Di Maida F, et al. World J Mens Health. 2020 Jan;38:e34. https://doi.org/10.5534/wjmh.200065

Di Mauro M, et al. World J Mens Health. 2019 Jan;37:e17. https://doi.org/10.5534/wjmh.180100

Acute Cystitis Symptom Score (ACSS) is an 18-item self-reporting questionnaire for clinical diagnosis and follow-up of acute uncomplicated cystitis (AUC) in women. The ACSS, originally developed in Uzbek and Russian languages, is now available in several languages. The purpose of the study was to validate the ACSS questionnaire in the Italian language. Linguistic validation was carried out according to Linguistic Validation Manual for Patient-Reported Outcomes Instruments guidelines. Clinical validation was carried out by enrolling one hundred Italian-speaking women. All women were asked to fill in the ACSS questionnaire during their medical visit. Fifty-four women, median age 36 (Inter Quartile Range 28–49), were diagnosed with AUC, while 46 women, median age 38 (IQR 29–45), were enrolled as the control group attending the hospital’s fertility center for couples. The most frequently isolated pathogen in AUC was Escherichia coli (40; 74.0%) followed by Enterococcus faecalis (7; 13.0%) and Staphylococcus saprophyticus (3; 5.6%). Receiver operating characteristic (ROC) curve analysis performed at the first diagnostic visit on a typical symptoms domain cut-off score of 6 revealed a sensitivity of 92.5% and specificity of 97.8%. The Italian version of the ACSS has proved to be a reliable tool with a high accuracy in diagnosis and follow-up in women with AUC. The ACSS may also be useful for clinical and epidemiological studies.

Purpose: The aim of this article is to describe our modified surgical technique for the reconfiguration of the glans in the clitoris and the labia minora, known as the “M-shape neoclitorolabioplasty”. Methods: The glans with all its neurovascular bundle is isolated from the corpora cavernosa, incised in Y-shape mode and spread in order to obtain an M-shape glandular flap. The “belly” of the M-shape glans will constitute the triangular neoclitoris meanwhile the lateral flaps will constitute the labia minora. The inferior apex of the neoclitoris is fixed to the superior apex of the previously spatulated urethra. The two glans flaps are incised transversally to increase their length and sutured to the sides of the spatulated urethra forming the labia minora. Our technique permits to create an aesthetically pleasing neovagina preserving all the glandular erogenous sensitivity. Results: 94 patients have been treated with our modified technique of male-to-female (MtoF) gender affirming surgery. At median follow-up of 27.57 months, 81 (86.1%) patients reported vaginal intercourse and 78 (82.9%) patients referred presence of erogenous sensitivity during dilatations, intercourse or masturbations. All the glandular tissue is preserved and reconfigured forming the neoclitoris and the labia minora. The M-shape reconfiguration permit to create an aesthetically pleasant neoclitoris. Conclusions: This technique could be applied safely and easily to patients undergoing gender affirming surgery, allowing the creation of a neovagina with the best possible erogenous sensitivity without losing aesthetical results.

Background: To investigate in a longitudinal cohort study, the best treatment to preserve fertility in cryptorchid subjects. Patients treated with immediate hormonal vs. delayed vs. combined (hormone plus surgery) therapy consecutively enrolled during the period 1987–1997, were evaluated.Methods: Two hundred fifty-five subjects were enrolled and 192 patients completed the follow-upt. One hundred fifty-six patients and 36 out 192 had monolateral and bilateral cryptorchidism, respectively. Twenty-nine out of 192 were previously treated by surgery alone (Group A), 93/192 by hormone therapy alone (Group B), 51/192 received sequential combined hormone therapy plus surgery (Group C) whilst 19/192 refused any type of treatment (Group D). The other 63 patients were considered lost to follow-up. All the patients underwent medical consultation, scrotal ultrasound scan, sperm analysis and Inhibin B, Follicular Stimulating Hormone (FSH) and Testosterone (T) serum level determination.Results: Testicular volume was found decreased in the Group D patients whilst hormone serum levels were comparable in all groups. Statistically significant differences for sperm characteristics were found in patients treated with hormonal therapy alone or combined with surgery (Groups B and C). These two groups reported better semen quality than patients who received surgery alone or no treatment. No differences were observed between monolateral and bilateral cryptorchidism patients.Conclusions: Early prolonged hormonal therapy is advisable in all patients with cryptorchidism independently from the surgical option of promoting testicular descent to the scrotum. Hormonal therapy provides in our study better chance to obtain adequate sperm quality in adult life.