Abstract Objective The study aims to assess whether the use of a peritoneal flap (PF) during robotic‐assisted radical prostatectomy (RARP) with pelvic lymph node dissection (PLND) reduces the incidence of lymphoceles compared to the standard surgical approach without a flap. Methods The review was prospectively registered on PROSPERO (CRD420251052120). A systematic search of PubMed, MEDLINE, Embase, Scopus, Web of Science, CENTRAL and Google Scholar was performed up to May 2025. Eligible studies were randomised controlled trials (RCTs) or observational studies comparing PF use with the standard surgical technique without the flap during RARP with PLND. Primary outcomes were symptomatic, asymptomatic, total lymphoceles and lymphoceles requiring intervention. Secondary outcomes included complications, operative time, blood loss, positive surgical margins and hospital stay. Results Fourteen studies (six RCTs, eight observational) including 7316 patients were analysed, with 2997 receiving the PF and 4319 receiving the standard technique. PF use was associated with a significantly lower incidence of symptomatic, asymptomatic, total lymphoceles and lymphoceles requiring intervention. PF use reduces overall complications without significantly increasing operative time, hospital stay or positive margins. Intraoperative blood loss was slightly lower in the standard group. Conclusions PF use during RARP with PLND significantly reduces the incidence of lymphoceles and postoperative complications without compromising oncological or perioperative outcomes. These findings support PF use as a safe and effective technique for preventing lymphoceles.

INTRODUCTION:The introduction of the purpose-built single-port (SP) robotic platform has allowed for the advent of regionalized minimally invasive surgical approaches for robotic radical prostatectomy (RARP), including the extraperitoneal and transvesical techniques. This study sought to develop a best practice consensus on the key principles, patient selection, surgical techniques, expected clinical outcomes, and learning curves pertaining to SP-RARP. METHODS:A modified Delphi consensus was developed by a panel of experts, consisting of a 33-item questionnaire, with each statement rated using a binary Likert scale ('agree' or 'disagree'). The survey was distributed via email to all practicing SP-RARP surgeons across the USA and Europe. Consensus was defined as ≥75% agreement on a given statement. RESULTS:A total of 53 surgeons participated in the Delphi Consensus across the two rounds. Of 33 statements, 28 (84.8%) reached agreement in the first round. The remaining consensus was achieved in the second round, involving 35 surgeons, and with one additional statement. The panel agreed that, although are no absolute contraindications to SP-RARP, the preference towards specific SP-RARP techniques should remain guided by the individual patients and surgical expertise. Although the SP extraperitoneal technique is recommended to pursue pelvic lymph node dissections, the panel agreed that transvesical SP-RARP showed promise in promoting shorter hospital stay, faster recovery of urinary continence, and utility in patients with extensive prior abdominal surgery. Consensus was also reached on the need for a structured training pathway, with most recommending beginning with extraperitoneal SP-RARP before advancing to the transvesical approach. CONCLUSION:This Delphi consensus demonstrates broad agreement among experienced SP surgeons in the USA and Europe, forming the foundation for future research on the clinical utility and necessary training pathways for SP-RARP. Nevertheless, empirical validation based on clinical data from large cohort studies remains important.

More patients with significant comorbidities and greater perioperative risk are being selected for robot-assisted surgery (RAS) in urology. Cardiopulmonary arrest (CPA) during RAS is an intraoperative complication that poses unique challenges. This exploratory study surveyed practicing urologists to describe preparedness to manage CPA events during RAS. An expert-developed survey was distributed via social media platforms and during international urology conferences between June 2023 and March 2025. The questionnaire assessed demographic characteristics, training background, exposure to CPA during RAS, and institutional preparedness. A total of 50 responses were included in the final analysis. Among 50 respondents, 94% were male, 74% were over 35 years old, and 56% practiced in the United States. Over half (56%) were fellowship-trained. CPA events during RAS were most commonly witnessed by respondents during residency training (76%). However, 78% had never received formal instruction on management of CPA during RAS. Of those who had, training occurred during residency (12%), fellowship (6%), or instructional courses (12%). Most (80%) were unaware of any institutional protocols for CPA during RAS. Respondents selected similar initial management steps and post-arrest strategies across hypothetical scenarios for CPA during pelvic and renal RAS. These findings identify variability in self-reported training exposure and protocol awareness, suggesting areas where structured education and institutional intervention may be considered.

Background/Objectives: Prostate biopsy is essential for diagnosing prostate cancer. Social determinants of health (SDOH), including socioeconomic status, race, occupation, education, and environment, affect access, outcomes, and quality of life. Recognizing disparities from technology access to complications is crucial for equitable care. A systematic review examined how SDOH impacts biopsy access, technology, and complications. Methods: A systematic search of PubMed, Web of Science, and Scopus was performed to identify eligible studies published through February 2026. We included studies that evaluated the association between one or more SDOHs and prostate biopsy. Relevant outcomes included biopsy utilization, use of specific biopsy technologies (e.g., magnetic resonance imaging (MRI)-guided, transperineal), and post-procedural complications. Results: Nine observational studies met the inclusion criteria. The findings revealed disparities across three key domains. First, access to advanced biopsy technology was uneven. Four studies showed that Black men were significantly less likely than White men to receive MRI-guided biopsies. Additionally, post-biopsy outcomes showed that Black and Hispanic men faced significantly higher rates of post-biopsy infection and hospitalization compared to White men. Lastly, patients in rural areas, those in public hospitals, and individuals with lower socioeconomic status demonstrated reduced access to modern techniques, including MRI-guided or transperineal biopsy. Conclusions: Social and economic factors influence who receives a prostate biopsy and who has access to advanced technologies. Minority and low-income patients face diagnosis barriers and higher complication rates, highlighting systemic inequities. The healthcare system often rewards access over need, and without bold policy changes, gaps in technology and resources will worsen, moving us further from truly equitable prostate cancer care.

INTRODUCTION:Outpatient pathways are increasingly implemented, including robot-assisted partial nephrectomy (RAPN). However, the evidence supporting same-day RAPN originates from heterogeneous center series. As such, we synthesized the evidence in this systematic review and meta-analysis, comparing operative outcomes between outpatient and inpatient RAPN. METHODS:We adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 and AMSTAR guidelines. Three electronic databases (PubMed, Scopus, and Web of Science) were searched from their inception until June 18, 2025. Original studies reporting operative outcomes and relevant data, comparing the outpatient and inpatient RAPN, were included. We used risk ratio (RR) and mean difference (MD) with their 95% confidence interval (CI) to compare dichotomous and continuous outcomes, respectively. The primary outcome was the major postoperative complication rate, and the secondary outcomes were overall complications, unscheduled visits, and readmission after operation. RESULTS:A total of 168 titles and abstracts were included for initial screening. The full-text assessment was conducted on 22 articles, and 6 remained in our final analysis. This represented 1559 patients, of which 830 (53.24%) and 729 (46.76%) composed the outpatient and inpatient cohorts, respectively. In the outpatient group, the proportion of low ASA scores (I-II) was significantly higher than that in the inpatient group (RR = 1.41, 95% CI: 1.13-1.77, P = 0.003). Regarding perioperative outcomes, the outpatient had shorter operative time (MD = -19.4 minutes, 95% CI -34.48 to 4.27, P = 0.012), shorter warm ischemia time (MD = -4.94 minutes, 95% CI: -9.45 to 0.43, P = 0.032), and more pathologic T1 stage (RR = 1.06, 95% CI: 1.01-1.11, P = 0.018). After an operation, outpatients were at lower risk of major complications (RR = 0.44, 95% CI: 0.24-0.81, P = 0.009), but more likely to have unscheduled visits (RR = 2.78, 95% CI: 1.24-6.21, P = 0.013). Overall and minor complications, postoperative readmission, transfusion rates, and estimated blood loss were comparable between the two groups. CONCLUSIONS:Based on the available evidence, outpatient RAPN could be a safe and feasible option for carefully selected patients, provided an appropriate postoperative support is available.

Background and Objectives Single Port (SP) robotic radical prostatectomy (RARP) has been increasingly used, with Extraperitoneal (EP) and Transvesical (TV) approaches being the most common. This study sought to describe the multi-institutional clinical experience of EP and TV SP-RARP. Materials and Methods A retrospective review was conducted using the prospectively maintained, Institutional Review Board-approved database of the SP Advanced Research Consortium (SPARC) to identify all consecutive patients who underwent EP or TV SP-RARP between 2019 and 2025. A 1:1 propensity score-matched comparison analysis was performed based on the age, prostate volume, PSA levels, and ISUP Grade Groups on the preoperative prostate biopsy. Results and Limitations A total of 2230 patients were reviewed, which included 1699 (76.2%) EP and 531 (23.8%) TV SP-RARP. Following propensity score-matched analysis, 884 patients were included, with 442 being analyzed from each group. History of previous abdominal surgery was more prevalent in the TV cohort (EP 33% vs TV 49.5%, SMD = 0.342). All procedures were completed successfully, with similar operative times (median, 184 vs 192 min, p = 0.733), risk of intraoperative complications (0.6% vs 1%, p = 0.307), and positive surgical margin status (pT2, 13.3% vs 14.7%, p = 0.070). Postoperatively, the SP-TV approach was associated with higher rates of same-day discharges (60.6% vs 78.2%, p < 0.001), a shorter Foley catheter duration (median, 7 vs 5 d, p < 0.001), with no differences in the incidence of major complications (3.2% vs 1.6%, p = 0.185). With 42.3% of patients achieving immediate urine continence following TV SP-RARP, the regionalized technique conferred improved early continence recovery at both 6 wk (44% vs 52.9%, p < 0.001), 3 mo (69.7% vs 79.1%, p = 0.040), and 6 mo (77.9% vs 87.2%, p < 0.001). At 12 mo, satisfactory erectile function was reported in 85.7% and 88.4% of the SP EP and TV groups, respectively (p = 0.174). At a median follow-up duration of 10 mo, biochemical recurrence rates were similar between the two groups (3.1% vs 3.6%, p = 0.678). Limitations of this study included the retrospective study design of the relatively novel surgical techniques, with limited long-term follow-up data. Conclusion TV SP-RARP offers notable advancements in patient comfort, featuring higher rates of same-day discharges, reduced opioid use, shorter Foley catheter duration, and early recovery of urine continence, whilst maintaining comparable perioperative safety and oncological adequacy to EP SP-RARP.

INTRODUCTION:Despite ergonomic advancements in robotic technology, physical symptoms and discomfort remain significant concerns for urologists, with symptoms increasing with years of practice. Eye symptoms, including accommodation lag, dry eyes, and eye strain, have been reported. This study aims to detail the visual challenges faced by robotic urologists and to further examine what factors could be contributing to these symptoms. METHODS:A 22-item standardized survey developed with the recommendations from the Endourological Society Data Committee was distributed between October 2024 and April 2025. A total of 84 responses were received. Patients who performed no monthly robotic cases (n = 9) and those missing ≥ 5 questions (n = 1) were excluded. The survey addressed demographics, practice patterns, console time, and eye symptoms such as strain, pain, or watering. It also explored symptom timing, impact on postconsole activities, and preventive measures like breaks or eye drops. RESULTS:The final analysis included data from 74 participants. Overall, 86% of respondents were older than 35 years. Most urologists (81%) had been practicing for more than 5 years, with 84% performing ≥ 3 robotic surgeries monthly. Console times were estimated to be 60-120 minutes for 43% of participants and > 120 minutes for 52%. About 73% used corrective eyeglasses, and 42% reported eye symptoms such as strain, pain, or watering while on the surgical console, which mostly occurred after more than an hour into surgical procedure (90%). Postoperation, 35% experienced headaches and eye fatigue, 30% had difficulties adjusting focus when transitioning from console work to paper/computer work, and 47% reported dry eyes. Over time, 33% observed a progression in symptoms. CONCLUSION:This survey highlights the prevalence of eye and vision problems among robotic urologists, underscoring the need for better ergonomic design, effective lighting, and preventive measures.

Introduction Prostate cancer (PCa) survivorship is associated with substantial psychological distress, yet racial differences in mental health outcomes are incompletely understood. We used multivariable logistic regression models to evaluate associations between race and post-diagnosis depressive episodes and patient-reported psychosocial outcomes, including quality of life, mental health, and social satisfaction, among PCa survivors in a diverse national cohort. Methods We conducted a cross-sectional study using the National Institutes of Health (NIH) All of Us Research Program Controlled Tier Dataset (version 8). Adults with electronic health records (EHR)-documented PCa who completed surveys after diagnosis were included. Non-Hispanic White (NHW) and Black participants were compared. Primary outcomes included depressive episodes after diagnosis and patient-reported quality of life, mental health, and social satisfaction. Multivariable regression models adjusted for age, time since diagnosis, socioeconomic factors, medical comorbidities, and baseline depression. Results Among 4,524 PCa survivors, 3,965 (87.6%) were NHW and 559 (12.4%) were Black. Black participants were younger (median 66.8 years vs 72.6, p<0.001) and experienced greater socioeconomic disadvantage (219 (39.2%) with <$25,000 annual household income vs. 262 (6.6%), p<0.001). Depressive episodes were more common among Black individuals (97 (17.4%) vs 509 (12.8%)). On univariate analysis, Black race was associated with higher odds of depressive episode (OR 1.31, 95% CI 1.07-1.59, p=0.008), but this association did not persist after adjustment (adjusted OR 0.80, 95% CI 0.60-1.06, p=0.119). In contrast, NHW participants reported worse psychosocial outcomes, with higher proportions reporting fair or poor quality of life, mental health, and social satisfaction. Black race was associated with lower odds of worse self-reported primary outcomes on univariate analysis; after adjustment, this association persisted for quality of life (adjusted OR 0.75, 95% CI 0.61-0.92, p=0.005). Conclusion Racial differences in EHR-documented depression were largely explained by socioeconomic factors, while patient-reported psychosocial outcomes were similar or more favorable among Black individuals. Divergence between clinical diagnoses and patient-reported measures highlights challenges in accurately assessing psychological distress across populations.

Therapeutic options for advanced prostate cancer have expanded in recent years, incorporating multiple-system treatment approaches with differing mechanisms of action. However, comparative real-world safety data following drug approval remain limited. As such, the aim of this study is to characterize adverse events and disproportionate safety signals among advanced prostate cancer therapies using the FDA Adverse Event Reporting System (FAERS). A retrospective pharmacovigilance study of FAERS reports evaluated enzalutamide, darolutamide, apalutamide, abiraterone acetate, relugolix, niraparib/abiraterone, talazoparib, rucaparib, cabazitaxel, sipuleucel-T, and lutetium-177 vipivotide. Adverse events were categorized by System Organ Class and Preferred Terms. Reporting odds ratios (RORs) with 95% confidence intervals identified safety signals. Among 172,440 reports, most involved patients aged 65–85 years. Cabazitaxel had the highest proportion of serious reports (86.6%) and deaths (22%), whereas relugolix had the lowest (23.3% and 4.8%). Nervous system disorders predominated with enzalutamide and darolutamide, gastrointestinal disorders with abiraterone, rucaparib, and niraparib/abiraterone, and hematologic toxicities with cabazitaxel, talazoparib, and lutetium-177 vipivotide. Significant safety signals were identified for abiraterone and cabazitaxel, but not other therapies. The absence of a detected signal should not be interpreted as evidence of safety or equivalence, as reporting volume, detection bias, and statistical power varied across therapies. Overall, the therapies demonstrated distinct toxicity profiles, which may inform treatment selection, toxicity monitoring, and patient counseling.