EAU 2026: Highlights from Day 2
Optimizing Mitomycin C Maintenance for Intermediate-Risk Ta NMIBC: A Multicentre Analysis on Instillation Duration
Presenter: Contieri
The optimal duration of adjuvant mitomycin C (MMC) maintenance therapy for intermediate-risk Ta non–muscle invasive bladder cancer (NMIBC) remains unclear. This retrospective multicentre analysis included 292 patients treated with adjuvant MMC across 13 Italian centers between 2010 and 2023. Median follow-up was 33 months, and 147 patients (50%) experienced recurrence.
In a 12-month landmark analysis, maintenance therapy significantly improved 3-year recurrence-free survival (RFS) compared with no maintenance (67% vs 30%; p<0.001) and reduced recurrence risk (adjusted HR 0.13; p<0.001). Classification and Regression Tree analysis identified more than six monthly instillations as the optimal threshold. Three-year RFS was 77% in long-term maintenance (>6 instillations), 49% in short-term maintenance (≤6 instillations), and 30% with no maintenance (p<0.001). Multivariable Cox analysis confirmed significantly lower recurrence risk with long-term maintenance compared with no maintenance (adjusted HR 0.09; p<0.001) and short-term maintenance (adjusted HR 0.26; p=0.005). No significant differences were observed in high-grade recurrence-free survival (p=0.063).
In patients with Ta IR-NMIBC, maintenance mitomycin C (MMC) significantly improved recurrence-free survival, with treatment beyond six months providing the greatest reduction in recurrence. These real-world findings support shared decision-making regarding prolonged maintenance, although the benefit did not extend to high-grade recurrence and requires prospective validation.
Feasibility and Outcomes of Robot-Assisted Radical Prostatectomy with The Hugotm RAS System in Patients with Locally Advanced Prostate Cancer: Insights from A Multicentric Cohort
Presenter: A. Barretta
This multicentre cohort study evaluated the feasibility and outcomes of robot-assisted radical prostatectomy (RARP) using the Hugo™ RAS System in patients with locally advanced prostate cancer. A total of 754 patients undergoing RARP without pelvic lymph node dissection were included from six high-volume centres. Patients were stratified by MRI findings into extracapsular extension (ECE) (8.4%) and non-ECE (91.6%) groups. All procedures were completed robotically with no conversions or additional ports.
Patients with ECE were older (66 vs 64 years, p=0.04) and had higher PSA (8.1 vs 6.8 ng/mL, p=0.03). Operative time was slightly longer (225 vs 212 minutes, p=0.02), while blood loss and perioperative complications were comparable. At final pathology, pT3–4 disease (44.1% vs 10.7%, p<0.001) and positive surgical margins (24.6% vs 14.8%, p=0.04) were more frequent in the ECE group. At 12 months, outcomes were similar between groups: continence recovery (94.5% vs 96.8%, p=0.21), potency recovery (73% vs 80.4%, p=0.14), and biochemical control (92.0% vs 94.9%, p=0.68).
In conclusion, RARP performed with the Hugo RAS System was feasible in patients with and without MRI-detected ECE
Urodynamic Risk Factors for Transient Urinary Incontinence after Endoscopic Enucleation of Prostate Hyperplasia
Presenter: O. Nesterova
This prospective study evaluated urodynamic predictors of urinary incontinence after endoscopic enucleation for benign prostatic hyperplasia (BPH). The study included 69 men undergoing surgery between October 2023 and August 2024, including thulium fibre enucleation (62 patients) and bipolar enucleation (7 patients) performed by a single surgeon.
Transient urinary incontinence occurred in 36.2% of patients, with symptoms resolving within three months in all cases. Multivariate analysis identified several independent predictors: Bladder Outlet Obstruction Index (BOOI) (OR 1.027; p=0.027), Bladder Contractility Index (BCI) (OR 1.020; p=0.043), and maximum intraurethral pressure (Pura max) (OR 0.920; p<0.001), where higher pressure reduced the risk. The predictive model demonstrated accuracy of 88.1%, sensitivity 90.5%, specificity 86.8%, and AUC 0.897. Among intraoperative factors, operation time was the only independent predictor (OR 1.022; p=0.011), with each additional minute increasing incontinence risk by 2.2%. Energy modality and early sphincter release were not independently associated with postoperative incontinence.
Longer surgical duration, higher BOOI and BCI, and lower Pura max were associated with an increased risk of urinary incontinence after endoscopic enucleation of BPH.
Efficacy of Vaginal Laser Therapy for Recurrent Cystitis in Postmenopausal Women: First Real-World Clinical Evidence
Presenter: E. Kasuya
This retrospective study assessed the effectiveness of vaginal laser therapy (VLT) in postmenopausal women with recurrent cystitis. A total of 51 women with recurrent infections were treated with three sessions of non-ablative 2,940 nm Er:YAG laser therapy at 4-week intervals, with 86% receiving concomitant vaginal estriol. The median age was 63 years, and median follow-up was 8 months.
The median cystitis-free interval was 9.2 months, and infection frequency decreased from 4 episodes to 0 in the six months before versus after treatment (p<0.001). Vaginal health improved significantly, with Vaginal Health Index increasing from 10 to 18 (p<0.001) and vaginal pH decreasing from 8.0 to 5.5 (p<0.001). Cystoscopic assessment in 40 patients also demonstrated improvement in vaginal and periurethral atrophy. Patients not receiving estrogen therapy also showed improvement in infection frequency and vaginal parameters. Adverse events occurred in 7.8% of patients, all Grade 1, and resolved without intervention.
Vaginal laser therapy significantly reduced cystitis recurrence in postmenopausal women and improved vaginal health parameters, including VHI and vaginal pH. The treatment was well tolerated, including in patients not receiving estrogen therapy.
Effect of Diabetes on Quality-Of-Life Improvement after Platelet-Rich Plasma Therapy for Women with Stress Urinary Incontinence
Presenter: A. Petca
This prospective, non-randomized cohort study evaluated the effectiveness of platelet-rich plasma (PRP) therapy in diabetic and non-diabetic women with SUI. A total of 102 women were included, comprising 80 non-diabetic and 22 diabetic patients. Each participant received up to three periurethral PRP injections at 4–6-month intervals using a standardized preparation protocol.
PRP therapy resulted in significant improvements across all KHQ domains, with overall improvement of 48.9% in non-diabetic women and 38.3% in diabetic women. The most notable improvements occurred after the second injection, with smaller but sustained benefits after subsequent treatment. Non-diabetic patients showed earlier and more consistent improvement, particularly between the first and second sessions. Diabetic patients also experienced improvement, although the response was slower and less consistent. Stamey scale analysis showed significant symptom reduction in both groups (p<0.001). However, the subgroup of insulin-treated diabetic patients did not reach statistical significance in SUI improvement (p=0.083).
Single-Centre Experience in the Surgical Treatment of Cuff-Related Urethral Erosion in Men with Artificial Urinary Sphincters
Presenter: L. Mas Grilló
This retrospective observational study evaluated the management of cuff-related urethral erosion and compared outcomes between urethrorrhaphy and end-to-end (E-E) urethroplasty. A total of 675 AUS devices were implanted at the study center (637 AMS 800 and 38 Zephyr), and 39 patients developed urethral cuff erosion. Median age was 76 years (range 68–82). The most common presenting symptom was urinary incontinence, occurring at a median of 69 months (range 24–122) after implantation.
Urethrorrhaphy was performed in 20 patients (51%), and end-to-end urethroplasty in 19 (49%). In the urethrorrhaphy group, five patients developed Clavien–Dindo grade II complications (three urinary leakages, one infection, and one deep vein thrombosis), and four patients (20%) developed urethral strictures. AUS reimplantation was performed in eight patients (40%), with recurrent erosion in four cases (50%). In the end-to-end urethroplasty group, five patients developed grade II complications (three infections and two urinary leakages), and no urethral strictures were observed. Three patients (15%) underwent AUS reimplantation, with one case (33%) of recurrent erosion.
End-to-end urethroplasty is a safe and effective option for cuff-related urethral erosion, offering fewer complications and strictures than urethrorrhaphy while preserving AUS reimplantation in most patients.
Complications and Causes of Readmission Following Midurethral Sling Surgery for Stress Urinary Incontinence in 88,880 Patients
Presenter: A. Blondeau
This study evaluated MUS removal rates and complications following retropubic (TVT) and transobturator (TOT) sling procedures using the French national hospital database. Data from 88,880 women treated between 2016 and 2019 were analyzed with a 5-year follow-up, including 69,879 TOT and 19,001 TVT procedures. Complications were recorded during the initial hospitalization and any rehospitalization within 60 months.
The TVT group showed higher rates of sling removal and slightly higher urinary tract infection rates (0.7% vs. 0.5%, p<0.01). However, patients treated with TOT had a 19% higher risk of reintervention for SUI (HR=1.19, 95% CI 1.10–1.29, p<0.001).
Overall, while TVT was associated with slightly more perioperative complications, it demonstrated better long-term effectiveness compared with TOT.
Increased Risk of Erectile and Testicular Dysfunction Among Young Men with Type 2 Diabetes Treated with Semaglutide: A Global Trinetx Cohort Analysis
Presenter: J.Y. Hsu
This retrospective real-world study used the TriNetX Global Collaborative Network to compare the risk of erectile dysfunction (ED) and testicular dysfunction in men aged 20–50 years initiating semaglutide or DPP-4 inhibitors between 2018 and 2025. Patients with prior ED, testicular dysfunction, testosterone therapy, prostate cancer, or pulmonary hypertension were excluded. After 1:1 propensity score matching, 42,867 patients were included in each cohort.
Semaglutide users had a higher incidence of ED or PDE5 inhibitor use (3.8% vs 2.8%; RR 1.35, 95% CI 1.25–1.45, p<0.001), ED diagnosis alone (2.8% vs 2.1%; RR 1.30, 95% CI 1.19–1.41, p<0.001), and testicular dysfunction (0.8% vs 0.4%; RR 2.35, 95% CI 1.95–2.83, p<0.001). Event-free survival was significantly lower in the semaglutide group for all outcomes (log-rank p<0.001). The hazard ratio for testicular dysfunction was 3.13 (95% CI 2.59–3.79).
Semaglutide use was associated with higher risks of erectile and testicular dysfunction compared with DPP-4 inhibitors.
The Presence of a Dose Response Relationship Between Obstructive Sleep Apnoea and Erectile Dysfunction: A Systematic Review
Presenter: K. Pang
This systematic review and meta-analysis evaluated the correlation between OSA severity markers and erectile function. Following PRISMA guidelines, studies were identified from PubMed, Embase, and Scopus that reported correlations between the Apnoea–Hypopnea Index (AHI) or minimum oxygen saturation (SaO₂) and the International Index of Erectile Function (IIEF).
Seven studies including 594 patients demonstrated a significant moderate negative correlation between AHI and IIEF scores (pooled Fisher’s Z = –0.465; 95% CI –0.547 to –0.383), indicating worse erectile function with increasing OSA severity. Additionally, analysis of three studies (n=513) showed a small but significant positive correlation between minimum SaO₂ and IIEF scores (pooled Fisher’s Z = 0.219; 95% CI 0.132–0.306).
Narrative synthesis showed a high prevalence of ED among patients with OSA (59–69%), consistent improvement in erectile function following CPAP therapy, and age as an important confounding factor.
A Decade of Surgical Trends in BPO Management: Real-World Evidence from A High-Volume LUTS Centre Demonstrating the Shift Towards Laser Enucleation Over TURP
Presenter: Stadelmeier L.F.
Laser enucleation of the prostate (LEP) has increasingly been used to treat male lower urinary tract symptoms (LUTS) caused by benign prostatic obstruction (BPO), although its adoption has been limited by a steep learning curve. This retrospective study analyzed 4,886 patients treated surgically for LUTS/BPO at a tertiary referral center between 2013 and 2023 to evaluate changes in surgical practice over time, particularly the shift from transurethral resection of the prostate (TURP) to LEP.
Over the study period, the proportion of patients undergoing TURP decreased nearly five-fold, from 76% to 18%, while the use of laser enucleation increased from 24% to 82%. The average prostate volume treated with LEP increased by approximately 25% (79 cc to 99 cc), whereas the average volume for TURP decreased by more than 35% (48 cc to 30 cc). Additionally, perioperative efficiency for LEP improved nearly two-fold during the study period.
In conclusion, the study demonstrates a substantial shift in surgical management of LUTS/BPO over the past decade, with laser enucleation increasingly replacing TURP and showing improved efficiency and applicability to larger prostate volumes as surgical experience increases.
Development of A ChatGPT-Based Assistant in Multidisciplinary Team Discussions in Oncological Urology: The Uromdt Advisor Study
Presenter: Lombardo R.
Large language models (LLMs) such as ChatGPT are increasingly explored for clinical decision support. This study developed UroMDT Advisor, a ChatGPT-based application designed to assist multidisciplinary team (MDT) discussions in oncological urology by generating case summaries, suggesting guideline-based treatments (EAU, ESMO, NCCN), providing references, identifying inter-specialty discrepancies, drafting MDT reports, and producing patient summaries.
A total of 180 anonymized oncological cases from eight centres were analysed (68% prostate cancer, 12% renal cancer, 11% urothelial cancer, 7% testicular cancer, and 2% penile cancer). GPT-generated recommendations were compared with MDT participant opinions and final MDT decisions. The model demonstrated significant correlations with urologists (r=0.534), oncologists (r=0.563), radiotherapists (r=0.606), and overall MDT consensus (r=0.553), all p<0.001. Overall agreement with MDT decisions was moderate (κ=0.453). Expert evaluation rated GPT-generated reports and patient summaries as accurate in 90% of cases, fairly accurate in 8%, and inaccurate in 2%. Completeness and clarity were rated high in 95% of cases.
The ChatGPT-based UroMDT Advisor demonstrated moderate agreement with multidisciplinary team decisions and high accuracy, completeness, and clarity in generating case summaries and recommendations.
EAU Congress 2026, 13–16 March, London
