80 research outputs found
A Novel Penile Splint as Early Traction Therapy After Grafting Techniques for Peyronie's Disease.
Background
Some studies showed encouraging results on the efficacy and safety of penile traction therapy after Peyronie's disease (PD) surgery. The early traction therapy (ETT) could be an effective and safe approach to minimize penile shortening in patients undergoing PD surgery.
Aim
To evaluate the feasibility, efficacy, and safety of a novel penile splint as ETT in patients with PD undergoing grafting techniques.
Methods
Patients with PD underwent plaque incision and grafting technique; at the end of the procedure, a novel penile splint (ETT) was applied to all patient. The device consisted of 2 10CH intubating stylets, self-adapted to each patient, that kept the penis stretched with the aid of non-absorbable sutures. The total expense for the materials needed to build each penile splint was less than 15 euros. This active traction was maintained for 1â3 weeks; then, we removed the stitches leaving the device on-site for a passive traction. Within 3â4 weeks from surgery, the penile splint was replaced by a standard penile traction device.
Outcomes
The main outcomes evaluated at 6 months included stretched penile length (SPL), penile curvature, International Index of Erectile Function-erectile function (IIEF-EF) domain, patient satisfaction, and time to first satisfactory sexual intercourse.
Results
A total of 46 patients were enrolled. The median preoperative IIEF-EF, penile curvature, and SPL were 27 points, 70°, and 13 cm, respectively. The median follow-up was 15 months. The median postoperative IIEF-EF was 25 points (P < .001). The median residual penile curvature was 10° (P < .001). The median postoperative SPL was 13 cm (P = .269). 8 patients (17.4%) lost 1 cm of SPL; no shortening greater than 1 cm was recorded. The median time to first satisfactory sexual intercourse and patient satisfaction score was 6 weeks and 9 points, respectively.
Clinical Implications
Our results could pave the way for a new line of research, which in turn could lead to an improvement in the postoperative management of the patient undergoing surgery for PD.
Strength & Limitations
This is the first study evaluating the ETT after PD surgery. The main limitation of this study is the lack of a randomized control group. Other weaknesses are the small sample size and the short follow-up time.
Conclusion
Our novel penile splint is inexpensive, easy to assemble, and adaptable to the patient. ETT using this novel device, followed by standard traction therapy, seems to be feasible, effective, and safe.pre-print449 K
Use of penile shear wave elastosonography for the diagnosis of Peyronie's Disease: a prospective case-control study
Background: To evaluate the stiffness of the tunica albuginea (TA), we used a new noninvasive diagnostic technique called shear wave elastography (SWE). We determined whether SWE values are correlated with the degree of penile curvature, the time of disease onset, and pain severity experienced by patients during erection. This study analyzed the elasticity of the TA of patients with Peyronie's disease compared to that of the control group. We also analyzed any correlations between the stiffness of the cavernous bodies and the degree of curvature, time from diagnosis to curvature onset, and erectile pain severity. This was a prospective case-control study involving 100 men enrolled from September 2020 to August 2021. Participants were divided into group A (case group, nâ=â50), which included men with PD, with or without pain, and with penile curvature, or group B (control group, nâ=â50), which included healthy patients older than 18Â years who visited the urology clinic for reasons other than PD. The medical history was collected for all patients who also underwent objective examination, B-mode ultrasound evaluation, and SWE. The International Index of Erectile Function (IIEF-15) visual analog scale (VAS) questionnaire was administered to all participants. Results: There were no significant between-group differences regarding age, weight, and height (pâ>â0.05); however, there was a significant difference in the stiffness values (pâ<â0.05). An inverse correlation was observed between stiffness and the VAS score (pâ<â0.0001). A positive correlation was observed between the degree of curvature (pâ<â0.0001) and the time of curvature onset (pâ<â0.0001). The IIEF-15 scores were poorer in group A than in group B (pâ<â0.0001). Conclusion: SWE is an inexpensive, noninvasive method that can be used to measure the stiffness of PD patients
Predicting Recurrence and Progression in Patients with Non-Muscle-Invasive Bladder Cancer : Systematic Review on the Performance of Risk Stratification Models
BACKGROUND: Several classifications have been reported to stratify non-muscle-invasive bladder cancer (NMIBC) in risk groups according to the probability of recurrence and progression. OBJECTIVE: To systematically review the current evidence regarding risk stratification of NMIBC. METHODS: The systematic review was performed in accordance with the PRISMA statement. Studies providing data on development and/or external validation cohorts of models and risk stratification tables for recurrence and/or progression for patients with NMIBC, reporting at least one discrimination measure (AUC or C-Index) were included. RESULTS: Twenty-five studies involving 22,737 patients were included. Six classifications were identified, three of them were predictive models (EORTC, CUETO, EAU 2021) and three were based on expert opinion (EAU 2020, AUA, NCCN). A high risk of bias was present in the majority of the studies. Certain heterogenicity was found among the studies regarding adjuvant therapy, postoperative instillation or second resection. The definition of oncological outcomes was not standardized in the included studies. CUETO and EORTC scoring systems are the most validated. In general, validations showed a poor discrimination capability to predict recurrence, slightly better for progression. The EAU 2021 model overestimates the risk of progression in patients treated with BCG. Carcinoma in situ is underrepresented in all the studies analyzed. CONCLUSIONS: The existing classifications show poor discrimination capability for recurrence and possibly helpful discrimination capability for progression in NMIBC patients. These results highlight the unmet need to develop novel accurate risk models for patients with NMIBC, which could be improved with the combination of clinicopathological and molecular information
Post-Thyroidectomy Hypocalcemia: Timing of Discharge Based on Serum Calcium Levels
Purpose: The study concerns about the evaluation of Calcium serum levels in patients who underwent
total thyroidectomy. Our previous experience underlined how patients who had levels
of serum Calcium more than 9 mg/dl at the first day after surgery, did not show Hypocalcemia
in the next days,so that this value could be considered a good cut-off for the decision of an
early discharge. With regards to this experience, the aim of our current study was to confirm
the effective feasibility of an early discharge based on the levels of serum Calcium at the first
post-operative day.
Patients and Methods: Our study included 102 consecutive patients (82 F; 20 M, age with a
range between 14-78 year sold, average 52.6) that were submitted to total thyroidectomy in the
years 2010 to 2014, performed by the same operator and all done with sutureless technique (Ligasure
precise©) We classify hypocalcemia, according to their normal range (8.6 to 10.4 mg/dl),
in mild (not less than 7.6 mg/dL), moderate (between 7.5 mg/dL and 7 mg/dL) and severe (less
than 7 mg/dL) We classified the normal range of serum Calcium between 8.6 mg/dl and 10.4
mg/dl. Patients that showed levels of serum Calcium under this limit (<8.6 mg/dl) were treated
with 6 fials of Gluconate Calcium 40 mEq in 500 ml of saline solution NaCl 0.9% i.v. (one per
day), until the return to the normal range. Patients who had serum Calcium levels more than 9
mg/dl at the first post-operative days, and did not have other complications, were discharged at
the same day and revaluated after 7 days.
Discussion and Conclusion: Moreover our study has been useful to confirm what we observed
in the previous experience, that levels of serum Calcium more than 9 mg/dl at the first postoperative
day can be considered a feasible cut-off to exclude the appearance of hypocalcaemia
in future.
Therefore, according to our results, we assume to propose an early discharge for the patients
who have serum Calcium levels more than 9 mg/dl, asking them to come back for controls one
week after discharge
Risk Factors for Revision After Artificial Urinary Sphincter Implantation in Male Patients With Stress Urinary Incontinence: A 10-Year Retrospective Study.
Purpose
To evaluate the preoperative and intraoperative risk factors for revision after artificial urinary sphincter (AUS) implantation in male patients with stress urinary incontinence (SUI).
Methods
A retrospective analysis from a prospectively maintained database was performed. Male patients, with moderate-tosevere SUI, undergoing AUS implantation were included. All patients underwent placement of AMS 800. Cause of revision, type of revision, and time to revision were recorded. Multivariable analyzes were performed using a logistic regression to investigate the risk factors. Competing risk analysis according to Fine-Gray model was used to study time to event data.
Results
A total of 70 patients were included. Revision surgery was performed in 22 of 70 patients (31.4%), after a median (interquartile range) time of 26.5 months (6.5â39.3 months). Overall, 19 of 22 repairs (86.4%) and 3 of 22 explants (13.6%) were recorded. Mechanical dysfunction, urethral erosion, urethral atrophy, and device infection were the causes of revision in 11 of 22 (50.0%), 6 of 22 (27.3%), 3 of 22 (13.6%), and 2 of 22 patients (9.1%). Vesicourethral anastomosis stenosis (P=0.02), urethral cuff size of 3.5 cm (P=0.029), and dual implantation (P=0.048) were independent predictors for revision. Vesicourethral anastomosis stenosis (P=0.01) and urethral cuff size of 3.5 cm (P=0.029) predicted a lower survival of the AUS.
Conclusions
The vesicourethral anastomosis stenosis, urethral cuff size of 3.5 cm, and dual implantation are independent predictors for revision after AUS implantation. However, only the vesicourethral anastomosis stenosis and urethral cuff size of 3.5 cm predict a lower survival of AUS.pre-print441 K
mpMRI-US Fusion-Guided Targeted Cryotherapy in Patients with Primary Localized Prostate Cancer: A Prospective Analysis of Oncological and Functional Outcomes.
Targeted therapy (TT) for prostate cancer (PCa) aims to ablate the malignant lesion with
an adequate margin of safety in order to obtain similar oncological outcomes, but with less toxicity
than radical treatments. The main aim of this study was to evaluate the recurrence rate (RR) in
patients with primary localized PCa undergoing mpMRI/US fusion targeted cryotherapy (FTC). A
secondary objective was to evaluate prostate-specific antigen (PSA) as a predictor of recurrences.
We designed a prospective single-center single-cohort study. Patients with primary localized PCa,
mono or multifocal lesions, PSA 15 ng/mL, and a Gleason score (GS) 4 + 3 undergoing FTC
were enrolled. RR was chosen as the primary outcome. Recurrence was defined as the presence of
clinically significant prostate cancer in the treated areas. PSA values measured at different times were
tested as predictors of recurrence. Continuous variables were assessed with the Bayesian t-test and
categorical assessments with the chix-squared test. Univariate and logistic regression assessment
were used for predictions. A total of 75 cases were included in the study. Ten subjects developed a
recurrence (RR: 15.2%), while fifty-six (84.8%) patients showed a recurrence-free status. A %PSA drop
of 31.5% during the first 12 months after treatment predicted a recurrence with a sensitivity of 53.8%
and a specificity of 79.2%. A PSA drop of 55.3% 12 months after treatment predicted a recurrence
with a sensitivity of 91.7% and a specificity of 51.9%. FTC for primary localized PCa seems to be
associated with a low but not negligible percentage of recurrences. Serum PSA levels may have a role
indicating RR.post-print644 K
Preoperative Fibrinogen-to-Albumin Ratio as Potential Predictor of Bladder Cancer: A Monocentric Retrospective Study
: Background and objective: Fibrinogen and albumin are two proteins widely used, singularly and in combination, in cancer patients as biomarkers of nutritional status, inflammation and disease prognosis. The aim of our study was to investigate the preoperative fibrinogen-to-albumin ratio (FAR) as a preoperative predictor of malignancy as well as advanced grade in patients with bladder cancer. Materials and Methods: A retrospective analysis of patients who underwent TURBT at our institution between 2017 and 2021 was conducted. FAR was obtained from preoperative venous blood samples performed within 30 days from scheduled surgery and was analyzed in relation to histopathological reports, as was the presence of malignancy. Statistical analysis was performed using a KruskalâWallis Test, and univariate and multivariate logistic regression analysis, assuming p < 0.05 to be statistically significant. Results: A total of 510 patients were included in the study (81% male, 19% female), with a mean age of 71.66 ± 11.64 years. The mean FAR was significantly higher in patients with low-grade and high-grade bladder cancer, with values of 80.71 ± 23.15 and 84.93 ± 29.96, respectively, compared to patients without cancer (75.50 ± 24.81) (p = 0.006). Univariate regression analysis reported FAR to be irrelevant when considered as a continuous variable (OR = 1.013, 95% CI = 1.004â1.022; p = 0.004), while when considered as a categorical variable, utilizing a cut-off set at 76, OR was 2.062 (95% CI = 1.378â3.084; p < 0.0001). Nevertheless, the data were not confirmed in the multivariate analysis. Conclusions: Elevated preoperative FAR is a potential predictor of malignancy as well as advanced grade in patients with bladder cancer. Further data are required to suggest a promising role of the fibrinogen-to-albumin ratio as a diagnostic biomarker for bladder tumors
Mobile health applications in kidney stone disease management: A reliable support for patients?
Introduction: Mobile health applications (MHAs) represent an interesting issue to assist and improve the quality of life of patients affected by Kidney Stone Disease (KSD). Despite this, their scientific quality and adherence to guidelines are not yet addressed.Material and methods: On 2 November 2022, we conducted an observational cross-sectional descriptive study of all MHAs on KSD. A search in the Apple App Store and Google Play Store was performed. We reviewed all mobile apps from Apple App Store and Google Play Store for KSD and evaluated their usage in screening, prevention, management, and adherence to EAU guidelines.Results: In total 13 MHA were included in the final analysis. All MHAs, 4 (30.8%) from the Apple App Store and 9 (69.2%) from the Google Play Store are geared towards the patient. Engagement ranged from 1.73 to 4.06; Functionality ranged from 3.17 to 4.75; Aesthetics ranged from 1.9 to 4.12; Information ranged from 2.25 to 4.27, and Subjective quality ranged from 1.58 to 3.23. MHAs reported low and medium adherence to EAU guidelines.Conclusions: MHAs provide a very useful assistance in several medical fields, including KSD. Despite MHAs development is constantly increasing, the scientific validation, content, and quality are not yet solved. Future research is necessary to improve the quality of the apps and promote new user designed, and high-quality apps
AlimentaciĂłn a conciencia. Experiencia de prĂĄctica sociocomunitaria
En el 2014 se incorporaron las PrĂĄcticas Socio Comunitarias a la Facultad de IngenierĂa de la Universidad Nacional de Mar del Plata. Mediante el âAprendizaje-Servicioâ, los y las estudiantes contextualizan los contenidos en los que se estĂĄn formando al interactuar con la sociedad y su realidad. Se realizĂł un taller integrando docencia y extensiĂłn. Por un lado, participaron docentes e investigadoras/es y alumnos/as y por otro lado, la Cooperativa de Cuidadores Domiciliarios Mar del Plata e instituciones educativas. Se analizaron las deficiencias que poseen los actores de la comunidad respecto al âconsumo seguro e informadoâ de los alimentos. A partir de ello es que las y los estudiantes, con la orientaciĂłn de sus docentes tutores, recopilaron, analizaron y compararon con la legislaciĂłn vigente informaciĂłn sobre alimentos light, apto celĂaco, bajo en sodio, ultraprocesados y funcionales. Se generaron recursos audiovisuales logrando una comunidad de aprendizaje consciente de los criterios para seleccionar un alimento.In 2014, the Socio-Community Practices were incorporated into the Faculty of Engineering of the National University of Mar del Plata. Through âService-Learningâ, the students contextualize the contents in which they are being trained by interacting with society and its reality. A workshop was held integrating teaching and extension. On the one hand, teachers and researchers and students participated, and on the other hand, the Mar del Plata Home Caregiver Cooperative and educational institutions. The deficiencies that the community actors have regarding the âsafe and informed consumptionâ of food were analyzed. Based on this, the students, with the guidance of their tutors, collected, analyzed and compared information on light foods, celiac-friendly, low-sodium, ultra-processed and functional foods with current legislation. Audiovisual resources were generated, achieving a learning community aware of the criteria to select a food.Fil: Agustinelli, Silvina Paola. Universidad Nacional de Mar del Plata. Facultad de IngenierĂa. Departamento de IngenierĂa QuĂmica. Grupo de InvestigaciĂłn en PreservaciĂłn y Calidad de Alimentos; Argentina. Consejo Nacional de Investigaciones CientĂficas y TĂ©cnicas. Centro CientĂfico TecnolĂłgico Conicet - Mar del Plata; ArgentinaFil: Benitez, Carmen. Universidad Nacional de Mar del Plata. Facultad de IngenierĂa. Departamento de IngenierĂa QuĂmica. CĂĄtedra de QuĂmica General I; ArgentinaFil: Goñi, MarĂa Gabriela. Consejo Nacional de Investigaciones CientĂficas y TĂ©cnicas; Argentina. Universidad Nacional de Mar del Plata. Facultad de IngenierĂa. Departamento de IngenierĂa QuĂmica. CĂĄtedra de QuĂmica General I; ArgentinaFil: Olaizola, Lourdes. Universidad Nacional de Mar del Plata. Facultad de IngenierĂa; ArgentinaFil: Pellegrini, MarĂa Celeste. Universidad Nacional de Mar del Plata. Facultad de Ingenieria. Instituto en Ciencia y TecnologĂa de Alimentos y Ambiente; . Consejo Nacional de Investigaciones CientĂficas y TĂ©cnicas; ArgentinaFil: Wasswrman, Cecilia. Universidad Nacional de Mar del Plata. Facultad de IngenierĂa; ArgentinaFil: VĂĄzquez, MarĂa Guadalupe. Consejo Nacional de Investigaciones CientĂficas y TĂ©cnicas. Centro CientĂfico TecnolĂłgico Conicet - Mar del Plata. Instituto de Investigaciones Marinas y Costeras. Universidad Nacional de Mar del Plata. Facultad de Ciencias Exactas y Naturales. Instituto de Investigaciones Marinas y Costeras; ArgentinaFil: Schroeder, Carolina. Universidad Nacional de Mar del Plata. Facultad de IngenierĂa; ArgentinaFil: Puglia, Iara Constanza. Consejo Nacional de Investigaciones CientĂficas y TĂ©cnicas. Centro CientĂfico TecnolĂłgico Conicet - Mar del Plata. Instituto de Investigaciones en Ciencia y TecnologĂa de Materiales. Universidad Nacional de Mar del Plata. Facultad de IngenierĂa. Instituto de Investigaciones en Ciencia y TecnologĂa de Materiales; ArgentinaFil: Pages, Iara. Universidad Nacional de Mar del Plata. Facultad de IngenierĂa; ArgentinaFil: Lasaga, L. I.. Universidad Nacional de Mar del Plata. Facultad de IngenierĂa; ArgentinaFil: Garcia Machin, T.. Universidad Nacional de Mar del Plata. Facultad de IngenierĂa; ArgentinaFil: De Pascuale, Sofia. Universidad Nacional de Mar del Plata. Facultad de IngenierĂa; ArgentinaFil: Coppa Legarreta, J. F.. Universidad Nacional de Mar del Plata. Facultad de IngenierĂa; ArgentinaFil: Cyras, Viviana Paola. Consejo Nacional de Investigaciones CientĂficas y TĂ©cnicas; ArgentinaFil: Ponce, Alejandra Graciela. Consejo Nacional de Investigaciones CientĂficas y TĂ©cnicas; ArgentinaFil: Manfredi, Lorena. Universidad Nacional de Mar del Plata. Facultad de IngenierĂa; Argentin
AlimentaciĂłn a conciencia. Experiencia de prĂĄctica sociocomunitaria
En el 2014 se incorporaron las PrĂĄcticas Socio Comunitarias a la Facultad de IngenierĂa de la Universidad Nacional de Mar del Plata. Mediante el âAprendizaje-Servicioâ, los y las estudiantes contextualizan los contenidos en los que se estĂĄn formando al interactuar con la sociedad y su realidad. Se realizĂł un taller integrando docencia y extensiĂłn. Por un lado, participaron docentes e investigadoras/es y alumnos/as y por otro lado, la Cooperativa de Cuidadores Domiciliarios Mar del Plata e instituciones educativas. Se analizaron las deficiencias que poseen los actores de la comunidad respecto al âconsumo seguro e informadoâ de los alimentos. A partir de ello es que las y los estudiantes, con la orientaciĂłn de sus docentes tutores, recopilaron, analizaron y compararon con la legislaciĂłn vigente informaciĂłn sobre alimentos light, apto celĂaco, bajo en sodio, ultraprocesados y funcionales. Se generaron recursos audiovisuales logrando una comunidad de aprendizaje consciente de los criterios para seleccionar un alimento.In 2014, the Socio-Community Practices were incorporated into the Faculty of Engineering of the National University of Mar del Plata. Through âService-Learningâ, the students contextualize the contents in which they are being trained by interacting with society and its reality. A workshop was held integrating teaching and extension. On the one hand, teachers and researchers and students participated, and on the other hand, the Mar del Plata Home Caregiver Cooperative and educational institutions. The deficiencies that the community actors have regarding the âsafe and informed consumptionâ of food were analyzed. Based on this, the students, with the guidance of their tutors, collected, analyzed and compared information on light foods, celiac-friendly, low-sodium, ultra-processed and functional foods with current legislation. Audiovisual resources were generated, achieving a learning community aware of the criteria to select a food.Fil: Agustinelli, Silvina Paola. Universidad Nacional de Mar del Plata. Facultad de IngenierĂa. Departamento de IngenierĂa QuĂmica. Grupo de InvestigaciĂłn en PreservaciĂłn y Calidad de Alimentos; Argentina. Consejo Nacional de Investigaciones CientĂficas y TĂ©cnicas. Centro CientĂfico TecnolĂłgico Conicet - Mar del Plata; ArgentinaFil: Benitez, Carmen. Universidad Nacional de Mar del Plata. Facultad de IngenierĂa. Departamento de IngenierĂa QuĂmica. CĂĄtedra de QuĂmica General I; ArgentinaFil: Goñi, MarĂa Gabriela. Consejo Nacional de Investigaciones CientĂficas y TĂ©cnicas; Argentina. Universidad Nacional de Mar del Plata. Facultad de IngenierĂa. Departamento de IngenierĂa QuĂmica. CĂĄtedra de QuĂmica General I; ArgentinaFil: Olaizola, Lourdes. Universidad Nacional de Mar del Plata. Facultad de IngenierĂa; ArgentinaFil: Pellegrini, MarĂa Celeste. Universidad Nacional de Mar del Plata. Facultad de Ingenieria. Instituto en Ciencia y TecnologĂa de Alimentos y Ambiente; . Consejo Nacional de Investigaciones CientĂficas y TĂ©cnicas; ArgentinaFil: Wasswrman, Cecilia. Universidad Nacional de Mar del Plata. Facultad de IngenierĂa; ArgentinaFil: VĂĄzquez, MarĂa Guadalupe. Consejo Nacional de Investigaciones CientĂficas y TĂ©cnicas. Centro CientĂfico TecnolĂłgico Conicet - Mar del Plata. Instituto de Investigaciones Marinas y Costeras. Universidad Nacional de Mar del Plata. Facultad de Ciencias Exactas y Naturales. Instituto de Investigaciones Marinas y Costeras; ArgentinaFil: Schroeder, Carolina. Universidad Nacional de Mar del Plata. Facultad de IngenierĂa; ArgentinaFil: Puglia, Iara Constanza. Consejo Nacional de Investigaciones CientĂficas y TĂ©cnicas. Centro CientĂfico TecnolĂłgico Conicet - Mar del Plata. Instituto de Investigaciones en Ciencia y TecnologĂa de Materiales. Universidad Nacional de Mar del Plata. Facultad de IngenierĂa. Instituto de Investigaciones en Ciencia y TecnologĂa de Materiales; ArgentinaFil: Pages, Iara. Universidad Nacional de Mar del Plata. Facultad de IngenierĂa; ArgentinaFil: Lasaga, L. I.. Universidad Nacional de Mar del Plata. Facultad de IngenierĂa; ArgentinaFil: Garcia Machin, T.. Universidad Nacional de Mar del Plata. Facultad de IngenierĂa; ArgentinaFil: De Pascuale, Sofia. Universidad Nacional de Mar del Plata. Facultad de IngenierĂa; ArgentinaFil: Coppa Legarreta, J. F.. Universidad Nacional de Mar del Plata. Facultad de IngenierĂa; ArgentinaFil: Cyras, Viviana Paola. Consejo Nacional de Investigaciones CientĂficas y TĂ©cnicas; ArgentinaFil: Ponce, Alejandra Graciela. Consejo Nacional de Investigaciones CientĂficas y TĂ©cnicas; ArgentinaFil: Manfredi, Lorena. Universidad Nacional de Mar del Plata. Facultad de IngenierĂa; Argentin
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