[Urology]

This article points at recent developments in urology in the field of malignant diseases of the urinary system and the diagnostic and therapeutic management of benign conditions as well, that occur frequently in our ageing population.

A Pediatrician's Take on a Few Common Infant Urologic and Gynecologic Issues

Urologic and gynecologic issues are common in a pediatric primary care office. This article focuses on the evaluation and management of a few common diagnoses in infants and young children: fetal hydronephrosis, labial adhesions, physiologic phimosis, and hydrocele. This article can help pediatricians decide when these common issues can be managed in the primary care office and when they need subspecialty guidance. [Pediatr Ann. 2017;46(11):e397-e399.].

Bending percutaneous drainage catheters to facilitate CT-guided insertion using curved trocar technique

PURPOSE

To assess the safety and efficacy of placing thoraco-abdominal drainage catheters under CT-guidance using a curved trocar technique.

METHODS

A retrospective study of 182 CT/CT-fluoroscopy-guided thoraco-abdominal catheter drainages was conducted; half were performed by residents or fellows under the supervision of one radiologist (Group 1) and the other half under the supervision of 10 other radiologists (Group 2). Group 1 procedures employed a curved catheter assembly placed using trocar technique (n = 44) or straight catheters placed with Seldinger technique (n = 47). Group 2 procedures employed a straight catheter placed using trocar technique (n = 16) or straight catheters placed with Seldinger technique (n = 75). Technical success, procedure time, radiation dose (CT Dose Index CTDI_vol), and adverse events (Common Terminology Criteria for Adverse Events, 4.0) were compared between techniques and groups using Student's t test, Fisher's exact test or Chi-square analysis.

RESULTS

All procedures in groups 1 and 2 were technically successful. Mean procedure time for Group 1 curved trocar technique (28 ± 8 min) was shorter than groups 1 and 2 Seldinger technique (37 ± 11 min, p = .00002). Mean CTDI_vol for Group 1 curved trocar technique (107.8 ± 54.2 mGy) was lower than groups 1 and 2 Seldinger technique (136.1 ± 99.7 mGy, p = 0.032). Adverse event rates for curved trocar, straight trocar, and Seldinger techniques were 2.3% (1/44), 0% (0/16), and 3.3% (4/122), respectively (p = 1); all were grade 1 or 2, and no catheter malfunctions occurred.

CONCLUSIONS

The curved catheter trocar technique is a safe and effective modification of the standard trocar technique that may facilitate CT-guided procedures impeded by CT gantry size limitations.

[Not Available]

Zusammenfassung. Die funktionelle Urologie befasst sich mit der Diagnostik und Therapie von Störungen der Harnblasen- und Beckenbodenfunktion und der Harninkontinenz. Die urodynamische Funktionsdiagnostik als zentrale diagnostische Methode ermöglicht durch die Messung einfacher physiologischer Parameter eine direkte Beurteilung der Funktion des unteren Harntraktes. Die Urodynamik dient dazu, klinische Symptome quantitativ zu reproduzieren, die Änderung physiologischer Parameter während der Messung in einen pathophysiologischen Zusammenhang zu stellen, eine Diagnose abzuleiten, eine Behandlung einzuleiten und im Verlauf deren Erfolg zu kontrollieren. Facetten der funktionellen Urologie sind die Neurourologie, die Urologie der Frau, die funktionelle Kinderurologie, die psychosomatische Urologie und die Behandlung der Harninkontinenz bei Frauen und Männern jeglichen Alters.

Surgery for benign prostatic hyperplasia: Profile of patients in a tertiary care institution

BACKGROUND

Medical therapy is widely used for managing benign prostatic hyperplasia (BPH) and has made an impact on the profile of patients who ultimately undergo surgery. This changing profile may impact outcomes of surgery and associated complications. To assess the impact of medical management, we evaluated the profile of patients who had surgery for BPH at our institution.

METHODS

A retrospective chart-review was performed of patient demographics, indications for surgery, preoperative comorbid conditions and postoperative course in patients who underwent surgery for BPH over a 5-year period. The data were analysed for demographic trends in comparison with historical cohorts.

RESULTS

A total of 327 patients underwent surgery for BPH between 2008 and 2012. Their mean age was 66.4 years, the mean prostate gland weight was 59.2 g and the mean duration of symptoms was 35.3 months; 34% had a prostate gland weight of >60 g; 1 59 (48.6%) patients had an absolute indication for surgery; 139 (42.5%) of these were catheterized and 6.1% of patients presented with azotaemia or upper tract changes without urinary retention.

CONCLUSIONS

In comparison with historical cohorts, more patients are undergoing surgery for absolute indications including retention of urine and hydroureteronephrosis. However, the patients are younger, they have fewer comorbid conditions and have a similar rate of complications after the procedure.

Renal transplantation: technical aspects, diagnosis and management of early and late urological complications

INTRODUCTION

Renal transplantation (RT) represents actually the most effective therapy in patients with end-stage renal failure as it is cost effective, allows for a normal life style and reduces the risk of mortality from dialysis related complications. The purpose of the present review is to update the recent published literature regarding the technical aspects, diagnosis and the urological complications associated with renal transplantation.

EVIDENCE ACQUISITION

A comprehensive literature review was performed using PubMed and Thomson-Reuters Web of Science between February 2014 and June 2016. Using free-text protocol, the following terms were applied: "chronic kidney failure", "renal transplantation", "robot-assisted surgery", "laparoscopy", "living donor nephrectomy", "surgical techniques", "urological complications".

EVIDENCE SYNTHESIS

RT represents actually the most effective therapy in patients with end-stage renal failure as it is cost effective, allows for a normal life style and reduces the risk of mortality from dialysis related complications. In the last 2 years, an increased number of published studies on the use of robot-assisted surgery for RT has been presented.

CONCLUSIONS

We could expect that in the next future RKT and LDN are both destined to replace open surgery also in a special field as RT.

Special situations in ureteroscopy

Ureteroscopy is the treatment of choice for small ureteral or renal calculi and for diagnosis of ureteral abnormalities suspicious for urothelial carcinoma. In certain scenarios ureteroscopy may be used to treat large stones or tumors when other more favorable treatment modalities are not possible. In such situations ureteroscopy can prove to be a challenging procedure. Specific patient anatomic and physiological characteristics can make even a simple ureteroscopy a difficult procedure. Such situations include surgically altered urinary tract anatomy, congenital anomalies and obesity. Pathologic and iatrogenic bleeding diatheses are examples of where pathophysiology can adversely affect the procedure. Finally, pregnancy is an example of where a normal physiologic condition can make diagnosis and treatment of urolithiasis difficult due to concerns for the fetus. In this review we will discuss the use of ureteroscopy in such challenging patient scenarios.

The Poet and the Disease

Ugo Foscolo, was an Italian writer, revolutionary and poet whose works rank among the masterpieces of Italian literature. Talented and well educated in philosophy, classics and Italian literature, Foscolo gave literary expression to his ideological aspirations and to his numerous amorous experiences in odes, sonnets, plays, poems and an epistolary novel. Concurrent with his rich literary output, Foscolo's correspondence represents a unique perspective from which to monitor his literary and political views and investigate aspects of his everyday life. Among other interesting information, one can find elements of Foscolo medical history which is generally unknown. In the present article we investigate the longstanding lower urinary tract symptoms as reported by the poet in his correspondence to his family and friends.

Stem Cell Therapy: Current Applications and Potential for Urology

Stem cell therapy holds the potential to revolutionize the treatment of a number of chronic conditions. Stem cells ability to home in on injured sites of the body, stimulate angiogenesis, tissue regeneration, immunomodulation, anti-inflammatory, and anti-fibrotic factors have attracted their use in the treatment of many conditions. Urology has registered one of the highest experimental successes using stem cell therapy. However, the rate of clinical applications is comparatively lower. This review takes a look at our efforts so far and what needs to be done in order to maximize the clinical benefit we can derive from stem cells.

[Novelties in Urology in 2015]

This paper brings to the general practitioner some clarifications with regard to open questions - such as prostate cancer screening - and points at some disease management in different fields - such as urinary stones, overactive bladder and immunotherapy in bladder cancer.

[Patients with spinal cord injuries experience many sequelae]

Spinal cord injuries (SCI) affect all organs and may cause multiple sequelae. Complications after SCI can be life-threatening and socially disabling. Furthermore, a spinal cord injury is often a chronic condition and the patient may have contact with both the general practitioner and several departments in a hospital. Thus, it is important for all doctors to recognize risks and morbidities related to SCI, in order to prevent and treat the short- and long-term complications and disabilities. This article systematically describes the most commonly encountered sequelae after SCI.

Veterans Affairs Telemedicine: Bringing Urologic Care to Remote Clinics

OBJECTIVE

To report the use of telemedicine to deliver general urologic care to remote locations within the Veterans Affairs Greater Los Angeles Healthcare System. We describe the diagnoses managed, patient satisfaction, safety, and benefit to patients in terms of saved travel time and expense.

METHODS

We conducted a retrospective chart review examining care delivered through urology telemedicine clinics over a 6-month period. We examined the urologic conditions, patient satisfaction, and emergency department visits within 30 days of the visit. We estimated patient benefit by calculating travel distance and time and the saved travel-associated costs using Google Maps and US Census income data.

RESULTS

Ninety-seven unique telemedicine visits were conducted and a total of 171 urologic diseases were assessed. The most common conditions were lower urinary tract symptoms (35%), elevated prostate-specific antigen level (15%), and prostate cancer (14%). One patient was seen in the emergency department within 30 days with an unpreventable urologic complaint. Patient satisfaction was "very good" to "excellent" in 95% of cases, and 97% would refer another veteran to the urology telemedicine clinic. Patients saved an average of 277 travel miles, 290 minutes of travel time, $67 in travel expenses, and $126 in lost opportunity cost.

CONCLUSION

Telemedicine was successfully and safely used to evaluate and treat a wide range of urologic conditions within the Veterans Affairs Greater Los Angeles Healthcare System, and saves patients nearly 5 hours and up to $193 per visit. Further investigation of the potential of telemedicine for the delivery of urologic care in a cost-effective manner is warranted.

[Urology]

This article is addressed to general practitioners and summarizes some of the latest developments in urology. Recent advances in screening, diagnosis and medical as well as surgical treatments of common urological diseases are reviewed.

[High resolution for all in the clinics área of a Urology Department]

OBJECTIVES

To evaluate the performance of a one-stop clinic in terms of proportion of diagnostic-therapeutic orientation during 2013.

METHODS

All patients were referred from primary care facilities in the district of Fuenlabrada, Madrid, Spain (population 221.705). Previously, referral protocols were agreed. Seven senior urologists participated. 6674 referrals (January-December 2013) were eligible.

RESULTS

4534 referrals (4535/6674, 68%) were eventually evaluable. Patients taking advantage of the one-stop format were significantly younger than those needing extra consultations (chi2<0,001). Overall, reasons for consultation clearly affected the feasibility of the one-stop approach (chi2<0.001), the one-stop policy being substantiated in most consultations due to subfertility (89.4%), male sexual dysfunction (89.2%), testicular complains (88.3%) and other male genital complains (80.3%). On the contrary, extra consultations were the rule for degenerative diseases of the urinary tract (45%), malignancy (57%) and renal colic pain or urinary lithiasis (63.2%). No relationships could be identified between the referral centre and the feasibility of the one-stop approach (p=ns). The multivariate analysis confirmed the independent effect of the health problem (p<0.001) and patient age (p<0002) on the chances of having a successful one-stop approach.

CONCLUSIONS

a one-stop philosophy should be the standard for all patients in urology clinics.

Advances in Female Urology: A Review of the 2013 Literature

The field of female urology covers a broad spectrum of lower urinary tract dysfunction and pelvic disorders. The aim of this article is to provide a comprehensive review of the most significant literature published during 2013.

Two Sessions of Behavioral Urotherapy for Bowel and Bladder Dysfunction: Does It Get Any Better?

This study sets to determine the optimal duration of behavioral urotherapy necessary to achieve maximal improvement in the management of pediatric bowel and bladder dysfunction.

Survey of satisfaction in hospitalized patients at a urology department

OBJECTIVES

To assess the level of satisfaction with the care provided to hospitalized patients in the Department of Urology at 12 de Octubre Hospital and analyze demographic and clinical factors influencing satisfaction.

METHODS

A cross-sectional study was carried out using the SERVQHOS questionnaire, delivered at the time of discharge. A data sheet for each patient was collected, which included if they undergone surgery, type of surgery and whether or not presented postoperative complications, rated by the Clavien scale.

RESULTS

479 surveys were collected, with a participation of 92%. 95.4% of patients rated their overall level of satisfaction with the care received as "satisfied" or "very satisfied". Top-rated aspects were the kindness of the staff and personalized attention. The worst rated issue was the condition of the rooms, but this did not influence perceived quality. Variables related to greater overall satisfaction were male gender, shorter hospital stay, knowing the name of the nurse, the information received and subjective factors such as personalized service and willingness to help.

CONCLUSIONS

Our patients show a high level of satisfaction, which is mainly dependent on subjective factors. The negative issues related to the facilities do not mean lower satisfaction.