Villa Torri Hospital

To evaluate the effect of intraoperative administration of 1g of tranexamic acid (TXA) on perioperative and postoperative outcomes in patients receiving antithrombotic therapy undergoing endoscopic enucleation of the prostate (EEP). This multicenter, prospective, observational study included 932 patients across 30 centers (December 2024-June 2025). Patients were divided into four groups based on TXA use and continuation or discontinuation of blood thinners during EEP. The primary endpoint was bleeding complications within 30 days, defined as a composite of transfusion, clot retention, bleeding requiring restart of continuous bladder washout (CBWO), or surgical reintervention to control hemostasis. Multivariable Logistic regression analysis identified independent predictors of bleeding complications. There were 534 patients in Group 1 (stopped blood thinners, no TXA given), 316 in Group 2 (on blood thinners, no TXA given), 69 in Group 3 (stopped blood thinners, TXA given), and 13 in Group 4 (on blood thinners, TXA given). Median total operative time was longest in Group 2 (88min [IQR 70-127]) and shortest in Group 3 (55min [IQR 39-69]). Hemostasis time was shortest in TXA groups (p < 0.001). Transfusions occurred in 0.6-7.7% and surgical reinterventions in 0.6-7.7% across groups (p < 0.001). At 3 months, urinary symptoms and continence were comparable. On multivariable analysis, TXA reduced the odds of bleeding complications (OR 0.17, p < 0.001), while ongoing anticoagulant therapy (OR 2.93, p = 0.01), dual therapy (OR 4.31, p < 0.001), and longer operative time (OR 1.01, p < 0.001) increased the odds. Intraoperative TXA might mitigate perioperative bleeding and potentially protect patients at higher hemorrhagic risk.

Premenstrual dysphoric disorder (PMDD) is a severe mood-related condition affecting 3-8% of women of reproductive age. It is characterized by affective, cognitive, and physical symptoms that occur during the luteal phase of the menstrual cycle and resolve shortly after menstruation. This study explored the prevalence of self-reported psychological symptoms consistent with PMDD criteria among Italian women during the COVID-19 quarantine. We conducted a cross-sectional, anonymous online survey, which included items based on DSM-5 symptom criteria, in May 2020, using Google Forms. A total of 109 women were enrolled; 77% of the sample reported suffering from premenstrual symptoms. Approximately 36.7% of respondents reported experiencing at least five symptoms, including one core affective symptom. The results of this study are not consistent with the existing literature. These findings highlight the need for greater attention to women's mental health during periods of heightened stress.

To provide an updated national overview of the clinical management of congenital and acquired penile curvature (PC) in Italy, evaluating current diagnostic and therapeutic practices among Italian urologists. A 23-item anonymous digital survey was distributed by the Italian Society of Urology (SIU) to 2034 affiliated urologists between 2024 and 2025. The survey includes demographic data, diagnostic approaches, and treatment strategies for PC, including Peyronie's disease (PD). Participants were categorized by practice setting and geographic region. SPSS software was used to conduct descriptive and comparative analyses. Overall, 442 urologists had completed the survey (response rate: 21.7%). Most participants were affiliated either with university hospitals (34.6%) or public non-university hospitals (32.8%). The major incidence of PD cases, as reported by 310 (70.1%) respondents, were in patients between 45-60 years old and the most frequent presentation was a dorsal curvature (223 responses, 50.5%). The routine clinical practice, as reported by respondents, includes anamnestic data with photographs collection and penile ultrasound (in 261 (59%) and 188 (42.5%) of respondents, respectively), while penile dynamic CCDU was mainly used in patients with erectile dysfunction. In regard to therapeutic strategies, 142 (32.8%) of urologists used Clostridium Collagenase Histolyticum (CCH) for intralesional therapy; a similar proportion used verapamil/nicardipine, despite limited supporting evidence. Interestingly, surgical approaches varied widely: tunica plication was preferred in non-complex cases by 169 (38.2%), while penile prosthesis was offered in complex cases by 129 (29.2%) urologists. Finally, penile prosthesis implantation was offered in patients with severe ED unresponsive to pharmacological therapy, regardless of penile curvature only by 176 respondents (39.8%), meanwhile, 177 respondents considered penile prothesis only for severe PC over >60 degrees associated with ED. This nationwide survey reveals a significative heterogeneity in PC and PD management in Italy, with frequent reliance on off-label treatments and variable adherence to international guidelines. Economic limitations and regional differences appear to be a primary factor influencing clinical decisions and clinical practice. These findings underline the need for a major dissemination of evidence-based guidelines associated with national healthcare strategies aimed at standardized care and improving patient outcomes.

This study aims to compare and organize recommendations from the most eminent international guidelines on the staging and treatment of lymph node (LN) involvement in penile cancer (PC). Early recognition and appropriate management of nodal disease remain the cornerstone of care, influencing both survival and treatment-related morbidity. This study compares and organize recommendations form the most eminent international guidelines-including NCCN, ESMO-EURACAN, and EAU-ASCO-on the staging and treatment of lymph node involvement in penile cancer. Open inguinal LN dissection (ILND) remains the standard treatment for not superficial cancers and its morbidity has driven interest in minimally invasive surgical approaches, such as video-endoscopic inguinal lymphadenectomy (VEIL), including its robot-assisted variant (RA-VEIL). Their role is well defined in clinically node-negative (cN0) patients but remains investigational in node-positive (cN+) cases. For cN3 disease and pelvic node involvement, multimodal strategies including chemotherapy, surgery, and radiotherapy are required. The variability among guidelines underscores the need for collaborative efforts and high-quality prospective trials to refine and standardize treatment recommendations.

Subjects with chronic kidney disease (CKD) are at higher risk for various neurological disorders, including dementia, depression, and sleep disturbances, all of which can influence disease progression and clinical outcomes. Cognitive impairment is often linked to renal decline, with the severity of cognitive deficits increasing in parallel with a reduction in glomerular filtration rate (GFR). For patients undergoing dialysis, the risk of moderate to severe cognitive impairment is significantly elevated. A central, unifying hypothesis proposes that the brain and kidneys share a similar microvascular architecture, making both organs highly susceptible to vascular injury. In this review, we make explicit two complementary mechanisms within this framework: (i) a common-cause model in which shared systemic risk factors (such as hypertension, diabetes, inflammation) concurrently damage renal and cerebral small vessels, and (ii) a CKD-mediated causal pathway whereby kidney dysfunction and its treatments propagate downstream neurovascular injury (uremic toxins, endothelial dysfunction and blood-brain barrier changes, anemia/hypoxia, metabolic and mineral disturbances, and dialysis-related hemodynamic stress), increasing the risk of cognitive impairment. We synthesize the current evidence on these mechanisms, outline the epidemiological patterns and clinical manifestations of cognitive decline in CKD, and discuss prevention, early diagnosis, and multidisciplinary management strategies aimed at improving outcomes in this vulnerable population.

To develop a practical consensus for standardizing communication between rheumatologists and radiologists regarding magnetic resonance imaging (MRI) of the sacroiliac joints and spine in the diagnosis and management of axial spondyloarthritis (axSpA). A task force comprising six rheumatologists and five musculoskeletal radiologists with expertise in axSpA imaging reviewed the Assessment of SpondyloArthritis International Society (ASAS) framework to draft initial recommendations and define project goals. A broader expert panel (21 rheumatologists, 19 radiologists) then participated in a voting process to refine and validate these recommendations. Final endorsement was sought from the steering committees of the Italian Society of Medical and Interventional Radiology (SIRM) and the Italian Society of Rheumatology (SIR) using a modified Delphi method. Thirty-one recommendations were validated, organized into eight domains. Domain 1 outlines five overarching principles. Domain 2 comprises recommendations on clinical features, symptoms, and risk factors. Additional domains address MRI technical parameters, including image quality and sequencing (Domain 3), and standardized reporting criteria. For the sacroiliac joints (Domains 4 and 5), five signs of inflammation and six of structural damage are defined. For the spine (Domains 6 and 7), five inflammatory and four structural features are specified. Domain 8 provides guidance on report conclusions. The recommendations were endorsed by SIRM/SIR with 88.5% approval. This consensus offers structured guidance for MRI requesting and reporting in axSpA, fostering clear communication between radiologists and rheumatologists. The standardized approach aims to improve diagnostic accuracy and patient outcomes.

BackgroundThe prognostic stratification is the cornerstone of treatment decision-making for mRCC. The novel Meet-URO score (IMDC score + NLR + Bone metastases) was developed in the immunotherapy era and has shown better prognostic performance compared with the IMDC score in different settings. Its application in the first-line IO-TKI setting was awaited.MethodsThe Meet-URO 33 is a multicentric prospective observational study enrolling mRCC patients receiving first-line systemic therapy. A retrospective cohort of patients treated from 01.01.2021 was included. The Meet-URO score was assessed compared with the IMDC score in predicting OS. An exploratory analysis on PFS was also conducted.ResultsA total of 1,557 patients were enrolled, 1400 (90%) were assessable. Median age was 66 years, 75% were males, 84% had clear cells, and 64% underwent nephrectomy; 20% received IO-IO, 66% IO-TKI (32% Pembrolizumab+Axitinib) and 14% TKI; 45% had NLR ≥ 3.2 and 29% bone metastases.After a mFU of 14.1 months, mOS was 40.5 months, and mPFS was 16.8 months. The Meet-URO score confirmed a better prognostic stratification compared with the IMDC score (c-index 0.714 vs 0.688) (Table 1). Although the Meet-URO score was developed as an OS model, it showed a similar PFS performance (c-index 0.62 vs 0.61).ConclusionsThe Meet-URO score confirmed its better prognostic accuracy compared with the IMDC score, also in a large-scale prospective cohort receiving first-line therapy. The adoption of the Meet-URO score should be implemented in clinical practice and as a stratification factor of clinical trials for more individualized patient management.ScoreGroup distributionHR (95%CI)P valuemOS (months)3y-OSMeet-URO 116%RefNR85% 230%2.19 (1.34-3.56).002 NR64% 322%3.62 (2.22-5.90)<.001 37.852% 424%6.76 (4.25-10.75)<.001 22.435% 58%12.59 (7.54-21.04)<.001 10.918%IMDC Favorable21%RefNR82% Intermediate57%2.97 (1.99-4.42)<.001 43.756% Poor22%8.45 (5.61-12.70)<.001 13.726%

Abstract The focus of this interview is on curatorial influence on visitors’ experience, enumerating the most common steps of engagement with Edward Burtynsky’s images: (1) a burst of aesthetic wonder during the initial visual impact of the large-scale photographs; (2) a gradual recognition of the subject and meaning behind the photograph; (3) an intuition of the method’s complexity—how Burtynsky’s specific techniques and photographic tools are deployed to elicit these responses; and, finally, (4) the resulting causation—visitors engage with the underlying motivations, influences, and environmental concerns (sometimes the loop repeats itself from the beginning). The recent exhibition serves as an example.

IntroductionSeveral studies have demonstrated that psoriasis severity is generally greater in male patients, but it is unclear whether this gender difference may affect short-term therapeutic response. Notably, no studies have specifically investigated bimekizumab, a humanized, full-length IgG1 monoclonal antibody that acts as a dual inhibitor of interleukin (IL)-17A and IL-17F.MethodsThis was a cross-sectional, observational, retrospective, multicenter analysis. A cohort of 318 patients with moderate to severe psoriasis, 229 male patients (median [IQR] age 35 [23–67] years) and 89 female patients (median [IQR] age 33 [20–68] years), were retrospectively evaluated for short-term response (16 weeks) to bimekizumab according to standard dosage (320 mg at weeks 0, 4, 8, 12, and 16, and every 8 weeks thereafter). Patients were assessed to evaluate whether gender differences in demographic and clinical characteristics can affect treatment response to standard dose of bimekizumab, during the first 16 weeks of treatment. Therapeutic outcomes were evaluated by analyzing Psoriasis Area and Severity Index (PASI) and Dermatology Life Quality Index (DLQI) scores recorded in each patient at three consecutive time points: baseline (T0), after 4 weeks (T4), and after 16 weeks of treatment (T16).ResultsMale patients showed more severe disease at baseline, compared to female patients (p = 0.01). A significant reduction in disease severity was observed in both male and female patients after 16 weeks of treatment, but male patients showed a faster decrease in PASI score between baseline and week 4 of treatment compared to female patients (p < 0.001). Nevertheless, by week 16, difference in PASI response and DLQI reduction between genders became less pronounced.ConclusionAlthough male patients exhibit greater disease severity at baseline compared to female patients, this does not result in a differential response to bimekizumab over the short term. Both male and female patients had equal probability of achieving complete or near-complete disease remission within the first 4 weeks of treatment, and both maintain this response status through week 16. The therapeutic benefit of bimekizumab may be due to the rapid dual inhibition of IL-17A and IL-17F, which may lead to consistent and robust clinical response across genders, regardless of baseline disease severity. Our results suggest a “gender severity-invariant effect” of bimekizumab, highlighting the treatment as rapidly effective in both genders, despite initial differences in disease severity.Supplementary InformationThe online version contains supplementary material available at 10.1007/s13555-025-01435-w.