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Asthma can present in early childhood or de novo in adulthood. Our understanding of the burden of comorbidities in adult asthmatic patients stratified by age at onset is incomplete.To evaluate how different comorbidities may affect symptom control in two distinct groups of patients with early- and late-onset asthma (EOA and LOA, respectively) and to explore whether reported comorbidities are associated with lung function and inflammatory parameters.We conducted a cross-sectional study of 175 adult asthmatic patients (aged 57.5 ± 17.1 years) recruited at our university asthma clinic. We defined EOA as asthma onset less than 12 years, and LOA as onset greater than 40 years. The primary outcome was symptom control and main comorbidities evaluated were rhinitis, gastroesophageal reflux, obesity, cardiovascular conditions, and bronchiectasis. We used multivariable regression analysis to identify potential predictors of poor control in EOA and LOA.Of 175 subjects, 77 had EOA (44%), 98 had LOA (56%), and comorbidities had a differential impact in the two groups. Rhinitis was more frequent in EOA (76 vs 53%; P = .02) and was associated with uncontrolled asthma (P .001), reduced FEVEarly-onset persistent asthma and late-onset asthma are distinct phenotypes with different underlying inflammatory patterns and different comorbidities affecting symptom control.

The correct use of antimicrobial drugs represents a major strategy to slow down or avoid the development of antimicrobial resistance.1 Given the high incidence of bladder cancer, transurethral resection of the bladder (TURB) is one of the most common urological procedures.2 Nowadays, many urologists give 1 or more doses of antimicrobial drugs as antimicrobial prophylaxis (AMP) to patients who undergo TURB. This practice is probably based on common habits but remarkably, as stated by Bausch et al in their recent review,3 there is an absence of evidence in the literature demonstrating that using AMP before routine TURB reduces the risks of infection complications.4 So far, in the age of evidence-based medicine, the study of Bausch et al importantly underlines the need for better quality evidence in sustaining or not the very common practice of the use of AMP for patients who undergo TURB. Interestingly enough, the answer to the question, “Does AMP reduce the rate of postoperative symptomatic urinary tract infection in patients undergoing TURB?” could be negative. It is a matter of fact that low quality evidence sustaining safety of TURB without using AMP exists. In our department, according to a nearly 11-year internal protocol, almost all patients with negative urine culture who undergo routine TURB do not receive any AMP regardless of the dimension of the tumor or the burden of patient comorbidity. With the purpose to assess results of this practice, we retrospectively reviewed all clinical files connected to hospitalization and the following first month after discharge of all patients who underwent TURB at our institution be- tween January 2011 and December 2013. We identified 223 patients who underwent TURB without AMP. In this population, only 6 (2.7%) patients developed postoperative infection compli- cations and no cases of sepsis were reported. According to these results we concluded that AMP should not be routinely used prior to TURB.5 We are well aware that many local factors could influence the risks of postoperative infectious complications and could limit the generalizations of our results. Furthermore, a randomized controlled trial would produce better evidence. However, despite limitations, we recommend consideration of our experience because avoiding the use of AMP prior to routine TURB even in a part of patients would spare thousands of doses of antibiotics every day. In the era of antimicrobial resistance, good use of antimicrobial drugs counts; and even small acts, like avoiding antimicrobial prophylaxis if not necessary, matter.

Introduzione Sebbene esistano molti studi sul microbiota genitale maschile e femminile i sono molto scarsi i dati relativi alla composizione della microflora della vagina in donne transessuali sottoposte ad intervento di conversione dei genitali con tecnica penoscrotale. Materiali e metodi Sono state arruolate nello studio le donne trans sottoposte ad intervento di conversione androginoide presso la Clinica Urologica di Trieste con tecnica penoscrotale. Queste pazienti hanno eseguito 2 tamponi uno a livello della mucosa uretrale in prossimità del meato uretrale, l’altro a livello del fondo della neovagina. Sono stati inoltre raccolti tamponi di una paziente operata da circa 4 mesi e di altre 2 pazienti operate da circa 24 mesi. Ogni tampone l’analisi della microflora è stata eseguita mediante la metodica V3-16S rRNA Next Generation Sequencing (NGS) e multiplex PCR. Per tutte le pazienti sono stati prospetticamente raccolti dati anagrafici e relativi alle proprie abitudini sessuali inoltre è stata indagata la storia di infezioni genitourinarie. Il follow-up ha previsto come da protocollo interno visite di controllo a 3, 6, 12, 24, 36 mesi. Risultati Dal Luglio 2016 all’ottobre 2017, 14 pazienti sottoposti ad intervento di conversione dei genitali in senso androginoide MtoF. L’età media era 35,2 anni (range 24-50). Tutte le pazienti stavano assumendo una terapia ormonale a base di antiandrogeni ed estrogeni da almeno 1 anno al momento della chirurgia. Una paziente era HIV sieropositiva. Tutte le altre pazienti erano HIV, HBV ed HCV sieronegativi. Quindici pazienti (93,75%) presentavano un orientamento eterosessuale mentre una paziente (6,25%) era omosessuale. I tamponi sono stati eseguiti durante la degenza post-operatoria per 13 pazienti mentre una paziente è stata arruolata a 3 mesi dall’intervento e 2 pazienti 24 mesi dopo la chirurgia. Il follow-up medio dell’intera corte di pazienti è di 21,1 mesi (DS: 8,03 mesi). La flora neovaginale è risultata esser composta prevalentemente da Provetella, Escherichia e Provetella. In nessun campione è stata identificata la presenza di lattobacilli. Solo 2 pazienti hanno riferito storia di infezioni urinarie ricorrenti. Non è stato quindi possibile identificare correlazioni tra le caratteristiche del microbiota e l'insorgenza di infezioni urinarie. Conclusioni La nostra analisi ha permesso la caratterizzazione della microflora vaginale nell’immediato post-operatorio delle pazienti che si sottopongono ad intervento di conversione ginoandroide. Nonostante la terapia ormonale, la neovagina è risultata esser massivamente colonizzata da batteri comunemente presenti nei genitali maschili e spesso responsabili di infezioni del tratto genitourinario nelle donne biologiche. E’ stata esclusa la presenza di lactobacilli. Questo studio è il primo che fornisce un modello di microbiota vaginale nelle pazienti sottoposte ad intervento di conversione androginoide.

Stuttering priapism is a variation of ischemic priapism, generally transient and self-limiting, occurring during sleep and lasting less than 3-4 hours. It may progress to episodes of complete ischemic priapism in approximately one third of cases, necessitating emergent intervention.

Gender distribution of COVID-19 severity is unbalanced. Higher mortality rates are reported in men (60-70% deaths in men). We reviewed 243 BCGitis cases reported in the literature. The M/F ratio in BCGitis is 49:1 and is not fully explained by the higher incidence of bladder cancer among males, neither by anatomical reasons. We discuss the M/F ratio in BCGitis in the light of immune system differences among different genders, with a focus on interferon response (higher in females).

Additional file 1. Quality assessment using the modified Newcastle-Ottawa scale of included cohort

Objectives: To provide a valid guideline for an effective dilatation in MtF patients who underwent vaginal reconstructive surgery. Materials and Methods: Dilatation Informative Leaflet is composed by 5 parts: description of dilatators (with photos), setting, performance, behavioral aspects, psychosexual aspects. Figures show three positions suggested to perform a correct dilatation. Vaginal dilatators have different sizes (lenght cm x diameter cm): 9x2cm, 11x2.5cm, 14x3cm,16x3,5cm. We submit the Dilatation Informative Leaflet to all patients at first medical examination in order to give them the adequate time to read it toghether with the surgeon and understand it completely before surgery. Patients are partnered by the surgeon and the dedicate nurse for the first dilatation (3th-4th Day after surgery), then they are usually able to do it individually. For the first 6 months after surgery we suggest to do 3-4 dilatations daily, then almost twice daily lifetime. Results: Pre-operative knowledge of dilatation management allows patients to learn the best technique briefly and start functional rehabilitation of neovagina shortly after surgery. Conclusion: Dilatation of neovagina has crucial role after sex reassignment surgery in MtF patients. A proper dilatation technique guarantees an adequate depth and diameter of neovagina and prevents from scar stenosis. Understanding the importance of correct management of dilatations plays a central role in sexual health for subjects who underwent sex reassignment surgery.

BACKGROUND: To assess the efficacy of emergency extracorporeal shockwave lithotripsy (eSWL) as first-line treatment in patients with acute colic due to obstructive ureteral stone. METHODS: 74 patients were randomized to emergency SWL within 12 hours (eSWL group) and deferred SWL later than 3 days (dSWL group). Follow-up included ultrasound, KUB (Kidney-Ureter-Bladder) radiography and CT (computed tomography) scan at 24 hours, 7 days, 1 and 3 months from the treatment. When necessary, repeated SWL (re-SWL) or ureteroscopy (auxiliary-URS) was performed. Preoperative and postoperative data were compared and stone free rates (SFR) and efficiency quotients (EQ) were evaluated. Analyses were performed using SAS software. RESULTS: Complete data of 70 patients were collected. 36 underwent eSWL and 34 dSWL. The mean patient age was 48.7. Mean stone size was 9.8 mm (CI 95%, 8.9-10.8). 25 (35.7%) were proximal and 45 (64.3%) distal. Mean SWL energy was 19.2 kV (CI 95%, 18.5-19.9) and mean number of shocks was 2657 (CI 95%, 2513-2802). eSWL patients needs less auxiliary-URS than dSWL patients (13.9% vs 44.1%, p=0.039) and less re-SWL sessions (8.3% vs 32.4%, p=0.093). SFR at 24 hours was 52.8% and 11.8% (p

INTRODUCTION AND OBJECTIVES: Acquired penile curvature (APC) and congenital penile curvature (CPC) are the most frequent causes of penile deformity. This can have psychological repercussions and effects on patient’s self-image (potentially resulting in depressive symptoms, relationship discord, self-esteem, confidence and social isolation). It has been demonstrated that only 20% of patients accurately report the degree of curvature and preoperative objective measures of erect deformity are necessary in order to accurately counsel patients. Aim: to evaluate the perceived magnitude of curvature among patients affected by penile curvature. METHODS: We recruited, from January 2013 to September 2014, patients with APC or CPC and invited them to: - assess their magnitude of curvature by drawing their own penis in erection on the orthogonal planes; - answer 2 questionnaires: International Index of Erectile Function (IIEF-5) and Beck Depression Inventory II (BDI-II); - undergo a physical examination and history; - have their erected penis photographed on the orthogonal planes Alprostadil was used to obtain an optimal rigidity. Drawing curvature angle and the photograph curvature angle were compared. RESULTS: The sample consisted of 86 men (67 APC and 19 CPC). Mean age was 55 (DS: 9.8) years old in APC group and a 34 years old in CPC group. In both groups had not been observed differences statistically significant regards IIEF-5 or BDI-II score, which otherwise correlate significantly with age. The real mean curvature, measured on the photograph, was 44.63 and 46.0 degrees for APC and CPC group, respectively. The mean curvature assessed by the patient, measured on the drawing, was 56.1 and 32.7 degrees for APC and CPC group, respectively. The mean difference between the 2 measurements were: þ12 degrees in APC group and -14 degrees in CPC group. This data was statistically significant (p

Introduction: Fournier’s Gangrene (FG) has still a mortality rate up to 45%. Several studies identified prognostic factors but there is a knowledge gap concerning procalcitonin (PCT) levels and mortality risk in FG. This study is aimed to assess the role of PCT as prognostic factor in FG. Materials and methods: The medical records of 20 male FG patients admitted at the Department of Urology of “Cattinara” Hospital, University of Trieste between January 2019 and November 2020 were retrospectively reviewed. Clinical, demographic, microbiological data were collected. The Fournier’s Gangrene Severity Index (FGSI) was calculated for each patient. Results: Thirteen (65%) of 20 patients survived. Median age was 58 years (IQR 51–88), 15 patients (75%) had a Charlson Comorbidity Index (CCI) score ⩾2, 1 (5%) equal to 0, 4 to 1 (20%). Median FGSI score was 6 (IQR 2–12) and median PCT 0.8 ng/ml (IQR 0.04–2.12). At multivariate analysis PCT levels >0.05 ng/ml were associated with an increased overall mortality risk (OR 2.14, CI 1.25–4.27, p = 0.002). CCI score ⩾2 (OR 1.51, CI 1.01–2.59, p = 0.04), Streptococcical etiology (OR 3.41, CI 2.49–4.61, p = 0.002) and FGSI score >9 (OR 1.41, CI 1.19–2.21, p = 0.004) were associated with unfavorable outcome. Conclusion: PCT might be a prognostic factor in FG. CCI and FGSI are useful tools in mortality risk stratification. Streptococcical etiology is associated with unfavorable outcome. Further larger clinical trials are pending.

Background: A correct approach to recurrent urinary tract infections (rUTIs) is an important pillar of antimicrobial stewardship. We aim to define an Artificial Neural Network (ANN) for predicting the clinical efficacy of the empiric antimicrobial treatment in women with rUTIs. Methods: We extracted clinical and microbiological data from 1043 women. We trained an ANN on 725 patients and validated it on 318. Results: The ANN showed a sensitivity of 87.8% and specificity of 97.3% in predicting the clinical efficacy of empirical therapy. The previous use of fluoroquinolones (HR = 4.23; p = 0.008) and cephalosporins (HR = 2.81; p = 0.003) as well as the presence of Escherichia coli with resistance against cotrimoxazole (HR = 3.54; p = 0.001) have been identified as the most important variables affecting the ANN output decision predicting the fluoroquinolones-based therapy failure. A previous isolation of Escherichia coli with resistance against fosfomycin (HR = 2.67; p = 0.001) and amoxicillin-clavulanic acid (HR = 1.94; p = 0.001) seems to be the most influential variable affecting the output decision predicting the cephalosporins- and cotrimoxazole-based therapy failure. The previously mentioned Escherichia coli with resistance against cotrimoxazole (HR = 2.35; p < 0.001) and amoxicillin-clavulanic acid (HR = 3.41; p = 0.007) seems to be the most influential variable affecting the output decision predicting the fosfomycin-based therapy failure. Conclusions: ANNs seem to be an interesting tool to guide the antimicrobial choice in the management of rUTIs at the point of care.

Introduction and objectives: Impending erosion is an unusual complication of inflatable penile prosthesis that can strongly impact on patient’s morbidity and quality of life. In this case report we present a salvage surgery technique for impending erosion performed in a 57-year-old man. Materials and methods: We present our surgical technique for cylinder reimplantation in an impending erosion of a three-component inflatable prosthesis with a peno-scrotal access and extracapsular reseating of the cylinder. Results: No post-operative complication occurred, and the patient regained full function of the prosthesis after recovery. The surgical site healed well with no signs of infections. Conclusions: Impending erosion is a problematic complication of penile prosthesis; however, can be administered with a salvage technique avoiding the explant of the IPP.

Background and Objectives: To assess efficacy and safety of Percutaneous Cryoablation (PCA) of small renal masses (SRMs) using Trifecta outcomes in a large cohort of patients who were not eligible for surgery. Materials and methods: All PCAs performed in four different centers between September 2009 and September 2019 were retrospectively evaluated. Patients were divided in two different groups depending on masses dimensional criteria: Group-A: diameter ≤ 25 mm and Group-B: diameter > 25 mm. Complications rates were reported and classified according to the Clavien–Dindo system. The estimate glomerular filtration rate (eGFR) was calculated before PCA and during follow-up schedule. Every patient received a Contrast Enhanced Ultrasound (CEUS) evaluation on the first postoperative day. Radiological follow-up was taken at 3, 6, and 12 months for the first year, then yearly. Radiological recurrence was defined as a contrast enhancement persistence and was reported in the study. Finally, Trifecta outcome, which included complications, RFS, and preservation of eGFR class, was calculated for every procedure at a median follow-up of 32 months. Results: The median age of the patients was 74 years. Group-A included 200 procedures while Group-B included 140. Seventy-eight patients were eligible for Trifecta evaluation. Trifecta was achieved in 69.6% of procedures in Group-A, 40.6% in Group-B (p = 0.02). We observed an increased rate of complication in Group-B (13.0% vs. 28.6; p < 0.001). However, 97.5% were

OBJECTIVE: To investigate the incidence of infectious complications after routine office nephrostomy tube replacement (NTR) in patients that did not receive antimicrobial prophylaxis (AMP).METHODS: We prospectively enrolled all patients undergoing routine office NTR between July 2018 and September 2019. Each procedure was considered an independent event. Clinical, microbiological, demographic data were collected. AMP was exclusion criterion. All patients received a questionnaire via phone call within 3 weeks after NTR investigating fever, antibiotics use, hospital admissions. Infectious complications risk was assessed with univariate and multivariate binomial logistic regression analysis.RESULTS: One hundred forty-five routine NTRs were performed. Nineteen patients receiving AMP were excluded. Median age was 78 years (interquartile range 71-81). Charlson Comorbidity Index (CCI) score was ≥5 in 53.2% of patients, 34 had positive urine culture, none received AMP. Seventeen (13.49%) patients reported fever after procedure, 9 received antibiotic therapy while fever resolved spontaneously in 8. Three patients needed hospitalization, 2 for nephrostomy malfunction, 1 for infectious complications. At multivariate analysis only CCI score ≥3 was associated (P < .001) with increased infectious complications risk.CONCLUSION: In this study fever occurs after the 13.5% of the routine NTRs, in almost half cases resolves spontaneously rather than with oral antimicrobial therapy. Avoiding AMP before routine NTR does not expose patients to life-threatening infections.

Percutaneous microwave ablation (MWA) of renal masses (RM) is still considered experimental as opposed to established procedures such as cryoablation (CA). We aimed to compare perioperative, functional and oncological outcomes of patients with RM treated with CA and MWA.Data from 116 (69.9%) and 50 (30.1%) patients treated with CA and MWA for RM were analyzed. Patients' demographics and perioperative data were collected including nephrometry scores, complications, pre- and postprocedural renal function. Tumor persistence and recurrence were recorded. Descriptive statistics compared functional outcomes between groups. Cox regression analyses tested risk factors associated with recurrence.Groups were similar in terms of RM diameter, nephrometry scores and histology distribution. Median follow-up was 26 (13-46) and 24 (14-36) months for CA and MWA, respectively. The rate of overall (36.2% for CA vs. 24% for MWA, P= .1) and major (Clavien ≥ 3a) complications (1.7% vs. 5.4%, P = .1) were similar among groups. The median decline of renal function after 6 months follow-up did not differ between CA and MWA (P = .8). Tumor persistence [4.3% vs. 12%] and recurrence [9.5% and 7.1%] rates were similar for CA and MWA. Three years recurrence free and overall survival were 91% versus 95% (log-rank P = .77) and 80 versus 88% (log-rank P = .23) in the CA and MWA groups, respectively. At Cox analysis no predictors were found associated with recurrence.Despite being considered still experimental, MWA showed comparable outcomes relative to CA in terms of safety, preservation of renal function and oncological efficacy.

In the last years the incidence of renal neoplasms has been steadily increasing, along with the average age of patients at the time of diagnosis. Surgical management for localized disease is becoming more challenging because of patients’ frailty. We conducted a multi-center prospective study to evaluate the role of the G8 as a screening tool in the assessment of intra and post-operative complications of elderly patients (≥70 y.o.) undergoing surgery for kidney cancer. A total of 162 patients were prospectively enrolled between January 2015 to January 2019 and divided into two study groups (frail vs. not-frail) according to their geriatric risk profile based on G8 score. Several factors (i.e., age, CCI, ASA score, preoperative anemia, RENAL score, surgical procedures, and techniques) were analyzed to identify whether any of them would configure as a statistically significant predictor of surgical complications. According to the G8 Score, 90 patients were included in the frail group. A total of 52 frail patients vs. 4 non-frail patients developed a postoperative complication of any kind (p < 0.001). Of these, 11 were major complications and all occurred in the frail group. Our results suggest that the G8 screening tool is an effective and useful instrument to predict the risk of overall complications in elderly patients prior to renal surgery.

Nowadays, antimicrobial resistance is challenging our health care system [3, 4]. Currently available urological guidelines mainly refer to endourologic surgery [5, 6], while the utility of antimicrobial prophylaxis in patients undergoing nephrostomy tubes and ureteral stents insertion or replacement remains an understudied topic. Given the number of these procedures performed in the daily routine of every urology department worldwide, further studies producing evidence regarding proper antimicrobial use in this setting should be encouraged in order to avoid unnecessary use of these precious drugs and help preserving their power.

Introduction, The aim of this systematic review was to evaluate the current evidence for the effectiveness of ginseng, Rutin and Moringa for treating erectile dysfunction. Methods, A broad search of the Scopus, PubMed, Cochrane and Web of Science databases was performed in complicance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. The following criteria were required for articles to be included in the review: English language; observational studies (cohort studies, case control/comparative studies, single-arm studies); randomized controlled trials; non-randomized comparative studies; case series; number of participants: ≥5 for case series or ≥5 patients per group for comparative studies. The Cochrane risk of bias (RoB) assessment tool for RCTs was used to assess the risk of bias of included studies. Results, Seven full-text articles were included in this review. All studies were randomized controlled trials. No studies on Rutin and Moringa alone matched the inclusion criteria. The methodological quality of the RCTs was variable. In all studies, the group treated with ginseng reported an improvement of erectile function (EF) compared to the control groups. IIEF and IIEF-5 were used to evaluate erectile function in six studies and in four of them, the improvement of the scores in the group treated with ginseng over the control group reached the statistical significance. Conclusion, This review suggests a positive effect of ginseng on EF in men. The association of ginseng along with other nutritional components with potential beneficial effects on ED appears promising and deserves further investigation in large randomized controlled trials.

Background During the past two decades cryoablation (CA) has become a therapeutic option for the management of localized cT1 renal masses in comorbid patients. We analyzed the midterm functional and oncological outcomes of CA in the treatment of cT1 renal masses which were classified as high-complexity masses according to the PADUA system. Methods A total of 299 patients underwent percutaneous CA between November 2007 and December 2018 in 4 institutions for cT1N0M0 renal masses. All patients with highcomplexity (PADUA ≥ 10) renal tumors were included. Technical failure of CA was considered an exclusion criterion. Results Inclusion criteria were met by 45 patients. Median Charlson Comorbidity Index (CCI) was 6.0 (IQR: 5.0-7.0), median age was 74 years (IQR: 64.5-79.5). Seven Clavien 1 and 1 Clavien 2 procedure-related complications were reported. Median eGFR at baseline was 64.3ml/min (IQR: 52.0 - 82.3) while at the 1-year follow-up was 61.4 ml/min (IQR: 44.0-74.5). The median follow-up was 32 months (IQR: 13.25-47.5). Local recurrences were detected in 6 patients; 3 of them underwent re-cryoablation while the others started active surveillance. Median time to recurrence was 17.5 months (IQR: 7.8-27.3). Cancer-Specific Survival and Metastasis-Free Survival were 100%. Overall survival was 86.7%. Conclusions CA proved to be a valuable therapeutic option for the management of patients with cT1 high-complexity PADUA ≥ 10 renal tumors as it provides a low rate of procedural morbidity and good preservation of renal function. However, these results are counterbalanced by a recurrence rate that appears to be higher than those reported on surgically treated patients.

Yuichiro Oishi et al. presented an interesting study reporting the ability of Artifi- cial Intelligence (AI) to diagnose and locate prostate cancer from multiparametric MRI (mpMRI) [1]. The authors evaluated the diagnostic performance of their AI with a ROC analysis; interestingly the area under the ROC curve was 0.985, while the sensitivity and the specificity were 0.875 and 0.961 (p < 0.01), respectively. Figure 1 of the paper shows that the regions of the prostate labeled by AI as prostate cancer correspond strictly to the cancer areas identified at pathological examination of the gland. These good results justified the strong conclusions of the paper: “diagnostic partition using the superpixel method and SVM-computed likelihood maps enables automated diagnosis of prostate cancer location and shape in mpMRI” [1]. Many aspects of this paper deserve to be emphasized. During the last two decades, numerous attempts to use radiomics for the diagnosis of cancer have been made [2]. So far, the dimensions of the dataset have always been a major limiting factor for the AI training and consequently for its diagnostic performance. The AI-based computer-aided diagnosis used in this study interestingly reached a good result with only a small number of patients, apparently overcoming the need for a large dataset. The authors achieved this result by sampling all the peripheral zone pixels for training the Support Vector Machine. Using this strategy, the dataset which resulted was very large despite the small number of patients included in the study. Because of the previous consideration, the strategy proposed by Yuichiro Oishi et al. will probably be crucial in the development of future diagnostic tools.

Background Active surveillance (AS) and minimally invasive ablative therapies such as percutaneous cryoablation (PCA) are emerging as alternative treatment modalities in the management of small renal masses (SRMs). Methods Fifty-nine patients underwent PCA since 2011 and 75 underwent AS since 2010 at two different institutions. Only patients with follow-up ≥ 6 months were included. All patients were followed with a standardized protocol. Treatment failure was defined by dimensional progression for AS and renal recurrence for PCA, in addition to stage and/or metastatic progression for both groups. Results Treatment failure was observed in 14 cases (18,7%) during AS (mainly due to dimensional progression) and 12 patients (16%) underwent delayed intervention with a mean follow-up of 36,83 months. Seven patients (11,9%) in the PCA group experienced treatment failure with a mean follow-up of 33,39 months and 3 of them underwent re-ablation successfully. Cancer-specific-survival at 2 and 5 years was 100% and 95,8% in AS-group vs. 98,2% and 98,2% in PCA-group (p=0,831). One patient in both groups died from metastatic disease. Overall-survival at 2 and 5 years was 91,7% and 82,4% in the AS-group vs. 96,5% and 96,5% in the PCA-group (p=0,113). Failure-free survival at 2 and 5 years was 90,9% and 70,1% in the AS-group vs. 93,1% and 70,9% in the PCA-group (p=0,645). Conclusions AS and PCA provide similar survival outcomes and are safe and valid treatment options for elderly and comorbid patients with SRMs.

BACKGROUND: Abdominopelvic computer tomography (CT) is widely used in the follow up of seminoma patients after radical orchidectomy. The aim of this study is to evaluate the clinical utility of abdominopelvic computer tomography in the follow-up of patients with Stage I seminoma. METHODS: The pathological reports of all patients that have undergone radical orchidectomy in our tertiary referral center between January 2002 and January 2018 have been retrospectively reviewed. All patients with Stage I seminoma and negative serum tumor markers after radical orchidectomy were included. Patients with follow-up shorter than 12 months were excluded. Surveillance records of every patient were reviewed with particular regard to abdominopelvic imaging. RESULTS: Of the 133 patients who have undergone radical orchidectomy in our center, 55 had stage I pure seminoma with normal levels of serum tumor markers after surgery. Two patients were excluded as the follow-up was inadequate. Mean follow-up was 63,2 months (IQR: 30-73). The results of 211 abdominopelvic CTs performed as part of the follow up were reviewed. Two (3,7%) patients developed recurrence; one consisted of a scrotal lump and was diagnosed with ultrasonography (US) while the second appeared as paraaortic nodal metastasis and was diagnosed with abdominopelvic CT. The recurrence was successfully treated in both patients. A single abdominopelvic CT was useful for the detection of recurrent disease in our entire study population. No cancer specific death has been reported in the study population. CONCLUSIONSː Follow-up schedules for stage I seminoma exposes patients to potential risks of radiation- induced tumors, emotional distress and represent a significant burden for the healthcare system. The current series suggests that a better risk adapted patient-tailored follow-up program is needed in order to avoid unnecessary investigations.

Introduction and objectives To evaluate the prognostic role of albumin-to-fibrinogen ratio (AFR) for the prediction of oncological outcomes in a multi-institutional cohort of bladder cancer (BC) patients treated with radical cystectomy (RC). Materials and methods We retrospectively analyzed a multicenter cohort of patients treated with upfront RC for localized (cT1-4aN0M0) BC. Multivariable logistic regression analyses were performed to evaluate the ability of AFR to predict non-organ confined (NOC) disease and lymph-node involvement (LNI) at time of RC. Multivariable Cox’ regression models were performed to evaluate the prognostic effect of AFR on Time-to-Progression (TTP), overall survival (OS), and cancer-specific survival (CSS). Results A cut-off value to discriminate between low and high AFR was determined by calculating the receiver operating characteristic (ROC) curve. The area under the curve was 0.73 with an optimal cut-off at 9.53. Data were available for 246 patients (91 with low AFR, 155 with high AFR). Low AFR was associated with characteristics of tumor aggressiveness and independently predicted NOC (OR 2.11, P = 0.02) and LNI (OR 1.58, P = 0.04) at final pathological report. On multivariable Cox’ regression analyses, preoperative low AFR was independently associated with worse TTP (HR 2.21, P = 0.02), OS (HR 2.24, P = 0.03), and CSS (HR 2.70, P = 0.01). Conclusion Preoperative low AFR is a prognostic biomarker for worse TTP, OS, CSS, and is independently associated with adverse tumor pathological features in BC patients undergoing RC. Our results suggest that especially patients with low AFR may be considered for neoadjuvant treatment.

Introduction and objectives: As erectile dysfunction is more commonly being diagnosed and treated with a preexisting inflatable penile prosthesis (IPP) insertion at younger ages, surgeons will increasingly encounter pre-placed abdominal reservoirs when performing pelvic surgery. Materials and methods: A 69-year-old Caucasian man with BCG refractory carcinoma-in-situ (CIS) and past history of non-invasive high-grade urothelial carcinoma of the bladder was a candidate for a radical cystectomy and an ileal-neobladder diversion. He had a three-components IPP inserted for the treatment of Peyronie disease and organic erectile dysfunction (ED). During the radical cystectomy the reservoir was encapsulated on the left lateral pelvic wall over the external iliac vessels. It was isolated and IPP was inflated to reduce the reservoir size. After accurate disinfection, the reservoir was removed from Retzius space without disconnecting it from the pump. Then, the radical cystectomy was carried out without any intraoperative complications and Studer ileal orthotopic neobladder was performed. At the end of the surgery, the reservoir was disinfected with the Mulcahy protocol and then placed in the same position. Results: A week after catheter removal the IPP was successfully activated. The patient’s postoperative recovery was uneventful and no postoperative complication occurred. Definitive histological examination described a multifocal urothelial carcinoma of the bladder: pG3Tis N0 R0. The patient reports excellent functionality of the penile prosthesis and is currently using it. Conclusions: Sexual functionality preservation in oncologic patients should be pursued when possible. In this report, the functionality of the IPP was preserved, while still performing oncologically radical procedures. A multicenter study is needed to assure more solid recommendations on this rare procedure that is surely burdened by a lot of risks.

Background Recently, renal angioembolization (RAE) has gained an important role in the non-operative management (NOM) of moderate to high-grade blunt renal injuries (BRI), but its use remains heterogeneous. The aim of this review is to examine the current literature on indications and outcomes of angioembolization in BRI. Methods We conducted a search of MEDLINE, EMBASE, SCOPUS and Web of Science Databases up to February 2021 in accordance with PRISMA guidelines for studies on BRI treated with RAE. The methodological quality of eligible studies and their risk of bias was assessed using the Newcastle–Ottawa scale Results A total of 16 articles that investigated angioembolization of blunt renal injury were included in the study. Overall, 412 patients were included: 8 presented with grade II renal trauma (2%), 97 with grade III renal trauma (23%); 225 with grade IV (55%); and 82 with grade V (20%). RAE was successful in 92% of grade III–IV (294/322) and 76% of grade V (63/82). Regarding haemodynamic status, success rate was achieved in 90% (312/346) of stable patients, but only in 63% (42/66) of unstable patients. The most common indication for RAE was active contrast extravasation in hemodynamic stable patients with grade III or IV BRI. Conclusions This is the first review assessing outcomes and indication of angioembolization in blunt renal injuries. The results suggest that outcomes are excellent in hemodynamic stable, moderate to high-grade renal trauma.

Background and objectives: Cryoablation is emerging as a safe and effective therapeutic option for treating renal cell carcinoma. This study analyzed the safety and long-term oncological outcomes of cryoablation in our center. Materials and methods: Patients who underwent computed tomography (CT)-guided percutaneous cryoablation between February 2011 and June 2020 for one or more clinically localized renal tumors were identified. Technical success and treatment efficacy were assessed. Post-procedural complications were classified according to the Clavien-Dindo system. Recurrence–free survival was determined for biopsy-proven malignant renal tumors. Results: A total of 174 renal tumors, 78 of which were biopsy-proven malignant carcinomas, were treated in 138 patients (97 males and 41 females, mean age: 73 years, range: 43–89 years). Mean tumor size was 2.25 cm and 54.6% of the lesions required a complex approach. Technical success was achieved in 171 out of 174 tumors (98.3%). Primary treatment efficacy was 95.3% and increased to 98.2% when retreats were taken into account. The overall complication rate was 29.8%. No complications of Clavien-Dindo grade III or more were encountered. Median follow-up was 21.92 months (range: 0.02–99.87). Recurrence-free survival was 100% at 1 year, 95.3% (95% CI: 82.1%–98.8%) at 3 years, and 88.6% (95% CI: 71.8%–95.7%) at 5 years. Conclusions: Cryoablation is a safe and effective technique for the treatment of small renal lesions, with no major complications when performed by expert interventional radiologists. The multidisciplinary discussion is essential, especially considering the high number of histologically undetermined lesions. Our long-term oncological outcomes are encouraging and in line with the literature.

Objective: Intravesical Bacillus Calmette-Guerin (BCG) is an effective treatment in non––muscle-invasive bladder cancer, however, extravesical BCG infection may occur in remote organs as a potentially serious complication. Researchers aimed to assess whether a different timing of BCG infection after intravesical administration of BCG could be identified and estimated for each single involved organ. Methods: We performed a systematic literature review over systemic and genitourinary BCG infection case reports, including 271 published case reports for a total of 307 patients. Demographic data, clinical features, and timing of BCG infection development were collected and analyzed for each patient. Results: BCG infection developed with a different timing from last instillation, depending on the involved organ. Among the genitourinary complications, penile lesions occurred as early as 1 (1;3) weeks, while orchiepididymitis occurred as late as 56 (6.25;156) weeks. At the same time, granulomatous hepatitis and lungs involvement such as miliary pulmonary BCG infection occurred earlier, with a median time of 1 (1;4) and 1 (1;6) weeks respectively, whereas vascular, osteoarticular, and muscular complications developed with a median timing from last instillation of 52 (20;104), 68 (14;156), and 93 (29;156) weeks, respectively. The analysis detected a cluster between lungs, liver, and bone marrow complications on one side and muscular and osteoarticular or vascular complications on the other side was also observed. Conclusions: BCG infection after intravesical BCG for bladder cancer may develop even several months or years after the last instillation, depending on the involved organs. When BCG infection interests one or more organ, 2 main associative patterns are common: one involving lungs, liver, and bone marrow, with earlier occurrence but lower rates of microbiological diagnosis achievement, and one involving muscular and osteoarticular or vascular districts, with later occurrence but higher rates of microbiological evidence.