Prevention and treatment of infectious complications after urogenital prosthesis surgery

Prostheses are widely used in urogenital surgery for many decades and have gained a fundamental role in the management of multiple diseases with good results in terms of functionality, aesthetic outcomes and patients\u2019 satisfaction. It is remarkable that prosthetic device vary in term of mechanical sophistication, costs and surgical implantation techniques ranging from simple device widely used in urological practice like testicular prosthesis to highly sophisticated devices as Inflatable Penile Prosthesis (IPP) and Artificial Urinary Sphincter (AUS). Despite continuous implementations of the devices and improvements of surgical implantation techniques infective complications are still fearful and not uncommon events. Risk of infection depends on patients\u2019 individual features, perioperative strategies, implantation techniques and prosthetic devices. Prevent these complications is imperative because the management of prosthesis infection requires removal of the device in most cases. Centres that plan prosthetic implantations should based on these strategies protocols in order to prevent as far as possible infective complications

“Real life use” of troponin in the emergency department: a survey of over 3000 cases

Introduction: The aim of this study was to identify clinical variables which may be independently associated with positivity of a cardiac troponin I (cTnI) assay in a large population of patients admitted to the emergency department (ED). Materials and methods: 3166 subjects, with at least two troponin I tests ordered within 6 hours in the ED, were studied. Patient data were statistically analyzed to identify clinical associations with increased values of Troponin I. Results: Although patients with diagnosis of acute coronary syndrome displayed troponin I values significantly higher than those of other groups, positivity to troponin I (> 40 ng/L) was also observed in patients with other clinical conditions. In multivariate analysis, age, elevated heart rate and electrocardiographyc changes were independently associated with troponin I positivity at admission. In the whole study population troponin I positivity exhibited high sensitivity and negative predictive value, counterbalanced by low specificity and limited positive predictive value. Conclusions: Troponin I positivity should be combined with history and clinical evaluation and cautiously interpreted in the ED, especially in patients exhibiting factors associated with higher troponin I levels such as older age, elevated heart rate or ECG changes

Intraoperative ultrasound in robot-assisted partial nephrectomy: State of the art

Introduction: Nephron-sparing surgery (NSS) is of one of the most studied fields in urology due to the balancing between renal function preservation and oncological safety of the procedure. Aim of this short review is to report the state of the art of intra-operative ultrasound as an operative tool to improve localization of small renal masses partially or completely endophytic during robotassisted partial nephrectomy (RAPN). Material and methods: We performed a literature review by electronic database on Pubmed about the use of intra-operative US in RAPN to evaluate the usefulness and the feasibility of this procedure. Results: Several studies analyzed the use of different US probes during RAPN. Among them some focused on using contrastenhanced ultra sonography (CEUS) for improving the dynamic evaluation of microvascular structure allowing the reduction of ischemia time (IT). We reported that nowaday the use of intraoperative US during RAPN could be helpful to improve the preservation of renal tissue without compromising oncological safety. Moreover, during RAPN there is no need for assistant to hand the US probe increasing surgeon autonomy. Conclusions: The use of a robotic ultrasound probe during partial nephrectomy allows the surgeon to optimize tumor identification with maximal autonomy, and to benefit from the precision and articulation of the robotic instrument during this key step of the partial nephrectomy procedure. Moreover US could be useful to reduce ischemia time (IT). The advantages of nephron-sparing surgery over radical nephrectomy is well established with a pool of data providing strong evidence of oncological and survival equivalency. With the progressive growth of robot-assisted partial nephrectomy (RAPN) techniques, the use of several tools has been progressively developed to help the surgeon in the identification of masses and its vascular net. In this short review we tried to analyze the current use of intra-operative ultrasound as an operative tool to improve localization of small renal masses partially or completely endophytic during RAPN

MP58-13 The role of G8 screening tool in Elderly population undergoing radical cystectomy: preliminary evaluation

INTRODUCTION AND OBJECTIVES The G8 screening tool represents a valid instrument for the identification of functional decline in oncological geriatric patients (pts). Recently it has demonstrated good predictive value in surgery to identify fragile pts candidates for oncological abdominal surgery. Our study has the objective to define if G8 score is a good tool to identify the risk of post operative complications in elderly pts (= 70 years) undergoing radical cystectomy (RC). METHODS From January 2012 to August 2017 we recruited 56 pts 70 yrs or older at the surgical time, undergone RC. Median age was 76 yrs (SD 4,37). The G8 screening questionnaire was perfomed to all patients preoperatively, and fragile pts were identified with a score = 14. We registered intra operative complications, post operative complications and their gravity using Clavien Dindo scale, estimated glomerular filtration rate (eGFR) and its variation postoperatively, length of hospital stay after surgery and readmission rate within 30 days. We compared the clinicalpathological data between the frail (G8 score 14) group. Statistical analysis was made by computing software SPSS. RESULTS Median preoperative G8 score was 13,65 (SD 2,3). Pts were divided in fragile (N=35, 62,5%) and fit (N=21, 37,5%). Intra operative complications were registered in 1 pts (2,8 %) with G8 score =14 and 0 pt (0%) with G8>14 (p= 0,625). Post operative complications occurred in 24 pts (68,5 %) with G8 score =14 and 8 pts (38,09 %) with G8>14 (p=0,025), 12 and none of them had a Clavien Score = 3 respectevely (p= 0,015). Postoperative eGFR was 61,45 (SD 29,2) in G8=14 group and 57,66 (SD 25,84) in G8>14 group (p=0,62) and median variation between pre and postoperative eGFR was 7,8 (SD 27,43) and 8,0 (SD 26,01) for each group (p= 0,97). Median hospital stay was 25,45 days (SD 11,01) for fragile pts and 24,23 days (SD 11,32) for fit pts (p=0,69). 5 pts (14,28 %) with G8score=14 were readmitted within 30 days of discharge, and for 6 pts (28,57 %) with G8score>14 was necessary a new hospitalization (p= 0,298). No significative difference was registered for overall mortality (p= 0,23) and cancer related mortality (p= 0,53) between the two groups. CONCLUSIONS The G8 screening tool represents a good predictive instrument for RC morbidity, identifying fragile pts at risk of post operative complications and their severity. Further analyses are necessary to confirm the data obtained from this preliminary study

MP58-13 The role of G8 screening tool in Elderly population undergoing radical cystectomy: preliminary evaluation

INTRODUCTION AND OBJECTIVES The G8 screening tool represents a valid instrument for the identification of functional decline in oncological geriatric patients (pts). Recently it has demonstrated good predictive value in surgery to identify fragile pts candidates for oncological abdominal surgery. Our study has the objective to define if G8 score is a good tool to identify the risk of post operative complications in elderly pts (= 70 years) undergoing radical cystectomy (RC). METHODS From January 2012 to August 2017 we recruited 56 pts 70 yrs or older at the surgical time, undergone RC. Median age was 76 yrs (SD 4,37). The G8 screening questionnaire was perfomed to all patients preoperatively, and fragile pts were identified with a score = 14. We registered intra operative complications, post operative complications and their gravity using Clavien Dindo scale, estimated glomerular filtration rate (eGFR) and its variation postoperatively, length of hospital stay after surgery and readmission rate within 30 days. We compared the clinicalpathological data between the frail (G8 score 14) group. Statistical analysis was made by computing software SPSS. RESULTS Median preoperative G8 score was 13,65 (SD 2,3). Pts were divided in fragile (N=35, 62,5%) and fit (N=21, 37,5%). Intra operative complications were registered in 1 pts (2,8 %) with G8 score =14 and 0 pt (0%) with G8>14 (p= 0,625). Post operative complications occurred in 24 pts (68,5 %) with G8 score =14 and 8 pts (38,09 %) with G8>14 (p=0,025), 12 and none of them had a Clavien Score = 3 respectevely (p= 0,015). Postoperative eGFR was 61,45 (SD 29,2) in G8=14 group and 57,66 (SD 25,84) in G8>14 group (p=0,62) and median variation between pre and postoperative eGFR was 7,8 (SD 27,43) and 8,0 (SD 26,01) for each group (p= 0,97). Median hospital stay was 25,45 days (SD 11,01) for fragile pts and 24,23 days (SD 11,32) for fit pts (p=0,69). 5 pts (14,28 %) with G8score=14 were readmitted within 30 days of discharge, and for 6 pts (28,57 %) with G8score>14 was necessary a new hospitalization (p= 0,298). No significative difference was registered for overall mortality (p= 0,23) and cancer related mortality (p= 0,53) between the two groups. CONCLUSIONS The G8 screening tool represents a good predictive instrument for RC morbidity, identifying fragile pts at risk of post operative complications and their severity. Further analyses are necessary to confirm the data obtained from this preliminary study

Analysis of clinical utility of abdominopelvic computer tomography in the follow up of Stage I Seminoma. A single center evaluation

BACKGROUND: Abdominopelvic computer tomography (CT) is widely used in the follow up of seminoma patients after radical orchidectomy. The aim of this study is to evaluate the clinical utility of abdominopelvic computer tomography in the follow-up of patients with Stage I seminoma. METHODS: The pathological reports of all patients that have undergone radical orchidectomy in our tertiary referral center between January 2002 and January 2018 have been retrospectively reviewed. All patients with Stage I seminoma and negative serum tumor markers after radical orchidectomy were included. Patients with follow-up shorter than 12 months were excluded. Surveillance records of every patient were reviewed with particular regard to abdominopelvic imaging. RESULTS: Of the 133 patients who have undergone radical orchidectomy in our center, 55 had stage I pure seminoma with normal levels of serum tumor markers after surgery. Two patients were excluded as the follow-up was inadequate. Mean follow-up was 63,2 months (IQR: 30-73). The results of 211 abdominopelvic CTs performed as part of the follow up were reviewed. Two (3,7%) patients developed recurrence; one consisted of a scrotal lump and was diagnosed with ultrasonography (US) while the second appeared as paraaortic nodal metastasis and was diagnosed with abdominopelvic CT. The recurrence was successfully treated in both patients. A single abdominopelvic CT was useful for the detection of recurrent disease in our entire study population. No cancer specific death has been reported in the study population. CONCLUSIONS\u2d0 Follow-up schedules for stage I seminoma exposes patients to potential risks of radiation- induced tumors, emotional distress and represent a significant burden for the healthcare system. The current series suggests that a better risk adapted patient-tailored follow-up program is needed in order to avoid unnecessary investigations

Prevention and treatment of infectious complications after urogenital prosthesis surgery

Prostheses are widely used in urogenital surgery for many decades and have gained a fundamental role in the management of multiple diseases with good results in terms of functionality, aesthetic outcomes and patients\u2019 satisfaction. It is remarkable that prosthetic device vary in term of mechanical sophistication, costs and surgical implantation techniques ranging from simple device widely used in urological practice like testicular prosthesis to highly sophisticated devices as Inflatable Penile Prosthesis (IPP) and Artificial Urinary Sphincter (AUS). Despite continuous implementations of the devices and improvements of surgical implantation techniques infective complications are still fearful and not uncommon events. Risk of infection depends on patients\u2019 individual features, perioperative strategies, implantation techniques and prosthetic devices. Prevent these complications is imperative because the management of prosthesis infection requires removal of the device in most cases. Centres that plan prosthetic implantations should based on these strategies protocols in order to prevent as far as possible infective complications

Perioperative antimicrobial prophylaxis for preventing infectious complications after transurethral resection of the bladder: to use or not to use?

Purpose Transurethral Resection of the Bladder (TURB) is a very common endoscopic procedure. Perioperative antimicrobial prophylaxis (AMP) is used to reduce the risk of infectious complications. However, there is a lack of knowledge about both incidence of infectious complications after TURB and advantage of AMP in general. The objective of this study is to determinate the prevalence of post-operative infectious complications after routine TURB without AMP. Methods We retrospectively reviewed clinical data of all patients who underwent TURB in the same Academic Urological Department between January 2011 and December 2013. We consider as relevant for analysis, patients that underwent TURB without receiving any AMP. Infection was defined as a body temperature >37.5 \ub0C sustained for at least 24h. Sepsis was defined according to the third international consensus definition for sepsis and septic shock. Results In the period of the study, 223 TURBs were performed without use of AMP. Mean age was 70,3 years (Standard deviation [SD] 11,3). Mean operative time was: 25.14 minutes (SD 16). Median length of hospital stay was 3 days (IQR: 2-4). 6 (2,7%) patients developed postoperative infective complications. No case of sepsis was reported. 2 (0,9%) patients received an antimicrobial therapy with fluoroquinolones despite absence of any signs of infection. 215 (96,4%) patients-TURBs did not receive any antimicrobial drugs and did not developed any infectious complications. Conclusion In our series, infectious complications after TURB occurred in less than 3% of cases. In conclusion AMP should not be routinely used prior TURB

Analysis of clinical utility of abdominopelvic computer tomography in the follow up of Stage I Seminoma. A single center evaluation

Abdominopelvic computer tomography (CT) is widely used in the follow up of seminoma patients after radical orchidectomy. The aim of this study is to evaluate the clinical utility of abdominopelvic computer tomography in the follow-up of patients with Stage I seminoma