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Introduction: With advances in endoscopic treatment of upper tract urothelial carcinoma (UTUC) lesions, the recommended upper limit of lesion size amenable to laser ablation was set to 2 cm. However, this limit is based on expert opinion only, and debate still exists regarding this definition. Objective: To determine the maximal size of the tissue, for which total endoscopic ablation with laser energy is achievable, from a laser performance perspective. Materials and Methods: Simulating endoscopic surgery conditions, renal tissue blocks from pork kidneys in growing size from 1 cm3 to 3 cm3 were totally ablated with Ho:YAG laser (1 J, 10 Hz). The time to ablation was recorded for each tissue mass. Following the ablation, each sample was inspected microscopically by an expert pathologist to determine the extent to which the tissue was destroyed. Results: Time to ablation ranged from 16.4 min for a 1 cm3 mass, to 69.7 min for a 3 cm3 mass. Histologic evaluation after laser ablation showed that ablation was achieved in all tissue masses, and no “unaffected” tissue was present, even for lesions with a size of 3 cm3. Conclusions: This study showed that laser ablation can be achieved for tumor lesions up to a size of 3 cm3. The results of this study can contribute to the debate regarding the limits of endoscopic management of UTUC lesions and strengthen the recommended upper limit of 2 cm3 for endoscopic treatment of tumor lesions.

A 74-years-old patient, without comorbidity, underwent malleable penile prosthesis (MPP) implantation in 2007. In 2015, after a perineal trauma, he experienced stress urinary incontinence, medial extrusion of the left prosthetic cylinder and an urethrocavernous fistula. The cylinder was removed and an artificial urinary sphincter (AUS) implanted, together with a three-component inflatable penile prosthesis (IPP). The left corpus cavernosum (CC) was significantly shorter than the right one due to fibrosis. After 8 months, partial lateral extrusion of the right prosthetic cylinder prompted a replacement with a shorter extensor. Six months after, a new diastasis of the ruptured area occurred due to a further CC shortening. The extensor was removed and the cylinder shortened, with a dermal graft applied to the area. Long-term patient satisfaction was high.

Rectal bleeding seen after a transrectal ultrasound-guided prostate biopsy is often mild and self-limiting. We report a rare case of delayed massive rectal bleeding, post transrectal ultrasound-guided biopsy, in a man in active surveillance for prostate carcinoma, without risk factors for bleeding. We managed this complication with a successfully angiographic embolization.We present this case in detail and we analyze the possible causes of this complication.

Pseudoaneurysm (PA) associated with an arteriovenous fistula (AVF) of the internal pudendal artery branches are very uncommon. We report a case of post-traumatic PA with AVF connected to Santorini plexus. Diagnosis was made with trans-rectal ultrasound (TRUS) after recurrent hematuria. TRUS reported a 1.7 × 1.4 × 1.5 cm anechoic area, on anterior prostate apex close to Santorini plexus. The use of color Doppler in this area revealed high flow velocity that was indicative for AVF. The feeding artery was a distal branch of the left pudenda artery. After selective embolization was observed complete occlusion of the feeding branches and disappearance of PA with AVF. Prostate PA with concomitant symptomatic AVF detected with TRUS has not yet described in literature after pelvic trauma and represents complex diagnostic challenges. This case report suggests that the use of TURS and color Doppler can provide an important diagnostic and follow-up to address the clinical suspicion of occult vascular injuries using a noninvasive approach.

Objective: Active Surveillance (AS) is a viable alternative to surgery or radiotherapy dedicated to selected patients suffering from low-risk prostate cancer. Aim of the study was to evaluate the onset of Erectile Dysfunction (ED) in patients underwent to AS option and identify potential factors associated to the onset of ED. Methods: From January 2011 to May 2014 were prospectively assessed patients included in AS; we evaluated baseline comorbidity including Diabetes, Hypertension, Body Mass Index (BMI), International Prostate Symptoms Score (IPSS) and International Index of Erectile Function-5 (IIEF-5) score. Were excluded from the assessment patients with baseline ED, defined as an IIEF-5 score < 22 and patient with follow-up less than 24 months. Results: Among the 28 patients underwent to AS aged between 48 and 67 years who meet the selection criteria, 16 (57%) developed new onset of ED with different degrees. At multivariate analysis, no comorbidity were statistically associated to ED even thought a correlation with the onset of E.D. and BMI, Diabetes, Hypertension and age were founded. Conclusions: AS is associated to a high occurrence of ED; among the comorbidities, BMI, Diabetes and Hypertension showed a correlation to a new onset of ED; additional studies are needed to confirm this hypothesis.