Robot-assisted surgery (RAS) has been integrated into clinical practice to overcome several limitations of conventional open or laparoscopic surgery. After the expiration of the long key patent period of Intuitive Surgical, various robotic systems (RSs) have been developed aiming at improving certain characteristics of the first robotic platform, the Da Vinci RS. This narrative review provides an overview of the current RSs utilized in urology along with the initial results from their application in urologic procedures. Nine robotic platforms are being analyzed regarding their unique characteristics as well as their efficacy, safety, feasibility, and outcomes in urologic, oncological or non-oncological operations. The main barrier to the wide application of RAS has been the increased cost which refers to both acquisition and maintenance costs. Besides, the health inequality resulting from the lack of expert robotic surgeons and the difficulty of performing robot-assisted procedures in provincial hospitals should be overcome. However, large properly designed comparative studies are required to establish the role of newly introduced RSs. Additionally, urologists should keep abreast of new developments and research in robot-assisted urologic procedures.

(1) Background: This study aims to evaluate how different irrigation settings and the use of ureteral access sheaths (UASs) of varying sizes impact intrarenal pressure (IRP) during flexible ureteroscopy (fURS) procedures in pigs. (2) Methods: This study utilized three anesthetized female pigs. A novel flexible ureteroscope with the ability to continuously record live intrarenal pressure was used to perform ureteroscopy in different settings. Ureteroscopy was performed without UAS and with the use of 11/13 and 12/14 UAS at the ureteropelvic junction. Two different irrigation methods were employed for each parameter: one using gravity flow and the other using manual pumping with a commercial pump. IRP was also recorded with the presence of a laser fiber or lithotripsy basket. (3) Results: The recorded mean IRP during flexible URS without UAS was 28.25 (±11.2) under gravity irrigation; 35.46 (±10.08) under manual pumping; 22.5 (±3.05) and 30.75 (±5.79) with a laser fiber under gravity irrigation and manual pumping, respectively; and 16.45 (±1.27) and 17.27 (±3.69) with a lithotripsy basket under gravity irrigation and manual pumping, respectively. With an 11/13 UAS, the mean IRP was 15.41 (±8.57) and 19.33 (±4.26) under gravity and manual pumping irrigation, respectively; 14.56 (±2.50) and 18.64 (±5.13) with a laser in each irrigation setting, respectively; and 13.10 (±3.39) and 13.86 (±4.63) with a lithotripsy basket, respectively. With a 12/14 UAS, the mean IRP was 7.64 (±3.08) and 9.25 (±1.42) under gravity and manual pumping irrigation, respectively; 9.50 (±6.04) and 10.28 (3.46), respectively, in each setting when the laser fiber was used; and 5.32 (±1.57) and 6.26 (±1.79), respectively, when the lithotripsy basket was inserted. (4) Conclusion: Novel flexible ureteroscopes with integrated pressure sensors are both a feasible and reliable tool during fURS, giving the surgeon the ability to live-track the IRP. The results of the IRP measurements with and without UAS are in accordance with the current literature and exhibit a consistent pattern with previous studies.

Objective: The aim of the study was to characterize artificial stones which are used for research in endourology from the perspective of radiological properties and hardness in terms of stone fragmentation, and to compare them to real stones from those assessments. Materials and Methods: We built artificial stones from BegoStone Plus powder (BEGO Lincoln, RI, USA) with powder(grams): water(ml) ratios from 15:03 to 15:12. The CT Gemstone Spectral Imaging Software (GE Medical Systems, LLC. Waukesha, WI, U.S.A) was used to evaluate the radiological density in Hounsfield Units (HU) and spectral properties. Stone fragmentation was assessed with an in vitro experimental setting. Artificial stones were compared to real urinary calculi from those perspectives. Results: Regarding radiological density in terms of HU, 15:03 artificial calculi showed similar results compared to real stones composed of Calcium Oxalate and Calcium Phosphate. Spectral properties wise, 15:03 and 15:04 artificial stones showed similar results than calcium pyrophosphate stones. Stone fragmentation wise, 15:11 artificial stones showed similar results than real stones composed of uric acid. 15:03 artificial calculi showed similar results than apatite and cystine stones. Conclusions: Artificial stones are very useful for research in endourology. Stones with a gr of powder: ml water ratio of 15:03 proved to mimic hard real stones in terms of HU, atomic number and stone fragmentation in our study and could be used as artificial hard stones. 15:11 stones showed similar stone fragmentation than uric acid stones. Our study might suggest that standard Bego stones are a very useful material to investigate different areas in endourology but not radiological properties because radiological homogeneity is not ensured unless using more sophisticated mixing methods.

Bladder malignancy represents the fourth most common cancer in men and the eighth in women in the western world. Women under 75 years of age have a risk of 0.5–1% of developing bladder cancer. The diagnosis usually occurs between 65 and 70 years of age, whereas the mortality rate for women varies from 0.5 to 4 per 100,000 every year. Nulliparous women present a greater risk than women who have given birth. The risk is further decreased when parity increases. Theoretically, hormonal changes occurring during pregnancy play a protective role. Smoking and occupational exposure to specific chemicals are the most common risk factors of bladder cancer. Other risk factors such as chronic urinary tract inflammation, cyclophosphamide, radiotherapy, and familial correlation have been reported. The aim of this review is to highlight a rare combination, which is the co-existence of bladder malignancy and pregnancy. We present thirteen different cases of women who were diagnosed with malignant bladder tumors during their pregnancy. A review of the literature was conducted, focusing on the unspecific symptoms, possible diagnostic tools, and suitable treatment modalities. The management of bladder cancer in pregnancy is a challenging process. The fragile balance between the possible complications of pregnancy and maternal health is yet to be discussed.

The Mayo Adhesive Probability (MAP) score is a radiographic scoring system that predicts the presence of adherent perinephric fat (APF) during partial nephrectomies (PNs). The purpose of this systematic review is to summarize the current literature on the application of the MAP score for predicting intraoperative difficulties related to APF and complications in laparoscopic PNs. Three databases, PubMed, Scopus and Cochrane, were screened, from inception to 29 October 2023, taking into consideration the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Guidelines. All the inclusion criteria were met by eight studies. The total operative time was around two hours in most studies, while the warm ischemia time was <30 min in all studies and <20 min in four studies. Positive surgical margins, conversion and transfusion rates ranged from 0% to 6.3%, from 0% to 5.0% and from 0.7% to 7.5%, respectively. Finally, the majority of the complications were classified as Grade I-II, according to the Clavien–Dindo Classification System. The MAP score is a useful tool for predicting not only the presence of APF during laparoscopic PNs but also various intraoperative and postoperative characteristics. It was found to be significantly associated with an increased operative time, estimated blood loss and intraoperative and postoperative complication rates.