Matteo Balzarro

General State of Health and Psychological Well-Being in Patients after Surgery for Urological Malignant Neoplasms

Objective: To evaluate the general state of health and the psychological well-being in a group of 155 patients after surgery for urological malignant neoplasms. Materials and Methods: Surgery was performed in 55 patients for renal cell carcinoma, in 54 for invasive bladder carcinoma, in 30 for adenocarcinoma of the prostate, and in 16 for squamous penile carcinoma. All patients were invited to self-compile the General Health Questionnaire (GHQ) – 12 items according to Goldberg and the Hospital Anxiety and Depression Scale. Results were compared with those in a group of patients who underwent retropubic prostatectomy for benign prostatic hyperplasia. Results and Conclusion: The general state of health was significantly more impaired in neoplastic patients than in the control group. Levels of anxiety were significantly higher but depression levels were similar in both groups. As far as the type of tumor is concerned, patients who underwent radical cystectomy for bladder carcinoma and those treated with partial penectomy for squamous penile carcinoma showed a significant impairment of the general state of health compared with controls. Higher levels of anxiety were observed in patients who underwent ileal conduit after radical cystectomy, in those treated with radical prostatectomy for prostate cancer and in those who underwent partial penectomy. Significantly higher levels of depression than in the control group were observed only in patients with ileal conduit.

Nephrogenic adenoma of the urinary bladder: our experience and review of the literature.

Objective: To assess our experience in the treatment and clinical outcome of bladder nephrogenic adenoma (NA) updating and reviewing the literature concerning this issue. Patients and Methods: From September 1976 to June 1999, bladder NA was diagnosed in 8 patients: 6 men and 2 women with a 3:1 male ratio, aged 26–80 (mean 58.3) years. Follow-up ranged from 4 to 194 (mean 93.5) months. Results: NA was associated with transitional cell carcinoma in 3 cases. Predisposing factors were assessed in all patients. Previous surgery of the lower urinary tract was detected in 5 cases: ureterocystoneostomy in 2, partial cystectomy in 1, repair of vesicouterine fistula in 1, and multiple urethroplasties in 1. Previous endoscopic treatments were carried out in 2 patients, transurethral resection of the prostate in 1 and repeated transurethral resection of the vesicle in the other. A history of intravesical instillation of bacillus Calmette-Guérin was assessed in 1 case. Patients complained of irritative voiding symptoms in 6 cases and hematuria in 2. Endoscopically, the lesions appeared polypoid and multifocal in 5 patients, and flat and single in 3. The lesions were removed endoscopically, providing relief of symptoms in all cases. Histopathology assessed the diagnosis of nephrogenic adenoma, detecting focal atypic cells in 1 case only. Five patients (63%) relapsed 2–24 months after management. Recurrences were also treated endoscopically. Conclusions: Clinical and endoscopic features of bladder NA are not specific, simulating urothelial carcinoma or chronic cystitis. Endoscopic management allows accurate histological diagnosis and provides long-lasting relief of symptoms. NA needs careful and long-term follow-up, because of the high risk of recurrences and the potential neoplastic degeneration of the metaplastic urothelium.

The Pathophysiology, Diagnosis and Therapy of the Transurethral Resection of the Prostate Syndrome

In this article, the authors analyze a syndrome first described by Creevy in the 1940s, which may occur during a transurethral resection of the prostate (TURP). The syndrome is characterized by cardiocirculatory and neurological problems due to rapid changes in intravascular volume and plasma solute concentrations caused by excess irrigating fluid absorption. This article reviews the available literature and reports on the experience of our clinic, a specialist department in the physiopathology, diagnosis, therapy and prevention of TURP syndrome.

Current clinical management of renal and perinephric abscesses: a literature review

Renal and perinephric abscesses are rare but very severe conditions resulting from infections in or surrounding the kidneys. Symptoms and imaging techniques, such as computed tomography (CT), magnetic resonance imaging (MRI) and renal ultrasound (US) of higher quality have led to an early diagnosis that is very important for patients’ prognosis. The best clinical approach to manage this disease is still debated. Antibiotic therapy represents the usual treatment of small renal abscesses. This management can be insufficient in case of larger renal abscesses requiring percutaneous or surgical drainage. Perinephric abscesses most commonly need invasive maneuvers. We conducted a literature review to clearly define the most recommended clinical managements for all cases of renal and perinephric abscesses.

Spontaneous Nephrocutaneous Fistula: A Case Report, Update of the Literature and Management Algorithm

Aims: Spontaneous nephrocutaneous fistula (NCF) is a rare and severe condition. The aim of this study was to update the data of the literature about this disease and, reporting and considering also our experience in 1 case of NCF, to make a new clinical algorithm. Methods: This study was done with a review of all the literature and a comparison with our experience. Results: The characteristic sign of spontaneous NCF is a flank sinus discharging material. Physical examination and computed tomography usually lead to the diagnosis. The main predisposing factors are renal stones/staghorn calculi, xanthogranulomatous pyelonephritis and renal tuberculosis. In the vast majority of the cases kidneys are poorly functioning or nonfunctioning. Surgical approach is the common management and usually consists of open nephrectomy. We create a clinical management algorithm obtained by a review of the literature and our experience with spontaneous NCF. Conclusions: Spontaneous NCF represents a very serious renal disease leading to loss of the kidney in the vast majority of cases. We propose a revised and user-friendly clinical diagnostic-therapeutic algorithm for spontaneous NCF based on the worldwide literature.

Prostate chronic inflammation type IV and prostate cancer risk in patients undergoing first biopsy set: Results of a large cohort study

Objective In prostate specimens, chronic inflammatory infiltrate (CII) type IV has been detected, but its association with prostate cancer (PCa) is controversial. The aim of the present study is to investigate on associations of CII with PCa detection in patients undergoing prostate first biopsy set. Methods Ultrasound transrectal-guided biopsies by the transperineal approach were retrospectively evaluated in 441 consecutive patients. The study excluded patients who were in active surveillance, prostate specific antigen (PSA) ≥30 ng/mL, re-biopsies, incidental PCa after transurethral resection of the prostate (TURP), less than 14 cores or metastatic. Analysis of population and subpopulations (with or without PCa) was performed by statistical methods which included Mann–Whitney (U test), Kruskal–Wallis test, Chi-squared statistic, logistic regression. Multivariate logistic regression models predicting mean probability of PCa detection were established. Results PCa detection rate was 46.03%. Age, PSA, prostate volume (PV), prostate intraepithelial neoplasia (PIN) and CII were the significant independent predictors of PCa detection. PV (OR = 0.934) and CII (OR = 0.192) were both negative independent predictors. CII was a significant negative independent predictor in multivariate logistic regression models predicting the mean probability of PCa detection by age, PSA and PV. The inverse association of CII with PCa does not necessary mean protection because of PSA confounding. Conclusion In a population of patients undergoing prostate first biopsy set, CII was a strong negative independent predictor of PCa detection. CII type IV should be considered as an adjunctive parameter in re-biopsy or active surveillance protocols.

A unique case of late complication of rectum mesh erosion after laparoscopic sacrocolpopexy.

Sacrocolpopexy, a surgical technique with a low morbidity rate, is a valid procedure for repairing vaginal vault prolapse. To our knowledge, only 1 case of rectum erosion after open sacrocolpopexy has been reported in the literature, and there is no record of any such incident after laparoscopic sacrocolpopexy. We report the first case of mesh erosion involving the rectum instead of the vagina assessed 8 years after laparoscopic sacrocolpopexy.

Long‐term follow‐up of anterior vaginal repair: A comparison among colporrhaphy, colporrhaphy with reinforcement by xenograft, and mesh

To assess the long‐term complications and outcomes in patients treated for pelvic organ prolapse (POP) with transvaginal anterior colporrhaphy (AC) alone, transvaginal naterior AC with reinforcement by using porcine Xenograft (AC‐P) (Pelvisoft® Biomesh), and transvaginal anterior repair with polypropylene mesh (AC‐M).

MP63-02 PURE STRESS URINARY INCONTINENCE: ANALYSIS OF THE PREVALENCE, ESTIMATION OF COSTS AND FINANCIAL IMPACT

INTRODUCTION AND OBJECTIVES: Aim of our study was to evaluate the prevalence of ‘pure’ SUI (P-SUI), in a cohort underwent urodynamic test (UD) for urinary incontinence (UI), and the correspondence with UD findings. We also estimated the amount of costs of UD, and if the UD data could change the surgical indications. METHODS: We did a retrospective evaluation of the UDdatabase selecting 544 women with UI between January 2012 and July 2016. Pure SUI was defined by the International Continence Society criteria (table 1). Two very experienced urologists evaluated data. Data researched were: Prevalence of clinical and UD P-SUI Correspondence between clinical P-SUI and UD findings Accurate estimation in V of a single UD examination, including the human resources and materials used Total amount of UD costs in V in P-SUI patients Number of surgical procedures avoided due to UD results Related avoided surgical costs in V in P-SUI patients

Original flow chart for the management of hydroureteronephrosis caused by pessary placement

Hydroureteronephrosis due to pessary is a dangerous complication that can become critical if urosepsis is present. We propose a flow chart to manage the condition. Introduction The use of a pessary to treat a pelvic organ prolapse (POP) is a valid non-invasive option. Severe complications are usually associated with neglected, oversized, or misplaced pessaries. Major complications include fistulas, bowel or bladder erosion, and hydroureteronephrosis (HUN). Materials and Methods We reviewed the literature and our experience in the management of HUN in the last decade, as a consequence of pessary placement. Results We used flow charts to take an accurate medical history of each patient. Blood and urine analyses were taken at admission to assess the potential presence of sepsis, renal failure, and urinary tract infection. Physical examination included vaginal examination. In cases of pessary presence with a concomitant increase of serum creatinine value, a possible ureteral obstruction is suspected. In order to assess the presence of HUN and its underlying causes, a computed tomography (CT) scan should be performed to assess the mechanism of urinary tract obstruction. However, in case of renal insufficiency, abdominal ultrasonography (US) could be sufficient. If HUN is detected in a patient with no signs of urosepsis, we suggest a conservative management by the removal of the pessary and catheter placement. When urosepsis is suspected, it is mandatory to administer antibiotic therapy and evaluate the HUN drainage by nephrostomy. Conclusions There is no uniform management of women with HUN and a concomitant pessary. For this reason, and based on the literature and our experience, we propose an original management flowchart.