Background: Sexual dysfunctions (SD) are highly prevalent in Chronic Liver Diseases (CLD). Whether Metabolic dysfunction-Associated Steatotic Liver Disease (MASLD) carries a higher risk of SD is unknown as is the role of dietary patterns or quality of Life (QoL). Aim: to assess (1) prevalence of SD in CLD; (2) whether MASLD is a risk factor for SD; (3) the role of adherence to Mediterranean Diet (MD) or QoL. Methods: Observational, cross-sectional study, 207 CLD patients (84 females and 123 males), median age 57 years (IQR:46-63); 96 (46.4%) MASLD; and 111 (53.6%) nonMASLD. Outcomes: SD were assessed through Female Sexual Function Index (FSFI) and International Index of Erectile Function (IIEF) questionnaires. Adherence to MD was evaluated by the MD Score, QoL by SFHS-12 questionnaire evaluating physical [(ie, Physical Component Summary (PCS)] and mental [(ie, Mental Component Summary (MCS)] health. Multivariate analysis identified predictors of SD. Results: (1) SD prevalence in CLD was 157/207 (75.8%); 80.9% females were at risk for SD, altered sexual desire/arousal and dyspareunia being the most common complaints, whereas 72.3% males had erectile dysfunction (ED); (2) prevalence of SD was higher in MASLD (89%) than in nonMASLD (64%) (P < 0.001); (3) in females, at univariate analysis, a negative correlation was found between FSFI and age, hypertension, or MASLD; (4) in males, at univariate analysis, IIEF-ED negatively correlated with age, DM2, or MASLD, whereas positively correlated with PCS and MCS; (5) in females, at multivariate analysis BMI (OR = 0.779,CI 95% = 0.640-0.948) and MCS (OR = 0.840,CI 95% = 0.741-0.953) were protective against SD, whereas age (OR = 1.115,CI 95% = 1.040–1.263) and DM2 (OR = 120.894,CI 95% = 1.396–10 741) were predictive of SD; (6) in males, at multivariate analysis, age (OR = 1088,CI 95% = 1032-1.148) and MASLD (OR = 4.075,CI 95% = 1.120-14.828) were risk factors for, whereas PCS (OR = 0,928,CI 95% = 0,865-0,995), and disease duration (OR = 0.393,CI 95% = 0.187-0.822) were protective against SD; 7) MD adherence, while higher in nonMASLD vs MASLD (P = 0.004), was not an independent protective factor against SD. Clinical Implications: SD should not be underestimated in CLD patients, in particular those with MASLD. Strengths and Limitations: Comprehensive study evaluating SD in a large cohort of CLD patients of both sexes, comparing MASLD vs nonMASLD. Due to its cross-sectional design, no conclusions can be drawn about cause and effect. Conclusions: (1) CLD, in particular MASLD, have a high prevalence of SD which is not affected by MD adherence, whereas QoL seems to play a role; (2) CLD patients should be evaluated for SD, for early diagnosis and treatment.

Background/Objectives: Prostate-specific antigen (PSA) persistence, defined as a postoperative PSA level ≥ 0.1 ng/mL measured within 4–8 weeks after radical prostatectomy (RP), predicts biochemical recurrence (BCR) and adverse oncological outcomes. The influence of nerve-sparing (NS) surgical techniques on PSA persistence remains debated, especially among patients with high-risk pathological features. This study aimed to evaluate the impact of NS techniques on PSA persistence following robot-assisted radical prostatectomy (RARP), considering tumor characteristics, surgical parameters, and patient-specific factors. Methods: A retrospective cohort analysis was performed on 779 patients who underwent RARP at a single institution between January 2002 and December 2015. The inclusion criteria consisted of histologically confirmed prostate cancer with available preoperative and postoperative data, including PSA measurements taken 4–8 weeks after surgery. PSA persistence served as the primary outcome. Statistical analyses included descriptive statistics, univariate and multivariable logistic regression models to identify predictors of PSA persistence, and Spearman’s correlation along with the Kruskal–Wallis H test to evaluate associations. Results: Of the 779 patients included, 55% underwent NS surgery (51% unilateral, 49% bilateral). The mean preoperative PSA was 11.85 ng/mL (SD: 7.63), while the mean postoperative PSA was 0.70 ng/mL (SD: 4.42). An elevated postoperative PSA was associated with a larger tumor size (r = 0.1285, p < 0.001), advanced pathological stages (χ² = 45.10, p = 3.79 × 10⁻⁹), and higher Gleason scores (χ² = 24.74, p = 1.57 × 10⁻⁴). NS surgery correlated with a lower postoperative PSA (mean: 0.20 ng/mL) compared to non-NS procedures (mean: 0.65 ng/mL), with slight differences between unilateral (mean: 0.30 ng/mL) and bilateral (mean: 0.35 ng/mL) NS approaches. Multivariable regression analysis identified advanced pathological stage (coefficient = 1.16, p = 0.04) as an independent predictor of PSA persistence, while NS techniques had no significant independent effect (coefficient = −0.01, p = 0.99). Conclusions: Nerve-sparing surgical techniques do not independently predict PSA persistence after RARP when adjusting for tumor-related factors and confounders. Advanced pathological stage, particularly stage pT3b, primarily determines PSA persistence. These findings highlight the necessity of personalized surgical planning informed by preoperative imaging and patient-centered decision making to optimize oncological and functional outcomes.

Background/Objectives: Intravesical Bacillus Calmette–Guérin (BCG) is the standard adjuvant treatment for high-risk non-muscle-invasive bladder cancer (NMIBC), but treatment-related urinary toxicity may compromise quality of life (QoL) and adherence. The neutrophil-to-lymphocyte ratio (NLR), a marker of systemic inflammation, has been linked to oncologic outcomes in bladder cancer, but its association with urinary symptom burden during BCG therapy remains unclear. We aimed to assess whether baseline NLR is associated with early deterioration in urinary symptoms and urinary QoL following BCG induction. Methods: This prospective study included male patients with NMIBC treated with intravesical BCG. Baseline demographics, comorbidities, laboratory parameters, and urinary symptoms were recorded. Patients were stratified into two groups according to baseline NLR (<3 vs. ≥3). Urinary outcomes were assessed at baseline and 8 weeks using the International Prostate Symptom Score (IPSS) and the IPSS-related QoL item. Univariable and multivariable linear regression analyses were performed. Results: A total of 96 patients were analyzed. Median baseline NLR was 2.6 (IQR: 2.1–3.8). Patients with NLR ≥ 3 (n = 34) and NLR < 3 (n = 62) had comparable baseline characteristics and urinary scores. At 8 weeks, patients with NLR ≥ 3 experienced a greater worsening of urinary symptoms (median IPSS 24 vs. 21, p = 0.02; median change +5 vs. +2, p = 0.01) and QoL (median 5 vs. 4, p = 0.03). Univariable regression confirmed the association of NLR ≥ 3 with worse QoL (β = +0.74; p = 0.003) and higher IPSS (β = +2.20; p = 0.021). Modeled as a continuous variable, each one-unit increase in NLR corresponded to a +0.20 worsening in QoL (p = 0.008). In the multivariable analyses adjusted for baseline IPSS and concomitant CIS, NLR remained independently associated with QoL decline. Conclusions: Baseline NLR was independently associated with worsening urinary symptoms and QoL during BCG induction in NMIBC patients. NLR may represent a simple and accessible biomarker for early risk stratification during BCG induction, warranting validation in larger, longer-term prospective trials.

We evaluated a Remote Surgical Training model (ReST) in which the tutor operates a second da Vinci Xi console from an adjacent room while preserving integrated audio and the ability to take over control. A comparative feasibility study was conducted at RAIN (A. Cardarelli Hospital, Naples, Italy) between March 2021 and April 2023 using a porcine model. Thirty training sessions were analysed (15 ReST, 15 in-room dual-console controls). Trainee performance was assessed with the Global Evaluative Assessment of Robotic Skills (GEARS); post-session surveys captured perceptions, tutor-trainee agreement (weighted Cohen’s κ), priority rankings (Kemeny aggregation with τX) and satisfaction. GEARS internal consistency was acceptable (Cronbach’s α overall 0.805; control 0.837; ReST 0.768). No statistically significant differences were observed for the GEARS total score (Mann-Whitney U = 105, p = 0.595) or domains (p = 0.074–0.683). Tutor-trainee agreement was significant for three interaction items: ease of teaching/training (p = 0.004), ability to follow the trainee’s actions (p = 0.011) and overall interaction quality (p = 0.014). Priority rankings in both roles emphasised clarity of instruction and takeover capability, while physical proximity ranked lowest. Tutors and trainers reported high satisfaction in both groups; one trainee reported low satisfaction in the ReST group. Adjacent-room ReST with takeover capability was feasible in this porcine-model training setting and showed no observed performance decrement compared with conventional in-room dual-console training. These findings should not be interpreted as proof of equivalence or as validation of true long-distance teleproctoring; further work is required for larger samples, participant-level baseline adjustment, and longer-distance configurations.

Background: In prostate cancer (PCa) patients, discrepancies between biopsy-assigned Gleason Scores and those determined from surgical specimens are frequently reported. This phenomenon, known as Gleason score upgrade (GSU), can have significant clinical implications. This work aims to understand the factors contributing to GSU for refining prostate cancer management strategies. Methods: Data from 779 patients diagnosed with histologically confirmed PCa who underwent robot-assisted radical prostatectomy at a single tertiary care institution between January 2005 and December 2020 were examined. Results: In the univariable setting, 5-alpha reductase inhibitor (5-ARI) use was associated with a higher percentage of upgrading (42.3% vs. 30.4% among non-users; p = 0.03942). A more advanced pathological T stage (p = 0.01114) and lymph node positivity (p < 0.00001) correlated significantly with GSU. In the logistic regression model, advanced pathological stage increased the odds more than twofold (OR = 2.807, p = 0.00135). 5-ARI use was associated with notably higher odds of upgrading (OR = 3.809, p = 0.00004). Younger age slightly increased the likelihood of GSU (OR = 0.951 per year increase in age, p = 0.01101). Conclusions: Younger age, advanced pathological stage, and the use of 5-alpha reductase inhibitors were identified as significant predictors of GSU.

Obesity is a highly prevalent global health issue, affecting more than 890 million adults worldwide, with over 2.5 billion adults being overweight. In men, obesity is a leading determinant of…