Posterior retroperitoneal laparoscopic adrenalectomy (PRLA) has emerged as a revolutionary, minimally invasive technique for adrenal gland surgery, offering significant advantages over traditional open approaches. This narrative review aims to provide a comprehensive update on PRLA, focusing on its anatomical foundations, surgical technique, and clinical implications. We conducted an extensive review of the current literature and surgical practices to elucidate the key aspects of PRLA. The procedure leverages a unique “backdoor” approach, accessing the adrenal glands through the retroperitoneum, which necessitates a thorough understanding of the posterior abdominal wall and retroperitoneal anatomy. Proper patient selection, meticulous surgical planning, and adherence to key technical principles are paramount for successful outcomes. In this paper, the surgical technique is described step by step, emphasizing critical aspects such as patient positioning, trocar placement, and adrenal dissection. PRLA demonstrates reduced postoperative pain, shorter hospital stays, and faster recovery times compared to open surgery, while maintaining comparable oncological outcomes for appropriately selected cases. However, the technique presents unique challenges, including a confined working space and the need for surgeons to adapt to a posterior anatomical perspective. We conclude that PRLA, in the right clinical setting, offers a safe and effective alternative to traditional adrenalectomy approaches. Future research should focus on expanding indications and refining techniques to further improve patient outcomes.

Background/Objectives: The aim of this study was to investigate the relationship between age, the severity of erectile dysfunction (ED), and the various hormones that may influence erectile function. Methods: A multicenter cross-sectional study was conducted between January 2015 and December 2023. The study assessed age, sexual function using the IIEF-15 questionnaire, and the levels of total testosterone (TT), free testosterone (FT), FSH, LH, estradiol, prolactin (PRL), and SHBG. Results: A total of 411 patients were included in the study. The mean age of the patients was 63.19 years. The vast majority (91.73%) exhibited some degree of ED. The severity of ED increases with age, ranging from 56.26 years for patients without ED to 73.12 years for those with severe ED. A statistically significant negative correlation was observed between IIEF and age, while a positive correlation was observed between IIEF and serum levels of TT and FT (p < 0.05). Age was significantly correlated with all evaluated hormones (p < 0.01), except estradiol and prolactin. Total testosterone levels progressively decreased with the increase in the severity of erectile dysfunction, from a median of 7.05 ng/mL in patients with normal erectile function to 3.56 ng/mL in those with severe symptoms, remaining above the normal minimum threshold across all groups, whereas free testosterone (FT) levels also declined progressively. All erectile dysfunction groups had median FT levels below the normal minimum threshold. FSH, LH, and SHBG showed an increase with each progressive severity of erectile dysfunction. The multivariate linear regression revealed that IIEF scores are significantly associated with age, TT, and FT levels, while FSH did not present a statistically significant association in this model. Conclusions: Age shows a significant statistical correlation with both the severity of erectile dysfunction and the levels of total testosterone, free testosterone, LH, FSH, and SHBG. Total and free testosterone levels are significantly associated with the severity of erectile dysfunction, with free testosterone median values remaining above the normal minimum threshold in all patients with erectile dysfunction. Therefore, free testosterone should be considered a routine test, alongside total testosterone. In contrast, LH, estradiol, SHBG, and prolactin do not demonstrate any statistical correlation with erectile dysfunction and should not be recommended as routine investigations.

Background/Objectives: Ureteral stents are indispensable tools in contemporary urological practice; however, their prolonged indwelling is frequently associated with a spectrum of complications. This study aims to evaluate the correlation between indwelling duration and the extent of stent encrustation, as well as the impact on extraction difficulty. Methods: A retrospective analysis was conducted on 33 patients treated at Clinical County Emergency Hospital of Brașov between December 2023 and December 2024. All patients had polyurethane double-J ureteral stents placed. Parameters assessed included the degree of stent encrustation, discoloration, incidence of urinary tract infections (UTIs), and extraction difficulty. These were analyzed in relation to indwelling time and patient comorbidities. Statistical processing was performed using SPSS 23.0 software, with significance set at p < 0.05. Results: A statistically significant association was observed between longer stent indwelling times and higher grades of encrustation, particularly for the intervals of 45–90 days and over 90 days (p = 0.008 and p = 0.01, respectively). Low encrustation demonstrated correlations with certain comorbidities, whereas no statistically relevant associations were found for moderate and severe encrustation. Black coloration of the stents was strongly associated with UTIs caused by Escherichia coli, Klebsiella spp., and Enterococcus spp. (p < 0.001), as well as with extended indwelling durations (p < 0.001). No significant correlation was identified between the presence of UTIs and the degree of stent encrustation. Conclusions: Indwelling time is a critical determinant of both ureteral stent encrustation and discoloration, with direct implications for clinical decision-making regarding stent management and extraction planning. Timely removal and close monitoring are essential to reduce the risk of complications associated with long-term stent placement.

Background/Objectives: The objective of this study is to explore potential correlations between prostate volume, LUTS, and IIEF, with a particular emphasis on the relationship between prostate dimensions—width, height, and length—and both LUTS and IIEF and to assess patients based on risk factors such as hypertension, diabetes, cardiovascular disease, smoking, alcohol consumption, and PSA levels. Methods: A retrospective multicenter study was conducted between January 2007 and December 2023, focusing on male patients over the age of 40. The study evaluated hypertension, diabetes, cardiovascular diseases, smoking, alcohol consumption, and lower urinary tract symptoms (LUTS) through the completion of the IPSS and QoL questionnaires, sexual function using the IIEF-15, and PSA levels. Abdominal ultrasound was performed to determine prostate volume and its dimensions (width, height, and length). Results: A total of 943 patients were included in the study, with a mean age of 61.89 ± 8.51 years. From the 40–49 age group to the 80–90 age group, IPSS increased from 10.29 to 14.26 points, PSA from 1.1 ng/mL to 3.05 ng/mL, and prostate volume from 23.79 mL to 41.16 mL. Meanwhile, over the same age intervals, IIEF showed a decline from 52.57 to 24.76 points. The IPSS demonstrated a statistically significant positive correlation (p < 0.05) with prostate volume and patient age, while showing an inverse correlation with IIEF. The only statistically significant correlation between IPSS and prostate dimensions was with the length diameter of the prostate (p = 0.011). The severity of sexual symptoms was inversely correlated with both prostate volume and age. Additionally, IIEF was negatively correlated with the width and length diameters of the prostate. Hypertension (p = 0.57), diabetes (p = 0.57), smoking (p = 0.76), and alcohol consumption (p = 0.27) did not have a statistically significant impact on IPSS, and IIEF except for cardiovascular diseases, which showed a significant correlation with IPSS in patients experiencing moderate to severe symptoms (p = 0.0001). The statistically significant correlation between cardiovascular diseases and IIEF was observed only in patients with severe symptoms (p = 0.0001). Conclusions: There is a correlation between prostate volume, IPSS, and IIEF. Only length of the prostate shows a statistically significant correlation with both IPSS and IIEF. PSA levels increase progressively with each decade of age. Hypertension, diabetes, smoking, and alcohol consumption do not have a statistically significant impact on LUTS and erectile function. Cardiovascular diseases show a correlation with patients experiencing moderate to severe LUTS, as well as with those who have severe symptoms according to the IIEF evaluation.

Posterior retroperitoneal laparoscopic adrenalectomy (PRLA) has emerged as a revolutionary minimally invasive technique for adrenal gland surgery, offering significant advantages over traditional open approaches. This narrative review aims to provide a comprehensive update on PRLA, focusing on its anatomical foundations, surgical technique, and clinical implications. We conducted an extensive review of the current literature and surgical practices to elucidate the key aspects of PRLA. The procedure leverages a unique "backdoor" approach, accessing the adrenal glands through the retroperitoneum, which necessitates a thorough understanding of posterior abdominal wall and retroperitoneal anatomy. Proper patient selection, meticulous surgical planning, and adherence to key technical principles are paramount for successful outcomes. The surgical technique is described step-by-step, emphasizing critical aspects such as patient positioning, trocar placement, and adrenal dissection. PRLA demonstrates reduced postoperative pain, shorter hospital stays, and faster recovery times compared to open surgery, while maintaining comparable oncological outcomes for appropriately selected cases. However, the technique presents unique challenges, including a confined working space and the need for surgeons to adapt to a posterior anatomical perspective. We conclude that PRLA, in the right clinical setting, offers a safe and effective alternative to traditional adrenalectomy approaches. Future research should focus on expanding indications and refining techniques to further improve patient outcomes.

Background: To diagnose prostate cancer, a prostate biopsy is required. Two methods are commonly used for biopsy: transrectal and transperineal. The transperineal approach, particularly the “freehand” technique under local anesthesia, offers better access to the anterior prostate, lower infection risk, and higher detection rates. Methods: This retrospective study examined the records of 1674 patients who underwent ultrasound-guided prostate biopsies between 2015 and 2022. Of these, 1161 patients had transperineal biopsy using the “freehand” method, and 513 had transrectal biopsy. All the biopsies were carried out under local anesthesia, with a combined systematic and targeted approach for patients with MRI-identified lesions. Results: This study demonstrates that the transperineal biopsy approach significantly increased the detection rate of clinically significant prostate cancer compared with the transrectal method, with detection rates of 65.7% and 59.4%, respectively. Notably, the transperineal technique also achieved superior detection of anteriorly located tumors (94.1% vs. 43.1%), supporting its use as the preferred biopsy strategy, particularly in anatomically challenging regions. Moreover, patients who underwent transperineal biopsy demonstrated more favorable diagnostic outcomes, characterized by a higher detection rate for clinically significant cancers and a reduced incidence of clinically insignificant cases. The transperineal method outperformed the transrectal approach, especially among younger patients and those presenting with lower PSA values. These results highlight the diagnostic superiority and broader clinical applicability of the transperineal biopsy technique across various patient subgroups.