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INTRODUCTION Emerging evidence supports the hypothesis that metabolic syndrome is associated with cancer pathogenesis. In particular regarding prostate cancer, observational studies from various settings report different results. This systematic review and meta-analysis aim to provide a quantitative estimate of the association between metabolic syndrome in prostate cancer, in particular Gleason Score >6, accounting for different study designs. EVIDENCE ACQUISITION A systematic research of available literature in English language until 2020 was conducted through in EMBASE, MEDLINE, Cochrane Library and NIH Registry of Clinical Trials. For each study, information regarding the study design, the population, the definition of metabolic syndrome, data relating to prostate cancer were collected. , the association between MetS and outcome of interest was determined by calculating the generic inverse variance with random effects method. EVIDENCE SYNTHESIS In the final sample 19 studies were included with total of 114329 patients, 29.4% met the criteria for metabolic syndrome. We report a significant association between metabolic syndrome and prostate cancer in cross-sectional studies (OR 1.30; 95% CI 1.13, 1.49) and for patients with clinically significant prostate cancer (OR 1.56; 95% CI 1.23, 1.99]. Association between metabolic syndrome and prostate cancer combining all studies, in cohort studies and case-control studies was not significant. CONCLUSIONS Growing evidence support the association between metabolic syndrome and prostate cancer, bias derived from observational studies might conceal further findings.

The management of a ureteral orifice injury occurring during robotic radical prostatectomy (RARP) represents a challenge for urologists. Several techniques have been proposed to treat an intraoperative injury, but intraoperative positioning of a DJ stent represents the most common treatment in cases of a partial injury of the ureteral orifice. We present a technique to ensure the successful outcome in cases of a partial detachment of the ureter during RARP. When the orifice is identified after the incision of the bladder neck and it appears very close to the anastomosis line setting up a partial detachment of the ureter, before implanting a DJ stent, one tip could be to perform a small incision of the anterior wall of the orifice to spatulate it and then proceeding to a short slip of the ureter: the eversion of the mucosa - thus creating a sort of "folded shirt cuff" - allows the fixation of the ureter to the bladder wall. We successfully performed this technique in two cases of RARP.

We demonstrated that a complete left ureteral substitution with appendix is a feasible and safe technique. To our knowledge, this is the first case of a successful complete substitution of the left ureter with vermicular appendix in an adult patient reported in the literature.

Introduction and aim: Speedy diagnosis are mandatory in testicular torsion, nevertheless some cases of irreversible ischemia still occur. In this study we analysed the results of patients undergoing surgical exploration for acute scrotum. Materials and methods: A multicentric retrospective clinical evaluation was carried out on patients who underwent urgent scrotal exploration at 12 different departments in North-Eastern Italy. Data included complete anagraphic information, clinical presentation, numeric pain rating scale, previous testicular surgery, Doppler serial ultrasonography (US) evaluation and concordance with surgical findings, testicular mobility, surgical treatment, staged or concurrent treatment of the contralateral gonad. Statistical analysis was conducted both for descriptive and inferential statistics with SPSS v26. Results: Three hundred and sixty-eight cases were collected between January 2010 and June 2019. The time between symptom onset and ER access time was within 6 h in majority of patients. However, 17.4% of subject presented after more than 12 h. In patients undergoing US, this showed signs of ischemia in 237 patients (77.2%) and normal vascularisation in 70 (22.8%) of whom 26 had signs of testicular torsion at surgical exploration. Overall, the US data were concordant with the surgical findings in 254 cases (82.7%). A significant association was found between time-to-evaluation and time-to-treatment and the need for orchiectomy (p < 0.01). Conclusion: Testicular torsion management is still challenging in terms of time-saving decision making. Scrotal US is helpful, but even in the contemporary its sensitivity is low era in a non-neglectable number of cases, therefore surgical exploration is warranted in acute scrotum when torsion cannot be ruled out, even when US shows vascularisation.

Aim To report an endourology management of uretero-ileal anastomosis stricture after cystectomy and orthotopic neobladder reconstruction (Vescica Ileale Padovana, VIP). Materials and methods A nephrostomy was placed to provide a route of access for an anterograde canalization and a secure and working guide placement. These were than taken with a cystoscopy grasp and pulled out through the neobladder. Laser endoureterotomy of the stricture over a stiff working guide wire was than performed. A DJ stent was then placed in order to protect the urinary flow for the first month after surgery. Results No immediate and late complications occurred during a follow up of 1 year according to the Clavien Dindo classification. The patient continued to be asymptomatic with a renal function stable over the years. Discussion Endourological management of uretero-ileal anastomosis stricture after cystectomy and orthotopic neobladder (VIP) is safe and reproducible. It may avoid the difficulties and complications of invasive surgery and has durable results.