Yu Xi Terence Law

Background Chronic malignant ureteric obstruction compromises renal function and may disrupt oncological management. Conventional polymeric stents are limited by external compression, encrustation, and frequent exchange requirements. Metallic stents were developed to enhance long-term patency; however, comparative evidence remains heterogeneous. Methods A PRISMA-compliant systematic review of PubMed, MEDLINE, Embase, Web of Science, Cochrane CENTRAL, and Scopus (31 May 2025) identified comparative studies of metallic versus polymeric ureteric stents in adults with chronic malignant ureteric obstruction. Random-effects meta-analysis evaluated stent failure, stent-related symptoms, and Clavien-Dindo complications using risk ratios. Functional duration, renal outcomes, quality of life, and cost implications were synthesised narratively. Results Six retrospective cohort studies encompassing 511 patients and 595 ureteric stents met inclusion criteria. Metallic stents showed a trend toward lower stent failure compared with polymeric stents (RR 0.68, 95% CI 0.44-1.03; I² = 0%, p = 0.07). Stent-related symptoms and complication rates were comparable. Metallic stents demonstrated fewer exchange requirements in narrative synthesis, although renal function, quality-of-life, and cost outcomes could not be pooled because of inconsistent reporting. Conclusions Metallic ureteric stents are a feasible long-term alternative to polymeric stents for selected patients with chronic malignant ureteric obstruction, with potential benefits in reducing exchange burden. Current evidence is not practice-changing and remains limited by retrospective designs, clinical heterogeneity, and sparse patient-centred and cost-effectiveness data. Trial registry Prospero: CRD420251021868

Purpose The primary aim was to study the in-vitro suction performance of three different Flexible and Navigable Suction Ureteral Access Sheaths (FANS) of two sizes each. The secondary aim was to study the impact of digital occlusion versus thumb sliders on suction performance. Methods We used the 7.5Fr single-use Flexible Ureterorenoscope from Innovex Medical (US27F-12-EU). The six FANS used were: 10/12Fr and 11/13Fr Innovex 40 cm FANS, ClearPetra 46 cm FANS, and Reborn 40 cm FANS. Time taken to suction 100 ml saline was measured. To test efficiency of stone suction, 1000mm³ of 1 to 2 mm stones were distributed equally between the upper and lower poles of a kidney model. Results All three 11/13Fr FANS had suction rates three times faster than their 10/12Fr counterparts (p = 0.001 for all FANS), when digital occlusion was used. Innovex and Clearpetra FANS had faster suction rates than Reborn FANS when suctioning 100 ml saline, for both 10/12Fr and 11/13Fr. For the Innovex FANS, there was no difference in suction rate when using the thumb slider or digital occlusion. However, Reborn FANS had slower suction rates when using the thumb slider compared to digital occlusion for both 10/12Fr and 11/13Fr sizes. Innovex FANS was the fastest in suctioning upper pole calculi, followed by Clearpetra FANS, and Reborn FANS the slowest for 10/12Fr (198s versus 237s versus 537s respectively, p < 0.001) and 11/13Fr (158s versus 174s versus 332s respectively, p < 0.001). 10/12Fr and 11/13Fr Reborn FANS were not able to reach the lower pole calculi. Between Clearpetra and Innovex, there was no significant difference in time taken to suction lower pole calculi. Conclusions Faster suction was achieved with 11/13Fr instead of 10/12Fr FANS. With digital occlusion, the Innovex and Clearpetra FANS both performed similarly better in their suction performance than the Reborn FANS.

Bladder cancer ranks as the 10th most common cancer globally. Currently, the standard surgical approach for bladder tumor removal involves transurethral piecemeal resection, which carries high recurrence (60%) and perforation (12%) rates. Although various techniques and robotic systems have been developed for en bloc tumor resection, achieving a negative resection margin remains challenging with standard resectoscopes. Here, we present the Robot-Optimized Bladder Endoscopy Resection of Tumor (ROBERT) system, a dual-arm robotic system designed to fit into a standard irrigation sheath along with an endoscope. The ROBERT system offers enhanced dexterity and payload capacity, allowing surgeons to perform en bloc tumor resections effectively. In both ex vivo and in vivo experiments, the ROBERT system achieves negative margins, with muscular tissue visually identified in the excised samples. The fastest resection is completed in approximately 6 min, and the largest excised tissue size is 15 × 15 × 3 mm. These results demonstrate the ROBERT system’s feasibility and potential for improving bladder tumor resection outcomes.

Introduction: To compare the clinical outcomes and complication rates of convective water vapor energy ablation (Rezum ^® ) and prostatic urethral lift (Urolift ^® ). To identify predictive factors for treatment failures in both treatments. Materials & Methods: Prospective clinico-epidemiological data of patients who underwent Urolift ^® or Rezum ^® in a single institution for benign prostatic hyperplasia (BPH) was collected. The choice of intervention depended on the preference of the patients after patient-centric discussions. Results: From October 2019 to October 2022, 86 patients underwent Rezum ^® , and 62 patients underwent Urolift ^® . Rezum ^® involved a longer indwelling catheter duration (12.38 ± 5.548 vs 1.39 ± 3.010 days, p < 0.001) compared with Urolift ^® . Rezum ^® was associated with more complications compared with Urolift ^® (36 [41.9%] vs 10 [16.1%] cases, p < 0.001). Rezum ^® had more cases of hematuria (17 [19.8%] vs 4 [6.5%] cases [ p = 0.022]) and urinary tract infections (27 [31.4%] vs 3 [4.8%] cases, p < 0.001) compared with Urolift ^® . There were no significant differences in Clavien–Dindo Grade 3–5 complications between the interventions. Urolift ^® was associated with higher reoperation rates (5 [8.1%] vs 0 [0%] cases, p = 0.010) compared Rezum ^® . Rezum ^® had higher anticholinergic usage rates compared with Urolift ^® post-operation (22 [25.6%] vs 8 [12.9%] cases, p = 0.024). Both interventions showed improvement in the International Prostate Symptom Score (IPSS), quality of life score, and peak velocity flow over the 2 years with no significant difference between the two. Based on receiver operating characteristic curve, preoperation IPSS ≥16 had 95.7% sensitivity and 38.4% specificity to predict the probability of treatment failures after the interventions. Conclusions: There was no difference in clinical outcomes of patients who underwent Rezum ^® and Urolift ^® . However, patients who had undergone Rezum ^® faced more minor complications and more required anti-cholinergic medications. Lastly, physicians should note that patients with IPSS ≥16 would unlikely benefit from either intervention.

Introduction Androgen receptor targeted agents (ARTA) have increasingly been incorporated into treatment regimens for various stages of prostate cancer. Patients are living longer with prostate cancer, and thus have a higher cumulative exposure to the treatment and its accompanying side effects, especially those of cardiovascular disease. We aim to assess the differences in the incidence of cardiac-related adverse events after treatment of prostate cancer with ARTA versus placebo. Methods Three databases were thoroughly searched for relevant articles. The PICOS model was used to frame our clinical question, with which 2 independent authors went through several rounds of screening to select the final included studies. Meta-analysis was done using the Cochran-Mantel-Haenszel Method. Quality assessment was carried out with the Cochrane Risk of Bias tool RoB 2. Results The use of ARTA in prostate cancer increases the incidence of cardiac-related adverse events (RR: 1.56, 95% CI: 1.29–1.90, p < 0.00001), such as hypertension (RR: 1.69, 95% CI: 1.46–1.97, p < 0.00001), ischaemic heart disease (RR: 1.84, 95% CI: 1.36–2.50, p < 0.0001), and arrhythmia (RR: 1.38, 95% CI: 1.11–1.71, p = 0.004), although this did not manifest in an increased incidence of cardiac arrests/deaths (RR: 1.28, 95% CI: 0.87–1.88, p = 0.21). Discussion ARTA increases the risk of cardiac-related adverse events, hypertension, ischaemic heart disease and arrhythmia. Armed with this knowledge, we will be better poised to manage cardiac risks accordingly and involve a cardiologist as required when starting patients on ARTA.

Introduction: Men with detrusor underactivity (DUA) and concomitant bladder outlet obstruction (BOO) due to benign prostatic enlargement (BPE) may present poorer functional outcomes after surgical desobstruction. This study aimed to evaluate the safety and efficacy of BPE surgery in men with DUA compared with those with normal detrusor contractility (NC).Materials and Methods: This review was performed according to the 2020 PRISMA framework. A comprehensive literature search was performed until May 7, 2023, using MEDLINE, EMBASE, and Cochrane Database. No date limits were imposed. Only comparative studies were accepted. The primary endpoint was to assess if there was any difference in short‐ and long‐term functional outcomes after BPE surgery in men with DUA and NC. The secondary endpoint was to evaluate the differences in perioperative outcomes and postoperative complications between the two groups. Meta‐analysis was performed using Review Manager (RevMan) software.Results: There were 5 prospective nonrandomized studies and 12 retrospective studies, including 1701 DUA and 1993 NC patients. Regarding surgical procedures, there were eight TURP (transurethral resection of the prostate) studies, four GreenLight PVP (photoselective vaporization of the prostate) studies, two HoLEP (Holmium laser enucleation of the prostate) studies, one GreenLight PVP/HoLEP study, one Holmium laser incision of the prostate study, and one study did not report the type of surgery. We did not find a statistically significant difference between the two groups in terms of perioperative outcomes, including postoperative catheterization time, hospitalization time, urinary retention, need to recatheterization, transfusion rate, or urinary tract infections. Also, we found no significant differences in long‐term complications, such as bladder neck stenosis or urethral stenosis. Posttreatment bladder recatheterization and retreatment rate for BPE regrowth could not be evaluated properly, because only one study reported these findings. When we analyzed functional outcomes at 3 months, those with NC had lower International Prostatic Symptom Score (IPSS), lower quality‐of‐life (QoL) score, better maximum flow rate (Qmax), and lower post‐voiding residual (PVR) of urine. These results were maintained at 6 months postoperatively, with exception of PVR that showed no difference. However, at 12 and more than 12 months the functional outcomes became similar regarding IPSS and QoL. There were few data about Qmax and PVR at longer follow‐up.Conclusion: In this meta‐analysis, data suggest that BOO surgical treatment in patients with concomitant BPE and DUA appears to be safe. Despite patients with DUA may present worse functional outcomes in the short postoperative term compared with the NC population, IPSS and QoL scores become comparable again after a longer follow‐up period after surgery.

Background: We aimed to analyze the influence of near-infrared fluorescence (NIRF) using indocyanine green (ICG) with standard robot-assisted partial nephrectomy (RAPN) in patients with a kidney tumor (KT). Methods: We performed a literature search on 12 September 2023 through PubMed, EMBASE, and Scopus. The analysis included observational studies that examined the perioperative and long-term outcomes of patients with a KT who underwent RAPN with NIRF. Results: Overall, eight prospective studies, involving 535 patients, were eligible for this meta-analysis, with 212 participants in the ICG group and 323 in the No ICG group. For warm ischemia time, the ICG group showed a lower duration (weighted Mean difference (WMD) = −2.05, 95% confidence interval (CI) = −3.30–−0.80, p = 0.011). The postoperative eGFR also favored the ICG group (WMD = 7.67, 95% CI = 2.88–12.46, p = 0.002). No difference emerged for the other perioperative outcomes between the two groups. In terms of oncological radicality, the positive surgical margins and tumor recurrence rates were similar among the two groups. Conclusions: Our meta-analysis showed that NIRF with ICG during RAPN yields a favorable impact on functional outcomes, whereas it exerts no such influence on oncological aspects. Therefore, NIRF should be adopted when preserving nephron function is a paramount concern.

Objective: To perform a systematic review and meta‐analysis to evaluate the impact of body mass index (BMI) on oncological (primary) and surgical (secondary) outcomes of patients who underwent nephrectomy, as obesity or high BMI is a known risk factor for renal cell carcinoma (RCC) and predictor of poorer outcomes. Methods: Studies were identified from four electronic databases from database inception to 2 June 2021, according to the Preferred Reporting Items for Systematic Review and Meta‐analysis statement. The review protocol was registered in the International Prospective Register of Systematic Reviews with the identification number: CRD42021275124. Results: A total of 18 studies containing 13 865 patients were identified for the final meta‐analysis. Regarding oncological outcomes, higher BMI predicted higher overall survival (BMI >25 vs BMI 25 vs BMI 2 : HR 0.60, 95% CI 0.50–0.73; BMI 25–30 vs BMI 30 vs BMI 25 vs BMI 2 : HR 0.72, 95% CI 0.63–0.82; BMI 25–30 vs BMI 2 : HR 0.59, 95% CI 0.42–0.82). Those with a lower BMI fared better in surgical outcomes, such as operation time and warm ischaemic time, although the absolute difference was minimal and unlikely to be clinically significant. There was no difference between groups for length of hospital stay, intraoperative or postoperative complications, blood transfusion requirements, and conversion to open surgery. Conclusion: Our study suggests that a higher BMI is associated with improved long‐term oncological survival and similar perioperative outcomes as a lower BMI. More research into the underlying biological and physiological mechanisms will enable better understanding of the effect of BMI, beyond mere association, on post‐nephrectomy outcomes.

Purpose To assess the effect of aromatherapy with lavender oil alone, and in combination with music, on pain and anxiety during extracorporeal shockwave lithotripsy for kidney stones. Methods This was a single-centre prospective, randomised controlled trial. The subjects were block randomised into 3 study groups, Group 1: Control; Group 2: Aromatherapy only; Group 3: Aromatherapy and music. All subjects were given patient-controlled intravenous alfentanil as standard analgesia. The primary outcome measures were pain and anxiety scores using visual analogue scale (VAS) and State-Trait Anxiety Inventory. Results Ninety patients were recruited and randomised prospectively into Group 1 (n = 30), Group 2 (n = 30), and Group 3 (n = 30). For pain outcome, both Group 2 and Group 3 showed a trend towards lower mean VAS pain scores of 2.73 in both groups compared to the control with a mean VAS score of 3.50, but it was not statistically significant (p = 0.272). There was no significant difference in anxiety scores between groups post-treatment. Conclusions Our study was unable to show a significant improvement in pain relief and anxiety when aromatherapy with lavender oil was added to standard analgesia alone during shockwave lithotripsy. There was also no difference when aromatherapy was combined with music.