The evaluation and management of lower urinary symptoms (LUTS) experienced in the immediate post-operative period after benign prostatic obstruction surgery (BPO), remain unclear. Aim of our study is to systematically report the evidence on management of post-operative transient urinary symptoms after BPO surgery. A systematic review of the literature was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses checklist (PRISMA). PubMed, Embase, Scopus and Cochrane databases were searched up to March 2025. Studies evaluating pharmacotherapy, phytotherapy and/or physical treatment for post-operative transient LUTS in men aged were evaluated. Only randomized clinical trials (RCTs) were included. Overall, nine RCTs were included. Among the surgical techniques investigated, most data were available for transurethral resection of the prostate. The methods used to assess post-operative LUTS, as well as the timing of evaluation, varied considerably across studies. The most commonly submitted questionnaire was the International Prostate Symptom Score, and the most frequently performed diagnostic tool was uroflowmetry. Anticholinergic drugs seems to have the greatest efficacy in improving post-operative LUTS, even if the level of evidence is low. In contrast, alpha-blockers did not appear to offer significant additional benefits in this setting of patients. Phytocomplexes (Graminex G63, Curcumin complexes) were effective in improving patients’ quality of life (QoL) after BPO surgery. Pelvic floor muscle exercises (PFME) also demonstrated a reduction in symptom-related bother. Current strategies for evaluating and managing transient postoperative LUTS are heterogeneous, and available evidence remains limited. Anticholinergic agents and phytotherapeutic compounds are among the most commonly prescribed treatments, though their efficacy is suboptimal. High-quality randomized trials are needed to provide robust clinical recommendations.

Background/Objectives: Urology residency training widely varies across countries, and evidence comparing residents’ experiences at an international level is limited. This study reports the results of an international survey of urology residents from different countries worldwide, aiming to characterize training environments, educational exposure, and trainee expectations across diverse healthcare systems. Methods: A 39-item online survey was administered to urology residents during the Société Internationale d’Urologie (SIU) Regional Meeting (Florence, November 2024), assessing demographics, training exposure, educational resources, workload, satisfaction, and career perspectives. The results were compared between trainees at different postgraduate years (PGYs) to explore associations for key outcomes. Results: Overall, 208 urology residents from 21 countries completed the survey. Most residents were actively involved in research (76.4%), although confidence in independent scientific production was moderate (significantly lower among junior trainees). Surgical exposure increased with PGY, with good experience in endoscopy but limited hands-on exposure and expected autonomy in laparoscopic, robotic, and major open surgery. Despite high overall satisfaction with urology, residents described heavy workloads, inconsistent access to structured teaching and international fellowships, and a long-term shift in career expectations toward private practice. Conclusions: Urology residents worldwide report high engagement in research, strong satisfaction with their specialty choice, and interest in international mobility. Nonetheless, persistent disparities in surgical exposure, research confidence, workload, and gender representation highlight the need for competency-based curricula, structured mentorship, and improved training organization to promote equitable and high-quality urology education globally.

The European association of Urology (EAU) suggests a prognostic stratification of Upper Tract Urothelial Cancer (UTUC) based on high and low risk patients, with Radical nephroureterectomy (RNU) and bladder cuff resection being the gold standard for the treatment of non-metastatic High risk UTUC. However, no consensus on post-operative patient management or tools that predict who would benefit the most from a close follow-up rather than adjuvant chemotherapy regimen exist. in Machine Learning (ML) is gaining interest in Urology providing models for prognostic prediction purpose; It’s role in UTUC has not yet been investigated. We aim to develop and validate multiple supervised ML models based on patient- and tumor- related features to predict prognosis in patients with preoperative Histological or Imaging proved UTUC treated with RNU within a multiethnic large cohort. Data from an international multicenter large cohort of histologically proven UTUC patients from Asia and Europe treated with RNU were retrospectively collected. Twenty different ML-supervised predictive models were first trained and then external validate with two separate set. Nomograms were constructed based on 8 independent prognostic factors (age, gender, grading, pT, pN, presence of Carcinoma in Situ (CIS), multifocality and Lymphovascular invasion(LVI)) to predict 6 Outcomes (Overall Survival (OS), Cancer Specific Survival (CSS) and Disease Free Survival (DFS) at 3 and 5 year). Performances were compared using Area-under-curve (AUC) of Receiver-Operating Characteristics (ROC). A total of 3129 patients were enrolled: 637 Asian Patients (training cohort) and 2492 European patients (validation cohort). Upon training assessment, LR models achieved the best results, being the best model for prediction of 4/6 outcomes, with the best result in CSS both at 3 and 5 years (AUC: 0.85, 0.84, 0.81 for CSS-3y, CSS-5y and DFS-3y respectively). Upon external validation, LR(CSL) models achieve the best results, being the number 1 model for prediction of 3/6 outcomes (AUC: 0.84, 0.79, 0.77 for CSS-3y, OS-3y and OS-5y respectively). ML is a promising technology in the field of UTUC. Our model achieve favorable results in terms of prediction of prognosis after RNU, especially in terms of CSS at 3 and 5 years, moreover is the first model of prognosis taking into account the differences in epidemiology existing between European and Asian patients. Further clinical validation and verification of its reliability for the case selection of adjuvant therapy are needed to assess its use in clinical practice linked to clinical decision making. ML is an advancing technology in the field of medicine and urology, which can also be applied to the definition of the prognosis of patients with UTUC undergoing RNU. Our study represents the first experience investigating this potential.

Recently, the EAU guidelines presented the EAU guidelines bot to assist urologists in the reading of the guidelines; however, up to date, no external validation is available. The aim of our study is to assess the accuracy, completeness, and clarity of the guideline’s bot in testicular cancer. A total of 36 questions based on the EAU testicular cancer guidelines recommendations were developed. Each question was systematically presented to the EAU guidelines bot and the responses were independently assessed by two expert urologists to assess the accuracy, completeness, and clarity. A 5-point Likert scale was used as a score, and in case of discrepancies, a third urologist was queried. Accuracy, completeness, and clarity were assessed per chapter and per grade of recommendation. All questions and answers were recorded in an Excel file. Overall, 36 questions were developed. In terms of accuracy, 36/36 (100

BACKGROUND:Recently, the European Association of Urology (EAU) Guidelines presented an official Bot to assist urologists during Guidelines navigation. However, up to date no external validation is available. Aim: To assess accuracy, completeness, and clarity of the Guidelines Bot for Sexual and Reproductive Health. METHODS:A total of 228 questions based on the EAU Sexual and Reproductive Health Guidelines recommendations were developed. Each question was inputted to the EAU Guidelines Bot and the response was reviewed by two expert uro-andrologists. Discrepancies were resolved by discussion with a third expert. Results were further stratified per grade of recommendation. Outcomes: Evaluate the rate of accurate, complete, and clear answers to guidelines-related questions using a 5-point Likert scale and the impact of the grade of recommendation on the quality of the answer. RESULTS:Overall, 228 questions were developed. In terms of accuracy 224/228 (98.3%) were defined as accurate (score-4-5), 2/228 (0.9%) presented a fair accuracy (score = 3) while 2/228 (0.9%) were deemed not accurate (score 1-2). In terms of completeness, 223/228 (97.8%) were defined as complete (score-4-5), 2/228 (0.9%) presented a fair completeness (score 3), while 3/228 (1.3%) were deemed not complete. Finally in terms of clarity, 225/228 (98.7%) were defined as clear (score-4-5), 2/228 (0.9%) presented a fair clarity (score 3) and 0/228 were not clear. When comparing strong and weak recommendations, no differences were recorded. CLINICAL IMPLICATIONS:The EAU Guidelines Bot may serve as a reliable clinical decision support tool for urologists seeking rapid, evidence-based guidance on sexual and reproductive health management. STRENGTHS & LIMITATIONS:This is the first external evaluation of the EAU Guidelines Bot. Our results suggest a significant improvement in terms of reliability when compared to general AI tools. However, our queries were straightforward and developed directly from guideline recommendations and results might not apply to complex real-world clinical scenarios. CONCLUSIONS:EAU Guidelines Bot represents an accurate and reliable tool for Sexual and Reproductive Health Guidelines navigation, but further validation is required to evaluate its applicability in clinical practice.

This study aimed to externally validate the performance of the European Association of Urology (EAU) Guidelines Bot in neuro-urology by assessing the accuracy, completeness, and clarity of chatbot-generated answers to guideline-based questions and to compare its performance with that of a general-purpose large language model (ChatGPT 5.5). A cross-sectional validation study was conducted using 47 questions derived from the EAU Neuro-Urology Guidelines. Each question was linked to a specific recommendation and classified by recommendation strength (strong vs weak). Questions were independently submitted to both the EAU Guidelines Bot and ChatGPT 5.5 without additional prompting. Two expert urologists independently evaluated each response for accuracy, completeness, and clarity using a five-point Likert scale; discrepancies were resolved by a third reviewer. Overall, 45 questions (95.7%) were linked to strong recommendations and two (4.3%) to weak recommendations. The EAU Guidelines Bot and ChatGPT 5.5 achieved identical mean accuracy scores (4.96 ± 0.20), with all responses rated as highly accurate (Likert 4-5). ChatGPT 5.5 indicated significantly higher completeness scores than did the EAU Guidelines Bot (4.74 ± 0.44 vs 4.57 ± 0.54; p = 0.011), whereas clarity scores were not significantly different (4.83 ± 0.38 vs 4.77 ± 0.43; p = 0.083). High-quality completeness was observed in 46/47 EAU Guidelines Bot responses (97.9%) and 47/47 ChatGPT responses (100%). Score discrepancies between systems were identified in ten of 47 questions (21.3%) and were limited to completeness and clarity domains. Performance remained uniformly high across recommendation grades, with no meaningful differences observed. The EAU Guidelines Bot showed excellent accuracy, completeness, and clarity when applied to neuro-urology guideline-based questions. Its performance was comparable to that of ChatGPT 5.5, with both systems providing highly accurate guideline-concordant responses. Although ChatGPT 5.5 generated more comprehensive answers, the EAU Guidelines Bot maintained closer adherence to the original guideline recommendations. Although not a substitute for clinical judgment, the tool appears to be a reliable adjunct for rapid access to evidence-based neuro-urological guidance.

Aim of this review is to evaluate the pharmacological efficacy and safety of Serenoa repens extracts in managing lower urinary tract symptoms (LUTS) and benign prostatic hyperplasia (BPH). Using PubMed, Web of Science, and the Cochrane database, we identified studies published until November 2023 reporting effect of Serenoa repens extracts on LUTS and BPH. All studies were included in the literature search. The most relevant studies were selected to identify the effects of different extracts of serenoa repens in terms of pharmacology, efficacy and safety. Hexanic extract of Serenoa repens (HESr), presents important anti-inflammatory, antiproliferative, and antiandrogenic activities proven through various in vitro, in vivo, and clinical trials. The current phytotherapeutic landscape is very heterogeneous and limited by the lack of a regulatory framework for herbal substances. There is a clear disparity in the qualitative and quantitative composition of extracts due to varied extractive processes, affecting the therapeutic efficacy. Several studies (prospective randomized clinical trials) demonstrated the clinical efficacy of HESr compared to placebo and other pharmacological treatments. Particularly, HESr improves nocturia and Qmax. Other extraction techniques, such as alcoholic and CO2 need further RCT to better define their efficacy. The review identifies the critical role of Serenoa repens extract in managing LUTS in patients with BPH. Particularly the evidence suggests significant in vitro and in vivo differences in terms of inflammation reduction, symptoms relief and flow improvement depending on the extraction technique.

BACKGROUND:The most frequent complication in subjects of a radical prostatectomy (RP) is represented by urinary incontinence (UI), which can arise following the destruction of the pelvic floor muscles. OBJECTIVES:The aim of this retrospective analysis was to assess the effect of Flat Magnetic Stimulation (FMS) in treating male stress urine incontinence (SUI) following RP. MATERIALS AND METHODS:A total of 40 patients affected by SUI after RP, with a mean age of 56.8 (± 5.7) years old, underwent eight sessions with FMS. The Incontinence Impact Questionnaire-Short Form (IIQ-7) was administered from baseline up to 3 months of follow-up (3MFU) after the last treatment session. All possible adverse events were retrospective analysed. RESULTS:The analysis demonstrates that the scores for each individual questionnaire item decreased from baseline up to 3MFU after the last treatment session, leading to a significant (p < 0.05) reduction in the total IIQ-7 median score from 71.35 (66.6-76.11) at baseline to 28.54 (38.05-23.78) at 3MFU after the last treatment session. No adverse events were recorded over the whole course of treatment.  Conclusions: Our findings reveal that this technology may serve as a convenient and alternative treatment option for stress-caused urinary incontinence following RP.

Background/Objectives: Recently the European Association of Urology (EAU) guidelines presented the EAU Guidelines bot to assist urologists in the reading of the guidelines; however, there is a lack of up-to-date external validation. The aim of our study is to assess the accuracy, completeness, and clarity of the guidelines bot in urethral strictures. Methods: A total of 117 questions based on the EAU urethral strictures guidelines recommendations were developed. Each question was input to the EAU guidelines bot and the response was assessed by two expert urologists to assess the accuracy, completeness, and clarity. Moreover, 10 simple clinical cases were input. A 5-point Likert scale was used as a score and, in case of discrepancies, a third urologist was queried. Accuracy, completeness and clarity were assessed per chapter and per grade of recommendation. All questions and answers were recorded in an Excel file. Results: Overall 117 questions were developed. In terms of accuracy, 111/117 (95%) were defined as accurate (scores 4–5), 4/117 (3%) presented a fair accuracy (score 3), and 2/117 (2%) were deemed not accurate. In terms of completeness, 93/117 (80%) were defined as complete (scores 4–5), 22/117 (19%) presented a fair completeness (score 3), and 2/117 (2%) were deemed not complete. Finally, in terms of clarity, 104/117 (89%) were defined as clear (scores 4–5), 13/117 (11%) presented a fair clarity (score 3), and 0/109 (0%) were deemed not clear. When comparing strong and weak recommendations, no differences were recorded. Overall the answers to simple clinical cases were in line with the guidelines with good accuracy, completeness and clarity scores. Conclusions: The EAU guidelines bot represents an accurate tool for urethral stenosis guidelines. Some fine-tuning is needed to improve readability and clarity.

BACKGROUND AND OBJECTIVE:Management of young men with primary bladder neck obstruction (PBNO) and dysfunctional voiding (DV) is challenging. We systematically reviewed evidence on diagnostic strategies and treatment outcomes in men aged 18-50 yr with PBNO or DV. METHODS:We conducted a comprehensive bibliographic search on the Embase, Medline, and Cochrane Library databases in July 2024. KEY FINDINGS AND LIMITATIONS:Twenty-five publications were identified. Videourodynamics represents the standard diagnostic approach. Standard therapies for PBNO include alpha-blockers (ABs) as the first-line approach and bladder neck incision (BNI) in patients failing medical therapy. Pooled estimates of total International Prostate Symptom Score (IPSS) and maximum urinary flow rate (Qmax) improvements at 3 mo in patients receiving ABs are 7.0 points and 4.0 ml/s, respectively. The incidence of ejaculatory dysfunction (EjD) and failure rates range from 47% to 50% and from 23% to 52%, respectively. Corresponding figures in patients undergoing surgery are 11.2 points, 6.9 ml/s, 0-88.8%, and 11.1-13.3%, respectively. OnabotulinumtoxinA, as experimental second-line therapy in PBNO, provides 2-mo mean total IPSS and mean Qmax improvements of 14.1 points and 9.1 ml/s, respectively, with a 0% EjD rate. However, improvements deteriorate over time. Behavioral modifications plus biofeedback represent the only approach in patients with DV, providing symptom improvement of at least 50% in 83% of patients at 3 mo. Limits of evidence include few studies, mainly retrospective design, heterogeneous populations, small sample sizes, lack of direct comparisons, and short follow-up. CONCLUSIONS AND CLINICAL IMPLICATIONS:Diagnosis of PBNO/DV in young men requires the integration of anatomical and functional data. ABs represent the first-line approach for PBNO followed by BNI in cases of failure. Behavioral modification plus biofeedback represents the only strategy tested for DV. Given the low quality of evidence, a shared decision-making approach for diagnosis and treatment is required.

Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) has a significant negative impact on people’s quality of life. Aims: the objective of this study was to evaluate the efficacy and the safety of a new device that uses Top Flat Magnetic stimulation to treat hypertonia in men affected by CP/CPPS condition. 20 male patients affected by CPPS underwent 8 treatment sessions which were conducted twice weekly for four consecutive weeks. Data were collected at baseline and 1-month follow-up (1MFU) after the last treatment session. The Italian version of The National Institute of Health Chronic Prostatitis Symptom Index (NIHCPSI) was administered to all patients. The mean “pain” score, “urinary symptoms” and patient’s quality of life (“QL”) were evaluated at baseline and 1MFU after the last treatment session. The mean pain score was also assessed using the Pain Intensity Visual Analog Scale (VAS). In addition, The International Index of Erectile Function (IIEF) was provided before and 1MFU after the last treatment session. All possible side effects were evaluated. Changes in the total mean NIHCPSI score significantly decreased from 31.5 (±2.9) at baseline to 12.75 (±3.5) at 1MFU after the last treatment session showing an improvement in CP/CPPS symptoms. The total mean IIEF score significantly increased from 21.3 (±2.7) at baseline to 24.3 (±0.5) at 1MFU after the last treatment session, showing better erectile functioning. Finally, also the mean VAS score significantly decreased from 7 (±1.0) at baseline to 3 (±0.9) at 1MFU after the last treatment session. Based on the study results, this technology could represent a new treatment option for CP/CPPS conditions. none.

PURPOSE:To conduct a Delphi consensus in order to address key uncertainties and provide expert insights to bridge the gap between guidelines and real-world practice concerning minimally invasive surgical techniques (MISTs) for benign prostatic hyperplasia (BPH). METHODS:The Advisory Board developed 343 statements on 35 debated topics in the surgical management of BPH, each including multiple items rated on a 9-point Likert scale. The questionnaire was emailed to a Panel of 28 Italian urologists with 5-year experience in MISTs for the first round of voting. Statements that did not reach consensus were identified as "hot topics" and underwent a second round of voting during a Consensus conference, attended by all first-round participants, where the results were reviewed, debated, and re-voted upon anonymously. RESULTS:The Panel agreed in defining TPLA, Rezum, iTIND, PAE and Urolift as MISTs, but no consensus was reached regarding Aquablation. Essential characteristics for being defined as MISTs were considered the feasibility in outpatient and one-night stay settings, minimal bleeding risk, early postoperative recovery of daily activities and a reduced impact on urinary continence and ejaculatory function. The Panel agreed that, compared to TURP, PAE, TPLA, Rezum, iTIND and Urolift were associated with lower postoperative bleeding rates, lower operative and hospitalization time, lower risk of postoperative incontinence; non consensus on these topics was achieved for Aquablation. The Panel agreed that flow rates after PAE, TPLA, iTIND and Urolift were worse than TURP, however, no consensus was achieved for Rezum and Aquablation. A high risk of retreatment was recognized for TPLA, iTIND and Urolift, but this was not the case for Rezum and Aquablation. iTIND and Urolift were deemed as the best options for prostate volume 30 ml, TPLA, Rezum and Aquablation for prostate volume 30-80 ml while no consensus was obtained for the best approach in larger volumes. No consensus was achieved for various aspects of postoperative management of MISTs. CONCLUSIONS:Results from this Delphi project confirmed the lack of agreement on certain topics related to MISTs for BPH including the ideal treatment for large prostate volumes, functional outcomes and postoperative management.