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Introduction and Objectives. Prostate cancer is the 2nd most common cancer in men worldwide. Latest prostate cancer data also shows that this pathology is the 4th most common cancer overall. There were more than 1.4 million new cases of prostate cancer in 2020. Guadeloupe had the highest incidence for prostate cancer in 2020, with 722 new cases, 183.6/100000 inhabitants. In Europe, Ireland, Estonia, Sweden and France are the countries with the highest incidence rate for prostate cancer. Materials and Methods. We present the case of a 65 years old patient, which was diagnosed in July 2020 with a high risk prostate cancer. Firstly, he was referred to a Urology Clinic for a clinical examination and possibly to have a diagnosis formulated after an elevated prostate specific antigen (PSA) was observed in another medical setting. After a more precise measurement, the PSA was surprisingly high, a finding that was the trigger for a multidisciplinary approach, using the latest information and treatments described in important clinical trials. Results. The evolution of the patient during the 32 months long surveillance period varied, as the PSA level fell and rose, prompting many changes in the treatment of the prostate cancer. Various clinical trials were reviewed in order to present the rationale for treatment changes occurring at certain moments. Conclusions. Even though the metastatic high risk prostate cancer proves to be very difficult to treat, and the patients are still suffering from this pathology, the progress made in the last decade seem to improve the chances for a longer survival and a better quality of life. [ABSTRACT FROM AUTHOR]

Post prostatectomy urinary incontinence is a bothersome condition, marked by severe leakage in most cases, with poor response to most treatments. Our paper aims to review the history, current indications and future perspectives of the artificial urinary sphincter (AUS), a device which imposed itself as the gold standard therapy for post prostatectomy urinary incontinence. We describe the AMS 800, the Rigicon ContiClassic and the newer Rigicon ContiReflex devices, with data from the international literature and practice guidelines, underlining pros and cons of each sphincter. Our paper concludes that there is a significant improvement in the field of AUS and that future projects are promising in terms of better efficacy and safety. [ABSTRACT FROM AUTHOR]

Introduction and Objectives. Lichen sclerosus is a chronic inflammatory condition that usually affects the genital and anal areas. It causes irritation, skin changes, itching, and pain, often the foreskin gets tighter and more difficult to retract, leading to painful erections and bleeding during intercourse. The etiology is still unknown, is not caused by an infection, and cannot be passed to a sexual partner. Materials and Methods. During the period January 1st, 2016-to January 1st, 2017 we selected 137 patients with the diagnosis of urethral stricture disease and were candidates for urethroplasty. Patients were followed rigorously for 2 years after the surgery with uroflowmetry, measurement of post-void residual urine volume, IPSS, and IPSS QoL. For stricture recurrence confirmation the patients underwent retrograde urethrography. Other data used were weight, height, body mass index and established etiology of the urethral stricture, and age of patients at enrolment. Results. Only 18 patients had definitive criteria for clinical diagnosis of LS, and out of these, 17 were circumcised. The relationship between BMI and LS was not statistically sustainable in our study results. Studies suggest that the lichen sclerosus has a more severe evolution in older patients, and we managed to demonstrate a statistically significant relationship between the age of the patient and the LS. Conclusions. The treatment of urethral strictures in patients with confirmed lichen sclerosus is two-stage buccal mucosa graft urethroplasty. Urethral stricture disease in combination with LS appears to be a much more common and challenging disease and requires particular care. [ABSTRACT FROM AUTHOR]

Introduction and Objectives. Benign prostatic hyperplasia (BPH) is one of the main causes of low urinary tract symptoms (LUTS) and the surgical standard of treatment for of symptomatic BPH up to 80 mL is the trans- urethral resection (TUR-P). One of the non-ablative techniques is the second-generation Temporary Implantable Nitinol Device (ITIND), a safe technology with promising results that does not seem to affect the patient's sexual or ejaculatory functions and treats effectively the BPH-related LUTS in the short and medium terms, further studies being required to confirm the results. The aim of this work is to describe its characteristics, the surgical technique and to provide a systematic review of the available literature. Materials and Methods. The PubMed, SCOPUS and Google Scholar databases were utilized for a comprehensive literature research of original English-language articles on the subject, focusing on the functional results and perioperative morbidity. Results. The few prospective available studies from the published literature reveal promising short-term results at 6 and 12 months, regarding symptom control, maximum urinary flow, sexual and ejaculatory function and complication rates. Conclusions. The iTIND procedure seems to be a safe, minimally invasive alternative to the usual techniques proposed for the surgical treatment of the clinical BPH but it is still under evaluation. Further randomized controlled studies are required to assess the selection criteria and the utility of this procedure over a longer period of time also compared to the available techniques. [ABSTRACT FROM AUTHOR]

Introduction and Objectives. Flexible ureterorenoscopy (f-URS) gained a lot of field in treating reno-ureteral lithiasis, with a clear indication for kidney stones smaller than 20 mm with an acceptable stone free rate (SFR) compared to its complications, but also with a specific learning curve. The goal of this study is to investigate the learning curve in f-URS and its impact on success and complication rates. Materials and Methods. 60 patients from a tertiary care urology clinic who underwent f-URS were enrolled in this prospective study and divided into two study groups of 30 patients each based on the period of time the surgery was performed. Patients' and lithiasis characteristics, f-URS-related parameters, hospital stay time, SFR and complications were gathered into a database for comparison and statistical assessment of the differences. Results. The two study groups were comparable, regarding the age, sex, BMI, stone location, stone density and stone sizes. Time passed till the introduction of the flexible ureteroscope was 18.5 minutes in group 1 versus 12.4 minutes in group 2 (p = 0.001). The fluoroscopy time was shorter in group 2 40.8 versus 83 seconds (p = 0.001). The operative time decreased significantly from 49.2 minutes to 32 minutes in the second group (p = 0.001). Complication rate and hospital stay showed no major difference between the two patient groups, but the SFR was significantly improved in the latest study group-86.66% versus 66%. Conclusions. Flexible ureteroscopy is a minimally invasive surgical intervention that requires experience and surgical skills gained after overpassing a specific learning curve. Our study shows that a good level of proficiency might be obtained after the completion of at least 30 cases in terms of operative time, fluoroscopy time, complication, and stone free rates. Further standardized prospective trials ought to be conducted to better characterize assess the precise learning curve. [ABSTRACT FROM AUTHOR]

Introduction and Objectives. When it comes to the best treatment option for small (<10 mm) and intermediate (10- 20 mm) kidney stones, the EAU offers the possibility to choose between ESWL and f-URS. Given the fact that the management of kidney stones smaller than 2 cm in diameter is still controversial, we aimed to retrospectively compare the efficacy of these two techniques in our clinical department. Materials and Methods. A retrospective evaluation between January and December 2022 was conducted at our clinic including 231 patients with a single renal opaque stone ≤2 cm who underwent ESWL or f-URS. In order to assess the efficacy of each treatment, we set the stone-free rate as our main objective and complications, operating time and hospital stay as our secondary outcomes. As a way to a more precise comparison, we divided the patients in two subgroups regarding the stone size: One subgroup with small renal stone (<10 mm) and one with intermediate renal stone (10-20 mm). Results. Overall, a better stone free rate was found in f-URS group (f-URS 87.5% vs. 70.58% ESWL), although both the operative (63.2 min vs. 44.5 min) and hospitalization (3.65 days vs. 1.43 days) time were longer for f-URS than ESWL. Regarding small sized stones (Subgroup 1), the stone-free rate was similar between each procedure (ESWL 87.5% vs. 94.2% f-URS). When it comes to intermediate sized stones (Subgroup 2), more f-URS patients achieved a stone-free status (81.6% vs. 44.6%). In both subgroups, the ESWL procedure achieved a better operative time, as well as a shorter hospital stay. Less complications were encountered when ESWL was the treatment option. Conclusions. We advocate for using ESWL as primary treatment option for kidney stones smaller than 10 mm and to strongly consider it regarding intermediate renal stones. [ABSTRACT FROM AUTHOR]

Introduction and Objectives. The most common cause for Congenital adrenal hyperplasia (CAH) is due to 21- hydroxylase deficiency which can produce disorders of sex development. 46,XX maleness is a rare syndrome with an incidence of 1 in 20000-25000 males, and they are defined by ambiguous genitalia or partially to fully mature male genitalia. Materials and Methods. We present the case of a 49-year-old patient (46,XX) with CAH resulting from 21-hydroxylase deficiency, diagnosed with penoscrotal hypospadias at the age of 3 and a half years for whom multiple corrective surgeries were performed and was referred to our hospital for evaluation of urethrocutaneous fistulas. Results. In 2021, the patient was diagnosed by the endocrinology department with 46,XX Karyotype, male phenotype and congenital adrenal hyperplasia due to 21 hydroxylase deficiency. The urological diagnosis established at "Prof. Dr. Theodor Burghele" Clinical Hospital was of multiple urethrocutaneous fistulas that occurred after penoscrotal hypospadias repair in childhood. The surgical indication consisted of urethroplasty with oral mucosa graft in two steps, the time between interventions being about four months. The surgical evolution was good, without complications. Complications after multiple times operated hypospadias are redoubtable, including strictures of the anterior urethra, urethral fistulas, urethritis, and recurrent urinary tract infections. The treatment of such cases is particularly difficult. Conclusions. The use of extragenital tissues for urethral reconstruction (oral mucosa graft) provides superior functional and aesthetic results compared to the techniques using skin flaps. [ABSTRACT FROM AUTHOR]

Objective: To access the feasibility of palliative cystoprostatectomy/pelvic exenteration in patients with bladder/rectal invasion due to prostate cancer (PC). Patients and methods: Twenty-five men with cT4 PC were retrospectively identified in the institutional databases of six tertiary referral centers in the last decade. Local invasion was documented by CT or MRI scans and was confirmed by urethrocystoscopy. Oncological therapies, local symptoms, previous local treatments, time from diagnosis to intervention and type of surgical procedure were recorded. Patients were divided into groups: ADT group (12 pts) and 13 pts without any history of previous local/systemic treatments for PCa (nonADT groups). Perioperative complications were classified using the Clavien–Dindo system. Overall survival (OS) was defined as the time from surgery to death from any cause. A Cox regression analysis, stratified for ISUP score and previous hormonal treatment (ADT) was also performed for survival analysis. Results: Ileal conduit was the main urinary diversion in both cohorts. For the entire cohort, complication rate was 44%. No significant differences regarding perioperative complications and complication severity between both subgroups were observed (p = 0.2). Median follow-up was 15 months (range 3–41) for the entire cohort with a median survival of 15 months (95% CI 10.1–19.9). In Cox regression analysis stratified for ISUP score, no statistically significant differences in OS in patients with and without previous ADT before cystectomy or exenteration were observed (HR 3.26, 95% CI 0.62–17.23, p = 0.164). Conclusion: Palliative cystoprostatectomy and pelvic exenteration represent viable treatment options associated with acceptable morbidity and good short-term survival outcome. [ABSTRACT FROM AUTHOR]