EAU 2026: Highlights from Day 1
Recurrent UTI Care in The Real World: Low Guideline Adherence, High Investigation Burden, and Suboptimal Outcomes
Presenter: V. Bodean
Recurrent urinary tract infection (rUTI) is associated with significant symptom burden, reduced quality of life, and high healthcare utilization, yet adherence to guideline-recommended management remains low. A retrospective review evaluated 107 women referred to a general urology clinic for rUTI to assess management in primary and secondary care.
In primary care, conservative measures were used in 21.5%, while antibiotics were frequently prescribed (18.5% acute treatment, 24.5% prophylaxis; total 43%). Methenamine hippurate use was rare (1.5%), and 24.6% had no documented management. Only 61% (65/107) had a positive urine culture within the previous 12 months. In secondary care, rUTI was confirmed in 73% of patients. Management included lifestyle advice (53%), prophylactic antibiotics (31%), and methenamine hippurate (18%). Investigations were common but had low diagnostic yield, including flexible cystoscopy (73%), renal ultrasound (79%), and CT (33%). 37.5% were discharged after the first clinic review, while complete treatment response was achieved in only 26.9% (18/67) at first follow-up.
These findings highlight misalignment with guideline recommendations and emphasize the need for structured care pathways promoting diagnostic accuracy and non-antibiotic management.
A Randomized Placebo-Controlled Trial of Combined Medical Treatment for Recurrent UTI Prevention
Presenter: L. Spivak
A double-blinded, prospective multicentre randomized phase IV study evaluated whether a D-mannose-based combination therapy could reduce relapse in women with recurrent lower urinary tract infection. A total of 106 women aged 18–60 years with relapsing UTI were enrolled (54 experimental, 52 placebo; median age 34 years [IQR 27–40]). The experimental group received D-mannose 2000 mg, cranberry extract 100 mg, bearberry extract 80 mg (8 mg arbutin), and magnesium 30 mg for 12 weeks, alongside a short antibiotic course (≤5 days).
Three-month relapse-free survival was significantly higher in the treatment group (74.1% vs 28.8%, p=0.001). Median time to relapse was 116 days (IQR 79.2–201) versus 59.5 days (IQR 46.2–74.2) in the placebo group. Symptom resolution occurred at a median of 7 days in both groups (p=0.82). However, during months 3–6 after treatment completion, relapse rates were similar (85.2% vs 92.3%, p=0.36). Leukocyturia and bacterial types did not differ significantly between groups, and no serious adverse events were reported.
The findings suggest the combination therapy reduces recurrence during treatment but may require repeated courses to maintain benefit.
Ultrasound-Based Predictors of Polyacrylamide Hydrogel Injection Success in Stress Urinary Incontinence: Longitudinal Study by A Single Experienced Surgeon
Presenter: E. Illiano
Bulking agents are widely used for female stress urinary incontinence (SUI), but outcomes vary depending on technical and anatomical factors. This prospective study included 50 women aged 18–80 years with mild-to-moderate SUI treated with polyacrylamide hydrogel (PAHG, Bulkamid®) injections at a tertiary urogynaecology unit. All procedures were performed by a single experienced surgeon. Mean follow-up was 15 ± 2.4 months.
Objective continence was achieved in 84% at 1 month, declining to 56% at 6 months and 36% at final follow-up. Treatment failure was strongly associated with distal PAHG placement (70% vs 4.2%, p<0.0001; OR 65.10) and oblong implant morphology (65% vs 3.4%, p<0.0001; OR 93). Persistent open bladder neck was also significantly associated with failure (78% vs 10.2%, p<0.0001; OR 5.88). In multivariate analysis, distal implant placement (OR 2.42, p=0.03) and open bladder neck (OR 5.23, p<0.0001) remained independent predictors of failure, while implant shape was not significant (p=0.07).
Translabial ultrasound may therefore help identify anatomical predictors of treatment success and guide optimization of injection technique.
Implantation of An AMS-800 Artificial Urinary Sphincter in Women with Severe Stress Urinary Incontinence: Comparison between Open and Robot-Assisted Approaches in A Single-Center Retrospective Study
Presenter: S. Duboys Fresney
Artificial urinary sphincter (AUS) implantation with the AMS-800 device is an established treatment for severe female stress urinary incontinence. This retrospective single-centre study evaluated 456 women who underwent AUS implantation, comparing open (n=364) and robot-assisted (n=87) approaches. Median follow-up was 8.8 years (IQR 2.6–16.3).
The robot-assisted approach was associated with significantly improved perioperative outcomes, including shorter hospital stay (5.6 vs 13.1 days, p<0.001) and lower bladder injury rates (4.4% vs 21.6%, p<0.001). Long-term device outcomes were similar between approaches, with no significant difference in explantation-free survival (p=0.22), reintervention-free survival (p=0.07), or revision-free survival (p=0.88), although the explantation rate was numerically lower in the robotic group (13.2% vs 18.1%). Overall, 220 patients required at least one revision, including 70 second, 20 third, 8 fourth, and 3 fifth revisions.
These findings suggest robot-assisted AUS implantation may reduce perioperative morbidity while maintaining comparable long-term device outcomes.
EAU Congress 2026, 13th-16th March 2026, London.
