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Tension-band wiring with Kirschner wires (TBW) is a common surgical technique for olecranon fractures (OFs), but has limitations like implant removal and soft tissue irritation. Tension-band high-strength suture with absorbable screw (TBSAS) technique can effectively solve these issues. This study aims to demonstrate the biomechanical stability and clinical efficacy of the TBSASC technique for treating OFs (Mayo IIA) (AO 21-B1.1). Four finite element models for OFs (Mayo IIA) compared fixation constructs: TBW with cortical penetration (TBWC), TBW with intramedullary fixation (TBWM), TBSAS with cortical penetration (TBSASC), and TBSAS with intramedullary fixation (TBSASM). Displacement and stress distributions were analyzed under various loading conditions. Corresponding 3D-printed physical models tested static tensile strength, fatigue resistance, and torsional stability. Clinically, 13 patients with OFs (Mayo IIA) treated with TBSASC between April 2023 and April 2025 were prospectively followed. Operative data, complications, fracture healing, range of motion, VAS pain score, and MEPS were recorded to assess safety and efficacy. Finite element analysis (FEA) showed the TBSASC group achieved mean fracture displacements slightly inferior but without statistical significance to the gold-standard TBWC group (max 0.192 mm vs. 0.178 mm, p > 0.05). TBSASC significantly reduced stress on both implants (max 79.99 MPa) and bone (85.80 MPa) compared to TBWC (464.82 MPa and 137.54 MPa, respectively). Biomechanically, TBSASC withstood physiological loads without failure, with its ultimate load, fatigue, and torsional resistance slightly inferior but without statistical significance to TBWC (p > 0.05). Clinically, 13 patients treated with TBSASC were followed for a mean of 14.7 months. Mean operative time was 66.1 min. Fractures healed by 7.1 weeks. Pain (VAS) decreased from 6.0 at 1 month to 0.15 at 6 months, and elbow function (MEPS) improved from 79.2 to 95.8 over 12 months, with 76.9% of patients very satisfied. No complications occurred. The TBSASC technique demonstrates acceptable preliminary safety and feasibility for OFs (Mayo IIA), providing sufficient stability for fracture fixation and early functional exercise, effectively reducing complications associated with metal implants and trauma from secondary removal surgery, suggesting its potential as a promising alternative that warrants further investigation in larger, prospective comparative studies.

Conventional strategies for tendon-bone interface (TBI) repair primarily focus on structural healing, often overlooking the essential processes of neural regeneration and proprioceptive recovery required for functional restoration. This review aims to explore the potential of biodegradable magnesium (Mg) alloys and the released magnesium ions (Mg2 +) in establishing a "Mg2 +-Stem Cell-Nerve" axis as a novel strategic foundation for achieving neurotized regeneration at the TBI. This review provides a narrative synthesis of the existing literature on the roles of Mg2 + in regulating stem cell functions and promoting neural regeneration. A multidimensional perspective integrating "immunity-metabolism-nerve" interactions was adopted to dissect the underlying synergistic molecular mechanisms. Furthermore, the design of intelligent Mg-based implants predicated on this theory was discussed. Analysis of the existing evidence suggests that Mg2 + may act as a pivotal bioactive signal, independently and synergistically regulating stem cell behavior and neural regeneration processes, thereby supporting the proposal of a conceptual "Mg2 +-Stem Cell-Nerve" axis. This proposed axis could theoretically synchronize structural repair and neural re-innervation of the TBI. Based on this mechanism, the design of intelligent Mg-based implants demonstrates significant potential for achieving spatiotemporally precise modulation. Biodegradable Mg alloys, through the proposed "Mg2 +-Stem Cell-Nerve" axis, offer a promising paradigm for advancing TBI healing from structural integration toward neurotized functional regeneration. However, clinical translation remains at an early stage, requiring further validation in large-animal models, resolution of degradation control challenges, and rigorous long-term safety and efficacy evaluation. Although the proposed "Mg2 +-Stem Cell-Nerve" axis provides a novel integrative framework, it is important to note that its full sequential and closed-loop operation currently remains a working hypothesis derived from synthesizing fragmented pairwise evidence from disparate model systems, rather than a fully established pathway directly validated in the TBI microenvironment.

Objectives: Titanium plates may offer advantages in fracture healing, yet concerns remain regarding hardware removal due to risks such as screw stripping and cold welding. Whether titanium removal is more difficult than stainless steel remains uncertain. This study compared the ease of implant removal, focusing on distal femur fractures treated with titanium versus stainless-steel plates. We conducted a retrospective cohort study of patients with distal femur fractures who underwent implant removal after fixation with either stainless-steel or titanium plates. The primary outcome was difficulty of removal, including cold welding, screw stripping, hardware breakage, and use of advanced tools (screw removal set, trephine, burr). The secondary outcome was operative duration. Seventy-two patients were included: 31 stainless steel and 41 titanium. Mean in-vivo implant time was 421 ± 498 days for stainless steel and 360 ± 409 days for titanium (P = 0.57). Difficulties with removal occurred in 13% of stainless-steel cases and 12% of titanium cases (P = 0.92). Screw removal sets were required in 9.7% and 9.8% of patients, respectively (P = 0.99). Advanced extraction tools were used in 3 patients per group (P = 0.72). Cold-welded or stripped screws occurred in 2 patients in each group (P = 0.77). Mean operative time was 155 ± 80 minutes for stainless steel versus 118 ± 67 minutes for titanium (P = 0.06). In distal femur fractures, titanium plate removal is not associated with increased technical difficulty compared with stainless steel implants.

Angiosarcoma is a rare, aggressive malignancy that accounts for less than 1% of sarcomas of bone. Epithelioid angiosarcoma, a subtype, is characterized by pleomorphic cells with vascular differentiation and commonly arises in deep soft tissues of the extremities. Angiosarcoma associated with orthopedic implants or retained foreign bodies, such as ballistic debris, is exceedingly rare. Here, the authors present the case of epithelioid angiosarcoma in a 54-year-old male with a history of a prior proximal femur ballistic injury and intramedullary nail fixation who was initially misdiagnosed with chronic osteomyelitis.

Cochlear implants (CIs) restore hearing in individuals with severe sensorineural hearing loss. In recent years, electrically evoked auditory steady-state responses (EASSRs) to amplitude modulated (AM) signals have been studied as an objective measure. EASSRs can be objectively detected in electroencephalography (EEG) recordings at the modulation frequency using statistical tests. However, the presence of electrical stimulation artifacts from the CI itself hinders the EASSR detection. Whereas previous research has focused on an experimental characterization of these artifacts, this study presents a theoretical analysis of the stimulation signal together with an experimental analysis of the resulting artifacts to characterize their properties, origins and the effects of system nonlinearities. A stimulation signal model is presented and analyzed. The effects of pulse asymmetry and nonlinearity are examined. The theoretical statements are experimentally validated using an experimental setup containing a head phantom. The analysis shows that the stimulation artifact at the modulation frequency is inherent to the stimulation signal, even in the absence of system nonlinearities. Moreover, when the pulse asymmetry is taken into account, second and higher order polynomial nonlinearities are found to contribute negligibly to the spectral component at the modulation frequency. The experimental analyses indicate the proposed signal model is a more accurate model for the stimulation signal and the resulting stimulation artifact at the modulation frequency. The model may form an important step in determining artifact contamination in EEG recordings of EASSRs and other envelope-following responses in CI recipients, enabling improved response detection.

For more than half a century, mice have been the workhorse of biomedical research. Their small size, rapid reproduction, and well-characterized genetics make them ideal disease models, and genome editing has enabled transgenic, knock-out, and knock-in lines that mimic numerous human conditions. These advances transformed modern biology, yielding fundamental insights into cancer, metabolism, immunity, and more. Their strengths notwithstanding, mouse models have important limitations, as biology does not scale neatly across species. Differences in physiology, size, and metabolism can obscure-or even distort-experimental outcomes. Nowhere is this clearer than in musculoskeletal research. Human bones are dynamic tissues that undergo Haversian remodeling, whereas mice exhibit limited Haversian remodeling and display distinct temporal growth trajectories. Moreover, mice have monophyodont dentition and craniofacial development diverges in ways that impact maxillofacial studies, and aging timelines differ. These differences limit our ability to understand human bone disorders from murine models alone. Biotechnology offers a new path forward: advances in genome sequencing, assembly and molecular engineering enable precise DNA editing in larger domesticated species-sheep, goats, and pigs-whose skeletal size, biomechanics, growth patterns, and remodeling dynamics more closely mirror humans. By introducing targeted, patient-relevant mutations, large-animal models can replicate mechanisms difficult to capture in mice and support longitudinal, clinically-relevant phenotyping-imaging, histomorphometry, serum biomarkers, and functional testing-in a translatable human-like context. The implications are profound. Large-animal models can validate disease pathways, refine biomarkers, and evaluate drugs, biologics, and implants, potentially improving treatment strategies and reducing clinical failures and costs. This shift does not diminish the value of mice, whose genetic tractability and cost-effectiveness ensure a central and continued important role in discovery. Rather, it adds a complementary strategy: expand to gene-edited large-animal models when human skeletal-like biology matters and where mice fall short, thereby bridging the gap between fundamental research and clinical reality.

Surgical site infections are a major postoperative complication because microbial contamination may destabilize healing and undermine the effectiveness of regenerative biomaterials. Conventional approaches tend to focus on infection control and tissue regeneration in isolation, thereby restricting their efficacy in complicated surgical procedures. Recent advancements in bioinspired and living multiscale composite materials offer new methods of antimicrobial functionality and regenerative support through hierarchical material design and bioinspired strategies. This review presents an extensive discussion on bioinspired and living multiscale composites in regenerative medicine to address surgical site infections. This review discusses the principles of biology, design of multiscale architectures, and provides an overview of how inert implants have evolved into bioactive, antimicrobial, and adaptive multiscale material systems. Most important material classes and fabrication strategies are addressed, with literature on the modes of incorporating structural hierarchy, antimicrobial strategies, and biological integration through the composite platform. The existing uses in preventing infections, regeneration of contaminated defects, delivering infection-responsive drugs, and biosensing have been critically evaluated. Translational, industrial, and regulatory issues, as well as the problems of scale-up, manufacturing obstacles, biosafety, standardization, and clinical integration specifically for living and hybrid systems, are also discussed here. This review summarizes the prospects and shortcomings of multiscale composite strategies through the synthesis of materials science, biology, and translational research to identify key directions for creating effective, safe, and clinically viable anti-infective regenerative materials.

Erectile dysfunction (ED) following radical prostatectomy (RP) is a common and challenging complication that often does not respond to first- or second-line therapies. Penile prosthesis (PP) implantation offers a definitive solution, particularly in refractory cases. We present the case of a young patient with ED following RP for prostate cancer. After unsuccessful medical treatments, the patient underwent implantation of a three-piece inflatable penile prosthesis (IPP), resulting in high patient satisfaction, restoration of sexual function, and improved psychosocial well-being. The choice of prosthesis type should be individualized, considering patient factors such as manual dexterity, comorbidities, and anatomy. Both IPP and semirigidPP devices provide excellent outcomes but require careful counseling regarding expectations, device operation, and potential complications. Advances in surgical techniques have significantly reduced infection and mechanical failure rates. Despite satisfactory outcomes, penile prostheses remain underutilized due to barriers to access and delayed referral. Penile prosthesis implantation should be offered to patients with ED refractory to first- or second-line treatments. Earlier referral, comprehensive patient education, and integration into survivorship care are essential, especially for younger post-cancer patients. HINTERGRUND: Die erektile Dysfunktion (ED) nach radikaler Prostatektomie (RP) ist eine häufige und herausfordernde Komplikation, die oft nicht auf die Erst- oder Zweitlinientherapie anspricht. Insbesondere in therapierefraktären Fällen bietet die Penisprothesen(PP)-Implantation eine definitive Lösung. Dargestellt wird der Fall eines jungen Patienten mit ED nach RP bei Prostatakarzinom. Nach Versagen medikamentöser Behandlungen erfolgte bei dem Patienten die Implantation einer 3‑teiligen aufblasbaren Penisprothese (IPP), was zu einer hohen Patientenzufriedenheit, Wiederherstellung der sexuellen Funktion und verbesserten psychosozialem Wohlbefinden führte. Die Wahl des Prothesentyps sollte individualisiert erfolgen, unter Berücksichtigung von Patientenfaktoren wie Fingerfertigkeit, Komorbiditäten und Anatomie. Sowohl mit IPP als auch mit semirigiden Prothesen lassen sich ausgezeichnete Ergebnisse erzielen, jedoch ist eine sorgfältige Beratung hinsichtlich der Erwartungen, der Gerätehandhabung und möglicher Komplikationen erforderlich. Fortschritte in der chirurgischen Technik haben zu signifikant verminderten Raten an Infektionen und mechanischem Versagen geführt. Trotz zufriedenstellender Ergebnisse werden Penisprothesen aufgrund von Zugangshindernissen und verzögerten Überweisungen immer noch zu wenig genutzt. Die Penisprothesenimplantation sollte Patienten mit ED angeboten werden, bei denen die Erst- oder Zweitlinientherapie versagt hat. Eine frühere Überweisung, umfassende Patienteninformation und die Integration in die Behandlung von Krebsüberlebenden sind essenziell, v. a. für jüngere Patienten nach Krebs.

Posterior cruciate ligament (PCL) avulsion fractures at the tibial insertion can cause posterior knee instability and accelerate osteoarthritis. Meyers-McKeever type II/III fractures require surgery. Traditional open approaches are traumatic, while arthroscopic techniques are limited by equipment, learning curves, and fixation efficacy. To evaluate the short-term clinical outcomes and feasibility of a combined vertical medial posterior incision approach using a small T-plate and high-strength suture fixation for isolated PCL avulsion fractures. We retrospectively reviewed 21 patients with isolated Meyers-McKeever type II/III PCL tibial avulsion fractures treated with posteromedial longitudinal mini-incision fixation using a mini T-plate combined with high-strength suture. Operative parameters, fracture healing, knee ROM, Tegner-Lysholm score, IKDC score, posterior drawer test, and complications were assessed. The mean surgery duration was 81.5&#x2009;&#xb1;&#x2009;20.9&#xa0;min, with an average intraoperative blood loss of 33&#x2009;&#xb1;&#x2009;11&#xa0;ml. All fractures achieved anatomical reduction, with an average healing time of 10.9&#x2009;&#xb1;&#x2009;1.6 weeks. At the final follow-up (mean 10.6&#x2009;&#xb1;&#x2009;5.2 months), knee ROM improved significantly from 76.5&#xb0;&#xb1;12.1&#xb0; preoperatively to 132.2&#xb0;&#xb1;4.2&#xb0; (P&#x2009;<&#x2009;0.05). Both Tegner-Lysholm scores (from 45.5&#x2009;&#xb1;&#x2009;9.3 to 95.5&#x2009;&#xb1;&#x2009;2.8) and IKDC scores (from 35.9&#x2009;&#xb1;&#x2009;8.9 to 96.8&#x2009;&#xb1;&#x2009;1.5) showed statistically significant improvements (P&#x2009;<&#x2009;0.05). The posterior drawer test was negative in all patients, and no infection, implant failure, or gastrocnemius weakness was observed. Posteromedial longitudinal mini-incision fixation with a mini T-plate combined with high-strength suture achieved satisfactory clinical outcomes for PCL tibial avulsion fractures. The proposed 5T concept summarizes the main practical advantages of this technique. In this descriptive case series (Level IV evidence), the technique achieved satisfactory short-term clinical outcomes for PCL tibial avulsion fractures, particularly in patients with small or comminuted fragments. Further prospective comparative studies are needed to validate its long-term clinical value.

Central venous stenosis and occlusion are recognized complications in hemodialysis patients and commonly present with ipsilateral arm, neck, or facial swelling. Unilateral breast edema is an uncommon manifestation that may mimic primary breast disorders and delay diagnosis. A 58-year-old woman with end-stage kidney disease receiving maintenance hemodialysis through a left-arm arteriovenous fistula presented with progressive unilateral left breast swelling accompanied by ipsilateral arm edema and facial congestion. Clinical evaluation excluded infection, malignancy, and lymphedema. Duplex ultrasonography suggested a central venous abnormality, and venography demonstrated complete occlusion of the left brachiocephalic vein with extensive collateral venous circulation. Endovascular treatment was performed with balloon angioplasty followed by self-expanding stent implantation because of significant elastic recoil. Post-procedural venography confirmed restoration of venous flow. The patient experienced rapid improvement in breast, arm, and facial swelling, with near-complete resolution at 1-month follow-up while maintaining functional dialysis access. Central venous obstruction should be considered in the differential diagnosis of unilateral breast swelling in hemodialysis patients. Prompt recognition and endovascular intervention can provide effective symptom relief, prevent unnecessary diagnostic procedures, and preserve vascular access.

The UmboMic is a recently developed middle ear microphone that functions by detecting the sound-induced motion of the umbo [1]. To prepare for a live animal study of the in vivo performance of the UmboMic, we developed the surgical implantation and fixation system in cadaveric sheep ears. Temporal bones from seven female sheep were prepared for implantation of the UmboMic system. Fixation hardware for sheep was designed to secure the UmboMic sensor in position so that the sensing tip contacted the umbo in the middle-ear cavity and the non-sensing tail end was secured to the surrounding mastoid bone. First, pre-surgical micro-CT scans of the temporal bones and open-source software were used to simulate surgical drilling, and to virtually plan and fit the UmboMic fixation system. Then, in physical sheep temporal bones, sound-induced umbo motion was measured with a laser Doppler vibrometer as a preliminary step. After surgical implantation of the UmboMic system, the position of the UmboMic sensor was evaluated with microscopic visualization and post-surgical micro-CT. Implanted UmboMic sensor function in response to acoustic frequency sweeps to the external ear canal&#xa0;was measured in two specimens. Measurements of sheep temporal bone anatomical dimensions with micro-CT showed that the facial recess featured a mean maximum height of 2.36&#xa0;mm, length of 12.2&#xa0;mm, and depth from outer opening surface of facial recess to the umbo of 11.1&#xa0;mm. The amplitude of umbo motion prior to UmboMic implantation was consistent with that previously reported by [2], with a displacement of&#x2009;~&#x2009;14&#xa0;nm/Pa up to a frequency of 5.5&#xa0;kHz, followed by a gradual drop-off. When bench tested and implanted in sheep temporal bones, the UmboMic sensitivity was as predicted from [1],&#x2009;~&#x2009;1-2 fC/nm. When implanted in sheep cadaveric ears, UmboMic performance was similar to previous measurements in fresh human cadaveric temporal bones. The method of simulating surgical drilling using micro-CT and simple open-source software is economical and broadly applicable in understanding the 3D biological anatomy and implantable device design and customization. The UmboMic implantation in cadaveric sheep ears was possible, and this study represents a step towards planned live animal studies.

High-frequency jet ventilation (HFJV) is the standard technique for rigid bronchoscopy. Few studies have comprehensively examined the complications associated with this technique. Previous evidence suggests that an ASA 4 score and basal SpO2 less than 95% may increase the likelihood of periprocedural complications. This retrospective study aimed to quantify and characterise the frequency and types of complications linked to HFJV, and to identify independent factors associated with their occurrence.DESIGN A retrospective pilot cohort study. This monocentric pilot study was conducted in a tertiary university hospital in Brussels, Belgium, between 1 January 2019, and 31 December 2023. A total of 1385 patients who underwent bronchoscopy under general anaesthesia were screened, of whom 833 (444 men and 389 women) met inclusion criteria and were retained for final analysis. Inclusion criteria were age at least 18&#x200a;years, rigid bronchoscopy and general anaesthesia using HFJV. Exclusion criteria included endotracheal intubation, incomplete medical records or explicit refusal to allow the use of their medical records for research. Complications were defined as hypoxaemia (oxygen saturation &#x2264; 90% for at least 1&#x200a;min), hypotension (SBP < 90&#x200a;mmHg), cardiac arrhythmia, laryngospasm or bronchospasm, pneumothorax or requirement for ICU admission. Univariate analyses were performed to compare groups of patients with and without complications, and variables with P less than 0.05 were entered into a backward logistic regression to identify independent predictors of complications. Hypoxaemia and hypotension were the most frequent periprocedural events occurring in 11 and 28% of cases, respectively. Shorter stature, stent implantation and basal oxygen saturation below 96% emerged as independent predictors of incidents during HFJV for rigid bronchoscopy (logistic regression model, area under the curve 0.62 (95% CI 0.58 to 0.67). We observed a relatively high number of minor complications associated with general anaesthesia for interventional bronchoscopy using HFJV. Shorter stature, lower basal SpO2 and stent procedures were independent predictors of incidents; however, the model demonstrated poor predictive value and limited clinical applicability. NCT06285994.

Risk stratification for sudden cardiac death (SCD) in non-ischemic dilated cardiomyopathy (NICM) and a left ventricular ejection fraction (LVEF) &#x2264;35%. remains controversial. The value of a low LVEF alone is limited, as it cannot distinguish between arrhythmic and nonarrhythmic mortality. This led to further investigation into markers of electrical instability. Prior studies have evaluated noninvasive and invasive markers, including ambient arrhythmias, signal-averaged ECG, QT dispersion, T-wave alternans, heart rate variability, and programmed ventricular stimulation. None of these markers have consistently improved the predictive accuracy for SCD beyond LVEF. Cardiac magnetic resonance (CMR) imaging with late gadolinium enhancement (LGE) has emerged as a tool for substrate characterization, with myocardial fibrosis burden and LGE patterns associated with SCD, arrhythmic events, as well as appropriate therapies in patients with implantable cardioverter-defibrillators. Quantitative LGE thresholds and integrated CMR-based models may enhance SCD risk discrimination, although methodological heterogeneity, scanner-dependent quantification, and lack of randomized trials challenge the inclusion of CMR parameters in current guidelines. Emerging tiered approaches like the ReCONSIDER framework, combining noninvasive markers, CMR tissue characterization, and electrophysiologic testing to capture the heterogeneity of NICM, may also be of value. However, at the present time, no single imaging, clinical, or electrophysiologic marker has achieved guideline-level validation as an adjunct or a replacement for LVEF. Future studies may focus on standardizing CMR acquisition and quantification, prospective validation of multimodal risk models, and assessment of dynamic, serial biomarkers to establish a more accurate approach to SCD risk stratification in NICM.

Pediatric patients with cardiac implantable electronic devices (CIEDs) face limited MRI access due to RF-induced heating, and computational modeling is increasingly used to characterize this risk. The validity of these simulations, however, depends on pairing body models with clinically realistic lead configurations, guidance that is currently lacking. We retrospectively analyzed 302 CIED surgeries in 281 pediatric patients to derive weight-based constraints for simulation design. Weight alone discriminated epicardial from endocardial lead implantation with AUC = 0.90, and adding age and height yielded no improvement, supporting weight as a sufficient single-parameter selection metric. The probabilistic crossover between approaches occurred at 44 kg, substantially higher than the 10 to 15 kg threshold commonly cited in the literature, with a broad transition zone of 21 to 66 kg in which both lead types were routinely used. Lead length was likewise weight-constrained: only 25 cm leads were observed in patients below 6 kg, and leads of 45 cm or longer were uncommon below 50 kg. These findings yield a three-tier framework, with epicardial-only configurations below 21 kg, dual configurations within 21 to 66 kg, and weight-thresholded lead lengths throughout, enabling MRI safety simulations to focus on clinically realizable anatomy and device combinations.

Precise Stage I electrode implantation is critical for the success of sacral neuromodulation (SNM); however, conventional fluoroscopy-guided puncture is limited by reliance on bony landmarks and significant radiation exposure. This study evaluated the clinical value of an optical navigation system (ONS) combined with multimodal image fusion for SNM electrode implantation. A prospective, single-blind, randomized controlled trial was conducted between March 2024 and June 2025. Eighty patients with refractory lower urinary tract dysfunction (including neurogenic bladder, overactive bladder, and interstitial cystitis/bladder pain syndrome) undergoing SNM were randomly assigned (1:1) to receive either ONS-assisted puncture (experimental group, n&#x2009;=&#x2009;40) or conventional X-ray guidance (control group, n&#x2009;=&#x2009;40). The primary outcome was the conversion rate to Stage II permanent implantation. Secondary outcomes included the number of puncture attempts, puncture time, total operative time, radiation dose, minimum effective voltage, and perioperative complications. Baseline characteristics were comparable between groups. The Stage II conversion rate was significantly higher in the ONS group than in the control group (87.5% vs. 62.5%, P&#x2009;<&#x2009;0.05). Patients in the ONS group required fewer median puncture attempts [2.0 (2.0, 2.2) vs. 5.0 (4.0, 7.0), P&#x2009;<&#x2009;0.01] and shorter puncture time [7.5 (5.8, 10.2) min vs. 16.0 (12.0, 25.0) min, P&#x2009;<&#x2009;0.01]. Intraoperative radiation exposure was substantially reduced in the ONS group [145.5 (108.4, 202.3) mGy vs. 473.3 (354.5, 635.2) mGy, P&#x2009;<&#x2009;0.01]. Furthermore, the minimum effective voltage was significantly lower in the ONS group [1.8 (1.8, 2.5) V vs. 2.8 (1.8, 3.0) V, P&#x2009;=&#x2009;0.010], suggesting superior electrode-neural positioning accuracy. No surgical complications occurred in either group. ONS combined with multimodal image fusion significantly improves the precision of SNM electrode implantation, reduces surgical trauma and radiation exposure, and increases Stage II conversion rates. This technique demonstrates stable clinical efficacy across various etiologies of refractory lower urinary tract dysfunction and represents a valuable navigation tool warranting broader clinical adoption. Chinese Clinical Trial Registry #ChiCTR2500098093 3/3/2025.

FS-LASIK, small-incision lenticule extraction (SMILE), and phakic intraocular lens (ICL) implantation are widely used for correcting moderate to high myopia, yet their effects on peripheral optical quality remain incompletely understood. This study compared central and peripheral optical outcomes after these three procedures using on-axis and off-axis wavefront measurements. This retrospective comparative study included 598 eyes (18-35 years) that underwent FS-LASIK, SMILE, or phakic ICL implantation. Wavefront aberrations were measured preoperatively and at 6 months postoperatively, both centrally and at &#xb1;&#x2009;30&#xb0; eccentric fixation, using a modified Shack-Hartmann aberrometer. The measurements were reconstructed over a 4.5-mm pupil, ensuring consistency across subjects.Second-, third-, and fourth-order RMS aberrations, peripheral relative defocus, astigmatic vector J0, and horizontal coma were analyzed pre- and postoperatively, with inter-group comparisons and correlations with preoperative spherical equivalent (SE). All procedures achieved high refractive accuracy with minimal surgically induced astigmatism. Second-order aberrations were substantially reduced in all groups. Third-order aberrations increased postoperatively, most prominently after FS-LASIK, followed by SMILE and then ICL implantation, while fourth-order changes were small and similar among groups. Peripheral relative defocus shifted toward hyperopia after all procedures, greatest after FS-LASIK. Induced higher-order aberrations and peripheral defocus were significantly correlated with preoperative SE, particularly in the FS-LASIK group. Although FS-LASIK, SMILE, and phakic ICL implantation all provided effective correction of moderate to high myopia, they were associated with different patterns of postoperative central and peripheral optical change. In this cohort, phakic ICL implantation showed relatively smaller changes in peripheral optical quality measures, whereas FS-LASIK was associated with greater spherical equivalent-dependent increases in higher-order aberrations and peripheral hyperopic defocus. Peripheral wavefront assessment may provide clinically relevant information beyond central aberrometry.