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In this study, we aimed to investigate the presence of an alteration in the feeding ecology of fish after the deployment of anti-trawling reefs at the Punta Tramontana site (Sardinia, Italy). To achieve this aim, we examined prey in the stomach contents of two target species of fish: Diplodus annularis and Mullus surmuletus. The samples were obtained from fishing activities carried out over one year from June 2017 to October 2018 at two impact sites, selected by the presence of artificial reefs, and two control sites. The results showed that installing these artificial devices increased the food spectrum availability of the target species and induced two different ecological feeding behaviors, probably derived from their different ecologies. D. annularis changed its alimentary strategy from generalist at control sites to specialist at impact sites, focusing its diet on the crustacean Gnathia maxillaris. Mullus surmuletus was not affected by the presence of the barriers, which constitute an additional site where the fish feed during their foraging activities. In conclusion, these anti-trawling reefs, in addition to the purpose for which they are designed (in this case, avoiding illegal trawling), did not produce any negative environmental impact on surrounding marine biota.

Background Lombardy has been the first and one of the most affected European regions during the first and second waves of the novel coronavirus (severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2]). Objective To evaluate the impact of coronavirus disease 2019 (COVID-19) on all urologic activities over a 17-wk period in the three largest public hospitals in Lombardy located in the worst hit area in Italy, and to assess the applicability of the authorities’ recommendations provided for reorganising urology practice. Design, setting, and participants A retrospective analysis of all urologic activities performed at three major public hospitals in Lombardy (Brescia, Bergamo, and Milan), from January 1 to April 28, 2020, was performed. Outcome measurements and statistical analysis Join-point regression was used to identify significant changes in trends for all urologic activities. Average weekly percentage changes (AWPCs) were estimated to summarise linear trends. Uro-oncologic surgeries performed during the pandemic were tabulated and stratified according to the first preliminary recommendations by Stensland et al (Stensland KD, Morgan TM, Moinzadeh A, et al. Considerations in the triage of urologic surgeries during the COVID-19 pandemic. Eur Urol 2020;77:663–6) and according to the level of priority recommended by European Association of Urology guidelines. Results and limitations The trend for 2020 urologic activities decreased constantly from weeks 8–9 up to weeks 11–13 (AWPC range –41%, –29.9%; p, Take Home Message Coronavirus disease 2019 (COVID-19) pandemic urologic recommendations redefined treatment options and timing of urological surgical activities to support urologists during this healthcare crisis to avoid delaying life-saving treatments. These recommendations should be adapted according to hospital resources and local incidence of the pandemic.

Objective: To evaluate the relationship between enlarged prostate, bulky median lobe (BML) or prior benign prostatic hyperplasia (BPH) surgery and perioperative functional, and oncological outcomes in high-risk (HR) prostate cancer (PCa) patients treated with Retzius-sparing robot-assisted radical prostatectomy (RS-RARP). Methods: 320 HR-PCa patients treated with RS-RARP between 2011 and 2020 at a single high-volume center. The relationship between prostate volume, BML, prior BPH surgery and perioperative outcomes, Clavien-Dindo (CD) grade >= 2 90-day postoperative complications, positive surgical margins (PSMs), and urinary continence (UC) recovery was evaluated respectively in multivariable linear, logistic and Cox regression models. Complications were collected according to the standardized methodology proposed by EAU guidelines. UC recovery was defined as the use of zero or one safety pad.Results: Overall, 5.9% and 5.6% had respectively a BML or prior BPH surgery. Median PV was 45 g (range: 14-300). The rate of focal and non-focal PSMs was 8.4% and 17.8%. 53% and 10.9% patients had immediate UC recovery and CD >= 2. The 1- and 2-yr UC recovery was 84 and 85%. PV (p = 0.03) and prior BPH surgery (p = 0.02) was associated with longer operative time. BML was independent predictor of time to bladder catheter removal (p = 0.001). PV was independent predictor of PSMs (OR: 1.02; p = 0.009). Prior BPH surgery was associated with lower UC recovery (HR: 0.5; p = 0.03). Conclusion: HR-PCa patients with enlarged prostate have higher risk of PSMs, while patients with prior BPH surgery have suboptimal UC recovery. These findings should help physicians for accurate preoperative counseling and to improve surgical planning in case of HR-PCa patients with challenging features.

Background Over the years, several techniques for performing robot-assisted prostatectomy have been implemented in an effort to achieve optimal oncological and functional outcomes. Objective To provide an evidence-based description and video-based illustration of currently available dissection techniques for robotic prostatectomy. Design, setting, and participants A literature search was performed to retrieve articles describing different surgical approaches and techniques for robot-assisted radical prostatectomy (RARP) and to analyze data supporting their use. Video material was provided by experts in the field to illustrate these approaches and techniques. Surgical procedure Multiple surgical approaches are available: extraperitoneal, transvesical, transperitoneal posterior, transperitoneal anterior, Retzius sparing, and transperineal. Surgical techniques for prostatic dissection sensu strictu are the following: omission of the endopelvic fascia dissection, bladder neck preservation, incremental nerve sparing by means of an antegrade or retrograde approach, and preservation of the puboprostatic ligaments and dorsal venous complex. Recently, techniques for total or partial prostatectomy have been described. Measurements Different surgical approaches and techniques for robotic prostatectomy have been analyzed. Results and limitations Two randomized controlled trials evaluating the extraperitoneal versus the transperitoneal approach have demonstrated similar results. Level I evidence on the Retzius-sparing approach demonstrated earlier return to continence than the traditional anterior approach. The question whether Retzius-sparing RARP is associated with a higher rate of positive surgical margins is still open due to the intrinsic bias in terms of surgical expertise in the available comparative studies. This technique also offers an advantage in patients who have received kidney transplantation. Retrospective evidence suggests that the more the anatomical dissection (eg., more periprostatic tissue is preserved), the better the functional outcome in terms of continence. Yet, two randomized controlled trials evaluating the different techniques of dissection have so far been produced. Partial prostatectomies should not be offered outside clinical trials. Conclusions Several techniques and approaches are available for prostate dissection during RARP. While the Retzius-sparing approach seems to provide earlier return to continence than the traditional anterior transperitoneal approach, no technique has been proved to be superior to other(s) in terms of long-term outcomes in randomized studies. Patient summary We have summarized available approaches for the surgical treatment of prostate cancer. Specifically, we described the different techniques that can be adopted for the surgical removal of the prostate using robotic technology.

Aim: We aimed to evaluate trifecta outcomes after Retzius-sparing robot-assisted radical prostatectomy (rs-RARP). Methods: We evaluated 1488 patients who had undergone rs-RARP at our institution from 2011 to 2019. All patients filled out questionaries for functional outcomes before surgery, and only patients with baseline continence and IIEF-5 scores of > 16 were included. Biochemical recurrence (BCR) was defined as two consecutive prostatic specific antigen levels of > 0.2 ng/mL after rs-RARP. Postoperative continence was defined as the use of no pads. Potency was defined as the ability to achieve erections for sexual intercourse, with or without phosphodiesterase-5 (PDE-5) inhibitors. A multivariable logistic regression model was performed to identify predictors of trifecta outcome. Results: In total, 1240 patients were included in the analysis. During the 24-month follow-up time, 149 patients (11.9%) harbored BCR. Urinary continence was observed in 981 patients (79.5%), while 171 (13.8%) still used a safety pad daily after 24 months. Sexual potency was reported in 643 patients (51.9%), of whom 379 (30.6%) had spontaneous erections and 264 (21.3%) used a PDE-5 inhibitor. Overall, the trifecta outcome was reached by 42.1% of the study’s population. The trifecta outcome was easily reached by younger patients and patients who underwent a full nerve-sparing (NS) prostatectomy. In the multivariable model, age [odds ratio (OR) = 0.89; 95% confidence interval (CI): 0.84-0.90; P < 0.01] and type of NS surgery [partial NS (OR = 3.34; 95%CI: 1.01-11; P = 0.04) full NS (OR = 4.57; 95%CI: 1.86-12; P < 0.01)] resulted as independent predictors. Conclusion: rs-RARP is associated with optimal trifecta outcome rate. Age and NS technique are independent predictors of trifecta outcomes.

Rivers are undoubtedly the main pathway of waste dispersed in the environment that from land reaches oceans and seas increasing the amount of marine litter. Major cities are a great source of riverine litter as large urbanization can originate pressure on the integrated waste management resulting in litter entering the rivers. Within this study, we aim to investigate the dynamic of floating riverine macrolitter (items2.5 cm) in the city of Rome before it reaches the sea by assessing the composition, amount, and seasonal trends of litter transported from the urban centre to the main river mouth of Tiber River. Visual surveys for a whole year (March 2021-February 2022) were conducted from two bridges, Scienza Bridge (in the city) and Scafa Bridge (at the main river mouth) and followed JRC/RIMMEL protocol for riverine litter monitoring. Overall, similar litter composition was observed from the city centre to the mouth with a prevalence of plastic material, mainly related to fragmentation process (i.e. plastic pieces) and single use items, mainly in food and beverage sectors. An extrapolated annual loading of 4 × 10

OBJECTIVE: Retzius-sparing robot-assisted radical prostatectomy (RSP) is a novel approach for radical prostatectomy that was described by our group for the first time in 2010 and is spreading all around the world. The aim of the present study was to assess the effect of surgical experience (SE) on perioperative, functional and oncological outcomes during the first 50 RSP cases performed by a naive surgeon for this novel approach. MATERIALS AND METHODS: We retrospectively evaluated the initial cases operated by 14 surgeons in 12 different international centers. Pre-, peri- and post- operative features of the first 50 patients operated by each surgeon in all the participating centers were collected. The effect of the SE on perioperative, functional and oncological outcomes was firstly evaluated after stratification of surgical experience in initial (≤25) and expert cases (>25) and after using locally weighted scatter-plot smoother (LOWESS) function to graphically explore the relationship between SE and the outcomes of interest. RESULTS: We evaluated 626 patients. Median follow-up was 13 months in the first group and 9 months in the second (p=0.002). Preoperative features were overlapping between the two groups. Lower console time (140 min vs 120 minutes, p=0.001) and a trend for lower complications rates (13 vs 5.5%, p=0.038) were observed in the second group. The relationship between SE and console time, immediate urinary continence recovery and Clavien Dindo complications ≥2 was linear without reaching a plateau after 50 cases. Conversely, a non-linear relationship was observed between SE and PSMs. CONCLUSIONS: We reported the first multi-center experience of Retzius-sparing RARP during the learning curve. We found that console time, immediate urinary continence recovery and postoperative complications are optimal from the beginning and further quickly improve during the learning process, while PSMs rates did not clearly enhance over the first 50 cases.

INTRODUCTION AND OBJECTIVE:There has been a significant development of minimally invasive surgical techniques (MISTs) for the treatment of BPH. Prostatic artery embolization (PAE) is one of the mos...

We investigated the temporal changes from spring to summer of the stranded litter and the composition of plastic encrusting biota along an Italian beach. Our findings highlight a higher quantity of litter (average value 1510.67 ± 581.27 items) in spring, particularly plastic material with a composition driven by currents, winds and waves transported from rivers to sea. During summer the source was caused by anti-social behaviours (e.g. cigarettes). Regarding the plastic size, the most is macroplastic (85.96 %), followed by mesoplastic (13.74 %) and megaplastic (0.30 %) overall, and no seasonal trend was observed. Concerning the encrusting biota, Mollusca was the most frequent phylum found on plastic beach litter, whereas Porifera the most abundant overall. During spring a greater abundance of individuals was recorded compared to summer. The trend of taxa richness was decreasing from spring to summer. Arthropoda, Porifera and Mollusca phyla were significantly more abundant in spring, while Algae in summer.

Background: To date, few series on robot-assisted radical prostatectomy (RARP) in kidney transplant recipients (KTRs) have been published. Purpose: To report the experience of two referral centers adopting two different RARP approaches in KTRs. Surgical, oncological and functional results were primary outcomes evaluated in the study. Material and methods: We retrospectively analyzed data from 9 KTRs who underwent transperitoneal RARP or Retzius-sparing RARP for PCa from October 2012 to April 2016. Data were reported as median and interquartile range (IQR). Pre- and postoperative outcomes were compared by non-parametric Wilcoxon signed-rank test. Significant differences were accepted when p ≤ 0.05. Overall survival was assessed using Kaplan-Meier method. Results: Four KTRs underwent a T-RARP and 5 a RS-RARP. Patient median age was 60 (56-63) years. Charlson comorbidity index was 6 (5-6). Preoperative median PSA was 5.6 (5-15) ng / mL. Preoperative Gleason score (GS) was 6 in 5 patients, 7 (3 + 4) in 3, and 8 (4 + 4) in one. Pre- and postoperative creatinine were 1.17 (1.1; 1.4) and 1.3 (1.07; 1.57) mg / dL (p = 0.237), while eGFR was 66 (60-82) and 62 (54-81) mL / min / 1.73m2 (p = 0.553), respectively. One (11.1%) Clavien-Dindo grade II complication occurred. Two extended template lymphadenectomies were performed, both with nodal invasion. These two patients experienced a biochemical recurrence and were subjected to RT. Two patients (22.2%) had PSMs. Median follow-up was 42 months. Seven patients (77.8%) were continent, 5 (55.6%) were potent. Two (22.2%) patients died during follow-up for oncologic unrelated causes. Conclusions: Our series suggests that both RARP approaches are safe and feasible techniques in KTRs for PCa.

The technological evolution from open surgery to laparoscopy and finally to robot-assisted surgery has dramatically changed the approach to prostate cancer. From an anatomical point of view, the robotic technology allowed to increase the understanding of the structures involved during prostatic surgery. In this chapter, we will describe the most important anatomical landmarks that are found during robot assisted radical prostatectomy, approached from three different points of view: perineal, retropubic, Retzius-sparing. With this aim, we will describe the key steps of radical prostatectomy according to the three different anatomical perspectives: bundles, seminal vesicles, bladder neck, apex, vesico-urethral anastomosis.

Patients with neurogenic lower urinary tract dysfunction (NLUTD), specially with indwelling bladder catheter (iBC), have an increased risk of developing bladder stones, incomplete bladder emptying, recurrent urinary tract infections, sepsis, urethral trauma and bladder cancer. We present the case of a patient with a large bladder stone in iatrogenic NLUTD treated with iBC for about 30 years, who underwent a cystectomy followed by several life-threatening complications, like septic episodes and multiple surgeries. Our case outlines the importance of limiting the time of iBC in favor of CIC to avoid severe complications. Clinicians should instruct on the correct CIC technique and hygiene practices, and monitor patients with periodic abdominal US in order to diagnose and treat precociously any disease, like bladder stones.(www.actabiomedica.it)

Several authors claimed that the Retzius-sparing robot-assisted radical prostatectomy (RS-RARP) needs a prolonged learning curve, and outcomes during this phase could be suboptimal.To verify the safety and outcomes of RS-RARP performed by young surgeons during the learning curve.We conducted a retrospective analysis of the pre-, intra-, and postoperative features of all the patients who underwent RS-RARP from 2013 to 2017. We divided our patients into two groups: patients operated by two experienced surgeons (ESs) with100 procedures and patients operated on by five younger surgeons in the learning curve (LCSs). LCSs had no previous experience in radical prostatectomy, and the very first RS-RARP procedures of each LCS case are included in the analysis.Perioperative, oncological, and functional data were analyzed. Short-term oncological results were reported as positive surgical margins (PSMs) and 1-yr disease-free survival. Complications were graded according to the Clavien-Dindo system. Potency was defined as erections sufficient for intercourse; continence was defined as no pad or one safety liner. A propensity score-matching analysis was used to adjust the difference in baseline preoperative parameters between the groups.We obtained two homogeneous groups of 256 patients each. After the matching, preoperative variables were similar in the two groups. The mean console time was longer for younger surgeons (98 vs 122 min, p0.001). Postoperative course, complications, and functional results were similar in the two groups; the final pathological analysis showed a worse T stage in the ES group (p = 0.017). PSMs and 1-yr disease-free survival did not differ between the groups.RS-RARP can be safely performed by inexperienced surgeons who have received adequate training.Surgeons in the learning curve can perform Retzius-sparing robot-assisted radical prostatectomy safely, with similar early oncological results and functional outcomes.

BACKGROUND The aim of this study is to evaluate differences in discomfort, complications and functional results after Retzius-sparing robot-assisted radical prostatectomy (RS-RARP) according to different urinary drainage: suprapubic tube (SPT) and standard urethral catheter (UC). METHODS Prospective, comparative, consecutive, non-randomized study. In all patients with a water-tight anastomosis, no hematuria, obesity, previous suprapubic surgery or history of bladder cancer, a SPT (two-way Foley 14-Fr catheter) was positioned instead of a Foley 18-Fr UC. One week after surgery, an institutional self-compiled questionnaire was administered. The patients were divided into two groups according to the presence of UC or SPT and were compared concerning pain, perioperative results, complications, functional outcomes. RESULTS Fifty-six patients with UC and 135 with SPT agreed to participate to the study. Median postoperative pain score was 3 (IQR: 2-5) in UC and 3 (IQR: 1-5) in SPT group (P=0.324); urinary drain-related pain scores were 3 (IQR: 1-5) in UC and 1 (IQR: 0-3) in SPT groups (P

Robot-assisted laparoscopic radical prostatectomy (RARP) is nowadays considered the main surgical option for localized prostate cancer (PCa). We recently developed a new approach for RARP avoiding all the Retzius structures involved in continence and potency preservation, the so called Retzius-sparing technique (RSP). The objective of the paper is to report technical aspects and functional results of RSP. METHODS: We evaluated our data and available literature regarding RSP, functional results and advantages. RESULTS: RSP is oncologically safe and guarantee high early continence rates.Long-term, prospective, comparative, and possibly randomized studies are needed but RSP is now spreading all over the world thanks to the different advantages that offers to patients. The most recognized benefit is surely the achievement of early continence, as well documented in multiple studies and papers, without compromising the oncological outcomes.ARTICULO SOLO EN INGLES. OBJETIVO: La prostatectomía radical laparoscópica asistida por robot (PRAR) se considera hoy en día la principal opción quirúrgica para el cáncer de próstata localizado. Recientemente desarrollamos un nuevo abordaje para la PRAR evitando todas las estructuras del Retzius involucradas en la conservación de la continencia y la potencia, la conocida como técnica de prostatectomía conservadora del Retzius (PCR). El objetivo de este artículo es comunicar los aspectos técnicos y funcionales de la PCR. MÉTODOS: Evaluamos nuestros datos y la literatura disponible sobre PCR, resultados funcionales y ventajas. RESULTADOS: La PCR es oncológicamente segura y garantiza unas tasas altas de continencia precoz. CONCLUSIONES: Son necesarios estudios a largo plazo, prospectivos, comparativos y posiblemente aleatorizados pero la PCR está actualmente extendiéndose por todo el mundo gracias a las diferentes ventajas que ofrece a los pacientes. El beneficio más reconocido es seguramente la consecución de continencia precoz, bien documentada en múltiples estudios y artículos, sin compromiso de los resultados oncológicos.

A conflict of interest (COI) is a situation in which a person has competing loyalties or interests that make it difficult to fulfil his or her duties impartially. Conflict of interest is not categorically improper in itself but requires proper management. A SCOPUS literature search was performed for publications on the efficacy/safety of Phospho-Di-Esterase Inhibitors (PDEIs) for treating erectile dysfunction. A categorization tool (CoOpCaT) was used to review and classify the publications as supportive/not-supportive for the discussed active ingredient and reporting or not reporting a COI for that specific drug or for the remaining PDEIs (i.e. competitors). Multivariable binary logistic regression was performed. In the 419 selected records the prevalence of supportive opinions was higher when a COI for the index label was declared. The CoOpCaT showed good internal consistency, discriminative validity and intra/inter-rater agreement. The strongest predictor for a supportive opinion was the total number of financial COIs for the index label. A mild protective effect of the total number of financial COIs for any competitor label was noted. Financial COIs have frequently been associated with bias, and the measures currently adopted to restrain it lack effectiveness. Some evidence for monitoring and/or compensating this bias is reported here, but the ultimate solution remains distant.

Bei kleinen Nierentumoren gilt heute die Organ-erhaltende Therapie als Standard. Haufig ist aber die Tumorgrose nicht der einzige bestimmende Faktor fur das operative Vorgehen, sondern auch Komplexitat des Tumors und anatomische Lokalisation spielen eine Rolle. Eine Reihe von Nephrometrie-Scores soll die verschiedenen Tumorparameter erfassen und bei der Operationsplanung helfen. Borgmann et al. haben deren Nutzen in der Praxis untersucht.

The objective of our study is to evaluate the effect of prostatic volume on the outcomes of Retzius-sparing robot-assisted radical prostatectomy (RSP).All the consecutive patients undergoing RSP up to January 2015 were included. The series was divided into three groups based on prostate weight at radical prostatectomy specimen (40 g, 40-60 g,60 g). Perioperative, oncological and functional data were prospectively recorded. Potency was defined as erections sufficient for penetration; continence as no pad or one safety liner. Oncological results were reported as positive surgical margins (PSMs) and 1-year biochemical disease-free survival (PSA0.2 ng/mL).We evaluated 750 patients (366 with40 g prostates, 272 with 40-60 g prostates, 112 with60 g prostates). Median follow-up was 22 months; PSA was higher in larger prostates (6.6 vs. 6.8 vs. 8 ng/mL). Nerve-sparing and bladder-neck sparing procedures were in similar percentages. Larger prostates required longer surgeries (90 vs. 100 vs. 100 minutes, P=0.002). Perioperative results were similar (blood loss, discharge, complications, catheter removal). Larger prostates had more frequently localized disease (pT2 in 49.5% vs. 60.7% vs. 68.5%; P=0.001); PSMs were similar both in pT2 (15.5% vs. 9.4% vs. 11.8%) and in pT3 cases (40.1% vs. 42% vs. 34%). In the three study groups, immediate continence was reached by 88%, 89.5% and 81.3% (P=0.045), while no differences were observed concerning continence (93.4%, 94.1%, 94.7%; P=0.892) or potency after follow-up.RSP is feasible in patients with prostates of any volume, with similar oncological and functional outcomes. Despite being inferior to the figures obtained in low volume prostates, the very high immediate continence rates observed in larger prostates encourage the use of this approach also in larger prostates.

Robot-assisted laparoscopic radical prostatectomy (RARP) is currently the standard surgical treatment for localized prostate cancer. Since 2010, Dr. Aldo Bocciardi has developed a new anatomical approach through the rectovesical pouch at Niguarda Hospital in Milan.

The Retzius-sparing approach for Robot-assisted laparoscopic radical prostatectomy (RARP) was born in 2010 at Niguarda Hospital in Milan from an original idea of Aldo Bocciardi. Since then, more than 1200 cases have been operated at Niguarda, and several hundreds in many centers throughout the world.