Introduction: We aimed to examine the change in the number and severity of visits to the emergency departments (EDs) and subsequent admissions for urgent urologic conditions in the early stage of the coronavirus disease 2019 (COVID-19) pandemic in Poland.Material and methods: We evaluated data from 13 urologic centers in Poland and compared the number of visits to the EDs and subsequent admissions before and after the advent of COVID-19 in 2020, and before and after the escalating national restrictions. Furthermore, data on types of urologic complaints, crucial laboratory parameters, and post-admission procedures were analyzed.Results: In total 1,696 and 2,187 urologic visits (22.45% decrease) and 387 and 439 urologic urgent admissions (11.85% decrease) were reported in given periods in 2020 and 2019, respectively. The year-over-year difference in daily mean visits was clear (36.1 vs. 46.5; p < 0.001). Declines were seen in all complaints but device malfunction. In 2020 daily mean visits and admissions decreased from 40.9 and 9.6 before lockdowns to 30.9 (p < 0.001) and 6.9 (p = 0.001) after severe restrictions, respectively. There was a trend towards more negative laboratory parameter profiles in 2020, with patients who visited the EDs after severe restrictions having twice as high median levels of C-reactive protein (15.39 vs. 7.84, p = 0.03).Conclusions: The observed declines in ED visits and admissions were apparent with the significant effect of national lockdowns. Our results indicate that some of the patients requiring urgent medical help did not appear at the ED or came later than they would have done before the pandemic, presenting with more severe complaints.

The Central European Journal of Urology is an open access quarterly-issued journal, which provides a forum for the presentation of original clinical, experimental and other research studies...

Background: Urachal pathologies, while rare, carry a risk of malignant transformation. Robot-assisted urachal excision and partial cystectomy (RAUEPC) is a minimally invasive technique that offers potential advantages, but the available evidence remains limited. This study aims to evaluate the outcomes of RAUEPC for benign and malignant urachal pathologies through a systematic review and single-center experience. Methods: A systematic review was conducted using PubMed, Scopus, the Cochrane Library, and ScienceDirect (last search: 1 November 2024). Inclusion criteria encompassed studies reporting on RAUEPC for urachal pathologies, while non-robotic approaches and incomplete data were excluded. Risk of bias was assessed using the Newcastle-Ottawa Scale for cohort studies and the JBI Critical Appraisal Checklist for Case Reports. Descriptive statistics summarized continuous data (means, medians, 95% confidence intervals), and chi-square tests analyzed associations between categorical variables. Heterogeneity analysis was infeasible, necessitating narrative synthesis. Institutional retrospective data from three cases (2021–2024) were included for comparison. This study was registered in PROSPERO (CRD42024597785). No external funding was received. Results: A total of 44 studies (n = 145) met the inclusion criteria. Benign lesions accounted for 66.2% and malignant lesions for 33.8%. Mean operative time was 177.8 min (cumulative), 162.7 min (benign), 192.2 min (malignant), 85.33 min (institutional, 95% CI: 74.13–96.53). Mean blood loss was 85.4 mL (cumulative), 99.5 mL (benign), 72.7 mL (malignant), 216.66 mL (institutional). Mean hospital stay was 3.64 days (cumulative), 3.26 days (benign), 4.36 days (malignant), 6.33 days (institutional, 95% CI: 3.46–9.20). Complications occurred in 10.04% (cumulative), 11.82% (benign), 8.57% (malignant), with one minor event (Clavien–Dindo II) in institutional cases. No conversions to open surgery were reported. All cases achieved complete excision with no R1 resections. No recurrences were observed at 10.66-month (institutional) mean follow-up. Conclusions: RAUEPC appears to be a feasible and safe approach with promising short-term outcomes. The associations between symptoms and diagnostic methods highlight its utility. The limitations of the evidence include small sample sizes and retrospective designs. Further prospective studies are needed to validate these findings.

Introduction: This article juxtaposes case series with a systematic review to evaluate the feasibility, safety, and clinical outcomes of concurrent robotic multisite urological surgeries, specifically robot-assisted radical prostatectomy (RARP) and robot-assisted partial nephrectomy (RAPN), for synchronous prostate and kidney cancers. Aim: The aims of this study were to evaluate the feasibility, safety, and clinical outcomes of urological concurrent robotic multisite surgeries through a comparison of institutional findings with the existing literature. Materials and Methods: A retrospective analysis was conducted on eight institutional cases of concurrent robotic multisite surgeries performed between 2021 and 2024. The primary outcomes measured were operative time, blood loss, and postoperative complications. A systematic review of the literature was performed, searching PubMed, Embase, and Cochrane Library databases, with the last search conducted on 1 July 2024. Studies were included if they reported on concurrent robotic surgeries corresponding to the procedures performed at the institution, including RARP with RAPN, RARP with robotic transabdominal preperitoneal inguinal hernia repair (RTAPPIHR), and other multisite robotic surgeries. Risk of bias was assessed using the modified Newcastle–Ottawa Scale. Descriptive statistics were used to analyze operative time and blood loss, with confidence intervals (CIs) calculated to assess precision. Categorical variables, including postoperative complications, were summarized using frequencies and percentages. Heterogeneity was assessed using the I² statistic, with values above 50% indicating substantial heterogeneity. A random effects model was applied when necessary, and sensitivity analyses excluded studies with high risk of bias. Results: We describe a unique docking technique employed in our procedures, which allows for atraumatic transitions between surgeries using the same port sites. Our institutional cases demonstrated the feasibility and safety of concurrent robotic multisite surgery, with a mean operative time of 315 min (95% CI: 290–340) and mean blood loss of 300 mL (95% CI: 250–350). There were no significant intraoperative complications reported. These findings are consistent with the literature, where mean operative times range from 390 to 430 min and blood loss ranges from 200 to 330 mL. Notably, no positive surgical margins or declines in postoperative renal function were observed in our cases. The systematic review included nine retrospective studies involving 40 cases of concurrent RARP and RAPN, as well as eleven studies including 392 cases of RARP combined with RTAPPIHR. The findings from these studies support the feasibility and safety of concurrent surgeries, showing similar rates of operative time, blood loss, and postoperative complications. Conclusions: Concurrent robotic multisite surgeries, such as RARP combined with RAPN or RTAPPIHR, appear to be safe and feasible. Our data suggest these procedures are non-inferior to separate surgeries in terms of safety and complication rates. Potential benefits, including reduced operative times, shorter hospital stays, and more efficient resource use, may translate into cost savings, although no formal cost-effectiveness analysis was conducted. Limitations include the small sample size, retrospective design, and lack of long-term follow-up. Prospective trials are needed to validate these findings and further refine the techniques. Funding: this review did not receive any external funding. Registration: this review was not registered in any public protocol registry due to its comparative retrospective nature.

Background: Bleeding from an ileal conduit after radical cystectomy is uncommon and is usually attributed to tumor recurrence, infection, stones, or local stomal trauma. Portal hypertensive stomal varices are rare. FOLFIRINOX adds further diagnostic complexity because oxaliplatin may cause sinusoidal endothelial injury and noncirrhotic portal hypertension, whereas irinotecan may damage gastrointestinal mucosa. We report a case of massive hemorrhage from a long-functioning Bricker ileal conduit during FOLFIRINOX therapy. Case presentation: A 72-year-old man with prior radical cystoprostatectomy with Bricker diversion in 2022, robot-assisted left adrenalectomy in 2023, and pancreatic head adenocarcinoma treated with FOLFIRINOX was admitted in February 2026 because of sudden gross hematuria that rapidly filled the urostomy bag with blood and clot. He had received two FOLFIRINOX cycles. With a height of 170 cm and weight of 70 kg, body-surface area was 1.82 m² by the Mosteller formula. Using the standard FOLFIRINOX oxaliplatin dose of 85 mg/m², the reconstructed cumulative oxaliplatin exposure was approximately 170 mg/m², corresponding to about 310 mg in total. Bleeding began 8 days after the most recent irinotecan-containing cycle. Contrast-enhanced computed tomography showed periportal tumor-related changes with a biliary stent, variceal collaterals adjacent to the conduit, and circumferential thickening of the conduit wall, whereas the upper urinary tracts were nondilated and there was no radiologic evidence of recurrent urothelial carcinoma. Looposcopy demonstrated diffusely inflamed and friable conduit mucosa, but biopsy was not performed. Doppler ultrasonography demonstrated portal vein dilatation with preserved hepatopetal flow and no imaging features of cirrhosis. Platelet counts remained within the reference range, and retrospective review of restaging computed tomography showed no interval splenomegaly; the craniocaudal splenic length was approximately 11 cm and unchanged. Urine culture grew extended-spectrum beta-lactamase-producing Escherichia coli and Enterococcus faecalis, but inflammatory markers remained low and there were no clinical features of sepsis. The most cautious interpretation was a mixed mechanism: portal hypertensive stomal varices, possibly related to pancreatic venous distortion and/or early oxaliplatin-associated sinusoidal injury, compounded by presumed irinotecan-associated conduit mucositis. Bleeding ceased with supportive, anti-inflammatory, antimicrobial, transfusion, and nonselective beta-blocker therapy. By May 2026, conduit bleeding had not recurred, although the patient remained chronically unwell with poor ECOG performance status because of the underlying pancreatic cancer. Conclusions: Massive bleeding from a Bricker conduit during FOLFIRINOX therapy may be multifactorial. Early portal-phase imaging and portal venous assessment are essential when hemorrhage is disproportionate to routine urinary tract findings. In the absence of histology, catheter venography, and portal pressure measurement, causal language should remain cautious. If bleeding recurs, management should move beyond local measures and consider venous mapping, targeted embolization or sclerotherapy, portal decompression or venous stenting in suitable anatomy, and surgical undiversion to bilateral cutaneous ureterostomies when durable conduit preservation appears unlikely.