Our study aimed to compare the incidence of infective complications after transrectal ultrasound-guided prostate biopsy (TRUSBx) when adopting different antimicrobial prophylaxis regimens. A multi-institutional cohort of 1150 patients who underwent TRUSBx was retrospectively analyzed. Procedures were performed between 2017 and 2019 (before and after the EMA warning about the use of fluoroquinolones for the antibiotic prophylaxis of patient candidates to TRUSBx). The primary endpoint was the occurrence of infective complications, including sepsis and/or fever. The population was stratified according to the antibiotic prophylaxis adopted: fluoroquinolones (levofloxacin, ciprofloxacin, prulifloxacin), cephalosporins (cefixime, ceftriaxone) or trimethoprim/sulfamethoxazole. Univariable and multivariable binomial logistic regression models were used to assess the odds ratio (OR) with 95% confidence interval (CI) testing of the risk of infective complication after adjusting for each prebiopsy covariate. In total, 478 (41.6%) patients received fluoroquinolone-based prophylaxis. Among these, 443 (38.5%), 25 (2.2%) and 10 (0.9%) patients received levofloxacin prophylaxis, ciprofloxacin and prulifloxacin, respectively while 14.6% received cefixime, 20.7% received the comedication of ceftriaxone/fosfomycin and 23.1% received trimethoprim/sulfamethoxazole. The trimethoprim/sulfamethoxazole and fluoroquinolone regimens were significantly associated with a lower risk of infective complications (OR 0.15, 95% CI 0.03–0.48, p = 0.003 and OR 0.17, 95% CI 0.06–0.43, p < 0.001, respectively). The ceftriaxone/fosfomycin (OR 0.21, 95% CI 0.04–0.92, p = 0.04) and fluoroquinolone (OR 0.07, 95% CI 0.00–0.70, p = 0.048) prophylaxis were associated with a lower risk of infective sequelae. Fluoroquinolone-based prophylaxis was associated with a lower risk of infective complications after TRUSBx compared to other prophylaxis regimens although its clinical application was recently forbidden by European Medical Agency restrictions.

Objectives: Incidence and prevalence o f patients in dialytic therapy increased considerably in recent years. The onset of new issues, once overshadowed, linked to a lower quality of life like sexual dysfunction became increasingly common. The first study in this area, dating back to the 1970s, shows the high prevalence of sexual dysfunction among patients in dialytic therapy of both sexes. Later studies proved an association of sexual dysfunction with psyche disorders, anxiety, depression and lack of self-confidence. The aim of this study is to describe the incidence of male and female sexual main dysfunctions, the latter not least in literature, in patients in hemodialytic therapy. With this aim two dialytic centers have been compared, one located in northern Italy and one in southern Italy, and the different prevalence has been compared to the general population. Methods: We conducted a prospective cross-sectional observational study in patients undergoing dialytic therapy in two hemodialysis centers, one located in Palermo and one in Lecco. Male sexual dysfunction was investigated by the International Index of Erectile Function-15 (HEF15) questionnaire and the Premature Ejaculation Diagnotic Tool (PEDT) questionnaire, and the female dysfunction by Female Sexual Function Index (FSFI) questionnaire. Criteria for inclusion in our study were: age < 75 years and dialytic age > 3 months; exclusion criteria were: advanced cancer diseases, life expectancy < 6 months, previous urological manipulation, anti-androgenic therapy, sexual dysfunction unrelated to kidney disease, psychiatric disorders. Data were compared with mean-standard deviation (SD) and with the variance analysis (ANOVA). A value of p < 0.05 is considered significant. Discrete data were analyzed with contingency analysis. A chi2 < 0.05 was considered significant. Results: Data of 78 patients have been collected. Mean age and dialytic time were 54 +/- 12 years and 42 +/- 35 month; 33 patients were from Palermo and 24 from Lecco; 21 patients were excluded. Age and dialytic age of the two subgroups did not demonstrate statistically significant differences. Between the two centers there was a statistically significant difference (p < 0.005) in the distribution of basic nephropathy: an higher incidence of diabetic and obstructive nephropathy has been observed in the southern center compared to northern center, while glomerulonephritis and polycystic kidney disease had an higher incidence in the northern center compared to southern one. The main sexual dysfunctions in both sexes, erectile dysfunction (ED) and premature ejaculation (PE) in men and orgasm disorder and pelvic pain in women, have been investigated. ED was present in 70% of hemodialyzed patients, which is an higher incidence compared to the general population. The severity of ED between patients of the two groups was significantly different (chi2 < 0.001) with higher incidence of moderate/severe forms in northern Italy. The score, in addition to discrete data (severe, moderate, mild, absence), of ED was significantly different (p < 0.001) between patients of the two centers (22 +/- 7 Palermo vs. 9 +/- 8, Lecco). The PE was absent in 20 patients (54%), present in 12 patients (32%) and probable in 5 patients (14%) (scores of 7.6 +/- 4.0 and 8.9 +/- 6.8, respectively in Palermo and Lecco patients). For women, orgasmic dysfunction was severe in 10 patients (50%), mild in 4 patients (20%), very mild in 5 patients (25%), while it was normal in 1 patient (5%), with a statistically significant difference (p< 0.05) between Palermo and Lecco patients (3.0 +/- 1.4 vs 1.2 +/- 2.0). Sexual pain in women was severe in 11 patients (55%), moderate in 4 patients (20%) and mild in 5 patients (2.5%). Sexual pain was present in all patients (p < 0.05). Conclusions: Regardless of sex, sexual dysfunction is one of the most common side effect in patients with end stage renal disease in dialytic therapy. Our study confirms literature data. The growing number of the dialytic population with sexual disorders needs specialist support to improve quality of life of these patients.

Ureteroscopy (URS) represents the most used procedure in the treatment of urolithiasis, conversely ureteral stenting before URS is still a topic of scientific discussion. The aim of our study is to evaluate the possible benefits and uses of pre-stenting and if it can be used in the everyday practice. In our retrospective observational study, we collected data of patients undergoing URS for ureteral and renal lithiasis from January 2018 to December 2020 at our Department. Patients were stratified by procedure (ureterolithotripsy or URSL vs retrograde intrarenal surgery or RIRS) and by pre-stenting. We collected the patients' clinical characteristics and the timing of pre-stenting insertion. As outcomes variables, we analyzed the stone free rate (SFR), operating times (OT) and short-term complications. 244 patients were included in the study, 84 had undergone pre-stenting with a mean of 44.3±42.7 days before surgery, while 160 did not. Regarding OT there are no differences in URSL and in the RIRS of stones in the renal pelvis; considering the RIRS of caliceal stones it is observed how the OT are lower in pre-stenting patients undergoing RIRS of caliceal stones (mean 79.29±34.7 vs 91.08±53.8 mins, p=0.1) and in case of multiple caliceal stones (mean 83.24±31.2 vs 103.53±48.6 mins, p=0.1). No differences were reported in the SFR for every URSL subgroups while it is higher in patients undergoing RIRS with a pre-stenting (85% vs 75%, p=0.08). Regarding the short term complications, in the pre-stenting group fewer cases of post-operative pain (20.4% vs 39.6% p<0.02) and hematuria (14.8% vs 28.3% p=0.08) were reported. Our study is in accordance with the indications of guidelines which advise against the routine use of pre-stenting before URS. RIRS deserve a separate evaluation and our study, although considering the routine use of pre-stenting unnecessary, recognize its usefulness in achieving SFR and reducing intraoperative complications.

Sepsis is one of the most dangerous post-operative complications. Recently, Monocyte Distribution Width (MDW), a blood test parameter able to measure morphological changes in monocytes, has been proposed and investigated as a new promising biomarker of sepsis. The aim of our study was to evaluate if MDW can be influenced by surgery to better understand if it could be use as a sepsis marker. All clinical and laboratories data were collected of all patients admitted from April to August 2021 to the Unit of Urology of our Department for elective kidney and ureteral stones surgery. The blood samples collected to evaluate MDW of each patient were analyzed on the UniCel DxH 900 analyzer (Beckman Coulter, Inc., USA), with an MDW value of 23 considered as significative value. Times of collection of blood samples were before surgery (BS), after surgery (AS) and at discharge time (DT) In all 66 patients enrolled in this study, while White Blood Cells (WBC) significantly increased after surgery (BS:7.95x109/L vs AS:11.4x109/L; p<0.001) with a trend to normalization at discharge (AS:11.40x109/L vs DT:9.90x109/L; p:0.021), there were no statistically significative differences for MDW (BS:17.6 vs AS:18.1; p:1) before and after surgery, as well comparing before surgery and at the time of discharge (BS:17.6 vs DT:18.5; p:0.237). In conclusion, MDW is not affected by surgical procedures and is easily measurable when compared to other biomarkers, considering that is part of a routine CBC. For these reasons, MDW could be a valid, cost-effective and fast biomarker to predict the risk of post-operative sepsis in elective surgery

Surgery is the curative treatment for localized Renal Cancer Carcinoma (RCC). Nephron sparing surgery is the recommended treatment modality in patients with T1 tumors based on oncological and functional outcomes [1]. Patients with stage T1a renal cancer who have undergone conservative surgery have demonstrated better survival and functional outcomes [2]. Renorrhaphy and resection technique are important for the preservation of the renal function. To date no technique is clearly preferable, and the choice can be made based on preference and experience of the surgeon [5]. The criss-cross technique guarantees excellent haemostasis by limiting the insult on healthy renal parenchyma.

Background and Objectives: The aim was to compare the intra and postoperative outcomes between the Enhanced Recovery After Surgery (ERAS) protocol versus the standard of care protocol (SCP) in patients who underwent radical cystectomy performed by a single surgeon. Materials and Methods: A retrospective comparative study was conducted including patients who underwent radical cystectomy from 2017 to 2020. Length of stay (LOS), incidence of ileus, early postoperative complications, and number of re-hospitalizations within 30 days were considered as primary comparative outcomes of the study. Results: Data were collected for 91 patients who underwent cystectomy, and 70 and 21 patients followed the SCP and ERAS protocol, respectively. The mean age of the patients was 70.6 (SD 9.5) years. Although there was a statistically significant difference in time to flatus (TTF) [3 (2.7–3) vs. 1 (1–2 IQR) days, p < 0.001, in the SC hospital and in the ERAS center respectively], no difference was reported in time to first defecation (TTD) [5 (4–6) vs. 4 (3–5.8), p = 0.086 respectively]. The median LOS in the SCP group was 12 (IQR 11–13) days vs. 9 (IQR 8–13 p = 0.024). In the postoperative period, patients reported 22 complications (37% in SCP and 42.8% in ERAS group, p = 0.48). Conclusions: The study reveals how even partial adherence to the ERAS protocols leads to similar outcomes when compared to SCP. As a single surgeon series, our study confirmed the role of surgeons in reducing complications and improving surgical outcomes.