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To evaluate the diagnostic performance and clinical significance of 4 systems of substaging cases with non-muscle invasive urothelial bladder carcinoma. In addition 4 cutoff measures were evaluated for prediction of muscularis-mucosa invasion. Four substaging systems were applied to 57 NMIBC cases to assess which of these reported methods correlates best with recurrence and progression. On univariate regression analysis patients having tumor size more than 3 cm, solid tumor architecture, high grade, substage B, substage T1e, substage ROL 2 and Tumor depth more than 1 mm were associated with higher recurrence. On multivariate analysis all the four substaging systems, tumor size, grade and tumor type had significant prognostic value for recurrence. Regarding progression only the metric substaging method was associated with tumor progression (p = 0.04). However, on univariate and multivariate regression analysis none of the substaging systems showed prognostic significance and only solid tumor architecture and CIS had significant prognostic value for tumor progression. The ROC curve analysis showed that 1 mm depth of invasion had the best accuracy for detection of muscularis-mucosa invasion (80.2%). Using 1 mm cutoff in measuring the depth and 0.5 mm for the diameter of infiltration may provide clinically relevant information to guide a more personalized therapy for NMIBC. Inclusion of both measures in addition to other histopathologic variables may aid in the development of a scoring system.

Background The standard surgical treatment of localized prostate cancer (PCa) has been rapidly changed along the last two decades from open to laparoscopic and finally robot-assisted techniques. Herein, we compare the three procedures for radical prostatectomy (RP), namely radical retropubic (RRP), laparoscopic (LRP), and robot-assisted laparoscopic (RALRP) regarding the perioperative clinical outcome and complication rate in four academic institutions. Methods A total of 394 patients underwent RP between January 2016 and December 2018 in four academic institutions; their records were reviewed. We recorded the patient age, BMI, PSA level, Gleason score and TNM stage, type of surgery, the pathological data from the surgical specimen, the perioperative complications, unplanned reoperating, and readmission rates within 3 months postoperatively. Statistical significance was set at (P P values are two-sided. Results A total of 123 patients underwent RALRP, 220 patients underwent RRP, and 51 underwent LRP. There was no statistically significant difference between the three groups regarding age, BMI, prostatic volume, and preoperative PSA. However, there were statistically significant differences between them regarding the operating time (P < .0001), catheterization period (P < .001), hospital stay (P < .0001), and overall complications rate (P = .023). Conclusions The minimally invasive procedures (RALRP and LRP) are followed by a significantly lower complication rate. However, the patients’ factors and surgical experience likely impact perioperative outcomes and complications.

Background: Behcet’s disease (BD) is a chronic multisystem autoimmune disease characterized by orogenital ulceration, uveitis, skin lesions and vascular involvement of different organs in the body. The sexual and psychological aspects of the disease are still not fully recognized. Objectives: We aimed to evaluate the sexual and psychological status of BD male patients and to assess the relationship between the sexual function and depression in this cohort. Methods: The patients, fulfilling the International Criteria for Behcet’s disease (ICBD), and healthy controls, of a comparable age, were evaluated in the Rheumatology and Urology Clinics. The demographic and clinical data was collected. Disease activity of the patients was assessed using Behcet’s Syndrome Activity Score (BSAS). For both groups, the sexual function and the psychological status were evaluated using the International Index of Erectile Functions (IIEF- 5) and the Beck Depression Inventory (BDI), respectively. Spearman’s rho, Chi-Square and Mann-Whitney U tests were used as appropriated. Results: The number of BD patients was 26 and that of the controls was 27. The mean age of the patients was 36±7.4 and that of controls was 40.9±5.2. Though BD patients were younger in age they exhibited significantly lower scores in sexual function, and scored higher in depression as illustrated in Table 1. There were no associations between the disease duration, smoking status or different clinical phenotypes and the sexual or psychological functions. However, there was an inverse relationship between BSAS and the sexual function (rho= -.443, p=.024). The duration of corticosteroids intake was negatively correlating with the sexual function (rho= -.604, p= .001) as well. The depression scores correlated significantly with the presence of inflammatory back pain (rho= .413, p=.036). There was no association between the severity of sexual dysfunction and that of depression. The patients showed different degrees of depression, and there was a tendency towards increased rates of erectile dysfunction in all groups as shown in Table 2. ED; erectile dysfunction. Conclusion: BD has a negative impact on men’s psychological state and sexual function. Severe disease states, evident in the long duration of corticosteroids use and the high activity scores, are linked to sexual dysfunction. Disclosure of Interests: None declared

OBJECTIVE Surgical site infection (SSI) is defined as infection at or near surgical incisions within 30 days of an operative procedure and classified either incisional superficial and deep or organ/space. The aim of the study is to report and compare the incidence and management of SSIs after robot-assisted laparoscopic radical prostatectomy (RALP) and retropubic radical prostatectomy (RRP). MATERIAL AND METHODS Within the last 4 years, we identified 285 patients that underwent RRP, n=187 (66%) or RALP, n=98 (34%). We reviewed the frequency, types and way of management of SSI complications. RESULTS A significant difference was found between RALP and RRP (2/98, 2% vs. 27/187, 14.4%; p

Objectives To report the findings and management of patients with persistent Müllerian duct syndrome (PMDS). Patients and methods Nineteen phenotypically male patients (aged 8 months to 27 years) presented with testicular maldescent. All of them had normal male external genitalia. Two of them had had a previous diagnosis of persistent Müllerian structures. All patients were karyotyped, and had a hormonal profile, diagnostic laparoscopy, retrograde urethrocystogram, gonadal biopsies, and surgical management according to the findings. The follow-up was based on a clinical examination, abdominal ultrasonography (US) and scrotal colour-Doppler US at 3 and 6 months after surgery, and every 6 months thereafter. Results Diagnostic laparoscopy showed the presence of persistent Müllerian structures in all 19 patients. All patients had a normal male karyotype (46XY). Ten patients had a laparoscopic excision of their Müllerian structures while the remaining nine patients had their Müllerian structures left in place. No malignant changes were found in the excised Müllerian tissues. Of the 37 gonadal biopsies taken, 31 (84%) indicated normal testes. Conclusions The incidence and prevalence of PMDS are not well estimated. Müllerian structures should be removed whenever possible to avoid the risk of malignant transformation. The early diagnosis of PMDS makes possible the excision of Müllerian structures and a primary orchidopexy. A long-term follow-up is needed for patients with intact Müllerian structures and magnetic resonance imaging might be a better method than US for that purpose. Most of the patients had normal testicular histology, which might allow fertility.

Background The aim was to evaluate cancer-specific survival (CSS) and overall survival (OS) in patients with prostate cancer (PCa) recurrence who underwent salvage extended pelvic lymph node dissection (ePLND), taking into consideration pre- and postoperative androgen deprivation therapy (ADT). Methods Salvage ePLND was performed in a cohort of 54 patients with PCa recurrence, and data from 45 patients were analyzed. The indications for salvage ePLND were biochemical recurrence (BCR) of PCa and suspect findings on 11C-choline PET/CT. PSA-level, biochemical response (BR), duration of biochemical recurrence freedom (BCRF), number of metastases, OS and CSS were analyzed retrospectively. Results The average follow-up was 42.7 ± 20.8 months. Thirty-three patients (73.3 %, 95 % CI: 60.5–83.6 %) achieved BCRF during follow-up. The mean BCRF-period was 31.4 ± 19.7 months. CSS and OS were both 91.7 % ± 4.8 % (3-year survival) and 80.6 ± 8.6 % (5-year survival). Twenty-four patients (53.3 %, 95 % CI: 40.0–66.3 %) with castration-resistant PCa (CRPC) responded again to ADT after salvage ePLND. Conclusions Salvage ePLND for selected patients with BCR and clinically recurrent nodal disease can achieve an immediate complete PSA response (i. e. BCRF) in nearly half of the patients. Patients with CRPC responded again to ADT after ePLND. Multicenter prospective studies with a control group are needed.

Introduction: Partial segmental thrombosis of the corpus cavernosum (PSTCC) is an uncommon clinical condition; it is known in the literature as partial priapism which chiefly affects young men; the underlying reasons and its pathogenesis are inadequately understood. Case report: A 26-year-old male presented with a perineal swelling and pain of 11 hours duration, which had started after 10-hour flight, and a dull aching pain with insidious onset. The patient denied a history of excessive sexual activities, drug abuse, or trauma with unremarkable past medical history. Aims and methods: With deficiency of curd data for PSTCC, only case reports without precisely case numbers; therefore all existing case reports, whether abstracts or full text, under the title of partial segmental thrombosis of the corpus cavernosum or partial priapism have been screened and statistically analyzed. Results and outcome: The total number of cases was 41 and chiefly affects young men: 63.4% of the patients are in the age group 20-40, with a mean age of 32.3 yrs. 10 cases 24.4% were treated surgically, 21 cases 51.2% were managed conservatively, while 3 cases 7.3% were treated by surgical aspiration ± injection or irrigation and 2 cases 4.9% were only follow up without treatment. Conclusion: PSTCC is a rare non-emergency urological condition that usually has a good outcome. Conservative treatment with systemic anticoagulants has shown an excellent outcome and surgical treatment should be reserved for cases, if conservative management fails.

INTRODUCTION: Priapism is the persistent erection resulting from dysfunction of the mechanisms that regulate penile swelling, stiffness, and sagging. It is a full or partial erection that persists for a period more than 4 hours beyond sexual stimulation and/or orgasm or is unrelated to sexual stimulation. Ischemic priapism should be managed in a step-by-step fashion. OBJECTIVE: To demonstrate step-by-step management of stuttering refractory ischemic priapism. We report a case of stuttering refractory ischemic priapism. Moreover, we reviewed different approaches to priapism management in the literature. CASE PRESENTATION: A 53-year-old male presented with a painful erection of 29 hours' duration, probably caused by consumption of alcohol. The penile blood gas showed a pH of 7.08, PCO2 of 75 mmHg and PO2 of 39 mmHg. Aspiration was followed by irrigation of an α-adrenergic, Winter and T-shunt operations were preformed, and finally a semi-rigid penile prosthesis was implanted to overcome the refractory stuttering ischemic priapism. CONCLUSION: In case of stuttering refractory ischemic priapism, immediate implantation of a penile prosthesis is a simple and effective procedure that manages both the acute episode and the inevitable erectile dysfunction that would otherwise occur, while preserving penile length.