Background: Catheter-based urodynamic studies remain the standard for diagnosing lower urinary tract dysfunction, but are limited by discomfort, infection risk, and restricted monitoring duration. Emerging implantable bladder sensors offer the potential for real-time wireless pressure monitoring without the need for catheters, with promising applications in neurology. This study was aimed to systematically review and compare the performance, safety, and translational readiness of intravesical and submucosal implantable bladder sensors used for real-time urodynamic assessments in preclinical and clinical studies. Materials and methods: A systematic literature search was conducted in PubMed, Scopus, and IEEE Xplore from their inception to July 10, 2025, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies that evaluated wireless implantable bladder pressure sensors in animal or human models were included. Data on the pressure fidelity, biocompatibility, implantation site, and signal stability were extracted and compared. Results: Four studies met the inclusion criteria: 3 preclinical studies (rabbit or pig) and 1 human feasibility trial. Intravesical sensors showed superior pressure fidelity (correlation coefficients up to r = 0.885), minimal error (±1 cm H 2 O), and favorable safety with no adverse effects. In humans, the UroMonitor device demonstrated an event-detection accuracy of 98% and was well tolerated. Submucosal devices achieved high event-specific correlations (r = 0.75–0.94) but were limited by erosion and signal degradation. Heterogeneity in sensor design, implantation duration, and biocompatibility has limited direct comparisons. Conclusions: Intravesical implantable sensors demonstrated higher accuracy, safety, and translational readiness than submucosal alternatives. The success of the UroMonitor in human feasibility studies underscores its potential for catheter-free ambulatory bladder pressure monitoring. Future studies should focus on long-term implantation, artificial intelligence integration, and comparative trials using conventional urodynamics.

Background:Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) accounts for 25% urology clinic visits. Due to significant overlap with other conditions, CP/CPPS is frequently misdiagnosed and inadequately managed. Therefore, we provided a simplified diagnostic and treatment approach to CP/CPPS by subdividing it into distinct subcategories.Materials and methods:We systematically reviewed the published literature about CP/CPPS and its “associated entities”, including interstitial cystitis/bladder pain syndrome, chronic bacterial vesiculitis, symptomatic prostate calcification, pudendal neuropathy, male accessory gland Inflammation, and Chlamydia trachomatis infection. We applied the UPOINTS system to differentiate CP/CPPS phenotypes, using male accessory gland inflammation solely to flag potential inflammatory–pelvic pain overlap.Results:The review yielded an evidence base of 140 articles pertaining to CP/CPPS treatment antibiotics, α-blockers, anti-inflammatory drugs, phytotherapeutics, neuromodulators, physical therapy, local blocks, injections, and minimal invasive treatments. CP/CPPS, interstitial cystitis/bladder pain syndrome, chronic bacterial vesiculitis, symptomatic prostate calcification, pudendal neuropathy, and C trachomatis infection, and developed type-specific, step-by-step diagnostic and therapeutic algorithms. The proposed treatment model includes physiotherapy, minimally invasive options, and innovative interventions.Conclusions:Dividing CP/CPPS into 6 distinct subtypes offers clinicians more targeted guidance when selecting appropriate diagnostic tools and therapeutic interventions. Sperm analysis is recommended for patients with a history of infertility, painful ejaculation, or hematospermia, whereas pyospermia warrants investigation using semen cultures, polymerase chain reaction testing, and transrectal ultrasound. Ct-infection should be ruled out in young patients with prostatitis-like symptoms, burning micturition, “penile tip irritation,” and a thick urethral discharge. Patients over 50 years of age who have failed conventional therapy may require cystoscopy. Transrectal ultrasound can help rule out clustered prostatic calcifications, especially in older, overweight patients with a persistently elevated International Prostate Symptom Score and an increased white blood cell count in postprostatic massage urine. This approach is recommended for guiding CP/CPPS treatment.

To the Editor, Microplastics and nanoplastics, plastic particles smaller than 5 mm, are now pervasive in the environment and are increasingly detected in human tissues, raising growing concerns about their potential health impacts.[1] They can cross critical biological barriers such as the blood–brain barrier and blood–placenta barrier, accumulate in protected organs such as the brain and placenta, and exert effects ranging from oxidative stress and systemic inflammation to endocrine disruption, DNA damage, and interference with reproductive function.[2] Despite these findings, the effects of microplastics and nanoplastics on human health remain underexplored, highlighting the urgent need for further research and discussion, especially in fields that focus on the organs most susceptible to their accumulation. While focus has been centered on microplastic penetration of the blood–brain barrier and blood–placenta barrier, their potential impact on male reproductive health warrants urgent attention. Of particular concern is the blood–testis barrier (BTB), a highly selective barrier formed by tight junctions between Sertoli cells that protects developing germ cells from toxicants and immune attacks. Substances capable of breaching this barrier pose a unique threat to fertility by disrupting spermatogenesis and testicular immune privilege. This issue is particularly relevant for the fields of urology and reproductive health. Recent studies in murine models have shown that nanoplastics can disrupt the BTB, reduce sperm count, alter testosterone levels, and damage testicular tissue architecture.[3] Furthermore, particle size appears to influence these effects, with some sizes inducing more abnormal spermatogenic responses and others increasing testicular weight, while all tested sizes contributed to testicular inflammation (Fig. 1). Differently sized plastic particles caused differential expression of inflammatory markers.[4] Particles of 5 and 0.5 μm reduced the area occupied by Leydig cells, suggesting a decline in their number. Interestingly, larger microplastics appeared to induce more profound dysfunction, potentially due to reduced clearance from the testicular tissue.Figure 1.: Effects of microplastics and nanoplastics on testes. Created in BioRender. Koff, B. (2025) https://BioRender.com/roueyjc.In another study, rats administered nanoplastics accumulated these particles in their testicular tissue, and oxidative stress and inflammation increased in these rats compared with controls.[5] Microplastics not only cross the BTB but also impair its structural integrity by interfering with key tight junction proteins. Nanoplastics have been shown to disrupt the production of occludin and claudin-11, two proteins that play important roles in the cell junctions that constitute the BTB.[6] With the global decline in sperm counts and rising levels of microplastics in the environment, we urge the urology and reproductive health research community to take proactive steps to address this rapidly emerging issue.[7] Understanding the downstream effects of microplastic accumulation in the testes, including the mechanisms by which it affects the BTB and spermatogenesis, may prove crucial for the future of reproductive health. Addressing this challenge requires concerted efforts spanning environmental science, urology, reproductive medicine, and toxicology to understand and mitigate the reproductive risks associated with microplastic exposure. Acknowledgments None. Statement of ethics Not applicable. Conflict of interest statement The authors declare that they have no conflicts of interest. Funding source None. Author contributions BK: Investigation, methodology development, original draft writing, and manuscript review and editing;JK: Investigation, methodology development, and project administration;RW: Oversaw project administration and contributed to manuscript review and editing;TC: Manuscript review and editing. All authors have read and approved the final manuscript. Data availability Data sharing not applicable to this article as no datasets were generated or analyzed during the current study.

Urological tumors represent a significant global health challenge, with conventional therapies often proving insufficient to control disease progression. Recent breakthroughs in cellular immunotherapy, particularly in chimeric antigen receptor (CAR)-T cell, CAR–natural killer cell, and CAR-macrophage therapies, have demonstrated remarkable potential for treating these malignancies. Ongoing research is actively refining CAR-based strategies to enhance their precision in targeting tumor-associated antigens. This review comprehensively summarizes the applications of CAR cell therapy in the following 3 major urological tumors: renal cell carcinoma, bladder cancer, and prostate cancer. Furthermore, we analyzed the current advantages and limitations of these approaches and propose potential strategies for optimization focused on CAR-T cells. This review will provide future directions in this field and contribute to the development of more effective treatments for patients with urological cancer.

1. The Urology Workforce Shortage Problem The United States (US) is facing a dramatic shortage of urologists, negatively impacting access to specialized care and exacerbating healthcare inequalities, particularly in rural areas. Advocating for this problem is essential for understanding its causes and providing potential solutions for planning and implementing effective interventions to mitigate its impact. Despite its significance, this issue remains underrecognized in the current discourse, suggesting a critical gap in advocacy efforts to prevent its consequences. The urologist shortage discussion is often framed as a concern for the future; however, the reality is that this issue is already manifesting today, although it remains frequently overlooked. Securing timely specialized urological care can be highly challenging. Rural populations across the US experience a pronounced struggle to find urological specialist care. An ecological study that leveraged data from the Department of Health and Human Services Area Resources (2006) and the United States Census (2004) found that 63% of counties in the US lack urologists.[1] According to the State of the Urology Workforce Census Book 2018, the national urologist-to-population ratio was 3.89 per 100,000 population, and the states of Wyoming and Nevada had the lowest urologist-to-population ratio of 2.59 and 2.40 per 100.000 people, respectively. In compariso, the national average of all physicians per 100,000 population in 2022 was 297, meaning that both states have figures that are less than 1% of the national physician average, clearly.,[2] demonstrating a dramatic shortage of urologists. 2. Why does this issue hold such significance and why is it projected to worsen in the coming years? First, the US population continues to age, and the number of patients requiring urological care will continue to grow. Simultaneously, the urology workforce is also getting older. According to the American Urological Association (AUA), the percentage of urologists practicing beyond the age of 65 years has increased from 22.9% in 2014 to 29.8% in 2021, and over the next decade, many are expected to retire.[3] The demand for urological services is growing; nonetheless, for the 2025 Urology Residency Match, only 385 positions are available across various programs in the US. This production rate cannot match the approaching wave of retirements or the needs of the population, thereby creating a widening gap.[4] 3. What are the potential solutions and what should we do? 3.1. Advocate for the problem! The first step is to acknowledge the scale and urgency of this problem. Collaboration between urologists, the AUA, policymakers, and healthcare organizations is essential to address this shortage and drive change by implementing effective measures and solutions. 3.2. Conduct more research Research can be an excellent tool for raising awareness and illuminating the factors associated with the shortage to better understand the drivers behind the shortage. 3.3. Increase training opportunities Expand residency training centers to address the scarcity of slots, as many qualified candidates are left unmatched each year. 3.4. Facilitate pathways for foreign graduates This is one of the fastest ways to tackle this problem. There is a large pool of extremely well-trained urologists who, after completing the United States Medical Licensing Examination board exams and training in the US, need to return to their home countries because of Visa issues. 3.5. Leverage advanced practice providers Increasing the number of nurse practitioners and physician assistants is vital for addressing this disparity and bridging the healthcare gap. 3.6. Incentivize practice in underserved areas Improving incentives, such as the repayment program for young urologists to practice in underserved areas as well as offering higher compensation packages. 3.7. Promote telehealth usage This cost-effective tool was shown to be extremely effective during the coronavirus disease pandemic, as it helped close the healthcare access gap, particularly in rural areas. 3.8. Support legislative efforts Support for the Resident Physician Shortage Act and Conrad State 30. Last year, at the AUA Advocacy Summit 2024, urologists brought legislative asks to members of the House and Senate; this type of effort should continue and be reinforced in subsequent AUA Advocacy Summits.[5] 4. Conclusions: A call to collective action to ensure the future of urological care Considering that the US population continues to age and the current urology workforce is getting older, the urology workforce shortage remains a problem that should be a priority. This is not a one-person or one-organization job. This requires communication and coordination among many stakeholders to address the problem simultaneously at different levels. Urologists, healthcare institutions, urological societies, and policymakers should collaborate to discuss and plan strategies to implement policies that will drive change and mitigate this problem.

ObjectivesTo describe the surgical approach and perioperative outcomes of a multicenter series evaluating a robotic-assisted approach to radical cystectomy with total intracorporeal urinary diversion in the setting of prior pelvic radiotherapy.Materials and methodsWe analyzed our prospective cystectomy database for patients who underwent robotic-assisted radical cystectomy for bladder cancer after radiotherapy between 2018 and 2022. Demographic information and data regarding preoperative factors including stage of disease, preoperative hydronephrosis, and history of pelvic radiotherapy were collected via review of electronic medical records. All operations were performed by 1 of 2 experienced urologists using the da Vinci X, Xi, or Si surgical platforms.ResultsTen patients were identified for this study. The median age of participants was 73.5 years (range, 41–84 years). The median American Society of Anesthesiologists classification score was 3 (range, 3–4). The median Charlson Comorbidity Index was 6 (range, 2–12). Among the patients, 4 out of 10 patients (40%) had muscle invasive bladder cancer before salvage surgery. Intracorporeal ileal conduit urinary diversion was performed in 8 patients, whereas 2 patients underwent intracorporeal neobladder formation. Median intraoperative blood loss was 250 mL (range, 150–600 mL), and median operative duration was 390 minutes (range, 195–450 minutes). The overall 30-day complication rate was 60% with a Clavien-Dindo grade ≥3 complication rate of 15%. Perioperative mortality was 0%. Median duration of follow-up was 210 days (range, 60–1580 days).ConclusionsThis series describing the outcomes of salvage robotic-assisted radical cystectomy using total intracorporeal urinary diversion demonstrates the safety of this technique. Further studies with long-term follow-up, including oncological outcomes, are required to support the widespread adoption of this procedure.

Renal cell carcinoma with inferior vena cava (IVC) tumor thrombus (RCC-IVCTT) has a high mortality rate, and surgery is the only promising treatment. Open surgery has been the gold standard treatment for several decades. However, with the development of minimally invasive surgical technologies, the advantages of robotic surgery have gradually emerged. The classic Mayo Clinic Classification system has certain limitations in guiding robotic surgery. Therefore, a new classification system that is compatible with robotic surgery is urgently needed. Advancements in robotic surgery must be systematically summarized and evaluated. Since Abaza's initial report on robotic surgery, the exploration of robotic radical nephrectomy (RRN) with IVC thrombectomy has resulted in numerous related techniques and approaches, including surgical positions and approaches, control of blood vessels, assisted exposure, step-by-step strategy, and preoperative and intraoperative auxiliary technology and equipment. Our team proposed a new tumor thrombus classification system termed the “301 Classification” based on RRN with venous thrombectomy, which matches each level of tumor thrombus with a distinct robotic surgical strategy. With advances in technology and accumulated experience, RRN with IVC thrombectomy holds promise as the preferred surgical option for RCC-IVCTT. Although “301 Classification” can provide objective advantages in robotic surgery, more cases are needed to be optimized for guiding surgery accurately. The overview provided in this paper aims to serve as a reference and inspiration for future research and clinical practice regarding RCC-IVCTT.

Penile abscesses have been reported to occur because of a wide range of causes, including blunt trauma, infection (eg, gonorrhea), and intracorporeal injections (eg, for erectile dysfunction).[1] The reported incidences are low, and published images of this pathology are rare.[2] We share such images in the case of a 47-year-old man who was previously fit and well but presented with complications after circumcision and meatal dilation at another healthcare provider. The symptoms included penile swelling, localized pain, and chills. Computed tomography revealed a penile abscess originating from the corpus cavernosum (Fig. 1). Cystoscopy confirmed concomitant urethrocavernosal fistula. Abscess drainage was assessed using interventional radiology. However, this did not fully resolve the abscess; therefore, the patient underwent open incision and drainage. Intraoperative examination revealed necrosis of the cavernosal tissue (Fig. 2). In addition to culture-guided antibiotic therapy, the patient underwent prolonged catheterization to manage the fistula. This resolved accordingly, as confirmed by using urethrography. At 6-month follow-up, the patient recovered fully and was referred to another center for consideration of a penile implant because of impaired erectile function.Figure 1: Sagittal view on computed tomography of abscess originating in the corpus cavernosum.Figure 2: Intraoperative image of necrotic cavernosal tissue.In addition to being educational, these images and cases serve as reminders that serious complications can occur even after routine and minor urological surgeries.