Background: The miniaturization of ureterorenoscopes increasingly enables atraumatic primary ureteroscopy, without ureteral dilation or presenting. This study aims to evaluate the feasibility and safety of primary ureteroscopy using the HU30M (6.3 Fr, HugeMed, Shenzhen HugeMed Medical Technical Development Co., Ltd., Shenzhen, China), the smallest currently available ureteroscope. Methods: We analyzed consecutive patients in whom primary ureteroscopy using the HU30M was performed or attempted, using prospectively collected in-hospital and 30-day follow-up data for retrospective evaluation. The primary outcome was the success rate of primary ostial intubation. Secondary outcomes included the stone-free rate (SFR) in patients with urolithiasis, incidence of in-hospital complications (Clavien–Dindo classification) and 30-day emergency readmission. Additionally, we conducted a propensity score-matched comparative analysis of the HU30M versus a contemporary 7.5 Fr digital single-use ureteroscope (PUSEN PU3033AH, Zhuhai Pusen Medical Technology Co., Ltd., Jinhua, China). Results: Between January and April 2025, primary ureteroscopy using the HU30M was performed or attempted in 34 patients, including four bilateral procedures. Primary ureteroscopy was defined as ureteroscopic access without prior stenting or dilation. Indications were diagnostic evaluation in 15 patients (44%), uretreroscopic stone treatment in 10 patients (29%) and endoscopic combined intrarenal surgery (ECIRS) in 9 patients (27%). Successful primary ostial intubation was achieved in 36 of 38 renal units (95%). Among urolithiasis cases, SFR was 17/19 (90%) in-hospital complications were limited to postoperative fever in two patients (6%) and no procedure-related 30-day emergency readmission occurred. In matched analyses, HU30M demonstrated significantly shorter operative times compared with the 7.5 Fr ureteroscope, while postoperative hemoglobin drop, inflammatory parameters and renal function were comparable. Conclusions: Primary ureteroscopy with HU30M is feasible and safe across diverse indications, achieving high success of atraumatic ostial access. Comparative analyses suggest procedural efficiency advantages and overall safety comparable to the current digital single-use ureteroscope standard.

Background: Erectile dysfunction (ED) affects up to 50% of men over 40. While phosphodiesterase‐5 inhibitors (PDE5i) are the first line of medical treatment, they are not always effective. Alprostadil, available in injectable, topical, and intraurethral forms, offers an alternative treatment modality. Objectives: This systematic review and meta‐analysis aim to evaluate the efficacy and safety of topical and intraurethral forms of alprostadil. Materials and methods: The objectives and methods of this systematic review and meta‐analysis were predefined in a protocol registered on PROSPERO (CRD42021260894). We systematically searched PubMed, EMBASE, and the Cochrane Library up to April 2024. Using a random‐effects model, we compared the efficacy of topical and intraurethral forms of alprostadil against placebo. Additionally, we performed a qualitative assessment of the studies using RoB‐2 and ROBINS‐I tools. Results: The analysis included 11 randomized controlled trials and 4 non‐randomized studies, encompassing 5869 patients with a mean age of 60 ± 9.4 years. The meta‐analysis showed a statistically significant improvement in the IIEF score by 4.7 points (95% CI: 2.4–7.1, I ² = 97%) in patients using the topical form of alprostadil compared to placebo. There was also a statistically significant improvement of ED in patients using intraurethral alprostadil compared to placebo, with a pooled odds ratio of 0.08 (95% CI: 0.04–0.16, I ² = 54%). The most common adverse events reported were penile pain and erythema. Discussion: These results are limited by the variability in study designs and the relatively small number of included studies in the meta‐analysis. Moreover, the low methodological quality of the included studies further limits the strength of the conclusions. Conclusions: Topical and intraurethral alprostadil significantly improve ED symptoms compared to placebo and are generally safe, with no serious adverse events. Further trials are necessary to confirm and expand on these findings.

Introduction: Ureteral diverticula are rare urological anomalies characterized by outpouchings of the ureteral wall. Malignancy arising from these structures is exceptionally rare, with only a few cases reported. Case Presentation: We report a 57‐year‐old male with high‐grade urothelial carcinoma arising from a ureteral diverticulum in the left distal ureter. The patient experienced painless gross hematuria, and computed tomography revealed a 3 cm undetermined mass near the left distal ureter. Multiple endoscopic diagnostic procedures were inconclusive, with the final diagnosis confirmed intraoperatively. The surgery involved resection of the mass, and intraoperative frozen section analysis revealed high‐grade urothelial carcinoma. A segmental ureteral resection was performed with reconstruction using a Boari flap and Psoas hitch. Final histopathology confirmed locally advanced, high‐grade pT3 urothelial carcinoma, and adjuvant chemotherapy was recommended. Conclusion: This case underscores the diagnostic and management challenges of upper tract urothelial carcinoma, especially in rare cases involving ureteral diverticula.