Melanoma in situ of the penis: A very rare entity with an even rarer presentation.

Penile melanoma in situ is a very rare malignant neoplasm. Surgical treatment is the standard approach, although there are no recommendations regarding the extent and best technique. A 28-year-old male presented with a dark-brown macule on the glans, whose biopsy revealed melanoma in situ. A local excision followed by a partial resurfacing was performed, with follow-up revealing no sign of recurrence and good quality of life. Melanoma is a very dangerous tumor due to its metastization potential. The main challenge is early diagnosis. Surgical treatment is the best approach, although it is difficult to balance resection and organ preservation.

Improving the identification of high-risk non-metastatic castration-resistant prostate cancer patients in clinical practice.

Non-metastatic castration-resistant prostate cancer (nmCRPC) represents a challenging disease state in prostate cancer care. nmCRPC patients with a high risk of progression to metastatic disease who are identified by a prostate-specific antigen doubling time (PSADT) ≤10 months are eligible for treatment with the novel androgen receptor inhibitors (ARIs), shown to delay disease progression and extend survival. However, nmCRPC is often unexploited in clinical practice due to a lack of standardization in the methodology and in the tools used for its identification. In this article, a group of Urology and Oncology specialists with acknowledged expertise in prostate cancer reviews the state of the art in the management of high-risk nmCRPC patients, identifies gaps and unmet needs, and proposes strategies to optimize the identification of this patient subgroup in the clinical practice and improve their health outcomes.

Prostate resection weight matters in severely obstructed men undergoing transurethral resection of the prostate.

OBJECTIVES: Transurethral resection of the prostate (TURP) remains one of the goldstandard surgical treatments for benign prostatic hyperplasia/lower urinary tract symptoms. The usefulness of a complete adenoma resection is questionable, with studies reporting no impact of the amount of resected tissue on surgical outcomes, irrespective of prostate volume. The aim of this study was to assess whether in less obstructed patients a less extensive TURP may be considered. MATERIALS AND METHODS: Retrospective analysis of 185 men undergoing TURP in one university hospital. Retrieved data included pre-operative prostate volume and Qmax, as well as resected prostate weight and post-operative Qmax. Patients were divided in two groups according to pre-operative Qmax < 10mL/s and ≥ 10 mL/s. RESULTS: A correlation was found between absolute resected prostate weight and post-operative Qmax in the group of patients with pre-operative Qmax < 10 mL/s (r2 = 0.038, p = 0.032), independently of the pre-operative prostate volume. This association was neither observed in the group of patients with pre-operative Qmax ≥ 10 mL/s (r2 = -0.033, p = 0.796) nor in whole population analysis (r2 = 0.019, p = 0.064). Likewise, in the group of patients with pre-operative Qmax < 10 mL/s, the improvement in Qmax was correlated with absolute resected weight and percentage of prostate resected weight (r2 = 0.036, p = 0.037 and r2 = 0.040, p = 0.029, respectively). None of these correlations was found in the group of patients with pre-operative Qmax ≥ 10 mL/s (r2 = 0.009, p = 0.463 and r2 = -0.018, p = 0.294, respectively). CONCLUSIONS: Patients with pre-operative Qmax ≥ 10 mL/s may do well with less profound prostate resections, whereas patients with lower pre-operative Qmax seem to benefit from a complete adenoma resection.

Cylinder rerouting for lateral extrusion after inflatable penile prosthesis implantation - Surgical technique revision.

Lateral cylinder extrusion is a potential complication of penile prosthesis implantation. Several methods have been proposed for repairing this complication. We present a case where a cylinder re-routing technique, first described by Dr. John Mulcahy, was used and a revision of the literature.

Alkalinized lidocaine solution as a first-line local anesthesia protocol for intradetrusor injection of onabotulinum toxin A: Results from a double-blinded randomized controlled trial.

AIMS: Local anesthesia protocols for intradetrusor onabotulinum toxin A (BoNTA) injection lack standardization. We aimed to determine if an alkalinized lidocaine solution is more effective than lidocaine only. METHODS: Patients of both genders aged 18 or above enlisted for intradetrusor BoNTA injection (idiopathic, neurogenic, and bladder pain syndrome) were included in a double-blinded randomized controlled trial after obtaining their informed consent. All participants filled a bladder diary and a urine culture was performed. Subjects were randomized 1:1 to Protocol A (20 ml 2% lidocaine + 10 ml 8.4% sodium bicarbonate) or Protocol B (20 ml 2% lidocaine + 10 ml 0.9% saline solution). A Numeric Rating Scale (0-10) was used to assess the level of pain immediately after the procedure (primary endpoint). Secondary endpoints included pain after 1 h, urinary tract infection, acute urinary retention, and hematuria related to the procedure. RESULTS: A total of 116 patients were randomized. Baseline characteristics (age, sex, indication, and bladder diary parameters) of patients in Group A and B were similar. Pain scores at the end of the procedure were significantly lower with the alkalinized solution (Protocol A and B, respectively, 2.37 ± 0.31 vs. 4.44 ± 0.36, p < .01). No differences were observed 1 h after treatment (Protocol A and B, respectively, 0.54 ± 0.17 vs. 0.69 ± 0.19, p = .487). The only adverse event reported was mild-to-moderate self-limited hematuria in 15.4% of patients. CONCLUSIONS: The use of an alkalinized lidocaine solution has proven to be significantly superior to lidocaine only as local anesthesia before intradetrusor BoNTA injection, suggesting that this may be considered a first-line option.

Isolated Shotgun Injury to the Ureter: The Importance of Clinical Suspicion.

Traumatic ureteral injuries are rare and account for less than 1% of all urological traumas. Associated abdominal injuries are almost always present. We present a rare case of isolated shotgun injury to the ureter where clinical suspicion was of paramount importance.

Overactive Bladder Symptoms after Transobturator Sling Surgery for Pure Stress Urinary Incontinence: A Cross-Sectional Comparative Study.

INTRODUCTION: Transobturator tape (TOT) surgery has been associated with increased overactive bladder (OAB) although much controversy exists. METHODS: In a cross-sectional study, women who underwent TOT surgery for pure stress incontinence (MonarcTM) answered the 6 questions of the symptom bother (SB) subscale of the OAB questionnaire - short form (OABq-SF) and an additional question regarding whether symptoms began after surgery. Women with SB score over the 4th quartile (≥30/100) were reassessed after a longer follow-up. Patients from primary care were recruited as controls. RESULTS: We recruited 213 patients (135 in the TOT group and 78 age-adjusted controls). The mean age of operated patients was 58.7 ± 10.1 years with a mean follow-up of 25.9 ± 13.2 months. OABq-SF SB scores did not differ between the TOT group and controls (respectively, 18.5 ± 30 and 15.5 ± 6.7, p = 0.202). A total of 48% patients reported no relationship between symptoms and surgery. Highly symptomatic operated patients were reassessed after a longer follow-up (46.3 ± 10.6 months). The mean score in the second follow-up (n = 25) was not statistically different from the first assessment (46.4 ± 22.7 and 58.1 ± 19.8, p = 0.059). CONCLUSIONS: Women who underwent TOT surgery did not show increased OAB SB scores when compared to controls. Our study suggests that OAB symptoms may thus be present but overlooked during initial clinical assessment.

Primary synovial sarcoma of the kidney with unusual follow up findings.

We present a case report of a 17-year-old patient with a large renal mass that was detected on a computed tomography scan during investigation for secondary hypertension. Radical nephrectomy was performed and the morphologic and immunocytochemical findings were compatible with a diagnosis of monophasic synovial sarcoma of the kidney. A cytogenetic search for t(X;18) translocation was performed, which was negative. The patient underwent an ifosfamide-based chemotherapy regimen. During follow up, a positron emission tomography scan showed increased 18F-fluorodeoxyglucose metabolism at the right femur. Although cancer cells were expected in the biopsy specimen, only fibrous dysplasia of the bone was found. The patient was disease free at his 29 month follow up check up.