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Context Low-intensity shockwave therapy (LiST) has emerged as an effective treatment for pain in patients with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), and it has been postulated that LiST may also be effective in patients with lower urinary tract symptoms (LUTS). Objective To perform a systematic review and meta-analysis of experimental and clinical studies exploring the effect of LiST on LUTS in an attempt to provide clinical implications for future research. Evidence acquisition We systematically searched PubMed, Cochrane Library, and Scopus databases from inception to March 2021 for relevant studies. We provided a qualitative synthesis regarding the role of LiST in LUTS and performed a single-arm, random-effect meta-analysis to assess the absolute effect of LiST on LUTS only in patients with CP/CPPS (PROSPERO: CRD42021238281). Evidence synthesis We included 23 studies (11 experimental studies, seven nonrandomized controlled trials [non-RCTs], and five RCTs) in the systematic review and seven in the meta-analysis. All experimental studies were performed on rats with LUTS, and the clinical studies recruited a total of 539 participants. In patients with CP/CPPS, the absolute effect of LiST on maximum flow rate and postvoid residual was clinically insignificant. However, the available studies suggest that LiST is effective for the management of pain in patients with either CP/CPPS or interstitial cystitis/bladder pain syndrome. Additionally, LiST after intravesical instillation of botulinum neurotoxin type A may enhance its absorption and substitute botulinum neurotoxin type A injections in patients with overactive bladder. Furthermore, the available evidence is inconclusive about the role of LiST in patients with benign prostatic obstruction, stress urinary incontinence, or underactive bladder/detrusor hypoactivity. Conclusions LiST may be effective for some disorders causing LUTS. Still, further studies on the matter are necessary, since the available evidence is scarce. Patient summary Low-intensity shockwave therapy represents a safe, easily applied, indolent, and repeatable on an outpatient basis treatment modality that may improve lower urinary tract symptoms.

Context: Recently developed concepts for higher efficacy ESWL with low-pressure wide focus systems resulting in finer fragmentation of the calculi. Objective: To compare two different electromagnet...

Context Live surgery events (LSEs) have been used in all surgical fields for education and training and to demonstrate new techniques. The European Association of Urology (EAU) live surgery guidelines were established in 2014. Objective To review the compliance of outcomes for procedures performed at EAU-affiliated LSEs with the 2014 guidelines and to establish updated guidelines for LSEs and semi-LSEs. Evidence acquisition Patients from EAU-affiliated LSEs were included for all surgical procedures carried out between January 2015 and January 2020. All these events were pre-evaluated by the EAU Live Surgery Committee and met the criteria for an EAU LSE, with outcomes recorded and submitted to the registry. Data were collected for the type of procedure and for intraoperative and short- and long-term complications. Evidence synthesis A total of 246 procedures were performed across 18 LSEs, with an annual volume ranging from 19 to 74 procedures. These included 109 (44.3%) robot-assisted procedures, 21 (8.5%) laparoscopic procedures, 10 (4%) transurethral bladder procedures, 11 (4.4%) prostate enucleation procedures, 72 (29.2%) endourological procedures, and 23 (9.3%) andrology or reconstruction procedures. A total of 77 different surgical techniques and variations for 55 different types of surgery were performed as LSEs over the past 5 yr. There were 44 (17.8%) short-term complications and 11.3% (nine/79) long-term complications observed, with Clavien grade III/IV complications seen in 5.2% and 7.5% of cases over short- and long-term follow-up, respectively. Conclusions The 5-yr outcomes for EAU LSEs show that they are safe and follow previous guidelines set by the panel. It seems likely that the fine balance between patient safety and educational value might be best achieved if LSEs are performed by local surgeons in their parent hospital with patients and staff they know, and that technological advances will make live streaming a seamless process. The current EAU Live Surgery Committee has updated the guidelines on LSEs and provided new guidelines for semi-live events. Patient summary We reviewed 5-year outcomes for live surgery events endorsed by the European Association of Urology. We found that the operations carried out at these events were safe and followed the guidelines previously set. We have updated the guidelines and provided new guidelines for semi-live events.

In the care for patients with urological diseases, outpatient urology secures a near-to-home treatment by specialists in urology and is located between general practitioner and urological clinic. Comparably little is known about the structure and fields of work in this area of urology. A survey of the EAU Section ESUO of outpatient and office urology ( https://uroweb.org/section/esuo/ ) shows the diversity in terms of content and organisation of this sector in Europe, in which more than 16,500 outpatient urologists and thus about half of all professional urologists work full-time. This diversity is related to the diagnostic and therapeutic methods in outpatient urology and to the working conditions of outpatient urologists. For comparison, this information about European countries is contrasted with data from the German office urology as one type of outpatient urology.

In May 2024, all medical devices in Europe will require to comply with the new Medical Device Regulation 2017/745, including those we have been using for years. Currently, there are major delays and problems associated with this new certification. As clinicians, we express our serious concerns regarding whether the system will be ready on time to ensure that all the medical devices that we use will be available for patient care.

The therapeutic range of cyclic nucleotide phosphodiesterase 5 inhibitors (PDE5) inhibitors is getting wider in the last years. This review study focuses on the potential employment of PDE5 inhibitors as an adjunct tool for the therapeutic management of male infertility. The literature tends to suggest a beneficial effect of PDE5 inhibitors on Leydig and Sertoli cells secretory function. It also appears that PDE5 inhibitors play a role in the regulation of the contractility of the testicular tunica albuginea and the epididymis. Moreover, scientific data suggest that PDE5 inhibitors enhance the prostatic secretory function leading to an improvement in sperm motility. Other studies additionally demonstrate the role of PDE5 inhibitors in the regulation of the sperm capacitation process. Placebo-controlled, randomized, blind studies are necessary to unambiguously incorporate PDE5 inhibitors as an adjunct tool for the pharmaceutical treatment of semen disorders and male infertility.

Aim To evaluate whether surgical trainees undergoing additional simulation, compared to conventional training, are able to achieve proficiency sooner with better patient outcomes. Methods This international, multicentre randomised controlled superiority trial recruited urology trainees (n=94) who had performed ≤10 ureterorenoscopy (URS) cases, as a selected index procedure, with no prior simulation experience. Recruits were randomised to simulation-based training or non-simulation-based training groups, the latter of which is the current standard of training. Training sessions were conducted for the simulation arm, utilising an expert-developed multi-modality training curriculum. The primary outcome was the number of procedures required to achieve proficiency, defined as achieving a score of ≥28 on an OSATS scale, on 3 consecutive operations, without complications. Inpatient surgical complications were also recorded. All participants were followed up for 25 procedures or over 18 months. Results A total of 1140 cases were performed by 65 participants where proficiency was achieved in 21 simulation and 18 conventional participants over a median of 8 and 9 procedures, respectively (HR: 1.41 [95% CI 0.72–2.75]). More participants reached proficiency in the simulation arm in flexible ureterorenoscopy, requiring fewer number of procedures (HR 0.89 [95% CI 0.39–2.02]). Significant differences were observed in overall comparison of OSATS scores between groups (mean difference 1.42 [95% CI 0.91–1.92]; p Conclusions Simulation-based training demonstrated higher overall proficiency and fewer procedures were required to achieve proficiency in the complex form of the index procedure with surgical complications.

The coronavirus has challenged all medical systems worldwide. Herein both waves of COVID-19 (coronavirus disease 2019) in spring and autumn 2020 differ principally. Whereas Europe was hit by the first wave more or less unprepared, which was aggravated by the high virulence of COVID-19, the second wave is characterized by a much higher contagiosity of the virus with very high incidences. On the other hand the virus has attenuated, which is reflected by the significantly lower incidence-related mortality rate. However, the overall increasing number of infected patients represents again a great challenge for the medical management of the disease. France and Spain are doing better in comparison to Germany and Italy this time. The absolute number of deaths per week is higher than during the peak of the first wave. However, urologists in these countries have also experienced greater restrictions in their activities in the second shutdown than in Germany, where there is only a reduction of beds to between 75 and 90%. Mostly all levels are operated. Of importance for Germany, however, is the plateau on a high level for several weeks probably due to the reduced efficacy of a light lock-down. This finally resulted in a total lock-down in mid-December 2020. Subsequently in Germany some hospitals are also reaching their limits with similar consequences for the departments of urology facing a 50% reduction of beds and operating only level III and IV indications. Nevertheless, the management of urologic patients during the COVID-19 pandemic is carried out in Europa on a high standard. Therefor the risk of secondary harm to our patients is expected to be rather minimal in the long run.

Contains fulltext : 237261.pdf (Publisher’s version ) (Closed access) Adherence to national and international clinical practice guidelines is suboptimal throughout Europe. The European Association of Urology Guidelines Office project "IMAGINE" (IMpact Assessment of Guidelines Implementation and Education) has been developed to measure baseline adherence to urological guideline recommendations across Europe and to identify issues that drive nonadherence.

Urology has always been closely linked to technological progress. In the last few decades, we have witnessed increasing implementation of various technologies and innovations in subdisciplines of urology. While conventional laparoscopy is increasingly being replaced by robot-assisted procedures and the introduction of new robotic systems from various manufactures will continue for years, the field of endourolgy is still not dominated by robotic systems. However, new systems (e.g., autonomous, robot-controlled aquablation of the prostate) are becoming increasingly popular and numerous development projects will also probably change clinical care in coming years. In addition, further advancements in the combination of robotics with intraoperative navigation through the integration of imaging and augmented-reality (AR) and virtual reality (VR) technology can be expected. This combination of navigation and robotic technology is already being used successfully in prostate biopsy.

Background The unexpected coronavirus disease 2019 (COVID-19) pandemic has spread worldwide rapidly, developing into a global health crisis. At the same time, it has seriously impacted the daily activities in all the fields of urology. Objective To better understand the impact of the COVID-19 pandemic on clinical, academic, and scientific activities as well as on the quality of life of urologists from the main centers in Europe. Design, setting, and participants We conducted a survey using a 37-item questionnaire. The survey included three main sections: clinical practice, academic/scientific activities, and personal/social quality of life. Outcome measurements and statistical analysis A descriptive analysis was performed using the collected data. Results and limitations A total of 107 representatives affiliated to different centers from 22 countries completed the survey. Clinical activities were affected in 54.2% of the centers, and 85.0% of the elective surgeries were cancelled. Of the urological departments, 64.5% were still performing minimally invasive surgery for malignant disease. In 33.6% of the hospitals, dedicated and specially equipped operating theaters for COVID-19–positive patients were not available. According to 72.9% of participants, COVID-19 had a substantial negative impact on academic activities, and 82.3% of the respondents agreed that their quality of life has been affected negatively by the pandemic. Finally, 92.5% of the participants believe that the pandemic will have a moderate to severe impact on the health system of their countries. Conclusions Data collected in this survey provide insight into changes brought about in clinical and academic settings amid COVID-19. Along with shortages such as bed occupancy and personal protective equipment, it highlights negative impacts on academic and scientific activities, including the personal and social life of urologists. Patient summary It is essential to understand the impact of the coronavirus disease 2019 (COVID-19) pandemic on clinical, academic, and scientific urological activities, as well as on related personal and social issues. As situations similar to the coronavirus disease 2019 (COVID-19) pandemic may recur, we must be prepared to react quickly and effectively. It is important that urology departments look after the well-being of their patients, while protecting their staff and continuing with academic/research activities.

Die extrakorporale Stoswellenlithotripsie (ESWL) ist seit 1985 ein etabliertes Therapieverfahren der Urolithiasis. Ausgehend vom Dornier HM3 hat die Entwicklung neuer Lithotriptoren mehrere Phasen durchlaufen, wobei zunachst auf alternative Stoswellenquellen und die Integration in multifunktionelle urologische Rontgenarbeitsplatze Wert gelegt wurde. In jungster Zeit bestehen zunehmend Zweifel an der Effektivitat des Verfahrens im Vergleich zu endoskopischen Techniken. Dieser Trend wird auch dadurch unterstutzt, dass Harnleitersteine, die meist notfallmasig mit endourologischen Techniken (Stent, Ureteroskopie) behandelt werden konnen, deutlich zunehmen. Die Patienten wunschen bevorzugt die komplette Steinsanierung in einer Sitzung, statt nach mehreren ESWL-Sitzungen auf das Abgehen der Steinfragmente warten zu mussen. In Deutschland kommt hinzu, dass nur noch eine ESWL-Sitzung pro Jahr ambulant abgerechnet werden kann. Die deutliche Abnahme der ESWL im Vergleich zu anderen Verfahren betrifft vor allem Nierensteine groser 1 cm und Harnleitersteine. Jungere Studien zum Mechanismus der Steindesintegration und der Applikationstechniken der Stoswelle haben allerdings ein erneutes Umdenken bezuglich des Stellenwerts der ESWL angestosen.

OBJECTIVE: Microscope-assisted vasovasostomy (MAVV) is a standard procedure used to reverse vasectomies. Robotic surgery has been established primarily for technically demanding urological procedures and has also been recently implemented in male reproductive surgery. We aimed to review the current evidence of robot-assisted vasovasostomy (RAVV) and robot-assisted vasoepididymostomy (RAVE). MATERIAL AND METHODS: We performed a systematic literature review using PubMed to identify relevant original articles. We identified 2017 records through database search, and after removing duplicates, 782 records remained for further analysis. RESULTS: In total, 12 human and three animal studies were selected. Reported vasal patency rate ranges were 88%–100% for RAVVs and 55%–61% for RAVEs. The sperm count and postoperative pregnancy rates of RAVV ranged between 8.4 × 10(6)–120 × 10(6) sperm/mL and 65%, respectively. Finally, procedure times in the human studies, recorded for extracorporeal RAVVs and RAVEs ranged from 97 to 238 minutes. CONCLUSION: Robot-assisted vasal reversal is feasible with similar patency rates as for the microsurgical approach and showing comparable outcomes. Additional benefits of this technique include improved vision and movement precision.

Context Surgical repair of a vesicovaginal fistula (VVF) has been described extensively in the literature for several decades. Advances in robotic repair have been adopted since 2005. Objective A consensus review of existing data based on published case series, expert opinion, and a survey monkey. Evidence acquisition This document summarizes the consensus group meeting and survey monkey results convened by the European Association of Urology Robotic Urology Section (ERUS) relating to the robotic management of VVF. Evidence synthesis Current data underline the successful robotic repair of supratrigonal nonobstetric VVF. The panel recommends preoperative marking of the fistula by a guidewire or ureteral catheter, and placement of a protective ureteral JJ stent. An extravesical robotic approach usually provides a good anatomic view for adequate and wide dissection of the vesicovaginal space, as well as bladder and vaginal mobilization. Careful sharp dissection of fistula edges should be performed. Tension-free closure of the bladder is of utmost importance. Tissue interposition seems to be beneficial. The success rate of published series often reaches near 100%. An indwelling bladder catheter should be placed for about 10 d postoperatively. Conclusions When considering robotic repair for VVF, it is essential to establish the size, number, location, and etiology of the VVF. Robotic assistance facilitates dissection of the vesicovaginal space, harvesting of a well-vascularized tissue flap, and a tension-free closure of the bladder with low morbidity for the patient being operated in the deep pelvis with delicate anatomical structures. Patient summary Robotic repair of a vesicovaginal fistula can be applied safely with an excellent success rate and very low morbidity. This confirms the use of robotic surgery for vesicovaginal fistula repair, which is recommended in a consensus by the European Association of Urology Robotic Section Scientific Working Group for reconstructive urology.

Die minimal-invasive Chirurgie in der Urologie ist seit Anfang der 1990er-Jahre mit klaren Vorteilen wie bessere kosmetische Ergebnisse, weniger Blutverlust, postoperative Schmerzen und schnellere Genesung der Patienten ein elementarer Bestandteil des operativen urologischen Armamentariums geworden. Mit den kumulierenden operativen Erfahrungen in der Laparoskopie kamen spater die mit den offenen Techniken vergleichbaren und in den letzten Jahren besseren onkologischen und funktionellen Ergebnisse bei den publizierten groseren Serien von den urologischen Eingriffen. Die robotische Chirurgie wurde am Anfang des neuen Jahrhunderts in die Urologie eingefuhrt und hat die minimal-invasive Chirurgie deutlich gefordert. Robotische Operationen wie radikale Prostatektomie oder Nierenteilresektion wurden in einer kurzen Zeit entwickelt und in einem grosen Spektrum Akzeptanz gefunden. Dabei war die robotische Chirurgie allerdings in einer Monopolsituation von der Firma Intuitive Surgical, der die meisten Patentrechten in diesem Feld gehorten. Der robotische Markt war sehr schnell gewachsen; dazu aber auch die Da Vinci-Preise, die uber 2 Mio. € gingen. Diese Preisrealitat stellte das wesentliche Hindernis fur die Kliniken, die einen Da Vinci-Roboter haben wollten, dar. Die neuen Roboterfirmen haben in den letzten Jahren nach dem Auslaufen von den fruheren Patents von Intuitive Surgical alternative robotische Systeme entwickelt und patentiert. Somit konnte auf dem Robotermarkt endlich eine Konkurrenz existieren. Wir stellen hier diese neuen robotischen Plattformen mit den Hauptmerkmalen vor.

ZusammenfassungDie Entwicklung der Minimal-invasiven Chirurgie (MIC) in der Urologie umfasst die Teilbereiche transurethrale Techniken, Endourologie und Extrakorporale Stosswellenlithotripsie, Uroradiologie sowie Laparoskopie und Robotische Chirurgie. Basierend auf persönlichen Erfahrungen mit der Entwicklung minimal-invasiver Verfahren seit Ende der 70iger Jahren präsentieren wir eine historische Analyse der Literatur mit dem Ziel, die wesentlichen Meilensteine der Minimal-Invasiven Therapie in der Urologie herauszuarbeiten.Motor der rasanten Entwicklung der MIC in der Urologie war die Einführung der digitalen Videotechnologie, Lasertechnologie, Fortschritte der Elektrochirurgie begleitet von den Glanzleistungen vor allem Deutscher Technologiefirmen mit zunehmender Miniaturisierung des Instrumentariums. Bedeutsam war auch die gute Kooperation zwischen Urologen, Ingenieuren und Radiologen.Die Laparoskopie wird trotz zahlreicher Weiterentwicklungen (3D-Prismentechnolgie, ETHOS-chair) zunehmend von der Robotik ersetzt. Auf Grund der auslaufendenden Patenten von Intuitive Surgical existiert seit diesem Jahr eine Konkurrenzsituation mit neuen Herstellern von Operationsrobotern. Allerdings müssen diese erst belegen, ob sie den hohen Qualitätsstandard der aktuellen Da Vinci-serie bieten können. Robotersysteme für die Endourologie werden zukünftig eine Rolle spielen, wie Avicenna RoboflexR für die flexible Ureteroskopie und AquaBeamR- für die roboter-assistierte Aquaablation der Prostata. Während RoboflexR ähnlich dem Da Vinci-system die Ergonomie des Eingriffes erleichtert, ersetzt die robotergestützte Aquablation erstmals den Operateur.

In the care for patients with urological diseases, outpatient urology secures a near-to-home treatment by specialists in urology and is located between general practitioner and urological clinic. Comparably little is known about the structure and fields of work in this area of urology. A survey of the EAU Section ESUO of outpatient and office urology ( https://uroweb.org/section/esuo/ ) shows the diversity in terms of content and organisation of this sector in Europe, in which more than 16,500 outpatient urologists and thus about half of all professional urologists work full-time. This diversity is related to the diagnostic and therapeutic methods in outpatient urology and to the working conditions of outpatient urologists. For comparison, this information about European countries is contrasted with data from the German office urology as one type of outpatient urology.In der Versorgung von Patienten mit urologischen Erkrankungen sichert die ambulante Urologie eine meist wohnortnahe Behandlung durch urologische Fachärzte und steht damit zwischen Hausarzt und urologischer Klinik. Trotz dieser wichtigen Aufgabe ist vergleichsweise wenig über Struktur und Tätigkeitsfeld dieses Sektors dokumentiert. Eine Befragung der EAU Section of Outpatient and Office Urology (ESUO; https://uroweb.org/section/esuo/ ) zeigt die inhaltliche und organisatorische Vielfalt dieses Sektors in Europa, in dem immerhin über 16.500 ambulante Urologen und damit etwa die Hälfte aller berufstätigen Urologen hauptberuflich arbeiten. Diese Vielfalt bezieht sich auf die diagnostischen und therapeutischen Methoden in der ambulanten Urologie und auf ihre Arbeitsbedingungen. Den Informationen aus europäischen Ländern werden Daten aus der deutschen Praxisurologie als einer Spielart der ambulanten Urologie zum Vergleich gegenübergestellt.

Die demographische Entwicklung und der medizinische Fortschritt bedingen ein immer hoheres Lebensalter. Eine mittlere Lebenserwartung von 90 Jahren wird voraussichtlich in der nachsten Dekade in vielen Landern erreicht werden. Damit bekommt die geriatrische Medizin, die sich mit den spezifischen Anforderungen der hochbetagten, oft gebrechlichen und meist komorbiden Patienten auseinandersetzt, einen immer groseren Stellenwert. Infektionen des Urogenitaltrakts nehmen mit dem Lebensalter zu, gleichzeitig ist in zunehmendem Mase ein kritisches, bewusstes Verordnungsverhalten in der antimikrobiellen Therapie gefordert. Die vorliegende Ubersicht soll dem Leser die Besonderheiten von Harnwegsinfekten und asymptomatischer Bakteriurie im hohen Lebensalter in Bezug auf Epidemiologie, Keim- und Resistenzspektrum sowie Therapieindikation und -durchfuhrung bewusst machen.

To compare iPad-assisted (Apple Inc., Cupertino, USA) percutaneous access to the kidney to the standard puncturing technique for percutaneous nephrolithotomy (PCNL). For the iPad-assisted PCNL, a computed tomography is performed prior to surgery, using fiducial radiopaque markers. The important anatomical structures (i.e. kidney, stones) are segmented using specific software enabling the superimposition of images semi-transparently on the iPad by marker-based navigation. Twenty-two patients underwent an iPad-assisted percutaneous puncture of the kidney for PCNL. Twenty-two patients of the clinical database from the Urological Department SLK Hospital Heilbronn, who underwent the standard puncturing technique, were matched to these patients. Matching criteria were age, gender, stone volume, body mass index, stone site and the absence of anatomical variation. Puncture time, radiation exposure and number of attempts for a successful puncture were evaluated. All procedures were performed by two experienced urologists. The standard puncturing method consisted of a combination of ultrasound and fluoroscopy guidance. Chi-square and t test were used to ensure that there was no difference in the matching criteria between the groups. To compare the two methods, U test, Kruskal–Wallis and Chi-square test were used. Examination of radiation exposure showed a significant difference between the two groups in favour of the standard puncturing method (p

Das Spektrum der chirurgischen Verfahren zur minimal-invasiven Behandlung der benignen Prostatavergroserung (BPH) hat sich uber die letzten 2 Jahrzehnte signifikant verbreitert. Die einfache suprapubische Prostatektomie („simple prostatectomy“/„subtotal prostatectomy“, SP) hat gravierend an Bedeutung verloren. Die transurethrale Resektion der Prostata (TURP) wurde weiter standardisiert und durch die Einfuhrung der bipolaren Technik sowie Niederdrucksysteme sicherer gemacht. Die transurethralen (endoskopischen) Enukleationstechniken (endoskopische Enukleation der Prostata, EEP) stellen zunehmend eine wichtige Konkurrenz, insbesondere bei groseren Adenomvolumina, zu der als Goldstandard geltenden TURP dar und losen die SP ab. Dieser Vorgang ist v. a. durch die rasante Entwicklung der Lasertechnik bedingt, welche, ahnlich wie in der Steintherapie, das Gesicht der modernen BPH-Behandlung nachhaltig verandert. Diese Anderung fuhrte zur Beschreibung, klinischen Erprobung und Standardisierung zahlreicher Operationsmethoden, welche in diesem Artikel systematisch beschrieben werden. Zudem wurden Bestrebungen unternommen, weitere Energiequellen, wie z. B. den bipolaren Strom, in der EEP zu nutzen. Hinsichtlich der wissenschaftlichen Objektivierbarkeit werden regelmasig hochwertige Studien publiziert, welche die Position der EEP weiter starken.

Purpose of review In the recent past, there were numerous and promising technological developments in the field of endourology leading to tremendous changes in the management of urolithiasis. This review will try to weave ancient stone therapy with the very modern advent of flexible ureteroscopy and recent developments in robotic systems. Recent findings In the broad field of flexible ureteroscopy for stone surgery, new disposable scopes have been developed and established. The use of robotic instruments is also a new and interesting concept. Additionally, clinical research on the understanding of laser features leads to a specific and appropriate use of lasers for lithotripsy, both holmium, and nowadays also interestingly thulium. Summary Disposable, digital flexible ureteroscopes for the treatment of both ureteric and kidney stones are taking an essential role in the medical field. Until recently, the clinically relevant laser systems for stone surgery during ureteroscopy are mainly based on Holmium laser YAG (Ho:YAG) devices, but a new thulium variant with promising features is giving interesting results. Additional research in laser features will guide to a better, more effective and safer treatment algorithm. Robotic technologies are promising but their definitive role still needs to be determined.

Roboterassistierte Systeme gewinnen bei der operativen Therapie urologischer Krankheitsbilder zunehmend an Bedeutung. Aktuell werden verschiedene Roboterassistenzsysteme entwickelt. Zwar haben diese bislang keine FDA-/CE-Zertifizierung — da sich hier jedoch fur die Zukunft interessante Optionen auftun, sollen sie hier vorgestellt und diskutiert werden. Weiterhin wird auf Robotersysteme fur Single-Port-Chirurgie eingegangen.

BACKGROUND Factor affecting sperm retrieval rate (SRR) or pregnancy rates (PR) after testicular sperm extraction (TESE) in patients with non-obstructive azoospermia (NOA) have not been systematically evaluated. In addition, although micro-TESE (mTESE) has been advocated as the gold standard for sperm retrieval in men with NOA, its superiority over conventional TESE (cTESE) remains conflicting. OBJECTIVE AND RATIONALE The objective was to perform a meta-analysis of the currently available studies comparing the techniques of sperm retrieval and to identify clinical and biochemical factors predicting SRR in men with NOA. In addition, PRs and live birth rates (LBRs), as derived from subjects with NOA post-ICSI, were also analysed as secondary outcomes. SEARCH METHODS An extensive Medline, Embase and Cochrane search was performed. All trials reporting SRR derived from cTESE or mTESE in patients with NOA and their specific determinants were included. Data derived from genetic causes of NOA or testicular sperm aspiration were excluded. OUTCOMES Out of 1236 studies, 117 studies met the inclusion criteria for this study, enrolling 21 404 patients with a mean age (± SD) of 35.0 ± 2.7 years. cTESE and mTESE were used in 56 and 43 studies, respectively. In addition, 10 studies used a mixed approach and 8 studies compared cTESE with mTESE approach. Overall, a SRR per TESE procedure of 47[45;49]% (mean percentage [95% CI]) was found. No differences were observed when mTESE was compared to cTESE (46[43;49]% for cTESE versus 46[42;49]% for mTESE). Meta-regression analysis demonstrated that SRR per cycle was independent of age and hormonal parameters at enrolment. However, the SRR increased as a function of testis volume. In particular, by applying ROC curve analysis, a mean testis volume higher than 12.5 ml predicted SRR >60% with an accuracy of 86.2% ± 0.01. In addition, SRR decreased as a function of the number of Klinefelter’s syndrome cases included (S = −0.02[−0.04;−0.01]; P WIDER IMPLICATIONS This analysis shows that cTESE/mTESE in subjects with NOA results in SRRs of up to 50%, with no differences when cTESE was compared to mTESE. Retrieved sperms resulted in a LBR of up to 28% ICSI cycle. Although no difference between techniques was found, to conclusively clarify if one technique is superior to the other, there is a need for a sufficiently powered and well-designed randomized controlled trial to compare mTESE to cTESE in men with NOA.

ZusammenfassungDie Robotik hat die klassische Laparoskopie in den letzen Jahren etwas an den Rand gedrängt. Dennoch hat sich auch die Laparoskopie und Retroperitoneoskopie in den letzten Jahren technologisch weiterentwickelt mit 4K-Ultra-HD-Videotechnologie, 3D-HD-Videosystemen, miniaturisierten Instrumenten, modernen Schneid- und Koagulationsverfahren, Instrumenten mit 7 Freiheitsgraden und ergnomischen Plattformen Ethos Chair®. Aufgrund der auslaufendenden Patente von Intuitive Surgical wird ab 2019 eine Konkurrenzsituation mit neuen Herstellern von Operationsrobotern existieren. Diese müssen erst belegen, ob sie den hohen Qualitätsstandard der Da-Vinci-Serie (SI, X, XI) bieten können. Dies betrifft die Art der Konsole, Anordnung der Roboterarme, Technologie des 3D-Videosystems und Qualität und Freiheitsgrade der Endeffektoren. Robotersysteme für die Endourologie sind Avicenna Roboflex® für die flexible Ureteroskopie und AquaBeam®-System für die Roboter-assistierte Aquaablation der Prostata. Während Roboflex ähnlich dem Da-Vinci-System die Ergonomie des Eingriffes erleichtert, ersetzt die robotergestützte Aquaablation erstmals den Operateur.

Artificial intelligence (AI) is the field of computer science that aims to build smart devices performing tasks that currently require human intelligence. Through machine learning (ML), the deep learning (DL) model is teaching computers to learn by example, something that human beings are doing naturally. AI is revolutionizing healthcare. Digital pathology is becoming highly assisted by AI to help researchers in analyzing larger data sets and providing faster and more accurate diagnoses of prostate cancer lesions. When applied to diagnostic imaging, AI has shown excellent accuracy in the detection of prostate lesions as well as in the prediction of patient outcomes in terms of survival and treatment response. The enormous quantity of data coming from the prostate tumor genome requires fast, reliable and accurate computing power provided by machine learning algorithms. Radiotherapy is an essential part of the treatment of prostate cancer and it is often difficult to predict its toxicity for the patients. Artificial intelligence could have a future potential role in predicting how a patient will react to the therapy side effects. These technologies could provide doctors with better insights on how to plan radiotherapy treatment. The extension of the capabilities of surgical robots for more autonomous tasks will allow them to use information from the surgical field, recognize issues and implement the proper actions without the need for human intervention.