Maria Angela Cerruto

A comparison of schaefer, International continence society and bladder contractility index nomograms in the diagnosis of obstruction and detrusor underactivity in men with lower urinary tract symptoms

between the 2 nomograms was 97.4%. There was a complete concordance of un-obstruction only in Sn class 0, while in class I the concordance reached 70%. Among patients with equivocal diagnosis at ICSn, the Sn class II was the most usual (67.2%). Among patients clearly obstructed at ICSn, there was a complete concordance between the 2 nomograms. Moreover, 74.4% of the patients were in Sn classes III-IV, and 22.4% in classes VVI. Table 1 resumes data regarding BOO. We found a high correspondence in patients with normal detrusor contractility between the 2 nomograms (96.7%). In case of DU at BCI we found that 96.2% of males were in classes W/VW of Sn. Among males with normal detrusor contractility at Sn, 11% had a diagnosis of DU at BCI. Table 2 reports data on DU. From January 2012 to October 2017, we collected data on 458 men underwent Flow-Pressure study for lower urinary tract symptoms. All urodynamics (UD) were performed according to Good Urodynamic Practice[1] and analyzed with Sn, ICSn and BCI. Bladder outlet obstruction (BOO) was defined as Sn obstruction classes ranging from II to VI, and ICSn score <40. Detrusor underactivity (DU) was considered as Sn contractility classes Weak (W)/Very Weak (VW), and BCI score <100. We found a high concordance between Schaefer and ICS nomograms. Only Sn class 0 was completely associated to diagnosis of unobstruction at ICSn. Equivocal diagnosis at ICSn corresponded in most of cases at Sn class II. When ICSn documented obstruction, Sn reached a complete correspondence.

Acute Flank Pain, Flank Mass and Hypovolemic Shock due to Kidney Cysts Rupture: An Emblematic Case of Wunderlich Syndrome

Spontaneous perinephric hemorrhage (SPH) due to kidney cysts rupture is uncommon compli- cation but when it occurs can cause an emergency situation that may endanger the patients life. Wunderlich first described the condition of spontaneous, non-traumatic renal bleeding confined to the subcapsular and perirenal spaces. Herein, we report a case of Wunderlich syndrome (WS) due to spontaneous rupture of a simple kidney cyst. In our case, the spontaneous retroperito- neal hemorrage (SRH) was associated to a probable giant haemorragic cyst that is uncommon since cyst rupture occurs into caliceal system rather than the perinephric space. Wunderlich syndrome after spontaneous, non-traumatic kidney cyst rupture is a rare entity. A multimodal- ity approach is necessary to a have a definitive diagnosis in order to choose the best treatment possible for the patient.