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Simple Summary: Bladder cancer is among the most common malignancies worldwide, often requiring radical cystectomy (RC) for muscle-invasive and high-risk non-muscle-invasive cases. While effective, this procedure frequently leads to significant functional impairments, including urinary incontinence and sexual dysfunction, adversely affecting quality of life. In response, sexual-sparing techniques in robot-assisted radical cystectomy (RARC) have emerged as a promising approach to improve functional outcomes without compromising oncological control. This review examines the latest evidence on sexual-sparing RARC, highlighting its potential to preserve sexual and urinary function in both male and female patients. Techniques such as nerve-sparing, capsule-sparing, and pelvic organ-preserving approaches show encouraging functional outcomes. In select patients, oncological outcomes align closely with those of standard RC. Careful patient selection remains crucial, favoring those with organ-confined disease and good baseline function. While early data is promising, further prospective studies and standardized protocols are needed to validate these findings and facilitate broader clinical adoption. Sexual-sparing RARC represents a step forward in balancing cancer control with improved postoperative quality of life. Background/Objectives: Radical cystectomy (RC) is the standard treatment for muscle-invasive and high-risk non-muscle-invasive bladder cancer, but it often results in significant functional impairments, including sexual and urinary dysfunction, adversely affecting quality of life (QoL). Sexual-sparing robotic-assisted radical cystectomy (RARC) has been introduced to mitigate these effects. This review evaluates the oncological and functional outcomes of sexual-sparing RARC in male and female patients. Methods: A systematic literature search identified 15 studies including 793 patients who underwent sexual-sparing RARC using techniques such as nerve-sparing, capsule-sparing, and pelvic organ-preserving approaches. Data on oncological and functional outcomes were analyzed. Results: Sexual-sparing RARC achieves oncological outcomes comparable to open RC, with negative surgical margin (NSM) rates exceeding 95% in most studies. RFS and CSS rates were robust, often surpassing 85% at intermediate follow-ups. Functional outcomes were also favorable, with continence rates exceeding 90% and erectile function recovery surpassing 70% in well-selected male patients. Female patients undergoing pelvic organ-preserving techniques demonstrated improved continence, preserved sexual function, and enhanced QoL. Patient selection emerged as critical, favoring those with organ-confined disease and good baseline function. Conclusions: Sexual-sparing RARC offers a promising balance between oncological control and functional preservation, making it an effective option for selected patients. Further research is needed to refine techniques and establish standardized protocols for broader adoption. [ABSTRACT FROM AUTHOR]

To assess differences in the distribution of type and number of D'Amico high-risk criteria (DHRCs) according to race/ethnicity (R/E) and their effect on cancer-specific mortality (CSM) in prostate cancer (PCa) patients treated with external beam radiotherapy (RT). In the SEER database (2004–2016), we identified 31,002 PCa patients treated with RT with at least one DHRCs, namely PSA >20 ng/dL, biopsy Gleason Grade Group 4–5, and clinical T stage ≥T2c. Competing risks regression (CRR) model tested the association between DHRCs and 5-year CSM in all R/E subgroups. Of 31,002 patients, 20,894 (67%) were Caucasian, 5256 (17%) were African American, 2868 (9.3%) were Hispanic-Latino, and 1984 (6.4%) were Asian. The distributions of individual DHRCs and combinations of two DHRCs differed according to R/E, but not for the combination of three DHRCs. The effect related to the presence of a single DHRC, and combinations of two or three DHRCs on absolute CSM rates was lowest in Asians (1.2–6.8%), followed by in African Americans (2.3–12.2%) and Caucasians (2.3–12.1%), and highest in Hispanic/Latinos (1.7–13.8%). However, the opposite effect was observed in CRR, where hazard ratios were highest in Asians vs. other R/Es: Asians 1.00–2.59 vs. others 0.5–1.83 for one DHRC, Asians 3.4–4.75 vs. others 0.66–3.66 for two DHRCs, and Asians 7.22 vs. others 3.03–4.99 for all three DHRCs. R/E affects the proportions of DHRCs. Moreover, within the four examined R/E groups, the effect of DHRCs on absolute and relative CSM metrics also differed. Therefore, R/E-specific considerations may be warranted in high-risk PCa patients treated with RT. [ABSTRACT FROM AUTHOR]

Introduction The aim of this study was to assess the association between the type and number of D'Amico high-risk criteria (DHRCs) with rates of pathologically non-organ-confined (NOC) prostate cancer in patients treated with radical prostatectomy (RP) and pelvic lymphadenectomy (PLND). Material and methods In the Surveillance, Epidemiology, and End Results database (2004-2016), we identified 12961 RP and PLDN patients with at least one DHRC. We relied on descriptive statistics and multivariable logistic regression models. Results Of 12 961 patients, 6135 (47%) exclusively harboured biopsy Gleason score (GS) 8-10, 3526 (27%) had clinical stage ≥T2c, and 1234 (9.5%) had prostate-specific antigen (PSA) >20 ng/mL. Only 1886 (15%) harboured any combination of 2 DHRCs. Finally, all 3 DHRCs were present in 180 (1.4%) patients. NOC rates increased from 32% for clinical T stage ≥T2c to 49% for either GS 8-10 only or PSA >20 ng/mL only and to 66-68% for any combination of 2 DHRCs, and to 84% for respectively all 3 DHRCs, which resulted in a multivariable logistic regression OR of 1.00, 2.01 (95% CI 1.85-2.19; p <0.001), 4.16 (95% CI 3.69-4.68; p <0.001), and 10.83 (95% CI 7.35-16.52; p <0.001), respectively. Conclusions Our study indicates a stimulus-response effect according to the type and number of DHRCs. Hence, a formal risk-stratification within high-risk prostate cancer patients should be considered in clinical decision-making. [ABSTRACT FROM AUTHOR]

Objectives: To assess the change of storage symptoms (SS) and their impact on quality of life in men undergoing thulium:YAG laser enucleation of the prostate (ThuLEP) for benign prostatic hyperplasia (BPH). Materials and Methods: BPH patients requiring surgery were prospectively evaluated (April 2019–October 2020). Inclusion criteria: International Prostate Symptom Score (IPSS) ≥8, maximum urinary flow rate ≤15 mL/s, and urinary retention. Exclusion criteria: previous urethral/prostatic surgery, pelvic irradiation, bladder/prostate cancer, neurogenic bladder, concomitant transurethral surgery, and active urinary tract infection. IPSS, International Continence Society-Overactive Bladder (ICIQ-OAB) and International Continence Society-Overactive Bladder Quality of Life (ICIQ-OABq) scores were gathered before surgery and 1, 3, 6, and 12 months after surgery. Results: In total, 117 men were included. Mean age was 68.0 ± 7.7 years. Mean prostate volume was 86.6 ± 34 cc. Mean IPSS subscore was 8.7 ± 3.1 and 11.7 ± 4.7 for storage and voiding symptoms, respectively. Mean ICIQ-OAB was 29.1 ± 16.8. Mean ICIQ-OABq was 80.3 ± 30.6. Voiding IPSS decreased 72.8% at 1 month, whereas the reduction of storage IPSS was 38.0%. ICIQ-OAB decreased 49.6% at 1 month. ICIQ-OABq showed a 30.0% reduction. One year after surgery, the reduction of voiding IPSS was 94.8%, ICIQ-OAB 85.5%, storage IPSS 76.7%, and ICIQ-OABq 60.5%. Urge incontinence was present in 26.5% of men at 1 month, 15.4% at 3 months, and 4.3% at 6 months. Four (3.4%) patients complained of urge incontinence 12 months after surgery. Conclusion: Both storage and voiding lower urinary tract symptoms significantly decreased after ThuLEP, but storage symptoms showed less reduction with a significant impact on patients' quality of life, particularly during the first 3 months. [ABSTRACT FROM AUTHOR]

Objective: The Contact Surface Area (CSA) is a predictor for peri-operative parameters and represents the contact area between the tumor and the organ. A precise method for calculating CSA is yet to be found. We tested a new CSA calculation method as a predictor of intra-operative parameters in robot assisted partial nephrectomy (RAPN)., Materials & Methods: The study population consisted of all consecutive patients treated with RAPN at a single high-volume European institution (between 2020 to 2023; 82 patients). We proposed a new method to measure the real value of CSA using an algorithm that leverages the geometry of kidneys and tumors obtained from 3D reconstruction. These reconstructions were obtained using the certified software Materialized Mimics InPrint. The peri-operative parameters of patients were recorded in an anonymous database. We explored the correlation between real CSA (RCSA), CSA of Hsieh (HCSA), PADUA and R.E.N.A.L. scores with peri-operative parameters using Spearman's correlation. Furthermore, we examined which of RCSA, PADUA and R.E.N.A.L. score better describes the intra-operative parameters, Warm Ischemia Time (WIT), Operating Time (OT), and Estimated Blood Loss (EBL) using Receiver Operating Characteristic (ROC) curve analysis. Multivariable linear regression analyses were performed., Results: Seventy-eight patients were prospectively enrolled. We observed a significant correlation between RCSA and WIT (P < 0.001), OT (P < 0.001) and EBL (P < 0.001). Moreover, RCSA outperformed both the PADUA and R.E.N.A.L. score as demonstrated in the ROC curve analysis. In ROC analysis was chosen a threshold for each of the parameters: for WIT 20 minutes, for OT 180 minutes and for EBL 200 mL. At multivariable regression analysis, RCSA emerged as the only independent predictor for WIT (P = 0.002), OT (P = 0.01) and EBL (P < 0.001)., Conclusions: Our original 3D RCSA calculation method was associated to intra-operative surgical outcomes. As compared to PADUA and RENAL score, our calculated RCSA represented a more reliable predictor of intra-operative parameters., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier Inc.)

Introduction: In recent years numerous applications have been developed with different purposes, aimed both at simplifying the lives of doctors and patients also within the urological field., Material and Methods: In January 2020 we conducted a search in the Apple App Store and Google Play Store., Results: A total of 521 apps were reviewed, an increase of 8 times as compared to the last complete available review of eight years ago. Most of the urological apps are geared towards the patient and provide information and services to improve the understanding and treatment of different diseases. Some of these apps also get the patient directly in touch with healthcare staff allowing for an improvement in doctor-patient communication., Conclusions: Although the usefulness of many of these tools is undoubted, the problem of scientific validation, content control and privacy are not yet solved., Competing Interests: The authors declare no conflicts of interest., (Copyright by Polish Urological Association.)