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The introduction of robot-assisted surgery represents a milestone in the history of surgery. Today, many surgical disciplines make use of the DaVinci robotic system in performing surgery, even complex ones. Italy stands as one of the countries with a greater diffusion of robotics in surgery, particularly in urological surgery. In Italy, every year, numerous urological surgeries are performed with the DaVinci robot; however, costs of this technology are high and, although likely to decrease, constitute a limit to the spread of the same and restricting its use to shared areas.

Male stress urinary incontinence, which has radical prostatectomy as the main aetiology, affects about 39% of the adult male population and is one of the complications of radical prostatectomy with the greatest impact on the quality of life of patients. There are a wide range of treatments for stress urinary incontinence available to the urologist, ranging from conservative treatments to surgical treatments, from minimally invasive procedures to the implant of artificial sphincter prosthesis. The aim of this work is to define the state-of-the-art of surgical treatments for male stress urinary incontinence, analyzing the most recent studies in the literature and evaluating the available scientific evidence.

Introduction: Antibiotic prophylaxis (AP) is used to minimize infectious complications resulting from interventions. Due to high rates of development of bacterial resistance and side effects, the use of antibiotics must be weighed on the basis of high levels of evidence. The main endpoints of urology AP are the prevention of symptomatic urogenital infections, urosepsis and wound infections. The purpose of this review is to bring objectives, principles and recommendations on urology AP according to the latest scientific evidence., Methods: We carried out a systematic search of MEDLINE, EMBASE and the Cochrane Library using keywords such as AP, prophylaxis, antibiotics, urological surgery, urogenital surgery and the names of the urologic procedures. The results of studies on the AP for each procedure were classified according to the levels of evidence and grades of recommendation from the European Association of Urology., Results: There are a number of good quality studies on AP about endoscopic resection of the prostate (TURP), urodynamic studies and transrectal prostate biopsies (trPB). The majority of the studies about other procedures have several limitations (sample size, consistency of definitions, statistics and trial design). Lack of consistency in the definitions of infectious complications does not allow comparison between different studies., Conclusions: The AP is evidence-based is indicated only for TURP and trPB. It is desirable to perform randomized, prospective and controlled trials in order to rationalize the use of antibiotics, improve the cost/benefit ratio and reduce bacterial antibiotic resistances.

Urinary tract infections (UTI) are amongst the most frequent bacterial infections and therefore are responsible for a significant fraction of antibiotic use, thus carrying a relevant social and economic burden. UTI may present as benign, uncomplicated cystitis or severe, life-threatening urosepsis. Due to the heterogeneity of UTI the European Section of Infections in Urology (ESIU) has introduced a phenotypical classification, based upon the clinical presentation, the risk factors and the antibiotic susceptibility of the causative pathogens. Presence of risk factors is a key point and could change dramatically the course of UTI. In scenario of uroseptic patients, early diagnosis and therapy are mandatory and a successful decompression of the obstructed urinary tract is predictor of survival. The multidisciplinary approach and a timely microbiological characterization are critical in this context.

Overactive bladder syndrome (OAB) is a highly prevalent condition associated with a significant impairment of patients' Quality of Life (QoL) because of its adverse effects on social, sexual, interpersonal, and professional functions. Cost-of-illness analyses showed the huge economic burden related to OAB for patients, public healthcare systems, and society, secondary to both direct and indirect costs. These types of cost analyses, however, exclude intangible costs related to QoL impairment. Recently, many novel therapies have been introduced, arising the need to apply the modern methodology of Health Technology Assessment (HTA) to new therapies in order to evaluate objectively their value in terms of both improvement in length/Quality of Life and costs. By producing information on the clinical, economic, organizational, social and ethical impact of health technologies, HTA has been used worldwide to inform decision makers at different levels in health systems. The HTA approach demonstrated, worldwide, to be a useful approach to increase the level of appropriateness in the use of medical technology and, as a consequence of that, of resources. Health utilities are instruments that allow a measurement of QoL and its integration in the economic evaluation using the Quality-of-life-Adjusted-Life-Years (QALYs) model and cost-utility analysis. The development of suitable instruments for quantifying utility in the specific group of OAB patients is vitally important to extend the application of cost-utility analysis in OAB and to guide healthcare resources allocation for this disorder. Studies are required to define the cost-effectiveness of available pharmacological and non-pharmacological therapy options.

The Authors stress the importance of a correct sonographic study in the follow-up of neonatal adrenal hemorrhage; the diagnostic conclusion are: the best criterion for differential diagnosis is the chronological variability. However the differential diagnosis is rather easy. The differential d. usually is against cystic-neuroblastoma, cortical renal cyst, adrenal abscess. They remark that laparatomy is unnecessary.