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.

Introduction: Surgical management of prostate cancer has evolved significantly over more than a century, transitioning from open procedures to modern robot-assisted techniques. This narrative review traces the historical progression of surgical treatments for localized prostate cancer, from early approaches to the most recent advancements. Materials and Methods: An extensive literature search was conducted from 1 April to 1 June 2025, using PubMed and cross-referencing citations. The search gathered studies on the evolution of prostate cancer surgery, technical aspects, and comparisons between surgical and non-surgical treatments. Keywords included “PROSTATE CANCER”, “PROSTATE CANCER SURGICAL TREATMENT”, “RADICAL PROSTATECTOMY EVOLUTION”, “ROBOT-ASSISTED RADICAL PROSTATECTOMY”, and “FOCAL THERAPY AND PROSTATE CANCER”. Results: A total of 65 manuscripts, including original articles, systematic reviews, meta-analyses, and clinical trials focusing on the surgical treatment of localized prostate cancer, were selected. The review begins with the history of prostatic surgery, chronicling its evolution through laparoscopic and, ultimately, robotic approaches. It highlights how improved visualization and new technologies have led to better functional outcomes and preservation of structures while maintaining oncological safety. A specific focus is placed on the technical evolution of robot-assisted radical prostatectomy, new robotic platforms, and the role of focal therapy as an ultra-minimally invasive technique for localized disease. Conclusions: Robot-assisted radical prostatectomy represents the current reference surgical technique for localized prostate cancer. However, it is crucial to acknowledge RALP’s elevated cost and the need for further long-term, randomized data to establish definitive oncological equivalence compared to non-surgical options.

Objective: To provide an updated national overview of the clinical management of congenital and acquired penile curvature (PC) in Italy, evaluating current diagnostic and therapeutic practices among Italian urologists.Materials and methods: A 23-item anonymous digital survey was distributed by the Italian Society of Urology (SIU) to 2034 affiliated urologists between 2024 and 2025. The survey includes demographic data, diagnostic approaches, and treatment strategies for PC, including Peyronie’s disease (PD). Participants were categorized by practice setting and geographic region. SPSS software was used to conduct descriptive and comparative analyses.Results: Overall, 442 urologists had completed the survey (response rate: 21.7%). Most participants were affiliated either with university hospitals (34.6%) or public non-university hospitals (32.8%). The major incidence of PD cases, as reported by 310 (70.1%) respondents, were in patients between 45-60 years old and the most frequent presentation was a dorsal curvature (223 responses, 50.5%). The routine clinical practice, as reported by respondents, includes anamnestic data with photographs collection and penile ultrasound (in 261 (59%) and 188 (42.5%) of respondents, respectively), while penile dynamic CCDU was mainly used in patients with erectile dysfunction. In regard to therapeutic strategies, 142 (32.8%) of urologists used Clostridium Collagenase Histolyticum (CCH) for intralesional therapy; a similar proportion used verapamil/nicardipine, despite limited supporting evidence. Interestingly, surgical approaches varied widely: tunica plication was preferred in non-complex cases by 169 (38.2%), while penile prosthesis was offered in complex cases by 129 (29.2%) urologists. Finally, penile prosthesis implantation was offered in patients with severe ED unresponsive to pharmacological therapy, regardless of penile curvature only by 176 respondents (39.8%), meanwhile, 177 respondents considered penile prothesis only for severe PC over >60 degrees associated with ED.Conclusions: This nationwide survey reveals a significative heterogeneity in PC and PD management in Italy, with frequent reliance on off-label treatments and variable adherence to international guidelines. Economic limitations and regional differences appear to be a primary factor influencing clinical decisions and clinical practice. These findings underline the need for a major dissemination of evidence-based guidelines associated with national healthcare strategies aimed at standardized care and improving patient outcomes.

Objective: To evaluate the early oncological outcomes of patients treated with robot-assisted radical prostatectomy for prostate cancer with multiple PIRADS lesions at baseline mpMRI in a tertiary referral center. Methods: Data of consecutive patients undergoing robot-assisted radical prostatectomy between 2020 and 2022 at a high-volume tertiary referral center were prospectively collected. mpMRI data was evaluated by two expert uro-radiologists at our center. All patients received an MRI–ultrasound fusion biopsy. Results: Overall, 286 patients with multiple PIRADS lesions treated with robot-assisted radical prostatectomy at a tertiary referral center were included. Unilateral and bilateral nerve-sparing were achieved in 63 (22.3%) and 124 (43.1%) patients, respectively. Median age was 69 years (IQR: 64–72), while median Charlson Comorbidity Index was 3 (IQR: 2–4). The presence of two PIRADS lesions was found in the 81.8% of cases, while 18.2% presented with three or more. Bilateral lesions were observed in 67.4% of cases. The dominant lesion was PIRADS 4 in 57.3% and PIRADS 5 in 32.3% of cases, with a median diameter of 12 mm (IQR: 10–17). Pathological upstaging to pT3 occurred in 61% of patients. Overall, 9.8% of cases exhibited positive surgical margins (PSMs), most of them single and limited in extent. Postoperative major complications were recorded in 6.3% of patients. At a median follow-up of 18 months (IQR: 6–29), biochemical recurrence (BCR) occurred in 8% of patients. Patients with PIRADS 5 lesions experienced shorter BCR-free survival compared to those with PIRADS 3–4. On multivariable Cox regression, PIRADS 5 independently predicted biochemical recurrence (HR: 2.52; 95% CI: 1.10–5.80; p = 0.029), after adjustment for age, number of lesions, and nerve-sparing status, with the performance of nerve-sparing not associated with an increased risk of recurrence, including in patients with multifocal disease. Conclusions: Nerve-Sparing Robot-Assisted Radical Prostatectomy in patients with multiple PIRADS lesions achieves encouraging short-term oncologic outcomes, with biochemical recurrence-free survival exceeding 84% at 3 years, despite high rates of multifocality and pathological upstaging.

Background: Orthotopic neobladder in women presents functional challenges, notably hyper-continence requiring intermittent self-catheterization. Here, we describe a three-layer urethro-ileal anastomosis incorporating a peritoneal flap and evaluate its impact on functional outcomes at the time of robot-assisted radical cystectomy (RARC) and Florence Robotic Intracorporeal Neobladder (FloRIN) reconfiguration. Methods: Clinical data from consecutive patients treated with non-sexual-sparing RARC and FloRIN were prospectively collected between March 2016 and January 2024. Hyper-continence was defined as intermittent self-catheterization or postvoid residual > 200 cc at last follow-up. A three-layer anastomosis was performed incorporating a peritoneal flap and utilizing a three-step barbed suture technique for posterior reconstruction: (1) the peritoneum of the rectouterine pouch was sutured to the paraurethral ligaments, (2) the external ileal layer was approximated to the paraurethral ligaments, and (3) the ileal mucosa was anastomosed to the urethra. Urodynamic evaluation was performed 6 months postoperatively. Results: Overall, 32 patients entered the study. Median age was 72 (IQR 67–75) years, and median BMI was 24 (IQR 22–27) kg/m². Preoperative incontinence was reported in 10% of cases, while no hyper-continence was recorded preoperatively. Median console time was 334 (IQR 305–363) minutes. Early major complications (30 days) were observed in four (12.5%) cases. After a median follow-up of 36 (IQR 30–42) months, hyper-continence was observed in 7.2% of patients with a median self-catheterization number of 3 (IQR 2–5) per day. Multivariable analysis confirmed BMI > 25 kg/m² (OR: 1.24, p = 0.03) and age > 70 years (OR: 1.18, p = 0.04) as independent predictors of hyper-continence after FloRIN. Conclusions: Robot-assisted three-layer posterior reconstruction during FloRIN configuration in female patients demonstrated low rates of hyper-continence and no cases of permanent catheterization in long-term follow-up.