OBJECTIVE:To evaluate long term success rates and patient reported outcomes of redo urethroplasty (RU), a technically challenging urological procedure that may be associated with lower success rates due to increased scarring, compromised blood supply and poor surgical planes from prior surgery. MATERIALS AND METHODS:We retrospectively reviewed RU patients between 2010-2023, excluding failed hypospadias repair, and compared with a cohort of primary urethroplasty patients. Failure was defined as need for urethral intervention or imaging/cystoscopy-confirmed stricture recurrence prompted by symptoms. Primary endpoint was stricture-free survival. Secondary endpoints included patient-reported outcomes (USS-PROM), satisfaction, and subgroup analysis by stricture location. Statistical tests included T-tests, Wilcoxon signed-rank, and Fisher's exact test. RESULTS:Sixty redo urethroplasty patients (median age 48.5) were compared to 316 primary cases (median age 45, p=0.84). Median follow-up was 35 (IQR 14-81) vs. 51 (IQR 20-114) months for redo and primary cases, respectively (p=0.07). Failure rates were not significantly different: 23% in redo vs. 15% in primary cases (p=0.12). However, time to failure was significantly shorter in the redo group (median 6 vs. 17 months, p=0.01). USS-PROM questions 1-6 favored the primary group, although bother scores (Q7) were similar. Overall satisfaction was high in both groups but slightly higher after primary repair (95% vs. 87%, p=0.04). CONCLUSION:Despite greater complexity, redo urethroplasty demonstrates similar long-term success rates to primary urethroplasty. Patient-reported bother was similar, supporting redo urethroplasty as a viable option for recurrent urethral stricture after previous repair. However, recurrences occurred significantly earlier in the redo group.

To evaluate whether prostate size influences perioperative, urinary, and sexual outcomes following Aquablation for benign prostatic hyperplasia (BPH), by comparing men with prostates < 80 cc and ≥ 80 cc treated within a prospective real-world cohort. This prospective, single-center cohort study included consecutive men undergoing Aquablation between 2023 and 2025. Patients were stratified by prostate volume (< 80 cc vs. ≥80 cc). Baseline characteristics, perioperative parameters, and functional outcomes were assessed using validated instruments, including IPSS, IPSS-QoL, irritative subscore, ICIQ-SF, IIEF-EF, MSHQ-EjD, and MSHQ-bother, at baseline and at 3, 6, 12, and 24 months. Complications were graded according to the Clavien–Dindo classification. A total of 628 men were included (324 with prostates < 80 cc and 304 with prostates ≥ 80 cc). Men with larger prostates had higher rates of preoperative catheter dependence (34

INTRODUCTION:Benign prostatic hyperplasia is a leading cause of lower urinary tract symptoms in aging men. When medical therapy fails, surgery is indicated. This study evaluates the safety and efficacy of Aquablation compared with transurethral resection of the prostate (TURP) and Holmium laser enucleation of the prostate (HoLEP) in patients with bladder outlet obstruction. METHODS AND MATERIALS:A prospective analysis of 318 Aquablation patients (2023-2025) was conducted and compared with 83 TURP and 83 HoLEP patients from a retrospective database. Functional outcomes were assessed using International Prostate Symptom Score (IPSS), ICIQ-UI, EF-IIEF, and MSHQ-EJD SF. Complications were graded using the Clavien-Dindo classification. Follow-ups were performed at 3, 6, and 12 months. RESULTS:Aquablation patients had larger prostates than TURP (94 versus 54.7 cc; P < .0001) but smaller than HoLEP (105 cc; P = .002) patients. More Aquablation patients had indwelling catheters and were on anticoagulants (P < .0001). IPSS improvement was the greatest in Aquablation (18.9 points) versus TURP (13.8) and HoLEP (14.7; P = .000). Erectile function was preserved in Aquablation (P = .859), with significantly better ejaculatory function (82.8% preserved) than TURP (36%) and HoLEP (18%). Furthermore, Clavien-Dindo grade 1-2 complications were higher in Aquablation, but serious events (CD 3-4) were comparable. Complication rates declined significantly after the first 30 Aquablation cases. CONCLUSION:Aquablation is an effective surgical option for medium to large prostates, offering superior symptom relief and preservation of sexual function. Although its learning curve is shorter than HoLEP's, proper training is essential to minimize early complications.

376 Background: Prostate cancer (PC) is the most common malignant tumor for men in Israel. There are known inherited pathogenic variants (PVs) in DNA repair genes that are linked to PC. Risk factors for hereditary PC include aggressive PC, a family history of PC, and/or other malignancies such as breast and ovarian cancer or colorectal and uterine cancer. Our main goal is to understand the impact of inherited PVs on the clinical characteristics of PC. This is to enable early detection, prediction of the course of the disease and response to treatment. Methods: This is a multidisciplinary multicenter study including urology, oncology and genetics departments enrolls PC patients from all ethnicities and stages during their clinic visit. Blood is taken and a family cancer history questionnaire is completed. Germline DNA is processed using exome slice technology targeting the following genes: BRCA2, BRCA1, CHEK2, ATM, PALB2, MLH1, MSH2/EPCAM, MSH6, PMS2, HOXB13, TP53, NBN, ATR, BRIP1, FANCA, GEN1, RAD51C, RAD51D, ABRAXAS1, MRE11. These genes are analyzed for PVs according to the "ACMG/AMP interpreting sequence variant guidelines". Results are returned to the patient and the recruiting physician. Results: Among 440 enrolled patients, 219 have completed germline genotyping analysis with the remainder under evaluation. Of these 207 (94%) are non-PV carriers and 12 (6%) carry PVs (see table). PVs included BRCA1/BRCA2 (n=1), BRCA2 (n=3), CHEK2 (n=2), MSH2+CHEK2 (n=1) and single cases of the following genes: BRCA1, TP53, ATR, FANCA and ABRAXAS1. PV carriers had higher proportions of metastatic disease at diagnosis (p=0.0015) and ISUP grade 4-5 (p=0.006). There is a significant increase in BRCA PVs both in metastatic disease and the ISUP grade 4-5. Conclusions: Early detection and favorable tumor biology are associated with curative treatment options. Those diagnosed in late stages or with high-risk characteristics have fewer curative treatment options available. Germline PVs are significantly higher in patients with late-stage disease, aggressive behavior and familial risk. Knowledge of PVs status may inform surveillance strategies for early detection. There exists a challenge in discovering PV male carriers due to the lack of germline testing in this group. Lastly, we are continuing our analysis of the genetic data to determine its link to high risk, aggressive and familial PC. Clinical phenotype and genotype. TotalN (%) Non-PV carriersN (%) PV germline carriersN (%) p-value* PV BRCA*** carriersN (%) p-value* Genetic results 219 207 (94) 12 (6) 5 Age at diagnosis Median(1,3 quartile) 71 (65,76) 70(65,76) 75(68,80) ns** 76(72,80) ns** Stage at diagnosis local or N+ 192 (88) 185 (89) 7 (58) 2 (40) Metastatic 27 (12) 22 (11) 5 (41) 0.0015 3 (60) 0.0007 ISUP 1-3 137 (63) 134 (65) 3 (25) 1 (20) 4-5 82 (37) 73 (35) 9 (75) 0.006 4 (80) *p-values are provided using Chi-square. **ns, not significant. **Double mutation counted as one.

PURPOSE:Aquablation and Rezūm are established minimally invasive surgical therapies for benign prostatic hyperplasia (BPH) in men with moderate-sized prostates. However, direct real-world data comparing outcomes of these techniques in prostates <80 g remain limited. This study aimed to evaluate and contextualize perioperative and functional outcomes of Aquablation and Rezūm in a prospective, nonrandomized cohort. METHODS:We conducted a prospective, nonrandomized comparative cohort study between 2023 and 2025 at a single tertiary center. Treatment allocation was based on the patient's informed preference following standardized counseling. Men with moderate-to-severe lower urinary tract symptoms and prostate volume <80 g were included. Outcomes included the International Prostate Symptom Score, quality of life (QoL), irritative symptoms, urinary continence, sexual function, perioperative parameters, complications, and retreatment. Between-group comparisons were exploratory and interpreted descriptively due to baseline differences. RESULTS:A total of 428 patients were analyzed, including 324 who underwent Aquablation and 104 who underwent Rezūm. Baseline characteristics differed between groups, with Aquablation patients being older and having larger prostates and higher comorbidity burden. Both procedures resulted in significant and durable improvements in lower urinary tract symptoms and QoL. Aquablation demonstrated numerically greater symptom improvement and faster reduction in irritative symptoms, while Rezūm was associated with shorter operative time and same-day discharge. Erectile and ejaculatory function were largely preserved in both cohorts. Perioperative complication and retreatment rates were low and comparable. CONCLUSION:In this real-world, nonrandomized cohort, both Aquablation and Rezūm provided meaningful and durable symptom relief with preservation of sexual function in men with prostates <80 g. Given baseline imbalances and patient-preference-based allocation, outcomes should be interpreted as descriptive of real-world performance rather than as definitive comparative superiority. These findings support both modalities as effective minimally invasive options, with treatment selection guided by patient characteristics, expectations, and resource considerations.

Purpose:To evaluate whether the superior diagnostic accuracy of non-contrast computed tomography (NCCT) translates into clinically meaningful changes in management compared with ultrasonography (US) during routine postoperative follow-up after endourological stone surgery. Patients and methods:In this prospective observational study (n=60), adult patients undergoing ureteroscopy (URS) or percutaneous nephrolithotomy (PCNL) were assessed at 4-6 weeks postoperatively using both US and NCCT within ≤72 hours. NCCT served as the reference standard. The primary outcome was the diagnostic performance of US. The secondary outcome was the proportion of cases in which NCCT findings led to a change in clinical management. Multivariable logistic regression was used to identify predictors of false-positive US findings. Results:Sixty patients were included (mean age 52.3 ± 18.6 years; mean BMI 26.2 ± 6.8 kg/m2). NCCT identified residual stones in 14 patients (23.4%), totaling 27 stones. On stone-based analysis, US demonstrated a sensitivity of 79% (95% CI 69-86%) and a positive predictive value of 75%. NCCT detected additional findings not visualized on US in 6 patients (10%), all of which were small (≤4 mm) and non-obstructive. Importantly, NCCT findings resulted in clinically meaningful changes in management in only 2 of 60 patients (3.3%), despite its higher diagnostic sensitivity. US demonstrated a tendency to overestimate stone size, particularly with increasing BMI, which was the only significant predictor of false-positive findings (OR 1.12 per kg/m2, p = 0.008). Conclusion:Although NCCT demonstrates superior diagnostic accuracy, it rarely results in clinically meaningful changes in management in routine postoperative follow-up after endourological stone surgery. Ultrasonography provides acceptable diagnostic performance for clinically relevant stones. These findings support a risk-adapted imaging strategy in which ultrasonography serves as first-line surveillance, reserving CT for cases where results are expected to influence management.

OBJECTIVE:To determine whether antibiotic prophylaxis at discharge reduces post-operative urinary tract infection (UTI) after pediatric pyeloplasty, and to identify independent predictors of infection. METHODS:We retrospectively reviewed 435 consecutive patients who underwent pyeloplasty at 2 pediatric urology centers. Post-operative UTI was defined as a culture-proven infection accompanied by fever or urinary symptoms; asymptomatic bacteriuria was excluded. Univariate comparisons used chi-square, Fisher's exact and Mann-Whitney U tests. A multivariable logistic regression model with Wald-based confidence intervals identified independent predictors; collinearity was assessed by variance inflation factors and confirmed by sensitivity, interaction and surgical-era analyses. RESULTS:UTI occurred in 80 patients (18.4%). Drain type was the strongest predictor (P=.003): 14.8% with double-J stent (DJS) alone, 26.6% with Pippi Salle external stent and 35.1% with combined DJS+PCN. Both externalized configurations remained independent risk factors after adjustment (OR 1.77, 95% CI 1.18-2.68, P=.006; OR 1.63, 95% CI 1.21-2.21, P=.001). Pelvic reduction was independently protective (OR 0.52, 95% CI 0.30-0.88, P=.015). Open surgery was significant on univariate analysis (25.5% vs 15.0%, P=.011) but not after adjustment (OR 1.34, P=.302). Prophylaxis, prescribed in 168 patients (38.6%), showed no association with infection (OR 0.96, P=.781) and no benefit within any drainage subgroup. Drain duration was not associated with infection. CONCLUSION:Drainage configuration, not antibiotic prophylaxis, is the principal determinant of infection risk after pediatric pyeloplasty. Routine post-discharge prophylaxis confers no measurable benefit and may reasonably be withheld in patients managed with an internal stent, supporting a risk-stratified approach guided by drain selection.

Introduction:The study aimed to evaluate whether continuing α-blocker therapy for one month after aquablation improves early clinical outcomes in patients undergoing surgery for benign prostatic obstruction (BPO). Material and methods:This prospective, single-center study enrolled 240 consecutive patients with symptomatic BPO who underwent aquablation between 2023 and 2025. Patients were divided into two cohorts: cohort A (n = 120) discontinued BPH medications postoperatively, while cohort B (n = 120) continued α-blocker therapy for one month. Functional, sexual, and safety outcomes were assessed at 3, 6, and 12 months using validated tools (IPSS, QoL, VAS, IIEF, MSHQ-EjD-SF, SF-ICIQ). Statistical analysis was used to compare symptom scores, complication rates, and retreatment frequencies between groups. Results:Both cohorts experienced significant symptom improvement following aquablation. However, cohort B showed superior early outcomes, including a greater reduction in irritative symptoms (p = 0.014 at 3 months; p = 0.02 at 12 months), lower VAS pain scores, and fewer postoperative complications (22.5% vs 30.8%, p = 0.15), with nonsignificantly lower rates of moderate (Grade II) complications in cohort B. Sexual function remained stable in both groups, with cohort B demonstrating improved ejaculatory function scores at all time points. No increase in adverse events was observed with continued use of α-blockers. Conclusions:Short-term continuation of α-blocker therapy following aquablation enhances early postoperative recovery, reduces complications, and improves patient-reported well-being without compromising sexual or functional outcomes. Routine one-month α-blocker therapy is a valuable adjunct in aquablation postoperative care.