Faculty Bibliography

The intersection between urology and plastic surgery represents an important collaborative frontier in modern reconstruction. Defects involving the genitourinary and perineal regions frequently require the coordinated expertise of both specialties to restore urinary continuity, soft-tissue coverage, sexual function, and aesthetics. Despite the expanding scope of this reconstructive collaboration that spans oncological, traumatic, congenital, and gender-affirming care, no formal designation has been defined to unify these efforts. This review introduces the concept of "uroplastics," a reconstructive field that integrates the principles and techniques of urology and plastic surgery under a shared philosophy of restoring both form and function. Drawing a parallel to the evolution of other blended specialties, such as neuroplastics, oncoplastics, and orthoplastics, uroplastics seeks to codify existing interdisciplinary practice into a coherent framework. Three collaborative models are identified across the literature: consultative, concurrent, and integrated. Each represents a progressive stage of interaction, from reactive consultation to fully integrated reconstructive programs and research partnerships. Representative studies demonstrate that early, structured collaboration improves wound healing, functional outcomes, and patient satisfaction in complex genitourinary reconstruction. Beyond the operating room, the formalization of uroplastics has implications for education, institutional design, and translational research, including advances in microsurgery, robotics, and tissue engineering. Its formal recognition as a collaborative reconstructive discipline will strengthen multidisciplinary training, accelerate innovation, and ultimately improve outcomes for patients requiring comprehensive genitourinary reconstruction.

PURPOSE/OBJECTIVE:Ileal ureter interposition is a well-established option for complex ureteral strictures. While minimally invasive approaches have evolved, the application of the single-port (SP) robotic platform for ileal ureter reconstruction has not been previously reported. This study presents the first clinical series evaluating the feasibility, technique, and early outcomes of SP robotic ileal ureter reconstruction. METHODS:We retrospectively reviewed a prospectively maintained database of patients who underwent SP robotic ileal ureter substitution between September 2019 and November 2024 by a single surgeon. Demographic, perioperative, and functional data were analyzed. Surgical success was defined as freedom from reintervention, absence of radiographic obstruction, and stable renal function. Pre- and postoperative renal function was compared using paired statistical analysis. RESULTS:Seventeen patients underwent SP robotic ileal ureter reconstruction (29% male), with a mean age of 54 years. Radiation-induced strictures accounted for 70.6% of cases. Unilateral reconstruction was performed in 8 (47.1%), while 8 (47.1) required bilateral reconstruction with V-shaped or reverse-7 configurations, including bladder augmentation in selected cases. One patient (5.9%) underwent unilateral ileal ureter with bladder neck reconstruction. The median ileal segment length was 25 cm. Mean operative time was 308 min, and median blood loss was 70 mL. One intraoperative complication (5.9%) occurred. Postoperative complications were observed in 47%, with 11.8% classified as Clavien-Dindo grade IIIa. Renal function remained stable (preoperative eGFR 56.4 vs. postoperative 57.5 mL/min/1.73 m², p = 0.803). At a median follow-up of 20.5 months, the overall success rate was 94.1%. CONCLUSIONS:Single-port robotic ileal ureter reconstruction is a feasible and effective technique for complex ureteral strictures, achieving high early success with acceptable morbidity.

BACKGROUND:Achieving adequate analgesia in patients undergoing vaginoplasty facilitates early ambulation, reduces postoperative morbidity and increases patient satisfaction. This study evaluated the use of intraoperative nerve blocks (transverse abdominis plane [TAP] block and perineal block) in reducing postoperative pain and decreasing opioid use in robotic-assisted peritoneal flap vaginoplasty. METHODS:A prospective cohort study of 150 consecutive adult patients undergoing robotic peritoneal flap vaginoplasty performed by the senior authors was conducted at a single institution from December 2023 to October 2024. 75 consecutive patients who did not receive a block and 75 consecutive patients who did receive blocks were included based upon power analysis calculations with assumptions yielding 99% power. Demographic data as well as multimodal analgesic use was compared between groups with respect to use during the preoperative, intraoperative, and post anesthesia phases of care, as well as on each day of inpatient admission. RESULTS:Groups did not differ significantly in baseline characteristics. Block-treated patients demonstrated a significantly reduced total opioid requirement throughout their hospital stay, inclusive of intraoperative and perioperative dosing, as measured in total morphine milligram equivalents (MME) (median 675 versus 26 MME; p < 0.001). Block-treated patients required almost no oxycodone or hydromorphone after surgery with a median oxycodone dose of 0 mg compared with 33 mg in controls (p < 0.001); their total median hydromorphone dose was 0.4 mg versus 1.2 mg (p < 0.001). CONCLUSIONS:The block intervention achieved a dramatic reduction in total postoperative opioid use (oral and intravenous) throughout the hospital stay.

INTRODUCTION/UNASSIGNED:Most transgender women have their prostate left in situ throughout and after their transition. Managing prostate‑related conditions in transgender women remains challenging due to the lack of clear recommendations. This review aims to summarize the available data on prostate health, including cancer screening and treatment, lower urinary tract symptoms, and prostate evaluation. MATERIAL AND METHODS/UNASSIGNED:A comprehensive literature review was conducted in accordance with the PRISMA statement using PubMed, Embase, and The Cochrane Library, with the keywords (prostate), (lower urinary tract symptoms (LUTS)), (prostate evaluation), and (transgender women). All relevant data were analyzed. RESULTS/UNASSIGNED:Twenty studies were included in the final analysis: 15 focused on prostate cancer, four on LUTS, and one on prostate evaluation. A total of 961 prostate cancer cases were identified. Of the 17 detailed oncologic treatments, the most common were surgery and hormone therapy. Data regarding LUTS and prostate evaluation were very limited; the most frequently reported symptom was a split urinary stream. Surgical interventions for LUTS included two cases of transurethral resection of the prostate (TURP) and one Rezum procedure. Prostate evaluation was performed via transvaginal exam in 50 patients. Transvaginal ultrasonographic assessment of the prostate was feasible in 67 out of 70 patients (96%). CONCLUSION/UNASSIGNED:The present systematic review demonstrates that prostatic diseases can occur in transgender women. Neovaginal prostatic exam appears as the appropriate way to assess the prostate on physical exam. The paucity of data highlights the need to raise awareness of healthcare professionals and to promote further research on this critical issue.

The advent of the purpose-built da Vinci single-port robotic platform marks a pivotal advancement in minimally invasive urological surgery. Designed to overcome the ergonomic and technical limitations of prior single-site approaches, the single-port system enables complex procedures through a single incision, with enhanced dexterity, optimized use of confined spaces and improved cosmetic and peri-operative outcomes. The single-port system has been increasingly used across a wide range of urological indications, including robot-assisted radical prostatectomy, partial nephrectomy, nephroureterectomy and reconstructive surgeries such as pyeloplasty and ureteral re-implantation. Innovative access strategies, such as the single-port transvesical and low anterior access approaches, have facilitated regionalized and multi-quadrant surgeries without the need for repositioning or robot re-docking. These advances have translated into reduced morbidity, faster recovery and increased feasibility of opioid-sparing, same-day discharge protocols. As surgical expertise deepens and technology evolves, the single-port robotic platform stands as a refinement of minimally invasive surgery, and also as a potential paradigm shift in urological practice.

BACKGROUND AND OBJECTIVE/OBJECTIVE:To report our multi-institutional outcomes with robotic intracorporeal ileal ureter replacement (RIUR). METHODS:We performed a retrospective review of patients who underwent RIUR at three institutions from April 2016 to June 2025. Surgical success was defined as the absence of flank pain and of ureteral obstruction on functional imaging and/or endoscopic evaluation, and freedom from operative intervention related to RIUR at ≥6-mo follow-up. KEY FINDINGS AND LIMITATIONS/UNASSIGNED:Of 48 patients, 31 (64.6%) had unilateral and 17 (35.4%) had bilateral reconstruction. Twenty (41.7%) had a history of radiation. Median stricture length was 20 cm (interquartile range [IQR] 20-25). In 19 patients (39.6%), a concomitant abdominopelvic reconstruction was performed (9 bladder augmentations, 5 contralateral ureteral reconstructions, and 5 other procedures). Median operative time was 359 min (IQR 292-418), estimated blood loss was 100 ml (IQR 50-175), and length of stay was 5 d (IQR 4-7). There were nine (18.8%) major (Clavien grade ≥III) 30-d complications: five urinary anastomotic leaks, two intra-abdominal abscesses, one small bowel leak that required exploratory laparotomy, and one renal bleed requiring angioembolization. Thirty-six patients (75%) had ≥6-mo follow-up, which confirmed surgical success in 33/36 (91.7%) at median follow-up of 24 mo (IQR 14-35). All three failures were in the radiation subgroup, which had a significantly lower rate of surgical success (76.9% vs 100%; p = 0.031). CONCLUSIONS AND CLINICAL IMPLICATIONS/CONCLUSIONS:RIUR is an effective and durable treatment for patients with devastating ureteral injuries. However, the procedure is challenging and associated with a significant major complication rate. PATIENT SUMMARY/RESULTS:This study looked at a complex surgery in which a piece of intestine is used to rebuild the urinary tube that drains urine from the kidney to the bladder. Across three hospitals, the procedure worked well for the large majority of patients, and helped to restore function and relieve symptoms.

BACKGROUND AND OBJECTIVE/UNASSIGNED:Robot-assisted buccal mucosa graft (BMG) ureteroplasty was introduced a decade ago and has since gained wide adoption within the urology community. However, available data on the outcomes of robot-assisted BMG ureteroplasty remain limited, and no large European series has been published to date. This study aims to report the outcomes of a multicenter European experience with robot-assisted BMG ureteroplasty (RBMGU) for the management of ureteral strictures. METHODS/UNASSIGNED:Medical records of all the patients who underwent RBMGU for ureteral strictures at four European centers between 2018 and 2024 were reviewed retrospectively. The primary outcome was the absence of stricture recurrence at the last follow-up, defined as the lack of need for urinary drainage or repeat surgery, or the presence of symptomatic hydronephrosis. KEY FINDINGS AND LIMITATIONS/UNASSIGNED:A total of 39 patients were included. The median stricture length was 3 cm, with 36% involving the pelvic ureter. A period of ureteral rest was implemented in 85% of patients. Early postoperative complications occurred in eight patients (21%), with only one major event (3%). After a median follow-up of 12 mo, the overall success rate was 87%. No predictive factors for recurrence were identified. CONCLUSIONS AND CLINICAL IMPLICATIONS/UNASSIGNED:RBMGU for ureteral stricture appears to be a feasible and reproducible technique across multiple surgeons and institutions. The outcomes demonstrate a promising trend, with preliminary results indicating low morbidity and recurrence rates. Further studies with larger cohorts are warranted to identify the risk factors for recurrence and to better define the optimal indications for this procedure. PATIENT SUMMARY/UNASSIGNED:In this report, we present the outcomes of robotic ureteral stricture reconstruction using buccal mucosa grafts across four European centers. The results are encouraging, demonstrating low rates of stricture recurrence and postoperative complications. We emphasize the key advantages of robotic-assisted reconstruction and the broad spectrum of ureteral strictures that may benefit from this approach.

PURPOSE:Robot-assisted surgical management of ureteral stricture is a relatively uncommon procedure with numerous techniques described. This literature review combined with expert opinion outlines the key surgical principles of ureteral reconstruction and proposes an algorithm for the robot-assisted treatment of ureteral strictures. METHODS:A narrative literature review was conducted using PubMed and Cochrane databases with a predefined search strategy including terms related to ureteroplasty and upper urinary tract reconstruction. The search yielded approximately 900 results. After screening, 219 relevant studies were selected for analysis. Two authors independently reviewed all included articles, and whenever evidence was inconsistent or insufficient, consensus was reached through discussion within the full author group. RESULTS:Robotic ureteral reconstruction includes several techniques, with the choice of procedure guided by multiple factors. Key principles include the use of healthy tissue, creation of a tension-free anastomosis, and ensuring adequate drainage. Outcomes may be further optimized by preoperative ureteral rest, intraoperative ureteroscopy, and the use of intravenous indocyanine green (ICG). Buccal mucosa grafting has emerged as a breakthrough in minimally invasive reconstruction. The robotic approach is adept at managing standard techniques such as ureteroureterostomy, psoas hitch, Boari flap, ureteroneocystostomy, and more recently described methods such as non-transecting ureteral reimplantation and bladder flap ureteroplasty. Ileal ureter remains a good option in cases of challenging reconstructions and patients with prior radiation therapy or extensive defects. CONCLUSION:Robot- assisted ureteral reconstruction has shifted the paradigm in stricture management, allowing complex reconstructive operations to be performed with minimally invasive techniques. This expert review summarizes key surgical approaches and presents a practical algorithm to guide urologists in the management of ureteral strictures.