The intraprostatic injection of ethanol for the treatment of bening prostatic hyperplasia

Benign prostatic hyperplasia (BPH) is one of the most common disease affecting the aging male. In fact there is an increase of the absolute number and the size of the epithelial and stromal cells of the prostate gland. The prostatic enlargement is defined as histologic hyperplasia, lower urinary tract symptoms, diminished uroflow or urodynamic obstruction. The obstructive voiding may cause serious obstructive and bothersome symptoms in male with BPH. Patients with BPH will develop serious complications such as urinary retention, urinary tract infections and deterioration of renal function. When the oral therapy failures, then the patient must undergo some invasive treatment. The invasive methods for the treatment of BPH may have a lot of complications. The intraprostatic injection of ethanol, is a minimal invasive method for the treatment of BPH. In the present clinical study, that includes 78 patient (the largest number of patients worldwide) it is studied the safety and the efficacy of transurethral injection of ethanol of prostate (TIEP). The results for a year follow up showed that there is an improvement in obstructive voiding and symptoms. To investigate the efficacy and the safety of this method, the patient undergo in clinical examinations: 1. Physical examination 2. Serum examinations 3. Uroflowometry 4. Urodynamic examination 5. Trans rectal ultra sound, And filling questionnary: 1. IPSS 2. QoL. The patients’ follow up were in five visits: Day one, before the intervention: visit one - 15 days after the intervention: visit two - six months after the intervention: visit three - A year after the intervention: visit four. The results found that the (TIEP) is a minimal invasive method for the treatment of BPH, effective and safe even for high risk patients, who are better to avoid an open surgery method and anaesthesia and their complications.Η καλοήθης υπερπλασία του προστάτη αποτελεί μία συνήθη νόσο του γηράσκοντα άνδρα. Στην ουσία πρόκειται για αύξηση τόσο του απόλυτου αριθμού όσο και του μεγέθους των αδενικών κυττάρων, αλλά και των κυττάρων του στρώματος του αδένα. Η αύξηση του αδένα σε όγκο, αποτελεί τον στατικό παράγοντα για την αποφρακτική ούρηση, και η αύξηση και ο τόνος των λείων μυϊκών ινών του στρώματος αποτελεί το δυναμικό στοιχείο της αποφρακτικής ούρησης. Η αποφρακτική αυτή ούρηση, προκαλεί σημαντικά δυσουρικά και ερεθιστικά συμπτώματα στον άνδρα. Η αποφρακτική ούρηση μπορεί να προκαλέσει απλά συμπτώματα, δυσουρικά η αποφρακτικά αλλά μπορεί να οδηγήσει τον ασθενή και σε τελικό στάδιο νεφρικής ανεπάρκειας. Όταν η συντηρητική αγωγή αποτύχει για την θεραπεία της νόσου, τότε ο ασθενής πρέπει να υποβληθεί σε κάποια επεμβατική μέθοδο θεραπείας. Οι επεμβάσεις όμως για την αντιμετώπιση της (ΚΥΠ) δεν στερούνται επιπλοκών. Η ενδοπροστατική έγχυση αλκοόλης είναι μία ελάχιστα επεμβατική μέθοδος για την αντιμετώπιση της (ΚΥΠ). Στην παρούσα κλινική μελέτη που περιλαμβάνει 78 ασθενείς (τον μεγαλύτερο αριθμό διεθνώς) ελέγχεται η ασφάλεια και η αποτελεσματικότητα της μεθόδου. Τα αποτελέσματα σε χρόνο παρακολούθησης ενός έτους, έδειξαν πως βελτιώνεται σημαντικά η αποφρακτική ούρηση, αλλά και τα ερεθιστικά και αποφρακτικού τύπου συμπτώματα. Η παρακολούθηση των ασθενών έγινε σε τέσσερις επισκέψεις: Επίσκεψη 1 την ημέρα πριν την έγχυση αλκοόλης. Επίσκεψη 2 την ημέρα 15 μετά την έγχυση αλκοόλης. Επίσκεψη 3 έξι μήνες μετά την έγχυση αλκοόλης. Επίσκεψη 4 ένα χρόνο μετά την έγχυση αλκοόλης. Ο έλεγχος της αποτελεσματικότητας της μεθόδου γίνονταν με αντικειμενικές εξετάσεις τα χρονικά διαστήματα που αναφέρθηκαν (ουροροομετρία, πλήρης ουροδυναμικός, διορθικός υπέρηχος, βιοχημικός έλεγχος, υπολοιπόμενο ούρων με υπέρηχο κύστης), αλλά και υποκειμενικές (ερωτηματολόγια IPSS και QoL). Η ενδοπροστική έγχυση αλκοόλης, αποτελεί μια ελάχιστα επεμβατική μέθοδο για την αντιμετώπιση της καλοήθους υπερπλασίας προστάτου, είναι δε μέθοδος αποτελεσματική αλλά ταυτόχρονα και ασφαλής, ακόμη και σε ασθενής υψηλού κινδύνου, που είναι καλό να αποφύγουν τις άμεσες επιπλοκές ενός χειρουργείου, την αναισθησία, και την παρατεταμένη παραμονή στο νοσοκομείο

The impact of Diabetes Mellitus on Lower urinary tract symptoms (LUTS) in both male and female patients

Introduction Contemporary studies examine the connection of Diabetes Mellitus (DM) with Lower urinary tract symptoms (LUTS), alone or associated with other factors of the metabolic syndrome. However, little research has occurred concerning patients with diabetes of both genders and sexes without other diseases of the lower urinary tract. The aim of this study is to examine the relationship between DM and LUTS. Methods The study enrolled 110 patients with DM and 134 healthy individuals. The IPSS questionnaire was used for the evaluation of symptoms from lower urinary tract. Data was analyzed with univariate and multivariate logistic regression using SPSS v.24. Results Analysis with moderate/severe LUTS as dependent variable and plausible confounding factors (age group, BMI, hypertension, dyslipidemia, years with DM and reported HbA1c) as covariates revealed that only HbA1c levels correlated independently with the presence of moderate/severe LUTS (p = 0,024, OR:2,729, CI:1,144–6,509) in diabetic women, while there was no statistically significant difference between male groups. HbA1c levels' correlation with IPSS-voiding and IPSS- storage score was not statistically significant. Quality of life is also affected in women with diabetes mellitus (p: 0,02). Conclusion Only an increase in HbA1c was independently connected with a deterioration of LUTS in the female group

Urology during a Crisis: A Management Algorithm

As of March 11, 2020, Coronavirus disease (COVID-19) has been declared a pandemic from WHO organization. On June 30, 2020, the disease has already spread in all continents numbering 10 million confirmed cases and 500.000 deaths(1). In regions with limited cases, health-care units suffice to provide routine services and manage infected with coronavirus patients simultaneously. However, during an epidemic outbreak, the high number of cases compared to the shortage of health workforce increases the risk of system collapse. In order to respond adequately, hospitals should reprioritize their services, including operations and outpatient clinics and protect its personnel from infection(2) Shrinkage of surgical activity in emergency surgeries saves equipment and personnel necessary for the care of COVID-19 patients and protects high risk patients from getting infected(3). In order to maximize the provided urological surgeries, 4 parameters should be considered: the emergency of the operation, the risk of infection, the capacity of the hospital and cooperation between different urological departments. Initially, all emergency surgeries should be performed promptly in order to ameliorate the health status of the patient and reduce hospital stay (Table 1). In case the results of COVID-19 test, are not readily available the operation should be performed without delay in special operating rooms and the patient treated in separate wards. Regarding elective operations, all non-oncological surgeries should be postponed. In oncological diseases, where possible, opt for alternative treatments, such as radiotherapy with ADT in prostate cancer or ablation of renal tumors. Next, all surgical candidates should be tested for COVID-19 before surgery. In case of positive result, the surgery should be rescheduled. In countries where this measure is not feasible, preoperative evaluation of the respiratory tract from an internist, including a chest x-ray is suggested. Following that, the operating program should be adapted to hospital capacities. In case of small number of COVID-19 cases, surgical candidates should continue to be treated according to oncological severity. On the contrary, when hospital capabilities are overwhelmed by the inflow of COVID-19 patients consider treating patients with the longest expected survival, irrespective of the underline disease. Otherwise, urologist must consider maximizing the number of treated patients and minimizing the hospital stay, possibly by performing less time-consuming surgeries particularly in patients without good performance status. The expertise of each center should also be evaluated and candidates for radical, time-consuming operations referred to specialized centers (Figure 1). During de-escalation phase, special attention should be given in patients with urolithiasis and ureteral stents, since they are at increased risk of encrustation and complicated pyelonephritis (4). All previous measures could reduce attendance in hospitals with the cost of increasing waiting lists. Despite, closure of outpatient departments prevents crowding and hinders dispersion of the virus(5), the demand for urological services is ongoing and, also expected to increase during the de-escalation phase of COVID-19 pandemic. However, there is no single protocol in the management of urological patients. In order to preserve general population healthy and face current demands the urologist should consider the following questions (Figure 2). 1. Is this case an emergency? In order to provide consultation in urological patient urologists are encouraged to use telemedicine(6). Through video-communications urologist can diagnose effectively common urological disease and even prescribe medications and tests. Additionally, urologists can screen patients with acute urological problems and symptoms of COVID-19 infection referring appropriately. Particularly patients at increased risk for severe COVID-19 pneumonia such as renal transplant patients, oncological patients and those with renal dysfunction should have their clinical evaluation through telemedicine(7). On the contrary, the inability to perform clinical and diagnostic tests, along with the lack of experience in teleconsultation lowers diagnostic accuracy. 2. Is there a possibility of COVID-19 infection? Screening for COVID-19 is necessary for all urological patients. Regarding outpatients, phone screening about respiratory symptoms within the last 14 days (fever, cough, myalgia, fatigue, dyspnea), travel history and fever could detect high risk patients requiring further referral to special units

The impact of burnout and occupational stress on sexual function in both male and female individuals: a cross-sectional study

Burnout and occupational stress are common problems in the modern society. The aim of the study was to investigate the association of burnout and occupational stress with sexual dysfunction. The study enrolled 251 residents, 143 males and 108 females. The personal medical history, demographics, and professional data of the participants were recorded. The Copenhagen Burnout Inventory (CBI) and the job stress measure were used for the evaluation of burnout and occupational stress, correspondingly. The International Index of Erectile Function (IIEF) and the Female Sexual Function Index (FSFI) were used for the assessment of sexual function. The majority of the respondents were males (57%), with a mean age of 31 years. From the analysis concerning males, personal burnout, hypertension, and alcohol consumption correlated independently with erectile dysfunction (p = 0.001) and reduced total satisfaction (p < 0.001). With respect to the female participants, the number of children was found to be related to easier arousal (p = 0.009), better lubrication (p = 0.006), and orgasm (p = 0.016). Contrariwise, job stress related negatively with lubrication (p = 0.031) and orgasm (p = 0.012). This is the first study examining the effect of burnout on sexual function. Personal burnout was observed to be associated with sexual dysfunction in men whereas job stress correlated with female sexual problems. Further examination in different occupational groups and a greater number of patients is required

Efficacy of Early and Enhanced Respiratory Physiotherapy and Mobilization after On-Pump Cardiac Surgery: A Prospective Randomized Controlled Trial

Background: This randomized controlled trial aimed to investigate the influence of physical activity and respiratory physiotherapy on zero postoperative day on clinical, hemodynamic and respiratory parameters of patients undergoing cardiac surgeries under extracorporeal circulation. Methods: 78 patients undergoing coronary artery bypass graft (CABG) or/and valvular heart disease surgeries were randomly assigned into an early and enhanced physiotherapy care group (EEPC group; n = 39) and a conventional physiotherapy care group (CPC group; n = 39). Treatment protocol for the EEPC group included ≤3 Mets of physical activity and respiratory physiotherapy on zero post-operative day and an extra physiotherapy session during the first three post-operative days, whereas the CPC group was treated with usual physiotherapy care after the first post-operative day. The length of hospital and intensive care unit (ICU) stay were set as the primary study outcomes, while pre- and post-intervention measurements were also performed to assess the oxymetric and hemodynamic influence of early mobilization and physiotherapy. Results: Participants’ mean age was 51.9 ± 13.8 years. Of them 48 (61.5%) underwent CABG. Baseline and peri-procedural characteristics did not differ between the two groups. The total duration of hospital and ICU stay were significantly higher in the CPC group compared to the EEPC group (8.1 ± 0.4 days versus 8.9 ± 0.6 days and 25.4 ± 3 h versus 23.2 ± 0.6 h, p p = 0.022, 0.027 and 0.001, respectively). Conclusion: In on-pump cardiac surgery, early and enhanced post-procedural physical activity (≤3 METS) can prevent a prolonged ICU stay and decrease the duration of hospitalization while ameliorating post-operative hemodynamic and oxymetric parameters