New concepts and challenges in functional neurourology

The session featured the Spotlight Talk “To know where you're going, know where you come from: Insights in functional and neurourology” by Prof. Philip Van Kerrebroeck (BE). He addressed several current key challenges such as diagnostic limitations (i.e., urodynamics as being invasive), treatment limitations (e.g., surgery is “slow to adopt robotic techniques”), patient-reported outcomes and (health) literacy gap, workflow and training, and transitioning care (lack of established protocols for the transition of adolescent patients into adult care).

Prof. Van Kerrebroeck also underscored the need for systemic reviews to address unmet clinical needs. Prospective multicentre studies and registries, as well as large multicentre databases on functional/neurological urinary tract problems and dysfunctions are essential. Progress in the field will also depend on the integration of artificial intelligence into both research and clinical practice, as well as the development of a motivated, well‑trained workforce of functional and neuro‑urologists who can operate at an optimal level. In addition, multidisciplinary small‑pelvis superspecialisation and policy reform around benign urinary tract conditions through initiatives such as Urge to Act can contribute to 

Ketamine is used in veterinary medicine, human anaesthesiology, and in the treatment of depression. However, it is also used as a recreational drug due to its relatively low cost and accessibility. A daily intake of 1 gram can lead to ketamine-induced uropathy (KIU); 25% of heavy users develop KIU.

“The abuse of ketamine is rising,” stated Prof. Laetitia De Kort (NL) in her State-of-the-art Lecture “Ketamine cystitis: What all urologists should know”.

Therapeutic use of ketamine typically involves doses of up to about 200 mg per week, whereas recreational users commonly consume between 15 and 150 mg per day. Individuals with ketamine dependence may use several grams per week.

High doses can produce dissociative effects, including intense hallucinations, “out-of-body” experiences, and the so-called “K-hole,” a state of profound detachment from reality.

Prof. De Kort reported that approximately 18% of users show upper urinary tract involvement, often associated with a reduced voided bladder volume. In male heavy users, ketamine use also affects sexual function: only 42% remain sexually active compared with 85% in the general population. Additionally, 51–70% experience erectile dysfunction, and 64% report a high sexual bother score. Among female heavy users, higher levels of sexual dysfunction are reported across all domains except sexual desire.

Mr. Arun Sahai (GB) discussed ureteral rest and ICG, and other new concepts in his presentation, “Latest advancement in robotic functional and reconstructive urology”.

Mr. Sahai cited the CORRUS study, which has shown that taking stents out before ureteral reconstruction results to better outcomes. He stated that the success rates are better. He also cited “Preoperative Factors for Success of Robotic Ureteral Reconstruction for distal Ureteral Strictures” (M. Lee, et al.) which demonstrated that ureteral rest is an independent predictor of success.

According to Mr. Sahai, ICG can be very useful in understanding where the ureter is. “It’s very good in identification. Its key is understanding vascularity,” aid Mr. Sahai. He cited the study “Indocynanine-guided ureter resection for radical cystectomy - a systemic review and meta-analysis” (CM Haney, et al) which involved around 1,100 patients. The study showed that ICG is beneficial in reducing stricture rates.

For the full presentations, please watch the webcasts on the EAU26 Resource Centre.