bluuebunny/crossref_metadata_2025 huggingface dataset:
Interstitial Cystitis: Minimal Diagnostic Criteria
Authors: Galosi Andrea Benedetto , Montironi Rodolfo , Mazzucchelli Roberta , Lacetera Vito , Muzzonigro Giovanni
Published: June 2018

Any article reporting on Interstitial Cystitis (IC) will list numerous investigations. This paper presents a review of the minimum investigations needed and their significance for the initial evaluation and diagnosis of patients with Interstitial Cystitis. To optimize patient's early diagnosis and disease monitoring, a comprehensive algorithm for the diagnosis of IC has been proposed. The paper defines interstitial cystitis (IC) as a disease of the urinary bladder diagnosed by at least one of the following 3 requirements: 1) endoscopic criteria (cystoscopy findings); 2) pathologic criteria of bladder biopsy; and 3) clinical criteria including pain and lower urinary tract symptoms evaluation. Furthermore, the exclusion of confusable diseases is mandatory in all cases. These are recommendations, mostly based on expert opinions and literature review. Where possible, a level of recommendation was developed according to a 3–grade scale: mandatory (grade 1), recommended (grade 2), and optional (grade 3). By using a stepwise approach and an evidence-based thought process, the diagnosis of IC is made easier and reliable.
Treatment of Acute Iatrogenic Cystitis Secondary to Bladder Chemo-Immuno-Instillation or Pelvic Radiotherapy
Authors: Sommariva Monica L , Sandri Sandro D. , Guerrer Chiara S.
Published: June 2018

The onset of cystitis during intravesical chemo-immunotherapy for the treatment of non-muscle invasive transitional cell bladder tumor, or after pelvic radiotherapy mainly for prostate cancer, is a frequent clinical situation, not easily manageable due to the lack of responsiveness to symptomatic drugs, often resulting in discontinuation of cancer treatment in many cases.

The similarity of symptoms with those of the painful bladder syndrome, otherwise called interstitial cystitis, has led us to use the same treatment with intravesical sodium hyaluronate in order to obtain an improvement of symptomatology. We therefore performed a prospective study on 55 consecutive male symptomatic patients, aged from 54 to 81 years: 11 after radiotherapy, 17 after BCG and 27 after Mitomicyn C bladder instillations, 12 of whom in combination with bladder hyperthermia.

All subjects underwent bladder instillations with sodium hyaluronate 40 mg in 50 mL weekly for 8 to 24 weeks depending on the time needed to the resolution of the symptoms.

During the first 4 weeks 32 mg of dexamethasone were also instilled intravesically, mixed with hyaluronate, in order to obtain a stronger anti-inflammatory activity due also to its higher capacity of penetration in the bladder mucosa. The symptoms intensity was evaluated through a Visual Analogue Score (VAS) of the discomfort and pain perceived from 0 to 10, and bladder capacity was recorded with micturition diary before and after the treatment.

After 16 weeks VAS improved in every case of chemical cystitis from an initial mean value of 8.6 to a final mean value of 1(with 3 as a maximum value recorded). The difference was highly significant (p <0.001). Bladder capacity increased in all cases of chemical cystitis from a mean value of 56 to 276 mL with a highly significant improvement (p <0.001) and in all cases of post-actinic cystitis from a mean bladder capacity of 89 to a final mean value of 239 mL, with a significant improvement (p= 0.05). We did not observe any side effect due to our treatment. Therefore, we can conclude that bladder instillation with sodium hyaluronate for at least 8 weeks and dexamethasone in the first 4 weeks can solve the symptoms of iatrogenic cystitis secondary to chemo-immunotherapy or pelvic radiotherapy, without incurring in side effects. To our knowledge this treatment has never been published before in scientific medical literature.
Conservative treatment of persistent calyceal fistula after tumor excision. Case report and clinical remarks
Authors: Chierigo Paolo , Rahmati Mojtaba , Lazzarotto Maurizio , Brotza Davide , Bernabei Massimiliano , Franzolin Nicola
Published: June 2018

Background

Nowadays, ultrasounds allow to discover accidentally a large number of renal small tumors. So, radical nephrectomy, which years ago was considered as the gold standard, is rarely required. Today, nephron sparing surgery is often prescribed for renal masses smaller than 4 cm. Its most frequent complication is calyceal fistula. It can be prevented exploring carefully the surgical surface, and suturing any opening. It can heal over within a few days or some weeks, so it can be a trouble for both the patient and the surgeon. A complete urinary drainage, obtained with an ureteral stent and an open bladder catheter, helps heal. Recently, it has become common practice to spread synthetic or biological tissue sealants over the surgical surface, to improve hemostasis. These surgical glues have also been used to repair calyceal openings, with conflicting results.

Methods

We performed left renal tumor excision (3.5 × 3 cm) in a 72-years-old man, during temporary renal artery occlusion with surface hypothermia. We placed intraoperatively an ureteral stent. The visual examination of the surgical cavity did not reveal any calyceal opening. We electrocauterized it and stuffed it with FloSeal. Surgical edges were free from illness. After 5 days urinary leakage from the drainage tube increased. Pyelography showed a calyceal fistula. A further stent was placed, with no results. Bladder catheter was kept open for about 2 months. Urinary leakage stopped 34 days after surgery.

Results

Urinary leakage increased when the catheter was removed, and stopped only after many days of complete urinary drainage.

Conclusions

The conservative treatment of a calyceal fistula must be considered a still effective therapy, also in difficult cases, provided that a complete and long-lasting urinary drainage is carried out.
Hydronephrosis caused by Inferior Vena Cava Penetration by a Mobi-nuddin Filter
Authors: Fugini Andrea Vismara , Mirabella Giuseppe , Perucchini Laura , Zani Danilo , Simeone Claudio , Cunico Sergio Cosciani
Published: June 2018

The inferior vena cava (IVC) filter placement represents an excellent protection from significant pulmonary embolism in at-risk patients. Perforation of the wall of the IVC by components of caval filters is a recognized complication. We report a case of asymptomatic hydronephrosis caused by transcaval penetration of a Mobin-Uddin filter.
Real-Time Elastography in the Diagnosis of Prostate Cancer: Personal Experience
Authors: Romagnoli Andrea , Autieri Gaspare , Centrella Danilo , Gastaldi Christian , Pedaci Giuseppe , Rivolta Lorenzo , Pozzi Emilio , Anghileri Alessio , Cerabino Maurizio , Bianchi Carlo Maria , Roggia Alberto
Published: June 2018

Introduction

Prostate cancer is the most common cancer in men. In the future, a significant further increase in the incidence of prostate cancer is expected. The indication to perform a prostate biopsy is digital rectal examination suspicious for prostate cancer, total prostate specific antigen (PSA) value, free PSA/total PSA ratio, PSA density and PSA velocity, and an evidence of hypoechoic area at transrectal ultrasound scan. Unfortunately the specificity and sensibility are still poor. The aim of this retrospective study is to evaluate the specificity and sensibility of real time elastography versus ultrasound transrectal B-mode scan.

Methods

We retrospectively evaluated 108 pts. having undergone TRUS-guided transrectal prostate biopsy (10 samples). The indication for biopsy is: digital rectal examination, total prostate specific antigen (PSA) value, PSA ratio, PSA density and PSA velocity suspicious for prostate cancer, and/or an evidence of hypoechoic area at transrectal ultrasound scan, and/or hard area at real-time elastography. The mean age of patients is 66.8 years, mean PSA 6.5 ng/mL, and mean ratio 16.5%. We compared the histopathological findings of needle prostate biopsies with the results of transrectal ultrasound and transrectal real-time elastography.

Results

32/108 (29.6%) pts. were positive for prostate cancer (mean Gleason score 7.08), mean PSA 14 ng/mL and mean ratio 9.5%. Transrectal ultrasound scan shows a sensibility of 69% and specificity of 68%. Transrectal ultrasound scan shows a VPP of 51.4%. Transrectal ultrasound scan shows a VPN of 80.9%. Real-time elastography shows a sensibility of 56% and specificity of 85.7%. Real-time elastography shows a VPP of 60.1%. Real-time elastography shows a VPN of 83%.

Conclusions

Elastography has a significantly higher specificity for the detection of prostate cancer than the conventionally used examinations including DRE and TRUS. It is a useful real-time diagnostic method because it is not invasive, and simultaneous evaluation is possible while performing TRUS.
Can Hyperbaric OxygenTherapy (HOT) have a Place in the Treatment of some Urological Diseases?
Authors: Passavanti Giandomenico
Published: June 2018

HOT (Hyperbaric Oxygen Therapy) is used in urological diseases: Scrotal/perineal fasciitis and Radiation-induced cystitis (and proctopathy); in urgency and frequency syndrome and with chronic pelvic pain the use of HOT is still experimental.

The basic principle of HOT is to increase oxygen dissolved in the blood when it is administered at high pressure. 02 is then distributed to the tissues through the pressure gradient; tissue hyper-oxygenation has anti-inflammatory and pain-killing effects, it increases bacterial permeability to antibiotics, strengthens neo-angiogenesis, reinforces lymphocytes and macrophages function, augments testosterone secretion (in males), and finally enhances wound healing process.

We treated with HOT (integrating other treatments) 17 cases of necrotizing fasciitis, 13 radiation-induced cystitis and 4 cases of urgency and frequency syndrome. We always had good results, with a good cleansing of the dissected areas in Fournier's gangrene; in the cases of radiation-induced cystitis we had an improvement in the symptoms and hematuria, and finally in cases of urgency and frequency syndrome we had a transient reduction of symptomatology and pain.

Our experiences and the specific literature on this subject suggest that HOT, sometimes associated with other medical and surgical therapies, can be an effective tool to treat urological diseases; in some cases its efficacy was well demonstrated (Fournier's gangrene and Radiation-induced cystitis), in others (urgency-frequency syndrome and chronic pelvic pain) it is a promising technique which definitely needs further research.
Single Session Cystolitholapaxy and PCNL for Encrusted DJ Stent with Large Associated Stone Burden
Authors: Ferruti Mario , Paparella Stefano , Cozzi Gabriele , Oliva Isabella , Finkelberg Elisabetta , Maggioni Augusto , Rocco Francesco
Published: June 2018

Introduction

Ureteral stent use is commonplace in urology to prevent or relieve ureteral obstruction. If ureteral stents are neglected, they can cause severe morbidity due to migration, occlusion, encrustation, breakage, stone formation, and even death, due to life-threatening urosepsis or complications related to operative intervention. Extracorporeal Shockwave lithotripsy, ureterorenoscopy electro-hydraulic lithotripsy, laser lithotripsy, and percutaneous nephrolitholapaxy (PCNL) have been reported for forgotten ureteral stent management, but currently there are no guidelines for this challenging situation and only few algorithms have been introduced by some studies.

Methods

We present a case of a man presenting with an encrusted left double J (DJ) stent, inserted two years before, and bulky radiolucent lithiasis at both ends of the stent. The patient was studied with intravenous pyelogram and non contrast-enhanced computed tomography, and then treated with cystolithotripsy and PCNL in a single session. RESULTS. Complete clearance of the stones was obtained and the DJ stent was removed without breaking from the percutaneous access.

Conclusions

Neglected stents still represent a challenge in urology: while endourology remains the best option for treatment, the management of ureteral stents should be based on follow-up and prevention, using for example a computerized warning and stent retrieval software system.
Riparazione Trans-Vaginale di Fistola Neovescico-Vaginale
Authors: Negro C.L.A. , Destefanis P. , Bosio A. , Bisconti A. , De Maria C. , Carchedi M. , Buffardi A. , Rolle L. , Fontana D.
Published: June 2018

Introduction

Neobladder vaginal fistula is a known complication after cystectomy and orthotopic neobladder in women. The exact incidence is still unknown, even if in some of the largest series is reported in about 5% of female patients. We present our personal experience with a case of neobladder vaginal fistula.

Methods

A fifty-year old woman affected by T2G3 bladder cancer underwent radical cystectomy and orthotopic neobladder in December 2007. Definitive pathological examination revealed pT3aN0G3 urothelial cancer with squamous aspects. Two cycles of neoadjuvant chemotherapy were administered before cystectomy. Three weeks after cystectomy, a retrograde cystography revealed a fistula between vagina and neobladder. At first, the patient was treated conservatively, keeping the urethral catheter for two months. Cystographies, repeated every month, recorded a reduction in size of the fistula but not the complete closure. A surgical correction was planned. Preoperative cystoscopy showed the neobladder opening of the fistula on the posterior wall. Then a transvaginal approach with fistula excision and a two layer cross suture were performed.

Results

At the cystography performed 1 month after surgical repair no fistula was detected, and the patient was completely dry. At 3 months follow-up the patient was completely dry.

Conclusion

The development of a neobladder-vaginal fistula is a significant, even if infrequent, complication after cystectomy. In our case, we performed a transvaginal approach without tissue interposition, with good results. Such procedure is easy and effective and, in our opinion, can be tempted as first line surgical treatment.
Avulsione della Cute Peniena: Un Approccio Conservativo
Authors: Negro C.L.A. , Destefanis P. , Bosio A. , Bisconti A. , De Maria C. , Carchedi M. , Buffardi A. , Rolle L. , Fontana D.
Published: June 2018

Introduction

Skin avulsion of male genital is a rare urological emergency. Although not life-threatening such lesions are both physically and psychologically traumatic. If poorly managed in the acute setting, these injuries may result in long-term problems or permanent disabilities.

Methods

A 58 year-old male patient was admitted to the Emergency Department of our hospital with a traumatic injury of the penis, caused by a bike trauma. At the inspection, a rather complete degloving of penis and a tear in scrotal skin with no involvement of testes were observed. The skin was completely detached, out of the penis, but for a small flap at the penoscrotal angle. After a careful cleaning, the penis was covered again with the skin attached to penoscrotal angle through multiple circumferential sutures.

Results

A complete cover of the defects was obtained with one-step surgery. The patients was treated with broad spectrum of antibiotics for 1 month. No infections occurred. The patient was discharged from hospital after 5 days. After 3 months from trauma, the patient is able to achieve a sexual intercourse, with normal erectile function, no painful erections and no penile recurvatum.

Conclusions

Traumatic skin avulsion of penis is a rare condition; the best aesthetic and functional results depends on the choice of the proper treatment. Conservative approach in selected cases can provide good results both aesthetically and functionally.
Liposarcoma Renale Aspetti Clinici ed Anatomo-Patologici. Case Report e Revisione Della Letteratura
Authors: Martini C. , Pedalino M. , Di Primio O.G. , Velia R. , Vercesi E. , Montincone C. , Genovese E. , Dongiovanni V. , Stramignoni D. , Di Roma A. , Marino G.
Published: June 2018

Sarcomas of the retropehtoneum represent 0.2% of tumors and 15% of soft tissue sarcomas. Retro peritoneal differentiated liposarcoma must be distinguished from the connective neoplasm of kidney. The main features of these tumors are: the rapid growth, ‘infiltration of surrounding tissue, the tendency to local relapse and very fast metastasis (60–80%). Authors report a clinical case of a patient 61 old years with occasional reflected ultrasound is performed for lombar pain a retro peritoneal mass. CT described a retro peritoneal mass that raised medially and displaced the left kidney. The patient was subjected to removal of the mass now to his kidney capsule, which was nevertheless preserved. The histological examination showed a picture of well-differentiated liposarcoma with areas of high-grade sarcoma with malignant morphology fibroistiocitoma-like aspects and fibromixomatosi. The well-differentiated liposarcoma has biological behavior similar to other sarcomas with high degree of adults with high local recurrence and distant metastases in 15–20% with overall mortality at 5 years about 30%. The most significant prognostic factor is the location of the cancer and the extent and degree of differentiation did not impact on the clinical prognosis is conditioned by the difficulty of obtaining a radical surgery in spite linfoadenectomia a retro peritoneal accurate.
Batson's Paravertebral Venous Plexus and Single Vertebral Metastases from Renal cell Carcinoma
Authors: Tosco L , Palazzetti A. , Crivellaro S. , Guaitoli P. , Abbinante M. , Frea B.
Published: June 2018

Objectives

The presence of a single site bone metastasis in patients with renal cell carcinoma (RCC) is a rare clinical event. We report a single case of RCC with solitary vertebral metastasis and review of literature about renal tumor spreading in order to understand the anatomic explanation for this peculiar clinical case.

Methods

We have considered the single case and reviewed current and past literature to describe the anatomic and functional background of this clinical situation.

Results

There are rare cases of single vertebral metastasis from RCC and these are characterized from a contemporary neoplastic thrombus. The neoplastic thrombus could justify the tumoral back-flow into the paravertebral anasthomoses and so into vertebral venous sinusoids. The rich anasthomotic system that surrounds kidneys and the experimental evidence of anasthomotic links among perirenal Lejars venous system and paravertebral Batson's venous system could explain these clinical evidences.

Conclusion

Enrolment of para-vertebral Batson's venous system could have a major role in the RCC vertebral metastatic diffusion.
Endometriosis: Aetiopathogenetic Basis
Authors: Larosa M. , Facchini F. , Pozzoli G. , Leone M. , Grande M. , Monica B.
Published: June 2018

Endometriosis, defined by the presence of endometrial tissue outside the uterine cavity, is a common condition affecting 10% of women in the reproductive age. Menstrual factors reported to increase risk include dysmenorrhea, early menarche, and shorter cycle lengths. The theory of retrograde menstruation with implantation of endometrial fragments, in conjunction with peritoneal factors to stimulate cell growth is the most widely accepted.

There is a growing body of evidence that immunological factors and angiogenesis play a key role in the pathogenesis of endometriosis. In women with endometriosis, there appears to be an alteration in the function of peritoneal macrophages, natural killer cells and lymphocytes, with production of growth factors and inflammatory mediators in the peritoneal fluid. Survival, adhesion, proliferation, invasion and vascularization of endometrial tissue in abdominal cavity may be the consequence of retrograde menstruation and referred to as implantation theory.
High Alpha-Fetoprotein Persistence after Orchiectomy. On a Case of Uncommon Etiology
Authors: Chierigo Paolo , Puccetti Oliviero , Visonà Alfonsino , Bassan Franco , Rahmati Mojtaba , Lazzarotto Maurizio , Franzolin Nicola
Published: June 2018

Background

The following report describes a case of inherited elevation of alpha-fetoprotein (AFP) in a young male suspected for testicular cancer. AFP shows very high values during fetal life. After birth the synthesis of AFP decreases dramatically, and only trace amounts are detected in the adult. From this age on, serum AFP can rise above normal in some diseases, e.g. liver disorders, and in some kind of tumors. A condition in which persistent high levels of AFP are found, named Hereditary Persistence of AFP [HPAFP), was first reported in 1983 by Ferguson-Smith, and then recorded in the literature only on eleven occasions till 2004. The occurrence of HPAFP may be underestimated. HPAFP can be easily confirmed by testing AFP levels in blood-related family members.

Methods

An elevated serum AFP (about 20 μg/mL) was found in a 27–year-old white man with an unremarkable medical history, who was concerned to have left testicular cancer. By our examination, his left testis was markedly reduced in size. β-HCG, LDH, and liver function were normal. Surgical inguinal exploration with testis and spermatic cord excision was carried out. Postoperative repeated AFP levels remained persistently elevated, in the range from 20 to 30 μg/mL. Careful evaluation for occult cancer showed no abnormality. Histology showed necrotic tissue and could not make a reliable diagnosis. A literature search was done using PubMed by key word “alpha-fetoprotein” and “elevation”. Thinking of a hereditary trait, we decided to screen patient's blood-related family members.

Results

AFP was found to be elevated in another four out of six relatives within three generations, unrelated to any disease. This pedigree was consistent with an autosomal dominant inheritance pattern.

Conclusions

HPAFP could mislead the physician. Failure to recognize HPAFP can lead to unsuitable treatments. The existence of this clinically benign condition needs to be considered in both children and adults with unexplained and persistent elevation of AFP, e.g. those diagnosed or suspected for germ cell tumor.
A Case of Chronic Schistosomiasis four years after Infestation
Authors: Pedalino M. , Vercesi E. , Martini C. , Piras D. , Di Primio Og. , Velia R. , Marino G.
Published: June 2018

Authors present a case of bilharziosis incidentally diagnosed in a patient undergoing TURB for suspected bladder cancer. The patient, who in 2005 had gone to Malaysia, had been suffering from recurrent hemorrhagic cystitis since 2007, which were treated with antibiotic therapy. In November 2009 he presented to our observation for persistent hematuria, underwent ultrasound examination, fibroscopy and TURB diagnostics for suspicious lesions. The histopathology diagnosis found granulomatous lesions with typical parasites eggs due to schistosomiasis eggs. As a consequence of that, the patient underwent medical therapy. The pathologist's role becomes nullifying not only for the diagnosis of parasitic infections but also for the exclusion or evidence of urothelial squamous neoplasia. The low incidence of this rare parasitic disease in European tourists and the presence of immigrants in our country require to spread the knowledge of these parasites and the most simple tests for early detection.
Urethral Recurrence of Invasive Carcinoma following BCG Treatment for Bladder Ca in Situ
Authors: Ruoppolo M. , Gozo M. , Milesi R. , Spina R. , Fragapane G.
Published: June 2018

CIS is a flat, high-grade, non-invasive microscopic urothelial carcinoma. It is considered a precursor of invasive bladder cancer. CIS is classified as primary, secondary or concurrent, when occurred as isolated CIS without cuncurrent papillary tumors, or detected during the follow-up of patients with a previous papillary tumor, or finally in the presence of bladder neoplasm. BCG is widely established as the treatment of choice for CIS with a success rate of approximately 70%. BCG reduces the risk of progression of CIS into invasive carcinoma in 30 to 50% of cases. Direct and prolonged contact between the urothelium and BCG is a prerequisite for successful therapy. Discovery of CIS in the prostatic or membranous urethra represents an ominous sign. CIS may be present only in the epithelial lining of the prostatic urethra or in the ducts, or in the worst case it may be found in the prostatic tissue stroma. Urethral involvement by CIS is at high risk of tumor progression and development of metastases due to reduced thickness of lamina propria and absence of muscolaris mucosa. 83 patients, enrolled from 1/1996 to 12/2005 at our urological department with CIS: primary (focal and multifocal) in 25, secondary in 7 and cuncurrent in 51 (associated with T1bG3 cancer in 37 cases), and urethral CIS in 5 and conservatively treated by TUR and intravescical instillations of BCG, 4 developed after words only invasive cancer of the urethra in the absence of bladder involvement. In 2 cases cancer arised from the prostatic fossa after TURP, in 1 from membranous urethra and in the last from prostatic ducts. Among the 4 patients, 3 were treated by cystoprostatourethrectomy and Platinum-based chemotherapy, 1 refused surgical treatment. Two patients died for disseminated disease. 1 patient is alive at 60–month's follow-up. In the last patient cancer relapsed at 36–month's follow-up. We conclude that prostatic/urethral involvement during follow-up after successful intravesical treatment with BCG in CIS represents a high risk of developing invasive and incontrolled cancer. A careful watch is recommended in these patients.
Chemioprevenzione Delle Infezioni Urinarie Nel Mieloleso
Authors: Vercelli Dario
Published: June 2018

Il presente studio si è posto l'obiettivo di valutare l'efficacia di un trattamento “naturale” a lungo termine per la profilassi delle infezioni urinarie in soggetti affetti da mielolesione e vescica neurologica. La scelta è caduta su di un prodotto commerciale a base di L-Metionina + Cranberry (avente cioè sia azione antimicrobica grazie all'azione di ostacolo all'adesività batterica da parte della proantocianidine, sia azione stabilizzante l'acidità urinaria): ACIDIF (Biohealth-Italia).
Clinical reappraisal and state of the art of nephropexy
Authors: Mogorovich Andrea , Selli Cesare , De Maria Maurizio , Manassero Francesca , Durante Jacopo , Urbani Lucio
Published: June 2018

The diffusion of minimally invasive techniques for renal surgery has prompted a renewed interest in nephropexy which is indicated to prevent nephroptosis in symptomatic patients and to mobilize the upper ureter downward in order to bridge a ureteral defect. Recent publications have been reviewed to present the state of the art of the diagnosis and management of these two challenging conditions and to try to foresee the next steps. The evaluation of patients with mobile kidney can be made relying on diagnostic criteria such as ultrasound with color Doppler and measurement of resistive index, conventional upright X-ray frames after a supine uro-computerized tomography scan and both static and dynamic nuclear medicine scans, always with evaluation in the sitting or erect position. Laparoscopic nephropexy emerges as the current treatment option combining both objectively controlled repositioning of the kidney and resolution of symptoms with minimal invasiveness, low morbidity, and short hospital stay. The use of robotics is presently limited by its higher cost, but may increase in the future. Downward renal mobilization and nephropexy is a safe and versatile technique which has been adopted as a unique strategy or more often in combination with other surgical maneuvers in order to cope with complex ureteral reconstruction.
The clinical role of X-ray computed tomography to predict the clinical efficiency of extracorporeal shock wave lithotripsy
Authors: Glybochko Peter Vitalevich , Alyaev Yuri Gennadevich , Rudenko Vadim Igorevich , Rapoport Leonid Mikhailovich , Grigoryan Vagarshak Aramaisovich , Butnaru Denis Victorovich , Perekalina Anna Nikolaevna , Kraev Igor Georgievich , Korolev Dmitry Olegovich
Published: June 2018

Aim:

To evaluate the clinical efficiency of computed tomography for diagnostics of patients with urolithiasis and the choice of treatment strategy.

Material and methods:

The study was carried out at the Urological Clinic of I.M. Sechenov First Moscow State Medical University and included 1044 patients with urinary stones. The ultimate goal of this study was to predict the clinical efficiency of extracorporeal shock wave lithotripsy using a combination of computed tomography and densitometry. Extracorporeal shock wave lithotripsy was performed on “Siemens Lithostar Plus,” “Siemens Modularis Uro,” and “Dornier Gemini” lithotripters. Statistical analysis of clinical data included evaluation of individual sampling groups and calculation of weighted arithmetic mean ( M).

Results:

The efficiency of extracorporeal shock wave lithotripsy has been determined primarily using X-ray analysis of the concrement outlines and the structure (homogeneous or heterogeneous) of its central zone. However, in terms of efficiency and repetition rate (the number of fragmentation procedures required for complete clearance) of extracorporeal shock wave lithotripsy, the mean density of the concrement along the whole length of its three-dimensional structure (expressed in Hounsfield units) appeared to be the most reliable and informative predictive index in this study.

Conclusion:

The combination of computed tomography with densitometry in the treatment of patients with urolithiasis allows one (1) to determine the exact localization, size, X-ray structure, and structural density of urinary stones and (2) to predict, on the basis of densitometric data histograms, the clinical efficiency and repetition rate of extracorporeal shock wave lithotripsy with due regard to the X-ray structure of peripheral and central zones, and mean density (in Hounsfield units) of urinary concrements.
Effectiveness of the addition of tadalafil to tamsulosin in the treatment of acute urinary retention in patients with benign prostatic hyperplasia: A randomized clinical trial
Authors: Baghani Aval Hamidreza , Ameli Zeinab , Ameli Mojtaba
Published: June 2018

Introduction:

Acute urinary retention is one of the most significant complications of benign prostatic hyperplasia. Until now, standard treatments include catheterization and use of α-blockers. Tadalafil has been recently seen to also play a role in the treatment of urinary symptoms caused by benign prostatic hyperplasia. The aim of this study was to survey the addition of tadalafil to tamsulosin in the treatment of acute urinary retention in patients with benign prostatic hyperplasia.

Materials and Methods:

This is a randomized, double-blind placebo-controlled clinical trial. In all, 80 patients with benign prostatic hyperplasia–related acute urinary retention referred to the emergency department of the hospital were divided into two groups of 40 each and randomly assigned to receive either 0.4 mg tamsulosin plus placebo or 0.4 mg tamsulosin plus 10 mg tadalafil daily for 7 days. At the same first visit, the catheter was removed and the ability to void in 24 h and 1 week later was assessed in each group.

Results:

The differences in age, urine retention volume, history of drug use, lower urinary tract symptoms, and previous acute urinary retention were not significant between the two groups ( p = 0.619, 0.149, 0.501, 0.284, and 0.371, respectively). After catheter removal, 23 (57.5%) patients in the placebo group and 26 (65%) in the tadalafil group voided successfully at 24 h ( p = 0.491). After 1 week, 29 (72.5%) patients taking placebo and 26 (65%) taking tadalafil could void, yet indicating no significant difference ( p = 0.469).

Conclusion:

Addition of tadalafil to α-blockers has no significant advantage in improving benign prostatic hyperplasia–related acute urinary retention versus tamsulosin alone.
Risk factors of overactive bladder syndrome and its relation to sexual function in menopausal women
Authors: Hakimi Sevil , Aminian Elham , Alizadeh Charandabi Sakineh Mohammad- , Bastani Parvin , Mohammadi Marzieh
Published: June 2018

Background:

Overactive bladder syndrome is a common and annoying complication worldwide that could negatively affect the quality of life of afflicted individuals. We aimed to determine the prevalence and risk factors of overactive bladder syndrome and its relation to sexual function in healthy menopausal women.

Methods:

This cross-sectional study was done on 340 women aged 45-60 years in Tabriz, northwest Iran, during 2015-2016. Data were collected using a demographic data questionnaire, the Overactive Bladder Syndrome Score, and the McCoy Female Sexuality Questionnaire.

Results:

Fifty-six (16.5%), 63 (18.5%), and 10 (2.9%) of the participating women had mild, moderate, and severe overactive bladder syndrome, respectively. Predictors of overactive bladder included: night sweats, central prolapse, episiotomy, varicose disease, illiteracy or education at the primary level, systolic blood pressure >140 mmHg and lack of physical activity. We found a significant difference between the women with and without overactive bladder with respect to the total score and sub-domain scores related to sex partner (p = 0.029) and sexual interest (p = 0.049).

Conclusions:

The prevalence of overactive bladder was quite high in this study. Since sexual dysfunction is not an easy topic to talk about and can affect women’s quality of life, physicians should consider talking about these issues besides urinary issues to all middle-aged women.
In vitro and in vivo models for the study of urolithiasis
Authors: Khan Aslam
Published: June 2018

Preclinical animal research has greatly contributed and will continue to contribute in our understanding of various disease states and provided methods for more understanding of disease states and designs to test novel pharmaco-therapeutic interventions against these diseases. For urolithiasis, scientists have developed numerous in vitro and in vivo models that attempt to replicate human urolithiasis. In this review, I have explained in vitro and in vivo models that are more common, affordable, and easy to replicate. In the in vitro models, I have focused on the CaOx crystallization models and in the in vivo models, hyperoxaluric rat model has been explained along with other available option such as Knockout (KO) mice and fly models. Each model has been explained stepwise along with its pros and cons.
Serum procalcitonin levels in prostate cancer: A new biomarker?
Authors: Canat Lütfi , Atalay Hasan A , Can Osman , Alkan İlter , Ötünçtemur Alper
Published: June 2018

Background:

To examine the role of serum procalcitonin as a biomarker for the detection of prostate cancer in patients with a serum prostate-specific antigen less than 20.0 ng/mL.

Methods:

The prospective study included patients with a prostate-specific antigen level of 2–20 ng/mL, who underwent prostate biopsy. Clinical and pathological data such as age, prostate volume, prostate-specific antigen, procalcitonin, and Gleason score were reviewed. All patients were divided into three groups with total prostate-specific antigen level between 2 and 4 ng/mL, 4.1 and 10 ng/mL, and 10.1 and 20 ng/mL.

Results:

Of 227 patients who underwent biopsy, prostate cancer was diagnosed in 74 (32.6%) patients and the remaining 153 patients had a benign condition. The difference in mean serum procalcitonin values was significantly higher in the prostate cancer compared with the benign group (0.06 ± 0.03 vs 0.04 ± 0.03 ng/mL; p = 0.0001). Using a threshold of 0.045 ng/mL, procalcitonin was 54.1% sensitive and 80.3% specific (area under curve = 0.683). Serum procalcitonin levels were not able to differentiate between prostate cancer patients with prostate-specific antigen level of 2–4, 4.1–10, and 10.1–20 ng/mL.

Conclusion:

Based on this prospective study, procalcitonin can be a novel supplementary biomarker to increase the accuracy of prostate cancer screening.
Could spinal anesthesia be a choice for retrograde intrarenal surgery
Authors: Karabulut Ibrahim , Koc Erdem , Yilmaz Ali Haydar , Ahiskali Elif Oral , Keskin Ercument , Adanur Senol , Resorlu Berkan
Published: June 2018

Objective:

In this study, we aimed to compare cases of retrograde intrarenal surgery performed under spinal or general anesthesia through investigating relevant parameters for the first time in the literature.

Material and method:

In total, 86 patients with diagnosis of kidney stone who were treated by retrograde intrarenal surgery were included in this randomized controlled prospective study. In total, 43 of these operations were performed under spinal anesthesia (group I) and 43 were performed under general anesthesia (group II). The groups were compared in terms of demographic features, American Society of Anesthesiologists score, duration of operation, complication rates, postoperative visual analogue scale, postoperative hospitalization period, stone-free rates, and cost value ratios.

Results:

There were no significant differences between the two groups in terms of demographic findings, preoperative stone loads, postoperative stone-free rates, complication rates and postoperative hospitalization periods (p > 0.05). Postoperative visual analogue scale scores and cost value ratios were found statistically significantly lower in the spinal anesthesia group (group I) when compared with the general anesthesia group (group II; p < 0.001).

Conclusion:

Performing retrograde intrarenal surgery in the presence of spinal anesthesia is equally effective with general anesthesia. Spinal anesthesia also appears to be a more advantageous method due to statistically significantly lower mean postoperative pain scores and treatment cost value ratios.
Perioperative inadvertent hypothermia among urology patients who underwent transurethral resection with either TURis or transurethral resection of the prostate method
Authors: Chalari Eleftheria , Intas George , Zyga Sofia , Fildissis Georgios , Tolia Maria , Toutziaris Chrysovalantis , Tsoukalas Nikolaos , Kyrgias George , Panoutsopoulos Georgios
Published: June 2018

Purpose:

The purpose of the study was to investigate the incidence of perioperative hypothermia in urology patients undergoing transurethral resection with either TURis or transurethral resection of the prostate method and to recognize the risk factors that were responsible for the occurrence of hypothermia intraoperatively in these patients.

Methods:

It was a randomized prospective study. A total of 168 patients, according to American Society of Anesthesiologists physical status I–III, were scheduled for transurethral resection either with TURis or transurethral resection of the prostate method. We measured the core body temperature before (preoperative), during (perioperative) and after (postoperative) the surgery. Age, body mass index, American Society of Anesthesiologists score, duration of surgery, preoperative prostatic volume, and vital signs were also recorded.

Results:

The prevalence of inadvertent hypothermia was 64.1% for the TURis group and 60% for the transurethral resection of the prostate group. Hypothermic patients in TURis group were significantly older (87.7 ± 1.7 vs 68 ± 6.7 years, p < 0.05) and had lower body mass index (26.9 ± 3.6 vs 29.2 ± 2.7, p < 0.05), while hypothermic patients in the transurethral resection of the prostate group were significantly older (86 ± 1.1 vs 70 ± 7.4 years, p < 0.05) and had notably higher duration of surgery (140.6 ± 28.9 vs 120.3 ± 14.3 min, p < 0.05) than normothermic patients.

Conclusion:

Perioperative inadvertent hypothermia among urology patients who underwent transurethral resection with both TURis and transurethral resection of the prostate method is of high incidence. We recommend monitoring of the temperature of core body of all these patients, especially those with advanced age and lower body mass index.
Relevance of testicular histopathology on prediction of sperm retrieval rates in case of non-obstructive and obstructive azoospermia
Authors: Cito Gianmartin , Coccia Maria E , Dabizzi Sara , Morselli Simone , Della Camera Pier A , Cocci Andrea , Criscuoli Luciana , Picone Rita , De Carlo Candida , Nesi Gabriella , Micelli Elisabetta , Serni Sergio , Carini Marco , Natali Alessandro
Published: June 2018

Introduction:

The aim of our research was to establish the relevance of testicular histopathology on sperm retrieval after testicular sperm extraction in patients with non-obstructive azoospermia and in patients with obstructive azoospermia, who already underwent a previous failure testicular fine needle aspiration.

Methods:

We evaluated a total of 82 azoospermic men, underwent testicular sperm extraction, referring to the Assisted Reproductive Technology Centre of the University of Florence, Italy between January 2008 and March 2017. A general and genital physical examination, scrotal and trans-rectal ultrasound, semen analysis, hormone measurements, including follicle-stimulating hormone, luteinizing hormone and total testosterone, were collected.

Results:

Successful sperm retrieval was obtained in 36 men of total (43.9%). Successful sperm retrieval was 29.5% in non-obstructive azoospermia patients, while men with obstructive azoospermia, who, underwent a previous failure testicular fine needle aspiration, had sperm retrieval in 86% of cases. Mean luteinizing hormone was 6.55 IU/L, total testosterone 4.70 ng/mL, right testicular volume 13.7 mL and left testicular volume 13.6 mL. Mean Follicle-stimulating hormone was 13.45 IU/L in patients with negative sperm retrieval and 8.18 IU/L in men with successful sperm retrieval. According to histology, 20.7% had normal spermatogenesis, 35.3% hypospermatogenesis, 35.3% maturation arrest and 8.5% Sertoli cell-only syndrome. Successful sperm retrieval was 88.2% in patients with normal spermatogenesis, 24.1% in the maturation arrest group and 48.27% in patients with hypospermatogenesis, while negative sperm retrieval was reported in Sertoli cell-only syndrome patients. Seven cases with maturation arrest showed a successful sperm retrieval.

Conclusion:

Testicular histopathology after testicular sperm extraction offers important information on prediction of sperm retrieval and can guide the surgeon in choosing the more suitable therapeutic practice.
Paraneoplastic digital ischemia in clear-cell renal-cell carcinoma: Report of a case and review of the literature
Authors: Kampoli Katerina , Gardeli Dimitra , Mouktaroudi Maria , Fanouriakis Antonis , Lazaris Andreas M , Koumarianou Anna
Published: June 2018

Digital ischemia has been rarely associated, as a paraneoplastic syndrome, with renal cancer. Since it can severely compromise the patients’ quality of life, early recognition is important, in order to optimally address it with currently available treatment options, such as tyrosine inhibitors. Digital ischemia may occur in the general population and it can be the result of other non-cancerous diseases; accordingly, a thorough and aggressive work-up is mandatory, together with appropriate therapeutic steps such as tyrosine kinase inhibitors, vasodilators, and antiaggregants. Herein, we report a 78-year-old male patient with a history of clear-cell renal-cell cancer, who presented in the emergency department with critical ischemia in the upper limbs.
The role of blood neutrophil count and the neutrophil-to-lymphocyte ratio as a predictive factor for prostate biopsy results
Authors: Kamali Koosha , Ashrafi Mojtaba , Shadpour Pejman , Ameli Mojtaba , Khayyamfar Amirmahdi , Abolhasani Maryam , Azizpoor Amin
Published: June 2018

Background:

It is apparent that prostate cancer has harmful effects on the erythrocytes, leucocytes, and platelets. In addition, it has been suggested that the toxic granules in neutrophils lead to inflammation in the cancerous tissues besides the activation of monocytes, so in this study we aimed to evaluate the blood neutrophil count besides the neutrophil-to-lymphocyte ratio as a predictive factor for prostate biopsy results and their relationship with prostate cancer grade in patients undergoing biopsy of the prostate.

Methods:

For all men with irritative lower urinary tract symptoms visiting Hasheminezhad Hospital from January to July 2015, in case of having a suspicious digital rectal examination or aged above 40 years, prostate-specific antigen was requested and in case of abnormal results, they underwent prostate biopsy. In order to examine the study hypothesis, the blood neutrophil count and the neutrophil-to-lymphocyte ratio were measured and compared with the abnormal prostate-specific antigen results and suspicious digital rectal examination.

Results:

Among the 500 referred samples for biopsy, 352 (70.4%) had a negative biopsy result, while it was positive in the other 148 (29.6). The mean neutrophil count showed no statistical difference regarding the biopsy results (p = 0.381). When measuring the neutrophil-to-lymphocyte ratio again with biopsy results, no statistically significant difference was obtained based on the biopsy results (p = 0.112).

Conclusion:

Neutrophil count and neutrophil-to-lymphocyte ratio cannot be predictive factors for positive prostate cancer biopsy.
Biplanar oblique access technique: A new approach to improve the success rate of percutaneous nephrolithotomy
Authors: Basiri Abbas , Shakiba Behnam , Hoshyar Hasan , Ansari Anahita , Golshan Alireza
Published: June 2018

Introduction:

Achieving suitable percutaneous access to the kidney is the most important step in percutaneous nephrolithotomy. The triangulation biplanar access technique under fluoroscopy is the standard method to achieve percutaneous renal access, but it is not successful in all cases. We used the new biplanar oblique access technique as a rescue method for the failed standard biplanar technique. The aim of this study was to evaluate the effects of this oblique access technique on access outcome.

Methods:

In total, 782 percutaneous nephrolithotomy procedures were performed under the standard triangulation biplanar technique. The biplanar access failed in 35 cases. Access failure was defined as no urine dropping from the needle or inability to insert the guide wire into the renal pelvis or selected calyx. In 28 failed access cases, the lower calyx was the targeted calyx. We used the oblique access technique for these cases. Initially, the arm of fluoroscopy was in the vertical position. Then the fluoroscopy device was rotated to 30° near the surgeon and 30° caudal to the patient and the needle was inserted into the appropriate calyx.

Results:

Percutaneous nephrolithotomy procedures were performed by the oblique access technique in 28 patients. Successful access was achieved in eight patients by the oblique technique (success access rate = 28.6%). No major or minor complication occurred in these patients.

Conclusion:

The oblique technique is an auxiliary method for accessing the lower calyx in cases which the standard triangular biplanar method has failed. As the failure rate of the biplanar technique is low, the oblique technique can be considered as a useful method for percutaneous access.
Erasmus the Educator
Authors: Powell Justin
Published: June 2018

Erasmus is famous as the humanist scholar who helped shape what became modem education. W. H. Woodward and Erika Rummel have written standard works on his life and teachings, and others offer nuanced analysis. This article hopes to fill a small gap in Erasmus studies in that his “philosophy of Christ”, which finds its roots in the Early Church Fathers, is directly related to his pedagogy.