INTRODUCTION: Despite the importance of residents and fellows to the national urologic workforce, comprehensive data describing Canadian urology trainees has been limited. This study reports findings from the inaugural Canadian Urological Association (CUA) Resident Census. METHODS: A national, cross-sectional, anonymous, electronic survey of Canadian urology residents and fellows was conducted between May and August 2025. Survey develop-ment was led by the CUA Resident and Fellow Committee and the Postgraduate Training Committee. Descriptive statistics were used to characterize demographics, recruitment, train-ing experiences, workload, career planning, and future priorities. RESULTS: Of 271 eligible trainees, 143 responded (53%), including 116 residents (81%) and 27 fellows (19%); 33.7% of respondents were female and 2% were queer/non-binary. Urology trainees reported high satisfaction with the residency match process. Almost all residents (89%) indicated their intention to pursue fellowship training, most commonly in oncology and endourology. Insufficient exposure was greatest among andrology, urogynecol-ogy/reconstructive pelvic surgery, and gender-affirming care subspecialties. Trainees reported working an average of 75 clinical hours per week, with over half exceeding 80 hours. Over one-third (36%) reported experiencing mistreatment during training, most frequently from clinical supervisors. CONCLUSIONS: This first national CUA Resident Census identified changing trends in demographics, while also highlighting potential issues such as high workload and variable subspecialty exposure. Limitations included a moderate response rate, regional overrepre-sentation of larger provinces, and reliance on self-reported data. These findings establish a baseline to inform advocacy, educational planning, and future longitudinal assessment.
Erectile dysfunction (ED) is a common male sexual disorder with significant implications for quality of life, interpersonal relationships, and overall health. Although its prevalence increases with age and comorbid conditions, ED remains underdiagnosed and undertreated worldwide. This narrative review provides a comprehensive overview of the epidemiology, pathophysiology, diagnostic evaluation, and management of ED, drawing primarily on established global evidence and clinical guidelines. Data and experiences from African settings are incorporated, where available, to illustrate contextual challenges related to healthcare access, cultural perceptions, and resource limitations, as well as emerging trends in presentation and treatment patterns.
INTRODUCTION: We aimed to evaluate the efficacy and safety of lutetium-177-PSMA-617 in patients with metastatic castration-resistant prostate cancer (mCRPC) following approval in the real-world Canadian clinical context. METHODS: Data on the first 50 patients with mCRPC who were treated with 177Lu-PSMA-617 at a single center in Quebec, Canada, were retrospectively analyzed. Patients were treated with 7.4 GBq of 177Lu-PSMA-617 administered every six weeks for up to six cycles. RESULTS: Median (95% confidence interval [CI]) patient age and pre-radioligand therapy prostate-specific antigen (PSA) levels were 72.55 (65.92-76.77) years and 49.19 (15.61-180.65) ng/mL, respectively. Median (95% CI) time between oncologist referral for radioligand therapy and nuclear medicine consultation or first dose of 177Lu-PSMA-617 were 12 (7.0-32.0) and 42 (28.0-54.0) days, respectively. Overall, 26.0% of patients completed six radioligand therapy cycles. Declines in PSA levels of 25%, 50%, and 90% were reached in 57%, 51%, and 17% of patients, after a median of two, two, and three cycles, respectively. At last followup, after a mean followup time of 8.5 months, 61% (25/41) of patients not on ongoing therapy were alive, with an estimated median overall survival of 13.0 months (95% CI 8.0-not reached). CONCLUSIONS: Real-world data show that use of177Lu-PSMA-617 in patients with mCRPC is feasible in a universal healthcare system, with comparable oncologic activity to that observed in the phase 3 VISION trial. The study is limited by the short followup and its retrospective nature.
INTRODUCTION: Automated segmentation using artificial intelligence (AI) has the potential to rapidly perform three-dimensional (3D) segmentation of small renal masses (SRM). The objective of this study was to test for clinically and statistically significant differences in time spent segmenting, accuracy, and reliability when comparing manual and automated segmentation of computed tomography (CT) scans with SRM. METHODS: Patients with a CT scan, SRM <4 cm, and renal neoplasm were identified through an institutional database. Of the 854 patients identified, 184 were excluded. Forty test cases were randomly selected. There were 630 cases for training (using nnU-Net) to which 488 cases from the KiTS23 open-source dataset were added. Each of the test cases was segmented by a radiologist, a urologist, and the AI model. Time to segment and Dice coefficients were compared. Deidentified segmented CTs were provided to two independent radiologists, who attempted to identify the segmentor and rated the acceptability of the segmented images on a five-point Likert scale. RESULTS: There were 39 cases with complete timing data. The median time for the AI model to segment was one-third of the radiologist's (152.4 s, interquartile range [IQR] 120.9-177.8 vs. 450 s, IQR 318.8-551.2) and about one-fifth of the urologist's (800.0 s, IQR 492.0-1538.0) (p<0.001). There was a high degree of inter-rater reliability (median Dice coefficients 0.86-0.90, p=0.09). The scoring radiologists were able to correctly identify the true segmentor in 61.6% of cases (p <0.001). The AI segmentations were scored highest among the three segmentors (median score 4.1/5, standard deviation [SD] 1.0) compared to 3.8 (SD 0.7) for the radiologist, and 3.3 (SD 0.7) for the urologist. CONCLUSIONS: Automated segmentation of CT scans for patients with SRM was efficient, accurate, and acceptable in this study. This approach has the potential to greatly improve the clinical use of radiomics to assess medical images for these patients.
INTRODUCTION: Vasectomy is a safe and effective method of male sterilization, traditionally conceptualized in practice to be pursued by older, partnered fathers; however, shifting socioeconomic, political, and cultural landscapes may be contributing to changes in the demographic profile of the vasectomized patient. Specifically, this study sought to compare the proportion of men undergoing vasectomy with no prior children between pre-and post-COVID pandemic periods. Secondary outcomes included differences in age, relationship status, and overall vasectomy volume trends. METHODS: We conducted a retrospective chart review of patients undergoing vasectomy by two high-volume urologists in Toronto, Ontario, from 2018-2024. Patients were divided into two cohorts: pre-pandemic (2018-2019) and post-pandemic (2022-2024). Demographic variables, including age, relationship status, and number of children, were collected and analyzed using multivariable logistic regression to identify whether childlessness was independently associated with the cohort. No vasectomies were performed in 2020-2021 due to COVID-19 restrictions. RESULTS: A total of 565 patients were included (152 pre-pandemic, 413 post-pandemic). The proportion of men without children rose significantly from 6% to 16% post-pandemic (p=0.04). The mean number of children decreased from 2.1 to 1.8 (p=0.03). Single men were also significantly more likely to be childless; however, age and relationship status did not differ significantly between groups. CONCLUSIONS: The demographic profile of vasectomy patients in Canada is evolving. Post-pandemic, more childless men are pursuing sterilization, challenging traditional assumptions about vasectomy candidacy and highlighting broader changes in reproductive decision-making among men.
INTRODUCTION: The Canadian Anatomic Kidney Score (CAKS) is a quantitative score used to assess donor kidneys, which has been shown to predict transplant outcomes. We hypothesized that the quantification of this score is highly reproducible across surgeons with varying levels of experience. METHODS: An anonymous survey was distributed to surgical attendings, fellows, and residents at teaching centers across Canada. The survey included photographs of six distinct kidneys (two images for each) taken during intraoperative back-table dissection. Participants evaluated the kidneys based on vascular features, anatomy, and sticky fat. Scores ranged from 0-2 points for each category. Comparisons of mean scores among residents, fellows, and staff were made using one-way ANOVA, and the intraclass correlation coefficient (ICC) was calculated for each scoring factor and overall. RESULTS: Among the 35 respondents, 570 sets of evaluations were performed, with a mean evaluation time of one minute 37 seconds per kidney. Across the 18 survey questions, there was no significant difference in scoring among fellows, residents, and attendings, except for two of the six "sticky fat" image sets. The ICC for the CAKS overall was 0.78 when evaluated against a gold standard, and 0.80 when compared between raters, indicating excellent agreement between groups. CONCLUSIONS: CAKS is reproducible by surgeons across different levels of training and various centers in Canada. This scoring system provides a reliable means to convey quantitative anatomic information between transplant professionals.
INTRODUCTION: Urology is a surgical subspecialty with a wide scope of practice treating benign, malignant, and emergent disease processes involving the genitourinary system. METHODS: We performed an anonymous survey of British Columbian (BC) urologists in 2022 exploring wait times, workload, and burnout. The survey was distributed via email to all urologists in the BC Urological Society. RESULTS: There was a 92% completion rate. On average, urologists operate for 9.3 hours per week, and 84% of urologists are also operating emergently at least once per week. A typical workday is 10 hours, and most urologists spend at least 20% of their lives on call. When on call, urologists are woken up approximately 50% of the time. Burnout rates are over 60% and exceed the national average. Urologic patients are waiting an average of 8.7 months for non-urgent surgery or on waitlists of over 1000 people to see a surgeon. CONCLUSIONS: Urologists in BC have long wait times, high workloads, and are experiencing burnout at a high rate. Thus, there is a need for additional urologists within the province.
Introduction: We aimed to evaluate the impact of surgical mentorship on case outcomes and learning curves of early-career surgeons performing pediatric open pyeloplasty. Methods: Using an institutionally maintained prospective case log, we retrospectively analyzed all open pyeloplasty cases consecutively performed by an index junior academic surgeon under the mentorship of a senior surgeon between April 2020 and May 2023. The mentor was available for all cases and scrubbed in for early cases, with decreasing direct involvement over time. The data collected included case characteristics, operative times, followup durations, and surgical complications within a two-year postoperative period. A cumulative sum (CUSUM) analysis was employed to identify peaks, plateaus, and trends for complications (defined as Clavien-Dindo classification ≥3b) and operative time. Results: We analyzed 54 open pyeloplasty cases performed under surgical mentorship and categorized them into four phases using CUSUM analysis. Based on this, the junior surgeon reached the competency-proficiency phase between the 12th and 26th case, demonstrating consistent technical skill development, reduced operative times, and satisfactory outcomes under mentorship. In the case-mix phase (45th-54th case), a slight increase in operative time was noted, coinciding with more complex cases and increased trainee involvement. Conclusions: This analysis demonstrated that surgical mentorship for junior academic surgeons facilitates early technical proficiency in pediatric open pyeloplasty, enabling them to safely achieve comparable outcomes early in their careers. These findings suggest that mentorship is key to ensuring satisfactory surgical outcomes during the initial stages of a surgeon’s learning curve.
INTRODUCTION:The integration of artificial intelligence (AI) into surgical training is rapidly evolving, driven by advancements in machine learning. This review aimed to map the current landscape of AI's educational applications in urology. METHODS:A systematic search of MEDLINE, PubMed, Embase, Cochrane, Scopus, and Engineering Village identified studies exploring AI applications in video-based surgical education and assessment. Search terms included AI, urologic procedures, and training/assessment components, and results were screened in Covidence®. AI applications involving urologic procedures were included. For every study, two reviewers independently conducted screening. Data were synthesized thematically to evaluate AI's application in urology training. RESULTS:Our search yielded 2774 studies, of which 59 relevant ones were identified. AI was most frequently applied with robotic-assisted radical prostatectomy (RARP), followed by robotic-assisted partial nephrectomy (RAPN). AI applications were broadly categorized into three domains: 1) annotation, where key anatomy and instruments from procedural videos are labelled; 2) feedback, such as recognizing surgical phases or monitoring surgical events; and 3) evaluation, where the surgical gestures are recognized or evaluated to stratify skill level and predict patient outcomes. CONCLUSIONS:The emergence of AI use in urologic procedures underscores its transformative potential in procedural education and training. AI has wide applications in annotation, feedback, and assessment across different procedures. While prostatectomy dominates in the literature, the adaptability of AI frameworks exists across other urologic procedures. New, commercially available tools demonstrate promising results, making them potentially beneficial additions to urology training programs. Future efforts should focus on multicentric collaboration and longitudinal skill assessments.
INTRODUCTION: Testicular cancer (TC) affects young men in their reproductive years. Although sperm cryopreservation is recommended before treatment, real-world utilization and patient experiences in Canada remain poorly described. METHODS: We conducted a retrospective chart review with a prospective telephone survey of men with TC who underwent sperm cryopreservation (2007-2019) at Manitoba's sole fertility preservation center. Demographic, treatment, and semen parameters were abstracted from medical records. A structured questionnaire assessed counseling, decision-making, costs, banked sperm utilization, and fertility outcomes. RESULTS: Of 42 eligible men, 24 (57%) completed the survey. The mean age at banking was 25.6 years. Most (71%) received chemotherapy in addition to orchiectomy; 29% underwent orchiectomy alone. Only two men (8%) banked sperm before orchiectomy; the remainder did so prior to systemic therapy. Abnormal semen parameters were common (79%), with a median sperm concentration (13.0 million/mL, interquartile range [IQR] 3.0-21.5) and total sperm count (14.8 million, IQR 8.6-84.9) below World Health Organization (WHO) 2021 limits. Counseling occurred for 88% of men, although half felt rushed in their decision-making. The mean cost was approximately $2000 over three years, and 58% found this burdensome. Only three men (13%) used their cryopreserved sperm, all after chemotherapy, each resulting in a live birth through assisted reproductive technology. Eleven men (46%) conceived naturally after treatment, eight (33%) had not yet attempted conception. CONCLUSIONS: In this Canadian cohort, sperm banking utilization was low, and most survivors achieved natural conception. Financial burden and decisional stress were frequent. Enhanced counseling and public funding for fertility preservation may improve equitable access and survivorship care.
INTRODUCTION: Recurrent, uncomplicated urinary tract infections (rUTIs) in women are associated with burdensome symptoms, high antibiotic use, and significant costs. The sublingual vaccine MV140 has demonstrated significant reduction in rUTI rates in Canada and Europe. This analysis examined the cost-effectiveness of MV140 as an alternative to prophylactic antibiotics (pAbs) for rUTI prevention in adult women in the Canadian healthcare setting. METHODS: A cost-utility model was developed to follow rUTI patients over 1.25 years through four health states: UTI-free survival, acute UTI, pyelonephritis, and death. A decision tree was used to model the acute UTI state, accounting for Ab resistance and choice of first-line Ab treatment, while Markov model transition probabilities were derived from a published direct comparison. Cost inputs included drug acquisition/administration, healthcare resource use, adverse events, and lost productivity, and were based on Canadian governmental resources. Utilities were derived from published literature. The base case was probabilistic (n=5000); multiple one-way sensitivity analyses were performed to assess model uncertainty. RESULTS: MV140 was associated with cost-savings (-$1442) and increased quality of life years (0.01) compared to pAbs, with an incremental cost-effectiveness ratio of-$229 088 in the base case (societal perspective). MV140 remained dominant over pAbs in most scenario analyses, with incremental costs ranging from-$256 207 to $875. CONCLUSIONS: MV140 represents a consistently cost-effective alternative to pAbs in the Canadian healthcare system. When societal costs are considered, MV140 is consistently dominant over pAbs irrespective of variation in scenario inputs, demonstrating the considerable economic value of MV140 in this disease setting.
INTRODUCTION: Management of short bulbar urethral strictures (<2 cm) typically involves either endoscopic dilation or excision and primary anastomosis urethroplasty. While dilation is inexpensive and minimally invasive, it carries high recurrence rates. Urethroplasty is more durable but requires higher upfront resources. We conducted a decision analysis to compare the 10-year costs of both strategies. METHODS: A decision tree was constructed to model stricture recurrence and complications after either index procedure. Direct institutional costs were obtained from hospital financial data and the Quebec physician fee schedule, expressed in 2023 Canadian dollars. Ten-year cumulative costs were calculated with a 3% annual discount rate. One-way sensitivity analyses varied recurrence and complication rates across published ranges. RESULTS: The average cost of urethroplasty was $7186.27 CAD compared with $441.20 CAD for dilation. Stricture recurrence was 15.5% after urethroplasty vs. 60%, 80%, and 95% after first, second, and third dilations, respectively. Over 10 years, cumulative costs were $21 714.04 CAD for urethroplasty and $25 037.45 CAD for dilation, with a break-even point at approximately 80 months. Across sensitivity analyses, urethroplasty became more expensive with varying complication rates, but remained cost-efficient across a range of recurrence rates. CONCLUSIONS: Despite higher initial expenses, urethroplasty is the more cost-efficient strategy for managing short bulbar urethral strictures. Given patients' relatively young age at diagnosis, cost benefits are likely to accrue beyond 10 years, supporting urethroplasty as the preferred definitive approach after at most one dilation attempt.
INTRODUCTION: This study aimed to investigate the impact of peritoneal patency during extraperitoneal laparoscopic radical prostatectomy (eLRP) on perioperative and postoperative outcomes. METHODS: Between May 2018 and March 2025, 255 patients who underwent eLRP were retrospectively evaluated. Patients without peritoneal opening were classified as group 1 (n=223), while those with peritoneal opening were classified as group 2 (n=32). Demographic data, operative time, complication rates, and complication grades based on the Clavien-Dindo classification were analyzed. Logistic regression analysis was performed to identify associated risk factors. RESULTS: A history of abdominal surgery was significantly more common in group 2 (p<0.001) and the mean operative time was also significantly longer in this group (p<0.001). Although the overall complication rate was higher in group 2 (37.5% vs. 24.2%), the difference was not statistically significant (p=0.131). Multivariate analysis revealed that a history of abdominal surgery, operative time >180 minutes, and estimated blood loss >150 ml were significantly associated with postoperative complications; however, peritoneal opening was not identified as an independent risk factor (p=0.113). CONCLUSIONS: Although peritoneal opening may introduce technical challenges that compromise the advantages of the extraperitoneal approach, it does not significantly affect postoperative complication rates. With sufficient surgical experience, it appears to be a manageable intraoperative event.
INTRODUCTION:Kidney transplantation (KT) is the standard of care for children with end-stage kidney disease. When the donor's kidney is right-sided, the graft can be placed ipsilaterally using an inverted kidney allograft (IKA) technique, facilitating the anastomosis of a shorter renal vein and renal hilum spatial orientation with anterior positioning of the urinary tract. We aimed to compare the safety and efficacy of IKA and standard anatomical position (AP) in pediatric KT. METHODS:We performed a retrospective study of all patients ≤18 years of age who underwent KT at the Hospital Italiano de Buenos Aires (January 2010 to December 2021). A comparative analysis of baseline demographics, urologic and vascular complications, graft survival, and one-year creatinine clearance was performed between patients with IKA and those with AP allografts. RESULTS:Overall, 157 KT were performed: 61 were IKA and 96 were in the AP. Median age at transplantation was nine years (range 1-18). Allografts from cadaveric donors were more frequently implanted using the IKA technique (p≤0.001). No significant difference in urologic (16.4% vs. 13.5%, p=0.79) or vascular complication rates (1.2% vs. 5.2%, p=0.47) were observed. Median one-year creatine clearance was similar between the groups (73.1 ml/min/m2 vs. 75.3 ml/min/m2). Graft survival and overall mortality rates were comparable between groups. CONCLUSIONS:In the largest study of its kind, we observed that the IKA technique did not increase the risk of urologic or vascular complications and yielded comparable one-year graft survival and creatine clearance. This approach appears to be feasible when the AP is not ideal.
Introduction: High-grade T1 (HGT1) bladder cancer is considered to have high five-year recurrence and progression rates, at 50-70% and 25-50%, respectively; however, contemporary data are lacking. We examined the contemporary outcomes of HGT1 bladder cancer to inform patient counseling, management, and clinical trial design. Methods: We identified patients aged 18 years or older with a new diagnosis of HGT1 bladder cancer between 2010 and 2022 treated at our institution. Recurrence-free (RFS), progression-free (PFS), and cancer-specific (CSS) survival were estimated using the Kaplan-Meier method. Associations of baseline characteristics with outcomes were evaluated using Cox regression. Results: A total of 213 patients were included, representing 332 cancer occurrences. Median age at diagnosis was 72 (interquartile range [IQR] 6580) years. Median followup for RFS, PFS, and CSS was 13, 20, and 36 months, respectively. The one-, three-, and five-year event-free rates were 65%, 51%, and 48% for RFS; 85%, 78%, and 72% for PFS; and 99%, 95%, and 95% for CSS. There was a median of 1 (IQR 1-2) recurrence per patient, with a median time to first recurrence of seven months (IQR 4-14) and a median time between recurrences of seven months (IQR 5-18). Larger tumor size was associated with increased risks of recurrence. Receipt of adjuvant intravesical therapy was associated with reduced risks of recurrence and progression. Conclusions: Contemporary five-year recurrence and progression rates for HGT1 bladder cancer remain high at 53% and 28%, respectively. The disease burden is substantial, with a median time between recurrences of seven months. These results can inform patient counseling, management, and clinical trial design.
Introduction: We aimed to evaluate intraoperative point-of-care urinalysis (UA) for predicting positive urine cultures and postoperative urinary tract infections (UTIs) in children undergoing cystoscopy, and to assess its potential to reduce unnecessary cultures and antibiotics. Methods: In this retrospective cohort at a tertiary pediatric urology center (August 2023 to April 2024), 62 cystoscopy cases with paired dipstick UA and quantitative culture were analyzed after excluding recent antibiotic use or incomplete data. Dipstick markers —leukocyte esterase and nitrite — were evaluated alone and combined (“either-positive” vs. “both-positive”). Positive culture was defined as ≥10⁵ CFU/mL; postoperative UTI required fever, clinical signs, and a positive culture within seven days. Diagnostic accuracy was assessed by ROC curves and χ² tests. A multivariable logistic regression adjusted for age, sex, procedure, laterality, and clinical condition. A retrospective quality improvement (QI) model estimated reductions in culture orders and empiric antibiotics. Results: Thirty-nine patients (62.9%) were dipstick-negative by the “either-positive” rule; one had a positive culture (negative predictive value [NPV] 97.4%; 95% confidence interval [CI] 86.5–99.9). Of 23 dipstick-positive patients, 13 (56.5%) had positive cultures. In multivariable analysis, “either-positive” dipstick was the sole predictor of culture positivity (odds ratio [OR] 330.2, 95% CI 30.5–3 574.1, p=0.003). QI modeling indicated that restricting cultures to the 23 dipstick-positive specimens would have averted 39 of 62 cultures (62.9%), at the expense of missing one infection (2.6% of uncultured cases). Conclusions: Intraoperative dipstick UA reliably identifies pediatric cystoscopy patients at low risk for postoperative UTI, offering a rapid, cost-effective tool to enhance antimicrobial stewardship and reduce laboratory utilization. This single-center, retrospective study with a modest sample and low event rate may limit generalizability; prospective, multicenter validation is warranted.
INTRODUCTION:This study aimed to evaluate the performance of three artificial intelligence (AI) models - ChatGPT, Gemini, and Copilot - in addressing priapism-related inquiries. The accuracy, comprehensiveness, and clinical applicability of AI-generated responses were systematically analyzed. METHODS:Frequently asked questions (FAQs) regarding priapism were collected from medical guidelines, literature, and online health platforms. Each AI model generated responses, which were independently assessed by two experts based on accuracy, fluency, and clinical relevance. The Global Quality Score (GQS) was used for evaluation. Statistical analysis was performed using one-way ANOVA, with a significance threshold of p<0.05. RESULTS:ChatGPT and Gemini demonstrated comparable performance across all thematic categories, with mean scores ranging from 4.5-4.9, while Copilot showed significantly lower scores (3.2-4.2, p<0.001). Both ChatGPT and Gemini provided clinically relevant and accurate information, whereas Copilot's responses frequently lacked guideline-based recommendations. CONCLUSIONS:ChatGPT and Gemini were statistically comparable in generating reliable, clinically useful responses, making them valuable tools for medical education and patient counseling. Copilot, however, exhibited lower accuracy and applicability. These findings highlight the need for continuous refinement of AI models to enhance their role in clinical decision-making while ensuring human expertise remains central to patient care.
INTRODUCTION:This study evaluated the long-term efficacy and safety of Rezūm water vapor thermal therapy (WVTT) for treating lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH). The objective was to assess the durability of symptom relief and sustained LUTS improvement over a three-year followup in a real-world, multicenter cohort. METHODS:A prospective registry was maintained at two high-volume international centers for men undergoing Rezūm therapy between April 2019 and October 2024. All participants had baseline clinical data recorded, including BPH history, uroflowmetry parameters (peak flow rate [Qmax] and postvoid residual [PVR]), and validated questionnaires (International Prostate Symptom Score [IPSS], IPSS quality of life [QoL], BPH Impact Index [BPHII], International Index of Erectile Function [IIEF-15], and Male Sexual Health Questionnaire for Ejaculatory Dysfunction [MSHQ-EjD]). RESULTS:A total of 712 men with at least one year of followup were analyzed. The mean age was 67.2 years (stanadrad deviation [SD] 8.9), and the average baseline prostate volume was 74.1 cc (SD 34.4). Mean IPSS scores improved from 22 at baseline to 9.8 at 36 months. IPSS QoL scores improved from 4.5 to 1.9. Qmax increased from 8.6 ml/s at baseline to 15 ml/s at 24 months and 12.1 ml/s at 36 months. PVR decreased from 134.9 ml to 38.5 ml. There were no significant changes in IIEF or MSHQ-EjD domains. CONCLUSIONS:Rezūm WVTT provides significant, durable symptom relief and improved urinary function over three years, with preserved sexual function.
INTRODUCTION:Several studies have reported the preoperative and intraoperative predictors of urinary continence after robotic-assisted laparoscopic radical prostatectomy (RARP). No studies have addressed the impact of surgeon satisfaction and perceived surgical difficulty on continence recovery after RARP. METHODS:We conducted a retrospective study of prospectively collected data for patients treated with RARP for clinically organ-confined prostate cancer. Perioperative variables were recorded and studied. Patients were followed with regular visits at one, three, six, 12, and 24 months after surgery. The primary endpoint of the study was time to continence. RESULTS:A total of 322 patients treated with RARP were included. At least 80% of patients had 24-month postoperative continence followup. Continence rates were 39.1, 58.2, 71.1, 80.9, and 90.7% at one, three, six, 12, and 24 months, respectively. Perceived intermediate and high difficulty cases were associated with lower hazards of continence after RARP compared to low-difficulty cases (hazard ratio [HR] intermediate vs. low: 0.63, p=0.006; HR high vs. low: 0.52, p<0.001). Similarly, increased prostate size and decreased operative time were associated with low hazard of continence after RARP. Conversely, no statistically significant differences were recorded for surgeon satisfaction and preoperative Sexual Health Inventory for Men score (all p>0.05) at multivariate analysis. CONCLUSIONS:Overall difficulty encountered by the surgeon at time of RARP is an independent predictor of continence recovery, in addition to prostate size and preoperative International Prostate Symptoms Score. Predictive preoperative factors for difficult surgery should be dealt with by an experienced surgeon to hasten continence recovery after surgery.
