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The application of biparametric magnetic resonance imaging (bpMRI) [T2-weighted (T2W) and diffusion weighted imaging (DWI)/apparent diffusion coefficient (ADC)] using dedicated structured methods, such as Simplified Prostate Imaging Reporting and Data System (S-PI-RADS) for the detection, categorization, and management of prostate cancer (PCa) is reported. Also, Prostate Imaging Reporting for Local Recurrence and Data System (PI-RRADS) for the detection and assessment of the probability of local recurrence after radiotherapy (RT) or radical prostatectomy (RP) in patients with biochemical recurrence (BCR) is proposed. Both S-PI-RADS and PI-RRADS assign to DWI/ADC a main role for the above purpose. S-PI-RADS identifies four categories and, on the basis of the qualitative and quantitative analysis of the restricted diffusion on ADC map and lesion volume, distinguishes two categories of lesions: category 3 (moderately homogeneous hypointense on ADC map) and category 4 (markedly homogeneous or inhomogeneous hypointense on ADC map). Ιn category 3, two subcategories (3a: volume0.5 cm

Oligometastatic prostate cancer is commonly considered a transition between high metastatic and local- ized disease and includes a large spectrum of conditions with a polymorphic clinical behavior. The current management of these patients contemplates systemic therapy (i.e., androgen-deprivation drugs, chemothera- peutic drugs, or both treatments administered simultaneously) which have been shown to improve survival. Radiotherapy has also been introduced, into a multimodal setting, among the therapeutic treatments forpatients who are defined as oligometastatic prostate cancer according to Chemohormonal Therapy Versus Androgen Ablation Randomized Trial for Extensive Disease in Prostate Cancer (CHAARTED) criteria.The role of surgical debulking in patients with oligometastatic prostate cancer has always been considered impracticable, both for a marginal therapeutic role and for the greater risk of sequelae and/or complications related to the procedure itself. Several authors have demonstrated some mechanisms by which the persistence of the primary tumor can facilitate the clinical progression of the disease itself and promote carcinogenesis, differentiation, migration, and angiogenesis in prostate cancer. From these studies emerges the hypothesis of a possible therapeutic advantage in oncological terms also for cytoreductive radical prostatectomy, in a multimodal therapy setting, compared to systemic therapy alone. The present review summarizes the main knowledge regarding the safety, feasibility, and oncological outcomes of cytoreductive radical prostatectomy in oligometastatic prostate cancer patients.

Biparametric magnetic resonance imaging (bpMRI) of the prostate has emerged as an alternative to multiparametric MRI (mpMRI) for the detection of clinically significant prostate cancer (csPCa). However, while the Prostate Imaging Reporting and Data System (PI-RADS) is widely known for mpMRI, a proper PI-RADS for bpMRI has not yet been adopted. In this review, we report the current status and the future directions of bpMRI, and propose a simplified PI-RADS (S-PI-RADS) that could help radiologists and urologists in the detection and management of PCa.

Prostate cancer (PCa) is the most common tumor in men with extremely variable outcome, varying from latent or indolent form to very aggressive behavior. High grade tumors, expansions exceeding the prostatic capsule into the surrounding soft tissues and spreading through lymph vascular channels, represent the most consistent unfavorable prognostic factors. However, accuracy in the prediction of the disease progression is sometimes difficult. Along with new molecular diagnostic techniques and more accurate histopathological approaches, proteomic studies challenge to identify potential biomarkers predictive of PCa progression. In our study we analyzed the urinary proteomes of 42 patients affected by PCa through two-dimensional electrophoresis associated with mass spectrometry. Proteomic profiles were correlated to histopathological features including pTNM stage and tumor differentiation in order to provide new promising markers able to define more accurately the PCa aggressiveness and driving new therapeutic approaches.

Prostate specific antigen (PSA) remains the most used test to assess the response after therapies including the radiation therapy (RT). Apparent diffusion coefficient (ADC) derived from the conventional diffusion-weighted imaging (DWI), as a part of noncontrast or biparametric MRI (bpMRI) (T2-weighted and DWI), offers diagnostic accuracy and cancer detection rate equivalent to that of multiparametric MRI. Cellular changes induced by RT can be quali-qualitatively demonstrated as early as 3 months after RT as an increase in the signal intensity of the tumor on the ADC map. ADC, in association with PSA, represents a potential biomarker imaging for evaluating treatment efficacy in PCa both during and shortly after RT.

Prostate Imaging Reporting and Data System (PI-RADS) version 2.1 update, in the attempt to improve clinical guidelines for multiparametric magnetic resonance imaging (mpMRI) of the prostate, has clear limitations. The role of dynamic contrast-enhanced sequences is not defined, precise guidance on the clinical management (biopsy or clinical surveillance) for score 3 lesions [equivocal for clinical significant prostate cancer (sPCa)] is not offered and criteria for lesions interpretation remain difficult and subjective. We report criteria and arguments in supporting the use of abbreviated or biparametric prostate MRI protocol in clinical practice for detection and management of PCa.

We have read with great interest and appreciate the article by Jambor and colleagues published in the June 2019 issue of PLoS Med (1).

Objective To report a new technique for thulium laser enucleation of the prostate, which we called “en bloc” ThuLEP. Methods A full anatomic description of the technique is provided. We assessed operative variables of a 50-patient series, treated with the new “en bloc” ThuLEP, and compared them with another series of 50 patients (who had the same preoperative parameters) operated with the classical “3-lobe” technique, to assess the feasibility of the new one. All procedures were carried out by the same surgeon. Results In our experience, “en bloc” ThuLEP permits an easier enucleation of the adenoma, reduces operating time, and reduces the amount of energy delivered per adenoma gram compared with the classical technique. Further studies are needed to validate this technical evolution of prostatic enucleation and verify the reduction of postoperative irritative symptoms. Conclusion “En bloc” ThuLEP may represent a valid alternative for prostatic adenoma enucleation, mostly in medium-sized prostates.

Prostate Imaging Reporting and Data System version 2 (PI-RADS v2) does not offer a precise guidance on the clinical management (biopsy or not biopsy) for PI-RADS v2 score 3 lesions. Lesion volume calculated on biparametric MRI (bpMRI) [T2-weighted imaging (T2WI) and diffusion-weighted imaging (DWI)] by introducing a cut-off of 0.5 mL, allows to distinguish the lesions assigned by the multiparametric MRI (mpMRI) to the category PI-RADS v2 score 3 in two subgroups: a) Indolent or low risk lesions with volume

To investigate the long-term effects of Floseal® on erectile function recovery (EFR) after nerve-sparing robot-assisted radical prostatectomy (RALP). We prospectively collected results of the self-administered International Index Erectile Function Questionnaire 1–5 and 15 (IIEF 1–5 and 15) of 532 consecutive patients who underwent RALP for prostate cancer in our institution between October 2007 and December 2015. Patients were divided into two groups according to Floseal® application after prostatectomy. They were enrolled according to the following criteria: (a) bilateral nerve-sparing procedure; (b) preoperative IIEF ≥ 17; adherence to our erectile rehabilitation protocol; (c) 1-year follow-up. Outcomes were measured as mean IIEF score, EFR (IIEF 25). A total of 120 patients were enrolled. Group A included 40 consecutive patients who received traditional hemostasis, and Group B included 80 consecutive patients in which Floseal® was additionally used. No differences were observed in terms of preoperative mean IIEF score (p = 0.65). Group B patients showed a trend toward a higher mean IIEF score 3 months after surgery (p = 0.06) but no differences in terms of EFR (p = 1.000). Long-term results (6, 9, 12 months after surgery) showed a significantly and progressively higher mean IIEF score (p = 0.04, 0.003, 0.003) and EFR (p = 0.043, 0.027, 0.004) in Group A patients. Comparison between the groups in terms of severe, moderate, mild and no ED becomes significant at 9 and 12 months (p = 0.002, 0.006). The results of our study suggest that local use of Floseal® worsens the long-term erectile function recovery in patients selected for nerve-sparing RALP.

This narrative review summarizes the current knowledge about multiparametric and biparametric magnetic resonance imaging of the prostate. This is provided from both a radiological and a urological point of view analyzing the technical aspects of fusion-targeted biopsy using the transperineal approach. We report practical considerations concerning pure cognitive and software-assisted settings, discuss the principal transperineal fusion software now available, and debate the pros and cons of choosing one approach over the other.

Introduction About 20% of patients with a diagnosis of primary renal cell carcinoma (RCC) present directly with metastatic disease. The aim of the present manuscript is to describe, for the first time a RCC metastasis located to the distal female urethra and to present an update on metastatic locations to the male spermatic cord. Materials and methods We report two cases of rare RCC metastases. The first concerns a 92-year-old female patient who came to our attention for recurrent urethral bleeding, which was initially believed to be secondary to urethral mucosal ectropion. Pathology demonstrated a RCC metastasis. The second concerns a 67-year-old male patient with a previous history of RCC who came to our attention for the finding of palpable, mobile and indolent right inguinal lump. Given the past history of malignancy, it was excised and revealed to be a RCC metastasis. Discussion In the first case, the pathologic specimen allowed the detection of an unknown renal tumor, whereas in the second, the previous neoplastic history of the patient has led clinicians to focus on a possible neoplastic recurrence, perform a correct excision of the node, and begin an early systemic therapy. Conclusions These cases are emblematic of possible unexpected RCC metastasis. These findings should be taken into account in order to clarify the differential diagnosis and to address these patients to a correct therapeutic course.

Resumen Antecedentes La laparoscopia es una tecnica minimamente invasiva para acceder a la cavidad abdominal, para aplicaciones diagnosticas o terapeuticas. La optimizacion de la tecnica de acceso es un paso importante para los procedimientos laparoscopicos. El objetivo de este estudio es evaluar los resultados de las diferentes tecnicas de acceso laparoscopico e identificar el mas seguro. Metodos El cuestionario de acceso laparoscopico fue remitido por correo electronico a los 60 centros que son socios en el grupo de trabajo para la cirugia laparoscopica y robotica de la Sociedad Italiana de Urologia (SIU), y sus centros de referencia de America y Europa. Resultados La tasa de respuesta fue del 68,33%. El numero total de procedimientos considerados fue de 65.636. El 61,5% de los cirujanos utiliza aguja de Veress para crear el neumoperitoneo. La tecnica de trocar ciego es la mas comunmente utilizada, pero tiene el mayor numero de complicaciones. La tecnica de trocar optico parece ser la mas segura, pero es la menos utilizada comunmente. El 28,2% de los cirujanos adoptan tecnica abierta de Hasson. La tasa total de complicaciones intraoperatorias fue del 3,3%. La tasa de conversion abierta fue del 0,33%, la tasa de transfusion fue del 1,13% y la tasa de complicaciones postoperatorias totales fue del 2,53%. Conclusion El acceso laparoscopico es una tecnica segura, con una baja tasa de complicaciones. La mayoria de las complicaciones se pueden gestionar de forma conservadora o por via laparoscopica. La eleccion de la tecnica de acceso puede afectar la tasa y el tipo de complicaciones, y debe ser planeada de acuerdo a la experiencia del cirujano, la seguridad de cada tecnica y las caracteristicas de los pacientes. Todos los tipos de acceso tienen complicaciones perioperatorias. De acuerdo con nuestro estudio la tecnica de trocar optico parece ser la mas segura.

To assess the incidence of long-term side effects after shock-wave lithotripsy treatment performed with an electromagnetic Dornier Lithotripter S device. A specific follow-up was undertaken on a cohort of 100 selected patients that underwent SWL for a single renal stone in our center from 2002 to 2004. Previous and current data were compared using the Student t test. Factors associated with the incidence of hypertension and diabetes mellitus were determined. Ten years after treatment, mean serum creatinine level and glomerular filtration rate remained similar to previous values (serum creatinine level: 0.96 ± 0.22 vs. 0.92 ± 0.19 mg/dL; glomerular filtration rate: 92.8 ± 17.8 vs. 88.1 ± 21.7 mL/min). There were marked increases in blood cholesterol, blood pressure, and blood glucose levels, while smoking decreased. Age, glomerular filtration rate, body mass index, blood glucose and blood pressure at the time of treatment were significantly associated with the presence of hypertension and diabetes mellitus at follow-up; blood cholesterol was associated with diabetes mellitus development. After 10 years, overall renal function appeared to have been unaffected by shock-wave lithotripsy treatment. The increased rate of hypertension and diabetes mellitus were consistent with the incidence in the global population. This is the first report on the long-term safety of a third generation electromagnetic lithotripter, and indicates that there are no long-term sequelae.

Background: Perioperative bleeding is a potential complication of robot-assisted laparoscopic radical prostatectomy (RALP) that may worsen outcomes. The role of local hemostatic materials in RALP has not been adequately assessed. We evaluated the hemostatic impact of FloSeal (Baxter International Inc., Fremont, Calif., USA) in RALP. Methods: A retrospective analysis was performed of 392 consecutive patients with prostate cancer who underwent RALP at our institution between February 2008 and July 2014. The patients were divided into 2 consecutive homogenous groups based on the use of FloSeal. Group A included 200 patients who underwent RALP between February 2008 and May 2011, with hemostasis performed using only traditional techniques. Group B included the remaining 192 patients, who underwent RALP between June 2011 and July 2014 and received FloSeal 5 ml after traditional hemostatic methods. We compared the blood transfusion rate, the differences between immediate postoperative hemoglobin (Hb) and mean postoperative day 1 (POD1) Hb levels, difference between POD1 and least Hb levels and difference between immediate postoperative Hb and least Hb levels. Results: The intraoperative use of FloSeal significantly decreased the blood transfusions rate, from 8.5 to 2.1% (p = 0.004). FloSeal was also associated with significant improvements in the difference between the immediate postoperative Hb and POD1 Hb levels (p = 0.03), mean POD1 Hb and least Hb (p = 0.01) and mean immediate postoperative Hb and least Hb levels (p = 0.034). Conclusions: In this study, the use of FloSeal improves hemostatic outcomes in patients undergoing RALP compared with traditional hemostatic techniques, without increase of cost.

Background: The aim of our study was to compare perioperative and functional outcomes of two different prostatic laser enucleation techniques performed in two high-volume centers: 100 W holmium laser enucleation of the prostate (HoLEP) (Lyon, France) and 110 W thulium laser enucleation of the prostate (ThuLEP) (Varese, Italy). Materials and Methods: A nonrandomized, observational, retrospective and matched-pair analysis was performed on two homogeneous groups of 117 patients that underwent prostate laser enucleation in the HoLEP or ThuLEP centers between January 2015 and April 2017, following the classical ‘three lobes’ enucleation technique. The American Society of Anesthesiologists (ASA) score and prostate volume were the main parameters considered for matching the patients between the two groups. Patients on anticoagulant therapy, with documented detrusor hypoactivity or hyperactivity or with the finding of concurrent prostate cancer were excluded from the study. Follow up was assessed at 3, 6 and 12 months after surgery. Results: Median enucleation and morcellation time was 75.5 and 11.5 min, respectively, in the HoLEP group versus 70.5 and 12 min, respectively, in the ThuLEP group ( p = 0.001 and 0.49, respectively). Enucleated adenoma weight was comparable (44 g versus 45.6 g, p = 0.60). Energy index (3884.63 versus 4137.35 J/g, p = 0.30) and enucleation index (0.57 versus 0.6 g/min, p = 0.81) were similar in the two groups. Catheterization time was comparable (1 versus 1 day; p = 0.14). The International Prostate Symptom Score and Quality of Life score significantly decreased, as well as maximal urinary flow rate. Median prostate-specific antigen (PSA) drop 1 year after surgery was 2.1 ng/ml in the HoLEP group (−52.83%) versus 1.75 ng/ml in the ThuLEP group (−47.85%) ( p = 0.013). Conclusion: Both HoLEP (100 W) and ThuLEP (110 W) relieve lower urinary tract symptoms in a comparable way with high efficacy and safety, with negligible clinical differences.

Introduction Renal cysts are common findings in nearly 10% of general population. According to Bosniak classification, they are classified into simple and complex renal cysts based on their CT characteristics. The majority of simple renal cysts are asymptomatic and require no intervention. Once they become symptomatic or complicated, a non-conservative management should be considered. Evidence acquisition This paper is a narrative review of existing manuscripts regarding the non-conservative management of renal cysts. To perform it a search through PubMed was carried out in January 2017. The search was conducted using the following key words: "simple renal cysts," "non-conservative management," "treatment outcomes comparison" etc. EVIDENCE SYNTHESIS: We found 1880 publications that were reviewed by 2 of our authors, and only 46 manuscripts were considered for this review. The most common treatment were investigated and compared to understand the best treatment modality in accordance with patients' and cysts' characteristics. Different treatment modalities are available for the management of simple renal cysts. Surgical exploration is a historical procedure that is no longer used. Simple aspiration without sclerotherapy has high recurrence rate (20-80%), so sclerosants agents are recommended. Ethanol is the most commonly used sclerosing agent with high efficacy up to 97%. Laparoscopy is the gold standard for management in large cysts especially in younger patients. Other techniques are described for parapelvic renal cysts like percutaneous endoscopic ablation and ureteroscopic marsupialization. Conclusions Different factors affect the treatment decision including natural history of the cyst, presence of symptoms and/or complications and patients' choice. This literature overview shows that ethanol percutaneous sclerotherapy and laparoscopy are the most commonly reported treatment modality for simple renal cysts.

We describe our institutional experience using a simplified Prostate Imaging Reporting and Data System (PI-RADS) based on biparametric prostate MRI. We discuss two important controversies: the use of gadolinium-based contrast agents and the management of PI-RADS category 3 lesions.Our simplified PI-RADS identifies four categories and suggests management strategies for each. The simplified PI-RADS can be an effective system to facilitate multidisciplinary cooperation and to improve the management of suspected prostate cancer.

Background: Numerous surveys have been performed to determine the competence and the confidence of residents. However, there is no data available on the condition of Italian residents in urology. Objective: To investigate the status of training among Italian residents in urology regarding scientific activity and surgical exposure. Design, setting, and participants: A web-based survey that included 445 residents from all of the 25 Italian Residency Programmes was conducted between September 2015 and November 2015. Outcome measurements and statistical analysis: The main outcomes were represented by scientific activity, involvement in surgical procedures, and overall satisfaction. Results and limitations: In total, 324 out of 445 (72.8%) residents completed the survey. Overall, 104 (32%) residents had not published any scientific manuscripts, 148 (46%) published ≤5, 38 (12%) ≤10, 26 (8%) ≤15, four (1%) ≤20, and four (1%) >20 manuscripts, respectively. We did not observe any differences when residents were stratified by sex (p = 0.5). Stent positioning (45.7%), extracorporeal shock wave lithotripsy (30.9%), transurethral resection of bladder tumor (33.0%), hydrocelectomy (24.7%), varicocelectomy (17%), ureterolithotripsy (14.5%), and orchiectomy (12.3%) were the surgical procedures more frequently performed by residents. Overall, 272 residents (84%) expressed a good satisfaction for urology specialty, while 178 (54.9%) expressed a good satisfaction for their own residency programme. We observed a statistically decreased trend for good satisfaction for urology specialty according to the postgraduate year (p = 0.02). Conclusions: Italian Urology Residency Programmes feature some heavy limitations regarding scientific activity and surgical exposure. Nonetheless, satisfaction rate for urology specialty remains high. Further improvements in Residency Programmes should be made in order to align our schools to others that are actually more challenging. Patient summary: In this web-based survey, Italian residents in urology showed limited scientific productivity and low involvement in surgical procedures. Satisfaction for urology specialty remains high, demonstrating continuous interest in this field of study from residents. Italian Residency Programs in urology shows some limitation regarding scientific productivity and surgical activity. Resident involvement in many urological procedures still remains low and there is a risk in providing the near future urologists with no expertise.

PURPOSE: To determine the association between Prostate Imaging Reporting and Data System (PI-RADS) version 2 scores and prostate cancer (PCa) in a cohort of patients undergoing biopsy of transition zone (TZ) lesions. MATERIALS AND METHODS: A total of 634 TZ lesions in 457 patients were identified from a prospectively maintained database of consecutive patients undergoing prostate magnetic resonance imaging. Prostate lesions were retrospectively categorized with the PI-RADS version 2 system by two readers in consensus who were blinded to histopathologic findings. The proportion of cancer detection for all PCa and for clinically important PCa (Gleason score ≥3+4) for each PI-RADS version 2 category was determined. The performance of PI-RADS version 2 in cancer detection was evaluated. RESULTS: For PI-RADS category 2 lesions, the overall proportion of cancers was 4% (one of 25), without any clinically important cancer. For PI-RADS category 3, 4, and 5 lesions, the overall proportion of cancers was 22.2% (78 of 352), 39.1% (43 of 110), and 87.8% (129 of 147), respectively, and the proportion of clinically important cancers was 11.1% (39 of 352), 29.1% (32 of 110), and 77.6% (114 of 147), respectively. Higher PI-RADS version 2 scores were associated with increasing likelihood of the presence of clinically important PCa (P < .001). Differences were found in the percentage of cancers in the PI-RADS category between PI-RADS 3 and those upgraded to PI-RADS 4 based on diffusion-weighted imaging for clinically important cancers (proportion for clinically important cancers for PI-RADS 3 and PI-RADS 3+1 were 11.1% [39 of 352] and 30.8% [28 of 91], respectively; P < .001). CONCLUSION: Higher PI-RADS version 2 scores are associated with a higher proportion of clinically important cancers in the TZ. PI-RADS category 2 lesions rarely yield PCa, and their presence does not justify targeted biopsy. © RSNA, 2018 Online supplemental material is available for this article.

Introduction Two cases of severe ureteral obstruction following nonspecific, postinfectious, chronic retroperitoneal fibrosis are described, which both originated by a primitive intestinal pathology. Patients This complication was observed in two women: first, 65 years old, submitted for ulcerative colitis to a total proctocolectomy, with ileo-pouch-anal anastomosis, complicated by an anastomotic fistula; and second, 66 years old, operated with an extended left hemicolectomy, for an adenocarcinoma of the recto-sigmoid colon complicated with a vaginal fistula. In these cases, computerized tomography demonstrated a unilateral hydronephrosis, secondary to a complete obstruction of the ureter; a subsequent nephro-ureterectomy became necessary. Histology demonstrated nonspecific inflammatory lesions. Discussions Postinfectious, chronic inflammation of the retroperitoneum acts on the ureteral and peri-ureteral tissues, inducing an inflammatory and then a fibrotic process. Conclusions We underline the opportunity of a precocious and radical treatment of every retroperitoneal infection.

Background To evaluate the safety and efficacy of abiraterone acetate (AA) in the “real life” clinical practice for men with chemotherapy-naïve metastatic castration-resistant prostate. Methods A consecutive series of patients with mCRPC in 9 Italian tertiary centres treated with AA was collected. Demographics, clinical parameters, treatment outcomes and toxicity were recorded. The Brief Pain Inventory scale Q3 was tracked and patient treatment satisfaction was evaluated. Survival curves were estimated by the method of Kaplan-Meier and Cox regression and compared by the log-rank test statistic. Results We included 145 patients (mean age 76.5y). All patients were on androgen deprivation therapy. Patients had prior radiotherapy, radical prostatectomy, both treatments or exclusive androgen deprivation therapy in 17%, 33%, 9% and 40%, respectively. 57% of the patients had a Gleason score higher more than 7 at diagnosis. 62% were asymptomatic patients. The median serum total PSA at AA start was 17 ng/mL (range 0,4–2100). The median exposure to AA was 10 months (range 1–35). The proportion of patients achieving a PSA decline ≥50% at 12 weeks was 49%. Distribution of patient satisfaction was 32% “greatly improved”, 38% “improved”, 24% “not changed”, 5.5% “worsened”. Grade 3 and 4 toxicity was recorded in 17/145 patients 11.7% (70% cardiovascular events, 30% critical elevation of AST/ALT levels). At the last follow-up, median progression free and overall survival were 17 and 26.5 months, respectively. Both outcomes significantly correlated with the presence of pain, patient satisfaction, PSA baseline and PSA decline. Conclusions The AA is effective and well tolerated in asymptomatic or slightly symptomatic mCRPC in a “real life” setting. The survival outcomes are influenced by the presence of pain, patient satisfaction, baseline PSA and PSA decline. Trial registration The study was retrospectively registered at ISRCTN as DOI:10.1186/ISRCTN 52513758 in date April the 30th 2016. Electronic supplementary material The online version of this article (10.1186/s12885-017-3755-x) contains supplementary material, which is available to authorized users.

Prostate Imaging Reporting and Data System version 2 (PI-RADS v2) provides clinical guidelines for multiparametric magnetic resonance imaging (mpMRI) [T2-weighted imaging (T2WI), diffusion-weighted imaging (DWI) and dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI)] of prostate. However, DCE-MRI seems to show a limited contribution in prostate cancer (PCa) detection and management. In our experience, DCE-MRI, did not show significant change in diagnostic performance in addition to DWI and T2WI [biparametric MRI (bpMRI)] which represent the predominant sequences to detect suspected lesions in peripheral and transitional zone (TZ). In this article we reviewed the role of DCE-MRI also indicating the potential contribute of bpMRI approach (T2WI and DWI) and lesion volume evaluation in the diagnosis and management of suspected PCa.

To investigate the long-term effects of FlosealWe prospectively collected results of the self-administered International Index Erectile Function Questionnaire 1-5 and 15 (IIEF 1-5 and 15) of 532 consecutive patients who underwent RALP for prostate cancer in our institution between October 2007 and December 2015. Patients were divided into two groups according to FlosealA total of 120 patients were enrolled. Group A included 40 consecutive patients who received traditional hemostasis, and Group B included 80 consecutive patients in which FlosealThe results of our study suggest that local use of Floseal

BACKGROUND Extracorporeal shock wave lithotripsy (ESWL) for distal ureteral stones can be performed in prone or supine position. The aim of this study was to investigate the advantages brought by the supine transgluteal ESWL approach for distal ureteral stones treatment using real-time ultrasound (US), and to show how computerized tomography (CT) scan parameters may be related to the outcomes. METHODS Seventy consecutive supine transgluteal ESWL of distal ureteral stones were performed. All patients had a pre-treatment CT scan. The following parameter were evaluated: stone size, Hounsfield Units, skin-to-stone distance, sciaticum majus foramen width, stone to ureteral ostium distance, fragmentation and expulsion perception during the treatment, and the stone-free status. Stone focusing was obtained US, which allows a real-time visualization of stone location and fragmentation. Follow-up included a kidney ureter bladder (KUB) film and US examination at 2-3 weeks after treatment (median time: 18 days). Stone-free condition was defined as the complete absence of stone fragments. A linear regression analysis was used to assess the possible variables mostly related to stone-free status. P

This article highlights the possible role of “patient-reported outcomes” in the evaluation of a new therapy. Abiraterone acetate is a novel treatment for metastatic prostate cancer characterized by good safety and oncologic efficacy. Few studies have investigated patients' satisfaction with treatment. Our data show that abiraterone acetate is associated with good satisfaction with treatment and that patient's satisfaction can be a predictor of good oncologic outcomes. Introduction Abiraterone acetate (AA) gives a significant improvement in survival for patients with metastatic castration-resistant prostate cancer (mCRPC) before and after chemotherapy and has a favorable effect on patients' health-related quality of life and pain. Only a few studies have investigated patient-reported outcomes (PROs) in AA treatment for mCRPC. The aim of this study was to investigate patients' satisfaction in men affected by mCRPC treated with AA. Materials and Methods This was a retrospective analysis of a database of consecutive chemonaive patients with progressive mCRPC. Patients were treated with AA until disease progression, death, or unacceptable toxicity. Evaluation was performed at baseline and every 4 weeks by means of physical examination and laboratory studies. Eastern Cooperative Oncology Group score, pain symptoms, treatment-related toxicity, prostate-specific antigen (PSA), and overall and progression-free survival were recorded. Satisfaction with treatment was investigated at 6 months by means of a 4-point arbitrary scale. Results One-hundred twenty-eight patients were enrolled. Patients' satisfaction with treatment was “greatly improved” in 36.1% of patients and “improved” in 32.4% of them. Patients with higher satisfaction had lower baseline and final PSA values (P < .05), lower PSA levels at 12 weeks (P = .080), and less pain symptoms and lower Brief Pain Inventory scores (P = .001). Satisfaction with treatment was significantly correlated with baseline PSA level (P = .018), presence of pain (P = .007), duration of androgen deprivation therapy >12 months (P = .025), and number of hormonal manipulations (P = .051). Progression-free survival significantly correlated with patient satisfaction (P < .001). Conclusion AA is safe and well tolerated in chemonaive mCRPC patients, ensures good oncological and PROs. Patient's satisfaction is a predictor of progression-free survival.

Background and study objective: Several studies suggest a protective role of green tea catechins against prostate cancer (PCa). In order to evaluate the efficacy of green tea catechins for chemoprevention of PCa in patients with high-grade prostate intraepithelial neoplasia (HG-PIN) we performed a phase II clinical trial. Methods: Sixty volunteers with HG-PIN were enrolled to carry out a double-blind randomized placebo-controlled phase II clinical trial. Treated group took daily 600 mg of green tea catechins (Categ Plus®) for 1 year. Patients were screened at 6 and 12 months through prostatic biopsy and measurements of prostate-specific antigen (PSA). Results: Despite the statistically significant reduction of PSA observed in subjects who received green tea catechins for 6 and 12 months, we did not find any statistical difference in PCa incidence between the experimental groups neither after 6 nor after 12 months. However, throughout the one-year follow- up we observed very limited adverse effects induced by green tea catechins and a not significant improvement in lower urinary tract symptoms and quality of life. Conclusions: Although the small number of patients enrolled in our study and the relatively short duration of intervention, our findings seems to deny the efficacy of green tea catechins. However, results of our clinical study, mainly for its low statistical strength, suggest that the effectiveness of green tea catechins should be evaluated in both a larger cohort of men and longer trial.

Biparametric Magnetic Resonance Imaging (bpMRI) of the prostate combining both morphologic T2-weighted imaging (T2WI) and diffusion-weighted imaging (DWI) is emerging as an alternative to multiparametric MRI (mpMRI) to detect, to localize and to guide prostatic targeted biopsy in patients with suspicious prostate cancer (PCa). BpMRI overcomes some limitations of mpMRI such as the costs, the time required to perform the study, the use of gadolinium-based contrast agents and the lack of a guidance for management of score 3 lesions equivocal for significant PCa. In our experience the optimal and similar clinical results of the bpMRI in comparison to mpMRI are essentially related to the DWI that we consider the dominant sequence for detection suspicious PCa both in transition and in peripheral zone. In clinical practice, the adoption of bpMRI standardized scoring system, indicating the likelihood to diagnose a clinically significant PCa and establishing the management of each suspicious category (from 1 to 4), could represent the rationale to simplify and to improve the current interpretation of mpMRI based on Prostate Imaging and Reporting Archiving Data System version 2 (PI-RADS v2). In this review article we report and describe the current knowledge about bpMRI in the detection of suspicious PCa and a simplified PI-RADS based on bpMRI for management of each suspicious PCa categories to facilitate the communication between radiologists and urologists.

Aim To assess the sensitivity of biparametric magnetic resonance imaging (bpMRI) with non-endorectal coil in the detection and localization of index (dominant) and non-index lesions in patients suspected of having prostate cancer. Patients and methods We carried-out a retrospective analysis of multiparametric MRI (mpMRI) of 41 patients who underwent radical prostatectomy. Results of MRI for detection and localization of index and non-index lesions were correlated with those of histology. Results No statistically significant difference in size was seen between tumor lesion at histology and index lesion at MRI. In 41 patients, a total of 131 tumors were identified at histology, while bpMRI (T2-weighted and diffusion-weighted MRI) approach detected 181 lesions. bpMRI gave 27.6% false-positives and 3.3% false-negatives. Sensitivity in lesion detection by bpMRI increased with lesion size assuming high values for lesions ≥10 mm. For bpMRI and mpMRI, the sensitivity for detecting index lesions was the same and equal: 100% in the peripheral zone 97.6% and 94.7% in the entire prostate and transitional zone, respectively. Conclusion bpMRI can be used alternatively to mpMRI to detect and localize index prostate cancer.

Introduction Although differentiation between benign and malignant small renal tumors (≤4 cm) is still difficult, it is a demand for decision making and determining the treatment strategy. Our aim is to evaluate the role of multidetector row computed tomography (MDCT) in the differentiation of small renal clear cell carcinoma (RCC) and renal oncocytoma (RO). Methods We reviewed triphasic computed tomographic (CT) scans performed in 43 patients diagnosed with RCC (n = 23) and RO (n = 21). After an unenhanced CT phase of the upper abdomen, triple-phase acquisition included a cortico-medullary phase (CMP), a nephrographic phase (NP), and a pyelographic phase (PP), and lesions were evaluated both qualitatively and quantitatively. Results RCCs were hypervascular in 13 cases and hypovascular in 10 cases, while ROs were hypervascular in nine cases and hypovascular in 12 cases. Mean attenuation values (MAVs) for hypervascular RCCs and hypervascular ROs on unenhanced examination were 34.0 ± 7.1 and 31.3 ± 8.1 HU, respectively. Enhancement in CMP was 173.1 ± 45.2 HU for RCCs and 151.1 ± 36.0 HU for ROs and a gradual wash-out in NP (148.8 ± 34.3 and 137.1 ± 33.9 HU for RCCs and ROs, respectively) and in PP (98.2 ± 36.0 HU for RCCs and 79.4 ± 21.5 HU for ROs) was observed. MAV for hypovascular RCCs and hypovascular ROs on unenhanced examination were 32.4 ± 12.0 and 28.9 ± 8.0 HU, respectively. Both hypovascular RCCs and ROs showed a statistically significant difference in each post contrastographic phase. Conclusions Absolute attenuation and the quantitative amount of the enhancement were not strong predictors for RO and RCC differentiation.

To demonstrate the association between magnetic resonance imaging (MRI) estimated lesion volume (LV), prostate cancer detection and tumour clinical significance, evaluating this variable alone and matched with Prostate Imaging Reporting and Data System version 2 (PI-RADS v2) score.We retrospectively analysed 157 consecutive patients, with at least one prior negative systematic prostatic biopsy, who underwent transperineal prostate MRI/ultrasonography fusion-targeted biopsy between January 2014 and February 2016. Suspicious lesions were delineated using a 'region of interest' and the system calculated prostate volume and LV. Patients were divided in groups considering LV (≤0.5, 0.5-1, ≥1 mL) and PI-RADS score (1-5). We considered clinically significant prostate cancer as all cancers with a Gleason score of ≥3 + 4 as suggested by PI-RADS v2. A direct comparison between MRI estimated LV (MRI LV) and histological tumour volume (HTV) was done in 23 patients who underwent radical prostatectomy during the study period. Differences between MRI LV and HTV were assessed using the paired sample t-test. MRI LV and HTV concordance was verified using a Bland-Altman plot. The chi-squared test and logistic and ordinal regression models were used to evaluate difference in frequencies.The MRI LV and PI-RADS score were associated both with prostate cancer detection (both P0.001) and with significant prostate cancer detection (P0.001 and P = 0.008, respectively). When the two variables were matched, increasing LV increased the risk within each PI-RADS group. Prostate cancer detection was 1.4-times higher for LVs of 0.5-1 mL and 1.8-times higher for LVs of ≥1 mL; significant prostate cancer detection was 2.6-times for LVs of 0.5-1 mL and 4-times for LVs of ≥1 mL. There was a positive correlation between MRI LV and HTV (r = 0.9876, P0.001). Finally, Bland-Altman analysis showed that MRI LV was underestimated by 4.2% compared to HTV. Study limitations include its monocentric and retrospective design and the limited cohort.This study demonstrates that PI-RADS score and the MRI LV, independently and in combination, are associated with prostate cancer detection and with tumour clinical significance.

To assess the sensitivity of biparametric magnetic resonance imaging (bpMRI) with non-endorectal coil in the detection and localization of index (dominant) and non-index lesions in patients suspected of having prostate cancer.We carried-out a retrospective analysis of multiparametric MRI (mpMRI) of 41 patients who underwent radical prostatectomy. Results of MRI for detection and localization of index and non-index lesions were correlated with those of histology.No statistically significant difference in size was seen between tumor lesion at histology and index lesion at MRI. In 41 patients, a total of 131 tumors were identified at histology, while bpMRI (T2-weighted and diffusion-weighted MRI) approach detected 181 lesions. bpMRI gave 27.6% false-positives and 3.3% false-negatives. Sensitivity in lesion detection by bpMRI increased with lesion size assuming high values for lesions ≥10 mm. For bpMRI and mpMRI, the sensitivity for detecting index lesions was the same and equal: 100% in the peripheral zone 97.6% and 94.7% in the entire prostate and transitional zone, respectively.bpMRI can be used alternatively to mpMRI to detect and localize index prostate cancer.

Objective: To test the impact of Thulium laser enucleation of the prostate (ThuLEP) on erectile and ejaculatory functions, on lower urinary tract symptoms and on quality of life (QoL). Methods: From July 2013 to May 2015, we prospectively evaluated 177 patients with LUTS related to benign prostatic hyperplasia. All patients were assessed with the International Index of Erectile Function (IIEF-5), Male Sexual Health Questionnaire-Ejaculatory Disease (MSHQ-EjD), International Prostate Symptom Score (IPSS), QoL, PSA and uroflowmetry before and at 4 and 8 months after surgery. Results: Erectile function did not show variation with IIEF-5 preoperative score 22.49 ± 1.8 and postoperative score 22.14 ± 3.1 (p = 0.195) and 22.18 ± 3.2 (p = 0.26) at 4 and 8 months after treatment. The ejaculatory function on the MSHQ-EjD test indicated the reduction of ejaculation, changing from 14.90 ± 6.88 to 5.51 ± 4.17 (p < 0.0001) and 5.38 ± 3.93 (p < 0.0001) at 4 and 8 months follow-up. IPSS score decreased from preoperative 21.12 ± 5.81 to 3.14 ± 3.16 (p < 0.0001) and 3.08 ± 3.12 (p < 0.0001) 4 and 8 months after surgery. PSA decreased from 4.50 ± 3.72 to 1.39 ± 1.04 (p < 0.0001) and 1.47 ± 1.14 ng/ml (p < 0.0001) at 4 and 8 months follow-up, while QoL score improved from 5.41 ± 0.69 to 0.57 ± 0.84 (p < 0.0001) and 0.51 ± 0.80 (p < 0.0001) at 4 and 8 months follow-up. Conclusions: ThuLEP does not affect erectile function and determines the resolution of LUTS with improvement of QoL. Loss of ejaculation did not impair the sexual intercourse activities of the patients.

To assess whether any relationship exists between the number of histologically examined lymph nodes and the detection of metastases in pelvic lymph node dissection (PLND) specimens taken from patients with radical prostatectomy (RP) for prostatic adenocarcinoma. 1690 cases of RP with PNLD were included in the study; 54 % of the patients were submitted to extended PLND (ePLND). Kaplan-Meier curves confirm the negative prognostic significance of nodal metastases on the overall patients' survival (P < 0.0001). Nodal metastases are significantly associated with older age of patients (P = 0.0466), higher pT status (P < 0.0001), higher Gleason score (P < 0.0001) and positive surgical margin (P < 0.0001). The frequency of nodal metastases is significantly increased in cases submitted to ePLND (P < 0.0001), presumably due to the significantly higher number of lymphnodes retrieved using this procedure (P < 0.0001). In addition, regardless of the extent of PLND procedure, entire histological examination of PLND specimens is significantly associated with a higher frequency of nodal metastases (P < 0.0001). When we considered only pN0 cases, 21 display adverse prognosis and died of disease during the follow-up. The number of pelvic lymphnodes examined is significantly lower in the group of patients who die of the disease compared to that of survivors (P = 0.0448). In addition, Kaplan-Meier analysis shows that patients with 10 or fewer examined lymphnodes have significantly shorter disease-specific survival (P = 0.0151). Our findings confirm the negative prognostic significance of N status in prostate cancer. We suggest the examination of a minimum number of 10 lymphnodes, together with entire PLND processing, for accurate assessment of N status.

Background Laparoscopy is a minimally invasive technique to access the abdominal cavity, for diagnostic or therapeutic applications. Optimizing the access technique is an important step for laparoscopic procedures. The aim of this study is to assess the outcomes of different laparoscopic access techniques and to identify the safest one. Methods Laparoscopic access questionnaire was forwarded via e-mail to the 60 centers who are partners in working group for laparoscopic and robotic surgery of the Italian Urological Society (SIU) and their American and European reference centers. Results The response rate was 68.33%. The total number of procedures considered was 65,636. 61.5% of surgeons use Veress needle to create pneumoperitoneum. Blind trocar technique is the most commonly used, but has the greatest number of complications. Optical trocar technique seems to be the safest, but its the less commonly used. The 28.2% of surgeons adopt open Hasson's technique. Total intra-operative complications rate was 3.3%. Open conversion rate was 0.33%, transfusion rate was 1.13%, and total post-operative complication rate was 2.53%. Conclusion Laparoscopic access is a safe technique with low complication rate. Most of complications can be managed conservatively or laparoscopically. The choice of access technique can affect the rate and type of complications and should be planned according to surgeon experience, safety of each technique and patient characteristics. All access types have perioperative complications. According to our study, optical trocar technique seems to be the safest.