G. Franco

Metabolic Syndrome and Lower Urinary Tract Symptoms in Patients With Benign Prostatic Enlargement: A Possible Link to Storage Symptoms

OBJECTIVEnTo evaluate the association between metabolic syndrome (MetS) and lower urinary tract symptoms (LUTS) in patients with benign prostatic enlargement (BPE).nnnMATERIALS AND METHODSnFrom 2009 onward, a consecutive series of patients with LUTS-BPE were enrolled. Patients were evaluated using the International Prostate Symptom Score (IPSS) and ultrasonographic prostate volume. Body mass index, waist circumference, and blood pressure were measured. Blood samples were collected for prostate-specific antigen levels, fasting glucose levels, triglyceride levels, high-density lipoprotein levels, and testosterone levels. MetS was defined according to Adult Treatment Panel III (ATP III). The risk of detecting LUTS as a function of MetS was evaluated using the logistic regression analysis.nnnRESULTSnA total of 431 patients were enrolled with a median age and prostate-specific antigen level of 67 years (61-73 years) and 3 ng/mL (2.2-4.3 ng/mL), respectively; median body mass index was 27 kg/m2 (25-29 kg/m(2)); median testosterone was 3.9 ng/mL (3.1-4.7 ng/mL); median IPSS was 8 (4-14), median prostate volume was 43 mL (35-56 mL). One hundred three of 431 patients (23.8%) presented with a MetS. Patients with MetS presented a higher IPSS storage subscore (4; interquartile range, 2-7 vs 3; interquartile range 1-7; P = .002). On multivariate analysis, the presence of MetS was associated with an increased risk of an IPSS storage subscore ≥4 (odds ratio, 1.782; 95% confidence interval, 1.045-3.042; P = .030).nnnCONCLUSIONnIn our single-center study, MetS is associated with an increased risk of storage symptoms in patients with BPE. Although these results should be confirmed, and the pathophysiology is yet to be understood, it can be assumed that MetS and its metabolic components should be considered as possible factors involved in LUTS-BPE pathogenesis.

Transuretral resection of the bladder (TURB): Analysis of complications using a modified Clavien system in an Italian real life cohort

INTRODUCTIONnTo evaluate the applicability of a modified Clavien classification system (CCS) in grading postoperative complications of transurethral resection of bladder tumours (TURB).nnnMATERIALS AND METHODSnA series of patients undergoing monopolar TURB from April 2011 to March 2012 at five Italian centers were enrolled. All complications occurring within the first 30-day postoperative period were prospectively recorded and graded according to the CCS.nnnRESULTSnOverall, 275 patients were included. Median age was 71 (63/78) years; median BMI was 28 (25.4/30.8) Kg/m(2), median tumour size was 2 (1-3) cm; median number of tumour lesions was 1 (1-3). Median operative time was 30 (20/45) min. Fifty-seven complications were recorded in 43 patients. Overall postoperative morbidity rate was 16%. Most of the complications were not serious and classified as Clavien type I (42 cases; 74%) or II (8 cases, 14%). Higher grade complications were scarce: CCS IIIa in 1 case (2%) and CCS IIIb in six cases (10%). No TURB related death was reported. Six patients were re-operated due to significant bleeding or clot retention on postoperative days 2-7. On univariate (73.5 ± 38 versus 36.7 ± 21.6 min) and multivariate analysis longer operative time was an independent predictor of complications (OR: 1.06 per min, 95%CI 1.04-1.08, p = 0.001).nnnCONCLUSIONSnA modified CCS can be used as a standardized tool to objectively define the complications of TURB which confirms to be a safe procedure with a low surgical morbidity. This tool can be used to aid in patient counselling and to facilitate scientific assessment.

INSIST-ED: Italian Society of Andrology registry on penile prosthesis surgery. First data analysis

OBJECTIVESnThe Italian Society of Andrology, i.e. Società Italiana di Andrologia (S.I.A.), launched on December 2014 a prospective, multicenter, monitored and internal review board approved Registry for penile implants, the INSIST-ED (Italian Nationwide Systematic Inventarisation of Surgical Treatment for ED) Registry. Purpose of this first report is to present a baseline data analysis of the characteristics of penile implant surgery in Italy.nnnMATERIAL AND METHODSnThe INSIST-ED Registry is open to all surgeons implanting penile prostheses (all brands, all models) in Italy, providing anonymous patient, device, surgical procedure, outcome, follow-up data, for both first and revision surgeries. A Registry project Board overviews all the steps of the project, and a Registry Monitor interacts with the Registry implanting surgeons.nnnRESULTSnAs by April 8, 2016, 31 implanting surgeons actively joined the Registry, entering 367 surgical procedures in its database, that comprise: 310 first implants, 43 prosthesis substitutions, 14 device explants without substitution. Implanted devices account for: 288 three-component devices (81,3%), 20 two-component devices (5,4%), 45 non-hydraulic devices (12,3%). Leading primary ED etiologies in first implant surgeries resulted: former radical pelvic surgery in 111 cases (35,8%), Peyronies disease in 66 cases (21,3%), diabetes in 39 cases (12,6%). Two intraoperative complications have been recorded. Main reasons for 57 revision surgeries were: device failure (52,6%), erosion (19,3%), infection (12,3%), patient dissatisfaction (10,5%). Surgical settings for patients undergoing a first penile implant were: public hospitals in 251 cases (81%), private environments in 59 cases (19%).nnnCONCLUSIONSnThe INSIST-ED Registry represents the first European experience of penile prosthesis Registry. This baseline data analysis shows that: three-pieces inflatable prosthesis is the most implanted device, leading etiology of erectile dysfunction (ED) in patient receiving a prosthesis is former radical pelvic surgery, primary reason for revision surgery is device failure, primary settings for first penile implant surgery are public hospitals. Evaluation of penile implant impact on recipients quality of life is presently ongoing.

Chirurgia dell'infertilità maschile: update

Surgery for male infertility includes three main areas: varicocele surgery, recanalization of seminal tract, sperm retrieval. Varicocele treatment in infertily is still controversial. Recent scientific evidence appears to demonstrate that in selected cases varicocele treatment is beneficial in improving semen parameters and pregnancy rate. The key for the success of treatment seems to be a correct indication. It is our opinion that varicocele should be treated in presence of abnormal semen parameters, when clinically significant, and in adolescents with atrophy of the affected testis. So far, no specific technique, either surgical, microsurgical or sclerotherapic, can be considered the gold standard. Good results in our hands have been obtained with the microsurgical lymphatic sparing high ligation of internal spermatic vein. Innovations in surgery for seminal tract obstructions include the new tubular invagination techniques for epididimovasostomy, which showed excellent results with a simplified and time-saving microsurgical approach. In distal obstructions, a new transperineal ultrasound-guided approach has been proposed for the diagnostic work-up and treatment. Advantages of this technique and of the TURED must be balanced with those of immediate sperm retrieval for ART. In sperm retrieval, microTESE represents the most important surgical evolution in non-obstructive azoospermia. We have recently proposed a new stepwise approach starting with a minimal equatorial incision for conventional testicular biopsy which is extended to perform microTESE only when no sperm is retrieved. In this way microTESE is offered only to patients who really need it. Another field of innovation is sperm retrieval for ICSI in patients with Klinefelter Syndrome.