Operated Male-to-Female Sexual Function Index: Validity of the First Questionnaire Developed to Assess Sexual Function after Male-to-Female Gender Affirming Surgery.

PURPOSE: No questionnaire is currently available to evaluate sexual function after male-to-female gender affirming surgery. Such a limit leads to a suboptimal evaluation in postoperative sexual function in these patients. We developed and validated a new questionnaire, the oMtFSFI (operated Male-to-Female Sexual Function Index), for assessing sexual function in male-to-female patients after surgery. MATERIALS AND METHODS: A panel of experts in gender dysphoria defined the main content areas to be assessed, including genital self-image, desire, arousal, lubrication, orgasm, satisfaction and sexual pain. After a pretest on 10 patients the oMtFSFI was applied in the main study to 65 operated male-to-female patients, recruited at 7 Italian centers, and 57 women. The participants provided self-ratings on online oMtFSFI, Female Sexual Function Index, Beck Depression Inventory for Primary Care and Short Form Health Survey questionnaires. Operated male-to-female patients completed the oMtFSFI twice, 4 weeks apart. RESULTS: Principal component analysis performed on self-ratings provided by operated male-to-female patients on oMtFSFI items yielded a 3-domain structure of sexual dissatisfaction, sexual pain and genital self-image. The 3 domains were internally consistent and test-retest reliable. Convergent associations with Female Sexual Function Index scales emerged for sexual dissatisfaction and sexual pain but not for genital self-image. Male-to-female patients reported lower sexual function levels than cisgender women. CONCLUSIONS: The present preliminary results support reliability and psychometric validity of the oMtFSFI in the assessment of key sexual function domains in transgender women, further revealing that genital self-image represents an assessment area to be considered in male-to-female patients, in addition to domains that are salient for cis women as well.

Ileal vaginoplasty as vaginal reconstruction in transgender women and patients with disorders of sex development: an international, multicentre, retrospective study on surgical characteristics and outcomes.

OBJECTIVE: To describe the surgical outcomes of ileal vaginoplasty in transgender women and patients with disorders of sex development (DSD). PATIENTS AND METHODS: Transgender women and patients with DSD, who underwent ileal vaginoplasty at the VU University Medical Center Amsterdam, University Hospital Trieste, University Hospital Essen, and Belgrade University Hospital, were retrospectively identified. A chart review was performed, recording surgical technique, intraoperative characteristics, complications, and re-operations. RESULTS: We identified a total of 32 patients (27 transgender and five non-transgender), with a median (range) age of 35 (6-63) years. Ileal vaginoplasty was performed as the primary procedure in three and as a revision procedure in the remaining 29. The mean (sd) operative time was 288 (103) min. The procedure was performed laparoscopically (seven patients) or open (25). An ileal 'U-pouch' was created in five patients and a single lumen in 27. Intraoperative complications occurred in two patients (one iatrogenic bladder damage and one intraoperative blood loss necessitating transfusion). The median (range) hospitalisation was 12 (6-30) days. Successful neovaginal reconstruction was achieved in all. The mean (sd) achieved neovaginal depth was 13.2 (3.1) cm. The median (range) clinical follow-up was 35 (3-159) months. In one patient a recto-neovaginal fistula occurred, which lead to temporary ileostomy. Introital stenosis occurred in four patients (12.5%). CONCLUSION: Ileal vaginoplasty can be performed with few intra- and postoperative complications. It appears to have similar complication rates when compared to sigmoid vaginoplasty. It now seems to be used predominantly for revision procedures.

Ultrasound follow up: Is an undetected spontaneous expulsion of stone fragments a sign of extracorporeal shock wave treatment failure in kidney stones?

INTRODUCTION: After extracorporeal lithotripsy (SWL), a spontaneous expulsion of fragments is often reported. The aim of this study is to demonstrate the presence of a stone free status or the presence of clinically insignificant residual fragments (CIRFs, defined as "asymptomatic, noninfectious, ≤ 3 mm fragments") in people with undetected spontaneous expulsion. MATERIALS AND METHODS: Between May and September 2017, we performed a total of 87 treatments. The device used was a Storz Medical Modulith® SLK. All the patients were treated in prone position to reduce respiratory movements and underwent sonography before and four to eight weeks after the treatment. An in line ultrasound targeting was possible with all the stones. People lost to follow up or with ureteral stones were excluded. Patients were divided in groups according to gender, previous treatments, stone diameter and position. RESULTS: We enrolled 73 patients. 57 patients had a single stone and 16 multiple stones. A mean number of 3044 shock waves was administered with a maximum average energy of 0.68mj/mmq. At follow up, 41 patients (56.2%) were found stone free or with CIRFs. The association between undetected expulsion and the presence of CIRFs is considered to be not statistically significant (p = 0.89). Among patients with CIRFs, 25/41 didn't report expulsion. Taking in account the groups our population was divided in, according to gender (p = 0.36), previous treatments (p = 0.44), stone diameter (p = 0.28) and stone position (p = 0.35), the association between undetected spontaneous expulsion and presence of CIRFs was never statistically significant. CONCLUSIONS: An undetected spontaneous expulsion of stone fragments could not be considered a sign of SWL treatment failure. The association between undetected expulsion and presence of CIRFs is never statistically significant if gender of the patients, previous treatments, stone diameter and stone position are considered.

Comparison of an electromagnetic and an electrohydraulic lithotripter: Efficacy, pain and complications.

INTRODUCTION: We analyzed efficacy and complications of extracorporeal shock wave lithotripsy (SWL) and analgesia requirement during the treatment in two groups of patients treated with different lithotripters. MATERIALS AND METHODS: The patients treated were 189, 102 between September 2016 and April 2017 with HMT Lithotron® LITS 172, electrohydraulic, and 87 between May and September 2017 with Storz Medical Modulith® SLK, electromagnetic. The main differences between the lithotripters are: type of energy source, patient position, frequency and number of shock waves. All the patients underwent sonography before and four to eight weeks after the treatment. The targeting was sonographic for renal stones and X-ray for ureteral stones. All the patients received Ketorolac before the treatment with a supplement of Pethidine if needed. People lost to follow-up and with incomplete data were excluded. RESULTS: We enrolled 173 patients, 94 treated with the electrohydraulic lithotripter and 79 with the electromagnetic one. 43 patients (54%) in the electromagnetic group and 31 (33%) in the electrohydraulic group were stone free or presented clinically insignificant residual fragments (CIRFs), defined as asymptomatic, noninfectious, ≤ 3 mm. The association between CIRFs and the kind of lithotripter was statistically significant (p = 0.004). An increased need for analgesia was found in 14.9% of patients in the electromagnetic group and in 81% of patients in the electrohydraulic group (p < 0.001). The access to emergency room (intractable pain, kidney failure, fever, Steintrasse) after the treatment was similar in the two groups (p = 0.37). CONCLUSIONS: The best results in stones fragmentation and less analgesia requirement were demonstrated in the electromagnetic lithotripter group. No differences were demonstrated considering the need for emergency room after the treatment.

Intraoperative ultrasound-guided enucleation of testicular nodule.

OBJECTIVE: We report a case of enucleation of a non-palpable right testicular lesion found incidentally at testicular ultrasonography during investigations in a patient with azoospermia. MATERIALS AND METHODS: In 2011 bilateral hypoechoic nonpalpable testicular lesions (5 mm and 3 mm to the right, 3 mm to the left) were found in a 28 years old patient, during diagnostic investigations for azoospermia. In March 2016, ultrasonography showed that the diameter of the right major nodule had grown to 12 mm, characterized by increased vascularization and increased texture. Blood exams showed serum FSH above normal levels with negative oncologic markers. The patients underwent surgical enucleation of the right nodule under ultrasonography guidance. RESULTS: In post operative day 1 a control ultrasonography documented the disappearance of the lesion. Hystopathologic examination diagnosed a Leydig cell tumor, with negative surgical margins. The patient is in good clinical conditions and is under periodic ultrasonographic follow up. CONCLUSION: Organ sparing surgery represent a good therapeutic option for little intraparenchymal lesions, mostly in young patients in which is preferable to preserve fertility. Intraoperatory ultrasonography represent an important tool for the localization of the lesion.

A singular case of polyorchidism.

We report a case of polyorchidism, a rare congenital anomaly, frequently discovered by chance. At current knowledge is still not defined which is the best clinical and therapeutic approach as well the best follow- up scheme due to the unclear malignant potential and rate of complications if a conservative approach is used. MRI (Magnetic Resonance Imaging) seems to be a good method to discriminate this mass from others pathological findings but there is still not enough evidence to standardize the procedure.

Varicocele treatment: a 2-centers comparison between non microsurgical open correction, laparoscopic approach and retrograde percutaneous sclerotization on 463 cases.

OBJECTIVES: To determine whether there are differences in sperm parameters improvement after different varicocele correction techniques. To determine the role of age in sperm parameters improvement. METHODS: 2 different European centers collected pre- and postoperative sperm parameters of patients undergoing varicocele correction. Among 463 evaluated patients, 367 were included. Patients were divided in procedure-related and age-related groups. Ivanissevich inguinal open surgical procedure (OS), lymphatic-sparing laparoscopic approach (LSL) and retrograde percutaneous transfemoral sclerotization (RPS) were performed. As outcome measurements sperm count (millions/mL, SC) and percentage of mobile sperms were analyzed. Univariate and multivariate regression between the defined groups; bivariate regression analysis between age and sperm count and motility. RESULTS: Number of patients: OS 78; LSL 85; RPS 204. Mean age 30.2 (SD 6.83); postoperative SC increased from 18.2 to 30.1 (CI 95% 27.3-32.9; p < 0,001); motility from 25.6 to 32.56% (30.9-34.2; p < 0.001). OS: SC varied from 16.9 to 18.2 (p < 0.001); sperm motility from 29% to 33% (p < 0.001). LSL: SC from 15.5 to 17.2 (p < 0.001); motility from 27 to 31% (p < 0.001). RPS: SC from 18.9 to 36.2 (p < 0.001); motility from 24% to 32% (p < 0.001). Univariate and multivariate analysis confirmed the significant difference of SC variation in RPS, compared to the other groups (p < 0.001). No significance between LSL and OS (p = 0.826). No significant differences regarding motility (p = 0.8). CONCLUSIONS: Varicocele correction is confirmed useful in improving sperm parameters; sclerotization technique leads to a better sperm improvement compared to other studied procedures; improvement in seminal parameters is not affected by age of the patients treated.

Trend analysis of COVID-19 mis/disinformation narratives-A 3-year study.

To tackle the COVID-19 infodemic, we analysed 58,625 articles from 460 unverified sources, that is, sources that were indicated by fact checkers and other mis/disinformation experts as frequently spreading mis/disinformation, covering the period from 1 January 2020 to 31 December 2022. Our aim was to identify the main narratives of COVID-19 mis/disinformation, develop a codebook, automate the process of narrative classification by training an automatic classifier, and analyse the spread of narratives over time and across countries. Articles were retrieved with a customised version of the Europe Media Monitor (EMM) processing chain providing a stream of text items. Machine translation was employed to automatically translate non-English text to English and clustering was carried out to group similar articles. A multi-level codebook of COVID-19 mis/disinformation narratives was developed following an inductive approach; a transformer-based model was developed to classify all text items according to the codebook. Using the transformer-based model, we identified 12 supernarratives that evolved over the three years studied. The analysis shows that there are often real events behind mis/disinformation trends, which unverified sources misrepresent or take out of context. We established a process that allows for near real-time monitoring of COVID-19 mis/disinformation. This experience will be useful to analyse mis/disinformation about other topics, such as climate change, migration, and geopolitical developments.

Change in Postoperative Storage Symptoms and De Novo Urge Incontinence After Thulium:YAG Laser Enucleation of the Prostate: Results from a Prospective Multicenter Study.

Objectives: To assess the change of storage symptoms (SS) and their impact on quality of life in men undergoing thulium:YAG laser enucleation of the prostate (ThuLEP) for benign prostatic hyperplasia (BPH). Materials and Methods: BPH patients requiring surgery were prospectively evaluated (April 2019-October 2020). Inclusion criteria: International Prostate Symptom Score (IPSS) ≥8, maximum urinary flow rate ≤15 mL/s, and urinary retention. Exclusion criteria: previous urethral/prostatic surgery, pelvic irradiation, bladder/prostate cancer, neurogenic bladder, concomitant transurethral surgery, and active urinary tract infection. IPSS, International Continence Society-Overactive Bladder (ICIQ-OAB) and International Continence Society-Overactive Bladder Quality of Life (ICIQ-OABq) scores were gathered before surgery and 1, 3, 6, and 12 months after surgery. Results: In total, 117 men were included. Mean age was 68.0 ± 7.7 years. Mean prostate volume was 86.6 ± 34 cc. Mean IPSS subscore was 8.7 ± 3.1 and 11.7 ± 4.7 for storage and voiding symptoms, respectively. Mean ICIQ-OAB was 29.1 ± 16.8. Mean ICIQ-OABq was 80.3 ± 30.6. Voiding IPSS decreased 72.8% at 1 month, whereas the reduction of storage IPSS was 38.0%. ICIQ-OAB decreased 49.6% at 1 month. ICIQ-OABq showed a 30.0% reduction. One year after surgery, the reduction of voiding IPSS was 94.8%, ICIQ-OAB 85.5%, storage IPSS 76.7%, and ICIQ-OABq 60.5%. Urge incontinence was present in 26.5% of men at 1 month, 15.4% at 3 months, and 4.3% at 6 months. Four (3.4%) patients complained of urge incontinence 12 months after surgery. Conclusion: Both storage and voiding lower urinary tract symptoms significantly decreased after ThuLEP, but storage symptoms showed less reduction with a significant impact on patients' quality of life, particularly during the first 3 months.

An Observational Cohort Study Investigating the Incidence Rate of Infectious Complications After Routine Office Nephrostomy Tube Replacement Without Using Antimicrobial Prophylaxis.

OBJECTIVE: To investigate the incidence of infectious complications after routine office nephrostomy tube replacement (NTR) in patients that did not receive antimicrobial prophylaxis (AMP). METHODS: We prospectively enrolled all patients undergoing routine office NTR between July 2018 and September 2019. Each procedure was considered an independent event. Clinical, microbiological, demographic data were collected. AMP was exclusion criterion. All patients received a questionnaire via phone call within 3 weeks after NTR investigating fever, antibiotics use, hospital admissions. Infectious complications risk was assessed with univariate and multivariate binomial logistic regression analysis. RESULTS: One hundred forty-five routine NTRs were performed. Nineteen patients receiving AMP were excluded. Median age was 78 years (interquartile range 71-81). Charlson Comorbidity Index (CCI) score was ≥5 in 53.2% of patients, 34 had positive urine culture, none received AMP. Seventeen (13.49%) patients reported fever after procedure, 9 received antibiotic therapy while fever resolved spontaneously in 8. Three patients needed hospitalization, 2 for nephrostomy malfunction, 1 for infectious complications. At multivariate analysis only CCI score ≥3 was associated (P < .001) with increased infectious complications risk. CONCLUSION: In this study fever occurs after the 13.5% of the routine NTRs, in almost half cases resolves spontaneously rather than with oral antimicrobial therapy. Avoiding AMP before routine NTR does not expose patients to life-threatening infections.

Analysis of clinical utility of abdominopelvic computed tomography in the follow-up of Stage I seminoma: a single center evaluation.

BACKGROUND: Abdominopelvic computed tomography (CT) is widely used in the follow-up of seminoma patients after radical orchidectomy. The aim of this study was to evaluate the clinical utility of abdominopelvic computed tomography in the follow-up of patients with Stage I seminoma. METHODS: The pathological reports of all patients that have undergone radical orchidectomy in our tertiary referral center between January 2002 and January 2018 have been retrospectively reviewed. All patients with Stage I seminoma and negative serum tumor markers after radical orchidectomy were included. Patients with follow-up shorter than 12 months were excluded. Surveillance records of every patient were reviewed with regard to abdominopelvic imaging. RESULTS: Of the 133 patients who have undergone radical orchidectomy in our center, 55 had Stage I pure seminoma with normal levels of serum tumor markers after surgery. Two patients were excluded as the follow-up was inadequate. Mean follow-up was 63.2 months (IQR: 30-73). The results of 211 abdominopelvic CTs performed as part of the follow-up were reviewed. Two (3,7%) patients developed recurrence; one consisted of a scrotal lump and was diagnosed with ultrasonography (US) while the second appeared as paraaortic nodal metastasis and was diagnosed with abdominopelvic CT. The recurrence was successfully treated in both patients. A single abdominopelvic CT was useful for the detection of recurrent disease in our entire study population. No cancer specific death has been reported in the study population. CONCLUSIONS: Follow-up schedules for Stage I seminoma expose patients to potential risks of radiation-induced tumors, emotional distress and represent a significant burden for the healthcare system. The current series suggests that a better risk adapted patient-tailored follow-up program is needed in order to avoid unnecessary investigations.

Sonography of the penis/erectile dysfunction.

Erectile dysfunction (ED) is defined as the persistent inability to achieve and/or maintain an erection for a satisfactory sexual activity. It is secondary to several organic, psychogenic, and combined causes, and represents a serious health dilemma affecting both men and their partners. The diagnostic approach to erectile dysfunction has significantly changed in the last years with the advent of phosphodiesterase-5 (PDE5) inhibitors, and with the recognition that surgical treatment of both arterial insufficiency and penile venous leak have poor long-term clinical outcomes. Although imaging modalities have diminished in importance, differentiating among causes of erectile dysfunction remains mandatory in good medical practice, and ultrasound (US) still remains the cornerstone of the diagnostic workup. US provides an objective, minimally invasive evaluation of penile hemodynamics. Moreover, it provides an excellent depiction of the penile anatomy and of its changes in pathological conditions such as in patients with Peyronie's disease, priapism, and posttraumatic erectile dysfunction.

Vaginoplasty in Male to Female transgenders: single center experience and a narrative review.

Vaginoplasty in Male to Female (M to F) transgenders is a challenging procedure, often accompanied by numerous complications. Nowadays the most commonly used technique involves inverted penile and scrotal flaps. In this paper the data of 47 M to F patients who have undergone sex affirmation surgery at the Department of Urology of the University of Trieste, Italy since 2014, using our modified vaginoplasty technique with the "Y" shaped urethral flap, have been retrospectively reviewed. Moreover, a non structured review of the literature with regards to short and long-term complications of vaginoplasty has been provided. All patients followed a standardized neo-vaginal dilation protocol. At follow up 2 patients were lost. At 12 months 88.9% of patients (40/45) were able to reach climax, 75.6% (34/45) were having neo-vaginal intercourses and median neo-vaginal depth was 11 cm (IQR 9-13.25): no statistically significant decrease in depth was found at follow up. Only one patient was dissatisfied with aesthetic appearance at 12 months. Our technique provided excellent cosmetic and functional results without severe complications (Clavien-Dindo ≥ 3). The review of the literature has highlighted the need to standardize a postoperative follow up protocol with particular regard to postoperative dilatation regimen. Further, larger randomized clinical trials are pending to draw definitive conclusions.

The management of stuttering priapism.

INTRODUCTION: Stuttering priapism is a variation of ischemic priapism, generally transient and self-limiting, occurring during sleep and lasting less than 3-4 hours. It may progress to episodes of complete ischemic priapism in approximately one third of cases, necessitating emergent intervention. EVIDENCE ACQUISITION: This review aims to provide an up-to-date picture of the pathophysiology and management of stuttering priapism. A search using Medline and EMBASE for relevant publications using the terms "priapism", "stuttering", "diagnosis", "treatment", "fibrosis", was performed. EVIDENCE SYNTHESIS: Stuttering priapism shares its etiologies with ischemic priapism and a large number of diseases or clinical situations have risk association for developing the disorder. The most common causes are sickle cell disease or other hematologic and coagulative dyscrasias especially in children. In the adult population, idiopathic priapism occurring without any discernible cause is considered to be the most common form in adults. The medical management of priapism represents a therapeutic challenge to urologists. Unfortunately, although numerous medical treatment options have been reported, the majority are through small trials or anecdotal reports. Understanding the underlying pathophysiology and understanding the current and emerging future agents and therapeutic options are mandatory in order to provide the best solution for each patient. CONCLUSIONS: The goal of management of priapism is to achieve detumescence of the persistent erection in order to preserve erectile function. To achieve successful management, urologists should address this emergency clinical condition. In the present article, we review the diagnosis and clinical management of the three types of priapism.

Efficacy and safety of combined oral therapy with tadalafil and alfuzosin: an integrated approach to the management of patients with lower urinary tract symptoms and erectile dysfunction. Preliminary report.

INTRODUCTION: Alpha1-blockers (AB) are the first-line monotherapy for lower urinary tract symptoms (LUTS). Phosphodiesterase type 5 (PDE5) inhibitors are the first-line treatment for erectile dysfunction (ED). Numerous studies have supposed a significant association between ED and LUTS, but a causal relationship cannot be established. AIM: The aim was to evaluate the efficacy of a combined therapy with an AB (alfuzosin) and PDE5 inhibitors (tadalafil) in patients with LUTS and ED. METHODS: This was a randomized, open-label, three-arm study. A total of 66 men complaining of ED and LUTS were included in the study. Patients were assessed at baseline and after 12 weeks of study treatment, and then underwent randomized allocation to either alfuzosin 10 mg once a day (22 patients) or tadalafil 20 mg on alternative days (21 patients), or a combination of both (23 patients). MAIN OUTCOME MEASURES: All participants completed the erectile function domain of the International Index of Erectile Function (IIEF-EF) and the International Prostatic Symptom Score (IPSS). Other efficacy variables included maximum urinary flow rate (Qmax) and medium urinary flow rate (Qave). RESULTS: IIEF-EF tended to improve with alfuzosin alone (+15%), while it was clearly improved with tadalafil alone (+36.3%). The greatest improvement was experienced with the combination therapy (+37.6%). Improvement in Qmax was observed in all groups, but patients receiving combination therapy had greater improvement (29.6%) than patients receiving either only alfuzosin (21.7%) or only tadalafil (9.5%). IPSS was significantly improved in alfuzosin group (27.2%), was more marked with the combination therapy (41.6%), and a small increase, although not significant, was also observed with tadalafil (8.4%). CONCLUSIONS: Combined therapy improved ED and LUTS as demonstrated by the significant improvement in uroflowmetry measures and in IPSS and IIEF-EF scores. A significant improvement was also observed in quality of life assessments. The beneficial effects of tadalafil on LUTS similar to the benefits of alfuzosin on ED, although present, were smaller.

Complete penile corporeal septation: evaluation with contrast enhanced US.

BACKGROUND: Complete penile corporeal septation is a rare malformation in which the corpora cavernosa are completely isolated. We describe a new method to reach the diagnosis of this malformation using contrast enhanced US. METHODS: Two patients with complete penile corporeal septation underwent color Doppler and contrast enhanced US after bilateral cavernosal injection of 10 microg prostaglandin E1. Contrast enhanced US was performed using a contrast specific software (Contrast-Tuned imaging, EsaOte, Genoa, Italy) and a linear transducer designed to evaluate superficial structures. Microbubbles of SonoVue (Bracco, Milan, Italy) were injected in one corpus cavernosum. RESULTS: After cavernosal injection of microbubbles no adverse events were observed. Contrast enhanced US showed unilateral enhancement of the corpus cavernosum in which microbubbles were injected. Cavernosography confirmed unilateral corporeal opacification. CONCLUSION: Contrast enhanced US can be used effectively to diagnose complete penile corporeal septation.

Semen quality before and after orchiectomy in men with testicular cancer.

OBJECTIVE: We evaluated the impact of removal of the tumour bearing testis on semen quality in men with testicular cancer and the effect of tumour histologic feature on semen quality. MATERIAL AND METHODS: We took into account the semen analysis before and after orchiectomy in 30 patients. RESULTS: The median sperm concentration before and after orchiectomy was respectively of 26.7 x 10(6)/ml (range: 0-120 x 10(6)/ml) and 16.6 x 10(6)/ml (range: 0-75 x 10(6)/ml) (p = 0.001). Median sperm concentration before and after surgery in patients affected by seminomatous cancer were respectively of 35.47 x 10(6)/ml and 23.99 x 10(6)/ml, while cases of non-seminomatous cancer were respectively of 17.9 x 10(6)/ml and 8.16 x 10(6)/ml. CONCLUSIONS: Semen quality at the diagnosis was poorer in patients affected by non-seminomatous testicular cancer. Sperm concentration deteriorated after orchiectomy. Our findings suggest that the most appropriate time for cryopreservation of semen is before orchiectomy.

Contrast-enhanced ultrasound for characterizing renal masses.

On cross-sectional imaging studies performed for other indications, incidental discovery of renal lesions is not uncommon. In daily use, grey-scale ultrasonography (US) and conventional Doppler modes are often the modality of choice for the initial assessment. While simple cysts are fully characterized with US, other lesions require further characterization, which is traditionally obtained by multiphase imaging, such as contrast-enhanced CT and MRI. Contrast-enhanced ultrasound (CEUS) has become a powerful additional tool for imaging renal lesions. With its lack of nephrotoxicity, the absence of ionizing radiation, and the ability to evaluate the enhancement pattern of renal lesions quickly and in real- time, CEUS has unique advantages over traditional modes. Established applications are differentiation between solid tumours, pseudolesions, and complex cysts; characterization of complex cysts with different malignant potential, and evaluation of tumor ablation. Microbubble contrast agents are safe. Adverse reactions are rare. This article provides an overview of the current clinical applications of CEUS in characterizing renal masses, discussing advantages and limitations. The aim is to provide the framework for sonologists to make informed decisions regarding this emerging imaging test in appropriate circumstances.

Multiparametric US for scrotal diseases.

Multiparametric US is increasingly recognized as a valuable problem-solving technique in scrotal pathologies. Compared to conventional Doppler modes, contrast-enhanced ultrasonography (CEUS) has higher sensitivity in assessing the presence or absence of flows, and to improve differentiation between poorly vascularized tumors and non-neoplastic, avascular lesions. Characterization of benign and malignant complex cysts is improved. In trauma patients, CEUS can help evaluating the viability of testicular parenchyma. In patients with severe epididymo-orchitis, it allows unequivocal assessment of post-inflammatory ischemic changes and abscess formation. CEUS does not add significantly to conventional Doppler modes in spermatic cord torsion. Attempt of differentiating benign and malignant tumors remains a research tool. In the clinical practice, elastography has a limited role for tumor characterization. The majority of malignant tumors are stiff at elastography, but they may display soft areas, or appear globally soft. A quantitative evaluation of testicular stiffness is feasible using shear-wave elastography. Potential clinical applications for elastographic modes could include work-up of infertile patients.