Iatrogenic or recurrent bladder neck contracture treated by the Palminteri-Ferrari technique: a new way to approach a frustrating condition.

PURPOSE: Bladder neck stricture (BNS) is a bothersome disease which may affect patients after trauma or prostatic surgery. It is frustrating due to the low durable success rate of currently available surgical techniques. The aim of the study is to explore the efficacy of a novel technique. MATERIALS & METHODS: The surgical protocol was developed by two high case-volume surgeons. The technique consists of Holmium laser incisions at 3-6-9-12 o'clock. Subsequently, triamcinolone acetonide 40 mg is injected. Two months later, the BNS is endoscopically checked in operatory room and re-procedure take place, if necessary (max 3 times). Failure was defined as the need of definitive urinary diversion. Subjective satisfaction was measured through PGI-I Questionnaire. RESULTS: A total of 45 patients were enrolled. Median age was 63 (IQR 59-69) years and BNS developed by different causes. Naïve BNS procedure patients were 12 (26.7%), others 33 (73.3%) underwent median 2 (IQR 1-4) previous urethrotomies, including 16 other surgeries. Suprapubic bladder catheter was present in 34 patients (75.6%). No complications were registered. Re-procedure at control was necessary in 24 patients (53.3%) for a median of 1 (IQR 1-3) procedures. At median follow-up of 18 months, failures were 4 (8.9%) and urinary incontinence was reported in 2 patients (4.5%) who required incontinence surgery. Median PGI-I was 2. CONCLUSIONS: Our technique of BNS treatment allows good outcomes and high rate of subjective improvement amongst patients. Moreover, naïve patients seem to have better results. However, longer follow-up and higher sample size are mandatory to further assess these data.

Small intestinal submucosa graft bulbar urethroplasty is a viable technique: results compared to buccal mucosa graft urethroplasty after propensity score matching.

PURPOSE: Small intestinal submucosa (SIS) graft urethroplasty has been employed to decrease buccal mucosa morbidity and facilitate the procedure. The first published series had a short follow-up, inhomogeneous patient selection, and a lack of a control group. Our purpose is to report treatment outcomes at 13 years in a propensity score-matched cohort comparing bulbar urethroplasty with SIS (SISU) or buccal mucosa (BMU). METHODS: From our institutional database of 1132 bulbar urethroplasties, we used propensity score matching with the nearest-neighbor method without replacement to generate a study sample of 25 BMU and 25 SISU. Failure was defined as any treatment after urethroplasty. Survival analyses were used to analyze treatment failure occurrence with data censored at 156mo. RESULTS: Matching resulted in a complete correction of bias between the two samples except for the follow-up duration, which was slightly longer in the SIS group. The cumulative treatment success probability of BMU and SISU at 156mo was 83.4% and 68%, respectively. At multivariable Cox regression, SIS graft, previous urethrotomy, stricture length, and lower postoperative Qmax (within 2mo after catheter removal) were predictors of failure. Stricture length had a more remarkable effect in SISU, with estimated survival probabilities from the Cox model lower than 80% in strictures > = 3 cm. CONCLUSION: SIS has poorer outcomes compared to BM but may still be useful when BM grafting is not possible. The best candidates for SISU, with similar success to BMU, are patients with strictures shorter than 3 cm, preferably without a history of DVIU.

Variation of inflammatory indexes in patients with chronic abacterial prostatitis treated with an herbal compound/extract.

INTRODUCTION: Inflammation is a highly prevalent finding in the prostate. Men with inflammation have higher IPSS score and increased prostate size. For men with prostatic inflammation, there is a significantly increased risk of developing acute urinary retention and the need of a surgical approach to the disease. Some laboratory tests (i.e. fibrinogen, C-reactive protein), can play a role in identifying patients at greatest risk of complications and adverse outcomes after surgery. There have been several experiences exploring the role of nutraceutical approach to the prostate inflammation. Aim of our study were to describe the variation in symptoms and inflammatory indexes in men affected by chronic abacterial prostatitis, treated with an herbal extract containing Curcuma Longa 500 mg, Boswellia 300 mg, Urtica dioica 240 mg, Pinus pinaster 200 mg and glycine max 70 mg. MATERIALS AND METHODS: A prospective multicenter study was conducted from February 2021 and March 2022. One hundred patients, with a diagnosis of Chronic Prostatitis were enrolled in a multicentric phase III observational study. They were treated with the herbal extract, one capsule per day, for 60 days. No placebo arm was included. In each patient, inflammatory indexes, PSA, prostate volume, IIEF-5, PUF, uroflowmetry (Qmax), IPSS-QoL, NIH-CPPS were registered and statistically compared at baseline and at the follow up visit. RESULTS: The variation obtained on the inflammation indexes showed a global improvement after treatment, including the PSA reduction. We also recorded a significant improvement on IPSS-QoL, NIH-CPPS, PUF and Qmax scores. CONCLUSIONS: The herbal extract considered in our study may represent a promising and safe therapeutic agent leading to a reduction of inflammation markers, and could be used in the treatment of prostatitis and benign prostatic hyperplasia.

Long-term follow-up of two-sided dorsal plus ventral oral graft bulbar urethroplasty: single center experience on 216 patients.

BACKGROUND: Two-sided dorsal plus ventral oral graft urethroplasty is a new urethra-sparing technique suggested in tight bulbar strictures which are too severe for a simple one-side grafting. The aim of this study was to evaluate long-term outcomes and the success predictive factors of this technique. METHODS: A descriptive retrospective study was conducted on 216 patients undergoing dorsal plus ventral graft urethroplasty for bulbar strictures between 2002 and 2018 in a single high-volume center by a single surgeon (EP). The primary outcome measure was stricture recurrence at follow-up. Surgical procedure was considered failed when any postoperative instrumentation was needed. Univariable and multivariable logistic regression analysis were performed. RESULTS: Median follow-up was 98 months (IQR: 41-131). Among the 216 patients, 188 (87%) were successful and 28 (13%) were failures. Most of the failures (78.4%) were observed during the first 7 years of follow-up, afterward failures were less frequently recorded. Stricture length <1.5 cm and the absence of previous treatments resulted as independent success predictors (respectively P=0.04, OR=0.55 (0.29-0.99) and P=0.02, OR=0.23 (0.06-0.79). Age and stricture etiology were not significant predictors of surgical outcome. The limitation of our survey is that it is a retrospective single center experience. Multicentric experiences from different centers should be performed. CONCLUSIONS: After long-term follow-up in our wide series, the two-sided dorsal plus ventral oral graft bulbar urethroplasty showed a high success rate. Stricture length <1.5 cm and the absence of previous treatments resulted as independent success predictors.

The Role of Multi-Staged Urethroplasty in Lichen Sclerosus Penile Urethral Strictures.

BACKGROUND: One-stage buccal mucosa graft urethroplasty (BMGU) is advised for non-obstructing, simple penile strictures due to lichen sclerosus (LS), while a multistage approach is preferred for most complex cases. Our study aims to evaluate long-term treatment outcomes and patient-reported outcomes (PROs) in patients undergoing multistage BMGU for LS-associated penile strictures. METHODS: This is a retrospective analysis of prospectively collected data on multistage penile BMGU from 2001. All patients underwent a 2-stage (2St) or 3-stage (3St) BMGU with the final closure of the urethral plate. PROs were collected from a pre-defined questionnaire. RESULTS: Twenty patients were successfully treated, while five experienced recurrence. If a first-stage Johanson was only performed, a 3St-BMGU was more likely, and higher treatment success was observed. A time course between the first and last stages shorter than 12 m was an independent predictor of treatment failure. Patients reported high overall satisfaction and urinary flow improvement. Sexual life was not significantly affected, while aesthetic appearance was the most affected dimension. CONCLUSIONS: Staged approaches have satisfactory treatment success rates, likely depending on the duration from the first to the last stage. PROs do not differ based on the number of stages performed, and overall satisfaction with the procedure is high.

Cross-reactive immunity potentially drives global oscillation and opposed alternation patterns of seasonal influenza A viruses.

Several human pathogens exhibit distinct patterns of seasonality and circulate as pairs. For instance, influenza A virus subtypes oscillate and peak during winter seasons of the world's temperate climate zones. Alternation of dominant strains in successive influenza seasons makes epidemic forecasting a major challenge. From the start of the 2009 influenza pandemic we enrolled influenza A virus infected patients (n = 2980) in a global prospective clinical study. Complete hemagglutinin sequences were obtained from 1078 A/H1N1 and 1033 A/H3N2 viruses. We used phylodynamics to construct high resolution spatio-temporal phylogenetic hemagglutinin trees and estimated global influenza A effective reproductive numbers (R) over time (2009-2013). We demonstrate that R oscillates around R = 1 with a clear opposed alternation pattern between phases of the A/H1N1 and A/H3N2 subtypes. Moreover, we find a similar alternation pattern for the number of global viral spread between the sampled geographical locations. Both observations suggest a between-strain competition for susceptible hosts on a global level. Extrinsic factors that affect person-to-person transmission are a major driver of influenza seasonality. The data presented here indicate that cross-reactive host immunity is also a key intrinsic driver of influenza seasonality, which determines the influenza A virus strain at the onset of each epidemic season.

Shockwave Therapy for Erectile Dysfunction: Which Gives the Best Results? A Retrospective National, Multi-Institutional Comparative Study of Different Shockwave Technologies.

BACKGROUND: Low-intensity shockwave therapy (Li-SWT) is a promising option for the treatment of erectile dysfunction (ED). Many devices with different characteristics in terms of generators, shockwaves, set-up parameters and procedure protocols are commercially available. In this report, we present our experience with the main shockwave technologies currently in use in clinical practice for ED treatment. METHODS: A retrospective national, multi-institutional study was performed to compare the effects of different shockwave technologies in ED patients. All of the subjects underwent 8 consecutive weekly physical treatments with SWT under either a focused or non-focused regimen: 3,000 shocks per session at 0.09 mJ/mm2 and 10,000 shocks per session at 15 Hz and 90 mJ, respectively. Efficacy was evaluated by comparing pre- and post-treatment Sexual Health Inventory in Men (SHIM) scores, International Index of Erectile Function (IIEF-5) and Erection Hardness Score (EHS). Possible relationships between type of shockwave generator, source, morphology and type of ED were investigated. RESULTS: A total of 94 men were included in the analysis. There were no significant differences in the baseline clinical characteristics or demographics. The mean (SD) increase in the scores from questionnaires evaluated at 8 weeks was clinically and statistically significant, with overall improvements of +5.49, +5.47 and +1.18 (p<0.0001) in the IIEF-5, SHIM, and EHS scores, respectively. The increases in these scores were evaluated by a multiple regression analysis, in relation to the shockwave generator, type of ED, shockwave source and morphology, but none of the factors examined predicted improvement. No side effects were reported with any device. CONCLUSIONS: SWT is a clinically effective and safe treatment for ED that is independent of the generator type, source, shockwave morphology emitted, type of ED and perhaps treatment protocol.

Green light laser enucleation of the prostate with early apical release is safe and effective: single center experience and revision of the literature.

BACKGROUND: Green Light laser enucleation of the prostate (GreenLEP) is an endoscopic treatment to treat bladder outlet obstruction in men with large prostate (>100 cc). Herein, we describe our GreenLEP series and describe its safety and efficacy. METHODS: Between February 2014 and April 2019, 120 patients from a single center underwent en-bloc GreenLEP with early apical release. All procedures were performed with the AMS XPS laser generator (set: 120 W for vaporization and 20 W for coagulation). Morcellation was carried out with the Wolf Piranha morcellator. Data concerning the pre-, intra- and postoperative outcomes were prospectively collected. The follow-up data at 6, 12 months and at the last control were collected. RESULTS: The median age was 66.0 (IQR: 61.0-71.0) years; 37.5% of the patients were under antiplatelet/anticoagulant therapy, 15.0% had indwelling catheter history. The median prostate volume and the baseline PSA value were 98.5 mL (IQR 83.0-130.0) and 4.2 ng/mL (IQR: 3.2-6.8), respectively. The median operative and lasing time were 65.0 (IQR: 51.0-83.5) and 6.0 (IQR: 6.0-10.0) minutes, respectively. In the postoperative period 1 patient was transfused. The median follow-up was 18.0 (IQR: 12.0-39.5) months. All patients had significant improvement in terms of improvement of uroflowmetry (median from 9 mL/sec [IQR 7.8, 11.0] to 20.0 [IQR 18.0, 22.0], P<0.001) and symptoms control (IPSS median score from 26.0 mL/sec [IQR 22.0, 28.0] to 7.0 [IQR 6.0, 8.0], P<0.001]) over time. After 12 months 1 patient complained of stress incontinence (1 pad/day) and 1 of "de novo" wet urgency. CONCLUSIONS: En-bloc GreenLEP with early apical release is a safe and effective procedure even for large volume prostates. It allows us to limit the use of laser energy and shorten the operating times with stable and satisfactory long-term outcomes.

ProPIP: a tool for progressive multiple sequence alignment with Poisson Indel Process.

BACKGROUND: Current alignment tools typically lack an explicit model of indel evolution, leading to artificially short inferred alignments (i.e., over-alignment) due to inconsistencies between the indel history and the phylogeny relating the input sequences. RESULTS: We present a new progressive multiple sequence alignment tool ProPIP. The process of insertions and deletions is described using an explicit evolutionary model-the Poisson Indel Process or PIP. The method is based on dynamic programming and is implemented in a frequentist framework. The source code can be compiled on Linux, macOS and Microsoft Windows platforms. The algorithm is implemented in C++ as standalone program. The source code is freely available on GitHub at https://github.com/acg-team/ProPIP and is distributed under the terms of the GNU GPL v3 license. CONCLUSIONS: The use of an explicit indel evolution model allows to avoid over-alignment, to infer gaps in a phylogenetically consistent way and to make inferences about the rates of insertions and deletions. Instead of the arbitrary gap penalties, the parameters used by ProPIP are the insertion and deletion rates, which have biological interpretation and are contextualized in a probabilistic environment. As a result, indel rate settings may be optimised in order to infer phylogenetically meaningful gap patterns.

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.

Metabolites Secreted by a Plant-Growth-Promoting Pantoea agglomerans Strain Improved Rooting of Pyrus communis L. cv Dar Gazi Cuttings.

Strains belonging to Pantoea agglomerans species are known for their ability to produce metabolites that can act in synergy with auxins to induce the adventitious root (AR) formation. The latter is critically important in the agamic propagation of several woody species, including pear (Pyrus communis L.), playing a considerable role in the commercial nursery farms including those using micropropagation techniques. When grown on a medium amended with tryptophan, the plant-growth-promoting (PGP) strain P. agglomerans C1 produces a cocktail of auxin and auxin-like molecules that can be utilized as biostimulants to improve the rooting of vegetable (Solanum lycopersicum L.) and woody crop species (Prunus rootstock GF/677 and hazelnut). In this study, we evaluated the morphological and molecular responses induced by strain C1 exometabolites in microcuttings of P. communis L. cv Dar Gazi and the potential benefits arising from their application. Results showed that exometabolites by P. agglomerans C1 induced a direct and earlier emergence of roots from stem tissues and determined modifications of root morphological parameters and root architecture compared to plants treated with the synthetic hormone indole-3-butyric acid (IBA). Transcription analysis revealed differences in the temporal expression pattern of ARF17 gene when IBA and C1 exometabolites were used alone, while together they also determined changes in the expression pattern of other key auxin-regulated plant genes. These results suggest that the phenotypic and molecular changes triggered by P. agglomerans C1 are dependent on different stimulatory and inhibitory effects that auxin-like molecules and other metabolites secreted by this strain have on the gene regulatory network of the plant. This evidence supports the hypothesis that the strategies used to harness the metabolic potential of PGP bacteria are key factors in obtaining novel biostimulants for sustainable agriculture. Our results demonstrate that metabolites secreted by strain C1 can be successfully used to increase the efficiency of micropropagation of pear through tissue culture techniques.

A Genetic and Metabolomic Perspective on the Production of Indole-3-Acetic Acid by Pantoea agglomerans and Use of Their Metabolites as Biostimulants in Plant Nurseries.

The species Pantoea agglomerans includes strains that are agronomically relevant for their growth-promoting or biocontrol traits. Molecular analysis demonstrated that the IPDC pathway involved in the conversion of tryptophan (Trp) to indole-3-acetic acid (IAA) is highly conserved among P. agglomerans strains at both gene and protein levels. Results also indicated that the promoter region controlling the inducible expression of ipdC gene differs from the model system Enterobacter cloacae, which is in accordance with the observation that P. agglomerans accumulates higher levels of IAA when cells are collected in the exponential phase of growth. To assess the potential applications of these microorganisms for IAA production, P. agglomerans C1, an efficient auxin-producer strain, was cultivated in 5 L fermenter so as to evaluate the effect of the medium formulation, the physiological state of the cells, and the induction timing on the volumetric productivity. Results demonstrated that higher IAA levels were obtained by using a saline medium amended with yeast extract and saccharose and by providing Trp, which acts both as a precursor and an inducer, to a culture in the exponential phase of growth. Untargeted metabolomic analysis revealed a significant effect of the carbon source on the exometabolome profile relative to IAA-related compounds and other plant bioactive signaling molecules. The IAA-enriched metabolites secreted in the culture medium by P. agglomerans C1 were used as plant biostimulants to run a series of trials at a large-scale nursery farm. Tests were carried out with in vitro and ex vitro systems following the regular protocols used for large-scale plant tree agamic propagation. Results obtained with 4,540 microcuttings of Prunus rootstock GF/677 and 1,080 plantlets of Corylus avellana L. showed that metabolites from strain C1 improved percentage of rooted-explant, number of adventitious root formation, plant survival, and quality of plant as vigor, with an increase in the leaf area between 17.5 and 42.7% compared to IBA-K (indole-3-butyric acid potassium salt)-treated plants.

Does student orientation improve nursing image and positively influence the enrolment of nursing students in the University? An observational study.

BACKGROUND AND AIM OF THE STUDY: Nursing has not yet received full social recognition and in general the public opinion does not have a completely positive perception of it, which regards it as an auxiliary profession to the medical profession. This study aims to investigate the image of the nurse among year 4 and 5 high school students. METHODS: Two groups of students were interviewed, one at their institution without any previous orientation (n = 102) and one at the University of Bologna during orientation day (n = 388). A validated questionnaire (Nursing Attitude Questionnaire) of 30 items was delivered. Two additional questions were added to explore the possibility of advising relatives and acquaintances to become a nurse and therefore to choose the nursing degree course. RESULTS: All areas of the NAQ scored significantly higher in the group where students attended the orientation day, especially the ones related to the professional role, stereotypes and professional value items. Female students ≥ 21 had a more positive image of the nurse. Both groups recognized that nurses are important figures for patients and that they are intelligent people, who must have a degree in order to carry out their work duties. Differences between the groups were recorded. Students in group 1 did not accept nursing autonomy while students in group 2 understood differences between nursing and medical careers, attributing to them the same value. A positive correlation between the positive image of the nursing profession and the interest in becoming nurses or advising others to undertake the nursing course was found. In conclusion, orientation is effective in helping high school students in the choice of their university courses. Regarding nursing, strategies to improve the image of the nurse and enrollment should be combined during orientation day with current up to date communication and learning tools, such as social media and simulation laboratories. Furthermore, it appears increasingly important to extend orientation and tutoring activities to junior high school students, families and teachers.

Day-Length Is Involved in Flooding Tolerance Response in Wild Type and Variant Genotypes of Rootstock Prunus cerasifera L.

Current and predicted climate changes scenarios require crops with an improved adaptability to mutable environmental features, such as, hypoxia for the root system. In order to overcome the reduction of oxygen, plants activate coping mechanisms and strategies. Prunus spp. are hypoxia-sensitive woody species and although many information has been gathered over the last decades, many physiological mechanisms remain unclear. To verify whether anoxic plant responses are also regulated by photoperiod, plants of Mr.S.2/5-WT plum, and its variant genotypes S.4 tolerant (plus) and S.1 sensitive (minus) to flooding, were grown in a greenhouse and were submitted to natural photoperiod (NP) and to constant photoperiod (CP) from mid-July until the first 10 days of October. From mid-September plants from each genotype, grown under the two photoperiods, were divided into two groups, and one of them underwent long-term flooding. Gas exchange parameters, energetic and biochemical activities, leaf chlorophyll contents, and stress symptoms were measured at different times, whereas soluble sugars were quantified in leaves and roots 14 days after flooding, when stress symptoms in WT and S.1 became prominent. Seasonal changes in the photoperiod played a role in the adaptability to anoxia, although flooding stress response differed among the three genotypes. Anoxia affected leaf gas exchange and S.4 flooded-leaves retained higher ACO2 under conditions of NP and CP. Leaf soluble sugar concentration differed among genotypes. Regardless the photoperiod, S.4 anoxic-leaf sugar concentration was the lowest, except for sorbitol. S.4 anoxic-roots under CP accumulated the highest levels of sucrose and sorbitol. Influences of the photoperiod were observed in WT and S.1 anoxic-leaves, whereas S.1 anoxic roots accumulated the lowest concentration of sugars, regardless of photoperiod. Leaf and root respiratory activity in flooded-plants was highest in S.4, and ADH activity increased in all flooded plants under CP but the highest activity was observed only in S.1 under NP during flooding. Results are consistent with the hypothesis that the S.4 genotype has a plastic adaptability to flooding stress, escaping from the photoperiod regulatory cross-talk system, and can better cope with the new scenarios generated by climate changes.

EpiTools: An Open-Source Image Analysis Toolkit for Quantifying Epithelial Growth Dynamics.

Epithelia grow and undergo extensive rearrangements to achieve their final size and shape. Imaging the dynamics of tissue growth and morphogenesis is now possible with advances in time-lapse microscopy, but a true understanding of their complexities is limited by automated image analysis tools to extract quantitative data. To overcome such limitations, we have designed a new open-source image analysis toolkit called EpiTools. It provides user-friendly graphical user interfaces for accurately segmenting and tracking the contours of cell membrane signals obtained from 4D confocal imaging. It is designed for a broad audience, especially biologists with no computer-science background. Quantitative data extraction is integrated into a larger bioimaging platform, Icy, to increase the visibility and usability of our tools. We demonstrate the usefulness of EpiTools by analyzing Drosophila wing imaginal disc growth, revealing previously overlooked properties of this dynamic tissue, such as the patterns of cellular rearrangements.

[Short and medium term oncological results after robot-assisted prostatectomy: a comparative prospective non randomized study]. / Risultati oncologici a breve-medio termine dopo prostatectomia robotica: studio comparativo prospettico non randomizzato.

BACKGROUND: Our aim was to compare both the perioperative and the short/medium-term post-operative oncological results after radical prostatectomy between two groups of prostate cancer patients: one group treated with radical retropubic prostatectomy (RRP), the other one with robot-assisted laparoscopic prostatectomy (RALP). METHODS: We collected all the clinical, surgical, pathological and follow-up data of the patients who underwent radical prostatectomy with the two different surgical methods in a dedicated database. The positive surgical margins were defined by the presence of disease at the resection margin marked with China ink. The biochemical persistence of disease was defined as a PSA value >0.1 ng/mL 30 days after surgery, while the biochemical recurrence of the neoplasia was defined as a PSA value >0.2 ng/mL. RESULTS: The positive surgical margins (PSM) were identified as follows: 29.3% (RRP) versus 25.4% (RALP) in pT2 cancer (p 0.563), and 63.6% (RRP) versus 50.0% (RALP) in case of >pT2 cancer (p 0.559). If stratified by surgical approach, the results are: 53.3% (RRP) versus 25.6% (RALP) (p <0.001) in case of nerve-sparing technique. The persistence of disease is detectable in 5.4% (RRP) versus 4.6% (RALP), while the data on biochemical recurrence are: 2.7% (RRP) versus 0% (RALP). CONCLUSIONS: In our experience, in two groups of patients matched for clinic-pathological features who underwent RRP and RALP, oncological results are slightly better in the second group; this figure is even more significant when evaluating surgeries conducted with nerve-sparing technique. In this study we analyzed data of RALP, recently introduced in our center, comparing with RRP, a surgical technique consolidated through the decades. Therefore it can be said that even during the learning curve, RALP provides oncological results comparable to RRP.

Robot-assisted laparoscopic removal of perirenal lymphangioma: a case report.

The lymphangioma is a congenital malformation caused by abnormal development of the lymphatic vessels. The perirenal lymphangioma is extremely rare, and very few cases have been described in literature. A case of retroperitoneal perirenal lymphangioma is reported. Following recurring episodes of colic-like, right side back pain, a 16 year woman underwent an ultrasound which detected a multiloculated cystic lesion of 5 x 1 cm surrounding the lower pole of the right kidney. Subsequently a CT scan and an MRI detected, in the right perirenal space, a liquid multiloculated lesion, with no enhancement. Surgery was performed using the Da Vinci robotic system with transperitoneal access. Once dissection was concluded it was possible to identify a lymphatic duct coming from the renal pedicle, which likely drained the lesion, and selectively close it using clips. In conclusion, the cystic lymphangioma, must be considered among the differential diagnoses of retroperitoneal cystic lesions. These rare tumours have an excellent prognosis, with full remission of the symptomatology following complete surgical excision.

[ProACT (Adjustable Continence Therapy) implants in case of failure of other techniques for urinary incontinence]. / Reimpianto del sistema ProACT in caso di fallimento precoce nella cura dell'incontinenza urinaria dopo prostatectomia radicale.

BACKGROUND: Urinary incontinence after radical prostatectomy is one of the most feared problems. It can affect almost 40% of patients, with different degrees of severity according to each specific case. The aim of this work is to analyze our experience in ProACT (Adjustable Continence Therapy) implants, especially in case of failure of other techniques. METHODS: Between November 2007 and December 2010, 31 patients with post-radical prostatectomy incontinence underwent a ProACT implant. Eight patients had their device explanted (in local anesthesia): in two cases the device spontaneously broke, three of them migrated in the urethra (one patient received radiation therapy), another one was infected in the device site (one in BCG treatment for non-muscle invasive bladder cancer), two devices were wrongly placed. Seven of these patients had had their device replaced with success. Using pad score, incontinence was classified as mild, moderate and severe. Overall, the total amount of procedures, most of them fluoroscopic-guided in spinal anesthesia, were 38; the average duration of the surgery was 37.6 minutes. In one patient with impaired balloon volume due to monolateral device malfunction, we noticed good results in controlling incontinence; therefore, we successfully applied the same technique in other four cases with previous partial results. RESULTS: With a total amount of 28 implants, we had 17 (60.7%) complete responses, 6 (25%) partial and 4 (14.3%) failures. We had 4 post-radiotherapy implants: one was completely dry, two were in balloon adjustment, and one of them had a replacement due to urethral erosion of the first implant.
All patients with impaired balloon inflation were satisfied: one was completely dry and three had sensible improvement. CONCLUSIONS: The ProACT is a minimally invasive surgical therapy for post-radical prostatectomy urinary incontinence. Early failure is frequent and is mainly due to rupture and migration of the device. In these cases the solution can be the replacement, even with impaired balloon inflation.

[Sliding-clip robotic nephropexy]. / Sliding-clip robotic nephropexy.

BACKGROUND: Nephroptosis is a clinical condition characterized by an abnormal caudal movement of the kidney that descends more than 2 vertebral bodies (or more than 5 cm) during a position change from supine to upright. In the last decade, the availability of laparoscopic surgery has led to a revival of interest in nephroptosis and nephropexy. We describe our technique for transperitoneal laparoscopic robotic-assisted nephropexy. METHODS: The surgery was performed on a 78-year-old woman with a BMI of 18 and ASA 2. The diagnosis of nephroptosis was preoperatively confirmed by excretory urography in the supine and upright positions. The patient was placed in Trendelemburg position on the left side. The laparoscopic surgery was performed, through a transperitoneal approach, using the daVinci system: the ptosic kidney was fixed using two separated stiches of non-absorbable prolene 2.0 between the superior surface of the kidney and the quadratus lumborum muscle. The sutures were fixed using Hem-o-lok clips. RESULTS: Intra- or post-operative complications have not occurred. The effectiveness of treatment was demonstrated by an intravenous urography 60 days after. CONCLUSIONS: Robotic-assisted nephropexy is a safe and effective procedure that leads to both clinical and aesthetic excellent results, comparable to the ones obtained with the laparoscopic approach for the treatment of symptomatic renal ptosis. The robotic-assisted nephropexy appears to be easier, with the particular advantages of the intracorporeal suturing and a better intraoperative view; the sliding-clips method allows reducing the organ trauma to the minimum.

[Which factors allow to anticipate the diagnosis of prostate cancer in pin patients? A study on 546 patients]. / Quali fattori permettono di prevedere la diagnosi di carcinoma prostatico nei pazienti con PIN? Studio su 546 pazienti.

AIM OF THE STUDY: To analyze which factors allow to assess the risk of finding a prostate cancer (PCa) at repeated biopsies in patients with diagnosis of prostatic intraepithelial neoplasia (PIN). PATIENTS AND METHODS: At our institute all patients with a diagnosis of PIN undergo a 6-monthly control biopsy until the achievement of a benign histology or up to a maximum of 4 consecutive biopsies. For this study a retrospective review of clinical and bioptic data of patients with a diagnosis of isolated PIN (i.e. without associated atypical small acinar proliferation or small cancer foci) was carried out. The correlation between these features and the probability to find PCa at the first re-biopsy or at a further re-biopsy was independently analyzed. RESULTS: The data of 546 patients subjected to a median number of 3 biopsies, (mean: 10.8 and 12.9 cores at initial biopsy and at first re-biopsy, respectively), and with a mean "bioptic" follow-up time of 14.8 months, were analyzed. PCa was found in 174 cases (31.8%): for 116 of them it took place at the first re-biopsy, with a mean latency of 7.8 months from PIN diagnosis, whereas for 58 at a further re-biopsy, with a mean latency of 21.6 months. The risk of diagnosing PCa at the first re-biopsy was statistically correlated with the PSA value--for which a cut-off value of 7 ng/mL was identified--and with an anomalous rectal prostatic examination at the time of the initial biopsy. Differently, the risk of diagnosing PCa after the first re-biopsy correlated with the number of cores positive for PIN at the initial biopsy--for which a cut-off of 4 was identified--and to the ratio between these and the total number of cores, defined as PIN density--for which a cut-off of 50% was determined. DISCUSSION AND CONCLUSIONS. It is possible to suggest a tailored protocol of controls in patients with a diagnosis of PIN on the basis of the data available at the initial biopsy: a) high PSA value and/or an anomalous prostatic rectal examination: the diagnosis of PCa is probably just unacknowledged by the initial sampling and it is advisable to carry out an early re-biopsy; b) number of cores with PIN equal to or higher than 4 and/or PIN density equal to or higher than 50%: a true transition from PIN to PCa is likely to happen with time and it is advisable to carry out a delayed re-biopsy; c) no risk factors: just clinical and PSA monitoring to establish the indication to re-biopsy.