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ABSTRACT Objective To describe the most common sexual problems and changes experienced by male urological cancer survivors, focusing on evidence-based practices for assessment and intervention. Materials and Methods We search the PubMed, Embase, and SciELO databases between 1994 and 2022, using the following key words: “urological cancer”, “urological malignances”, “genitourinary cancer”, “male sexual health”, and “male sexual dysfunction”. Results This narrative review provides an overview of the current literature involving the impact of diagnosis and treatment of urological cancers on male sexual function. Male “genital” or “reproductive” tumors, such as prostate, penile, and testicular tumors, clearly appear to affect sexual function. However, tumors that do not involve genital parts of the body, such as the bladder and kidney, can also affect male sexual function. Conclusion Male sexual dysfunction is very common after urologic cancer diagnosis and treatment. Changes in body image and anatomical damage can be associated with impaired masculinity and sexual function, especially after prostate, penile or testicular cancer treatment. Moreover, anxiety, depression, and fear of recurrence have an impact on quality of life and sexual function regardless of the cancer location. Therefore, patients need be counseled about the likely changes in sexual function before treatment of any urological cancer.

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ABSTRACT Purpose The aim of this meta-analysis is to assess the efficacy of extended dose of preoperative antibiotics to reduce infectious risk in patients undergoing percutaneous nephrolithotomy (PCNL). Materials and Methods A literature search for prospective case-control studies or randomized controlled trials was done. PICO framework was used. Population: adult patients that underwent to PCNL; Intervention: extended dose preoperative antibiotic prophylaxis before PCNL; Control: short dose preoperative antibiotic prophylaxis before PCNL; and Outcome: systemic inflammatory response syndrome (SIRS) or sepsis, fever after PCNL and positive intraoperative urine and stone culture. This meta-analysis was registered in PROSPERO database under the number: CRD42022359589. Results Three RCT and two prospective studies (475 patients) were included. SIRS/sepsis outcome was retrieved from all studies included. Seven days preoperative oral antibiotics for PCNL was a protective factor for developing SIRS/sepsis (OR 0.366, 95% CI 0.234 - 0.527, p < 0.001). There was no statistical association between seven-day use of antibiotics and fever (OR 0.592, 95% CI 0.147 – 2.388, p = 0.462). Patients who received seven days preoperative antibiotics had lower positive intraoperative urine culture (OR 0.284, 95% CI 0.120 – 0.674, p = 0.004) and stone culture (OR 0.351, 95% CI 0.185 – 0.663, p = 0.001) than the control group. Conclusion one week of prophylactic oral antibiotics based on local bacterial sensitivity pattern plus a dose of intravenous antibiotics at the time of surgery in patients undergoing PCNL reduces the risk of infection.

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ABSTRACT Objectives To compare the dusting efficiency and safety with basketing for treating renal stones ≤ 2 cm during flexible ureteroscopy (fURS). Materials and methods This study included 218 patients with renal stones ≤ 2 cm treated with fURS. Among them, 106 patients underwent dusting, and 112 patients underwent fragmentation with basket extraction. All patients were followed up for 3 months postoperatively. The operating time, lasing time, stone-free rate (SFR) and complication rate were compared. Results The mean stone size in the dusting group was 1.3 cm, whereas 1.4 cm in the basketing group. The mean operative time was significantly lower in the dusting group than in the basketing group (43.1±11.7 minutes VS 60.5±13.4 minutes, P <0.05), but the lasing time was significantly longer for the dusting group than for the basketing group (17.7±3.9 minutes VS 14.1±3.6 minutes, P <0.05). SFR was significantly higher in the basketing group immediately after the operation and follow-up after 1 month (76.8% vs 55.7%, P= 0.001 and 88.4% vs 78.3%, P = 0.045). However, the SFR was similar for both groups (88.8% in the dusting group vs. 90.2% in the basketing group) after 3 months postoperatively. There was no statistical difference in the complication rates between the two groups. Conclusions Dusting has advantages in shortening the operation time and reducing the operation cost, but the lasing time was longer compared with the basketing. Although there is no difference in long-term effect, basketing is superior to dusting in terms of short-term SFR. Moreover, dusting should be avoided in some special cases and basketing a better choice. Both techniques are effective for the treatment of renal stones ≤ 2 cm and choice depends on patient demographic and stone characteristics.

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ABSTRACT Purpose Bladder endometriosis (BE) accounts for 84% of cases of urinary tract involvement. The use of cystoscopy for preoperative evaluation is limited. The aim of this study was to evaluate the accuracy of preoperative dynamic cystoscopy (DC) in patients undergoing surgery for deep endometriosis and to describe the main findings and their impact on surgical planning. Materials and Methods This cross-sectional observational study was conducted from January 2011 to March 2022. DC findings were divided into two groups according to the depth of involvement. To estimate sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV), laparoscopic findings of bladder involvement and histopathological report were used as the gold standard. Results We included 157 patients in this study. 41 had abnormalities in DC. Of these, 39 had abnormalities that were confirmed intraoperatively. The sensitivity and specificity of the test were 58.21% and 97.78%, respectively. PPV was 95.12%, and NPV was 75.86%. The presence of any lesions in the DC had a diagnostic odds ratio (OR) of 61.28 for BE. Patients with BE type 2 had a higher rate of partial cystectomy than those with BE type 1 lesions (OR 9.72 CI 95% 1.9-49.1) Conclusion DC appears to be a highly specific test with lower sensitivity. DC abnormalities are associated with a higher ratio of bladder surgery for the treatment of deep endometriosis, and BE type 2 seems to be associated with a greater ratio (9.72) of partial cystectomy.

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ABSTRACT Background The results and benefits of Robotic-assisted Radical Prostatectomy (RARP) are already established in the literature. However, new robotic platforms have been released recently in the market and their outcomes are still unknown. In this scenario, our objective is to describe our experience implementing the HugoTM RAS robot and report the clinical data of patients who underwent Robotic-assisted Radical Prostatectomy. Material and Methods We retrospectively analyzed fifteen consecutive patients who underwent RARP with HugoTM RAS System (Medtronic, Minneapolis, USA) from June to October 2021. The patients underwent transperitoneal RARP on lithotomy position, using six trocars (4 robotic trocars and 2 for the assistant). We reported the clinical feasibility and safety of this platform, assessing perioperative data, including complications and early outcomes. Continuous variables were reported as median and interquartile ranges, categorical variables as frequencies and proportions. Results and Limitations All procedures were safe and feasible with no major complications or conversion. Median operative time was 235 minutes (213-271), and median estimated blood loss was 300ml (100-310). Positive surgical margins were reported in 5 patients (33%). The median hospitalization time was 2 days (2-2), and the median time to remove the foley was 7 days (7-7). On the first appointment four weeks after surgery, all patients had undetectable PSA values, and 61% were continent. Conclusions We described preliminary results with safe and feasible procedures performed with HugoTM RAS System robotic platform. The surgeries were successfully executed with acceptable perioperative outcomes, without conversions or major complications. However, as this technology is very recent, further studies with a long-term follow-up are awaited to access postoperative functional and oncological outcomes.

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ABSTRACT Purpose To construct a predicting model for urosepsis risk for patients with upper urinary tract calculi based on ultrasound and urinalysis. Materials and Methods A retrospective study was conducted in patients with upper urinary tract calculi admitted between January 2016 and January 2020. The patients were randomly grouped into the training and validation sets. The training set was used to identify the urosepsis risk factors and construct a risk prediction model based on ultrasound and urinalysis. The validation set was used to test the performance of the artificial neural network (ANN). Results Ultimately, 1716 patients (10.8% cases and 89.2% control) were included. Eight variables were selected for the model: sex, age, body temperature, diabetes history, urine leukocytes, urine nitrite, urine glucose, and degree of hydronephrosis. The area under the receiver operating curve in the validation and training sets was 0.945 (95% CI: 0.903-0.988) and 0.992 (95% CI: 0.988-0.997), respectively. Sensitivity, specificity, and Yuden index of the validation set (training set) were 80.4% (85.9%), 98.2% (99.0%), and 0.786 (0.849), respectively. Conclusions A preliminary screening model for urosepsis based on ultrasound and urinalysis was constructed using ANN. The model could provide risk assessments for urosepsis in patients with upper urinary tract calculi.

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ABSTRACT Introduction To evaluate the possible effects of the coronavirus disease 2019 (COVID-19) pandemic on the oncologic results of patients with prostate cancer regarding clinical staging, presence of adverse pathological outcomes, and perioperative complications. Materials and methods This retrospective study included patients who underwent radical prostatectomy. The time between biopsy and surgery, staging tests, final histopathological evaluation after surgery, lymphadenectomy rate, postoperative complications, and prostatic specific antigen (PSA) levels (initial and 30 days after surgery) were analyzed and compared in a group of patients before and during the pandemic period. Results We included 226 patients: 88 in the pre-pandemic period and 138 during the pandemic period. There was no statistically significant difference in mean age, body mass index, ASA, pathological locally advanced disease, the proportion of patients who underwent lymphadenectomy, and ISUP grade in the biopsy between the groups. Positive surgical margins, prostatic extracapsular extension, and PSA levels at 30 days were also similar between the groups. The mean time between medical consultation and surgery was longer in the pandemic period than in the pre-pandemic (124 vs. 107 days, p<0.001), and the mean time between biopsy and medical consultation (69.5 days vs. 114 days, p<0.001) and between biopsy and surgery (198.5 days vs. 228 days, p=0.013) was shorter during the pandemic. The incidence of severe early and late perioperative complications was similar between the periods. Conclusions There was no delay between diagnosis and treatment at our institution during the COVID-19 pandemic period. No worsening of the prostate cancer features was observed.

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ABSTRACT Purpose Our objective was to investigate the prevalence of SWA, associated factors, relationship with STIs, and behavioral aspects in men attended at Referral Centers for STIs and acquired immunodeficiency syndrome (AIDS)/CR-STI/AIDS in northeast Brazil. Materials and Methods In this cross-sectional study, a questionnaire with sociodemographic, clinical, sexual and SWA practices information was applied to 400 men attended at two CR-STI/AIDS in Northeast Brazil on the years of 2018 and 2019. Clinical and laboratory diagnoses of STIs were confirmed in medical records. Logistic regression models were performed to identify the independent predictors for SWA. Results The prevalence of SWA over total samples was 15.00%. Of the participants, 239 (59.75%) of the participants were diagnosed with STIs, and of these 37 (15.48%) reported SWA. Most men practiced SWA in adolescence, being the last episode more than 20 years ago, usually with asinine and mules, in vaginal route and without a condom. SWA practitioners have higher percentages of occurrence of some viral STIs. SWA was associated with increasing age, history of residence in a rural area with remained over 12 years, married or widowed/separated, heterosexuals, with less than 7 years of study, Catholics, with hepatitis B, former user of alcoholic beverages and smokers, with a history of STI and intercourse with sex workers. Conclusion SWA practices increase STIs vulnerability. The association between hepatitis B and SWA highlights the importance of educational campaigns and conclusive studies on the topic.

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ABSTRACT Introduction Retroperitoneal lymphadenectomy (RPLND) is well established as a primary treatment, especially for high-risk stage I and stage IIA/B nonseminomatous tumors, but its value in seminomatous tumors is underreported (1). Classically, seminomas with isolated retroperitoneal lymphadenopathy are treated with external beam radiation therapy or systemic chemotherapy. Although these modalities are effective, they are associated with significant long-term morbidity (2, 3). Some retrospective studies have demonstrated the potential of RPLND as a first-line treatment for stage IIa seminoma, and two very recent prospective trials, still with interim results: SEMS TRIAL and PRIMETEST(3-7). The RPLND robotic technique has been previously described in the post-chemotherapy scenario, however, surgical videos of primary laparoscopic approach are lacking, especially in seminomatous disease (8). Materials and Methods We present two cases of primary videolaparoscopic RPLND, using different approaches.Case 1: Thirty four years-old, with prior right orchiectomy for mixed tumor. After 8 months he presented an two cm enlarged interaortocaval lymph node. Percutaneous biopsy showed pure seminoma metastasis.Case 2: Thirty three years-old, with previous left orchiectomy for stage I pure seminoma, without risk factors. After nine months, the patient had a three cm enlarged para-aortic lymph node. Results The surgical time ranged from 150 to 210 minutes, with a maximum bleeding of 300 mL and hospital discharge in 48 hours. In one of the cases, we identified a significant desmoplastic reaction, with firm adhesions to the great vessels, requiring vascular sutures, however, no major complication occurred. Pathological anatomy confirmed pure seminoma lymph node metastases in both cases. Conclusion Laparoscopic primary RPLND proved to be technically feasible, with less postoperative pain and early hospital discharge. We understand that more studies should be performed to confirm our oncological results.

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ABSTRACT Purpose Hartmann’s procedure is the resection of the rectosigmoid colon with an end colostomy formation and closure of the anorectal stump (1). Its reversal has a morbidity rate up to 58% (2, 3) with an incidence of fistulae formation of 4.08% (1). Herein, we present a robotic-assisted repair of a complex fistula that occurred as complication of Hartmann’s reversal when the stapler was introduced inadvertently through the vaginal canal. Patient and methods Eighty-three-year-old female with past medical history of hysterectomy and ischemic colitis that required colectomy and colostomy placement in December 2020. In March 2022, the patient underwent a colostomy takedown, after which she reported fecaluria, urine leakage per vagina, and recurrent urinary tract infections. Cystoscopy and vaginoscopy revealed a large colovesical fistula, a staple in the bladder trigone, and several staples in the anterior vaginal wall. Robotically, extensive adhesiolysis was performed, the sigmoid was separated from the bladder, and the intact rectal stump was dissected free. The staple from the bladder trigone was removed. Bladder was closed in two layers with 3-0 V-Loc. Colorectal anastomosis was not feasible due to the short length of both ends. Therefore, a permanent colostomy was placed. Results Operative time was 454min., and estimated blood loss was 100cc. Discharged on postoperative day 4 with a JP drain and a 20Fr Foley catheter. Drain, and Foley were removed on postoperative days 9 and 23, respectively. No postoperative complications were reported. Conclusion Robotic-assisted repair represents an effective approach for the management of colovesical fistulae after Hartmann’s reversal.