Deep early tumour shrinkage in metastatic upper tract urothelial carcinoma treated with enfortumab vedotin plus pembrolizumab

access during PCNL is feasible and safe in a real-world training environment.Consecutive, non-hand-selected patients were included, and access was successfully achieved by surgeons across varying levels of experience, addressing known barriers to urologist-directed access [5,6].Although the success rate reflects an early learning phase, performance metrics, minimal radiation exposure, and absence of complications are encouraging.Several limitations were identified.The phased-array probe's restricted field of view occasionally limited simultaneous visualisation of adjacent structures during needle descent, particularly for high intercostal or upper-pole access.Image quality was variably affected by rib attenuation, and systemsuggested needle trajectories were not always optimal for tract geometry, underscoring the continued importance of operator judgement.These factors contributed to the two unsuccessful device-assisted cases and represent areas for future software and hardware refinement.In summary, robot-assisted ultrasound-guided renal access using this platform was successfully performed in the majority of cases, with minimal radiation exposure and no observed complications.These preliminary findings support further evaluation in larger comparative studies to define safety, efficacy, learning curves, and costeffectiveness.