Chi-Hang Yee

• Introduction
  Eddie ChanHong Kong, China Speaker 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.
• Institute Presentation I
  Chi-Hang YeeHong Kong, China Speaker Robotic Total Intracorporeal Urinary Diversion – from Ileal Conduit to Neobladder to Ileal Interposition Prostate Cancer Focal Therapy: Ready for Prime Time?
• Institute Presentation II
  Kenneth ChenSingapore Speaker Debate: PIRADS 4/5 Negative Biopsies Should
• Institute Presentation III
  Hung-Jen WangTaiwan Speaker Technical Pearls: Nerve-SparingPreserving the neurovascular bundles (NVB) during robotic-assisted radical prostatectomy (RARP) is crucial for maintaining postoperative continence and sexual function, while still ensuring complete cancer removal. We will share "technical pearls" for nerve-sparing in RARP, emphasizing practical innovations that enhance surgical precision without compromising oncologic control. Retrograde nerve-sparing involves a bottom-up (apex-to-base) dissection of the NVB using an athermal, gentle approach. This technique, adapted from open surgery, allows early identification and release of the nerves under direct vision. By minimizing traction and avoiding cautery near the NVB, it reduces inadvertent nerve injury and even lowers the risk of positive margins at the prostatic base. Clinically, adopting a retrograde approach (often with 30° lens “toggling”) has been linked to faster functional recovery of potency, contributing to potency rates approaching 90% at 1 year in fully nerve-sparing cases. Parallel advances in augmented reality (AR) are providing real-time surgical navigation. AR technology superimposes 3D virtual models (e.g. from MRI) onto the operative field, enhancing visualization of patient-specific anatomy. Surgeons can pinpoint tumor location relative to the NVB, enabling selective, confidence-guided nerve preservation even in locally advanced disease. This approach helps modulate nerve-sparing extent on a case-by-case basis, maintaining oncologic safety (low positive surgical margin rates) while maximizing nerve preservation. Finally, refined anatomical landmarks have emerged to guide nerve-sparing. A notable example is the identification of a consistent small arterial branch (“landmark artery”) at the NVB’s medial aspect. This vessel serves as a guide for partial nerve-sparing: dissecting just lateral to it yields an approximate 3 mm tissue margin from the prostatic capsule, sufficient to clear potential extracapsular extension while preserving the remaining nerve fibers. Such landmark-oriented dissection provides a reproducible framework for tailoring nerve-sparing to tumor risk, moving beyond the traditional “all-or-none” approach. These advanced techniques and concepts are empowering robotic surgeons to achieve optimal outcomes. By integrating retrograde nerve-sparing, AR-assisted navigation, and anatomical landmark guidance, one can improve early continence recovery and postoperative sexual function for patients without sacrificing cancer control.
• Small Group Discussion

• Urothelial Cancer
  Chi-Hang YeeHong Kong, China Moderator Robotic Total Intracorporeal Urinary Diversion – from Ileal Conduit to Neobladder to Ileal Interposition Prostate Cancer Focal Therapy: Ready for Prime Time?

  Yuh-Shyan TsaiTaiwan Moderator
• How to Deal with High-Risk NMIBC with BCG-Refractory Status?
  Tsu-Ming ChienTaiwan Speaker How to Deal with High-Risk NMIBC with BCG-Refractory Status?
• Avoiding Complication in Orthotopic Neobladder
  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.
• Robotic Intracoporeal Urinary Diversion: How to Optimize Outcome for Neobladder Reconstruction
  Chi-Hang YeeHong Kong, China Speaker Robotic Total Intracorporeal Urinary Diversion – from Ileal Conduit to Neobladder to Ileal Interposition Prostate Cancer Focal Therapy: Ready for Prime Time?
• Changing Treatment Landscape of Urothelial Cancers in New Era of Immunotherapy
  Ali Hamidi MadaniIran Speaker Changing Treatment Landscape of Urothelial Cancers in New Era of Immunotherapy
• Kidney Preservation Strategies for Upper Tract Urothelial Cancer
  Khurram Mutahir SiddiquiOman Speaker Kidney Preservation Strategies for Upper Tract Urothelial CancerAbstract: Upper tract urothelial carcinoma (UTUC) is a rare but aggressive malignancy that affects the renal pelvis and ureter, often leading to significant challenges in treatment and kidney preservation. This lecture provides a comprehensive overview of the state-of-the-art kidney preservation techniques employed in the management of UTUC, with a focus on preserving renal function while ensuring oncological control. Surgical approaches, including nephron-sparing surgery (NSS) and minimally invasive techniques, such as endoscopic resections and robotic-assisted procedures, are discussed, highlighting their role in achieving optimal outcomes with reduced morbidity. In addition, the importance of careful patient selection based on tumor characteristics, location, and stage is emphasized, as these factors significantly influence the decision-making process regarding kidney preservation versus radical nephroureterectomy. The lecture further explores the evolving role of neoadjuvant and adjuvant therapies, including chemotherapy and immunotherapy, in conjunction with surgical intervention, to improve survival rates while maintaining renal function. Recent advancements in genetic profiling and molecular diagnostics are also addressed, as these innovations may lead to more personalized treatment strategies that preserve the kidney while effectively targeting the malignancy. Lastly, the challenges of balancing oncological safety with renal preservation are discussed, and future directions in research, including potential breakthroughs in regenerative medicine and advanced surgical techniques, are explored. This lecture aims to provide a current and thorough understanding of the multidisciplinary approaches to kidney preservation in UTUC, offering insights into best practices and emerging trends in the field.
• Discussion

• AI and Novel Techs in GU Cancer Application
  Byong Chang JeongKorea (Republic of) Moderator

  Wei-Yu LinTaiwan Moderator 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.
• Assistance of the AI during RAPN - Surgical Navigation to Outcome Prediction
  Cheryn SongKorea (Republic of) Speaker Assistance of the AI during RAPN - Surgical Navigation to Outcome PredictionArtificial Intelligence (AI) has deeply infiltrated many, if not every, aspects of our lives - both professional and ordinary corners. In medicine, it seems that any research dealing with large amounts of data has to employ AI in one way or another - from radiomics and radiogenomics to drug developments and simulations. In managing patients with renal tumors, majority of which now present with localized, small masses, I have focused on developing a tool to help establish a plan preoperatively and navigate throughout the surgery, in real-time with the help of the AI. Using kidney dynamic CT scans of 100 patients undergoing robot-assisted partial nephrectomy, software was developed to render a 3-dimensional image of the kidney harboring the tumor along with several other tools to enhance visualization of the lesion. Scans from an additional 30 patients were used to test for performance and validate the software. Before surgery, main renal pedicles, tumor location with respect to the major hilar vasculature, important landmarks including the calyces and branches of the vessels can be studied from all angles; tumor shape especially when it is not a perfect sphere can be visually presented and the excision of the tumor with desired margin thickness can be simulated to see what vital structures come into contact. Connected to the surgeon console through the TilePro® screen, it was designed to aid a urologic surgeon from before surgery as well as throughout the procedure as needed. In a phase I feasibility trial investigating the efficacy of the system, we confirmed that the integration of the 3D navigation system into RAPN was both feasible and safe, providing enhanced anatomical information while maintaining a consistent level of operative risk. The use of navigation system resulted in reduced renal parenchymal volume resected, suggesting potential benefits in renal function preservation. Subsequent phase 2 trial investigating accuracy of the reconstruction and a multicenter randomized controlled trial with surgeons with varying degrees of experience are underway to validate the benefits. On the other hand, the fundamental question as to best manage the small renal masses – i.e. indications for partial nephrectomies - still harbor some gray areas: is partial nephrectomy at all possible situations the best? In a given patient how will oncological and renal functional outcome differ between partial and radical nephrectomy? Previous statistical methods could only calculate risk ratios in the best-matched cohorts and the issue of counterfactual remained. Using demographic and tumor descriptive parameters of 1,448 patients with pT1N0M0 RCC patients from three academic centers, causal inference was modeled using a double machine learning algorithm to predict progression-free survival and eGFR at five years according to each surgical method: partial and radical nephrectomy. We identified significant factors and their contribution to the outcomes of interest to be included in the model. Selecting a model with the highest performance among various machine learning models for each outcome, an online interface was constructed. External validation confirmed the robustness, presenting AUROC of 0.758, AUPRC of 0.200 with XGBoost model for recurrence, and RMSE of 15.9 with GBM model for eGFR. By presenting numerical predictions of oncologic and functional outcomes associated with partial and radical nephrectomy in a given patient, our model facilitates individualized, evidence-based clinical decision-making.
• Prostate Cancer Focal Therapy: Ready for Prime Time?
  Chi-Hang YeeHong Kong, China Speaker Robotic Total Intracorporeal Urinary Diversion – from Ileal Conduit to Neobladder to Ileal Interposition Prostate Cancer Focal Therapy: Ready for Prime Time?
• Training AI as Our Best Helper in Prediction of Continence Recovery after Robotic Prostatectomy
  Hong-Cheng Gan Taiwan Speaker Training AI as Our Best Helper in Prediction of Continence Recovery after Robotic Prostatectomy
• Digital communication and GU Oncology in the AI era
  Renu EapenAustralia Speaker Digital communication and GU Oncology in the AI era
• Discussion