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no data exist concerning functional and oncological outcomes of Retzius-sparing robot-assisted radical prostatectomy (RS-RARP), in patients previously treated with trans -urethral resection of the prostate (p-TURP), for benign prostate obstruction. Our study addressed the impact of p-TURP on immediate and 12-months urinary continence recovery (UCR), as well as peri-operative outcomes and surgical margins, after RS-RARP. all patients treated with RS-RARP for prostate cancer at a single high-volume European institution, between 2010 and 2021, were identified and stratified according to p-TURP status. Logistic, Poisson and Cox regression models were performed. Of 1386 RS-RARP patients, 99 (7%) had history of p-TURP. Between p-TURP and no-TURP patients no differences were detected regarding both intra- and post-operative complications (p values = 0.9). The rates of immediate UCR were 40 vs 67% in p-TURP vs no-TURP patients (p < 0.001). At 12 months from RS-RARP, the rates of UCR were 68 vs 94% in p-TURP vs no-TURP patients (p < 0.001). At multivariable logistic and Cox regression models, p-TURP was independently associated, respectively, with lower immediate (odds ratio [OR]: 0.32, p < 0.001) and 12-months UCR (hazard ratio: 0.54, p < 0.001). At multivariable Poisson analyses, p-TURP predicted longer operative time (rate ratio: 1.08, p < 0.001) but not longer length of stay or time to catheter removal (p values > 0.05). Positive surgical margins rates were 23 vs 17% in p-TURP vs no-TURP patients (p = 0.1), which translated in a non-statistically significant multivariable OR of 1.14 (p = 0.6). p-TURP does not increase surgical morbidity but portends longer operative time and worse urinary continence after RS-RARP. [ABSTRACT FROM AUTHOR]

We investigated the temporal changes from spring to summer of the stranded litter and the composition of plastic encrusting biota along an Italian beach. Our findings highlight a higher quantity of litter (average value 1510.67 ± 581.27 items) in spring, particularly plastic material with a composition driven by currents, winds and waves transported from rivers to sea. During summer the source was caused by anti-social behaviours (e.g. cigarettes). Regarding the plastic size, the most is macroplastic (85.96 %), followed by mesoplastic (13.74 %) and megaplastic (0.30 %) overall, and no seasonal trend was observed. Concerning the encrusting biota, Mollusca was the most frequent phylum found on plastic beach litter, whereas Porifera the most abundant overall. During spring a greater abundance of individuals was recorded compared to summer. The trend of taxa richness was decreasing from spring to summer. Arthropoda, Porifera and Mollusca phyla were significantly more abundant in spring, while Algae in summer. • Temporal turnover of beach litter and encrusting biota is investigated. • Cotton buds are dominant plastic items in Central Italy beach. • Litter source is land based, mainly due to the local tourism in summer. • A total of 9 taxa as plastic encrusting biota is found. • Arthropoda, Porifera, Mollusca are more abundant in spring, while Algae in summer. [ABSTRACT FROM AUTHOR]

Background: We describe our 20-year experience with a posterior transrectal approach (York-Mason procedure) to treat recto-urinary fistula (RUF). Most RUFs are secondary to lower urinary or intestinal tract surgery. Spontaneous closure is infrequent, and operative treatment is often mandatory. Several surgical approaches have been proposed. Methods: We reviewed retrospectively the medical records of 14 patients presenting with RUF in our Department between 1988 and 2010. In 10 patients, RUFs developed after radical retropubic prostatectomy (RRP); in the other 4 patients, RUFs resulted after other surgical interventions. All patients were treated with the York-Mason approach. A temporary colostomy and suprapubic cystostomy were performed in all patients except one. Results: All patients were treated successfully. After fistulectomy, colostomies were closed after 4 mo, and patients reported fecal continence and no postoperative anal strictures. The colostomy was left in place permanently in 1 patient due to the simultaneous presence of Crohn’s disease, in another with ulcerative rectocolitis, and in a third scheduled for adjuvant radiotherapy for relapse after RRP. In 1 patient, daily medications were essential because of wound infection. In the patient with Crohn’s disease, the fistula recurred 11 years after first repair. Two patients died of metastatic prostate cancer 1 year after repair of the RUF. Conclusion: The posterior sagittal transrectal approach allows easy access and good surgical exposure, facilitating identification of the fistulous tract. In our opinion, the York-Mason approach guarantees the greatest success rate with the least morbidity. [Copyright &y& Elsevier]

Abstract: Context: Recurrent stress urinary incontinence (R-SUI) represents a management dilemma; however, only a limited number of randomised controlled trials (RCTs) have assessed the various surgical procedures used for its treatment. Objective: To assess the effectiveness and complications of various surgical procedures for the treatment of female R-SUI. Evidence acquisition: A prospective peer-reviewed protocol was prepared a priori. A systematic literature review of all published RCTs comparing surgical procedures for treatment of R-SUI was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analysis statement. Data were analysed using RevMan 5. Evidence synthesis: We conducted a literature search from 1945 to February 2013. Data were available for a total of 350 women in 10 RCTs with a mean follow-up of 18.1 mo. Meta-analysis was possible for the comparison of retropubic tension-free vaginal tape (RP-TVT) versus transobturator tension-free vaginal tape (TO-TVT) in five RCTs (n = 135). There was no statistically significant difference between RP-TVT and TO-TVT in the patient-reported improvement (odds ratio [OR]: 0.84, 95% confidence interval [CI], 0.41–1.69) or objective cure/improvement (OR: 1.75; 95% CI, 0.86–3.54). One RCT showed a trend towards a higher rate of patient-reported and objective cure/improvement with the inside-out TO-TVT compared with the outside-in; however, it was not statistically significant (OR: 3.00; 95% CI, 0.85–10.57, and OR: 3.32; 95% CI, 0.96–11.41, respectively). There was no significant difference between Burch colposuspension and RP-TVT (one RCT) in patient-reported improvement (OR: 0.33; 95% CI, 0.01–8.57) or objective cure/improvement (OR: 0.52; 95% CI, 0.13–2.05). Conclusions: This meta-analysis shows no evidence of a significant difference in patient-reported and objective cure/improvement rates between RP-TVT and TO-TVT in the surgical treatment of women with R-SUI. However, due to the relatively low number of patients, the analysis might be underpowered. This review highlights the poor level of evidence in this field and the need for well-designed clinical trials to address this important clinical dilemma. [Copyright &y& Elsevier]