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Francesca Ambrosini,1,2 Niccolò Riccardi,3,4 Sara Occhineri,3,4 Tommaso Matucci,3,4 Irene Paraboschi,5 Alessandro Calarco,6 Alfredo Berrettini,5 Giusy Tiseo,3 Diana Canetti,7 André Van Der Merwe,8 Carlo Terrone,1,2 Guglielmo Mantica1,2 1IRCCS Ospedale Policlinico San Martino, Genova, Italy; 2Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, Genova, Italy; 3Infectious Diseases Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy; 4StopTB Italia Onlus, Milan, Italy; 5Department of Pediatric Urology, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy; 6Villa Pia Hospital, Via Folco Portinari 5, Rome, Italy; 7Infectious Diseases Unit, San Raffaele Scientific Institute, Milan, Italy; 8Department of Urology, Faculty of Medicine and Health Sciences, 26697 Stellenbosch University, Cape Town, South AfricaCorrespondence: Guglielmo Mantica, Department of Surgical and Diagnostic Intergrated Sciences (DISC), University of Genova, Genova, Italy, Tel +390105555960, Email guglielmo.mantica@gmail.comPurpose: Haemorrhagic cystitis may be due to different etiologies with infectious diseases representing an insidious cause to diagnose. The aim of this narrative review is to provide a comprehensive overview of less common but difficult-to-diagnose causes of infectious haemorrhagic cystitis of bacterial, mycobacterial, and parasitic origin, Moreover, we highlight possible diagnostic tools and currently available treatment options in order to give an updated tool for urologists to use in daily practice.Patients and Methods: The search engine PubMed was used to select peer-reviewed articles published from 1/Jan/2010 to 31/Aug/2022.Results: Bacteria, fungal, TB and schistosomiasis are uncommon causes of haemorrhagic cystitis burdened by high morbidity, especially if not promptly diagnosed.Conclusion: Because haemorrhagic cystitis ranges in severity from mild dysuria associated with pelvic discomfort to severe life-threatening haemorrhage, punctual diagnosis, and immediate treatment are essential to avoid further complications.Keywords: cystitis, haemorrhagic cystitis, schistosomiasis, tuberculosis, GUTB

Guglielmo Mantica,1 Francesco Chierigo,1,2 Farzana Cassim,3 Francesca Ambrosini,1,2 Stefano Tappero,1,2 Rafaela Malinaric,1,2 Stefano Parodi,1,2 Andrea Benelli,4 Federico Dotta,4 Marco Ennas,4 Martina Beverini,1,2 Chiara Vaccaro,5 Salvatore Smelzo,6 Giovanni Guano,1,2 Federico Mariano,1,2 Calogero Paola,1,2 Giorgia Granelli,1,2 Virginia Varca,5 Carlo Introini,4 Salvatore Dioguardi,7 Alchiede Simonato,7 Andrea Gregori,8 Franco Gaboardi,6 Carlo Terrone,1,2 André Van der Merwe3 1IRCCS Ospedale Policlinico San Martino, U.O. Urologia, Genova, Italy; 2Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, Genova, Italy; 3Department of Urology, Tygerberg Academic Hospital, Stellenbosch University, Cape Town, South Africa; 4Department of Urology, Galliera Hospital, Genoa, Italy; 5Department of Urology, ASST Rhodense, G. Salvini Hospital, Milan, Italy; 6Department of Urology, San Raffaele Turro Hospital, Milan, Italy; 7Department of Surgical, Oncological, and Oral Sciences, Section of Urology, University of Palermo, Palermo, Italy; 8Urology Unit, Ospedale Sacco, Milan, ItalyCorrespondence: Guglielmo Mantica, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, 10, Genoa, 16132, Italy, Tel +390105552815, Email guglielmo.mantica@gmail.comPurpose: To evaluate the prostate cancer (PCa) detection rate in men with chronic use of Aspirin and to compare it with the detection rate of non-users.Patients and Methods: Prospectively maintained database regarding patients undergoing prostate biopsy over the last 10 years in five institutions. Patients were divided into two groups according to their exposure to Aspirin. We relied on multivariable linear and logistic regression models to test whether Aspirin administration was associated with lower PSA values at prostate biopsy, higher PCa diagnosis, and higher Gleason Grade Grouping (GGG) at biopsy.Results: Were identified 1059 patients, of whom 803 (76%) did not take Aspirin vs 256 (24%) were taking it. In multivariable log-linear regression analysis, Aspirin administration was associated with lower PSA levels (OR 0.83, 95% CI 0.71– 0.97, p = 0.01), after controlling for age, prostate volume, smoking history, associated inflammation at prostate biopsy, presence of PCa at biopsy, and GGG. In multivariable logistic regression analysis, Aspirin administration was not found to be a predictor of PCa at prostate biopsy (OR 1.40, 95% CI 0.82– 2.40, p = 0.21) after controlling for age, PSA, smoking history, prostate volume, findings at digital rectal examination and the number of biopsy cores. In patients with PCa at prostate biopsy (n = 516), Aspirin administration was found to predict higher GGG (OR 2.24, 95% CI 1.01– 4.87, p = 0.04).Conclusion: Aspirin administration was found to be a predictor of more aggressive GGG. These findings suggest that a lower PSA threshold should be considered in patients taking Aspirin, as, despite low PSA levels, they might harbour aggressive PCa.Keywords: prostate-specific antigen, aspirin, inflammation, prostate cancer, prostate biopsy

Aldo Franco De Rose, Francesca Ambrosini, Luca Genova Gaia, Guglielmo Mantica, Carlo Terrone IRCCS Ospedale Policlinico San Martino, Genova, ItalyCorrespondence: Francesca Ambrosini, Department of Urology - Policlinico San Martino Hospital, University of Genoa, Largo Rosanna Benzi, 10, Genoa, 16132, Italy, Tel +39 3480497079, Email f.ambrosini1@gmail.comPurpose: Literature on priapism as a concomitant manifestation of COVID-19 infection is scarce since less than 10 cases are reported. It is crucial to determine whether priapism in a COVID-19 patient is related to the infection itself or to the ongoing therapy, especially in those critically ill. Our study aims to create an alert for all physicians faced with the management of priapism in SARS-CoV-2 patients. We tried to explore any potential leading factors presenting a case of priapism arising during COVID-19 pneumonia, and we reviewed the current literature available on this topic.Case Presentation: We reported the case of a 62-year-old man with severe COVID-19 pneumonia complicated by acute respiratory distress syndrome who developed ischemic priapism during his stay in intensive unit care. Corporal aspiration was performed with injection of 200 μg of intracavernosal phenylephrine resulting in detumescence. After recovery, the patient reported complete erectile dysfunction.Conclusion: The etiopathogenetic mechanism of priapism remains not completely clear. The most frequently hypothesized cause is the prothrombotic state associated with the infection. Further elements including the drugs administered during the infection may play a crucial role. Further studies are needed to obtain stronger evidence.Keywords: priapism, erectile dysfunction, COVID-19, respiratory distress syndrome

Guglielmo Mantica, Francesca Ambrosini, Stefano Parodi, Stefano Tappero, Carlo Terrone Department of Urology, Policlinico San Martino Hospital, University of Genova, Genova, ItalyCorrespondence: Guglielmo ManticaDepartment of Urology, Policlinico San Martino Hospital, University of Genova, Largo Rosanna Benzi 10, Genova 16132, ItalyTel +39 0105553935Email guglielmo.mantica@gmail.comAbstract: Pyeloplasty is considered the gold standard for the management of ureteropelvic junction obstruction in cases of flank pain, recurrent stone formation or infection, and deteriorating renal function. Over the last two decades, minimally invasive techniques such as robotic (RALP) and laparoscopic pyeloplasty (LP) have become increasingly popular and have been moderately replacing the open approach. This paper aims to provide a comprehensive up-to-date review on safety, efficacy and outcomes regarding robotic repair of UPJO compared to the conventional laparoscopic procedure. RALP represents a viable and innovative alternative to conventional LP with a comparable success and complication rate both in adult and in paediatric fields. The robotic approach seems to add further technical advantages when compared to conventional LP but sustains a higher costs. Currently, the choice to adopt one of the different minimally invasive approaches depends on the surgeon’s preference or experience, and on institutional availability.Keywords: robotic pyeloplasty, laparoscopic pyeloplasty, ureteropelvic junction obstruction, hydronephrosis, pyeloplasty