Yazan Al Salhi

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.

Combined laparoscopic pyelolithotomy and endoscopic pyelolithotripsy for staghorn calculi: long-term follow-up results from a case series

Purpose: Staghorn renal stones are a challenging field in urology. Due to their high recurrence rates, particularly those associated with an infective process, a complete removal is the ultimate goal in their management. We report our experience with a combined approach of laparoscopic pyelolithotomy and endoscopic pyelolithotripsy, the stone clearance rate, and long-term, follow-up outcomes. Methods: From June 2012 to October 2014, nine adult patients with large staghorn renal calculi (mean size, 7.2 cm; range, 6.2–9.0 cm) underwent a combined laparoscopic and endoscopic approach. The technique comprised laparoscopic pyelolithotomy and holmium-YAG laser stone fragmentation with the use of a flexible cystoscope introduced through a 12 mm trocar. Results: The average operative time was 140 min (range, 90–190 min). The mean estimated hemoglobin loss was 0.6 mmol/l (range 0.5–0.7 mmol/l). None of the patients required an open- surgery conversion. The mean hospital stay was 4 days (range, 2–6 days). A computed tomography urogram control at 6 months of follow up did not show any stone recurrence. Conclusions: Laparoscopic pyelolithotomy combined with endoscopic pyelolithotripsy could be a therapeutic option in cases where mini-invasive procedures, that is, extracorporeal shock wave lithotripsy, ureteroscopic lithotripsy, and percutaneous nephrolithotomy (PCNL) have failed. This technique has a high stone-clearance rate (75–100%) comparable with open surgery and PCNL. However, it could be technically demanding and should be performed by skilled laparoscopy surgeons.

Bladder Outlet Obstruction in Neurogenic Patients: When is Surgery Mandatory?

In patients with neurogenic vesico-sphincteric disease, bladder outlet obstruction (BOO) may further increase the risk of complications to the lower and upper urinary tract, such as high post-voiding residual urine, urinary infections, bladder stones formation, vesicoureteral reflux, and ureterohydronephrosis. These complications, if not treated, can inexorably lead to a severe damage of renal function, thus forcing patients to dialysis. The main cause of BOO in patients with neurogenic bladder (NB) has a functional origin represented by detrusor sphincter dyssynergia (DSD); however, it has to be considered that also an organic obstruction can develop in these subjects, especially in men. Furthermore, in some patients, both conditions may coexist. Therefore, only a correct diagnostic approach, based on a thorough knowledge and understanding of the pathophysiologic mechanisms involved in these conditions, may contribute to establish the adequate treatment and prevent potential iatrogenic complications. According to the International Consultation on Incontinence [1] and the European Association of Urology Guidelines [2], first-line therapeutic options of BOO in NB are represented by conservative approaches. Lifestyle interventions, alpha-1-adrenergic blockers, intermittent catheterization, and external specific devices (i.e., pessary in case of pelvic organ prolapse) have to be preferred until patient’s QoL and therapeutic goals are maintained. When these treatments fail and cannot avoid the risk of the abovementioned severe complications to the urinary tract or when they do not achieve patient’s satisfaction, surgery may become necessary.

Management of lower urinary tract symptoms associated with benign prostatic hyperplasia in elderly patients with a new diagnostic, therapeutic and care pathway.

Benign prostatic hyperplasia (BPH) resulting in lower urinary tract symptoms (LUTS) is a widespread disease that strongly interferes with the quality of life (QoL) of elderly males. It represents a real clinical and socio‐economic problem may be due to the lack of a diagnostic, therapeutic and care pathway (DTCP) tool for LUTS/BPH that considers elderly people population in its whole complexity. The aim of this study was to evaluate the clinical effectiveness of the proposed DTCP LUTS/BPH tool.

Pelvic muscle floor rehabilitation as a therapeutic option in lifelong premature ejaculation: long-term outcomes

The aim of the study was to evaluate the long-term outcomes of pelvic floor muscle (PFM) rehabilitation in males with lifelong premature ejaculation (PE), using intravaginal ejaculatory latency time (IELT) and the self-report Premature Ejaculation Diagnostic Tool (PEDT) as primary outcomes. A total of 154 participants were retrospectively reviewed in this study, with 122 completing the training protocol. At baseline, all participants had an IELT ≤60 s and PEDT score >11. Participants completed a 12-week program of PFM rehabilitation, including physio-kinesiotherapy treatment, electrostimulation, and biofeedback, with three sessions per week, with 20 min for each component completed at each session. The effectiveness of intervention was evaluated by comparing the change in the geometric mean of IELT and PEDT values, from baseline, at 3, 6, and 12 months during the intervention, and at 24 and 36 months postintervention, using a paired sample 2-tailed t-test, including the associated 95% confidence intervals. Of the 122 participants who completed PFM rehabilitation, 111 gained control of their ejaculation reflex, with a mean IELT of 161.6 s and PEDT score of 2.3 at the 12-week endpoint of the intervention, representing an increase from baseline of 40.4 s and 17.0 scores, respectively, for IELT and PEDT (P < 0.0001). Of the 95 participants who completed the 36-month follow-up, 64% and 56% maintained satisfactory ejaculation control at 24 and 36 months postintervention, respectively.

PD23-03 PROSPECTIVE RANDOMIZED STUDY COMPARING MONOPOLAR WITH BIPOLAR TRANSURETHRAL RESECTION OF PROSTATE ON A LARGE COHORT OF PATIENTS WITH BENIGN PROSTATIC OBSTRUCTION: LONG TERM OUTCOMES

INTRODUCTION AND OBJECTIVES: Monopolar transurethral resection of the prostate (TURP) is the gold standard surgical treatment for bothersome moderate to severe lower urinary tract symptoms (LUTS) secondary to benign prostate obstruction with enlarged prostates. The aim of the study is to compare monopolar vs. bipolar TURP focusing on operative and functional outcomes with a long term follow-up. METHODS: From January 2007 to July 2013 a total of 379 patients were randomized and prospectively scheduled to undergo bipolar (202) or monopolar (177) TURP. International prostate symptom score (IPSS), IPSS-Quality of life (QoL), post-void residual and maximum flow rate were assessed preoperatively and postoperatively at 3, 12, 24 and 36 months. Operative time, length of catheterization and length of hospitalization were all recorded. Rates of urethral strictures and bladder neck contractures were also reported. RESULTS: Perioperative results showed no statistical significance between the two groups in terms of catheterization days, postvoid residual, IPSS, IPSS-QoL score, blood transfusion and TUR syndrome. The operative time was proved to be statistically significant in the monopolar group while the hospitalization days was found statistically significant in the bipolar group. The 3, 12, 24 and 36 months follow up showed significant and equal improvements in LUTS related to BPO in the 2 treatment groups. CONCLUSIONS: Monopolar and bipolar TURP are safe and effective techniques for BPH. The 2 significant differences between them were operative time in favour of the monopolar group and hospitalization days in favour of the bipolar group. Bipolar TURP has the principle advantage in preventing TUR syndrome that was reported in 2 monopolar TURP patients.

MP85-14 PERISTEEN TRANSANAL IRRIGATION SYSTEM FOR THE TREATMENT OF NEUROPATHIC BOWEL DYSFUNCTION AND ABDOMINAL PAIN

INTRODUCTION AND OBJECTIVES: Lower urinary tract symptoms, while common, are under reported in patients with multiple sclerosis. It is unclear what the impact of lower urinary tract symptoms due to MS is on the overall quality of life. We aim to define the incidence of lower urinary tract symptoms in patients with MS and their effect on neurologic quality of life. METHODS: We identified patients presenting to neurology clinic for routine follow up for multiple sclerosis. Each patient responded to validated questionnaires regarding urinary quality of life (MSQLI) and overall neurologic quality of life (NeuroQOL). Medical records were reviewed to assess for the presence of lower urinary tract symptoms. Overall neurologic quality of life was measured in the presence and absence of lower urinary tract symptoms and p-values were calculated using student0s t-test. Urinary quality of life score was correlated to overall neurologic quality of life score by calculating the Spearman0s rank correlation coefficient. RESULTS: 91 patients were included in the study. All 91 patients completed the validated questionnaires. 85 patients (93%) described the presence of at least one lower urinary tract symptom. The most common urinary tract symptoms were urgency (84%), frequency (69%), incontinence (54%), and retention (38%). 72 patients reported urologic symptoms negatively impacted urinary quality of life. Presence of lower urinary tract symptoms negatively impacted overall neurologic quality of life (Figure 1). Urinary quality of life was predictive of the overall neurologic quality of life (-0.24, p1⁄40.02). CONCLUSIONS: Lower urinary tract symptoms are very common in patients with multiple sclerosis. These symptoms greatly impact and importantly predict the overall neurologic quality of life in patients with multiple sclerosis.

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,