Mirko Preto

A prospective multicentric international study on the surgical outcomes and patients’ satisfaction rates of the ‘sliding’ technique for end-stage Peyronie's disease with severe shortening of the penis and erectile dysfunction

To report the results from a prospective multicentric study of patients with Peyronies disease (PD) treated with the ‘sliding’ technique (ST).

Detection of multiple mutations in urinary exfoliated cells from male bladder cancer patients at diagnosis and during follow-up

Most bladder cancer (BC) patients need life-long, invasive and expensive monitoring and treatment, making it a serious burden on the health system. Thus, there is a pressing need for an accurate test to assist diagnosis and surveillance of BC as an alternative to cystoscopy. Mutations in human TERT, FGFR3, PIK3CA, and RAS genes have been proposed as potential molecular markers in bladder tumor. Their concomitant presence in urine samples has not been fully explored. We investigated a panel of mutations in DNA from exfoliated urinary cells of 255 BC patients at diagnosis. Forty-one mutations in TERT, FGFR3, PIK3CA, and RAS were analyzed by SNaPshot assay in relation to clinical outcome. In 81 of these patients under surveillance, the same set of mutations was screened in additional 324 samples prospectively collected. The most common mutations detected in urine at diagnosis were in the TERT promoter. In non-invasive BC, these mutations were related to high risk and grade (p<0.0001) as well as progression to muscle-invasive disease (p=0.01), whereas FGFR3 mutations were observed in low-grade BC (p=0.02) and patients with recurrences (p=0.05). Stronger associations were observed for combined TERT and FGFR3 mutations and number of recurrences (OR: 4.54 95% CI: 1.23-16.79, p=0.02). Analyses of the area under the curve for combinations of mutations detected at diagnosis and follow-up showed an accuracy of prediction of recurrence of 0.80 (95% CI: 0.71-0.89). Mutations in urine of BC patients may represent reliable biomarkers. In particular, TERT and FGFR3 mutations have a good accuracy of recurrence prediction.

Sexual function after surgical treatment for penile cancer: Which organ-sparing approach gives the best results?

INTRODUCTION We compared the postoperative sexual function of patients who underwent wide local excision (WLE) and glansectomy with urethral glanduloplasty for penile cancer. METHODS We retrospectively reviewed clinical data of 41 patients affected by superficial, localized penile cancer (≤cT2a) between 2006 and 2013. Patients with severe erectile dysfunction and not interested in resuming an active sexual life were selected for penile partial amputation. Patients with preoperative satisfying erectile function and concerned about the preservation of their sexual potency were scheduled for WLE (Group A) or glansectomy with urethral glanduloplasty (Group B). Sexual function was assessed with the International Index of Erectile Function (IIEF) questionnaire and the Sex Encounter Profile (SEP). At 1 year, patients were asked to complete the questionnaires again and were questioned about their genital sensibility and ejaculatory reflex persistence. Postoperative complications were reported according to the Clavien-Dindo classification. Statistical analysis was performed by two-tailed test: Student t-test and chi-square. RESULTS Among the 41 patients enrolled, 12 underwent WLE (29.2%), 23 glansectomy with urethral glanduloplasty (56%) and 6 with penile partial amputation (14.6%). A decrease in postoperative IIEF was recorded in both groups, but was statistically significant only in Group B (p = 0.003). As for the SEP, while no significant changes were recorded postoperatively in Group A, a marked reduction was reported for Group B, with a statistically significant decrease in the possibility of achieving penetrative intercourse (p = 0.006) and in the perceived satisfaction during sexual activity (p = 0.004). CONCLUSIONS WLE lead to better sexual outcomes and less postoperative complications as compared to glansectomy with urethral glanduloplasty.

Increased micronucleus frequency in peripheral blood lymphocytes predicts the risk of bladder cancer.

Background:Bladder cancer (BC) is among the most common malignancies worldwide. The identification of new biomarkers for early BC detection, recurrence/progression is urgently needed. The cytokinesis-block micronucleus assay (CBMN) evaluates chromosome damage in cultured human lymphocytes and micronuclei (MN) provide a convenient and reliable index of both chromosome breakage and loss.Methods:Chromosomal damage (expressed as frequencies of MN, nucleoplasmic bridges and nuclear buds (NBUD)) was evaluated by CBMN assay in cryopreserved lymphocytes from 158 age/smoking-matched pairs of cases and controls in relation to BC risk, recurrence or progression. Moreover, non-muscle invasive BC (NMIBC) patients were characterised for 783 DNA repair gene polymorphisms for their possible association with the investigated cytogenetic end points.Results:MN and NBUD frequencies were significantly higher in cases than in controls (P=0.001 and P=0.006, respectively), with the associations being stronger in NMIBC. In a logistic regression model, for each increase of one unit in the MN frequency, a 1.12 increased risk of developing NMIBC was observed. In NMIBC cases, 10 polymorphisms were associated with different MN frequencies after genotype stratification.Conclusions:A model including traditional BC risk factors, MN frequency and the selected polymorphisms differentially distributed in cases and controls improved BC patient identification. Understanding the meaning of systemic chromosomal damage in BC patients with respect to the general population may help to adopt specific prevention strategies and therapeutic intervention.

Oral mucosa harvest for urologic reconstruction: role of maxillofacial surgeon and donor-site morbidity evaluation.

PurposeThe aim of this study was to present retrospective analysis of our experience regarding complications associated with the donor site after oral mucosa harvest for urethral reconstruction. Materials and MethodsBetween May 2010 and January 2013, a total of 18 patients with recurrent urethral strictures received a buccal mucosal graft for urethral reconstruction at the San Giovanni Battista Hospital, University of Turin, Turin. All operations were performed in a 2-team approach. All patients were retrospectively evaluated by clinical examination and using a questionnaire. ResultsUrethroplasty with oral mucosa graft was performed successfully in a 1-step procedure in 17 of 18 patients. No intraoperative complications were observed.The most common complication occurring at the buccal donor site was scarring and contracture (n = 3). ConclusionsOral mucosa graft for urethroplasty is a simple and safe method in the interdisciplinary treatment of urethral strictures. Donor-site morbidity measured by clinical assessment and questionnaire is tolerable.

A Single-center Analysis on the Learning Curve of Male-to-Female Penoscrotal Vaginoplasty by Multiple Surgical Measures

OBJECTIVE To asses and quantify the learning curve (LC) of the penoscrotal inversion flap vaginoplasty (PSV). PATIENTS AND METHODS We retrospectively reviewed clinical records of 69 patients who underwent PSV from January 2005 to January 2015. Two validated methods were used: a scatterplot representation and a splitting group. We selected as primary outcomes the operative time and vaginal depth. Surgical outcomes including blood losses, hospital stay, and postoperative complications such as vaginal stenosis or atresia or urethral meatus stenosis were also evaluated. RESULTS The overall median operative time was 245 minutes. Severe intraoperative complications were not reported. The overall incidence of postoperative major complications was 21.7 %, most of them being urethral issues. The splitting group analysis revealed a statistically remarkable difference between groups for the operative time (P < .01), the vaginal depth (P = .01), the hospital stay (P < .01), and the intraoperative complication rate (P = .01). On the contrary, no differences were evidenced between the cohorts for the amount of blood loss (P = .08). The scatterplot logarithmic analysis demonstrated a clear visible LC for most parameters. The operative time showed a sharp decrease within the first 20-30 cases, reaching a plateau after 40 cases. Considering the analysis of the vaginal depth, the logarithmic scatterplot curve evidenced a slight increase within the first 10 cases, reaching a clear stabilization after nearly 30-40 cases. CONCLUSION An evident LC for PSV is detectable, consisting of at least 40 cases needed to the surgical team to develop adequate skills to guarantee a safe and high-quality procedure.

Does Sex Reassignment Surgery Induce Cerebral Modifications in MTF Transsexuals

DOI: 10.1111/jsm.12355Despite widely accepted biological theories, the etiopathogenesisof the gender dysphoria [1] remains largely unclear.Several studies have shown the existence of some gender-related cerebral areas. Indeed, various areas belonging to thelimbic system such as stria terminalis, preoptic nucleus, and amyg-dalaarecharacterizedbyasexualdimorphismbothinmacroscopicand microscopic structures [2,3]. Men and women are different inprocessing cognitive and emotional stimuli [4].A common neurophysiologic approach to assess cognitivefunctions is based on event-related potential (ERP) analysis, espe-cially on the evoked component called P300. The P300 wave is acentro-parietal positive deflection in human ERP, which occursabout 300 milliseconds after stimuli’s appearance and it is knownas the “cognitive wave” [5].Few scholars have studied male to female (MTF) transsexualsthrough neurophysiologic studies.We designed a prospective case-control study. Fifteen MTFtranssexuals, aged average 35 years and an age matched controlgroup of 20 healthy right-handed heterosexual volunteers (10males and 10 females) underwent an emotional ERP test. Thecognitive-emotional ERPs were achieved while the subjects werewatching slides extracted from the International Affective PictureSystem (IAPS). Sixty pictures, divided in two series with positive/neutral and negative/neutral valences were shown randomly to thesubjects. The area below the P300 wave, its amplitude and latencywere compared before and after sex reassignment surgery (SRS) intranssexuals and with control groups.The P300 component of control females was characterized bya larger latency, amplitude and area, comparing to the male’s one,in both the pleasant and unpleasant pictures (

Sperm collection for medically assisted procreation in azoospermic patients

Infertility is defined as the inability of a sexually active non-contracepting couple to achieve spontaneous pregnancy in one year. Factors of male infertility are present in 50% of infertile couples. Azoospermia is defined as the absence of sperm in the ejaculate, even after centrifugation of the sample, and affects 10%-15% of the infertile male population. Therefore, it represents a pathological condition of primary importance in the context of infertility management. Any assisted reproductive procedure must first refer to the availability of a suitable number of good quality gametes. As regards sperm collection, if ejaculated semen is not suitable or available, it may be taken from the seminal duct or directly from the testicular parenchyma with different methodologies and techniques, which can be divided into percutaneous techniques and open surgical (TeSE and ESA) or microsurgical (micro-TeSE) techniques. The purpose of this work is to evaluate and compare the retrieval rate in infertile patients suffering from azoospermia and treated with the various surgical techniques.

Role of perioperative dynamic sentinel node biopsy for cN0 penile cancer management: experience from an Italian tertiary referral center

Purpose: Inguinal lymphadenectomy (iLAD) reduces mortality in patients with cN0 penile cancer but yields high complication rates. Thus, its prophylactic role has been questioned and dynamic sentinel node biopsy (DSNB) was introduced to select men who should undergo the procedure. Our aim was to investigate the accuracy of a contemporary DSNB cohort. Methods: We performed a retrospective analysis of ≥T1 or ≥G2 cN0 penile cancer undergoing perioperative DSNB from June 2009 to June 2015 at a tertiary referral center. We excluded men with <18 months follow-up or with local recurrence after primary curative treatment. Complications were graded according to the Clavien-Dindo classification. Results: Thirty-five men underwent DSNB; 85.71% had ≤T2 penile cancer with ≤G2a histology. Per groin detection rate was 80% (scintigraphy being positive bilaterally in 60% and unilaterally in 20.0%). In no cases did DSNB prolong the postoperative course compared to primary surgery. Nine men (n = 15/109 nodes removed) had positive results, 8 of whom underwent iLAD. Among negative DSNB patients, 2 developed nodal penile cancer recurrence; none of them had node biopsy due to inconclusive scintigraphy. At a median follow-up of 42 months (interquartile range 30-78 months), if considering only men with scintigraphy detected inguinal nodes, per-patient sensitivity and specificity were 50% and 80% whereas positive predictive value and negative predictive value were 25% and 92.3%, respectively. Conclusions: Perioperative DSNB is a safe procedure, yielding promising results when performed at a tertiary referral center. Future prospective large studies are needed to investigate how to optimize detection rate and reduce false-negative rates.

Surgical checklist impact on recurrence-free survival of patients with non-muscle-invasive bladder cancer undergoing transurethral resection of bladder tumour

To evaluate the impact of an eight‐item surgical checklist (SC) on the recurrence‐free survival (RFS) of patients with non‐muscle‐invasive bladder cancer (NMIBC) undergoing transurethral resection of bladder tumour (TURBT).