Amelia Pietropaolo

The Female Sexual Function Index (FSFI): Linguistic Validation of the Italian Version

INTRODUCTION Although several new measurements for female sexual dysfunction (FSD) have recently been developed, the Female Sexual Function Index (FSFI) remains the gold standard for screening and one of the most widely used questionnaires. The Italian translation of the FSFI has been used in several studies conducted in Italy, but a linguistic validation of the Italian version does not exist. AIM The aim of this study was to perform a linguistic validation of the Italian version of the FSFI. METHODS A multicenter cross-sectional study conducted in 14 urological and gynecological clinics, uniformly distributed over Italian territory. We performed all steps necessary to determine the reliability and the test-retest reliability of the Italian version of the FSFI. The study population was a convenience sample of 409 Italian women. MAIN OUTCOME MEASURES The reliability of the questionnaire was calculated using Cronbachs alpha, which was considered weak, moderate, or high if its value was found less than 0.6, between 0.6 and 0.8, or equal to or greater than 0.8, respectively. The test-retest reliability was assessed for all women in the sample by calculating Pearsons concordance correlation coefficient for each domain and for the total score, both at baseline and after 15 days (r range between -1.00 to +1.00, where +1.00 indicates the strongest positive association). RESULTS Cronbachs alpha coefficients for total and domain score were sufficiently high, ranging from 0.92 to 0.97 for the total sample. The test-retest procedure revealed that the concordance correlation coefficient was very high both for FSFI-I total score (Pearsons P = 0.93) and for each domain (Pearsons P always >0.92). CONCLUSION For the first time in the literature, our study has produced a validated and reliable Italian version of the FSFI questionnaire. Consequently, the Italian FSFI can be used as a reliable tool for preliminary screening for female sexual dysfunction for Italian women.

Morphological changes of bladder mucosa in patients who underwent instillation with combined sodium hyaluronic acid-chondroitin sulphate (Ialuril®).

Objective: To investigate what changes are endoscopically evident after glycosaminoglycans (GAGs) therapy by hyaluronic acid (HA) and chondroitin sulphate (CS) (Ialuril®) in female patients affected by bladder pain syndrome(BPS)/ interstitial cystitis (IC) or recurrent urinary tract infections (rUTIs). Patients and Methods: 21 female patients over 18 years affected by rUTIs or BPS/IC received intravesical instillation of HA and CS (4 weekly instillations followed by 2 instillations every 2 weeks and 2 instillation monthly). Post-treatment evaluation included cystoscopy and patient assessment of improvement in symptoms and satisfaction on a visual analogue scale (VAS) from 0 to 10. Results: The post-treatment endoscopy showed a positive effect on bladder mucosa morphology. In 2 cases, treatment did not change endoscopic findings and clinical symptoms. In the other patients, when macroscopic features of the bladder mucosa normalized, the clinical picture improved. Conclusions: GAGs therapy by HA and CS (Ialuril) improves the morphology of bladder mucosa in patients with rUTI or BPS/IC.

Urodynamics useless before surgery for female stress urinary incontinence: Are you sure? Results from a multicenter single nation database

The role of urodynamics (UDS) before surgery for stress urinary incontinence (SUI) remains a debated issue in female urology as well as in urogynaecology and it has been recently questioned on the basis of data coming from selected population of patients defined as “uncomplicated.” The aim of this study was to investigate the percentage of “uncomplicated” patients undergoing urodynamic evaluations in six referral Italian centers. The secondary aim was to assess the prevalence of women, for whom the urodynamic evaluation could add new information to the pre‐urodynamic picture and in how many cases these findings had a significant impact on patient management.

Urology Residency Training in Italy: Results of the First National Survey

BACKGROUND Numerous surveys have been performed to determine the competence and the confidence of residents. However, there is no data available on the condition of Italian residents in urology. OBJECTIVE To investigate the status of training among Italian residents in urology regarding scientific activity and surgical exposure. DESIGN, SETTING, AND PARTICIPANTS A web-based survey that included 445 residents from all of the 25 Italian Residency Programmes was conducted between September 2015 and November 2015. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The main outcomes were represented by scientific activity, involvement in surgical procedures, and overall satisfaction. RESULTS AND LIMITATIONS In total, 324 out of 445 (72.8%) residents completed the survey. Overall, 104 (32%) residents had not published any scientific manuscripts, 148 (46%) published ≤5, 38 (12%) ≤10, 26 (8%) ≤15, four (1%) ≤20, and four (1%) >20 manuscripts, respectively. We did not observe any differences when residents were stratified by sex (p=0.5). Stent positioning (45.7%), extracorporeal shock wave lithotripsy (30.9%), transurethral resection of bladder tumor (33.0%), hydrocelectomy (24.7%), varicocelectomy (17%), ureterolithotripsy (14.5%), and orchiectomy (12.3%) were the surgical procedures more frequently performed by residents. Overall, 272 residents (84%) expressed a good satisfaction for urology specialty, while 178 (54.9%) expressed a good satisfaction for their own residency programme. We observed a statistically decreased trend for good satisfaction for urology specialty according to the postgraduate year (p=0.02). CONCLUSIONS Italian Urology Residency Programmes feature some heavy limitations regarding scientific activity and surgical exposure. Nonetheless, satisfaction rate for urology specialty remains high. Further improvements in Residency Programmes should be made in order to align our schools to others that are actually more challenging. PATIENT SUMMARY In this web-based survey, Italian residents in urology showed limited scientific productivity and low involvement in surgical procedures. Satisfaction for urology specialty remains high, demonstrating continuous interest in this field of study from residents.

Safety and Efficacy of Day-case Percutaneous Nephrolithotomy: A Systematic Review from European Society of Uro-technology

CONTEXT Day case or ambulatory percutaneous nephrolithotomy (PCNL) has risen over the last few years with the aim of discharging patients within 24h. OBJECTIVE We perform a systematic review of literature to evaluate the outcomes of day-case PCNL surgery. EVIDENCE ACQUISITION A Cochrane style search was performed and the following bibliographic databases were accessed: PubMed, Science Direct, Scopus, and Web of Science. This was carried out in accordance with the Preferred Reporting Items for Systematic reviews and Meta-analyses (PRISMA) guidelines. All studies in the English language reporting on PCNL patients discharged within 24h were included. EVIDENCE SYNTHESIS Based on the literature search of 97 articles, nine (502 patients) met the inclusion criteria (mean age: 47 yr), with a mean stone size of 20.5mm. The mean operating time was 66min, and over a mean hospital stay of 17.5h, the stone-free rate was 95%. The overall complication rate was 13.5%; the vast majority of these complications were Clavien I-II complications, with a readmission rate of 3%. CONCLUSIONS Day-case PCNL is a safe and feasible strategy in carefully selected cases. However, for its success, detailed planning and adherence to surgical protocol are paramount with strict criteria for inpatient admission and a thorough follow-up plan. PATIENT SUMMARY Day-case percutaneous nephrolithotomy procedure seems to be a safe procedure with good outcomes, and low risk of complications and readmissions. Detailed preoperative protocol and planning are paramount, with indications for inpatient admission as well as a thorough follow-up plan.

Outcomes of Elective Ureteroscopy for Ureteric Stones in Patients with Prior Urosepsis and Emergency Drainage: Prospective Study over 5 yr from a Tertiary Endourology Centre

BACKGROUND Elective treatment of ureteric stones is needed after emergency drainage of urosepsis. OBJECTIVE We wanted to look at the outcomes of elective ureteroscopic stone treatment in patients with prior sepsis and emergency drainage via retrograde ureteric stent (RUS) or percutaneous nephrostomy (PCN). DESIGN, SETTING, AND PARTICIPANTS Data of all patients who underwent elective ureteroscopy (URS) for stone disease over 5 yr (March 2012-December 2016) were prospectively collected. INTERVENTION Elective URS following previous emergency RUS or PCN. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Outcomes were collated for consecutive patients who underwent emergency drainage for urosepsis secondary to stone disease, followed by elective URS. Data was collected regarding patient demographics, stone parameters, and clinical outcomes. Statistical analysis was performed using SPSS version 24. RESULTS AND LIMITATIONS In total, 76 patients underwent 82 elective procedures (six underwent bilateral URS) with a male to female ratio of 1:2 and a mean age of 57 yr. Emergency decompression was achieved via RUS in 63 (83%) and PCN in 13 (17%) patients. A positive urine culture on presentation was obtained in 26 (34%) patients, and 27 (36%) patients were admitted to the intensive care unit (ICU). The mean single and overall stone size was 8.6 (2-23) and 10.8 (2-32) mm, respectively. The mean operating time was 42 (5-129) min with stone-free rate (SFR) of 97% (n=74). There were three (4%) complications in total, of which two patients developed urinary tract infection needing intravenous antibiotics (Clavien II) and a third developed sepsis (Clavien IV) needing ICU admission. There was no difference in ureteroscopic lithotripsy outcomes (operative time, complications, or SFR) on comparing initial RUS or PCN, admission to ICU or ward, positive or negative urine culture result, presence of single or multiple stones, and between American Society of Anaesthesiologists (ASA) grade of patients. The ASA grade of patients was a significant predictor of day case procedures (p=0.001). CONCLUSIONS Elective URS achieved excellent outcomes in patients who previously presented with obstructing calculi and sepsis needing emergency decompression. Overnight inpatient admission was needed in some patients with a higher ASA grade. PATIENT SUMMARY In this report, we look at the outcomes of planned ureteroscopy procedures for stone disease in patients with previous urosepsis. These patients with previous emergency drainage for urosepsis had excellent outcomes from their planned ureteroscopic surgery. This information will help in preoperative patient optimisation and counselling.

Effect of music on outpatient urological procedures: A systematic review and meta-analysis from European section of Uro-Technology (ESUT)

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MP75-07 SONOGRAPHY TAPE CHARACTERISTIC AND INCONTINENCE OUTCOME AFTER TRANS-OBTURATOR TAPE (TOT) SURGERY

INTRODUCTION AND OBJECTIVES: Sacral nerve stimulation (SNS) (InterStim , Medtronic, Inc., Minneapolis, MN) has been used as a second-line therapy for both urinary and bowel control. There is limited data in the literature regarding trends of utilization of SNS to explore precisely who is treated with SNS. We sought to explore disparities in the utilization of SNS among Medicare beneficiaries. METHODS: A 5% national random sample of all Medicare claims for 2001, 2004, 2007, and 2010 was queried to identify patients of interest. All patients with an International Classification of Diseases, 9th Edition (ICD-9) diagnosis code that was a potential indication for SNS system were included. Patients who underwent SNS implantation were identified with Current Procedure Terminology (CPT-4) codes. Statistical tests used included the c2 and Fisher tests, as well as multivariate logistic regression analyses using SAS v9.3 (SAS Institute Inc., Cary, NC) and SPSS v20 (IBM Corp., Armonk, NY). RESULTS: A total of 3,198,300 patients were identified with a diagnosis that could potentially be treated with SNS. Of these patients, 14,780 patients underwent treatment with SNS (0.46%). The percentage of patients diagnosed who ultimately underwent treatment increased from 0.02% to 0.75% (p <0.001) over the 10-year study period. On logistic regression analysis, women (OR1⁄44.60, p<0.0001) and patients aged less than 65 years (OR1⁄41.00, compared to older age groups OR1⁄40.29-0.44, p<0.0001) were more likely to be treated with SNS. Non-white individuals (OR1⁄40.48, p<0.0001) and those living in the western U.S. (OR1⁄40.55, p<0.0001) were less likely to receive surgical treatment (see Table). CONCLUSIONS: The usage of SNS among patients diagnosed with a potential indication has significantly increased among Medicare beneficiaries over a 10-year period. Patients were more likely to be treated with SNS if they were female, white, were <65 years of age, and lived outside of the west coast of the U.S. Knowledge of these data might promote more equal access to SNS nationwide.

383 Sonography tape characteristic and incontinence outcome after trans-obturator tape (TOT) surgery

INTRODUCTION AND OBJECTIVES: Sacral nerve stimulation (SNS) (InterStim , Medtronic, Inc., Minneapolis, MN) has been used as a second-line therapy for both urinary and bowel control. There is limited data in the literature regarding trends of utilization of SNS to explore precisely who is treated with SNS. We sought to explore disparities in the utilization of SNS among Medicare beneficiaries. METHODS: A 5% national random sample of all Medicare claims for 2001, 2004, 2007, and 2010 was queried to identify patients of interest. All patients with an International Classification of Diseases, 9th Edition (ICD-9) diagnosis code that was a potential indication for SNS system were included. Patients who underwent SNS implantation were identified with Current Procedure Terminology (CPT-4) codes. Statistical tests used included the c2 and Fisher tests, as well as multivariate logistic regression analyses using SAS v9.3 (SAS Institute Inc., Cary, NC) and SPSS v20 (IBM Corp., Armonk, NY). RESULTS: A total of 3,198,300 patients were identified with a diagnosis that could potentially be treated with SNS. Of these patients, 14,780 patients underwent treatment with SNS (0.46%). The percentage of patients diagnosed who ultimately underwent treatment increased from 0.02% to 0.75% (p <0.001) over the 10-year study period. On logistic regression analysis, women (OR1⁄44.60, p<0.0001) and patients aged less than 65 years (OR1⁄41.00, compared to older age groups OR1⁄40.29-0.44, p<0.0001) were more likely to be treated with SNS. Non-white individuals (OR1⁄40.48, p<0.0001) and those living in the western U.S. (OR1⁄40.55, p<0.0001) were less likely to receive surgical treatment (see Table). CONCLUSIONS: The usage of SNS among patients diagnosed with a potential indication has significantly increased among Medicare beneficiaries over a 10-year period. Patients were more likely to be treated with SNS if they were female, white, were <65 years of age, and lived outside of the west coast of the U.S. Knowledge of these data might promote more equal access to SNS nationwide.

287 COST-UTILITY RATIOS (CURS) AND DIFFERENT LEVELS OF EFFECTIVENESS IN URINARY INCONTINENCE (UI) MANAGEMENT

impact that ‘never events’ had on mortality, length of stay (LOS), and total hospital charges was determined. RESULTS: The overall rate for ‘never event’ was 8.2%. Most common were SSI (3.7%), DVT/PE (2.7%), and vascular-catheter infection (1.3%). Demographics that predicted ‘never events’ included black race (OR 1.5, 95% CI 1.3 – 1.8), increasing age (OR 1.01, 95% CI 1.00 – 1.01), comorbidities (OR 1.3, 95% CI 1.1 – 1.5), Medicare insurance (OR 1.3, 95% CI 1.2 – 1.4). ‘Never event’ rate was decreased in females (OR 0.8, 95% CI 0.7 – 0.9), urban nonteaching hospitals (OR 0.7, 95% CI 0.6 – 0.8) and high cystectomy volume hospitals (OR 0.8, 95% CI 0.7 – 0.9). ‘Never events’ increased average LOS (by 13 days), total charges (by