Search Results (240)

Objective: Our objective was to compare clinical safety and postoperative efficacy between transvesicoscopic Politano–Leadbetter (TPL) and laparoscopic Lich–Gregoir (LLG) ureteral reimplantation in infants and toddlers under 36 months diagnosed with primary obstructive megaureter (POM). Methods: This was a single-center retrospective cohort study of pediatric patients with POM who underwent ureteral reimplantation between January 2018 and April 2025. Patients were stratified into TPL and LLG groups by surgical approach. Baseline characteristics, perioperative outcomes, perioperative complications, imaging findings, renal functional outcomes, and long-term complications were collected and analyzed. Primary group comparisons were unadjusted, with additional multivariable linear regression performed for operative duration. Results: We enrolled 65 children: 30 in the TPL group and 35 in the LLG group. Baseline characteristics showed no statistically significant differences across the two study cohorts. There were no open conversions in either group. Total operative duration did not differ significantly between the TPL and LLG groups (145.8 ± 30.6 min vs. 136.9 ± 25.2 min; mean difference, 8.9 min; 95% CI, −4.9 to 22.7; p = 0.210). In multivariable linear regression, TPL showed a non-significant trend toward longer operative time after adjustment for age, preoperative ureteral diameter, and surgery year (B = 10.4 min; 95% CI, −3.7 to 24.4; p = 0.141). Time to postoperative oral intake was slightly shorter in the TPL group (6.1 ± 2.3 h vs. 8.2 ± 2.9 h; mean difference, −2.1 h; 95% CI, −3.4 to −0.8; p = 0.002). No statistically significant differences were detected in estimated blood loss, ureteral tapering rate, double-J stent placement rate, postoperative pain score, acetaminophen use, urinary catheterization duration, or length of hospital stay. Perioperative complications occurred in 3 patients in the TPL group and 5 patients in the LLG group (10.0% vs. 14.3%; risk difference, −4.3%; 95% CI, −20.1% to 11.5%; p = 0.716). No Clavien–Dindo grade III or higher complications occurred in either group. During follow-up, both groups showed reductions in anteroposterior pelvic diameter (APD) and ureteral diameter (UD), with preserved differential renal function (DRF). Low-grade postoperative vesicoureteral reflux (VUR) was detected in two LLG patients, including one grade I case at 4 months and one grade II case at 6 months after surgery; both were managed conservatively. Neither group experienced recurrent ureterovesical junction obstruction (UVJO) nor required reoperation during follow-up. Conclusions: In this single-center retrospective cohort of infants and toddlers with POM, no statistically significant differences were detected in the main perioperative and follow-up outcomes between TPL and LLG. TPL enables intravesical reconstruction and better preserves the natural anatomical course of the ureter and may serve as an alternative minimally invasive option for this patient population. Full article

Background/Objectives: Radical nephroureterectomy (RNU) is the standard of care for high-risk upper tract urothelial carcinoma (UTUC) but causes permanent renal decline, often disqualifying patients from essential cisplatin-based adjuvant chemotherapy. Segmental ureteral resection (SUR) preserves renal function, but its safety in high-risk patients remains fiercely debated due to historical treatment selection biases and a lack of competing risk adjustments. We aimed to compare long-term oncological outcomes and postoperative renal function preservation between SUR and RNU for high-risk UTUC strictly localized to the ureter. Methods: Retrospective data from 859 patients (783 RNU, 76 SUR) with high-risk ureteral UTUC (high-grade or pathologic T2–T4) were analyzed from a 21-hospital nationwide database. Propensity score overlap weighting was implemented to achieve covariate balance. Overall survival (OS) was assessed via Cox proportional hazards regression, whereas cancer-specific survival (CSS), metastasis-free survival (MFS), and local recurrence-free survival (LRFS) were evaluated using multivariable Fine–Gray subdistribution hazard models to robustly account for the competing risk of non-cancer mortality. Results: Overlap weighting achieved excellent baseline comparability with an effective sample size of 429.5 patients per cohort. Weighted analyses demonstrated comparable long-term trajectories between SUR and RNU for OS (p = 0.62), CSS (hazard ratio [HR]: 0.94, p = 0.835), and MFS (HR: 0.88, p = 0.664). The Fine–Gray model confirmed that the surgical approach was not a significant independent predictor of local recurrence (HR: 0.74, p = 0.351). Crucially, the SUR group demonstrated a significantly lower renal function decline both at 1 month (−0.11 vs. −10.58 mL/min/1.73 m², p < 0.001) and through final clinical follow-up (−5.33 vs. −12.49 mL/min/1.73 m², p = 0.001). Conclusions: For meticulously selected patients with high-risk ureteral UTUC, SUR provides equivalent oncological control and survival outcomes to standard RNU. Crucially, this kidney-sparing approach significantly preserves postoperative renal function, safeguarding the physiological reserve required for patients to maintain eligibility for optimal subsequent systemic adjuvant therapies. Full article

Background/Objectives: Prostate cancer is one of the most common non-skin solid malignancies among male solid organ transplant recipients (SOTRs), in whom radical prostatectomy is technically demanding. We report the first use of indocyanine green (ICG) fluorescence for simultaneous transplanted-ureter identification and renal graft vascular mapping during robot-assisted radical prostatectomy (RARP), and the first use of the CMR Versius^® platform in a SOTR. Methods: Retrospective case series of four consecutive male SOTRs (two renal [RTRs], two hepatic) undergoing RARP. In both RTRs, a dual-route ICG protocol was used on the da Vinci Xi with Firefly^® imaging: pre-docking intraureteral ICG via a ureteral catheter for ureter identification, plus an intravenous ICG bolus for graft vascular mapping and cortical perfusion. One hepatic recipient was operated with the CMR Versius^® system using an infra-umbilical port configuration to avoid the chevron transplant scar. Results: All four procedures were completed robotically without conversion. Median operative time was 176 min and median estimated blood loss 350 mL. Surgical margins were negative (R0) in all four; final pathology was pT3aN0 in three and pT2N0 in one, although in the renal recipients nodal staging reflected a contralateral-only dissection. PSA was undetectable at three months in all patients. One hepatic recipient later developed biochemical recurrence, managed with salvage radiotherapy and androgen deprivation therapy, with subsequent undetectable PSA. One hepatic recipient had a Clavien–Dindo IIIa complication. No graft dysfunction occurred. Conclusions: ICG-guided RARP and the CMR Versius^® platform appear technically feasible in carefully selected solid organ transplant recipients treated at an experienced multidisciplinary centre, with no graft-related complications observed in this small initial series. These preliminary findings require validation in larger, multicenter studies before general safety and oncological efficacy can be established. Full article

Background: Upper tract urothelial carcinoma (UTUC) is a rare malignancy with prognosis predicated on clinical and pathological factors. Radical nephroureterectomy is the standard treatment for higher risk localized UTUC, although competing mortality may influence optimal treatment selection in older patients. Methods: A retrospective population-based cohort study was conducted using the Surveillance, Epidemiology, and End Results program. Individuals diagnosed with UTUC of the renal pelvis or ureter between 2000 and 2017 were included. Patients with unknown tumor grade or size were excluded. Results: A total of 10,894 patients were included. During a median follow-up of 26 months, 57% died from any cause and 27% died from UTUC. For each 5-year increase in age of diagnosis, the cancer-specific mortality risk rises more in low-grade patients (21% increased riskjtp: 0.008) than high-grade patients (9% increased risk p: 0.023). Other-cause mortality risk rose markedly with increasing age (SHR 3.54 for ages 85+, p < 0.001). Conclusions: Age at diagnosis is significantly associated with cancer-specific mortality in UTUC. Incorporating age and competing risk into risk stratification may help inform shared decision-making regarding treatment approaches in older patients. Full article

Background/Objectives: Intermittent ureteropelvic junction obstruction (UPJO), classically termed Dietl’s crisis, may be missed when imaging is obtained outside symptomatic periods. The challenge is amplified in duplicated collecting systems, where the obstructed moiety may not be recognized on screening ultrasonography. Case Presentation: A 14-year-old boy presented with recurrent severe right flank pain triggered by heavy fluid intake, associated with nausea and vomiting and separated by symptom-free intervals. An initial renal ultrasound performed between attacks was normal. One week later, the same pain pattern recurred together with a febrile urinary tract infection. Computed tomography urography (CTU) demonstrated an incomplete right duplex collecting system with a bifid ureter, marked hydronephrosis of the lower moiety, delayed contrast excretion, and focal narrowing at the lower-moiety ureteropelvic junction adjacent to one crossing artery and one crossing vein. Diuretic ^99mTc-mercaptoacetyltriglycine (MAG3) renography documented obstructive drainage, with a post-furosemide drainage half-time (T1/2) > 20 min, differential renal function of 51% on the right, and split moiety function of 31% (upper) and 20% (lower). The patient underwent transperitoneal robot-assisted dismembered Anderson–Hynes pyeloplasty of the lower moiety with the reconstructed ureteropelvic junction repositioned anterior to the crossing vessels; a 6 Fr × 26 cm double-J stent was placed and subsequently removed at 4 weeks postoperatively. Total skin-to-skin operative time was 75 min, estimated blood loss < 100 mL, and the postoperative course was uneventful. At early 3-month follow-up, the patient remained free of Dietl-type episodes, and ultrasonography showed marked reduction in lower-moiety hydronephrosis. Selective postoperative CTU, obtained because of the unusual bifid anatomy, demonstrated patent drainage. Conclusions: A normal interval ultrasound should not exclude intermittent UPJO when the history is stereotypical, and cross-sectional plus functional imaging is decisive when duplex anatomy and crossing vessels coexist. Full article

Background: This study aimed to determine whether incorporating radiologic contrast during the excretory (urographic) phase enhances the detection of recurrence on [68Ga]Ga-PSMA-11 PET/CT in patients with biochemical relapse (BCR) following radical prostatectomy (RP). Methods: A single-center retrospective analysis included 43 men with BCR after RP who underwent [68Ga]Ga-PSMA-11 PET/CT. Each patient underwent two comparative assessments. In the first assessment, whole-body PET images acquired at 60 min post-injection were fused with the non-contrast CT from early dynamic pelvic imaging (PET/CTd), and local recurrence and pelvic nodal involvement were evaluated according to PROMISE V2 and E-PSMA frameworks by two blinded readers. In the second assessment, the same PET dataset was fused with the excretory-phase CT urography (CT-U) obtained during the same imaging session at 60 min post-injection, and the same parameters were re-evaluated. Endpoints included surgical-bed classification, peri-ureteric nodal status, reader confidence, ureter visualization/opacification, and interpretation time. Inter- and intra-observer agreement was assessed, and discrepancies were resolved by consensus. Results: Surgical-bed positivity decreased from 12/43 (27.9%) on PET/CTd to 5/43 (11.6%) on PET/CT-U, leading to reclassification in seven patients (p = 0.016). Reader confidence improved significantly in five cases (p < 0.005). Peri-ureteric nodal status was changed in four patients (two positive-to-negative and two negative-to-positive), with overall positivity unchanged (5/43 vs. 5/43; p = 1.000). Ureter visualization improved markedly (inadequate: 31 vs. 10 cases), reducing diagnostic uncertainty by 50%. CT-U opacification was ≥50% in most cases (κ = 0.814), enabling reliable delineation of the ureteral course. Inter-reader agreement remained strong (surgical bed κ: 0.944 vs. 0.876; nodes κ: 0.896 both). Interpretation time decreased for both readers (senior: 3.12 vs. 2.10 min (−32.7%); junior: 4.06 vs. 2.42 min (−40.4%)). Conclusions: Adding an excretory-phase CT urography to [68Ga]Ga-PSMA-11 PET/CT improves diagnostic confidence, reduces interpretive uncertainty in the surgical bed, clarifies peri-ureteric nodal findings, enhances ureter visualization, and shortens interpretation time. CT-U is a practical enhancement to low-dose PET/CT protocols for BCR after RP. Full article

Background and Objectives: Hysterectomy is one of the most frequently performed gynecological surgical procedures worldwide. It is well established that the laparoscopic approach offers better outcomes for patients compared to abdominal hysterectomy. However, the technique for vaginal cuff closure during laparoscopic hysterectomy (TLH) remains insufficiently standardized in the international literature. Based on our results, we aim to demonstrate that closure of the vaginal cuff using a figure-of-eight suture is a sufficient, reproducible, time-efficient and safe method during total laparoscopic hysterectomy. Materials and Methods: Our retrospective observational study analyzed 173 patients who underwent a TLH from January 2016 to December 2021 at the University of Debrecen, Department of Obstetrics and Gynecology. Standardized surgical steps were applied in all cases (ligation of the uterine arteries at their origin, fenestration of the broad ligament above the ureter), and the vaginal cuff was closed laparoscopically with an absorbable suture, incorporating vesicovaginal fascia, vaginal mucosa and uterosacral ligaments. Patient demographics, operative data, and perioperative outcomes were extracted and analyzed. Results: TLH was successfully performed in 173 cases, and no conversion to open surgery was necessary. The mean age of the patients was 51.4 (23–86) years, the median body mass index (BMI) was 26.9 (16.9–45) kg/m², and the operative time was 92 (35–240) minutes. The mean uterine weight was 151 (16–440) g. The mean hemoglobin drop was 15.8 (0–44) g/L after the surgery. Regarding complications, ureteral injuries occurred in two cases (1.2%). One patient (0.6%) required relaparotomy due to rectosigmoid perforation. Postoperative complications included vaginal cuff dehiscence in two cases (1.2%), with one patient (0.6%) requiring resuturing, fever in six cases (3.5%), vaginal discharge in four cases (2.3%), and vaginal bleeding in one case (0.6%). Pulmonary embolism occurred in one patient (0.6%). Three patients (1.7%) required blood transfusion based on postoperative blood counts. Conclusions: Our results demonstrate an acceptable operative time and a low rate of postoperative complications, suggesting that closing of the vaginal cuff with a figure-of-eight suture is a sufficient and safe technique. This method can be reliably reproduced and incorporated into the standardized steps of total laparoscopic hysterectomy. Full article

Background/Objectives: To externally validate and compare four postoperative upper tract urothelial carcinoma (UTUC) nomograms in a contemporary Australian radical nephroureterectomy (RNU) cohort, and to identify independent clinicopathological predictors of survival. Methods: We conducted a retrospective study across a multi-site tertiary service in Victoria of patients who underwent RNU for localised UTUC between January 2011 and December 2021. Patients were excluded if RNU was performed for non-UTUC-related reasons or if they had incomplete data. Univariable and multivariable Cox models assessed prognostic factors. Discrimination of the nomograms was evaluated using Harrell’s C-index with bootstrap-corrected calibration. Results: Of 142 total patients undergoing RNU, 103 were included in the final study cohort. In our multivariable Cox regression analysis, increasing age, sessile architecture and higher tumour stage emerged as independent predictive factors for worse overall survival (OS). For cancer-specific survival (CSS), increasing age, higher tumour stage, tumour location in the kidney, and synchronous tumours in the kidney and ureter were statistically significant. Four nomograms (Seisen, Abdul-Muhsin, Cha and Roupret) were identified. External validation showed the best discrimination of CSS for Seisen (C-index 0.814, 95% confidence interval (CI) 0.687–0.915); Abdul-Muhsin had good OS but moderate CSS discrimination (C-index 0.708 and 0.651), Cha showed good CSS but excellent recurrence-free survival (RFS) discrimination (C-index 0.770 and 0.826) and Roupret CSS nomogram showed good CSS discrimination (C-index 0.789, 95% CI (0.653, 0.900). Conclusions: The Seisen nomogram provided the most accurate, well-calibrated five-year cancer-specific predictions after RNU, outperforming the Abdul-Muhsin, Cha and the Roupret models, likely due to its weighting of age, location, and sessile architecture, which are independent predictors of worse CSS. These data endorse a risk-adapted strategy using the Seisen nomogram to guide postoperative counselling, surveillance intensity, and consideration for adjuvant therapy. Full article

Accurate segmentation of the ureter on abdominal computed tomography (CT) remains challenging due to its thin tubular structure and limited expert-annotated training data. While recent deep learning approaches have shown promise on non-contrast CT, arterial-phase imaging remains under-researched. We systematically compared nnU-Net-based configurations for ureter segmentation on arterial-phase CT using 25 radiologist-annotated cases from Seoul St. Mary’s Hospital. Seven training strategies were evaluated with five-fold cross-validation: binary ureter-only segmentation, multi-organ training with anatomical context from eight structures, alternative encoder architectures (ResEncM), specialized loss functions (Tversky, clDice), and a multi-phase fusion architecture. Multi-organ training with Tversky-Focal loss (Config 6) achieved the highest mean Dice of 0.743 ± 0.021 with the best clDice connectivity score (0.800 ± 0.046) and lowest fragmentation (6.56 connected components). Multi-phase fusion yielded a mean Dice of 0.713 on the 12-case subset; a controlled arterial-phase single-channel ablation on the identical 12-case subset achieved 0.721, marginally exceeding the two-channel fusion result (0.713). These findings are scoped to a single-institution exploratory cohort and should be interpreted as internally comparative benchmarking results; they may not generalize to other centres, scanners, or patient populations, and do not constitute clinical validation. Full article

Despite their reduced viability, kidneys from donors-after-circulatory-death (DCD) increase the pool of transplantable kidneys. Molecular hydrogen (H₂) is emerging as a gas with therapeutic potential against graft injury. We investigated the effect of H₂ in an ex vivo porcine model of DCD kidney transplantation. Renal arteries of male Yorkshire pigs (n = 6) were clamped in situ for 60 min to induce ischemia, and ureters and arteries were cannulated to mimic DCD kidney injury. Upon nephrectomy, kidneys were flushed with UW solution or H₂-saturated UW solution and then preserved by machine perfusion at 4 °C for 4 h followed by a 4-h reperfusion period with warm autologous blood. Urine and arterial blood samples were collected hourly. H₂ preserved renal architecture, evidenced by significantly reduced tubular necrosis and renal expression of damage markers, which corresponded with the downregulated renal expression of pro-inflammatory genes compared to the UW-only group (p < 0.05). H₂ also markedly reduced levels of serum creatinine, BUN and intrarenal resistance, while flow rate, creatinine clearance and urine output were significantly higher, which positively correlated with Trx-1 and HO-1 expression in comparison with UW only group (p < 0.05). Improvement in renal graft quality and function is associated with Trx-1/HO-1 activation, suggesting preliminary clinical trials in kidney transplantation. Full article

Background and Objectives: The systemic inflammatory response is important in cancer prognosis and progression. The inflammatory burden index (IBI) provides information about both inflammation and the immune response. Urothelial carcinomas are immunogenic; therefore, it has been suggested that inflammatory indices may predict disease prognosis. The aim of this study was to investigate the effects of systemic inflammatory indices, particularly the inflammatory burden index, on disease progression and overall survival in patients with metastatic urothelial cancer (affecting the bladder and upper urinary system) before first-line treatment and to demonstrate their prognostic importance. Materials and Methods: Within the scope of the study, the medical records of 130 patients who received systemic treatment for metastatic urothelial carcinoma at the medical oncology clinic were retrospectively reviewed. Receiver operating characteristic (ROC) curve analysis was performed to determine the optimal threshold values for IBI. Survival rates were calculated using the Kaplan–Meier method, and survival differences between groups were compared with the log-rank test. Univariate and multivariate analyses were performed using the Cox proportional hazards regression model to evaluate prognostic factors. Results: A total of 130 patients were included in the study. The median age was 64.9 years (IQR: 57.2–70.5). The primary tumor location was the bladder in 84.6% of patients, while the remaining 15.4% originated from the ureter and renal pelvis. In first-line systemic treatment, patients received a median of 4 cycles (IQR: 3–6). The median number of total treatment lines administered for metastatic disease was 1 (IQR: 1–2). In progression-free survival (PFS) analyses, the median PFS was 9.20 (95% CI 6.55–11.85) months in the IBI-low group (n = 47) and 5.82 (95% CI 4.56–7.07) months in the IBI-high group (n = 83) (p < 0.001). The median OS was calculated to be 18.96 (95% CI 16.61–21.30) months in the IBI-low group (n = 47), while it was found to be 9.50 (95% CI 7.70–11.29) months in the IBI-high group (n = 83) (p < 0.001). In multivariate analysis, high IBI and the presence of brain metastasis were found to be associated with the risk of progression. In terms of overall survival, the presence of brain metastasis, the presence of visceral metastasis, ECOG PS status, receipt of maintenance therapy, LMR, and the IBI score showed statistically significant prognostic effects. Conclusions: In metastatic urothelial carcinoma, the IBI was identified as an independent prognostic factor associated with progression-free and overall survival. These findings suggest that the IBI may have potential utility as a prognostic biomarker; however, larger, multicenter, and prospective studies are required to further validate its clinical applicability. Full article

Schistosomiasis (bilharzia) is a parasitic infection caused by trematodes of the Schistosoma genus and remains a significant health burden in endemic regions. Granulomatous host responses to deposited Schistosoma eggs in small veins and tissues result in progressive changes and characteristic imaging findings. This diagnostic radiological review synthesizes the published literature and highlights key and robust imaging findings that facilitate the diagnosis of Schistosoma mansoni and Schistosoma haematobium, with emphasis on modality-specific patterns and disease staging. Schistosoma mansoni primarily affects the liver, causing periportal fibrosis visible as “pipe-stem” echogenic thickening upon ultrasonography, which may progress to portal hypertension and chronic liver disease. Liver cirrhosis is the end-stage disease manifested as an irregular liver contour with surface nodularity and lobar redistribution as right lobe atrophy with left and/or caudate lobe hypertrophy. Schistosoma haematobium predominantly affects the genitourinary system, causing urinary bladder wall thickening and calcification. Early disease, within three months of infection, may present with fine calcification, firstly in the bladder base and then extending to the whole bladder and even to the ureters. Calcification appears as a line or two parallel lines on radiography and as a circle in axial computed tomography (CT) images, which is pathognomonic for early-stage Schistosomiasis. In contrast studies, including conventional urography and CT urography, Schistosoma eggs appear as bubble-like filling defects in the ureter, kidney, and bladder, manifested as ureteritis, pyelitis, and cystitis cystica. Late stages appear as coarse calcification, fibrosis, strictures, and reduced bladder capacity and are associated with an increased risk of bladder squamous cell carcinoma. Moreover, Schistosomiasis calcification can present in genital organs, especially in the seminal vesicles; in the prostate in males; and in the vulva, cervix, and perineum in females. Ultimately, Schistosoma mansoni and haematobium eggs can reach the spinal cord, leading to acute myelopathy with paraparesis, urinary retention, or paraplegia. Recognition of characteristic imaging patterns of Schistosomiasis is essential for early diagnosis, accurate staging, and prevention of long-term complications. Full article

A 14-year-old spayed female Maltese dog presented with hematuria, pollakiuria, decreased urine volume per voiding, and prolonged urination time, and was diagnosed with multifactorial urinary obstruction involving suspected trigonal neoplasia and extensive urolithiasis affecting the kidneys, ureters, bladder, and urethra. Diagnosis was based on serum biochemical analysis, radiography, and ultrasonography, which revealed diffuse urolithiasis, urethral involvement, and a trigonal mass consistent with a suspected neoplastic lesion. Due to the multifocal nature of obstruction, surgical management was considered impractical. The patient underwent urethral stent placement as a minimally invasive palliative intervention. Following the procedure, rapid restoration of urine flow was achieved, and significant improvement in renal parameters, including blood urea nitrogen and creatinine, was observed within 3 days. During follow-up, the stent remained well positioned without migration. Although transient deterioration, including hydronephrosis and increased renal parameters, was noted at day 52, subsequent improvement was observed by day 64, suggesting a dynamic course of obstruction. This case demonstrates that urethral stenting can be an effective treatment option for managing complex, multifactorial lower urinary tract obstruction in dogs, providing rapid clinical improvement and sustained urinary patency. However, progressive changes in the upper urinary tract may occur, emphasizing the importance of comprehensive evaluation and continuous monitoring. Full article

Background and Clinical Significance: Rare adnexal tumors with Wolffian or sex cord-like differentiation may undergo major diagnostic reclassification after integrated histologic and molecular review. The contribution of minimally invasive surgery to this process has rarely been described in detail. Case Presentation: We focused on the case of a 33-year-old woman underwent laparoscopic right salpingectomy in October 2021 for a right-sided tubo-adnexal lesion initially diagnosed as adult granulosa cell tumor and later reinterpreted as high-grade endometrioid carcinoma. Completion staging in February 2022 was negative. Positron emission tomography/computed tomography in January 2023 raised concern for recurrence, and exploratory laparoscopy in March 2023 documented peritoneal metastatic disease, followed by four cycles of cisplatin given within the then-prevailing carcinoma-based diagnostic framework. A second laparoscopic reassessment in October 2023 was negative. Because of multifocal abdominal relapse, the patient underwent major cytoreductive surgery in October 2024. Integrated pathologic and molecular review then documented serine/threonine kinase 11 alteration together with forkhead box L2 negativity, favoring classification within the STK11-altered adnexal tumor spectrum. After external review, everolimus plus anastrozole was started in May 2025. Imaging in late 2025 documented persistent pelvic recurrence, and salvage xipho-pubic laparotomy in December 2025 revealed extensive disease involving both ureters, the bladder base, the rectosigmoid wall, and parietal peritoneum; recurrent tissue showed cluster of differentiation 117 positivity. At the most recent available follow-up in April 2026, the patient had no documented death and remained under postoperative surveillance. Discussion and Conclusions: This case illustrates the diagnostic importance of repeated tissue reassessment and the practical value of minimally invasive surgery as a relatively low-burden means of resection, restaging, and tissue acquisition in a rare molecularly reclassified adnexal tumor. Full article

Therapeutic interventions within the urinary system are often limited by the complex and tortuous anatomy of the renal pelvis and ureters, restricting access to deep regions and increasing the risk of mucosal trauma. In this study, we present a multifunctional, magnetically controlled ferrofluid droplet robotic platform engineered for high deformability and precision navigation. A custom electromagnetic actuation system was developed and optimized via COMSOL Multiphysics (version 6.3, COMSOL Inc., Stockholm, Sweden) simulations to generate programmable magnetic fields. Experimental validation in both simplified environments and anatomically realistic 3D-printed urinary tract models demonstrated the droplets’ capacity for controlled locomotion, reversible deformation, and traversing constrictions significantly smaller than their resting diameter. The droplets’ locomotion and extreme deformability are governed by the dynamic balance between the applied magnetic gradient forces, the restoring interfacial tension of the ferrofluid, and the fluidic viscous drag. Quantitatively, the droplets achieved robust translational velocities up to 260 mm/s under single-coil actuation (51 mT, 20 Hz) and 108 mm/s under a more stable dual-coil configuration (51 mT, 8.3 Hz). Furthermore, two clinically relevant functionalities were successfully executed: rapid vibration-induced release of encapsulated dye for targeted drug delivery, and the precise mechanical capture and transport of artificial kidney stones. These results establish a highly versatile platform for minimally invasive urological procedures, highlighting the immense potential of soft magnetic microrobotics for integrated therapeutic applications. Full article