EAU 2026: Highlights from Day 4
Validation of The Epi-FAB Score to Predict Residual Disease Following Cooled Focal Laser Ablation with Profocaltm in Prostate Cancer
Presenter: Y. Bushati
Multiparametric MRI (mpMRI) is used for planning and monitoring focal therapy in prostate cancer. This retrospective cohort study evaluated the early Prostate Imaging after Focal Ablation (ePI-FAB) score in predicting residual cancer after cooled focal laser ablation (CFLA) with ProFocal™. A total of 100 patients with localized prostate cancer underwent mpMRI within 14 days post-treatment. Images were reviewed by a radiologist blinded to 3-month biopsy results and scored using the ePI-FAB system (scores 1–3).
Increasing ePI-FAB scores were significantly associated with residual cancer (χ² = 34, p < 0.001). ROC analysis showed strong predictive performance (AUC 0.83, 95% CI 0.74–0.93). Using a MRI score ≥2 threshold gave 83% sensitivity, 79% specificity, and 80% accuracy. Residual cancer occurred in 6.2% of score 1, 43% of score 2, and 71% of score 3 cases, indicating the score’s ability to stratify risk after focal therapy.
Delaying Biochemical Recurrence Post-RP: The Long-Term Impact of Testosterone Replacement Therapy Vs. No Treatment
Presenter: E. Haddadin
Testosterone replacement therapy (TRT) has traditionally been contraindicated in men with prostate cancer. This retrospective single-surgeon study evaluated long-term outcomes of TRT after radical prostatectomy (RP) with a mean follow-up of 7.27 years. The analysis included 273 men who received TRT (topical cream, gel, or intramuscular injection) after RP.
Patients were frequency matched 1:1 with controls based on preoperative characteristics including calculated free testosterone (cFT), total testosterone (TT), PSA, prostate weight, age at surgery, Gleason score, and pathological stage. Baseline characteristics were similar between groups except for sex hormone-binding globulin (SHBG) levels (41.3 vs 45.4 nmol/L; p=0.0372). Patients receiving TRT had a significantly lower risk of biochemical recurrence (BCR) and longer time to BCR (p<0.001 and p=0.0292, respectively). There was no significant difference in prostate cancer–specific mortality (PCSM).
15-year Kaplan–Meier analyses showed significant differences for time to BCR (p<0.0001) and time to PCSM (p=0.02). These findings suggest TRT after RP may reduce the risk of BCR with long-term follow-up.
PC-PEP Phase 4: International Implementation of a Digital Whole-Person Survivorship Program for Men with Prostate Cancer
Presenter: R. Rutledge
The Prostate Cancer Patient Empowerment Program (PC-PEP) is a 6-month digitally enabled survivorship program integrating physical activity, mindfulness, pelvic-floor training, nutrition, and peer support for men with prostate cancer. Phase 4 of the program was implemented as a multi-site international initiative across 11 Canadian provinces and expansion sites in New Zealand and South Africa. This ongoing prospective implementation trial enrolled 705 participants between January 2024 and October 2025 (Canada: 650, New Zealand: 50, South Africa: 5). The mean age was 67.4 ± 6.8 years, with 78% post-treatment and 22% on active surveillance.
Participants completed daily activities and attended monthly virtual sessions, with outcomes assessed using validated questionnaires. Mean program satisfaction was 8.3 ± 1.1/10, and feasibility of clinical integration was rated 8.9 ± 0.9/10. In the Canadian randomized trial subset, the program produced a mean reduction of 8.7 points in psychological distress (K10; p < 0.001) and improved urinary incontinence scores by 13 EPIC points at 6 months (p < 0.01). Mediation analysis showed 41% of continence improvement was attributable to adherence behaviors. Participants in New Zealand reported improved energy and social connectedness, while preliminary South African data showed >90% weekly adherence.
These findings indicate that PC-PEP is a feasible and scalable survivorship model with positive psychosocial and urinary outcomes.
Risk Factors and Microbial Etiology of Healthcare-Associated Urinary Tract Infections in Neurological Patients: Analysis of 1100 Cases
Presenter: S.V. Kotov
This study evaluated risk factors and microbial patterns of healthcare-associated urinary tract infections (UTIs) in neuro-urological patients to improve prevention and treatment strategies. The analysis included 1100 adult patients (2022–2025) with a median age of 62 years, of whom 68% were men. Neurological conditions included stroke sequelae (40%), spinal cord injuries (35%), multiple sclerosis (15%), and other disorders (10%).
The overall UTI incidence was 32.7% (p<0.001). Infection rates varied by bladder management method: indwelling urethral catheterization (71.2%, p<0.001), suprapubic cystostomy (46.4%, p<0.001), intermittent catheterization (18.5%, p=0.003), and spontaneous voiding (9.2%). However, spontaneous voiding showed higher risk of hydronephrosis (18.5%, p<0.01) and renal function deterioration (12.4%, p<0.05). The most common pathogens were Escherichia coli (45%), Klebsiella pneumoniae (28%), Pseudomonas aeruginosa (22%), and Proteus mirabilis (12%), with polymicrobial infections in 18%. High antimicrobial resistance was observed: ampicillin 86.5%, ciprofloxacin 54.3%, and third-generation cephalosporins 42.7% (all p<0.001). Carbapenem resistance was found in 15% of Enterobacterales (p=0.002) and 31% of Pseudomonas aeruginosa (p<0.001).
Multivariate analysis identified indwelling urethral catheterization (OR 12.4, 95% CI 8.1–19.0) and suprapubic cystostomy (OR 4.8, 95% CI 2.9–8.1) as significant risk factors. Each additional catheterization day increased infection risk by 8% (OR 1.08, 95% CI 1.05–1.11).
Magnetic Resonance Imaging at Initial Suspicion of Prostate Cancer: Experience and Mid-Term Outcomes
Presenter: Estella Lucena M.D.L.P
This study evaluated the effectiveness of an MRI-first diagnostic pathway for suspected prostate cancer, where biopsy is performed only in patients with suspicious MRI findings. Data were obtained from a prospective database of 1512 men who underwent prostate MRI. The mean age was 65.1 ± 8.2 years, mean PSA 6.99 ± 3.21 ng/mL, and mean prostate volume 60.8 ± 36.1 cc. MRI findings included PI-RADS 3 (168; 23.3%), PI-RADS 4 (399; 55.3%), and PI-RADS 5 (149; 20.7%). Among suspicious lesions, 568 cases (78.78%) were biopsy-confirmed positive.
Biopsy was performed when overall cancer risk >20% (213 patients; 26.96%), with 86 positive biopsies (44 with Grade Group ≥2). In the 12.5–20% risk group with significant cancer risk >4%, 2 patients underwent biopsy and both were positive (GG≥2). Based on physician discretion, 125 patients were biopsied, with 63 positive cases and 41 with Grade Group ≥2 disease.
During follow-up, 69 patients (8.25%) underwent a second MRI, with suspicious lesions detected in 14 cases, of which 9 (64.29%) were malignant. Additionally, 79 patients (9.45%) underwent a second biopsy, with malignancy detected in 27 (34.2%). Overall, cancer was detected in 46 patients (44.7%) undergoing second biopsy, including 27 cases (58.7%) with ISUP Grade Group ≥2. These findings support the MRI-first strategy combined with RPCRC as a safe approach that may reduce unnecessary biopsies.
5-Year Outcomes of Optilume for Recurrent Anterior Urethral Strictures: Pooled Results from The Robust I, II and III Trials
Presenter: S.P. Elliott
This analysis pooled data from three clinical studies evaluating the Optilume drug-coated balloon (DCB) for recurrent anterior urethral strictures: ROBUST-I (53 patients), ROBUST-II (16 patients), and ROBUST-III (125 patients). A total of 194 men with anterior urethral strictures ≤3 cm and 1–4 prior endoscopic interventions were treated with DCB. Outcomes assessed included International Prostate Symptom Score (IPSS), peak urinary flow rate (Qmax), freedom from re-intervention (FFR), erectile function, and safety.
Mean IPSS improved from 22.7 at baseline to 11.8 at 5 years, while Qmax increased from 7.1 mL/s to 14.6 mL/s. Kaplan–Meier analysis estimated 5-year freedom from re-intervention at 65%. In crossover patients, FFR was 53%, while excluding crossover patients increased the pooled FFR to 67%. No negative impact on erectile function was observed, and no serious adverse events were reported.
These findings show sustained improvement in symptoms and urinary flow over 5 years following treatment with the Optilume DCB.
A Randomized, Double-Blind, Prospective, Multicenter Trial of Lipus Therapy for Urinary Incontinence Recovery Following Robot-Assisted Radical Prostatectomy
Presenter: D. Cui
This multicenter, double-blinded randomized study evaluated the effectiveness of low-intensity pulsed ultrasound (LIPUS) in treating post-prostatectomy urinary incontinence (PPI) following robot-assisted radical prostatectomy (RARP). A total of 254 men with urinary leakage two weeks after RARP were randomized 2:1 to receive active LIPUS therapy or zero-dose treatment, while both groups performed pelvic floor exercises. The active group received LIPUS (400 mW/cm²) twice weekly for 8 weeks (16 sessions, 20 minutes each).
At 12 weeks, the LIPUS group showed significantly lower leakage on the 1-hour pad test (0 g vs. 1.90 g; p=0.002). Median time to zero pad use was 13 weeks with LIPUS vs. 28 weeks in controls, indicating a 15-week faster recovery of continence. Patients receiving LIPUS also used fewer pads per day (5 vs. 7; p=0.002) and more frequently improved from moderate to mild/no incontinence (55.26% vs. 35.71%; p=0.017). Significant improvements were also seen in ICI-Q-SF scores (6 vs. 8; p=0.034), ICI-Q-SF reduction rate (-64% vs. -50%; p=0.046), and I-QOL scores (89.77 vs. 81.25; p=0.034).
These findings suggest LIPUS therapy accelerates continence recovery and improves quality of life in patients with PPI.
Surgical Indication at 6 Months for Post-Prostatectomy Urinary Incontinence Risks Overtreatment and Inappropriate Sling Vs. AUS Selection
Presenter: R. Domínguez
This study evaluated how stress urinary incontinence (SUI) severity changes between 6 and 12 months after radical prostatectomy (RP) and how this affects decisions on surgical treatment. Data from a prospectively maintained database (2001–2025) included 1,476 men with paired 24-hour pad test (24h-PT) results. At 6 months, 56% had mild SUI (<100 g), 22% moderate (100–399 g), and 22% severe (≥400 g), with median pad-test values of 7 g, 205 g, and 737 g, respectively.
Among 820 men with mild SUI, 99.9% remained mild and 0.1% progressed to moderate at 12 months. Of 328 men with moderate SUI, 91% improved to mild, 8.2% remained moderate, and 0.9% progressed to severe. Among 328 men with severe SUI, 57% improved to mild, 24% improved to moderate, and 20% remained severe at 12 months.
Overall, half of men with severe SUI at 6 months improved to mild SUI at 12 months, and one-quarter improved to moderate SUI, suggesting many patients initially considered for artificial urinary sphincter (AUS) could later be suitable for sling therapy or observation. These findings indicate significant spontaneous recovery between 6 and 12 months, supporting delayed surgical decision-making.
Metaphylaxis of Recurrent UTI by A Combined Medical Therapy. A Randomized Placebo-Controlled Trial
Presenter: L. Spivak
This open-label prospective multicenter randomized phase IV study evaluated whether D-mannose–based combination therapy could reduce relapse frequency in women with recurrent lower urinary tract infections (UTIs). A total of 96 women aged 18–45 years (median age 29.2 ± 7.3 years) with recurrent UTIs were enrolled. All patients received 1 week of antibiotic therapy (furazidin, nitrofurantoin, or nifuratel). The experimental group additionally received D-mannose (2000 mg), cranberry extract (500 mg), and vitamin D3 (500 IU) for 3 months. Patients were followed for 12 months, with symptom monitoring using the ACSS questionnaire, along with urinalysis, urine culture, and RP-PCR testing.
At 3 months, the relapse rate was significantly lower in the experimental group (46%) compared with the control group (73%) (p=0.012). The median time to relapse was longer with combination therapy (135 days; 95% CI 82–167) compared with control (54.5 days; 95% CI 42–82), with a hazard ratio for relapse of 0.49 (95% CI 0.32–0.74). No differences in ACSS scores were observed after 7 days of treatment, but after 3 months, improvement in the “typical symptoms” domain favored the experimental group. No serious adverse events were reported.
These findings suggest that D-mannose–based combination therapy can reduce early recurrence and prolong time to relapse in women with recurrent UTIs.
Accuracy, Readability, and Understandability of EAU Guidelines Bot for Urinary Infections Guidelines
Presenter: L.M. Coppola
This study evaluated the accuracy, completeness, and clarity of the EAU guidelines bot designed to assist urologists in interpreting urinary infection guidelines. A total of 109 questions based on the EAU infection guideline recommendations were developed and entered into the bot. Responses were independently evaluated by two expert urologists using a 5-point Likert scale, with disagreements resolved by a third reviewer.
Overall, 98/109 responses (89%) were rated accurate (score 4–5), 7/109 showed fair accuracy, and 4/109 were considered inaccurate. For completeness, 101/109 responses (92%) were rated complete, 4/109 had fair completeness, and 4/109 were incomplete. Regarding clarity, 102/109 responses (94%) were rated clear, 6/109 showed fair clarity, and 1/109 was unclear. No differences were observed between responses related to strong versus weak guideline recommendations.
These findings indicate that the EAU guidelines bot generally provides accurate and clear responses, although further refinement may improve its performance.
The COBRA Study: Chemoablation or Bladder Resection with Adjuvant Chemotherapy in Recurrent Non-Muscle Invasive Bladder Cancer
Presenter: S. Klingenberg
This international multicenter randomized controlled trial is evaluating dose-dense mitomycin C (MMC) chemoablation as an alternative to standard surgical management for recurrent Ta low-grade non-muscle invasive bladder cancer (NMIBC). The study is being conducted across nine Nordic sites in Denmark, Norway, Sweden, and Iceland, with a target enrollment of 272 patients who have recurrent Ta LG NMIBC and no prior intravesical therapy. Participants are randomized 1:1 into two groups.
The control arm undergoes TURBT or office-based tumor removal followed by adjuvant MMC or BCG depending on histology. The intervention arm receives dose-dense MMC chemoablation (three instillations per week for two weeks), followed by continued MMC or tumor removal with BCG depending on treatment response. As of October 2025, 14 patients have been enrolled at Aarhus University Hospital in Denmark. The primary endpoint is 2-year recurrence-free survival (RFS), while secondary outcomes include 5-year RFS, progression-free survival, overall survival, and number of TURBT or office procedures during follow-up.
Statistical analyses will include Kaplan–Meier survival curves, log-rank testing, chi-squared analysis, and Cox proportional hazards models to estimate hazard ratios with 95% confidence intervals.
Bacteriophage Therapy in Women with Chronic Recurrent Cystitis Caused by Multidrug-Resistant Bacteria: A Prospective, Observational, Comparative Study
Presenter: D. Krakhotkin
This clinical trial evaluated the effectiveness of bacteriophage therapy alone and in combination with antibiotics in women with chronic recurrent cystitis caused by multidrug-resistant bacteria. A total of 217 women were initially screened, and 178 patients were included in the final analysis. Patients were allocated into four groups: Group I received bacteriophage therapy (Sextaphage) alone; Group II received bacteriophage plus furazidin; Group III received bacteriophage plus furazidin and cefixime; and Group IV received furazidin and cefixime without bacteriophage.
After 14 days of treatment, significant improvements in Acute Cystitis Symptom Scale (ACSS) scores for typical symptoms, differential symptoms, and quality-of-life domains were observed in groups II, III, and IV. Pain scores on the visual analog scale also decreased significantly in these groups compared with bacteriophage monotherapy (group I). In group I, the mean bacteriuria level of Escherichia coli decreased from 10⁶ to 10² CFU/mL after 14 days. Improvements in voided volume were seen in groups II, III, and IV, while daytime and nighttime urinary frequency decreased significantly in all four groups by day 14.
These findings suggest bacteriophage therapy, alone or combined with antibiotics, may help improve symptoms and support treatment of multidrug-resistant cystitis.
The New Graft Era in Panurethral Reconstruction: Long-Term Outcomes of Split-Thickness Thigh Skin Urethroplasty
Presenter: B. Bucca
This study evaluated single-stage dorsal onlay urethroplasty using an extended split-thickness thigh skin graft (STSG) as an alternative to buccal mucosa for panurethral strictures. Between 2019 and 2023, 17 patients (mean age 55.6 years) underwent the procedure using a one-sided perineal approach with penile invagination. The urethra was dissected while preserving vascular supply, followed by dorsal urethrotomy and placement of a fenestrated STSG (up to 20 cm) harvested from the thigh.
The mean stricture length was 10.4 cm, with iatrogenic causes (70.6%) and lichen sclerosus (23.5%) being the most common etiologies. Median operative time was 249 minutes, with a hospital stay of 5 days and minor complications in 11.8% of patients. Functional outcomes improved significantly, with median Qmax increasing from 8.2 to 22.3 mL/s, remaining >18 mL/s at 3 years, along with preserved erectile function and >80% patient satisfaction.
The findings suggest that STSG urethroplasty is a durable and effective option for long urethral strictures when buccal mucosa is unsuitable.
Female Urethroplasty: What Did The 100 Consecutive Cases Over Nine Years Teach Us?
Presenter: R S.
This retrospective study analyzed outcomes of female urethroplasty for female urethral stricture (FUS) at AIIMS Bhubaneswar between 2016 and 2025, representing the largest single-center series reported to date. A total of 111 patients underwent urethroplasty, with 106 (99.1%) completing ≥6 months follow-up (mean 46.38 ± 21.4 months). Surgical techniques included ventral inlay buccal mucosal graft urethroplasty (VI-BMGU, n=70), dorsal onlay buccal mucosal graft urethroplasty (DO-BMGU, n=37), and labia minora graft urethroplasty (LMGU, n=4).
Postoperatively, there was significant improvement in AUA symptom score, maximum urinary flow rate (Qmax), and postvoid residual urine (PVR). The overall success rate was 85.82% (91 patients), while 15 patients (14.15%) experienced anatomical failure. Among the anatomically successful patients, 19 (17.92%) had functional failure with persistent symptoms despite anatomical patency. Failures were associated with higher postoperative AUA symptom scores and PVR, and lower Qmax compared with the success group (p < 0.05).
These results demonstrate that female urethroplasty provides durable anatomical and functional outcomes, with significant improvements in AUA symptom score and urinary flow parameters.
EAU Congress 2026, 13–16 March, London
