Current trends in non-surgical management of Peyronie's disease-A narrative review.

Peyronie's disease (PD) is a connective tissue disorder affecting the tunica albuginea. It can cause pain and penile deformation, and its prevalence increases with age. Although surgery is the gold standard for the chronic phase of the disease, there are several conservative treatment methods available, and the optimal management of the acute phase of the disease remains a matter of debate. In this article, we aim to summarize the recent trends in research on the subject of non-surgical treatment of PD. The search was performed in PubMed, Scopus, and Web of Science databases and included studies in English published between 2012 and 2022 investigating the clinical outcomes of non-surgical PD management in humans. We have identified 20 distinct conservative treatment strategies. Among the oral therapeutics, only the use of phosphodiesterase type 5 inhibitors is currently recommended for clinical use in patients with concomitant erectile dysfunction. The use of collagenase from Clostridium histolyticum is supported by the best quality evidence in terms of intralesional injections for patients suffering from significant penile curvature; however, interferon alpha-2b can also be an option in such patients. Among other non-invasive methods, extracorporeal shockwaves can be useful for pain reduction, and penile traction therapy can lead to a reduction in penile curvature and plaque size. Despite a wide range of non-surgical methods available for PD treatment, the majority are not supported by sufficient scientific evidence, and the treatment efficacy is underwhelming. Further research on the subject of non-surgical management of PD is highly warranted.

Role of preoperative patient education among prostate cancer patients treated by radical prostatectomy.

Introduction: Radical prostatectomy, as a prostate cancer treatment option, is associated with the presence of certain postoperative dysfunctions - physical, psychosocial, emotional and economic. However, regular and planned preoperative patient education can help and support physical and emotional well-being by reducing levels of anxiety, building feelings of being in control, and providing instruments for self-management by patients. Material and methods: A literature search was conducted on the subject of educational interventions among cancer patients, focusing on men with prostate cancer undergoing radical prostatectomy. Results: Preoperative patient education can affect key factors which have an impact on health-related quality of life such as levels of fear and anxiety, expectations and satisfaction in relation to treatment, postoperative activity, self-care management, and others. Conclusions: Effective education of patients can lead to increased involvement in courses of treatment, which can in turn result in decreased postoperative complications and shorter recuperative periods. Patient education should be scheduled and organized using not only traditional methods but also modern technology, e.g. 3D printed models of organs or tumours.

A randomized controlled study to analyze the safety and efficacy of percutaneous nephrolithotripsy and retrograde intrarenal surgery in the management of renal stones more than 2 cm in diameter.

OBJECTIVE: The gold standard for removal of renal stones more than 2 cm in diameter is percutaneous nephrolithotripsy (PCNL). Retrograde intrarenal surgery (RIRS) has become more and more fashionable because of its high safety and repeatability, especially in smaller stones. Many retrospective studies have proved its efficacy and safety in larger calculi, however. We decided to compare prospectively both procedures in terms of safety and efficacy in renal pelvic stones more than 2 cm in diameter. PATIENTS AND METHODS: This was a randomized single tertiary care center trial with two arms (32 patients in each arm). The first group comprised patients who underwent PCNL, while in the second group, there were patients in whom RIRS with a semirigid ureteroscope was used. The primary end points were hematocrit and hemoglobin drop after surgery as equivalents of safety and stone disintegration rate in terms of efficacy. The secondary end points comprised operating room time, visual analogue scale of pain, pain treatment, and hospital stay. RESULTS: The mean hematocrit drop after the procedure was lower in the second group. Similarly, operating room time and hospital stay were significantly shorter after RIRS in comparison with PCNL. In the second group, patients had favorable features in terms of pain intensity and treatment after the procedure. PCNL showed higher efficacy (94%) in comparison with RIRS (75%). The power of 83% was calculated for the primary end point. CONCLUSION: The efficacy of RIRS is acceptable and, emphasizing its high safety, it should be considered as a valuable alternative option for management of renal pelvic stones more than 2 cm in diameter.

[Place of laparoscopic cysts decortication (LCD) in the treatment of autosomal dominant polycystic kidney disease (AD PKD)]. / Place de la résection laparoscopique des kystes rénaux pour polykystose rénale autosomique dominante symptomatique.

INTRODUCTION: Decortication of many cysts in patients with autosomal dominant policystic kidney disease (AD PKD) allows to reduce renal mass, decreases hydrostatic pressure in cysts; moreover it diminishes pain. METHODS: Between the years 2000-2005, 15 patients underwent laparoscopic cyst decortication (LCD) inculuding 5 (33.3%) men and 10 (66.7%) women. Patients age ranged between 41-73 years (mean 54 y.). Two patients underwent extraperitoneal and 13 transperitoneal LCD. In 2 patients were performed bilateral and in others unilateral decortication. LCD was done in 6 patients on the left side and in 7 on the right side. In all patients except three only 3 ports were used during these operations. Preoperative and postoperative diagnos was based on physical, laboratory, sonographic and computer tomografy (CT) examinations. Renal function was estimated by GFR and renal dynamic Tc99 scyntigraphy. Pain intensity was estimated in visual (VAS) 10 degree score. Follow-up after LCD was 9 to 77 months (mean 36 months). RESULTS: The mean operative time and the mean hospitalization time were respectively: 197 minutes and 5,4 days. The mean convalescence time was 10.5 days. The mean number of operated cysts was 43,5 per one patient. Pain was relieved in all (100%) patients into 6 months after LCD but has returned in 20% patients after 12 months and in 27% patients after 24 months. Hypertension regressed in 4 patients among 6 (40.0%) with high blood pressure before operation, but haematuria regressed in all patients among 5 (33.3%) with this symptom before LCD. The mean renal function (GFR) increase was observed about 10%, but blood purification in scitiscanning about 4.9% in all patients. CONCLUSIONS: (1) Laparoscopic cyst decortication (LCD) in patients with symptomatic AD PKD is safe, effective and repeatable alternative to non-radical open surgery. (2) LCD stabilizes renal function which together with improved renal perfusion and renal decontamination decreases number of severe, life-threatening complications.