Sacral neuromodulation (SNM) offers a therapeutic approach to urological patients suffering from idiopathic overactive bladder (OAB) syndrome, with or without incontinence and non-obstructive urinary retention (NOR), who are not responding to or are not compliant with conservative or medical therapies. The exact mechanism of action of SNM is not fully understood but modulation of the spinal cord reflexes and brain networks by peripheral afferents is regarded as the main pathway. Over the years, surgical techniques improved, leading to the development of the modern two-stage implantation technique. The quadripolar lead is positioned percutaneously under fluoroscopy guidance through the third sacral foramen following the trajectory of S3. The procedure can be performed under local or general anesthesia with the patient in prone position. Current applications of sacral neuromodulation in urology are increasing thanks to the recent improvements of the devices that make this a valuable option not only in conditions such as overactive bladder and non-obstructing urinary retention but also neurogenic lower urinary tract dysfunction.

INTRODUCTION GreenLight laser vaporization of the prostate (PVP) is a safe and effective procedure for Benign Prostatic Hyperplasia. Long term results and advantages of PVP in patients with large and symptomatic prostate are still under evaluation. MATERIALS AND METHODS In a multicenter experience, patients who underwent standard or anatomical PVP were retrospectively reviewed. Patients with follow-up >12 months were divided into two groups based on prostate volume (<100cc vs ≥100cc). Pre- and peri-operative data as well as post-operative results and complications were recorded after 3, 6, 12 months and then annually. RESULTS 1031 patients were eligible, 916 of these had a prostate volume of <100 cc (G1) and 115 ≥100 cc (G2). Median follow-up period was 25.0 months (IQR 16.5-35.0) and 16.0 months (IQR 12.0-24.0) in G2 and G1 groups, respectively. No difference was found in terms of catheterization time, post-operative stay and post-operative acute urine retention. G2 patients required longer operative time (75 versus 55 minutes), lasing time (41.7 versus 24.9 minutes), and higher energy used but lower energy density. G2 patients had a higher incidence of early (50.4 versus 35.7%) and late complications (21.7 versus 12.8%) and early urge/incontinence symptoms (40.9 versus 29.3%). No statistically significant differences were found for the Qmax and IPSS results between the two groups. The re-intervention rate in G2 group was 3.5% versus 2.3% in G1. CONCLUSIONS In the midterm follow-up, Greenlight PVP guarantees the same results in different prostate volumes groups. Early and late complications are more frequent in large prostates.

Background: the aim of this study was to perform an Italian telematics survey analysis on the changes in couples’ sex lives during the coronavirus disease 2019 (COVID-19) lockdown. Methods: a multicenter cross sectional study was conducted on people sexually active and in stable relationships for at least 6 months. To evaluate male and female sexual dysfunctions, we used the international index of erectile function (IIEF-15) and the female sexual function index (FSFI), respectively; marital quality and stability were evaluated by the marital adjustment test (items 10–15); to evaluate the severity of anxiety symptoms, we used the Hamilton Anxiety Rating Scale. The effects of the quarantine on couples’ relationships was assessed with questions created in-house. Results: we included 2149 participants. The sex lives improved for 49% of participants, particularly those in cohabitation; for 29% it deteriorated, while for 22% of participants it did not change. Women who responded that their sex lives deteriorated had no sexual dysfunction, but they had anxiety, tension, fear, and insomnia. Contrarily, men who reported deteriorating sex lives had erectile dysfunctions and orgasmic disorders. In both genders, being unemployed or smart working, or having sons were risk factors for worsening the couples’ sex lives. Conclusion: this study should encourage evaluation of the long-term effects of COVID-19 on the sex lives of couples.

Aims: Intradetrusor injection of Onabotulinum Toxin A (BTX‐A) is a third‐line treatment for overactive bladder (OAB). Voiding dysfunction and the need for intermittent catheterization are potential complications, consequent to bladder contractility (BC) decrement.Primary aim: to evaluate BC variation after BTX‐A detrusor injection in women with idiopathic OAB.Methods: A prospective multi‐institutional observational study was conducted. Medical history, bladder diary, 24‐h pad test, and invasive urodynamic parameters were recorded before and 4–6 weeks after BTX‐A 100U administration. BC was measured as Modified Projected Isovolumetric Pressure (PIP1), that is, maximum flow rate (Qmax) + detrusor pressure at Qmax (PdetQmax).Continuous variables were expressed as median and interquartile range. We compared continuous variables using Wilcoxon test and proportions between two times with Fisher exact test.Results: No changes in PIP1 were observed (p > 0.05) in 45 women enrolled between January 2018 and September 2019. Median age was 54.6 years. At baseline, 91.1% had urge urinary incontinence, with 4.9 ± 2.6 daily pads used and a 24‐h pad test of 205.4 ± 70.8 g. Baseline detrusor contractility was normal in all the patients.Postoperatively, an improvement in the 24‐h pad test (p < 0.01), daily voids (p < 0.01), and nocturia (p < 0.01) occurred. Urodynamics pointed out a significant reduction of detrusor overactivity rate (p < 0.01) and an increase of median maximum cystometric capacity (p < 0.01). No difference was observed in median Qmax (p > 0.05), PdetQmax (p > 0.05), and PVR (p > 0.05). No patient needed postoperative catheterization.Conclusions: The current series provides evidence that detrusor injection of botulinum toxin is an effective option for treating OAB, without causing voiding dysfunction and BC impairment.