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.

Flexible Cystoscopy Patient Experience: Comparative Effects of Irrigation Techniques on Comfort and Satisfaction - The Medical Bulletin of Haseki

Background/Objectives: This study aimed to systematically evaluate the accuracy and clinical relevance of ChatGPT-4’s answers to a set of questions on upper tract urothelial carcinoma (UTUC) as adjudged by expert urologists. To juxtapose performance, one question set consisted of queries derived from the 2025 EAU (European Association of Urology) guidelines, and the other was a miscellaneous set of frequently asked patient-oriented questions. Methods: Seventy-seven questions were posed to ChatGPT-4 in English: 60 were systematically selected from the 2025 EAU UTUC guidelines, and 17 were compiled as frequently asked questions (FAQs) from reputable urology sources. Two board-certified urologists independently scored the given responses, employing (a) binary scoring (correct = 1, incorrect = 0) and (b) detailed accuracy scoring (1 = completely accurate, 2 = accurate but inadequate, 3 = mixed accurate–misleading, 4 = completely inaccurate). Comparative analyses used the Mann–Whitney U test with effect size estimation. Results: Overall, 71 of 77 responses (92.2%) were correct. Accuracy rates were 90.0% (54/60) for EAU guideline questions and 100.0% (17/17) for the FAQs. The mean accuracy score for the guideline-based questions was 1.28 ± 0.74, compared with 1.00 ± 0.00 for the FAQs. Differences between the groups were not statistically significant (p = 0.094, r = 0.191). A subgroup analysis showed perfect accuracy (100%) in four EAU categories—Classification and Staging Systems, Diagnosis, Disease Management, and Metastatic Disease Management—while the Follow-up category had the lowest accuracy (25% correct, mean score = 2.75), indicating domain-specific limitations. Conclusions: ChatGPT-4 demonstrated high overall accuracy, particularly for patient-oriented UTUC questions, but showed reduced reliability in complex, guideline-specific areas, especially follow-up protocols. The model shows promise as an educational tool for patients but cannot replace expert clinical judgment for decision-making. These findings have important implications for the integration of AI tools in urological practice and highlight the need for domain-specific optimization.

We aimed to evaluate the efficacy and safety of mirabegron monotherapy in very older (>80 years) women with overactive bladder (OAB) who were discontinued anticholinergic drugs by the other departments. The present retrospective study evaluated very older (>80 years) women with OAB who were discontinued anticholinergic drugs by the other departments between May 2018 and January 2021. Efficacy assessments were performed using Overactive Bladder-Validated Eight-Question (OAB-V8) scores before and after mirabegron monotherapy (12 weeks). Safety was evaluated based on adverse events (hypertension, nasopharyngitis, and urinary tract infection), electrocardiography, hypertension measure, uroflowmetry (UFM), and post-voiding. Patient data including demographic characteristics, diagnoses, values before and after mirabegron monotherapy, and adverse events were evaluated. A total of 42 very older (>80 years) women with OAB who used mirabegron monotherapy (50 mg per day) were included in this study. Frequency, nocturia, urgency, and total OAB-V8 scores were significantly lower after mirabegron monotherapy than before mirabegron monotherapy (p < 0.05, p < 0.05, p < 0.05, and p < 0.05, respectively). There was no significant difference between systolic-diastolic blood pressure and heart rate before and after mirabegron monotherapy treatment. Mirabegron monotherapy is an effective and safe therapy in very older (>80 years) women with OAB.

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.