Postoperative Delirium after Urological Surgery: A Literature Review

Purpose: We aimed to thoroughly search and identify studies referring to risk factors associated with postoperative delirium (POD) in patients undergoing open as well as en-doscopic urological surgery. Methods: The review after a systematic literature search included 5 studies. Results: The incidence of POD was reported to be between 7.8 and 30% depending on the type of the urologic surgery, while in the majority of the studies the onset happened on the first postoperative day and the symptoms lasted 3 ± 0.8 days. Seventeen different risk factors for POD were identified and presented in detail. Conclusion: The Mini-Mental State Examination score and older age were significantly associated with the development of POD. However, the Confusion Assessment Method is very well validated against the diagnosis of delirium from the specialists. © 2019 S. Karger AG, Basel

Single lower calyceal percutaneous tract combined with flexible nephroscopy: A valuable treatment paradigm for staghorn stones

Introduction: We evaluated the efficacy and safety of single lower calyceal tract combined with flexible nephroscopy for the management of staghorn renal stones by percutaneous nephrolithotomy. Methods: The medical records of patients who underwent percutaneous nephrolithotomy for the management of staghorn stones were analyzed. We included patients aged >18 years, while patients with incomplete data and renal anatomical anomalies were excluded from the study. Stone-free rate, postoperative complications, procedure duration, fluoroscopy time, and length of hospitalization were recorded. Postoperative outcomes were evaluated by non-contrast computed tomography scan 4-6 weeks after the operation. Stonefree status was defined as the absence of residual stones >4 mm. Results: The study cohort consisted of 103 consecutive patients. Stonefree rate was 65.0%. No complications were observed in 69.9% of the cases; most postoperative complications were Grade 1 (13.6%) and 2 (10.7%). Five patients (4.9%) suffered a Grade 3a complication and another patient (1.0%) suffered a Grade 3b complication. Conclusions: Percutaneous nephrolithotomy through a single lower calyceal tract combined with flexible nephroscopy can be a valuable treatment option for the treatment of staghorn calculi, providing efficacy and safety. Nevertheless, the present study is limited by both its retrospective nature and being conducted at a single centre and, thus, proper prospective studies with head-on comparisons are needed to prove or disprove the advantages and disadvantages of either approach. © 2018 Canadian Urological Association

Determination of the effect of pressure on viscosity at high shear rates by using an injection molding machine

The effect of pressure on rheological behavior of polymer melts is surely a significant phenomenon for polymer processing, and its determination has been the object of several studies which highlighted the difficulties in performing accurate measurements. Even more important is the determination of this effect at very high shear rates, which cannot easily be obtained by conventional rheometers. In this work, a slit rheometer was located at the nozzle of the injection molding machine to obtain rheological measurements by means of two pressure transducers. Pressure values were analyzed by an original method to evaluate the pressure coefficient and the viscosity at zero pressure. The zero pressure viscosity aligned with independent rheological measurements obtained in previous works. The effect of pressure on viscosity was described by means of a parameter whose values resulted to be in line with those obtained in previous works, although the highest shear rates explored in this work were at least one order of magnitude larger. © 2017 Wiley Periodicals, Inc. J. Appl. Polym. Sci. 2017, 134, 45277

External validation of Resorlu–Unsal stone score as predictor of outcomes after retrograde intrarenal surgery

Purpose: To externally validate Resorlu–Unsal stone score (RUSS) and to evaluate its predictive accuracy. Methods: Data of patients who underwent retrograde intrarenal surgery (RIRS) between October 2013 and June 2015 were collected. RUSS was applied to all patients, and the nomogram was externally validated. Area under the curve (AUC) was used for clinical validity assessment. Results: A total of 85 patients were included in the study. Mean patient age was 54.3 ± 16.5, and mean stone size was 12.0 ± 6.21 mm. After applying RUSS, 56.5, 28.2, 9.41, and 5.88 % had score 0, 1, 2, and 3, respectively. RUSS was significantly associated with stone location and size. Postoperative stone-free rate was 74.1 %. Postoperative outcomes were significantly associated with RUSS and stone size. RUSS was found to be the only significant independent predictor in multivariate analysis, while it provided high predictive accuracy with an estimated AUC of 0.707. Conclusions: RUSS is a simple scoring system that may predict postoperative stone-free rate after RIRS with great efficacy and accuracy. © 2016, Springer Science+Business Media Dordrecht

Hyaluronic acid and hyaluronidase as possible novel urine biomarkers for the diagnosis of prostate cancer

The goal of the study is to examine the possible use of HA (hyaluronic acid) and HAase (hyaluronidase) as novel urine biomarkers for the early diagnosis for prostate cancer (Pca). After a prostatic massage, the urine of 118 high-risk patients for Pca was collected, and the patients were submitted to ultrasound-guided transrectal biopsy. HA and HAase were detected and analyzed with Enzyme-Linked Immunosorbent Assay, and a statistical analysis of the urine levels of the two biomarkers according to the histology results was performed. HAase and HA were independently associated with Pca, and both HAase and HA showed significant predictive ability for prostate cancer. With an optimal cut-off point of 183.71 HAase had 70% sensitivity maintaining at the same time a 55.2% specificity, while the optimal cut-off point for HA was 50.13 with 65% sensitivity and 53.9% specificity. Patients with HAase more than 183.71 ng/ml had 3.67 times greater likelihood for prostate cancer and Patients with HA more than 50.13 ng/ml had 2.31 times greater likelihood for prostate cancer. The need of novel biomarkers that will improve the efficacy of PSA is urgent. HAase and HA showed significant predictive ability for prostate cancer and were independently associated with Pca, and greater levels were associated with greater odds for prostate cancer. To Our Knowledge, this is the first study referring to the detection of HAase and HA as potential urine biomarkers for the early diagnosis of Pca. © 2018, Springer Science+Business Media, LLC, part of Springer Nature

Comparing the efficacy and safety of 365- and 550-μm laser fibers in semirigid ureteroscopic Ho:YAG lithotripsy

Purpose: To compare the efficacy and safety of 365- and 550-μm Ho:YAG laser fiber in semirigid ureteroscopic lithotripsy and to identify parameters that may affect laser energy and time during the procedure. Methods: A database of 111 patients who undergone a semirigid ureteroscopy (SRURS) for ureteral stone lithotripsy was analyzed. A 365-μm core fiber was used in 56 cases, and a multiple-uses 550-μm laser fiber was used in 55 cases. A standard 6.4 W protocol (8 Hz, 0.8 J/pulse) was used in all cases. The association between laser fiber diameter and several preoperative, intraoperative and postoperative parameters was evaluated. Results: Mean stone burden was 54.1 ± 39.1 mm2, and postoperative stone-free and complication rate was 100.0 and 16.2 %, respectively. The 550-μm laser fiber diameter was significantly associated with lower laser energy (p = 0.01), energy/mm3 (p = 0.031), number of pulses (p = 0.012), laser time (p = 0.012) and laser time/mm3 (p = 0.043), while it did not affect postoperative outcomes. The multivariate analysis showed that shorter procedure duration, smaller stone burden and the 550-μm laser fiber were all significant independent predictors for decreased laser energy consumption. Conclusion: The 550-μm laser fiber may decrease laser energy and time during SRURS lithotripsy with Ho:YAG laser compared to the 365 μm. Given its lower cost, it may represent the optimal choice for semirigid procedures. © 2015, Springer Science+Business Media Dordrecht

Detecting Novel Urine Biomarkers for the Early Diagnosis of Prostate Cancer: Platelet Derived Growth Factor-BB as a Possible New Target

Introduction: Although the prostate specific antigen revolutionized the diagnosis of prostate cancer (PCa), it has its limitations. We prospectively examined the potential use of the platelet-derived growth factor-BB (PDGF-BB) as a urine biomarker for the early diagnosis of PCa. Materials and Methods: The urine samples of 118 patients were collected after a prostatic massage and all the patients subsequently underwent ultrasound-guided transrectal biopsy. PDGF-BB was detected in the urine by enzyme-linked immunosorbent assay. Results: Patients with PCa had greater levels of prostate specific antigen and PDGF-BB. Receiver operating characteristic curve analysis showed that the optimal cut-of of PDGF-BB for the prediction of PCa was 1,504.9 with a sensitivity of 60% and a specificity of 51.3%. For a 100 unit increase in PDGF-BB, the likelihood for PCa increased about 4%. Conclusion: PDGF-BB showed a significant predictive ability for PCa. Detection of PDGF-BB in urine with Elisa was easy and improved our diagnostic accuracy in the diagnosis of PCa. © 2018 2018 The Author(s) Published by S. Karger AG, Basel