Surgical treatments for benign prostatic hyperplasia (BPH) often impair sexual function. The 450 nm blue laser, with its high hemoglobin absorption and shallow penetration, offers rapid tissue vaporization while preserving sexual function. This study aims to evaluate the efficacy and safety of our blue laser vaporization technique, with a focus on preserving erection and antegrade ejaculation. This prospective cohort study enrolled 105 consecutive sexually active men (≥2 episodes/mo) with BPH who underwent transurethral blue laser vaporization between January 2023 and December 2023. The primary outcomes were the International Prostate Symptom Score (IPSS) and International Index of Erectile Function-5 (IIEF-5) at 12 mo. The median age, prostate volume, and operation time were 63 yr, 44 ml, and 25 min, respectively. The IPSS decreased from 24 to 8 (p < 0.001), and the maximum urinary flow rate (Qmax) increased from 9 ml/s to 25 ml/s (p < 0.001). Erectile function was preserved (IIEF-5: 18 vs 18, p = 0.479). Although ejaculate volume decreased (2.0 ml to 1.0 ml, p < 0.001), anejaculation occurred in only 2.8% of the patients. Transient hematuria occurred in 31.4% of the patients; 1 patient (1.0%) required reoperation for hemostasis. There were no new cases of erectile dysfunction or incontinence. The blue laser vaporization technique effectively and efficiently improves voiding outcomes through rapid prostate vaporization while preserving erectile function and antegrade ejaculation.
Lower urinary tract symptoms (LUTS) affect up to 90% of men aged >50 yrs, but few (around 10%) receive appropriate treatment. Research indicates that men with LUTS are mostly poorly informed about their urinary symptoms and view LUTS as largely unworthy of clinical attention. As a result, many men endure symptoms for lengthy periods without seeking support. In this uninformed and untreated context, men with LUTS are susceptible to anxiety about prostate cancer, fueled by widespread misconceptions about the association between prostate cancer and LUTS. Prostate cancer fear drives a sizeable proportion of male LUTS primary care consultations. This mini review examines the hitherto largely unrecognized "PSA test loop"-whereby over time, men with LUTS undergo repeated cycles of prostate-specific antigen (PSA) testing with negative results, but do not receive clinically recommended information or guidance within primary care to support their urinary symptoms. This concept arose through qualitative research, which was part of a large UK randomized controlled trial of conservative management for male LUTS [TRIUMPH study: ISRCTN11669964]. The PSA test loop is set in motion when men with LUTS attend primary care with a focus on prostate cancer and PSA testing, and when general practitioner (GP) attention subsequently shifts away from urinary symptoms and the provision of appropriate information, guidance and treatment to support male LUTS. The effect is compounded by GP consultation time constraints and by limitations in GPs' attitudes and knowledge in relation to the self-management of male LUTS. The PSA test loop is activated when men with LUTS receive negative PSA results, often by telephone, and experience relief in relation to their prostate cancer concerns, leading them to exit primary care-without follow-up and without receiving guidance to support their untreated urinary symptoms. Over time, as symptoms persist and prostate cancer fears resurface, the cycle repeats. The TRIUMPH study has demonstrated that a structured and tailored self-management intervention can be effectively delivered in primary care, outside of GP consultation time (eg, by trained health care assistants or nurses), and can provide information, guidance, reassurance and symptom relief. We propose prioritizing self-management guidance for men with LUTS in primary care, especially following negative PSA testing, to better inform men, to alleviate untreated urinary symptoms and associated prostate cancer concerns, and to deactivate the PSA test loop cycle. PATIENT SUMMARY: Older men with urinary symptoms can become trapped in cycles of prostate cancer testing (prostate-specific antigen - or 'PSA' - tests), without receiving proper advice to help relieve their symptoms. We explain how this can happen and propose offering men who receive negative PSA results a follow-up appointment in primary care with a trained nurse or health care assistant. The follow-up appointment would be an opportunity to provide men with up-to-date information on their urinary symptoms and tailored guidance, based on clinically trialed and recommended self-help techniques, to help men manage their urinary symptoms.
BACKGROUND:Prostate-specific membrane antigen (PSMA)-radioguided surgery (RGS) is an emerging technique providing real-time intraoperative guidance. The prospective TRACE-I trial demonstrated that robot-assisted 99mtechnetium-PSMA-Investigation & Surgery-RGS ([99mTc]Tc-PSMA-I&S-RGS) using a DROP-IN gamma probe is feasible and safe in recurrent prostate cancer (PCa). OBJECTIVE:To report the oncological outcmes of a post hoc analysis of the prospective TRACE-I trial cohort. DESIGN, SETTING, AND PARTICIPANTS:TRACE-I prospectively enrolled 30 patients with biochemical recurrence (prostate-specific antigen (PSA) ≥0.2 ng/ml after radical prostatectomy (RP) or ≥2 ng/ml above nadir after radiotherapy (RT) and ≤3 pelvic recurrences (nodal and/or local) on PSMA-positron emission tomography/computed tomography (PET/CT; 2020-2023). INTERVENTION:Patients underwent single-photon emission CT/CT and then robot-assisted PSMA-RGS. OUTCOMES MEASUREMENTS AND STATISTICAL ANALYSIS:Oncological outcomes were biochemical progression (PSA ≥0.2 ng/ml after RP or ≥2 ng/ml above nadir after RT), radiological recurrence on PSMA-PET/CT, and time to salvage therapy. Biochemical progression-free survival (bPFS), distant metastasis-free survival (dMFS), and therapy-free survival (TFS) were analysed using Kaplan-Meier and univariable Cox regression. RESULTS AND LIMITATIONS:Among 30 patients (19 RP, 9 RT, and 2 RP + RT), the median age was 68 yr, and the median PSA at RGS was 1.02 ng/ml (interquartile range, 0.46-2.86), 28 (93%) showed PSA decline after RGS, and 20 (66%) reached PSA <0.2 ng/ml or PSA nadir. The 1- and 2-yr bPFS were 40% and 30%; 2-yr dMFS and TFS were 62% and 58%, respectively. Recurrences were pelvic in 37% and distant in 40%. Limitations include single-centre design and small sample size. CONCLUSIONS:PSMA-RGS in the robotic setting for recurrent PCa shows an early PSA decline in almost all patients. Although biochemical progression after PSMA-RGS is common, PSMA-RGS presents an opportunity to prolong bPFS and TFS in a selection of patients. PATIENT SUMMARY:We updated outcomes from TRACE-I patients with recurrent prostate cancer. We found that PSMA-guided surgery led to PSA declines in most patients and delayed disease progression in some, but careful patient selection is essential.
BACKGROUND:The artificial urinary sphincter (AUS) is the most common surgical procedure for persistent stress urinary incontinence (SUI) after prostate surgery, whereas the male sling is a newer alternative. OBJECTIVE:To compare the 24-mo outcomes of the sling versus the AUS. DESIGN, SETTINGS, AND PARTICIPANTS:This was an unblinded, noninferiority randomised controlled trial including men from 27 UK urological centres with bothersome urodynamic SUI after prostate surgery. INTERVENTION:Men were randomised to receive a transobturator sling (n = 190) or an AUS (n = 190). Randomisation was minimised by type of surgery (radical prostatectomy/transurethral resection of the prostate), previous radiotherapy for prostate cancer (yes/no), and centre. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS:The primary outcome was self-reported continence (a composite outcome derived from two items in the validated International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form [ICIQ-UI SF]) at 12 mo after randomisation, with a noninferiority margin of 15%, via postal questionnaire. The secondary outcomes were self-reported continence, further treatments, patient-reported measures and serious adverse events up to 24 mo. RESULTS AND LIMITATIONS:A total of 380 participants were included. In terms of continence, the sling was noninferior to the AUS at 24 mo (estimated absolute risk difference in the intention-to-treat analysis, -0.006; 95% confidence interval [CI], -0.092 to 0.080; noninferiority p = 0.001), indicating lower success in the sling group, but with a CI excluding the noninferiority margin. Incontinence symptom scores (ICIQ-UI SF) decreased from 16.1 and 16.4 at baseline to 7.9 and 7.1 in the sling and AUS groups, respectively. The mean difference was 1.4 (95% CI, 0.2-2.6; p = 0.024). Secondary outcomes favoured the AUS over the sling. By 24 mo, more men underwent further surgery after receiving a sling (n = 20, 11%) than after receiving an AUS (n = 4, 2%). CONCLUSIONS:The 24-mo results confirm that the sling is noninferior to the AUS. Symptoms and quality of life significantly improved in both groups. Overall, secondary and post hoc analyses favour the AUS. PATIENT SUMMARY:Continence levels and symptoms improve with both surgeries. Most men are satisfied with their surgery, despite not being completely dry. Almost all other results show that men who have an artificial urinary sphincter have better outcomes than those who have a sling. Trial registration International Randomised Controlled Trial Registry, ISRCTN49212975. This trial was registered on July 22, 2013, and participants were randomised between January 29, 2014, and December 28, 2017.
The International Continence Society (ICS) report on the terminology for adult male lower urinary tract and pelvic floor symptoms and dysfunction provides the terminology to categorise patients based on their symptoms, signs, and study findings. It is designed to standardise communication among health care professionals involved in the care of men with lower urinary tract symptoms (LUTS). The 2026 European Association of Urology Guidelines on Non-neurogenic Male Lower Urinary Tract Symptoms and the 2026 American Urological Association Guideline on the Management of Lower Urinary Tract Symptoms Attributed to Benign Prostatic Hyperplasia are key references in the diagnosis and treatment of male patients with LUTS. The purpose of this paper is to examine how these prominent guidelines align with ICS terminology, which is considered the gold standard for the communication of male LUTS.
Transurethral resection of the prostate (TURP) has historically provided tissue for histological assessment as a by-product of surgery, but contemporary prostate cancer (PCa) pathways increasingly rely on risk stratification before surgery for benign prostatic obstruction. Although modern series suggest that incidental PCa detected in TURP specimens is relatively common, it is predominantly low grade and managed conservatively. Moreover, transition zone cancers, which are typically sampled by TURP, may show more favorable pathological features and recurrence outcomes than peripheral zone cancers, suggesting a lower risk of missing aggressive disease if routine TURP chip analysis is omitted. Routine processing is also resource intensive, may cause psychological harm, and is costly. These findings do not support routine histological examination of TURP chips in men with low preoperative suspicion of patient-important PCa and instead support evaluation of a risk-adapted strategy. PATIENT SUMMARY: Transurethral resection of the prostate is an operation to remove prostate tissue blocking urine flow. Sometimes cancer is found unexpectedly in this tissue. Most such cancers are small, slow growing, and unlikely to cause harm. Avoiding routine tissue testing may reduce worry and unnecessary follow-up while still allowing patients at higher risk to undergo selective histological evaluation.
BACKGROUND AND OBJECTIVE:Pure urothelial carcinoma (UC) and histological subtypes (HS) in bladder cancer (BC) are associated with distinct pathological features and oncologic outcomes across disease stages. Circulating tumor DNA (ctDNA) is a promising perioperative biomarker, but its prognostic performance across histologic subtypes remains unclear. We evaluated the prognostic value of perioperative tumor-informed ctDNA in patients with pure UC and HS. METHODS:We analyzed a database of consecutive patients with BC who underwent radical cystectomy with available preoperative or postoperative ctDNA between 2021 and 2025. Patients were stratified into four groups according to histology status and ctDNA detectability at both preoperative and postoperative time points. Disease-free survival (DFS) was estimated using the Kaplan-Meier method and compared with log-rank tests. Associations between groups and DFS were evaluated using uni- and multivariable Cox regression analyses. KEY FINDINGS AND LIMITATIONS:Among 138 patients with preoperative ctDNA, negative ctDNA status was associated with significantly higher 24-mo DFS compared with positive ctDNA in both pure UC (89% vs 49%, p < 0.001) and HS (79% vs 43%, p = 0.012). Multivariable Cox regression confirmed positive preoperative ctDNA as an independent predictor of recurrence or death in pure UC (hazard ratio [HR] = 4.07, 95% confidence interval [CI] = 1.29-12.81, p = 0.020) and HS groups (HR = 3.99, 95% CI = 1.24-12.82, p = 0.023). Similarly, among 144 patients with postoperative ctDNA, negative ctDNA status predicted higher 24-mo DFS in pure UC (81% vs 30%, p < 0.001) and HS (66% vs 29%, p < 0.001), with positive postoperative ctDNA independently associated with disease recurrence or death in pure UC (HR = 4.38, 95% CI = 1.66-11.52, p < 0.01) and HS groups (HR = 4.52, 95% CI = 1.86-11.03, p < 0.001). Limitations include the retrospective design and relatively short follow-up. CONCLUSIONS AND CLINICAL IMPLICATIONS:Perioperative ctDNA is a robust biomarker with consistent prognostic value and can refine perioperative risk stratification in patients with BC with pure UC or HS.
This study aimed to externally validate the performance of the European Association of Urology (EAU) Guidelines Bot in neuro-urology by assessing the accuracy, completeness, and clarity of chatbot-generated answers to guideline-based questions and to compare its performance with that of a general-purpose large language model (ChatGPT 5.5). A cross-sectional validation study was conducted using 47 questions derived from the EAU Neuro-Urology Guidelines. Each question was linked to a specific recommendation and classified by recommendation strength (strong vs weak). Questions were independently submitted to both the EAU Guidelines Bot and ChatGPT 5.5 without additional prompting. Two expert urologists independently evaluated each response for accuracy, completeness, and clarity using a five-point Likert scale; discrepancies were resolved by a third reviewer. Overall, 45 questions (95.7%) were linked to strong recommendations and two (4.3%) to weak recommendations. The EAU Guidelines Bot and ChatGPT 5.5 achieved identical mean accuracy scores (4.96 ± 0.20), with all responses rated as highly accurate (Likert 4-5). ChatGPT 5.5 indicated significantly higher completeness scores than did the EAU Guidelines Bot (4.74 ± 0.44 vs 4.57 ± 0.54; p = 0.011), whereas clarity scores were not significantly different (4.83 ± 0.38 vs 4.77 ± 0.43; p = 0.083). High-quality completeness was observed in 46/47 EAU Guidelines Bot responses (97.9%) and 47/47 ChatGPT responses (100%). Score discrepancies between systems were identified in ten of 47 questions (21.3%) and were limited to completeness and clarity domains. Performance remained uniformly high across recommendation grades, with no meaningful differences observed. The EAU Guidelines Bot showed excellent accuracy, completeness, and clarity when applied to neuro-urology guideline-based questions. Its performance was comparable to that of ChatGPT 5.5, with both systems providing highly accurate guideline-concordant responses. Although ChatGPT 5.5 generated more comprehensive answers, the EAU Guidelines Bot maintained closer adherence to the original guideline recommendations. Although not a substitute for clinical judgment, the tool appears to be a reliable adjunct for rapid access to evidence-based neuro-urological guidance.
PRostate cancer Awareness and Initiative for Screening Europe (PRAISE-U) is a project testing organized, risk-stratified prostate cancer screening. Micro-, meso-, and macrolevel stakeholders involved in PRAISE-U are participating in collaborative user boards. These stakeholders have identified themes including men's health beliefs, accessibility of screening, and considerations for success.
The BULLSEYE study suggests a role for [177Lu]Lu-PSMA-617 in the management of oligometastatic hormone-sensitive prostate cancer.
Describing a "high bladder neck" is common practice, yet it is not a standardized entity, and it lacks an evidence base in diagnostics and therapy. Recent systematic reviews report few trials, yet incision of the bladder neck remains a first-line therapy. The concept insinuates a basis for bladder outlet obstruction, so it is during voiding that such an issue should be assessed. For cystourethroscopy, the urinary tract is in the storage phase. A pressure-flow study in videourodynamics can visualize when the bladder neck is deflected into the proximal prostatic urethra by the force of bladder contraction, but this is rarely undertaken. Standard urodynamics may infer this diagnosis, but only by assuming the cause. Other forms of imaging are being evaluated, though they remain remote from delivering evidence based on therapy outcomes. Proper consensus regarding the "high bladder neck" is needed, primarily for standardization of terminology and agreement on justifiable endoscopic and imaging approaches.
