1,721,005 research outputs found
Spontaneous Nephrocutaneous Fistula: A Case Report, Update of the Literature and Management Algorithm
No full textAims: Spontaneous nephrocutaneous fistula (NCF) is a rare and severe condition. The aim of this study was to update the data of the literature about this disease and, reporting and considering also our experience in 1 case of NCF, to make a new clinical algorithm. Methods: This study was done with a review of all the literature and a comparison with our experience. Results: The characteristic sign of spontaneous NCF is a flank sinus discharging material. Physical examination and computed tomography usually lead to the diagnosis. The main predisposing factors are renal stones/staghorn calculi, xanthogranulomatous pyelonephritis and renal tuberculosis. In the vast majority of the cases kidneys are poorly functioning or nonfunctioning. Surgical approach is the common management and usually consists of open nephrectomy. We create a clinical management algorithm obtained by a review of the literature and our experience with spontaneous NCF. Conclusions: Spontaneous NCF represents a very serious renal disease leading to loss of the kidney in the vast majority of cases. We propose a revised and user-friendly clinical diagnostic-therapeutic algorithm for spontaneous NCF based on the worldwide literatur
Outcomes of lateral tube positioning technique for ams 800 (TM) artificial urinary sphincter placement
No full textWe evaluated 46 males. Mean f‐up was 28.2 (3‐57) months. There was no mechanical failure. Cuff erosion rate was 8.7% (4 males). We had no complications, nor infections attributed to the new tubing path. Visual analog scale (VAS) showed postoperative pain intensity as none in 74%, and mild in 26%. Urinary retention longer than 48 hours occurred in 10.9% of the patients (5 cases), and suprapubic tube placement was easy, fast, and safe with any tubing damage.Outcomes of lateral tube positioning technique for ams 800 (TM) artificial urinary sphincter placemen
Detrusor underactivity and complicated stress urinary incontinence: a cross-data study
No full textIntroduction It is still uncertain whether detrusor underactivity (DUA) influences the outcomes of women undergoing surgery for stress urinary incontinence (SUI). Even less evidence is available about women with complicated stress urinary incontinence (C-SUI). The aim of the study was to assess outcomes of middle urethral sling (MUS) placement according to the type of SUI, and the impact of DUA on uncomplicated SUI (U-SUI) and C-SUI functional and surgical results. Material and methods The study was conducted among patients undergoing MUS. The population was divided into 4 groups: 1: C-SUI with DUA; 2: C-SUI without DUA; 3: U-SUI with DUA; and 4: U-SUI without DUA. Women were qualified for the DUA group if they met one of the Jeong, Abarbanel and Marcus, BVE, and PIP1 Griffiths criteria. Post-operative functional outcomes and differences in POUR rate, de novo overactive bladder syndrome (OAB), and SUI recurrence were examined. Results 142 women took part in the study, of whom 97 completed the 2-year follow-up. DUA was found in 54.6% (53/97) of patients. C-SUI was prevalent also in the no-DUA group (59.1%). Post-operative ICIQ-FLUTS improved more in the no-DUA patients compared to the DUA women. Post-operative Qmax was statistically significant higher the in no-DUA than in the DUA population. After surgery, neither the PVR nor the PVR ratio differed in the DUA and the no-DUA patients. C-SUI and U-SUI patients showed a POUR rate of 15.6%-12.1%, de novo OAB 12.5%-3%, tape incision 3.1%-3%, and SUI recurrence 4.6%-3%, respectively. Conclusions The impact of pre-operative DUA on the outcomes of patients undergoing MUS was negligible, even in C-SUI cases. DUA women with SUI, even if complicated, should not be excluded from this kind of surgery
Resilience in the face of pelvic pain: A pilot study in males and females affected by urologic chronic pelvic pain
Get PDFAims Resilience represents a fundamental element in the experience of pain, as it allows adaptation to suffering and increases psychological social well-being and quality of life (QoL). We investigated resilience in patients affected by urologic chronic pelvic pain (UCPP) and the relationships with pain severity and distribution, catastrophizing and psychological distress.Methods Forty-eight consecutive UCPP patients were classified on a pain body map as being affected by pelvic pain only or widespread pain (WP), and underwent the evaluation of resilience with the 14-item Resilience Scale (RS-14), with higher scores indicating high resilience levels; scores < 56 denote very poor resilience. Pelvic and nonpelvic pain intensity and the bother of urinary symptoms on QoL were measured by means of Pain Numerical Rating Scale (PNRS) and Visual Analog Scale (VAS). Pain Catastrophizing Scale (PCS) and Depression Anxiety Stress Scales (DASS-21) investigated catastrophizing and psychological conditions.Results Overall, RS-14 mean +/- SD total score was 50.2 +/- 12.5 in patients with pelvic pain only and 40.2 +/- 10.2 in those with WP. Significant relationships were observed between low resilience levels and high scores of pelvic and nonpelvic PNRS, VAS, pain catastrophizing scale and depression and anxiety, stress scale (for all: p < 0.001). Significantly lower RS-14 scores were detected in females and in patients with WP.Conclusions A very poor resilience has been identified in UCPP patients, particularly in those with greater catastrophizing and mood alterations. WP and female gender were mostly affected. In UCPP patients, low resilience appears as a crucial factor in pain experience
Role of Bladder Emptying on Outcomes of Transurethral Resection of the Prostate
No full textOBJECTIVE To assess the role of bladder emptying on outcomes of males undergoing transurethral resection of the prostate (TURP).MATERIALS AND METHODS This prospective study involved candidates for TURP (January 2017-2018) with a follow-up of 3 years. Preoperative and follow-up evaluation comprised: UF, simple PVR (S-PVR), PVR-Ratio (PVR-R) as the ratio of PVR to bladder volume (BV: voided volume (VV) + PVR), Bladder void-ing efficiency (BE) as the ratio between VV and BV-(voided volume/total bladder capacity) & POUND; 100 -and the IPSS. Patients were stratified for S-PVR, PVR-R, and BVE.RESULTS Patients recruited were 100 (mean & PLUSMN; SD age: 68.8 & PLUSMN; 8.7 years). No patient had severe complica-tions, re-admission, nor needed blood transfusion. At baseline, 38% of the patients showed S-PVR & LE; 50 mL, 62% a S-PVR & LE; 100 mL, and 25% a S-PVR >150 mL. In both pre-and postopera-tive evaluation there were no significant differences in Qmax and IPSS score among the groups. In each group we found a significant improvement in Qmax, IPSS score, and S-PVR, PVR-R and BVE after TURP (except for PVR in group with lowest preoperative S-PVR). Analysing a preop-erative S-PVR threshold >100 mL, PVR-R significantly increased, and BVE significantly decreased after TURP. Conversely, when preoperative S-PVR was >100 mL, PVR-R, and BVE relevantly but non significantly improved after surgery.CONCLUSION Bladder emptying is only partially related to TURP outcomes and other preperative parameters. Patients with baseline S-PVR lower than 100 mL had the chance of greater recovery of bladder emptying after TURP
Urodynamic findings and functional outcomes after laparoscopic sacrocolpopexy for symptomatic pelvic organ prolapse
No full textIntroduction and hypothesisThe aim of this study was to evaluate the functional outcomes and urodynamic findings after laparoscopic sacrocolpopexy (LSC) in patients with stages II-IV pelvic organ prolapse (POP).MethodsIn this single-center prospective study, we evaluated 63 women (mean age 62.57.5 years) women with symptomatic and advanced POP (stage II-IV) who underwent LSC without concomitant anti-incontinence surgery. The preoperative evaluation incuded history, clinical examination, and urodynamic testing. Women were followed up at 1, 3, 6, and 12months after surgery and then annually using history, examination, and uroflowmetry. At 6months, we performed urodynamic testing. To evaluate urinary symptoms, we used the Urogenital Distress Inventory (UDI)-6 questionnaire before and 6months after surgery.ResultsMedian follow- up was 22months (range 8-48). After surgery, maximum flow (Q(max)) significantly improved compared with baseline (14.17 +/- 2.3 vs 27 +/- 8.4ml/s; p=0.02), and the percentage of patients with elevated postvoid residual (PVR) significantly decreased (33.3% vs 11.1%; p=0.001). Detrusor overactivity and bladder outlet obstruction disappeared in 73.6% and 85.7% of patients, respectively, while detrusor underactivity persisted in 66.6% of women. Twenty women (31.7%) reported stress urinary incontinence (SUI) before surgery (14 clinically evident and 6 as occult form), which persisted in only 7/20 (11%) patients following LSC, with no de novo cases. The most common preoperative symptoms were voiding symptoms, present in 42/63 (66.6%) patients, which resolved in 36 (85.7%). The overactive bladder syndrome disappeared in 60% of women, with no de novo cases. Results were reflected by a significant decrease in UDI-6 score from a median of 16 (0-45) at baseline to 5.5 (0-17) at the final follow-up (p=0.001). The domain on storage symptoms (median 3 vs 1) and voiding symptoms (median 3 vs 1) of UDI-6 showed an improvement after surgery (p=0.001).Conclusions: The urodynamic finding showed that LSC in women with advanced POP provides good functional outcomes
Current clinical management of renal and perinephric abscesses: a literature review
No full textRenal and perinephric abscesses are rare but very severe conditions resulting from infections in or surrounding the kidneys. Symptoms and imaging techniques, such as computed tomography (CT), magnetic resonance imaging (MRI) and renal ultrasound (US) of higher quality have led to an early diagnosis that is very important for patients' prognosis. The best clinical approach to manage this disease is still debated. Antibiotic therapy represents the usual treatment of small renal abscesses. This management can be insufficient in case of larger renal abscesses requiring percutaneous or surgical drainage. Perinephric abscesses most commonly need invasive maneuvers. We conducted a literature review to clearly define the most recommended clinical managements for all cases of renal and perinephric abscesses
Detrusor underactivity in symptomatic anterior pelvic organ prolapse
No full textIntroduction The aim of this study was to assess the detrusor underactivity (DUA) prevalence of females with symptomatic anterior pelvic organ prolapse (POP) and to evaluate the relationship between DUA and pelvic organ prolapse (POP) stage. Material and methods This was a prospective study recruiting women with symptomatic anterior POP. Patients with symptomatic stage 2-4 POP quantification system (POP-Q) who underwent urodynamics (UD) between January 2018 and April 2021 were included. Results Data on 330 women (mean age 63.7 +/- 18.4 years old) with anterior vaginal wall defect were enrolled. Concomitant apical defect (uterine/vaginal vault) requiring surgical correction was diagnosed in 38 women (11.5%). DUA was found in 166 females (50.3%). In DUA women, POP-Q stage 2 was found in 45.2%, stage 3 in 50.9% and stage 4 in 76.5%. Only stage POP-Q stage 4 showed a statistically significant difference between DUA and non-DUA females (p 0.006). Conclusions In women with symptomatic POP, regardless of the POP-Q stage, the chance of DUA occurrence was high. DUA was diagnosed in approximately half of the women undergoing UD for symptomatic POP, and it was three-fold higher in cases of POP-Q stage 4. Due to the high incidence of DUA in POP-Q 4 stage, it may be advantageous to identify and treat prolapse before they progress to stage 4
43rd Annual Congress of the Italian Urodynamic Society, Rome, Italy, 13th-15th June 2019: Role of the preoperative post void residual urine in males underwent turp for lower urinary tract symptoms
No full textIntroduction and aim of the study: The role of post void residual (PVR) urine in the evaluation of men with lower urinary tract symptoms (LUTS) is still controversial due to the missing standardization of PVR pathological thresholds. Therefore, the influence of PVR on the decision‐making of treatments for males with LUTS remains unclear. Aim of this study was to assess the role and the values of the preoperative PVR in males underwent transurethral resection of the prostate (TURP) for LUTS and the related outcomes after the procedure. Materials and methods: This is a prospective ongoing study started in January 2017 involving males with LUTS candidates for TURP. The medical and urological history was recorded in all the population. Both preoperative evaluation and the 1‐year follow‐up consisted in: peak flow (Qmax), PVR, PVR‐ratio as the ratio of PVR to bladder volume (BV: voided volume + PVR), and the International Prostate Symptoms Score Questionnaire (IPSS). Patients were also distributed in groups according to preoperative PVR thresholds: i) PVR 0‐50ml; ii) PVR 51‐100ml; iii) PVR 101‐150ml; iiii) PVR 151‐200ml; iiiii) PVR>200ml. Statistical analysis was performed using T‐test, Wilcoxon test, one‐way ANOVA test, the Kruskal‐Wallis Test.Results: Data were complete in 52 patients, with a mean age of 68.9+8.5 years. A significant improvement in voided volume, Qmax, PVR, IPSS score was documented (Table 1). The majority of the males showed a PVR <100ml (59.6%), while the remaining 21/52 patients (40.4%) had a PVR >100ml. No significant difference was found in Qmax and IPSS score among the groups, in both preoperative and postoperative assessment (Table 2). In each group we found a significant improvement in Qmax and IPSS score after prostate resection. Interpretation of results: Only a minor part of the males showed a high preoperative PVR (>100ml), therefore PVR did not have a crucial role in the decision‐making. Quite the reverse, Qmax and symptoms score had the main influence. PVR was not correlated to preoperative and postoperative Qmax and IPSS. This finding suggests that PVR was a poor predictive factor for the decision‐making and outcomes in males candidates for TURP. Conclusions: In our cohort a high PVR was present only in a minority of patients candidates for TURP and did not significantly influence the outcomes of TURP. This study confirmed that PVR is still a controversial and poor reliable parameter in the evaluation of males with LUTS as well in the treatments’ decision‐making
Advances in Female Urology: A Review of the 2013 Literature
No full textThe field of female urology covers a broad spectrum of lower urinary tract dysfunction and pelvic disorders. The aim of this article is to provide a comprehensive review of the most significant literature published during 2013
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