Purpose:Vesicourethral anastomotic stenosis (VUAS) occurs after 1 to 3% of robotic-assisted radical prostatectomies (RARPs). Pelvic fascia-sparing techniques preserve more native anatomy and may reduce stenoses, but evidence is lacking. The aim of this study was to compare stenosis incidence, management, and outcomes after standard vs pelvic fascia-sparing RARP. Materials and Methods:We conducted a multi-institutional retrospective study of 910 standard, 409 Retzius-sparing, and 272 hood RARP during February 2012-September 2025. Standard and hood techniques used 18Fr urethral catheters, and the Retzius-sparing technique used 18Fr suprapubic catheters. The primary end point was cystoscopically confirmed VUAS requiring intervention within 12 months. Urinary continence was assessed using the validated Expanded Prostate Cancer Index Composite for Clinical Practice (EPIC-CP). Multivariable logistic regression assessed factors associated with VUAS. Results:There were 19 VUASs overall, with an incidence of 1.6%, 1.5%, and 0% after standard, hood, and Retzius-sparing techniques, respectively. In 88.2%, VUAS resolved with a single endoscopic incision or dilation followed by 6 months of intermittent self-catheterization, without worsening urinary continence (P = .317). In adjusted analyses, Retzius-sparing vs standard RARP was associated with lower odds of VUAS (odds ratio [OR] 0.051; 95% confidence interval [CI] 0.003 to 0.870; P = .040). Diabetes was associated with almost three-fold higher odds of VUAS (OR 2.974; 95% CI 1.146-7.721; P = .025). Increasing surgeon experience was associated with fewer VUASs (OR 0.998; 95% CI 0.995-1.000; P = .046). Conclusions:There were no VUAS after Retzius-sparing RARP, and Retzius-sparing vs standard approach was associated with lower odds of stenosis. Endoscopic management with structured self-catheterization achieved high success without worsening incontinence. Prospective studies are needed to validate our findings.

[This corrects the article DOI: 10.1097/JU9.0000000000000394.].

Test statistics comparing each post-RT time point to baseline (pre) in the GU cohort.

Prostate cancer (CaP) remains the most diagnosed malignancy in men, and the incidence of high-grade disease at diagnosis is increasing [...]

Reactome based longitudinal pathway analysis showing significantly dysregulated pathways at 1 h, 24 hours, 1-, 3-, 6-, and 12-months following RT in the GU prostate cancer cohort.

Volcano plot showing significant dysregulation of plasma metabolites at 24 hours (Panel A), one month (Panel B), 3 months (Panel C) and six months (Panel D) as compared to baseline (pre-RT).

Heatmap visualization of significantly dysregulated metabolites following RT.

Overall and sub-cohort based longitudinal (24 hours to 24 months) test statistics for proteomics data set comparing each time post-RT to baseline for the prostate cancer cohort.

Background/Objectives: Innovations in robotic prostatectomy have transformed a highly morbid operation to a procedure with fewer complications and shorter hospital stays, yet techniques continue to evolve. Our objective is to discuss the most recent advances in robotic prostatectomy techniques designed to minimize morbidity related to urinary incontinence and erectile dysfunction. Methods: This review is adapted from a comprehensive committee chapter on published in the 3rd WUOF/SIU (World Urologic Oncology Federation/Société Internationale d’Urologie) International Consultation on Urologic Diseases on Localized Prostate Cancer. Results: This review article describes both traditional and emerging techniques in robotic prostatectomy techniques and discusses their respective outcomes. Conclusions: Improved understanding of pelvic anatomy has enabled robotic-assisted techniques to preserve key structures and enhance recovery and functional outcomes while preserving oncologic safety

Validation of metabolite identification using tandem mass spectrometry-based fragmentation matching.

Linear Mixed Effect Models analysis of proteomics data combining all time points post-RT.

A posterior approach to endopelvic neurovascular total sparing (PATENTS) during robotic-assisted radical prostatectomy (RARP) may improve recovery of sexual function through preservation of anterolateral periprostatic tissue. We compared RARP erectile function recovery with PATENTS vs the conventional anterior nerve-sparing approach. We conducted a single surgeon retrospective review of 495 RARP (278 anterior nerve-sparing, 217 PATENTS) performed during 2015 to 2025, with initiation of PATENTS in 2022. Our primary outcome was erectile function recovery defined as erections sufficient for sexual activity (at least masturbation/foreplay) from the Expanded Prostate Cancer Index Composite for Clinical Practice (EPIC-CP). Cox proportional hazard models evaluated factors affecting recovery of erectile function. PATENTS patients were older (median 66 vs 64 years; P = .002) and more likely to have clinically significant cancer at diagnosis (95.8% vs 86.0%; P = .003). Despite shorter follow-up (5 months [IQR 3-15] vs 10 [3-21], P < .001), PATENTS was associated with shorter duration to erections sufficient for intercourse ( P = .022). In adjusted analyses, PATENTS was associated with improved erections firm enough for intercourse (hazard ratio [HR] 2.3, confidence interval [CI]: 1.45-3.68, P < .001), erections firm enough for sexual activity (HR 1.5, CI: 1.21-1.96, P < .001), and any partial erections (HR 1.4, CI: 1.13-1.63, P < .001). There were no differences in margin status ( P = .234) or adverse events ( P = .933). Study limitations include single surgeon, retrospective study design. PATENTS facilitated recovery of erectile function without compromising surgical margins or adverse events. Prospective, multisurgeon series are needed to validate our findings.

Linear mixed effects model analysis of metabolomics data augments validation of immune response findings with proteomics.

BACKGROUND AND OBJECTIVE:Pelvic fascia-sparing (PFS) approaches during robotic-assisted radical prostatectomy (RARP) may lead to faster and better recovery of urinary continence. However, direct comparisons are limited. We compared continence recovery across standard, anterior PFS (APFS), and posterior PFS (PPFS) RARP approaches. METHODS AND SURGICAL PROCEDURE:We conducted a multicenter retrospective study of 1155 RARP (593 standard, 332 PPFS, and 230 APFS) procedures performed between February 2012 and May 2024. Our primary outcome was urinary continence defined as the use of zero to one pad per day, identified from the Expanded Prostate Cancer Index Composite for Clinical Practice. Multivariable models evaluated the factors affecting early and long-term urinary continence. KEY FINDINGS AND LIMITATIONS:PPFS and APFS versus the standard approach were associated with improved urinary continence at 3 mo (90%, 83%, and 64%, respectively; p < 0.001), 12 mo (96%, 89%, and 84%, respectively; p < 0.001), and 20 mo (97%, 99%, and 90%, respectively; p < 0.001). In adjusted analyses, PPFS (odds ratio [OR] 3.71; confidence interval [CI] 2.27-6.07; p < 0.001) and APFS (OR 3.54; CI 1.97-6.37; p < 0.001) were associated with improved 3-mo continence compared with standard RARP. Similar results were observed for both PFS approaches at 12 mo. Only PPFS was associated with better long-term continence (20 mo: OR 3.00; CI 1.74-5.17; p < 0.001). However, PPFS had the highest positive surgical margins (standard: 29.5%; PPFS: 37.4%; APFS: 30.0%; p = 0.04). The sequential adoption of techniques from standard RARP to PPFS and then to APFS leads to disparate follow-up and sample sizes as a limitation. CONCLUSIONS:PPFS and APFS were associated with better urinary continence recovery, although PPFS was found to have more positive surgical margins. Randomized trials are needed to validate our findings. PATIENT SUMMARY:We compared the recovery rate of urinary continence after three surgical approaches with varying degrees of pelvic fascia sparing (PFS). Our findings suggest that PFS improves short- and long-term urinary continence compared with the standard approach.

Introduction Active surveillance (AS) is the standard of care for low risk prostate cancer (PCa), and a guidelines-based treatment option for intermediate-risk PCa. Black men experience racial disparities in PCa evaluation and treatment including higher overall incidence, higher risk of advanced disease at diagnosis, and greater overall mortality rates from PCa. Prior studies have shown racial differences in use of;AS in Black patients, though these are limited to low risk patients. The objective of this study was to evaluate racial disparities in patients on AS with low- and intermediate-risk PCa using the Pennsylvania Urologic Regional Collaborative (PURC) registry. Methods A prospectively-maintained regional collaborative of multiple academic urology practices throughout the East Coast from 2015-2023 was retrospectively queried. Risk categories were defined using National Comprehensive Cancer Network (NCCN) criteria. Patients were placed on AS according to each practices’ criteria. Information regarding each patient's demographics, PSA levels, pre-biopsy magnetic resonance imaging (MRI), pathologic information, time to confirmatory biopsy, and treatment plans were collected by the collaborative in a central database. Delayed primary treatment was defined as any treatment after initially being placed on AS. Descriptive statistics were reported and univariate analyses were performed using chi-squared, Fisher's exact, Student t, analysis of variance (ANOVA), and Wilcoxon rank sum tests as appropriate. Results There were 3054 low-risk (19.6% Black and 80.4% Other) and 445 intermediate-risk (30.5% Black and 69.5% Other) patients in total. No racial differences in AS utilization rates were found in low- (64.2% vs 62.5%, p = 0.407) or intermediate-risk groups (3.8% vs 8.9%, p = 0.452). Few patients were on AS in the intermediate-risk group. Fewer Black men in low- (50.4% vs 64.7%, p = 0.057) and intermediate-risk groups (63.2% vs 68.3% p = 0.527) obtained a pre-biopsy MRI, although this was not statistically significant. Neither group had a difference in time to confirmatory biopsy or number of positive cores. Delayed primary treatments after AS were similar in low-risk; most opted for prostatectomy (61.8% vs 69.3% p = 0.560). Education and marital status differed significantly. Black men were more likely to be single with lower education levels. Black men were younger in the intermediate-risk group (<59 yo 19.9% vs 10.4%, p = 0.035). Conclusions Contrary to prior reported studies, we observed;no differences found in rates of AS for low- or intermediate-risk patients within the PURC registry. This may indicate that such collaboratives encourage more guideline based practice with fewer disparities among academic centers, though more low-risk men had radical treatment than expected.;This information shows a closing, but still present gap in care surrounding AS for Black patients from an academic regional collaborative dataset.

You have accessJournal of UrologyProstate Cancer: Localized: Surgical Therapy II (MP52)1 May 2024MP52-12 ASSOCIATION BETWEEN AGE AND MAJOR COMPLICATIONS AFTER ROBOTIC ASSISTED RADICAL PROSTATECTOMY: A MULTI-INSTITUTIONAL SERIES Alec Zhu, Amy L. Tin, Andrew J. Vickers, Keith Kowalczyk, Behfar Ehdaie, Belen Mora, Sofia Gereta, and Jim C. Hu Alec ZhuAlec Zhu , Amy L. TinAmy L. Tin , Andrew J. VickersAndrew J. Vickers , Keith KowalczykKeith Kowalczyk , Behfar EhdaieBehfar Ehdaie , Belen MoraBelen Mora , Sofia GeretaSofia Gereta , and Jim C. HuJim C. Hu View All Author Informationhttps://doi.org/10.1097/01.JU.0001008864.84854.b7.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Traditionally, older patients were at greater risk for perioperative complications with open radical prostatectomy, and radiotherapy was preferred. However, contemporary outcomes after robotic-assisted radical prostatectomies (RARP) are unknown. We conducted a multi-center study to examine the association between age and RARP complications. METHODS: We pooled outcomes from Weill Cornell (n=558), Medstar Georgetown (n=320), and Memorial Sloan Kettering (n=6,632) for patients undergoing RARP during 2012-2022. Our primary outcome was any major complication (Clavien-Dindo grade ≥3) within 30 days of surgery. We used multivariable logistic regression, adjusting for surgeon volume and oncologic risk using a postoperative nomogram (which included pre-operative PSA, RARP Gleason Grade Group, extracapsular extension, seminal vesical invasion, lymph node involvement, and surgical margin status), to assess the association between continuous age and major complications. Using a meta-analytic approach, we also tested for heterogeneity in the association between age and risk of complication between the three institutions. RESULTS: A total of 7,540 patients were treated across the three institutions. Unadjusted rates of major complications were 2.2%, 4.1%, and 2.0% at Cornell, Georgetown, and MSKCC, respectively. Increasing age was significantly associated with increased risk of complications (adjusted OR 1.03, 95% CI 1.00-1.05, p=0.022). For the average patient (with all covariates in the model set to the mean), the estimated risk of major complication for a 50-, 60-, and 70-year-old is 1.5% (95% CI 1.1-2.2), 2.0% (95% CI 1.7-2.4), and 2.6% (95% CI 2.1-3.2), respectively (Figure 1). No evidence of heterogeneity in the association between age and complications was found based on institution (test for heterogeneity p>0.9). CONCLUSIONS: Risks of RARP complications were low even for the oldest patients. Although older age is associated with a statistically significant increase in the risk of complications, the effect is minimal and not clinically significant within our well-selected patient population. Thus, when counseling patients regarding prostate cancer treatment options, older age should not be a contraindication to RARP. Download PPT Source of Funding: N/A © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e857 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Alec Zhu More articles by this author Amy L. Tin More articles by this author Andrew J. Vickers More articles by this author Keith Kowalczyk More articles by this author Behfar Ehdaie More articles by this author Belen Mora More articles by this author Sofia Gereta More articles by this author Jim C. Hu More articles by this author Expand All Advertisement PDF downloadLoading ...

This randomized clinical trial compares the effect of transperineal vs transrectal prostate biopsy on infection rates after biopsy.