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Purpose: We evaluated intradetrusorial OnabotulinumtoxinA (Onabot/A) treatment protocols in patients with idiopathic overactive bladder (OAB), in order to assess the care of patients before, during and after treatment., Methods: In 64 OAB patients injected with Onabot/A, we reviewed the length of the hospital stay, frequency of catheterization, frequency of intraoperative and postoperative complications, and patients' satisfaction to the proposed treatment protocol (as assessed by VAS). We also compared the results of the 3-day voiding diary, uroflowmetry with postvoid residual urine (PVR) and VAS to score the bother of urinary symptoms on quality of life (QoL) before and after treatment., Results: Twenty-one patients were firstly treated in an 'inpatient' setting. The mean ± SD duration of hospitalization and catheterization was 39.4 ±12.6 and 37.8 ± 10.6 h, respectively. The mean ± SD VAS values of treatment satisfaction and of bother of urinary symptoms on QoL were 6.3 ± 1.1 and 8.2 ± 1.3, respectively. The mean ± SD PVR value was 74.3 ± 15.2 ml. Frequency of UTIs was 2.4 ± 1.6. Forty-three patients were treated on an outpatient basis; the mean ± SD duration of catheterization, the 'outpatient' stay and the mean ± SD frequency of UTIs were lower than those of patients treated in an inpatient setting. The mean ± SD VAS value to score QoL was high., Conclusions: Intradetrusorial Onabot/A injection is a simple and fast procedure that can be easily carried on in an outpatient setting under local anesthesia, with low rates of intraoperative and postoperative complications.

Introduction: Radical prostatectomy (RP) in patients with high-risk prostate cancer (PC) [prostate specific antigen (PSA) ≥ 20 ng/mL, and/or Gleason score ≥ 8, and/or cT3a disease] is considered an optional therapy, usually as a part of multimodal approach. Aim of the study is to evaluate the outcome of radical prostatectomy in case of specimen-confined (SC) disease and to compare it with patients with pathological locally-advanced disease., Materials and Methods: Data from 176 consecutive patients with high-risk prostate cancer who underwent RP as initial therapy were analyzed, identifying subjects with specimen-confined disease (i.e. negative margins and negative lymph-nodes) in which RP was considered as monotherapy, and comparing oncological outcomes to patients with pathological non-SC disease, in which RP was considered as the first step of a multimodal approach., Results: In high-risk prostate cancer, pathological report showed the presence of specimen-confined disease in 28.3% of cases. At univariate analysis, age and PSA correlate with the presence of SC disease at radical prostatectomy, while at multivariate analysis only PSA was a significant predictor of SC disease. At 5 years, Kaplan-Meier estimation of biochemical-free and cancer-specific survival was 56.2% and 97.7% vs 40.8% and 92.8% in specimen-confined disease and non-specimen-confined disease, respectively., Conclusions: High-risk prostate cancer presents challenges for uro-oncologists since standard treatment is still under debate. One third of patients will present with specimen-confined disease, for which radical prostatectomy represents the sole, initial curative therapy; RP as multimodal therapy in patients without SC disease permits excellent long-term oncological outcomes.

The urinary epithelium has been the subject of considerable interest and much research in recent years. What has radically changed in the last decade is the concept of what the bladder epithelium really is. It is currently no longer considered just a simple barrier and a non-specific defence against infections, and it has been recognized as a specialized tissue regulating complex bladder functions and playing a fundamental and active role in the pathogenesis of cystitis. Researchers have been focussing on the receptors and mediators that are active in the sub-epithelial layer, with the hope that understanding the role of the urothelium defect will offer the opportunity for new therapeutic strategies. On the surface of the urothelial umbrella-cells there is a thick layer of glycoproteins and proteoglycans, which together are called Glycosaminoglycans (GAGs). They constitute a hydrophilic mucosal coating and act as a barrier against solutes found in urine. In recent years they have received special attention because injury to Gags, due to different noxae, has been identified as the first step in the genesis of chronic inflammatory bladder diseases, such as recurrent urinary tract infections, chemical or radiation cystitis, interstitial cystitis and/or Bladder Pain Syndrome. Aim of this study is to define the importance of the urothelium starting from the anatomy and physiology of the bladder wall. Furthermore, we will underline the role of glycosaminoglycans, focusing both on their pathophysiological role in the principal bladder diseases and on the therapeutic aspects from the clinical point of view.

Aim of the Study: Botulinum toxin A (BoNT/A) has been recently used in the treatment of benign prostatic hyperplasia due to its apoptotic activity on prostatic epithelium but few data exist on this issue in prostate cancer. Also no information exist on the eventual modulation exerted by the neurotoxin on Phospholipase A2 (PLA2) expression in prostate cancer. The aim of this study was to evaluate the activity of BoNT/A on cell growth and expression of PLA2 in prostate cancer lines., Materials and Methods: PC-3 and LNCaP cell lines were exposed to BoNT/A (Xeomin®), different doses and time of exposure. Presence of SV2 receptors (SV2-A and SV2-B) for the neurotoxin was also investigated. The expression of P-Ser505-cPLA2-α (phosphorylated enzyme) was performed immunofluorescence., Results: After 96 hours of BoNT/A administration a 20% reduction of cell growth in LNCaP and 25% in PC-3 were observed. SV-2 receptors were expressed in both cell lines. No cPLA2-α total expression was found in LnCaP. In PC-3 there was a high expression of cPLA2-α total which was not modified after BoNT/A treatment. In both LNCap and PC-3 the expression of P-Ser505-cPLA2-α (phosphorylated enzyme) increases significantly after treatment with [10 U/ml] of BoNT/A., Conclusions: LNCaP and PC-3 cell lines are sensitive to treatment with BoNT/A which probably enters the cells by SV2 receptors. The increase in the phosphorylated form of cPLA2-a, induced by BoNT/A may represent one mechanism by which the toxin reduces cell growth and proliferation.

Background: Female pelvic organ prolapse (POP) is a common condition that often leads to lower urinary tract symptoms (LUTS) and may require surgical intervention to alleviate those symptoms. However, the relationship between LUTS and pelvic organ descent however, remains unclear. The aim of this paper is to determine the correlation between LUTS and POP and changes after POP repair., Methods: We retrospectively review female patients who attended our tertiary high- volume centre center for LUTS and POP, and underwent integral pelvic floor reconstruction., Results: An overall of 256 patients presented with POP and LUTS and underwent POP repair. Most of 50% of patients reported two or more symptoms and only 4.2% were asymptomatic for LUTS. 189/256 (73.8%) patients had voiding symptoms and 39 a urodynamic detrusor overactivity. Thirteen suffered from hydronephrosis. 148/256 (57.8%) showed a stress urinary incontinence. All the patients underwent POP repair with or without contemporary anti- incontinence procedure., Conclusions: Urologists and gynaecologists should recognisebe aware of the high frequency of the POP and LUTS association of POP and LUTS. POP repair my restore a normal situation but symptoms may last after the surgery or develop "de novo."

Vesical urothelium was long considered to simply be a protection barrier, which passively separates the urinary content from the underlying smooth muscle and the blood stream. Recent observations, though, have pointed out that vesical urothelium cells have clear active and sensory functions, in response to various physical and chemical stimuli. Among these characteristics are the expression of several neurotransmitters and receptors: Acetylcholine, Nitric Oxide, VIP, CGRP, NKA, SP and cholinergic, vanilloid, purinergic, and tachykinin receptors. Urothelium-produced neurotransmitters are likely supposed to act through a receptor stimulation of the afferent nerve fibers within the sub-urothelial spaces. Sub-urothelial myofibroblasts are considered to play a mediation role between urothelium-produced neurotransmitters and the underlying receptors. According to these observations, a pharmacologic modulation, directly affecting the urothelium, can be hypothesized.

The lower urinary tract (LUT) is densely innervated by capsaicin-sensitive primary afferent neurons, a sub set of sensory nerves, in a number of species including humans. These fibers exhibit both a sensory (afferent) function, including the regulation of the micturition reflex and the perception of pain, and an 'efferent' function, involved in the detrusor smooth muscle contractility and plasma protein extravasation. The discovery of specific binding sites for capsaicin, the pungent ingredient of red chilli, initiated a rush that ended up with the cloning of the 'vanilloid receptor', which belongs to the TRP (transient receptor potential) family. Here we reviewed the knowledge about the presumable functions of TRP family proteins in the LUT as regulators of bladder reflex activity, pain perception and cell differentiation. This review will focus on experimental evidence and promising clinical applications of targeting these proteins for the treatment of detrusor overactivity and bladder pain syndrome. As TRP receptor ligands may promote cellular death, and inhibit the growth of normal and neoplastic cells, the translation of basic science evidence into new clinical prospective for bladder and prostate cancer will be shown.