Despite advancements in prostate multiparametric magnetic resonance imaging (mpMRI) and fusion biopsy (FB), the management of incidental prostate cancer (IPCa) after surgery for benign prostatic obstruction (BPO) remains unclear. The aim of this retrospective study is to determine the prevalence of IPCa in our cohort and identify potential predictors for its occurrence. We enrolled patients underwent TURP or simple prostatectomy for BPO at our high-volume center between January 2020-December 2022. Data on age, pre-operative total PSA (tPSA) and PSA density (PSAd) levels, prostate volume, previous MRI, biopsies, specimen weight, rates of positive tissue slices, ISUP score and three-month tPSA were collected. Of 454 patients with negative digital rectal examination who underwent BPO surgery, 74 patients (16.3

using Log-rank test. RESULTS: After screening, 629 patients were identified in the NCDB with cN0M0 UC. Median patient age was 59.0 years, and median tumor size was 4.0 cm. Surgical margins were positive in 61 of 516 (12%) patients who had complete margin status documented. Lymphadenectomy was performed at the time of surgery in 326 (52%) patients, of whom 66 (20%) had pNþ disease. Death occurred in 329 (52%) patients, with a median OS of 73 months (95% CI 67.8-79.4). The results of the OS analysis are shown in Table 1. Tumor size >5cm contributed to a lower OS (63 vs. 77.2 months, p[0.05). The incidence of pNþ cancer increased with primary tumor size (Table 2). CONCLUSIONS: High rates of positive surgical margins and lymph node positive disease advocate for wide surgical excision and routine lymphadenectomy as standard of care in patients with UC. Despite excluding patients with cNþMþ UC, study limitations include the presence of surgeon selection bias for lymphadenectomy.

significant (39.0% vs. 47.4%, p[0.518). The overall complication rate was 1.7%. There were 3 complications, an infection in the aspiration alone group, a postoperative bleed in the STDS group, and a repeat procedure for severe pain in the STDS group. These were not statistically significant. CONCLUSIONS: Ethanol was the most effect sclerotic agent in our patient cohort. Though similarly effective, STDS is interestingly roughly twice as expensive as ethanol at our institution. Hydrocele recurrence was not significantly improved with STDS however, though it did delay timing to recurrence onset. We conclude that ethanol sclerosis is both more effective, and cost effective, than STDS sclerosis. Future studies with increased patient numbers may help confirm these conclusions.

You have accessJournal of UrologyCME1 May 2022MP32-20 LAPAROSCOPIC VERSUS ULTRASOUND GUIDED TRANSVERSUS ABDOMINIS PLANE (TAP) BLOCK FOR POSTOPERATIVE ANALGESIA AFTER RADICAL PROSTATECTOMY: A RANDOMIZED CONTROLLED TRIAL Angelo Civitella, Francesco Prata, Piergiorgio Tuzzolo, Luca Romei, Vito Giuseppe Crimi, Francesco Tedesco, Alberto Ragusa, Noemi Deanesi, Antonio Testa, Loris Cacciatore, Gerardo Paolo Flammia, Antonio Alcini, Annamaria Salerno, Salvatore Mario Prata, Francesco Esperto, Roberto Mario Scarpa, and Rocco Papalia Angelo CivitellaAngelo Civitella More articles by this author , Francesco PrataFrancesco Prata More articles by this author , Piergiorgio TuzzoloPiergiorgio Tuzzolo More articles by this author , Luca RomeiLuca Romei More articles by this author , Vito Giuseppe CrimiVito Giuseppe Crimi More articles by this author , Francesco TedescoFrancesco Tedesco More articles by this author , Alberto RagusaAlberto Ragusa More articles by this author , Noemi DeanesiNoemi Deanesi More articles by this author , Antonio TestaAntonio Testa More articles by this author , Loris CacciatoreLoris Cacciatore More articles by this author , Gerardo Paolo FlammiaGerardo Paolo Flammia More articles by this author , Antonio AlciniAntonio Alcini More articles by this author , Annamaria SalernoAnnamaria Salerno More articles by this author , Salvatore Mario PrataSalvatore Mario Prata More articles by this author , Francesco EspertoFrancesco Esperto More articles by this author , Roberto Mario ScarpaRoberto Mario Scarpa More articles by this author , and Rocco PapaliaRocco Papalia More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002581.20AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: To evaluate the efficacy of laparoscopic TAP block in relation to the US-TAP block comparing: surgery time, operating room time, post-operative pain, use of opioids and hospitalization in patients undergoing laparoscopic radical prostatectomy. METHODS: From January 2021 to June 2021, 60 consecutive patients undergoing laparoscopic radical prostatectomy were enrolled and randomized in two groups receiving US or LAP guided TAP block. The primary outcome was pain score expressed by a 0-10 Visual Analogic Scale (VAS) evaluated in the first 72 hours after surgery. Secondary outcomes included postoperative opioid consumption, surgical time, complications, time to ambulation and total hospital length of stay. RESULTS: No statistically significant differences were observed between the two groups in surgery time, blood loss, time to ambulation, length of stay and pain after surgery. In the LAP tap-block group the overall operating room time was significantly shorter than in the US tap-block group (140’ vs 152’ P=0,04). CONCLUSIONS: Laparoscopic approach compared to US-TAP block was equally safe, not inferior in reducing analgesic drugs use post operatively. Moreover, the LAP TAP block has proven to be a time sparing procedure. Further studies with a larger sample are expected to confirm the efficacy LAP guided TAP block in urologic surgery. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e540 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Angelo Civitella More articles by this author Francesco Prata More articles by this author Piergiorgio Tuzzolo More articles by this author Luca Romei More articles by this author Vito Giuseppe Crimi More articles by this author Francesco Tedesco More articles by this author Alberto Ragusa More articles by this author Noemi Deanesi More articles by this author Antonio Testa More articles by this author Loris Cacciatore More articles by this author Gerardo Paolo Flammia More articles by this author Antonio Alcini More articles by this author Annamaria Salerno More articles by this author Salvatore Mario Prata More articles by this author Francesco Esperto More articles by this author Roberto Mario Scarpa More articles by this author Rocco Papalia More articles by this author Expand All Advertisement PDF downloadLoading ...

BACKGROUND: The COVID-19 pandemic induced a global emergency that overwhelmed most hospitals around the world. Access to hospitals has been restricted to selective oncological and urgent patients to minimize surgeries requiring Intensive Care Unit care. All other kind of non-urgent and benign surgeries have been rescheduled. The burden of oncological and urgent cases on the healthcare system has increased.METHODS: We have been asked to become the referral center for major oncological and urgent urological surgeries, increasing our surgical volume. Through meticulous hospital protocols on PPE, use of nasopharyngeal swabs, controlled hospital access and the prompt management of suspected/positive cases, we were able to perform 31% more urological surgical procedures during the COVID-19 pandemic compared to the same period in 2019.RESULTS: We observed a 72% increase in oncological surgical procedures and 150% in urgent procedures.CONCLUSIONS: Our experience shows how the management of oncological and urgent cases can be maintained during unexpected, global emergencies, such as COVID-19.

OBJECTIVES:To report the data from a single series of 46 patients who underwent cystectomy and Padua ileal bladder (PIB) substitution during a 48-month period. Data are lacking concerning the changes in urodynamic characteristics of the orthotopic ileal neobladder. METHODS:From January 2002 to April 2003, 46 consecutive male patients underwent radical cystectomy and PIB substitution for muscle-invasive bladder cancer. Uroflowmetry, cystometry, and urethral pressure profilometry were analyzed at 12 and 48 months after surgery. All patients were asked to complete a questionnaire regarding quality of life (the European Organization for Cancer Research and Treatment of Cancer Quality of Life Questionnaire and the bladder cancer-specific module). RESULTS:Of the 46 patients, 8 were lost to follow-up because of cancer-related death. When comparing the 12- and 48-month urodynamic characteristics, no significant changes were observed in cystometric capacity or urethral closing pressure. However, the end-filling pressure, peak flow pressure, and postvoid residual urine volume were significantly lower at the 48-month evaluation (P = .0005, P = .0007, and P = .013, respectively). The number of involuntary contractions at 48 months had increased significantly (P = .0012), and the amplitude of the contractions was comparable (P = .084). The daytime continence rate was 96% and 90% at 12 and 48 months, respectively. The nighttime continence rate was 60% at the 48-month evaluation. The questionnaires about the quality of life highlighted the excellent results. CONCLUSIONS:An ileal tone is maintained despite detubularization and most likely prevents enlargement of the neobladder. PIB was revealed to maintain an adequate capacity and low pressure during a 48-month period. The urodynamics results and quality of life support this urinary diversion as a valid treatment option for muscle-invasive bladder cancer.

OBJECTIVE:To investigate the prevalence of asymptomatic bacteriuria (ABU) and urinary tract infection (UTI), and the local and systemic inflammatory response, in patients with ileal neobladder.PATIENTS AND METHODS:The study included 40 patients who had a radical cystectomy and ileal neobladder. Two urine samples, one for chemical and physical analysis, and cytofluorimetry, and one for urine culture, were collected every 3 months for 9 months after surgery.RESULTS:Of 119 urine cultures, 69 (57%) were positive for bacteria. Only nine of the 40 patients had no bacteriuria on urine culture. Escherichia coli strains were cultured from eight of 10 patients with persistently positive urine. The incidence of bacteriuria was different according to gender. There was a high concentration of leukocytes (0-6 microL) in 118 of 119 samples. The mean concentration of leukocytes in sterile urine culture was 1181/microL, while in patients with ABU the mean was 491 (P < 0.05).CONCLUSION:A positive urine culture is a very common finding in patients with an orthotopic bladder. The most interesting results was the absence of elevated inflammatory indices and/or symptoms, even in those patients with high levels of bacteriuria. Probably this is due to the completely different inflammatory response of ileal mucosa against bacteria than has bladder mucosa. Indeed, the leukocyte concentration detected in urinary sediment was inversely association with bacterial growth in urine cultures. These findings suggest a redefinition of ABU and UTI in patients with an orthotopic neobladder.

PURPOSE We evaluated the collagen content and differentiation of the ureteropelvic junction (UPJ) of patients who underwent Anderson-Hynes dismembered pyeloplasty after failure of antegrade endopyelotomy. MATERIALS AND METHODS A total of 12 UPJ obstructions were examined more than 12 months after endopyelotomy with both histochemical staining to analyze total collagen content and immunohistochemical staining to analyze collagen types I and III. The specimens were compared with 12 primary UPJ obstructions and 6 normal UPJs. Statistical analysis was performed using Fisher's test and Wilcoxon matched-pairs signed-rank test. RESULTS Immunohistochemical staining revealed that collagen type I was located in the interfascicular space and collagen type III in the intrafascicular space in all UPJs. We found more collagen in obstructed than in normal UPJs. Collagen type III was more abundant in secondary than in primary UPJ obstructions (P < 0.01). In obstruction after endopyelotomy, the staining intensity of collagen type III was greater than the intensity of collagen type I (P < 0.01). CONCLUSION Our results suggest that the success of antegrade endopyelotomy was impaired by an inflammatory process. This condition determined a shift of collagen differentiation toward type III, which is more fibrous than type I.

PURPOSE:We compare the absorption of D-xylose and vitamin B12, and the metabolic status in ileocecal and ileal orthotopic neobladders.MATERIALS AND METHODS:D-xylose plasma levels after an oral load, body composition, plasma vitamin B12, acid base and electrolyte balance were studied in 33 patients with an ileocecal reservoir and 13 patients with an ileal reservoir. Mean followup was 55 months. Results of both types of operation and a healthy control group were compared.RESULTS:Plasmic levels of D-xylose and vitamin B12 were significantly lower in the ileal reservoir than in ileocecal reservoir group and normal controls.CONCLUSIONS:Despite an acceptable body composition, intestinal malabsorption could be present in patients with an ileal reservoir but the ileocecal tract appears to be safe.