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Posterior nerve-sparing modifications during radical prostatectomy aim to improve preservation of the cavernous nerves and microvasculature to enhance postoperative erectile recovery. Current techniques for this are associated with varied functional outcomes and have a number of key anatomical and technical considerations.
Transrectal ultrasound-guided prostate biopsy is associated with limitations including high infection rates, sampling limitations and patient discomfort, which have led to the development of the transperineal approach. Randomized trials show that transperineal biopsy offers at least equivalent detection of clinically significant prostate cancer, providing robust evidence for a clinical practice change.
New evidence shows that NeuroSAFE, an intraoperative frozen section technique during radical prostatectomy, improves erectile function recovery. Traditional NeuroSAFE using frozen section analysis might not work for all centres, but new technologies for intraoperative margin assessment might facilitate more pragmatic alternatives during radical prostatectomy.
Urinary incontinence is a common sequela of robot-assisted radical prostatectomy and adversely affects quality of life. Advances in surgical technique preserve the pelvic anatomy to mitigate postoperative urinary incontinence. Pelvic-fascia-sparing techniques such as Retzius-sparing and hood with single-port or multi-port robotic approaches can improve outcomes.
Understanding of metastatic prostate cancer is mainly defined by macroscopic findings, but prostate-specific membrane antigen (PSMA) PET has increased sensitivity. PSMA+ serosal-based findings on the surface of the liver and other organs might not have the same implications when seen on PSMA PET versus conventional imaging. Awareness of this phenomenon is important in assessing whether treatment escalation is truly required.
Evidence of polypropylene mesh degradation has revealed particle accumulation in surrounding tissues, raising concerns about potential local and systemic immune responses. Associations between polypropylene degradation and autoimmune/autoinflammatory syndrome induced by adjuvants-like symptoms have been made, and vigilant clinical assessment is important, especially in patients with a predisposition for allergy or autoimmune diseases.
Autonomic dysreflexia is a sudden rise in systolic blood pressure observed in individuals with spinal cord injury at or above the sixth thoracic spinal cord segment, often triggered by stimuli from the urinary bladder, bowel or sexual organs. Autonomic dysreflexia can cause severe complications, including stroke or death. Cardiovascular monitoring during urological procedures is crucial, particularly for individuals with cervical spinal cord injury who are at the highest risk of developing autonomic dysreflexia.
