INTRODUCTION:Even today, despite technological evolution, erectile dysfunction remains the most feared complication after radical prostatectomy surgery expecially for patients who report pre-existent refractory erectile dysfunction (ED) and patients in whom there is a high risk of extracapsular disease, such as any cT2c or cT3, who undergo non-nerve sparing radical prostatectomy (RP). To overcome this issue, Khoudary et al. performed the first simultaneous placement of a penile prosthesis during open RP in 1997, aiming at an early return to sexual function without any impact on oncological outcomes and without significant adverse effects. Ten years ago we performed laparoscopic extraperitoneal RP and simultaneous penile prosthesis implantation (PPI) on ten patients in order to preserve the full length of the penis and to improve their satisfaction and quality of life (QoL) increasing the chances of ED resolution. OBJECTIVES:Aim of this study is to illustrate the ten years follow up of this case series which has no terms of comparison in the world. Oncological and functional results were analyzed. MATERIALS AND METHODS:In 2013 10 patients underwent simultaneous PPI (with an AMS InhibiZone prosthesis). Patients were evaluated by means of urological visits, questionnaires, and objective measurements before surgery, at discharge from the hospital, on postoperative days 21 to 28, each 3 months for the first year, and each year thereafter. The main outcome measures were biochemical recurrence-free rate, penile length and quality of life. RESULTS:Eight patients with mean age 71 (range 66-75) were reached at the 10-year follow-up; one patient died of acute infarction 10 years after surgery and another one died of disease 7 years after surgery. Partners had, currently, mean age 60 (range 37-71). Mean preoperative PSA was 9.3 (6.3-13.7) and mean PSA at 10 years was 0.08 (range 0.01-1.2). International index erectile function IIEF before surgery was 11 (range 9-14) and 23 (range 22-25) at 10 years. Partner satisfaction rating increased from 7 (post-surgical) to 8 at 10 years. Penis length was unchanged after 10 years: mean intraoperative length was 9 cm (range 8.5-9.5) and mean length at 10 years was 8.8 cm (range 8-9.5). CONCLUSIONS:In our cases, laparoscopic radical prostatectomy with the simultaneous implant of a penile prosthesis demonstrate to be an interesting option to offer to selected and highly motivated patients. Outcomes like preservation of the penis length, resuming of normal sexual activity 21 days after surgery, partner satisfaction and oncological safety at 10-year follow-up make it a valid surgical technique to be proposed in clinical practice if performed by an experienced team in prosthetic surgery.

BACKGROUND:Teupolioside effectively reduced hirsutism in policystic ovary sindrome by lowering hormonal levels, thus suggesting potential for benign prostatic hyperplasia (BPH) treatment. This study will assess Dihydrotestosterone (DHT) levels and prostate inflammation in BPH patients before and after Xipag® (Ajuga Reptans extract) administration. METHODS:Formalin-fixed paraffin embedded (FFPE) samples from prostate biopsies (PB) and trans-urethral resection (TURP) specimens of 10 patients with elevated Prostate Specific Antigen (PSA) were analyzed. All had prostate inflammation and BPH at biopsy and received Xipag® (1 tablet/day, median 50 days) between PB and TURP. DHT tissue levels, CD4+, and CD8+ lymphocyte expression were assessed via 3'-3' diaminobenzidine staining on 5 µm sections. Serum PSA levels were measured before PB and prior to TURP. All antigens were visualized using the same secondary antibody, producing a uniform brown stain. A paired t-test compared conditions. RESULTS:Total PSA serum levels dropped from 4.21 (3.61-8) ng/mL pre-PB to 2 (1.53-3.03) ng/mL post-Xipag® and pre-TURP (P=0.016). Xipag® significantly reduced CD4+ recruitment by 46.1% and increased CD8+ by 19.89%, enhancing CD4+ target cell elimination (P=0.0003; P=0.0006), indicating inflammatory normalization in BPH tissue. DHT expression decreased by 26.67% post-treatment (P=0.0002; CI -36.08, -17.25). CONCLUSIONS:The short period of Xipag® administration effectively reduced DHT and PSA levels in patients affected by BPH. Additionally, it decreased CD4+ T lymphocyte infiltration while promoting CD8+ T lymphocytes, leading to a normalization of the prostate tissue inflammatory infiltrate.

Photodynamic diagnosis (PDD) significantly enhances the detection of bladder cancer (BCa) and is able to reduce the risk of disease recurrence, although it may not affect disease progression and mortality rates. Despite its advantages, widespread adoption of PDD is limited by cost considerations and the absence of unified guidelines on its application, highlighting the need for continued evaluation of its cost-effectiveness across different healthcare settings. To date, no specific recommendations for PDD in non-muscle invasive bladder cancer (NMIBC) management have been provided by the Italian Society of Urology (Società Italiana di Urologia, SIU). Therefore, the aim of this paper is to report on the position of SIU on the role of PDD in NMIBC. According to available evidence and international guidelines (i.e., European Association of Urology, American Association of Urology, National Comprehensive Cancer Network and other national guidelines) on BCa, a Panel of twelve Italian urologists with long and renowned experience in treating BCa defined current indications for PDD in the management of NMIBC. The final document was ultimately reviewed and approved by the expert Panel prior to publication. The consensus highlighted the role of PDD during the initial transurethral resection of the bladder (TURB) to detect carcinoma in situ (CIS) and small papillary lesions that might otherwise be missed, leading to disease persistence. Additionally, in clinical scenarios such as positive urine cytology with negative cystoscopy, PDD-guided biopsies can significantly increase the detection of CIS. For cases involving larger or multifocal tumors, or atypical macroscopic features during cystoscopy, PDD is valuable for identifying subtle high-grade disease elements, thereby facilitating more precise risk stratification and targeted treatment planning. In the setting of re-TURB, aiming to detect the presence and extent of concomitant CIS and to gain all possible additional information, PDD may be used in all procedures if not already performed during initial resection. Finally, PDD may be used for disease recurrence in patients with a history of HG NMIBC and to evaluate the response of CIS to Bacillus Calmette-Guérin (BCG). This position paper of the SIU highlights the current recommendation for the use of PDD in the management of NMIBC, from initial TURB, to re-TURB and follow-up.

INTRODUCTION:Our goal was to evaluate the role of supine extraperitoneal single-port radical prostatectomy on intraoperative ventilatory and cardiovascular parameters and on surgical outcomes compared with a cohort of patients treated with the Trendelenburg-associated transperitoneal approach. METHODS:Data from all consecutive patients who underwent radical prostatectomy between September 2019 and January 2024 were prospectively collected and retrospectively analyzed. Patients were divided into 2 groups based on the surgical approach: single-port supine extraperitoneal (SP-EP-RARP) and multiport or single-port transperitoneal (MP-TP-RARP or SP-TP-RARP) radical prostatectomy. Intraoperative ventilatory and cardiovascular parameters were collected from anesthesia induction to the end of the procedure, and perioperative surgical outcomes were assessed. RESULTS:A total of 211 patients who underwent robot-assisted radical prostatectomy were analyzed: 97 (46%) underwent MP-TP-RARP or SP-TP-RARP, whereas 114 (54%) underwent SP-EP-RARP. The median peak inspiratory pressure and end-tidal CO2 were significantly lower throughout the surgery in the SP-EP-RARP group (P < .001 and P = .02, respectively). Similar results were found for median systolic and diastolic blood pressure. SP-EP-RARP was associated with lower postoperative pain, fewer narcotic administrations, shorter length of stay, and fewer postoperative complications. After adjusting for age, American Society of Anesthesiologists score, and Charlson Comorbidity Index, the transperitoneal approach was found to be an independent risk factor for complications. CONCLUSIONS:The supine SP-EP approach improved intraoperative ventilatory and cardiovascular outcomes, reducing postoperative pain, length of stay, and complications. This finding is constrained by the retrospective design and the involvement of 4 surgeons with differing experience. Notably, the surgeon with the highest volume was also the sole user of the SP-EP approach, introducing biases.

BACKGROUND:Peyronie's disease (PD) is a progressive fibrotic disorder of the tunica albuginea that impairs penile anatomy, sexual function, and quality of life. With no approved pharmacological treatments in Europe after the withdrawal of collagenase Clostridium histolyticum (CCH), intralesional hyaluronic acid (HA) has emerged as a potential option. This study aims to assess the clinical effectiveness of HA in PD, focusing on patient-reported outcomes via the Peyronie's Disease Questionnaire (PDQ). METHODS:This prospective observational study included patients treated with weekly intralesional HA injections for 8 weeks, combined with penile modeling and daily tadalafil. Inclusion required a penile curvature >30° and at least one episode of penetrative intercourse within the past 3 months. Penile curvature, IIEF-5, and PDQ scores were assessed at baseline and after 3 months. RESULTS:Sixty-six patients were included. Total PDQ scores improved from 61.5 (50.0-67.0) to 40.0 (26.8-49.0; P<0.001), with a mean reduction of -19.9±9.7. Specifically, all three domains of the PDQ questionnaire (Penile Pain, Penile Deformity, and Symptom Bother) showed a significant improvement (P<0.001). No adverse events were recorded. CONCLUSIONS:Intralesional HA injections are safe and effective in improving patient's reported symptoms and subsequently quality of life in PD patients. This therapy may represent a valuable alternative in real-world clinical practice, especially in Europe where other pharmacological options are lacking.

BACKGROUND: Prognostic tools in pathological-node (pN) patients after radical cystectomy (RC) are needed. OBJECTIVES: To evaluate the prognostic impact of lymph node (LN)-density on disease-specific survival (DSS) in patients with bladder cancer (BC) undergoing RC with pelvic lymph node dissection. METHODS: We analyzed a multi-institutional cohort of 1169 patients treated with upfront RC for cT1-4aN0M0 urothelial BCat nine centers. LN-densitywas calculated as the ratio of the number of positive LNs×100% to the number of LNs removed. The optimal LN-density cut-off value was defined by creating a time-dependent receiver operating characteristic (ROC) curve in pN patients. Univariable and multivariable Cox’ regression analyses were used to assess the effect of conventional Tumor Nodes Metastasis (TNM) nodal staging system, LN-density and other LN-related variables on DSS in the pN-positive cohort. RESULTS: Of the 1169 patients, 463 (39.6%) patients had LN-involvement. The area under the ROC curve was 0.60 and the cut-off for LN-density was set at 20%, 223 of the pN-positive patients (48.2%) had a LN-density ≥ 20%. In multivariable models, the number of LN-metastases (HR 1.03, p = 0.005) and LN-density, either as continuous (HR 1.01, p = 0.013) or as categorical variable (HR 1.37, p = 0.014), were independently associated with worse DSS, whereas pN-stage was not. CONCLUSIONS: LN-density ≥ 20% was an independent predictor of worse DSS in BC patients with LN-involvement at RC. The integration of LN-density and other LN-parameters rather than only conventional pN-stage may contribute to a more refined risk-stratification in BC patients with nodal involvement.

BACKGROUND: On March 11th 2019, European Medicines Agency (EMA) issues a warning after a review of serious, disabling and potentially permanent adverse events (AEs), particularly on musculoskeletal and nervous system, with quinolone (QN) and fluoroquinolone (FQ) antibiotics. Aim of this study was to evaluate the effect of the EMA warning on the rate of AEs after QN and FQ treatments, reported in the EudraVigilance (EV) database.METHODS: EV database is the system for managing and analyzing information on suspected AEs to medicines which have been authorized or being studied in clinical trials in the European Economic Area (EEA). We retrospectively ex-plored the effect of FQs and QNs on musculoskeletal and nervous system from the EMA warning up to now (21 months) and compared these results with the 21 months before the EMA warning.RESULTS: Main part of AEs in EV database were reported for ciprofloxacin, levofloxacin, moxifloxacin, norfloxacin, ofloxacin. Ciprofloxacin total AEs before 21 months till 12 months of EMA warning were 2763. 12 months before EMA Warning they were 2935. Twelve months after EMA Warning they were 3419. Between 12 months till 21 months they were 3174. Musculoskeletal disorders were respectively 574 (21% of the total) 21 months before, 558 (19%) 12 months before, 1048 (31%) after 12 months, 540 (17%) after 21 months of EMA Warning. Nervous system disorders were re-spectively 606 (22% of the total) 21 months before, 517 (18%) 12 months before, 680 (20%) after 12 months, 560 (18%) after 21 months of EMA Warning (respectively OR 1,16 95%CI 1,10-1,22, P 0,12 ; OR 0,76 95%CI 0,69-0,83, P 0,27 ; OR 1,01 95%CI 0,96-1,06 P 0,05). CONCLUSIONS: Our analysis clearly showed no significant differences before and after EMA warning, opening new insights in the role of the EMA warning in clinical practice.

Background and Objectives: To date, sparse evidence exists about the impact of inflammatory serum markers in predicting perioperative complications after radical cystectomy (RC) for bladder cancer (BC). Here, we evaluated the role of the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), systemic immune-inflammation index (SII), C-reactive protein (CRP), and plasma fibrinogen in predicting perioperative morbidity and unplanned 30-days readmission after RC for BC. Materials and methods: We relied on a collaborative database of 271 patients who underwent open RC for cT1-4a N0 M0 BC between January 2012 and December 2022. Univariable and multivariable binomial logistic regression analyses were performed to assess the odds ratio (OR) with 95% confidence intervals (CI) testing the ability of each serum marker to predict postoperative complications (any-grade and major complications), and 30-days unplanned readmission. Results: The median age at RC was 73 yr (IQR 67–79). A total of 182 (67.2%) patients were male and the median BMI was 25.2 (IQR 23.2–28.4). Overall, 172 (63.5%) patients had a Charlson Comorbidity Index (CCI) greater than 2 points and 98 (36.2%) were current smokers at the time of RC. Overall, 233 (86.0%) patients experienced at least one complication after RC. Of these, 171 (63.1%) patients had minor complications (Clavien–Dindo grade 1–2) while 100 (36.9%) experienced major complications (Clavien–Dindo grade ≥ 3). According to multivariable analysis, current smoking status, high plasma fibrinogen, and preoperative anemia were independently associated with major complications (OR 2.10, 95%CI 1.15–4.90, p = 0.02), (OR 1.51, 95%CI 1.26–1.98, p = 0.09), and (OR 1.35, 95%CI 1.17–2.57, p = 0.03), respectively. Overall, 56 (20.7%) patients experienced a 30-days unplanned readmission. According to univariable analysis, high preoperative CRP and hyperfibrinogenemia were significantly associated with an increased risk of unplanned readmission (OR 2.15, 95%CI 1.15–4.16, p = 0.02; OR 2.18, 95%CI 1.13–4.44, p = 0.02, respectively). Conclusions: In our study, the preoperative immune-inflammation signature described by NLR, PLR, LMR, SII, and CRP showed a low reliability in predicting perioperative course after RC. Preoperative anemia and hyperfibrinogenemia were independent predictors of major complications. Further studies are pending in order to draw definitive conclusions.

Although tuberculosis (TB) ranks among the most frequent infectious diseases worldwide, one of its extrapulmonary (EP) manifestations, genitourinary (GU) TB, is often underestimated by urologists, particularly in areas such as Europe where TB is not endemic. The aim of this review is to give urologists a concise overview of GUTB as a supplement to the more comprehensive European Association of Urology 2023 update on urological infections guidelines. EPTB can develop in 16% of TB cases. GUTB accounts for 4.6% of EPTB and is often asymptomatic or nonspecific, so it can be confused with other urogenital diseases. GUTB can be highly destructive, leading to failure of urogenital organs. Diagnosis is via microbiological, molecular, and histological testing for urine, genital secretions, or genitourinary tissue, supported by imaging. A 6-mo combinational medical regimen is the first-line treatment for GUTB. However, surgical interventions are also frequently required for the treatment of GUTB complications. Therefore, it is important to keep GUTB in mind for differential diagnosis. Patient summary We reviewed scientific studies on the occurrence, diagnosis, and treatment of tuberculosis in the genitourinary tract. Our aim is to raise awareness among urologists from countries where this disease does not occur frequently, as urogenital tuberculosis can occur without any symptoms or with unspecific symptoms that can be confused with other diseases.

ObjectiveTo evaluate the usefulness of Power Doppler to improve the diagnostic work up of veno-occlusive erectile dysfunction patients.Materials and MethodsPatients affected by erectile dysfunction, mean IIEF 5 = 13.5 (12-17) for at least 6 months, were enrolled in a prospective cross-sectional study. All patients underwent Dynamic Power Doppler after intracavernous injection of vasoactive drugs (PGE1 20 mcg and Papaverine 6 mg). Poor responders’ patients subsequently underwent to cavernosometry to get a full assessment of the vascular framework.Results202 patients (mean age 46 years), were included in the study. 96 subjects (47.5%) who did not adequately respond to the intracavernous injection -test, subsequently underwent to cavernosometry. In 42 of 96 patients (43.7%) cavernosometry was positive for veno-occlusive dysfunction. In a total of 160 patients who did not have veno-occlusive dysfunction (54 with negative cavernosometry + 106 intracavernous injection-test responders), the Power Doppler was normal in 126 (78.8%) and pathological in 34 (21.3%) in terms of steric conformation of “low flow” vessels corresponding to the Cavernosal Terminal Unit. The diagnostic sensitivity of Power Doppler towards veno-occlusive dysfunction was found to be 52.4% (Positive Predictive Value: 39.3%), the specificity was 78.8% (Negative Predictive Value: 86.3%) and the total diagnostic accuracy was equal to 73.3%.ConclusionCollected data evidenced that patients who reported altered morphological features of the Cavernosal Terminal Unit had an approximately 4-fold greater risk of having veno-occlusive dysfunction compared to patients who had normal Power Doppler features (OR = 4.076; 95% CI: 1.996-8.327).

To develop a surgical technique to achieve greater depth of the neovaginal cavity in transgender patients undergoing scrotovaginoplasty, and to propose a method for restoring neovaginal integrity in case of lack of genital skin or reduction of the depth due to scarring after infections or ischaemic processes.

Radical cystectomy (RC) often affects patients’ life as this surgery is a traumatic and invasive event for the patients, with drawbacks on their daily, social, working, and sex life. Such changes in the quality of life (QoL) of patients are commonly studied through retrospective clinical evaluations and rarely with longitudinal studies. To date, studies focusing on functional outcomes, sexual function, and health-related QoL for female patients are lacking. We evaluated 37 patients using EORTC QLQ-C30 (QLQ-30) and Short-Form 36 (SF-36) questionnaires, before and after surgery, at 3 and 6 months of follow-up. The mean values for the emotional functioning in QLQ-C30 as well as the mental health in SF-36 were significantly higher in the ONB group compared to the IC group at 3 months of follow-up. These differences were not significant at 6 months of follow-up. At 6 months of follow-up, the ONB group showed a higher mean score in the physical and role functioning than the IC group. Although there was a statistically significant age difference at baseline of the two groups, none of the results are correlated with age, as demonstrated by Spearman’s analysis. The ONB seems to represent the most advantageous solution compared to the IC in terms of QOL at the 6-month follow-up.

Untargeted metabolomics approaches deal with complex data hindering structural information for the comprehensive analysis of unknown metabolite features. We investigated the metabolite discovery capacity and the possible extension of the annotation coverage of the Feature-Based Molecular Networking (FBMN) approach by adding two novel nutritionally-relevant (contextual) mass spectral libraries to the existing public ones, as compared to widely-used open-source annotation protocols. Two contextual mass spectral libraries in positive and negative ionization mode of ~300 reference molecules relevant for plant-based nutrikinetic studies were created and made publicly available through the GNPS platform. The postprandial urinary metabolome analysis within the intervention of Vaccinium supplements was selected as a case study. Following the FBMN approach in combination with the added contextual mass spectral libraries, 67 berry-related and human endogenous metabolites were annotated, achieving a structural annotation coverage comparable to or higher than existing non-commercial annotation workflows. To further exploit the quantitative data obtained within the FBMN environment, the postprandial behavior of the annotated metabolites was analyzed with Pearson product-moment correlation. This simple chemometric tool linked several molecular families with phase II and phase I metabolism. The proposed approach is a powerful strategy to employ in longitudinal studies since it reduces the unknown chemical space by boosting the annotation power to characterize biochemically relevant metabolites in human biofluids.