EAU 2026: Highlights from Day 3

Predictors of Recurrence After Bulbar Urethroplasty Following BPH Surgery: A Multicentre Retrospective Study

Presenter: M. Deger

Recurrence after urethroplasty for urethral strictures following benign prostatic hyperplasia (BPH) surgery remains a clinical challenge. This multicentre retrospective study evaluated factors associated with recurrence after bulbar urethroplasty performed for post-BPH urethral strictures. Medical records of 112 patients undergoing bulbar urethroplasty with dorsal or ventral buccal mucosal grafts or a non-transecting anastomotic technique were reviewed. Patients with traumatic strictures, balanitis xerotica obliterans, previous anastomotic urethroplasty, preoperative urinary incontinence, use of non-oral mucosal grafts, or missing follow-up data were excluded. 

Overall, 39 patients (30.7%) experienced recurrence. The recurrence group had significantly higher rates of chronic obstructive pulmonary disease and smoking history (p<0.001). Multivariate analysis identified smoking and COPD as independent predictors of recurrence (OR 8.9; 95% CI 2.4–31.6; p=0.001). No significant differences were observed between groups in the number of prior urethral interventions, type of urethroplasty, or graft length. Across the cohort, only one case of stress urinary incontinence occurred following ventral buccal mucosal graft urethroplasty.

In conclusion, recurrence after bulbar urethroplasty for urethral strictures following BPH surgery is significantly associated with patient-related factors, particularly smoking and chronic obstructive pulmonary disease, rather than surgical technique or graft characteristics.

Beyond LUTS: Broad Mental Health and Cognitive Benefits of BPH Surgery - Evidence from The Trinetx Global Network

Presenter: WY. Cheng

This retrospective cohort study used the TriNetX Global Collaborative Network, which includes electronic health records from 155 healthcare organizations worldwide, to evaluate long-term psychiatric and cognitive outcomes after BPH surgery. Male patients aged ≥40 years diagnosed with BPH between 2015 and 2024 were identified. Patients with prior depression, anxiety, insomnia, dementia, or delirium were excluded to assess new-onset outcomes. After propensity score matching (1:1) for age, comorbidities, medication use, and baseline lower urinary tract symptoms (LUTS), 20,323 patients were included in both the surgical and non-surgical cohorts. 

Compared with non-surgical management, surgical treatment was associated with significantly lower risks of persistent LUTS (HR 0.917; p<0.001), depression (HR 0.616; p<0.001), anxiety (HR 0.551; p<0.001), insomnia (HR 0.645; p<0.001), dementia (HR 0.705; p=0.013), and delirium (HR 0.694; p=0.007). Subgroup analyses showed that surgery significantly reduced the risk of depression and anxiety in both age groups. Additional reductions in LUTS and insomnia were observed in men aged 40–70 years, while reduced dementia risk was observed in men older than 70 years. Surgery also produced greater reductions in LUTS, depression, and anxiety among patients not receiving medications, whereas the effects were less pronounced in medication users.

The surgical treatment for benign prostatic hyperplasia is associated with significantly lower risks of persistent lower urinary tract symptoms and several psychiatric and cognitive disorders compared with non-surgical management.

Durability of Contemporary BPH Surgery: Real-World Reoperation Rates Across Eight Procedures

Presenter: Uy MU1

This study evaluated real-world reoperation rates after BPH procedures. Patients undergoing procedures including water vapor thermal therapy (WVTT), transurethral resection of the prostate (TURP), prostatic urethral lift (PUL), laser photovaporization (PVP), simple prostatectomy (SP), transurethral microwave thermotherapy (TUMT), robotic waterjet therapy (RWJT), and laser enucleation of the prostate (LEP) were identified. Reoperations were defined as a subsequent BPH procedure performed at least six months after the index procedure to exclude urgent or emergent surgeries related to the initial treatment.

A total of 56,703 patients were included. Median age was 73 years (IQR 37–78), and the median Elixhauser comorbidity score was 3 (IQR 1–5). Unadjusted reoperation rates varied by procedure, ranging from 2.6% for laser enucleation of the prostate to 16.1% for transurethral microwave thermotherapy. In multivariable analysis, preoperative catheter dependence was associated with a higher risk of reoperation (HR 1.1; 95% CI 1.0–1.2). Compared with TURP, higher reoperation risk was observed with TUMT (HR 2.4; 95% CI 2.2–2.8), PUL (HR 2.0; 95% CI 1.9–2.2), WVTT (HR 1.8; 95% CI 1.6–2.2), RWJT (HR 1.5; 95% CI 1.0–2.2), and PVP (HR 1.3; 95% CI 1.2–1.4). Lower risk of reoperation was observed with LEP (HR 0.4; 95% CI 0.3–0.5) and SP (HR 0.3; 95% CI 0.2–0.6).

This shows that, reoperation rates after surgical treatment for benign prostatic hyperplasia vary considerably by procedure, with laser enucleation and simple prostatectomy demonstrating the lowest risks, while minimally invasive therapies show higher retreatment rates.

A Phase 1 Safety, PK and Preliminary Efficacy Study of Localized Therapy Using Enolenâ® (Enzalutamide) Implants for Early-Stage Prostate Cancer

Presenter: B. Millan

This ongoing first-in-men Phase 1 trial (NCT06257693) evaluated the feasibility, safety, pharmacokinetics, and preliminary efficacy of Enolen®, a polymer-based enzalutamide implant designed for continuous local drug delivery to the prostate in men with localized prostate cancer. Up to 16 intraprostatic implants (~15 mm long, 1 mm diameter) were placed into MRI-visible lesions in men scheduled for robotic-assisted radical prostatectomy (RARP) within 6–12 weeks. Eligible patients had at least one biopsy-confirmed MRI-visible lesion >0.5 cm, PSA >3 ng/mL, and ISUP Grade Group ≥2. Plasma samples were collected for pharmacokinetic analysis, and prostate tissue was analyzed for enzalutamide levels at prostatectomy

As of October 31, 2025, 18 patients had consented and 15 patients (median age 64 years, range 50–76) received 7–16 implants (average 12). ISUP Grade Group ranged from 2 to 5. The average in situ implant duration was 52 days (range 41–71). Treatment-related adverse events included Grade 1 fatigue (n=1), Grade 1 procedure-related pain (n=4), and Grade 1 hematuria or dysuria (n=3 each). Grade ≥3 adverse events occurring after prostatectomy included small intestinal obstruction (n=1), anemia (n=1), hypertension (n=1), erectile dysfunction (n=1), and two Grade 2 thromboembolic events. Erectile dysfunction was not observed during the post-implant period. Mean testosterone levels were 502±96 ng/mL at screening and 449±86 ng/mL on the day of prostatectomy. Fourteen of 15 patients underwent RARP without delay to definitive treatment. Supratherapeutic enzalutamide levels were observed in prostate tissue surrounding the implants (mean 19,896±2,931 ng/g) with corresponding plasma levels of ~25 ng/mL (range 11.4–33.6 ng/mL) between days 8 and 29 after implantation.

In conclusion, intraprostatic implantation of the polymer-based enzalutamide delivery system demonstrated favourable feasibility, safety, and pharmacokinetic profiles, achieving high local drug concentrations with minimal systemic exposure.

Interim 24-Month Outcomes from A Randomized, Sham Controlled Study Evaluating A Novel Prostatic Urethral Stent for The Treatment Of BPH

Presenter: S.A. Kaplan

The ProVee Urethral Expander System is a minimally invasive device consisting of a nitinol stent and delivery system designed to treat lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH). The ProVIDE study is a prospective, randomized, double-blind, sham-controlled trial evaluating the safety and effectiveness of ProVee. A total of 221 men with symptomatic BPH (IPSS ≥13, Qmax ≤12 mL/s, prostate volume 30–80 cc, and prostatic urethral length ≥3.75 cm) were randomized. Subjects and research personnel, except the operating surgeon, were blinded to treatment for 3 months.

At 3 months, the ProVee arm showed a >125% greater mean improvement in IPSS compared with the sham arm (9.5 vs 5.6; p=0.001). At 12 months, mean IPSS improved by 38.3% from baseline (p=0.002). Among the 80 subjects who completed 24-month follow-up, the ProVee arm showed a 44.6% improvement in mean IPSS and an 85.5% improvement in mean Qmax compared with baseline. No procedural- or device-related serious adverse events were reported through 24 months. There were no cases of de novo sustained retrograde ejaculation or erectile dysfunction, and no extended postoperative urinary catheterization was required during the 24-month follow-up period.

The ProVee Urethral Expander System demonstrated significant and durable improvements in urinary symptoms and flow with a favourable safety profile, supporting its potential as an effective minimally invasive treatment option for men with lower urinary tract symptoms due to benign prostatic hyperplasia.

Real-World Evaluation of Clinically Meaningful Improvement in Symptoms and Quality of Life in Greek Patients with Benign Prostatic Hyperplasia After Six Months of Treatment with The Fixed Dose Combination of Dutasteride/Tamsulosin. Pooled Analysis of The PROSPERITY I and II Studies

Presenter: G. Tsioumas

A pooled analysis of the multicentre, prospective observational PROSPERITY I and II studies (NCT04831476) evaluated the 6-month effectiveness of fixed-dose dutasteride/tamsulosin combination therapy in Greek patients with BPH. A total of 1,296 men were enrolled (mean age 71.95±8.73 years; mean BPH duration 35±36.62 months). Symptoms were assessed using the International Prostate Symptom Score (IPSS), including total score (IPSS-T), storage symptoms (IPSS-S), voiding symptoms (IPSS-V), and quality of life (IPSS-L). 

Among enrolled patients, 1,099 (85%) completed 6 months of treatment and showed significant symptom improvement. Mean IPSS-T decreased by 9.44 points (95% CI −9.85 to −9.03; p<0.001), IPSS-S by 3.77 points (95% CI −3.95 to −3.59; p<0.001), and IPSS-V by 5.67 points (95% CI −5.93 to −5.41; p<0.001). Quality of life also improved, with IPSS-L decreasing by 1.94 points (95% CI −2.02 to −1.86; p<0.001). Multivariate analysis showed that worse baseline QoL increased the likelihood of clinically meaningful improvement (OR 2.27; p<0.001). Larger prostate size (OR 0.99; p=0.001), presence of at least one comorbidity (OR 0.63; p<0.001), and prior combination therapy (OR 0.60; p=0.015) were associated with lower response probability. Cardiovascular (OR 2.49; p<0.001), gastrointestinal (OR 1.72; p=0.035), malignancy (OR 2.20; p=0.041), and dermatological disorders (OR 8.90; p=0.004) were independently associated with greater improvement.

The fixed-dose dutasteride/tamsulosin combination therapy was associated with significant improvements in urinary symptoms and quality of life in men with BPH, with treatment response influenced by baseline symptom severity, prostate size, comorbidities, and prior therapy.

Integrating Patient Priorities into Personalized Surgical Decision-Making for BPH: A Patient-Centred Digital Interactive Decision Aid

Presenter: M. Cheetham

This study evaluated a digital interactive Patient Decision Aid (PtDA) designed to support shared decision making. The PtDA uses a Fast-and-Frugal Trees (FFT) method, which guides patients through a structured stepwise process to clarify personal priorities, such as symptom relief, speed of improvement, and procedural invasiveness, and match them to treatment options. 

Ten BPH patients and ten urologists evaluated the PtDA using a semi-structured enquiry and assessment protocol. Inductive–deductive thematic analysis was used to assess user engagement, comprehensibility, perceived utility, and feasibility in clinical practice. Patients reported that the stepwise approach was intuitive and helped them organize their thoughts, identify treatment priorities, and feel more confident and prepared for shared decision making. Urologists reported that the tool could streamline consultations, improve efficiency, and support value-based decision making. Suggested improvements included the use of more lay-friendly terminology and age-adapted interface features such as larger buttons and tooltips to improve usability.

The digital interactive patient decision aid using a Fast-and-Frugal Trees approach was well received by both patients and urologists, demonstrating potential to enhance shared decision making by helping patients clarify treatment priorities and facilitating more efficient, patient-centred consultations in BPH care.

Risk of Death After Aquablation and Minimally Invasive Surgical Treatment for LUTS/BPH: Analysis of The Food And Drug Administration's Manufacturer and User Facility Device Experience Database

Presenter: A. Nacchia

This study evaluated reported deaths associated with these procedures using the U.S. Food and Drug Administration Manufacturer and User Facility Device Experience (MAUDE) database. Medical device were reviewed for water vapor thermal therapy (WVTT), temporary implanted nitinol device (Tind), prostatic urethral lift (PUL), Aquablation, and Optilume. Death reports were identified and categorized based on the reported event and procedure type.

A total of 2,496 adverse events were reported during the 10-year period. Of these, 398 (16%) were related to PUL, 1,038 (41%) to Aquablation, 1,028 (41%) to WVTT, 14 (1%) to Tind, and 18 (1%) to Optilume. Overall, 43 deaths (1.7%) were reported. Fatal events included 12/398 (3%) with PUL, 22/1,038 (2%) with Aquablation, and 9/1,028 (0.9%) with WVTT, while no deaths were reported for Optilume or Tind. In all reported deaths related to Aquablation and PUL, no specific device- or use-related issue was identified. Cardiac arrest was the most common reported cause of death, accounting for 7/22 (32%) Aquablation cases, 3/12 (25%) PUL cases, and 2/9 (22%) WVTT cases. Embolism was another reported cause of death for Aquablation, occurring in 6/22 cases (27%).

The analysis of MAUDE database reports suggests that deaths associated with minimally invasive therapies and Aquablation for LUTS/BPO are rare, with most cases lacking identifiable device-related causes.

Accuracy, Readability, and Understandability of EAU Guidelines Bot for Male Non-Neurogenic LUTS Guidelines

Presenter: E. Pilliteri

A guidelines chatbot has recently been introduced to assist urologists in navigating the European Association of Urology (EAU) guidelines; however, external validation is limited. This study evaluated the accuracy, completeness, and clarity of the EAU Guidelines Bot for the male non-neurogenic lower urinary tract symptoms (LUTS) guidelines. A total of 105 questions based on guideline recommendations were developed and submitted to the bot. Responses were independently assessed by two expert urologists using a 5-point Likert scale, with a third reviewer consulted in cases of disagreement. Outcomes were analyzed by guideline chapter and recommendation strength.

Among the 105 responses evaluated, 95 (92%) were rated as accurate (score 4–5), while 3 (3%) had fair accuracy (score 3). In terms of completeness, 102 responses (97%) were rated as complete (score 4–5), with 3 (3%) considered incomplete. Clarity was also rated highly, with 102 responses (97%) classified as clear (score 4–5), while 3 responses were considered unclear. No differences were observed when comparing responses related to strong versus weak guideline recommendations.

In conclusion, the EAU Guidelines Bot demonstrated high levels of accuracy, completeness, and clarity in responding to questions on male non-neurogenic LUTS guidelines, supporting its potential as a reliable tool to assist urologists in accessing and interpreting guideline-based recommendations.

Therapeutic Intervention for Control of LUTS After TURBT: Prospective Comparison Between Tamsulosin, Oxybutynin And Control

Presenter: M. Capinha

Lower urinary tract symptoms (LUTS) are common after transurethral resection of bladder tumor (TURBT), affecting approximately 90% of patients. This prospective, non-randomized comparative study evaluated the efficacy of oxybutynin 5 mg three times daily versus tamsulosin 0.4 mg once daily for the management of post-operative LUTS. A total of 119 patients undergoing TURBT between April and August 2024 were screened, and 64 were included after exclusions; 48 completed the study. Patients were assigned to oxybutynin, tamsulosin, or control groups. 

In the oxybutynin group, dysuria significantly decreased from the first postoperative day to two weeks after catheter removal (VAS 4.50, IQR 4.00 vs 0.00, IQR 1.00; p<0.001). In the tamsulosin group, significant reductions were observed in total IPSS between two days and two weeks after catheter removal (10.00, IQR 6.00 vs 6.00, IQR 7.00; p<0.001) and between preoperative assessment and two weeks after catheter removal (13.00, IQR 10.00 vs 6.00, IQR 7.00; p<0.001). Storage IPSS also decreased significantly between two days and two weeks after catheter removal (6.00, IQR 5.00 vs 4.00, IQR 4.00; p<0.001) and between preoperative assessment and two weeks after catheter removal (7.00, IQR 7.00 vs 4.00, IQR 4.00; p<0.001). Quality-of-life IPSS scores improved between two days and two weeks after catheter removal (2.00, IQR 1.00 vs 1.00, IQR 1.00; p<0.001) and between preoperative assessment and two weeks after catheter removal (2.00, IQR 1.00 vs 1.00, IQR 1.00; p<0.001). 

Both oxybutynin and tamsulosin were associated with improvements in postoperative LUTS after TURBT, with oxybutynin primarily reducing dysuria and tamsulosin improving overall symptom scores and quality of life.

Differential Downregulation of Piezo1 and Piezo2 in Patients with BPH and Chronic Urinary Retention

Presenter: L. Albuquerque

Piezo1 and Piezo2 are mechanosensitive channels involved in stretch-induced signalling in the lower urinary tract and play a role in bladder sensation and voiding reflexes. This study evaluated PIEZO1 and PIEZO2 mRNA expression in bladder tissue from men with benign prostatic hyperplasia (BPH). A total of 61 patients undergoing simple prostatectomy for BPH were included, and 15 cadaveric organ donors served as controls. All patients underwent preoperative evaluation including urodynamics. During surgery, full-thickness bladder wall samples were collected for gene expression analysis. 

Among the 61 patients (median age 72 years; median prostate volume 141 cm³), 33 (54.1%) voided spontaneously and 28 (45.9%) had urinary retention. Median bladder outlet obstruction index was 77 and median bladder contractility index was 115. Compared with controls, both PIEZO1 and PIEZO2 mRNA expression were significantly downregulated in the urothelium and detrusor of BPH patients (all p<0.05). Urothelial PIEZO1 expression was lower in patients with urinary retention than in those with spontaneous voiding (0.00065±0.00012 vs 0.00090±0.00024; p=0.044). PIEZO2 expression was also reduced in retention cases (0.00162±0.00036 vs 0.00424±0.00059; p=0.010). Detrusor PIEZO2 expression showed a negative correlation with bladder compliance (r=–0.28; p=0.046) but was not correlated with postvoid residual volume, bladder outlet obstruction index, or bladder contractility index. No differences in PIEZO1 or PIEZO2 expression were observed between patients with and without detrusor overactivity.

The reduced expression of PIEZO1 and PIEZO2 in the bladder tissue of men with BPH, particularly in those with urinary retention, suggests that impaired mechanosensory signalling may contribute to bladder dysfunction associated with bladder outlet obstruction.

 

EAU Congress 2026, 13–16 March, London