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Objective: To describe the initial experience with PSMA-PET/CT-guided biopsy in European referral centres., Methods: This multicenter observational cohort study was endorsed by the Young Academic Urologist (YAU) Prostate Cancer Group of the EAU and conducted across 6 tertiary-level European centres. PSMA-guided biopsies were carried out in a cognitive/fusion manner for all the recruited patients with or without MRI-guided biopsies and/or standard biopsy (SB). PCa and clinical significant PCa (csPCA) detection rate (DR) at prostate biopsy was assessed. Uni- and multivariable models were employed to identify features related to csPCA., Results: Overall, 72 patients were recruited. The topographic location of the dominant lesion depicted by PSMA PET/CT was significantly associated with the location of csPCa, especially in the biopsy naïve cohort. The DR for PCa and csPCa of PSMA-PET/CT-guided biopsies was significantly higher than SB (0.40 ± 0.43 vs 0.23 ± 0.29, and 0.36 ± 0.44 vs 0.21 ± 0.30, respectively, both P <.05) but did not surpass MRI-guided biopsies (0.40 ± 0.43 vs 0.47 ± 0.44, and 0.36 ± 0.44 vs 0.47 ± 0.34, respectively, both P >.05). PSMA-PET/CT-guided biopsy performed better in the biopsy naïve than in the repeated biopsy setting. A SUVmax cut-off value equal to 4.8 provided the best results for detecting csPCa., Conclusion: Our real-world data illustrate the potentialities of PSMA-PET/CT-guided biopsy in diagnosing PCa. Specifically, in biopsy naïve patients with suspicion of high-risk disease, the use of PSMA-PET/CT-targeted biopsy can be considered. Additionally, in the context of repeated biopsies, a PSMA-PET/CT target biopsy might be advisable over the SB., Competing Interests: Declaration of Competing Interest The authors have no conflict of interest to declare., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Objective: To assess the relevance of the endoscopic evaluation in clinically suspected cases of Bladder Pain Syndrome/Interstitial Cystitis (BPS/IC), using ESSIC criteria, established in 2008 by the European Society for the Study of Interstitial Cystitis (ESSIC)., Methods: We included all patients who underwent endoscopic evaluation between January 01, 2015 and October 31, 2019 for clinical suspicion of BPS/IC. Collected data included demographic and baseline clinical features, endoscopic appearance (prior and after hydrodistension), and bladder wall biopsy results, both defined according to ESSIC criteria. Data were cross tabulated to define ESSIC phenotypes, while subgroups and multivariate analyses were carried out to assess the influence of clinical variables on ESSIC phenotypes., Results: Fifty-two subjects were included, mainly women (92%). Median age at evaluation was 45 (32.9-58.2) years. At hydrodistension, 21 patients (42%) had positive and 29 (58%) had negative findings. Grade 2-3 glomerulations were found in 18 patients, while Hunner lesions were reported only in 1 patient. Positive results at biopsy were found in 24 pts (51.1%), while negative in 23 (48.9%). Overall, the positive and negative concordance between hydrodistension and biopsy results was 78%. No significant differences in ESSIC subtypes were found after stratification based on clinical features and at multivariate analysis. Retrospective design is the main limitation., Conclusion: Cystoscopy with hydrodistension and biopsy do have a role in the diagnostic pathway of BPS/IC. However, results should be considered in the clinical context of the individual patient., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Iliac-urinary fistula is a rare cause of severe hematuria after urinary diversion. Indwelling stents and advanced atherosclerosis may be risk factors. Angiography with embolization is usually resolutive., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Objective: To reduce the risk of symptomatic lymphocele after robotic pelvic lymph node dissection (PLND), we present a technique, preventing lymphocele ensuring absorption transperitoneally (P.L.E.A.T.), where the peritoneum is "pleated" along its midline, leaving 2 lateral openings and allowing lymphatic fluid to drain away from the pelvis and into the abdomen., Materials and Methods: We analyzed a single-surgeon series of PLNDs during robotic radical prostatectomy, comparing 195 "standard" PLNDs (in which the peritoneum was "re-approximated" or left completely open) with 176 cases in which P.L.E.A.T. was performed., Results: In the group without P.L.E.A.T., 8 cases of symptomatic (grade ≥3, according to the Clavien-Dindo Classification) lymphoceles (4.1%) were recorded. Only 1 patient in the P.L.E.A.T. group complained of symptoms because of a lymphocele (P = .039). No patient reported complications because of the procedure., Conclusion: The P.L.E.A.T. technique is a fast, easy-to-perform, and safe method of reducing the risk of symptomatic lymphocele after transperitoneal robotic PLND., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Objective: To evaluate the impact of standardized training and institutional checklists on improving teamwork during complications requiring open conversion from robotic-assisted partial nephrectomy (RAPN)., Materials and Methods: Participants to a surgical team safety training program were randomly divided into 2 groups. A total of 20 emergencies were simulated: group 1 performed simulations followed by a 4-hour theoretical training; group 2 underwent 4-hour training first and then performed simulations. All simulations were recorded and scored by 2 independent physicians. Time to conversion (TC) and procedural errors were analyzed and compared between the 2 groups. A correlation analysis between the number of previous conversion simulations, total errors number, and TC was performed for each group., Results: Group 1 showed a higher TC than group 2 (116.5 vs 86.5 seconds, P = .0.53). As the number of simulation increased, the numbers of errors declined in both groups. The 2 groups tend to converge toward 0 errors after 9 simulations; however, the linear correlation was more pronounced in group 1 (R 2  = 0.75). TC shows a progressive decline for both groups as the number of simulations increases (group 1, R 2  = 0.7 and group 2, R 2  = 0.61), but it remains higher for group 1. Lack of task sequence and accidental falls or loss of sterility were higher in group 1., Conclusion: OC is a rare but potentially dramatic event in the setting of RAPN, and every robotic team should be prepared to manage intraoperative emergencies. Training protocols can effectively improve teamwork and facilitate timely conversions to open surgery in the event of intraoperative emergencies during RAPN. Further studies are needed to confirm if such protocols may translate into an actual safety improvement in clinical settings., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Objective: To analyze the prevalence of cardiovascular disease (CVD) and osteoporosis in patients treated with androgen deprivation therapy (ADT) for prostate cancer (PCa) but not adherent to European Association of Urology (EAU) guidelines., Materials and Methods: The CHOosIng Treatment for Prostate CanCEr (CHOICE) study was an Italian multicenter, cross-sectional study conducted from December 2010 to January 2012. A total of 1386 patients treated with ADT for PCa (first prescription or renewal of ADT) were selected. According to EAU guidelines, the cohort was categorized in discordant ADT (Group A) and concordant ADT (Group B). The prevalence of CVD and osteoporosis after ADT was recorded., Results: The final cohort included 1075 patients. According to EAU guidelines adherence, 285 (26.51%) and 790 (73.49%) were considered discordant and concordant, respectively. The proportion of men with Charlson Comorbidity Index  > 2 at baseline was statistically similar in Group A (81.8%) compared to Group B (80.8%) (P = .96). The number of complications reported at enrollment was as follows: cardiovascular in 351 (32.7%), endocrine in 166 (15.4%), sexual in 498 (46.3%), osteoporosis in 181 (16.8%), and gynecomastia in 274 (25.5%) subjects. At the multivariate logistic regression analysis adjusted for confounding factors, discordant ADT was associated with greater risk of cardiovascular complications (odds ratio: 2.07; P < .01) and osteoporosis (odds ratio: 1.75; P = .04)., Conclusion: About one-third of patients with PCa received inappropriate ADT and showed a greater risk of CVD and osteoporosis. These results could be useful for setting better policy strategies to limit the inappropriateness of ADT prescription., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Objective: To present a detailed description of the "Ves.Pa." procedure to create a novel robotic intracorporeal ileal orthotopic neobladder, together with technical tips for the creation of a time-efficient robotic intracorporeal neobladder., Materials and Methods: We evaluated the presumed volume of the final Ves.Pa. in silico, exploring ex vivo the anatomical and technical feasibility of reconfiguring the bowel. During tests performed in a robotic pelvic model, procedures were recorded to identify possible improvements in operating times., Results: After initial evaluation of the anatomical feasibility of the technique, its practicability was confirmed during ex vivo tests. It is also possible to create two different versions of the pouch, in cases of short right or short left ureter ("Ves.Pa. Reverse"). Tests on our robotic pelvic model confirmed the feasibility of the technique, and some details to improve its time efficiency were identified, for example, further simplification of the suturing of the neobladder., Conclusion: Despite the increasing use of robotic radical cystectomy, most urological departments do not perform "ideal" intracorporeal urinary diversion due to perceived technical difficulties in reconfiguring the ileum and operating times in comparison with open surgery. An idea for a novel intracorporeal robotic orthotopic neobladder (with many characteristics for creating a feasible test pouch) has been designed. Clinical studies are needed to confirm these findings., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Introduction: To determine whether a novel intraoperative technique of COmplete Reconstruction of the Posterior Urethral Support (CORPUS) improves early urinary continence after robotic-assisted radical prostatectomy (RARP). In this prospective study, between November 2012 and June 2013, 36 consecutive patients suitable for non-nerve-sparing RARP were alternatively assigned to either CORPUS surgery or Rocco's standard reconstruction., Technical Considerations: In the CORPUS group, fibers of the bilateral portions of the puborectalis muscle were used to create a sort of posterior hammock for the urethra. The International Consultation on Incontinence Questionnaire, Short Form Questionnaire (ICIQ-SF) and International Prostate Symptom Score were collected for all patients preoperatively and then ICIQ-SF at 1 day and both tests at 30 days after catheter removal after RARP. Intraoperative and/or postoperative complications were evaluated. Pearson chi-square test compared urinary continence according to ICIQ-SF at 1 and 30 days. Statistical significance was set at P <.05., Conclusion: Fifty percent of CORPUS patients were continent immediately after catheter removal and 83% after 30 days. In controls, the respective percentages were 16% and 61%. The differences were statistically significant in both cases. The International Prostate Symptom Score at 30 days did not show obstructive symptoms in either group. One limitation of this study is the low number of cases, "superselected" to evaluate the true effect of CORPUS reconstruction. The very early continence rate of the CORPUS patients was significantly improved compared with that of patients undergoing Rocco's standard technique. Further studies extending the inclusion criteria are needed to confirm the impact of the new CORPUS technique in a more heterogeneous group., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Objectives: To compare the prognostic accuracy of the Solsona and European Association of Urology (EAU) risk groups in the identification of lymph node involvement in a cohort of patients with squamous cell carcinoma of the penis., Methods: The clinical and pathologic data of 175 patients who had undergone surgery for squamous cell carcinoma of the penis from 1980 to 2002 at 11 urologic centers of northeastern Italy were retrospectively collected., Results: According to the EAU risk group, 25 patients were categorized as at low (15.1%), 23 (13.9%) as intermediate, and 118 (71.1%) as high risk of lymph node metastasis. Similarly, using the criteria of the Solsona risk group stratification, 25 (15.1%), 55 (33.1%), and 86 patients (51.8%) were categorized as at low, intermediate, and high risk. At the median follow-up of 26 months, lymph node involvement was observed in 71 (40.6%) of 175 patients. Receiver operating characteristic curve analysis showed that both the EAU risk group (area under the curve = 0.632) and Solsona risk group (area under the curve = 0.697) had a low accuracy for predicting lymph node involvement. Both risk groups were independent predictors of lymph node involvement, as well as the clinical stage of lymph node involvement and the presence of vascular and/or lymphatic embolization., Conclusions: The Solsona and EAU risk groups were both independent predictors of lymph node involvement, although the receiver operating characteristic curve analysis showed that both risk groups had low predictive accuracy.

Objectives: To define whether six-core biopsies still have a role in patients presenting with prostate-specific antigen (PSA) levels greater than 10 ng/mL and abnormal digital rectal examination (DRE) findings. Recent studies have suggested that the six-core biopsy is inadequate for the diagnosis of prostate cancer; however, it remains controversial whether an increased number of cores is justified in all patients., Methods: From June 2002 to February 2005, 122 (18.8%) of 650 patients underwent prostate biopsy because of a PSA level greater than 10 ng/mL and abnormal DRE findings. All patients underwent transperineal ultrasound-guided prostate biopsy in a standardized fashion: a six-core biopsy was performed first, followed by six additional cores during the same session, four in the peripheral and two in the transition zone., Results: The detection rate in patients with a PSA level greater than 10 ng/mL and abnormal DRE findings was 72.1% (88 of 122) and 75.4% (92 of 122) using the 6-core and 12-core biopsy, respectively. One case of tumor was missed by the six-core biopsy among patients with a PSA level greater than 15 ng/mL and abnormal DRE findings. No cases of tumor were missed by six-core biopsy in the group with a PSA level greater than 20 ng/mL and abnormal DRE findings., Conclusions: Six-core biopsy provided a similar cancer detection rate compared with 12-core biopsy in patients with PSA levels greater than 10 ng/mL and abnormal DRE findings. An initial approach with 6-core biopsy is reasonable in patients with a PSA level greater than 10 ng/mL and abnormal DRE findings and is advocated in those with PSA greater than 20 ng/mL and abnormal DRE findings.

Objectives: To use the elementary physical measurements of temperature and size to prove that the thermal effects produced by the holmium laser's pulses are due to the formation of a plasma bubble. The physical phenomenon related to high temperatures generated during procedures with the holmium laser (holmium:yttrium-aluminum-garnet) was the object of our interest., Methods: Using a double micrometric slide attached to a 550-microm optic fiber and two thermocouples submerged in water, a series of pulses of 0.8 J at 10 to 30 Hz was delivered from a holmium:yttrium-aluminum-garnet laser, and we recorded temperatures on both frontal and lateral planes. Subsequently, samples of prostatic tissue and small stones were treated with 1.5 J at 20 Hz on both frontal and lateral planes., Results: Treatment with 1.5 J at 30 Hz (frontal plane) and with 1.5 J at 20 Hz (lateral plane) produced the ablation of the structure of the thermocouple at 2 mm and 1 mm, respectively, indicating plasma formation. The dimensions of the bubble after the delivery of 1.5 J at 20 Hz was 2 x 1.5 mm. Coagulation of the prostatic tissue took place at 1 mm from the plasma bubble, on both frontal and lateral planes., Conclusions: The plasma bubble that forms at the tip of the fiber connected to the holmium:yttrium-aluminum-garnet laser makes it possible to work on stones and soft tissues. The coagulation of the prostatic tissue is caused by the hot water-vapor bubble that forms on the edge of the plasma bubble. During lithotripsy, guidewires and baskets within the expansion area of the plasma bubble risk damage.

Objectives: To compare the pathologic stage and surgical margin status in patients undergoing either immediate radical prostatectomy or surgery preceded by 3 or 6 months of neoadjuvant hormonal treatment (NHT) in a prospective, randomized study., Methods: Four hundred thirty-one men with prostate cancer were enrolled in the Italian randomized prospective PROSIT study. The whole-mount sectioning technique was used. By May 1999, the reviewing pathologist had evaluated 303 specimens. One hundred seven patients were untreated before radical prostatectomy was performed, and 114 and 82 patients had been treated for 3 and 6 months, respectively, with complete androgen blockade., Results: Pathologic organ-confined disease was found in 63.1% of patients with clinical Stage B disease treated with 6 months of NHT versus 61.0% after 3 months of NHT and 37.5% after immediate surgery. Among patients with clinical Stage C tumors, pathologic staging found organ-confined disease in 62.5%, 32.1%, and 11.1% of patients after 6 months of NHT, 3 months of NHT, and immediate surgery, respectively. Three months of NHT produced a significant increase in negative margins both in patients with clinical Stage B and C disease, but the addition of another 3 months of treatment did not significantly improve this result. A lower degree of benefit was observed in patients with clinical Stage C tumors., Conclusions: This study shows that complete androgen blockade before surgery is beneficial in men with clinical Stage B disease. The effects are more pronounced after 6 months of NHT than after 3 months.

Bladder pathologic features related to intravesical bacillus Calmette-Guerin (BCG) therapy in superficial bladder cancer (Ta, T1, Tis) were evaluated and related to clinical outcome. A total of 105 patients were treated with 75 mg Pasteur BCG weekly for six consecutive weeks. When tumor was not demonstrated a maintenance course was given. An additional six-week course was given when tumor recurrence or persistence, without progression, was observed after the induction course. An inflammatory change in the bladder was the most common pathologic finding. Granuloma was the only specific BCG-related feature and did not appear to be a prognostic factor because of low incidence (24%) and lack of correlation with clinical course. Dysplasia occurred more frequently (57%) in nonresponder patients and (26%) in responder patients, often heralding recurrence of tumor. All patients showing concurrent squamous and/or glandular metaplasia were unresponsive to BCG therapy. Histology and cytology did not correlate perfectly: cytology was ineffective in low-grade tumors and improved diagnostic accuracy, particularly when dysplasia was histologically evident.

A new 17-F nephroscope was used for percutaneous renal stone management. It appeared useful in reducing the possible main vascular injuries after percutaneous nephrolithotomy. Personal experience with pediatric as well as selected adult cases is presented.

Fine-needle aspiration biopsy of the prostate is of great advantage in the diagnosis of prostatic disease. The procedure is quick, safe, and reliable. Several aspirations can be done even in outpatients with minimum trauma. Complications are rare. In this study cytologic diagnosis was obtained in 511 consecutive patients. To evaluate the cytologic accuracy, 195 cytologic diagnoses were compared with histologic findings obtained from transperineal biopsy on the same patients. Correlation was achieved in 96.42 per cent of these cases. The findings in 127 histologically graded prostatic cancers were compared with the cytologic differentiation observed in aspiration smears of the same patients. Cytologic grading of prostatic carcinoma corresponded to the histologic grading in 85.8 per cent of the cases.

Experience with Octoson water-path echotomography in examining 21 testicular masses is reported. Sonographic results were confirmed by surgical and pathologic findings in all cases. We believe this procedure to be of value in differential diagnosis of intrascrotal swellings.