Background and Objectives: This study aimed to compare perioperative, functional, and oncological outcomes of ultrapreservation and Retzius-sparing techniques in robotic radical prostatectomy for patients with localized prostate cancer. Materials and Methods: We retrospectively evaluated data from 189 patients who underwent robotic radical prostatectomy using either the ultrapreservation (n = 97) or the Retzius-sparing (n = 92) technique by a single surgeon at a single center between January 2022 and November 2024. Patients were divided into two groups based on the surgical technique. Demographics, perioperative outcomes, functional outcomes (continence and potency), oncological outcomes, and complications were compared. Results: There were no statistically significant differences in baseline demographics between the groups (p > 0.05). The ultrapreservation group demonstrated superior perioperative outcomes: operative time (174.8 vs. 188.7 min, p < 0.001), console time (112.4 vs. 132.0 min, p < 0.001), blood loss (119.0 vs. 133.3 mL, p = 0.002), and hospital stay (2.3 vs. 2.5 days, p = 0.004) were all significantly shorter. Complication rates were comparable between groups (8.2% vs. 10.9%). In terms of continence, the Retzius-sparing group achieved earlier recovery after catheter removal (56.5% vs. 27.8%, p < 0.001), while long-term continence outcomes were similar (12-month: 93.8% vs. 91.3%, p = 0.703). Potency recovery favored the ultrapreservation group at 3 and 6 months postoperatively (3 months: 76.9% vs. 41.2%, p < 0.001; 6 months: 79.5% vs. 60.0%, p = 0.013). Oncological outcomes were comparable between groups. Conclusions: Both ultrapreservation and Retzius-sparing techniques provide safe oncological outcomes with distinct functional advantages. The ultrapreservation technique offers perioperative advantages and superior potency recovery, while the Retzius-sparing approach facilitates faster early continence recovery. Clinical decision-making should be individualized: ultrapreservation may be preferred in younger patients with good preoperative potency prioritizing erectile function preservation, while Retzius-sparing may benefit patients prioritizing immediate continence recovery, particularly those with baseline erectile dysfunction or advanced age.

Objective: The aim of this study is to evaluate current urologic practice regarding the management of priapism in Turkey and compare with international guidelines. Methods: Urologists and urology residents were invited to an online survey consisting of 30 multiple-choice questions on priapism-related clinical practices that were consid- ered most important and relevant to practices by using Google Forms. Results: Total number of responses was 340. Respondents reported that they recorded a detailed patient’s medical history and physical examination findings (n = 340, 100%) and laboratory testing, which includes corporal blood gas analysis (n=323, 95%). Participants announced that they performed Doppler ultrasound for 1/4 cases (n = 106, 31%), but 22% of the participants (n=75) replied that they performed in >75% of cases. Participants (n=311, 91%) responded that the first-line treatment of ischemic priapism is decompression of the corpus cavernosum. Moreover, most respondents (n = 320, 94%) stated that sympathomimetic injection drugs should be applied as the second step. About three-quarters of respondents (n = 247, 73%) indicated adrenaline as their drug of choice. Phosphodiesterase type 5 inhibitors seems to be the most pre- ferred drug for stuttering priapism (n=141, 41%). Participants (n=284, 84%) replied that corpora-glanular shunts should be preferred as the first. A large number of par- ticipants (n = 239, 70%) declared that magnetic resonance imaging can be performed in cases with delayed (>24 hours) priapism to diagnose corporal necrosis. Most of the participants (84%) responded that penile prosthesis should be preferred to shunts in cases with delayed (>48 hours) priapism. Conclusion: It would be appropriate to improve the training offered by professional associations and to give more training time to the management of priapism during residency. Cite this article as: Kalkanli A, Zeki Sönmez S, Guvel M, et al. Management of priapism: Results of a nationwide survey and comparison with international guidelines. Urol Res Pract. 2023;49(4):225-232.

Background/Objectives: To examine whether extending sexual arousal through lengthened erotic video viewing during semen collection improves semen parameters in infertile men. Methods: In this prospective within-subject study, 205 infertile men supplied semen samples in two sessions about four weeks apart and followed strict uniform protocols. In the first session, participants ejaculated after the customary viewing length of erotic videos. During the second session, viewing time was increased prior to ejaculation. Semen volume, sperm concentration, total motility, progressive motility, and morphology were assessed as per the WHO 2021 guidelines. Comparisons were analyzed using paired samples t-test or Wilcoxon signed-rank test and correlation analysis was performed using Spearman’s rank correlation. Results: Median duration of erotic video watching increased from 8 min (IQR: 5–10) to 15 min (IQR: 11–20) (p < 0.001). Moreover, extended arousal was associated with increased sperm concentration (from 19 × 10⁶/mL to 24 × 10⁶/mL, p < 0.001), total motility (43% to 46%, p < 0.001), and progressive motility (33% to 37%, p < 0.001) with unchanged morphology (p = 0.053). Increases in arousal duration exhibited a weak but significant correlation with changes in concentration (ρ = 0.21, p = 0.003), total motility (ρ = 0.27, p < 0.001), and progressive motility (ρ = 0.22, p = 0.002). Subgroup analysis showed improvements in non-smokers but not in smokers. Conclusions: Extended erotic stimulation during semen sample collection significantly enhances sperm motility and modestly increases concentration in men with infertility, albeit without changing morphology. These findings suggest that extended erotic stimulation during semen collection may be a simple, non-invasive strategy to help optimize semen quality in infertile men, especially non-smokers.

Background/Objectives: Prostate cancer ranks as the second-most prevalent cancer globally, and is the fifth-ranking cause of cancer-related mortality. Radical prostatectomy presents a significant risk of postoperative sequelae, including erectile dysfunction. Postoperative erectile dysfunction adversely affects the patient’s quality of life and can severely impact total treatment satisfaction. Nomograms have demonstrated efficacy in forecasting diverse outcomes in urology. We sought to create a nomogram to facilitate a more precise, evidence-based, and individualized prediction of erectile function outcomes following radical prostatectomy. Between January 2018 and January 2022, one hundred and eleven prostate cancer patients had robot-assisted radical prostatectomy, excluding those who had undergone prior transurethral prostatectomy, radiotherapy, or hormone therapy. Demographics, medical records, preoperative and postoperative erectile function statuses, and IIEF scores (≥17 indicating retained erections, <17 indicating full erectile dysfunction) were evaluated. Outcomes: Patients’ ages ranged from 45 to 76 years, with an average of 61.18 ± 6.72 years. Patients in the emergency department were considerably older (p = 0.004; p < 0.01) and exhibited elevated Charlson Comorbidity Indices (3.63 ± 0.85; p = 0.004; p < 0.01). Preoperative IIEF scores in ED patients were lower (14.29 ± 5.34), although obturator internus thickness (20.61 ± 2.91) and intraprostatic urethra length (36.48 ± 9.3) were considerably elevated. Altered surgical techniques were linked to maintained erections (p = 0.002; p < 0.01), but traditional approaches were connected with erectile dysfunction (p = 0.007; p < 0.01). Bilateral nerve-sparing procedures were more prevalent among patients preserving erectile function (p = 0.003; p < 0.01). Conclusions: The nomogram, which includes age, Charlson Comorbidity Index, preoperative IIEF, obturator internus thickness, intraprostatic urethra length, surgical technique, and degree of nerve preservation, provides clinicians with a pragmatic instrument for forecasting postoperative erectile dysfunction in prostate cancer patients.

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.