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Re: Indwelling Ureteral Stents and Sexual Health: A Prospective, Multivariate Analysis. M. C. Sighinolfi, S. Micali, S. De Stefani, A. Mofferdin, M. Grande, M. Giacometti, N. Ferrari, M. Rivalta and G. Bianchi J Urol 2007; 178: 229-231
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During the last few decades progress in endourology has led to a widespread application of such techniques, and procedures such as ureteral stenting and nephrostomic drainage have become routinely adopted. As a result, the number of patients dealing with these devices has rapidly increased, thus focusing attention on the related quality of life.
Consistent with this statement, Joshi et al developed the Ureteral Stent Symptom Questionnaire in 2003,1 which represents a validated instrument to assess stent related bother, concerns and impact on global quality of life. [5] and [7] The USSQ actually addresses in a proper and detailed approach the whole of urinary symptoms, as well as the consequent bother that so frequently affects these patients. Domains regarding pain and stent related therapies (antibiotics, painkillers) are accurately designed. Furthermore, work, occupation, social activities and relationships are considered with regard to ureteral stent permanence. Sexuality is assessed in the questionnaire by 4 questions, investigating the presence vs absence of sexual activity, and then dealing with pain and sexual satisfaction. As a result, all crucial points of stent related sexuality are analyzed according to the questionnaire.
However, the aim of our study was to perform a detailed analysis of all the domains connected to sexuality in both genders with particular attention to erectile function, which has been so widely addressed in the last decade.8 Moreover, since female sexuality represents a complexity of events, we attempted to investigate all steps of the process to emphasize the critical points. In this setting the use of the International Index of Erectile Function-5 and the Female Sexual Function Index seems to be an adequate choice, matching our aims more properly. Furthermore, an additional end point of the study was to investigate thoroughly the sequential changes that occur in sexual health before and after stent insertion, and this goal can be achieved only with specific questionnaires administered to the patient before the procedure.
Since the recent literature focuses on the relationship between erectile dysfunction and lower urinary tract symptoms,9 we analyzed the correlation between urinary complaints and sexual dysfunction. Although this outcome can be assessed even with the USSQ, the use of specific questionnaires considering different sorts of symptoms is highly recommended to perform a critical and statistical analysis. Behind this consideration, our outcomes are consistent with those previously reported in other studies.
Ureteral stenting is a simple and safe procedure for the urologist but has significant consequences on the routine life of the patient in all of its main areas. The USSQ is a consistent and reliable instrument to analyze those concerns, and physicians have to consider this tool in urological practice.
References
1H.B. Joshi, N. Newns, A. Stainthorpe, R.P. MacDonagh, F.X. Keeley Jr, A.G. Timoney
Ureteral Stent Symptom Questionnaire: development and validation of a multidimensional quality of life measur
One-day laparoscopic surgery
No full textSince ten years laparoscopic techniques have been employed as alternatives of many established open procedures in gynecologic, abdominal and finally urologic surgery. Laparoscopic techniques show significant advantages compared to open surgery, such as less hospitalization, reduced need of analgesic drugs, quick return to daily activities and far a better cosmetic results. Laparoscopic surgery has been advocated for urologic, uro-gynecologic and andrologic diseases. Since 1983 one-day surgery was proposed for only a few gynecologic and abdominal procedures and only recently for laparoscopic renal biopsy and abdominal testis evaluation. In these preliminary experiences the conditions for a correct management of laparoscopic one-day surgery have been clearly pointed out: 1. correct surgical indication; 2. through knowledge of surgical technique; 3. duration of the procedure less than 90 minutes; 4. correct anesthesia. Technique of anesthesia must be adapted to the surgical procedure required, its duration and the physical features of the patient. General anesthesia is usually preferred for either longer and more complex procedures or when a higher abdominal insufflation pressure is needed. Spinal or local anesthesia are preferred for simpler procedures or when only one trocar is required. At date only few urologic procedures seem to be suitable to one-day laparoscopic surgery. 1) Varicocele: although laparoscopic varicocelectomy in one-day surgery has never been reported previously, it can be performed in a short time, only 3 trocars are needed and insufflation pressure can be maintained within 15 mm Hg. 2) Renal biopsy and marsupialization of renal cysts. These are usually managed percutaneously but in some particular indications procedures under direct vision should be preferable. Both are short-lasting and only superficial general anesthesia is required; as surgical access is retroperitoneal only two trocars are sufficient; at date only renal biopsies have previously been reported. 3) Diagnostic procedures on abdominal testis. The procedure is brief only superficial general anesthesia is needed and only one trocar is required. Conclusions. One-day laparoscopic surgery will require in the future a more and more strict cooperation between urologists and anesthetists in order to tailor the correct anesthesiological and laparoscopic technique to the procedure required and the features of the patient
Preparation of the patient. In Retroperitoneoscopy and extraperitoneal laparoscopy in pediatric and adult urology
No full textPreparation of the patient. In Retroperitoneoscopy and extraperitoneal laparoscopy in pediatric and adult urolog
Dal metaromanzo al metateatro: i Quaderni di Serafino Gubbio e Ciascuno a suo modo
No full textIl saggio analizza il rapporto tra il romanzo "Quaderni di Serafino dubbio operatore" e il suo adattamento teatrale, la commedia "Ciascuno a suo modo"; in particolare, l'intervento si concentra sui procedimenti di adattamento intermediale, e su come essi si riflettano sul significato complessivo dell'oper
Right varicocele associated with inferior vena cava malformation in situs inversus: percutaneous treatment with retrograde sclerotherapy
No full textIsolated right varicocele is a rare condition. It could be secondary to a retroperitoneal neoplastic mass involving the right internal spermatic vein, but sometimes, an anatomic variant must be considered. We present a case of a young man with situs inversus and right varicocele, a mirror image of the normal condition, associated with inferior vena cava malformation, who was treated successfully with retrograde selective percutaneous sclerotherapy of the right internal spermatic vein. Selective sclerotherapy of the internal spermatic vein at the time of venography has proved to be a valuable therapeutic option in right-sided varicocele associated with anatomic abnormalities
Retroperitoneal laparoscopic access in children using a direct vision technique
No full textPurpose: Retroperitoneal procedures were initiated in 1992 by balloon dissection of the retroperitoneum. More recently a new type of retroperitoneal access has been obtained by directly entering the retroperitoneum using the Visiport visual trocar.* We present our initial experience with direct visual access to the retroperitoneum in the pediatric population. Materials and Methods: A total of 31 children underwent retroperitoneal laparoscopy, including renal biopsy in 22, varicocelectomy in 5, renal cyst ablation in 3 and pyelolithotomy for a staghorn stone in 1. Patients were placed in the full flank position. A maximum of 3 ports was used and the initial trocar was placed under direct vision. The laparoscope was then used to dissect bluntly a working space in the retroperitoneum. Results: All procedures were successful. Blood loss was minimal. Operative time was 4 hours for pyelolithotomy and less than 1 for the other procedures. Mean hospital stay was 1.5 days and all patients returned to normal activity at a mean of 6 days. Two minor complications developed. The peritoneum was inadvertently entered in 1 case, in which no further treatment was necessary and convalescence was uneventful and short. In another case severe arrhythmia developed, resulting in an aborted procedure. Conclusions: This technique is simple, safe and does not require extensive laparoscopic experience
Il sex appeal dell'incorporeo. L'immaginario dell'intelligenza artificiale
No full textIl saggio delinea una tipologia degli esseri artificiali nell'immaginario contemporaneo, rielaborando il sistema dei tre ordini del simulacro proposto da Jean Baudrillard. In particolare, ci si sofferma sulle caratteristiche dell'intelligenza artificiale e sulla sua componente spettrale e perturbante
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