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Placement of constricting devices around the penis for autoerotic purposes or increasing of sexual performance represents a well-known challenge for urologists. Penile incarceration is a urologic emergency with potentially severe clinical consequences. In many cases a rapid intervention and a sudden removal of the foreign body it is enough so that patients need no further intervention. We report three different cases of strangulating objects (metallic ring, metal bearing and plumbing pipe) presented at our emergency department and three different methods of devices extraction practiced. Remove these devices can be challenging and often requires resourcefulness and multidisciplinary approach. [ABSTRACT FROM AUTHOR]

Aim Scrotal bruises are quite frequent injuries affecting young subjects, with psychological repercussions on body image and fertility. The interest of ultrasound in the context of the emergency remains controversial. The aim of our study was to investigate clinical, ultrasonographic and operative features of scrotal contusions, and to evaluate the contribution of ultrasound in the description of traumatic lesions. Methods In this retrospective and descriptive study 71 scrotal contusions operated from December 2015 to April 2020 were collected. We retrospectively analysed 26 patients (aged between 14 and 79 years) of 71 who sustained a scrotal ultrasound, where the latter was positive. The primary endpoint was albuginea rupture, whose concordance between ultrasound and surgery was assessed using the Kappa method. Positive and negative predictive values, sensitivity and specificity for the presence of albuginea rupture were evaluated for a set of ultrasound data: scrotal haematoma, haematocele, regularity of testicular contours, testicular fracture (specificity (93%), testicular haematoma, and Doppler signal intensity. Results Surgical treatment was necessary in 26 (37%) patients; only six orchiectomy were performed. Surgical exploration should be performed if haematocele is found in the genital examination without any ultrasound complement. Conclusion The ultrasonography is useful, detailed and accurate when the haematocele is not clinically evident. [ABSTRACT FROM AUTHOR]

The most common subtype of renal cell carcinoma (RCC) is the clear cell RCC (ccRCC) that accounts for 70–80% of cases. The fate of ccRCC is linked to alterations of genes that regulate TP53. The dysfunction of p53 affects several processes including autophagy, which is increased in different advanced carcinomas and could be associated with cancer progression. We report that different kidney cancer cell lines show higher levels of autophagy than control cells. The increased autophagy is associated with the upregulation of miR501-5p, which stimulates mTOR-independent autophagy by the activation of AMP kinase. AMPK activation occurs through the decrease of ATP generation caused by the downregulation of the mitochondrial calcium uniporter (MCU) that leads to the reduction of mitochondrial calcium uptake. Autophagy induction promotes the degradation of p53 through the autophagolysosomal machinery. Consistently, the inhibition of autophagy reduces both cell proliferation and migration enhancing the expression of p53, p21 and E-Cadherin as well as decreasing Vimentin synthesis. Taken together, these findings indicate that autophagy is involved in the progression of kidney cancer. Therefore, the pharmacological targeting of this process could be considered an interesting option for the treatment of advanced renal carcinoma. Image 1 • MicroRNA501-5p increases AMPK-dependent autophagy in kidney cancer cells. • AMPK is activated by ATP reduction due to mitochondrial calcium impairment. • Autophagic machinery is used to seize and degrade p53 in kidney carcinoma cells. • Autophagy inhibition restores p53 expression reducing proliferation and migration. • The targeting of autophagic proteins could represent a new therapeutic option for RCC. [ABSTRACT FROM AUTHOR]

Aim: The purpose of this study is to identify the clinical outcomes of patients during acute phase of Peyronie's disease (PD) treated with daily Tadalafil 5 mg associated with non-surgical treatments such as intra-plaque verapamil injections (IVI), vacuum erection devices (VED) or extra corporeal shockwave therapy (ESWT)., Methods: 445 patients with PD in acute stage were treated as it follows: Group 1(G1) 117 men with only Tadalafil 5 mg once a day for 3 months; Group 2(G2) 106 men with IVI plus Tadalafil 5 mg for a period of 12 weeks; Group 3(G3) 124 men that received ESWT for 6 weeks plus Tadalafil with the same protocol of G1; Group 4(G4) 98 men with VED plus Tadalafil 5 mg for 3 months. There were assessed at baseline and follow-up: Erectile dysfunction (ED), presence and severity of painful erections, penile plaque size and penile curvature degree. The results were evaluated at baseline and 3,6,12 months., Results: Not statistically significant differences emerged between the two groups at baseline, except for higher presence of patients with ED in in G3(7.4%) vs other groups(p < 0.001). Three months after the treatment in G3 men had a significant reduction of penile curvature degrees after 1 year by treatments, whereas pain in an erection or during intercourse was resolved completely in 75% of the patients., Conclusions: Our study highlights that multimodal therapy has beneficial long-term effects not only in the decrease of ED symptoms, but also in the relief of the penile curvature and the quality of life., (© 2024. The Author(s), under exclusive licence to Royal Academy of Medicine in Ireland.)

Background: The purpose of this study is to examine the combination of the mechanical effects of penile therapy with vacuum erection devices (VEDs) plus PDE5i, which improve clinical outcomes after extracorporeal shockwave therapy (ESWT) in men affected by erectile dysfunction (ED) associated with Peyronie's disease (PD)., Methods: A total of 153 medical records of patients affected by PD in stable stage with ED and treated with ESWT were divided into two groups. Group A (GA) included 72 men treated with ESWT, mechanical stretching with VEDs and PDE5ì (Tadalafil 5 mg), and Group B (GB) included 81 men who received only ESWT plus Tadalafil 5 mg with the same protocol of GA. The patients in both groups were assessed at baseline and follow-up for erectile function, painful erections, penile plaque size, and penile curvature. The results were evaluated at baseline and 3, 6, and 12 months after the treatments., Results: Three months after the treatment, GA patients had a reduction in penile curvature degree from a mean ± SD of 33.91 ± 8.34° at baseline to a mean ± SD of 19.46 ± 7.15° after 12 months, whereas pain in an erection or during intercourse was resolved completely in 88.9% of the patients. The mean ± SD IIEF-15 score of patients affected by severe/moderate ED further improved significantly in the GA group ( p < 0.001) after 3, 6, and 12 months of treatment. There were no permanent adverse sequelae after treatments., Conclusions: The regular use of a VED plus Tadalafil in patients who had undergone ESWT significantly provided more benefit in patients with PD in terms of penile deformity, pain, and erectile function.

Objective: To determine whether small, incidentally detected testicular lesions can be safely followed up, by assessing growth rate and volume threshold for benign vs. malignant lesions., Methods: This retrospective observational study includes a consecutive series of 130 testicular incidentalomas < 1 cm and with negative tumour markers identified from October 2001 to November 2022, which were initially followed up with ultrasound. A total of 39 cases proceeded to surgery during the study period, either due to lesion growth (n = 28) or patient preference/recommendation by the referring urologist (n = 11). For the lesions that were growing, specific growth rate (SGR) and doubling time (DT) were calculated assuming an exponential growth pattern. In addition, the velocity of increase of the average diameter (∆D av ) and of the maximum diameter (∆D max ) were calculated., Results: Of the 130 nodules that were initially followed up, six disappeared, eight were reduced in size, eighty-eight were stable, and twenty-eight increased in size. For operated nodules all 18 malignant tumours, 8/9 benign tumours, and 2/12 surgically proved non-neoplastic lesions were growing. The best cut-off values of the growth indicators to differentiate between malignant and non-malignant histology were 3.47 × 10 -3 %volume/day, ≤ 179 days, > 10 × 10 -3  mm/day, and > 5 × 10 -3  mm/day for SGR, DT, ∆D max , ∆D av , respectively., Conclusions: Malignant and non-malignant small incidentalomas can be effectively differentiated based on growing parameters, even though overlap exists. An increase of the maximum diameter of about 1 mm and 2 mm in three months and in six months, respectively, suggests malignancy., Clinical Relevance Statement: Growing parameters allow an educated assessment of benign and malignant small testicular incidentalomas. Non-aggressive management is justified and safe when follow-up includes self-examination and tumour marker assessment to reduce the risk of interval tumour growth., Key Points: Small, non-palpable and asymptomatic testicular nodules < 1 cm are unexpectedly discovered during scrotal ultrasound. Growth indicators estimate the potential malignancy, even though overlap with non-malignant lesions exists. Non-growing incidentalomas can be safely followed up., (© 2024. The Author(s).)

Introduction: Erectile dysfunction (ED) and kidney dysfunction share common risk factors linked to conditions involving endothelial impairment, such as coronary artery disease, dyslipidemia, diabetes mellitus, hypertension, smoking, and obesity. Men with chronic kidney disease experience a high incidence and prevalence of ED. While a functional renal graft can alleviate the issue for some patients, a significant portion of recipients still experience ED (20%-50%)., Objectives: This narrative review describes the variety of current treatments modalities on ED in kidney transplant recipients (KTRs) and their clinical outcomes., Methods: MEDLINE, Web of Science, PubMed, and Google Scholar were used to find eligible articles pertaining to the treatment options of ED in KTRs. A total of 64 articles were evaluated., Results: In KTRs, ED stems from a multifaceted etiology: anxiety, drug side effects, interference with penile vascularity, or the response of cavernosal muscle to neurotransmitters, along with changes in the endocrine milieu. A diverse range of treatments to restore erectile function has proven to be safe and effective for KTRs. Options include drug therapy, surgical interventions, intracavernosal injection therapies, vacuum erection devices, and extracorporeal shockwave therapy., Conclusion: The initial treatment approach may involve the use of a phosphodiesterase type 5 inhibitors at a low dosage, especially if testosterone-circulating levels align with the diagnosis of hypogonadism. The consideration of a combination therapy involving testosterone and phosphodiesterase type 5 inhibitors should be contemplated due to the associated beneficial effects. Extracorporeal shockwave therapy has shown positive short-term clinical and physiological effects on erectile function in patients who did not respond to first-line treatments, resulting in spontaneous erections sufficient for sexual penetration in 50% of cases. Penile implants should be considered as third-line options based on specific patient needs and compliance with clinical conditions., (© The Author(s) 2024. Published by Oxford University Press on behalf of The International Society of Sexual Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Here is presented the first case of internal hernia developing from the space between ureter and muscle fascia after robot-assisted radical cystectomy with uretero-cutaneostomy diversion. An 82-year-old man underwent robot-assisted radical cystectomy with uretero-cutaneostomy diversion for high-grade urothelial carcinoma (pT2). On the Postoperative Day 7, the patient presented abdominal pain and nausea. Abdominal computed tomography showed that a part of the small intestine was protruding between the right ureter and the transverse fascia, and was strangulated, causing an obstruction of the intestine. Patient underwent an emergency laparotomy that revealed prolapse and strangulation of the small intestine through the space between the right ureter and the transversalis fascia. The ischemic intestinal tract and ureter were resected. A new right uretero-cutaneostomy diversion anastomosis with use of ureteral stent single J was created. The man was discharged 28 days after surgery, and his clinical course was uneventful through follow-up., Competing Interests: None declared., (Published by Oxford University Press and JSCR Publishing Ltd. © The Author(s) 2024.)

Background/aim: Multiparametric magnetic resonance imaging (mpMRI) is the recommended modality for local staging of prostate cancer (PCa). The use of dynamic contrast-enhanced (DCE) imaging alone significantly improves staging performance. However, several studies have revealed that DCE imaging adds no extra benefit for PCa detection. Many authors observed benefits of performing prostate MRI without DCE, so called biparametric MRI (bpMRI), such as the elimination of the toxicity of gadolinium administration, reduction of examination time, costs and better accessibility. This narrative review describes the variety of imaging modalities in Local staging of PCa with bpMRI utilization and its comparison to mpMRI., Materials and Methods: A search of medical databases was performed to find eligible articles using the following key words: "prostate cancer", "MRI", "multiparametric", "biparametric" and "staging". MEDLINE, Web of Science, PubMed and Google Scholar were used to search for eligible articles published in the past 5 years and compared the diagnostic accuracy of mpMRI and bp MRI in local staging of PCa., Results: A total of 48 articles were evaluated. Multiple systematic reviews used pooled data to compare the accuracy of biparametric and multiparametric examinations. However, all these studies advise caution on using pooled data for clinical practice, pointing to multiple sources of heterogeneity among the studies evaluated., Conclusion: Given the absence of prospective data comparing bpMRI and mpMRI, randomized, prospective, multicenter studies are encouraged. However, mpMRI is the recommended modality for local staging of PCa. It has superior performance compared to traditional staging based on clinical nomograms, and provides additional information on the site and extent of disease., (Copyright © 2024 International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.)

Background: Currently, there are no studies evaluating the feasibility of a prostate biopsy approach in men undergoing a kidney transplant (KT). Owing to this evidence, we planned a retrospective population-based study to evaluate our experience of a transrectal prostate biopsy (TR-PB) approach and studied the impact on the complication rate and outcomes in patients undergoing KT with suspected prostate cancer (PCa)., Methods: We collected data from KT patients who underwent PB with a transrectal approach. One week and two weeks after the PB, patients' information was collected regarding possible complications during the post-biopsy period., Results: A total of 121 patients were included in this study. Among them, Group 1 was composed of 59 patients undergoing TR-PB with an ultrasound (US) standard technique, and Group 2 consisted of 62 patients undergoing TR-PB with an MRI-US cognitive technique. We observed a 28.9% Clavien-Dindo grade ≤ 2 of early side effect rates (mostly rectal bleeding and other minor hematuria), with a very low rate of hospital re-admission for acute urinary retention (3.3%); only one man required hospitalization for rectal bleeding, and there were no major complications., Conclusions: We can affirm that TR-PB can be a safe procedure with a low risk of severe complications when performed by skilled specialists with a standardized procedural pathway.

Background: A business continuity plan (BCP) facilitates the performance of primary functions during emergencies or other situations that can disrupt normal operations. If risk management is done analytically, a business impact analysis (BIA), according to ISO 22301 certification, makes it possible to define the best strategy for supporting the company's assets and image, optimizing the operational efficiency of service recovery and redesigning spaces for health. Since 2015, our healthcare company has embarked on a certification process for all sectors and activities through the implementation and development of diagnostic and therapeutic paths for operational diagnos-tic-therapeutic-assistance pathways (PDTAs). PDTA processes are all certified by the ISO 9001:2015 management system hospital. Our hospital is the first healthcare company to have obtained ISO 22301:2019 certification concerning PDTA processes, offering patients the highest standards of quality and safety of care in emergency medical services., Methods: The formal BCP process includes several steps prior to the creation of a BCP: create a BCP team, conduct a BIA, determine the continuity plan by using the results of the analyses, and conduct training and exercises to educate staff and improve the BCP., Results: From the BIA analysis, the team identified the time-employee PDTAs in company paths under emergency and urgency: acute ST-elevation myocardial infarction (STEMI), TRAUMA, and STROKE, providing for a planning path that took advantage of the duration of approximately 12 months. This path included the creation of structural procedures, the redefinition and updating of the PDTA in the light of the BCP, the preparation of exercises aimed at guaranteeing the business continuity objectives, and, finally, the awareness of our stakeholders regarding its correct application., Conclusions: With a business continuity management (BCM) system, companies take preventative measures to ensure they can start operations again quickly in an emergency. An exhaustive BIA in a hospital company reveals the effects when processes fail, how critical each process is for the company, and the amount of time required to get up and running again, thus providing the organization with important information for risk management. The measures for handling risks derived from this analysis are incorporated into a BCM system where the emergency plans are defined, too, so that business operations continue even in the event of an emergency.

Objective: To assess the relationship between baseline total serum testosterone (T) and clinical outcomes in men affected by Peyronie's disease (PD) stable stage and treated by extra corporeal shockwave therapy (ESWT)., Methods: In this study, 168 patients affected by PD in stable stage (≥12 months) and treated with ESWT, were divided into 2 groups. Group 1 (G1) counted 71 patients with low T levels (≤ 300 ng/dL); group 2 (G2) consisted of 97 patients with normal T that received ESWT with the same protocol of G1 for 6 weeks. There were assessed at baseline and follow-up: Erectile dysfunction (ED), presence and severity of painful erections, penile plaque size, and penile curvature degree. The results were evaluated at baseline and 3, 6, 12, months after the treatment., Results: Not statistically significant differences emerged between the 2 groups at baseline, except for higher presence of patients with ED in G1 (90%) vs G2 (52%). Three months after the treatment in G2 pain was resolved completely in 80.4% of the patients, compared with G1 (54.9%). G2 had a reduction of curvature degree after the 3-month treatment (P <.001). Mean plaque size decreased in both groups without statistically differences with baseline values. Mean ± SD International Index of Erectile Function-5 score progressively improved significantly in the eugonadal men., Conclusion: This study demonstrated greater efficacy for the treatment of PD in men with normal T concentrations compared with men with low T concentrations. The results obtained from this study suggest that may be valuable in considering T therapy in men with PD prior to ESWT., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Purpose: To assess the clinical effectiveness of extra corporeal shockwave therapy (ESWT) administration compared with ESWT plus a low-intensity laser diode therapy (LILDT) in the management of Peyronie's disease (PD) stable stage., Methods: In this study, 214 patients affected by PD in stable stage (≥ 12 months), were divided into two groups. Group 1 (G1) counted 111 patients treated only with ESWT; Group 2 (G2) consisted of 103 patients that received ESWT with the same protocol of G1 plus LILDT for six weeks. The patients of both groups were assessed at baseline and follow-up for erectile function, painful erections, penile plaque size and penile curvature. The results were evaluated at baseline and 3, 6, 12 months after the treatment., Results: Three months after the treatment in G2 pain in an erection or during intercourse was resolved completely in 78.6% of the patients, whereas in 55.8% cases of G1 (p < 0.003). G2 patients had a reduction of curvature degree after the 3 months treatment (p < 0.002). However, mean plaque size decreased in both groups without statistically differences with baseline values. Mean ± SD IIEF-5 score further improved significantly in the group treated with ESWT plus LILDT (p < 0.001). There were no permanent adverse sequelae after treatments., Conclusion: This study demonstrates an interesting therapeutic strategy when combined to the synergistic action of a shock wave therapy with low-intensity laser therapy on the stable plaques with significant benefits in terms of pain perception, penile curvature and sexual activity., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Competing Interests: The authors declare no conflict of interest.

Background/aim: Prostate cancer (PCa) is one of the most common tumors in men accounting for the 7.3% of all cancer-associated diseases in 2020. In advanced stage, this pathology is a lethal disease and is the fifth cause of cancer death in men worldwide. The diagnosis of PCa is performed by prostate-specific antigen (PSA) detection combined with direct rectal examination (DRE). However, high PSA levels can be detected in non-malignant conditions leading to overtreatment of non-oncological patients. Moreover, PSA levels are not associated with disease progression; therefore, the research of novel biomarkers could improve diagnosis and prognosis of this tumor. In this regard, genetic polymorphisms may affect PCa outcome as well as to be associated with cancer familiarity. In fact, germline variations detected in different genes including BRCA1, BRCA2, ATM and HOXB13 seem to be associated with PCa susceptibility and progression., Materials and Methods: Somatic and germline polymorphisms were detected by next generation sequencing (NGS) in 48 PCa subjects and paired controls. Gene variants were matched with patient outcome and cancer familiarity to identify mutations linked to prognosis and tumor predisposition., Results: NGS sequencing has allowed to identify different genetic polymorphisms that could be linked to cancer outcome and predisposition. In particular, somatic and germline mutations found in ATM, FOXA1 and SPOP genes correlate with poor prognosis and/or high Gleason score. Moreover, germline variants lying mainly in ATM, but also in ZFHX3, SPOP, CHD1, CDK12 and APC seem to be associated with hereditary-predisposing cancer syndrome., Conclusion: Variants correlating with poor prognosis and cancer susceptibility could be usable as possible tumor biomarkers in prostate cancer., (Copyright © 2023 International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.)

Prostate cancer (PCa) is the most common non-cutaneous tumor among men worldwide and, if diagnosed late, it exhibits a high mortality representing the sixth most lethal tumor in men. The main method to detect PCa is the prostate-specific antigen (PSA) level followed by direct rectal examination (DRE). Unfortunately, the PSA test has limited accuracy, as it does not provide information on disease outcome leading to the overtreatment of benign tumors. Thus, PSA analysis does not allow for stratifying PCa patients in high or low risk groups for disease recurrence or distant metastasis. Currently, the detection of several genetic markers might improve the risk stratification, addressing patients with PCa to the best therapeutic option. Here we describe the current clinical practice for PCa patients, the possible genetic polymorphisms associated with diagnosis, prognosis and therapy response as well as variants linked to familial PCa. The use of genetic markers could be routinely introduced in clinical practice leading to improvements in the management of PCa., (Copyright © 2023 International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.)

Worldwide, we have witnessed an expansion of robot-assisted laparoscopic surgery (RALS) and thanks to the global adoption of high-resolution diagnostic imaging technologies, an increased incidence of newly diagnosed prostatic, renal and bladder cancers has been recorded with concurrent second primary urological cancer diagnoses increasing by 1.5%. Diverse authors have reported their findings concerning synchronous multi-visceral malignances robotic treatment within the scientific literature. The aim of this study is to comprehensively review all reported articles describing concurrent upper and lower RALS using a singular robotic port scheme within the same intervention for renal malignances and concomitant prostatic or bladder cancers. To the best of our knowledge and vigorous literature search, this is the first study that comprehensively evaluates and reports all combined upper and lower urinary tract surgeries published so far. In carefully selected patients, thanks to multidisciplinary preoperative assessment and surgical planning a combined robotic approach can reduce the morbidity, complications, hospital admissions and the overall length of hospitalization., (© 2021. The Author(s), under exclusive licence to Springer-Verlag London Ltd., part of Springer Nature.)

Gene mutations may affect the fate of many tumors including prostate cancer (PCa); therefore, the research of specific mutations associated with tumor outcomes might help the urologist to identify the best therapy for PCa patients such as surgical resection, adjuvant therapy or active surveillance. Genomic DNA (gDNA) was extracted from 48 paraffin-embedded PCa samples and normal paired tissues. Next, gDNA was amplified and analyzed by next-generation sequencing (NGS) using a specific gene panel for PCa. Raw data were refined to exclude false-positive mutations; thus, variants with coverage and frequency lower than 100× and 5%, respectively were removed. Mutation significance was processed by Genomic Evolutionary Rate Profiling, ClinVar, and Varsome tools. Most of 3000 mutations (80%) were single nucleotide variants and the remaining 20% indels. After raw data elaboration, 312 variants were selected. Most mutated genes were KMT2D (26.45%), FOXA1 (16.13%), ATM (15.81%), ZFHX3 (9.35%), TP53 (8.06%), and APC (5.48%). Hot spot mutations in FOXA1, ATM, ZFHX3, SPOP, and MED12 were also found. Truncating mutations of ATM, lesions lying in hot spot regions of SPOP and FOXA1 as well as mutations of TP53 correlated with poor prognosis. Importantly, we have also found some germline mutations associated with hereditary cancer-predisposing syndrome. gDNA sequencing of 48 cancer tissues by NGS allowed to detect new tumor variants as well as confirmed lesions in genes linked to prostate cancer. Overall, somatic and germline mutations linked to good/poor prognosis could represent new prognostic tools to improve the management of PCa patients., (© 2022 The Authors. Cell Biology International published by John Wiley & Sons Ltd on behalf of International Federation of Cell Biology.)

Objectives: Retrograde intrarenal surgery (RIRS) is commonly performed under general anesthesia (GA) because renal mobility during breathing may affect lithotripsy. However, spinal anesthesia (SA) is adopted in clinical practice due to clinical conditions that contraindicate GA. We aimed to compare results of RIRS for stones performed under GA compared to SA regarding stone-free rate (SFR) status and postoperative complications in a consecutive single-center series., Methods: We retrospectively reviewed all patients who underwent RIRS for stones between 2017 and 2020., Inclusion Criteria: age ≥ 18 years, renal stone burden deemed suitable for RIRS with a stone diameter ≤ 20 mm., Exclusion Criteria: stones >20 mm, urinary tract infection, bilateral surgery, second-look procedures, unmodifiable bleeding diathesis, <5mm asymptomatic lower calyx stones. SFR was defined as no residual fragment >3 mm at 6-12 weeks follow-up. The choice of anesthesia was a shared decision between anesthesiologists and patient preference., Results: 230 patients were included in the analysis. Mean age was 57.50±13.73 years. 33% of stones were located in the pelvis. 28.7% of patients had multiple stones. Mean cumulative stone diameter was 16.60±6.54 mm. 63% of patients underwent RIRS under SA. There were no significant differences between the two groups in terms of preoperative characteristics, except for comor-bidity, significantly higher in the GA group. Mean time of operating room occupation was longer in the GA group (81.58±35.37 minutes) than in the SA group (72.85±25.91 minutes,p=0.033). Length of stay was shorter in the SA group (mean 2.2±1.66 days vs 3.46±5.88 in GA,p=0.019). Logistic regression showed that multiple stones in the collecting system were associated with residual fragments (HR 0.386, 95%CI 0.151-0.991,p=0.04). There were no statistically significant differences in overall and high-grade complications, and in SFR between SA (75.9%) and GA groups (70.6%,p=0.317)., Conclusion: SA does not affect SFR and postoperative complications in patients who underwent RIRS in daily practice.

Background: Systemic inflammatory response syndrome (SIRS) is a dangerous complication after percutaneous nephrolithotomy (PCNL) and retrograde intrarenal surgery (RIRS). We aimed to review the diagnostic accuracy of midstream urine culture (MSUC), pelvic urine culture (PUC), and stone culture (SC) derived from the same cases to predict SIRS after PCNL and/or RIRS. Materials and Methods: A comprehensive literature search was performed, using MEDLINE, EMBASE, and Cochrane Central Controlled Register of Trials. Sensitivity and specificity were calculated for MSUC, PUC, and SC. The diagnostic odds ratio (DOR) was estimated for each study with a random effect and hierarchical summary receiver operating characteristic (HSROC) model leading to a corresponding 95% confidence interval (CI). Overall test accuracy was measured by finding the area under the curve (AUC). An AUC value >0.70 stands for adequate overall accuracy. Results: The search retrieved 537 articles. After screening, 21 studies involving 5238 patients were included for the meta-analysis. The pooled sensitivity for MSUC was 0.322 (95% CI 0.2228-0.432), and pooled specificity 0.854 (95% CI 0.810-0.889). The DOR was low at 2.780 (95% CI 1.769-4.368), showing poor overall diagnostic accuracy. The pooled sensitivity for PUC was 0.323 (95% CI 0.224-0.440) and specificity 0.931 (95% CI 0.896-0.954). The DOR was 6.377 (95% CI 4.065-10.004), showing a mild overall diagnostic accuracy. The pooled sensitivity for SC was 0.552 (95% CI 0.441-0.658) and specificity 0.847 (95% CI 0.798-0.886). The DOR was 6.820 (95% CI 4.435-10.488), showing mild overall diagnostic accuracy. The AUC for HSROC for MSUC was 0.65, 0.73, and 0.75 for PUC and SC, respectively. Conclusion: MSUC is a poor predictor for postoperative SIRS. PUC or SC should be collected during lithotripsy to better predict the possibility of developing postoperative SIRS after PCNL and RIRS.

Objective: To review the literature on the impact on female quality of life and sexual function of orthotopic reconstruction after radical cystectomy for non-malignant bladder conditions. Radical cystectomy is commonly required to treat malignant conditions but may also be considered for the treatment of non-malignant diseases. These heterogeneous group of disorders includes interstitial cystitis, painful bladder syndrome, neurogenic bladder, haemorrhagic/ radiation cystitis, endometriosis and refractory genitourinary fistula. Treatment begins with non-invasive medical therapies but, in non-responder cases, a surgical solution should be considered. Such invasive techniques include urinary diversion and reconstructive procedures that have an impact on healthrelated quality of life, physical, social, and mental status., Materials and Methods: This narrative review research was done using the PubMed database up until 2020, July. All papers referring to cystectomy for benign indication were considered., Results: In comparison to other reconstructive options, orthotopic neobladder allows the restoration of a normal self-image and consequently it is the most suitable procedure when a surgical reconstruction is necessary for non-malignant conditions. However, women can face many disorders that impact on everyday life, such as voiding dysfunction or sexual activity problems., Conclusions: Scant data is available about quality of life, sexual life and self-perception in women treated by cystectomy for benign conditions and most literature is dedicated to those indicators in cancer patients. More research is needed to understand the tolerability and the quality of life results of the female population affected by benign conditions undergoing this kind of surgical approach.

Penile dislocation following a traumatic pubic bone fracture is a very rare condition. Only a few cases are reported in the literature and the presentation mechanism is still not completely understood. The impact energy on the pelvis usually causes a displaced fracture with concomitant withdrawal of the pubic bone. The retraction of the pubic bone pulls the penis by its suspensory ligament leading to penile dislocation. We describe a rare case of a "hidden" penis 2 months after a blunt pelvic trauma following a motor vehicle accident. Clinical examination revealed a retracted penile skin. The penis was not visible, neither palpable in the expected position. Micturition took place by dripping urine from the opening of the prepubic skin where urine got trapped in the surrounding skin. He also complained of not having erections. A magnetic resonance imaging that showed invaginated penis, located in the anterior pelvic wall, adjacent to the right inguinal canal. Surgical repair was performed trough an inverted "V" suprapubic incision that allowed exploring the pubic area. The degloved penile shaft was identified and isolated from fibrotic adhesions to the surrounding tissue. The invaginated penile skin that was thin and retracted. The point of fixation was located deeply in the right pubic area where the subcutaneous tissue and skin were firmly attached to a spike of the fractured pubic bone. This adhesion was sharply resected and the penis and its skin were restored in their anatomical position. The suspensory ligament was partially detached. Erection was simulated using saline solution injection into the corpora cavernosa to exclude penile curvature. Postoperative course was uneventful. One year after surgery, the penis had a normal appearance without retraction and sexual function was completely restored. Our case pointed out the importance of genitalia evaluation by practitioners involved in the care of pelvic trauma patients., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://dx.doi.org/10.21037/tau-21-333). The authors have no conflicts of interest to declare., (2021 Translational Andrology and Urology. All rights reserved.)

Introduction & Objectives: We tested the role of multiparametric magnetic resonance imaging (mpMRI) in disease reclassification and whether the combination of mpMRI and clinicopathological variables could represent the most accurate approach to predict the risk of reclassification during active surveillance., Materials & Methods: Three-hundred eighty-nine patients (pts) underwent mpMRI and subsequent confirmatory or follow-up biopsy according to the Prostate Cancer Research International Active Surveillance (PRIAS) protocol. Pts with negative (-) mpMRI underwent systematic random biopsy. Pts with positive (+) mpMRI [Prostate Imaging Reporting and Data System, version 2 (PI-RADS-V2) score ≥3] underwent targeted + systematic random biopsies. Multivariate analyses were used to create three models predicting the probability of reclassification [International Society of Urological Pathology ≥ Grade Group 2 (GG2)]: a basic model including only clinical variables (age, prostate-specific antigen density, and number of positive cores at baseline), an Magnetic resonance imaging (MRI) model including only the PI-RADS score, and a full model including both the previous ones. The predictive accuracy (PA) of each model was quantified using the area under the curve., Results: mpMRI negative (-) was recorded in 127 (32.6%) pts; mpMRI positive (+) was recorded in 262 pts: 72 (18.5%) had PI-RADS 3, 150 (38.6%) PI-RADS 4, and 40 (10.3%) PI-RADS 5 lesions. At a median follow-up of 12 months, 125 pts (32%) were reclassified to GG2 prostate cancer. The rate of reclassification to GG2 prostate cancer was 17%, 35%, 38%, and 52% for mpMRI (-), PI-RADS 3, 4, and 5, respectively ( P  < 0.001). The PA was 69% and 64% in the basic and MRI models, respectively. The full model had the best PA of 74%: older age ( P  = 0.023; Odds ratio (OR) = 1.040), prostate-specific antigen density ( P  = 0.037; OR = 1.324), number of positive cores at baseline ( P  = 0.001; OR = 1.441), and PI-RADS 3, 4, and 5 (overall P  = 0.001; OR = 2.458, 3.007, and 3.898, respectively) were independent predictors of reclassification., Conclusions: Disease reclassification increased according to the PI-RADS score increase, at confirmatory or follow-up biopsy. However, a no-negligible rate of reclassification was found also in cases of mpMRI (-). The combination of mpMRI and clinicopathological variables still represents the most accurate approach to pts on active surveillance., Competing Interests: All authors have no conflict of interest to declare., (© 2020 Asian Pacific Prostate Society. Published by Elsevier B.V.)

Purpose: We wished to present the clinical applications and to evaluate the benefits of the use of a carbon dioxide (CO 2 ) laser versus the conventional procedure for circumcision in adults, in terms of duration of surgery, surgical techniques, complications, pain and cosmetic appearance., Patients and Methods: The medical records of 482 patients who had been circumcised were retrospectively evaluated. The patients were divided into two groups: 168 patients (Group A) were circumcised with traditional techniques; and 314 patients (Group B) were circumcised using a CO 2 laser. All the patients were circumcised under local anesthesia. Pain was evaluated using a verbal numerical rating scale for pain assessment. Postoperative wound swelling, bleeding, infection and pain were assessed at 4 hours, 24 hours and 7 days after surgery., Results: There were no significant differences between the two groups in terms of bleeding and infections. The difference in operating times between the groups was significant ( p <0.001). Wound disruptions occurred in one patient in Group A at 3 days and two patients in Group B at 1 week. Pain scores were low and there was less pain in Group B than in Group A during the first 4 hours (1.8 vs 3.7; p <0.002). Compared with the conventional method, the CO 2 laser technique was associated with much less pain at both 1 day ( p <0.002) and 7 days ( p <0.001) postoperatively. The cosmetic results were superior in Group B; a linear surgical scar developed in 94.9% of patients in Group B versus 61.3% in Group A ( p <0.001)., Conclusion: Our results show that the use of a CO 2 laser was associated with a shorter operative time, less wound irritation and better cosmetic appearance compared with standard surgical techniques for circumcision., Competing Interests: The authors report no conflicts of interest in this work., (© 2020 Ronchi et al.)

Renal cell carcinoma (RCC) is extremely rare in pregnant women. However, this is one of the most reported urologic tumors during pregnancy. The aim of this review was to evaluate RCC during pregnancy in terms of epidemiology, risk factors, diagnosis, natural history of disease, and the safety of laparoscopic approach in the management of this tumor. RCC presentation is frequently made incidentally during an ultrasonography performed for other reasons, such as hydronephrosis owing to non-neoplastic causes. The optimal time for surgery during pregnancy and the consequences of surgery on the maternal and fetal well-being are major considerations. Risks for adverse pregnancy outcomes should be explained, and the patient's decision about pregnancy termination should be considered. Ultrasound is good in diagnosing renal masses, with a sensitivity comparable to that of computed tomography only for exophytic masses larger than 3 cm. Magnetic resonance imaging is reproducible and a good, though expensive, alternative to computed tomography scans for the evaluation of renal lesions in pregnant women. Radical nephrectomy or nephron-sparing surgery are essential treatments for management of RCC. Laparoscopic surgery has historically been considered dangerous during pregnancy and avoided whenever possible, because of concerns regarding surgery-related risks, such as uterine injury, miscarriage, teratogenesis, preterm birth, and hypercapnia. The laparoscopic treatment during pregnancy is becoming increasingly accepted where feasible with low morbidity. However, the combination of a multidisciplinary approach, multi-specialty communication, and skilled surgeons can give the best possible outcomes for mother and fetus., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Introduction: Uretero-iliac artery fistulae (UIAF) are the consequence of chronic inflammatory events that create a fibrous and poorly vascularized uretero-vascular adhesion. They often occur in patients with a history of surgery, pelvic radiotherapy, and chronic ureteral stenting. The presentation is usually massive gross hematuria with acute anemia unto to hemorrhagic shock, representing a life-threatening condition. High mortality rate is reported (7-23%)., Materials and Methods: We present four cases in three patients, treated in our Institution from 2013 to 2018, and reviewed the published literature. UIAF was defined as the ratified presence of an abnormal communication between the ureter and any artery. In all patients, the UIAF was initially evaluated by contrast-enhanced computed tomography (CT) angiography. The management strategy was defined individually based on the specific risk profile of each patient., Results: In all cases, ureteral-iliac artery fistula occurred in female patients with previous surgery or radiation and with presence of indwelling ureteral stent. In every case the hematuria was massive and life-threatening. Diagnosis was delayed because of the poor diagnostic accuracy of CT scan, leading to over-treatment. Angiography resulted the best diagnostic tool. The endovascular treatment proved good outcomes in terms of early complications, with no case of mortality., Conclusions: In case of gross hematuria during ureteral stent change in female patients with history of previous pelvic surgery and radiation, UIAF must be suspected and immediately treated, since it represents a urological emergency. Angiography can be useful to confirm the diagnosis and endovascular treatment with vascular endoprosthesis is the best therapeutic option.

Objective: To assess functional outcomes after surgical correction of congenital and acquired penile curvatures using Yachia's technique (YT) with degloving (DG) and without degloving (WDG) of the penis., Materials and Methods: A penile deformity with angle ≥30°, difficulty in vaginal penetration, and severity of erectile dysfunction secondary to penile curvatures were the indications for a surgical treatment with YT. The preoperative characteristics of the patients, postoperative outcomes (change in angulation, palpation of sutures, penile shortening, and patient satisfaction), operative time, and hospital stay were recorded. A total of 64 patients were included in this review and divided into 2 groups: 34 in group I (YT with DG) and 30 in group II (YT-WDG)., Results: The mean operative time was 65.87 ± 21.32 minutes for group I and 48.17 ± 23.82 minutes for group II (P < .02). The mean hospital stay was 3.09 ± 0.96 and 2.87 ± 0.93 days in DG and WDG, respectively (P = .324). There were no significant differences in recurrence rates and complications (palpation of sutures: group I: 14.7% vs. group II: 13.3%; penile shortening: group I: 8.9% vs. group II: 10%). At follow-up of 20.8 months, all treated patients were able to insert the penis in the partner's vagina, were satisfied overall with sexual intercourse., Conclusion: The outcomes of the DG and WDG techniques were similar, even if the YT-WDG presents better results in terms of less healing and operative time., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Purpose: We report an unclamped sutureless laparoscopic simple enucleation (LSE) technique for renal tumors with low nephrometry score and analyze complication rates as well as functional and oncologic outcomes., Patients and Methods: We reviewed the data of 143 consecutive patients who underwent sutureless laparoscopic tumor enucleation with zero ischemia by a single experienced laparoscopic surgeon. The inclusion criteria for LSE with zero ischemia were tumor size ≤ 5 cm and RENAL nephrometry score of 4 to 6. The following data were collected: age, gender, body mass index, tumor side, renal function, tumor characteristics, American Society of Anesthesiologists score, operative time, positive surgical margins, estimated blood loss, and surgical complications., Results: The median RENAL score of patients was 4.7. Median tumor size was 2.7 cm. Conversion to open surgery and hilum vessels clamped were not necessary in any patient. There were no changes in postoperative creatinine values and estimated glomerular filtration rate. The median operation duration time was 78.2 minutes, and median estimated blood loss was 110.2 mL. The median hospital stay was 3.8 days. A total of 2.8% of the patients had positive surgical margins at pathologic examination. Of the 143 patients, 7% developed fever after surgery requiring an adequate antibiotic regimen, 1.4% developed postoperative bleeding requiring blood transfusions, and 0.7% had postoperative urinary leakage from the drainage requiring double-J stent position., Conclusion: The unclamped sutureless LSE is a rational and safe approach to renal tumors with a low nephrometry score. This surgical technique does not increase the complication rate despite the reduction in parenchymal mass excised and the absence of hilar control., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Female urethra adenocarcinoma (FUA) is a rare aggressive tumor that occurs in Skene ducts and glands. It is associated with a relatively poor prognosis. The aim of this review was to evaluate FUA in terms of epidemiology, risk factors, diagnosis, natural history of disease, modalities of treatment, and outcomes. These tumors are usually large masses, which typically spread through the lymphatic system. Patients present with vague symptoms similar to urinary tract infections. Cystourethroscopy permits visualization of the urethral tumor and allows biopsies to be performed to remove samples for histologic examination. Magnetic resonance imaging is recommended for tumor staging. Local, superficial, and distal urethral tumors may be treated by partial resection with preservation of the urethra. Radical urethrectomy with wide, comprehensive resection of the paraurethral tissues and anterior vaginal wall may offer superior local control for this disease. Advanced FUA and lymph node positivity are associated with poor prognosis for all survival outcomes (recurrence-free, cancer-specific, and overall survival). Multimodal therapy including surgery, chemotherapy, and radiotherapy is required in the modern management of FUA, although the specific role and combination of each treatment is less clearly determined. Wide resection after chemotherapy and/or radiotherapy is associated with the best local control, but it reduces quality of life., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Purpose: To analyze the dimensional characteristics between non-palpable testicular masses detected during ultrasonographic (US) study and their postoperative dimensions reported in definitive histological diagnosis, and evaluate if the sonographic measurements may be a relevant parameter to improve the identification of testicular lesions amenable to treatment with testicular-sparing surgery (TSS)., Methods: A total of 77 patients who underwent radical orchiectomy or TSS for non-palpable testicular masses suspected for malignant neoplasms were included into this study. Preoperative US studies were also carried out in all patients to evaluate the diameter, volume and sonographic characteristics of the testicular lesions and the contralateral testes. All patients underwent inguinal orchiectomy or testicular exploration (for masses ≤1.5 cm) through an inguinal approach., Results: The mean age at the time of diagnosis was 36.5 years. The predominant finding was a hypoechoic mass (71.4%). The vast majority of all malignant masses appeared markedly hypoechoic (89.8%); moreover, this differed significantly from benign lesions (39.3%, p<0.001). Calcified lesions were significantly associated with benign tumors (77.8%, p<0.002). The mean maximum lesion diameter of the affected testicle determined by preoperative US study was 14.1 mm (range 7-21). The mean maximum lesion determined postoperatively by pathology was 13.4 mm (range 5-20). Tumor lesions estimated by US study were more accurate in benign tumors, but the results were not statistically significant (p=0.323)., Conclusions: We demonstrated that the sonographic diameter of the testicular lesions seems to be one of the most important parameter for the indication of an elective TSS and US is an accurate method for detecting and measuring these lesions.

The current literature does not support the usefulness of clinical markers on predicting which patients with atypical small acinar proliferation (ASAP) are more likely to progress to prostate cancer (PCa). Androgens have long been considered to be the potential risk factors for PCa. However, the role of testosterone is controversial. The present study aims to analyze the relationship between serum testosterone (TS) levels and the diagnosis of PCa after a first prostate biopsy in patients affected by ASAP. This retrospective study included 143 patients diagnosed with ASAP in an initial transrectal ultrasound-guided prostate biopsy for suspicious PCa according to the European Association of Urology guidelines. Their TS levels, age, PSA, prostate volume, digital rectal examination, and prostate biopsy Gleason score (GS) were collected retrospectively for statistical analysis. All patients included in the study had a second biopsy and were suitable for further analysis. Re-biopsy was carried out 3-6 months after the first diagnosis of ASAP. Low and normal TS groups were composed of 29 (20.3%) and 114 (79.7%) patients, respectively. The diagnosis of the second biopsy was ASAP in 25.2% and PCa in 36.4% of patients. The comparison between patients with PCa and those with negative or an ASAP result in the second biopsy reported that men with cancer had significantly higher levels of TS (P < 0.001). However, there was no statistically significant association between GS postbiopsy and TS (P = 0.324). Our experience demonstrated that eugonadal patients may be a clinical risk factor for the diagnosis of PCa on re-biopsy after ASAP diagnosis than hypogonadal.

Purpose: Perineural space invasion (PNI) is an important mechanism for progression of cancer through the prostatic capsule, the prognostic significance of PNI remains controversial. The purpose of the present study was to assess the prognostic significance of PNI between prostate biopsy and radical prostatectomy (RP) samples of patients affected by clinically localized prostate cancer (PCa)., Methods: 75 patients undergoing RP who had PNI on prostate needle biopsy were retrospectively reviewed. To evaluate the correlation between PNI and adverse pathological characteristics of PCa we examined these demographic and clinicopathologic variables: patients age, family history, prostate specific antigen (PSA) level at the time of diagnosis, biopsy Gleason score (GS), clinical stage, extraprostatic extension (EPE), positive surgical margins (PSM), biochemical recurrence (BR), positive lymph nodes (PLN) involvement and seminal vesicle invasion (SVI)., Results: At RP 24% of patients had organ-confined disease, whereas EPE in neurovascular bundle (NVB) and SVI were present in 76% and 6.7%, respectively. PSM were shown in 32% and PLN in 17.3% of our cases. At a median follow-up of 44 months, 36% had BR, 9.3% developed metastatic disease, and 2.6% died of PCa. GS (>6) on needle biopsy and PSA level (?10) were helpful in predicting which patients were likely to have tumor in the NVB (p<0.002)., Conclusions: PNI on biopsy is correlated with an increased risk of BR, while is not statistically associated with PSM. Nerve-sparing surgery does not compromise the oncological outcomes for patients with PNI on biopsy.

Purpose: To assess the efficacy of a short prophylaxis with tranexamic acid in reducing blood loss during transrectal ultrasound-guided prostate biopsy (TRUSBx) in patients taking oral anti-platelet therapy and to prospectively compare this approach with patients without oral prophylaxis., Methods: A total of 359 consecutive patients taking chronic low dose aspirin were enrolled in this prospective study. Before TRUSBx all patients were randomly assigned into two groups; a short oral prophylaxis with tranexamic acid 500 mg orally, taken one hour before the procedure (group A, N:178 ) and those without oral prophylaxis (group B, N:181). Patients were asked about complications, their frequency, severity of bleeding (hematuria, hematospermia, rectal bleeding) on a 0-5 scale, with 0 representing absence of bleeding and 5 very severe bleeding., Results: No significant differences were noted between the two groups in radiation to age, preoperative PSA level, prostate volume, biopsy numbers, and Gleason score. There were no severe bleeding complications (grade 5) recorded in both groups. The study revealed significant differences in the incidence of hematuria (p<0.001) and rectal bleeding (p<0.002) between the groups. Patients in group A (16.9%) experienced fewer hematuria and rectal bleeding episodes than did the group B patients (31.5%). The number of sexually active men still reporting hematospermia was 16.6% in group A and 19.4% in group B, with no statistical difference (p=0.32)., Conclusion: The continued use of anti-platelet agents in patient undergoing TRUSBx does not increase the incidence of mild bleeding complications, if these are associated with a short-term tranexamic acid treatment.

Purpose: Pelvic congestion syndrome is an uncommon poorly understood and frequently misdiagnosed disorder of the pelvic venous circulation, which causes chronic pelvic pain in women in premenopausal age. This condition has typical features, such as pelvic varicosities, pelvic pain worsened by prolonged standing, coitus, menstruation, and pregnancy., Methods: The precise etiology of this syndrome remains uncertain, and it is probably multifactorial. Valvular insufficiency, venous obstruction, and hormones all may play a role in the development of congestion of the pelvic veins., Results: Pelvic pain and venous varices are often both present in premenopausal women, but not necessarily causally related. Furthermore, incompetent and dilated pelvic veins are a common finding in asymptomatic women. As such, it is challenging but important to determine which patients have chronic pelvic pain specifically related to pelvic congestion syndrome in order to treat them properly., Conclusions: Once the syndrome has been accurately diagnosed, medical, surgical, or minimally invasive endovascular treatments can improve symptoms in a high percentage of cases. This updated nonsystematic review of the literature explores the pathophysiology, clinical features, diagnostic investigations, and treatment option of this complex condition that affects young women with considerable implications for their daily social and psychological condition.

Purpose: Digital rectal examination (DRE) is a routine part of prostate cancer Purpose: Digital rectal examination (DRE) is a routine part of prostate cancer (PCa) screening and provides important prognostic information. The purpose of this study was to analyse the potential association between obese patients and DRE findings for PCa detection., Methods: We retrospectively reviewed the medical records of patients who underwent an initial prostate needle biopsy for abnormal DRE, high prostate specific antigen (PSA) levels (≥4 ng/mL), or both at the Department of Urology. Patients with a history of biopsy, surgical treatment of prostatic disease, or incomplete clinical data were excluded from this study. A total of 1113 patients were included in the analysis. Before the biopsy procedure body mass index (BMI) was calculated. Age, PSA, BMI, DRE findings, prostate volume and Gleason score were analysed to assess the potential association between obesity and PCa detection., Results: The mean + SD BMI was 28.3 + 4.1 kg/m2. A total of 373 (33.5%) patients were classified as obese (BMI ≥30 kg/m2). No significant difference was noted in the number of biopsy cores between obese and non obese patients. The obese men were older, had a lower PSA concentration, a large prostate volume, and were less likely to have abnormal DRE findings. Patients with high grade prostate cancer (HGPCa) had higher BMI. Age, PSA and prostate volume were not significantly associated with a higher risk of cancer at biopsy., Conclusions: Our data demonstrated that obese patients have lower PSA levels, larger prostates and abundant perirectal fat. Lower PSA serum levels and large prostate size associated with high BMI, indicated a potential risk for delayed diagnosis and poor pathological outcomes.PCa) screening and provides important prognostic information. The purpose of this study was to analyse the potential association between obese patients and DRE findings for PCa detection., Methods: We retrospectively reviewed the medical records of patients who underwent an initial prostate needle biopsy for abnormal DRE, high prostate specific antigen (PSA) levels (≥4 ng/mL), or both at the Department of Urology. Patients with a history of biopsy, surgical treatment of prostatic disease, or incomplete clinical data were excluded from this study. A total of 1113 patients were included in the analysis. Before the biopsy procedure body mass index (BMI) was calculated. Age, PSA, BMI, DRE findings, prostate volume and Gleason score were analysed to assess the potential association between obesity and PCa detection., Results: The mean + SD BMI was 28.3 + 4.1 kg/m(2). A total of 373 (33.5%) patients were classified as obese (BMI ≥30 kg/m(2)). No significant difference was noted in the number of biopsy cores between obese and non obese patients. The obese men were older, had a lower PSA concentration, a large prostate volume, and were less likely to have abnormal DRE findings. Patients with high grade prostate cancer (HGPCa) had higher BMI. Age, PSA and prostate volume were not significantly associated with a higher risk of cancer at biopsy., Conclusions: Our data demonstrated that obese patients have lower PSA levels, larger prostates and abundant perirectal fat. Lower PSA serum levels and large prostate size associated with high BMI, indicated a potential risk for delayed diagnosis and poor pathological outcomes.

Purpose: Several studies have reported upgrading of patients with Gleason score (GS) at the time of prostate biopsy to GS following radical prostatectomy (RP). We reviewed the predictive accuracy of extended 14-core prostate biopsies, in terms of GS and tumor location in patients with prostate cancer (PCa) treated by RP., Methods: We retrospectively reviewed 163 patients who underwent RP for clinically localized PCa. Preoperatively, all patients underwent a transrectal ultrasound-guided biopsy of the prostate (TRUSBP) with 14-core scheme for suspected PCa. According to GS, patients were categorized as low (GS 2-6), moderate (GS 7), and high (GS 8-10). A comparison between GS and tumor laterality of the needle biopsy and RP specimens was carried out., Results: Bioptic GS was low (≤ 6) in 55.9%, moderate (7) in 34.9%, and high (≥8) in 9.2% of the patients. Pathological GS was 40.5, 46.6, and 12.9%, respectively. Of the 66 patients with low GS by RP, 41 (62.1%) were in agreement with TRUSBP, whereas 25 (37.9%) were underestimated by TRUSBP. Of the 76 patients with moderate GS by RP, 47 were in agreement with TRUSBP (61.8%), and 4 were underestimated by TRUSBP (5.3%). In the assessment of tumor laterality, TRUSBP falsely showed 51 cases as unilateral tumors, whereas RP diagnosed that both sides had PCa (p<0.001)., Conclusion: These data are in line with those of the literature, although the group of low-risk tumors remained the same only in 40.5% of the cases. Therefore, we conclude that this type of biopsy (14-core TRUSBP) should not be used alone to guide therapy in PCa.

Purpose: The aim of the present study was to evaluate evolution of conservative echo-guided surgery for testicular tumours ≤1.5 cm and to assess the safety of this surgical procedure., Methods: 49 consecutive patients diagnosed with ultrasonography testicular lesions (mono or bilateral) ≤1.5 cm and treated with conservative echo-guided testicular surgery were examined. The parameters considered in this retrospective analysis included case history, physical examination, scrotal and abdominal ultrasonography, computed tomography scan, size of the nodule (maximum diameter), tumour markers, chest radiography, frozen section examination, histologic size of the tumour, overall survival (OS) and findings on follow-up., Results: Mean age of patients was 33 years (range 18-62). Patients who presented with a palpable testicular nodule were 32.7 %, gynecomastia 10.2 %, precocious pseudopuberty 4 %, and scrotal pain 12.2 %. Permanent section examination confirmed the FSE data in all cases of certainty malignant lesion and definitive histological types were: 22 seminoma, 13 non-seminomatous or mixed germ cell tumours, 4 Leydig tumours, 2 hamartoma, 1 epidermoid cyst, 2 sertoli cell tumours, and 5 fibrous pseudotumour. No complications intra- and postoperative were observed. Overall survival was 100 % and scrotal US showed evidence of local tumour recurrence in 6 patients (12.2 %) after a mean follow-up of 34.7 months., Conclusion: The OS, the low rate of local recurrence, and absence of complications, tend to demonstrate the safety of the procedure. The benefits to testicular-sparing surgery include improving the patient's overall quality of life, fertility, endocrine function and negative cosmetic effects of radical orchiectomy.

Renal cell carcinoma is a common neoplasia of the adult kidney that accounts for about 3% of adult malignancies. Clear cell renal carcinoma is the most frequent subtype of kidney cancer and 20-40% of patients develop metastases. The absence of appropriate biomarkers complicates diagnosis and prognosis of this disease. In this regard, small noncoding RNAs (microRNAs), which are mutated in several neoplastic diseases including kidney carcinoma, may be optimal candidates as biomarkers for diagnosis and prognosis of this kind of cancer. Here we show that patients with clear cell kidney carcinoma that express low levels of miR501-5p exhibited a good prognosis compared with patients with unchanged or high levels of this microRNA. Consistently, in kidney carcinoma cells the downregulation of miR501-5p induced an increased caspase-3 activity, p53 expression as well as decreased mTOR activation, leading to stimulation of the apoptotic pathway. Conversely, miR501-5p upregulation enhanced the activity of mTOR and promoted both cell proliferation and survival. These biological processes occurred through p53 inactivation by proteasome degradation in a mechanism involving MDM2-mediated p53 ubiquitination. Our results support a role for miR501-5p in balancing apoptosis and cell survival in clear cell renal carcinoma. In particular, the downregulation of microRNA501-5p promotes a good prognosis, while its upregulation contributes to a poor prognosis, in particular, if associated with p53 and MDM2 overexpression and mTOR activation. Thus, the expression of miR501-5p is a possible biomarker for the prognosis of clear cell renal carcinoma.

Introduction: The aim of the present study was to document the role of ultrasound in the diagnosis and management of symptomatic hydronephrosis during pregnancy., Methods: In this study, we reviewed 36 consecutive cases of pregnant women whose pregnancy was complicated by symptomatic hydronephrosis. In all patients, management was initially conservative (analgesics and fluids) after hospitalization. The following criteria were used to indicate double-J stent placement under US guidance rather than a conservative treatment: persistent pain with no improvement after conservative treatment, progressive hydronephrosis (>2 cm dilatation of the renal pelvis) or presence of uterine contractions., Results: The mean patient's age was 25 years (17-35) and gestational age at clinical presentation was 24 weeks (13-37). 81 % of cases had a renal pelvis dilatation >2 cm, while in only 19 % of cases there was a hydronephrosis between 1 and 2 cm in diameter; however, calculi were confirmed only in 25 patients. 28 patients required an invasive management with double-J stent insertion under US guidance. The sensitivity and specificity of US in the etiological diagnosis of hydronephrosis during pregnancy was 83 and 91 %, respectively., Conclusion: Conservative management with medical therapy and observation should be the first-line treatment approach. In our opinion a rapid ureteral decompression with the insertion of a ureteral double-J stent, under US visualization, is the safest method in the treatment of pregnant women with obstructed renal systems.

Introduction: Transrectal ultrasound (TRUS) has significantly improved the diagnostic rate, nevertheless, the correlation between findings on TRUS and clinically significant prostate cancer (PCa) is not completely understood. The purpose of this study was to evaluate the diagnostic accuracy and utility of preoperative TRUS in patients with PCa to define the sonographic signs of cohesion of the Denonvilliers' fascia (DF) to prostate capsula (PC) to detect the local advancement of the disease., Methods: Between April 2010 and May 2013, at our Department of Urology, the clinical anatomy of preoperative regions and excised specimens was reviewed macroscopically for 68 cases of radical retropubic prostatectomy for PCa and compared to ultrasound images obtained by TRUS., Results: Pathological analysis detected on the surface of the prostate the DF fused with the PC at the midpoint of the prostatic posterior surface in 94 % of the cases, in 4 % the DF remained at a certain distance from PC in this region and in 1 case lateral pelvic fascia fused with PC and little adipose tissue was present between them (P < 0.005). The TRUS allowed a more precise result in terms of tumor extension to DF with a detection rate of 95 %. (P < 0.001)., Conclusion: In our opinion, it is very important to recognize preoperatively the possibility of cancer extracapsular extension to the DF and to the rectum wall, using a simple and low cost examination as TRUS. The knowledge of the fascial structures anatomy around the prostate is necessary to perform a nerve-sparing radical prostatectomy, avoiding excessive bleeding, iatrogenic positive surgical margin, and post-operative complications.

We report a rare case of hematoma in Retzius' space in a 62-year-old man who underwent transrectal prostate biopsy using an endocavitary, end-fire, convex probe. Clinical symptoms resolved spontaneously after catheter placement and appropriate antibiotic therapy. Transrectal ultrasound 1 month later showed partial resolution of the hematoma. Based on the analysis of this unusual complication, we demonstrate the effectiveness of transrectal biopsy as compared to transperineal biopsy in detecting cancer of the anterior prostate. We have also analyzed the various factors that may be the reason why core biopsy harvested in this "hidden" area may be inadequate.

Penile Mondor's disease (superficial thrombophlebitis of the penis dorsal vein) is an uncommon and benign pathology that affects sexually active men. Although the diagnosis is made by physical examination in most patients, sonography may be required in some cases. Color-Doppler ultrasonography clearly visualizes dorsal vein thrombosis and the associated hemodynamic alterations. We describe the symptoms, the sonographic findings and treatment of this disease in a 26-year-old male with superficial thrombophlebitis of the penis dorsal vein.

Introduction: The main purpose of our study was to determine, through the introduction of a checklist in the operating room, the incidence rate of adverse events and their predictability in a representative sample of patients admitted to our Urology unit and undergoing surgery., Methods: The study includes 324 patients. The checklist includes 3 phases (Sign In, Time Out, Sign Out), 20 items with checks to be performed during surgery and the marking of boxes after a successful check. All the staff in the operating room has been specifically trained with a theoretical and practical 20-hour course., Results: The overall average incidence of adverse events reported was determined by 4.8%, is consistent with the expectations of the study protocol, and is at a lower level than the average median rate of international studies (8.9%). The overall complication rate fell from 11% to 7.9%, the rate of intra-hospital mortality from 1.7% to 0.9%, the rate of surgical site infection decreased from 8.2% to 4.7%., Conclusions: The results were consistent with the results of other international studies similar in scope in terms of study (definition of the rate of adverse events) and epidemiological study (retrospective study). The variability of the results obtained in our inquiry is likely attributable to varied factors occurred during the study.