OBJECTIVES:Early-onset prostate cancer is becoming increasingly prevalent, and MRI-first strategies are gaining interest as a potential screening tool. However, MRI characteristics of the prostate in younger men remain underexplored. This study aimed to characterize prostate MRI features in a young, asymptomatic male cohort undergoing contrast-free biparametric MRI for prostate cancer screening, to determine the detection rate of clinically significant prostate cancer, and to identify clinical and imaging predictors of clinically significant disease. METHODS:A total of 659 prostate MRIs were acquired; after excluding men who declined biopsy, 641 participants formed the final cohort. Peripheral-zone signal patterns on T2-weighted imaging (T2WI), diffusion-weighted imaging (DWI), and apparent diffusion coefficient (ADC) maps were assessed by two blinded radiologists. PI-RADS scores were assigned independently. Men with PI-RADS ≥ 4 were offered targeted MRI-TRUS fusion biopsy (PI-RADS 3 in case of PSAD ≥ 0.16). Multivariable logistic regression was performed to identify independent predictors of csPCa. RESULTS:Median PSA 1.02 ng/mL (IQR 0.58-2.03) and PSA density (PSAD) 0.03 ng/mL/mL (IQR 0.02-0.05). The most common peripheral-zone appearance was heterogeneous T2 hypointensity (74.7%), homogeneous DWI hyperintensity (59.4%), and homogeneous ADC hypointensity (66.1%). PI-RADS distribution was: 0.5% PI-RADS 1, 81.1% PI-RADS 2, 14.2% PI-RADS 3, 3.6% PI-RADS 4, and 0.6% PI-RADS 5. Forty-one men (6.4%) underwent biopsy, yielding 5 ciPCa, 23 csPCa, and 13 negative results, corresponding to csPCa in 3.6% of the entire cohort. In multivariable analysis, PSAD ≥ 0.15 ng/mL/mL, PI-RADS 4-5, and family history were independently associated with csPCa (all p < 0.01). CONCLUSIONS:Contrast-free bpMRI effectively characterizes prostate morphology in younger men and identifies csPCa at an early stage. PSAD, PI-RADS category, and family history significantly enhance risk stratification, supporting the integration of bpMRI-based approaches into future MRI-first screening strategies for younger, asymptomatic populations.

We report a novel fluorescence-guided approach for robot-assisted partial nephrectomy in a completely endophytic renal tumor. A 73-year-old woman with a 3-cm entirely endophytic left renal mass underwent ultrasound-guided percutaneous intratumoral indocyanine green injection after failure of selective arterial embolization. Near-infrared fluorescence imaging allowed accurate intraoperative localization and complete tumor enucleation. Operative time was 125 minutes, with a warm ischemia time of 25 minutes. The postoperative course was uneventful, renal function was preserved, and histopathology confirmed renal oncocytoma. Percutaneous intratumoral indocyanine green injection represents a safe and effective alternative for fluorescence-guided nephron-sparing surgery in anatomically challenging endophytic renal tumors.

BACKGROUND AND OBJECTIVE:This is the first prospective study analyzing the predictive value of preoperative Node-Reporting And Data System (RADS) determination at imaging for pelvic lymph node (PLN) involvement in cases of prostate cancer (PCa) considered for radical prostatectomy (RP) with extended pelvic lymph node dissection (ePLND). Node-RADS was compared with the validated predictive nomograms Briganti 2012, Gandaglia 2017, and Briganti 2019, and with prostate-specific membrane antigen - positron emission tomography/computed tomography (PSMA-PET/CT) total body scan. METHODS:A total of 267 patients with a histological diagnosis of PCa undergoing RP with an ePLND were prospectively examined. Overall, n = 104 patients underwent PSMA-PET/CT. Node-RADS determination of PLNs was centrally performed using preoperative magnetic resonance imaging and compared with the validated nomograms and PSMA-PET/CT. Correspondence in terms of positivity and localization with final pathology was analyzed. RESULTS:Node-RADS exceeded PSMA-PET/CT in overall accuracy (area under the curve [AUC] 0.637 vs 0.526), whereas the Briganti 2019 nomogram achieved the highest AUC (0.711). Combining Node-RADS and Briganti 2019 improved performance further (AUC 0.719). Node-RADS showed high specificity (0.993) and positive predictive value (0.506), useful to confirm nodal involvement, whereas Briganti 2019 demonstrated high sensitivity (0.952) and excellent NPV (0.960), useful to exclude nodal disease. PET/CT exhibited limited sensitivity and anatomical correspondence. At multivariate analysis, a high Node-RADS score (4-5) and pathological tumor (pT) stage (pT3) were the only variables associated with a higher risk of positive PLNs involvement at final pathology (adjusted odds ratio [aOR]: 12.60, 95% confidence interval [CI] 2.99-52.96, p < 0.001 for Node-RADS 4-5 and aOR 16.98, 95% CI 4.29-67.17, p < 0.001 for pT3b). CONCLUSIONS:Node-RADS, especially when combined with the Briganti 2019 nomogram, showed promising performance as a structured radiologic tool for preoperative nodal staging in this selected ePLND-eligible cohort.

BACKGROUND AND OBJECTIVE:Patients undergoing radical cystectomy (RC) for bladder cancer may present with synchronous or metachronous upper tract urothelial carcinoma (UTUC). These scenarios may differ in oncological outcomes and surgical complexity. This study sought to compare oncologic and perioperative outcomes in patients undergoing RC and radical nephroureterectomy (RNU) for synchronous or metachronous UTUC. METHODS:Data from 23 tertiary referral centers were retrospectively collected (2002-2024). Perioperative outcomes included length of stay (LOS) and complications (Clavien-Dindo classification). Disease-free survival (DFS), cancer-specific survival (CSS) and overall survival (OS) were estimated from RC using Kaplan-Meier and landmark analysis. Multivariable Cox regression modeling identified predictors of DFS and OS and explored the impact of RNU timing on oncological outcomes. KEY FINDINGS AND LIMITATIONS:Among 177 RC patients (n = 142 [80%] males), 106 (60%) underwent RNU subsequent to RC for metachronous UTUC. Concomitant RC and RNU led to longer LOS (10 vs. 7 days, P = 0.004), and statistically significant higher rate of major complications (Clavien-Dindo ≥ IIIa, 29.6% vs. 15.1%, P = 0.03). Metachronous disease showed better 60-month DFS (69.1% vs. 47.6%), CSS (80.3% vs. 66.4%) and OS (69.2% vs. 47.6%). Histological subtype at RNU independently predicted worse DFS (HR 2.64, P = 0.01) and OS (HR 3.22, P = 0.01), while metachronous presentation predicted better DFS (HR 0.36, P < 0.001) and OS (HR 0.53, P = 0.04). Limitations include the retrospective design and a relatively limited sample size. CONCLUSIONS AND CLINICAL IMPLICATIONS:Synchronous panurothelial disease at diagnosis requiring RC and RNU is related to worse perioperative and survival outcomes compared to metachronous disease. Our results highlight the need for dedicated studies to define individualized treatment and surveillance strategies for this challenging patient population.

Recently, the EAU guidelines presented the EAU guidelines bot to assist urologists in the reading of the guidelines; however, up to date, no external validation is available. The aim of our study is to assess the accuracy, completeness, and clarity of the guideline’s bot in testicular cancer. A total of 36 questions based on the EAU testicular cancer guidelines recommendations were developed. Each question was systematically presented to the EAU guidelines bot and the responses were independently assessed by two expert urologists to assess the accuracy, completeness, and clarity. A 5-point Likert scale was used as a score, and in case of discrepancies, a third urologist was queried. Accuracy, completeness, and clarity were assessed per chapter and per grade of recommendation. All questions and answers were recorded in an Excel file. Overall, 36 questions were developed. In terms of accuracy, 36/36 (100

BACKGROUND:Recently, the European Association of Urology (EAU) Guidelines presented an official Bot to assist urologists during Guidelines navigation. However, up to date no external validation is available. Aim: To assess accuracy, completeness, and clarity of the Guidelines Bot for Sexual and Reproductive Health. METHODS:A total of 228 questions based on the EAU Sexual and Reproductive Health Guidelines recommendations were developed. Each question was inputted to the EAU Guidelines Bot and the response was reviewed by two expert uro-andrologists. Discrepancies were resolved by discussion with a third expert. Results were further stratified per grade of recommendation. Outcomes: Evaluate the rate of accurate, complete, and clear answers to guidelines-related questions using a 5-point Likert scale and the impact of the grade of recommendation on the quality of the answer. RESULTS:Overall, 228 questions were developed. In terms of accuracy 224/228 (98.3%) were defined as accurate (score-4-5), 2/228 (0.9%) presented a fair accuracy (score = 3) while 2/228 (0.9%) were deemed not accurate (score 1-2). In terms of completeness, 223/228 (97.8%) were defined as complete (score-4-5), 2/228 (0.9%) presented a fair completeness (score 3), while 3/228 (1.3%) were deemed not complete. Finally in terms of clarity, 225/228 (98.7%) were defined as clear (score-4-5), 2/228 (0.9%) presented a fair clarity (score 3) and 0/228 were not clear. When comparing strong and weak recommendations, no differences were recorded. CLINICAL IMPLICATIONS:The EAU Guidelines Bot may serve as a reliable clinical decision support tool for urologists seeking rapid, evidence-based guidance on sexual and reproductive health management. STRENGTHS & LIMITATIONS:This is the first external evaluation of the EAU Guidelines Bot. Our results suggest a significant improvement in terms of reliability when compared to general AI tools. However, our queries were straightforward and developed directly from guideline recommendations and results might not apply to complex real-world clinical scenarios. CONCLUSIONS:EAU Guidelines Bot represents an accurate and reliable tool for Sexual and Reproductive Health Guidelines navigation, but further validation is required to evaluate its applicability in clinical practice.

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.

(I) To determine clinicopathological determinants of metachronous Upper Tract Urothelial Carcinoma (UTUC) requiring Radical Nephroureterectomy (RNU) after Radical Cystectomy (RC). (II) To evaluate long-term survival of patients who underwent RC + RNU compared with matched RC only controls. Patients undergoing RNU for metachronous UTUC were extracted from a multi-institutional RC database. A 1:2 Propensity Score Match (PSM) was performed based on age, gender, BMI, CCI, Smoking Status, and cT stage between RC only and RC + RNU patients. Simon-Makuch plots, landmark analyses and Multivariable Cox regressions were adopted to compare survival outcomes. Of 1804 RC patients, 85 (4.7

OBJECTIVE:This study aims to evaluate the additional diagnostic value of systematic (SBx) and perilesional biopsies (PBx) compared with targeted biopsy (TBx) in patients with mpMRI-detected PI-RADS 3-4-5 lesions. METHODS:We performed a retrospective analysis of 208 men with PI-RADS ≥ 3 lesions who underwent mpMRI-ultrasound fusion biopsy at a single institution. Clinically significant prostate cancer (csPCa; ISUP ≥ 2) was identified in 155 patients (74.5%), who constituted the study cohort. All patients underwent a standardized biopsy protocol consisting of 3-5 TBx cores, 3 PBx cores sampled within a 10 mm radius of the index lesion, and 10 SBx cores using the KOELIS Trinity® system. Detection rates of csPCa and ISUP grade upgrading were analyzed and stratified by PI-RADS category. RESULTS:TBx csPCa detection rates increased progressively with PI-RADS score: 39% for PI-RADS 3, 50% for PI-RADS 4, and 60% for PI-RADS 5 lesions. PBx showed a 42.5% detection rate of csPCa in PI-RADS 3 and 58% and 85.3% of csPCa in PI-RADS 4 and 5 respectively, whereas SBx detected 34.5% of csPCa in PI-RADS 3, 46% of csPCa in PI-RADS 4, and 60.5% of csPCa in PI-RADS 5. Despite these detection rates, PBx and SBx rarely provided clinically meaningful upgrading over TBx findings. ISUP grade upgrading occurred in only 7.3% of PBx cases and 1.8% of SBx cases in PI-RADS 5 lesions, with similarly low upgrading rates observed in PI-RADS 3-4 lesions. CONCLUSIONS:In patients with high-grade lesions like PI-RADS 4-5, TBx alone identifies the vast majority of csPCa, while SBx and PBx contribute minimal additional diagnostic or grading benefit. These findings support biopsy de-escalation strategies in high-risk mpMRI settings to reduce unnecessary sampling and procedure-related morbidity. On the other hand, in the PI-RADS 3 subgroup, omitting non-targeted sampling (SBx and/or PBx) may lead to underdiagnosis of higher-grade tumors not captured by TBx alone, potentially resulting in substantial changes in therapeutic strategy and, consequently, patient prognosis.

Background/Objectives: Recently the European Association of Urology (EAU) guidelines presented the EAU Guidelines bot to assist urologists in the reading of the guidelines; however, there is a lack of up-to-date external validation. The aim of our study is to assess the accuracy, completeness, and clarity of the guidelines bot in urethral strictures. Methods: A total of 117 questions based on the EAU urethral strictures guidelines recommendations were developed. Each question was input to the EAU guidelines bot and the response was assessed by two expert urologists to assess the accuracy, completeness, and clarity. Moreover, 10 simple clinical cases were input. A 5-point Likert scale was used as a score and, in case of discrepancies, a third urologist was queried. Accuracy, completeness and clarity were assessed per chapter and per grade of recommendation. All questions and answers were recorded in an Excel file. Results: Overall 117 questions were developed. In terms of accuracy, 111/117 (95%) were defined as accurate (scores 4–5), 4/117 (3%) presented a fair accuracy (score 3), and 2/117 (2%) were deemed not accurate. In terms of completeness, 93/117 (80%) were defined as complete (scores 4–5), 22/117 (19%) presented a fair completeness (score 3), and 2/117 (2%) were deemed not complete. Finally, in terms of clarity, 104/117 (89%) were defined as clear (scores 4–5), 13/117 (11%) presented a fair clarity (score 3), and 0/109 (0%) were deemed not clear. When comparing strong and weak recommendations, no differences were recorded. Overall the answers to simple clinical cases were in line with the guidelines with good accuracy, completeness and clarity scores. Conclusions: The EAU guidelines bot represents an accurate tool for urethral stenosis guidelines. Some fine-tuning is needed to improve readability and clarity.

Non-contrast MRI (bi-parametric MRI—bpMRI) has been investigated as a potential tool to be integrated in clinically significant prostate cancer (csPCa) screening. Moreover, artificial intelligence (AI) is emerging too as a potential support, especially for less-experienced radiologists. Therefore, the aim of this study was to evaluate the effectiveness of an AI-based software in csPCa screening using bpMRI, with a focus on supporting less-experienced radiologists. A retrospective analysis was conducted within the PROSA-trial, a randomized, single-center study involving 759 men eligible for PCa screening. BpMRI were acquired using prostate imaging reporting and data system (PI-RADS) v2.1-compliant protocols and evaluated independently by an expert radiologist, a less-experienced reader, AI-based software, and the less-experienced reader with AI support. Diagnostic performance was assessed using ROC curves and inter-reader agreement (Cohen’s kappa), using expert interpretation as the reference standard. Four hundred ninety-nine bpMRI were analyzed. The AI-assisted less-experienced reader achieved the highest diagnostic performance (sensitivity 76.5

For more than 20 years, after the introduction of the first robotic system, research on prostate cancer (PCa) surgery has mainly focused on evaluating outcomes of Robotic-Assisted Radical Prostatectomy (RARP). In the last few years, however, a new generation of innovative techniques, surgical approaches, and expanded indications have emerged. The Single Port (SP) robotic system was the first real hardware innovation in robotic surgery, and has already demonstrated advantages in terms of shorter length of stay, better cosmetic results and reduced postoperative pain. Artificial Intelligence (AI)-powered algorithms are being proposed as reliable tools for surgical assistance, aiding in standardization and mass implementation of robotic training. New surgical indications are emerging on the basis of patient and tumor characteristics. The extensive adoption of PCa screening and the precision of diagnostic tools have increased the rate of PCa diagnoses in a localized stage. Partial prostatectomy, despite needing further validation, has emerged as a safe and minimally invasive treatment option for confined tumors, able to minimize the side effects of prostate surgery. For locally advanced PCa, radioguided surgery has not only enhanced the oncological effectiveness of lymphadenectomy by enabling the precise identification and extraction of pathological lymph nodes, but has also contributed to minimizing the side effects associated with unnecessarily extensive dissections. Finally, in light of the increased efficacy of modern systemic therapies and the longer life expectancy, RP is currently being evaluated for primary tumor management in the metastatic phase. Despite the novelty of the aforementioned treatment options, they are already set to shape the future evolution of PCa management and international guidelines.

BACKGROUND:Chronic inflammation is commonly observed in benign prostatic hyperplasia (BPH) tissue and may contribute to lower urinary tract symptoms (LUTS) as well as disease progression. This study evaluated the efficacy of combining a standardized extract of Serenoa repens (Sr) with alfuzosin versus alfuzosin monotherapy in men with LUTS due to BPH. METHODS:In this prospective Phase III, randomized, multicenter, real-world study, 300 treatment-naïve men with moderate-to-severe LUTS (IPSS > 7) and prostate volume > 30 cc were enrolled. Patients received either alfuzosin 10 mg/day or alfuzosin 10 mg plus HESr 320 mg/day for 12 months. Primary endpoints included changes in IPSS and uroflowmetry (Qmax). Secondary endpoints included quality of life (IPSS-Q8), storage symptoms (IPSS-Q2 and Q4), nocturia (IPSS-Q7), erectile function (IIEF-5), and ejaculatory function (MSHQ-Ej). Outcomes were analyzed using mixed-model ANOVA with post hoc Tukey's tests. Statistical analysis was performed using JMP Pro 14 (SAS Institute Inc.). The protocol was approved by our Ethical Committee Lazio Area 1, Protocol 0949/2023, Rif 7385 on December 12, 2023. RESULTS:Both treatments significantly improved total IPSS over time (p < 0.0001). Across all time points, combination therapy was associated with consistently lower IPSS scores, demonstrating a significant time-by-treatment interaction (p = 0.007). Nocturia improved significantly over time (p < 0.0001); the combination group showed greater benefit from Month 3 onward (p = 0.006), though the main treatment effect was not statistically significant (p = 0.076). Qmax improved in both groups (p < 0.0001), with a significant time-treatment interaction (p = 0.006), but no significant main effect of treatment type (p = 0.113). A mild but significant decline in IIEF-5 was observed in both groups over time. Treatment adherence exceeded 86% in both arms. CONCLUSIONS:The combination of HESr and alfuzosin was significantly more effective than alfuzosin monotherapy in relieving LUTS, with greater benefits from Month 3 onward. Qmax and nocturia also showed greater, although mild, improvements with combination therapy. Sexual function outcomes were comparable between groups. High adherence and real-world applicability support the clinical value of this combination in managing BPH-related LUTS.