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Objectives: Several trials have dealt with residents well-being and burn-out, few data are available on residents Sexual Health. We aim to investigate Sexual Health among Italian residents in urology. Methods: Female Sexual Function Index (FSFI), Brief Index of Sexual Functioning Male (BISF-M), General Health Survey (SF-36) and Beck Depression Inventory Primary Care (BDI-PC) questionnaires were webbased administered to 299 residents from all of the 25 Italian Residency Programs. Data included: year of training (PGY), location, age, gender, sexual orientation, marital status, children, duty hours. Mean level differences in BDI-PC, FSFI and BISF-M levels for between-people variables such as gender, day/night shifts and children were inspected via ANOVA; correlations between depression and sexual functioning were investigated. Results: Responding rate 49%. Mean age 30.4 (SD 2.2), 83% M, 86% F had stable relationship, 33% engaged to a colleague, 6% had children. 97% heterosexual, 2% bisexual, 1% homosexual. 19% F reported FSFI total score < 26, indicating a possible sexual dysfunction. 33% F, 11% M had a BMIPC >3, indicating a mild to severe depression level. 64% did night shifts, ANOVAs revealed a significant interaction effect (p < 0.05, eta square ¼.06) between sexual function and night shifts on BDI-PC levels; F with night shifts reaching a critical mean BDI-PC score of 4.21. Higher BDI scores were associated with lower FSFI Arousal (p< 0.001), higher FSFI Dyspareunia (p< 0.05), lower FSFI total scores (p< 0.05). No correlations between BDI-PC and BISF-M or between sexual satisfaction and PGY, stable relationship and workload. Conclusion: Residency is a stressful period and personal relationship may be affected. These results indicate that female suffer more than male from such an experience. These findings highlight the importance of introducing stressmanagement efforts in residency programs to improve sexual health and quality of life with probable positive effects on residents work.

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Introduction Lymphoid neoplasms of the urinary tract and male genital organs are relatively rare, comprising less than 5% of all primary extranodal lymphomas; only a handful of small case series and isolated case reports have been published to describe their predominant sites and subtypes. Material and Methods We searched our institution's electronic archive of pathology reports from 2001 to 2012. We considered lymphoid neoplasms involving the kidney, bladder, testes and prostate. Patient age at diagnosis, sex, clinical history, and outcome were recorded using the relevant electronic medical records. Results We identified 25 patients with lymphoid neoplasms of the urogenital tract. 11 cases out of 40 were primary genitourinary lymphomas. Mean age at diagnosis was 61.7 years (range 13–87 years). Among bladder lymphomas cases, a male predominance was noted. As regards the types of lymphoid neoplasms, the following subtypes were observed: diffuse large B-cell lymphoma (32%), chronic lymphocytic leukemia (24%), small lymphocytic lymphoma (20%), Malt lymphoma (8%), Burkitt lymphoma (4%), follicular lymphoma (4%); diffuse large B-cell ALK+ (4%) and lymphoblastic lymphoma (4%). Conclusions Genitourinary tract lymphomas most commonly occurred in the kidney. B-cell non-Hodgkin's lymphomas were predominant, with diffuse large B-cell lymphoma being the most common subtype in the entire group. Although this study confirms the predominance of diffuse large B-cell lymphoma in extranodal sites, the findings also highlight the variety of lymphomas that may occur in the genitourinary tract. This diversity of subtypes affirms the importance of fully characterizing lymphomas by immunohistochemistry and other modalities, which are indispensable for accurate diagnosis.

Background Several trials have reported on the impact of social restrictions due to SARS-CoV-2 (COVID-19) pandemic on sexual function and psycho-physical well-being. However, data showing modifications of these outcomes over time and at the end of lock-down are scant. Aim We investigated the longitudinal changes in sexual function during social restrictions for COVID-19 pandemic in Italy. Methods A web-based survey was administered to Italian citizens of legal age via social networks. The Beck Depression Inventory Primary Care, the General Health Survey, Female Sexual Function Index, International Index of Erectile Function, UCLA Loneliness Scale-version 3 questionnaires were used to test mental, physical and sexual well-being. The questionnaires were administered at the beginning of the lockdown (T0), 15 days from the first assessment (T1) and 1 month after the end of the restrictions in 2020 (T2). Outcomes Descriptive statistics and multiple regression analysis were applied to investigate changes in sexual function over and at the end of social restrictions. Results Data were available for 2543 people (47.2% of men; 43.4% women; 9.4% undefined). Mean age was 48.3 ± 15.1 years for males and 43.9 ± 13.4 for females. Overall, 2.6% reported depressive symptoms according to Beck Depression Inventory Primary Care, 7.4% reported a high level of UCLA loneliness and 19.4% low levels of general mental health. Mild to severe erectile dysfunction was reported by 59.1% of men at T0, while 68.4% of women reported sexual dysfunction. Sexual function levels remain generally unchanged at further follow-up over the social restriction time period (T1), although those who were sexually active at baseline showed a decrease in sexual function scores. At T2, there was an overall improvement in sexual function scores with a rate of severe erectile dysfunction decreasing from 37.1% to 24.1% from T0 to T2 among males and a significant decrease of female sexual dysfunction from 68.4% to 51.2%. Clinical Implications Young individuals and those with good mental and physical health were more likely to improve sexual function at the end of social restrictions. Strengths & Limitations Valid and reliable questionnaires and longitudinal approach design represent strengths; a large but convenient sample and lack of pre-pandemic baseline data represent limits. Conclusion Social restrictions due to COVID-19 pandemic led to an increase in sexual dysfunctions in both genders. However, these conditions appeared temporary since an overall improvement was observed at the end of lockdown and especially in younger individuals with higher psycho-physical well-being.

PURPOSE: No questionnaire is currently available to evaluate sexual function after male-to-female gender affirming surgery. Such a limit leads to a suboptimal evaluation in postoperative sexual function in these patients. We developed and validated a new questionnaire, the oMtFSFI (operated Male-to-Female Sexual Function Index), for assessing sexual function in male-to-female patients after surgery. MATERIALS AND METHODS: A panel of experts in gender dysphoria defined the main content areas to be assessed, including genital self-image, desire, arousal, lubrication, orgasm, satisfaction and sexual pain. After a pretest on 10 patients the oMtFSFI was applied in the main study to 65 operated male-to-female patients, recruited at 7 Italian centers, and 57 women. The participants provided self-ratings on online oMtFSFI, Female Sexual Function Index, Beck Depression Inventory for Primary Care and Short Form Health Survey questionnaires. Operated male-to-female patients completed the oMtFSFI twice, 4 weeks apart. RESULTS: Principal component analysis performed on self-ratings provided by operated male-to-female patients on oMtFSFI items yielded a 3-domain structure of sexual dissatisfaction, sexual pain and genital self-image. The 3 domains were internally consistent and test-retest reliable. Convergent associations with Female Sexual Function Index scales emerged for sexual dissatisfaction and sexual pain but not for genital self-image. Male-to-female patients reported lower sexual function levels than cisgender women. CONCLUSIONS: The present preliminary results support reliability and psychometric validity of the oMtFSFI in the assessment of key sexual function domains in transgender women, further revealing that genital self-image represents an assessment area to be considered in male-to-female patients, in addition to domains that are salient for cis women as well.

Purpose: The aim of this article is to describe our modified surgical technique for the reconfiguration of the glans in the clitoris and the labia minora, known as the “M-shape neoclitorolabioplasty”. Methods: The glans with all its neurovascular bundle is isolated from the corpora cavernosa, incised in Y-shape mode and spread in order to obtain an M-shape glandular flap. The “belly” of the M-shape glans will constitute the triangular neoclitoris meanwhile the lateral flaps will constitute the labia minora. The inferior apex of the neoclitoris is fixed to the superior apex of the previously spatulated urethra. The two glans flaps are incised transversally to increase their length and sutured to the sides of the spatulated urethra forming the labia minora. Our technique permits to create an aesthetically pleasing neovagina preserving all the glandular erogenous sensitivity. Results: 94 patients have been treated with our modified technique of male-to-female (MtoF) gender affirming surgery. At median follow-up of 27.57 months, 81 (86.1%) patients reported vaginal intercourse and 78 (82.9%) patients referred presence of erogenous sensitivity during dilatations, intercourse or masturbations. All the glandular tissue is preserved and reconfigured forming the neoclitoris and the labia minora. The M-shape reconfiguration permit to create an aesthetically pleasant neoclitoris. Conclusions: This technique could be applied safely and easily to patients undergoing gender affirming surgery, allowing the creation of a neovagina with the best possible erogenous sensitivity without losing aesthetical results.

Aim of the study: Several trials have dealt with residents well-being and burn-out, however, few data are available on residents Sexual Health. We aim to investigate Sexual Health among Italian residents in urology. Materials and methods: Between March and August 2018 Female Sexual Function Index (FSFI), Brief Index of Sexual Functioning Male (BISF-M), General Health Survey (SF-36) and Beck Depression Inventory Primary Care (BDI-PC) questionnaires were web-based administered to 299 residents from all of the 25 Italian Residency Programs. Data included: year of training (PGY), location, age, gender, sexual orientation, marital status, children, duty hours. Mean level differences in BDI-PC, FSFI and BISF-M levels for between-people variables such as sex (BDI-PC only), day/night shifts, and children were inspected via ANOVA; correlations between depression and sexual functioning were investigated as well. Results: The responding rate was 49%, 101 males (M), 50 females (F); 38 surveys were however incomplete, and the final sample consisted of 113 participants. They well represent the PGYs. Mean age was 30.4 (SD 2.2), 83% M and 86% F had a stable relationship, 33% of the residents were engaged to a colleague (35%M, 42%F), 6% had children (5%M, 6%F). 97% defined themselves heterosexual, 2% bisexual, 1% homosexual. Among females, 19% reported a FSFI total score below the critical value of 26, indicating a possible sexual dysfunction. In addition, 33% F and 11% M had a BMI-PC score >3, indicating a mild to severe depression level. Such percentages are higher than the quoted lifetime prevalence of depression in Italian general population (1.7% age group 15–44 years). 64% of the residents did night shifts, ANOVAs revealed a significant interaction effect ( p < 0.05, eta square=.06) between sex and night shifts on BDI-PC levels, with women with night shift work reaching a critical mean BDI-PC score of 4.21. Chi square analysis also demonstrated that women with night vs day-only shifts reported BDI scores in the critical range (p

Introduction The aim of this study is to accomplish a systematic review on the surgical techniques available for male-to-female gender assignment surgery (MtoF GAS) published in the last 15 years, from January 2002 to May 2017, assessing advantages and disadvantages. Evidence acquisition A specific search on MEDLINE, Scopus and Web of Science databases included vaginoplasty for gender exchange. Preoperative (age, gender, body mass index, prior surgery), intraoperative (mean operating time, intraoperative complications, transfusion rate, conversion rate), postoperative (hospital stays, readmission rate, early and late complication rate), postoperative sexual activity, subjective satisfaction, vaginal depth, and long-term outcomes (vaginal stenosis, prolapse, dyspareunia and labial abscess) data of vaginoplasty for sexual exchange were collected. 29 articles were included (2.402 patients). Evidence synthesis Out of the 29 papers, 19 studies assessed penile skin inversion and 10 evaluated intestinal vaginoplasty. No comparative studies were found. Penile skin inversion vaginoplasty reported slightly shorter operative time compared to intestinal vaginoplasty (109-420 vs 145-420 minutes). Intraoperative complications for penile skin inversion vaginoplasty not exceeded an incidence of 10%. No significant differences in terms of postoperative complications or hospitalization time were reported. Intestinal vaginoplasty provides a deeper neovagina. Female Sexual Function Index score was significantly higher in patients undergoing intestinal vaginoplasty. Conclusions A standardized data collection may allow a better understanding of effectiveness and outcomes of different techniques.