Dissipation Function: Nonequilibrium Physics and Dynamical Systems.

An exact response theory has recently been developed within the field of Nonequilibrium Molecular Dynamics. Its main ingredient is known as the Dissipation Function, Ω. This quantity determines nonequilbrium properties like thermodynamic potentials do with equilibrium states. In particular, Ω can be used to determine the exact response of particle systems obeying classical mechanical laws, subjected to perturbations of arbitrary size. Under certain conditions, it can also be used to express the response of a single system, in contrast to the standard response theory, which concerns ensembles of identical systems. The dimensions of Ω are those of a rate, hence Ω can be associated with the entropy production rate, provided local thermodynamic equilibrium holds. When this is not the case for a particle system, or generic dynamical systems are considered, Ω can equally be defined, and it yields formal, thermodynamic-like, relations. While such relations may have no physical content, they may still constitute interesting characterizations of the relevant dynamics. Moreover, such a formal approach turns physically relevant, because it allows a deeper analysis of Ω and of response theory than possible in case of fully fledged physical models. Here, we investigate the relation between linear and exact response, pointing out conditions for the validity of the response theory, as well as difficulties and opportunities for the physical interpretation of certain formal results.

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.

A simple non-chaotic map generating subdiffusive, diffusive, and superdiffusive dynamics.

Analytically tractable dynamical systems exhibiting a whole range of normal and anomalous deterministic diffusion are rare. Here, we introduce a simple non-chaotic model in terms of an interval exchange transformation suitably lifted onto the whole real line which preserves distances except at a countable set of points. This property, which leads to vanishing Lyapunov exponents, is designed to mimic diffusion in non-chaotic polygonal billiards that give rise to normal and anomalous diffusion in a fully deterministic setting. As these billiards are typically too complicated to be analyzed from first principles, simplified models are needed to identify the minimal ingredients generating the different transport regimes. For our model, which we call the slicer map, we calculate all its moments in position analytically under variation of a single control parameter. We show that the slicer map exhibits a transition from subdiffusion over normal diffusion to superdiffusion under parameter variation. Our results may help to understand the delicate parameter dependence of the type of diffusion generated by polygonal billiards. We argue that in different parameter regions the transport properties of our simple model match to different classes of known stochastic processes. This may shed light on difficulties to match diffusion in polygonal billiards to a single anomalous stochastic process.

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.

Annealed inhomogeneities in random ferromagnets.

We consider spin models on complex networks frequently used to model social and technological systems. We study the annealed ferromagnetic Ising model for random networks with either independent edges (Erdos-Rényi) or prescribed degree distributions (configuration model). Contrary to many physical models, the annealed setting is poorly understood and behaves quite differently than the quenched system. In annealed networks with a fluctuating number of edges, the Ising model changes the degree distribution, an aspect previously ignored. For random networks with Poissonian degrees, this gives rise to three distinct annealed critical temperatures depending on the precise model choice, only one of which reproduces the quenched one. In particular, two of these annealed critical temperatures are finite even when the quenched one is infinite because then the annealed graph creates a giant component for all sufficiently small temperatures. We see that the critical exponents in the configuration model with deterministic degrees are the same as the quenched ones, which are the mean-field exponents if the degree distribution has finite fourth moment and power-law-dependent critical exponents otherwise. Remarkably, the annealing for the configuration model with random independent and identically distributed degrees washes away the universality class with power-law critical exponents.

Combined Effects of Age and Comorbidities on Electrocardiographic Parameters in a Large Non-Selected Population.

Background: Previous studies have evaluated average electrocardiographic (ECG) values in healthy subjects or specific subpopulations. However, none have evaluated ECG average values in not selected populations, so we examined ECG changes with respect to age and sex in a large primary population. Methods: From digitized ECG stored from 2008 to 2021 in the Modena province, 130,471 patients were enrolled. Heart rate, P, QRS and T wave axis, P, QRS and T wave duration, PR interval, QTc, and frontal QRS-T angle were evaluated. Results: All ECG parameters showed a dependence on age, but only some of them with a straight-line correlation: QRS axis (p < 0.001, R2 = 0.991, r = 0.996), PR interval (p < 0.001, R2 = 0.978, r = 0.989), QTc (p < 0.001, R2 = 0.935, r = 0.967), and, in over 51.5 years old, QRS-T angle (p < 0.001, R2 = 0.979, r = 0.956). Differences between females and males and in different clinical settings were observed. Conclusions: ECG changes with ageing are explainable by intrinsic modifications of the heart and thorax and with the appearance of cardiovascular diseases and comorbidities. Age-related reference values were computed and applicable in clinical practice. Significant deviations from mean values and from Z-scores should be investigated.

The suburethral tension adjustable sling (REMEEX system) in the treatment of female urinary incontinence due to 'true' intrinsic sphincter deficiency: results after 5 years of mean follow-up.

OBJECTIVE: • To retrospectively report the objective and subjective outcomes of suburethral tension adjustable sling (Remeex system) implantation for stress urinary incontinence (SUI) caused by 'true' intrinsic sphincter deficiency (ISD) with fixed urethra. PATIENTS AND METHODS: • Thirty female patients with severe SUI, mainly because of iatrogenic ISD, underwent Remeex system positioning between May 2002 and July 2008 (mean follow-up 60.6 months, range 22-96 months). • Before surgery, patients were evaluated by physical examination, translabial ultrasonography, flexible cystoscopy, urodynamics, 1-hour pad test and compilation of a 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 the final follow-up visit, 26 (86.0%) patients were cured, 2 (7.0%) were improved and 2 (7.0%) had failed. • In particular, the total mean pad weight decreased to 33.2 ± 15.6 (71%) and the total mean questionnaire score significantly increased to 86.9 ± 6.7 (74.0%). • Sling tension readjustment was needed during follow-up in two patients (7%). • Among the complications, persistent urinary retention (10%), seroma formation (3%) and de novo urgency (7%) were easily treated. CONCLUSION: • The Remeex system produced remarkable 5-year results with a low complication rate. These outcomes have also been confirmed in a worse prognosis patient group as reported in the present study.

The bone anchor suburethral synthetic sling for iatrogenic male incontinence: critical evaluation at a mean 3-year followup.

PURPOSE: We retrospectively report objective and subjective outcomes in 40 male patients who underwent bone anchored suburethral synthetic sling positioning for stress urinary incontinence due to intrinsic sphincter deficiency. MATERIALS AND METHODS: Patients with stress urinary incontinence due to radical retropubic prostatectomy (32), robot assisted laparoscopic prostatectomy (3) and transurethral prostate resection (5) underwent bone anchored suburethral synthetic sling positioning between December 2002 and December 2007. Mean followup was 35.2 months (range 2 to 62). Previous anti-incontinence procedures, radiotherapy and transurethral procedures due to urethral stricture were performed in 5, 11 and 5 patients, respectively. Before and after surgery patients were evaluated by physical examination, urethral cystoscopy, urodynamics, a 1-hour pad test and a quality of life questionnaire. Patients were stratified into 3 groups, including group 1-cured (dry with a pad weight of 0 to 1 gm), group 2-improved (mild to moderate incontinence with a pad weight of 2 to 50 gm) and group 3-failed (patient condition unchanged with a pad weight of greater than 50 gm). RESULTS: At the final followup visit 22 (55%), 5 (12.5%) and 13 patients (32.5%) were cured, improved and failed, respectively. Mean pad weight significantly decreased to 51.3 gm in 54% of cases, while the mean total questionnaire score significantly increased to 72.9 in 65% and abdominal leak point pressure significantly increased to 92.5 cm H(2)O in 52%. Statistical analysis showed a significant association between preoperative radiotherapy and treatment failure (85% of patients). Complications were perineal pain in 73% of cases, detrusor overactivity in 5% and sling infection in 15%. CONCLUSIONS: The bone anchored suburethral synthetic sling is a simple and attractive procedure that can produce immediate good results with low morbidity, especially when strictly selected patients are treated. Radiotherapy remains a strong predictor of failure.

Penetration of orally administered prulifloxacin into human prostate tissue.

BACKGROUND AND OBJECTIVE: Prulifloxacin, a fluoroquinolone antibacterial agent, may be a useful addition to the antimicrobial armamentarium against prostatitis once the ability of its active metabolite, ulifloxacin, to penetrate prostatic tissue has been determined. This study set out to evaluate ulifloxacin penetration into the prostate following administration of the oral fluoroquinolone prodrug prulifloxacin in patients undergoing transurethral resection of the prostate (TURP). METHODS: This was a phase I, randomized, open-label, single-centre study involving 20 male Caucasian patients (mean age 63.1 years) requiring TURP for treatment of benign prostatic hyperplasia. Sixteen patients were randomized to receive prulifloxacin; the other four patients were not treated (controls) in order to validate the bioanalytical method. Patients in the active treatment groups were randomized to receive one or three once-daily doses of prulifloxacin 600 mg, with the last administration 3 hours prior to surgery. Central/transitional and peripheral zone prostatic tissue samples were obtained from the 6 o'clock and 9 o'clock positions in the prostate, and blood samples were collected concurrently. Ulifloxacin concentrations were determined in the tissue samples and plasma using liquid chromatography-tandem mass spectrometry. Safety was also assessed. RESULTS: Prostatic tissue concentrations of ulifloxacin always exceeded those in plasma. Mean ulifloxacin concentrations measured in samples collected from the 6 o'clock central/transitional zone of the prostate were higher in patients who received prulifloxacin for 3 days than in those who received a single dose. Mean prostatic tissue/plasma ulifloxacin concentration ratios after single and repeated prulifloxacin administration ranged from 3.8 to 7.1 and from 3.9 to 9.5, respectively. The highest mean ratio was found in the 6 o'clock central/transitional zone after repeated dosing. Prostatic levels of ulifloxacin were above the minimum inhibitory concentrations for the most common causative pathogens of bacterial prostatitis. No treatment-related toxicities were reported. CONCLUSION: These findings confirm the ability of prulifloxacin to penetrate prostatic tissues, indicating high exposure of the target tissue to ulifloxacin and, therefore, a potential therapeutic role for prulifloxacin in the treatment of bacterial prostatic infections.

Dosimetry doesn't seem to predict the control of organ-confined prostate cancer after I-125 brachytherapy. Evaluation in 150 patients.

OBJECTIVE: To evaluate the dose-response relationship (D90 >144 Gy: probable absence of biochemical failure) in patients with prostate cancer treated by iodine-125 (I-125) brachytherapy. MATERIAL AND METHODS: From May 1999 to December 2006, 150 patients were treated by I-125 brachytherapy. The median follow-up was 60 months. All patients had clinical stage T1-T2, PSA < or =10 ng/ml, Gleason Scores < or = 3+3=6, IPSS >14 ml/sec. and prostate weight <50 gr. Implantation was ultrasound-guided, using a real-time technique and loose seeds of I-125 (dose 160 Gy). After 30 days, a post-implantation assessment was performed by pelvic CT scan for a definitive evaluation of the D90. All patients were subjected to clinical evaluation, PSA dosage and compilation of IPSS and IEFF questionnaires. In the event of biochemical failure (ASTRO), a prostate biopsy was performed. A D90 >144 Gy was considered the cut-off in order to predict the absence of biochemical failure. RESULTS: Biochemical failure was observed in 9 patients: 5 with positive and 4 with negative prostate biopsies. The D90 >144 Gy cut-off was not achieved in 18 patients at the post-implantation assessment, however only 2 of them (one of whom had a positive biopsy) had biochemical failure (11.1%). On the other hand, only 2 of the 9 patients with biochemical failure had a D90 < 144 Gy while 6 patients had D90 >150 Gy, 5 with positive prostate biopsies. CONCLUSIONS: In our experience, the D90 >144 Gy cut-off does not seem to predict, in a reliable way, the control of prostate cancer following brachytherapy. Limitations of the analysis were the number of the patients, the learning curve, dosimetry processing and the relatively short follow-up.

Advances in stem cell therapy for male stress urinary incontinence.

INTRODUCTION: Among the several options that have been proposed in recent years for the management of male stress urinary incontinence (SUI), stem cell therapy represents a new frontier in treatment. The aim of this paper is to update the current status of stem cell therapy in animal and human studies for the management of iatrogenic male SUI. AREAS COVERED: A literature review was conducted based on MEDLINE/PubMed searches for English articles using a combination of the following keywords: stem cell therapy, urinary incontinence, prostatectomy, regenerative medicine, mesenchymal stem cells. EXPERT OPINION: The few studies reported in the literature have demonstrated short-term safety and promising results of stem cell therapy in treating male SUI. However, many aspects need to be clarified before stem cell therapy can be introduced into daily urologic practice. In fact, important issues such as the limitations of these studies in terms of small sample sizes and short follow-ups, the incomplete knowledge of the mechanism of action of stem cells, the technical details regarding the delivery method and the best sources of stem cells, the safety risks regarding genomic or epigenetic changes and potential immune reactions in the longer term need to be identified in more stringent clinical trials.

A case of iliac-artery-ureteral fistula managed with a combined endoscopic approach.

BACKGROUND: A 66-year-old man presented to hospital with gross hematuria and clots. He had previously undergone surgical repair of a right iliac artery aneurysm with placement of a vascular prosthesis at the same hospital, which had resulted in iliac urethral stricture that required the placement of a right ureteral stent. He had attended repeatedly for recurrent ureteral stent replacement, with the most recent replacement having occurred 1 month before the current presentation. INVESTIGATIONS: Ultrasonography, cystography, retrograde pyelography and provocative arteriography via a percutaneous right femoral arterial approach. DIAGNOSIS: An iliac-artery-ureteral fistula between the right ureter and a pseudoaneurysm of the right common iliac artery. MANAGEMENT: The patient underwent placement of a covered, self-expandable vascular stent with angioplasty balloon, which resulted in complete exclusion of the pseudoaneurysm and fistula and resolution of the patient's hematuria. A pigtail catheter was placed in the right ureter for 5 days and replaced with a double-J ureteral stent on day 6 after exclusion of the pseudoaneurysm; the patient was discharged from hospital on the same day. Color-Doppler ultrasonography of the right iliac vessels performed 2 months later showed patency of the right iliac artery. The patient's ureteral stent has been replaced every 2 months since his discharge without recurrence of hematuria.

Nonequilibrium two-dimensional Ising model with stationary uphill diffusion.

Usually, in a nonequilibrium setting, a current brings mass from the highest density regions to the lowest density ones. Although rare, the opposite phenomenon (known as "uphill diffusion") has also been observed in multicomponent systems, where it appears as an artificial effect of the interaction among components. We show here that uphill diffusion can be a substantial effect, i.e., it may occur even in single component systems as a consequence of some external work. To this aim we consider the two-dimensional ferromagnetic Ising model in contact with two reservoirs that fix, at the left and the right boundaries, magnetizations of the same magnitude but of opposite signs.We provide numerical evidence that a class of nonequilibrium steady states exists in which, by tuning the reservoir magnetizations, the current in the system changes from "downhill" to "uphill". Moreover, we also show that, in such nonequilibrium setup, the current vanishes when the reservoir magnetization attains a value approaching, in the large volume limit, the magnetization of the equilibrium dynamics, thus establishing a relation between equilibrium and nonequilibrium properties.

Ultrametricity in the Edwards-Anderson model.

We test the property of ultrametricity for the spin-glass three-dimensional Edwards-Anderson model in zero magnetic field with numerical simulations up to 20(3) spins. We find an excellent agreement with the prediction of the mean field theory. Since ultrametricity is not compatible with a trivial structure of the overlap distribution, our result contradicts the droplet theory.

Normally attracting manifolds and periodic behavior in one-dimensional and two-dimensional coupled map lattices.

We consider diffusively coupled logistic maps in one- and two-dimensional lattices. We investigate periodic behaviors as the coupling parameter varies, i.e., existence and bifurcations of some periodic orbits with the largest domain of attraction. Similarity and differences between the two lattices are shown. For small coupling the periodic behavior appears to be characterized by a number of periodic orbits structured in such a way to give rise to distinct, reverse period-doubling sequences. For intermediate values of the coupling a prominent role in the dynamics is played by the presence of normally attracting manifolds that contain periodic orbits. The dynamics on these manifolds is very weakly hyperbolic, which implies long transients. A detailed investigation allows the understanding of the mechanism of their formation. A complex bifurcation is found which causes an attracting manifold to become unstable. (c) 1994 American Institute of Physics.

Paraurethral leiomyoma.

A case of a asymptomatic paraurethral leiomyoma in a young female patient is presented. Paraurethral leiomyoma is a benign hormone-dependent tumor of mesenchymal origin. Up today only 7 true paraurethral leiomyomas have been reported in the literature. The tumor can be asymptomatic, but can cause dysuria, urinary frequency, urinary retention and dispareunia. simple excision is usually the adequate treatment.

Simultaneous bilateral robotic partial nephrectomy: Case report and critical evaluation of the technique.

We report our first simultaneous bilateral robot assisted partial nephrectomy (RAPN) in order to show and critically discuss the feasibility of this procedure. Materials and methods A 69-year-old male patient visited our department due to incidental finding of bilateral mesorenal small masses (2.5 cm on the right and 3.5 cm on the left) suspicious for malignancy. We started from the right side with patient in flank position. Port placement: 12-mm periumbilical camera port, two 8-mm robotic ports in wide ''V''configuration, additional 12 mm assistant port on the midline between the umbilicus and symphysis pubis. A right unclamping RAPN with sliding clip renorrhaphy was performed. The trocars were removed and the robot undocked. Without interrupting the anesthesiological procedures, the patient was reported in supine position and, after 180 degrees rotation of the surgical bed, was newly placed in contralateral flank position. Using both the previous periumbilical and midline ports, two other 8-mm robotic trocars were placed. The robot was then redocked and RAPN was also performed on the left side using the same previously reported technique. Results Total time: 285 min. Estimated blood losses: 150 cc. Postoperative period: uneventful. Pathological examination: bilateral renal cell carcinoma, negative surgical margins. Conclusions Our experience was encouraging and confirmed the feasibility and safety of this procedure. The planning of our technique was time and cost effective with cosmetic benefit for the patient. However, we think that an appropriate selection of the patients and a skill in robotic renal surgery are advisable before approaching this type of surgery.

[
Robotic pyeloplasty: the results after the first 30 patients]. / Pieloplastica robotica: i risultati dopo i primi 30 pazienti.

INTRODUCTION: The aim of this paper is to report the outcomes of 30 (first) robot-assisted pyeloplasties (RPs) performed at our institute for the treatment of ureteropelvic junction obstruction (UPJO).
 METHODS: In the period between March 2005 and September 2012, 30 RPs due to UPJO have been performed at our institute using a three arms Da Vinci Robot, standard version. All the procedures were performed transperitoneally with Anderson-Hynes technique. 29/30 (97%) patients were affected by primary UPJO and 1/30 (3%) reported a recurrent disease. The access foresaw the positioning of three robotic trocars (one 12 mm trocar for the camera and two 8-mm trocars for the robotic arms) and one assistant 12 mm trocar. The anastomosis was confectioned on a double-J ureteral tutor with 4/0 monocryl running sutures. Outcome success was defined as resolution of preoperative symptoms and ureteropelvic junction obstruction, confirmed by the improvement of the diuretic renogram. Mean follow-up was 48.3 months (range 5-96).
 RESULTS: All procedures have been completed robotically and no conversion was needed. 
Mean operative times, blood losses and hospital stay were respectively 189 minutes (range 105-420), 60 mL (range 25-100) and 4.2 days (range 2-14).
 29/30 patients were cured, with a success rate of 97%.
 As regards mild complications, 3/30 patients (10%) reported a moderate abdominal pain a few hours after surgery, which was successfully treated with common analgesic drugs.
 A s for major complications, one patient (3%) developed ileus, probably due to a mild urine extravasation through the ureteropelvic suture, which spontaneously disappeared three days after surgery.
 CONCLUSION: RP seems to be a "new gold standard" in the treatment of UPJO.
 The three-dimensional versatility and the outstanding accuracy of robot-assisted intracorporeal suturing produced excellent results after the first procedures without requiring a previous 'sound' laparoscopic experience.

[Prostate brachytherapy: oncological and functional results after 400 cases]. / Brachiterapia prostatica: risultati oncologici e funzionali dopo 400 casi.

INTRODUCTION: Brachytherapy (BT) with real-time technique for the treatment of low and medium risk prostate cancer (CaP) has been a well known practice for over 25 years in the USA and for over 15 years in Italy. However, it is an uncommon procedure, because of problems related to the organization and cooperation among urologists, radiotherapists and physics, to the competition of alternative therapies, to dogmatic and educational beliefs, and to the poor knowledge of this technique.
 METHODS: Between May1999 and July 2013, 400 patients with low and medium risk CaP underwent I 125 BT using a "real-time" approach. The seeds implantation was performed using a Mick applicator in the first 190 patients and the "QuickLink" technique in the last 210 cases. Oncologic results were reported for the first 250 cases with a mean follow-up of 10 years, while functional outcomes and complications were assessed in 350 patients with a minimum follow-up of 1 year.
 RESULTS: A good quality implantation was assessed in 90% of the patients (D90>145 Gy). A biochemical failure was assessed, based on Phoenix criteria, in 12 patients (4.8%). Out of these patients, 10 underwent prostate biopsy (the other 2 patients showed a systemic disease). The biopsy showed a CaP in 6/10 patients who underwent retropubic radical prostatectomy (4 patients) and external radiotherapy (2 patients) respectively. The remaining 4/10 patients with negative biopsy were treated with total androgen blockade (3 patients) and watchful waiting (1 patient) respectively. Functional results showed an incidence of postoperative irritative disorders in 70% of the patients during the first six months and a good recovery of erectile function in 78.8% and 68.2% of the patients after one and five years from BT respectively.
 CONCLUSION: Brachytherapy is a good alternative to radical prostatectomy in the low and medium risk prostatic cancers with excellent oncologic and functional results.