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Purpose Therapeutic strategies for prostate cancer (PCa) have been evolving dramatically worldwide. The current article reports on the evolution of surgical management strategies for PCa in Italy. Methods The data from two independent Italian multicenter projects, the MIRROR-SIU/LUNA (started in 2007, holding data of 890 patients) and the Pros-IT-CNR project (started in 2014, with data of 692 patients), were compared. Differences in patients' characteristics were evaluated. Multivariable logistic regression models were used to identify characteristics associated with robot-assisted (RA) procedure, nerve sparing (NS) approach, and lymph node dissection (LND). Results The two cohorts did not differ in terms of age and prostate-specific antigen (PSA) levels at biopsy. Patients enrolled in the Pros-IT-CNR project more frequently were submitted to RA (58.8% vs 27.6%,p < 0.001) and NS prostatectomy (58.4% vs. 52.9%,p = 0.04), but received LND less frequently (47.7% vs. 76.7%,p < 0.001), as compared to the MIRROR-SIU/LUNA patients. At multivariate logistic models, Lower Gleason Scores (GS) and PSA levels were significantly associated with RA prostatectomy in both cohorts. As for the MIRROR-SIU/LUNA data, clinical T-stage was a predictor for NS (OR = 0.07 for T3, T4) and LND (OR = 2.41 for T2) procedures. As for Pros-IT CNR data, GS >= (4 + 3) and positive cancer cores >= 50% were decisive factors both for NS (OR 0.29 and 0.30) and LND (OR 7.53 and 2.31) strategies. Conclusions PCa management has changed over the last decade in Italian centers: RA and NS procedures without LND have become the methods of choice to treat newly medium-high risk diagnosed PCa.

Background There are several treatments available to newly diagnosed prostate cancer (PCA) patients. Although surgery and radiotherapy (RT) with or without androgen deprivation therapy (ADT) are widely adopted treatment options for localized PCA together with active surveillance (AS), there is no consensus nor randomised trials on treatment selection, prospective quality of life (QOL), along with toxicity outcomes and according to treatment modality in the Italian population. The current study aimed to describe clinical-therapeutic features and QOL at PCA diagnosis, according to different treatment patterns in a large prospective, Italian population, enrolled in the Pros-IT CNR study. Methods The Pros-IT CNR is an on-going national, multicenter, observational, prospective study on patients affected by PCA who have been referred by 97 Italian Urology, Radiation Oncology and Medical Oncology facilities participating in the project. The possible relationships between the treatment patterns reported in the 6 month follow-up case report form and patients' features at diagnosis were evaluated using exploratory multiple correspondence analysis (MCA) and other data analysis method. Results At diagnosis, surgery and AS patients were significantly younger, had fewer comorbidities, lower PSA levels and Gleason Score (GS) values; they were also diagnosed at an earlier stage of disease with respect to the RT or ADT patients who showed significantly worse QoL scores at the time of diagnosis. Conclusions An analysis of the data collected at baseline and 6 months later uncovered substantial differences in ages, comorbidities, clinical and QOL features in the various treatment groups. These findings do not fully reflect the current PCA treatment guidelines and suggest the need for a multidisciplinary consensus guideline to ameliorate both the counselling and treatments of PCA patients.

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: Sexual dysfunctions (SD) are frequently encountered in patients with rheumatologic diseases. In this scenario, a multidisciplinary approach to rheumatologic diseases is often mandatory. The aim of this survey was to assess whether Italian rheumatologists routinely explore sexual health of their patients, their knowledge on the topic, and the barriers to discussing SD in clinical practice. Methods: A 32-items anonymous questionnaire was mailed to members of the Italian Society of Rheumatology (rheumatologists and residents in rheumatology training) in February 2023. The questionnaire aimed to determine attitudes, knowledge, and practice patterns regarding the discussion of SD with rheumatologic patients. A descriptive analysis of responses was performed. Results: A total of 162 responses were received. Overall, 50.0% of respondents occasionally asked patients about SD related to their rheumatologic pathologies, while 37.1% never did so. Respondents declared that patients occasionally (82.3%) or never (16.1%) reported SD related to rheumatologic diseases. The main barriers to discussing sexual health were lack of time during medical examination (46.6%), patients’ discomfort (44.8%), and lack of knowledge/experience (39.7%). Overall, 41.9% and 33.9% of respondents respectively totally and partially agreed that rheumatologists should routinely investigate patients' sexual health. Most of the respondents (79.0%) thought that discussing sexual health problems could help patients cope with their rheumatologic diseases. Of all respondents, 74.2% felt the need to broaden their personal knowledge about SD. Finally, 45.9% and 34.4% of respondents respectively partially and totally agreed that training courses for rheumatologists could be helpful in the management of sexual health in rheumatological patients. Conclusions: SD was not routinely discussed in rheumatology practice, still remaining a neglected issue. The most frequent explanations for the lack of attention toward SD were lack of time, patients’ discomfort, and lack of knowledge/experience. Most of the respondents expressed the possible usefulness of attending SD courses to improve knowledge about these conditions.

Several previous studies on YouTube™ on urological field have already been published. The aim of the current study was to evaluate the quality information of YouTubeTM videos on testicular pain. Using Google Trends tool, the frequency of worldwide YouTubeTM and Google Search on testicular pain was examined from 2010 to 2020. The keywords “testicular pain”, “testicular ache” and “scrotal pain” were used on the YouTube platform and the first 100 YouTubeTM videos were analyzed for each one. The Patient Education Materials Assessment Tool (PEMAT) for Audiovisual (A/V) Materials, the DISCERN score and Misinformation tool were used to assess video quality. According to YouTube™ Search the mean relative frequency search for “testicular pain” ranged from 10.5 to 30.0%. According to GoogleTM Search it ranged from 73.7 to 91.0%, Of all 300 videos, 117 were eligible for the analysis. The median number of views, thumbs-up and thumbs-down was respectively: 47060 (interquartile range [IQR] = 6297.0–144188.0), 289 (IQR = 40–912) and 19 (IQR = 4–53). Of all videos, 68.4% and 31.6% were produced respectively by Medical Doctors and Other. The median PEMAT Actionability and Understandability scores were 66.7% and 66.7%, respectively. The median DISCERN score ranged from 1 to 5, with an overall median score of 3, defined from question 16. The median misinformation score ranged from 2 to 5. In conclusion, an increased interest on testicular pain was recorded on both YouTubeTM and Google search during the last decade. However, according to the quality assessment tools used, YouTube™ users cannot get trustful and exhaustive information on testicular pain. Therefore, authors with/without medical background should improve the quality of information on YouTube™ videos.

Marco Capece,1 Marco Falcone,2 Tommaso Cai,3 Alessandro Palmieri,1 Andrea Cocci,4 Roberto La Rocca1 1Department of Urology, AOU Federico II, University Hospital, Naples, Italy; 2Department of Neurourology, A.O.U. Città della Salute e della Scienza di Torino - Unità Spinale Unipolare, Turin, Italy; 3Ospedale Santa Chiara, Trento, Italy; 4Department of Oncologic, Minimally-Invasive Urology and Andrology, Careggi Hospital, University of Florence, Florence, ItalyCorrespondence: Alessandro PalmieriDepartment of Neuroscience, Reproductive Science and Odontostomatology, University Federico II of Naples, via S.Pansini 5, Naples, 80131, ItalyTel +39 081 746 2611Fax +39 081 746 4311Email androfedii@gmail.comAbstract: Ischemic priapism accounts for more than 95% of all priapic episodes. It has to be considered a urological emergency because its time extension may lead to necrosis of smooth muscle cells of the corpora cavernosa, resulting in a complete erectile dysfunction, penile shortening and loss of girth. In the present systematic review, we perform an up-to-date literature search for patients suffering from refractory ischemic priapism who undergo penile prosthesis implantation with particular interests to the patients characteristics. The conservative management of the priapic episode consists of a sympathomimetic agent in the first istance.Failure or recurrence of priapism following these conservative measures is an indication for surgical management. Shunt procedures between the corpora cavernosa and the neighbouring structures are often used first line; however, in refractory ischemic priapism the success rate is minimal. In such cases (> 48 h) an indication of immediate placement of a penile prosthesis could be the best solution.Keywords: refractory ischemic priapism, erectile dysfunction, priapism, penile prosthesis

Gianluigi Califano,1 Claudia Collà Ruvolo,1 Massimiliano Creta,1 Marco Capece,1 Roberto La Rocca,1 Giuseppe Celentano,1 Luigi Napolitano,1 Francesco Paolo Calace,1 Gianluca Spena,1 Francesco Trama,1 Felice Crocetto,1 Francesco Mangiapia,1 Nicola Longo,1 Ferdinando Fusco2 1Department of Neurosciences, Reproductive Sciences and Odontostomatology – Federico II University of Naples, Naples, Italy; 2Department of Urology, Luigi Vanvitelli University of Naples, Naples, ItalyCorrespondence: Massimiliano CretaDepartment of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, via Sergio Pansini 5, Naples 80131, ItalyTel/Fax +390817462611Email max.creta@gmail.comAbstract: Medical management of lower urinary tract symptoms related to benign prostatic obstruction engages healthcare professionals worldwide. Currently, alpha-1 adrenergic antagonists are strongly recommended as first-line therapy for patients with moderate to severe symptoms because of their safety, efficacy and good tolerability. These agents are highly heterogeneous in terms of pharmacological selectivity for the adrenergic receptor subtypes with silodosin being the agent characterized by the highest α1A/α1B affinity ratio. This property has been proposed to confer to silodosin advantages in terms of bladder outlet obstruction improvement and lower incidence of cardiovascular side effects at the cost of a higher incidence of ejaculatory dysfunction. These aspects should be carefully taken in consideration when personalizing medical therapy for lower urinary tract symptoms related to benign prostatic obstruction.Keywords: alpha-1 adrenergic antagonists, benign prostate enlargement, lower urinary tract symptoms, bladder outlet obstruction

Objective: Coronaviruses (CoVs) are a group of RNA viruses involved in several human diseases affecting respiratory, enteric, hepatic, and neurological systems. COVID-19 was identified in 2020 and was named SARS-CoV-2. To limit worldwide contagion, many countries instituted a lockdown, which conducted to disruption of routine life. In fact, pandemic was associated with several stresses among population, such as loss of employment, deaths of family members, friends, or colleagues, financial insecurity, and isolation. This led to long-lasting psychosocial effects as anxiety and depression, increasing the prevalence of stress and traumarelated disorders in the population. The aim of this study was to investigate the correlation between lower urinary tracts symptoms (LUTS) and stress/depressive symptoms during COVID-19 pandemic. Materials and methods: An anonymous cross-sectional webbased survey (comprehending anthropometric data, education level, occupation status, smoking and alcohol habits, current therapies, quarantine and COVID-19 infection status) was conducted from March to May 2020 in Italy. LUTS were examined through National Institute of Health-Chronic Prostatitis Symptom Index (NIH-CPSI) and Genitourinary Pain Index (GUPI). Hamilton Depression Rating Scale (HDRS) was utilized to evaluate depressive and anxiety symptoms. Non-parametric Kruskal-Wallis H Test was used for statistical analysis. Results: A total of 356 out of 461 subjects fully completed the survey, with a response rate of 77.2%. Data showed that subjects involved in economic difficulties, quarantine measures or with increased HDRS reported a significative statistic worsened urinary symptoms (H(3) = 11.731, p = 0.008), quality of life, (H(3) = 10.301, p = 0.016), total NIH-CPSI/GUPI score (H(3) = 42.150, p = 0.000), and quality of life (H(3) = 48.638, p = 0.000). Conclusions: COVID-19 pandemic provoked several alterations in everyday life. Although general lockdown, quarantine and social distancing have been necessary to prevent virus spreading, this had long term effects on all population in terms of mental and physical health. NIH-CPSI and GUPI scores increased linearly with stress and anxiety levels measured at HDRS, confirming worse LUTS in subjects who suffered anxiety and stress from COVID-19 pandemic.

The objective of the current study was to evaluate the quality of the information provided in YouTubeTM videos on phimosis. The term “phimosis” was searched on YouTubeTM, and the Patient Education Materials Assessment Tool (PEMAT) for Audio/Visual Materials (Understandability and Actionability sections, good-quality score of minimum 70%) and misinformation scale (rated from 1 to 5) were used to assess video quality. Quality assessment was investigated over time. Of all, 60 were eligible for analysis. Healthcare providers were the authors of 75.0% of the videos, and 73.3% of the videos were patient-targeted. The median Understandability score was 42.9% (interquartile range [IQR]:34.5–58.9) and ranged from 28.6 to 42.9% (2013–2020). The median Actionability score was 50.0% (IQR:25.0–56.2) and ranged from 25.0 to 50.0% (2013–2020). The median misinformation score was 2.8/5 (IQR:1.6–3.6), and although the score fluctuated over time, the median score was 2.6 both in 2013 and in 2020. According to our results, although an increase of PEMAT over time was observed, the overall quality of the information uploaded on YouTubeTM is low. Therefore, at present, YouTubeTM cannot be recommended as a reliable source of information on phimosis. Video producers should upload higher-quality videos to help physicians and patients in the decision-making process.

Introduction Ischemic priapism (IP) is the most common form of priapism. In cases of priapism persisting for >36 hours, conservative management usually fails, and the patients’ erectile tissue will be inevitably compromised, resulting in corporal fibrosis, shortening of the penis, and refractory erectile dysfunction. In this subset of patients, early implantation of a penile prosthesis (PP) could be a solution for both the priapic episode and the erectile dysfunction. Aim To analyze the current literature with regard to the correlation between refractory ischemic priapism and immediate implantation of PP. Methods An extensive literature research was conducted to retrieve studies focusing on immediate PP implantation in patients suffering from refractory ischemic priapism (RIP). Main Outcome Measures We evaluated the functional outcomes of patients who have undergone the immediate insertion of a PP as treatment for an acute episode of IP refractory to medical therapy or shunt surgery. Results Nine studies were included in this systematic review, including 3 case reports and 6 retrospective analyses. All studies agreed that in patients with RIP, early insertion of a PP is a safe and effective procedure, and all studies but 1 preferred malleable implants to inflatable implants. Conclusion The systematic review does not demonstrate superiority of immediatePP implantation over delayed PP implantation, because none of the studies was designed with this purpose. However, considering the reduced complication rate and the ease of the procedure, all studies are in favor of early implantation over delayed implantation. Capece M, La Rocca R, Mirone V, et al. A Systematic Review on Ischemic Priapism and Immediate Implantation: Do We Need More Data? Sex Med Rev 2018;7:530–534.

none 11 no The aim of the study is to extrapolate clinical features of Premature Ejaculation (PE) patients and female partners of men affected with PE, in order to get a profile that can be of assistance for physicians within the dynamics of a couple, one of which is a PE patient. An observational, non-interventional, cross-sectional epidemiological study entitled IPER (Italian Premature Ejaculation Research) was conducted and included two different cohorts of subjects that were randomly sampled from a patient dataset of selected General Practitioners: 1. IPER-M sub-cohort (1.104 subjects) was made of male subjects in which they were then distinguished patients with or without PE based on the score of the PEDT questionnaire; IPER-F sub-cohort (1.109 subjects) was made of female subjects from an independent sample of women (therefore not the partners of the IPER-M males) in which they then distinguished those partners of a male subject with PE or not. In addition to an identical general questionnaire to explore demographic aspects and habits, each subcohort was then evaluated using validated questionnaires. No differences were noted between PE+/PE- patients in terms of alcohol consumption, smoking habits, physical activity nor stress condition in everyday life, employment, socio-economic class and marital status. While the prevalence of PE proportionally increased with age, excluding the 50-59 and 70-80 years decades, in the IPER-M group an overall statistically significant difference for the mean age between the PE+ and PE- groups (p = 0.002) was detected, but without reaching any difference amongst the different age classes in the IPER-F group. The PE+ patients reported a significantly lower frequency rate of sexual intercourse, worse QoL (p = 0.006 and p < 0.0001, respectively), and increased anxiety status (p < 0.0001 for both subgroups). This study shows that, rather than talking with a patient affected by PE it would be advisable to introduce the concept of couple counseling with the person patient and his partner, because it is only through classification of both partners as one couple and a full understanding of their mutual sexual experience that PE treatment can be optimized and its results measured accurately. none Verze P.; La Rocca R.; Spirito L.; Califano G.; Venturino L.; Napolitano L.; Cardi A.; Arcaniolo D.; Rosati C.; Palmieri A.; Mirone V. Verze, P.; La Rocca, R.; Spirito, L.; Califano, G.; Venturino, L.; Napolitano, L.; Cardi, A.; Arcaniolo, D.; Rosati, C.; Palmieri, A.; Mirone, V.

Penile prostheses (PPs) are an excellent treatment to be considered for patients suffering from erectile dysfunction (ED), refractory to oral medications, or unwilling to consider intracavernosal injections or other therapeutic strategies. Nowadays the market is dominated by three-piece inflatable penile prosthesis (IPP), which are considered the best option available. However, in some specific cases three-piece IPP may be superseded by semi-rigid penile prosthesis (SRPP) and two-piece IPP. Despite the advantages of these implants, the literature is quite scarce, not robust and rarely takes into consideration the partner's satisfaction. This clearly affects the strength of our conviction. Most of the studies confirm that SRPPs and two-piece IPPs can be considered a valid alternative in patients with hand dexterity issues, refractory ischaemic priapism, neophallus and in cases of complex anatomies. In addition, the ease of placement and the high confidence level of surgeons make them a powerful tool in the armamentarium of urologists.

Objective: We aimed to assess the attitudes and perceptions towards multiparametric magnetic resonance imaging (mpMRI) of the prostate among Italian urologists. Material and Methods: A national, web-based survey was performed. A questionnaire composed of 18 multiple choice questions was e-mailed to 941 currently active urologists, members of the Italian Society of Urology. Preserving anonymity, respondents’ demographics were collected (e.g. geographic region, type of workplace, prostate procedures performed) as well as data concerning their attitudes and perceptions towards mpMRI (e.g. indications deemed appropriate, degree of confidence in mpMRI results). Data were expressed as raw numbers and percentages of survey answers. Results: In total, 98 responses were received (participation rate = 10.4%). Respondents mostly worked in urban areas (96%) and primarily in hospital settings (89%), while 48% of them worked in southern Italy. 97% of respondents considered mpMRI useful to detect Prostate Cancer (PCa) in patients with prior negative biopsy, 64% in biopsy-naïve patients and 60% for PCa pre-operatory staging. About half (42%) of the participants declared that mpMRI results frequently lead them to change PCa management strategy. Standardization of mpMRI acquisition and reporting was partially unsatisfactory. Reported waiting time for mpMRI scans was longer than 4 weeks for 51% of respondents. The major limitation of this survey includes the small number of participants. Conclusions: Prostate mpMRI is used by Italian urologists mainly for detection and for pre-operative staging of PCa. Further improvements in terms of mpMRI availability and report standardization are required.

Background Evidence about the clinical benefits of Hyperbaric Oxygen Therapy (HBOT) in patients with Fournier's Gangrene (FG) is controversial and inconclusive. We aimed to compare the mortality related to FG between patients undergoing surgical debridement and/or standard antibiotic therapy alone or in combination with HBOT. Methods We performed a retrospective multi-institutional observational case-control study. All patients admitted with diagnosis of FG from June 2009 to June 2019 were included into the study. Patients received surgical debridement and/or standard antibiotic therapy alone or in combination with HBOT. Factors associated with FG related mortality were assessed with uni-and multivariate analyses. The main outcome measure was FG related mortality. Results A total of 161 patients with diagnosis of FG were identified. Mean FG Severity Index was 8.6±4.5. All patients had broad-spectrum parenteral antibiotic therapy. An aggressive debridement was performed in 139 (86.3%) patients. A total of 72 patients (44.7%) underwent HBOT. Mortality due to FG was observed in 32 (36.0%) of patients who do not underwent HBOT and in 14 (19.4%) of patients who underwent HBOT (P=0.01). At the multivariate analysis, surgical debridement and HBOT were independent predictors of lower mortality while higher FG Severity Index was independent predictor of higher mortality. Conclusions HBOT and surgical debridement are independent predictors of reduced FG related mortality.

The aim of this multicenter study was to investigate the prognostic role of neutrophil-to-lymphocyte ratio (NLR) and to validate the NLR cutoff of 3 in a large multi-institutional cohort of patients with primary T1 HG/G3 non-muscle-invasive bladder cancer (NMIBC)., M.D.V. is supported by the Scholarship Foundation of the Republic of Austria - OeAD and by the EUSP Scholarship - European Association of Urology.

Background: Couple distress is a crucial point in premature ejaculation (PE). PE has been associated with significant bother, interpersonal problems, and dissatisfaction with sexual intercourse for both men and their partners. Objectives: The primary objective of this study was to assess the effect of PE on female sexuality in female partners of men affected from PE. Secondary objectives were to assess the impact of PE on female sexual quality of life, to assess the presence of sexual problems of the male partner, and to evaluate the prevalence and characteristics of comorbidities. Materials and methods: Adult women aged 18 to 80years old, sexually active, were randomly sampled from the patient lists of General Practitioners in Italy and were included in this observational, non-interventional, cross-sectional epidemiological study. Subjects were asked to fill: a general questionnaire regarding anthropometric data, lifestyle, marital status, education, occupation, economic conditions, general health status, comorbidities, and sexual habits; the Sexual Quality of Life Questionnaire-Female (SQoL-F); the Female Sexual Distress Scale (FSDS-R-PE); the Self-rating Depression Scale (SDS); and Self-rating Anxiety Scale (SAS). In addition, females reported about their partner's ejaculation time and the presence of sexual dysfunctions. Results: A total of 3,104 women were included. Mean age was 45.1years. Woman with PE partners presented a higher percentage of sexual dysfunction and reported more anxiety compared with female partners of men not affected from PE (42.69% vs. 20.56% and 30.95% vs. 15,34%, respectively). In addition, they referred more sexual dysfunction in their partners. Hypertension, hypercholesterolemia, arthritis, heart diseases, thyroid disease, a history of menopause, or hysterectomy resulted in significantly more prevalence in women with PE partners. Discussion and conclusions: Female partners of PE patients present an increased prevalence of sexual distress, a reduced quality of sexual life, and an increased anxiety score when compared to women whose partners are not affected from PE.

No study has yet been done to evaluate topical alprostadil as a less invasive alternative vasoactive agent for Penile Dynamic Duplex Ultrasonography (PDDU) in the diagnosis of erectile dysfunction. The main aim of our study was to evaluate the usability and reliability of topical alprostadil for PDDU compared with standard intracavernous injection. A further objective was to determine the patients' preference between these two different approaches. During session A, patients received injection while during session B, they received topical alprostadil. Each patient underwent both sessions, 1week apart from the other. A total of 80 patients were enrolled. After 20min from drug administration, no significant difference was found between the two procedures in terms of peak systolic velocity and end-diastolic velocity, while Erection Hardness Score was significantly higher with injection. Patients reported less pain/discomfort during the procedure in case of topical alprostadil use and an overall preference towards this examination modality. Topical alprostadil could represent a usable and reliable alternative to intracavernous injection for PDDU, with less discomfort and greater preference by patients.

Leiomyoma of the bladder is a very rare disorder that accounts for 0.43% of all bladder neoplasms. Although the pathophysiology of the bladder leiomyoma is unknown, there are some theories on it. The patients can be asymptomatic; when present, clinical symptoms (lower urinary tract symptoms and\or hematuria), are associated with tumor size and location. For diagnosis, imaging plays an important role: ultrasound, computed tomography (CT) scan and magnetic resonance imaging (MRI) are the examinations most frequently performed. Treatment consists of surgical removal of the tumor, and the prognosis is excellent.

Aim of the Study: We aimed to compare the diagnostic accuracy of three Tesla BiparametricMagnetic Resonance Imaging (bpMRI) of the prostate, Prostate Specific Antigen Density (PSA-D) and their combination for the detection of clinically significant Prostate Cancer (PCa). Materials and Methods: We performed a retrospective study. Patients with clinical suspicion of PCa and PSA value between 2.5 and 10 ng/dL who underwent three Tesla bpMRI and subsequent prostate biopsy in a single institution were included into the study. Patients with history of previous prostate biopsy were excluded. PSA-D value was calculated based on prostate volume obtained during bpMRI. PCa lesions with an International Society of Urological Pathology (ISUP) score = or >3 were considered clinically significant PCa. Sensitivity and specificity in detecting clinically significant PCa were determined for bpMRI, PSA-D, and their combination. Receiver operating characteristic (ROC) curves were calculated. A p < 0.05 was considered statistically significant. Results: A total of 114 patients who underwent bpMRI and prostate biopsy between January 2015 and September 2017 were included into the study. bpMRI imaging consisted of T2-weighted imaging and diffusion weighted imaging acquisitions (b-values 0, 400, 1500) and was evaluated with a Likert score based on PI-RADS v2. All patients received 16-core transrectal prostate biopsy by a single operator. The sensitivity of bpMRI ad PSA-D in detecting clinically significant PCawas 93% and 77%, respectively (p < 0.005). ROC curves analysis showed that area under the curve (AUC) of bpMRI, PSA-D and combinationwas 0.87, 0.79 and 0.91, respectively (Figure 1). Based on the results of ROC curves, combination showed no significant improvement versus bpMRI alone. Discussion: bpMRI has a greater sensitivity and similar specificity compared to the PSA-D in the detection of clinically significant PCa. bpMRI combined with PSA-D does not provide superior results compared to bpMR alone. Our analysis suggests a possible independent role for bpMRI in the detection of clinically significant PCa.

Aim of the Study: To evaluate the efficacy of combination therapy with Low Intensity Shock Wave Therapy (LISWT) and Tadalafil 5 mg daily (TAD oad) in diabetic patients with ED and to compare protocols of LISWT characterized by different number of shock waves for session. Materials and Methods: We performed a retrospective observational case-control study. We enrolled diabetic patients with ED naïve for ED treatment. The case group (Group 1) consisted of patients who received TAD oad bed-time for 12 weeks and LISWT. Shockwaves were delivered by a probe attached to an electrohydraulic unit with a focused shockwave source. Shockwaves were delivered to the distal, mid, and proximal penile shaft, and the left and right crura. The duration of each LI-ESWT session was about 20 min. Energy density was set at 0.09 mJ/mm2 and frequency at 120/min. The number of number of shock waves delivered during each session varied from 1500 to 2400. Treatment protocol consisted of 2 treatment sessions per week for 3 weeks. Patients with same demographic and clinical characteristics who received only TAD oad for 12 weeks served as controls (Group 2). International Index of Erectile Function (IIEF-5) scores recorded at baseline, at 4 and 12 weeks after the end of the treatment were compared. A subgroup analysis was performed according to the number of shock waves administered during each session (1500, 1800, 2400). Results: Thirty-one and 10 patients were enrolled in Group 1 and 2, respectively. Eleven, 10 and 10 patients belonging to the Group 1 received 1500, 1800 and 2400 hits, respectively. Mean baseline IIEF-5 scores were 16.8 and 15 in Group 1 and 2, respectively (p = 0.09). A statistically significant improvement of mean IIEF-5 score was observed in both groups at 4 weeks follow-up (19.7 and 18.3 in Groups 1 and 2, respectively) (p < 0.05 vs baseline). Mean IIEF-5 scores recorded at 12 weeks did not varied significantly in comparison to values recorded at 4 weeks (p = 0.1 in both groups). Inter-group analysis did not show significant differences at 4 and 12 weeks (p = 0.2 in both cases). Subgroup analysis revealed a statistically significant improvement of mean IIEF-5 score at 12 weeks with respect to 4 weeks only in patients who received 2400 hits (Figure 1). The percentage of patients in which it was registered a normalization of erectile function after 12 weeks of treatment was 20%, 27.2%, 20% and 50%, in Group 2 and in the subgroups of Group 1 treated with 1500,1800 and 2400 hits, respectively Discussion: The combination of TAD oad and LISWT leads to a statistically significant improvement of erectile function in diabetic patients with concomitant ED at 4 weeks follow-up, with a stable trend over time up to 12 weeks. The administration of 2400 hits for session allows to get an additional, significative improvement of erectile function at 12 weeks follow-up.