Despite transrectal prostate biopsy (TRPB) being still widespread globally, the EAU Guidelines strongly recommend the transperineal approach, due to the reported lower infectious risk. Our study aims to evaluate the impact of a standardized clinical pathway for TRPB on post-operative complications. We prospectively collected data from all patients undergoing mpMRI-targeted TRPB at our Academic Centre from January 2020 to December 2022. All patients followed a standardized, structured multistep pathway. Post-procedural complications were collected and classified according to the Clavien–Dindo (CD) Classification. Among 458 patients, post-procedural adverse events were reported by 203 (44.3%), of which 161 (35.2%) experienced CD grade 1 complications (hematuria [124, 27.1%], hematochezia [22, 4.8%], hematospermia [14, 3.1%], or a combination [20, 4.4%]), and 45 (9.0%) reported CD grade 2 complications (acute urinary retention or hematuria needing catheterization, as well as urinary tract infections, of which 2 cases required hospitalization). No major complications, including sepsis, were observed. At uni- and multivariable analysis, age > 70 years and BMI > 25 kg/ m² for patients were identified as predictors of post-operative complications. The results of our study confirm that TRPB is a safe and cost-effective procedure with a low risk of severe adverse events in experienced hands and following a standardized pathway.

Objectives: The aim of this work was to review the available evidence on transperineal focal laser ablation (FLA) for patients with localized PCa, focusing on both functional and oncological outcomes. Methods: A comprehensive review of the English-language literature was performed using the MEDLINE (via PubMed) and Web of Science (WOS) databases until 30 December 2024, using a combination of free text and MeSH subject headings. The review process was carried out according to the PRISMA guidelines. Results: The literature search found 156 papers, and among these, 10 papers were finally accepted and included. A risk of bias assessment was conducted, revealing low-quality evidence and high heterogeneity among the available data. Low- to high-risk cancers were treated across the studies. A drop in PSA values was observed in all studies after FLA, but no definition of biochemical disease-free survival was established. The postfocal presence of cancer rate ranged from 4% to 57%, while clinically significant cancer was detected in 0 up to 31% of cases. Secondary treatments were necessary for 7 to 30%. The overall complication rate ranged from 0% to 66%, most being mild and transient. Functional outcomes appeared to be preserved both in the short- and long-term follow-ups. Quantitative analyses were not performed due to the low number and heterogeneity of the studies included. Conclusions: Transperineal FLA for the treatment of clinically localized prostate cancer appears to be a feasible, safe technique with an efficacy comparable to other focal therapy modalities. However, the low quality of the evidence available highlights the need for comparative, randomized long-term follow-up studies versus standard of care and other focal therapy options in order to standardize patient selection, treatment protocols, and follow-up strategies.

Background: Three-dimensional (3D) virtual reconstruction has emerged as a tool for preoperative planning in urological tumors. The aim of this study was to evaluate the feasibility and perceived clinical utility of 3D virtual models in minimally invasive urologic oncologic surgery. Methods: We performed a retrospective multicenter analysis across four tertiary hospitals from January 2023 to May 2025. Forty patients were included: 30 underwent partial nephrectomy (25 robotic, 5 laparoscopic) and 10 underwent robotic radical prostatectomy. 3D virtual models were generated using the Cella Medical Solutions (CellaMS®) platform. Demographic, perioperative, pathological, and oncologic variables were analyzed descriptively. Surgeon perceptions regarding the use of 3D models were assessed using a survey. Results: In the partial nephrectomy cohort, mean tumor size was 5.2 cm, with mean RENAL and PADUA scores of 8.1 and 8.7, respectively, clear cell carcinoma accounted for 70% of cases. Mean operative time was 101 min, with vascular clamping performed in 60% of procedures (mean clamp time 19 min). Negative surgical margins rate was 93.3% in partial nephrectomies. In the radical prostatectomy cohort, mean Prostate Specific Antigen (PSA) was 7.8 ng/mL; ISUP Grade Groups 2–3 accounted for 80% of cases and Grade Group 4 for 20%. Two patients underwent lymphnode dissection (mean 15 nodes, all pN0). Mean operative time was 112 min, with positive surgical margins rate of 20%. The overall complication rate (Clavien–Dindo ≥ II) was 7.5%. Surgeons reported perceived improvements in anatomical understanding (85%), intraoperative orientation (78%) and patient counseling (70%). Conclusions: In our experience, 3D virtual models for preoperative planning were feasible and associated with favorable surgeon-reported perceptions. Given the descriptive design, absence of a control group, and reliance on subjective outcomes, these findings should be considered hypothesis-generating. Prospective, controlled studies incorporating objective clinical, functional, and cost-related endpoints are required to define the role of 3D virtual modeling in routine practice.