Andrew Shepherd

Background/Objectives: Stevens–Johnson Syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare, potentially fatal immunological conditions that affect cutaneous and mucosal surfaces and have the potential to involve the genitourinary tract. While genital involvement is common, urological manifestations are under-recognised clinically and there is a paucity of clear, evidence-based management pathways specific to urological manifestations of SJS/TEN. To map the spectrum of urological manifestations of SJS/TEN, to describe the short- and long-term outcomes of these manifestations, and to synthesise management and prevention strategies to inform clinical practice. Methods: This was a scoping review conducted in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guideline. Data sources: Medline and PubMed articles published in English with publication date up to December 2025. Study selection: Eligible studies included case reports, case series, observational studies, clinical guidelines, and review articles describing urological manifestations, outcomes, management, or prevention strategies for patients with SJS/TEN. Articles limited to renal or isolated gynaecological involvement were excluded. Data extraction and synthesis: Articles were screened independently by two reviewers using a pre-defined data extraction template covering four domains: urological manifestations, outcomes and sequelae, management strategies, and prevention strategies. This criterion was refined after a pilot of 20 studies. Discrepancies were resolved by consensus with a third reviewer. Formal risk-of-bias assessment was not performed, consistent with scoping review methodology. Results: One hundred and four studies published between 1987 and 2025 were included in this review. Selected articles included case reports (n = 63), retrospective cohort studies (n = 23), prospective studies (n = 2), guidelines (n = 5), and summary articles (n = 11). Reported urological involvement ranged from genital cutaneous and mucosal disease including erosions, adhesions, and balanitis to urethral manifestations such as urethritis, stenosis, and strictures, as well as scarce upper urinary tract involvement including ureteric stricture and ureteric mucosal sloughing. While some manifestations resolved with supportive care, others progressed to chronic sequelae including persistent urethral strictures, voiding dysfunction, sexual dysfunction, recurrent infection, and in rare cases, obstructive uropathy. A multidisciplinary approach was recommended for all patients with SJS/TEN. Urological management centred around early and repeated urogenital examination, manual lysis of adhesions, urinary catheterisation, and timely intervention for urethral or ureteric obstruction. Long-term urological follow-up of 12 months was recommended for patients with significant urogenital involvement. Conclusions: Urological manifestations of SJS/TEN are diverse, clinically significant, and frequently under-recognised. Early urological involvement, systematic genital and urinary tract assessment, and proactive preventative measures may reduce long-term morbidity. This review provides a comprehensive synthesis of knowledge and recommendations to support urologists’ role in multidisciplinary care of patients with this pathology. This review also highlights the need for prospective research to guide further evidence-based management of urological complications of SJS/TEN.

Eshetie S, et al. World J Mens Health. 2026 ;44:e63. https://doi.org/10.5534/wjmh.260050

Robotic-assisted partial nephrectomy (RAPN) has become a widely used modality for the excision of renal tumours. Medtronic’s Hugo™ Robotic-Assisted Surgery (RAS) system has emerged as a promising alternative to the established Intuitive da Vinci® platform. Due to increasing use, this systematic review has been conducted to assess the safety and efficacy of the Hugo™ RAS system for RAPN. A comprehensive search was conducted to identify eligible studies that reported outcomes and experience of using the Hugo™ system for RAPN. Following appropriate screening and risk of bias assessment using ROBINS-I, results were collated into a narrative synthesis. Eight studies were included in the review. Within these, 145 patients had undergone RAPN using the Hugo™ system. These studies comprised one comparative and seven single-arm case series. Patient demographics, peri-operative outcomes, pathological outcomes and safety and feasibility parameters were extracted from the included studies. Across all these metrics, the Hugo™ system performed well. One notable finding was longer docking times compared to the da Vinci® system; however, with increasing experience and familiarity with this novel platform, this is expected to decrease. Despite the lack of high-quality evidence and few studies, the Hugo™ RAS system is a feasible option for conducting RAPN. It offered comparable and promising initial outcomes in several aspects compared to da Vinci®, alongside flexibility in docking setup. Further large-scale comparative studies are needed to corroborate the findings of this review and evaluate the longer term safety and efficacy of the Hugo™ RAS system for RAPN.

Background/objectives: Robotic-assisted partial nephrectomy (RAPN) is increasingly utilised for the management of renal masses, with the growing use of different robotic platforms and increasing complexity of renal masses managed robotically. Appropriate patient selection, the development of operative skills and experience and sensible surgical decision making are required to optimise the outcomes of RAPN and minimise the risk of complications. We provide a comprehensive review of strategies to predict, avoid and manage the complications of RAPN. Methods: We conducted a comprehensive literature review to outline many of the reported complications arising from RAPN, with a focus on preoperative considerations (patient selection, imaging, 3D modelling and predictive models), intraoperative considerations (positioning and kidney exposure complications) and practical management strategies to identify and manage the complications of this procedure. Results: Many complications of RAPN can be predicted, and we outline strategies to mitigate these risks through careful preparation prior to surgery, including descriptions of preventative strategies and important preoperative considerations. We also present a detailed outline of management for the most common complications of RAPN, including bleeding/haemorrhage, urine leak and intraoperative complications such as adjacent organ injuries. Conclusions: RAPN can be a challenging procedure with a significant risk of complications. Assiduous preoperative planning, thoughtful intraoperative decision making and the early recognition and management of complications are essential to optimise patient outcomes following RAPN.

Objectives: To describe the surgical approach and perioperative outcomes of a multicenter series evaluating a robotic-assisted approach to radical cystectomy with total intracorporeal urinary diversion in the setting of prior pelvic radiotherapy. Materials and methods: We analyzed our prospective cystectomy database for patients who underwent robotic-assisted radical cystectomy for bladder cancer after radiotherapy between 2018 and 2022. Demographic information and data regarding preoperative factors including stage of disease, preoperative hydronephrosis, and history of pelvic radiotherapy were collected via review of electronic medical records. All operations were performed by 1 of 2 experienced urologists using the da Vinci X, Xi, or Si surgical platforms. Results: Ten patients were identified for this study. The median age of participants was 73.5 years (range, 41–84 years). The median American Society of Anesthesiologists classification score was 3 (range, 3–4). The median Charlson Comorbidity Index was 6 (range, 2–12). Among the patients, 4 out of 10 patients (40%) had muscle invasive bladder cancer before salvage surgery. Intracorporeal ileal conduit urinary diversion was performed in 8 patients, whereas 2 patients underwent intracorporeal neobladder formation. Median intraoperative blood loss was 250 mL (range, 150–600 mL), and median operative duration was 390 minutes (range, 195–450 minutes). The overall 30-day complication rate was 60% with a Clavien-Dindo grade ≥3 complication rate of 15%. Perioperative mortality was 0%. Median duration of follow-up was 210 days (range, 60–1580 days). Conclusions: This series describing the outcomes of salvage robotic-assisted radical cystectomy using total intracorporeal urinary diversion demonstrates the safety of this technique. Further studies with long-term follow-up, including oncological outcomes, are required to support the widespread adoption of this procedure.

Objectives: To assess the feasibility and safety of the new Hugo robotic-assisted surgery (RAS) system for robotic-assisted radical prostatectomy (RARP), describing iterative changes in our operative technique—IDEAL stage 2. Design: Prospective, single-centre series. Setting: Tertiary urological unit in London, UK. Participants: Male patients diagnosed with clinically localised prostate cancer and suitable for RARP from February 2023 to May 2024. Main outcome measures: The primary outcome was to assess the safety of using the device without converting to the existing robotic platform (da Vinci), laparoscopy or open. Secondary outcomes assessed surgical (operative time, blood loss, time to catheter removal, complications), oncologic (surgical pathology and margin status) and early functional (continence) outcomes. Results: 50 patients were included in the study. No cases required conversion to an existing robotic platform, laparoscopy or open, and there were no intraoperative surgical complications. Mean age was 60 years and mean prostate-specific antigen was 12.2 ng/mL. The mean operative time was 148 min and estimated blood loss was 168 mL. Mean length of stay was 1.5 days and mean length of catheter duration was 13 days. On final pathology, 18 patients (36%) had T3 disease and four had positive surgical margins (8%). The mean International Consultation on Incontinence Questionnaire–Urinary Incontinence score for urinary continence at 3 months was 7. There were six Clavien-Dindo grade 2 complications and two Clavien-Dindo 3a complications. There were four instances of recoverable, temporary device failure. Iterative improvements were made to docking setup, use of robotic instruments and reduction in robotic arm collisions. Conclusions: We demonstrated feasibility and the safe introduction of the Hugo RAS for RARP into an experienced robotic urological programme. Perioperative, early oncological and functional outcomes were similar to other early series. Further studies will aim to describe the learning curve with this robot and optimisation of surgical quality.

Urology’s pioneering role in surgical innovations, from cystoscopy to laparoscopic surgery, culminated in the twenty-first-century advent of robotic surgery. The dominant da Vinci^® system faced new competition following its 2019 patent expiration. Medtronic’s Hugo^™ system emerged. Its growing global adoption, especially in robot-assisted radical prostatectomy (RARP), necessitates a systematic review, evaluating safety, feasibility, and comparison with established systems. A comprehensive search identified eligible studies of the Hugo^™ robotic platform for RARP, presenting their current experiences. Following systematic screening, quality of eligible studies was assessed using ROBINS-I. Results then underwent a narrative synthesis. This systematic review analysed 19 eligible studies, consisting of 9 comparative and 10 single arm studies. Due to the non-randomised nature of the studies, a moderate risk of bias was concluded in most. On account of the high heterogeneity between studies, a narrative synthesis of data was enacted; categorised into themes relating to operative timings, transfer of skills, patient demographics, plus safety and feasibility. Eligible studies demonstrated the promise of the Hugo^™ platform within these themes, in comparison to currently available platforms. Despite a paucity of high-quality randomised controlled trials, available evidence indicates Hugo^™ as a promising, safe alternative for RARP. Positive experiences across diverse centres and surgeons revealed minimal differences in surgical outcomes compared to the established da Vinci^® system, fostering global Hugo^™ adoption. Despite evidence demonstrating Hugo^™ safety and comparability, the review underscores the scarcity of high-quality evidence, attributing it to early stage implementation challenges.

Background Dysregulated lipid metabolism is associated with more aggressive pathology and poorer prognosis in prostate cancer (PC). The primary aim of the study is to assess the relationship between the plasma lipidome and clinical outcomes in localised and metastatic PC. The secondary aim is to validate a prognostic circulating 3-lipid signature specific to metastatic castration-resistant PC (mCRPC). Patients and methods Comprehensive lipidomic analysis was performed on pre-treatment plasma samples from men with localised PC (N = 389), metastatic hormone-sensitive PC (mHSPC)(N = 44), or mCRPC (validation cohort, N = 137). Clinical outcomes from our previously published mCRPC cohort (N = 159) that was used to derive the prognostic circulating 3-lipid signature, were updated. Associations between circulating lipids and clinical outcomes were examined by Cox regression and latent class analysis. Results Circulating lipid profiles featuring elevated levels of ceramide species were associated with metastatic relapse in localised PC (HR 5.80, 95% CI 3.04–11.1, P = 1 × 10⁻⁶), earlier testosterone suppression failure in mHSPC (HR 3.70, 95% CI 1.37–10.0, P = 0.01), and shorter overall survival in mCRPC (HR 2.54, 95% CI 1.73–3.72, P = 1 × 10⁻⁶). The prognostic significance of circulating lipid profiles in localised PC was independent of standard clinicopathological and metabolic factors (P < 0.0002). The 3-lipid signature was verified in the mCRPC validation cohort (HR 2.39, 95% CI 1.63–3.51, P = 1 × 10⁻⁵). Conclusions Elevated circulating ceramide species are associated with poorer clinical outcomes across the natural history of PC. These clinically actionable lipid profiles could be therapeutically targeted in prospective clinical trials to potentially improve PC outcomes.