Search Results (156)

Background/Objectives: Early recovery of urinary continence and sexual function remains a key focus following radical prostatectomy. The transvesical single-port robot-assisted radical prostatectomy (SP-TV-RARP) approach is a novel technique with very limited evidence that has been suggested to preserve the Retzius space and allow extraperitoneal access through the bladder. We aimed to evaluate early functional and oncologic outcomes following SP-TV-RARP at a single academic institution. Methods: We retrospectively reviewed 21 patients who underwent SP-TV-RARP by a single surgeon between September 2024 and May 2025. Continence is defined as being pad-free, and return of erectile function is defined as having erections sufficient for penetration. Functional and oncologic outcomes were assessed using clinical follow-up documentation and analyzed with Kaplan–Meier analysis. Results: The median patient age was 65 years, and 52.4% had pT3 disease. Positive surgical margins were observed in 62% overall and 30% in men with organ-confined disease. No intraoperative or 30-day postoperative complications occurred. Approximately 43% of patients achieved continence within one day of urethral catheter removal, with 75% of patients being pad-free at 3 months. Median SHIM and AUA-SS scores did not significantly decline at 3 months compared to baseline. The median time to recovery of erectile function was 69 days, and 67% recovered at the last follow-up. Biochemical recurrence occurred in 2 patients (15.4%) within 6 months. Conclusions: SP-TV-RARP appears safe and may facilitate early return of urinary continence and erectile function. Although inferior oncologic outcome is a potential concern during early adoption, functional outcomes were favorable. Further prospective evaluation is warranted to confirm long-term oncologic efficacy. Full article

Background/Objectives: De novo stress urinary incontinence (SUI) can develop postoperatively in patients without prior symptoms, and can persist beyond 6 months, posing clinical challenges. This study aimed to identify predictors of persistent de novo SUI after transvaginal mesh (TVM) surgery and to evaluate management strategies. Methods: A retrospective review of 817 women with anterior and apical pelvic organ prolapse (POP) (stage II–IV) who underwent TVM surgery from 2013 to 2021 was conducted. Fifty patients developed de novo SUI postoperatively. Assessments included urodynamic studies, validated symptom questionnaires, and POP quantification (POP-Q) staging. Logistic regression analysis was used to identify predictors of persistent symptoms. Results: Spontaneous resolution occurred in 30% (15/50) of participants within six months, while 70% (35/50) had persistent SUI. Concomitant posterior mesh repair was more frequent in the persistent group compared to the self-limiting group (29% vs. 7%), and was significantly associated with symptom persistence (OR 5.6, 95% CI, 0.65–48.4; p = 0.03, chi-square test). During conservative management with observation alone, 30% (15/50) experienced spontaneous resolution within 6 months, while 70% (35/50) had persistent symptoms. Among those with persistent symptoms, 56% required no further treatment, 10% improved with vaginal laser therapy, and 4% underwent sling surgery. Conclusions: Conservative management remains critical in the early postoperative period, given the high rate of spontaneous symptom resolution. For persistent cases, minimally invasive options such as vaginal laser therapy may be beneficial. Notably, only 4% required anti-incontinence surgery. Full article

Objectives: Strain elastography (SE) is a non-invasive ultrasound-based technique for evaluating tissue elasticity. This study investigated whether SE can reproducibly detect differences in suburethral tissue stiffness between women with stress urinary incontinence (SUI) and continent controls. Methods: In this prospective cohort study, 40 women (20 with SUI, 20 continent controls) underwent introital two-dimensional (2D) ultrasound in the midsagittal plane at rest. SE was performed at three predefined suburethral regions of interest (ROIs): the internal urethral orifice (IUO), midurethra (MU), and external urethral orifice (EUO), with the adipose layer (AL) serving as reference tissue. Group comparisons and reproducibility analyses were conducted. Results: SE enabled reliable in vivo assessment of suburethral elasticity. Women with SUI demonstrated significantly higher tissue elasticity at all three urethral levels compared to controls. The MU level showed the highest diagnostic accuracy (AUC = 0.813; sensitivity = 0.65; specificity = 0.85). Measurement reproducibility was excellent, with intraclass correlation coefficients exceeding 0.95 across all ROIs. Conclusions: SE is a feasible, reproducible imaging modality for assessing suburethral biomechanics in women with SUI. It effectively distinguishes affected individuals from continent controls, particularly at the midurethral level. Standardized protocols and diagnostic thresholds are needed to facilitate clinical integration of SE in the evaluation and management of SUI. Full article

Background: Anorectal malformations (ARMs) are rare congenital anomalies requiring surgical correction and long-term multidisciplinary care. Despite advances in surgical techniques like posterior sagittal anorectoplasty (PSARP), patients often experience ongoing issues with bowel and urinary function and psychosocial well-being. Aim: To evaluate the long-term outcomes of bowel function, urinary function, and quality of life in patients born with anorectal malformation and treated at our center. Methods: A cross-sectional study evaluated 55 ARM patients treated at the University Hospital of Palermo between 2002 and 2020. Data on clinical characteristics, surgical management, bowel and urinary function, and quality of life were collected using the following validated tools: Rintala Bowel Function Score, PedsQL Family Impact Module, Fecal Incontinence Quality of Life Score, and Lower Urinary Tract Symptoms Questionnaire. Statistical analysis was performed using Fisher’s exact test and ANOVA. Results: Excellent bowel function was observed in 44% of patients, particularly those with low-type ARMs. A bowel management program (BMP) was required in 62% of cases, though 44% of these patients, especially adolescents, showed poor adherence. BMP non-adherence significantly correlated with lower quality of life and worse bowel function (p < 0.01). Bladder dysfunction was noted in 24% of patients, mainly younger ones. Conclusions: Tailored BMPs and transition care are important for long-term success in ARM patients. Adherence to BMPs improves continence and quality of life, highlighting the need for continuous, multidisciplinary follow-up from childhood into adulthood. Full article

Background: Neurogenic bladder (NB) in children may lead to recurrent urinary tract infections (UTIs), renal deterioration, and a reduced quality of life. Clean intermittent catheterization (CIC) is the standard of care, but in some patients, CIC may be unfeasible due to anatomical, sensory, or compliance issues. Button cystostomy (BC) has emerged as a minimally invasive, bladder-preserving alternative. This study aimed to assess the feasibility, safety, and outcomes in the long-term of BC in pediatric NB patients. Methods: Retrospective analysis was conducted on children with NB who underwent endoscopic BC placement between January 2020 and December 2024 in a tertiary pediatric center. Demographic data, operative time, complications, and follow-up outcomes were collected. All procedures used an endoscopic approach with cystoscopic guidance for safe device placement. Results: Thirty-three patients (25 males; median age 7.96 years) underwent BC placement. Most had spinal dysraphism (63.6%). The mean operative time was 48.5 ± 6 min. During a mean follow-up of 2.1 ± 1.4 years, five patients (15.2%) had febrile UTIs and two had minor leakage. No major complications occurred. Four buttons were removed due to clinical improvement (N = 1), the fashioning of a continent derivation (N = 1) and implantation of a sacral neuromodulator (N = 2); two patients accepted CIC. Satisfaction was reported by 93.9% of families. Conclusions: BC is an effective, minimally invasive alternative for urinary drainage in children with NB, even when compared to continent diversion techniques such as the Mitrofanoff, due to its lower invasiveness, greater feasibility, and lower complication rate. Broader adoption may be warranted, but prospective studies are needed to confirm long-term outcomes. Full article

Background and Objective: Adverse pathology to high-risk prostate cancer (PCa) after radical prostatectomy (upgrading) poses a threat to risk stratification and treatment planning. The impact on sexual function, urinary continence, and health-related quality of life (HRQOL) remains unclear. Methods: From 2004 to 2024, 4189 patients with preop low-/intermediate-risk PCa (Gleason score 6 or 7a, PSA ≤ 20 ng/mL) underwent radical prostatectomy at our department and were analyzed. Primary endpoint was HRQOL, erectile function, and urinary continence. Secondary endpoint was rate of salvage therapies and biochemical-free survival. Propensity score matching was performed using “operative time”, “robot-assisted surgery”, “blood loss”, “nerve-sparing surgery”, “age”, and “BMI” to represent comparable surgical approach. Median follow-up was 39 months (Interquartile-range (IQR) 15–60). Key Findings and Limitations: Patients who were upgraded to high-risk PCa showed a higher rate of postoperative radiotherapy and androgen-deprivation therapy compared to patients who were not upgraded (21% vs. 7%, p < 0.001; 9% vs. 3%, p = 0.002). Five-year biochemical recurrence-free survival was 68% in the upgrading group vs. 84% in the no-upgrading group (p < 0.001). We saw no difference in patient-reported HRQOL, urinary continence, or erectile function. Multivariable analysis showed that postoperative upgrading was a significant risk for not achieving good overall HRQOL (OR: 0.77, 95% CI: 0.61–0.97, p = 0.028) during the follow-up. Conclusions and Clinical Implications: Although postoperative upgrading to high-risk PCa leads to worse oncologic outcomes and higher salvage therapy rates, this study indicates that its impact on health-related quality of life is minimal and should not deter a cautious approach to radical prostatectomy. Full article

Background: Circadian rhythms regulate critical cellular processes, including DNA repair and cell cycle dynamics, potentially influencing the effectiveness of radiotherapy (RT). This study evaluated whether RT timing impacts clinical outcomes and symptom burden in prostate cancer patients. Patients/Methods: This retrospective study (n = 336, median follow-up 55 months) included men who received curative intent external beam RT between 2010 and 2019 (median age 69, 69% black, median PSA 11.3, 40% with Gleason 8–10). Treatment times (TTs) were averaged and analyzed by quartile/median. Outcomes included freedom from biochemical failure (FFBF) and distant metastasis (FFDM), GI and GU toxicity, and quality of life (QOL). Subgroup analyses by race and hormone therapy status were performed. Results: Across the overall cohort, TT was not associated with FFBF or FFDM. However, in white men, earlier TTs were significantly associated with higher 5-year FFBF (89% vs. 67%, p = 0.0139) and FFDM (93% vs. 72%, p = 0.0268). In the multivariate analysis (MVA), TT was not associated with FFBF or FFDM for all men, but in white men, earlier TT was associated with improved FFBF (HR 2.8, p = 0.06) in a model also including risk category (p = 0.21). Overall, no significant differences were observed for grade 2–3+ toxicity and TT. Trends for inferior QOL, and worse grade 2+ (p = 0.2) and 3+ GU toxicity (p = 0.1) were observed for later TTs. In white men, bowel, urinary continence, and irritative/obstructive urinary QOL were worse with later TTs (p < 0.05). Conclusions: TT may influence clinical outcomes and symptom burden, particularly in white men. These findings underscore the potential of chronoradiotherapy as a personalized treatment strategy and highlight the need for prospective trials. Full article

Background: The aim of this review was to analyze training interventions used and their effectiveness in improving pelvic floor muscle function related to urinary continence in postmenopausal women. We then characterized the recommended pelvic floor muscle training programs used in experimental studies based on four training components: frequency, intensity, duration, and type of pelvic floor muscle exercise. Methods: For this purpose, we conducted a literature review of works published up until the end of 2024, available in the Web of Science, PubMed, MEDLINE, and SPORTDiscus with Full Text databases. We used the keywords “pelvic floor muscle”, “training”, and “postmenopausal women”. Initially, we identified 205 articles published between 1997 and 2024. Then, based on specific criteria, we qualified 15 for analysis. Results: Thirteen studies included only PFMT, while three of them combined PFMT with other physical activity. In two studies, training was conducted in the form of a virtual video game using a pressure platform. We have noted that researchers most often use a 1 h pad test, digital palpation, and surface electromyography to assess the function of pelvic floor muscles. In improving pelvic floor muscle function related to urinary incontinence, 14 out of the 15 analyzed studies showed improvement. In only eight of the fifteen articles, researchers characterized all components of the implemented PFMT that enable full replication of the training intervention. In four of the studies, only one of the required components, namely intensity, was missing. The recommended number of training sessions was 2 to 7 per week, on average 3 ± 2 (M ± SD). Training interventions lasted from 2 to 24 weeks, on average 10 ± 6 weeks. Conclusions: Regardless of the chosen form of training intervention, PFMT is an effective method in improving the function of pelvic floor muscles in postmenopausal women. Full article

Background and Objectives: Penile tissue loss, which can be an acquired condition due to trauma or infection, but is also seen in congenital anomalies, is a rare condition in children. A standard surgical approach is often not possible due to the different degrees and etiologies of penile tissue loss. The continuing growth and the presence of various congenital anomalies in children require a different penile reconstruction approach than in adults. We aimed to share our experience and surgical results with children in whom we performed penile reconstruction with different techniques due to penile tissue loss. Materials and Methods: Ten cases that underwent penile reconstruction between 2018 and 2023 were evaluated retrospectively. Age at initial operation, associated anomalies, surgical technique, and other related surgical attempts, as well as functional and cosmetic results, were recorded. Results: Ten boys aged between 6 months and 17 years underwent phalloplasty due to penile tissue absence. In six cases, penile tissue loss was due to acquired causes, and in four cases, congenital anomalies were the reason. The most common cause of penile tissue loss was circumcision complications. In four cases, penile reconstruction was achieved by mobilization of the remaining corpus cavernosum tissues, in two cases, the cavernous tissue was adequate and repaired with glansplasty and penile skin graft. Phalloplasty was performed by tubularization of a skin and subcutaneous fat flap, removed from the pubic region and scrotal region, in two cases. A microvascular radial forearm flap was performed in a 17-year-old patient with penile tissue loss because of trauma, and a free skin flap taken from the forearm was used for penile reconstruction. Thirty percent of patients required a second surgery. Urinary continence was present in eight of the cases. Although four cases were classified as cosmetically unsatisfactory in our evaluation, all patients and their families reported being satisfied with the cosmetic results. Conclusions: Penile reconstruction for penile tissue loss in children should be performed in clinics where different scenarios can be applied. With maximum preservation and mobilization of existing cavernous tissues, temporary penile reconstruction with local flaps should be performed in young children at an early stage to minimize the psychological effects of penile absence. Although an esthetically perfect result cannot be guaranteed, patients and families are generally satisfied with the outcome. Full article

Background/Objectives: Prostate cancer is the second most common malignancy in men, and robot-assisted radical prostatectomy (RARP) has become a preferred treatment for localized disease. Postoperative urinary continence is a key determinant of quality of life. The aim of this study was to evaluate the preoperative patient characteristics and multiparametric magnetic resonance imaging (mpMRI) data that determine early postoperative continence in patients who underwent robotic radical prostatectomy at our clinic. Methods: In this study, patients who underwent robotic radical prostatectomy at our clinic between March 2020 and June 2022 were evaluated. The patients’ demographic data, preoperative PSA levels, digital rectal examination findings, preoperative lower urinary tract symptoms, sexual function, mpMRI findings, Briganti scores, surgical techniques used during the procedure and postoperative continence status were assessed. Results: A total of 111 patients were included in the study. The mean age of the patients was 61.1 years. The median follow-up duration was twelve months. According to the postoperative continence status, 22% of the patients were incontinent, 53% had moderate continence and 24% were fully continent in the first month. At the third month, 16.8% of the patients were incontinent, 31.3% had moderate continence and 51.8% were fully continent. At the one-year postoperative follow-up, the percentages of incontinent, moderately continent and fully continent patients were 4.8%, 13.2% and 81.9%, respectively. Urethral width in mpMRI (p: 0.012), pelvic transverse (p: 0.002) and AP (anterior–posterior) diameters (p: 0.033), preoperative IPSS scores (p: 0.033) and the presence of bilateral nerve-sparing surgery (p: 0.047) were found to be associated with postoperative urinary continence. No significant differences were found between groups regarding the relationship of other parameters evaluated by mpMRI with continence. Conclusions: In our study, preoperative IPSS scores, urethral width in mpMRI, pelvic transverse and AP diameters and the performance of nerve-sparing surgery were associated with early postoperative continence. Further studies with larger patient populations are needed to better understand the long-term predictors of postoperative urinary incontinence following radical prostatectomy. Full article

Background/Objectives: Urinary incontinence (UI) is a frequent and distressing complication after radical prostatectomy (RP). Pelvic floor muscle training (PFMT) is widely recommended as first-line rehabilitation, yet the clinical factors influencing its effectiveness remain incompletely understood. Methods: This prospective cohort study included 182 men undergoing RP who completed a standardized physiotherapy program involving pelvic floor muscle exercises, biofeedback (BFB), and ultrasound-guided training. UI severity was assessed using the 1-h pad test and recorded absorbent product use. Outcomes were evaluated at three time points: one month, three months, and six months post-catheter removal. A multiple linear regression model was used to identify the predictors of continence improvement, defined as the change in pad test result between baseline and six months. Results: Pad test results and absorbent use decreased significantly across all UI severity stages (p < 0.0001). The greatest absolute improvement was observed in patients with severe incontinence at baseline (UI stage 3: mean reduction from 130.8 g to 23.7 g). Regression analysis revealed that only the baseline pad test result was significantly associated with the magnitude of improvement (β = 0.91; 95% CI: 0.85–0.97, p < 0.001; R² = 0.89). Age, BMI, and time to rehabilitation were not significant predictors. Conclusions: Pelvic floor rehabilitation after RP is effective in improving continence, including in patients with severe baseline symptoms. The baseline pad test value emerged as the strongest predictor of rehabilitation response, highlighting the importance of initial assessment. These findings support the use of PFMT in clinical practice and emphasize the need for individualized treatment planning based on baseline UI severity. Full article

Background/Objectives: Focal therapy (FT) for prostate cancer (PCa) is an alternative to radical treatments that aims to balance cancer control and quality of life preservation in well-selected patients. Understanding its general principles and outcomes is key for its widespread adoption and proper implementation. Methods: The International Consultation on Urological Diseases nominated a committee to review the literature on FT for PCa. A comprehensive PubMed search was conducted to identify articles focused on the different aspects of FT, including patient selection, imaging techniques, treatment modalities, cancer control and safety outcomes, integration with other approaches and future perspectives. Results: FT for PCa was introduced in the 1990s with cryotherapy and high-intensity focused ultrasound (HIFU) as pioneering modalities. Though initially guided by transrectal ultrasound (TRUS) and large biopsy templates, FT implementation expanded significantly with the advent of multiparametric magnetic resonance imaging (MRI) and the validation of the index lesion concept. Appropriate patient selection is key for FT and relies on prostate-specific antigen (PSA) metrics, MRI findings and targeted biopsy information. Multiple energy sources are now available, each with specific technical characteristics. Cancer control rates vary by energy modality, tumor characteristics, and institutional experience, demonstrating comparable outcomes to radical treatments in well-selected patients. The safety profile is excellent, with high rates of urinary continence and sexual function preservation. Post-treatment surveillance integrates PSA measurements, imaging, and histological assessment. Future directions for further FT adoption include the availability of long-term data, protocol standardization and technological improvements to enhance patient selection and treatment planning and delivery. Conclusions: FT is a valuable therapeutic option for selected patients with localized PCa, demonstrating promising oncological outcomes and better functional preservation compared to radical treatments. Understanding its principles and technical aspects is essential for offering comprehensive PCa care. Full article

Background: Vesicourethral anastomosis (VUA) is a critical step in radical prostatectomy (RP), with interrupted suture (IS) and running suture (RS) as common techniques. However, there is no conclusive evidence suggesting the superiority of one technique over the other regarding voiding function. This study compares their effects on voiding function and continence recovery after retropubic RP. Methods: A two-group, parallel-design study included 70 patients with localized prostate cancer (pT1-pT2) undergoing retropubic RP by a single surgical team. Patients were randomized to VUA with IS (n = 35) or RS (n = 35). The primary outcomes included uroflowmetry parameters—maximum flow rate (MFR), voiding volume (VV)—post-void residual volume (PVR), urinary function assessed by the International Prostate Symptom Score (IPSS), and continence recovery. These outcomes were measured preoperatively and at 1, 3, 6, and 12 months post-surgery. Secondary outcomes included surgical parameters, perioperative complications and one-year oncological outcomes. Results: Suturing time was shorter for RS than IS (21 vs. 33 min, p = 0.001). Minimal anastomotic leakage occurred more frequently in the IS group (23% vs. 9%), while long-term anastomotic stenosis rates were comparable between RS and IS groups (12% vs. 9%). IS demonstrated significantly higher MFR at 1-month post-surgery (23.3 vs. 17.2 mL/s, p = 0.003). In subsequent follow-ups (3, 6, and 12 months), the mean MFR remained higher in the IS group, though without statistical significance. Logistic regression favored IS for early MFR outcomes (OR 4.16; 95% CI, 1.22–14.18; p = 0.023). Continence recovery and IPSS scores were similar between groups. Conclusions: Both techniques are effective and safe. RS reduces suturing time and leakage risk, while IS improves early postoperative MFR. Full article

Background: Cold dissection (CD) during nerve-sparing robot-assisted radical prostatectomy (nsRARP) in patients with prostate cancer has been proposed to improve functional outcomes by reducing the thermal damage to neurovascular bundles (NVBs). This study compares the impact of CD versus thermal dissection (TD) on postoperative early continence and erectile function recovery. Methods: A prospective comparative analysis was conducted on patients undergoing nsRARP, comparing CD and TD techniques. Continence was assessed at 15, 30, and 90 days, while erectile function was evaluated at 30, 90, and 180 days using IIEF-5 scores. Logistic and linear regression analyses were performed to identify predictors of functional recovery. Results: CD significantly improved early continence at 15 and 30 days (p < 0.05), although the difference diminished by 90 days. Erectile function recovery was consistently higher in the CD group at all time points (p < 0.01). Age negatively impacted continence and erectile function recovery, while preoperative IIEF-5 scores were strong predictors of erectile function. Prostate volume, BMI, and metabolic syndrome showed no significant influence on outcomes. Conclusions: CD enhances early continence and erectile function recovery following nsRARP by preserving NVBs and minimizing thermal damage. This technique offers a valuable approach to improving patient functional outcomes. Further studies are required to validate its long-term benefits. Full article

Background and Objectives: The limited literature on the significance and risk factors of intraoperative anastomotic leakage (IAL) following Retzius-sparing robot-assisted radical prostatectomy (Rs-RARP) highlights the need for further investigation. This study aimed to assess the incidence of IAL, identify its associated risk factors, and evaluate its clinical implications. Materials and Methods: Patients with prostate adenocarcinoma who underwent Rs-RARP performed by a single surgeon between February 2015 and August 2023 were included in this study. Positive IAL was defined as the presence of anastomotic leakage identified through a water injection test performed immediately after vesicourethral anastomosis (VUA). Postoperative urinary continence was defined as the use of no pads or only a safety pad. Patients were categorized into two groups: those with positive IAL and those without. Immediate repair was performed in cases of positive IAL, and cystography was conducted approximately 10–14 days postoperatively. Chi-square test, Fisher’s exact test, Mann–Whitney U test, as well as univariable and multivariable logistic regression analyses, were used to evaluate the risk factors associated with IAL. Additionally, we analyzed the continence rate and the time to achieve continence following surgery. Results: A total of 230 patients underwent Rs-RARP for prostate adenocarcinoma performed by a single surgeon at our center during the aforementioned period. A water injection test was performed in all patients immediately after the VUA. IAL was observed in 32 patients (14%) during the water injection test. Postoperative cystography revealed very mild contrast medium leakage in only two patients (0.9%), with no impact on clinical recovery. No major IAL cases were identified on postoperative cystography. Patients with positive IAL required a significantly longer time to achieve continence compared to those without IAL (2.13 vs. 0.46 months, p = 0.008). Univariable analysis showed that a locally advanced T stage (>T2), longer console time, and absence of nerve-sparing were significantly associated with positive IAL. In multivariable analysis, a longer console time and a locally advanced T stage remained significant predictors of IAL. Conclusions: IAL detected by the water injection test was associated with the development of postoperative urinary incontinence and delayed recovery of continence. A tumor stage greater than T2 and longer console time were significant predictors of IAL. Further prospective randomized studies with larger sample sizes are required to validate our findings. Full article