As surgical training shifts from a traditional method to a more standardized approach, objective analysis and assessment of surgeon performance has become a key focus. Surgical gestures, defined as the smallest independent units of instrument-tissue interaction, offer a quantifiable way to analyze surgical performance. Standardizing the terminology for describing surgical gestures can enhance communication during surgical training in the operating room. More importantly, surgical gesture usage has been linked to surgeon expertise and has been shown to be associated with patient outcomes. This review examines current classification systems for surgical gestures in dissection and suturing tasks, across open, laparoscopic, and robotic procedures, which serve as an armamentarium for training surgeons. It also explores how surgical gestures can complement conventional surgical assessment tools. Finally, it reviews current artificial intelligent models on gesture recognition and automation, envisions a future where gesture recognition forms the foundation for intelligent assistance in the operating room.

Coronavirus disease (COVID-19) is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which may infect the cells through binding with the angiotensin-converting enzyme 2 (ACE2) receptors that can also be found in the male reproductive organs. Relevant studies were searched in medical databases and gray literature using controlled search terms including COVID-19, SARS-CoV-2, semen, and sperm, among other related keywords. The authors of this systematic review assessed the eligibility of selected articles, followed by analysing the quality and reliability of the studies using the Cochrane Risk of Bias in Nonrandomized Studies of Exposure (ROBINS-E) tool. Collected data were processed using RevMan5 software, with a random effects model for meta-analysis. Combined mean difference and confidence intervals of semen parameters were obtained by using inverse variance method for assigning the weight of each included article. Seven studies with complete pre- and post-COVID-19 semen analysis data of the same individuals were included in the systematic review. Compiled data from a total of 153 participants revealed that COVID-19 is associated with semen quality impairment, with meta-analysis showing significant decrease of sperm concentration and progressive motility. However, the risk of bias analyses considered all the included studies as "very high risk." This study revealed the susceptibility of semen parameter impairments in association with COVID-19. However, this finding is limited by the small number of high-quality studies and the lack of control for other confounding variables of semen quality and male fertility.

Background: Adrenal tumor is a common condition that often requires adrenalectomy. The objective of this study is to compare the safety and implementation of the enhanced recovery after surgery (ERAS) among patients who received open, laparoscopic and robotic-assisted operation. The impact of ERAS on health economics was also preliminarily evaluated.

Methods: This is a retrospective study using the electronic medical records of patients with adrenal tumor at the University of Hong Kong-Shenzhen Hospital between January 2013 and December 2023. All the patients received partial or total adrenalectomy via different surgical approaches.

Results: A total of 254 participants were included in our study. Among them, 229 (90.2%) received laparoscopic adrenalectomy, 12 (4.7%) received robotic-assisted operation, and 13 (5.1%) received open surgery. The majority of the patients' costs (n = 200, 78.7%) were covered by national health insurance in China. The proportion of robotic surgery increased significantly over time (p < 0.001). Laparoscopic surgery showed significantly shorter operating time and less bleeding than open surgery (p < 0.001). Implementation of ERAS after surgery increased from 3% in 2013-2015 to 46% in 2022-2023 following the 4N protocol (no drainage, no antibiotics, no opioid analgesia, and no intravenous fluids). The out-of-pocket expenses for patients decreased from CNY 11 700 in 2013 to CNY 2700 in 2023.

Conclusion: The proportion of ERAS has increased. Despite increased total expenses, the out-of-pocket expenses for patients have significantly decreased over time via implementation of the ERAS approach.

Background: Demographic and clinical factors significantly influence urinary stone composition; however, data from other Arabian Gulf countries still lack further exploration of these variables with the aid of multivariate analyses. This study aims to address this gap by conducting an in-depth multivariate analysis of the demographic and clinical variables associated with different urinary stone compositions.

Methods: A retrospective analysis of data from 1193 patients' charts between January 2017 and February 2019. Demographic, clinical data, and stone characteristics were recorded. Statistical analyses included one-way analysis of variance, Pearson's chi-square, and multinomial logistic regression to identify factors associated with different stone compositions.

Results: A total of 1193 patients were analyzed (male:female ratio = 8:1, mean age = 42.53 ± 11.31 years, mean body mass index (BMI) = 28.22 ± 5.23 kg/m²). Calcium oxalate (CaOx) was the most common stone type (87.7%), followed by uric acid (UA) stones (9.13%). CaOx was predominant across all ethnicities. Patients with CaOx stone were younger than patients with UA and other stone types. BMI was significantly higher in the UA group. UA stone formers were more likely to have hypertension, chronic kidney disease (CKD), and recurrent urolithiasis than CaOx patients. Multinomial logistic regression identified UA stones as significantly associated with older East Asians, higher BMI, recurrent stone formation, and lower baseline glomerular filtration rate compared to CaOx.

Conclusion: CaOx was the most prevalent stone type, whereas UA stones were more commonly observed in patients with higher BMI, CKD, older age, and a history of recurrent urolithiasis. These differences highlight the importance of targeted prevention and personalized management strategies.

Background: Bladder cancer (BLCA) is the most prevalent malignancy in the urinary tract system, while ST3GAL5 is a protein-coding gene that catalyzes the formation of ganglioside monosialodihexosylganglioside 3 (GM3) synthase. GM3 synthase has been reported to significantly influence the malignant process of various cancers. However, the expression profile and functional role of ST3GAL5 specifucally in BLCA remain to be elucidated.

Methods: In order to investigate the relationship between ST3GAL5 expression and malignant biological behavior and prognosis in BLCA. The mRNA expression of ST3GAL5 and clinicopathological characteristics in BLCA were firstly evaluated by public databases. Next, immunohistochemical staining was performed to analyze the protein expression of ST3GAL5 in BLCA and paracancerous tissues, as well as the expression of various types of malignant biological behavior. Subsequently, the gene set enrichment analyses (GSEA) were performed for ST3GAL5 and all correlated genes in BLCA by sorting Pearson's Correlation Coefficient. GSEA was also used to validate the pathways affected by the different expression levels of ST3GAL5 in BLCA patients.

Results: The mRNA and protein expression of ST3GAL5 in BLCA were significantly higher in low-grade and non-muscle-invasive BLCA (p < 0.05). The results from bioinformatics databases indicated that upregulation of ST3GAL5 have a lower grade, lower pathological stage, less susceptibility to lymphatic metastasis, and lower mortality rates. Kaplan-Meier survival analysis demonstrated that upregulation of ST3GAL5 was associated with better survival in BLCA (p < 0.05).

Conclusion: Upregulation of ST3GAL5 may be related to tumor suppression in BLCA, and may be a potential prognostic and therapeutic marker for BLCA.

Background: Neuroendocrine carcinoma of the prostate is a rare tumor subtype found in the spectrum of prostate cancer, and is more difficult to detect, due to the low prostate-specific antigen values associated with it. A high degree of suspicion is hence needed to arrive at the diagnosis in such cases. Even rarer is the presentation of this subtype with metastasis to the penis.

Case Presentation: A 61-year-old South Asian gentleman presented with a penile swelling which, on evaluation with prostate-specific membrane antigen positron emission tomography-computed tomography and fine-needle aspiration cytology, turned out to be metastatic involvement from neuroendocrine-prostate cancer. The patient received a combination of pelvic radiotherapy, androgen deprivation therapy (ADT) and chemotherapy which led to a resolution in the penile lump, but subsequent rapid renal metastasis ensued and second-line chemotherapy was instituted.

Conclusion: Our case illustrates an extraordinary presentation of neuroendocrine prostate cancer with penile metastasis and urinary retention, showcasing the efficacy of radiotherapy and ADT, but also rapid progression to the viscera, underscoring the complexity of this malignancy.

Background: Hypertension secondary to giant hydronephrosis (GH) is a rare but treatable renal condition mediated by the renin-angiotensin-aldosterone system and tubuloglomerular feedback. In adults, GH is often diagnosed late due to nonspecific abdominal symptoms that may not manifest until advanced stages. Early identification is crucial, as failure to diagnose can lead to significant complications.

Case Presentation: A 60-year-old hypertensive female presented with vague right-sided abdominal pain for two weeks. Contrast enhanced computed tomography of abdomen and pelvis revealed a grossly hydronephrotic right kidney with severe pelvicaliectasis crossing the midline with thinned out parenchyma, due to ureteropelvic junction obstruction (UPJO). A renogram confirmed a non-functioning right kidney. She underwent right nephrectomy, during which 2.5 L of hemorrhagic fluid were drained. Histopathology confirmed hydronephrosis with chronic pyelonephritis. Postoperatively, her hypertension resolved, and antihypertensive medication was discontinued. At 1- and 3-month follow-ups, her blood pressure remained stable, underscoring the connection between GH and secondary hypertension.

Conclusion: GH in adults is a rare but treatable cause of secondary hypertension. Clinicians should consider renal imaging for patients presenting with unexplained hypertension to rule out hydronephrosis, ensuring timely diagnosis and management.

Applying for a urology residency as a medical student can be very intimidating. The goal of this study is to help provide the framework for understanding the process of becoming a urologist in the United States. This begins with learning about the field of urology, including what they do, the breadth of the specialty, the length of training, and career satisfaction/hours. Following this, it is important to explore the field firsthand when deciding on a specialty. This can be done through many avenues including shadowing in the clinic setting or operating room, doing urologic clinical/translational research, and attending conferences. Once someone has decided that they want to apply for a urology residency, there are several steps along the path. This article attempts to lay out these steps in a structured manner so that prospective applicants can be best set up for success in applying and matching to their desired training program.