Valerio Iacovelli

Nosocomial urinary tract infections: A review.

Nosocomial urinary tract infections are a common complication in healthcare systems worldwide. A review of the literature was performed in June 2014 using the Medical Literature Analysis and Retrieval System Online (MEDLINE) database, through either PubMed or Ovid as a search engine, to identify publications regarding nosocomial urinary tract infections (NUTIs) definition, epidemiology, etiology and treatment. According to current definitions, more than 30% of nosocomial infections are urinary tract infections (UTIs). A UTI is defined ‘nosocomial’ (NUTI) when it is acquired in any healthcare institution or, more generally, when it is related to patient management. The origin of nosocomial bacteria is endogenous (the patients flora) in two thirds of the cases. Patients with indwelling urinary catheters, those undergoing urological surgery and manipulations, long-stay elderly male patients and patients with debilitating diseases are at high risk of developing NUTIs. All bacterial NUTIs should be treated, whether the patient is harboring a urinary catheter or not. The length of treatment depends on the infection site. There is abundance of important guidance which should be considered to reduce the risk of NUTIs (hand disinfection with instant hand sanitizer, wearing non-sterile gloves permanently, isolation of infected or colonized catheterized patients). Patients with asymptomatic bacteriuria can generally be treated initially with catheter removal or catheter exchange, and do not necessarily need antimicrobial therapy. Symptomatic patients should receive antibiotic therapy. Resistance of urinary pathogens to common antibiotics is currently a topic of concern.

IgG4-Related Kidney Disease: Report of a Case Presenting as a Renal Mass

IgG4-related disease (IgG4-RD) is a nosological entity defined as a chronic immune-mediated fibro-inflammatory condition characterized by a tendency to form tumefactive, tissue-destructive lesions or by organ failure. Urologic involvement in IgG4-RD has been described in some short series of patients and in isolated case reports, most often involving the kidneys in so-called IgG4-related kidney disease (IgG4-RKD). The disease can occasionally mimic malignancies and is at risk of being misdiagnosed due to its rarity. We report the case of a 56-year-old man presenting with a right renal mass suspected of being malignant. Laboratory tests showed normal creatinine levels, a high erythrocyte sedimentation rate, and high levels of C-reactive protein and microalbuminuria. The patient underwent radical right nephroureterectomy and histopathologic examination revealed features proving IgG4-RKD. He was therefore referred to immunologists. Typical clinical presentation of IgG4-RKD includes altered renal function with inconstant or no radiologic findings. Conversely, in the case we presented, a single nodule was detected upon imaging evaluation, thus mimicking malignancy. This raises the issue of a proper differential diagnosis. A multidisciplinary approach can be useful, although in clinical practice the selection of patients suspected of having IgG4-RKD is critical in the cases presenting with a renal mass that mimics malignancy.

Laparoscopic Radical Prostatectomy

1.1 Historical aspects Laparoscopic radical prostatectomy (LRP) has become an established treatment for organconfined prostate cancer and is increasingly performed at selected centers worldwide even though open radical retropubic prostatectomy (RRP) is widely considered the treatment of choice (Walsh, 2000). For the first time in 1992, Schuessler, a non-academic, attempted the first LRP assisted by two endourologists with laparoscopic experience in renal surgery (Schuessler et al., 1992). These pioneers were able to successfully perform 9 LRP procedures, but found no benefit over open prostatectomy. The operation was cumbersome and difficult with unacceptably prolonged operative time. The authors concluded that the procedure offered no advantage compared to RRP (Schuessler et al., 1997). In 1998 Guillonneau et al. detailed their stepwise approach to transperitoneal LRP. After substantially improving the techniques at Montsouris in France, Guillonneau and associates published their series demonstrating substantial improvements in postoperative convalescence. The operation was shown to be feasible, but more importantly, although the learning curve remained steep (Guillonneau et al., 1999). Since then, various European teams have added to the overall experience with this technique (Bollens et al., 2001; Rassweiler et al., 2001; Turk et al., 2001; De La Rosette et al., 2002). In USA, even experienced laparoscopists remained very skeptical about LRP. Gill and Zippe, who at that time focused on renal laparoscopic surgery, were one of the few who established a program of laparoscopic pelvic surgery (Gill & Zippe,2001). After 1997 LRP has slowly risen in popularity and became, in some centers, the surgical approach of choice for the treatment of the localized prostate cancer for its advantages. The lower blood loss and transfusion rate associated with the laparoscopic approach together with shorter hospital stay, reduced catheterization time, better pain control and the faster return to everyday activities seem the most encouraging improvements obtained (Hoznek et al., 2005).

Videourodynamic in Children

Urodynamic studies (UDS) have become a major tool in evaluating lower urinary tract dysfunction in children with neurogenic or non-neurogenic bladder. Lower urinary tract dysfunctions (LUTD) in children frequently occur in combination with other disorders of the lower part of the body. By definition of the International Children’s Continence Society (ICCS) standardization paper on LUTD in children [1], any item that gives information on the function of the urinary tract and the bowel is part of UDS.

Adolescence transitional care in neurogenic detrusor overactivity and the use of OnabotulinumtoxinA: A clinical algorithm from an Italian consensus statement

OnabotulinumtoxinA (onaBNTa) for treating neurogenic detrusor overactivity (NDO) is widely used after its regulatory approval in adults. Although the administration of onaBNTa is still considered off‐label in children, data have already been reported on its efficacy and safety. Nowadays, there is a lack of standardized protocols for treatment of NDO with onaBNTa in adolescent patients in their transition from the childhood to the adult age. With the aim to address this issue a consensus panel was obtained.

Progressive bladder remodeling due to bladder outlet obstruction: a systematic review of morphological and molecular evidences in humans

BackgroundBladder outlet obstruction is a common urological condition. We aimed to summarize available evidences about bladder outlet obstruction-induced molecular and morphological alterations occurring in human bladder.MethodsWe performed a literature search up to December 2017 including clinical and preclinical basic research studies on humans. The following search terms were combined: angiogenesis, apoptosis, bladder outlet obstruction, collagen, electron microscopy, extracellular matrix, fibrosis, hypoxia, histology, inflammation, innervation, ischemia, pressure, proliferation, remodeling, suburothelium, smooth muscle cells, stretch, urothelium.ResultsWe identified 36 relevant studies. A three-stages model of bladder wall remodeling can be hypothesized involving an initial hypertrophy phase, a subsequent compensation phase and a later decompensation. Histological and molecular alterations occur in the following compartments: urothelium, suburothelium, detrusor smooth muscle cells, detrusor extracellular matrix, nerves. Cyclic stretch, increased hydrostatic and cyclic hydrodynamic pressure and hypoxia are stimuli capable of modulating multiple signaling pathways involved in this remodeling process.ConclusionsBladder outlet obstruction leads to progressive bladder tissue remodeling in humans. Multiple signaling pathways are involved.

Rotigotine Effects on Bladder Function in Patients with Parkinson's Disease

The objective of this study was to assess the effect of rotigotine treatment on bladder function in patients with Parkinsons disease (PD) who have urinary urgency.

Comment on the long-term effects of vacuum extraction on pelvic floor function: a cohort study in primipara

Sir, The well-conducted trial by Nilsson et al. proposes some new findings on the role of operative delivery in the onset of pelvic floor dysfunction (PFD) [1]. In this paper, vacuum extraction (VE) was not associated with a higher long-term rate of PFDs. However, the authors found a triple rate of obstetric anal sphincter injury (OASI) after VE, but the rate of fecal incontinence (FI) after OASI was similar for both groups. It is not easy to understand these findings; is it really possible that a triple rate of OASI associated with the use of VE does not cause a higher rate of perineal tears and of anal incontinence (AI)? In every case, the authors correctly concluded that it is unacceptable to have high levels of pelvic floor injuries in the case of VE. This technique requires training, experience, and adherence to well-established guidelines. In the last few decades, the prevalence of PFDs appears to have been increasingmore quickly than would be expected. In this scenario, obstetric risk factors have a great impact, especially with regard to the long-term effects. For this reason, the physicians are focusing their efforts on prevention. It is well known that vaginal childbirth has a relevant impact on the pelvic floor, whereas cesarean delivery seems to offer substantial protection against pelvic floor trauma. In contrast, assisted vaginal delivery, with VE or forceps, could increase the risk of PFDs. Several studies demonstrated that VE and perineal tears are two important risk factors for the postpartum onset of de novo urinary incontinence (UI), AI, and sexual dysfunction [2]. In a recent meta-analysis on the long-term impact of the mode of delivery on urinary incontinence [3], the authors demonstrated that vaginal delivery, compared with cesarean section, is associated with an almost twofold increase in the risk of long-term stress urinary incontinence (SUI), with an absolute increase of 8%. This effect is largest in younger women. There is also an increased risk of urgency urinary incontinence (UUI). In addition, other new studies, demonstrated that operative vaginal delivery was associated with an increased risk of OASI with a double risk of longer-term AI [4]. It is mandatory that gynecologists improve their management of delivery, while not being afraid to perform CS, as it is not the devil incarnate of obstetric practice. In several women, CS prevents postpartum PFDs and subsequent impairment in quality of life, without increasing the risks of maternal, neonatal, or infant mortality [5].