Sismanoglio General Hospital

Interstitial cystitis/bladder pain syndrome is a clinical entity that affects many people especially worsening their quality of life. It appears with symptoms of pelvic pain, urgency and frequency. Hunner’s ulcers are common findings on these patients. Hyperbaric oxygen therapy, currently indicated for the treatment of other urologic conditions such as radiation cystitis, has been also tested in interstitial cystitis/bladder pain syndrome. The promotion of neovascularization that hyperbaric oxygen offers seems to have a healing effect on patients with interstitial cystitis/bladder pain syndrome, especially on those presenting with Hunner’s ulcers. It has been found to improve symptoms of pain, frequency and urgency. Thus, it could serve as a safe, alternative treatment, when other therapies fail. However, most of the studies suggesting the beneficial use of hyperbaric oxygen, are not of high level of evidence.

Background: Facial palsy constitutes a profoundly disabling condition, often leading to marked functional deficits and a decline in facial appearance, which substantially reduces the patient’s quality of life. A combined therapy of botulinum toxin (BoNTA), hyaluronic acid (HA) and calcium hydroxylapatite (CaHA) appears promising in the pharmacological approach of these patients. Methods: We reported our single center experience of patients with facial palsy, either of central or peripheral etiology who were treated with the combination of BoNTA, HA and CaHA, during a 6-month period (January 2025–June 2025). Results: Eight consecutive adult patients [mean age: 49.50 ± 7.95 years, 6 (75%) female] with facial palsy, either of central (4 patients) or peripheral (4 patients) etiology, received the combination of BoNTA, HA and CaHA. No serious adverse reactions were documented. Localized bruising and swelling at injection sites resolved without requiring any additional intervention. Facial Disability Index (FDI) was assessed both prior to and following treatment. The functional subscale increased from 65.63 ± 16.13 to 80.63 ± 10.50 (improvement rate = 24.4%, p-value = 0.002), while the psychosocial subscale increased from 63.00 ± 17.34 to 74.50 ± 10.89 (improvement rate = 18.3%, p-value = 0.004). Consequently, the total FDI score improved from 128.63 ± 28.92 to 155.13 ± 17.96 (overall improvement = 20.6%, p-value = 0.001). Conclusions: The present case series underscores the potential therapeutic role of CaHA as an adjunct to BoNTA and HA injections in patients with central or peripheral facial palsy.

To conduct a meta-analysis comparing the outcomes of vacuum-assisted access sheath (VAAS) mini-percutaneous nephrolithotomy (mPCNL) vs conventional access sheath (CAS) mPCNL. A systematic review and meta-analysis was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines, with registration in PROSPERO (CRD42024619780). A comprehensive search identified comparative studies (randomised controlled trials and observational studies). The primary outcomes included operating time, stone-free rate (SFR) and complications. Secondary outcomes included transfusion rates, haemoglobin deficit, and length of hospital stay. Data were analysed using Review Manager V5.4, with quality of evidence assessed using the Grading of Recommendation Assessment, Development and Evaluation (GRADE) tool. Fourteen studies with 2510 patients (1298 in the VAAS and 1212 in the CAS mPCNL groups) were included. VAAS mPCNL significantly reduced operating time, by 17.45 (13.12-21.79) min (P < 0.001), and was associated with a higher SFR: odds ratio (OR) 1.92 (95% confidence interval [CI] 1.57, 2.35; P < 0.001). The VAAS mPCNL group also had a lower postoperative fever rate (OR 0.45 [95% CI 0.35, 0.61]; P < 0.001) and a lower sepsis rate (OR 0.45 [95% CI 0.22, 0.93]; P = 0.03). The overall complication rate for VAAS mPCNL was significantly lower than for CAS mPCNL (P < 0.001), with fewer minor complications. Hospital stay was shorter for VAAS mPCNL (mean reduction of 0.79 days; P = 0.03). There were no significant differences in transfusion rates (OR 0.78 [95% CI 0.46, 1.31]; P = 0.3) or haemoglobin deficit (0.00 g/dL [95% CI 0.22-0.22]; P > 0.9). The use of VAAS mPCNL offers significant advantages over CAS mPCNL, including shorter operating time, improved stone clearance, and reduced complications. These findings support the use of VAAS mPCNL in managing kidney stones, with further high-quality studies recommended.

Timing of invasive coronary angiography in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS) remains controversial. Angiographic risk and, hence, myocardium at risk are not necessarily considered in currently used non-ST elevation myocardial infarction management algorithms. The aim of this study was to assess the diagnostic performance of the SAVE score in NSTE-ACS patients to noninvasively identify patients with high-risk angiographic risk who might benefit from an early invasive strategy. We prospectively assessed 950 consecutive patients admitted to five different hospitals with a diagnosis of NSTE-ACS, 598 (491 male, mean age 63 ± 12 years) of whom were risk-stratified according to the SAVE risk score. The primary endpoint was the identification of high-risk angiographic features. High-risk angiographic features were observed in 347 (58%) (292 male/55 female). SAVE score was significantly higher in patients in the high-risk angiography group compared with patients without high-risk features [6 (4.5-8) ± vs. 4 (2-5.5); P < 0.001]. Using the proposed risk score, 79% (275 out of 347 patients) were correctly identified as having a high angiographic risk, and 58% (145 out of 251 patients with low-risk angiographic features) were also correctly identified by the SAVE score. The SAVE score adequately identified patients with high angiographic risk who may benefit from early invasive management strategies.

A range of techniques have been described for robotic-assisted intracorporeal neobladder construction. The pyramid neobladder has now been performed for over 10years. We now describe the long-term outcomes, including the impact of function preservation through nerve and prostate capsule sparing in the male population. All patients who underwent pyramid neobladder construction between January 2015 and December 2023 at the University College London Hospital (UK) were reviewed. Patients were selected for function preservation based on baseline sexual function/wishes, PSA ± multiparametric prostate MRI. Selected oncological, functional and patient reported outcomes were assessed. A total of 71 patients were included; 87% (61/71) were men. About 65% (40/61) underwent either nerve- or prostate capsule-sparing surgery. Median follow-up was 57.8months (IQR 48.3). In male patients, there was no difference between the 12- and 24-month cancer specific and overall survival rates between the function sparing groups. There were no positive prostate cancer margins. Daytime continence was 75% (39/52) and 67% (6/9), and nighttime was 17% (9/52) and 11% (1/9), in men and women, respectively. There was no significant difference between the male function sparing groups (p < 0.342). About 94% of men (29/31) were sexually active before surgery, falling to 55% (17/31) after, with 76% (13/17) using treatment for erectile dysfunction. The median change in SHIM score was 4.5 (SD 5.3) in prostate capsule-sparing, 6 (SD 7.7) in nerve-sparing and 17 (SD 2.8) in standard groups.About 45% (30/66) of patients had a significant reduction in eGFR (>10mL/min/1.73m2). Uretero-ileal strictures were confirmed in 4.2% (3/71). About 28% (19/67) of patients reported recurrent UTIs and 7% (5/71) reported neobladder rupture. Sexual function had the largest impact on quality of life and may be improved with function-sparing techniques. The burden of additional complications including neobladder rupture and urinary tract infections was also highlighted.

In the latest years the advent of minimally invasive focal treatment for prostate cancer (PCa) has gained a wide diffusion. Different platforms and sources of energy have been developed (HIFU, cryotherapy, focal brachytherapy…) and reported to be able to effectively treat PCa with minimal impact on sexual function. The aim of this systematic review is to summarize, evaluate and compare the impact of these focal therapies on the sexual function (erectile and ejaculatory function) of men harboring low to intermediate risk PCa. A systematic literature search was conducted in October 2022 and updated in August 2024 using Medline (via PubMed), Embase (via Ovid), Scopus, and Web of Science (registered on PROSPERO as CRD42022370237). The search strategy used PICO criteria and article selection was conducted following the PRISMA guidelines. The risk of bias and the quality of the articles included were assessed. A dedicated data extraction form was used to collect the data of interest. Overall, our electronic search identified 4465 papers, 96 of which ultimately met the inclusion criteria and thus were included in the analysis. Among them, 87 were single arm studies, eight were comparative studies, whilst only 1 was a randomized prospective study. Overall, 6244 patients were evaluated (2318 HIFU, 2034 focal cryoablation, 1194 irreversible electroporation [IRE], 346 focal laser ablation [FLA], 147 high-dose brachytherapy [HDB], 247 Vascular photodynamic therapy [VPT], 21 focal microwave ablation [FMA], 151 low-dose brachytherapy [LDB], 10 focal bipolar radiofrequency ablation [FBRA] and 22 trans-urethral ultrasound ablation [TULSA]). The most reported measure of sexual function was IIEF-5, with baseline scores ranging from 16.2 (IRE) to 22.35 (VPT). At 12 months post-treatment, VPT and high-dose brachytherapy had the highest IIEF-5 scores (20.01 and 19.90, respectively), while cryotherapy, low-dose brachytherapy, and HIFU had the lowest (14.08, 14.94, and 15.40, respectively). Ejaculatory function was underreported, with only two studies assessing its preservation after HIFU. Safety analysis showed an overall complication rate of 21%, with major complications occurring in 1.4% of cases. FT offers a promising balance between oncologic control and functional preservation in low- to intermediate-risk PCa. However, significant variability in FT modalities, ablation strategies (focal vs. hemigland vs. zonal), and outcome assessment methods limits direct comparisons. Future prospective studies with standardized protocols and long-term follow-up are essential to optimize patient selection and improve functional outcomes.