Functional urology is reshaping the profile of ambulatory major urological surgery, driving a shift from conventional benign procedures toward a more complex functional and reconstructive surgical portfolio. The aim of this study was to analyze the evolution of functional urology within the ambulatory surgery program of a Urology Department, assessing its growth, its relative contribution to overall activity, and changes in its surgical case mix.

We conducted a single-center retrospective observational study of the ambulatory major surgery activity of the Urology Department between 2021 and 2025. All consecutive procedures recorded in the department’s surgical database were included, using the procedure as the unit of analysis. Cases were reclassified into six functional areas: General Urology, Functional Urology, Andrology, Reconstructive/BPH, Bladder, and Stone Disease. A descriptive analysis was performed of annual volume, subspecialty distribution, and surgical typology, with particular focus on the evolution of functional urology within the overall ambulatory surgery activity.

A total of 555 ambulatory major urological procedures were analyzed. Overall annual volume increased from 63 procedures in 2021 to 258 in 2025, representing a 309.5% increase. In 2025, functional urology reached 63 procedures and accounted for 24.4% of all ambulatory activity, ranking as the second most represented area after bladder surgery (35.7%). The functional urology case mix included prolapse surgery (n=21), mesh surgery and associated reconstructive procedures (n=11), male incontinence surgery with artificial urinary sphincter or sling (n=7), and neuromodulation procedures (n=11). Over the study period, the relative proportion of classical general urology procedures decreased.

These findings suggest that functional urology has become a major contributor to the expansion of ambulatory major urological surgery in our center. Its growth was not only quantitative but also qualitative, with progressive incorporation of more complex pelvic floor and reconstructive procedures into the ambulatory setting. The relative decline in classical general urology indicates a shift in surgical case mix, supporting the idea that ambulatory surgery is evolving from a model focused mainly on conventional benign procedures toward a more specialized and complex functional surgical practice.

Ambulatory major surgery provides a favorable framework for the expansion of functional urology in tertiary hospitals, with potential implications for surgical planning, perioperative pathways, and the development of specialized units.