The edition · Urology
Suction changes what a flexible ureteroscopy achieves
A Bayesian network meta-analysis of 3,657 patients puts aspiration sheaths well ahead of conventional access for stones under 2 cm, including on sepsis; an FDA recall hits sildenafil and tadalafil compounding powder; and one in six schoolchildren has daytime urinary symptoms.
The edition in brief
Today's urology edition opens with paediatric bladder and bowel function: a nationwide survey of 3,100 caregiver responses found daytime lower urinary tract symptoms in 17.5% of children aged 6 to 15, nocturnal enuresis in 5.1%, and chronic functional constipation by Rome III criteria in 14.0%, with urgency the commonest symptom and boys more affected for both urinary outcomes. The regulatory sweep carries three Class II recalls dated 19 August 2026 covering sildenafil citrate and tadalafil active pharmaceutical ingredient supplied for prescription compounding, issued for good manufacturing practice deviations found on inspection at a single Indian manufacturer. A meta-analysis of four studies and 787 patients addresses whether parenchymal renorrhaphy is needed in off-clamp robot-assisted partial nephrectomy: the single randomised trial met non-inferiority without showing superiority, while propensity-matched studies favoured omitting it — a divergence the authors attribute to intraoperative selection bias. A first-in-human study of an integrated outpatient biopsy instrument in 18 patients with small recurrent non-muscle-invasive bladder cancer produced evaluable biopsies in 92% of samples under local anaesthesia with a median pain score of 0.5 out of 10 and no device-related adverse events. The practice-changer is suction-assisted flexible ureteroscopy, where flexible aspiration navigable sheaths raised the 30-day stone-free rate with an odds ratio of 2.5 (95% credible interval 2.0 to 3.1) and lowered postoperative sepsis (0.40, 0.12 to 0.97), with performance differing sharply between specific devices.
One in six children has daytime urinary symptoms
Ask about stools in every child with daytime urinary symptoms or bedwetting — 14% of children in this survey met criteria for chronic functional constipation, and it is the more treatable half of the problem.
Class II recall of sildenafil and tadalafil compounding powder
Only bulk compounding powder is affected, not licensed tablets — but if you have patients on compounded sildenafil or tadalafil preparations, check with the pharmacy where the active ingredient came from.
The randomised trial and the matched cohorts disagree about the stitch
In selected off-clamp robotic partial nephrectomy, omitting routine renorrhaphy while repairing selectively is supported as non-inferior — but there is no evidence it is better.
Taking the small bladder recurrence out of theatre
Promising and early: outpatient biopsy of small bladder recurrences under local anaesthesia gave evaluable histology in 92% of samples, but 18 patients with no comparison arm changes nothing yet.
Send the stone, and chase the result
Collect fragments at every stone procedure, send them for composition analysis, and put the result in the follow-up letter — the composition, not the image, determines what happens next.
Aspiration sheaths clear more stone and cause less sepsis
For renal stones under 2 cm, default to a flexible aspiration navigable sheath where available — higher stone clearance and, more importantly, lower postoperative sepsis.
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