Medical Expulsive Therapy for Symptomatic Distal Ureter Stones: Is the Combination of Bromelain and Tamsulosin More Effective than Tamsulosin Alone? Preliminary Results of a Single-Center Study.

OBJECTIVES: To assess the safety and efficacy of bromelain plus tamsulosin versus tamsulosin alone as medical expulsive therapy (MET) for promoting spontaneous stone passage (SSP) of symptomatic distal ureter stones. PATIENTS AND METHODS: One-hundred-fourteen patients with a 4-10 mm distal ureteral stone were enrolled (Group A). Patients self-administered daily bromelain with tamsulosin for 30 days or until SSP or intervention was mandatory. Patients were compared to those from a control group taking tamsulosin as MET (Group B) and matched for the following factors: sex, age ±10%, stone diameter. A logistic regression model evaluated bromelain and the ureteral stone diameter as explanatory variables. RESULTS: SSP rates were 87.7 vs. 75.4% for group A vs. group B respectively (p = 0.016); with no difference observed for the time to self-reported stone expulsion (11.68 vs. 11.57 days; p = 0.91). Considering larger stones (> 5 mm), the SSP rate was 83.3% in group A and 61% in group B (p < 0.01). With each millimeter increment of stone diameter, the probability of SSP decreased by 59.1% (p < 0.0001), while it increased of 3.3 when bromelain was present. Only 3 cases of tamsulosin-related adverse events were recorded. CONCLUSION: The association of bromelain and tamsulosin as MET increases the probability of SSP of symptomatic distal ureteral stones, with no bromelain-related side effects recorded.

Current status of salvage robot-assisted laparoscopic prostatectomy for radiorecurrent prostate cancer.

Radiation therapy (RT) is one of the treatment options for prostate cancer (PCa). Transperineal low-dose rate brachytherapy (BT) is another safe and effective technique for low-risk PCa. Recurrence after RT for localized PCa can be defined by a PSA value of 2 ng/mL above the nadir after RT, and biochemical recurrence (BCR) rate after RT is 40-60 %. In case of radiorecurrent PCa, treatment options include salvage radical prostatectomy (RP), cryotherapy, high-intensity focused ultrasound (HIFU), and salvage BT. Only salvage RP has cancer control results for over 10-year follow-up in a substantial portion of patients (30-40 %). However, salvage RP is technically demanding, and experienced surgeons are needed; in fact, RT-induced cystitis, fibrosis, and tissue plane obliteration can lead to significant complications, such as rectal injuries, anastomotic stricture, and urinary incontinence. This review describes indications, oncologic and functional outcomes, surgical techniques, and complications of salvage robot-assisted RP.

Sexual and ejaculatory function after holmium laser enucleation of the prostate and bipolar transurethral enucleation of the prostate: a single-center experience.

Currently available surgical treatments for Lower Urinary Tract Symptoms (LUTS) due to Benign Prostatic Obstruction (BPO) are associated with an increased risk of sexual dysfunction. The aim of our study is to compare sexual and ejaculatory function after Holmium Laser Enucleation of the Prostate (HoLEP) and Bipolar Transurethral Enucleation of the Prostate (B-TUEP). We performed a retrospective analysis of data prospectively collected from 62 (44.9%) and 76 (55.1%) patients who underwent HoLEP and B-TUEP, respectively. Erectile function and ejaculation characteristics were assessed with the International Index of Erectile Function-Erectile Function (IIEF-EF) domain and the Male Sexual Health Questionnaire-Ejaculatory function (MSHQ-EJ) questionnaires. Our study recorded no change in erectile function and no significant difference in rates of preserved antegrade ejaculation after both surgeries. One month after surgery, rates of physical pain/discomfort and perceived decreased physical pleasure during ejaculation were higher in HoLEP than B-TUEP patients (all p < 0.03). Moreover, HoLEP patients were more bothered by their ejaculatory difficulties than B-TUEP men (p = 0.03). At 3- and 12-months follow-up, all ejaculation-related differences disappeared. In conclusion, both procedures are valid alternatives for BPO treatment as they offer comparable urinary and sexual outcomes in the long term. However, in the first month after surgery, HoLEP patients present with more ejaculatory difficulties.

Ten-year experience with penile prosthetic surgery for the treatment of erectile dysfunction: outcomes of a tertiary referral center and predictors of early prosthetic infection.

We aimed to evaluate ten-year outcomes of penile prosthesis (PP) implantation for the treatment of erectile dysfunction and to assess predictors of early prosthetic infection (EPI). We identified 549 men who underwent 576 PP placements between 2008 and 2018. Univariate and multivariate analyses were used to identify potential predictors of EPI. An EPI predictive nomogram was developed. Thirty-five (6.1%) cases of EPI were recorded with an explant rate of 3.1%. In terms of satisfaction, 82.0% of the patients defined themselves as "satisfied," while partner's satisfaction was 88.3%. Diabetes (P = 0.012), longer operative time (P = 0.032), and reinterventions (P = 0.048) were associated with EPI risk, while postoperative ciprofloxacin was inversely associated with EPI (P = 0.014). Rifampin/gentamicin-coated 3-piece inflatable PP (r/g-c 3IPP) showed a higher EPI risk (P = 0.019). Multivariate analyses showed a two-fold higher risk of EPI in diabetic patients, redo surgeries, or when a r/g-c 3IPP was used (all P < 0.03). We showed that diabetes, longer operative time, and secondary surgeries were the risk factors for EPI. Postoperative ciprofloxacin was associated with a reduced risk of EPI, while r/g-c 3IPP had higher EPI rates without an increased risk of PP explant. After further validation, the proposed nomogram could be a useful tool for the preoperative counseling of PP implantation.

Development of a Novel Clinical and Radiologic Risk Score to Predict Septic Complications After Urinary Decompression in Patients with Obstructive Uropathy.

Background: Well-defined clinical predictors of sepsis after upper tract drainage for obstructive uropathy are lacking. The study aim is to develop a data-driven score to predict risk of sepsis after decompression of the upper urinary tract. Materials and Methods: Complete clinical and radiologic data from 271 patients entering the emergency department for obstructive uropathy and submitted to stent/nephrostomy tube decompression were evaluated. The Charlson Comorbidity Index (CCI) was used to score comorbidities. The definition of sepsis was an increase in ≥2 Sequential Organ Failure Assessment points (or a postoperative persistently elevated score +1 additional increase) and documented blood or urine cultures. Descriptive statistics and stepwise multivariable logistic regression modeling with receiver operating characteristic analysis were performed to obtain a composite risk score to predict the risk of sepsis after surgery. This study was approved by our local Ethics Commitee (Prot. 25508). Results: Fifty-five (20.3%) patients developed sepsis. At multivariable analysis, CCI ≥2 (odds ratio [OR] 3.10; 95% confidence interval [CI] 1.36-7.04), maximum body temperature ≥38°C (OR 4.35; 95% CI 1.89-9.44), grade III-IV hydronephrosis (OR 2.37; 95% CI 1.10-4.98), HU of the dilated collecting system ≥7.0 (OR 4.47; 95% CI 2.03-9.81), white blood cells ≥15 × 103/mmc (OR 2.77; 95% CI 1.24-6.19), and C-reactive protein ≥10 (OR 3.27; 95% CI 1.41-7.56) were independently associated with sepsis. The positive predictive value of a true sepsis increased incrementally as a function of number of positive variables, ranging from 1.6% to 100.0% among patients with 1 and 6 positive variables, respectively. Conclusion: Our risk score identifies accurately patients with an increased risk of sepsis after urinary decompression for obstructive uropathy, hence improving clinical management.

Renal cell carcinoma and synchronous thyroid metastasis with neoplastic thrombosis of the internal jugular vein: report of a case.

A case of thyroid metastasis of a renal clear cell carcinoma is presented. The fine-needle aspiration cytology pointed out the primary tumor origin. The patient underwent robot-assisted radical nephrectomy and contextual thyroidectomy. During the operative procedure, a neoplastic thrombus extending from the thyroid metastasis and protruding into the internal jugular vein was found. As a result, thrombectomy and ligation of the internal jugular vein were required. In cases of single synchronous thyroid metastases form RCC, radical surgery should be advisable. Robotic approach allows to associate major surgery procedures, as nephrectomy, with radical metastasectomy.

How the COVID-19 Wave Changed Emergency Urology: Results From an Academic Tertiary Referral Hospital in the Epicentre of the Italian Red Zone.

OBJECTIVE: To quantify and characterize the burden of urological patients admitted to emergency department (ED) in Lombardy during Italian COVID-19 outbreak, comparing it to a reference population from 2019. METHODS: We retrospectively analysed all consecutive admissions to ED from 1 January to 9 April in both 2019 and 2020. According to the ED discharge ICD-9-CM code, patients were grouped in urological and respiratory patients. We evaluated the type of access (self-presented/ambulance), discharge priority code, ED discharge (hospitalization, home), need for urological consultation or urgent surgery. RESULTS: The number of urological diagnoses in ED was inversely associated to COVID-19 diagnoses (95% confidence interval -0.41/-0.19; Beta = -0.8; P < .0001). The average access per day was significantly lower after 10 March 2020 (1.5 ± 1.1 vs 6.5 ± 2.6; P < .0001), compared to reference period. From 11 March 2020, the inappropriate admissions to ED were reduced (10/45 vs 96/195; P = .001). Consequently, the patients admitted were generally more demanding, requiring a higher rate of urgent surgeries (4/45 vs 4/195; P = .02). This reflected in an increase of the hospitalization rate from 12.7% to 17.8% (Beta = 0.88; P < .0001) during 2020. CONCLUSION: Urological admissions to ED during lockdown differed from the same period of 2019 both qualitatively and quantitatively. The spectrum of patients seems to be relatively more critical, often requiring an urgent management. These patients may represent a challenge due to the difficult circumstances caused by the pandemic.

Spontaneous Upper Urinary Tract Rupture Caused by Ureteric Stones: Clinical Characteristics and Validation of a Radiological Classification System.

BACKGROUND: This study seeks to validate a radiological classification system of spontaneous upper urinary tract rupture (sUUTR) and to analyse its relationship with clinical, laboratory and radiological characteristics of sUUTR. METHODS: We analysed data from 66 patients with a computerised tomography (CT)-proven sUUTR treated with ureteral or nephrostomy catheter positioning. Comorbidities were scored with the Charlson Comorbidity Index (CCI). All CT scans were reviewed by two experienced radiologists and one urologist, who classified sUUTR in (a) local spread, (b) free fluid and (c) urinoma. Interobserver agreement for radiological score was evaluated with the Intraclass Correlation Coefficient (ICC) and Cohen's Kappa analyses. Descriptive statistics and logistic regression models verified the association between clinical variables and sUUTR severity. RESULTS: The interobserver agreement for sUUTR classification was high among radiologists and between the radiologists and the urologist (all Kappa > 0.7), with an overall high interrater reliability (ICC 0.82). Local spread, free fluid and urinoma were found in 24 (36.4%), 39 (59.1%) and 3 (4.5%) cases, respectively. Patients with free fluid/urinoma had higher rate of CCI ≥ 1 than those with local spread (40.5% vs. 16.7%, p = 0.04). Intraoperative absence of urine extravasation was more frequently found in patients with local spread than those with free fluid/urinoma (66.7% vs. 28.6%, p < 0.01). Multivariable logistic regression analysis revealed that local spread (OR 4.5, p < 0.01) was associated with absence of contrast medium extravasation during pyelography, after accounting for stone size, fever and CCI. CONCLUSIONS: The analysed sUUTR classification score had good inter/intra-reader reliability among radiologists and urologists. Absence of urine extravasation was five times more frequent in patients with local spread, making conservative treatment feasible in these cases.

Bipolar Transurethral Enucleation of the Prostate: Is it a size-independent endoscopic treatment option for symptomatic benign prostatic hyperplasia?

BACKGROUND: Bipolar Transurethral Enucleation of the Prostate (B-TUEP) is recommended as a first-choice treatment for benign prostatic obstruction in prostates >80 ml. Differently, B-TUEP is only considered as an alternative option after TURP for smaller prostates (30-80 ml). The aim of our study is to assess the relation between prostate size and surgical outcomes after B-TUEP. METHODS: We performed a retrospective analysis of data collected from 172 patients submitted to B-TUEP. Patients were segregated according to tertiles of prostate volume (PV) (≤60 ml, 61-110 ml, >110 ml). For each group we evaluated enucleation efficacy (enucleated weight/enucleation time), complication rates, urinary and sexual function parameters. Functional and sexual parameters were compared between groups at baseline, 1 and 3 months follow up. Descriptive statistics and linear and logistic regression models tested the association between PV and postoperative complications/outcomes. RESULTS: Operative time and weight of enucleated adenomas increased along with prostate volumes (all p≤0.01). Enucleation efficacy was higher in men with PV >110 ml compared to other groups (p≤0.001). Length of hospital stay, catheterization time and rates of postoperative complications, such as transfusion and clot evacuation rates and bladder neck/urethral strictures, were comparable between groups. Urinary symptoms improved at 1-and 3-months in each group as compared to baseline evaluation (all p<0.01) but they did not differ according to PV. In each group maximum urinary flow and post-void residual volume significantly improved at 3 months compared to baseline (all p≤0.01), without differences according to PV. Sexual symptoms were similar between groups at each follow up assessment. At multivariable linear and logistic regression analysis, prostate volume was not associated with postoperative functional outcomes and complications. Conversely, patient's comorbid status and antiplatelet/anticoagulation use were independently associated with postoperative complications. CONCLUSION: According to our findings, B-TUEP should be considered a "size independent procedure" as it can provide symptom relief in men with prostates of all sizes with the same efficacy and safety profile.

Endoscopic repair of a vesicouterine fistula with the injection of microfragmented autologous adipose tissue (Lipogems®).

Vesicouterine fistula (VUF) is a rare extra-anatomical communication developing between the uterus or cervix and the urinary bladder, most commonly after an iatrogenic injury during a cesarean section. Patients with VUF may have various clinical presentations, ranging from Youssef's syndrome (vaginal urine leakage, amenorrhea, and menouria) to urinary tract infection and infertility. Quality of life for patients having this pathology is strongly affected owing to the psychological burden. Treatment is surgery based because low success rates have been reported for conservative or minimally invasive approaches. Herein, we present a case of a 35-year-old woman successfully treated by a minimally invasive endoscopic repair procedure with the injection of microfragmented autologous adipose tissue (Lipogems®).

Life-threatening Double-J stent migration with helicoidal appearance: Length matters.

BACKGROUND: The Double-J stent is one of the most commonly used devices in urologic practice. Due to its widespread use, numerous common complications have been reported, such as irritative symptoms, infection, and encrustation. More rare complications have also been described, such as up or downward migration and displacement outside the urinary tract. We present a rare case of downward migration of a Double-J stent in a 21-year-old Caucasian female. CASE PRESENTATION: A 21-year-old female with a solitary kidney presented to the emergency department with acute renal failure, left flank pain, and fever. She had undergone left Double-J stenting 1 week earlier in her homeland for left renal colic and anuria. A kidney-ureter-bladder X-ray revealed a 10-mm lumbar ureteral stone and the proximal coil of the Double-J stent making multiple loops along the ureter, resulting in a helical appearance. She underwent surgery to remove the previous stent and to place a new one. She was discharged 2 days later and her renal function had returned to normal values at her 1-week follow-up. CONCLUSIONS: Double-J Stent placement is a common procedure in the management of urinary tract diseases but is not devoid of life-threatening complications. Regular follow-up of stents and on-time evaluation of clinical complaints are mandatory for an aggressive treatment of complications.

Hounsfield unit attenuation value can differentiate pyonephrosis from hydronephrosis and predict septic complications in patients with obstructive uropathy.

We aimed to assess the role of computerized tomography attenuation values (Hounsfield unit-HU) for differentiating pyonephrosis from hydronephrosis and for predicting postoperative infectious complications in patients with obstructive uropathy. We analysed data from 122 patients who underwent nephrostomy tube or ureteral catheter placement for obstructive uropathy. A radiologist drew the region of interest for quantitative measurement of the HU values in the hydronephrotic region of the affected kidney. Descriptive statistics and logistic regression models tested the predictive value of HU determination in differentiating pyonephrosis from hydronephrosis and in predicting postoperative sepsis. A HU cut-off value of 6.3 could diagnose the presence of pyonephrosis with 71.6% sensitivity and 71.5% specificity (AUC 0.76; 95%CI: 0.66-0.85). At multivariable logistic regression analysis HU ≥ 6.3 (p ≤ 0.001) was independently associated with pyonephrosis. Patients who developed sepsis had higher HU values (p ≤ 0.001) than those without sepsis. A HU cut-off value of 7.3 could diagnose the presence of sepsis with 76.5% sensitivity and 74.3% specificity (AUC 0.79; 95%CI: 0.71-0.90). At multivariable logistic regression analysis, HU ≥ 7.3 (p ≤ 0.001) was independently associated with sepsis, after accounting for clinical and laboratory parameters. Measuring HU values of the fluid of the dilated collecting system may be useful to differentiate pyonephrosis from hydronephrosis and to predict septic complications in patients with obstructive uropathy.

Blastoid variant of mantle cell lymphoma of the female urethra mimicking a caruncle: A rare but highly aggressive subtype case with literature review.

Primary urethral lymphoma is a rare entity without a standardized treatment protocol. We report a case of an elderly woman presenting with a caruncle associated with vaginal spotting and intermittent dysuria. She underwent surgical excision of the lesion. Histological analysis revealed a blastoid variant of mantle cell lymphoma, a previously unreported subtype. The patient received chlorambucil assisting a rapid local disease progression. She died of disseminated disease 6 months after diagnosis. A review of the lymphomas of the urethra is included.

Spontaneous upper urinary tract rupture caused by ureteric stones: A prospective high-volume single centre observational study and proposed management. / Rotura espontanea del tracto urinario superior causada por litiasis ureteral: Estudio prospectivo observacional en un único centro de alto volumen y propuesta de manejo.

OBJECTIVE: To evaluate incidence, clinical, radiological and laboratory features of spontaneous upper urinary tract rupture (s-UUTR) due to ureteric stones and discuss their management. METHODS: Out of 1629 patients admitted to the Emergency Department (ED) for renal colic from January 2015 to December 2016 and studied by kidney US and contrast enhanced CT (CECT), 31 patients had a s-UUTR categorized in 3 stages: a) local spread, b) free fluid, c) urinoma. Presentation, therapeutic procedures and outcomes were registered. RESULTS: S-UUTR is reported in 1.9% of renal colic. The stone was most commonly identified at the vesicoureteric junction (VUJ) (61.3%) and mean (standard deviation, SD) stone size was 5.71 mm (2.31). S-UUTR was most frequently located in a calyx (54.84%). 26 patients (83.87%) had a clinical presentation of a renal colic, 3 cases (9.68%) had an atypical presentation and 2 (6.45%) presented an acute abdomen. In 26 cases a J-J stent (83,87%) was placed, 3 patients underwent primary ureteroscopic lithotripsy (9.67%); in 1 patient (3.23%) a nephrostomy was inserted and in 1 case (3.23%) active surveillance was adopted. Cases who underwent sole urinary derivation were revaluated after 30 days: ureteroscopic lithotripsy was performed in 48.15% of the cases; extracorporeal shock wave lithotripsy in 3.7%; in 22.2% of cases a CT demonstrated the spontaneous expulsion of the stone. 7 patients were lost at follow-up. The patient undergoing an active surveillance spontaneously expelled the stone. CONCLUSIONS: S-UUTR is a rare radiological sign of a renal colic most commonly located in a calyceal fornix. A high incidence of s-UUTR is caused by small distal ureteral stones in which a spontaneous passage is reasonable. Clinical presentation usually does not arise the suspicion of s-UUTR. In our experience, most patients were actively treated with good results but a conservative approach can be offered in selected cases.

OBJETIVO: Evaluar la incidencia, las características clínicas, radiológicas y de laboratorio de la rotura espontanea del tracto urinario superior (re-TUS) debido a litiasis ureterales y discutir su manejo. MÉTODOS: De 1629 pacientes admitidos en el Departamento de Urgencias por cólico renal entre enero 2015 y diciembre 2016 estudiados con ecografía renal y TAC con contraste, 31 pacientes presentaron re-TUS categorizada en 3 estadios: a) difusión local, b) líquido libre y c) urinoma. Se registraron la presentación, los procedimientos terapéuticos y los resultados. RESULTADOS: Se comunica la re-TUS en 1,9% de los cólicos renales. La localización más frecuente de la litiasis es la unión ureterovesical (61,3%) y el tamaño medio (DE) fue de 5,71 mm (2,31). La localización más frecuente de la re-TUS fue en un cáliz (54,84%). En 26 pacientes (83,87%) la presentación clínica fue cólico renal, 3 (9,68%) una presentación atípica y 2 (6,45%) abdomen agudo. En 26 casos (83,87%) se colocó un catéter doble J, 3 pacientes fueron sometidos a ureteroscopia y litotricia in situ (9,67%); en 1 paciente (3,23%) se insertó una nefrostomía y en otro (3,23%) se adoptó la vigilancia activa. Los casos con derivación urinaria fueron reevaluados a los 30 días: se realizó ureteroscopia con litotricia en 48,15%, litotricia extracorporea por ondas de choque (LEOC) en 3,7%; en el 22,2% de los pacientes la TAC demostró la expulsión espontánea de la litiasis. 7 pacientes se perdieron en el seguimiento. El paciente sometido a vigilancia activa expulsó la litiasis espontáneamente. CONCLUSIONES: La re-TUS es un signo radiológico raro del cólico renal localizado con mayor frecuencia en un fornix calicial. Las litiasis pequeñas del uréter distal en las que una expulsión espontanea es razonable, causan una alta incidencia de re-TUS. La presentación clínica no levanta habitualmente la sospecha de re-TUS. En nuestra experiencia, la mayoría de los pacientes fueron tratados activamente con buenos resultados, aunque se puede ofrecer tratamiento conservador en casos seleccionados.

Segmental testicular infarction: Case series and brief literature review of a great mime.

Segmental testicular infarction is rare, and the etiology is mostly idiopathic. We report a case series of four young patients, one of them with metachronous bilateral disease, presenting with an acute scrotum and treated with a testis-sparing approach, if feasible, after a negative intraoperative biopsy. Etiology, differential diagnosis, and management are reviewed. To be aware of clinical and imaging features of this benign testicular pathology, it is crucial to avoid unnecessary orchiectomies to preserve vital testicular tissue left.

Comparison of Infrapubic vs Penoscrotal Approaches for 3-Piece Inflatable Penile Prosthesis Placement: Do We Have a Winner?

BACKGROUND: The 3-piece inflatable penile prosthesis (IPP) is the gold standard treatment for male erectile dysfunction when other less invasive approaches are contra-indicated or unacceptable for the patient. There are currently 2 surgical approaches for IPP implantation: the penoscrotal (PS) and the infrapubic (IP) incision. AIM: To assess the most recent evidence on the impact of surgical approach for 3-piece IPP implantation in patients with erectile dysfunction. METHODS: A systematic literature review was performed using the MEDLINE (PubMed) and Cochrane Libraries databases in November 2017 to identify all studies investigating 3-piece IPP with a specified surgical access. OUTCOMES: The following key words were used in combination: "infrapubic," "transcrotal," "penoscrotal," "peno-scrotal," and "penile prosthesis." Additional references were obtained from the reference lists of full-text manuscripts. We used a narrative synthesis for the analyses of the studies. RESULTS: 22 Studies reporting data on 3-piece IPP implantation with a specified surgical approach were found in the literature. While IPPs are most commonly positioned through a PS incision, the IP approach is a faster procedure. No cases of glans hypoesthesia after IPP placement with an IP approach were reported, and the overall peri-prosthetic infection rate was 3.3% or less. Patient satisfaction rates were higher than 80% in both groups. CONCLUSIONS: Both the IP and PS approaches are viable and effective strategies for a 3-piece IPP placement, and result in high satisfaction rates. To date there is no evidence that an incision strategy may reduce infection rates. Penile sensory loss following an IP approach remains a virtual risk. It is recommended that the surgeon executing the implant have knowledge of both accesses and be capable of tailoring the incision strategy for complex cases. The chosen method should be based on the patient's specific anatomy, surgical history, and surgeon experience. Palmisano F, Boeri L, Cristini C, et al. Comparison of Infrapubic vs Penoscrotal Approaches for 3-Piece Inflatable Penile Prosthesis Placement: Do We Have a Winner? Sex Med Rev 2018;6:631-639.

Incidence and predictors of readmission within 30 days of transurethral resection of the prostate: a single center European experience.

Hospital readmission rates have been analyzed due to their contribution to increasing medical costs. Little is known about readmission rates after urological procedures. We aimed to assess the incidence and predictors of 30-day readmission after discharge in patients treated with transurethral resection of the prostate (TURP). Data from 160 consecutive patients who underwent TURP from January 2015 to December 2016 were analysed. Intra hospitalization characteristics included length of stay (LOS), catheterization time (CT) and complications. Comorbidities were scored with the Charlson Comorbidity Index (CCI). Mean (SD) age was 70.1 (8.1) yrs and mean prostate volume was 80 (20.1) ml. Mean LOS and CT were 4.9 (2.5) days and 3.3 (1.6) days, respectively. The overall 30-day readmission rate was 14.4%, but only 7 (4.4%) patients required hospitalization. The most frequent reasons for readmission were haematuria (6.8%), fever/urinary tract infections (4.3%) and acute urinary retention (3.1%). Multivariable logistic regression analysis revealed age, CCI and CT to be independent predictors of readmission. However, when analysed according to age at the time of surgery, a beneficial effect from longer CT was observed only for patients older than 75 years. These parameters should be taken in account at the time of discharge after TURP.

Emergency testicular sperm extraction after scrotal trauma in a patient with a history of contralateral orchiopexy for cryptorchidism: case report and review of the literature.

OBJECTIVE: To report a case of successful testicular sperm extraction performed during an emergency scrotal exploration for trauma in a patient with a history of previous contralateral cryptorchidism. DESIGN: Case report. SETTING: Clinica Urologica I, Università degli Studi di Milano, Fondazione Istituto di Ricerca e Cura a Carattere Scientifico Ca' Granda, Ospedale Maggiore Policlinico. PATIENT(S): A 28-year-old man with a history of right orchiopexy for cryptorchidism presenting with blunt trauma of the pelvis. INTERVENTION(S): Seminiferous tubules extraction. MAIN OUTCOME MEASURE(S): Successful sperm retrieval. RESULT(S): Scrotal ultrasonography (US) showed a suspected rupture of the left tunica albuginea, and color Doppler examination evidenced testicular perfusion only in the region near the mediastinum testis. Twelve hours after scrotal exploration, the extracted testicular tissue was successfully processed, and seven vials of sperm were frozen. CONCLUSION(S): After testicular trauma in selected patients, such as individuals with a history of monorchism or cryptorchidism, emergency testicular sperm extraction (TESE) can be a useful option to preserve fertility.

Massive recurring angiomyxoma of the scrotum in a obese man.

Aggressive angiomyxoma (AAM) is a rare mesenchymal benign myxoid tumor, characterized by locally infiltrative nature and high recurrence rate. AAM occurs almost exclusively in adult females, arising from the soft tissue of the pelvic region: to our knowledge, only 43 cases occurring in men have been reported. We report a case of massive recurrence of scrotal AAM in a 46-year-old obese man, who already underwent surgery for the same disease in 2004 and 2005. The mass had a circumference of 106 cm and weighted 30 kg. It was impossible to appreciate the testes and to find the penis. The patient underwent scrotal resection, bilateral orchidopexia and transposition of the penis, by means of a preputial flap. Residual scrotal skin was modeled in order to create a neoscrotum, where the testes were placed and secured with interrupted sutures. Histologic examination showed diffuse angiomyxoma-like lipomatosis. After three months, the patient presented with local relapse which also involved the external urethral orifice.