Rui Pedrosa

Background: Benign prostatic hyperplasia is a leading cause of lower urinary tract symptoms and bladder outlet obstruction in ageing men. Transurethral resection of the prostate remains a benchmark surgical treatment, although contemporary practice has been challenged by less invasive techniques. We aimed to evaluate real-world effectiveness and safety outcomes of transurethral resection of the prostate for benign prostatic obstruction. Materials and Methods: Single-center, retrospective, observational cohort study including all consecutive patients who underwent TURP between October 2020 and March 2025. Baseline, perioperative and postoperative variables were analyzed, including 30-day emergency department (ED) visits, catheter-free status among previously catheterized patients, persistence of lower urinary tract symptoms (LUTS), and uroflowmetry parameters. Results: A total of 530 patients were included (median age 69 years). Median hospitalization was 2 days, with 15.7% discharged within 24 hours. Within 30 days, 109 patients (20.6%) attended the ED, mainly due to acute urinary retention (39.4%) and hematuria (31.2%); perioperative hemoglobin drop was the only independent predictor of ED attendance (OR 1.267; p = 0.004). Among chronically catheterized patients, 89.4% became catheter-free postoperatively. Prostate volume was independently associated with longer hospitalization and persistent postoperative LUTS. Antithrombotic monotherapy was not significantly associated with greater hemoglobin drop, catheterization duration, or ED attendance. Maximum urinary flow rate improved significantly from 8.20 to 19.47 mL/s (p < 0.001). Conclusions: This real-world cohort confirms TURP as an effective and safe procedure for benign prostatic obstruction, providing objective functional improvement and a high catheter-free rate. ED visits, mainly due to urinary retention and hematuria, represent a relevant target for pathway optimization. Standardized antithrombotic protocols and structured postoperative follow-up may further improve safety and quality of care.

Background/Objectives: Mesh-related complications after surgery for stress urinary incontinence (SUI) and pelvic organ prolapse (POP) remain a clinical challenge, and surgical revision is often required. However, its impact on functional outcomes and continence status is incompletely defined. This study aimed to evaluate voiding and continence outcomes after surgical revision of vaginal synthetic mesh. Methods: This retrospective multicenter study included 55 consecutive women undergoing surgical revision of synthetic mesh for symptomatic complications after SUI or POP procedures between March 2021 and April 2025. Preoperative evaluation included clinical assessment, uroflowmetry, and selective imaging or urodynamic studies. Surgical management included mesh section, partial removal, or total removal via vaginal, abdominal, or combined approaches. The primary outcome was change in Qmax and post-void residual (PVR). Secondary outcomes included symptom resolution, changes in urgency urinary incontinence (UUI) and SUI, and postoperative complications. Results: Obstructive voiding dysfunction was the leading indication for revision (47.3%). Median Qmax increased from 13.0 to 18.0 mL/s (p = 0.0013), and median PVR decreased from 55.0 to 5.0 mL (p < 0.001). UUI improved from 56.4% to 34.5% (p = 0.017, McNemar’s exact test). Conversely, SUI increased from 20.0% to 56.4% (p < 0.001), although only 16 patients (29.1%) had clinically significant postoperative SUI, of whom 7 underwent a secondary anti-incontinence procedure. Intraoperative complications were infrequent (5.5%), while postoperative urinary tract infections occurred in 16.4%. Conclusions: Mesh revision surgery improves voiding function and reduces storage symptoms in selected patients but carries a substantial risk of recurrent or de novo SUI, underscoring the need for careful patient selection and counseling, with an acceptable safety profile in experienced centers.

Background: Incidental prostate cancer (iPCa) remains a clinically relevant diagnosis in men undergoing surgery for benign prostatic hyperplasia (BPH). This study aimed to determine the incidence, characterize pathological features, and identify preoperative predictors of iPCa.Materials and methods: We conducted a retrospective cohort study of 735 men undergoing BPH surgery between November 2020 and December 2024. Demographic, clinical, surgical, and pathological variables were analyzed. Predictors of iPCa were evaluated using logistic regression; discrimination was assessed by ROC curves and Youden-optimized cut-offs.Results: The incidence of iPCa was 5.6%. Among iPCa cases, 48.8% were ISUP 1, while 17.1% corresponded to high-grade tumors (ISUP ≥4). Patients with iPCa had significantly higher PSA (4.8 vs 1.9 ng/mL), higher PSA density (PSAD 0.099 vs 0.029 ng/mL/cmÑ), and smaller prostates (47 vs 66 mL) (all p<0.001). In multivariable analysis including age and PSAD, only PSAD remained independently associated with iPCa (per 0.01 ng/mL/cmÑ increase). PSAD discriminated iPCa better than PSA (AUC 0.86 vs 0.80). A PSAD threshold around 0.15 ng/mL/cmÑ provided balanced performance (sensitivity ≈0.82; specificity ≈0.78). At a median follow-up of 24 months, most patients were managed conservatively (active surveillance or watchful waiting) with favorable short-term biochemical control; a minority required systemic therapy (hormonotherapy), and cancer-specific mortality was low.Conclusions: iPCa occurred infrequently after BPH surgery, although higher-grade tumors were still observed. PSA density was the strongest preoperative predictor and should be integrated into risk stratification before BPH surgery.

Introduction: Tumor regression grade (TRG) is a recognized prognostic marker in several solid tumors treated with neoadjuvant therapy, but its clinical relevance in muscle-invasive bladder cancer (MIBC) remains under investigation. This study aimed to evaluate the prognostic value of TRG and its integration with pathological TNM staging in patients with MIBC treated with neoadjuvant chemotherapy (NAC) followed by radical cystectomy (RC).Materials and methods: We conducted a retrospective analysis of 51 patients with MIBC who received platinum-based NAC followed by RC and lymphadenectomy between 2013 and 2024. TRG was assessed according to the Fleischmann classification and combined with ypTNM stage to categorize patients as complete, partial or non-responders. Overall survival (OS) and disease-free survival (DFS) were estimated using Kaplan–Meier analysis, and independent prognostic factors were identified through Cox regression models.Results: Complete response (ypT≤1, ypN0, TRG1) was observed in 43.1% of patients. Median OS was 19 months, with 3- and 5-year OS rates of 28.6% and 14.3%, respectively. Complete responders demonstrated significantly improved OS and DFS (p<0.001). On multivariable analysis, absence of nodal involvement (p=0.047) and complete response (p=0.012) were independently associated with better OS. Negative surgical margins showed a trend toward improved survival (p=0.064).Conclusions: TRG is a reproducible and clinically meaningful histopathologic scoring system that enhances prognostic stratification when combined with pathological TNM staging. Its integration into routine post-NAC assessment may improve postoperative decision-making and help identify patients who could benefit from tailored surveillance or adjuvant strategies.

Background: Despite the benefits of minimally invasive pelvic floor reconstructive surgery, serious life-threatening complications have been described. The most serious complications are vascular and intestinal. This review discusses the incidence, diagnosis, management and prevention of vascular complications in minimally invasive pelvic floor reconstructive surgery (sacrocolpopexy and artificial urinary sphincter). Objectives: We aimed to determine the incidence and management of vascular complications in minimally invasive pelvic floor reconstructive surgery. Methods: This narrative literature review on the incidence and management of vascular complications at sacrocolpopexy and artificial urinary sphincter was performed after the search of relevant manuscripts indexed in PubMed, EMBASE and Scielo published in English between January 2011 and June 2025. The keywords used were “vascular”, “complication”, “sacrocolpopexy”, and “artificial urinary sphincter”. We selected 19 manuscripts for comprehensive review. Conclusions: Dissection of the sacral promontory during sacrocolpopexy requires an exquisite knowledge of pelvic anatomy and adequate preoperative planning to avoid vascular injuries and find alternatives for mesh fixation if it cannot be performed in the usual anatomical location.