Psychological perspective of medication adherence in transplantation

To identify the risk factors and the post-transplant psychological symptoms that affect adherence to therapy in a population of kidney transplant recipients

The social and economic burden of stroke survivors in Italy: a prospective, incidence-based, multi-centre cost of illness study

The aim of this study was to estimate the one-year societal costs due to a stroke event in Italy and to investigate variables associated with costs in different phases following hospital admission. The patients were enrolled in 44 hospitals across the country and data on socio-demographic, clinical variables and resource consumption were prospectively surveyed for 411 stroke survivors at admission, discharge and 3, 6 and 12 months post the event. We adopted a micro-costing procedure to identify cost generating components and the attribution of appropriate unit costs for three cost categories: direct healthcare, direct non-healthcare (including informal care costs) and productivity losses. The significant role of informal care in stroke management and different distribution of costs over time suggest that appropriate planning should look at both incident and prevalent stroke cases to forecast health infrastructure needs and more importantly, to assure that stroke patients have adequate “social” support

Prostatic Inflammation in Prostate Cancer: Protective Effect or Risk Factor?

The relationship between prostatic chronic inflammation (PCI) and prostate cancer (PCa) is unclear and controversial. Some authors reported that a history of chronic prostatitis may be correlated with PCa induction, while others associate chronic inflammation with less aggressive disease or consider inflammation as a possible protective factor against PCa. Four different types of prostatitis are known: bacterial acute prostatic inflammation, bacterial chronic prostatic inflammation, abacterial prostatitis/chronic pelvic pain syndrome, and asymptomatic prostatic chronic inflammation. Prostatic inflammation is underestimated during daily clinical practice, and its presence and degree often go unmentioned in the pathology report of prostate biopsies. The goal of this report is to further our understanding of how PCI influences the biology of PCa. We investigated the main pathogenetic mechanisms responsible for prostatic inflammation, including the cellular response and inflammatory mediators to describe how inflammation modifies the prostatic environment and can lead to benign or malignant prostatic diseases. We found that prostatic inflammation might have a pivotal role in the pathogenesis of prostatic diseases. Details about PCI in all prostate biopsy reports should be mandatory. This will help us better understand the prostatic microenvironment pathways involved in PCa biology, and it will allow the development of specific risk stratification and a patient-tailored therapeutic approach to prostatic diseases

EFFECTIVENESS OF SACRAL NEUROMODULATION IN THE MANAGEMENT OF REFRACTORY BLADDER PAIN SYNDROME

INTRODUCTION AND AIM OF THE STUDY Bladder Pain Syndrome (BPS) is a complex, under-diagnosed invalidating pathology. It is difficult to estimate BPS prevalence, because this condition is underestimated. A survey estimated the prevalence of BPS symptoms among adult females in the USA to be 7% [1], whereas Chronic Pelvic Pain symptoms show an incidence overlapping to migraine, asthma and lumbago [2]. Treatment of BPS symptoms is an actual therapeutic challenge and needs a multi-disciplinary management. Paracetamol, NSAID's, antidepressant and anti-convulsivants are the first line treatment; in refractory patients, capsaicin, Transcutaneous Electrical Nerve Stimulation (TENS) and sacral neuromodulation (SNM) may be further options. SNM can reduce BPS symptoms and improves voids and over 90% of patients treated with neuromodulation would undergo the implant again [3]. The aim of this study was to evaluate the effectiveness of SNM for the treatment of symptoms in patients with refractory BPS. MATERIALS AND METHODS A retrospective chart review was performed of patients with BPS, refractory to medical/conservative therapy, who underwent InterStim\uae unilateral sacral neuromodulation implant between March 2012 and July 2014 in a single Italian centre. All patients were affected by BPS according to the diagnostic criteria (pelvic pain>6 months, with pressure or discomfort to the bladder, associated to at least one of lower urinary tract symptoms (LUTS). All patients were non responders to oral or endovesical therapy; all patients were>18 year-old and a complete work-up was conducted, in order to exclude organic causes of BPS. Patients with pelvic organ prolapse, stress urinary incontinence or neurologic disease were excluded from the treatment. Bladder pain was assessed with Visual Analogue Scale (VAS) before the treatment, one year after the treatment and at the last follow-up visit. LUTS were evaluated using a three-day bladder diary before the treatment, one year after and in the last follow-up visit. All complications were recorded. RESULTS Twenty-three patients (18 women, and 5 men) underwent first stage unilateral S3 stimulation; median age was 56 years (range 43\u201375 years) and mean follow-up was 32 months. Average symptoms duration was 2.5 years (range 1\u20136.5); 78% of the patients (only women) showed a significant improvement ( 6550% relief of pain and LUTS) and underwent a definitive implant, In all patients, the implantable pulse generator (IPG) was placed in a subcutaneous pouch in the gluteal region, on the right side in 85% of cases. Baseline and post-treatment VAS and parameters of the bladder diary were compared, showing significant improvements. Patients' reported an average pain score decreased from a mean of 8 (9\u201310) at baseline to 3 (2\u20135) at one-year follow-up (p\u2009<\u20090.001). Urgency decreased from 4.6\u2009\ub1\u20092.4 up to 1.3\u2009\ub1\u20091.9 (p\u2009<\u20090.001). Daily urinary frequency improved from 12.7\u2009\ub1\u20094.8 times up to 8.7\u2009\ub1\u20092.8 (p\u2009<\u20090.001) and nocturia decreased from 2.5\u2009\ub1\u20091.9 up to 0.7\u2009\ub1\u20091 (p\u2009<\u20090.001). Mean voided volume increased from 145.4\u2009\ub1\u200970.5\u2009ml to 208.2\u2009\ub1\u200973.4\u2009ml (p\u2009<\u20090.001). Clinical effectiveness was maintained in the last follow-up visit. There were no cases of: infection, pain at the site of implantation, replacement of IPG due to ended battery life. INTERPRETATION OF RESULTS Although literature studies are at high risk of bias and are difficult to compare, due to the different NMS techniques, evaluation of the outcomes and patient selection, our results are at least overlapping with the literature data. CONCLUSIONS Sacral neuromodulation appears to be effective and safe in treating refractory BPS with LUTS associated. Our study provides further evidence for the role of this therapy in BPS, an invalidating pathology with a major impact on patients' quality of life and that is difficult to diagnose and to treat

Acute kidney injury strongly influences renal function after radical nephroureterectomy for upper tract urothelial carcinoma: A single-centre experience

The aim of our study was to investigate frequency and predictors both of postoperative acute kidney injury (AKI) and renal function decline in a population of consecutive upper tract urothelial carcinoma (UTUC) patients who underwent radical nephroureterectomy (RNU)

Impact of functional impairment and cognitive status on perioperative outcomes and costs after radical cystectomy: The role of Barthel Index

Objectives: To investigate the association between Barthel Index (BI), which measures level of patients independence during daily living activities (ADL), and perioperative outcomes in a large cohort of consecutive bladder cancer (BCa) patients, who underwent radical cystectomy (RC) at a tertiary referral center. Methods: We retrospectively evaluated data from clinically nonmetastatic BCa patients treated with RC between 2015 and 2022. For each patient, BI was assessed preoperatively. According to BI score, patients were divided into three groups: ≤60 (total/severe dependency) vs. 65–90 (moderate dependency) vs. 95–100 (slight dependency/independency). Regression analyses tested the association between BI score and major postoperative complications (Clavien–Dindo &gt;2), length of in-hospital stay (LOHS), 90-days readmission, and total costs. Results: Overall, 288 patients were included. According to BI score, the patient cohort was distributed as follows: 4% (n = 11) BI ≤60 vs. 15% (n = 42) BI 65–90 vs. 81% (n = 235) BI 95–100. Patients with BI ≤60 had more frequent ureterocutaneostomy performed, shorter operative time, higher rates of postoperative complications, longer LOHS, higher rates of readmission, and were associated with higher total costs, compared to patients with BI 65–90 and 95–100. In multivariable regression models, BI ≤60 remained an independent predictor of increased risk of major postoperative complications (odds ratio: 6.62, p = 0.006), longer LOHS (rate ratio: 1.25, p &lt; 0.001), and higher costs (b: 2.617, p = 0.038). Conclusions: Total/severe dependency in ADL assessed by BI was associated with higher rates of major postoperative complications, longer hospitalization, and higher costs in BCa patients treated with RC. BI assessment should be considered during patients selection process and counseling before surgery

Low endogenous testosterone levels are associated with the extend of lymphnodal invasion at radical prostatectomy and extended pelvic lymph node dissection

To investigate clinical factors associated to lymphnodal metastasis load in patients who underwent to radical prostatectomy (RP) and extended pelvic lymph node dissection (ePLND)