Effect of body mass and physical activity at younger age on the risk of prostatic enlargement and erectile dysfunction : Results from the 2018 #Controllati survey

Objective: Overweight and low physical activity (PA) increase the risk of prostatic enlargement and erectile dysfunction (ED). Less clear is the role of these factors at young age on the lifelong risk. Materials and methods: During June 2018 the Italian Society of Urologists organized the month of Male Urologic Prevention "#Controllati". Men aged 18 years or more were invited to attend urologic centers for a visit and counselling about urologic/andrologic conditions. Each participating man underwent a physical examination and was asked about urologic symptoms, sexual activity and possible related problems. Results: We analyzed data from 2786 men, aged 55.1 years (SD 10.9, range 19-97). A total of 710 (25.5%) subjects had a diagnosis of prostatic enlargement and 632 (22.7%) of DE. Overweight/obese men were at increased risk of prostatic enlargement and ED with corresponding odds ratio (0R) in comparison with normal or underweight men, being respectively 1.18 (95% Confidence Interval (CI) 1.00-1.44) and 1.69 (95% CI 1.39-2.05). The OR of prostatic enlargement in comparison with men reporting at age 25 a BMI < 25.0 was 1.22 (95% CI 1.01-1.51) for men with a BMI at 25 years of age 65 25; the corresponding OR value for ED was 1.17 (0.92- 1.48). Considering total PA at diagnosis, the OR of prostatic enlargement in comparison with no or low PA, was 0.69 (95%CI 0.55-0.86) for men reporting moderate PA and 0.75 (95%CI 0.58-0.98) for those reporting intense PA. When we considered PA at 25 years of age, the OR of subsequent diagnosis of prostatic enlargement, in comparison with men reporting no/low PA at 25 years of age was 0.81 (95%CI 0.63-1.04) for men reporting moderate PA and 0.70 (95%CI 0.52-0.99) for those reporting intense PA. Conclusions: These findings underline the utility of encouraging healthy lifestyle habits among young men in order to reduce the subsequent risk of prostatic enlargement and ED

Comparison between "In-bore" MRI guided prostate biopsy and standard ultrasound guided biopsy in the patient with suspicious prostate cancer: Preliminary results.

OBJECTIVES: To evaluate the detection rate of prostate cancer (PCa) in patients who underwent to "in bore" Magnetic Resonance Imaging -guided prostate (MRI-GB) biopsy compared to the standard transrectal ultrasound guided prostate biopsy (TRUS-GB). MATERIALS AND METHODS: Between January 2017 and March 2015 a cohort of 39 consecutive patients was prospectively enrolled. All the patients underwent an "in-bore" guided MRI prostatic biopsy and subsequently ultrasound-guided standard prostate biopsy. RESULTS: Median age of patients was 65.5 years (SD \ub1 6.6), median total PSA serum level was 6.6 ng/ml (SD \ub1 4.1), median prostate total volume was 51.1 cc (SD \ub1 26.7). Thirty of 39 (76.9%) were biopsy-na\uefve patients while 7/39 (17.9%) had at least one previous negative random TRUS-GB; 2/39 (5.1%) patients were already diagnosed as PCa and were on active surveillance. In 18/39 (53.8%) men Pca was diagnosed; as regards the MRI-GB results related to the PI-RADS score, biopsies of PIRADS 3 lesions were positive in 5/18 cases (27.8%), while the number of positive cases of PI-RADS 4 and 5 lesions was 7/11 (63.6%) and 6/10 (60%)respectively. At the histological examination, 4/39 (10.3%) had a PCa ISUP grade group 1, 11/39 (28.2%) had a ISUP 2, 6/39(15.4%) had a ISUP grade group 3 and 2/39 (5.1%) had a ISUP 4-5. CONCLUSIONS: MRI-GB represents a promising technique that may offer some of advantages compared to standard systematic TRUSGB. Our preliminary experience in MRI-GB resulted safe and feasible and represents a viable procedure for the diagnosis and characterization of PCa

Does Exist a Differential Impact of Degarelix Versus LHRH Agonists on Cardiovascular Safety? Evidences From Randomized and Real-World Studies

The main systemic therapy for the management of hormone-sensitive prostate cancer (PC) is androgen deprivation therapy (ADT), with the use of long-acting luteinizing hormone releasing-hormone (LHRH) agonists considered the main form of ADT used in clinical practice to obtain castration in PC. The concomitant administration of antiandrogens for the first weeks could reduce the incidence of clinical effects related to the testosterone flare-up in the first injection of LHRH. On the contrary, Gonadotropin Rh (GnRH) antagonists produce a rapid decrease of testosterone levels without the initial flare-up, with degarelix commonly used in clinical practice to induce castration in PC patients. Even if no long-term data are reported in terms of survival to define a superiority of GnRH or LHRH, for oncological efficacy and PC control, data from randomized clinical trials and from real-life experiences, suggest a difference in cardiovascular risk of patients starting ADT. The age-related decline in testosterone levels may represent a factor connected to the increase of cardiovascular disease risk, however, the role of ADT in increasing CV events remains controversial. For these reasons, the aim of the paper is to synthesize the difference in cardiovascular risk between LHRH and degarelix in patients undergoing ADT. A difference in cardiovascular risk could be indeed an important parameter in the evaluation of these two forms of castration therapy. The Randomized trials analyzed in this paper sustain a possible protective role for degarelix versus LHRH agonists in reducing the rate of new CV events and interventions in the short-term period. On the contrary, real-word data are contradictory in different national experiences and are strongly conditioned by huge differences between the LHRH agonists group and the degarelix group

Mini-invasive robotic assisted pyelolithotomy: Comparison between the transperitoneal and retroperitoneal approach.

OBJECTIVE: To compare the retroperitoneal with the transperitoneal approach in a series of patients underwent to robotic-assisted pyelolithotomy (RP). MATERIALS AND METHODS: From January 2015 to December 2018 we evaluated 20 patients subjected to robotic pyelolithotomy; 11 patients were treated with retroperitoneal approach (RRP) and 9 with transperitoneal approach (TRP). For each patient intra and perioperative data were recorded: operative time (OT), blood loss (BL), length of hospital stay (LOS), stone clearance, post-operative complications and time to remove the drain. The presence of stone fragments < 4 mm was considered as stone free rate. RESULTS: The principal stone burden was greater in the TRP group than in the RRP group (48 ± 10 mm vs 32 ± 14 mm, p = 0.12). Preoperative hydronephrosis was present in 7 (64%) patients in RRP group and a mild hydronephrosis in 3 of TRP group (p = 0.04). The average operative time was higher in the RRP group than in the TRP group (203 ± 45 min vs 137 ± 31 min, p = 0.002). The average blood loss was 305 ± 175 ml in the RRP group versus 94 ± 104 ml in the TRP group (p = 0.005). The stone free rate was similar between the two groups, 36% (4 patients) in the RRP group and 44% (4 patients) in the TRP (p = 0.966). CONCLUSIONS: RP appears to be a safe and effective minimally invasive treatment for some patients with renal staghorn calculi or urinary tract malformations. The TRP may give lower operative time and better results in terms of blood loss and length of hospital stay

ROBOT-ASSISTED LAPAROSCOPIC HYSTEROSACROPEXY FOR PELVIC ORGAN PROLAPSE

Introduction Pelvic organ prolapse (POP) surgery can be performed either transperineally or transabdominally. The individual woman\u2019s surgical history and goals, as well as her individual risk for surgical complications, prolapse recurrence and de novo symptoms impact the selection of surgical route. Transabdominal repairs are the most common surgical procedures for POP and are associated to recurrence rates up to 10%, whereas transperineal approaches are reported to be a source of higher recurrence rates. Transabdominal procedures can be performed either by laparotomy or by laparoscopy. Recently several series have reported that laparoscopic approach to treat POP (with or without robotic assistance) is feasible and safe with good short and intermediate-term results, comparable to open approaches. This paper describes the technical aspects of robot-assisted laparoscopic hysterosacropexy (RALHSP) using the da Vinci surgical system. Design Since 2006, 10 consecutive patients with POP (mean age 54.5 years), who wished to preserve the uterus, underwent RALHSP as single reconstructive procedure. Two surgeons performed all procedures with the same technique. All complications were collected at a 90-day follow-up using the standardised Clavien classification system. The following outcomes were evaluated: operative time, blood loss, complications, in hospital stay, catheterization time, cure rate. The surgical steps were: bilateral dissection of the perimetrium; identification and extraperitonealization of the uterine cervix; incision of the peritoneum at presacral level and distal to the cervix; placement of a 20 x 2.5 cm polypropylene mesh, willing to embrace the cervix, secured to the anterior longitudinal sacral legament with 0 Tycron stitches; mesh extraperitonealization. Results Al procedures were performed successfully using the Robot-assisted approach. No additional reconstructive procedures were thought to be necessary at the end of surgery. The mean operative time was 103 minutes; the mean blood loss was 18 mL. Neither intra- nor major post-operative complications occurred. According to the Clavien classification system, 4 patients (40%) had grade 1 early complications (two nausea episodes, two electrolyte disturbance); and one patient (10%) had grade 2 complication (diarrhoea). At a mean follow-up of 9.3 months all patients declared themselves satisfied with the anatomical and functional results achieved. Conclusion RALHSP represents an effective option for the management of POP in selected women who wish to preserve the uterus. Moreover da Vinci robotic system allows performing similar procedures to those performed by standard laparoscopy or laparotomy without increasing the morbidity rate when compared to standard laparoscopy, and allows the same functional results

ROLE OF SYMPTOMS DURATION AS PROGNOSTICATOR FOR SACRAL NEUROMODULATION IN REFRACTORY OVERACTIVE BLADDER

Hypothesis / aims of study Sacral neuromodulation (SNM) offers a well-tolerated treatment option for patients with overactive bladder syndrome (OAB) refractory to conservative treatment. The advantageous effect of SNM depends on the accurate identification of suitable candidates during pre-implant percutaneous nerve evaluation. In the Literature there are conflicting data regarding the role of age, duration of complaints and neurogenic bladder dysfunction in predicting the effect of SNM, and up to-date no specific urological pre-treatment factors have been associated with response to SNM. The aim of this multicentric study was to investigate data from 103 patients with refractoy OAB who underwent SNM implant in order to evaluate the role of symptoms duration as possible pre-treatment prognosticator. Study design, materials and methods From September 2001 to November 2010 a total of 103 patients attending four different urological centres with refractory OAB underwent a temporary SNM implant. Patient data (demographics, medical history,urologic investigations, and diagnosis) were collected. Temporary implant results were evaluated from a voiding diary and patient history. More than 50% improvement of voiding parameters was considered a successful SNM and those patients were selected for implantation. We test the duration of complaints as prognosticator for predicting SNM result. We performed the Pearson correlation analysis. For comparison between groups either Student's t test or Mann-Whitney test were used, as appropriate. Results Eighty patients (77%) underwent a definitive implant. At a mean follow-up of 25.2 \uf0b1 22.9 months we observed a significant decrease (p<0.001) in the mean number of incontinence episodes/die (1.3\ub1 1.9 versus 4.6\ub12.4), number of pads/die (1.2 \ub1 1.4 versus 3.7 \ub1 2.2), daily urinary frequency (8.7 \ub1 2.8 micturitions/die versus 12.7 \ub1 4.8). Stratifying patients according to the lower urinary tract dysfunction aetiology (idiopathic, neurogenic, iatrogenic), we did not find any significant correlation between symptoms duration (neither as continuous nor categorical variables) and the improvement rates of incontinence episodes (figures 1-2), and micturition frequency (figures 3-4), although we observed better results mainly in neurogenic patients with < 4- year history of urinary symptoms (figure 5). Interpretation of results Patients with urgency and urge urinary incontinence due to neurogenic lower urinary tract dysfunction for a relatively long period of time may have a lower chance of a positive test compared with patients with neurogenic dysfunction for a relatively short period. Concluding message Duration of complaints was not found to be significant predictive factor for the success of SNM. Disclosure

Enhanced Immunogenicity of Mitochondrial-Localized Proteins in Cancer Cells.

Epitopes derived from mutated cancer proteins elicit strong antitumor T-cell responses that correlate with clinical efficacy in a proportion of patients. However, it remains unclear whether the subcellular localization of mutated proteins influences the efficiency of T-cell priming. To address this question, we compared the immunogenicity of NY-ESO-1 and OVA localized either in the cytosol or in mitochondria. We showed that tumors expressing mitochondrial-localized NY-ESO-1 and OVA proteins elicit significantdly higher frequencies of antigen-specific CD8+ T cells in vivo. We also demonstrated that this stronger immune response is dependent on the mitochondrial location of the antigenic proteins, which contributes to their higher steady-state amount, compared with cytosolic localized proteins. Consistent with these findings, we showed that injection of mitochondria purified from B16 melanoma cells can protect mice from a challenge with B16 cells, but not with irrelevant tumors. Finally, we extended these findings to cancer patients by demonstrating the presence of T-cell responses specific for mutated mitochondrial-localized proteins. These findings highlight the utility of prioritizing epitopes derived from mitochondrial-localized mutated proteins as targets for cancer vaccination strategies.S

CdZnTe detectors tested at the DA{\Phi}NE collider for future kaonic atoms measurements

The SIDDHARTA-2 collaboration at the INFN Laboratories of Frascati (LNF) aims to perform groundbreaking measurements on kaonic atoms. In parallel and beyond the ongoing kaonic deuterium, presently running on the DA$\Phi$NE collider at LNF, we plan to install additional detectors to perform further kaonic atoms' studies, taking advantage of the unique low energy and low momentum spread $K^-$ beam delivered by the at-rest decay of the $\phi$ meson. CdZnTe devices are ideal for detecting transitions toward both the upper and lower levels of intermediate-mass kaonic atoms, like kaonic carbon and aluminium, which have an important impact on the strangeness sector of nuclear physics. We present the results obtained in a set of preliminary tests conducted on DA$\Phi$NE, in view of measurements foreseen in 2024, with the twofold aim to tune the timing window required to reject the extremely high electromagnetic background, and to quantify the readout electronics saturation effect due to the high rate, when placed close to the Interaction Region (IR). In the first test we used commercial devices and electronics, while for the second one both were customized at the IMEM-CNR of Parma and the University of Palermo. The results confirmed the possibility of finding and matching a proper timing window where to identify the signal events and proved better performances, in terms of energy resolution, of the custom system. In both cases, strong saturation effects were confirmed, accounting for a loss of almost 90\% of the events, which will be overcome by a dedicated shielding structure foreseen for the final experimental setup

First measurement of kaonic helium-4 M-series transitions

In this paper we present the results of a new kaonic helium-4 measurement with a 1.37 g/l gaseous target by the SIDDHARTA-2 experiment at the DA{\Phi}NE collider. We measured, for the first time, the energies and yields of three transitions belonging to the Mseries. Moreover, we improved by a factor about three, the statistical precision of the 2p level energy shift and width induced by the strong interaction, obtaining the most precise measurement for gaseous kaonic helium, and measured the yield of the L{\alpha} transition at the employed density, providing a new experimental input to investigate the density dependence of kaonic atoms transitions yield.Comment: 12 pages, 5 figures, 3 table

Transperitoneal vs retroperitoneal minimally invasive partial nephrectomy: comparison of perioperative outcomes and functional follow-up in a large multi-institutional cohort (The RECORD 2 Project)

Background Aim of this study was to evaluate and compare perioperative outcomes of transperitoneal (TP) and retroperitoneal (TR) approaches in a multi-institutional cohort of minimally invasive partial nephrectomy (MI-PN). Material and methods All consecutive patients undergone MI-PN for clinical T1 renal tumors at 26 Italian centers (RECORd2 project) between 01/2013 and 12/2016 were evaluated, collecting the pre-, intra-, and postoperative data. The patients were then stratified according to the surgical approach, TP or RP. A 1:1 propensity score (PS) matching was performed to obtain homogeneous cohorts, considering the age, gender, baseline eGFR, surgical indication, clinical diameter, and PADUA score. Results 1669 patients treated with MI-PN were included in the study, 1256 and 413 undergoing TP and RP, respectively. After 1:1 PS matching according to the surgical access, 413 patients were selected from TP group to be compared with the 413 RP patients. Concerning intraoperative variables, no differences were found between the two groups in terms of surgical approach (lap/robot), extirpative technique (enucleation vs standard PN), hilar clamping, and ischemia time. Conversely, the TP group recorded a shorter median operative time in comparison with the RP group (115 vs 150 min), with a higher occurrence of intraoperative overall, 21 (5.0%) vs 9 (2.1%);p = 0.03, and surgical complications, 18 (4.3%) vs 7 (1.7%);p = 0.04. Concerning postoperative variables, the two groups resulted comparable in terms of complications, positive surgical margins and renal function, even if the RP group recorded a shorter median drainage duration and hospital length of stay (3 vs 2 for both variables),p &lt; 0.0001. Conclusions The results of this study suggest that both TP and RP are feasible approaches when performing MI-PN, irrespectively from tumor location or surgical complexity. Notwithstanding longer operative times, RP seems to have a slighter intraoperative complication rate with earlier postoperative recovery when compared with TP