The edition · Urology
Four weeks of prehabilitation before robotic prostatectomy lifted early quality of life and continence
A randomised prehabilitation trial before RARP, pooled phase 3 subgroups for a new oral antibiotic in uncomplicated UTI, extended LUNAR follow-up on radioligand therapy before SBRT, and a millimetre threshold that could double active surveillance eligibility.
The edition in brief
In a single-centre randomised trial of 100 men scheduled for robotic prostatectomy, a four-week multimodal programme of exercise, pelvic floor training, nutrition and psychological support raised global health status at one month by 15 points (95% CI 7-22) on a 100-point scale and improved continence scores; the overall difference narrowed to 4.5 points by six months, while continence and mental health gains persisted. Pooled EAGLE-2 and EAGLE-3 data in women with uncomplicated UTI found gepotidacin had higher therapeutic success than nitrofurantoin, by 9.6 points in susceptible infections and 20.8 points in non-susceptible ones, driven by microbiological rather than symptomatic response. In LUNAR, two cycles of 177Lu-PSMA radioligand before SBRT for oligorecurrent prostate cancer extended median PFS from 7.4 to 17.6 months (HR 0.38) at 32 months' follow-up. In 2,499 prostatectomy patients, less than 2 mm of Gleason pattern 4 on biopsy carried risks similar to favourable intermediate-risk disease regardless of grade group.
Gepotidacin outperformed nitrofurantoin on microbiological cure in pooled phase 3 data
Consider gepotidacin for uncomplicated UTI when nitrofurantoin resistance is known or likely, where it is available.
Radioligand therapy before SBRT more than doubled PFS in oligorecurrent prostate cancer
177Lu-PSMA before SBRT for oligorecurrent prostate cancer is promising phase 2 evidence, not yet standard care.
Under 2 mm of Gleason pattern 4 behaved like favourable intermediate risk, whatever the grade group
Ask for Gleason pattern 4 length on biopsy reports, but keep current criteria for active surveillance until the threshold is validated.
Culture before you change antibiotics for cystitis
Send a urine culture before switching antibiotics for cystitis that recurs or fails to settle.
Prehabilitation before robotic prostatectomy improved early recovery and continence
Consider multimodal prehabilitation, including pelvic floor training, in the weeks before robotic prostatectomy.
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