Aim: The aim of the study was to investigate the relationship between prostatic apical shape and continence recovery after robot-assisted radical prostatectomy (RARP) in a large multicentric cohort. Materials and Methods: Data of patients who underwent transperitoneal RARP at 10 referral robotic centers between January 2017 and December 2022 were retrospectively analyzed. Patients were stratified into four groups based on the multiparametric magnetic resonance imaging (mpMRI) prostatic apex shape. Pre-, intra-, and postoperative variables were compared. Continence recovery was defined as no pad or 1 safety pad/day. Results: A total of 822 patients were retrieved and classified as Group A (n = 206), Group B (n = 221), Group C (n = 143), and Group D (n = 252) based on the mpMRI. At baseline, statistically significant differences were found in Charlson's comorbidity index (CCI) (p < 0.001), body mass index (BMI) (p = 0.01), prostatic urethral length (p = 0.008), and membranous urethral length (p = 0.03). In terms of bladder neck-sparing technique, a statistically significant difference was found among groups (p = 0.005). Group D achieved continence significantly earlier than the other groups after RARP, with a median recovery time of 3 months (95% confidence interval [CI]: 3-3), compared with 4 months for all other groups (95% CI: 4-4). Group D showed an earlier continence recovery after RARP with respect to all the other shapes (hazard ratio [HR] = 1.23, 95% CI: 1.05-1.43, p = 0.005). The estimated HR remained unchanged after adjusting by age, BMI, CCI, bladder neck-sparing, nerve-sparing, and presence of median lobe (HR = 1.17, 95% CI: 1.00-1.38, p = 0.046). Cox model showed an association with BMI (HR = 0.97, 95% CI: 0.95-0.99, p = 0.03), bladder neck-sparing (HR = 1.45, 95% CI: 1.24-1.70, p < 0.001), and nerve-sparing (HR = 1.27, 95% CI: 1.11-1.46, p = 0.001). Conclusions: Our multi-institutional study confirmed that prostatic apical shape has a significant impact on time-to-continence after RARP.

Background To explore the role of preoperative MRI prostate shape in urinary incontinence after robot-assisted radical prostatectomy (RARP). Methods Patients were stratified into four groups based on the mpMRI prostatic apex shape: Group A (prostatic apex overlapping the membranous urethra anteriorly and posteriorly), Group B and C (overlap of the prostatic apex of the anterior or posterior membranous urethra, respectively) and Group D (no overlap). Preoperative variables and intraoperative data were compared. Continence recovery was defined as no pad/day or 1 safety pad/day by an outpatient evaluation performed at 1, 3, 6, and 12 months after RARP. Results One hundred patients underwent RARP were classified as belonging to Group A ( n = 30), Group B ( n = 16), Group C ( n = 14), and Group D ( n = 40). Group D showed a significantly more favorable urinary continence recovery after RARP respect to all the other shapes presenting any forms of overlapping (HR = 1.9, 95% CI 1.2–3.1, p = 0.007). The estimated HR remained substantially unchanged after adjusting by age, body mass index, CCI, prostate volume, and bladder neck sparing (HR = 1.9, 95% CI 1.1–3.2, p = 0.016). The continence recovery median time was 9 months for Group A + B + C (95% CI 5–11) and 4 months for Group D (95% CI 2–6) ( p = 0.023). Conclusion Shape D showed a better continence recovery when compared to other shapes presenting any kind of overlapping of the prostatic apex over the membranous urethra.

Purpose: To evaluate if thulium laser vapoenucleation of the prostate (ThuVEP) is equally safe and effective in a selected cohort of elderly patients when compared to "younger" patients. Materials and methods: We performed a retrospective analysis of consecutive patients who underwent ThuVEP between September 2018 and February 2020. After application of the inclusion/exclusion criteria, patients were stratified according to the 75 years-old cut-off point suggested by the WHO. Group A included patients <= 75 years-old; Group B included patients >75 years-old. Preoperative assessment included urological consultation, prostate specific antigen (PSA), International Prostate Symptom Score (IPSS) and quality of life index, transrectal ultrasound to estimate prostate volume (PVol), and uroflowmetry to assess preoperative Qmax, Qave and post-void residual volume (PVR). Perioperative and postoperative data were analyzed during 3-month follow-up. Results: After propensity-score analysis, 51 versus 51 patients were 1:1 matched according to PVol, PSA, Qmax, IPSS and QoL. Patients were comparable at baseline excluding age (65 (IQR 59-70) versus 79 (IQR 77-82) years, Group A versus B, respectively, P-value < .001). No differences were found in terms of hemoglobin drop, complications rate, catheterization time and length of hospital stay. Group A (younger) patients had more significant improvement in 30-days absolute Qmax, Qave and Delta Qmax. At 90-days follow-up, the differences between the groups disappeared. Within the 90-days follow-up, no significant differences were found in the readmission rate, with no need of reinterventions. Conclusions: In our hands, even in elderly patients affected by BPH, ThuVEP appears to be a safe and effective treatment option. (C) 2021 AEU. Published by Elsevier Espana, S.L.U. All rights reserved.

Introduction. - We aimed to compare the pathway including multi-parametric Magnetic Resonance Imaging (mpMRI) versus the one without mpMRI in detection of prostate cancer (PCa) when mpMRI is not centralized. Materials. - January 2019-March 2020: prospective data collection of trans-perineal prostate biopsies. Group A: biopsy-naive patients who underwent mpMRI (at any institution) versus Group B: patients who did not. Within Group A, patients were stratified into those with negative mpMRI (mpMRI-, PIRADS v2.1 = 1-3, with PSA density < 0.15 if PIRADS 3) who underwent standard biopsy (SB), versus those with positive mpMRI (mpMRI+, when PIRADS 3-5, with PSA density > 0.15 if PIRADS 3) who underwent cognitive fusion biopsy. Results. - Two hundred and eighty one biopsies were analyzed. 153 patients underwent mpMRI(Group A). 98 mpMRI+ underwent fusion biopsy; 55 mpMRI-underwent SB. 128 Group B patients underwent SB. Overall PCa detection rate was 52.3% vs. 48.4% (Group A vs. B, P = 0.5). Non-clinically-significant PCa was detected in 7.8 vs. 13.3% (Group A vs. B, P = 0.1). Among the 98 mpMRI+ Group A patients only 2 had non clinically-significant disease. In 55 mpMRI- patients who underwent SB, 10 (18.2%) had clinically-significant PCa. Prostate volume predicted detection of PCa. In Group B, age and PSA predicted PCa. Sensitivity of mpMRI was 75.0% for all PCa, 85.3% for clinically-significant PCa. Conclusion. - Higher detection of PCa and lower detection of non-clinically-significant PCa favored mpMRI pathway. A consistent number of clinically-significant PCa was diagnosed after a mpMRI-. Thus, in real-life scenario, mpMRI- does not obviate indication to biopsy when mpMRI is not centralized. (C) 2020 Elsevier Masson SAS. All rights reserved.

Evaluar la seguridad y efectividad de la vapoenucleación prostática con laser Tulio (TuLEP) en una cohorte seleccionada de pacientes ancianos en comparación con pacientes «más jóvenes». Se realizó un análisis retrospectivo de los pacientes consecutivos que se sometieron a TuLEP entre septiembre de 2018 y febrero de 2020. Tras aplicar los criterios de inclusión/exclusión, los pacientes se estratificaron según el punto de corte de 75 años sugerido por la OMS: el grupo A incluyó a los pacientes < 75 años; el grupo B incluyó a los pacientes > 75 años. La evaluación preoperatoria incluyó una consulta con el urólogo, el valor del antígeno prostático específico (PSA), el International Prostate Symptom Score (IPSS) y quality of life (QoL), ecografía transrectal para estimar el volumen prostático (PVol) y uroflujometría para evaluar los valores preoperatorios de maximum urinary flow rate (Qmax) y average urinary flow rate (Qave), así como el volumen residual postmiccional (PVR). Se analizaron los datos perioperatorios y postoperatorios con un seguimiento de 3 meses. Tras el análisis de puntuación de propensión, 51 pacientes fueron emparejados 1:1 frente a otros 51 con base en PVol, PSA, Qmax, IPSS y QoL. Los pacientes eran comparables al inicio excluyendo la edad 65 (IQR 59-70) vs. 79 (IQR 77-82) años, Grupo A vs. grupo B, respectivamente (valor p < 0,001). No se encontraron diferencias en cuanto al descenso de la hemoglobina, la tasa de complicaciones, el tiempo de cateterismo y la duración de la estancia hospitalaria. Los pacientes del grupo A (más jóvenes) experimentaron una mejora significativamente mayor en cuanto al valor absoluto de Qmax, Qave y ΔQmax a los 30 días. A los 90 días de seguimiento, las diferencias entre los grupos desaparecieron. Durante los 90 días de seguimiento, no se encontraron diferencias significativas en la tasa de reingreso ni se requirieron reintervenciones. La TuLEP parece ser una opción de tratamiento segura y efectiva en nuestras manos, incluso en pacientes ancianos afectados por hiperplasia prostática benigna (HBP). To evaluate if thulium laser vapoenucleation of the prostate (ThuVEP) is equally safe and effective in a selected cohort of elderly patients when compared to "younger" patients. We performed a retrospective analysis of consecutive patients who underwent ThuVEP between September 2018 and February 2020. After application of the inclusion/exclusion criteria, patients were stratified according to the 75 years-old cut-off point suggested by the WHO. Group A included patients < 75 years-old; Group B included patients > 75 years-old. Preoperative assessment included urological consultation, prostate specific antigen (PSA), International Prostate Symptom Score (IPSS) and quality of life index, transrectal ultrasound to estimate prostate volume (PVol), and uroflowmetry to assess preoperative Qmax, Qave and post-void residual volume (PVR). Perioperative and postoperative data were analyzed during 3-month follow-up. After propensity-score analysis, 51 versus 51 patients were 1:1 matched according to PVol, PSA, Qmax, IPSS and QoL. Patients were comparable at baseline excluding age (65 (IQR 59-70) versus 79 (IQR 77-82) years, Group A versus B, respectively, p-value < 0.001). No differences were found in terms of hemoglobin drop, complications rate, catheterization time and length of hospital stay. Group A (younger) patients had more significant improvement in 30-days absolute Qmax, Qave and ΔQmax. At 90-days follow-up, the differences between the groups disappeared. Within the 90-days follow-up, no significant differences were found in the readmission rate, with no need of reinterventions. In our hands, even in elderly patients affected by BPH, ThuVEP appears to be a safe and effective treatment option.

Hypothesis / aims of study Pressure flow study (PFS) is considered the standard procedure to diagnose bladder outlet obstruction (BOO). Nevertheless, PFS is an invasive test, with possible morbidity; furthermore, it is time consuming and costly. For this reason, research has been performed, with the aim to develop a non invasive examination, able to assess BOO. The penile cuff test has been proposed (1) as a non invasive tool to assess BOO. In the penile cuff test, a cuff is placed around the penis before voiding urine (see figure 1). This is automatically inflated during the voiding process to stop urine flow, and then deflated again. The inflation/deflation cycle is repeated several times during a single emptying of the bladder and the cuff pressure needed to stop the flow of urine is determined. This provides a measure of the fluid pressure generated in the bladder which is used to distinguish BOO from problems associated with under-active bladder muscle. Few data have been published about correlations between penile cuff test and PFS findings (2). Aim of the present study was to investigate these correlations and to evaluate the role of the penile cuff test in the diagnosis of BOO.