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In the “Precision Surgery Era”, new technologies are being developed in order to guide the surgeon in the execution of “tailored” surgical procedures. Among them, the use of 3-dimensional (3D) virtual models of the organs have already demonstrated an outstanding potential in urology. Moreover, the use of colors in the operative room provides the surgeon an intuitive and precise guidance during the crucial steps of the surgery. In this scenario, Artificial Intelligence is considered a very promising and fascinating tool able to harmonize and maximize the performances of these technologies, obtaining an automatic surgical guidance both for prostate and renal surgery.

Objective: To evaluate the safety and efficacy of a virtual reality (VR) mask as a distraction tool during minimally invasive functional urological interventions as part of the local anesthesia protocol., Methods: This is a single-center prospective observational pilot cohort study which included all consecutive patients undergoing intradetrusor botulinum toxin injection, sacral neuromodulation, and urethral bulking agent injection with combined anesthetic protocol composed by local anesthesia and a VR mask (Hypno VR virtual reality mask, Strasbourg, France). Preoperative and postoperative evaluation included the State-Trait Anxiety Inventory (STAI) index. Intraoperatively, a 4-point Likert anxiety rating scale and a visual analog scale (VAS) pain score were assessed. Vital signs were measured preoperative and intraoperatively. Postoperatively, 2 questionnaires exploring patient satisfaction were administered. The evaluated outcomes were the tolerability of the device and patient's reported intraoperative pain and anxiety., Results: Thirty-nine patients were included. Mean age was 64 years. Eleven patients (28%) were affected by neurological conditions. Two patients experienced subjective discomfort. Preoperative and intraoperative mean arterial pressure was 105 and 111 mmHg (P = .01), respectively. Preoperative and intraoperative mean heart rate was 72 and 75 bpm (P = .12), respectively. Preoperative and postoperative STAI index were 34.8 + -10 and 32.8 + -10.3 (P = .88). Mean Likert anxiety scale value was 2.2 + -1.1, mean intraoperative VAS score was 5.3 + -2.5. Thirty-four (87%) patients declared themselves satisfied with the surgical procedure and 36 (92.3%) patients would have recommended the same procedure to a relative., Conclusion: Virtual reality mask may play a role in reducing pain and anxiety in minimally invasive functional urological interventions., Competing Interests: Declaration of Competing Interest The authors have no conflict of interest to declare., (Copyright © 2024. Published by Elsevier Inc.)

Objective: To describe the initial experience with PSMA-PET/CT-guided biopsy in European referral centres., Methods: This multicenter observational cohort study was endorsed by the Young Academic Urologist (YAU) Prostate Cancer Group of the EAU and conducted across 6 tertiary-level European centres. PSMA-guided biopsies were carried out in a cognitive/fusion manner for all the recruited patients with or without MRI-guided biopsies and/or standard biopsy (SB). PCa and clinical significant PCa (csPCA) detection rate (DR) at prostate biopsy was assessed. Uni- and multivariable models were employed to identify features related to csPCA., Results: Overall, 72 patients were recruited. The topographic location of the dominant lesion depicted by PSMA PET/CT was significantly associated with the location of csPCa, especially in the biopsy naïve cohort. The DR for PCa and csPCa of PSMA-PET/CT-guided biopsies was significantly higher than SB (0.40 ± 0.43 vs 0.23 ± 0.29, and 0.36 ± 0.44 vs 0.21 ± 0.30, respectively, both P <.05) but did not surpass MRI-guided biopsies (0.40 ± 0.43 vs 0.47 ± 0.44, and 0.36 ± 0.44 vs 0.47 ± 0.34, respectively, both P >.05). PSMA-PET/CT-guided biopsy performed better in the biopsy naïve than in the repeated biopsy setting. A SUVmax cut-off value equal to 4.8 provided the best results for detecting csPCa., Conclusion: Our real-world data illustrate the potentialities of PSMA-PET/CT-guided biopsy in diagnosing PCa. Specifically, in biopsy naïve patients with suspicion of high-risk disease, the use of PSMA-PET/CT-targeted biopsy can be considered. Additionally, in the context of repeated biopsies, a PSMA-PET/CT target biopsy might be advisable over the SB., Competing Interests: Declaration of Competing Interest The authors have no conflict of interest to declare., (Copyright © 2024 Elsevier Inc. All rights reserved.)