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Iacovelli V, Ficarra V, Maestroni UV, Tutolo M, Finazzi Agrò E. Open questions on lower urinary tract infections: Results of a Delphi consensus study. Neurourol Urodyn 2024; 43:915-924. [PMID: 38213058 DOI: 10.1002/nau.25385] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 12/21/2023] [Indexed: 01/13/2024]
Abstract
BACKGROUND AND OBJECTIVE This is a Delphi study that aims to explore expert consensus regarding open questions in current literature evidence on lower urinary tract infections (UTIs). This manuscript deals with adults and analyzed the most recent guidelines and meta-analysis on the topic. METHODS A panel of leading urologists and urogynaecologists participated in a consensus-forming project using a Delphi method to reach consensus on gray zone issues on recurrent lower UTIns (rUTIs), asymptomatic bacteriuria (AB) in pregnant women, and catheter-associated UTIs (CAUTI) in adults. All the panelists were invited to participate the four phases consensus. Consensus was defined as ≥75% agreement. An ordinal scale (0-10) was used. A systematic literature review was analyzed for diagnostic workup and prevention of rUTIs, AB, and CAUTI. RESULTS In total, 37 experts participated. All panelists participated in the four phases of the consensus process. Consensus was reached if ≥75% of the experts agreed on the proposed topic. Online meetings and a face-to-face consensus meeting was held in Milan in March 2023. Formal consensus was achieved for 12/13 items. CONCLUSIONS This manuscript is a Delphi survey of experts that showed interest on some debated points on rUTIs, AB in pregnancy, and prevention of CAUTI. There is still little data on nonantibiotic prevention of UTIs and CAUTI; quite old studies have been reported on AB in pregnancy. The emerging problem of antibiotic resistance is relevant and nonantibiotic prophylaxis may play a role in its prevention.
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Affiliation(s)
- Valerio Iacovelli
- Urology Unit, San Carlo di Nancy General Hospital - GVM Care and Research, Rome, Italy
| | - Vincenzo Ficarra
- Gaetano Barresi Department of Human and Paediatric Pathology, Urologic Section, University of Messina, Messina, Italy
| | | | - Manuela Tutolo
- Division of Oncology, Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Enrico Finazzi Agrò
- Department of Surgical Sciences, Urology Unit, University of Rome Tor Vergata, Rome, Italy
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Asimakopoulos AD, Finazzi Agrò E, Piechaud T, Gakis G, Gaston R, Rosato E. Urodynamic Parameters and Continence Outcomes in Asymptomatic Patients with Ileal Orthotopic Neobladder: A Systematic Review and Metanalysis. Cancers (Basel) 2024; 16:1253. [PMID: 38610933 PMCID: PMC11010941 DOI: 10.3390/cancers16071253] [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: 02/02/2024] [Revised: 03/19/2024] [Accepted: 03/19/2024] [Indexed: 04/14/2024] Open
Abstract
INTRODUCTION The orthotopic neobladder is the type of urinary diversion (UD) that most closely resembles the original bladder. However, in the literature the urodynamic aspects are scarcely analysed. OBJECTIVE To provide the first systematic review (SR) on the urodynamic (UDS) outcomes of the ileal orthotopic neobladders (ONB). Continence outcomes are also presented. METHODS A PubMed, Embase and Cochrane CENTRAL search for peer-reviewed studies on ONB published between January 2001-December 2022 was performed according to the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) statement. RESULTS AND CONCLUSION Fifty-nine manuscripts were eligible for inclusion in this SR. A great heterogeneity of data was encountered. Concerning UDS parameters, the pooled mean was 406.2 mL (95% CI: 378.9-433.4 mL) for maximal (entero)cystometric capacity (MCC) and 21.4 cmH2O (95% CI: 17.5-25.4 cmH2O) for Pressure ONB at MCC. Postvoid-residual ranged between 4.9 and 101.6 mL. The 12-mo rates of day and night-time continence were 84.2% (95% CI: 78.7-89.1%) and 61.7% (95% CI: 51.9-71.1%), respectively.Despite data heterogeneity, the ileal ONB seems to guarantee UDS parameters that resemble those of the native bladder. Although acceptable rates of daytime continence are reported the issue of high rates of night-time incontinence remains unsolved. Adequately designed prospective trials adopting standardised postoperative care, terminology and methods of outcome evaluation as well as of conduction of the UDS in the setting of ONB are necessary to obtain homogeneous follow-up data and to establish UDS guidelines for this setting.
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Affiliation(s)
| | - Enrico Finazzi Agrò
- Department of Surgical Sciences, Unit of Urology, University of Rome Tor Vergata, 00133 Rome, Italy; (E.F.A.); (E.R.)
| | - Thierry Piechaud
- Unit of Urology, Clinique Saint-Augustin, 33074 Bordeaux, France; (T.P.); (R.G.)
| | - Georgios Gakis
- University Clinic and Polyclinic of Urology, University Hospital of Halle (Saale), D-06120 Halle, Germany;
| | - Richard Gaston
- Unit of Urology, Clinique Saint-Augustin, 33074 Bordeaux, France; (T.P.); (R.G.)
| | - Eleonora Rosato
- Department of Surgical Sciences, Unit of Urology, University of Rome Tor Vergata, 00133 Rome, Italy; (E.F.A.); (E.R.)
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Agrò EF, Serati M, Mancini V. Reply to "Lower urinary tract (LUT) symptoms like over- (OAB) or underactive bladder (UAB) often are caused by pelvic organ prolapse (POP) in women and can often be cured by ligamentous POP-repair". Neurourol Urodyn 2024. [PMID: 38451039 DOI: 10.1002/nau.25431] [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] [Received: 02/08/2024] [Accepted: 02/13/2024] [Indexed: 03/08/2024]
Affiliation(s)
- Enrico Finazzi Agrò
- Department of Surgical Sciences, University of Rome Tor Vergata and Urology Unit, Policlinico Tor Vergata University Hospital, Rome, Italy
| | - Maurizio Serati
- Urogynecology Unit, Department of Obstetrics and Gynecology, 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
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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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Rosato E, Lombardo R, Li Marzi V, Finazzi Agrò E, De Nunzio C, Albisinni S. Re: Rano Matta, Refik Saskin, Sarah Neu, et al. Predicting Mirabegron Treatment Response in Patients with Overactive Bladder: A Post Hoc Analysis of Data from Clinical Trials. Eur Urol Focus. In press. https://doi.org/10.1016/j.euf.2023.04.001. Eur Urol Focus 2023:S2405-4569(23)00207-9. [PMID: 37806851 DOI: 10.1016/j.euf.2023.08.015] [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] [Received: 08/05/2023] [Accepted: 08/15/2023] [Indexed: 10/10/2023]
Affiliation(s)
- Eleonora Rosato
- Department of Surgical Sciences, Unit of Urology, University of Rome Tor Vergata, Rome, Italy
| | - Riccardo Lombardo
- Unit of Urology, Sant'Andrea Hospital, Sapienza University, Rome, Italy.
| | - Vincenzo Li Marzi
- Department of Minimally Invasive and Robotic Urologic Surgery, Careggi University Hospital, University of Florence, Florence, Italy
| | - Enrico Finazzi Agrò
- Department of Surgical Sciences, Unit of Urology, University of Rome Tor Vergata, Rome, Italy
| | - Cosimo De Nunzio
- Unit of Urology, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Simone Albisinni
- Department of Surgical Sciences, Unit of Urology, University of Rome Tor Vergata, Rome, Italy
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Stalder SA, Gross O, Anderson CE, Bachmann LM, Baumann S, Birkhäuser V, Bywater M, Del Popolo G, Engeler DS, Agrò EF, Friedl S, Grilo N, Kiss S, Koschorke M, Leitner L, Liechti MD, Mehnert U, Musco S, Sadri H, Stächele L, Tornic J, van der Lely S, Wyler S, Kessler TM. bTUNED: transcutaneous tibial nerve stimulation for neurogenic lower urinary tract dysfunction. BJU Int 2023; 132:343-352. [PMID: 37204144 DOI: 10.1111/bju.16081] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
OBJECTIVE To present the protocol for a randomized controlled trial (RCT) evaluating the efficacy and safety of transcutaneous tibial nerve stimulation (TTNS) for refractory neurogenic lower urinary tract dysfunction (NLUTD). STUDY DESIGN AND RESULTS bTUNED (bladder and TranscUtaneous tibial Nerve stimulation for nEurogenic lower urinary tract Dysfunction) is an international multicentre, sham-controlled, double-blind RCT investigating the efficacy and safety of TTNS. The primary outcome is success of TTNS, defined as improvements in key bladder diary variables at study end compared to baseline values. The focus of the treatment is defined by the Self-Assessment Goal Achievement (SAGA) questionnaire. Secondary outcomes are the effect of TTNS on urodynamic, neurophysiological, and bowel function outcome measures, as well as the safety of TTNS. CONCLUSIONS A total of 240 patients with refractory NLUTD will be included and randomized 1:1 into the verum or sham TTNS group from March 2020 until August 2026. TTNS will be performed twice a week for 30 min during 6 weeks. The patients will attend baseline assessments, 12 treatment visits and follow-up assessments at the study end.
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Affiliation(s)
- Stephanie A Stalder
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Oliver Gross
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Collene E Anderson
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
- Swiss Paraplegic Research, Nottwil and Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | | | - Sarah Baumann
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Veronika Birkhäuser
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Mirjam Bywater
- Department of Urology, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Giulio Del Popolo
- Department of Neuro-Urology, Azienda Ospedaliera-Universitaria Careggi, Florence, Italy
| | - Daniel S Engeler
- Department of Urology, School of Medicine, University of St. Gallen, St. Gallen, Switzerland
| | - Enrico Finazzi Agrò
- Unit of Urology, Department of Surgical Sciences, Tor Vergata University Hospital, Tor Vergata University, Rome, Italy
| | - Susanne Friedl
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Nuno Grilo
- Department of Urology, Lausanne University Hospital, Lausanne, Switzerland
| | - Stephan Kiss
- Department of Urology, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Miriam Koschorke
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Lorenz Leitner
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Martina D Liechti
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Ulrich Mehnert
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Stefania Musco
- Department of Neuro-Urology, Azienda Ospedaliera-Universitaria Careggi, Florence, Italy
| | - Helen Sadri
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Lara Stächele
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Jure Tornic
- Department of Urology, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | - Stéphanie van der Lely
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Stephen Wyler
- Department of Urology, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Thomas M Kessler
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
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Martoccia A, Al Salhi Y, Fuschi A, Rera OA, Suraci PP, Scalzo S, Antonioni A, Valenzi FM, Sequi MB, De Nunzio C, Lombardo R, Sciarra A, Di Pierro G, Bozzini G, Asimakopoulos AD, Finazzi Agrò E, Zucchi A, Gubiotti M, Cervigni M, Carbone A, Pastore AL. Robot-Assisted Sacrocolpopexy versus Trans-Vaginal Multicompartment Prolapse Repair: Impact on Lower Bowel Tract Function. Biomedicines 2023; 11:2105. [PMID: 37626605 PMCID: PMC10452351 DOI: 10.3390/biomedicines11082105] [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: 04/21/2023] [Revised: 06/05/2023] [Accepted: 07/21/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND This study evaluated the effectiveness, safety, and possible changes in bowel symptoms after multicompartment prolapse surgery by comparing two different surgical approaches, transvaginal mesh surgery with levatorplasty (TVMLP) and robot-assisted sacrocolpopexy (RSC). METHODS All patients underwent pelvic (POP-Q staging system) and rectal examination to evaluate anal sphincter tone in the lithotomy position with the appropriate Valsalva test. The preoperative evaluation included urodynamics and pelvic magnetic resonance defecography. Patient Global Impression of Improvement (PGI-I) at follow-up measured subjective improvement. All patients completed Agachan-Wexner's questionnaire at 0 and 12 months of follow-up to evaluate bowel symptoms. RESULTS A total of 73 cases were randomized into the RSC group (36 cases) and TVMLP group (37 cases). After surgery, the main POP-Q stage in both groups was stage I (RCS 80.5% vs. TVMLP 82%). There was a significant difference (p < 0.05) in postoperative anal sphincter tone: 35%. The TVMLP group experienced a hypertonic anal sphincter, while none of the RSC group did. Regarding subjective improvement, the median PGI-I was 1 in both groups. At 12 months of follow-up, both groups exhibited a significant improvement in bowel symptoms. CONCLUSIONS RSC and TVMLP successfully corrected multicompartment POP. RSC showed a greater improvement in the total Agachan-Wexner score and lower bowel symptoms.
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Affiliation(s)
- Alessia Martoccia
- Urology Unit, Department of Medical-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, “Sapienza” University of Rome, 04100 Latina, Italy; (A.M.); (Y.A.S.); (A.F.); (O.A.R.); (P.P.S.); (S.S.); (A.A.); (F.M.V.); (M.B.S.); (M.C.); (A.C.)
| | - Yazan Al Salhi
- Urology Unit, Department of Medical-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, “Sapienza” University of Rome, 04100 Latina, Italy; (A.M.); (Y.A.S.); (A.F.); (O.A.R.); (P.P.S.); (S.S.); (A.A.); (F.M.V.); (M.B.S.); (M.C.); (A.C.)
| | - Andrea Fuschi
- Urology Unit, Department of Medical-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, “Sapienza” University of Rome, 04100 Latina, Italy; (A.M.); (Y.A.S.); (A.F.); (O.A.R.); (P.P.S.); (S.S.); (A.A.); (F.M.V.); (M.B.S.); (M.C.); (A.C.)
| | - Onofrio Antonio Rera
- Urology Unit, Department of Medical-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, “Sapienza” University of Rome, 04100 Latina, Italy; (A.M.); (Y.A.S.); (A.F.); (O.A.R.); (P.P.S.); (S.S.); (A.A.); (F.M.V.); (M.B.S.); (M.C.); (A.C.)
| | - Paolo Pietro Suraci
- Urology Unit, Department of Medical-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, “Sapienza” University of Rome, 04100 Latina, Italy; (A.M.); (Y.A.S.); (A.F.); (O.A.R.); (P.P.S.); (S.S.); (A.A.); (F.M.V.); (M.B.S.); (M.C.); (A.C.)
| | - Silvio Scalzo
- Urology Unit, Department of Medical-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, “Sapienza” University of Rome, 04100 Latina, Italy; (A.M.); (Y.A.S.); (A.F.); (O.A.R.); (P.P.S.); (S.S.); (A.A.); (F.M.V.); (M.B.S.); (M.C.); (A.C.)
| | - Alice Antonioni
- Urology Unit, Department of Medical-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, “Sapienza” University of Rome, 04100 Latina, Italy; (A.M.); (Y.A.S.); (A.F.); (O.A.R.); (P.P.S.); (S.S.); (A.A.); (F.M.V.); (M.B.S.); (M.C.); (A.C.)
| | - Fabio Maria Valenzi
- Urology Unit, Department of Medical-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, “Sapienza” University of Rome, 04100 Latina, Italy; (A.M.); (Y.A.S.); (A.F.); (O.A.R.); (P.P.S.); (S.S.); (A.A.); (F.M.V.); (M.B.S.); (M.C.); (A.C.)
| | - Manfredi Bruno Sequi
- Urology Unit, Department of Medical-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, “Sapienza” University of Rome, 04100 Latina, Italy; (A.M.); (Y.A.S.); (A.F.); (O.A.R.); (P.P.S.); (S.S.); (A.A.); (F.M.V.); (M.B.S.); (M.C.); (A.C.)
| | - Cosimo De Nunzio
- Department of Urology, Sant’Andrea Hospital, Sapienza University of Rome, 00189 Rome, Italy; (C.D.N.); (R.L.)
| | - Riccardo Lombardo
- Department of Urology, Sant’Andrea Hospital, Sapienza University of Rome, 00189 Rome, Italy; (C.D.N.); (R.L.)
| | - Alessandro Sciarra
- Policlinico Umberto I, Department of Urology, Sapienza University of Rome, 00161 Rome, Italy; (A.S.); (G.D.P.)
| | - Giovanni Di Pierro
- Policlinico Umberto I, Department of Urology, Sapienza University of Rome, 00161 Rome, Italy; (A.S.); (G.D.P.)
| | - Giorgio Bozzini
- Department of Urology, ASST Lariana-Sant’Anna Hospital, 22100 Como, Italy;
| | - Anastasios D. Asimakopoulos
- Urology Unit, Fondazione PTV Policlinico Tor Vergata University Hospital, 00133 Rome, Italy; (A.D.A.); (E.F.A.)
| | - Enrico Finazzi Agrò
- Urology Unit, Fondazione PTV Policlinico Tor Vergata University Hospital, 00133 Rome, Italy; (A.D.A.); (E.F.A.)
| | | | | | - Mauro Cervigni
- Urology Unit, Department of Medical-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, “Sapienza” University of Rome, 04100 Latina, Italy; (A.M.); (Y.A.S.); (A.F.); (O.A.R.); (P.P.S.); (S.S.); (A.A.); (F.M.V.); (M.B.S.); (M.C.); (A.C.)
| | - Antonio Carbone
- Urology Unit, Department of Medical-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, “Sapienza” University of Rome, 04100 Latina, Italy; (A.M.); (Y.A.S.); (A.F.); (O.A.R.); (P.P.S.); (S.S.); (A.A.); (F.M.V.); (M.B.S.); (M.C.); (A.C.)
| | - Antonio Luigi Pastore
- Urology Unit, Department of Medical-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, “Sapienza” University of Rome, 04100 Latina, Italy; (A.M.); (Y.A.S.); (A.F.); (O.A.R.); (P.P.S.); (S.S.); (A.A.); (F.M.V.); (M.B.S.); (M.C.); (A.C.)
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Montanaro M, Agostini M, Anemona L, Bonanno E, Servadei F, Finazzi Agrò E, Asimakopoulos AD, Ganini C, Cipriani C, Signoretti M, Bove P, Rugolo F, Imperiali B, Melino G, Mauriello A, Scimeca M. ZNF750: A Novel Prognostic Biomarker in Metastatic Prostate Cancer. Int J Mol Sci 2023; 24:ijms24076519. [PMID: 37047491 PMCID: PMC10095592 DOI: 10.3390/ijms24076519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 03/24/2023] [Accepted: 03/25/2023] [Indexed: 04/03/2023] Open
Abstract
Prostate cancer is the most frequently diagnosed cancer and the fifth leading cause of cancer death among men in 2020. The clinical decision making for prostate cancer patients is based on the stratification of the patients according to both clinical and pathological parameters such as Gleason score and prostate-specific antigen levels. However, these tools still do not adequately predict patient outcome. The aim of this study was to investigate whether ZNF750 could have a role in better stratifying patients, identifying those with a higher risk of metastasis and with the poorest prognosis. The data reported here revealed that ZNF750 protein levels are reduced in human prostate cancer samples, and this reduction is even higher in metastatic samples. Interestingly, nuclear positivity is significantly reduced in patients with metastatic prostate cancer, regardless of both Gleason score and grade group. More importantly, the bioinformatics analysis indicates that ZNF750 expression is positively correlated with better prognosis. Overall, our findings suggest that nuclear expression of ZNF750 may be a reliable prognostic biomarker for metastatic prostate cancer, which lays the foundation for the development of new biological therapies.
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10
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Orecchia L, Ricci M, Ippoliti S, Asimakopoulos AD, Rosato E, Fasano A, Manfrin D, Germani S, Finazzi Agrò E, Nardi A, Miano R. External Validation of the "Tor Vergata" 3D Printed Models of the Upper Urinary Tract and Stones for High Fidelity Simulation of Retrograde Intrarenal Surgery. J Endourol 2023; 37:607-614. [PMID: 36924301 DOI: 10.1089/end.2022.0847] [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: 03/18/2023] Open
Abstract
INTRODUCTION Novel training modalities are being investigated to overcome the challenges associated with learning Retrograde IntraRenal Surgery (RIRS). Consequently, a series of 3D printed models of the upper urinary tract and stones designed for ex-vivo surgical simulation was introduced in 2021. This study aims to provide external validation of the training model and assess its role in the development of surgical skills. MATERIALS AND METHODS A mixed cohort of 20 urologists at different levels of expertise participated in a whole-day live simulation event to examine the model and perform a timed simulation of intrarenal navigation, stone relocation and laser fragmentation. Operative times were recorded and two independent expert endourologists scored the simulations according to a modified Objective Structured Assessment of Technical Skills" (OSATS) scale. Five novice urologists from the cohort performed three further simulations in a subsequent event to assess improvement in surgical skills. RESULTS Face validity was demonstrated with a median score of ≥ 4/5 in in each of the 11 items investigated. Content validity was also successfully reached, with 100% positive impressions with regard to the usefulness for the acquisition of surgical skills. Significant differences were observed among operative times stratified per surgeon experience (all p < 0.0050), thus providing construct validity. Median total OSATS score for novices was 14 (range 8,25) and was found to be significantly different from expected expert performance (p = 0.0010). Repeated simulations by novices led to a progressive reduction of operative times (p=0.0313) and increase in median total OSATS (p =0.0625). CONCLUSION The 3D printed models of upper urinary tract and synthetic training stones for the high-fidelity simulation of each phase of RIRS were validate by this study. The results encourage the usage of the models in simulation courses and the evaluation of their potential role in standardised training curricula.
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Affiliation(s)
- Luca Orecchia
- University of Rome Tor Vergata Faculty of Medicine and Surgery, 60259, Via Montpellier 1, Roma, Italy, 00133;
| | - Matteo Ricci
- University of Rome Tor Vergata Faculty of Medicine and Surgery, 60259, Roma, Italy;
| | - Simona Ippoliti
- Hull University Teaching Hospitals NHS Trust, 4020, Urology, Hull, Kingston upon Hull, United Kingdom of Great Britain and Northern Ireland;
| | - Anastasios D Asimakopoulos
- Fondazione PTV Policlinico Tor Vergata, 90352, Unit of Urology,Fondazione PTV Policlinico Tor Vergata, Rome, Italy, Viale Oxford 81, Roma, Italy, 00133;
| | - Eleonora Rosato
- University of Rome Tor Vergata Faculty of Medicine and Surgery, 60259, Roma, Italy;
| | - Angelica Fasano
- University of Rome Tor Vergata Faculty of Medicine and Surgery, 60259, Roma, Italy;
| | | | - Stefano Germani
- Fondazione PTV Policlinico Tor Vergata, 90352, Unit of Urology,Fondazione PTV Policlinico Tor Vergata, Rome, Italy, Roma, Italy;
| | - Enrico Finazzi Agrò
- Universita degli Studi di Roma Tor Vergata, 9318, Experimental Medicine and Surgery - Urology Unit, Roma, Italy;
| | - Alessandra Nardi
- University of Rome Tor Vergata Macro Area of Mathematical Physical and Natural Sciences, 531262, Mathematics, Roma, Lazio, Italy;
| | - Roberto Miano
- Tor Vergata University, Urology, Via Giulio Curioni 131, Rome, Italy, 00157.,Italy;
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11
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Braga A, Barba M, Serati M, Soligo M, Li Marzi V, Finazzi Agrò E, Musco S, Caccia G, Castronovo F, Manodoro S, Frigerio M. Update on Italian-validated questionnaires for pelvic floor disorders. Minerva Obstet Gynecol 2023; 75:62-68. [PMID: 34328299 DOI: 10.23736/s2724-606x.21.04901-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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 Pelvic floor disorders (PFDs), which include urinary incontinence, pelvic organ prolapse, sexual dysfunction and gastrointestinal disorders, affect over 20% of the adult population. Prevalence may also be underestimated, since a certain portion of patients may be reluctant to talk to physicians about PFDs due to embarrassment. Consequently, there is a need for self-assessed diagnostic tools with the capability to screen population and collect clinical information. Symptom and quality of life (QoL) questionnaires - also identified as patient-reported outcomes (PROs) - have been developed with this purpose. Despite the large number of questionnaires available for the assessment of PFDs and QoL-related issues in the English language, few of them have been validated for the Italian language. The objective of this article is to update the list of Italian-validated PROs for PFDs along with practical information concerning literature references and suggestions on how to obtain every single questionnaire. EVIDENCE ACQUISITION PubMed/MEDLINE databases and websites were used to update the list of available Italian-validated questionnaires about PFDs. Once identified, the possibility to get a copy of the questionnaire was verified and steps to obtain it are reported in the tables. EVIDENCE SYNTHESIS Eight additional questionnaires validated into the Italian language, for diagnosis and overall management of common urinary, vaginal, sexual and bowel conditions, were retrieved. The complete list of PFDs PROS is reported in a modular format for consultation. CONCLUSIONS This format is intended to serve as a tool to promote appropriateness in PROs adoption while investigating PFDs in Italian patients.
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Affiliation(s)
- Andrea Braga
- Department of Obstetrics and Gynecology, EOC-Beata Vergine Hospital, Mendrisio, Switzerland - .,Faculty of Biomedical Sciences, Università della Svizzera Italiana, Mendrisio, Switzerland -
| | - Marta Barba
- Department of Obstetrics and Gynecology, San Gerardo Hospital, Milano Bicocca University, Monza, Italy
| | - Maurizio Serati
- Department of Obstetrics and Gynecology, Del Ponte Hospital, University of Insubria, Varese, Italy
| | - Marco Soligo
- Department of Obstetrics and Gynecology, Buzzi Hospital, Milan, Italy
| | - Vincenzo Li Marzi
- Department of Urology, AOU Careggi Hospital, University of Florence, Florence, Italy
| | - Enrico Finazzi Agrò
- Unit of Urology, Department of Surgical Sciences, Tor Vergata University Hospital, Rome, Italy
| | - Stefania Musco
- Department of Urology, Careggi Hospital, Florence, Italy
| | - Giorgio Caccia
- Department of Obstetrics and Gynecology, EOC-Beata Vergine Hospital, Mendrisio, Switzerland
| | - Fabiana Castronovo
- Department of Obstetrics and Gynecology, EOC-Beata Vergine Hospital, Mendrisio, Switzerland
| | - Stefano Manodoro
- Department of Obstetrics and Gynecology, San Paolo Hospital, Milan, Italy
| | - Matteo Frigerio
- Department of Obstetrics and Gynecology, San Gerardo Hospital, Milano Bicocca University, Monza, Italy
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12
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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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13
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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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14
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DE Nunzio C, Nacchia A, Lombardo R, Brassetti A, Sica A, Baldassarri V, Guarnotta G, Al Salhi Y, Tuderti G, Li Marzi V, Finazzi Agrò E, Pastore A, Carbone A, Simone G, Tubaro A. Effect of vacation on urinary symptoms in health care workers: an Italian multicenter study. Minerva Urol Nephrol 2022; 74:755-760. [PMID: 33781024 DOI: 10.23736/s2724-6051.21.04274-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Aim of our study was to assess the impact of vacation on urinary symptoms in health care workers. METHODS Between March 2018 to October 2019 a survey was carried out by enrolling health care system workers in three centers. Demographic and clinical characteristics of health care workers (i.e. age, smoking status, medical history) were collected. Lower urinary tract symptoms (LUTS) and work related quality of life were assessed before and after vacation with validated questionnaires: Overactive Bladder Questionnaire Short Form (OABq-sf), International Prostate Symptom Score (IPSS), Work-related Quality of Life (WRQOL) and SF-36 questionnaires. As well, night shift workers (NSWs), defined as working at least one time a week from 8 pm to 8 am, were compared to traditional workers (TWs). RESULTS A total of 236 participants (118 males and 118 females) with a median of 41 (32/49 IQR) years old were included in the survey. Healthcare workers presented after vacation an improvement in LUTS, in work related quality of life and overall health. Overall, 89 (37%) were NSWs and 147 (62%) subjects were TWs. NSWs reported a significant higher median OABq Total Score and IPSS than TWs: respectively, 27 (IQR 23-34) vs. 20 (IQR 19-24) P=0.01, 2 (0/6) vs. 0 (0/2) (P<0.01). No significative differences were found for WRQOL and SF36, respectively 66 (IQR 59/77) vs. 67 (IQR 61/82) (P<0.29) and 98 (97/101) vs. 98 (97/100) (P<0.79). CONCLUSIONS NSWs present worst urinary symptoms when compared to TWs. Vacation has a beneficial effect, particularly in NSWs, on urinary symptoms and work-related quality of life.
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Affiliation(s)
| | | | | | - Aldo Brassetti
- Department of Urology, Regina Elena National Cancer Institute, Rome, Italy
| | - Angela Sica
- Department of Urology, Sant'Andrea Hospital, Rome, Italy
| | | | | | - Yazan Al Salhi
- Department of Urology, Traumatological Orthopedic Surgical Institute, Latina, Italy
| | - Gabriele Tuderti
- Department of Urology, Regina Elena National Cancer Institute, Rome, Italy
| | - Vincenzo Li Marzi
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | | | - Antonio Pastore
- Department of Urology, Traumatological Orthopedic Surgical Institute, Latina, Italy
| | - Antonio Carbone
- Department of Urology, Traumatological Orthopedic Surgical Institute, Latina, Italy
| | - Giuseppe Simone
- Department of Urology, Regina Elena National Cancer Institute, Rome, Italy
| | - Andrea Tubaro
- Department of Urology, Sant'Andrea Hospital, Rome, Italy
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15
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Asimakopoulos AD, Colalillo G, Miano R, Finazzi Agrò E, Farullo G, Fuschi A, Pastore AL, Germani S. Double-J stent placement during laparoscopic ureterolithotomy: the "seagull" technique. BJU Int 2022; 130:839-843. [PMID: 35934989 DOI: 10.1111/bju.15866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
| | - Gaia Colalillo
- Unit of Urology, Fondazione PTV Policlinico Tor Vergata, Rome, Italy
| | - Roberto Miano
- Division of Urology, Department of Surgical Sciences, University of Rome Tor Vergata, Rome, Italy
| | - Enrico Finazzi Agrò
- Division of Urology, Department of Surgical Sciences, University of Rome Tor Vergata, Rome, Italy
| | - Giuseppe Farullo
- Unit of Urology, Fondazione PTV Policlinico Tor Vergata, Rome, Italy
| | | | | | - Stefano Germani
- Unit of Urology, Fondazione PTV Policlinico Tor Vergata, Rome, Italy
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16
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Giammò A, Ammirati E, Geretto P, Manassero A, Squintone L, Falcone M, Del Popolo G, Pistolesi D, Risi O, Costantini E, Giannantoni A, Mancini V, Marzi VL, Agrò EF, Pastorello M, Musco S, Gontero P. Can urethral re-bulking improve the outcomes of a prior urethral bulking? Ther Adv Urol 2022; 14:17562872211069265. [PMID: 35069806 PMCID: PMC8771729 DOI: 10.1177/17562872211069265] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 12/08/2021] [Indexed: 11/16/2022] Open
Abstract
Aims: To analyze the outcomes of urethral re-bulking in the treatment of female stress urinary incontinence. Materials and Methods: We performed a multicenter observational retrospective study, which included all consecutive patients treated with urethral re-bulking for the treatment of persistent stress or mixed urinary incontinence after a previous urethral bulking. Objective outcomes were evaluated with the 24 h pad-test, while PGI-I questionnaires were administered to evaluate subjective outcomes. Clinical outcomes were assessed before re-bulking procedure and at last follow-up. Mann–Whitney’s U test was used for subgroup analysis. Shapiro-Wilk’s tests were used as normality tests. Results: In total, 62 patients who underwent urethral re-bulking between 2013 and 2020 in a multicenter setting were included. Most patients did not reach complete continence after the first procedure (n = 56) while the remainder reported recurrence of urinary incontinence after initial benefit. Median age at surgery was 66 (IQR: 55-73). Median overall follow-up was 30 months (IQR: 24-41). Median time occurred between the first procedure and reintervention was 12 months (IQR: 7-27). Bulking agents for the re-bulking procedures were bulkamid(n = 56), macroplastique(n = 4), and Prolastic(n = 2). A statistically significant reduction of median 24 h pad test from 100 g(IQR: 40-200) to 35 g(IQR: 0-120) was observed (p = 0.003). Dry rate after rebulking was 36.6%, while 85.4% patients declared themselves ‘very much improved’ or ‘much improved’ (PGI-I 1-2). Very few low-grade complications were observed (n = 4). A single case of major complication occurred. Conclusions: Urethral re-bulking can be an effective technique for the treatment of stress urinary incontinence refractory to a previous urethral bulking and can determine a cumulative benefit after the first procedure.
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Affiliation(s)
- Alessandro Giammò
- SC Neuro-Urologia, Spinal Cord Unit/CTO, Città della Salute e della Scienza di Torino, Torino, Italy
| | - Enrico Ammirati
- Neuro-Urology Department, CTO-Spinal Cord Unit, Città della Salute e della Scienza di Torino, Via Zuretti 24, 10126 Torino, TO, Italy
| | - Paolo Geretto
- SC Neuro-Urologia, Spinal Cord Unit/CTO, Città della Salute e della Scienza di Torino, Torino, Italy
| | - Alberto Manassero
- SC Neuro-Urologia, Spinal Cord Unit/CTO, Città della Salute e della Scienza di Torino, Torino, Italy
| | - Luisella Squintone
- SC Neuro-Urologia, Spinal Cord Unit/CTO, Città della Salute e della Scienza di Torino, Torino, Italy
| | - Marco Falcone
- SC Neuro-Urologia, Spinal Cord Unit/CTO, Città della Salute e della Scienza di Torino, Torino, Italy
| | | | - Donatella Pistolesi
- Division of Urology, Department of Translational Research and New Technologies, University of Pisa, Pisa, Italy
| | - Oreste Risi
- SSD Urodinamica, ASST Bergamo Ovest, Bergamo, Italy
| | - Elisabetta Costantini
- Andrology and Urogynecology Clinic, Santa Maria Terni Hospital, University of Perugia, Terni, Italy
| | - Antonella Giannantoni
- Functional and Surgical Urology Unit, Department of Medical and Surgical Sciences and Neurosciences, University of Siena, Siena, Italy
| | - Vito Mancini
- Department of Urology and Organ Transplantation, University of Foggia, Policlinico Riuniti, Foggia, Italy
| | - Vincenzo Li Marzi
- Urology Clinic, Careggi Hospital, University of Florence, Florence, Italy
| | | | - Mauro Pastorello
- Department of Urology, ‘Sacro Cuore-Don Calabria’ Hospital, Negrar, Italy
| | - Stefania Musco
- SOD of Neuro-Urology, Careggi University Hospital, Florence, Italy
| | - Paolo Gontero
- SC Neuro-Urologia, Spinal Cord Unit/CTO, Città della Salute e della Scienza di Torino, Torino, Italy
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17
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De Rienzo G, Minafra P, Finazzi Agrò E, Ditonno P. Re: Can we say that detrusor contractility didn't change in: "Evaluation"evaluation of the effect of 100 U of onabotulinum toxin A on detrusor contractility in women with idiopathic OAB: A multicentre prospective study"? Neurourol Urodyn 2022; 41:687-688. [PMID: 35005806 DOI: 10.1002/nau.24862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 12/16/2021] [Indexed: 11/10/2022]
Affiliation(s)
- Gaetano De Rienzo
- Department of Emergency and Organ Transplantation-Urology, Andrology, and Kidney Transplantation Unit, University of Bari "Aldo Moro", Bari, Italy
| | - Paolo Minafra
- Urology Unit, SS. Annunziata Hospital, Taranto, Italy
| | | | - Pasquale Ditonno
- Department of Emergency and Organ Transplantation-Urology, Andrology, and Kidney Transplantation Unit, University of Bari "Aldo Moro", Bari, Italy.,Urology Unit, National Cancer Institute IRCCS "Giovanni Paolo II", Bari, Italy
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18
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Carilli M, Asimakopoulos AD, Pastore S, Germani S, Orecchia L, Agrò EF, Miano R. Can circumcision be avoided in adult male with phimosis? Results of the PhimoStop TM prospective trial. Transl Androl Urol 2022; 10:4152-4160. [PMID: 34984181 PMCID: PMC8661253 DOI: 10.21037/tau-21-673] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 07/30/2021] [Accepted: 10/04/2021] [Indexed: 11/29/2022] Open
Abstract
Background Circumcision as surgical treatment of adult phimosis is not devoid of complications. Efficacy of alternative non-surgical options is unclear. PhimoStopTM is a therapeutic protocol which involves the use of appropriately shaped silicone tuboids of increasing size to obtain a non-forced dilation of the prepuce. The aim of the study was to evaluate the efficacy and durability of results of PhimoStopTM device for the treatment of adult male phimosis. Methods A prospective trial was conducted between 2018 and 2020 on 85 consecutive adult male patients affected by phimosis and with an indication for circumcision. Patients were treated with PhimoStopTM protocol and they were evaluated at baseline and after treatment through a subjective (patient self-reported information on various domains of his sexual function) and an objective assessment (evaluation of phimosis severity grade according to the Kikiros scale pre- and post-treatment, re-assessment of indication for circumcision post-treatment and validated questionnaires scores). Primary endpoint was to avoid the scheduled circumcision in 33% of the patients enrolled. Results Seventy-one patients (84%) completed the device usage phase as per study protocol. Median duration of tuboid application was 60 days. Thirty-seven patients (52.1%) had no indication for circumcision after treatment. Even considering patients lost to follow-up as failures, primary endpoint was reached in 43.5% of cases. There was a significant reduction of the grade of phimosis after treatment (P<0.001). Moreover IIEF-5 showed a statistically significant improvement after treatment (P<0.001). Thirty/37 patients who met the primary endpoint (81%) still have a successful resolution of their phimosis avoiding circumcision at a median follow-up of 24 months. Conclusions PhimoStopTM device is effective for the treatment of adult male phimosis of Kikiros grade ≤2. The results seem to be durable in most patients at a median follow-up of 24 months. Randomized clinical trials are necessary in order to confirm our results and assess cost-efficacy.
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Affiliation(s)
- Marco Carilli
- Division of Urology, Fondazione PTV Policlinico Tor Vergata, Rome, Italy
| | | | - Serena Pastore
- Division of Urology, Fondazione PTV Policlinico Tor Vergata, Rome, Italy
| | - Stefano Germani
- Division of Urology, Fondazione PTV Policlinico Tor Vergata, Rome, Italy
| | - Luca Orecchia
- Division of Urology, Fondazione PTV Policlinico Tor Vergata, Rome, Italy
| | - Enrico Finazzi Agrò
- Department of Surgical Sciences, Division of Urology, University of Rome Tor Vergata, Rome, Italy
| | - Roberto Miano
- Department of Surgical Sciences, Division of Urology, University of Rome Tor Vergata, Rome, Italy
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19
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Andretta E, Finazzi Agrò E, Calabrese M, Orecchia L, Furlan A, Zuliani C. Antimuscarinics for neurogenic overactive bladder in multiple sclerosis: real-life data. Ther Adv Urol 2022; 14:17562872221122484. [PMID: 36172491 PMCID: PMC9510970 DOI: 10.1177/17562872221122484] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 08/05/2022] [Indexed: 11/27/2022] Open
Abstract
Background: Antimuscarinics (AMs) represent the mainstay of treatment for storage lower
urinary tract symptoms (LUTS) but few data are available on their impact in
multiple sclerosis (MS) patients. Objective: To assess effectiveness and tolerability of AMs in MS patients with
neurogenic detrusor overactivity (NDO). Methods: Sixty consecutive outpatients, who started treatment with AMs at one centre,
were recruited. The primary endpoint was change in Patient’s Perception of
Intensity of Urgency Scale (PPIUS) at 6 months; secondary endpoints were
post-void residual urine (PVR) and pads used daily. Incidence and severity
of adverse events (AEs) were recorded. Results: Significant reduction (p < 0.001) of mean PPIUS and pads
use were detected, as well as a significant increase
(p < 0.001) of PVR (143 ± 42 ml). AEs, recorded in 53% of patients, were frequently multiple and caused
suspension of AM in 10% of cases, mainly for xerostomia, which has been the
commonest AE (26.6%). Neurological AEs appeared in 11.7% of subjects, mostly
with oxybutynin. Worsening/onset of voiding LUTS, reported by 8.3% of MS,
resulted to be the unique AE correlated to AM dosage. Conclusion: This study suggests that AMs are effective in MS patients, but their use
should be tailored on every patient as even low dosages can be poorly
tolerated. AEs, including neurological ones, are common.
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Affiliation(s)
- Elena Andretta
- Department of Urology, General Hospital, Dolo (Venice), Italy
| | - Enrico Finazzi Agrò
- Department of Surgical Sciences, University of Rome Tor Vergata, Via Montpellier, 1, 00133 Rome, Italy.,Urology Unit, Policlinico Tor Vergata Foundation, Rome, Italy
| | - Massimiliano Calabrese
- Department of Neuroscience, Biomedicine and Movements, University of Verona, Verona, Italy
| | - Luca Orecchia
- Urology Unit, Policlinico Tor Vergata Foundation, Rome, Italy
| | - Antonietta Furlan
- Department of Rehabilitation, General Hospital, Dolo (Venice), Italy
| | - Cristina Zuliani
- Department of Neurology, General Hospital, Mirano (Venice), Italy
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20
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Iacovelli V, Serati M, Bianchi D, Braga A, Turbanti A, Agrò EF. Preoperative abdominal straining in uncomplicated stress urinary incontinence: is there a correlation with voiding dysfunction and de novo overactive bladder after mid-urethral sling procedures? Ther Adv Urol 2021; 13:17562872211058243. [PMID: 34868350 PMCID: PMC8637698 DOI: 10.1177/17562872211058243] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 10/20/2021] [Indexed: 11/29/2022] Open
Abstract
Objectives: To evaluate the role of preoperative abdominal straining in predicting
de novo overactive bladder (OAB) and voiding
dysfunction in female patients undergoing suburethral taping by
trans-obturator approach (TVT-O) for uncomplicated stress urinary
incontinence (SUI). Methods: Data from patients who underwent TVT-O surgery for SUI were retrospectively
analyzed. Inclusion criteria included: history of pure SUI. Exclusion
criteria included previous surgery for urinary incontinence, pelvic
radiation, pelvic surgery within the last 3 months, and anterior or apical
pelvic organ prolapse (POP) ⩾ +1 cm. Voiding dysfunction has been defined
through symptoms and or urodynamics (UDS) signs. Accordingly, patients were
divided into group A and group B according to the presence of abdominal
straining during UDS. Patients were observed clinically and with UDS at a
3-year follow-up. Results: A total of 192 patients underwent TVT-O surgery for uncomplicated SUI.
Preoperative abdominal straining was identified in 60/192 patients (Group A:
31.2% vs Group B: 68.8%). Qmax was not different in the two
groups (Group A: 19.5 vs Group B: 20.5 mL/s,
p = 0.76). Demographics was similar for the two groups
regarding age, parity. At 3-year follow-up, voiding dysfunction was reported
in Group A: 9 and Group B: 8 patients (p = 0.056),
de novo OAB was significantly reported in Group A: 23
and Group B: 26 patients (p = 0.007). Conclusion: Preoperative abdominal straining was found to be related to a significant
incidence of de novo OAB. A significant correlation was not
assessed for postoperative voiding dysfunction. Further studies may better
define the impact of preoperative abdominal straining.
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Affiliation(s)
- Valerio Iacovelli
- Department of Surgical Sciences, Urology Unit, San Carlo di Nancy Hospital, GVM Care and Research, University of Rome Tor Vergata, Via Aurelia 275, 00165 Rome, Italy
| | - Maurizio Serati
- Department of Obstetrics and Gynecology, University of Insubria, Varese, Italy
| | - Daniele Bianchi
- Department of Surgical Sciences, Urology Unit, University of Rome Tor Vergata, Rome, Italy
| | - Andrea Braga
- Department of Obstetrics and Gynecology, EOC - Beata Vergine Hospital, Mendrisio, Switzerland
| | | | - Enrico Finazzi Agrò
- Department of Surgical Sciences, Urology Unit, University of Rome Tor Vergata, Rome, Italy
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21
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De Rienzo G, Minafra P, Iliano E, Agrò EF, Serati M, Giammò A, Bianchi FP, Costantini E, Ditonno P. Evaluation of the effect of 100U of Onabotulinum toxin A on detrusor contractility in women with idiopathic OAB: A multicentre prospective study. Neurourol Urodyn 2021; 41:306-312. [PMID: 34664738 PMCID: PMC9297902 DOI: 10.1002/nau.24820] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 09/20/2021] [Accepted: 09/20/2021] [Indexed: 01/22/2023]
Abstract
Aims Intradetrusor injection of Onabotulinum Toxin A (BTX‐A) is a third‐line treatment for overactive bladder (OAB). Voiding dysfunction and the need for intermittent catheterization are potential complications, consequent to bladder contractility (BC) decrement. Primary aim: to evaluate BC variation after BTX‐A detrusor injection in women with idiopathic OAB. Methods A prospective multi‐institutional observational study was conducted. Medical history, bladder diary, 24‐h pad test, and invasive urodynamic parameters were recorded before and 4–6 weeks after BTX‐A 100U administration. BC was measured as Modified Projected Isovolumetric Pressure (PIP1), that is, maximum flow rate (Qmax) + detrusor pressure at Qmax (PdetQmax). Continuous variables were expressed as median and interquartile range. We compared continuous variables using Wilcoxon test and proportions between two times with Fisher exact test. Results No changes in PIP1 were observed (p > 0.05) in 45 women enrolled between January 2018 and September 2019. Median age was 54.6 years. At baseline, 91.1% had urge urinary incontinence, with 4.9 ± 2.6 daily pads used and a 24‐h pad test of 205.4 ± 70.8 g. Baseline detrusor contractility was normal in all the patients. Postoperatively, an improvement in the 24‐h pad test (p < 0.01), daily voids (p < 0.01), and nocturia (p < 0.01) occurred. Urodynamics pointed out a significant reduction of detrusor overactivity rate (p < 0.01) and an increase of median maximum cystometric capacity (p < 0.01). No difference was observed in median Qmax (p > 0.05), PdetQmax (p > 0.05), and PVR (p > 0.05). No patient needed postoperative catheterization. Conclusions The current series provides evidence that detrusor injection of botulinum toxin is an effective option for treating OAB, without causing voiding dysfunction and BC impairment.
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Affiliation(s)
- Gaetano De Rienzo
- Urology, Andrology, and Kidney Transplantation Unit, Department of Emergency and Organ Transplantation, University of Bari "Aldo Moro", Bari, Italy
| | - Paolo Minafra
- Urology Unit, SS. Annunziata Hospital, Taranto, Italy
| | - Ester Iliano
- Andrology and Urogynecology Clinic, Santa Maria Terni Hospital, University of Perugia, Terni, Italy
| | | | - Maurizio Serati
- Department of Obstetrics and Gynecology, Del Ponte Hospital, University of Insubria, Varese, Italy
| | - Alessandro Giammò
- CTO-Spinal Cord Unit, Department of Neurourology, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Francesco Paolo Bianchi
- Department of Biomedical Science and Human Oncology, Aldo Moro University of Bari, Bari, Italy
| | - Elisabetta Costantini
- Andrology and Urogynecology Clinic, Santa Maria Terni Hospital, University of Perugia, Terni, Italy
| | - Pasquale Ditonno
- Urology, Andrology, and Kidney Transplantation Unit, Department of Emergency and Organ Transplantation, University of Bari "Aldo Moro", Bari, Italy.,Urology Unit, National Cancer Institute IRCCS "Giovanni Paolo II", Bari, Italy
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22
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Manenti G, Perretta T, Calcagni A, Ferrari D, Ryan CP, Fraioli F, Meucci R, Malizia A, Iacovelli V, Agrò EF, Floris R. 3-T MRI and clinical validation of ultrasound-guided transperineal laser ablation of benign prostatic hyperplasia. Eur Radiol Exp 2021; 5:41. [PMID: 34532768 PMCID: PMC8445741 DOI: 10.1186/s41747-021-00239-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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: 05/06/2021] [Accepted: 08/06/2021] [Indexed: 12/12/2022] Open
Abstract
Background Transperineal laser ablation (TPLA) of the prostate is a novel, mini-invasive option for men with lower urinary tract symptoms (LUTS) due to benign prostate hyperplasia (BPH). Our aim was to assess the impact of ultrasound-guided TPLA regarding urodynamic improvement and sexual function, monitoring clinical data, postprocedural complications and imaging findings at 3-T multiparametric magnetic resonance imaging. Methods Forty-four patients aged ≥ 50 affected with moderate to severe LUTS (International Prostate Symptoms score ≥ 12) due to benign prostatic obstruction and refractoriness, intolerance or poor compliance to medical therapies underwent US-guided TPLA between May 2018 and February 2020. Clinical measurements included PSA, uroflowmetry, sexual function assessment (using the International Index of Erectile Function and Male Sexual Health Questionnaire-Ejaculatory Dysfunction short form) and quality of life questionnaire. Adverse events were evaluated using the Clavien-Dindo scale. Volume changes were measured by MRI and automatic segmentation software during 1-year follow-up. Registration: NCT04044573 – May 5th, 2018, https://www.clinicaltrials.gov Results MRI assessed the changes over time with a 53% mean reduction of adenoma volume and 71% of the ablated area, associated with clinical and functional improvement and resolution of LUTS in all cases. Five of 44 patients (11.3%) had urinary blockage due to clots and required re-catheterisation for 2 weeks. The overall adverse event rate was 7%. Conclusion US-guided TPLA performed as a safe, manageable and effective treatment for LUTS. It could be considered an alternative effective mini-invasive procedure to standard treatments for BPH in the outpatient setting.
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Affiliation(s)
- Guglielmo Manenti
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", 00133, Rome, Italy. .,Department of Diagnostic Imaging and Interventional Radiology, University of Rome "Tor Vergata", Viale Oxford 81, 00133, Rome, Italy.
| | - Tommaso Perretta
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", 00133, Rome, Italy
| | - Antonello Calcagni
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", 00133, Rome, Italy
| | - Donatella Ferrari
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", 00133, Rome, Italy
| | - Colleen P Ryan
- Department of Neuromotor Physiology, Fondazione Santa Lucia IRCCS, Rome, Italy
| | - Federico Fraioli
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", 00133, Rome, Italy
| | - Rosaria Meucci
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", 00133, Rome, Italy
| | - Andrea Malizia
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", 00133, Rome, Italy
| | - Valerio Iacovelli
- Department of Urology, University of Rome "Tor Vergata", 00133, Rome, Italy
| | | | - Roberto Floris
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", 00133, Rome, Italy.,Department of Diagnostic Imaging and Interventional Radiology, University of Rome "Tor Vergata", Viale Oxford 81, 00133, Rome, Italy
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23
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Asimakopoulos AD, Colalillo G, Telesca R, Mauriello A, Miano R, Di Stasi SM, Germani S, Finazzi Agrò E, Petrozza V, Caruso G, Carbone A, Pastore AL, Fuschi A. T1 Bladder Cancer: Comparison of the Prognostic Impact of Two Substaging Systems on Disease Recurrence and Progression and Suggestion of a Novel Nomogram. Front Surg 2021; 8:704902. [PMID: 34497827 PMCID: PMC8419324 DOI: 10.3389/fsurg.2021.704902] [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: 05/04/2021] [Accepted: 07/19/2021] [Indexed: 11/13/2022] Open
Abstract
Background: The T1 substaging of bladder cancer (BCa) potentially impacts disease progression. The objective of the study was to compare the prognostic accuracy of two substaging systems on the recurrence and progression of primary pathologic T1 (pT1) BCa and to test a nomogram based on pT1 substaging for predicting recurrence-free survival (RFS) and progression-free survival (PFS). Methods: The medical records of 204 patients affected by pT1 BCa were retrospectively reviewed. Substaging was defined according to the depth of lamina propria invasion in T1a-c and the extension of the lamina propria invasion to T1-microinvasive (T1m) or T1-extensive (T1e). Uni- and multivariable Cox regression models evaluated the independent variables correlated with recurrence and progression. The predictive accuracies of the two substaging systems were compared by Harrell's C index. Multivariate Cox regression models for the RFS and PFS were also depicted by a nomogram. Results: The 5-year RFS was 47.5% with a significant difference between T1c and T1a (p = 0.02) and between T1e and T1m (p < 0.001). The 5-year PFS was 75.9% with a significant difference between T1c and T1a (p = 0.011) and between T1e and T1m (p < 0.001). Model T1m-e showed a higher predictive power than T1a-c for predicting RFS and PFS. In the univariate and multivariate model subcategory T1e, the diameter, location, and number of tumors were confirmed as factors influencing recurrence and progression after adjusting for the other variables. The nomogram incorporating the T1m-e model showed a satisfactory agreement between model predictions at 5 years and actual observations. Conclusions: Substaging is significantly associated with RFS and PFS for patients affected by T1 BCa and should be included in innovative prognostic nomograms.
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Affiliation(s)
| | - Gaia Colalillo
- Division of Urology, Department of Surgical Sciences, University of Rome Tor Vergata, Rome, Italy
| | - Rossana Telesca
- Pathology, Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy
| | - Alessandro Mauriello
- Pathology, Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy
| | - Roberto Miano
- Division of Urology, Department of Surgical Sciences, University of Rome Tor Vergata, Rome, Italy
| | - Savino Mauro Di Stasi
- Division of Urology, Department of Surgical Sciences, University of Rome Tor Vergata, Rome, Italy
| | - Stefano Germani
- Division of Urology, Fondazione PTV Policlinico Tor Vergata, Rome, Italy
| | - Enrico Finazzi Agrò
- Division of Urology, Department of Surgical Sciences, University of Rome Tor Vergata, Rome, Italy
| | - Vincenzo Petrozza
- Pathology, Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
| | - Gianluca Caruso
- Pathology, Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
| | - Antonio Carbone
- Urology Unit ICOT, Department of Medico-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, Sapienza University of Rome, Latina, Italy
| | - Antonio Luigi Pastore
- Urology Unit ICOT, Department of Medico-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, Sapienza University of Rome, Latina, Italy
| | - Andrea Fuschi
- Urology Unit ICOT, Department of Medico-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, Sapienza University of Rome, Latina, Italy
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24
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Pericolini M, Miget G, Hentzen C, Finazzi Agrò E, Chesnel C, Lagnau P, Haddad R, Grasland M, Amarenco G. Cortical, Spinal, Sacral, and Peripheral Neuromodulations as Therapeutic Approaches for the Treatment of Lower Urinary Tract Symptoms in Multiple Sclerosis Patients: A Review. Neuromodulation 2021; 25:1065-1075. [PMID: 34496454 DOI: 10.1111/ner.13525] [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: 05/02/2021] [Revised: 06/30/2021] [Accepted: 07/28/2021] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Multiple sclerosis (MS) is often associated with urological disorders, mainly urinary incontinence and retention, the management of which being necessary to improve patient's quality of life (QOL) and to reduce potential urological complications. Besides the classical treatments based mainly on anticholinergics and/or self-catheterization, several neuromodulation techniques have been tried in recent years to improve these urinary disorders. By this review, we aim at providing an overview of neuromodulation and electrostimulation approaches to manage urinary symptoms in MS patients. MATERIALS AND METHODS A literature search using MEDLINE was performed. Only papers in English, and describing the effects of neuromodulation in MS patients, were considered. RESULTS A total of 18 studies met inclusion criteria and were reviewed. Of them, four related to sacral neuromodulation (SNM), seven to percutaneous tibial nerve stimulation (PTNS), six to spinal cord stimulation (SCS), and one to transcranial magnetic stimulation (TMS). DISCUSSION PTNS and SNM seem to be effective and safe therapeutic options for treating lower urinary tract symptoms in MS patients principally in case of overactive bladder (OAB) symptoms. Similarly, also SCS and TMS have been shown to be effective, despite the very limited number of patients and the small number of studies found in the literature. Interestingly, these techniques are effective even in patients who do not respond well to conservative therapies, such as anticholinergics. Furthermore, given their safety and efficacy, stimulations such as PTNS could be considered as a first-line treatment for OAB in MS patients, also considering that they are often preferred by patients to other commonly used treatments.
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Affiliation(s)
- Martina Pericolini
- Urology Department, Policlinico Tor Vergata, Università Degli Studi di Roma, Rome, Italy.,GRC 001, GREEN Groupe de recherche clinique en neuro-urologie, Hôpital Tenon, Sorbonne Université, Paris, AP-HP, France
| | - Gabriel Miget
- GRC 001, GREEN Groupe de recherche clinique en neuro-urologie, Hôpital Tenon, Sorbonne Université, Paris, AP-HP, France
| | - Claire Hentzen
- GRC 001, GREEN Groupe de recherche clinique en neuro-urologie, Hôpital Tenon, Sorbonne Université, Paris, AP-HP, France
| | - Enrico Finazzi Agrò
- Urology Department, Policlinico Tor Vergata, Università Degli Studi di Roma, Rome, Italy
| | - Camille Chesnel
- GRC 001, GREEN Groupe de recherche clinique en neuro-urologie, Hôpital Tenon, Sorbonne Université, Paris, AP-HP, France
| | - Philippe Lagnau
- GRC 001, GREEN Groupe de recherche clinique en neuro-urologie, Hôpital Tenon, Sorbonne Université, Paris, AP-HP, France
| | - Rebecca Haddad
- GRC 001, GREEN Groupe de recherche clinique en neuro-urologie, Hôpital Tenon, Sorbonne Université, Paris, AP-HP, France
| | - Matthieu Grasland
- GRC 001, GREEN Groupe de recherche clinique en neuro-urologie, Hôpital Tenon, Sorbonne Université, Paris, AP-HP, France
| | - Gerard Amarenco
- GRC 001, GREEN Groupe de recherche clinique en neuro-urologie, Hôpital Tenon, Sorbonne Université, Paris, AP-HP, France
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25
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Pavese C, Scivoletto G, Puci MV, Schubert M, Curt A, Finazzi Agrò E, Montomoli C, Kessler TM. External Validation Confirms Validity of a Simple Model to Predict Bowel Outcome After Traumatic Spinal Cord Injury. Neurorehabil Neural Repair 2021; 35:659-662. [PMID: 34114519 DOI: 10.1177/15459683211023191] [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] [Indexed: 11/15/2022]
Abstract
Background. The prediction of functional outcomes after spinal cord injury (SCI) is essential to plan the rehabilitation phase and the social reintegration. Recently, 2 models to predict independent and reliable bowel management 1 year after traumatic SCI have been derived and validated in 2 cohorts of patients included in the European Multicenter Study about Spinal Cord Injury (EMSCI). Objective. We aimed to validate 2 prediction models for bowel outcome after traumatic SCI in a patient sample external to EMSCI. Methods. The simplified model (based on a single predictor, the International Standards for Neurological Classification of Spinal Cord Injury [ISNCSCI] total motor score) and the full model (based on 2 predictors, the ISNCSCI total motor score and item 3a of the Spinal Cord Independence Measure) were applied to the retrospectively collected data of 111 patients with traumatic SCI. Results. The simplified and the full models showed excellent discrimination with an area under the receiver operating characteristic curve of .939 (95% confidence interval (CI) .87-1.00) and .922 (95% CI 0.85-.99), respectively. Both models displayed similar results for sensitivity and negative predictive values; however, the simplified model showed higher values for specificity, positive predictive values, and accuracy. The calibration analysis showed a partial overlap between predicted probabilities and observed proportion, with better and acceptable calibration for the simplified model. Conclusions. Using an independent sample, our study demonstrates the validity of a simple model to predict independent and reliable bowel management 1 year after traumatic SCI.
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Affiliation(s)
- Chiara Pavese
- Neurology, Spinal Cord Injury Center, Balgrist University Hospital, University of Zürich, Switzerland.,Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Italy.,Neurorehabilitation Unit, IRCCS ICS Maugeri Spa-SB, Pavia, Italy
| | - Giorgio Scivoletto
- Spinal Cord Unit and Spinal Rehabilitation (SpiRe) Lab, IRCCS Fondazione Santa Lucia, Rome, Italy
| | - Mariangela V Puci
- Unit of Bio Statistics and Clinical Epidemiology, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Italy
| | - Martin Schubert
- Neurology, Spinal Cord Injury Center, Balgrist University Hospital, University of Zürich, Switzerland
| | - Armin Curt
- Neurology, Spinal Cord Injury Center, Balgrist University Hospital, University of Zürich, Switzerland
| | - Enrico Finazzi Agrò
- Department of Surgical Sciences, Tor Vergata University, Rome, Italy.,Department of Urology, Policlinico Tor Vergata, Rome, Italy
| | - Cristina Montomoli
- Unit of Biostatistics and Clinical Epidemiology, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Italy
| | - Thomas M Kessler
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Switzerland
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26
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Orecchia L, Manfrin D, Germani S, Del Fabbro D, Asimakopoulos AD, Finazzi Agrò E, Miano R. Introducing 3D printed models of the upper urinary tract for high-fidelity simulation of retrograde intrarenal surgery. 3D Print Med 2021; 7:15. [PMID: 34097158 PMCID: PMC8182943 DOI: 10.1186/s41205-021-00105-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 12/22/2020] [Accepted: 05/27/2021] [Indexed: 12/16/2022] Open
Abstract
PURPOSE Training in retrograde intrarenal surgery for the treatment of renal stone disease is a challenging task due to the unique complexity of the procedure. This study introduces a series of 3D printed models of upper urinary tract and stones designed to improve the training process. METHODS Six different models of upper urinary tract were algorithmically isolated, digitally optimized and 3D printed from real-life cases. Soft and hard stones in different sizes were produced from 3D printed moulds. The models were fitted onto a commercially available part-task trainer and tested for retrograde intrarenal surgery. RESULTS Each step of the procedure was simulated with extraordinary resemblance to real-life cases. The unique anatomical intricacy of each model and type of stones allowed us to reproduce surgeries of increasing difficulty. As the case-load required to achieve proficiency in retrograde intrarenal surgery is high, benchtop simulation could be integrated in training programs to reach good outcomes and low complication rates faster. Our models match incredible anatomical resemblance with low production cost and high reusability. Validation studies and objective skills assessment during simulations would allow comparison with other available benchtop trainers and the design of stepwise training programs. CONCLUSIONS 3D printing is gaining a significant importance in surgical training. Our 3D printed models of the upper urinary tract might represent a risk-free training option to hasten the achievement of proficiency in endourology.
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Affiliation(s)
- Luca Orecchia
- Urology Unit, Policlinico Tor Vergata Foundation, Viale Oxford 81, 00133, Rome, Italy.
| | | | - Stefano Germani
- Urology Unit, Policlinico Tor Vergata Foundation, Viale Oxford 81, 00133, Rome, Italy
| | | | | | - Enrico Finazzi Agrò
- Urology Unit, Policlinico Tor Vergata Foundation, Viale Oxford 81, 00133, Rome, Italy.,Division of Urology, Department of Surgical Sciences, University of Rome Tor Vergata, Rome, Italy
| | - Roberto Miano
- Urology Unit, Policlinico Tor Vergata Foundation, Viale Oxford 81, 00133, Rome, Italy.,Division of Urology, Department of Surgical Sciences, University of Rome Tor Vergata, Rome, Italy
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Cipriani C, Iacovelli V, Sandri M, Bertolo R, Maiorino F, Antonucci F, Micali S, Rocco B, Puliatti S, Ferrarese P, Benedetto G, Minervini A, Cocci A, Pastore AL, Al Salhi Y, Antonelli A, Morena T, Volpe A, Poletti F, Celia A, Zeccolini G, Leonardo C, Proietti F, Finazzi Agrò E, Bove P. The microbiological profile of patients with Fournier's gangrene: A retrospective multi-institutional cohort study. Urologia 2021; 89:437-443. [PMID: 34024222 DOI: 10.1177/03915603211018441] [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] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To evaluate the role of the microbiological profile and of disease-related factors in the management of patients affected with Fournier's gangrene (FG). PATIENTS AND METHODS Data regarding patients admitted for FG at nine Italian Hospitals (March 2007-June 2018) were collected. Patients were stratified according to the number of microorganisms documented: Group A - one microorganism; Group B - two microorganisms; Group C - more than three microorganisms. Baseline blood tests, dedicated scoring systems, predisposing risk factors, disease's features, management and post-operative course were analyzed. UpSet technique for visualizing set intersections in a matrix layout and Cuzick's nonparametric test for trend across ordered groups were used. RESULTS Eighty-one patients were available for the analysis: 18 included in Group A, 32 in Group B, 31 in Group C. The most common microorganism isolated was Escherichia coli. In Group B-C, Escherichia coli was often associated to Enterococcus faecalis, Pseudomonas aeruginosa, and Klebsiella pneumoniae. Statistically significant positive association was highlighted among the number of pathogens (Group A vs B vs C) and serum C-reactive Protein (p < 0.001), procalcitonin (p = 0.02) and creatinine (p = 0.03). Scoring systems were associated with the number of microorganisms detected (p < 0.02). A significant association between the number of microorganisms and the use of VAC therapy and need of a fecal diversion was found (p < 0.02). The number of microorganisms was positively associated with the length of stay (LOS) (p = 0.02). Ten weeks after initial debridement, wound closure was achieved in 11 (91.7%), 22 (84.6%) and 20 (80%) patients in Group A, B, and C, respectively, with no differences in overall survival. CONCLUSION Polymicrobial infections in FG are positively associated with inflammatory scores, the need for fecal diversion and the LOS. This results may help the counseling and the clinical management of this rare niche of patients.
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Affiliation(s)
- Chiara Cipriani
- Urology Unit, San Carlo di Nancy Hospital - GVM Care and Research, Rome, Italy
| | - Valerio Iacovelli
- Urology Unit, San Carlo di Nancy Hospital - GVM Care and Research, Rome, Italy.,Department of Surgical Sciences, University Tor Vergata, Roma, Italy
| | - Marco Sandri
- Big and Open Data Innovation Laboratory (BODaI-Lab), University of Brescia, Brescia, Italy
| | - Riccardo Bertolo
- Urology Unit, San Carlo di Nancy Hospital - GVM Care and Research, Rome, Italy
| | - Francesco Maiorino
- Urology Unit, San Carlo di Nancy Hospital - GVM Care and Research, Rome, Italy
| | | | - Salvatore Micali
- Department of Urology, Ospedale Policlinico e Nuovo Ospedale Civile S.Agostino Estense Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Bernardo Rocco
- Department of Urology, Ospedale Policlinico e Nuovo Ospedale Civile S.Agostino Estense Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Stefano Puliatti
- Department of Urology, Ospedale Policlinico e Nuovo Ospedale Civile S.Agostino Estense Modena, University of Modena and Reggio Emilia, Modena, Italy
| | | | | | - Andrea Minervini
- Department of Urology, University of Florence, Careggi Hospital, Florence, Italy
| | - Andrea Cocci
- Department of Urology, University of Florence, Careggi Hospital, Florence, Italy
| | | | | | - Alessandro Antonelli
- University Hospital of Verona, Department of Surgery, Dentistry, Paediatrics and Gynaecology, Urology Unit, Verona and Confortini - Borgo General Hospital, Trento, Italy
| | - Tonino Morena
- Department of Urology, University of Brescia, Spedali Civili di Brescia, Brescia, Italy
| | - Alessandro Volpe
- Department of Urology, University of Eastern Piedmont, Maggiore della Carità Hospital, Novara, Italy
| | - Filippo Poletti
- Department of Urology, University of Eastern Piedmont, Maggiore della Carità Hospital, Novara, Italy
| | - Antonio Celia
- Department of Urology, San Bassiano Hospital, Bassano del Grappa, Italy
| | | | | | - Flavia Proietti
- Department of Urology, La Sapienza University of Rome, Rome, Italy
| | | | - Pierluigi Bove
- Urology Unit, San Carlo di Nancy Hospital - GVM Care and Research, Rome, Italy.,Department of Surgical Sciences, University Tor Vergata, Roma, Italy
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De Nunzio C, Franco A, Lombardo R, Baldassarri V, Borghesi A, Li Marzi V, Trucchi A, Agrò EF, Tubaro A. Phamacological treatment of persistant lower urinary tract symptoms after a transurethral resection of the prostate is predictive of a new surgical treatment: 10 years follow-up study. Neurourol Urodyn 2021; 40:722-727. [PMID: 33508153 DOI: 10.1002/nau.24616] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 11/25/2020] [Revised: 12/30/2020] [Accepted: 01/16/2021] [Indexed: 01/25/2023]
Abstract
AIM To evaluate possible risk factors of re intervention in patients with benign prostatic enlargement (BPE) undergoing transurethral resection of the prostate (TURP). MATERIALS AND METHODS A consecutive series of patients with LUTS and BPE underwent TURP in our center in 2004 and 2005 and they were then followed up to September 2016. Patients were assessed at baseline, 3-, 6-month postoperatively and yearly thereafter with medical history, international prostate symptom score, prostate specific antigen, maximal urinary flow rate, post void residual urine. Reoperation was defined as the requirement of a new TURP to relieve bothersome LUTS. Cox regression was used to determine covariates associated with reoperation rate and the Kaplan-Meier curve assessed the time to reoperation. RESULTS Overall, 92 patients were enrolled. Median follow up was 142 months. 13 patients underwent a second TURP during the follow-up period (reoperation rate was 14%); out of them 9/13 (69%) received medical treatment for persistent LUTS (p = .001). The need of LUTS/BPE pharmacological treatment after TURP is an independent risk factor for a second surgical procedure (odds ratio 9,3; p = .001). Out of the 13 patients treated with a re-TURP, 12 (92%) underwent surgery within 5 years of follow-up. CONCLUSION In our single center study, the need of LUTS/BPE pharmacological treatment was a predictive factor of a re-TURP. Considering that more than 90% of re-TURP were performed during the first 5 years of follow-up, it is assumable that a follow-up longer than 5 years is not needed in these patients.
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Affiliation(s)
- Cosimo De Nunzio
- Azienda Ospedaliera Sant'Andrea- Università, "La Sapienza", Roma
| | - Antonio Franco
- Azienda Ospedaliera Sant'Andrea- Università, "La Sapienza", Roma
| | | | | | | | - Vincenzo Li Marzi
- Department of Urologic Robotic Surgery and Renal Transplantation, Careggi University Hospital, University of Florence, Florence, Italy
| | - Alberto Trucchi
- Azienda Ospedaliera Sant'Andrea- Università, "La Sapienza", Roma
| | | | - Andrea Tubaro
- Azienda Ospedaliera Sant'Andrea- Università, "La Sapienza", Roma
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Iacovelli V, Cipriani C, Sandri M, Filippone R, Ferracci A, Micali S, Rocco B, Puliatti S, Ferrarese P, Benedetto G, Minervini A, Cocci A, Pastore AL, Al Salhi Y, Antonelli A, Morena T, Volpe A, Poletti F, Celia A, Zeccolini G, Leonardo C, Proietti F, Finazzi Agrò E, Bove P. The role of vacuum-assisted closure (VAC) therapy in the management of FOURNIER'S gangrene: a retrospective multi-institutional cohort study. World J Urol 2021; 39:121-128. [PMID: 32236663 PMCID: PMC7223519 DOI: 10.1007/s00345-020-03170-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 03/14/2020] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To explore the role of vacuum assisted closure (VAC) therapy versus conventional dressings in the Fournier's gangrene wound therapy. PATIENTS AND METHODS This is a retrospective multi-institutional cohort study. Data of 92 patients from nine centers between 2007 and 2018 were retrospectively analyzed. After surgery, patient having a local or a disseminated FG were managed with VAC therapy or with conventional dressings. The 10-weeks wound closure cumulative rate and OS were analyzed. RESULTS Of the 92 patients, 62 (67.4%) showed local and 30 (32.6%) a disseminated FG. After surgery, 19 patients (20.7%) with local and 14 (15.2%) with disseminated FG underwent to VAC therapy; 43 (46.7%) with local and 16 (17.4%) with disseminated FG were treated using conventional dressings. The multivariable logistic regression analysis demonstrated that the VAC in patients with disseminated FG led to a higher cumulative rate of wound closure than patients treated with no-VAC (OR = 6.5; 95% CI 1.1-37.4, p = 0.036). The Kaplan-Meier survival curves for the OS showed a significant difference between no-VAC patients with local and disseminated FG (OS rate at 90 days 0.90, 95% CI 0.71-0.97 vs 0.55, 95% CI 0.24-0.78, respectively; p = 0.039). Cox regression confirmed that no-VAC patients with disseminated FG showed the lowest OS (hazard ratio adjusted for sex and age HR = 3.4, 95% CI 1.1-10.4; p = 0.033). CONCLUSIONS In this large cohort study, VAC therapy in patients with disseminated FG may offer an advantage in terms of 10-weeks wound closure cumulative rate and OS at 90 days after initial surgery.
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Affiliation(s)
- Valerio Iacovelli
- Urology Unit, San Carlo Di Nancy Hospital, GVM Care and Research, Via Aurelia 275, 00100, Rome, Italy.
- Department of Surgical Sciences, University Tor Vergata, Roma, Italy.
| | - Chiara Cipriani
- Urology Unit, San Carlo Di Nancy Hospital, GVM Care and Research, Via Aurelia 275, 00100, Rome, Italy
| | - Marco Sandri
- Data Methods and System Statistical Laboratory, University of Brescia, Brescia, Italy
| | - Roberta Filippone
- Department of Surgical Sciences, University Tor Vergata, Roma, Italy
| | | | - Salvatore Micali
- Department of Urology, Ospedale Policlinico E Nuovo Ospedale Civile S.Agostino Estense Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Bernardo Rocco
- Department of Urology, Ospedale Policlinico E Nuovo Ospedale Civile S.Agostino Estense Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Stefano Puliatti
- Department of Urology, Ospedale Policlinico E Nuovo Ospedale Civile S.Agostino Estense Modena, University of Modena and Reggio Emilia, Modena, Italy
| | | | | | - Andrea Minervini
- Department of Urology, University of Florence, Careggi Hospital, Florence, Italy
| | - Andrea Cocci
- Department of Urology, University of Florence, Careggi Hospital, Florence, Italy
| | | | | | - Alessandro Antonelli
- Urology Unit, Department of Surgery, Dentistry, Paediatrics and Gynaecology, University Hospital of Verona, Verona and Confortini, Borgo General Hospital, Trento, Italy
| | - Tonino Morena
- Urology Unit, Department of Surgery, Dentistry, Paediatrics and Gynaecology, University Hospital of Verona, Verona and Confortini, Borgo General Hospital, Trento, Italy
| | - Alessandro Volpe
- Department of Urology, University of Eastern Piedmont, Maggiore Della Carità Hospital, Novara, Italy
| | - Filippo Poletti
- Department of Urology, University of Eastern Piedmont, Maggiore Della Carità Hospital, Novara, Italy
| | - Antonio Celia
- Department of Urology, San Bassiano Hospital, Bassano del Grappa, Italy
| | | | | | - Flavia Proietti
- Department of Urology, La Sapienza University of Rome, Rome, Italy
| | | | - Pierluigi Bove
- Urology Unit, San Carlo Di Nancy Hospital, GVM Care and Research, Via Aurelia 275, 00100, 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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Abstract
Although urodynamics (UDS) is essential for the diagnosis and treatment of neurogenic lower urinary tract dysfunction, several possible pitfalls can be identified. In this paper we identify pitfalls in UDS and highlight limiting factors. UDS pitfalls that depend on the patient, on the physician, or on the test itself are described and analyzed. PATIENT SUMMARY: In this report we looked into pitfalls of urodynamics. Urodynamics is an essential tool in the diagnosis and treatment of neurogenic lower urinary tract dysfunction and always requires standardization and quality control to limit possible pitfalls.
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Affiliation(s)
- Enrico Finazzi Agrò
- Department of Experimental Medicine and Surgery, Tor Vergata University, Rome, Italy
| | | | - Valerio Iacovelli
- Department of Experimental Medicine and Surgery, Tor Vergata University, Rome, Italy; Ospedale San Carlo di Nancy, Rome, Italy
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Soligo M, Nelva Stellio L, De Ponti E, Turri A, Del Popolo G, Finazzi Agrò E, On Behalf Of The Publication Committee Of The Italian Urodynamic Society Siud. Italian electronic personal assessment questionnaire-pelvic floor (I.ePAQ-PF): Psychometric validation of the urinary section. Neurourol Urodyn 2020; 39:2192-2197. [PMID: 32754948 DOI: 10.1002/nau.24472] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 07/21/2020] [Indexed: 11/09/2022]
Abstract
AIM Tools for remote clinical assessment have become increasingly important. Patient-reported outcome questionnaires are increasingly being considered as the keystones of pelvic floor disorder assessment. An innovative English language multidisciplinary electronic Personal Assessment Questionnaire (ePAQ-PF) was psychometrically validated in 2006. A certified Italian version (I.ePAQ-PF) has been recently made available by the Italian Society of Urodynamics. In this study, we aimed to test the psychometric properties to validate the urinary dimension of the I.ePAQ-PF. METHODS Women complaining of lower urinary tract symptoms were enrolled. After providing informed consent, women filled in the I.ePAQ-PF via a dedicated touch-screen display (T0), together with concurrent questionnaires: International Consultation on Incontinence Questionnaire-Short form, Urgency Severity Scale, Urogenital Distress Inventory, and Patient Global Impression of Improvement. Cronbach's α and Spearman's correlation coefficients were adopted (validity). A test-retest was performed in 47 cases (reliability), and the intraclass correlation coefficient (ICC) was analyzed. I.ePAQ-PF was also administered after treatment (T1) and compared with baseline data via a Wilcoxon's test and Cohen's effect-size tests (responsiveness). RESULTS Ninety-three women were included. Internal consistency was confirmed (Cronbach's α >.7). A Spearman's correlation test showed a good correlation (>0.6) between I.ePAQ-PF and conceptually similar questionnaires. I.ePAQ-PF seems to be highly reproducible in all domains (ICC >0.86). The questionnaire scored significantly differently (Wilcoxon test P < .003) in all domains after the treatment. Responsiveness was further confirmed by Cohen's effect size of more than 30%. CONCLUSIONS The Italian ePAQ-PF (urinary domain) fully satisfies the psychometric properties of validity, reliability, and responsiveness and is ready for clinical application in Italian clinical settings.
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Affiliation(s)
- Marco Soligo
- Urogynecology Unit, Department of Woman, Mother, and Neonate, Buzzi Children's Hospital, ASST Fatebenefratelli-Sacco, University of Milan, Milan, Italy
| | - Leonardo Nelva Stellio
- Urogynecology Unit, Department of Woman, Mother, and Neonate, Buzzi Children's Hospital, ASST Fatebenefratelli-Sacco, University of Milan, Milan, Italy
| | | | - Alice Turri
- Urogynecology Unit, Department of Woman, Mother, and Neonate, Buzzi Children's Hospital, ASST Fatebenefratelli-Sacco, University of Milan, Milan, Italy
| | - Giulio Del Popolo
- Neuro-Urology Department, Careggi University Hospital, Florence, Italy
| | - Enrico Finazzi Agrò
- Department of Surgical Sciences, University of Rome Tor Vergata and Unit of Urology, Policlinico Tor Vergata University Hospital, Rome, Italy
| | - On Behalf Of The Publication Committee Of The Italian Urodynamic Society Siud
- Urogynecology Unit, Department of Woman, Mother, and Neonate, Buzzi Children's Hospital, ASST Fatebenefratelli-Sacco, University of Milan, Milan, Italy.,Medical Physics Department, ASST, Monza, Italy.,Neuro-Urology Department, Careggi University Hospital, Florence, Italy.,Department of Surgical Sciences, University of Rome Tor Vergata and Unit of Urology, Policlinico Tor Vergata University Hospital, Rome, Italy
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Serati M, Cantaluppi S, Coluccia AC, Scancarello C, Cimmino C, Braga A, Salvatore S, Finazzi Agrò E, Ghezzi F. Is urodynamic evaluation able to change and improve the management of women with idiopathic overactive bladder? Minerva Urol Nephrol 2020; 73:823-830. [PMID: 32573171 DOI: 10.23736/s2724-6051.20.03801-1] [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
BACKGROUND For women with overactive bladder (OAB), current guidelines recommend the use of urodynamic studies (UDS) only in complicated cases. This study aimed to investigate whether UDS can also be helpful in uncomplicated cases. Specific aims of the study were: 1) to evaluate objective benefit and subjective patient satisfaction with tailored treatment based on the UDS diagnosis compared to the outcomes of the pharmacological treatment only based on the symptoms; 2) to investigate the correlation between symptoms and UDS findings in women with uncomplicated idiopathic OAB symptoms; 3) to assess the ability of UDS to modify management decisions in these patients. METHODS Women presenting to our clinic with a history of uncomplicated OAB symptoms for the past three months or more, and who completed the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), were considered for this study. We proposed UDS to all participants. In women who accepted UDS (group 1), management decisions were made on the basis of urodynamic findings and post-treatment evaluation was scheduled at three months. The outcomes of treatments in these patients were compared to the results in women who did not accept UDS and who received pharmacological treatment symptoms-based (group 2). Objective outcomes were based on completion of a 3-day micturition diary. Subjective outcomes were captured using the Overactive Bladder Questionnaire Short Form (OABq-SF), the Patient Global Impression of Improvement (PGI-I) scale, and a patient satisfaction scale. RESULTS A total of 680 women were enrolled in the study; 478 underwent UDS and 202, at the contrary, declined UDS. In 53.6% of cases, UDS led to modification of the proposed management approach. At the 3-month follow-up, the overall patient satisfaction rate in group 1 and group 2 was 77% and 65.8%, respectively (P=0.003). CONCLUSIONS We showed that OAB management tailored according to the UDS diagnosis results in higher subjective satisfaction if compared with a pharmacological treatment symptoms-based. Our study confirmed a lack of correlation between OAB symptoms and the urodynamically proven diagnosis of detrusor overactivity (DO). It also suggested that UDS can determine the underlying pathophysiology of every woman with OAB syndrome, whether complicated or uncomplicated, allowing treatment to be appropriately tailored with better results.
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Affiliation(s)
- Maurizio Serati
- Department of Obstetrics and Gynecology, University of Insubria, Varese, Italy
| | - Simona Cantaluppi
- Department of Obstetrics and Gynecology, University of Insubria, Varese, Italy
| | - Anna C Coluccia
- Department of Obstetrics and Gynecology, University of Insubria, Varese, Italy
| | - Chiara Scancarello
- Department of Obstetrics and Gynecology, University of Insubria, Varese, Italy
| | - Chiara Cimmino
- Department of Obstetrics and Gynecology, University of Insubria, Varese, Italy
| | - Andrea Braga
- Department of Obstetrics and Gynecology, EOC - Beata Vergine Hospital, Mendrisio, Switzerland -
| | - Stefano Salvatore
- Unit of Obstetrics and Gynecology, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Enrico Finazzi Agrò
- Department of Surgical Sciences, Tor Vergata University, Rome, Italy.,Unit of Urology, Tor Vergata University Hospital, Rome, Italy
| | - Fabio Ghezzi
- Department of Obstetrics and Gynecology, University of Insubria, Varese, Italy
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Finazzi Agrò E, Farullo G, Balzarro M, Del Popolo G, Giannantoni A, Herms A, Li Marzi V, Musco S, Giammò A, Costantini E. Triage of functional, female and neuro-urology patients during and immediately after the Covid-19 outbreak. MINERVA UROL NEFROL 2020; 72:513-515. [PMID: 32400146 DOI: 10.23736/s0393-2249.20.03909-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Enrico Finazzi Agrò
- Department of Surgical Sciences, Tor Vergata University, Rome, Italy - .,Unit of Urology, Tor Vergata University Hospital, Rome, Italy -
| | - Giuseppe Farullo
- Department of Surgical Sciences, Tor Vergata University, Rome, Italy
| | - Matteo Balzarro
- Department of Urology, Verona University Hospital, Verona, Italy
| | - Giulio Del Popolo
- Department of Neuro-Urology, Careggi University Hospital, Florence, Italy
| | - Antonella Giannantoni
- Department of Medical and Surgical Sciences and Neurosciences, Functional and Surgical Urology Unit, University of Siena, Siena, Italy
| | - Achim Herms
- Department of Urology, South Tyrolean Healthcare Service, Brixen, Italy
| | - Vincenzo Li Marzi
- Department of Urologic Robotic Surgery and Renal Transplantation, Careggi University Hospital, University of Florence, Florence, Italy
| | - Stefania Musco
- Department of Neuro-Urology, Careggi University Hospital, Florence, Italy
| | - Alessandro Giammò
- Department of Neuro-Urology, CTO-Spinal Unit, Città della Salute e della Scienza, Turin, Italy
| | - Elisabetta Costantini
- Andrology and Urogynecology Clinic, Santa Maria Terni Hospital, University of Perugia, Terni, Italy
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Bove P, Iacovelli V, Tirindelli MC, Bianchi D, Flammia GP, Cipriani C, Ferraro AS, Ferro M, Arcese W, Ingrosso G, Vespasiani G, Finazzi Agrò E. Endoscopic Intravesical Fibrin Glue Application in the Treatment of Refractory Hemorrhagic Radiation Cystitis: A Single Cohort Pilot Study. J Endourol 2020; 33:93-98. [PMID: 30280911 DOI: 10.1089/end.2018.0028] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To evaluate the clinical value of endoscopic fibrin glue (FG) application therapy in treating hemorrhagic radiation cystitis (HRC). PATIENTS AND METHODS This is a single-cohort, prospective pilot study. We collected data from patients with HRC who were treated at our urology unit from May 2014 to December 2016. Patients with grade ≥2 HRC for whom conventional therapy and transurethral endoscopic electrocoagulation had failed were treated with endoscopic intravesical FG. The mean follow-up was 26.2 ± 9.78 months. Our analysis included data on patient demographics, pelvic malignancies, radiotherapy regimens, total dose of radiation received, time of onset and severity of hematuria, and previous intravesical management. Following FG intervention, patients' clinical status was defined as: (1) clinical response; absence of dysuria, urgency, and frequency; discontinuation of analgesic medication; and Foley catheter removal, but with ongoing hematuria grade <2; (2) complete response, clinical response, and no further hematuria; or (3) no response, no clinical response, and sustained hematuria. RESULTS A total of 20 patients (12 women and 8 men; mean age, 69 ± 7.5 years) were treated with 12 mL FG intravesically, using endoscopic application. Of the 20 patients, 16 (80%) had a complete response and 4 (20%) had a clinical response. In the case of four patients (20%), treatment was carried out twice. Mean hospital stay was 6 ± 2.5 days. The intervention showed good tolerability in all patients. No major adverse events were reported. Bladder spasms were the only minor adverse events reported in six patients (30%). CONCLUSION Application of FG is an effective, practical, affordable, and repeatable procedure for the treatment of grade ≥2 HRC.
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Affiliation(s)
- Pierluigi Bove
- 1 Urology Unit, San Carlo di Nancy General Hospital, Rome, Italy.,2 Department of Experimental Medicine and Surgery, Tor Vergata University of Rome, Rome, Italy
| | - Valerio Iacovelli
- 1 Urology Unit, San Carlo di Nancy General Hospital, Rome, Italy.,2 Department of Experimental Medicine and Surgery, Tor Vergata University of Rome, Rome, Italy
| | - Maria Cristina Tirindelli
- 3 Hematology and Stem Cell Transplant Transfusion Medicine and Cellular Therapy, Campus Bio-Medico University Hospital, Rome Italy
| | - Daniele Bianchi
- 4 Urology Unit, Department of Experimental Medicine and Surgery, Tor Vergata University of Rome, Rome, Italy
| | | | - Chiara Cipriani
- 4 Urology Unit, Department of Experimental Medicine and Surgery, Tor Vergata University of Rome, Rome, Italy
| | | | - Matteo Ferro
- 7 Department of Urology, European Institute of Oncology, Milan, Italy
| | - William Arcese
- 8 Hematology and Stem Cell Transplant Unit, Tor Vergata University of Rome, Rome, Italy
| | - Gianluca Ingrosso
- 9 Diagnostic Imaging, Molecular Imaging, Interventional Radiology and Radiotherapy Unit, Tor Vergata University of Rome, Rome, Italy
| | - Giuseppe Vespasiani
- 4 Urology Unit, Department of Experimental Medicine and Surgery, Tor Vergata University of Rome, Rome, Italy
| | - Enrico Finazzi Agrò
- 4 Urology Unit, Department of Experimental Medicine and Surgery, Tor Vergata University of Rome, 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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Creta M, Cornu JN, Roehrborn CG, Finazzi Agrò E, Montorsi F, Longo N, Imperatore V, De Sio M, Arcaniolo D, Mirone V, Fusco F. Clinical Efficacy of Silodosin in Patients with Severe Lower Urinary Tract Symptoms Related to Benign Prostatic Obstruction: A Pooled Analysis of Phase 3 and 4 Trials. Eur Urol Focus 2020; 7:440-443. [PMID: 32057739 DOI: 10.1016/j.euf.2020.01.014] [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: 11/11/2019] [Revised: 01/16/2020] [Accepted: 01/31/2020] [Indexed: 10/25/2022]
Abstract
We performed a post hoc analysis of data from phase 3 and 4 studies to evaluate the efficacy of silodosin 8mg in patients with severe lower urinary tract symptoms (LUTS) related to benign prostatic obstruction (BPO). The presence of two or more of the following criteria was adopted to define severity: total International Prostate Symptom Score (IPSS) 20-35, quality of life (QoL) score 5-6, maximum urinary flow <5ml/s or postvoid residual volume ≥100ml, and prostate volume ≥50ml. Mean improvements in total (8.1 vs 4.7), storage (3.1 vs 2.0), voiding (5.0 vs 2.7), and QoL (1.3 vs 0.7) IPSS scores were significantly greater for patients receiving silodosin compared to placebo (all p< 0.0001). Mean improvements in total, storage, voiding, and QoL IPSS scores were similar for the severe and not severe LUTS cohorts. In conclusion, silodosin significantly improves symptoms and QoL in all LUTS/BPO patients, including those with severe symptoms. PATIENT SUMMARY: Silodosin improves symptoms and quality of life for patients with severe lower urinary tract symptoms related to benign prostatic obstruction.
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Affiliation(s)
- Massimiliano Creta
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Jean-Nicolas Cornu
- Department of Urology, Charles-Nicolle University Hospital, Rouen Cedex, France
| | - Claus G Roehrborn
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Enrico Finazzi Agrò
- Department of Surgery, Chair of Urology, Tor Vergata University, Tor Vergata University Hospital, Rome, Italy
| | - Francesco Montorsi
- Department of Urology and Division of Experimental Oncology, Urological Research Institute, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Nicola Longo
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy
| | | | - Marco De Sio
- Department of Urology, Luigi Vanvitelli University of Naples, Naples, Italy
| | - Davide Arcaniolo
- Department of Urology, Luigi Vanvitelli University of Naples, Naples, Italy
| | - Vincenzo Mirone
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Ferdinando Fusco
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy.
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Serati M, Iacovelli V, Cantaluppi S, Braga A, Balzarro M, Pletto S, Soligo M, Finazzi Agrò E. Impact of urodynamic evaluation on the treatment of women with idiopathic overactive bladder: a systematic review. MINERVA UROL NEFROL 2020; 72:420-426. [PMID: 32026667 DOI: 10.23736/s0393-2249.20.03685-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Overactive bladder (OAB) is a common clinical condition affecting women. The impact of urodynamics (UDS) on the management of idiopathic OAB in women is highly debated. This systematic review analyzes the impact of UDS on the choice and on the outcomes of treatment of female idiopathic OAB. EVIDENCE ACQUISITION A systematic literature search in the PubMed/Medline, Web of Science, Scopus and Cochrane databases 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 on female OAB and UDS published from 2000. A total of 1554 records were initially identified and 12 articles were included in the final qualitative synthesis. EVIDENCE SYNTHESIS UDS represents the main tool to diagnose detrusor overactivity (DO) in OAB female patients which is considered one of the major OAB underlying pathophysiology factor. UDS can underline the presence of voiding dysfunction that could be considered as another underlying cause of uncomplicated female OAB. On the basis of this urodynamic findings, we can better define different aspects of OAB syndrome leading to a more tailored and proper treatment. CONCLUSIONS UDS can have a useful role in the diagnosis of idiopathic OAB in women given the possibility to gain a precise diagnosis and, therefore, a tailored treatment based on the underlying cause. The integration of clinics with UDS and all the other diagnostic available tools is desirable.
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Affiliation(s)
- Maurizio Serati
- Unit of Urogynecology, Department of Obstetrics and Gynecology, University of Insubria, Varese, Italy -
| | - Valerio Iacovelli
- Unit of Urology, Department of Surgical Sciences, Tor Vergata University Hospital, Rome, Italy.,San Carlo di Nancy General Hospital, Rome, Italy
| | - Simona Cantaluppi
- Unit of Urogynecology, Department of Obstetrics and Gynecology, University of Insubria, Varese, Italy
| | - Andrea Braga
- Department of Obstetrics and Gynecology, Beata Vergine Hospital, Mendrisio, Switzerland
| | | | - Simone Pletto
- School of Specialization in Urology, Tor Vergata University, Rome, Italy
| | - Marco Soligo
- Department of Obstetrics and Gynecology, Buzzi Hospital - ASST FBF Sacco, University of Milan, Milan, Italy
| | - Enrico Finazzi Agrò
- Unit of Urology, Department of Surgical Sciences, Tor Vergata University Hospital, Rome, Italy
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Gammie A, Speich JE, Damaser MS, Gajewski JB, Abrams P, Rosier PFWM, Arlandis S, Tarcan T, Finazzi Agrò E. What developments are needed to achieve less-invasive urodynamics? ICI-RS 2019. Neurourol Urodyn 2020; 39 Suppl 3:S36-S42. [PMID: 32022941 DOI: 10.1002/nau.24300] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 01/27/2020] [Indexed: 11/07/2022]
Abstract
AIMS To assess the state of technologies for urodynamics that are less invasive than standard cystometry and pressure-flow studies and to suggest areas needing research to improve this. METHODS A summary of a Think Tank debate held at the 2019 meeting of the International Consultation on Incontinence Research Society is provided, with subsequent analysis by the authors. Less-invasive techniques were summarized, classified by method, and possible developments considered. Discussions and recommendations were summarized by the co-chairs and edited into the form of this paper by all authors. RESULTS There is a full spectrum of technologies available for less-invasive assessment, ranging from simple uroflowmetry through imaging techniques to emerging complex technologies. Less-invasive diagnostics will not necessarily need to replace diagnosis by, or even provide the same level of diagnostic accuracy as, invasive urodynamics. Rather than aiming for a technique that is merely less invasive, the priority is to develop methods that are either as accurate as current invasive methods, or spare patients from the necessity of invasive methods by improving early triaging. CONCLUSIONS Technologies offering less-invasive urodynamic measurement of specific elements of function can be potentially beneficial. Less-invasive techniques may sometimes be useful as an adjunct to invasive urodynamics. The potential for current less-invasive tests to completely replace invasive urodynamic testing is considered, however, to be low. Less-invasive techniques must, therefore, be tested as screening/triaging tools, with the aim to spare some patients from invasive urodynamics early in the treatment pathway.
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Affiliation(s)
- Andrew Gammie
- Bristol Urological Institute, Southmead Hospital, Bristol, UK
| | - John E Speich
- Department of Mechanical and Nuclear Engineering, Virginia Commonwealth University College of Engineering, Richmond, Virginia
| | - Margot S Damaser
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, Ohio
| | - Jerzy B Gajewski
- Department of Urology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Paul Abrams
- Bristol Urological Institute, Southmead Hospital, Bristol, UK
| | | | | | - Tufan Tarcan
- Department of Urology, Marmara University School of Medicine, İstanbul, Turkey
- Department of Urology, Koç University School of Medicine, Istanbul, Turkey
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Braga A, Finazzi Agrò E, Illiano E, Manassero F, Milanesi M, Natale F, Torella M, Pistolesi D, De Nunzio C, Soligo M, Serati M. When should we use urodynamic testing? Recommendations of the Italian Society of Urodynamics (SIUD). Part 1 - Female population. MINERVA UROL NEFROL 2020; 72:58-65. [PMID: 31086135 DOI: 10.23736/s0393-2249.19.03443-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Abstract
Although, until a few years ago, the diagnostic power of urodynamic testing had never been questioned, recent studies in the literature have raised some doubts on the routine use of this tool. The benefits of the urodynamic studies (UDS) should be weighted against costs, time-consumption and patient discomfort. These recommendations are intended to guide clinicians in the right selection of the female patients to submit to a urodynamic evaluation. We reviewed the literature, regarding the use of UDS in female adults with lower urinary tract symptoms (LUTS) and pelvic floor dysfunction. Specifically, we analyzed and compared the guidelines and recommendations of the most important urology and uro-gynecology international scientific societies. These publications were used to create the evidence basis for characterizing the recommendations to perform urodynamic testing. A panel of 10 experts was composed and Delphi process was followed to obtain the panelist consensus. The final recommendations were approved by the unanimous consensus of the panel and compared with the best practice recommendations available in the literature. The recommendations are provided for diagnosis and management of common LUTS in female population. This review provides a summary of the most effective utilization of urodynamic studies for the global evaluation of patients with lower urinary tract symptoms and how to use them when really needed, avoiding unnecessary costs and patient inconveniences.
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Affiliation(s)
- Andrea Braga
- Department of Obstetrics and Gynecology, Beata Vergine Regional Hospital, Mendrisio, Switzerland -
| | | | - Ester Illiano
- Department of Urology and Andrology Clinic, Surgical and Biomedical Sciences, University of Perugia, Perugia, Italy
| | - Francesca Manassero
- Division of Urology, Department of Translational Research and New Technologies, University of Pisa, Pisa, Italy
| | - Martina Milanesi
- Department of Urology, Careggi University Hospital, University of Florence, Florence, Italy
| | - Franca Natale
- Department of Urogynecology, San Carlo of Nancy Hospital, Rome, Italy
| | - Marco Torella
- Department of Woman, Child and General and Specialized Surgery, Second University of Naples, Naples, Italy
| | - Donatella Pistolesi
- Division of Urology, Department of Translational Research and New Technologies, University of Pisa, Pisa, Italy
| | - Cosimo De Nunzio
- Department of Urology, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Marco Soligo
- Department of Women, Mothers and Neonates, Buzzi Children's Hospital, ASST Fatebenefratelli Sacco, University of Milan, Milan, Italy
| | - Maurizio Serati
- Department of Obstetrics and Gynecology, Del Ponte Hospital, University of Insubria, Varese, Italy
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Brusa L, Ponzo V, Stefani A, Ceravolo R, Palermo G, Agrò EF, Viselli F, Altavista MC, Iani C, Stocchi F, Stanzione P, Vitale C. Extended release levodopa at bedtime as a treatment for nocturiain Parkinson's disease: An open label study. J Neurol Sci 2019; 410:116625. [PMID: 31877419 DOI: 10.1016/j.jns.2019.116625] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 11/21/2019] [Accepted: 12/10/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND Bladder dysfunction may cause disabling symptoms in Parkinson's disease (PD) patients. The majority patients' experience symptoms as urinary urgency and nocturia suggest overactive bladder. This seems to be due to an altered brain-bladder relationship because of alteration in fronto-basal ganglia D1-dopaminergic circuit that normally suppresses micturition-reflex. Previous studies demonstrated beneficial effect of D1/D2 dopamine-receptors chronic-stimulation on detrusor overactivity of PD-patients.The present study was aimed to evaluate possible effect of extended-release (ER) Levodopa administered at bed-time on both nocturia and nocturia-related quality-of-life (NQoL) in PD-patients. METHODS 106 PD-patients (Hoehn and Yahr>1 and < 4, mean age 66 years, 59 females and 47 males) were enrolled by 7 Movement Disorders out-patients clinics. Patients undergo to International Prostatic Symptoms Scale-IPSS, including 1-item about nocturia (item 7), and to Nocturia Quality of Life-NQoL questionnaire, at baseline and after two-months of Extended-Release L-dopa (L-dopa/carbidopa or L-dopa benserazide) treatment at bed-time. RESULTS Statistical analysis showed significant improvement on both total IPSS, item 7and NQoL scores following two-months ER L-dopa-treatment. ΔIPSS score inversely correlated with disease duration. CONCLUSIONS This results support previous evidence of pathophysiological involvement of dopaminergic transmission on bladder dysfunction in PD.
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Affiliation(s)
- Livia Brusa
- UOC Neurology Unit S Eugenio Hospital, Rome, Italy.
| | - Viviana Ponzo
- IRCCS Neurosurgery Unit, Bambino Gesù Children's Hospital, Rome, Italy; IRCCS Santa Lucia Foundation, Rome, Italy
| | | | - Roberto Ceravolo
- Department of Clinic and Sperimental Medicine, Universityof Pisa, Pisa, Italy
| | - Giovanni Palermo
- Department of Clinic and Sperimental Medicine, Universityof Pisa, Pisa, Italy
| | | | | | | | - Cesare Iani
- UOC Neurology Unit S Eugenio Hospital, Rome, Italy
| | | | | | - Carmine Vitale
- Department of Motor Sciences and Wellness, University of Naples, Parthenope, Italy
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Gammie A, Almeida F, Drake M, Finazzi Agrò E, Kirschner-Hermanns R, Lemos N, Martens F, Mehnert U, Rosier P, Valentini F, Abrams P. Is the value of urodynamics undermined by poor technique?: ICI-RS 2018. Neurourol Urodyn 2019; 38 Suppl 5:S35-S39. [PMID: 31821637 DOI: 10.1002/nau.23978] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 12/03/2018] [Revised: 01/18/2019] [Accepted: 03/04/2019] [Indexed: 11/09/2022]
Abstract
INTRODUCTION The quality of urodynamic measurements in clinical practice has been debated as a matter of concern. It is considered plausible that this has a direct bearing on patient care and the perceived value of urodynamic testing. METHODS This is a report of the proceedings of the Think Tank: "Is the value of urodynamics undermined by poor technique?" from the Annual International Consultation on Incontinence-Research Society, which took place in June 2018 in Bristol, UK. The Think Tank discussed the evidence for deficiencies in urodynamic test quality and considered the implications of improvements for clinical diagnosis and practice. RESULTS There is evidence that technique affects urodynamic quality, and that urodynamic practice is variable. Factors such as team skill set, technologies used, and training received will also affect the quality of urodynamic service. Questions exist regarding the influence of technique on the utility and perceived value of urodynamics. CONCLUSIONS We suggest research questions that will provide the necessary evidence on the link between technique, reporting, and outcome, and clarify the role of good practice in the utility of urodynamic testing.
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Affiliation(s)
| | | | | | | | | | | | - Frank Martens
- Radboud University Medical Centre, Nijmegen, The Netherlands
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Verratti V, Mrakic-Sposta S, Moriggi M, Tonacci A, Bhandari S, Migliorelli D, Bajracharya A, Bondi D, Agrò EF, Cerretelli P. Urinary physiology and hypoxia: a pilot study of moderate-altitude trekking effects on urodynamic indexes. Am J Physiol Renal Physiol 2019; 317:F1081-F1086. [DOI: 10.1152/ajprenal.00333.2019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Exposure to high altitude is one of the most widely used models to study the adaptive response to hypoxia in humans. However, little is known about the related effects on micturition. The present study addresses the adaptive urinary responses in four healthy adult lowlanders, comparing urodynamic indexes at Kathmandu [1,450 m above sea level (a.s.l.); K1450] and during a sojourn in Namche Bazar (3,500 m a.s.l.; NB3500). The urodynamic testing consisted of cistomanometry and bladder pressure/flow measurements. Anthropometrics, electrocardiographic, and peripheral capillary oxygen saturation data were also collected. The main findings consisted of significant reductions in bladder power at maximum urine flow by ~30%, bladder contractility index by 13%, and infused volume both at first (by 57%) and urgency sensation (by 14%) to urinate, indicating a reduced cystometric capacity, at NB3500. In addition to the urinary changes, we found that oxygen saturation, body mass index, body surface area, and median RR time were all significantly reduced at altitude. We submit that the hypoxia-related parasympathetic inhibition could be the underlying mechanism of both urodynamic and heart rate adaptive responses to high-altitude exposure. Moreover, increased diuresis and faster bladder filling at altitude may trigger the anticipation of being able to void, a common cause of urgency. We believe that the present pilot study represents an original approach to the study of urinary physiology at altitude.
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Affiliation(s)
- Vittore Verratti
- Department of Psychological Sciences, Health, and Territory, University “G. d’Annunzio” of Chieti-Pescara, Chieti, Italy
- Laboratory of Clinical and Hypoxic Physiology, University “G. d’Annunzio” of Chieti-Pescara, Chieti, Italy
| | - Simona Mrakic-Sposta
- Institute of Bioimaging and Molecular Physiology, National Research Council of Italy, Segrate, Italy
| | - Manuela Moriggi
- Institute of Bioimaging and Molecular Physiology, National Research Council of Italy, Segrate, Italy
| | - Alessandro Tonacci
- Institute of Clinical Physiology, National Research Council of Italy, Pisa, Italy
| | - Suwas Bhandari
- Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | | | | | - Danilo Bondi
- Department of Neuroscience, Imaging, and Clinical Sciences, University “G. d’Annunzio” of Chieti-Pescara, Chieti, Italy
| | - Enrico Finazzi Agrò
- Department of Surgical Sciences, University of Rome “Tor Vergata” and Unit of Urology Policlinic, Tor Vergata University Hospital, Rome, Italy
| | - Paolo Cerretelli
- Institute of Bioimaging and Molecular Physiology, National Research Council of Italy, Segrate, Italy
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Bianchi D, Iacovelli V, Parisi I, Petta F, Gaziev G, Topazio L, Bove P, Vespasiani G, Finazzi Agrò E. Real-life data on long-term follow-up of patients successfully treated with percutaneous tibial nerve stimulation. Minerva Urol Nephrol 2019. [PMID: 31487975 DOI: 10.23736/s0393-2249.19.03492-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The aim of this cross-sectional study is to evaluate the "real-life" data of patients following successful treatment with PTNS for overactive bladder syndrome (OAB) or non-obstructive voiding dysfunction (NOVD) at a seven-year follow-up after the procedure. METHODS Patients who were successfully treated with PTNS for OAB or NOVD between February 2008 and January 2009 were contacted for a telephonic interview seven years after the end of their PTNS stimulation protocol. Patients who agreed to the interview were asked to complete a global response assessment (GRA). Patients in the OAB category completed the OAB short-form questionnaire Symptom Bother Scale (OAB-q SF) and the OAB Health-Related Quality of Life Scale (OAB HRQL), and NOVD patients were evaluated using the International Prostate Symptom Score - voiding questions (v-IPSS). Results of both questionnaires were compared with those obtained seven years previously, at the time of the initial PTNS treatment. RESULTS Seventeen patients were identified in our database. Sixteen agreed to the interview, but the remaining patient was unreachable and was therefore considered as lost at follow-up. Eight patients were classified into the OAB group, and eight were classified into the NOVD group. No patient reported a worsening condition after PTNS. Six of the eight patients (75%) in the OAB group gave positive responses in the GRA. All patients in the NOVD group gave positive responses in the GRA. CONCLUSIONS Despite some limitations, this study shows that the majority of patients who responded to PTNS considered themselves still improved at a seven-year follow-up. Larger studies are needed to confirm our results, but our study has the novel advantage of showing data derived from "real life" over the longest follow-up yet considered in the literature.
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Affiliation(s)
- Daniele Bianchi
- Department of Urology, Tor Vergata Polyclinic Hospital, Rome, Italy -
| | - Valerio Iacovelli
- Department of Experimental Medicine and Surgery, Tor Vergata University, Rome, Italy
| | | | - Filomena Petta
- Department of Urology, Tor Vergata Polyclinic Hospital, Rome, Italy
| | - Gabriele Gaziev
- Department of Urology, Tor Vergata Polyclinic Hospital, Rome, Italy
| | - Luca Topazio
- Department of Urology, Tor Vergata Polyclinic Hospital, Rome, Italy
| | - Pierluigi Bove
- Department of Experimental Medicine and Surgery, Tor Vergata University, Rome, Italy
| | - Giuseppe Vespasiani
- Department of Experimental Medicine and Surgery, Tor Vergata University, Rome, Italy
| | - Enrico Finazzi Agrò
- Department of Experimental Medicine and Surgery, Tor Vergata University, Rome, Italy
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Bianchi D, Iacovelli V, Parisi I, Petta F, Gaziev G, Topazio L, Bove P, Vespasiani G, Finazzi Agrò E. Real-life data on long-term follow-up of patients successfully treated with percutaneous tibial nerve stimulation. Minerva Urol Nephrol 2019; 73:260-264. [PMID: 31487975 DOI: 10.23736/s2724-6051.19.03492-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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
BACKGROUND The aim of this cross-sectional study is to evaluate the "real-life" data of patients following successful treatment with PTNS for overactive bladder syndrome (OAB) or non-obstructive voiding dysfunction (NOVD) at a seven-year follow-up after the procedure. METHODS Patients who were successfully treated with PTNS for OAB or NOVD between February 2008 and January 2009 were contacted for a telephonic interview seven years after the end of their PTNS stimulation protocol. Patients who agreed to the interview were asked to complete a global response assessment (GRA). Patients in the OAB category completed the OAB short-form questionnaire Symptom Bother Scale (OAB-q SF) and the OAB Health-Related Quality of Life Scale (OAB HRQL), and NOVD patients were evaluated using the International Prostate Symptom Score - voiding questions (v-IPSS). Results of both questionnaires were compared with those obtained seven years previously, at the time of the initial PTNS treatment. RESULTS Seventeen patients were identified in our database. Sixteen agreed to the interview, but the remaining patient was unreachable and was therefore considered as lost at follow-up. Eight patients were classified into the OAB group, and eight were classified into the NOVD group. No patient reported a worsening condition after PTNS. Six of the eight patients (75%) in the OAB group gave positive responses in the GRA. All patients in the NOVD group gave positive responses in the GRA. CONCLUSIONS Despite some limitations, this study shows that the majority of patients who responded to PTNS considered themselves still improved at a seven-year follow-up. Larger studies are needed to confirm our results, but our study has the novel advantage of showing data derived from "real life" over the longest follow-up yet considered in the literature.
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Affiliation(s)
- Daniele Bianchi
- Department of Urology, Tor Vergata Polyclinic Hospital, Rome, Italy -
| | - Valerio Iacovelli
- Department of Experimental Medicine and Surgery, Tor Vergata University, Rome, Italy
| | | | - Filomena Petta
- Department of Urology, Tor Vergata Polyclinic Hospital, Rome, Italy
| | - Gabriele Gaziev
- Department of Urology, Tor Vergata Polyclinic Hospital, Rome, Italy
| | - Luca Topazio
- Department of Urology, Tor Vergata Polyclinic Hospital, Rome, Italy
| | - Pierluigi Bove
- Department of Experimental Medicine and Surgery, Tor Vergata University, Rome, Italy
| | - Giuseppe Vespasiani
- Department of Experimental Medicine and Surgery, Tor Vergata University, Rome, Italy
| | - Enrico Finazzi Agrò
- Department of Experimental Medicine and Surgery, Tor Vergata University, Rome, Italy
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Pavese C, Bachmann LM, Schubert M, Curt A, Mehnert U, Schneider MP, Scivoletto G, Finazzi Agrò E, Maier D, Abel R, Weidner N, Rupp R, Kessels AG, Kessler TM. Bowel Outcome Prediction After Traumatic Spinal Cord Injury: Longitudinal Cohort Study. Neurorehabil Neural Repair 2019; 33:902-910. [DOI: 10.1177/1545968319868722] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background. Predicting functional outcomes after traumatic spinal cord injury (SCI) is essential for counseling, rehabilitation planning, and discharge. Moreover, the outcome prognosis is crucial for patient stratification when designing clinical trials. However, no valid prediction rule is currently available for bowel outcomes after a SCI. Objective. To generate a model for predicting the achievement of independent, reliable bowel management at 1 year after traumatic SCI. Methods. We performed multivariable logistic regression analyses of data for 1250 patients with traumatic SCIs that were included in the European Multicenter Study about Spinal Cord Injury. The resulting model was prospectively validated on data for 186 patients. As potential predictors, we evaluated age, sex, and variables from the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) and the Spinal Cord Independence Measure (SCIM), measured within 40 days of the injury. A positive outcome at 1 year post-SCI was assessed with item 7 of the SCIM. Results. The model relied on a single predictor, the ISNCSCI total motor score—that is, the sum of muscle strengths in 5 key muscle groups in each limb. The area under the receiver operating characteristics curve (aROC) was 0.837 (95% CI: 0.815-0.859). The prospective validation confirmed high predictive power: aROC = 0.817 (95% CI: 0.754-0.881). Conclusions. We generated a valid model for predicting independent, reliable bowel management at 1 year after traumatic SCI. Its application could improve counseling, optimize patient-tailored rehabilitation planning, and become crucial for appropriate patient stratification in future clinical trials.
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Affiliation(s)
- Chiara Pavese
- Balgrist University Hospital, University of Zürich, Zürich, Switzerland
- University of Pavia, Pavia, Italy; Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
| | | | - Martin Schubert
- Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Armin Curt
- Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Ulrich Mehnert
- Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Marc P. Schneider
- Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | | | | | | | | | | | - Rüdiger Rupp
- Heidelberg University Hospital, Heidelberg, Germany
| | | | - Thomas M. Kessler
- Balgrist University Hospital, University of Zürich, Zürich, Switzerland
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Braga A, Serati M, Illiano E, Manassero F, Milanesi M, Natale F, Torella M, Pistolesi D, De Nunzio C, Soligo M, Finazzi Agrò E. When should we use urodynamic testing? Recommendations of the Italian Society of Urodynamics (SIUD). Part 2 - Male and neurogical population. MINERVA UROL NEFROL 2019; 72:187-199. [PMID: 31166102 DOI: 10.23736/s0393-2249.19.03447-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Recent studies in literature, have raised some doubts on the routine use of urodynamic testing. Many physicians and articles recommend a selective use of this tool, considering carefully risks and benefits. These recommendations are intended to guide clinicians in the right selection of the male and neurological patients to submit to a urodynamic evaluation. This is the second part of a previous article regarding the urodynamic recommendations in the female population. We reviewed the literature, regarding the use of UDS in male and neurological population with lower urinary tract symptoms (LUTS). Specifically, we analyzed and compared the guidelines and recommendations of the most important urology and urogynecology international scientific societies. These publications were used to create the evidence basis for characterizing the recommendations to perform urodynamic testing. A panel of 10 experts was composed and Delphi process was followed to obtain the panelist consensus. The final recommendations were approved by the unanimous consensus of the panel and compared with the best practice recommendations available in the literature. The recommendations are provided for diagnosis and management of common LUTS in male and neurological population. This review provides a summary of the most effective utilization of urodynamic studies for the global evaluation of patients with LUTS, and how to use them when really needed, avoiding unnecessary costs and patient inconveniences.
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Affiliation(s)
- Andrea Braga
- Department of Obstetrics and Gynecology, EOC - Beata Vergine Hospital, Mendrisio, Switzerland -
| | - Maurizio Serati
- Department of Obstetrics and Gynecology, Del Ponte Hospital, University of Insubria, Varese, Italy
| | - Ester Illiano
- Division of Urology and Andrology Clinic, Department of Surgical and Biomedical Sciences, University of Perugia, Perugia, Italy
| | - Francesca Manassero
- Division of Urology, Department of Translational Research and New Technologies, University of Pisa, Pisa, Italy
| | - Martina Milanesi
- Department of Urology, AOU Careggi Hospital, University of Florence, Florence, Italy
| | - Franca Natale
- Department of Urogynecology, San Carlo of Nancy Hospital, Rome, Italy
| | - Marco Torella
- Department of Woman, Child and General and Specialized Surgery, Second University of Naples, Naples, Italy
| | - Donatella Pistolesi
- Division of Urology, Department of Translational Research and New Technologies, University of Pisa, Pisa, Italy
| | - Cosimo De Nunzio
- Department of Urology, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Marco Soligo
- Department of Women, Mothers and Neonates, Buzzi Children's Hospital, ASST Fatebenefratelli Sacco, University of Milan, Milan, Italy
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Rubilotta E, Balzarro M, D'Amico A, Cerruto MA, Bassi S, Bovo C, Iacovelli V, Bianchi D, Artibani W, Finazzi Agrò E. Pure stress urinary incontinence: analysis of prevalence, estimation of costs, and financial impact. BMC Urol 2019; 19:44. [PMID: 31164133 PMCID: PMC6549321 DOI: 10.1186/s12894-019-0468-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 04/26/2019] [Indexed: 12/02/2022] Open
Abstract
Background The prevalence of pure stress urinary incontinence (P-SUI) and the role of urodynamic investigation (UDI) prior to surgery for stress urinary incontinence (SUI) is debated. Since the exact prevalence of P-SUI is not clear, its clinical and economic impact is not well defined. The aims of this study were to evaluate the prevalence of P-SUI in a population of women who underwent UDI for urinary incontinence (UI), also assessing: 1) the correspondence between clinical diagnosis of P-SUI and urodynamic findings; 2) the analysis of costs in terms of UDI and eventually post-UDI avoided surgical procedures. Methods A single cohort of women who underwent UDI for UI between January 2012 and July 2016 was prospectively collected and retrospectively analyzed. Clinical P-SUI was defined by the strict criteria of the International Continence Society. For each patient, history, physical examination and UDI were collected. The correspondence between clinical and urodynamic findings of P-SUI was analyzed. The rate of clinical P-SUI changed after performing UDI and the number of unnecessary intervention after UDI were reported. A wide cost analysis of UDIs, and the amount of surgical procedures that were believed unnecessary after UDI was reported. Results Stress urinary incontinence was present in 323/544 (59.4%) patients. The prevalence of clinical P-SUI was 20.7% (67/323), while the prevalence of complicated SUI (C-SUI) was 79.3% (256/323). After UDI, diagnosis of P-SUI decreased to 18.3% (59/232). In 10.2% of cases (6/59) the scheduled middle urethral sling (MUS) was suppressed after the UDI results because 3/6 cases had detrusor overactivity and urge incontinence, in 2/6 cases SUI was treated with a conservative management, in 1/6 case an important voiding dysfunction was detected. Considering the national reimbursement in our country, the cost of each UDI was 296.5 euros and the total amount was 17,493.5 euros. So far the surgery-related savings covered 61.7–105.0% of the costs of total number of UDIs performed in the uncomplicated patients. Conclusions The prevalence of clinical P-SUI is relevant, involving about 20% of women with clinical SUI. Although the correspondence between clinical and urodynamic diagnosis was high, we demonstrated that UDI may help in some cases to avoid an inappropriate surgical treatment. Therefore, UDI prior to SUI surgery should be considered to achieve a correct diagnosis and a proper therapeutic strategy.
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Affiliation(s)
- Emanuele Rubilotta
- Department of Urology, Azienda Ospedaliera Universitaria Integrata (AOUI), Piazzale Aristide Stefani, 1, 37126, Verona, Italy.
| | - Matteo Balzarro
- Department of Urology, Azienda Ospedaliera Universitaria Integrata (AOUI), Piazzale Aristide Stefani, 1, 37126, Verona, Italy
| | - Antonio D'Amico
- Department of Urology, Azienda Ospedaliera Universitaria Integrata (AOUI), Piazzale Aristide Stefani, 1, 37126, Verona, Italy
| | - Maria Angela Cerruto
- Department of Urology, Azienda Ospedaliera Universitaria Integrata (AOUI), Piazzale Aristide Stefani, 1, 37126, Verona, Italy
| | - Silvia Bassi
- Department of Urology, Azienda Ospedaliera Universitaria Integrata (AOUI), Piazzale Aristide Stefani, 1, 37126, Verona, Italy
| | - Chiara Bovo
- Healthcare Department Administrator, Azienda Ospedaliera Universitaria Integrata (AOUI), Verona, Italy
| | - Valerio Iacovelli
- Department of Experimental Medicine and Surgery, Urology Unit, Tor Vergata University, Rome, Italy
| | - Daniele Bianchi
- Department of Experimental Medicine and Surgery, Urology Unit, Tor Vergata University, Rome, Italy
| | - Walter Artibani
- Department of Urology, Azienda Ospedaliera Universitaria Integrata (AOUI), Piazzale Aristide Stefani, 1, 37126, Verona, Italy
| | - Enrico Finazzi Agrò
- Department of Experimental Medicine and Surgery, Urology Unit, Tor Vergata University, Rome, Italy
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Soligo M, Roberti Maggiore UL, Oprandi NC, Nelva Stellio L, De Ponti E, Del Popolo G, Finazzi Agrò E, Ferrazzi E. Electronic Personal Assessment Questionnaire-Pelvic Floor: Italian cultural adaptation and face validity. Urologia 2019; 86:86-92. [PMID: 30983546 DOI: 10.1177/0391560319840196] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Electronic questionnaires offer invaluable advantages over paper-based ones. The aims of this study were to make available to Italian clinicians a culturally adapted version of the multidimensional electronic Personal Assessment Questionnaire-Pelvic Floor and to test face validity and factorial analysis for the Urinary section. METHODS The original English-language version of electronic Personal Assessment Questionnaire-Pelvic Floor was cross-culturally adapted to the Italian language. At the Urogynaecology Unit of Buzzi Hospital in Milan, the Urinary section of the Italian version was completed by women symptomatic for pelvic floor dysfunction. Time to questionnaire completion was recorded, and a nine-item paper questionnaire about the questionnaire was completed. Descriptive analysis to define patient population characteristics and nine-item paper questionnaire analysis were performed. Factorial analyses on the Urinary section of the questionnaire and on the nine-item paper questionnaire were performed, and internal reliability was assessed using Cronbach's alpha. RESULTS A culturally adapted Italian version of electronic Personal Assessment Questionnaire-Pelvic Floor was provided. In total, 95 women complaining of pelvic floor dysfunction took part in the study. Mean time to electronic questionnaire completion was 9 min (range: 5-17), with 95% of patients completing within 15 min. More than 95% of women considered the Italian version of electronic Personal Assessment Questionnaire-Pelvic Floor helpful, relevant, easy to use and comprehensive and would be happy to use it again. The questionnaire being overly long was an issue for 17% of women. The internal consistency of items in the nine-item paper questionnaire was confirmed with Cronbach's alpha scores > 0.8 for both the 'Value' and 'Burden' domains. DISCUSSION Our Italian cultural adaptation of electronic Personal Assessment Questionnaire-Pelvic Floor was well accepted by an appropriate target population. A full psychometric validation is now warranted.
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Affiliation(s)
- Marco Soligo
- 1 Department of Women, Mothers and Neonates, Buzzi Children's Hospital, ASST Fatebenefratelli Sacco, University of Milan, Milan, Italy
| | | | - Nadia C Oprandi
- 3 Department of Human Sciences, University of Verona, Verona, Italy
| | - Leonardo Nelva Stellio
- 1 Department of Women, Mothers and Neonates, Buzzi Children's Hospital, ASST Fatebenefratelli Sacco, University of Milan, Milan, Italy
| | | | | | | | - Enrico Ferrazzi
- 7 Obstetrics and Gynecology Clinic, Luigi Mangiagalli Institute, University of Milan, Milan, Italy
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Serati M, Andersson KE, Dmochowski R, Agrò EF, Heesakkers J, Iacovelli V, Novara G, Khullar V, Chapple C. Systematic Review of Combination Drug Therapy for Non-neurogenic Lower Urinary Tract Symptoms. Eur Urol 2019; 75:129-168. [PMID: 30293906 DOI: 10.1016/j.eururo.2018.09.029] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 09/14/2018] [Indexed: 01/05/2023]
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