Objective: To explore the impact of supine retroperitoneal single-port robot-assisted partial nephrectomy with lower anterior access on perioperative ventilatory, cardiovascular, and pain-related outcomes compared to a cohort of patients treated with single-port robot-assisted retroperitoneal or transperitoneal partial nephrectomy with standard flank patient positioning. Materials and Methods: Clinical and surgical data of all consecutive patients treated with single-port robot-assisted partial nephrectomy between March 2019 and January 2024 were prospectively collected and retrospectively analyzed. Specific same-day-discharge guidelines were applied to all cases. Failed same-day discharge was defined as the presence of early (<90 days) perioperative complications or the absence of opioid-free postoperative recovery. Results: Overall, 105 consecutive patients treated with single-port robot-assisted partial nephrectomy were analyzed. No differences emerged in baseline features. Peak inspiratory pressure and plateau pressure changes were significantly lower in the supine retroperitoneal lower anterior access group from the time of CO₂ insufflation throughout every 30-min operative setpoint assessment (p = 0.02, p = 0.03, and p = 0.02, respectively). The transperitoneal group showed significantly higher values of mean, systolic, and diastolic blood pressure compared to retroperitoneal approaches. The supine lower anterior access group also showed significantly lower non-surgical operative room time, perioperative opioid administration, and postoperative median VAS pain score. Conclusions: The adoption of supine lower anterior access improved perioperative ventilatory, cardiovascular, and pain-related outcomes, also optimizing operating room efficiency. Further multicenter series with longer follow-ups are still needed to validate our preliminary results.

Background and Objectives: Totally endophytic renal tumors are a unique subset that pose significant technical challenges during partial nephrectomy (PN). The aim of this study was to evaluate the perioperative, oncologic, and functional outcomes of PN in this particular setting. Materials and Methods: We retrospectively evaluated 4151 patients who had surgical treatment for renal tumors between January 2013 and December 2016 at 26 urological Italian Centers (RECORD 2 project). Only patients treated with PN for entirely endophytic renal tumor were considered for final analyses. Results: A total of 211 patients were included, with a median PADUA score of 10 (IQR 9-11). Open, laparoscopic, and robotic approaches were used in 94 (44.5%), 52 (24.6%), and 65 (30.8%) cases, respectively. While surgical approach did not impact complication rates, robotic PN had significantly lower median blood loss (100 vs. 185 vs. 175 cc, p = 0.04) and shorter operative time (126 vs. 140 vs. 160 min, p = 0.01) compared to open and laparoscopic PN. At a median follow-up of 36.3 months (IQR 21.9–49.2), recurrence-free survival was 93.8%. Median %eGFR drop at 24 months was 12.1 (IQR 5.1–21.9), with significant eGFR loss (≥25%) in 36 (17.1%) patients. The robotic approach was associated with a lower %eGFR drop at 1-month and 1-year evaluations, but the benefit diminished at 24 months. Multivariate analysis showed age and open surgery as independent predictors of renal function loss at 1 month and Trifecta failure. Conclusions: The conservative management of entirely endophytic renal tumors is associated with favorable functional and oncologic outcomes. Whenever technically feasible, conservative surgery should be prioritized to optimize early renal function recovery.

Background/Objective: The impact of adjuvant immunotherapy (IO) on the prognosis of patients with upper tract urothelial carcinoma (UTUC) remains unclear. This study examines the association of adjuvant IO with oncologic outcomes in patients with high-risk UTUC. Methods: This retrospective study reviewed patients with high-risk UTUC treated with adjuvant IO using the ROBotic surgery for Upper tract Urothelial cancer STudy (ROBUUST) database. Propensity-score-matched analysis (nearest-neighbor algorithm, caliper 0.1) was conducted to compare patients receiving adjuvant IO versus those who did not, with matching based on pathologic T and N category and receipt of neoadjuvant chemotherapy. Associations between adjuvant IO and urothelial recurrence-free survival (URFS), non-urothelial recurrence-free survival (NRFS), and overall survival (OS) were estimated using a Cox proportional hazards model. Results: Seventy-five patients received adjuvant IO following nephroureterectomy (median four cycles, including eleven (14.7%) nivolumab, thirty-one (41.3%) pembrolizumab, four (5.3%) atezolizumab, and twenty-nine (38.6%) other agents. These patients were matched to 68 patients without adjuvant therapy. Median follow-up times were 17 (IQR, 10–29) months and 20 (9–44) months for IO and no adjuvant therapy, respectively. Multivariable analysis revealed that adjuvant IO was not associated with URFS, NRFS, or OS. Pathologic nodal involvement (HR 7.52, p < 0.001) was the only independent predictor of worse OS. Conclusions: In this real-world retrospective data set, adjuvant IO does not have an impact on oncologic outcomes of UTUC patients following extirpative surgery.

Background: Renal tumors in solitary kidneys require treatments that optimize both oncological and functional outcomes. Robot-assisted partial nephrectomy (RAPN) offers a balance between these needs and reduced morbidity. This study investigates the oncologic and functional outcomes of RAPN in solitary-kidney patients. Methods: We analyzed data from 1852 patients with cT1-T4N0M0 renal cell carcinoma treated by RAPN from January 2018 to June 2022. The cohort included patients with solitary kidneys based on preoperative characteristics, tumor staging and perioperative outcomes using the Trifecta criteria. Results: Of the study participants, 39 had solitary kidneys. Fifteen patients (38.6%) had an ASA score > 2, indicating a higher preoperative risk. The median PADUA score was 7 (IQR 8–9). Moreover, 28 (71.8%) patients had a chronic kidney disease stage > 2. Trifecta success was achieved in 26 (66.6%) of the cases. During a median follow-up of 36 months, tumor recurrence was observed in 12 patients (30.7%), with local recurrences in 4 (10.2%) and systemic recurrences in 8 (20.5%). A higher ASA score and global ischemic clamping were independent predictors of renal function decline at the third postoperative day and Trifecta failure. Only a higher ASA score significantly predicted a significant long-term decline in renal function. Nucleolar grade at pathological stage was the only factor significantly associated with tumor recurrence. Conclusions: RAPN is as an effective treatment for renal tumors in solitary kidneys, balancing oncological control and renal function preservation. Global ischemia and patient physical status are the most important factors influencing outcomes and highlight the importance of patient selection and tailored surgical strategies.

Background: With the rapid advancement of artificial intelligence (AI), its applications in andrology are expanding across diagnostic assessment, preoperative planning, intraoperative assistance, and postoperative management. This narrative review aims to synthesize current evidence regarding AI applications across the spectrum of andrological surgery. Methods: A comprehensive literature search was conducted using the PubMed, Scopus and Web of Science databases to identify relevant studies published between January 2020 and October 2025. The search strategy utilized combinations of keywords including “artificial intelligence,” “andrology,” “erectile dysfunction,” “male infertility,” “microsurgery,” and “robotic-assisted surgery.” Original research and review articles published in English were selected based on their clinical relevance to surgical practice. Results: AI has shown promise in the evaluation and management of erectile dysfunction (ED), male infertility-related microsurgery, and complex reconstructive procedures. AI-based models can improve risk prediction and diagnosis of ED, standardize semen analysis, support individualized selection of surgical candidates for varicocele repair and other interventions, and augment microsurgery through enhanced visualization and decision support. In the postoperative phase, AI-driven tools are being explored for complication prediction, functional recovery monitoring, and long-term quality-of-life follow-up, enabling more patient-centered, continuous care. Conclusions: AI holds significant promise for advancing precision medicine in andrological surgery by enhancing objective assessment and intraoperative guidance. However, large-scale, standardized datasets and rigorous multi-institutional validation are needed. Establishing robust ethical and legal frameworks will be essential to ensure the safe and effective integration of AI into routine andrological care.

Background: Chronic Prostatitis/Chronic Pelvic Pain syndrome NIH-class III is a widespread condition affecting men universally, with existing treatments showing limited success. This study evaluated the efficacy and safety of a natural supplement, composed of Serenoa repens, Solanum lycopersicum, lycopene, and bromelain, in managing symptoms of this condition among a substantial patient group. Methods: In this prospective study, 245 patients diagnosed with Chronic Prostatitis/Chronic Pelvic Pain syndrome NIH-class III were treated with the aforementioned supplement, alongside lifestyle alterations, such as refraining from spicy foods, alcohol, caffeine, and cycling, for a duration of three months. Patients’ progress was assessed at one and three months using the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI), the International Prostate Symptom Index (IPSS), quality of life (QoL) scores, and changes in total prostate-specific antigen (PSA) levels. Results: The supplement was well received with no serious adverse events reported. Significant improvements were observed in NIH-CPSI scores, IPSS, QoL scores, and a substantial decrease in total PSA levels at three months compared to baseline, with a positive trend noted from one-month to three-month evaluations. This was consistent in either patients with predominantly voiding or storage urinary symptoms. Conclusions: Our results suggest that this natural supplement in conjunction with lifestyle changes could offer a safe and effective alternative treatment for patients suffering from Chronic Prostatitis/Chronic Pelvic Pain syndrome NIH-class III. However, these findings require validation through further large-scale randomized controlled trials.