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Marginal land exploitation devoted to versatile crops, such as giant reed, is related to the degree of land marginality. Two experiments were conducted in two sites of Sardinia (Italy) to investigate the effects of management on dry matter yield and water productivity (WP). Experiment 1 compared four crop evapotranspiration restoring treatments (100%, 75%, 50%, 25%, and a rainfed control) over 5 years. Experiment 2 lasted 7 years and investigated zero-input supply on crop response. Experiment 1, notwithstanding well-watered conditions (Irr100), showed a higher value of biomass production during the last year monitored, but yielding only 13.5 Mg DM ha−1 and with no significant difference from Irr75. Moreover, being equal the average dry matter yield, in the Irr100, we would save 3630 m3 of irrigation water by achieving the same WP recorded in the Irr25 (25% ETc restoring). Experiment 2, being equal rainfall amount, raised WP values that picked 8.2 kg m−3 during 2018. Results indicate that in less favourable soils as the Experiment 1, well-watered conditions do not ensure better crop growth and productivity, whereas in deep soils (Experiment 2) promising productive results, as well as ecosystem services, could be obtained without any input supply.

To describe our robotic Y intracorporeal neobladder (ICNB) technique and to report its post-operative complications and urodynamics (UD) findings.and Methods: In this prospective study we enrolled patients affected by MIBC (T1-T4N0-N1M0) from 01/2017 to 06/2021 at our Centers. All the patients underwent robotic radical cystectomy (RARC) with Y-ICNB reconfiguration. Early and late complications were collected and classified according to Clavien-Dindo. Continence and potency at 1, 3, 6 and 12 months were evaluated. At the 3rd month of follow-up patients underwent UD. Finally, in a retrospective match paired analysis the functional outcomes of Y RARC patients were compared with a cohort of open Y radical cystectomy.45 patients were enrolled. Overall 30-day complications were observed in 25 (55,5%) patients and 30 to 90-days complications in 4 (8,9%). 9 patients (20%) had Clavien ≥3 complications. UDs revealed median neobladder capacity of 268 cc, with a median compliance of 13 ml/cm H20; the voiding phase showed a voiding volume and a post void residual (PVR) of 154 cc and 105 cc respectively. At 12 months of follow-up 4.4%, 15.5% and 4.4% of the patients experienced urge, stress and mix urinary incontinence respectively. The comparison between Y RARC and Y open RC revealed a higher neobladder capacity with open approach (p = 0.049) with subsequent better findings during the voiding phase in terms of maximum flow (p = 0.002), voiding volume (p = 0.001) and PVR (p = 0.01). Focusing on continence recovery, a slight trend in favor of RARC was shown without reaching the statistical significance.Robotic Y-ICNB is feasible and safe as shown by the low rate of postoperative complications. Satisfying UD functional outcomes are achievable, both during filling and voiding phase.

The prefabricated industrial buildings, similar to the one presented in this paper, featured a high seismic vulnerability during the 2012 Emilia earthquake (Italy). The main structural defi...

In recent years there has been an increasing spread of photovoltaic greenhouses, especially in southern European countries, due to the higher incentives recognized to solar photovoltaic (PV) panels integrated on the greenhouse roofs and/or to local laws which limit the photovoltaic systems on the ground. To maximize the income from the production of electricity, often solar panels cover 50% or more of the roof, but the shading caused by these elements on the growing surface seriously limits the productivity and affects crop development. In order to assess the effects of the spatial distribution of the solar radiation inside these structures on yield and quality of leaf vegetable crops, the response of lettuce, grown in two cycles (autumn and winter-spring), in an east-west oriented photovoltaic greenhouse with the 50% of the roof covered by PV modules was analysed. The influence of span orientation, plant position (under plastic or PV roof) and cultivar were analysed as experimental treatments in a split-split plot design with two replications. Total and marketable yield of the lettuce heads and some quality parameters (dry matter and nitrate content) were evaluated. A significant variability of the total and marketable yield due to the plant position and as consequence to the solar radiation distribution inside the structure during the growing cycle was observed. Furthermore, ranges and variability of the nitrate content of lettuce (expressed as NO(3) mg kg(‑1) of fresh weight) were affected by the plant position and harvest season. In order to maximize yield and quality of the crops, the arrangement of plant rows and transit areas, as well as the management of nutrition, should be optimized in relation to the shading caused by the PV roof during the growing cycle.

The sustainability of energy and food supplies has come to represent a major concern throughout the world today. Greenhouse cultivation, an intensive food-production system, contributes fresh vegetables and fruits to the world food supply. Greenhouse crop yields and quality can be improved by microclimate controls powered by fuels and grid electricity inputs. Therefore, producing abundant and quality crops with improved energy efficiency has been pursued as a challenge to be addressed by researchers and practitioners. Although application of photovoltaics (PV) to greenhouses can reduce fuel and grid electricity consumption, PV inherently conflicts with cultivation because both photosynthesis and PV depend on sunlight availability. Various contrivances have been explored to enhance the compatibility of cultivation and PV power generation. This review describes important aspects of greenhouse cultivation, electricity demand in greenhouses, state-of-the-art of greenhouse PV systems, and PV shading effects on plants. Finally, prospects for energy-sustainable greenhouse PV technologies are presented.

The cultivation of the horticultural crops inside photovoltaic greenhouses (PVG) should be studied in relation to the shading cast by the photovoltaic (PV) panels on the roof. This work evaluated the green bean cultivation inside PVGs with a percentage of the greenhouse area covered with PV panels (PV cover ratio, PVR) ranging from 25 to 100%. Three dwarf green bean cycles (Phaseolus vulgaris L., cv. Valentino) were conducted inside an iron–plastic PVG with a PVR of 50%. The average yield was 31% lower than a conventional greenhouse. Adverse effects on quality were noticed under the PV roof, including a reduction of pod weight, size, and caliber. Negative net photosynthetic assimilation rates were observed on the plants under the PV roof, which adapted by relocating more resources to the stems, increasing the specific leaf area (SLA), leaf area ratio (LAR), and the radiation use efficiency (RUE). The fresh yield increased by 0.44% for each additional 1% of cumulated PAR. Based on the linear regressions between measured yield and cumulated PAR, a limited yield reduction of 16% was calculated inside a PVG with maximum PVR of 25%, whereas an average yield loss of 52% can occur with a PVR of 100%. The economic trade-off between energy and green bean yield can be achieved with a PVR of 10%. The same experimental approach can be used as a decision support tool to identify other crops suitable for cultivation inside PVGs and assess the agricultural sustainability of the mixed system.

The integration of the photovoltaic (PV) energy in the greenhouse farm has raised concerns on the agricultural sustainability of this specific agrosystem in terms of crop planning and management, due to the shading cast by the PV panels on the canopy. The PV greenhouse (PVG) can be classified on the basis of the PV cover ratio (PVR), that is the ratio of the projected area of PV panels to the ground and the total greenhouse area. In this paper, we estimated the yield of 14 greenhouse horticultural and floricultural crops inside four commercial PVG types spread in southern Europe, with PVR ranging from 25 to 100%. The aim of the work is to identify the PVG types suitable for the cultivation of the considered species, based on the best trade-off between PV shading and crop production. The daily light integral (DLI) was used to compare the light scenarios inside the PVGs to the crop light requirements, and estimate the potential yield. The structures with a PVR of 25% were compatible with the cultivation of all considered species, including the high light demanding ones (tomato, cucumber, sweet pepper), with an estimated negligible or limited yield reduction (below 25%). The medium light species (such as asparagus) with an optimal DLI lower than 17 mol m−2 d−1 and low light crops can be cultivated inside PVGs with a PVR up to 60%. Only low light demanding floricultural species with an optimal DLI lower than 10 mol m−2 d−1, such as poinsettia, kalanchoe and dracaena, were compatible inside PVGs with a PVR up to 100%. Innovative cropping systems should be considered to overcome the penalizing light scenarios of the PVGs with high PVR, also implementing LED supplementary lighting. This paper contributes to identify the sustainable PVG types for the chosen species and the alternative crop managements in terms of transplantation period and precision agriculture techniques, aimed at increasing the crop productivity and adaptability inside the PVG agrosystems.

The aim of this work was to calibrate CROPGRO-Tomato model, included in the Decision Support System for Agrotechnology Transfer (DSSAT) software, for a cherry tomato genotype grown in a photovoltaic greenhouse in southern Europe (39°19'59”N; 8°59'19”E). The experiment was carried out in Decimomannu, Sardinia, in an East-West oriented pitched-roof greenhouse with two spans (50×9.6 m each) covering an area of 960 m2. Silicon photovoltaic panels were used to completely replace the south-oriented roof of each span, resulting in a 50% roof cover ratio. Tomato was grown hydroponically with a plant density of 2.3 plants m-2. An autumn-winter tomato crop cycle was carried out from August 2011 to January 2012. Microclimatic conditions were monitored for the whole lifespan of the experiment (e.g., internal global and PAR radiation and greenhouse internal temperature). Phenology was monitored at weekly interval. Leaf area, aboveground biomass, and fresh fruit production was determined at fifteen day interval. CROPGRO-Tomato model was calibrated over the uncovered roof data and it was evaluated over the covered roof data. The genotype file (cultivar), including the main parameters of crop phenology and plant growth, was adapted to the cherry tomato cultivar 'Shiren'. The first flowering date showed a good agreement between simulated and observed data. The model fitted well the observed leaf area index data with an index of agreement (D-Index) of 0.87 and an average root mean square error (RMSE) of 0.53. Good agreement was observed between the measured and simulated plant development parameters as biomass and fresh weight yield. Overall, the CROPGRO-Tomato model proved to be suitable for predicting tomato growth and yields inside PV greenhouses and under different light intensity conditions. However, model validation is also necessary to show how the model works under a spring-summer cycle and with supplementary lighting system.

The food and drink manufacturing industry is constantly seeking for alternative sanitation and disinfection systems that may achieve the same antimicrobial efficiency of conventional chemical sanitisers and at the same time be convenient in terms of energy and water savings. A candidate technology for this purpose is the use of light in combination with photosensitisers (PS) to generate a bioactive effect against microbial agents in a process defined as photodynamic inactivation (PDI). This technology can be applied to the food processing of different food matrices to reduce the microbial load of foodborne pathogens such as bacteria, fungi, viruses and protozoa. Also, the PDI can be exploited to increase the shelf-life period of food by inactivation of spoiling microbes.\ud This review analyses new developments in the last five years for PDI systems applied to the food decontamination from foodborne pathogens. The photosensitisation mechanisms and methods are reported to introduce the applied technology against microbial targets in food matrices. Recent blue light emitting diodes (LED) lamp systems for the PDI mediated by endogenous PS are discussed as well PDI technologies with the use of exogenous PS from plant sources such as curcumin and porphyrin-based molecules.\ud The updated overview of the most recent developments in the PDI technology both in wavelengths and employed PS will provide further points of analysis for the advancement of the research on new competitive and effective disinfection systems in the food industry.

This study introduces a novel algorithm to estimate the cumulated global radiation inside photovoltaic (PV) greenhouses at the desired time interval. The direct and diffuse radiation were calculated on several observations points (OPs) inside the PV greenhouse. The PV panels were assimilated to polygons that can overlap the sun path seen from a specific OP. The algorithm was tested in a greenhouse with 50% PV cover ratio on the roof. The results were showed as the percentage ratio of the cumulated yearly global radiation with and without PV array on the roof (GGR), and used to draw maps of light distribution on different canopy heights (from 0.0 to 2.0 m). The maps displayed the variability of the light distribution and the most adversely affected zones inside the PV greenhouse. The yearly GGR increased with the canopy height on the zones under the plastic cover (GGR from 59% at 0.0 m to 73% at 2.0 m), and decreased under the PV cover (GGR from 57% at 0.0 m to 40% at 2.0 m). Most zones close to the side walls and the gable walls were the least affected by shading on all canopy heights. The different light distribution on the canopy heights showed that the incident solar energy on the crop changes consistently, according to the growth stage of the plants. The algorithm can be applied to several PV greenhouse types and may provide a decision support tool for the identification of the most suitable plant species, based on their light requirements.

Agriculture is strongly linked to climate change and has a two-sided relationship with climate change. Although climate change contributes to reducing agricultural productivity, the primary sector is responsible for the production of greenhouse gas (GHG) emissions; on the other hand, the primary sector could mitigate emissions to foster soil carbon sequestration. Specifically, perennial energy crop systems could produce relevant environmental and socio-economic benefits. This study aimed to highlight the potential efficacy of various fertilizer management strategies in reducing GHG emissions and increasing the social value obtained from carbon storage. Using two methodological approaches, namely, the carbon footprint (CF) and social carbon cost (SCC) methods, five nitrogen fertilization patterns (low input, LI; high input, HI; LI + biochar, LI + Bi; LI + cover crop, LI + CC; and LI + Bi + CC) were compared in an experiment on cardoon cultivation for three consecutive growing seasons. GHG release exceeded GHG removal and ranged from 0.20 (HI) to 0.14 (LI + CC) t CO2e per production unit. LI + CC reduced GHG emissions and optimized yield. The rates of carbon sequestration ranged from 72.7 (HI) to 26.2 (LI) t CO2e t −1 of biomass. Furthermore, the combined use of biochar and a cover crop had no positive effects on C sequestration or GHG emission reduction, unlike these treatments individually. In fact, LI + Bi provided the highest value for C storage (61.1 t CO2e t − 1 of biomass), and LI + CC had the best GHG balance (0.14 t CO2e per production unit). The monetary evaluation of C storage showed that HI would produce the greatest benefits until 2050 (i.e., 9 K US dollars per t CO2e). Although a single best option was not identified among the fertilizer management practices, identifying the optimal trade-offs among productivity, GHG emissions reduction and SCC value is important in ensuring that an energy crop will provide food security as well as environmental and socio-economic sustainability. Furthermore, a potential optimal solution could allow improvements in long-term crop system planning and land use and the development of effective strategies to combat climate change.

INTRODUCTION AND OBJECTIVE:Endoscopic Combined IntraRenal Surgery (ECIRS) involves simultaneously a percutaneous and endoscopic access for the treatment of large renal stones or for multiple large ...

The spherical micro-cells are a semi-transparent photovoltaic (PV) technology which can contribute to improve the sustainability of greenhouse systems. Previous prototypes were tested in laboratory conditions, but the size was not suitable for the greenhouse roof application. In this work, a new prototype has been developed and tested on a real greenhouse roof. The semi-transparent PV module (STM) was composed by 4800 spherical silicon micro-cells (1.2 mm diameter) sandwiched between glass plates and integrated on a greenhouse roof with 26.5° slope. The STM was 910 mm long and 610 mm wide to match the size of the greenhouse framework. The percentage of the STM area covered with micro-cells was 2.3%, reaching 9.7% considering the metallic conductors. The cell density was 2 cells cm−2 and the measured perpendicular light transmissivity of the semi-transparent area was 73%. The characteristics of the prototype were compared with those of a conventional planar multi-crystalline silicon module (CPM). The module conversion efficiency was steadily around 0.2% over wide incident sunlight angle. The micro-cells never completely eclipse the incident sunlight when observed from more than 1 m distance from the roof, keeping the eclipsing level at 9.7%. The yield factor of the STM was slightly higher than the CPM because of the isotropic properties of the spherical cells, which are able to use both the sky-incident and the ground-reflected irradiation for energy production, irrespective of the module slope. The prototype STM is promising for greenhouse roof applications and its performance can be improved by increasing the conversion efficiency.

The application of the photovoltaic (PV) energy to the European greenhouse industry has led to installations designed to maximise the energy production but detrimental for the greenhouse crops, due to the effect of shading of the PV panels on the roof. To assess these issues, the first step is to characterize the PV greenhouse microclimate, especially in terms of solar radiation at canopy level. After a comprehensive review of the current state-of-art of the PV greenhouse sector, four representative commercial PV greenhouse types are compared, with a percentage of the area covered with PV panels (PV cover ratio) ranging from 25% to 100%. The aim is to define the general relations between the main design parameters (PV cover ratio, greenhouse height and orientation, checkerboard pattern) and the available solar radiation, to provide original information on the design of next-generation PV greenhouses with improved agronomic sustainability. The yearly global radiation decreased averagely by 0.8% for each additional 1.0% PV cover ratio and increased by 3.8% for each further meter of gutter height. The N-S orientation increased the average cumulated global radiation on the greenhouse area by 24%, compared to the E-W orientation. Both the checkerboard pattern and the N-S orientation improved the uniformity of light distribution. All PV greenhouse types are provided with light distribution maps to evaluate the light variability on the greenhouse area. The light distribution is crucial to support adequate agronomic plans for both preexisting and new PV greenhouses, aiming to sustainable mixed systems for both energy and crop production.

The prefabricated industrial buildings, similar to the one presented in this paper, featured a high seismic vulnerability during the 2012 Emilia Earthquake (Italy). The main structural deficiencies were a consequence of the lack of connection between columns, beams and roof elements. The case study presented in this paper is an industrial building composed of two structural units with different initial stiffness. The strengthening approach was different for the two parts. The stiffer part was equipped with Buckling Restrained Braced Frames (BRBF), thus adding stiffness and energy dissipation. The more flexible part was decoupled from the rest of the building and fluid viscous dampers were installed in the joint between the two structural units. The relative movement between the two parts can activate the damping devices, which dissipate part of the input seismic energy, hence a structural weakness is turned into a positive resource for energy dissipation.

This study assessed the climate conditions inside a greenhouse in which 50% of the roof area was replaced with photovoltaic (PV) modules, describing the solar radiation distribution and the variability of temperature and humidity. The effects of shading from the PV array on crop productivity were described on tomato, also integrating the natural radiation with supplementary lighting powered by PV energy. Experiments were performed inside an east–west oriented greenhouse (total area of 960 m 2 ), where the south-oriented roofs were completely covered with multi-crystalline silicon PV modules, with a total rated power of 68 kWp. The PV system reduced the availability of solar radiation inside the greenhouse by 64%, compared to the situation without PV system (2684 MJ m −2 on yearly basis). The solar radiation distribution followed a north–south gradient, with more solar energy on the sidewalls and decreasing towards the center of the span, except in winter, where it was similar in all plant rows. The reduction under the plastic and PV covers was respectively 46% and 82% on yearly basis. Only a 18% reduction was observed on the plant rows farthest from the PV cover of the span. The supplementary lighting, powered without exceeding the energy produced by the PV array, was not enough to affect the crop production, whose revenue was lower than the cost for heating and lighting. The distribution of the solar radiation observed is useful for choosing the most suitable crops and for designing PV greenhouses with the attitude for both energy and crop production.

Background Percutaneous nephrolithotomy (PCNL), the gold standard for the management of large and/or complex urolithiasis, is conventionally performed with the patient in the prone position, which has several drawbacks. Of the various changes in patient positioning proposed over the years, the Galdakao-modified supine Valdivia (GMSV) position seems the most beneficial. It allows simultaneous performance of PCNL and retrograde ureteroscopy (ECIRS, Endoscopic Combined Intra-Renal Surgery) and has unquestionable anaesthesiological advantages. Objective To prospectively analyse the safety and efficacy of endoscopic combined intrarenal surgery (ECIRS) in GMSV position for the treatment of large and/or complex urolithiasis. Design, setting, and participants From April 2004 to December 2007, 127 consecutive patients who were followed in our department for large and/or complex urolithiasis were selected for surgery (American Society of Anesthesiologists [ASA] score 1–3, no active urinary tract infection [UTI], any body mass index [BMI]). Intervention All the patients underwent ECIRS in GMSV position. Technical choices about percutaneous access, endoscopic instruments and accessories, and postoperative renal and ureteral drainage are detailed. Measurements Patients' mean age plus or minus standard deviation (± SD) was 53.1 yr±14.2. Of the 127 patients, 5.5% had congenital renal abnormalities, 3.9% had solitary kidneys, and 60.6% were symptomatic for renal colics, haematuria, and recurrent UTI. Mean stone size±SD was 23.8mm±7.3 (range: 11–40); 33.8% of the calculi were calyceal, 33.1% were pelvic, 33.1% were multiple or staghorn, and 4.7% were also ureteral. Results and limitations Mean operative time±SD was 70min±28, including patient positioning. Stone-free rate was 81.9% after the first treatment and was 87.4% after a second early treatment using the same percutaneous access during the same hospital stay (mean±SD: 5.1 d±2.9). We registered overall complications at 38.6% with no splanchnic injuries or deaths and no perioperative anaesthesiological problems. Conclusions ECIRS performed in GMSV position seems to be a safe, effective, and versatile procedure with a high one-step stone-free rate, unquestionable anaesthesiological advantages, and no additional procedure-related complications.

AIM To investigate if targeted prostate biopsy (TBx) has superior performance to standard untargeted biopsy (SBx) in determining the optimal agreement between biopsy and surgical Gleason Score (GS). PATIENTS AND METHODS An analysis of our institutional longitudinal database identified 683 consecutive patients who underwent either SBx (18-20 standardized transrectal ultrasound peripheral/transitional zone cores) or TBx alone (4-6 cores for each multiparametric magnetic resonance suspicious lesion, Prostate Imaging Reporting and Data System [(PI-RADS)≥3] after a previous negative first SBx. A total of 246 consecutive patients with diagnosis of prostate cancer (117 SBx and 129 TBx diagnoses) who underwent robot-assisted radical prostatectomy between January 2014 and December 2015, were enrolled. The concordance of biopsy GS to pathological GS, as well as the association between categorical variables [age, digital rectal exam (DRE), TNM, PI-RADS], were analyzed by Fisher's exact test. RESULTS Prostate cancer was diagnosed in 32.0% of the SBx group and in 49.3% of TBx. The rate of correctly classified, up-graded and down-graded GS was 53.8% vs. 91.5%, 39.3% vs. 7.8% and 6.8% vs. 0.8% for SBx and TBx, respectively (p

Objective The most commonly used staging system for renal cell carcinoma (RCC) is the tumor-node-metastasis (TNM) system. In the most recent TNM edition, lymph node (LN) involvement is defined as pN0, pN1, or pN2, depending on the number of metastatic LNs (none, 1, or >1). This study evaluated the prognostic value of this classification and tried to improve its clinical impact by considering an additional parameter, that is, LN density (ratio between number of positive LNs and total number of LNs retrieved). Methods All pathologic reports of radical nephrectomies performed for RCC in two urologic centers between November 1983 and December 1999 were reviewed. For each patient, complete clinical and pathologic data, number of LNs removed, location and number of positive LNs, and LN density were recorded. The Kaplan-Meyer method and the log-rank test were used to calculate cause-specific survival rates and to compare survival curves, respectively. Results A total of 735 patients underwent radical nephrectomy. Lymphadenectomy was performed in 618 cases, and the rate of positive LNs was 14.2%. The 5-yr cause-specific survival rate of pN+ patients was 18%, with no statistically significant difference between pN1 and pN2. The average number of LNs removed was 13 (range, 1–35). The median number of LNs involved was 3 (range, 1–18). LN density ranged between 3.7% and 100% (median, 22.9%). The number of LNs removed had no impact on survival in pN+ patients. The only significant unfavorable prognostic factors were >4 LNs involved ( p =0.02) and LN density >60% ( p =0.01). Conclusion The results show that in RCC the current TNM stratification of positive LNs is not significantly correlated with prognosis. From our data it appears that classification as ≤4 or >4 LNs involved, supported by LN density, better reflects the impact of the disease on survival.

Objective To demonstrate the safety of the Millin extraperitoneal laparoscopic adenomectomy by comparing the laparoscopic and open approaches. Methods From January 2003 to April 2005, patients, with indication of prostatic adenomectomy, were offered the chance to choose between 2 types of procedure: Millin adenomectomy with open or extraperitoneal laparoscopic approach. Forty patients were included in this prospective non-randomised study. The patients were divided into 2 Groups. Group A (20 patients) underwent extraperitoneal laparoscopic adenomectomy, while Group B (20 patients) was treated by open surgery. Pre-operative, peri-operative and post-operative parameters were evaluated. Group A was subdivided in two sub-groups (first ten and last ten) and peri-operative parameters were considered in order to determine the learning curve. Results In terms of pre-operative parameters considered, the 2 study groups are comparable ( p >0.3). As far as peri and post-operative parameters are concerned: mean blood loss for Group A was 411.6±419ml, for Group B 687.5±298.6ml ( p =0.004). For all the other parameters no significant statistical differences were recorded ( p >0.4). Mean operative time was 107.2±34.9min in Group A, and 95.5±22.5min in Group B. Mean adenoma weight in Group A was: 69,5±21.5g, in Group B: 88.1±43.8g. Mean haemoglobin levels in Group A was: 11.2±1.8g/dl, Group B: 11.6±1.2 (10–13.4) g/dl. Mean Analgesic consuming (Tramadol) during the post-operative stay was 385±36mg in Group A, versus 430±108mg in Group B. Mean catheterization time was 6.3±3.7 days in Group A, 5.6±1.1 days in Group B. The mean hospital stay was 7.8±4.1 days in Group A, and 7±1.6 days in Group B. One patient (5%) from Group A was re-operated for bleeding and clot retention, whilst in Group B patients did not present complications which required any further intervention. As far as peri-operative and post-operative parameters of the two sub-Groups A (first ten patients and last ten patients) are concerned, the statistical evaluation shows a significant difference only on operative time ( p =0.01). The p-value for the other parameters was not significant ( p >0.1). Conclusions The extraperitoneal laparoscopic adenomectomy is a safe technique presenting results comparable to open surgery with the advantage of significantly lower peri-operative blood loss.

Urachal carcinoma is a rare neoplasm treated with surgical resection. We report a case of adenocarcinoma of the urachus treated with a new surgical technique. In a 44-year-old man affected by urachal carcinoma we performed a combined endoscopic-laparoscopic surgical en bloc resection of the urachus and bladder dome. The procedure lasted 240 min, and no postoperative complications were recorded. The patient was discharged on fourth day and the catheter was removed on eighth day. Bladder capability resulted normal with no evident physical change. Multiple bladder biopsy and computed tomography scans at 6, 12 and 18 months proved negative.

Over the last 40 years the treatment of urolithiasis passed from open surgical therapies to minimally invasive approaches. From the introduction of the first ureteroscopes in ‘80s many technological improvements allowed to reduce endourological instruments’ size, ensuring in the meanwhile an increasingly high success rate in the resolution of the urolithiasis. The purpose of the study is to review the current role of the ureteroscopy(URS) in the treatment of urinary stones. A non-systematic review was performed considering the most recent Guidelines and results from Literature. The results confirm that, considering ureteral calculi, the stone-free rate (SFR) for URS is significantly higher than for ESWL in the treatment of distal ureteral stones 10 mm. Endoscopy has a first-line role also in the treatment of proximal ureteral stones >10 mm, together with ESWL. Retreatment rate and ancillary procedures are also lower in patients treated with URS, despite it is more invasive if compared with ESWL. Recent data are available in Literature about the treatment of nephrolithiasis with Retrograde Intra-Renal Surgery (RIRS). RIRS is the first-line treatment, together with ESWL, for stones 20 mm. However, for large renal stones the role of RIRS is still being discussed. In conclusion, the majority of urinary stones can be treated by rigid or flexible URS. Further studies are required to clarify the role of endoscopy in the treatment of large stones, especially if compared to percutaneous approaches.

We describe our technique of laparoscopic diverticulectomy under ultrasound (US) guidance after a transurethral resection of prostate (TURP) in the treatment of patients with benign prostatic hyperplasia and bladder diverticulum. A standard TURP is performed with an Iglesias resectoscope. A 12-Fr Foley catheter is positioned in the diverticulum and the catheter balloon is then inflated with 30 mL of water; then a Tiemann catheter is placed through the urethra into the bladder. A US probe is inserted through the 12 mm port placed in the right side by the surgeon, then laparoscopic transperitoneal bladder diverticulectomy is performed under US guidance. In our experience, the use of endolaparoscopic US makes identification and dissection of the diverticulum easy, safe and effective, even when the procedure has to be performed in disadvantageous anatomic conditions such as lateral-posterior diverticulum or post-TURP imbibition of pelvic tissue.

Acute Distress Respiratory Syndrome (ARDS) is defined as a severe respiratory failure characterized by marked hypoxemia, bilateral infiltrates on the chest X-ray and the absence of signs of cardiogenic pulmonary edema. ARDS treatment remains primarily supportive and the use of mechanical ventilation with positive and expiratory pressure is required to maintain adequate gas exchange. Lung-protective mechanical ventilation strategy decreases mortality and increases ventilator free days. Prone positioning is considered a rescue therapy despite it improves gas exchange through resolution of dorsal atelectases with lung recruitment, better distribution of pulmonary perfusion and reduction of lung stress and strain. Nevertheless, several randomized controlled trials failed to demonstrate a reduction in mortality in pronated ARDS patients. Recent meta-analysis instead demonstrated a significant reduction of mortality in patients with most severe ARDS (PaO2/FiO2 ratio < 200) ventilated in prone position. These data were confirmed by the results of the PROSEVA study, published in June 2013 that reports a 16% reduction of mortality rate. The results of several meta-analysis and this large clinical trial suggest that prone positioning is a useful strategy that saves lives in more severely ill ARDS patients, when applied earlier and for at least 16 hours/day.

OBJETIVOS El carcinoma de celulas transicionales del tracto urinario superior es relativamente raro, supone entre el 2-5% de todos los tumores uroteliales. Su incidencia parece estar aumentando como resultado de los progresos en tecnicas de imagen, endoscopia y la mejoria de la supervivencia del carcinoma vesical. Los tumores de la pelvis renal representan el 10% de todos los canceres renales. Las neoplasias pielicas tienen una incidencia de dos a cuatro veces superior a la de los tumores de ureter, de los que el sitio mas comun es el tracto distal (sobre el 70%). Un tercio de los carcinomas uroteliales del tracto urinario superior son multifocales, y el 1% simultaneos y bilaterales. Los dos abordajes endoscopicos alternativos para las lesiones localizadas en el sistema colector del rinon son la ureteroscopia retrograda y la via percutanea anterograda. El tratamiento de eleccion depende de varios criterios: tamano de la lesion, localizacion y multifocalidad. Las lesiones pequenas < 1 cm accesibles se tratan preferentemente por ureteroscopia, manteniendo la integridad del tracto urinario. La introduccion de los laseres represento un gran paso del diagnostico y tratamiento endoscopico de los tumores del tracto urinario superior. El exito de un tratamiento laser en pacientes afectos de lesiones del tracto urinario viene definido por una seleccion cuidadosa. Generalmente, solo los pacientes con lesiones de bajo grado y papilares deberian tratarse endoscopica mente con laser. Los pacientes con lesiones de alto grado o invasivas deberian mejor ser sometidos a intervencion quirurgica clasica. En realidad, el urologo dispone de una amplia gama de tecnologia laser para elegir (laser de Holmio, de Tulio). Para un tratamiento correcto y seguro de las lesiones ureterales y pielicas con el laser es absolutamente necesario respetar algunos consejos tecnicos. Antes de nada, es imperativo un acceso adecuado para obtener una buena vision de ureter y de la pelvis renal. De hecho, el urologo siempre deberia trabajar con seguridad, con un control optimo de sus instrumentos. Por lo tanto, es importante definir el tipo de laser y el nivel de energia; el desarrollo de la tecnologia laser (por ejemplo fibras de laser flexibles y pequenas) permite tambien un tratamiento radical, seguro y minimamente invasivo de los tumores uroteliales utilizando ureteroscopios flexibles. Por supuesto es obligatorio evaluar el grado y estadio de los tumores despues de la biopsia por ureteroscopia: los tumores invasivos deben ser tratados inmediatamente mediante nefroureterectomia, mientras que el tratamiento endoscopico deberia reservarse para aquellos pacientes con rinon unico, insuficiencia renal, tumores bilaterales, comorbilidad severa o afectos de tumores solitarios con menos de 15 mm de diametro y bajo grado/estadio.

Randomised prospective studies have shown that single-stage management of cholecysto-choledocholithiasis yields results equal or superior to sequential treatment, with a lower incidence of complications primarily associated with choledochotomy. We report the first case of transcystic Holmium:YAG laser lithotripsy using a flexible ureteroscope. The method was found to be a valuable aid in reducing the percentage of choledochotomies when calculi are too large to be retrieved from the common bile duct with normal graspers.

Objective This article describes both the open and laparoscopic operative techniques of supra-ampullar cystectomy (SAC). Methods Both open (photographs and drawings) and laparoscopic (attached DVD) SAC are explained step by step. Results Between May 1984 and December 2005, 31 patients with bladder tumour underwent SAC with ileal orthotopic neobladder (2 Camey I, 26 Camey II, and 3 Y). Three patients underwent laparoscopy. Preoperatively, 26 patients had superficial high-risk transitional cell carcinoma (TCC). Median follow-up was 95.0 mo (range: 5–260 mo). The 10-yr cause-specific survival rate was 76.7%. Two patients had local recurrence. Potency was preserved in 28 patients (90.3%); 15 patients (48.3%) also maintained antegrade ejaculation, allowing procreation in 3 cases. In one patient the Camey I neobladder was converted into an ileal conduit (high postvoid residual, recurrent pyelonephritis). None of the remaining patients had daytime incontinence, eight had nightime urinary incontinence, and six performed intermittent self-catheterisation. Conclusion SAC with detubularised ileal orthotopic neobladder allows preservation of sexual function and maintenance of urinary continence in most patients, without compromising oncologic outcome. The key element is the very strict and careful preoperative selection of the patients.

Purpose: To present a simple alternative technique to close the membranous urethra during laparoscopic radical cystectomy. Patients and Methods: A series of 18 laparoscopy-assisted cystectomies were performed in our institute from November 2002 to May 2005. In order to prevent neoplastic-cell spillage, in 14 of these patients, the membranous urethra was closed with Hem-o-lok® clips after careful dissection of the urethra and withdrawal of the bladder catheter. Results: In all cases, one or two Hem-o-lok® clips were easily, safely, and quickly positioned. The remaining length of the membranous urethra was sufficient for anastomosis with the neobladder if appropriate. In follow-up (mean 14 months), no local recurrence has been recorded. Conclusion: The closing of the membranous urethra with Hem-o-lok clips during laparoscopy-assisted cystectomy is in our experience a simple, fast, safe, and effective alternative that should be considered when laparoscopic radical cystectomy is performed.

We compared two techniques of early ligature of the renal artery during transperitoneal laparoscopic radical nephrectomy: a standard technique and a direct approach to the artery.Of 100 patients undergoing transperitoneal laparoscopic radical nephrectomy at our institution, in the last 70, we used early renal-artery ligature. Of these, the standard technique after exposure of the vascular pedicle was used in 45 patients (group A), and ligature with a direct access to the renal artery was attempted in 25 patients (group B).No statistical differences were noted between the two groups in terms of age, lesion size, operative time, estimated blood loss, or intraoperative and postoperative complications. There were no recurrences of disease by CT evaluation in either group during follow-up (range 1-46 months).Transperitoneal laparoscopic radical nephrectomy with direct access to renal artery for early ligature is technically difficult but feasible and safe.

physical therapy. He received adjuvant chemotherapy and is alive without evidence of disease recurrence at 1 year. CONCLUSIONS: There is a risk of obturator nerve injury during pelvic lymph node dissection. Hem-o-lock clips may be removed with the use of a clip remover or harmonic instrument. If transected and recognized, immediate apposition of the nerve is necessary to yield recovery. Robotic suturing of the transected nerve was technically feasible in this case.