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Introduction: The size of penis can cause concern in patients, even if the organ is clinically normal. Additionally, the cost of phosphodiesterase 5 inhibitors (iPDE5) and long waiting lists to access penile prosthesis placement can lead patients to resort to non-medical and potentially dangerous alternatives. One of these dangerous alternatives is the injection of building silicone at the level of the subcutis of the penis or the corpora cavernosa causing the formation of a granuloma that increases the girth and consistency of the penis., Case Report: The article describes the case of a 43-year-old patient who self-injected aedile silicone at the level of his penis in an attempt to achieve greater penile size and greater rigidity. The patient reported that he could not economically afford the iPDE5.The persistence of severe pain in the penis forced the patient to go to a urological examination. The patient subsequently underwent the penile granuloma exeresis procedure and skin reconstruction with scrotal flap., Conclusion: The pursuit of sexual well-being can lead some patients to rely on unconventional and potentially harmful techniques. The role of the andrologist and of the scientific society should be to dissuade the patient from using these dangerous methods and to provide valid alternatives accessible to the patient. The economic difficulty in purchasing drugs that facilitate erection or the long waiting lists for the placement of penile prostheses can favor dangerous methods such as penile injection of silicon. There is therefore a clear need to facilitate access to drugs and surgical techniques that favor the patient's sexual well-being.

Literature: The cancer of testicles represents 1% of male neoplasms and 5% of urological malignant neoplasm. Its incidence has been growing in Western societies. Cancer of testicles usually presents as an increase of consistence in one testicles and absence of pain, as a casual ultrasound scan finding, or it could be highlighted by a scrotal injury. The surgical treatment is either radical orchiectomy or radical orchiectomy plus retroperitoneal lymph node dissection., Case Presentation: The case presented concerns a 48-year-old male with a history of left testicular trauma and subsequent hypotrophy. Over the next 4 years, the patient developed a testicle size increase up to 15 cm in diameter. At diagnosis, he had retroperitoneal lymphadenopathy. The patient was, after surgery, referred to the oncology department., Conclusion: The awareness of the male population respect to testicular cancer and its screening methods (e.g. self-examination) is essential to make the diagnosis at an early stage. It is also essential to psychologically support patients undergoing surgical and/or pharmacological therapy due to risk of determining anxiety or depression compared to the whole population.

Purpose: Inguinal lymphadenectomy (iLAD) reduces mortality in patients with cN0 penile cancer but yields high complication rates. Thus, its prophylactic role has been questioned and dynamic sentinel node biopsy (DSNB) was introduced to select men who should undergo the procedure. Our aim was to investigate the accuracy of a contemporary DSNB cohort., Methods: We performed a retrospective analysis of ≥T1 or ≥G2 cN0 penile cancer undergoing perioperative DSNB from June 2009 to June 2015 at a tertiary referral center. We excluded men with <18 months follow-up or with local recurrence after primary curative treatment. Complications were graded according to the Clavien-Dindo classification., Results: Thirty-five men underwent DSNB; 85.71% had ≤T2 penile cancer with ≤G2a histology. Per groin detection rate was 80% (scintigraphy being positive bilaterally in 60% and unilaterally in 20.0%). In no cases did DSNB prolong the postoperative course compared to primary surgery. Nine men (n = 15/109 nodes removed) had positive results, 8 of whom underwent iLAD. Among negative DSNB patients, 2 developed nodal penile cancer recurrence; none of them had node biopsy due to inconclusive scintigraphy. At a median follow-up of 42 months (interquartile range 30-78 months), if considering only men with scintigraphy detected inguinal nodes, per-patient sensitivity and specificity were 50% and 80% whereas positive predictive value and negative predictive value were 25% and 92.3%, respectively., Conclusions: Perioperative DSNB is a safe procedure, yielding promising results when performed at a tertiary referral center. Future prospective large studies are needed to investigate how to optimize detection rate and reduce false-negative rates.

Purpose: A sentinel lymph node (SNL) is the primary landing zone of cancer cells that spreads through the lymphatic vessels. The rational of the detection of sentinel node (SLN) during radical prostatectomy (RP) for prostate cancer (PCa) is the removal of the first nodal stations to provide a restriction of the template of node dissection. A review of the outcomes of SNL detection during RP for PCa was performed., Materials and Methods: A systematic review of the literature was conducted, searching on PubMed and Web of Science, using the following keywords: lymph node dissection, prostatic neoplasm, sentinel node., Results: Twenty articles were selected and analyzed including over 2000 PCa patients. Although promising and technically feasible, many points remain to be clarified before clinical application can be recommended., Conclusions: The technique of SNL detection is feasible and provides a higher sensitivity and detection rate than standard lymphadenectomy, especially for organ-confined tumors. Larger series and long-term follow-up data are mandatory to assess the oncologic effectiveness of the detection of SNL for PCa.

Renal transplant (RT) represents the treatment of choice for end-stage renal disease (ESRD) but harbours a wide range of possible complications and therapeutic challenges of urological competence. Dialysis years and clinical medical background of these patients are risk factors for sexual dysfunction and lower urinary tract symptoms (LUTS). On the contrary, RT itself may have a number of possible surgical complications such as ureteral stenosis and urinary leakage, while immunosuppressive treatment is a known risk factor for de-novo malignancies.The present review describes the main urologic problems of RT patients and their up-to-date treatment options according to the most recently available literature evidences.

Female urinary incontinence represents a medical and social problem with huge impact regarding both patient's quality of life and social costs. The diagnosis is important for therapeutic choice and should consider some factors: the degree of urethral mobility, urodynamics parameters, patient's will and expectations, information about surgical complications and risks. Nowadays suburethral sling evolution and bulking therapy for selected cases consent to perform miniinvasive surgery; the most relevant problem concerns the management of postoperative complications: in this sense autologous slings are used after urethrolisis. In most difficult cases, it is possible to consider artificial sphincter as the best option.

Infertility is defined as the inability of a sexually active non-contracepting couple to achieve spontaneous pregnancy in one year.
 Factors of male infertility are present in 50% of infertile couples.
 Azoospermia is defined as the absence of sperm in the ejaculate, even after centrifugation of the sample, and affects 10%-15% of the infertile male population. Therefore, it represents a pathological condition of primary importance in the context of infertility management.
 Any assisted reproductive procedure must first refer to the availability of a suitable number of good quality gametes.
 As regards sperm collection, if ejaculated semen is not suitable or available, it may be taken from the seminal duct or directly from the testicular parenchyma with different methodologies and techniques, which can be divided into percutaneous techniques and open surgical (TeSE and ESA) or micro-surgical (micro-TeSE) techniques.
 The purpose of this work is to evaluate and compare the retrieval rate in infertile patients suffering from azoospermia and treated with the various surgical techniques.

A case of primary prostate involvement by mantle-cell lymphoma diagnosed at the time of transvesical adenomectomy is reported. Diagnostic difficulties and clinical outcome are also presented. The possibility of prostate involvement by malignant lymphomas, albeit rare, should be considered in any case of histological evidence of dense prostate lymphoid infiltrate in patients with lower urinary tract obstruction, and should be highly suspected in patients with prior history of systemic lymphoma. Immunohistochemical analysis is essential for a correct diagnosis. Both urologists and pathologists should be aware of the existence of such a rare clinical condition.

Bladder cancer is the most common tumor of the urinary tract, with a worldwide incidence of 8.6 x 100000 in men and 2.6 x 100000 in women (1). The majority of patients (75-85%) present as non-muscle invasive bladder cancer (NMIBC); within this category the most represented stage is Ta (70%), followed by T1 (20%) and, less frequently, carcinoma in situ (CIS) (10%) (2). The diagnosis of NMIBC and, more generally, of bladder cancer, depends on urine cytology and endoscopic examination with histological evaluation of the resected tissue. Clearly, an optimal cystoscopy with accurate transurethral resection (TUR) is of great importance in order to improve the detection rate and to reduce the probability of recurrence and progression. Today the cystoscopy is routinely performed with the white light technique (WLC), the same of about 80 years ago (3). Several studies have demonstrated that an initial TUR with WLC can miss small papillary lesions and, particularly, flat lesions such as CIS. Moreover, recurrence rates of non-muscle invasive bladder cancer (NMIBC) are directly related to the possibility of achieving a complete resection: residual cancer is present in a large percentage of re-TUR, showing a not so good performance of resection with this method. For these reasons new methodologies have been investigated in order to improve the sensitivity and specificity of WLC, such as photodynamic diagnosis (PDD), narrow band imaging (NBI), optical coherence tomography (OCT) and CT virtual cystoscopy. Some of them have been well established and supported by consistent literature while others are still to be viewed as experimental. The purpose of this review is to investigate the state of the art of these new techniques.

Urethral hemangiomas are rare and benign tumors, probably originating from a unipotent angioblastic stem cell. They can vary in size and the clinical appearance can range from asymptomatic lesions to urethral bleeding or gross hematuria. We present the case of an 18-year-old male, with a history of urethral bleeding. Cystourethoscopy revealed a solitary bulging mass into the lumen, about 6 cm far from the external meatus. Doppler study confirmed that the lesion was in communication with the vessels of the left spongious body. The patient underwent surgical removal of the lesion. The post-procedure Doppler study revealed an inflammation-based remodeling of the spongoius urethra and the absence of the previous vascular connection. At the time of publication the patient is still symptom-free. The surgical removal of urethral hemangiomas is by far the technique of choice for treating such lesions in young patients, thus avoiding side effects of LASER treatments.

Cigarette consumption was compared between 355 males with cancer of the lower urinary tract and 276 male hospital controls. Both duration of smoking and average daily consumption of cigarettes showed a dose-response relationship with risks of developing bladder cancer. Quitting smoking seems to have a protective role, whereas higher relative risks are associated with an early age at start of smoking. The use of a filter seems to have a weak protective effect.