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08:00
12:00
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TWTC - 2F Conference Room 5
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08:00
10:50
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Vu Le ChuyenVietnam
Speaker
Recurrent UTI in FemaleBackground:
Recurrent urinary tract infections (rUTIs) in women present a significant clinical burden due to their high prevalence, impact on quality of life, and growing antibiotic resistance. Despite decades of research, prevention and long-term management remain challenging, requiring a multifaceted approach.
Objectives:
This presentation aims to provide an evidence-based update on the definition, epidemiology, risk factors, antimicrobial resistance, and prevention strategies for rUTIs in women, with special consideration of individual patient factors and emerging alternatives to antibiotic therapy.
Methods and Evidence Review:
Current literature and international guidelines were reviewed, including randomized controlled trials, meta-analyses, and consensus statements. Key studies addressed behavioral modifications, increased fluid intake, use of cranberry products, methenamine hippurate, D-mannose, vaginal estrogen therapy, and prophylactic antibiotics. Comparative effectiveness data between non-antibiotic strategies and vaccination were also examined.
Results:
Multiple non-antibiotic preventive strategies demonstrated clinically meaningful reductions in rUTI recurrence. For instance, vaginal estrogen showed a significant reduction in postmenopausal women (50% vs. 94% recurrence; p = 0.041). Methenamine and D-mannose also presented promising outcomes with fewer side effects than continuous antibiotics. Barriers to adherence and challenges in special populations (e.g., older adults) were identified as persistent obstacles to optimal management.
Conclusion:
Effective rUTI management in women requires individualized strategies that incorporate patient risk factors, antimicrobial stewardship, and evidence-based non-antibiotic therapies. Future directions include improved vaccine development and microbiome-based interventions. Enhancing patient adherence and addressing knowledge gaps will be key to reducing recurrence and improving outcomes
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Peter LimSingapore
Moderator
Chronic Pelvic Pain in Women: Practical Guideline on Diagnostic and TreatmentCPPS is a debilitating often painful condition that requires a wholistic approach to treatment. Aim is to alleviate symptoms improve quality of life and requires a multidisciplinary approach of systematic evaluation to adopting pyschlogical counselling and judicious exhibition of drug therapy to use minimally invasive procedures or even open surgery. A practical and effective method to use will be outlined and discussed in the lecture Optimal Management of Bladder Pain SyndromeThis lecture will serve to reveal the real facts about chronic bladder pain and pelvic pain. How to identify and manage it with behavioural techniques. Nutritional manupularion. Drug ans other mis and new cutting edge bladder instillations and therapies.
Vu Le ChuyenVietnam
Moderator
Recurrent UTI in FemaleBackground:
Recurrent urinary tract infections (rUTIs) in women present a significant clinical burden due to their high prevalence, impact on quality of life, and growing antibiotic resistance. Despite decades of research, prevention and long-term management remain challenging, requiring a multifaceted approach.
Objectives:
This presentation aims to provide an evidence-based update on the definition, epidemiology, risk factors, antimicrobial resistance, and prevention strategies for rUTIs in women, with special consideration of individual patient factors and emerging alternatives to antibiotic therapy.
Methods and Evidence Review:
Current literature and international guidelines were reviewed, including randomized controlled trials, meta-analyses, and consensus statements. Key studies addressed behavioral modifications, increased fluid intake, use of cranberry products, methenamine hippurate, D-mannose, vaginal estrogen therapy, and prophylactic antibiotics. Comparative effectiveness data between non-antibiotic strategies and vaccination were also examined.
Results:
Multiple non-antibiotic preventive strategies demonstrated clinically meaningful reductions in rUTI recurrence. For instance, vaginal estrogen showed a significant reduction in postmenopausal women (50% vs. 94% recurrence; p = 0.041). Methenamine and D-mannose also presented promising outcomes with fewer side effects than continuous antibiotics. Barriers to adherence and challenges in special populations (e.g., older adults) were identified as persistent obstacles to optimal management.
Conclusion:
Effective rUTI management in women requires individualized strategies that incorporate patient risk factors, antimicrobial stewardship, and evidence-based non-antibiotic therapies. Future directions include improved vaccine development and microbiome-based interventions. Enhancing patient adherence and addressing knowledge gaps will be key to reducing recurrence and improving outcomes
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Le Phuc LienVietnam
Speaker
Female Incontinence: What to Do When Synthetic Mid-Urethral Sling FailSurgical failure rates following midurethral sling (MUS) procedures vary widely, with reported rates ranging from approximately 8% to 57% at five years of follow-up. This variability is largely attributed to inconsistent definitions of surgical failure and a general lack of long-term follow-up data. A recent Cochrane review highlights the absence of high-quality evidence to support or refute specific management strategies for recurrent or persistent stress urinary incontinence (SUI) following failed MUS procedures.
A thorough clinical evaluation is essential and should include a detailed patient history, comprehensive physical examination, and clarification of the patient’s treatment goals. Conservative management options encompass pelvic floor physiotherapy, the use of an incontinence pessary, commercially available intravaginal devices (e.g., Uresta®, Impressa®), and pharmacologic therapy.
Minimally invasive interventions include periurethral bulking agent injections (bladder neck injections) and sling plication. Surgical alternatives involve repeat MUS—with or without removal of the existing mesh—salvage pubovaginal sling using autologous fascia, Burch colposuspension, or, in select cases, insertion of an artificial urinary sphincter.
In this article, we review the current evidence supporting each of these treatment modalities and describe the management algorithm adopted by our expert panel for patients presenting with SUI following failed midurethral sling surgery.
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Peter LimSingapore
Speaker
Chronic Pelvic Pain in Women: Practical Guideline on Diagnostic and TreatmentCPPS is a debilitating often painful condition that requires a wholistic approach to treatment. Aim is to alleviate symptoms improve quality of life and requires a multidisciplinary approach of systematic evaluation to adopting pyschlogical counselling and judicious exhibition of drug therapy to use minimally invasive procedures or even open surgery. A practical and effective method to use will be outlined and discussed in the lecture Optimal Management of Bladder Pain SyndromeThis lecture will serve to reveal the real facts about chronic bladder pain and pelvic pain. How to identify and manage it with behavioural techniques. Nutritional manupularion. Drug ans other mis and new cutting edge bladder instillations and therapies.
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Trieu DoUnited States
Speaker
Robotic Sacrocolpopexy and Current TrendsRobotic-assisted sacrocolpopexy (RASCP) has been widely used as a primary procedure to address apical prolapse. Despite its popularity, there are nuances to the RA SCP when the surgeons choose to perform this procedure. In this mini-lecture, we will discuss several trends of RA SCP including:
1. Multi-ports vs single port robotic approach
2. Retroperitoneal tunneling vs dissection technique
3. Total vs supracervical hysterectomy with SCP
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Peter LimSingapore
Moderator
Chronic Pelvic Pain in Women: Practical Guideline on Diagnostic and TreatmentCPPS is a debilitating often painful condition that requires a wholistic approach to treatment. Aim is to alleviate symptoms improve quality of life and requires a multidisciplinary approach of systematic evaluation to adopting pyschlogical counselling and judicious exhibition of drug therapy to use minimally invasive procedures or even open surgery. A practical and effective method to use will be outlined and discussed in the lecture Optimal Management of Bladder Pain SyndromeThis lecture will serve to reveal the real facts about chronic bladder pain and pelvic pain. How to identify and manage it with behavioural techniques. Nutritional manupularion. Drug ans other mis and new cutting edge bladder instillations and therapies.
Vu Le ChuyenVietnam
Moderator
Recurrent UTI in FemaleBackground:
Recurrent urinary tract infections (rUTIs) in women present a significant clinical burden due to their high prevalence, impact on quality of life, and growing antibiotic resistance. Despite decades of research, prevention and long-term management remain challenging, requiring a multifaceted approach.
Objectives:
This presentation aims to provide an evidence-based update on the definition, epidemiology, risk factors, antimicrobial resistance, and prevention strategies for rUTIs in women, with special consideration of individual patient factors and emerging alternatives to antibiotic therapy.
Methods and Evidence Review:
Current literature and international guidelines were reviewed, including randomized controlled trials, meta-analyses, and consensus statements. Key studies addressed behavioral modifications, increased fluid intake, use of cranberry products, methenamine hippurate, D-mannose, vaginal estrogen therapy, and prophylactic antibiotics. Comparative effectiveness data between non-antibiotic strategies and vaccination were also examined.
Results:
Multiple non-antibiotic preventive strategies demonstrated clinically meaningful reductions in rUTI recurrence. For instance, vaginal estrogen showed a significant reduction in postmenopausal women (50% vs. 94% recurrence; p = 0.041). Methenamine and D-mannose also presented promising outcomes with fewer side effects than continuous antibiotics. Barriers to adherence and challenges in special populations (e.g., older adults) were identified as persistent obstacles to optimal management.
Conclusion:
Effective rUTI management in women requires individualized strategies that incorporate patient risk factors, antimicrobial stewardship, and evidence-based non-antibiotic therapies. Future directions include improved vaccine development and microbiome-based interventions. Enhancing patient adherence and addressing knowledge gaps will be key to reducing recurrence and improving outcomes
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Vu Le ChuyenVietnam
Speaker
Recurrent UTI in FemaleBackground:
Recurrent urinary tract infections (rUTIs) in women present a significant clinical burden due to their high prevalence, impact on quality of life, and growing antibiotic resistance. Despite decades of research, prevention and long-term management remain challenging, requiring a multifaceted approach.
Objectives:
This presentation aims to provide an evidence-based update on the definition, epidemiology, risk factors, antimicrobial resistance, and prevention strategies for rUTIs in women, with special consideration of individual patient factors and emerging alternatives to antibiotic therapy.
Methods and Evidence Review:
Current literature and international guidelines were reviewed, including randomized controlled trials, meta-analyses, and consensus statements. Key studies addressed behavioral modifications, increased fluid intake, use of cranberry products, methenamine hippurate, D-mannose, vaginal estrogen therapy, and prophylactic antibiotics. Comparative effectiveness data between non-antibiotic strategies and vaccination were also examined.
Results:
Multiple non-antibiotic preventive strategies demonstrated clinically meaningful reductions in rUTI recurrence. For instance, vaginal estrogen showed a significant reduction in postmenopausal women (50% vs. 94% recurrence; p = 0.041). Methenamine and D-mannose also presented promising outcomes with fewer side effects than continuous antibiotics. Barriers to adherence and challenges in special populations (e.g., older adults) were identified as persistent obstacles to optimal management.
Conclusion:
Effective rUTI management in women requires individualized strategies that incorporate patient risk factors, antimicrobial stewardship, and evidence-based non-antibiotic therapies. Future directions include improved vaccine development and microbiome-based interventions. Enhancing patient adherence and addressing knowledge gaps will be key to reducing recurrence and improving outcomes
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Peter LimSingapore
Speaker
Chronic Pelvic Pain in Women: Practical Guideline on Diagnostic and TreatmentCPPS is a debilitating often painful condition that requires a wholistic approach to treatment. Aim is to alleviate symptoms improve quality of life and requires a multidisciplinary approach of systematic evaluation to adopting pyschlogical counselling and judicious exhibition of drug therapy to use minimally invasive procedures or even open surgery. A practical and effective method to use will be outlined and discussed in the lecture Optimal Management of Bladder Pain SyndromeThis lecture will serve to reveal the real facts about chronic bladder pain and pelvic pain. How to identify and manage it with behavioural techniques. Nutritional manupularion. Drug ans other mis and new cutting edge bladder instillations and therapies.
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Martin LauHong Kong, China
Speaker
Role of PTNS in Refractory OABPTNS offers a valuable treatment alternative for refractory OAB, especially in cases where traditional therapies have failed. Its role in managing OAB highlights the importance of individualized patient care and the need for innovative approaches in urology.
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Vu Le ChuyenVietnam
Speaker
Recurrent UTI in FemaleBackground:
Recurrent urinary tract infections (rUTIs) in women present a significant clinical burden due to their high prevalence, impact on quality of life, and growing antibiotic resistance. Despite decades of research, prevention and long-term management remain challenging, requiring a multifaceted approach.
Objectives:
This presentation aims to provide an evidence-based update on the definition, epidemiology, risk factors, antimicrobial resistance, and prevention strategies for rUTIs in women, with special consideration of individual patient factors and emerging alternatives to antibiotic therapy.
Methods and Evidence Review:
Current literature and international guidelines were reviewed, including randomized controlled trials, meta-analyses, and consensus statements. Key studies addressed behavioral modifications, increased fluid intake, use of cranberry products, methenamine hippurate, D-mannose, vaginal estrogen therapy, and prophylactic antibiotics. Comparative effectiveness data between non-antibiotic strategies and vaccination were also examined.
Results:
Multiple non-antibiotic preventive strategies demonstrated clinically meaningful reductions in rUTI recurrence. For instance, vaginal estrogen showed a significant reduction in postmenopausal women (50% vs. 94% recurrence; p = 0.041). Methenamine and D-mannose also presented promising outcomes with fewer side effects than continuous antibiotics. Barriers to adherence and challenges in special populations (e.g., older adults) were identified as persistent obstacles to optimal management.
Conclusion:
Effective rUTI management in women requires individualized strategies that incorporate patient risk factors, antimicrobial stewardship, and evidence-based non-antibiotic therapies. Future directions include improved vaccine development and microbiome-based interventions. Enhancing patient adherence and addressing knowledge gaps will be key to reducing recurrence and improving outcomes
TICC - 2F 201BC
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08:00
16:50
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Cheng-Chia LinTaiwan
Speaker
DISS plus FANS used in RIRSNew technologies and techniques are constantly emerging, but the most important part of our discussions is how to use them most effectively. Through this surgical demonstration, we hope to share the procedure and our experience with everyone.健保各領域審查共識及討論－結石
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Cheng-Chia LinTaiwan
Moderator
DISS plus FANS used in RIRSNew technologies and techniques are constantly emerging, but the most important part of our discussions is how to use them most effectively. Through this surgical demonstration, we hope to share the procedure and our experience with everyone.健保各領域審查共識及討論－結石
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Yi Quan TanSingapore
Speaker
How Suction Changed My Hospital Practice of Flexible UreteroscopySuction in Endourology has truly been a gamechanger in recent years. In this talk, Dr Yi Quan Tan discusses how rapid technological advancements have evolved his hospital's practice of performing RIRS. Working alongside Dr Vineet Gauhar in the Endourology unit at Ng Teng Fong General Hospital in Singapore, Dr Tan provides a glimpse of how early adoption of new technology and concepts have helped push boundaries and improved RIRS outcomes for their patients.
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Han Kyu ChaeKorea (Republic of)
Speaker
Endoscopic Combined Intra Renal Surgery: New FrontiersBackground:
Endoscopic Combined Intra Renal Surgery (ECIRS) has evolved as a versatile approach that combines the strengths of percutaneous nephrolithotomy (PCNL) and retrograde intrarenal surgery (RIRS), allowing for simultaneous anterograde and retrograde access. This dual approach has shown advantages in treating large or complex renal stones, including full or partial staghorn calculi, particularly in cases where monotherapy may be suboptimal.
Objectives:
This lecture will explore recent advancements in ECIRS, highlight regional practices in Asia, and propose future directions that may redefine the standard of care in endourology.
Key Topics Covered:
Technical evolution: From prone to modified supine position; advancement in ultra-mini PCNL and flexible ureteroscopy integration.
Instrument synergy: Role of suction PCNL systems and navigable ureteroscopes in optimizing stone clearance and reducing operative time.
Asian perspective: Surgical position, tract size, and imaging modality preferences vary across countries, reflecting diverse adaptations and innovations in ECIRS techniques.
Clinical outcomes: Review of recent multicenter data showing ECIRS's impact on stone-free rates, complication reduction, and postoperative recovery.
Future frontiers: Integration of AI-guided navigation, pressure-controlled irrigation systems, and 3D intraoperative imaging to refine intrarenal surgery.
Conclusion:
As endourological technology advances, ECIRS stands at the intersection of innovation and practicality. The next frontier lies not only in technical refinement but also in tailoring approaches to anatomical and cultural variability across Asia. This session aims to foster collaboration and knowledge sharing to drive further evolution in combined intrarenal stone surgery.
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Boyke SoebhaliIndonesia
Speaker
Updates on Pharmacological Therapy for UrolithiasisUrolithiasis, a prevalent and recurrent urological condition, requires a multifaceted approach combining pharmacological, dietary, and surgical interventions. Recent advancements in pharmacological therapy emphasize personalized treatment based on stone composition, metabolic profiles, and patient-specific risk factors.
For calcium oxalate stones, the most common type, thiazide diuretics remain first-line therapy to reduce urinary calcium excretion, while potassium citrate is recommended to increase urinary citrate levels, inhibiting stone formation. Dietary modifications, such as reduced oxalate intake and adequate calcium consumption, are adjunctive measures. In primary hyperoxaluria (PH), novel RNA interference (RNAi) agents like lumasiran and nedosiran significantly lower urinary oxalate levels, offering promising alternatives for patients unresponsive to pyridoxine.
Uric acid stones are managed with urinary alkalinization using potassium citrate or sodium bicarbonate to maintain a pH >6.0, enhancing uric acid solubility. Xanthine oxidase inhibitors (allopurinol, febuxostat) are reserved for hyperuricemic patients. Cystine stones, though rare, require alkalinization and thiol-based drugs (tiopronin) to improve cystine solubility.
Struvite stones, associated with urease-producing infections, necessitate antibiotics and urinary acidification (e.g., L-methionine) alongside surgical removal. Emerging therapies like theobromine show potential in inhibiting uric acid crystallization, while phytate demonstrates inhibitory effects on calcium salt aggregation.
Medical expulsive therapy (MET) with alpha-blockers (tamsulosin) remains effective for distal ureteral stones (5–10 mm), reducing time to expulsion and need for surgery. However, MET efficacy diminishes for proximal stones or those >10 mm, necessitating surgical intervention.
Future directions include optimizing RNAi therapies for hereditary stone diseases and integrating smartphone apps to enhance treatment adherence. A tailored, evidence-based approach combining pharmacological and lifestyle interventions is crucial for reducing recurrence and improving patient outcomes.Suction PCNL vs Suction RIRS? Do We Have a WinnerThe management of renal stones has evolved with the introduction of suction-assisted techniques in both percutaneous nephrolithotomy (PCNL) and retrograde intrarenal surgery (RIRS). Suction PCNL, including mini-PCNL and flexible mini-PCNL (F-mPCNL), utilizes negative pressure to improve stone clearance and reduce intrarenal pressure, while suction RIRS employs vacuum-assisted ureteral access sheaths (V-UAS) or direct in-scope suction (DISS) to enhance fragment removal and minimize infectious complications.
Recent studies highlight that suction PCNL achieves superior stone-free rates (SFRs) in a single session, particularly for stones >2 cm, with SFRs ranging from 93.8% to 95.1% compared to 77.8%–87.9% for suction RIRS. However, suction RIRS offers advantages in reduced invasiveness, shorter hospital stays (1–3 days vs. 2–5 days for PCNL), and lower complication rates (e.g., bleeding, transfusion needs). For infectious stones, suction RIRS with V-UAS demonstrates lower postoperative infection markers (CRP, PCT) and fewer febrile complications than PCNL .
Operative times vary, with suction PCNL often being faster for large stones (47–82 min) but requiring fluoroscopy, while suction RIRS avoids tract-related risks but may necessitate staged procedures for stones >2 cm. Cost-effectiveness analyses favor suction PCNL due to fewer retreatments, though RIRS reduces radiation exposure.
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Anil ShresthaNepal
Moderator
Clearpetra the Sheath of Choice for Lower Pole StonesSFR Assessment: Timing and Modalities
Chinnakhet
Ketsuwan Thailand
Moderator
Intra Renal Pressure Defines Outcomes: Current EvidenceIntrarenal pressure (IRP) is a crucial physiological parameter during endourological interventions, as elevated IRP is closely linked to increased fluid absorption, intrarenal backflow, compromised renal perfusion, and postoperative complications. Experimental studies in animal models have consistently demonstrated a correlation between increased IRP and augmented irrigation fluid absorption, renal parenchymal backflow, and reductions in renal blood flow. Clinical studies have reported baseline IRP values ranging from 14 to 17 mmHg, with transient peristaltic peaks reaching up to 25 mmHg. Notably, IRP frequently surpassed 60 mmHg during endoscopic procedures, particularly when utilizing manual hand-pump irrigation or employing ureteral access sheaths (UAS) with smaller diameters. Significant risk factors identified for sustained elevations of IRP include non-prestented ureters, Asian ethnicity, and omission of UAS placement. Furthermore, elevated IRPs have demonstrated a direct association with infectious adverse events, notably postoperative sepsis. Randomized controlled trials have established that manual hand-pump irrigation generates substantially higher IRPs compared to pressurized irrigation bags. Additionally, serial manual irrigation boluses have been shown to produce prolonged IRP elevations, with maximum peaks exceeding 100 mmHg and durations surpassing 40 seconds. Collectively, both preclinical and clinical evidence underscores the necessity of meticulous intraoperative IRP management during endourological procedures. Strategic optimization of irrigation techniques and appropriate UAS selection are imperative to effectively maintain IRP within safe physiological limits, thereby minimizing the risk of complicationsRole of VR/AR/MR in Endourology and Urolithiasis Renal stone disease is a common urological condition affecting diverse patient populations. Percutaneous nephrolithotomy (PCNL) is widely recognized as the primary treatment for large or complex renal calculi, offering high stone-free rates with low complication profiles. Nevertheless, achieving accurate percutaneous renal access (PCA) remains technically challenging due to anatomical proximity to vital structures and insufficient hands-on training opportunities for urologists. Virtual reality (VR) simulators, such as the PERC Mentor and Uro Mentor, have demonstrated significant improvements in PCA proficiency, operative efficiency, and complication reduction, establishing their validity as effective training platforms. Additionally, mixed reality (MR) and 3D holographic technologies, exemplified by HoloLens, enhance surgical planning and procedural accuracy, particularly in calyceal targeting during PCNL. Recent nationwide training needs assessments have further advocated for the integration of these advanced simulation technologies into urological education curricula. Ultimately, systematic incorporation of VR and MR simulation into residency training holds substantial promise in bridging existing skill gaps, refining surgical competencies, and circumventing ethical concerns associated with traditional methods of surgical education.
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Takaaki InoueJapan
Speaker
New Advancement on Retrograde Intrarenal SurgeryRetrograde intrarenal surgery (RIRS) has dramatically grown up around world for stone management. Why has RIRS been getting popullar and increasing nowadays?. The reaseon are absoulutely "Technological development with collaborated engineering comapny" and " Global communicaton and collaboration in Endourology". Endourology has still been improving and expanding more and more. Thereby, many novel devices and machine are launching faster. We, urologists should catch up this faster trend and acquire these knowledge for our clinical use. However, most of urologists can not catch up it. Therefore, I will share you all these novel chage of mind and tech-knowledge of stone field in this session. Do We Need Augmented Reality for Renal Stone Management?What is Augmented reality and Vertual reality in medicine?. The paradigm shift of medicine which includes AI, Robotics, VR, and AR etc named Digital transformation has been still emerging. Of course, these shift is gradually permeating in stone field. Especially, in terms of VR, AR, we wonder if this kind of DX is useful in stone management. if so, how do we use it in clinical practice? Today, I will talk these future role in stone management, and expectation. Which Laser for RIRS: Pulsed Thulium YAG Laser We can use three kind of laser such as Holumium YAG, Thulium YAG, and Thulium fiber laser for stone management. Which lase are best option for stone patients? I will talk about featurs and advantage of pulsed-Thulium YAG laser. There are two kinds of p-Tm;YAG laser machine nowadays. P^Tm;YAG has unique characteristics as laser wave. Therefore, this laser would be able to use Stone, BPH, UTUC. Especially, p-Tm YAG laser can utilize for Stone ablation, fragmentingand and UTUC ablation, shock wave. We will share our experoence and thoughts. New Advancement on Retrograde Intrarenal Surgery
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Albert El HajjLebanon
Speaker
Battle of the Robots in Flexible Ureteroscopy: What's the Verdict?AAU Lecture: Robotic Flexible Ureterorenoscopy— Gimmick or a True Helper? What’s It Cost Performance Value?
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Jeremy TeohHong Kong, China
Speaker
Transurethral En Bloc Resection of Bladder Tumor: Where Are We Now?There is increasing evidence that transurethral en bloc resection of bladder tumour (ERBT) could lead to better peri-operative and oncological outcomes in patients with non-muscle-invasive bladder cancer. Modified approaches of ERBT have also been proposed to expand its indications for larger bladder tumours. The quality of resection is also the key for bladder-sparing treatment for muscle-invasive bladder cancer. We foresee an exciting journey ahead for ERBT, and as a urologist, we must embrace this novel technique for the best interest of our bladder cancer patients. To Publish or not to Publish? Navigating the path to academia in urologyDoing good science is the basis for technological advancement in healthcare. However, pursuing a path to academic in urology is often tough, stressful and frustrating. In this talk, I will share with you what I have learnt throughout my 15 years of research work. I will let you know what's the best and fastest way to become a globally renowned and successful researcher. Most importantly, I will explain what it takes to develop a great team and create a positive impact in people's lives. Believe in yourself! If I can do it, so can you.SIU Lecture: Role of MISTs in Male LUTS Surgical Management (Will TUR-P/ Laser Prostatectomy be Replaced?)Transurethral resection of prostate (TURP) is the current gold standard in treating patients with benign prostatic hyperplasia. Laser prostatectomy has also been used widely especially in patients who are on anticoagulants. However, both TURP and laser prostatectomy are associated with several problems including the need of spinal / general anaesthesia and the risk of male sexual dysfunction. In the past decade, we have witnessed the introduction of multiple new technologies including Rezum, Urolift, iTind and Aquablation. in this SIU lecture, we will discuss about the technical details, as well as the pros and cons of every new technology. We will also invite you to be our jury and decide whether TURP and laser prostatectomy will be replaced in the future. Novel Intravesical Therapeutics in the Evolving Landscape of NMIBCNon-muscle-invasive bladder cancer (NMIBC) is well known to be a difficult disease to manage, with a 1-year recurrence rate of up to 61% and 5-year recurrence rate of 78%. Despite the use of intravesical BCG therapy, NMIBC patients may still experience recurrence and develop what we call BCG-unresponsive NMIBC. Conventionally, we offer upfront radical cystectomy for patients with BCG-unresponsive NMIBC, however, this is an ultra-major surgery with significant risk of complications and could also lead to significant deterioration in quality of life in the long run. We are in urgent need for novel therapies to manage this difficult condition. In this lecture, we will discuss the evidence on the different novel intravesical therapies in treating BCG-unresponsive NMIBC. SIU Lecture: Role of MISTs in Male LUTS Surgical Management (Will TUR-P/ Laser Prostatectomy be Replaced?)
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Hsiang-Ying LeeTaiwan
Speaker
Best Laser for UTUCManagement of Total Ureteral Avulsion during Ureteroscopy
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Albert El HajjLebanon
Moderator
Battle of the Robots in Flexible Ureteroscopy: What's the Verdict?AAU Lecture: Robotic Flexible Ureterorenoscopy— Gimmick or a True Helper? What’s It Cost Performance Value?
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Azimjon TursunkulovUzbekistan
Speaker
How to Perform Supine PCNL in Pediatrics? Is It Different from Adults?Percutaneous nephrolithotomy (PCNL) is increasingly favored as a minimally invasive method for treating kidney stones, especially in the supine position, due to its benefits for anesthesia, ergonomics, and overall patient safety. However, when performing supine PCNL in children, urologists encounter distinct challenges that differ significantly from adult patients. In this presentation, we will discuss the key differences and specialized techniques required to successfully and safely perform supine PCNL in pediatric cases.
Important considerations in pediatric patients include their smaller anatomical size, larger stone-to-kidney size ratios, increased sensitivity to fluid overload, and greater vulnerability to radiation exposure. Particular care is needed in patient positioning due to fewer clear anatomical landmarks, making precise ultrasound-guided kidney access crucial to minimize radiation and enhance accuracy. The use of specially designed miniaturized instruments is essential for pediatric procedures, alongside careful management of fluid to prevent complications.
Drawing from extensive personal experience and evidence-based practices, this presentation will cover practical adjustments, such as optimal patient positioning, precise kidney puncture techniques, careful tract dilation, nephroscopic approaches, effective stone removal strategies, and tailored postoperative care. This presentation aims to provide attendees with practical insights and techniques to enhance their approach to supine PCNL in pediatric patients, supporting outcomes comparable to those achieved in adult cases.
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Shemeem Kachereente VitaQatar
Speaker
ESWL for Ureteric Stones: Art of Achieving 100% Stone Free RateExtracorporeal Shock Wave Lithotripsy (ESWL) remains a valuable, non-invasive option for managing ureteric stones, despite growing preference for endoscopic approaches. In this talk, I will share insights from over 40,000 ESWL procedures performed at our center, with a focus on optimizing technique, patient selection, and procedural nuances that have allowed us to consistently achieve near-complete clearance rates—even for distal and impacted stones.
Key points include:
Understanding anatomical and technical factors that influence ESWL success
Strategies to overcome limitations traditionally associated with ureteric stone location
The role of stenting, pain control, and imaging in maximizing outcomes
Real-world evidence demonstrating ESWL’s continued relevance in modern stone management
This session aims to reignite interest in ESWL by presenting practical, reproducible methods that can raise clearance rates close to 100%, when done with precision and experience.
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Hsiang-Ying LeeTaiwan
Facilitator
Best Laser for UTUCManagement of Total Ureteral Avulsion during Ureteroscopy
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Vineet GauharSingapore
Speaker
Experimental and Real World Take Away Messages on DISSSuction in Renal Stone Treatment: DISS, FANS or Combined Procedure?Need of Future EndourologyChoosing the Correct Laser and Flex Scope Combination in Suction Ureteroscopy Can Be the Deal Breaker
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Joy CastilloPhilippines
Moderator
Advance Course of Urolithiasis & Technology, Company Sponsored SymposiumWith continuous innovations in endourology, particularly in the field of retrograde intrarenal surgery (RIRS), the role of intrarenal pressure (IRP) has emerged as a key factor influencing surgical outcomes. This session will delve into the growing body of evidence linking elevated IRP to complications such as postoperative infections, renal injury, and reduced stone-free rates.
The symposium will also introduce a focused discussion on pressure management strategies during RIRS, highlighting the Tidor System—an advanced platform designed to monitor and regulate IRP in real time. By combining current evidence with practical solutions, this session aims to equip urologists with a deeper understanding of IRP’s clinical impact and how emerging technologies can enhance safety and efficacy in stone surgery.
Steffi YuenHong Kong, China
Moderator
The Power of Powerbend in Management of Lower Pole and Complex StonesThe management of lower pole stones (LPS) and complex renal calculi remains one of the most challenging aspects of contemporary urolithiasis treatment, with the deflection capability of flexible ureteroscopes serving as the critical determinant of surgical success. Modern flexible ureteroscopes achieve impressive bidirectional deflection angles of 270° or even more, representing a significant advancement from earlier generation instruments. However, this “working deflection” capacity becomes substantially compromised when therapeutic instruments, such as laser fibers or stone baskets, are inserted through the working channel.
The anatomical challenges of lower pole access, particularly steep infundibulopelvic angles, necessitate prolonged maximal deflection during lithotrispy that significantly increases the risk of ureteroscope damage and surgeon fatigability. Deflection deterioration is also directly proportional to instrument usage, with newer single-use scopes coming to the rescue.
The introduction of flexible and navigable suction access sheaths (FANS) has revolutionized lower pole stone management allowing direct access to performing lithotriopsy and stone fragments retrieval, reducing the need for stone basket in stone relocation and fragment retrieval. Recent multicenter studies demonstrate comparable stone-free rates (<2mm) between lower pole and non-lower pole locations (96.6% vs 98.4%) when using FANS, with minimal complications and low reintervention rates. With current technological advancements, combined with improved surgical techniques and the strategic choice of single-use ureteroscopes with good deflection power, one can significantly achieve high stone-free rates with low infectious complications and reinterventions with FANS flexible ureteroscopy in the treatment of complex lower pole stones.
FANs in Endourology: Finding the Best Combination with Lasers and Scopes for Optimal Outcomes
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Chinnakhet
Ketsuwan Thailand
Speaker
Intra Renal Pressure Defines Outcomes: Current EvidenceIntrarenal pressure (IRP) is a crucial physiological parameter during endourological interventions, as elevated IRP is closely linked to increased fluid absorption, intrarenal backflow, compromised renal perfusion, and postoperative complications. Experimental studies in animal models have consistently demonstrated a correlation between increased IRP and augmented irrigation fluid absorption, renal parenchymal backflow, and reductions in renal blood flow. Clinical studies have reported baseline IRP values ranging from 14 to 17 mmHg, with transient peristaltic peaks reaching up to 25 mmHg. Notably, IRP frequently surpassed 60 mmHg during endoscopic procedures, particularly when utilizing manual hand-pump irrigation or employing ureteral access sheaths (UAS) with smaller diameters. Significant risk factors identified for sustained elevations of IRP include non-prestented ureters, Asian ethnicity, and omission of UAS placement. Furthermore, elevated IRPs have demonstrated a direct association with infectious adverse events, notably postoperative sepsis. Randomized controlled trials have established that manual hand-pump irrigation generates substantially higher IRPs compared to pressurized irrigation bags. Additionally, serial manual irrigation boluses have been shown to produce prolonged IRP elevations, with maximum peaks exceeding 100 mmHg and durations surpassing 40 seconds. Collectively, both preclinical and clinical evidence underscores the necessity of meticulous intraoperative IRP management during endourological procedures. Strategic optimization of irrigation techniques and appropriate UAS selection are imperative to effectively maintain IRP within safe physiological limits, thereby minimizing the risk of complicationsRole of VR/AR/MR in Endourology and Urolithiasis Renal stone disease is a common urological condition affecting diverse patient populations. Percutaneous nephrolithotomy (PCNL) is widely recognized as the primary treatment for large or complex renal calculi, offering high stone-free rates with low complication profiles. Nevertheless, achieving accurate percutaneous renal access (PCA) remains technically challenging due to anatomical proximity to vital structures and insufficient hands-on training opportunities for urologists. Virtual reality (VR) simulators, such as the PERC Mentor and Uro Mentor, have demonstrated significant improvements in PCA proficiency, operative efficiency, and complication reduction, establishing their validity as effective training platforms. Additionally, mixed reality (MR) and 3D holographic technologies, exemplified by HoloLens, enhance surgical planning and procedural accuracy, particularly in calyceal targeting during PCNL. Recent nationwide training needs assessments have further advocated for the integration of these advanced simulation technologies into urological education curricula. Ultimately, systematic incorporation of VR and MR simulation into residency training holds substantial promise in bridging existing skill gaps, refining surgical competencies, and circumventing ethical concerns associated with traditional methods of surgical education.
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Vineet GauharSingapore
Moderator
Experimental and Real World Take Away Messages on DISSSuction in Renal Stone Treatment: DISS, FANS or Combined Procedure?Need of Future EndourologyChoosing the Correct Laser and Flex Scope Combination in Suction Ureteroscopy Can Be the Deal Breaker
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Steffi YuenHong Kong, China
Speaker
The Power of Powerbend in Management of Lower Pole and Complex StonesThe management of lower pole stones (LPS) and complex renal calculi remains one of the most challenging aspects of contemporary urolithiasis treatment, with the deflection capability of flexible ureteroscopes serving as the critical determinant of surgical success. Modern flexible ureteroscopes achieve impressive bidirectional deflection angles of 270° or even more, representing a significant advancement from earlier generation instruments. However, this “working deflection” capacity becomes substantially compromised when therapeutic instruments, such as laser fibers or stone baskets, are inserted through the working channel.
The anatomical challenges of lower pole access, particularly steep infundibulopelvic angles, necessitate prolonged maximal deflection during lithotrispy that significantly increases the risk of ureteroscope damage and surgeon fatigability. Deflection deterioration is also directly proportional to instrument usage, with newer single-use scopes coming to the rescue.
The introduction of flexible and navigable suction access sheaths (FANS) has revolutionized lower pole stone management allowing direct access to performing lithotriopsy and stone fragments retrieval, reducing the need for stone basket in stone relocation and fragment retrieval. Recent multicenter studies demonstrate comparable stone-free rates (<2mm) between lower pole and non-lower pole locations (96.6% vs 98.4%) when using FANS, with minimal complications and low reintervention rates. With current technological advancements, combined with improved surgical techniques and the strategic choice of single-use ureteroscopes with good deflection power, one can significantly achieve high stone-free rates with low infectious complications and reinterventions with FANS flexible ureteroscopy in the treatment of complex lower pole stones.
FANs in Endourology: Finding the Best Combination with Lasers and Scopes for Optimal Outcomes
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Boyke SoebhaliIndonesia
Moderator
Updates on Pharmacological Therapy for UrolithiasisUrolithiasis, a prevalent and recurrent urological condition, requires a multifaceted approach combining pharmacological, dietary, and surgical interventions. Recent advancements in pharmacological therapy emphasize personalized treatment based on stone composition, metabolic profiles, and patient-specific risk factors.
For calcium oxalate stones, the most common type, thiazide diuretics remain first-line therapy to reduce urinary calcium excretion, while potassium citrate is recommended to increase urinary citrate levels, inhibiting stone formation. Dietary modifications, such as reduced oxalate intake and adequate calcium consumption, are adjunctive measures. In primary hyperoxaluria (PH), novel RNA interference (RNAi) agents like lumasiran and nedosiran significantly lower urinary oxalate levels, offering promising alternatives for patients unresponsive to pyridoxine.
Uric acid stones are managed with urinary alkalinization using potassium citrate or sodium bicarbonate to maintain a pH >6.0, enhancing uric acid solubility. Xanthine oxidase inhibitors (allopurinol, febuxostat) are reserved for hyperuricemic patients. Cystine stones, though rare, require alkalinization and thiol-based drugs (tiopronin) to improve cystine solubility.
Struvite stones, associated with urease-producing infections, necessitate antibiotics and urinary acidification (e.g., L-methionine) alongside surgical removal. Emerging therapies like theobromine show potential in inhibiting uric acid crystallization, while phytate demonstrates inhibitory effects on calcium salt aggregation.
Medical expulsive therapy (MET) with alpha-blockers (tamsulosin) remains effective for distal ureteral stones (5–10 mm), reducing time to expulsion and need for surgery. However, MET efficacy diminishes for proximal stones or those >10 mm, necessitating surgical intervention.
Future directions include optimizing RNAi therapies for hereditary stone diseases and integrating smartphone apps to enhance treatment adherence. A tailored, evidence-based approach combining pharmacological and lifestyle interventions is crucial for reducing recurrence and improving patient outcomes.Suction PCNL vs Suction RIRS? Do We Have a WinnerThe management of renal stones has evolved with the introduction of suction-assisted techniques in both percutaneous nephrolithotomy (PCNL) and retrograde intrarenal surgery (RIRS). Suction PCNL, including mini-PCNL and flexible mini-PCNL (F-mPCNL), utilizes negative pressure to improve stone clearance and reduce intrarenal pressure, while suction RIRS employs vacuum-assisted ureteral access sheaths (V-UAS) or direct in-scope suction (DISS) to enhance fragment removal and minimize infectious complications.
Recent studies highlight that suction PCNL achieves superior stone-free rates (SFRs) in a single session, particularly for stones >2 cm, with SFRs ranging from 93.8% to 95.1% compared to 77.8%–87.9% for suction RIRS. However, suction RIRS offers advantages in reduced invasiveness, shorter hospital stays (1–3 days vs. 2–5 days for PCNL), and lower complication rates (e.g., bleeding, transfusion needs). For infectious stones, suction RIRS with V-UAS demonstrates lower postoperative infection markers (CRP, PCT) and fewer febrile complications than PCNL .
Operative times vary, with suction PCNL often being faster for large stones (47–82 min) but requiring fluoroscopy, while suction RIRS avoids tract-related risks but may necessitate staged procedures for stones >2 cm. Cost-effectiveness analyses favor suction PCNL due to fewer retreatments, though RIRS reduces radiation exposure.
Takaaki InoueJapan
Moderator
New Advancement on Retrograde Intrarenal SurgeryRetrograde intrarenal surgery (RIRS) has dramatically grown up around world for stone management. Why has RIRS been getting popullar and increasing nowadays?. The reaseon are absoulutely "Technological development with collaborated engineering comapny" and " Global communicaton and collaboration in Endourology". Endourology has still been improving and expanding more and more. Thereby, many novel devices and machine are launching faster. We, urologists should catch up this faster trend and acquire these knowledge for our clinical use. However, most of urologists can not catch up it. Therefore, I will share you all these novel chage of mind and tech-knowledge of stone field in this session. Do We Need Augmented Reality for Renal Stone Management?What is Augmented reality and Vertual reality in medicine?. The paradigm shift of medicine which includes AI, Robotics, VR, and AR etc named Digital transformation has been still emerging. Of course, these shift is gradually permeating in stone field. Especially, in terms of VR, AR, we wonder if this kind of DX is useful in stone management. if so, how do we use it in clinical practice? Today, I will talk these future role in stone management, and expectation. Which Laser for RIRS: Pulsed Thulium YAG Laser We can use three kind of laser such as Holumium YAG, Thulium YAG, and Thulium fiber laser for stone management. Which lase are best option for stone patients? I will talk about featurs and advantage of pulsed-Thulium YAG laser. There are two kinds of p-Tm;YAG laser machine nowadays. P^Tm;YAG has unique characteristics as laser wave. Therefore, this laser would be able to use Stone, BPH, UTUC. Especially, p-Tm YAG laser can utilize for Stone ablation, fragmentingand and UTUC ablation, shock wave. We will share our experoence and thoughts. New Advancement on Retrograde Intrarenal Surgery
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Anil ShresthaNepal
Speaker
Clearpetra the Sheath of Choice for Lower Pole StonesSFR Assessment: Timing and Modalities
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Deepak Ragoori India
Speaker
How to Use Clearpetra Shetah to Minimize Post Operative Stenting after FANS
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TICC - 2F 201DE
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Jalil HosseiniIran
Speaker
Posterior Urethral Disruption with Open Bladder Neck in Antegrade Cystoscopy and Urethro-Rectal Fistula
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Farzin SoleimanzadehIran
Speaker
short segment Bulbar stricture (first lecture, Last version of APSARUS program)This is a lecture presenting a patient with short bulbo-penile urethral stricture with a short evidence-based discussion on the treatment technique and then a 5-minute video of the surgical procedure chosen for this patient (total time less than 12 min).
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Sanjay KulkarniIndia
Speaker
12 cm Peno-Bulbar Stricture due to Lichen SclerosusPan Urethroplasty with Kulkarni technique, bilateral buccaneers mucosa grafts or spiral prepucial graft technique.Oral Mucosa and Beyond: Tissue Substitutes in Urethroplasty
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Jalil HosseiniIran
Speaker
Posterior Urethral Disruption with Open Bladder Neck in Antegrade Cystoscopy and Urethro-Rectal Fistula
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Omid SedighItaly
Speaker
Total Incontinence, Day And Night, 8 Months after Prostate Surgery, No Improvement with 20 Sessions of PFMT
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TICC - 1F 101B
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Tai-Lung ChaTaiwan
Speaker
Novel Target for GU Cancer Metastasis and TherapeuticsCancer progression is shaped by both cell-intrinsic adaptations and complex extrinsic interactions within the tumor microenvironment (TME). Here, we identify a transmembrane protein, Meta1, as a shared therapeutic target that exhibits a Janus-like role: promoting malignant phenotypes in cancer cells while restraining tumor-supportive functions in non-cancerous stromal and immune cells. Meta1 is expressed in both compartments of the TME, orchestrating a dual program that supports metastasis and immune evasion. Mechanistically, we uncovered a malignancy-promoting factor (MPF) that acts as a functional ligand for Meta1, selectively enhancing pro-invasive signaling in cancer cells. We further identify Meta1 as an unconventional G protein–coupled receptor (GPCR) that plays as an accelerator in cancer cells of the TME. Meta1 interacts with Rho-GDI and Gαq to activate RhoA-mediated cytoskeletal remodeling and amoeboid migration, facilitating metastatic dissemination. We further identify MPF binding to Meta1 initiates Gβγ signaling, elevating intracellular cAMP and activating Rap1, thereby amplifying cell motility and metastatic potential. Leveraging the Meta1–MPF interaction, we designed MPF-derived peptides that specifically bind Meta1 and serve as the basis for a novel peptide-based PROTAC, which efficiently induces degradation of Meta1 and abrogates its pro-metastatic functions. Our study unveils Meta1 as an atypical GPCR with canonical signaling capacity and topological divergence, representing a shared and targetable vulnerability that bridges cancer cell-intrinsic adaptation with extrinsic TME communication. These findings establish the Meta1–MPF axis as a compelling therapeutic target for suppressing metastasis and reprogramming the TME.
Allen W. ChiuTaiwan
Speaker
Reflecting on the Past, Shaping the Present, and Envisioning the Future of UAASince 1990, the Urological Association of Asia (UAA) has stood as a beacon of collaboration, innovation, and advancement in urology in Asia. As we reflect on its evolution, acknowledge its current impact, and envision its future, it becomes clear that the UAA has played - and will continue to play - a pivotal role in shaping urological care, education, and research throughout Asia. Reflecting on the path we’ve traveled together from 16 member associations and 1,000 individual members in 2014 to 28 member associations and over 4,500 individual members today - I see more than growth. I see unity, commitment, and a shared belief in something bigger than ourselves. A defining milestone was enrolling the Urological Society of Australia and New Zealand into the UAA, further enriching our diversity and strengthening our position as a truly Asia-Pacific organization. The UAA proudly supports several journals, including the International Journal of Urology, the Indian Journal of Urology, Asian Urology, which continue to shape the academic discourse. The Asian Urological Resident Course (AURC) started in 2014, in collaboration with the American Urological Association, has become a cornerstone in nurturing clinical excellence among young urologists. The Young Leadership Forum, since 2012, developed in partnership with the European Urological Association, has fostered cross-continental mentorship and exchange. These initiatives symbolize our commitment to creating a future shared across borders. We have faced challenges under the impact of COVID-19, but conquered it with resilience and shared purpose. As healthcare needs evolve and patient expectations rise, the UAA aims to: 1. Promote regional research 2. Enhance training and education 3. Strengthen partnerships 4. Champion equity in healthcare.Complex Robotic Assisted Surgery for Urinary Fistula RepairRobotic-assisted (da Vinci) surgery is increasingly used for repair of urinary fistulas, including vesicovaginal, ureterovaginal, and enterovesical fistula. It offers a minimally invasive alternative to open surgery. A case report described using the da Vinci X system to fix a vesicovaginal fistula (VVF) post-hysterectomy in 105 min with no complications, a 2 day hospital stay, and excellent patient reported quality-of-life at 12 months. A literature review including 30 cases showed robotic repair of VVF reduced blood loss and shortened hospital stays by 2 days compared to open repair. A review found that robotic repair of complex urinary fistulas is technically feasible in expert hands, with good early outcomes and less morbidity than open techniques.
This presentation illustrated the key operative procedures, inlcuding ureteral catheter placement to identify the ureteral tract, anchoring stitches on opened urinary bladder wall, robotic excision of the fistula tract, layered closure of bladder wall and adjacent organ (vagina or colon), with or without Interposition of tissue flaps (e.g. omentum or peritoneal flaps) to reinforce repair. The robot provides precise and secure ileal isolation with ICG technique for the ileal isolation, and and intracorporeal anastomosis to ureter and urinary bladder are safe. Intracorporeal bowel re-anastomosis and accessibility of the da Vinci platform is becoming more popular. The isolated ileal technique provides good urinary reconstruction (e.g., Neobladder, Augmentation Cystoplasty Ileal conduit (Bricker’s procedure), Orthotopic neobladder (Studer, Hautmann, etc.) The Role of the robot to harvestest, detubularize, and fold ileum to form bladder substitute. Suture to urethra and ureters. It is often performed entirely intracorporeally with the da Vinci Xi system.
Yen-Chuan OuTaiwan
Speaker
ARUS–PRUS Partnership Ceremony: A New Chapter in Asia Robotic Urology CollaborationDear colleagues and friends,
It’s a great honor to witness the signing of this partnership between the Asian Robotic Urology Society (ARUS) and the Philippines Robotic Urology Society (PRUS).
This marks the beginning of a new chapter in regional collaboration—one that emphasizes shared training, joint research, and mutual support to advance robotic urology across Asia. PRUS brings energy, expertise, and vision to this partnership, and ARUS is proud to walk alongside you as we work toward higher standards and better outcomes for our patients. Let us move forward together—with unity, purpose, and innovation.
Congratulations to both ARUS and PRUS!Aquablation Revolutionizing BPH Treatment: A New Era of Minimally Invasive Therapy-Tungs' Taichung Metroharbor Hospital ExperienceIntroduction
Aquablation is a waterjet ablation therapy for benign prostatic hyperplasia (BPH) that has gained significant attention. While its efficacy, durability, and safety have been established across various prostate sizes (30–150 mL), local data on its efficacy, safety, and learning curve in Taiwan remain limited. Our team have been performed 85 cases between March 2024 and July 2025. This lecture presents the learning curve observed in the first 50 patients who underwent Aquablation for BPH, highlighting its role in revolutionizing BPH treatment.
Materials and Methods
We conducted a retrospective review of 50 consecutive patients who underwent Aquablation between March 2024 and February 2025, dividing them into two groups: Group I (first 25 cases) and Group II (subsequent 25 cases). Assessments included IPSS, QoL, uroflowmetry parameters (voiding volume, Qmax, Qmean, PVR), operative time, hemoglobin drop, Clavien-Dindo grade ≥2 complications, hospital stay, and urethral catheter duration.
Results
Patients in Group II were younger and had smaller prostates. Aquablation was successfully performed in all cases. IPSS, QoL, voiding volume, Qmax, and Qmean improved significantly and were sustained for three months, while PVR improved only in Group I. Operative time was significantly shorter in Group II, and hemoglobin drop was greater in Group I. Complication rates, hospital stay, and catheter duration were similar between groups.
Conclusions
Aquablation provided significant and immediate improvements in voiding parameters and symptoms, with sustained PVR benefits in larger prostates. Surgeon proficiency improved after 25 cases. Overall, Aquablation proved safe and effective, even in an unselected patient population. Aquablation represents a promising advancement that could transform the therapeutic landscape for BPH—particularly if costs are reduced.Experience of 100 Consecutive Hugo Robotic Radical ProstatectomiesIntroduction and background:
Dr. Ou’ surgical team of Tungs’ Taichung MetroHarbor Hospital performed the first Hugo robotic radical prostatectomy on May 9, 2023. In 2023, we published the results of the first series of 12 Hugo robotic radical prostatectomies performed. In 2024, we published a comparison of 30 Hugo robotic radical prostatectomies and 30 Da Vinci robotic radical prostatectomies. Professor Ou is the Hugo robotic arm instructor recognized by Medtronic. Many Southeast Asian doctors come to this Hospital to observe the surgery and learn.
Material and Methods:
We prospectively collected data for retrospective analysis and statistics from May 9, 2023 to April 30, 2025, performing 100 consecutive Hugo robotic radical prostatectomies. We compared the surgical results of 1-50 cases (group 1) and 51-100 cases (group 2). The data analyzed included basic information, age, risk of anesthesia, BMI , prostate-specific antigen, clinical stage, and Gleason score grade. The two groups were compared in terms of surgical difficulty, receipt of neoadjuvant hormonal therapy, obesity, prostate volume >70 g, prostate protrusion more than 1 cm into the bladder neck, previous transurethral resection of prostate, history of abdominal surgery, extensive pelvic lymphadenectomy, salvage radical prostatectomy, and time from biopsy to radical prostatectomy less than 6 weeks. The two groups were compared in terms of robotic console time, blood loss, blood transfusion rate, and surgical complications. We compared the two groups in terms of postoperative pathological staging and grade, the proportion of tumor, and the proportion of urinary control at one month and three months.
Results:
The study showed that the age of patients in the second group was slightly higher, but the statistical p value was 0.058, which did not reach statistical difference. The second group of patients had significantly higher rates of stage III, stage IV, lymph node and bone oligometastasis, with a p value of 0.021. The rate of neoadjuvant hormonal therapy received by the second group was 16 percent, which was statistically significant compared with 2 percent of the first group (p = 0.021). The rates of other surgical difficulty factors were the same between the two groups. The average blood loss of patients in the second group was 156 CC, which was significantly less than the 208 CC in the first group. The operation time and surgical complications were comparable between the two groups. The cancer volume of the second group of patients was significantly reduced compared with that of the first group (3.30±2.93 versus 5.09±5.24, p value=0.049). The reason was that more patients in the second group received neoadjuvant hormonal therapy, which significantly reduced the cancer. Both groups of patients had very good urinary control after surgery.
Conclusion:
We conclude that Hugo robotic radical prostatectomy is an effective and feasible method with extremely low complications and good recovery of urinary control function after surgery. After the experience of the first 50 operations, the surgeon will choose patients with higher difficulty, especially those receiving neoadjuvant hormone therapy, to perform the operation.Total Solution of Maintenance of Urinary and Sex Function during Robotic Radical ProstatectomyBackground:
Robotic-assisted radical prostatectomy (RARP) has become a preferred surgical approach for localized prostate cancer due to its minimally invasive nature and precision. However, the preservation of urinary continence and sexual function remains a significant postoperative challenge. Traditional outcomes have focused heavily on oncological safety. Yet, contemporary perspectives emphasize a more holistic view—embodied in the concept of the “Pentafecta,” which includes continence, potency, negative surgical margins, biochemical recurrence-free survival, and absence of perioperative complications.
Objective:
This presentation introduces a comprehensive and integrative approach aimed at maximizing functional outcomes—particularly urinary continence and erectile function—through a modified pubovesical complex-sparing RARP under regional hypothermia, supplemented with real-time nerve imaging, neurovascular preservation strategies, and biological enhancement techniques.
Methods:
We present data and experience from Tungs’ Taichung MetroHarbor Hospital (TTMHH), including a series of 3780 robotic procedures performed between December 2005 and July 2025. Among these, 100 cases were completed using the Hugo™ RAS system and 21 with the da Vinci SP™ platform. Our modified technique builds upon Dr. Richard Gaston’s pubovesical complex-sparing method, with the addition of localized hypothermia (24°C), near-infrared fluorescence (NIRF) imaging with indocyanine green (ICG), and application of dehydrated human amnion/chorion membrane (dHACM). In selected cases, nerve grafting with Axogen® technology was applied.
Results:
Initial results indicate a significantly improved early return of continence (95% by 16 weeks) and promising erectile function recovery, particularly in patients who received adjunctive therapies such as phosphodiesterase inhibitors or vacuum erection devices. The precision afforded by robotic technology enabled preservation of
prostate capsular arteries and accessory pudendal arteries. Localized hypothermia contributed to reduced tissue edema, minimized neural trauma, and improved nerve recovery. The use of ICG-NIRF allowed real-time identification of critical vascular landmarks, enhancing nerve-sparing accuracy. Preliminary analysis suggests our technique is both feasible and reproducible.
Conclusion:
The modified pubovesical complex-sparing RARP under hypothermia, augmented with vascular imaging and biologic materials, offers a promising paradigm for functional preservation in prostate cancer surgery. This total solution approach not only protects neurovascular integrity but also accelerates recovery of continence and potency.
Continued accumulation of clinical cases and controlled comparative studies are warranted to further validate the efficacy and long-term benefits of these techniques.
Significance:
This strategy reflects a patient-centered evolution in robotic prostate surgery, merging surgical innovation with anatomical preservation and technological augmentation. It represents an epic collaboration of surgical precision, team-based care, and thoughtful application of biomedical advances to improve quality of life outcomes in prostate
cancer patients.Total Solution of Maintenance of Urinary and Sex Function during Robotic Radical Prostatectomy
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Yen-Chuan OuTaiwan
Speaker
ARUS–PRUS Partnership Ceremony: A New Chapter in Asia Robotic Urology CollaborationDear colleagues and friends,
It’s a great honor to witness the signing of this partnership between the Asian Robotic Urology Society (ARUS) and the Philippines Robotic Urology Society (PRUS).
This marks the beginning of a new chapter in regional collaboration—one that emphasizes shared training, joint research, and mutual support to advance robotic urology across Asia. PRUS brings energy, expertise, and vision to this partnership, and ARUS is proud to walk alongside you as we work toward higher standards and better outcomes for our patients. Let us move forward together—with unity, purpose, and innovation.
Congratulations to both ARUS and PRUS!Aquablation Revolutionizing BPH Treatment: A New Era of Minimally Invasive Therapy-Tungs' Taichung Metroharbor Hospital ExperienceIntroduction
Aquablation is a waterjet ablation therapy for benign prostatic hyperplasia (BPH) that has gained significant attention. While its efficacy, durability, and safety have been established across various prostate sizes (30–150 mL), local data on its efficacy, safety, and learning curve in Taiwan remain limited. Our team have been performed 85 cases between March 2024 and July 2025. This lecture presents the learning curve observed in the first 50 patients who underwent Aquablation for BPH, highlighting its role in revolutionizing BPH treatment.
Materials and Methods
We conducted a retrospective review of 50 consecutive patients who underwent Aquablation between March 2024 and February 2025, dividing them into two groups: Group I (first 25 cases) and Group II (subsequent 25 cases). Assessments included IPSS, QoL, uroflowmetry parameters (voiding volume, Qmax, Qmean, PVR), operative time, hemoglobin drop, Clavien-Dindo grade ≥2 complications, hospital stay, and urethral catheter duration.
Results
Patients in Group II were younger and had smaller prostates. Aquablation was successfully performed in all cases. IPSS, QoL, voiding volume, Qmax, and Qmean improved significantly and were sustained for three months, while PVR improved only in Group I. Operative time was significantly shorter in Group II, and hemoglobin drop was greater in Group I. Complication rates, hospital stay, and catheter duration were similar between groups.
Conclusions
Aquablation provided significant and immediate improvements in voiding parameters and symptoms, with sustained PVR benefits in larger prostates. Surgeon proficiency improved after 25 cases. Overall, Aquablation proved safe and effective, even in an unselected patient population. Aquablation represents a promising advancement that could transform the therapeutic landscape for BPH—particularly if costs are reduced.Experience of 100 Consecutive Hugo Robotic Radical ProstatectomiesIntroduction and background:
Dr. Ou’ surgical team of Tungs’ Taichung MetroHarbor Hospital performed the first Hugo robotic radical prostatectomy on May 9, 2023. In 2023, we published the results of the first series of 12 Hugo robotic radical prostatectomies performed. In 2024, we published a comparison of 30 Hugo robotic radical prostatectomies and 30 Da Vinci robotic radical prostatectomies. Professor Ou is the Hugo robotic arm instructor recognized by Medtronic. Many Southeast Asian doctors come to this Hospital to observe the surgery and learn.
Material and Methods:
We prospectively collected data for retrospective analysis and statistics from May 9, 2023 to April 30, 2025, performing 100 consecutive Hugo robotic radical prostatectomies. We compared the surgical results of 1-50 cases (group 1) and 51-100 cases (group 2). The data analyzed included basic information, age, risk of anesthesia, BMI , prostate-specific antigen, clinical stage, and Gleason score grade. The two groups were compared in terms of surgical difficulty, receipt of neoadjuvant hormonal therapy, obesity, prostate volume >70 g, prostate protrusion more than 1 cm into the bladder neck, previous transurethral resection of prostate, history of abdominal surgery, extensive pelvic lymphadenectomy, salvage radical prostatectomy, and time from biopsy to radical prostatectomy less than 6 weeks. The two groups were compared in terms of robotic console time, blood loss, blood transfusion rate, and surgical complications. We compared the two groups in terms of postoperative pathological staging and grade, the proportion of tumor, and the proportion of urinary control at one month and three months.
Results:
The study showed that the age of patients in the second group was slightly higher, but the statistical p value was 0.058, which did not reach statistical difference. The second group of patients had significantly higher rates of stage III, stage IV, lymph node and bone oligometastasis, with a p value of 0.021. The rate of neoadjuvant hormonal therapy received by the second group was 16 percent, which was statistically significant compared with 2 percent of the first group (p = 0.021). The rates of other surgical difficulty factors were the same between the two groups. The average blood loss of patients in the second group was 156 CC, which was significantly less than the 208 CC in the first group. The operation time and surgical complications were comparable between the two groups. The cancer volume of the second group of patients was significantly reduced compared with that of the first group (3.30±2.93 versus 5.09±5.24, p value=0.049). The reason was that more patients in the second group received neoadjuvant hormonal therapy, which significantly reduced the cancer. Both groups of patients had very good urinary control after surgery.
Conclusion:
We conclude that Hugo robotic radical prostatectomy is an effective and feasible method with extremely low complications and good recovery of urinary control function after surgery. After the experience of the first 50 operations, the surgeon will choose patients with higher difficulty, especially those receiving neoadjuvant hormone therapy, to perform the operation.Total Solution of Maintenance of Urinary and Sex Function during Robotic Radical ProstatectomyBackground:
Robotic-assisted radical prostatectomy (RARP) has become a preferred surgical approach for localized prostate cancer due to its minimally invasive nature and precision. However, the preservation of urinary continence and sexual function remains a significant postoperative challenge. Traditional outcomes have focused heavily on oncological safety. Yet, contemporary perspectives emphasize a more holistic view—embodied in the concept of the “Pentafecta,” which includes continence, potency, negative surgical margins, biochemical recurrence-free survival, and absence of perioperative complications.
Objective:
This presentation introduces a comprehensive and integrative approach aimed at maximizing functional outcomes—particularly urinary continence and erectile function—through a modified pubovesical complex-sparing RARP under regional hypothermia, supplemented with real-time nerve imaging, neurovascular preservation strategies, and biological enhancement techniques.
Methods:
We present data and experience from Tungs’ Taichung MetroHarbor Hospital (TTMHH), including a series of 3780 robotic procedures performed between December 2005 and July 2025. Among these, 100 cases were completed using the Hugo™ RAS system and 21 with the da Vinci SP™ platform. Our modified technique builds upon Dr. Richard Gaston’s pubovesical complex-sparing method, with the addition of localized hypothermia (24°C), near-infrared fluorescence (NIRF) imaging with indocyanine green (ICG), and application of dehydrated human amnion/chorion membrane (dHACM). In selected cases, nerve grafting with Axogen® technology was applied.
Results:
Initial results indicate a significantly improved early return of continence (95% by 16 weeks) and promising erectile function recovery, particularly in patients who received adjunctive therapies such as phosphodiesterase inhibitors or vacuum erection devices. The precision afforded by robotic technology enabled preservation of
prostate capsular arteries and accessory pudendal arteries. Localized hypothermia contributed to reduced tissue edema, minimized neural trauma, and improved nerve recovery. The use of ICG-NIRF allowed real-time identification of critical vascular landmarks, enhancing nerve-sparing accuracy. Preliminary analysis suggests our technique is both feasible and reproducible.
Conclusion:
The modified pubovesical complex-sparing RARP under hypothermia, augmented with vascular imaging and biologic materials, offers a promising paradigm for functional preservation in prostate cancer surgery. This total solution approach not only protects neurovascular integrity but also accelerates recovery of continence and potency.
Continued accumulation of clinical cases and controlled comparative studies are warranted to further validate the efficacy and long-term benefits of these techniques.
Significance:
This strategy reflects a patient-centered evolution in robotic prostate surgery, merging surgical innovation with anatomical preservation and technological augmentation. It represents an epic collaboration of surgical precision, team-based care, and thoughtful application of biomedical advances to improve quality of life outcomes in prostate
cancer patients.Total Solution of Maintenance of Urinary and Sex Function during Robotic Radical Prostatectomy
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Allen W. ChiuTaiwan
Moderator
Reflecting on the Past, Shaping the Present, and Envisioning the Future of UAASince 1990, the Urological Association of Asia (UAA) has stood as a beacon of collaboration, innovation, and advancement in urology in Asia. As we reflect on its evolution, acknowledge its current impact, and envision its future, it becomes clear that the UAA has played - and will continue to play - a pivotal role in shaping urological care, education, and research throughout Asia. Reflecting on the path we’ve traveled together from 16 member associations and 1,000 individual members in 2014 to 28 member associations and over 4,500 individual members today - I see more than growth. I see unity, commitment, and a shared belief in something bigger than ourselves. A defining milestone was enrolling the Urological Society of Australia and New Zealand into the UAA, further enriching our diversity and strengthening our position as a truly Asia-Pacific organization. The UAA proudly supports several journals, including the International Journal of Urology, the Indian Journal of Urology, Asian Urology, which continue to shape the academic discourse. The Asian Urological Resident Course (AURC) started in 2014, in collaboration with the American Urological Association, has become a cornerstone in nurturing clinical excellence among young urologists. The Young Leadership Forum, since 2012, developed in partnership with the European Urological Association, has fostered cross-continental mentorship and exchange. These initiatives symbolize our commitment to creating a future shared across borders. We have faced challenges under the impact of COVID-19, but conquered it with resilience and shared purpose. As healthcare needs evolve and patient expectations rise, the UAA aims to: 1. Promote regional research 2. Enhance training and education 3. Strengthen partnerships 4. Champion equity in healthcare.Complex Robotic Assisted Surgery for Urinary Fistula RepairRobotic-assisted (da Vinci) surgery is increasingly used for repair of urinary fistulas, including vesicovaginal, ureterovaginal, and enterovesical fistula. It offers a minimally invasive alternative to open surgery. A case report described using the da Vinci X system to fix a vesicovaginal fistula (VVF) post-hysterectomy in 105 min with no complications, a 2 day hospital stay, and excellent patient reported quality-of-life at 12 months. A literature review including 30 cases showed robotic repair of VVF reduced blood loss and shortened hospital stays by 2 days compared to open repair. A review found that robotic repair of complex urinary fistulas is technically feasible in expert hands, with good early outcomes and less morbidity than open techniques.
This presentation illustrated the key operative procedures, inlcuding ureteral catheter placement to identify the ureteral tract, anchoring stitches on opened urinary bladder wall, robotic excision of the fistula tract, layered closure of bladder wall and adjacent organ (vagina or colon), with or without Interposition of tissue flaps (e.g. omentum or peritoneal flaps) to reinforce repair. The robot provides precise and secure ileal isolation with ICG technique for the ileal isolation, and and intracorporeal anastomosis to ureter and urinary bladder are safe. Intracorporeal bowel re-anastomosis and accessibility of the da Vinci platform is becoming more popular. The isolated ileal technique provides good urinary reconstruction (e.g., Neobladder, Augmentation Cystoplasty Ileal conduit (Bricker’s procedure), Orthotopic neobladder (Studer, Hautmann, etc.) The Role of the robot to harvestest, detubularize, and fold ileum to form bladder substitute. Suture to urethra and ureters. It is often performed entirely intracorporeally with the da Vinci Xi system.
Yen-Chuan OuTaiwan
Moderator
ARUS–PRUS Partnership Ceremony: A New Chapter in Asia Robotic Urology CollaborationDear colleagues and friends,
It’s a great honor to witness the signing of this partnership between the Asian Robotic Urology Society (ARUS) and the Philippines Robotic Urology Society (PRUS).
This marks the beginning of a new chapter in regional collaboration—one that emphasizes shared training, joint research, and mutual support to advance robotic urology across Asia. PRUS brings energy, expertise, and vision to this partnership, and ARUS is proud to walk alongside you as we work toward higher standards and better outcomes for our patients. Let us move forward together—with unity, purpose, and innovation.
Congratulations to both ARUS and PRUS!Aquablation Revolutionizing BPH Treatment: A New Era of Minimally Invasive Therapy-Tungs' Taichung Metroharbor Hospital ExperienceIntroduction
Aquablation is a waterjet ablation therapy for benign prostatic hyperplasia (BPH) that has gained significant attention. While its efficacy, durability, and safety have been established across various prostate sizes (30–150 mL), local data on its efficacy, safety, and learning curve in Taiwan remain limited. Our team have been performed 85 cases between March 2024 and July 2025. This lecture presents the learning curve observed in the first 50 patients who underwent Aquablation for BPH, highlighting its role in revolutionizing BPH treatment.
Materials and Methods
We conducted a retrospective review of 50 consecutive patients who underwent Aquablation between March 2024 and February 2025, dividing them into two groups: Group I (first 25 cases) and Group II (subsequent 25 cases). Assessments included IPSS, QoL, uroflowmetry parameters (voiding volume, Qmax, Qmean, PVR), operative time, hemoglobin drop, Clavien-Dindo grade ≥2 complications, hospital stay, and urethral catheter duration.
Results
Patients in Group II were younger and had smaller prostates. Aquablation was successfully performed in all cases. IPSS, QoL, voiding volume, Qmax, and Qmean improved significantly and were sustained for three months, while PVR improved only in Group I. Operative time was significantly shorter in Group II, and hemoglobin drop was greater in Group I. Complication rates, hospital stay, and catheter duration were similar between groups.
Conclusions
Aquablation provided significant and immediate improvements in voiding parameters and symptoms, with sustained PVR benefits in larger prostates. Surgeon proficiency improved after 25 cases. Overall, Aquablation proved safe and effective, even in an unselected patient population. Aquablation represents a promising advancement that could transform the therapeutic landscape for BPH—particularly if costs are reduced.Experience of 100 Consecutive Hugo Robotic Radical ProstatectomiesIntroduction and background:
Dr. Ou’ surgical team of Tungs’ Taichung MetroHarbor Hospital performed the first Hugo robotic radical prostatectomy on May 9, 2023. In 2023, we published the results of the first series of 12 Hugo robotic radical prostatectomies performed. In 2024, we published a comparison of 30 Hugo robotic radical prostatectomies and 30 Da Vinci robotic radical prostatectomies. Professor Ou is the Hugo robotic arm instructor recognized by Medtronic. Many Southeast Asian doctors come to this Hospital to observe the surgery and learn.
Material and Methods:
We prospectively collected data for retrospective analysis and statistics from May 9, 2023 to April 30, 2025, performing 100 consecutive Hugo robotic radical prostatectomies. We compared the surgical results of 1-50 cases (group 1) and 51-100 cases (group 2). The data analyzed included basic information, age, risk of anesthesia, BMI , prostate-specific antigen, clinical stage, and Gleason score grade. The two groups were compared in terms of surgical difficulty, receipt of neoadjuvant hormonal therapy, obesity, prostate volume >70 g, prostate protrusion more than 1 cm into the bladder neck, previous transurethral resection of prostate, history of abdominal surgery, extensive pelvic lymphadenectomy, salvage radical prostatectomy, and time from biopsy to radical prostatectomy less than 6 weeks. The two groups were compared in terms of robotic console time, blood loss, blood transfusion rate, and surgical complications. We compared the two groups in terms of postoperative pathological staging and grade, the proportion of tumor, and the proportion of urinary control at one month and three months.
Results:
The study showed that the age of patients in the second group was slightly higher, but the statistical p value was 0.058, which did not reach statistical difference. The second group of patients had significantly higher rates of stage III, stage IV, lymph node and bone oligometastasis, with a p value of 0.021. The rate of neoadjuvant hormonal therapy received by the second group was 16 percent, which was statistically significant compared with 2 percent of the first group (p = 0.021). The rates of other surgical difficulty factors were the same between the two groups. The average blood loss of patients in the second group was 156 CC, which was significantly less than the 208 CC in the first group. The operation time and surgical complications were comparable between the two groups. The cancer volume of the second group of patients was significantly reduced compared with that of the first group (3.30±2.93 versus 5.09±5.24, p value=0.049). The reason was that more patients in the second group received neoadjuvant hormonal therapy, which significantly reduced the cancer. Both groups of patients had very good urinary control after surgery.
Conclusion:
We conclude that Hugo robotic radical prostatectomy is an effective and feasible method with extremely low complications and good recovery of urinary control function after surgery. After the experience of the first 50 operations, the surgeon will choose patients with higher difficulty, especially those receiving neoadjuvant hormone therapy, to perform the operation.Total Solution of Maintenance of Urinary and Sex Function during Robotic Radical ProstatectomyBackground:
Robotic-assisted radical prostatectomy (RARP) has become a preferred surgical approach for localized prostate cancer due to its minimally invasive nature and precision. However, the preservation of urinary continence and sexual function remains a significant postoperative challenge. Traditional outcomes have focused heavily on oncological safety. Yet, contemporary perspectives emphasize a more holistic view—embodied in the concept of the “Pentafecta,” which includes continence, potency, negative surgical margins, biochemical recurrence-free survival, and absence of perioperative complications.
Objective:
This presentation introduces a comprehensive and integrative approach aimed at maximizing functional outcomes—particularly urinary continence and erectile function—through a modified pubovesical complex-sparing RARP under regional hypothermia, supplemented with real-time nerve imaging, neurovascular preservation strategies, and biological enhancement techniques.
Methods:
We present data and experience from Tungs’ Taichung MetroHarbor Hospital (TTMHH), including a series of 3780 robotic procedures performed between December 2005 and July 2025. Among these, 100 cases were completed using the Hugo™ RAS system and 21 with the da Vinci SP™ platform. Our modified technique builds upon Dr. Richard Gaston’s pubovesical complex-sparing method, with the addition of localized hypothermia (24°C), near-infrared fluorescence (NIRF) imaging with indocyanine green (ICG), and application of dehydrated human amnion/chorion membrane (dHACM). In selected cases, nerve grafting with Axogen® technology was applied.
Results:
Initial results indicate a significantly improved early return of continence (95% by 16 weeks) and promising erectile function recovery, particularly in patients who received adjunctive therapies such as phosphodiesterase inhibitors or vacuum erection devices. The precision afforded by robotic technology enabled preservation of
prostate capsular arteries and accessory pudendal arteries. Localized hypothermia contributed to reduced tissue edema, minimized neural trauma, and improved nerve recovery. The use of ICG-NIRF allowed real-time identification of critical vascular landmarks, enhancing nerve-sparing accuracy. Preliminary analysis suggests our technique is both feasible and reproducible.
Conclusion:
The modified pubovesical complex-sparing RARP under hypothermia, augmented with vascular imaging and biologic materials, offers a promising paradigm for functional preservation in prostate cancer surgery. This total solution approach not only protects neurovascular integrity but also accelerates recovery of continence and potency.
Continued accumulation of clinical cases and controlled comparative studies are warranted to further validate the efficacy and long-term benefits of these techniques.
Significance:
This strategy reflects a patient-centered evolution in robotic prostate surgery, merging surgical innovation with anatomical preservation and technological augmentation. It represents an epic collaboration of surgical precision, team-based care, and thoughtful application of biomedical advances to improve quality of life outcomes in prostate
cancer patients.Total Solution of Maintenance of Urinary and Sex Function during Robotic Radical Prostatectomy
Chi-Fai NgHong Kong, China
Moderator
Novel Robotic Surgery PlatformsOver the past decades, robotic surgery has become an essential approach in urological care. The recent blooming of different robotic platforms, in particular in Asian countries, has helped popularize robotic surgery in less developed countries. The introduction of robotic technology in endoluminal surgery has also helped to open up opportunities to further improve endourology. In the future, the incorporation of AI in robotic systems will help upgrade the standard of care in urology.
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Gang ZhuChina
Speaker
Enhancing Robotic Surgery with AI and Imaging Navigation: Bridging Precision and EfficiencyBackground: Robotic surgery faces persistent challenges in real-time anatomical navigation during complex procedures like partial nephrectomy (PN), where millimeter-scale precision impacts oncological and functional outcomes.
Objective: This review explores the integration of artificial intelligence (AI) and augmented reality (AR)-based holographic imaging to overcome these limitations, synergistically advancing surgical precision and operational efficiency.
Design, setting and participants: Holographic imaging, an AR technique reconstructed from CT/MRI via surface rendering, provides detailed 3D anatomical models for preoperative planning, patient counseling, surgical training, and intraoperative navigation. These models enable precise tumor localization, super-selective vascular clamping, and parenchymal preservation, in particular the PN.
Results: Clinical outcomes demonstrate significant improvements. AI-automated modeling cuts 3D model reconstruction time while improving segmentation accuracy. AI enhanced holographic imaging in patient consultation, education and training, surgical planning, and surgical navigation have demonstrated value. Holographic imaging navigation overlays virtual models onto endoscopic views, reducing collecting system injury and increasing enucleation rates for endophytic tumors. AI-based holographic imaging visualization alters surgical strategy for complex cases, reducing conversion from partial to radical nephrectomy. Challenges persist in tracking robustness due to intraoperative organ deformation. Future directions include multimodal Integration: Combining holographic imaging and PET CT to define the metastatic lymph nodes, enabling personalized complete resection; Full-Cycle Coverage: Extending from preoperative assessment to postoperative recovery (e.g., recurrence prediction, customized rehabilitation plans); Telesurgery Empowerment: 5G + holographic imaging to support telesurgical guidance, promoting the decentralization of medical resources.
Conclusions: AI-powered holographic imaging navigation bridges critical gaps in robotic surgery by transforming static anatomical data into dynamic, real-time guidance. This synergy enhances precision in tumor resection and vascular management while streamlining workflows—ultimately improving patient outcomes through reduced ischemia, fewer complications, and greater nephron preservation, enhancing survival and quality of life for cancer patients. Real-time navigation integrating “anatomy-function-metabolism”, advancing MIS from “precision resection” to “personalized treatment” and "functional preservation”.
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Xu Zhang China
Speaker
From Console to Cloud: The Evolution of Robotic Telesurgery in Urology – Innovations, Trials, and Ethical FrontiersTelesurgery is an emerging branch of surgery that utilizes telecommunication technology and surgical robots to perform operations. It breaks the spatial constraints on the conduct of surgical procedures and represents a systematic innovation brought about by the intersection of new technologies and concepts such as robotic surgery, telecommunication, and artificial intelligence. It holds promise as a potential solution to the uneven distribution of medical resources. Currently, China's research in telesurgery has reached the forefront of the international stage. Building a high-quality disciplinary development ecosystem and a regional collaborative system for remote surgery will be the inevitable path to maintaining a leading position. Providing national-level project support for telesurgery, establishing a national-level joint innovation group, creating a regional medical consortium for remote surgery, and formulating legal norms and treatment guidelines will pave the way for the sustainable development of telesurgery in China. It is believed that with the strong support of the state, Chinese surgeons will seize the opportunity, lead the new wave of surgical development, integrate new telesurgery technologies into the national universal healthcare system, and benefit a large number of patients.
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John DavisUnited States
Speaker
Open Surgery Training: Is It Necessary in the Era of Robotics?Open surgery training in the era of robotics may or may not be a training environment that urology has control of, given worldwide access to robotic or at least laparoscopic techniques and strong patient preference. There may be some applications where a given experienced urologist can prefer open over minimally invasive surgery (MIS), such as radical cystectomy, or indications possibly outside of MIS feasibility such as large renal tumors with caval thrombus. Specific to training and expertise, there are 3 principle features of surgical skills desired: 1) knowing ideal exposure, 2) recognition of surgical planes, and 3) knowing anatomy before it can be seen. Although some trainees may only see MIS for certain indications, open surgery may expedite the process. There are no human studies identified on the topic, but a skills lab study was instructive (Farah, J Surgical Education 2023) showing that interns with open and MIS training performed higher comparing pre-intern to post intern bootcamp skills. The benefits of a solid training pathway including open experience are to move trainees towards the faster-to-progress part of the learning curve such that the attending can offer a safe training environment while moving the case along efficiently.The Future of Surgical Skills Evaluation: What Is on Your Wish List?Surgical skills training vary significantly by region with some systems putting trainees on a timed set of years, while others apprentice trainees until meeting a threshold for skills. Early training assessments were basic timed events with qualitative scores (subject to strong attending selection for success). Trainees should experience and/or study the key pitfalls to avoid and performance goals. Surgical simulation can be highly useful, but tend to improve only certain skills and not full case needs. Updated simulation moves from digital to hands on surgical models and may move the needle towards human experience. Training can be augmented with descriptors of surgical gestures and measuring which ones are most effective. The experience for the trainee is often depicted as an "autonomy gap" whereby the training desires to have case control, possibly before they are ready. Progression can be measured by descriptors of performance from assistance through full performance without coaching. The next frontier will be artificial intelligence guided measurement where specific performances can be characterized and diagnosed for success. My ultimate wishlist would be for methods to correlate skills to outcomes, optimized curricula, and a specific pathway to correct underperformance.Tips and Tricks in Challenging Cases of Robotic Radical ProstatectomyThere are many specific challenges with robotic radical prostatectomy (RARP) that can be described and illustrated--the most 5 common are 1) difficulty access, 2) obesity, 3) pubic arch interference, 4) anatomic challenges, and 5) reconstruction challenges. In this video sample, we demonstrate 2 challenges: obesity requiring a pelvic lymph node dissection and significant pelvic de-fatting to identify the proper surgical landmarks. Next a massive sized prostate that has had a partial transurethral resection--together presenting challenges with landmarks, a difficult bladder neck to diagnose, and final reconstruction challenges.
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Ryoichi Shiroki Japan
Speaker
Surgical Robot-System hinotori in Urological Surgery: Clinical Applications and Future PotentialThe hinotori system was developed by Medicaroid, the partnership between Kawasaki, a leader in the industrial robots, and Sysmex, with its abundant expertise and networks in advanced medicine, released the first made-in-Japan RAS in 2020. The hinotori has been designed to reduce interference between arms and the surgeon at bedside. Equipped with four 8-axis robotic arms, providing smooth, highly articulated movements that mimic the human hand. In addition, docking-free design allows for a wide operative field around trocars, ensuring smooth workflows for surgeons and assistants. As a made-in-Japan system, it offers high adaptability to local clinical needs and faster implementation of user feedback.
Since the first launch, more 90 systems have been installed for the clinical use, not only inside Japan but foreign countries such as Singapore and Malaysia. The first one was performed in December 2020 on prostatectomy. Since then, more than 100,000 cases performed, including urology GI surgery, gynecology and thoracic fields. In urological surgery, robot-assisted surgery has been widely and promptly accepted as a standard approach for the majority of major surgeries, including robot-assisted radical prostatectomy (RARP), partial nephrectomy (RAPN), radical nephrectomy (RARN), radical nephroureterectomy (RANU), and radical cystectomy (RARC), and has generally shown findings superior to those of conventional open and laparoscopic surgeries
In conclusion, hinotori is a cutting-edge Japanese surgical robot already in use at many medical institutions. With strong performance across various surgical specialties and growing insurance coverage, it is expected to benefit even more patients as its technology continues to evolve and its global presence expands.Comparison of Various Current Surgical Robotic Systems - Nuances, Advantages, & DrawbacksIn the field of urology, robotic surgery has gained rapid and wide acceptance as a standard surgical care in the majority of surgeries over the last decade. To date, the da Vinci surgical system has been the dominant platform in robotic surgery; however, several newly developed robotic systems have recently been introduced in routine clinical practice. We, Fujita, installed the four different kinds of robotic platform for clinical usage such as, daVinci Xi, SP, hinotori and Hugo. In this study, we want to analyze the perioperative outcomes of robotic radical prostatectomy (RARP) and characterize the differences between four platforms.
hinotori : The hinotori system was developed by Medicaroid, the partnership between Kawasaki, a leader in the industrial robots, and Sysmex, with its abundant expertise and networks in advanced medicine, released the first made-in-Japan RAS in 2020. The hinotori has a compact operation arm with eight axes of motion, one more than the DaVinci, leading to reduce interference between arms and the surgeon at bedside.
DaVinci SP : The characteristic of the SP system can operate one 3D flexible camera and three forceps through a single port, and various surgical access is possible without the external interference of the arms. The various complicated procedures have been feasible such as NOTES or transoral surgery through the narrow space without the large wound, and retroperitoneal approach like the prostatectomy and partial nephrectomy. SP system is expected to contribute to develop the high quality surgery with minimal invasiveness.
Hugo : Hugo system (Medtronic) consists of an open-site console with two arm-controllers that are operated with a grip similar to a pistol. It also has a footswitch that controls the camera, energy source, and reserve arm. The system includes four separate arm carts, each with six joints to increase the range of motion. Additionally, it uses specific 3D glasses for head tracking technology.
Despite a small case series, there seemed to need learning-curve to get familiar with systems in setting-up and surgical procedures in introductory-phase. However, all the surgical procedures were efficaciously and safely performed, resulting in the achievement of favorable perioperative outcomes surgically as well as oncologically.
In conclusion, these new robots will lead to competition and reduce the costs of RAS and will contribute to an increase in use. Robotic-assisted surgery will become more common than laparoscopic surgery especially in the field of urology.
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Jian-Ri LiTaiwan
Moderator
Applying Vision Augmentation in Robotic Surgery: Reality or FictionApplying Vision Augmentation in Robotic Surgery: Reality or Fiction
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Vipul R. PatelUnited States
Speaker
Lessons from 20,000 Robotic Prostatectomies: A Global Expert’s PerspectiveTechnical Considerations for Large Prostates over 100gmsTelesurgery: The Future of Surgery
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Yen-Chuan OuTaiwan
Speaker
ARUS–PRUS Partnership Ceremony: A New Chapter in Asia Robotic Urology CollaborationDear colleagues and friends,
It’s a great honor to witness the signing of this partnership between the Asian Robotic Urology Society (ARUS) and the Philippines Robotic Urology Society (PRUS).
This marks the beginning of a new chapter in regional collaboration—one that emphasizes shared training, joint research, and mutual support to advance robotic urology across Asia. PRUS brings energy, expertise, and vision to this partnership, and ARUS is proud to walk alongside you as we work toward higher standards and better outcomes for our patients. Let us move forward together—with unity, purpose, and innovation.
Congratulations to both ARUS and PRUS!Aquablation Revolutionizing BPH Treatment: A New Era of Minimally Invasive Therapy-Tungs' Taichung Metroharbor Hospital ExperienceIntroduction
Aquablation is a waterjet ablation therapy for benign prostatic hyperplasia (BPH) that has gained significant attention. While its efficacy, durability, and safety have been established across various prostate sizes (30–150 mL), local data on its efficacy, safety, and learning curve in Taiwan remain limited. Our team have been performed 85 cases between March 2024 and July 2025. This lecture presents the learning curve observed in the first 50 patients who underwent Aquablation for BPH, highlighting its role in revolutionizing BPH treatment.
Materials and Methods
We conducted a retrospective review of 50 consecutive patients who underwent Aquablation between March 2024 and February 2025, dividing them into two groups: Group I (first 25 cases) and Group II (subsequent 25 cases). Assessments included IPSS, QoL, uroflowmetry parameters (voiding volume, Qmax, Qmean, PVR), operative time, hemoglobin drop, Clavien-Dindo grade ≥2 complications, hospital stay, and urethral catheter duration.
Results
Patients in Group II were younger and had smaller prostates. Aquablation was successfully performed in all cases. IPSS, QoL, voiding volume, Qmax, and Qmean improved significantly and were sustained for three months, while PVR improved only in Group I. Operative time was significantly shorter in Group II, and hemoglobin drop was greater in Group I. Complication rates, hospital stay, and catheter duration were similar between groups.
Conclusions
Aquablation provided significant and immediate improvements in voiding parameters and symptoms, with sustained PVR benefits in larger prostates. Surgeon proficiency improved after 25 cases. Overall, Aquablation proved safe and effective, even in an unselected patient population. Aquablation represents a promising advancement that could transform the therapeutic landscape for BPH—particularly if costs are reduced.Experience of 100 Consecutive Hugo Robotic Radical ProstatectomiesIntroduction and background:
Dr. Ou’ surgical team of Tungs’ Taichung MetroHarbor Hospital performed the first Hugo robotic radical prostatectomy on May 9, 2023. In 2023, we published the results of the first series of 12 Hugo robotic radical prostatectomies performed. In 2024, we published a comparison of 30 Hugo robotic radical prostatectomies and 30 Da Vinci robotic radical prostatectomies. Professor Ou is the Hugo robotic arm instructor recognized by Medtronic. Many Southeast Asian doctors come to this Hospital to observe the surgery and learn.
Material and Methods:
We prospectively collected data for retrospective analysis and statistics from May 9, 2023 to April 30, 2025, performing 100 consecutive Hugo robotic radical prostatectomies. We compared the surgical results of 1-50 cases (group 1) and 51-100 cases (group 2). The data analyzed included basic information, age, risk of anesthesia, BMI , prostate-specific antigen, clinical stage, and Gleason score grade. The two groups were compared in terms of surgical difficulty, receipt of neoadjuvant hormonal therapy, obesity, prostate volume >70 g, prostate protrusion more than 1 cm into the bladder neck, previous transurethral resection of prostate, history of abdominal surgery, extensive pelvic lymphadenectomy, salvage radical prostatectomy, and time from biopsy to radical prostatectomy less than 6 weeks. The two groups were compared in terms of robotic console time, blood loss, blood transfusion rate, and surgical complications. We compared the two groups in terms of postoperative pathological staging and grade, the proportion of tumor, and the proportion of urinary control at one month and three months.
Results:
The study showed that the age of patients in the second group was slightly higher, but the statistical p value was 0.058, which did not reach statistical difference. The second group of patients had significantly higher rates of stage III, stage IV, lymph node and bone oligometastasis, with a p value of 0.021. The rate of neoadjuvant hormonal therapy received by the second group was 16 percent, which was statistically significant compared with 2 percent of the first group (p = 0.021). The rates of other surgical difficulty factors were the same between the two groups. The average blood loss of patients in the second group was 156 CC, which was significantly less than the 208 CC in the first group. The operation time and surgical complications were comparable between the two groups. The cancer volume of the second group of patients was significantly reduced compared with that of the first group (3.30±2.93 versus 5.09±5.24, p value=0.049). The reason was that more patients in the second group received neoadjuvant hormonal therapy, which significantly reduced the cancer. Both groups of patients had very good urinary control after surgery.
Conclusion:
We conclude that Hugo robotic radical prostatectomy is an effective and feasible method with extremely low complications and good recovery of urinary control function after surgery. After the experience of the first 50 operations, the surgeon will choose patients with higher difficulty, especially those receiving neoadjuvant hormone therapy, to perform the operation.Total Solution of Maintenance of Urinary and Sex Function during Robotic Radical ProstatectomyBackground:
Robotic-assisted radical prostatectomy (RARP) has become a preferred surgical approach for localized prostate cancer due to its minimally invasive nature and precision. However, the preservation of urinary continence and sexual function remains a significant postoperative challenge. Traditional outcomes have focused heavily on oncological safety. Yet, contemporary perspectives emphasize a more holistic view—embodied in the concept of the “Pentafecta,” which includes continence, potency, negative surgical margins, biochemical recurrence-free survival, and absence of perioperative complications.
Objective:
This presentation introduces a comprehensive and integrative approach aimed at maximizing functional outcomes—particularly urinary continence and erectile function—through a modified pubovesical complex-sparing RARP under regional hypothermia, supplemented with real-time nerve imaging, neurovascular preservation strategies, and biological enhancement techniques.
Methods:
We present data and experience from Tungs’ Taichung MetroHarbor Hospital (TTMHH), including a series of 3780 robotic procedures performed between December 2005 and July 2025. Among these, 100 cases were completed using the Hugo™ RAS system and 21 with the da Vinci SP™ platform. Our modified technique builds upon Dr. Richard Gaston’s pubovesical complex-sparing method, with the addition of localized hypothermia (24°C), near-infrared fluorescence (NIRF) imaging with indocyanine green (ICG), and application of dehydrated human amnion/chorion membrane (dHACM). In selected cases, nerve grafting with Axogen® technology was applied.
Results:
Initial results indicate a significantly improved early return of continence (95% by 16 weeks) and promising erectile function recovery, particularly in patients who received adjunctive therapies such as phosphodiesterase inhibitors or vacuum erection devices. The precision afforded by robotic technology enabled preservation of
prostate capsular arteries and accessory pudendal arteries. Localized hypothermia contributed to reduced tissue edema, minimized neural trauma, and improved nerve recovery. The use of ICG-NIRF allowed real-time identification of critical vascular landmarks, enhancing nerve-sparing accuracy. Preliminary analysis suggests our technique is both feasible and reproducible.
Conclusion:
The modified pubovesical complex-sparing RARP under hypothermia, augmented with vascular imaging and biologic materials, offers a promising paradigm for functional preservation in prostate cancer surgery. This total solution approach not only protects neurovascular integrity but also accelerates recovery of continence and potency.
Continued accumulation of clinical cases and controlled comparative studies are warranted to further validate the efficacy and long-term benefits of these techniques.
Significance:
This strategy reflects a patient-centered evolution in robotic prostate surgery, merging surgical innovation with anatomical preservation and technological augmentation. It represents an epic collaboration of surgical precision, team-based care, and thoughtful application of biomedical advances to improve quality of life outcomes in prostate
cancer patients.Total Solution of Maintenance of Urinary and Sex Function during Robotic Radical Prostatectomy
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Isaac KimUnited States
Speaker
Update on the Apa Neoadjuvant TrialIn patients with high-risk prostate cancer (PCa), neoadjuvant androgen deprivation therapy (ADT) is not an accepted standard of care. However, we hypothesize that neoadjuvant ADT may result in improved quality of life by down-staging prostate cancer and thereby, permitting a better quality of nerve sparing. has demonstrated benefit in surgical outcomes after radical prostatectomy (RP). To test this hypothesis, we conducted a prospective randomized trial evaluating the effect of neoadjuvant Apalutamide (Apa) +/- abiraterone acetate/prednisone (AAP) and a gonadotropin-releasing hormone (GnRH) agonist on nerve sparing during RP in men with high-risk PCa. Update on the Results of SIMCAP StudyApproximately 7% of new prostate cancer (PCa) patients in the US will be diagnosed with metastatic disease. The role of surgery in this population remains unclear. To investigate the therapeutic value of radical prostatectomy in men with de novo metastatic prostate cancer, we are conducting the phase 2.5 randomized clinical trial SIMCAP (NCT03456843).
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Cheng-Kuang YangTaiwan
Speaker
Robotic Radical Prostatectomy: Trying to Fit the Right Surgery to the Right PatientDefinitive treatment for localized prostate cancer included radical prostatectomy and radiation. Successful criteria of radical prostatectomy have to meet oncology control, not persistent PSA after surgery without salvage therapy. MRI imaging stage and PSA density are predictors for short‐term BCR after prostatectomy. NCCN‐defined high‐risk patients with a high initial PSA 28 density, imaging stage (T3aN0M0 and T3bN0M0), and 29 pathologic stage (any N1) had a higher risk of BCR when 30 compared with other patients with undetectable PSA, while 31 those with pathologic stage (T3bN0M0 or any N1) displayed 32 a higher risk of postoperatively detectable PSA. These find‐ 33 ings may help urologists to identify patients for whom active 34 therapeutic protocols are necessary.
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Simone CrivellaroUnited States
Speaker
Single-Port vs. Multi-Port Robotic Prostatectomy: Balancing Innovation, Precision, and OutcomesThe Application & Limitation of Urological SP SurgerySingle Port Retroperitoneal Partial NephrectomySingle Port Prostate Surgery
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Ming LiuChina
Speaker
Comparison of Hood technique vs Retzius sparing RARP: Beijing Hospital Experience.
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Eddie ChanHong Kong, China
Moderator
How to Escape Surgical ComplicationsSurgical complications can significantly impact patient outcomes and healthcare resources. This talk will focus on practical strategies to minimize complications in urologic surgery, tailored specifically for urology fellows. Real-life case examples will illustrate how thoughtful preparation and proactive communication can prevent or mitigate complications. Additionally, we will discuss structured approaches to managing complications when they arise, including communication with the patient and team, documentation, and timely intervention. Through real-life case examples, this session aims to enhance surgical judgment, promote patient safety, and build confidence in complication management.
Bannakij LojanapiwatThailand
Moderator
PSA Kinetics Following PADT in mHSPC. Is It a Real-World Tool for Predicting Oncologic Outcome?PSA Kinetics following Primary Androgen Deprivation Therapy
(PADT) in mHSPC. Is it a Real-world Tool for Prediction Oncologic Outcome?
Bannakij Lojanapiwat, M.D.
Professor of Urology, Chiang Mai University, Thailand.
Of recent guidelines, upfront primary androgen deprivation monotherapy or combination therapy (PADT) is recommended for the treatment of metastatic hormone sensitive prostate cancer (mHSPC). Limitation of real-world treatment such as culture difference, financial barrier, geographic access to treatment and high operation/ radiation risks associated with medical comorbidity led to underutilization of combination therapy as the standard guideline. Prognostic factors are important in clinical practice which can predict the clinical outcome that offer the pre-treatment counseling for patients to select the optimal treatment.
Prostate specific antigen (PSA) levels is one of the important key prognostic markers. PSA kinetics of nadir PSA level and time to nadir PSA following the treatment are the important role for progression to CRPC and oncologic outcome. Our study and the previous studies reported better oncologic outcome especially overall survival, cancer specific survival and time to developed CRPC in mHSPC patients received upfront PADT who decline PSA≥95% (deep responder), PSA nadir ≤ 0.2 ng/ml (low PSA nadir level), time to PSA nadir ≥ 6 month and PSA decline velocity <11 ng/ml/month.
PSA Kinetics following Primary Androgen Deprivation Therapy (PADT) is one of a real-world tool for prediction oncologic outcome in the treatment of mHSPC.
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Ketan BadaniUnited States
Speaker
Expanding horizons: SP for complex RAPNThe Future of Urological Robotic SurgerySingle-Port Robotic Partial Nephrectomy for Multiple or Large Renal TumorsHow to Standardize Training by AI-Learning from The Best Practice of Urological Robotic SurgerySP Partial Nephrectomy
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Xuepei ZhangChina
Speaker
Robotic IVC Thrombectomy: Expanding the Role of Robotics in Vascular Involvement
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Jimmy NomuraJapan
Speaker
Robotic Sacrocolpopexy: Techniques, Challenges, and Long-Term Outcomes
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Narasimhan RagavanIndia
Speaker
Robotic Vesico-Rectal and Vesico-Vaginal Repair: Innovations in Complex Fistula ManagementWe will be presenting our work on Vesicle vaginal fistula . We have described this as Chennai technique .
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Xuesong LiChina
Speaker
Robotic Ureteral Reconstruction: Managing Strictures and Injuries
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Masatoshi EtoJapan
Moderator
Current Status & Future Perspective of Surgical Navigation in Robotic SurgeryRobot-assisted partial nephrectomy (RAPN) is a standard treatment for small renal cancer, however, the number of reports on the development of the image supported system and its effectiveness is small. The key point in the procedure of RAPN is to reliably identify renal artery in a space with few landmarks and to resect a tumor. To performe RAPN safely and reliably, we have already developed a surgical navigation specialized for RAPN, and published its usefulness in daVinci surgical systems. In this lecture, I would like to talk our recent projects updating our current navigation system. The first project focuses on 3D navigation using real-time forceps tracking. The second project is to develop an AI-based autonomous registration method for surgical navigation in RAPN. I hope that these 2 projects will further enhance the usefulness of our navigation system in RAPN.
Jeremy TeohHong Kong, China
Moderator
Transurethral En Bloc Resection of Bladder Tumor: Where Are We Now?There is increasing evidence that transurethral en bloc resection of bladder tumour (ERBT) could lead to better peri-operative and oncological outcomes in patients with non-muscle-invasive bladder cancer. Modified approaches of ERBT have also been proposed to expand its indications for larger bladder tumours. The quality of resection is also the key for bladder-sparing treatment for muscle-invasive bladder cancer. We foresee an exciting journey ahead for ERBT, and as a urologist, we must embrace this novel technique for the best interest of our bladder cancer patients. To Publish or not to Publish? Navigating the path to academia in urologyDoing good science is the basis for technological advancement in healthcare. However, pursuing a path to academic in urology is often tough, stressful and frustrating. In this talk, I will share with you what I have learnt throughout my 15 years of research work. I will let you know what's the best and fastest way to become a globally renowned and successful researcher. Most importantly, I will explain what it takes to develop a great team and create a positive impact in people's lives. Believe in yourself! If I can do it, so can you.SIU Lecture: Role of MISTs in Male LUTS Surgical Management (Will TUR-P/ Laser Prostatectomy be Replaced?)Transurethral resection of prostate (TURP) is the current gold standard in treating patients with benign prostatic hyperplasia. Laser prostatectomy has also been used widely especially in patients who are on anticoagulants. However, both TURP and laser prostatectomy are associated with several problems including the need of spinal / general anaesthesia and the risk of male sexual dysfunction. In the past decade, we have witnessed the introduction of multiple new technologies including Rezum, Urolift, iTind and Aquablation. in this SIU lecture, we will discuss about the technical details, as well as the pros and cons of every new technology. We will also invite you to be our jury and decide whether TURP and laser prostatectomy will be replaced in the future. Novel Intravesical Therapeutics in the Evolving Landscape of NMIBCNon-muscle-invasive bladder cancer (NMIBC) is well known to be a difficult disease to manage, with a 1-year recurrence rate of up to 61% and 5-year recurrence rate of 78%. Despite the use of intravesical BCG therapy, NMIBC patients may still experience recurrence and develop what we call BCG-unresponsive NMIBC. Conventionally, we offer upfront radical cystectomy for patients with BCG-unresponsive NMIBC, however, this is an ultra-major surgery with significant risk of complications and could also lead to significant deterioration in quality of life in the long run. We are in urgent need for novel therapies to manage this difficult condition. In this lecture, we will discuss the evidence on the different novel intravesical therapies in treating BCG-unresponsive NMIBC. SIU Lecture: Role of MISTs in Male LUTS Surgical Management (Will TUR-P/ Laser Prostatectomy be Replaced?)
Rajeev KumarIndia
Moderator
Troubleshooting in Endoscopic Stone Surgery: How to Handle Unexpected Challenges in RIRS and ECIRSProstate Cancer Nomograms and Their Application in Asian MenNomograms help to predict outcomes in individual patients rather than whole populations and are an important part of evaluation and treatment decision making. Various nomograms have been developed in malignancies to predict and prognosticate clinical outcomes such as severity of disease, overall survival, and recurrence-free survival. In prostate cancer, nomograms were developed for determining need for biopsy, disease course, need for adjuvant therapy, and outcomes.
Most of these predictive nomograms were based on Caucasian populations. Prostate cancer is significantly affected by race, and Asian men have a significantly different racial and genetic susceptibility compared to Caucasians, raising the concern about the generalizability of these nomograms.
There are very few studies that have evaluated the applicability and validity of the existing nomograms in in Asian men. Most have found significant differences in the performance in this population. Thus, relying on such nomograms for treating Asian men may not be appropriate and collaborative efforts are required within Asian countries to develop locally relevant nomograms.What Is Critical Appraisal?Critical appraisal is the process of systematically evaluating research studies to assess their validity, relevance, and trustworthiness. The goal is to determine whether a study’s results are credible and useful for clinical decision-making, research, or policy. This has become increasingly important as there has been a massive increase in the number of scientific journals and not all published research is of equal quality. Critical appraisal helps healthcare professionals avoid being misled by poor-quality studies, make evidence-based decisions and improve patient outcomes.
The key purposes are to assess validity of the study and its results and determine applicability to the specific population. It involves assessing the study design, methodological quality, completeness of reporting, potential sources of bias and potential for misconduct.
There are number of reporting guidelines that can be used for performing critical appraisal. Additionally, being aware of essential reporting standards and common problems with studies can help readers make informed decisions.Scientific Misconduct and PitfallsNo abstractExample of the “Ideal” AbstractNo Abstract
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Kittinut KijvikaiThailand
Speaker
Robotic Surgery: Past, Present and Future PerspectivesMastering the Details: Tips and Tricks on Robotic Radical Cystectomy
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Wei-Yu LinTaiwan
Speaker
Step-by-Step: Intra-Corporeal Orthotopic Bladder CreationIntra-corporeal orthotopic neobladder creation is a technically demanding yet feasible procedure performed following robotic radical cystectomy. Using a 40–50 cm segment of ileum, the bowel is isolated, detubularized along the antimesenteric border, and configured into a low-pressure reservoir. Urethro-ileal anastomosis is carefully performed to ensure a tension-free, watertight connection, followed by uretero-ileal anastomoses using the Wallace technique with ureteral stent placement. The intra-corporeal approach minimizes bowel handling, facilitates faster recovery, and preserves pelvic anatomy, offering potential advantages in continence and postoperative outcomes when performed by experienced robotic surgeons.
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Noor Ashani Md YusoffMalaysia
Speaker
Technical Pearls: Node Dissection in Robotic CystectomyHighlight and Limitation in Urology Service in MalaysiaRobotic Pelvic LN Dissection: A critical Component of Bladder Cancer Surgery
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Yen-Chuan OuTaiwan
Speaker
ARUS–PRUS Partnership Ceremony: A New Chapter in Asia Robotic Urology CollaborationDear colleagues and friends,
It’s a great honor to witness the signing of this partnership between the Asian Robotic Urology Society (ARUS) and the Philippines Robotic Urology Society (PRUS).
This marks the beginning of a new chapter in regional collaboration—one that emphasizes shared training, joint research, and mutual support to advance robotic urology across Asia. PRUS brings energy, expertise, and vision to this partnership, and ARUS is proud to walk alongside you as we work toward higher standards and better outcomes for our patients. Let us move forward together—with unity, purpose, and innovation.
Congratulations to both ARUS and PRUS!Aquablation Revolutionizing BPH Treatment: A New Era of Minimally Invasive Therapy-Tungs' Taichung Metroharbor Hospital ExperienceIntroduction
Aquablation is a waterjet ablation therapy for benign prostatic hyperplasia (BPH) that has gained significant attention. While its efficacy, durability, and safety have been established across various prostate sizes (30–150 mL), local data on its efficacy, safety, and learning curve in Taiwan remain limited. Our team have been performed 85 cases between March 2024 and July 2025. This lecture presents the learning curve observed in the first 50 patients who underwent Aquablation for BPH, highlighting its role in revolutionizing BPH treatment.
Materials and Methods
We conducted a retrospective review of 50 consecutive patients who underwent Aquablation between March 2024 and February 2025, dividing them into two groups: Group I (first 25 cases) and Group II (subsequent 25 cases). Assessments included IPSS, QoL, uroflowmetry parameters (voiding volume, Qmax, Qmean, PVR), operative time, hemoglobin drop, Clavien-Dindo grade ≥2 complications, hospital stay, and urethral catheter duration.
Results
Patients in Group II were younger and had smaller prostates. Aquablation was successfully performed in all cases. IPSS, QoL, voiding volume, Qmax, and Qmean improved significantly and were sustained for three months, while PVR improved only in Group I. Operative time was significantly shorter in Group II, and hemoglobin drop was greater in Group I. Complication rates, hospital stay, and catheter duration were similar between groups.
Conclusions
Aquablation provided significant and immediate improvements in voiding parameters and symptoms, with sustained PVR benefits in larger prostates. Surgeon proficiency improved after 25 cases. Overall, Aquablation proved safe and effective, even in an unselected patient population. Aquablation represents a promising advancement that could transform the therapeutic landscape for BPH—particularly if costs are reduced.Experience of 100 Consecutive Hugo Robotic Radical ProstatectomiesIntroduction and background:
Dr. Ou’ surgical team of Tungs’ Taichung MetroHarbor Hospital performed the first Hugo robotic radical prostatectomy on May 9, 2023. In 2023, we published the results of the first series of 12 Hugo robotic radical prostatectomies performed. In 2024, we published a comparison of 30 Hugo robotic radical prostatectomies and 30 Da Vinci robotic radical prostatectomies. Professor Ou is the Hugo robotic arm instructor recognized by Medtronic. Many Southeast Asian doctors come to this Hospital to observe the surgery and learn.
Material and Methods:
We prospectively collected data for retrospective analysis and statistics from May 9, 2023 to April 30, 2025, performing 100 consecutive Hugo robotic radical prostatectomies. We compared the surgical results of 1-50 cases (group 1) and 51-100 cases (group 2). The data analyzed included basic information, age, risk of anesthesia, BMI , prostate-specific antigen, clinical stage, and Gleason score grade. The two groups were compared in terms of surgical difficulty, receipt of neoadjuvant hormonal therapy, obesity, prostate volume >70 g, prostate protrusion more than 1 cm into the bladder neck, previous transurethral resection of prostate, history of abdominal surgery, extensive pelvic lymphadenectomy, salvage radical prostatectomy, and time from biopsy to radical prostatectomy less than 6 weeks. The two groups were compared in terms of robotic console time, blood loss, blood transfusion rate, and surgical complications. We compared the two groups in terms of postoperative pathological staging and grade, the proportion of tumor, and the proportion of urinary control at one month and three months.
Results:
The study showed that the age of patients in the second group was slightly higher, but the statistical p value was 0.058, which did not reach statistical difference. The second group of patients had significantly higher rates of stage III, stage IV, lymph node and bone oligometastasis, with a p value of 0.021. The rate of neoadjuvant hormonal therapy received by the second group was 16 percent, which was statistically significant compared with 2 percent of the first group (p = 0.021). The rates of other surgical difficulty factors were the same between the two groups. The average blood loss of patients in the second group was 156 CC, which was significantly less than the 208 CC in the first group. The operation time and surgical complications were comparable between the two groups. The cancer volume of the second group of patients was significantly reduced compared with that of the first group (3.30±2.93 versus 5.09±5.24, p value=0.049). The reason was that more patients in the second group received neoadjuvant hormonal therapy, which significantly reduced the cancer. Both groups of patients had very good urinary control after surgery.
Conclusion:
We conclude that Hugo robotic radical prostatectomy is an effective and feasible method with extremely low complications and good recovery of urinary control function after surgery. After the experience of the first 50 operations, the surgeon will choose patients with higher difficulty, especially those receiving neoadjuvant hormone therapy, to perform the operation.Total Solution of Maintenance of Urinary and Sex Function during Robotic Radical ProstatectomyBackground:
Robotic-assisted radical prostatectomy (RARP) has become a preferred surgical approach for localized prostate cancer due to its minimally invasive nature and precision. However, the preservation of urinary continence and sexual function remains a significant postoperative challenge. Traditional outcomes have focused heavily on oncological safety. Yet, contemporary perspectives emphasize a more holistic view—embodied in the concept of the “Pentafecta,” which includes continence, potency, negative surgical margins, biochemical recurrence-free survival, and absence of perioperative complications.
Objective:
This presentation introduces a comprehensive and integrative approach aimed at maximizing functional outcomes—particularly urinary continence and erectile function—through a modified pubovesical complex-sparing RARP under regional hypothermia, supplemented with real-time nerve imaging, neurovascular preservation strategies, and biological enhancement techniques.
Methods:
We present data and experience from Tungs’ Taichung MetroHarbor Hospital (TTMHH), including a series of 3780 robotic procedures performed between December 2005 and July 2025. Among these, 100 cases were completed using the Hugo™ RAS system and 21 with the da Vinci SP™ platform. Our modified technique builds upon Dr. Richard Gaston’s pubovesical complex-sparing method, with the addition of localized hypothermia (24°C), near-infrared fluorescence (NIRF) imaging with indocyanine green (ICG), and application of dehydrated human amnion/chorion membrane (dHACM). In selected cases, nerve grafting with Axogen® technology was applied.
Results:
Initial results indicate a significantly improved early return of continence (95% by 16 weeks) and promising erectile function recovery, particularly in patients who received adjunctive therapies such as phosphodiesterase inhibitors or vacuum erection devices. The precision afforded by robotic technology enabled preservation of
prostate capsular arteries and accessory pudendal arteries. Localized hypothermia contributed to reduced tissue edema, minimized neural trauma, and improved nerve recovery. The use of ICG-NIRF allowed real-time identification of critical vascular landmarks, enhancing nerve-sparing accuracy. Preliminary analysis suggests our technique is both feasible and reproducible.
Conclusion:
The modified pubovesical complex-sparing RARP under hypothermia, augmented with vascular imaging and biologic materials, offers a promising paradigm for functional preservation in prostate cancer surgery. This total solution approach not only protects neurovascular integrity but also accelerates recovery of continence and potency.
Continued accumulation of clinical cases and controlled comparative studies are warranted to further validate the efficacy and long-term benefits of these techniques.
Significance:
This strategy reflects a patient-centered evolution in robotic prostate surgery, merging surgical innovation with anatomical preservation and technological augmentation. It represents an epic collaboration of surgical precision, team-based care, and thoughtful application of biomedical advances to improve quality of life outcomes in prostate
cancer patients.Total Solution of Maintenance of Urinary and Sex Function during Robotic Radical Prostatectomy
Gang ZhuChina
Speaker
Enhancing Robotic Surgery with AI and Imaging Navigation: Bridging Precision and EfficiencyBackground: Robotic surgery faces persistent challenges in real-time anatomical navigation during complex procedures like partial nephrectomy (PN), where millimeter-scale precision impacts oncological and functional outcomes.
Objective: This review explores the integration of artificial intelligence (AI) and augmented reality (AR)-based holographic imaging to overcome these limitations, synergistically advancing surgical precision and operational efficiency.
Design, setting and participants: Holographic imaging, an AR technique reconstructed from CT/MRI via surface rendering, provides detailed 3D anatomical models for preoperative planning, patient counseling, surgical training, and intraoperative navigation. These models enable precise tumor localization, super-selective vascular clamping, and parenchymal preservation, in particular the PN.
Results: Clinical outcomes demonstrate significant improvements. AI-automated modeling cuts 3D model reconstruction time while improving segmentation accuracy. AI enhanced holographic imaging in patient consultation, education and training, surgical planning, and surgical navigation have demonstrated value. Holographic imaging navigation overlays virtual models onto endoscopic views, reducing collecting system injury and increasing enucleation rates for endophytic tumors. AI-based holographic imaging visualization alters surgical strategy for complex cases, reducing conversion from partial to radical nephrectomy. Challenges persist in tracking robustness due to intraoperative organ deformation. Future directions include multimodal Integration: Combining holographic imaging and PET CT to define the metastatic lymph nodes, enabling personalized complete resection; Full-Cycle Coverage: Extending from preoperative assessment to postoperative recovery (e.g., recurrence prediction, customized rehabilitation plans); Telesurgery Empowerment: 5G + holographic imaging to support telesurgical guidance, promoting the decentralization of medical resources.
Conclusions: AI-powered holographic imaging navigation bridges critical gaps in robotic surgery by transforming static anatomical data into dynamic, real-time guidance. This synergy enhances precision in tumor resection and vascular management while streamlining workflows—ultimately improving patient outcomes through reduced ischemia, fewer complications, and greater nephron preservation, enhancing survival and quality of life for cancer patients. Real-time navigation integrating “anatomy-function-metabolism”, advancing MIS from “precision resection” to “personalized treatment” and "functional preservation”.
Xu Zhang China
Speaker
From Console to Cloud: The Evolution of Robotic Telesurgery in Urology – Innovations, Trials, and Ethical FrontiersTelesurgery is an emerging branch of surgery that utilizes telecommunication technology and surgical robots to perform operations. It breaks the spatial constraints on the conduct of surgical procedures and represents a systematic innovation brought about by the intersection of new technologies and concepts such as robotic surgery, telecommunication, and artificial intelligence. It holds promise as a potential solution to the uneven distribution of medical resources. Currently, China's research in telesurgery has reached the forefront of the international stage. Building a high-quality disciplinary development ecosystem and a regional collaborative system for remote surgery will be the inevitable path to maintaining a leading position. Providing national-level project support for telesurgery, establishing a national-level joint innovation group, creating a regional medical consortium for remote surgery, and formulating legal norms and treatment guidelines will pave the way for the sustainable development of telesurgery in China. It is believed that with the strong support of the state, Chinese surgeons will seize the opportunity, lead the new wave of surgical development, integrate new telesurgery technologies into the national universal healthcare system, and benefit a large number of patients.
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Ryoichi Shiroki Japan
Speaker
Surgical Robot-System hinotori in Urological Surgery: Clinical Applications and Future PotentialThe hinotori system was developed by Medicaroid, the partnership between Kawasaki, a leader in the industrial robots, and Sysmex, with its abundant expertise and networks in advanced medicine, released the first made-in-Japan RAS in 2020. The hinotori has been designed to reduce interference between arms and the surgeon at bedside. Equipped with four 8-axis robotic arms, providing smooth, highly articulated movements that mimic the human hand. In addition, docking-free design allows for a wide operative field around trocars, ensuring smooth workflows for surgeons and assistants. As a made-in-Japan system, it offers high adaptability to local clinical needs and faster implementation of user feedback.
Since the first launch, more 90 systems have been installed for the clinical use, not only inside Japan but foreign countries such as Singapore and Malaysia. The first one was performed in December 2020 on prostatectomy. Since then, more than 100,000 cases performed, including urology GI surgery, gynecology and thoracic fields. In urological surgery, robot-assisted surgery has been widely and promptly accepted as a standard approach for the majority of major surgeries, including robot-assisted radical prostatectomy (RARP), partial nephrectomy (RAPN), radical nephrectomy (RARN), radical nephroureterectomy (RANU), and radical cystectomy (RARC), and has generally shown findings superior to those of conventional open and laparoscopic surgeries
In conclusion, hinotori is a cutting-edge Japanese surgical robot already in use at many medical institutions. With strong performance across various surgical specialties and growing insurance coverage, it is expected to benefit even more patients as its technology continues to evolve and its global presence expands.Comparison of Various Current Surgical Robotic Systems - Nuances, Advantages, & DrawbacksIn the field of urology, robotic surgery has gained rapid and wide acceptance as a standard surgical care in the majority of surgeries over the last decade. To date, the da Vinci surgical system has been the dominant platform in robotic surgery; however, several newly developed robotic systems have recently been introduced in routine clinical practice. We, Fujita, installed the four different kinds of robotic platform for clinical usage such as, daVinci Xi, SP, hinotori and Hugo. In this study, we want to analyze the perioperative outcomes of robotic radical prostatectomy (RARP) and characterize the differences between four platforms.
hinotori : The hinotori system was developed by Medicaroid, the partnership between Kawasaki, a leader in the industrial robots, and Sysmex, with its abundant expertise and networks in advanced medicine, released the first made-in-Japan RAS in 2020. The hinotori has a compact operation arm with eight axes of motion, one more than the DaVinci, leading to reduce interference between arms and the surgeon at bedside.
DaVinci SP : The characteristic of the SP system can operate one 3D flexible camera and three forceps through a single port, and various surgical access is possible without the external interference of the arms. The various complicated procedures have been feasible such as NOTES or transoral surgery through the narrow space without the large wound, and retroperitoneal approach like the prostatectomy and partial nephrectomy. SP system is expected to contribute to develop the high quality surgery with minimal invasiveness.
Hugo : Hugo system (Medtronic) consists of an open-site console with two arm-controllers that are operated with a grip similar to a pistol. It also has a footswitch that controls the camera, energy source, and reserve arm. The system includes four separate arm carts, each with six joints to increase the range of motion. Additionally, it uses specific 3D glasses for head tracking technology.
Despite a small case series, there seemed to need learning-curve to get familiar with systems in setting-up and surgical procedures in introductory-phase. However, all the surgical procedures were efficaciously and safely performed, resulting in the achievement of favorable perioperative outcomes surgically as well as oncologically.
In conclusion, these new robots will lead to competition and reduce the costs of RAS and will contribute to an increase in use. Robotic-assisted surgery will become more common than laparoscopic surgery especially in the field of urology.
Gang ZhuChina
Speaker
Enhancing Robotic Surgery with AI and Imaging Navigation: Bridging Precision and EfficiencyBackground: Robotic surgery faces persistent challenges in real-time anatomical navigation during complex procedures like partial nephrectomy (PN), where millimeter-scale precision impacts oncological and functional outcomes.
Objective: This review explores the integration of artificial intelligence (AI) and augmented reality (AR)-based holographic imaging to overcome these limitations, synergistically advancing surgical precision and operational efficiency.
Design, setting and participants: Holographic imaging, an AR technique reconstructed from CT/MRI via surface rendering, provides detailed 3D anatomical models for preoperative planning, patient counseling, surgical training, and intraoperative navigation. These models enable precise tumor localization, super-selective vascular clamping, and parenchymal preservation, in particular the PN.
Results: Clinical outcomes demonstrate significant improvements. AI-automated modeling cuts 3D model reconstruction time while improving segmentation accuracy. AI enhanced holographic imaging in patient consultation, education and training, surgical planning, and surgical navigation have demonstrated value. Holographic imaging navigation overlays virtual models onto endoscopic views, reducing collecting system injury and increasing enucleation rates for endophytic tumors. AI-based holographic imaging visualization alters surgical strategy for complex cases, reducing conversion from partial to radical nephrectomy. Challenges persist in tracking robustness due to intraoperative organ deformation. Future directions include multimodal Integration: Combining holographic imaging and PET CT to define the metastatic lymph nodes, enabling personalized complete resection; Full-Cycle Coverage: Extending from preoperative assessment to postoperative recovery (e.g., recurrence prediction, customized rehabilitation plans); Telesurgery Empowerment: 5G + holographic imaging to support telesurgical guidance, promoting the decentralization of medical resources.
Conclusions: AI-powered holographic imaging navigation bridges critical gaps in robotic surgery by transforming static anatomical data into dynamic, real-time guidance. This synergy enhances precision in tumor resection and vascular management while streamlining workflows—ultimately improving patient outcomes through reduced ischemia, fewer complications, and greater nephron preservation, enhancing survival and quality of life for cancer patients. Real-time navigation integrating “anatomy-function-metabolism”, advancing MIS from “precision resection” to “personalized treatment” and "functional preservation”.
TICC - 1F 101D
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Management of UTUC and RIRS Updates
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Bannakij LojanapiwatThailand
Moderator
PSA Kinetics Following PADT in mHSPC. Is It a Real-World Tool for Predicting Oncologic Outcome?PSA Kinetics following Primary Androgen Deprivation Therapy
(PADT) in mHSPC. Is it a Real-world Tool for Prediction Oncologic Outcome?
Bannakij Lojanapiwat, M.D.
Professor of Urology, Chiang Mai University, Thailand.
Of recent guidelines, upfront primary androgen deprivation monotherapy or combination therapy (PADT) is recommended for the treatment of metastatic hormone sensitive prostate cancer (mHSPC). Limitation of real-world treatment such as culture difference, financial barrier, geographic access to treatment and high operation/ radiation risks associated with medical comorbidity led to underutilization of combination therapy as the standard guideline. Prognostic factors are important in clinical practice which can predict the clinical outcome that offer the pre-treatment counseling for patients to select the optimal treatment.
Prostate specific antigen (PSA) levels is one of the important key prognostic markers. PSA kinetics of nadir PSA level and time to nadir PSA following the treatment are the important role for progression to CRPC and oncologic outcome. Our study and the previous studies reported better oncologic outcome especially overall survival, cancer specific survival and time to developed CRPC in mHSPC patients received upfront PADT who decline PSA≥95% (deep responder), PSA nadir ≤ 0.2 ng/ml (low PSA nadir level), time to PSA nadir ≥ 6 month and PSA decline velocity <11 ng/ml/month.
PSA Kinetics following Primary Androgen Deprivation Therapy (PADT) is one of a real-world tool for prediction oncologic outcome in the treatment of mHSPC.
Chen-Hsun HoTaiwan
Moderator
Laser Lithotripsy in RIRS: Choosing the Right Settings for Better Outcomes
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Kay Seong NgooMalaysia
Speaker
Overview of UTUC: from Diagnosis to Treatment to SurveillanceUpper tract urothelial carcinoma (UTUC) accounts for approximately 5% to 10% of all urothelial carcinomas, with an annual incidence of about 2 per 100,000 population. It predominantly affects men, who are typically diagnosed at a younger age. At the time of diagnosis, approximately two-thirds of UTUC cases involve the intrarenal collecting system, 70% are high-grade, and around two-thirds are invasive. Established risk factors include cigarette smoking, exposure to aristolochic acid, and Lynch syndrome.
The majority of patients present with locally advanced disease. Diagnostic workup typically includes contrast-enhanced computed tomography (CT) urography, ureteroscopy with tissue biopsy, and selective urinary cytology. Technological advancements in ureteroscopy, including the integration of optical coherence tomography and confocal laser endomicroscopy, have shown promise in improving in vivo tumour grading and staging.
Treatment strategies are guided by risk stratification and the potential for disease progression. In low-risk cases—and in selected high-risk patients with imperative indications—nephron-sparing approaches such as endoscopic ablation, segmental ureterectomy, and chemoablation may be considered. Recent evidence suggests comparable oncologic outcomes between nephron-sparing surgery (NSS) and radical approaches. Advances in endoscopic techniques, including newer laser technologies, have further improved the feasibility and efficacy of NSS. Due to higher recurrence rates following NSS, adjuvant intraluminal therapy is recommended.
For high-risk UTUC, radical nephroureterectomy with bladder cuff excision remains the gold standard, irrespective of surgical modality. This is typically followed by a single postoperative intravesical instillation of chemotherapy. Adjuvant platinum-based chemotherapy has demonstrated improved disease-free survival, and emerging data suggest a potential role for immunotherapy in the perioperative setting.
Given the high risk of local recurrence, especially after nephron-sparing interventions, long-term and rigorous surveillance is essential. This includes periodic CT urography, cystoscopy, and urinary cytology. Surveillance protocols vary across guidelines, particularly in terms of recommended frequency and duration.
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Hammad Ather Pakistan
Speaker
Current Evidence Supporting Adjuvant and Neo-Adjuvant TreatmentThe Upper Tract Urothelial Cancer (UTUC) is increasingly being considered as a genetic disorder. Following RNU, the IHC can detect a deficiency in mismatch repair proteins or microsatellite instability (MSI) using PCR. In the presence of MSI, it is necessary to undergo germline testing. High-grade UTUC is an aggressive cancer and is often associated with micrometastases, resulting in early recurrence and development of metastases. Risk classification and recognising more aggressive cancers in whom adjuvant or even neoadjuvant chemotherapy may be of benefit. One of the most crucial steps in considering patients for chemotherapy is the platinum eligibility, renal function (<30ml/min), functional status (ECOG >2) and comorbidities >2 grade are considered ineligible. There is good-quality evidence of improved survival for adjuvant chemotherapy in eligible patients following RNU for pT2–T4 and/or pN+ disease. The 2025 EAU guidelines recommend discussing adjuvant nivolumab with PD-L1-positive patients unfit for, or who declined, platinum-based adjuvant chemotherapy for ≥ pT3 and/or pN+ disease after previous RNU alone or ≥ypT2 and/or ypN+ disease after previous neoadjuvant chemotherapy, followed by RNU. However, the evidence supporting this recommendation is weak. Single intravesical chemotherapy is strongly recommended. There is currently no level 1 evidence supporting neo-adjuvant chemotherapy; however, non-randomised series have shown a decreased incidence of positive surgical margins, recurrence, and improved survival over RNU alone.Avoiding Complication in Orthotopic NeobladderIn most large series from Europe, approximately 1-2 of every 10 patients undergoing radical cystectomy have an orthotopic neobladder (ONB). Data is supporting ONB in terms of quality of life, cosmetics, and improved patient satisfaction. Early and late morbidity in up to 22% of patients is reported. The terminal ileum is the GI segment most often used for orthotopic bladder substitution. With ileo-ureteral anastomoses, there is UUT reflux, and renal functional deterioration is a concern. Various forms of UUT reflux protection, including a simple isoperistaltic tunnel, ileal intussusception, tapered ileal prolongation implanted subserosally, and direct (sub)mucosal or subserosal ureteral implantation, have been described. Superiority of one over the other is not proven. Urethral recurrence is a significant concern; therefore, patient selection must be optimal. Short-term complications are related to the GI tract, including atelectasis and metabolic acidosis. They are all preventable with standardised post-operative measures. The ERAS protocol is particularly useful in avoiding short-term complications and decreasing postoperative hospital stay, among other benefits. The key to success in preventing complications is meticulous patient selection and the implementation of preemptive measures to avoid common complications.Prostate Biopsy Technique: Current EvidenceOptimal prostate biopsy is critical in risk-stratifying patients for appropriate patient care. The traditional TRUS-guided biopsy is associated with UTI sepsis and other infectious complications. Recently, the use of the transperineal route has been advocated for the diagnosis of prostate cancer. Biopsy is either systematic or targeted. There is evidence supporting the notion that MRI-targeted biopsy without systematic biopsy significantly reduces the over-diagnosis of low-risk disease, compared to systematic biopsy. This seems true even when systematic biopsies are indicated after risk stratification with the Rotterdam Prostate Cancer Risk Calculator. EAU recommends performing prostate biopsy using the transperineal approach due to the low risk of infectious complications and better antibiotic stewardship. They also recommend using either target prophylaxis based on rectal swab or stool culture, or augmented prophylaxis (two or more different classes of antibiotics), for transrectal biopsy.
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Hammad Ather Pakistan
Speaker
Current Evidence Supporting Adjuvant and Neo-Adjuvant TreatmentThe Upper Tract Urothelial Cancer (UTUC) is increasingly being considered as a genetic disorder. Following RNU, the IHC can detect a deficiency in mismatch repair proteins or microsatellite instability (MSI) using PCR. In the presence of MSI, it is necessary to undergo germline testing. High-grade UTUC is an aggressive cancer and is often associated with micrometastases, resulting in early recurrence and development of metastases. Risk classification and recognising more aggressive cancers in whom adjuvant or even neoadjuvant chemotherapy may be of benefit. One of the most crucial steps in considering patients for chemotherapy is the platinum eligibility, renal function (<30ml/min), functional status (ECOG >2) and comorbidities >2 grade are considered ineligible. There is good-quality evidence of improved survival for adjuvant chemotherapy in eligible patients following RNU for pT2–T4 and/or pN+ disease. The 2025 EAU guidelines recommend discussing adjuvant nivolumab with PD-L1-positive patients unfit for, or who declined, platinum-based adjuvant chemotherapy for ≥ pT3 and/or pN+ disease after previous RNU alone or ≥ypT2 and/or ypN+ disease after previous neoadjuvant chemotherapy, followed by RNU. However, the evidence supporting this recommendation is weak. Single intravesical chemotherapy is strongly recommended. There is currently no level 1 evidence supporting neo-adjuvant chemotherapy; however, non-randomised series have shown a decreased incidence of positive surgical margins, recurrence, and improved survival over RNU alone.Avoiding Complication in Orthotopic NeobladderIn most large series from Europe, approximately 1-2 of every 10 patients undergoing radical cystectomy have an orthotopic neobladder (ONB). Data is supporting ONB in terms of quality of life, cosmetics, and improved patient satisfaction. Early and late morbidity in up to 22% of patients is reported. The terminal ileum is the GI segment most often used for orthotopic bladder substitution. With ileo-ureteral anastomoses, there is UUT reflux, and renal functional deterioration is a concern. Various forms of UUT reflux protection, including a simple isoperistaltic tunnel, ileal intussusception, tapered ileal prolongation implanted subserosally, and direct (sub)mucosal or subserosal ureteral implantation, have been described. Superiority of one over the other is not proven. Urethral recurrence is a significant concern; therefore, patient selection must be optimal. Short-term complications are related to the GI tract, including atelectasis and metabolic acidosis. They are all preventable with standardised post-operative measures. The ERAS protocol is particularly useful in avoiding short-term complications and decreasing postoperative hospital stay, among other benefits. The key to success in preventing complications is meticulous patient selection and the implementation of preemptive measures to avoid common complications.Prostate Biopsy Technique: Current EvidenceOptimal prostate biopsy is critical in risk-stratifying patients for appropriate patient care. The traditional TRUS-guided biopsy is associated with UTI sepsis and other infectious complications. Recently, the use of the transperineal route has been advocated for the diagnosis of prostate cancer. Biopsy is either systematic or targeted. There is evidence supporting the notion that MRI-targeted biopsy without systematic biopsy significantly reduces the over-diagnosis of low-risk disease, compared to systematic biopsy. This seems true even when systematic biopsies are indicated after risk stratification with the Rotterdam Prostate Cancer Risk Calculator. EAU recommends performing prostate biopsy using the transperineal approach due to the low risk of infectious complications and better antibiotic stewardship. They also recommend using either target prophylaxis based on rectal swab or stool culture, or augmented prophylaxis (two or more different classes of antibiotics), for transrectal biopsy.
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Michael WongSingapore
Moderator
Introduction to Asia School of UrologyAsian School of Urology 2022-2026 – New initiatives
Dr Michael YC Wong
Principal Director of ASU 2022-2026
President Endourological Society and WCET 2026
Introduction
Asian School of Urology (ASU) officially started in 1999 with the appointment of her first director Prof Pichai Bunyaratavej from Thailand (1999-2002) Subsequent directors were Dato Dr Rohan Malek from Malaysia (2002-2006) Prof Foo Keong Tatt from Singapore (2006-2010) Prof Rainy Umbas from Indonesia (2010-2014 ) and Prof Shin Egawa from Japan ( 2014-2022 ).
One of the highlights of the ASU in the early days were the organization of several workshops outside of UAA congress by three active sub-specialty sections of UAA namely Asian society of Endourology (over 16 workshops held from 1998-2008), Asian Society of Female Urology and Asia-Pacific society of Uro-Oncology. Other subspecialty sections were subsequently introduced and have matured very well including Asian Society of UTI and STI, Asian-Pacific Society of Andrological and Reconstructive Urology Surgeons.
In the last 8 years, ASU has seen tremendous growth under the steady leadership of Prof Shin Egawa with introduction of UAA lecturers at national Meetings and further maturation of the subspecialty sections of UAA e.g., Conversion of Asian society of endourology to Asian Robotic Urological Society to reflect the growth and development of UAA. During the past 8 years, ASU-South-East Asia section has also managed to organize 15 physical workshops and 4 webinars outside of UAA congress.
The Growth Trajectory for the next 4 years 2022-2026
There are many areas where ASU can grow further. Bearing in mind our limited resources and our excellent relationships with the world urological leaders at this point in our history.
There are three areas which I will focus on. Please remember that ASU is always open to other new initiatives as we must stay relevant to our Asian urological community.
1. Lasting and strong Relationships
1.1 AUA. Over a dish of chili crab with AUA secretary general Gopal Badlani, we explored the common desire to elevate Asian Urology and strengthen UAA Family. This led to our first joint UAA-AUA residency course at UAA Singapore 2016. After successful completion, a MOU was signed at AUA 2017 with Richard Babayan, Manoj Monga, Allen Chiu and myself in attendance. The AURC at UAA Hong Kong under Prof Eddie Chan was the result of this signed MOU. We are extremely grateful for the generosity of AUA for this program. What may not be obvious is that Gopal Badlani, Manoj Monga, John Denstedt and I served as faculty and board directors at WCE. We will sign the extension MOU in 2023 for another three years.
1.2 EAU. We have a very successful UAA-EAU Youth program since UAA Thailand 2012. This has been the work of several UAA senior members. From 2023, we are exploring joint webinars with EAU to build on this relationship.
1.3 SIU and WCE. We will further explore options based on available resources and manpower. Joint Webinar are planned for early 2026
2. Education Platform for Asian Urology Residents
From 2023, we will continue to grow our relationship with BJUI. BJUI has developed a world class online learning platform with tremendous investments since 2013. This platform is called BJUI Knowledge. ASU will reach out to all Asian residents via their national urological association president and secretary to encourage every resident to sign up for a free access to more than 420 interactive 30-minute modules covering the whole urology syllabus suitable for learning, exit exams and recertification exams. I am personally involved in developing all modules under Endourology and urolithiasis Section and have been associate editor since May 2013. The modest aim is for at least 10 residents per country to sign up by UAA 2023. We will report progress at each UAA council meeting. Pls see attached information and if there are any questions pls email me personally at email@drmichaelwong.com
3. Re-Strategize Training cum fellowship sites for ASU.
3.1 In the past we have always talked about the possibility about training sites for UAA and ASU. It has always been a difficult task due to financial and multiple logistics issues.
3.2 What can we do that is possible? Let us consider two options in the next 4 years.
3.3 For the last 6 years a group of Asian urologists started AUGTEG to design and provide two-day surgical training which includes lectures as well as dry and wet lab to develop surgical skills. AUSTEG has direct access to physical training centres in Thailand, South Korea, and China.
ASU will work with AUGTEC to pool resources since we are the same people working on both sides e.g., Anthony Ng (chairman of AUSTEG) Michael Wong (vice chairman) Eddie Chan (treasurer). AUGTEG is registered in HK.
3.4 The second option is to recognise elected university or training Asian centres to allow an attachment for young urologist post residency in a flexible format. ASU will recognise officially these sites as endorsed by UAA. At UAA 2025 , several potential ASU/UAA fellowship sites directors will be presenting their programmes to kickstart this initiative
4. In conclusion, ASU will continue to grow and serve the Asian Urological Community. The above initiatives are only the beginning of a next chapter. Can you contribute your ideas and current available resources for this purpose? If you can, Pls email me personally at email@drmichaelwong.com
Which Position is the Best for PCNL in 2025?With tremendous advances in both technique and technology , the MIS approach to staghorn calculi has evolved significantly over the last 30 years.
It is timely to review all the landmark articles on patient positioning as this ultimately determines renal access which in turn plays a major role in stone free rates. We will gain much insight as we debate and attempt to answer the question of which position is best in 2026!
Takaaki InoueJapan
Moderator
New Advancement on Retrograde Intrarenal SurgeryRetrograde intrarenal surgery (RIRS) has dramatically grown up around world for stone management. Why has RIRS been getting popullar and increasing nowadays?. The reaseon are absoulutely "Technological development with collaborated engineering comapny" and " Global communicaton and collaboration in Endourology". Endourology has still been improving and expanding more and more. Thereby, many novel devices and machine are launching faster. We, urologists should catch up this faster trend and acquire these knowledge for our clinical use. However, most of urologists can not catch up it. Therefore, I will share you all these novel chage of mind and tech-knowledge of stone field in this session. Do We Need Augmented Reality for Renal Stone Management?What is Augmented reality and Vertual reality in medicine?. The paradigm shift of medicine which includes AI, Robotics, VR, and AR etc named Digital transformation has been still emerging. Of course, these shift is gradually permeating in stone field. Especially, in terms of VR, AR, we wonder if this kind of DX is useful in stone management. if so, how do we use it in clinical practice? Today, I will talk these future role in stone management, and expectation. Which Laser for RIRS: Pulsed Thulium YAG Laser We can use three kind of laser such as Holumium YAG, Thulium YAG, and Thulium fiber laser for stone management. Which lase are best option for stone patients? I will talk about featurs and advantage of pulsed-Thulium YAG laser. There are two kinds of p-Tm;YAG laser machine nowadays. P^Tm;YAG has unique characteristics as laser wave. Therefore, this laser would be able to use Stone, BPH, UTUC. Especially, p-Tm YAG laser can utilize for Stone ablation, fragmentingand and UTUC ablation, shock wave. We will share our experoence and thoughts. New Advancement on Retrograde Intrarenal Surgery
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Chen-Hsun HoTaiwan
Speaker
Laser Lithotripsy in RIRS: Choosing the Right Settings for Better Outcomes
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Shuji IsotaniJapan
Speaker
ECIRS in Daily Practice: How to Achieve Better Stone-Free Rates with Fewer Complications
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Joseph LiHong Kong, China
Speaker
Troubleshooting in Endoscopic Stone Surgery: How to Handle Unexpected Challenges in RIRS and ECIRS
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Steffi YuenHong Kong, China
Speaker
The Power of Powerbend in Management of Lower Pole and Complex StonesThe management of lower pole stones (LPS) and complex renal calculi remains one of the most challenging aspects of contemporary urolithiasis treatment, with the deflection capability of flexible ureteroscopes serving as the critical determinant of surgical success. Modern flexible ureteroscopes achieve impressive bidirectional deflection angles of 270° or even more, representing a significant advancement from earlier generation instruments. However, this “working deflection” capacity becomes substantially compromised when therapeutic instruments, such as laser fibers or stone baskets, are inserted through the working channel.
The anatomical challenges of lower pole access, particularly steep infundibulopelvic angles, necessitate prolonged maximal deflection during lithotrispy that significantly increases the risk of ureteroscope damage and surgeon fatigability. Deflection deterioration is also directly proportional to instrument usage, with newer single-use scopes coming to the rescue.
The introduction of flexible and navigable suction access sheaths (FANS) has revolutionized lower pole stone management allowing direct access to performing lithotriopsy and stone fragments retrieval, reducing the need for stone basket in stone relocation and fragment retrieval. Recent multicenter studies demonstrate comparable stone-free rates (<2mm) between lower pole and non-lower pole locations (96.6% vs 98.4%) when using FANS, with minimal complications and low reintervention rates. With current technological advancements, combined with improved surgical techniques and the strategic choice of single-use ureteroscopes with good deflection power, one can significantly achieve high stone-free rates with low infectious complications and reinterventions with FANS flexible ureteroscopy in the treatment of complex lower pole stones.
FANs in Endourology: Finding the Best Combination with Lasers and Scopes for Optimal Outcomes
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Special Forum in Urinary Tract Reconstruction
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Chih-Chieh LinTaiwan
Speaker
Vesico-Vaginal Fistula: General Concept and Patient Preparation健保各領域審查共識及討論－功能性
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Po-Yen ChenTaiwan
Speaker
Entero-Vesical Fistula: Concept and RepairEntero-vesical fistulas (EVFs), most commonly colovesical in origin, represent a complex and morbid communication between the gastrointestinal tract and the urinary bladder. They are most frequently caused by diverticulitis, Crohn’s disease, malignancy, or prior radiation. Patients typically present with pneumaturia, fecaluria, and recurrent urinary tract infections. While conservative treatment may be appropriate for select high-risk patients, surgical intervention remains the definitive treatment for most cases.
Robotic-assisted repair of EVFs has emerged as a minimally invasive alternative to open surgery, offering advantages in visualization, precision, and tissue handling, especially in cases with extensive adhesions or post-radiation fibrosis. The robotic approach facilitates meticulous dissection, safe resection of the fistula tract, multilayer closure, and reliable interposition of omentum or peritoneal flap.
This presentation will review the pathophysiology, diagnostic work-up, and classification of EVFs, and then focus on surgical decision-making and robotic techniques. Step-by-step surgical strategies, technical pearls, and pitfalls will be illustrated using real operative footage. Outcomes from recent literature and expert centers will be discussed, with emphasis on patient selection and factors influencing success. Robotic repair, when performed in experienced hands, provides excellent functional outcomes with low morbidity.
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Hao-Han ChangTaiwan
Speaker
Surgical Reconstruction of Ureteral StrictureUreteral reconstruction remains a critical challenge in urologic surgery, especially when managing complex ureteral strictures or iatrogenic injuries. This lecture provides a comprehensive overview of current surgical techniques, including ureteroureterostomy, ureteroneocystostomy, psoas hitch, Boari flap, and transureteroureterostomy. We will also explore the indications, decision-making algorithms, and outcomes associated with these procedures. Emphasis will be placed on real-world clinical scenarios, surgical tips, and complication management. Additionally, emerging techniques such as robotic-assisted reconstruction and tissue engineering approaches will be briefly discussed. This session aims to equip practicing urologists with practical knowledge and updated insights into optimizing surgical outcomes in ureteral reconstruction.
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Chung-Cheng WangTaiwan
Speaker
Ureteral Stent and SelectionUreteral stents are widely used in urology for the management of obstructive uropathies, including urologic or non-urologic malignancy, radiation therapy, ureteral calculus, infection, surgical or nonsurgical trauma, or congenital factors. An untreated ureteral obstruction could result in urinary tract infection, abdominal or flank pain, and a deterioration of renal function. Despite their widespread utility, the selection of an appropriate ureteral stent remains a complex clinical decision involving multiple variables including patient-specific factors, disease pathology, duration of stenting, and the desired balance between drainage efficacy and patient comfort.
Advancements in stent technology have led to the development of a variety of stent types, distinguished by their material composition (e.g., polyurethane, silicone, and hydrophilic-coated polymers), design features (e.g., double-J, multi-length, tail stents), drug-eluting capabilities, reinforced metallic stent, and biodegradable stents. Each design aims to optimize certain aspects of performance such as resistance to encrustation, migration, infection, and stent-related symptoms.
Key considerations in stent selection include indwelling time, risk of infection or encrustation, patient anatomy, and comorbidities or prior urologic surgery. For short-term use, polyurethane or co-polymer stents are often preferred due to their balance of flexibility and cost-effectiveness. In contrast, silicone stents may be more appropriate for long-term indwelling due to their superior biocompatibility and reduced encrustation rates. Drug-eluting stents are emerging as promising options in cases of recurrent infection or tumor-associated obstruction. Softer materials, tapered tips, and biodegradable stents aim to reduce stent-related lower urinary tract symptoms.
Recently, we reported the efficacy and safety of Allium metallic ureteral stents in treating 13 patients with refractory ureteral strictures. The median (IQR) age of the patients was 63 (46–76) years. The median (IQR) follow-up was 15 (13.5–21) months. Treatment success and improvement were noted in 9 (69.2%) and 3 (23.1%) patients, respectively. Compared to the preoperative levels, the median (IQR) serum creatinine levels were significantly improved at 3 months after the operation [1.6 (1.25–2.85) vs. 1.2 (1.05–2.05), p = 0.02] and at the last visit [1.6 (1.25–2.85) vs. 1.2 (1.05–1.8), p = 0.02]. Stent migration and encrustation were noted in three (23.1%) and one (7.7%) patients, respectively. The preliminary results showed that Allium ureteral stents were safe and effective for patients with refractory ureteral strictures.
In conclusion, as technology continues to evolve, the future of ureteral stenting lies in personalized device selection based on real-time patient feedback, predictive analytics, and enhanced biomaterials. Further clinical trials and comparative studies are essential to establish evidence-based guidelines that can assist clinicians in making the most appropriate stent choices for optimal outcomes
Fixed and Adjustable Male Slings: Key Techniques for Primary Implantation and Troubleshooting in Challenging CasesMale slings have emerged as an effective surgical solution for stress urinary incontinence (SUI) following radical prostatectomy, offering an alternative to artificial urinary sphincters, particularly in patients with mild to moderate incontinence. Among the available options, fixed and adjustable male slings represent two major categories, each with distinct mechanisms of action, implantation techniques, and postoperative management considerations.
Fixed male slings work by repositioning and compressing the bulbar urethra against the pubic ramus to restore continence. These slings rely on proper patient selection—typically individuals with preserved sphincter function, low-volume leakage, and no prior pelvic radiation. Key technical considerations include precise dissection of the perineal space, adequate urethral mobilization, tension-free sling placement, and symmetric anchoring of the arms. Avoidance of over-tensioning is crucial to prevent postoperative urinary retention and perineal discomfort.
Adjustable male slings offer intraoperative or postoperative modification of sling tension to accommodate varying degrees of incontinence or suboptimal initial outcomes. These slings are particularly useful in patients with higher degrees of incontinence, previous pelvic surgery, or radiation. The implantation techniques vary but generally involve positioning a cushion or compressive element under the urethra, with external or subcutaneous access ports for saline adjustment. Mastery of device calibration, port placement, and infection prevention are critical to long-term success.
Challenging cases—such as those involving prior sling failure, prior pelvic radiation, fibrosis, or altered anatomy—require tailored strategies. In irradiated patients, tissue integrity and healing potential are compromised, often necessitating the use of adjustable systems with minimal tissue dissection or the combination of sling and bulking agents. In reoperative fields, precise identification of tissue planes and modified dissection techniques are required to prevent urethral injury or inadequate compression. Troubleshooting sling failure involves assessing continence status, sling positioning via imaging or endoscopy, and determining whether revision, adjustment, or conversion to an artificial urinary sphincter is most appropriate.
Postoperative complications including infection, urethral erosion, urinary retention, and persistent incontinence can be mitigated by proper surgical technique, patient education, and regular follow-up. Management of these complications should be proactive and individualized, balancing intervention timing with patient expectations and functional goals. In this topic, we will share our experiences to avoid these complications and increase the successful outcome.
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Yao-Chi ChuangTaiwan
Moderator
Road to Excellent ResearchYao Chi Chuang, Professor of Urology, Kaohsiung Chang Gung Memorial Hospital, and National Sun Yat-sen University Taiwan.
Medical research is what allows doctors to explore unmet medical need and decide how to best treat patients. It is what makes the development of new diagnostic tools, new biomarkers, new medicines, and new procedures. Without medical research, we would not be able to creative new knowledge and decide if new treatments are better than our current treatments.
There are some Tips on what to do about what research is and how to get into it:
1. Ask a good question from your daily practice, what is unmet medical need?
2. Search the old literature of your research interests- what is known? What is unknown?
3. Find a new method to solve your question or an old method but applying to a new field.
4. Start from jointing a pre-planned research project, and join a research collaborative.
5. Try to be an independent researcher from a small project without funding support, retrospective study.
6. Try to get funding support from your institute, national grant, or industry.
As a young doctor, it’s important to look after yourself and maintain a healthy balance between daily practice and research work. There is a range of options for doctors interested in research, from smaller time commitments as a co-investigator to longer-term projects and experience as chief investigator. Research works are all optional activities, so do what you can but don’t overwhelm yourself. Road to Excellent Research
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Yao-Chi ChuangTaiwan
Moderator
Road to Excellent ResearchYao Chi Chuang, Professor of Urology, Kaohsiung Chang Gung Memorial Hospital, and National Sun Yat-sen University Taiwan.
Medical research is what allows doctors to explore unmet medical need and decide how to best treat patients. It is what makes the development of new diagnostic tools, new biomarkers, new medicines, and new procedures. Without medical research, we would not be able to creative new knowledge and decide if new treatments are better than our current treatments.
There are some Tips on what to do about what research is and how to get into it:
1. Ask a good question from your daily practice, what is unmet medical need?
2. Search the old literature of your research interests- what is known? What is unknown?
3. Find a new method to solve your question or an old method but applying to a new field.
4. Start from jointing a pre-planned research project, and join a research collaborative.
5. Try to be an independent researcher from a small project without funding support, retrospective study.
6. Try to get funding support from your institute, national grant, or industry.
As a young doctor, it’s important to look after yourself and maintain a healthy balance between daily practice and research work. There is a range of options for doctors interested in research, from smaller time commitments as a co-investigator to longer-term projects and experience as chief investigator. Research works are all optional activities, so do what you can but don’t overwhelm yourself. Road to Excellent Research
Yoshitaka KuranoJapan
Speaker
Clinical Outcomes of Contact Laser Vaporization of the Prostate(CVP): Insights from Pressure Flow Studies【Introduction】
Contact laser Vaporization of the Prostate (CVP) is one of the surgical treatment options for benign prostatic hyperplasia (BPH).
CVP is the instant evaporation of swollen prostate tissue that is accomplished by irradiating the prostate tissue with a laser beam (e.g., a 980 nm diode laser) through an optical fiber.
In Japan, regulatory approval was obtained in April 2016, and Kochi University Hospital is the first public university hospital in Japan to introduce this procedure in March 2023.
This study aimed to evaluate the surgical outcomes of CVP, including findings from a pressure flow study (PFS).
【Materials and Methods】
Between March 31, 2023, and March 1, 2025, 82 patients underwent CVP at our institution. Among them, 31 patients with PFS findings both before and 3 months after surgery were analyzed for treatment outcomes using the Overactive Bladder Symptom Score (OABSS), International Prostate Symptom Score (IPSS), Quality of Life (QOL) scores, and PFS parameters. Perioperative complications were assessed in 82 patients.
【Results】
The mean patient age was 75.9 years, with an average prostate volume of 64.9 mL and post-void residual volume of 150mL. The mean bladder outlet obstruction (BOO) score from the Schafer nomogram was 3.9. The mean OABSS total score was 7.2, and the mean total IPSS score was 16.7. CVP using the XCAVATOR fiber was performed in 8 patients.
Surgical outcomes were as follows: the mean operation time was 91.3 minutes, laser irradiation time was 48.7 minutes, catheterization duration was 3.1 days, and the mean hospital stay was 4.8 days. Significant improvements in IPSS and QOL scores were observed one month postoperatively. Three months postoperatively, PFS showed significant improvements in the bladder outlet obstruction index (BOOI), PdetQmax, Qmax, voided volume, and post-void residual volume. However, no significant changes were observed in the bladder contractility index (BCI), first desire to void (FDV), normal desire to void (NDV), or maximum cystometric capacity (MCC).
Perioperative complications included transient urinary retention in eight patients (9.7%), urinary tract infection in eight patients (9.7%), postoperative bleeding in four patients (4.8%), and urinary incontinence in one patient (1.2%).
【Conclusions】
Our study demonstrated that CVP effectively improved lower urinary tract symptoms and bladder outlet obstruction. PFS evaluation confirmed significant improvements in bladder outlet obstruction parameters. Further studies are warranted to assess the long-term outcomes and their impact on bladder function.
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Yao-Chi ChuangTaiwan
Moderator
Road to Excellent ResearchYao Chi Chuang, Professor of Urology, Kaohsiung Chang Gung Memorial Hospital, and National Sun Yat-sen University Taiwan.
Medical research is what allows doctors to explore unmet medical need and decide how to best treat patients. It is what makes the development of new diagnostic tools, new biomarkers, new medicines, and new procedures. Without medical research, we would not be able to creative new knowledge and decide if new treatments are better than our current treatments.
There are some Tips on what to do about what research is and how to get into it:
1. Ask a good question from your daily practice, what is unmet medical need?
2. Search the old literature of your research interests- what is known? What is unknown?
3. Find a new method to solve your question or an old method but applying to a new field.
4. Start from jointing a pre-planned research project, and join a research collaborative.
5. Try to be an independent researcher from a small project without funding support, retrospective study.
6. Try to get funding support from your institute, national grant, or industry.
As a young doctor, it’s important to look after yourself and maintain a healthy balance between daily practice and research work. There is a range of options for doctors interested in research, from smaller time commitments as a co-investigator to longer-term projects and experience as chief investigator. Research works are all optional activities, so do what you can but don’t overwhelm yourself. Road to Excellent Research
Masahiro KurobeJapan
Speaker
Robot-Assisted Laparoscopic Partial Cystectomy and Bladder Repair for Urachal Cyst, Suspected of Urachal TumorBackground: Urachal cyst is a type of congenital anomaly that may undergo malignant transformation. Partial cystectomy with en-block resection of the urachus is appropriate treatment for urachal remnants. We performed near infrared ray-guided surgery (NIRGS) for the accurate localization of tumor margins using the Firefly® technology of the daVinci Surgical system and intra-operative cystoscopy. In the normal visible light mode, we could not recognize the cystoscopic light; however, after changing to the Firefly® mode, the near infrared rays transmitted through the bladder wall were visible as a green image.
Methods: The patient is a 76-year-old woman. She was referred to urology for a tumor at the dome of the bladder. Cystoscopy revealed a round submucosal mass at the dome of the bladder. The possibility of urachal tumor could not be excluded. Since she was already diagnosed with rectal cancer and scheduled to undergo robot-assisted laparoscopic proctosigmoidectomy, we performed robot-assisted partial cystectomy during the same operative session.
Results: The rectum was removed by a surgeon with robot-assistance. Then we detached the median umbilical cord from just below the umbilicus toward the bladder. Both medial umbilical ligaments were dissected from abdominal wall to the dome of the bladder. A simultaneous cystoscopic light depicted the bladder boundaries of the mass with the Firefly® mode. The bladder mucosa was repaired with a 3-0 V-Loc® followed by a second 2-0 V-Loc® on the muscle and peritoneum. There was no residual tumor at the resected margin, and pathological findings revealed that the urachal cyst was benign. Her urinary catheter was removed on day 14. At the four month follow up, the patient was voiding well. Surveillance cystograms showed a well-healed bladder at eight month follow up. She has remained symptom free over the past 18 months since surgery.
Conclusions: Robot-assisted laparoscopic partial cystectomy is technically feasible. Near infrared ray-guided technology plays a major role in obtaining accurate resection lines.
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Chun-Hou LiaoTaiwan
Moderator
Regeneration Medicine in Urology - A Promising Future or Hoax?Regenerative medicine comprises therapeutic strategies aimed at restoring tissue structure and function, rather than merely alleviating symptoms. By deploying cells, biomaterials, bioactive molecules, or combinations thereof, these interventions stimulate the body’s intrinsic repair mechanisms. This paradigm extends beyond traditional symptomatic treatment, offering the potential for true self-healing and organ reconstruction—ultimately prioritizing cure over chronic disease management.
Cell-based therapy has emerged as a promising intervention for various urogenital disorders, including erectile dysfunction (ED), bladder dysfunction, and male infertility. Current clinical research primarily focuses on mesenchymal stem cells (MSCs), investigating their safety, tolerability, and preliminary efficacy. Although early-phase studies suggest functional benefits—such as improved hemodynamics and tissue regeneration—most programs remain in preclinical or early clinical stages. A critical limitation remains the lack of standardization in MSC source, dose, and delivery route.
Among alternative sources, human amniotic fluid-derived stem cells (hAFSCs) have shown particular promise. In preclinical models of cavernous nerve injury, hAFSCs demonstrated prolonged retention in penile tissue and in-situ differentiation into α-smooth muscle actin-positive corporal smooth muscle cells, effectively replacing damaged tissue and restoring function. These findings represent an encouraging step toward curative therapy. However, the mechanisms governing their in vivo behavior—such as engraftment, differentiation, and immunogenicity—will ultimately determine their clinical translatability and therapeutic stability. Whether cell-based approaches can evolve from experimental platforms into routine clinical care remains a central question.
Platelet-Rich Plasma (PRP)
Platelet-rich plasma (PRP) is an autologous biologic product enriched with supraphysiologic levels of platelets, growth factors, chemokines, and extracellular vesicles. Upon activation, PRP releases a bioactive cocktail that promotes angiogenesis, neuroregeneration, and antifibrotic remodeling—key processes in the restoration of urogenital tissues.
In rodent models of cavernous nerve injury, PRP has been shown to preserve corporal sinusoidal endothelial cells and axonal scaffolds, while restoring erectile hemodynamics. Clinical studies further support PRP's safety in humans and report variable but promising improvements in IIEF scores following intracavernous injection. Nevertheless, the therapeutic response appears heterogeneous, likely influenced by patient factors, PRP preparation techniques, and injection protocols. Beyond ED, PRP has shown potential in other urologic indications such as stress urinary incontinence (SUI), interstitial cystitis/bladder pain syndrome (IC/BPS), and chronic pelvic pain, where it may contribute to tissue regeneration and symptom relief. However, broader adoption will require the establishment of individualized blood-quality metrics, standardized preparation methods, and randomized controlled trials demonstrating durable benefit.
Emerging Regenerative Strategies
Beyond cell-based and autologous biologics, a suite of innovative regenerative technologies is progressing from bench to bedside. These include:
Energy-based devices such as low-intensity extracorporeal shock wave therapy (Li-ESWT), which promotes neovascularization and tissue regeneration via mechanotransduction pathways.
Gene therapies, targeting dysfunctional or absent proteins in disorders like overactive bladder.
Smart biomaterials, capable of delivering cells or bioactive molecules in a controlled, responsive manner.
Extracellular vesicle (EV)-based therapeutics, which leverage cell-free vesicles derived from MSCs or urine-derived stem cells. These EVs carry signaling molecules (e.g., microRNAs, cytokines, growth factors) that mimic the paracrine effects of stem cells, offering a potentially safer and more scalable alternative to cell transplantation.
In preclinical models of ED and bladder dysfunction, EVs have demonstrated the capacity to promote smooth muscle regeneration, nerve sprouting, and fibrosis reduction, with functional improvements comparable to stem cell therapy.
Regenerative medicine has propelled the field of urologic tissue repair from theoretical promise to an early clinical reality. While substantial challenges remain—including the need for deeper mechanistic insight, protocol standardization, and regulatory clarity—the field is advancing rapidly. The convergence of cell therapy, PRP, EVs, and device-based modalities is creating a multifaceted toolkit for urologic regeneration. With continued scientific rigor, large-scale clinical trials, and interdisciplinary collaboration, regenerative medicine holds the potential to shift urologic care from chronic symptomatic management to durable, tissue-level cure.Stem Cell Therapy: Advancements and Clinical Insights for Erectile Dysfunction Treatment Erectile dysfunction (ED)—defined as the persistent inability to achieve or maintain an erection sufficient for satisfactory sexual activity—affects over 150 million men worldwide. While phosphodiesterase-5 inhibitors (PDE5is) remain the first-line treatment, many patients, particularly those with diabetes, age-related vascular decline, or neuropathy following radical prostatectomy, show suboptimal responses. Consequently, regenerative medicine—particularly stem-cell therapy—has gained interest for its potential to address the root causes of ED rather than merely managing symptoms.
Stem-cell therapy offers a multifaceted approach to treating ED through neuroregeneration, angiogenesis, anti-apoptotic signaling, and fibrosis inhibition. Once introduced into the target tissue, stem cells can differentiate into specific cell types or exert paracrine effects via secretion of growth factors and extracellular vesicles. Among the various sources studied, bone marrow-derived mesenchymal stem cells (BM-MSCs), adipose-derived stem cells (ADSCs), and umbilical cord-derived MSCs (UC-MSCs) have been most extensively explored.
Preclinical studies consistently demonstrate that MSC-based therapies enhance cavernous nerve regeneration, suppress fibrosis, and preserve endothelial integrity. In rat models of diabetes- or nerve-injury-induced ED, intracavernosal injections of ADSCs or BM-MSCs significantly restore intracavernosal pressure (ICP) and improve corpus cavernosum histology. Phase I/II clinical trials also support the safety and preliminary efficacy of stem-cell approaches. For example, in men with diabetic ED treated with autologous BM-MSCs, significant improvements in International Index of Erectile Function-5 (IIEF-5) scores and penile arterial flow have been reported without major adverse events. Similarly, ADSC therapy in post-prostatectomy ED has shown encouraging short-term results. However, large-scale trials are needed to clarify long-term efficacy, immune responses, and safety profiles.
Human amniotic fluid stem cells (hAFSCs) represent a promising alternative, offering characteristics that bridge embryonic and adult stem-cell profiles. These include broad multipotency, high proliferation, and low immunogenicity—traits ideal for allogeneic use and neuroregenerative purposes. Notably, hAFSCs secrete potent regenerative mediators such as brain-derived neurotrophic factor (BDNF), vascular endothelial growth factor (VEGF), and insulin-like growth factor-1 (IGF-1), all of which support neurovascular repair and smooth muscle integrity. Our recent studies demonstrate, for the first time, that hAFSCs persist long-term in penile tissue and can differentiate into cavernous smooth-muscle cells, effectively replacing damaged tissue and improving erectile function even in chronic neurogenic ED models.
Despite these advantages, our findings did not reveal in-vivo homing of hAFSCs to nerve injury sites or differentiation into neural tissue. This suggests a need for future studies to identify the specific microenvironmental cues required to induce such responses. Additionally, combining hAFSCs with platelet-rich plasma (PRP) may provide synergistic benefits—enhancing stem-cell homing, paracrine signaling, and in-vivo differentiation—thereby advancing a more effective, scalable, and safe therapeutic strategy.
Hidenori AkaihataJapan
Speaker
The Activation of Humoral Immunity Causes Lower Urinary Tract Dysfunction Related with Prostate Through the Different Mechanism from the Prostate VolumeAim of this study
The prostate volume and morphological features of the prostate are well known to be associated with lower urinary tract dysfunction (LUTD) in the male patients. However, the causative agents and factors of LUTD related with prostate are multifactorial and incompletely understood. The aim of this study was to find out the novel mechanism underlying LUTD related with prostate except for prostate volume and morphological features.
Materials and methods
A total of 31 patients who had a diagnosis of benign by the random prostate biopsy were enrolled in this study. Comprehensive gene expression analysis (CGEA) was performed with prostate specimens obtained by the prostate biopsy. The patients were divided into control group (prostate volume < 30 mL) and benign prostatic enlargement (BPE) group (prostate volume ≥ 30 mL). Hierarchical clustering was performed to identify the clusters with similar gene expression by the genes indicated significantly different between two groups by t-test. The histological examinations and uroflowmetry parameters were compared among each cluster by Mann-Whitney's U test.
Results
CGEA selected 12 genes with significant difference in mean converted value between control and BPE (P<0.01) from 11,907 genes. Hierarchical clustering analysis using these 12 genes categorized three different clusters: the control (n=8), the BPE (n=11) and BPE with inflammatory (n=12) clusters. As compared BPE cluster, the BPE with inflammatory cluster have activation of humoral immunity (increased VSIG2 gene and reduced MME gene). The collagen/muscle was significantly increased in the BPE with humoral immunity cluster as compared with other clusters (control vs BPE with inflammatory P=0.04, BPE vs BPE with inflammatory P<0.01). The maximum flow rate was significantly lower in the BPE with inflammatory cluster than in the control cluster (P=0.03). There was no significant difference about the maximum flow rate between control cluster and BPE cluster.
Conclusions
Our results suggested that inflammation by activated humoral immunity in the prostate cause prostatic fibrosis, resulting in the LUTD through the increased urethral resistance.
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Chun-Hou LiaoTaiwan
Moderator
Regeneration Medicine in Urology - A Promising Future or Hoax?Regenerative medicine comprises therapeutic strategies aimed at restoring tissue structure and function, rather than merely alleviating symptoms. By deploying cells, biomaterials, bioactive molecules, or combinations thereof, these interventions stimulate the body’s intrinsic repair mechanisms. This paradigm extends beyond traditional symptomatic treatment, offering the potential for true self-healing and organ reconstruction—ultimately prioritizing cure over chronic disease management.
Cell-based therapy has emerged as a promising intervention for various urogenital disorders, including erectile dysfunction (ED), bladder dysfunction, and male infertility. Current clinical research primarily focuses on mesenchymal stem cells (MSCs), investigating their safety, tolerability, and preliminary efficacy. Although early-phase studies suggest functional benefits—such as improved hemodynamics and tissue regeneration—most programs remain in preclinical or early clinical stages. A critical limitation remains the lack of standardization in MSC source, dose, and delivery route.
Among alternative sources, human amniotic fluid-derived stem cells (hAFSCs) have shown particular promise. In preclinical models of cavernous nerve injury, hAFSCs demonstrated prolonged retention in penile tissue and in-situ differentiation into α-smooth muscle actin-positive corporal smooth muscle cells, effectively replacing damaged tissue and restoring function. These findings represent an encouraging step toward curative therapy. However, the mechanisms governing their in vivo behavior—such as engraftment, differentiation, and immunogenicity—will ultimately determine their clinical translatability and therapeutic stability. Whether cell-based approaches can evolve from experimental platforms into routine clinical care remains a central question.
Platelet-Rich Plasma (PRP)
Platelet-rich plasma (PRP) is an autologous biologic product enriched with supraphysiologic levels of platelets, growth factors, chemokines, and extracellular vesicles. Upon activation, PRP releases a bioactive cocktail that promotes angiogenesis, neuroregeneration, and antifibrotic remodeling—key processes in the restoration of urogenital tissues.
In rodent models of cavernous nerve injury, PRP has been shown to preserve corporal sinusoidal endothelial cells and axonal scaffolds, while restoring erectile hemodynamics. Clinical studies further support PRP's safety in humans and report variable but promising improvements in IIEF scores following intracavernous injection. Nevertheless, the therapeutic response appears heterogeneous, likely influenced by patient factors, PRP preparation techniques, and injection protocols. Beyond ED, PRP has shown potential in other urologic indications such as stress urinary incontinence (SUI), interstitial cystitis/bladder pain syndrome (IC/BPS), and chronic pelvic pain, where it may contribute to tissue regeneration and symptom relief. However, broader adoption will require the establishment of individualized blood-quality metrics, standardized preparation methods, and randomized controlled trials demonstrating durable benefit.
Emerging Regenerative Strategies
Beyond cell-based and autologous biologics, a suite of innovative regenerative technologies is progressing from bench to bedside. These include:
Energy-based devices such as low-intensity extracorporeal shock wave therapy (Li-ESWT), which promotes neovascularization and tissue regeneration via mechanotransduction pathways.
Gene therapies, targeting dysfunctional or absent proteins in disorders like overactive bladder.
Smart biomaterials, capable of delivering cells or bioactive molecules in a controlled, responsive manner.
Extracellular vesicle (EV)-based therapeutics, which leverage cell-free vesicles derived from MSCs or urine-derived stem cells. These EVs carry signaling molecules (e.g., microRNAs, cytokines, growth factors) that mimic the paracrine effects of stem cells, offering a potentially safer and more scalable alternative to cell transplantation.
In preclinical models of ED and bladder dysfunction, EVs have demonstrated the capacity to promote smooth muscle regeneration, nerve sprouting, and fibrosis reduction, with functional improvements comparable to stem cell therapy.
Regenerative medicine has propelled the field of urologic tissue repair from theoretical promise to an early clinical reality. While substantial challenges remain—including the need for deeper mechanistic insight, protocol standardization, and regulatory clarity—the field is advancing rapidly. The convergence of cell therapy, PRP, EVs, and device-based modalities is creating a multifaceted toolkit for urologic regeneration. With continued scientific rigor, large-scale clinical trials, and interdisciplinary collaboration, regenerative medicine holds the potential to shift urologic care from chronic symptomatic management to durable, tissue-level cure.Stem Cell Therapy: Advancements and Clinical Insights for Erectile Dysfunction Treatment Erectile dysfunction (ED)—defined as the persistent inability to achieve or maintain an erection sufficient for satisfactory sexual activity—affects over 150 million men worldwide. While phosphodiesterase-5 inhibitors (PDE5is) remain the first-line treatment, many patients, particularly those with diabetes, age-related vascular decline, or neuropathy following radical prostatectomy, show suboptimal responses. Consequently, regenerative medicine—particularly stem-cell therapy—has gained interest for its potential to address the root causes of ED rather than merely managing symptoms.
Stem-cell therapy offers a multifaceted approach to treating ED through neuroregeneration, angiogenesis, anti-apoptotic signaling, and fibrosis inhibition. Once introduced into the target tissue, stem cells can differentiate into specific cell types or exert paracrine effects via secretion of growth factors and extracellular vesicles. Among the various sources studied, bone marrow-derived mesenchymal stem cells (BM-MSCs), adipose-derived stem cells (ADSCs), and umbilical cord-derived MSCs (UC-MSCs) have been most extensively explored.
Preclinical studies consistently demonstrate that MSC-based therapies enhance cavernous nerve regeneration, suppress fibrosis, and preserve endothelial integrity. In rat models of diabetes- or nerve-injury-induced ED, intracavernosal injections of ADSCs or BM-MSCs significantly restore intracavernosal pressure (ICP) and improve corpus cavernosum histology. Phase I/II clinical trials also support the safety and preliminary efficacy of stem-cell approaches. For example, in men with diabetic ED treated with autologous BM-MSCs, significant improvements in International Index of Erectile Function-5 (IIEF-5) scores and penile arterial flow have been reported without major adverse events. Similarly, ADSC therapy in post-prostatectomy ED has shown encouraging short-term results. However, large-scale trials are needed to clarify long-term efficacy, immune responses, and safety profiles.
Human amniotic fluid stem cells (hAFSCs) represent a promising alternative, offering characteristics that bridge embryonic and adult stem-cell profiles. These include broad multipotency, high proliferation, and low immunogenicity—traits ideal for allogeneic use and neuroregenerative purposes. Notably, hAFSCs secrete potent regenerative mediators such as brain-derived neurotrophic factor (BDNF), vascular endothelial growth factor (VEGF), and insulin-like growth factor-1 (IGF-1), all of which support neurovascular repair and smooth muscle integrity. Our recent studies demonstrate, for the first time, that hAFSCs persist long-term in penile tissue and can differentiate into cavernous smooth-muscle cells, effectively replacing damaged tissue and improving erectile function even in chronic neurogenic ED models.
Despite these advantages, our findings did not reveal in-vivo homing of hAFSCs to nerve injury sites or differentiation into neural tissue. This suggests a need for future studies to identify the specific microenvironmental cues required to induce such responses. Additionally, combining hAFSCs with platelet-rich plasma (PRP) may provide synergistic benefits—enhancing stem-cell homing, paracrine signaling, and in-vivo differentiation—thereby advancing a more effective, scalable, and safe therapeutic strategy.
Po-Ting LinTaiwan
Speaker
Age Related Impairment of Serum Testosterone Level after Prostate SurgeryBackground and Objective
Anatomical endoscopic enucleation of the prostate (AEEP) may impact testosterone levels in aging males with benign prostatic hyperplasia (BPH). This study aimed to identify a preoperative testosterone threshold predictive of postoperative stabilization, proposing a 4.5 ng/dL cutoff for better metabolic optimization.
Methods
This retrospective study analyzed 304 patients who underwent AEEP between 2018 and 2021. Pre- and postoperative morning serum testosterone levels were assessed, with postoperative measurements taken 6–12 months post-surgery. Receiver operating characteristic (ROC) analysis determined the optimal preoperative testosterone threshold for predicting significant postoperative elevation. Subgroup analysis and logistic regression identified associated factors.
Key Findings and Limitations
The ROC curve analysis identified 4.5 ng/dL as the optimal preoperative testosterone threshold (AUC = 0.737). Patients with preoperative testosterone <4.5 ng/dL exhibited higher rates of metabolic conditions, including diabetes mellitus and obesity (p < 0.05). Regression analysis confirmed the 4.5 ng/dL threshold as a strong predictor of postoperative testosterone improvement (OR: 4.345; 95% CI: 2.533–7.453). Limitations include the retrospective design and lack of physiological markers to elucidate mechanisms.
Conclusions and Clinical Implications
A preoperative testosterone level of 4.5 ng/dL offers a robust threshold for predicting postoperative stabilization and aligns with metabolic optimization criteria. Adopting this threshold may refine testosterone deficiency diagnoses and management, mitigating underdiagnosis in aging males with BPH.
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Chun-Hou LiaoTaiwan
Moderator
Regeneration Medicine in Urology - A Promising Future or Hoax?Regenerative medicine comprises therapeutic strategies aimed at restoring tissue structure and function, rather than merely alleviating symptoms. By deploying cells, biomaterials, bioactive molecules, or combinations thereof, these interventions stimulate the body’s intrinsic repair mechanisms. This paradigm extends beyond traditional symptomatic treatment, offering the potential for true self-healing and organ reconstruction—ultimately prioritizing cure over chronic disease management.
Cell-based therapy has emerged as a promising intervention for various urogenital disorders, including erectile dysfunction (ED), bladder dysfunction, and male infertility. Current clinical research primarily focuses on mesenchymal stem cells (MSCs), investigating their safety, tolerability, and preliminary efficacy. Although early-phase studies suggest functional benefits—such as improved hemodynamics and tissue regeneration—most programs remain in preclinical or early clinical stages. A critical limitation remains the lack of standardization in MSC source, dose, and delivery route.
Among alternative sources, human amniotic fluid-derived stem cells (hAFSCs) have shown particular promise. In preclinical models of cavernous nerve injury, hAFSCs demonstrated prolonged retention in penile tissue and in-situ differentiation into α-smooth muscle actin-positive corporal smooth muscle cells, effectively replacing damaged tissue and restoring function. These findings represent an encouraging step toward curative therapy. However, the mechanisms governing their in vivo behavior—such as engraftment, differentiation, and immunogenicity—will ultimately determine their clinical translatability and therapeutic stability. Whether cell-based approaches can evolve from experimental platforms into routine clinical care remains a central question.
Platelet-Rich Plasma (PRP)
Platelet-rich plasma (PRP) is an autologous biologic product enriched with supraphysiologic levels of platelets, growth factors, chemokines, and extracellular vesicles. Upon activation, PRP releases a bioactive cocktail that promotes angiogenesis, neuroregeneration, and antifibrotic remodeling—key processes in the restoration of urogenital tissues.
In rodent models of cavernous nerve injury, PRP has been shown to preserve corporal sinusoidal endothelial cells and axonal scaffolds, while restoring erectile hemodynamics. Clinical studies further support PRP's safety in humans and report variable but promising improvements in IIEF scores following intracavernous injection. Nevertheless, the therapeutic response appears heterogeneous, likely influenced by patient factors, PRP preparation techniques, and injection protocols. Beyond ED, PRP has shown potential in other urologic indications such as stress urinary incontinence (SUI), interstitial cystitis/bladder pain syndrome (IC/BPS), and chronic pelvic pain, where it may contribute to tissue regeneration and symptom relief. However, broader adoption will require the establishment of individualized blood-quality metrics, standardized preparation methods, and randomized controlled trials demonstrating durable benefit.
Emerging Regenerative Strategies
Beyond cell-based and autologous biologics, a suite of innovative regenerative technologies is progressing from bench to bedside. These include:
Energy-based devices such as low-intensity extracorporeal shock wave therapy (Li-ESWT), which promotes neovascularization and tissue regeneration via mechanotransduction pathways.
Gene therapies, targeting dysfunctional or absent proteins in disorders like overactive bladder.
Smart biomaterials, capable of delivering cells or bioactive molecules in a controlled, responsive manner.
Extracellular vesicle (EV)-based therapeutics, which leverage cell-free vesicles derived from MSCs or urine-derived stem cells. These EVs carry signaling molecules (e.g., microRNAs, cytokines, growth factors) that mimic the paracrine effects of stem cells, offering a potentially safer and more scalable alternative to cell transplantation.
In preclinical models of ED and bladder dysfunction, EVs have demonstrated the capacity to promote smooth muscle regeneration, nerve sprouting, and fibrosis reduction, with functional improvements comparable to stem cell therapy.
Regenerative medicine has propelled the field of urologic tissue repair from theoretical promise to an early clinical reality. While substantial challenges remain—including the need for deeper mechanistic insight, protocol standardization, and regulatory clarity—the field is advancing rapidly. The convergence of cell therapy, PRP, EVs, and device-based modalities is creating a multifaceted toolkit for urologic regeneration. With continued scientific rigor, large-scale clinical trials, and interdisciplinary collaboration, regenerative medicine holds the potential to shift urologic care from chronic symptomatic management to durable, tissue-level cure.Stem Cell Therapy: Advancements and Clinical Insights for Erectile Dysfunction Treatment Erectile dysfunction (ED)—defined as the persistent inability to achieve or maintain an erection sufficient for satisfactory sexual activity—affects over 150 million men worldwide. While phosphodiesterase-5 inhibitors (PDE5is) remain the first-line treatment, many patients, particularly those with diabetes, age-related vascular decline, or neuropathy following radical prostatectomy, show suboptimal responses. Consequently, regenerative medicine—particularly stem-cell therapy—has gained interest for its potential to address the root causes of ED rather than merely managing symptoms.
Stem-cell therapy offers a multifaceted approach to treating ED through neuroregeneration, angiogenesis, anti-apoptotic signaling, and fibrosis inhibition. Once introduced into the target tissue, stem cells can differentiate into specific cell types or exert paracrine effects via secretion of growth factors and extracellular vesicles. Among the various sources studied, bone marrow-derived mesenchymal stem cells (BM-MSCs), adipose-derived stem cells (ADSCs), and umbilical cord-derived MSCs (UC-MSCs) have been most extensively explored.
Preclinical studies consistently demonstrate that MSC-based therapies enhance cavernous nerve regeneration, suppress fibrosis, and preserve endothelial integrity. In rat models of diabetes- or nerve-injury-induced ED, intracavernosal injections of ADSCs or BM-MSCs significantly restore intracavernosal pressure (ICP) and improve corpus cavernosum histology. Phase I/II clinical trials also support the safety and preliminary efficacy of stem-cell approaches. For example, in men with diabetic ED treated with autologous BM-MSCs, significant improvements in International Index of Erectile Function-5 (IIEF-5) scores and penile arterial flow have been reported without major adverse events. Similarly, ADSC therapy in post-prostatectomy ED has shown encouraging short-term results. However, large-scale trials are needed to clarify long-term efficacy, immune responses, and safety profiles.
Human amniotic fluid stem cells (hAFSCs) represent a promising alternative, offering characteristics that bridge embryonic and adult stem-cell profiles. These include broad multipotency, high proliferation, and low immunogenicity—traits ideal for allogeneic use and neuroregenerative purposes. Notably, hAFSCs secrete potent regenerative mediators such as brain-derived neurotrophic factor (BDNF), vascular endothelial growth factor (VEGF), and insulin-like growth factor-1 (IGF-1), all of which support neurovascular repair and smooth muscle integrity. Our recent studies demonstrate, for the first time, that hAFSCs persist long-term in penile tissue and can differentiate into cavernous smooth-muscle cells, effectively replacing damaged tissue and improving erectile function even in chronic neurogenic ED models.
Despite these advantages, our findings did not reveal in-vivo homing of hAFSCs to nerve injury sites or differentiation into neural tissue. This suggests a need for future studies to identify the specific microenvironmental cues required to induce such responses. Additionally, combining hAFSCs with platelet-rich plasma (PRP) may provide synergistic benefits—enhancing stem-cell homing, paracrine signaling, and in-vivo differentiation—thereby advancing a more effective, scalable, and safe therapeutic strategy.
Yu-An ChenTaiwan
Speaker
Evaluation of Ferroptosis and the Potential Treatment Effect of Dexmedetomidine in Diabetic Mice CystopathyMaterial and methods:
24 Wistar female rat (8 weeks of age) with an average body weight of 220 ± 10 g (range 200–250 g) was divided to 3 groups. group 1 as sham group, group 2 induces DM by STZ subcutaneous injection. Group 3 STZ and give dexmedetomidine 50mcg/kg, SC. We then recorded urodynamic assay and biochemistry profile
Result:
1.DM caused bladder overactivity in rat model
2.DM could cause the bladder weight to increase in rat model, possibly causing fibrosis and affects compliance
3.Dexmeditomidine could attenuate DM related overactive bladder
4.The mechanism is glucose independent
5.Dex could protect diabetic nephropathy shown by lowering the serum UN level and lower urine glucose level
Conclusion:
Dexmeditomidine could attenuate DM related overactive bladder
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Chun-Hou LiaoTaiwan
Moderator
Regeneration Medicine in Urology - A Promising Future or Hoax?Regenerative medicine comprises therapeutic strategies aimed at restoring tissue structure and function, rather than merely alleviating symptoms. By deploying cells, biomaterials, bioactive molecules, or combinations thereof, these interventions stimulate the body’s intrinsic repair mechanisms. This paradigm extends beyond traditional symptomatic treatment, offering the potential for true self-healing and organ reconstruction—ultimately prioritizing cure over chronic disease management.
Cell-based therapy has emerged as a promising intervention for various urogenital disorders, including erectile dysfunction (ED), bladder dysfunction, and male infertility. Current clinical research primarily focuses on mesenchymal stem cells (MSCs), investigating their safety, tolerability, and preliminary efficacy. Although early-phase studies suggest functional benefits—such as improved hemodynamics and tissue regeneration—most programs remain in preclinical or early clinical stages. A critical limitation remains the lack of standardization in MSC source, dose, and delivery route.
Among alternative sources, human amniotic fluid-derived stem cells (hAFSCs) have shown particular promise. In preclinical models of cavernous nerve injury, hAFSCs demonstrated prolonged retention in penile tissue and in-situ differentiation into α-smooth muscle actin-positive corporal smooth muscle cells, effectively replacing damaged tissue and restoring function. These findings represent an encouraging step toward curative therapy. However, the mechanisms governing their in vivo behavior—such as engraftment, differentiation, and immunogenicity—will ultimately determine their clinical translatability and therapeutic stability. Whether cell-based approaches can evolve from experimental platforms into routine clinical care remains a central question.
Platelet-Rich Plasma (PRP)
Platelet-rich plasma (PRP) is an autologous biologic product enriched with supraphysiologic levels of platelets, growth factors, chemokines, and extracellular vesicles. Upon activation, PRP releases a bioactive cocktail that promotes angiogenesis, neuroregeneration, and antifibrotic remodeling—key processes in the restoration of urogenital tissues.
In rodent models of cavernous nerve injury, PRP has been shown to preserve corporal sinusoidal endothelial cells and axonal scaffolds, while restoring erectile hemodynamics. Clinical studies further support PRP's safety in humans and report variable but promising improvements in IIEF scores following intracavernous injection. Nevertheless, the therapeutic response appears heterogeneous, likely influenced by patient factors, PRP preparation techniques, and injection protocols. Beyond ED, PRP has shown potential in other urologic indications such as stress urinary incontinence (SUI), interstitial cystitis/bladder pain syndrome (IC/BPS), and chronic pelvic pain, where it may contribute to tissue regeneration and symptom relief. However, broader adoption will require the establishment of individualized blood-quality metrics, standardized preparation methods, and randomized controlled trials demonstrating durable benefit.
Emerging Regenerative Strategies
Beyond cell-based and autologous biologics, a suite of innovative regenerative technologies is progressing from bench to bedside. These include:
Energy-based devices such as low-intensity extracorporeal shock wave therapy (Li-ESWT), which promotes neovascularization and tissue regeneration via mechanotransduction pathways.
Gene therapies, targeting dysfunctional or absent proteins in disorders like overactive bladder.
Smart biomaterials, capable of delivering cells or bioactive molecules in a controlled, responsive manner.
Extracellular vesicle (EV)-based therapeutics, which leverage cell-free vesicles derived from MSCs or urine-derived stem cells. These EVs carry signaling molecules (e.g., microRNAs, cytokines, growth factors) that mimic the paracrine effects of stem cells, offering a potentially safer and more scalable alternative to cell transplantation.
In preclinical models of ED and bladder dysfunction, EVs have demonstrated the capacity to promote smooth muscle regeneration, nerve sprouting, and fibrosis reduction, with functional improvements comparable to stem cell therapy.
Regenerative medicine has propelled the field of urologic tissue repair from theoretical promise to an early clinical reality. While substantial challenges remain—including the need for deeper mechanistic insight, protocol standardization, and regulatory clarity—the field is advancing rapidly. The convergence of cell therapy, PRP, EVs, and device-based modalities is creating a multifaceted toolkit for urologic regeneration. With continued scientific rigor, large-scale clinical trials, and interdisciplinary collaboration, regenerative medicine holds the potential to shift urologic care from chronic symptomatic management to durable, tissue-level cure.Stem Cell Therapy: Advancements and Clinical Insights for Erectile Dysfunction Treatment Erectile dysfunction (ED)—defined as the persistent inability to achieve or maintain an erection sufficient for satisfactory sexual activity—affects over 150 million men worldwide. While phosphodiesterase-5 inhibitors (PDE5is) remain the first-line treatment, many patients, particularly those with diabetes, age-related vascular decline, or neuropathy following radical prostatectomy, show suboptimal responses. Consequently, regenerative medicine—particularly stem-cell therapy—has gained interest for its potential to address the root causes of ED rather than merely managing symptoms.
Stem-cell therapy offers a multifaceted approach to treating ED through neuroregeneration, angiogenesis, anti-apoptotic signaling, and fibrosis inhibition. Once introduced into the target tissue, stem cells can differentiate into specific cell types or exert paracrine effects via secretion of growth factors and extracellular vesicles. Among the various sources studied, bone marrow-derived mesenchymal stem cells (BM-MSCs), adipose-derived stem cells (ADSCs), and umbilical cord-derived MSCs (UC-MSCs) have been most extensively explored.
Preclinical studies consistently demonstrate that MSC-based therapies enhance cavernous nerve regeneration, suppress fibrosis, and preserve endothelial integrity. In rat models of diabetes- or nerve-injury-induced ED, intracavernosal injections of ADSCs or BM-MSCs significantly restore intracavernosal pressure (ICP) and improve corpus cavernosum histology. Phase I/II clinical trials also support the safety and preliminary efficacy of stem-cell approaches. For example, in men with diabetic ED treated with autologous BM-MSCs, significant improvements in International Index of Erectile Function-5 (IIEF-5) scores and penile arterial flow have been reported without major adverse events. Similarly, ADSC therapy in post-prostatectomy ED has shown encouraging short-term results. However, large-scale trials are needed to clarify long-term efficacy, immune responses, and safety profiles.
Human amniotic fluid stem cells (hAFSCs) represent a promising alternative, offering characteristics that bridge embryonic and adult stem-cell profiles. These include broad multipotency, high proliferation, and low immunogenicity—traits ideal for allogeneic use and neuroregenerative purposes. Notably, hAFSCs secrete potent regenerative mediators such as brain-derived neurotrophic factor (BDNF), vascular endothelial growth factor (VEGF), and insulin-like growth factor-1 (IGF-1), all of which support neurovascular repair and smooth muscle integrity. Our recent studies demonstrate, for the first time, that hAFSCs persist long-term in penile tissue and can differentiate into cavernous smooth-muscle cells, effectively replacing damaged tissue and improving erectile function even in chronic neurogenic ED models.
Despite these advantages, our findings did not reveal in-vivo homing of hAFSCs to nerve injury sites or differentiation into neural tissue. This suggests a need for future studies to identify the specific microenvironmental cues required to induce such responses. Additionally, combining hAFSCs with platelet-rich plasma (PRP) may provide synergistic benefits—enhancing stem-cell homing, paracrine signaling, and in-vivo differentiation—thereby advancing a more effective, scalable, and safe therapeutic strategy.
Chen-Yen TsaiTaiwan
Speaker
Transvaginal Ultrasound-Guided Botulinum Toxin A External Sphincter Injection and Transurethral Incision of the Bladder Neck in Female Underactive BladderManaging female underactive bladder (UAB) with chronic urinary retention poses significant clinical challenges. In our previous study, we proposed a novel approach—transvaginal ultrasound-guided botulinum toxin A (BoNT-A) injection into the external urethral sphincter—which showed promising results in improving lower urinary tract symptoms, reducing post-void residual volume, and minimizing the need for clean intermittent catheterization (CIC). Building upon these findings, we developed a combined surgical strategy incorporating BoNT-A injection with transurethral incision of the bladder neck (TUI-BN). This dual approach further enhanced voiding efficiency, with 88% of patients achieving over 50% spontaneous voiding at 3 months. Throughout both studies, we observed favorable safety profiles and significant improvements in patient-reported outcomes. These results suggest that our ultrasound-guided technique, particularly when combined with TUI-BN, may offer an effective and durable treatment option for women with UAB and chronic urinary retention.
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Tai-Lung ChaTaiwan
Speaker
Novel Target for GU Cancer Metastasis and TherapeuticsCancer progression is shaped by both cell-intrinsic adaptations and complex extrinsic interactions within the tumor microenvironment (TME). Here, we identify a transmembrane protein, Meta1, as a shared therapeutic target that exhibits a Janus-like role: promoting malignant phenotypes in cancer cells while restraining tumor-supportive functions in non-cancerous stromal and immune cells. Meta1 is expressed in both compartments of the TME, orchestrating a dual program that supports metastasis and immune evasion. Mechanistically, we uncovered a malignancy-promoting factor (MPF) that acts as a functional ligand for Meta1, selectively enhancing pro-invasive signaling in cancer cells. We further identify Meta1 as an unconventional G protein–coupled receptor (GPCR) that plays as an accelerator in cancer cells of the TME. Meta1 interacts with Rho-GDI and Gαq to activate RhoA-mediated cytoskeletal remodeling and amoeboid migration, facilitating metastatic dissemination. We further identify MPF binding to Meta1 initiates Gβγ signaling, elevating intracellular cAMP and activating Rap1, thereby amplifying cell motility and metastatic potential. Leveraging the Meta1–MPF interaction, we designed MPF-derived peptides that specifically bind Meta1 and serve as the basis for a novel peptide-based PROTAC, which efficiently induces degradation of Meta1 and abrogates its pro-metastatic functions. Our study unveils Meta1 as an atypical GPCR with canonical signaling capacity and topological divergence, representing a shared and targetable vulnerability that bridges cancer cell-intrinsic adaptation with extrinsic TME communication. These findings establish the Meta1–MPF axis as a compelling therapeutic target for suppressing metastasis and reprogramming the TME.
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Po-Hung LinTaiwan
Speaker
Robotic Prostatectomy Using da Vinci SP SystemIn this semi-live section I will demonstrate the steps of extraperitoneal-approach radical prostatectomy using DAVINCI SP system.How to Make the Best Decision with Systemic Therapy Sequence in Respective of Genetic AnalysisRenal cell carcinoma (RCC) is a biologically heterogeneous disease driven by a limited set of convergent pathways that together shape oncogenesis, immune evasion, and therapeutic response. Across clear-cell RCC (ccRCC), recurrent alterations include VHL, PBRM1, BAP1, and SETD2, mapping onto five dominant axes: hypoxia signaling (VHL–HIF), PI3K/AKT/mTOR, chromatin remodeling, cell-cycle control, and metabolic rewiring. These lesions variably interact—e.g., mTORC1 enhances HIF translation—creating therapeutic opportunities (VEGF tyrosine-kinase inhibitors, HIF-2α inhibition, mTOR blockade) and constraints (adaptive resistance via metabolic plasticity). While immune checkpoint inhibitors (ICIs) and ICI–TKI combinations have improved outcomes in metastatic RCC, robust predictive biomarkers remain elusive. Tumor mutational burden is typically low and noninformative; PD-L1 shows assay- and context-dependent utility; PBRM1 and BAP1 are more prognostic than predictive. Emerging signals include angiogenic versus T-effector/myeloid transcriptional signatures, sarcomatoid/rhabdoid histology as a surrogate of immune-inflamed state, and host factors such as HLA genotype and gut microbiome composition. Liquid-biopsy modalities (ctDNA and methylome profiling) and spatial/single-cell atlases reveal intratumoral heterogeneity, T-cell exclusion niches, and myeloid programs (e.g., TREM2⁺ macrophages) linked to recurrence or ICI benefit. Early data support metabolism-targeted strategies (e.g., glutaminase inhibition) and rational combinations co-targeting angiogenesis, hypoxia signaling, and immune checkpoints; however, toxicity management and resistance evolution require prospective, biomarker-integrated trials. A clinical schema that pairs baseline multi-omic and microenvironmental profiling with adaptive surveillance (serial liquid biopsies, functional imaging) can lead to dynamically select among ICI–ICI, ICI–TKI, targeted, and experimental regimens. Robotic Prostatectomy Using da Vinci SP System
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Jeremy TeohHong Kong, China
Speaker
Transurethral En Bloc Resection of Bladder Tumor: Where Are We Now?There is increasing evidence that transurethral en bloc resection of bladder tumour (ERBT) could lead to better peri-operative and oncological outcomes in patients with non-muscle-invasive bladder cancer. Modified approaches of ERBT have also been proposed to expand its indications for larger bladder tumours. The quality of resection is also the key for bladder-sparing treatment for muscle-invasive bladder cancer. We foresee an exciting journey ahead for ERBT, and as a urologist, we must embrace this novel technique for the best interest of our bladder cancer patients. To Publish or not to Publish? Navigating the path to academia in urologyDoing good science is the basis for technological advancement in healthcare. However, pursuing a path to academic in urology is often tough, stressful and frustrating. In this talk, I will share with you what I have learnt throughout my 15 years of research work. I will let you know what's the best and fastest way to become a globally renowned and successful researcher. Most importantly, I will explain what it takes to develop a great team and create a positive impact in people's lives. Believe in yourself! If I can do it, so can you.SIU Lecture: Role of MISTs in Male LUTS Surgical Management (Will TUR-P/ Laser Prostatectomy be Replaced?)Transurethral resection of prostate (TURP) is the current gold standard in treating patients with benign prostatic hyperplasia. Laser prostatectomy has also been used widely especially in patients who are on anticoagulants. However, both TURP and laser prostatectomy are associated with several problems including the need of spinal / general anaesthesia and the risk of male sexual dysfunction. In the past decade, we have witnessed the introduction of multiple new technologies including Rezum, Urolift, iTind and Aquablation. in this SIU lecture, we will discuss about the technical details, as well as the pros and cons of every new technology. We will also invite you to be our jury and decide whether TURP and laser prostatectomy will be replaced in the future. Novel Intravesical Therapeutics in the Evolving Landscape of NMIBCNon-muscle-invasive bladder cancer (NMIBC) is well known to be a difficult disease to manage, with a 1-year recurrence rate of up to 61% and 5-year recurrence rate of 78%. Despite the use of intravesical BCG therapy, NMIBC patients may still experience recurrence and develop what we call BCG-unresponsive NMIBC. Conventionally, we offer upfront radical cystectomy for patients with BCG-unresponsive NMIBC, however, this is an ultra-major surgery with significant risk of complications and could also lead to significant deterioration in quality of life in the long run. We are in urgent need for novel therapies to manage this difficult condition. In this lecture, we will discuss the evidence on the different novel intravesical therapies in treating BCG-unresponsive NMIBC. SIU Lecture: Role of MISTs in Male LUTS Surgical Management (Will TUR-P/ Laser Prostatectomy be Replaced?)
Tuan Thanh NguyenVietnam
Speaker
Debate: Bladder Preservation Should Be Considered for All Cases of MIBCPractice Changing Papers
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Noor Ashani Md YusoffMalaysia
Speaker
Technical Pearls: Node Dissection in Robotic CystectomyHighlight and Limitation in Urology Service in MalaysiaRobotic Pelvic LN Dissection: A critical Component of Bladder Cancer Surgery
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Lui Shiong LeeSingapore
Speaker
Technical Pearls: Robotic Intra-Corporeal OBSThis session will demonstrate the key steps required in the intra-corporeal creation of a Studer type orthotropic bladder substitute.
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Bannakij LojanapiwatThailand
Moderator
PSA Kinetics Following PADT in mHSPC. Is It a Real-World Tool for Predicting Oncologic Outcome?PSA Kinetics following Primary Androgen Deprivation Therapy
(PADT) in mHSPC. Is it a Real-world Tool for Prediction Oncologic Outcome?
Bannakij Lojanapiwat, M.D.
Professor of Urology, Chiang Mai University, Thailand.
Of recent guidelines, upfront primary androgen deprivation monotherapy or combination therapy (PADT) is recommended for the treatment of metastatic hormone sensitive prostate cancer (mHSPC). Limitation of real-world treatment such as culture difference, financial barrier, geographic access to treatment and high operation/ radiation risks associated with medical comorbidity led to underutilization of combination therapy as the standard guideline. Prognostic factors are important in clinical practice which can predict the clinical outcome that offer the pre-treatment counseling for patients to select the optimal treatment.
Prostate specific antigen (PSA) levels is one of the important key prognostic markers. PSA kinetics of nadir PSA level and time to nadir PSA following the treatment are the important role for progression to CRPC and oncologic outcome. Our study and the previous studies reported better oncologic outcome especially overall survival, cancer specific survival and time to developed CRPC in mHSPC patients received upfront PADT who decline PSA≥95% (deep responder), PSA nadir ≤ 0.2 ng/ml (low PSA nadir level), time to PSA nadir ≥ 6 month and PSA decline velocity <11 ng/ml/month.
PSA Kinetics following Primary Androgen Deprivation Therapy (PADT) is one of a real-world tool for prediction oncologic outcome in the treatment of mHSPC.
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Peter Ka-Fung ChiuHong Kong, China
Speaker
Minimal Invasive Therapy: Where do We Stand in 2025Endourological, Laparoscopic and robotic surgeries have replaced most open surgeries in Urology. Emergence of new robotic platforms have provided urologists with new opportunities. Both boom-type and module-type robots have been used, and they each have their strengths in practice. Tele-surgeries have provided a new paradigm of long-distance robotic surgeries to facilitate new surgical possibilities and proctorship. State of the art robotic surgeries in retrograde intrarenal surgeries and enbloc resection MDT Discussion: Personalizing Treatment in High Volume CSPCN/ADebate: Should We Only Offer Consolidative Cytoreductive Nephrectomy in Metastatic RCC?N/AFocal Therapy in Asia – Is It Prime Time?The increase in incidence of Prostate cancer has been rapid in Asia in the past 10 years. While Robotic radical prostatectomy and Radiotherapy has been the commonest treatments for localized prostate cancer, significant long-term morbidities are observed after surgery or radiotherapy including incontinence, erectile dysfunction and irradiation injury to the bladder and rectum. In the current era of MRI-guided prostate biopsy, focal diseases can be targeted and diagnosed, and image-guided focal therapy emerged as an alternative treatment. Although Focal therapy has a relatively higher rate of local recurrence, it has the advantages of minimal or no long-term complication after treatment, and it is possible to perform retreatment with focal therapy, prostatectomy or radiotherapy. In properly selected patients, the need for salvage prostatectomy or radiotherapy after focal therapy is less than 20% at 8 years, and patients’ quality of life could be preserved. In well-selected patients, focal therapy is an attractive option. Current focal therapy for prostate cancer available in Asia includes HIFU, Cryotherapy, Targeted Microwave Ablation (TMA), irreversible electroporation (IRE) and TULSA.
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Enrique Ian LorenzoPhilippines
Speaker
Debate: PIRADS 4/5 Negative Biopsies ShouldDebate: Should We Only Offer Consolidative Cytoreductive Nephrectomy in Metastatic RCC?
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Tanet ThaidumrongThailand
Speaker
Technical Pearls: Retzius SparingTreating SRM in a 65-Year-Old ECOG 1 with Multiple Previous Operations-Is Minimally Invasive Treatment Feasible?
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Hung-Jen WangTaiwan
Speaker
Technical Pearls: Nerve-SparingPreserving the neurovascular bundles (NVB) during robotic-assisted radical prostatectomy (RARP) is crucial for maintaining postoperative continence and sexual function, while still ensuring complete cancer removal. We will share "technical pearls" for nerve-sparing in RARP, emphasizing practical innovations that enhance surgical precision without compromising oncologic control.
Retrograde nerve-sparing involves a bottom-up (apex-to-base) dissection of the NVB using an athermal, gentle approach. This technique, adapted from open surgery, allows early identification and release of the nerves under direct vision. By minimizing traction and avoiding cautery near the NVB, it reduces inadvertent nerve injury and even lowers the risk of positive margins at the prostatic base. Clinically, adopting a retrograde approach (often with 30° lens “toggling”) has been linked to faster functional recovery of potency, contributing to potency rates approaching 90% at 1 year in fully nerve-sparing cases.
Parallel advances in augmented reality (AR) are providing real-time surgical navigation. AR technology superimposes 3D virtual models (e.g. from MRI) onto the operative field, enhancing visualization of patient-specific anatomy. Surgeons can pinpoint tumor location relative to the NVB, enabling selective, confidence-guided nerve preservation even in locally advanced disease. This approach helps modulate nerve-sparing extent on a case-by-case basis, maintaining oncologic safety (low positive surgical margin rates) while maximizing nerve preservation.
Finally, refined anatomical landmarks have emerged to guide nerve-sparing. A notable example is the identification of a consistent small arterial branch (“landmark artery”) at the NVB’s medial aspect. This vessel serves as a guide for partial nerve-sparing: dissecting just lateral to it yields an approximate 3 mm tissue margin from the prostatic capsule, sufficient to clear potential extracapsular extension while preserving the remaining nerve fibers. Such landmark-oriented dissection provides a reproducible framework for tailoring nerve-sparing to tumor risk, moving beyond the traditional “all-or-none” approach.
These advanced techniques and concepts are empowering robotic surgeons to achieve optimal outcomes. By integrating retrograde nerve-sparing, AR-assisted navigation, and anatomical landmark guidance, one can improve early continence recovery and postoperative sexual function for patients without sacrificing cancer control.
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John YuenSingapore
Speaker
Technical Pearls: Total Extraperitoneal TechniquePractice-Changing Development in RaLRP
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John YuenSingapore
Moderator
Technical Pearls: Total Extraperitoneal TechniquePractice-Changing Development in RaLRP
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Tanet ThaidumrongThailand
Speaker
Technical Pearls: Retzius SparingTreating SRM in a 65-Year-Old ECOG 1 with Multiple Previous Operations-Is Minimally Invasive Treatment Feasible?
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Jeffrey TuanSingapore
Speaker
Treating SRM in a 65-Year-Old ECOG 1 with Multiple Previous Operations-Is SBRT the New Kid on the Block?The management of small renal masses (SRMs) in older adults with prior surgical histories remains complex, particularly in patients with limited physiological reserve and increased perioperative risk. We present the case of a 65-year-old patient with an ECOG performance status of 1 and multiple prior abdominal surgeries, highlighting the challenges of repeated surgical intervention and the evolving role of stereotactic body radiotherapy (SBRT) as a non-invasive alternative. SBRT offers ablative doses of radiation with sub-millimeter precision, enabling tumor control while preserving renal function and minimizing treatment-related morbidity. Emerging data support its safety and efficacy in medically inoperable patients or those at high surgical risk. This case underscores the need to reconsider SBRT as a frontline therapeutic option in selected patients with SRM, particularly when traditional surgical or ablative approaches are contraindicated or carry significant risk. Further prospective studies are warranted to define optimal patient selection and long-term outcomes
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Enrique Ian LorenzoPhilippines
Speaker
Debate: PIRADS 4/5 Negative Biopsies ShouldDebate: Should We Only Offer Consolidative Cytoreductive Nephrectomy in Metastatic RCC?
Peter Ka-Fung ChiuHong Kong, China
Speaker
Minimal Invasive Therapy: Where do We Stand in 2025Endourological, Laparoscopic and robotic surgeries have replaced most open surgeries in Urology. Emergence of new robotic platforms have provided urologists with new opportunities. Both boom-type and module-type robots have been used, and they each have their strengths in practice. Tele-surgeries have provided a new paradigm of long-distance robotic surgeries to facilitate new surgical possibilities and proctorship. State of the art robotic surgeries in retrograde intrarenal surgeries and enbloc resection MDT Discussion: Personalizing Treatment in High Volume CSPCN/ADebate: Should We Only Offer Consolidative Cytoreductive Nephrectomy in Metastatic RCC?N/AFocal Therapy in Asia – Is It Prime Time?The increase in incidence of Prostate cancer has been rapid in Asia in the past 10 years. While Robotic radical prostatectomy and Radiotherapy has been the commonest treatments for localized prostate cancer, significant long-term morbidities are observed after surgery or radiotherapy including incontinence, erectile dysfunction and irradiation injury to the bladder and rectum. In the current era of MRI-guided prostate biopsy, focal diseases can be targeted and diagnosed, and image-guided focal therapy emerged as an alternative treatment. Although Focal therapy has a relatively higher rate of local recurrence, it has the advantages of minimal or no long-term complication after treatment, and it is possible to perform retreatment with focal therapy, prostatectomy or radiotherapy. In properly selected patients, the need for salvage prostatectomy or radiotherapy after focal therapy is less than 20% at 8 years, and patients’ quality of life could be preserved. In well-selected patients, focal therapy is an attractive option. Current focal therapy for prostate cancer available in Asia includes HIFU, Cryotherapy, Targeted Microwave Ablation (TMA), irreversible electroporation (IRE) and TULSA.
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Henry HoSingapore
Speaker
Technical Pearls: Wheel-Barrow TechniquesBringing Innovation to PatientRobotic Partial Nephrectomy: Beyond Technique
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Tuan Thanh NguyenVietnam
Speaker
Debate: Bladder Preservation Should Be Considered for All Cases of MIBCPractice Changing Papers
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Lui Shiong LeeSingapore
Speaker
Technical Pearls: Robotic Intra-Corporeal OBSThis session will demonstrate the key steps required in the intra-corporeal creation of a Studer type orthotropic bladder substitute.
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Oncology Bladder UTUC (A)
TICC - 2F 201BC
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Oncology Prostate (A)
Pradeep PrakashIndia
Moderator
Single Centre Experience of Robot Assisted Radical Prostatectomy with CMR Versius® Robotic Surgical SystemIntroduction:
Robot assisted radical prostatectomy (RARP) is the standard of care for localized prostate cancer worldwide, but the most important barrier to widespread availability of robotic systems is the associated high cost. Recent availability of newer robotic systems has brought down the cost, but limited data is available about their efficacy and safety.
We present our experience and outcomes of RARP with CMR Versius® surgical system and a comparison of cost-effectiveness to RARP with Da Vinci® surgical system in India.
Materials and Methods:
Consecutive patients undergoing RARP in our department between January 2023 to October 2024 were included. Operative time, docking time of system, anastomosis time, blood loss and other parameters were assessed. Postoperative recovery data and follow up data including days to socially acceptable continence (defined as single diaper use in 24 hours) were recorded.
Results:
Seventeen patients underwent RARP during the study period. The median age was 67 years (Range 58 – 73) and the median BMI was 31.4 (range 26.8 – 39.1). The median prostate size was 48 g (range 28-80) and median PSA was 8.9 ng/dL (4.7 – 18.2). The median operating time was 290 minutes (range 240 – 330) and median vesicourethral anastomosis time was 50 minutes (range 40 – 60). The median docking time was 15 minutes (range 10-25). The median blood loss was 350 ml (250 – 750 ml) and 2 patients (11.7%) required blood transfusion. The robotic malfunction was limited to errors in instruments bedside units which were 5 times in first case which came down to zero by fourth case. There was no major intraoperative or postoperative complications and median hospital stay was 4 days (range 4-6). The median time for return to socially acceptable continence was 10 days (range 3 – 30). The median cost of RARP at our centre was 4470 USD (4117 – 5085 USD) as compared to average 7500 USD for RARP in India with Da Vinci® Surgical system.
Conclusions:
To our knowledge, this is the largest reported series of RARP on CMR Versius® system in India. It is feasible and safe to perform RARP with this system with comparable perioperative and functional recovery outcomes and significant cost benefits compared to Da Vinci® system. The errors encountered during the surgery leads to longer operating times initially but they improve gradually with technical modifications as we get accustomed to the system.
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Stephen S. YangTaiwan
Speaker
UTI & Hydronephrosis: What's New and Asian Guideline UpdateHydronephrosis is a common urological condition in both adults and children. It is frequently associated with urinary tract infection (UTI). However, not all hydronephrosis means upper urinary tract obstruction (UUTO). So, differentiating hydronephrosis into pathological or physiological is important. In pathological hydronephrosis or UUTO, risk factors of UTI should be identified. While in physiological UTI, no further study is required.
In this lecture, classification of upper urinary tract dilatation will be introduced, including SFU and UTD system. Other than intra-venous pyelourography, diuretic renal scan can be useful in differentiating hydronephrosis into physiological or pathological hydronephrosis. Pitfalls in interpreting diuretic renogram will be discussed. A brief review of risk factors of UTI will be done. Finally, Asian guideline on UTI will be updated.
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Jun KameiJapan
Speaker
Definition of Perioperative Infections and Surgical Classification
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Pei-Shan YangTaiwan
Speaker
Optimizing Pre-operative Patient Factors to Reduce Post-Surgical ComplicationsOptimizing Pre-operative Patient Factors to Reduce Post-surgical Complications
Preoperative care
• Preoperative documentation
• Assessment of physical function and frailty
• Cognititve screening
• Pulmonary risk
• Cardiovascular risk
• Elective urological surgery should be delayed for 14 days after coronar balloon angioplsty, 30 days after bare metal stent 1 year after drug-eluting implantation
• Atrial fibrillation do not need bridge therapy except for high risk of stroke, venous thrmoembolism <12 wks recent stenting or chronic anticoagulation
• Endocrine
• Delay elective procedure for HbA1C>6.9%
• Longterm steriod dose adjustment for risk of GI bleeding or reactive airway issues
• GI
• Preoperaive fasting (6hrs befoere GA for solids, 2 hrs for clear liquids) is recommended to reduce the risk of intraoperative aspiration
• Renal
• ESRD: evaluate for hyperkalemia, acid-base status, anemia
• Consider antibiotics covering endocarditis for dialysis patients
• Nutrition
• Immunonutrition (IMN)
• Some equivocal results
• lower postop infectious copmlications but no diff in other outcomes
• Earlier return to bowel function with IMN but no diff in other outcomes
• There was no difference in any grade CD complications by type of nutritional supplement for patients with bladder cancer undergoing RC.
• From SWOG s1600
• Endourology
• Scoring system
• Novel techniques for puncture planning
• Prevention of ureteral injury
• Stenting
•
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Kazuyoshi ShigeharaJapan
Speaker
Essential Intraoperative Protocols for Infection PreventionSurgical site infections (SSIs) represent a significant burden on routine clinical practice and medical costs. Many interventions have been proposed over the past years to minimize the occurrence of SSIs. These interventions are broadly delivered at three stages including preoperative, intraoperative, and postoperative managements. Intraoperative interventions are largely focused on skin and would decontamination, precautions to prevent transfer of microorganisms into incisions, and optimising the patient's own bodily functions to promote best recovery, which can be performed by the surgeons and medical staffs during operation. These interventions include skin cleansing protocols, wound closure procedure, wound lavage and irrigation, and drain placement. In this lecture, I would like to mention summaries of intraoperative managements for the prevention of SSIs based on the Japanese Guidelines for Prevention of Perioperative Infections in Urology, which had been newly revised by 2023.
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Shang-Jen ChangTaiwan
Moderator
Which Surgical Treatment is Best for UPJO in Infants: Open, Laparoscopic, Robotic AssistedAbstract
Ureteropelvic junction obstruction (UPJO) in infants is a condition that can significantly impair renal function and requires timely surgical intervention when certain criteria are met, such as decreased split renal function, poor drainage on diuretic renography, or recurrent urinary tract infections. The three main surgical approaches for treating UPJO are open pyeloplasty (OP), laparoscopic pyeloplasty (LP), and robot-assisted laparoscopic pyeloplasty (RALP). Each technique has its own benefits and limitations, especially when applied to infants.
Minimally invasive surgery (MIS), including LP and RALP, has gained popularity in pediatric urology due to advantages such as shorter hospital stays, reduced postoperative pain, faster recovery, and better cosmetic outcomes. However, the small working space in infants, the steep learning curve, and higher costs are significant limitations. In particular, the utility of MIS in infants remains controversial due to undefined benefits and technical challenges, including limited space for trocar placement and difficulty in intracorporeal suturing.
Current guidelines from the European Association of Urology (EAU) indicate that while RALP is considered the gold standard for older pediatric patients, its role in infants remains less defined due to anatomical and logistical constraints. Open surgery continues to be the mainstay for infantile UPJO due to its well-established success rate and lower cost.
Several studies have addressed the learning curve associated with these techniques. Laparoscopic pyeloplasty requires about 30 cases for a surgeon to achieve proficiency, while RALP demands approximately 18–31 cases depending on the metrics used. Simulation-based training, dry labs, and multicenter collaboration are proposed solutions to accelerate skill acquisition and ensure patient safety.
Cost is another critical consideration. Although RALP generally incurs higher upfront costs, especially in low-volume centers, innovations such as magnetic stents have helped offset some of these expenses by eliminating the need for anesthesia during stent removal. Moreover, the availability of pediatric-specific robotic instruments remains limited and necessitates ongoing development to fully support MIS in smaller patients.
In conclusion, while RALP is increasingly recognized as the standard for pediatric UPJO, its application in infants should be considered selectively, depending on surgeon experience, institutional resources, and patient anatomy. Open pyeloplasty remains a safe and effective option, particularly in very young children. Advances in surgical training, cost reduction strategies, and instrument development will be key to expanding the use of minimally invasive techniques in this population.
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Tze-Chen ChaoTaiwan
Speaker
Prevention of Surgical Site Infection: Endoscopic examinations and drainage tube related proceduresThe presentation outlines antibiotic prophylaxis in urologic examinations and drainage tube-related procedures. For diagnostic examinations like urodynamics and cystoscopy without manipulation, prophylactic antibiotics are generally not required in low-risk patients without UTI risk factors. Ureteroscopy has increased infection risk due to potential mucosal trauma, increased intrarenal pressure, and therefore requires antibiotic prophylaxis.
For drainage procedures, DJ stent placement typically warrants prophylaxis except in carefully selected low-risk patients, as colonization rates increase with duration and certain risk factors such as diabetes, chronic kidney disease, malignancy, female gender, pregnancy, and emergency procedures. First-time nephrostomy placement requires single-dose prophylaxis due to renal parenchymal injury and bacteremia risk. On the other hand, routine exchanges of nephrostomy generally don't need prophylaxis unless tube obstruction occurs.
The key principle is individualized risk assessment. Current evidence supports selective rather than universal prophylaxis to prevent infection and minimize bacterial resistance.Transurethral Surgery
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Chi-Fang ChenTaiwan
Speaker
Antibiotic prophylaxis for surgery using foreign bodiesWhile existing guidelines offer important frameworks for antibiotic prophylaxis in AUS and penile prosthesis surgeries, they are insufficiently comprehensive and sometimes inconsistent, particularly regarding coverage of all relevant pathogens, duration of antibiotic use, and tailoring to patient risk profiles. This underscores the need for further high-quality research to refine prophylaxis protocols and improve infection prevention outcomes in these prosthetic surgeries.
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Li-Yi LimMalaysia
Speaker
Pediatric Urological SurgeryWhat’s New in Nocturnal Enuresis?
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Seung-Kwon ChoiKorea (Republic of)
Speaker
Urethroplasty for Urethral StenosisUrethroplasty is a definitive treatment for urethral stricture disease. Despite its high success rate, surgical site infections (SSIs) and urinary tract infections (UTIs) remain notable postoperative complications. Antibiotic prophylaxis practices vary significantly among reconstructive urologists, ranging from single-dose perioperative regimens to prolonged courses until catheter removal. However, there is limited high-quality evidence to guide optimal antibiotic duration in this context.
Recent prospective cohort studies demonstrated no significant reduction in UTI or wound infection with extended antibiotic prophylaxis versus limited regimens. Moreover, prolonged antibiotic use was associated with a significantly higher incidence of multidrug-resistant (MDR) organisms. Additional studies confirmed the lack of correlation between bacteriuria and stricture recurrence or wound complications.
Prolonged postoperative antibiotic prophylaxis offers no clear benefit in preventing SSIs or UTIs following urethroplasty. In contrast, it may promote the development of MDR organisms. Current evidence support a practice shift toward single-dose perioperative antibiotics. These strategies enhance antibiotic stewardship while maintaining clinical safety.
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Stephen S. YangTaiwan
Speaker
UTI & Hydronephrosis: What's New and Asian Guideline UpdateHydronephrosis is a common urological condition in both adults and children. It is frequently associated with urinary tract infection (UTI). However, not all hydronephrosis means upper urinary tract obstruction (UUTO). So, differentiating hydronephrosis into pathological or physiological is important. In pathological hydronephrosis or UUTO, risk factors of UTI should be identified. While in physiological UTI, no further study is required.
In this lecture, classification of upper urinary tract dilatation will be introduced, including SFU and UTD system. Other than intra-venous pyelourography, diuretic renal scan can be useful in differentiating hydronephrosis into physiological or pathological hydronephrosis. Pitfalls in interpreting diuretic renogram will be discussed. A brief review of risk factors of UTI will be done. Finally, Asian guideline on UTI will be updated.
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Endourology (A)
Ching-Heng YenTaiwan
Moderator
What are the New Supportive Modalities in the Horizon to Increase the Efficacy of ESWL Extracorporeal shock wave lithotripsy (ESWL) has long been a standard non-invasive modality for managing urinary stones, yet its efficacy remains suboptimal in certain scenarios due to variable stone composition, size, and anatomical factors. Recent advancements have introduced several supportive modalities aimed at enhancing stone fragmentation and clearance. Among these, Burst Wave Lithotripsy (BWL) emerges as a promising technology utilizing focused, low-intensity ultrasound bursts to achieve finer stone fragmentation with greater precision and reduced tissue injury. In parallel, adjunctive approaches such as external physical vibration, ultrasonic propulsion, and optimized patient positioning are gaining traction. Pharmacologic aids including alpha-blockers and potassium citrate have also demonstrated improved stone passage rates post-ESWL. Furthermore, artificial intelligence–driven targeting and real-time imaging advances contribute to improved shock wave focusing and treatment personalization. This review explores the evolving landscape of supportive technologies, with a focus on BWL and its integration with existing ESWL protocols, potentially reshaping the future paradigm of non-invasive stone management.
TICC - 2F 201BC
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Endourology (A)
Cheng-Chia LinTaiwan
Moderator
DISS plus FANS used in RIRSNew technologies and techniques are constantly emerging, but the most important part of our discussions is how to use them most effectively. Through this surgical demonstration, we hope to share the procedure and our experience with everyone.健保各領域審查共識及討論－結石
TICC - 1F 101A
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Oncology Bladder UTUC (A)
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Da Vinci SP Experience Sharing Session How Shall We Start?
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Ryoichi Shiroki Japan
Moderator
Surgical Robot-System hinotori in Urological Surgery: Clinical Applications and Future PotentialThe hinotori system was developed by Medicaroid, the partnership between Kawasaki, a leader in the industrial robots, and Sysmex, with its abundant expertise and networks in advanced medicine, released the first made-in-Japan RAS in 2020. The hinotori has been designed to reduce interference between arms and the surgeon at bedside. Equipped with four 8-axis robotic arms, providing smooth, highly articulated movements that mimic the human hand. In addition, docking-free design allows for a wide operative field around trocars, ensuring smooth workflows for surgeons and assistants. As a made-in-Japan system, it offers high adaptability to local clinical needs and faster implementation of user feedback.
Since the first launch, more 90 systems have been installed for the clinical use, not only inside Japan but foreign countries such as Singapore and Malaysia. The first one was performed in December 2020 on prostatectomy. Since then, more than 100,000 cases performed, including urology GI surgery, gynecology and thoracic fields. In urological surgery, robot-assisted surgery has been widely and promptly accepted as a standard approach for the majority of major surgeries, including robot-assisted radical prostatectomy (RARP), partial nephrectomy (RAPN), radical nephrectomy (RARN), radical nephroureterectomy (RANU), and radical cystectomy (RARC), and has generally shown findings superior to those of conventional open and laparoscopic surgeries
In conclusion, hinotori is a cutting-edge Japanese surgical robot already in use at many medical institutions. With strong performance across various surgical specialties and growing insurance coverage, it is expected to benefit even more patients as its technology continues to evolve and its global presence expands.Comparison of Various Current Surgical Robotic Systems - Nuances, Advantages, & DrawbacksIn the field of urology, robotic surgery has gained rapid and wide acceptance as a standard surgical care in the majority of surgeries over the last decade. To date, the da Vinci surgical system has been the dominant platform in robotic surgery; however, several newly developed robotic systems have recently been introduced in routine clinical practice. We, Fujita, installed the four different kinds of robotic platform for clinical usage such as, daVinci Xi, SP, hinotori and Hugo. In this study, we want to analyze the perioperative outcomes of robotic radical prostatectomy (RARP) and characterize the differences between four platforms.
hinotori : The hinotori system was developed by Medicaroid, the partnership between Kawasaki, a leader in the industrial robots, and Sysmex, with its abundant expertise and networks in advanced medicine, released the first made-in-Japan RAS in 2020. The hinotori has a compact operation arm with eight axes of motion, one more than the DaVinci, leading to reduce interference between arms and the surgeon at bedside.
DaVinci SP : The characteristic of the SP system can operate one 3D flexible camera and three forceps through a single port, and various surgical access is possible without the external interference of the arms. The various complicated procedures have been feasible such as NOTES or transoral surgery through the narrow space without the large wound, and retroperitoneal approach like the prostatectomy and partial nephrectomy. SP system is expected to contribute to develop the high quality surgery with minimal invasiveness.
Hugo : Hugo system (Medtronic) consists of an open-site console with two arm-controllers that are operated with a grip similar to a pistol. It also has a footswitch that controls the camera, energy source, and reserve arm. The system includes four separate arm carts, each with six joints to increase the range of motion. Additionally, it uses specific 3D glasses for head tracking technology.
Despite a small case series, there seemed to need learning-curve to get familiar with systems in setting-up and surgical procedures in introductory-phase. However, all the surgical procedures were efficaciously and safely performed, resulting in the achievement of favorable perioperative outcomes surgically as well as oncologically.
In conclusion, these new robots will lead to competition and reduce the costs of RAS and will contribute to an increase in use. Robotic-assisted surgery will become more common than laparoscopic surgery especially in the field of urology.
Steven L. ChangUnited States
Speaker
The Progression Landscape of Diagnostic and Treatment Options for Kidney CancerPros and Cons in the daVinci SP System Applications in Urological Surgeries
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Ryoichi Shiroki Japan
Moderator
Surgical Robot-System hinotori in Urological Surgery: Clinical Applications and Future PotentialThe hinotori system was developed by Medicaroid, the partnership between Kawasaki, a leader in the industrial robots, and Sysmex, with its abundant expertise and networks in advanced medicine, released the first made-in-Japan RAS in 2020. The hinotori has been designed to reduce interference between arms and the surgeon at bedside. Equipped with four 8-axis robotic arms, providing smooth, highly articulated movements that mimic the human hand. In addition, docking-free design allows for a wide operative field around trocars, ensuring smooth workflows for surgeons and assistants. As a made-in-Japan system, it offers high adaptability to local clinical needs and faster implementation of user feedback.
Since the first launch, more 90 systems have been installed for the clinical use, not only inside Japan but foreign countries such as Singapore and Malaysia. The first one was performed in December 2020 on prostatectomy. Since then, more than 100,000 cases performed, including urology GI surgery, gynecology and thoracic fields. In urological surgery, robot-assisted surgery has been widely and promptly accepted as a standard approach for the majority of major surgeries, including robot-assisted radical prostatectomy (RARP), partial nephrectomy (RAPN), radical nephrectomy (RARN), radical nephroureterectomy (RANU), and radical cystectomy (RARC), and has generally shown findings superior to those of conventional open and laparoscopic surgeries
In conclusion, hinotori is a cutting-edge Japanese surgical robot already in use at many medical institutions. With strong performance across various surgical specialties and growing insurance coverage, it is expected to benefit even more patients as its technology continues to evolve and its global presence expands.Comparison of Various Current Surgical Robotic Systems - Nuances, Advantages, & DrawbacksIn the field of urology, robotic surgery has gained rapid and wide acceptance as a standard surgical care in the majority of surgeries over the last decade. To date, the da Vinci surgical system has been the dominant platform in robotic surgery; however, several newly developed robotic systems have recently been introduced in routine clinical practice. We, Fujita, installed the four different kinds of robotic platform for clinical usage such as, daVinci Xi, SP, hinotori and Hugo. In this study, we want to analyze the perioperative outcomes of robotic radical prostatectomy (RARP) and characterize the differences between four platforms.
hinotori : The hinotori system was developed by Medicaroid, the partnership between Kawasaki, a leader in the industrial robots, and Sysmex, with its abundant expertise and networks in advanced medicine, released the first made-in-Japan RAS in 2020. The hinotori has a compact operation arm with eight axes of motion, one more than the DaVinci, leading to reduce interference between arms and the surgeon at bedside.
DaVinci SP : The characteristic of the SP system can operate one 3D flexible camera and three forceps through a single port, and various surgical access is possible without the external interference of the arms. The various complicated procedures have been feasible such as NOTES or transoral surgery through the narrow space without the large wound, and retroperitoneal approach like the prostatectomy and partial nephrectomy. SP system is expected to contribute to develop the high quality surgery with minimal invasiveness.
Hugo : Hugo system (Medtronic) consists of an open-site console with two arm-controllers that are operated with a grip similar to a pistol. It also has a footswitch that controls the camera, energy source, and reserve arm. The system includes four separate arm carts, each with six joints to increase the range of motion. Additionally, it uses specific 3D glasses for head tracking technology.
Despite a small case series, there seemed to need learning-curve to get familiar with systems in setting-up and surgical procedures in introductory-phase. However, all the surgical procedures were efficaciously and safely performed, resulting in the achievement of favorable perioperative outcomes surgically as well as oncologically.
In conclusion, these new robots will lead to competition and reduce the costs of RAS and will contribute to an increase in use. Robotic-assisted surgery will become more common than laparoscopic surgery especially in the field of urology.
John DavisUnited States
Speaker
Open Surgery Training: Is It Necessary in the Era of Robotics?Open surgery training in the era of robotics may or may not be a training environment that urology has control of, given worldwide access to robotic or at least laparoscopic techniques and strong patient preference. There may be some applications where a given experienced urologist can prefer open over minimally invasive surgery (MIS), such as radical cystectomy, or indications possibly outside of MIS feasibility such as large renal tumors with caval thrombus. Specific to training and expertise, there are 3 principle features of surgical skills desired: 1) knowing ideal exposure, 2) recognition of surgical planes, and 3) knowing anatomy before it can be seen. Although some trainees may only see MIS for certain indications, open surgery may expedite the process. There are no human studies identified on the topic, but a skills lab study was instructive (Farah, J Surgical Education 2023) showing that interns with open and MIS training performed higher comparing pre-intern to post intern bootcamp skills. The benefits of a solid training pathway including open experience are to move trainees towards the faster-to-progress part of the learning curve such that the attending can offer a safe training environment while moving the case along efficiently.The Future of Surgical Skills Evaluation: What Is on Your Wish List?Surgical skills training vary significantly by region with some systems putting trainees on a timed set of years, while others apprentice trainees until meeting a threshold for skills. Early training assessments were basic timed events with qualitative scores (subject to strong attending selection for success). Trainees should experience and/or study the key pitfalls to avoid and performance goals. Surgical simulation can be highly useful, but tend to improve only certain skills and not full case needs. Updated simulation moves from digital to hands on surgical models and may move the needle towards human experience. Training can be augmented with descriptors of surgical gestures and measuring which ones are most effective. The experience for the trainee is often depicted as an "autonomy gap" whereby the training desires to have case control, possibly before they are ready. Progression can be measured by descriptors of performance from assistance through full performance without coaching. The next frontier will be artificial intelligence guided measurement where specific performances can be characterized and diagnosed for success. My ultimate wishlist would be for methods to correlate skills to outcomes, optimized curricula, and a specific pathway to correct underperformance.Tips and Tricks in Challenging Cases of Robotic Radical ProstatectomyThere are many specific challenges with robotic radical prostatectomy (RARP) that can be described and illustrated--the most 5 common are 1) difficulty access, 2) obesity, 3) pubic arch interference, 4) anatomic challenges, and 5) reconstruction challenges. In this video sample, we demonstrate 2 challenges: obesity requiring a pelvic lymph node dissection and significant pelvic de-fatting to identify the proper surgical landmarks. Next a massive sized prostate that has had a partial transurethral resection--together presenting challenges with landmarks, a difficult bladder neck to diagnose, and final reconstruction challenges.
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Ryoichi Shiroki Japan
Moderator
Surgical Robot-System hinotori in Urological Surgery: Clinical Applications and Future PotentialThe hinotori system was developed by Medicaroid, the partnership between Kawasaki, a leader in the industrial robots, and Sysmex, with its abundant expertise and networks in advanced medicine, released the first made-in-Japan RAS in 2020. The hinotori has been designed to reduce interference between arms and the surgeon at bedside. Equipped with four 8-axis robotic arms, providing smooth, highly articulated movements that mimic the human hand. In addition, docking-free design allows for a wide operative field around trocars, ensuring smooth workflows for surgeons and assistants. As a made-in-Japan system, it offers high adaptability to local clinical needs and faster implementation of user feedback.
Since the first launch, more 90 systems have been installed for the clinical use, not only inside Japan but foreign countries such as Singapore and Malaysia. The first one was performed in December 2020 on prostatectomy. Since then, more than 100,000 cases performed, including urology GI surgery, gynecology and thoracic fields. In urological surgery, robot-assisted surgery has been widely and promptly accepted as a standard approach for the majority of major surgeries, including robot-assisted radical prostatectomy (RARP), partial nephrectomy (RAPN), radical nephrectomy (RARN), radical nephroureterectomy (RANU), and radical cystectomy (RARC), and has generally shown findings superior to those of conventional open and laparoscopic surgeries
In conclusion, hinotori is a cutting-edge Japanese surgical robot already in use at many medical institutions. With strong performance across various surgical specialties and growing insurance coverage, it is expected to benefit even more patients as its technology continues to evolve and its global presence expands.Comparison of Various Current Surgical Robotic Systems - Nuances, Advantages, & DrawbacksIn the field of urology, robotic surgery has gained rapid and wide acceptance as a standard surgical care in the majority of surgeries over the last decade. To date, the da Vinci surgical system has been the dominant platform in robotic surgery; however, several newly developed robotic systems have recently been introduced in routine clinical practice. We, Fujita, installed the four different kinds of robotic platform for clinical usage such as, daVinci Xi, SP, hinotori and Hugo. In this study, we want to analyze the perioperative outcomes of robotic radical prostatectomy (RARP) and characterize the differences between four platforms.
hinotori : The hinotori system was developed by Medicaroid, the partnership between Kawasaki, a leader in the industrial robots, and Sysmex, with its abundant expertise and networks in advanced medicine, released the first made-in-Japan RAS in 2020. The hinotori has a compact operation arm with eight axes of motion, one more than the DaVinci, leading to reduce interference between arms and the surgeon at bedside.
DaVinci SP : The characteristic of the SP system can operate one 3D flexible camera and three forceps through a single port, and various surgical access is possible without the external interference of the arms. The various complicated procedures have been feasible such as NOTES or transoral surgery through the narrow space without the large wound, and retroperitoneal approach like the prostatectomy and partial nephrectomy. SP system is expected to contribute to develop the high quality surgery with minimal invasiveness.
Hugo : Hugo system (Medtronic) consists of an open-site console with two arm-controllers that are operated with a grip similar to a pistol. It also has a footswitch that controls the camera, energy source, and reserve arm. The system includes four separate arm carts, each with six joints to increase the range of motion. Additionally, it uses specific 3D glasses for head tracking technology.
Despite a small case series, there seemed to need learning-curve to get familiar with systems in setting-up and surgical procedures in introductory-phase. However, all the surgical procedures were efficaciously and safely performed, resulting in the achievement of favorable perioperative outcomes surgically as well as oncologically.
In conclusion, these new robots will lead to competition and reduce the costs of RAS and will contribute to an increase in use. Robotic-assisted surgery will become more common than laparoscopic surgery especially in the field of urology.
Simone CrivellaroUnited States
Speaker
Single-Port vs. Multi-Port Robotic Prostatectomy: Balancing Innovation, Precision, and OutcomesThe Application & Limitation of Urological SP SurgerySingle Port Retroperitoneal Partial NephrectomySingle Port Prostate Surgery
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Ryoichi Shiroki Japan
Moderator
Surgical Robot-System hinotori in Urological Surgery: Clinical Applications and Future PotentialThe hinotori system was developed by Medicaroid, the partnership between Kawasaki, a leader in the industrial robots, and Sysmex, with its abundant expertise and networks in advanced medicine, released the first made-in-Japan RAS in 2020. The hinotori has been designed to reduce interference between arms and the surgeon at bedside. Equipped with four 8-axis robotic arms, providing smooth, highly articulated movements that mimic the human hand. In addition, docking-free design allows for a wide operative field around trocars, ensuring smooth workflows for surgeons and assistants. As a made-in-Japan system, it offers high adaptability to local clinical needs and faster implementation of user feedback.
Since the first launch, more 90 systems have been installed for the clinical use, not only inside Japan but foreign countries such as Singapore and Malaysia. The first one was performed in December 2020 on prostatectomy. Since then, more than 100,000 cases performed, including urology GI surgery, gynecology and thoracic fields. In urological surgery, robot-assisted surgery has been widely and promptly accepted as a standard approach for the majority of major surgeries, including robot-assisted radical prostatectomy (RARP), partial nephrectomy (RAPN), radical nephrectomy (RARN), radical nephroureterectomy (RANU), and radical cystectomy (RARC), and has generally shown findings superior to those of conventional open and laparoscopic surgeries
In conclusion, hinotori is a cutting-edge Japanese surgical robot already in use at many medical institutions. With strong performance across various surgical specialties and growing insurance coverage, it is expected to benefit even more patients as its technology continues to evolve and its global presence expands.Comparison of Various Current Surgical Robotic Systems - Nuances, Advantages, & DrawbacksIn the field of urology, robotic surgery has gained rapid and wide acceptance as a standard surgical care in the majority of surgeries over the last decade. To date, the da Vinci surgical system has been the dominant platform in robotic surgery; however, several newly developed robotic systems have recently been introduced in routine clinical practice. We, Fujita, installed the four different kinds of robotic platform for clinical usage such as, daVinci Xi, SP, hinotori and Hugo. In this study, we want to analyze the perioperative outcomes of robotic radical prostatectomy (RARP) and characterize the differences between four platforms.
hinotori : The hinotori system was developed by Medicaroid, the partnership between Kawasaki, a leader in the industrial robots, and Sysmex, with its abundant expertise and networks in advanced medicine, released the first made-in-Japan RAS in 2020. The hinotori has a compact operation arm with eight axes of motion, one more than the DaVinci, leading to reduce interference between arms and the surgeon at bedside.
DaVinci SP : The characteristic of the SP system can operate one 3D flexible camera and three forceps through a single port, and various surgical access is possible without the external interference of the arms. The various complicated procedures have been feasible such as NOTES or transoral surgery through the narrow space without the large wound, and retroperitoneal approach like the prostatectomy and partial nephrectomy. SP system is expected to contribute to develop the high quality surgery with minimal invasiveness.
Hugo : Hugo system (Medtronic) consists of an open-site console with two arm-controllers that are operated with a grip similar to a pistol. It also has a footswitch that controls the camera, energy source, and reserve arm. The system includes four separate arm carts, each with six joints to increase the range of motion. Additionally, it uses specific 3D glasses for head tracking technology.
Despite a small case series, there seemed to need learning-curve to get familiar with systems in setting-up and surgical procedures in introductory-phase. However, all the surgical procedures were efficaciously and safely performed, resulting in the achievement of favorable perioperative outcomes surgically as well as oncologically.
In conclusion, these new robots will lead to competition and reduce the costs of RAS and will contribute to an increase in use. Robotic-assisted surgery will become more common than laparoscopic surgery especially in the field of urology.
Ketan BadaniUnited States
Speaker
Expanding horizons: SP for complex RAPNThe Future of Urological Robotic SurgerySingle-Port Robotic Partial Nephrectomy for Multiple or Large Renal TumorsHow to Standardize Training by AI-Learning from The Best Practice of Urological Robotic SurgerySP Partial Nephrectomy
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TICC - 1F 101B
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