[Magnetic resonance pyelography: optimization of the technic and the preliminary results].

Magnetic resonance pyelography (MRP) is a new noninvasive method which demonstrates dilated urinary tracts with no need of contrast agent injection. This study was aimed at technique optimization, using new fast sequences with high intrinsic contrast, to demonstrate the urinary tract in obstructive uropathy patients. Twelve consecutive patients and 4 healthy volunteers were included in this prospective study; all the exams were performed with a high gradient power 0.5-T unit using T2- weighted turbo SE sequences, acquired three-dimensionally on the coronal plane. Obstructive uropathy was caused in 9 patients by neoplastic lesions, in 2 by postoperative strictures and in 1 by inflammatory tissue. In all patients MRP depicted the dilated urinary tract optimally, with good morphological detailing and the accurate assessment of both level and cause of obstruction. In the healthy volunteers, the absence of dilatation did not permit the complete visualization of the urinary tract. To conclude, MRP is a new technique which permits high-quality imaging of the urinary tract. Further studies are needed to assess its actual potentials and clinical role

[Assessment of renal function using low doses of paramagnetic contrast media].

Dynamic MR techniques with Gd-DTPA bolus administration can be used to study renal perfusion and function. In previous studies, the concentration of Gd-DTPA injected was never lower than 0.1 mmol/kg: as a result, depending on the magnetic susceptibility effect, renal signal intensity reduced in the early phases, right after contrast agent injection. To prevent signal intensity from reducing in the early phases, in our study we used a concentration of 0.05 mmol/kg. Qualitative and quantitative evaluations were performed. Seven healthy subjects and 14 patients with different degrees of renal insufficiency were enrolled in the study. All exams were performed using an 0.5-T magnet (Philips Gyroscan T5, II), with 15 mT/m gradient power. Signal intensity measurements at the cortical, external medullary and internal medullary levels, allowed the drawing of curves typical of each degree of renal insufficiency which correlated well with nuclear medicine (scintigraphy) findings. The qualitative evaluation provided results comparable with scintigraphic findings in all 7 normal subjects, in 3 of 4 cases of moderate renal insufficiency, in all 7 cases of moderate/severe renal insufficiency and in the only case of severe renal insufficiency. To conclude, this trial demonstrates the feasibility of MR studies of renal function, which provide morphological and functional pieces of information. Low concentration Gd-DTPA is decisive to avoid the magnetic susceptibility artifacts observed in previous studies

A ten-year observational study of the use of two-way catheters post-transurethral resection of the prostate without the use of post-op irrigation

Background: Over 15,000 transurethral resections of the prostate (TURP) are performed annually in the United Kingdom. It is therefore vital that every aspect of peri-operative care be optimised. Our centre favours the use of two-way catheters post-operatively without the use of continuous bladder irrigation (CBI). Objectives: To evaluate our practice of using two-way catheters without irrigation post-TURP and to determine impact on patient care compared with standard three-way catheterisation. Our primary outcome was duration of admission, but multiple secondary outcomes were also analysed. Design, setting, and participants: This was a prospective observational study. Every patient undergoing TURP at our centre from 2009 to 2019 was included. Following TURP patients were catheterised with two-way catheters. Prospective patient data were collected pertaining to peri-operative factors. These data were then compared with the data published in the literature. Results: 687 patients underwent TURP at our centre between 2009 and 2019. The average age of patients was 71.42 (±7.89). 87.17% (n = 598) had two-way catheters placed post-operatively. Average duration of admission was 1.61 (±1.35) days, increasing to 2.20 days if patients required three-way catheters or 2.53 days if requiring CBI. TWOC was successful in 97.71% of patients. Complication rate was 8.73% (n = 60). When compared with other centres, our method reduced lengths of admission and transfusion rates (1.6 days versus 3.1 days and 0.87% versus 2.83%, respectively). Conclusion: Our method is safe and is associated with a reduced length of admission. We recommend this practice to the wider urological community. Patient summary: This study looked at whether there was any impact on patients if two-way catheters were used following TURP. We found that use of two-way catheters reduced length of admission and duration of catheterisation. We also found that it did not increase likelihood of peri-operative complications in comparison with other centres

Serenoa repens + selenium + lycopene vs tadalafil 5 mg for the treatment of lower urinary tract symptoms secondary to benign prostatic obstruction: a Phase IV, non-inferiority, open-label, clinical study (SPRITE study)

Objective: To compare in a randomised, open-label, non-inferiority clinical study, the efficacy and tolerability of Serenoa repens (SeR) + selenium (Se) + lycopene (Ly) (SeR-Se-Ly) therapy vs tadalafil 5 mg in men with lower urinary tract symptoms (LUTS). Patients and methods: From May 2015 to January 2017, 427 patients were enrolled in 21 different centres (International Standard Randomised Controlled Trial Number Register [ISRCTN] 73316039). Inclusion criteria included: age between 50 and 80 years, International Prostate Symptom Score (IPSS) 6512, maximum urinary flow rate (Q max ) 64 15 mL/s, and post-void residual (PVR) <100 mL. Patients were randomised into two groups in a 2:1 ratio: Group A (SeR-Se-Ly, 1 tablet daily for 6 months) and Group B (tadalafil 5 mg, 1 tablet daily for 6 months). The primary endpoint of the study was the non-inferior variation in the IPSS and Q max in Group A vs Group B after 6 months of treatment. Results: In all, 404 patients completed the full protocol. When comparing both therapies, Group A was statistically not inferior to Group B considering the median change in IPSS ( 123.0 vs 123.0; P < 0.01), IPSS quality of life ( 122.0 vs 122.0; P < 0.05), and Q max (2.0 vs 2.0 mL/s; P < 0.01). We found statistically significant differences in the increase of at least 3 points in Q max (38.2% vs 28.1%; P = 0.04) and of at least 30% of Q max (39.2% vs 27.3%; P < 0.01) in Group A compared to Group B. The percentage of patients with an increase of at least 3 points in the IPSS and a decrease of at least 25% of the IPSS was not statistically different between the two groups. For adverse events, four patients in Group A (1.44%) and 10 in Group B (7.81%) (P < 0.05) reported side-effects. Conclusion: We have shown that treatment with SeR-Se-Ly was not inferior to tadalafil 5 mg for improving IPSS and Q max in men with LUTS