Microbiota in anorexia nervosa: potential for treatment.

Anorexia nervosa (AN) is characterised by the restriction of energy intake in relation to energy needs and a significantly lowered body weight than normally expected, coupled with an intense fear of gaining weight. Treatment of AN is currently based on psychological and refeeding approaches, but their efficacy remains limited since 40% of patients after 10 years of medical care still present symptoms of AN. The intestine hosts a large community of microorganisms, called the "microbiota", which live in symbiosis with the human host. The gut microbiota of a healthy human is dominated by bacteria from two phyla: Firmicutes and, majorly, Bacteroidetes. However, the proportion in their representation differs on an individual basis and depends on many external factors including medical treatment, geographical location and hereditary, immunological and lifestyle factors. Drastic changes in dietary intake may profoundly impact the composition of the gut microbiota, and the resulting dysbiosis may play a part in the onset and/or maintenance of comorbidities associated with AN, such as gastrointestinal disorders, anxiety and depression, as well as appetite dysregulation. Furthermore, studies have reported the presence of atypical intestinal microbial composition in patients with AN compared with healthy normal-weight controls. This review addresses the current knowledge about the role of the gut microbiota in the pathogenesis and treatment of AN. The review also focuses on the bidirectional interaction between the gastrointestinal tract and the central nervous system (microbiota-gut-brain axis), considering the potential use of the gut microbiota manipulation in the prevention and treatment of AN.

Robotic Partial Nephrectomy for Bilateral Renal Masses.

PURPOSE OF REVIEW: There are very few data on patients undergoing robot-assisted partial nephrectomy (RAPN) for bilateral renal masses. The aim of this review is to update the literature and discuss the controversial points on this topic. RECENT FINDINGS: Nine papers have been published regarding RAPN for bilateral renal masses. In particular, five papers were case reports while the remaining four reported patient series. Concerning the outcomes, all these papers highlighted the safety, feasibility, and efficacy of bilateral RAPN for bilateral renal masses. The literature confirmed RAPN as an optimal procedure for the treatment of bilateral renal masses. However, these outcomes mainly derived from selected group of patients who underwent complex surgical procedures by expert robotic surgeons at high volume centers and cannot be generalizable to all categories of patients or centers. The simultaneous bilateral approach resulted feasible showing some advantages and without higher complications than a staged procedure in particular when clampless or selective clamping techniques were performed.

Simultaneous robotic partial nephrectomy for bilateral renal masses.

PURPOSE: There is currently no consensus regarding the optimal treatment strategy for patients presenting with synchronous bilateral renal masses. The decision to perform bilateral procedures on the same intervention or in staged procedures is debated. The aim of this manuscript is to analyse the outcomes of simultaneous robot-assisted partial nephrectomy (RAPN) in a series of patients with bilateral renal masses treated at five Italian robotic institutions. METHODS: Data from a prospectively maintained multi-institutional database on patients subjected to simultaneous RAPN between November 2011 and July 2019 were reviewed. RAPNs were performed with da Vinci Si or Xi surgical system by expert robotic surgeons. Baseline demographics and clinical features, peri- and post-operative data were collected. RESULTS: Overall, 27 patients underwent simultaneous bilateral RAPN, and 54 RAPNs were performed without need of conversion; median operative time was 250 minutes, median estimated blood loss was 200 mL. Renal artery clamping was needed for 27 (50%) RAPNs with a median warm ischemia time of 15 minutes and no case of acute kidney injury. Complications were reported in 7 (25.9%) patients, mainly represented by Clavien 2 events (6 blood transfusions). Positive surgical margins were assessed in 2 (3.7%) of the renal cell carcinoma. At the median follow-up of 30 months, recurrence-free survival was 100%. CONCLUSION: Our data showed that, in selected patients and expert hands, simultaneous bilateral RAPNs could be a safe and feasible procedure with promising results for the treatment of bilateral synchronous renal masses.

The dramatic COVID 19 outbreak in Italy is responsible of a huge drop of urological surgical activity: a multicenter observational study.

OBJECTIVE: To describe the trend in surgical volume in urology in Italy during the coronavirus disease 2019 (COVID-19) outbreak, as a result of the abrupt reorganisation of the Italian national health system to augment care provision to symptomatic patients with COVID-19. METHODS: A total of 33 urological units with physicians affiliated to the AGILE consortium (Italian Group for Advanced Laparo-Endoscopic Surgery; www.agilegroup.it) were surveyed. Urologists were asked to report the amount of surgical elective procedures week-by-week, from the beginning of the emergency to the following month. RESULTS: The 33 hospitals involved in the study account overall for 22 945 beds and are distributed in 13/20 Italian regions. Before the outbreak, the involved urology units performed overall 1213 procedures/week, half of which were oncological. A month later, the number of surgeries had declined by 78%. Lombardy, the first region with positive COVID-19 cases, experienced a 94% reduction. The decrease in oncological and non-oncological surgical activity was 35.9% and 89%, respectively. The trend of the decline showed a delay of roughly 2 weeks for the other regions. CONCLUSION: Italy, a country with a high fatality rate from COVID-19, experienced a sudden decline in surgical activity. This decline was inversely related to the increase in COVID-19 care, with potential harm particularly in the oncological field. The Italian experience may be helpful for future surgical pre-planning in other countries not so drastically affected by the disease to date.

Urology in the Time of Coronavirus: Reduced Access to Urgent and Emergent Urological Care during the Coronavirus Disease 2019 Outbreak in Italy.

PURPOSE: The coronavirus disease 2019 (COVID-19) pandemic has put a substantial burden on the Italian healthcare system, resulting in the restructuring of hospitals to care for COVID-19 patients. However, this has likely impacted access to care for patients experiencing other conditions. We aimed to quantify the impact of COVID-19 on access to care for patients with urgent/emergent urological conditions throughout Italy. MATERIALS AND METHODS: A questionnaire was sent to 33 urological units in the AGILE consortium, asking clinicians to report on the number of urgent/emergent urological patients seen and/or undergoing surgery over a 3-week period during the peak of the COVID-19 outbreak and a reference week prior to the outbreak. ANOVA and linear regression models were used to quantify these changes. RESULTS: Data from 27 urological centres in Italy showed a decrease from 956 patients/week seen just prior to the outbreak to 291 patients/week seen by the end of the study period. There was a difference in the number of patients with urgent/emergent urological disease seen within/during the different weeks (all p values < 0.05). A significant decrease in the number of patients presenting with haematuria, urinary retention, urinary tract infection, scrotal pain, renal colic, or trauma and urgent/emergent cases that required surgery was reported (all p values < 0.05). CONCLUSION: In Italy, during the COVID-19 outbreak there has been a decrease in patients seeking help for urgent/emergent urological conditions. Restructuring of hospitals and clinics is mandatory to cope with the COVID-19 pandemic; however, the healthcare system should continue to provide adequate levels of care also to patients with other conditions.

Mid- to long-term results of the Remeex system for the treatment of female incontinence due to intrinsic sphincter deficiency: A retrospective analysis of the first 50 patients.

AIMS: To retrospectively report our mid- to long-term results following suburethral tension adjustable sling (Remeex system) implantation for stress urinary incontinence (SUI) due to intrinsic sphincter deficiency (ISD). METHODS: Fifty female patients with severe SUI due to ISD underwent Remeex system positioning between May 2002 and March 2013 (mean follow-up 83.8 months, median follow-up 85.4 months). Before surgery, patients were evaluated by physical examination, translabial ultrasonography, cystoscopy, urodynamics, 1 hr pad test and compilation of quality-of-life questionnaire. Postoperatively, based on the physical examination and pad test, patients were stratified into three groups: (i) Cured: perfectly dry patients at stress test, pad weight 0-1 g; (ii) Improved: patients with mild to moderate incontinence, pad weight 2-50 g; and (iii) Failed: unchanged or worsened patients, pad weight >50 g. RESULTS: At 7-years mean follow-up, 45 (90.0%) patients were cured, three (6.0%) were improved, and two (4.0%) had failed. Concerning the mean total score of the quality-of-life questionnaire, it increased significantly up to 87.1 ± 5.9 with an improvement of 76.9%. Sling tension readjustment was needed in three patients (6%). The incontinence-free survival curve showed that, after sling positioning and tension readjustments, all the cured patients remained continent during all the follow-up. Complications were represented by bacterial cystitis (6%), de novo urgency (10%), persistent urinary retention (6%), and seroma formation (2%). CONCLUSIONS: Our 7-year results showed the efficacy of the Remeex procedure in the treatment of SUI due to ISD. These outcomes tended to be confirmed in the mid- to long-term follow-up which would highlight the durability of this technique. Neurourol. Urodynam. 36:770-773, 2017. © 2016 Wiley Periodicals, Inc.

Robotic prostatectomy versus brachytherapy for the treatment of low risk prostate cancer.

INTRODUCTION: To compare oncological and functional results of robot-assisted radical prostatectomy (RARP) and brachytherapy (BT) with a single-center prospective randomized study. MATERIALS AND METHODS: From January 2012 to January 2014, 165 patients with low risk prostate cancer, prostate volume ≤ 50 g, normal urinary (IPSS ≤ 7 and mean flow rate ≥ 15 mL/sec) and erectile functions (IIEF-5 > 17) were enrolled and randomly assigned to the RARP or BT group. Our end points included the comparison of biochemical recurrence-free survival rates, urinary function (IPSS and EPIC scores) and potency rates (IIEF-5 score) at different time points during the first 2 years after surgery between the two groups. RESULTS: The biochemical recurrence-free survival rates were 96.1% and 97.4% for the BT and RARP groups, respectively (p = 0.35). Significantly higher IPSS scores were assessed in the BT than in the RARP group at all the postoperative time points (p < 0.05). Significantly higher continence rates were assessed in the BT than in the RARP group during only the first 6 months of follow up (p < 0.05). Significantly lower potency rates were assessed in the BT than in the RARP group at all the postoperative time points (p < 0.05). CONCLUSIONS: Our data showed similar biochemical recurrence-free survival rates after BT and RARP. BT patients confirmed constantly higher rates of urinary symptoms while only reporting better continence rates for the first 6 months after surgery. RARP patients reported higher potency rates than BT patients during all the follow up period.

Musculoskeletal disorders among robotic surgeons: a questionnaire analysis.

OBJECTIVE: Robotic surgical systems offer better workplace in order to relieve surgeons from prolonged physical efforts and improve their surgical outcomes. However, robotic surgery could produce musculoskeletal disorders due to the prolonged sitting position of the operator, the fixed position of the console viewer and the movements of the limbs. Until today, no one study has been reported concerning the association between robotics and musculoskeletal pain. The aim of this work was verify the prevalence of musculoskeletal disorders among Italian robotic surgeons. MATERIAL AND METHODS: Between July 2011 and April 2012 a modified Standardized Nordic Questionnaire was delivered to thirty-nine Italian robotic centres. Twentytwo surgeons (56%) returned the questionnaires but only seventeen questionnaires (43.5%) were evaluable. RESULTS: Seven surgeons (41.2%) reported musculoskeletal disorders, by since their first use of the robot which significantly persisted during the daily surgical activity (P < 0.001). Regarding the body parts affected, musculoskeletal disorders were mainly reported in the cervical spine (29.4%) and in the upper limbs (23.5%). Six surgeons (35.3%) defined the robotic console as less comfortable or neither comfortable/uncomfortable with a negative influence on their surgical procedures. CONCLUSIONS: In spite of some important limitations, our data showed musculoskeletal disorders due to posture discomfort with negative impact on daily surgical activity among robotic surgeons. These aspects could be due to the lack of ergonomic seat and to the fixed position of the console viewer which could have produced an inadequate spinal posture. The evaluation of these postural factors, in particular the development of an integrated and more ergonomic chair, could further improve the comfort feeling of the surgeon at the console and probably his surgical outcomes.

Genital diseases awareness in young male students: Is information necessary to protect them?

INTRODUCTION: Few studies on the prevalence of male sexual diseases are currently available due to difficult application of observational studies or andrological disease prevention campaigns on large series of apparently healthy subjects. The medical check-up linked to compulsory military service represented in Italy a valid tool for epidemiological and observational study for 18 year old boys from 1861 to 2004. The stopping of compulsory military service and its related medical check-up could have determined an important social impact in terms of a lower level of attention and care on male genital/sexual diseases. The aim of the present observational study was to check the prevalence of genital/sexual diseases among young male high-school students and promote an alternative campaign of information among young students. METHODS: A prospective observational analytical study on young male students was conducted by 6 urological centres. Genital and sexually transmitted diseases were presented with slides to students in a general assembly. Some students were then counselled and filled out a short questionnaire on their lifestyle. RESULTS: 12,535 students (10,432 males-83.6%) followed the presentation. and 4,897 males (46.7%) decided to be checked-up by the urologist and out of them 1554 (31.7%) presented relevant andrological diseases. Five-hundred students completed the questionnaire concerning their lifestyle. Many of them had not yet experienced condom use during sexual intercourse (27.8%). Drug abuse was reported by 39.6% of subjects and alcohol consumption in 80.8% of them. CONCLUSIONS: These data suggest the need for a national information campaign on male sexual disorders to promote sexual health.

A rare case of syncronous solitary para-pharyngeal metastasis of clear cell carcinoma in a patient with small renal mass.

INTRODUCTION: Unusual metastatic sites of renal cell carcinoma (RCC) are not infrequent. We report a rare case of solitary pharyngeal metastasis as first presentation of RCC. CASE DESCRIPTION: A 74 years-old man was referred to our hospital due to rapidly progressive dyspnoea and dysphagia. Physical examination showed a large right para-pharyngeal mass. Imaging findings showed a 5.5 cm mass, suspicious for malignancy, which extended to right para and retro-pharyngeal spaces with compression of the major right cervical vessels, C2-C3 vertebral bodies osteolysis, dural sac compression and dislocation. Futhermore, a small (2.6 × 2 cm) mass located at the upper pole of the right kidney was shown. Patient underwent partial trans-oral removal of the mass. Pathological examination and immunochemistry resulting strongly suggestive for metastatic RCC. Considering the metastatic stage of the tumour and the rapidly progressive clinical worsening with poor performance status, we offered the patient a palliative treatment with tyrosine kinase and cytoreductive radiotherapy on vertebral bodies. The patient developed a rapidly progressive multifocal metastatic disease and died 4 months after the presentation. CONCLUSION: We think that our case is noteworthy for some aspects. Firstly, pharyngeal localizations of RCC are very rare and this is the first case of solitary pharyngeal metastasis. Secondly, this metastatic lesion was really particular because it was synchronous and twice as big than the primary tumour. Thirdly, this case is consistent with previous evidence that synchronous compared with metachronous metastasis RCC is associated with adverse effect on outcome and response to targeted treatment.