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Osteomyelitis of the pubic symphysis is a rare condition often occurring in patients with radiation therapy-related urethral strictures after prostate cancer treatment.We retrospectively reviewed patients who presented with osteomyelitis of the pubic symphysis from November 2016 to September 2021. We investigated the factors leading to urosymphyseal fistulas, clinical presentation, radiological assessment, treatments, and outcomes.A total 4 cases were collected. All patients underwent surgery and adjuvant or salvage radiotherapy for prostate cancer. Subsequently, they developed stricture of the vesicourethral anastomosis which was initially treated conservatively. Symptoms of pubic bone osteomyelitis included pain in the pubic area, fever, difficulty walking, and recurrent urinary tract infections. In all cases, computed tomography and magnetic resonance imaging showed a urinary fistula arising from the vesicourethral anastomosis with the involvement of the pubic bone, and severe osteomyelitis. Due to the failure of conservative treatment, debridement of the pubic bone with cystectomy and ileal conduit was performed in 3 patients. One patient refused surgery and bilateral percutaneous nephrostomies were placed. Patients regained their original performance status 1 to 6 months after surgery.General recommendations for the best diagnostic and therapeutic approach to osteomyelitis of the pubic symphysis due to urosymphyseal fistula still do not exist. Conservative treatment often fails and a surgical approach with definitive urinary diversion may be required.

Intraoperative adverse events (iAEs) are surgical and anesthesiologic complications. Despite the availability of grading criteria, iAEs are infrequently reported in the surgical literature and in cases for which iAEs are reported, these events are described with significant heterogeneity.To develop Intraoperative Complications Assessment and Reporting with Universal Standards (ICARUS) Global Surgical Collaboration criteria to standardize the assessment, reporting, and grading of iAEs. The ultimate aim is to improve our understanding of the nature and frequency of iAEs and our ability to counsel patients regarding surgical procedures.The present study involved the following steps: (1) collecting criteria for assessing, reporting, and grading of iAEs via a comprehensive umbrella review; (2) collecting additional criteria via a survey of a panel of experienced surgeons (first round of a modified Delphi survey); (3) creating a comprehensive list of reporting criteria; (4) combining criteria acquired in the first two steps; and (5) establishing a consensus on clinical and quality assessment utility as determined in the second round of the Delphi survey.Panel inter-rater agreement and consistency were assessed as the overall percentage agreement and Cronbach's α.The umbrella review led to nine common criteria for assessing, grading, and reporting iAEs, and review of iAE grading systems led to two additional criteria. In the first Delphi round, 35 surgeons responded and two criteria were added. In the second Delphi round, 13 common criteria met the threshold for final guideline inclusion. All 13 criteria achieved the consensus minimum of 70%, with agreement on the usefulness of the criteria for clinical and quality improvement ranging from 74% to 100%. The mean inter-rater agreement was 89.0% for clinical improvement and 88.6% for quality improvement.The ICARUS Global Collaboration criteria might aid in identifying important criteria when reporting iAEs, which will support all those involved in patient care and scientific publishing.We consulted a panel of experienced surgeons to develop a set of guidelines for academic surgeons to follow when publishing surgical studies. The surgeon panel proposed a list of 13 criteria that may improve global understanding of complications during specific procedures and thus improve the ability to counsel patients on surgical risk.

Objective Italy is facing the COVID‐19 outbreak with an abrupt reorganization of its national health‐system, in order to augment care provision to symptomatic patients. The sudden shift of personnel and resources towards COVID‐19 care has led to the reduction of surgery, with possible severe drawbacks. The aim of the study is to describe the trend in surgical volume in urology, in Italy. Materials and Methods Thirty‐three urological units with physicians affiliated to the AGILE consortium were involved in a survey. Urologists were asked to report the amount of surgical elective procedures week‐by‐week, from the beginning of the emergency to the following month. Results The 33 hospitals involved in the study account, globally, for 22,945 beds and are distributed in 13/20 Italian regions. Before the outbreak, the involved urology units performed an overall amount of 1,213 procedures per week, half of which were oncological. One month later, the amount of surgery declined by 78%. Lombardy, the first region with positive‐cases, experienced a 94% reduction. The decrease in oncological and non‐oncological surgical activity was 35,9% and 89%, respectively. The trend of the decline showed a delay of roughly 2 weeks for the other regions. Conclusion Italy, the country with the highest fatality rate from COVID‐19, is experiencing a sudden decline in surgical activity. It is inversely related to the increase in COVID‐19 care, with potential harm particularly in the oncological field. The Italian experience can be helpful for future surgical pre‐planning in other countries not so hardly hit by the disease yet.

Introduction: COVID-19 outbreak represented an unprecedented event that led to a redefinition of health care systems worldwide The impact of the emergency required a deviation of the care toward the assistance to COVID-19 patients, with reduction of resources for elective activities, including surgery We aim to report the decrease of urological surgical activity during the first weeks from the beginning of the pandemic, aiming to highlight the prioritization we applied to select patients for surgery Materials and methods: Thirty-three urological units with physicians affiliated to the AGILE group were involved in a survey Urologists were asked to report the amount of surgical elective procedures week- by-week, from the beginning of the emergency to the following month The type of surgery (oncologic, for urolithiasis, for benign prostate obstruction, other) was assessed as well Results: The 33 hospitals involved in the study account, globally, for 22,945 beds and are distributed in 13/20 Italian regions Before the outbreak, the involved urology units performed an overall amount of 1,213 procedures per week, half of which were oncological By the 20 of March, the amount of surgery declined by 78% Lombardy, the first region with positive-cases, experienced a 94% reduction The decrease in oncological and non- oncological surgical activity was 35,9% and 89%, respectively Among non-oncological procedures, stone surgery declined by 35,9% as well, whereas BPH and minor urological procedures completely dropped Reassessing for surgical activity on 20, April, a slight trend toward surgical restoration (+11%) started to appear Conclusions: Italy, the country with the highest fatality rate from COVID-19, had experienced a sudden decline in surgical activity;by the end of April, a current trend toward restoration of surgery started to appear Criteria for prioritization were consistent with an urgent/ emergent principle, with trauma, tumours and septic conditions being the ones prioritized The Italian experience can be helpful for future surgical pre-planning in other countries or pandemic settings Smart Communications (SC1–SC28) Andrology

Purpose: The coronavirus disease 2019 (COVID-19) pandemic has put a substantial burden on the Italian healthcare system, resulting in the restructuring of hospitals to care for COVID-19 patients. However, this has likely impacted access to care for patients experiencing other conditions. We aimed to quantify the impact of COVID-19 on access to care for patients with urgent/emergent urological conditions throughout Italy. Materials and Methods: A questionnaire was sent to 33 urological units in the AGILE consortium, asking clinicians to report on the number of urgent/emergent urological patients seen and/or undergoing surgery over a 3-week period during the peak of the COVID-19 outbreak and a reference week prior to the outbreak. ANOVA and linear regression models were used to quantify these changes. Results: Data from 27 urological centres in Italy showed a decrease from 956 patients/week seen just prior to the outbreak to 291 patients/week seen by the end of the study period. There was a difference in the number of patients with urgent/emergent urological disease seen within/during the different weeks (all p values < 0.05). A significant decrease in the number of patients presenting with haematuria, urinary retention, urinary tract infection, scrotal pain, renal colic, or trauma and urgent/emergent cases that required surgery was reported (all p values < 0.05). Conclusion: In Italy, during the COVID-19 outbreak there has been a decrease in patients seeking help for urgent/emergent urological conditions. Restructuring of hospitals and clinics is mandatory to cope with the COVID-19 pandemic; however, the healthcare system should continue to provide adequate levels of care also to patients with other conditions.

BACKGROUND: In the past years several reviews have analysed different aspects of surgical techniques for patients with LUTS due to BPE however none of them have concentrated on large prostates treatment exclusively. Moreover, none of the reviews have focused on level 1 evidence which is essential to avoid bias and wrong conclusions. With this knowledge in mind, aim of the present review is to analyse the available randomized clinical trials assessing the management of patients with big prostates (>80cc). EVIDENCE ACQUISITION: A systematic review of the literature using the Medline, Scopus and Web of Science databases for relevant articles published until January 2019 was performed using both the Medical Subjects Heading and free test protocols. The search was conducted by combining the following terms: "Enucleation", "Prostate", "Benign Prostatic Hyperplasia", "Holmium", "laser", "adenomectomy" "Randomized clinical trial", "Big" "large" "prostate", ">80", "≥80", "transurethral resection of prostate", "Thulium", "Diode", "laparoscopy", "robotic", "Plasmakinetic", "green light" "532 nm" "YAG" "Lower Urinary tract symptoms". Only randomized clinical trials were included in the analysis. EVIDENCE SYNTHESIS: Overall 9 RCTs were retrieved with most of them reporting data at 1 year. The present trials compared enucleation, vaporization and open techniques between each other. In terms of perioperative outcomes all the techniques had similar operative times and resected weight however catheterization time and hospital stay were better in endoscopic techniques when compared to open surgery. In terms of functional outcomes (IPSS, QMAX and PVR) none of the techniques was proven superior to the other. When considering complications open procedures carried a higher risk of transfusions whileno technique was proven superior to the others in terms of transient urge urinary incontinence, bladder neck contracture and reintervention. Only one trial was retrieved reporting five years data confirming the safety, efficacy and durability of simple prostatectomy SP and holmium laser enucleation of the prostate at five years. CONCLUSIONS: According to our review no technique may be considered better than the other when treating large adenomas. Studies are still lacking to prove long term efficacy and future studies should clarify the role of prostatic artery embolization and minimally invasive simple prostatectomy in the management of prostates larger than 80 ml.

The treatment of bladder diverticula consists of diverticulectomy, mainly by a laparoscopic approach or transurethral resection of the diverticular neck and fulguration of the mucosa. The endoscopic approach is generally dedicated to small diverticula. The aim of this study was to compare laparoscopic diverticulectomy versus endoscopic fulguration for bladder diverticula larger than 4 cm.A retrospective review of the medical records of consecutive patients undergoing endoscopic or laparoscopic treatment for bladder diverticula larger than 4 cm at two tertiary hospitals was performed. Therapeutic success was defined as either complete resolution or a decrease of at least 80% in the size of the diverticulum. Complications were recorded and graded according to the Clavien-Dindo classification.All patients were treated with transurethral resection of the prostate in the same operative session. The endoscopic group included a cohort of 20 male patients. The median age, diverticular diameter and operative time were 65 years, 7 cm and 62.5 min, respectively. No early postoperative complications were observed. Therapeutic success was achieved in 15 cases (75%). The laparoscopic group included a cohort of 13 male patients with a median age of 63 years and median diverticular diameter of 7.0 cm. The median operative time was 185 min (p 0.0001). Two grade III postoperative complications were observed (15.3%). Therapeutic success was achieved in all patients (100%).Acquired bladder diverticula larger than 4 cm can be effectively managed either by a laparoscopic approach or by endoscopic fulguration.

Background The National Research Council (CNR) prostate cancer monitoring project in Italy (Pros-IT CNR) is an observational, prospective, ongoing, multicentre study aiming to monitor a sample of Italian males diagnosed as new cases of prostate cancer. The present study aims to present data on the quality of life at time prostate cancer is diagnosed. Methods One thousand seven hundred five patients were enrolled. Quality of life is evaluated at the time cancer was diagnosed and at subsequent assessments via the Italian version of the University of California Los Angeles-Prostate Cancer Index (UCLA-PCI) and the Short Form Health Survey (SF-12). Results At diagnosis, lower scores on the physical component of the SF-12 were associated to older ages, obesity and the presence of 3+ moderate/severe comorbidities. Lower scores on the mental component were associated to younger ages, the presence of 3+ moderate/severe comorbidities and a T-score higher than one. Urinary and bowel functions according to UCLA-PCI were generally good. Almost 5% of the sample reported using at least one safety pad daily to control urinary loss; less than 3% reported moderate/severe problems attributable to bowel functions, and sexual function was a moderate/severe problem for 26.7%. Diabetes, 3+ moderate/severe comorbidities, T2 or T3-T4 categories and a Gleason score of eight or more were significantly associated with lower sexual function scores at diagnosis. Conclusions Data collected by the Pros-IT CNR study have clarified the baseline status of newly diagnosed prostate cancer patients. A comprehensive assessment of quality of life will allow to objectively evaluate outcomes of different profile of care.

Background There is no clear consensus as to the optimal method of entry in laparoscopic renal surgery and no reports have compared them in Urology. To analyze contemporary practice patterns in entry technique and port placement for laparoscopic kidney surgery. Methods We identified 60 high volume urological laparoscopic centers. A purpose-built questionnaire was sent to surgeons. The survey included 22 questions regarding access techniques and port configuration during laparoscopic kidney surgery. Data on were collected and retrospectively analyzed. Concordance among port configurations was assessed using Cohen's Kappa statistics. Results The survey was sent to 60 surgeons and completed by 32 of them. Surgical procedures included were laparoscopic radical nephrectomy (1177 LRN/year) and laparoscopic partial nephrectomy (1047 LPN/year). The transperitoneal route was preferred (85%). Hasson technique was used for the access in 55% of the cases. Patient lateral recumbent position is the most frequently used during the port placement (41%). Although there is a high variability in the port positioning among the surgeons, in more than 90% of cases it was found a specific concordance in triangulation of optics and operating trocars. There were no significant differences between port configuration in LRN and LPN. Limitations include retrospective design and limited sample. Conclusions A standard port configuration has not been previously reported in urological literature. Our study suggests that the transperitoneal approach, the Hasson technique and a specific triangulation of optics and operating trocars have a significant concordance in some high volume laparoscopic urologic centers.

Aim The aim of our study is to evaluate the status of positive margins (PSMs) comparing their incidence between aparoscopic radical prostatectomy (LRP) and robot assisted radical prostatectomy (RARP) in centers with medium case-load (50–150 cases/year). We also analyzed the correlations between surgical technique, nerve-sparing approach (NS), and incidence of PSMs, stratifying our results by pathological stage. Materials and methods We analyzed 1992 patients who underwent RP in various urologic centers. We evaluated the incidence of PSMs, and then we compared the stage-related incidence of PSMs, for both the techniques. Results We did not find a statistically significant difference between the two surgical modalities in the study regarding the overall incidence of PSMs. Conclusions In our retrospective study, we did not find any difference in terms of PSMs in RARP versus LRP. Our PSMs were not negligible, particularly in pT3 stages, compared with high-volume centers; surgical experience and patients' selection can be a possible explanation.

The treatment of ureteral strictures represents a challenge due to the variability of aetiology, site and extension of the stricture; it ranges from an end-to-end anastomosis or reimplantation into the bladder with a Boari flap or Psoas Hitch. Traditionally, these procedures have been done using an open access, but minimally invasive approaches have gained acceptance. The aim of this study is to evaluate the safety and feasibility and perioperative results of minimally invasive surgery for the treatment of ureteral stenosis with a long-term follow-up. Data of 62 laparoscopic (n = 36) and robotic (n = 26) treatments for ureteral stenosis in 9 Italian centers were reviewed. Patients were followed according to the referring center's protocol. Laparoscopic and robotic approaches were compared. All the procedures were completed successfully without open conversion. Average estimated blood loss in the two groups was 91.2 ± 71.9 cc for the laparoscopic and 47.2 ± 32.3 cc for the robotic, respectively (p = 0.004). Mean days of hospitalization were 5.9 ± 2.4 for the laparoscopic group and 7.6 ± 3.4 for the robotic group (p = 0.006). No differences were found in terms of operative time and post-operative complications. After a median follow-up of 27 months, the robotic group yielded 2 stenosis recurrence, instead the laparoscopic group shows no cases of recurrence (p = 0.091). Minimally invasive approach for ureteral stenosis is safe and feasible. Both robotic and pure laparoscopic approaches may offer good results in terms of perioperative outcomes, low incidence of complications and recurrence.

Objectives Previous prospective studies of the surgical treatment of locally advanced prostate cancer have enrolled patients selected on the basis of a limited T3 disease extension. The aim of the present study was to assess the feasibility and the oncologic outcome of radical prostatectomy administered to a consecutive unselected series of advanced, non-bone metastatic prostate cancers. Methods Between March 1998 and February 2003 radical prostatectomy was offered at our institution to any patient diagnosed with prostate cancer with no sign of extranodal metastatic disease. Data on morbidity and survival for 51 clinically advanced cases (any T ≥3, N0–N1, or any N1 or M1a disease according to the TNM 2002 classification system) operated on by a single expert surgeon were compared with a series of 152 radical prostatectomies performed during the same period by the same operator for clinically organ-confined disease. Adjuvant treatment was administered according to current guidelines. Results The two groups did not differ significantly in surgical morbidity except for blood transfusion, operative time, and lymphoceles, which showed a higher rate in patients with advanced disease. The Kaplan-Meier estimate of overall survival and prostate cancer–specific survival at 7 yr were 76.69% and 90.2% in the advanced disease group and 88.4% and 99.3% in the organ-confined disease group, respectively. Conclusions Even in the scenario of extensive surgical indications up to M1a disease, radical prostatectomy proved to be technically feasible and to have an acceptable morbidity rate compared with organ-confined disease. Our initial survival data strengthen the role for surgery as an essential part in the multimodal approach to treating advanced prostate cancer.

Ehlers-Danlos syndrome type IV (vascular EDS), is a life-threatening inherited connective tissue disorder resulting from mutations in the COL3A1 gene coding for type III procollagen. Vascular EDS causes severe fragility of connective tissues. We report a case of a 26-year-old male with bilateral staghorn renal calculi, the patient underwent a left nephrolithotomy, during the suspension of the renal artery incredibly, it was lacerated by the vessel loop, without any actraction. Subsequently, all hemostatic attempts, although gentle, resulted in important and catastrophic aortic and caval injures; the patient died due to an uncontrollable abdominal and thoracic hemorrhage. The early diagnosis of the vascular EDS is difficult if there are no known cases. Every surgical procedure in patients with Enlers-Danlos syndrome has a high risk of fatal vascular injuries.

The Trans Obturator Tape (TOT) is a new technique, based on positioning of a tape under the middle urethra through the obturator foramina. The outcomes and complications of the TOT at 1 year follow up were evaluated. Materials and Methods 50 patients underwent to TOT for stress urinary incontinence (SUI) have been prospectively evaluated. In the first 6 patients was used the Uratape, a polypropylene tape covered by silicon in the middle part. Eventually, because of 1 case of extrusion due to the silicon part, it was created and used the Obtape, the same tape without the silicon part. The patient was positioned in lithotomy position and a Foley catheter was inserted. A small (2 cm) incision was performed 1 cm below the external meatus in order to allow the digital dissection of the paraurethral. Through the skin the obturator foramen was identified and a small incision was done in the medial part just above the level of the urethral meatus bilaterally. Eventually a hooked tunneler was inserted through the incision at the level of the obturator foramen and the obturator fascia is perforated anteroposteriorly. The tunneler is than directed medially in the paraurethral space previously prepared and under direct digital control. The tape is inserted into the eye of the tunneler to retract the tape through the obturator foramina. The procedure is repeated on the other side. Patients were evaluated preoperatively, at 1, 6, 12 months of follow up with a physical examination, validated questionnaire (AUA score) and reported percentage of improvement, and uroflowmetry. Results The mean age was 57 (range 36 – 76). 70% of the patients had urodynamic stress incontinence, 30% had stress incontinence associated with urgency. The median follow up was 12 months (range 1–24 months). - The average of the AUA score has been decreased of 13 points (form 16 to 3) and the average percentage of improvement was 81 % up to a maximum follow up of 18 months. - 88% (44/50) patients were dry one year after the surgery and 12% (6/50) were improved.- No significant changes in uroflowmetry parameters. One case of extrusion have been reported, using the Uratape, no cases of extrusion have been reported using the Obtape. One patient had developed new urgency. Conclusions The Trans Obturator Tape is a simple, direct and quick procedure. It is associated with good outcomes and high patient satisfaction up to an average follow up of 12 months. Additionally the Obtape does not seem associate to erosion, extrusion or alteration of the normal voiding.

To compare surgical results, morbidity and positive surgical margins rate of patients undergoing robotic partial nephrectomy (RPN) versus open partial nephrectomy (OPN). This is an observational multicenter study promoted by the “Associazione GIovani Laparoscopisti Endoscopisti” (AGILE) no-Profit Foundation, which involved six Italian urologic centers. All clinical, surgical, and pathological variables of patients treated with OPN or RPN for renal tumors were gathered in a prospectively maintained database. Tumor nephrometry was measured with PADUA score, and complications were stratified with modified Clavien system. Differences between RPN and OPN group were assessed with univariate analysis. Perioperative variables independently associated with complications were assessed with multivariate analysis. A total of 198 and 105 patients were enrolled in OPN and RPN group, respectively. Both had similar demographics, indications to surgery, tumor nephrometry, renal function, WIT (18.7 vs. 18.2 min; p = NS), positive margin rate (5.6 vs. 5.7 %; p = NS), intraoperative complications, and postoperative medical complications. Compared to OPN, RPN group was significantly more morbid (p = 0.04), included tumors with smaller size (p = 0.002), had longer operative time (p

The R.E.N.A.L. nephrometry nomogram (RNN) is a statistical tool to predict the malignancy or aggressiveness of renal masses. In this study, we tried an external validation in a cohort of 506 cT1a tumors submitted to partial nephrectomy (PN), showing a poor predictive ability. We can conclude that this nomogram cannot contribute to the preoperative management of small renal masses (SRM). Introduction/Background: The prediction of histology of SRM could be essential for their management. The RNN is a statistical tool designed to predict malignancy or high grading of enhancing renal masses. In this study we aimed to perform an external validation of the RNN in a cohort of patients who received a PN for SRM. Materials and Methods: This was a multicentric study in which the data of 506 consecutive patients who received a PN for cT1a SRM between January 2010 and January 2013 were analyzed. For each patient, the probabilities of malignancy and aggressiveness were estimated preoperatively using the RNN. The performance of the RNN was evaluated according to receiver operating characteristic (ROC) curve, calibration plot, and decision curve analyses. Results: The area under the ROC curve for malignancy was 0.57 (95% confidence interval (CI), 0.51-0.63; P ¼ .031). The calibration plot showed that the predicted probability of malignancy had a bad concordance with observed frequency (Brier score ¼ 0.17; 95% CI, 0.15-0.19). Decision curve analysis confirmed a poor clinical benefi tf rom use of the system. The estimated area under the ROC curve for high-grade prediction was 0.57 (95% CI, 0.49-0.66; P ¼ .064). The calibration plot evidenced a bad concordance (Brier score ¼ 0.15; 95% CI, 0.13-0.17). Decision curve analysis showed the lack of a remarkable clinical usefulness of the RNN when predicting aggressiveness. Conclusions: The RNN cannot accurately predict histology in the setting of cT1a SRM amenable to PN.

Since December 1999 a new adjustable device for female stress urinary incontinence called the ACT (Adjustable Continence Therapy) has been used in a multicentre study. The two year follow-up of the Italian multicentre study is presented. Material & Methods A group of 37 female patients, affected by SUI was evaluated before and after the positioning of the ACT with physical examination, urodynamic study and quality of life questionnaires (I-QOL) Mean age was 58,5 (range 21.9 – 84.6). 59% (22/37) had type II SUI while 42% (15/37) had type III SUI. 57% (21/37) had had prior urogenital surgery. The ACT device consists of an adjustable silicon balloon, a subcutaneously positioned titanium port and a two lumen tube in between. The devices are positioned via a percutaneous perineal approach, using either local or regional anaesthesia. A 2 cm skin incision is made on each labia majora and through these incisions a delivery trocar is directed toward the bladder neck. The trocar is manoeuvred into the desired position using tactile guidance and an image intensifier (III). Each ACT device is then inserted via the delivery tool. Each balloon is positioned lateral to the bladder neck, proximal to the vesico-vaginal space, below the endopelvic fascia. Each balloon is then filled with one to two millilitres of the isotonic contrast/sterile water mixture with X rays confirmation of the correct location. The injection ports attached to each balloon are then positioned subcutaneously in each labia majora; the balloons are subsequently adjusted, if this is required. Results 15 patients reached 24 months of follow-up. 46% of them were dry at physical examination and wear no pads. Additional 26% were significantly improved. This group of patients had to wear 1 pad/daily. 56% of the patients required one adjustment to achieve continence, 10% two adjustments, 10% three adjustments 24% need no adjustments. No cases of urinary retention were reported out of 37 cases. One patient had a transient dyspareunia. Conclusions 70 % of our patients where dry or substantially improved and the patients quality of life increases significantly, this results includes mainly the patient with sever intrinsic sphincter deficiency and failed previous incontinence surgery. The ability to post-operatively adjust the ACT permits to reach the appropriate volume to each patient. However a longer follow up and a bigger number of procedures are required for definitive conclusions.

The incidence of reported male stress urinary incontinence (SUI) status prostate surgery varies widely between 2–40%. While the artificial urinary sphincter (AUS) reports good long-term efficacy, this procedure is associated with a high rate of reoperation. The aim of this study was to assess the results at 1 year of follow up of a new minimally invasive surgical technique called Pro ACT (Adjustable Continence Therapy). Material & Methods The ProACT is a new implant for post-prostatectomy incontinence. A balloon, a port and a tube of connection are the components of the Pro ACT. It is percutaneously implanted and is postoperatively adjustable. From September 2000 to December 2003 16 males underwent to the procedure. The mean age was 56.5 years (range 29–83). The SUI was due in 13 cases to radical retropubic prostatectomy, in one case to TURP, in one case to open prostatectomy for benign prostatic hypertrophy and one case to congenital incontinence associated with epispadia. The urodynamic exam revealed SUI due to intrinsic sphincteric deficiency in all patients. Efficacy was assessed by change in use of average number of pads used daily, and overall impression Results The average number of adjustments after the surgery was 1.6. The average number of pads used decreased from a mean 5.11 at baseline to 1.62 at 12 months. Overall 42.8% of the patients are now completely dry. 28% are improved and 30% are either not improved or only slightly improved. In three of these patients the adjustments are still on going. The only post-operative complication was a migration of both the balloons into the bladder in one patient, which necessitated the removal of both devices as a minor procedure under local anesthetic. Conclusions The ProACT is a new surgical therapy for the male SUI. This technique is easy, quick to learn and associated with a low rate of complications and a satisfactory rate of success. 70% patients were dry or improved at 1-year follow up. The device is well accepted from the patients because it doesn't require any manual skill to operate implanted components. Complications are easily managed because of the possibility to remove the Pro ACTs implants completely, or by simply deflating the balloons via percutaneous injection.

Introduction Standardized methods of reporting complications after radical cystectomy (RC) and urinary diversions (UD) are necessary to evaluate the morbidity associated with this operation to evaluate the modified Clavien classification system (CCS) in grading perioperative complications of RC and UD in a real life cohort of patients with bladder cancer. Materials and methods A consecutive series of patients treated with RC and UD from April 2011 to March 2012 at 19 centers in Italy was evaluated. Complications were recorded according to the modified CCS. Results were presented as complication rates per grade. Univariate and binary logistic regression analysis were used for statistical analysis. Results Results and limitations: 467 patients were enrolled. Median age was 70 years (range 35–89). UD consisted in orthotopic neobladder in 112 patients, ileal conduit in 217 patients and cutaneous ureterostomy in 138 patients. 415 complications were observed in 302 patients and were classified as Clavien type I (109 patients) or II (220 patients); Clavien type IIIa (45 patients), IIIb (22 patients); IV (11 patients) and V (8 patients). Patients with cutaneous ureterostomy presented a lower rate (8%) of CCS type ≥IIIa ( p = 0.03). A longer operative time was an independent risk factor of CCS ≥III (OR: 1.005; CI: 1.002–1.007 per minute; p = 0.0001). Conclusions In our study, RC is associated with a significant morbidity (65%) and a reduced mortality (1.7%) when compared to previous experiences. The modified CCS represents an easily applicable tool to classify the complications of RC and UD in a more objective and detailed way.

In this study we have reviewed patients with prostate cancer clinically advanced at the diagnosis, and subjected at radical prostatectomy, to evaluate the morbility, mortality, and results of the surgery. We have subjected 38 patients with sure clinically advanced disease to radical prostectomy (PSA average 80 ng/mL). An ureteral injury and no rectal lesion have been observed. The rate of urinary incontinence have not been increased in comparison with the literature data, while more frequently are been developed stenosis of bladder neck (26%). At 2 years the 15% of the patients is disease free survival. Our opinion is that radical prostectomy in patients with locally advanced prostate cancer is feasible and the rate of the complications is acceptable.

In this study we have tried to define which are the most useful predictive factors in the diagnosis of the prostate cancer in patients with first negative biopsy and with PSA in the grey zone. We have therefore analysed 123 patients subjected at re-biopsy: in 25 patients (20%) it is been diagnosed a prostate cancer at the second biopsy, while in 98% (80%) also the second biopsy was negative. The PSA ratio and the PSA density of the transitional zone have demonstrated having the highest sensitiveness in finding patients with cancer at the re-biopsy (92% and 88%) in comparison with the ER and the TRUS (20% and 32%). Moreover the PSA DTZ let spare the 41% of the re-biopsy that will result negatives.