ABSTRACT Purpose: To assess the impact of thinness on the outcome of the percutaneous nephrolithotomy (PCNL). Materials and Methods: A matched case–control study was performed using a prospectively collected database of all patients who underwent PCNL between June 2011 and October 2021. The patients were stratified into two groups according to their phenotypic characteristics, arbitrarily defined according to their body mass index (BMI): <20 kg/m2 (Group 1, very thin patients, G<20) and ≥25 kg/m2 (Group 2, non-thin patients, G≥25). Patients were randomly matched based on Guy's Stone Score (GSS) according to case complexity at a ratio of 1:3. Results: A total of 204 patients were enrolled in this study: 51 patients (G<20) and 153 controls (G≥25). Complications occurred in 15.2% of the patients, with 5.4% of these complications classified as major complications (Clavien grade ≥ 3). According to complications there were no significant differences between the groups. The overall complication rates were 17.6% in the G<20 and 14.4% in the G≥25 (p = 0.653). The major complication rates were 3.9% in the G<20 and 5.8% in the G≥25 (p=0.429). No differences in transfusion or urinary fistula rates were found. Conclusions: In this study, very thin patients were not at a higher risk of complications when submitted to PCNL than in those with a BMI of ≥25 kg/m2. Apparently, this technique can be used in these patients, just as it is used in any other type of patient, independently of their BMI. Purpose PCNL. . (PCNL) Methods casecontrol control 201 2021 characteristics (BMI) 20 <2 kgm2 kgm kg m2 m kg/m Group 1 G20 G 25 ≥2 2 nonthin non G≥25. G25 G≥25) Guys Guy s GSS (GSS 13. 13 3. 3 1:3 Results 5 (G<20 15 (G≥25) 152 15.2 54 4 5.4 Clavien 3) 176 17 6 17.6 G<2 144 14 14.4 G≥2 p 0.653. 0653 0.653 0 653 0.653) 39 9 3.9 58 8 5.8 p=0.429. p0429 p=0.429 429 (p=0.429) found Conclusions Apparently patient (PCNL 202 (BMI < G2 1: (G<2 (G≥25 15. 5. 17. G< 14. G≥ 065 0.65 65 p042 p=0.42 42 (p=0.429 (G< (G≥2 06 0.6 p04 p=0.4 (p=0.42 (G (G≥ 0. p0 p=0. (p=0.4 p=0 (p=0. p= (p=0 (p=

ABSTRACT Introduction: We aim to compare the safety and effectiveness of the KangDuo (KD)-Surgical Robot-01 (KD-SR-01) system and the da Vinci (DV) system for robot-assisted radical nephroureterectomy (RARNU). Materials and Methods: This multicenter prospective randomized controlled trial was conducted between March 2022 and September 2023. Group 1 included 29 patients undergoing KD-RARNU. Group 2 included 29 patients undergoing DV-RARNU. Patient demographic and clinical characteristics, perioperative data, and follow-up outcomes were collected prospectively and compared between the two groups. Results: There were no significant differences in patient baseline demographic and preoperative characteristics between the two groups. The success rates in both groups were 100% without conversion to open or laparoscopic surgery or positive surgical margins. No significant difference was observed in docking time [242 (120-951) s vs 253 (62-498) s, P = 0.780], console time [137 (55-290) min vs 105 (62-220) min, P = 0.114], operative time [207 (121-460) min vs 185 (96-305) min, P = 0.091], EBL [50 (10-600) mL vs 50 (10-700) mL, P = 0.507], National Aeronautics and Space Administration Task Load Index scores, and postoperative serum creatinine levels between the two groups. None of the patients showed evidence of distant metastasis, local recurrence, or equipment-related adverse events during the four-week follow-up. One (3.4%) patient in Group 2 experienced postoperative enterovaginal and enterovesical fistulas (Clavien-Dindo grade III). Conclusions: The KD-SR-01 system is safe and effective for RARNU compared to the DV Si or Xi system. Further randomized controlled studies with larger sample sizes and longer durations are required. Introduction KDSurgical KD Surgical Robot01 Robot 01 Robot-0 KDSR01 KDSR SR (KD-SR-01 (DV robotassisted robot assisted RARNU. . (RARNU) Methods 202 2023 KDRARNU. KDRARNU KD-RARNU DVRARNU. DVRARNU DV-RARNU data followup follow up Results 100 margins 242 [24 120951 120 951 (120-951 25 62498 62 498 (62-498 0.780, 0780 0.780 , 0 780 0.780] 137 [13 55290 55 290 (55-290 10 62220 220 (62-220 0.114, 0114 0.114 114 0.114] 207 [20 121460 121 460 (121-460 18 96305 96 305 (96-305 0.091, 0091 0.091 091 0.091] [5 10600 600 (10-600 5 10700 700 (10-700 0.507, 0507 0.507 507 0.507] scores metastasis recurrence equipmentrelated equipment related fourweek four week followup. up. 3.4% 34 3 4 (3.4% ClavienDindo Clavien Dindo III. III III) Conclusions KD-SR-0 required Robot0 Robot- KDSR0 (KD-SR-0 (RARNU 20 24 [2 12095 12 95 (120-95 6249 6 49 (62-49 078 0.78 78 13 [1 5529 (55-29 6222 22 (62-22 011 0.11 11 12146 46 (121-46 9630 9 30 (96-30 009 0.09 09 [ 1060 60 (10-60 1070 70 (10-70 050 0.50 3.4 (3.4 KD-SR- (KD-SR- 1209 (120-9 624 (62-4 07 0.7 7 552 (55-2 622 (62-2 0.1 1214 (121-4 963 (96-3 00 0.0 106 (10-6 107 (10-7 05 0.5 3. (3. KD-SR (KD-SR (120- (62- 0. (55- (121- (96- (10- (3 (120 (62 (55 (121 (96 (10 ( (12 (6 (5 (9 (1

ABSTRACT Objective: To describe the evidence of Platelet Rich Plasma (PRP), Stem cells therapy (SCT) and Extracorporeal shockwave therapy (ESWL) for the treatment of Peyronies disease (PD), including information from the main urological society guidelines. Materials and Methods: A literature review of PubMed articles published between 2000 and 2023 was conducted, utilizing keywords such as "Peyronie's Disease", "Penile curvature", "Platelet Rich Plasma", "Stem cells", and "Extracorporeal shockwave therapy". Only full-text articles in English were included, excluding case reports and opinions. Results: A considerable number of clinical trials were conducted using PRP penile injections for therapy of PD, showing reduction of curvature, plaque size and improvement in quality of life. Preclinical studies in rats have shown the potential benefit of adipose-derived stem cells, with improvements in erectile function and fibrosis. Human studies with mesenchymal stem cells demonstrated promising results, with reduction of curvature and plaque size. ESWL effects on PD were investigated in randomized clinical trials and demonstrated no significant impact in curvature or plaque size, but reasonable effect on pain control. Conclusion: Restorative therapies has emerged as an innovative treatment option for PD and the results from current studies appear to be promising and demonstrated good safety profile. Unfortunately, due to scarce evidence, PRP and SCT are still considered experimental by American Urological Association (AUA) and European Association of Urology (EAU) guidelines. ESWT is recommended, by the same guidelines, for pain control only. More high-quality studies with long-term follow-up outcomes are needed to evaluate efficacy and reproducibility of those therapies. Objective PRP, , (PRP) (SCT (ESWL (PD) guidelines Methods 200 202 Peyronie s Disease, Disease Disease" Penile curvature" Plasma, Plasma" cells" therapy. . therapy" fulltext full text included opinions Results life adiposederived adipose derived fibrosis Conclusion profile Unfortunately AUA (AUA EAU (EAU recommended only highquality high longterm long term followup follow up (PRP (PD 20 2

ABSTRACT Purpose: Ureteroplasty using buccal or lingual mucosa graft Is feasible for complex proximal ureteral stricture (1, 2). Ileal ureter replacement is considered as the last resort for ureteral reconstruction. Totally intracorporeal robot-assisted ileal ureter replacement can be performed safely and effectively (3). In China, the KangDuo Surgical Robot 2000 Plus (KD-SR-2000 Plus) has been developed featuring two surgeon consoles and five robotic arms. This study aims to share our experience with totally intracorporeal robot-assisted bilateral ileal ureter replacement using KD-SR-2000 Plus. Materials and Methods: A 59-year-old female patient underwent a complete intracorporeal robot-assisted bilateral ileal ureter replacement for the treatment of ureteral strictures using KD-SR-2000 Plus. The surgical procedure involved dissecting the proximal ends of the bilateral ureteral strictures, harvesting the ileal ureter, restoring intestinal continuity, and performing an anastomosis between the ileum and the ureteral end as well as the bladder. The data were prospectively collected and analyzed. Results: The surgery was successfully completed with single docking without open conversion. The length of the harvested ileal ureter was 25 cm. The docking time, operation time and console time were 3.4 min., 271 min and 231 min respectively. The estimated blood loss was 50 mL. The postoperative hospitalization was 6 days. No perioperative complications occurred. Conclusions: It is technically feasible to perform totally intracorporeal robot-assisted bilateral ileal ureter replacement for the treatment of ureteral strictures using KD-SR-2000 Plus. A longer follow-up and a larger sample size are required to evaluate its safety and effectiveness. Purpose 1, 1 (1 2. 2 . 2) reconstruction robotassisted robot assisted 3. 3 (3) China 200 KDSR2000 KDSR KD SR (KD-SR-200 arms KD-SR-200 Methods 59yearold yearold 59 year old continuity bladder analyzed Results conversion cm 34 4 min. 27 23 respectively 5 mL days occurred Conclusions followup follow up effectiveness ( (3 20 KDSR200 (KD-SR-20 KD-SR-20 KDSR20 (KD-SR-2 KD-SR-2 KDSR2 (KD-SR- KD-SR- (KD-SR KD-SR

ABSTRACT Purpose: Minimally invasive radical nephrectomy is often preferred for larger renal tumours not suitable for partial nephrectomy (1). When performed with a multiport robot, the procedure is routinely performed with a transperitoneal approach, with recent studies highlighting important factors for surgical outcomes, including predictive factors (2), segmental artery unclamping techniques (3), and comparisons of robotic techniques (4). This video shows that SP Robot-Assisted Radical Nephrectomy (RARN) via a lower anterior approach is valuable in challenging cases. Materials and Methods: We performed SP-RARN on two complex patients using a retroperitoneal lower anterior approach. The first patient, a 54-year-old female with a BMI of 36.8 kg/m2, had a ventral hernia and bowel obstruction history, with a 9 cm right middle kidney mass. The second patient, a 58-year-old male with a BMI of 31.19 kg/m2, had ESRD and was on peritoneal dialysis for 8 years, with a 3.4x3.7 cm mass in the right superior pole, suspected to be RCC. The surgical technique is detailed in the video. Results: Both procedures were successful, with operative times of 173 and 203 minutes and blood loss of 150 mL. No complications occurred. Patients were discharged after 31 and 38 hours, respectively. Histopathology confirmed RCC. At the 3-month follow-up, no complications or readmissions were reported. Second patient continued peritoneal dialysis without issues. Conclusion: Retroperitoneal SP-RARN via the lower anterior approach avoids the peritoneal cavity, making it suitable for certain patients. In these patients, more so than in others, this procedure is feasible, safe, and less morbid than the standard multiport approach. Purpose 1. 1 . (1) robot outcomes 2, 2 , (2) 3, 3 (3) 4. 4 (4) RobotAssisted Robot Assisted RARN (RARN cases Methods SPRARN 54yearold yearold 54 year old 368 36 36. kgm2 kgm kg m2 m kg/m2 history 58yearold 58 3119 19 31.1 years 34x37 x 4x3 7 3.4x3. pole RCC Results successful 17 20 15 mL occurred hours respectively 3month month followup, followup follow up, up follow-up reported issues Conclusion cavity others feasible safe (1 (2 (3 (4 5 kg/m 311 31. 34x3 4x 3.4x3 ( 34x 3.4x

ABSTRACT Introduction: Robotic Radical Prostatectomy using the Da-Vinci Single-Port (SP) robot can provide comparable functional and oncological outcomes with potential advantages pertaining to peri-operative morbidity, especially in patients with an extensive history of prior abdominal surgeries (1, 2). Materials and Methods: Our case is a 74-year-old male with a history of diabetes, cardiac bypass, hypertension, and hyperlipidemia, presenting with a PSA of 7.2. His MRI showed a PIRADS-5 lesion in the left apex and mid-gland peripheral zone, and he was diagnosed with unfavorable intermediate-risk prostate cancer after MRI guided fusion biopsy. His BMI was 31, and past surgical history was pertinent for two exploratory laparotomies due to gunshot wounds and a colostomy creation followed by reversal. The standardized steps of robotic radical prostatectomy were carried out using SP robotic platform performed by author SH (3, 4). Results: Total operative time and estimated blood loss were 210 minutes and 150mL respectively. The patient was discharged on postoperative day one and final pathology showed adenocarcinoma of the prostate Gleason score 4+3=7, pT2NxR0 and negative surgical margins. The patient was continent four weeks after surgery and the PSA continues to be undetectable after three months. Conclusion: Transvesical Radical prostatectomy using the single port platform provides acceptable oncological and functional outcomes and quicker recovery given decreased risk of ileus and peritoneal irritation. Given that the abdominal cavity is not violated, the risk of bowel or vascular injury is mitigated, especially in patients with a hostile abdomen. Introduction DaVinci Da Vinci SinglePort Single Port (SP perioperative peri morbidity 1, 1 (1 2. 2 . 2) Methods 74yearold yearold 74 year old diabetes bypass hypertension hyperlipidemia 72 7 7.2 PIRADS5 PIRADS 5 PIRADS- midgland mid gland zone intermediaterisk intermediate biopsy 31 reversal 3, 3 (3 4. 4 4) Results 21 mL respectively 437 4+3=7 pTNxR pT NxR pT2NxR margins months Conclusion irritation violated mitigated abdomen ( 7. 43 4+3= 4+3 4+

ABSTRACT Objectives: To evaluate the safety and effectiveness of robot-assisted radical cystectomy (RARC), laparoscopic radical cystectomy (LRC), and open radical cystectomy (ORC) in bladder cancer. Methods: A literature search for network meta-analysis was conducted using international databases up to February 29, 2024. Outcomes of interest included baseline characteristics, perioperative outcomes and oncological outcomes. Results: Forty articles were finally selected for inclusion in the network meta-analysis. Both LRC and RARC were associated with longer operative time, smaller amount of estimated blood loss, lower transfusion rate, shorter time to regular diet, fewer incidences of complications, and fewer positive surgical margin compared to ORC. LRC had a shorter time to flatus than ORC, while no difference between RARC and ORC was observed. Considering lymph node yield, there were no differences among LRC, RARC and ORC. In addition, there were statistically significant lower transfusion rates (OR=-0.15, 95% CI=-0.47 to 0.17), fewer overall complication rates (OR=-0.39, 95% CI=-0.79 to 0.00), fewer minor complication rates (OR=-0.23, 95% CI=-0.48 to 0.02), fewer major complication rates (OR=-0.23, 95% CI=-0.68 to 0.21), fewer positive surgical margin rates (OR=0.22, 95% CI=-0.27 to 0.68) in RARC group compared with LRC group. Conclusion: LRC and RARC could be considered as a feasible and safe alternative to ORC for bladder cancer. Notably, compared with LRC, RARC may benefit from significantly lower transfusion rates, fewer complications and lower positive surgical margin rates. These data thus showed that RARC might improve the management of patients with muscle invasive or high-risk non-muscle invasive bladder cancer. Objectives robotassisted robot assisted RARC, , (RARC) (LRC) (ORC cancer Methods metaanalysis meta analysis 29 2024 characteristics Results metaanalysis. analysis. loss rate diet observed yield addition OR=0.15, OR015 OR OR= 0.15, 0 15 (OR=-0.15 95 CI=0.47 CI047 CI CI= 0.47 47 CI=-0.4 0.17, 017 0.17 17 0.17) OR=0.39, OR039 0.39, 39 (OR=-0.39 CI=0.79 CI079 0.79 79 CI=-0.7 0.00, 000 0.00 00 0.00) OR=0.23, OR023 0.23, 23 (OR=-0.23 CI=0.48 CI048 0.48 48 0.02, 002 0.02 02 0.02) CI=0.68 CI068 0.68 68 CI=-0.6 0.21, 021 0.21 21 0.21) OR=0.22, OR022 22 (OR=0.22 CI=0.27 CI027 0.27 27 CI=-0.2 068 Conclusion Notably highrisk high risk nonmuscle non (RARC (LRC 2 202 OR=0.15 OR01 015 0.15 1 (OR=-0.1 9 CI=0.4 CI04 047 0.4 4 CI=-0. 01 0.1 OR=0.39 OR03 039 0.39 3 (OR=-0.3 CI=0.7 CI07 079 0.7 7 0.0 OR=0.23 OR02 023 0.23 (OR=-0.2 048 CI=0.6 CI06 0.6 6 0.2 OR=0.22 (OR=0.2 CI=0.2 CI02 027 06 20 OR=0.1 OR0 (OR=-0. CI=0. CI0 04 0. CI=-0 OR=0.3 03 0.3 07 OR=0.2 (OR=0. OR=0. (OR=-0 CI=0 CI=- (OR=0 OR=0 (OR=- (OR= (OR

ABSTRACT Introduction: Endoscopic Combined Intrarenal Surgery (ECIRS) has emerged as a promising technique for the management of large and complex kidney stones, potentially offering advantages over traditional Percutaneous Nephrolithotomy (PCNL). This study aims to evaluate best practices, outcomes, and future perspectives associated with ECIRS. Materials and Methods: A comprehensive PubMed search was conducted from 2008 to 2024, using MESH terms and the following key words: "ECIRS" and "Endoscopic Combined Intrarenal Surgery" The search yielded 157 articles, including retrospective cohort studies, two randomized controlled trials (RCTs), and four meta-analyses comparing ECIRS with PCNL. Most important findings were summarized regarding indications, patient positioning, kidney access, tract size, surgical outcomes, and complications. Results: ECIRS demonstrated higher stone-free rate, lower complication rate, and a reduced need for multiple procedures compared to traditional PCNL. Additionally, ECIRS has the potential to integrate new technologies to further enhance outcomes. Conclusion: ECIRS demonstrates significant advantages in the management of large kidney stones. Future research should focus on well-designed RCTs to provide robust evidence of its efficacy, safety, and cost-effectiveness, potentially establishing ECIRS as the first option treatment for complex kidney stones. Introduction (ECIRS stones PCNL . (PCNL) practices outcomes Methods 200 2024 words "ECIRS 15 articles studies RCTs, , (RCTs) metaanalyses meta analyses indications positioning access size complications Results stonefree stone free rate Additionally Conclusion welldesigned well designed efficacy safety costeffectiveness, costeffectiveness cost effectiveness, effectiveness cost-effectiveness (PCNL 20 202 1 (RCTs 2

ABSTRACT Purpose: Vacuum-assisted mini-percutaneous nephrolithotomy (vmPCNL) is being increasingly adopted due to its faster operating times and lower incidence of postoperative infectious complications (IC), however, studies have been limited by small sample sizes. We hypothesize that vmPCNL is an efficacious treatment for renal stone disease with acceptable stone-free rates (SFR) and low incidence of IC. The objectives of this study were to measure SFR three months after surgery, determine the factors influencing SFR, and determine the rates of postoperative IC after vmPCNL. Materials and Methods: Seven hundred and sixty seven patients underwent vmPCNL for the treatment of renal stones > 20 mm at a single institution. Patients underwent postoperative computed tomography at three months to assess SFR. Postoperative fever and SIRS/Sepsis were recorded for individual patients. Multivariate logistics regression was performed to assess predictors of SFR. Results: The SFR was found to be 73.7% at three months. Stone burden (OR 0.39, 95% CI [0.33-0.46]) and age (OR 1.03, 95% CI [1.01-1.04]) emerged as statistically significant predictors of SFR on multivariate analysis. 5.5% of patients experienced postoperative fever, while 2.9% experienced SIRS/Sepsis. Conclusions: This is the largest continuous cohort of patients to undergo vmPCNL for stone disease and demonstrates that vmPCNL is safe and efficacious, with an SFR of 74% at three months. The incidence of postoperative fever and SIRS/Sepsis is 5.5% and 2.9% respectively. Further randomized studies with large sample sizes are required to ascertain the rates of these complications in comparison to conventional approaches. Purpose Vacuumassisted Vacuum assisted minipercutaneous mini percutaneous (vmPCNL IC, , (IC) however stonefree free (SFR surgery Methods 2 institution SIRSSepsis SIRS Sepsis Results 737 73 7 73.7 OR 039 0 39 0.39 95 0.330.46 033046 0.33 0.46 33 46 [0.33-0.46] 103 1 03 1.03 1.011.04 101104 1.01 1.04 01 04 [1.01-1.04] analysis 55 5 5.5 29 9 2.9 Conclusions 74 respectively approaches (IC 73. 3 0.3 330 0.330.4 03304 033 046 0.4 4 [0.33-0.46 10 1.0 011 1.011.0 10110 101 104 [1.01-1.04 5. 2. 0. 0.330. 0330 [0.33-0.4 1. 1.011. 1011 [1.01-1.0 0.330 [0.33-0. 1.011 [1.01-1. [0.33-0 [1.01-1 [0.33- [1.01- [0.33 [1.01 [0.3 [1.0 [0. [1. [0 [1 [

ABSTRACT Purpose: We reported, as a referral center in prostate cancer, our perspectives and experience performing Telesurgery using robotic surgery and 5G network. Material and methods: We described and illustrated the Telesurgery applications and outcomes to treat a patient with prostate cancer located 1300 kilometers away from the surgeon (Beijing-Harbin) in China. We used the Edge Medical Robot (MP1000) in November 2023 in a 71-year-old patient with Gleason 6 (ISUP 1) in 8 cores from 13, PSA of 14 ng/dL, and clinical stage cT2a. MRI described a PIRADS 5 nodule on the left peripheral zone at the base, and 20gr prostate. We described details about the connection between centers, perioperative outcomes, and our perspectives as a referral center in prostate cancer. Results: We had no delays, or problems with network connection between the centers. The procedure was performed in 60 minutes, with no intra- or postoperative complications. Estimated blood loss was 100 mL. The patient was ambulating soon after anesthesia recovery. Final pathology described a Gleason 6 (ISUP 1) involving the left base and left seminal vesicle, negative surgical margins, and no lymph node involvement (pT3bN0). The patient was continent soon after catheter removal (7 days). Conclusion: As technological progress introduced novel robotic platforms and high-speed networks, the concept of Telesurgery became a tangible reality while 5G technology solved latency and transmission concerns. However, with these advancements, ethical considerations and regulatory frameworks should underline the importance of transparency and patient safety with responsible innovation in the field. Purpose reported G methods 130 BeijingHarbin Beijing Harbin (Beijing-Harbin China MP1000 MP (MP1000 202 71yearold yearold 71 year old ISUP 1 13 ngdL ng dL ng/dL cT2a cTa cT gr centers Results delays minutes intra complications 10 mL recovery vesicle margins pT3bN0. pT3bN0 pTbN . pT bN (pT3bN0) 7 ( days. days days) Conclusion highspeed high speed networks concerns However advancements field MP100 (MP100 20 pT3bN (pT3bN0 MP10 (MP10 2 (pT3bN MP1 (MP1 (MP

ABSTRACT Introduction: The introduction of Single-Port (SP) platform opened the field to new surgical options, allowing to perform major urological robot-assisted procedures extraperitoneally and with a supine patient positioning (1–3). Nevertheless, a comprehensive description of different supine access options is still lacking (4–6). In this light, we provided a step-by-step guide of SP extraperitoneal supine access options also exploring preliminary surgical outcomes. Materials and methods: Transvesical access was performed by a transversal incision 3cm above the pubic bone, after the anterior abdominal sheet incision, the bladder was insufflated with a flexible cystoscope and the detrusor muscle was incised at the level of the bladder dome. Similarly, the extraperitoneal access was carried out with a 4cm incision above the pubic bone, once visualized the preperitoneal space the prevesical fat was gently spread. The Low Anterior Access was performed with a 3cm incision at the McBurney point, the abdominal muscles were then spread. A gentle dissection was used laterally to develop the retroperitoneal space. Results: Overall, sixteen different procedures were performed with supine extraperitoneal access on 623 consecutive patients. No intraoperative conversions occurred. The median access time was 16 (IQR 12-21), 11 (IQR 7-14) and 14 (IQR 10-18) minutes in case of transvesical, extraperitoneal and low anterior access, respectively. Notably, 81.5 % of patients were discharged on the same day with a postoperative opioid free rate of 73%. Conclusion: The Atlas provides a comprehensive step-by-step guide to successfully perform all major urological SP procedures extraperitoneally and with supine patient positioning. Introduction SinglePort Single Port (SP robotassisted robot assisted 1–3. 13 1–3 . 1 3 (1–3) Nevertheless 4–6. 46 4–6 4 6 (4–6) light stepbystep step outcomes methods cm bone dome Similarly spread point Results Overall 62 occurred IQR 1221, 1221 12 21 , 12-21) 714 7 7-14 1018 10 18 10-18 transvesical respectively Notably 815 81 5 81. 73 73% Conclusion 1– (1–3 4– (4–6 122 2 12-21 71 7-1 101 10-1 8 (1– (4– 12-2 7- 10- (1 (4 12- (

ABSTRACT Introduction: Although nerves and vessels of the penis play important role in erection, there are few studies on their development in human fetus. Therefore, the objective of the present study is to analyze, quantitatively, in the corpora cavernosa and corpus spongiosum, the development of the nerves and vessels in the fetal penis at different gestational ages. Material and Methods: Fifty-six fresh, macroscopically normal human fetuses aged from 13 to 36 weeks post-conception (WPC) were used. Gestational age was determined by the foot length criterion. Penises were immediately fixed in 10% formalin, and routinely processed for paraffin embedding, after which tissue sections from the mid-shaft were obtained. We used immunohistochemical staining to analyze the nerves and vessels in the corpus cavernous and in the corpus spongiosum. These elements were identified and quantified as percentage by using the Image-J software. Results: The quantitative analysis showed that the percentage of nerves varied from 3.03% to 20.35% in the corpora cavernosa and from 1.89% to 23.88% in the corpus spongiosum. The linear regression analysis indicated that nerves growth (incidence) in the corpora cavernosa and corpus spongiosum correlated significantly and positively with fetal age (r2=0.9421, p<0.0001) and (r2=0.9312, p<0.0001), respectively, during the whole fetal period studied. Also, the quantitative analysis showed that the percentage of vessels varies from 2.96% to 12.86% in the corpora cavernosa and from 3.62% to 14.85% in the corpus spongiosum. The linear regression analysis indicated that vessels growth (appearance) in the corpora cavernosa and corpus spongiosum correlated significantly and positively with fetal age (r2=0.8722, p<0.0001) and (r2=0.8218, p<0.0001), respectively, during the whole fetal period studied. In addition, the linear regression analysis demonstrated a more intense growth rate of nerves in the corpus spongiosum during the 2nd trimester of gestation, when compared with nerves in the corpora cavernosa. In addition, the linear regression analysis demonstrated a more intense growth rate of vessels in the corpus spongiosum when compared with the corpora cavernosa, during the whole fetal period studied. Conclusions: In the fetal period, the human penis undergoes major developmental changes, notably in the content and distribution of nerves and vessels. We found strong correlation between nerves and vessels growth (amount) with fetal age, both in the corpora cavernosa and corpus spongiosum. There is significant greater proportional number of nerves than vessels during the whole fetal period studied. Also, nerves and vessels grow in a more intense rate than that of the corpora cavernosa and corpus spongiosum areas. Introduction erection fetus Therefore quantitatively ages Methods Fiftysix Fifty six fresh 1 3 postconception post conception WPC (WPC criterion 10 formalin embedding midshaft mid shaft obtained ImageJ Image J software Results 303 03 3.03 2035 20 35 20.35 189 89 1.89 2388 23 88 23.88 incidence (incidence r2=0.9421, r209421 r r2 0 9421 (r2=0.9421 p<0.0001 p00001 p 0001 r2=0.9312, r209312 9312 (r2=0.9312 p<0.0001, , respectively studied Also 296 2 96 2.96 1286 12 86 12.86 362 62 3.62 1485 14 85 14.85 appearance (appearance r2=0.8722, r208722 8722 (r2=0.8722 r2=0.8218, r208218 8218 (r2=0.8218 addition nd gestation Conclusions changes amount (amount areas 30 3.0 203 20.3 18 8 1.8 238 23.8 r2=0.9421 r20942 942 (r2=0.942 p<0.000 p0000 000 r2=0.9312 r20931 931 (r2=0.931 29 9 2.9 128 12.8 6 3.6 148 14.8 r2=0.8722 r20872 872 (r2=0.872 r2=0.8218 r20821 821 (r2=0.821 3. 20. 1. 23. r2=0.942 r2094 94 (r2=0.94 p<0.00 p000 00 r2=0.931 r2093 93 (r2=0.93 2. 12. 14. r2=0.872 r2087 87 (r2=0.87 r2=0.821 r2082 82 (r2=0.82 r2=0.94 r209 (r2=0.9 p<0.0 p00 r2=0.93 r2=0.87 r208 (r2=0.8 r2=0.82 r2=0.9 r20 (r2=0. p<0. p0 r2=0.8 r2=0. (r2=0 p<0 r2=0 (r2= p< r2= (r2 (r