using Prostate Specific Antigen (PSA) testing, and to explore variations in both screening and shared decision-making (SDM) practices. An electronic survey was distributed in 25 Health Centers in Portugal between June 2024 and June 2025. The questionnaire assessed respondents' demographic and practice characteristics, PSA screening criteria and frequency, implementation of SDM, knowledge and use of decision aids, and urology referral patterns. Associations between provider characteristics and screening practices were analyzed using Pearson chi-square or Fisher's exact tests. A total of 107 PCPs participated in the study, the majority being female (81.3%) and under 40 years old (72.9%). Those with less than 10 years of experience were more likely to adjust PSA testing frequency based on initial PSA levels, especially for men aged 50-59 (p = 0.015) and 60-74 (p = 0.004). Routine screening of younger men or those over 75 was uncommon unless specific clinical factors were present. National guidelines were the primary influence on clinical practice (75.7%), particularly among less experienced physicians (p = 0.027). In terms of SDM, most PCPs explained PSA testing (80.4%), but only 64.5% consistently discussed its benefits and risks or explored patient preferences, with those in the South region of Portugal more likely to do so (p = 0.012 and p = 0.002 respectively) than those in the North/Centre. Decision aid awareness and use were low; only 6.5% reported having used them, while 72% were unfamiliar with these tools. Most referrals to urology were triggered by abnormal transrectal ultrasound findings (72%) rather than elevated PSA alone (16.8%). Full support for population-based PCa screening was limited (12.2%), and male physicians were significantly more likely to endorse it (p = 0.007). PCa screening practices among Portuguese PCPs remain a complex area of primary care, characterized by variability in clinical approaches, inconsistent guideline adherence, and limited application of SDM. Despite general awareness, notable gaps persist in the use of decision aids and evidence-based referral criteria. These results highlight the need for clearer national guidance and greater support for individualized, patient-centered screening strategies. not applicable.
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Penile curvature due to Peyronie's disease (PD) or congenital penile curvature (CPC) may impair sexual function and quality of life. We aimed to evaluate effectiveness, safety, and patient satisfaction after corporoplasty at a tertiary referral center. We retrospectively analyzed 324 men undergoing corporoplasty between 2020 and 2025. Patients were stratified according to curvature etiology (PD vs. CPC) and surgical technique (16-dot plication, Yachia, modified Nesbit, Surgisis grafting). Curvature severity was assessed during pharmacologically induced erection and classified as mild (< 30°), moderate (30-60°), or severe (> 60°). Outcomes assessed at 6-48 months included postoperative erectile function (IIEF-5), Global Assessment Questionnaire (GAQ-1/GAQ-2), satisfaction, complications, side effects, anesthesia type, and operative setting. 274 (84.6%) had PD and 50 (15.4%) CPC. Moderate curvature was present in 217 (67%) patients and severe curvature in 100 (31%). Local anesthesia was used in 256 (79%) cases, and 253 (78.1%) procedures were ambulatory. Overall, 181 (56%) patients reported normal postoperative erectile function, 211 (65%) improved sexual quality of life, and 249 (77%) satisfaction with surgery. Descriptively, CPC patients showed higher rates of preserved postoperative erectile function than PD patients (47 [94%] vs. 137 [50%]). Complete straightening was achieved in 298 (92%) patients, while re-curvature occurred in 26 (8%). Complications developed in 67 (20.7%) patients and side effects in 89 (27.5%), penile shortening being the most common. Corporoplasty provided high anatomical success and favorable patient satisfaction in both PD and CPC. CPC patients showed descriptively more favorable functional and satisfaction outcomes, while penile shortening and re-curvature represented the main determinants of dissatisfaction.
Patient-reported outcome measures (PROMs) are commonly used to monitor lower urinary tract symptoms attributed to benign prostatic hyperplasia (LUTS/BPH). However, there is limited evidence on patients' perspectives on integrating PROMs into clinical practice and on best practices to improve their implementation to better meet patient needs. The aim of this study is to explore patients' experiences completing PROMs during routine BPH management, and to develop patient-informed strategies for PROM implementation in urologic care. Virtual semi-structured telephone interviews were conducted with English-speaking patients aged 50 years or older with BPH who attended outpatient urology clinics between May and October 2025. Patients were purposively sampled based on the type of treatment received (medical or surgical). Interview data were analyzed using interpretive description. Themes were synthesized inductively, and practical implementation strategies were developed from participants' suggestions. Twenty patients participated (12 received medical treatment and 8 received surgical treatment). Four themes emerged regarding patient perspectives on PROM use in routine care: (1) Perceived benefits-patients viewed PROMs as valuable tools for tracking symptom progression, prompting self-reflection, and facilitating communication among the clinical care team; (2) Questionnaire content-patients questioned the relevance of specific domains, particularly the non-specificity of the PROMIS pain scales as well as mental health, and sexual health items; (3) Perceived barriers-participants criticized the excessive volume of questionnaires; and (4) Considerations for PROM Integration-participants emphasized the importance of visible follow-up actions based on PROM results. Practical recommendations for PROM integration in routine clinical practice included: (1) enhancing patient understanding of PROMs by providing a brief rationale prior to survey administration; (2) implementing a patient-preference PROM workflow in the electronic health record (EHR); and (3) providing tangible actions based on PROM results, such as summarizing scores in plain language and incorporating results into discussions during visits. This study provides patient-informed insights into the implementation of a broad PROM battery in LUTS/BPH care. Participants emphasized that PROMs are more acceptable when their purpose is clearly explained and when responses are visibly discussed or acted upon in care. Future research should examine how these patient-informed strategies can be operationalized within clinical workflows and integrated with clinician, administrator, and EHR perspectives to support sustainable PROM use in routine practice.
The practice of living donor kidney transplantation has evolved through innovations in logistics, technology, and clinical practice. In the United States, Good Samaritan donation, a historical label exclusive to nondirected donors, now incorporates voucher-based models. To determine how voucher-based nondirected living kidney donation has influenced the volume and practice of Good Samaritan living kidney donation in the United States, we analyzed living donor kidney transplants from 2000 to 2024 using data from the National Kidney Registry (103 transplant centers) and the Scientific Registry of Transplant Recipients. Temporal trends were derived by linear regression. We identified 4662 Good Samaritan living donor kidney transplants, defined as historical nondirected and novel voucher-based nondirected donations. Of 2131 Good Samaritan living donor kidney transplants facilitated by the National Kidney Registry, donors had a median age of 43 y, were predominantly of White race (93%), and were women (60%). Recipients had a median age of 52 y and were racially and ethnically diverse (63% White, 14% Black, and 10% Hispanic). Annual Good Samaritan donation counts in the United States increased from 17 in 2000 to 439 in 2024, corresponding to a growth rate of 14.5%. Voucher-based nondirected donations increased from 2 in 2015 to 314 in 2024, comprising 72% of all Good Samaritan donations in that year. The advent of voucher-based nondirected donation correlated with growth in Good Samaritan donation volume. Given the prevalence of voucher-based donations, connecting local kidney paired donation practices to voucher-based nondirected donation may improve access to and participation in living kidney donation.
Pediatric urinary tract infections (UTIs) significantly affect children's health and quality of life. Health education plays a key role in improving parental health literacy, treatment adherence, and recurrence prevention. This study aimed to systematically synthesize the best available evidence on health education for the prevention and management of pediatric UTIs to serve as a reference for clinical practice. Following the "6S" evidence resource model, an evidence search was conducted in a top-down manner across the following sources: BMJ Best Practice, UpToDate, National Institute for Health and Care Excellence (NICE), Guidelines International Network (GIN), National Guideline Clearinghouse (NGC), Registered Nurses' Association of Ontario (RNAO), Canadian Medical Association (CMA), New Zealand Ministry of Health Guidance Library, MedLive, American Academy of Pediatrics (AAP), European Association of Urology (EAU), Cochrane Library, EMbase, Ovid MEDLINE, PubMed, Web of Science, CINAHL, China National Knowledge Infrastructure (CNKI), Wanfang Data, VIP, and SinoMed. The search period covered from database inception to October 31, 2025. Two reviewers independently screened and evaluated the retrieved literature. Evidence was extracted and summarized according to the JBI evidence grading and recommendation system. A total of 14 publications were finally included: 4 clinical decisions, 5 guidelines, 1 evidence summary, 3 expert consensuses, and 1 systematic review. Through evidence synthesis and integration, 42 best-evidence statements were developed across eight domains: disease awareness, symptom recognition, diagnosis and evaluation, urine specimen collection, imaging examinations, treatment and medication, recurrence prevention, and follow-up instructions. This best-evidence summary comprehensively synthesizes evidence-based health education for pediatric urinary tract infections. The rigorous methodology and broad content coverage provide valuable scientific guidance for healthcare professionals involved in UTI health education.
The objective of this study is to characterize contemporary international practice in pediatric gastrostomy insertion and perioperative management. A cross-sectional electronic survey was developed by the European Pediatric Surgeons' Association (EUPSA) Network Office and distributed through the EUPSA network between June 2024 and January 2025. The survey contained 32 primary questions and addressed multiple aspects of the perioperative gastrostomy pathway. Responses were analyzed descriptively. Categorical variables were compared using chi-square or Fisher's exact tests, and continuous variables using the Mann-Whitney U test. Comparisons were performed between European and non-European, and high- and low-/middle-income settings. A two-sided p-value < 0.05 was considered statistically significant. A total of 181 pediatric surgical respondents from 132 cities across 59 countries were included. Of these, 117/181 (64.6%) completed the survey in full. Preferred primary gastrostomy insertion technique varied, with percutaneous endoscopic gastrostomy without laparoscopy preferred most frequently (59/137, 43.1%). Open gastrostomy was reported more frequently in low- and middle-income than high-income settings (11/35, 31.4% vs. 3/102, 2.9%; p < 0.001) and in non-European than European settings (12/45, 26.7% vs. 2/92, 2.2%; p < 0.001). Reported timing of postoperative gastrostomy use varied substantially; enteral feeding was initiated earlier in European than non-European settings and in high-income than low- and middle-income settings (median 8 vs. 24 hours for both comparisons; p < 0.001 for both). Pediatric gastrostomy practice varies substantially across the perioperative pathway, with important differences across geographic and economic settings. These findings highlight persistent uncertainty in key aspects of care and support the need for prospective outcome-based research, prioritization of key areas, and consensus development.
Male urethral hemangioma is an exceedingly rare benign vascular tumor, research remains limited globally, and clinical research for it's long-term prognosis is scarce. This study aimed to investigate the procedural safety and long-term outcomes of male patients undergoing transurethral hemostasis/electrocautery for urethral hemangioma. Data from male patients with urethral hemangioma who had undergone transurethral hemostasis/electrocautery at two hospitals from July 2018 to December 2023 were retrospectively analyzed. In total, twenty-nine patients with urethral hemangioma met our inclusion and exclusion criteria. Twenty-nine patients underwent surgery, of whom 16 (55.2%) underwent transurethral hemostasis, and 13 (44.8%) underwent transurethral electrocautery. All procedures were conducted successfully without intensive care unit (ICU) admission. The median procedural time was 20.0 [10.0-37.5] minutes. No intraoperative complications were detected. There was no report of unplanned re-catheterization or any documented postoperative complications, including urethral stricture, urinary incontinence, retrograde ejaculation, urethral bleeding, gross hematuria, or ejaculatory pain. After a median follow-up length of 50.0 months [interquartile range (IQR), 35.0-75.5 months], there were no cases of disease recurrence. Furthermore, no long-term complications were recorded during the surveillance period, including urinary incontinence, retrograde ejaculation, urethral bleeding, ejaculatory pain, urethral stricture, or hematuria. All patients remained symptom-free at their last follow-up evaluation. This study indicated that transurethral hemostasis/electrocautery offers high long-term stability and minor complications for male urethral hemangioma, representing a safe and effective treatment option. Clinical practice should enhance awareness of this condition, improve early diagnosis rates, and individualize surgical approach selection to optimize the outcomes and quality of life of patients.
Nontechnical skills (NTS), such as communication, leadership, and situational awareness, are essential for ensuring surgical safety. However, they are often prioritized less than technical skills. This narrative review summarizes recent technological progress in teaching and evaluating NTS in urology, emphasising the use of simulation, robotic-specific frameworks, and artificial intelligence. Validated assessment tools such as NoTSUS and ICARS have been developed to provide objective measures of NTS, particularly to address communication difficulties in the robotic console setting. Recent research indicates that technical seniority does not necessarily correlate with NTS mastery, but the use of distributed and hybrid simulation significantly enhances trainee outcomes. Additionally, the adoption of large language models (LLMs) and machine learning is enabling automated tone and emotion analysis, giving trainees detailed, unbiased feedback. New virtual patient platforms like SimConverse and SimURO provide affordable and psychologically safe environments for repeated NTS practice. The rapid advancement in urological surgery, marked by increasing use of robotics and greater physical separation from patients, calls for a structured approach to NTS training. Breakthroughs in AI and immersive simulation are shifting NTS from a vague 'soft skill' to a concrete, data-driven, measurable skill. To achieve the best patient results, these digital technologies should be deliberately incorporated into urological education as vital additions to standard technical instruction and mentorship.
Renal cell carcinoma (RCC) is a predominant malignancy of the urinary system, with clear cell renal cell carcinoma (ccRCC) representing 75-85% of clinical cases. Since the early stages are often asymptomatic, nearly 30% of patients present with metastases at diagnosis, which significantly complicates the prognosis. The diverse mechanisms and clinical indications of current strategies, despite recent breakthroughs in immunotherapy, pose a major challenge for systematic application. This review employs the cancer-immunity cycle as a framework to evaluate four critical steps: antigen presentation, T-cell activation, reversal of exhaustion, and immune evasion in the tumor microenvironment. We introduce the major immunotherapy strategies in RCC in this cycle and summarize their clinical position. Combining immune checkpoint inhibitors (ICIs) with tyrosine kinase inhibitors (TKI) has redefined the first-line standard for advanced RCC by addressing both T-cell infiltration barriers and functional suppression. Standalone approaches such as tumor vaccines and cytokines in contrast have shown limited efficacy in advanced settings. In this context, we further propose emerging research directions, such as individualized immunotherapy and multi-target blockade, and point out the relevant biomarkers, offering an integrated perspective of the RCC immune landscape and providing insights for both clinical practice and future research.