Minimally invasive simple prostatectomy: Robotic-assisted versus laparoscopy. A comparative study

Purpose: Robotic-assisted simple prostatectomy (RASP) is a novel surgical procedure for the management of obstructive symptoms caused by enlarged prostate glands. Before the introduction of minimally invasive techniques, the standard approach was the open simple prostatectomy (OSP). The aim of our study was to compare intraoperative and perioperative outcomes of robotic (RASP) and laparoscopic (LSP) simple prostatectomy. Methods: We retrospectively analyzed data from patients who underwent minimally invasive simple prostatectomy at the Urological Department of Portogruaro Hospital, Portogruaro, and at the Urological Department of "San Bassiano" Hospital, in Bassano del Grappa, from March 2015 to December 2020. Data collected from medical records included age, body mass index, prostate volume, operative time, preoperative International Prostatic Symptoms Score (IPSS), postoperative IPSS, time with drainage, blood transfusion, intraoperative complications, perioperative complications and length of hospital stay. Results: Robotic-assisted (n = 25) and laparoscopic simple prostatectomy (n = 25) were performed with a transvesical approach. No significant differences were observed regarding baseline characteristics, body mass index, prostate volume and IPSS. Operative time was lower in the laparoscopic group (122 min vs 139 min) (p = 0.024), while hospital stay was lower in the robotic group (4 days vs 6 days) (p = 0.047). Conclusions: Robotic-assisted simple prostatectomy is a safe technique with results comparable to laparoscopic simple prostatectomy, encompassing the advantage of a shorter hospitalization. Considering the costs and the limited availability of robotic-assisted simple prostatectomy, laparoscopic simple prostatectomy is a valid and safe alternative for experienced surgeons

Toxicity of antioxidant supplements in patients with male factor infertility: A systematic review and meta-analysis of randomized controlled trials

Treating oxidative stress through antioxidant therapy has been considered an appealing strategy in the management of male infertility. However, evidence regarding the toxicity of an-tioxidant therapy is controversial. We summarized the available clinical evidence on the toxicity associated with the use of antioxidants in infertile males. A systematic review was performed in March 2021. We included randomized controlled trials evaluating the incidence of adverse events in male patients with infertility receiving antioxidant therapy. Thirteen studies involving 1999 male patients were identified. Antioxidant supplementation in patients with male factor infertility was associated with a statistically significantly increased risk of nausea (Odds Ratio: 2.16, 95% Confidence Interval: 1.05–4.43, p = 0.036), headache (Odds Ratio: 3.05, 95% Confidence Interval: 1.59– 5.85 p = 0.001), and dyspepsia (Odds Ratio: 4.12, 95% Confidence Interval: 1.43–11.85, p = 0.009) compared to a placebo. Treatment discontinuation due to adverse events was not significantly higher in patients taking antioxidants compared to a placebo (Odds Ratio: 2.29, 95% Confidence Interval: 0.76–6.88, p = 0.139). When antioxidant supplementation is considered, a more accurate risk/benefit analysis is warranted

Impact of Circadian Desynchrony on Spermatogenesis: A Mini Review

The purpose of this mini review is to provide data about pre-clinical and clinical evidence exploring the impact of circadian desynchrony on spermatogenesis. Several lines of evidence exist demonstrating that disruption of circadian rhythms may interfere with male fertility. Experimental knock-out or knock-down of clock genes, physiologically involved in the regulation of circadian rhythms, are associated with impairments of fertility pathways in both animal and human models. Moreover, disruption of circadian rhythms, due to reduction of sleep duration and/or alteration of its architecture can negatively interfere in humans with circulating levels of male sexual hormones as well as with semen parameters. Unfortunately, current evidence remains low due to study heterogeneity

The Role of Testosterone in the Elderly: What Do We Know?

Testosterone is the most important hormone in male health. Aging is characterized by testosterone deficiency due to decreasing testosterone levels associated with low testicular production, genetic factors, adiposity, and illness. Low testosterone levels in men are associated with sexual dysfunction (low sexual desire, erectile dysfunction), reduced skeletal muscle mass and strength, decreased bone mineral density, increased cardiovascular risk and alterations of the glycometabolic profile. Testosterone replacement therapy (TRT) shows several therapeutic effects while maintaining a good safety profile in hypogonadal men. TRT restores normal levels of serum testosterone in men, increasing libido and energy level and producing beneficial effects on bone density, strength and muscle as well as yielding cardioprotective effects. Nevertheless, TRT could be contraindicated in men with untreated prostate cancer, although poor findings are reported in the literature. In addition, different potential side effects, such as polycythemia, cardiac events and obstructive sleep apnea, should be monitored. The aim of our review is to provide an updated background regarding the pros and cons of TRT, evaluating its role and its clinical applicability in different domains

Flavoxate: present and future

OBJECTIVE: This non-systematic review discusses the available evidence on the use of flavoxate in the treatment of overactive bladder (OAB). METHODS: Medline was searched for inclusion of relevant studies. No limitations in time were considered. RESULTS: Flavoxate hydrochloride is an antispasmodic agent which exerts an inhibition of the phosphodiesterases, a moderate calcium antagonistic activity, and a local anesthetic effect. Results from preclinical and clinical studies show that flavoxate significantly increases bladder volume capacity (BVC), with greater results if compared to other drugs such as emepronium bromide and propantheline. Moreover in clinical trials, both versus placebo or versus active comparators, flavoxate treatment was associated with a significant improvement in different low urinary tract symptoms, such as diurnal and night frequency, urgency and urinary incontinence, suprapubic pain, dysuria, hesitancy and burning. In addition flavoxate was associated with an overall more favourable safety profile than competitors. CONCLUSIONS: Several researches and a number of years of clinical practice have proven the efficacy and tolerability of flavoxate administration in the treatment of OAB and associated symptoms. However, new studies are necessary to collect more evidence on the role of this molecule in the treatment of OAB and to further explore its use in other indications such as symptomatic treatment of lower urinary tract infections

Male to female transsexualism.

The transsexual is a person who suffers from a deep identity disturbance caused by physical characteristics which do not correspond to mental traits and tendencies. The persistent sense of contradiction between his or her deceptive sexual appearance and his or her inner perception, causes a strong desire to achieve harmonization of the two. This aspiration, even if modification of chromosomal sex is impossible, can be fulfilled by undergoing SRS (Sex Reassignment Surgery). SRS represents the last major step of a clinical, therapeutic and diagnostic program involving skilled professionals in the physical and psychological sciences. Their assistance and counseling helps the patient to calmly and consciously decide to undergo SRS. A surgeon has the obligation not only to validate the operation outcome, but to also to maintain a long-term follow-up. A transsexual is not just like any other person; he or she should therefore be treated with sympathy and understanding. The surgeon should try his best to establish a relationship of mutual trust, taking into account the causes of anxiety and stress felt by the patient, and keeping in mind the ultimate objective, which is an improvement in the quality of life. At present, the most widely used surgical techniques are the Simple Penile Skin Inversion, the Penile-scrotal flap Inversion and the enterovaginoplasty. Each surgical technique has its own advantages and disadvantages, and it is up to the surgeon, in discussion with the patient, to make the appropriate choice. The surgical technique performing the Simple Penile Skin Inversion seems to ensure a better cosmetic appearance and an adequate lubrication, but a lower rate of satisfaction, in relation to the neocavity depth. On the contrary, the Penile-Scrotal Flap Inversion guarantees an adequate vaginal depth and lubrication, even though the cosmetic appearance is not always completely satisfactory. In our experience, a significant number of patients were satisfied with the chosen surgery and felt comfortable with their new post-operative gender. Taking into account all the complications involved, none of the patients did regret; actually, they would recommend the same operation to others. The overall results of some studies carried out on patient satisfaction before and after SRS show a marked post-surgery improvement of sexual life