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OBJECTIVE: To investigate the incidence of infectious complications after routine office nephrostomy tube replacement (NTR) in patients that did not receive antimicrobial prophylaxis (AMP).METHODS: We prospectively enrolled all patients undergoing routine office NTR between July 2018 and September 2019. Each procedure was considered an independent event. Clinical, microbiological, demographic data were collected. AMP was exclusion criterion. All patients received a questionnaire via phone call within 3 weeks after NTR investigating fever, antibiotics use, hospital admissions. Infectious complications risk was assessed with univariate and multivariate binomial logistic regression analysis.RESULTS: One hundred forty-five routine NTRs were performed. Nineteen patients receiving AMP were excluded. Median age was 78 years (interquartile range 71-81). Charlson Comorbidity Index (CCI) score was ≥5 in 53.2% of patients, 34 had positive urine culture, none received AMP. Seventeen (13.49%) patients reported fever after procedure, 9 received antibiotic therapy while fever resolved spontaneously in 8. Three patients needed hospitalization, 2 for nephrostomy malfunction, 1 for infectious complications. At multivariate analysis only CCI score ≥3 was associated (P < .001) with increased infectious complications risk.CONCLUSION: In this study fever occurs after the 13.5% of the routine NTRs, in almost half cases resolves spontaneously rather than with oral antimicrobial therapy. Avoiding AMP before routine NTR does not expose patients to life-threatening infections.

Background During the past two decades cryoablation (CA) has become a therapeutic option for the management of localized cT1 renal masses in comorbid patients. We analyzed the midterm functional and oncological outcomes of CA in the treatment of cT1 renal masses which were classified as high-complexity masses according to the PADUA system. Methods A total of 299 patients underwent percutaneous CA between November 2007 and December 2018 in 4 institutions for cT1N0M0 renal masses. All patients with highcomplexity (PADUA ≥ 10) renal tumors were included. Technical failure of CA was considered an exclusion criterion. Results Inclusion criteria were met by 45 patients. Median Charlson Comorbidity Index (CCI) was 6.0 (IQR: 5.0-7.0), median age was 74 years (IQR: 64.5-79.5). Seven Clavien 1 and 1 Clavien 2 procedure-related complications were reported. Median eGFR at baseline was 64.3ml/min (IQR: 52.0 - 82.3) while at the 1-year follow-up was 61.4 ml/min (IQR: 44.0-74.5). The median follow-up was 32 months (IQR: 13.25-47.5). Local recurrences were detected in 6 patients; 3 of them underwent re-cryoablation while the others started active surveillance. Median time to recurrence was 17.5 months (IQR: 7.8-27.3). Cancer-Specific Survival and Metastasis-Free Survival were 100%. Overall survival was 86.7%. Conclusions CA proved to be a valuable therapeutic option for the management of patients with cT1 high-complexity PADUA ≥ 10 renal tumors as it provides a low rate of procedural morbidity and good preservation of renal function. However, these results are counterbalanced by a recurrence rate that appears to be higher than those reported on surgically treated patients.

Background Active surveillance (AS) and minimally invasive ablative therapies such as percutaneous cryoablation (PCA) are emerging as alternative treatment modalities in the management of small renal masses (SRMs). Methods Fifty-nine patients underwent PCA since 2011 and 75 underwent AS since 2010 at two different institutions. Only patients with follow-up ≥ 6 months were included. All patients were followed with a standardized protocol. Treatment failure was defined by dimensional progression for AS and renal recurrence for PCA, in addition to stage and/or metastatic progression for both groups. Results Treatment failure was observed in 14 cases (18,7%) during AS (mainly due to dimensional progression) and 12 patients (16%) underwent delayed intervention with a mean follow-up of 36,83 months. Seven patients (11,9%) in the PCA group experienced treatment failure with a mean follow-up of 33,39 months and 3 of them underwent re-ablation successfully. Cancer-specific-survival at 2 and 5 years was 100% and 95,8% in AS-group vs. 98,2% and 98,2% in PCA-group (p=0,831). One patient in both groups died from metastatic disease. Overall-survival at 2 and 5 years was 91,7% and 82,4% in the AS-group vs. 96,5% and 96,5% in the PCA-group (p=0,113). Failure-free survival at 2 and 5 years was 90,9% and 70,1% in the AS-group vs. 93,1% and 70,9% in the PCA-group (p=0,645). Conclusions AS and PCA provide similar survival outcomes and are safe and valid treatment options for elderly and comorbid patients with SRMs.

Introduction and objectives To evaluate the prognostic role of albumin-to-fibrinogen ratio (AFR) for the prediction of oncological outcomes in a multi-institutional cohort of bladder cancer (BC) patients treated with radical cystectomy (RC). Materials and methods We retrospectively analyzed a multicenter cohort of patients treated with upfront RC for localized (cT1-4aN0M0) BC. Multivariable logistic regression analyses were performed to evaluate the ability of AFR to predict non-organ confined (NOC) disease and lymph-node involvement (LNI) at time of RC. Multivariable Cox’ regression models were performed to evaluate the prognostic effect of AFR on Time-to-Progression (TTP), overall survival (OS), and cancer-specific survival (CSS). Results A cut-off value to discriminate between low and high AFR was determined by calculating the receiver operating characteristic (ROC) curve. The area under the curve was 0.73 with an optimal cut-off at 9.53. Data were available for 246 patients (91 with low AFR, 155 with high AFR). Low AFR was associated with characteristics of tumor aggressiveness and independently predicted NOC (OR 2.11, P = 0.02) and LNI (OR 1.58, P = 0.04) at final pathological report. On multivariable Cox’ regression analyses, preoperative low AFR was independently associated with worse TTP (HR 2.21, P = 0.02), OS (HR 2.24, P = 0.03), and CSS (HR 2.70, P = 0.01). Conclusion Preoperative low AFR is a prognostic biomarker for worse TTP, OS, CSS, and is independently associated with adverse tumor pathological features in BC patients undergoing RC. Our results suggest that especially patients with low AFR may be considered for neoadjuvant treatment.

Introduction and objectives: As erectile dysfunction is more commonly being diagnosed and treated with a preexisting inflatable penile prosthesis (IPP) insertion at younger ages, surgeons will increasingly encounter pre-placed abdominal reservoirs when performing pelvic surgery. Materials and methods: A 69-year-old Caucasian man with BCG refractory carcinoma-in-situ (CIS) and past history of non-invasive high-grade urothelial carcinoma of the bladder was a candidate for a radical cystectomy and an ileal-neobladder diversion. He had a three-components IPP inserted for the treatment of Peyronie disease and organic erectile dysfunction (ED). During the radical cystectomy the reservoir was encapsulated on the left lateral pelvic wall over the external iliac vessels. It was isolated and IPP was inflated to reduce the reservoir size. After accurate disinfection, the reservoir was removed from Retzius space without disconnecting it from the pump. Then, the radical cystectomy was carried out without any intraoperative complications and Studer ileal orthotopic neobladder was performed. At the end of the surgery, the reservoir was disinfected with the Mulcahy protocol and then placed in the same position. Results: A week after catheter removal the IPP was successfully activated. The patient’s postoperative recovery was uneventful and no postoperative complication occurred. Definitive histological examination described a multifocal urothelial carcinoma of the bladder: pG3Tis N0 R0. The patient reports excellent functionality of the penile prosthesis and is currently using it. Conclusions: Sexual functionality preservation in oncologic patients should be pursued when possible. In this report, the functionality of the IPP was preserved, while still performing oncologically radical procedures. A multicenter study is needed to assure more solid recommendations on this rare procedure that is surely burdened by a lot of risks.

Background Recently, renal angioembolization (RAE) has gained an important role in the non-operative management (NOM) of moderate to high-grade blunt renal injuries (BRI), but its use remains heterogeneous. The aim of this review is to examine the current literature on indications and outcomes of angioembolization in BRI. Methods We conducted a search of MEDLINE, EMBASE, SCOPUS and Web of Science Databases up to February 2021 in accordance with PRISMA guidelines for studies on BRI treated with RAE. The methodological quality of eligible studies and their risk of bias was assessed using the Newcastle–Ottawa scale Results A total of 16 articles that investigated angioembolization of blunt renal injury were included in the study. Overall, 412 patients were included: 8 presented with grade II renal trauma (2%), 97 with grade III renal trauma (23%); 225 with grade IV (55%); and 82 with grade V (20%). RAE was successful in 92% of grade III–IV (294/322) and 76% of grade V (63/82). Regarding haemodynamic status, success rate was achieved in 90% (312/346) of stable patients, but only in 63% (42/66) of unstable patients. The most common indication for RAE was active contrast extravasation in hemodynamic stable patients with grade III or IV BRI. Conclusions This is the first review assessing outcomes and indication of angioembolization in blunt renal injuries. The results suggest that outcomes are excellent in hemodynamic stable, moderate to high-grade renal trauma.

Background and objectives: Cryoablation is emerging as a safe and effective therapeutic option for treating renal cell carcinoma. This study analyzed the safety and long-term oncological outcomes of cryoablation in our center. Materials and methods: Patients who underwent computed tomography (CT)-guided percutaneous cryoablation between February 2011 and June 2020 for one or more clinically localized renal tumors were identified. Technical success and treatment efficacy were assessed. Post-procedural complications were classified according to the Clavien-Dindo system. Recurrence–free survival was determined for biopsy-proven malignant renal tumors. Results: A total of 174 renal tumors, 78 of which were biopsy-proven malignant carcinomas, were treated in 138 patients (97 males and 41 females, mean age: 73 years, range: 43–89 years). Mean tumor size was 2.25 cm and 54.6% of the lesions required a complex approach. Technical success was achieved in 171 out of 174 tumors (98.3%). Primary treatment efficacy was 95.3% and increased to 98.2% when retreats were taken into account. The overall complication rate was 29.8%. No complications of Clavien-Dindo grade III or more were encountered. Median follow-up was 21.92 months (range: 0.02–99.87). Recurrence-free survival was 100% at 1 year, 95.3% (95% CI: 82.1%–98.8%) at 3 years, and 88.6% (95% CI: 71.8%–95.7%) at 5 years. Conclusions: Cryoablation is a safe and effective technique for the treatment of small renal lesions, with no major complications when performed by expert interventional radiologists. The multidisciplinary discussion is essential, especially considering the high number of histologically undetermined lesions. Our long-term oncological outcomes are encouraging and in line with the literature.

Objective: Intravesical Bacillus Calmette-Guerin (BCG) is an effective treatment in non––muscle-invasive bladder cancer, however, extravesical BCG infection may occur in remote organs as a potentially serious complication. Researchers aimed to assess whether a different timing of BCG infection after intravesical administration of BCG could be identified and estimated for each single involved organ. Methods: We performed a systematic literature review over systemic and genitourinary BCG infection case reports, including 271 published case reports for a total of 307 patients. Demographic data, clinical features, and timing of BCG infection development were collected and analyzed for each patient. Results: BCG infection developed with a different timing from last instillation, depending on the involved organ. Among the genitourinary complications, penile lesions occurred as early as 1 (1;3) weeks, while orchiepididymitis occurred as late as 56 (6.25;156) weeks. At the same time, granulomatous hepatitis and lungs involvement such as miliary pulmonary BCG infection occurred earlier, with a median time of 1 (1;4) and 1 (1;6) weeks respectively, whereas vascular, osteoarticular, and muscular complications developed with a median timing from last instillation of 52 (20;104), 68 (14;156), and 93 (29;156) weeks, respectively. The analysis detected a cluster between lungs, liver, and bone marrow complications on one side and muscular and osteoarticular or vascular complications on the other side was also observed. Conclusions: BCG infection after intravesical BCG for bladder cancer may develop even several months or years after the last instillation, depending on the involved organs. When BCG infection interests one or more organ, 2 main associative patterns are common: one involving lungs, liver, and bone marrow, with earlier occurrence but lower rates of microbiological diagnosis achievement, and one involving muscular and osteoarticular or vascular districts, with later occurrence but higher rates of microbiological evidence.

INTRODUCTION AND OBJECTIVE: Doubtless, advances in imaging technology such as abdominal ultrasounds, computed tomography(CT) and multiparametric magnetic resonance imaging (mpMRI) are playing an important role in the diagnosis of renal masses(RM) and so of renal cell carcinoma (RCC) before the presence of clinical symptoms. This aspect has prompted interest in active surveillance (AS) as a treatment option for the small renal masses (sRM), especially if supported by an imaging-guided biopsy that can characterize the tumor, that most likely will not contribute to cancer-specific mortality. To the best of our knowledge, contemporary data evaluating the temporal trend of pathological characteristics and the relationship with cancer-related death of the incidental RM are not available, especially in a setting of an elderly population. The aim of this study was to analyze incidence trend, changes in clinical characteristics, pathological features and cancer-related death of RM incidentally discovered at time of autopsy in a long period of time. METHODS: Data were retrieved from the autopsy register of the Pathology Department of a single tertiary referral academic center from 15086 consecutive autopsies performed between January 2004 and December 2017. Patients with previous history of primary RCC and patient with a kidney metastatic involvement from other tumors were excluded from this study. RESULTS: Overall, 184 (1.22%) RM were found. Benign and malignant lesions were 32 (17.4%) and 152 (82.6%) respectively. The median age at death was 84 years (IQR, 76.8-90) and the majority of patients were female (56,5%). Histologically were oncocytoma 13 (7.1%), angiomyolipoma 13 (7.1%), papillary adenoma 4 (2.2%), cystic nephroma 3 (1.6%), metanephric tumor 2 (1.1%), clear-cell RCC 136 (73.9%) in which occured 2 (1.5%) sarcomatoid variant, papillary RCC 2 (1.1%), chromophobe RCC 5 (2.7%), carcinoma of the collecting ducts of Bellini 5 (2.7%), nephroblastoma 1 (0.5%). Considering the malignancies, pathological stage was: pT1 126 (80.3%), pT2 10 (6.4%), pT3 16 (10.2%) and pT4 5 (3.2%). Overall, in 16 (10.2%) cases RM was cause-related death. Considering time between 2004 and 2010 vs 2011 and 2017, temporal trend of incidence of RM and consequently of RCC decreased significantly over the years (p=0.01, p=0.01 respectively). While the median age at death, sex and the distribution of the different histological types remained constant over the time, RM found in the last years are increasingly smaller(p=0.04) and only in one case in the last seven years RM was associated with cancer-specific mortality. CONCLUSIONS: The autopsy finding of incidental RM is decreasing. Although the distribution of the different kidney tumor histological types appears constant, the mean size of the lesions that are incidentally identified at autopsy are increasingly smaller and more harmless.

INTRODUCTION AND OBJECTIVE: Despite indications of international guidelines the use of antimicrobical prophylaxis (AMP) for routine nephrostomy catheter replacement is still quite common. So far in studies sustaining guidelines' indications, data about incidence of infective complications after nephrostomy replacement are poor. Aim of the study is to determine the frequency of febrile infective complications after office nephrostomy tube replacement in patients that did not receive AMP. METHODS: We prospectively enrolled all patients that underwent routine office nephrostomy tube replacement between July 2018 and September 2019 in our tertiary referral center. Each procedure was evaluated as an independent event. Clinical, microbiological and demographic data were collected. All patients that received AMP were excluded. 15-days after the nephrostomy tube replacement all patients received a phone interview aimed to investigate presence of fever, assumption of antimicrobial therapies and hospital admissions. Univariate and multivariate binomial logistic regression analysis was performed to assess the risk of infectious disease presented with temperature, flank pain and or hematuria that needed antibiotics administration. RESULTS: In the study period 145 routine nephrostomy tube replacements were performed. Before 19 procedures patients received AMP, these cases were excluded from the analysis. Mean patients’ age was 78 (56-92). Charlson comorbidity index (CCI) score was ≤2 in 23,8% of patients, 3-4 in 23% and ≥5 in 53,2%. Mean glomerular filtration rate (CDK–EPI) was 36.8 ml/min (s.d. 18.6). In 34 cases urine culture was positive but no patients received AMP. After 17 (13.49%) procedures patients reported temperature. In this subgroup 7 patients received antibiotic therapy while in 10 cases fever resolved spontaneously. 3 patients needed hospitalization, 2 for nephrostomy malfunction and 1 for temperature with elevations of inflammatory markers. At multivariate analysis only CCI score ≥5 showed to be significantly associated (p=0.03) with the risk of infective complications needing antibiotics administration. CONCLUSIONS: Episodes of fever after nephrostomy tube replacement could occur after about 10% of procedures. In our series of elderly patients with high burden of comorbities only 7 patients received an antibiotic therapy because of temperature or suspected infective complications related to the nephrostomy tube replacement, only one first aid readmission for infective complications was reported. Our prospective series strongly suggest that AMP can be safely omitted before routine office nephrostomy tube replacement.

Purpose: Transurethral resection of the bladder (TURB) is a common endoscopic procedure. Perioperative antimicrobial prophylaxis (AMP) is used to reduce the risk of infectious complications. However, there is an absence of knowledge about both incidence of infectious complications after TURB and advantage of AMP in general. The objective of this study is to determinate the prevalence of postoperative infectious complications after routine TURB without AMP. Methods: We retrospectively reviewed clinical data of all patients who underwent TURB in the same Academic Urologic Department between January 2011 and December 2013. We consider as relevant for analysis, patients that underwent TURB without receiving any AMP. Infection was defined as a body temperature >37.5°C sustained for at least 24 hours. Sepsis was defined according to the third international consensus definition for sepsis and septic shock. Results: In the period of the study, 223 TURBs were performed without use of AMP. Mean age was 70.3 years (standard deviation [SD] 11.3). Mean operative time was 25.14 minutes (SD 16). Median length of hospital stay was 3 days (interquartile range [IQR]: 2-4). Six (2.7%) patients developed postoperative infective complications. No case of sepsis was reported. Two (0.9%) patients received an antimicrobial therapy with fluoroquinolones despite absence of any signs of infection. Two hundred fifteen (96.4%) patients of TURBs did not receive any antimicrobial drugs and did not develop any infectious complications. Conclusion: In our series, infectious complications after TURB occurred in

We present the results of a multicenter retrospective study of 35 difficult-to-treat patients with urinary tract infections associated with indwelling urinary catheters (CAUTIs). All patients received oral administration of 3 g fosfomycin trometamol once a day for two days and then with a dose of 3 g every 48 h for two weeks. The most commonly isolated strains were: Escherichia coli (65.7%) and Enterococcus spp. (25.7%); prevalence of Extended-Spectrum Beta-Lactamase strains was 48.5%. Six patients (17.1%) had a clinical response after a single dose of fosfomycin trometamol, 12 (34.2%) after two doses and 13 (37.1%) patients had a clinical response after three or more doses. Four patients (11.6%) failed prolonged antibiotic treatment with fosfomy- cin trometamol. During the follow-up period, 30 out of 35 (85.7%) patients were without symptomatic infec- tions. No significant side effects were reported. In conclusion, fosfomycin trometamol seems to be a valid treatment option in patients with CAUTIs.

INTRODUCTION AND OBJECTIVES: Several trials have dealt with residents well-being and burn-out, however, few data are available on residents Sexual Health. We aim to investigate Sexual Health among Italian residents in urology. METHODS: Between March and August 2018 Female Sexual Function Index (FSFI), Brief Index of Sexual Functioning Male (BISF-M), General Health Survey (SF-36) and Beck Depression Inventory Primary Care (BDI-PC) questionnaires were web-based administered to 299 residents from all of the 25 Italian Residency Programs. Data included: year of training (PGY), location, age, gender, sexual orientation, marital status, children, duty hours. Mean level differences in BDI-PC, FSFI and BISF-M levels for between-people variables such as sex (BDI-PC only), day/night shifts, and children were inspected via ANOVA; correlations between depression and sexual functioning were investigated as well. RESULTS: The responding rate was 49%, 101 males (M), 50 females (F); 38 surveys were however incomplete, and the final sample consisted of 113 participants. They well represent the PGYs. Mean age was 30.4 (SD 2.2), 83% M and 86% F had a stable relationship, 33% of the residents were engaged to a colleague (35%M,42%F), 6% had children (5%M, 6%F). 97% defined themselves heterosexual, 2% bisexual, 1% homosexual. Among females, 19% reported a FSFI total score below the critical value of 26, indicating a possible sexual dysfunction. In addition, 33% F and 11% M had a BMI-PC score >3, indicating a mild to severe depression level. Such percentages are higher than the quoted lifetime prevalence of depression in Italian general population (1.7% age group 15-44 years). 64% of the residents did night shifts, ANOVAs revealed a significant interaction effect (p

INTRODUCTION AND OBJECTIVES The investigation of the neovaginal microflora can help during the post-surgery follow-up of transgender women in order to ensure a proper therapy in case of the onset of an infectious disease. We mapped the neovaginal microflora during the early perioperative days after male to female (M-F) gender reassignment surgery in HIV, HBV and HCV seronegative and healthy transsexual women. METHODS Between November 2016 and January 2017 we collected 2 neovaginal swabs (one in the neo-vaginal fundus and one in the proximity of the urethral meatus) during the early perioperative days from 8 patients (pts) who underwent M-F gender surgical reassignment. The V3-16S rRNA Next Generation Sequencing (NGS) and a multiplex PCR technology were used to investigate the microbial composition and the presence of Sexual Transmitted Infections, respectively. QIIME 1.8.01 was used to process the NGS data. RESULTS Patients median age was 35 (24-49) years. For at least one year, all pts were taking an androgen deprivation therapy and an estrogen therapy, which was suspended at least 20 days before surgery. All pts were HIV, HBV and HCV seronegative and heterosexual. Swabs were performed between the 4th and the 10th postoperative days when no sign of infection was clinically present. All pts were using an iodone solution for the daily neovaginl hygiene. No STI, including Chlamydia tracomatis, Neisseria gonorrhoeae, Mycoplasma/Ureaplasma, HPV, Trichomonas vaginalis and Treponema pallidum, was detected in the samples analyzed. Prevotella was the predominant genus in the neovagina. Moreover, the samples showed the presence of Bacteroides, Escherichia, and Proteus while no Lactobacilli were reported. CONCLUSIONS We characterized the microbiome of the neovagina in the early postoperative days after M-F gender reassignment surgery. Despite estrogen substitute therapy, neovagina appeared massively colonized by microorganisms usually resident in the male urogenital tract and often responsible for genito-urinary infections in women while the native vaginal Lactobacilli were absent. To our knowledge, this is the first report describing the neovaginal microbiota in the early postoperative days after M-F gender reassignment surgery in healthy transsexuals women. Therefore, our study provides the standard model of vaginal microbiota of healthy transsexual women.

INTRODUCTION AND OBJECTIVES Partial nephrectomy (PN) is considered the standard approach for small renal masses (SRMs). Active surveillance (AS) and ablative therapies represent emerging strategies for older and comorbid patients due to the indolent behaviour of most SRMs and to the high competing risk mortality. Aim of this study was to compare the mid-term oncological outcomes of AS and percutaneous cryoablation (PCA) of small renal masses (SRMs). METHODS Data regarding PCA and AS in patients with a single T1a renal tumors were collected prospectively at two large academic centers. 60 patients underwent PCA and 77 were enrolled in a AS protocol. The minimum follow-up period was 6 months. The most frequent indications for AS were severe comorbidities (48,1%)

INTRODUCTION AND OBJECTIVES: European Association of Urology, National Comprehensive Cancer Network and American Uro- logical Association provide follow-up guidelines for surgically treated Renal Cell Carcinoma (RCC). However these guidelines are not sup- ported by good quality evidence. The potential exposure of the patients (pts) to the risks connected to unnecessary ionizing radiations is an important factor to consider. Aim of this study was to evaluate the oncological outcomes in a large cohort of pts to better tailor follow-up schedules of pts that underwent surgery for RCC. METHODS: We enrolled 1932 pts surgically treated for spo- radic pT1 pN0, M0 RCC from 7 Italian Accademic Centers with mini- mum follow-up of 6 months. The exclusion criteria were: high nuclear grade, presence of intratumoural necrosis, lymphovascular invasion, collecting system invasion, rare histological RCC subtype and positive surgical margin. Recurrences were classified in accordance to their location: abdomen, chest, multiple districts and other sites (including central nervous system, bone and skin). RESULTS: Median age of the pts was 60 years (53-70). 1174 pts underwent partial nephrectomy and 758 radical nephrectomy. His- tological subtype of the specimens were: 1491 Clear Cell RCC (ccRCC), 244 papillary RCC (pRCC) and 197 chromopobe RCC (chRCC). Median follow-up was 90 months (36-125). 145 (7,5%) pts developed a recurrence. Site and rate of recurrences are reported in table 1. Statistical analysis identifies a significant difference in the incidence of all site recurrences among all histological subtypes (P1⁄40,0017); significant statistical difference was observed also in the incidence of primary chest recurrences for all histological subtypes (P1⁄40,002). In the chRCC subgroup no chest recurrences were observed. 20 pts with ccRCC have a chest recurrence, 13 of them more than 5 years from surgery. CONCLUSIONS: According to our data currently guidelines for RCC surveillance potentially expose a considerable number of pts to unnecessary chest examinations. Furthermore concluding follow-up after 5 years could lead to lose many primary chest recurrences in pts with ccRCC. In conclusion chest follow-up schedules should be differ- entiated and tailored on the basis of histological subtype.

Background: Numerous surveys have been performed to determine the competence and the confidence of residents. However, there is no data available on the condition of Italian residents in urology. Objective: To investigate the status of training among Italian residents in urology regarding scientific activity and surgical exposure. Design, setting, and participants: A web-based survey that included 445 residents from all of the 25 Italian Residency Programmes was conducted between September 2015 and November 2015. Outcome measurements and statistical analysis: The main outcomes were represented by scientific activity, involvement in surgical procedures, and overall satisfaction. Results and limitations: In total, 324 out of 445 (72.8%) residents completed the survey. Overall, 104 (32%) residents had not published any scientific manuscripts, 148 (46%) published ≤5, 38 (12%) ≤10, 26 (8%) ≤15, four (1%) ≤20, and four (1%) >20 manuscripts, respectively. We did not observe any differences when residents were stratified by sex (p = 0.5). Stent positioning (45.7%), extracorporeal shock wave lithotripsy (30.9%), transurethral resection of bladder tumor (33.0%), hydrocelectomy (24.7%), varicocelectomy (17%), ureterolithotripsy (14.5%), and orchiectomy (12.3%) were the surgical procedures more frequently performed by residents. Overall, 272 residents (84%) expressed a good satisfaction for urology specialty, while 178 (54.9%) expressed a good satisfaction for their own residency programme. We observed a statistically decreased trend for good satisfaction for urology specialty according to the postgraduate year (p = 0.02). Conclusions: Italian Urology Residency Programmes feature some heavy limitations regarding scientific activity and surgical exposure. Nonetheless, satisfaction rate for urology specialty remains high. Further improvements in Residency Programmes should be made in order to align our schools to others that are actually more challenging. Patient summary: In this web-based survey, Italian residents in urology showed limited scientific productivity and low involvement in surgical procedures. Satisfaction for urology specialty remains high, demonstrating continuous interest in this field of study from residents. Italian Residency Programs in urology shows some limitation regarding scientific productivity and surgical activity. Resident involvement in many urological procedures still remains low and there is a risk in providing the near future urologists with no expertise.

Introduction The effectiveness of phosphodiesterase type 5 (PDE5) inhibitors over the conservative management of Peyronie’s disease (PD) has been widely questioned. Aim To determine the role of sildenafil 25 mg film formulation twice a day (S25 b.i.d.) in the improvement of curvature after treatment of collagenase of Clostridium hystoliticum (CCH) in penile curvature owing to PD. Methods From April 2017 to April 2018, 161 consecutive patients were treated with S25 b.i.d. + CCH or CCH alone. Adjustment variables consisted of age, penile curvature, and the 15-question International Index of Erectile Function (IIEF-15) questionnaire at baseline using 1:1 propensity-score matching. Overall, 50 patients were considered subdivided into the following: 25 patients who received S25 b.i.d. + CCH (group A) and 25 who received CCH alone (group B). Patients received CCH injection using a shortened protocol and vacuum device in both groups. Main Outcome Measure The primary outcome of the study was the change in penile curvature after treatment, and secondary outcomes were the change in sexual function (IIEF-15) and in the Peyronie’s Disease Questionnaire (PDQ) and its subscores, PDQ-PS (psychosexual symptoms), PDQ-PP (penile pain), and PDQ-SB (symptom bother). Results Overall, mean penile curvature was 47.0° (SD 21.88), the mean IIEF-EF (erectile function) was 23.56 (SD 4.10), and the mean PDQ was 27.06 (SD 13.55). After the treatment, we observed a mean change for penile curvature of 25.6 (SD 9.05) in group A and –25.6 (SD 9.7) in group B (P < .01), for IIEF-EF of 2.28 (SD 2.33) in group A and 1.36 (SD 1.77) in group B (P = .03), for PDQ-PS of –3.04 (SD 2.95) in group A and of –2.12 (SD 2.06) in group B (P = .11), for PDQ-PP of –1.0 (SD 4.48) in group A and of –0.88 (SD 2.04) in group B (P = .60), for PDQ-SB of –5.84 (SD 4.58) in group A and of –4.16 (SD 4.45) in group B (P = .60), and for Female Sexual Function Index of 3.8 (SD 2.45) in group A and of 2.72 (SD 2.28) in group B (P = .14). We found a rate of global satisfaction of 70.83% in group A and of 84.0% in group B (P = .27). Clinical Implications Addition of S25 b.i.d. to CCH is superior to CCH alone for improving penile curvature and erectile function. Strength & Limitations This is the first study comparing sildenafil + CCH vs CCH alone for the treatment of PD. Lack of randomization and direct verification of appropriate use of penile modeling could be considered limitations. Conclusion In this study, combination therapy was superior in terms of penile curvature and erectile dysfunction improvement.

OBJECTIVE: To compare fosfomycin trometamol (FT) and ciprofloxacin (CIP) for antibiotic prophylaxis in transrectal prostate biopsy (TR-PB). PATIENTS AND METHODS: Data for 1109 patients (mean age 66.7 ± 8.45) who underwent TR-PB between March to September 2015 in seven Italian urological institutions were retrospectively reviewed, of which 632 received FT (Group 1) and 477 received CIP (Group 2) for prophylaxis. We reviewed all urine culture results obtained after the procedure, all adverse drug reactions (ADRs) related to the drug and all febrile and/or symptomatic urinary tract infections (UTIs) occurring within 1 month after TR-PB. The rate of symptomatic UTIs and the rate of ADRs were considered the main outcome measures. RESULTS: In the total study population, 72/1109 (6.5 %) patients experienced symptomatic UTIs and among these 11 (0.9 % of total) had urosepsis. Out of 72, 53 (73.6 %) symptomatic UTIs were caused by fluoroquinolone-resistant strains. Out of 632, 10 (1.6 %) patients in Group 1 and 62/477 (12.9 %) patients in Group 2 had symptomatic UTIs (p < 0.001); in particular, 2/632 (0.3 %) patients in Group 1 and 9/477 (1.8 %) patients in Group 2 had urosepsis (p < 0.001). No differences were reported in terms of adverse events (0.6 vs 0.4 %; p = 0.70). A Charlson comorbidity index ≤1 and type of antimicrobial prophylaxis (FT) were found to be associated with a lower probability of symptomatic UTIs in the multivariate model. CONCLUSIONS: Antibiotic prophylaxis with FT for TR-PB had a lower rate of adverse events and a lower rate of symptomatic UTIs as compared with CIP. Fosfomycin trometamol appears as an attractive alternative prophylactic regimen in prostate biopsies.

Background A new oro-dispersible film (ODF) formulation of sildenafil has been developed for the treatment of erectile dysfunction (ED) to overcome the drawbacks that some patients experience when taking the conventional film-coated tablet (FCT). Aim To assess the effectiveness and safety of sildenafil ODF formulation in patients with ED who were using the conventional FCT. Methods From May 2017 through July 2017, 139 patients with ED were enrolled. Data from penile color-duplex ultrasound, medical history, hormonal evaluation, and patient self-administered questionnaires were collected. All patients were administered sildenafil 100-mg FCT for 4 weeks. Thereafter, they underwent a 2-week washout period and subsequently took sildenafil 75-mg ODF for 4 weeks. Outcomes The International Index of Erectile Function (IIEF-15), Hospital Anxiety and Depression Scale (HADS), Patient Global Impressions of Improvement (PGI-I), and Clinician Global Impressions of Improvement (CGI-I) questionnaires were administered and severity of ED was classified as severe (IIEF-15 score ≤ 10), moderate (IIEF-15 score 11–16), or mild (IIEF-15 score = 17–25). Results All patients completed the final protocol. Differences in mean IIEF scores for erectile function, orgasmic function, sexual desire, and intercourse satisfaction were significantly in favor of sildenafil 100-mg FCT, whereas the mean score for overall satisfaction was in favor of sildenafil 75-mg ODF. A significant difference in changes in HADS score was found from washout to final follow-up (mean difference = −0.19; P < .01). For the ODF formulation, the median CGI-I score was 3.5 (interquartile range [IQR] = 2.5–4.5) and the median PGI-I score was 3.0 (IQR = 2.0–4.0). The median action time was 20.0 minutes (IQR = 15.0–30.0) and the median mouth time was 60.0 seconds (IQR = 30.0–120.0). Clinical Implications The ODF formulation of a widely known drug, with the same safety and effectiveness of the FCT, was better appreciated by patients in overall satisfaction. Strengths and Limitations This is the first clinical trial to assess the efficacy of a new formulation of sildenafil in patients with ED. The limitations of the study are related to the methodology used: it was not a case-control study and the patients were not drug-naïve for ED treatment. Therefore, only the “additional” side effects of the ODF formulation compared with FCT are reported. Conclusion The new ODF formulation is as efficient and safe as the FCT formulation and offers a new choice of treatment to specialists for more precisely tailored therapy.

Background: Urinary tract infections (UTIs) are extremely common. In the global scenario, due to the rise of antibiotic resistance worldwide, they present a substantial public health challenge. The aim of this cross-sectional study was to review antibiotic utilization in the management of UTIs in primary care practices in Italy. Materials and methods: Patients in Italian primary care settings with a confirmed diagnosis of UTI and receiving antibiotic therapy were enrolled in a cloud-based pharmacovigilance study. Results: The study included 5232 patients (3903 females, 1329 males) who had been prescribed antibiotics for UTI between July 2014 and December 2015. Quinolones were prescribed for 4889 patients (94%) as the first line treatment. In the 14-days follow-up period, 3181 patients (60%) received at least one different antibiotic medication. Fifty-eight percent (n=1844) of patients further received antibiotics on day 2 and day 3 of the follow-up period. Different quinolones and cephalosporins were the most prescribed medications in this sub-population. Conclusion: The study raises concerns about antibiotic and specifically quinolone overuse in Italian UTI outpatients. Policy-making bodies and professional societies should prioritize reducing the inappropriate use of antibiotics. This can be achieved through antimicrobial stewardship programs, which are one of the primary solutions to address the growing problem of antimicrobial drugs resistance.

INTRODUCTION AND OBJECTIVES: The aim of this study is to investigate the role of emergency ureteroscopy (eURS), in the definitive treatment of ureteric stones and to determine the factors predicting favorable results. METHODS: We retrospectively analyzed all the patients underwent eURS from January 2012 throught December 2014 by the same surgeon. Only patients presenting with a first episode of ureteric colic were included in the study. All the procedures were performed within 48 hours from the presentation to the emergency room. Laser litotripsy, basket stone removal and ureteral stenting were performed when necessary. The database included: age, gender, anthropometric parameters, side of disease, position of the stone, size of the stone, presence of hydronephrosis, serum creatinine, urinalysis and pretreatment imaging. Operative time, hospitalization, complications, stone free status (SFR) and need for auxiliary procedures were evaluated. Regarding the results, patients were separated into two groups, Gr1 had successful eURS and Gr2 failed their tretment and needed auxiliary procedures (ESWL or URS). The collected data were analyzed using SPSS software with the purpose to assess the efficacy of the procedure and the presence of factors predicting favorable results. RESULTS: Of the 212 patients underwent eURS the mean stone size was 6.72 mm (6.55 mm in Gr1 and 7.70 mm in Gr2) and most of them were located in the distal ureter 64.1% (75.3% in Gr1 and 34,5% in Gr2). 72.1% of the patients had hydronephrosis at diagnosis (18.3% severe). 154 patients (72.6%) were stone free after eURS (Gr1) and 58 patients (27.4%) failed treatment and went on to have a secondary procedure (Gr2). SFR for proximal and distal stones was 50% and 85.3% respectively. SFR for distal stones smaller than 7 mm reached 90%. Ureteral stenting was slightly higher in Gr2 than in Gr1, 96.6% vs 89.6% respectively. The mean operative time and hospitalization time was comparable in both groups, 43.1 min and 3.4 days in Gr1 and 32.6 min and 3.9 days in Gr2. Complications rate was higher in Gr2 than in Gr1, 17.2% and 7.8% respectively; no patient experienced major perioperative and postoperative complications. CONCLUSIONS: In our experience, immediate ureteroscopy for ureteral stone colic proved to be safe and effective, offering both immediate stone fragmentation and pain relief. The success rate of the procedure is higher in patients with smaller stones (

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The surgical management of neovaginal stenosis in a transsexual patient is a complex problem and constitutes a significant technical challenge.

BACKGROUND: There is a lack of good data in the literature evaluating the Health-Related Quality of Life (HR- QoL) in patients with urinary diversions. The aim of this study was to examine the changes in expectation and needs in terms of human adaptation and behavioural profiles in patients with ileal conduit (IC) after radical cystectomy (RC) for bladder cancer (BC). MATERIALS AND METHODS: A qualitative, multicenter cross-sectional study using a "narrative based" approach was planned. We proceed with a sampling reasoned choice (purposive), selecting groups of patients with follow-up from one up to more than 7 years after surgery. Data were collected through individual interviews. RESULTS: Thirty patients participated in the study. The processing of the interviews allowed us to identify 2 major profiles: positive and negative. Patients with a positive profile resumed normal daily activities with no or limited restrictions both on the personal and the social level. This profile reflects a good HR-QoL. The negative profile reflects the patients for whom the ostomy has meant a worsening of HR-QoL. A positive profile was statistically more frequent in older patients (p = 0.023), with a longer follow-up (p = 0.042) and less complications rates (p = 0.0002). According to the length of follow-up and the occurrence of complitations, we identified further 5 intermediate profiles. CONCLUSIONS: Patients' satisfaction is related to the degree of adaptation to their new life with an urinary stoma and its correct management. Live "with urinary diversion" represents a new phase of life and not a deterioration.

Male infertility affects 10% of couples and is treatable in many cases. The evaluation of infertility is initiated typically after 1 year of failure to conceive. Clinical evaluation of the infertile man requires a complete medical history, physical examination, and laboratory studies in order to identify and treat correctable causes of subfertility and recognize those who are candidates for assisted reproductive technologies, those who are sterile and should consider adoption or artificial insemination using donor sperm, and those who should undergo genetic screening. Although pregnancies can be achieved without any evaluation other than a semen analysis, this test alone is insufficient to adequately evaluate the male patient. Treatment of correctable male-factor pathology is cost effective, does not increase the risk of multiple births, and can spare the woman invasive procedures and potential complications associated with assisted reproductive technologies.

Scrotal lesions can be broadly grouped by anatomical location as intratesticular or extratesticular. The clinician must consider a wide differential diagnosis based on this location, and a reliable and rapid differentiation of harmless from serious conditions such as cancer of the testis, is essential. Solid testicular masses are considered germ cell tumors until proven otherwise, but numerous other possible pathologies exist. The paratesticular region has the broadest differential diagnosis, as it contains numerous distinct structures and it is a common location for ectopic tissue and metastatic disease.

Introduction We present a refinement to our original technique in MtF gender reassignment surgery. Our goal was to construct a neoclitoris, which is wet and covered with urethral neoprepuce. Since 1995 more than 300 transgender MtF patients have been operated at our institution. Our refinement has been applied to 12 cases and showed both excellent functional and cosmetic results during midterm follow-up. Patients and Methods During 2010 several sex reassignment surgeries have been performed using our new technique that includes: bilateral orchiectomy, removal of corpora cavernosa of the penis, formation of the neourethra with neomeatus, neovaginoplasty by inversion of penoscrotal skin flaps, construction of the neoclitoris with preservation of the neurovascular bundle and exterior vulva formation. The refinement consists in creating a neoclitoris embedded in urethral mucosa using urethral flaps. These flaps are in continuity with the previously spatulated urethra. The urethral plate is further incised distally in a Y fashion. The urethral flaps are sutured around the neoclitoris to form a neourethroclitoris covered by urethral neoprepuce, which resembles a real female clitoris. The neoclitoris is positioned in the anatomical position of the male suspensory ligament of the penis that is also the natural anatomical position of the female clitoris. Results With this method we are able to construct a clitoris with a normal sensitivity embedded in urethral mucosa that remains wet and hairless. It can be easily stimulated during sexual intercourse, as most of the patients reported great satisfaction and ability to reach orgasm. Discussion We want to emphasize how both the cosmetic results and functionality of the neovagina and neoclitoris are important in this type of surgery for the quality of life of our patients. We are still far from a perfect surgical solution, but we are further improving our technique and follow our aims step by step.

Objectives: To review the cases of patients with suspected penile fracture and asses erectile and sexological outcomes. Materials and methods: from 1987 to 2013 presented to the Urology Clinic of Trieste and at the AIED of Pordenone a total of 41 cases that were divided into two groups according to the timing of treatment: 18 patients with anamnestic diagnosis of penile fracture treated nonimmediately and 23 patients treated immediately after the trauma. For all patients we evaluated the type of treatment adopted, the occurrence of complications and reoperations and the follow-up. The erectile function was also evaluated through the IIEF, as well as the psychological impact of the trauma on social and sex life, using a psycho- sexological questionnaire. Results: Among patients treated immediately after the trauma 14 were subjected to surgery. About a year after surgery, penile curvature was reported in 1 patient, pain in 3 patients, urinary disorders in 1 patient, while none reported erectile dysfunction (ED). Out of these, only 3 patients underwent reoperation. Among those treated conservatively 1 patient reported curvature, 1 patient reported pain and none reported ED. Among patients who were admitted at a later date, 14 reported curvature and 4 reported pain whereas urinary disorders were reported in 1 and ED in 4 patients. From a psychological point of view, the trauma caused in most cases a fear of new trauma and of repercussions on erectile function and sensitivity. Conclusions: The diagnosis is mainly clinical; however, radiological investigation is essential to confirm the diagnosis, assess the site and extent of the trauma and possible urethral involvement, so as to plan the most appropriate treatment. In addition, immediate treatment leads to better long-term results, with a lower incidence of ED and penile curvature. Psychologically, penile trauma intensifies the fear of reoccurrence; it decreases, however, with the passage of time.