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Introduction Stuttering priapism is a variation of ischemic priapism, generally transient and self-limiting, occurring during sleep and lasting less than 3-4 hours. It may progress to episodes of complete ischemic priapism in approximately one third of cases, necessitating emergent intervention. Evidence acquisition This review aims to provide an up-to-date picture of the pathophysiology and management of stuttering priapism. A search using Medline and EMBASE for relevant publications using the terms "priapism", "stuttering", "diagnosis", "treatment", "fibrosis", was performed. Evidence synthesis Stuttering priapism shares its etiologies with ischemic priapism and a large number of diseases or clinical situations have risk association for developing the disorder. The most common causes are sickle cell disease or other hematologic and coagulative dyscrasias especially in children. In the adult population, idiopathic priapism occurring without any discernible cause is considered to be the most common form in adults. The medical management of priapism represents a therapeutic challenge to urologists. Unfortunately, although numerous medical treatment options have been reported, the majority are through small trials or anecdotal reports. Understanding the underlying pathophysiology and understanding the current and emerging future agents and therapeutic options are mandatory in order to provide the best solution for each patient. Conclusions The goal of management of priapism is to achieve detumescence of the persistent erection in order to preserve erectile function. To achieve successful management, urologists should address this emergency clinical condition. In the present article, we review the diagnosis and clinical management of the three types of priapism.

INTRODUCTION AND OBJECTIVES:Testicular cancer represents the most common solid tumors in young men and malignant germ cell tumors constitute the majority of these masses. Orchiectomy is the treatme...

Introduction & Objectives: Non-muscle invasive urothelial bladder cancer (NMIBC) represents a common neoplasm in patients older than 75 years old. Our aim was to analyze retrospectively the population of patients (pts) older than 85 years old treated at our department for bladder tumor. Primary outcome measures were the evaluation of overall survival (OS) and recurrence related to clinical-pathological features. Secondary outcome measures were the evaluation of any relation between treatmeants and OS. Materials & Methods: We looked retrospectively at 118 patients aged 85 years old or more who underwent transurethral resection (TURBT) for bladder tumor (BT) in our hospital between 2001 and 2015. We registered pre-operative clinical-pathological features and clinical outcomes. Statistical analysis was performed by SPSS. Results: A total of 47 females (39.8%) and 71 males (60.2%) with an a mean age of 88.13 (SD +/- 3.17) and mean ASA score 2.55 (+/- 0.5) were included in this study; 91 pts died (77.1%) and 27 (22.9%) are alive. Median time-to-death was 13.5 months (IQR 2-34) and median disease free survival (DFS) was 8 months (IQR 0-24). At diagnosis 28 pts already had advanced disease (23.72%). 4 pts underwent radical cistectomy (RC), 2 had partial cistectomy, 1 had radiotherapy for palliation and 110 had no further radical treatments (93.22%). Histotype was urothelial in 99 pts (83.89%), squamoid in 9 patients (7.62%) and undifferentiated in 10 cases (8.47%). 92 pts had no intravescical therapy (77.96%); 19 had BCG (16.1%) and 7 had MMC (5.93%). 79 pts had low grade (LG) disease (66.94%), 38 had high grade (HG) disease (32.20%) and 1 patient had CIS (0.84%). Among pts with HG disease 7 survived (18.4%) and 31 died (81.6%); among those with LG disease 20 survived (25.3%) and 59 died (74.7%). Among pts who received an intravescical treatment 33.33% survived; among those who did not received it 19.57% survived. Total recurrence rate was 38.14%. Conclusions: Bladder cancer is a well-known disease with an high rate of morbidity and mortality. In our series, HG grade disease, was not associated with higher mortality rate (81.6% vs 74,7% p=0.157) nor with recurrence rate (p=0.452). Tumor size and histotype seemed to be related to recurrence (p=0.001 and p=0.009 respectively). Intravescical treatment did not seemed to improve OS (p=0.06). Men seemed to have higher risk of recurrence (47.8% vs 23.4%, p=0.006). In the whole population recurrence seemed to not affect overall survival (p=0.72). Our study seems to demonstrate that clinico-pathological features of BT does not affect OS in very elderly pts. Further studies in larger cohorts of pts maybe needed.

We report a case of a 69-years-old man who presented with a solitary 1 cm nodule in the lower lobe of the left lung almost 3 years after radical prostatectomy for pT3aN0M0, Gleason score 4+3 disease, without evidence of osseous or lymphatic spread. Surgical resection of the pulmonary lobe confirmed the metastatic nature of the lesion, with subsequent reduction of serum PSA to undetectable levels. After 2 years from the metastasis resection, serum PSA is still undetectable, without the necessity of additional treatments. Solitary pulmonary metastases from prostate cancer (Pca) are rare in clinical practice, with only 29 previous cases described besides the one that we present.

Aim of the Study: Penile cancer (PC) is an uncommon malignant tumor, with an overall incidence of around 1/100,000 males in Europe and the USA. The incidence of penile cancer increases with age, with a peak in the sixth decade but it does occur in younger men. The aims of the treatment of the primary tumour are complete tumour removal with as much organ preservation as possible, without compromising oncological control. Local treatment modalities for localised PC include excisional surgery, external beam radiotherapy (EBRT), brachytherapy and laser ablation. However, treatment choice depends on tumour size, histology, stage and grade, localisation (especially relative to the meatus) and patient preference. Glansectomy with distal corporectomy and reconstruction or partial amputation with reconstruction are recommended for disease invading the corpora cavernosa and/or urethra (T3). We report two cases of patients undergoing partial penectomy and total penectomy with perineal urrthrostomy. Year of production: 2018. Materials and Methods: The first patient (61 years) came to our attention with a hard, swelling and necrotic lesion involving the glans and the distal portion of the penis, in association with bilateral lymphadenopathy. Ulrtrasonographic and magnetic resonance investigations confirmed the invasion of the right corpus cavernosum. The patient underwent partial penectomy and bilateral lymphadenectomy. The second patient (75 years) presented with a big necrotic lesion involving the glans and the foreskin, that appeared fused together. Ultrasonographic and magnetic resonance imaging confirmed the invasion of the glans, with dubious involment of corpora cavernosa. Total penectomy, bilateral orchidectomy and perineal urethrostomy was performed, in association with fine needle aspiration cytology to the lymphnodes. Results: In the first case histopathological diagnosis was squamous cell carcinoma involving the glans, the corpus spongiosum and urethra. Marginal involving of the corpora cavernosa. Lymphnodes resulted free from desease. (TNM Classification: pG2.C2.T3.N0.Pn1). The histopathological diagnosis in the second case was squamous cell carcinoma with verrucoid aspects involving the glans and the corpus spongiosum, with corpora cavernosa and urethral margin free from desease (TNM Classification: pG2.C2.T2.R0.Nx). Discussion: As PC can be a morbid and disfiguring ailment, every effort must be made to preserve penile length and functionality, while attaining adequate cancer control. Although maximal penile preservation would be ideal, proper cancer control remains the primary goal of treatment and therefore must be pursued in the management plan for each individual patient with adapted techniques to minimize recurrence and improve functional outcomes.

INTRODUCTION AND OBJECTIVES The G8 screening tool represents a valid instrument for the identification of functional decline in oncological geriatric patients (pts). Recently it has demonstrated good predictive value in surgery to identify fragile pts candidates for oncological abdominal surgery. Our study has the objective to define if G8 score is a good tool to identify the risk of post operative complications in elderly pts (= 70 years) undergoing radical cystectomy (RC). METHODS From January 2012 to August 2017 we recruited 56 pts 70 yrs or older at the surgical time, undergone RC. Median age was 76 yrs (SD 4,37). The G8 screening questionnaire was perfomed to all patients preoperatively, and fragile pts were identified with a score = 14. We registered intra operative complications, post operative complications and their gravity using Clavien Dindo scale, estimated glomerular filtration rate (eGFR) and its variation postoperatively, length of hospital stay after surgery and readmission rate within 30 days. We compared the clinicalpathological data between the frail (G8 score 14) group. Statistical analysis was made by computing software SPSS. RESULTS Median preoperative G8 score was 13,65 (SD 2,3). Pts were divided in fragile (N=35, 62,5%) and fit (N=21, 37,5%). Intra operative complications were registered in 1 pts (2,8 %) with G8 score =14 and 0 pt (0%) with G8>14 (p= 0,625). Post operative complications occurred in 24 pts (68,5 %) with G8 score =14 and 8 pts (38,09 %) with G8>14 (p=0,025), 12 and none of them had a Clavien Score = 3 respectevely (p= 0,015). Postoperative eGFR was 61,45 (SD 29,2) in G8=14 group and 57,66 (SD 25,84) in G8>14 group (p=0,62) and median variation between pre and postoperative eGFR was 7,8 (SD 27,43) and 8,0 (SD 26,01) for each group (p= 0,97). Median hospital stay was 25,45 days (SD 11,01) for fragile pts and 24,23 days (SD 11,32) for fit pts (p=0,69). 5 pts (14,28 %) with G8score=14 were readmitted within 30 days of discharge, and for 6 pts (28,57 %) with G8score>14 was necessary a new hospitalization (p= 0,298). No significative difference was registered for overall mortality (p= 0,23) and cancer related mortality (p= 0,53) between the two groups. CONCLUSIONS The G8 screening tool represents a good predictive instrument for RC morbidity, identifying fragile pts at risk of post operative complications and their severity. Further analyses are necessary to confirm the data obtained from this preliminary study.

INTRODUCTION AND OBJECTIVES: Increasing life expec- tancy in the general population and the fact that a disproportional burden of cancer occurs in people age ! 65 years old have generated great interest in delivering better cancer care for older adults. EORTC and NCCN recommend that all patients with cancer age ! 70 years old should undergo some form of geriatric assessment. G8 Screening Tool is a robust geriatric tool to identify a geriatric risk profile and for prediction of functional decline and prognostic information for overall survival. We evaluated the role of G8 Screening Tool in the assessment of outcome of elderly patients (! 70 y.o.) underwent surgery for kidney tumours. METHODS: We prospectively enrolled 162 patients (! 70 years old at surgery date) from January 2012 to January 2016 underwent surgery at two urological institution.G8 Screening Tool was applied to each patient before surgery. We divided population into two groups (frail group vs. not-frail group) in relation to the geriatric risk profile based on G8 score ( 14 vs. > 14 respectively). The aim was to identify the role of G8 Score in predicting intraoperative, postoperative complications and functional outcomes. RESULTS: A total of 70 females (34%) and 92 (46%) males were included in the analysis. 69 patients (42,6%) underwent PN, while 93 patients (57,4%) underwent RN. Mean age at surgery was 76.57 (SD6,37). Comorbidity factors were included: mean CCI was 3.06 (SD1,99) with CCI > 5 points in 18 patients (15,65%), mean BMI was 25,15 (SD2,87), 55 patients (34%) with DM, 98 patients (60%) with HTN. CKD stage III was present in 73 patients (45,1%) underwent sur- gery. Mean ECOG PS was 1,53 (SD0,66) with score ! 3 in 7 patients (6,1%). Mean ASA Score was 2,84 (SD0,73). According to the G8 Score, 91 patients (60%) were included in the frail group and 71 (40%) in the not-frail group. 41 patients of frail group vs. 2 patients of not-frail group developed intraoperative complications (p

Aim of the study: Post-operative erosion of prosthesis components is an uncommon but devastating complication worth noting. Distal cylinder and scrotal pump erosion is usually related to infection but isolated erosion has been described in the literature. If the prosthetic material is not exposed to the exterior, impending erosion is present. Patients complain of pain over the end of the cylinder and worry that it will wear through the skin. and the prosthesis components may be evident with physical examination and can be confirmed if necessary through magnetic resonance imaging. Distal cylindrical erosion through the corpus cavernosum with extrusion affecting the urethra, glans, or corporeal shaft can be managed through multiple methods. Options include reseating the cylinders and using fibrotic tissue to support the containment of the cylinders, utilization of alloplastic materials such as Gortex polytetrafluoroethylene polypropylene mesh to create a “windsock” or utilization of prefabricated autologous fascial grafts. Herein we describe the technique of salvage extracapsular re- implantation for penile prosthesis impending erosion with the use of a distal corporoplasty by reseating the cylinder in a new cavity of spongy erectile tissue more dorsal or lateral to the extrusion site. Materials and methods: Circumcising incision is made and the distal corpora are exposed. A lateral longitudinal corporotomy of about 4 cm is made over the cylinder in the area of impending erosion and the inflatable cylinder is retracted proximally using a suture inserted through the hole in the end. At this point, the posterior wall of the fibrotic capsula containing the cylinder is incised transversely about 3–4 cm proximal to the glans. Subsequently The space is developed for a short distance by sharp dissection initially, then fully by inserting a metal dilator.In this manner a new cavity in the distal end of the corpus cavernosum is created. Using a Keith needle and introducer the inflatable cylinder is introduced into this new cavity. The corporotomy is closed using long-term absorbable suture. The cylinder is now secured in its proper location by 2 tough layers comprising the back wall of the original sheath and the corporotomy closure. Results: Routine post-operative care is followed. This technique ensured that the cylinder remained in the newly created, appropriately positioned channel. Discussion: We propose that, on salvage for implant distal extrusion or impending erosion, the replacement implant can be inserted into the cavernous tissue surrounding the capsule, between the capsule and tunica albuginea (extracapsular reimplantation), rather than intra- capsular. Using this technique, the cylinder can be replaced in a more medial and secure position under the glans penis by creating a new cavity for the cylinder behind the back wall of the fibrotic sheath Moreover, this may reduce contact between the replacement implant

Aim of the study: Until 1918 Trieste was part of the Habsburgic Empire. In this period the city was in full economic and demographic growth. In this context, among the medical and surgical society raised the figure of Giorgio Nicolich senior, brilliant surgeon and researcher. He was initially chief of the Surgical Division and gave birth lately to the Urological Division in 1887, in which he practiced until 1925, year of retirement and death. Materials and methods: Giorgio Nicolich was born in Venice in 1852. He graduated in 1875 at the University of Padua, and became trainee of Tito Vanzetti (1809–1888), a surgeon particularly versed in urinary tract surgery and known for both routine surgical capacity and exceptional operations, that gave throughout his activity new and advanced boundaries to the uro-nephrology field. His activity was open to novelties like the use of radio needles for prostate cancer, the use of nephrectomy, mercurial care of the syphilis. After moving to Trieste, the year after his graduation, he entered the Trieste Civic Hospital as a secondary physician of the Division for chronic syphilitic and surgical diseases and became its chief in 1886. From 1887 he obtained the urological characterization of the Division, and the other surgical specialties were transferred to the pre-existing Surgical Division and to the new 10th Division. At the end of the Great War, in 1919 he became professor of Urology, retired in 1925, after an extension for merit of 5 years. In these last years he was joined by Carlo Ravasini, who succeeded him. Nicolich died in the same year. Results: He carried out a wide activity. He attended the Parisian school of Urology with Gujon and Albarran and, in 1921, he founded the Italian Society of Urology. He was an authority in the field of urology in the national and international landscape (he was a pupil in Vienna of Theodor Billroth) and was coauthor of the “Manual of Urology” and President of the Italian Society of Urology. He became also honorary member of the Urological Society of Berlin, of the Belgian Society and member of the Academy of Medicine of Constantinople. In 1924, the year before his death, he founded the Italian Archives of Urology. Discussion: Apart from his extraordinary ability as a surgeon, Giorgio Nicolich was a member of that small number of doctors born in Trieste or came to Trieste, who created a cohesive environment of remarkable level, between the various Divisions of the City Hospital. He is credited and reminded not only for have given life to the Urology of Trieste, but for have practiced avant-garde medicine and surgery, forming a new generation of specialist surgeons.

Objective: We report a case of enucleation of a non-palpable right testicular lesion found incidentally at testicular ultrasonography during investigations in a patient with azoospermia. Materials and methods: In 2011 bilateral hypoechoic nonpalpable testicular lesions (5 mm and 3 mm to the right, 3 mm to the left) were found in a 28 years old patient, during diagnostic investigations for azoospermia. In March 2016, ultrasonography showed that the diameter of the right major nodule had grown to 12 mm, characterized by increased vascularization and increased texture. Blood exams showed serum FSH above normal levels with negative oncologic markers. The patients underwent surgical enucleation of the right nodule under ultrasonography guidance. Results: In post operative day 1 a control ultrasonography documented the disappearance of the lesion. Hystopathologic examination diagnosed a Leydig cell tumor, with negative surgical margins. The patient is in good clinical conditions and is under periodic ultrasonographic follow up. Conclusion: Organ sparing surgery represent a good therapeutic option for little intraparenchymal lesions, mostly in young patients in which is preferable to preserve fertility. Intraoperatory ultrasonography represent an important tool for the localization of the lesion.