Daniele Castellani

Low-Dose Intravaginal Estriol and Pelvic Floor Rehabilitation in Post-Menopausal Stress Urinary Incontinence

Introduction: Pelvic floor muscle training (PFMT) and electrical stimulation (ES) are conservative models of therapy for treating female stress urinary incontinence (SUI). The presence of estradiol receptors in the lower urinary tract advances the case for estradiol therapy in SUI. The aim of our study was to investigate the effects of the combination of pelvic floor rehabilitation and intravaginal estriol (IE) on SUI treatment in postmenopausal women. Material and Methods: Sixty-two women with SUI were randomized to PFMT, ES and biofeedback (Group 1) or the same treatment plus 1 mg IE (Group 2) for 6 months. Patients were evaluated with medical history, pelvic examination, urodynamics, 24-hour pad test. Urinary incontinence was evaluated using the International Consultation on Incontinence questionnaire on urinary incontinence short form and quality of life using the Incontinence Impact Questionnaire-Short Form. Results: Two patients were lost at follow-up and one discontinued the study. Mean urine leakage at the 24-hour pad test dropped from 42.3 ± 20.2 g/die to 31.5 ± 14.2 g/die in Group 1 and from 48.3 ± 19.8 g/die to 22.3 ± 10.1 g/die in Group 2. Symptoms scores and incontinence status were statistically significant better in Group 2 when compared to Group 1. Conclusion: IE added to PFMT, ES and BF is a safe and efficacious first-line therapy in postmenopausal women with SUI.

Transobturator surgery in presence of corona mortis: a study in 13 women.

Purpose Severe and life-threatening bleeding has been reported in the literature after retropubic mid-urethral slings procedure, due to corona mortis damage. The aim of this study is to evaluate safety of transobturator passage of the tape in stress-urinary incontinence (SUI) correction and anchoring the mesh in pelvic-organ prolapse (POP) repair in the presence of corona mortis. Materials and methods Thirteen women with a pre-operatory contrast-enhanced abdominal multidetector computed tomography were prospectively enrolled in the study between January 2009 and December 2014. Eight women underwent a Monarc® and one a Spark® Sling System procedures for SUI correction, and three an Elevate® Anterior and Apical prolapse system and one a Perigee procedure to repair anterior/apical POP. All procedures were performed by a single experienced pelvic surgeon. Results Surgery was uneventful in all cases. No major bleeding was seen during surgery. No pelvic hematoma was identified 24 hours after the procedure. All women were discharged 1 day after surgery. Conclusions Transobturator surgery seems to be a safe way in the presence of the corona mortis. However, further studies are needed to confirm these preliminary findings.

Comparison Between Two Different En Bloc Thulium Laser Enucleation of the Prostate: Does Technique Influence Complications and Outcomes?

OBJECTIVE To evaluate whether 2 similar en bloc thulium laser enucleation of the prostate (ThuLEP) techniques can influence surgical complications and outcomes. MATERIAL Within 2 institutional databases 164 men who underwent 2 different en bloc ThuLEP techniques were compared using propensity scores. With the first technique prostatic lobes were all enucleated en bloc, whereas, with the second the median lobe was enucleated first and the lateral lobes were enucleated en bloc thereafter. All patients were evaluated at baseline and 6 months after surgery with PSA, Qmax, and self-administrated IPSS. Operative data and 30-day postoperative complications were gathered. RESULTS Surgical time and 24-hour blood loss were similar between 2 groups (55 vs 55 minutes, P .97288; -0.9 vs -1.3 g/dL, P .112 respectively). Median hospital stay after surgery was 3 days in both groups (P .3251). IPSS and Qmax improved equally in both groups (median 3 vs 3, P .941; 19.17 vs 20.63 mL/s, P .8232 respectively). Early complications were mild to moderate (Clavien I 12.2% vs 12.2%; Clavien II 3.6% vs 4.84%; Clavien IIIb 1.2% vs 2.4%). CONCLUSION Our results show that en bloc ThuLEP approaches appear feasible, have similar complications and outcomes and can be considered surgeon-independent techniques. En bloc ThuLEP may be proposed even for laser-naïve urologists as an alternative to the original 3-lobe technique.

Radical cystectomy in frail octogenarians in thoracic continuous spinal anesthesia and analgesia: a pilot study

Background: Radical cystectomy (RC) is the gold standard therapy in nonmetastatic muscle-invasive bladder cancer and is usually performed under general anesthesia (GA). GA is high risk in most older patients due to comorbidities. Continuous spinal anesthesia (CSA) may be an alternative solution to reduce postoperative morbidity in elderly. The aim of this study was to assess the feasibility, morbidity, and mortality of RC performed under CSA in octogenarian patients. Methods: We retrospectively reviewed data of five frail patients aged ⩾80 who underwent RC in CSA. CSA was achieved starting with 2.5 mg hyperbaric bupivacaine plus 25 µg fentanyl. Postoperative analgesia was achieved through the intrathecal catheter, using continuous delivery of levo-bupivacaine 60 mg plus fentanyl 75 µg in 72 hours. Results: Surgery was completed in all cases in CSA. No patients required postoperative intensive care unit admission. Complications were Clavien I for four in three patients, Clavien II for seven in five patients, and Clavien IIIb for one patient. Postoperative consumption of painkillers was negligible. Oral feeding resumed within 3 days in all cases. The mean postoperative stay was 9.6 days. All patients were alive at 3 months of follow up. Conclusions: Management of muscle-invasive bladder cancer (MIBC) in older patients is becoming an important issue due to the continuous aging of the population. Age should not preclude RC, but careful management is mandatory because perioperative morbidity and mortality are increased in the elderly. Our preliminary results show that CSA and analgesia is a feasible option as an additional way to reduce morbidity and mortality in frail octogenarians who require RC.

Solitary fibrous tumor/hemangiopericytoma of the penis: Report of the first case

Hemangiopericytoma (HPC) is an uncommon perivascular tumor, first described in 1942, occurring most frequently in the extremities (pelvis, meninges, head and neck), and rarely affecting the urogenital system. In 1870, Wagner published the first histological description of a Solitary Fibrous Tumor (SFT) of the pleura. It is now thought that the majority of lesions previously called hemangiopericytomas (HPCs) are essentially indistinguishable from solitary fibrous tumors (SFTs). Nowadays, the new WHO classification of soft tissue tumors categorizes most HPCs as SFTs. We report the first case of penile SFT-HPC in a 44-year-old man, presenting with a 3-year history of slow-growing penile mass. The patient underwent a tumor excision. Six months after surgery he is free of local recurrence and distant metastasis.

Unilateral sling transection for patients with postoperative voiding dysfunction after transobturator sling surgery

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Uncommon complication of endoscopic ureterolithotripsy: The stone granuloma

Abstract  Endoscopic management of urolithiasis is one of the commonest urological procedures today. It is usually safe and effective but one of the possible complications is ureteral obstruction. Stone fragmentation after ballistic lithotripsy and ureteral wall perforation could explain the mechanism responsible for this occurrence. We report a case of stone granuloma, occurring after a ballistic ureterolithotripsy.