Urology is a technically demanding specialty, where training opportunities can be limited by patient safety, working hours, and case availability. Simulation-based medical education (SBME) is being increasingly integrated into urology training, offering opportunities for deliberate practice in a structured, reproducible, and risk-free environment. The effectiveness of modern simulation modalities and the extent of clinical skill transfer, however, remain variably reported. This review aims to evaluate the educational outcomes, validity evidence, and clinical skill transfer associated with contemporary simulation-based training in urology.

The Holmium:Yttrium Aluminum Garnet (Ho:YAG) laser has been the standard energy source for endoscopic lithotripsy for over two decades; however, limitations such as inefficient energy transmission, strong retropulsion, and large fiber diameters have prompted the development of newer laser technologies. Pulse-modulated Ho:YAG platforms (e.g., Moses™ (Boston Scientific, Marlborough, USA), Virtual Basket™ (Quanta System, Milan, Italy), Magneto™ (Quanta System, Milan, Italy)) and the Thulium Fibre Laser (TFL) were introduced to improve energy coupling, fragmentation efficiency, and surgical precision. This systematic review aims to evaluate and compare the clinical efficacy and safety of TFL and pulse-modulated Ho:YAG systems in the management of urolithiasis. A systematic search of PubMed, Cochrane Library, and Embase was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies comparing TFL and pulse-modulated Ho:YAG lasers in ureteroscopy (URS), retrograde intrarenal surgery (RIRS), or mini-percutaneous nephrolithotomy (mini-PCNL) were included. Data on stone-free rate (SFR), operative and lasering times, retropulsion, visibility, complications, and safety were extracted. Due to heterogeneity in definitions and study design, a qualitative synthesis without meta-analysis (SWiM) was performed. Risk of bias was assessed using the Risk of Bias (RoB) 2.0 (The Cochrane Collaboration, London, UK) and ROBINS-I (The Cochrane Collaboration, London, UK), and evidence certainty was graded with Grading of Recommendations Assessment, Development and Evaluation (GRADE). Eight studies, including two randomized controlled trials and six observational studies, were included in the review. Across most studies, TFL achieved similar or slightly higher SFRs (82-98%) compared with pulse-modulated Ho:YAG (56-95%). Operative and lasering times were comparable, while TFL demonstrated less retropulsion, superior endoscopic visibility, and an equivalent complication profile. No clinically significant differences in thermal safety or re-hospitalization were observed. In summary, TFL provides comparable or marginally superior performance to pulse-modulated Ho:YAG lasers for endoscopic stone surgery. It offers consistent safety and improved intraoperative control, suggesting an emerging role as a preferred next-generation lithotripsy platform pending further multicenter randomized trials.

Kidney stone disease (KSD) is a common and recurrent healthcare problem. Calcium oxalate stones are the most common type of stones, influenced by urinary oxalate levels. Increasingly, the role of the gut microbiome is being studied, particularly oxalate-degrading bacteria such as Oxalobacter formigenes, Lactobacillus, and Bifidobacterium, as potential therapeutic targets. Probiotic and synbiotic interventions aimed at enhancing intestinal oxalate degradation have, therefore, been proposed as strategies to reduce urinary oxalate excretion and mitigate stone recurrence. A comprehensive search of PUBMED, Cochrane Library, Scopus, and Embase databases was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A total of nine studies, published between January 1, 2000, and September 3, 2025, met the inclusion criteria, comprising five randomized controlled trials and four observational studies. Interventions included O. formigenes preparations, lactic acid bacteria mixtures, and multi-strain probiotics or synbiotics. Urinary oxalate excretion was the most consistently reported outcome, while assessment of kidney stone recurrence was limited due to short study durations and follow-ups. Across trials, probiotic or synbiotic therapy did not consistently reduce urinary oxalate levels compared with placebo or standard care. Although several studies demonstrated successful gastrointestinal colonization with O. formigenes, this did not translate into meaningful biochemical improvements. One randomized trial reported a reduction in the incidence of hyperoxaluria compared with an active comparator; however, this finding was not replicated elsewhere, and no included study demonstrated a significant reduction in clinically confirmed stone recurrence. Overall, the quality of evidence was limited by small sample sizes, heterogeneity in probiotic strains, dosing regimens, and short intervention periods. Current evidence does not support the use of probiotics or synbiotics targeting oxalate-degrading bacteria as effective therapies for reducing urinary oxalate excretion or preventing kidney stone recurrence. Despite their biological plausibility and favourable safety profile, their clinical utility remains unproven. Future research should prioritize long-term, randomized trials using standardized microbial formulations and incorporating imaging-confirmed recurrence outcomes to more definitively establish the role of microbiome-based interventions in KSD prevention.

The city of Wuhan located in Hubei province of central China was burdened with a series of cases presenting with atypical acute respiratory infections in December 2019. Little did people know at that point in time, that a novel virus known as SARS-CoV-2 (COVID-19) or simply corona virus, was responsible for these peculiar presentations. COVID-19 had begun spreading at an alarming rate worldwide, eventually gaining official status as a global pandemic, as affirmed by the World Health Organisation (WHO) on 11 March 2020. By 6 July 2020, globally, there were 1.5 million cases and around 536 893 deaths. As the pandemic took its toll globally, scientists struggled to classify and specify the manifestations of the virus. Medical practitioners, microbiologists and scientists worldwide gradually joined forces to define COVID-19 as an infection characterised by an immense inflammatory reaction or cytokine storm which may cause acute respiratory distress syndrome (ARDS) and multi-organ dysfunction (MODS). During the latter half of 2020, multiple hospitals in India, France, America, Germany and Netherlands reported an increasing incidence of fatal invasive fungal infections in recovered SARS-CoV-2 patients. Increased severity of infections as well as mortality was observed in immunocompromised patients and those with co existing medical illnesses such as diabetes and hypertension. Furthermore, even though many patients recovered from SARS-CoV-2 infection, it was noted that their immunity post recovery was significantly diminished, and it was during this period they were more susceptible to fatal bacterial and fungal co-infections. This review article explores the pathophysiology of COVID 19 infection and difference in response to the infection in adult and paediatric populations.

Background: Kidney stone disease is increasingly prevalent worldwide, resulting in a growing use of ureteroscopy (URS) for stone management. Although URS is generally safe and effective, elevated intrarenal pressure (IRP) during the procedure may contribute to perioperative morbidity, particularly infectious complications. Excessive IRP can promote intrarenal backflow into tubular, venous, lymphatic, and interstitial compartments, potentially resulting in tissue injury, impaired renal perfusion, and systemic exposure to bacteria and endotoxins. Advances in pressure-monitoring technology have enabled continuous intraoperative assessment of IRP and highlighted substantial pressure variability and transient spikes during routine URS. Methods: This narrative review examines the historical understanding and contemporary evidence surrounding IRP during URS, based on a structured search of PubMed/MEDLINE, the Cochrane Library and Europe PMC (January 1980 to October 2026), supplemented by manufacturer and regulatory sources. The review evaluates current approaches to IRP measurement, the pathophysiological and clinical consequences of elevated pressure, patient-specific susceptibility, and strategies aimed at pressure mitigation. Results: Available experimental and clinical evidence indicates that elevated IRP may contribute to acute renal tissue injury, impaired renal perfusion and intrarenal backflow, although most reported pressure thresholds derive from experimental models rather than validated human safety limits. IRP is influenced by irrigation inflow, outflow resistance, and renal compliance, and may vary considerably during URS, with transient pressure spikes occurring even during routine procedures. Multiple strategies can reduce IRP. Novel pressure-guided platforms integrating real-time pressure monitoring with automated irrigation and suction control can regulate IRP in early studies, but evidence that they improve clinical outcomes remains limited. Suction-assisted access sheaths are associated with fewer postoperative infectious complications in comparative studies, although this benefit has not been shown to result specifically from IRP reduction. Conclusions: IRP is an increasingly recognised and potentially modifiable determinant of safety during ureteroscopy. Further clinical research, including standardised reporting of IRP metrics, is required to establish clinically relevant pressure thresholds and determine whether pressure-guided URS improves patient outcomes. The integration of real-time monitoring with automated irrigation and suction control represents a promising direction toward safer, pressure-conscious endourological practice.