bluuebunny/crossref_metadata_2025_split huggingface dataset:
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.
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.
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.
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.
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.