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Bajčiová V, Zerhau P, Husár M, Ježová M, Krejčí D. Long-term results of treatment of testicular tumors in children and adolescents. A retrospective analysis of a group of patients (1998-2021). Aim: Retrospective analysis of 96 patients with primary testicular cancer treated at a pediatric oncology department in the period 1998-2021. Evaluation of epidemiology, age-specific distribution of types of germinal testicular tumors, type of operation, type of chemotherapy and treatment results. Evaluation of late effects of treatment in long-term survivors. Methods and characteristics: during the study period, 96 patients with primary testicular tumor - 89 germinal tumor type (TGCT), 6 stromal tumor type were treated. 1 patient was diagnosed with primary non-Hodgkin's testicular lymphoma. In 1 case, the tumor was bilateral. In 58 cases, TGCT was a malignant type of tumor, and a mature prepubertal teratoma was diagnosed in 31 cases. The TGCT subtype was significantly associated with the patient's age. Malignant tumors predominated in adolescents; in prepubertal age, most tumors were benign. Higher clinical stages (III and IV) were more common in adolescents. All patients underwent surgery - radical orchiectomy in 81 patients, testis sparing surgery (TSS) in 15 patients. Residual tumor mass surgery in metastatic patients after the end of chemotherapy took place in 9 patients, only 2 patients showed signs of vital tumor. No retroperitoneal lymph node dissection was indicated in any patient. Watch and wait strategies without adjuvant treatment were indicated in all prepubertal patients, in 14 adolescent patients and in all patients with stromal tumor type. Chemotherapy was indicated according to the type of tumor, clinical stage, age of the patient, the dynamics of the tumor markers and the classification into the risk group. Results: All 89 patients with TGCT achieved remission. 2 patients with vital residual tumor after the end of first-line treatment achieved clinical remission after the second-line treatment. 1 patient developed metachronous malignant TGCT in the contralateral testis 7,4 years after the primary diagnosis. 1 patient developed late metastatic progression of mixed TGCT after 3,1 years and exited. 5-year overall survival (OS) is 98,7%, 5-year event free survival (EFS) is 98,7%. The median follow-up after treatment is 11,5 years. Nephrotoxicity and ototoxicity gr I and II and fertility disorders were confirmed in 11 patients. Pulmonary toxicity is present in 2 patients, 2 patients have psychological problems. Conclusion: Testicular tumors are rare in prepubertal children, their incidence increases with age. They are the most common cancer in adolescents. The germ cell tumors are the most frequent type. The distribution of histological types of TGCT is age-specific. The patient's prognosis depends on early diagnosis, the extent of the disease and the dynamics of the decline in tumor markers. The gold standard of treatment is radical orchiectomy, TSS is possible in a well-defined group of prepubertal boys. Chemotherapy significantly improved the prognosis of TGCT and included testicular tumors among the curative types of tumors. The risks of toxicity and late effects of treatment lead to efforts to reduce the dose and duration of chemotherapy while maintaining the result

Major statement: This study evaluates the prevalence and risk factors of erectile dysfunction in a retrospective male cohort, identifying age and body mass index as independent predictors. The findings highlight substantial underdiagnosis and emphasize the need for multidisciplinary prevention and management.

Aim: The aim of the study was to retrospectively analyze the occurrence of erectile dysfunction (ED), its coded dominant etiology, and selected associated factors, particularly age, body mass index, and the use of selected medication groups, in men examined at a single specialized sexology center in the Ústí nad Labem Region.
Material and Methods: This was a retrospective observational analysis of secondary data obtained from the hospital information system of the Department of Sexology, Masaryk Hospital in Ústí nad Labem. Men aged ≥ 18 years who were examined for ED at their first outpatient visit between January 1, 2021, and December 31, 2024, were included. The type of ED was derived from clinical documentation, where it had been established by a physician during the initial evaluations. Based on this previously coded dominant etiology, patients were classified into organic ED (N48.4) or psychogenic ED (F52.2) according to the revision of the International Classification of Diseases (ICD-10).
Results: A total of 2,901 men were analyzed, with a mean age 50.47 ± 12.79 years. Psychogenic ED was coded in 52.77% of patients and organic ED in 47.23%. Body mass index data were available for 93.83% of the cohort, when more than 80% of patients were overweight or obese. Selected medication groups were used by 27.13% of patients, most commonly antihypertensives. In multivariable logistic regression analysis, body mass index (OR 1.22; 95% CI 1.01-1.48; p = 0.045) and age (OR 1.01; 95% CI 1.00-1.01; p = 0.024) were significantly associated with ED category, whereas the use of the selected medications was not. However, the magnitude of these associations was relatively small.
Conclusion: This regional cohort of men with ED shows a high prevalence of overweight and obesity and significant differences in the distribution of ED type across age categories. Age and body mass index were independently associated with coded ED etiology, whereas the use of selected medication groups was not. The interpretation of differences between etiological groups is limited by the classification based on the initial clinical assessment. The findings support the need for systematic cardiometabolic screening in men with ED.

Introduction: The indications for nephroureterectomy (NUE) for upper tract urothelial carcinoma (UTUC) are relatively clear, but questions remain regarding the technique used to perform NUE and the indications for lymphadenectomy (LND – lymph node dissection) during NUE. There is a wide range of NUE techniques (open surgery, laparoscopy, endoscopy). Basically, there is a nephrectomy phase and an ureterectomy phase, and possibly also LND, with individual techniques being combined. Open NUE remains the dominant technique for advanced tumors, otherwise minimally invasive techniques are widely used. After many years of gradually performing three methods of laparoscopic NUE, we were able to switch to the complete minimally invasive RA-NUE technique with the purchase of the da Vinci Xi robotic system. No change of position, no need for endoscopy. We present our technique in a video. Method: From July 2021 to December 2025, we performed NUE in 93 (85.3%) of 109 UTUC cases and kidney-sparing surgery in 16 (14.7%). RA-NUE from NUE in 43 (46.2%) selected patients, 5 of whom had LND (high-risk cT2–3 or high-grade and cN0). RA-NUE was performed twice for a final histology other than UC – clear cell renal carcinoma and xanthogranulomatous pyelonephritis. In another 5 (4.6%) patients, RA-NUE was performed followed by RA radical cystectomy. Laparoscopic NUE was performed in 11 (10.1%) cases when the robotic system was unavailable. Open surgery (34, 31.2%) was indicated for patients with advanced findings, who were significantly obese, or who had undergone previous extensive intraabdominal surgery. The surgical technique presented in the video: RA-NUE on the left with upper lymphadenectomy: A 4-arm da Vinci Xi system, urinary catheter, and 60° lateral position are used. The most caudal port is 12 mm for stapler application, the others are 8 mm. The assistant port is more medial, 15 mm for final insertion of the Endocatch™ bag II extraction bag. Camera 30°, ProGrasp™, Maryland™ bipolar grasper, monopolar scissors, or SynchroSeal™ sealing tool. The procedure begins with a standard nephrectomy, but the ureter is clipped early to minimize UC dissemination into the bladder. This is followed by paraaortic or paracaval LND using scissors or a sealing device. Without re-docking the system, the ureter is excised craniocaudally in this direction up to the pelvis. The testicular vein is usually preserved, and in women, the ovarian vein is preserved and the entire adnexa is folded medially. The video shows a woman after a panhysterectomy. The ureter is excised from the bladder with the bladder cuff and the bladder defect is sutured with V-Loc® 90 3-0. The suture is applied to the bladder before complete transection of the ureter, which is used for traction. The upper LND can also be performed at the end of the procedure. Extraction of the urinary catheter on the 6th postoperative day after elective cystoradiography (CRG). We do not use intravesical single-dose cytostatics. Results: A total of 45 RA-NUE in 29 men and 16 women. Average age 71.4 ± 9.3 (47.7–86.1) years. Body mass index 28.0 ± 3.77 (20.2–35.7) kg/sqm. In 38 cases, the described descending technique was used, 7 times with redocking to the pelvic part in the Trendelenburg

Male infertility is a multifactorial condition contributing to approximately 50% of all cases of couple infertility. In recent years, significant advances have been made in both diagnostics and treatment. This review summarizes key developments from 2019 to 2024 with direct relevance to routine clinical practice in Czech urology and andrology. Particular attention is paid to the updated semen analysis standards (World Health Organisation 6^th edition, 2021), sperm DNA fragmentation testing, genetic evaluation (karyotyping, Y chromosome microdeletions, and exome sequencing), surgical management of varicocele, and sperm retrieval techniques for azoospermia, including microdissection testicular sperm extraction (micro-TESE). The article also discusses pharmacological options (gonadotropins, selective estrogen receptor modulators, antioxidants), the impact of lifestyle factors, and the importance of interdisciplinary collaboration with assisted reproduction centers. Future perspectives, including the role of preventive strategies in male reproductive health, are also addressed. The aim is to provide a comprehensive and clinically applicable overview of current recommendations and therapeutic approaches in andrology, with a focus on their implementation in the Czech urological setting.

Objective: The aim of this study was to compare the incidence of positive surgical margins (PSM) in nephron-sparing surgeries on the kidneys, postoperative follow-up, and complications in patients at our institution with global trends.
Material and methods: The analysis was conducted on a set of procedures performed at the Urology clinic of University Hospital Královské Vinohrady from 2011 to 2021.
Results: During the analyzed period, a total of 611 nephron-sparing surgeries were performed at our clinic. Of these, 117 patients underwent laparoscopic partial nephrectomy (LPN) and 494 patients underwent open partial nephrectomy (OPN). Among the patients who underwent OPN, malignant histology was confirmed in 336 cases, with PSM observed in 21 patients (6.25%). In the LPN group, malignant histology was confirmed in 81 cases, with PSM found in 6 patients (7.4%). Another subgroup consisted of patients with uncertain surgical margins. Overall, in the cohort of patients who underwent OPN, this type of surgical margin was observed in 16 cases (4.7%), while in the LPN group, it was observed in 6 cases (7.4%). Local recurrence occurred in 5 cases and metastasis in 4 cases in the OPN group. In patients who underwent LPN with confirmed PSM, no cases of recurrence or metastasis were observed.
Conclusion: This research confirms alignment with the overall trend in several key aspects. The incidence of positive surgical margins in nephron-sparing surgeries on the kidneys corresponds to the values reported in the literature and confirms that positive surgical margins rarely lead to disease relapse.

Objective: To present the technique of robot-assisted diverticulectomy (RADE) in a video.File: Between 2011 and 2020, we performed 35 laparoscopic diverticulectomies, 15 of which were combined with photoselective vaporization of the prostate using a green laser (PVP). From 2021 to October 2025, we performed 16 RADE procedures. RADE technique: Supine position, lower limbs abducted. We begin with cystoscopy using a flexible (supine position) or rigid cystoscope - previously in the lithotomy position, in the last four cases already in the final position. The ureter on the side of the diverticulum is probed with a ureteral catheter. Capnoperitoneum is created with a Veres needle at a pressure of 12 mmHg. Four 8mm robotic ports and one 12mm assistant port are inserted at the level of the navel. The patient is tilted into a 30° Trendelenburg position. The Da Vinci Xi system is docked. The peritoneum is opened with scissors or a SynchroSeal™ sealing device, and the diverticulum is gradually dissected on an artificially filled bladder. Care must be taken in the area adjacent to the ureter. The bladder neck is interrupted and the defect in the bladder is closed in two layers with V-Loc™ 90 3-0. The bladder is filled to verify watertightness. The peritoneal defect is closed with V-Loc™ 90. The specimen is extracted and the defects after the ports are closed, usually without a drain. On the sixth to seventh postoperative day, the urinary catheter is removed after cystography.Results: RADE: Average age 65.1 ± 7 (52.4-72.4) years, body mass index 28.3±3.5 (21.9-33.6) kg/sqm, average procedure time (14 RADE without additional procedures) 111 ± 37 (50-182) minutes. One case had diverticulum duplex, one triplex (182 minutes). In five cases, transurethral resection of the prostate (TURP) was performed in the first stage, holmium laser enucleation of the prostate (HoLEP) in six cases, transurethral incision of the prostate (TUIP) once, simultaneous radical prostatectomy once (135 minutes) and twice without desobstructive surgery (one of which had a urothelial tumor in the diverticulum). One case was combined with nephroureterectomy (first in the lateral position for nephrectomy, then rotation to the supine position - 206 minutes). One case of partial ureter transection was treated with suture - long-term follow-up without stenosis. No postoperative complications were observed. Conclusion: RADE via transperitoneal extravesical approach is now our preferred option of diverticulectomy. We perform the desobstructive procedure in the first stage, mainly TURP or, more recently, HoLEP. Another possible option for the future is a combination of RADE and adenoma enucleation. Key words: bladder diverticulum - laparoscopy - robot - diverticulectomy Střet zájmů: Autoři prohlašují, že nemají žádný konflikt zájmů. Prohlášení o podpoře: Zpracování tohoto článku nebylo podpořeno žádnou společností.

Motolová M. The place of laparoscopy in the surgical treatment of urolithiasis. Objective: The aim of this case study is to show the advantages of laparoscopic management for therapy of complex and large pelvi-/uretherolithiasis, particularly in situations where an endoscopic approach is not successful or feasible. Simultaneously it should encourage the experienced laparoscopic surgeons to broaden their fields of interest to the therapy of urolithiasis. Methods: This single-center, retrospective study presents data collected from 02/2017 to 02/2021. Inclusion criteria: Primary laparoscopic access for therapy of lithiasis in upper urinary tract in a single session. Altogether 16 patients were subsumed - with these indications: 2× pyelolitomy (PL) for calculi in one-half of a horseshoe kidney, 5× PL for solitary large renal pelvic stones, 2× ureterolithotomy (UL) for management of large proximal ureteric stones 1× UL in the indication of an encrusted ureteral stent, with maximum stone - mass in distal ureteral portion. 6× pyeloplasty with concomitant pyelolithotomy. Primary endpoint was the evaluation of effectivity of the laparoscopic procedures based on stone free rate, operative time, complication-rate and recovery time. Secondary endpoint was the comparision with endoscopy - retrograde intrarenal surgery and percutaneus nephrolithotomy. Results: Stone free results were achieved in all cases of our study - 100% in only 1 session. Average OP time was 42 minutes. The maximal grade of complications according to the Clavien-Dindo classification was Grade I. Age range of patients: from 24 to 78 years. Average hospitalization time was 4 days. No additional radiation exposure of patients was necessary. Conclusion: Laparoscopic stone surgery is reserved for extraordinary situations, in rare cases of selected patients. In expert hands it is a safe and minimally invasive modality with high efficacy, therefore is of growing interest to urologists all over the world.

Drlík M, Krátká Z, Novák J. Qualitative and quantitative semen parameters in the light of the latest edition of the WHO manual for the examination and processing of human semen. The assessment of fertility in a man is based on the semen examination. There isn't any single universal indicator, fertility is determined by a complex of quantitative and qualitative parameters. Methods for determining these parameters are evolving and becoming more precise. They are standardised in the WHO Manual, which is regularly updated. The latest is the sixth edition of 2021. The aim of this review article is to summarize the current options for male fertility testing and to highlight some of the changes brought by the latest edition of the manual.

Študent V ml., Kurfürstová D, Skanderová D, Seifriedová Z, Česák O, Študentová H, Purová D, Študent V. Peroperative histology during robotic-assisted radical prostatectomy with lymphadenectomy: a feasibility study. Introduction: Peroperative histology (IFS) during robot-assisted radical prostatectomy (RARP) is used to ensure better oncological outcomes of surgery and, thanks to the possibility of safer nerve-sparing surgery (NS), which could improve functional outcomes such as continence. and erection. Aim: This work aims to develop our own IFS technique, verify its feasibility and describe its peroperative results in patients indicated for RARP with extended pelvic lymphadenectomy (ePLND). Materials and methods: From September 2020 to May 2021, 21 RARPs with ePLNDs were performed with IFS (intervention group). The control group (n = 42) was selected from a database of patients with RARP with ePLND without IFS operated on between December 2019 and May 2021. The control group was assigned in a 2 : 1 ratio based on age, body mass index (BMI), and risk classification groups for biochemical recurrence (EAU risk groups). The IFS technique was developed, its reliability and effect on the length of the operation, the number of positive surgical margins (PSM), and the extended PSM (ePSM, defined as PSM in multiple locations or PSM one location with a length greater than 3 mm) were verified. In the case of a positive finding on IFS, periprostatic tissue resection was performed. Baseline and perioperative results were evaluated in both groups. Results: The two groups did not differ in preoperative and pathological characteristics. The duration of surgery was longer in the intervention group (median 176 minutes, interquartile range - IQR 151-183 vs. 145 minutes, IQR 133-164, p = 0.0003). The time from specimen removal to reporting the IFS result was 55 minutes (median), IQR 52-64 minutes. The number of patients with a positive margin (PSM) was in the intervention group 6 (28,6%), while only three patients (14.3%) had an ePSM finding. In the control group, 18 patients with PSM were described (42%), while in 3 (7.1%), ePSM was found. Although the groups did not differ in the total number of PSM (p = 0.593), in the control group, there was a smaller number of patients with ePSM (p = 0.031). The degree of agreement of IFS with the definitive histopathological finding was 90.5%. The percentage of complete removal of the tumor by secondary resection was 28.6%. Conslusion: We have demonstrated the feasibility of IFS in RARP with ePLND in the Czech healthcare system. IFS showed good agreement with the definitive histopathological evaluation. It is associated with longer operation time. IFS did not improve overall PSM in this cohort but contributed to complete tumor resection in one-third of PSM patients. This feasibility study helped to gain experience with IFS and led to the launch of another study with more patients.

Dolejšová O, Bendová B, Kouba J, Heindereich F, Hora M. Urogenital system trauma in children and adolescents. Material and method: In the period from December 2012 to May 2021, a total of 72 children aged 0-19 were treated in our hospital. We retrospectively evaluated the cause of the injury, the extent of the trauma, the need for hospitalization and the method of treatment. In renal trauma, the severity of the injury was assessed according to the AAST classification (American Association for the Surgery of Trauma) and the presence of hematuria. Iatrogenic injuries were not part of our cohort. Results: 62 boys and 10 girls were injured. Injuries of external genitalia occurred the most frequently in our group - 44 cases (61 %). The whole group was treated conservatively in 41 (57 %) children. Kidney injury was reported in 24 cases (33 %). According to gender, 15 boys and 9 girls were treated with kidney injuries. Hematuria was reported in 18 children (75 %). For renal injuries, a conservative approach was chosen in 18 cases (75 %). Nephrectomy was performed four times. A total of 40 (56 %) children were hospitalized. Injuries were most often caused by sports and leisure activities and traffic accidents. Conclusion: In our group, the injuries of external genitalia occurred most often, which in most cases could be solved without the need for hospitalization. In contrast, almost all children with kidney injuries were hospitalized. In accordance with European recommendations, a conservative approach was chosen for renal injury in order to maximize the preservation of the functional renal parenchyma. According to the literature, the presence of hematuria and its severity did not correlate with the degree of renal injury. Children were most often injured in sports, leisure activities and traffic accidents.

Pacík D, Wasserbauer R, Varga G, Vít V, Fedorko M. REZUM. From the initial idea, through experiments and clinical studies to everyday clinical practice. Goal: To evaluate medium term results of treatment of lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH) using the REZUM method. Material and methods: A cohort of patients (N 177) with medium to severe LUTS were treated with the REZUM method from December 2019 until June 2021 and prospectively followed up. Before treatment all patients filled out IPSS and OABv8 questionnaires and underwent uroflometry, transrectal ultrasonography, urine examination and PSA test. These parameters were repeated 3 months and 1 year after procedure and were statistically evaluated. Results: Evaluation of symptoms after 3 months and one year were finished by 170 patients and 139 patients, respectively. Significant improvement (p < 0.001 was observed in IPSS score after 3 months and one year (median 22 vs 6.9 vs 7), in QoL score (median 4 vs 1.1 vs 1.3), OABv8 (median 17 vs 5.4 vs 6). Significant increase was observed also in Qmax (median 6.9 vs 19 vs 17.3), Qave (median 3,0 vs 9.8 vs 8.9), voided volume (median 170 vs 251 vs 289) and decrease in post voided volume (median 125 vs 0 vs 0). Significant decrease was also observed in prostate volume (median 59 vs 37.2 vs 39) and total PSA (median 2.8 vs 1.9 vs 1.9). Conclusion: REZUM is a safe and effective method in treatment LUTS due to BPH after one year follow­‑up.

Machynová S, Fedorko M, Vít V. The results of percutaneous nephrostomy tube placement under ultrasound guidance. Goal: We would like to present the experiences of our department with nephrostomy tube placement under ultrasound guidance, considering the low number of articles on this topic. Materials and Methods: In years 2018-2021, a total of 592 ultrasound-guided percutaneous nephrostomies were performed in 363 patients. The data was analyzed retrospectively. We evaluate the indications for the drainage of the upper urinary tract, the technical success rate and the number and type of complications. Results: The most common oncological indication was the obstruction or infiltration of a ureter 284 (47,97 %); and the most common non-oncological indication was obstructive pyelonephritis 156 (26,35 %). During the observed period, the success rate was 90 %. The most frequent complication was nephrostomy drain dislodgment in 105 cases within 11 weeks after the insertion. Repeated dislodgement of percutaneous nephrostomies was significantly more common in patients with bilateral nephrostomies. Conclusion: Percutaneous nephrostomy insertion under ultrasound guidance is a safe method for achieving upper urinary tract drainage.

Hrabec R., Poprach A., Čapák I., Uher M., Hulová M., Šebová N., Lakomý R., Doležel J., Staník M. Long­‑term results of neoadjuvant chemotherapy and radical cystectomy in the treatment of muscle invasive bladder cancer. Aims: Neoadjuvant chemotherapy (NAC) with radical cystectomy (RC) is the recommended treatment for muscle invasive bladder tumors (MIBC). However, more than half of patients are unable to undergo NAC due to contraindications. The aim of the study is to evaluate the long­‑term oncological results from one tertiary center and thus demonstrate the effectiveness of neoadjuvant chemotherapy in muscle­‑invasive bladder tumors. Methods: In the years 2010-2021, 100 patients with MIBC underwent neoadjuvant (for cN0) / induction (for cN+) chemotherapy - most often as a combination of cisplatin and gemcitabine. Patients with cT3-4 or cN+ were indicated for NAC; in the subgroup of cT2N0, the patients were selected according to risk factors. Out of a of 100 patients, 49 were without lymphadenopathy (cN0) and 51 with enlarged nodes (cN1-3). Progression occurred in 8 patients during NAC (2× in cN0, 6× in cN+), two patients refused surgical treatment after NAC. Subsequent radical cystectomy was performed in 47/49 cN0 and 43/51 cN1-3 patients. The study evaluated the intention­‑to­‑treat population, even the patients who did not undergo surgical treatment were included. We assessed five­‑year cancer­‑specific survival (CSS) using Kaplan­‑Meier curves and compared survival within subgroups using the log­‑rank test. Response to chemotherapy was defined as complete (pCR - ypT0N0), partial (pPR ≤ ypT1N0) or no response (non­‑R; ≥ypT2N0-3). The influence of clinical and histopathological parameters on progression­‑free survival (PFS) was evaluated using the Cox regression model. Median follow­‑up was 43 months (IQR 16-87). Results: The average age of the patients was 64 years, men and women comprised 76% and 24% of the cohort, respectively. The extent of the primary tumor was cT2 in 39 and cT3-4 in 61 cases. The median number of lymph nodes removed during procedure was 24 (IQR 19;29). Five­‑year CSS reached 84% in cT2-4N0 and 52% in cT2-4N1-3. Five­‑year CSS was not different for cN1 versus cN2-3 (53% and 50%, respectively). We recorded a response to chemotherapy (cCR+pCR) in 34/49 (69%) patients with cN0 and in 24/51 (47%) cN1-3. Achieving response to chemotherapy improved 5-year CSS in both subgroups, in cN0 patients 93% versus 60% (p=0.001), in cN1-3 85% versus 27% (p<0.001). In the entire group, the 30-day and 90-day mortality reached 0% and 3%, respectively. In multivariate analysis, significant predictors of progression­‑free survival were initial nodal involvement (HR 2.92; p=0.007) and failure to respond to NAC (HR 6.56; p≤0.001) Conclusion: In patients with invasive bladder cancer who are treated with neoadjuvant chemotherapy followed by radical cystectomy, excellent oncological results can be achieved in clinically localized disease. Even in the case of clinical lymphadenopathy, up to half of patients survive five years. Achieving a response to chemotherapy and the absence of lymphadenopathy at the time of diagnosis reduce the risk of recurrence.

Trávníček I, Mlynarčík M, Ferda J, Malán A, Michalová K, Kacerovská D, Hora M. Dynamic sentinel lymph node biopsy and its role in invasive staging of cN0 penile cancer. A 10-year experience of one institution. Aim: Invasive staging of the inguinal lymph nodes is indicated in penile cancer in intermediate- and high-risk tumours (T1 G2 and higher). Dynamic sentinel lymph node biopsy (DSLNB) or modified inguinal lymph node dissection (mILND) or minimally invasive modified video-endoscopic inguinal lymph node dissection (mVEILND) are used. Minimally invasive VEILND can also be performed robotically. The aim of this study is to evaluate the results of DSLNB at a single institution over a period of more than 10 years. Material and methods: A total of 112 patients with penile cancer (mean age 64.2 years, 24-90 years) were hospitalized between 12/2010 and 6/2021. A total of 62 patients underwent invasive lymph node staging. In 50 of them, we chose the DSLNB method for at least one groin, targeting 92 cN0 inguinal regions. In the case of a non-labeled lymph node, mILND or mVEILND was performed. For high-risk tumors (≥cT2 or G3) or suspected metastases by imaging (18F-FDG PET/CT/MRI), we chose mVEILND as the primary treatment. We evaluated the applicability and sensitivity of DSLNB. Results: Sixty-eight groins out of 92 (73.9%) were well scintigraphically labeled. In 2 cases (2.9%; 2/68), cancer metastasis was correctly identified and the procedure was extended to include radical lymphadenectomy. In 2 cases (2.9%; 2/68), DSLNB was false negative with subsequent development of metastatic involvement of the groin after previous negative DSLNB. In our cohort, DSLNB has a sensitivity of 50% (2/4). In 24 groins, no labeling occurred (26.1%). Of these, 16 groins were then managed with mILND, in one case the nodes were not captured and metastasis developed further down the line. The other 3 groins were managed by mVEILND without metastasis finding. Five groins were elected for follow up, and in 1 case, progression of unrecognized nodal metastasis occurred. Conclusion: In more than a quarter of cases, there was no scintigraphic labeling of the sentinel node, so DSLNB could not be applied. However, even with good labeling and proper performance of DSLNB, 2 of the 4 nodal metastases present were not detected and subsequent progression of metastatic involvement of the groin occurred. The sensitivity of DSLNB is 50% in our series. Therefore, in invasive staging for penile cancer, we always consider mILND and especially minimally invasive mVEILND.

Dolejšová O, Sedláčková H, Pitra T, Trávníček I, Heindereich F, Hora M. Bladder injury. Introduction: Bladder injury is an uncommon presentation encountered by urologists in clinical practice. Injury can be traumatic or iatrogenic, or more rarely spontaneous rupture. The aim of our work is to evaluate the causes, diagnostics and method of treatment in one institution. Material and methods: A group of patients was retrospectively evaluated in the period from January 2012 to May 2021. A total of 52 patients, 23 women (44%) and 29 men (56%) were treated. The mean age was 53.1 years (range 15-91, median 53,5). Results: In 20 cases (38%) the cause of the injury was iatrogenic, in 17 cases (33%) a traffic accident, in 15 cases (29%) falls from above or falls at home. The injury was diagnosed by CT scan in 40 patients (77%), perioperatively in 11 (21%) and only one patient underwent X-ray cystography. Bladder rupture occurred in 43 (83%) cases (extraperitoneal 29 (67%), intraperitoneal 14 (33%)), 9 patients (17%) suffered from bladder contusion. A total of 43 cases (83%) underwent surgical repair (one without the need for suturing), of which in 3 cases the repair was performed using a laparoscopic and once a robotic approach. Conclusion: In our group, in agreement with the professional literature, the most common was extraperitoneal rupture of the bladder (67%). CT examination was used to diagnose 77% of injuries, proving the decline of classic X-ray cystography and the preference for CT examination, which enables a comprehensive evaluation of the extent of the injury in relation to the surrounding organs. In selected cases (in our group in 4 cases, 4.8%), it is possible to successfully treat bladder injuries with a minimally invasive approach without the need for laparotomy.

Introduction: Urine cytology is primarily used for the detection of high-grade urothelial carcinoma (HGUC) in a urine sample. The typical use of urine cytology is the detection of lower urinary tract UC. There is a relatively limited knowledge about the efficacy of urinary cytology in setting of upper urinary tract urothelial carcinoma (UUTUC), i.e., urothelial carcinoma of the renal pelvis and ureter. Material and methods: A total of 68 patients treated at the Department of urology Faculty hospital Pilsen were involved retrospectively (the time period 2017-2022). All patients had histologic dia­gnosis UUTUC (based on bio­psy) and cytological examination of the urine performed before the bio­psy. The results of the urinary cytology were compared to final histology. Results: The study group included 34 patients with voided urine samples, 11 patients with washing samples, 5 patients with both types of urine collection (voided and washing urine cytology), and 18 patients with no available information regarding the method of sample collection. Urinary cytology detected 64% of HG UUTUC and 36% of low-grade (LG) UUTUC. Urinary cytology revealed 50% UC in a voided urine group, 40% UC in a selective washing group, and 55% UC in a group with no specified method of urine collection. The sensitivity of urinary cytology for HG UUTUC detection was 65% and 55% respectively (voided versus instrumented urine). In LG UUTUC, voided samples reached a sensitivity of 40%, and selective washings 20%. Conclusion: The sensitivity of urine cytology for UUTUC is not significantly different from the literature data for lower urinary tract UC; however, the sensitivity of urine cytology in UUTUC detection is in a lower percentage range of reported lower urinary tract sensitivity. Our results relatively favour voided urine samples for cytological detection of UUTUC.

Major statement: The article summarizes the medical, legal, and psychosocial aspects of gender conversion in the Czech Republic. It describes diagnostics, hormonal and surgical therapy, legislative changes effective from July 2025, and emphasizes the need for multidisciplinary, long-term, and respectful care.

Summary: Gender dysphoria currently represents an important medical, legal, and social issue, closely linked to fundamental human rights and freedoms. In the Czech Republic, the process of gender transition is embedded in the legal system, with its conditions and procedures defined primarily by the Civil Code, the Act on Specific Health Services, and related decrees. Until recently, the key legal requirement was surgical transition (specifically procedures leading to infertility), without which it was not possible to complete the official gender change in the civil registry. Although this topic is gaining attention, it remains controversial and burdened with prejudices, stereotypes, and legislative ambiguities. From a medical perspective, the process of gender transition involves comprehensive multidisciplinary care, starting with psychological and sexological assessment, followed by hormone therapy, and culminating in surgical procedures that alter primary and secondary sex characteristics. Care is concentrated in specialized centers and requires long-term interdisciplinary collaboration. The aim of this paper is to present the current legal framework of gender transition in the Czech Republic, highlight its problematic aspects, and at the same time provide an overview of medical procedures and standards of care for individuals with gender identity disorder.

Introduction: We present an innovative procedure for the surgical treatment of a significantly enlarged prostate causing urinary retention. The very good long-term results of transvesical prostatectomy led us to search for a less invasive surgical alternative. Robot- -assisted simple prostatectomy for benign prostatic hyperplasia is increasingly promoted in many countries with advanced healthcare systems. The clear surgical procedure and significantly shortened postoperative recovery led us to adopt this method. We present the performance of robotic enucleation on the da Vinci Xi - multiport device, which we adopted from abroad. Case report: A 61-year-old man, with excellent performance status, without serious comorbidities, had a significantly enlarged prostate measuring 7 × 6 × 5.5 cm with endovesical prominence and had refractory urinary retention, despite the administered combination pharmacotherapy at maximum dose. A magnetic resonance imaging was performed before the operation, which demonstrated enlarged benign prostatic hyperplasia without suspicion of prostate cancer. Similarly, the rectal examination and repeated prostatic specific antigen collection were without suspicion of the presence of carcinoma. The patient was offered robot-assisted enucleation of the enlarged prostate, which he agreed to. The operation was performed with the da Vinci Xi multiport robotic operating system. The ports were placed above the umbilicus similarly to radical prostatectomy. The patient was in the Trendelenburg position and the surgical approach was intraperitoneal. The bladder was opened at the apex with a longitudinal incision and temporary fixation sutures were placed on the edges of the incision for sufficient access for robotic instruments and a camera. The ureteral orifices, which are often close to the enlarged prostate, were localized and then enucleation was initiated. First, the entire layer of the bladder mucosa is cut with scissors and then the whitish hyperplasia of the prostate is enucleated from the surgical capsule. Bleeding is promptly stopped by coagulation. In some operations, it is possible to remove the entire enlarged prostate at once, sometimes removal in lobes is necessary. The next step is to pull the mucosa over the enucleation site and fix it with a continuous suture. It is appropriate to use a barbed suture (for example, V-Loc or similar). Finally, a catheter is inserted and left in place for 5-7 days. From June 2024 to September 2026, 24 operations have been performed. The median duration of the operation was 145 (90-220) minutes and the estimated blood loss was 220 (100-800) mL. The median weight of enucleated prostate was 89 (57-142) g. We did not experience any serious perioperative or early complications. In three patients, a temporary indwelling catheter was required due to high post-void residual. After repeated catheter removal, urinary retention recurred in only one patient. In three patients, a bladder diverticulum was also resected together with the enucleation of the benign prostatic hyperplasia. Conclusion: Robotic enucleation is a suitable alternative to open surgery for a severely enlarged prostate, especially with a large middle lobe. The disadvantage is the higher cost of the operation. The advantages are enucleation under visual contro

Introduction: Benign prostatic hyperplasia (BPH) is a common cause of lower urinary tract symptoms. When conservative treatment fails, surgical management is indicated. Robot-assisted transvesical prostatectomy represents a minimally invasive alternative to open surgery. At our department, patients with large adenomas (> 100 mL) are indicated for either HoLEP or robot-assisted transvesical prostatectomy. The procedure is performed using a multi-port system, although recent publications suggest that a single-port approach may represent a promising alternative. A potential advantage of this procedure compared to HoLEP is the avoidance of transurethral instrumentation, which may reduce the risk of urethral strictures and improve early postoperative continence. Material and methods: We present a case of a 76-year-old male with massive benign prostatic enlargement (142 mL) and chronic urinary retention. Preoperative prostatic specific antigen (PSA) level was 14.3 ng/mL; due to a PSA density of 0.10, prostate biopsy wasn\'t indicated. The procedure was performed in December 2024. The surgical video demonstrates all key steps of the surgery - bladder incision, adenoma enucleation, hemostasis, and bladder reconstruction. Operative time was 85 minutes, and 66 g of prostatic tissue was removed. Histopathology confirmed benign hyperplasia. The patient was discharged on postoperative day three, and the catheter was removed 9 days after surgery. The patient is fully continent, with no postvoid residual urine on ultrasound. Postoperative PSA was 2.09 ng/mL. Conclusion: Robot-assisted transvesical prostatectomy is a feasible and safe option for the treatment of BPH. In patients with large adenomas, it may represent an effective alternative to other surgical techniques. Further clinical evaluation is required to better define its role, particularly in comparison with HoLEP.

Major statement: Microwave ablation is a miniinvasive method of cT1 renal cell carcinomas treatment. The aim of the study is to present the oncological results and the occurrence of postoperative complications of this method at our institution.

Summary: Aim: Microwave ablation is an alternative to partial nephrectomy in the treatment of cT1 renal carcinomas. This retrospective study aims to evaluate the oncological results and postoperative complications of this method.
Patient population: The retrospective, single institution study included 63 patients who underwent a total of 78 microwave ablations at our institution, between 2012 and 2023.
Results: The study demonstrated a close relationship between oncological results and tumor size. In patients with tumors < 3 cm, 86% of patients remained recurrence-free during the follow-up, while in the group with tumors over 3 cm in the largest dimension, 68% of patients did not have a recurrence. Postoperative complications occurred in 18% of patients in general and 6% were serious (Clavien-Dindo score ≥ 3). Conclusion: Microwave ablation in the treatment of localized renal tumors (cT1) represents a modern and safe miniinvasive technique. The therapeutic outcome is closely dependent on the tumor size. For tumors up to 3 cm, the method achieves comparable oncological results with a similar frequency of postoperative complications as partial nephrectomy.