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Many physicians are familiar with patients who leave against medical advice, much less known is the refusal to leave the hospital. Here we report a case, that we encountered during the Covid pandemic, of a patient who was convinced of having Cauda-Equina syndrome and refused to leave the hospital until the MRI was done. Taking inspiration from this case, we decided to offer a practical approach to dealing with situations like these, to avoid discharge to the street and discuss the ethical implications of similar situations, like the one we encountered. Proactive psychiatric consultation services were demonstrated to reduce the length of stay. Based on these considerations we also suggest early psychiatric consultation to assist medical teams in identifying possible barriers to discharge and help with the management of these difficult cases. Hospitals should also develop internal protocols to deal with difficult discharges. Well-defined protocols could help to deal with emotional states such as bursts of outrage and allegations of abandonment by the patients, like the ones we recently encountered. Nonetheless, we believe a shared discharge decision between patients and physicians should be the common goal. This problem is often encountered in clinical practice but literature on the matter is scarce, since staying against medical advice (SAMA) is far less common than its sibling: leaving against medical advice (LAMA).

The diagnosis of prostate carcinoma has been monitored in Sicily and Calabria for one year.Material e Methods Twenty-seven urological centres of Sicily and Calabria joined the study. Detailed informations about age, familiarity, PSA, Gleason score and TNM stage at diagnosis were centralized between november 2001 and november 2002.Results 721 patients have been recruited. The median age was 73 years. More than 80% of the patients were older than 65 years. Median PSA was 14 ng/ml. The clinical stage at diagnosis was T1c in 33% of patients and 67% had an organ confined prostate cancer (T1-T2). Familiarity was detected in 8% of cases. Age and PSA at diagnosis in these patients were similar to those of the remaining population. However, only 18% of them had a T1 tumor, emphasizing the delay in diagnosis in these patients. Although only 10% of the patients shows at diagnosis a metastatic tumor, 29% only are fit for radical prostatectomy in according to age, PSA and stage.

A 9-year-old girl, who had no family history of neurologic diseases in the first-degree relatives, had a 3-year history of progressive myoclonus epilepsy (PME). A thorough laboratory investigation was normal. As two sisters of her paternal grandmother were said to have Huntington’s disease (HD), the authors looked for HD and found a CAG repeat expansion of 115 repeats. This diagnosis should be considered in addition to other causes in patients with PME. Moreover, the current case further supports the notion that HD should be considered even when a family history is not obvious.

There is evidence that patients with chronic daily headache (CDH) may have isolated intracranial hypertension without papilledema (IHWOP). Recent studies have emphasized that isolated IH may be due to cerebral venous thrombosis (CVT).

Mutations in the parkingene have been reported in patients with early onset PD. The authors investigated the parkingene in 118 patients who had an onset of PD after age 45 years 95 subjects were sporadic patients and 23 subjects were from 18 families with a probable autosomal recessive inheritance. No pathogenetic mutations in the parkingene were detected either in familial or in sporadic patients. Moreover, no differences were found between patients and 100 age-matched normal controls in the allele and genotype frequencies of four exonic parkinpolymorphisms.

The authors report their experience with 10 patients subjected to chemotherapy for urinary cancer. The decision to prolong therapy sprang from the persistent efficacy of the same and the will to live of the actual patients, while respecting the classical moral principles of bioethics.

A case of pseudohermaphroditism with persistence of Mullerian duct derivates in a 77-year-old patient is reported. The patient was phenotypically male and the caryotype was 46 XY. He had a normal penile size and normal sexual function until 3 years previously. The vagina and uterus communicated with the posterior urethra. Laparatomy showed an almost normal uterus with the testicles at the end of the fallopian tubes. Problems concerning embryogenesis and management are discussed.

The Authors describe a case of urachal adenocarcinoma. The patient was a 36-year-old man who had already undergone segmentai (cupula) cystectomy at another hospital. The result of the histological test was: urachal adenocarcinoma. Afterwards a C.T. scan was taken which was negative. Then the patient had a cystoscopy with biopsy (negative) in our hospital, and underwent a new segmentai cystectomy releasing the urachus. The result of the second histological test was urachal adenocarcinoma. The Authors underline the rareness of this pathology, and the importance of total or segmentai cystectomy for treatment of the above.

The Authors report their experience on traumatic rupture of the corpora cavernosa. The importance of immediate surgery, in order to fully repair the lesions and avoid complications, is underlined.

The authors report their experience with 20 patients subjected to metabolic radiotherapy with Sr-89 for palliation of bone metastases in advanced prostatic cancer. Sr-89 is an effective symptomatic treatment, generally well tolerated, with minimal adverse effects.

The authors describe 4 recently observed cases of retroperitoneal hematoma from spontaneous rupture of renal neoplasia. The aim of this report is to underline the problems concerning the pathogenesis, diagnosis, staging and therapy.

The authors describe their experience with 40 patients subjected to TUIP for BPH from May ‘92 to November ‘96. The criteria used for including patients in the study were based on the prostatic weight calculated ultrasonically by means of the ellipsoid rule. Results were similar to those reported in world literature. The authors conclude that although TURP is the best endoscopic technique for BPH, TUIP is also important since both catheterisation and hospitalisation times are shorter with resulting cost savings.

– In this work the authors describe a case of post-trauma renal artery thrombosis. The 46-year-old male patient, with a post trauma to the right flank, underwent emergency urography during which he went into shock. Emergency laparotomy was therefore performed by anterior transperitoneal approach. Trauma of the spleen and rupture of the right kidney with thrombosis of the right renal artery was found. The aim of the authors is to show that immediate operation is sometimes necessary without careful pre-operative radiological exams in order to save the patient's life.

In the last ten years (1983–1993) we treated 18 patients, 17 men and 1 woman, less than 40 years old, with bladder tumour: nine were 15 to 30 years old. The mean follow-up is 40 months. All the patients are living. Of the 18, 2 (more than 30 years old) have had resectable recurrences, in one (27 years old), cystectomy and continent urinary diversion was performed for invasive disease. We think that all patients regardless of age, should be treated as aggressively as necessary on the basis of the stage and grade of the tumour.

The authors report their experience in 10 cases of giant calculosis of the bladder. Their formation secondary to obstructive cervico-urethral pathology is highlighted and treatment of the latter remains of prime importance.

In view of the lack of spinal units in Calabria and Institutes from which information can be obtained on the conditions of patients with injuries to the spinal cord, we researched such patients (approx. 500,000) with urological risk in our territory. We included in our study 81 patients, 62 men and 19 women, aged between 18 and 78 years. Significant uro-andrological problems were found in 42 patients. It is to be hoped that the survey contributes to improving the poor assistance at present provided for persons with injuries to the spinal cord in Calabria.