Role of Pelvic Ischemia in Human Lower Urinary Tract Symptoms and Sexual Function Among Patients With Common Iliac Artery Obstruction Undergoing Revascularization Surgery

Purpose In this case-control study, we explored the relationships among pelvic ischemia, lower urinary tract symptoms (LUTS), and sexual function in patients with common iliac artery steno-occlusive disease, along with the potential therapeutic role of revascularization. Methods We recruited 33 men diagnosed with radiologically documented common iliac artery stenosis (>80%) who underwent endovascular revascularization, and 33 healthy controls. Five patients had obstruction of the abdominal aorta (Leriche syndrome). The International Prostate Symptom Score (IPSS), Overactive Bladder Questionnaire, and International Index of Erectile Function were used to evaluate LUTS and erectile function. Medical history, anthropometrics, urinalysis, and blood tests, including levels of serum prostate-specific antigen, urea, creatinine, triglycerides, cholesterol, low-density lipoprotein, high-density lipoprotein, and hemoglobin A1c, were recorded. Uroflow (maximum flow, average flow, voided volume, and voiding time) and ultrasound parameters (prostate volume and postvoid residual [PVR]) were also measured. Patients with moderate-to-severe LUTS (IPSS>7) underwent complete urodynamic investigation. Patients were examined at baseline and 6 months postoperatively. Results Patients exhibited poorer total IPSS (P<0.001), storage (P=0.001) and voiding symptom (P<0.001) subscores, as well as worse OAB-bother (P=0.015), OAB-sleep (P<0.001), OAB-coping (P<0.001), and OAB-total (P<0.001) scores than control participants. Additionally, erectile function (P=0.002), sexual desire (P<0.001), and satisfaction from intercourse (P=0.016) deteriorated in the patient group. Six months postoperatively, significant improvements were observed in erectile function (P=0.008), orgasm (P=0.021), and desire (P=0.014). Similarly, PVR significantly improved (P=0.012), while fewer patients experienced increased bladder sensation (P=0.035) and detrusor overactivity (P=0.035) upon postoperative urodynamic study. No significant differences were found between patients with bilateral and unilateral obstruction or between either of those groups and Leriche syndrome patients. Conclusions Patients with steno-occlusive disease of the common iliac artery experienced more severe LUTS and sexual dysfunction than healthy controls. Endovascular revascularization alleviated LUTS in patients with moderate-to-severe symptoms and improved bladder and erectile function

Συγκριτική μελέτη υγροχρωματογραφίας κατανομής αντίστροφης φάσης με υγροχρωματογραφία υδρόφιλης αλληλεπίδρασης για τη σάρωση διογκωτικών πλάσματος σε ούρα αθλητών με αναλυτή μαζών χρόνου πτήσης (LC-ESI/qTOF/MS)

Στόχος της παρούσας εργασίας ήταν η ανάπτυξη και επικύρωση μιας μεθόδου σάρωσης (screening) για την ανίχνευση των διογκωτικών όγκων πλάσματος – του υδροξυαιθυλου- άμυλου και της δεξτράνης – σε ούρα αθλητών με χρήση υγροχρωματογραφίας φασματομετρίας μαζών αντίστροφης φάσης και αναλυτή χρόνου πτήσης σε σειρά με τετράπολο (Liquid Chromatography- Quadrupole-Time of Flight, LC-qTOF) με θετικό ηλεκτροψεκασμό (electrospray ionization, [+] ESI) και σύγκριση της με υγροχρωματογραφία φασματομετρία μαζών υδρόφιλης αλληλεπίδρασης. Αρχικά, επιλέχθηκαν τα ιόντα προσδιορισμού για τους δύο αναλυτές δοκιμάστηκε η χρωματογραφική συμπεριφορά τους στις δύο χρωματογραφίες και στη συνέχεια ακολούθησε επικύρωση των δύο μεθόδων σύμφωνα με τις Προδιαγραφές και τις τυποποιημένες μορφές εργασίας του Εργαστηρίου Ελέγχου Ντόπινγκ. Και οι δύο μέθοδοι κρίνονται κατάλληλες για τον προσδιορισμό του υδροξυαιθυλου αμύλου και της δεξτράνης, αλλά η μέθοδος υγροχρωματογραφίας υδρόφιλης αλληλεπίδρασης δείχνει καλύτερη χρωματογραφική συμπεριφορά και εμφανίζει ικανοποιητικές επιδράσεις από το υπόστρωμα σε σχέση με την υγροχρωματογραφία αντίστροφης φάσης.This Master Thesis presents the development and validation of a screening method in order to detect Plasma Volume Expanders (PVEs) - Dextran and Hydroxyethyl starch – in athlete’s urine with Reversed Phase Liquid Chromatography - Mass Spectrometry and the use of a Time of Flight mass analyzer coupled with a quadrupole (LC-qTOF) with positive electronspray ionization (+ESI), compared to Hydrophilic Interaction Liquid Chromatography – Mass Spectrometry. At first, they were selected the ions for the identification of the two analytes and studied their chromatographic behavior in both reversed phase liquid chromatography and hydrophilic interaction chromatography. Then, a method validation was performed for both methods in accordance with the Specification and the Standardized Work Format of Doping Control Laboratory, As a result, both of the methods being proposed were considered to be capable of detecting hydroxyethyl- starch and dextran, but hydrophilic interaction chromatography has shown better chromatographic behavior and less matrix interferences rather than reversed phase liquid chromatography

Impact of hospital educational environment and occupational stress on burnout among Greek medical residents

A number of risk and protective factors have been described on the development of burnout syndrome amongst medical residents. The current study aims to investigate the impact of hospital educational environment and occupational stress on trainee doctors burnout. A cross-sectional study among 269 medical residents was conducted. Greek version of Postgraduate Hospital Educational Environment Measure (PHEEM-G) for the assessment of their educational environment, Greek Version of Job Stress Measure (JSM-G) for the stress assessment and Copenhagen Burnout Inventory (CBI) for burnout measurement were used. RESULTS: Medical residents' perceptions about their educational environment are rather negative. Their job-related stress ranged between moderate and high levels, while burnout ranged in medium levels. A significant positive association was observed between total CBI and its subscales and stress. Positive evaluation of the clinical learning environment was inversely related with burnout levels. Job stress was correlated independently and positively with higher total burnout levels and its' three dimensions. Work-related burnout was independently and negatively related with social support

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

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

Translation and validation of the Copenhagen Burnout Inventory amongst Greek doctors

The Copenhagen Burnout Inventory (CBI) is a tool for burnout measurement and includes three different subscales: (i) personal, (ii) work-related and (iii) client-related burnout. The aim of this study was the translation and validation of CBI into the Greek Language. The forward-backward translation method was performed. Initially the questionnaire was distributed to 35 medical students for face validity assessment. Then, 284 residents answered the Greek version of CBI so as for construct validity to be examined. The data analysis was performed by using SPSS and AMOS. Face validity was estimated above 0.8 for the Greek version of CBI. The three factors model of CBI-Greek, with 1 item removed, achieved not so well-defined inner structure in CFI. However, the 16-item model achieved good levels of goodness-of-fit indices (Cmin/df 2.52, RMSEA 0.074, GFI 0.901, CFI70.938, NFI 0.901, TLI 0.923). The composite reliability values, also varied from 0.842 to 0.852. Cronbach's alpha index values surpassed 0.844. The 16-item model of CBI-Gr is a valid tool with high internal consistency that can be used in the evaluation of burnout in Greek population. The original 3-items model is a possible alternative

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