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The article discusses a new surgical technique for urethroplasty that aims to preserve the bulbospongiosus muscle in patients with proximal bulbar urethral strictures. By avoiding the traditional one-sided dissection approach and selectively cutting the muscle's monolateral insertion, this technique offers promising results in maintaining both micturition and sexual function. The study conducted on 19 patients showed positive outcomes with no recurrence of strictures and notable preservation of ejaculatory function, highlighting the importance of preserving the bulbospongiosus muscle in urethroplasty for improved postoperative outcomes and patient quality of life. [Extracted from the article]

Objective: To assess the diagnostic performance of 18F‐fluoro‐2‐deoxy‐d‐glucose (18F‐FDG) positron emission tomograpy (PET)/computed tomography (CT) in nodal staging before radical cystectomy (RC) and pelvic lymph node dissection (PLND) for bladder cancer (BCa). Materials and Methods: This analysis was based on a cohort of 199 BCa patients undergoing RC and bilateral PLND between 2015 and 2022. Neoadjuvant chemotherapy (NAC) or immunotherapy (NAI) was administered after oncological evaluation. All patients received preoperative 18F‐FDG PET/CT to assess extravesical disease. Point estimates for true negative, false negative, false positive, true positive, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of conventional imaging and PET/CT were calculated. Subgroup analysis in patients receiving neoadjuvant treatment was performed. Results: At preoperative evaluation, 30 patients (15.1%) had 48 suspicious nodal spots on 18F‐FDG PET/CT. At RC and bilateral PLND, a total of 4871 lymph nodes (LNs) were removed with 237 node metastases corresponding to 126 different regions. Pathological node metastases were found in 17/30 (57%) vs 39/169 patients (23%) with suspicious vs negative preoperative 18F‐FDG PET/CT, respectively (sensitivity = 0.30, specificity = 0.91, PPV = 0.57, NPV = 0.77, accuracy = 0.74). On per‐region analysis including 1367 nodal regions, LN involvement was found in 19/48 (39%) vs 105/1319 (8%) suspicious vs negative regions at PET/CT, respectively (sensitivity = 0.15, specificity = 0.98, PPV = 0.40, NPV = 0.92, ACC = 0.90). Similar results were observed for patients receiving NAC (n = 44, 32.1%) and NAI (n = 93, 67.9% [per‐patient: sensitivity = 0.36, specificity = 0.91, PPV = 0.59, NPV = 0.80, accuracy = 0.77; per‐region: sensitivity = 0.12, specificity = 0.98, PPV = 0.32, NPV = 0.93, ACC = 0.91]). Study limitations include its retrospective design and limited patient numbers. Conclusions: In eight out of 10 patients with negative preoperative 18F‐FDG PET/CT, pN0 disease was confirmed at final pathology. No differences were found based on NAC vs NAI treatment. These findings suggest that 18F‐FDG PET/CT could play a role in the preoperative evaluation of nodal metastases in BCa patients, although its cost‐effectiveness is uncertain. [ABSTRACT FROM AUTHOR]

Objective: To test the hypothesis that longer warm ischaemia time (WIT) might have a marginal impact on renal functional outcomes and might, in fact, reduce haemorrhagic risk intra‐operatively. Patients and Methods: Data from 1140 patients treated with elective partial nephrectomy (PN) for a cT1‐2 cN0 cM0 renal mass were prospectively collected. WIT was defined as the duration of clamping of the main renal artery with no refrigeration and was tested as a continuous variable. The primary outcome of the study was evaluation of the effect of WIT on renal function (estimated glomerular filtration rate [eGFR]) postoperatively, at 6 months and in the long term (measured between 1 and 5 years after surgery). The secondary outcome of the study was haemorrhagic risk, defined as estimated blood loss (EBL) or peri‐operative transfusions. Multivariable linear, logistic and Cox regression analyses, accounting for age, Charlson comorbidity index, clinical size, preoperative eGFR and year of surgery, were used and the potential nonlinear relationship between WIT and the study outcomes was modelled using restricted cubic splines. Results: A total of 863 patients (76%) underwent PN with WIT and 277 (24%) without. The baseline median eGFR was 87.3 (68.8–99.2) mL/min/1.73m2 for the on‐clamp population and 80.6 (63.2–95.2) mL/min/1.73m2 for the off‐clamp population. The median duration of WIT was 17 (13–21) min. At multivariable analyses predicting renal function, longer WIT was associated with decreased postoperative eGFR (estimate: −0.21, 95% confidence interval [CI] −0.31; −0.11 [P < 0.001]). Conversely, no association between WIT and eGFR was recorded at 6‐month or long‐term follow‐up (all P > 0.8). At multivariable analyses predicting haemorrhagic risk, clampless resection with no ischaemia time and PN with short WIT was associated with an increased EBL (estimate: −21.56, 95% CI −28.33; −14.79 [P < 0.001]) and peri‐operative transfusion rate (estimate: −0.009, 95% CI −0.01; −0.003 [P = 0.002]). No association between WIT and positive surgical margin status was recorded (all P = 0.1). Conclusion: Patients and clinicians should be aware that performing PN with very limited or even with zero WIT might increase bleeding and the need for peri‐operative transfusion while not improving long‐term renal function outcomes. [ABSTRACT FROM AUTHOR]

Context: The use of scrotal ultrasonography (SUS) has increased the detection rate of indeterminate testicular masses. Defining radiological characteristics that identify malignancy may reduce the number of men undergoing unnecessary radical orchidectomy. Objective: To define which SUS or scrotal magnetic resonance imaging (MRI) characteristics can predict benign or malignant disease in pre‐ or post‐pubertal males with indeterminate testicular masses. Evidence Acquisition This systematic review was conducted in accordance with Cochrane Collaboration guidance. Medline, Embase, Cochrane controlled trials and systematic reviews databases were searched from (1970 to 26 March 2021). Benign and malignant masses were classified using the reported reference test: i.e., histopathology, or 12 months progression‐free radiological surveillance. Risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies‐2 tool (QUADAS‐2). Evidence Synthesis: A total of 32 studies were identified, including 1692 masses of which 28 studies and 1550 masses reported SUS features, four studies and 142 masses reported MRI features. Meta‐analysis of different SUS (B‐mode) values in post‐pubertal men demonstrated that a size of ≤0.5 cm had a significantly lower odds ratio (OR) of malignancy compared to masses of >0.5 cm (P < 0.001). Comparison of masses of 0.6–1.0 cm and masses of >1.5 cm also demonstrated a significantly lower OR of malignancy (P = 0.04). There was no significant difference between masses of 0.6–1.0 and 1.1–1.5 cm. SUS in post‐pubertal men also had a statistically significantly lower OR of malignancy for heterogenous masses vs homogenous masses (P = 0.04), hyperechogenic vs hypoechogenic masses (P < 0.01), normal vs increased enhancement (P < 0.01), and peripheral vs central vascularity (P < 0.01), respectively. There were limited data on pre‐pubertal SUS, pre‐pubertal MRI and post‐pubertal MRI. Conclusions: This meta‐analysis identifies radiological characteristics that have a lower OR of malignancy and may be of value in the management of the indeterminate testis mass. [ABSTRACT FROM AUTHOR]

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Keywords: kidney; paraneoplastic; partial nephrectomy; RCC; small renal mass; symptoms; fever EN kidney paraneoplastic partial nephrectomy RCC small renal mass symptoms fever 434 436 3 03/24/23 20230401 NES 230401 In January 2015, a 62-year-old age woman arrived at the San Raffaele Emergency Department complaining of fever of unknown origin (FUO) and two recent syncopal episodes. Out of 3769 patients submitted to active treatment for RCC registered in our prospectively maintained database from 1987 until 2021, 46 (1.2%) had a SRM with paraneoplastic systemic symptoms. These 46 patients represented 16.6% of all the patients with systemic symptoms at presentation, and 2.8% of all the patients with a SRM. [Extracted from the article]

Objective: To evaluate whether the position of the working channel affects the effectiveness of flexible ureteroscopy. Materials and Methods: We compared the ureteroscopes Flex‐X2S and Flex‐XC (working channel at the 9 and 3 o'clock positions, respectively) in eight cavities of a K‐Box model, simulating the distribution of the right and left intrarenal calyces. In the first and second settings, each cavity contained a 1‐cm stone, lying on the bottom and fixed on the anterior sheet covering the box, respectively. In the third setting, the posterior and lateral surface of each cavity was draped with graph paper. Once the flexible ureteroscope entered each cavity, we measured and compared (i) the proportion of stone surface targeted by the laser (STL) and (ii) the proportion of graph paper burned by the laser (PBL) obtained with the two instruments. Results: Higher STLs and PBLs were obtained with the 3 o'clock position than the 9 o'clock position in the right posterior and left anterior cavities (mean ± sd STL 87% ± 15% vs 46% ± 38% and 78% ± 35% vs 43% ± 24%, respectively; P < 0.05), and on the right posterior surfaces of the middle‐lower/lower cavities (PBL 72% vs 31% and 77% vs 35%, respectively; P < 0.01) and on the left lateral surface of the lower cavities (PBL 45% vs 25%; P = 0048), respectively. Conversely, the 9 o'clock position provided higher STLs and PBLs than the 3 o'clock position in the left posterior and right anterior cavities (mean ± sd STL 84% ± 20% vs 65% ± 28% and 79% ± 30% vs 44% ± 35%, respectively; P ≤ 0.02), and on the left posterior and right lateral surfaces of the lower cavities (PBL 59% vs 34% and 50% vs 21%, respectively; P ≤ 0.04). Conclusions: The position of the working channel of the flexible ureteroscope should be considered when planning flexible ureteroscopy, especially when dealing with the lower pole. [ABSTRACT FROM AUTHOR]

Objective: To investigate whether local injection of autologous adipose stromal vascular fraction (SVF) can prevent the development of fibrosis and elastosis in the tunica albuginea (TA) using a rat model of the acute phase of Peyronie's disease (PD). Methods: A total of 24 male 12‐week‐old Sprague–Dawley rats were divided into three equal groups: sham; PD without treatment (transforming growth factor‐β [TGF ‐β]); and PD treated with SVF 1 day after disease induction. Sham rats received two injections of vehicle into the TA 1 day apart. TGF ‐β rats received TGF‐ β1 injection and injection of vehicle 1 day later. SVF rats received TGF‐β1 injection, followed by SVF 1 day later. One month after treatment, all rats underwent measurement of intracavernosal pressure and mean arterial pressure during electrostimulation of the cavernous nerve. The rats were then killed and penises were harvested for histology and Western blot analysis. Results: Erectile function was moderately reduced in the TGF‐β group and was significantly improved after SVF treatment (P < 0.05). PD rats developed areas of fibrosis with a significant upregulation of collagen III, collagen I and elastin protein expression. These fibrotic changes were prevented when treated with SVF. Conclusions: Local injection of SVF may represent treatment for the acute phase of PD. [ABSTRACT FROM AUTHOR]

Objective: To study the prevalence and the risk associated with prediabetes (PreDM) in primary infertile men. Patients and methods: Data from 744 infertile men were analysed. Health‐significant comorbidities were scored with the Charlson Comorbidity Index (CCI). Serum hormones were measured in every man. Semen analysis was based on 2010 World Health Organization (WHO) reference criteria. PreDM was defined according to the clinical criteria detailed by the American Diabetes Association (Diabetes Care 2014; 37 (Suppl. 1): S81). Descriptive statistics and logistic regression analyses tested the association between PreDM status, hormonal milieu and seminal parameters. The predictive accuracy of all variables was evaluated using the area under the curve, and the clinical net benefit estimated by decision curve analysis (DCA). Results: Of the 744 men, PreDM was found in 114 (15.4%). Men with PreDM (+PreDM) were older, had higher CCI scores, lower total testosterone and sex hormone‐binding globulin but higher follicle‐stimulating hormone (FSH) and 17β‐oestradiol values compared to those without PreDM (−PreDM) (all P ≤ 0.04). Higher sperm DNA fragmentation index (DFI; P = 0.014) and idiopathic non‐obstructive azoospermia (iNOA; P < 0.001) were found more frequently in +PreDM men. At multivariable logistic regression analysis, older age, FSH and iNOA (all P ≤ 0.04) were significantly associated with +PreDM status. DCA demonstrated a clinical net benefit in discriminating men at higher risk of a +PreDM status. Conclusions: About 15% of primary infertile men had criteria suggestive of undiagnosed PreDM. A PreDM status was associated with a greater risk of hypogonadism, higher DFI values and iNOA status. Age, FSH values and iNOA status could be considered as useful parameters to recognise men with PreDM and implement early preventive interventions in those men at risk of the consequences from poor glycaemic control. [ABSTRACT FROM AUTHOR]

Objective: To assess the relationship between the duration of infertility (DI) and the seminal parameters of a cohort of White‐European primary infertile men. Patients and Methods: Data from 1644 infertile men were analysed. Patients were grouped according to the self‐reported DI into 12‐month time frames. Semen analysis values were assessed based on 2010 World Health Organisation reference criteria. Descriptive statistics tested the difference in clinical, hormonal and seminal parameters between groups. Logistic regression models assessed the impact of DI on semen parameters. Results: A DI of <12, 13–24, 25–36, 37–48, 49–60 and >60 months was found in 207 (12.6%), 651 (39.6%), 387 (23.5%), 168 (10.2%), 92 (5.6%) and 139 (8.4%) men, respectively. Patient's age (P < 0.001) and body mass index (P < 0.001) significantly increased along with DI. Hormonal values were similar across groups. Sperm concentration significantly decreased with DI (P = 0.01). Similarly, a higher rate of non‐obstructive azoospermia (NOA) was more frequently found in men with a longer DI (P = 0.03). There were no differences in semen volume, sperm progressive motility, total motile sperm count (TMSC), and normal morphology across groups. Multivariable logistic regression analysis showed that DI was significantly associated with the risk of oligozoospermia (P < 0.001), TMSC <5 × 106 (P < 0.001), and NOA (P < 0.001). Conclusions: This cross‐sectional study showed that DI had a negative impact on semen parameters in primary infertile men. Sperm concentration was negatively associated with DI and patients with a longer DI reported higher rates of azoospermia. Furthermore, DI was significantly associated with a higher risk of oligozoospermia, low TMSC, and NOA. [ABSTRACT FROM AUTHOR]

Objectives: To investigate scores and predictors of patient satisfaction at 1 year after penile prosthesis implantation (PPI) using the validated Quality of Life and Sexuality with Penile Prosthesis (QoLSPP) questionnaire. Patients and Methods: Analyses were performed for 142 patients prospectively included in the national multicentre registry Italian Nationwide Systematic Inventarization of Surgical Treatment for Erectile Dysfunction (INSIST‐ED), which provided 1‐year follow‐up data. Postoperative patient satisfaction was assessed using the validated QoLSPP tool. Linear logistic regression analyses assessed predictors of QoLSPP total and single domain scores, including age at surgery, erectile dysfunction aetiology, type of prosthesis, surgical approach, surgeon experience and complications. Locally weighted regression methods were used to explore the relationship between surgeon experience and QoLSPP scores. Results: Overall, high median functional, relational, social, personal and total QoLSPP scores were reported at 1 year after PPI. Patients implanted with hydraulic devices had higher functional (23 vs 21.5; P = 0.01) and total scores (68 vs 65.5; P = 0.03) than those with a malleable prosthesis. Surgeon experience emerged as the only independent predictor of higher satisfaction scores, depicting a non‐linear association with both QoLSPP total and single domain scores (all P < 0.03). Data suggested that the higher the number of procedures per year, the greater the satisfaction scores, reaching a plateau after l5 procedures/year. Conclusions: This study reports high functional and patient satisfaction scores at 1 year after PPI surgery using a dedicated tool for the first time. Better outcomes should be expected for patients treated by surgeons with greater experience. [ABSTRACT FROM AUTHOR]