Insight Urology

Phitsanu Mahawong — 2026-06-28

Kidney health for all: caring for people, protecting the planet

Raymond Vanholder — 2026-06-28

The current kidney care model with its focus on late-stage disease and in-center hemo-dialysis is unsustainable, largely because of costs, environmental burden, poor outcomes, and reduced quality of life. Recognition of kidney disease by the 78th World Health Assembly as a serious health threat presents a critical opportunity to reshape kidney care. Aligned with this, the 2026 World Kidney Day theme, “Kidney Health for All: Caring for People, Protecting the Planet”, calls for a systematic change. A sustainable model must prioritize early detection and prevention, reducing the need for kidney replacement therapy. Transplantation and home dialysis benefit people with kidney failure, environment and society, however, dialysis itself must become more eco-friendly without compromising care quality, recognizing that planetary perturbations in turn affect kidney health. Conservative care should also be considered, particularly in the case of elderly and frail patients when the quality-of-life benefits potentially out-weigh the perspectives offered by dialysis. Achieving this shift requires coordinated action across all stakeholders; education and engagement of the public, policy makers and health professionals to raise awareness about the threat of kidney disease; and an urgent move toward patient-centered care.

Contemporary management of locally advanced and metastatic renal cell carcinoma: An update of current evidence

Tanan Bejrananda — 2026-06-28

Management of renal cell carcinoma (RCC), particularly locally advanced (laRCC) and metastatic disease (mRCC), has evolved rapidly with the integration of immune checkpoint inhibitors, targeted therapies, and multimodal strategies. The aim of this review is to provide an updated, evidence-based overview of current treatment paradigms and emerging concepts.

A comprehensive literature review was conducted focusing on pivotal phase III trials, contemporary guidelines (EAU, NCCN), and recent advances in systemic therapy, surgery, and metastasis-directed approaches. Key domains included: (i) management of locally advanced RCC; (ii) first-line systemic therapy in clear cell mRCC; (iii) second- and later-line treatment; (iv) non-clear cell and sarcomatoid variants; and (v) oligometastatic and oligoprogressive disease.

Adjuvant immunotherapy, particularly in regard to pembrolizumab, has become standard in selected high-risk laRCC following nephrectomy. In mRCC immune checkpoint inhibitor–based combination therapies (IO–IO or IO–TKI) have demonstrated superior survival outcomes in comparison to monotherapy. Novel agents such as HIF-2α inhibitors (e.g., belzutifan) are expanding treatment options in later lines. Increasing emphasis is placed on individualized strategies, including active surveillance in favorable-risk patients and metastasis-directed therapy in oligometastatic disease.

The management of la/mRCC is increasingly personalized and multidisciplinary. While immunotherapy-based combinations dominate current practice, ongoing trials and biomarker development will further refine treatment sequencing and patient selection.

Current management practices of the posterior urethral valve

Kittipong Phinthusophon — 2026-06-28

The posterior urethral valve is a condition with a broad clinical spectrum. To understand the severity of bladder outlet obstruction, the different forms of valve need to be understood. Early diagnosis and treatment in both prenatal and postnatal periods improve renal outcome and may also benefit bladder function. Initial surgical intervention aims to eliminate outlet obstruction and restore renal function. However, long-term follow-up and treatment are also important especially for bladder dysfunction which can change during childhood and persist into adulthood. The treatment should include all of the modalities that assist bladder function in both filling and voiding phases.

Instructions for Authors

Phitsanu Mahawong — 2026-06-28

Covers

Phitsanu Mahawong — 2026-06-28

Editorial Board

Phitsanu Mahawong — 2026-06-28

Comparison of surgical efficacy in total en-bloc Holmium laser enucleation of the prostate: Self-learning vs. mentor-guided training

Makkati Boonma — 2026-06-28

Objective: To compare the efficacy of prostate enucleation using Holmium laser (HoLEP) with total en bloc technique between urologists learning HoLEP inde- pendently versus those receiving mentorship. The aim of this study is to provide valuable insights for the optimization of surgical education.

Materials and Methods: A retrospective study was conducted at Thammasat University Hospital, Thailand, comparing the outcomes of surgery carried out by two urologists performing their first 30 HoLEP cases. One of the surgeons learned independently through online surgical videos, while the other received direct mentorship from an experienced HoLEP surgeon. The primary outcome was enucleation efficiency (EE), measured as weight of prostate tissue removed (grams) per minute of enucleation time. Secondary outcomes included perioperative complications, blood loss, catheterization time, length of hospital stay, and functional outcomes such as changes in International Prostate Symptom Score (IPSS), Qmax, and post-void residual urine (PVR).

Results: Sixty patients underwent HoLEP between 2019 and 2025, with 30 patients operated on by each surgeon. The analysis of enucleation efficiency (EE) between the two surgeons reveals notable differences in surgical performance. Across the 30 cases, a consistently higher EE value was recorded in the cases operated on by the mentor-guided surgeon suggesting a more efficient enucleation process. The analysis revealed that the mean EE in the mentor-guided surgeon group was 1.15 ± 0.44 g/minute, whereas in the patients operated on by the self-learning surgeon it was 0.71 ± 0.20 g/minute. This difference was found to be statistically significant (p < 0.001). Additionally, a higher improved Qmax of 9.2 ± 4.6 ml/sec was shown in the mentor-guided surgeon group in comparison to the cohort operated on in the self-learning group which was 12.9 ± 8.8 (p < 0.05). There was also a decrease in some of 30 day post-op complications specifically hematuria 13 (43.3%) vs 1(3.3%) (p < 0.05), capsular perforation 2 (6.7%) vs 0 (0.0%) (p < 0.05) and urinary retention 12 (40.0%) vs 0 (0.0%) (p < 0.05) in the mentor guided patients.

Conclusion: In this study it was found that mentor-guide training in HoLEP significantly enhances enucleation efficiency in comparison to self-learning. These findings highlight the importance of structured training in improving surgical proficiency and patient outcomes in HoLEP surgery.

Comparison of surgical outcomes in adrenal vein control between advanced bipolar vessel sealer and titanium clips in laparoscopic transperitoneal adrenalectomy for aldosterone- producing adenoma: A retrospective cohort study

Jirayu Chalermpong — 2026-06-28

Objective: To compare the outcomes of laparoscopic adrenalectomy carried out for aldosterone-producing adenoma (APA) with a focus on the controlled manipulation of the adrenal vein using LigaSureTM versus titanium clips.

Materials and Methods: This retrospective study included patients diagnosed with APA undergoing laparoscopic adrenalectomy from January 1, 2015, to October 30, 2023. A total of 84 patients were divided into two groups. In the first 42 patients (Group 1) titanium clips were used for adrenal vein control, while in the subsequent 42 patients (Group 2) LigaSureTM (clipless) was used. Procedures were performed by a single surgeon at Rajavithi Hospital. The primary outcomes used to evaluate the overall effectiveness of adrenal vein control were operative time, estimated blood loss, and duration of hospital stay.

Results: Statistically significant differences were observed favoring the LigaSureTM group in operative time (100.83 ± 21.26 minutes vs. 128.69 ± 29.85 minutes, p < 0.001), estimated blood loss (9.10 ± 8.50 ml vs. 38.69 ± 40.84 ml, p < 0.001), and hospital stay (4.19 ± 0.89 days vs. 5.57 ± 1.81 days, p < 0.001).

Conclusion: LigaSureTM demonstrated superior efficacy over titanium clips with regard to adrenal vein control during laparoscopic adrenalectomy in patients with APA, offering shorter surgery time, reduced blood loss, and shorter hospital stays.

Comparison of tubeless drainage and nephrostomy tube as a drainage method after percutaneous nephrolithotomy procedure: A prospective study

Prakhar Chaudhary — 2026-06-28

Objective: The standard procedure of PCNL involves insertion of a nephrostomy tube for drainage. The nephrostomy tube also serves as a medium to tamponade bleeding, and in cases where any remnant calculus requires re-exploration, the nephrostomy tube has been proved to be beneficial in providing access. However, presence of a tube may hamper PCNL in cases of day surgery. Tubeless PCNL could be the ideal approach in selecting which patients might be suitable for same day discharge. The objective of this study is to re-explore each drainage technique following PCNL and to compare the safety of these drainage procedures with a clear-cut clinical parameter imposed.

Materials and Methods: Inclusion Criteria: people aged 18 years and above, patients of either gender, all cases of renal calculi who underwent percutaneous nephrolithotomy. Exclusion Criteria: patients who needed more than 2 percutaneous tracts, patients with a solitary kidney or with bilateral renal calculi or with staghorn calculi or patients who had a residual stone after the procedure, patients having congenital renal anomalies, for example horse shoe kidney, mal rotated kidney, duplex moiety, ectopic kidney, patients with pelvis injury and extravasation during surgery. Total sample size was calculated to be 140 (70 in each group). Post operatively, patients in the two groups will be assessed on the following parameters: postoperative pain, analgesic requirement, complications, duration of hospital stay, return to normal activity and mean Hb decrease.

Results: Tubeless PCNL was significantly associated with shorter operative time, shorter hospital stay, faster time to return to normal activity, lower postoperative pain score, lower postoperative analgesia requirements, and lower urine leakage. There were no significant differences in postoperative haemoglobin reduction, stone-free rate, postoperative fever rate, or rate of blood transfusion.

Conclusion: Conclusions made from the outcomes of this study were that in com- parison to standard PCNL, use of the tubeless PCNL conferred statistically significant advantages in terms of post-operative pain, morbidity, length of hospital stay and period of convalescence. As tubeless PCNL decreased length patient hospital stay and analgesic requirement this procedure is more efficacious for day care surgery.

Editorial

Phitsanu Mahawong — 2026-06-28

Insight Urology

Contents

Kidney health for all: caring for people, protecting the planet

Contemporary management of locally advanced and metastatic renal cell carcinoma: An update of current evidence

Current management practices of the posterior urethral valve

Instructions for Authors

Covers

Editorial Board

Comparison of surgical efficacy in total en-bloc Holmium laser enucleation of the prostate: Self-learning vs. mentor-guided training

Comparison of surgical outcomes in adrenal vein control between advanced bipolar vessel sealer and titanium clips in laparoscopic transperitoneal adrenalectomy for aldosterone- producing adenoma: A retrospective cohort study

Comparison of tubeless drainage and nephrostomy tube as a drainage method after percutaneous nephrolithotomy procedure: A prospective study

Editorial