Amparore D, Piramide F, Checcucci E, et al. Three-dimensional virtual models of the kidney with colored perfusion regions: a new algorithm-based tool for optimizing the clamping strategy during robot-assisted partial nephrectomy. Eur Urol. 2023;10.1016/j.eururo.2023.04.005.

Special thanks to Drs Grace Chen and Simone Crivellaro at the University of Illinois at Chicago.

Preservation of renal function through sparing nephrons is a key goal of partial nephrectomy, and selective clamping of branches of the renal artery preserves renal function better than clamping the main renal artery. To guide the surgeon in accurately clamping the right vascular structures, 3-dimensional virtual models generated from 4-phase contrast-enhanced computed tomography scans were developed. These models can even be directly superimposed on the operative field through augmented reality technology. In this study, the researchers tested the reliability of a new 3-dimensional virtual model that employs a unique mathematical algorithm to split the kidney into more precise vascular perfusion regions.

The investigators enrolled over 100 patients with renal masses of varying complexity to undergo 3-dimensional virtual model-assisted partial nephrectomy with augmented-reality guidance. Use of this new model allowed surgeons to successfully perform selective clamping in the majority of patients, with only a small number of the more complex cases requiring global clamping. Most arteries clamped were second-order arteries, with about one-third of patients undergoing third-order artery clamping. As expected, more selective clamping strategies were associated with significantly less change in split renal function and estimated renal plasmatic flow on postoperative scintigraphy. The successful use of this innovative 3-dimensional virtual model introduces an exciting advancement in technology to aid surgeons in performing safer and more precise selective clamping during partial nephrectomy.

Krhut J, Rejchrt M, Slovak M, et al. Prospective, randomized, multicenter trial of peroneal electrical transcutaneous neuromodulation vs solifenacin in treatment-naïve patients with overactive bladder. J Urol. 2023;209(4):734-741.

Special thanks to Drs Grace Chen and Omer Acar at the University of Illinois at Chicago.

URIS is a novel electrical transcutaneous neuromodulation system designed to treat overactive bladder via selective stimulation of the peroneal nerve. A unique aspect of this system is that it does not require percutaneous needle puncture and is designed for home use. Like any new technology, the system’s safety and efficacy must be demonstrated before being offered to patients, which was the aim of this multicenter, prospective, randomized, controlled study. Treatment-naïve adult women with chronic overactive bladder symptoms were stratified to 2 treatment arms, 1 using the URIS system and the other solifenacin. The URIS neuromodulation had comparable efficacy to solifenacin but was significantly better tolerated with fewer treatment-related adverse events.

Given that this study was funded by the company producing the URIS device, such promising results should naturally be interpreted with caution and supplemented with larger-scale studies. If the results prove true, it could be a game-changer in the management of overactive bladder, a disorder plagued by low compliance rates due to poor efficacy and intolerable side effects. The only options for patients suffering from refractory overactive bladder are invasive ones such as intradetrusor botulinum toxin A injections, percutaneous tibial nerve stimulation, or sacral neuromodulation. These options all represent a significant time and cost burden to patients due to frequent clinic visits and repeat procedures. The URIS neuromodulation system could offer similar benefits with a fully noninvasive technology that can be done by the patient at home.

Lewin J, Lukaszewski T, Sangster P, et al. Reproductive outcomes after surgical sperm retrieval in couples with male factor subfertility: a 10-year retrospective national cohort. Fertil Steril. 2023;119(4):589-595.

Special thanks to Drs Ashraf Selim and Mahmoud Mima at the University of Illinois at Chicago.

Does it matter for intracytoplasmic sperm injection (ICSI) if the sperm is from the testis or epididymis, or if it is fresh or frozen? Embryology technicians will tell you that fresh is best because it comforts them to see the sperm wiggle before they mash and insert it into an egg. But is that right? Years of evidence and analysis say otherwise. In this retrospective review of almost one-quarter million ICSI cycles over 10 years from the UK Human Fertilisation and Embryology Authority, there were slightly higher implantation, pregnancy, and birth rates for epididymal vs testicular sperm, but there was no difference in outcomes between cycles using fresh and frozen sperm. Given the manifest advantages of frozen sperm—that the members of the couple don’t have to go through simultaneous procedures, that the procedure can be scheduled, and most importantly, that for an azoospermic man you know whether or not biological gametes will be available prior to ICSI—it’s clear that freezing sperm from any source makes a lot of sense.