Davide Moschese

A multistep approach to manage Fournier’s gangrene in a patient with unknown type II diabetes: surgery, hyperbaric oxygen, and vacuum-assisted closure therapy: a case report

IntroductionFournier’s gangrene is an infectious necrotizing fasciitis of the perineum and genital regions and has a high mortality rate. It is a synergistic infection caused by a mixture of aerobic and anaerobic organisms and predisposing factors, including diabetes mellitus, alcoholism, malnutrition, and low socioeconomic status. We report a case of Fournier’s gangrene in a patient with unknown type II diabetes submitted to 24-hour catheterization 15 days before gangrene onset.Case presentationThe patient, a 60-year-old Caucasian man, presented with a swollen, edematous, emphysematous scrotum with a crepitant skin and a small circle of necrosis. A lack of resistance along the dartos fascia of the scrotum and Scarpa’s lower abdominal wall fascia combined with the presence of gas and pus during the first surgical debridement also supported the diagnosis of Fournier’s gangrene. On the basis of the microbiological culture, the patient was given multiple antibiotic therapy, combined hypoglycemic treatment, hyperbaric oxygen therapy, and several surgical debridements. After five days the infection was not completely controlled and a vacuum-assisted closure device therapy was started.ConclusionsThis report describes the successful multistep approach of an immediate surgical debridement combined with hyperbaric oxygen and negative pressure wound therapy. The vacuum-assisted closure is a well-known method used to treat complex wounds. In this case study, vacuum-assisted closure treatment was effective and the patient did not require reconstructive surgery. Our report shows that bladder catheterization, a minimally invasive maneuver, may also cause severe infective consequences in high-risk patients, such as patients with diabetes.

Synchronous primary neoplasms of the bladder, skin and breast in a male patient: a case report

The incidence of multiple primary malignant neoplasms increases with age, reflecting an increase in overall cancer risk in older patients. Cases of two or more concurrent primary cancers are still rare, although its incidence is increasing. Here, we report the case of a 57-year-old man who was referred to our institution with synchronous squamous cell carcinoma of the skin on the forehead, infiltrating ductal carcinoma of the breast, and transitional cell carcinoma of the urinary bladder. To the best of our knowledge, this is the first reported case in literature of this combination of primary neoplasms.

Penile metastasis from primary cholangiocarcinoma: the first case report

BackgroundMetastatic penile carcinoma derived from cholangiocarcinoma (CCA) has not been previously reported in the literature. Common metastatic sites for CCA include the regional lymph nodes and adjacent organs. CCAs are not highly vascularised tumours, making hematogenous metastases uncommon. Hematogenous CCA metastases commonly occur at distant organs such as the lungs, adrenal glands, and bones. Median survival for patients with metastatic disease is generally less than 1 year.Case presentationA 74-year-old Caucasian man consulted us after having undergone penile ultrasonography for pain and increased thickness at the base of the penis after self-examination. The patient presented with a history of hepatitis C-related cirrhosis and intrahepatic CCA, diagnosed 3 years previously. A biopsy of the corpora cavernosa on both sides revealed a carcinoma harbouring the same histological and immunophenotypical features as the primary hepatic lesion.ConclusionsTo date, there is no case of penile or urogenital system metastasis from CCA described in the literature. Therefore, this article represents the first case report of penile metastasis from CCA.

Botulinum Toxin, Endoscopy, and Mini-Invasive Treatment

Urinary incontinence and voiding dysfunction are well represented in pediatric population, mostly as the consequence of malformations, obstetric trauma, or neurogenic conditions. Today, various mini-invasive and endoscopic procedures are available for treating these disorders, preventing severe complications to lower and upper urinary tract and providing quality of life improvement. These techniques have highly developed in the last 10 years, and most of them are supported by clear evidence of efficacy and safety and represent a standard of care. Endoscopic surgery is used to treat ureterocele, vesicoureteral reflux, urethral valves, urethral strictures, and stress urinary incontinence, which can also be cured by minimally invasive surgical approaches (pubovaginal slings). An important therapeutic option for urinary incontinence secondary to neurogenic detrusor overactivity but also for neurogenic voiding dysfunction should be the injection of onabotulinum toxin A. In fact, phase III trials are ongoing to evaluate efficacy and safety of this treatment in children and should support the registration as “on-label” therapeutic approach, already obtained in adults, also in this population. This chapter focuses the attention on mini-invasive and endoscopic approaches to urinary incontinence and voiding dysfunction.

MP76-20 IMPACT OF BARIATRIC SURGERY ON OVERACTIVE BLADDER SYMPTOMS IN A COHORT OF OBESE PATIENTS: A PROSPECTIVE INVESTIGATION

Epidemiological data show an association between obesity and lower urinary tract symptoms (LUTS), especially urinary frequency, urinary urgency and urinary incontinence. Patients with pathologic obesity satisfying specific criteria may be submitted to bariatric surgery which provides a significant reduction of body mass index (BMI) improving quality of life. The aim of this prospective pilot study was to assess the impact of bariatric surgery in a cohort of obese patients suffering from overactive bladder (OAB) symptoms. Giovanni Palleschi*, Antonio Luigi Pastore, Luigi Silvestri, Andrea Fuschi, Yazan Al Salhi, Davide Moschese, Cristina Maggioni, Andrea Ripoli, Antonio Carbone,