Maria Alonso Grandes, José Antonio Herranz Yagüe, Rocío Roldán Testillano, Alfonso María Márquez Negro, Casilda Cernuda Pereira, E. Ripalda Ferretti, Álvaro Páez Borda
Purpose: Parastomal hernia (PH) is one of the most frequent complications after stoma creation. Our objective was to analyze the incidence, evolution and predictive factors of PH in Bricker-type urinary diversion. Patients and methods: Case series analysis of 125 patients submitted to radical cystectomy and ileal conduit diversion for cancer in a single center during 2006-2021. Patient’s record and imaging tests were reviewed to identify those suffering PH. Moreno-Matías classification was used to define radiological PH (rPH). Demographic and preoperative characteristics of the patients, surgical details and postoperative complications were recorded. Univariate and multivariate analyses were conducted to determine the effect of each predictive variable on the development and progression of PH. Results: 21.6% of patients developed PH (median follow-up 37 months). Incidence increased with follow-up time (15.2% at 1 year, 20.8% at 2 years). BMI ≥ 25 (Expβ 8.31, 95% CI 1.06- 65.18, p = 0.04), previous midline laparotomy (Expβ 6.74, 95% CI 1.14-39.66, p = 0.04) and wound infection (Expβ 3.87, 95% CI 1.21-12.33, p = 0.02) were significantly associated with PH. Half of the patients with hernia had symptoms, 25.9% requiring surgical correction. 46% of type 1 hernias and 40% of type 2 hernias progressed to grade 3 with a median of 11 months. No variable was associated with radiological progression. Conclusions: This study proved 3 independent factors (overweight, laparotomy and wound infection) that increase the risk of developing PH.
{"title":"Parastomal hernia after radical cystectomy. Incidence, natural history and predictive factors – A single center study","authors":"Maria Alonso Grandes, José Antonio Herranz Yagüe, Rocío Roldán Testillano, Alfonso María Márquez Negro, Casilda Cernuda Pereira, E. Ripalda Ferretti, Álvaro Páez Borda","doi":"10.4081/aiua.2023.12108","DOIUrl":"https://doi.org/10.4081/aiua.2023.12108","url":null,"abstract":"Purpose: Parastomal hernia (PH) is one of the most frequent complications after stoma creation. Our objective was to analyze the incidence, evolution and predictive factors of PH in Bricker-type urinary diversion. Patients and methods: Case series analysis of 125 patients submitted to radical cystectomy and ileal conduit diversion for cancer in a single center during 2006-2021. Patient’s record and imaging tests were reviewed to identify those suffering PH. Moreno-Matías classification was used to define radiological PH (rPH). Demographic and preoperative characteristics of the patients, surgical details and postoperative complications were recorded. Univariate and multivariate analyses were conducted to determine the effect of each predictive variable on the development and progression of PH. Results: 21.6% of patients developed PH (median follow-up 37 months). Incidence increased with follow-up time (15.2% at 1 year, 20.8% at 2 years). BMI ≥ 25 (Expβ 8.31, 95% CI 1.06- 65.18, p = 0.04), previous midline laparotomy (Expβ 6.74, 95% CI 1.14-39.66, p = 0.04) and wound infection (Expβ 3.87, 95% CI 1.21-12.33, p = 0.02) were significantly associated with PH. Half of the patients with hernia had symptoms, 25.9% requiring surgical correction. 46% of type 1 hernias and 40% of type 2 hernias progressed to grade 3 with a median of 11 months. No variable was associated with radiological progression. Conclusions: This study proved 3 independent factors (overweight, laparotomy and wound infection) that increase the risk of developing PH.","PeriodicalId":46900,"journal":{"name":"Archivio Italiano di Urologia e Andrologia","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2023-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139145559","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
V. Quaresma, Francisca Magalhães, Lorenzo Marconi, J. Lima, Manuel Lopes, Ana-Marta Ferreira, Pedro Nunes, Arnaldo Figueiredo
To the Editor, Upper urinary tract obstruction (UUTO) is a common scenario in clinical practice, and it is caused by a variety of diseases. Lithiasis, tumours and strictures are some of the principal aetiologies. Multiple factors may influence both the need for decompression of the obstructed collecting system and the urgency of procedure...
{"title":"National consensus survey on management approaches for upper urinary tract obstruction: A comparative analysis of retrograde ureteric stent and percutaneous nephrostomy","authors":"V. Quaresma, Francisca Magalhães, Lorenzo Marconi, J. Lima, Manuel Lopes, Ana-Marta Ferreira, Pedro Nunes, Arnaldo Figueiredo","doi":"10.4081/aiua.2023.12118","DOIUrl":"https://doi.org/10.4081/aiua.2023.12118","url":null,"abstract":"To the Editor, Upper urinary tract obstruction (UUTO) is a common scenario in clinical practice, and it is caused by a variety of diseases. Lithiasis, tumours and strictures are some of the principal aetiologies. Multiple factors may influence both the need for decompression of the obstructed collecting system and the urgency of procedure...","PeriodicalId":46900,"journal":{"name":"Archivio Italiano di Urologia e Andrologia","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2023-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139144739","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Aftab Karimi, R. Yaghobi, J. Roozbeh, Zahra Rahimi, A. Afshari, Zahra Akbarpoor, Mojdeh Heidari
Background: Renal transplantation stands as the sole remedy for individuals afflicted with end-stage renal diseases, and safeguarding them from transplant rejection represents a vital, life-preserving endeavor posttransplantation. In this context, the impact of cytokines, notably IL-27, assumes a critical role in managing immune responses aimed at countering rejection. Consequently, this investigation endeavors to explore the precise function of IL-27 and its associated cytokines in the context of kidney transplant rejection. Methods: The study involved the acquisition of blood samples from a cohort of participants, consisting of 61 individuals who had undergone kidney transplantation (comprising 32 nonrejected patients and 29 rejected patients), and 33 healthy controls. The expression levels of specific genes were examined using SYBR Green Real-time PCR. Additionally, the evaluation encompassed the estimation of the ROC curve, the assessment of the relationship between certain blood factors, and the construction of protein-protein interaction networks for the genes under investigation. Results: Significant statistical differences in gene expression levels were observed between the rejected group and healthy controls, encompassing all the genes examined, except for TLR3 and TLR4 genes. Moreover, the analysis of the Area Under the Curve (AUC) revealed that IL-27, IL-27R, TNF-α, and TLR4 exhibited greater significance in discriminating between the two patient groups. These findings highlight the potential importance of IL-27, IL-27R, TNF-α, and TLR4 as key factors for distinguishing between individuals in the rejected group and those in the healthy control group. Conclusions: In the context of kidney rejections occurring within the specific timeframe of 2 weeks to 2 months post-transplantation, it is crucial to emphasize the significance of cytokines mRNA level, including IL-27, IL-27R, TNF-α, and TLR4, in elucidating and discerning the diverse immune system responses. The comprehensive examination of these cytokines’ mRNA level assumes considerable importance in understanding the intricate mechanisms underlying kidney rejection processes during this critical period.
{"title":"Study the mRNA level of IL-27/IL-27R pathway molecules in kidney transplant rejection","authors":"Aftab Karimi, R. Yaghobi, J. Roozbeh, Zahra Rahimi, A. Afshari, Zahra Akbarpoor, Mojdeh Heidari","doi":"10.4081/aiua.2023.11691","DOIUrl":"https://doi.org/10.4081/aiua.2023.11691","url":null,"abstract":"Background: Renal transplantation stands as the sole remedy for individuals afflicted with end-stage renal diseases, and safeguarding them from transplant rejection represents a vital, life-preserving endeavor posttransplantation. In this context, the impact of cytokines, notably IL-27, assumes a critical role in managing immune responses aimed at countering rejection. Consequently, this investigation endeavors to explore the precise function of IL-27 and its associated cytokines in the context of kidney transplant rejection. Methods: The study involved the acquisition of blood samples from a cohort of participants, consisting of 61 individuals who had undergone kidney transplantation (comprising 32 nonrejected patients and 29 rejected patients), and 33 healthy controls. The expression levels of specific genes were examined using SYBR Green Real-time PCR. Additionally, the evaluation encompassed the estimation of the ROC curve, the assessment of the relationship between certain blood factors, and the construction of protein-protein interaction networks for the genes under investigation. Results: Significant statistical differences in gene expression levels were observed between the rejected group and healthy controls, encompassing all the genes examined, except for TLR3 and TLR4 genes. Moreover, the analysis of the Area Under the Curve (AUC) revealed that IL-27, IL-27R, TNF-α, and TLR4 exhibited greater significance in discriminating between the two patient groups. These findings highlight the potential importance of IL-27, IL-27R, TNF-α, and TLR4 as key factors for distinguishing between individuals in the rejected group and those in the healthy control group. Conclusions: In the context of kidney rejections occurring within the specific timeframe of 2 weeks to 2 months post-transplantation, it is crucial to emphasize the significance of cytokines mRNA level, including IL-27, IL-27R, TNF-α, and TLR4, in elucidating and discerning the diverse immune system responses. The comprehensive examination of these cytokines’ mRNA level assumes considerable importance in understanding the intricate mechanisms underlying kidney rejection processes during this critical period.","PeriodicalId":46900,"journal":{"name":"Archivio Italiano di Urologia e Andrologia","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2023-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139145750","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Michele Zazzara, Marina P. Gardiman, Fabrizio Dal Moro
Introduction: The post-prostatectomy incontinence is influenced by multiple elements, anatomic components and biological factors. The bladder neck preservation, more accurate during robot assisted radical prostatectomy, works on two anatomic components responsible for post-prostatectomy continence. The bladder neck preservation spares the internal sphincter, which is responsible for passive continence, and results in earlier return to continence and lower rates of post-prostatectomy incontinence. Moreover, this surgical technique spares the zone of urothelium coaptation and provides primary resistance to the urine to maintain postprostatectomy continence. The potential risk of bladder neck positive surgical margins (PSM) may prevent the usage of the bladder neck preservation. Aim: The purpose of this study is to evaluate the surgical and pathological outcome in prostate cancer patients underwent robot assisted radical prostatectomy with bladder neck preservation. Materials and methods: Prospectively, we have collected demographic, clinical, surgical and pathological data of prostate cancer patients underwent robot assisted radical prostatectomy with bladder neck preservation, from January 2014 to December 2016, in Urological Clinic of the University of Padua. Moreover, it was valued the presence of alterations or continuous solutions of specimen external capsule, attributable to the surgical technique of bladder neck preservation, by microscopic and macroscopic pathological analysis. Results: According to D'Amico risk classification, 40 patients (45.4%) had a low risk neoplasia, 35 patients (39.8%) had an intermediate risk neoplasia, 13 patients (14.8%) had an high risk neoplasia. The median prostatic volume, valued on specimen, was 30.84 cc (21.5-44.75 cc). The median prostatic weight, valued on specimen, was 51 gr (36-67 gr). The pathological stage of disease was pT2a in 11 cases (12.5%), pT2b in 37 cases (42.1%), pT3a in 28 cases (31.8%), pT3b in 12 cases (13.6%). The pathological stage of lymph node involvement was pNx in 17 cases (19.3%), pN0 in 66 cases (75%), pN1 in 5 cases (5.7%). The prostate cancers diagnosed had a Gleason score at specimen of 6 in 10 cases (10.4%), 7 (3+4) in 30 cases (34.1%), 7 (4+3) in 20 cases (22.7%), 8 in 19 cases (21.6%) and 9 in 9 cases (10.2%). The prostatic base was involved by neoplasia in 14 patients (15.9%); of these, 5 patients (35.7%) had bladder neck PSM. The patients with bladder neck PSM had: a pathological stage of disease as pT3a in 2 cases (40%) and pT3b in 3 cases (60%); a pathological stage of lymph node involvement as pN0 in 2 cases (40%) and pN1 in 3 cases (60%); a Gleason score at specimen of 8 in 3 cases (60%) and 9 in 2 cases (40%); multiple PSM. Nobody had alterations or continuous solutions of specimen external capsule, attributable to surgical technique of bladder neck preservation. Conclusions: The bladder neck preservation, during robot assisted radical prostatectomy, is a safe oncologic
{"title":"The bladder neck preservation in robot assisted radical prostatectomy: Surgical and pathological outcome","authors":"Michele Zazzara, Marina P. Gardiman, Fabrizio Dal Moro","doi":"10.4081/aiua.2023.12138","DOIUrl":"https://doi.org/10.4081/aiua.2023.12138","url":null,"abstract":"Introduction: The post-prostatectomy incontinence is influenced by multiple elements, anatomic components and biological factors. The bladder neck preservation, more accurate during robot assisted radical prostatectomy, works on two anatomic components responsible for post-prostatectomy continence. The bladder neck preservation spares the internal sphincter, which is responsible for passive continence, and results in earlier return to continence and lower rates of post-prostatectomy incontinence. Moreover, this surgical technique spares the zone of urothelium coaptation and provides primary resistance to the urine to maintain postprostatectomy continence. The potential risk of bladder neck positive surgical margins (PSM) may prevent the usage of the bladder neck preservation. Aim: The purpose of this study is to evaluate the surgical and pathological outcome in prostate cancer patients underwent robot assisted radical prostatectomy with bladder neck preservation. Materials and methods: Prospectively, we have collected demographic, clinical, surgical and pathological data of prostate cancer patients underwent robot assisted radical prostatectomy with bladder neck preservation, from January 2014 to December 2016, in Urological Clinic of the University of Padua. Moreover, it was valued the presence of alterations or continuous solutions of specimen external capsule, attributable to the surgical technique of bladder neck preservation, by microscopic and macroscopic pathological analysis. Results: According to D'Amico risk classification, 40 patients (45.4%) had a low risk neoplasia, 35 patients (39.8%) had an intermediate risk neoplasia, 13 patients (14.8%) had an high risk neoplasia. The median prostatic volume, valued on specimen, was 30.84 cc (21.5-44.75 cc). The median prostatic weight, valued on specimen, was 51 gr (36-67 gr). The pathological stage of disease was pT2a in 11 cases (12.5%), pT2b in 37 cases (42.1%), pT3a in 28 cases (31.8%), pT3b in 12 cases (13.6%). The pathological stage of lymph node involvement was pNx in 17 cases (19.3%), pN0 in 66 cases (75%), pN1 in 5 cases (5.7%). The prostate cancers diagnosed had a Gleason score at specimen of 6 in 10 cases (10.4%), 7 (3+4) in 30 cases (34.1%), 7 (4+3) in 20 cases (22.7%), 8 in 19 cases (21.6%) and 9 in 9 cases (10.2%). The prostatic base was involved by neoplasia in 14 patients (15.9%); of these, 5 patients (35.7%) had bladder neck PSM. The patients with bladder neck PSM had: a pathological stage of disease as pT3a in 2 cases (40%) and pT3b in 3 cases (60%); a pathological stage of lymph node involvement as pN0 in 2 cases (40%) and pN1 in 3 cases (60%); a Gleason score at specimen of 8 in 3 cases (60%) and 9 in 2 cases (40%); multiple PSM. Nobody had alterations or continuous solutions of specimen external capsule, attributable to surgical technique of bladder neck preservation. Conclusions: The bladder neck preservation, during robot assisted radical prostatectomy, is a safe oncologic","PeriodicalId":46900,"journal":{"name":"Archivio Italiano di Urologia e Andrologia","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2023-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139151735","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Rawa Bapir, Ahmed Mohammed Abdalqadir, Esmaeel Aghaways, Hemn Hussein Bayz, Hiwa O. Abdullah, Shaho F. Ahmed, Berun A. Abdalla, Jihad Ibrahim Hama, B. O. Muhammed, Karokh Fadhil Hamahussein, Farman Mohammed Faraj, F. Kakamad
Brucella epididymo-orchitis (BEO) is a rare complication of brucellosis. Despite the high incidence of brucellosis in developing countries, few case series on BEO are available. This study focuses on the clinical presentations, diagnosis, and treatment of BEO with a review of the literature. This study included consecutive BEO patients diagnosed and treated at Smart Health Tower between 2021 and 2023. The required data were retrospectively collected from patients' profiles. The BEO diagnosis was established through scrotal Doppler ultrasound in cases with a positive Rose Bengal test and positive IgG and IgM results for brucellosis, in addition to scrotal pain and swelling. This study included 11 cases whose ages ranged from 22 to 55 years. Most of the cases presented with testicular pain (72.7%), followed by fever (63.6%) and arthralgia (63.6%). The right side (54.5%) was slightly more affected than the left side (45.5%). The major abnormal laboratory finding was an elevated C-reactive protein (82%). The treatment was conservative, in which a combination of gentamicin, doxycycline, and rifampicin was administered to the patients for about 6-8 weeks. One case underwent an orchiectomy due to the abscess formation. All the patients responded well to the treatment, with no recurrence. In the Middle East, brucellosis remains a concerning infectious disease. Early diagnosis, aimed at preventing abscess formation and other complications, takes first priority to avoid invasive interventions.
{"title":"Brucella epididymo-orchitis: A single-center experience with a review of the literature","authors":"Rawa Bapir, Ahmed Mohammed Abdalqadir, Esmaeel Aghaways, Hemn Hussein Bayz, Hiwa O. Abdullah, Shaho F. Ahmed, Berun A. Abdalla, Jihad Ibrahim Hama, B. O. Muhammed, Karokh Fadhil Hamahussein, Farman Mohammed Faraj, F. Kakamad","doi":"10.4081/aiua.2023.11978","DOIUrl":"https://doi.org/10.4081/aiua.2023.11978","url":null,"abstract":"Brucella epididymo-orchitis (BEO) is a rare complication of brucellosis. Despite the high incidence of brucellosis in developing countries, few case series on BEO are available. This study focuses on the clinical presentations, diagnosis, and treatment of BEO with a review of the literature. This study included consecutive BEO patients diagnosed and treated at Smart Health Tower between 2021 and 2023. The required data were retrospectively collected from patients' profiles. The BEO diagnosis was established through scrotal Doppler ultrasound in cases with a positive Rose Bengal test and positive IgG and IgM results for brucellosis, in addition to scrotal pain and swelling. This study included 11 cases whose ages ranged from 22 to 55 years. Most of the cases presented with testicular pain (72.7%), followed by fever (63.6%) and arthralgia (63.6%). The right side (54.5%) was slightly more affected than the left side (45.5%). The major abnormal laboratory finding was an elevated C-reactive protein (82%). The treatment was conservative, in which a combination of gentamicin, doxycycline, and rifampicin was administered to the patients for about 6-8 weeks. One case underwent an orchiectomy due to the abscess formation. All the patients responded well to the treatment, with no recurrence. In the Middle East, brucellosis remains a concerning infectious disease. Early diagnosis, aimed at preventing abscess formation and other complications, takes first priority to avoid invasive interventions.","PeriodicalId":46900,"journal":{"name":"Archivio Italiano di Urologia e Andrologia","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2023-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139149687","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
T. Abouelgreed, Ayman K. Koritenah, Yasser Badran, Ibrahim Tagreda, Mohamed Algammal, Hesham Abozied, Hany A. Eldamanhory, Hossam A. Shouman, Abdelhamid A. Khattab , Munira Ali , Mohammad Thabet Alnajem , Ahmed A. Abdelwahed
Objective: To evaluate safety and efficacy of Rezum therapy as a minimally invasive modality for management of benign prostatic hyperplasia in patients with prostate volume < 80cc and those with prostate volume > 80cc. Methods: Between June 2020 and February 2023, A total of 98 patients diagnosed with BPH and managed by Rezum were included in this study. Patients were divided based on their prostate volume of either less than 80 cc or greater than 80 cc. We evaluated several parameters related to their condition, including prostate volume, post-voiding residual (PVR) before and after surgery, number of treatments received, maximum urine flow rate (Qmax) before and after surgery and mean follow- up periods. Results: The mean age was 68 years (SD 11.2). The median prostatic volume was 62 cc (IQR 41, 17). A maximum of 9 treatments were administered. Six months was determined to be the average post-operative follow-up period (IQR: 3.5-7.2). The mean preoperative total PSA was 2.7 (IQR 1, 2), preoperative mean PVR was 79.8 cm3, preoperative mean Qmax was 8.2 ml/s (IQR 4.7-10.5), and median post-operative days until catheter removal was four days (IQR 3,1). Post-operative PVR was 24.7 cm3 (IQR 18.2, 29.4) and the mean post-operative Qmax was 18.3 ml/s (SD 6.3). Qmax levels significantly increased, by an average of 8.2 ml/s (SD 7.13) (p < 0.001). Similarly, a decrease of average PVR of 97.28 cm3 (SD 95.85) (p < 0.001) was detected, which is a substantial reduction. Between prostates less 80cc and those over 80cc, there were no appreciable differences in Qmax or PVR (p-values: 0.435 and 0.431, respectively). Conclusions: From our study, we conclude that Rezum water vapor thermal therapy, as a minimally invasive modality, is an effective and safe surgical option for management of benign prostatic hyperplasia of men with moderate to severe lower urinary tract symptoms (LUTS). This procedure has been shown to be effective in patients with varying larger prostate volumes.
{"title":"Evaluation of Rezum therapy as a minimally invasive modality for management of Benign Prostatic Hyperplasia: A prospective observational study","authors":"T. Abouelgreed, Ayman K. Koritenah, Yasser Badran, Ibrahim Tagreda, Mohamed Algammal, Hesham Abozied, Hany A. Eldamanhory, Hossam A. Shouman, Abdelhamid A. Khattab , Munira Ali , Mohammad Thabet Alnajem , Ahmed A. Abdelwahed","doi":"10.4081/aiua.2023.12026","DOIUrl":"https://doi.org/10.4081/aiua.2023.12026","url":null,"abstract":"Objective: To evaluate safety and efficacy of Rezum therapy as a minimally invasive modality for management of benign prostatic hyperplasia in patients with prostate volume < 80cc and those with prostate volume > 80cc. Methods: Between June 2020 and February 2023, A total of 98 patients diagnosed with BPH and managed by Rezum were included in this study. Patients were divided based on their prostate volume of either less than 80 cc or greater than 80 cc. We evaluated several parameters related to their condition, including prostate volume, post-voiding residual (PVR) before and after surgery, number of treatments received, maximum urine flow rate (Qmax) before and after surgery and mean follow- up periods. Results: The mean age was 68 years (SD 11.2). The median prostatic volume was 62 cc (IQR 41, 17). A maximum of 9 treatments were administered. Six months was determined to be the average post-operative follow-up period (IQR: 3.5-7.2). The mean preoperative total PSA was 2.7 (IQR 1, 2), preoperative mean PVR was 79.8 cm3, preoperative mean Qmax was 8.2 ml/s (IQR 4.7-10.5), and median post-operative days until catheter removal was four days (IQR 3,1). Post-operative PVR was 24.7 cm3 (IQR 18.2, 29.4) and the mean post-operative Qmax was 18.3 ml/s (SD 6.3). Qmax levels significantly increased, by an average of 8.2 ml/s (SD 7.13) (p < 0.001). Similarly, a decrease of average PVR of 97.28 cm3 (SD 95.85) (p < 0.001) was detected, which is a substantial reduction. Between prostates less 80cc and those over 80cc, there were no appreciable differences in Qmax or PVR (p-values: 0.435 and 0.431, respectively). Conclusions: From our study, we conclude that Rezum water vapor thermal therapy, as a minimally invasive modality, is an effective and safe surgical option for management of benign prostatic hyperplasia of men with moderate to severe lower urinary tract symptoms (LUTS). This procedure has been shown to be effective in patients with varying larger prostate volumes.","PeriodicalId":46900,"journal":{"name":"Archivio Italiano di Urologia e Andrologia","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2023-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139148965","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Domenico Prezioso, Gaetano Piccinocchi, Veronica Abate, Michele Ancona, Antonio Celia, Ciro De Luca, Riccardo Ferrari, Pietro Manuel Ferraro, Stefano Mancon, Giorgio Mazzon, Salvatore Micali, Giacomo Puca, Domenico Rendina, Alberto Saita, Andrea Salvetti, Andrea Spasiano, Elisa Tesè, Alberto Trinchieri
Background: The prevalence of kidney stones tends to increase worldwide due to dietary and climate changes. Disease management involves a high consumption of healthcare system resources which can be reduced with primary prevention measures and prophylaxis of recurrences. In this field, collaboration between general practitioners (GPs) and hospitals is crucial. Methods: a panel composed of general practitioners and academic and hospital clinicians expert in the treatment of urinary stones met with the aim of identifying the activities that require the participation of the GP in the management process of the kidney stone patient. Results: Collaboration between GP and hospital was found crucial in the treatment of renal colic and its infectious complications, expulsive treatment of ureteral stones, chemolysis of uric acid stones, long-term follow-up after active treatment of urinary stones, prevention of recurrence and primary prevention in the general population. Conclusions: The role of the GP is crucial in the management and prevention of urinary stones. Community hospitals which are normally led by GPs in liaison with consultants and other health professional can have a role in assisting multidisciplinary working as extended primary care.
{"title":"The role of the general practictioner in the management of urinary calculi","authors":"Domenico Prezioso, Gaetano Piccinocchi, Veronica Abate, Michele Ancona, Antonio Celia, Ciro De Luca, Riccardo Ferrari, Pietro Manuel Ferraro, Stefano Mancon, Giorgio Mazzon, Salvatore Micali, Giacomo Puca, Domenico Rendina, Alberto Saita, Andrea Salvetti, Andrea Spasiano, Elisa Tesè, Alberto Trinchieri","doi":"10.4081/aiua.2023.12155","DOIUrl":"https://doi.org/10.4081/aiua.2023.12155","url":null,"abstract":"Background: The prevalence of kidney stones tends to increase worldwide due to dietary and climate changes. Disease management involves a high consumption of healthcare system resources which can be reduced with primary prevention measures and prophylaxis of recurrences. In this field, collaboration between general practitioners (GPs) and hospitals is crucial. Methods: a panel composed of general practitioners and academic and hospital clinicians expert in the treatment of urinary stones met with the aim of identifying the activities that require the participation of the GP in the management process of the kidney stone patient. Results: Collaboration between GP and hospital was found crucial in the treatment of renal colic and its infectious complications, expulsive treatment of ureteral stones, chemolysis of uric acid stones, long-term follow-up after active treatment of urinary stones, prevention of recurrence and primary prevention in the general population. Conclusions: The role of the GP is crucial in the management and prevention of urinary stones. Community hospitals which are normally led by GPs in liaison with consultants and other health professional can have a role in assisting multidisciplinary working as extended primary care.","PeriodicalId":46900,"journal":{"name":"Archivio Italiano di Urologia e Andrologia","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2023-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139151337","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
E. Bosnalı, Enes Abdullah Baynal, N. B. Cinar, Enes Malik Akdas, Engin Telli, B. Yaprak Bayrak, K. Teke, Hasan Yılmaz, Ö. Dillioğlugil, Ö. Kara
Objective: To report long-term functional and oncological outcomes of OPN Methods: We enrolled 182 patients who underwent consecutive OPN with a diagnosis of kidney tumor in our clinic between April 2002 and February 2020 and were selected from our prospective OPN database. Preoperative demographic and clinical characteristics, intraoperative and pathological results, and patients' postoperative functional and oncological follow-up data were retrospectively analyzed. Overall survival (OS) and disease- free survival (DFS) were evaluated using Kaplan-Meier survival analysis. The time-dependent variation between preoperative and postoperative functional results was statistically analyzed and presented in a graph. Results and limitations: The mean age was 54.4 ± 10.8 yr, and the median age-adjusted Charlson comorbidity index (ACCI) was 1 (interquartile range [IQR] 0-1). The mean tumor size was 3.1 ± 1.2 cm, and the median RENAL score was 6 (IQR 5-8). The most common malign histopathological subtype was clear cell carcinoma with 76.6%, and five cases (3.4%) had positive surgical margins (PSMs). The most common surgical techniques were the retroperitoneal approach (98.9%) and cold ischemia (88.5%). Estimated glomerular filtration rate (eGFR) preservation was 92% (80.8-99.3, IQR), which translates to 32% chronic kidney disease (CKD) upstaging. Acute kidney injury (AKI) was detected in 27 (14.8%) patients according to RIFLE criteria. The intraoperative complication rate was 5.5%, and the postoperative overall complication rate (Clavien-Dindo 1-5) was 30.2%. Major complications (Clavien-Dindo 3-5) were observed in 13 (7.1%) patients. The median oncological follow-up was 42 mo (21.3- 84.6, IQR), and the 5- and 10-yr OS were 90.1% and 78.6%, 5 and 10-yr DFS were 99.4% and 92.1%, respectively. No local recurrence was observed in 5 (3.4%) patients with PSMs; only one had distant metastasis in the 8th postoperative month. The retrospective design, the small number of patients who underwent PN based on mandatory indication, and one type of surgical approach may limit the generalizability of our findings. Conclusions: This study confirms excellent long-term oncologic and functional outcomes after OPN in a cohort of patients selected from a single institution. In light of the information provided by the literature and our study, our recommendation is to push the limits of PN under every technically feasible condition in the treatment of kidney tumors to protect the kidney reserve and achieve near-perfect oncological results.
{"title":"Oncological and functional outcomes of patients who underwent open partial nephrectomy for kidney tumor","authors":"E. Bosnalı, Enes Abdullah Baynal, N. B. Cinar, Enes Malik Akdas, Engin Telli, B. Yaprak Bayrak, K. Teke, Hasan Yılmaz, Ö. Dillioğlugil, Ö. Kara","doi":"10.4081/aiua.2023.12130","DOIUrl":"https://doi.org/10.4081/aiua.2023.12130","url":null,"abstract":"Objective: To report long-term functional and oncological outcomes of OPN Methods: We enrolled 182 patients who underwent consecutive OPN with a diagnosis of kidney tumor in our clinic between April 2002 and February 2020 and were selected from our prospective OPN database. Preoperative demographic and clinical characteristics, intraoperative and pathological results, and patients' postoperative functional and oncological follow-up data were retrospectively analyzed. Overall survival (OS) and disease- free survival (DFS) were evaluated using Kaplan-Meier survival analysis. The time-dependent variation between preoperative and postoperative functional results was statistically analyzed and presented in a graph. Results and limitations: The mean age was 54.4 ± 10.8 yr, and the median age-adjusted Charlson comorbidity index (ACCI) was 1 (interquartile range [IQR] 0-1). The mean tumor size was 3.1 ± 1.2 cm, and the median RENAL score was 6 (IQR 5-8). The most common malign histopathological subtype was clear cell carcinoma with 76.6%, and five cases (3.4%) had positive surgical margins (PSMs). The most common surgical techniques were the retroperitoneal approach (98.9%) and cold ischemia (88.5%). Estimated glomerular filtration rate (eGFR) preservation was 92% (80.8-99.3, IQR), which translates to 32% chronic kidney disease (CKD) upstaging. Acute kidney injury (AKI) was detected in 27 (14.8%) patients according to RIFLE criteria. The intraoperative complication rate was 5.5%, and the postoperative overall complication rate (Clavien-Dindo 1-5) was 30.2%. Major complications (Clavien-Dindo 3-5) were observed in 13 (7.1%) patients. The median oncological follow-up was 42 mo (21.3- 84.6, IQR), and the 5- and 10-yr OS were 90.1% and 78.6%, 5 and 10-yr DFS were 99.4% and 92.1%, respectively. No local recurrence was observed in 5 (3.4%) patients with PSMs; only one had distant metastasis in the 8th postoperative month. The retrospective design, the small number of patients who underwent PN based on mandatory indication, and one type of surgical approach may limit the generalizability of our findings. Conclusions: This study confirms excellent long-term oncologic and functional outcomes after OPN in a cohort of patients selected from a single institution. In light of the information provided by the literature and our study, our recommendation is to push the limits of PN under every technically feasible condition in the treatment of kidney tumors to protect the kidney reserve and achieve near-perfect oncological results.","PeriodicalId":46900,"journal":{"name":"Archivio Italiano di Urologia e Andrologia","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2023-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139148980","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
T. Abouelgreed, M. Elhelaly, El-Sayed I. El-Agamy, Rasha Ahmed, Yasser M. Haggag, M. Abdelwadood, Salma F. Abdelkader , Sameh S. Ali , Naglaa M. Aboelsoud, Mosab F. Alassal , Gehad A. Bashir, T. Gharib
Objective: To assess the surgical results of patients who underwent retrograde intrarenal surgery (RIRS) using a ureteral access sheath (UAS) for management of renal stones sized 1-2 cm compared between patients who did and did not undergo preoperative ureteral stenting. Materials and methods: This prospective study included 83 patients (aged ≥ 20 years) who underwent RIRS from July 2021 to January 2023. All patients had renal calculi (stone size: 1-2 cm) located within the pelvicalyceal system. 43 and 40 patients were allocated to the non-prestent (group A) and prestent (group B), respectively. Patient baseline characteristics, renal stone details, operative data, stone-free rate (SFR) at 4 weeks and 6 months, and perioperative complications were compared between groups. Results: The baseline characteristics of all patients were comparable across the groups. Four weeks after surgery, the overall stone-free rate (SFR) stood at 62.65%. In the non-prestent and prestent groups, the SFRs were 58.12% and 67.5%, respectively (p = 0.89). By the sixth month post-surgery, the overall SFR rose to 80.72%. In the non-prestent and prestent groups, the SFRs were 76.74% and 85%, respectively (p = 0.081). No notable differences emerged in other variables, including perioperative complications, between the two groups. Conclusions: The SFR showed no significant difference between the prestenting and non-prestenting groups at the 4-week and 6-month postoperative marks. Additionally, there were no substantial differences in complications during surgery and recovery between the groups. Notably, the SFR increased from 4 weeks to 6 months without any additional procedures in either group.
{"title":"Effect of preoperative ureteral stenting on the surgical outcomes of patients with 1-2 cm renal stones managed by retrograde intrarenal surgery using a ureteral access sheath","authors":"T. Abouelgreed, M. Elhelaly, El-Sayed I. El-Agamy, Rasha Ahmed, Yasser M. Haggag, M. Abdelwadood, Salma F. Abdelkader , Sameh S. Ali , Naglaa M. Aboelsoud, Mosab F. Alassal , Gehad A. Bashir, T. Gharib","doi":"10.4081/aiua.2023.12102","DOIUrl":"https://doi.org/10.4081/aiua.2023.12102","url":null,"abstract":"Objective: To assess the surgical results of patients who underwent retrograde intrarenal surgery (RIRS) using a ureteral access sheath (UAS) for management of renal stones sized 1-2 cm compared between patients who did and did not undergo preoperative ureteral stenting. Materials and methods: This prospective study included 83 patients (aged ≥ 20 years) who underwent RIRS from July 2021 to January 2023. All patients had renal calculi (stone size: 1-2 cm) located within the pelvicalyceal system. 43 and 40 patients were allocated to the non-prestent (group A) and prestent (group B), respectively. Patient baseline characteristics, renal stone details, operative data, stone-free rate (SFR) at 4 weeks and 6 months, and perioperative complications were compared between groups. Results: The baseline characteristics of all patients were comparable across the groups. Four weeks after surgery, the overall stone-free rate (SFR) stood at 62.65%. In the non-prestent and prestent groups, the SFRs were 58.12% and 67.5%, respectively (p = 0.89). By the sixth month post-surgery, the overall SFR rose to 80.72%. In the non-prestent and prestent groups, the SFRs were 76.74% and 85%, respectively (p = 0.081). No notable differences emerged in other variables, including perioperative complications, between the two groups. Conclusions: The SFR showed no significant difference between the prestenting and non-prestenting groups at the 4-week and 6-month postoperative marks. Additionally, there were no substantial differences in complications during surgery and recovery between the groups. Notably, the SFR increased from 4 weeks to 6 months without any additional procedures in either group.","PeriodicalId":46900,"journal":{"name":"Archivio Italiano di Urologia e Andrologia","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2023-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139151926","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Débora Araújo, Alexandre Gromicho, Jorge Dias, Samuel Bastos, Rui Miguel Maciel, Ana Sabença, Luís Xambre
Introduction and objectives: The Prostate Imaging Reporting and Data System (PI-RADS) score reports the likelihood of a clinically significant prostate cancer (CsPCa) based on various multiparametric prostate magnetic resonance imaging (mpMRI) characteristics. The PI-RADS category 3 is an intermediate status, with an equivocal risk of malignancy. The PSA density (PSAD) has been proposed as a tool to facilitate biopsy decisions on PI-RADS category 3 lesions. The objective of this study is to determine the frequency of CsPCa, assess the diagnostic value of targeted biopsy and identify clinical predictors to improve the CsPCa detection rate in PI-RADS category 3 lesions.
Methods: Between 1st January 2017 and 31st December 2022, a total of 1661 men underwent a prostate biopsy at our institution. Clinical and mpMRI data of men with PI-RADS 3 lesions was reviewed. The study population was divided into two groups: target group, including those submitted to systematic plus targeted biopsy versus non-target group when only systematic or saturation biopsy were performed. Patients with PI-RADS 3 lesions were divided into three categories based on pathological biopsy results: benign, clinically insignificant disease (score Gleason = 6 or International Society of Urologic Pathologic (ISUP) 1) and clinically significant cancer (score Gleason ≥ 7 (3+4) or ISUP ≥ 2) according to target and non-target group. Univariate and multivariate analyses were performed to identify clinical predictors to improve the CsPCa detection rate in PI-RADS category 3 lesions.
Results: A total of 130 men with PIRADS 3 index lesions were identified. Pathologic results were benign in 77 lesions (59.2%), 19 (14.6%) were clinically insignificant (Gleason score 6) and 34 (26.2%) were clinically significant (Gleason score 7 or higher). Eighty-seven of the patients were included in the target group (66.9%) and 43 in the non-target group (33.1%). The CsPCa detection was higher in the non-target group (32.6%, n = 14 vs 23.0%, n = 20 respectively). When systematic and target biopsies were jointly performed, if the results of systematic biopsies are not considered and only the results of target biopsies are taken into account, a CsPCa diagnosis would be missed on 9 patients. The differences of insignificant cancer and CsPCa rates among the target or non-target group were not statistically significant (p = 0.50 and p = 0.24, respectively). on multivariate analysis, the abnormal DRE and lesions localized in Peripheral zone (PZ) were significantly associated with a presence of CsPCa in PI-RADS 3 lesions (oR = 3.61, 95% CI [1.22,10.72], p = 0.02 and oR = 3.31, 95% CI [1.35, 8.11], p = 0.01, respectively). A higher median PSAD significantly predisposed for CsPCa on univariate analyses (p = 0.05), however, was not significant in the multivariate analysis (p = 0.76). In our population, using 0.10 ng/ml/ml as a cut-off to perform biopsy,
{"title":"Predictors of prostate cancer detection in MRI PI-RADS 3 lesions - Reality of a tertiary center.","authors":"Débora Araújo, Alexandre Gromicho, Jorge Dias, Samuel Bastos, Rui Miguel Maciel, Ana Sabença, Luís Xambre","doi":"10.4081/aiua.2023.11830","DOIUrl":"10.4081/aiua.2023.11830","url":null,"abstract":"<p><strong>Introduction and objectives: </strong>The Prostate Imaging Reporting and Data System (PI-RADS) score reports the likelihood of a clinically significant prostate cancer (CsPCa) based on various multiparametric prostate magnetic resonance imaging (mpMRI) characteristics. The PI-RADS category 3 is an intermediate status, with an equivocal risk of malignancy. The PSA density (PSAD) has been proposed as a tool to facilitate biopsy decisions on PI-RADS category 3 lesions. The objective of this study is to determine the frequency of CsPCa, assess the diagnostic value of targeted biopsy and identify clinical predictors to improve the CsPCa detection rate in PI-RADS category 3 lesions.</p><p><strong>Methods: </strong>Between 1st January 2017 and 31st December 2022, a total of 1661 men underwent a prostate biopsy at our institution. Clinical and mpMRI data of men with PI-RADS 3 lesions was reviewed. The study population was divided into two groups: target group, including those submitted to systematic plus targeted biopsy versus non-target group when only systematic or saturation biopsy were performed. Patients with PI-RADS 3 lesions were divided into three categories based on pathological biopsy results: benign, clinically insignificant disease (score Gleason = 6 or International Society of Urologic Pathologic (ISUP) 1) and clinically significant cancer (score Gleason ≥ 7 (3+4) or ISUP ≥ 2) according to target and non-target group. Univariate and multivariate analyses were performed to identify clinical predictors to improve the CsPCa detection rate in PI-RADS category 3 lesions.</p><p><strong>Results: </strong>A total of 130 men with PIRADS 3 index lesions were identified. Pathologic results were benign in 77 lesions (59.2%), 19 (14.6%) were clinically insignificant (Gleason score 6) and 34 (26.2%) were clinically significant (Gleason score 7 or higher). Eighty-seven of the patients were included in the target group (66.9%) and 43 in the non-target group (33.1%). The CsPCa detection was higher in the non-target group (32.6%, n = 14 vs 23.0%, n = 20 respectively). When systematic and target biopsies were jointly performed, if the results of systematic biopsies are not considered and only the results of target biopsies are taken into account, a CsPCa diagnosis would be missed on 9 patients. The differences of insignificant cancer and CsPCa rates among the target or non-target group were not statistically significant (p = 0.50 and p = 0.24, respectively). on multivariate analysis, the abnormal DRE and lesions localized in Peripheral zone (PZ) were significantly associated with a presence of CsPCa in PI-RADS 3 lesions (oR = 3.61, 95% CI [1.22,10.72], p = 0.02 and oR = 3.31, 95% CI [1.35, 8.11], p = 0.01, respectively). A higher median PSAD significantly predisposed for CsPCa on univariate analyses (p = 0.05), however, was not significant in the multivariate analysis (p = 0.76). In our population, using 0.10 ng/ml/ml as a cut-off to perform biopsy,","PeriodicalId":46900,"journal":{"name":"Archivio Italiano di Urologia e Andrologia","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2023-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138800525","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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