It’s Saturday, which means it’s time for your PSAWeekly. This week, we’re highlighting a particularly interesting topic that could directly influence your practice by introducing a new approach that may eventually be incorporated into routine general urology procedures.

We’d also like to apologize for the delay in this week’s issue. The timing coincided with the official Eid holiday in our region, but our team remained committed to bringing you this brief and worked hard to finalize it, even in the last hours of their vacation.

As always, PSAWeekly is here to help you stay up to date with the key developments that matter most. Please consider referring your colleagues to PSAWeekly.com so they can join our growing community of urologists and never miss a brief.

Your feedback is highly appreciated as well don't hesitate to drop us an email at [email protected] with your thoughts, suggestions, or topics you'd like us to cover. Grab your coffee, settle in, and let's dive into this week's brief.

This population-based study examined long-term outcomes after pediatric dismembered pyeloplasty for children with ureteropelvic junction obstruction in Ontario. The researchers reviewed patients treated over a 14-year period and followed them for at least five years to understand how often additional procedures were needed after the initial surgery and how follow-up care was being used. Their goal was to clarify how long children should continue to be monitored after pyeloplasty.

The findings showed that most pyeloplasties were successful without further surgery, although a minority of patients required some type of secondary intervention, including a smaller group who underwent a repeat pyeloplasty. Importantly, the large majority of these additional procedures took place within the first three years after the original operation. After that point, delayed interventions became much less common. The authors also found that common clinical factors such as age, sex, surgical technique, and early postoperative complications did not reliably predict which children would later need another intervention.

Another key message from the study is that follow-up practice was highly variable, with substantial differences in associated healthcare costs. Because most clinically important postoperative issues appeared within three years, the authors suggest that follow-up beyond that period may often provide limited additional value for many patients. Overall, the study supports a minimum follow-up duration of three years after pediatric pyeloplasty while also highlighting the need for more standardized and cost-conscious surveillance strategies.

This study examined whether the way surgeons manage the distal ureter and bladder cuff during radical nephroureterectomy affects cancer outcomes in patients with upper tract urothelial carcinoma (UTUC). Using data from the international CROES UTUC registry, the authors compared two approaches: formal transvesical/extravesical excision (Tr/Ex) and endoscopic management. Because the study was observational rather than randomized, the researchers used propensity score matching to create more comparable groups.

The analysis suggested that patients who underwent formal Tr/Ex excision had better recurrence-free survival than those treated with endoscopic techniques. In the matched cohort, cancer recurrence occurred less often in the Tr/Ex group, and Kaplan-Meier analysis showed a significant difference favoring this method. However, after statistical adjustment, the advantage remained only a trend and was no longer clearly significant. This means the results point toward a possible benefit of formal excision, but they do not prove it definitively.

For other outcomes, the picture was less clear. Overall survival was similar between the two groups, and the rate of intravesical recurrence tumor recurrence in the bladder did not differ significantly when analyzed with competing-risk methods, although the estimates still numerically favored Tr/Ex. The authors also explored whether tumor location, such as the renal pelvis versus ureter, changed the relationship between surgical technique and outcomes, but they did not find convincing evidence that it did.

The study’s main message is that formal removal of the distal ureter and bladder cuff may provide better control of recurrence than endoscopic management, but the findings should be interpreted carefully. The authors emphasize several limitations, including the retrospective design, variation in surgical methods across centers, relatively short follow-up, and the possibility of unmeasured confounding. Overall, the study supports the idea that more complete distal ureter management may be oncologically preferable, while also highlighting the need for stronger prospective research before firm recommendations are made.

This study evaluated whether single-port transvesical simple prostatectomy (SP-SP) remains safe and effective in men with very large prostates, including glands larger than 160 mL. The authors reviewed 90 consecutive patients treated by a single experienced surgeon between 2020 and 2025 and divided them into three groups based on prostate size: 80–120 mL, 120–160 mL, and over 160 mL.

The main finding was that larger prostates made surgery more technically demanding, but did not clearly worsen overall recovery or complication rates. Patients in the largest-volume group had higher preoperative PSA levels, longer operative times, and more estimated blood loss than those with smaller glands. However, these increases in surgical difficulty did not translate into significantly higher rates of postoperative complications, longer catheter time, worse symptom improvement, or poorer continence outcomes.

The study also found that estimated blood loss, rather than prostate size itself, was the only independent predictor of postoperative complications. For every 10 mL increase in blood loss, the risk of complications rose modestly. By contrast, prostate volume alone was not independently associated with complications in the multivariable analysis.

In terms of functional results, patients across all three groups showed strong improvement after surgery. At follow-up, measures such as PSA, postvoid residual urine, symptom scores, and quality of life improved substantially regardless of prostate size. Urinary continence outcomes were also favorable: most patients had recovered continence by 3 months, and all patients with available follow-up were continent by 6 months.

The authors conclude that SP-SP appears to be a feasible and safe minimally invasive option even for very large prostates, although surgeons should expect longer operations and somewhat greater blood loss in the biggest glands. Because the study was retrospective, single-center, and involved one surgeon with a relatively small sample, the findings should be viewed as preliminary rather than definitive. Larger multicenter studies with longer follow-up are needed to confirm these results.

This article compares the two leading single-port robotic radical prostatectomy techniquesextraperitoneal (EP) and transvesical (TV) using a large multi-institutional dataset from the SPARC consortium. After matching patients with similar baseline cancer and prostate features, the authors found that both approaches had similar operative times, low complication rates, comparable positive surgical margin rates, and similar short-term biochemical recurrence outcomes, suggesting that both are oncologically sound and technically safe options.

The main differences appeared in postoperative recovery. Patients who underwent the transvesical approach were more likely to go home the same day, needed less opioid medication, and had their catheters removed sooner. The TV group also showed faster recovery of urinary continence, with better pad-free or near-pad-free rates in the first weeks and months after surgery. Erectile function recovery was also reported as favorable in the transvesical group, while long-term cancer control appeared similar between the two techniques over the available follow-up period.

Another notable point is that the transvesical method seemed especially useful in patients with prior abdominal surgery or more complex abdominal histories, since it may avoid some of the challenges associated with other access routes. Still, the authors caution that the study was retrospective, surgeon practices varied across centers, and long-term follow-up remains limited, so future prospective studies are needed to confirm durability of both cancer and functional outcomes.

This study explored whether testosterone replacement therapy (TRT) works better when combined with regular exercise in men with hypogonadism, especially for improving body composition. The researchers followed 214 men and divided them into four groups: those who exercised and received TRT, those who received TRT without exercising, those who exercised without TRT, and a control group that received neither intervention.

The findings showed that the best results occurred in the group that combined TRT with exercise. In these patients, body fat percentage decreased significantly after 6 months, and both lean body mass (LBM) and fat-free mass index (FFMI) increased significantly at both 6 and 12 months. These changes suggest that the combination of hormonal treatment and physical activity may help improve muscle-related body composition more effectively than either approach alone.

By contrast, men who used TRT alone, exercise alone, or neither intervention did not experience the same meaningful improvements in lean mass measures. This indicates that TRT may have greater physical benefits when paired with a consistent exercise routine, rather than being relied on as a stand-alone treatment for body composition changes.

Overall, the study concludes that one year of TRT combined with regular exercise may improve muscle mass and reduce body fat in hypogonadal men, while TRT alone or exercise alone may be less effective for these outcomes.

This prospective randomized controlled study compared standard retrograde intrarenal surgery (RIRS) with Needle-perc-assisted RIRS for treating 1.5–2.5 cm lower pole renal stones. A total of 83 patients with a single lower pole stone were randomly assigned to one of the two treatment groups. The goal was to determine whether the newer combined technique could improve stone clearance while keeping complications low.

The study found that Needle-perc-assisted RIRS performed better than standard RIRS in stone removal. Patients treated with the combined technique had a higher stone-free rate both one day after surgery and one month later. The procedure was also associated with a shorter average operating time, suggesting that it may be a more efficient option for managing these moderately sized lower pole stones.

In terms of safety, the two approaches showed similar complication rates. No severe postoperative complications were reported in either group, and there were no meaningful differences in blood loss, pain scores, kidney function changes, or length of hospital stay. Although a few patients in both groups developed postoperative fever, these cases were managed successfully with conservative treatment or antibiotics.

Overall, the study suggests that Needle-perc-assisted RIRS may offer a practical advantage over standard RIRS for selected patients with lower pole renal stones in the 1.5–2.5 cm range. It appears to improve the likelihood of complete stone clearance without increasing serious risks. However, the authors note that larger multicenter studies are still needed to confirm these early findings.

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