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Natal women with anorgasmia possess a smaller clitoral glans and clitoral components farther from the vagina lumen than women with normal orgasmic function. There are no studies evaluating this correlation in operated transgender women. We evaluated whether differences in magnetic resonance imaging (MRI) measurements of neoclitoris volume and distance between the neoclitoris and the neo-vagina were correlated with differences in sexual function. We recruited for a prospective survey study 40 operated male to female patients (oMtF) who had undergone gender affirming surgery (GAS), using two different techniques, the pubic neoclitoris technique (PNT) and the neourethroclitoroplasty according to Petrović (NCP), and postoperative pelvic MRI. Individual pelvic MRIs were reviewed by two blinded investigators, the three axes of the neoclitoris were measured and the volume was calculated using the ellipsoid formula. The distance between the neoclitoris and the neovagina was also measured. Sexual functioning was assessed using the Female Sexual Function Index (FSFI) and the operated Male to Female Sexual Function Index (oMtFSFI). Mean scores differences in FSFI, oMtFSFI were examined; associations with clitoral size, location, sexual functioning and demographical variables were investigated as well. The response rate was 55%, 11 oMtFs were operated with PNT and 11 with NCP. The PNT group presented a neo-clitoris mean volume of 1.04 cc vs 1.31 cc of the other group (p = 0.55). The mean distance between neo-clitoris and neovagina was 4.20 cm in the PNT group and 2.55 in the NCP group (p 0.20). According to pelvic MRI measurements, this study suggests a correlation between neoclitoris location and operated male to female sexual satisfaction.

In the last years the incidence of renal neoplasms has been steadily increasing, along with the average age of patients at the time of diagnosis. Surgical management for localized disease is becoming more challenging because of patients’ frailty. We conducted a multi-center prospective study to evaluate the role of the G8 as a screening tool in the assessment of intra and post-operative complications of elderly patients (≥70 y.o.) undergoing surgery for kidney cancer. A total of 162 patients were prospectively enrolled between January 2015 to January 2019 and divided into two study groups (frail vs. not-frail) according to their geriatric risk profile based on G8 score. Several factors (i.e., age, CCI, ASA score, preoperative anemia, RENAL score, surgical procedures, and techniques) were analyzed to identify whether any of them would configure as a statistically significant predictor of surgical complications. According to the G8 Score, 90 patients were included in the frail group. A total of 52 frail patients vs. 4 non-frail patients developed a postoperative complication of any kind (p < 0.001). Of these, 11 were major complications and all occurred in the frail group. Our results suggest that the G8 screening tool is an effective and useful instrument to predict the risk of overall complications in elderly patients prior to renal surgery.

Background Several trials have reported on the impact of social restrictions due to SARS-CoV-2 (COVID-19) pandemic on sexual function and psycho-physical well-being. However, data showing modifications of these outcomes over time and at the end of lock-down are scant. Aim We investigated the longitudinal changes in sexual function during social restrictions for COVID-19 pandemic in Italy. Methods A web-based survey was administered to Italian citizens of legal age via social networks. The Beck Depression Inventory Primary Care, the General Health Survey, Female Sexual Function Index, International Index of Erectile Function, UCLA Loneliness Scale-version 3 questionnaires were used to test mental, physical and sexual well-being. The questionnaires were administered at the beginning of the lockdown (T0), 15 days from the first assessment (T1) and 1 month after the end of the restrictions in 2020 (T2). Outcomes Descriptive statistics and multiple regression analysis were applied to investigate changes in sexual function over and at the end of social restrictions. Results Data were available for 2543 people (47.2% of men; 43.4% women; 9.4% undefined). Mean age was 48.3 ± 15.1 years for males and 43.9 ± 13.4 for females. Overall, 2.6% reported depressive symptoms according to Beck Depression Inventory Primary Care, 7.4% reported a high level of UCLA loneliness and 19.4% low levels of general mental health. Mild to severe erectile dysfunction was reported by 59.1% of men at T0, while 68.4% of women reported sexual dysfunction. Sexual function levels remain generally unchanged at further follow-up over the social restriction time period (T1), although those who were sexually active at baseline showed a decrease in sexual function scores. At T2, there was an overall improvement in sexual function scores with a rate of severe erectile dysfunction decreasing from 37.1% to 24.1% from T0 to T2 among males and a significant decrease of female sexual dysfunction from 68.4% to 51.2%. Clinical Implications Young individuals and those with good mental and physical health were more likely to improve sexual function at the end of social restrictions. Strengths & Limitations Valid and reliable questionnaires and longitudinal approach design represent strengths; a large but convenient sample and lack of pre-pandemic baseline data represent limits. Conclusion Social restrictions due to COVID-19 pandemic led to an increase in sexual dysfunctions in both genders. However, these conditions appeared temporary since an overall improvement was observed at the end of lockdown and especially in younger individuals with higher psycho-physical well-being.

Author of the Study: Re-staging transurethral resection of bladder tumor re-TURBt is nowadays considered the gold-standard treatment for patients with non-muscle invasive bladder cancer (NMIBC) harboring high-risk features. Although the rationale behind it’s well established in the current guidelines, it must be considered its potential morbidity, procedure-related costs and the need of general or locoregional anesthesia. To assess a risk-adapted strategy, we analyzed the role of clinicopathological, laboratory and surgical predictors of residual tumor at the time of re-TURBt in a single- Institution series of T1 NIMIBC. Materials and Methods: A prospectively maintained internal databasewas queried. Data about 114 consecutive patients who underwent re-TURBt for T1 NMIBC were analyzed. Binomial logistic regression models were applied to evaluate residual tumor predictors. Step function was used to select the best model according to the Akaike Information Criterion (AIC). Results: Of these 114 patients, 97 were men (85.1%) and 17 were women (14.9%). The median age of the participants at the time of the interventionswas 73 years (IQR 68–79). Regarding smoking habits, 36 patients were no smokers (31.6%), 47 were former smokers (41.2%), and 31 were active smokers (27.2%). The Charlson Comorbidity Index (CCI) was ≥ 2 in 53 cases (46.5%), 1 in 35 cases (30.7%) and 0 in the remaining 26 (22.8%). In 48.2% of cases, the tumor was multifocal. Detrusor muscle was present in 97 (81,5%) samples of the first TURBt. Residual tumor was present in 40 (35.1%) patients. Pathological stage at re-TURBt was pTa in 7.9%, pT1 in 23.7% and pT2 in 3.5% of cases. In the remaining 40 patients with residual disease, the histologic stage of the lesion was pTa in 7.9%, pT1 in 23.7% and pT2 in 3.5% of cases. In 19.3% of patients, a high-grade tumor was found at re-TURBT. After multivariate binomial logistic regression analysis, we observed that age (OR 1.05; 95% CI 1.01–1.11; p = 0.02), previous history for bladder neoplasm (OR 3.14; 95% CI 1.10–11.10; p = 0.04), presence of preoperative anemia (OR 5. 4; 95% CI 1.36–9.65; p = 0.02), preoperative platelet count (OR 1.01; 95% CI 1.00–1.01; p = 0.02), preoperative high neutrophil-to-lymphocyte ratio (NLR) (OR1.23; 95% CI 1.01–1. 55; p = 0.05), training level of the surgeon (OR 0.09; 95% CI 0.01–0.42; p = 0.01), and tumor grading (OR 2.71; 95% CI 1.14–8.43; p = 0.04)were independently associated with outcome. The Area Under the Curve (AUC) of the model was 0.80. Conclusions: Increasing age, preoperative anemia, impaired neutrophil- to-lymphocyte ratio, and high-grade tumor at first TURBt were independent risk factors for residual tumor at re-TURBt. These initial Results may allow a more accurate selection of patients to be considered for re-TURBt. Further investigations are needed.

Introduction: Percutaneous treatment of persistent urinary fistula after partial nephrectomy using N-butyl-2-cyanoacrylate and gelatin sponge (Spongostan®) is an effective and relatively non-invasive procedure that should be considered when a conservative approach fails. Three successful cases of percutaneous embolization by using N-butyl-2-cyanoacrylate have been reported in the literature. To our knowledge, the use of Spongostan for the treatment of urinary fistula after partial nephrectomy has not been previously described. Case report: We present the case of an 82-year old man who underwent percutaneous closure of a urinary fistula following partial nephrectomy by using gelatin sponge (Spongostan®) and N-butyl-2-cyanoacrylate.Conclusions: We encourage the use of this technique in selected cases. Collaboration amongst urologists and skilled interventional radiologist is strongly recommended.

INTRODUCTION AND OBJECTIVE: Doubtless, advances in imaging technology such as abdominal ultrasounds, computed tomography(CT) and multiparametric magnetic resonance imaging (mpMRI) are playing an important role in the diagnosis of renal masses(RM) and so of renal cell carcinoma (RCC) before the presence of clinical symptoms. This aspect has prompted interest in active surveillance (AS) as a treatment option for the small renal masses (sRM), especially if supported by an imaging-guided biopsy that can characterize the tumor, that most likely will not contribute to cancer-specific mortality. To the best of our knowledge, contemporary data evaluating the temporal trend of pathological characteristics and the relationship with cancer-related death of the incidental RM are not available, especially in a setting of an elderly population. The aim of this study was to analyze incidence trend, changes in clinical characteristics, pathological features and cancer-related death of RM incidentally discovered at time of autopsy in a long period of time. METHODS: Data were retrieved from the autopsy register of the Pathology Department of a single tertiary referral academic center from 15086 consecutive autopsies performed between January 2004 and December 2017. Patients with previous history of primary RCC and patient with a kidney metastatic involvement from other tumors were excluded from this study. RESULTS: Overall, 184 (1.22%) RM were found. Benign and malignant lesions were 32 (17.4%) and 152 (82.6%) respectively. The median age at death was 84 years (IQR, 76.8-90) and the majority of patients were female (56,5%). Histologically were oncocytoma 13 (7.1%), angiomyolipoma 13 (7.1%), papillary adenoma 4 (2.2%), cystic nephroma 3 (1.6%), metanephric tumor 2 (1.1%), clear-cell RCC 136 (73.9%) in which occured 2 (1.5%) sarcomatoid variant, papillary RCC 2 (1.1%), chromophobe RCC 5 (2.7%), carcinoma of the collecting ducts of Bellini 5 (2.7%), nephroblastoma 1 (0.5%). Considering the malignancies, pathological stage was: pT1 126 (80.3%), pT2 10 (6.4%), pT3 16 (10.2%) and pT4 5 (3.2%). Overall, in 16 (10.2%) cases RM was cause-related death. Considering time between 2004 and 2010 vs 2011 and 2017, temporal trend of incidence of RM and consequently of RCC decreased significantly over the years (p=0.01, p=0.01 respectively). While the median age at death, sex and the distribution of the different histological types remained constant over the time, RM found in the last years are increasingly smaller(p=0.04) and only in one case in the last seven years RM was associated with cancer-specific mortality. CONCLUSIONS: The autopsy finding of incidental RM is decreasing. Although the distribution of the different kidney tumor histological types appears constant, the mean size of the lesions that are incidentally identified at autopsy are increasingly smaller and more harmless.

PURPOSE: No questionnaire is currently available to evaluate sexual function after male-to-female gender affirming surgery. Such a limit leads to a suboptimal evaluation in postoperative sexual function in these patients. We developed and validated a new questionnaire, the oMtFSFI (operated Male-to-Female Sexual Function Index), for assessing sexual function in male-to-female patients after surgery. MATERIALS AND METHODS: A panel of experts in gender dysphoria defined the main content areas to be assessed, including genital self-image, desire, arousal, lubrication, orgasm, satisfaction and sexual pain. After a pretest on 10 patients the oMtFSFI was applied in the main study to 65 operated male-to-female patients, recruited at 7 Italian centers, and 57 women. The participants provided self-ratings on online oMtFSFI, Female Sexual Function Index, Beck Depression Inventory for Primary Care and Short Form Health Survey questionnaires. Operated male-to-female patients completed the oMtFSFI twice, 4 weeks apart. RESULTS: Principal component analysis performed on self-ratings provided by operated male-to-female patients on oMtFSFI items yielded a 3-domain structure of sexual dissatisfaction, sexual pain and genital self-image. The 3 domains were internally consistent and test-retest reliable. Convergent associations with Female Sexual Function Index scales emerged for sexual dissatisfaction and sexual pain but not for genital self-image. Male-to-female patients reported lower sexual function levels than cisgender women. CONCLUSIONS: The present preliminary results support reliability and psychometric validity of the oMtFSFI in the assessment of key sexual function domains in transgender women, further revealing that genital self-image represents an assessment area to be considered in male-to-female patients, in addition to domains that are salient for cis women as well.

INTRODUCTION AND OBJECTIVES:The available literature does not provide any questionnaire to evaluate sexual function after male to female (MtF) gender reassignment surgery (GRS). The assessment of s...

INTRODUCTION AND OBJECTIVES: Several trials have dealt with residents well-being and burn-out, however, few data are available on residents Sexual Health. We aim to investigate Sexual Health among Italian residents in urology. METHODS: Between March and August 2018 Female Sexual Function Index (FSFI), Brief Index of Sexual Functioning Male (BISF-M), General Health Survey (SF-36) and Beck Depression Inventory Primary Care (BDI-PC) questionnaires were web-based administered to 299 residents from all of the 25 Italian Residency Programs. Data included: year of training (PGY), location, age, gender, sexual orientation, marital status, children, duty hours. Mean level differences in BDI-PC, FSFI and BISF-M levels for between-people variables such as sex (BDI-PC only), day/night shifts, and children were inspected via ANOVA; correlations between depression and sexual functioning were investigated as well. RESULTS: The responding rate was 49%, 101 males (M), 50 females (F); 38 surveys were however incomplete, and the final sample consisted of 113 participants. They well represent the PGYs. Mean age was 30.4 (SD 2.2), 83% M and 86% F had a stable relationship, 33% of the residents were engaged to a colleague (35%M,42%F), 6% had children (5%M, 6%F). 97% defined themselves heterosexual, 2% bisexual, 1% homosexual. Among females, 19% reported a FSFI total score below the critical value of 26, indicating a possible sexual dysfunction. In addition, 33% F and 11% M had a BMI-PC score >3, indicating a mild to severe depression level. Such percentages are higher than the quoted lifetime prevalence of depression in Italian general population (1.7% age group 15-44 years). 64% of the residents did night shifts, ANOVAs revealed a significant interaction effect (p

Aim of the study: Several trials have dealt with residents well-being and burn-out, however, few data are available on residents Sexual Health. We aim to investigate Sexual Health among Italian residents in urology. Materials and methods: Between March and August 2018 Female Sexual Function Index (FSFI), Brief Index of Sexual Functioning Male (BISF-M), General Health Survey (SF-36) and Beck Depression Inventory Primary Care (BDI-PC) questionnaires were web-based administered to 299 residents from all of the 25 Italian Residency Programs. Data included: year of training (PGY), location, age, gender, sexual orientation, marital status, children, duty hours. Mean level differences in BDI-PC, FSFI and BISF-M levels for between-people variables such as sex (BDI-PC only), day/night shifts, and children were inspected via ANOVA; correlations between depression and sexual functioning were investigated as well. Results: The responding rate was 49%, 101 males (M), 50 females (F); 38 surveys were however incomplete, and the final sample consisted of 113 participants. They well represent the PGYs. Mean age was 30.4 (SD 2.2), 83% M and 86% F had a stable relationship, 33% of the residents were engaged to a colleague (35%M, 42%F), 6% had children (5%M, 6%F). 97% defined themselves heterosexual, 2% bisexual, 1% homosexual. Among females, 19% reported a FSFI total score below the critical value of 26, indicating a possible sexual dysfunction. In addition, 33% F and 11% M had a BMI-PC score >3, indicating a mild to severe depression level. Such percentages are higher than the quoted lifetime prevalence of depression in Italian general population (1.7% age group 15–44 years). 64% of the residents did night shifts, ANOVAs revealed a significant interaction effect ( p < 0.05, eta square=.06) between sex and night shifts on BDI-PC levels, with women with night shift work reaching a critical mean BDI-PC score of 4.21. Chi square analysis also demonstrated that women with night vs day-only shifts reported BDI scores in the critical range (p

The available literature does not provide any questionnaire to evaluate sexual function after male to female (MtF) gender reassignment surgery (GRS). The assessment of sexual function in these patients is routinely performed by using tools designed for biological women, such as Female Sexual Function Index (FSFI). Such a limit leads to a suboptimal evaluation, especially in domains like lubrication and dyspareunia. Moreover, FSFI scores in MtF patients often are similar to those observed in non-transsexual women with sexual dysfunction. We aim at developing validate new questionnaire, the operated Male to Female Sexual Function Index (oMtFSFI) in order to assess sexual function in patients who underwent MtF GRS.

Introduction The aim of this study is to accomplish a systematic review on the surgical techniques available for male-to-female gender assignment surgery (MtoF GAS) published in the last 15 years, from January 2002 to May 2017, assessing advantages and disadvantages. Evidence acquisition A specific search on MEDLINE, Scopus and Web of Science databases included vaginoplasty for gender exchange. Preoperative (age, gender, body mass index, prior surgery), intraoperative (mean operating time, intraoperative complications, transfusion rate, conversion rate), postoperative (hospital stays, readmission rate, early and late complication rate), postoperative sexual activity, subjective satisfaction, vaginal depth, and long-term outcomes (vaginal stenosis, prolapse, dyspareunia and labial abscess) data of vaginoplasty for sexual exchange were collected. 29 articles were included (2.402 patients). Evidence synthesis Out of the 29 papers, 19 studies assessed penile skin inversion and 10 evaluated intestinal vaginoplasty. No comparative studies were found. Penile skin inversion vaginoplasty reported slightly shorter operative time compared to intestinal vaginoplasty (109-420 vs 145-420 minutes). Intraoperative complications for penile skin inversion vaginoplasty not exceeded an incidence of 10%. No significant differences in terms of postoperative complications or hospitalization time were reported. Intestinal vaginoplasty provides a deeper neovagina. Female Sexual Function Index score was significantly higher in patients undergoing intestinal vaginoplasty. Conclusions A standardized data collection may allow a better understanding of effectiveness and outcomes of different techniques.

OBJECTIVE: To investigate the role of MRI in the evaluation of both the new female anatomy and complications in male-to-female sex reassignment surgery (MtF-SRS). METHODS: 71 consecutive patients with MtF-SRS had 74 MRI [age range, 21-63 years; mean (±standard deviation) age, 36 ± 10 years; median age, 37 years]. In 47 patients, MRI was performed to rule out early post-operative complications after gender conversion (n = 40), vaginoplasty (n = 6) or remodelling of the labia majora (n = 1). In 27 patients, MRI was performed 1-20 years after MtF-SRS for late post-operative complications, pain or dysuria, inflammatory changes or poor cosmetic outcome. Three patients had MRI both before and after the operation. RESULTS: MRI allowed investigation of the new female anatomy in all cases. Soon after MtF-SRS, a small amount of blood was identified in all patients around the neoclitoris, urethral plaque and labia. Post-operative complications were clinically significant fluid collections (n = 5), labial abscesses (n = 2), severe cellulitis (n = 3), partial neovaginal prolapse (n = 3), focal necrosis and dehiscence of the vaginal wall (n = 2) and hypovascularization of the neoclitoris (n = 1). After ileal vaginoplasty, three patients developed clinically insignificant haematomas, one a large rectovaginal fistula with dehiscence of the intestinal anastomosis and bowel perforation (n = 1). In the 27 patients investigated 1-20 years after MfF-SRS, MRI demonstrated cavernosal remnants (n = 10), spared testis (n = 1) neovaginal strictures (n = 8), fistulas and abscesses (n = 3) and prolapse (n = 2). Three of these patients also had fibrotic changes. In the remaining three patients, no pathological features were identified. CONCLUSION: After genital reconfiguration, MRI allows assessment of the post-operative anatomy and of post-operative complications. Advances in knowledge: Imaging features of the new anatomy and of surgical complications after SRS are discussed and illustrated.

Si definisce varicocele la dilatazione varicosa delle vene del plesso pampiniforme e viene considerato la causa correggibile più frequente di infertilità maschile, anche se il meccanismo che porta all’infertilità non è ancora chiaro. Colpisce il 15% circa della popolazione generale (1) e più del 40% degli uomini infertili (2-4). Tuttavia l’80% dei pazienti affetti presenta uno spermiogramma nei limiti della norma. Il varicocele è valutato e classificato clinicamente secondo dei criteri introdotti da Dubin e Amelar nel 1970 (5), ma questi sono molto soggettivi e dipendono fortemente dall’esperienza dell’esaminatore (6), poiché l’iperattività del dartos e la contrazione del cremastere, indotte dalla palpazione o dalla manovra di Valsalva, possono mimare o mascherare la dilatazione varicosa testicolare (7). La soggettività della stadiazione clinica del varicocele è stata confermata sia da Hargreave e Liakatas (8), che riscontrarono una discrepanza nel 26% dei pazienti esaminati da due esperti medici specialisti, che da uno studio multicentrico, sponsorizzato dall’Organizzazione Mondiale della Sanità (9), condotto su 141 uomini affetti da una sub-infertilità, che ha dimostrato che la valutazione clinica, rispetto alla venografia, ha una sensibilità del 50% circa, con un tasso di falsi positivi pari al 23%. Usando l’ecocolorDoppler, Niedzielski et al. (10) trovarono un reflusso venoso solo nel 39% dei pazienti con sospetto clinico di varicocele. Poiché la diagnosi e la conseguente stadiazione clinica del varicocele hanno dei limiti, sono state introdotte negli anni nella comune pratica diagnostica numerose tecniche di imaging come l’ecocolorDoppler, la termografia, la venografia, la scintigrafia, la TC e la RMN. Ad oggi però l’ecocolorDoppler è la tecnica diagnostica di scelta, mentre le altre vengono utilizzate solamente in casi selezionati.

Beyond the use of gray scale and color Doppler modes, other imaging modalities may be indicated for imaging prostatitis in selected cases. Sonography may be normal and reveal totally nonspecific abnormalities, which may be seen in the absence of symptoms, and Doppler scan can reveal an increased vascularization. Several studies have investigated the role of magnetic resonance imaging in order to find any specific features in the diagnosis of granulomatous prostatitis. We analyzed the imaging techniques and their application for the diagnosis of prostatitis.

Objective To present a novel surgical concept by using the trans-Douglas approach to perform a robotic-assisted simple prostatectomy (RASP) for high-volume benign prostate hyperplasia. This transposition from oncological surgery enables performance of a better bladder neck sparing adenomectomy with good functional results. Materials and Methods The index patient is a 67-year-old man with a history of severe urinary flow outlet obstruction. Combination medical therapy is not effective. Transrectal ultrasound scan detected a 130-cm3 enlarged prostate with middle lobe. The International Prostate Symptoms Score (IPSS) was 30. The patient was scheduled for a RASP with a trans-Douglas approach to preserve the bladder neck. The patient was put in 30° Trendelenburg position. Six ports were placed across the lower abdomen: four 8-mm robotic trocars and 2 assistant trocars (12 and 5 mm). The parietal peritoneum was incised at the anterior surface of the Douglas space, according to the access to the prostate described by Bocciardi. The Denonvillier fascia was opened, seminal vesicles were exposed, and above the vesicles, the prostatic capsule was incised. The adenoma, together with the middle lobe, was split by the capsule from the base to the verumontanum. The bladder neck was advanced and remodeled to the distal urethral mucosa and then closed to the prostatic capsule by a double-layer suture. The peritoneal breach was closed. Results The operation time was 120 minutes. Blood loss was 80 cc. There was no perioperative or postoperative complication. The catheter was removed after 4 days. Uroflowmetry showed a peak flow of 30 mL/s. Pathologic examination was negative for tumor. After 60 days, the IPSS score was 8. Conclusion Trans-Douglas-RASP is a safe and effective minimally invasive treatment for benign prostate hyperplasia. It is a novel technique to perform bladder neck sparing prostatic adenomectomy and could be 1 more field of application of robotic technology.

Gender reassignment surgery is a complex process of surgical procedures, including both genital and nongenital surgery, performed to alter the phenotypic expression of the biological sex in order to alleviate gender dysphoria. Theoretically, the ideal female-to-male sex reassignment surgery should be a one-stage procedure. We present our experience with one-step technique in female-to-male reassignment surgery.

We present the case and radiologic images of a 64-year-old man who presented with gross hematuria and fever 2 months after undergoing retroperitoneal partial nephrectomy for a 4.7 × 4.6 cm papillary renal cell carcinoma. Angio-TC demonstrated an aneurysmatic dilatation of the anterior inferior segmental artery of the right kidney with an art-riovenous fistula; the patient was treated with angiography and selective cannulation by deploying 4 platinum coils. At follow-up, we used contrast-enhanced ultrasound to monitor coil embolization of the renal artery pseudoaneurysm.

We report a case of primary renal lymphoma of mucosa-associated lymphoid tissue in an 82-year-old woman. She presented with a history of renal mass previously treated with kidney percutaneous cryoablation at another centre.

Objectives: To review the cases of patients with suspected penile fracture and asses erectile and sexological outcomes. Materials and methods: from 1987 to 2013 presented to the Urology Clinic of Trieste and at the AIED of Pordenone a total of 41 cases that were divided into two groups according to the timing of treatment: 18 patients with anamnestic diagnosis of penile fracture treated nonimmediately and 23 patients treated immediately after the trauma. For all patients we evaluated the type of treatment adopted, the occurrence of complications and reoperations and the follow-up. The erectile function was also evaluated through the IIEF, as well as the psychological impact of the trauma on social and sex life, using a psycho- sexological questionnaire. Results: Among patients treated immediately after the trauma 14 were subjected to surgery. About a year after surgery, penile curvature was reported in 1 patient, pain in 3 patients, urinary disorders in 1 patient, while none reported erectile dysfunction (ED). Out of these, only 3 patients underwent reoperation. Among those treated conservatively 1 patient reported curvature, 1 patient reported pain and none reported ED. Among patients who were admitted at a later date, 14 reported curvature and 4 reported pain whereas urinary disorders were reported in 1 and ED in 4 patients. From a psychological point of view, the trauma caused in most cases a fear of new trauma and of repercussions on erectile function and sensitivity. Conclusions: The diagnosis is mainly clinical; however, radiological investigation is essential to confirm the diagnosis, assess the site and extent of the trauma and possible urethral involvement, so as to plan the most appropriate treatment. In addition, immediate treatment leads to better long-term results, with a lower incidence of ED and penile curvature. Psychologically, penile trauma intensifies the fear of reoccurrence; it decreases, however, with the passage of time.

Background Few studies have investigated how physical, mental and sexual function are associated with each other in operated transgender women (oTW). Aim To provide information on the physical, mental and sexual health of oTW in comparison with a group of cisgender women (cisW). Methods An age-matched control study was carried out, recruiting 125 oTW in 7 national referral centers and 80 volunteer women. Beck Depression Inventory Primary Care (BDI-PC), General Health Survey (SF-36), Female Sexual Function Index (FSFI) and operated Male to Female Sexual Function Index (oMtFSI) questionnaires were web-based administered. Data included: age, area of origin, educational level, sexual orientation, years since surgery and hormone therapy. Outcomes T-test was applied to inspect mean score differences between oTW and cisW, in mental, sexual and physical health; simple correlations and multiple regression analysis revealed how mental, sexual and physical health were concurrently associated in the two groups Results Response rate 60% (52% oTW, 71% cisW). oTW mean age 38.5 years (SD = 9.3), cisW 37.7 years (SD = 11.5). Both cisW and oTW reported average values in the range of mental, physical and sexual health. Statistical comparisons revealed no significant group differences in mental and physical health. oTW who referred a worse sexual function also reported worse overall mental well-being and higher levels of depressive symptoms. FSFI scores were negatively associated with years since surgery, but not with age. Multiple regression analysis showed that FSFI Pain accounted for a significant unique variance proportion of risk of depression in oTW. FSFI Sexual Pain was the strongest estimator of inter-individual differences in BDI-PC among oTW (P Clinical Implications No significant differences in the levels of depressive symptoms, physical and mental well- being were found in oTW and cis-W. The relation between depressive symptoms and sexual function in oTW is stronger than in cisW, and sexual pain substantially predicts risk of depression in oTW. Strengths & Limitations The evaluation of outcomes using validated questionnaires and the relatively large sample size. The convenience control group reported mental, physical and sexual health levels within the range of Italian normative data. Since this is a cross-sectional study, we must be careful in drawing conclusions from our results. Conclusions Sexual pain and lubrication difficulties are the main causes of worse sexual function in oTW, highlighting the importance of perioperative counseling to make surgical expectations realistic and to educate to a proper neovagina management. Vedovo F, Di Blas L, Aretusi F, et al. Physical, Mental and Sexual Health Among Transgender Women. A comparative Study Among Operated Transgender and Cisgender Women in a National Tertiary Referral Network. J Sex Med Rev 2021;18:982–989.