Outcomes of thulium prostatectomy with "Oyster technique" versus transurethral prostatectomy (TURP): a randomized control trial.

PURPOSE: To compare the perioperative and postoperative outcomes between Oyster prostate vaporesection using Tm-YAG laser and the conventional transurethral prostatectomy using monopolar energy. METHODS: Patients with LUTS with an accumulative size of at least 60 ml were randomly assigned to one of two parallel groups to undergo Tm-YAG laser vaporesection (Group 1) or conventional monopolar transurethral prostatectomy (Group 2). The primary endpoints were the reduction in IPSS and the increase in Qmax postoperatively. Secondary endpoints included the Hemoglobin drop, the complication rate, the changes in urodynamic parameters, the duration of hospitalization and catheterization and the changes in IIEF during the 24-month follow-up. RESULTS: In total 32 and 30 patients were enrolled in Groups 1 and 2, respectively. Patient age (p = 0.422) and prostate volume were similar among the groups (p = 0.51). The outcomes in terms of IPSS decrease and Qmax amelioration were comparable (p = 0.449 and p = 0.237, respectively). Operative and hospitalization times were lower in Group 1 (p = 0.002 and p = 0.004, respectively). Hemoglobin drop, changes in urodynamic parameters and improvement in IIEF and QoL scores did not differ among the two Groups. The average time with the catheter was 2.06 ± 0.35 and 2.5 ± 0.82 (p = 0.003) days for Group 1 and Group 2, respectively. The overall complication rate was 6.2% for Group 1 and 13.3% for Group 2. CONCLUSIONS: The Oyster technique leads to similar postoperative outcomes compared to the standard monopolar transurethral prostatectomy. The shorter catheterization, hospitalization and operation time should be considered advantages of the Oyster technique.

Platelet-Rich Plasma (PRP) Improves Erectile Function: A Double-Blind, Randomized, Placebo-Controlled Clinical Trial.

BACKGROUND: Animal studies postulate that platelet-rich plasma (PRP) injections improve key elements of the pathophysiologic mechanisms leading to erectile dysfunction (ED). AIM: To conduct the first double-blind, randomized, placebo-controlled trial assessing the efficacy and safety of PRP injections in patients with mild and moderate ED. METHODS: Sixty sexually active patients with mild and moderate ED were randomly assigned to two sessions, with a one-month difference, of 10 mL PRP (n = 30) or placebo (n = 30) intracavernosal injections. An FDA-approved separation system was used. Patients were evaluated at 1, 3 and 6 months after completion of the treatment protocol. A per-protocol analysis was applied. All participants withheld any ED treatment during the trial. OUTCOMES: The achievement of minimal clinically important difference (MCID) in the International Index of Erectile Function - Erectile Domain (IIEF-EF) from baseline to 6 months after final treatment. Erectile function at all time points, as well as safety of PRP injections, were also evaluated. RESULTS: At 6 months, a MCID was achieved by 20/29 (69%) patients in the PRP group compared to 7/26 (27%) in the placebo group. The risk difference between the two groups was 42% (95%CI: 18-66), P < 0.001 and the baseline-adjusted mean between-group-difference in the IIEF-EF score was 3.9 points (95%CI: 1.8-5.9). Similarly, a statistically significant difference of both the number of participants attaining a MCID and the IIEF-EF score was also observed at the 1- and 3-month evaluation between the two groups. Accordingly, patients receiving PRP were more satisfied with the treatment. No adverse events were observed during the study period. CLINICAL IMPLICATIONS: Intracavernosal PRP injection therapy used as outlined in this trial appears to be a safe and effective short-term treatment for the management of mild to moderate ED. STRENGTHS & LIMITATIONS: We conducted the first clinical trial exploring the role of PRP in the management of ED. Conversely, our findings lack external validity due to single-center design. Furthermore, our results cannot be extrapolated to other PRP separation systems. CONCLUSIONS: PRP intracavernosal injections may be a promising addition to the urologist's armamentarium for the management of ED. Still, further high-quality studies are warranted to corroborate our findings. Evangelos P, Mykoniatis I, Pyrgidis N, et al. Platelet-Rich Plasma (PRP) Improves Erectile Function: A Double-Blind, Randomized, Placebo-Controlled Clinical Trial. J Sex Med 2021;18:926-935.

Therapeutic Effects of Micronutrient Supplements on Sperm Parameters: Fact or Fiction?

BACKGROUND: Despite the limited evidence about the effect of micronutrient supplementation on the semen quality, many micronutrient supplements have been used to improve male fertility. Approximately, 40%- 50% of male infertility cases in general and up to 80% in men with idiopathic infertility cases are caused by oxidative stress and decreased level of seminal total antioxidant capacity. OBJECTIVE: To investigate the beneficial effects of micronutrient supplementation on sperm concentration, motility and morphology. METHODS: A PubMed, Google Scholar, Embase data, Web of Science and Cochrane Library database extensive research of the randomized controlled studies utilizing micronutrient vitamins and supplements was performed. RESULTS: The existent international literature is rather heterogeneous and a definitive is difficult to be drawn. Several micronutrients have beneficial effects on sperm parameters. Rational use of micronutrients might be helpful for infertile patients. CONCLUSION: Further randomized, controlled clinical trials are required to elucidate the efficacy and safety of micronutrients and propose proper protocols for their use. A well-rounded, balanced diet is more preferable than the widespread use of micronutrient supplements beyond the recommended doses. Future studies should concern the pregnancy rate as a primary outcome in their designs. Further research should be done to determine the appropriate antioxidant compounds, the duration of the treatment, as well as a certain dose of antioxidants in clinical practices. The pre-treatment evaluation of the seminal oxidative status is also an important parameter to proceed with micronutrient supplementation without the risk of reductive stress. Under these conditions, supplements could support the quality of sperm and help to alleviate male infertility.

Flow resistive forces index (QRF): Development and clinical applicability assessment of a novel measure of bladder outlet resistance, aiming to enhance the diagnostic performance of uroflowmetry.

BACKGROUND: Currently, the diagnostic ability of uroflowmetry, the most widely used urodynamic test available for initial assessment of patients with lower urinary tract symptoms (LUTS), is considered limited by its inability to accurately discriminate between the underlying mechanisms of this condition. To improve the diagnostic accuracy of uroflow, we developed a mathematical formula that calculates the flow resistive forces index (QRF), a novel measure of bladder outflow/urethral resistance, and assessed its clinical applicability compared to the maximum flow rate (Qmax ). MATERIALS AND METHODS: A cross-sectional observational study was conducted in a cohort of 61 adult men presenting with voiding dysfunction symptoms, who all underwent free uroflowmetry followed by pressure flow study. The development of the mathematical formula which contains five key uroflowmetry variables (voided volume, flow time, Qmax , average flow rate, and peak flow time) was based on the assumption that urine volume momentum changes during voiding, the concept of diphasic uroflow pattern (acceleration/deceleration), and the urethral resistance factor (URA) equation. Study subjects were classified either as obstructed or nonobstructed according to established urodynamic criteria (linearized passive urethral resistance relation, LinPURR; Abrams-Griffiths number, AGN [also called bladder outlet obstruction index, BOOI]; and URA). Univariate linear correlations, binary logistic regression model, and receiver operating characteristic (ROC) curve statistical analysis were employed (SPSS-22, MedCalc, GraphPad [P < .05]). RESULTS: Outflow obstruction was diagnosed in 50.8% (1 in 2) patients. Univariate analysis, and bivariate linear correlation, binary logistic regression, and ROC curve analyses showed that the QRF was a strong independent predictor of bladder outlet/outflow obstruction (BOO), significantly outperforming Qmax . CONCLUSIONS: QRF index accurately predicts BOO, significantly outperforming the currently widely used bladder outlet obstruction estimator Qmax . Despite potential study limitations (mainly small cohort size and lack of control group), we anticipate that with further study and proper clinical validation, QRF could become a valuable complement to uroflowmetry.

The efficacy and safety of string stents after retrograde intrarenal surgery for urolithiasis.

INTRODUCTION: Ureteral stent insertion is frequently chosen after upper tract endourological procedures. The use of stents carrying a suture string is sometimes used to facilitate the extraction of the stent. In this systematic review and meta-analysis, we aimed to provide stronger evidence for the efficacy of string stents, by comparing them to non-string stents, in matters of patients' quality of life (QoL), stent-related symptoms (SRS) and complications. EVIDENCE ACQUISITION: A systematic review was conducted on PubMed, SCOPUS, Cochrane, EMBASE and Web of Science. The studies included were only comparative randomized controlled trials which included at least one group with tethered ureteral stent and one group with standard stent after the performance of endoscopic surgery for lithiasis of upper urinary tract. Primary endpoints were QoL expressed as general health, urinary symptoms as well as impact on work performance and SRS, expressed by VAS score. Secondary endpoints included complications such as stent migration, stent dislodgement, urinary tract infections (UTIs), emergency room visits and retained stent. EVIDENCE SYNTHESIS: We identified nine studies to be included in the qualitative synthesis and 3 randomized controlled trials to be included in the quantitative synthesis and the meta-analysis. The statistical difference in the stent related QoL was insignificant. General health was less affected in the non-string group. The urinary symptoms and the impact on work performance were similar between the groups. VAS pain score during the time that the patients were stented was insignificantly less in the non-string group, while VAS pain score was higher in the non-string group at extraction. Stent dislodgement was more frequent in the string group. There was no difference between the groups concerning the rate of UTIs. CONCLUSIONS: Non-string stents affected less the patients' QoL, in terms of general health and urinary symptoms, caused less stent related pain in cases of stent in situ and caused stent dislodgment in fewer patients. On the contrary, string stents caused less pain at extraction. All the aforementioned differences did not reach statistical difference.

Combination Therapy with Alpha-blocker and Phosphodiesterase-5 Inhibitor for Improving Lower Urinary Tract Symptoms and Erectile Dysfunction in Comparison with Monotherapy: A Systematic Review and Meta-analysis.

CONTEXT: The effects of combination therapy consisted of an α-blocker and a phosphodiesterase-5 inhibitor (PDE5I) for the treatment of lower urinary tract symptoms (LUTS) and erectile dysfunction (ED). OBJECTIVE: To systematically investigate the efficacy and safety of combination therapy in comparison with monotherapy. EVIDENCE ACQUISITION: The study complied with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement and the recommendations of the European Association of Urology Guidelines office. The study was registered in the PROSPERO database with ID CRD42018086619. Only comparative prospective studies, randomized or quasirandomized, with at least one control group with monotherapy were selected for the meta-analysis. The primary endpoint was the quality of life related to LUTS and ED, measured with the International Prostate System Score (IPSS), maximum flow rate (Qmax), postvoid residual (PVR), and International Index of Erectile Function (IIEF). Secondary endpoints included the adverse events rate. In the subgroup analysis of the influence of adding a PDE5I to the treatment of LUTS, the use of different PDE5Is was considered. EVIDENCE SYNTHESIS: After the screening of 6687 publications, 25 randomized controlled trials were considered eligible to be included in the meta-analysis. In the combination group, IPSS was lower and Qmax was higher than in the α-blocker group, with mean differences (MDs) of 1.41 (95% confidence interval [CI]: 0.42, 2.41; I2 = 71%, p = 0.005) and -1.01 ml/s (95% CI: -1.58, -0.43; I2 = 58%, p = 0.0006), respectively. The mean change of the IPSS was bigger in the combination group, with an MD of -1.72 (95% CI: -2.55, -0.89; I2 = 37%, p < 0.0001). The mean change of Qmax was insignificant, with an MD of -0.61 (95% CI: -1.57, 0.34; I2 = 63%, p = 0.21), as well as PVR and the mean change of PVR, with MDs of 0.65 (95% CI: -5.37, 6.66; I2 = 76%, p = 0.83) and -20.79 (95% CI: -48.94, 7.37; I2 = 75%, p = 0.15), respectively. The IIEF and the mean change of the IIEF had no difference between the combination group and the PDE5I-monotherapy group, with MDs of 1.82 (95% CI: -0.91, 4.54; I2 = 40%, p = 0.19) and 0.25 (95% CI: -1.11, 1.62; I2 = 47%, p = 0.72), respectively. Regarding the adverse events, the meta-analysis was in favor of monotherapy. None of the studies reported any serious or severe adverse event. CONCLUSIONS: Treatment with combination therapy is more effective for the improvement of the IPSS. Less significant improvement was shown in Qmax. The beneficial effect of combination therapy regarding ED remains equivocal. The combination therapy seemed to be safe and well tolerated. PATIENT SUMMARY: In this study, we review the effects of the combination therapy consisting of an α-blocker and a phosphodiesterase-5 inhibitor for the treatment of lower urinary tract symptoms (LUTS) and erectile dysfunction (ED). We found strong evidence to suggest the combination therapy for the improvement of LUTS. Benefits regarding the treatment of ED are less clear.

Experimental Studies of Nonabsorbable Polymeric Surgical Clips for Use in Urologic Laparoscopy.

Objective: This study aimed to compare the stability of the Click'aV® (Grena®), Click'aV plus (Grena), and Hem-o-lok® (Weck®, Teleflex®) polymer clips and the evaluation of the clips stability on a complete porcine artery. Materials and Methods: A dynamometer with a custom support and clamp unit was used. The crank gradually increased the tension force being applied on the clip via the suture. Different directions for the application of the force were tested. The highest force before the start of slipping the suture was noted. The procedure was repeated three times for each ligating clip. Results: For transverse stability, the "XL-size" Grena Click'aV Plus required preventing slippage at a greater force compared to the Hem-o-lok (p = 0.0071). No significant differences found statistically between the Grena Click'aV and Hem-o-lok clips (p = 0.1). For longitudinal stability, the Hem-o-lok required a significantly higher force to be opened compared to the Click'aV (p = 0.0036), but no statistically significant difference was found compared to the Click'aV Plus (p = 0.1). Concerning porcine artery stability, the artery slipped through the Click'aV clip in both measurements at a force of 10.2 and 9.4 N. In contrast, the arteries were cut in all measurements using the Click'aV Plus and the Hem-o-lok clips at forces of 11.8 and 12.8 N and 12.9 and 14.2 N, respectively. None of the clips leaked with up to 300 mm Hg of intra-arterial pressure applied to porcine renal arteries. Conclusions: The Grena Click'aV Plus clip has similar performance to the Hem-o-lok clip, and this clip can be equally useful for ligating vessels in laparoscopic urologic surgeries. We believe, from our findings in this study as well as those from other reports, that vascular clips applied properly by experienced surgeons provide a safe, reliable, and considerable cost-saving option for vascular control in urologic laparoscopic surgery.

The use of S-curved coaxial dilator for urethral dilatation: Experience of a tertiary department.

OBJECTIVE: Urethral strictures can be treated by urethral dilation, optical internal urethrotomy, or open surgical reconstruction (urethroplasty). Urethral dilation is done with filiforms and followers, balloons, or coaxial dilators inserted over a guidewire. The S-curved coaxial dilator (SCCD) was designed to facilitate the passage of the dilator through the stricture and the urethra because it imitates the curved anatomy of the male urethra. This study presents our experience with SCCD. MATERIALS AND METHODS: We used this kind of dilation in 310 patients. The technique included the insertion of a hydrophilic floppy-tipped guidewire through the urethra directly into the bladder under fluoroscopic control. The SCCDs were then inserted over the guidewire. Dilators of gradually increased size from 8F to 20F were used. The follow-up of the patients includes uroflowmetry and measurement of postvoid residual at 4 weeks, 6 months, or in the case of a recurrence of symptoms. RESULTS: The age of the patients were 69.08 ± 15.77 years. The causes of urethral stricture were iatrogenic (n = 114), traumatic (n = 35), infectious (n = 22), and of unknown origin (n = 139). The stricture length was 1.62 ± 0.85 cm. The mean number of dilations needed per case was 2 (range: 1-15), and the time between the dilations was 212.19 ± 253.9 days. We had seven failures. CONCLUSION: We propose the S-curved coaxial dilators for urethral dilation as a safe and effective technique because of their similarity to the shape of the male urethra and because of their hydrophilic coating.

Diet and stone formation: a brief review of the literature.

PURPOSE OF REVIEW: Urolithiasis is a very common condition, which can be accompanied by serious complications. Diagnosis, treatment, and prevention are of great cost for national health systems. Many studies have been published about the role of diet in both stone formation and prevention. The aim of this review is to summarize the most recent developments that correlate diet to lithiasis. RECENT FINDINGS: Recurrent stone formers should undergo metabolic evaluation and stone chemical analysis. Current evidence propose difference approaches based on the metabolic disorder that is diagnosed. Diet could have a detrimental role in the prevention of recurrences. Prevention advises include increased fluid uptake, vegetables and fruit intake but decreased sugar, salt, and meat consumption. SUMMARY: The analysis of the food contents and their role to lithogenesis prevention are of great importance. Modifying diet to prevent stones could help many people who suffer from lithiasis to avoid recurrence and the consequences. Furthermore, the cost for diagnosis and treatment could be significantly reduced. Therefore, the field of dietary factors in lithogenesis should be further investigated.

Robot-Assisted Simple Prostatectomy by an Extraperitoneal Approach.

The incidence of symptomatic benign prostate hyperplasia and bladder outlet obstruction has increased during the last two decades. Most of men are treated conservatively. When medical therapy is inadequate to relief symptoms, surgical treatment is necessary. Absolute indications for surgical treatment are gross hematuria, recurrent urinary infections and retentions as well as bladder stones. With advent of minimally invasive surgery, large prostates tend to be treated either endoscopically or laparoscopically (including robotic assistance). Herein, the robotic-assisted simple prostatectomy is described.

Histological changes caused by the prolonged placement of ureteral access sheaths: an experimental study in porcine model.

The objective is to evaluate the histological damage to the ureteral wall caused by the prolonged placement of an access sheath in porcine model. Six ureters from three female pigs were randomized into three groups. In each group, an UAS with different indwelling time was inserted. 9.5/11.5 Fr Flexor® ureteral access sheaths were inserted in both ureters with left indwelling for 30 min and right for 60 min. The ureteral access sheath was advanced up to the proximal ureter. No resistance was observed during the insertion. Ureters were harvested in immediately after the sheath placement process in one pig. The ureters of the remaining two pigs were removed at 1 and 2 weeks after the procedure, respectively. Histological examination took place also in these specimens. Ureters with an indwelling time of 30 min: histological examination of the ureter after immediate dissection revealed signs of acute inflammation at the distal ureter. The ureter dissected at 1 week showed minimal focal transmural inflammation along its length with minimal epithelial hyperplasia. The ureter dissected at 2 weeks, no signs of inflammation. Ureters with an indwelling time of 60 min: histological examination of the immediately dissected ureter revealed signs of acute inflammation at the distal ureter. At 1 week, chronic transmural inflammation was predominantly observed in the distal ureter. At 2 weeks, minimal transmural inflammation was observed. The use of UAS did not cause any severe histological damage on porcine ureters. Acute signs of inflammation gradually recovered within 2 weeks.

The effectiveness of ureteric metal stents in malignant ureteric obstructions: A systematic review.

OBJECTIVE: To review the literature on the effectiveness, safety and long-term patency of ureteric metal mesh stents (MSs), as a variety of MSs have been used for managing malignant ureteric obstruction over the last three decades. MATERIALS AND METHODS: A systematic review using the search string; Ureter∗ AND (stent OR endoprosthesis) AND metal∗ was conducted on PubMed, Scopus, Web of science and Cochrane Library online databases in May 2016. Prospective, retrospective, and comparative studies including MSs were included. The primary endpoint was the patency rate and the secondary endpoint was complications. RESULTS: In all, 324 publications were screened and 31 articles were included in the systematic review; 21 prospective and 10 retrospective studies. These studies reported the effectiveness of specific MSs in population studies, in comparative studies among different MSs, as well as among MSs and JJ stents. It should be noted that all comparative studies were retrospective. CONCLUSION: The experiences with vascular MSs, such as the Wallstent™ (Boston Scientific/Microvasive, Natick, MA, USA), were related to high occlusion rates, due to endoluminal hyperplasia, and long-term disappointing patency. The use of covered MSs designed for the vascular system was also unfavourable. The Memokath 051™ (PNN Medical A/S, Kvistgaard, Denmark) had better patency rates, but also higher migration rates. The long-term results were acceptable and rendered the Memokath 051 as a viable option for the management of malignant ureteric obstruction. The Uventa™ (Taewoong Medical, Seoul, Korea) and Allium™ (Allium Medical Solutions Ltd, Caesarea, Israel) MSs, specifically designed for ureteric placement, provided promising results. Nevertheless, the wide acceptance of these MSs would require well-designed clinical studies and long-term follow-up.

Percutaneous Nephrolithotomy Puncture and Tract Dilation: Evidence on the Safety of Approaches to the Infundibulum of the Middle Renal Calyx.

OBJECTIVE: To investigate the anatomical relations of the papillary, infundibular, and pelvic approach to percutaneous nephrolithotomy and evaluate the amount of vascularization at the respective sites. MATERIALS AND METHODS: 99mTc-dimercaptosuccinic acid single-photon emission computed tomography/computed tomography (SPECT/CT) renal scintigraphies or computed tomography perfusion (CTP) was performed in 40 patients (prone n = 20 or supine position n = 20). The angle of approach (AoA) for access tracts and the respective regions of interest to the mid-calyceal papilla and infundibulum as well as renal pelvis were designed and compared. RESULTS: The design of access tracts aiming to the renal pelvis, papilla, and infundibulum of the renal calyx was impossible for the nondilated collecting systems as all these tracts were in close vicinity. In both SPECT/CT and CTP, there was no statistical difference between the AoA for infundibular or pelvic access in comparison with the papillary puncture in either prone or supine position regardless of the degree of dilation of the system. The comparison of the measurements in the regions of interest showed that there was no difference in blood supply between the infundibular and pelvic access in comparison with the papillary approach in both positions regardless of the degree of collecting system dilation. CONCLUSION: The use of SPECT/CT and CTP showed that the punctures to the mid-calyceal renal papilla-fornix and infundibulum as well as the renal pelvis at the same level have similar AoA. The sites of the parenchyma involved in the tract dilation of the respective approaches are not related to significant differences in terms of vascularization.

Prostate Cancer Predictive Simulation Modelling, Assessing the Risk Technique (PCP-SMART): Introduction and Initial Clinical Efficacy Evaluation Data Presentation of a Simple Novel Mathematical Simulation Modelling Method, Devised to Predict the Outcome of Prostate Biopsy on an Individual Basis.

INTRODUCTION: We developed a mathematical "prostate cancer (PCa) conditions simulating" predictive model (PCP-SMART), from which we derived a novel PCa predictor (prostate cancer risk determinator [PCRD] index) and a PCa risk equation. We used these to estimate the probability of finding PCa on prostate biopsy, on an individual basis. MATERIALS AND METHODS: A total of 371 men who had undergone transrectal ultrasound-guided prostate biopsy were enrolled in the present study. Given that PCa risk relates to the total prostate-specific antigen (tPSA) level, age, prostate volume, free PSA (fPSA), fPSA/tPSA ratio, and PSA density and that tPSA ≥ 50 ng/mL has a 98.5% positive predictive value for a PCa diagnosis, we hypothesized that correlating 2 variables composed of 3 ratios (1, tPSA/age; 2, tPSA/prostate volume; and 3, fPSA/tPSA; 1 variable including the patient's tPSA and the other, a tPSA value of 50 ng/mL) could operate as a PCa conditions imitating/simulating model. Linear regression analysis was used to derive the coefficient of determination (R2), termed the PCRD index. To estimate the PCRD index's predictive validity, we used the χ2 test, multiple logistic regression analysis with PCa risk equation formation, calculation of test performance characteristics, and area under the receiver operating characteristic curve analysis using SPSS, version 22 (P < .05). RESULTS: The biopsy findings were positive for PCa in 167 patients (45.1%) and negative in 164 (44.2%). The PCRD index was positively signed in 89.82% positive PCa cases and negative in 91.46% negative PCa cases (χ2 test; P < .001; relative risk, 8.98). The sensitivity was 89.8%, specificity was 91.5%, positive predictive value was 91.5%, negative predictive value was 89.8%, positive likelihood ratio was 10.5, negative likelihood ratio was 0.11, and accuracy was 90.6%. Multiple logistic regression revealed the PCRD index as an independent PCa predictor, and the formulated risk equation was 91% accurate in predicting the probability of finding PCa. On the receiver operating characteristic analysis, the PCRD index (area under the curve, 0.926) significantly (P < .001) outperformed other, established PCa predictors. CONCLUSION: The PCRD index effectively predicted the prostate biopsy outcome, correctly identifying 9 of 10 men who were eventually diagnosed with PCa and correctly ruling out PCa for 9 of 10 men who did not have PCa. Its predictive power significantly outperformed established PCa predictors, and the formulated risk equation accurately calculated the probability of finding cancer on biopsy, on an individual patient basis.

Papillary vs Nonpapillary Puncture in Percutaneous Nephrolithotomy: A Prospective Randomized Trial.

INTRODUCTION: Literature suggests that the percutaneous punctures for percutaneous nephrolithotomy (PCNL) must be performed at the papilla of the renal calix and a puncture at the infundibulum or the direction of the pelvis is not advisable because of increased hemorrhagic risk. A prospective randomized study was conducted to investigate the safety in terms of blood loss of the infundibular approach for PCNL. MATERIALS AND METHODS: Patients with renal stones with an accumulative size of at least 2 cm were randomly assigned to one of two parallel groups to undergo PCNL with either papillary (Group 1) or infundibular (Group 2) renal access. The primary outcome measures were the reduction in hemoglobin on first postoperative day and the need for transfusion during the first postoperative month. Secondary endpoints included the operative and fluoroscopy time, number of accesses performed, overall complication rate, hospitalization time, and complications up to 3 months. RESULTS: In total, 27 and 28 patients were enrolled in Groups 1 and 2, respectively. Patient age, body mass index, and stone size were similar among the groups (p = 0.672, 0.256, and 0.889, respectively). Reduction in hemoglobin and transfusion rate did not differ among Groups 1 and 2 (p = 0.916, p = 1.0, respectively). Operative time was higher in the case of Group 1 (p = 0.027). The overall complications rate was 7.4% for Group 1 and 7.14% for Group 2. Hospitalization time was not significantly different in the study groups (p = 0.724). CONCLUSIONS: The infundibular approach for PCNL to the posterior middle renal calices is not associated with higher blood loss or transfusion rate in comparison with the respective approach to the fornix of the papilla when the currently described technique is performed.

Is vitamin D related to pathogenesis and treatment of Hashimoto's thyroiditis?

OBJECTIVE: The aim of this study was to investigate vitamin D status by measuring serum 25(OH)D levels in euthyroid patients with Hashimoto's thyroiditis (HT) who lived and worked on the sunny island of Crete, Greece, and to evaluate whether vitamin D3 supplementation is beneficial for the management of HT patients with vitamin D deficiency. SUBJECTS AND METHODS: We studied 218 HT patients, euthyroid Caucasian Cretan Greek citizens: 180 females and 38 males. Among these patients, 186 (85.3%) had vitamin D deficiency defined as serum 25(OH)D levels < 30 ng/mL. The mean age of all these 218 HT patients was 35.3 ± 8.5 years. The mean age of the 186 vitamin D deficient HT patients (173 females and 13 males) was 37.3 ± 5.6 years. The 186 vitamin D deficient HT patients received vitamin D3 (cholecalciferol, CF) orally, 1200-4000 IU, every day for 4 months aiming to maintain serum 25(OH)D levels ≥ 40 ng/mL. Anthropometric characteristics (height, weight, waist circumference), systolic and diastolic blood pressure, serum concentration of 25(OH)D, thyrotropin (TSH), free thyroxine (FT4), anti-thyroid peroxidase (anti-TPO), antithyroglobulin (anti-TG), calcium and phosphorus levels and thyroid and kidney sonographic findings were recorded and measured before and after CF administration. RESULTS: There was a significant negative correlation only between serum 25(OH)D levels and anti-TPO levels among all 218 HT patients. Also, anti-TPO levels were significantly higher in 186/218 vitamin D deficient HT patients compared to 32/218 HT patients with no vitamin D deficiency (364 ± 181IU/mL versus 115.8 ± 37.1IU/mL, P<0.0001). Supplementation of CF in 186 vitamin D deficient HT patients caused a significant decrease (20.3%) in serum anti-TPO levels. Although at the end of the 4 months period of the study body mass index (BMI), serum anti-TG and TSH levels decreased by 2.2%, 5.3% and 4% respectively, these differences were not significant. No changes in the sonographic findings were observed. CONCLUSION: The majority (85.3%) of the Greek Caucasian patients with HT studied who lived and worked in Crete had low serum 25(OH)D levels inversely correlated with serum anti-TPO thyroid antibodies. After 4 months of CF supplementation in the 186 HT patients with vitamin D deficiency, a significant decrease (20.3%) of serum anti-TPO levels was found. These findings suggest that vitamin D deficiency may be related to pathogenesis of HT and that its supplementation could contribute to the treatment of patients with HT.

The hepatoprotective and hypolipidemic effects of Spirulina (Arthrospira platensis) supplementation in a Cretan population with non-alcoholic fatty liver disease: a prospective pilot study.

BACKGROUND: A pilot study was conducted to determine the effects of Spirulina (Arthrospira platensis) on Cretan patients with non-alcoholic fatty liver disease (NAFLD). Spirulina is a filamentous cyanobacterium taken as a dietary supplement. METHODS: Fifteen adult Cretan outpatients (13 men), median age 48 (range: 29-62) years, with NAFLD were orally supplemented with 6 g of Spirulina (Greek production) per day for six months. Anthropometric characteristics (height, weight, waist circumference), systolic and diastolic blood pressure, complete blood count, biochemical assessments, homeostasis model assessment of insulin resistance (HOMA-IR) index, health-related quality of life and abdominal sonographic findings were recorded and measured, before and after Spirulina supplementation. RESULTS: At the end of the 6-month intervention period, the mean levels of aspartate aminotransferase, alanine aminotransferase, gamma-glutamyltransferase, triglycerides, low-density lipoprotein-cholesterol, total cholesterol, and the ratio of total cholesterol to high-density lipoprotein cholesterol were significantly decreased: 38.5%, 37.5%, 26.7%, 24.8%, 9.6%, 9.1%, and 13.5% respectively, whereas the mean levels of high-density lipoprotein-cholesterol and hemoglobin were significantly increased: 4.2% and 4.1% respectively. Spirulina supplementation resulted also in a significant reduction in weight and HOMA-IR index (8.1% and 19.6% respectively) and a significant improvement in health-related quality of life scale. No changes in sonographic findings were observed. CONCLUSION: Spirulina supplementation at a high dosage of 6 g daily in NAFLD patients has strong and multiple beneficial metabolic effects and improves their health-related quality of life.

Hashimoto's autoimmune thyroiditis and vitamin D deficiency. Current aspects.

Hashimoto's thyroiditis (HT) is a chronic autoimmune thyroid disease caused by an interaction between genetic factors and environmental conditions, both of which are not yet completely understood. The significant association between vitamin D deficiency and HT has been investigated regarding the immune role of this hormone. In HT, an immunologic reaction is triggered when thyrocytes express major histocompatibility complex (MHC) class II surface HLA-DR antigens, a process induced by the production from T helper (Th)1 type lymphocytes, of inflammatory cytokines (especially IFN-γ), which may be inhibited by 1,25[OH]2D. Genetic polymorphism of vitamin D receptor (VDR), binding protein (DBP) and of 1α-hydroxylase (CYP1α) may also predispose to the development of HT. Considering current evidence, presented in this review, screening for vitamin D deficiency and careful vitamin D supplementation, when required, may be recommended for patients with HT. Further research is needed in patients with HT in order to investigate the mechanisms by which vitamin D affects autoimmunity and also to evaluate the cost-effectiveness of vitamin D supplementation and to suggest the possible optimal dose treatment.