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Introduction: The aim of the study was to evaluate if and when the presence of radiological urinary leakages of vesico-urethral anastomosis, after robotic radical prostatectomy, could provoke urethral strictures or affect continence recovery., Methods: We enrolled 216 patients, undergoing robot-assisted radical prostatectomy between January 2020 and December 2022 in three high-volume referenced centres for robotic surgery. Before removal of the bladder catheter, all patients underwent a cystourethrography in which the presence/absence of leakage was assessed at level of vesico-urethral anastomosis. Based on degree of severity of urinary leakage on cystourethrography, patients were classified as no leakage or grade 0, grade 1 with transversal diameter ≤1 cm, and grade 2 with transversal diameter ≥1 cm. At follow-up, urethral stenosis formation and urinary continence recovery were assessed; furthermore, post-operative 12-month functional outcome was determined using EORTC-QLQ-PR25 questionnaire., Results: Radiological urinary leakage was found in 30 patients with grade 1 and 33 patients with grade 2, for a total of 63 patients. Only 1 patient (1.5%), grade 2 urinary leakage, developed significant urethral stricture and required endoscopic urethrotomy after 6 months. Analysing the differences in those who removed the bladder catheter after 7-9 days and those who kept it longer, we found no statistically significant differences regarding recovery of continence (p = 0.23) or about urinary symptoms (p = 0.94)., Conclusions: RARP remains gold-standard approach for treatment of localized prostate cancer and the superiority of this technique is safe in preventing urethral strictures and continence recovery, even in presence of significant anastomotic urinary leakage., (© 2024 S. Karger AG, Basel.)

Objective: To study and analyze any correlations between positive surgical margins after RARP and biochemical recurrence., Methods: We enrolled 105 patients who underwent robot-assisted radical prostatectomy (RARP) from 2016-2020 with PSMs on final pathology, all performed or supervised by a senior surgeon in two tertiary referral center. Pathology has been described indicating also the area (apical, base, mediolateral, anterior, or multiple) and the extent of PSMs: focal (≤3 mm) or extensive (>3 mm). Cox univariable and multi-variable regression models were used to find the correlation between clinico-pathologic factors: age, local staging, PSA, grading, area, and size of PSMs)., Results: We found a good correlation between PSA and grading and between PSA and local staging (T) ( p  < 0.001). There was no clear correlation between the PSM area with grading nor with T staging. There is a statistically significant correlation between extensive PSM and the worsening of grading and local staging ( p  < 0.001). BCR rate also has a strong correlation with the worsening of grading and local staging (T) ( p  < 0.001). A relevant fact is the difference between the BCR rate in the apical and base PSM (34.88%vs 62.5%; p  < 0.001) which are the most frequent locations of PSMs., Discussion: PSMs remain a predictor of BCR but which may have controversial significance. The likelihood of BCR increases as grading or local staging gets worse. However, apical PSM is a relatively less powerful predictor of postoperative BCR. This can help to better select patients for subsequent RT, which still causes important side effects., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Introduction: The objective of this study is to compare the safety and efficacy, through the stone-free rate (SFR), as well as the costs, between retrograde intrarenal surgery (RIRS) and percutaneous nephrolithotomy (PCNL), for 2-4 cm kidney stones., Material and Methods: We analysed the data relating to RIRS and PCNL performed in 3 reference centres for kidney stones, in the period between 1/2019 and 12/2021. The total number of procedures was 130 (63 RIRS and 67 PCNL). We defined SFR as the absence of lithiasic fragments or stones <3 mm. Results were compared between 2 groups depending on the stone size: 2-3 cm stones (group 1) and >3 cm stones (group 2)., Results: The duration of RIRS was 90 minutes for group 1 and 115 minutes for group 2, and for PCNL it was 135 minutes for group 1 and 145 minutes for group 2. RIRS had shorter duration with a significant difference in group 1 (p = 0.000014). SFR for RIRS was 78% for group 1 and 21% for group 2, and for PCNL it was 92% for group 1 and 81% for group 2. Therefore, there is a statistically significant difference, which is more evident for 3 cm and multiple stones (p = 0.0057 for group 1, p = 0.000146 for group 2). The difference in costs was estimated by calculating the expected costs for a single surgical procedure and the estimated cost per day for ordinary hospitalization., Conclusions: 2-4 cm stones can be safely treated with both RIRS and PCNL, but RIRS should not be chosen as an option for stones >3 cm, except in selected cases. PCNL remains the gold standard for the treatment of complex stones, especially for stones >3 cm. Risk of postoperative complications is higher in PCNL, even if this difference is not great. The costs associated with RIRS, even when recalculating with the need for new treatments, remain cheaper., Competing Interests: The authors declare no conflicts of interest., (Copyright by Polish Urological Association.)

Introduction: An important issue in robotic surgery is the training of urologists and the learning curve to perform a robot-assisted partial nephrectomy (RAPN), especially for those procedures that require vascular clamping., Material and Methods: We retrospectively enrolled 333 patients, undergoing RAPN in the period between 01/2014 and 12/2020. Surgical complexity, surgery duration, perioperative complications, and clamping were evaluated for each patient. Comparisons were made between an experienced surgeon and 3 urologists with initial experience in robotic surgery., Results: Total number of RAPN was 333, of wich 172 were performed by the chief and 142 by the team. Analyzing the data, after an initial training in robotic surgery, it's possible to perform surgery of medium complexity (RENAL score 6-7) after 15 procedures performed in total independence. To proceed to high complexity tumors (RENAL score 8-9) with possible vascular clamping and warm ischemia time <25 minutes at least 25 completely independent procedures are required. There were no significant differences in the comparisons regarding the duration of the procedures (p = 0.19), complications (p = 0.44) and positive margins (p = 0.96)., Conclusions: Robotic training for complex procedures, with low intra and postoperative complication rates, acceptable positive margin rates and sustainable cost-effective durations, requires a minimum number of medium complexity procedures, which in our study we have identified as 25 procedures, considering the initial ability in simple procedures of our 3 surgeons in training., Competing Interests: The authors declare no conflicts of interest., (Copyright by Polish Urological Association.)

Background: Bladder cancer (BC) is the 9th most common cancer diagnosis worldwide. Low grade (LG) represents 70% of all BCs, characterized by recurrence and rare ability (10-15%) to progress to high grade (HG) and invade. The remaining 30% is high grade (HG), fast invasive BC, which is resistant to therapy. Identifying biomarkers for predicting those tumors able to progress is a key goal for patient outcome improvement. This study focuses on the most promising prognostic markers., Materials and Methods: TP53 and FGFR3 mutational status, Survivin, CK19, CK20, E-cadherin and CD44 gene expression analysis were performed on 66 BCs., Results: Survivin was found associated to tumor grade (p<0.05). Moreover, Survivin correlated with CD44 in TP53 wild type (p = 0.0242) and FGFR3 wild type (p = 0.0036) tumors. In particular the Survivin-CD44 correlation was associated to HG FGFR3 wild type BCs (p = 0.0045). Unsupervised hierarchical clustering based on gene expression data identified four distinct molecular groups reflecting the patient histology (p = 0.038)., Conclusion: We suggest Survivin, both as a biomarker associated to G3 BCs but negatively related to TP53 mutational status, and as a potential novel therapeutic target., Competing Interests: The authors have declared that no competing interests exist.

Expression levels of p27(kip1) , a negative regulator of the G1 phase of the cell cycle, and 8-hydroxydeoxyguanosine (8-OHdG), a marker of oxidative DNA damage, were assessed by immunostaining in a series of renal cell carcinomas (RCCs) and their prognostic significance was evaluated. Expression of p27(kip1) as well as of the α-subunit of the dystroglycan (DG) complex, previously reported to be altered in RCC, was also evaluated by western blot analysis. Nuclear expression of p27(kip1) was reduced in a significant fraction of tumors and low p27(kip1) staining correlated with higher tumor grade (P < 0.01). Recurrence and death from clear cell RCCs were significantly more frequent in p27(kip1) -low expressing tumors and Kaplan-Meier curves showed a significant separation between high vs low expressor groups for both disease-free (P = 0.011) and overall (P = 0.002) survival. Low nuclear expression of p27(kip1) as well as loss of α-DG were confirmed to be independent prognostic parameters at a multivariate analysis and the simultaneous loss of both molecules defined a "high-risk" group of patients with increased risk of recurrence (RR = 28.7; P = 0.01) and death (RR = 12.9; P = 0.03). No significant correlation with clinical or pathological parameters was found for 8-OHdG staining. Western blot analyses suggested a post-translational mechanism for the loss of α-DG expression and demonstrated that cytoplasmic dislocation of the protein contributes to the loss of active nuclear p27(kip1) . Loss of nuclear p27(kip1) is a frequent event in human RCCs and is a powerful predictor of poor outcome which, in combination with low DG expression, could help to identify high-risk patients with clear cell RCC., (© 2010 Japanese Cancer Association.)

The authors report an extremely rare case of adenoid cystic carcinoma of the prostate. No satisfactory clinical and pathological classification exists for this tumour, creating particular difficulties for therapeutic decisions and prognosis. Descriptions of cases with excellent survival rates are reported in the literature, to the extent that this is sometimes regarded as a low-malignancy tumour, but other reports also exist of massive diffusion of the pathology with fatal consequences. Advances in the knowledge of this tumour have enabled a number of earlier pathogenetic hypotheses to be ruled out, namely its possible derivation from ectopic salivary cells, ectopic periurethral glands or metaplastic urethral mucosa, but the origin of this carcinoma is still not certain. It is also difficult to differentiate this form from the typical adenocarcinoma and to make a prognosis for survival. In the case reported here, the final diagnosis was made on the lymph node biopsy obtained during surgery, given that a preoperative biopsy was not feasible owing to the scarcity of material available. The patient received standard hormonal therapy for prostate carcinoma.

A case of multiple fibrous pseudotumors of the tunica vaginalis is reported. Ultrasonography led to diagnosis 10 years previously and the patient underwent surgical exploration when the lesions were up to 6 cm in diameter.

The urethral stent is a relatively new treatment modality for benign prostatic hypertrophy ostruction. Although the ultimate prostatic endoprosthesis has yet to be developed, various stents have been produced and investigated with good results. We review the several currently available stents and we report the preliminary clinical experience with a new device (Trestle).

Gleason score has been identified as an important variable to predict disease extent and biologic behaviour of prostate cancer. However, the correlation between Gleason score of needle biopsy and surgical specimen is often poor. We studied 72 patients who underwent needle biopsy and radical prostatectomy to correlate Gleason score with PSA, clinical and pathological tumour stage. Only 47.2% of Gleason scores were identical in the biopsy and specimens, 37.5% were undergraded and 15.2% were overgraded. Correlations between clinical and pathological stage were identical in 30.5% of patients, 61.1% of patients were understaged and 8.3% overstaged. In conclusion, accuracy of clinical staging and grading of prostate cancer is low. Although the Gleason score on needle biopsy might be useful to predict the final stage and grade, correlation with surgical specimen is poor.

A case of extrarenal spreading of transitional cell carcinoma caused by rupture of ureterohydronephrosis by ureteral transitional cell carcinoma is reported. Ultrasonography and CT revealed the presence of a severe right ureterohydronephrosis with large septa and a 2 cm diameter exophytic neoplasia of the middle ureter. Nephroureterectomy was performed with excision of a perirenal mass. Histologic examination revealed the presence of transitional cell carcinoma in the perirenal mass, caused by dissemination after renal rupture. CT and ultrasonography were not able to differentiate hydronephrosis from pericapsular spreading because of the extreme disruption of the renal parenchyma.

Fracture of the penis is not a frequent event and it consists of a rupture of the tunica albuginea of the corpora cavernosa and sometimes of the urethra; the lesion occurs when the penis is erect because during erection the tunica albuginea is very thin and not flexible and it can be easily damaged by a trauma; most lesions occur during intercourse for impact of the erect penis against the female perineum or the pubic synphisis, but lesions during masturbation, fightings or falling off the bed are also described [1-2-3]. Clinically there are pain, detumescence, hematoma and recurvatum of the penis toward the opposite side of the lesion and hematuria if also the urethra is damaged. Usually diagnosis is quite easy with a good anamnesis, clinical examination and echotomography which can reveal presence of hematoma and hypoechogenic areas along the tunica albuginea or the urethra that appears irregular. Nowadays, fractures of the penis need a surgical approach to obtain good results avoiding consequences such as recurvatum or fibrotic areas [3-4-7-8]. We describe two cases of fracture of the penis occurred in two young men during masturbation and treated surgically with excellent results: twelve and eighteen months respectively after surgery patients are well and can enjoy a normal sexual activity with no problems at all.

Sclerotherapy for hydroceles was performed in 18 patients. Cutaneous anaesthesia was induced with an anaesthetic cream (lidocaine and prilocaine, EMLA cream) and a fibrin sealant (Tissucol) was injected into the sac after fluid aspiration. Patients experienced no pain during needle insertion and sclerosant procedure; 2 recurrences were observed during follow-up. EMLA cream anaesthesia and fibrin adhesive sclerotherapy represent a useful alternative to surgical treatment of hydroceles.

Endometriosis of the urinary tract is a relatively rare condition. Since clinical signs are not specific the diagnosis is difficult and the therapy is not well defined. Two cases and a review of the literature are presented.

The use of absorbable staples may allow to reduce the operating time of orthotopic bladder replacement. We report our experience in 14 patients with a modification of the Studer technique using absorbable PolyGIA instruments. The technique has been shown to be simple and quick to perform (time for pouch creation 15-40 minutes, mean 16 minutes) with no significant intraoperative difficulties. Urodynamic data and continence are satisfactory and seem comparable to different procedures and not related to staples' use. The main question remains if the reduced operating time equalizes the high cost of staple devices.

Electrovaporization is a new and potentially useful modification of transurethral resection of the prostate which is rapidly becoming a treatment of choice for symptomatic benign prostatic hyperplasia. We report our experience with 22 patients treated using the Circon Acmi Grooved Vaportrode vaporization electrode. Procedures were carried out using the standard technique of electrovaporization with general or regional anaesthesia. Mean operative time was 40 minutes (range 25-65 minutes) and all patients were discharged without catheter after 1 or 2 days. Symptom score, peak uroflow and postvoid residual urine showed statistically significant improvement at 3 months (p < 0.01). There were no significant complications. Transurethral electrovaporization of the prostate seems to be a easy and safe procedure with significantly lower costs and excellent results. However, long-term efficacy and complications need to be evaluated in multicentre clinical trials.

Objective: We report our preliminary experience with a vacuum constriction device and topical minoxidil for the management of impotence., Methods: We evaluated 18 patients, 8 with neurogenic and 10 with psychogenic impotence with a vacuum constriction device and topical minoxidil (1 ml 2% solution)., Results and Conclusions: All patients responded to treatment but 100 cases refused home use because of psychological impact. Twelve patients did not need the application of the constrictive ring because of the erection facilitation effect of minoxidil. No side effects were observed. In our opinion the association of the vacuum constriction device with topical minoxidil might be useful in the treatment of impotence; however, several factors must be evaluated in selecting patients. Application of minoxidil before vacuum constriction device might be useful to reduce the time of device application, to increase the efficacy of the device and in some cases to avoid the use of the constrictive ring.

We present our experience with colour duplex sonography in the assessment of 38 impotent men, whose ten underwent radical prostatectomy, following intracavernous pharmacological stimulation with PGE1. All patients with a clinical good response following PGE1 injection had peak cavernosal artery velocities > 30 cm/sec. The remaining suboptimal responders who presented an elevated end-diastolic velocity (> 5 cm/sec) showed a venous leakage demonstrated with cavernosography. Colour duplex sonography is a valuable and non-invasive tool in the assessment of impotence and can provide valuable information in the diagnosis of vasculogenic erectile dysfunction.

Endometriosis is defined as the presence of endometrial tissue outside the cavity of the uterus. The urinary tract is rarely affected, only 1 to 11%. Bladder is the most frequent urinary localization while the ureteral involvement is rare. We report a case of intrinsic ureteral endometriosis in a woman with left hydronephrosis, lumbar pain and septic fever. Instrumental and laboratory investigations can hardly lead to a reliable diagnosis of ureteral endometriosis. A final diagnosis is feasible only by histologic examination, which obviously implies surgery.

The Authors report 28 cases of scrotal traumas evaluated during a period of 5 years on an amount of 1.100 scrotal echography: 5 patients with severe scrotal trauma are investigated with echography within 2 hours while the others between 1 and 6 days. Some cases of overlooked trauma were studied some months later. In their experience the authors underline the importance of echography in early diagnosis of scrotal contents lesions which need a surgical exploration and those which allow a medical treatment. Also ultrasound investigation is important in evaluating and in the follow-up the scrotal content lesions caused by trauma.

The Authors report 3 cases of penile trauma observed in a period of 6 months. The patients were studied by penile echography and cavernosography. In this series+ echotomography resulted more accurate than cavernosography which gave always negative results.