It’s Saturday, which means it’s time for your PSAWeekly. This week, we’re highlighting a particularly interesting topic that could directly influence your practice by introducing a new approach that may be incorporated into routine general surgery procedures.

We’re also adding an extra issue this week to help cover the most important articles, so you can stay up to date with the key developments that matter most. If you find this issue valuable, please consider referring your colleagues to PSAWeekly.com so they can join our growing community of urologists and never miss a brief.

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This study examined whether suprapubic urinary diversion or transurethral diversion leads to better outcomes after hypospadias repair in children. Hypospadias surgery often requires temporary urinary drainage to protect the surgical site during healing, but there is still disagreement over which method is more beneficial.

The authors carried out a systematic review and meta-analysis following PRISMA guidelines. They searched major medical databases and included studies that directly compared the two diversion techniques in pediatric patients. In total, five studies involving 680 children were included. The main outcomes assessed were urethrocutaneous fistula, meatal stenosis, and bladder spasms.

The pooled results initially showed no clear overall difference between suprapubic and transurethral diversion in the rate of fistula formation. However, when one highly variable study was removed in a sensitivity analysis, suprapubic diversion appeared to be associated with a lower risk of fistula. For meatal stenosis, the two approaches produced similar results, with no statistically meaningful difference. Regarding bladder spasms, the first combined analysis also found no major difference, but after sensitivity analysis, suprapubic diversion seemed to reduce this complication.

The review also discussed other postoperative outcomes such as urethral stricture, wound infection, repair disruption, hospital stay, nursing care, and cosmetic satisfaction. These findings were inconsistent across studies. Some reports suggested that suprapubic diversion caused less discomfort and made postoperative care easier, while others found that transurethral stenting produced better cosmetic results and fewer complications. Because the included studies differed in design, patient characteristics, surgical methods, and catheter types, the findings were not fully consistent.

Overall, the authors concluded that both urinary diversion methods are reasonable options after hypospadias repair. Although suprapubic diversion may have some possible benefits in selected outcomes, the current evidence is not strong enough to prove that it is clearly better or worse than transurethral diversion. The limited number of studies, small sample sizes, and differences between studies prevent a firm clinical recommendation. The paper emphasizes the need for larger, better-designed randomized trials with standardized reporting to determine the best diversion strategy.

This study examined whether aspects of men’s sexual behavior are linked to the risk of developing lower urinary tract symptoms (LUTS). To do this, the authors combined data from two cross-sectional sources: 4,241 men from the U.S. NHANES surveys collected between 2005 and 2018, and 1,240 men from a questionnaire-based study in China conducted in 2024. The goal was to identify which sexual behavior patterns might be associated with either higher or lower odds of LUTS.

The results suggest that some sexual behavior factors may be linked to a lower likelihood of urinary symptoms. In both datasets, men who reported their first sexual intercourse at age 20 or older were less likely to have LUTS. In the U.S. cohort, men with a higher annual frequency of sexual activity especially 104 or more times per year also showed lower odds of LUTS after adjustment for other factors. In the Chinese cohort, greater sexual satisfaction was similarly associated with fewer urinary symptoms.

The study also found several factors associated with worse urinary symptoms. Across both groups, common health conditions such as hypertension, diabetes, and prior heart attack were linked to a greater risk of LUTS. In the Chinese sample, alcohol use was also associated with higher odds of symptoms. Two behavior-related findings stood out in that cohort: men who urinated immediately after sex and those who had used medication to improve sexual performance were more likely to report LUTS.

The authors argue that LUTS in men may be influenced not only by age and medical conditions, but also by sexual health and behavior. Their interpretation is that a more balanced sexual life and better sexual well-being may be connected with lower urinary symptom burden. At the same time, they stress that the study does not prove cause and effect, because both datasets are cross-sectional and based partly on self-reported information.

Overall, the paper suggests that sexual history and sexual well-being may be useful to consider when evaluating men with LUTS. However, the findings should be interpreted cautiously, since the design cannot show whether these behaviors directly change LUTS risk, and the Chinese sample may not represent the broader population.

This study evaluated whether contrast-free biparametric MRI (bpMRI) could work as an early screening tool for prostate cancer in younger, asymptomatic men. The researchers analyzed 641 men, mostly active-duty military personnel aged 40–69, to describe normal prostate MRI patterns in this age group, measure how often clinically significant prostate cancer was found, and identify factors linked to higher cancer risk.

A major finding was that the prostate often looks different in younger men than in older patients typically seen in prostate imaging studies. In this cohort, the peripheral zone commonly showed heterogeneous low signal on T2-weighted images and diffusion patterns that might appear suspicious if age-related changes are not recognized properly. The authors suggest that these appearances may reflect normal tissue composition in younger men rather than disease, which is important for avoiding overcalling benign findings.

Most scans were low risk by MRI scoring: over 80% were PI-RADS 2, while only a small fraction were PI-RADS 4 or 5. Of the 641 men, 41 underwent targeted biopsy, and 23 were found to have clinically significant prostate cancer, which equals 3.6% of the full screened group. This suggests that MRI-first screening may detect meaningful cancers even in men without symptoms, while limiting biopsy to a relatively small subgroup.

The strongest predictors of clinically significant prostate cancer were PSA density of at least 0.15 ng/mL/mL, PI-RADS 4–5 lesions, and a family history of prostate cancer. Age and other health conditions did not remain independent predictors after adjustment. In practical terms, the study argues that MRI findings become more useful when interpreted together with PSA density and inherited risk.

The authors also noted that MRI frequently revealed incidental findings outside the prostate, such as diverticulosis, inguinal hernias, and occasional bladder or lymph node abnormalities. This broadens the potential clinical value of screening MRI, though it can also lead to additional follow-up.

Overall, the paper concludes that non-contrast prostate MRI may be a feasible and informative first-line screening approach in younger men, especially when combined with PSA density and family history for better risk stratification. However, the results should be interpreted cautiously because the study was done at a single center, involved a relatively healthy and specialized population, and did not include long-term follow-up for all participants.

This article compares the two leading single-port robotic radical prostatectomy techniquesextraperitoneal (EP) and transvesical (TV) using a large multi-institutional dataset from the SPARC consortium. After matching patients with similar baseline cancer and prostate features, the authors found that both approaches had similar operative times, low complication rates, comparable positive surgical margin rates, and similar short-term biochemical recurrence outcomes, suggesting that both are oncologically sound and technically safe options.

The main differences appeared in postoperative recovery. Patients who underwent the transvesical approach were more likely to go home the same day, needed less opioid medication, and had their catheters removed sooner. The TV group also showed faster recovery of urinary continence, with better pad-free or near-pad-free rates in the first weeks and months after surgery. Erectile function recovery was also reported as favorable in the transvesical group, while long-term cancer control appeared similar between the two techniques over the available follow-up period.

Another notable point is that the transvesical method seemed especially useful in patients with prior abdominal surgery or more complex abdominal histories, since it may avoid some of the challenges associated with other access routes. Still, the authors caution that the study was retrospective, surgeon practices varied across centers, and long-term follow-up remains limited, so future prospective studies are needed to confirm durability of both cancer and functional outcomes.

This randomized Scandinavian trial compared two surgical options for short, nonobliterative bulbar urethral strictures: transecting excision and primary anastomosis (tEPA) and buccal mucosa graft (BMG) urethroplasty. Adults treated at four centers between 2015 and 2019 were assigned to one of the two techniques and followed after surgery to assess sexual and penile outcomes, recurrence, and complications. The investigators found that baseline characteristics were similar between groups, making the comparison more reliable.

The main finding was that patients who underwent tEPA experienced more penile- related complications than those treated with BMG urethroplasty. Reports of weaker ejaculation early after surgery, reduced glans rigidity, perceived penile shortening, and temporary changes in penile angulation were more common in the transecting group. By contrast, erectile function scores did not differ significantly between the two approaches, suggesting that overall erectile performance was broadly comparable despite the higher rate of other sexual or penile side effects with tEPA.

In terms of surgical success, the two methods performed similarly for stricture control. Recurrence rates were nearly the same in both groups, and postoperative urinary flow and residual urine outcomes were not meaningfully different. However, postoperative bleeding occurred more often after tEPA, while patients in the BMG group had a small risk of mild oral discomfort related to graft harvest. Overall, the study suggests that when technically feasible, avoiding transection of the corpus spongiosum may reduce penile complications without compromising short-term functional success.

This commentary argues that the real importance of robotic bladder tumor surgery is not the robotic hardware itself, but the fact that it may help advance and standardize en bloc resection of bladder tumour (ERBT) as an anatomically precise surgical method. The authors highlight the first-in-human VIABLE trial of the Virtuoso Endoscopy System as an important proof of feasibility and safety, especially because bladder surgery is technically difficult due to the organ’s changing shape and lack of fixed landmarks. In their view, the study shows that robotics can support more controlled and reproducible transurethral dissection.

The article emphasizes, however, that the larger shift in bladder cancer surgery is the move from piecemeal TURBT toward ERBT. According to the authors, ERBT has already shown advantages such as improved staging quality, lower recurrence, and possible downstream cost benefits even when carried out with conventional instruments. For that reason, they suggest that the key innovation is the adoption of a clear anatomical resection strategy, while robotics should be seen as an enabling platform rather than the main goal.

A central theme of the piece is that future technologies such as artificial intelligence, digital guidance, and automation require procedures that are standardized and clearly structured. The authors argue that ERBT fits this need because it can be defined and mapped in a consistent way, whereas piecemeal resection is less suitable for this kind of technological integration. From this perspective, robotic ERBT may help transform surgery into something more teachable, reproducible, and eventually less dependent on individual surgeon variation.

At the same time, the commentary stresses that broad improvements in patient care will depend more on teaching the principles of anatomical ERBT widely than on access to expensive robotic systems. Robotic tools may be valuable in expert centers and may help prepare surgery for future digital developments, but they should not be seen as necessary for delivering high-quality bladder cancer treatment. The authors conclude that widespread understanding and adoption of ERBT principles remains the most important step for improving equitable care.

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