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Introduction: We present the management of the second reported case of carcinosarcoma of the kidney parenchyma with malignant degeneration of both epithelial and mesenchymal components., Case Report: A 36-year-old woman came to our attention for an incidental sonographic finding of a lesion in the lower pole of the left kidney. A contrasted computed tomography scan confirmed the presence of a 50 × 52 mm 2 contrasted lesion in the left lower kidney pole. The patient underwent a challenging laparoscopic left partial nephrectomy and para-aortic lymphadenectomy. The histological examination led to the diagnosis of a carcinosarcoma of the kidney parenchyma with malignant degeneration of both epithelial and mesenchymal components. The patient underwent adjuvant chemotherapy with paclitaxel at 175 mg/m 2 plus carboplatin area under the curve 6 intravenously for six cycles. At a follow-up of 42 months, the patient is alive and does not show any local recurrences or distant metastases., Conclusion: A multi-disciplinary therapeutic approach, combined with an adequate doctor-patient relationship and a close and detailed follow-up, is of fundamental importance in obtaining good outcomes in such rare and challenging cases.

Objective: Flexible cystoscopy for ureteral stent removal after ureteroscopy is widely performed. In this scenario, the real need for antimicrobial prophylaxis is still uncertain. Aim of this study is to determine the urinary tract infections rate after 4 weeks from outpatient flexible cystoscopies for ureteral stent removal without antimicrobial prophylaxis., Patients and Methods: A prospective observational study was performed between November 2017 and August 2018 in a single, high-volume Institution.Risk factors for UTIs were recorded. Immediately before cystoscopy, each patient submitted a voided urine specimen. Antibiotics were not given before or after cystoscopy. About 7 and 28 days after cystoscopy all the patients underwent abdomen US, urine analysis and culture, and clinical evaluation to assess possible symptoms of UTI., Results: A total of 192 patients were enrolled in the study, 76 patients (39.2%) were female. Median age was 55 years [IQR 47- 68]. Median BMI was 24.2 [22.9-26.7]. Eighteen patients (9.4%) had asymptomatic bacteriuria before cystoscopy and 39 (20.3%) had positive culture at 7 days. About 21 patients (10.9%) were diagnosed with febrile UTI in the 28 days FU period. The 28.6 % of the Febrile patients had asymptomatic bacteriuria before the stent removal ( p  < 0.001), this group was slightly older ( p  = 0.085) and with higher BMI ( p  = 0.036).Forty-eight patients had positive urine culture at 7 days, of whom 27 (14.1%) were asymptomatic and were classified as asymptomatic bacteriuria. Multivariate analysis shows that only high BMI and bacteriuria before the procedure were significantly associated with developing a febrile UTI, none of the other risk factors was significant., Conclusion: Our data show a high rate of UTI after flexible cystoscopies for ureteral stent removal without antimicrobial prophylaxis especially in patients with asymptomatic bacteriuria, in those with high BMI and in the elderly; in these subgroups, antimicrobial prophylaxis should be recommended.

Objective: To report the results of a survey supported by the Italian Andrological Association (ASS.A.I.), aimed at documenting sexual disorders in a large population of patients who visited general practitioners for general health problems., Methods: Between April and October 2016, 15,000 questionnaires were distributed to general practitioners throughout Italy and made available to all the people who visited the doctor's offices. The data were collated separately for age ranges, 15-30, 31-50 and 51-65 years, respectively., Results: A final sample of 5441 questionnaires was evaluable (4000 men and 1441 women). Sexual disorders were reported by 1795 out of 5441 (33.0%) patients. Among the male population, phimosis, varicocele, prostate and testicular disorders were the most common conditions interfering with sexuality, being reported by 42.0%, 37.0%, 39.0% and 31.0% of the sample, respectively. Furthermore, erectile dysfunction, sexually transmitted diseases, infertility, premature ejaculation and penile curvature were reported by 27.7%, 27.0%, 17.0%, 14.4% and 7.8% of the male sample, respectively. Among the female population, low sexual satisfaction was the more common complaint, reported by 65.0% of the sample. Sexually transmitted diseases, low libido, dyspareunia, infertility and arousal disorder were reported by 32.0%, 29.0%, 24.0%, 24.0% and 19.7% of the female sample, respectively., Conclusion: Our data show sexual disorders among 33.0% of people visiting doctors' offices. The majority of these sexual disorders increased with age among both male and female subjects. Despite the limitations of our study, we consider that these data confirm the importance of sexual function evaluation during a physician's daily clinical practice.

Introduction: Leiomyomas are rare benign tumors that can occur in the male urinary tract. We present a unique case of leiomyoma of the vas deferens., Case Description: We present the clinical case of a 69-year-old patient with a suspected bulk close to the right epididymis, which turned out to be a leiomyoma of the vas deferens. To our knowledge, it is the fourth case in literature., Conclusions: A proper identification and the knowledge of this pathology, even if it is a very unusual event, is necessary to avoid a surgical over treatment and preserve the testicle, by removing only the tumor.

Introduction: Three-dimensional (3D) laparoscopy with a flexible camera was developed to overcome the main limitation of traditional laparoscopic surgery, which is two-dimensional (2D) vision.The aim of our article is to present the largest casistic of 3D laparoscopic radical prostatectomy (LRP) available in literature and evaluate our results in terms of pentafecta and compare it with the literature., Methods: We retrospectively evaluated consecutive patients who underwent LRP with 3D technology between March 2014 and December 2015. Total operative time (TOT), anasthomosis time (AT), blood loss and complications were registered. All patients presented at least 3 months of follow-up. Surgical outcome was evaluated in terms of Pentafecta., Results: One hundred fifty consecutive patients underwent 3D LRP. Mean follow-up was 16.9 months. Mean age was 67.7 ± 8.3 years (range 50-76). Mean preoperative PSA value was 8.3 ± 5.8 ng/ml and mean bioptic Gleason Score (GS) was 6.6. We had a mean TOT of 158 ± 23 minutes and a mean AT of 25 ± 12.6. Mean blood loss was 240 ± 40 ml. Eighteen (12%) postoperative complications occurred. Pathologic results: pT2 in 91 patients (58%) and pT3 in 59 (39.3%). Pentafecta was reached by 31.3% of patients at 3 months and 51.6% at 12 months., Conclusions: Our oncological and functional results are comparable to those present in literature for laparoscopic and robotic surgery. We believe that our findings can encourage the use of 3D laparoscopy especially considering the increasing attention to healthcare costs.

Purpose: To assess the opinions of urologists, oncologists and radiation oncologists on the indication for androgen deprivation therapy (ADT) and the definition and management of castration-resistant prostate cancer (CRPC)., Methods: In this study using the Delphi method, a list of 15 statements (66 items overall) addressing key issues in ADT and CRPC was sent to 255 participants (urologists, oncologists and radiation oncologists). Responses were rated on a 5-point Likert scale (1=strong disagreement; 5=strong agreement). Disagreement was defined as ≥66% responses with scores 1-2 and agreement as ≥66% responses with scores 3-5. No consensus was absence of agreement/disagreement., Results: Overall, there was agreement and disagreement in 50% and 15% of the items, respectively. In 71.2% of the items the panelists agreed with each other. The highest concordance rate was observed between urologists and oncologists (87.8%). There were no items with 3 different opinions between the specialists. All panelists agreed on the definition of CRPC. Urologists and oncologists agreed on the recommendation to continue ADT in CRPC. In both nonmetastatic and metastatic asymptomatic CRPC patients with biochemical progression, treatment should be based on PSA kinetics. The panelists agreed on the use of chemotherapy in symptomatic and asymptomatic metastatic CRPC patients but not in those with nonmetastatic CRPC. There was agreement on the timing of initiation of abiraterone and enzalutamide either before or after chemotherapy., Conclusions: With few exceptions there was agreement among urologists, oncologists and radiation oncologists about the management of CRPC, although the indications were not always in line with international guidelines.

Purpose: A sentinel lymph node (SNL) is the primary landing zone of cancer cells that spreads through the lymphatic vessels. The rational of the detection of sentinel node (SLN) during radical prostatectomy (RP) for prostate cancer (PCa) is the removal of the first nodal stations to provide a restriction of the template of node dissection. A review of the outcomes of SNL detection during RP for PCa was performed., Materials and Methods: A systematic review of the literature was conducted, searching on PubMed and Web of Science, using the following keywords: lymph node dissection, prostatic neoplasm, sentinel node., Results: Twenty articles were selected and analyzed including over 2000 PCa patients. Although promising and technically feasible, many points remain to be clarified before clinical application can be recommended., Conclusions: The technique of SNL detection is feasible and provides a higher sensitivity and detection rate than standard lymphadenectomy, especially for organ-confined tumors. Larger series and long-term follow-up data are mandatory to assess the oncologic effectiveness of the detection of SNL for PCa.

Aims and Background: The free/total (F/T) prostate-specific antigen (PSA) ratio is probably the most promising tool proposed to increase the specificity of PSA in the diagnosis of prostate cancer. The aim of the present study was to evaluate the clinical value of the F/T ratio in 138 patients with benign hyperplasia, 101 with untreated prostate cancer, and 176 apparently healthy men., Methods: We used a new immunometric assay of free PSA (FPSA-RIACT, CIS Diagnostici, Italy) which has shown good analytical performance; sample handling and storage under routine conditions did not affect the antigen stability., Results: The diagnostic efficiency of the F/T ratio was significantly better than that of total PSA. In patients with total PSA ranging from 4 to 10 ng/ml, at a specificity level of 95% total PSA showed a sensitivity of 7%, whereas the sensitivity of F/T increased to 70%. Using the F/T ratio as a decision tool in association with total PSA and considering all cases candidate to biopsy (total PSA greater than 3.79 ng/ml corresponding to the 95% level), we demonstrated a 35% reduction of total biopsies that would have been required on the basis of total PSA alone., Conclusions: The determination of the percentage of F/T serum PSA significantly improves the specificity of the marker, particularly in the 4-10 ng/ml dose range where unnecessary prostate biopsies can be reduced.