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ABSTRACT Purpose: To compare patency, pregnancy, and overall live-birth outcomes after microsurgical vasovasostomy (VV) versus vasoepididymostomy (VE), and to evaluate mixed bilateral procedures as a distinct analytic category. Materials and Methods: A systematic search of four databases was conducted. Eligible studies were observational cohorts reporting patency, pregnancy, or overall live-birth outcomes of men undergoing microsurgical VV, VE, or mixed bilateral reversal for post-vasectomy obstructive azoospermia. The quality of studies was assessed using the Newcastle-Ottawa Scale. Random-effects meta-analysis using restricted maximum likelihood was performed in R, reporting pooled odds ratios (OR) for dichotomous outcomes and mean differences (MD) for continuous outcomes, both with 95% confidence intervals (CI). Heterogeneity was quantified using I2. The protocol was registered in PROSPERO (CRD420261357366). Results: Thirteen studies encompassing 6,867 patients (4,053 VV; 1,430 VE; 1,384 mixed) were included. VV was associated with significantly higher patency than VE (OR 6.98, 95% CI 4.23 to 11.50; I2=52.6%), higher natural pregnancy odds (OR 2.01, 95% CI 1.38 to 2.91), higher overall live-birth odds (OR 2.79, 95% CI 1.67 to 4.67), and earlier sperm return (MD −1.95 months). Mixed procedures yielded intermediate patency. Findings were robust across all sensitivity analyses; small-study effects could not be fully excluded given the limited number of studies contributing to some outcomes. Conclusions: VV is associated with higher patency, pregnancy, and overall live-birth rates than VE, reflecting more favorable anatomical conditions. Mixed bilateral procedures yield intermediate outcomes from asymmetric anatomy. These findings support VV and VE as complementary techniques selected according to intraoperative vasal fluid findings.

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ABSTRACT Purpose: To develop contemporary evidence-informed recommendations for robot-assisted radical cystectomy (RARC), urinary reconstruction, and perioperative management, integrating current evidence with the experience of Latin American experts in uro-oncology and robotic surgery. Materials and methods: A modified Delphi consensus process was conducted involving 42 experts with extensive experience in RARC. Topics included patient selection, perioperative optimization, enhanced recovery after surgery (ERAS), lymph node dissection, urinary reconstruction, functional preservation, perioperative systemic therapy, complex clinical scenarios, and emerging robotic technologies. A comprehensive literature review was performed using Medline, Scopus, and Web of Science through November 2025, following PRISMA principles and incorporating recommendations from EAU, AUA/ASCO/SUO, and NCCN guidelines. Consensus was defined as ≥75% agreement. Results: Consensus supported routine implementation of ERAS protocols, structured frailty and nutritional assessment, extended pelvic lymph node dissection, and perioperative systemic therapy in eligible patients. Intracorporeal urinary diversion was associated with improved recovery and lower wound-related morbidity. Nerve-sparing and organ-preserving approaches were recommended in selected patients to optimize continence, sexual function, and quality of life. Orthotopic neobladder reconstruction should be individualized according to oncologic safety, functional status, renal function, and patient preference. RARC was considered feasible in complex settings, including obesity, bulky lymphadenopathy, locally advanced disease, and salvage surgery, when performed in experienced high-volume centers. Areas without consensus included urinary drainage strategies and antibiotic prophylaxis duration. Conclusions: This expert consensus provides recommendations for RARC and urinary reconstruction, aiming to standardize practice, optimize perioperative care, and improve oncological and functional outcomes. Future prospective studies are needed.

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ABSTRACT The objective of this narrative review is to show the most relevant aspects of the structure of epidydimal anomalies (EAs) and processus vaginalis (PV) during testicular migration and in patients with undescended testis. Smooth and striated muscles develop around the processus vaginalis (PV) within the gubernaculum during fetal life. The testis migrates through the PV by the means of peristaltic activity generated by those muscles. After migration is completed, the smooth muscle undergoes programmed cell death, resulting in obliteration of PV and leaving only the dartos muscle. Initiation of programmed cell death requires a shift in autonomic balance characterized by a decrease in sympathetic tone and a concomitant increase in parasympathetic tone. The shift represents a critical step in the migration process. If the shift occurs prematurely, smooth muscle mass decreases before migration is completed, potentially preventing adequate propulsion of the testis and resulting in undescended testis. Premature shift is persistent. Persistence of this shift links the clinical features associated with failed migration. Conversely, if the shift fails to occur or is insufficient, smooth muscle persists and inhibits obliteration of the PV, leading to inguinal hernia or hydrocele depending on the remaining amount of smooth muscle. Epididymal disjunctions anomalies and epididymis atresia could be associated with infertility and are very usual in undescended testis. We can divided EAs in 3 groups: normal variant, disjunction anomalies and epididymis atresia. In the normal variant the epididymis is attached to the testis at the head and tail and totally attached to the testis. The transient presence of SM, its programmed elimination, and regulation by autonomic tone together offer a coherent model that integrates developmental, physiological, and clinical observations. EAs are frequently found in cryptorchidism. Knowledge of anomalies associated with cryptorchidism is relevant in clinical practice, both to prevent accidents during orchidopexy and to counsel and predict infertility in the future, such as in cases of epididymis atresia and total disjunction between the testis and the epididymis.

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ABSTRACT Introduction: Nephrolithiasis is a prevalent and recurrent condition affecting approximately 10–11% of the population. Percutaneous nephrolithotomy (PCNL) and mini-PCNL are established treatments for large renal stones. Outcomes are influenced by the choice of lithotripsy energy source. Available technologies include pneumatic, ultrasonic, Holmium:YAG (Ho:YAG), and thulium fiber laser (TFL), each with specific advantages and limitations. This review summarizes current evidence on these energy sources in PCNL and mini-PCNL. Materials and methods: A narrative review was performed using PubMed and Cochrane Library, including studies published between 2014 and 2024. The search included terms related to PCNL and lithotripsy energy sources. Studies involving pediatric populations, anomalous kidneys, or non-standard energy sources were excluded. After screening 95 articles, 32 studies were included, of which 13 provided comparative data on different energy sources and were analyzed. Results: Differences were observed in operative time, stone-free rates (SFR), bleeding, transfusion rates, complications, and hospital stay. In PCNL, ultrasonic and Ho:YAG lithotripsy showed comparable outcomes, while pneumatic demonstrated slightly lower SFR. In mini-PCNL, ultrasonic and laser technologies yielded similar efficacy. TFL displayed shorter operative time and reduced bleeding and transfusion rates compared to Ho:YAG, although many differences did not reach statistical significance. Conclusion: Ultrasonic and Holmium:YAG lithotripsy provide comparable outcomes in PCNL, while pneumatic devices may correlate with slightly lower stone-free rates. In mini-PCNL, ultrasonic and laser modalities show similar outcomes. TFL demonstrates potential advantages in operative time and bleeding, however, evidence remains heterogeneous, and further high-quality studies are needed.

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ABSTRACT Purpose: Robotic-assisted surgery represents a leading innovation in kidney-sparing procedures across specialized urology centers. As new robotic platforms continue to emerge, comparisons with conventional laparoscopy remain necessary. This study focuses on comparing oncological, perioperative and functional outcomes of robot-assisted partial nephrectomy (RAPN) with the Hugo™ RAS system and laparoscopic partial nephrectomy (LPN) within a tertiary institution. Materials and Methods: A retrospective single-center study included 165 patients who underwent LPN (n=95) or RAPN (n=70). Perioperative clinical data, tumor characteristics, oncological and functional outcomes were obtained. Propensity score matching (1:1) was implemented to mitigate selection bias. Trifecta and pentafecta were assessed as composite surgical success endpoints. Multivariate logistic regression analyses were performed to identify the predictive factors for each. Results: Following propensity score matching, 70 patients were included in each group. Operative time, WIT and estimated blood loss did not differ significantly. RAPN was associated with a shorter length of stay (3 days vs 5 days, p<0.001) without increased complication rate. Renal functional outcomes, including ≥90% eGFR preservation and CKD upstaging, were similar. Trifecta (LPN 84.3% vs. RAPN 85.7%) and pentafecta (LPN 48.6% vs. RAPN 57.4%) achievement were comparable. On multivariate analysis, higher RENAL score was the only independent predictor of trifecta failure (OR 1.410, p=0.027). For pentafecta, higher RENAL score (OR 1.396, p=0.030), older age (OR 0.929, p=0.001), and lower pre-operative eGFR (OR 0.981, p=0.049) were independent predictors of failure. Conclusions: The study reinforced the effectiveness and safety of the new Hugo™ RAS platform for partial nephrectomy, without compromising oncological and functional success.

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ABSTRACT Objective: To evaluate long term success rates and patient reported outcomes of redo urethroplasty (RU), a technically challenging urological procedure that may be associated with lower success rates due to increased scarring, compromised blood supply and poor surgical planes from prior surgery. Materials and methods: We retrospectively reviewed RU patients between 2010–2023, excluding failed hypospadias repair, and compared with a cohort of primary urethroplasty patients. Failure was defined as need for urethral intervention or imaging/cystoscopy-confirmed stricture recurrence prompted by symptoms. Primary endpoint was stricture-free survival. Secondary endpoints included patient-reported outcomes (USS-PROM), satisfaction, and subgroup analysis by stricture location. Statistical tests included T-tests, Wilcoxon signed-rank, and Fisher's exact test. Results: Sixty redo urethroplasty patients (median age 48.5) were compared to 316 primary cases (median age 45, p=0.84). Median follow-up was 35 (IQR 14-81) vs. 51 (IQR 20-114) months for redo and primary cases, respectively (p=0.07). Failure rates were not significantly different: 23% in redo vs. 15% in primary cases (p=0.12). However, time to failure was significantly shorter in the redo group (median 6 vs. 17 months, p=0.01). USS-PROM questions 1–6 favored the primary group, although bother scores (Q7) were similar. Overall satisfaction was high in both groups but slightly higher after primary repair (95% vs. 87%, p=0.04). Conclusion: Despite greater complexity, redo urethroplasty demonstrates similar long-term success rates to primary urethroplasty. Patient-reported bother was similar, supporting redo urethroplasty as a viable option for recurrent urethral stricture after previous repair. However, recurrences occurred significantly earlier in the redo group.

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ABSTRACT Purpose: The objective of the present study was to evaluate real-world practices of Brazilian urologists regarding bladder cancer management within the supplementary healthcare system. Materials and Methods: A cross-sectional, survey-based study was conducted among Brazilian urologists. A structured questionnaire assessed demographics, practice characteristics, and management strategies for non–muscle-invasive (NMIBC) and muscle-invasive bladder cancer (MIBC). Data were collected during the 2025 Brazilian Congress of Urology and via electronic distribution. Descriptive statistics were used, and exploratory comparisons were performed. Results: A total of 914 urologists from 25 federative units (24 states and the federal district) participated in the study. Cystoscopy was nearly universal (93.8%), but access to enhanced imaging (17.9%) and office-based flexible cystoscopy (19.3%) was limited. In NMIBC, most urologists maintained patient care (82.9%), but management was heterogeneous. Immediate postoperative intravesical chemotherapy was rarely used. Bacillus Calmette-Guérin (BCG) was prescribed in most cases of recently treated NMIBC by 39.3% of respondents, while 54.2% referred patients for administration. Although 74.5% reported access to it, only 14.3% had availability for all patients. Preference flow analysis showed BCG as the main first-line therapy (65.4%), intravesical chemotherapy as second-line (51.2%), and pembrolizumab (31.3%) and radical cystectomy (30.2%) as third-line options. Radical cystectomy is annually performed by 65.1% of respondents; however, most reported low annual volumes, with 95% performing fewer than ten cases per year. Conclusions: Bladder cancer management in the Brazilian supplementary healthcare system is heterogeneous, with important gaps in access, technology availability, and adherence to recommended practices. Despite limitations inherited to survey-based research, including potential selection bias, reliance on self-reported data, and possible overlap between public and private practice settings, these findings highlight opportunities for educational initiatives and system-level improvements.

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ABSTRACT Objective: The treatment of vesico-urethral anastomotic stenosis (VUAS) is difficult because of the high risk of urinary incontinence. Cystoscopy-guided robotic Y-V plasty is hypothesized to reduce the incidence of urinary incontinence compared to traditional Y-V plasty. The purpose of this study was to evaluate the efficacy of cystoscopy-guided robotic Y-V plasty. Materials and Methods: All patients diagnosed with VUAS following radical prostatectomy between January 2019 and December 2024 were retrospectively reviewed. Patients with damaged external urethral sphincter or stenosis involving the external sphincter were excluded. Cystoscopy-guided robotic Y-V plasty was performed at least three months after the last failed intervention. After catheter removal, patients were scheduled for re-examination at one, six, twelve and twenty-four months. Uroflowmetry was routinely performed and cystoscopy was performed at six months after surgery. Postoperative changes in patients’ erectile function, lower urinary tract symptoms, and urinary continence were followed up using Five-item International Index of Erectile Function (IIEF-5), International Prostate Symptom Score (IPSS), and urinary continence grading. Results: Twenty-eight patients were enrolled. All patients were followed up for 6–59 (median 30) months after surgery. The final success rate was 96.4% (27/28). Normal continence was achieved in 25 patients (92.6%). Social continence occurred in 2 (7.4%). No patients experienced clinical incontinence. The patients’ postoperative IPSS scores achieved significant improvement compared with preoperative. Conclusion: The surgical strategy cystoscopy-guided robotic Y-V plasty is more precise, direct and efficient in protecting the external urethral sphincter. It ensures a high success rate and simultaneously reduces the occurrence of urinary incontinence.

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ABSTRACT Purpose: Immediate urinary continence (UC) recovery following Retzius-sparing robot-assisted radical prostatectomy (RS-RARP) remains highly variable, highlighting the need for reliable preoperative prediction. We aimed to develop and validate models to identify patients likely to achieve immediate UC recovery following RS-RARP. Materials and Methods: A total of 580 prostate cancer patients who underwent RS-RARP from four medical centers were assigned to a training set (n=348), an internal validation set (n=103) and an external validation set (n=129). Independent predictors were identified through univariate analysis and LASSO regression. A nomogram was constructed using multivariate logistic regression. Its performance was evaluated with receiver operating characteristic (ROC) curve, calibration curves, and decision curve analysis. Results: Immediate UC recovery was observed in 84.5% (294/348) of patients in the training cohort, 80.6% (83/103) in the internal validation cohort, and 81.4% (105/129) in the external validation cohort, respectively. Multivariate analysis identified membranous urethral length (MUL) (OR=1.23, P=0.029) and urethral curvature (OR=2.84, P<0.001) as independent predictors, while prostate volume (PV) (OR=0.84, P<0.001) as a protective factor. The nomogram integrating MUL, PV, and urethral curvature demonstrated superior predictive accuracy, with an AUC of 0.87 (95% CI, 0.83-0.91) in the training cohort. The bootstrap-corrected calibration slope was 0.96, and the Brier score was 0.08. Calibration curves and decision curve analysis confirmed the predictive accuracy and clinical utility of the nomogram. Conclusions: Our study introduces a novel quantitative method for assessing urethral curvature. The mpMRI-based model, integrating urethral curvature and prostate spatial configuration, offers enhanced predictive accuracy for postoperative immediate UC recovery.