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There is evidence that, after severe acute respiratory syndrome coronavirus 2 infection, male reproductive function and semen quality may be damaged OBJECTIVES: To evaluate a panel of inflammatory mediators in semen in patients recovered from coronavirus disease 2019.Sexually active men with previous severe acute respiratory syndrome coronavirus 2 infection and proven recovery from coronavirus disease 2019 were enrolled in a prospective cohort study. Clinical, uro-andrological data and semen specimens were prospectively collected. For previously hospitalized coronavirus disease 2019 patients, data on serum inflammatory markers were retrospectively collected.A total of 43 men were enrolled in the study. Of these, 32 men were normozoospermic, three were oligozoospermic, and eight were crypto-azoospermic. Serum inflammatory markers (procalcitonin and C-reactive protein) were analyzed in previously hospitalized patients both at admission and at peak of infection. Levels at admission were statistically significantly higher in patients resulting in crypto-azoospermic with respect to those resulting in normozoospermic (p = 0.05; p = 0.03 and p = 0.02, respectively) after healing. Seminal cytokine levels were similar among all groups. Interleukin-1β and tumor necrosis factor-α levels were significantly negatively related to sperm total number and concentration, whereas interleukin-4 was correlated with sperm motility.Negative correlations between interleukin-1β and tumor necrosis factor-α and sperm number and the overall high levels of semen cytokines indicate a potential detrimental role of severe acute respiratory syndrome coronavirus 2 driven inflammation on spermatogenesis. Overall, our results indicate that male patients recovering from coronavirus disease 2019 deserve accurate follow-up for their fertility status.

According to current studies, COVID-19 might have an impact on semen quality. Therefore, SARS-CoV-2 may affect other traits of male reproductive system, including the prostate. Thus, we recruited patients who experienced COVID-19 infection in-between prostate biopsy and radical prostatectomy and compared prostate samples inflammation, measured with IRANI score, to those who did not. Indeed, we recruited 20 patients, aged 69 (62-73) years, finding no difference between the 10 patients with COVID-19 infection and the others in IRANI score and all its sub-scores. Hence, according to our exploratory and limited results, COVID-19 infection might have no gross effect on prostate inflammation.

Introduction: The world population is ageing and surgical procedures for older patients are associated with higher perioperative morbidity and mortality rates than in younger patients. Segmental ureterectomy (SU) has been proposed as an alternative to radical nephroureterectomy (RNU) for selected upper tract urothelial carcinomas (UTUC), to reduce post-operative morbidity, and preserve renal function. The aim of this study was to compare RNU and SU in terms of post-operative complications, functional outcomes, and overall survival (OS) in older patients treated for UTUC. Materials and methods: Data of patients aged 75 years or older and treated for UTUC were included. The primary outcome was to compare RNU versus SU according to post-operative complications, the estimated glomerular filtration rate (eGFR) variation, and OS. Complications were defined according to the Clavien-Dindo classification. eGFR was calculated according to the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula. Un-adjusted OS curves were plotted using the Kaplan-Meier method. Results: Overall, 177 patients (150 RNU and 27 SU) were eligible for the analysis. Pre- and post-operative characteristics were similar between the 2 groups. RNU patients showed higher incidence of post-operative complications (34.0% vs. 7.4%, P = .011). The mean post-operative serum creatinine was lower in SU patients in comparison with the RNU ones (1.23 vs. 1.69 mg/dL, P = .046), but no differences were found in terms of eGFR variation (P = .258). At 3 years of follow-up, the OS was comparable between the two surgical techniques (P = .129). Conclusion: In older patients diagnosed with UTUC, SU could offer lower rates of post-operative complications without affecting survival.

Objective: To prove the feasibility of Multimodal Fiber Optic Spectroscopy (MFOS) analysis in bladder cancer (BCa) detection, grading, and staging. Materials and methods: Bladder specimens from patients underwent TURBT or TURP were recorded and analyzed with MFOS within 30 min from excision. In detail, our MFOS combined fluorescence, Raman spectroscopy, and diffuse reflectance. We used these optical techniques to collect spectra from bladder biopsies, then we compared the obtained results to gold standard pathological analysis. Finally, we developed a classification algorithm based on principal component analysis-linear discriminant analysis. Results: A total of 169 specimens were collected and analyzed from 114 patients, 40 (23.7%) healthy (from TURP), and 129 (76.3%) with BCa. BCa specimens were divided according to their grade—34 (26.4%) low grade (LG) and 95 (73.6%) high grade (HG) BCa—and stage—64 (49.6%) Ta, 45 (34.9%) T1, and 20 (15.5%) T2. MFOS-based classification algorithm correctly discriminated healthy versus BCa with 90% accuracy, HG versus LG with 83% accuracy. Furthermore, it assessed tumor stage with 75% accuracy for Ta versus T1, 85% for T1 versus T2, and 86% for Ta versus T2. Conclusions: Our preliminary results suggest that MFOS could be a reliable, fast, and label-free tool for BCa assessment, providing also grading and staging information. This technique could be applied in future for in vivo inspection as well as of ex vivo tissue biopsies. Thus, MFOS might improve urothelial cancer management. Further studies are required.

STUDY QUESTION How is the semen quality of sexually active men following recovery from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection? SUMMARY ANSWER Twenty-five percent of the men with recent SARS-Cov-2 infections and proven healing were oligo-crypto-azoospermic, despite the absence of virus RNA in semen. WHAT IS KNOWN ALREADY The presence of SARS-CoV-2 in human semen and its role in virus contagion and semen quality after recovery from coronavirus disease 2019 (COVID-19) is still unclear. So far, studies evaluating semen quality and the occurrence of SARS-CoV-2 in semen of infected or proven recovered men are scarce and included a limited number of participants. STUDY DESIGN, SIZE, DURATION A prospective cross-sectional study on 43 sexually active men who were known to have recovered from SARS-CoV2 was performed. Four biological fluid samples, namely saliva, pre-ejaculation urine, semen, and post-ejaculation urine, were tested for the SARS-CoV-2 genome. Female partners were retested if any specimen was found to be SARS-CoV-2 positive. Routine semen analysis and quantification of semen leukocytes and interleukin-8 (IL-8) levels were performed. PARTICIPANTS/MATERIALS, SETTING, METHODS Questionnaires including International Index of Erectile Function and Male Sexual Health Questionnaire Short Form were administered to all subjects. The occurrence of virus RNA was evaluated in all the biological fluids collected by RT-PCR. Semen parameters were evaluated according to the World Health Organization manual edition V. Semen IL-8 levels were evaluated by a two-step ELISA method. MAIN RESULTS AND THE ROLE OF CHANCE After recovery from COVID-19, 25% of the men studied were oligo-crypto-azoospermic. Of the 11 men with semen impairment, 8 were azoospermic and 3 were oligospermic. A total of 33 patients (76.7%) showed pathological levels of IL-8 in semen. Oligo-crypto-azoospermia was significantly related to COVID-19 severity (P LIMITATIONS, REASONS FOR CAUTION Although crypto-azoospermia was found in a high percentage of men who had recovered from COVID-19, clearly exceeding the percentage found in the general population, the previous semen quality of these men was unknown nor is it known whether a recovery of testicular function was occurring. The low number of enrolled patients may limit the statistical power of study. WIDER IMPLICATIONS OF THE FINDINGS SARS-CoV-2 can be detected in saliva, urine, and semen in a small percentage of men who recovered from COVID-19. One-quarter of men who recovered from COVID-19 demonstrated oligo-crypto-azoospermia indicating that an assessment of semen quality should be recommended for men of reproductive age who are affected by COVID-19. STUDY FUNDING/COMPETING INTEREST(S) None. TRIAL REGISTRATION NUMBER N/A.

The aim of this study was to assess the impact of tadalafil 5 mg/die plus tamsulosin 0.4 mg/die combination therapy on lower urinary tract symptoms (LUTS) and erectile dysfunction (ED), according to presence vs. absence of metabolic syndrome (MetS).Seventy-five consecutive men presenting with ED and LUTS were enrolled. Patients were divided into two groups according to MetS presence. All subjects were treated with combination therapy for 12 weeks. Patients were re-evaluated after treatment with uroflowmetry and post-void residual volume (PVR), International Prostate Symptoms Score (IPSS), IPSS Quality of Life (QoL), overactive bladder questionnaire (OAB-q) and International Index Erectile Function-5 (IIEF-5) Score.After enrollment, 50 patients were included: 31 (62.0%) with MetS and 19 (38.0%) without MetS. At baseline, patients without MetS showed a significantly better IPSS, IIEF and OAB-q, as compared to those with MetS. After 12 weeks of combination therapy LUTS, ED and flowmetry significantly improved in both groups (P0.001). The improvement after 12 weeks was similar between groups in all parameters (P0.05), except for ∆OAB-q that was significantly better for patients with MetS (P=0.028). Nevertheless, total IPSS, all IPSS subscores and OAB-q were significantly better at 12 weeks in men without MetS (P0.05). Despite IIEF-5 was significantly different at baseline, after 12 weeks of combination therapy, erectile function was similar in men with or without METS: 16.3±3.8 vs. 17.7±4.7 (P=0.238). No serious adverse event (AE) was reported, and complications were comparable between groups (P0.05).Patients with MetS have worse LUTS and ED profiles. However, tadalafil plus tamsulosin combination treatment provided them a similar ED profile and a greater relief of overactive bladder (OAB) symptoms at the end of the trial. Combination therapy had the same safety profile in men besides MetS. Further randomized controlled trials are needed.

Background: The aim of our study is to evaluate the prevalence and predictive factors of short- (30 d) and mid-term continence in a contemporary cohort of patients treated with robotic-assisted laparoscopic prostatectomy (RALP) without any posterior or anterior reconstruction at our referral academic center. Methods: Data from patients undergoing RALP between January 2017 and March 2021 were prospectively collected. RALP was performed by three highly experienced surgeons following the principles of the Montsouris technique, with a bladder-neck-sparing intent and maximal preservation of the membranous urethra (if oncologically safe) without any anterior/posterior reconstruction. (Self-assessed urinary incontinence (UI) was defined as the need of one or more pads per die (excluding the need for a safety pad/die. Univariable and multivariable logistic regression analysis was used to assess the independent predictors of early incontinence among routinely collected patient- and tumor-related variables). Results: A total of 925 patients were included; of these, 353 underwent RALP (38.2%) without nerve-sparing intent. The median patient age and BMI were 68 years (IQR 63–72) and 26 (IQR 24.0–28.0), respectively. Overall, 159 patients (17.2%) reported early (30 d) incontinence. In multivariable analysis adjusting for patient- and tumor-related features, a non-nerve-sparing procedure (OR: 1.57 [95% CI: 1.03–2.59], p = 0.035) was independently associated with the risk of urinary incontinence in the short-term period, while the absence of cardiovascular diseases before surgery (OR: 0.46 [95% CI: 0.320.67], p ≤ 0.01) was a protective factor for this outcome. At a median follow-up of 17 months (IQR 10–24), 94.5% of patients reported to be continent. Conclusions: In experienced hands, most patients fully recover urinary continence after RALP at mid-term follow-up. On the contrary, the proportion of patients who reported early incontinence in our series was modest but not negligible. The implementation of surgical techniques advocating anterior and/or posterior fascial reconstruction might improve the early continence rate in candidates for RALP.

Background: Recent reports evidenced an impairment of semen parameters in men affected by coronavirus disease 2019 (COVID-19). In particular, our group previously reported that 1 over 4 COVID-19 healed men were found to be crypto- / azoo-spermic. Moreover, most patients had elevated IL-8 semen levels at sperm analysis. The aim of our study was to assess semen parameters and inflammation by evaluating a panel of sperm cytokine levels (IL-1, IL-4, IL-6, IL-8, IL-17, INF gamma, TNF-alpha) on average 1 month after the second SARS-CoV-2 negative nasopharyngeal swab and 3 months later. Methods: Ten men who showed normozoospermia (n=3), oligozoospermia (n=3) or crypto/azoospermia (n=4) 1 month after healing from COVID-19 in our previous study, were re-called and re-evaluated 3 months after the first semen analysis. Semen parameters were evaluated according to WHO manual and seminal plasma cytokine levels by an ELISA method. Results: At 3-months follow-up, 8 men showed an overall increase of semen parameters compared to levels assessed after 1 month. In particular, of the 4 crypto-/azoo-spermic men 1 month after healing, 2 resulted oligozoospermic, 1 normozoospermic and only 1 remained azoospermic. Two of the 3 oligozoospermic men turned normozoozpermic. Semen cytokine levels were remarkably high one month after healing and remained elevated after 3 months, with the exception of IL-6. Conclusions: This is the first longitudinal, prospective study comparing semen parameters and semen inflammatory markers one and three months after recovering from COVID-19. Our data indicate an overall tendency to an improvement of semen parameters although a genital tract inflammatory condition appears to persist at least 3 months after COVID-19 recovery. This condition could have an impact on male fertility requiring a careful follow up of these patients.

Study question This study aimed to investigate the influence of lifestyle factors on sperm quality according to Motile Sperm Organelle Morphology Examination (MSOME) criteria. Summary answer The introduction of MSOME permits the examination of subcellular defect like nuclear vacuoles at hight magnification (6000x) in real time on vital sperm. What is known already It is increased accepted that lifestyle factors have an impact on sperm quality. Recent evidence shows that the selection of spermatozoa based on the analysis of morphology under high magnification may have a positive impact on embryo development in cases with severe male factor infertility and/or previous implantation failures. Therefore, MSOME has been considered as representing an improvement in the evaluation of semen quality. Although numerous studies have shown the influences of nutrition, lifestyle, age on semen quality, only very few study, have considered the influence of these factors on the vacuolization rate in semen analysis (MSOME criteria) Study design, size, duration The objective of this prospective study was to compare the semen parameters of 87 male patients undergoing evaluation or treatment of infertility at Unit of Pathophysiology of Reproduction ad PMA-Santa Maria Goretti Hospital -Latina according to MSOME and WHO (World Health Organization) criteria between January and September 2019.Written informed consent was obtained from all partecipant of this study. Participants/materials, setting, methods The subjects were divided into three groups according to age: Group 1 ≤ 35 yearş group II ,36–40 years; and Group III ≥ to 41 years .All patients filled a questionnaire answering questions regarding age, BMI, caffeine and alcohol consumptions, smoking and nutrition behavior. Were excluded from the study patients with chromosomal alteration. For multifactorial lifestyle influence patients were evaluated with a point base system with a cut-off >2 and cut off Main results and the role of chance There was no difference between the groups with regard all semen parameters such as volume, concentration, number of leukocytes, morphology and vitality (%).The percentage of spermatozoa with LNV (Large Nuclear vacuoles) was significantly higher in the older group than in the younger (I and II) (39,14±13,74 vs 31,8±12 and 31,7 ±13,4 rispectively (p Limitations, reasons for caution Although the sample examined in this study is limited in size and other studies are needed to confirm this evidence, the data available to us support the routine use of MSOME for ICSI and as a criterion for semen analysis with potential clinical repercussions. Wider implications of the findings: To date, there are few works in the literature that analyze the relationship between the morphology assessed with the MSOME and the age of the patients and the results are conflicting. To our knowledge many works agree with our results. Trial registration number Not applicable

Background: Low-risk prostate cancer (PCa) is currently managed also with active surveillance (AS). However, up to 40% of patients in AS may require radical treatment at a long-term follow-up. The aim of our study is to further investigate the role of prostate-specific antigen (PSA) density in AS. Methods: A prospective observational study on PCa naïve patients with PSA

Background: To investigate the role of Cumulative Cancer Length (CCL) and PCa positive core number (PCapcn) in random prostate biopsies as predictors of Adverse Pathology (AP) at definitive pathology. Methods: We prospectively enrolled patients submitted to random ultrasound guided prostate biopsies for suspect PCa in our center since 2016. Inclusion criteria were PSA 3 ng/ml and age2mm) or PCa Positive Lymph Node. ROC curve was used to establish an appropriate CCL and PCapcn thresholds that were then investigated as predictors of AP at definitive pathology. Results: Among 882 eligible biopsies, 344 had PCa and underwent RP. Mean age was 64 years (SD 5). Mean PSA was 7.75 (SD: 3.66). At definitive pathology there were AP features in 196 (56.9%) RP. PCapcn and CCL were statistically significantly associated with AP (p6mm and PCapcn >3 thresholds for AP were established (Area: 0.769; p6mm AP had OR 5.462 (CI 95% 2.717-10.978) p3 had OR 7.127 (CI 95% 3.366-15.090) p6mm had OR 3.989 (CI 95% 1.839-8.652) p3 had OR 5.541 (CI 95% 2.390-12.849) p6mm or PCapcn >3 might be associated with AP features, in particular for low and favorable intermediate risk PCa. Keywords: Prostate cancer, Prostate biopsy, Upgrading, Adverse pathology, Clinically significant prostate cancer

Previous data have shown that patients with metabolic syndrome (MetS) and lower urinary tract symptoms (LUTS) secondary to benign prostatic enlargement (BPE) could be refractory to the medical treatment. In this context, the evidence suggests a role for statin use in LUTS/BPE patients. The present systematic review aimed to evaluate the impact of statins on the treatment of men with LUTS/BPE. This review has been registered on PROSPERO (CRD42019120729). A systematic review of English-language literature was performed up to January 2020 in accordance with the preferred reporting items for systematic reviews and meta-analyses (PRISMA statement) criteria. Retrieved studies had to include adults with LUTS connected to BPE treated with statins drugs for metabolic syndrome. After removing duplicates, a total of 381 studies were identified by the literature search and independently screened. Of these articles, 10 fit the inclusion criteria and were further assessed for eligibility. Data from our systematic review suggest that a long-term therapy with statins, at least 6 months, is required to achieve significant impacts on prostate tissue and LUTS. Moreover, besides statins’ direct activity, the risk reduction of LUTS might be connected to the improvement of hypercholesterolemia and MetS. The role of statins for the treatment of LUTS/BPE may be beneficial; however, evidence from robust studies is not enough, and more clinical trial are required.

We are still experiencing the consequences from the globalCOVID-19 pandemic [1]. The public health emergency hasresulted in a significant reallocation of health resources,with the consequent reorganization of all clinical activitiesin urological Departments all over the world [2].Within the first weeks of the outbreak, UrologicalDepartments progressively stopped the outpatient visitsfor benign diseases, limiting the access to the hospitalexclusively for life-threatening conditions, emergencysurgery, and oncological diseases [3]. Male LUTS due toBenign Prostatic Hyperplasia (BPH) were considered as anon-urgent deferrable condition; therefore, outpatientvisits were postponed or canceled, even if the bothersomeurinary symptoms had remarkable impact on quality oflife and patient’s capability to comply with the limitationsimposed by the lockdown. As a result, this has led tothe development of new strategies with telemedicineto appear as a pragmatic approach to screen clinicallyrelevant cases and provide adequate treatment andfollow-up [4]. GlaxoSmithKline

Recording the entire sexual history of a patient from the very first sexual experiences to the current sexual habits is a challenging issue that physicians usually address with partial and non-standardized interviews.To validate the SExual Chronicle REcording Table (SECRETA multicenter national validation study was performed asking 300 male patients affected by uro-andrological diseases to complete SECRETOverall, 295 patients (98.4%) filled all the questions. SECRETSECRET

To assess the safety and efficacy of contrast-enhanced ultrasound (CEUS) imaging for monitoring small (

Background To assess the impact of Tadalafil 5mg/die plus Tamsulosin 0.4mg/die combination therapy on LUTS and ED, according to presence vs. absence of Mets. Methods 75 consecutive men presenting with ED and LUTS were enrolled. Patients were divided into two groups according to MetS presence. All subjects were treated with combination therapy for 12 weeks. Patients were re-evaluated after treatment with Uroflowmetry and PVR, IPSS, IPSS QoL, OAB-q and IIEF-5. Results After enrollment, 50 patients were included: 31(62.0%) with MetS and 19(38.0%) without MetS. At baseline, patients without MetS showed a significantly better IPSS, IIEF and OAB-q, as compared to those with MetS. After 12 weeks of combination therapy LUTS, ED and flowmetry significantly improved in both groups(p 0.05), except for ΔOAB-q that was significantly better for patients with MetS(p=0.028). Nevertheless, total IPSS, all IPSS subscores and OAB-q were significantly better at 12 weeks in men without MetS(p 0.05). Conclusions Patients with MetS have worse LUTS and ED profiles. However, tadalafil plus tamsulosin combination treatment provided them a similar ED profile and a greater relief of OAB symptoms at the end of the trial. Combination therapy had the same safety profile in men besides MetS. Further randomized controlled trials are needed.

Purpose of Review Aim of our systematic review is to evaluate and summarize the efficacy and safety of tadalafil alone or in combination with tamsulosin for the management of lower urinary tract symptoms (LUTS)/benign prostatic hyperplasia (BPH) and erectile dysfunction (ED). Recent Findings Daily tadalafil, in particular 5 mg, according to retrieved studies, appears to be both safe and effective in treating LUTS/BPH and ED, compared with placebo or tamsulosin. The combination of daily tadalafil 5 mg and tamsulosin 0.4 mg allows a better improvement of LUTS compared with both the monotherapies, even if with an increased, but acceptable and tolerated, adverse events rate. After discontinuation of tamsulosin or tadalafil in patients previously treated with their combination, the improvement of LUTS retains significance compared with baseline. Summary Tadalafil 5 mg should be considered a primary treatment option for patients with LUTS/BPH and ED. Evidence highlight an excellent tolerability, safety, and effectiveness profile, both alone or in combination with tamsulosin 0.4 mg. A better efficacy on LUTS relief has been observed for combination therapy, preserving also sexual function. The further switch to monotherapy allows to preserve LUTS relief, but tadalafil only is able to retain ED improvement. Our results support the evidence for a more and more tailored and modular LUTS treatment.

BACKGROUND Health sciences are steadily developing apps to help people to have a correct lifestyle and, in case of chronic diseases, to help physicians to follow their patients. However, a proper validated tool to evaluate patients’ perception of apps’ usefulness, graphic and comfort to use it still lacks in many languages. At present time, there is an English validated questionnaire called User Version of the Mobile Application Rating Scale (uMARS). OBJECTIVE Aim of the study is to translate and validate uMARS in Italian. METHODS uMARS questionnaire have been translated into Italian by an official translator from English. Then, questionnaire has been administrated to 100 smartphone users to evaluate the same App at time 0 and at time 1 (after 2 weeks). Paired t test, Pearson Correlation Coefficient,Intraclass Correlation Coefficient (ICCs) and Cronbach’s Alpha were used to evaluate Italian uMARS reliability and validity. RESULTS Subjects were 100, 52 male (52%) and 48 females (48%). Mean age was 22.8 (SD: 3.4). All the enrolled subjects answered to all questions both at time 0 and at time 1. Paired t test showed no statistically significant difference for each answer or answers group between time 0 and 1 (P>0.05). In detail, higher variability was observed for question E20, regarding the subjective evaluation of the app: “What is your overall (star) rating of the app?” T0 mean 3.7 (SD: 0.8) vs T1 mean 3.6 (SD:1.0) p=0.089. The lower variability was observed in the Information Section for question D16 “Credibility of source: does the information within the app seem to come from a credible source? “, T0 mean 3.6 (SD:1.1) T1 mean 3.6 (SD: 1.1) p=1.000. Cronbach’s alpha was 0.945, as all patients answered to all questions. Each question was furtherly assessed through Pearson correlation coefficient, which demonstrated high reliability, with significant P ( CONCLUSIONS Our results allow the validation of uMARS in Italian language and it may become a reliable and useful tool to evaluate health app

Urothelial carcinoma (UC) is the most common type of bladder cancer, and its treatment depends from both tumour invasiveness (stage) and aggressiveness (grade). The gold standard for detecting UC is white-light cystoscopy, followed by tissue biopsy and histopathological examination; however, such process is invasive, time-consuming, operatordependent and prone to sampling errors. In this framework, optical spectroscopy techniques could be a promising solution for fast and label-free diagnosis of bladder tissues and for early detection of UC. Thus, we combined autofluorescence, diffuse reflectance and Raman spectroscopy in a compact and transportable setup based on an optical fibrebundle probe. This experimental setup was used for studying fresh biopsies of urothelial tumour (140 samples) and healthy bladder (50 samples) collected from 90 patients undergoing Transurethral Resection of Bladder Tumours (TURBT). The aim of this study was to develop an automated classification of the examined tissues based on the intrinsic spectral information provided by all three techniques. We found that healthy and diseased tissues showed significant spectral differences for each technique, resulting in high accuracy (up to 90%) from a Linear Discriminant Analysis (LDA) routine. In particular, fluorescence spectroscopy – excited either with blue or UV light – provided very good results in detecting UC. However, tumour grading and staging proved to be more challenging tasks, for which no single spectroscopic technique could provide sufficient sensitivity and specificity. Therefore, we found that a multimodal approach can improve significantly the diagnosis of UC stages and grades.

INTRODUCTION Prostate specific antigen and Prostate specific antigen-density are used for the initial evaluation of patient with LUTS due to benign prostatic enlargement in order to discriminate between benign conditions and prostate cancer. Conversely, the role of these markers during the follow up of benign prostatic enlargement patients is still unclear. The aim of our study is to evaluate the role of prostate specific antigen and prostate specific antigen density as outcome parameter for both medical and surgical treatment in patients with male LUTS. EVIDENCE ACQUISITION We performed a systematic review and meta-analysis based on data from clinical trials evaluating the clinical effect of medical or surgical therapy on LUTS/benign prostatic enlargement. Meta-regression analyses were done to evaluate the effects of several factors on IPSS score improvement. EVIDENCE SYNTHESIS We selected 12 studies out of 433, including data on 1959 patients. Both medical and surgical treatment lead to a significant reduction of PSA levels as compared to baseline (P

Objectives: To compare segmental ureterectomy (SU) and radical nephroureterectomy (RNU) in terms of overall survival (OS) and impact on postoperative renal function in patients treated for upper tract urothelial carcinoma (UTUC) of the ureter with preoperatively reduced estimated glomerular filtration rate (eGFR). Materials and methods: We retrospectively collected the data of consecutive patients treated for UTUC, in 6 Italian tertiary referral centers, from 2003 to 2013, and analyzed those treated with RNU or SU for ureteral cancer and with a preoperative eGFR

BACKGROUND Recording the entire sexual history of a patient from the very first sexual experiences to the current sexual habits is a challenging issue that physicians usually address with partial and non-standardized interviews. OBJECTIVES To validate the SExual Chronicle REcording Table (SECRET® ), a structured written interview, developed and copyrighted both in English and Italian languages. MATERIALS AND METHODS A multicenter national validation study was performed asking 300 male patients affected by uro-andrological diseases to complete SECRET® . The structured interview is based on four sexual dimensions (masturbation, oral, vaginal and anal sex), declined in seven items (1.Have you ever performed/Do you perform; 2.At what age did you first experience; 3.How many times a month; 4.With how many partners; 5.How much did/do you enjoy; 6.How many times did/do you use a condom; 7.How many times did/do you use the pull-out method). Data were stratified according to four stages of life ( 60 years old). Validity and reliability were assessed by using standard statistical methods for SECRET® validation. RESULTS Overall, 295 patients (98.4%) filled all the questions. SECRET® showed a high level of internal coherence (Cronbach's alpha coefficient ranged from 0.85 to 0.97) and reproducibility (paired sample t-test at Test-Retest: p > .10). CONCLUSIONS SECRET® represents a novel, simple instrument to record a patient's sexual history in daily clinical practice and clinical research. SECRET® has shown a good validity, internal consistence and reliability in different clusters of patients with uro-andrological diseases.

Introduction: Microchimerism (MC) is the presence of a small amount of foreign cells or DNA within a person’s circulation or tissues. It has been identified also in recipients of solid organ transplants where it seems to be critical for the development and maintenance of immunological tolerance. Nevertheless, natural and/or iatrogenic MC can be acquired prior to transplantation, through pregnancy and/or blood transfusion. Objective: The aim of this study was to detect the presence of MC in women after renal transplantation from male cadaveric donors and its relationship with graft outcomes. Methods: We studied by qPCR the presence of the DYS14 gene sequence of the Y chromosome in 12 females who received a kidney graft from a male donor before transplantation (T0), after 15 days (T1) and 1 year of transplantation (T2). We found the sequence in all recipients after renal transplantation. Results: All the women were negative for this sequence prior to transplantation (T0). Mean (SD) Y-related DNA quantity was 0.80 (0.69) ng/mL plasma and 0.15 (0.26) ng/mL plasma at T1 and T2, respectively. No acute rejection was observed, and mean (SD) estimated Cr clearance was 68.8 (16.9) mL/min within 1 year from transplantation. Conclusions: Presence of MC was associated with good kidney graft outcomes after 1 year of transplantation, but further studies will be needed to investigate the relationship between clinical outcomes and the development of MC in renal transplant recipient.

A systematic review and meta-analysis was carried out to evaluate the efficacy and safety of mirabegron 50 mg and 100 mg in the treatment of storage lower urinary tract symptoms/overactive bladder in comparison with a placebo and tolterodine 4 mg. A total of 491 articles were collected and eight randomized studies were identified as eligible for this meta-analysis. Overall, eight trials were included in the meta-analysis evaluating 10 248 patients. Mirabegron at both doses of 50 mg and 100 mg, and and tolterodine 4 mg were significantly associated with the reduction of incontinence episodes per 24 h, reduction of mean number of micturitions per 24 h, increase of voided volume and reduction of urgency episodes per 24 h, compared to a placebo. Both mirabegron 50 mg and mirabegron 100 mg were associated with a significant reduction of nocturia episodes when compared with a placebo. Conversely, tolterodine 4 mg did not prove to be more effective than a placebo in the reduction of nocturia episodes. Furthermore, mirabegron 50 mg showed a slightly, but significantly, better efficacy than tolterodine 4 mg in the improvement of nocturia episodes. Mirabegron 50 mg and mirabegron 100 mg shared the same risk of overall treatment-emergent adverse events rate with the placebo. Otherwise, tolterodine 4 mg was associated with a significantly greater risk than the placebo. However, mirabegron 100 mg showed a slight trend toward an increased risk of hypertension (odds ratio 1.41; P = 0.08) and cardiac arrhythmia (odds ratio 2.18; P = 0.06). Mirabegron is an effective treatment for patients with storage lower urinary tract symptoms/overactive bladder, providing a reduction of incontinence, urgency and frequency; an improvement of voided volume with a slight, but statistically, significant improvement of nocturia; with a good safety profile. These findings should be considered for the treatment planning of patients with storage lower urinary tract symptoms/overactive bladder.

Although the exact nature of the association between metabolic syndrome (MetS) and lower urinary tract symptoms (LUTS) is still not completely understood, findings that men with metabolic alterations experience faster-developing LUTS or are more frequently candidates for benign prostatic enlargement (BPE) surgery support the hypothesis that metabolic and pathological derangements characterizing MetS can promote the development and progression of BPE and LUTS. The strong evidence that MetS is associated with larger prostate size supports a role for metabolic derangements in the development and progression of BPE. However, the relationship between MetS and LUTS is currently based on conflicting results. Most of the US and European population-based studies demonstrate a positive association between MetS and LUTS, but Asian studies often show opposite results. These findings indicate that ethnicity, diet and lifestyle could represent a central issue for the association between MetS and LUTS. Patient summary The strong evidence that metabolic syndrome is associated with greater prostate size supports a role for metabolic derangements in the development and progression of benign prostatic enlargement. Ethnicity, diet, and lifestyle could represent central issues for the association between metabolic syndrome and lower urinary tract symptoms.

To compare segmental ureterectomy (SU) and radical nephroureterectomy (RNU) in terms of overall survival (OS) and impact on postoperative renal function in patients treated for upper tract urothelial carcinoma (UTUC) of the ureter with preoperatively reduced estimated glomerular filtration rate (eGFR).We retrospectively collected the data of consecutive patients treated for UTUC, in 6 Italian tertiary referral centers, from 2003 to 2013, and analyzed those treated with RNU or SU for ureteral cancer and with a preoperative eGFR90 ml/min/1.73mOut of 521 patients with UTUC, 228 patients had preoperative reduced eGFR. Out of these patients, 93 had ureteral cancer and were included in the primary analyses - 67 (72.0%) treated with RNU and 26 (28.0%) with SU. Preoperative characteristics were similar in the 2 groups. The overall median follow-up period was 26.5 months. A nonsignificant postoperative eGFR decrease of 3.0 ml/min/1.73mThe type of surgery (SU vs. RNU) has a low impact on postoperative renal function and OS in patients with ureteral cancer and preoperative eGFR90 ml/min/1.73m

The most common type of bladder cancer is urothelial carcinoma (UC), whose treatment depends from both tumour extension (stage) and aggressiveness (grade). The gold standard for detecting UC is white-light cystoscopy, followed by tissue biopsy and pathological examination for determining tumour stage and grade. However, such process is invasive, time-consuming and prone to sampling errors. In this framework, optical spectroscopy techniques provide fast, label-free and non-invasive alternatives to standard histopathology. Thus, we combined auto-fluorescence, diffuse reflectance and Raman spectroscopy in a compact and transportable setup based on an optical fibre-probe. The latter was coupled to three laser diodes (emitting at 378 nm, 445 nm and 785 nm) and to a halogen lamp for exciting and collecting auto-fluorescence, Raman and reflectance spectra, respectively. This experimental setup was used for studying fresh biopsies of urothelial tumour (103 samples) and healthy bladder (34 samples) collected from 63 patients undergoing Transurethral Resection of Bladder Tumours (TURBT). All spectral recordings were done within 30 minutes from surgical resection, and optical inspection required less than 2 minutes for each sample. The recorded data were analysed using Principal Component Analysis (PCA) for obtaining an automated classification of the examined samples based on the intrinsic spectral information provided by all three techniques. We found that multimodal spectroscopy provides high-sensitivity, high-specificity discriminating capability for UC detection, grading and staging. The presented strategy generates results similar to gold standard histology, but in a fast and label-free way, offering the potential for endoscopic in vivo applications.

Tadalafil 5 mg represents the standard for men with Erectile dysfunction (ED) and lower urinary tract symptoms (LUTS)/benign prostatic enlargement (BPE). We carried out an observational trial aiming to assess the efficacy and safety of Tadalafil compared with Tadalafil plus Tamsulosin. Seventy-five patients complaining of ED and LUTS were treated for 12-weeks with Tadalafil plus placebo (TAD+PLA-group) or with combination therapy tadalafil plus tamsulosin (TAD+TAM-group). Efficacy variables were: International Index of Erectile Function (IIEF), International Prostate Symptom Score (IPSS), maximum urinary flow rate (Qmax) and safety assessments. Data were evaluated using paired samples T-test (baseline vs. 12-weeks) and analysis of variance (&Delta, group-TAD+PLA vs. &Delta, group-TAD+TAM). At baseline, both groups presented similar characteristics and symptoms scores (all: p &gt, 0.05). From baseline to 12-weeks, all the subjects showed a significant improvement of IIEF, total-IPSS, storage-IPSS, Qmax (all: p &lt, 0.001). Conversely, a significant improvement of voiding-IPSS was observed in TAD+TAM-group (&minus, 3.5 points, p &lt, 0.001). Indeed, TAD+PLA-group showed a not significant improvement of voiding-IPSS (&minus, 2.0 points, p = 0.074). When we compared between-groups differences at 12-weeks, IIEF (p = 0.255), total-IPSS (p = 0.084) and storage-IPSS (p = 0.08) did not show any statistically significant differences, whereas, voiding-IPSS and Qmax were significantly better in TAD+TAM-group (p = 0.006 and p = 0.027, respectively). No severe treatment adverse events (TAEs) were reported in both groups. Tadalafil achieved the same improvements of IIEF, total-IPSS, storage-IPSS when compared to combination therapy. Instead, Qmax and voiding-IPSS were better managed with combination therapy, without change of TAEs.

INTRODUCTION AND OBJECTIVES:Robot-assisted cystectomy (RARC) with intracorporeal ileal neobladder can be offered to selected patients with muscle-invasive or high-risk non-muscle invasive bladder c...