Perioperative outcomes of patients undergoing urological elective surgery during the covid-19 pandemic: A national overview across 28 italian institutions

Introduction: The aim of this study was to assess the safety of elective urological surgery performed during the pandemic by estimating the prevalence of COVID-19-like symptoms in the postoperative period and its correlation with perioperative and clinical factors. Material and methods: In this multicenter, observational study we recorded clinical, surgical and postoperative data of consecutive patients undergoing elective urological surgery in 28 different institutions across Italy during initial stage of the COVID-19 pandemic (between February 24 and March 30, 2020, inclusive). Results: A total of 1943 patients were enrolled. In 12%, 7.1%, 21.3%, 56.7% and 2.6% of cases an open, laparoscopic, robotic, endoscopic or percutaneous surgical approach was performed, respectively. Overall, 166 (8.5%) postoperative complications were registered, 77 (3.9%) surgical and 89 (4.6%) medical. Twenty-eight (1.4%) patients were readmitted to hospital after discharge and 13 (0.7%) died. In the 30 days following discharge, fever and respiratory symptoms were recorded in 101 (5.2%) and 60 (3.1%) patients. At multivariable analysis, not performing nasopharyngeal swab at hospital admission (HR 2.3; CI 95% 1.01-5.19; p = 0.04) was independently associated with risk of developing postoperative medical complications. Number of patients in the facility was confirmed as an independent predictor of experiencing postoperative respiratory symptoms (p = 0.047, HR:1.12; CI95% 1.00-1.05), while COVID-19-free type of hospitalization facility was a strong independent protective factor (p = 0.02, HR:0.23, CI95% 0.07-0.79). Conclusions: Performing elective surgery during the COVID-19 pandemic does not seem to affect perioperative outcomes as long as proper preventive measures are adopted, including nasopharyngeal swab before hospital admission and hospitalization in dedicated COVID-19-free facilities

Impact of gastrointestinal side effects on patients’ reported quality of life trajectories after radiotherapy for prostate cancer: Data from the prospective, observational pros-it CNR study

Radiotherapy (RT) represents an important therapeutic option for the treatment of localized prostate cancer. The aim of the current study is to examine trajectories in patients’ reported quality of life (QoL) aspects related to bowel function and bother, considering data from the PROState cancer monitoring in ITaly from the National Research Council (Pros-IT CNR) study, analyzed with growth mixture models. Data for patients who underwent RT, either associated or not associated with androgen deprivation therapy, were considered. QoL outcomes were assessed over a 2-year period from the diagnosis, using the Italian version of the University of California Los Angeles-Prostate Cancer Index (Italian-UCLA-PCI). Three trajectories were identified for the bowel function; having three or more comorbidities and the use of 3D-CRT technique for RT were associated with the worst trajectory (OR = 3.80, 95% CI 2.04–7.08; OR = 2.17, 95% CI 1.22–3.87, respectively). Two trajectories were identified for the bowel bother scores; diabetes and the non-Image guided RT method were associated with being in the worst bowel bother trajectory group (OR = 1.69, 95% CI 1.06–2.67; OR = 2.57, 95% CI 1.70–3.86, respectively). The findings from this study suggest that the absence of comorbidities and the use of intensity modulated RT techniques with image guidance are related with a better tolerance to RT in terms of bowel side effects

Disease-specific and general health-related quality of life in newly diagnosed prostate cancer patients: The Pros-IT CNR study

Background: The National Research Council (CNR) prostate cancer monitoring project in Italy (Pros-IT CNR) is an observational, prospective, ongoing, multicentre study aiming to monitor a sample of Italian males diagnosed as new cases of prostate cancer. The present study aims to present data on the quality of life at time prostate cancer is diagnosed. Methods: One thousand seven hundred five patients were enrolled. Quality of life is evaluated at the time cancer was diagnosed and at subsequent assessments via the Italian version of the University of California Los Angeles-Prostate Cancer Index (UCLA-PCI) and the Short Form Health Survey (SF-12). Results: At diagnosis, lower scores on the physical component of the SF-12 were associated to older ages, obesity and the presence of 3+ moderate/severe comorbidities. Lower scores on the mental component were associated to younger ages, the presence of 3+ moderate/severe comorbidities and a T-score higher than one. Urinary and bowel functions according to UCLA-PCI were generally good. Almost 5% of the sample reported using at least one safety pad daily to control urinary loss; less than 3% reported moderate/severe problems attributable to bowel functions, and sexual function was a moderate/severe problem for 26.7%. Diabetes, 3+ moderate/severe comorbidities, T2 or T3-T4 categories and a Gleason score of eight or more were significantly associated with lower sexual function scores at diagnosis. Conclusions: Data collected by the Pros-IT CNR study have clarified the baseline status of newly diagnosed prostate cancer patients. A comprehensive assessment of quality of life will allow to objectively evaluate outcomes of different profile of care

Endovascular treatment of infrarenal abdominal aortic aneurysms using automated carbon dioxide angiography (Angiodroid): a preliminary monocentric study.

reservedObiettivo: Nonostante l’evidenza di buoni risultati in campo endovascolare, l’utilizzo della CO2, viene spesso limitato ai pazienti affetti da insufficienza renale o allergia al mezzo di contrasto, nei quali quest’ultimo potrebbe provocare un peggioramento clinico. L’obiettivo di questo studio è stato valutare l’efficacia dell’utilizzo routinario della CO2 negli EVAR. Metodi: è stata eseguita un’analisi retrospettiva monocentrica dei pazienti sottoposti ad EVAR con CO2 per il trattamento di aneurismi dell’aorta addominale sottorenale presso l’unità di chirurgia vascolare dell’Ospedale Mater Salutis di Legnago (VR) da Settembre 2023 a Settembre 2024. I dati sono stati comparati con quelli dei pazienti sottoposti ad EVAR con mezzo di contrasto nello stesso periodo di tempo. Gli EVAR con CO2 sono stati eseguiti con un iniettore automatico digitale (Angiodroid SRL). L’obiettivo primario è stato valutare il successo tecnico della procedura EVAR con CO2. Obiettivo secondario è stato confrontare la variazione della creatinina sierica pre e post-operatoria tra EVAR eseguiti con mezzo di contrasto iodato e CO2. E’ stata inoltre ricercata la presenza di fattori predittivi per la visualizzazione delle renali, nonché la presenza di complicanze intra o post-operatorie maggiori o minori. Risultati: 26 pazienti sono stati sottoposti ad EVAR in elezione tra Settembre 2023 e Settembre 2024. Il successo tecnico è stato del 100% nel gruppo di pazienti sottoposti ad EVAR CO2. Non sono state documentate differenze statisticamente significative nel delta di creatinina sierica pre e post-operatoria tra i due gruppi (p = 0.858). L’arteria renale inferiore è stata visualizzata nel 66,7% dei casi. Non sono stati identificati valori predittivi di visualizzazione delle renali. Non si sono verificati eventi avversi maggiori, mentre l’80% dei pazienti sottoposti ad EVAR con CO2 in anestesia loco-regionale sono andati incontro ad eventi avversi minori (nausea, vomito e ipotensione) senza conseguenze e regrediti nel giro di pochi minuti. Conclusioni: Gli EVAR con CO2 possono essere efficacemente eseguiti concentrazioni inferiori di MdC rispetto a quelle richieste per gli EVAR con MdC. L’anestesia loco-regionale, pur creando maggiore discomfort per il paziente, rappresenta spesso una garanzia per la sua sicurezza. Trattandosi di una popolazione esigua non è stata riscontrata alcuna correlazione statisticamente significativa tra caratteristiche anatomiche e visualizzazione dell’arteria renale inferiore.Objective: Despite the evidence of good results with CO2, its use is often limited to patients suffering from renal failure or allergy to iodinated contrast medium, in which the latter could cause clinical worsening. A study was conducted to evaluate the effectiveness of routinely using CO2 in EVARs. Methods: A single-center retrospective analysis was performed of patients undergoing EVAR with CO2 for the treatment of infrarenal abdominal aortic aneurysms at the vascular surgery unit of the Mater Salutis Hospital in Legnago (VR) from September 2023 to September 2024. Comparisons were made with those of patients who underwent EVAR with contrast media during the same time frame. CO2-EVAR was performed using an automated injector (Angiodroid SRL). Primary objective was to evaluate the technical success of the CO2-EVAR procedure. Secondary objective was to compare serum creatinine variation between EVAR performed with iodinated contrast medium and CO2. The presence of predictive factors for visualization of the kidneys was also sought, as well as the presence of major or minor intra or post-operative complications. Results: 26 patients underwent elective EVAR between September 2023 and September 2024. Technical success was 100% in the group of patients subjected to CO2 -EVAR. No statistically significant differences in pre and post procedural serum creatinine were documented between the two groups (p = 0.858). Lowest renal artery was visualized in 66.7% of cases. No predictive values for renal visualization have been identified. No major adverse events occurred, while 80% of patients undergoing EVAR with CO2 under regional anesthesia experienced minor adverse events (nausea, vomiting and hypotension). Conclusions: CO2-EVAR can effectively run lower concentrations of contrast medium than those required for contrast-enhanced EVAR. Local-regional anesthesia, although creating greater discomfort for the patient, often represents a guarantee of his safety. Since the small population, no statistically significant correlation was found between anatomical characteristics and visualization of the lowest renal artery

Spondylodiscitis: A Rare Complication following Percutaneous Nephrostomy

Spondylodiscitis is an inflammation of the intervertebral disc and the adjacent vertebral bodies. The spondylodiscitis can not only be a complication of medical interventions such as an operation near spinal column but also urogenital and vascular interventions and intravenous catheter use. A 71-year-old man was admitted to our emergency department with fever and severe abdominal pain. Antibiotic therapy had been performed with intravenous administration of 2 g of ceftriaxone and the patient underwent the placement of a percutaneous nephrostomy according to Seldinger technique. After 1 week, the patient experienced a severe pain at the lumbar tract of the vertebral column associated with a moderate abdominal pain and septic fever. A magnetic resonance imaging (MRI) of the lumbar spine showed widespread impregnation of the upper portion of L3 and the lower portion of L2 compressing the spinal roots as well as the ileopsoas muscle such as a spondylodiscitis. Liquor culture showed an increase of liquor immunoglobulin G, total liquor protein and was positive for Extended-spectrum beta-lactamases (ESBL) - producing Escherichia coli. After the antibiotic therapy, the spondylodiscitis resolves without important sequelae. In the present case report, we describe a very rare complication of percutaneous nephrostomy tube placement, despite of the prophylactic antibiotic therapy according to the most recent guidelines. Predisposing factors to spondylodiscitis include the very young and elderly, the immunosuppressed, diabetic individuals and a general debilitating disease such as renal failure. This case suggests the importance of remembering spondylodiscitis when septic fever and back pain occurs following the placement of a percutaneous nephrostomy in a septic patient. </jats:p