Clinical Case Reports for the Evidence-Based Era

Methods This narrative literature review was conducted by systematically searching online databases including PubMed, Scopus, and Cochrane Library for publications between January 2018 and May 2025. The primary focus was on clinical applications of robotic and laser-assisted surgical techniques in urology. The search strategy employed keywords and Boolean operators such as: “robotic surgery” AND “urology”, “laser enucleation” OR “HoLEP” OR “PVP”, “minimally invasive” AND “urologic cancer”, “robot-assisted prostatectomy” OR “robot-assisted nephrectomy”. Inclusion criteria were: • Peer-reviewed studies, clinical trials, meta-analyses, and systematic reviews. • Publications in English. • Studies involving adult patients undergoing urologic procedures. • Focus on either robotic-assisted or laser-assisted interventions. Exclusion criteria were: • Case reports, letters to the editor, or editorials without data. • Non-English publications. • Studies focused exclusively on veterinary or pediatric populations (except where relevant for robotic urology). A total of 137 articles were identified. After screening titles and abstracts, 68 full-text articles were reviewed, and 38 studies were included in this review based on relevance, methodological quality, and recency. The primary endpoints analyzed were operative time, estimated blood loss (EBL), length of hospital stay, complication rates, and functional outcomes. Secondary endpoints included cost analysis, training requirements, and ethical implications. Robotic-Assisted Urologic Procedures Robotic-assisted surgery has revolutionized the field of urology by enhancing precision, minimizing invasiveness, and improving postoperative outcomes. The da Vinci Surgical System, approved by the FDA in 2000, remains the most widely used platform. Robotic platforms enable three-dimensional magnified vision, greater instrument articulation, and improved ergonomics, all of which are critical for complex pelvic and retroperitoneal procedures. Robotic Radical Prostatectomy (RARP) Radical prostatectomy is one of the most established robotic procedures in urology. Robotic-assisted radical prostatectomy (RARP) has largely replaced open and laparoscopic techniques due to superior visualization of the neurovascular bundles and improved continence and erectile function recovery in some cohorts (1). Multiple studies demonstrate comparable oncologic control between RARP and open surgery, with significantly reduced blood loss, lower transfusion rates, and shorter hospitalization(2). Innovations like dual-console systems and nerve-sparing algorithms are further enhancing patient outcomes. Robotic Partial and Radical Nephrectomy Robotic partial nephrectomy (RPN) is considered the standard for small renal masses due to its nephron-sparing advantages. The robotic approach allows precise tumor excision with minimal warm ischemia time and improved suturing of the renal defect(3). Compared to laparoscopic partial nephrectomy, RPN demonstrates lower conversion rates and better postoperative renal function(4)Robotic radical nephrectomy, while less commonly used than partial nephrectomy, is advantageous in selected cases for complex tumor locations or large renal masses.

Radical prostatectomy is a cornerstone of curative therapy for localized prostate cancer, offering favorable oncologic outcomes in appropriately selected patients. However, one of its most common and distressing complications is post-prostatectomy incontinence (PPI), with reported rates ranging from 4% to 40% depending on the definition used, the surgical technique, and the timing of assessment. (1,2) This complication significantly impacts health-related quality of life, causing physical discomfort, emotional distress, and social withdrawal.(3) PPI differs from other types of male urinary incontinence in both etiology and management. It primarily results from iatrogenic damage to the sphincteric mechanism during prostate removal, although additional contributing factors include detrusor overactivity, impaired compliance, and changes in bladder neck dynamics.(4,5) Despite advancements in minimally invasive and robotic-assisted surgical approaches, PPI remains a challenge for both patients and clinicians. A comprehensive understanding of the pathophysiology and risk factors for PPI is essential to develop optimal prevention and management strategies. In addition, clinicians must be well-versed in both non-surgical and surgical treatment modalities to tailor therapy to individual patient needs and expectations.(6,7) This review aims to synthesize the current evidence on PPI, focusing on identifiable risk factors, effective rehabilitative strategies, and available surgical treatments. By consolidating contemporary research and clinical guidelines, this paper seeks to provide a clear framework for the management of PPI in urologic practice.

Acute promyelocytic leukemia (APL) is a subtype of acute myeloid leukemia (AML) that underlies a block of differentiation at the promyelocyte level, which in 95% of cases is mediated by a translocation between chromosomes 15 and 17, t(15;17)(q22,q21), resulting in a fusion of the PML and RARA genes. As a result, the PML-RARα fusion protein is produced, the presence of which leads to self-renewal and inhibition of cell differentiation from the myeloid lineage at the promyelocyte stage [1, 2]. The disintegrating promyelocytes release thromboplastic granules, resulting in the induction of disseminated intravascular coagulation (DIC) syndrome, with secondary fibrinolysis and a high risk of fatal hemorrhagic complications [3]. The diagnosis of APL is made on the basis of clinical symptoms, results of peripheral blood count, flow cytometry and marrow studies including cytogenetic and molecular tests. The myelogram shows the presence of abnormal morphological promyelocytes containing characteristic granules in the cytoplasm, the so-called Aurea scabra. On cytometric examination, the analyzed marrow cells are characterized by high expression of CD13, CD33 antigens and low or absent expression of CD11b, CD34, CD117, HLA-DR antigens. However, in order to diagnose APL, it is necessary to demonstrate the presence of t(15;17) translocation by FISH or PML-RARα protein by RT-PCR or other common, less common RARα gene rearrangements [1, 4]. Due to the high risk of developing DIC syndrome and the associated high risk of patient death, antitumor treatment is already initiated when APL is suspected, that is, before results confirming the t(15;17) translocation and/or PML-RARα gene rearrangement are obtained. Treatment is based on the use of all-trans retinoic acid (ATRA), which affects the conformation of the abnormal PML-RARα fusion protein, resulting in the induction of differentiation and maturation of promyelocytes [1, 5]. COVID-19 infection is still a poorly understood disease entity. The course of the infection, its complications and distant effects are not fully known. In some cases, it may be suspected of contributing to hematopoietic dysfunction, resulting in impaired maturation of various cell lines. Covid-19 infection can, among other things, lead to the proliferation of blastic cells in the blood or bone marrow, even suggesting a diagnosis of acute proliferative disease [6]. We present the case of a patient who developed hematologic abnormalities mimicking acute promyelocytic leukemia during COVID-19 infection.