The edition · Urology
Prehabilitation before radical prostatectomy lowered the odds of early incontinence
Sixteen randomised trials support starting pelvic floor and exercise training before surgery; EAU restructures its infection guidelines and updates biopsy prophylaxis; testosterone was not linked to progression on active surveillance; and Stockholm3 could spare a fifth of surveillance biopsies.
The edition in brief
A meta-analysis of 16 randomised trials (1,542 men) found prehabilitation before radical prostatectomy reduced urinary incontinence at 1 month (OR 0.58, 0.39 to 0.84) and 6 months (OR 0.52, 0.28 to 0.96), and improved quality of life to 6 months, but did not change incontinence severity, erectile function or 12-month outcomes. The 2026 EAU Urological Infections Guidelines restructure around a new UTI classification, add chapters on genital herpes and fungal UTI, and update the evidence on antibiotic prophylaxis for prostate biopsy, with stewardship throughout. In 3,324 men with grade group 1–2 prostate cancer on active surveillance at one US centre, the 79 on testosterone therapy showed no difference in biopsy progression (HR 0.99, 0.67 to 1.48). In the prospective STHLM3-AS trial of 199 men with grade group 1 cancer, a Stockholm3 threshold of 15 had 93% sensitivity for upgrading and would have spared 19% of surveillance biopsies, missing five upgrades, none grade group 3 or higher. PSA density and MRI performed comparably.
EAU 2026 infection guidelines reorganise around a new UTI classification
Update your biopsy prophylaxis and empirical UTI protocols against the EAU 2026 guidelines, adapted to your local antibiogram.
Testosterone therapy was not linked to progression on active surveillance
Testosterone therapy can be considered for symptomatic hypogonadism in men on active surveillance, with close PSA and surveillance monitoring.
Stockholm3 could spare a fifth of surveillance biopsies
Use PSA density and MRI together to target surveillance biopsies; a blood-based score adds similar information where available.
FDA records a supplement to a generic carvedilol licence
No action is needed on this administrative record, but check for carvedilol before adding an alpha-blocker for BPH, because the two add up to postural hypotension.
Teach the pelvic floor contraction before the catheter goes in
Refer men for pelvic floor training when they are listed for prostatectomy, not after the catheter is out.
Prehabilitation reduced early incontinence after radical prostatectomy
Start pelvic floor prehabilitation before radical prostatectomy to speed recovery of continence over the first six months.
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