Introduction:Transurethral resection of the prostate (TURP) is widely recognized as the gold standard surgical treatment for benign prostatic enlargement (BPE). However, despite its effectiveness, TURP is associated with male sexual dysfunction, with up to 70% of patients developing retrograde ejaculation. Recent evidence suggests that preserving supramontanal tissue around the verumontanum may preserve sexual outcomes. This study aims to assess the efficacy of supramontanal-sparing TURP as an ejaculation sparing approach in sexually active males with BPE through a systematic review and meta-analysis. Material and methods:The present review was performed using a systematic search, registered in PROSPERO (CRD42024614954), and followed PRISMA guideline. Sexual function and voiding outcomes were measured, including symptom scores, maximum flow rate (Qmax), and post-void residual (PVR). The results were presented as risk ratios (RRs) and mean differences (MDs), with 95% confidence intervals (CIs). Results:Six studies involving 540 patients, supramontanal-sparing TURP was compared to conventional TURP. The supramontanal-sparing TURP significantly reduced retrograde ejaculation (RR = 0.26, 95% CI: 0.14-0.46, p <0.01) and preserved semen volume better (MD = 1.04 ml, 95% CI: 0.36-1.73, p <0.01). Both techniques showed comparable outcomes in voiding function, including postoperative maximum flow rate, IPSS scores, and post-void residual volume (p = 0.49, p = 0.97, and p = 0.82, respectively). Conclusions:The supramontanal-sparing TURP technique demonstrated lower rates of retrograde ejaculation, while achieving similar voiding outcomes compared to standard TURP. These findings highlight the potential for preserving antegrade ejaculation after TURP when using the supramontanal-sparing technique.
Introduction:Enfortumab vedotin (EV) is an antibody-drug conjugate (ADC) targeting nectin-4 and is widely used for patients with locally advanced or metastatic urothelial carcinoma (mUC) after prior systemic therapies. However, it remains unclear whether EV efficacy is influenced by responses to preceding platinum-based chemotherapy (PBC) or immune checkpoint inhibitors (ICI). This study evaluated the relationship between responses to prior therapy and EV outcomes in a real-world cohort. Material and methods:We retrospectively analyzed 60 patients with mUC who received EV between December 2021 and March 2024. All patients had previously undergone PBC and ICI. Based on responses to these therapies, patients were classified as responders (complete or partial response) or non-responders (stable or progressive disease). Primary endpoints were objective response rate (ORR), progression-free survival (PFS), and overall survival (OS). Multivariable Cox proportional hazards models were used to evaluate factors associated with survival outcomes. Results:The overall EV ORR was 41.7%. EV responders demonstrated significantly longer PFS and OS than non-responders. No significant differences in EV efficacy were observed between responders and non-responders to prior chemotherapy or ICI. Multivariable analyses confirmed that prior treatment response was not independently associated with PFS or OS. Conclusions:EV response was strongly associated with prolonged survival. Importantly, consistent antitumor activity was observed regardless of prior treatment efficacy, suggesting that even patients refractory to PBC or ICI may derive meaningful benefit. EV should be offered promptly even for patients with double-refractory mUC, as the presence of a prior non-response does not signify compromised efficacy.
