The modified Clavien classification system: a standardized platform for reporting complications in transurethral resection of the prostate

The aim of the study was to evaluate the applicability of the modified Clavien classification system (CCS) in grading perioperative complications of transurethral resection of the prostate (TURP). All patients with benign prostatic hyperplasia submitted to monopolar TURP from January 2006 to February 2008 at a non-academic center were evaluated for complications occurring up to the end of the first postoperative month. All complications were classified according to the modified CCS independently by two urologists, and the final decision was based on consensus. If multiple complications per patient occurred, categorization was done in more than one grade. Results were presented as complication rates per grade. Forty-four complications were recorded in 31 out of 198 patients (overall perioperative morbidity rate: 15.7%), and their grading was generally easy, non-time-consuming and straightforward. Most of them were classified as grade I (59.1%) and II (29.5%). Higher grade complications were scarce (grade III: 2.3% and grade IV: 6.8%, respectively) There was one death (grade V: 2.3%) due to acute myocardial infarction (overall mortality rate: 0.5%). Negative outcomes such as mild dysuria during this early postoperative period or retrograde ejaculation were considered sequelae and were not recorded. Nobody was complicated with severe dysuria. There was one re-operation due to residual adenoma (0.5%). The modified CCS represents a straightforward and easily applicable tool that may help urologists to classify the complications of TURP in a more objective and detailed way. It may serve as a standardized platform of communication among clinicians allowing for sound comparison

Emorragia renale spontanea in paziente in emodialisi per nefropatia cistica acquisita: descrizione di un caso e revisione della letteratura

In questo articolo si descrive un raro caso clinico di emorragia renale spontanea in paziente con nefropatia cistica acquisita in emodialisi. Si prospettano le opinioni moderne circa il trattamento di questa situazione rara sulla base di una breve revisione della letteratura

Unusual case of multilocular cystic renal cell carcinoma treated with nephron-sparing technique

Il nefroma multiloculare cistico è una lesione benigna relativamente rara del rene da ascrivere al gruppo delle malatie cistiche non genetiche. Sia la presentazione clinica che l’ imaging radiologica non sono caratteristici e la diagnosi esatta si fa solo con l’esame istologico definitivo del pezzo asportato. Presentiamo un caso di nefroma cistico multiloculare (MLCN) con foci di carcinoma a cellulle chiare. La diagnosi differenziale tra MLCN e altre malattie cistiche del rene è difficile perché la fenomenologia clinica non è specifica e l’imaging non consente una corretta diagnosi. Anche se il MLCN è una malattia benigna, ci sono alcune rare pubblicazioni nella letteratura medica in cui si descrivono casi di carcinoma. Il nostro paziente è libero da malattia 12 anni dopo l’ intervento chirurgico di exeresi

The effectiveness of a scientific symposium to change urologists' attitude towards treatment of LUTS/BPH

Purpose The use of interactive voting systems in continuing education helps to evaluate the alteration in the audience’s views after a presentation. This study was designed to evaluate whether urologists’ attitude towards management of benign prostate hyperplasia can be changed, and to estimate objectively the achievement of educational goals by using an interactive voting system. Methods The audience attitude was repetitively estimated by responding to questions using wireless keypads. Educational goal achievement was calculated by adding the percentage of those changing their opinion from “wrong” to “right” and that of those insisting on their initial “right” opinion. Results Giving a “wrong” answer and the probability of opinion change were independent of age and board certification. Being initially on the “wrong” side resulted in a greater probability of opinion change. The educational goals were achieved in 20.8-86.2% of cases. Conclusions Satellite symposia are helpful learning environments. The use of an interactive voting system may help to evaluate objectively the achievement of educational goals

Extracorporeal shock wave lithotripsy in the treatment of pediatric urolithiasis: a single institution experience

PURPOSE: To compare the efficacy and safety of the electromagnetic lithotripter in the treatment of pediatric lithiasis to that of the earlier electrohydraulic model. MATERIALS AND METHODS: Two groups of children with lithiasis aged between 10 and 180 months who underwent extracorporeal shock wave lithotripsy (ESWL). In the first group (26 children), ESWL was performed by using the electrohydraulic MPL 9000X Dornier lithotripter between 1994 and 2003 while in the second group (19 children) the electromagnetic EMSE 220 F-XP Dornier lithotripter was used from April 2003 to May 2006. RESULTS: In the first group, 21/26 children (80.7%) were stone free at first ESWL session. Colic pain resolved by administration of an oral analgesic in 6 (23%), brief hematuria (< 24 h) resolved with increased fluid intake in 5 (19.2%), while slightly elevated body temperature (< 38°C) occurred in 4 (15.3%). Four children (15.3%) failed to respond to treatment and were treated with ureteroscopy. In the second group 18/19 children were completely stone free at first ESWL session (94.7%). Complications were infrequent and of minor importance: colic pain treated with oral analgesic occurred in 1 (5.26%), brief hematuria (< 24 h), resolved with increased fluid intake in 4 (21%) and slightly elevated body temperature (< 38°C) monitored for 48 hours occurred in 6 (31.5%). Statistical analysis showed that electromagnetic lithotripter is more efficacious and safer than the earlier electrohydraulic model. CONCLUSIONS: Technological development not only has increased efficacy and safety of lithotripter devices in treating pediatric lithiasis, but it also provided less painful lithotripsy by eliminating the need for general anesthesia

Endocervicosis of the Bladder: Report of a Case and Review of the Current Literature

An important variety of metaplastic lesions of the urinary bladder have been reported in the medical literature up to date. Among those of Müllerian origin, endocervicosis is the most infrequent. We report a 67 years old woman who presented with a history of left flank pain and dysuria for the past 2 months. Imaging studies revealed a solid mass in the posterior bladder wall protruding into the lumen. Transurethral resection of the lesion was performed. Both pathologic examination and immunohistochemistry confirmed the diagnosis of endocervicosis. The patient was monitored with 6 months interval follow up and remains disease free 12 months post surgery