Percutaneous Nephrostomy Catheter Misplacement into Inferior Vena Cava in a Patient with a Horseshoe Kidney

Background: Percutaneous nephrostomy (PCN) is commonly indicated for upper urinary tract drainage in case of obstruction or fistula. Only a few cases of PCN catheter misplacement into the inferior vena cava (IVC) have been published. Case Presentation: We report a case of a PCN catheter misplaced into the IVC through a fistula between the urinary tract and an ipsilateral renal vein in a patient with horseshoe kidney, after bedside urgent replacement for hemorrhage and hemorrhagic shock. Conclusion: Although a nephrostomy Foley catheter can be used for adequate urinary drainage and hemostatic purposes after percutaneous nephrolithotomy, its placement should be always verified through antegra…

Comparison of Fluoroquinolones and Other Antibiotic Prophylaxis Regimens for Preventing Complications in Patients Undergoing Transrectal Prostate Biopsy

Our study aimed to compare the incidence of infective complications after transrectal ultrasound-guided prostate biopsy (TRUSBx) when adopting different antimicrobial prophylaxis regimens. A multi-institutional cohort of 1150 patients who underwent TRUSBx was retrospectively analyzed. Procedures were performed between 2017 and 2019 (before and after the EMA warning about the use of fluoroquinolones for the antibiotic prophylaxis of patient candidates to TRUSBx). The primary endpoint was the occurrence of infective complications, including sepsis and/or fever. The population was stratified according to the antibiotic prophylaxis adopted: fluoroquinolones (levofloxacin, ciprofloxacin, prulifl…

Risk of Virus Contamination Through Surgical Smoke During Minimally Invasive Surgery: A Systematic Review of the Literature on a Neglected Issue Revived in the COVID-19 Pandemic Era

Abstract Context The coronavirus disease 2019 (COVID-19) pandemic raised concerns about the safety of laparoscopy due to the risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) diffusion in surgical smoke. Although no case of SARS-CoV-2 contagion related to surgical smoke has been reported, several international surgical societies recommended caution or even discouraged the use of a laparoscopic approach. Objective To evaluate the risk of virus spread due to surgical smoke during surgical procedures. Evidence acquisition We searched PubMed and Scopus for eligible studies, including clinical and preclinical studies assessing the presence of any virus in the surgical smoke fr…

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Background: Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods: This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, r…

Segmental Ureterectomy Versus Radical Nephroureterectomy in Older Patients Treated for Upper Tract Urothelial Carcinoma

Introduction: The world population is ageing and surgical procedures for older patients are associated with higher perioperative morbidity and mortality rates than in younger patients. Segmental ureterectomy (SU) has been proposed as an alternative to radical nephroureterectomy (RNU) for selected upper tract urothelial carcinomas (UTUC), to reduce post-operative morbidity, and preserve renal function. The aim of this study was to compare RNU and SU in terms of post-operative complications, functional outcomes, and overall survival (OS) in older patients treated for UTUC. Materials and methods: Data of patients aged 75 years or older and treated for UTUC were included. The primary outcome wa…

Time to safely omit bladder cuff removal for low-risk upper tract urothelial carcinoma

Editorial comment on: Measurement of serum isoform [–2]proPSA derivatives shows superior accuracy to magnetic resonance imaging in the diagnosis of prostate cancer in patients with a total prostate-specific antigen level of 2–10 ng/ml

MP43-14 COMPARISON BETWEEN QUINOLONES AND OTHER ANTIBIOTICS IN PREVENTING INFECTIVE COMPLICATIONS IN TRANSRECTAL PROSTATE BIOPSY

INTRODUCTION AND OBJECTIVE:Sepsis is one of the most feared complications of prostate biopsy: it’s incidence is 1-3%. Prevention of infection after biopsy procedure consists in prophylactic antibio...

Segmental ureterectomy vs. radical nephroureterectomy for ureteral carcinoma in patients with a preoperative glomerular filtration rate less than 90 ml/min/1.73 m2: A multicenter study

Objectives: To compare segmental ureterectomy (SU) and radical nephroureterectomy (RNU) in terms of overall survival (OS) and impact on postoperative renal function in patients treated for upper tract urothelial carcinoma (UTUC) of the ureter with preoperatively reduced estimated glomerular filtration rate (eGFR). Materials and methods: We retrospectively collected the data of consecutive patients treated for UTUC, in 6 Italian tertiary referral centers, from 2003 to 2013, and analyzed those treated with RNU or SU for ureteral cancer and with a preoperative eGFR <90 ml/min/1.73m2. The primary outcome was to compare the postoperative eGFR variation and the OS according to the surgical tec…

Spontaneous extrusion of male genital pearling

Pearling is a practice of inserting small beads beneath the skin of the genitalia. Patients generally underwent this practice believing that this would have made their penis bigger and able to better satisfy their partners during intercourse. Pearling can cause complications. We report a case of spontaneous extrusion of genital pearling exiting in a granuloma of the inner face of the foreskin.

Urology practice during the COVID-19 vaccination campaign

Introduction: The current scenario of the COVID-19 pandemic is significantly different from that of the first, emergency phase. Several countries in the world are experiencing a second, or even a third, wave of contagion, while awaiting the effects of mass vaccination campaigns. The aim of this report was to provide an update of previously released recommendations on prioritization and restructuring of urological activities. Methods: A large group of Italian urologists directly involved in the reorganization of their urological wards during the first and second phase of the pandemic agreed on a set of updated recommendations for current urology practice. Results: The updated recommendations…

Lingual mucosal graft urethroplasty 12 years later: Systematic review and meta-analysis

Objective: To evaluate the functional results and complications of the lingual mucosal graft (LMG) urethroplasty and to sum up the current state of the art of this surgical technique. Methods: A systematic search of PubMed and Scopus electronic databases was performed, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Studies involving male patients treated with LMG urethroplasty for urethral stricture were included. Complete protocol is available at http://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42017080121. A meta-analysis comparing functional and long-term oral complication outcomes of LMG and buccal mucosal graft (BMG) w…

SARS-CoV-2 infection and venous thromboembolism after surgery: an international prospective cohort study

SARS-CoV-2 has been associated with an increased rate of venous thromboembolism in critically ill patients. Since surgical patients are already at higher risk of venous thromboembolism than general populations, this study aimed to determine if patients with peri-operative or prior SARS-CoV-2 were at further increased risk of venous thromboembolism. We conducted a planned sub-study and analysis from an international, multicentre, prospective cohort study of elective and emergency patients undergoing surgery during October 2020. Patients from all surgical specialties were included. The primary outcome measure was venous thromboembolism (pulmonary embolism or deep vein thrombosis) within 30 da…

Characterization of human infiltrating and circulating gamma-delta T cells in prostate cancer

Purpose The aim of our study was to prospectively evaluate the distribution of gamma-delta (γδ)1 and γδ2 T cells and their phenotypes in peripheral blood and prostate samples of patients diagnosed with or without prostate cancer (PCa) at prostate biopsy. Materials and methods A consecutive series of 43 outpatients underwent trans-rectal echo-guided prostate biopsy for suspected PCa. Flow cytometry analysis was used to identify and characterize the γδ T cells populations in peripheral blood and tissue samples. Patients were stratified according to the presence or not of PCa, and its International Society of Urological Pathology (ISUP) grade (1 vs. ≥2). Results The distribution of γδ T cells …

Pathways for urology patients during the COVID-19 pandemic

The public health emergency caused by the Coronavirus Disease 2019 (COVID-19) pandemic has resulted in a significant reallocation of health resources with a consequent reorganization of the clinical activities also in several urological centers. A panel of Italian urologists has agreed on a set of recommendations on pathways of pre-, intra- and post-operative care for urological patients undergoing urgent procedures or non-deferrable oncological interventions during the COVID-19 pandemic. Simplification of the diagnostic and staging pathway has to be prioritized in order to reduce hospital visits and consequently the risk of contagion. In absence of strict uniform regulations that impose th…

Sildenafil orodispersible film in the treatment of erectile dysfunction after radical prostatectomy: A single‐centre open‐label uncontrolled trial

Phosphodiesterase-5 inhibitors are the first-line therapy for erectile dysfunction (ED) after radical prostatectomy (RP). This single-centre open-label uncontrolled study evaluated the efficacy and safety of the new sildenafil orodispersible film (ODF) in ED treatment after RP. Sildenafil 100 mg ODF was administered twice a week for 3 months to patients under 75 years of age, with a Framingham cardiovascular risk score < 20% and a pre-operative International Index of Erectile Function (IIEF)-5 score ≥ 17, who had undergone open RP between 2016 and 2018. Erectile function was assessed pre-operatively, post-operatively and after treatment through the IIEF-5 score, the Sexual Encounter Prof…

Clinical pathways for urology patients during the COVID-19 pandemic

The public health emergency caused by the Coronavirus Disease 2019 (COVID-19) pandemic has resulted in a significant reallocation of health resources with a consequent reorganization of the clinical activities also in several urological centers. A panel of Italian urologists has agreed on a set of recommendations on pathways of pre-, intra- and post-operative care for urological patients undergoing urgent procedures or non-deferrable oncological interventions during the COVID-19 pandemic. Simplification of the diagnostic and staging pathway has to be prioritized in order to reduce hospital visits and consequently the risk of contagion. In absence of strict uniform regulations that impose th…

Prognostic role in common clinical practice of neutrophil-to-lymphocyte ratio in unselected bladder cancer

Urology practice during COVID-19 pandemic

The severe acute respiratory syndrome coronavirus 2 and the disease it causes, coronavirus disease 2019 (COVID-19) is generating a rapid and tragic health emergency in Italy due to the need to provide assistance to an overwhelming number of infected patients and, at the same time, treat all the non-deferrable oncological and benign conditions. A panel of Italian urologists has agreed on possible strategies for the reorganization of urological routine practice and on a set of recommendations that should facilitate the process of rescheduling both surgical and outpatient activities during the COVID-19 pandemic and in the subsequent phases. This document could be a valid tool to be used in rou…

Circumcision and Sexually Transmitted Disease Prevention: Evidence and Reticence

Circumcision is one of the oldest surgical procedures and the most common surgical procedure performed on males. It is practiced for three main reasons: ritual or religious meanings, prophylactic hygienic purposes, and therapeutic indications. Male circumcision is advocated as an efficacious prevention strategy against sexually transmitted diseases. One of the main biological mechanisms responsible for the lower human immunodeficiency virus (HIV) infection rate in heterosexual circumcised men is the protective effect of keratinization of the glans. Moreover, male circumcision removes the inner part of the prepuce containing Langerhans cells that are targeted by HIV. Several observational st…

Sexual dysfunction in dialytic patients. A prospective cross-sectional observational study in two hemodialysis centers

Objectives: Incidence and prevalence of patients in dialytic therapy increased considerably in recent years. The onset of new issues, once overshadowed, linked to a lower quality of life like sexual dysfunction became increasingly common. The first study in this area, dating back to the 1970s, shows the high prevalence of sexual dysfunction among patients in dialytic therapy of both sexes. Later studies proved an association of sexual dysfunction with psyche disorders, anxiety, depression and lack of self-confidence. The aim of this study is to describe the incidence of male and female sexual main dysfunctions, the latter not least in literature, in patients in hemodialytic therapy. With th…

Cancer of the Penis

Penile carcinoma is a rare and aggressive disease. Its incidence is related with age over 60 and presence of comorbidities such as HPV infection. The higher incidence rate is reached in developing countries. Penile carcinoma is generally a squamous cell carcinoma and it is frequently foregone by a premalignant lesion. Because of its short time to progression, an early detection is mandatory. Good physical examination is the first step toward a correct diagnosis and staging. CT scan and chest X-ray are useful for nodal stage while US and MRI can provide a preoperative assessment of local invasion. Surgical approach depends on invasion and nodal involvement, varying from a local laser ablatio…

Segmental resection of distal ureter with termino-terminal ureteric anastomosis vs bladder cuff removal and ureteric re-implantation for upper tract urothelial carcinoma: results of a multicentre study

OBJECTIVES: To compare overall (OS), cancer-specific (CSS), recurrence free survival (RFS) and post-operative renal function among patients affected by upper tract urothelial carcinoma (UTUC) of the distal (lower lumbar and pelvic) ureter, electively treated with segmental resection and termino-terminal anastomosis (TT) vs bladder cuff removal and ureteral re-implantation (RR). PATIENTS AND METHODS: A multicentre retrospective study, including 84 patients diagnosed with UTUC of the distal ureter and treated with TT or RR, is presented. The primary endpoint was to compare TT and RR in terms of OS, CSS and RFS. As a secondary outcome we compared the post-operative creatinine values as an inde…

Clinical and biochemical markers of visceral adipose tissue activity: Body mass index, visceral adiposity index, leptin, adiponectin, and matrix metalloproteinase-3. Correlation with Gleason patterns 4 and 5 at prostate biopsy

Context: The correlation between aggressive prostate cancer and obesity mainly based on body mass index (BMI) and pathology after surgery remains controversial. Aims: The aim of the study was to correlate BMI, visceral adiposity index (VAI), and the plasmatic levels of leptin, adiponectin, and matrix metalloproteinase-3 (MMP-3), and biomarkers of adipose tissue function, with the detection of Gleason patterns 4 and 5 at biopsy. Subjects and Methods: Consecutive patients with prostate cancer at 12-core transrectal biopsy were enrolled. BMI, waist circumference (WC), blood samples to evaluate the plasmatic levels of triglycerides (TG) and high-density lipoproteins (HDL), adiponectin, leptin, …

Is Kelami's Method Still Useful in the Smartphone Era? The Virtual 3-Dimensional Reconstruction of Penile Curvature in Patients With Peyronie's Disease: A Pilot Study

Abstract Background Peyronie's disease is an idiopathic fibrotic disease affecting the penile tunica albuginea. Among other resulting deformities, the more common penile curvature should be assessed preferentially with in-office goniometric estimation after pharmacologically induced erection, although clearly invasive and uncomfortable. Aim In the present pilot study, we investigated the usefulness for the patient and the surgeon of a 3-dimensional (3D) reconstruction of the penile curvature obtained through photogrammetry software in clinical evaluation and surgical planning. Methods Enrolled patients received alprostadil 10 μg by intracavernous injection. Then, the medical personnel took …

Predictive variables of spontaneous micturition recovery after acute urinary retention in men with benign prostatic enlargement: An observational prospective study

Objective: Acute urinary retention (AUR) is the sudden and painful inability to urinate spontaneously. AUR is one of the most significant complications of benign prostatic enlargement. The management of AUR is based on transurethral catheterization. Subsequent therapy is uncertain, but AUR seems to benefit from the use of alpha-blockers. The aim of this study was to evaluate the variables that could predict which patients would recover spontaneous micturition after trial without catheter. Methods: The present prospective observational study included men with AUR in an Italian tertiary care institute in 2016. Patients were catheterized and treated orally with fluoroquinolones, alpha-blockers…

Preliminary Results of ERAS Protocol in a Single Surgeon Prospective Case Series

Background and Objectives: The aim was to compare the intra and postoperative outcomes between the Enhanced Recovery After Surgery (ERAS) protocol versus the standard of care protocol (SCP) in patients who underwent radical cystectomy performed by a single surgeon. Materials and Methods: A retrospective comparative study was conducted including patients who underwent radical cystectomy from 2017 to 2020. Length of stay (LOS), incidence of ileus, early postoperative complications, and number of re-hospitalizations within 30 days were considered as primary comparative outcomes of the study. Results: Data were collected for 91 patients who underwent cystectomy, and 70 and 21 patients followed …

Can We Clinically Distinguish Anejaculation From Retrograde Ejaculation in Patients on α1A-Blockers Therapy for Lower Urinary Tract Symptoms?

To investigate the physiopathology of ejaculatory disorders (EjD) and discriminate between retrograde ejaculation (REj) and anejaculation (AEj) induced by α1A-blockers, through the association between the mean postorgasm seminal vesicle volume and the presence of sperm in midstream urine, in patients with moderate-to-severe lower urinary tract symptoms (LUTS) secondary to benign prostatic enlargement.Therapy-naïve male patients with LUTS and without previous EjD were treated with α1A-blockers. Pre- and post-treatment EjD were investigated through question 4 of the 4-item Male Sexual Function questionnaire and the Male Sexual Health Questionnaire for Ejaculatory Dysfunction Short Form (MSHQ-…

ADIPONECTIN, LEPTIN AND MMP-3 PLASMATIC LEVELS CANNOT IDENTIFY HIGH-RISK PROSTATE CANCER IN PATIENTS UNDERGOING BIOPSY

The potential role of COVID-19 hygienic measures in reducing infective complications during hospitalization