Abstract Background There is no information regarding challenges faced by European urology residents in starting a family. The aim of this study was to examine pregnancy and parenting experiences and policies during urology residency, identify regulatory gaps and provide recommendations for standardized European guidelines. Methods A cross‐sectional English‐language electronic survey targeted urology residents and young urologists across Europe. The 44‐item, self‐administered survey was pilot‐tested and iteratively revised with European Society of Residents in Urology (ESRU) board members. Data were collected between August and October 2024 from ESRU, the European Association of Urology (EAU) and the European School of Urology (ESU) via mailing lists and social media platforms. Results From 387 respondents, 237 (61%) were females and 255 (66%) were residents. Written policies on pregnancy and parenthood management were reported by 112 (29%) respondents. Formal discussions on pregnancy and parenting were reported to be absent from 319 (82%) respondents, though 228 (59%) agreed about their importance. Among 250 non‐childbearing participants, parenthood was postponed due to fears of missing training opportunities in 130 (92%) female versus 76 (86%) male respondents and due to fears of missing career opportunities in 122 (86%) female versus 62 (70%) male respondents. Concerns about falling behind peers in training were present in 119 (84%) female versus 58 (66%) male respondents (p < 0.001). Across all participants, 283 (87%) and 277 (85%) supported adjusting residency working and training schedules, respectively, upon return to work to ensure the completion of residency requirements. Both male and female respondents strongly endorsed standardized European guidelines on pregnancy and parenting in urology residency. Conclusions This survey highlights the significant barriers to family planning in European urology residency. Fear of career setbacks and training disruptions drives parenthood delays. Standardized policies are needed to support residents while maintaining training requirements and career progression during pregnancy and parenthood.

Bladder and sphincter disorders are common in neurological conditions (stroke, multiple sclerosis, Parkinson's disease, spinal cord injury, peripheral neuropathies, etc.). The type of dysfunction varies depending on the location and extent of the lesion. Treatment must prevent urological and extra-urological complications, improve quality of life, and promote patient autonomy. It must ensure proper bladder emptying (urination), maintain low bladder pressure, and achieve satisfactory urethral resistance. Depending on the initial assessment and follow-up, several treatments may be offered, the most invasive of which are discussed in a specialized neuro-urology center. Patient follow-up is based on keeping a voiding diary and regular morphological and functional assessment of the lower and upper urinary tract (renal-vesical ultrasound, renal function assessment, urodynamic assessment, urethrocystoscopy, retrograde and voiding urethrocystography). The frequency of follow-up is adapted to the urological and nephrological risk. A sudden worsening of urological symptoms, the occurrence of recurrent urinary tract infections, the appearance of gross hematuria, and/or deterioration of renal function are red flags that require urgent treatment at a specialized neuro-urology center.

BACKGROUND:Work-related musculoskeletal disorders are a growing concern in surgical practice, particularly in the context of robot-assisted surgery. Physical strain can significantly impact the well-being and performance of surgeons and surgical staff. This study aimed to evaluate the prevalence and severity of surgical strain among urologists using different available surgical platforms. METHODS:An anonymized, web-based survey was conducted between March and October 2024 using the REDCap platform. Distributed via professional networks and social media, the survey collected data on demographics, surgical experience, platform usage, and self-reported physical discomfort. Statistical analysis included Mann-Whitney U and Chi-squared tests, with P<0.05 considered significant. RESULTS:A total of 427 urologists participated. Most console surgeons (up to 83% for one robotic system variant) reported some level of physical discomfort. Discomfort was also reported by 83% of open surgeons and 80% of bedside assistants, the latter of whom had the highest incidence of injury (53%) from robotic arms. A noteworthy subset of survey respondents required physiotherapy (13-15%), medical (6-11%), or surgical (2-3.8%) interventions due to physical strain. No significant differences were observed by age or sex among console users. CONCLUSIONS:Ergonomic strain is prevalent among urologic surgeons, regardless of surgical platform, with bedside assistants particularly vulnerable. These findings underscore the need for ergonomic training, physical conditioning, and design improvements in surgical systems to safeguard surgeon health and maintain procedural efficacy.

Background and objective This aim of this international expert consensus project was to clarify the appropriate use of urodynamics (UDS) in men with bothersome lower urinary tract symptoms (LUTS) who are considering prostate surgery in light of high-quality published evidence, particularly high-certainty data from the UPSTREAM study, and expert clinical experience. Methods A modified version of the Delphi method was used. Postsurgical patients, catheterised patients, and patients with neurological disease were not included. Eight questions covered UDS in specific contexts; four addressed quality assurance. Key findings and limitations Consensus was reached on the need for UDS in any of the following circumstances: if the corrected maximum flow rate is ≥13 ml/s; if bothersome urinary urgency is present; if scores are below stated thresholds for overall symptoms or voiding symptoms; if the postvoid residual volume is considered meaningfully elevated; if there is extensive comorbidity; and if incontinence (any type) is identified. Consensus was not reached on the need for UDS in men with scores below the stated threshold for the impact on quality of life. Consensus was achieved for quality assurance in terms of cross-checking UDS pressure traces and derived indices; ensuring the trustworthiness of traces by experienced health care professionals; and review within the individual clinical context. UDS was considered important when benign prostatic obstruction (BPO) is less likely and in cases in which detrusor underactivity or overactivity is more likely. In cases with severe voiding symptoms, UDS was not considered necessary to increase confidence in recommending surgery to treat LUTS. Conclusions and clinical implications UDS retains an important role in men with bothersome LUTS considering surgery for presumed BPO. Our consensus recommends specific criteria to guide selective UDS use.

BACKGROUND:People with multiple sclerosis (pwMS) often experience urinary symptoms but may be unaware that they are linked to the disease. The MS Bladder Check self-assessment tool was developed by a multi-disciplinary team of experts to address this issue. OBJECTIVE:To evaluate the usefulness of the MS bladder check tool in raising awareness of urinary symptoms among pwMS and healthcare professionals (HCPs). METHODS:pwMS used the MS bladder check tool prior to HCP consultation and completed a survey to evaluate the tool. HCPs also completed a survey about the tool after their consultations. RESULTS:A total of 503 pwMS and 32 HCPs from France, Italy, Netherlands, Norway, and the United Kingdom completed the MS bladder check tool and the survey. 28.2 % of pwMS recognized current or prior urinary symptoms that were unknown to them; of these, 80.3 % reported that the MS bladder check tool made it easier to discuss urinary symptoms with their HCP. The MS bladder check tool increased awareness of urinary symptoms amongst pwMS and made discussions with their HCP easier. HCPs reported that they would use the MS bladder check tool in their clinical practice and that they would share it amongst their colleagues. CONCLUSION:The MS bladder check tool is of value in clinical practice, empowering pwMS and HCPs to engage in discussions about urinary symptoms with a view to early identification, specialist referral, and optimal intervention.

Background and objective:Overactive bladder (OAB) is a bothersome condition for which anticholinergic drugs remain a cornerstone treatment. However, many patients have comorbidities that require treatment with medications that have anticholinergic properties, which contribute to what is known as the anticholinergic burden (ACB). Our aims were (1) to describe ACB in a treatment-naïve OAB cohort, (2) to analyze prescription trends according to ABC status, and (3) to study the impact of ACB on OAB treatment success. Methods:We reviewed all patients referred to our outpatient clinic for OAB in 2021 and 2022. Exclusion criteria were applied to select only patients with treatment-naïve idiopathic OAB. ACB status was assigned using the Drug Burden Index (DBI). Key findings and limitations:We included 102 treatment-naïve patients with OAB. OAB wet was the most frequent presentation. An anticholinergic drug was the initial treatment in 98% of cases. The median DBI was 0.09 (range 0-3.07). Anticholinergic drugs were the therapy most frequently prescribed across all DBI groups (DBI 0 vs 0-1 vs >1). At follow-up, 61.5% of patients reported an improvement with their prescribed therapy. Stratified by DBI status, the proportion of patients reporting an improvement after anticholinergic therapy was 77.1% in the DBI 0 group, 52% in the DBI 0-1 group, and only 25.9% in the DBI >1 group. DBI was significantly higher in the subgroup of patients reporting no improvement than in the subgroup who reported an improvement. This result was confirmed in a binary logistic regression model. Conclusions and clinical implications:Anticholinergic agents were the drugs most frequently prescribed for OAB, irrespective of DBI. Higher ACB was associated with worse treatment outcomes, which confirms that ACB is an important determinant of the success of anticholinergic therapy for OAB. Patient summary:We looked at how some drugs can affect treatment for overactive bladder (OAB), which is a condition involving sudden urges to urinate. Patients taking high quantities of these drugs before treatment for their OAB may not see as much of a benefit from additional similar drugs. This highlights the importance of tailoring treatments for individual patients according to the medications they are already taking.

Lower urinary tract dysfunction (LUTD) is common in parkinsonian syndromes (PS) and requires special treatment due to limitations in the use of certain drugs and the progression of the disease. Tibial nerve stimulation by transcutaneous electrical nerve stimulation (TENS) is a simple, well-tolerated treatment with proven effectiveness in LUTD. The aim of our study was to evaluate the efficacy on urinary symptoms in patients with a parkinsonian syndrome. A prospective, double-blind, multicenter, randomized study to compare the effects of TENS 20 min a day for 3 months with sham stimulation using the 3-month Patient Global Impression of Improvement (PGI-I) score in adults with PS and LUTD for whom conventional treatments had failed. The secondary endpoints studied were 3-month changes in PGI-S (Severity), Urinary Symptom Profile (USP), Qualiveen questionnaire, voiding diary (VD), post-void residue and the rate of complications. Between 2015 and 2020, 100 patients with a mean age of 68.6 ± 8.4 years were randomized and included in the intention to treat analysis population (ITT). Among them were 71 men and 85 patients with idiopathic Parkinson’s disease. Initially, the PGI-S was moderate to severe (score of 3–4) in 80 patients: 38 (83

Antimuscarinics are historically considered the cornerstone for pharmacological treatment of overactive bladder syndrome (OAB). The more recent introduction of β3 adrenoreceptor agonists has increased the range of therapeutic possibilities, but it is still not possible to determine a priori which drug class should be used first. Considering the comparable effectiveness in terms of symptom improvement, the choice should take into account the different tolerability profile of these drugs according to the patient's clinical features (age, neurologic disease and comorbidities, and risk factors for adverse events). In the absence of specific characteristics that guide the choice towards one of these drug classes, shared decision-making with the patient that takes into account their personal values, preferences, and expectations should be undertaken. PATIENT SUMMARY: We provide recommendations on choice of the first drug type to use in treating overactive bladder. Two drug classes with similar effectiveness but different side effects are available. The decision on which medication to use first should take into account the patient's characteristics and their personal values, preferences, and expectations.

While artificial urinary sphincter (AUS) represents the gold standard for treatment for male stress urinary incontinence (SUI), this same tool has not yet gained equivalent popularity for the same condition in female patients. This may be related to the apparent technical difficulties and perceived risk of complications traditionally related to the open approach. Use of robotic surgery could drive a paradigm shift in female SUI treatment thanks to better ergonomics and visibility. Results reported in the literature show that robot-assisted AUS placement is feasible, safe, and effective for female SUI. Comparative studies suggest superiority to the open approach in terms of intraoperative complications and functional outcomes. Novel technological advances may further facilitate AUS implantation and contribute to diffusion of this technique. PATIENT SUMMARY: This mini-review summarises research results for robot-assisted implantation of artificial urinary sphincter in female patients with stress incontinence. This approach is safe and effective and seems to provide advantages in comparison to traditional open surgery.

BACKGROUND:Robot-assisted artificial urinary sphincter (AUS) implantation is a suitable option for the treatment of severe stress urinary incontinence (SUI) in female patients. However, to the best of our knowledge, any report of robotic AUS revision in case of recurrent SUI is available. The present study aims to provide the outcomes of a cohort of female patients subjected to robot-assisted AUS revision at a single tertiary referral center and to describe the surgical technique. METHODS:The main surgical steps are the following: through robotic technique, the AUS reservoir and urethral cuff are found by following the connection tubes. The reservoir and the activating pump are then removed, and the urethral cuff is opened. A measuring tape is used to obtain the correct size of the bladder neck and to choose the correct new cuff, which is then placed. The reservoir is replaced, and the connection tubes are exteriorized. Finally, a subcutaneous passage towards the right labia majora is obtained and the connections are closed. The outcomes of a retrospective cohort of female patients subjected to robotic AUS revision according to the described technique are also provided. RESULTS:Four patients were included. The median age was 63 (51-76 years); the median time to revision was 12 years (5-16 years). Median operative time was 160.5 (130-185 minutes). The reason for the AUS revision was a mechanical failure of the device in all cases. Any intra-operative or severe postoperative complication (Clavien-Dindo ≥3) was observed. After AUS activation at 4 weeks, all patients were dry. CONCLUSIONS:Robotic AUS revision in female patients is a feasible and safe technique and can give excellent functional outcomes.

In the last few years, the scientific community has seen an increasing interest towards the potential applications of artificial intelligence in medicine and healthcare. In this context, urology represents an area of rapid development, particularly in uro-oncology, where a wide range of applications has focused on prostate cancer diagnosis. Other urological branches are also starting to explore the potential advantages of AI in the diagnostic and therapeutic process, and functional urology and neurourology are among them. Although the experiences in this sense have been quite limited so far, some AI applications have already started to show potential benefits, especially for urodynamic and imaging interpretation, as well as for the development of AI-based predictive models for treatment response. A few experiences on the use of ChatGPT to answer questions on functional urology and neurourology topics have also been reported. Conversely, AI applications in functional urology surgery remain largely unexplored. This paper provides a critical overview of the current evidence on this topic, highlighting the potential benefits for the diagnostic workflow, therapeutic evaluation and surgical training, as well as the current limitations that need to be addressed to enable the integration of this tools in the clinical practice in the future.

OBJECTIVE To evaluate the safety and efficacy of a virtual reality (VR) mask as a distraction tool during minimally invasive functional urological interventions as part of the local anesthesia protocol. METHODS This is a single-center prospective observational pilot cohort study which included all consecutive patients undergoing intradetrusor botulinum toxin injection, sacral neuromodulation, and urethral bulking agent injection with combined anesthetic protocol composed by local anesthesia and a VR mask (Hypno VR virtual reality mask, Strasbourg, France). Preoperative and postoperative evaluation included the State-Trait Anxiety Inventory (STAI) index. Intraoperatively, a 4-point Likert anxiety rating scale and a visual analog scale (VAS) pain score were assessed. Vital signs were measured preoperative and intraoperatively. Postoperatively, 2 questionnaires exploring patient satisfaction were administered. The evaluated outcomes were the tolerability of the device and patient's reported intraoperative pain and anxiety. RESULTS Thirty-nine patients were included. Mean age was 64 years. Eleven patients (28%) were affected by neurological conditions. Two patients experienced subjective discomfort. Preoperative and intraoperative mean arterial pressure was 105 and 111 mmHg (P = .01), respectively. Preoperative and intraoperative mean heart rate was 72 and 75 bpm (P = .12), respectively. Preoperative and postoperative STAI index were 34.8 + -10 and 32.8 + -10.3 (P = .88). Mean Likert anxiety scale value was 2.2 + -1.1, mean intraoperative VAS score was 5.3 + -2.5. Thirty-four (87%) patients declared themselves satisfied with the surgical procedure and 36 (92.3%) patients would have recommended the same procedure to a relative. CONCLUSION Virtual reality mask may play a role in reducing pain and anxiety in minimally invasive functional urological interventions. UROLOGY 196: 93-99, 2025. (c) 2024 Published by Elsevier Inc.

Background and objective Lower urinary tract symptoms (LUTS) and overactive bladder (OAB) intimately affect the psychological wellbeing and mental health of men. However, to date, the association of aggression with LUTS and OAB has not been investigated. To address this knowledge gap, we evaluated the association of aggression with LUTS and OAB in a large representative cohort of men at the population level. Methods We used computer-assisted web interviews that included reliable questionnaires for assessment of LUTS, OAB, and aggression. A population-representative group of men was based on the most recent census. For data analysis, we developed univariate and multivariate regression models. Key findings and limitations We analyzed data for a cohort of 3001 men that was representative for age and place of residence. Aggression was more prevalent among respondents with LUTS and OAB in comparison to men without these conditions (p < 0.001). The scores for aggression were directly proportional to the scores for LUTS and OAB (Spearman’s rank correlation coefficients of 0.261 for LUTS and 0.284 for OAB). Univariate linear regression models revealed an association between aggression and LUTS or OAB in all age groups. Finally, multivariable linear regression models confirmed that correlations of aggression with LUTS and OAB were independent of age, sociodemographic parameters, comorbidities, and lifestyle habits (regression coefficients of 0.013 for LUTS and 0.024 for OAB). Conclusions and clinical implications Our study is the first to show that aggression among men is consistently associated with LUTS and OAB. Our results open a new research area on the effect of LUTS and OAB or their causes on psychological wellbeing and mental health, and may even support screening for hostile behavior in the clinical setting for individuals who report LUTS and OAB. Patient summary We performed the first study to investigate whether aggression is linked to lower urinary tract symptoms (LUTS) and overactive bladder (OAB). Results from our survey in a representative group of men in Poland show that aggression is linked to LUTS and OAB. More research is needed to confirm these results.