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08:30
17:00
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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
-
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
-
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 Efficiency
-
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?The Future of Surgical Skills Evaluation: What Is on Your Wish List?Tips and Tricks in Challenging Cases of Robotic Radical Prostatectomy
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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
Debulking the Primary: Robotic Cytoreductive Radical ProstatectomyUpdate on the Results of SIMCAP Study
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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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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.
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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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 Efficiency
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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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