Urology

Transvesical SP-RARP yields faster early continence and more same-day discharges than extraperitoneal approach

In a 1:1 propensity-matched multi-institutional study of SP-RARP (n=884), transvesical (TV) and extraperitoneal (EP) approaches had similar operative times and positive margin rates. TV patients had higher same-day discharge (78.2% vs 60.6%) and shorter median Foley duration (5 vs 7 days). Early continence recovery favored TV at 6 weeks, 3 months, and 6 months, with similar erectile function and 12-month biochemical recurrence. Limitations include retrospective design and median follow-up under one year, so long-term oncologic and functional equivalence remains unproven. 1

PI-RADS v2 score 5 associates with markedly worse cancer outcomes across cohorts

Across three retrospective cohorts (total cohorts described) PI-RADS v2 score 5 strongly associated with prostate cancer–specific mortality and worse survival endpoints. In the Helsinki cohort PI-RADS 5 had HR 18.4 for prostate cancer–specific mortality after multivariable adjustment. PI-RADS 5 also correlated with worse overall survival, metastasis-free survival, and biochemical recurrence in other cohorts. Main caveat: retrospective data; PI-RADS 5 should inform prognosis but not replace histologic grading or comorbidity assessment. 2

Individualised intraoperative BP raises MAP but does not significantly cut postoperative AKI

Meta-analysis of 10 RCTs (n=5842) showed individualised BP management increased intraoperative MAP versus routine care. There was no significant reduction in postoperative AKI (RR 0.83, 95% CI 0.65–1.07) or 30-day mortality. Postoperative delirium was reduced (RR 0.46), and Bayesian analysis showed a 91% probability of any AKI protection but only 39% probability of a clinically meaningful benefit. Interpretation: routine practice change to universal individualised BP targets for AKI prevention is not supported. 3