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Spinal cord evaluation is an integral part of spine assessment, and its reliable imaging work-up is mandatory because even localized lesions may produce serious effects with potentially irreversible sequelae. Spinal cord alterations are found both incidentally during spine evaluation in otherwise neurologically asymptomatic patients or during neurologic/neuroradiologic assessment in myelopathic patients. Myelopathy (an umbrella term for any neurologic deficit that refers to spinal cord impairment) can be caused by intrinsic lesions or extrinsic mechanical compression, and its etiology may be both traumatic and/or nontraumatic. The symptoms largely depend on the size/extension of lesions, ranging from incontinence to ataxia, from spasticity to hyperreflexia, from numbness to weakness. Magnetic resonance imaging is the reference imaging modality in spinal cord evaluation, ensuring the best signal and spatial resolution. We provide an overview of the most common spinal cord disorders encountered by radiologists and describe the technical measures that offer optimal spinal cord visualization.

Objectives The Rotterdam Prostate Cancer Risk calculator (RPCRC) has been validated in the past years. Recently a new version including multiparametric magnetic resonance imaging (mpMRI) data has been released. The aim of our study was to analyze the performance of the mpMRI RPCRC app. Methods A series of men undergoing prostate biopsies were enrolled in eleven Italian centers. Indications for prostate biopsy included: abnormal Prostate specific antigen levels (PSA>4 ng/ml), abnormal DRE and abnormal mpMRI. Patients’ characteristics were recorded. Prostate cancer (PCa) risk and high-grade PCa risk were assessed using the RPCRC app. The performance of the mpMRI RPCRC in the prediction of cancer and high-grade PCa was evaluated using receiver operator characteristics, calibration plots and decision curve analysis. Results Overall, 580 patients were enrolled: 404/580 (70%) presented PCa and out of them 224/404 (55%) presented high-grade PCa. In the prediction of cancer, the RC presented good discrimination (AUC = 0.74), poor calibration (p = 0.01) and a clinical net benefit in the range of probabilities between 50 and 90% for the prediction of PCa (Fig. 1). In the prediction of high-grade PCa, the RC presented good discrimination (AUC = 0.79), good calibration (p = 0.48) and a clinical net benefit in the range of probabilities between 20 and 80% (Fig. 1). Conclusions The Rotterdam prostate cancer risk App accurately predicts the risk of PCa and particularly high-grade cancer. The clinical net benefit is wide for high-grade cancer and therefore its implementation in clinical practice should be encouraged. Further studies should assess its definitive role in clinical practice.

Background Female urethral stricture (FUS) represents a sporadic condition. There is a lack of data and standardized guidelines on diagnostics and therapeutics. Several surgical techniques have been described for FUS urethroplasty, among which the flap-based or graft-based ones are most reported. Buccal mucosa graft (BMG) represents the gold standard for male urethroplasty, and this can theoretically be applied also to FUS treatment. Objective To describe and present preliminary results of a novel minimally invasive technique for buccal mucosa dorsal graft (mini-dorsal BMG) urethroplasty for the treatment of FUS. Design, setting, and participants This is a retrospective study on buccal mucosa dorsal graft urethroplasty for the treatment of FUS. Surgical procedure Every patient was placed in lithotomic position. Two stiches were placed at 10 and 2 o’clock positions to facilitate the dorsal median urethrotomy. The margins of the incised dorsal urethra at the 12 o’clock position are then dissected from the periurethral tissue. This dissection results in an elliptical raw area between the edges of the urethra over the periurethral tissue. The harvested BMG was fixed with several quilting sutures, using 5-0 and 4-0 absorbable sutures, to cover the raw area. The margins of the graft were sutured to the edges of the incised urethra. Measurements A chart review was performed. Results and limitations Thirteen patients underwent the mini-dorsal-BMG technique. The median preoperative uroflow was 5.6 (3–13) ml/s, and the median postoperative value was 23.4 (14–58) ml/s. Conclusions The mini-dorsal-BMG technique for the treatment of FUS gives good results with low complication rates. Other series and long-term follow-up are necessary to confirm the reproducibility of this technique. Patient summary We present the technical aspects and the promising preliminary results of a novel surgical technique for the treatment of female urethral stricture by using the buccal mucosa to correct this invalidating disease.

To report stoma stenosis rates and efferent channel (EC) complications at long term follow-up for Turin pouch (TP). This is a retrospective analysis of the prospectively maintained database of patients who underwent TP between March 2006 and May 2018. The TP is a U-shaped right colon pouch. The EC was conceived by the tubularization of 5 cm of the colon wall with the use of a stapler and sutured to the skin (EC-cutaneostomy). The ureters are sutured separately to the last 10 cm of ileum before the ileocecal valve. In literature, catheterization problems have been described on average in 20.3% of patients and stoma stenosis in 19.5% of the patients with flap valve systems. Thirty-eight consecutive patients underwent a TP procedure. The median age was 55 years (IQR: 52–60). Median operative time was 201 min (IQR: 170–210), median reconstructive time was 61 min (IQR: 55–65) and the blood loss was 244 ml (IQR: 150–300) and 4 patients (10.5%) needed blood transfusions. The median follow-up was 52 months (IQR: 37–92). Complete 24h continence was achieved in 34 (89%) patients. Seven (18.4%) patients reported difficulties in EC catheterization and 4 (10.5%) patients had stoma stenosis. This study is limited by the relatively small number of patients. In relation to similar systems, the TP seems to offer comparatively good functional results but EC and stoma complications were lower than other pouch variants in literature.

Multiple sclerosis is a chronic disease of the central nervous system characterized by demyelination and destruction of axons. The most common form of the disease is the relapsing-remitting multiple sclerosis in which episodic attacks with typical neurological symptoms are followed by episodes of partial or complete recovery. One of the underestimated factors that contribute to the pathogenesis of multiple sclerosis is excessive angiogenesis. Here, we review the role of angiogenesis in the onset and in the development of the disease, the molecular mechanisms underlying angiogenesis, the current therapeutic approaches, and the potential therapeutic strategies with a look at natural compounds as multi-target drugs with both neuroprotective and anti-angiogenic properties.

Patients with upper tract urothelial carcinoma (UTUC) often have a delayed diagnosis and by then, present with advanced disease which has been shown to be associated with lymphovascular invasion (LVI). It has been suggested to be involved in the metastatic cascade of the disease. In this review, we provide an extensive up-to-date summary of the current knowledge about the prognostic impact of LVI in patients undergoing radical nephroureterectomy (RNU). A systematic search of PubMed/MEDLINE, Scopus, EMBASE, and Web of Science for all reports published from 2010 through 2021 was performed. We performed pooled analyses of hazard ratios (HRs) and their corresponding 95% confidence intervals (CIs) of series that evaluated LVI as a prognostic factor in adults with UTUC who underwent RNU. The assessed oncological outcomes were disease recurrence, cancer-specific and overall survival. A meta-regression analysis was used to explore potential heterogeneity. A total of 58 series met the eligibility criteria for qualitative and quantitative synthesis. We included 29,829 patients, ranging from 101 to 2492 per study. All series were retrospective. LVI was present in 7,818 patients (26.2%). The median age of the patients was 69 years and the median follow-up was 40 months. In 40 of 58 studies (68.9%), adjuvant chemotherapy was given. The pooled HRs show that LVI predicts a greater risk of recurrence of the disease (pooled HR 1.43, 95% CI: 1.31-1.55, P = 0.000; I

Purpose:We sought to identify predictive factors of the transition from off clamp to on clamp robotic partial nephrectomy following an intraoperative decision.Materials and Methods:In the multicent...

To prove that the Net PlugPatch is a valid device for the surgical treatment of inguinal hernia.The authors of a previous study decided to continue the follow-up for a further three years on 33 patients who had had hernia repair surgery using the three-dimensional NeT PlugPatch device at their Hernia Center.All of the patients involved took part and the follow-up appointments were scheduled as follows: clinical examination at two years; telephone contact at three years and telephone contact and questionnaire at four years. No symptoms were observed at the second, third and fourth year follow-up time-points. There were no cases of recurrence.The Lichtenstein technique is currently considered the gold standard. However, many surgeons now prefer to use the MPR (Mesh Plug Repair) technique, despite the potential complications of using a plug. The technique had a short learning curve with no complications associated directly with the plug used such as migration or possible erosion of the adjacent hollow abdominal organs or blood vessels.the NeT PlugPatch device thus proved to be comfortable, safe and efficacious in inguinal repair surgery using the MPR technique.Mesh Plug Repair (MPR), Plug migration, Trabucco repair.Il rischio di sviluppare la patologia erniaria inguinale è del 27%-43% per gli uomini e 3%-6% per le donne nella popolazione mondiale 1. Tra le tecniche chirurgiche di riparazione del difetto erniario che prevedono l’utilizzo di devices protesici, la tecnica di Lichtenstein viene tutt’oggi considerata il gold standard. Molti chirurghi attualmente preferiscono la tecnica MPR (Mesh Plug Repair) nonostante le complicanze che possono derivare dall’utilizzo del plug. Quest’ultimo, infatti, può restringersi con conseguente formazione di “meshoma” ed eventuale sintomatologia dolorosa cronica o, addirittura, migrare provocando erosione nelle strutture anatomiche circostanti 3,17,18. Già in passato sono stati sviluppati dispositivi di forme diverse, ma senza portare alla completa risoluzione del problema. Il presente lavoro riparte dai risultati di un follow-up di 12 mesi condotto su 100 pazienti sottoposti ad intervento chirurgico di ernioplastica utilizzando il dispositivo tridimensionale NeT PlugPatch (Herniamesh®, Chivasso, Torino, Italy) 8. Lo studio mostrava risultati incoraggianti che, a nostro avviso, andavano però supportati con un followup a più lungo termine. Gli autori hanno deciso pertanto di proseguire il follow-up per ulteriori tre anni sui 33 pazienti sottoposti a intervento chirurgico presso il loro Hernia Center. I risultati a seguito di 48 mesi di follow-up hanno evidenziato una ridotta intensità di dolore e la protesi NeT PlugPatch si è pertanto confermata essere confortevole, sicura ed efficace negli interventi di ernioplastica inguinale secondo la tecnica MPR.

Objective To evaluate the impact of preoperative markers of systemic inflammation on complications and oncological outcomes in patients aged ≥75 years treated with radical cystectomy (RC) for urothelial bladder cancer (UBC). Patients and methods The clinical data of 694 patients treated with open RC for UBC at our institution between January 2008 and December 2015 were retrospectively reviewed. Patients aged 3 was independently associated with OM (hazard ratio 1.38, 95% CI 1.01–1.77; P = 0.01). Conclusions In a cohort of elderly patients with UBC treated with RC, fibrinogen and mGPS appeared to be the most relevant prognostic measurements and increased the accuracy of clinicopathological preoperative models to predict major postoperative complications, disease recurrence and mortality. Abbreviations ASA: American Society of Anesthesiologists; CCI: Charlson Comorbidity Index; CIS: carcinoma in situ; CRP: C-reactive protein; CSM: cancer-specific mortality; CSS: cancer-specific survival; ECOG PS: Eastern Cooperative Oncology Group Performance Status; HDL: high-density lipoprotein; (S)HR: (subdistribution) hazard ratio; LND: lymphadenectomy; LVI: lymphovascular invasion; mGPS: modified Glasgow Prognostic Score; NLR: neutrophil-to-lymphocyte ratio; NOC: non-organ-confined; OM: overall mortality; OR: odds ratio; OS: overall survival; RC: radical cystectomy; RNU: radical nephroureterectomy; UBC: urothelial bladder cancer; UTUC: upper urinary tract urothelial carcinoma

Introduction Chronic obstruction and stones formation are common in pelvic ectopic kidney (PEK), and stone treatment in such conditions can be challenging. Aim of this systematic review was to examine all the available active treatment modalities for PEK stones in order to critically appraise their advantages and limitations. Evidence acquisition A search on Medline, Embase, and the Cochrane Library databases was performed to identify literature focused on the active treatment of PEK stones. Original articles, case report and case series were included in the search. The systematic review was conducted in accordance to the PRISMA checklist. The study period went from inception of databases to October 2019. Evidence synthesis Of the 256 articles identified, 23 met the inclusion criteria. 334 patients were included in the studies and 119 had stones in PEK. Five patients were treated with SWL, 40 with ureterorenoscopy, 37 with percutaneous nephrolithotomy both by ultrasound/X-Ray or lap-assisted puncture, and 37 with minimally invasive laparoscopic or robot assisted pyelolithotomy. Overall, stone free rate after first treatment was higher in minimally invasive laparoscopic or robot assisted pyelolithotomy (97.2%) compared to percutaneous nephrolithotomy (84.96%) and ureterorenoscopy studies (65.94%). The higher complication rate was reported in percutaneous nephrolithotomy not lap-assisted (33.3%). Conclusions The choice of the approach depends on different factors such as stone size, density and location in accordance with upper urinary tract alterations, kidney anatomy and operator experience. The choice of a retrograde, percutaneous or lap/robot approach should be carefully selected evaluating upper urinary tract anatomy and stone features.

Purpose: The conservative management of localized renal masses has been recently widened to cT2 tumors showing encouraging functional and oncological outcomes (1). This video aims to report the conservative management of a highly complex renal tumor treated with robotic pure enucleation in our center, specifically focusing on preoperative work-up, video-reported surgical steps and perioperative outcomes. Materials and Methods: A 63 year-old lady underwent CT scan revealing a single 75 x 68mm, mainly endophytic, right renal mass dislocating the vascular pedicle (cT3a). Two renal arteries and two veins were identified. PADUA, RENAL and simplified SPARE scores were 14a, 12a and 12 respectively. Since the contralateral kidney was hypotrophic, the indication for nephron-sparing approach was considered absolute. Preoperative surgical planning included the employment of 3D-virtual models (2). Results: Operative time was 150 minutes and warm ischemia time was 25 minutes. No major complication occurred. Histopathological analysis revealed a cromophobe renal cell carcinoma with extension to perirenal fat tissue (pT3a). Resection technique was classified as pure enucleation since Surface-Intermediate-Base (SIB) score was 0-0-0 (3, 4). At seven-months follow-up no signs of local or systemic recurrence were recorded. Postoperative CT-scan revealed optimal parenchymal volume preservation with last creatinine blood level of 1.16mg/dL. Conclusion: This video highlights how, in experienced hands, robotic partial nephrectomy represents a feasible, effective treatment option for surgical management of highly complex renal tumors. The employment of intraoperative ultrasonography and 3D-virtual models allowed to accurately tailor surgical approach, improving the perception of tumor anatomy and its vascularization and maximizing perioperative outcomes.

Context Smoking habit at the time of surgery is associated with higher perioperative complications and mortality across different types of surgeries. In recent years, several studies have attempted to explore the influence of smoking on perioperative outcomes following radical cystectomy (RC) for urothelial bladder cancer (UBC) with contradictory results. Objective To systematically investigate and meta-analyze the association between smoking habit and perioperative morbidity and mortality in UBC patients treated with RC. Evidence acquisition A systematic review of the literature published between January 2000 and January 2020 investigating the impact of smoking habit on perioperative outcomes of patients treated with RC for UBC was performed according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement and the Cochrane Handbook for Systematic Reviews of Interventions. Evidence synthesis Overall, 27 articles involving 27 854 patients were included in the systematic review, and of these, 11 studies were included in the meta-analysis. The studies included showed a moderate to high risk of bias. Smoking status (smokers vs nonsmokers) was significantly associated with the onset of major postoperative complications (hazard ratio [HR] 1.87, 95% confidence interval [CI] 1.51–2.32; I2 = 0%), infections (HR 1.34, 95% CI 1.02–1.72; I2 = 66.2%), and mortality (HR 1.84, 95% CI 1.14–2.98; I2 = 4.9%). Conclusions Smoking status at the time of RC is associated with increased risk for major postoperative complications, infections, and mortality. These results suggest the need for strict postoperative monitoring in smokers due to the increased risk of experiencing adverse events and underline the need for intensive smoking cessation interventions in the preoperative setting. Patient summary In this study, we reviewed the impact of smoking habit on perioperative outcomes following radical cystectomy (RC). Based on the available data, the impact of smoking on morbidity and mortality after RC is significant and relevant; as such, every effort should be made in the preoperative setting to encourage smoking cessation.

INTRODUCTION Transurethral resection of the prostate (TURP) remains the gold standard for treatment of benign prostatic hyperplasia (BPH). Yet, the introduction of lasers for the treatment of LUTS due to BPO has dramatically changed the surgical landscape of benign prostatic obstruction (BPO) treatment. Recently, "en-bloc" techniques have shown to prove advantageous in terms of better visualization, more prompt identification of the surgical capsule and the correct plane to dissect. Herein we provide a comprehensive overview of available series of en-bloc enucleation of the prostate, focusing on surgical techniques, perioperative and functional outcomes. EVIDENCE ACQUISITION A systematic review of the literature was performed according to PRISMA recommendations and was conducted on surgical techniques and perioperative outcomes of minimally invasive en-bloc surgery for prostate adenoma detachment. EVIDENCE SYNTHESIS Overall, 16 studies with 2750 patients between 2003 and 2019 were included. Specific technical nuances have been described to maximize perioperative outcomes of en-bloc prostatic enucleation, including early apical release, horse-shape incisions, inverted U-shape tractions and low power. Overall, regardless of the energy employed, en-bloc prostatic enucleation achieved favorable outcomes including low risk of major complications and quality of life improvement. However, a great heterogeneity of study design, patients' inclusion criteria, prostate volume and en-bloc surgical strategy was found. CONCLUSIONS En-bloc endoscopic enucleation of the prostate has been shown to be technically feasible and safe, with potential technical advantages over the classic three-lobe technique. Larger comparative studies are needed to evaluate the ultimate impact of the en-bloc approach on postoperative outcomes, in light of the surgeon's learning curve.

Minimally invasive techniques can be a valuable alternative to traditional surgery with low cost, low risk of complications, high utility, and high reproducibility without preventing the surgery at later date if they should fail. All techniques can be performed under computed tomography or fluoroscopy guidance and under local anesthesia in outpatient surgery. All procedures can be performed at the cervical or lumbar level. The rationale for all percutaneous treatments is to reduce intradiskal pressure in different ways, creating the space required for retropulsion of the disk.

Recently, the Cormio et al. nomogram has been developed to predict prostate cancer (PCa) and clinically significant PCa using benign prostatic obstruction parameters. The aim of the present study was to externally validate the nomogram in a multicentric cohort. Between 2013 and 2019, patients scheduled for ultrasound-guided prostate biopsy were prospectively enrolled at 11 Italian institutions. Demographic, clinical and histological data were collected and analysed. Discrimination and calibration of Cormio nomogram were assessed with the receiver operator characteristics (ROC) curve and calibration plots. The clinical net benefit of the nomogram was assessed with decision curve analysis. Clinically significant PCa was defined as ISUP grade group > 1. After accounting for inclusion criteria, 1377 patients were analysed. 816/1377 (59%) had cancer at final pathology (574/816, 70%, clinically significant PCa). Multivariable analysis showed age, prostate volume, DRE and post-voided residual volume as independent predictors of any PCa. Discrimination of the nomogram for cancer was 0.70 on ROC analysis. Calibration of the nomogram was excellent (p = 0.94) and the nomogram presented a net benefit in the 40–80% range of probabilities. Multivariable analysis for predictors of clinically significant PCa found age, PSA, prostate volume and DRE as independent variables. Discrimination of the nomogram was 0.73. Calibration was poor (p = 0.001) and the nomogram presented a net benefit in the 25–75% range of probabilities. We confirmed that the Cormio nomogram can be used to predict the risk of PCa in patients at increased risk. Implementation of the nomogram in clinical practice will better define its role in the patient’s counselling before prostate biopsy.

To compare the safety of on- vs off-clamp robotic partial nephrectomy (RAPN).302 patients with RENAL masses ≤ 10 were randomized to undergo on-clamp (150) vs off-clamp (152) RAPN (CLOCK trial-ClinicalTrials.gov NCT02287987) at seven institutions by one experienced surgeon per institution. Intra-operative data, complications, and positive surgical margins were compared.Due to a relevant rate of shift from the assigned treatment, the per-protocol analysis only was considered and the data from 129 on-clamp vs 91 off-clamp RAPNs analyzed. Tumor size (off-clamp vs on-clamp, 2.2 vs 3.0 cm, p 0.001) and RENAL score (5 vs 6, p 0.001) significantly differed. At univariate analysis, no differences were found regarding intra-operative estimated blood loss (off- vs on-clamp, 100 vs 100 ml, p = 0.7), post-operative complications rate (19% vs 26%, p = 0.2), post-operative anemia (Hb decrease 2.5 g/dl 26% vs 27%, p = 0.9; transfusion rate 3.4% vs 6.3%, p = 0.5; re-intervention due to bleeding 1.1% vs 4%, p = 0.4), acute kidney injury (4% vs 6%, p = 0.8), and positive surgical margins (3.5% vs 8.2%, p = 0.1). At multivariate analysis accounting for tumor diameter and complexity, considering the on-clamp group as the reference category, a significant difference was noted in the off-clamp group exclusively for blood loss (OR 0.3, 95% CI 0.09-0.52, p = 0.008).The on-clamp and off-clamp approaches for RAPN showed a comparable safety profile.

Aims To present the long term-results and complications of a large series of stapled ileal orthotopic neobladders. Materials and methods From 1992 to 2012 we performed 606 radical cystectomies with stapled orthotopic neobladder substitution in male patients. The median patient age was 65 years (interquartile range [IQR]: 58–71). Results Median operative time was 205 min (IQR: 180–225). The overall survival rates at 5, 10, 15, and 20 yr were 68% (336 of 494), 55% (207 of 376), 38% (98 of 259), and 23% (14 of 62), respectively, and the disease specific survival rates were 75% (371 of 494), 59% (222 of 376), 50% (130 of 259), and 35% (22 of 62), respectively. After a median follow-up of 81 months (IQR: 30–144), a total of 147 early (less than 90 days) complications (38 diversion related, 109 diversion unrelated) occurred in 144 patients (24%); 163 late complications (141 diversion related, 22 diversion unrelated) affected 141 patients (23%). At 60 months, daytime and nighttime continence was complete in 96% and 72% of cases, respectively. Urodynamic studies showed that maximum capacity, residual volume, maximum flow rate, pressure at maximum capacity, and maximum outlet closure pressure were not statistically different at 12 and 60 months postoperatively. Conclusions The use of a stapler when performing orthotopic neobladders significantly reduces the operating time, and offers good functional results with acceptable complication rates. Our results could encourage the use of a stapler when performing an ileal neobladder during laparoscopic and robotic radical cystectomies.

Objective To demonstrate the oncologic and functional results of seminal-sparing cystectomy (SSC) in patients with bladder cancer (BC) and to describe the evolution of our surgical technique over a 20-year period. Methods From 1990 to 2009 we performed SSC in 88 patients with non–muscle-invasive BC and in 10 patients with muscle-invasive BC away from the bladder neck. Sixty-one of the 98 patients (1990-2002) underwent cystoadenomectomy with ileocapsuloplasty (ICP), consisting of the anastomosis between the Camey II ileal reservoir and the upper edge of the prostatic capsule. This technique was affected by a relevant percentage of anastomotic stricture (11%). From 2003 to 2009, we performed the endocapsular ileourethral anastomosis (EIUA) in 30 patients, on the basis of the direct anastomosis between the ileal reservoir and the urethral stump inside the prostatic apex. Seven patients were lost to follow-up. Results After a mean follow-up of 102 months, 81 patients (89%) were alive, and 10 patients (11%) had died (8 of disease progression). Early and late complication rates were 25% and 24%, respectively. Complete daytime continence was obtained in 87 patients (95.6%), and nighttime continence was achieved in 34 patients (37%). In the ICP group, stricture of the prostatic fossa affected 7 patients (11%), whereas no neobladder-urethral anastomosis stricture was noticed in the EIUA group. Normal erectile function was preserved in 87 patients (95.6%). Conclusion SSC offers good oncologic and functional results in carefully selected patients. EIUA represents an evolution from ICP because EIUA reduces the risk of stenosis.

Spine is a multiarticular system formed by column, muscles and tendons and central nervous system. It supports the head and trunk during posture and movements and at the same time it protects the spinal cord and the nerve roots. Its function presupposes stability which is obtained with bony and soft movement restraints.

The increasing trend of performing radical cystectomy with a minimally invasive approach has made stapled neobladders an attractive alternative to hand-sewn pouches. To date, data on the incidence and clinical impact of stone formation in long surviving neobladder cases are scarce. We report a long-term, single-center experience of stapled orthotopic ileal neobladder and identify predictors of stone formation.From May 2001 to October 2012, 445 consecutive patients (388 male, 57 female) underwent radical cystectomy and stapled orthotopic ileal neobladder. Univariable and multivariable analyses were performed to identify independent predictors of an increased risk of stone formation.At a median followup of 41 months (IQR 16-58) neobladder stone formation occurred in 41 patients (9.2%). All of these patients successfully underwent endoscopic stone lithotripsy with 34 as outpatient procedures. On univariable Cox analysis only female gender (p = 0.001, HR 3.29, 95% CI 1.59-6.83) and intermittent self-catheterization (p0.001, HR 15.2, 95% CI 5.87-39.5) were associated with an increased risk of stone formation. On multivariable analysis the only independent predictor of stone formation was intermittent self-catheterization (p = 0.001, HR 8.98, 95% CI 2.59-31.1).In our series of stapled orthotopic ileal neobladders the rate of stone formation was comparable to that reported in the literature for completely hand-sewn ileal reservoirs. The only variable independently predictive of stone formation was intermittent self-catheterization.

Aims To report feasibility, safety and effectiveness of “zero-ischemia” laparoscopic partial nephrectomy (LPN) following preoperative superselective transarterial embolization (STE) for clinical T1 renal tumors. Methods We retrospectively reviewed perioperative data of 23 consecutive patients, who underwent STE prior LPN between March 2010 and November 2012 for incidental clinical T1 renal mass. STE was performed by two experienced radiologists the day before surgery. Surgical procedures were performed in extended flank position, transperitoneally, by a single surgeon. Results Mean patients age was 68 years (range 56–74), mean tumor size was 3.5 cm (range 2.2–6.3 cm). STE was successfully completed in 16 patients 12–15 h before surgery. In 4 cases STE failed to provide a complete occlusion of all feeding arteries, while in 3 cases the ischemic area was larger than expected. LPN was successfully completed in all patients but one where open conversion was necessary; a “zero-ischemia” approach was performed in 19/23 patients (82.6%) while hilar clamp was necessary in 4 cases, with a mean warm-ischemia time of 14.8 min (range 5–22). Mean operative time was 123 min (range 115–130) and mean intraoperative blood loss was 250 mL (range 20–450). No patient experienced postoperative acute renal failure and no patient developed new onset IV stage chronic kidney disease at 1-yr follow-up. Conclusions STE is a viable option to perform “zero-ischemia” LPN at beginning of learning curve; however, hilar clamp was necessary to achieve a relatively blood-less field in 17.4% of cases.

Inferior vena-cava (IVC) injuries are uncommon but mortality is high, despite the improved organization and technical skills. The most important prognostic factors are the grade of hemorragic shock, the anatomical level of caval injury and the associated vascular lesions. Supra and retro-hepatic lacerations have the worst prognosis and their management is more difficult, as it's sometimes necessary performing complicated and high mortality related procedures, such as atrio-caval shunt and total vascular occlusion. Still controversial is the management of retroperitoneal hematomas due to suspect caval laceration. Non-operative treatment can represent a good option in non-pulsatile hematomas, while packing can be performed in case of very poor hemodynamic condition, delaying definitive surgical treatment. Vascular repair by primary venorrhaphy can usually be performed, sometimes a patch is to be used. Infrarenal cava ligation can be an acceptable, significant complication free option. Caval thrombosis and pulmonary embolism represent the most important but uncommon complications. US and CT-scan are used in non-invasive follow-up of injuried IVC but timing is still controversial.