PSMA-PET/CT provided superior detection of prostate cancer lesions with better sensitivity than mpMRI. PSMA-PET/CT can be used to enhance locoregional mpMRI to provide improved detection and characterization of lesions.

Abnormalities of the inferior vena cava (IVC) and renal veins are extremely rare. However, with the increasing use of computed tomography (CT), these anomalies are more frequently diagnosed. The majority of venous anomalies are asymptomatic and they include left sided IVC, duplicated IVC, absent IVC as well as retro-aortic and circumaortic renal veins. The embryological development of the IVC is complex and involves the development and regression of three sets of paired veins. During renal surgery, undiagnosed venous anomalies may lead to major complications. There may be significant hemorrhage or damage to vascular structures. In addition, aberrant vessels may be mistaken for lymphadenopathy and may be biopsied. In this review we discuss the embryology of the IVC and the possible anomalies of IVC and its tributaries paying particular attention to diagnosis and implications for renal surgery.

Objectives To compare the performance and surgical outcomes of two different single‐use digital flexible ureteroscopes with a reusable video flexible ureteroscope. Methods Patients undergoing retrograde flexible ureteroscopy at Nepean Hospital, Sydney, Australia, were included in this study. Three different flexible ureteroscopes were used in this study: (i) single‐use digital LithoVue (Boston Scientific, Marlborough, MA, USA); (ii) single‐use digital PU3022A (Pusen, Zhuhai, China); and (iii) reusable digital URF‐V2 (Olympus, Tokyo, Japan). Visibility and maneuverability was rated on a 5‐point Likert scale by the operating surgeon. Operative outcomes and complications were collected and analyzed. Results A total of 150 patients were included in the present study. Of these, 141 patients had ureteroscopy for stone treatment, four for endoscopic combined intrarenal surgery and five for diagnostic/tumor treatment. There were 55 patients in the LithoVue group, 31 in the PU3022A group and 64 patients in the Olympus URF‐V2 group. The URF‐V2 group had higher visibility scores than both the single‐use scopes and higher maneuverability scores when compared with the PU3022A. The LithoVue had higher visibility and maneuverability scores when compared with the PU3022A. There were no differences in operative time, rates of relook flexible ureteroscopes, scope failure or complication rates observed. Conclusions Single‐use digital flexible ureteroscopes have visibility and maneuverability profiles approaching that of a reusable digital flexible ureteroscope. Single‐use flexible ureteroscopes achieve similar clinical outcomes to the more expensive reusable versions.

The uterosacral ligaments (USL) have been reported to be the most common site of deep endometriosis (DE) in the pelvis 1 . A nodule within the USL may infiltrate the parametrium, increasing the complexity of surgical resection, and larger nodules (≥ 17 mm) noted on transvaginal ultrasound (TVS) should raise suspicion of ureteral involvement 2 . Nodules may also invade the torus uterinus, which is the thickening between the insertion of the USL behind the posterior cervix. The diagnostic test accuracy of TVS for USL DE is only moderate, with sensitivity and specificity of 67% and 86%, respectively 3 , which may be related to the absence of a standardized technique for its assessment. We present a method that allows easier identification of normal and abnormal USL and classification of USL DE nodules.The proposed method for TVS assessment of USL is summarized in Videoclip S1 and consists of the following steps.1. Insert the TVS probe into the posterior vaginal fornix behind the cervix and uterus. 2. Decrease the penetration depth of field and position the focal point nearest to the probe. 3. Angle the probe toward the rectum in the midsagittal position ( Figure S1). Visualize the hypoechoic posterior vaginal fornix nearest to the probe; adjacent is the hyperechoic pouch of Douglas peritoneum. Follow this hyperechoic line closely in the next step. 4. To evaluate the right USL, simultaneously sweep the ultrasound beam to the patient's right ( Figure S1) and rotate clockwise (usually not more than 45 • ); the hyperechoic line (peritoneum) should begin to thicken. The USL should be evaluated at the thickest point of the hyperechoic line. For the left USL, follow the same procedure, but instead rotating the probe counterclockwise. 5. If a hypoechoic lesion is seen within the hyperechoic USL ( Figures S2 and S3), measure it in three orthogonal planes ( Figure S4). 6. Evaluate the portion of the nodule that is within the borders of the USL and characterize the lesion according to the proposed USL DE classification system (Table 1, Figures 1 and 2), in line with the leiomyoma subclassification of submucosal leiomyomas 4 . 7. Evaluation of the ureters should always be performed ( Figure S5). A ureter of ≥ 6 mm in diameter should be considered as dilated. The kidneys should be assessed for hydronephrosis 5 .We believe that the proposed USL DE classification system (Table 1) provides a simple and standardized approach to describe such lesions, which may assist sonographers and surgeons in predicting ureteral involvement and/or the need for ureterolysis. Corresponding surgical images of USL DE with parametrial involvement are shown in Figure S6. Of course, evaluation of the USL DE classification system for its utility in diagnosis and/or preoperative planning is required before clinical implementation is considered.