Abstract in English:

ABSTRACT Introduction: Concomitant bladder neck incision (BNI) with posterior urethral valve ablation (VA) was proposed to mitigate the long-term sequela of posterior urethral valve (PUV) and reduce the reoperation rates. This study aimed to investigate the short-term outcomes of concomitant BNI and VA, particularly short-term reoperation rates. Patients and Methods: Patients with PUV and bladder neck hypertrophy on preoperative imaging were randomized to undergo VA only or VA with concomitant BNI. Surgical reoperation within one year was the primary endpoint. Renal function, UTI, hydronephrosis and VUR improvement at one year were secondary endpoints. Results: Sixty-three patients were included in the final analysis, 33 in VA group (group A) and 30 in concomitant BNI and VA group (group B). After one year of follow-up, the reoperation rate was similar [5(15.2%) in group A and 3(10%) in group B, p=0.18]. The median (IQR) nadir serum creatinine was lower in group B [0.2 (0.1-0.3) vs. 0.2 (0.2-0.4) mg/dL in group A, p=0.049]. The last follow-up serum creatinine median (IQR) eGFR [107 (89.5-163) in group A vs. 139(102-165) mL/min/1.73 m2 in groups B, p=0.37], and febrile UTI rates were not different between the two groups. Hydronephrosis improved/ resolved in 27 (40.9%) renal units in group A vs. 33 (55%) renal units in group B (p=0.286). Vesicoureteral reflux improved/ resolved in 23(34.8%) and 12 (20%) renal units in group A and B, respectively (p=0.074). Conclusion: Concomitant BNI with VA does not confer a lower short-term reoperation rate or better upper urinary tract outcomes compared to VA only.

Abstract in English:

ABSTRACT Purpose: Ejaculatory alterations are among the most frequent sexual side effects of α1-adrenergic antagonists. Although often attributed to retrograde ejaculation, recent evidence indicates that tamsulosin primarily disrupts seminal emission, occasionally leading to transient azoospermia. This study evaluated the frequency, timing, and reversibility of ejaculatory and seminal changes following a single oral dose of 0.8 mg tamsulosin in healthy men. Materials and Methods: Thirty-one healthy male volunteers (aged 18–45 years) underwent a baseline semen analysis, followed by six additional collections at 1–3 week intervals. Each collection was performed at a different post-dose time point, spaced every 4 hours, to construct a 24-hour post-administration profile. Semen parameters were assessed according to WHO criteria, and post-ejaculatory urine was examined to detect retrograde ejaculation. Temporal variations were analyzed using repeated-measures ANOVA, with effect sizes estimated by Cohen's d. Results: Seminal volume decreased significantly in 93.6% of participants, with aspermia in 80.7%, peaking 12 h after ingestion (p<0.001, d=2.05). Sperm concentration declined markedly, with azoospermia in 80.7% (p<0.001, d=1.59) and normalized after wash-out in 2 days. No retrograde ejaculation was observed. Adverse effects were mild and self-limited. A single 0.8 mg dose of tamsulosin caused a consistent, time-dependent disruption of seminal emission, producing transient azoospermia rather than retrograde ejaculation. Conclusions: A single 0.8 mg dose of tamsulosin transiently suppressed seminal emission, leading to reversible azoospermia within 12 hours most recovered by 24h, and all recovered within 48h. Its predictable, reversible effect supports caution in men seeking conception and further exploration as an on-demand male contraceptive model.

Abstract in English:

ABSTRACT Male hypogonadism is a prevalent and clinically relevant condition with substantial effects on reproductive, metabolic, skeletal, and psychosocial health. Rising obesity rates, metabolic syndrome, and anabolic-androgenic steroid use have increased the frequency of functional hypogonadism in Brazil. Despite advances in diagnosis and treatment, clinical practice remains heterogeneous and access to standardized recommendations is limited. This joint position statement from the Department of Female Endocrinology, Andrology and Transgenderism (DEFAT) of the Brazilian Society of Endocrinology and Metabolism (SBEM), the Brazilian Society of Urology (SBU), and the Brazilian Association for Sexual Medicine and Health (ABEMSS) provides practical, evidence-based guidance for the evaluation and management of male hypogonadism in Brazil. The document outlines diagnostic criteria, including morning total testosterone confirmation and assessment of gonadotropins, and emphasizes recognition of functional etiologies such as obesity-related hypogonadism. Therapeutic recommendations include testosterone replacement therapy for confirmed organic hypogonadism, preferential use of long-acting intramuscular or transdermal formulations, and fertility-preserving strategies (SERMs, hCG, aromatase inhibitors) when indicated. The statement also addresses monitoring protocols, safety considerations, and the management of adverse effects. This is the first multidisciplinary Brazilian guideline harmonizing endocrine, urological, and sexual medicine perspectives to support national clinical practice. This consensus aims to promote consistent clinical decision-making, reduce underdiagnosis and overtreatment, and ensure safe, individualized care aligned with international principles and adapted to the national context.

Abstract in English:

ABSTRACT Purpose: The combination of systematic biopsy (SB) and MRI-targeted biopsy (TB) is the current approach for prostate cancer (PCa) diagnosis; however, the clinical benefit of including SB remains controversial. This study aimed to determine whether SB adds value beyond TB in detecting clinically significant prostate cancer (csPCa) in men with suspicious lesions. Materials and Methods: Retrospective, single-center study conducted between January 2019 and September 2023. It enrolled men with suspicious lesions identified on multiparametric MRI (PI-RADS≥3) who had undergone combined biopsy (TB+SB). Sociodemographic and clinical data were secondarily collected. csPCa was defined when ISUP≥2. Results: This study included 997 men with a median age of 68 years, of whom 497 had a negative prior biopsy. The TB+SB approach identified 53.0% of PCa and 36.8% of csPCa cases. TB alone significantly outperformed SB in identifying csPCa, with detection rates of 34.8% vs. 10.3%, respectively, missing only 4.8% of PCa diagnosis—most of which were low-grade tumors. SB contributed marginally, identifying additional csPCa cases in 1.4% of patients. In patients with a prior negative biopsy, the addition of SB to TB only accounted for 12.5% of PCa diagnosis. Limitations include the study single-center design, restricting generalizability, and the lack of whole-mount prostatectomy for histological confirmation. Conclusions: In conclusion, SB adds limited diagnostic value, with TB alone being sufficient for detecting csPCa cases in patients with MRI-visible lesions. The results suggest that SB may be safely omitted in selected patients to reduce biopsy burden and lead to better clinical outcomes.

Abstract in English:

ABSTRACT Purpose: To analyze the renal length in patients submitted to computed tomography (CT scans) and compare it according to age, gender, laterality and body parameters like height, weight and Body Mass Index (BMI). Methods and Methods: We analyzed 74 patients (148 kidneys) submitted to CT scans and evaluated renal length in centimeters, gender, height, weight and BMI. The abdominal CT scans acquisition and image analysis was done using 16 and 64 slice multidetector computed tomography (MDCT) scanners to perform multiplanar reconstructions (MPR) and measure the kidney length (KL) in coronal plane. The statistical analysis was performed with the GraphPad Prism software (Version 9.2.0). Results: The 74 patients analyzed (28 Males/37.83% and 46 females/62.17%) presented mean age of 54.1 years-old, right kidney length between 8.4 to 13.1cm (mean=10.79) and left kidney length between 8.3 to 13.1cm (mean=10.97). The kidney length on both sides was significantly greater in male sex (p<0.001). The length of the left kidney was significantly greater than that of the right kidney (p=0.017). The linear regression analysis showed non-significant correlation between both right kidney length and positive correlations between kidney length and BMI, weight and height. Conclusions: CT scan accurately assessed renal length. We observed that renal length was greater in males and in the left side. Weight, age, height and body mass index showed a positive correlation with kidney length.

Abstract in English:

ABSTRACT Objective: To assess long-term changes in renal volume and function after laparoscopic partial nephrectomy using 3D modeling and to identify key predictors. Patients and Methods: This retrospective study included 187 patients who underwent laparoscopic partial nephrectomy between October 2012 and January 2023. Patients underwent the same cross-sectional imaging both pre- and postoperatively, with a minimum follow-up of one year. Pre- and postoperative volumes were reconstructed with 3D Slicer software. Results: The median age of the patients was 58 years. The median Radius-Exophytic-Nearness-Anterior-Location (RENAL) score was 7. The median tumor volume was 15.8 cm³. The median warm ischemia time was 14 minutes, and the median surgical time was 80 minutes. The mean tumor-free renal parenchymal volume before surgery was 168,87 ± 40,91 cm³, which decreased to a mean operated renal parenchymal volume of 137.6 ± 41.7 cm³ at 5 years postoperatively. The estimated glomerular filtration rate (eGFR) declined from a median value of 90.6 to 75.9 mL/min/1.73 m² over the same period. The predictors of renal function decline were parenchymal volume loss, age, female gender, diabetes mellitus, and tumor-to-parenchyma contact surface area. Factors affecting parenchymal volume loss included age, RENAL score, comorbidities, Surface-Intermediate-Base (SIB) score, and operative time. Conclusions: While the most influential factor on renal function in the early postoperative period was the preserved renal volume, diabetes mellitus (DM) emerged as the primary determinant of long-term functional outcomes. Tumor resection technique and operative time are modifiable factors influencing parenchymal volume preservation. Enucleation-based approaches may enhance parenchymal preservation without compromising oncological outcomes.

Abstract in English:

ABSTRACT Purpose: To report our institutional technique for robot-assisted kidney transplantation (RAKT) (1, 2) in a detailed, step-by-step manner. Materials and methods: This is a case of RAKT from a living donor successfully performed at our institution. A 29-year-old male with end-stage renal disease secondary to focal segmental glomerulosclerosis, undergoing hemodialysis with a baseline serum creatinine of 1035 μmol/L at admission, received a left kidney donated by his 55-year-old mother. Preoperative evaluation confirmed one HLA mismatch (0-0-1) and ABO compatibility, making the patient suitable for living donation. Results: The procedure was performed using the da Vinci Xi robotic system (Intuitive, Sunnyvale, CA, USA). The recipient was placed in a 23° Trendelenburg position. Four robotic ports were aligned above the umbilicus, and two additional ports were used for the assistant. Graft introduction was performed via a 7-cm Pfannenstiel incision using an Alexis O Wound Protector-Retractor with Laparoscopic Cap (Applied Medical, Rancho Santa Margarita, CA, USA). Following robotic living donor nephrectomy, extracorporeal bench preparation was performed (warm ischemia time = 4 min; cold ischemia time = 239 min). RAKT was then completed with intracorporeal vasculares anastomoses using 5-0 Gore-Tex sutures (warm ischemia time = 45 min), and ureteral reimplantation according to the Lich-Gregoire technique, performed with 4/0 monofilament suture (3). The surgery was uneventful, with excellent graft reperfusion and no perioperative complications. Postoperative renal Doppler ultrasound and radionuclide renal scan were normal. Serum creatinine and eGFR at discharge were 1.45 mg/dL and 62 mL/min, respectively (4). Conclusions: Our experience confirms the feasibility and safety of RAKT with a living donor in a selected setting, supporting further integration of robotic assistance into renal transplantation programs.

Abstract in English:

ABSTRACT Purpose: Multifocal ureteral strictures pose significant challenges for reconstructive surgery due to their segmental distribution and the need to preserve the ureteral blood supply (1, 2). Robotic-assisted surgery, owing to its precision and minimally invasive advantages, has increasingly become a preferred approach (3). Although the da Vinci surgical system has long dominated this field, several novel robotic platforms have recently emerged with comparable safety and efficacy (4, 5). This study reports our experience with robotic-assisted laparoscopic buccal mucosal graft ureteroplasty combined with ureteral reimplantation for complex ureteral stricture repair using the modular Carina™ robotic surgical system. Materials and Methods: A 32-year-old man presented with a one-month history of flank pain and was found to have both proximal and distal ureteral strictures. Using the modular Carina™ robotic system, the procedure was performed as follows: dissection of the proximal stricture, longitudinal ureterotomy, posterior augmented anastomosis, harvesting of buccal mucosa for ventral onlay grafting; followed by dissection of the distal ureteral stricture and bladder wall and completion of a side-to-side ureterovesical anastomosis. Results: The procedure was completed successfully without conversion, with a total operative time of 272 minutes. The patient was discharged on postoperative day 7. Histopathological examination revealed granulomatous inflammation, and anti-tuberculosis therapy was initiated. The double-J stent and nephrostomy tube were removed 2 months postoperatively. During an 8-month follow-up, the patient's symptoms resolved, imaging demonstrated improvement of hydronephrosis, renal function remained stable, and no postoperative complications were observed. Conclusions: Robotic-assisted reconstructive surgery for complex ureteral strictures using the modular Carina™ robotic system is technically feasible. However, larger studies with longer follow-up are required to validate these preliminary findings.

Abstract in English:

ABSTRACT Introduction: Focal therapy with high-intensity focused ultrasound (HIFU) has emerged as a treatment option for selected patients with localized prostate cancer; however, disease recurrence requiring salvage intervention remains a recognized challenge (1–5). Salvage radical prostatectomy is technically demanding due to post-ablative tissue changes, which may compromise oncologic and functional outcomes (6,7). Herein, we describe the surgical technique and clinical outcomes of salvage robotic-assisted radical prostatectomy (RARP) performed using a single-port (SP) transvesical approach following HIFU. Materials and Methods: The index case was a 57-year-old man with a history of right hemigland HIFU for ISUP Grade Group 2 prostate cancer. During routine surveillance four years after HIFU, his PSA rose to 3.64 ng/mL, prompting repeat biopsy. Biopsy confirmed clinically significant recurrent prostate cancer both within and outside the prior treatment field, with bilateral involvement. Preoperatively, the patient reported satisfactory erectile function, with a Sexual Health Inventory for Men (SHIM) score of 25/25. After informed consent, salvage transvesical SP-RARP was performed. Dissection was carried out with anticipation of post-ablation tissue changes, and bilateral nerve-sparing was incorporated to optimize functional outcomes. Results: The procedure was completed in 82 minutes without placement of additional ports and without intraoperative complications. Estimated blood loss was 75 mL. The patient was discharged home the same day (4.3 hours postoperatively). Foley catheter removal on postoperative day 6 was followed by immediate urinary continence. Erectile function remained satisfactory at 3 months, indicating preservation of baseline functional outcomes. Final pathology demonstrated pT3b ISUP Grade Group 2 prostate cancer with evidence of prior ablation and negative surgical margins. At the most recent follow-up (12 months), PSA remained undetectable, with no biochemical recurrence. Conclusion: Transvesical SP-RARP appears to be a safe and effective salvage option following focal ablative therapy for prostate cancer. Leveraging the advantages of single-port robotic technology (8,9), this approach may facilitate outpatient surgery while maintaining favorable functional and oncologic outcomes.