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Lower urinary tract and bowel disorders and multiple sclerosis. Role of sacral neuromodulation. A preliminary report
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464 Cost comparison for different medical treatments in conservative — expulsive therapy of distal ureteral stones
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Metaphylaxis of urolithiasis.
No full textThe urolithiasis is a growing disease because of the changes in dietary habits and in he general life style. Urolithiasis is characterized by the recurrent clinical manifestation and possible effect of structural damage of the kidneys and of the urinary tract ast well as the potential increase in systemic blood pressure. Moreover, frequent need for medical cure and invasive urological treatment exposes the patient to the complications of such procedures. The lithogenic process involves a wide number of systemic pathologies that are often undiagnosed. However, once identified they can be treated more precisely having an impact on the stone's forming process. For these reasons, prevention of new urolithiasis in patients, and in particular in those with high risk, appears to be clinically important. Metaphylaxis can be differentiated in two ways: "general metaphylaxis" in patients with lithiasis of the urinary tract, and "specific metaphylaxis" meant for patients with risk factors for recurrent calculosis. The aim of this narrative review is to present an algorithm for clinical practice for patients that have undergone one or more attacks of renal/ureteral colic from lithiasis in order to prevent further attacks. As such, this review deals with a method of secondary prevention (prophylaxis) that aims at identifying and correcting metabolic disorders (from which the term metaphylaxis comes) that favor and support the lithogenic process in the urinary tract
Randomized trial on the efficacy of tamsulosin, nifedipine and phloroglucinol in medical-expulsive therapy of distal ureteral calculi.
No full textPurpose: Recent studies show the interesting efficacy of different drug combinations for the
spontaneous expulsion of distal ureteral stones. We performed a randomized, prospective study
to assess and compare the efficacy of 3 drugs as medical expulsive therapy for distal ureteral
calculi.
Materials and Methods: A total of 210 symptomatic patients with distal ureteral calculi greater
than 4 mm were randomly allocated to home treatment with phloroglucinol, tamsulosin or
nifedipine (groups 1 to 3, respectively). Each group was given a corticosteroid drug and antibiotic
prophylaxis with an injectable nonsteroidal anti-inflammatory drug was also used on demand.
The primary end point was the expulsion rate and the secondary end points were expulsion time,
analgesic use, need for hospitalization and endoscopic treatment as well as the number of
workdays lost, quality of life and drug side effects
Results: The expulsion rate was significantly higher in group 2 (97.1%) than in groups 1
(64.3%, p 0.0001) or 3 (77.1%, p 0.0001). Group 2 significantly achieved stone passage in a
shorter time than the other 2 groups and showed a significantly decreased number of hospitalizations
as well as a better decrease in endoscopic procedures performed to remove the stone. The
control of renal colic pain was significantly superior in group 2 compared with the other groups,
resulting in fewer workdays lost. Group 3 showed lower analgesic use and decreased workdays
lost compared with group 1. No difference in side effects was observed among the groups.
Conclusions: Medical expulsive therapy should be considered for distal ureterolithiasis without
complications before ureteroscopy or extracorporeal lithotripsy. The use of tamsulosin in this
treatment regimen produced stone expulsion in almost all cases in a short time, allowing
complete home patient treatment
Acupunctural reflexotherapy as anaesthesia in day-surgery cases. Our experience in left internal vein ligature for symptomatic varicocele and in circumcision.
No full textAcupunctural reflexotherapy has been performed in patients during minimally invasive treatments for benign prostatic hyperplasia and in patients with lower urinary tract symptoms. We report two cases of left internal spermatic vein ligature for varicocele and a case of circumcision using acupunctural reflexotherapy, a procedure, to our knowledge, never applied before in open surgery. A 38 and a 24 years old male patients came to our observation for a 2nd degree symptomatic left varicocele and a 40 years old patient came to have a circumcision; they requested alternative anaesthesia for the operation and acupunctural reflexotherapy has been performed. This technique for analgesia can be useful and can be applied in selected cases, i.e. minor surgery in patients who do not wish or cannot have a general anaesthesia; it can be associated to other techniques of anaesthesia as peri- and post-operative analgesia. No contraindications nor collateral effects exist. The limits of this methods are represented by the length of time required for preparation of the patient and the existence of patients non-responder to electrostimulation
Salvage cryosurgery for recurrent prostate carcinoma after radiotherapy
No full textCryotherapy is a salvage treatment for patients with biopsy-proved prostatic adenocarcinoma recurrent after radiotherapy. Proper sampling, labeling, and analysis of prostate biopsies allows prompt diagnosis, identification of important prognostic parameters, and planning of an appropriate therapeutic strategy. Whereas androgen-suppressive therapy is associated with only a temporary benefit, transperineal salvage cryosurgery offers a potentially curative option for patients with localized disease, even those with significant comorbidities. Technological advances, including computerized treatment planning and miniaturized cryoprobes, may provide further therapeutic advantages and lower complication rates. Cryotherapy should be included among the established therapeutic options for recurrence after radiotherap
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