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.

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.

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.

Background and Objectives: Low-pressure pneumoperitoneum (PP) during robot-assisted radical prostatectomy (RARP) has been shown to improve postoperative recovery in patients with non-obesity. However, its efficacy in individuals with obesity remains unclear. This study aimed to evaluate postoperative outcomes in patients with obesity undergoing RARP with low-pressure (7 mmHg) versus standard-pressure (12 mmHg) PP. Materials and Methods: In this retrospective cohort study, 130 patients with obesity (BMI > 30 kg/m²) undergoing RARP were divided into low-pressure (n = 60) and standard-pressure (n = 70) groups. Postoperative recovery was assessed using the Quality of Recovery-15 (QoR-15) questionnaire on postoperative days (POD) 1, 3, and 30. Secondary outcomes included surgical workspace (SWS) scores, operative time, blood loss, intraoperative and postoperative complications, hospital stay, and pathological results. ANCOVA and chi-square tests were used for analysis. Results: QoR-15 scores were significantly higher in the low-pressure group on POD1 (123.58 vs. 111.41), POD3 (128.37 vs. 116.41), and POD30 (132.88 vs. 125.61; p < 0.001). Operative time (98.5 vs. 71.57 min; p < 0.001) and blood loss (129 vs. 97.07 mL; p = 0.039) were higher in the low-pressure group. SWS scores were lower in the low-pressure group (p < 0.001). There were no significant differences between groups in complication rates, hospital stay, or positive surgical margins. Conclusions: In patients with obesity undergoing RARP, low-pressure PP improves postoperative recovery without increasing complications. Despite longer operative times and higher blood loss, this approach is a viable option to enhance recovery in this population.