Stone free rate and clinical complications in patients submitted to retrograde intrarenal surgery (RIRS): Our experience in 571 consecutive cases.

INTRODUCTION: The purpose of this study is to report the stone free rate (SFR) and clinical complications in patients submitted to retrograde intrarenal surgery (RIRS). MATERIALS AND METHODS: A total of 571 procedures of upper urinary stones treated using flexible ureteroscopy and holmium laser lithotripsy from January 2014 to February 2020 have been analyzed. Overall SFR was evaluated after 3 months following the procedure by means of a non-contrast computed tomography. Success was considered as stone-free status or ≤ 0.4 cm fragments. RESULTS: The overall SFR was 92.3% in group 1 (stone size: < 1 cm), 88.3% in group 2 (stone size: > 1 ≤ 2 cm), 56.7% in group 3 (stone size: 2-3 cm) and 69.6% in group 4 (multiple stones). Post-operative complications, according to the Clavien- Dindo (CD) classification system, were recorded in 32 (5.6%) procedures. The major complications recorded were: one case of subcapsular hematoma (SRH) associated with pulmonary embolism two days after the procedure (CD Grade IIIa) treated conservatively and one case of hemorrhagic shock 2 hour with multiple renal bleedings requiring urgent nephrectomy (CD Grade IVA). CONCLUSIONS: The RIRS is an effective and safe procedure with a high SFR significantly correlated with the stone size; at the same time, RIRS could be characterized by severe clinical complications that require rapid diagnosis and prompt treatment.

A complicated case of recurrent Cowper's gland abscess.

A Caucasian man 64 years old was admitted to our department for fever, strangury, frequency and pain in the perineum secondary to the relapse of Cowper's gland abscess previously treated by antibiotic therapy and trans-perineal ultrasound-guided aspiration. At admission, the clinical parameters were suggestive of sepsis; moreover, the trans-perineal ultrasound detected an hypoechoic mass suspicious for the recurrence of Cowper's gland abscess. A suprapubic catheter was positioned and a targeted antibiotic therapy (Colistin 9000.000 U intravenously every day for 8 days plus meropenem 500 mg intravenously every 8 hours for 10 days) was administered. The patient during the follow up presented long fibers of mucus in the urine and recurrent positive urine culture, therefore two months later underwent trans-perineal surgical asportation of the left Cowper's gland. One month after surgery the patient was readmitted for the presence of a urinary fistula between bulbar urethra and perineum. A new suprapubic catheter was positioned and after three months was removed because a complete restitutio ad integrum was shown by retrograde cystourethrogram and uroflowmetry. In conclusion, the abscess of Cowper's gland could represent a very rare but severe clinical event that need aggressive therapy and close follow up for its potentially high rate of early and late clinical complications; in the presence of recurrence the surgical asportation of the Cowper's gland should be considered.

Acute Scrotum Following Traumatic Spermatic Cord Hematoma: A Case Report and Review.

Acute scrotum constitutes the most common urological emergency secondary to spermatic cord torsion, testicular trauma, orchiepididymitis and hernias. We report a very rare case of unique traumatic spermatic cord hematoma following scrotum injury occurred during a football match. Clinical exam showed an increased volume of the left spermatic cord; the color Doppler ultrasound (CDU) demonstrated left testicular ischemia secondary to a large spermatic cord hematoma that needs surgical exploration. Spermatic cord hematoma rarely induces acute scrotum, however it could be treated conservatively surgery is mandatory when pain is persistent or testicular ischemia is confirmed by CDU.

Primary carcinoid tumour of the testis: A case-report.

Testicular carcinoid tumours (TCT) account for less than 1% of all testicular neoplasms. A 17-year-old male underwent radical orchiectomy for a painful indurated and increased in size right testicle; a mixed echogenic mass, with a central homogeneous area surrounded by a hypoechoic edge with calcifications was found at ultreasound with increased vascularity at color Doppler examination. Biochemical markers were within normal limits. These symptoms are not specific and the majority of TCT are only diagnosed on histopathology. Patients should undergo long-term biochemical and radiological follow-up given potential for delayed metastases, in one case 17 years after primary treatment.

Active surveillance of nosocomial infections in urologic patients.

OBJECTIVES: We report the results of a 4-month survey implemented at the urologic clinic of an Italian university hospital, with the following aims: (1) to describe the incidence of nosocomial infections (NI) in our setting for comparison within and between urologic wards and (2) to provide relevant information to monitor and target infection control policies. METHODS: A 4-month prospective survey was performed from April to July 2004, preceded by the 1-month surveillance pilot study; both performed in accordance with the methods, protocols and definitions of the National Nosocomial Infections Surveillance System. The following indicators were included site-specific incidence rates and device-adjusted infection rates. For surgical site infections, rates were calculated by operative procedure and risk index category. Antimicrobial usage was also monitored. RESULTS: Incidence of symptomatic urinary tract infections was 1.4 per 1000 patient-days, 1.3 per 100 catheterized patients and 3.0 per 1000 urinary catheter-days. Incidence and incidence density of surgical site infections were respectively 1.3 per 100 patients and 1.8 per 1000 patient-days. CONCLUSIONS: Our study represents a contribution to improve the quality of care in our urologic ward by monitoring the size of the NI problem using standardized definitions, data collection and indicators to compare the results of the unit with possible future ones, and by identifying practices that should be changed. This study supports close surveillance of antibiotic administration among urologists who may be unaware of the inappropriate antibiotic administration in their patients. Two major items were identified for planning future intervention: focusing on the use of closed urinary drainage systems and on appropriate antimicrobial prophylaxis.