Lira Pelari Mici

Background/Objectives: Mesh-related complications after surgery for stress urinary incontinence (SUI) and pelvic organ prolapse (POP) remain a clinical challenge, and surgical revision is often required. However, its impact on functional outcomes and continence status is incompletely defined. This study aimed to evaluate voiding and continence outcomes after surgical revision of vaginal synthetic mesh. Methods: This retrospective multicenter study included 55 consecutive women undergoing surgical revision of synthetic mesh for symptomatic complications after SUI or POP procedures between March 2021 and April 2025. Preoperative evaluation included clinical assessment, uroflowmetry, and selective imaging or urodynamic studies. Surgical management included mesh section, partial removal, or total removal via vaginal, abdominal, or combined approaches. The primary outcome was change in Qmax and post-void residual (PVR). Secondary outcomes included symptom resolution, changes in urgency urinary incontinence (UUI) and SUI, and postoperative complications. Results: Obstructive voiding dysfunction was the leading indication for revision (47.3%). Median Qmax increased from 13.0 to 18.0 mL/s (p = 0.0013), and median PVR decreased from 55.0 to 5.0 mL (p < 0.001). UUI improved from 56.4% to 34.5% (p = 0.017, McNemar’s exact test). Conversely, SUI increased from 20.0% to 56.4% (p < 0.001), although only 16 patients (29.1%) had clinically significant postoperative SUI, of whom 7 underwent a secondary anti-incontinence procedure. Intraoperative complications were infrequent (5.5%), while postoperative urinary tract infections occurred in 16.4%. Conclusions: Mesh revision surgery improves voiding function and reduces storage symptoms in selected patients but carries a substantial risk of recurrent or de novo SUI, underscoring the need for careful patient selection and counseling, with an acceptable safety profile in experienced centers.

Purpose: Complicated urinary tract infections (cUTIs) are a frequent indication for admission to Hospital-at-Home (HaH) and outpatient parenteral antimicrobial therapy (OPAT) programmes. We describe the clinical, urological and microbiological profile, antimicrobial treatment and outcomes of a cUTI cohort managed in a HaH unit, and explored, in an exploratory analysis, factors associated with the 30-day composite of unplanned readmission or death. Methods: Prospective observational single-centre cohort of 262 consecutive cUTI episodes managed in a tertiary HaH unit (March 2023-October 2025). Baseline, urological, microbiological, treatment and outcome variables were recorded prospectively. Bivariate comparisons and an exploratory multivariable logistic regression were used to examine associations with the composite endpoint. Results: Median age was 79.7 years (Q1-Q3 66.1–87.2); 76.0% had multimorbidity. Escherichia coli was the most frequent isolate (45.4%; 41.2% ESBL-producing, 95% CI 32.7–50.2%), and the overall rate of resistance-mechanism-positive isolates was 30.2% (95% CI 24.9–36.0%). Ertapenem (42.8%) and ceftriaxone (41.2%) were the most frequently used intravenous agents. Clinical cure occurred in 92.0% (95% CI 88.1–94.7%) of episodes and 5.3% (95% CI 3.2–8.8%) required unplanned transfer to conventional care, with no deaths during the HaH episode. Within 30 days, 11.5% of episodes (95% CI 8.1–15.9%) were followed by hospital readmission and 4.2% (95% CI 2.4–7.4%) by death (composite endpoint, 13.4%, 95% CI 9.8–18.0%). In exploratory, hypothesis-generating analyses limited by the small number of events, older age and prior urological manipulation were identified as potential factors associated with the composite endpoint (age: OR 1.05, 95% CI 1.01–1.10; prior urological manipulation: OR 2.98, 95% CI 1.12–7.98), with wide confidence intervals. Conclusion: In this single-centre, uncontrolled descriptive cohort, cUTI managed through HaH/OPAT was associated with high clinical cure and low unplanned transfer, despite a substantial burden of ESBL-producing organisms and other resistance-mechanism-positive isolates. Older age and prior urological manipulation emerged as potential markers associated with adverse outcomes, warranting further characterisation in larger, adequately powered cohorts before informing risk stratification at HaH admission.

Robotic retroperitoneal lymph node dissection (R-RPLND) represents an evolution in the surgical management of testicular germ cell tumors, offering reduced morbidity compared with open approaches. However, this procedure remains technically challenging, particularly after chemotherapy, due to dense fibrosis and distortion of the retroperitoneal anatomy. We report a case of an unrecognized intraoperative thermal injury causing a partial transection of the proximal ureter presenting postoperatively as a urinary fistula following R-RPLND for residual mass resection, along with a focused review of the contemporary literature on procedure-related complications. A review of large series highlights severe complications (Clavien–Dindo ≥ III) occurring in 6–12% of cases, with ureteral injuries occurring in up to 6%, often identified after surgery. This case underscores the importance of meticulous dissection, awareness of altered anatomy, and prompt intervention when unexpected events arise during R-RPLND.

Background/Objectives: Prostate cancer is the most prevalent malignancy in men and remains a leading cause of cancer-related mortality worldwide. Conventional imaging modalities exhibit limited sensitivity, particularly in the context of disease recurrence and advanced disease. Methods: A narrative review was conducted of studies published between 2015 and 2025, identified through PubMed, Embase, and Cochrane. Eligible publications addressed advanced imaging techniques, PSMA-targeted diagnostics and therapies, radiogenomics, liquid biopsy approaches, and artificial intelligence applications and personalized medicine. Preclinical studies, single case reports, and conference abstracts without full text were excluded. Results: PSMA PET/CT outperforms conventional imaging for detection, and restaging, influencing clinical management across disease stages. Lutetium-177–PSMA-617 has become the standard radioligand therapy for metastatic castration-resistant prostate cancer, whereas alpha-emitting agents remain under clinical investigation. Radiogenomics and liquid biopsy assays (ctDNA, CTCs, AR-V7) provide complementary molecular insights. Artificial intelligence enhances imaging interpretations, standardization, and reproducibility, while multimodal data integration supports individualized risk stratification. Integrative models combining imaging, genomic, and liquid biopsy data pave the way toward precision oncology and personalized therapeutic decision-making. Conclusions: Advances in imaging and theragnostics are reshaping prostate cancer management, bridging the gap between molecular biology and clinical practice to enable precision oncology.

Background/Objectives: Prostate cancer is the most prevalent malignancy in men and remains a leading cause of cancer-related mortality worldwide. Conventional imaging modalities exhibit limited sensitivity, particularly in the context of disease recurrence and advanced disease. Methods: A narrative review was conducted of studies published between 2015 and 2025, identified through PubMed, Embase, and Cochrane. Eligible publications addressed advanced imaging techniques, PSMA-targeted diagnostics and therapies, radiogenomics, liquid biopsy approaches, and artificial intelligence applica-tions and personalized medicine. Preclinical studies, single case reports, and conference abstracts without full text were excluded. Results: PSMA PET/CT outperforms conven-tional imaging for detection, and restaging, influencing clinical management across disease stages. Lutetium-177–PSMA-617 has become the standard radioligand therapy for metastatic castration-resistant prostate cancer, whereas alpha-emitting agents remain under clinical investigation. Radiogenomics and liquid biopsy assays (ctDNA, CTCs, AR-V7) provide complementary molecular insights. Artificial intelligence enhances imaging interpretations, standardization, and reproducibility, while multimodal data integration supports individualized risk stratification. Integrative models combining imaging, genomic, and liquid biopsy data pave the way toward precision oncology and personalized therapeutic decision-making. Conclusions: Advances in imaging and theragnostics are reshaping prostate cancer management, bridging the gap between molecular biology and clinical practice to enable precision oncology.

Background/Objectives: Bladder cancer is characterized by high recurrence and progression rates, posing a challenge to current diagnostic and treatment strategies. This review aims to provide a comprehensive overview of emerging technologies, including novel PET tracers, AI-assisted cystoscopy, theragnostics, and molecular biomarkers. Methods: We performed a narrative review of the recent literature focusing on innovations in imaging, AI, theragnostics, and biomarker research relevant to bladder cancer diagnosis and management. Results: Several novel PET tracers, such as 68Ga-PSMA and fibroblast activation protein inhibitor (FAPI), demonstrated potential in improving detection sensitivity. AI-enhanced cystoscopy has shown promise in real-time lesion detection, while theragnostic agents enable combined diagnostic and therapeutic applications. Advances in molecular biomarkers, including circulating Tumor DNA (ctDNA) and gene expression signatures, offer new avenues for patient stratification and monitoring. Conclusions: Integration of advanced imaging, AI, theragnostics, and biomarker analysis may transform bladder cancer management, supporting personalized and more effective care strategies.

Pelvic organ prolapse (POP) is a prevalent condition worldwide with detrimental effects on patients’ quality of life. Laparoscopic sacrocolpopexy (LSC) has emerged as the gold standard for managing complex and high-grade POP. While anatomical and subjective outcomes have been extensively documented, the management of its associated complications, particularly urinary incontinence, remains challenging. This study evaluates the strategies implemented to address complications arising from LSC, focusing on urinary incontinence. A retrospective multicenter study analyzed 325 patients who underwent LSC using lightweight macroporous Surelift Uplift mesh between 2011 and 2019. Data on perioperative and long-term complications, with emphasis on urinary incontinence management, were extracted from participating centers. Among them, the incidence of new-onset stress urinary incontinence (SUI) postoperatively was 12.9%. A total of 21 patients required further treatment for urinary symptoms, including mid-urethral sling (MUS) procedures in 5.5% and botulinum toxin injections for overactive bladder (OAB) in 0.9%. The findings underscore the importance of proactive and tailored management strategies for urinary incontinence following LSC. While the procedure demonstrates low complication rates and high anatomical success, urinary symptoms require vigilant monitoring and intervention in a two-step procedure for stress incontinence, if needed.

Background: Neoadjuvant chemoradiotherapy with CROSS-protocol is the standard of care for locally advanced esophageal cancer. The purpose of this study was to demonstrate an improvement in complete pathological response (ypCR) after a dose-escalation neoadjuvant protocol compared to standard treatment. Secondary endpoints were disease-free survival (DFS) and acute gastrointestinal toxicity. Material and methods: We prospectively evaluated patients with locally advanced esophageal adenocarcinoma who received neoadjuvant chemoradiotherapy. The radiation dose was 41.4 Gy in 23 fractions or 50.4 Gy in 28 fractions with weekly administration of six intravenous cycles of carboplatin AUC 2 mg/mL and intravenous paclitaxel 50 mg/m² followed by surgery. Results: Between December 2015 and July 2020, 21 patients were treated according to the reported radiation schedules. Median age was 61 years (57–67). 20 (95.2%) tumors were located at the esophagogastric junction and 1 (4.8%) in the middle esophagus. Five (23.8%) were stage II and 16 (76.2%) stage III. Twelve (57.1%) patients received 41.4 Gy (standard group) and 9 (42.9%) received 50.4 Gy (intensification group), with 5 (41.67%) and 5 (55.6%) presenting ypCR in the standard and intensification group, respectively (p = 0.67). After a median follow-up of 17 months (8–30), DFS in the standard group was 17.78 months [95% (CI, confidence interval): 12.9–22.6] and 45.5 months (95% CI: 24.4–66.05) in the intensification group (p = 0.299). Grade III acute gastrointestinal toxicity was 16% and 33.33%, respectively (p = 0.552). Postoperative toxicity events ≥ Grade III were 5 (41.7%) and 4 (44.4%), respectively (p = 0.623). Conclusions: In our study we found a trend towards a higher complete pathological response-rate and disease-free survival in the intensification group compared to the standard group, with no differences in gastrointestinal toxicity. Well-designed randomized and controlled trials are needed to obtain conclusive data. Background: Neoadjuvant chemoradiotherapy with CROSS-protocol is the standard of care for locally advanced esophageal cancer. The purpose of this study was to demonstrate an improvement in complete pathological response (ypCR) after a dose-escalation neoadjuvant protocol compared to standard treatment. Secondary endpoints were disease-free survival (DFS) and acute gastrointestinal toxicity. Material and methods: We prospectively evaluated patients with locally advanced esophageal adenocarcinoma who received neoadjuvant chemoradiotherapy. The radiation dose was 41.4 Gy in 23 fractions or 50.4 Gy in 28 fractions with weekly administration of six intravenous cycles of carboplatin AUC 2 mg/mL and intravenous paclitaxel 50 mg/m² followed by surgery. Results: Between December 2015 and July 2020, 21 patients were treated according to the reported radiation schedules. Median age was 61 years (57–67). 20 (95.2%) tumors were located at the esophagogastric junction and 1 (4.8%) in the middle esophagus. Five (23.8%) were stage II and 16 (76.2%) stage III. Twelve (57.1%) patients received 41.4 Gy (standard group) and 9 (42.9%) received 50.4 Gy (intensification group), with 5 (41.67%) and 5 (55.6%) presenting ypCR in the standard and intensification group, respectively (p = 0.67). After a median follow-up of 17 months (8–30), DFS in the standard group was 17.78 months [95% (CI, confidence interval): 12.9–22.6] and 45.5 months (95% CI: 24.4–66.05) in the intensification group (p = 0.299). Grade III acute gastrointestinal toxicity was 16% and 33.33%, respectively (p = 0.552). Postoperative toxicity events ≥ Grade III were 5 (41.7%) and 4 (44.4%), respectively (p = 0.623). Conclusions: In our study we found a trend towards a higher complete pathological response-rate and disease-free survival in the intensification group compared to the standard group, with no differences in gastrointestinal toxicity. Well-designed randomized and controlled trials are needed to obtain conclusive data.