Virtual and augmented reality (VR/AR) technologies hold great promise in various medical fields. The release of a new generation of headsets for medical enhanced VR/AR (MER) opens new possibilities for applications in medicine, particularly in urology, to improve accessibility to everyone. These innovative headsets offer deep immersion without requiring a controller, which represents a novel approach to VR/AR engagement. The potential of these headsets applies to all aspects of urology, including surgical training, virtual meetings, communication between health care providers, patient counseling, telemedicine, delivering patient advice, and pain control. MER has the potential to improve operative planning and enhance intraoperative navigation and spatial awareness. The surgeon's visualization and overall experience can be significantly enhanced via improved guidance and visualization, ultimately leading to greater precision and safety. This cutting-edge technology has the potential to reshape urology practice, communication methods, and medical procedures, and ultimately to improve patients' experience of their urological condition. PATIENT SUMMARY: This mini review explores how a new generation of headsets for medical enhanced virtual reality could revolutionize urology by improving surgical planning, assistance during procedures, and medical education. Patients can benefit from better pain management and a deeper understanding of their conditions. However, challenges such as costs, accuracy, and ethical concerns must be addressed. This technology holds promise for transforming urological practice and patient care.

The restoration of bowel continuity following Hartmann’s Procedure (HP) has been reported hitherto with high morbidity and mortality rates. No clear guidelines exist about timing in Hartmann’s Reversal (HR), the literature data being conflicting. We have sought to investigate the effect of the interval time between HP and HR in short- and long-term HR outcomes through a retrospective study based on consecutive patients undergoing HR between 2009 and 2017 in two regional hospitals in Italy. Demographic characteristics, comorbidities, intra- and post-operative data, as well as early complications, were recorded. Long-term data were collected on the surgical site occurrences of Incisional Ventral Hernia (IVH). One hundred and five patients were recruited for the study. Late HR, female gender, and long operating time were related to the highest incidence of peri-operative complications. Patients who developed IVH had undergone HR at significantly shorter times and had a higher Body Mass Index (BMI). The timing of HR seems to be an important variable linked to the onset of early and late post-operative complications. The patients submitted to early HR show a significantly lower complication rate but, at the same time, a higher rate of IVH incidence after restorative surgery. These data, in our opinion, reflect the need for planning, where possible, an early restoration of bowel continuity after HP.

Purpose: Nephrometry scores are essential tools for classifying and comparing tumor complexity and guiding surgical planning in partial nephrectomy. However, their performance in single-port robot-assisted partial nephrectomy (SP-RAPN) has not been formally assessed. We aimed to externally validate and compare the predictive performance of the Preoperative Aspects and Dimensions Used for an Anatomical (PADUA), Radius-Exophytic/Endophytic-Nearness-Anterior/Posterior-Location (RENAL), and Simplified PADUA Renal (SPARE) nephrometry scores in patients undergoing SP-RAPN. Methods: We retrospectively reviewed 211 consecutive patients who underwent SP-RAPN for solitary ≤ cT2 renal tumors at two academic centers between 2019 and 2024. The primary endpoint was Trifecta achievement, defined as the simultaneous presence of negative surgical margins, absence of perioperative complications, and warm ischemia time ≤ 25 min. Discrimination and clinical utility of each nephrometry score were assessed using receiver operating characteristic (ROC) curve analysis and decision curve analysis (DCA). Multivariable logistic regression adjusted for relevant clinical covariates. Results: Trifecta was achieved in 50.7% of patients. The SPARE score demonstrated the highest discriminative performance (AUC 0.681), followed by PADUA (0.661) and RENAL (0.654), though these differences were not statistically significant. DCA showed overlapping net benefit curves, with SPARE offering marginally superior. Limitations include the retrospective design and underrepresentation of highly complex tumors. Conclusions: PADUA, RENAL, and SPARE scores show comparable performance in predicting Trifecta achievement in the setting of SP-RAPN. SPARE may perform slightly better, and it represents a more practical choice for routine preoperative assessment due to its ease of use.

Surgical treatments for benign prostatic hyperplasia (BPH) have expanded with the diffusion of minimally invasive surgical treatments (MISTs), but concerns persist regarding their long-term durability. This study aimed to provide a comprehensive, real-world description of current treatment trends, retreatment rates, and medication reinitiation up to 5 yr following MISTs and traditional procedures. This observational retrospective fixed-cohort study was conducted using Epic Cosmos, including data of 6 450 295 patients and 420 611 procedures between 2014 and 2024. The primary outcome was procedural trend; the secondary outcomes were surgical retreatment and medication reinitiation. Analyses were descriptive and unadjusted for potential confounders due to the aggregated nature of the dataset. At 5 yr, retreatment rates were higher after prostatic urethral lift (PUL; 16%), transurethral needle ablation of the prostate (15%), transurethral microwave thermotherapy (17%), and Rezūm (14%), and lower after holmium laser enucleation of the prostate (HoLEP)/thulium laser enucleation of the prostate (ThuLEP; 4.4%) and simple prostatectomy (1.2%) when compared with transurethral resection of the prostate (TURP; 7.1%). Medication reinitiation at 5 yr was more common after MISTs (PUL: 21% α-blockers, 25% 5α-reductase inhibitors [5-ARIs], and 27% overactive bladder [OAB] drugs; all p < 0.001; Rezūm: 18% α-blockers, p = 0.001; 22% 5-ARIs, p = 0.05; and 23% OAB drugs, p > 0.99) and lower following traditional procedures, including HoLEP/ThuLEP-11% α-blockers (p < 0.001), 12% 5-ARIs (p < 0.001), and 21% OAB drugs (p = 0.3), and simple prostatectomy-5.4% α-blockers (p < 0.001), 6.5% 5-ARIs (p < 0.001), and 9.4% OAB drugs (p < 0.001), when compared with TURP (15% α-blockers, 17% 5-ARIs, and 23% OAB drugs). Limitations include the use of aggregated electronic health record data subject to coding errors and the inability to adjust for clinical variables such as prostate size and symptom severity. In this large, real-world cohort, anatomical procedures such as HoLEP, ThuLEP, and simple prostatectomy were associated with the lowest long-term rates of retreatment and medication restart, whereas higher rates were observed with MISTs, particularly PUL and Rezūm. TURP remained the most performed procedure. As the use of MISTs declines after its initial uptake, future studies should clarify which patient characteristics may underlie these observed differences.

Purpose: To evaluate the learning curve of robotic-assisted simple prostatectomy (RASP) using a transvesical approach and to identify the impact of patient-related factors, such as prostatic volume and Body Mass Index (BMI), on operative efficiency. Materials and methods: A retrospective analysis of 103 consecutive RASP procedures performed by a single surgeon was conducted. A multiple linear regression model was developed to calculate predicted operative times adjusted for prostatic volume and BMI. Risk-adjusted Cumulative Sum (RA-CUSUM) analysis was applied to the residuals to characterize the learning curve. Perioperative outcomes were compared across the identified phases using the χ² test or Fisher’s exact test for categorical variables and one-way ANOVA or the Kruskal-Wallis test for continuous variables. Results: Both prostatic volume ( p < 0.001) and BMI ( p = 0.029) were independent predictors of operative duration. The RA-CUSUM analysis identified a learning phase (cases 1–33), a proficiency phase (34–73), and a consolidation phase (74–103). Significant improvements were observed across phases for median operative time (210 vs. 176 vs. 190 min, p = 0.011) and median length of stay (11 vs. 9 vs. 9 h, p < 0.001). No significant differences were found regarding complications or functional outcomes. Conclusions: Proficiency in robotic transvesical simple prostatectomy is achieved after approximately 33 cases, with technical consolidation occurring after the 75th procedure. The transvesical approach provides direct access that may mitigate the technical challenges associated with high BMI, although prostatic volume remains the primary driver of operative duration.