Background and objective:Postprostatectomy incontinence (PPI) reduces quality of life, yet remains undertreated despite effective surgical options. Persistently low intervention rates in Europe for PPI suggest a care gap. This study assessed patients' knowledge of surgical PPI treatments and barriers to treatment uptake. Methods:Cross-sectional baseline analysis of ProKontinenz trial. Men with persistent PPI for ≥12 mo after radical prostatectomy (≥2 pads/d, no prior incontinence surgery) from 34 certified prostate cancer centers were surveyed during January-June 2025, using validated questionnaires and 24-h pad test. The primary outcome was knowledge of incontinence surgery; secondary outcomes included information sources, treatment barriers, and associations with symptom burden/quality of life. Associations with knowledge were assessed using logistic regression. Key findings and limitations:A total of 526 of 692 men participated (90% response rate). Among the participants, common reasons for not considering incontinence surgery were satisfaction with incontinence products (79%), concerns about surgical risks (53%), and doubts about success of surgery (51%). Fifty-nine percent men reported no knowledge of surgical PPI treatment. Independent predictors of lacking knowledge were low urine loss (odds ratio [OR] 2.4, 95% confidence interval [CI] 1.3-4.7), less severe King's Health Questionnaire (KHQ)-score "role limitation" (OR 2.2, 95% CI 1.1-4.3), concerns about treatment success (OR 2.2, 95% CI 1.2-4.1), and missing information from the urologist (OR 4.2, 95% CI 1.1-16.7) or partner (OR 2.0, 95% CI 1.2-3.8). Limitations of the study include self-reported data and a nonvalidated definition of "knowledge." Conclusions and clinical implications:Among patients with PPI for ≥12 mo after radical prostatectomy, more than half did not have any knowledge of potentially effective surgery. Information deficits and symptom severity influence knowledge. Strengthening guideline-based information and clinician-patient communication may help close this gap.

BACKGROUND AND OBJECTIVE:Stress urinary incontinence (SUI) is a common yet often undertreated condition. While several treatment options exist for moderate SUI, women with severe incontinence - particularly due to intrinsic sphincter deficiency (ISD) or a fixed urethra - often have limited effective options after failed procedures. The artificial urinary sphincter (AUS) is the gold standard for severe incontinence in men, but its use in women remains limited due to surgical complexity, higher complication rates, and restricted availability to specialized centers. Consequently, high-quality evidence supporting its use in women is lacking. The VENUS registry aims to address this gap by collecting prospective, standardized data across multiple European centers. METHODS:This is a prospective, non-controlled cohort study evaluating outcomes of AUS implantation in female patients using various surgical approaches (robot-assisted, laparoscopic, open, or other). Data will be collected across European centers (NCT04114266). The primary outcome is the cure rate of AUS implantation for female SUI due to ISD. Secondary outcomes include patient-reported outcomes, urodynamic and uroflowmetric changes, postoperative complications, and revision-free survival. The study aims to recruit 150 patients with a follow-up of 5 years. CONCLUSION:The VENUS registry will provide real-world evidence on the safety and efficacy of AUS in women. Its findings may support broader adoption and future trials, while identifying clinical and surgical factors associated with successful outcomes, ultimately improving care for women with severe SUI.

Intraoperative consultation is frequently used during the surgical treatment of lung tumors for the diagnosis of malignancy and the assessment of surgical margins. The latter is often problematic given the nature of the applied staple lines, which cannot be readily examined in frozen sections. Seventy-nine samples of surgical margins (71 staple lines and 8 open margins) from 52 lung specimens were examined using an ex vivo fluorescence confocal microscope (FCM). The diagnoses of the FCM scans were compared to the corresponding paraffin section images of the same material. The procedure provided intraoperative FCM imaging of the surgical margins and staple lines without having to remove the metal clips. Tumor-involved open margins (5/5) and tumor-involved staple lines (3/4) were correctly identified in the FCM images. The results also provided additional information to the conventional frozen sections. This is the first time staple lines of lung specimens have been visualized as preserved tissue using FCM. The method potentially provides an additional approach for intraoperative decisions when the margins in conventional frozen sections are unclear. Our promising results, however, need to be validated on a larger number of cases.

Aims:: To present the body of evidence about the practice of objective assessment of lower urinary tract (LUT) function and dysfunction of female patients with stress urinary incontinence symptoms It serves as a scientific background review and evidence base for a presentation made available on the International Continence Society (ICS) website. Methods:: This narrative review has been prepared by a working group instituted by the ICS Urodynamics Committee. The method to develop the educational module used included narrative literature review, consensus formation by the members of the Working Group, and review by members of the ICS Urodynamics Committee core panel. Results:: On the basis of the available guidelines and articles, we addressed the following topics: Indications for comprehensive urodynamic study (UDS); the best way to inform and prepare the patient; the urodynamic study protocol in women with SUI; the practice of the different tests (cystometry with pressure flow study, leak point pressure and urethral pressure profile). Conclusions:: This ICS teaching module includes an expert-based profile of patients with signs and symptoms of SUI that can be considered complicated and includes specific recommendations for the practice of testing. UDS helps diagnosing the dysfunction that leads to the symptoms. Most of the testing for women with stress urinary incontinence can be performed in the already standardized manner; some adaptions of practice and evaluation are mentioned.

The most frequent initial clinical symptom is flank pain, which occurs in approximately half of affected patients with stones of the upper urinary tract. Of these patients approximately half require treatment and 50% will again have new stones in the future. Only 8% of urinary stones are clinically inapparent with 25-50% of the stones located in the lower calyx group and are incidentally discovered during the diagnostics of symptomatic stones. Stones in the lower calyx are more difficult to treat than other kidney stones due to the localization and the resulting access possibilities. The treatment must therefore be planned and carried out individually according to the available treatment options. Since the development of modern flexible ureterorenoscopes (URS) retrograde stone removal, which has few complications, has been highly valued in the treatment of stones of the lower calyx due to the desired primary stone clearance rates. Limiting factors are the longer treatment times for large stone masses and the considerable material costs. Furthermore, the various forms of percutaneous nephrolitholapaxy provide additional methods for the treatment of larger lower caliceal stones.

Ureteral strictures represent a common urological challenge, often requiring repeated interventions. This case report presents a patient with bilateral ureteral strictures who successfully underwent staged bilateral robotic-assisted ureteral reconstruction using a buccal mucosa graft (BMG). In recent years, significant advancements in minimally-invasive techniques and technologies have transformed the treatment of ureteral strictures. Historically, the management of these strictures often required open surgery, however, the introduction of minimally-invasive techniques has allowed for effective treatment in most patients without the necessity to use open procedures [1].

Background: Intraoperative frozen sections (FS) are frequently used to establish the diagnosis of lung cancer when preoperative examinations are not conclusive. The downside of FS is its resource-intensive nature and the risk of tissue depletion when small lesions are assessed. Ex vivo fluorescence confocal microscopy (FCM) is a novel microimaging method for loss-free examinations of native materials. We tested its suitability for the intraoperative diagnosis of lung tumors. Methods: Samples from 59 lung resection specimens containing 45 carcinomas were examined in the FCM. The diagnostic performance in the evaluation of malignancy and histological typing of lung tumors was evaluated in comparison with FS and the final diagnosis. Results: A total of 44/45 (98%) carcinomas were correctly identified as malignant in the FCM. A total of 33/44 (75%) carcinomas were correctly subtyped, which was comparable with the results of FS and conventional histology. Our tests documented the excellent visualization of cytological features of normal tissues and tumors. Compared to FS, FCM was technically less demanding and less personnel intensive. Conclusions: The ex vivo FCM is a fast, effective, and safe method for diagnosing and subtyping lung cancer and is, therefore, a promising alternative to FS. The method preserves the tissue without loss for subsequent examinations, which is an advantage in the diagnosis of small tumors and for biobanking.

Background: MRI-guided prostate biopsies from visible tumor-specific lesions (TBx) can be used to diagnose clinically significant carcinomas (csPCa) requiring treatment more selectively than conventional systematic biopsies (SBx). Ex vivo fluorescence confocal microscopy (FCM) is a novel technique that can be used to examine TBx prior to conventional histologic workup. Methods: TBx from 150 patients were examined with FCM on the day of collection. Preliminary findings were reported within 2 h of collection. The results were statistically compared with the final histology. Results: 27/40 (68%) of the csPCa were already recognized in the intraday FCM in accordance with the results of conventional histology. Even non-significant carcinomas (cisPCa) of the intermediate and high-risk groups (serum prostate-specific antigen (PSA) > 10 or 20 ng/mL) according to conventional risk stratifications were reliably detectable. In contrast, small foci of cisPCa were often not detected or were difficult to distinguish from reactive changes. Conclusion: The rapid reporting of preliminary FCM findings helps to reduce the psychological stress on patients, and can improve the clinical management of csPCa. Additional SBx can be avoided in individual cases, leading to lower rates of complications and scarring in the future surgical area. Additional staging examinations can be arranged without losing time. FCM represents a promising basis for future AI-based diagnostic algorithms.

The glycoprofiling of two proteins, the free form of the prostate-specific antigen (fPSA) and zinc-α-2-glycoprotein (ZA2G), was assessed to determine their suitability as prostate cancer (PCa) biomarkers. The glycoprofiling of proteins was performed by analysing changes in the glycan composition on fPSA and ZA2G using lectins (proteins that recognise glycans, i.e. complex carbohydrates). The specific glycoprofiling of the proteins was performed using magnetic beads (MBs) modified with horseradish peroxidase (HRP) and antibodies that selectively enriched fPSA or ZA2G from human serum samples. Subsequently, the antibody-captured glycoproteins were incubated on lectin-coated ELISA plates. In addition, a novel glycoprotein standard (GPS) was used to normalise the assay. The glycoprofiling of fPSA and ZA2G was performed in human serum samples obtained from men undergoing a prostate biopsy after an elevated serum PSA, and prostate cancer patients with or without prior therapy. The results are presented in the form of an ROC (Receiver Operating Curve). A DCA (Decision Curve Analysis) to evaluate the clinical performance and net benefit of fPSA glycan-based biomarkers was also performed. While the glycoprofiling of ZA2G showed little promise as a potential PCa biomarker, the glycoprofiling of fPSA would appear to have significant clinical potential. Hence, the GIA (Glycobiopsy ImmunoAssay) test integrates the glycoprofiling of fPSA (i.e. two glycan forms of fPSA). The GIA test could be used for early diagnoses of PCa (AUC = 0.83; n = 559 samples) with a potential for use in therapy-monitoring (AUC = 0.90; n = 176 samples). Moreover, the analysis of a subset of serum samples (n = 215) revealed that the GIA test (AUC = 0.81) outperformed the PHI (Prostate Health Index) test (AUC = 0.69) in discriminating between men with prostate cancer and those with benign serum PSA elevation.

Bash JC, Bassale S, and Isharwal S1 focus on the unnecessary pathological investigation and related costs for an expected benign outcome without clinical relevance. Although a benign cause is expected, a pathological investigation is performed in most cases which have been confirmed by the authors on other topics and by previously cited publications. Although 91.1% of all cases in this series were sent for pathology, one of which did not have a final assessment (was it lost?), and in 10.8%, the pathology description was missing: Therefore, malignancy cannot be completely excluded resulting in further treatment. Only very few cases are reported, and the majority of cases were adults with a primary cancer in their history.2 In most cases, the pathology was performed in pediatric cases (66.5%), despite the fact that UPJO is most commonly congenital.3,4 Secondarily, b) if the surgeon excludes malignancy during surgery (in addition to the patient's history), it might be reflected by the related guidelines4 that there is no need for pathological verification. The exception: The surgeon has any doubt of its benign cause (in dubeo pro reo). The result: Resources are then freed up for an increasingly relevant diagnostic requests to verify the expected diagnoses without any further relevance to the case. Reducing unnecessary pathology investigations would avoid duplication and reduce the cost.5 An exception would be the request of the insurance, but the diagnosis of UPJO remains to be a clinical and in majority of cases is verified by ultrasound/radiology.4 In the specialty of urology, it might worthwhile to incorporation this aspect into the related guidelines to reduce the work load, use of necessary chemicals (environmental influence), and obviously related cost.

The standard procedure for the diagnosis of prostate carcinoma involves the collection of 10-12 systematic biopsies (SBx) from both lobes. MRI-guided targeted biopsies (TBx) from suspicious foci increase the detection rates of clinically significant (cs) PCa. We investigated the extent to which the results of the TBx predicted the tumor board treatment decisions. SBx and TBx were acquired from 150 patients. Risk stratifications and recommendations for interventional therapy (prostatectomy and radiotherapy) or active surveillance were established by interdisciplinary tumor boards. We analyzed how often TBx alone were enough to correctly classify the tumors as well as to indicate interventional therapy and how often the findings of SBx were crucial for therapy decisions. A total of 28/39 (72%) favorable risk tumors were detected in TBx, of which 11/26 (42%) very-low-risk tumors were not detected and 8/13 (62%) low-risk tumors were undergraded. A total of 36/44 (82%) intermediate-risk PCa were present in TBx, of which 4 (9%) were underdiagnosed as a favorable risk tumor. A total of 12/13 (92%) high-risk carcinomas were detected and correctly grouped in TBx. The majority of csPCa were identified by the sampling of TBx alone. The tumor size was underestimated in a proportion of ISUP grade 1 tumors. Systematic biopsy sampling is therefore indicated for the next AS follow-up in these cases.

Bladder acontractility caused by a lower motor neuron lesion is an irreversible and debilitating voiding disorder affecting a large number of relatively young people. In the following, based on our pilot study, we presented the long-term clinical results in a multicenter setting concerning the latissimus dorsi detrusor myoplasty (LDDM) in patients with an acontractile bladder for whom there is no treatment alternative than lifelong clean intermittent catheterization (CIC) which is often linked to chronic urinary infections. From May 2001 to February 2008, 24 patients (mean age: 37 years; range: 14–63; 15 males, 9 females) were enrolled in four clinical worldwide centers requiring complete CIC four to eight times/day. The mean follow-up was 46 months (8–89) and was carried out by questionnaire and measurement of post-void residual urine volume (PVR). Seventeen of the 24 patients (70.8%) gained complete spontaneous voiding and did not require further CIC with PVR from 0 to 100 ml. In three patients (16.5%), the frequency of CIC was reduced from four to six times/day preoperatively to two to four times/day postoperatively with RUVs from 150 to 250 ml. Twenty-one of 23 patients (91.3%) had no recurrent urinary tract infections postoperatively (mean preoperatively: 7.8/year; 0–24). Four patients (12.5%) needed CIC four to six times/day as before. No functional restrictions and chronic pain of the operated upper extremity were observed in any patient. Complete (n = 17) or incomplete spontaneous voiding (n = 3) was achieved in 20 of the 24 patients (83.3%). Recurrent urinary tract infections terminated in 21 of the 23 patients postoperatively (91.3%). These results were maintained during the long-term follow-up period of up to 7.5 years. Overall, the LDDM procedure is an option for a specific group of patients with an acontractile detrusor to undergo this procedure. The surgery should be performed in a center of excellence as these primary published reports have recommended. The patient needs to be informed that in approximately 30% of the cases, the LDDM procedure is not successful and the continuation of CIC will be mandatory.

Peripheral neuromodulation is derived from techniques used in traditional Chinese medicine, better known as acupuncture. The location of SP-6 and the organs affected by its stimulation have remarkable similarities with current posterior tibial nerve stimulation (PTNS). In combination with the applied ground patch, an electrical current is applied to the acupuncture needle, which transforms into an electrical form of acupuncture. McGuire et al. were the first to report the use of PTNS in 22 patients with neurogenic OAB. PTNS was effective in 87% of patients who demonstrated a complete or partial improvement of their symptoms. Subsequently, Stoller et al. further developed PTNS (known as Stoller afferent nerve stimulation (SANS)), as a clinical treatment for OAB. More recently, new and improved products have entered into trials. There continues to be other devices on the market that are placed on the skin surface (transcutaneous) and have demonstrated success in nDO patients. The upcoming CTNM improves the individual patient's quality of life and makes them more independent when compared to common PTNS.

Background: The diagnosis of prostate carcinoma (PCa) requires time- and material-consuming histopathological examinations. Ex vivo fluorescence confocal microscopy (FCM) can detect carcinoma foci in diagnostic biopsies intraoperatively. Methods: MRI-guided and systematic biopsies were identified in a dataset of our previously published study cohort. Detection rates of clinically relevant tumors were determined in both groups. A retrospective blinded trial was performed to determine how many tumors requiring intervention were detectable via FCM analysis of MRI-guided targeted biopsies alone. Results: MRI-guided targeted biopsies revealed tumors more frequently than systematic biopsies. Carcinomas in need of intervention were reliably represented in the MRI-guided biopsies and were identified in intraoperative FCM microscopy. Combined with serum PSA levels and clinical presentation, 91% of the carcinomas in need of intervention were identified. Conclusions: Intraoperative FCM analysis of MRI-guided biopsies is a promising approach for the efficient diagnosis of PCa. The method allows a timely assessment of whether a tumor disease requiring intervention is present and can reduce the psychological stress of the patient in the waiting period of the histological finding. Furthermore, this technique can lead to reduction of the total number of biopsies needed for the diagnosis of PCa.

Background: Biobanking of prostate carcinoma is particularly challenging due to the actual cancer within the organ often without clear margins. Frozen sections are to date the only way to examine the biobank material for its tumor content. We used ex vivo fluorescence confocal microscopy (FCM) to analyze biobank samples prior to cryoasservation. Methods: 127 punch biopsies were acquired from prostatectomy-specimens from 40 patients. These biopsies were analyzed with a Vivascope 2500-G4 prior to their transfer to the biobank. In difficult cases, larger samples of the prostatectomy specimens were FCM scanned in order to locate tumor foci. After patient acquisition, all samples were taken from the biobank and analyzed. We compared the results of the FCM examinations with the results of conventional histology and measured the DNA content. Results: With upstream FCM, the tumor content of biobank samples could be determined with high confidence. The detection rate of representative biobank samples was increased due to the rapid feedback. The biobank samples were suitable for further molecular analysis. Conclusion: FCM allows for the first time lossless microscopic analysis of biobank samples prior to their cryoasservation and guarantees representative tumor and normal tissue for further molecular analysis.

Ex vivo Fluorescence Confocal Microscopy (FCM) is a technique providing high-resolution images of native tissues. The method is increasingly used in surgical settings in areas of dermatology and urology. Only a few publications exist about examinations of tumors and non-neoplastic lesions of the liver. We report on the application of FCM in biopsies, surgical specimens and autopsy material (33 patients, 39 specimens) of the liver and compare the results to conventional histology. Our preliminary examinations indicated a perfect suitability for tumor diagnosis (ĸ = 1.00) and moderate/good suitability for the assessment of inflammation (ĸ = 0.4–0.6) with regard to their severity and localization. Macro-vesicular steatosis was reliably detected, micro-vesicular steatosis tended to be underestimated. Cholestasis and eosinophilic granules in granulocytes were not represented in the scans. The tissue was preserved as native material and maintained its quality for downstream histological, immunohistological and molecular examinations. In summary, FCM is a material sparing method that provides rapid feedback to the clinician about the presence of tumor, the degree of inflammation and structural changes. This can lead to faster therapeutic decisions in the management of liver tumors, treatment of hepatitis or in liver transplant medicine.

Background Fluorescence confocal microscopy (FCM) is a novel micro-imaging technique providing optical sections of examined tissue. The method has been well established for the diagnosis of tumours in dermatological specimens. Preliminary results found good feasibility when this technique was used to examine prostate cancer (PCa) specimens. Methods We report on the application of FCM in magnet resonance imaging (MRI)-fused prostate biopsies (10 patients, total number of biopsy specimens: n=121) and compare the results to conventional histology. Results Specific structures of the prostatic tissue were very well represented in the FCM images comparable to conventional histology. Prostate carcinoma was diagnosed with good sensitivity (79/68%) and high specificity (100%) by two pathologists with substantial/almost perfect levels of agreement with the results of conventional histology (kappa 0.79/0.86). Depending on the quality of the scans, malignant lesions of 1.8 mm and more in diameter were reliably diagnosed. Smaller lesions were rated as suspect for malignancy, but could not be consistently differentiated from reactive changes. Optimal image qualities were achieved in focus depths of up to 50 µm, whereas deeper scans led to insufficient representation of cytological features. Pre-treatment with acridine orange (AO) did not alter immunoreactivity of the tissue or its feasibility for fluorescence in situ hybridization (FISH) analyses and adequate amounts of DNA could be extracted for further polymerase chain reaction (PCR)-based examinations. Conclusions FCM seems to be a promising tool for the timely diagnosis in cases of PCa in patients requiring therapy. In particular, this technique is a material-sparing method that conserves the biopsies as unfixed material for further analysis such as molecular tumour companion diagnosis.

Background: Fluorescence confocal microscopy (FCM) is a novel micro-imaging technique providing optical sections of examined tissue. The method has been well established for the diagnosis of tumors in dermatological specimens. Methods: We compare intraoperative diagnoses of the real-time application of FCM in pre-therapeutic prostate biopsies (35 patients, total number of biopsy specimens: n = 438) with the findings of conventional histology. Results: Prostate carcinoma was reliably diagnosed in all patients. Depending on scan quality and experience of the examiner, smaller lesions of well differentiated carcinoma (ISUP1) could not be consistently differentiated from reactive changes. Furthermore, in some cases there was difficulty to distinguish ISUP grade 2 from ISUP grade 1 tumors. ISUP grades 3–5 were reliably detected in FCM. Conclusions: Despite some limitations, FCM seems to be an effective tool for the timely assessment of prostate biopsies enabling reliable diagnosis of prostate cancer in patients requiring therapy.

This study is part of a research project with the aim of reducing physical demand and workload of surgery staff. In a first step, human factors of assistant additional to the surgeon should be analyzed. Therefore subjective and objective measurement approach was utilized. In general the subjective results show slight perceived demand. Furthermore, the assistant in urology perceived less demand than in gynecology. The objective results show slight demand for the assistant in gynecology. Life-record-data revealed similar static body, head and arm postures for the assistant and the surgeon in gynecology. Furthermore, this study shows the observation that human factors are influenced by the common working space and the significance of the common task as a team. The workflow-chart shows many parallels in the movements of the upper arm of the surgeon and the assistant during the preparation phase. In conclusion, one similar technical supporting system might be developed for the surgeon and the assistant because of many parallels in ergonomics with the aim of reducing physical demand and workload.