Abstracts book - XIV Congresso Nazionale UrOP by Edizioni Scripta Manent

COP UrOP 2019 2.qxp_Cop+Ed+fisse 2006 16/05/19 13:56 Pagina I

ISSN 1124-3562

Vol. 91; n. 1, Supplement 1, March 2019

ABSTRACTS BOOK

COP UrOP 2019 2.qxp_Cop+Ed+fisse 2006 16/05/19 13:56 Pagina II

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Info.qxp_Programma 16/05/19 13:57 Pagina I

Urological and Andrological Sciences Founded in 1924 by: G. Nicolich, U. Gardini, G.B. Lasio

Official JournalEditorial of SIA, board SIEUN, UrOP and GUN

UrOP EDITOR C. Boccafoschi (Alessandria) UrOP EDITORIAL BOARD R. Colombo (Milano), R. Giulianelli (Roma), M. Lazzari (Firenze), A. Porreca (Abano Terme - PD), A. Russo (Milano), M. Scarcia (Acquaviva delle Fonti - BA), N. Suardi (Milano)

Indexed in Medline/Index Medicus - EMBASE/Excerpta Medica - Medbase/Current Opinion - SIIC Data Base

Info.qxp_Programma 16/05/19 13:57 Pagina II

XXIV Congresso Nazionale UrOP

Cari Amici e Soci, pubblichiamo in questo volume i Contributi Scientifici fatti pervenire alla Segreteria Scientifica di UrOP per essere presentati al 14° Congresso Nazionale del 6-8 Giugno 2019. I Contributi sono divisi per tematica e modalità di presentazione (video/comunicazioni orali/poster). Siamo sicuri che la loro raccolta e consultazione vi sarà di utilità sia durante lo svolgimento dei lavori scientifici del Congresso sia nella vostra pratica clinica quotidiana. Ringraziamo sentitamente tutti gli Autori e i membri del Comitato Scientifico per il loro lavoro di valutazione, selezione e raccolta dei contributi scientifici. A tutti Voi i nostri più sentiti auguri di buon lavoro

Renzo Colombo Il Presidente del Comitato Scientifico

Archivio Italiano di Urologia e Andrologia 2019; 91, 1, Supplemento 1

Carmelo Boccafoschi Chief UrOP Editor Archivio Italiano di Urologia e Andrologia

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XIV CONGRESSO NAZIONALE UROP

INDICE VIDEO V_01

NUOVA MODALITÀ DI CIRCONCISIONE CON “LANGHE DISPOSABLE CIRCUMCISION SUTURE DEVICE”. SEMPLICITÀ, RAPIDITÀ E BUONI RISULTATI ESTETICI. ESPERIENZE PRELIMINARI Pozza D. p. 10

V_02

NERVE SPARING ROBOT ASSISTED RADICAL CYSTECTOMY AND “SHELL” NEOBLADDER: THE EVOLUTION OF TECHNIQUE AND AN UPDATE IN A HIGH VOLUME CENTER Bianchi R.

p. 23

ROBOTIC ASSISTED LAPAROSCOPIC PARTIAL NEPHRECTOMY IN A HORSESHOE KIDNEY: SURGICAL TECHNIQUE AND FEASIBILITY IN A RARE ANATOMICAL ANOMALY Bianchi R.

p. 23

V_03

V_04

PROSTATECTOMIA RADICALE NERVE SPARING LAPAROSCOPICA CON TECNICA RETROGRADA Grosso G. p. 24

V_05

SUPER-EXTENDED LYMPH NODE DISSECTION DURING LAPAROSCOPIC RADICAL CYSTECTOMY, INITIAL EXPERIENCE AND DESCRIPTION OF THE TECHNIQUE Corongiu E. p. 24

V_06

SAFETY AND EFFICACY OF RETROPERITONEAL SUTURELESS ZERO ISCHEMIA LAPAROSCOPIC PARTIAL NEPHRECTOMY FOR LOW NEPHROMETRY SCORE MASSES Corongiu E. p. 24 Archivio Italiano di Urologia e Andrologia 2019; 91, 1, Supplemento 1

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XXIV Congresso Nazionale UrOP - Indice

V_07

V_08

V_09

V_10

V_11

V_12

V_13

V_14

V_15

V_16

V_17

LINFADENECTOMIA INGUINALE ROBOT ASSISTITA PER CARCINOMA A CELLULE SQUAMOSE (SCC) DEL PENE: TECNICA CHIRURGICA Dente D.

p. 25

TUMORECTOMIA RENALE ROBOTICA CLAMPLESS RETROPERITONEALE Gallo G.

p. 26

NEFRECTOMIA DESTRA LAPAROSCOPICA RETROPERITONEALE CON CAVOTOMIA Polara A.

p. 27

CISTO-ISTERO-ANNESSIECTOMIA ROBOTICA IN PREGRESSA PLURIMA CHIRURGIA ADDOMINALE Pomara G.

p. 27

ROBOTIC SURGERY IN PATIENTS WITH ACHONDROPLASTIC DWARFISM: RIGHT PARTIAL NEPHRECTOMY De Marchi D.

p. 27

LOW ENERGY BIPOLAR PROSTATE ENUCLEATION. AN INNOVATIVE TECHNIQUE TO MINIMALIZE ENERGY SIDE EFFECTS OF ENDOSCOPIC ADENOMA REMOVAL Calarco A.

p. 42

GREENLEP: ENUCLEAZIONE EN BLOC CON GREEN LIGHT LASER Rabito S.

p. 43

NEW TECHNOLOGIES FOR OLD PROCEDURES WHEN FIREFLY TECHNOLOGIE IMPROVES ROBOTIC BLADDER DIVERTICULECTOMY Vedovo F.

p. 44

THULIUM LASER COAGULATION OF RESIDUAL URETERAL ENDOMETRIOSIS Signorini C.

p. 44

COLPOSACROPESSI ROBOTICA Gallo G.

p. 45

ROBOTIC MANAGEMENT OF NEO-BLADDER-VAGINAL FISTULA WITH BOVINE-PERICARDIUM MESH INTERPOSITION Pomara G. p. 45

Archivio Italiano di Urologia e Andrologia 2019; 91, 1, Supplemento 1

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XXIV Congresso Nazionale UrOP - Indice

COMUNICAZIONI C_01

C_02

L'ADERENZA ALLA DIETA MEDITERRANEA E L'ATTIVITÀ FISICA ASSICURANO UNA BUONA SALUTE SESSUALE E PSICHICA Della Camera P.A.

p. 11

ERECTILE DYSFUNCTION THERAPY AFTER NERVE SPARING PROSTATECTOMY: SIX MONTH COMPARISON BETWEEN AVANAFIL 200 MG AND SILDENAFIL 100 MG Della Camera P.A.

p. 11

C_03

BODY FAT DISTRIBUTION AND CORRELATION WITH SEXUAL DISORDERS AND HYPOGONADISM: NEW EVIDENCE ON THE ROLE OF SUBCUTANEOUS DEPOSITS Della Camera P.A. p. 12

C_04

PRESA IN CARICO DEL PAZIENTE IN UN REPARTO DI CHIRURGIA ANDROLOGICA. COSA PERCEPISCE L'AMMALATO COME SODDISFACENTE ASSISTENZA MEDICA ED INFERMIERISTICA? Amato C. p. 12

C_05

“DETAIL” NELLA PRESERVAZIONE DELLA FUNZIONE ERETTILE POSTPROSTATECTOMIA NERVE SPARING. STUDIO PILOTA DI UN NUOVO AUSILIO ELETTRONICO PER LA VALUTAZIONE DEL DANNO NERVOSO Della Camera P.A. p. 13

C_06

WHAT IS THE REAL IMPACT OF LONG-TERM FINASTERIDE ADMINISTRATION (FAD) FOR A TREATMENT OF ANDROGENIC ALOPECIA ON MALE FERTILITY? A REVIEW OF A RECENT STUDIES AND REPORTS Kinzikeeva E.

p. 13

C_07

ESWT IN THE TREATMENT OF ERECTILE DYSFUNCTION (ED): OUR INITIAL EXPERIENCE Inneo V.

p. 14

C_08

SPERM P53 CONCENTRATION: A POTENTIAL NEW BIOMARKER FOR ENVIRONMENTAL POLLUTION. PRELIMINARY DATA. (ECOFOODFERTILITY PROJECT) Notari T. p. 14

C_09

HUMAN SEMEN: EXCELLENT BIOACCUMULATOR OF VOLATILE ORGANIC COMPOUNDS (VOCS). (ECOFOODFERTILITY PROJECT) Montano L. p. 15

C_10

INQUINAMENTO AMBIENTALE E VARIAZIONI DI ALCUNI BIOMARCATORI SEMINALI: LDH-X, TRANSFERRINA E IL-6. (PROGETTO ECOFOODFERTILITY) Notari T.

C_11

p. 15

A RANDOMIZED CONTROLLED TRIAL ON THE EFFECTS OF LIFESTYLE CHANGES ON SEMEN QUALITY IN HEALTHY YOUNG MEN Zani D. p. 16 Archivio Italiano di Urologia e Andrologia 2019; 91, 1, Supplemento 1

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XXIV Congresso Nazionale UrOP - Indice

C_12

p. 17

C_13

CAPACITÀ ANTIOSSIDANTE TOTALE DEL LIQUIDO SEMINALE, SPERMIOGRAMMA E ABITUDINI ALIMENTARI DI UN CAMPIONE DI GIOVANI ADULTI SANI RESIDENTI IN LOMBARDIA p. 17 Zani D.

C_14

THE ROLE OF THE EXCESSIVE PREPUCE AND THE EFFECTS OF A NEW SURGICAL TECHNIQUE FOR PREMATURE EJACULATION: THE DISTAL CIRCUMCISION Gallo L. p. 18

C_15

MORBO DI LA PEYRONIE: PRIME ESPERIENZE DI TERAPIA CON ONDE D'URTO (ESWT) E CRIOELETTROFORESI Brunori S.

p. 18

C_16

THE AUTOEXPANDABLE URETERAL PROSTHESYS ALLIUM FOR THE POST URETERORENOSCOPIC URETERAL STRICTURES TREATMENT. AN OPTION TO KEEP IN MIND De Marco F. p. 20

C_17

EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY TREATMENT FOR KIDNEY STONES: COULD IT BE STILL AN OPTION? De Marco F.

p. 20

COULD ROBOTIC SURGERY BE THE INITIAL TREATMENT IN LARGE RENAL STONES? ROBOTIC PYELOLITHOTOMY, A SINGLE CENTRE HIGH VOLUME EXPERIENCE Zazzara M.

p. 21

C_18

ESISTE UN LIMITE DI ETÀ PER L'IMPIANTO PROTESICO PENIENO? NOSTRA ESPERIENZA CON PAZIENTI TRA 76 ED 86 ANNI Pozza D.

C_19

CORRELATION BETWEEN URETERAL STONES CHARACTERISTICS AND URINARY LEAKAGE Blezien O. p. 21

C_20

ENDOUROLOGICAL MANAGEMENT OF FORGOTTEN URETERAL STENTS Seveso M.

p. 21

C_21

STENT URETERALE DOPPIO-J O CATETERE URETERALE MONO-J? LA NOSTRA ESPERIENZA Di Paola G.

p. 22

C_22

MALIGNANT MELANOMA OF THE BLADDER: CASE REPORT Toffoli L.

p. 28

C_23

ACCURATEZZA DIAGNOSTICA DELLA RISONANZA MAGNETICA MULTI-PARAMETRICA (RM-MP) NELLA DIAGNOSI DEL CARCINOMA PROSTATICO CLINICAMENTE SIGNIFICATIVO Manenti G. p. 29

C_24

VALUTAZIONE DELL’ACCURATEZZA DELLA RISONANZA MAGNETICA MULTI-PARAMETRICA DELLA PROSTATA E RELATIVO PIRADS SCORE, NELLA DIAGNOSI DI CARCINOMA PROSTATICO MEDIANTE BIOPSIA CON TECNICA DI “FUSIONE RM/US”. Manenti G. p. 29

Archivio Italiano di Urologia e Andrologia 2019; 91, 1, Supplemento 1

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XXIV Congresso Nazionale UrOP - Indice

C_25

INTRAOPERATIVE AND PERIOPERATIVE OUTCOMES OF CLAMP VS OFF-CLAMP LAPAROSCOPIC PARTIAL NEPHRECTOMY: PRELIMINARY RESULTS FROM A MULTICENTRE RANDOMIZED CLINICAL TRIAL (THE CLOCK2 STUDY) p. 30 Bove P.

C_26

EFFECT OF NUTRITIONAL SUPPLEMENTS ON SERUM PSA IN YOUNG PATIENTS AT RISK OF PROSTATE CANCER (PCA): LONG TERM RESULTS OF A PROSPECTIVE FOLLOW-UP STUDY Brausi M. p. 30

C_27

A NEW RISK CLASSIFICATION SYSTEM FOR THERAPEUTIC DECISION MAKING FOR INTERMEDIATE RISK PROSTATE CANCER (PCA) PATIENTS TREATED WITH RADICAL PROSTATECTOMY (RP) Brausi M. p. 31

C_28

EFFICACY OF INTRAVESICAL BCG IN OCTOGENARIANS AND IN YOUNGER PATIENTS (=/<65-YR): RESULTS OF A COMPARATIVE STUDY Brausi M. p. 31

C_29

OUTPATIENT ENDOSCOPIC TREATMENT OF SOLITARY LOW-RISK TA-T1 BLADDER TUMOURS < 1 CM UNDER LOCAL ANESTHESIA: COST-EFFECTIVENESS Brausi M. p. 32

C_30

PATHOLOGICAL LYMPH NODES EXAMINATION USING FROZEN SECTION (FS) DURING RADICAL CYSTECTOMY (RC) IS USEFUL TO SELECT PATIENTS WHO NEED EXTENDED LYMPH NODE DISSECTION (ELAD) Brausi M.

p. 33

NERVE SPARING EXTRAPERITONEAL ROBOT-ASSISTED RADICAL PROSTATECTOMY: FUNCTIONAL OUTCOME IN A HIGH-VOLUME SURGICAL CENTER EXPERIENCE Scarcia M.

p. 33

C_31

C_32

INTRAVESICAL TREATMENT WITH ELECTRO-MEDIATED ADMINISTRATION OF MYTOMICIN C FOR INTERMEDIATE AND HIGH-RISK NON-MUSCLE-INVASIVE BLADDER CANCER: A HIGH-VOLUME SURGICAL CENTER EXPERIENCE Zazzara M. p. 34

C_33

THE VARIATION OF SELECTIVE UNGAL LEVELS AFTER ROBOT-ASSISTED PARTIAL NEPHRECTOMY: EARLY RESULTS OF A PROSPECTIVE SINGLE CENTER STUDY Colamonico O. p. 34

C_34

A COMPARISON BETWEEN TRANS-RECTAL ULTRASOUND-GUIDED MRI-FUSION VERSUS MRI-COGNITIVE VERSUS STANDARD PROSTATE BIOPSIES PERFORMED AT THE SAME TIME, IN THE SAME PATIENT: CONCORDANCE RATE AND CLINICALLY SIGNIFICANT PROSTATE CANCER DETECTION Mistretta F.A. p. 34

C_35

A COMPREHENSIVE EVALUATION OF SEXUAL DISORDERS FOLLOWING ROBOT-ASSISTED RETROPERITONEAL LYMPH NODE DISSECTION FOR NON-SEMINOMATOUS GERM CELL TUMOUR Mistretta F.A. p. 35 Archivio Italiano di Urologia e Andrologia 2019; 91, 1, Supplemento 1

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XXIV Congresso Nazionale UrOP - Indice

C_36

PERCUTANEOUS IMAGE-GUIDED RADIOFREQUENCY ABLATION FOR CT1A-B RENAL MASSES: A COMPARISON BETWEEN PATIENTS YOUNGER VS. OLDER THAN 65 YEARS Mistretta F.A. p. 36

C_37

ORTHOTOPIC ILEAL NEOBLADDER “SEMINAL SPARING” Casilio M.

C_38

RANDOMIZED CONTROLLED STUDY ASSESSING THE EFFECT OF THE AIRSEAL SYSTEM DURING ROBOTIC ASSISTED RADICAL CYSTECTOMY WITH INTRACORPOREAL ILEAL CONDUIT Pomara G. p. 37

C_39

EFFECTIVENESS OF VACUUM-ASSISTED CLOSURE THERAPY (VAC) IN THE MANAGEMENT OF DISSEMINATED FOURNIER’S GANGRENE: A MULTICENTRE STUDY Bove P. p. 46

C_40

HIGH DOSE GREEN TEA (CLUSTERIN) IS EFFECTIVE IN REDUCING LOWER URINARY TRACT SYMPTOMS (LUTS) IN PATIENTS WITH BOO: FIRST RESULTS OF A PILOT STUDY Brausi M. p. 46

C_41

CLOSED SUCTION DRAINAGE (CSD) VERSUS NO DRAINAGE OF THE SCROTUM IN INFLATABLE PENILE PROSTHESIS (IPP) PLACEMENT WITH MINIMALLY INVASIVE INFRAPUBIC APPROACH: RETROSPECTIVE COMPARATIVE OUTCOMES AT TWO HIGH-VOLUME IMPLANTING CENTERS Antonini G. p. 47

C_42

POSTOPERATIVE VACUUM THERAPY (VED) FOLLOWING AMS LGX 700® INFLATABLE PENILE PROSTHESIS (IPP) PLACEMENT: PRELIMINARY RESULTS FROM AN ITALIAN SINGLE-CENTER EXPERIENCE Antonini G. p. 47

C_43

INFLATABLE PENILE PROSTHESIS (IPP) PLACEMENT, “SCRATCH TECHNIQUE”, AND POSTOPERATIVE VACUUM THERAPY (VED) AS A COMBINED APPROACH IN THE DEFINITIVE TREATMENT OF PATIENTS WITH PEYRONIE’S DISEASE: PRELIMINARY EXPERIENCE FROM AN ITALIAN SINGLE-CENTER PROSPECTIVE TRIAL Antonini G.

p. 48

NON-INVASIVE EVALUATION OF MALE URETHRA STENOSIS: THE CINE-URETHRO RM. PRELIMINARY REPORTS Corongiu E.

p. 49

C_44

p. 36

C_45

STUDY PROTOCOL FOR PELVIC MUSCLE FLOOR REHABILITATION (PFMR) AS AN ALTERNATIVE TREATMENT IN PATIENTS AFFECTED OF PREMATURE EJACULATION (PE) THAT HAVE TO DISCONTINUE THE THERAPY WITH DAPOXETINE Maruccia S. p. 49

C_46

“CLAM” ILEOCYSTOPLASTY: WHICH FUTURE? Casilio M.

Archivio Italiano di Urologia e Andrologia 2019; 91, 1, Supplemento 1

p. 50

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XXIV Congresso Nazionale UrOP - Indice

C_47

GREEN LASER EXPERIENCE IN OBSTUCTIVE PATHOLOGY Stefanucci M.

p. 51

C_48

KUBIKER SUPPLEMENT THERAPY: TREATMENT OF THE SAME SYMPTOMS IN PATIENTS WITH DIFFERENT ONSET AND PATHOGENESIS OF THEM GIVE DIFFERENT RESULTS Kinzikeeva E.

p. 51

IDRONEFROSI “GIGANTE” DA STENOSI DELLA GIUNZIONE PIELO-URETERALE: OUTCOME A LUNGO TERMINE NELLA PERSONALE ESPERIENZA Cretì G.

p. 52

TRANSITIONAL CARE IN UROLOGIA PEDIATRICA: MODELLI ORGANIZZATIVI E LORO SOSTENIBILITÀ NEI SISTEMI SOCIO-SANITARI Cretì G.

p. 53

LAPAROSCOPYC-ASSISTED LAPAROSCOPIC YV-PLASTY IN PATIENTS WITH REFRACTORY BLADDER NECK CONTRACTURE: 2 YEARS FOLLOW UP Di Marco M.

p. 53

TRANS OBTURATOR MALE SLING FOR TREATMENT OF STRESS URINARY INCONTINENCE AFTER RADICAL PROSTATECTOMY: 12 MONTHS FOLLOW UP Di Marco M.

p. 55

C_49

C_50

C_51

C_52

C_53

EMBOLIZZAZIONE DELL'IPERPLASIA PROSTATICA: ASPETTI TECNICI E RISULTATI PRELIMINARI Brunori S. p. 55

C_54

LASER TULLIO REVOLIX 200 VERSUS SISTEMA PLASMACINETICO GYRUS, COMPARATIVA E BENEFICI DEL LASER NELLA IPB Brunori S.

C_55

p. 56

EFFECTIVENESS OF A NOVEL ORAL COMBINATION OF D-MANNOSE, POMEGRANATE EXTRACT, PREBIOTICS AND PROBIOTICS (PROLACTIS IVU) FOR TREATING ACUTE UNCOMPLICATED CYSTITIS: RESULTS OF A PILOT STUDY Pugliese D. p. 56

POSTER P_01

P_02

P_03

GRIFFONIA, PASSIFLORA E VALERIANA: UNA NUOVA ALTERNATIVA TERAPEUTICA NEL TRATTAMENTO DELL'EIACULAZIONE PRECOCE? Militello A.

p. 19

CISTECTOMIA RADICALE LAPAROSCOPICA CON DERIVAZIONE URINARIA: RISULTATI E COMPLICANZE DI 45 CASI Bada M.

p. 38

PICCOLE MASSE RENALI: ANALISI MONOCENTRICA E RETROSPETTIVA DI 100 BIOPSIE RENALI Bada M. p. 38 Archivio Italiano di Urologia e Andrologia 2019; 91, 1, Supplemento 1

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XXIV Congresso Nazionale UrOP - Indice

P_04

FUNCTIONAL OUTCOMES AND COMPLICATIONS OF ROBOT-ASSISTED RADICAL PROSTATECTOMY IN A HIGH-VOLUME CENTER: LEARNING CURVE IS SAFE FOR PATIENTS. Cozzi G. p. 39

P_05

MULTIPARAMETRIC MAGNETIC RESONANCE IMAGING OF THE PROSTATE DURING ACTIVE SURVEILLANCE FOR LOW-RISK PROSTATE CANCER: TIME TO REDUCE THE NUMBER OF FOLLOW-UP BIOPSIES? Luzzago S. p. 40

P_06

PATHOLOGICAL FINDINGS AT RADICAL PROSTATECTOMY OF BIOPSY NAÏVE MEN SUBMITTED TO MRI-TARGETED BIOPSY ALONE WITHOUT STANDARD SYSTEMATIC SAMPLING Luzzago S. p. 40

P_07

A NOVEL NOMOGRAM PREDICTING LYMPH NODE INVASION AMONG PATIENTS WITH CLINICALLY LOCALIZED PROSTATE CANCER: THE IMPORTANCE OF EXTRACAPSULAR EXTENSION AT PREOPERATIVE MAGNETIC RESONANCE IMAGING Di Trapani E.

P_08

LA BIOPSIA PROSTATICA TRANSPERINEALE TRUS-MRI MIRATA “FUSION” ESEGUITA CONTESTUALMENTE A BIOPSIA MRI-COGNITIVA E SISTEMATICA: OUTCOMES DIAGNOSTICI IN CATEGORIE DI OPERATORI CON DIFFERENTE ESPERIENZA Costa B.M. p. 41

P_09

ROBOTIC RADICAL CYSTECTOMY WITH EXTRACORPOREAL ILEAL CONDUIT: INITIAL EXPERIENCE IN LOCALLY ADVANCED BLADDER CANCER Pomara G.

p. 42

DETRUSOR UNDERACTIVITY: ARE DIFFERENT DIAGNOSTIC CRITERIA OFTEN RELIABLE IN CLINICAL PRACTICE? Rapisarda S.

p. 57

P_10

P_11

p. 41

ENERGY IMPACT ON STORAGE SYMPTOMS AFTER THULIUM ENUCLEATION OF PROSTATE: A LARGE MULTI INSTITUTIONAL ANALYSIS Nazzani S. p. 58

Archivio Italiano di Urologia e Andrologia 2019; 91, 1, Supplemento 1

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XIV CONGRESSO NAZIONALE UROP

ELENCO AUTORI AUTORE Amato C. Antonini G. Bada M. Bianchi R. Blezien O. Bove P. Brausi M. Brunori S. Calarco A. Casilio M. Colamonico O. Corongiu E. Costa B.M. Cozzi G. CretĂŹ G. De Marchi D. De Marco F. Della Camera P.A. Dente D. Di Marco M. Di Paola G. Di Trapani E. Gallo G. Gallo L. Grosso G.

PAGINA 12 47, 48 38 23 21 30, 46 30, 31, 32, 33, 46 18, 55, 56 42 36, 50 34 24, 49 41 39 52, 53 27 20 11, 12, 13 25 53, 55 22 41 26, 45 18 24

AUTORE Inneo V. Kinzikeeva E. Luzzago S. Manenti G. Maruccia S. Militello A. Mistretta F.A. Montano L. Nazzani S. Notari T. Polara A. Pomara G. Pozza D. Pugliese D. Rabito S. Rapisarda S. Scarcia M. Seveso M. Signorini C. Stefanucci M. Toffoli L. Vedovo F. Zani D. Zazzara M.

PAGINA 14 13, 51 40 29 49 19 34, 35, 36 15 58 14, 15 27 27, 37, 42, 45 10, 17 56 43 57 33 21 44 51 28 44 16, 17 21, 34

Archivio Italiano di Urologia e Andrologia 2019; 91, 1, Supplemento 1

abstract Sinistra.qxp_Stesura Seveso 16/05/19 13:57 Pagina 10

XIV CONGRESSO NAZIONALE UROP

ABSTRACTS ANDROLOGIA V_01 NUOVA MODALITÀ DI CIRCONCISIONE CON “LANGHE DISPOSABLE CIRCUMCISION SUTURE DEVICE”: SEMPLICITÀ, RAPIDITÀ E BUONI RISULTATI ESTETICI. ESPERIENZE PRELIMINARI Pozza D1, Mosca A2, Berardi A2, Pozza M1. 1Studio

di Andrologia e di Chirurgia Andrologica. Karol Wojtyla Hospital - Roma;

2UO di Urologia-Andrologia, Ospedale S.Sebastiano, Frascati, Roma.

Introduzione ed Obiettivi. La Circoncisione è uno degli atti andrologici chirurgici più praticati nel mondo per motivi medici o rituali, dall’età neonatale a quella molto avanzata. La possibilità di effettuare resezioni e suture con meccanismi meccanici automatici (Stapler) è diventato uno “standard” per molte branche chirurgiche. I genitali maschili, per la ristrettezza dell’ambito operatorio e per le dimensioni degli organi non ha visto l’utilizzo di tali strumenti operatori. La suturatrice “LANGHE DISPOSABLE CIRCUMCISION SUTURE DEVICE” (LDCSD) è uno strumento meccanico che consente con un solo “gesto” di effettuare una ottimale circoncisione prepuziale in tempi molto ridotti, con minori impegni anestesiologici e con un risultato funzionale ed estetico estremamente soddisfacente. Materiali e Metodi. Lo strumento LDCSD, disponibile in una confezione sterile, “disposable” è stato finora utilizzato in 10 pazienti di età compresa tra 15 ed 80 anni affetti da fimosi congenita o esito di balanopostiti. Si opera in Sala Operatoria con anestesia locale o, in casi selezionati, con sedazione anestesiologica. Prepa-

Archivio Italiano di Urologia e Andrologia 2019; 91, 1, Supplemento 1

razione del campo con Betadine; si controlla che il frenulo prepuziale sia abbastanza estensibile, altrimenti si procede alla sua incisione. Si introduce la parte a coppetta dello strumento sotto il prepuzio a coprire il glande; la cute del prepuzio viene fissata con una fascetta di plastica attorno al manico della coppetta che viene introdotto nel meccanismo; la compressione dei due manici determina la stretta adesione dei margini cutaneo-mucosi, la loro sezione circolare e la loro sutura con 12 clips metalliche a perfetta tenuta meccanica ed idraulica. Si libera lo LCSD e si applica una medicazione compressiva di tipo circolare che viene mantenuta, a scopo emostatico, per 2 ore circa. Alla rimozione della garza compressiva, se non ci sono segni di sanguinamento il paziente può essere medicato senza compressione ed inviato a domicilio. Risultati. Esclusi i primi 2-3 casi che hanno richiesto una particolare prudenza ed attenzione delle procedure anestesiologiche e delle strutture operatorie, i 7 casi successivi sono stati effettuati con semplice anestesia locale alla base del pene e in 2 casi (<20 anni) con sedazione. I tempi operatori variano tra 5 e 7 minuti. Non abbiamo mai osservato complicanze di rilievo. Le agraphes metalliche sono cadute spontaneamente dopo 15-25 giorni. In due casi abbiamo rimosso, facilmente, qualche agraphe rimasta. Conclusioni. Lo LDCSD è un utile apparato per procedere ad una circoncisione rapida, estetica, efficace e sicura. Lo studio ha avuto finanziamenti: No Conflitto d’interessi: No

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C_01 L’ADERENZA ALLA DIETA MEDITERRANEA E L’ATTIVITÀ FISICA ASSICURANO UNA BUONA SALUTE SESSUALE E PSICHICA Della Camera PA1, Gacci M1, Mattioli S4, Cito G1, Cocci A1, Serni S1, Maggi M3, Vignozzi L3, Rastrelli G3, Mottola AR2, Picinotti A4.

C_02 ERECTILE DYSFUNCTION THERAPY AFTER NERVE SPARING PROSTATECTOMY: SIX MONTH COMPARISON BETWEEN AVANAFIL 200 MG AND SILDENAFIL 100 MG

Della Camera PA1, Gacci M1, Tasso G1, Bencini G1, Cito G1, Cocci A1, Serni S1, Natali A1, Mattioli S2, Picinotti A2.

Introduzione ed Obiettivi. Lo stile di vita e la dieta mediterranea sono fattori protettivi nei confronti di patologie cardiovascolari sebbene manchi una chiara correlazione con la disfunzione erettile (D.E.). Qualche evidenza, tuttavia esiste tra D.E. e depressione. Abbiamo analizzato la correlazione tra D.E., attività fisica, aderenza alla dieta mediterranea e sintomi depressivi. Materiali e Metodi. Abbiamo sottoposto a 67 pazienti afferenti in ambulatorio andrologico il questionario iief 15 (International Index of Erectil Function), il questionario di Hamilton per la depressione maggiore, il questionario Med-Diet, il Questionario Ipaq (International Index of Physical Activity) e calcolato il BMI (Body Mass Index). Abbiamo escluso pazienti con storia di tabagismo, iperlipidemia,malattia cardiovascolare e di età > 65 ed < ai 40 anni. In base alla presenza di D.E sono sati suddivisi in due gruppi e calcolato tramite il t student e tramite il chi2 le differenze statistiche tra gli score. Come post hoc analysys si è correlato i livelli di attività fisica, il BMI e l’aderenza alla dieta mediterranea con la depressione. Risultati. L’età media è stata di 64,3 anni (40±72). Il BMI medio è risultato di 27,23 (20±29). Il gruppo D.E. ha mostrato al t student una differenza statisticamente significativa in BMI rispetto al gruppo con funzione erettile normale. L’analisi statistica del Med-Diet ha mostrato una differenza statisticamente significativa tra i due gruppi <0,0001 (p<0,05). L’Ipaq non ha mostrato differenze statisticamente significative tra i due gruppi (p=0,732). Il test di Hamilton non ha mostrato correlazione statisticamente significativa tra i due gruppi (p=0,44; p= 0,14). L’attività fisica intensa (>2520 met), BMI < 25 e la forte aderenza alla dieta mediterranea (≥10) si sono mostrati fattori protettivi nei confronti della depressione (p 0,03). Conclusioni. Il peso corporeo e un’alimentazione sana sono fattori protettivi nei confronti del disturbo di erezione. Lo stato psichico inteso come la presenza di sintomi depressivi e l’attività fisica hanno mostrato solo una lieve tendenza ad essere rispettivamente fattori peggiorativi e protettivi nei confronti del D.E. La dieta mediterranea, un regolare peso corporeo e l’attività fisica si sono mostrati al contrario proteggere nei confronti dell’insorgenza della depressione. Lo studio ha avuto finanziamenti: No Conflitto d’interessi: No

Introduction and Objective. In the last decade, research efforts have tried to reduce surgical ivascivity and improve functional outcomes including preservation of postoperative sexual function because prostate cancer is increasingly recognized at an early age. Avanafil is a new PDE5i but there is little experience in literature for its use in post prostatectomy E.D. therapy. In this study we evaluated the efficacy and safety of avanafil 200 mg vs Sildenafil 100 mg as a drug for postprostatectomy nerve sparing rehabilitation. Materials and Methods. We enrolled 231 candidates for nerve sparing robot assisted prostatectomy from January 2015 to September 2017 with following preoperative criteria: CCI≤1, ECOG ≤1, IIEF 15≥ 17, EHS≥ 2, positive response to Sep q2 and Sep q3, Qol≤3 and finally, at least, one sexual intercourse every 2 week and no hypogonadism or neurological disorder. Using Research Randomizer patients were divided into two groups: avanafil 200 mg (A group) and sildenafil 100 mg group (S Group). Patients began therapy 3 times/week on the tenth day post operative. EHS, IIEF5, SEP, GAQs and QoL were re-evaluated at sixth months after the first administration of PDE5i. Results. Only 160 were eligible for study. Both groups were of 80 patients. 12 patients discontinued therapy in A group while 8 patients in S group and switched to intracavernose injections.IIEF in A group reaches an average of 18.34 vs the group s which reaches an average of 18.20 without statistically significant difference (p=0.872). The A group showed Qol averages of 3.05 while the S group of 2.478 and intragroup variation was statistically significant (p <0.05). Ehs showed a statistically significant difference between the two groups (2,02 Agroup 3,05 S group) S group which showed higher penile rigidity (p<0.0001). 72 patients of “S group” vs 58 patients of “A group” of responded positively to the sep q2 test (90%vs75%, p=0,022) and at the sep q3 test, 75% vs 72,5%, p=0,857. At Gaq q1 test, a percentage of 95% vs 85% and at Gaq 2 test 95% vs 87,5 % answered positivily (p=0,065; p=0,161). Adverse events occurred in 16 patients in the S group 20% and in 4 patients in A group 5%. Conclusion. Therapy with Avanafil 200 mg compared to the same therapy with Sildenafil 100 mg showed a lower ability to allow an effective erection only in the initial phase of sexual intercourse. However Avanafil 200 mg showed greater safety in its administration showing a lower presence of side effects.

Azienda Ospedaliera Universitaria Careggi, Urologia, Firenze, Italia; Azienda Ospedaliera Empoli, Urologia, Empoli, Italia; 3 Azienda Ospedaliera Universitaria Careggi, Endocrinologia e medicina della sessualità; 4 Centro Chirurgico Toscano, Arezzo, Italia.

Azienda Ospedaliera Universitaria Careggi, Firenze, Italia; Centro Chirurgico Toscano, Dipartimento di Urologia ed Andrologia, Arezzo.

Archivio Italiano di Urologia e Andrologia 2019; 91, 1, Supplemento 1

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Lo studio ha avuto finanziamenti: No Conflitto d’interessi: No

C_03 BODY FAT DISTRIBUTION AND CORRELATION WITH SEXUAL DISORDERS AND HYPOGONADISM: NEW EVIDENCE ON THE ROLE OF SUBCUTANEOUS DEPOSITS Della Camera PA1, Gacci M1, Vignozzi L3, Rastrelli G3, Maggi M3, Cocci A1, Tasso G1, Cito G1, Serni S1, Natali A1, Mattioli S2, Picinotti A2. 1

Azienda Universitaria Ospedaliera Careggi, Firenze, Italia;

Centro Chirurgico Toscano, Dipartimento di urologia ed andrologia, Arezzo;

Azienda Ospedaliera Universitaria Careggi, Dipartimento di endocrinologia e medicina della sessualità.

Introduction and Objective. Body fat distribution is, next to overall obesity, an important risk factor for cardiometabolic outcomes in the general population. Traditionally, visceral adipose tissue (VAT) is strongly associated with cardiometabolic risk factors. We investigated the associations between ultrasound measures of body fat distribution and sexual disorder and hypogonadism. Materials and Methods. We enrolled 104 eligible patients from March 2017 to January 2018. We evaluated ultrasonographically (esaote mylab) the subcutaneous deposits of fat (Sat) and visceral fat deposits (Vat) according to the Armellini technique and the prostatic diameters. Subsequently we collected data on blood testosterone, BMI and Whaist Hip Circonference and calculated IIEF 5. Med Calc was used for multivariate statistical analysis between the independent variables and the dependent variable (IIEF5). The chi-square test was used to find a correlation between hypogonadism and SAT, VAT, BMI, WHC. Results. Surprisingly, in the multivariate analysis, only Sat (p<0.0151) and BMI and WHC (p<0.0001) were related to D.E. The VAT (p=0.159), the ratio VAT/SAT (p=0,0725), the prostatic diameters, LL (p=0.595) AP (p=0.633) did not reach statistic significance. The chisquare test showed that only SAT (p=0.0398) and BMI (p=0.003) correlate with hypogonadism as opposed to WHC (p=0.5620) and VAT (p=0.9853). Conclusion. The study confirms the usefulness and eventually the superiority of BMI as a parameter related to the erection disorder and hypogonadism, however the SAT, an easy parameter to calculate during a routine ultrasound, would also seem useful in predicting the D.E. and the presence of hypogonadism. Lo studio ha avuto finanziamenti: No Conflitto d’interessi: No

Archivio Italiano di Urologia e Andrologia 2019; 91, 1, Supplemento 1

C_04 PRESA IN CARICO DEL PAZIENTE IN UN REPARTO DI CHIRURGIA ANDROLOGICA. COSA PERCEPISCE L’AMMALATO COME SODDISFACENTE ASSISTENZA MEDICA ED INFERMIERISTICA? Amato C1, Pietrini L1, Cito G3, Cocci A3, Tasso G3, Gacci M3, Serni S3, Mondaini N4, Natali A3, Mattioli S2, Picinotti A2, Della Camera PA2. 1 Azienda

Ospedaliera Universitaria Careggi , Dipartimento professioni sanitarie ricerca sviluppo e clinical practice, Firenze; 2

Centro Chirurgico Toscano, Reparto di Urologia ed Andrologia, Arezzo;

3 Azienda Ospedaliera Universitaria Careggi, Reparto di Urologia, Firenze; 4

Uroandrologia Villa Donatello, Firenze.

Introduzione. Lo studio nasce dalla collaborazione tra i reparti di Urologia ed Andrologia dei centri referenti e il Dipartimento di Scienze Infermeristiche del Policlinico Universitario di Careggi al fine di capire cosa possa percepire il paziente come assistenza sanitaria soddisfacente. Materiali e Metodi. Abbiamo raccolto i dati anamnestici e somministrato il test Servqual a 100 pazienti afferenti al reparto di andrologia chirurgica dei centri referenti, dal Marzo 2017 a Novembre 2018. Abbiamo, inoltre, calcolato il livello di ansia tramite la scala HRSA ed i giorni di ricovero totali. L’analisi statistica multivariata è stata utilizzare per confrontare i diversi domini del questionario e per valutare se età, giorni di ricovero e livello di ansia fossero dei fattori confondenti nelle risposte al questionario. L’analisi statistica è stata eseguita con il software MedCalc Statistical Software version 15.8 (MedCalc Software bvba, Ostend, Belgium; https://www.medcalc.org; 2015). Risultati. L’analisi statistica multivariata ha mostrato come i giorni di ricovero, l’età dei pazienti ed il livello di ansia non sono risultati dei fattori confondenti alle risposte del questionario Servqual (età p=0,636; giorni di ricovero p=0,574; livello di ansia p=0,4420). L’analisi statistica multivariata ha mostrato come tutte le aree del Servqual risultino essere egualmente rappresentative sullo score totale (p<0,0001e che soltanto i giorni di ricovero influenzano le risposte dei pazienti alla domanda n. 1 del Servqual. In altre parole i giorni di ricovero si correlano alla importanza che il paziente ripone nelle infrastrutture ospedaliere. Conclusioni. Lo studio effettuato mette in luce come sia necessaria una assistenza olistica dell’ammalato che parta dall’atto chirugico o comunque fisico, alla confortevolezza delle strutture alberghiere, sino alla empatia ed alla capacità di rispondere a tutti i bisogni del paziente come persona. Lo studio ha avuto finanziamenti: No Conflitto d’interessi: No

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C_05 “DETAIL” NELLA PRESERVAZIONE DELLA FUNZIONE ERETTILE POSTPROSTATECTOMIA NERVE SPARING. STUDIO PILOTA DI UN NUOVO AUSILIO ELETTRONICO PER LA VALUTAZIONE DEL DANNO NERVOSO Della Camera PA1, Lippi M2, Tasso G3, Cito G3, Cocci A3, Serni S3, Picinotti A1, Mattioli S1, Gacci M3, Manfredi C2, Natali A3. 1

Centro Chirurgico Toscano, Reparto di Urologia, Arezzo; 2 Facoltà di Ingegneria, Firenze; 3 Azienda Ospedaliera Universitaria Careggi, Reparto Di Urologia, Firenze.

Introduzione. Il danno neurovascolare durante un intervento di prostatectomia nerve sparing robotica risulta essere un evento inevitabile. La nascita del “Detail”, frutto della collaborazione tra il reparto di Urologia di Careggi e la Facoltà di Ingegneria, ha come scopo quello di misurare il danno da elettrocuzione sul bundle nervoso. Al momento è in via di brevettazione, per questa ragione i titolari, per il 50% gli Autori e per il 50% l’Università degli Studi di Firenze censurano volutamente particolari dello strumento e dello studio. Materiali e Metodi. Da Gennaio 2017 sino a Settembre 2018 sono stati arruolati 40 pazienti compresi tra i 50 e 70 anni, in lista per prostatectomia robotica nerve sparing monolaterale. Tutti gli interventi sono stati eseguiti da un solo operatore che ha utilizzato il “Detail” durante gli interventi per calcolare la dissipazione di energia. La corretta esecuzione dell’intervento nerve sparing è stata valutata da tre giudici che in caso di disaccordo determinavano l’esclusione del paziente dallo studio. Esclusi dallo studio pazienti con palpazione positiva e gleason bioptico >7 in piu della metà dei prelievi o malattia bilaterale. Abbiamo valutato la funzionalità erettile tramite il test iief 5 in sede preoperatoria e in sede post operatoria a distanza di 1 anno facendo eseguire a tutti i pazienti il medesimo programma riabilitativo. Risultati. L’analisi multivariata ha mostrato che l’energia dissipata durente l’intervento è statisticamente significativa nel recupero della funzionalità erettile (p<0,0475) soprattutto oltre 1795 joule (p<0,0001). Le dimensioni prostatiche e il tempo di nerve sparing hanno mostrato una correlazione statisticamente significativa con l’iief post operatorio (p<0,0001). Come corollario abbiamo valutato i tempi chirurgici di nerve sparing tra i primi e gli ultimi interventi apprezzando una significativa riduzione dei joule dissipati. Conclusioni. Il “Detail” ha dimostrato come l’energia dissipata durante un intervento nerve sparing puo ridurre la performance sessuale post operatoria. Lo strumento si è rilevato utile per il chirurgo che esercitandosi con il suo utilizzo quotidiano puo ridurre, sempre maggiormente, l’energia da elettrocuzione. Lo studio ha avuto finanziamenti: No Conflitto d’interessi: No

C_06 WHAT IS THE REAL IMPACT OF LONG-TERM FINASTERIDE ADMINISTRATION (FAD) FOR A TREATMENT OF ANDROGENIC ALOPECIA ON MALE FERTILITY? A REVIEW OF A RECENT STUDIES AND REPORTS

Kinzikeeva E1, Maruccia S1, Spiga P1, Tridico M1, Salonia A2, Casellato S1. 1 2

ICZ Monza; San Raffaele Hospital.

Introduction and Objective. Finasteride was approved since 1997, is used as an oral drug for the treatment of androgenic alopecia, at a dosage of 1 mg orally. The aim of this review was to summarize current research studies and reports on low dose FAd for alopecia associated with male infertility. Materials and Methods. Search was conducted up to February 4, 2019, and the search strategy used Finasterid and infertility against PubMed database to identify the studies dated from 1999 up to 2017, including men age 19-48 y. This review included 12 of 39 articles (6 studies and 6 case reports). Results. Overstreet et al showed that FAd 1 mg/daily for 48 weeks didn’t affect spermatogenesis or semen production in young men. However, from recent studies we see that FAd lead to low concentration, motility and morphology and also increased DNA frammentation. The mechanism of the adverse effects (AEs) of FAd on male fertility is poorly understood. Recent animal studies showed that Fad in male adult rats caused morphometric-stereological and functional changes in the epididymis and in sperm function that led to a reduction in sperm parameters (SPs) and may not only cause a decrease in the fertility of parental rats, but also could lead to incorrect, androgen-sensitive course of spermatogenesis in their offspring. According an informal survey, calculated potentially risk of FAd negatively impact of sperm counts is in 5% of the 4.1 million men. Fortunally, the AEs on fertility were reversible with the men showing improved SPs and decrease DNA frammentation after 3-6 months of FAd cessation. There were 2 cases of successful full-term pregnancy and live birth after long-term FAd. Also the reversibility after discontinuation of FAd was confirmed by Toronto study use on spermcounts in oligospermic men with male factor infertility (57% of men with severe oligozoospermia (<5 million/mL) having counts increase to >15 million/mL). Conclusion. There are very poor quantity of studies to evaluate real contribute in male infertility in men with long term FAd for hair loss. The recent data confirmed that long term FAd decrease SPs, increase DNA frammentation but these AEs it seems to be reversible after 3-6 months cessation of treatment and don’t obviously prevent pregnancy and live birth. But are the reported AEs of FAd are completely riversibile? Until now we don’t have any response. So it seems to be reasonable to suggest that infertile men consider to discontinue FAd. Archivio Italiano di Urologia e Andrologia 2019; 91, 1, Supplemento 1

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Lo studio ha avuto finanziamenti: No Conflitto d’interessi: No

C_07 ESWT IN THE TREATMENT OF ERECTILE DYSFUNCTION (ED): OUR INITIAL EXPERIENCE

Inneo V, Seveso M, Di Paola G, Meazza A, Tringali V. Istituto Clinico Città Studi di Milano.

Introduction. The current mainstream of non surgical treatment for erectile dysfunction (ED) is the use of oral PDE-5 inhibitors (PDE5i) and intracavernosal injections of vasodilating agents. Recent reports indicate that low-intensity extracorporeal shockwave therapy (LiESWT) to the corpora cavernosa could play a role in penile rehabilitation. LiESWT induces cellular microtrauma, promotes angiogenesis by enhancing the expression of vascular endothelial growth factor and recruitment of endothelial progenitor cells. The purpose of this study is to evaluate the feasibility of this technique and its functional outcomes. Materials and Methods. Patients with ED were prospectively enrolled from December 2017 to June 2018 in an open label single arm study at our Department. All patients receive informed consent. Inclusion criteria: age >18 years, failure or unsatisfactory outcome with oral PDE5i and/or intracavernosalvasoactive agents, five item version of the International Index of erectile Function (IIEF-5) score of >12. All patients received six weekly treatments, each patient received 9000 shockwaves, equally distributed to the distal penis the (3000 sw), base of the penis (3000 sw) and to the corporal bodies on the perineum (3000 sw). The duration of each LiESWT session was approximately 15 min and each session comprised 300 shocks per treatment point (1500 per session) at an energy density of 0,09 mJ/mm2 and a frequency of 120/min. Risk factors for ED were explored, including diabetes mellitus, hypertension, ischemic heart disease, dyslipidemia and smoking. Adverse events and functional follow up were monitored at 4 and 24 weeks after completion of treatment, with by IIEF-5 score, EHS (Erection Hardness Scale). Results. 42 patients were recruited. The mean age was 59,3 (range 39-71) and most of them (90%) had reported ED for over > 18 months. Cardiovascular risk factors were present in 22 patients, and 9 had diabetes mellitus. The mean IIEF-5 score was 13,8 (12-17). No local or systemic analgesia was necessary during the procedure. No adverse event was reported during or after Li-ESWT treatment. Four weeks after completion of LiESWT, 29 patients (69%) reported a > 5 points improvement in IIEF-5 score. Of them, 15 (35,7%) were able to achive spontaneous erections sufficient for sexual penetration. At the 6-month follow up, these improvements continued without changes in sexual satisfaction Discussion. The current treatment strategies for ED do not address or restore underlying changes in the penis.

Archivio Italiano di Urologia e Andrologia 2019; 91, 1, Supplemento 1

A treatment regimen that offers a safe rehabilitative or even curative intent to regain spontaneous erection is an ideal goal. Li-ESWT can significantly improve the erectile function of ED patients with no obvious adverse effects within 24 weeks after treatment. The feasibility and tolerability of this treatment, coupled with its potential rehabilitative characteristics, make it an attractive new therapeutic option for men with erectile dysfunction. Lo studio ha avuto finanziamenti: No Conflitto d’interessi: No

C_08 SPERM P53 CONCENTRATION: A POTENTIAL NEW BIOMARKER FOR ENVIRONMENTAL POLLUTION. PRELIMINARY DATA (ECOFOODFERTILITY PROJECT)

Notari T1, Raimondo S2, Gentile M2, Bosco L3, Gentile T2, Montano L4. 1Check

Up- Day Surgery Polydiagnostc and Research Center Salerno- Italy, Reproductive Medicine Unit, Salerno, Italy; 2“Gentile Research Centre”- Gragnano NA- Italy, Seminology Unit, Gragnano- Naples, Italy; 3University of Palermo, Department of Biological- Chemistry and Pharmaceutical Sciences and Technologies, Palermo, Italy; 4 Andrology Unit of “San Francesco D’Assisi” Hospital- Local Health Authority ASL Salerno, EcoFoodFertility Project Coordination Unit, Oliveto Citra- Salerno, Italy.

Introduction. International scientific literature shows that strong environmental impact may jeopardize the stability and integrity of sperm DNA. P53, the guardian of genome, seems to play a key role in these mechanisms. Within the EcoFoodFertility project, a biomonitoring study (www.ecofoodfertility.it) that is being conducted in the polluted areas of Italy, we assessed p53 concentration in sperm cells to test whether environmental pollution can affect expression levels of this protein. Materials and Methods. 237 healthy males, 18-36 years old, were observed according to their stable residence in low environmental impact area (LEIA – Valle del Sele) or High environmental impact area (HEIA, Terra dei Fuochi) of the Campania region (Southern Italy) in a period between July 2014 and June 2018. The study group has been divided into Group A: 109 permanent residents in LEIA, aged 19-36 years; Group B: 128 permanent residents in HEIA, aged 18-35 years. All participants were no smokers, not habitual alcohol drinkers, no professionally exposed to environmental pollutants, without varicoceles, prostatitis, urethritis or chronic diseases. Semen analysis was assessed according standard criteria of WHO Manual, fifth edition (2010). All semen samples were examined 30 minutes after collection and immediately processed for the p53 protein assay, using ELISA test, proposed by Raimondo et al. (2010). Quantitative dosage of p53 protein was expressed in ng / million of spermatozoa. Results. We have observed not significant differences in ejaculate volume between group A and group B. About sperm concentration, 44,9% (40/109) of group

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A samples were normozoospermic while only 20,3% (26/128) of group B samples were normozoospermic. The quantitative dosage of p53 protein has been corrected in relation to sperm concentration number and shows statistically significant differences between two groups: group A had a mean value of 1,74 ng/million of sperms; group B had a mean value of 6,45 ng/million of sperms. Statistical analysis was performed using Fisher’s correlation and then Student’s test and we obtained a p<0.0005. Conclusions. Quantitative dosage of p53, seems to give valuable informations on the degree of damage to sperm DNA by environmental pollution, suggesting it as potential new biomarker. The differences observed in this study underlines the efficacy of quantitative dosage of p53 protein in identify a cell suffering due to environmental pollution. Lo studio ha avuto finanziamenti: No Conflitto d’interessi: No

C_09 HUMAN SEMEN: EXCELLENT BIOACCUMULATOR OF VOLATILE ORGANIC COMPOUNDS (VOCS). (ECOFOODFERTILITY PROJECT)

Montano L1, Notari T2, Longo V3, Forleo A3, Pappalardo S4, Ferramosca A5, Siciliano P3, Capone S3.

1 Andrology Unit of the "S.Francesco d'Assisi" Hospital, Local Health Authority (ASL) Salerno, EcoFoodFertility Project Coordination Unit, Via M. Clemente, Oliveto Citra, SA Italy; 2 Check Up- Day Surgery Polydiagnostc and Research Center Salerno- Italy, Reproductive Medicine Unit, Salerno, Italy and Infertility Center – ASL Salerno ” Vallo della Lucania Hospital”, Salerno; 3 National Research Council of Italy, Institute for Microelectronics and Microsystems (CNR-IMM), Lecce, Italy; 4 Reproduction and Fertility Center – Rome, Italy; 5 Department of Environmental and Biological Sciences and Technologies, University of Salento, Lecce, Italy.

Introduction and Objectives. This study is part of the multicentre EcoFoodFertility project, a biomonitoring study with multi-disciplinary approaches involving life-style and diet, which has built a nationwide network of actions in several highly polluted living areas of Italy. In this work we used a double approach to analyse the Volatile Organic Compound (VOCs) component in 4 different biosamples (whole blood, urine, human semen and hairs) of young men living in two polluted areas of Central and Southern Italy (Valle del Sacco and Terra dei Fuochi). The double approach is based on two different technologies: a) SPME-GC/MS (solid phase microextraction-gas chromatograph and mass spectrometer) system and b) array of gas sensors. Materials and Methods. 1 mL whole blood, 1 mL urine, 250μL human semen and some hairs in 5 mL vials of 30 young men aged 18-22 underwent an overnight equilibration phase, under stirring in a bath at 60°C. Subsequently, SPME fibers were exposed for 15 minutes at room temperature in the sample headspace and

the absorbed VOCs have been separated and identified by GC/MS. The second approach is based on a 4-sensor array based on micromachined gas sensors using MOX sensing elements operating at 250 °C. The sensor responses were acquired by applying a constant voltage of 1 V across the electrodes and measuring the electrical current by an electrometer equipped with an internal multiplexer module. The gas-sensing response of the device is defined by the ratio Rair/Ranalyte, where Ranalyte and Rair denoted the measured resistance in the presence of the VOCs and in dry air carrier, respectively. Results. The chromatograms, related to the extracted VOCs in the human semen headspace, were richer in components than the chromatograms of the other biosamples (urine, blood and hairs). The sensor array finds a response to hair sample with a different trend, since it’s a drier matrix and consumes standard solvent, step by step, at single cycle. For the other biofluids, despite we had a smaller volume of human semen than blood and urine, it was evident that VOC composition in seminal plasma is much more abundant. Discussion. These preliminary data confirm that human semen is an excellent biological fluid to study volatile component and, in particular, the correlation with external factors with which we are daily in contact (diet, environment, life style, etc.). Human semen results to be a bioaccumulator of both exogenous and endogenous VOCs. References. Montano L, Iannuzzi L, Rubes J, et al. Andrology. 2014; 2,69. Longo V, Forleo A, Pinto Provenzano S, et al. Biomed. Phys. Eng. Express. 2018; 5,015006.

Lo studio ha avuto finanziamenti: No Conflitto d’interessi: No

C_10 INQUINAMENTO AMBIENTALE E VARIAZIONI DI ALCUNI BIOMARCATORI SEMINALI: LDH-X, TRANSFERRINA E IL-6 (PROGETTO ECOFOODFERTILITY) Notari T1,Gentile M2, Raimondo S2, De Filippo S2, Cuomo F2, Gentile T2, Montano L3. 1

Centro Ricerca Check Up – Day Surgery, Viale Andrea De Luca 5/c, Salerno; 2 Unità di Seminologia Centro ricerche Gentile, Via Vittorio Veneto 108, Gragnano (NA); 3 Unità di Andrologia, Ospedale San Francesco d’Assisi, ASL Salerno, Unità di Coordinamento Progetto EcoFoodFertility, Via M.Clemente, Oliveto Citra (SA).

Introduzione ed Obiettivi. L’obiettivo di tale studio è quello di indagare gli effetti dell’impatto ambientale sulla funzionalità delle cellule testicolari attraverso biomarcatori del liquido seminale: LDH-X per la funzionalità dell’epitelio germinale, Transferrina seminale (ST) per la funzionalità delle cellule del Sertoli e IL-6 per lo stato infiammatorio. Archivio Italiano di Urologia e Andrologia 2019; 91, 1, Supplemento 1

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Materiali e Metodi. Tra il 2014 e 2017 sono stati controllati 114 maschi sani di etĂ compresa tra i 19 e i 34 anni, non fumatori, suddivisi in gruppo (gr) A; 58 maschi, residenti stabilmente in zone a basso impatto ambientale (Cilento â&#x20AC;&#x201C; Alto Medio Sele), con concentrazione nemaspermica media di đ?&#x153;&#x2019; 46,8, motilitĂ progressiva media di đ?&#x153;&#x2019; 39,7, morfologia tipica media (sec. Kruger) di đ?&#x153;&#x2019; 13,8 e vitalitĂ media di đ?&#x153;&#x2019; 63,2: gr. B; 56 maschi, residenti stabilmente in zone ad alto impatto ambientale (Area Nord di Napoli â&#x20AC;&#x153;Terra dei Fuochiâ&#x20AC;?), con concentrazione nemaspermica media di đ?&#x153;&#x2019; 31,4, motilitĂ progressiva media di đ?&#x153;&#x2019; 23,1, morfologia tipica media di đ?&#x153;&#x2019; 10,5 e vitalitĂ media di đ?&#x153;&#x2019; 51,3. La ST misurata con metodica Immuno-Turbidimetrica (Îźg/eiaculato): la LDH-X con UVcinetica e separazione isoenzimantica con Elettroforesi (IU/eiaculato): lâ&#x20AC;&#x2122;IL-6 con Immunoenzimatica (pg/eiaculato). Risultati. Per la ST Ă¨ emerso un aumento patologico nel 36,2% dei controlli del gr. A, con valori tra 1.363 e 1935 e nel 70,6% del gr. B, con valori tra 1495 e 2130, p<0,001. La LDH-X Ă¨ aumentata nel 67,3% del gr. A, con valori tra 10.3 e 14.3 e nel 27,4% del gr. B con valori tra 9.4 e 13.1, p<0,05. Basse concentrazioni, invece sono state osservate nel 32,7% del gr. A con valori tra 7.9 e 8.9 e nel 72,6% del gr. B con valori tra 3.4 e 4.8, p<0,001. Per la IL-6 nel gr. A, i valori variavano tra i 31 e 545 con media dei valori đ?&#x153;&#x2019; 13,2 e nel gr. B tra 27 e 218 con media dei valori đ?&#x153;&#x2019; 25,1, p= NS. Ai soggetti che avevano aumentati livelli di ST Ă¨ stato proposto un protocollo terapeutico di Doxiciclina 100 mg/die per 15 giorni che ha dato i seguenti risultati: nel gr. A, riduzione nel 76,3 % dei casi, mentre nel gr. B la riduzione Ă¨ stata del 12,8 %. Conclusioni. La mancata riduzione dei livelli di ST nei soggetti del gr. B pone interrogativi. La resistenza potrebbe essere indotta dalle condizioni ambientali? Queste sarebbero in grado di generare eventuali mutazioni del gene Tf seminale? Questo studio ci suggerisce un allargamento delle indagini su piĂš larga scala, confrontando questi valori con i parametri di contaminazione individuale. Conclusioni. La mancata riduzione dei livelli di ST nei soggetti del gr. B pone interrogativi. La resistenza potrebbe essere indotta dalle condizioni ambientali? Queste sarebbero in grado di generare eventuali mutazioni del gene Tf seminale? Questo studio ci suggerisce un allargamento delle indagini su piĂš larga scala, confrontando questi valori con i parametri di contaminazione individuale. Letture consigliate. Orlando C. J Androl. 1988; 9 (3):220-3. Tsujii T. Hinyokika kiyo. 2002; 48(4):193-7. Liu DY. Clin Reprod Fert. 1986; 4(3):191-7. Silva GP. Arch Ital Urol Androl. 2018; 90(1):49-53. Wojtczak M. Biochem Mol Biol. 2007; 148(4),426-431. Xinyan L. Afr. J. Microbiol. Res. 2012; 6(3),594-602. Gomme PT. Drug Discov. Today. 2005; 10,267-273.

Lo studio ha avuto finanziamenti: No Conflitto dâ&#x20AC;&#x2122;interessi: No

Archivio Italiano di Urologia e Andrologia 2019; 91, 1, Supplemento 1

C_11 A RANDOMIZED CONTROLLED TRIAL ON THE EFFECTS OF LIFESTYLE CHANGES ON SEMEN QUALITY IN HEALTHY YOUNG MEN

Zani D1, Donato F2, Marullo M2, Viola GCV2, Arrighi N1, Lorenzetti S3, Montano L4. 1

Unit of Urology â&#x20AC;&#x201C; Hospital â&#x20AC;&#x153; CittĂ di Bresciaâ&#x20AC;? and University of Brescia, Italy; 2 Unit of Hygiene, Epidemiology and Public Health, University of Brescia, Italy; 3 Dpt. of Food safety, Nutrition and Veterinary Public Health, Italian National Institute of Health (ISS), Rome; 4 Andrology Unit - ASL Salerno â&#x20AC;&#x153; Oliveto Citra Hospitalâ&#x20AC;?, Salerno.

Introduction and Objectives. Human semen quality is affected by metabolic, lifestyle and environmental factors and is a predictor of disease occurrence and mortality. We planned a randomized controlled trial with the main objective to evaluate the effects of lifestyle changes on semen quality in healthy young men living in highly polluted areas in Italy. Materials and Methods. 150 non-smokers, non-alcohol drinkers and non-obese young healthy men, aged 18-22 years, living in each of three highly polluted areas in Italy (n=450 subjects), are enrolled and assigned to an intervention or control group according to a 1:1 randomization plan. The intervention group follows a 4month nutritional pathway based on a Mediterranean diet pattern and receives suggestions on practice of physical activity. All subjects undergo urologic examination, measurement of weight, height and abdominal circumference, an interview on demographic data and lifestyle variables, and provide blood and semen samples in fasting conditions, at the enrollment (month 0) and at the end of the intervention (mo. 4) and followup (mo. 8). Adherence to Mediterranean diet is assessed using the â&#x20AC;&#x153;PREvenciĂłn con DIeta MEDiterrĂĄneaâ&#x20AC;? (PREDIMED) tool, and physical activity using the â&#x20AC;&#x153;International Physical Activity Questionnaireâ&#x20AC;? (IPAQ). Automated sperm analysis for all semen parameters is performed on the SQA-V GOLD following the manufacturerâ&#x20AC;&#x2122;s guidelines. After Ethics Committeesâ&#x20AC;&#x2122; approval, enrollment started in May 2018 and is ongoing, with completion of the study planned for the end of 2019. The associations between abdominal circumference, PREDIMED and IPAQ scores and sperm parameters were assessed using Studentâ&#x20AC;&#x2122;s t and chi square, two-sided, tests with p=0.05 as the threshold. Results. Complete data of 101 subjects living in a highly industrialized area in North Italy (meanÂąSD: age: 20.3Âą1.2 years) were analyzed. No differences were found between the intervention (n=51) and control (n=50) groups for all the study variables. The sperm cell concentration was higher in subjects with IPAQ score>median than those with lower values (68.3Âą48.6 vs 63.7Âą47.0 106/mL). Total percent motility was higher in subjects with abdominal circumference<median than those with higher values (50.7Âą13.6 vs 41.2Âą18.8, p=0.004), and in subjects with IPAQ score>median than those with lower values

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(48.2±16.8 vs 44.2±16.8), and in subjects with PREDIMED score>7 than those with lower values (47.6±18.8 vs 45.0±15.0). Conclusion. These preliminary data suggest that semen quality may be associated with abdominal fat, diet and physical activity in healthy young men. This study is part of the project “Un modello di intervento per la prevenzione dell’infertilità in adolescenti sani residenti in aree a forte impatto ambientale”granted by the Italian Ministry of Health.

Finanziamenti: Ministry of Health Conflitto d’interessi: No

C_12 ESISTE UN LIMITE DI ETÀ PER L’IMPIANTO PROTESICO PENIENO? NOSTRA ESPERIENZA CON PAZIENTI TRA 76 E 86 ANNI Pozza D1, Mosca A2, Pozza M1, Berardi A2. 1

Studio di Andrologia e di Chirurgia Andrologica, Casa di Cura Karol Wojtyla Hospital, Roma; 2 UO Urologia-Andrologia, Ospedale S.Sebastiano, Frascati, Roma.

Introduzione ed Obiettivi. L’allungamento della aspettativa e qualità di vita degli ultimi 30 anni ha influenzato le tematiche Uro-Andrologiche. La naturale usura del tempo e la presenza di malattie generali influenzano la Funzione Erettile che tende a decrescere pur in presenza di normale libido. I grandi spostamenti migratori e sociali degli ultimi anni hanno creato una maggiore disponibilità e facilità di avere rapporti sessuali anche in età avanzata. Le modalità terapeutiche (Ormoni, 5PDEi, PGE1, Chirurgia) possono consentire rapporti sessuali penetrativi ad un rilevante numero di pazienti (pz) over-75 con grande gratificazione ed autostima. In molti casi le modalità farmacologiche possono non avere una corretta risposta mentre la soluzione chirurgica protesica garantisce risultati soddisfacenti. Materiali e Metodi. Nella nostra serie di 800 pz a cui abbiamo impiantato protesi peniene dal 1984 al 2018, abbiamo valutato 20 pz considerati “anziani” (76-86 anni). In molti era presente diabete, vasculopatia ipertensiva, coronaropatia, IPP, esiti di chirurgia urologica. Per la inefficacia, il rifiuto o la impossibilità ad utilizzare altri rimedi erettili (5PDEi, PGE1, creme uretrali, Vacuum) a 20 pz era stata prospettata la soluzione protesica peniena. Elemento importante nell’aspetto decisionale era stato il costo della soluzione protesica e la possibilità concreta di poter avere rapporti sessuali stabili. Risultati. Profilassi antibiotica preoperatoria (ciprofloxacina). Ricovero la sera prima o la mattina dell’intervento. Anestesia spinale in 12 pz; locale con sedazione in 8 pz. Nessuna complicanza intra e postoperatoria. 17 pz controllati dopo 12 mesi: 11 (64%) assolutamente soddisfatti, 4 (23%) moderatamente soddisfatti e 2 (12%) non soddisfatti (1 non aveva una relazione). 1 pz diabetico ha lamentato l'estrusione di 1 cilindro protesico a distanza di 2 aa. Dopo l'espianto del cilindro il pz si dichiarava soddisfatto con un solo cilindro in sede.

Conclusioni. La protesi peniena rappresenta una soluzione valida, duratura, con pochi effetti collaterali, sicuramente più pratica di altre soluzioni terapeutiche capaci di consentire una capacità sessuale penetrativa. Il ruolo della partner rappresenta un rilevante aspetto del problema tale da incentivare tale scelta e consentire un utilizzo positivo. Lo studio ha avuto finanziamenti: No Conflitto d’interessi: No

C_13 CAPACITÀ ANTIOSSIDANTE TOTALE DEL LIQUIDO SEMINALE, SPERMIOGRAMMA E ABITUDINI ALIMENTARI DI UN CAMPIONE DI GIOVANI ADULTI SANI RESIDENTI IN LOMBARDIA Zani D1, Donato F2, Arrighi N1, Marullo M2, Viola GCV2, Lorenzetti S3, Montano L4, Bergamo P5.

1 Unità Operativa di Urologia Istituto Clinico Città di Brescia, Cattedra di Urologia Università degli Studi di Brescia; 2 Unità di Igiene, Epidemiologia e Sanità Pubblica e UO di Urologia, Università degli Studi di Brescia; 3 Dipartimento di Sicurezza Alimentare, Nutrizione e Sanità Pubblica Veterinaria, Istituto Superiore di Sanità – ISS, Roma; 4 Unità Operativa Complessa di Urologia Ospedale S. Francesco d’Assisi di Oliveto Citra (SA), ASL Salerno; 5 Istituto di Scienze dell’Alimentazione (ISA) - Consiglio Nazionale delle Ricerche (CNR), Avellino.

Obiettivo. Lo stress ossidativo è una delle principali cause dell’infertilità maschile. Gli spermatozoi sono suscettibili ai danni indotti dallo stress ossidativo, poiché la loro membrana è costituita da acidi grassi polinsaturi e il loro citoplasma contiene una bassa concentrazione di enzimi antiossidanti. Il meccanismo del danno è la perossidazione dei lipidi di membrana con una conseguente astenospermia. La dieta mediterranea si caratterizza per l’elevato contenuto in antiossidanti che sembra avere un ruolo protettivo. L’obiettivo dello studio è la valutazione della capacità antiossidante totale in un gruppo di giovani adulti sani. Materiali e Metodi. Il progetto FAST (“Un modello di intervento per la prevenzione dell’infertilità in adolescenti sani residenti in aree a forte impatto ambientale”) è un trial randomizzato controllato, con 2 bracci paralleli (intervento e controllo), per valutare gli effetti di cambiamenti dello stile di vita sulla qualità del seme. Lo studio prevede il reclutamento di 150 giovani adulti sani, non bevitori, non fumatori e normopeso, in ognuna di 3 aree italiane ad alto impatto ambientale, Brescia inclusa. I partecipanti vengono sottoposti - al tempo 0, 4 e 8 mesi dal reclutamento - a una visita uro-andrologica, alla rilevazione di dati antropometrici e inerenti lo stile di vita tramite somministrazione di questionari validati, relativi all’attività fisica (IPAQ) e alle abitudini alimentari (PREDIMED ed EPIC). Vengono inoltre sottoposti a: esami ematochimici, ormonali, spermiogramma, valutazione degli elementi in traccia, e indagini epigenetiche. È stato effettuato un dosaggio della capacità antiossidante totale (TAC) su campioni di liquido semiArchivio Italiano di Urologia e Andrologia 2019; 91, 1, Supplemento 1

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nale con metodo spettrofotometrico, utilizzando un kit commerciale (“Antioxidant Assay Kit”, Cayman®). Sono state valutate le correlazioni tra la TAC e l’assunzione di alimenti oltre ai diversi parametri seminali, utilizzando il coefficiente di correlazione lineare di Pearson per le variabili continue e l’analisi della varianza non parametrica (test di Kruskal-Wallis) per i confronti della distribuzione della TAC tra gruppi. L’analisi dello spermiogramma è stata eseguita con un sistema automatizzato (SQA gold). Risultati. Sono stati finora esaminati 68 soggetti di età media pari a 20,3 anni, 32 randomizzati nel gruppo di intervento e 36 in quello di controllo il cui BMI medio +/-SD è, rispettivamente, di 22,5±2,0 e 22,1±2,0. Non sono emerse associazioni statisticamente significative tra TAC e aderenza alla dieta così come con i consumi dei singoli alimenti o con altri parametri quali introito di calorie, grassi saturi, zuccheri semplici, ecc. Anche per quanto riguarda l’attività fisica non ci sono differenze significative tra la TAC misurata in soggetti inattivi, sufficientemente attivi o molto attivi (rispettivamente 1,2±0,1, 1,1±0,1, 1,1±0,2 Mm). Si osserva invece una correlazione tra TAC e motilità spermatica totale e forme morfologicamente normali, anche se non statisticamente significativa, verosimilmente per il ridotto numero di casi analizzati. Conclusioni. Dai dati preliminari analizzati di questo studio non sembrano emergere correlazioni statisticamente significative tra TAC misurata nel seme e fattori che riguardano lo stile di vita, quali livello di attività fisica e aderenza alla dieta mediterranea. Si è osservato un trend positivo tra la qualità del liquido seminale e la capacità antiossidante totale. Finanziamenti: Ministero della Salute Conflitto d’interessi: No

C_14 THE ROLE OF THE EXCESSIVE PREPUCE AND THE EFFECTS OF A NEW SURGICAL TECHNIQUE FOR PREMATURE EJACULATION: THE DISTAL CIRCUMCISION

Gallo L.

Centro Uro-Andrologico Gallo - Napoli.

Introduction and Aims. Premature Ejaculation (PE) is one of the most common male sexual dysfunction. Penile hypersensitivity is an ascertained cause of PE . The area of the preputium is considered the most sensitive part of the human penis. Hence, men having an excessive prepuce could have a major risk to suffer of PE due an higher penile sensitivity. Determining a reduction of the excessive sensitivity, the surgical removal of the foreskin performed by circumcision could be a potential definitive treatment for patients presenting with an excessive prepuce and complaining of PE. Aims of the present study were: 1) to investigate the prevalence of the excessive prepuce in patients affected by lifelong PE; 2) to evaluate the effectiveness of a special type of circumcision named “distal circum-

Archivio Italiano di Urologia e Andrologia 2019; 91, 1, Supplemento 1

cision” on ameliorating PE symptoms and on lengthening the Intravaginal Ejaculatory Latency Time (IELT) in patients complaining of PE who were diagnosed to have an excessive prepuce. Materials and Methods. It was considered as an excessive prepuce every case in which, at the status of flaccid penis, the foreskin exceeded the external urethral meatus for at least 1 cm. The diagnosis of PE was based on the PEDT questionnaire score and on the intravaginal ejaculatory latency time (IELT). We proposed to all patients diagnosed with a lifelong PE and presenting an excessive prepuce to undergo a distal circumcision as treatment for this condition. Furthermore, in order to evaluate the prevalence of excessive prepuce in normal population, we even recorded the number of patients presenting with an excessive prepuce coming to our centre for other urologic problems and in whom a diagnosis of PE was excluded using the same diagnostic criteria (PEDT and IELT). PEDT and IELT were evaluated at baseline and 6 months after circumcision. It was performed a special type of circumcision in which the distal incision was executed very close to the corona glandis. Results. It was diagnosed a lifelong PE in 352 patients of whom 208 (59,1%) presented an excessive prepuce. We proposed them to undergo a circumcision as a potential definitive treatment for their problem: 27 (13%) accepted. After six months since the circumcision surgery we found an increase in the mean IELT from 40,4 seconds baseline (± 16,5 SD) to 254 seconds ((± 66,8 SD) (p<0,0001) while the mean PEDT score lowered from 17 (± 2 SD) to 6,6 (± 1,9 SD) (p<0,0001). Overall the 96,3% of our survey reported a IELT increase. Conclusions. The excessive prepuce is a very common condition in patients affected by PE. Although accepted by only 13% of our survey, distal circumcision was showed to be a very effective surgical treatment for definitive therapy of PE. We suggest to detect the potential presence of an excessive prepuce in patients complaining of lifelong PE and to propose them to undergo a distal circumcision. Lo studio ha avuto finanziamenti: No Conflitto d’interessi: No

C_15 MORBO DI LA PEYRONIE: PRIME ESPERIENZE DI TERAPIA CON ONDE D'URTO (ESWT) E CRIOELETTROFORESI Brunori S1, Cerasini M1, Iaboni L1, Intini G1, Mandarano G1, Mastrangeli B1, Sisti G2, Militello A3. 1

Cdc Nuova Itor – Roma; Centro medico EOS – Roma; 3 Cdc Villa Immacolata- Viterbo. 2

Introduzione. L’IPP è una patologia a carico del pene caratterizzata dalla formazione anomala di tessuto fibroso-cicatriziale in corrispondenza dei corpi cavernosi con successivo incurvamento e dolore alla penetra-

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zione. Nella fase tardiva della patologia l’incurvamento provoca severa disfunzione erettile. Durante la visita andrologica, si evidenzia quasi sempre una lesione del tipo nodulare che oltre ad essere dolorosa, da retrazione fibroso-cicatriziale dei cc con irrigidimento del pene e successivo incurvamento. Le linee guida indicano come Gold Standard il trattamento con onde d’urto extracorporee (OUE) con ottimi risultati sul dolore e sulla riduzione delle placche. Scopo. Nell’ambito dell’IPP le terapie fisiche trovano sempre più spazio e quindi abbiamo deciso di utilizzare in associazione due sistemi con indicazioni specifiche e riportare i risultati della nostra esperienza preliminare su 15 pazienti affetti da IPP trattati simultaneamente con ESWT e crioelettroforesi. Materiali e Metodi. Da marzo 2018 ad oggi, abbiamo trattato con terapia combinata 15 pz con IPP in fase florida. Tutti sono stati sottoposti a T0, ad eco-colorDoppler dinamico penieno, IIEF5 e foto acquisizione (FA) per la determinazione di stato e dimensione della lesione, grado della curvatura e funzione erettile, a T1-T2 (3-6 mesi) FA, IIEF5 e autodeterminazione del grado di dolore in fase erettile, al tempo T3 (9 mesi) è stato aggiunto l’eco-colorDoppler. Tecniche. 1) OUE con apparecchiatura elettromedicale Androwave Therapy: l’OU è definita come un’onda acustica caratterizzata da un elevato picco di pressione regolabile in un piccolo range di frequenza. La pressione esercitata dall’OU è molto più elevata della tradizionale onda ultrasonora, anche se dotata di una modulazione di frequenza meno accentuata. L’OU si diffonde, come gli ultrasuoni, attraverso i tessuti seguendo la legge dell’impedenza acustica, vale a dire la diversa capacità di ogni tessuto a riflettere l’onda acustica. (OU) sono impulsi che si propagano come onde pressorie, generando uno stress meccanico dei tessuti che attraversano. Nessun traumatismo nel punto di lavoro con gli organi genitali, minimo fastidio durante il ciclo. La terapia ha previsto una media di 16 sedute (range 12/20) con 3 step da 1200 colpi da 5 minuti ciascuno, ad una pressione di 1,1 bar e frequenza 4.0 Hz. 2) Crioelettroforesi: veicolazione transcutanea profonda per via elettrica di farmaci congelati; è costituita da un generatore di corrente computerizzato, da un elettrodo dispenser contenente il cocktail miscela di vari farmaci (diclofenac, EDTA, verapamil, escina, acido ialuronico) da veicolare congelati, da un elettrodo passivo e dal tessuto biologico (nel nostro caso il pene). I trattamenti sono stati effettuati nella stessa seduta di ESWT. Risultati. I risultati ottenuti mostrano una significativa riduzione dell’incurvamento penieno (13/15), del dolore (15/15) ed un miglioramento della qualità dei rapporti sessuali (13/15). In 15 Pz si è osservata una riduzione del volume della placca. Non ci sono stati severi effetti collaterali, nessun trattamento è stato sospeso e tutti i pazienti hannoportato a termine la terapia. Conclusioni. L’utilizzo della terapia fisica combinata nel

trattamento della IPP è di sicura efficacia nel migliorare la sintomatologia dolorosa-infiammatoria, con risultati incoraggianti anche sulle dimensioni della lesione. Lo studio ha avuto finanziamenti: No

P_01 GRIFFONIA, PASSIFLORA E VALERIANA: UNA NUOVA ALTERNATIVA TERAPEUTICA NEL TRATTAMENTO DELL’EIACULAZIONE PRECOCE? Militello A1, Di Francesco S1, 2. 1

Dipartimento di Scienze Urologiche, Biomediche e Traslazionali. Università Federiciana, Cosenza; 2 Dipartimento di Scienze Mediche, Orali e Biotecnologiche. Università degli Studi G. D’Annunzio di Chieti-Pescara.

Introduzione ed Obiettivi. Il riflesso eiaculatorio è la risposta ad un’interazione complessa di stimoli a livello del Sistema Nervoso Centrale (SNC) e Periferico (SNP) in cui la serotonina riveste un ruolo chiave. Tale neurotrasmettitore è in grado di controllare il riflesso eiaculatorio e la risposta sessuale maschile: un suo aumento a livello del SNC svolge un’azione inibitoria sull’eiaculazione, ritardandone la comparsa. Quindi l’eiaculazione precoce può essere associata ad una ridotta concentrazione di serotonina. Le soluzioni terapeutiche atte a regolare l’incremento dei livelli di serotonina possono essere sia di tipo farmacologico che naturale. L’approccio naturale punta su integratori a base di Griffonia, pianta ricca di 5-idrossitriptofano, precursore della serotonina. Scopo. Valutazione prospettica dell’efficacia e della sicurezza terapeutica della Griffonia, associata a Valeriana e Passiflora, in pazienti affetti da Eiaculazione precoce. Materiali e Metodi. Nel periodo Gennaio 2012 maggio 2018 sono stati sottoposti a visita presso la nostra struttura 488 pazienti affetti da Eiaculazione precoce. Dopo aver escluso la presenza di cause organiche locali sono stati selezionati e arruolati 175 soggetti. A ciascuno di essi è stata offerta l’opportunità di assumere , in alternativa alla terapia medica classica, per tre mesi consecutivi, un integratore a base di Griffonia, Valeriana e Passiflora. Al tempo zero e dopo tre mesi di trattamento, a ciascun paziente è stato chiesto di completare i seguenti questionari: International Index of Erectile Function (IIEF-5), Premature Ejaculation Diagnostic Tool (PEDT), Male Sexual Health Questionnaire (MSHQ). Risultati. Nel corso del Follow-up è stato registrato rispetto al basale un miglioramento statisticamente significativo dei sintomi in termini di controllo della eiaculazione precoce (IIEF-5: 8.7 vs 14.01; p <0.001) e della qualità dell’erezione, in assenza di effetti avversi significativi. Anche l’IELT (tempo di latenza dell’eiaculazione intravaginale) ha dimostrato un miglioramento staticamente significativo rispetto al basale (p <0,001). Conclusioni. I risultati dello studio dimostrano come la Griffonia integrata con Passiflora e Valeriana sia in grado di offrire ai pazienti affetti da Eiaculazione Precoce una possibile alternativa terapeutica rispetto alla Archivio Italiano di Urologia e Andrologia 2019; 91, 1, Supplemento 1

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terapia farmacologica tradizionale in grado di migliorare il controllo dell'eiaculazione in assenza di effetti avversi significativi. Lo studio ha avuto finanziamenti: No Conflitto d’interessi: No

CALCOLOSI E CHIRURGIA ENDOUROLOGICA C_16 THE AUTOEXPANDABLE URETERAL PROSTHESYS ALLIUM FOR THE POST URETERORENOSCOPIC URETERAL STRICTURES TREATMENT. AN OPTION TO KEEP IN MIND De Marco F. Stone Center I.N.I. Grottaferrata (Rome) Italy.

Introduction. Ureteral strictures are severe and difficult to treat disorders and significantly affects the quality of life of patients. Usually the definitive resolution required laser incision or surgical reconstructive procedures or ureteral stent replacement. In our experience we evaluate the use of new expandable ureteral stent (ALLIUM®) in the post endourological ureteral strictures as alternative to standard ureteral stent or reconstructive surgery. Materials and Methods. From September 2013 to April 2017, 100 patients were enrolled in the study and underwent to endoscopic positioning of the urinary tract autoexpandable prosthesys Allium® for different ureteral disorders. We selected 38 out of 100 patients with ureteral strictures ost-ureterolithotripsy. In this group the location and the lenght of the stenosys were evaluated, such as, the presence and the grade of hydroneprosys. In these patients an ureteral balloon dilatation was always performed and the positioning of the Allium was obtaining by both endoscopic and Xray control. The lenght and the design of the Allium depended on the location and the lenght of the strictures. All the patients were followed up by ultrasound adn KUB after 30 , 90 and 180 days. At 6 months the Allium system was removed and patients re-evaluated. Results. At the end of the study 28 out of 38 patients (73.6%) showed the absence of hydronephosis. 10 patients required reconstructive surgery for the persistence of the strictures. We reported 3 cases of stent migration and no infective complications were reported. Conclusions. The autoexpandablre ureteral prosthesys Allium® can be considered an option in the treatment of postoperative ureteral strictures with a succes rate of 73.6%. It requires a short learning curve, it has minimal post-operative complications and lower negative impact on the quality of life of patients. Lo studio ha avuto finanziamenti: No Conflitto d’interessi: No

Archivio Italiano di Urologia e Andrologia 2019; 91, 1, Supplemento 1

C_17 EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY TREATMENT FOR KIDNEY STONES: COULD IT BE STILL AN OPTION? De Marco F. Stone Center I.N.I. Grottaferrata (Rome) Italy.

Introduction and Objective. Based on EAU guidelines the success of SWL depends on the efficacy of the lithotripter and the following factors: • size, location and chemical composition of the stones; • patient’s habitus; • and performance of SWL (best practice, skill of the urologist). Each of these factors significantly influence the re treatment rate and final outcome of SWL but still the stone free rates range between 33.3% to 91.5 % in the literature. Endourological procedures are increasing in the treatment of renal stones reporting high stone free rates but the question if the ESWL is competitive is still on debate. Materials and Methods. We report our experience in a single Stone Center on 6059 patients with urinary tract stones using a lithotripter equipped with the EMSE type 220F-XXP. From October 2001 till May 2018, 6059 patients were treated using the Dornier Lithotripter DLS II. The treatment results were retrospectively evaluated. The inclusion criteria were patients with kidney stones, for which ESWL were appropriate and the dimensions of the stones are between 5-25 mm. Results. The overall “stone free rate” was equal to 80.1%. after a single treatment. The 3 month stone free rates, were in the pyelic group 84.8%, for stones of the upper calyx 65.0%, medium calyx 64.6%, for lower calyx 81.2%. Based on stone size, the stone free rates after 1 ESWL were <10 mm 82.9 %, between 10-20 mm 64.5% and larger than 20 mm 47.4%. The overall re-treatment rate was 26% and 14 patients presented clinically evident subacapsular hematoma, and were treated conservatively (0.23%). Conclusions. The results showed a large stone free rates and lower complications rates. The use of ESWL should be encouraged in this endourologic era through tutorial programs for new users, and following the correct guidelines and best practice rules. Lo studio ha avuto finanziamenti: No Conflitto d’interessi: No

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C_18 COULD ROBOTIC SURGERY BE THE INITIAL TREATMENT IN LARGE RENAL STONES? ROBOTIC PYELOLITHOTOMY, A SINGLE CENTRE HIGH VOLUME EXPERIENCE Zazzara M, Cardo G, Pagliarulo G, Nazaraj A, Maselli FP, Romano M, Portoghese F, Ludovico GM.

Department of Urology, Ospedale Generale Regionale “F. Miulli”, Acquaviva delle Fonti, Bari, Italy.

Background. Few studies have reported robotic pyelolithotomy (RPL) series; furthermore, the most of all have reported small and single centre series. Herein we report our experience from 70 cases of complex kidney stones treated with RPL at our surgical center; this study reports the largest series of RPL in a minimal invasive experienced center. Methods. Between February 2016 and March 2018, 70 patients with complex renal stones underwent RPL and included in a prospectively maintained institutional database. Baseline characteristics, clinical data, perioperative data, postoperative data and stone free status were assessed by descriptive statistics. Results. Of 70 patients, 72.85% presented renal pelvis stones. The mean maximum stone diameter was 33.1±14.5 mm (median 30 mm; interquartile range 2240 mm). Mean total operative duration was 122.5±34.4 min (median 120 min; interquartile range 105-135 min). In 2 patients (2.8%), a grade III complications were noted; no major complications (grade IV-V) were noted. The complete SFR, after a single robotic procedure, was 92.8%. Conclusions. Our findings suggest that RPL is a safe, reproducible and minimally invasive approach as primary treatment of large renal stones. RPL permits to achieve a stone free status, in a single definitive procedure, by removing the stone intact and avoiding stone fragmentation. Lo studio ha avuto finanziamenti: No Conflitto d’interessi: No

C_19 CORRELATION BETWEEN URETERAL STONES CHARACTERISTICS AND URINARY LEAKAGE Blezien O, Nazzani S, Picozzi SCM, Finkelberg E, Vizziello D, Ratti D, Stubinski R, Acquati P, Manfredi M, Motta G, Clementi MC, Signorini C, Carmignani L. IRCCS Policlinico San Donato - Università degli Studi di Milano, Dept. of Urology, Milan, Italy.

Introduction and Objectives. Urinary leakage is defined as a spontaneous excretory system rupture, not related to a traumatic event. The most common cause is ureteral stones. We evaluated correlation between stones and patients characteristics and urinary leakage. Materials and Methods. We retrospectively analyzed stones and patients characteristics of who were diagnosed with spontaneous urinary leakage. From 2012 to 2018 we had 29 patients with radiological diagnosis of urinary leakage caused by ureteral stones were selected.

All patients underwent a computed tomography and showed extravasation of contrast outside the excretory system caused by an ureteral stone. We evaluated correlation between ureteral stones characteristics and excretory system rupture. Results. Among 29 patients, 23 were men and 6 women with a median age of 59 years (range, 21-84 years). All patients were admitted to urology unit from emergency department of our hospital, where they arrived with severe flank colic pain. At the CT, 28 of them had hydronephrosis. We analyzed stones position along the ureter with following results: 3 junctional, 3 proximal, 4 medial, 17 distal and in 1 case there were multiple millimetrical stones in ureter. The median density of stones was 650 HU (HU: Hounsfield) (range, 322-1235 HU). The median measure of stones was 4.7mm (range, 1-14 mm, 21 of 29 patients had stone dimension under or similar to the median value). All patients underwent standard treatment with Double J stenting in urgency regimen followed by antibiotic therapy for at least 5 days. Conclusions. Ureteral stones can cause spontaneous excretory system rupture. The literature has few papers about the causes of urinary system leakage. Most of them are related to hydronephrosis. The urinary leakage is often related to small stones dimension and distal location along the ureter. Spontaneous ureteral rupture should be kept in consideration in patients with acute flank pain with renal or ureteral stones in anamnesis. Lo studio ha avuto finanziamenti: No Conflitto d’interessi: No

C_20 ENDOUROLOGICAL MANAGEMENT OF FORGOTTEN URETERAL STENTS Seveso M, Inneo V, Di Paola G, Tringali V, Meazza A. Istitito Clinico Città Studi di Milano.

Introduction. Double-J stents are widely used in urology practice, and their removal can sometimes be forgotten. A well-known complication of this situation is stent encrustation, which can result in significant morbidity such as stone formation, recurrent obstruction and urinary infection. Multiple urological approaches may be needed according to the encrustation burden. We present our experience with the management of this complication adopting different techniques. Materials and Methods. Between January 2011 and December 2018, 11 patients were treated for forgotten urereral stent at our Institution. Their charts were retrospectively reviewed, and information on the catheter indwelling time, presenting complaints, radiological and laboratory investigations, management techniques and postoperative complications was collected. Urine culture, serum creatinine and white blood cell counts were evaluated in all patients. The presence of the catheter, its incrustation and associated stone burden were assessed using non-contrast enhancement stone protocol computerized tomography (CT). EncrustaArchivio Italiano di Urologia e Andrologia 2019; 91, 1, Supplemento 1

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tions involving the lower coil of the stent were fragmented with a rigid grasper or a transurethral cystolithotripsy. Retrograde ureterorenoscopy was used to treat more proximal encrustations: the instrument was advanced beside the retained stent, and holmium laser was used to fragment encrustations involving the body or the upper coil of the stent. A ureteroscopic grasper was then used to retrieve the stent. A plan X-ray was performed postoperatively to ensure that patients became stent- and stone-free. Results. The mean patients’ age was 54 years (range 4278). Stents were indwelled for a mean of 18 months (range 11-69). Of the 11 cases, 3 stents were broken, 7 were encrusted and calcified, and 1 was migrated to the upper ureter. The stent was originally inserted after urolithiasis (n. 6), reconstructive urological surgery (n. 4) or for oncological disorders (n. 1). Severe encrustation was observed on the intrarenal (n. 7), intravescical (n. 3) or intraurethral (n. 1) segments of the stents. Renal function was preserved in all cases. Urinary tract infection was present in 5 cases. Cistolithotripsy was successful in 2 cases of lower coil encrustation, whereas retrograde rigid and flexible ureterorenoscopy was performed in 9 cases of upper coil encrustation. Laser lithotripsy was performed using a Holmium laser at various power, frequencies and fiber sizes. A second session to render the patient stone- and stent-free was necessary in 4 patients. A new ureteral stent was inserted in all cases. No intraoperative complication was observed. The mean hospital stay was 2.8 days. Conclusions. Forgotten stents are observed in urological practice due to insufficient patients’ education by the physician, or by their inadequate compliance. These stents can carry considerable morbidities such as haematuria, urinary tract obstruction, renal failure and recurrent urinary tract infections. Presently, there is no pre-defined algorithm for the management of forgotten DJ stents: it depends on factors like site of encrustation, stone burden and function of the affected kidney. Treatment is usually carried out through endourological approaches, but open surgery may still play a role in particular cases. A combination of several surgical techniques is often necessary, but the best treatment remains the prevention of this problem by providing patient education. Lo studio ha avuto finanziamenti: No Conflitto d’interessi: No

C_21 STENT URETERALE DOPPIO-J O CATETERE URETERALE MONO-J? LA NOSTRA ESPERIENZA Di Paola G, Seveso M, Inneo V, Tringali V, Meazza A. Istituto Clinico Città Studi di Milano

Introduzione. La cateterizzazione ureterale in seguito a procedure urologiche endoscopiche è pratica comune, ed argomento di dibattito, in quanto recenti evidenze sembrano non dimostrarne i reali benefici. I cateteri più comunemente utilizzate sono il catetere doppio J

Archivio Italiano di Urologia e Andrologia 2019; 91, 1, Supplemento 1

(DJ) o il catetere mono-J (MJ). Scopo di questo studio prospettico è paragonare i due tipi di stent, in rapporto alla tollerabilità per il paziente e alle relative complicanze. Pazienti e Metodi. Dal novembre 2017 al novembre 2018, abbiamo osservato in modo prospettico Pazienti sottoposti a procedure endoscopiche dell’alto apparato urinario presso il nostro Istituto, eseguite mediante ureterorenoscopia flessibile (URF) o rigida (URR). Tutti i pazienti presentavano all’ingresso urinocoltura negativa, e venivano sottoposti a profilassi preoperatoria con cefalosporina di III generazione. Gli stent MJ venivano solidarizzati al catetere vescicale e rimossi dopo 24 ore, mentre gli stent DJ venivano rimossi ambulatorialmente dopo due settimane. Tutti i pazienti venivano dimessi con terapia alfalitica, e rivalutati ambulatorialmente a 3 settimane ed a 3 mesi dalla procedura. Sono state valutate le caratteristiche anagrafiche dei pazienti, la tollerabilità allo stent in modo duplice, tramite l’analisi della sintomatologia del basso tratto urinario (questionario IPSS), e della sintomatologia algica (scala visuo-analogica, VAS), e le complicanze postoperatorie tramite il monitoraggio delle rivalutazioni in Pronto Soccorso, dei nuovi ricoveri, della presenza di ematuria, infezioni delle vie urinarie o febbre. È stato inoltre valutato il tasso di stone-free (TC addome senza contrasto). Risultati. Nel periodo di osservazione sono state eseguite 211 procedure: 154 URR e 57 URF. L’età media dei pazienti era 47,6 anni, con un rapporto femmine/maschi di 0,56 (135 e 76). In 137 pazienti (122 URR, 25 URF) è stato posizionato uno stent DJ (gruppo DJ). In 74 pazienti (42 URR, 32 URF) è stato posizionato un catetere ureterale MJ (gruppo MJ). Sintomatologia a carico del basso tratto urinario era presente in 99 pazienti (97 DJ, 2 MJ) a 3 settimane della procedura, ed in nessun paziente a 3 mesi. Dolore (VAS >4), era presente in 21 pazienti a 3 settimane (20 DJ, 1 MJ), ed in 2 pazienti (DJ) a 3 mesi. 17 pazienti (15 DJ, 2 MJ) hanno effettuato accessi al Pronto Soccorso entro 3 settimane, 5 pazienti (4 DJ, 1 MJ) a 3 mesi. Macroematuria si è manifestata in 20 pazienti (19 DJ, 1 MJ) a 3 settimane, e in nessun caso a 3 mesi. Infezioni delle vie urinarie o febbre sono avvenute in 21 casi (20 DJ, 1 MJ) a 3 settimane, ed in 11 pazienti (10 DJ, 1 MJ) a 3 mesi. Il tasso stone-free è stato ottenuto in 200 pazienti (130 DJ, 70 MJ) a 3 settimane; in 211 pazienti a 3 mesi. Conclusioni. La nostra casistica riporta un minore tasso di complicanze postoperatorie in seguito al posizionamento di cateteri ureterali MJ, a parità di tasso stonefree. Il posizionamento di uno stent ureterale DJ andrebbe riservato al termine di procedure endoscopiche lunghe, in caso di infezioni delle vie urinarie nel pre-operatorio e nei casi di accertato o presunto danno ureterale.

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ONCOLOGIA E CHIRUGIA ONCOLOGICA V_02 NERVE SPARING ROBOT ASSISTED RADICAL CYSTECTOMY AND “SHELL” NEOBLADDER: THE EVOLUTION OF TECHNIQUE AND AN UPDATE IN A HIGH VOLUME CENTER Bianchi R, Cozzi G, Turetti M, Conti A, Mistretta AF, Luzzago S, Catellani M, Bottero D, Di Trapani E, Ferro M, Matei DV, Musi G, De Cobelli O. IEO, European Institute of Oncology, IRCCS, Milan - Italy.

Introduction and Objective. Robotic assisted radical cystectomy with intracorporeal neobladder represents the minimal invasive surgical option for the treatment of muscle invasive bladder cancer. We descibe the evolution of our technique for nerve sparing robot assisted radical cystectomy and our “SHELL” technique for neobladder step by step. Materials and Methods. From January 2012 to September 2018 we performed 95 robot-assisted radical cystectomy (RARC) with extended pelvic lymph node dissection. In 49 cases we performed extracorporeal neobladder, in 46 cases intracorporeal neobladder. From 2016 we performed first 22 intracorporeal VIP neobladder (Padovana), then 4 intracorporeal “Karolinska” neobladder, and finally 20 intracorporeal “shell” neobladder. We divided the procedure in 3 phases: lymph nodes dissection, radical cystectomy,and reconfiguration of neobladder. No conversion to open surgery was required. The median follow up was 13 months. Results. Mean age was 58 years. Median console time was 470 min for the VIP-Karolinska reconfiguration, and 505 min for the SHELL reconfiguration. Transfusion rate for VIP-Karolinska and SHELL reconfiguration was 40% and 25% respectively. Median hospitalization time for the VIP-Karolinka group was 19 days, and 17 days for the SHELL group. Severe complications (Clavien Dindo III or more) rate was 27% and 20% for the VIP-Karolinska and for SHELL group respectively. Conclusions. Our step by step technique for SHELL neobladder is feasibile with surgical times comparable with the previous techniques and improving in length of stay, transfusion and severe complication rate. The limitations of our study are represented by the small number of patient and the short time follow up. Lo studio ha avuto finanziamenti: No Conflitto d’interessi: No

V_03 ROBOTIC ASSISTED LAPAROSCOPIC PARTIAL NEPHRECTOMY IN A HORSESHOE KIDNEY: SURGICAL TECHNIQUE AND FEASIBILITY IN A RARE ANATOMICAL ANOMALY.THE TECHNIQUE Bianchi R, Musi G, Conti A, Brescia A, Cordima G, Ferro M, Catellani M, Di Trapani E, Cozzi G, De Cobelli O. IEO, European Institute of Oncology IRCCS, Milan, Italy.

Introduction and Objectives. The horseshoe kidney is a renal fusion anomaly with an incidence rate ranging from 1 in 400 to 1 in 1000. As a results of this fusion the kidney cannot bypass the inferior mesenteric artery and is impeded in its ascent during the gestation. Renal tumors associated with a horseshoe kidney are extremely rare and fewer than 200 cases have been described. Partial or heminephrectomy for malignant renal tumor can be challenging depending on the location of the lesion, limited mobilization of the fused kidney and its multiple arterial blood supplies. Material and Methods. A 64 year old male patient was diagnosed with a 3-cm left renal tumor in a horseshoe kidney after CT scan performed because of back pain. A year and a half before he underwent robotic assisted radical prostatectomy for a intermediate risk prostate cancer. He underwent a no-diagnostic renal biopsy. After a multidisciplinary meeting we advised a robotic assisted partial nephrectomy by an anteriorior transperitoneal approach. Preoperative planning included a CT scan of the abdomen and a renal angiography which was able to reveal the aberrant pattern of vascularization. No distant metastasis were found. The patient was positioned on a supine position with a 27 degrees trendelemburg. Ports were placed as previously described for robotic retroperitoneal lymphadenectomy. Two 12 mm ports for the assistant have been positioned. We started with the incision of the peritoneum and mobilization of the meso to the level of the Treitz. After the identification of the tumor we proceeded its resection (SIB score 2) without any artery clamp. Then we sutured the renal medulla followed by the apposition of hemopatch. Results. Skin to skin time was 134 minutes. Blood loss was 100 ml and hospital stay was 4 days. The pathologic report diagnosed surprising a mixed tumor: grade 2 (according Fuhrman classification) renal cell carcinoma with clear cells subtype and an aggressive a B cell lymphoma. Margins were negative. Non postoperative complications were recorded. Conclusion. Robotic assisted partial nephrectomy in a horseshoe kidney with a transperitoneal anterior approach is a feasible procedure. In experienced hands it’s possible to perform minimally invasive surgery with excellent outcomes despite abnormal anatomical anomaly. Lo studio ha avuto finanziamenti: No Conflitto d’interessi: No Archivio Italiano di Urologia e Andrologia 2019; 91, 1, Supplemento 1

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V_04 PROSTATECTOMIA RADICALE NERVE SPARING LAPAROSCOPICA CON TECNICA RETROGRADA

Risultati. I tempi operatori registrati sono stati pari a 30 minuti, il sanguinamento 200 ml. Il drenaggio è stato rimosso in II giornata post-operatoria. Time removal catheter continence: 0 pads. L’esame istologico è esitato in adenocarcinoma prostatico pT2c Gleason score 7 (3+4), margini chirurgici negativi. Discussione. Nonostante nell’approccio laparoscopico si prediliga una procedura demolitiva discendente, nei pazienti che presentano un’anatomia favorevole come il caso trattato è possibile adattare una strategia retrograda, che ripropone l’approccio open, con il razionale delle preservazione anatomica delle fibre circolari del collo vescicale, e della lunghezza funzionale dell’uretra (tecnica a doppio sfintere) per il raggiungimento dell’early continence rate ed una precoce ripresa dell’attività sessuale. Lo studio ha avuto finanziamenti: No Conflitto d’interessi: No

Materials and Methods. From December 2016 to December 2017, 10 consecutive patients with muscleinvasive bladder cancer undergoing laparoscopic radical cystectomy and super-extended lymph node and were included in the study. Clinical, surgical and pathological data were prospectively collected. Complications were reported according to the Modified Clavien Classification. All patients underwent lymph node dissection prior to cystectomy. Patients were investigated for lymphocele only if symptomatic, and followed-up with routine schedule for muscle-invasive bladder cancer. The dissection is carried out along the common, internal and external iliac vessels on both sides in order to completely skeletonize the vessels and the obturator nerve. Cranially the dissection proceeds with the lateralization on the right side of the sigma and incision of the mesosigma in order to expose the aortic bifurcation to remove lympho-fatty tissue located at the bifurcation and on the promontory of the sacrum. Most of the time at this level a clip is used to secure the proximal inter aorto-caval lymphatic chain. The entire dissection is performed with bipolar forceps and harmonic scalpel. Results. There were no intraoperative complications, in no case conversion to open surgery was necessary. Median (IQR) LND time was 80 (73-90) min, median (IQR) operative time was 220 (198-230) min. median (IQR) hospital stay was 8 days (7-11). A median (IQR) of 22 (21-24) lymph node were removed. Pathological examination showed positive nodal status in 2/10 pts. Concerning bladder specimen 1 patient had CIS at final examination, 3 pts a pT2, 5 pts a pT3 and 1 pT4 urothelial cancer. Post-operative complications occurred in 5 pts, none of them greater than Clavien 1. No symptomatic lymphocele occurred after 3 months of follow-up. Conclusions. In our preliminary experience, laparoscopic super-extended lymph node dissection during radical cystectomy showed to be safe and feasible. Granting a similar accuracy in lymph node retrieval as open surgery. A greater number of patients and a longer followup are however needed to draw definitive conclusions. Lo studio ha avuto finanziamenti: No Conflitto d’interessi: No

V_05 SUPER-EXTENDED LYMPH NODE DISSECTION DURING LAPAROSCOPIC RADICAL CYSTECTOMY, INITIAL EXPERIENCE AND DESCRIPTION OF THE TECHNIQUE

V_06 SAFETY AND EFFICACY OF RETROPERITONEAL SUTURELESS ZERO ISCHEMIA LAPAROSCOPIC PARTIAL NEPHRECTOMY FOR LOW NEPHROMETRY SCORE MASSES

Grosso G, Polara A, Rapisarda S. Ospedale Pederzoli, Peschiera del Garda (VR).

Introduzione. Presentiamo il trattamento laparoscopico di neoplasia prostatica Gleason 7 (3+4) in paziente di 62 anni con IIEF5 score pari a 20. La patologia è stata stadiata con RM multiparametrica documentante lesione PIRADS 4 al lobo destro. PSA totale 6,7 ng/ml. Materiali e Metodi. È stata posta indicazione a procedura di prostatectomia radicale pelvioscopica con strategia retrograda. Il video mostra i seguenti step chirurgici: - Incisione Neck sparing della linea vescico prostatica con mantenimento del collo vescicale; - Accesso laterale al piano vescicolare; - Incisione intrafasciale della fascia endopelvica; - Preparazione dell’apice prostatico e sezione dell’uretra; - Prostatectomia retrograda con trattamento a freddo dei peduncoli vascolari principali; - Sezione a freddo del collo vescicale; - Trattamento dei peduncoli seminali con clips; - Anastomosi in Running suture singola.

Corongiu E1, Grande P2, Liberati E1, Zampellia A1, Pagliarella G1, Squillacciotti S1, Di Santo A1, Forte F1. 1

Corongiu E1, Grande P2, Squillacciotti S1, Zampelli A1, Pagliarella G1, Di Santo A1, Liberati E1, Forte F1. 1

Dept. of Urology, M.G. Vannini Hospital, Rome, Italy; Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Pitié Salpétière, Urology Department, Paris, France.

Objective. To evaluate feasibility and outcomes of super-extended lymph node dissection during laparoscopic radical cystectomy.

Objective. To evaluate oncological feasibility, oncological and functional results of retroperitoneal sutureless zero ischemia laparoscopic partial nephrectomy (LPN).

Archivio Italiano di Urologia e Andrologia 2019; 91, 1, Supplemento 1

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Materials and Methods. From January 2016 to November 2017, 13 consecutive patients with posterior low nephrometrty score (RENAL<7) renal masses underwent retroperitoneal sutureless zero ischemia LPN in our institution. Clinical, surgical and pathological data were prospectively collected. Complications were reported according to the Modified Clavien Classification. The indication for nephron-sparing surgery was elective in 9 (69%) patients and imperative in 4 (31%). Median RENAL score was 5 (IQR: 5-7), median tumor diameter 25 mm (IQR: 20-35). In 11 cases, the tumor was located polar (85%), and in 2 cases hilar (15%). A 4-trocar approach was used. After placing the first trocar about 3 cm above the iliac crest on the medial axillary line, the other three were placed using digital guide after having created the retroperitoneal space with a dilatator balloon. The intervention started with dissection of perinephric fat using ultrasound scalpel, renal hilum was not dissected. Once the neoplasm is found and delimited, enucleation was performed using the ultrasound scalpel and the suction device to better expose the enucleation plain and maintain a bloodless surgical field. Suture of the parenchyma was never performed. Once the mass was removed, interlobar arteries are cauterized using ultrasonic scalpel or bipolar forceps. If necessary hemostatic agents (Tachosil or Floseal) were left on the enucleation site. No drain was left. Results. There were no intraoperative complications. In particular, no vascular lesions occurred during the procedure; no cases were converted to radical nephrectomy. Median operative time was 90 min (IQR:80120), in no case clamping of the renal artery was necessary, median hospital stay was 4 days (IQR:4-4). Mean GFR loss was 10.46 (SD: ±19.46) mL/min/1.73m2, mean EBL was 320 (SD: ±312) ml. Pathological analysis showed renal cell carcinoma in 11 patients (85%) staged T1a. In 2 (15%) an oncocytoma was found. There were no positive surgical margins. 1 patient developed a major postoperative complication, (postoperative renal bleeding requiring super-selective embolization). Trifecta rate was 92%. Conclusions. Our preliminary experience showed feasibility and safety of sutureless retroperitoneal zero ischemia LPN for the treatment of low-complexity posterior renal masses. Longer follow-up and higher numbers of patients are, however, warranted. Lo studio ha avuto finanziamenti: No Conflitto d’interessi: No

V_07 LINFADENECTOMIA INGUINALE ROBOT ASSISTITA PER CARCINOMA A CELLULE SQUAMOSE (SCC) DEL PENE: TECNICA CHIRURGICA

Dente D1, Musi G2, Mengoni F1, Orciani R1, Gallo G1, Cafarelli A1.

1 U.O. di Urologia Robotica e Mininvasiva - Casa di Cura Villa Igea - Ancona; 2 Dipartimento Di Urologia - Istituto Europeo di Oncologia (I.E.O.) - Milano.

Introduzione. La linfadenectomia inguinale open è considerata come l’opzione terapeutica per i pazienti affetti da SCC del pene con rischio di metastasi linfonodali loco-regionali. L’utilizzo del Robot Da Vinci ha permesso di poter effettuare l’intervento con tecnica mini-invasiva, minimizzando la percentuale di complicanze post operatorie. L’obiettivo del lavoro è quello di riportare la nostra esperienza in merito all’utilizzo del sistema robotico da vinci nella linfadenectomia inguinale superficiale e profonda. Materiali e Metodi. L’indicazione alla tecnica è la stessa applicata alla chirurgia open, come da linee guida. Si procede a tracciare i punti di repere con penna demografica in modo da definire il corretto posizionamento dei trocars robotici. Vengono utilizzate 3 porte robotiche e 1 per l’aiuto al tavolo. Si traccia una linea che identifica la posizione del legamento inguinale (Dal tubercolo pubico alla spina iliaca antero-superiore). Viene poi tracciata una linea che perpendicolarmente al legamento inguinale va in senso cranio-caudale per 25 cm al cui vertice si posiziona il primo trocar ottico. Dal vertice della suddetta linea, con angolo di 90° vengono tracciate altre 2 linee di 8 cm, ai cui vertici, dopo creazione dello spazio al di sotto della fascia di Camper vengono posizionati i trocar per le altre 2 braccia robotiche (Figure 1a e 1b). Si allestisce quindi il sistema robotico da vinci che viene messo lateralmente al letto del paziente a seconda del lato da operare (Figure 2a e 2b). Figura 1a. Preparazione del campo e dei reperi per il posizionamento dei trocars.

Archivio Italiano di Urologia e Andrologia 2019; 91, 1, Supplemento 1

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XXIV Congresso Nazionale UrOP - Abstracts

Figura 1b. Trocars in situ.

Con ottica 30° UP, si procede quindi a dissezione seguendo il piano al di sotto della fascia di Camper avendo come repere (laterale il muscolo sartorio, mediale l’adduttore lungo e superiore il legamento inguinale. Una volta identificati i reperi, con ottica 30° Down, si procede alla linfadenectomia. La vena safena viene schelettrizzata fino al cross con la vena femorale, esponendo i grossi vasi, e gli afferenti vengono chiusi con clip metalliche. Il pacchetto lifonodale viene posto in endobag. E viene posizionato drenaggio in aspirazione. Risultati. Ridotta ospedalizzazione del paziente, minore permanenza in situ dei drenaggi, assenza di infezioni o necrosi, mantenendo un numero di linfonodi sovrapponibile alla tecnica open. Conclusioni. Nonostante presso il nostro centro l’approccio a questa tecnica sia utilizzato da poco, per cui la casistica è ancora da aumentare, i risultati preliminari ne mostrano la fattibilità consentendo quindi una notevole diminuzione delle complicanze post operatorie di questo tipo di chirurgia. Lo studio ha avuto finanziamenti: No Conflitto d’interessi: No

V_08 TUMORECTOMIA RENALE ROBOTICA RETROPERITONEALE CLAMPLESS

Figura 2a e b. Posizionamento del Robot.

Gallo G.

Casa di Cura Villa Igea - Ancona.

Scopo. Questo video mostra una tumorectomia robotica clampless eseguita per via retroperitoneale con ausilio di Robot da Vinci Si. Materiali e Metodi. La paziente sottoposta a tale procedura è una donna di 55 anni con riscontro incidentale di neoformazione renale Sin polare superiore di circa 55 mm con associato nodulo surrenalico. Il video mostra la sequenza dei passaggi chirurgici quali il defatting preparatorio prerenale, l’individuazione della vena gonadica e dell’uretere fino all’ilo renale con l’isolamento di 3 arterie ed una vena renale che vengono repertate separatamente. Successivamente si procede con l’enucleazione della massa renale senza clampaggio. Previo utilizzo di colla emostatica su letto enucleativo, vengono apposte suture emostatiche utilizzando un monofilamento sulla midollare renale ed un filo intrecciato sulla corticale. Risultati. La procedura è stata eseguita senza clampaggio dell’aa. renale ed è stata portata a termine senza complicanze intraoperatorie o conversione chirurgica. La perdita ematica risultatrascurabile. I margini chirurgici sono risultati negativi all’esame istologico definitivo. Degenza di 3 giorni. Conclusioni. La tumorectomia renale robotica eseguita in centri specializzati è una procedura efficace e sicura per il trattamento delle masse renali. Il drenaggio posizionato al termine della procedura sarà poi rimosso in seconda giornata post operatoria. La dimissione della paziente è avvenuta in terza giornata post operatoria. Lo studio ha avuto finanziamenti: No Conflitto d’interessi: No

Archivio Italiano di Urologia e Andrologia 2019; 91, 1, Supplemento 1

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V_09 NEFRECTOMIA DESTRA LAPAROSCOPICA RETROPERITONEALE CON CAVOTOMIA

Polara A, Rapisarda S, Grosso G.

Ospedale Pederzoli, Peschiera del Garda (VR).

Il video descrive il trattamento laparoscopico di una voluminosa neoformazione renale destra in paziente ZD di anni 55, che ha eseguito follow-up per pregresso Ca mammario, con riscontro TC di lesione espansiva di 8 cm al III medio inferiore del rene destro, determinante infiltrazione del sistema collettore ed espansione della vena renale per estesa colonizzazione di tessuto neoformato che protrude leggermente nel lume cavale. TC torace negativa. Il video mostra la preparazione dello spazio di lavoro retroperitoneale destro, isolamento e trattamento dell’arteria renale destra, clippaggio della vena surrenalica e dell’uretere destro; preparazione della cava ed isolamento della vena renale destra, imbottita dal trombo neoplastico. Viene descritto il posizionamento di Satinsky sulla cava, cavotomia, asportazione del trombo cavale, doppia sutura in prolene 3-0: declampaggio cavale, completamento dell’isolamento del rene ed asportazione in endobag attraverso minilaparotomia di servizio. I tempi operatori sono stati di 100 minuti, le perdite ematiche intraoperatorie 400 ml. Gli esami di laboratorio hanno evidenziato un calo dell’emoglobina in prima giornata postoperatoria: 13.1 g/dl (da 15.1 preoperatoria), mentre la creatininemia postoperatoria è stata 1.0 (preoperatoria 0.9). Il drenaggio lombare è stato rimosso in II giornata post-operatoria, mentre la paziente è stata dimessa in IV giornata. Lo studio ha avuto finanziamenti: No Conflitto d’interessi: No

V_10 CISTO-ISTERO-ANNESSIECTOMIA ROBOTICA IN PREGRESSA PLURIMA CHIRURGIA ADDOMINALE

Pomara G, Di Vico T, Tesi L. Durante J, Bracchitta D, Meneghetti I, Santarsieri M, Francesca F. Urology Unit, AOUP, Pisa, Italy.

Il video mostra un complesso caso di chirurgia robotica in una donna di 47 anni già sottoposta a plurime chirurgie addominali. All’età di 2 anni la paziente veniva sottoposta ad intervento di resezione e reimpianto ureterale bilaterale transvescicale per un reflusso ureterale congenito. Dopo un anno, a causa di una stenosi ureterale sinistra, veniva effettuato reintervento di reimpianto ureterale sinistro. Nel corso degli anni successivi venivano effettuati plurimi tentativi infruttuosi di iniezioni di bulking agent. A Settembre 2017 si presenta alla nostra osservazione per rene sinistro pielonefritico funzionalmente escluso e rene destro dilatato per stenosi dell’uretere terminale. Viene posizionata nefrostomia destra. A Ottobre 2017 viene effettuato intervento di nefroure-

terectomia sinistra e reimpianto ureterale destro con tecnica open (istologico definitivo: malattia infiammatoria benigna). A Gennaio 2018 per comparsa di ematuria effettua cistoscopia che evidenzia area ulcerata trigonale di ndd. Diagnosi istologica definitiva dopo TURB-t: carcinoma sdifferenziato HG, T2. Compliance vescicale ridotta. La paziente viene sottoposta a cisto-istero-annessiectomia robotica con derivazione secondo Bricker. Il video dimostra l’efficacia della tecnica robotica anche in chirurgie complesse, gravate da multiple aderenze frutto di pregresse chirurgie addominali. Lo studio ha avuto finanziamenti: No Conflitto d’interessi: No

V_11 ROBOTIC SURGERY IN PATIENTS WITH ACHONDROPLASTIC DWARFISM: RIGHT PARTIAL NEPHRECTOMY

De Marchi D, Mantica G, Suardi N, Passaretti G, Smelzo S, Pini G, Proietti S, Rigatti L, Giusti G, Leonardi R, Gaboardi F. Department of Urology – San Raffaele Turro.

Introduction. The reports on the performance of robotic surgery in patients with dwarfism are anecdotal; anesthesiological issues and a challenging anatomy are the main factors that lead most of surgeons to prefer a more traditional approach. We present a case of right robotic partial nephrectomy in a patient affected by achondroplastic dwarfism. Materials and Methods. A 59-year-old achondroplastic dwarf was admitted in June 2018 for bilateral renal mass incidentally diagnosed with an abdominal sonography. He was 129 cm tall and 60 kg heavy with a resulting BMI of 36. The patient underwent an abdominal CT scan which showed the presence of a 35×25×26 mm renal mass in the anterior margin of the right kidney and another mass in the left kidney with the dimensions of 20×19×17 mm, both highly suspicious for malignancy. The PADUA score was 12 for the right mass and 6 for the left. The decision to treat first the right kidney mass was based on dimensional criteria as well as on the proximity of the renal hilum. The patient underwent a right Robot Assisted Laparoscopic Partial Nephrectomy (RAPN) with the use of the DaVinci Si. The patient was placed in a flexed, full flank position. A Hasson technique by transperitoneal approach was used to establish a pneumoperitoneum of 12 mm Hg. A 12-mm camera port with 0° lens was placed approximately 12-15 cm laterally to the umbilicus. We decided to place the optical access trocar more sideways compared to our standard placement, to gain space to guarantee an adequate extent of movements to the robotic arms. Monopolar scissors, Maryland bipolar forceps and robotic needle driver were the instruments of choice. The kidney was exposed by incising the peritoneum sharply along the right parietocolic gutter and reflecting the colon medially to provide optimal expoArchivio Italiano di Urologia e Andrologia 2019; 91, 1, Supplemento 1

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sure of the retroperitoneal space. Subsequently, the ureter, the gonadal vessels, and the lower pole of the kidney were identified and retracted laterally. The renal hilum was identified. An intra-operative real-time ultrasound was performed to identify the mass and to define its dimensions. Vascular clamping was performed with bulldog clamps placed by the assistant. The excision of the tumor was then performed following standard oncological principles, preferentially with monopolar scissors and the aid of the assistant’s suction to provide opposite traction and to maintain the surgical field dry. The renorrhaphy was performed using a sliding clip technique. A 2.0-braided absorbable suture with 27 mm 5/8 needle was used for the medullar layer. A 0braided absorbable suture with a 37-mm 1/2 needle was used for the cortical layer. Results. The operative time was about 3 h with an ischemia time of 27 min, and blood loss less than 150 ml. The patient was discharged in good conditions in the sixth POD with an Hb of 13.7 g/dl and a creatinine of 0.62 mg/dl. The pathological evaluation showed the presence of a Clear Cell Carcinoma p T1a p Nx R0 Fuhrman grade 2 without necrosis and lymphovascular infiltration. Discussion. Achondroplasia is the most frequent among the over 100 types of dwarfism. It is a genetic disorder caused by mutations in the FGFR3 gene which is responsible for lengthening bones. Very few are reports of laparoscopic or robotic abdominal surgery in these patients. From a surgical point of view, a shorter surgical field might represent an issue, especially for robotic’s arms that should have the necessary space to move. The obesity, that is often associated in dwarf patients, further complicates the robotic approach for several reasons. These include the potential for restricted instrument range of motion and reach due to a thicker abdominal wall as well as decreased intra-abdominal working space. The accentuated hyperlordosis and hyperkyphosis might also affect the intra-abdominal anatomy and must be considered during trocars insertion. Conclusions. Robotic partial nephrectomy represent a feasible and safe option also in achondroplastic dwarfism. Conflitto d’interessi: No

C_22 MALIGNANT MELANOMA OF THE BLADDER: CASE REPORT

Toffoli L, Belmonte P, Loiero G, Guaitoli P, Nisticò CD. Casa di Cura San Giorgio di Pordenone.

Summary. Primary malnoma of the bladder is rare and accounts for less than 0,2% of all melanomas (1). Malignant melanomas of the bladder are more commonly metastatic lesion (2) The histophatological appearance largely does not differ from that of melanoma at other body sites (3). Case Report. A 89 year-old cucasian man presented to the Emergency Room of our Hospital with massive monosyntomatic haematuria.

Archivio Italiano di Urologia e Andrologia 2019; 91, 1, Supplemento 1

The abdomen and thoracic CT scan performed documented only a 4 cm size mass which was located in the bladder dome. After obtaining informed consent we performed a trans urethral resection of ta darkly pigmented bladder mass. Histological examination of the resect specimen showed a poorly differentiated neoplasm with epithelioid and spindles cells, strongly infiltrating the muscular tunic. Immunoistochemical exam was positive for S-100, p75. Histological examination was compatible with melanoma. Patient denied an history of nevi-excision. The patient died two months later of a heart attack, before any radical treatment could be performed. Autopsy was not performed. Discussion. Primary melanoma is uncommon in the genitourinary tract, Wheelock et al. reported the first case of primary malignant melanoma of the urinary bladder in 1942 (4). There have been only 20 cases of primary melanoma of the urinary bladder reported in the medical litterature. Gross Hematuria is the most common presenting symptom. Some patients might also present with voiding symptoms, such as dysuria, frequency or urinary retention on the basis of tumor location and invasiveness. Ainsworth et al initially proposed criteria to confirm location of the primary lesion. These criteria require the following: 1) a detailed history and physical examination of the patient (2) confirmation of a pattern of recurrence and local metastasis in the pelvis, which is consistent with primary bladder tumor rather than the pattern of widespread metastasis seen in secondary metastatic melanoma (5). There is no standard guidline for staging mucosal melanoma (6). Clinical staging is determined by a combination of radiographic assessment for metastasis, TUR and biopsy of the tumor and pathologic assessment. The first line treatment of bladder melanoma is surgery. The options include TUR, partial cystectomy and radical cystectomy based on the stage of the tumor. An important consideration in choosing an appropiate treatment for a patient is the patient’s overall health status and life expectancy. Chemotherapy options include platinum-based regimens such as cisplatin/carboplatin with paclitaxel. Immunotherapy options include ipilimumab or, for patients with excellent performance status, high-dose interleukin 2. Inhibitors of oncogenic BRAF should be considered for patients whose tumors harbor a BRAF V600 mutation. Radiation therapy has a limited role for palliative prurposes in patients with primary bladder melanoma (7). Conclusion. Melanoma of the bladder is most commonly a secondary presentation of patients with widspread metastatic melanoma originating from the skin. Primary melanoma of the bladder is extremely rare and has a poor prognosis. It is a therapeutic challenge to urologists who managed patients with this rare disease. Lo studio ha avuto finanziamenti: No Conflitto d’interessi: No References. 1. Truong H, Sundi D, et all. A case report of primary Malignant melanoma of the Urinary Bladder. Urology Case reporti 1. 2013;2-4.

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XXIV Congresso Nazionale UrOP - Abstracts 2. Sayar H, Erdogan S et al. Malignant melanoma of the bladder: a case report. CUAJ. 2014; Vol. 8, Issues 1-2. 3. Hussein MR. Extracutanous malignant melanomas. Cancer Invest. 2008; 26:516-34. 4. Kojima T, Tanaka T, et all. Primary malignant melanoma of the urinary bladder: A case report. Korean J Pathol. 2010; 44:216-219. 5. Ainsworth AM, Clark WH. Primary malignant melanoma of the urinary bladder. Cancer. 1976; 37:1928-36. 6. Papes D, et al. Melanoma of the glans penis and urethra. Urology 2013. 7. National Cancer Institute: melanoma treatment. Bethesda, MD: National Cancer Institute. 2013.

C_23 ACCURATEZZA DIAGNOSTICA DELLA RISONANZA MAGNETICA MULTI-PARAMETRICA (RM-MP) NELLA DIAGNOSI DEL CARCINOMA PROSTATICO CLINICAMENTE SIGNIFICATIVO

Manenti G, Nezzo M, D’Amato D, Marsico S, Ryan CP, Meucci R, Turbanti A, Mariani M, Finazzi Agrò E. Diagnostica per Immagini e Radiologia Interventistica Policlinico Tor Vergata, II Università di Roma Tor Vergata, Roma (Italia).

Scopo. Valutare l’accuratezza diagnostica della Risonanza Magnetica Multiparametrica (RM-mp) nella diagnosi del carcinoma prostatico clinicamente significativo attraverso l’utilizzo della biopsia prostatica con tecnica “fusion”, in pazienti con rialzo significativo del PSA sierico ed in Sorveglianza Attiva. Materiali e Metodi. Sono stati arruolati 1608 pazienti tra Maggio 2016 e Dicembre 2018, tutti sottoposti a RM-mp. La RM-mp è stata effettuata con scanner 3T (Achieva, Philips) e bobina di superficie 32 canali, utilizzando sequenze TSE T2 pesate multiplanari ad alta risoluzione a livello della loggia prostatica, orientate nei tre piani dello spazio; la sequenza DWI, acquisita sul piano assiale (b-values 25, 1500, 2000 s/mm2) ed infine una sequenza dinamica T1 GRE 3D con tecnica di saturazione spettrale del grasso (slice thickness 3,0 mm), acquisita prima e dopo la somministrazione di mdc paramagnetico. In tutti i pazienti con PIRADS v2 compreso tra 3 e 5 è stata effettuata una biopsia con sistema di “fusione” sia random che mirata sulle lesioni focali evidenziate con la RM. Risultati. Dei 1608 pazienti analizzati con RM-mp in 952 è stata effettuata una biopsia di fusione eco-RM con sistema MyLab 9 Esaote. I valori di sensibilità, specificità, VPP e VPN delle lesioni con PIRADS ≥ 3 sono stati del 91%, CI 88-96%; 52%, 37-58%, 65% e 76% rispettivamente; È stata poi effettuata una sotto-analisi su pazienti classificati con PI-RADS = 3 per la valutazione sensibilità, specificità, VPP e VPN che sono risultati essere rispettivamente 31% CI 11-58%. 55% CI 36-72%, 26% CI 9-51%, 60% CI 40-78%, con evidenza di carcinoma con Gleason Score ≥3 +4 nel 10% dei pazienti. Analizzando inoltre parametri clinico laboratoristici dei pazienti, abbiamo evidenziato che l’età ≥70 anni e PSA density ≥0,15 ng/ml incrementano la correlazione con il carcinoma prostatico clinicamente significa-

tivo, rispetto al solo punteggio PIRADS (AUC=0.714; IC 95%=0.622-0.805 vs AUC=0.626; IC 95%=0.5210.730; p≤0.0001). Conclusioni. L’alta sensibilità e l’elevato VPN della RMmp come test di triage, unitamente alla valutazione dei parametri clinico laboratoristici del paziente, riducono fino al 25% il numero di biopsie prostatiche inutili, risparmiando una prima biopsia al 27% dei pazienti clinicamente indicati e del 5% la diagnosi di tumore clinicamente non significativo, aumentando del 18% il numero dei carcinomi clinicamente significativi diagnosticati, riducendo anche i costi sanitari, limitando il numero dei prelievi bioptici nei singoli pazienti e ed il rischio di sovra-trattamento per forme a bassa aggressività. Lo studio ha avuto finanziamenti: No Conflitto d’interessi: No

C_24 VALUTAZIONE DELL’ACCURATEZZA DELLA RISONANZA MAGNETICA MULTI-PARAMETRICA DELLA PROSTATA E RELATIVO PIRADS SCORE, NELLA DIAGNOSI DI CARCINOMA PROSTATICO MEDIANTE BIOPSIA CON TECNICA DI “FUSIONE RM/US”

Manenti G, Nezzo M, D’Amato D, Marsico S, Ryan CP, Meucci R, Turbanti A, Mariani M, Finazzi Agrò E.

Diagnostica per Immagini e Radiologia Interventistica Policlinico Tor Vergata, II Università di Roma Tor Vergata, Roma (Italia).

Scopo. Negli ultimi anni l’avvento della Risonanza Magnetica multi-parametrica e della standardizzazione interpretativa con PIRADS score, hanno cambiato l’approccio diagnostico al tumore prostatico. Abbiamo valutato la sensibilità e la specificità della RMmp e se la dimensione della lesione discariocinetica ed il PIRADS score elevato si correlano in maniera statisticamente significativa con la presenza di cancro prostatico. Materiali e Metodi. Da settembre 2016 a marzo 2018 sono stati arruolati 228 pazienti con età compresa tra 52-78 anni, PSA Sierico sospetto, esplorazione digito rettale sospetta oppure in sorveglianza attiva. Sono state effettuate mediante tecnica di “fusione RM/US”, biopsie prostatiche sia sistematiche che mirate su lesioni identificate alla RM-mp. Risultati. Sono state identificate 244 lesioni, con PIRADS compreso tra 3 e 5; di cui 37/244 (15,2%) con PIRADS v2:5; 157/244 (64,3%) con PI-RADS v2:4; 50/244 (20,5%) con PI-RADS v2:3. Delle lesioni con PIRADS v2:5 il 59,5% di esse si è rivelata essere una neoplasia clinicamente significativa; nelle lesioni con PIRADS v2:4 il 36 % presentava una neoplasia prostatica ed infine nelle 50 lesioni con PIRADS v2:3 nel 24% è stata rilevata una lesione discariocinetica clinicamente significativa. Nelle aree non sospette alla mpMRI la biopsia sistematica ha rivelato la presenza di carcinoma in 31 pazienti (31/157; 19,7%) 15 dei quali (15/157; 9,5%) con Gleason Score ≥ 7. Conclusioni. Lo studio dimostra che un PI-RADS v2 elevato ed il volume della lesione sono in correlazione con Archivio Italiano di Urologia e Andrologia 2019; 91, 1, Supplemento 1

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la presenza di carcinoma prostatico. Solo in alcuni casi lesioni che sembravano non significative alla mpMRI si sono rivelate neoplasie clinicamente rilevanti. Lo studio ha avuto finanziamenti: No Conflitto d’interessi: No

C_25 INTRAOPERATIVE AND PERIOPERATIVE OUTCOMES OF CLAMP VS OFF-CLAMP LAPAROSCOPIC PARTIAL NEPHRECTOMY: PRELIMINARY RESULTS FROM A MULTICENTRE RANDOMIZED CLINICAL TRIAL (THE CLOCK2 STUDY)

Bove P1, Cipriani C1, Sandri M2, Bertolo R1, Leonardo C3, Parma P4, Falsaperla M5, Veneziano D6, Minervini A7, Antonelli A8. 1

Urology Department, "San Carlo di Nancy" Hospital, Rome, Italy; Data Methods and System Statistical Laboratory, University of Brescia, Brescia, Italy; 3 Department of Urology, La Sapienza University of Rome, Rome, Italy; 4 Department of Urology, Ospedale "Carlo Poma" Mantova, Mantova, Italy; 5 Department of Urology, Vittorio Emanuele Hospital, Catania, Italy; 6 Department of Urology and Kidney Transplantation, O.O. Riuniti BMM, Reggio Calabria, Italy; 7 Department of Urology, University of Florence, Careggi Hospital, Florence, Italy; 8 Unit of Urology, Spedali Civili Hospital, University of Brescia, Brescia, Italy. 2

Aim. The duration of ischemia time necessary to determine a kidney damage during a partial nephrectomy is still an unsolved issue. The CLOCK-2 study is a perspective, randomized, multicenter trial aimed to compare Clamp vs. Off Clamp the Kidney during laparoscopic partial nephrectomy. In this preliminary report, we evaluate possible factors associated with choice to perform a Clamp or an Off-Clamp technique and implications of surgical approach performed on intra and peri-operative outcomes. Materials and Methods. From August 2014, 192 patients were centrally randomized to be submitted to clamp vs. off-clamp laparoscopic PN in 5 Italian hospitals. Inclusion criteria were normal coagulative function, healthy contralateral kidney, eGFR >=60 ml/min, R.E.N.A.L. score <=10. Intraoperative and perioperative data were collected in an e-crf, centrally managed. Any deviation from the assigned technique were recorded and motivated. Results. 140 patients were eligible for statistical analysis. Among the 69 patients randomized into clamp group, 35 patients (50.7%) were shifted to off-clamp surgery, preoperatively in 10 (28.6%) and intraoperatively in 25 cases (71.4%). Among the 71 patients randomized into off-clamp group, 23 patients (32.4%) were shifted to clamp surgery, preoperatively in 10 (43.5%), intraoperatively in 9 (39.1%) and because of bleeding during resection in 4 cases (17.4%). R.E.N.A.L. score didn’t correlate with the decision of the surgeon to shift the assigned technique (clamp vs.

Archivio Italiano di Urologia e Andrologia 2019; 91, 1, Supplemento 1

off-clamp mean R.E.N.A.L. score was 6.43 vs. 6.10, p=0.33). Nevertheless, a larger lesion size was associated with a lower probability to shift from clamp to offclamp (p=0.013). Higher glomerular filtration rate and Charlson Comorbidity Index were associated, respectively, with a lower (p=0.014) and a higher (p=0.013) probability of shift from off-clamp to clamp. As regards the intra and peri-operative data, no significant differences between clamp and off-clamp groups were found concerning intraoperative bleeding (186 ml vs. 208 ml), time of parenchymal suture (12.1min vs. 11.1min), complication's rate, creatinine in 1st postoperative day (1.08 mg/dL vs. 0.99 ml/dL), haemoglobin loss in 1st post-operative day (12.3 g/dL vs. 12.05 g/dL) and oncological control (1 vs. 1 positive margins). Operative time and post-operative stay were significantly longer in the clamp group (173 min vs. 135 min, p=0.002; 5.65 days vs. 4.85 days, p<005). Volume of parenchyma removed with lesion was lower in the clamp group (1.13 mm vs. 1.9 mm, p=0.003). Conclusion. Both of approaches are effective and safe in terms of oncological control. Clamp procedure appears more effective in terms of preservation of renal parenchyma despite of a longer operative time and hospital stay. Our data suggest that the decision making of the surgical approach is not influenced by nephrometric characteristics of lesions although the surgeon's experience plays a key role to make homogeneous outcomes in both approaches. Lo studio ha avuto finanziamenti: No Conflitto d’interessi: No

C_26 EFFECT OF NUTRITIONAL SUPPLEMENTS ON SERUM PSA IN YOUNG PATIENTS AT RISK OF PROSTATE CANCER (PCA): LONG TERM RESULTS OF A PROSPECTIVE FOLLOW-UP STUDY

Brausi M, Vitelli D, Ferrari R.

Department of Urology Hesperia Hospital Modena.

Introduction and Objectives. Nutritional supplements have been suggested for chemoprevention in Pca. An antioxidant activity and a cell proliferation block have been postulated. The objectives of this study were to evaluate the efficacy of a combination of 7 compounds (Soil oil extract, green tea extract, vitamin E and D3, lycopene, zinc, selenium), in reducing PSA in young patients (≤ 60years) with an elevated PSA (≥ 3.3 ng/ml), to observe the prevalence of Pca in time and to report side effects. Material and Methods. From 2003 to 2007 32 patients with constantly elevated serum PSA (3 determinations) were included in the study and followed in time. The mean age was 57.8 years (range 52-60years). Mean PSA at entry was 8.5 ng/ml (range 3.3-13.6 ). 25/32 patients (78.1%) had mild or moderate urinary symptoms (IPSS 5-14). All the patients had prostate mapping (8-24 cores) before entering the study. 8 pts. received 2 sets of biopsies and 3 pts. had 3 sets. Patho-

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logical diagnosis was BPH in 20 pts. 10/32 patients had chronic prostatitis with BPH, 2/32 pts. had BPH + low grade PIN. After the first negative prostate biopsies 9 pts. received orally 480 mg of 7 compounds in capsule (1/day), while 23 received 960 mg (2 cp/day). Patients were suggested to avoid the intake of other possible supplements which could interfere with the study. The supplements intake was continued for all the study period. Patients were controlled at our clinic every 3 months for the first year and twice a year thereafter. Physical examination (PE), PSA and I-PSS were required. Side effects were also recorded. Saturation biopsy was suggested in case of increased PSA (velocity). Results. The mean follow-up was 29.3 months (7-82 months). 16/32 pts.(50%) had a PSA reduction persisting in time, 2/32 pts.(6.5%) had stable PSA and 14/32 pts.(43.5%) had PSA progression. 11/17 pts. receiving 960 mg (2 cps) of compounds showed a mean PSA reduction of 2.6 ng/ml while 5 pts. who received 480 mg (1cp) had a mean PSA reduction of 1.3 ng/ml. 2 pts. with a stable PSA received 2 cps. 6/14 pts. with PSA progression (mean 1.5 ng/ml) received saturation biopsy (24-30 cores). 1/6 had adenocarcinoma and received radical prostatectomy (pT2c G3+3N0). 4 pts had BPH + chronic prostatitis. 1 patient underwent TUR (BPH). 15/32 pts. (47%) declared an improvement in urinary symptoms (mean I-PSS improvement = 2 points). In 17 pts. I-PSS did not change. Side effects:1/ 32 pts.stopped the treatment because of malaise. Conclusion. Nutritional supplements reduced serum PSA in pts. with constantly elevated PSA and BPH. The prevalence of Pca in time (29 months) was 3.1%. High dose (960 mg) was more effective than standard dose (480 mg). I-PSS was slightly improved in 50% of pts.Side effects were minimal. A PSA reduction or stabilisation compared with baseline can be used to select patients for further biopsies. Conflitto d’interessi: No

C_27 A NEW RISK CLASSIFICATION SYSTEM FOR THERAPEUTIC DECISION MAKING FOR INTERMEDIATE RISK PROSTATE CANCER (PCA) PATIENTS TREATED WITH RADICAL PROSTATECTOMY (RP)

Brausi M1, Papa N2, Muller D2, Ta A2, Lawrentshuk N2, Severi G2, Millar J2, Syme R2, Giles G2, Bolton D2. 1 2

Dept of Urology Hesperia Hospital, Modena; Melbourne Austin University, Australia.

Introduction and Objectives. The treatment of intermediate risk patients is still controversial due to the heterogeneity of the patients falling in this group category. The aim of this study was to evaluate the long term outcome of PCa patients at intermediate risk according to D’Amico classification who received RP in Victoria (Australia) and to sub-classify them eventually according to their pre-op PSA (</> 10 ng/ml), Gleason score (3+3,3+4,4+3) and stage (T1c, T2a,b). Materials and Methods. Between 1955 and 2000, 2154

men with PCa underwent RP and were registered in the Victorian Cancer Registry (AUS). Complete data were available in 1894. According to D’Amico classification 916 patients were at intermediate risk. Median age was 62.6 year, median pre-op PSA was 10.1 ng/ml, Gleason Score (GS) 6 in 58%, GS 3+4=31.4%, GS 4+3=10.6%. cStage: T1c=38.1%, T2a=19.4%, T2b=42.5%. All the patients received open RP: 54.5% of pts. received lymph node dissection. Patients were divided in 4 groups: Group A . Psa < 10ng/ml, GS6, cT2b. Group B. Psa <10ng/ml, GS 3+4, cT1c,T2a. Group C. Psa 1020ng/ml, GS 3+3, cT1c,T2a-b. Group D. Psa 1020ng/ml, any Gleason 7 (4+3,3+4), cT1c,T2a-b. Biochemical recurrence, overall and cancer specific survival were calculated for all the groups. Results. Median follow-up was 10.3 years. The overall death rate for all patients was 13.1% (120 pts.). 23(11.5%) in Group A, 15(7.7%) in Group B, 47 (14.2%) in Group C and 35 (18.3%) in Group D. Biochemical recurrence (BR): Group A=25%, Group B=32.5%, Group C=36%, Group D=14 (48.5%). Pca death: Group A=8/916 (4%), Group B=1%, Group C=1.8%, Group D=7.3%. When comparing D’Amico low risk group with Group A no difference on Biochemical recurrence and cancer death (statistically significant) was found vs Group B, C and D. The same occurred when D’Amico high risk group was compared to Group D vs Group A, B and C. Biochemical recurrence and overall mortality was calculated also according with the presence of 1, 2 or 3 negative factors (Psa> 10ng/ml, GS 7, cT2b). When only one factor was present BR was similar to the D’Amico low risk group. When 2 or 3 factors were present BR was similar to the one of high risk patients.This was true also for overall mortality. Gleason score 7 or higher was correlated with worst prognosis. Conclusion. Intermediate risk group should be sub-categorized in intermediate low and high risk. Intermediate low risk are patients with Psa < 10ng/ml, c T2b, Gleason score 3+3, pts with Psa 10-20ng/ml, GS 3+3 cT2b and pts. with Psa <10ng/ml, GS 3+4, T1c. For these pts. Active Surveillance should be the treatment of choice. Patients with GS 3+4, Psa 10-20ng/ml cT2b or pts with GS 4+3 any Psa or stage should be classified as intermediate-high risk.These patients have a high probability of BR and PCa mortality and should receive active treatment. Lo studio ha avuto finanziamenti: No

C_28 EFFICACY OF INTRAVESICAL BCG IN OCTOGENARIANS AND IN YOUNGER PATIENTS (=/<65-YR): RESULTS OF A COMPARATIVE STUDY

Brausi M, Peracchia GC, Viola M, Ferrari G.

Dep. of Urology AUSL and Hesperia Hospital Modena.

Objectives. To evaluate the efficacy of BCG in octogenarians (>80 yrs) and in younger patients (<65 yrs) with intermediate and high risk TCC of the bladder Archivio Italiano di Urologia e Andrologia 2019; 91, 1, Supplemento 1

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treated in the same period of time and to verify side effects (SE). Material and Methods. The charts of 90 pts. with intermediate and high risk Ta-T1 TCC of the bladder were reviewed. All the pts. received TUR +BCG. In 47/90 pts the mean age was 82 yrs (Group 1 O). 34/47 (72.3%) pts had multiple or recurrent TCC. Stage and Grade: TaLG(G1) = 11/47 (23.4%), TaLG(G2) = 9/47 (19.1%), T1G2 = 14/47 (29.8%). 10/47 pts were T1HG(G3)(21.3%). 3/47 had T1HG(G3)+ CIS (6.4%). 22/47 pts (46.8%) had BCG once a week x 6 weeks. 24/47 pts (51.1%) received maintenance therapy (1-3 yrs). 1(2.1%) had only 2 BCGs because of severe SE. In 43/90 pts the mean age was 62.5 yrs (Group 2 Y). 39/43 (91%) had multiple or recurrent TCC. Stage and Grade: TaG1=1/43 (2.3%), TaG2=5/43 (11.6%), T1G2=17/43 (39.5%),T1G3=17/43 (39.5%), 3/43(6.9%) had T1G3+CIS. They received BCG TICE 1 x 6 with maintenance 1/3 years according to EORTC protocols. Side Effects (SE):Pts.were divided into 3 groups: a. No or mild SE. b. Moderate SE with delay of instillations +/- anti-TB therapy. c. Severe SE requiring suspension of BCG and antiTB therapy. Results. In Group 1 O mean follow-up was 54 months. 39/47 pts recurred (83%): 10/47 after 3 months (21.3%), 29/47 (62.7%) in a mean time of 11.2 months. 8/47 had no recurrence (17%). 8/47 pts (17%) died: 4(8.5%) of BC after PR and 4 for other causes. 4/39 pts.(10.2%) received cystectomy. OS was 83% (39/47) DSS = 91% (43/47). Side Effects: 30/47 pts (63.8%) had NO or mild SE. 10/47 pts (21.2%) had moderate SE with delay of instillations+ INH (4). 7/47 pts(15%) had severe SE and stopped BCG: they received complete antiTB therapy. In Group 2 Y mean FU was 49.2 months. Recurrence was 25% while PR was 7.5%. OS was 87.5%; DSS= 95%. Side effects= 80% mild; 10% moderate and 10%severe (stop BCG). Conclusion. BCG in octogenarians resulted less effective than in younger patients (RR: 83% vs 25%). Progression was 8.5% vs 7.5%. OS: 83% vs 87.5% DSS: 91% vs 95% Side effects: In Group 1 O 36% of pts. had important SE causing the delay (21%) or stop (15%) of BCG. In Group 2 Y side effects were detected in only 20% of patients with 8 % of them stopping BCG treatment. Lo studio ha avuto finanziamenti: No

C_29 OUTPATIENT ENDOSCOPIC TREATMENT OF SOLITARY LOW-RISK TA-T1 BLADDER TUMOURS < 1 CM UNDER LOCAL ANESTHESIA: COST-EFFECTIVENESS

Brausi M, GhIdini N, Piazza R, Gatti L, Ferrari G.

Depts. of Urology Estense-S.Agostino and Hesperia Hospital, Modena.

Introduction. Fulguration (DTC) of small recurrent TaT1 baldder tumors in an outpatient setting is advocated by many authors. It is relatively inexpensive, rapid, of little disconfort for the patient. However DTC

Archivio Italiano di Urologia e Andrologia 2019; 91, 1, Supplemento 1

makes hystological study impossible and therefore its use in primary tumours is not suggested. The use of cold cup biopsy allows the complete tumor removal with a sample of DM. Objectives. To evaluate the feasibility of complete removal of small single bladder tumors (primary and recurrent) with a correct histopathological staging, the recurrence (RR) and progression (PR) rate, the tolerability of the procedure under local anesthesia and its cost effectiveness. Material and Methods. 105 patients with single primary or recurrent Ta-T1 bladder tumors <1 cm were treated by urethro-cystoscopy and tumor removal in an outpatient setting. 72/105 patients were male and 33 females. Mean age: 63.6 years. 35/105 patients had primary while 70/105 had recurrent tumors. Treatment: 83/105 patients (80%) received urethrocystoscopy with tumor removal by cold forceps biopsy, deep biopsy of tumor bed and DTC of peritumoral area and tumor base. 22/105 (20%) patients were treated by DTC (18) or Laser (4). Urethral jelly with Lidocaine was the only anesthesia use in all patients. Tumor diameter varied from 3 to 10 mm. 12 primary tumors were 10 mm in diameter. Staging and grading: 33/35 primary were TaG1-2, 2/35 T1G3. 41/70 recurrent were TaG1-2, 6 were T1G2 and 1 had an univerted papilloma of the bladder neck. 10/83 patients received adjuvant chemo-immunotherapy after tumor removal. RESULTS: Hystology revealed DM in the specimen of 58/83 patients(70%). 33/35 primary tumors had DM in their specimens (94.3%). The median F-up was 48 months. RR was 27%. 2/105 patients (8%) progress to > T1 and had cystectomy. Pain was analised using the analogic visual scale. The procedure was well tolerated by patients exept for 1 case who required spinal anesthesia. Mild disuria was registered in approximately 25% of the pats while 5/105 had subsequent gross hematuria requiring rehospitalization (4.7%). Costs: The cost of the outpatient procedure was compared with the cost of the same procedure done in hospitals. Outpatient biopsy and/or DTC: 130 Euro. Hospital procedure: 1548 Euro. Money gain of each procedure was: 1.218.00 Euro. Conclusion. Outpatients endoscopic treatment of single small superficial Ta- T1 BT in local anesthesia is feasible, well tolerated and safe. In primary Ts a correct pathological staging can be obtained in 94% of cases. The 4-year recurrence rate was 27%. It is cost-effective. Conflitto dâ&#x20AC;&#x2122;interessi: No

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C_30 PATHOLOGICAL LYMPH NODES EXAMINATION USING FROZEN SECTION (FS) DURING RADICAL CYSTECTOMY (RC) IS USEFUL TO SELECT PATIENTS WHO NEED EXTENDED LYMPH NODE DISSECTION (ELAD)

Brausi M1, Botticelli L2, Peracchia GC3, Ferrari R1, Vitelli D1. 1

Department of Urology Hesperia Hospital Modena; Department of Pathology University of Modena and Reggio E; 3 Department of Urology Ausl Modena. 2

Introduction and Objectives. The value of extemporary pathological examination of lymph nodes during RC using FS has been debated and is still controversial. In the majority of tertiary centers an extended or super-extended lymphadenectomy (E-SE-LAD) without intra-op evaluation of the nodes is performed. However this approach has drawbacks: 1. longer time of surgery 2. possible higher complication rate 3. intraperitoneal approach (a must). To prevent this an intraop path evaluation of the nodes removed can help in reducing the extent and time of surgery and complications. The objective of the study was of evaluate the path diagnosis on FS of lymph nodes during RC and to compare it to the final path report. Finally the impact of FS results on the extent of surgery was analized. Materials and Methods. The last 134 patients (20122018) who received RC with ELAD for TCC of the bladder at our center were included. Obturator, internal, external, common, pre-sacral and perivesical nodes were removed bilaterally before RC and sent immediately for FS. When 1 pos. node was detected LAD was extended to the aortic bifurcation bilaterally. If none or more than 1 node was pos. at FS LAD was stopped. 78 patients with MIBC requiring RC were recruited. Mean age was 63.5 year (58-78). Male/female ratio was: 54/24. 156 LADs were performed and nodes sent in separate containers (pelvic:obturator + internal, external, common iliac, pre-sacral,peri-vesical) for FS during RC. Pathological preparation: An established path protocol for extemporary diagnosis was followed in all cases. It consisted of different passages: 1. freezing (cryostat), 2. first staining (hematossilin-Eosin), 3. cutting (5 nm thickness sections), 4. quick re-staining with hematossilin-Eosin, 5. reading. Results. The median N of nodes sent for FS was 18 from each side (36 in total). 14/78 pts (19%) had pos. nodes at FS and all were confirmed at the final path evaluation. 3/14 pts. had only one pos. node (2 R, 1 L) and LAD was extended to the aortic bifurcation. The final path report confirmed the FS report and no further pos.nodes were detected. In one case (1/156LADs) a node was suspicious at FS and pos. at the final path

report: patient received ELAD. 10/14 pts. had more than one pos node: LAD was not extended further. The concordance between FS and final path report was 99.3% (151/156 LADs). In 2 patients the N of pos nodes at the final path examination was greater than the one found on FS (+5 and +2). In both cases surgery was not changed. Conclusions. A high concordance between intra-op FS diagnosis of lymph nodes and final path report was observed (99.3%). In 4% of patients (3/74) the surgical procedure was changed (ELND) due to the FS results. In 96% of our pts. an extended surgery was not necessary. FS resulted a valuable method for the detection of pos. nodes during RC. A well defined and strict path protocol and path/uro cooperation is the key. Conflitto d’interessi: No

C_31 NERVE SPARING EXTRAPERITONEAL ROBOT-ASSISTED RADICAL PROSTATECTOMY: FUNCTIONAL OUTCOME IN A HIGH-VOLUME SURGICAL CENTER EXPERIENCE

Scarcia M, Zazzara M, Divenuto L, Cardo G, Portoghese F, Romano M, Ludovico GM. Urology Department, Ospedale Generale Regionale “F. Miulli,” Acquaviva delle Fonti, Province of Bari, Italy.

Background. Although the transperitoneal route remains the most widely accepted approach for RARP and is associated with minimal perioperative morbidity, risks associated with penetration of the peritoneal cavity have spurred the development of feasible extraperitoneal approaches at some surgical centers We report our experience with the safety and effectiveness of robotic radical prostatectomy with an extraperitoneal approach (eRARP) in patients with prostate cancer; this study reports the largest series of extraperitoneal RARP in a minimal invasive experienced center. Materials and Methods. We performed a descriptive analysis of patients with prostate cancer who underwent eRARP at our department between April 2009 and March 2016. Nerve-sparing techniques were applied in accordance with Tewari classifications. Results. Of 1354 patients, 27.7% had low-risk prostate cancer, 61.0% had intermediate-risk prostate cancer, and 11.3% had high-risk prostate cancer as per the D’Amico classification. With regard to NSGS, 15.36% of cases were NSGS2 (bilateral intrafascial nerve-sparing); 35.75% were NSGS3–4 (at least monolateral intrafascial nerve-sparing or bilateral interfascial nerve-sparing grade 2); 34.05% were NSGS5–6 (bilateral interfascial nerve-sparing grade 2–3); and 14.84% were NSGS7–8 (monolateral interfascial nerve-sparing or no nerve sparing). Patients classified as NSGS2 showed the earliest recovery of continence and erectile potency; 81.2% were continent at 1 month and 65% reported erectile potency at 3 months post-operation. Conclusion. eRARP demonstrated high reproducibility Archivio Italiano di Urologia e Andrologia 2019; 91, 1, Supplemento 1

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and positive outcomes, especially for bilateral intrafascial nerve-sparing procedures. Lo studio ha avuto finanziamenti: No Conflitto d’interessi: No

C_32 INTRAVESICAL TREATMENT WITH ELECTROMEDIATED ADMINISTRATION OF MYTOMICIN C FOR INTERMEDIATE AND HIGH-RISK NONMUSCLE-INVASIVE BLADDER CANCER: A HIGHVOLUME SURGICAL CENTER EXPERIENCE Zazzara M, Cotrufo S, Rizzo P, Scarcia M, Maselli FP, Cardo G, Ludovico GM. Urology Department, Ospedale Generale Regionale “F. Miulli,” Acquaviva delle Fonti, Province of Bari, Italy.

Background. The topical therapy of non-muscle-invasive bladder cancer (NMIBC) is based on immunotherapy with Bacillus Calmette-Guerin (BCG) and chemotherapy with drugs administered through passive instillation into the bladder. An active drug administration has been shown to achieve a better concentration of the drugs inside the bladder. The aim of this study was to investigate the effectiveness of Electromotive Drug Administration (EMDA) of mitomycin C (EMDA/MMC) in intermediate and high risk NMIBC patients 3 months after the end of induction treatment. Material and Methods. 80 patients diagnosed with histologically confirmed NMIBC, with a complete transurethral resection of all visible tumors, and either treatment naïve or not responding to BCG treatment underwent EMDA/MMC. Primary endpoint was the proportion of responders after induction treatment and at 3 months after the end of induction treatment. Cystoscopy and histology had to be negative at to qualify for a positive response. Results. Data on follow up were available for 62 subjects at the end of induction treatment and for 48 patients at 3 months after the end of induction treatment. EMDA was effective in low, intermediate and high risk patients: because of the small number of cases, however, no conclusions can be drawn about the efficacy in the low risk group. No difference in the response to treatment between intermediate and high risk patients could be seen. The response after induction treatment and at 3 months after the end of induction treatment was 91.93% and 85.4%, respectively. Conclusion. EMDA/MMC is a useful technique for an effective and safe treatment of primary and recurrent NMIBC, and it is an effective therapeutic option in intermediate and high risk NMIBC patients. Lo studio ha avuto finanziamenti: No Conflitto d’interessi: No

Archivio Italiano di Urologia e Andrologia 2019; 91, 1, Supplemento 1

C_33 THE VARIATION OF SELECTIVE UNGAL LEVELS AFTER ROBOT-ASSISTED PARTIAL NEPHRECTOMY: EARLY RESULTS OF A PROSPECTIVE SINGLE CENTER STUDY

Colamonico O1, Cardo G1, Ceci E2, Scarcia M1, Zazzara M1, Dassira M3, Porreca A4, Ludovico GM1. 1

Urology Department, Ospedale Generale “F. Miulli”, Acquaviva delle Fonti, Province of Bari, Italy; 2 Specialistic

Clinical Biochemistry Department, Ospedale Generale “F. Miulli”, Acquaviva delle Fonti, Province of Bari, Italy; 3

Nuclear Medicine Department, Ospedale Generale “F. Miulli”, Acquaviva delle Fonti, Province of Bari, Italy;

4 Urology Department, Policlinico Abano Terme, Province of Padova, Italy.

Objectives. Acute kidney injury (AKI) secondary to nephron-sparing surgery represents a significant problem in order to preserve renal function. Since serum creatinine alone underestimates the early detection of AKI several biomarker have been investigated. Neutrophil Gelatinase-Associated Lipocalin (NGAL) is considered a good biomarker for AKI. Material and Methods. We report our experience in 28 patients affected by localized renal cell carcinoma and submitted to robot-assisted partial nephrectomy (RAPN). In each patient selective urinary NGAL levels were dosed before surgery, then 2 and 48 hours after the procedure, through a ureteral catheter inserted into the excretory axis of the operated kidney. Moreover we evaluated the split renal function of the preserved renal parenchyma by a 99mTC-DTPA renal scintigraphy, performed before surgery and three months later. Results. AKI was diagnosed, according to internationally criteria, in 3 patients (10,7 %). The baseline selective urinary NGAL level was 20,02 ng/ml. This level significantly increased after surgery with a selective urinary NGAL level that reached 56,36 ng/ml (p<0,0001). Moreover a significant reduction in 99mTC-DTPA clereance of the operated kidneys after three months was detected (p<0,0001). Conclusion. Selective urinary NGAL assay represent a sensitive biomarker of acute kidney injury after robotic nephron sparing urgery, capable of predicting the functional outcome of the operated kidney. Lo studio ha avuto finanziamenti: No Conflitto d’interessi: No

C_34 A COMPARISON BETWEEN TRANS-RECTAL ULTRASOUND-GUIDED MRI-FUSION VERSUS MRI-COGNITIVE VERSUS STANDARD PROSTATE BIOPSIES PERFORMED AT THE SAME TIME, IN THE SAME PATIENT: CONCORDANCE RATE AND CLINICALLY SIGNIFICANT PROSTATE CANCER DETECTION

Mistretta FA1, Conti A1, Musi G1, Cordima G1, Brescia A1,

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Alessi S2, Costa B1, Piacentini N1, Catellani M1, Pricolo P2, Luzzago S1, Cozzi G1, Bianchi R1, Petralia G2, De Cobelli O1. 1

Department of Urology, European Institute of Oncology, Milan, Italy;

2 Department of Radiology, European Institute of Oncology, Milan, Italy.

Introduction. To test the efficacy of three different prostate biopsy strategies, namely MRI-fusion vs. MRI-cognitive vs. standard, contextually performed in the same patient. Material. Between December 2017 and September 2018, 153 patients underwent a combined trans-rectal ultrasound-guided prostate biopsy composed of 3-5 MRI-fusion core samples, 3-5 MRI-cognitive core samples and 12 standard core samples. The number of MRI-targeted (fusion or cognitive) core samples varied according to tumour volume. Primary outcomes investigated were: concordance rate of prostate cancer (PCa) detection between the three strategies and rate of diagnosis of clinically significant PCa (defined as Gleason Score [GS] ≥ 7). Complete concordance between the three strategies was defined as: PCa simultaneously diagnosed with all the three-biopsy strategies or PCa not detected in any strategy. Multivariable logistic regression models (MLRMs) were used to identify preoperative predictors of complete concordance. In MLRMs, covariates consisted of: age, PSA, PI-RADS score (version 2), prostate volume, surgeon expertise. Results. Of all 153 patients, PCa was diagnosed in 87 (56.9%) MRI-fusion, 77 (50.3%) MRI-cognitive and 74 (48.3%) standard biopsies. In 104 (68%) patients, PCa was diagnosed in at least one biopsy strategy (MRIfusion and/or MRI-cognitive and/or standard). In 28 (18.3%) patients, PCa was simultaneously diagnosed in two different biopsy strategies. Complete concordance between the three-biopsy strategies was achieve in 102 (66.7%) patients, 53 (34.6%) simultaneously diagnosed for PCa in all the three strategies, 49 (32.0%) not diagnosed for PCa in any strategy. No predictors of complete concordance were identified in MLRMs. When only MRI-fusion and standard biopsy strategies were compared, a complete concordance was identified in 116 (75.8%) patients. In MLRMs predicting complete concordance between MRI-fusion and standard biopsy, PI-RADS 4 was an independent predictor of lower rate of complete concordance (OR: 0.3; CI: 0.1-0.9; p = 0.04). Of all 104 PCa-diagnosed patients, clinically significant PCa was detected in 61 MRI-fusion (58.7%; 71% out of 87 PCa positive MRIfusion biopsies), 55 MRI-cognitive (52.9%; 78% out of 77 PCa positive MRI-cognitive biopsies) and 52 standard biopsies (50.0%; 70% out of 74 PCa positive standard biopsies). Of all 153 patients, 15 (11%) were treated with radical prostatectomy (RP). In all of them clinically significant PCa was diagnosed at final pathology. Of these 15 patients, MRI-fusion failed to detect PCa in 1 (6.7%), MRI-cognitive in 4 (26.7%) and standard biopsy in 3 (20%). Conclusion. Low rate of complete concordance (66.7%) was described between the three-biopsy strategies. Higher rates of PCa detection and clinically significant

PCa were recorded in MRI-fusion patients. In patients with clinical significant PCa at final pathology after RP, MRI-fusion biopsy had higher rate of PCa detection. Lo studio ha avuto finanziamenti: No Conflitto d’interessi: No

C_35 A COMPREHENSIVE EVALUATION OF SEXUAL DISORDERS FOLLOWING ROBOT-ASSISTED RETROPERITONEAL LYMPH NODE DISSECTION FOR NONSEMINOMATOUS GERM CELL TUMOUR

Mistretta FA, Musi G, Conti A, Piacentini N, Luzzago S, Cozzi G, Bianchi R, Cordima G, Brescia A, Ferro M, De Cobelli O.

Department of Urology, Istituto Europeo di Oncologia, Milan, Italy.

Introduction. Sexual disorders following retroperitoneal pelvic lymph node dissection (RPLND) can affect the quality of life of patients with non-seminomatous germ cell tumour (NSGCT) of testis. The aim of the current study was to investigate several of the possible andrological aspects, which may be influenced by robot-assisted (RA) RPLND. Material and Methods. Between January 2012 and April 2018, 27 patients underwent RA-RPLND for stage I NSGCT or post-chemotherapy (PC) residual mass respectively. In all patients, modified unilateral RPLND template was used. A nerve-sparing procedure was always attempted. Major variable of interest was the occurrence of erectile dysfunction (ED), premature ejaculation (PE), dry ejaculation (DE), or orgasm alteration. Preoperatively, body mass index (BMI), scholar status, presence and type of preoperative sexual dysfunction (ED, PE, dimorphism, orgasmic alteration), and risk factors for sexual disorder (smoking status, alcohol intake, diabetes/metabolic syndrome, neuroleptic/antiepileptic drugs) were investigated. The abridged 5-item version of the International Index of Erectile Function (IIEF-5) was administered pre- and postoperatively. The pre-orchiectomy and post-RARPLND sperm count analyses, if performed, were retrieved. All patients were asked to evaluate whether their postoperative experiences in sexual desire, orgasmic functioning and sexual satisfaction were ‘better, same or worse’ respect to before RA-RPLND. Lastly, research and eventual obtainment of children was investigated, as well as the fecundation process (sexual intercourse or medically assisted procreation [MAP]). Results. Of all 27 patients, 9 (33.3%) presented an andrological disorder of any type after RA-RPLND. The median number of LN removed was similar for both patients who experienced postoperative sexual dysfunctions and who did not (17 vs. 16.5). Hypoposya was present in 4 (14.8%) patients, DE (IIEF-5 < 25) in 2 (7.4%) and ED in 3 (11.1%). No PE or orgasmic alterations were described. Similar median age at surgery (29 vs. 31 years) and BMI (23.8 vs. 24.6) were reported for both subgroups. Of all 9 patients presenting postoperative andrological disorders, no one preArchivio Italiano di Urologia e Andrologia 2019; 91, 1, Supplemento 1

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sented any preoperative risk factor for sexual dysfunction or altered preoperative spermiogram. Of all these 9 patients, 77.8% was treated at the beginning of our robotic experience (2012-2015). Of all 27 patients, 5 (18.5%) attempted to have a child after RA-RPLND. All of these 5 patients were successfully fathered children. Of all 5 patients, 2 (40%) required a MAP. Conclusion. A not negligible number of andrological complications occurred after RA-RPLND, mainly rep¬resented by ejaculation disorders, but ED occurrence and overall sexual satisfaction deficit should be definitely considered. No negative impact on fertility was described after RA-RPLND in patients with NSGCT. Lo studio ha avuto finanziamenti: No Conflitto d’interessi: No

C_36 PERCUTANEOUS IMAGE-GUIDED RADIOFREQUENCY ABLATION FOR CT1A-B RENAL MASSES: A COMPARISON BETWEEN PATIENTS YOUNGER VS. OLDER THAN 65 YEARS

Mistretta FA1, Mauri G2, Piacentini N1, Varano G2, Conti A1, Bonomo G2, Luzzago S1, Della Vigna P2, Catellani M1, Di Trapani E1, Ferro M1, Musi G1, Renne G3, Orsi F2, De Cobelli O1. 1

Department Of Urology, European Institute of Oncology, Milano; Of Interventional Radiology, European Institute of Oncology, Milano; 3Department Of Pathology, European Institute of Oncology, Milano. 2Department

Introduction. To compare the safety and efficacy of percutaneous image-guided radiofrequency ablation (RFA) for cT1a-b renal masses between patients younger vs. older than 65 years. Materials. From January 2008 to June 2015 a total of 152 consecutive patients underwent an image-guided percutaneous RFA. Primary outcomes investigated were technical success, complications, retreatment rate, cancer specific (CSM) and other cause mortality (OCM). Kaplan-Meier plots graphically depicted the recurrence free (RFS) rates. Univariable (ULRM) and multivariable (MLRM) logistic regression models were used to identify predictors of persistency/recurrence of the disease. Results. Of all 152 patients, 66 (43%) and 86 (57%) were respectively younger and older than 65 years. The overall median follow-up was 40 (IQR 28-49) months. Median tumour diameter was higher in older patients (27 vs. 22 mm; p = 0.01), relative to younger. No significant differences were identified in median number of masses treated per procedure, T-stage, gender, side of lesion, endophytic vs. exophytic nature and Padua score, between the tow age groups. Of all 152 patients, 63 (41.4%) younger vs. 74 (48.7%) older than 65 years (p = 0.06) were disease free after RFA. In 1 (0.7%) younger vs. 10 (6.7%) older than 65 years a persistence of disease was identified (p = 0.06). All of them received secondary RFAs. Two (1.3%) younger vs. 2 (1.3%) older than 65 years underwent multiple

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RFAs due to multiple synchronous renal masses. No persistence was described at last control in all of these 15 retreated patients. Eight (5.3%) younger vs. 9 (5.9%) older than 65 years experienced a recurrence (p = 0.9). In Kaplan-Meier analyses, the 3-year RFS rate was 90.9% in younger vs. 94.2% in older than 65 years, but failed to reach statistical significance (log rank = 0.7). Of these 17 patients, 4 (23.5%) experienced a distant (adrenal glands or contralateral kidney) recurrence, 1 (25%) younger vs. 3 (75%) older than 65 years. In all these patients, the oncologic control was achieved after a second RFA. No progression or cancer related deaths were identified. One (0.7%) younger vs. 3 (2.1%) older than 65 years died due to other causes (p = 0.8). Of all 152 patients, according to Society of Interventional Radiology complication scale, 7 (4.6%) experienced a grade A, 6 (3.9%) a grade C and 2 (1.3%) a grade D complication. No statistical difference was identified between the two age groups (p = 0.9). In MLRM, tumour size > 2.5 cm resulted the only predictor of persistence/recurrence (OR 1.05; CI: 1.0081.099; p = 0.02), while age younger vs. older than 65 years failed to predict this outcome. Conclusion. Imaging-guided percutaneous RFA resulted oncologically safe, with a low complication rate, in both patients younger or older than 65 years old. Tumour size > 2.5 cm resulted the only predictor of persistency/recurrence of disease, while age younger vs. older than 65 years failed to predict this outcome. Lo studio ha avuto finanziamenti: No Conflitto d’interessi: No

C_37 ORTHOTOPIC ILEAL NEOBLADDER “SEMINAL SPARING”

Casilio M, Pisanti F, Stefanucci M, Schettini M. Nuova Villa Claudia – Roma.

Introduction. Radical cystectomy is the gold standard in infiltrating bladder tumors or in high risk superficial bladder tumors. In these cases, when possible, we prefer to perform an orthotopic bladder reconstruction. Looking for a less demolitive surgery, most conservative when possible, we evaluated the possibility of preservation of erectile and ejaculatory function in young male patients and older sexually active at the time of diagnosis. To achieve this goal it is necessary to save not only the neurovascular bandles but all deferentovesicular structure (1). Material and Methods. From 2000 to 2011 we perform 12 radical cystectomy with reconstruction of orthotopic ileal neobladder seminal sparing type (2). The older patient was 55 years old and sexually active. The preoperative staging was performed by endoscopic resection of bladder, abdomino-pelvic TAC and total body bone scintigraphy. Histology of the resected lesions was in 8 cases an urothelial carcinoma of the bladder G3T1 relapsed, in three cases G3T2, in one case a leiomyosarcoma. Results. The average age was 47 years (39-55). The

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average operating time was 230 minutes. 7 patients needed blood trasfusion to treat post surgical anemia. Pelvic lymphadenectomy did not show the presence of pathological lymph nodes, except in the case of leiomyosarcoma, where were positive bilateral external iliac lymphnodes. Histological examination of the prostate has confirmed. The presence of benign hyperplasia in all cases. The mean follow up was 17.5 months (6-48). All patients were completely continent during the day at 6 months follow-up with night-time dribbling, hourly urination and evening water restriction. The resumption of sexual activity was possible in all and defined satisfactory in 4 (75%). 1 patient (25%) required oral therapy with sildenafil 100 mg on demand. 2 patients (25%) retained partial anterograde ejaculation. Discussion. Radical pelvic surgery with orthotopic reconstruction of urinary tracts always involve the functional problems of continence and sexual function. Our seminal sparing cystectomy technique contemplates contemporary adenomectomy and it seems to be the gold standard in a single surgical time with good saving and excellent disobstruction (6). Some considerations can be performed to sexual function: the sparing of the nerves and all the seminal system ensures these patients a sensational recovery of the erectile function that occurs very quickly (2-5, 7). In our experience in one case it was necessary to use sildenafil, but it was the oldest patient in the series. The spare of deferents, seminal vesicles and prostate capsule ensure the permanence of ejaculation, however, which is retrograde due to the demolition of the proximal urethral sphincter. Conclusion. In selected cases, the ortothopic reconstruction of ileal neobladder with “seminal sparing” can be an excellent technique for reconstruction and saving of sexual functions. The savings of deferents and the whole prostate block allows complete preservation of erectile function and partly of ejaculatory function. References. 1. Walsh PC, Donker PJ. Impotence following radical prostatectomy: insight into etiology and prevention. J. Urol. 1982; 128:492. 2. Muto G, Bardari F, D’Urso L, Giona C. Seminal sparing cystectomy and ileocapsuloplasty: long term followup results. J. Urol. 2004; 172:76-80. 3. Colombo R, Bertini R, Salonia A, et al. Overall clinical outcomes after nerve and seminal sparing radical cystectomy for the treatment of organ confined bladder cancer. J. Urol. 2004; 171:1819-1822. 4. Vallancien G, Abbou El Fettouh H, Cathelineau X, et al. Cystectomy with prostate sparing for bladder cancer in 100 patients: 10 years experience. J. Urol. 2002; 168:2413. 5. Meinhardt W, Horemblas S. Sexuality preserving cystectomy and neobladder (SPCN): functional results of a neobladder anastomosed to the prostate. Eur. Urol. 2003; 43:646. 6. Muto G. Prostate-sparing cystectomy : two sides of the moon. Eur. Urol. 2008; 53:237-239. 7. Nieuwenhuijzen JA, Meinhardt W, Horemblas S. Clinical outcomes after sexuality preserving cystectomy and neobladder (prostate sparing cystectomy) in 44 patients. J. Uol. 2005; 173:1314-1317.

C_38 RANDOMIZED CONTROLLED STUDY ASSESSING THE EFFECT OF THE AIRSEAL SYSTEM DURING ROBOTIC ASSISTED RADICAL CYSTECTOMY WITH INTRACORPOREAL ILEAL CONDUIT

Pomara G, Di Vico T, Tesi L, Durante J, Bracchitta D, Meneghetti I, Santarsieri M, Francesca F. Urology Unit, AOUP, Pisa, Italy.

Introduction. Robotic assisted radical cystectomy is one of the most complex operation in urological surgery with often long operation times and hospitalization times. Peer-reviewed studies and meta-analyses conclude that Low Pressure Laparoscopy offers significant clinical benefits. Moreover loss of the pneumoperitoneum stability, reducing the peritoneum space, can increase blood loss further prolonging the operating times. Airseal system represents a new generation of valve less and barrier-free surgical trocar able to mantain stable pneumoperitoneum with continuos smoke evacuation and CO2 recirculation during surgery. The aim of the study was to assess the effect of the Airseal system during robotic assisted radical cystectomy with intracorporeal ileal conduit. Methods. This was a single center randomized study comparing robotic assisted radical cystectomy, with extended pelvic lymph node dissection and intracorporeal ileal conduit diversion, with Airseal system versus standard CO2 insuflator. Forty five consecutive patients in the period from the Januombosisary 2017 and the October 2018 were included. After simple randomization, 23 were operated with Airseal and 22 with standard device. The primary end-points was console operative time, secondary endpoints were: CO2 pressure,blood loss, time to intestinal canalization and hospital lenght of stay. We also evaluated the early complications after discharge (3 months period). Results. The median operation time for the Airseal group was 218 min (range 200-265) and for the non Airseal group was 268 min (range 225-305) (p<0.05). Median CO2 pressure was 10 mmHg (range 8-12) for the Airseal group, 14 mmHg (12-15) for the non Airseal group (p<0.05). Median Blood loss was 100 cc (range 50-200) for the Airseal group, 200 cc (50-300) for the non Airseal group (p-ns). Median Time to intestinal canalization was 18 h (range 12-30 h) for the Airseal group, 30h (10-52 h) for the non Airseal group (p<0.05.). Median Hospital lenght of stay was 6 days h (range 48) for the Airseal group, 7 days (range 4-9) for the non Airseal group (p-ns). In 3 months after discharge 3 patient needed a new hospitalization for symptomatic lymphocele (2 in the Airseal group and 1 in the nonAirseal group) and 1 patient for deep vein thrombosis (in the Airseal group). Conclusion. AirSeal System’s ability to maintain stable Archivio Italiano di Urologia e Andrologia 2019; 91, 1, Supplemento 1

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pneumoperitoneum and constantly evacuate smoke enables to operate at lower pressures without compromising exposure. The results of our study demonstrated that AirSeal System, during totally robotic assisted radical cystectomy with intracorporeal ileal conduit, facilitates Low Impact Laparoscopy with clinical benefits for the patients. The post discharge complications seem to be due more to the comorbidity of the patient than to the use of AirSeal system. Lo studio ha avuto finanziamenti: No Conflitto d’interessi: No

P_02 CISTECTOMIA RADICALE LAPAROSCOPICA CON DERIVAZIONE URINARIA: RISULTATI E COMPLICANZE DI 45 CASI

Bada M, Zeccolini G, De Concilio B, Mazzon G, Caruso A, Silvestre P, Celia A.

Azienda ULSS 7 Pedemontana, UOC Urologia- Ospedale S. Bassiano (Bassano del Grappa).

Obiettivi. La cistectomia radicale laparoscopica con derivazione urinaria intra o extracorporea è un intervento tecnicamente impegnativo anche per gli urologi con una lunga esperienza in laparoscopia. Lo scopo del nostro studio è quello di descrivere la nostra esperienza riportando i nostri risultati in termini di outcomes oncologici e funzionali e le nostre complicanze secondo la classificazione di Clavien-Dindo. Metodi. Da marzo 2015 a gennaio 2017, 45 pazienti (33 uomini e 12 donne) sono stati sottoposti a cistectomia radicale laparoscopica (LRC) con diversione urinaria extracorporea (UD) per carcinoma a cellule transizionali della vescica. Diciassette pazienti hanno ricevuto neovescica ortotopica (10 VIP, 5 Y, 1 Camey II e 1 Reddy), venticinque condotti ileali (Bricker e Wallace) e tre ureterostomie. Risultati. Il tempo operatorio medio è stato di 370 minuti per LRC. Perdita di sangue media e degenza post operatoria ripsettivamente di 407 ml e 10 giorni. L’ASA pre operatorio era di score 3: meno della metà dei pazienti ha avuto complicanze di tipo Clavien I (febbre o dolore). Il tasso di trasfusione è stato del 28,9%, Clavien II. Il 47% dei pazienti ha avuto complicanze di Clavien IIIa (deiscenza della ferita 13,3%, dolore addominale 13,3%, dispnea 11,1%, dolore alla gamba 6,7%, linfocele pelvico 2,2% e 2,2% EGDS a causa dell'ematemesi). Un paziente (2,2%) ha avuto perdite urinarie a causa della rimozione accidentale di uno stent ureterale, gestito chirurgicamente (Clavien IIIb). Il 4,4% ha avuto insufficienza respiratoria, Clavien IVa. Due pazienti (4,4%) presentavano disfunzione multiorgano (Clavien IVb) e un (2,2%) paziente deceduto nel periodo postoperatorio a causa di fistola fecale e setticemia (Clavien V). Tutte le procedure sono state completate per via laparoscopica, solo in un caso è stato necessario convertire con approccio a cielo aperto. L’analisi istopatologica non ha rilevato malattia residua e la diagnosi è stata di carcinoma a cellule transizio-

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nali confinato alla vescica nel 57.6% e malattia localmente avanzata nel 22.1% dei casi. Tutti i pazienti presentavano margini chirurgici negativi. La linfadenectomia estesa è stata positiva in 7 pazienti (media di 18 linfonodi). Conclusioni. La cistectomia radicale laparoscopica è una procedura fattibile, sicura e riproducibile con eccellenti outcomes oncologici e funzionali e basso tasso di complicazioni a lungo termine. Tuttavia è una tecnica impegnativa che va limitato ai centri con una lunga esperienza in laparoscopia. Lo studio ha avuto finanziamenti: No Conflitto d’interessi: No

P_03 PICCOLE MASSE RENALI: ANALISI MONOCENTRICA E RETROSPETTIVA DI 100 BIOPSIE RENALI

Bada M, Zeccolini G, De Concilio B, Mazzon G, Massanova M, Sebben M, Celia A.

Azienda ULSS 7 Pedemontana, UOC Urologia- Ospedale S. Bassiano (Bassano del Grappa).

Obiettivi. L’uso crescente delle tecniche di imaging (ecografia e tomografia computerizzata) negli ultimi anni, ha portato un incremento diagnostico di masse renali incidentali. Gli incidentalomi più frequenti sono piccole masse renali di dimensioni inferiori ai 4 cm (PMR). È cruciale definire la natura istopatologica delle PMR per varie ragioni: nel 30% dei casi sono di natura benigna, quindi non tutte richiedono un intervento chirurgico (il rischio principale è appunto un over-treatment). La biopsia renale percutanea (BRP) svolge un ruolo cardine in questi pazienti: può infatti rivelare la natura istologica della lesione per candidare i pazienti a sorveglianza attiva, prima di un trattamento ablativo, prima di stabilire un corretto management della lesione renale e nel setting di una malattia metastatica. Abbiamo analizzato retrospettivamente la nostra esperienza sulle BRP per dimostrare l’efficacia, la sicurezza della procedura e l’accuratezza diagnostica della biopsia nello stabilire il corretto iter terapeutico nei pazienti affetti da PMR. Metodi. abbiamo analizzato retrospettivamente un totale di 100 BRP (core biopsy e FNA, fine needle aspiration) eseguite nel nostro centro in pazienti affetti da PMR da dicembre 2016 a dicembre 2018. Dal nostro database abbiamo valutato le caratteristiche demografiche e cliniche dei pazienti (età alla diagnosi, sesso e comorbidità), le caratteristiche delle lesioni (dimensione, lateralità, localizzazione, fuhrman) e le caratteristiche procedurali (tipo di anestesia, tipo di tecnica di imaging utilizzata, numero di frustoli bioptizzati, complicanze peri procedurali) e il trattamento successivo alla diagnosi. La BRP è stata eseguita con un ago da 18 Gauge; il numero dei frustoli prelevati per caso erano almeno due di buona qualità. L’istologia tumorale è stata classificata secondo WHO system e categorizzata come lesione maligna o lesione benigna. Il grado Fuhrman è stato assegnato solo per carcinoma a cellule

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renali. Se la biopsia non era in grado di definire la corretta diagnosi istologica, il risultato della biopsia era definita come non diagnostica. Risultati. Le PMR erano prevalentemente in pazienti di sesso maschile (55%), a sinistra (62%) con una dimensione media di 2.2 cm. La diagnosi era TC guidata ed eco guidata rispettivamente nel 55% e 45% dei casi. La prima biopsia era diagnostica nel 94% dei casi (n=94): di questi 60 pazienti erano affetti da lesioni maligne, 28 da lesioni benigne. In 6 pazienti non è stato possibile diagnosticare la natura della PMR (6%). Delle 6 biopsie non diagnostiche, sono state eseguite delle re biopsie risultate diagnostiche nel 4% (n=4) dei casi. Le complicanze peri procedurali sono state del 5% ed in accordo con la classificazione di Clavien, erano tutte di primo grado. L’accuratezza diagnostica della BRP con l’esame istologico definitivo (ottenuto dopo trattamento chirurgico mediante nefrectomia parziale, totale o tumorectomia) era del 94%. All’analisi univariata, l’età, la grandezza della lesione erano le uniche variabili associate con l’outcome della biopsia. Tuttavia all’analisi multivariata, la localizzazione esofitica della lesione (OR: 1.71; 95% CI, 1.71-2.50) e la grandezza iniziale della lesione stessa (OR: 2.91; 95% CI, 1.565.44) erano gli unici fattori associati alla iniziale biopsia diagnostica. Conclusioni. La BRP delle PMR ha una elevata percentuale di accuratezza diagnostica, è una procedura sicura con bassissime complicanze peri procedurali che riduce il numero di pazienti candidati a procedure chirurgiche non necessarie. Lo studio ha avuto finanziamenti: No Conflitto d’interessi: No

P_04 FUNCTIONAL OUTCOMES AND COMPLICATIONS OF ROBOT-ASSISTED RADICAL PROSTATECTOMY IN A HIGH-VOLUME CENTER: LEARNING CURVE IS SAFE FOR PATIENTS

Cozzi G1, Musi G1, Frassoni S2, Bagnardi V2, Ferro M1, Luzzago S1, De Cobelli O3. 1

Istituto Europeo di Oncologia, Milan, Italy; Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Milan, Italy; 3 Istituto Europeo di Oncologia, Milan, Italy. Università degli Studi di Milano, Milan, Italy. 2

Aim. High-volume surgeons reported less perioperative complications and better functional outcomes after robot-assisted radical prostatectomy (RARP). Aim of this study was to show that the learning curve in a high-volume center with an established training program did not affect perioperative complications and functional outcomes at 12 months. Material and Methods. We used the Expanded Prostate Cancer Index Composite (EPIC) questionnaire to investigate urinary continence and sexual function. Perioperative complications were recorded according to the Clavien-Dindo classification. After informed consent,

the first questionnaire has been administered at preadmission. At discharge, patients received other questionnaires to be filled and sent at 45 days and 3, 6, 9 and 12 months postoperatively. Complications were recorded during follow-up. For both baseline urinary continence and sexual function, patients were divided in 4 classes according to their score: 0%-25%, 26%-50%, 51%-75% and 76%100% of the maximal score respectively. Surgeons were divided in three classes: low-volume (<25 RARPs/year); average-volume (25–50 RARPs/ year) and high-volume (>50 RARP/s year). All lowvolume surgeons were experienced bedside assistants and were trained with a step-by-step program. A univariate analysis investigated the association between surgical caseload and functional outcomes or complications. Results. Six surgeons were low-volume, 4 average-volume, and 2 high-volume. They performed 153, 203 and 287 RARPs respectively. At baseline, there were no significant differences between the 3 groups regarding preoperative urinary continence, clinical stage, bioptic GS, initial PSA, ASA score, BMI and CCI. Patients operated by the high-volume surgeons were younger (p=0.011) and had a better baseline sexual function (p=0.046). Mean (standard deviation, SD) urinary continence at 12 months was 77% (26%), 76% (28%) and 85% (23%) for low-, average- and high-volume surgeons respectively. The recovery trajectories of urinary continence after surgery were not statistically significant across surgical caseload groups (p=0.052). Mean (SD) sexual function at 12 months was 31% (28%), 33% (28%) and 44% (31%) for low-, averageand high-volume surgeons respectively. A significant difference was observed comparing high-volume surgeons recovery trajectories with the other groups (p=0.008), while low- and average-volume surgeons obtained comparable results. Seventy-eight patients (12.1%) reported perioperative complications. Thirteen were Clavien-Dindo grade I, 34 were II, 17 were IIIa, 13 were IIIb, and one was IVa. No significant differences were observed between the groups (p=0.16). Conclusion. Learning curve for RARP in a high-volume center with an established training program did not increase complications or post-operative urinary incontinence. Only high-volume surgeons reported significantly better sexual function outcomes, but their patients were younger and with better baseline sexual function. Lo studio ha avuto finanziamenti: No Conflitto d’interessi: No Archivio Italiano di Urologia e Andrologia 2019; 91, 1, Supplemento 1

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P_05 MULTIPARAMETRIC MAGNETIC RESONANCE IMAGING OF THE PROSTATE DURING ACTIVE SURVEILLANCE FOR LOW-RISK PROSTATE CANCER: TIME TO REDUCE THE NUMBER OF FOLLOW-UP BIOPSIES?

Luzzago S1, Catellani M1, Mistretta FA1, Conti A1, Di Trapani E1, Bianchi R1, Cozzi G1, Pricolo P2, Alessi S2, Ferro M1, Cordima G1, Matei D1, Petralia G2, Musi G1, De Cobelli O1. 1

IEO, European Institute of Oncology, Dept of. Urology, Milan, Italy; 2 IEO, European Institute of Oncology, Dept. of Radiology, Milan, Italy.

Introduction. During active surveillance (AS), the possibility to spare follow-up biopsies in the setting of multi-parametric magnetic resonance (mpMRI) nonsuspicious for clinically significant prostate cancer (csPCa) has been proposed. The aim of our study is to evaluate pathological outcomes of men enrolled in an AS program and submitted to repeated mpMRIs during time. Material and Methods. From 2006 to 2018, 455 patients were enrolled in AS. All patients met PRIAS criteria and were scheduled to 1, 3 and 7-year surveillance-biopsies, and repeated 1.5-T mpMRIs. If a suspicious lesion (i.e. PI-RADS≥3) was seen at repeated mpMRI, 2-3 cores from the target area were addictionaly taken with a cognitive approach. Radiological upgrading was defined as a switching from a lower to a higher PI-RADS score at repeated mpMRIs. Imaging upstaging was calculated as significant increase in the maximum diameter of the lesion (i.e.≥2 mm). Pathological progression was defined as GS upgrading at repeated biopsies and/or at radical prostatectomy. Sensitivity, specificity, PPV and NPV were evaluated for radiological upgrading, imaging upstaging, both of them (upgrading + upstaging) and overall radiological progression (upgrading or upstaging). Results. Overall, 177 (40%), 71 (16%), 23 (5%) and 5 (1%) men were submitted to 2, 3, 4 and 5 repeated mpMRIs, respectively. Median time of persistence in AS was 36 (21-60) months. Globally, 89 (50%) and 32 (18%) patients underwent 3 and 4 prostate samplings, respectively. Overall, 2 (1%), 29 (17%), 46 (26%) and 100 (56%) patients has a PI-RADS score 5, 4, 3 and 2 at first mpMRI. During AS, 54 (30%), 58 (32.5%), 35 (20%) and 77 (43.5%) men developed radiological upgrading, upstaging, both of them and overall imaging progression, respectively. After a median time followup of 29 (13.25-50) months, 34 (20%) men were switched to active treatment. Moreover, 21 (62%) patients showed a pathological upgrading. Of the latter, 14 (66.6%), 12 (57%), 11 (52.5%) and 15 (71%) developed radiological upgrading, upstaging, both of them and overall imaging progression, respectively. Overall, radiological upgrading showed a PPV of 26% (14/54) and a NPV of 94% (116/123). PPV and NPV of imaging

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upstaging were 21% (12/58) and 92.5% (110/119), respectively. Moreover, the combination of both upgrading + upstaging showed a PPV of 31.5% (11/35) and a NPV of 93% (132/142). Finally, PPV and NPV of overall radiological progression, were 20% (15/77) and 94% (94/100), respectively. Conclusion. During AS, the possibility to spare repeated biopsies in patients without radiological progression should be taken into account, since only 6-8% of them harbour a csPCa. However, patients showing radiological progression should not be directly switched to active treatment because of the relatively low PPV of repeated mpMRIs. Lo studio ha avuto finanziamenti: No Conflitto d’interessi: No

P_06 PATHOLOGICAL FINDINGS AT RADICAL PROSTATECTOMY OF BIOPSY NAÏVE MEN SUBMITTED TO MRI-TARGETED BIOPSY ALONE WITHOUT STANDARD SYSTEMATIC SAMPLING

Luzzago S1, Catellani M1, Mistretta FA1, Conti A1, Di Trapani E1, Brescia A1, Pricolo P2, Alessi S2, Verweij F1, Ferro M1, Matei D1, Renne G3, Petralia G2, Musi G1, De Cobelli O1. 1

IEO, European Institute of Oncology, Dept. of Urology, Milan, Italy;

2 IEO, European Institute of Oncology, Dept. of Radiology, Milan, Italy; 3 IEO, European Institute of Oncology, Dept. of Pathology, Milan, Italy.

Introduction. Two prospective randomized trials have endorsed the use of mpMRI as a triage test for PCa diagnosis in biopsy-naïve men. Moreover, the PRECISION trial assessed the superiority of targeted biopsy strategy (without standard cores) over systematic sampling for the detection of csPCa. We evaluated pathological findings at prostatectomy (RP) of biopsy naïve men submitted to MRI-Targeted biopsy alone. Material and Methods. We respected ethical guidelines of the Declaration of Helsinki. From 2016 to 2018, 138 biopsy naïve men with PCa suspicion (rising PSA, positive DRE etc.) and a positive mpMRI (PI-RADS≥3) were submitted to in bore MRI-targeted biopsies (2-5 cores per area) of lesions suggestive for PCa, without standard sampling. Overall, 63 patients were then submitted to RP. Logistic regression analyses tested predictors of discordance between bioptic and pathological Grade Group (GG). Cancer location and tumor volume (TV) in the whole specimen were assessed. Finally, we evaluated how many csPCa (GG≥3) were underestimated (not seen at biopsy) and overestimated (not confirmed at RP) by performing only MRI targeted biopsy. Results. Overall, median age, PSA and PSA-D at RP were 63 (57-69), 6.7 (4.8-9.4) and 0.12 (0.09-0.2), respectively. Reported Index-Lesion (IL) PI-RADS score at in-bore biopsy was 3 in 13 (20%), 4 in 35 (55.5%) and 5 in 15 (24.5%) men, respectively. Median number of positive and overall cores performed were 2 (1-4) and 4 (3-5). Globally, 25 (39.5%), 24 (38%), 10 (16%), 3 (4.5%) and 1 (2%) patients had a

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GG 1, 2, 3, 4 and 5 at biopsy, respectively. Median TV at RP was 5.5 (2.6-9) ml. Globally, there was a perfect overlap between IL at mpMRI and tumor location at RP in 54 (86%) cases. In 4 (44.5%) patients, there was a laterality mismatch (i.e. right vs. left), while in 5 (55.5%) men the lesion was on the same lobe but in a different region of the gland (i.e. apex vs. base). Overall, 19 (30%), 16 (25%), 4 (6.5%) and 2 (3%) men had csPCa, ECE, SVI and LNI at RP, respectively. The discordance rate between bioptic and pathological GG was 44% (28/63). Of these patients, 5 (18%) and 23 (82%) had GG downgrading and upgrading, respectively. At logistic regression analysis, only max core length involvement (tumor mm of core with greatest involvement) [OR:1.2; 95%IC: 1.05-1.6] was associated with GG discordance. Finally, 3 (5%) and 7 (11%) csPCa were overestimated and underestimated by performing biopsies only in the target zone. At logistic regression analysis there were no predictors of csPCa under/overestimation. Conclusion. Roughly half of patients submitted to targeted biopsy strategy showed a GG discordance between bioptic and RP specimens. Moreover, 11% of patients are affected by csPCa that is misdiagnosed if standard biopsy cores are avoided. Future studies with larger cohorts of patients are needed to find predictors of csPCa underestimation. Lo studio ha avuto finanziamenti: No Conflitto d’interessi: No

P_07 A NOVEL NOMOGRAM PREDICTING LYMPH NODE INVASION AMONG PATIENTS WITH CLINICALLY LOCALIZED PROSTATE CANCER: THE IMPORTANCE OF EXTRA CAPSULAR EXTENSION AT PREOPERATIVE MAGNETIC RESONANCE IMAGING

Di Trapani E1, Catellani M1, Musi G1, Ferro M1, Bianchi R1, Cozzi G1, Alessi S2, Luzzago S1, Cordima G1, Mistretta FA1, Peveri G3, Conti A1, Matei DV1, Bagnardi V4, Petralia G2, De Cobelli O1.

1 IEO, European Institute of Oncology IRCCS, Dept. of Urology, Milan, Italy; 2 IEO European Institute of Oncology IRCCS, Dept. of Radiology, Milan, Italy; 3 Department of Molecular and Translational Medicine, Università degli Studi di Brescia, Brescia, Italy; 4 Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Milan, Italy.

Introduction and Objectives. Multiparametric magnetic Resonance Imaging (mpMRI) is taking place in the diagnosis of prostate cancer (PCa) patients. The available nomograms developed for the prediction of lymph node invasion (LNI) do not consider the mpMRI parameters (such as extracapsular extension [ECE] and PIRADS score) and/or based on a multi-institutional cohort. The aim of the present study was to develop and internally validate a novel tool that allow the prediction of LNI including mpMRI parameters, relying

on a large cohort of patients who underwent preoperative mpMRI and robot-assisted radical prostatectomy (RARP) with extended pelvic lymph node dissection (ePLND) at a single tertiary care referral Centre. Material and Methods. We identified 742 patients who underwent a preoperative mpMRI of the prostate and subsequent RARP with ePLND at a single high-volume institution between 2011 and 2017. Two multivariable logistic regression models predicting LNI were developed: 1) a base multivariable model using the standard clinical predictors (PSA, ISUP grade at biopsy and percentage of positive cores- PCP), ECE and PI-RADS score (both classified as <3 vs. 4. vs. 5); 2) a simplified model including only ECE score. Multivariable-derived coefficients were used to develop the two nomograms predicting the probability of LNI. The predictive accuracy (PA) of the models were assessed using the receiver operating characteristic-derived area under the curve (AUC). Calibration plots were used for internal validation. Decision curve analyses were used to assess the net benefit. Results. Overall, 149 patients (20%) had LNI at final pathology. The median number of nodes removed was 15. At multivariable analysis, PSA (OR 1.03), ISUP grade at biopsy (OR 1.33) and PCP (OR 1.01), ECE score (OR 2.99) and PIRADS score (OR 1.11) were independent predictors of LNI. The PA of the base and simplified models were both 0.81. The curve depicting the relationship between predicted and observed LNI closely approximates the ideal predictions for both models. Conclusion. We developed and internally validated a novel nomogram including mpMRI data to identify candidates for ePLND. The ECE score is the strongest predictor and PIRADS score do not improve the PA of the model. These findings should be considered to better select candidates to ePLND. External validation of our findings is urgently needed. Lo studio ha avuto finanziamenti: No Conflitto d’interessi: No

P_08 LA BIOPSIA PROSTATICA TRANSPERINEALE TRUSMRI MIRATA “FUSION” ESEGUITA CONTESTUALMENTE A BIOPSIA MRI-COGNITIVA E SISTEMATICA: OUTCOMES DIAGNOSTICI IN CATEGORIE DI OPERATORI CON DIFFERENTE ESPERIENZA Costa BM, Luzzago S, Ferro M, Musi G, De Cobelli O. IEO – Istituto Europeo di Oncologia, Milano.

Scopo. Con l’introduzione della risonanza magnetica multiparametrica della prostata (mpMRI), sono stati sviluppati software in grado di integrare le immagini RM con quelle dell’ecografia transrettale (TRUS) real-time e questo ha reso possibile lo sviluppo della biopsia prostatica Fusion. In questo lavoro vengono valutati i dati relativi alle biopsie prostatiche Fusion eseguite da due gruppi di operatori, suddivisi per livello di esperienza. L’obiettivo è determinare quali parametri possano influenzare l’esito Archivio Italiano di Urologia e Andrologia 2019; 91, 1, Supplemento 1

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della biopsia e confrontare gli outcomes diagnostici tra i due gruppi di operatori (tasso di cancer detection). Materiali e Metodi. Sono stati analizzati retrospettivamente i dati provenienti da 209 pazienti sottoposti a biopsie MRI-Fusion da dicembre 2017 a settembre 2018 presso la divisione di Urologia dell’Istituto Europeo di Oncologia. Tutti i pazienti sono stati sottoposti a biopsia prostatica standard (12 prelievi), cognitive (3 prelievi) e fusion (5 prelievi). I dati sono stati stratificati in due categorie a seconda dell’esperienza dell’operatore: Senior (136 procedure) e Junior (specializzandi, monitorati durante la procedura, 73 procedure). Risultati. La mediana di età dei pazienti è stata di 65 anni (IQR 45-82); i livelli di PSA mediano 6.5 ng/ml (IQR 0.6-48.8); il 20,7% presenta esplorazione digitorettale dubbia. Il volume prostatico mediano è 45 ml (IQR 17.6-140). Il 54,5% dei pazienti era biopsy-naive. Per ogni paziente è stata identificata una lesione target, che ai fini dello studio è viene distinta topograficamente anteriore (49) e posterolaterale (157). La maggior parte delle lesioni erano PI-RADS 3 e 4 (44% e 35%, rispettivamente). Il numero mediano di prelievi per campionamento sessione è stato 26 (range/IQR). Il tasso di detection non è risultato differente nelle due categorie di operatori in assoluto (p 0.468), nè nello specifico stratificando per biopsia Fusion, cognitiva o standard (p 0.485, P 0.320, P 0.879). Non sono state evidenziate differenze statisticamente significative tra i due gruppi per quanto concerne PI-RADS (p 0.390), ISUP grade (p 0.447) e sede della lesione (p 0.067). Dal modello predittivo si evince che nelle biopsie risultate positive sul target non ci sono differenze statisticamente significative tra operatori Senior e Junior per quanto riguarda PSA density, esperienza dell’operatore, numero totale di prelievi alla biopsia e sede della lesione; risultano invece predittori indipendenti di positività alla biopsia prostatica l’età del paziente (p 0.051) e la presenza di una lesione ipoecogena (p 0.040). Il tasso di complicanze totali è stato del 5.7%. Conclusioni. Dalle nostre analisi il livello di esperienza dell’operatore non risulta associato agli outcomes diagnostici della biopsia prostatica; non si sono evidenziate differenze del tasso di detection dei due gruppi in relazione a PSA density, numero e sede dei prelievi positivi, ma risultano predittori statisticamente significativi di positività alla biopsia l’età del paziente e la presenza di una lesione target che risulti ipoecogena alla TRUS. La biopsia Fusion rappresenta inoltre un momento formativo: nel processo di training dello specializzando non solo aiuta a standardizzare la tecnica, ma permette di migliorare le abilità di lettura della mpMRI. Lo studio ha avuto finanziamenti: No Conflitto d’interessi: No

Archivio Italiano di Urologia e Andrologia 2019; 91, 1, Supplemento 1

P_09 ROBOTIC RADICAL CYSTECTOMY WITH EXTRACORPOREAL ILEAL CONDUIT: INITIAL EXPERIENCE IN LOCALLY ADVANCED BLADDER CANCER

Pomara G, Di Vico T, Tesi L, Durante J, Bracchitta D, Meneghetti I, Santarsieri M, Francesca F. Urology Unit, AOUP, Pisa, Italy..

Aim. It’s a well-known fact that Robotic Assisted Radical Cystectomy with intracorporeal diversion is being increasingly performed worldwide. Aim of this study is to evaluate the safety, the outcomes and effectiveness of intra-corporeal robot-assisted radical cystectomy (RARC) with intracorporeal ileal conduit in the treatment of locally advanced bladder cancer. We defined locally advanced bladder cancer as T3a, T3b, T4a, N13 disease stage. Material and Methods. The study is designed as a nonprospective case series of 20 patients with a clinical diagnosis of locally advanced bladder cancer underwent RARC, pelvic lymphadenectomy and creation of an intra-corporeal ileal conduit. Surgical outcomes, pathologic data, and complication rates are reported. Results. 20 patients (17 male, 3 female). The mean patient age was 70.2 years (range 59.1-78.3) and the mean body mass index was 27.15 kg/m2 (range 24.730.9). The mean operative time, estimated blood loss, time to full diet and hospitalization were respectively 290.7 minutes (range 210-395), 250 ml (range 150500), 4 days (range: 3-6) and 8 days(range: 6-9). Pathological stage was pT3a in 4 patients, pT3b in 14 patients and pT4 in 2 patient. Pathological nodal status was positive in 6 patients. No peri-operative complication were reported. Only one patient with pT4aN2 pathological stage reported rectal pain 1 month after surgery. Conclusion. Main limitation of our study is the small sample size and the short oncological follow-up; however, the surgical outcomes are encouraging. RARC in clinical locally advanced bladder cancer seems to be safe. We expect that, with experience, the expense of robotic surgery can be compensated with early deambulation and shorter hospitalization. Lo studio ha avuto finanziamenti: No

PATOLOGIA BENIGNA V_12 LOW ENERGY BIPOLAR PROSTATE ENUCLEATION. AN INNOVATIVE TECHNIQUE TO MINIMALIZE ENERGY SIDE EFFECTS OF ENDOSCOPIC ADENOMA REMOVAL Calarco A. Ospedale Cristo Re, Roma.

Background. The best treatment for benign prostate enlargement (BPH) is represented by adenoma removal. There are many endoscopic techniques that allow us to obtain this result as classic trans urethral resection (TURP) performed with a mono or bipolar electrode,

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than we have laser ablation or enucleation (holmium, green light, thulium). All this techniques are characterized by the use of a big amount of energy especially for the laser techniques. All of them are comparable in terms of improving of Qmax (maximum urinary flow) but they differ in terms of irritative simptoms and side effects (deep heat damage or bladder neck contraction) expecially for green light laser in porcine models were is shown a three time deeper tissue damage (1, 2). Moreover is shown that there is an higher absorption of irrigation fluid during laser vaporization techniques and this should be considered in patients with cardiopulmonary or neurological symptoms (3). The high use of energy keeps harder to define correct planes because of the burned tissue. More energy means more side effects. So the best adenoma removal technique should match two parameters: a complete unblocking and at the same time the use of little energy as possible. Material and Methods. We present our innovative low energy prostate enucleation performed with the use of Storz Hermann handle and the scope's sheath. The combination of these two devices allow us to unstick the adenoma with mechanical movements and let use the bipolar energy only in few spots to release some adhesions. With the use of this technique we follow the anatomical plane of the prostate capsule that became perfectly viewable and unburned. So we have more advantages. We have the opportunity to entirely remove the adenoma from its base reducing the risk of residual adenoma. We reduce the use of bipolar energy to few quick spots. We respect capsule vessels for a better view. The technique is performed from the prostate apex by the mechanical detachment of the lobe to the base. Results. In our experience the technique is safe thanx to the better view of anatomical planes. Bleeding appear to be less compared to standard bipolar TURP thanx to the lack of a real tissue resection and to a better anatomical dissection. Postoperative controls show an important increase in Qmax, a better result in IPSS score. In an hybrid procedure (enucleation for one lobe and TURP for other lobe) postoperative cystoscopy (performed to evaluate the prostatic lodge) shows a better result of an enucleated lobe compared to a controlater TURP lobe. Discussion. We think that thanx to the modified sheath and this innovative low energy method, this technique could be the best alternative to TURP instead of a more invasive and damaging laser technology. Results are encouraging and push us to perform more in this way. Conclusion. In standard enucleation techniques the instrument sheath represent a passive accessory but we believe that with the modified sheath we can convert it in an active part of the instrument giving to this a wider functionality use both to lift the lobe and reduce the energy administration. References. 1. Hu B, Song Z, Liu H, et al. A comparison of incidences of bladder neck contracture of 80- versus 180-W GreenLight laserphotoselective vaporization of benign prostatic hyperplasia. Lasers Med Sci. 2016; 31(8):1573-1581. Epub 2016 Jun 30.

2. Kan CF, Chan AC, Pun CT, et al. Heat Damage Zones Created by Different Energy Sources Used in the Treatment of Benign Prostatic Hyperplasia in a Pig Liver Model. J Endourol. 2015; 29(6):714-7. Epub 2014 Dec 15. 3. Hermanns T, Grossmann NC, Wettstein MS, et al. Absorption of irrigation fluid occurs frequently during high power 532 nm laser vaporization of the prostate. J Urol. 2015; 193(1):211-6. Epub 2014 Aug 7.

Lo studio ha avuto finanziamenti: No Conflitto d’interessi: No

V_13 GREENLEP: ENUCLEAZIONE EN BLOC CON GREEN LIGHT LASER Rabito S, Gatti L, Vitelli D, Nyek N, Piazza R, Ghidini N, Brausi M, Ferrari R, Ferrari G. U.O. Urologia - Hesperia Hospital, Modena.

Scopo. La standardizzazione di una tecnica di enucleazione laser della prostata consente sia l’apprendimento sia il confronto dei risultati. La GreenLEP è un trattamento endoscopico per l’ipertrofia prostatica che consente di trattare ghiandole di volumi elevati con consumi ridotti di energia, rischi di sanguinamento minimi e risultati pari alla adenomectomia in termini di disostruzione cervicouretrale. Materiali e Metodi. Questo video è stato realizzato utilizzando estratti di un filmato realizzato presso il nostro centro durante un intervento di GreenLEP. Generatore Laser AMS XPS, Fibra 2090 (settaggio 120w vaporizzazione e 20w coagulazione), Cistoresettoscopio Wolf, Ottica 30°, Morcellatore Wolf Piranha. Risultati. I punti di riferimento anatomici non differiscono dagli altri approccio endoscopici alla prostata: sfintere uretrale, veru montanum, porizione distale degli apici prostatici. Si inizia con una vaporizzazione aprendo un ampio canale a ore 12, al fine di garantire il libero flusso della soluzione irrigante e delle bolle. Utilizzando l’energia laser si marcano gli limiti dell’adenoma prostatico, approfondendo la cosiddetta linea bianca sino al distacco dell’apice prostatico circonferenzialmente Successivo sviluppo retrogrado di un piano fra l’adenoma e la capsula prostatica partendo dal veru montanum in direzione del collo vescicale, utilizzando in combinazione l’energia laser e l’azione meccanica della punta del cistoscopio. È necessario coagulare i vasi man mano che si procede all’enucleazione. Si procede nel separare l’adenoma dalla capsula prostatica sino ad arrivare alla vescica. Sezione del collo vescicale e completamente con il laser del distacco dell’adenoma/terzo lobo. Completata l’enucleazione l’adenoma prostatico viene spinto in vescica. Accurata emostasi di piccoli vasi della capsula prostatica e del collo. Verifica delle pressione arteriosa del paziente. Al fine di minimizzare il sanguinamento dovuto alla decompressione della vescica durante le manovre di rimozione del cistoresettoscopio, inserimento del nefroscopio e del morcellatore, l’irrigazione viene mantenuta in questa fase e sostenuta aggiungendo una seconda linea di irrigazione. Apposizione di catetere a 3 vie. Conclusioni. La GreenLEP, ormai standardizzata e codiArchivio Italiano di Urologia e Andrologia 2019; 91, 1, Supplemento 1

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ficata, durante le numerose sessioni di training eseguite presso il nostro centro e poi presso i centri discenti, ha dimostrato: 1) di essere una tecnica replicabile, 2) di essere una tecnica adatta a chirurghi familiari con l’utilizzo del Green Light Laser, 3) di poter essere implementata nella pratica clinica riducendo al minimo la curva di apprendimento. Lo studio ha avuto finanziamenti: No Conflitto d’interessi: No

V_14 NEW TECHNOLOGIES FOR OLD PROCEDURES WHEN FIREFLY TECHNOLOGIE IMPROVES ROBOTIC BLADDER DIVERTICULECTOMY F 1,

M 2,

M 3,

Vedovo Sebben Bada Massanova De Concilio B5, Zeccolini G5, Mazzon G5, Celia A5.

M 4,

Università degli Studi di Trieste; Università degli Studi di Verona; 3 Università degli Studi di Chieti; 4 Università degli Studi di Napoli; 5 UOC Urologia, Ospedale San Bassiano, Bassano del Grappa (VI). 2

Aim. Several techniques have been described to aid in the intra-operative identification of the bladder diverticula. The video shows the peculiar advantage of using Firefly Fluorescence Imaging da Vinci System during bladder diverticula detection and dissection. Material and Methods. Patient is placed in the lithotomic position and 30° Trendelenburg. Supraumbilical camera trocar is inserted with the Hasson technique. We use a four-arm robotic approach and a 5 to 6 ports placement consisting of: one 8-mm camera port, three 8mm robotic ports and one to two assistant ports. The robotic ports run parallel at 14 cm from the pubic bone. Pneumoperitoneum is established at 12 Hg mm. The bladder is accessed via a transperitoneal route. We perform a flexible cystoscopy with the Firefly Fluorescence Imaging System on for the diverticulum detection. The peritoneum over the bladder is then incised to expose the diverticulum. We use this near-infrared technology also as a guide in the diverticulum dissection. Using sharp and blunt dissection, the diverticulum is resected to its neck. Completion of diverticulectomy and hydraulic tightness test. Drainage placement in the Retzius space and peritoneum reconstruction. Results. Several approaches have been described for intra-operative diverticulum identification and its dissections: Parra used a cystoscopic transillumination of diverticulum; Das proposed the use of a Foley 50 mL balloon inserted in the diverticulum, while Nadler used a balloon catheter, made from a surgical glove, placed in the diverticulum and bloated with 180 cc saline solution. We present our technique in which transperitoneal bladder diverticulectomy is performed under the Firefly guidance that provide real-time, image-guided identification of key anatomical landmarks. Conclusion. In our experience, intra-operative use of Firefly Fluorescence Imaging da Vinci System makes

Archivio Italiano di Urologia e Andrologia 2019; 91, 1, Supplemento 1

identification and dissection of the diverticulum rapid, safe and effective with no additional cost, even in disadvantageous anatomic conditions such as lateral-posterior diverticula. Lo studio ha avuto finanziamenti: No

V_15 THULIUM LASER COAGULATION OF RESIDUAL URETERAL ENDOMETRIOSIS Signorini C, Motta G, Vizziello D, Nazzani S, Clementi MC, Blezien O, Acquati P, Stubinski R, Picozzi S, Finkelberg E, Ratti D, Manfredi M, Carmignani LF. IRCCS Policlinico San Donato, Dept. of Urology, Milan, Italy.

Introduction. Urinary tract endometriosis (UTE) was considered a rare clinical disease. However, recent reports showed an increasing incidence. The incidence of UTE ranges from 1% to 6% of all women affected by endometriosis. The ureter is the second most common site affected by UTE and its obstruction may lead to progressive hydroureteronephrosis and silent renal failure (25%-50%). In 84%-91% of the patients, ureteral endometriosis is silent. Most frequent symptoms are dysmenorrhea, dyspareunia, pelvic pain, and menorrhagia. However, renal colic, flank pain, and catamenial hematuria are rare. This condition is incidentally diagnosed during a gynecologic checkup in most cases. Some authors suggested that localization of endometriosis involving uterosacral ligaments, broad ligament, and rectovaginal septum is strictly associated with ureteral involvement, particularly in the presence of nodules >3 cm. Which is the best treatment option for ureteral endometriosis is a controversial issue. In this article, we present a case report of a 36-year-old woman suffering from deep infiltrating endometriosis since 2009 who underwent left ureteral reimplantation with Leadbetter-Politano technique in 2011. In May 2018, the patient underwent hormonal stimulation for assisted reproductive treatment (ART) with the following appearance of macrohematuria, refractory to conservative treatment. We performed a thulium laser coagulation of bleeding spots of endometriosis in the left residual ureter. Materials and Methods. Medical history of the patient showed she underwent exploratory laparotomy for hemoperitoneum caused by tubaric vasal hemorrage, thoracoscopy, and biopsy for pleural effusion and pneumothorax in 2009. Moreover, she underwent appendectomy, ureterolysis, and left salpingectomy and a following left ureteral reimplantation with Leadbetter-Politano technique and psoas hitch in 2011. Renal function was preserved, with no signs of hydroureteronephrosis at renal ultrasonography. In May 2018, the patient underwent hormonal stimulation for ART with the following appearance of macrohematuria. A flexible cystoscopy and a semirigid ureteroscopy were performed with the evidence of an endometriotic bleeding spot in the left residual ureter. Results. To control the bleeding, a thulium laser

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coagulation (272 μm fiber, 15 W; Quanta System Cyber™) of the lesion was performed with immediate resolution of the symptoms. Preoperative hemoglobin was 13.5 g/dL. Postoperative hemoglobin was 12.7 g/dL. No bladder irrigation was required. Urinary catheter was removed after 1 day and the same day the patient was discharged. No further episodes of macrohematuria occurred during the 6 months of follow-up. As far as we know, this is the first case of thulium laser coagulation for endometriotic lesions. Castaneda et al. performed a holmium laser ablation of ureteral endometriosis with an overall success rate of 80% in terms of eradication of the disease. However, three of five patients developed ureteral strictures and underwent stenting and balloon dilatation. In our opinion, thulium laser could be considered a proper alternative to holmium laser in the treatment of ureteral endometriosis. Specifically, thulium laser characteristics allow to obtain an optimal coagulative effect with a shallow penetration in the tissues. Conclusion. Thulium laser can effectively coagulate endometriotic bleeding spots in residual ureteral tissue and could be used to control ureteral endometriosis with an endoscopic approach. However, a longer followup is needed. Conflitto d’interessi: No

vaginale e mesh con posizionamento di suture non ischemizzanti per ridurre il rischio di erosione parietale. La tridimensionalità della visione riduce le microlesioni della parete vaginale anch’esse condizione predisponente la erosione. Conclusioni. L’utlizzo di un patch di area sovrapponibile a quella del difetto fasciale vaginale sia nel versante anteriore che posteriore ed una adeguata solidarizzazione grazie ai vantaggi tecnici della chirurgia robotica, rappresenta una soluzione chirurgica sicura, efficace e facilmente ripetibile. Lo studio ha avuto finanziamenti: No Conflitto d’interessi: No

V_17 ROBOTIC MANAGEMENT OF NEO-BLADDER-VAGINAL FISTULA WITH BOVINE-PERICARDIUM MESH INTERPOSITION Pomara G, Di Vico T, Tesi L, Durante J, Bracchitta D, Meneghetti I, Santarsieri M, Francesca F. Urology Unit, AOUP, Pisa, Italy.

V_16 COLPOSACROPESSI ROBOTICA

A 63 years old female patient underwent robot assisted

Gallo G.

radical cystectomy with an intra-corporeal orthotopic

Casa di Cura Villa Igea - Ancona.

Scopo. Questo video mostra una procedura step by step per Colposacropessi robotica eseguita con l’impiego di una mesh in polipropilene ed ausilio di Robot da Vinci Si. Materiali e Metodi. La paziente sottoposta a tale procedura è una donna di 55 anni affetta da prolasso vaginale anteriore (cistocele di II°). La sintomatologia riferita comprende senso di peso/discomfort vaginale; nega incontinenza; pregressa chirurgia per isteroannessiectomia bilaterale. La mesh, la cui dimensione viene modificata di volta in volta in base al tipo e all’entità del difetto fasciale vaginale, viene fissata al sacro. La paziente veniva sottoposta ad inquadramento diagnostico che prevedeva anamnesi, esame obiettivo uro-ginecologico, esame urodinamico ed ecografia addominale. Risultati. Il tempo operatorio è stato di 130 minuti. La degenza è stata di 2 giorni. Non si sono verificate complicanze peri- o post-operatorie. Il catetere vescicale viene rimosso in I° giornata postoperatoria e la paziente viene dimessa in II° giornata dopo aver assistito a minzioni regolari con controlli ecografici negativi per ristagno urinario. Discussione. La colposacropessi è il gold standard per il trattamento del prolasso degli organi pelvici (POP) mono o multicompartimentali. L’approccio robot-assistito consente una efficace solidarizzazione tra parete

neobladder reconstruction in October 2017 for a BCGresistant T1 high grade and concomitant CIS urothelial bladder carcinoma. Post-surgical course was uneventful; discharged at POD 8; urinary catheter was removed POD 12. Full Continence after 2 months. After 8 months from catheter removal the patient complaints partial incontinence. Cystography and Uro-TC highlighted a neo-bladdervaginal fistula in the right posterior neo-bladder wall. In December 2018 a trans-vaginal approach was unsuccessful. We decided to proceed with a transperitoneal robotassisted fistula repair with an interposition of bovinepericardium mesh instead of omental flap. Post-surgical course was uneventful; discharged at POD 5; urinary and Bracci catheters were removed POD 16 after cystography that showed a correct neobladder conformation without leakage. Full Continence after 1 months. Lo studio ha avuto finanziamenti: No Conflitto d’interessi: No Archivio Italiano di Urologia e Andrologia 2019; 91, 1, Supplemento 1

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C_39 EFFECTIVENESS OF VACUUM-ASSISTED CLOSURE THERAPY (VAC) IN THE MANAGEMENT OF DISSEMINATED FOURNIER’S GANGRENE: A MULTICENTRE STUDY Bove P1, Cipriani C1, Sandri M2, Filippone R3, Ferracci A4, Ferrarese P5, Benedetto G5, Minervini A6, Cocci A6, Pastore AL7, Fuschi A7, Antonelli A8, Morena T8, Volpe A9, Poletti F9, Celia A10, Zeccolini G10, Leonardo C11, Proietti F11, Iacovelli V1, Vespasiani G1. 1

Urology Department, "San Carlo di Nancy" Hospital, Rome, Italy; Data Methods and System Statistical Laboratory, University of Brescia, Brescia, Italy; 3 Department of Eperimental Medicine and Surgery, University of Rome "Tor Vergata", Urology Unit, Policlinico Tor Vergata, Rome, Italy; 4 Department of Surgery, Policlinico Tor Vergata Foundation, Rome, Italy; 5 Urology Unit, San Bortolo Hospital, Vicenza, Italy; 6 Department of Urology, University of Florence, Careggi Hospital, Florence, Italy; 7 Department of Urology, ICOT Latina, Latina, Italy; 8 Unit of Urology, Spedali Civili Hospital, University of Brescia, Brescia, Italy, 9 Department of Urology, University of Eastern Piedmont, Maggiore della Carità Hospital, Novara, Italy; 10 Department of Urology, San Bassiano Hospital, Bassano del Grappa, Italy; 11 Department of Urology, La Sapienza University of Rome, Rome, Italy. 2

Aim. Fournier’s Gangrene (FG) is a potentially fatal polymicrobic soft tissue infection of the perineum, perianal and genital regions for which repeated surgical debridement is necessary, followed by multiple wound dressing for the entire healing process. Aim of this study was to evaluate the effectiveness of vacuum-assisted closure therapy (VAC) for treating patients with local and disseminated FG following initial debridement. Material and Methods. Data of patients admitted for FG in the emergency room of 8 Italian Hospitals, between February 2007 and December 2017, were retrospectively reviewed. Data regarding: patient gender, age, length of hospital stay, use of VAC, microbiology, predisposing conditions (diabetes mellitus type II, chronic alcoholism, obesity, hypertension, smoking and pelvic radiotherapy), origin of FG (anorectal, urogenital), blood results on admission, transfusions, enterostomies, urinary diversion and complications (sepsis, renal failure, acute respiratory distress syndrome and multi-organ failure) were collected. Our study population has been divided into two groups, patients with local (Group I – involving the perineum and/or pubic regions) and disseminated (Group II – extended out of these regions) FG. The effectiveness of VAC (surgical debridement + VAC application) respect to conventional treatments (surgical debridement + standard medication) was evaluated in terms of rate of non-closure of the wound and of overall survival (OS). Results. Seventy patients who underwent surgery were included in the study. There were no significant diffe-

Archivio Italiano di Urologia e Andrologia 2019; 91, 1, Supplemento 1

rences between the two groups in most of the variables considered. After the surgical debridement, the VAC has been used for 18 patients (62%) with local FG and for 11 patients (38%) with disseminated FG. In the Group I, treated using VAC, the timing of the wound closure was longer than in patients treated with conventional approaches. A rate of 50% of non-closure of the wound was reached after 15 days using conventional treatments and after 45 days with VAC. In the Group II treated using VAC, the rate of non-closure of the wound decreased in response to the therapy reaching a level of 9% in 126 days while, in response to conventional treatments, the minimum rate of non-closure of the wound was 62.5% in 18 days. A statistically significant difference of VAC effect between local and disseminated FG was found (p=0.031). Finally, the OS was higher in the group of patients with disseminated FG treated using VAC than those treated with conventional approaches (30-day OS: 0.88 vs 0.5, respectively, p=0.028). Conclusion. This study supports the effectiveness of VAC in the management of disseminated FG in terms of earlier wound closure and improvement of OS. The use of VAC doesn’t show any benefit over conventional approaches in treating local FG. Lo studio ha avuto finanziamenti: No Conflitto d’interessi: No

C_40 HIGH DOSE GREEN TEA (CLUSTERIN) IS EFFECTIVE IN REDUCING LOWER URINARY TRACT SYMPTOMS (LUTS) IN PATIENTS WITH BOO: FIRST RESULTS OF A PILOT STUDY Brausi M1, Ferrari R1, Nyeck B1, Bettuzzi S2. 1

Dept. of Urology Estense-S.Agostino and Hesperia Hospital Institutes Carpi-Modena; 2 Istituto Chimica Biologica Univeristà degli Studi di Parma.

Objectives. An increase in atrophic cell population in ventral prostate of aging rats with high level of clusterin (green tea) has been previously reported by our group. The objectives of this pilot study was to evaluate the impact of high dose green tea (clusterin) in patients with LUTS from BPH and to observe side effects. Also the effect on prostate volume and PSA was analised. Materials and Methods. 18 pts. with LUTS from BPH assessed by IPSS and QoL questionnaires were enrolled in the study after informed consent. The mean age of the patients was 64.1 year (range 45-76), the mean IPSS was 15.9 (range 15 to 20) and Qol was 1.2. Mean serum PSA was 3.9 ng/ml (range 0.6-14.6). Prostatic volume was determined before and after therapy in 12/18 patients with DRE and ultrasound. The mean prostate volume at diagnosis was 43.2 cc. All the patients received orally high dose of purified catechines present in green tea (3 tablets a day) for 3-9 moths. 4 patients were excluded from this analysis because they did not reach the 3 month-Follow-up (2/18) or were lost to follow-up (2). 14/18 pts were eva-

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luated with IPSS, QoL and prostate volume. In 11/14 patients PSA was determined before and after treatment. Results. After median of 4.5 months of therapy 12/14 pts.(86%) had their IPSS improved, 2/14 pts had stable IPSS. The mean IPSS improvement was of 5.2 points. 10/14 pts (71%) referred an improved QoL with a mean improvement of 1.1 points. Prostate volume measured by ultrasound and DRE after therapy was 42.2cc compared to previous 43.2 cc. Only 11/14 pts. had the 3-month PSA: 5/11 had stable PSA after therapy, 2 had a PSA rise (mean 1 ng/ml) and 4/11 had their PSA decreased (mean 1 ng/ml). Side effects: 1/18 of patients complained of mild diarrea which disappeared with low dose of Imodium. Conclusion. High dose green tea (clusterin) resulted effective in decreasing LUTS in patients with BOO. IPSS and QoL improved in 86% and 71% of patients respectively. Serum PSA levels were not affected. High dose green tea had no/mild effect on prostatic volume. Side effects were negligible. Since a placebo effect could not be excluded, larger randomized placebo controlled studies are needed to confirm these preliminary results. Conflitto d’interessi: No

C_41 CLOSED SUCTION DRAINAGE (CSD) VERSUS NO DRAINAGE OF THE SCROTUM IN INFLATABLE PENILE PROSTHESIS (IPP) PLACEMENT WITH MINIMALLY INVASIVE INFRAPUBIC APPROACH: RETROSPECTIVE COMPARATIVE OUTCOMES AT TWO HIGH-VOLUME IMPLANTING CENTERS Antonini G1, Del Giudice F1, Busetto GM1, Cristini C1, Tuzzolo D2, Perito PE3, De Berardinis E1. 1

Sapienza Rome University, Policlinico Umberto I, Roma, Italy; Department of Urology, Casa del Sole, Formia, Italy; 3 Department of Urology, Coral Gables Hospital, FL, USA. 2

Aim. To investigate the routine use of CSD in patients who underwent IPP surgery with infrapubic approach and were treated with or without postoperative CSD of the scrotum. Materials and Methods. Between September 2015 and June 2017, 147 patients with medically refractory ED who had undergone IPP placement and treated with or without CSD of the scrotum were retrospectively reviewed. Exclusion criteria included: patients undergone previous penile surgery and patients who had a previous diagnosis of moderate to severe Peyronie Disease. All patients undergone primary implantation with an antibiotic-impregnated or a hydrophilic-coated IPP with a minimally invasive infrapubic approach. 77 patients received a 10 French CSD (Jackson Pratt®) of the scrotum. The remaining 70 patients did not receive any drain. The choice to drain or not to drain the patients at that time was established according to surgeon’s personal preference. Follow up with daily outpatient postoperative evaluation for those who had received a CSD and standard postoperative evaluation at 1, 3, 12 and 24 weeks after the surgery for the whole cohort was revie-

wed in order to investigate early and delayed postoperative outcomes. Results. Looking at early postoperative complications, when comparing CSD vs. none-CSD groups, 0 and 2 (2.8%) infections of the device were seen respectively with one salvage explantation at 1.2 months after the surgery in the none-CSD group. Regarding postoperative hematoma formation out of the 74 CSD patients, 7 cases developed a mild scrotal swelling and only 1 case experienced an immediate postoperative scrotal hematoma. A different trend was achieved in the none-CSD group where out of 70 patients, 26 developed a mild scrotal swelling and 12 patients an immediate scrotal hematoma. Out of these, 4 required surgical exploration, hematoma evacuation, antibiotic washout, and CSD placement while the remaining 9 patients were treated with conservative measures including scrotal elevation, ice packs, restricted activity and antibiotics. Looking at functional outcomes, patients treated with CSD were significantly more satisfied with the procedure at the end of 1-year follow-up (mean EDITS-CSD: 84±5 Vs. mean EDITS-noneCSD: 72±2; p< 0.001). No differences in terms of IIEF score was observed between the two groups (mean IIEF-CSD: 24.6±1.8 Vs. mean IIEF-noneCSD: 25.1±0.9). Conclusion. Draining the scrotum after minimally invasive IPP placement is safe and decreases the risk of postoperative complications such as infections and/or scrotal hematoma. Functional outcomes are excellent, and quality of implant experience seems to be better than in the none- CSD group. Further prospective randomized studies are needed in order to definitively clarify this unresolved debate in the andrological community. Lo studio ha avuto finanziamenti: No Conflitto d’interessi: No

C_42 POSTOPERATIVE VACUUM THERAPY (VED) FOLLOWING AMS™ LGX 700® INFLATABLE PENILE PROSTHESIS (IPP) PLACEMENT: PRELIMINARY RESULTS FROM AN ITALIAN SINGLE-CENTER EXPERIENCE Antonini G1, Del Giudice F1, Busetto GM1, Cristini C1, Tuzzolo D2, Perito PE3, De Berardinis E1. 1

Sapienza Rome University, Policlinico Umberto I, Roma, Italy; Department of Urology, Casa del Sole, Formia, Italy; 3 Department of Urology, Coral Gables Hospital, FL, USA. 2

Aim. To investigate penile dimensions and patient satisfaction outcomes after one year of follow-up from AMS LGX-700 IPP surgery with six months of adjuvant VED therapy. Materials and Methods. Between March 2016 and January 2017, 37 patients with medically refractory erectile dysfunction (ED) were enrolled in this prospective single institution non- randomized study. Exclusion criteria included: previous pelvic surgery and/or oncologic pelvic treatment, previous penile surgery, penile curvature/Peyronie Disease. All patients underwent AMS™ Archivio Italiano di Urologia e Andrologia 2019; 91, 1, Supplemento 1

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(Boston Scientific, Marlborough, MA, USA) LGX 700® infrapubic IPP placement. Penile measurements were registered at three different times: one week prior to surgery measuring stretched flaccid penile length and girth at baseline (I) and following intracorporeal injection of 10 to 20 mcg of alprostadil (II) and then during the scheduled postoperative visits at maximum inflation (III). Starting 3 weeks after discharge, patients were asked to use a vacuum device for a 12-week period (Medis®, Vacuum Therapy Devices, Milan) without the constriction ring for 5 minutes twice daily after full device inflation was achieved. Follow-up with a standard postoperative evaluation and penile measurements at 12, 24 and 48 weeks was performed. Patients were asked to complete the International Index of Erectile Function (IIEF-5) and Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) before and at the end of the follow-up. Results. Thirty-seven patients with a median age of 54 (range 42-64) years completed the study. All surgical procedures were carried out within a median operative time of 39 (range 27-41) minutes and no intraoperative complications were reported. Median implant length (including rear tips extenders) was 18 (range 16-21) cm. Comparing penile sizes at any time during follow-up, penile length outcomes were always statistically significantly increased (p<0.0001). No patient reported a shortening in the length compared to the baseline flaccid stretched measurements [median 13 cm (range 11-18) Vs. 16 cm (range 14-22); p<0.0001] while, more importantly, no statistical difference was seen between the baseline ICI-induced penile length and the measurements at the end of follow-up [median 17 cm (range 12-20) Vs. 17 cm (range 13-21); p=0.52]. Baseline median IIEF-5 score was 10 (range 5-11), at 6 months 22 (range 19-27) and at 1 year was 25 (range 21-28) (p<0.0001). Median EDITS score at the end of the follow-up was 82 (range 66-89). Conclusion. AMS™ LGX 700® IPP insertion together with a postoperative VED program is a safe and highly satisfactory combined approach to preserve penile dimensional outcomes in our selected cohort of patients without increased risk for corporal fibrosis. Further prospective randomized trials are still needed in future to better investigate the role of VED therapies in the postoperative setting of patients undergone IPP surgery for erectile disfunction. Lo studio ha avuto finanziamenti: No Conflitto d’interessi: No

Archivio Italiano di Urologia e Andrologia 2019; 91, 1, Supplemento 1

C_43 INFLATABLE PENILE PROSTHESIS (IPP) PLACEMENT, “SCRATCH TECHNIQUE”, AND POSTOPERATIVE VACUUM THERAPY (VED) AS A COMBINED APPROACH IN THE DEFINITIVE TREATMENT OF PATIENTS WITH PEYRONIE’S DISEASE: PRELIMINARY EXPERIENCE FROM AN ITALIAN SINGLECENTER PROSPECTIVE TRIAL Antonini G1, Del Giudice F1, Busetto GM1, Cristini C1, Tuzzolo D2, Perito PE3, De Berardinis E1. 1

Sapienza Rome University, Policlinico Umberto I, Roma, Italy; Department of Urology, Casa del Sole, Formia, Italy; 3 Department of Urology, Coral Gables Hospital, FL, USA. 2

Aim. To investigate methodology, safety and efficacy results from our prospective cohort of patients with severe penile curvature and/or complex PD plaque as well as ED who were treated with our novel multimodal surgical and mechanical combined approach. Materials and Methods. Between June 2015 and September 2018, 62 patients with stable penile curvature > 30° with concomitant ED were identified and enrolled in this single institution study. Penile curvature was preoperatively examined using two different methods: at-home photography (AHP) and intracavernosal injection (ICI) within three months of surgery. All patients underwent preoperative duplex Doppler ultrasonography and/or penile MRI in order to identify ED, characterize the plaques, and identify penile deformity respectively. Exclusion criteria were the absence of penile curvature or ≤ 30°, ventral penile curvature, previous penile surgery, neurological diseases precluding successful IPP operation, major psychiatric disorders and patients who declined to participate to the study. All patients underwent minimally invasive infrapubic IPP placement with endocavernosal rupture of PD plaques using the “scratch technique”. Starting two weeks after discharge, patients were asked to purchase and use a vacuum device for a 12-week period (Medis®, Vacuum Therapy Devices, Milan, Italy and Osbon ErecAid®, Vacuum Therapy System, Collierville, TN, USA) without the constriction ring for three minutes twice daily. Results. 67 patients with a mean age of 53.8±9.8 years completed the study. Patients with plaques in the proximal third, middle third and subcoronal areas of the penis had a mean residual curvature of 23.5±5.5°, 18.3±3.8° and 14.5±4.1° respectively after surgery. After 24 weeks of vacuum therapy, penile curvature deviation decreased to 9±2.5°, 10±2.1° and 7.5±2.3° respectively. Preoperative mean IIEF-5 score was 8±2.3, at 6 months 20.2±3.4 (p<0.001) and at 1 year was 25±3.8 (p<0.001). Mean EDITS score at the end of the follow up was 73±11.8. Operative and postoperative complications were minimal. Conclusion. Our novel combination of intraoperative and postoperative VED therapies in the treatment of patients with PD and IPP is safe and efficacious with excellent functional outcomes. Penile curvature cor-

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rections were statistically significant, and complications were negligible. Lo studio ha avuto finanziamenti: No Conflitto d’interessi: No

C_45 STUDY PROTOCOL FOR PELVIC MUSCLE FLOOR REHABILITATION (PFMR) AS AN ALTERNATIVE TREATMENT IN PATIENTS AFFECTED OF PREMATURE EJACULATION (PE) THAT HAVE TO DISCONTINUE THE THERAPY WITH DAPOXETINE

C_44 NON-INVASIVE EVALUATION OF MALE URETHRA STENOSIS: THE CINE-URETHRO RM. PRELIMINARY REPORTS

Maruccia S1, Kinzikeeva E1, Pastore AL2, Spiga P1, Tridico M1, Bertoli A1, Salonia A3, Casellato S1.

Corongiu E1, Danti M2, Grande P3, Squillacciotti S1, Zampelli A1, Pagliarella G1, Di Santo A1, Liberati E1, Forte F1. 1

MG Vannini Hospital, Dept. of Urology, Rome, Italy;

MG Vannini Hospital, Dept. of Radiology, Rome, Italy;

Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Pitié Salpétière, Urology Department, Paris, France.

Objectives. To assess accuracy of non-invasive dynamic technique to investigate male urethra stenosis using MRI. Material and Methods. From January 2017 to February 2018, 40 patients with suspected urethral stenosis were prospectively enrolled in the study. Every patient underwent Cine-Urethro RM (INTERA 1,5T,Philips Medical Systems,Best, the Netherlands) without administration of gadolinium contrast. Balance sequences, with cycles every 0,5 second to result in cine effect were used. Two experienced radiologist independently revised the exam. Every patient underwent subsequent standard urethrocystography. Results. Cine-urethro MRI was completed in 33 (82,5%) patients, 7 (17,5%) were excluded as they were not able to urinate during the exam. MRI found a urethral stenosis was in 25/33 (75,8%). An assessment of the entire urethral length was possible only in 11/33 (33,3%) pts, in 12/33 (36,4%) three portions of the urethra (prostatic, bulbar and initial portion of the penile) while in 10 (30,3%) only prostatic and bulbar was assessed. Compared to conventional urethrographic study, MRI did not detect a stenosis in 8/33 (24,2%). Of those 5/33 (15,2%) cases were a stenosis of the penile urethra and 3 (9,1%) of the bulbar urethra. Conclusions. Cine-Urethra-MRI is a promising method to study the male urethra. It showed an excellent detection rate for stenosis located in the posterior urethra, avoiding patient catheterization and exposure to x-rays. Lo studio ha avuto finanziamenti: No Conflitto d’interessi: No

ICZ, Monza; Sapienza University of Rome; 3 San Raffaele Hospital. 2

Aim. According european guidelines Dapoxetin is the only approved pharmacological treatment for PE. But our clinical practice and some studies show that this treatment has high discontinuation rate (for cost, neccessity to take it before sex, sometimes (rare) side effects or ineffective responce). That’s why we looking for an alternative method to cure PE. From recent study (Pastore et al, 2014) and according our clinical practice, it seems that PFMR has a good and long-term results in reducing intravaginal ejaculatory latency time (IELT). Material and Methods. The inclusion criteria are: men >18 years old, without acute inflammation symptoms, with negative urine and seminal fluid culture; IELT <60s, without pathologic anatomic conditions of genitals (frenulum breve) or major psychiatric disorders, men that have to discontinue with farmacologic therapy: at least after 4 administrations of Dapoxetin 60 mg and with attempted sexual intercourse every time of medicine was assumed. Participants must complete 8-week program of PFMR, including physio-kinesiotherapy treatment, electrostimulation, and biofeedback, with two sessions for week for first 2 weeks and then 1 for week for the next 6 weeks, duration of each session is 45 minutes. The effectiveness of intervention was evaluated by comparing the change of IELT and PEDT (Premature Ejaculation Diagnostic Tool) values, from baseline, at 3, 6 and 12 months post-intervention. Results. Cine-urethro MRI was completed in 33 (82,5%) patients, 7 (17,5%) were excluded as they were not able to urinate during the exam. MRI found a urethral stenosis was in 25/33 (75,8%). An assessment of the entire urethral length was possible only in 11/33 (33,3%) pts, in 12/33 (36,4%) three portions of the urethra (prostatic, bulbar and initial portion of the penile) while in 10 (30,3%) only prostatic and bulbar was assessed. Compared to conventional urethrographic study, MRI did not detect a stenosis in 8/33 (24,2%). Of those 5/33 (15,2%) cases were a stenosis of the penile urethra and 3 (9,1%) of the bulbar urethra. Conclusions. Cine-Urethra-MRI is a promising method to study the male urethra. It showed an excellent detection rate for stenosis located in the posterior urethra, avoiding patient catheterization and exposure to x-rays. Lo studio ha avuto finanziamenti: No Conflitto d’interessi: No Archivio Italiano di Urologia e Andrologia 2019; 91, 1, Supplemento 1

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C_46 “CLAM” ILEOCYSTOPLASTY: WHICH FUTURE? Casilio M, Pisanti F, Stefanucci M, Schettini M. Urotrust – Nuova Villa Claudia - Roma.

Introduction. A normal urinary system works with a low pressure reservoir of good capacity that is able to contract voluntarily. The urinary bladder must have good compliance and must be normocontractile. When these two prerogatives are lost, a pathological condition is determined, characterized by incontinence and possible retrograde pressure. We consider our personal case studies for the last 22 years, noting the substantial decrease in indications and their clinical limitation. Material and Methods. From 1994 to 2016 we performed 37 ileocystoplasties in three groups of patients divided as follows: - Group 1: 21 Patients (13 men and 8 women) Patients with low capacity and low bladder compliance. 6 male patients had undergone transvescical adenomectomy, 7 radiotherapy and 1 had several cycles of BCG for Tis. Women undergone post-hysterectomy radiotherapy in 5 cases and in 2 cases other gynecological procedures. - Group 2: 10 Patients (8 Men and 2 Women) Patients with neurological bladder, areflexia, low compliance after medullary trauma. - Group 3: (6 Men) Patients with normal compliance but low capacity and severe detrusor hyperactivity. For each patient a thorough medical history and physical examination was performed. The second level investigations carried out on the basis of anamnestic data were urography or uro-CT, cystography, BK urinary research, cystoscopy with possible biopsy. In all cases an ileocystoplasty was performed with the use of 45 cm of ileal segment at 15-20 cm from the ileocecal valve. The obtained cuff was implanted on the bladder dome which had previously been opened transversely. Histological samples of the entire bladder wall have always been performed which have never shown the presence of neoplasia. Results. In 3 patients of group 3 there was a consistent improvement of symptoms with prolongation of the voiding time. In 3 patients in group 1 after the operation it was possible to implant an artificial sphincter and correct incontinence. For 3 patients in group 3 it was possible to start intermittent catheterization. In 6 patients, continence was also completely recovered. Overall, improvement in continence, increased capacity, decompression of the upper urinary tract with reduced bladder pressures and prevention of complications was achieved in most patients. Discussion. “Clam” cystoplasty is performed in conditions of reduced compliance, reduced bladder capacity and/or severe intractable detrusor hyperactivity. The goal of “clam” cystoplasty is to increase bladder capacity by improving the patient’s symptomatology, continence and decreasing the percentage of complications due to bladder-ureteral reflux. In this heterogeneous group there are very different pathological con-

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ditions. Various situations can induce these conditions: for the loss of compliance there is always a modification of the bladder wall which causes a loss of elasticity and therefore of capacity. Chronic cystitis primitives or resulting from surgery on the bladder or prostate, effects of ionizing radiation or neurological damage, may be the cause of this condition. Normal detrusor contractility is subject to a more complex control system that provides for complete integrity of the cerebro-medullary neurological axis, as well as the normal histology of the bladder wall. Bladder irritative stimuli and alterations of neurological control can modify the normal contractile functioning of the bladder inducing its release from the control mechanisms. This second problem has been gradually addressed with different methods but over time the pharmacological therapies have been imposed with anticholinergic drugs and physical therapies through electrostimulation. In the last decade, topical bladder therapy with botulinum toxin has taken great importance, which, despite the necessary repetitiveness, has become an elective therapy for these disorders. “Clam” cystoplasty is therefore nowadays limited to bladder shapes that are anatomically compromised and can not be treated with other techniques. For this reason we have seen our indications dramatically decrease over the years. Our case studies confirm the current trend. Most ileocystoplasty procedures were performed between 1996 and 2006. In the last 10 years we have performed only 5 procedures. The intervention was confirmed as safe, effective and with a high degree of patient satisfaction. Even if the indications are very limited, it is important to underline that clam ileocystoplasty remains an irreplaceable procedure in all refractory cases and therefore must necessarily form part of the urological armament. References. 1. Duthie JB, Vincent M, Herbison GP, et al. Botulinum toxin injections for adults with overactive bladder syndrome. Cochrane Database Syst Rev. 2011; (12):CD005493. 2. Herbison GP, Arnold EP. Sacral neuromodulation with implanted devices for urinary storage and voiding dysfunction in adults. Cochrane Database Syst Rev. 2009; (2):CD004202. 3. Mundy AR, Stephenson TP. “Clam” ileocystoplasty for the treatment of refractory urge incontinence. Br J Urol. 1985; 57(6):641-6. 4. Khastgir J, Hamid R, Arya M, et al. Surgical and patient reported outcomes of 'clam' augmentation ileocystoplasty in spinal cord injured patients. Eur Urol. 2003; 43(3):263-9. 5. Zachoval R, Pitha J, Medova E, et al. Augmentation cystoplasty in patients with multiple sclerosis. Urol Int. 2003; 70(1):21-6. 6. Shirley SW, Mirelman S. Experiences with colocystoplasties, cecocystoplasties and ileocystoplasties in urologic surgery: 40 patients. J Urol. 1978; 120(2):165-8. 7. Smith RB, van Cangh P, Skinner DG, et al. Augmentation enterocystoplasty: a critical review. J Urol. 1977; 118(1 Pt 1):35-9. 8. Swami KS, Feneley RC, Hammonds JC, Abrams P. Detrusor myectomy for detrusor overactivity: a minimum 1-year follow-up. Br J Urol. 1998; 81(1):68-72. 9. Kang IS, Lee JW, Seo IY. Robot-assisted laparoscopic augmentation ileocystoplasty: a case report. Int Neurourol J. 2010; 14(1):61-4.

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XXIV Congresso Nazionale UrOP - Abstracts 10. Hasan ST, Marshall C, Robson WA, Neal DE. Clinical outcome and quality of life following enterocystoplasty for idiopathic detrusor instability and neurogenic bladder dysfunction. Br J Urol. 1995; 76(5):551-7. 11. Soergel TM, Cain MP, Misseri R, et al. Transitional cell carcinoma of the bladder following augmentation cystoplasty for the neuropathic bladder. J Urol. 2004; 172:1649-51.

C_47 GREEN LASER EXPERIENCE IN OBSTUCTIVE PATHOLOGY Stefanucci M, Casilio M, PIsanti F, Schettini M. Urotrust - Casa di Cura Nuova Villa Claudia - Roma.

Objective. Demonstrate the efficiency, safety and simplicity in the execution of the prostate vaporization in a heterogeneous group of patients by an inhomogeneous group of surgeons. The laser used is a Green laser beam at lithium triborate (180W maximum power) used for the vaporization and coagulation of the prostate tissue (180W to 40W). Material and Methods. From July 2014 to January 2018, 158 Patients underwent 180-W XPS GreenLight vaporization (using a fiber MOXY©) for the treatment of LUTS due to BPH by a team made up of five surgeons with different experience regarding TURP. For weight less than 30 g were performed simple vaporization, for more than 30 g were performed anathomic vaporization. Patients were enrolled prospectively and preoperative, intraoperative and postoperative parameters were then reviewed retrospectively. Were enrolled patients with obstructive disease caused by different prostate disease, particularly 155 patients were affected by LUTS due to BPH and 3 patients were affected by prostate cancer. 3 Patients were also already undergoing TURP before Greenlight vaporization. Enrollment patients were evaluated according to the following parameters: IPSS score, preoperative and postoperative flow, post void residual, TRUS, PSA, prostate biopsy when necessary. The same parameters were evaluated postoperatively. Also operative time, the energy delivered, the time to catheterization and adverse events were evaluated. Results. The mean Patient age was 65 (range, 50-78); 81% of men were on an alpha-blocker preoperatively; mean (standard deviation; SD) prostate volume by transrectal ultrasound was 55,1 ml (27,5); mean (SD) operative time was 24,36 minutes (6,03); mean (SD) total laser kiloJoules used was 216,289 kJ (62,805); mean (SD) follow up time was 8,72 months (3,24); and mean (SD) time of catherization was 18,1 hours (6,3). The 1-year decrease in mean (SD) IPSS-score was 22,3 (7,2)-8,4 (3,9). The maximal urinary flow increased from 9,5 ml/s (2,3) to 27,5 (5,1). Patients postvoid residual improved from 119 mL (64) to 14 mL (11) over a 1-year period. (P <.01 for all). Adverse effects occurred: 1 bladder neck sclerosis after 3 months, 2 urge incontinence resolved with medical therapy, 1 unresolved hypocontractility bladder, 4 stress incontinence spontaneously resolved, 1 urinary sepsis, 2 acute urinary retention resolved by temporary catheterization.

Discussion. The use of lasers in the treatment of BPH is now consolidated by time: they exploit different methods for the vaporization or enucleation of the prostate tissue. The Greenlight Laser uses a green beam generated by an activated mixture of lithium triborate with power up to 180W. The beam, having a wavelength of 532Hz, is selectively absorbed by hemoglobin resulting in an immediate vaporization of the treated tissue. In particular, the selectivity of the beam allows not to cause deeper lesions of 2 mm, thereby avoiding damage to deep tissue. The hemoglobin makes selectivity also because of the particular hemostasis obtained during treatment. The action continues on prostate tissue makes possible the vaporization of about one gram of tissue per minute every 10000J applied, whereby it is possible with this mode vaporize 10 grams of prostate in 10 minutes. The almost complete absence of bleeding allows an accurate sculpture of the prostate bed. The treatment is effective, fast, safe. Conclusions. The use of the Greenlight Laser 180W makes possible an effective treatment of obstructive BPH: it is possible to use the laser energy for the vaporization of the prostate tissue and simultaneously for the anatomical incision of the tissue to be vaporized. This solves the obstructive diseases related to prostate of different volumes. The efficacy and rapidity of the method allows that with a vaporization minute can vaporize approximately 1 gram of prostatic tissue, delivering approximately 10,000 kJ, because the processing time is proportional to the volume of the prostate. The technique is simple: in our experience the results obtained from five different endoscopic surgeons with different experience are similar.

C_48 KUBIKER SUPPLEMENT THERAPY: TREATMENT OF THE SAME SYMPTOMS IN PATIENTS WITH DIFFERENT ONSET AND PATHOGENESIS OF THEM GIVE DIFFERENT RESULTS Kinzikeeva E, Maruccia S, Spiga P, Tridico M, Casellato S. ICZ, Monza.

Aim. This study was conducted to evaluate lower urinary tract symptoms (LUTS) as urgency, urge UI, nocturia, frequency, UFM parameters, IPSS score and QoL after Thulep and examine the efficacy of Kubiker to treat patients suffering from storage symptoms after surgery. Material and Methods. Among 60 patients who underwent Thulep, 30 undergo additional treatment with Kubiker for two months that might affect their urination pattern and 30 who did not undergo any treatment were included in the analysis, these data were analysed retrospectively. The International Prostate Symptom Score (IPSS), quality of life (QoL) score, and uroflowmetry were analyzed prior to Thulep and 2 months after ThuleP. Two months after ThuleP, IPSS, QoL score, and uroflowmetry were analyzed one more time. Results. Preoperatively, the mean IPSS for patients were 21±5,6 (range 12-35) for study group) and 18,7±8,68 (range 0-31) and for control group, respecArchivio Italiano di Urologia e Andrologia 2019; 91, 1, Supplemento 1

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tively. Two months after surgery the mean IPSS for 2 groups (patients undergoing THulep with administration of medication were 8,28±4,26 (range 1-16) for studio group and 6,3±2,9 (range 1-11) in control group without medication (p=0,1), respectively. (p=0,1) in particular, the mean storage and voiding symptom composites improved significantly after Thulep in both groups. There were no statistically significant differences in IPSS score, frequency, nocturia and urge UI and urowflowmetry parameters between study group after administration of medication and between control group after surgery but there is significant worsening of quality of life and presence in 21% (6 pts) urgency and urge incontinence episodes in men who had assumed Kubiker, there is no episodes of UI in control group. Also there are no significant differencies for uroflowmetry parameters as residual volume, maximum and medium velocity. Conclusions. Our study is retrospective, contain few persons and we didn’t calculate the influence of operating time, age, V prostate and other characteristics that can influence the results. The more omogeneous data and more patients are needed for future studies. Our results suggest that, in patients undergoing Thulep, urinary symptoms change over time, with improving storage and voiding symptoms, IPSS score, urowflowmetry parameters; but in patients who had a discomfort with storage symptoms after Thulep, Kubiker supplement therapy didn’t significantly improved them and sometimes worse the QoL. These results, probably, depend of presence of Capsaicin, an active component of chili pepers, that, as we suppose, has an irritant action for post-Thulep surgical wound. Contrarily, according the data of a recent study there was an improvement of storage symptoms and QoL after Kubiker supplement therapy in women affected of overactive bladder. We suppose that the pathogenesis of symptoms onset in these diverse cohorts of patients is different. Results of our study underline the importance of proper patient selection and endpoint selection in evaluation of new therapies. Lo studio ha avuto finanziamenti: No Conflitto d’interessi: No

C_49 IDRONEFROSI “GIGANTE” DA STENOSI DELLA GIUNZIONE PIELO-URETERALE: OUTCOME A LUNGO TERMINE NELLA PERSONALE ESPERIENZA Cretì G, Sebastio N, Latiano C, Rosati A, Santodirocco M, Marcucci G, Cisternino A. UOC Urologia – Ospedale Casa Sollievo della Sofferenza – S. Giovanni Rotondo (FG).

Introduzione. L’idronefrosi “gigante” (IG) è generalmente definita come una marcata idronefrosi in cui la pelvi renale supera volumetricamente la linea mediana della colonna vertebrale. La valutazione preoperatoria di una IG non è agevole, considerata la rilevante ed, a volte, estrema riduzione del parenchima renale residuo spesso rappre-

Archivio Italiano di Urologia e Andrologia 2019; 91, 1, Supplemento 1

sentato da un sottile anello periferico; per tale ragione ,in Letteratura, appare tuttora diffuso l’atteggiamento demolitivo (nefrectomia fino al 70% dei casi) piuttosto che quello conservativo (dismembered pyeloplasty). Rimane altrettanto incerto e non definito l’outcome a lungo termine dopo l’intervento chirurgico, sia per il numero limitato di casistiche riportate in Letteratura, sia per le intrinseche difficoltà di un follow-up a lungo termine in assenza di protocolli di gestione condivisi per questi pazienti. Obiettivo. Valutazione dell’outcome a lungo termine della IG trattata con pieloplastica “dismembered”. Materiali e Metodi. Nell’ambito della casistica personale sono stati analizzati retrospettivamente, dal 1994 al 2015, 196 pz affetti da SGPU sottoposti a pieloplastica “dismembered”(età compresa fra 45 gg.e 17 aa. Da questo pool di pazienti sono stati selezionati 12(6,1%) in cui le indagini diagnostiche preoperatorie (US, Uro-RMN, Renoscintigrafia) hanno conferito l’attribuzione del termine di “gigante” alla loro massiva idronefrosi al momento della loro presentazione clinica (età compresa fra 2 e 13 aa). I fattori analizzati sono stati: età all’intervento, sesso, lateralità, quadro clinico di presentazione, necessità di nefrostomia preoperatoria, follow-up non inferiore a 3 aa. Dei 12 pz, 5 si presentavano con massa addominale palpabile, 2 pz con diagnosi prenatale di idronefrosi ingravescente, 3 pz con infezione urinaria associata a dolori addominali ricorrenti, 1 pz con esordio di dolore al fianco di tipo colico, 1 pz asintomatico con diagnosi incidentale nel corso di accertamenti per incidente stradale. In 6 pz è stata posizionata preoperatoriamente una nefrostomia percutanea a scopo di decompressione temporanea (4-6 settimane), utile per una valutazione funzionale renoscintigrafica prima e dopo l’intervento. Risultati. Tutti i 12 pazienti selezionati sono stati sottoposti ad intervento chirurgico: 12 pieloplastiche (1 caso di SGPU bilaterale) 1 nefrectomia (SGPU con idropionefrosi e calcolosi secondaria). I parametri di riferimento utilizzati nel monitoraggio morfo-funzionale a breve e a lungo termine (min 3 / max 18 aa) sono stati lo spessore parenchimale renale valutato con l’US e la funzione renale differenziale mediante la renoscintigrafia sequenziale MAG3. In tutti i pazienti è stato registrato il moderato aumento dello spessore parenchimale renale ,specialmente nei bambini più piccoli, ed una stabilità della funzione renale differenziale nel tempo: 28-35% in 10 casi, 15-18% in 1 caso, 12-15% in 1 caso. I risultati funzionali a lungo termine non sono stati significativamente influenzati dal preliminare posizionamento della nefrostomia percutanea. In nessun caso è stato osservato il rialzo della creatina, né l’insorgenza di una ipertensione arteriosa. Conclusioni. Nella personale esperienza l’outcome a lungo termine della IG trattate con pieloplastica rileva sostanzialmente come l’approccio conservativo possa conservare o migliorare la funzionalità renale nella stragrande maggioranza dei casi e che, quindi, la nefrectomia non debba essere considerata come l’opzione terapeutica di prima scelta. Lo studio ha avuto finanziamenti: No Conflitto d’interessi: No

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C_50 TRANSITIONAL CARE IN UROLOGIA PEDIATRICA: MODELLI ORGANIZZATIVI E LORO SOSTENIBILITÀ NEI SISTEMI SOCIO-SANITARI Cretì G, Sebastio N, Latiano C, Colella A, Santodirocco M, Marcucci G, Cisternino A. UOC Urologia – Ospedale Casa Sollievo della Sofferenza – S. Giovanni Rotondo (FG).

Introduzione. In ambito urologico pediatrico numerose patologie malformative genito-urinarie, molte trattate in età pediatrica, emergono con le loro complesse criticità in età adolescenziale, virando invariabilmente in età adulta. Il denominatore comune che associa queste particolari condizioni s’identifica nei medesimi obiettivi verso i quali sono orientati i percorsi e le cure di transizione: la conservazione della funzione renale, la preservazione della funzione vescicale come serbatoio, l’integrità dei meccanismi della continenza urinaria, della fertilità e la soddisfacente conquista di un adeguato aspetto cosmetico dei genitali esterni. In un sistema sanitario moderno ed avanzato è universalmente condiviso da tutti gli operatori, coinvolti a vario titolo nella gestione clinico-assistenziale di questi pazienti, lo stato di necessità di una pianificazione di un percorso di transizione evolutivamente organizzato e standardidizzato di cure e prestazioni sanitarie senza soluzione di continuità fra modelli assistenziali pediatrici e quelli per l’età adulta, ispirati ad un progetto multidisciplinare di “global care” costruito a misura dei bisogni individuali dei singoli pazienti. A fronte di questo ambizioso ed innovativo progetto si riscontrano rilevanti difficoltà comunicative e crescenti limitazioni organizzative che frustrano i tentativi della “concertazione” tra le diverse figure coinvolte nella scelta delle opzioni disponibili e sostenibili: pazienti,genitori, caregivers, urologi pediatri, urologi dell’adulto, istituzioni socio-sanitarie, aziende ospedaliere etc. Obiettivo. Gli Autori propongono un modello organizzativo per la transizione in ambito urologico per complesse patologie malformative genito-urinarie dall’età pediatrica all’età adulta, valutandone l’appropriatezza e la sostenibilità economica-finanziaria nell’attuale sistema sanitario nazionale. Metodi. La metodologia applicativa proposta prevede una preliminare indagine conoscitiva tra urologi pediatri ed urologi dell’adulto mediante l’invio online di un questionario anonimo per verificare quale sia la loro percezione dei problemi e delle criticità legati al transitional care. Lo step successivo, già avviato da alcuni anni, è quello dell’implementazione del moderno progetto di transizione di cura, stimolando ad ogni livello, politico-istituzionale, scientifico-universitario, l’indispensabile interazione-integrazione culturale, favorendo un atteggiamento “fluido” nel trasferimento bidirezionale dell’esperienza urologica pediatrica verso quella dell’adulto e viceversa. Risultati. Il risultato atteso ed auspicabile è quello dell’attivazione sul territorio nazionale di alcune task force

di specialisti esperti in urologia funzionale e chirurgia ricostruttiva di complesse malformazioni genito-urinarie, reclutati nei rispettivi ambiti dell’area pediatrica e dell’adulto sulla base di criteri irrinunciabili: interesse, formazione ed esperienza clinica riconosciuta e validata da organismi scientifici ed istituzionali (società scintifiche ,università, agenzie regionali della salute, associazioni pazienti-caregivers). L’analisi della sostenibilità finanziaria del progetto sarà delegata a specifiche competenze del Ministero della Salute, dell’Assessorato alla Salute delle singole Regioni, alle Direzioni Generali delle Aziende Ospedaliere selezionate per la realizzazione del progetto di transitional care. Lo studio ha avuto finanziamenti: No Conflitto d’interessi: No

C_51 LAPAROSCOPYC-ASSISTED LAPAROSCOPIC YVPLASTY IN PATIENTS WITH REFRACTORY BLADDER NECK CONTRACTURE: 2 YEARS FOLLOW UP Di Marco M, Parascani R, Fraioli A, Avitabile C, Tasca A. U.O. Urology Clinica Guarnieri - Rome.

Introduction. Bladder neck contracture (BNC) in the adult male patient is iatrogenic following radical prostatectomy. There is general agreement on initial treatment comprising endoscopic procedures like balloon dilation, bladder neck incision. We present patients with refractory BNC treated with laparoscopyc YV-plasty of the bladder neck (LYV). Material and Methods. Three males 70-75 years old patient underwent to a retropubic open prostatectomy out of our clinic. They had 2 unsuccessful endoscopyic treatments each like balloon dilatation and bladder neck incision. Previous cistoscopy, cystogram and uroflowmetry test were performed and then we underwent patients to LYV. Results. Surgical technique of LYV is described in picture at right side. The procedures was performed using a transperitoneal six-port approach with the patients in Trendelenburg position. The bladder neck was identified. Then the Y incision is performed through all layers with cold scissors. Thereafter, interrupted sutures are placed in the way that the apex of the V-flap is brought to the base of the Y incision, so that a wide bladder neck is accomplished. There were no intraoperative and postoperative complications. The postoperative hospital stay was 5 days. We performed cystogram and catheter remouval after 21 days. The follow up at 3,6 12 and 18 months show a good uroflowmetry.

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Conclusions. This is our first long term report on LYV for refractory BNC. The results was successful and Preoperative Uroflometry

Post operative Uroflometry (3 months)

Post operative Cystogram (3 months)

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encouraging us to continue experience. Lo studio ha avuto finanziamenti: No Preoperatve Cystogram

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C_52 TRANS OBTURATOR MALE SLING FOR TREATMENT OF STRESS URINARY INCONTINENCE AFTER RADICAL PROSTATECTOMY: 12 MONTHS FOLLOW UP Di Marco M, Parascani R, Fraioli A, Avitabile C, Tasca A. U.O. Urology Clinica Guarnieri - Rome.

Introduction and Aim. Post-prostatectomy incontinence remains a problem. In order to minimize surgical morbidity and costs, sling procedures have been proposed. The authors have developed a transobturator male sling procedure and report their results after oneyear experience. Material and Methods. The restoring of urethral sphincter continence is due to a cranial relocation of the proximal urethral corpus spongiosum. 64 patients with SUI due to non-intrinsic sphincter deficiency after radical prostatectomy a retrourethral transobturator sling was implanted (Andromesh sling). Patients were followed up for 12 months. Diagnosis was based on 24-hour urine loss measured by a pad test, urodynamic assessment, ICIQ–SF and OAB-q-SF questionnare and cystoscopy. The exlusion criteria were severe detrusor iperactivity and severe stenosys of vescico-urethral anastomosis. A longitudinal perineal incision was made. Boulbocavernoso muscle exposed. Boulbocavernosal fiber divided longitudinally and boulbar urethra exposed. Boulbar urethra was disconnected perineal tendineous centre to allow the pull upward of the external urethral sfincter complex. A two arms polypropylenic sling was implanted, througt obturator foramen, under the boulbar urethra. Tensioning both the two queue of sling the boulbar and membranous urethra was pulled up for 4 cm and repositioned on nomal site. Results. At 1-year followup cure was achieved in 18 pts (28,1%) of patients and improvement was achieved in 34 pts (53,1%) (significant reduce of daily pad). No effect on incontinence was seen in 12 (21%) of patients. The success of treatment did not correlate with patient age or incontinence severity. Complications developed in 5 patients including urinary infection 2pts (3,1%), ematuria 1pts (1,5%), transitory perineal and scrotal hematoma 2pts (3,1%). All were managed conservatively. Conclusions. The transobturator sling suspension operation is minimally invasive, safe procedure for male postoperative stress incontinence.We observed a significant improve of continence and quality life of patients.The follow up shows a permanent improve of the continence or pad use. Lo studio ha avuto finanziamenti: No

C_53 EMBOLIZZAZIONE DELL’IPERPLASIA PROSTATICA: ASPETTI TECNICI E RISULTATI PRELIMINARI Brunori S1, Cerasini M1, Iaboni L1, Mandarano G1, Mastrangeli B1, Vagnarelli S2, Militello A3. 1

Cdc Nuova Itor - Roma;

Osp. San Giovanni Addolorata - Roma;

Cdc Villa Immacolata - Viterbo.

Scopo. Quello di valutare l’efficacia dell’embolizzazione prostatica rispetto alla terapia endourologica standard. Materiali e Metodi. Dal Gennaio 2017 al Marzo 2019, abbiamo trattato con tecnica di embolizzazione prostatica endovascolare, 12 pz con IPB affetti da LUTS con punteggio IPSS tra 20 e 35. Tutti i pazienti, prima dell’intervento sono stati valutati con Visita urologica (DRE senza alcuna caratteristica di allarme), IPSS, IEFF-5, Qol, TRUS (con peso della ghiandola fino a 70 gr e nessun nodulo prostatico), Uroflussimetria con valutazione del RPM, PSA (con valore non oltre 2,8 ng/ml), Hb, esame completo delle urine ed Urinocoltura; abbiamo ripetuto dopo 1 mese l’esame delle urine e l’urinocoltura, dopo 3 mesi Hb e PSA e dopo 6 mesi IPSS con QoL, IIEF5, uroflussometria con RPM. I pazienti sono stati valutati con RM pre-intervento ed ad un mese dalla procedura. L’età media dei pazienti di 66.4 (range 48-83 aa). L’intervento di embolizzazione endovascolare ha comportato un tempo medio d’intervento di 85 min. Abbiamo preso in considerazione anche il tempo di ospedalizzazione, Hb post operatoria ed eventuali complicanze locoregionali e sistemiche. Risultati. Abbiamo osservato un successo tecnico del 100% in assenza di complicanze locoregionali legate all’accesso arterioso e sistemiche. La RM ad 1 mese ha evidenziato la corretta embolizzazione sia in sede periferica che a livello dell’adenoma prostatico in tutti i pazienti con iniziale riduzione volumetrica della ghiandola in toto. Tutti i pazienti sono stati dimessi a 24 ore dall’intervento. In nessun paziente è stata necessaria terapia antalgica endovenosa continua mediante elastomero. Nessun paziente ha avuto necessità di cistoclisi continua la prima notte. Non sono state necessarie emotrasfusioni. Non è stato riferito alcun caso di incontinenza post-operatoria. Lo score IIEF5 a 6 mesi è statisticamente aumentato. Conclusioni. L’embolizzazione dell’iperplasia prostatica si è dimostrata tecnica sicura, efficace, in assenza di complicanze minori e maggiori in questa serie. La riduzione delle complicanze descritte in letteratura e legate all’embolizzazione di vasi non target risulta strettamente dipendente dall’esperienza dell’operatore. La tecnica endovascolare potrebbe essere una valida alternativa rispetto alle tecniche endo-urologiche standard. Archivio Italiano di Urologia e Andrologia 2019; 91, 1, Supplemento 1

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C_54 LASER TULLIO REVOLIX 200 VERSUS SISTEMA PLASMACINETICO GYRUS, COMPARATIVA E BENEFICI DEL LASER NELLA IPB Brunori S1, Cerasini M1, Iaboni L1, Intini G1, Mandarano G1, Mastrangeli B1, Militello A3. 1 2

Cdc Nuova Itor - Roma; Cdc Villa Immacolata - Viterbo.

Scopo. Quello di valutare l’efficacia del Laser Tullio rispetto al sistema plasmacinetico Gyrus bipolare, che il nostro gruppo fin’ora ha utilizzato come procedura standard nel trattamento dei LUTS da BOO da IPB. Riportiamo la nostra esperienza preliminare su 60 pazienti affetti da IPB trattati con Laser tullio Revolix 200. Materiali e Metodi. Dal Gennaio 2018 ad oggi, abbiamo trattato con vaporesezione con Laser tullio, Modello Laser: Revolix 200, marca Lisa Laser Products GmbH, 60 pz con IPB affetti da LUTS con punteggio IPSS tra 20 e 35. Tutti i pazienti, prima dell’intervento sono stati valutati con Visita urologica (DRE senza alcuna caratteristica di allarme), IPSS, IEFF-5, Qol, TRUS (con peso della ghiandola fino a 70 gr e nessun nodulo prostatico), Uroflussimetria con valutazione del RPM, PSA (con valore non oltre 2,8 ng/ml), Hb, esame completo delle urine ed Urinocoltura; abbiamo ripetuto dopo 1 mese l’esame delle urine e l’urinocoltura, dopo 3 mesi Hb e PSA e dopo 6 mesi IPSS con QoL, IIEF5, uroflussometria con RPM. L’età media dei pazienti di 68.6 (range 48-85 aa). La potenza media utilizzata è stata di 160W, il tempo medio di erogazione effettivo di 25 minuti e l’energia media erogata di 160W: 68 kJ ogni 10 minuti. Abbiamo preso in considerazione anche il tempo di ospedalizzazione, Hb post operatoria ed eventuali emotrasfusioni post operatorie. Risultati. Abbiamo osservato un incremento statisticamente significativo del Qmax e una riduzione dell’RPM (p<0,001), dell’IPPS (p<0,001), con riduzione del PSA (p<0,001) dopo 3 mesi. Ad un mese, i risultati dei pz trattati con sistema bipolare erano simili al gruppo Gyrus (p<0,001), per poi continuarlo ad essere dal 3 mese in poi, riguardo sia all’IPSS, che al Qmax, Qave e al RPM. L’unico dato statisticamente diverso è stato rappresentato dalla sintomatologia irritativa che nei pazienti trattati con vapo-resezione è stata maggiore al gruppo bipolare nel primo mese successivo alla procedura. Nei pz sottoposti a vaporesezione abbiamo osservato un periodo di cateterizzazione e di ospedalizzazione più breve rispetto a quelli trattati con sistema bipolare, rispettivamente di 1,7 giorni e 2,8 giorni (rispetto a 1,9 e 3 giorni con sistema bipolare). Due pz hanno avuto necessità di ricateterizzazione, tutti i pz hanno mantenuto la cistoclisi continua la prima notte. Non sono state necessarie emotrasfusioni. Non è stato riferito alcun caso di incontinenza post-operatoria. Lo scoreIIEF5 a 6 mesi è statisticamente aumentato. Conclusioni. Dopo un anno di utilizzo del Laser Tullio Revolix 200 possiamo concludere che questa metodica è estremamete sicura, garantendo una minore degenza

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post-operatoria con un periodo di cateterizzazione più breve, rendendola una sicura alternativa al sistema bipolare senza pero’ dimenticare che non può essere adatta a tutti i pz con LUTS da IPB ma solo in casi ben selezionati. Lo studio ha avuto finanziamenti: No

C_55 EFFECTIVENESS OF A NOVEL ORAL COMBINATION OF D-MANNOSE, POMEGRANATE EXTRACT, PREBIOTICS AND PROBIOTICS (PROLACTIS IVU) FOR TREATING ACUTE UNCOMPLICATED CYSTITIS: RESULTS OF A PILOT STUDY Pugliese D1, Acampora A2, Porreca A3, Schips L4, Cindolo L1. 1

Department of Urology “Villa Stuart” Private Hospital, Rome, Italy;

Institute of Public Health, Catholic University of Sacred Heart, Rome, Italy; 3 Department of Robotic Urological Surgery, Abano Terme Hospital,

Abano Terme, Italy; 4

Department of Urology, “G. D'Annunzio” University, Chieti, Italy.

Title. Urinary tract infection (UTI) is defined as the presence of pathogens in the urinary tract, is typically diagnosed by microscopy and culture of urine samples, and is among the most common bacterial infections in Western Countries. Up to one third of women after their first UTI experience recurrence or persistence of symptoms and this results in high costs to the health system and symptoms burden for the patients. Over the long term antibiotic courses, alternative prophylactic methods as probiotics, cranberry juices and D-mannose have been introduced and studied. Aim. The present study aimed to determine whether a new combination of D-Mannose, Pomegranate extract, Prebiotics and Probiotics is effective in modifying a specific questionnaire in women with acute uncomplicated cystitis. Material and Methods. This is a pilot study, performed between September 2018 and November 2018 at the Department of Urology of Villa Stuart Private Hospital. A dose of a new combination (Prolactis IVU©, Omega Pharma, Cantù, Italy) compound was administered twice daily for 5 days and then once a day for 10 days. Together with the compound, a forced hydration (>2 liters/day) has been strongly suggested. Antibiotics were permitted only in case of clinical worsening. Changes in patients’ symptoms, the therapeutic effects and changes in quality of life (QoL) were evaluated clinically and using a specifically validated questionnaire (ACSS) at the first visit (T0), 15 (T1) and 30 (T2) days later. Results. 33 patients were enrolled (mean age 38y), 21% were postmenopausal, 24% had a clinically significant cystocele, 27% suffered from diabetes. About 79% reported <3 episodes of UTI/year. At first follow-up visit (f-up), all symptoms or the majority of symptoms went off in 10 women (30.3 %) and at second f-up visit in 30 women (90.9 %); some symptoms still remained

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XXIV Congresso Nazionale UrOP - Abstracts

in 16 women (48.5 %) at first f-up visit and in 3 women (9.1%) at second f-up visit; the persistence of all symptoms or the worsening of the condition was observed in 7 patients (21.2%) at first f-up visit and in none of the patients at second f-up. Regarding the mean score at the ACSS subscales, the analysis showed a significant reduction in all the sub-scales (typical, differential and quality of life) between first visit and both the first and the second f-up visit, and between the first and the second f-up. The reported mean score in typical symptoms at baseline was 11.5 (10.5 to 12.6), falling to 4.9 (4.0 to 5.9) at first f-up and to 2.7 (2.1 to 3.3) at the second one (p-values <0.0001). The mean score in differential symptoms was 3.1 (2.6 to 3.6) at baseline, falling to 0.6 (0.3 to 0.9) at first fup and to 0.3 (0.1 to 0.5) at the second one (p-values 0.009 to <0.0001). Lastly, the QoL mean score was 7.2 (6.7 to 7.7) at baseline, falling to 4.0 (3.3 to 4.6) at first f-up and to 1.7 (1.2 to 2.1) at the second (p-values <0.0001). The adherence to the prescribed therapy has been >98%, 6 patients required antibiotics. No adverse events were recorded. Conclusions. Our study suggest that the synergistic action of the different compounds of this new combination could help the bacterial washout, resulting in an effective management of acute cystitis in women without antibiotics in a wide majority of the cases. However, longer studies will ascertain the prophylactic potential of this combination and larger studies are needed to confirm the results. Lo studio ha avuto finanziamenti: No Conflitto d’interessi: No

P_10 DETRUSOR UNDERACTIVITY: ARE DIFFERENT DIAGNOSTIC CRITERIA OFTEN RELIABLE IN CLINICAL PRACTICE? Rapisarda S1, Polara A2, Bada M1, Russo GI1, Lombardo R3, Cimino S1, Tubaro A3, Grosso G2. 1

University of Catania, Policlinico Gaspare Rodolico;

Ospedale Pederzoli, Peschiera del Garda;

Ospedale S.Andrea, Roma.

Introduction and Objectives. Detrusor underactivity (DU) is a common clinical problem in patient being referred with lower urinary tract symptoms (LUTS). DU is defined as a contraction of reduced strenght and/or duration, resulting in prolonged bladder emptying and/or failure to achieve complete bladder emptying within a normal time span (ICS in 2003). However, the majority of published criteria concentrate on detrusor strenght with the combinations of maximal flow rate (Qmax) and maximal detrusor pressure at Qmax (Pdet/Qmax) resulting incomplete consequence with regarde to definition perspective. Finally, many other tools have been proposed with the aim of chacterizing DU, but specific recommendations have been made on this regarding.

The aim of our study is to evaluate the diagnostic performance of different DU definitions in a large cohort of patients undergoing urodynamic study. Material and Methods. We prospectively collected data of patients receiving urodynamic examination from February 2010 to September 2018 according to EAU guidelines. Urodynamic exam has been performed on the basis of ICS recommendations. DU has been considered as the presence of a defined as detrusorial pressure (pDet)/Qmax < 30 cmH20 and it has been considered as the reference variable. We also calculated different variables including: bladder contractility index (BCI), watt factor (WF) and bladder voiding efficiency (BVE). The following cut-offs have been considered as suggestive for DU according to previious literature data: BCI < 100, BVE < 100, WF80 < 10. Results. In total, 792 patients have been included, 65.1% male and 34.9% female. The median age was 63.0 yrs (interquartile range: 47.0-71.0). 232 pts (29.29%) had a Pdet/Qmax < 30 cmH20, 590 (74.49%) had a BVE < 100, 370 (46.72%) had a BCI < 100 while 540 (68.2%) had a WF80 < 10. The agreements using the kappa Cohen’s coefficients between PdetQmax and the other parameters were as following: with BCI was 77.53% (p<0.01), with BVE was 36.87% (p=0.98) and with WF80 was 48.66% (p<0.01). At the univariate logistic regression analysis, BCI < 100 (odds ratio [OR]: 26.96; p<0.01), BVE < 100 (OR: 1.44; p=0.03) and WF80 < 10 (OR: 5.35; p<0.01) were associated with PdetQmax < 30 cmH20. We performed a bivariate logistic regression combining BCI < 100 with the other parameters and we showed that BCI (OR 0.94; p<0.01) and W80 (OR: 0.89; p=0.02) were both associated with DU. Finally, the decision curve analysis showed clinical benefit of BCI in predicting DU, with slightly increase in net benefit of BCI+WF80 over BCI. Conclusions. We found that BCI and WF80 exhibited agreement with PdetQmax for assessing DU and that combining both variables add clinical benefit in predicting DU. We suggest in improving definition of DU by investigating the clinical benefits of other variables for assessing DU. Lo studio ha avuto finanziamenti: No Conflitto d’interessi: No

Archivio Italiano di Urologia e Andrologia 2019; 91, 1, Supplemento 1

abstract Sinistra.qxp_Stesura Seveso 16/05/19 13:57 Pagina 58

XXIV Congresso Nazionale UrOP - Abstracts

P_11 ENERGY IMPACT ON VOIDING SYMPTOMS AFTER THULIUM ENUCLEATION OF PROSTATE: A LARGE MULTI INSTITUTIONAL ANALYSIS Nazzani S1, Motta G1, Blezien O1, Vizziello D1, Signorini C1, Maruccia S2, Casellato S2, Acquati P1, Stubinski R1, Carmignani LF1. 1

IRCCS Policlinico San Donato, Dept. of Urology, Milan, Italy;

Istituti Clinici Zucchi, Dept. of Urology, Monza, Italy.

Introduction and Objectives. Impact of energy delivery during enucleation of prostate on storage symptoms is still unknown. We aimed to test how energy delivery influences postoperative storage symptoms in a large cohort of benign prostatic obstruction patients who underwent Thulium enucleation of prostate (ThuVep). Material and Methods. Within our multi-institutional database with prospective collected data we selected patients treated with ThuVep (Quanta System Cyber TM 200 W). Preoperative, 7 days and 30 days International Prostatic Symptoms Score (IPSS) questionnaires were administered. Storage symptoms were considered as frequency, urgency and nocturia according to IPSS questionnaire. Energy administered during the procedure was recorded and its ratio with trans rectal ultrasound prostate size was calculated. Finally, patients were stratified according to median energy delivered per gram of prostate. The statistical significance of dif-

Archivio Italiano di Urologia e Andrologia 2019; 91, 1, Supplemento 1

ferences in medians and proportions was tested with the Kruskal-Wallis and chi-square tests. Results. Between 2014 and 2018, we identified 228 patients treated with ThuVep. Median prostate volume was 70 [Interquartile Range: (IQR) 50-104 grams] and median energy delivered per gram was 3207 Joule (IQR: 1904 - 4956 Joule). Median operative time was 86 minutes. Low energy (<3207 Joule) patients were less frequently in antiplatelet (10.5% vs 26%; p=0.01) and anticoagulant therapy (2.6% vs 7.9%; p=0.01). Preoperative urgency (1.5 vs 1.5; p=1), frequency (1.7 vs 1.9; p=0.7) and nocturia (2.3 vs 2.5; p=0.3) were similar in the two cohorts. Similarly, no differences were found in term of preoperative indwelling catheter. Hemoglobin drop (-0.9 vs -0.7 grams/dL; p=0.03) and catheterization time were lower (37 vs 30; p=0.05) in high energy patients. 7 and 30 days urgency and frequency were comparable in the two cohorts. Finally, 7 days nocturia was higher (1.8 vs 2.3; p=0.1) in high energy patients, albeit in a non significant fashion. Conclusions. Based on our results no statistically significant difference exist in term of overall storage symptoms according to energy per gram delivered. Conversely, 7 days nocturia appears to be more frequent in high-energy patients. However, no statistically significant difference was found. Finally, highenergy patients had lower catheterization time and hemoglobin drop. Conflitto dâ&#x20AC;&#x2122;interessi: No

Atlante pubb congresso facebook.qxp_Stesura Seveso 30/04/19 12:36 Pagina 1

ATLANTE di ECOGRAFIA UROLOGICA, ANDROLOGICA e NEFROLOGICA

ATLANTE di ECOGRAFIA UROLOGIC ANDROLOGA, NEFROLOG ICA e ICA

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