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Finazzi Agrò E, Rosato E, Wagg A, Sinha S, Fede Spicchiale C, Serati M, Mancini V, de Rijk M, Tarcan T, Wein A, Abrams P, Bou Kheir G. How do we make progress in phenotyping patients with lower urinary tract such as overactive bladder and underactive detrusor, including using urine markers and microbiome data, to personalize therapy? ICI-RS 2023-Part 2. Neurourol Urodyn 2024. [PMID: 38178629 DOI: 10.1002/nau.25379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 12/18/2023] [Indexed: 01/06/2024]
Abstract
INTRODUCTION Overactive bladder (OAB) and underactive bladder (UAB) could be associated with metabolic syndrome, affective disorders, sex hormone deficiency, changes in urinary microbiota, functional gastrointestinal disorders, or autonomic nervous system dysfunction. OBJECTIVES The aim of this Think Tank was to provide a guide on how to investigate OAB and/or detrusor underactivity (DU) patients to better clarify the underlying pathophysiology and possibly personalize the treatment. METHODS A compendium of discussion based on the current evidence related to phenotyping patients with OAB or DU using urodynamic tests, functional neuro-imaging, urinary markers, and microbiome. RESULTS AND CONCLUSIONS The article emphasizes the critical significance of adopting a comprehensive yet tailored approach to phenotyping patients with lower urinary tract (LUT) symptoms, such as OAB and UAB. The intricate interplay between the LUT and various factors, metabolic, neurological, psychological, and gastrointestinal can define unique LUT profiles, enabling personalized therapies to replace the one-size-fits-all approach.
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Affiliation(s)
- Enrico Finazzi Agrò
- Department of Surgical Sciences, University of Rome Tor Vergata and Urology Unit, Policlinico Tor Vergata University Hospital, Rome, Italy
| | - Eleonora Rosato
- School of Specialization in Urology, University of Rome Tor Vergata and Urology Unit, Policlinico Tor Vergata University Hospital, Rome, Italy
| | - Adrian Wagg
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Sanjay Sinha
- Department of Urology, Apollo Hospital, Hyderabad, India
| | | | - Maurizio Serati
- Department Obstetrics and Gynecology. Urogynecology Unit, University of Insubria, Varese, Italy
| | - Vito Mancini
- Urinary Incontinence Center, Urology and Renal Transplantation Unit, Policlinico di Foggia Hospital and University of Foggia, Foggia, Italy
| | - Mathijs de Rijk
- Department of Urology, School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University Medical Center, Maastricht University, Maastricht, The Netherlands
| | - Tufan Tarcan
- Marmara University School of Medicine, Istanbul, Turkey
- Koç University, Istanbul, Turkey
| | - Alan Wein
- Desai Sethi Institute of Urology, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Paul Abrams
- Department of Urology, University of Bristol, Bristol, UK
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Finazzi Agrò E, Rosato E, Wagg A, Sinha S, Fede Spicchiale C, Serati M, Mancini V, de Rijk M, Tarcan T, Wein A, Abrams P, Bou Kheir G. How do we make progress in phenotyping patients with LUT such as OAB and underactive detrusor, including using urine markers and microbiome data, in order to personalize therapy? ICI-RS 2023: Part 1. Neurourol Urodyn 2024. [PMID: 38178627 DOI: 10.1002/nau.25377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 12/18/2023] [Indexed: 01/06/2024]
Abstract
INTRODUCTION Overactive bladder (OAB) and Underactive bladder (UAB) could be associated with metabolic syndrome, affective disorders, sex hormone deficiency, changes in urinary microbiota, functional gastrointestinal disorders, or autonomic nervous system dysfunction. OBJECTIVES The aim of this Think Tank was to provide a guide on how to investigate OAB and/or detrusor underactivity (DU) patients to better clarify the underlying pathophysiology and possibly personalize the treatment. METHODS A compendium of discussion based on the current evidence related to phenotyping patients with OAB or DU investigating metabolic, neurogical, psychological and gastrointestinal aspects with the aim to personalize the treatment. RESULTS AND CONCLUSIONS The article emphasizes the critical significance of adopting a comprehensive yet tailored approach to phenotyping patients with lower urinary tract symptoms, such as OAB and UAB. The intricate interplay between the lower urinary tract and various factors, metabolic, neurological, psychological, and gastrointestinal can define unique LUT profiles, enabling personalized therapies to replace the one-size-fits-all approach.
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Affiliation(s)
- Enrico Finazzi Agrò
- Department of Surgical Sciences, University of Rome Tor Vergata and Urology Unit, Policlinico Tor Vergata University Hospital, Rome, Italy
| | - Eleonora Rosato
- School of specialization in Urology, Policlinico Tor Vergata University Hospital, University of Rome Tor Vergata and Urology Unit, Rome, Italy
| | - Adrian Wagg
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Sanjay Sinha
- Department of Urology, Apollo Hospital, Hyderabad, India
| | | | - Maurizio Serati
- Department Obstetrics and Gynecology, Urogynecology Unit, University of Insubria, Varese, Italy
| | - Vito Mancini
- Urology and renal transplantation Unit, Urinary incontinence center, Policlinico di Foggia Hospital and University of Foggia, Foggia, Italy
| | - Mathijs de Rijk
- Department of Urology, School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University Medical Center, Maastricht University, Maastricht, The Netherlands
| | - Tufan Tarcan
- Marmara University School of Medicine, Istanbul, Turkey and Koç University School of Medicine, Istanbul, Turkey
| | - Alan Wein
- University of Miami Miller School of Medicine, Desai Sethi Institute of Urology, Miami, Florida, USA
| | - Paul Abrams
- Department of Urology, University of Bristol, Bristol, UK
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Sinha S, Everaert K, Kheir GB, Roberts N, Solomon E, Belal M, Selai C, Perrouin-Verbe MA, Spicchiale CF, Wein A, Abrams P. Could a better understanding of the underlying pathophysiologies lead to more informed treatment choices in patients with lower urinary tract dysfunction due to an acontractile or underactive detrusor? ICI-RS 2023. Neurourol Urodyn 2023. [PMID: 37960931 DOI: 10.1002/nau.25329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Accepted: 10/25/2023] [Indexed: 11/15/2023]
Abstract
INTRODUCTION The underlying pathophysiology behind a diagnosis of acontractile or underactive detrusor at invasive urodynamics is very heterogeneous. Lack of etiological classification currently limits the possibility of stratifying therapy. METHODS This subject was discussed at a think-tank on the subject at the International Consultation on Incontinence-Research Society held in Bristol, June 2023. This manuscript is a result of those deliberations and the subsequent discussions of the think-tank. RESULTS There are challenges in defining abnormalities of detrusor contraction with resultant implications for available evidence. Pathology at any level of the neuromuscular pathway can impair or prevent a detrusor voiding contraction. Attempts have been made to identify clinical markers that might predict an underactive detrusor but strong supporting evidence is lacking. Hence, a holistic approach to phenotyping requires specialized neuro-imaging as well as physiological investigations. Several general measures can help individuals with an abnormal detrusor contraction. The search for a molecule to enhance the detrusor voiding contraction remains elusive but there are promising new candidates. Neuromodulation can help select individuals but data is not well stratified by underlying etiology. Manipulation of central neurotransmitters might offer an alternate therapeutic option. CONCLUSIONS A better understanding of the underlying pathophysiologies behind an abnormality of the detrusor voiding contraction is needed for improving management. Towards this goal, the think-tank proposes a classification of the underactive detrusor that might help in selecting and reporting more well-defined patient cohorts.
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Affiliation(s)
- Sanjay Sinha
- Department of Urology, Apollo Hospital, Hyderabad, India
| | | | | | - Neil Roberts
- Division of Cell Matrix Biology and Regenerative Medicine, The University of Manchester, Bristol, UK
| | - Eskinder Solomon
- Department of Functional Urology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Mohammed Belal
- Department of Urology, Queen Elizabeth Hospital, Birmingham, UK
| | - Caroline Selai
- UCL Department of Clinical and Movement Neurosciences, Queen Square Institute of Neurology, London, UK
| | | | | | - Alan Wein
- Department of Urology, Desai-Seth Institute of Urology, University of Miami, Miami, Florida, USA
| | - Paul Abrams
- Department of Urology, University of Bristol, Bristol, UK
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Spicchiale CF, Collura G, Mendes LL, Mele E, Del Prete L, Innocenzi M, Zarfati A, Castagnetti M. Where is the testis? The role of ultrasound and diagnostic laparoscopy for Crossed Testicular Ectopia (CTE): Case report and review of literature. Ann Ital Chir 2023; 94:400-403. [PMID: 37794801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Abstract
Crossed Testicular Ectopia (CTE) or transverse testicular ectopia is an anecdotic urogenital anomaly in which both testes are located on the same side, generally associated with a patent processus vaginalis (PPV). The condition can be detected by ultrasound. Nevertheless, the diagnosis is often missed preoperatively and CTE is recognized intraoperatively. Controversy exists regarding management and the role of diagnostic laparoscopy. The surgical technique depends on the anatomy of vas, vessels and testis found on surgical exploration. Diagnostic laparoscopy can be useful to rule out a vanishing testis and detect Müllerian remnants. We present the case of 8-months infant with no palpable testis on the right side and no signs of inguinal hernia, reporting the management and reviewing the scarce existing literature in this regarding. KEY WORDS: Crossed Testicular Ectopia, Laparoscopy, Ectopia, Testis, Transverse Testicular Ectopia, Urogenital Abnormalities.
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Carilli M, Pacini P, Serati M, Iacovelli V, Bianchi D, Petta F, Pastore S, Amato I, Fede Spicchiale C, D’Ippolito G, Pletto S, Cavaleri Y, D’Amico A, Parisi I, Finazzi Agrò E. Percutaneous tibial nerve stimulation in the treatment of neurogenic detrusor overactivity in multiple sclerosis patients: a historically controlled study. Ther Adv Urol 2023; 15:17562872231177779. [PMID: 37275300 PMCID: PMC10233582 DOI: 10.1177/17562872231177779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 05/08/2023] [Indexed: 06/07/2023] Open
Abstract
Background Percutaneous tibial nerve stimulation (PTNS) is widely used in the treatment of neurogenic detrusor overactivity (NDO) in multiple sclerosis (MS); however, controlled studies are still lacking.Objective:: To assess effectiveness of PTNS in MS patients with NDO unresponsive to pharmacological and behavioural therapies. Methods MS patients with NDO were enrolled. Inclusion criteria were NDO not responding to pharmacological and behavioural therapies. Exclusion criteria were the presence of relevant comorbidities and urinary tract infections. Patients were evaluated using 3-day bladder diaries and validated questionnaires at baseline, after 4 weeks of educational therapy and after 12 PTNS sessions. The primary outcome measure was the percentage of patients considered responders after the behavioural therapy and after the PTNS in a historical controlled fashion (definition of 'responder' was reduction ⩾50% of urgency episodes). Results A total of 33 patients (26 women, 7 men) were enrolled. Two patients dropped out for reasons not related to the protocol. Two out of 31 patients (6.5%) and 21/29 (72.4%) were considered responders at visits 1 and 2, respectively. In PTNS responders, a statistically significant improvement in both bladder diary results and standardized questionnaire scores was recorded, compared with that obtained with behavioural therapy alone. No serious adverse events were reported. Conclusion This historically controlled study suggests that PTNS may be effective in improving NDO in MS patients.
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Affiliation(s)
| | | | - Maurizio Serati
- Department of Obstetrics and Gynecology, Del
Ponte Hospital, University of Insubria, Varese, Italy
| | - Valerio Iacovelli
- Division of Urology, Department of Surgery, Tor
Vergata University Hospital, Rome, Italy
- Urology Unit, San Carlo di Nancy Hospital, GVM
Care and Research, Rome, Italy
| | - Daniele Bianchi
- Division of Urology, Department of Surgery, Tor
Vergata University Hospital, Rome, Italy
| | - Filomena Petta
- Urology Unit, San Carlo di Nancy Hospital, GVM
Care and Research, Rome, Italy
| | - Serena Pastore
- Division of Urology, Department of Surgery, Tor
Vergata University Hospital, Rome, Italy
| | - Ivana Amato
- Division of Urology, Department of Surgery,
Tor Vergata University Hospital, Rome, Italy
| | | | - Giulia D’Ippolito
- Division of Urology, Department of Surgery,
Tor Vergata University Hospital, Rome, Italy
| | - Simone Pletto
- Division of Urology, Department of Surgery,
Tor Vergata University Hospital, Rome, Italy
| | - Yuri Cavaleri
- Division of Urology, Department of Surgery,
Tor Vergata University Hospital, Rome, Italy
| | | | | | - Enrico Finazzi Agrò
- Division of Urology, Department of Surgery,
Tor Vergata University Hospital, Rome, Italy
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Anceschi U, DI Maida F, Flammia RS, Bigazzi B, Grosso AA, Fede Spicchiale C, Mari A, Brassetti A, Tuderti G, Ferriero MC, Bove AM, Misuraca L, Mastroianni R, Mattioli M, Fuschi A, Finazzi Agrò E, DE Nunzio C, Pastore AL, Minervini A, Simone G. Robotic intracorporeal Padua ileal neobladder vs. Florin pouch: comparison of mid-term urodynamic and functional profiles. Minerva Urol Nephrol 2022; 74:825-827. [PMID: 35274904 DOI: 10.23736/s2724-6051.22.04884-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Affiliation(s)
- Umberto Anceschi
- Department of Urologic Oncology, IRCCS Regina Elena National Cancer Institute, Rome, Italy -
| | - Fabrizio DI Maida
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi Hospital, Florence, Italy
| | - Rocco S Flammia
- Department of Urologic Oncology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Barbara Bigazzi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi Hospital, Florence, Italy
| | - Antonio A Grosso
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi Hospital, Florence, Italy
| | | | - Andrea Mari
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi Hospital, Florence, Italy
| | - Aldo Brassetti
- Department of Urologic Oncology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Gabriele Tuderti
- Department of Urologic Oncology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Maria C Ferriero
- Department of Urologic Oncology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Alfredo M Bove
- Department of Urologic Oncology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Leonardo Misuraca
- Department of Urologic Oncology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Riccardo Mastroianni
- Department of Urologic Oncology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Manuela Mattioli
- Department of Urology, S. Andrea Polyclinic Hospital, University of Rome, Rome, Italy
| | - Andrea Fuschi
- Department of Urology, ICOT Latina, Sapienza University, Rome, Italy
| | - Enrico Finazzi Agrò
- Department of Urology, Tor Vergata Polyclinic Hospital, University of Rome, Rome, Italy
| | - Cosimo DE Nunzio
- Department of Urology, S. Andrea Polyclinic Hospital, University of Rome, Rome, Italy
| | - Antonio L Pastore
- Department of Urology, ICOT Latina, Sapienza University, Rome, Italy
| | - Andrea Minervini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi Hospital, Florence, Italy
| | - Giuseppe Simone
- Department of Urologic Oncology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
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Ambrosi Grappelli VM, Pastore S, Spicchiale CF, Alteri L, Turbanti A, Agrò EF. Conservative treatment of monolateral giant renal angiomyolipoma in a patient with Tuberous Sclerosis Complex (TSC): A case report. Urol Case Rep 2020; 33:101413. [PMID: 33102110 PMCID: PMC7574276 DOI: 10.1016/j.eucr.2020.101413] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 09/10/2020] [Accepted: 09/14/2020] [Indexed: 11/15/2022] Open
Abstract
Tuberous sclerosis complex has several renal manifestations like angiomyolipomas. We report a case of a giant AML and discuss its diagnosis and treatment. A 42-year-old woman was admitted to emergency department due to flank pain and hematuria. The patient had history of mental retardation and epilepsy. Abdominal CT without contrast medium revealed a large mass with a fat/blood content inside. On those findings, we diagnosed the patient a bleeding giant AML. We performed selective embolization of the bleeding source with subsequent conservative management. TSC-associated AMLs occur more frequently as multiple lesions and grow to larger size than idiopathic AML.
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Affiliation(s)
| | - Serena Pastore
- Urology Department, Policlinico Tor Vergata, Università Degli Studi di Roma "Tor Vergata", Rome, Italy
| | - Claudia Fede Spicchiale
- Urology Department, Policlinico Tor Vergata, Università Degli Studi di Roma "Tor Vergata", Rome, Italy
| | - Lorenzo Alteri
- Urology Department, Policlinico Tor Vergata, Università Degli Studi di Roma "Tor Vergata", Rome, Italy
| | - Andrea Turbanti
- Urology Department, Policlinico Tor Vergata, Università Degli Studi di Roma "Tor Vergata", Rome, Italy
| | - Enrico Finazzi Agrò
- Urology Department, Policlinico Tor Vergata, Università Degli Studi di Roma "Tor Vergata", Rome, Italy
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Iacovelli V, Bianchi D, Pletto S, Pacini P, Fede Spicchiale C, Finazzi Agrò E. The role of glycosaminoglycans in the management of chronic pelvic pain: a systematic review. MINERVA UROL NEFROL 2020; 72:321-331. [PMID: 32182229 DOI: 10.23736/s0393-2249.20.03672-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Glycosaminoglycans (GAGs) are involved in the pathogenesis of several urologic chronic diseases. Thus, GAGs replenishment therapy is widely reported as a therapeutic tool for chronic pelvic pain (CPP) conditions such as interstitial cystitis/bladder pain syndrome (IC/BPS) and prostate pain syndrome/chronic prostatitis. In this article we reviewed the current status of evidence on the clinic applications of glycosaminoglycans (GAGs) in the CPP. EVIDENCE ACQUISITION A literature search from inception was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis statement to identify clinical trials, randomized controlled trials, meta-analyses, and guidelines. EVIDENCE SYNTHESIS A total of 29 papers were identified regarding the use of GAGs in CPP. CONCLUSIONS GAGs replenishment therapy results are encouraging in chronic forms of pelvic pain even though well-powered randomized clinical trials are needed to better comprehend the exact role of this treatment.
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Affiliation(s)
- Valerio Iacovelli
- Department of Surgical Sciences, Tor Vergata University, Rome, Italy.,Department of Urology, San Carlo di Nancy Hospital, Rome, Italy
| | - Daniele Bianchi
- Department of Urology, Tor Vergata Polyclinic, Rome, Italy -
| | - Simone Pletto
- School of Specialization in Urology, Tor Vergata University, Rome, Italy
| | - Patrizio Pacini
- School of Specialization in Urology, Tor Vergata University, Rome, Italy
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