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1.
Arch Ital Urol Androl ; 95(4): 11868, 2023 Nov 15.
Article in English | MEDLINE | ID: mdl-38193228

ABSTRACT

INTRODUCTION: Transurethral resection of the prostate (TURP) is the gold-standard for the treatment of benign prostate enlargement (BPE) associated with lower urinary tract symptoms (LUTS), after failure of conservative therapy. At present, only resection-rate (grams of prostate resected over time) is regarded as an efficiency parameter to evaluate the skill of the operator and to assess the outcome of the procedure. MATERIALS AND METHODS: Five surgeons performed TURP using a Gyrus-type bipolar system in 123 patients with BPE/LUTS who came to our observation from June 2016 to December 2019. The amount of irrigation fluid used during the procedure was registered and correlated to the operating time, resection-rate, prostate adenoma weight, post-operative bladder irrigation time, intraoperative bleeding and days of catheterization. RESULTS: We found an inverse correlation between the amount of irrigation fluid used during TURP and the resection-rate recorded for all operators, according to Spearman's Correlation (r = -0.78, p = 0.002); a direct correlation was also found between the amount of irrigation fluid and the adenoma weight. Finally, we also found a direct correlation with intraoperative bleeding and the duration and amount of bladder irrigation during and after TURP. CONCLUSIONS: The amount of irrigation fluid used is proposed as a reliable parameter to estimate the efficiency of the endoscopic procedure as well to assess the skill of the operator and shortterm results. The observed data encourage the possibility of applying this new efficiency indicator to all endoscopic maneuvers.


Subject(s)
Adenoma , Lower Urinary Tract Symptoms , Prostatic Hyperplasia , Surgeons , Transurethral Resection of Prostate , Male , Humans , Prostate , Urologic Surgical Procedures , Prostatic Hyperplasia/complications , Prostatic Hyperplasia/surgery
3.
J Endourol Case Rep ; 6(2): 53-55, 2020.
Article in English | MEDLINE | ID: mdl-32775676

ABSTRACT

Urinoma is a possible complication of ureteral lithiasis. Urine extravasation is normally localized in the retroperitoneum. We describe a rare case of hydrocele secondary to urinoma, resolved with ureteral stenting.

4.
Urol Case Rep ; 31: 101203, 2020 Jul.
Article in English | MEDLINE | ID: mdl-32322523

ABSTRACT

The importance of histologic characterization of renal masses is increasing in the management of small renal tumors and metastatic settings of renal cell carcinoma (RCC). Tissue sampling of renal lesions is generally achieved through a percutaneous approach yet endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) with cytological analysis could be more suitable in selected circumstances. We report a case of endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) of an anterior, mesorenal right kidney mass with a thrombus extending into the right atrium, unreachable via a percutaneous approach.

5.
J Endourol Case Rep ; 6(4): 402-404, 2020.
Article in English | MEDLINE | ID: mdl-33457685

ABSTRACT

Background: Because of the fear of being infected with coronavirus disease 2019 (COVID-19), patients with nephrolithiasis, who choose to stay home, may suffer serious complications such as obstructive uropathy, deterioration of renal function, sepsis, and death. We present such a case that led to renal failure and necessitated emergent urologic intervention. Case Presentation: A 60-year-old Caucasian man presented with right flank pain, dizziness, and dyspnea at the emergency room. History was significant for a previous diagnosis of right renal pelvic stone that was scheduled for retrograde intrarenal surgery before the pandemic lockdown. Upon evaluation, he was found to have an elevated creatinine of 40.2 mg/dL, bilateral hydronephrosis, pericardial and pleural effusion. The patient underwent emergency hemodialysis, followed by preliminary bilateral percutaneous nephrostomy, and subsequently by ureteral stenting. He was discharged stable with the future plan for endoscopic stone management. Conclusions: In the midst of the COVID-19 pandemic, urologists should follow up all known kidney stone patients, regularly assess their condition, and prioritize those who need urgent care. Patient education and telemedicine are useful tools for this purpose and may help minimize the risk of complications during a community lockdown.

6.
Arch Ital Urol Androl ; 89(3): 238-239, 2017 Oct 03.
Article in English | MEDLINE | ID: mdl-28969411

ABSTRACT

We present here the first case of successful management via preoperative ultrasonographic (US) study to detect a distant spreading of Fournier's gangrene (FG), which was happened in a 75-year-old man. US study showed the necrotizing infection in the periumbilical region distant 22 cm from the genital tract. A target incision of this periumbilical area and debridement of necrotic tissues was made. Computed tomography (CT) is superior to ultrasonography to confirm the diagnosis of FG and support in surgical management, but a CT evaluation in patients with FG may be limited by the frequent presence of concurrent acute renal failure or patient hemodynamic instability. Ultrasonography is an ideal technique for evaluating patients in bedside settings and can be routinely used in an emergency.


Subject(s)
Debridement/methods , Fournier Gangrene/diagnostic imaging , Ultrasonography/methods , Aged , Fournier Gangrene/pathology , Fournier Gangrene/surgery , Humans , Male , Preoperative Care/methods , Tomography, X-Ray Computed/methods
9.
Arch Ital Urol Androl ; 88(4): 292-295, 2016 Dec 30.
Article in English | MEDLINE | ID: mdl-28073195

ABSTRACT

We describe our experience in prostate biopsy using a new standardized cognitive fusion techniques, that we call "cognitive zonal fusion biopsy". This new technique is based on two operative options: the first based on target biopsies, the Cognitive Target Biopsy (CTB) if the same target was detected with transrectal ultrasound (TRUS) and multiparametric magnetic resonance (mpMRI); the second based on saturation biopsies, the Zonal Saturation Biopsy (ZSB) on anatomical zone/s containing the region of interest if the same target was not evident with TRUS and MRI. We evaluated results of our technique compared to standard biopsy in order to identify clinically relevant prostate cancer. METHODS: This is a single-center prospective study conducted in 58 pts: 25 biopsy-naïve, 25 with previous negative biopsy and in 8 with cancer in active surveillance. Based on mpMRI and transrectal ultrasonography (TRUS), all patients were scheduled for standard 12-core TRUS-guided biopsy. If mpMRI was suggestive or positive (PI-RADS 3, 4 or 5): patients underwent additional targeted 2 to 6 cores using cognitive zonal fusion technique. RESULTS: 31/58 (53.4%) patients had a cancer. Our technique detected 80.6% (25 of 31) with clinically significant prostate cancer, leading to detection of insignificant cancer in 20%. Using standard mapping in MR negative areas we found 5 clinically significant cancer and 4 not significant cancers. MRI cancer detection rate was 18/31 (58.1%), and 9/18 (50%) in high grade tumors. Therefore MRI missed 50% of high grade cancers. The mean number of cores taken with cognitive zonal fusion biopsy was 6.1 (2-17), in addition biopsy sampling was done outside the ROI areas. Overall 15.4 cores (12-22) were taken. Cancer amount in Zonal Biopsy was larger than 7.3 mm (1-54.5) in comparison with 5.2 mm (1-23.5) in standard mapping. Largest percentage of cancer involvement with cognitive zonal fusion technique was detected in 19.4% vs 15.9%. CONCLUSIONS: Cognitive Zonal Saturation Biopsies should be used to reduce operator variability of cognitive fusion biopsy in addition to standard biopsy. Cognitive zonal biopsy based on mpMRI findings identifies clinically relevant prostate in 80%, has larger cancer extension in fusion biopsies than in random biopsies, and reduce the number of cores if compared to saturation biopsy.


Subject(s)
Prostate/pathology , Prostatic Neoplasms/pathology , Aged , Humans , Image-Guided Biopsy/methods , Magnetic Resonance Imaging , Male , Middle Aged , Prospective Studies
10.
Arch Ital Urol Androl ; 86(4): 385-6, 2014 Dec 30.
Article in English | MEDLINE | ID: mdl-25641477

ABSTRACT

We report a case of Inflammatory Abdominal Aortic Aneurysm (IAAA) producing bilateral hydro-ureteronephrosis. A 74-year-old patient presented to urologist office for bilateral hydronephrosis detected by kidney and bladder ultrasound (US). Patient reported lower urinary tract symptoms and inconstant and slight low back pain irradiated to inguinal region dating 3 weeks. Renal function, urine analysis and abdominal examination were normal. However the repeated ultrasound in the urologist office revealed abdominal aortic aneurism extended to iliac vessels. The patient was sent directly to vascular surgery unit where contrast computerized tomography (CT) and successful surgical repair were done. Final diagnosis was IAAA. The post-operative course was uneventful. Renal function was regular and the hydronephrosis reduced spontaneously under monitoring by CT and US. We review diagnosis and management of hydronephrosis that is sometimes linked to IAAA rather than standard AAA. Abdominal ultrasound is mandatory in any bilateral hydronephrosis and it could save lives.


Subject(s)
Aortic Aneurysm, Abdominal/complications , Aortic Aneurysm, Abdominal/diagnosis , Aortitis/complications , Hydronephrosis/etiology , Ureteral Diseases/etiology , Aged , Humans , Young Adult
11.
Arch Ital Urol Androl ; 86(4): 387-8, 2014 Dec 30.
Article in English | MEDLINE | ID: mdl-25641478

ABSTRACT

Infection due to prostate biopsy afflicted more than 5% of patients and is the most common reason for hospitalization. A large series from US SEER-Medicare reported that men undergoing biopsy were 2.26 times more likely to be hospitalized for infectious complications within 30 days compared with randomly selected controls. The factors predicting a higher susceptibility to infection remain largely unknown but some authors have higlighted in the etiopathogenesis the importance of the augmented prevalence of ciprofloxacin resistant variant of bacteria in the rectum flora. We present one case of sepsis after transrectal prostate biopsy in a patient with history of pancreatic surgery. Based on our experience patients candidated to prostate biopsy with transrectal technique with history of recent major surgery represent an high risk category for infective complication. Also major pancreatic surgery should be consider an high risk category for infection. A transperineal approach and preventive measures (such as rectal swab) should be adopted to reduce biopsy driven infection.


Subject(s)
Anti-Bacterial Agents/adverse effects , Escherichia coli Infections/chemically induced , Pancreatectomy , Postoperative Complications/chemically induced , Prostate/pathology , Anti-Bacterial Agents/administration & dosage , Biopsy/adverse effects , Biopsy/methods , Drug Resistance, Bacterial , Escherichia coli Infections/epidemiology , Humans , Male , Middle Aged , Postoperative Complications/epidemiology , Rectum , Risk Assessment , Time Factors
12.
Arch Ital Urol Androl ; 86(4): 397-9, 2014 Dec 30.
Article in English | MEDLINE | ID: mdl-25641483

ABSTRACT

Objective of our study was to define a diagnostic-therapeutic pathway for proper treatment of not-palpable testicular masses, that may be benign in 38% of cases. Since the intraoperative diagnosis is difficult to reach in particular in small lesion (< 8 mm) and the risk of tissue loss in frozen section analysis occurs frequently, we propose a diagnostic flow chart for the best management of small testis lesions. This proposed protocol has to be shown in details to physicians and patients, who must understand the clinical implications and the risk to undergo a second radical surgery.


Subject(s)
Testicular Diseases/diagnosis , Testicular Diseases/therapy , Clinical Protocols , Critical Pathways , Humans , Male
13.
Int J Urol ; 18(7): 515-20, 2011 Jul.
Article in English | MEDLINE | ID: mdl-21592232

ABSTRACT

OBJECTIVES: The occurrence of residual storage symptoms after surgical relief of bladder outlet obstruction as a result of benign prostatic enlargement (BPE) underlines the intricate mechanism involved in lower urinary tract symptoms (LUTS). The aim of the present study was to compare tadalafil with solifenacin in modifying symptoms and uroflowmetric parameters in patients with erectile dysfunction (ED) and residual storage symptoms after prostate surgery. METHODS: From May 2007 to April 2009, we evaluated 68 patients who had undergone prostate surgery at least 6months earlier, and presented with ED and persistence of storage symptoms. A total of 56 patients were randomized to receive tadalafil 5mg (group 1) or solifenacin 5mg (group 2), both given daily for 12weeks. International Prostate Symptoms Score (IPSS), IPSS Quality of Life, International Index of Erectile Function-5 (IIEF-5) and uroflowmetry parameters were collected at baseline and after 12weeks of treatment. RESULTS: A total of 26 patients in group 1 and 25 patients in group 2 completed the study. Each group showed a significant and comparable improvement of urinary symptoms with a decrease of IPSS value. Only in group 1 did the treatment with tadalafil result in a significant increase of IIEF-5. No statistically significant variations were noted in uroflowmetric parameters in both groups. CONCLUSIONS: In patients suffering from ED and storage symptoms after surgical treatment for LUTS-BPE, tadalafil 5mg given once daily for 12weeks provided a comparable improvement in IPSS to solifenacin 5mg given for the same period of time.


Subject(s)
Carbolines/administration & dosage , Erectile Dysfunction/etiology , Postoperative Complications/drug therapy , Prostatic Hyperplasia/surgery , Quinuclidines/administration & dosage , Tetrahydroisoquinolines/administration & dosage , Urination Disorders/drug therapy , Aged , Carbolines/adverse effects , Humans , Male , Middle Aged , Muscarinic Antagonists/administration & dosage , Muscarinic Antagonists/adverse effects , Phosphodiesterase 5 Inhibitors/administration & dosage , Phosphodiesterase 5 Inhibitors/adverse effects , Prospective Studies , Quinuclidines/adverse effects , Solifenacin Succinate , Surveys and Questionnaires , Tadalafil , Tetrahydroisoquinolines/adverse effects , Therapeutics , Urination Disorders/etiology , Urodynamics/drug effects
14.
Arch Ital Urol Androl ; 81(4): 209-11, 2009 Dec.
Article in English | MEDLINE | ID: mdl-20608142

ABSTRACT

The objective of the present study was to evaluate the efficacy of the periprostatic nerve block (PNB) of the prostate-vesicular junction with low volume and high concentration of anesthetics in relieving pain during prostate biopsy. Two hundred and twenty patients were enrolled and randomized to receive PNB with 5 ml 2% lidocaine (group 1110 pts) and PNB with 5 ml 2% mepivacaine (group 2, 110 pts). The anesthetic was administered through a single puncture on each side at the prostate-vesicular junction using a 22-gauge needle. All patients filled in a ten visual analogue pain score scale (VAS) from 0 = no discomfort to 10 = severe pain, for the assessment of pain experienced during biopsy. The two groups were homogeneous concerning the anthropometrical data. The mean pain score with lidocaine was 1.4 +/- 1.02 (CI 95% = 1.53 to 3.57) and with mepivacaine was 1.3 +/- 1.06 (CI 95% = 2.66 +/- 4.84) with no statistical significant difference between groups (p = 0.43). No general or local adverse effects were observed between the anaesthetics. The use of a low volume (2.5 ml on each side) and high concentration (2%) of local anesthetics (lidocaine/mepivacaine) almost completely suppresses pain and discomfort associated with prostate biopsy. The anatomy of neurovascular bundle regions appears favourable to the administration of small amounts of anesthetic.


Subject(s)
Anesthetics, Local/therapeutic use , Biopsy, Needle , Lidocaine/therapeutic use , Mepivacaine/therapeutic use , Nerve Block/methods , Prostatic Neoplasms/diagnostic imaging , Prostatic Neoplasms/pathology , Aged , Anesthetics, Local/administration & dosage , Humans , Lidocaine/administration & dosage , Male , Mepivacaine/administration & dosage , Middle Aged , Pain Measurement , Patient Satisfaction , Ultrasonography, Interventional
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