Beatrice Turchi

Background: The aim of this study was to evaluate treatment satisfaction and decision regret in patients undergoing minimally invasive surgical therapies (MISTs) for lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH). Materials and Methods: We analyzed prospectively collected data from consecutive patients undergoing MISTs across five Italian primary care urology centers. All patients underwent a comprehensive clinical assessment, including detailed medical history and physical examination. Preoperative, perioperative, and postoperative variables were recorded. Decision regret was assessed using validated questionnaires, with significant regret defined as a score >25%. Results: A total of 155 patients were included, with a median age of 64 years (IQR 58–66) and a median IPSS of 23 (IQR 18–26). Among them, 90 patients (51%) underwent Aquablation, 21 (12%) received a temporary implantable nitinol device (iTIND), 26 (15%) underwent water vapor thermal therapy (WVTT), and 37 (21%) were treated with prostatic urethral lift (PUL). The overall median decision regret score was 0 (IQR 0–15), with 23 patients (15%) reporting significant regret (>25%). Higher regret rates were observed in patients treated with PUL and WVTT compared to those undergoing iTIND and Aquablation. None of the evaluated variables—including age, BMI, prostate volume, preoperative Qmax, or preoperative IPSS—were significantly associated with treatment regret. However, although not reaching statistical significance, a prostate volume >60 cc was associated with higher regret in patients undergoing WVTT (OR = 3.33) and PUL (OR = 4.2). Conclusions: Among patients undergoing MISTs, treatment regret is not negligible and appears higher when patient selection is suboptimal. Larger studies are warranted to better identify predictors of decision regret and optimize patient selection for these procedures.

Female urethral stricture (FUS) disease is a rare condition occurring in 4–20% of women with refractory LUTS due to bladder outflow obstruction (BOO). Due to the rarity of this condition, standardization of definition as well as diagnostic criteria and treatment outcomes are lacking. A non-systematic review was conducted exploring the available literature on PubMed and EMBASE databases to identify publications related to the management of FUS between January 2019 and June 2024. Overall, 22 studies were identified. Diagnostic work-up appeared heterogeneous among authors: uroflowmetry (UFM), post-voiding residual of urine (PVR), (video-) urodynamic study (UDS), voiding cystourethrogram (VCUG), urethral calibrations (UC) and urethrocystoscopy (UCS) are the mostly employed tests. Primary treatment consists of urethral dilatation (UD) or urethrotomy. A variety of different reconstructive techniques are currently available such as meatoplasty, flap urethroplasty and graft urethroplasty. Outcome measures varied widely among authors. Patient-reported outcomes (PROMs) were assessed, with a focus on sexual function (FSFI), symptoms and QoL (AUA-ss, IPSS, PGI-I, ICIQ-FLUTS, ICIQ-FLUTSsex, ICIQ-S, UDI, SF-36), demonstrating general improvement. Success rates reported in literature appear to fairly agree amongst authors, but the variability of outcome measures reduces the significance of comparisons between studies. Efforts should be put into pursuing a homogeneity of definitions and criteria. PROMs are promisingly being employed in post-surgical evaluation and should be integrated into standardized follow-up protocols.

Background and Objectives: The impact of lifestyle on lower urinary tract symptoms has been deeply evaluated in recent years; however, studies in the young population are missing. The aim of this study is to evaluate the impact of alcohol intake, tobacco and cannabinoid smoking, physical activity, and dietary regime on urinary symptoms and sexual function in young adults under 30 years of age. Methods: A prospectively enrolled population of healthy young adults of both sexes under 30 years of age was selected. Young people with comorbidities were excluded. All participants were assessed by completing an anonymous questionnaire which included questions on medical history, lifestyle, smoking and alcohol intake, urinary symptoms, and sexual function only in male subjects. The questionnaire was postponed in case there was an acute pathology. Results: Overall, 802 young adults were prospectively enrolled, of whom 44% were male and 56% female, with a median age of 26 (23/28) years. In our population, 580/818 (70.9%) subjects presented an IPSS ≥ 3. In the analysis of the association between urinary symptoms and smoking, smokers presented urinary symptoms more frequently than nonsmokers (76% vs. 61%; p < 0.05). No association between urinary symptoms and alcohol intake, cannabinoid smoking, physical activity, and dietary regimen was recorded. On multivariable analysis, smokers had an almost doubled risk of urinary symptoms compared to nonsmokers (OR: 1.78; p = 0.001). Conclusions: In conclusion, we demonstrated how even in the young population there can be a correlation between LUTSs and different lifestyles.

Introduction an objective: Urinary tract infections (UTIs) are a significant health concern with high costs and poor quality of life (QoL) impact. Managing recurrent UTIs (rUTI) in women requires effective treatments that relieve symptoms and reduce recurrence, while also sparing antibiotics due to rising resistance. This study evaluates the efficacy of a nutritional supplement in reducing UTI recurrences and improving QoL compared to antibiotic therapy. Materials and Methods: This is a multicentric case-control study involving female patients with rUTI. We compared the efficacy of a dietary supplement containing D-mannose 3gr, Palmitoylethanolamide 600 mg, N-acetylcysteine 600 mg, Lactobacillus rhamnosus 2x109, Hibiscus extract 400 mg- (1 sachet/day for 14 days per month for 6 months) against a low dose of Fosfomycin 3 g (one sachet every 10 days for 6 months). Patients were clinically (age, BMI, hormonal status, smoking, and sexual activity) and microbiologically (urine cultures with antibiograms) evaluated at baseline, after 3 months, and after 6 months of therapy. Validated questionnaires were administered to evaluate QoL (WHO-5) and satisfaction (PGI-I). UTI was defined by positive urine culture (bacterial load ≥105 CFU/ml) and patient reported lower urinary tract symptoms (LUTS). Results: A total of 55 patients were enrolled in the nutritional supplement group (NGroup) and 34 in the Fosfomycin group (FGroup). In the NGroup, the median age was 62.2±16.0, a median BMI of 27.2±3.8, 13 (23.6%) were smokers, 29 (52.7%) were sexually active, and 42 (76.4%) were postmenopausal. The mean number of UTI at baseline was 1.87±0.75, decreasing to 0.51±0.63 at 3 months (p<0.001) and 0.28±0.54 at 6 months (p<0.001). Adverse events (AEs) reported were 2 (3.6%) at 3 months and 1 (2.1%) at 6 months (mild gastrointestinal symptoms in all cases). Questionnaires indicated improvements in both QoL (WHO-5: 18.90±3.91 at 3 months and 20.2 ± 2.55 at 6 months; p<0.001) and satisfaction (PGI-I: 3.04±1.61 at 3 months and 2.43±1.26 at 6 months; p<0.001). In the FGroup, demographic data revealed a median age of 62.9±12.9, a median BMI of 23.5±3.0, 10 (29.4%) were smokers, 30 (88.2%) were postmenopausal and 18 (54.5%) were sexually active. The mean number of UTI at baseline was 2.68±0.81, also in this group we have an improvement at 3 months 0.87±0.54 (p<0.001), and at 6 months 0.67±0.80 (p<0.001). No AEs were reported. QoL improved (WHO-5: 17.80±1.40 to 21.4±2.19, p<0.001), but satisfaction declined (PGI-I increased from 2.20±0.41 to 4.05±0.69; p0.05). Lower satisfaction was observed in FGroup. Conclusions: Despite the limitations of this study, including a small patient population and the absence of a third placebo control group of patients, the oral preparation containing D-mannose, PEA, N-acetylcysteine, Lactobacillus rhamnosus and hibiscus extract may be a viable alternative to antibiotics for reducing rUTI in women.

Background and Aims: The aim of our study is to evaluate the possible urodynamic effect of prostatic urethral lift (PUL) in patients with lower urinary tract symptoms due to benign prostatic hyperplasia. Methods: A consecutive series of patients undergoing PUL placement were consecutively enrolled in two centers. Inclusion criteria: ≥50 years of age, benign prostatic obstruction (BPO), international prostate symptom score (IPSS) ≥ 13, prostate volume ≤ 60 mL, and no middle prostate lobe. All patients were evaluated using a detailed clinical history, a validated questionnaire, flexible cystoscopy, and pressure flow studies (PFS) at baseline. PFS were performed at 6 months to evaluate the urodynamic effect of PUL. Results: Overall, 20 patients with a median age of 63 were enrolled. At six months, statistically significant improvements in terms of median Qmax (11.5 vs. 8.5; p < 0.05) and median IPSS (16 vs. 10.5; p < 0.05) were recorded, and sexual function was maintained. All urodynamic parameters improved at 6 months, and significance was reached for all values except for PdetQmax. Finally, Schäfer’s class improved from a median of III to a median of II. More specifically, 16/20 presented an improvement in the Schäfer class, and 12/20 patients presented a BOOI < 20 at 6 months. Conclusions: PUL represents an effective treatment in patients with LUTS due to BPH and improves bladder outlet obstruction without any effect on sexual function.

The purpose of this study was to assess the importance of the post-void residual (PVR) ratio (PVR ratio) in achieving a favorable trifecta outcome for patients suffering from lower urinary tract symptoms and benign prostatic enlargement (LUTS-BPE) who undergo transurethral resection of the prostate (TURP). Starting from 2015, a series of patients with LUTS-BPE who underwent TURP were included in a forward-looking study. These patients were assessed using the international prostate symptom score (IPSS) screening tool, uroflowmetry, and a transrectal ultrasound to measure prostate volume (TRUS). Both the PVR urine volume and the PVR ratio (PVR-R), which is the PVR as a percentage of total bladder volume (voided volume + PVR), were measured. The assessment of outcomes was based on the trifecta favorable outcome, defined as meeting all of the following criteria: (1) absence of perioperative complications, (2) a postoperative IPSS of less than eight, and (3) a postoperative maximum urinary flow rate (Qmax) greater than 15 mL/s. A total of 143 patients were included, with a median age of 70 years (interquartile range 65–73). Of these, 58% (83/143) achieved a positive trifecta outcome. Upon conducting a multivariate analysis, both IPSS and Qmax were identified as predictors of a positive trifecta outcome, whereas the PVR-R did not prove to be an independent predictor. In summary, it was found that preoperative IPSS and Qmax are indicative of a trifecta outcome following TURP, whereas PVR-R is not.

The aim of our study was to compare the performance of residents vs. consultants in transrectal fusion prostate biopsies (FUS-PBs), as well as patient-reported comfort. Between January 2021 and October 2022, a consecutive series of patients undergoing FUS-PBs were randomized into two groups: (A) FUS-PBs performed by a consultant; (B) FUS-PBs performed by trained residents (>50 procedures). All patients underwent FUS-PBs with 12 systematic cores and 3/6 target cores. The detection rate and number of positive cores in the target lesion were compared between groups, and the patient’s discomfort after the procedure was evaluated using the VAS scale. Overall, 140 patients with a median age of 72 years were enrolled. Overall, 69/140 (49.3%) presented prostate cancer and 53/69 (76.8%) presented a clinically significant cancer (Grade Group ≥ 2). Consultants presented a detection rate of 37/70 (52.9%) and residents a detection rate of 32/70 (45.7%) (p > 0.2); the mean number of positive cores in the index lesion was similar in both groups (1.5 vs. 1.1; p > 0.10). In terms of the patients’ experiences, the procedure was well tolerated, with a median VAS score of 2 in both groups, with no statistically significant differences. Residents showed satisfactory outcomes in terms of detection rate, procedural time, and patient comfort when performing prostate biopsies. Residents, after adequate training, can safely perform prostate biopsies.

Registrative trials recommended the use of upfront chemotherapy in high-volume metastatic prostate cancer. We reported survival outcomes of patients with high-volume mCRPC treated with ARTA in a chemo-naïve setting compared to patients treated with chemotherapy as first-line from a longitudinal real-life multicenter series. We retrospectively collected data on mCRPC patients treated at six centers. The dataset was queried for high-volume disease (defined as more than 6 bone lesions or bulky nodes ≥ 5 cm). We compared the main clinical features of chemo-naïve versus chemo-treated patients. The Mann–Whitney U test and Chi-squared test were used to compare continuous and categorial variables, respectively. The Kaplan–Meier method was used to compare differences in terms of progression-free survival (PFS), cancer specific survival (CSS) and overall survival (OS) in an upfront ARTA or chemo-treated setting. Survival probabilities were computed at 12, 24, 48, and 60 months. Out of 216 patients, 88 cases with high-volume disease were selected. Sixty-nine patients (78.4%) received upfront ARTA, while 19 patients received chemotherapy as the first-line treatment option. Forty-eight patients received Abiraterone (AA), 21 patients received Enzalutamide (EZ) as the first-line treatment. The ARTA population was older (p = 0.007) and less likely to receive further lines of treatment (p = 0.001) than the chemo-treated cohort. The five-year PFS, CSS and OS were 60%, 73.3%, and 72.9%, respectively. Overall, 28 patients (31.8%) shifted after their first-line therapy to a second-line therapy: EZ was prescribed in 17 cases, AA in seven cases and radiometabolic therapy in four patients. Sixteen cases (18.2%) developed significant progression and were treated with chemotherapy. At Kaplan–Meyer analysis PFS, CSS and OS were comparable for upfront ARTA vs chemo-treated patients (log rank p = 0.10, p = 0.64 and p = 0.36, respectively). We reported comparable survival probabilities in a real-life series of high-volume mCRPC patients who either received upfront ARTA or chemotherapy. Patients primarily treated with chemotherapy were younger and more likely to receive further treatment lines than the upfront ARTA cohort. Our data support the use of novel antiandrogens as first line treatment regardless tumor burden, delaying the beginning of a more toxic chemotherapy in case of significant disease progression.