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Introduction The aim of this study was to evaluate the incidence of sexual dysfunctions in males with epilepsy, the type of epilepsy, the frequency of seizures, the type of antiepileptic drugs (AEDs), the serum hormonal profile and the presence of psychiatric comorbidity. Methods Sixty-one patients focused on type of epilepsy, frequency of seizures, AEDs, hormonal profile and presence of mood disorders. We excluded all patients with severe neurologic and psychiatric impairment and patient who were not able to fill questionnaires. Mean age was 31.2 years (range 18-50 years); 31 patients (50.8%) had an idiopathic generalised epilepsy and 30 (49.2%) a focal epilepsy; among them, latter 18 (60%) had probably symptomatic type and 12 (40%) symptomatic type. Sexual functions were evaluated by “International Inventory of Erectile Function” questionnaire. Results Out of 61 enrolled patients, 22 (36.7%) showed sexual dysfunctions: erectile dysfunctions in 14 (23%), orgasmic dysfunctions in (11.5%) and sexual drive dysfunctions in 12 (19.7%). Out of 61 patients, 36 were subjected to blood measurement of sexual hormones and 21 (58.3%) showed hormonal modifications. Conclusions Sexual dysfunction are present in 36.7% of enrolled males with epilepsy; there is any association between sexual dysfunctions and various AEDs in the treatment, except for carbamazepine (CBZ); there is not any association between sexual dysfunctions and frequency of seizures; hormonal changes are associated with sexual dysfunction in males with epilepsy treated with AEDs but not with the orgasmic dysfunction; there is not any association between hormonal changes and type of AEDs, except for CBZ; depression is associated with sexual dysfunctions.

The aim of our work was to evaluate the long-term changes in symptoms (median 42 months) and to analyze data for any negative predictive factors for the application of the procedure, in patients who underwent to urethroplasty with dorsal buccal mucosa graft. During the period from 2010 to 2015 27 patients were examined. Than they underwent urethroplasty using dorsal buccal mucosa graft (graft of 4 x 2.5 cm). The evaluation of symptoms has been addressed through the application of the IPSS Quality of Life Questionnaire (International Prostatic Symptoms Score) and the evaluation of urinary flow has been carried out by a comparative analysis between the pre- and post-operative uroflowmetry. As our study has shown, data obtained by the screening tests in the post-operative follow-up indicate that there is an increase in the maximum flow of urine until 1 month after surgery. The results in the long-term follow-up are different because they show a partial reduction of the maximum flow although it is maintained around an average value of 23 ml/s being still higher than the maximum flow in the pre-operative period. According to our results it follows that there is a low failure rate of the procedure after a median of 42 months. Only in patients with urethral stenosis longer than 2 cm, a lower long term success is achieved. From what we could observe, this length of the stenosis seems to be the only negative predictive factor for long-term maintenance of a good Quality of Life in patients undergoing the procedure. The results obtained from our study confirm literature data according to which, the gold standard for 2-cm long bulbar urethral stricture whose lumen is well preserved with circumferential spongiofibrosis limited to 1-2 mm is the dorsal graft urethroplasty with buccal mucosa that in our study showed success rates higher of 80% after a median follow up of 42 months and a percentage of relapse-free patients of 82.1% ( median 3.5 years).

INTRODUZIONE E OBIETTIVO DELLO STUDIO: Risultati a lungo termine dell'uretroplastica con innesto dorsale di mucosa buccale e fattori predittivi negativi della metodica. MATERIALI E METODI: Analisi retrospettiva di 27 pazienti sottoposti a uretroplastica con innesto di mucosa buccale (prelievo del graft della guancia di circa 4x2,5 cm) per stenosi uretrale nel periodo 2010-2015 (mediana 42 mesi). Flusso massimo (Qmax), residuo post-minzionale (RPM), ecografia del corpo spongioso uretrale, test IPSS (solo domanda su QoL) e percezione soggettiva allo svuotamento sono stati ottenuti prima e dopo l’intervento (un mese e dopo mediana di 3,5 anni). L’età media del campione era di 43,2 anni (range 24-77). Tre pazienti (11,12%) avevano molteplici stenosi, 1 paziente (3,7%) stenosi peniena anteriore, 19 pazienti (70,37%)stenosi bulbari e 4 pazienti (14,81%) stenosi membranosa. Lunghezza media della stenosi: 1,65cm. RISULTATI: La tecnica è stata considerata di successo in più dell’80% dopo una mediana di 42 mesi. La percentuale di pazienti liberi da recidiva è stata del 91,4% (1 anno), 82,1% (mediana 3,5 anni). Il Qmax post-operatorio è aumentato da un valore medio di 7,4 ml/s (range 5-11 ml/s) a 23 ml/s (range 5-42 ml/s) al primo mese è di 21,16 ml/s a 5 anni dopo l’intervento. Il punteggio medio dell’IPSS-QoL preoperatorio è stato 5,86, mentre nel periodo post-operatorio era 3,4 in 5 anni di follow-up (mediana 3,5). L’ecografia del corpo spongioso non ha registrato cambiamenti significativi nel periodo pre e post-operatorio. Stenosi maggiori di 2 cm hanno tassi di successo più bassi rispetto a stenosi più brevi. CONCLUSIONI: l’uretroplastica con innesto dorsale di mucosa buccale è considerato il metodo di scelta nel trattamento della stenosi uretrale. secondo il nostro studio, c’è una bassa percentuale di fallimento in una media di 3,5 mesi dopo la procedura. La lunghezza della stenosi sembra essere il principale fattore predittivo negativo.

association between obesity and prostate cancer, yielding inconsistent results. Metabolic syndrome has been suggested to promote aggressive prostate tumors. In a previous study we failed to detect a relation between Body Mass Index (BMI) and prostate cancer Gleason score (1). BMI, although routinely adopted to measure obesity, has low sensitivity and specificity. A novel sex-specific obesity index, based on waist circumference (WC), BMI, triglycerides (TGs) and high density lipoproteins (HDL), the Visceral Adiposity Index (VAI), has been proposed to estimate the visceral adiposity dysfunction (2). The aim of our preliminary research was to correlate VAI and BMI with the presence of prostate cancer and the Gleason score at biopsy. Patients and Methods: Patients, undergoing prostate biopsy for palpable prostate nodule and/or elevated PSA levels, entered the study. After informed consent a transrectal prostate biopsy, 12 cores at least, was performed. The number of cores increased in rebiopsies (18-24 cores). A database including clinical, biochemical and pathological data was created. Prostate cancer detection at biopsy, Gleason score (6 or less versus 7 or higher), VAI, BMI and PSA values were statistically analyzed with Wilcoxon rank sum test. Results: Fifty-one patients were evaluated. The median age was 66 years (range 47-80). Two patients (3.9%) had a previous negative biopsy. The median BMI was 27.7 kg/m2 (range 18.7-40) and the median VAI was 4.4 (range: 1.6-15.6). Median PSA was 8.5 ng/ml (range 3.2- 53). A prostate nodule was palpable in 9 (17.6%) patients. The median prostate volume was 48 cc (range: 14-106). A prostate cancer was detected in 24 (47%) patients, with a Gleason pattern 6 in 14 (58.3%) patients and 7 or higher in the remaining 10 (41.7%). Among patients with positive prostate biopsy, median PSA BMI and VAI were 10.2 ng/ml, 27.8 Kg/m2 and 5.8, respectively. Among patients with negative prostate biopsy, median PSA BMI and VAI were 7.0 ng/ml, 26.8 Kg/m2 and 5.5, respectively. Only PSA levels were slightly related to biopsy positivity (p-value=0.08), no difference was detected for VAI (p-value=0.89) and BMI (pvalue= 0.19). Median PSA, BMI and VAI resulted 9.2 ng/ml, 27.8 Kg/m2 and 5.6, respectively in patients with Gleason score of 6 or less, and 10.9 ng/ml, 27.7 Kg/m2 and 5.8, respectively, in patients with Gleason score >6. Even in this case PSA levels were slightly related to prostate cancer aggressiveness (p-value=0.12), while no difference was highlighted for VAI (p-value=0.6665) and BMI (pvalue= 0.6394). Discussion and Conclusion: The identification of patients harboring an aggressive prostate cancer remains an important goal. The contradictory results on the relation between obesity and prostate cancer could be due to the low accuracy of BMI as a marker of metabolic syndrome. VAI has been recommended as an accurate indicator of adipose tissue activity. Nevertheless, our preliminary results do not detect any significant correlation between VAI, BMI, positivity of prostate biopsy and Gleason score