Search Results (45)

Background: Pelvic floor dysfunction, more prevalent in women but affecting both genders, impairs sphincter control and sexual health, and causes pelvic pain. Pelvic floor muscle (PFM) training is the first-line treatment for urinary incontinence, supported by robust evidence. Rehabilitative ultrasound imaging (RUSI) serves as a visual biofeedback tool, providing real-time imaging to enhance PFM training, motor learning, and treatment adherence. Aim: This narrative review evaluates the role and efficacy of RUSI in pelvic floor rehabilitation. Method: A comprehensive search of PubMed, Cochrane, and MEDLINE was conducted using keywords related to pelvic floor rehabilitation, ultrasound, and biofeedback, limited to English-language publications up to July 2025. Systematic reviews, meta-analyses, and clinical trials were prioritized. Results: Transperineal and transabdominal ultrasound improve PFM function across diverse populations. In post-prostatectomy men, transperineal ultrasound-guided training enhanced PFM contraction and reduced urinary leakage. In postpartum women with pelvic girdle pain, transabdominal ultrasound-guided biofeedback combined with exercises decreased pain and improved function. Ultrasound-guided pelvic floor muscle contraction demonstrated superior performance compared to verbal instruction. Notably, 57% of participants who were unable to contract the pelvic floor muscles with verbal cues achieved a correct contraction with ultrasound biofeedback, and this approach also resulted in more sustained improvements in PFM strength. Compared to other biofeedback modalities, RUSI demonstrated outcomes that are comparable to or superior to those of alternative methods. However, evidence is limited by a lack of standardized protocols and randomized controlled trials comparing RUSI with other modalities. Conclusions: RUSI is an effective visual biofeedback tool that enhances outcomes of PFM training in pelvic floor rehabilitation. It supports clinical decision-making and patient engagement, particularly in cases where traditional assessments are challenging. Further research, including the development of standardized protocols and comparative trials, is necessary to optimize the clinical integration of this method and confirm its superiority over other biofeedback methods. Full article

Background/Objectives: Robotic-assisted simple prostatectomy (RASP) is an increasingly popular surgical approach for prostate enucleation. The aim of this study is to evaluate the incidence of perioperative and delayed complications following RASP and the medium- to long-term urinary function outcomes. Methods: This is a multi-centre retrospective chart analysis of patients who underwent RASP between October 2016 and October 2022. Surgery was performed using a transvesical approach with a DaVinci Xi system. Patients were reviewed pre- and postoperatively at six weeks and annually thereafter. Patient characteristics, perioperative outcomes, pre- and postoperative uroflowmetry and post-void residual (PVR) measurement were assessed. Results: A total of 50 patients with mean preoperative prostate volume of 180.3 ± 48.1 underwent RASP. The mean operative time was 140.7 ± 28.7 min and hospital length of stay was 5.2 ± 2.9 days. The mean intraoperative blood loss was 247.4 ± 153.7 mL and no patients required transfusion. The mean follow-up period was 37.2 ± 18.3 months. No patients developed stress urinary incontinence. Two patients developed delayed bladder neck contracture at 44 and 63 months. There was a significant improvement in peak urinary flow rate (Qmax) (preop Qmax 10.7 mL/s vs. postop Qmax 24.2 mL/s, p < 0.05) and PVR (preop PVR 366.5 mL vs. postop PVR 42.2 mL, p < 0.05). All patients were weaned off medical therapy for benign prostatic enlargement (BPE) and no patients had recurrent lower urinary tract symptoms requiring re-operation. Conclusions: RASP is a safe and effective enucleation technique for large prostates >100 mL with excellent long-term durability of urinary function outcomes beyond 36 months. Full article

Background/Objectives: Reconstruction of membranous urethral strictures poses significant surgical challenges, including risks of urinary incontinence and erectile dysfunction. Optilume drug-coated balloon dilation (DCBD) is a minimally invasive treatment for short, recurrent bulbar urethral strictures, but its application in strictures involving the sphincteric urethra remains controversial. This study aims to evaluate the safety, efficacy, and impact on continence of DCBD in membranous urethral strictures involving the male sphincter. Methods: A retrospective analysis was conducted on 53 consecutive patients with urethral strictures involving the sphincteric urethra, treated with Optilume DCBD between June 2021 and June 2025 at a tertiary center. After preoperative imaging, dilation to 20 Fr, then DCBD (30 Fr, 10 bar, 10 min) were performed. We assessed anatomical success (≥18 Fr as per cystoscopy/calibration), freedom from re-intervention, and continence status. Patients with neurological conditions or urinary infections were excluded. Results: The cohort included 35 membranous urethral strictures and 18 vesicourethral anastomosis stenoses that extended into the sphincter. The median follow-up was 13.3 months. At last follow-up, 66.6% and 65.6% of patients in both groups were free from recurrence and re-intervention with satisfactory voiding. No de novo incontinence was observed; two patients with prior post-prostatectomy incontinence remained incontinent. The median age was 68 years; median prior interventions were 2.5, and median stricture length was 3 cm. Conclusions: Optilume DCBD appears to be a safe and effective option for membranous urethral strictures involving the sphincter, without inducing de novo incontinence. Although not a replacement for reconstruction, it offers a minimally invasive alternative for selected patients. Full article

Background/Objectives: Urinary incontinence (UI) remains a common and distressing complication following radical prostatectomy (RP). This prospective observational study aimed to assess the effectiveness of structured pelvic floor rehabilitation and to identify clinical and surgical predictors of continence recovery. Methods: A total of 182 patients undergoing RP received standardized physiotherapist-guided pelvic floor muscle training (PFMT), including supervised sessions before and after surgery, as well as individualized home exercise programs. UI severity was evaluated using a 1 h pad test and a four-level UI stage classification at three time points. The primary outcomes were changes in UI stage and the achievement of full continence, defined as a pad test result ≤2 g. Results: Following three rehabilitation sessions, 80.2% of patients regained full continence. Preoperative PFMT (β = −1.27, p = 0.0061) and shorter time to rehabilitation (β = −0.04, p = 0.0026) were associated with greater improvement in continence outcomes. Patients treated with robot-assisted RP showed a higher probability of continence recovery compared to those undergoing laparoscopic RP, particularly in the presence of moderate to severe baseline incontinence. Higher baseline urinary leakage significantly decreased the odds of treatment success (β = −0.01, p = 0.0001). ISUP grade and extraprostatic extension were not independently associated with outcomes. Conclusions: Despite the absence of a control group, this study demonstrates the effectiveness of structured and personalized pelvic floor rehabilitation in improving post-RP continence. Early initiation and preoperative training should be prioritized to optimize recovery in routine clinical practice. Full article

Background/Objectives: Bulkamid^® (Axonics, Irvine, CA, USA) is a non-particulate polyacrylamide hydrogel used in the treatment of urinary incontinence. While its effectiveness is well-documented in female stress urinary incontinence (SUI), there is limited data on its role in male stress urinary incontinence, particularly post-prostatectomy incontinence (PPI). This study evaluates the efficacy of Bulkamid as a primary or adjunctive treatment for male PPI. Methods: A retrospective chart review was conducted on male patients who developed PPI and underwent Bulkamid injections between 2016 and 2021. Data collected included pre- and post-procedure pad usage, the volume of Bulkamid injected, prior and subsequent incontinence treatments, and patient-reported satisfaction. Bulkamid was injected transurethrally in four quadrants near the vesicourethral anastomosis using a rigid cystoscope. Results: Twenty-one men with a history of radical prostatectomy (six open and fifteen robotic), including four who received adjuvant radiotherapy, were included. Fifteen underwent Bulkamid injection as a primary treatment, with five (33%) requiring repeat injections due to initial improvement. Eight (54%) subsequently underwent an AdVance XP^® sling placement, while two (13%) required no further treatment. Six patients received Bulkamid as an adjunct to prior incontinence surgery, with 80% of post-sling patients reporting improved continence. Bulkamid was less effective in men with detrusor overactivity or prior radiation. Conclusions: Bulkamid demonstrated a higher success rate as an adjunct to the AdVance XP sling, with 80% of men experiencing improved continence. As a primary treatment for PPI, success was modest, with only 33% achieving improvement, often requiring repeat injections or conversion to a sling. Bulkamid presents a low-risk option for select male PPI patients, particularly those with prior sling placement, but durability and long-term effectiveness remain concerns. Full article

Cognitive decline can result from various factors, including direct neurotoxic injury, brain tissue damage, inflammation, and disruptions in coagulation and fibrinolysis. This study aimed to examine the relationship between biochemical markers associated with cognitive function and cognitive performance in men with prostate cancer (PC) following radical prostatectomy. Participants underwent a comprehensive evaluation, including clinical assessments (demographic information, medical history, PC progression, and complications such as erectile dysfunction [IIEF-5] and urinary incontinence [ICIQ-UI]), biochemical testing (testosterone, prostate-specific antigen, phosphorylated neurofilament heavy chain [pNF-H], brain-derived neurotrophic factor [BDNF], neuroserpin [NSP], and interleukin-6 [IL-6]), and neuropsychological assessment of cognitive functions. Statistical analysis revealed significant positive correlations between BDNF and NSP levels and performance on delayed memory tasks, specifically the number of correct responses. No other significant associations were found between protein biomarkers and cognitive test outcomes. These findings suggest that the relationship between biochemical markers and cognitive function is complex. However, BDNF and NSP may serve as potential biomarkers for delayed memory impairment in men post-prostatectomy. Full article

Background: We investigated the predictive role of prostatic morphology on preoperative multiparametric magnetic resonance imaging for post-prostatectomy urinary incontinence. Methods: Patients who underwent robot-assisted radical prostatectomy between February 2018 and October 2021 and who were not previously incontinent, did not undergo radiotherapy, hormone therapy, or transurethral resection of the prostate, and who had a follow-up longer than 12 months were selected. For each patient, a radiology physician evaluated the preoperative magnetic resonance imaging, measuring prostatic and membranous urethral length, classifying prostatic apex according to the Lee Type, and estimating the presence of the median lobe and its intravesical protrusion. Multivariate logistic regression models evaluated the influence of anatomic features measured in magnetic resonance imaging on urinary continence recovery, defined as daily pad usage less than or equal to one, considering age, body mass index, prostate volume, International Prostatic Symptoms Score, the usage of a nerve sparing technique, and the International Society of Urological Pathology classification. Results: A total of 95 patients who underwent robot-assisted radical prostatectomy were enrolled. Median age, median body mass index, and median PSA density were respectively 66 years (62, 70), 26.12 kg/m² (23.88, 28.09), and 0.16 ng/mL/cc (0.10, 0.26). Patients with urinary continence ranged from 32 (33.7%) at baseline to 93 (97.8%) after one year from surgery. At preoperative magnetic resonance, Lee Type was almost equally distributed, but Type C was less represented (18 patients, 18.9%) and Type D was more frequent (31 patients, 32.2%). Median prostatic urethral length, median membranous urethral length, and median intravesical prostatic protrusion were respectively 36 mm (31, 42), 15 mm (13, 16), and 0 mm (0, 0). Multivariate logistic regression models showed no statistical significance, except for Lee Type C and A comparison at vesical catheter removal after surgery (OR 0.17; 95% CI 0.04–0.71; p-value 0.01). Conclusions: The results of this study showed that patients who had Lee Type C might have higher probability of early urinary continence recovery, but no further statistically significant correlations were found. 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

Prostate cancer presents a substantial challenge, necessitating a delicate balance between effective treatment and preserving the overall quality of life for men, while robot-assisted radical prostatectomy (RARP) stands as the premier surgical approach, with a negligible rate of patients who remained incontinent. This review explores various technical modifications employed in RARP to improve early continence recovery, offering a summary of their implementation and potential benefits. Techniques like bladder neck preservation, subapical urethral dissection, and nerve-sparing approaches are critically discussed, highlighting their role in minimizing continence issues and ensuring a better post-operative experience for patients with prostate cancer. Full article

Background/Objectives: Robot-assisted radical prostatectomy (RARP) for the treatment of prostate cancer (PCa) has been standardized over the last 20 years. At our institution, only n = 3 rob arms are used for RARP. In addition, n = 2, 12 mm lap trocars are placed for the bedside assistant symmetrically at the midclavicular lines, which allows for direct pelvic triangulation and greater involvement of the assisting surgeon. The aim of our study was to compare surgical and perioperative outcomes of RARP performed using our alternative trocar placement with no fourth robotic arm in the subgroups of experienced attending surgeons and post-graduate residents as bedside assistants. Residents’ satisfaction was also explored. Methods: RARPs performed within the urology residency program between 2019 and 2024 were retrospectively analyzed. Only rob procedures performed using our 3+2 trocars configuration were included. Intra- and postoperative outcomes, as well as long-term functional outcomes including continence recovery and potency, were assessed, stratified by the level of expertise of the bedside assistant, i.e., an experienced attending or post-graduate Year I–III resident. Satisfaction of residents assigned to the two groups during their robotic rotation was evaluated considering three domains with a score from 1 to 10: insight into surgical procedure, confidence level, and gratification level. Results: Out of n = 281 RARP procedures, the bedside assistant was an attending in 104 cases and a resident in 177. Operative time was found to be slightly longer in cases where the second operator was a resident (attendings vs. residents: 134 ± 40 vs. 152 ± 24; p < 0.001). Postoperative hospitalization time was longer in patients in the resident group (attendings vs. residents: 3.9 ± 1.6 vs. 4.3 ± 1 days; p = 0.025). However, cases where the second operator was a resident had a lower rate of positive surgical margins, with rates of 19.7% in the resident and 43.3% in the attending surgeon cohorts (OR = 0.32; 95% CI 0.18–0.55). This difference remained significant in multivariate analysis. There was no significant difference in postoperative blood transfusion rates (attendings vs. residents: 1.9% vs. 1.2%; p = 0.6). Similarly, long-term functional outcomes in terms of erectile dysfunction and urinary incontinence rates mostly overlapped between groups. The mean score in all three domains evaluating residents’ satisfaction was significantly higher when residents actively participated in the surgical procedure as bedside assistants (p = 0.02, p = 0.004, and p < 0.001, respectively, for insights into surgical procedure, confidence level, and gratification level). Conclusions: These findings provide insight into how an alternative port positioning during RARP could improve the involvement of the bedside assistant, particularly residents, without compromising perioperative outcomes or surgical safety. Full article

Background and Objectives: To prove the feasibility of continuous spinal extraperitoneal robot-assisted laparoscopic radical prostatectomy (cseRALP) in order to expand the pool of eligible patients. Materials and Methods: According to IDEAL guidelines, a consecutive cohort of patients who underwent cseRALP was enrolled. Pre-, intra-, and post-operative data were collected, with particular focus on safety and oncological outcomes. Results: A total of three patients underwent this technique, with no intra- or post-operative medical complications. Only a grade 1 Clavien–Dindo complication was reported, small urinary leakage treated with an indwelling catheter. Oncological and functional results at month 3 were satisfactory, with no recurrence and no stress incontinence. Conclusions: cseRALP seems to be feasible and safe; further trials are mandatory. Full article

Stress urinary incontinence (SUI) is a common condition in patients following radical prostatectomy (RP), which has a significant impact on all aspects of quality of life and is associated with significant social stigma. The factors that improve urinary incontinence in patients following surgery remain controversial. The aim of our narrative review was to identify and synthesise the latest evidence on pre-, intra- and post-operative factors and predictors that contribute to early continence recovery after RP. In this narrative review, primary resources were identified by searching PubMed, EMBASE and Medline, and secondary resources were collected by cross-referencing citations in the relevant articles. We started our review by searching for systematic reviews of factors and predictors that contribute to early recovery of urinary continence after RP. We then reviewed societal guidelines such as the American Urological Association and European Urological Association guidelines on male urinary incontinence. This review focuses on the pre-, intra and postoperative factors that influence postoperative SUI after RP, as well as highlighting modifications in surgical techniques that lead to early continence recovery. Increasing age, higher BMI, shorter membranous urethral length (MUL), and larger PV are independent prognostic factors for SUI within 3 months after RP. Factors such as modified surgical technique preservation of anatomical structure lead to influence postoperative early continence recovery. SUI after RP is influenced by various factors. These factors include not only anatomical landmarks and patient-related factors such as age, BMI, length of MUL and prostate volume, but also prior transurethral resection or laser enucleation of the prostate, the surgeon’s expertise, the surgical approach and NS technique. Full article

Background/Objectives: Bladder outlet obstruction (BOO) resulting from benign prostate enlargement (BPE) is a common cause of lower urinary tract symptoms (LUTS) in men. Patients with central nervous system (CNS) diseases, such as spinal cord injury (SCI), Parkinson’s disease (PD), cerebrovascular accident (CVA) and multiple systemic atrophy (MSA), commonly experience lower urinary tract dysfunction. Men who suffer from CNS diseases may also experience symptoms related to BPE and BOO, which pose an additional burden to their overall clinical status and result in the need for catheter use and a deterioration in quality of life. The aim of this study was to identify if prostate surgery will benefit men with CNS diseases who have been diagnosed with BPE-related BOO. Methods: The systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. EMBASE, MEDLINE, Cochrane systematic reviews, Cochrane Central Register of Controlled Trials, Google Scholar, and ClinicalTrials.gov were searched from 1946 up to July 2023 for peer-reviewed publications addressing the primary outcome (success rate) and the secondary outcomes (postoperative changes in incontinence episodes, urodynamic parameters, questionnaire scores, and quality of life). In addition, the perioperative outcomes (adverse events and the need for further medical or surgical therapy) were reported. Results: A total of 1572 abstracts were screened, and 13 studies involving 1144 patients were eligible for inclusion. Six studies assessed the effect of prostate surgery for BPE-related BOO in SCI, four studies in CVA, two studies in PD, and one study in the MSA population. All studies were considered to have a high risk of bias. Transurethral resection of the prostate (TURP) was the most common de-obstruction procedure, followed by prostatic artery embolism and open prostatectomy. The overall pooled success rate was calculated as 81.4% (65–100%) in SCI, 27.1% (9–70%) in PD, and 66.7% (50–79%) in CVA populations. The risk of de novo incontinence was 24.7–50% in SCI, 20% in PD, 21–50% in CVA, and 60% in MSA population. In patients with SCI with BPE-related BOO, prostate surgery improved mean bladder compliance and detrusor filling pressure and resolved detrusor overactivity in up to 50% of patients. Improvement of free flow rate, voided volume, and post-void residual was observed in all patients. Patients with CVA had an increased risk of perioperative mortality compared to non-CVA patients, and the risk of postoperative complications was inversely proportional to the timing of the CVA insult since surgery. Conclusions: This systematic review provides an overview of the available evidence on the outcome of prostate surgery in patients with neurologic diseases and BPE-related BOO. Identifying the optimal practice was challenging due to the limited availability of high-quality studies and the high variability of the reported outcomes. Properly selected patients with neurological diseases may benefit from prostate surgery, provided that preoperative investigations indicate BPE-related BOO. Full article

Urinary incontinence after robotic-assisted radical prostatectomy (RARP) has been associated with older age, a longer operative time, a higher BMI, a short membranous urethral length and preoperative erectile function. The authors sought to assess the association between the neuromuscular characteristics and postoperative urinary incontinence. Methods: RARP specimens from 29 men who underwent bilateral nerve sparing were reanalyzed. Urinary incontinence was evaluated using the International Consultation on Incontinence Questionnaire—Short Form (ICIQ-SF) at 6 weeks post surgery and last follow-up. Linear and logistic regression analyses were performed to assess neuromuscular characteristics and incontinence. Results: At the 1-year follow-up, 11 patients (38%) reported severe incontinence (>12 ICIQ-SF score). The median number of peripheral nerves observed at the base and apex in the specimens was 52 (IQR 13–139) and 59 (IQR: 28–129), respectively. Ganglia were present in 19 patients (65%) at the base and 12 patients (41%) at the apex. Additionally, the median proportional area of detrusor smooth muscle fibers at the base was 0.54 (IQR 0.31–1), while the median proportional area of striated muscle fibers at the apex was 0.13 (IQR 0.08–0.24). No statistically significant associations were found. Conclusions: Histologic neuromuscular characteristics were not associated with postoperative urinary incontinence. Enhanced intraoperative evaluation and larger-scale studies may prove useful for the prediction of postprostatectomy incontinence. Full article

Background & Objectives: Patients with bladder outlet obstruction (BOO) due to massive prostate enlargement have several surgical treatment options, such as robot-assisted simple prostatectomy (RASP) and holmium laser enucleation of the prostate (HoLEP). Postoperative outcomes may differ between those undergoing RASP and HoLEP. RASP has been associated with a lower incidence of transient stress urinary incontinence (SUI), while HoLEP allows for shorter catheterization times. Here, we report on our experience with both surgical modalities. Methods: Data were collected from prospectively maintained databases for 37 RASP patients and 181 HoLEP patients treated from July 2021 to November 2023. To control for selection bias, propensity score matching (PSM) was utilized based on age and prostate size. We compared patients’ preoperative, perioperative, and postoperative outcomes both before and after applying PSM. Results: Before the PSM, the median prostate size was significantly lower in the HoLEP group (p < 0.001). The HoLEP group also had significantly shorter operative times (p ≤ 0.001) and lower weights of resected adenoma (p ≤ 0.001). After the PSM of 31 RASP and 31 HoLEP patients, all baseline patient characteristics were comparable. No significant differences were observed in operation time (p = 0.140) or in the weight of resected adenoma (p = 0.394) between the modalities. The median (IQR) length of catheterization was significantly shorter in the HoLEP group (1 [1–4] days) compared to the RASP group (7 [7–8] days), in both pre- and post-matching analyses (p ≤ 0.001 for both), reflecting the standard of practice. In contrast, in both pre- and post-PSM analyses, the average hospital stay was significantly shorter in the RASP cohort, as same-day discharge is standard in our center, whereas the HoLEP cohort required overnight stays due to routine continuous bladder irrigation before discharge (p < 0.001 for all). Notably, the SUI rates and American Urological Association (AUA) symptom scores were comparable at 3 months within both matched and unmatched cohorts (pre-PSM: p = 0.668, p = 0.083; post-PSM: p = 1, p = 0.152, respectively). Conclusions: Our comparative analysis indicates that both RASP and HoLEP yield similar outcomes, including SUI rates, at 3 months. While HoLEP provided shorter durations of postoperative catheterization, RASP offered shorter hospital stays. Full article