Background and Objective. The significance of microRNAs (miRNAs) in relation to neoplastic diseases; such as renal carcinoma carcinoma (RCC); has been brought to light by recent studies. Analyzing the main urinary miRNAs implicated in RCC and their potential diagnostic use was the goal of this systematic review of the literature. Methods. This systematic review was performed following the PROSPERO protocol CRD42024550716. Our literature search strategies were deciding which database to include (Pubmed; EMBASE and Clinicaltrial.gov) and composing strings with words related to urinary miRNA in patients with RCC. Key findings and limitations. After screening; 10 papers were included from the 593 records that the systematic review found. No miRNA was investigated in more than one paper by different authors. The miR-210 and let-7 family were the most investigated and resulted upregulated in RCC cases compared to controls. Five papers reported different expression of miRNAs in urine samples before and after surgery: miR-15a; miR-34a-5p; miR-200a-3p; miR-205-5p; miR-210; miR-210-3p; miR-365a-3p and let-7d-5p levels decreased after nephrectomy. Meta-analysis was not performed since the included studies were heterogeneous; in terms of studied miRNA; of the normalizer used during stabilization phase; and histologic type of RCC (clear cell RCC; papillary RCC; unspecified RCC). Conclusions. Considering the variability and heterogeneity of the obtained results; as well as the vastness of the topic; expanding research in this field appears highly promising. To support further advancements; it would be useful to establish a database that consolidates international findings.

Background: In recent years, research has highlighted the importance of microRNAs (miRNAs) in the context of oncological diseases, including renal cell carcinoma (RCC). The aim of this systematic review of the literature was to analyze the main serum miRNAs involved in RCC and their potential diagnostic power. Methods: This systematic review was performed following the PROSPERO protocol CRD42024550709. Literature search strategies were developed composing strings with text words related to serum miRNA in RCC for PubMed, EMBASE and Clinicaltrial.gov. The studies enrolling adult populations with RCC and healthy controls measuring circulating miRNAs were included. Results: We found 500 records, and 26 papers were included after screening. Four studies found that miR-210, the most investigated miRNA, was overexpressed in RCC patients compared to controls, while one reported no statistical difference. The expression of some miRNAs was consistently lower in cases compared to healthy controls, such as miR-1-3p and miR-129-5p, while others (miR-221, miR-222, miR-224-5p and miR-1233) were consistently upregulated. Conclusions: Circulating miRNAs represent a promising avenue for the non-invasive diagnosis of RCC. Future research should focus on standardization, validation in larger cohorts and the development of multi-marker diagnostic panels to address these current limitations and pave the way for miRNA-based diagnostics in RCC.

Objective: Fournier's gangrene (FG) is a rare, life-threatening necrotizing fasciitis primarily affecting the perineal, genital, and perianal regions. This rapidly progressing bacterial infection predominantly affects middleaged and elderly men. This multicenter study aims to describe the management in a wide cohort of Fournier's gangrene cases that presented to three tertiary centers with early extensive surgical debridement. Materials and Methods: We retrospectively collect data from patients with FG who were referred to the Urology Clinic of the Department of Medicine and Surgery (Perugia), the Urological Andrological Surgery and Minimally Invasive Techniques Unit (Terni) of the University of Perugia, and the Urology Unit of the Surgery Department of the Macerata Civic Hospital between January 2019 and March 2024 for onset of classic signs and symptoms of FG. Extensive surgical debridement was immediately performed under general anesthesia to reach normochromic and vascularized tissue in wide and depth extension, assuring vital and healthy margins. For all patients, intravenous daptomycin plus piperacillin/tazobactam were administered. Results: 28 male patients with FG underwent early surgical debridement. In two cases, orchidectomy and partial penectomy were required during surgical debridement due to extensive necrosis. Colon diversion and urinary diversion were not necessary for any of the patients. 32.1% complications were recorded according to the Clavien Dindo classification; 6 patients died in the perioperative. Excluding death data, the average duration of antibiotic therapy was 22.0±9.1 days, and the average length of stay was 17.6±11.8 days. Conclusions: Fournier's gangrene has high mortality rates. It requires timely surgical debridement and antibiotic therapy to achieve positive outcomes. This study shows that a primary extensive debridement can help reduce the need for further intervention and shorten the hospital stay.

Background: Sclerosing perivascular epithelioid cell tumors (PEComas) are rare mesenchymal neoplasms, typically benign but occasionally exhibiting aggressive behavior. This study reports a case of sclerosing PEComa of the adrenal gland that was treated with robotic partial adrenalectomy, with 13 years of follow-up and a review of the literature. Methods: A 48-year-old woman presented with abdominal pain. Imaging revealed a 10 × 9 cm adrenal mass displacing adjacent structures. MRI and 18F-FDG PET-CT suggested angiomyolipoma. Robotic partial adrenalectomy was performed. Intraoperative frozen section analysis identified the mass as angiomyolipoma, while final histopathology confirmed it as a sclerosing PEComa. Results: This case highlights the advantages of robotic surgery in the management of large adrenal tumors, allowing complete tumor removal while preserving functional adrenal tissue. The extended 13-year follow-up is significant, given the potential for recurrence or malignant transformation reported in other cases. A literature review identified 39 reported cases of sclerosing PEComas, with few documenting long-term outcomes. Conclusions: This is a documented case of robotic partial adrenalectomy for sclerosing PEComa. The findings support robotic surgery as a safe effective approach for managing this rare tumor, with excellent functional and oncological results. Extended follow-up reinforces the tumor’s benign behavior and the importance of long-term monitoring in PEComas.

Colovesical fistulas (CVFs) are abnormal connections between the colon and bladder, most commonly associated with complicated diverticular disease. The standard treatment involves bowel resection to remove the fistulous tract and reduce the risk of recurrence. This study aimed to evaluate the feasibility and safety of laparoscopic and robotic conservative surgery for CVFs, avoiding bowel resection. Between 2012 and 2019, 12 consecutive patients underwent conservative treatment: 5 with a laparoscopic approach and 7 with a robotic approach. Perioperative outcomes showed shorter operative time and lower blood loss in the robotic group (101 min vs. 144 min, p = 0.02; 47 mL vs. 176 mL, p = 0.02). No surgical conversions were required, and the complication rate was low. One recurrence occurred in the laparoscopic group due to extensive diverticular disease. Short- and long-term outcomes demonstrated favorable functional results, with a reduced risk of complications compared to traditional bowel resection. The robotic technique provided advantages in operative time and blood loss. A conservative approach is an option for selected patients, particularly those with non-extensive diverticular disease.

Urinary microRNAs (miRNAs) are promising noninvasive biomarkers for cancer detection, but their clinical utility is reduced by inconsistent normalization strategies, reducing reproducibility and comparability across studies. In this study, we assessed the stability of miR-20a as an endogenous normalizer for urinary miRNA profiling in clear cell renal cell carcinoma (ccRCC) while standardizing the pre-analytical phase using a urine stabilizing solution. Ninety-nine urine samples were analyzed: 47 from healthy individuals, 30 from ccRCC patients pre-surgery, and 22 post-operative patients. Six candidate miRNAs—miR-20a, miR-15b, miR-16, miR-15a, miR-210-3p, and miR-let-7b—were quantified via RT-qPCR. Stability analysis with RefFinder, integrating multiple algorithms (geNorm, normFinder, BestKeeper, and ΔCt methods), identified miR-20a as the most stable among the six candidates. Raw Ct values of miR-20a were normally distributed (Shapiro–Wilk test, p > 0.05), with no significant intergroup differences (one-way ANOVA, F(2.96) = 2.324, p = 0.103) and minimal intragroup variability (CV% 4.98–6.38). MiR-20a expression remained stable across different tumor staging, grading, and urine storage durations. These findings confirm miR-20a as a robust endogenous normalizer for urinary miRNA analyses and support the feasibility of developing reproducible urinary liquid biopsy workflows for ccRCC, even in settings where immediate sample processing is not feasible.