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The purpose of this study was to assess whether Immune CompleX Predictive Index (iXip) improves diagnostic accuracy of multiparametric prostate MRI (mpMRI) for clinically significant prostate cancer. This study included 72 patients (mean age: 68±8 years) with suspicion of prostate cancer and available iXip score. mpMRI images were evaluated by two radiologists according to the PI-RADS v2.1. Reference standard was based on fusion biopsy and standard transperineal 12-point biopsy. Diagnostic accuracy of iXip, mpMRI and their combination were calculated. Optimal cutoff of iXip with sensitivity and specificity was identified using the Youden index. Patients with clinically significant prostate cancers had significantly higher iXip values compared to patients without clinically significant prostate cancers (median 0.411 vs 0.273; p=0.026). The AUROC for iXip was 0.795 (95% CI 0.579-1.000, p=0.026). Sensitivity and specificity were 75% and 100% respectively for mpMRI alone, and 100% and 80% respectively for mpMRI combined with iXip > 0.375. The combination of mpMRI with a cutoff value of iXip > 0.375 has a very high sensitivity for the diagnosis of prostate cancer and a moderately high specificity.

We report a technique for the solution of an intraoperative complication occurred during penile prosthetic surgery. MATERIALS AND METHODS. A 70-year-old patient underwent open radical retropubic prostatectomy in 2004 due to a prostate cancer - Gleason 6 (3+3) pT2N0M0. The erectile dysfunction subsequently observed was not responsive to oral or intracavernosal drug administration, so a malleable penile implant surgery was recommended. RESULTS. During the positioning of the left penile cylinder, a septum perforation (cross-over) occurred. Instead of interrupting and postpone surgery in order to allow the septum to recover, we decided to proceed utilizing our technique for a safe positioning of the implants. As far as we know, this is the first detailed report on the technique. CONCLUSIONS. Septum perforation during a penile prosthesis implant does not represent an absolute contraindication to terminating surgery. Our technique allows a safe placing of the cylinders after septum perforation with optimal functional and aesthetic results at long-term follow-up. (Urologia 2009; 76: 218-20)

Introduction: The most relevant risk factor in T1G3 NMI transitional cell carcinoma of the bladder (TCCB) is the presence of Tis. The long term results of conservative management still are a matter of controversy. The role of BCG in preventing progression and death in this category of NMI TCCB is not definitely proved. The published experiences of conservative treatment of high risk TCCB often include unselected patients, small numbers and short follow-up. Immediate radical cystectomy is advocated by many urologists. Objectives: The aim of the study is to identify the survival risk factors in 236 selected patients conservatively treated. Methods: Between January 1976 and December 2005, 236 patients with T1G3 bladder tumors were treated by TUR plus adjuvant intravesical therapy. Patients with previuos T1G3, Tis, more than 3 tumors or greater than 3 cm were excluded. Tumors were primary in 177 (75.3%) and single in 144 (61.5%) cases. Urinary cytology was obtained within 30 days after TUR, the last 51 (21.6%) patients, since 2000, were submitted to re-TUR. A sequential combination of mitomycin C (30mg/30ml) and epirubicin (50mg/50ml) was adopted in 106 patients (44.9%). BCG or other agents were given intravesically in 85 (36.0%) and 38 (16.1%) patients respectively for 12 months. Seven (3%) patients refused intravescical therapy. In the case of Ta-T1 recurrence. TUR and one year of adjuvant intravesical therapy were repeated. Patients went off study if Tis, T1G3 or T-category tumor over T1 were detected. Age, previuos history, number of tumors, time to recurrence, re-TUR, adjuvant therapy, and response to treatment were considered for survival in multivariate analysis. Results: At a mean follow-up period of 52 months (range: 3-246 months), 116 patients (49.2%) recurred. The recurring tumor was T1 in 47 (40.5%) cases and T1G3 in 33 cases (28.4%). In 11 additional patients (9.5%) a Tis was detected. Twenty-five patients (10.6%) progressed and 15 patients (6.4%) underwent cystectomy. Median overall survival was 167 months. Median survival in 195 patients (82.6%) preserving their bladder was 119 months. The 5-year progression-free survival rate was 87.8%. Thirty-two patients (13.6%) died, 22 (9.3%) for bladder cancer.. Recurrence was found significantly lower in single tumors (p=0.012) and in BCG-treated patients (

Urine is a complex balanced solution containing dissociated and non-dissociated solutes. Any variation in urine saturation grade (number of crystals dissolved in a volume of urine), urinary pH and the concentration of crystallization inhibitors can break the normal existing balance and lead to urolithiasis. In the present article we analyze the principal mechanisms (absorptive, renal, resorptive) of hypercalciuria. It will be also shown how heredity directly influences the clinical aspects of cystine, xanthine and oxalate lithiasis and how diet, in association with metabolic disorders, interferes in uric acid and oxalate stone formation. Finally, we report on the roles of urinary tract malformations, urinary tract infections and drugs in the clinical characterization of urolithiasis.

Introduction and Objective: Adjuvant intravesical chemotherapy or BCG immunotherapy after transurethral resection (TUR) is a standard treatment for non–muscle-invasive transitional cell cancer of the bladder (NMI TCCB) at intermediate risk. Although the clinical value of early intravesical adjuvant chemotherapy is well established, the optimal schedule regimen and the role of maintenance is still debated. Methods: Between May 2002 and August 2003, 577 patients, undergoing TUR for NMI TCCB, were recruited. All patients underwent TUR and early (within 6 hours) intravesical chemotherapy with epirubicin at the dose of 80 mg diluted in 60 ml of saline solution. When histology was available, 95 patients were excluded from the study since they were harbouring T1G3, Tis and single and primary Ta G1-G2 tumors. 482 patients with intermediate risk tumors were randomized according 2 different regimens: arm A: 5 more weekly instillations; arm B: 5 more weekly instillations plus monthly instillations for a total of 16 instillations. All patients were submitted 3-monthly for the first 2-years and then 6-monthly to cytology, cystoscopy and biopsy of every suspicious bladder lesion.. Results: Out of 482 randomized patients, 396 are evaluable for toxicity and 392 for efficacy. The tumours were multiple in 318 patients (66.0%) and recurrent in 192 (39.8%). No difference emerged between the 2 arms in relation to tumors’ characteristics. The median follow-up time was 22 months (range: 3-56). Eighty-two (20.9%) patients recurred at a median time of 9 months from TUR and 4 patients (1%). The incidence of recurrences was 24.4% (47/192) in arm A and 18.5% (35/200) in arm B. No difference emerged between the two arms for recurrence rate at 3 months (p=0.06). Statistical analysis demonstrated an advantage in favour of maintenance in terms of recurrence rate at 6 (p=0.01), 9 (p=0.04) and 12 months (p=0.03) and in terms of recurrence-free interval (p=0.03). No difference for toxicity was detected according to treatment schedule. Conclusions: One-year maintenance significantly reduces the risk of tumour recurrence without enhanced toxicity, in patients with intermediate risk NMI TCCB treated with early epirubicin intravesical chemotherapy followed by 5 weekly instillation.