Background: The bladder is the most common affected site in urinary tract endometriosis, being diagnosed during gynecologic follow-up. The surgical urological treatment might lead to good results. Study Objective: To define the state of the art in the diagnosis and treatment of bladder endometriosis. Methods: We performed a literature review by searching the MEDLINE database for articles published between 1996 and 2011, limiting the searches to the words: urinary tract endometriosis, bladderendometriosis, symptoms, diagnosis and treatment.Results: Deep pelvic endometriosis usually involves the urinary system, with the bladder being affected in 85% of cases. The diagnosis has to be considered as a step-by-step procedure. Currently, the treatment is usually surgical, consisting of either transurethral resection or partial cystectomy, and eventually associated with hormonal therapy. The hormonal therapy alone counteracts only the stimulus of endometriotic tissue proliferation, with no effects on the scarring caused by this tissue. The overall recurrence rate is about 30% for combined therapies and about 35% for the hormonal treatment alone. Conclusions: The bladder is the most common affected site in urinary tract endometriosis. Most of the time, this condition is diagnosed because of the complaint of urinary symptoms during gynecologic follow-up procedures for a deep pelvic endometriosis: a close collaboration between the gynecologist and the urologist is advisable, especially in highly specialized centers. The surgical urological treatment might lead to good results in terms of patients’ compliance and prognosis.

Introduction: The ureteral involvement in deep pelvic endometriosis in usually asymptomatic and might lead to a silent loss of renal function. As a matter of fact, the diagnosis and the treatment modalities are still a matter of debate. Materials and Methods: We performed a literature review by searching the MEDLINE database for articles published in English between 1996 and 2010, using the key words urinary tract endometriosis, ureteral endometriosis, diagnosis and treatment. We found more than 200 cases of ureteral endometriosis (UE). Results: The disease most commonly affects a single distal segment of the ureter, with a left predisposition in most of the patients. Two major pathological types of UE may be distinguished: intrinsic and extrinsic. The symptoms are usually nonspecific and owing to secondary obstruction. The diagnosis has to be considered as a step- by-step procedure, starting from physical examination to highly detailed imaging methods. Nowadays, the treatment is usually chosen according to the type of UE, the site lesion and the distance to the ureteral orifice, with the use of JJ stents remaining a matter of debate. Conclusions: A close collaboration between the gynecologist and the urologist is advisable, especially in referral centers. Surgical treatment can lead to good results in terms of both patient compliance and prognosis.

surgeon, pathological T and N stage) and the presence of CSL.• Univariable and multivariable linear regression models were also used to test the association between the available predictors and lymphorrhoea. RESULTS• The median (range) number of LNs removed was 20 (1-63). Both linear and logistic multivariable regression analysis showed that the number of removed LNs and age were the only two statistically significant predictors of total amount of lymphorrhoea and CSL after RRP and PLND (both P < 0.01).• Specifically, the risk of developing a CSL increased by 5% for every LN removed. Similarly, every year of age increased the risk of having CSL by 5%.• The most informative thresholds for predicting CSL were 65 years of age and 20 LNs removed.• External iliac lymphadenectomy resulted in a higher associated risk of lymphorrhoea and CLS relative to obturator LN removal ( P = 0.001 vs P = 0.1, respectively). CONCLUSIONS• There was a positive association between the number of LNs removed and age at RRP with the amount of lymphorrhoea and the risk of developing a CSL.• The most informative thresholds in predicting CSL were 65 years of age and 20 LNs removed. External iliac lymphadenectomy resulted in a higher risk of lymphorrhoea and CLS relative to obturator LN removal. KEYWORDS prostate cancer, lymphadenectomy, lymphocoele, lymphorrhoeaWhat's known on the subject? and What does the study add? Lymphorrhoea is the leakage of lymph out of drains after surgery and may affect the perioperative period after retropubic radical prostatectomy (RRP) and extended pelvic lymphadenectomy (PLND). Similarly, lymphoceles represent a common complication after RRP and PLND, although only in few cases do lymphoceles become symptomatic.In the current study, the amount of lymphorrhoea and the risk of CSL in patients treated with RRP and PLND were prospectively assessed. Moreover, individual factors which can predict lymphorrhoea, CSL and total days of drainage, were identified, in order to improve treatment decision-making in PCa patients. Indeed, to foresee lymphorrhoea and CSL after RRP and PLND may assist clinicians in selecting the most appropriate surgical technique and the most proper management in the post-operative period, when surgery is performed.Study Type -Therapy (case series) Level of Evidence 4 OBJECTIVE

ObjectiveTo assess the impact of primary or progressive status on recurrence-free survival (RFS), cancer-specific mortality (CSM) and overall mortality (OM) after radical cystectomy (RC) for muscle-invasive bladder cancer (MIBC). Patients and MethodsA total of 768 consecutive patients underwent RC as treatment for MIBC at our institution between 2000 and 2012. Primary MIBC was defined as no previous history of bladder cancer and progressive was defined as recorded previous treated non-MIBC (NMIBC) that had progressed to MIBC. The median follow-up was 85 (60-109) months. Univariate and multivariate Cox regression models were used to compare RFS, CSM and OM between these two cohorts. ResultsIn all, 475 (61.8%) patients had primary and 293 (38.2%) patients had progressive MIBC. There were no differences between the two groups in terms of demographics, pathological and peri-operative complications (all P > 0.1).The 10-year RFS, CSM and OM rates for primary vs progressive status were 43 vs 36% (P = 0.01), 43 vs 37% (P = 0.01), and 35 vs 28% (P = 0.03), respectively. On multivariable Cox regression analyses, progressive status remained significantly associated with a higher rate of recurrence (hazard ratio [HR] 1.47, 95% confidence interval [CI] 1.12-1.79; P = 0.03), CSM (HR 1.42, 95% CI 1.07-1.89; P = 0.01) and OM (HR1.42, 95% CI 1.13-1.65; P = 0.02). ConclusionsAmong patients treated with RC for MIBC, progressive status was associated with a higher CSM, OM and recurrence rate after RC. The present study thus provides an impetus to improve risk sub-stratification when bladder cancer is still at the NMIBC stage, be it through new biomarkers or improved imaging, as a subset of patients with NMIBC are likely to benefit from early RC.