To evaluate transperineal laser ablation (TPLA) with Echolaser® (Echolaser® TPLA, Elesta S.p.A., Calenzano, Italy) as a treatment for benign prostatic hyperplasia (BPH) and prostate cancer (PCa) using the Delphi consensus method. Italian and international experts on BPH and PCa participated in a collaborative consensus project. During two rounds, they expressed their opinions on Echolaser® TPLA for the treatment of BPH and PCa answering online questionnaires on indications, methodology, and potential complications of this technology. Level of agreement or disagreement to reach consensus was set at 75%. If the consensus was not achieved, questions were modified after each round. A final round was performed during an online meeting, in which results were discussed and finalized. Thirty-two out of forty invited experts participated and consensus was reached on all topics. Agreement was achieved on recommending Echolaser® TPLA as a treatment of BPH in patients with ample range of prostate volume, from 80 mL (80%), comorbidities (100%), antiplatelet or anticoagulant treatment (96%), indwelling catheter (77%), and strong will of preserving ejaculatory function (100%). Majority of respondents agreed that Echolaser® TPLA is a potential option for the treatment of localized PCa (78%) and recommended it for low-risk PCa (90%). During the final round, experts concluded that it can be used for intermediate-risk PCa and it should be proposed as an effective alternative to radical prostatectomy for patients with strong will of avoiding urinary incontinence and sexual dysfunction. Almost all participants agreed that the transperineal approach of this organ-sparing technique is safer than transrectal and transurethral approaches typical of other techniques (97% of agreement among experts). Pre-procedural assessment, technical aspects, post-procedural catheterization, pharmacological therapy, and expected outcomes were discussed, leading to statements and recommendations. Echolaser® TPLA is a safe and effective procedure that treats BPH and localized PCa with satisfactory functional and sexual outcomes.

Objective: This study aims to evaluate long-term functional, sexual, and cosmetic outcomes in adult patients who underwent hypospadias repair during childhood at a national highly specialized pediatric hospital. Methods: Medical records of pediatric patients who had undergone surgical repair of hypospadias between 1993 and 2004 at Meyer Children Hospital of Florence were reviewed. Adult patients were contacted by telephone between July and August 2021 and invited to participate. Long-term surgical outcomes were assessed focusing on complications and reinterventions, and 3 validated questionnaires on urinary function, erectile function, and penile cosmetic appearance were administered. Results: From January 1993 to December 2004, a total of 799 patients with hypospadias underwent repair surgery. Two hundred thirty-nine patients gave consent to be included in the study. Follow-ups occurred between 17 and 28 years after the first surgery. Most patients had anterior localization of hypospadias (210/239) and associated penile curvature (132/239). The most frequent surgery for hypospadias repair was meatal advancement and glanduloplasty incorporated (MAGPI) (88/239), and the most used surgical treatment for penile curvature was the Nesbit technique (49/132). The complication rate was 27% (65/239) in an average time of 4.7 years, and 48 surgical procedures have been performed to treat them. At follow-up, the mean IPSS was 0.96 ± 1.97, the mean IIEF-5 score was 24.10 ± 1.02, and the mean HOSE score was 15.47 ± 0.45. Patients who underwent reintervention reported a lower IPSS than those who underwent only 1 surgery (0.29 vs. 1.16). Conclusion: Hypospadias repair during childhood leads to rather normal urinary and sexual function and penile cosmetic appearance in adolescence and adulthood. Cite this article as: Bocchino AC, Cocci A, Pezzoli M, et al. Long-term functional, sexual, and cosmetic outcomes in adult patients who underwent hypospadias repair during childhood at a highly specialized Italian Pediatric Hospital. Urol Res Pract. 2024;50(2):127-133.

This systematic review assesses the impact of different second-layer coverage techniques on complication rates following primary tubularized incised plate urethroplasty (TIPU) for distal and midpenile hypospadias. A systematic search of PubMed, EMBASE, Cochrane Central, and Scopus was conducted in August 2024. Studies were included if they reported outcomes of single- or double-layer neourethral coverage in primary TIPU for distal or midpenile hypospadias. A narrative synthesis was performed due to study heterogeneity. Forty studies met inclusion criteria. In distal hypospadias, single-layer coverage yielded urethrocutaneous fistula (UCF) rates below 10% in most cases. Meatal stenosis reached 33.3% but was uncommon with dorsal dartos (DD) flaps. Double-layer coverage, especially with double DD flaps, showed lower UCF rates (0–12)% and minimal stenosis. For midpenile hypospadias, single-layer coverage showed higher UCF rates (0–36.4%), with DD flaps performing worse (12.5–36.4%) than tunica vaginalis (TV) flaps (0–3.1%). Double-layer techniques consistently reduced UCF to < 5%, with double DD flaps showing no fistula or stenosis. In conclusion, second-layer coverage, particularly double layer, reduces complications in TIPU. The DD flap remains most commonly used due to its accessibility, while the technically demanding TV flap shows promising results. Further high-quality data are needed to identify the optimal technique.

Cocci A, et al. World J Mens Health. 2023 Aug;41:e70. https://doi.org/10.5534/wjmh.230102