ANalogical UroFlowmetry (ANUF): Correspondence Between This New Visual Pictogram and Uroflowmetry in Men With Lower Urinary Tract Symptoms: A new approach for the study of male micturition dynamics

OBJECTIVE

To study the correlation between a new visual tool (ANalogical UroFlowmetry (ANUF)) and uroflowmetry (UF) parameters when performed to assess male lower urinary tract symptoms (MLUTS).

METHODS

We configured an original pictogram composed of 4 different urine streams. In the setting of a University Hospital based prospective study where 545 men were enrolled between September 2018 and January 2019. Variables collected were age, UF pattern, Qmax, average flow rate (Qave), voided volume, postvoid residual, and selected image. The Spearman's rank test, ANOVA, and Tukey test, as well as the lineal regression model were used.

RESULTS

A total of 358 patients fulfilled the inclusion criteria. Mean age was 64.6 ± 12 years. Mean value and standard deviationfor the Qmax were 20.4 ± 10.5 mL/s for Image1; 15.5 ± 6.4 mL/s for Image2; 13.5 ± 6.0 mL/s for Image3 and 10.4 ± 5.4 mL/s for Image4. Statistically significant negative correlations were found between ANUF and Qmax (r = -0.317; P<.0001), and ANUF and Qave (r = -0.305; P<.0001). Qmax mean values among images were statistically different when compared in pairs, except Image1 and Image2 (P= .153). The confidence intervals calculated through the lineal regression model for the Qmax and each image were Image1) 17.8, confidence interval [CI] 95%: [14.9-21.5] mL/s; Image2) 14.3, CI 95%: [13.0-15.7] mL/s; Image3) 12.3, CI 95%: [11.5-13.1] mL/s and Image4) 9.1, CI 95%: [8.1-10.3] mL/s.

CONCLUSION

According to our results, ANUF is a useful and inexpensive tool presenting a correlation with the Qmax as well a correspondence of each image with a range of Qmax and its mean value.

Do candidates for penile implant prefer their doctors or another implanted patient as their information source? Results of a pilot study

INTRODUCTION

Erectile dysfunction incidence is about 19-26 cases for every 1000 men/year, requiring about 20,000 penile implants/year. There is high demand for information on the part of patients, however, there is a lack of evidence about the sources of information prior to penile implant and the figure of the Expert Patient (EP) has never been described in this area.

AIMS

To evaluate the sources of information used by candidates for penile implant as well as to describe the role of the EP as an information source.

METHODS

Pilot study of candidates for penile prosthesis. Patients already implanted attending for exchange or reallocation surgery were excluded. Each patient had an interview with an EP, and commercial documentation was given. Each source of information was evaluated in a face-to-face interview. SPSS™ version 20.0 was used.

MAIN OUTCOME MEASURES

The EP was evaluated by the International Index of Erectile Function, the Generalized Anxiety Disorder 7 questionnaire, and the Erectile Dysfunction Inventory of Treatment Satisfaction. Each source of information was evaluated by a non-validated 6-section questionnaire.

RESULTS

Ten patients were included. Mean age was 60±10.3 years. Medical interview with the urologist resulted in a global value and truthfulness score of 9.2±.9 and 9.8±.4, respectively. Commercial information had a global score of 8.5±.9 and a truthfulness score of 8.6±.6, while the internet had 6.8±.8 points for global value and 7.2±1 for truthfulness. The global score of the EP was 8.7±1.2 points and their veracity scored 9.6±.5 points.

CONCLUSIONS

The urologist remains the main source of information for patients with erectile dysfunction candidates for penile prosthesis implant. However, the EP is an alternative and could be a key pillar in presurgical counselling.

Evaluation of Adult Acute Scrotum in the Emergency Room: Clinical Characteristics, Diagnosis, Management, and Costs

OBJECTIVE

To evaluate the clinic characteristics, diagnosis, management, and costs of the adult acute scrotum in the emergency room (ER). Acute scrotum is a syndrome characterized by intense, acute scrotal pain that may be accompanied by other symptoms. It is usual in children and commonly found as well in adults, with different causal pathologies between these groups.

METHODS

Between November 2013 and September 2014, 669 cases of adult acute scrotum who presented to our ER were prospectively analyzed. Patients under 15 years of age were excluded. Patient age, reason for consultation, investigations performed, final diagnosis, management, and costs were evaluated. For the statistical analysis, the Mann-Whitney, Kruskal-Wallis U, and chi-square tests were used.

RESULTS

A total of 669 cases of acute scrotum were analyzed. The mean age at presentation was 40.2 ± 17.3 years. The most presented diagnoses were orchiepididymitis (28.7%), epididymitis (28.4%), symptoms of uncertain etiology (25.1%), and orchitis (10.3%). Diagnostic tests were carried out in 57.8% of cases. Most cases were treated as outpatients (94.2%), with 5.83% admitted and 1% undergoing surgical treatment. Overall, 13.3% of patients represented to the ER. Abnormal results in blood and urine tests were more common among older patients and infectious pathologies. The average cost generated by an acute scrotum ER consult was 195.03€.

CONCLUSION

Infectious pathologies are the most common causes of acute scrotum at ER. Abnormal blood and urine tests are unusual and are more common in older patients and infectious pathologies.

ONCO-TESE: Obtaining spermatozoa after radical orchiectomy for testicular tumour and azoospermia

OBJECTIVE

There is the possibility of diagnosing azoospermia in cases of testicular tumours in patients who wish to preserve fertility. Our objective is to present a technique for obtaining spermatozoa from testicles with ex vivo tumours in order to preserve fertility in these patients.

MATERIAL AND METHODS

A 34-year-old patient was referred for azoospermia. The physical examination revealed a node in the lower pole of the left testicle. In the scrotal ultrasound, the testicle presented disperse microcalcifications and a 1-cm hypoechoic mass in the lower pole. The tumour markers were negative, and the CT showed no distant disease. Left radical orchiectomy was performed, along with the placement of a testis prosthesis. Bench surgery was then performed, with extraction of the seminiferous tubules in the upper pole.

RESULTS

Of the submitted samples, 4 progressive and 1 nonprogressive motile spermatozoa were identified per field. Two samples were cryopreserved. The pathological report indicated the presence of a seminoma measuring 1.3 × 1 cm, with free margins and with no invasion of the rete testis (stage I). An assisted reproduction technique (intracytoplasmic sperm injection) was performed on the patient's partner with the frozen spermatozoa, which resulted in pregnancy and the subsequent birth of a healthy child.

CONCLUSION

We propose this technique as the method of choice for obtaining spermatozoa from patients who simultaneously present azoospermia and testicular tumours and who wish to preserve their fertility.

Step-gate polysilicon nanowires field effect transistor compatible with CMOS technology for label-free DNA biosensor

Currently, detection of DNA hybridization using fluorescence-based detection technique requires expensive optical systems and complex bioinformatics tools. Hence, the development of new low cost devices that enable direct and highly sensitive detection stimulates a lot of research efforts. Particularly, devices based on silicon nanowires are emerging as ultrasensitive electrical sensors for the direct detection of biological species thanks to their high surface to volume ratio. In this study, we propose innovative devices using step-gate polycrystalline silicon nanowire FET (poly-Si NW FETs), achieved with simple and low cost fabrication process, and used as ultrasensitive electronic sensor for DNA hybridization. The poly-SiNWs are synthesized using the sidewall spacer formation technique. The detailed fabrication procedure for a step-gate NWFET sensor is described in this paper. No-complementary and complementary DNA sequences were clearly discriminated and detection limit to 1 fM range is observed. This first result using this nano-device is promising for the development of low cost and ultrasensitive polysilicon nanowires based DNA sensors compatible with the CMOS technology.

[Usefulness of new schemes to group Fuhrman grades in clinical practice for clear cell renal tumour]

OBJECTIVE

To evaluate if re-grading renal cell carcinoma (CRCC) in two or three-tiered grading schemes versus the traditional Fuhrman classification maintains the same prognostic value.

MATERIAL AND METHODS

A study of a cohort of 383 treated CRCC with radical or partial nephrectomy between 1990-2009 was made. We analyzed the demographic data, evolution and survival of these patients. An uropathologist reassigned the Fuhrman grades blindly to the first classification. In order to study if the prognostic value was maintained with the different classification, three Cox multivariate regression analysis were performed, classifying the variable of grade into four categories: (I-II-III-IV), into three (I+II-III-IV) and into two (I+II-III+IV). The explanatory variables were: age, gender, tumor size, study stage and grade. The response variables were progression-free survival (local-regional recurrence/metastasis) and cancer specific survival time.

RESULTS

The median overall survival was 125 months (95% CI: 92-159). In the three multivariate analyses carried out, the Fuhrman classification showed independent predictive value (p=:0.0001) compared to progression-free survival and cancer specific survival. The predictive power was maintained in the new classifications. In the three categories, the changing from grade I+II to III meant RR: 2.31 (p=0.0001) and from grade III to IV RR: 2.47 (p=0.0001) and in two-tiered classification an RR: 2.8 (p=0.001) was found when changing from I+II to III+IV.

CONCLUSIONS

Our results show that categorizing the Fuhrman grade into three or two-tiered grading schemes provide the same predictive accuracy on progressive free survival and cancer specific survival. Grades III and IV have different outcomes so that the three-tiered classification seems to be more appropriate to described the course of these patients.