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Background. Post-prostatectomy stress urinary incontinence (PPSUI) is one of the major complaints after radical prostatectomy. Transoburator male sling (TMS) placement is indicated in persistent mild to moderate PPSUI. External beam radiation therapy (EBRT) might be a negative prognostic factor for TMS outcomes. Study objective was to analyze EBRT impact on TMS outcome. Methods. We retrospectively investigated patients submitted to TMS for PPSUI, with or without previous EBRT, in two tertiary referral centers since 2010. Objective outcome was measured through ICIQ-SF, 1-hour pad test, and pad per die and subjective improvement through PGI-I. Patients were divided according to EBRT to make in-group and between-group comparisons. Results. Patients were 56, 18 (32.1%) had previous EBRT. Median follow-up was 43.0 months (IQR: 22.3–64.0). TMS was placed at mean 18.8 months (SD 4.6) after EBRT. TMS determined a statistically significant reduction of pads, 1-hour pad test, and ICIQ-SF score ( P

Purpose. To evaluate the results of Damage Control Strategy (DCS) in the treatment of generalized peritonitis from perforated diverticular disease in patients with preoperative severe systemic diseases. Methods. All the patients with diffuse peritonitis (Hinchey 3 and 4) and the American Society of Anesthesiologists (ASA) score ≥3 were included and underwent DCS consisting of a 2-step procedure. The first was peritoneal lavage, perforated colon-stapled resection, and temporary abdominal closure with negative pressure wound therapy combined with instillation. The second step, 48 hours later, included the possibility of restoring intestinal continuity basing on local and general patients’ conditions. Results. Thirty patients (18 [60%] women and 12 [40%] men, median age 68.5 [range = 35-84] years) were included (18 [60%] ASA III, 11 [36.7%] ASA IV, and 1 [0.03%] ASA V). Seven patients (23.3%) showed sepsis and 1 (3.33%) septic shock. At second surgery, 24 patients (80%) received a colorectal anastomosis and 6 patients (20%) underwent a Hartmann’s procedure. Median hospital stay was 18 days (range = 12-62). Postoperative morbidity rate was 23.3% (7/30) and included 1 anastomotic leak treated with Hartmann’s procedure. Consequently, at discharge from hospital, 23 patients (76.6%) were free of stoma. Primary fascial closure was possible in all patients. Conclusions. DCS with temporary abdominal closure by negative pressure wound therapy combined with instillation in patients with diffuse peritonitis from complicated diverticulitis could represent a feasible surgical option both in hemodynamically stable and no stable patients, showing encouraging results including a low stoma rate and an acceptable morbidity rate.

To evaluate the preference for 2 dosing regimens of tadalafil 20 mg, on demand or 3 times/week, in Italian men affected by erectile dysfunction (ED). MATERIALS AND METHODS. SURE is a multicenter, crossover, open-label study, involving 94 urology centers in Italy. Patients aged 18 or more, affected by ED for at least 3 months were enrolled into the study and randomized to a tadalafil 20 mg treatment on demand or 3 times/week for 5-6 weeks. After a 1-week washout period, patients were crossed over to the alternate regimen for 5-6 weeks. A treatment preference question (TPQ) was used to determine the preferred treatment regimen. IIEF and SEP questionnaires were used as efficacy measures. RESULTS. 1058 men, mean age 54.8 years, were randomized to treatment. Overall, 59.1% of patients preferred the on-demand regimen and 41.9% preferred the 3 times/week dosing regimen. Both regimens were efficacious and well tolerated. CONCLUSIONS. Tadalafil is effective and well tolerated whether used both on demand and three times/week. Patients should be given the possibility to choose the best treatment regimen according to personal needs and preferences.

Benign prostatic hyperplasia is considered a progressive disease intimately linked with aging. The long-term use of combination therapy with a 5-alpha-reductase inhibitor, together with an alpha blocker in men with moderate-severe symptoms, reduces the risk of clinical progression and BPH-related surgery. It is unclear what the impact is of preoperative therapy with 5-ARI in patients that undergo surgery. The aim of our study was to evaluate the impact of preoperative therapy with 5-alpha-reductase inhibitors on: a) indication on the type of surgery; b) surgical and functional outcomes; c) surgical complications. This is a prospective observational study. It will include all patients undergoing surgery by TURP or Open Prostatectomy in a period of 24 months. We expect results that demonstrate significant and favorable influence of pretreatment with 5-alpha-reductase inhibitors on certain outcomes. Therefore, therapy with 5-ARI could be considered as neoadjuvant to surgery, whatever this is.