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Background: The purpose of this study is to examine the combination of the mechanical effects of penile therapy with vacuum erection devices (VEDs) plus PDE5i, which improve clinical outcomes after extracorporeal shockwave therapy (ESWT) in men affected by erectile dysfunction (ED) associated with Peyronie's disease (PD). Methods: A total of 153 medical records of patients affected by PD in stable stage with ED and treated with ESWT were divided into two groups. Group A (GA) included 72 men treated with ESWT, mechanical stretching with VEDs and PDE5ì (Tadalafil 5 mg), and Group B (GB) included 81 men who received only ESWT plus Tadalafil 5 mg with the same protocol of GA. The patients in both groups were assessed at baseline and follow-up for erectile function, painful erections, penile plaque size, and penile curvature. The results were evaluated at baseline and 3, 6, and 12 months after the treatments. Results: Three months after the treatment, GA patients had a reduction in penile curvature degree from a mean ± SD of 33.91 ± 8.34° at baseline to a mean ± SD of 19.46 ± 7.15° after 12 months, whereas pain in an erection or during intercourse was resolved completely in 88.9% of the patients. The mean ± SD IIEF-15 score of patients affected by severe/moderate ED further improved significantly in the GA group (p < 0.001) after 3, 6, and 12 months of treatment. There were no permanent adverse sequelae after treatments. Conclusions: The regular use of a VED plus Tadalafil in patients who had undergone ESWT significantly provided more benefit in patients with PD in terms of penile deformity, pain, and erectile function. [ABSTRACT FROM AUTHOR]

Background: Currently, there are no studies evaluating the feasibility of a prostate biopsy approach in men undergoing a kidney transplant (KT). Owing to this evidence, we planned a retrospective population-based study to evaluate our experience of a transrectal prostate biopsy (TR-PB) approach and studied the impact on the complication rate and outcomes in patients undergoing KT with suspected prostate cancer (PCa). Methods: We collected data from KT patients who underwent PB with a transrectal approach. One week and two weeks after the PB, patients' information was collected regarding possible complications during the post-biopsy period. Results: A total of 121 patients were included in this study. Among them, Group 1 was composed of 59 patients undergoing TR-PB with an ultrasound (US) standard technique, and Group 2 consisted of 62 patients undergoing TR-PB with an MRI-US cognitive technique. We observed a 28.9% Clavien–Dindo grade ≤ 2 of early side effect rates (mostly rectal bleeding and other minor hematuria), with a very low rate of hospital re-admission for acute urinary retention (3.3%); only one man required hospitalization for rectal bleeding, and there were no major complications. Conclusions: We can affirm that TR-PB can be a safe procedure with a low risk of severe complications when performed by skilled specialists with a standardized procedural pathway. [ABSTRACT FROM AUTHOR]

Purpose: To assess the clinical effectiveness of extra corporeal shockwave therapy (ESWT) administration compared with ESWT plus a low-intensity laser diode therapy (LILDT) in the management of Peyronie's disease (PD) stable stage. Methods: In this study, 214 patients affected by PD in stable stage (≥ 12 months), were divided into two groups. Group 1 (G1) counted 111 patients treated only with ESWT; Group 2 (G2) consisted of 103 patients that received ESWT with the same protocol of G1 plus LILDT for six weeks. The patients of both groups were assessed at baseline and follow-up for erectile function, painful erections, penile plaque size and penile curvature. The results were evaluated at baseline and 3, 6, 12 months after the treatment. Results: Three months after the treatment in G2 pain in an erection or during intercourse was resolved completely in 78.6% of the patients, whereas in 55.8% cases of G1 (p < 0.003). G2 patients had a reduction of curvature degree after the 3 months treatment (p < 0.002). However, mean plaque size decreased in both groups without statistically differences with baseline values. Mean ± SD IIEF-5 score further improved significantly in the group treated with ESWT plus LILDT (p < 0.001). There were no permanent adverse sequelae after treatments. Conclusion: This study demonstrates an interesting therapeutic strategy when combined to the synergistic action of a shock wave therapy with low-intensity laser therapy on the stable plaques with significant benefits in terms of pain perception, penile curvature and sexual activity. [ABSTRACT FROM AUTHOR]

Background: Male circumcision is a well‐known old surgery, and several recently developed techniques have been scaled up, including the introduction of laser technology, as alternative approaches to overcome morbidity of conventional surgery scalpel/suture method Objectives: We aimed to perform a systematic review and meta‐analysis of studies comparing laser circumcision versus conventional circumcision technique in terms of perioperative outcomes and efficacy (complications, unacceptable appearance, reoperation rate) both in children and adults. Materials and methods: This review was performed following the 2020 Preferred Reporting Items for Systematic Reviews and Meta‐Analyses framework. Continuous variables were analyzed using the inverse variance of the mean difference with a random effect, 95% confidence interval (CI), and p‐value. The incidence of complications, unacceptable appearance, and reoperation rate were pooled using the Cochran‐Mantel‐Haenszel Method with the random effect model and reported as odds ratio (OR), 95% CI, and p‐value. Significance was set at p‐value ≤0.05 and 95%CI. Results: Seven studies were included. In comparison to the conventional circumcision, laser circumcision shoved lower visual analogue score at 24‐h, and 7 days after surgery, a lower rate of overall complication rate (OR 0.33, 95% CI 0.24–0.47, p < 0.001), scarring (OR 0.09, 95% CI 0.02, 0.41, p = 0.002), and unacceptable appearance (OR 0.09, 95% CI 0.05, 0.15, p < 0.001). We found no statistically significant difference in surgical time, and incidence of bleeding, infection, wound dehiscence, and reoperation rate. Discussion and conclusion: Our review infers that laser‐assisted circumcision is certainly a safe and strong contender as the procedure of choice in both children and adult populations. [ABSTRACT FROM AUTHOR]

Purpose: We wished to present the clinical applications and to evaluate the benefits of the use of a carbon dioxide (CO2) laser versus the conventional procedure for circumcision in adults, in terms of duration of surgery, surgical techniques, complications, pain and cosmetic appearance. Patients and Methods: The medical records of 482 patients who had been circumcised were retrospectively evaluated. The patients were divided into two groups: 168 patients (Group A) were circumcised with traditional techniques; and 314 patients (Group B) were circumcised using a CO2 laser. All the patients were circumcised under local anesthesia. Pain was evaluated using a verbal numerical rating scale for pain assessment. Postoperative wound swelling, bleeding, infection and pain were assessed at 4 hours, 24 hours and 7 days after surgery. Results: There were no significant differences between the two groups in terms of bleeding and infections. The difference in operating times between the groups was significant (p< 0.001). Wound disruptions occurred in one patient in Group A at 3 days and two patients in Group B at 1 week. Pain scores were low and there was less pain in Group B than in Group A during the first 4 hours (1.8 vs 3.7; p< 0.002). Compared with the conventional method, the CO2 laser technique was associated with much less pain at both 1 day (p< 0.002) and 7 days (p< 0.001) postoperatively. The cosmetic results were superior in Group B; a linear surgical scar developed in 94.9% of patients in Group B versus 61.3% in Group A (p< 0.001). Conclusion: Our results show that the use of a CO2 laser was associated with a shorter operative time, less wound irritation and better cosmetic appearance compared with standard surgical techniques for circumcision. [ABSTRACT FROM AUTHOR]

To assess the relationship between baseline total serum testosterone (T) and clinical outcomes in men affected by Peyronie's disease (PD) stable stage and treated by extra corporeal shockwave therapy (ESWT). In this study, 168 patients affected by PD in stable stage (≥12 months) and treated with ESWT, were divided into 2 groups. Group 1 (G1) counted 71 patients with low T levels (≤ 300 ng/dL); group 2 (G2) consisted of 97 patients with normal T that received ESWT with the same protocol of G1 for 6 weeks. There were assessed at baseline and follow-up: Erectile dysfunction (ED), presence and severity of painful erections, penile plaque size, and penile curvature degree. The results were evaluated at baseline and 3, 6, 12, months after the treatment. Not statistically significant differences emerged between the 2 groups at baseline, except for higher presence of patients with ED in G1 (90%) vs G2 (52%). Three months after the treatment in G2 pain was resolved completely in 80.4% of the patients, compared with G1 (54.9%). G2 had a reduction of curvature degree after the 3-month treatment (P <.001). Mean plaque size decreased in both groups without statistically differences with baseline values. Mean ± SD International Index of Erectile Function-5 score progressively improved significantly in the eugonadal men. This study demonstrated greater efficacy for the treatment of PD in men with normal T concentrations compared with men with low T concentrations. The results obtained from this study suggest that may be valuable in considering T therapy in men with PD prior to ESWT. [ABSTRACT FROM AUTHOR]

Aims To describe the changes in urodynamic parameters and to assess patients' perceptions of voiding difficulties and improvements in symptom bother after solifenacin treatment in men with overactive bladder (OAB) and detrusor underactivity (DUA). Methods In this prospective study, 49 neurologically intact men were enrolled. DUA was defined as a bladder contractility index (BCI) <100. All subjects received 5 mg of solifenacin once a day for 120 days. A complete urodynamic study was carried out on the day before to the first dose of solifenacin and at day 120. Results Solifenacin treatment resulted in a decrease in Qmax during UDS (−0.6 ml/sec; P = 0.007), PdetQmax (−6.4 cmH2O; P < 0.001), BOOI (−7.5; P < 0.001), BCI (−3.8; P = 0.001), BVE (−4.4%; P = 0.006), and voided volume (−7.5 ml; P = 0.09). On the contrary, PVR (+6 ml; P = 0.152), and maximum cystometric capacity (+22.9 ml; P = 0.001) increased. The regression analysis suggested that changes in urodynamic parameters after solifenacin treatment were limited for BOOI (9.4%), PdetQmax (8.4%), and BCI (6.5%), with no significant impact on Qmax during UDS, BVE, volume voided and PVR. No significant change in subjective perception of voiding difficulties was found. The incidence of AUR was 2.2% and improvement in patient's experience of OAB symptoms bother after solifenacin treatment was observed. Conclusions Solifenacin treatment results in changes of urodynamic parameters. These changes, however, seem not to be of clinical significance as suggested by the lack of subjective deterioration in voiding difficulties and by the low incidence of AUR. Neurourol. Urodynam. 28:52-57, 2009. © 2008 Wiley-Liss, Inc. [ABSTRACT FROM AUTHOR]

Aim Scrotal bruises are quite frequent injuries affecting young subjects, with psychological repercussions on body image and fertility. The interest of ultrasound in the context of the emergency remains controversial. The aim of our study was to investigate clinical, ultrasonographic and operative features of scrotal contusions, and to evaluate the contribution of ultrasound in the description of traumatic lesions. Methods In this retrospective and descriptive study 71 scrotal contusions operated from December 2015 to April 2020 were collected. We retrospectively analysed 26 patients (aged between 14 and 79 years) of 71 who sustained a scrotal ultrasound, where the latter was positive. The primary endpoint was albuginea rupture, whose concordance between ultrasound and surgery was assessed using the Kappa method. Positive and negative predictive values, sensitivity and specificity for the presence of albuginea rupture were evaluated for a set of ultrasound data: scrotal haematoma, haematocele, regularity of testicular contours, testicular fracture (specificity (93%), testicular haematoma, and Doppler signal intensity. Results Surgical treatment was necessary in 26 (37%) patients; only six orchiectomy were performed. Surgical exploration should be performed if haematocele is found in the genital examination without any ultrasound complement. Conclusion The ultrasonography is useful, detailed and accurate when the haematocele is not clinically evident. [ABSTRACT FROM AUTHOR]

Purpose: We wished to present the clinical applications and to evaluate the benefits of the use of a carbon dioxide (CO 2 ) laser versus the conventional procedure for circumcision in adults, in terms of duration of surgery, surgical techniques, complications, pain and cosmetic appearance., Patients and Methods: The medical records of 482 patients who had been circumcised were retrospectively evaluated. The patients were divided into two groups: 168 patients (Group A) were circumcised with traditional techniques; and 314 patients (Group B) were circumcised using a CO 2 laser. All the patients were circumcised under local anesthesia. Pain was evaluated using a verbal numerical rating scale for pain assessment. Postoperative wound swelling, bleeding, infection and pain were assessed at 4 hours, 24 hours and 7 days after surgery., Results: There were no significant differences between the two groups in terms of bleeding and infections. The difference in operating times between the groups was significant ( p <0.001). Wound disruptions occurred in one patient in Group A at 3 days and two patients in Group B at 1 week. Pain scores were low and there was less pain in Group B than in Group A during the first 4 hours (1.8 vs 3.7; p <0.002). Compared with the conventional method, the CO 2 laser technique was associated with much less pain at both 1 day ( p <0.002) and 7 days ( p <0.001) postoperatively. The cosmetic results were superior in Group B; a linear surgical scar developed in 94.9% of patients in Group B versus 61.3% in Group A ( p <0.001)., Conclusion: Our results show that the use of a CO 2 laser was associated with a shorter operative time, less wound irritation and better cosmetic appearance compared with standard surgical techniques for circumcision., Competing Interests: The authors report no conflicts of interest in this work., (© 2020 Ronchi et al.)