Société Internationale d’Urologie Journal

Background/Objectives: For men with bothersome lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH) requiring surgical intervention, UroLift has been shown to be an effective and durable, minimally invasive method. Methods: A retrospective review was conducted for 72 patients who underwent UroLift at a single hospital in Australia between 2018 and 2025. Data regarding baseline demographics, the pre- and post-operative International Prostate Symptom Score (IPSS), maximum urinary flow rate (Qmax), the post-void residual (PVR), and complications were collected prospectively. Inclusion criteria for patients selected for UroLift were males over 50 years with a prostate volume between 20 and 70 mL, pre-operative PVR of <350 mL and Qmax and IPSSs of <15 mL/s and >12 respectively. The purpose of this study is to assess the clinical outcomes of patients treated with UroLift at our institution and compare these findings to the existing literature. Results: Complete data was available for 34 patients. Our cohort had a median age of 63.0 years (interquartile range [IQR] 58.0–69.0) and UroLift was performed using a median number of 4.05 implants per patient. Median prostate volume (mL) was 43.0 (IQR 38.0–59.0). Post-operatively, the median percentage changes in the IPSS, Qmax (mL/s) and PVR (mL) were −30.9% (IQR 5.8–−71.1, p = 0.0048), 40.1% (IQR −6.6–165.1, p = 0.0159) and −36.4% (IQR −84.6–29.8, p = 0.0232), respectively. Most patients (n = 24, 73.5%) were discharged on the same day of the UroLift procedure with the remainder (n = 9, 26.5%) being discharged on day 1 post-operatively. The median time (months) for post-operative review was 2 (IQR 0.9–3.3). Conclusions: UroLift is safe, effective, and a minimally invasive treatment option in suitable patients with bothersome LUTS requiring surgical intervention. Full article

Background/Objectives: Sarcopenia is a progressive skeletal muscle disorder linked to adverse outcomes. Computed Tomography (CT) can quantify skeletal muscle, while the Charlson Comorbidity Index (CCI) predicts mortality by categorising comorbidities. This study examined whether Computed Tomography of the Kidneys, Ureters, and Bladder (CT-KUB)-derived skeletal muscle measurements correlate with CCI scores in hospitalised patients. Methods: This retrospective study included all patients admitted with renal colic to the Urology Department, Blacktown Hospital and underwent cystoscopy between June 2022 and June 2025. Data were obtained from electronic medical records. CCI scores, incorporating age and comorbidities, generated 10-year survival estimates. CT-KUB scans were reviewed for psoas muscle perimeter, area, height, width and Hounsfield unit at the aortic bifurcation. Skeletal Muscle Index (SMI) was calculated as skeletal muscle area (SMA)/height². Associations between CCI, psoas muscle metrics and outcomes (length of stay, Intensive Care Unit (ICU) admission, Emergency Department (ED) re-presentation) were assessed using Pearson’s correlations and between-group comparisons. Results: A total of 397 patients were analysed. Median Length of Stay (LOS) was 1 day (mean = 1.92, SD = 1.88). ICU admission occurred in 2.3% of patients, and 18.6% re-presented to ED within 30 days. Both CCI survival percentage and psoas muscle metrics (including SMI) were significantly associated with LOS. Lower SMA, Hounsfield unit (HU), length and perimeter were linked to higher ICU admission risk. Neither CCI nor muscle measures predicted ED re-presentation. Conclusions: CCI and CT-derived muscle metrics were independently associated with outcomes such as LOS and ICU admission. Combining these measures may improve risk stratification, warranting further prospective evaluation. Full article

Background/Objectives: Urology residency training widely varies across countries, and evidence comparing residents’ experiences at an international level is limited. This study reports the results of an international survey of urology residents from different countries worldwide, aiming to characterize training environments, educational exposure, and trainee expectations across diverse healthcare systems. Methods: A 39-item online survey was administered to urology residents during the Société Internationale d’Urologie (SIU) Regional Meeting (Florence, November 2024), assessing demographics, training exposure, educational resources, workload, satisfaction, and career perspectives. The results were compared between trainees at different postgraduate years (PGYs) to explore associations for key outcomes. Results: Overall, 208 urology residents from 21 countries completed the survey. Most residents were actively involved in research (76.4%), although confidence in independent scientific production was moderate (significantly lower among junior trainees). Surgical exposure increased with PGY, with good experience in endoscopy but limited hands-on exposure and expected autonomy in laparoscopic, robotic, and major open surgery. Despite high overall satisfaction with urology, residents described heavy workloads, inconsistent access to structured teaching and international fellowships, and a long-term shift in career expectations toward private practice. Conclusions: Urology residents worldwide report high engagement in research, strong satisfaction with their specialty choice, and interest in international mobility. Nonetheless, persistent disparities in surgical exposure, research confidence, workload, and gender representation highlight the need for competency-based curricula, structured mentorship, and improved training organization to promote equitable and high-quality urology education globally. Full article

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. Full article

Background/Objectives: Transurethral Laser Ablation (TULA) is fast evolving as a surgical procedure, especially for small or recurrent bladder tumours. It offers a safe alternative for patients who are unsuitable for general anaesthetic (GA) or who cannot obtain timely pre-operative assessments for Transurethral Resection of Bladder Tumour (TURBT). Patients are identified for TULA in ‘Bladder Cancer Surgery Planning Meetings’ (BSPMs) and this significantly reduces their cancer waiting time (CWT). Its effectiveness as a diagnostic and therapeutic tool, including its complications and costs, has been assessed. Methods: All TULA procedures performed at the Trust were studied in two cycles. The first between August 2023 and November 2024, prior to initial audit, and then up to September 2025. Case notes, operation notes, and multidisciplinary team (MDT) outcomes were retrospectively reviewed. All procedures were performed with a flexible cystoscope and ‘cold cup’ biopsies with further ablation and haemostasis using a 1470 nm diode laser at 4 watts and 400 µm laser fibre. Patients were identified for TULA based on tumour size, location, and fitness for general anaesthetic. Results: During the study period, 95 TULA procedures were performed with a follow-up period between 4 weeks and 1 year. A total of 86 patients (90.5%) had local anaesthetic (LA) ± intravenous (IV) sedation, with 50% having LA alone in the second phase of the study; of the remaining patients, 8 had GA (8.4%) and 1 (1.1%) had spinal anaesthetic. None of the cases were considered to have missed a significant finding. One case (1.1%) was complicated, with ongoing bleeding requiring bladder washout under GA. BSPMs were introduced in July 2024 and audited in the first phase of this study. A total of 24 (39%) of patients were identified for TULA. Of those, 7 (29%) were originally scheduled for TURBT and were having difficulties obtaining pre-operative assessment (POA) clearance. Cost figures were provided by the hospital’s accountants. Conclusions: TULA has been implemented with a low complication rate and appropriate sampling. In the next phase, TULA will be rolled out to an outpatient setting, performed exclusively under LA. This will lead to a significant cost reduction. Full article

Background/Objectives: Ureteric stents are commonly used in urological procedures. However, they can cause pain; haematuria; voiding symptoms; or stent migration. When stent migration occurs, this can cause a significant impact on the patients’ therapeutic outcomes and may warrant a repeat procedure to retrieve or replace the ureteric stent. This study aims to assess if there are any patient; stent; or operative factors that may increase the risk of stent migration. Methods: This is a single-institute, retrospective cohort study that looked at patient; stent; and operative factors for 828 ureteroscopies and or laser lithotripsy for management of ureteric or intra-renal calculi over a 2-year period. The 828 procedures comprised 655 patients, as some patients had multiple procedures. Results: From the 828 cases, there was a 2.7% incidence of stent migration; all episodes of stent migration were distal migration. Stent migration was more likely among females (odds ratio (OR) = 3.0; 95% confidence interval (CI) [1.2; 7.1]) compared to males; older aged groups (over 65 years) (OR = 2.7; 95% CI [0.9; 7.8]) compared to the young aged group (16–44 years); and those who were obese (OR = 2.1; 95% CI [0.9; 5.0]), had musculocutaneous (MSK) conditions (OR = 2.7; 95% CI [0.9; 8.3]), neurological conditions (OR = 3.3; 95% CI [1.1; 10.0]), and stent dwelling time ≥ month (OR = 2.3; 95% CI [0.9; 6.0]) compared to <1 month. There was no observed association between stent and operative factors. Conclusions: Patient factors such as sex; age; comorbidities; and weight need to be considered by urologists in conjunction with modifiable stent factors to ensure that the decisions are made on an individual basis to try and reduce the risk of stent migration. Full article

Background/Objectives: This study aims to assess the prevalence and predictors of burnout among urology professionals in Pakistan using a validated tool and to explore underlying causes through qualitative input. Methods: A cross-sectional survey was conducted among urology trainees, fellows, and consultants across Pakistan. Burnout was measured using the Maslach Burnout Inventory–Human Services Survey (MBI-HSS). Burnout was defined using a criterion of high emotional exhaustion or high depersonalization. Descriptive statistics and chi-square tests were used to assess associations. Thematic analysis was applied to open-ended responses. Results: A total of 183 responses were received. When using the high emotional exhaustion (EE) or depersonalization (DP) criterion, 62% was classified as experiencing burnout. Significant predictors included excessive working hours (more than 80 h per week), frequent night calls, avoidance-based coping, workplace favouritism, and discrimination. No association was found with gender, age, or designation. Thematic responses highlighted five common causes of burnout. Conclusions: Burnout is prevalent among urology professionals in Pakistan and is largely driven by modifiable factors. Interventions must target institutional support, work–life balance, and healthier coping mechanisms. Full article

Background/Objectives: To evaluate whether medical cannabis (MC) use following dysuria diagnosis is associated with increased risk of developing substance use disorder (SUD), given rising cannabis prescriptions for urologic symptoms and concerns about long-term consequences. Methods: We conducted a retrospective cohort study using the TriNetX Research Network, a federated electronic health record database with over 120 million patients. Adult patients newly diagnosed with dysuria between 2003 and 2024 were identified and stratified by subsequent cannabis exposure. MC users were defined by a cannabis-related diagnostic code within 90 days of dysuria diagnosis. Propensity score matching (PSM) was performed 1:1 by age, sex, and race. The primary outcome was a new diagnosis of SUD (cannabis, opioid, or cocaine use disorders) within 12 months. Secondary analysis included Kaplan–Meier (KM) survival estimates over 5 years. Risk ratios (RR), odds ratios (OR), and hazard ratios (HR) were calculated. OR and RR estimated the likelihood of SUD within 12 months, and HR reflected relative hazard over 5 years. Results: After excluding patients with prior SUD, the final sample included 60,544 MC patients and 98,715 general dysuria (GD) patients. The MC group had a significantly higher incidence of new SUD diagnoses (11.13%) than the GD group (2.28%), yielding a risk difference of −8.85% (95% CI: −9.11 to −8.58; p < 0.0001), relative risk 0.205, and OR 0.186. KM analysis showed lower SUD-free survival in MC (80.96%) versus GD (96.35%; log-rank p < 0.0001). MC exposure was associated with nearly fivefold increased odds of SUD within 12 months (OR = 0.186) and sixfold higher hazard over 5 years (HR = 0.163). Conclusions: Medical cannabis use after dysuria is linked to markedly increased risk and earlier onset of SUD. Careful patient selection, counseling, and monitoring are essential when prescribing MC for urologic symptoms. Full article

Background/Objectives: Sacral neuromodulation (SNM) is an established therapy for refractory overactive bladder and non-obstructive urinary retention. With the rapid adoption of large language models (LLMs) such as ChatGPT, their accuracy in procedure-specific domains requires evaluation. The aim of this study was to compare the accuracy, completeness, and reproducibility of ChatGPT versions 3.5, 4.0, and 5.0 in answering patient- and guideline-based questions on SNM. Methods: Twenty questions were developed from international guidelines, device information, and common patient inquiries, covering five domains (mechanism, technique, outcomes, complications, postoperative management), two source types (frequently asked question [FAQs] vs. guideline), and three difficulty levels. These thematic domains were derived from core clinical counseling areas routinely addressed in SNM evaluation and follow-up. Each was submitted to ChatGPT versions 3.5, 4.0, and 5.0. Responses were rated independently by two urologists on a four-point accuracy scale. Combined success (Grades 1–2) and accuracy trends were compared across versions. Chi-square tests were used to assess differences across versions, Cramer’s V to measure effect size, and Cohen’s kappa to evaluate reproducibility. Results: Accuracy improved progressively across versions. Combined success rates rose from 70% in version 3.5 to 85% in 4.0 and 90% in 5.0 (p = 0.031, Cramer’s V = 0.29). Highest accuracy was observed in mechanism and procedural technique, while complication- and guideline-based questions showed lower performance. FAQ and straightforward questions were answered more reliably than guideline-based or complex ones. Reproducibility was excellent across all versions (κ = 0.81–0.91). Conclusions: ChatGPT 4.0 and 5.0 show strong potential as adjunctive tools for patient education in SNM, particularly for FAQs and procedural explanations. However, because persistent limitations were observed in guideline interpretation and complication management, clinician oversight remains essential, and these models should not be regarded as substitutes for professional clinical judgment. Full article

Male genitourinary (mGU) malignancies, including prostate, bladder, kidney, testicular, and penile cancers, represent a clinically and epidemiologically significant subset of global cancer burden. Although well-established etiological factors such as genetic mutations, androgen signaling, and environmental exposures contribute to tumorigenesis, the underlying mechanisms remain ill-defined. Recent advances in next-generation sequencing and metagenomics technologies have facilitated a deeper understanding of the human microbiome, revealing its potential role in carcinogenesis. While the gut microbiome has been extensively studied, emerging evidence indicates that site-specific microbial communities within the genitourinary (GU) tract may significantly influence cancer susceptibility, progression, and therapeutic outcomes. Accordingly, this review aims to comprehensively summarize the current evidence examining the relationship between the GU microbiome and the development, progression, and treatment of mGU cancers. To provide the specific context, relevant publications were collected from Google Scholar, PubMed, Science Direct, Dimension AI, and EBSCO Host using specific keywords such as “bladder cancer”, “dysbiosis”, “genitourinary”, “genitourinary cancer”, “microbiome”, “pathogens”, “penile cancer”, “prostate cancer”, “renal cancer”, “testicular cancer”, “urogenital microbiome”. We did not add any limits to the publication date during the inclusion of papers. However, it is noteworthy that the initial reports, including the aforementioned keywords, have been published since 2015. Emerging evidence highlights a significant association between the dysbiosis of the GU microbiome and the development of mGU cancers. Notably, an increase in bacterial richness and species diversity has been correlated with a rapid progression of these cancers, suggesting that such features may be explored as potential candidate biomarkers. Advanced sequencing and meta-omics technologies have enabled the identification of distinct microbial signatures with emerging diagnostic, prognostic, and therapeutic potential. Despite these advancements, the understanding of the functional and mechanistic roles of microbiota, particularly within the penile and seminal environments, remains limited. Full article