The impact of ventral oral graft bulbar urethroplasty on sexual life

Objective: To evaluate the pre- and postoperative aspects of sexual life (SL) in patients with bulbar urethral stricture who underwent ventral oral graft urethroplasty. Methods: Between 2009 and 2010, 52 men (mean age 36 years) were enrolled in our prospective study to ascertain sexual disorders before and after surgery. The validated Male Sexual Health Questionnaire-Long Form (MSHQ-LF) was completed pre- and postoperatively; the unvalidated but adapted Post-Urethroplasty Sexual Questionnaire (PUSQ) was completed postoperatively. Data were compared using the non parametric Wilcoxon test. Results: Before urethroplasty, most of the patients reported sexual disorders, in particular reduced ejaculatory stream (85%); many of them (35%) feared the risk of a postoperative worsening in the quality of SL. After urethroplasty, nobody reported a worsened erection, while most of the patients noticed a significant improvement in erection, ejaculation, relationship with their partner, sexual activity, and desire. Modifications in the scrotoperineal sensitivity were reported by 42% and 15% noticed esthetic changes without impact on SL. All patients reported an improvement in quality of life (QOL) and were satisfied with the outcome of urethroplasty. Conclusion: Urethral stricture disease may be responsible for sexual disorders that have a significant impact upon SL. Patients confessed a marked anxiety tackling urethroplasty and declared that one of their deepest fears regarded a potential further deterioration in the quality of SL. At short-term follow-up, the minimally invasive ventral graft urethroplasty does not cause sexual complications, apart from the post-ejaculation dribbling. On the contrary, this technique showed to restore SL in all its aspects

Comparison between Two Different Two-Stage Transperineal Approaches to Treat Urethral Strictures or Bladder Neck Contracture Associated with Severe Urinary Incontinence that Occurred after Pelvic Surgery: Report of Our Experience

Introduction. The recurrence of urethral/bladder neck stricture after multiple endoscopic procedures is a rare complication that can follow prostatic surgery and its treatment is still controversial. Material and Methods. We retrospectively analyzed our data on 17 patients, operated between September 2001 and January 2010, who presented severe urinary incontinence and urethral/bladder neck stricture after prostatic surgery and failure of at least four conservative endoscopic treatments. Six patients underwent a transperineal urethrovesical anastomosis and 11 patients a combined transperineal suprapubical (endoscopic) urethrovesical anastomosis. After six months the patients that presented complete incontinence and no urethral stricture underwent the implantation of an artificial urethral sphincter (AUS). Results. After six months 16 patients were completely incontinent and presented a patent, stable lumen, so that they underwent an AUS implantation. With a mean followup of 50.5 months, 14 patients are perfectly continent with no postvoid residual urine. Conclusions. Two-stage procedures are safe techniques to treat these challenging cases. In our opinion, these cases could be managed with a transperineal approach in patients who present a perfect operative field; on the contrary, in more difficult cases, it would be preferable to use the other technique, with a combined transperineal suprapubical access, to perform a pull-through procedure

Safety and feasibility of thullium laser transurethral resection of prostate for the treatment of benign prostatic enlargement in overweight patients

Objective: We aimed to determine safety and feasibility of thulium laser transurethral vapoenucleation of prostate (ThuVEP) for treatment of obese patients affected by benign prostatic hyperplasia (BPH). Methods: We retrospectively analysed data of 452 patients with BPH who underwent ThuVEP from February 2012 to March 2016 in a single center. Patients were divided into three groups according to body mass index (BMI, kg/m2): Normal weight (18.5 64 BMI < 25; Group A), overweight (25 64 BMI < 30; Group B) and obese (BMI 65 30; Group C), for a total of 412 patients evaluable for this study. Preoperative total serum prostate-specific antigen (PSA), digital rectal examination of the prostate, transrectal ultrasound (TRUS), renal ultrasound, urine culture, uroflowmetry, International Prostate Symptoms Score (IPSS), and Quality of Life (QoL) score were analyzed. Post-operative complications, hospital stay and days of catheterization, questionnaires and uroflowmetry at 1 and 3 months after surgery were evaluated. Preoperative data, surgical outcomes, complication rate and clinical outcomes were compared between groups. Results: The median age of patients was 69 years (Interquartile Range [IQR 10]). The preoperative median IPSS among groups was 19 (IQR 8.75), 20 (IQR 10), and 18 (IQR 10) respectively. At 1 and 3 months of follow-up, this value was 8 (IQR 7), 8 (IQR 4), 7 (IQR 5) and 5 (IQR 6.25), 5 (IQR 6), 6 (IQR 5), respectively (all p between groups > 0.05). There was no statistically significant difference among three groups as for hospital stay and days of catheterization (p > 0.05). Conclusion: Our results showed that ThuVEP was safe and feasible even in overweight patients with substantially enlarged prostate

Does Exist a Differential Impact of Degarelix Versus LHRH Agonists on Cardiovascular Safety? Evidences From Randomized and Real-World Studies

The main systemic therapy for the management of hormone-sensitive prostate cancer (PC) is androgen deprivation therapy (ADT), with the use of long-acting luteinizing hormone releasing-hormone (LHRH) agonists considered the main form of ADT used in clinical practice to obtain castration in PC. The concomitant administration of antiandrogens for the first weeks could reduce the incidence of clinical effects related to the testosterone flare-up in the first injection of LHRH. On the contrary, Gonadotropin Rh (GnRH) antagonists produce a rapid decrease of testosterone levels without the initial flare-up, with degarelix commonly used in clinical practice to induce castration in PC patients. Even if no long-term data are reported in terms of survival to define a superiority of GnRH or LHRH, for oncological efficacy and PC control, data from randomized clinical trials and from real-life experiences, suggest a difference in cardiovascular risk of patients starting ADT. The age-related decline in testosterone levels may represent a factor connected to the increase of cardiovascular disease risk, however, the role of ADT in increasing CV events remains controversial. For these reasons, the aim of the paper is to synthesize the difference in cardiovascular risk between LHRH and degarelix in patients undergoing ADT. A difference in cardiovascular risk could be indeed an important parameter in the evaluation of these two forms of castration therapy. The Randomized trials analyzed in this paper sustain a possible protective role for degarelix versus LHRH agonists in reducing the rate of new CV events and interventions in the short-term period. On the contrary, real-word data are contradictory in different national experiences and are strongly conditioned by huge differences between the LHRH agonists group and the degarelix group

An optimized derivative of an endogenous CXCR4 antagonist prevents atopic dermatitis and airway inflammation

Aberrant CXCR4/CXCL12 signaling is involved in many pathophysiological processes such as cancer and inflammatory diseases. A natural fragment of serum albumin, named EPI-X4, has previously been identified as endogenous peptide antagonist and inverse agonist of CXCR4 and is a promising compound for the development of improved analogues for the therapy of CXCR4-associated diseases. To generate optimized EPI-X4 derivatives we here performed molecular docking analysis to identify key interaction motifs of EPI-X4/CXCR4. Subsequent rational drug design allowed to increase the anti-CXCR4 activity of EPI-X4. The EPI-X4 derivative JM#21 bound CXCR4 and suppressed CXCR4-tropic HIV-1 infection more efficiently than the clinically approved small molecule CXCR4 antagonist AMD3100. EPI-X4 JM#21 did not exert toxic effects in zebrafish embryos and suppressed allergen-induced infiltration of eosinophils and other immune cells into the airways of animals in an asthma mouse model. Moreover, topical administration of the optimized EPI-X4 derivative efficiently prevented inflammation of the skin in a mouse model of atopic dermatitis. Thus, rationally designed EPI-X4 JM#21 is a novel potent antagonist of CXCR4 and the first CXCR4 inhibitor with therapeutic efficacy in atopic dermatitis. Further clinical development of this new class of CXCR4 antagonists for the therapy of atopic dermatitis, asthma and other CXCR4-associated diseases is highly warranted

A multivariate spatial interpolation of airborne {\gamma}-ray data using the geological constraints

In this paper we present maps of K, eU, and eTh abundances of Elba Island (Italy) obtained with a multivariate spatial interpolation of airborne {\gamma}-ray data using the constraints of the geologic map. The radiometric measurements were performed by a module of four NaI(Tl) crystals of 16 L mounted on an autogyro. We applied the collocated cokriging (CCoK) as a multivariate estimation method for interpolating the primary under-sampled airborne {\gamma}-ray data considering the well-sampled geological information as ancillary variables. A random number has been assigned to each of 73 geological formations identified in the geological map at scale 1:10,000. The non-dependency of the estimated results from the random numbering process has been tested for three distinct models. The experimental cross-semivariograms constructed for radioelement-geology couples show well-defined co-variability structures for both direct and crossed variograms. The high statistical correlations among K, eU, and eTh measurements are confirmed also by the same maximum distance of spatial autocorrelation. Combining the smoothing effects of probabilistic interpolator and the abrupt discontinuities of the geological map, the results show a distinct correlation between the geological formation and radioactivity content. The contour of Mt. Capanne pluton can be distinguished by high K, eU and eTh abundances, while different degrees of radioactivity content identify the tectonic units. A clear anomaly of high K content in the Mt. Calamita promontory confirms the presence of felsic dykes and hydrothermal veins not reported in our geological map. Although we assign a unique number to each geological formation, the method shows that the internal variability of the radiometric data is not biased by the multivariate interpolation.Comment: 43 pages, 9 figures, 5 tables. In Remote Sensing of Environment (2013

Un plan museológico para un museo virtual: MuVA-PROMU, UNC

Aunque existen museos que cuentan con tecnología digital en sus exposiciones o en su web, el MuVA –Museo Virtual de Arquitectura de Córdoba-, se acerca más a aquellos que carecen de una contraparte real. Dado que un plan museológico es, o puede llegar a ser -según Fernando Sáez Lara-, una herramienta de reflexión, motivación, organización interna, relación con las instituciones y evaluación, el MuVA ha avanzado en el desarrollo de su Plan Museológico asociado a otras alternativas como el Plan de Actuación, para adaptarse a la gestión de un museo totalmente virtual, cuyo documento final sirve de base a la presente comunicación. Elaborado el diagnóstico en el 2015 –perfil de la institución, colecciones, patrones expositivos, difusión, arquitectura, seguridad, RRHH, informáticos y económicos-, el Plan revisó la Misión y Visión del museo, y propuso las categorías de colecciones –Virtual Principal, Virtual Destacada-, la re-definición de salas virtuales y los patrones de acceso digital a las colecciones, para establecer finalmente las líneas estratégicas –educación, conservación y comunicación-, que debe abordar el Plan de Actuación 2015-2020.Eje 1: Políticas para la gestión de los museos universitarios.Red de Museos de la Universidad Nacional de La Plat

Un plan museológico para un museo virtual: MuVA-PROMU, UNC

Aunque existen museos que cuentan con tecnología digital en sus exposiciones o en su web, el MuVA –Museo Virtual de Arquitectura de Córdoba-, se acerca más a aquellos que carecen de una contraparte real. Dado que un plan museológico es, o puede llegar a ser -según Fernando Sáez Lara-, una herramienta de reflexión, motivación, organización interna, relación con las instituciones y evaluación, el MuVA ha avanzado en el desarrollo de su Plan Museológico asociado a otras alternativas como el Plan de Actuación, para adaptarse a la gestión de un museo totalmente virtual, cuyo documento final sirve de base a la presente comunicación. Elaborado el diagnóstico en el 2015 –perfil de la institución, colecciones, patrones expositivos, difusión, arquitectura, seguridad, RRHH, informáticos y económicos-, el Plan revisó la Misión y Visión del museo, y propuso las categorías de colecciones –Virtual Principal, Virtual Destacada-, la re-definición de salas virtuales y los patrones de acceso digital a las colecciones, para establecer finalmente las líneas estratégicas –educación, conservación y comunicación-, que debe abordar el Plan de Actuación 2015-2020.Eje 1: Políticas para la gestión de los museos universitarios.Red de Museos de la Universidad Nacional de La Plat