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Simple Summary: Renal Cell Carcinoma is a common cancer in Western countries. To date, the gold standard treatment for localized non-metastatic disease is partial or radical nephrectomy. When surgical treatment is feasible, the prediction of postoperative renal function might influence the treatment algorithm. On the other hand, there is growing evidence indicating that immune response and nutritional status are crucial factors in human cancer development and progression. In this scenario, the Controlling Nutritional Status (CONUT) score was initially developed as a malnutrition screening tool. Its formula includes serum albumin levels, total lymphocyte count, and total serum cholesterol. Serum albumin is used as an indicator of protein reserves. Cholesterol is used as a caloric depletion parameter. Total lymphocyte count represents an indicator of immune defense impairment due to malnutrition. In this study, we evaluated the impact of the CONUT score on clinically significant decline in estimated glomerular filtration rate in patients with non-metastatic Clear Cell Renal Cell Carcinoma undergoing radical nephrectomy. Our findings confirmed that a preoperative high CONUT score is an independent predictor of a significant renal function decline after surgery. Being easy to use, cost effective, and ideally a completely automated tool, its preoperative assessment could be part of a personalized risk-stratification tailored to the clinical conditions and comorbidities of each patient. Background and Objectives: We aimed at evaluating the impact of Controlling Nutritional Status (CONUT) score on clinically significant decline in estimated glomerular filtration rate (eGFR) in patients with non-metastatic Clear Cell Renal Cell Carcinoma (ccRCC) undergoing radical nephrectomy (RN). Materials and methods: We retrospectively analyzed a multi-institutional cohort of 140 patients with ccRCC who underwent RN between 2016 and 2018 at three Urological Centers. The CONUT score was calculated with an algorithm including serum albumin, total lymphocyte count, and cholesterol. Clinical and pathologic features were analyzed using Fisher's exact test for categorical variables and a Mann–Whitney U test for continuous variables. To define the independent predictors of clinically significant eGFR decline, univariable (UVA) and multivariable (MVA) binomial logistic regression analyses were performed in order to assess the Odds Ratio (OR) with 95% Confidence Intervals (CIs). Results: The optimal cut-off value to discriminate between a low and high CONUT score was assessed by calculating the ROC curve. The area under the curve (AUC) was 0.67 (95%CI 0.59–0.78) with the most appropriate cut-off value at 2 points. Overall, 46 patients (32.9%) had a high CONUT score (>2). Statistically significant variables associated with eGFR decline at 24 months were age ≥ 70 (OR 2.01; 95%CI 1.17–3.09; p = 0.05), stage II–III chronic kidney disease (CKD) (OR 6.05; 95%CI 1.79–28.3; p = 0.001), and a high CONUT score (OR 3.98; 95%CI 1.58–10.4; p = 0.004). Conclusions: The CONUT score is a low-time-consuming, cost-effective, and promising tool able to preoperatively screen patients at risk of developing CKD after a RN. [ABSTRACT FROM AUTHOR]

Bladder cancer (BC) is the tenth most commonly diagnosed malignancy worldwide. In approximately 25% of cases, it presents as a muscle-invasive disease, requiring a radical treatment. Traditionally, the mainstay of treatment has been radical cystectomy (RC), but in the last decade, bladder-sparing treatments have been gaining growing interest. In particular, trimodal therapy (TMT) seems to yield survival results comparable to RC with less morbidity and better quality of life (QoL) outcomes. In this scenario, we aimed at shedding light on the role of the histological subtypes (HS) of BC and their prognostic significance in muscle-invasive BC (MIBC), treated either surgically or with TMT. We performed a narrative review to provide an overview of the current literature on this topic. When compared with patients diagnosed with conventional urothelial carcinoma (UC) of the same disease stage, survival did not appear to be significantly worse across the reports. But when sub-analyzed for separate subtype, some appeared to be independently associated with adverse survival outcomes such as the micropapillary, plasmacytoid, small-cell, and sarcomatoid subtypes, whereas others did not. Moreover, the optimal management remains to be defined, also depending on the therapeutic susceptibility of each histology. From this perspective, multi-disciplinary assessment alongside the routine inclusion of such entities in randomized clinical trials appears to be essential. [ABSTRACT FROM AUTHOR]

Fluorescence confocal microscopy (FCM) represents a novel diagnostic technique able to provide real-time histological images from non-fixed specimens. As a consequence of its recent developments, FCM is gaining growing popularity in urological practice. Nevertheless, evidence is still sparse, and, at the moment, its applications are heterogeneous. We performed a narrative review of the current literature on this topic. Papers were selected from the Pubmed, Embase, and Medline archives. We focused on FCM applications in prostate cancer (PCa), urothelial carcinoma (UC), and renal cell carcinoma (RCC). Articles investigating both office and intraoperative settings were included. The review of the literature showed that FCM displays promising accuracy as compared to conventional histopathology. These results represent significant steps along the path of FCM's formal validation as an innovative ready-to-use diagnostic support in urological practice. Instant access to a reliable histological evaluation may indeed significantly influence physicians' decision-making process. In this regard, FCM addresses this still unmet clinical need and introduces intriguing perspectives into future diagnostic pathways. Further studies are required to thoroughly assess the whole potential of this technique. [ABSTRACT FROM AUTHOR]

Urothelial carcinoma (UC), the sixth most common cancer in Western countries, includes upper tract urothelial carcinoma (UTUC) and bladder carcinoma (BC) as the most common cancers among UCs (90–95%). BC is the most common cancer and can be a highly heterogeneous disease, including both non-muscle-invasive (NMIBC) and muscle-invasive (MIBC) forms with different oncologic outcomes. Approximately 80% of new BC diagnoses are classified as NMIBC after the initial transurethral resection of the bladder tumor (TURBt). In this setting, intravesical instillation of Bacillus Calmette–Guerin (BCG) is the current standard treatment for intermediate- and high-risk patients. Unfortunately, recurrence occurs in 30% to 40% of patients despite adequate BCG treatment. Radical cystectomy (RC) is currently considered the standard treatment for NMIBC that does not respond to BCG. However, RC is a complex surgical procedure with a recognized high perioperative morbidity that is dependent on the patient, disease behaviors, and surgical factors and is associated with a significant impact on quality of life. Therefore, there is an unmet clinical need for alternative bladder-preserving treatments for patients who desire a bladder-sparing approach or are too frail for major surgery. In this review, we aim to present the strategies in BCG-unresponsive NMIBC, focusing on novel molecular therapeutic targets. [ABSTRACT FROM AUTHOR]

Sentinel node biopsy (SNB) for prostate cancer (PCa) represents an innovative technique aimed at improving nodal staging accuracy. The routinary adoption of this procedure in patients undergoing radical prostatectomy (RP) might be crucial to identify candidates who could effectively benefit from extensive pelvic lymph nodal dissection (ePLND). Despite some promising results, SNB for PCa is still considered experimental due to the lack of solid evidence and procedural standardization. In this regard, our narrative review aimed to analyze the most recent literature in this field, providing an overview of both the diagnostic accuracy measures and the oncological outcomes of SNB. [ABSTRACT FROM AUTHOR]

Background and Objectives: To date, sparse evidence exists about the impact of inflammatory serum markers in predicting perioperative complications after radical cystectomy (RC) for bladder cancer (BC). Here, we evaluated the role of the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), systemic immune-inflammation index (SII), C-reactive protein (CRP), and plasma fibrinogen in predicting perioperative morbidity and unplanned 30-days readmission after RC for BC. Materials and methods: We relied on a collaborative database of 271 patients who underwent open RC for cT1-4a N0 M0 BC between January 2012 and December 2022. Univariable and multivariable binomial logistic regression analyses were performed to assess the odds ratio (OR) with 95% confidence intervals (CI) testing the ability of each serum marker to predict postoperative complications (any-grade and major complications), and 30-days unplanned readmission. Results: The median age at RC was 73 yr (IQR 67–79). A total of 182 (67.2%) patients were male and the median BMI was 25.2 (IQR 23.2–28.4). Overall, 172 (63.5%) patients had a Charlson Comorbidity Index (CCI) greater than 2 points and 98 (36.2%) were current smokers at the time of RC. Overall, 233 (86.0%) patients experienced at least one complication after RC. Of these, 171 (63.1%) patients had minor complications (Clavien–Dindo grade 1–2) while 100 (36.9%) experienced major complications (Clavien–Dindo grade ≥ 3). According to multivariable analysis, current smoking status, high plasma fibrinogen, and preoperative anemia were independently associated with major complications (OR 2.10, 95%CI 1.15–4.90, p = 0.02), (OR 1.51, 95%CI 1.26–1.98, p = 0.09), and (OR 1.35, 95%CI 1.17–2.57, p = 0.03), respectively. Overall, 56 (20.7%) patients experienced a 30-days unplanned readmission. According to univariable analysis, high preoperative CRP and hyperfibrinogenemia were significantly associated with an increased risk of unplanned readmission (OR 2.15, 95%CI 1.15–4.16, p = 0.02; OR 2.18, 95%CI 1.13–4.44, p = 0.02, respectively). Conclusions: In our study, the preoperative immune-inflammation signature described by NLR, PLR, LMR, SII, and CRP showed a low reliability in predicting perioperative course after RC. Preoperative anemia and hyperfibrinogenemia were independent predictors of major complications. Further studies are pending in order to draw definitive conclusions. [ABSTRACT FROM AUTHOR]

Bladder cancer (BCa) is one of the most diagnosed urological malignancies. A timely and accurate diagnosis is crucial at the first assessment as well as at the follow up after curative treatments. Moreover, in the era of precision medicine, proper molecular characterization and pathological evaluation are key drivers of a patient-tailored management. However, currently available diagnostic tools still suffer from significant operator-dependent variability. To fill this gap, physicians have shown a constantly increasing interest towards new resources able to enhance diagnostic performances. In this regard, several reports have highlighted how artificial intelligence (AI) can produce promising results in the BCa field. In this narrative review, we aimed to analyze the most recent literature exploring current experiences and future perspectives on the role of AI in the BCa scenario. We summarized the most recently investigated applications of AI in BCa management, focusing on how this technology could impact physicians' accuracy in three widespread diagnostic areas: cystoscopy, clinical tumor (cT) staging, and pathological diagnosis. Our results showed the wide potential of AI in BCa, although larger prospective and well-designed trials are pending to draw definitive conclusions allowing AI to be routinely applied to everyday clinical practice. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Oxalis pes-caprae L. is a South African geophyte that behaves as an invasive in the eurimediterranean area. According to a long-established hypothesis, O. pes-caprae may have invaded Europe and the Mediterranean area starting from a single plant introduced in the Botanical Garden of Malta at the beginning of the 19th century. The aim of this work was to test this hypothesis, to track the arrival of O. pes-caprae in different countries of the Euro-Mediterranean area and to understand the pathways of spreading and particularly its starting point(s). Historical data attesting the presence of the plant in the whole Euro-Mediterranean region were collected from different sources: herbarium specimens, Floras and other botanical papers, plant lists of gardens, catalogs of plant nurseries and plant dealers. First records of the plant (both cultivated and wild) for each Territorial Unit (3rd level of NUTS) were selected and used to draw up a diachronic map and an animated graphic. Both documents clearly show that oldest records are scattered throughout the whole area, proving that the plant arrived in Europe and in the Mediterranean region more times independently and that its spreading started in different times from several different centers of invasion. Botanical gardens and other public or private gardens, nurseries and plant dealers, and above all seaside towns and harbors seemingly played a strategic role as a source of either intentional and unintentional introduction or spread. A geographic profiling analysis was performed to analyse the data. We used also techniques (Silhouette, Kmeans and Voronoi tessellation) capable of verifying the presence of more than one independent clusters of data on the basis of their geographical distribution. Microsatellites were employed for a preliminary analysis of genetic variation in the Mediterranean. Even if the sampling was insufficient, particularly among the populations of the original area, our data supported three main groups of populations, one of them corresponding to the central group of populations identified by GP analysis, and the other two corresponding, respectively, to the western and the eastern cluster of data. The most probable areas of origin of the invasion in the three clusters of observations are characterized by the presence of localities where the invasive plant was cultivated, with the exception of the Iberian cluster of observation where the observations in the field predate the data about known cultivation localities. Alternative possible reasons are also suggested, to explain the current prevalence of pentaploid short-styled plants in the Euro-Mediterranean area. [ABSTRACT FROM AUTHOR]

Background: Traditional alcoholic beverages (TABs) have only received marginal attention from researchers and ethnobotanists so far, especially in Italy. This work is focused on plant-based TABs in the Alta Valle del Reno, a mountainous area on the border between Tuscany and Emilia-Romagna regions. The aims of our study were to document local knowledge about TABs and to analyze and discuss the distribution of related knowledge within the investigated communities. Methods: Field data were collected through semi-structured interviews. The relative importance of each plant species used to prepare TABs was assessed by calculating a general Use Value Index (UVgeneral), a current UV (UVcurrent) and a past UV (UVpast). We also assessed personal experience of use by calculating effective and potential UV (UVeffective, UVpotential). A multivariate analysis was performed to compare ingredients in recipes recorded in the Alta Valle del Reno with those reported for neighboring areas. Results: Forty-six plant species, belonging to 20 families, were recorded. Rosaceae was the most significant family (98 citations, 19 species), followed by Rutaceae (15, 3) and Lamiaceae (12, 4). The most important species was Prunus cerasus L. (UVgeneral = 0.44), followed by Juglans regia L. (0.38), Rubus idaeus L. (0.27) and Prunus spinosa L. (0.22). Species with the highest UVcurrent were Juglans regia (0.254), Prunus cerasus (0.238) and Citrus limon L. (0.159). The highest UVeffective values were obtained by Prunus cerasus (0.413), Juglans regia (0.254), Rubus idaeus (0.222) and Citrus limon (0.206). We also discuss the results of the multivariate analysis. Conclusions: TABs proved to occupy an important place in the traditional culture and social life of the studied communities. Moreover, data highlight the local specificity and richness of this kind of tradition in the Alta Valle del Reno, compared to other Italian areas. Some plant ingredients used for TABs have potential nutraceutical and even therapeutic properties that are well known by local people. These properties could constitute an additional economic value for TABs' commercialization, which in turn could promote the local rural economy. [ABSTRACT FROM AUTHOR]

Eight patients did not require medical evaluation nor antibiotic treatment as fever resolved spontaneously, 8 cases were managed with an oral antimicrobial therapy and 1 patient required hospitalization and intravenous antimicrobial therapy. Between 2018 and 2019, we prospectively evaluated the incidence of infectious complications in 39 patients undergoing routine office nephrostomy tube replacement performed without any antimicrobial prophylaxis. [Extracted from the article]

Recently, ecotourism has flourished and attracts eco-tourists who visit the ecological and cultural resources of the rural landscape, country parks and marine parks. This study was conducted in Sant'antioco Island, southern Sardinia, Italy. The study aimed at analysis suitability of the Island for ecotourism and formulate recommendation for sustainable development of ecotourism This research integrates three characteristics of ecotourism criteria that are environmental factors, recreation factors and sub- structure factors to identify and prioritize the suitable ecotourism sites in the Sant'antioco Island using a Geographic Information System (GIS) and followed FAO (1976) land suitability evaluation framework. The variables used for generating various indices were temperature, slope (%), elevation, land use/land cover, vegetation diversity, mountain sides (prevailing exposure), rock out crop and the infrastructure accessibility by either road and/or trekking routes in the island such distance from sea and city. The mentioned variables were used for both hard and soft tourists i.e. in this context, hard tourist are those who enjoy tough recreation way for example, rock climbing, and mountaineering and soft tourists are those who relatively like smooth environment for visiting. The suitability result endorsed that 37.28 %( 41km2), 58.78 %( 65 km2) and 3.94 %( 4 km2) of the study area were highly suitable, moderately suitable and marginally suitable respectively for the soft tourist. Here the non-existence of none-suitable class exhibited due to the study area being small in size as well as the major part of the area is moderate slopes. Besides the suitability for hard tourists were 25.49 %( 28km2), 55.60 %( 61 km2), 17.45% (19 km2) and1.46% (1km2) highly suitable, moderately suitable, marginally suitable and non-suitable, respectively. In conclusion the result indicated that the high suitable and moderately suitable area accounted for 96.60% and 81.09%of the total area for soft and hard tourist respectively, which suggested that the eco-tourism resource in the study area is relatively abundant. The study area is suitable for ecotourism development. Therefore sustainable ecotourism is an advocate-able investment area in the study Island. The ecotourism development of the study area should be community based. This strategy will have positive social implication; hence this is a form of ecotourism where the local community has substantial control over and involvement in, its development and management, and a major proportion of the benefits remain within the community. [ABSTRACT FROM AUTHOR]

Vaginoplasty in Male to Female (M to F) transgenders is a challenging procedure, often accompanied by numerous complications. Nowadays the most commonly used technique involves inverted penile and scrotal flaps. In this paper the data of 47 M to F patients who have undergone sex affirmation surgery at the Department of Urology of the University of Trieste, Italy since 2014, using our modified vaginoplasty technique with the "Y" shaped urethral flap, have been retrospectively reviewed. Moreover, a non structured review of the literature with regards to short and long-term complications of vaginoplasty has been provided. All patients followed a standardized neo-vaginal dilation protocol. At follow up 2 patients were lost. At 12 months 88.9% of patients (40/45) were able to reach climax, 75.6% (34/45) were having neo-vaginal intercourses and median neo-vaginal depth was 11 cm (IQR 9-13.25): no statistically significant decrease in depth was found at follow up. Only one patient was dissatisfied with aesthetic appearance at 12 months. Our technique provided excellent cosmetic and functional results without severe complications (Clavien-Dindo ≥ 3). The review of the literature has highlighted the need to standardize a postoperative follow up protocol with particular regard to postoperative dilatation regimen. Further, larger randomized clinical trials are pending to draw definitive conclusions., (© 2021. The Author(s), under exclusive licence to Springer Nature Limited.)