Search

Background: Phimosis is the inability to completely retract the foreskin and expose the glans. The treatment of phimosis varies depending on the age of the patient and the severity of the disease; a great number of conservative or surgical treatments are currently available. Aim: To provide the first review summarizing the available options for the treatment of adult phimosis. Methods: A PubMed, Cochrane and Embase search for peer-reviewed studies, published between January 2001 and December 2022 was performed using the search terms “phimosis AND treatment”. Results: A total of 288 publications were initially identified through database searching. Thirty manuscripts were ultimately eligible for inclusion in this review. Conservative treatment is an option. and it includes topical steroid application and the new medical silicon tubes (Phimostop™) application for gentle prepuce dilation. Concerning the surgical approach, the gold-standard treatment is represented by circumcision in which tissue synthesis after prepuce removal can be also obtained with barbed sutures, fibrin glues or staples. Laser circumcision seems to be providing superior outcomes in terms of operative time and postoperative complication rate when compared to the traditional one. Several techniques of preputioplasty and use of in situ devices (which crush the foreskin and simultaneously create haemostasis) have been also described. These in situ devices seem feasible, safe and effective in treating phimosis while they also reduce the operative time when compared to traditional circumcision. Patient satisfaction rates, complications and impact on sexual function of the main surgical treatments are presented. Conclusion: Many conservative and surgical treatments are available for the treatment of adult phimosis. The choice of the right treatment depends on the grade of phimosis, results, complications, and cost-effectiveness.

Aim:: Intravesical onabotulinum toxin A (BTX) injection is a widely recognized treatment for idiopathic detrusor overactivity (DO) and neurogenic detrusor overactivity (NDO) refractory to adjustments in oral medications.The primary end point of our study was to evaluate patients’ comfort and tolerability with intravesical BTX treatment given in an office-based setting inside a hospital. As a secondary end point, for a subgroup of patients who had previously undergone the procedure in an operating room, we aimed to ascertain if there was any difference in patients’ preferences between the office and operating room settings. Methods:: A cross-sectional descriptive study was designed to evaluate patients’ comfort and tolerability with intravesical BTX treatment given in an office-based setting. It was based on a questionnaire investigating the patients’ overall experience during the procedure and subsequent recovery. Results:: A total of 74 consecutive patients treated between January 2016 and July 2022 were enrolled: 48 males and 26 females; the average age was 57.09 years, ranging from 23–84 years. Among them, 66.2% presented with NDO, and 33.8% with DO. Conclusions:: According to our study, intravesical BTX injections in an office-based setting inside a hospital appear to be a well-tolerated procedure. Most of the patients in our study who experienced both options finally preferred the office setting rather than the operating room. This is an important result, especially if we consider that most patients are required to repeat the treatment over time.

The ICI–RS has proposed the definition of COUB (Coexistent Overactive-Underactive Bladder) as a syndrome characterized by voiding and filling LUTS in the same patient. The aim of this study is to explore whether the presence of DO can lead to DU, because of muscle asthenia and fatigue of the smooth muscle cells.Retrospectively, we included all consecutive male patients with LUTS who underwent an invasive UDS (January 2011–December 2022). Patients with neurologic diseases or with previous LUT surgery were excluded. They were divided into normal detrusor function, Group A and Detrusor Overactivity, Group B during the filling phase. BOOI, BCI, PVR and BVE were compared in the two groups. DO patients were divided according to the phasic or terminal DO contractions and mean BCI was calculated in these subgroups.We analysed 425 male patients with LUTS. During filling phase, 167 patients (39.3%, Group A) showed NDF and 258 patients (60.7% Group B) DO. 207 of them (80.2%) had phasic detrusor contractions and 51 (20.8%) had terminal DO. MCC was 409.8 mL and 308.7 mL (p100. 207 (80.2%) patients of the group B showed phasic, while 51 (19.8%) terminal DO; in these subgroups, mean BCI was 118.8 and 112.0 respectively (p 0.806658).