Early postoperative mortality in the elderly: a pilot study

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Perforation of the Urinary Bladder Caused by Transurethral Insertion of a Pencil for the Purpose of Masturbation in a 29-Year-Old Female

The urethra is a usual site of introduction of foreign bodies for autoerotic stimulation. We present an unusual case of bladder perforation caused by foreign body that was self-inserted in the urethra and consequently slipped inside the bladder in a 29-year-old female patient with psychiatric disease. The patient was referred to our department for macroscopic hematuria and abdominal pain. Imaging studies revealed the presence of a foreign body in the pelvic area which had perforated the left lateral wall of the bladder. The foreign body was removed via open cystotomy. In psychiatric patients hematuria and pelvic pain may result from insertion of a foreign body in the bladder usually during masturbation

Patient's adherence on pharmacological therapy for benign prostatic hyperplasia (BPH)-associated lower urinary tract symptoms (LUTS) is different: Is combination therapy better than monotherapy

Abstract BACKGROUND: Recent studies showed that the non-adherence to the pharmacological therapy of patients affected by BPH-associated LUTS increased the risk of clinical progression of BPH. We examined the patients adherence to pharmacological therapy and its clinical consequences in men with BPH-associated LUTS looking at the differences between drug classes comparing mono vs combination therapy. METHODS: A retrospective, population-based cohort study, using prescription administrative database and hospital discharge codes from a total of 1.5 million Italian men. Patients ≥ 40 years, administered alpha-blockers (AB) and 5alpha-reductase inhibitors (5ARIs), alone or in combination (CT), for BPH-associated LUTS were analyzed. The 1-year and long term adherence together with the analyses of hospitalization rates for BPH and BPH-related surgery were examined using multivariable Cox proportional hazards regression model and Pearson chi square test. RESULTS: Patients exposed to at least 6 months of therapy had a 1-year overall adherence of 29 % (monotherapy AB 35 %, monotherapy 5ARI 18 %, CT 9 %). Patient adherence progressively declined to 15 %, 8 % and 3 % for AB, 5ARI, and CT, respectively at the fifth year of follow up. Patients on CT had a higher discontinuation rate along all the follow-up compared to those under monotherapy with ABs or 5ARIs (all p < 0.0001). Moreover, CT was associated with a reduced risk of hospitalization for BPH-related surgery (HR 0.94; p < 0.0001) compared to AB monotherapy. CONCLUSIONS: Adherence to pharmacological therapy of BPH-associated LUTS is low and varies depending on drugs class. Patients under CT have a higher likelihood of discontinuing treatment for a number of reasons that should be better investigated. Our study suggests that new strategies aiming to increase patient's adherence to the prescribed treatment are necessary in order to prevent BPH progression

Arteriovenous malformation of the spermatic cord as the cause of acute scrotal pain: a case report

Arteriovenous malformations of the lower urinary tract are uncommon lesions, usually presenting as scrotal masses. A case of recurrent acute scrotal pain mimicking testicular torsion that was attributed to the presence of an arteriovenous malformation of the spermatic cord is described. To our knowledge this is the first reported case of an arteriovenous malformation of the spermatic cord presenting with acute scrotal pain

The Evolution of KTP Laser Vaporization of the Prostate

The search for a minimally invasive approach to the treatment of Lower Urinary Tract Symptoms (LUTS) suggestive of Benign Prostatic Hyperplasia (BPH) is probably as old as Transurethral Resection of the Prostate (TURP). In an effort to overcome the limitations and morbidities of TURP, and in light of evidence suggesting that medical treatment for BPH has a limited life-span, laser-based treatments have emerged during the last decade. Photoselective Vaporization of the Prostate (PVP) by the "GreenLight" KTP laser is considered one of the most promising options, one that is constantly evolving new technologies in prostate surgery. In this overview of KTP laser usage in BPH treatment, we will briefly discuss the evolution of this modality since it was first introduced and focus on the available evidence regarding safety, efficacy and cost parameters of its application

Radical penectomy, a compromise for life: results from the PECAD study

The use of organ sparing strategies to treat penile cancer (PC) is currently supported by evidence that has indicated the safety, efficacy and benefit of this surgery. However, radical penectomy still represents up to 15-20% of primary tumor treatments in PC patients. The aim of the study was to evaluate efficacy in terms of overall survival (OS) and disease-free survival (DFS) of radical penectomy in PC patients.Background: The use of organ sparing strategies to treat penile cancer (PC) is currently supported by evidence that has indicated the safety, efficacy and benefit of this surgery. However, radical penectomy still represents up to 15-20% of primary tumor treatments in PC patients. The aim of the study was to evaluate efficacy in terms of overall survival (OS) and disease-free survival (DFS) of radical penectomy in PC patients. Methods: Data from a retrospective multicenter study (PEnile Cancer ADherence study, PECAD Study) on PC patients treated at 13 European and American urological centers (Hospital \u201cSant'Andrea\u201d, Sapienza University, Roma, Italy; \u201cG.D'Annunzio\u201d University, Chieti and ASL 2 Abruzzo, Hospital \u201cS. Pio da Pietrelcina\u201d, Vasto, Italy; Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, FL, USA; Hospital of Budapest, Hungary; Department of Emergency and Organ Transplantation, Urology and Andrology Unit II, University of Bari, Italy; Hospital \u201cSpedali Civili\u201d, Brescia, Italy; Istituto Europeo di Oncologia, University of Milan, Milan, Italy; University of Modena &amp; Reggio Emilia, Modena, Italy; Hospital Universitario La Paz, Madrid, Spain; Ceara Cancer Institute, Fortaleza, Brazil; Virginia Commonwealth University, Richmond, VA, USA; Aristotle University of Thessaloniki, Thessaloniki, Greece; Maria Sk\u142odowska-Curie Memorial Cancer Center, Warsaw, Poland) between 2010 and 2016 were used. Medical records of patients who specifically underwent radical penectomy were reviewed to identify main clinical and pathological variables. Kaplan-Meier method was used to estimate 1- and 5-year OS and DFS. Results: Of the entire cohort of 425 patients, 72 patients (16.9%) treated with radical penectomy were extracted and were considered for the analysis. The median age was 64.5 (IQR, 57.5-73.2) years. Of all, 41 (56.9%) patients had pT3/pT4 and 31 (43.1%) pT1/pT2. Moreover, 36 (50.0%) were classified as pN1-3 and 5 (6.9%) M1. Furthermore, 61 (84.7%) had a high grade (G2-G3) with 6 (8.3%) positive surgical margins. The 1- and 5-year OS rates were respectively 73.3% and 59.9%, while the 1- and 5-year DFS rates were respectively 67.3% and 35.1%. Conclusions: PC is an aggressive cancer particularly in more advanced stage. Overall, more than a third of patients do not survive at 5 years and more than 60% report a disease recurrence, despite the use of a radical treatment

Role of voiding and storage symptoms for the quality of life before and after treatment in men with voiding dysfunction

Previous studies on associations between voiding dysfunction and quality of life (QoL) have largely been limited to baseline data. Therefore, we have explored associations between Q (max) and voiding and storage sub-scores of the International Prostate Symptom Score (IPSS) before and after treatment with QoL. Analysis of a single-center database of 2,316 men with voiding dysfunction attributed to benign prostatic hyperplasia undergoing various medical and surgical treatment forms. Q (max) exhibited little correlation with QoL before or after treatment. IPSS inversely correlated with QoL at baseline and after treatment, and IPSS improvements correlated with those of QoL. The associations applied to both the voiding and storage sub-score of the IPSS, with the latter consistently exhibiting somewhat tighter associations. Our post-treatment data support the idea of a cause-effect relationship between voiding symptoms and QoL irrespective of treatment form. While both voiding and storage symptoms contribute to this relationship, storage symptoms play a somewhat greater rol

A smart digital health platform to enable monitoring of quality of life and frailty in older patients with cancer: a mixed-methods, feasibility study protocol

Objectives: LifeChamps is an EU Horizon 2020 project that aims to create a digital platform to enable monitoring of health-related quality of life and frailty in patients with cancer over the age of 65. Our primary objective is to assess feasibility, usability, acceptability, fidelity, adherence, and safety parameters when implementing LifeChamps in routine cancer care. Secondary objectives involve evaluating preliminary signals of efficacy and cost-effectiveness indicators. Data Sources: This will be a mixed-methods exploratory project, involving four study sites in Greece, Spain, Sweden, and the United Kingdom. The quantitative component of LifeChamps (single-group, pre-post feasibility study) will integrate digital technologies, home-based motion sensors, self-administered questionnaires, and the electronic health record to (1) enable multimodal, real-world data collection, (2) provide patients with a coaching mobile app interface, and (3) equip healthcare professionals with an interactive, patient-monitoring dashboard. The qualitative component will determine end-user usability and acceptability via end-of-study surveys and interviews. Conclusion: The first patient was enrolled in the study in January 2023. Recruitment will be ongoing until the project finishes before the end of 2023. Implications for Nursing Practice: LifeChamps provides a comprehensive digital health platform to enable continuous monitoring of frailty indicators and health-related quality of life determinants in geriatric cancer care. Real-world data collection will generate “big data” sets to enable development of predictive algorithms to enable patient risk classification, identification of patients in need for a comprehensive geriatric assessment, and subsequently personalized care

The role of ligation of the left internal spermatic vein in the management of infertile patients with subclinical left varicocele

Aim. Surgical ligation of the internal spermatic veins in infertile men with palpable varicoceles has been proved to result in a significant im-provement in sperm parameters. On the contrary there is no consensus on the role of varicocelectomy for the treatment of infertile men with non pal-pable, subclinical, varicoceles. The aim of this study is to evaluate the effect of the surgical ligation of the internal spermatic veins for the treatment of infertile men with subclinical varicoceles diagnosed by ultrasonography and no other causes of spermatogenetic impairment. Materials and methods. A total of 34 infertile men with subclinical varicoceles diagnosed with high resolution Color Doppler ultrasonography and no other causes of infertility were enrolled in the study. The patients were allowed to choose between surgical ligation of the internal spermatic veins and observation. 18 men agreed to undergo microsurgical subinguinal ligation of the spermatic veins (group A) while 16 men opted for observa-tion and constituted the control group (group B). Baseline sperm parameters (sperm count, motility and morphology) were compared to values obtained after a period of 6-9 months for the patients in both groups (postoperative for group A). Results. In the group of patients that underwent surgical ligation of the internal spermatic veins there were no statistically significant differences between preoperative and postoperative values for all sperm parameters, although postoperatively there was a small increase in all sperm parameters. On the contrary, for the patients in the control group there was a statistically significant decrease in the percentage of morphologically normal spermato-zoa. There was a non-statistically significant decrease in the sperm count and motility in the control group. Conclusions. There is no evidence from the present study suggesting that infertile men with subclinical varicoceles and other causes of infertility would benefit from surgical ligation of the internal spermatic veins.Σκοπός. H χειρουργική απολίνωση της έσω σπερματικής φλέβας σε υπογόνιμους ασθενείς με ψηλαφητή αριστερή κιρσοκήλη συνήθως συνο-δεύεται από προοδευτική βελτίωση των παραμέτρων του σπέρματος. Αντί-θετα η αναγκαιότητα απολίνωσης της αριστερής έσω σπερματικής φλέβας σε υπογόνιμους ασθενείς με αριστερή υποκλινική κιρσοκήλη δεν έχει τεκ-μηριωθεί. Σκοπός της παρούσας μελέτης είναι να διερευνηθεί η επίδραση της χειρουργικής απολίνωσης των έσω σπερματικών φλεβών στην γονιμο-ποιητική ικανότητα υπογόνιμων ανδρών με αριστερή υποκλινική κιρσοκή-λη, διεγνωσμένη με υπερηχογράφημα οσχέου, και καμία άλλη αιτία σπερ-ματογενετικής δυσλειτουργίας. Υλικό και μέθοδος. Στην παρούσα μελέτη θα μελετηθούν οι ποσοτι-κές και ποιοτικές παράμετροι των σπερματοζωαρίων σε ασθενείς με αρι-στερή υποκλινική κιρσοκήλη μετά την απολίνωση της αριστερής έσω σπερ-ματικής φλέβας και θα συγκριθούν με τις αντίστοιχες προεγχειρητικές τιμές. Για το σκοπό αυτό 18 υπογόνιμοι ασθενείς (ομάδα A) με αριστερή υποκλι-νική κιρσοκήλη, διεγνωσμένη με υψηλής ευκρίνειας υπερηχογραφική εξέ-ταση, χωρίς άλλη γεννητική ή επίκτητη αιτία σπερματογεννετικής δυσλει-τουργίας επέλεξαν να υποβληθούν σε χειρουργική απολίνωση της αριστε-ρής έσω σπερματικής φλέβας με την υποβουβωνική μικροχειρουργική τε-χνική. Μια δεύτερη ομάδα 16 υπογόνιμων ασθενών (ομάδα B) με αριστερή υποκλινική κιρσοκήλη χωρίς άλλη γεννητική ή επίκτητη αιτία σπερματο-γεννετικής δυσλειτουργίας επέλεξε να μην λάβει χειρουργική ή φαρμακευ-τική θεραπεία και αποτέλεσε την ομάδα ελέγχου. Μέσα σε κάθε ομάδα α-σθενών οι αρχικές τιμές αριθμού σπερματοζωαρίων, ποσοστών κινητών σπερματοζωαρίων, και ποσοστών μορφολογικά φυσιολογικών σπερματο-ζωαρίων συγκρίθηκαν με τις αντίστοιχες τιμές (μετεγχειρητικές για την ομάδα A) στο τέλος της περιόδου παρατήρησης (6-9 μήνες). Αποτελέσματα. Στην ομάδα των ασθενών που υποβλήθηκαν σε μι-κροχειρουργική απολίνωση των έσω σπερματικών φλεβών διαπιστώθηκε μικρή βελτίωση μετεγχειρητικά σε όλες τις παραμέτρους του σπερμοδια-γράμματος η οποία ωστόσο δεν κατέστη στατιστικά σημαντική. Στην ομάδα ελέγχου αντίθετα διαπιστώθηκε μια στατιστικά σημαντική μείωση στο πο-σοστό των μορφολογικά φυσιολογικών σπερματοζωαρίων μεταξύ των αρ-χικών μετρήσεων και των μετρήσεων στο τέλος της περιόδου παρατήρησης. Ο αριθμός και η κινητικότητα των σπερματοζωαρίων στην ομάδα ελέγχου δεν παρουσίασαν στατιστικά σημαντική μείωση. Συμπεράσματα. Η μικροχειρουργική απολίνωση των έσω σπερματι-κών φλεβών δεν έχει σημαντική επίδραση στη βελτίωση των παραμέτρων του σπέρματος και κατ’επέκταση στη βελτίωση της γονιμοποιητικής ικανό-τητας υπογόνιμων ανδρών με υποκλινική αριστερή κιρσοκήλη. Με βάση τα αποτελέσματα της μελέτης δεν μπορεί να υποστηριχθεί η θέση ότι οι υπο-γόνιμοι άνδρες με υποκλινική αριστερή κιρσοκήλη θα ωφεληθούν από την χειρουργική απολίνωση των έσω σπερματικών φλεβών