Prostate Surgery Research Articles

Urinary Retention After GreenLight Laser Photoselective Vaporization of the Prostate (GLL.PVP) Surgery for Benign Prostatic Hyperplasia (BPH): A 3-6 Month Retrospective Follow-Up Study.

Objective Our study was designed to evaluate the postoperative urinary retention (UR) and success rate of the GreenLight Laser (Boston Scientific, Marlborough, MA, USA) photoselective vaporization of the prostate (GLL.PVP) procedure for Benign Prostatic Hyperplasia (BPH) patients, both with and without high-risk factors. Methodology We conducted a retrospective follow-up study of postoperative patients who underwent GLL.PVP for BPH. We collected data from clinical health records, including notes from the lower urinary tract symptoms (LUTS) clinic, trial without catheter (TWOC) clinic, and emergency department presentations with UR. The analysis examined several parameters, including the patient's age, high-risk factors, prostate volume, and both preoperative and postoperative objective voiding parameters. These voiding parameters included post-void residual (PVR) and maximum flow rate (Qmax). Additionally, the analysis looked into whether the patient had a catheter or experienced urinary retention prior to the surgery. Results A total of 50 GreenLight Laser PVP surgeries were performed over a 14-month period from May 2023 to July 2024 at West Middlesex University Hospital in London. Most of the patients were between the ages of 60 and 80. Prior to the surgery, data indicated that 17 patients (34%) were using long-term catheters, whereas 33 patients (66%) were not. Additionally, 25 patients (50%) were identified as having high-risk factors, which included being on anticoagulation therapy, a history of urinary retention, and a prostate volume exceeding 100 cc.Notably, the patient without h/o urinary retention had an average preoperative PVR of 150 mL and an averageQmaxof 7 mL/second In our 3-6 month retrospective postoperative follow-up study, we found that eight cases (16%) developed urinary retention, while 42 cases (84%) did not, with an average PVR volume of 105 mL and an average Qmax of 13.5 mL/second. In patients with preoperative urinary retention, 13 cases (76%) did not develop UR postoperatively whereas four cases (24%) developed. Conclusion Our study conclusively found that 42 cases (84%) of patients did not experience urinary retention (UR) in the follow-up after undergoing the GLL PVP operation, irrespective of any history of urinary retention or other high-risk factors. This unequivocally demonstrates the operation's efficacy. Furthermore, our findings revealed that three-quarters of patients with a preoperative history of urinary retention also did not develop UR post-surgery. The GLL.PVP procedure is safe and effective, leading to rapid improvements in voiding parameters.

Quality of Chatbot Information Related to Benign Prostatic Hyperplasia.

Large language model (LLM) chatbots, a form of artificial intelligence (AI) that excels at prompt-based interactions and mimics human conversation, have emerged as a tool for providing patients with information about urologic conditions. We aimed to examine the quality of information related to benign prostatic hyperplasia surgery from four chatbots and how they would respond to sample patient messages. We identified the top three queries in Google Trends related to "treatment for enlarged prostate." These were entered into ChatGPT (OpenAI), Bard (Google), Bing AI (Microsoft), and Doximity GPT (Doximity), both unprompted and prompted for specific criteria (optimized). The chatbot-provided answers to each query were evaluated for overall quality by three urologists using the DISCERN instrument. Readability was measured with the built-in Flesch-Kincaid reading level tool in Microsoft Word. To assess the ability of chatbots to answer patient questions, we prompted the chatbots with a clinical scenario related to holmium laser enucleation of the prostate, followed by 10 questions that the National Institutes of Health recommends patients ask before surgery. Accuracy and completeness of responses were graded with Likert scales. Without prompting, the quality of information was moderate across all chatbots but improved significantly with prompting (mean [SD], 3.3 [1.2] vs. 4.4 [0.7] out of 5; p < 0.001). When answering simulated patient messages, the chatbots were accurate (mean [SD], 5.6 [0.4] out of 6) and complete (mean [SD], 2.8 [0.3] out of 3). Additionally, 98% (39/40) had a median score of 5 or higher for accuracy, which corresponds to "nearly all correct." The readability was poor, with a mean (SD) Flesch-Kincaid reading level grade of 12.1 (1.3) (unprompted). LLM chatbots hold promise for patient education, but their effectiveness is limited by the need for careful prompting from the user and by responding at a reading level higher than that of most Americans (grade 8). Educating patients and physicians on optimal LLM interaction is crucial to unlock the full potential of chatbots.

First-Time Successful Trial Without Catheter (TWOC) After GreenLight Laser Photoselective Vaporization of the Prostate (GLL PVP) Surgery for an Enlarged Prostate.

Objective We aimed to assess the success rate of the GreenLight laser photoselective vaporization of the prostate (GLL PVP) procedure for enlarged prostates in patients with and without preoperative long-term catheters. Methodology A retrospective data analysis was conducted on 46 patients. Data were collected from clinical health records and radiology images. The parameters studied in this analysis included the patient's age, prostate volume, medical management before surgery, and whether the patient had a catheter or not prior to the surgery. Results A total of 46 GLL PVP surgeries were performed over a 12-month period from May 2023 to May 2024 at West Middlesex University Hospital in London. Patients had a mean age of 73.2 ± 8.12 years, and their prostate volume was 57.7 ± 25.96 cc. Before the surgery, 14 cases (30%) were using long-term catheters, and 32 cases (70%) were not. Additionally, 40 cases (87%) were receiving medical management for lower urinary tract symptoms (LUTS). After the surgery, 39 cases (85%) passed their first trial without catheter (TWOC), and seven cases (15%) failed it, regardless of whether they had used catheters before the surgery. Patients using long-term catheters before the operation had a 71% success rate in passing their first TWOC and a 29% failure rate. Conclusion Our study found that GLL PVP has a significant positive impact on elderly individuals with a large prostate volume, regardless of whether they had long-term catheters or not prior to the operation. Additionally, our findings indicate that patients without preoperative long-term catheters experience significantly better outcomes.

Pathologic prostate cancer grade concordance among high-resolution micro-ultrasound, systematic transrectal ultrasound and MRI fusion biopsy

Background and ObjectiveComparative studies among biopsy strategies have not been conducted evaluating pathologic concordance at radical prostatectomy(RP), especially with novel micro-ultrasound (micro-US) image-guided biopsy. MethodsA retrospective study among patients with PCa who underwent RP following TRUS, MRI-TRUS fusion, microUS, or MRI-microUS fusion biopsy in a multi-site single institution. We compared GG-upgrade from biopsy to RP based on highest GG in any biopsy core and examined clinical/pathologic factors associated with pathologic upgrading using descriptive statistics, and multivariable logistic-regression analysis. Results429 patients between 1/2021 and 6/2023 including 10 (25.6%) who underwent systematic TRUS, 237 (55.2%) MRI-TRUS, 67 (15.6%) MRI-microUS and 15 (3.5%) micoUS-alone biopsy prior to RP. 78 (18.2%) were upgraded on final pathology (TRUS 31 (28.2%), MRI-TRUS 31 (13.1%), MRI-microUS 10 (14.9%), microUS: 6 (40%)) and 99 downgraded. 14 (3.5%) experienced a major upgrade (≥2 GG increase). On multivariable-analysis both MRI-TRUS (odds ratio, OR: 0.31,95% CI:0.17–0.56, P < 0.001) and MRI-microUS (OR: 0.43,95%CI: 0.19–0.98, P = 0.044) were associated with lower odds pathological-upgrade compared with TRUS biopsy alone. No significant differences in the odds of upgrade between TRUS and microUS alone (P > 0.05), or between MRI-microUS and MRI-TRUS(P = 0.696) on pairwise comparisons. MRI-microUS was associated with lower upgrade compared with microUS (OR: 0.26,95% CI:0.08–0.90, P = 0.034). No difference among the biopsy strategies in pathologic downgrading or overall GG concordance. Limitations include retrospective analysis, inter-clinician experience and lesion selection in varying biopsy techniques. ConclusionBoth MRI-microUS and MRI-TRUS fusion were associated with similarly improved GG concordance compared with TRUS biopsy. No significant differences between microUS-alone and TRUS or between MRI-microUS and MRI-TRUS fusion approaches, may suggest similar accuracy performance for disease sampling. What does the study addTo our knowledge, this is the first study to investigate GG concordance based on type of biopsy, especially microUS related GG upgrading after RP. In a moderately sized cohort this is the first to investigate pathologic concordance in MRI-microUS fusion compared to MRI-TRUS fusion biopsy. Our study may help urologists in counseling patients after biopsy and choosing the ideal image guided biopsy technique, however randomized controlled trials are needed to validate our results. Patient SummaryWe performed a study to see if the type of prostate biopsy, including use of MRI assistance as well as a new image-guided biopsy using a more advanced ultrasound, was better able to identify the aggressiveness of prostate cancer patients had. We found that the new biopsy type when fused with MRI and the existing MRI-guided biopsy type were similar in predicting the type of prostate cancer found at prostate surgery. These were both more accurate than the conventional ultrasound only biopsy.

Does the hemodialysis program affect the testosterone serum level in patients with end-stage renal disease?

This study aimed to evaluate the effect of high flux membrane hemodialysis on total serum testosterone (TST) levels in male patients with end-stage renal disease (ESRD). The study included 60 male ESRD patients with a mean age of 54.02 ± 13.40years, undergoing a standard hemodialysis program et al. Najah National University Hospital. All patients underwent three weekly sessions of four hours each using high flux membrane hemodialysis. TST and hematocrit (Hct) levels were measured before and after hemodialysis. Patients with prostate cancer, liver insufficiency, prior prostate surgery, or those on androgen therapy were excluded. The study assessed changes in TST and Hct levels and their correlation. Post-dialysis, there was a significant increase in serum testosterone levels from 3.13 ± 1.44ng/ml to 4.17 ± 2.04ng/ml (r = 0.78, p = 0.001). Hematocrit levels also rose significantly from 32.31% ± 3.90% to 35.27% ± 4.89% (r = 0.754, p = 0.001). The percentage change in TST and Hct levels was 35 ± 0.33% and 9 ± 0.1%, respectively, with a correlation between these changes (r = 0.277, p = 0.032). High flux membrane dialysis did not filter testosterone molecules, and the significant increase in TST levels post-dialysis is likely due to hemoconcentration. Since many patients had low or borderline TST levels before dialysis, androgen supplementation may offer clinical benefits.

A case of rapidly progressive prostate cancer with bone and lymph node metastasis after contact laser vaporization for benign prostatic hyperplasia

IntroductionProstate cancer is incidentally diagnosed in 6%–11% of benign prostatic hyperplasia surgeries.Case presentationA 79‐year‐old man was diagnosed with benign prostatic hyperplasia. The prostate volume was 54.5 mL, and the prostate‐specific antigen level was 7.121 ng/mL. Magnetic resonance imaging and prostate biopsy were not performed. He then underwent contact laser vaporization of the prostate. After 3 months, gross hematuria occurred, and the prostate‐specific antigen level was 62.495 ng/mL. Cystoscopy and magnetic resonance imaging revealed prostate cancer with bladder invasion. Prostate biopsy and transurethral resection were performed, revealing adenocarcinoma with a Gleason score of 5 + 5. The patient was diagnosed with prostate cancer T4N1M1b, and triplet therapy was initiated. After 6 months, the prostate‐specific antigen level was 0.037 ng/mL, and the metastases had shrunk.ConclusionVaporization for high‐grade prostate cancer can lead to rapid progression. Therefore, screening for prostate cancer before benign prostatic hyperplasia surgery is important.

Streamlined surgical approach for coexistent urethral stricture and benign prostatic enlargement: feasibility, safety and patency results.

To evaluate the technical feasibility, safety, and patency results of a simultaneous surgical approach to repair urethral stricture and treat benign prostatic enlargement endoscopically in a highly selected group of patients at a tertiary referral center. We hypothesize that this is technically feasible, safe, and does not affect urethroplasty outcomes. A retrospective review of adult men who underwent simultaneous urethroplasty and endoscopic prostatic surgery between May 2017 and May 2024 at our institution was conducted. Patients with strictures < 15 French and prostates with adverse prognostic features of response to medical treatment were included. The primary outcome was technical feasibility and safety. The secondary outcome was stricture-free survival. Twenty men were treated during the study period. The median length of the urethral stricture was 3.0cm (IQR 2.0-5.0), and the median size of the prostate was 95.0cc (IQR 63.3-128.3). All patients were treated successfully with a median operative time of 194.5min (IQR 180.0-246.8), and no procedures required conversion to a staged procedure or open prostatectomy. There were seven Clavien-Dindo I-II complications and one Clavien-Dindo IIIb complication (hematuria requiring endoscopic clot evacuation). At 22months follow-up, two cases of urethral re-stricture were diagnosed, with one case requiring redo urethroplasty, though none had previous major complications. The combination of urethroplasty and endoscopic surgery for benign prostatic enlargement at the same stage appears to be technically viable and safe, and it does not compromise medium-term urethral patency results in a carefully selected group of patients.

Review of simultaneous treatment with intradetrusor onabotulinumtoxinA injections during transurethral prostate surgery for men with bladder outlet obstruction and overactive bladder

ABSTRACT Bladder outlet obstruction (BOO) is common in males with benign prostate enlargement (BPE) and often presents with different lower urinary tract symptoms. Overactive bladder (OAB) has been reported to be related to BOO, although it can also be idiopathic. The storage symptoms of BOO are often similar to those of OAB. The etiology and pathophysiology of both BPE and OAB are multifactorial with metabolic syndrome known as one of the factors. As of today, transurethral prostate surgery remains the gold standard for treating BOO associated with BPE. Intradetrusor onabotulinumtoxinA (BoNT-A) injections have been shown to be effective in treating OAB. However, they are usually administered after transurethral prostate surgery. In view of the strong therapeutic effects of both surgery and injections, the feasibility of combining them in one setting to increase patient comfort, convenience, and possibly results while decreasing costs is appealing to physicians. However, patient safety and possible complications have to be considered. In this article, we review available studies of concurrent intradetrusor BoNT-A injections during transurethral prostate surgery. Although there is no definitive evidence supporting the concurrent use of intradetrusor BoNT-A during transurethral prostate surgery, there are no reports of increased complications too. Further large-scale randomized controlled trials would be necessary to validate the feasibility of combining the treatments in one setting and observe for possible complications.

Menopause and Sexual Life Amongst Older Men: A Review Study

Objectives: To determine factors affecting the quality of men’s sexual life during menopause and identify the existing challenges. Design: A review study. Setting(s): Older people living in public institutions and living in their own homes. Participants: Older adults over 60 years of age. Outcome measures: All factors affecting the quality of sexual life of postmenopausal men in old age have been investigated in three physical, psycho-emotional, and social domains. Results: In the physical field, factors such as age, general health, disease, exercise, impotence, erectile dysfunction, genital warts, surgery of total hip arthroplasty, surgery of prostate, cancer radiotherapy, alopecia, and disorder in ejaculation, urinary disorders, and physical rehabilitation were known factors affecting the quality of men’s sexual life. The impacts of factors such as sleep problems, stressors, self-image, depression, alcohol addiction, premature ejaculation, emotional divorce, marital satisfaction, and fear of sexual activity were confirmed in the psycho-emotional field of studies. In the social field, factors such as education, duration of the marriage, marital status, income, life partners, number of sexual relations with spouse, the presence of multiple sexual partners, body mass of spouse (female), sex education and health literacy, sexual awareness, and quality of life related to health were recognized to be effective. Conclusions: Promoting sexual awareness through educational programs, providing opportunities for frequent sexual relationships, and addressing physical, psychological, emotional, cognitive, and social factors, and andropause could contribute to a more desirable sexual life quality in men during andropause.

Reply to Editorial Comment on “Safety and Efficacy of Same-day Discharge for Men Undergoing Contemporary Robotic-assisted Aquablation Prostate Surgery in an Ambulatory Surgery Center Setting—First Global Experience”

Reply to Editorial Comment on “Safety and Efficacy of Same-day Discharge for Men Undergoing Contemporary Robotic-assisted Aquablation Prostate Surgery in an Ambulatory Surgery Center Setting—First Global Experience”

Factors influencing urinary retention following freehand transperineal prostate biopsy: Insights from a tertiary care center study

ABSTRACT Objectives: In this study, we evaluated the risk factors for urinary retention after freehand transrectal ultrasound (TRUS) guided transperineal prostate biopsy (TPB). Patients and Methods: Data from 102 cases of freehand TPB at a single institution were retrospectively collected and analyzed. All patients underwent magnetic resonance imaging (MRI)-TRUS cognitive fusion TPB using a transperineal needle guide, with systematic biopsies from 10 prostate sectors and additional MRI-guided targeted biopsies. Exclusions comprised patients with coagulation abnormalities, prior prostate surgeries including biopsy, active urinary tract infection, or a lack of pre-biopsy multiparametric MRI. Results: 14/102 (13.72%) had urinary retention and required urethral catheterization for voiding difficulty or discomfort along with a bladder volume of ≥500 ml. Patients with retention exhibited significantly larger prostate volumes (median 75 cc vs. 40 cc; P &lt; 0.05). Receiver operating curve analysis revealed a prostate volume threshold of 57.5 cc and a core number cutoff of 23 for predicting post-TPB urinary retention, with sensitivities of 78.57% and 85.71%, specificities of 75% and 82.95%, positive predictive values of 33.33% and 44.44%, and negative predictive values of 95.75% and 97.33%, respectively, whereas the number of biopsy cores correlated positively with the development of urinary retention (median 25 vs. 22; P &lt; 0.05). Urinary retention was independent of the patient’s age, comorbidities, presenting prostate-specific antigen levels, prebiopsy severity of lower urinary tract symptoms, and use of alpha-blockers. Conclusion: Patients with larger prostates and higher number of biopsy cores are at a higher risk of postfreehand TPB urinary retention and should receive appropriate counselling. Targeted biopsies alone, rather than a full template, may help mitigate urinary retention in these high-risk groups.

A randomized, active-controlled, multicenter, phase 3 clinical trial to evaluate the efficacy and safety of GV1001 in patients with benign prostatic hyperplasia

ObjectivesTo determine and compare the efficacy and safety of GV1001 and 5 mg finasteride for benign prostatic hyperplasia (BPH) patients. Patients and methodsThis randomized, active-controlled, multicenter, phase 3 clinical trial enrolled 423 patients aged ≥50 years with a prostate volume (PV) >30 mL. Patients were randomized into Group 1 (GV1001 0.56 mg + finasteride placebo), Group 2 (GV1001 1.12 mg + finasteride placebo), or Group 3 (GV1001 placebo +5 mg finasteride). The patients received the study drug during clinic visits every 2 weeks at weeks 0–22. Changes in the international prostate symptom score (IPSS), PV, maximum urinary flow rate (Qmax), prostate-specific antigen (PSA) level, residual urine volume, testosterone and dihydrotestosterone (DHT) levels, and international index of erectile function (IIEF) were assessed. ResultsWe included 408 (96.45%) patients (Group 1, n = 138; Group 2, n = 134; Group 3, n = 136) in full analysis set for primary efficacy evaluations. All groups showed significant decreases and increases in the IPSS and Qmax, respectively (Groups 1, 2, and 3, IPSS: −4.78 ± 6.50, −4.99 ± 6.66, and −5.51 ± 6.42, respectively; P < 0.0001; Qmax: P = 0.0005, P = 0.0039, and P < 0.0001, respectively). PV reductions were observed in Groups 2 and 3 (−0.75 ± 8.21 mL [P = 0.3280] and −2.47 ± 7.92 mL [P = 0.0010], respectively). The PSA and testosterone levels of Group 3 significantly decreased and changed, respectively (−0.90 ± 1.25 ng/mL, P < 0.0001 and P < 0.0001, respectively). No significant differences were observed in the residual urine volume. DHT significantly decreased in all groups (Groups 1, 2, and 3: −71.41 ± 244.06 ng/mL [P = 0.0025], −73.84 ± 249.26 ng/mL [P = 0.0019], and −106.60 ± 178.29 ng/mL [P < 0.0001], respectively). Only Group 3 exhibited a significantly decreased IIEF (−3.06 ± 15.34; P = 0.0323). Acute urinary retention occurred in one patient in Group 2. No patients underwent prostate surgery or minimally invasive procedures during the study. ConclusionsGV1001 exhibited corresponding efficacy and tolerability, providing evidence of amelioration in urinary symptoms among patients with BPH in comparison to the use of 5 mg finasteride.

Metaverse in surgery - origins and future potential.

The metaverse refers to a collective virtual space that combines physical and digital realities to create immersive, interactive environments. This space is powered by technologies such as augmented reality (AR), virtual reality (VR), artificial intelligence (AI) and blockchain. In healthcare, the metaverse can offer many applications. Specifically in surgery, potential uses of the metaverse include the possibility of conducting immersive surgical training in a VR or AR setting, and enhancing surgical planning through the adoption of three-dimensional virtual models and simulated procedures. At the intraoperative level, AR-guided surgery can assist the surgeon in real time to increase surgical precision in tumour identification and selective management of vessels. In post-operative care, potential uses of the metaverse include recovery monitoring and patient education. In urology, AR and VR have been widely explored in the past decade, mainly for surgical navigation in prostate and kidney cancer surgery, whereas only anecdotal metaverse experiences have been reported to date, specifically in partial nephrectomy. In the future, further integration of AI will improve the metaverse experience, potentially increasing the possibility of carrying out surgical navigation, data collection and virtual trials within the metaverse. However, challenges concerning data security and regulatory compliance must be addressed before the metaverse can be used to improve patient care.

Editorial Comment on "Safety and Efficacy of Same Day Discharge for Men Undergoing Contemporary Robotic-Assisted Aquablation Prostate Surgery in an Ambulatory Surgery Center Setting - First Global Experience"

Editorial Comment on "Safety and Efficacy of Same Day Discharge for Men Undergoing Contemporary Robotic-Assisted Aquablation Prostate Surgery in an Ambulatory Surgery Center Setting - First Global Experience"

PE025 Initial experience in prostate surgery with the versius robotic system in Brazil

PE025 Initial experience in prostate surgery with the versius robotic system in Brazil

PE100 Preliminary single-surgeon experience in prostate and renal surgery with Hugo RAS at a robotic referral center

PE100 Preliminary single-surgeon experience in prostate and renal surgery with Hugo RAS at a robotic referral center

VE33 RARP after benign prostate surgery with Hugo RAS system. Our experience with 3 cases combined lateral and latero anterior approach

VE33 RARP after benign prostate surgery with Hugo RAS system. Our experience with 3 cases combined lateral and latero anterior approach

Penile compression devices for the treatment of urinary incontinence: current status and future prospects.

Urinary incontinence (UI), especially stress UI, is common after prostatectomy. Penile compression devices (PCDs) may be a safe, tolerable option for conservative management in men who are not candidates for or not interested in surgical intervention for their UI. This article examines the epidemiology of post-prostatectomy urinary incontinence (PPI), and options for management. All available studies on PCDs are explored, including those on biomechanics, safety, tolerability, and user experience. History, availability of PCDs, and areas for future development are discussed. PCDs are an option for conservative management of PPI. They are recommended for those men without impairment in cognition, dexterity, or sensation. They should be worn for short periods of time and are best used during situations when incontinence might be precipitated. Overall, data suggest they are well tolerated and effective when tested, but large randomized comparative trials and studies of long-term use with relevant patient reported outcome measures are lacking. More studies are needed on commercially available PCDs. Biomechanical studies suggest that there are superior designs and materials both for efficacy and tolerability. With an aging population, and more older men going for prostate surgery, a larger market for these devices is likely.

Adjustable continence therapy (ProACT/ACTTM) with periurethral balloons for treatment of stress urinary incontinence: a narrative review.

First-line surgical management of stress urinary incontinence (SUI) currently involves implantation of an artificial urinary sphincter (AUS) in male patients and midurethral sling in female patients. Still, there is demand for a less invasive treatment option without the need to use a device during voiding. Since its first description in 2005, many clinics have implemented adjustable continence therapy balloons in male (ProACTTM) and female patients (ACTTM). Publications on the use of ProACT/ACTTM were reviewed from 2002 until September 2022, focusing on functional and safety outcomes, including predictors of treatment failure and complications. Most publications report the use of ProACTTM in patients after prostate surgery, with approximately 60% experiencing a cure rate and 82% achieving over 50% improvement. Consistent functional outcome assessment in female and neurogenic lower urinary tract dysfunction (NLUTD) patients lacks. Few predictors of treatment failure were described, resulting in an advise to not use the balloons after male pelvic radiation therapy. High revision rates were observed in all patient groups, with balloon defects as one of the most common causes for revision. Based on the current literature, ProACTTM is safe and effective in male patients after prostate surgery, but the role of ProACT/ACTTM in female and NLUTD patients is still unclear. There is need for research of higher level of evidence with uniform outcome assessments. Preferably, ProACTTM is prospectively compared with AUS in a randomized setting. In addition, development of better-quality balloons should reduce mechanical failure and revision surgeries, resulting in improved functional and patient satisfaction outcomes.

Outcomes of the Victo™ adjustable artificial urinary sphincter in the treatment of male incontinence.

To report the clinical outcomes of the Victo™ (Promedon, Cordoba, Argentina) adjustable artificial urinary sphincter (AUS) implantation in a cohort of patients with severe urinary incontinence (UI) after prostate surgery. This study enrolled patients with UI following prostate surgery who underwent a Victo implantation between May 2018 and December 2023. Patients were prospectively evaluated at baseline, and at 3 and 12 months after device activation, and thereafter annually. The 24-h pad-weight test (24hPWT) was used to assess severity of UI, while the Patient Global Impression of Improvement (PGI-I) and patient satisfaction according to a Likert scale were used to measure patient-reported outcomes. A total of 96 patients with a median (interquartile range [IQR]) age of 68 (65-72) years were included in the final analysis. The median (IQR) follow-up was 3 (1-4) years. In all, 10 patients completed the 5-year follow-up. After the treatment, we observed a significant reduction in 24hPWT by the median of 83% (P < 0.001) at 3 months and by a median of 79% (P < 0.001) at 3 years. According to the PGI-I, a total of 87%, 92%, 87%, 81%, 83%, and 50% (five of 10) of patients rated their condition/incontinence as 'very much improved', 'much improved' or 'little improved' at 3 months, 1-, 2-, 3-, 4-, and 5-year follow-up visits, respectively. The proportion of patients, who were 'very satisfied' or 'satisfied' with the treatment outcome was 79%, 80%, 75%, 69%, 80%, and 60% (six of 10) at 3 months, 1-, 2-, 3-, 4-, and 5-years, respectively. There were a total of 13 (14%) device failures during the follow-up period. In conclusion, our data suggest that Victo AUS significantly reduces the severity of UI after prostate surgery and provides a reasonably high patient-reported satisfaction with treatment outcomes at mid-term follow-up.