Low-dose esketamine cut intraoperative erections during ureteroscopy from 22% to 6%

The edition in brief

In a single-centre double-blind trial of 356 men having ureteroscopy under general anaesthesia, intravenous esketamine 0.3 mg/kg before induction reduced intraoperative penile erection from 21.9% to 6.2% (RR 0.28; number needed to treat about 6), with fewer rescue treatments and no difference in recovery or hallucinations. The 2026 Advanced Prostate Cancer Consensus Conference reached consensus on only 44 of 134 questions about high-risk localised, locally advanced and biochemically recurrent prostate cancer, highlighting how much management still rests on opinion. A post hoc analysis of the LATITUDE and ARASENS trials linked testosterone above 35 ng/dL during intensified therapy to worse survival in LATITUDE (HR 1.49) but not significantly in ARASENS. Video review of nerve-sparing robotic prostatectomies found that cases ending in erectile dysfunction at 12 months had 43% more errors and 67% more neurovascular bundle errors. A LURN cohort analysis found people with urgency syndromes had three times the odds of vascular disease, and men with urgency incontinence had erectile dysfunction in 64%.