Archivio Italiano di Urologia e Andrologia最新文献

{"title":"Incidental prostate cancer following surgery for benign prostatic hyperplasia: a cohort study.","authors":"Rui Pedrosa, João Lorigo, Ana João Guerra, Bárbara Figueiredo, Vasco Quaresma, Miguel Eliseu, Paulo Temido, Arnaldo Figueiredo","doi":"10.4081/aiua.2026.14669","DOIUrl":"10.4081/aiua.2026.14669","url":null,"abstract":"<p><strong>Background: </strong>Incidental prostate cancer (iPCa) remains a clinically relevant diagnosis in men undergoing surgery for benign prostatic hyperplasia (BPH). This study aimed to determine the incidence, characterize pathological features, and identify preoperative predictors of iPCa.</p><p><strong>Materials and methods: </strong>We conducted a retrospective cohort study of 735 men undergoing BPH surgery between November 2020 and December 2024. Demographic, clinical, surgical, and pathological variables were analyzed. Predictors of iPCa were evaluated using logistic regression; discrimination was assessed by ROC curves and Youden-optimized cut-offs.</p><p><strong>Results: </strong>The incidence of iPCa was 5.6%. Among iPCa cases, 48.8% were ISUP 1, while 17.1% corresponded to high-grade tumors (ISUP ≥4). Patients with iPCa had significantly higher PSA (4.8 vs 1.9 ng/mL), higher PSA density (PSAD 0.099 vs 0.029 ng/mL/cmÑ), and smaller prostates (47 vs 66 mL) (all p<0.001). In multivariable analysis including age and PSAD, only PSAD remained independently associated with iPCa (per 0.01 ng/mL/cmÑ increase). PSAD discriminated iPCa better than PSA (AUC 0.86 vs 0.80). A PSAD threshold around 0.15 ng/mL/cmÑ provided balanced performance (sensitivity ≈0.82; specificity ≈0.78). At a median follow-up of 24 months, most patients were managed conservatively (active surveillance or watchful waiting) with favorable short-term biochemical control; a minority required systemic therapy (hormonotherapy), and cancer-specific mortality was low.</p><p><strong>Conclusions: </strong>iPCa occurred infrequently after BPH surgery, although higher-grade tumors were still observed. PSA density was the strongest preoperative predictor and should be integrated into risk stratification before BPH surgery.</p>","PeriodicalId":46900,"journal":{"name":"Archivio Italiano di Urologia e Andrologia","volume":" ","pages":"14669"},"PeriodicalIF":1.3,"publicationDate":"2026-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146221577","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness of CO₂ micro-ablative vaginal laser therapy in the treatment of recurrent cystitis.","authors":"Maurizio Filippini, Jessica Sozzi","doi":"10.4081/aiua.2026.14671","DOIUrl":"https://doi.org/10.4081/aiua.2026.14671","url":null,"abstract":"<p><strong>Background: </strong>Cystitis is the most common clinical manifestation of urinary tract infection (UTI) in women.</p><p><strong>Aim: </strong>The current study intends to assess the effectiveness of CO2 micro-ablative vaginal laser therapy in the treatment of recurrent cystitis RC.</p><p><strong>Methods: </strong>A total of 75 women were divided into 2 Groups: Group 1 included 34 women (22 were menopausal women and 12 were non-menopausal women) with bacterial cystitis who were positive to urine culture analysis. The Group 2 included 41 women (34 were menopausal women and 7 were nonmenopausal women) with interstitial cystitis who were negative for urine culture analysis. Patients received three treatment sessions with a dual-wavelength (10600 nm/1540 nm) laser system. A visual analog scale (VAS) evaluation, ranging from 0 to 10, was administered to assess baseline and post-laser treatment urinary symptoms associated with cystitis. Concerning IUS (stress urinary incontinence) and Urgency score measurements, a VAS ranging from 0 to 5 was used. The O'Leary-Sant Interstitial Cystitis Symptom Index (ICSI) was used as treatment outcome measures.</p><p><strong>Results: </strong>In both groups, a significant reduction in the average number of cystitis episodes after treatment was observed and the VAS scale showed a significant reduction in pre- and post-treatment symptoms. VAS results for patients' satisfaction and expectations showed positive outcomes revealing that more than 90% of patients were satisfied following the treatment.</p><p><strong>Conclusions: </strong>CO2 vaginal laser may represent an advantageous therapeutic approach to treating recurrent cystitis.</p>","PeriodicalId":46900,"journal":{"name":"Archivio Italiano di Urologia e Andrologia","volume":"98 1","pages":"14671"},"PeriodicalIF":1.3,"publicationDate":"2026-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147582562","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term patency and pregnancy after vasovasostomy: a comprehensive review.","authors":"Ramsey Ghaleb, Marwan Hamadeh, Fred Lee, Kareem Touleimat, Mohamad Abou Chakra, Igor Duquesne, Mahmoud Mima","doi":"10.4081/aiua.2026.14877","DOIUrl":"10.4081/aiua.2026.14877","url":null,"abstract":"<p><strong>Background: </strong>Vasovasostomy (VV) is often pursued by men seeking natural conception after vasectomy. Microsurgical VV is associated with high patency rates (~95%) and moderate pregnancy rates (~40%), according to existing literature. However, long-term outcome data remain limited. This review evaluates patency and pregnancy rates at ≥12 months following microsurgical VV.</p><p><strong>Materials and methods: </strong>A comprehensive literature search was conducted via PubMed using the terms \"vasovasostomy,\" \"patency rate,\" and \"pregnancy rate.\" Studies were included if they reported patency or pregnancy outcomes ≥12 months post-VV. Data were categorized and analyzed using MedCalc, applying the Freeman-Tukey transformation for normalization.</p><p><strong>Results: </strong>Only four clinical studies reported long-term patency data, and six studies reported long-term pregnancy rates following microsurgical VV. Patency rates ranged from 77% to 99%, with a mean follow-up of 25 months. Patency was defined as the presence of any sperm in the ejaculate in five studies, and as >1 million non-immotile sperm/mL in one study. Using the >1 million sperm definition, the patency rate was 77% at 12 months, but decreased to 33% when defined as ≥30% motile sperm in the ejaculate. Pregnancy rates across the six studies ranged from 28% to 54%, with a mean follow-up of 21 months.</p><p><strong>Conclusions: </strong>Long-term patency and pregnancy rates following VV vary widely due to inconsistent definitions and limited follow-up data. These findings underscore the need for standardized outcome measures and longitudinal follow-up to better understand factors influencing long-term success after VV.</p>","PeriodicalId":46900,"journal":{"name":"Archivio Italiano di Urologia e Andrologia","volume":" ","pages":"14877"},"PeriodicalIF":1.3,"publicationDate":"2026-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147436549","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transition learning curve of a single surgeon performing ultrasound-guided modified lateral position percutaneous nephrolithotomy.","authors":"Ngoc Thai Nguyen, Shinnosuke Kuroda, Trong Nhan Tran, Thanh Vu Phung, Huynh Dang Khoa Nguyen","doi":"10.4081/aiua.2026.14900","DOIUrl":"10.4081/aiua.2026.14900","url":null,"abstract":"<p><strong>Background: </strong>Ultrasound-guided percutaneous nephrolithotomy (PCNL) performed in the modified lateral position offers advantages in ergonomics, airway control, and radiation reduction. However, evidence describing the transition learning curve of surgeons previously trained in fluoroscopy-guided prone PCNL remains limited. This study evaluates learning progression, surgical efficiency, and safety outcomes as an experienced fluoroscopic surgeon adopts an ultrasound-guided modified lateral PCNL technique.</p><p><strong>Materials and methods: </strong>This retrospective study included 70 consecutive patients who underwent ultrasound-guided modified lateral PCNL with extended legs, performed by a single surgeon experienced in fluoroscopy-guided prone PCNL. Patients were divided chronologically into three groups (cases 1-25, 26-50, and 51-70). Operative parameters, puncture characteristics, fluoroscopy time, stone-free rate (SFR), and complications were analyzed. Learning progression was assessed using cumulative summation (CUSUM) analysis based on operative time.</p><p><strong>Results: </strong>Progressive improvements in performance were observed across the series. The proportion of single-attempt punctures increased from 40% to 75% (p=0.023), while upper calyceal access increased from 8% to 70% (p<0.001). Median operative, puncture, and fluoroscopy times all decreased significantly across the series. The overall SFR was 95.7%, increasing to 100% in the final group, with predominantly minor complications and no transfusion events. CUSUM analysis demonstrated a proficiency plateau at approximately 40 cases.</p><p><strong>Conclusions: </strong>Surgeons experienced in fluoroscopy-guided prone PCNL can achieve proficiency in ultrasound-guided modified lateral PCNL after approximately 40 cases, with improved efficiency, enhanced puncture precision, and reduced radiation exposure, without compromising safety or stone-free outcomes.</p>","PeriodicalId":46900,"journal":{"name":"Archivio Italiano di Urologia e Andrologia","volume":" ","pages":"14900"},"PeriodicalIF":1.3,"publicationDate":"2026-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147356948","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Extracorporeal shock wave therapy (ESWT) in the treatment of Peyronie's disease: our initial experience.","authors":"Giuseppe Saitta, Riccardo Trovato, Vincenzo Striano, Simone Di Salvatore, Giuseppe Di Paola, Andrea Simone Ceresoli, Franco Anacleto Mantovani, Attilio Luigi Meazza, Mauro Seveso","doi":"10.4081/aiua.2026.14737","DOIUrl":"10.4081/aiua.2026.14737","url":null,"abstract":"<p><strong>Background: </strong>Peyronie's disease (PD) is a connective tissue disorder of the penis that causes pain, curvature, and erectile dysfunction.  Methods: A prospective study was conducted on 112 patients treated with ESWT. Each received three sessions of 3,000 shockwaves at 0.11-0.17 mJ/mm2. Pain, curvature, and erectile function were assessed.</p><p><strong>Results: </strong>Pain relief occurred in 90% of patients (mean VAS reduction: 3, p<0.00001); 57.1% had curvature improvement (mean 30°, p<0.001); 26.2% of ED patients improved ≥ 4 points in IIEF.</p><p><strong>Conclusions: </strong>ESWT appears safe and effective in improving pain and curvature in PD patients.</p>","PeriodicalId":46900,"journal":{"name":"Archivio Italiano di Urologia e Andrologia","volume":" ","pages":"14737"},"PeriodicalIF":1.3,"publicationDate":"2026-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147356936","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Low-intensity extracorporeal shock wave therapy in vasculogenic erectile dysfunction refractory to PDE5 inhibitors: a prospective study with 12- and 18-month outcomes.","authors":"Giuseppe Saitta, Giuseppe Di Paola, Simone Di Salvatore, Benedetto Calabrese, Andrea Simone Ceresoli, Franco Mantovani, Attilio Luigi Meazza, Mauro Seveso","doi":"10.4081/aiua.2026.14707","DOIUrl":"10.4081/aiua.2026.14707","url":null,"abstract":"<p><strong>Background: </strong>Low-intensity extracorporeal shock wave therapy (Li-ESWT) has emerged as a promising treatment for vasculogenic erectile dysfunction (ED), particularly in men who do not respond to phosphodiesterase type-5 inhibitors (PDE5-Is).</p><p><strong>Objective: </strong>To evaluate the feasibility, safety, and clinical effectiveness of Li-ESWT in men with vasculogenic ED through a prospective 12- and 18-month follow-up.</p><p><strong>Methods: </strong>A prospective observational study was conducted on 188 patients with vasculogenic ED and inadequate response to PDE5-Is. Patients underwent 6 weekly sessions of Li-ESWT. Erectile function was assessed using the international index of erectile function (IIEF) and erection hardness score (EHS). Responders were defined as those achieving ≥ 3-point improvement on IIEF-EF and/or EHS ≥3.</p><p><strong>Results: </strong>Mean age was 66.6 years; mean ED duration was 24 months. IIEF-EF improved from 11 at baseline to 21 at 12 months and 18 at 18 months. At 12 months, 71% of patients showed improvement in EHS. Younger age (<45 years), shorter ED duration (<12 months), and moderate baseline severity predicted better response (p<0.05). Sustained improvement was observed in 65% of patients at 12 months and 54% at 18 months. No adverse events were reported.</p><p><strong>Conclusions: </strong>Li-ESWT is a safe and effective treatment for vasculogenic ED unresponsive to PDE5-Is, with maximum benefit observed within 12 months. Efficacy tends to decline at 18 months. Larger controlled studies are needed to define long-term outcomes.</p>","PeriodicalId":46900,"journal":{"name":"Archivio Italiano di Urologia e Andrologia","volume":" ","pages":"14707"},"PeriodicalIF":1.3,"publicationDate":"2026-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147356932","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"TOP Flat Magnetic Stimulation therapy for post-prostatectomy stress urinary incontinence.","authors":"Nicola Mondaini, Fabio Crocerossa, Mauro Gacci, Francesco Cantiello, Irene Fusco, Alessandra Comito, Tiziano Zingoni, Rocco Damiano","doi":"10.4081/aiua.2026.14666","DOIUrl":"10.4081/aiua.2026.14666","url":null,"abstract":"<p><strong>Background: </strong>The most frequent complication in subjects of a radical prostatectomy (RP) is represented by urinary incontinence (UI), which can arise following the destruction of the pelvic floor muscles.</p><p><strong>Objectives: </strong>The aim of this retrospective analysis was to assess the effect of Flat Magnetic Stimulation (FMS) in treating male stress urine incontinence (SUI) following RP.</p><p><strong>Materials and methods: </strong>A total of 40 patients affected by SUI after RP, with a mean age of 56.8 (± 5.7) years old, underwent eight sessions with FMS. The Incontinence Impact Questionnaire-Short Form (IIQ-7) was administered from baseline up to 3 months of follow-up (3MFU) after the last treatment session. All possible adverse events were retrospective analysed.</p><p><strong>Results: </strong>The analysis demonstrates that the scores for each individual questionnaire item decreased from baseline up to 3MFU after the last treatment session, leading to a significant (p < 0.05) reduction in the total IIQ-7 median score from 71.35 (66.6-76.11) at baseline to 28.54 (38.05-23.78) at 3MFU after the last treatment session. No adverse events were recorded over the whole course of treatment.  Conclusions: Our findings reveal that this technology may serve as a convenient and alternative treatment option for stress-caused urinary incontinence following RP.</p>","PeriodicalId":46900,"journal":{"name":"Archivio Italiano di Urologia e Andrologia","volume":" ","pages":"14666"},"PeriodicalIF":1.3,"publicationDate":"2026-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146126972","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence and pattern of antimicrobial resistance of main bacterial isolates from patients with communityacquired urinary tract infections in North of Iraq.","authors":"Saman Salih Fakhralddin, Proosha Adil Abdullah, Diyan Noori Ibrahim, Koras Bahaaldin Maarouf","doi":"10.4081/aiua.2026.14715","DOIUrl":"10.4081/aiua.2026.14715","url":null,"abstract":"<p><strong>Introduction: </strong>Urinary tract infections (UTIs) are among the most common bacterial infections, with Escherichia coli as the leading cause. Increasing antimicrobial resistance has reduced the effectiveness of standard empirical treatments, making continuous monitoring essential. This study evaluated the bacterial causes of community-acquired UTIs and their resistance patterns to commonlyused antibiotics.</p><p><strong>Methods: </strong>A descriptive cross-sectional study was conducted from November 2023 to July 2025 on patients presenting with symptoms of community-acquired UTI. Demographic and clinical data were collected with a structured form, and urine samples were subjected to culture and antimicrobial susceptibility testing. Patients with recent hospitalization, urinary procedures, catheterization, anatomical abnormalities, or pregnancy were excluded. Data were analyzed using SPSS v22, applying descriptive and comparative statistics with significance set at p<0.05.</p><p><strong>Results: </strong>Among 453 patients, 509 culture-positive samples were identified; 82% were female. Gram-negative organisms dominated (69.2%), with E. coli as the most frequent pathogen (44.4%). High resistance rates were observed to ampicillin, trimethoprim, and nalidixic acid. In contrast, carbapenem resistance remained low, and nitrofurantoin retained good activity. Staphylococcus haemolyticus showed the highest overall resistance burden. Older age, male sex, and comorbidities such as diabetes, renal insufficiency, and hypertension were significantly associated with increased antimicrobial resistance.</p><p><strong>Conclusions: </strong>Community-acquired UTI pathogens in Sulaimani  showed high resistance to widely used oral antibiotics, while carbapenems and nitrofurantoin remained effective. Higher resistance was especially noted among older adults, men, and patients with diabetes or renal disease. These findings highlight the need for improved empirical therapy and ongoing resistance surveillance.</p>","PeriodicalId":46900,"journal":{"name":"Archivio Italiano di Urologia e Andrologia","volume":" ","pages":"14715"},"PeriodicalIF":1.3,"publicationDate":"2026-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146126979","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Metabolic and surgical predictors in horseshoe and pelvic ectopic kidneys.","authors":"Ștefan Rașcu, Ovidiu Catalin Nechita, Tudor Marian Proca, Daniel Liviu Badescu, George-Sabin Popescu, Viorel Jinga","doi":"10.4081/aiua.2026.14702","DOIUrl":"10.4081/aiua.2026.14702","url":null,"abstract":"<p><strong>Background: </strong>Horseshoe kidney (HSK) and pelvic ectopic kidney (PEK) are congenital anomalies linked to impaired urinary drainage and a higher risk of nephrolithiasis. Evidence regarding metabolic profiles and surgical outcomes in these groups remains sparse. This study assessed predictors of postoperative stone clearance and 12-month recurrence in patients with HSK and PEK undergoing endourological procedures intervention.</p><p><strong>Methods: </strong>We conducted a retrospective analysis of 50 consecutive patients with CT-confirmed HSK or PEK treated with retrograde intrarenal surgery (RIRS) or mini-percutaneous nephrolithotomy (mini-PNL) over 12 months. All patients had a standardized 24-hour metabolic evaluation and imaging followup at 1, 6, and 12 months. Outcomes included stone-free status at one month and recurrence at one year. Predictors were assessed using univariable and multivariable logistic regression.</p><p><strong>Results: </strong>Stone-free status at 1 month was achieved in 62% of patients, with 22% having residual fragments ≥4 mm. Residual burden was strongly associated with recurrence, which occurred in 44% of the cohort. Patients with fragments ≥4 mm had the highest recurrence rate (72.7%), compared with 35.5% among stone-free individuals (p=0.047). Age was independently associated with reduced likelihood of achieving stone-free status (B = -0.069, p=0.011). Higher 24-hour urinary volume was the only biochemical parameter protective against recurrence (OR 0.243, p=0.039). Neither malformation type nor surgical technique significantly influenced postoperative outcomes or recurrence. Metabolic abnormalities were frequent but not predictive of stone type or recurrence.</p><p><strong>Conclusions: </strong>In HSK and PEK, postoperative residual fragments and low urine volume are the main determinants of recurrence, whereas anatomical subtype and surgical approach have limited prognostic value. Strategies focused on complete stone clearance and hydration optimization may improve long-term outcomes in this patient population.</p>","PeriodicalId":46900,"journal":{"name":"Archivio Italiano di Urologia e Andrologia","volume":" ","pages":"14702"},"PeriodicalIF":1.3,"publicationDate":"2026-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146221514","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early risk stratification after robot-assisted radical prostatectomy: the role of positive surgical margins.","authors":"Alberto Zambudio-Munuera, Irene Millán-Ramos, Patricia Rodríguez-Parras, Francisco Gutiérrez-Tejero, Maria Teresa Melgarejo-Segura, Miguel Arrabal-Martin, Miguel Angel Arrabal-Polo","doi":"10.4081/aiua.2026.14871","DOIUrl":"10.4081/aiua.2026.14871","url":null,"abstract":"<p><strong>Introduction: </strong>Positive surgical margins (PSMs) after robot-assisted radical prostatectomy (RARP) are consistently associated with biochemical recurrence (BCR), yet their prognostic heterogeneity and functional implications remain debated. This study aimed to evaluate the oncological and functional impact of PSMs and to explore clinicopathological predictors of margin positivity.</p><p><strong>Methods: </strong>We conducted a retrospective single-center study including 93 patients undergoing RARP. Surgical margin status, length, focality, and location were recorded. BCR was defined as PSA ≥0.2 ng/mL confirmed by two measurements. Functional outcomes (urinary continence and erectile function) were assessed at 6 months. Multivariable logistic regression identified predictors of PSM, and Kaplan-Meier analysis evaluated BCR-free survival.</p><p><strong>Results: </strong>PSMs were identified in 48 patients (51.6%). During a median follow-up of 11 months, BCR occurred more frequently in patients with PSMs than in those with negative margins (20.8% vs 4.4%, p=0.018). PSMs were associated with significantly worse early BCR-free survival (log-rank p=0.013). Margin length ≥3 mm did not stratify early BCR risk. In multivariable analysis, ISUP Grade Group 3-5 was the only independent predictor of PSM (OR 0.25, p=0.044). No significant differences in urinary continence or erectile function at 6 months were observed according to margin status.</p><p><strong>Conclusions: </strong>PSMs are associated with an increased risk of early biochemical recurrence, while early functional outcomes appear independent of margin status. Tumor biology, rather than surgical factors, emerges as the main determinant of margin positivity. These findings support a risk-adapted interpretation of PSMs and align with current guidelines favoring close surveillance and early salvage treatment over routine adjuvant therapy.</p>","PeriodicalId":46900,"journal":{"name":"Archivio Italiano di Urologia e Andrologia","volume":" ","pages":"14871"},"PeriodicalIF":1.3,"publicationDate":"2026-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147356977","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}