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Prostate cancer (PCa) surgery has a strong impact on men’s social and sexual lives. For this reason, many patients ask for robotic surgery. To assess the rate of lost patients due to the lack of a robotic platform (RPl) at our center, we retrospectively selected 577 patients who underwent prostate biopsy between 2020 and 2021 who were eligible for radical prostatectomy (RP) (ISUP ≥ 2; age ≤ 70 yr). Patients eligible for surgery who decided to be operated received a phone call interview asking the reason for their choice. Overall, 230 patients (31.7%) underwent laparoscopic-assisted radical prostatectomy (LaRP) at our center, while 494 patients (68.3%) were not treated in our hospital. Finally, 347 patients were included: 87 patients (25.1%) underwent radiotherapy; 59 patients (17%) were already under another urologist’s care; 113 patients (32.5%) underwent robotic surgery elsewhere; and 88 patients (25.4%) followed the suggestion of friends or relatives based on their surgical experience. Despite no surgical technique for RP having shown superiority in terms of oncological or functional outcomes, patients eligible for PCa treatment decided to be operated on elsewhere because of the lack of an RPl. Our results show how the presence of an RPl may increase the case volume of RP by 49% at our center.

Primary bladder neck obstruction (PBNO) is a dysfunction of the bladder neck (BN) in which the collum vesicae is narrow or fails to open adequately during voiding, resulting in a bladder outlet obstruction. PBNO causes storage or voiding LUTS often years before a correct diagnosis of PBNO is made. These patients have often been seen by many physicians and misdiagnosed as having psychogenic voiding dysfunction because of a normal prostate on rectal examination, a negligible residual urine volume, and a normal endoscopic bladder and prostate appearance. The cause of PBNO has not yet been clarified and has so far been a clinical differential diagnosis after the exclusion of the usual differential diagnoses of LUTS and bladder emptying disorders. Several publications let assume that PBNO could be induced by inflammatory processes, possibly by the same inflammatory patterns that have been previously described for BPH development, leading to an initially reversiblel and later irreversible remodeling of the connective tissue of the BN. The clinical value of these observations consists of a correct and precise diagnostic framework especially in young men referring pelvic pain and LUTS despite their small prostate volumes. The proper diagnosis could provide a tempestive calculated therapy proposal that can stop illness progression or in same cases reverse inflammation and collagenic deposition, limiting the risk of future obstruction and symtomatic progression.

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