Erectile dysfunction (ED) is a condition with multifactorial pathogenesis, quite common among men, especially those above 60 years old. A vascular etiology is the most common cause. The interaction between chronic inflammation, androgens, and cardiovascular risk factors determines macroscopically invisible alterations such as endothelial dysfunction and subsequent atherosclerosis and flow-limiting stenosis that affects both penile and coronary arteries. Thus, ED and cardiovascular disease (CVD) should be considered two different manifestations of the same systemic disorder, with a shared aetiological factor being endothelial dysfunction. Moreover, the penile arteries have a smaller size compared with coronary arteries; thus, for the same level of arteriopathy, a more significant blood flow reduction will occur in erectile tissue compared with coronary circulation. As a result, ED often precedes CVD by 2–5 years, and its diagnosis offers a time window for cardiovascular risk mitigation. Growing evidence suggests, in fact, that patients presenting with ED should be investigated for CVD even if they have no symptoms. Early detection could facilitate prompt intervention and a reduction in long-term complications. In this review, we provide an overview of the pathogenetic mechanisms behind arteriogenic ED and CVD, focusing on the role of endothelial dysfunction as the common denominator of the two disorders. Developed algorithms that may help identify those patients complaining of ED who should undergo detailed cardiologic assessment and receive intensive treatment for risk factors are also analyzed.

Background: Numerous continence-sparing radical prostatectomy techniques have been developed to enhance postoperative early continence recovery; however, evidence regarding the best approach remains controversial. The objectives are: to provide a critical appraisal of various prostatectomy techniques, based on the evidence of quality-assessed randomised control trials (RCT); to summarise the immediate continence and the early continence reported; to propose a new standardisation for continence outcomes reporting. Methods: Data acquired from five medical registries were reported to PRISMA standards. Evidence from published, English, full-text RCTs reporting postoperative urinary continence outcomes within 6 months from surgery were included. Heterogeneity of surgical techniques and continence definitions did not allow a meta-analysis. All RCTs were critically appraised and quality assessed. Results: 39 RCTs were included: 19/39 studies were low-quality RCTs, presenting small cohort, monocentric or single-surgeon data. The best RCT-supported evidence is in favour of RARP compared to LRP and of the Retzius-sparing technique over the traditional prostatectomy. Other techniques such as bladder neck and puboprostatic ligament preservation, posterior reconstruction with or without combination of anterior suspension technique and nerve-sparing approach seem to enhance EC. Oppositely, the endopelvic fascia preservation, bladder neck mucosa eversion/plication/slings and the selective ligature of dorsal venous complex were not significantly associated to early continence improvements. RCTs are lacking on pubovesical complex-sparing, seminal vesicle preservation, anterior reconstruction of the puboprostatic collar, musculofascial reconstruction, dorsal venous complex suspension to the periosteum of the pubic bone techniques. Conclusions: RARP and Retzius-sparing have high-quality evidence supporting their ability to enhance postoperative EC recovery. Nerve-sparing, bladder neck and puboprostatic ligament preservation may contribute to better EC recovery, although the evidence level is low. Further multicentre RCTs are needed to establish the optimal combination of standard surgical techniques. A new continence outcome-reporting standardisation was proposed.

Background: The prostatic urethra (PU) is conventionally resected during robot-assisted radical prostatectomy (RALP). Recent studies demonstrated the feasibility of the extended PU preservation (EPUP). Aims: To describe the histologic features of the PU. Methods: The PU was evaluated using cystoprostatectomy and RALP specimens. Cases of PU infiltration by prostate cancer or distortion by benign hyperplastic nodules were excluded. The thickness of the chorion and distance between the urothelium and prostate glands were measured. Prostate-specific antigen expression in the PU epithelium was evaluated with immunohistochemistry. Descriptive statistics were used. Results: Six specimens of PU were examined. Histologically, the following layers of the PU were observed: (1) urothelium with basal membrane, (2) chorion, and (3) prostatic peri-urethral fibromuscular tissue. The chorion measures between 0.2 and 0.4 mm. There is not a distinct urethral muscle layer, but rather muscular fibers that originate near the prostatic stroma and are distributed around the PU. This muscular tissue appears to be mainly represented in the basal and apical urethra, but not in the middle urethra. The mean distance between the chorion and prostatic glands is 1.74 mm, with significant differences between base of the prostate, middle urethral portion, and apex (2.5 vs. 1.49 vs. 1.23 mm, respectively). PSA-expressing cells are abundant in the PU epithelium, coexisting with urothelial cells. Conclusions: The exiguity of thickness of the PU chorion, short distance from glandular tissue, and coexistence of PSA-expressing cells in the epithelium raise important concerns about the oncologic safety of EPUP.

Testicular dislocation in the abdomen after scrotal trauma is a rare and sometimes unrecognised event. Early detection and timely management reduce possible complications which include the risk of fertility loss, endocrine dysfunction, and future malignancy. We present the case of a man who suffered a traumatic dislocation of the right testis in the abdomen after a motorcycle crash. The large scrotal haematoma did not permit adequate physical examination. Furthermore, during the clinical management of the polytrauma, the main focus was on active arterial bleeding, multiple pelvic fractures and clinical investigation of the integrity of the lower urinary tract. Therefore, the diagnosis and surgical management of the testicular dislocation were delayed. The patient underwent abdominal-inguinal surgical exploration, haematoma evacuation, identification of the right testis and right orchidopexy. After 6 months, the right testis of the patient is of regular volume, consistency and physiologic echogenicity on ultrasound evaluation. Hormonal evaluation and semen analysis were normal after 3 months.