bluuebunny/crossref_metadata_2025_split huggingface dataset:
Investigational Drug Therapies for Overactive Bladder Syndrome: The Potential Alternatives to Anticolinergics
Authors: Sacco E. , Pinto F. , Tienforti D. , Marangi F. , Destito A. , Racioppi M. , Gardi M. , Volpe A. , Bassi P.F. 
Published: June 2018

Background Overactive bladder is a high prevalent and quality of life affecting disease. The mainstay of the medical therapy is represented by antimuscarinic drugs, but their side effects markedly affect patient compliance and prompt studies on novel investigational drugs. Methods A systematic literature search of peer-reviewed papers and meeting abstracts published by December 2008 was performed. PubMed databank was searched for original English articles, by using the following search terms: “overactive bladder” or “detrusor overactivity” or “urinary incontinence” and “treatment”, alone and linked to any potential molecular target or novel drug cited in the literature. Results Effective alternative pharmacological treatments are currently scarce, but many new promising compounds are emerging which target key molecular pathways involved in micturition control. The most promising potential therapeutic targets include central nervous system GABAergic inhibitory pathway, dopaminergic and serotoninergic systems, b-adrenoceptors and cAMP metabolism, nonadrenergic-noncholinergic mechanisms such as purinergic and neuropeptidergic systems, vanilloid receptor, bladder sensory nervous terminals, nonneuronal bladder signalling systems including urothelium and interstitial cells, prostanoids, Rho-kinase and different subtypes of potassium and calcium channels. Conclusions Despite the enormous amount of new biologic insight, very few novel pharmacological therapies seems to have passed the proof-of-concept clinical stage. The ultimate clinical utility of new drugs will depend on the ability to exploit tissue-specific differences and disease-related changes in molecular expression/function and to improve storage phase dysfunctions without interfering with the emptying phase. Further preclinical investigations and controlled clinical trials are urgently needed in this challenging field.
The Activities of Risk Management
Authors: Marino G. , Di Primio O.G. , Cortese F.C. , Pedalino M. , Vella R. , Vercesi E. 
Published: June 2018

Introduction The activities of Risk Management at a department of urology involve specialist health workers, technical and administrative staff as the common denominator is communication, simplification of processes and the quality of health care provision. The Authors present their experience on the management of risk in urology and an attempted classification of adverse events with possible dysfunction in the clinical management in urology department. Materials and Methods Our analysis included those adverse events that occurred from January to December 2008. A total of 18 adverse events were identified from 638 urological procedures divided according to diagnosis, treatment and type of hospitalization. Results The following events were assessed: number of cases with wound infection: 5 (4.7%), diastasis of the surgical wound: 3 (0.47%), catheter obstructions that required therapeutic endoscopic or surgical haemostatic procedures: 5 (0.78%), delayed administration of treatment: 3 (0.47%) and accidental fall out of bed: 2 (0.31%). Conclusions The transition from a reactive to a preventive system remains the key to provide the citizen with the best health care in safety conditions. The involvement of different organizational and managerial levels in an optimal atmosphere in the absence of stress appears to be the most balanced and successful approach, especially putting aside the attitude of assigning error culpability. The transmission of individual experiences at a regional and national level will allow refining the project, which foresees the identification and classification of possible events and especially the ways and preventive procedures to achieve them.
Which Technical Aspects have an Impact on Perceived Pain during Transperineal Prostate Biopsy? A Prospective Study Involving 445 Cases
Authors: Antonelli A. , Simeone C. , Giovanessi L. , Zambolin T. , Zani D. , Cunico S. COSCIANI 
Published: June 2018

To assess the technical aspects determining the perceived pain during prostate biopsy via transperineal access. Materials and Methods We conducted prostate biopsy with transperineal access in local anesthesia. Between January 2007 and January 2008, data on prostatic biopsies were prospectively surveyed. The patient was requested to assess perceived pain by means of a Visual Analogue Scale ranging from 0 (no pain) to 10 (unbearable pain). Complications were recorded by telephone interviews 30 days after the biopsy. The histological diagnosis was recorded. Results 445 prostate biopsies were conducted. The average perceived pain score amounted to 2.60. At univariate analysis, a lower score was recorded in cases where the anesthetic agent was diluted with physiological saline, those in which a single cutaneous access was chosen along the middle line, those in the first bioptic series as compared to the following series and those in which no sampling involved the transition region. However, the multivariate analysis showed that only the single cutaneous access was statistically significant. In those cases, also the rates of delayed perineal pain were significantly lower. The cancer diagnosis rate showed no correlations with the type of cutaneous access. Conclusions A single median cutaneous access reduces the pain associated to transperineal prostatic biopsy.
Re-Biopsies of the Prostate after Endo-Magnetic Resonance Imaging (MRI) and Spectroscopy (MRS) in Patients with ASAP: Preliminary Results
Authors: Bosio A. , Destefanis P. , De Maria C. , Bisconti A. , Carchedi M. , Negro C. , Buffardi A. , Petracchini M. , Munoz F. , Cirillo S. , Fontana D. 
Published: June 2018

Introduction e Objectives There are some evidences that the combination of EndoMRI and MRS might be able to limit the number of iterative biopsies in patients with negative biopsies of the prostate and a still rising PSA. The aim of this study is to evaluate the possible role of EndoMRI/MRS in patients with ASAP. Methods From November 2005 to September 2008 we enrolled 28 consecutive patients diagnosed with ASAP at a TRUS-guided needle prostate biopsy. All patients underwent prostatic EndoMRI and MRS. A prostatic zone was classified as: suspicious for prostate cancer if low intensity signal was present on T2-weighted images and/or if the choline + creatine / citrate ratio was >0.86; equivocal or negative otherwise. A subsequent 12-core needle prostate biopsy was performed and supplementary biopsies were added in the suspicious zones. The results of MRI/MRS were then compared with histological findings. Results The combination of EndoMRI and MRS was suspicious for cancer in 70% of patients, equivocal in 23% and negative in 7%. Histological findings at re-biopsy included: prostate cancer in 35%, ASAP in 23%, BPH or prostatitis in 42%. In 78% of patients diagnosed with prostate cancer the combination MRI/MRS was suspicious and in 22% equivocal. In all patients the cancer was found in suspicious zones at MRI/MRS where targeted biopsies were performed. Conclusions The combination of EndoMRI and MRS proved to have a good sensitivity but a poor specificity in identifying a concurrent prostate cancer among patients with ASAP. The location of positive cores for prostate cancer was consistent with the suspicious zones at MRI/MRS.
ESWL and Triple Fire Lithotripter
Authors: Guiggi P. , Micheli C. , Nunzi E. , Bini V. , Porena M. 
Published: June 2018

The ideal lithotripter which all companies hope to achieve in the near future, should be characterized by high efficacy, low impact on the patient's sensitivity to pain and least detrimental action on the surrounding tissues. Yet, even the most modern technology seems to be still very far from achieving these goals. For around 1 year our Department has been using the last generation lithotripter Piezolith 3000® (variable triple-focus). Compared to its predecessor, this machine has some changes such as: a) triple focus module that allows to adjust the focal distance to the size of the calculation, b) greater focal depth ranging from 15 cm in Piezolith 3000® fixed focus to 16.5 cm in the new lithotripter, allowing for an easier and more effective treatment of obese patients, c) increase in power by opening the SW variable focal length (F1: 0.20–3.26 mJ/mm2, F2: 0.08–1.64 mJ/mm2, F3: 0.030–0.41 mJ/mm2). The objective of our work is to assess whether the technical characteristics of the new Piezolith 3000® determine a real improvement in management of urinary calculi. Methods 265 patients undergoing ESWL with variable triple-focus lithotripter from January 2008 to January 2009 (Group A) were compared to 265 patients treated with an equal lithotripter Piezolith 3000® fixed focus (Group B). The two groups were homogeneous as for the following variables: age, size and location of the calculi, which are distributed as follows: superior calyx (6), medium (20), inferior (32), renal pelvis (36), pyeloureteral junction (12), lumbar ureter (50), iliac (12), pelvis (6), iuxtavesical (70), bladder (7), multiple sites (14). The ESWL was performed in both groups with ultrasound exclusive point. Results In Group A the time of fragmentation is lower compared to Group B (p<0.01), with fewer days required for fragment expulsion and lower number of re-treatments (p<0.05). The latter result is probably due to increased average energy applied (2.35 mJ/mm2). However, the increase of this energy results in parallel increased perception of pain during ESWL. Conclusions Piezolith 3000® represents a real improvement in the effectiveness of fragmentation but there is, compared to the previous model, a significant reduction in the time of expulsion. This suggests that this variable is affected by other factors.
Urinary Stone Disease during Pregnancy: One Problem, Two Patients
Authors: Zanin M. , Vianello F. , Gigli F. , Beltrami P. , Zattoni F. 
Published: June 2018

Urolithiasis in pregnant women is a quite uncommon event: about one in 1500 pregnancies is complicated by urinary calculi and it occurs in 80–90% of the patients during the second or third trimester of pregnancy. Several factors may predispose stone formation in the upper urinary tract during pregnancy: the “physiological” hydronephrosis, the gestational hypercalciuria, and an elevation in both glomerular filtration rate and renal plasma flow, associated with an increase of creatinine clearance and higher renal filtration rate of sodium, calcium, and uric acid. Flank or abdominal pain is the most common symptom associated with evident or microscopic hematuria. Differential diagnosis of pain varies according to its location: it could be of gastrointestinal or gynecologic origin. Diagnosis is previously based on ultrasound evaluation. The use of radiation must be avoided during pregnancy, even if the risk of fetal injures depends on gestational age and radiation dosage. Most of the symptomatic ureteral stones affecting pregnant women pass spontaneously: therefore therapy could be conservative (hydration, analgesia, antibiotics, antiemetics) in the most of cases, although in the 15–30% of the cases it is necessary to adopt an active treatment, like percutaneous nephrostomy drainage, ureteral stent insertion or ureterorenoscopy.
Penile Carcinoma: Treatment of Metastatic Disease after Previous Neoadjuvant Chemotherapy and Locoregional Therapy
Authors: Longo N. , Di Lorenzo G. , Verze P. , Arcaniolo D. , Creta M. , Buonopane R. , Riccio R. , Mirone V. 
Published: June 2018

Introduction Metastatic squamous cell carcinoma of the penis is a rare condition in European countries. Neoadjuvant chemotherapy improves local disease control in patients with lymph node metastases and/or inoperable disease. Limited data exist on the efficacy and safety of chemotherapy in the adjuvant setting for patients with metastatic disease after previous neoadjuvant chemotherapy and locoregional therapy. Methods Twelve patients with metastatic penile carcinoma previously treated with neoadjuvant chemotherapy and locoregional therapy were enrolled into the study. Treatment protocol consisted of paclitaxel 175mg/m2 at a 3-week interval. Objective response rate according to Response Evaluation Criteria in Solid Tumors, progression-free survival, overall survival and toxicity were evaluated. Results A partial objective response, a disease stability, and a disease progression were documented in 3, 3 and 6 patients, respectively. Median progression-free survival and median overall survival were 4 and 6 months, respectively. Treatment was well tolerated; only one case of grade 4 toxicity was reported. Conclusions Our initial data suggest that paclitaxel monotherapy is active and well tolerated in patients with metastatic squamous cell penile carcinoma previously treated with neoadjuvant systemic chemotherapy and local therapy. Further studies are therefore needed.
Results at 48 Months of a Randomized Trial on Maintenance after Early Adjuvant
Authors: Serretta V. , Morgia G. , Altieri V. , Passalacqua D. , Falsaperla M. , Cacciatore M. , Nicolosi F. , Siragusa A. , Borruso L. , Vaccarella G. , Vacirca F. , Napoli M. , Paola Q. , Gange E. , Falvo F. , Allegro R. , Melloni D. 
Published: June 2018

Introduction and objectives The role of maintenance regimen following early intravesical chemotherapy after TUR of intermediate risk non-muscle invasive bladder cancer (NMI-BC) is still debated. Only few studies have been published on this topic, rarely dealing with patients receiving an early treatment. The aim of the present study is to evaluate the efficacy of one-year maintenance after a 6-week cycle of early intravesical chemotherapy. Methods Between May 2002 and August 2003, 482 patients with intermediate risk NMI-BC after TUR and early intravesical chemotherapy (epirubicin, 80mg/50mL) were randomized between 6-week induction cycle and induction plus maintenance with 10 monthly instillations. A written informed consent was obtained. All patients underwent cytology and cystoscopy 3-monthly for 2 years and 6-monthly thereafter. Results Treatment interruption for toxicity was required in 39 patients. Median follow-up was 48 months. Ten patients (2.5%) progressed and 117 patients (29.6%) recurred. The tumor characteristics were equally distributed between the two arms. No statistically significant difference in recurrence free survival (RFS) was detected between the two arms (p=0.43). An advantage in terms of recurrence free rate (RFR) in favor of the maintenance arm was evident only until 18 months after TUR (p=0.03). A trend for a higher benefit from maintenance in primary and multiple tumors was detected. Conclusions The risk of tumor recurrence is significantly reduced by one-year maintenance only for 18 months after TUR in comparison with patients receiving a 6-week cycle of early intravesical chemotherapy. The disadvantages of prolonged intravesical chemotherapy should be taken into account.
Conservative Management and Survival of Patients Affected by T1G3 Bladder Tumours. When Shall we Indicate it and When the Cystectomy?
Authors: Ruggirello A. , Serretta V. , Passalacqua D. , Zaccone V. , Daricello M. , Aragona F. , Allegro R. , Melloni D. 
Published: June 2018

Introduction Conservative management is not applicable to all T1G3 tumors. The appropriate treatment should minimize mortality while assuring reduced morbidity and good quality of life. Several attempts have been done to identify categories of T1G3 patients at higher risk. The role of biologic markers is unclear and the prognostic risk factors are mainly clinical. The proper time to abandon the conservative approach in favor of cystectomy is still object of debate. Objectives The aim of the present study is to assess the clinical tumor features showing a detrimental effect on survival, identify the clinical risk factors impacting survival in patients undergoing conservative management of T1G3 bladder tumor, and to analyze the prognostic role of recurrence. Methods The present analysis is extended to 236 patients with T1G3 bladder tumors treated by TUR plus intravesical therapy between 1976 and 2005. Patients with previous T1G3, Tis, more than 3 tumors or greater than 3cm were excluded. Urinary cytology was obtained within 30 days after TUR. Since 2000 re-TUR has been performed. A sequential combination of mitomycin-C (30mg/30ml) and epirubicin (50mg/50ml) was adopted in 106 patients (44.9%). BCG or other agents were given intravesically in 85 (36.0%) and 38 (16.1%) patients, respectively. Seven (3%) patients refused intravescical therapy. In the case of Ta-T1 recurrence, TUR and one year of adjuvant intravesical therapy were repeated. Patients went off study if Tis, T1G3 or T-category tumor over T1 were detected. Age, previous history, number of tumors, re-TUR, adjuvant therapy, recurrence and progression were considered for survival analysis. Results Tumors were primary in 177 (75.3%) and single in 144 (61.5%) cases. At a mean follow-up of 52 months (range: 3–246 months), 116 patients (49.2%) relapsed. The recurring tumor was T1 in 47 (40.5%) cases and T1G3 in 33 (28.4%). In 11 additional patients (9.5%) a Tis was detected. Twenty-five patients (10.6%) progressed and 15 patients (6.4%) underwent cystectomy. Median overall survival was 167 months. The 5-year progression-free survival rate was 87.8%. Thirty-two patients (13.6%) died, 22 (9.3%) for bladder cancer. A higher mortality was detected in recurrent (p= 0.002) and multiple (p=0.009) tumors undergoing conservative management. Survival was decreased by NMI recurrence (p<0.0001) and by progression (p=0.009). No statistical significant difference in survival was evident in relation to the grade and stage of the recurrent tumor. Conclusions Previous positive history and multiplicity are relevant risk factors for survival in patients affected by T1G3 NMI TCCB conservatively treated. Survival is decreased if conservative management is not given up at the time of NMI recurrence, independently from its grade and stage.
Renal Artery Thrombosis
Authors: Pettenò A. , Dotti P. , Coluccio A. , Dallavalle F. , Gentilini C. , Tralce L. 
Published: June 2018

The diagnosis of acute renal infarction is often delayed or failed due to the rarity of the disease and to its non-specific clinical presentation. Cigarette smoking, with its vasoconstrictive and prothrombotic effects, is a known and sure risk factor for the development of the atheroembolic artery disease. Case study This is the report of a case of acute renal infarction in a heavy-smoking patient, a 66-year-old man who arrived at our ward for right worsening backache with vomit and abdominal pain not reacting to the analgesic therapy. A urgent ultrasound showed excretory axes not dilated bilaterally. Therefore, we had to perform further diagnostic tests (CT and then angiography) which highlighted a case of a right massive renal infarction due to complete thrombotic obstruction of the renal artery with patent contralateral ramification. We performed a PTA and then a local infusion of thrombolytic (metalyse 2 mg in 10’). After this treatment the patient showed an immediate stop of the hurting symptomatology, an improvement of the flow and an opacification of the parenchyma. (lower and medium part) with persistence of vision concerning endoluminal thrombosis. A CT angiography 20 days later, after home therapy with LMWH at therapeutic doses, confirmed a restored and normalized vascularization of the lower and medium part of the right kidney. Conclusions In the light of these case results - good revascularization of the lower 2/3 of the right kidney, despite a prolonged time of ischemia from the beginning of the symptoms to the diagnosis and to the further thrombolytic therapy (about 14 hours) -, we assume that a wider use of the Doppler method can be of some usefulness, in case of recurring colics especially not reacting to analgesic therapy with negative ultrasonography check-up for the dilatation of the excretory routes, in order to considerably reduce the diagnosis time of renal diseases of vascular type.
Current Impact of Transrectal Ultrasonography in Prostate Cancer Diagnosis
Authors: Martella O. , Galatioto G. PARADISO , Pace G. , Bergamasco L. , Maselli G. , Vicentini C. 
Published: June 2018

Aims We evaluate the diagnostic accuracy of transrectal prostate ultrasonography (TRUS) in prostate cancer (PCa) diagnosis in a group of patients who underwent prostate biopsy in 2008. Material and Methods 100 patients (mean age 65 years) underwent transrectal prostate biopsy at our center. Indications to biopsy were: suspected malignancy at rectal examination or increase of total PSA and/or PSA velocity and/or PSA density and/or low percentage of free PSA. 10–12 biopsies and additional ones in case of suspected ecographic images in every patient were carried out. We classified the ecographic aspects as: highly suggestive for heteroplasia (focal or widespread hypoechoic area in the peripheral zone), weakly suggestive (small hypoechoic focal alterations), and isohecoic areas. Results At ultrasound examination, highly suggestive images were found in 20 patients, weakly suggestive images in 39 patients, and isoechoic images in 41 patients. PCa was diagnosed in 45 patients. 40% of cancers (18 pts) appeared as highly suggestive hypoechoic images, 31% (14 pts) as weakly suggestive, and 29% (13 pts) as isoechoic. 32% was the positive predictive value of isoechoic areas biopsies, 90% of highly suggestive hypoechoic images, and 36% of weakly suggestive images. In the last ones, the diagnosis was often coincidental, i.e. in the opposite lobe, or in a different sextant of the same lobe (serendipity). Detection rate was 60% for prostate volumes ≤50 cc and 24% for volumes >50 cc. Discussion The result analysis allowed us to formulate the following considerations: - 60% of currently diagnosed PCa are not detectable by ultrasonography, or there are aspecific ecographic findings - 40% of cancers are detectable by ultrasonography with specific ecographic findings - The clinical value of the hypoechoic focal alterations is similar to isoechoic ones - Detection rate is positively influenced by prostate volume. Conclusions The study of hypoechoic and isoechoic bioptised areas shows a significant difference in TRUS accuracy in prostate cancer diagnosis. In this set of patients, prostate volume and transrectal ultrasonographic findings proved to be the most informative variables about PCa risk at the moment of first biopsy at any age.