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A standing posture including various ankle positions might effectively facilitate pelvic floor muscle activity (PFMa) in incontinent women, and an ankle dorsiflexion (DS) at 15 degrees was identified as the best position able to increase PFMa. Nevertheless, this ankle inclination is very uncomfortable. We carried out this study aiming at identifying smaller ankle inclinations able to significantly affect PFMa in incontinent women reducing patient discomfort.Twenty women, not yet entered menopause and with mild-moderate uncomnplicated stress urinary incontinence, were enrolled. An electromyographic (EMG) biofeedback instrument using surface electrodes was employed to measure changes in PFMa while each patient assumed the following different ankle inclinations in upright position: horizontal standing (HS); DS at degrees (5DS), 10 degrees (10DS) and 15 degrees (15DS); and ankle plantar flexion (PS) at 5 degrees (5PS), 10 degrees (10PS) and 15 degrees (15PS).No EMG differences were found between HS and PS. PFM tension in DS, at whatever angle, was significantly greater than in both HS (P0.020) and PS (P0.040). No differences were found between IODS and 15DS in terms of resting PFMa. Concerning maximal PFMa, it was higher in 10DS than in 15DS (P = 0.010), and in 5PS than in both 5DS (P = 0.006) and 15DS (P = 0.010); no EMG differences were found between 5PS and 10DS.These preliminary results showed that 10DS in upright standing had comparable effects on resting PFMa than 15DS with same effectiveness and less patient's discomfort, facilitating a better maximal contraction. Moreover a slight PS might effectively facilitate maximal PFMa.

The aim of these study is to assess the understanding of the Italian version of the IIEF-5 questionnaire (International Index of Erectile Function) and the impact of patient's demographic and clinical characteristics on it.Each patient was asked to self complete the Italian version of the IIEF-5 questionnaire and to self report demographic information and any difficulties to complete the questionnaire and which question was considered more difficult to understand.A total of 89 patients were included in this study. Patients mean age was 61.2 +/- 15.4 (standard deviation = SD) years. The mean IIEF score at the time of the visit was 13.5 +/- 8.5 (SD). The questions considered more difficult to understand were number 5 (26%), number 4 (20%) and number 1 (20%). Statistically significant differences between patients with and without problems in completing the questionnaire were found in terms of education level (p = 0.0026).Patients with a lower educational level have more difficulties in understanding the questionnaire and the most difficult questions are items number 5, 4 and 1.

Background Correct identification of variant histologies (VHs) of bladder cancer (BCa) at transurethral resection of the bladder (TURB) could drive the subsequent treatment. Objective To evaluate the concordance in detecting VHs between TURB and radical cystectomy (RC) specimens in BCa patients. Design, setting, and participants We retrospectively analyzed 1881 BCa patients who underwent TURB and subsequent RC at seven tertiary care centers between 1980 and 2018. VHs were classified as sarcomatoid, lymphoepithelioma-like, neuroendocrine, squamous, micropapillary, glandular, adenocarcinoma, nested, and other variants. Outcome measurements and statistical analysis Concordance between TURB and RC was defined as the ability to achieve histological subtypes at TURB confirmed at RC specimen, and was expressed according to Cohen’s kappa coefficient. Results and limitations Of the patients, 14.6% and 21% were diagnosed with VH at TURB and RC specimens, respectively. The most common VHs at TURB were squamous, neuroendocrine, and micropapillary carcinoma (5.2%, 1.5%, and 1.5%, respectively). At RC, the most frequent VHs were squamous, micropapillary, and sarcomatoid carcinoma (7.2%, 3.0%, and 2.7%, respectively). The overall concordance in detecting VH was defined as slight concordance (coefficient: 0.18). Moderate concordance was found for neuroendocrine, adenocarcinoma, and squamous carcinoma (coefficient: 0.49, 0.47, and 0.41, respectively). Micropapillary, glandular, and other variants showed slight concordance (coefficient: 0.05, 0.17, and 0.12, respectively), while nested and sarcomatoid carcinoma showed fair concordance (coefficient: 0.32 and 0.26, respectively). Results may be limited by the absence of centralized pathological analysis. Conclusions A non-negligible percentage of patients were diagnosed with VH at both TURB and RC. TURB showed relatively low accuracy, ranging from poor to moderate, in detecting VHs. Our study underlines the need of additional diagnostic tools in order to identify VHs properly at precystectomy time and to improve patient survival outcomes. Patient summary In this report, we underlined the low accuracy of transurethral resection of the bladder in detecting variant histologies and the need for additional diagnostic tools.

Introduction Women undergoing radical cystectomy (RC) followed by urinary diversion (UD) for bladder cancer experience a substantial reduction in health-related quality of life (HRQOL). At present, studies comparing long-term QOL outcomes for different UD methods, needed to inform evidence-based choices of bladder reconstruction for female patients, are sparse. Our objective was to compare two common UD methods in terms of their HRQOL outcomes in women. Materials and methods We retrospectively analysed HRQOL in 73 consecutive female bladder cancer patients having undergone orthotopic ileal neobladder (IONB, N = 24) or ileal conduit (IC, N = 49) following RC between 2007 and 2013 in six Italian academic urological centres. Patients had no evidence of tumour recurrence and were actively followed up. Validated Italian versions of the European Organisation for Research and Treatment of Cancer (EORTC) generic (QLQ-C30) and bladder-cancer-specific (QLQ-BLM30) questionnaires were used to evaluate HRQOL. Results Patients in the IONB group were significantly younger than those in the IC group (median age: 67 and 73 years, respectively, p = 0.02). Barring that, the two groups did not present statistically significant differences in median length of follow-up (43 vs 54 months), pathological stage, grading of the neoplasm, or adjuvant chemo - or radiotherapy. No significant differences in QOL were found between the groups, with the exception of financial difficulties, affecting IONB patients significantly more than IC patients (mean score on a scale of 0–100: 33.3 ± 29.5 vs 18.4 ± 19.3, respectively; p = 0.05). Conclusion Financial difficulties was the only HRQOL item to differ between the two UD groups.

Author of the Study: The COVID-19 outbreak has brought challenges to the global healthcare community. The management of upper urinary tract stones has been affected even further, with potential severe sequelae for patient’s health. Materials and Methods: We report a multicentric retrospective study involving 9 Centers regularly delivering treatment for upper tract urinary stones across the country. All Centers suffered significant limitations during the pandemic period due to government limitations. We compared the 12 months-period prior to COVID-19 (from march 1st 2019 to February 28th 2020, named as period A) with postCOVID-19 period (from march 1st, 2020 to February 28th, 2021 named as period B). Aim of the study was to compare endourological procedures for upper urinary stones during period A and the period B. This study investigated all types of surgeries delivered in both elective and emergency setting. Results: A total of 4018 procedures were collected, including 2176 procedures in period A. In period B, 1842 procedures were carried out, corresponding to a loss of 15.35% of cases (p < 0.001). Looking into elective cases, 1622 procedures were delivered in period A, compared to 1280 in period B, resulting in a loss of 342 cases corresponding to 21.81% (p = 0.001). All types of stone treatments resulted affected, including ESWL (from 487 cases in period A to 344 in period B, − 29.37%, p = 0.001), PCNLs (from 170 to 125 cases, corresponding to − 26.47%, p:0.008), retrograde surgery for renal stones (from 433 to 387 cases, − 10.63%, p = 0.008) and for ureteric stones (from 614 cases to 484, − 21.18%, p.008). Additionally, waiting lists resulted affected, with significant delays in period B. In particular, for ureteric stones, mean waiting time in period A was 61.5 days compared to 87.5 days in period B (p = 0.008). Regarding renal stones, waiting list increased from 64.74 days in period A to 85.66 days in period B for RIRS. The waiting list for percutaneous surgeries increased from 79 days to 103 days (p = 0.001). We did not find any patient which acquired COVID-19 during hospitalization for elective or urgent surgery. We also found a longer waiting list for pre-stented patients, resulting to be 86.5 days in period B compared to 64 days in period A (p < 0.005). Conclusions: Our study showed how COVID-19 caused a significant disruption in endourological services across the country. Our data underlined how less patients received treatment in a longer time. This can potentially lead to an increased risk of stone- related complications, including sepsis and kidney loss.

The COVID-19 outbreak, in a few weeks, overloaded Italian hospitals, and the majority of medical procedures were postponed. During the pandemic, with hospital reorganization, clinical and learning activities performed by residents suffered a forced remodulation. The objective of this study is to investigate how urology training in Italy has been affected during the COVID-19 era. In this multi-academic study, we compared residents' training during the highest outbreak level with their previous activity. Overall 387 (67.1%) of the 577 Italian Urology residents participated in a 72-h anonymous online survey with 36 items sent via email. The main outcomes were clinical/surgical activities, social distancing, distance learning, and telemedicine. Clinical and learning activity was significantly reduced for the overall group, and after categorizing residents as those working only in COVID hospitals, both “junior” and “senior” residents, and those working in any of three geographical areas created (Italian regions were clustered in three major zones according to the prevalence of COVID-19). A significant decrease in outpatient activity, invasive diagnostic procedures, and endoscopic and major surgeries was reported. Through multivariate analysis, the specific year of residency has been found to be an independent predictor for all response modification. Being in zone 3 and zone 2 and having “senior” resident status were independent predictors associated with a lower reduction of the clinical and learning activity. Working in a COVID hospital and having “senior” resident status were independent predictors associated with higher reduction of the outpatient activity. Working in zone 3 and having “senior” resident status were independent predictors of lower and higher outpatient surgical activity, respectively. Working in a COVID hospital was an independent predictor associated with robotic surgical activity. The majority of residents reported that distance teaching and multidisciplinary virtual meetings are still not used, and 44.8% reported that their relationships with colleagues decreased. The COVID-19 pandemic presents an unprecedented challenge, including changes in the training and education of urology residents. The COVID era can offer an opportunity to balance and implement innovative solutions that can bridge the educational gap and can be part of future urology training.

Introduction: From the most recent systematic revision of the literature, an orthotopic neobladder would seem to show marginally better health related quality of life (HR-QoL) scores compared with an ileal conduit. The aim of this study was to review all relevant published studies about the comparison between ileal orthotopic neobladder (IONB) and ileal conduit using validated HR-QoL questionnaires. Materials and Methods: Studies were identified by searching multiple literature databases. Data were synthesized using meta-analytic methods conformed to the PRISMA statement. Results: The literature search identified 10 papers; pooled effect sizes of combined quality of life outcomes for ileal conduit versus IONB showed a significantly better HR-QoL in patients with IONB (Hedges' g = 0.278; p = 0.000);. The present study has an important limitation due to the type of the analyzed comparative studies, all retrospective and not randomized. Conclusion: This meta-analysis of not-randomized, retrospective comparative studies on the impact of ileal conduit versus IONB on HR-QoL showed a significant advantage of IONB subgroups.