Second-look TURBT: evaluation of anatomopatological and oncologic results in a single center.

INTRODUCTION: T1 bladder cancer is associated with a high risk of recurrence and progression; concomitant carcinoma in situ and/or multifocality are negative prognostic factors. Persistent disease after resection of T1 tumours has been observed in 33-55% of patients, and after resection of High-grade (HG) Ta tumour in 41,4%. It has been demonstrated that a second TURB can increase recurrence-free survival and it can make a restaging of the cancer. PATIENTS AND METHODS: From January 2011 to December 2016, 87 patients with superficial bladder tumor (Ta-T1), undergoing TURB and routine repeat TURB (Re-TURB) 4-6 weeks after the initial resection, were included in the study. Re-TURB was applied to the scar of the first resection and other suspicious lesions in the bladder. After the second-look, we studied the follow-up of each patient. RESULTS: Specimens obtained during the second TURBT showed no tumor in 47 (54,02%) patients; 40 (45,98%) patients had residual cancer: 34 of them had cancer of the same stage, 6 patients of pT1 had a lower stage, and 3 had a higher stage. 5 patient underwent radical cistectomy immediatly after re-TURBT. During the first year of follow up, 15 patients had a recurrent bladder cancer; 2 of them underwent radical cistectomy. CONCLUSIONS: T1 bladder cancer is an high risk tumor, so that second-look TURBT is a valuable procedure for accurate staging of nonmuscle-invasive bladder cancer and it can guarantee a better eradication of the neoplasm.

First cases of combined full robotic partial nephrectomy and colorectal resections: Results and new perspectives.

BACKGROUND: Nowadays the robotic platform is widespread in general surgery, urology, and gynecology. Combined surgery may represent an alternative to sequential procedures and it allows the treatment, at the same time, of coexisting lesions; in this perspective, full-robotic multiorgan surgery is starting to gain interest from surgeons worldwide. METHODS: Between April and June 2019, two patients presenting with synchronous colorectal and kidney cancers underwent, respectively, full-robotic right colectomy with right partial nephrectomy and anterior rectal resection with left partial nephrectomy. Surgeries were performed by both the general surgery and urology team. RESULTS: No intraoperative complications were registered and the postoperative course was uneventful in both cases. CONCLUSIONS: Combined multiple organ surgery with full robotic technique is safe and offers oncological adequate results. A multi-team surgical pre-planning is mandatory to reduce invasiveness and operative time. To the best of our knowledge, these are the first reports of full robotic partial nephrectomy combined with colorectal procedures.

Adjustable bulbourethral male sling: Experience after 30 cases of moderate to severe male stress urinary incontinence.

OBJECTIVE: To report our experience using the Argus perineal sling from July 2015 to April 2018 for male stress urinary incontinence (SUI) after prostatic surgery. To evaluate the safety, efficacy and healthrelated quality of life in patients undergoing this procedure. PATIENTS AND METHODS: The positioning of an adjustable bulbourethral male sling provides a perineal incision, exposure of the bulbospongiosus muscle and the application of the sling bearing on it with transobturator passage of the two extremities with out-in technique. To modulate the bearing tension on the urethra, with a rigid cystoscope the Retrogade Leak Point Pressure is measured, increasing it by 10-15 cm of H20 from baseline. We retrospectively evaluated the results of this implant performed by the same operator on 30 patients who presented post-operative SUI from medium to severe (> = 2 pads/day, pad test at one hour > = 11 g). Mean operative time and possible intra and postoperative complications were evaluated. Postoperatively each patient was reassessed according to the following parameters: number of pads consumed/ die, pad tesy at one hour, ICQS-F, any related side effects. RESULTS: After the intervention, 21 of 30 patients (70% of the total) were totally continent (< 1 pad / day, pad test at 1 h < 1-2 g, ICQS-F < 11), out of them 4 required a single adjustment at 3 months in order to achieve this result. 9 of 30 patients (30 %) achieved a clinically significant improvement without obtaining total continence (mean reduction of the n° pads/day: -2.5 ± 1 DS; average reduction of the pad test at 1 h: -20 g ± 4 DS; ICQS-F average reduction: -6 points ± 2 DS), out of them 5 required a 3 month adjustment to obtain these improvements resulting, 4 needed 2 adjustments resulting because the first adjustment was not satisfactory and one who ameliorated from severe to moderate incontinence decided to live in this clinical condition. CONCLUSIONS: The results of our study show that the positioning of this sling represents a valid treatment for the moderate and severe post-surgical male SUI. The possibility of adjusting the tension of the sleeve in a "second look" makes the intervention adaptable according to the results obtained. Only multicentric clinical trials on larger series would clarify and eventually confirm the clinical benefits of this sling in post-surgical male SUI.

Effects of D-Mannose, ElliroseTM and Lactobacillus Plantarum in treatment of urinary tract recurrent infections (rUTIs): A survey of urologists knowledge about its clinical application.

BACKGROUND AND AIM OF THE WORK: Urinary tract infections (UTIs) and recurrent urinary tract infections (rUTIs) are widespread disease and almost half of all women will experience at least one episode of cystitis during their life. Aim of this study was to review the evidence of literature about the therapeutic and preventive effects of a product containing D-Mannose, ElliroseTM and Lactobacollus Plantarum on patients' symptoms, quality of life and recurrence of UTIs and to investigate the practicing urologists' knowledge about the clinical application of this product. MATERIALS: We administrated an investigational survey about clinical use of a phytotherapeutic product made of D-Mannose, ElliroseTM and Lactobacollus Plantarum to 12 residents in Urology at the University of Modena and Reggio Emilia and to 32 urologists working in the provinces of Modena, Reggio Emilia and Parma. RESULTS: 61% of physicians have diagnosed rUTIs in 3-6 patients during a month, and 7% of them in more than 6 patients during the same period of time. By these results rUTIs appear as common pathological conditions. 59% prescribed the product at least 1 time a month and 14% prescribed it more than 5 times. 43% administrated the product after out-patient invasive examinations as cistoscopy and urodynamic exam for UTIs prevention. 55% noticed a significant improvement in patient's QoL (Quality of Life) suffering from rUTIs. Furthermore 48% also reported a significant effect for the improvement of urinary symptoms of patients. No gastric or general side effects have been noticed during the administration period. Finally the cost of integrator has been reported affordable for the great majority of patients. CONCLUSIONS: Many studies in Literature have shown that D-Mannose and H. sabdariffa (ElliroseTM) reduce the risk of development of rUTIs opposing colonization and proliferation of uropathogenic bacteria in urinary tract. Our investigational survey about the administration of a phytotherapeutic product showed that this product is well-known and has a proved positive impact.