Reliable Prediction of Post-Operative Complications’ Rate Using the G8 Screening Tool: A Prospective Study on Elderly Patients Undergoing Surgery for Kidney Cancer

Abstract: In the last years the incidence of renal neoplasms has been steadily increasing, along with the average age of patients at the time of diagnosis. Surgical management for localized disease is becoming more challenging because of patients’ frailty. We conducted a multi-center prospective study to evaluate the role of the G8 as a screening tool in the assessment of intra and post-operative complications of elderly patients ( 70 y.o.) undergoing surgery for kidney cancer. A total of 162 patients were prospectively enrolled between January 2015 to January 2019 and divided into two study groups (frail vs. not-frail) according to their geriatric risk profile based on G8 score. Several factors (i.e., age, CCI, ASA score, preoperative anemia, RENAL score, surgical procedures, and techniques) were analyzed to identify whether any of them would configure as a statistically significant predictor of surgical complications. According to the G8 Score, 90 patients were included in the frail group. A total of 52 frail patients vs. 4 non-frail patients developed a postoperative complication of any kind (p < 0.001). Of these, 11 were major complications and all occurred in the frail group. Our results suggest that the G8 screening tool is an effective and useful instrument to predict the risk of overall complications in elderly patients prior to renal surgery

MR imaging in patients with male-to-female sex reassignment surgery: Postoperative anatomy and complications

OBJECTIVE: To investigate the role of MRI in the evaluation of both the new female anatomy and complications in male-to-female sex reassignment surgery (MtF-SRS). METHODS: 71 consecutive patients with MtF-SRS had 74 MRI [age range, 21-63 years; mean (\ub1standard deviation) age, 36\u2009\ub1\u200910 years; median age, 37 years]. In 47 patients, MRI was performed to rule out early post-operative complications after gender conversion (n\u2009=\u200940), vaginoplasty (n\u2009=\u20096) or remodelling of the labia majora (n\u2009=\u20091). In 27 patients, MRI was performed 1-20 years after MtF-SRS for late post-operative complications, pain or dysuria, inflammatory changes or poor cosmetic outcome. Three patients had MRI both before and after the operation. RESULTS: MRI allowed investigation of the new female anatomy in all cases. Soon after MtF-SRS, a small amount of blood was identified in all patients around the neoclitoris, urethral plaque and labia. Post-operative complications were clinically significant fluid collections (n\u2009=\u20095), labial abscesses (n\u2009=\u20092), severe cellulitis (n\u2009=\u20093), partial neovaginal prolapse (n\u2009=\u20093), focal necrosis and dehiscence of the vaginal wall (n\u2009=\u20092) and hypovascularization of the neoclitoris (n\u2009=\u20091). After ileal vaginoplasty, three patients developed clinically insignificant haematomas, one a large rectovaginal fistula with dehiscence of the intestinal anastomosis and bowel perforation (n\u2009=\u20091). In the 27 patients investigated 1-20 years after MfF-SRS, MRI demonstrated cavernosal remnants (n\u2009=\u200910), spared testis (n\u2009=\u20091) neovaginal strictures (n\u2009=\u20098), fistulas and abscesses (n\u2009=\u20093) and prolapse (n\u2009=\u20092). Three of these patients also had fibrotic changes. In the remaining three patients, no pathological features were identified. CONCLUSION: After genital reconfiguration, MRI allows assessment of the post-operative anatomy and of post-operative complications. Advances in knowledge: Imaging features of the new anatomy and of surgical complications after SRS are discussed and illustrated

Penile fracture: Retrospective analysis of our case history with long-term assessment of the erectile and sexological outcome

Objectives: To review the cases of patients with suspected penile fracture and asses erectile and sexological outcomes. Materials and methods: from 1987 to 2013 presented to the Urology Clinic of Trieste and at the AIED of Pordenone a total of 41 cases that were divided into two groups according to the timing of treatment: 18 patients with anamnestic diagnosis of penile fracture treated nonimmediately and 23 patients treated immediately after the trauma. For all patients we evaluated the type of treatment adopted, the occurrence of complications and reoperations and the follow-up. The erectile function was also evaluated through the IIEF, as well as the psychological impact of the trauma on social and sex life, using a psycho- sexological questionnaire. Results: Among patients treated immediately after the trauma 14 were subjected to surgery. About a year after surgery, penile curvature was reported in 1 patient, pain in 3 patients, urinary disorders in 1 patient, while none reported erectile dysfunction (ED). Out of these, only 3 patients underwent reoperation. Among those treated conservatively 1 patient reported curvature, 1 patient reported pain and none reported ED. Among patients who were admitted at a later date, 14 reported curvature and 4 reported pain whereas urinary disorders were reported in 1 and ED in 4 patients. From a psychological point of view, the trauma caused in most cases a fear of new trauma and of repercussions on erectile function and sensitivity. Conclusions: The diagnosis is mainly clinical; however, radiological investigation is essential to confirm the diagnosis, assess the site and extent of the trauma and possible urethral involvement, so as to plan the most appropriate treatment. In addition, immediate treatment leads to better long-term results, with a lower incidence of ED and penile curvature. Psychologically, penile trauma intensifies the fear of reoccurrence; it decreases, however, with the passage of time

Varicocele

Si definisce varicocele la dilatazione varicosa delle vene del plesso pampiniforme e viene considerato la causa correggibile pi\uf9 frequente di infertilit\ue0 maschile, anche se il meccanismo che porta all\u2019infertilit\ue0 non \ue8 ancora chiaro. Colpisce il 15% circa della popolazione generale (1) e pi\uf9 del 40% degli uomini infertili (2-4). Tuttavia l\u201980% dei pazienti affetti presenta uno spermiogramma nei limiti della norma. Il varicocele \ue8 valutato e classificato clinicamente secondo dei criteri introdotti da Dubin e Amelar nel 1970 (5), ma questi sono molto soggettivi e dipendono fortemente dall\u2019esperienza dell\u2019esaminatore (6), poich\ue9 l\u2019iperattivit\ue0 del dartos e la contrazione del cremastere, indotte dalla palpazione o dalla manovra di Valsalva, possono mimare o mascherare la dilatazione varicosa testicolare (7). La soggettivit\ue0 della stadiazione clinica del varicocele \ue8 stata confermata sia da Hargreave e Liakatas (8), che riscontrarono una discrepanza nel 26% dei pazienti esaminati da due esperti medici specialisti, che da uno studio multicentrico, sponsorizzato dall\u2019Organizzazione Mondiale della Sanit\ue0 (9), condotto su 141 uomini affetti da una sub-infertilit\ue0, che ha dimostrato che la valutazione clinica, rispetto alla venografia, ha una sensibilit\ue0 del 50% circa, con un tasso di falsi positivi pari al 23%. Usando l\u2019ecocolorDoppler, Niedzielski et al. (10) trovarono un reflusso venoso solo nel 39% dei pazienti con sospetto clinico di varicocele. Poich\ue9 la diagnosi e la conseguente stadiazione clinica del varicocele hanno dei limiti, sono state introdotte negli anni nella comune pratica diagnostica numerose tecniche di imaging come l\u2019ecocolorDoppler, la termografia, la venografia, la scintigrafia, la TC e la RMN. Ad oggi per\uf2 l\u2019ecocolorDoppler \ue8 la tecnica diagnostica di scelta, mentre le altre vengono utilizzate solamente in casi selezionati

Hematuria following kidney tumorectomy: can it hide an arteriovenous fistula?

We present the case and radiologic images of a 64-year-old man who presented with gross hematuria and fever 2 months after undergoing retroperitoneal partial nephrectomy for a 4.7 7 4.6 cm papillary renal cell carcinoma. Angio-TC demonstrated an aneurysmatic dilatation of the anterior inferior segmental artery of the right kidney with an arteriovenous fistula; the patient was treated with angiography and selective cannulation by deploying 4 platinum coils. At follow-up, we used contrast-enhanced ultrasound to monitor coil embolization of the renal artery pseudoaneurysm

Primary renal MALToma: A rare differential diagnosis for a recurrent renal mass after primary ablative therapy

We report a case of primary renal lymphoma of mucosa-associated lymphoid tissue in an 82-year-old woman. She presented with a history of renal mass previously treated with kidney percutaneous cryoablation at another centre

[Incidence and distribution of lymphoid neoplasm of the urinary tract and male genital organs in an urban area of northern Italy in the last decade]

Lymphoid neoplasms of the urinary tract and male genital organs are relatively rare, comprising less than 5% of all primary extranodal lymphomas; only a handful of small case series and isolated case reports have been published to describe their predominant sites and subtypes.\u202

COMPARISON OF SEXUAL FUNCTION IN TRANSSEXUAL WOMEN WHO UNDERWENT SEX REASSIGNMENT SURGERY BY TWO DIFFERENT TECHNIQUES

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MP80-05 TREND, CHARACTERISTICS AND IMPACT ON CANCER-SPECIFIC MORTALITY OF INCIDENTAL RENAL MASSES: RESULTS FROM A LARGE SERIES OF AUTOPSIES

INTRODUCTION AND OBJECTIVE: Doubtless, advances in imaging technology such as abdominal ultrasounds, computed tomography(CT) and multiparametric magnetic resonance imaging (mpMRI) are playing an important role in the diagnosis of renal masses(RM) and so of renal cell carcinoma (RCC) before the presence of clinical symptoms. This aspect has prompted interest in active surveillance (AS) as a treatment option for the small renal masses (sRM), especially if supported by an imaging-guided biopsy that can characterize the tumor, that most likely will not contribute to cancer-specific mortality. To the best of our knowledge, contemporary data evaluating the temporal trend of pathological characteristics and the relationship with cancer-related death of the incidental RM are not available, especially in a setting of an elderly population. The aim of this study was to analyze incidence trend, changes in clinical characteristics, pathological features and cancer-related death of RM incidentally discovered at time of autopsy in a long period of time. METHODS: Data were retrieved from the autopsy register of the Pathology Department of a single tertiary referral academic center from 15086 consecutive autopsies performed between January 2004 and December 2017. Patients with previous history of primary RCC and patient with a kidney metastatic involvement from other tumors were excluded from this study. RESULTS: Overall, 184 (1.22%) RM were found. Benign and malignant lesions were 32 (17.4%) and 152 (82.6%) respectively. The median age at death was 84 years (IQR, 76.8-90) and the majority of patients were female (56,5%). Histologically were oncocytoma 13 (7.1%), angiomyolipoma 13 (7.1%), papillary adenoma 4 (2.2%), cystic nephroma 3 (1.6%), metanephric tumor 2 (1.1%), clear-cell RCC 136 (73.9%) in which occured 2 (1.5%) sarcomatoid variant, papillary RCC 2 (1.1%), chromophobe RCC 5 (2.7%), carcinoma of the collecting ducts of Bellini 5 (2.7%), nephroblastoma 1 (0.5%). Considering the malignancies, pathological stage was: pT1 126 (80.3%), pT2 10 (6.4%), pT3 16 (10.2%) and pT4 5 (3.2%). Overall, in 16 (10.2%) cases RM was cause-related death. Considering time between 2004 and 2010 vs 2011 and 2017, temporal trend of incidence of RM and consequently of RCC decreased significantly over the years (p=0.01, p=0.01 respectively). While the median age at death, sex and the distribution of the different histological types remained constant over the time, RM found in the last years are increasingly smaller(p=0.04) and only in one case in the last seven years RM was associated with cancer-specific mortality. CONCLUSIONS: The autopsy finding of incidental RM is decreasing. Although the distribution of the different kidney tumor histological types appears constant, the mean size of the lesions that are incidentally identified at autopsy are increasingly smaller and more harmless

Longitudinal Impact of Social Restrictions on Sexual Health in the Italian Population

9Background: Several trials have reported on the impact of social restrictions due to SARS-CoV-2 (COVID-19) pandemic on sexual function and psycho-physical well-being. However, data showing modifications of these outcomes over time and at the end of lock-down are scant. Aim: We investigated the longitudinal changes in sexual function during social restrictions for COVID-19 pandemic in Italy. Methods: A web-based survey was administered to Italian citizens of legal age via social networks. The Beck Depression Inventory Primary Care, the General Health Survey, Female Sexual Function Index, International Index of Erectile Function, UCLA Loneliness Scale-version 3 questionnaires were used to test mental, physical and sexual well-being. The questionnaires were administered at the beginning of the lockdown (T0), 15 days from the first assessment (T1) and 1 month after the end of the restrictions in 2020 (T2). Outcomes: Descriptive statistics and multiple regression analysis were applied to investigate changes in sexual function over and at the end of social restrictions. Results: Data were available for 2543 people (47.2% of men; 43.4% women; 9.4% undefined). Mean age was 48.3 ± 15.1 years for males and 43.9 ± 13.4 for females. Overall, 2.6% reported depressive symptoms according to Beck Depression Inventory Primary Care, 7.4% reported a high level of UCLA loneliness and 19.4% low levels of general mental health. Mild to severe erectile dysfunction was reported by 59.1% of men at T0, while 68.4% of women reported sexual dysfunction. Sexual function levels remain generally unchanged at further follow-up over the social restriction time period (T1), although those who were sexually active at baseline showed a decrease in sexual function scores. At T2, there was an overall improvement in sexual function scores with a rate of severe erectile dysfunction decreasing from 37.1% to 24.1% from T0 to T2 among males and a significant decrease of female sexual dysfunction from 68.4% to 51.2%. Clinical implications: Young individuals and those with good mental and physical health were more likely to improve sexual function at the end of social restrictions. Strengths & limitations: Valid and reliable questionnaires and longitudinal approach design represent strengths; a large but convenient sample and lack of pre-pandemic baseline data represent limits. Conclusion: Social restrictions due to COVID-19 pandemic led to an increase in sexual dysfunctions in both genders. However, these conditions appeared temporary since an overall improvement was observed at the end of lockdown and especially in younger individuals with higher psycho-physical well-being. Vedovo F, Capogrosso P, Di Blas L, et al. Longitudinal Impact of Social Restrictions on Sexual Health in the Italian Population. J Sex Med 2022;XX:XXX-XXX.reservedmixedVedovo, Francesca; Capogrosso, Paolo; Di Blas, Lisa; Cai, Tommaso; Arcaniolo, Davide; Privitera, Salvatore; Palumbo, Fabrizio; Palmieri, Alessandro; Trombetta, CarloVedovo, Francesca; Capogrosso, Paolo; Di Blas, Lisa; Cai, Tommaso; Arcaniolo, Davide; Privitera, Salvatore; Palumbo, Fabrizio; Palmieri, Alessandro; Trombetta, Carl