To evaluate whether the length of positive surgical margin carries a risk for recurrence, data of patients that underwent partial nephrectomy (PN) from six centers were evaluated. Fifty-three patints with positive surgical margins (PSMs) (the PSM group) and 438 patients with negative surgical margin (the NSM group) were included in the present study. Pathologic reevaluations were performed, and surgical margins were measured in micrometers. The number of positive margin areas, and the length of the maximum and total positive margins were evaluated. Data were analyzed using SPSS 27 package program. A p-value less than 0.001 was considered statistically significant. Local recurrence occured in 16.98% of patients in the PSM group and 4.24% of patients in the NSM group. (p<0.001). Patients with PSM were at fourfold increased risk for recurrence. Age, gender, tumor location, tumor side and size, and fuhrman grade were not associated with local recurrence of the tumor (p>0.01). However, positive surgical margin was an important risk factor for local recurrence (p<0.01). No relationship was found between pos-itive margin length and local recurrence (p=0.044). Logistic regression analysis did not identify any parameters associated with local recurrence. The presence of a PSM was significantly associated with an increased risk of local recurrence following PN. The number of positive margin foci and total or maximum length of margin involvement were not associated with recurrence. These findings suggest that it is the presence of PSM, rather than its extent, that may be the primary factor influencing oncological risk.

Objective: We aimed to investigate the effect of tube-shaped bladder neck, which we define as our modified urethral anastomosis technique, on early continence in patients undergoing robot-assisted radical prostatectomy. Methods: This retrospective study (2017-2020) compared standard anastomosis (group 1, n = 75) with a modified technique (group 2, n = 74) in patients undergoing radical prostatectomy. Preoperative, perioperative, postoperative, and histopathological characteristics of the patients were recorded. Continence was assessed using the Turkish version of the International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF), and daily pad usage was recorded. Patients who never used a pad and had an ICIQ-SF score of ≤6 were considered continent. Erectile function was evaluated using the International Index of Erectile Function-5 form. Results: When evaluating postoperative continence status, the number of pads used and the ICIQ-SF score were significantly lower in the group that received the new technique at the first, third, and sixth months. In our study, the postoperative continence rates were 18.7%-36.5% at 1 month, 38.7%-63.5% at 3 months, and 56%-77% at 6 months for groups 1 and 2. Our new technique provided statistically superior results during the first 6 months (P = .015, P = .002, and P = .007, respectively). Conclusion: The modified urethral anastomosis technique accelerates the recovery of early continence (within 1-6 months), while achieving comparable long-term outcomes to those of the standard method. Our new technique is oncologically reliable and does not compromise cancer control. Cite this article as: Aktaş Y, Yılmaz K, Kılıç Ş, et al. The impact of tube-shaped bladder neck modification on early-term continence in robotic radical prostatectomy. Urol Res Pract. 2026;52, doi: 10.5152/tud.2026.26053.

INTRODUCTION: This study aimed to assess the effectiveness of laparoscopic retroperitoneal partial nephrectomy (LRPN) and robot-assisted retroperitoneal partial nephrectomy (RRPN) in managing renal tumors, with a focus on perioperative efficiency, oncological safety, and preservation of renal function. METHODS: The cohort comprised 80 patients who underwent partial nephrectomy (PN), (centre A-LRPN =26, centre B-RRPN=54), excluding those with prior renal surgeries or conditions complicating renal function. Perioperative, postoperative, oncologic, and renal functional data were compared between the two surgical techniques. Tumor complexity was evaluated using the RENAL scoring system and surgical success was assessed using the margin, ischemia, and complication (MIC) scoring system. RESULTS: The median tumor size (4 vs. 2.5 cm) and RENAL scores (6 vs. 4) were significantly higher in the RRPN group (p<0.05). Trocar placement and operation times were significantly lower in the LRPN group (p<0.05). In terms of mean estimated blood loss, postoperative renal function, and reduction in hemoglobin levels, no significant differences were observed between the groups. The oncological outcomes were comparable between the groups, with no significant differences observed in positive surgical margin rates. DISCUSSION AND CONCLUSION: In minimally invasive partial nephrectomy, both robotic and laparoscopic approaches have their advantages. LRPN is a feasible method in less complicated tumors with its shorter trocar placement time and shorter operation time. Although RRPN can be applied in larger and more complex tumors, its oncological and functional results are similar to LRPN. This suggests that while the robotic approach is potentially more suitable for complex cases, it does not compromise patient safety or effectiveness.

Objective: The purpose of study was to identify the clinical utility of preoperative systemic immune-inflammation index (SII) in predicting biochemical recurrence (BCR) after robot-assisted radical prostatectomy (RARP). Materials and Methods: A retrospective analysis was performed using data from our robotic surgery database, which included 531 patients with localized prostate cancer (PCa) who received RARP from March 2015 through June 2021. Patients' characteristics and outcomes were recorded. The preoperative SII of each patient was calculated. Patients with and without BCR were confronted. The predictive ability of the SII was determined by receiver operating characteristic (ROC) curve analysis. Results: After applying the exclusion criteria, the study included 400 patients. Among them, 90 patients (22.5%) experienced BCR. Analysis of the relationship between BCR and preoperative variables demonstrated that prostate-specific antigen, biopsy International Society of Urological Pathology (ISUP) grade, clinical stage, and D'Amico classification statistically significant. Although the SII was higher in patients with BCR, the difference was not statistically significant (p=0.198). Previously reported pathological factors, such as ISUP grade at prostatectomy, pathological stage, lymphovascular invasion, perineural invasion, extraprostatic extension, seminal vesicle invasion, and positive surgical margin, were associated with BCR. The ROC curve for the SII demonstrated poor predictive ability for BCR (95% confidence interval: 0.412-0.545; p=0.532). Conclusion: SII did not appear to be a prognostic indicator for BCR after RARP in localized PCa patients.

Robot-assisted partial nephrectomy (RAPN) is widely used for small renal tumors and provides favorable oncological and functional outcomes. However, a significant risk of postoperative complications remains a concern. Existing nephrometry scores focus on tumor anatomy but neglect patient-specific and intraoperative factors. The Estimation of Physiologic Ability and Surgical Stress (E-PASS) score, originally developed for gastrointestinal surgery, combines physiological and surgical parameters for the prediction of postoperative risk. This study evaluates the predictive performance of the E-PASS score in RAPN. This observational study retrospectively analyzed 166 patients who underwent RAPN between March 2015 and September 2024. The preoperative risk score (PRS), surgical stress score (SSS), and comprehensive risk score (CRS) were calculated. Complications developing within 30 days were classified using the Clavien–Dindo system, with Grade 2 or higher events being considered significant. The performance of the CRS in predicting postoperative complications was evaluated via receiver operating characteristic (ROC) curve analysis, while model calibration was assessed by means of a calibration plot. Logistic regression was used to identify independent predictors of postoperative complication risk. Bootstrap resampling was used to estimate 95

Background:Penile fracture (PF) is a urological emergency that can lead to significant complications if not treated promptly and understanding the factors influencing complications and outcomes in PFs is crucial for improving patient management. Aim:This study aims to evaluate the impact of various factors on postoperative complications and outcomes in patients with PFs based on 10 years of experience at a single center. Methods:In this retrospective study, we analyzed data from 106 patients who underwent surgical treatment for PFs between 2013 and 2023 at our institution. Patient demographics, fracture characteristics, and postoperative outcomes were analyzed. Factors affecting complications including the timing of surgery, defect size were evaluated. Outcomes:The study revealed that early surgical intervention significantly reduced the risk of complications. Factors such as larger defect size and delayed surgery were associated with higher rates of postoperative complications. Results:The mean age of the participants was 46.3 ± 13.9 years. The primary causes of PFs were sexual intercourse (62.3%), masturbation (19.8%), forced penile bending (11.3%), rolling over in bed (4.7%), and falling from bed (1.8%). The mean time from trauma to surgery was 10.5 ± 8 hours, with a mean defect size of 12.7 ± 5.5 mm. Postoperative complications included penile curvature, palpable plaques, and painful erections, with rates of 10.4%, 39.6%, and 23.6%, respectively. International Index of Erectile Function (IIEF-5) scores significantly decreased from preoperative (21.36 ± 2.9) to postoperative values at 6 months (19.48 ± 3.7) (P < 0.001). The time from trauma to surgery significantly correlated with the change in IIEF-5 scores between preoperative and postoperative values (P = 0.007, R 2 = 0.067). The group experiencing complications exhibited a mean defect size of 14.54 ± 6 mm, whereas the non-complication group had a mean defect size of 11.07 ± 4.5 mm (P < 0.001). Clinical Implications:The findings suggest that timely surgical intervention and careful assessment of defect size are critical in managing PFs and these insights can guide urologists in optimizing treatment strategies and improving patient outcomes. Strengths and Limitations:This study benefits from a substantial sample size and a decade of surgical experience at a single center. However, the study's retrospective design and unknown patient history with erectogenic drugs are limitations. Conclusion:The timing of surgery significantly impacts IIEF-5 scores, while the size of the defect was associated with other postoperative complications; understanding the factors influencing complications in PFs can improve surgical outcomes.

PURPOSE:Non-muscle invasive bladder cancers (NMIBC) constitute approximately 75% of bladder cancer cases. Primary transurethral resection (TUR) plays a pivotal role in both diagnosis and treatment. However, despite initial resection, tumors are often missed, leaving behind microscopic residual tumors. This study aims to prospectively investigate the surgical margins of tumors, which may serve as a potential source of residual tumors. MATERIALS AND METHODS:Seventy patients diagnosed with NMIBC who underwent primary TUR were enrolled in this study. Following initial resection, samples were collected from the normal-appearing mucosa extending 1cm beyond the surgical margins. Lesions were categorized as 'healthy margins' for benign lesions, 'tumoral margins' for urothelial cancer, and 'dysplastic margins' for urothelial dysplasia. Clinical and pathological features of these groups were compared, and risk factors for detecting transitional cell carcinoma (TCC) in the normal-looking mucosa were analyzed. RESULTS:The tumoral margins group showed a significantly higher rate of T1 stage tumors compared to the healthy margins group, and a significantly higher rate of high-grade (HG) tumors compared to the dysplastic margins group. Moreover, the tumoral margins group had a significantly higher proportion of high-risk patients (85.7%) compared to the other groups, while the healthy margins group had a significantly higher proportion of low-risk patients (35.3%) compared to the tumoral margins group (0.0%). Additionally, the tumoral margins group demonstrated a significantly higher rate of carcinoma in situ (CIS) compared to the healthy margins group (35.7% vs. 5.9%). Detection of urothelial cancer at the margins was associated with T1 stage, HG stage, and the presence of CIS based on univariate analyses. CONCLUSION:To minimize residual tumors and prevent recurrence in patients undergoing primary TUR, we advocate for the resection of macroscopically visible tumors with nearly 2cm of intact bladder tissue, thereby enhancing the quality of TUR. LEVEL OF EVIDENCE:This study provides Level II evidence, based on its design as a prospective observational study. The findings are derived from well-designed cohort analyses, providing significant associations and insights into the factors affecting surgical margins in NMIBC patients.

Aim: To assess the oncological and functional outcomes of patients aged 70 years or older after robot-assisted radical prostatectomy (RARP) and compare their results with younger men. Materials and Methods: Our study included 496 men who underwent RARP in our clinic between March 2015 and December 2021 with at least 1-year follow-up. Of these patients, 130 were aged 70 or older, and 366 were between 60 and 69. Preoperative characteristics, perioperative parameters, postoperative oncological, and functional results were studied. Results: The entire cohort (496 patients) aged 67 years on median (range 60-84), with a median prostate-specific antigen of 8.4 ng/mL. All the patients had a minimum 1-year of follow-up and the median follow-up was 32 months. According to the perioperative parameters, the two groups were similar except for hospital length of stay. On final pathology, the pathological stage, positive surgical margin rate and lymph node positivity were statistically not different between the two groups. The International Society of Urological Pathology grades were higher on final pathology for both groups, but this increase was greater in the ≥70 age group, and this was statistically significant (P = .013). In both groups, the median International Index for Erectile Function scores decreased after surgery significantly (P < .001), and at the 1st year follow-up, the decrease between the two groups was not different (0.973). Concerning continence outcomes, pad-free continence was significantly better in the 60-69 age group (94.5%) compared to the ≥70 age group (93.1%). Conclusions: The perioperative safety, oncological, and functional results of RARP in elderly men are comparable to younger patients. Clinical trial registiration number: (30/06/2022-13/24).

Objective:The present study was aimed to determine the effect of penile pros-thesis implantation(PPI)surgery on penile sensation by evaluating the penile electromyog-raphy(EMG)variables. Methods:The research was designed as a prospective study.Thirty patients who were diag-nosed with organic erectile dysfunction and had underwent PPI surgery between January 2017 and January 2018 in the Urology Clinic of Antalya Training and Research Hospital were included in this study.Penile sensory EMG was performed on each patient 1 day prior to the surgery by the Physical Therapy and Rehabilitation clinic.Additionally,the control EMG study was also performed in the 3rd and 6th postoperative months. Results:We included 27 patients in this study who attended regular follow-ups and had com-plete EMG results.Out of the 27 patients,23(85.2％)patients had received malleable(ProMe-don)penile prosthesis,one(3.7％)patient had received a two-piece inflatable(Ambicor)penile prosthesis,and three(11.1％)patients had received a three-piece inflatable(AMS 700 CXR)penile prosthesis.The mean nerve conduction value(NCV)of the patients was 29.85(standard derivation:22.54;range:0-78.4)m/s during the preoperative period,whereas it was 27.64(standard derivation:24.72;range:0-83.3)m/s in the 3rd postoperative month and 24.80(standard derivation:22.31;range:0-88.4)m/s in the 6th postoperative month.There was no significant difference between preoperative NCV and 3rd postoperative month NCV(p=0.607).Similarly,no significant difference was observed between preoperative NCV and 6th postoperative month NCV(p=0.276).Additionally,the change between NCV values at postoperative 3rd and 6th months was not statistically significant(p=0.553). Conclusion:Significant loss of penile sensation does not occur in patients who undergo PPI sur-gery.

OBJECTIVE:The objective of this study was to evaluate the minimum number of required cases for successful robotic retroperitoneal partial nephrectomy for an experienced surgeon in transperitoneal robotic surgery.METHODS:Our prospectively collected clinic database was evaluated retrospectively, and 50 patients who underwent robotic retroperitoneal partial nephrectomy by a single experienced surgeon from January 2019 to February 2023 were included in this study. Demographic and perioperative data and R.E.N.A.L. nephrometry scores were noted. margin, ischemia, and complication score was used to predict surgical success. Receiver operating characteristic curve analysis was used to determine how many cases were required to achieve margin, ischemia, and complication score positivity and to apply the off-clamp technique. Also, the first 25 patients were assigned to Group 1 and the second 25 patients to Group 2, and the data were compared between the groups.RESULTS:The patients' demographic data and tumor characteristics were similar in the groups. The off-clamp technique and sutureless technique rates in Group 2 were significantly higher than that in Group 1. Margin, ischemia, and complication score positivity was observed in 60% (n=15) of Group 1 and 96% (n=24) of Group 2. At receiver operating characteristic curve analysis, the 25th and later cases were statistically significant in terms of margin, ischemia, and complication score positivity. In terms of performing surgery with the off-clamp technique, the 28th and subsequent cases were statistically significant.CONCLUSION:A total of 25 or more cases appear to be sufficient to provide optimal surgical results in robotic retroperitoneal partial nephrectomy for an experienced surgeon.

Background: The aim of the study is to compare the results of early urinary continence (UC), pathological results, console time (CT), and perioperative morbidity in patients who underwent transperitoneal robot-assisted radical prostatectomy (TR-RARP) and Retzius-sparing robot-assisted radical prostatectomy (RS-RARP) surgeries in the treatment of clinically localized prostate cancer.Methods: A total of 120 patients, 60 (Group 1) with the TR-RALP technique and 60 (Group 2) with the RS-RALP technique, who had no statistical difference in their preoperative demographic data, were selected retrospectively. Perioperative and postoperative data, and continence rates in the first, third and sixth months were compared between the 2 groups.Results: There was no significant difference between the groups in terms of CT, hemoglobin change, and perioperative and postoperative data. There was a statistically significant difference between the 2 groups in favor of RS-RARP in terms of UC in the first and third months, whereas there was no statistically significant difference between the groups at month 6 (P = .001, P = .002, and P = .245, respectively).Conclusion: This study demonstrates that the RS-RARP technique is a promising approach to achieve early continence without compromising oncological principles and without increased complication rates.

Bone pelvic dimensions and body habitus may have effects on robot-assisted radical prostatectomy (RARP). In this study, we examined the effects of body mass index, bone pelvis measurements and prostate measurements on console time (CT), decrease in postoperative hemogram level (DHL) and surgical margin(SM) in patients who underwent RARP for clinically localized prostate cancer in our institution. The data of transperitoneal RARP cases performed by a single surgeon between November 2016 and August 2020 were analyzed retrospectively. It was included in 125 patients who met the study criteria. Bone and soft tissue measurements were made on magnetic resonance imaging T2-weighted imaging in the mid-sagittal and transvers plane. In multivariate linear regression analyzes, only soft tissue width/transverse diameter of the prostate and CT were found to be correlated (p = 0.026). For the DHL, no pelvic dimension and body habitus had a significant association on multivariate linear regression analysis. In multivariate analyzes, a statistically significant difference was found only between pathological Gleason Score and SM (p = 0.008). Although we found statistically significant associations between prostate diameters and pelvic bone measurements and operative difficulties, we believe that further studies are needed to confirm these results. Such information can help identify patients with challenging anatomy and can be used in robotic surgery training to achieve optimal patient outcomes after RARP.

INTRODUCTION:We aimed to present our experience of robot-assisted laparoscopic radical prostatectomy (RARP).MATERIAL AND METHODS:The study was a retrospective review of 500 patients who underwent RARP between March 2015 and July 2021 in our clinic. A transperitoneal approach was used in all patients. All patients had clinically organ-confined prostate cancer (≤ cT2c).RESULTS:The mean age of the patients was 64.6 ± 5.7 years. The median PSA was 11.4 ng/dL (range 0.3-92.7). The mean operative time was 183.5 min. Positive surgical margin rate was 19.4%. During a mean follow-up of 23.5 months, 96 patients (19.2%) received adjuvant radiotherapy due to the biochemical recurrence and 28 patients (16%) with lymph node positivity received early adjuvant hormone therapy. Considering the continence rates, 69% of the patients were total continence in the 3rd month, while this rate increased to 83 in the 6th month and 91% in the 12th month.CONCLUSION:RARP is a safe and feasible method for experienced centers with patient comfort, surgeon comfort, and successful oncological and functional results.

Background: We aim to directly compare the feasibility and safety of extended pelvic lymph node dissection (PLND) during transperitoneal robotic-assisted radical prostatectomy (Tp-RARP) and extraperitoneal laparoscopic radical prostatectomy (Ep-LRP). Materials and Methods: We retrospectively identified the prospectively maintained database records of 162 patients diagnosed with prostate cancer (PC) who underwent Ep-LRP or Tp-RARP with extended PLND. Patients with risk of nodal metastases over 5% according to Briganti nomogram received extended PLND. All data analyzed in this study were based on the documentation in our PC database including age, body mass index, Charlson comorbidity index score, preoperative prostate-specific antigen, history of abdominal surgery, biopsy Gleason score, total operation time, postoperative pelvic drainage time, pathological results, lymph node yield (LNY), percentage lymph node involvement (%LNI), and perioperative complications. Patients were followed up for biochemical recurrence in the postoperative period. Results: Eighty-two of the 162 enrolled patients were in group 1 (Ep-LRP+PLND) and 80 were in group 2 (Tp-RARP+PLND). There were no statistically significant differences between the groups regarding preoperative demographics and clinical characteristics. The median LNY was 17 (range 8-27) and 17.5 (range 10-29) in groups 1 and 2, respectively, and no statistically significant difference was found. There was no significant difference between the groups in terms of biochemical recurrence-free survival with mean follow-up of 44.8 months after radical surgery. Conclusion: Our results support the view that extended PLND through the Ep-LRP approach is a feasible and safe procedure without compromising oncological efficacy compared with a similar template attempted during Tp-RARP. Clinical Trial Registration number is 01/21-2.

Nephrometry scores are designed to characterize tumors and stratify the surgical complexity. It remains unclear as to which nephrometry score can accurately predict the surgical outcomes. We aimed to assess the utility of radius, exophytic/endophytic, nearness, anterior/posterior, location (RENAL), preoperative aspects and dimensions used for anatomic classifications (PADUA), and centrality index (C-index) nephrometry scores for predicting the strict Trifecta achievement from a single institution series robotic-assisted partial nephrectomy (RAPN). We retrospectively identified the prospectively maintained robotic surgery database records of 91 patients who underwent RAPN between June 2015 and September 2020 in Antalya Training and Research Hospital. The main outcome of the study was the achievement of strict Trifecta (negative surgical margin, no major urologic complications, warm ischemia time ≤25 min, and ≥85% preservation of estimated glomerular filtration rate). A multivariable analysis was performed to identify the factors of strict Trifecta success. The mean patient age was 55.82 ± 13.37 years with a median clinical tumor size of 3.5 cm (IQR 2.5–4.9). The median RENAL, PADUA, and C-index score were 7(IQR 6–8), 8(IQR 7–10), and 2.01(IQR 1.64–2.72), respectively. A strict Trifecta could be achieved in 54 patients (59.3%). Clinical tumor size (P = 0.011), RENAL risk groups (low:reference; intermediate; P = 0.040; high; P = 0.009), PADUA risk groups (low:reference; intermediate; P = 0.044; high; P = 0.001) and C-index risk groups (low:reference; high; P = 0.015) were the independent predictors of strict Trifecta attainment in the multivariate analysis. None of the nephrometry scores were a superior predictor compared to other nephrometry scores in comparative analysis. RENAL, PADUA, and C-index scores were all independent predictors of a strict Trifecta achievement. Our comprehensive comparison of the three scores identified that none of the nephrometry scores proved to be inferior to others nephrometry scores.

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