Transmission beam pattern and dynamics of a spinner dolphin (Stenella longirostris).

Toothed whales possess a sophisticated biosonar system by which ultrasonic clicks are projected in a highly directional transmission beam. Beam directivity is an important biosonar characteristic that reduces acoustic clutter and increases the acoustic detection range. This study measured click characteristics and the transmission beam pattern from a small odontocete, the spinner dolphin (Stenella longirostis). A formerly stranded individual was rehabilitated and trained to station underwater in front of a 16-element hydrophone array. On-axis clicks showed a mean duration of 20.1 µs, with mean peak and centroid frequencies of 58 and 64 kHz [standard deviation (s.d.) ±30 and ±12 kHz], respectively. Clicks were projected in an oval, vertically compressed beam, with mean vertical and horizontal beamwidths of 14.5° (s.d. ± 3.9) and 16.3° (s.d. ± 4.6), respectively. Directivity indices ranged from 14.9 to 27.4 dB, with a mean of 21.7 dB, although this likely represents a broader beam than what is normally produced by wild individuals. A click subset with characteristics more similar to those described for wild individuals exhibited a mean directivity index of 23.3 dB. Although one of the broadest transmission beams described for a dolphin, it is similar to other small bodied odontocetes.

WhatsApp Use In The Evaluation of Hematuria.

INTRODUCTION: The advancements in telemedicine provide the possibility to send photos of hematuria cases to professionals for further evaluation. We aimed to evaluate the inter-rater reliability of WhatsApp use in the evaluation of hematuria. MATERIALS AND METHODS: Between December 2014 and April 2016, 212 patients were evaluated prospectively for hematuria by 2 groups of urologists; Group A: in direct contact with patients for evaluation; Group B: "blind" urologist who had no access to the patients' data but received pictures via WhatsApp. Two photos of voided urine in a sterile container were taken and sent using WhatsApp. The opinions of Group A and B about the grade of hematuria were evaluated. Shapiro-Wilk test and Fleiss' kappa statistics were used for statistical analyses. RESULTS: The median age of patients was 71 (min 22, max 96). The Group A urologists were in accordance in 96.22% of cases. Group B urologists had common opinions in 99.5% (n = 203) and there was almost perfect agreement between 2 groups (λ = 0.992). The number of common opinions among "blind" urologists is more than the number of common opinions among the consultants. When further classification is performed as serious and non-serious hematuria, the rate of misdiagnosing serious cases is approximately 6.5-7%. However, using WhatsApp, the urologists can differentiate normal urine and any form of hematuria with 100% accuracy. CONCLUSION: It is possible to evaluate hematuria remotely and also reduce unnecessary costs of services for hematuria of mild clinical significance by using telemedicine. WhatsApp can provide valuable aid to tertiary hospitals where the urologist is not always present as well as in rural areas.

Thulium Vaporesection of the Prostate and Thulium Vapoenucleation of the Prostate: A Retrospective Bicentric Matched-Paired Comparison with 24-Month Follow-Up.

INTRODUCTION: To evaluate the intermediate-term outcomes of thulium vapoenucleation of the prostate (ThuVEP) and thulium vaporesection of the prostate (ThuVaRP) in patients with benign prostate obstruction (BPO). MATERIALS AND METHODS: A bicentric retrospective matched-paired comparison of patients treated by ThuVEP (n = 80) or ThuVaRP (n = 80) was performed. The patients were preoperatively assessed with International Prostate Symptom Score (IPSS), quality of life (QoL), post-void residual urine (PVR), maximum urinary flow rate (Qmax), prostatespecific antigen (PSA) and re-evaluated at 12- and 24-month follow-up. RESULTS: Median prostate volume was 65 mL and not different between the groups. The immediate re-operation rate was significantly different between ThuVEP and ThuVaRP (5 vs. 0%, p ≤ 0.0434). IPSS, QoL, Qmax and PVR had improved significantly compared to preoperative assessment in both groups at 12- and 24-month follow-up (p ≤ 0.001). Median Qmax (18.2 vs. 21.0 mL/s) and PVR (29.4 vs. 0 mL) were significantly different between ThuVEP and ThuVaRP at 24-month follow-up (p ≤ 0.001), while IPSS and QoL showed no differences between the groups. However, the PSA reduction was significantly higher after ThuVEP compared to ThuVaRP (78.93 vs. 23.39%, p ≤ 0.006) at 24-month follow-up. CONCLUSIONS: ThuVEP and ThuVaRP are safe and efficacious procedures for patients with BPO. Although the peri-operative re-intervention rates were lower after ThuVaRP, the low PSA reduction rate after ThuVaRP at 24-month follow-up favours the ThuVEP procedure.

Cryotherapy for low risk prostate cancer, oncological and functional medium term outcomes: A three center prospective study.

OBJECTIVES: Analyze the oncologic and functional outcomes in patients affected by low risk prostate cancer underwent prostate cryotherapy. Materiasl and methods: It's a prospective tricentric study of 434 patients treated with prostate cryoablation for low risk prostate cancer. By low risk we refer to the D'Amico's risk classification. Two cycles of freezing/thawing are run for each patient following the technique described by Onik. RESULTS: For the 434 patients, the median age was 66 years with a standard deviation of ± 6.68, the average PSA was 6.17 ng/d/L, the median 5.55 with a standard deviation of ± 2.13, the mean prostate volume was 35.59 cc, the median 34.00 cc, with a standard deviation of ± 7.89. Biochemical failure occurred in 67 patients (15.4%). Pre-operative erectile function in men was distributed as follows: severe in 95 patients (19.2%), moderate in 95 (19.2%), medium-moderate in 180 (36.4%), mild in 92 (18.6%), with no dysfunction in 32 (6.5%) patients. Post-operative erectile function, measured 1 month after cryotherapy, was distributed as follows: severe in 321 (65%) patients, moderate in 69 (14%), medium-moderate in 79 (16%), mild in 23 (4.7%), and no dysfunction in only 2 patients (0.4%). Post-operative erectile function after 3 months was distributed as follows: severe in 233 (47.2%) patients, moderate in 66 (13.4%), medium-moderate in 122 (24.7%), mild in 65 (13.2%), and no dysfunction in 8 patients (1.6%). Urinary incontinence was present in 21 patients (4.8%) after 3 months while it dropped to 13 patients (2.9%) after 6 months. CONCLUSIONS: Cryotherapy in the treatment of prostate cancer remains a viable alternative. The availability of new cryoprobes and the use of new diagnostic means such as fusion magnetic resonance will make this more precise and more effective method.

Thulium laser vaporesection of the prostate: Can we operate without interrupting oral antiplatelet/anticoagulant therapy?

PURPOSE: Thulium vaporesection of the prostate (ThuVARP) is a new and safe approach for patients receiving anticoagulant therapy in whom transurethral resection of the prostate (TURP) may possess a high bleeding risk. We aimed to demonstrate the efficacy and safety of ThuVARP in patients receiving oral antiplatelet/anticoagulant (OAP/OAC) therapy. MATERIALS AND METHODS: A total of 103 patients who underwent ThuVARP between 2011 and 2013 were enrolled in the study. Patients were divided into 2 groups. Group A consisted of 47 patients who underwent low molecular weight heparin (LMWH) bridging and group B consisted of 56 patients who were operated on while receiving OAP/OAC therapy. RESULTS: The drop in hemoglobin levels in the pre- and postoperative periods was significantly higher in group A than in group B. When subgroups were analyzed, the mean drop in hemoglobin was significantly lower in the warfarin and ticlopidine subgroups of group B than in group A. International Prostate Symptom Scores were significantly lower 3, 12, 18, and 24 months after surgery in group A than in group B. Quality of life scores, maximal flow rate values, and postmicturition residual urine volumes (mL) were similar between the 2 groups. A total of 38 and 41 patients in groups A and B, respectively, had no complications. CONCLUSIONS: Our study showed the safety profile of continuing different OAP/OAC therapies in terms of bleeding problems in patients undergoing ThuVARP. We strongly recommend abandoning LMWH bridging and maintaining the OAP/OAC regimen patients are already receiving.

Etiology, pathophysiology and biomarkers of interstitial cystitis/painful bladder syndrome.

PURPOSE: Interstitial cystitis/painful bladder syndrome (IC/PBS) is a chronic pain syndrome and a chronic inflammatory condition prevalent in women that leads to urgency, sleep disruption, nocturia and pain in the pelvic area, to the detriment of the sufferer's quality of life. The aim of this review is to highlight the newest diagnostic strategies and potential therapeutic techniques. METHODS: A comprehensive literature review was performed on MEDLINE, PubMed, and Cochrane databases gathering all literature about "Interstitial cystitis" and "Painful Bladder Syndrome". Visual analogue scales, epidemiological strategies, pain questionnaires and similar techniques were not included in this literature survey. RESULTS: The etiology, exact diagnosis and epidemiology of IC/PBS are still not clearly understood. To date, its prevalence is estimated to be in the range of 45 per 100,000 women and 8 per 100,000 men, whereas joint prevalence in both sexes is 10.6 cases per 100,000. There are no "gold standards" in the diagnosis or detection of IC/PBS, therefore, several etiological theories were investigated, such as permeability, glycosaminoglycans, mast cell, infection and neuroendocrine theory to find new diagnostic strategies and potential biomarkers. CONCLUSION: Due to the fact that this disease is of an intricate nature, and that many of its symptoms overlap with other concomitant diseases, it could be suggested to classify the patients with emphasis on the phenotype, as well as their symptom clusters, to tailor the diagnostic and management choices according to the observed biomarkers.

Correlation Between Advanced Glycation End-Products, Lower Urinary Tract Symptoms and Bladder Dysfunctions in Patients with type 2 Diabetes Mellitus.

OBJECTIVES: To explore whether serum and urinary advanced glycation end-products (AGEs) are related to urinary symptoms and bladder dysfunctions in diabetic patients. METHODS: Forty-seven patients with type 2 Diabetes mellitus (T2DM) and lower urinary tract symptoms (LUTS) were enrolled. LUTS evaluation was performed by IPSS (International Prostatic Symptoms Score), QoL (quality of life), OAB (overactive bladder). ICI-SF (International Consultation on Incontinence - short form) quaestionneires; ultrasound examination, evaluation of postvoid residual (PVR), uroflowmetry, cystometry with pressure-flow study (PFS) were performed to detect bladder dysfunctions. Serum and urinary AGEs were quantified by ELISA method. RESULTS: Patients were divided into four subgroups: (i) normal-detrusor-contractility + normal- detrusor-activity (1 ♂ [4.8%] and 4 ♀ [21%]), (ii) impaired-detrusor-contractility + normal-detrusor- activity (4 ♂ [19.1%] and 0 ♀), (iii) normal-detrusor-contractility + detrusor-overactivity (1 ♂ [4.8%] and 6 ♀ [31.6%]), (iv) impaired-detrusor-contractility + detrusor-overactivity (15 ♂ [71.4%] and 9 ♀ [47.4%]). Serum AGEs were 12.2 ± 5.5 in men and 10.4 ± 5.6 in women; urinary AGEs were 1.5 ± 1.1 in men and 2.5 ± 1.6 in women. Serum AGEs exhibited a positive correlation with IPSS (P < 0.05) and OAB-q scores (P < 0.01). Increased serum AGEs were associated with a significant reduction in the parameters reflecting impaired detrusor contractility with simultaneous reductions of urinary AGEs (P < 0.01). A greater correlation was observed between serum AGEs and subgroup 4 (P < 0.05). CONCLUSIONS: Serum AGEs seem to be early markers of diabetic complications and appear to be related to LUTS and bladder dysfunctions.

Hybrid Transvaginal NOTES Nephrectomy: Postoperative Sexual Outcomes. A Three-center Matched Study.

OBJECTIVE: To evaluate our experience in patients undergoing hybrid transvaginal natural orifices transluminal endoscopic surgery (NOTES) nephrectomy and evaluate the sexual functions in the postoperative period. MATERIALS AND METHODS: Prospective data of 71 patients with renal tumors who underwent hybrid NOTES radical nephrectomy in three different centers were collected from March 2010 to October 2015. Patient and surgical characteristics were recorded. Sexual function was evaluated using the Female Sexual Function Index questionnaire the day prior to the operation and 3 months after. RESULTS: The mean age, tumor size, and operation duration were 66.16 ± 11.21, 8.51 ± 3.31 cm, and 119.94 ± 21.38 minutes, respectively. Five patients were immediately reoperated due to bleeding from uterine veins. The complication risk increases significantly with increasing tumor size. Among the whole cohort, even the Female Sexual Function Index score differences are small; there is a statistically significant decrease in the postoperative period in all domains except sexual satisfaction. In fact, the patients reported unaltered sexual function after surgery and satisfaction with the result when asked directly. In subgroup analyses, in nulliparous patients (n = 60), arousal, sexual desire, orgasm, and satisfaction domains have no significant differences in pre- and postoperative periods. CONCLUSIONS: Hybrid NOTES nephrectomy is a feasible, safe operation that can be performed for large renal tumors. Due to incisions in the vaginal wall for specimen retrieval, sexual function can be altered in the postoperative period. So patient selection, preoperative evaluation, and close follow-up are mandatory. With this in mind, we strongly support the use of hybrid transvaginal NOTES nephrectomy for large renal tumors especially in nulliparous patients.

Spontaneous Subcapsular Renal Hematoma: Strange Case in an Anticoagulated Patient with HWMH after Aortic and Iliac Endovascular Stenting Procedure.

Spontaneous subcapsular renal hematoma is a rare condition in clinical practice. It is caused by renal cysts, benign and malignant renal tumors, vascular lesions, and antiplatelet or anticoagulant therapy. In this paper we report an unusual case of rupture of a renal cyst of a 66-year-old male patient during an aortic and iliac endovascular procedure for a massive calcified atheroma above the iliac bifurcation. We suspected that the bolus of high weight molecular heparin given during the procedure caused the rupture of the cyst. According to the literature, this is the first case of renal cyst rupture during an endovascular aortic procedure after administering a high weight molecular heparin bolus.

Thulium Vaporesection of the Prostate and Thulium Vapoenucleation of the Prostate in Patients on Oral Anticoagulants: A Retrospective Three-Centre Matched-Paired Comparison.

INTRODUCTION: To evaluate the short-term results of thulium vaporesection of the prostate (ThuVEP) and thulium vapoenucleation of the prostate (ThuVARP) in patients with benign prostatic obstruction on oral anticoagulants (OA). METHODS: A 3-centre retrospective matched-paired comparison of patients treated by ThuVEP (n = 26) or ThuVARP (n = 26) was performed. Thirty-four patients were on aspirin/ticlopidin, 7 on clopidogrel or clopidogrel and aspirin, and 11 on phenprocoumon at the time of surgery. RESULTS: Haemoglobin decrease was higher after ThuVEP compared to ThuVARP (1.5 vs. 0.3 g/dl, p < 0.001). The rate of postoperative blood transfusions (3.9 vs. 0%), clot retention (3.9 vs. 0%), and re-operation (7.7 vs. 0%) was not different between ThuVEP and ThuVARP (p = 0.274). Catheterization time was shorter for ThuVARP (1 vs. 2 days, p < 0.01). Qmax was significantly higher after ThuVEP at 6-month follow-up (31 vs. 21.5 ml/s, p < 0.001), while improvements in International Prostate Symptom Score, quality of life, and post-voiding residual urine showed no differences between the groups. Urethral or bladder neck strictures did not occur during the 6-month follow-up in both groups. CONCLUSIONS: ThuVEP and ThuVARP are safe and efficacious procedures in patients on OA. Although patients assigned to ThuVEP had higher Qmax at 6-month follow-up, ThuVARP resulted in similar functional outcomes.

Comparison of Treatment Emergent Adverse Events in Men With Premature Ejaculation Treated With Dapoxetine and Alternate Oral Treatments: Results From a Large Multinational Observational Trial.

INTRODUCTION: Dapoxetine (DPX) has a pharmacokinetic profile suggesting a low rate of class-related adverse events (AEs). AIM: To assess the incidence of treatment emergent AEs (TEAEs) of special interest (known associations with selective serotonin reuptake inhibitors and/or potential clinically relevant AEs), and the related discontinuation rate in patients with premature ejaculation (PE) treated with DPX or alternate oral treatment (AOT), in routine clinical practice. METHODS: In a prospective, 12-week, open-label, postmarketing observational, multinational study (PAUSE), 7545 patients were enrolled and divided into 2 groups: DPX 30-60 mg and AOT. MAIN OUTCOME MEASURES: The incidence rate of predefined TEAEs of special interest (mood and related, neurocognitive related, cardiovascular, urogenital and sexual function, accidental injury, and abnormal bleeding) in the DPX and the AOT groups, and the rate of AEs leading to study discontinuation. RESULTS: The safety analysis was performed on 6128 patients treated with DPX and 1417 with AOT. The incidence of TEAEs of special interest in each AE category was greater for patients treated with AOT than with DPX. The higher differences were observed in the neurocognitive-related category (DPX 1.9% vs. AOT 4.7%; P < .001), in the mood and related category (DPX 0.4% vs. AOT 1.1%; P < .001), and in the urogenital system/sexual function (DPX 0.4% vs. AOT 0.8%; P = .04). Cardiovascular TEAEs were the only AEs numerically greater in the DPX group (1.3 vs. 1.6%, P = .34). The overall discontinuation rate was 10.9% in the DPX group and 6.9% in the AOT group). CONCLUSION: DPX has a favorable safety profile in terms of class-related TEAEs and clinically relevant AEs of special interest. In particular, it shows a significantly better safety profile in mood and related AEs, neurocognitive-related AEs, urogenital system, and sexual function, compared to the AOT group in the study population.

Different patterns of pelvic ureteral endometriosis. What is the best treatment? Results of a retrospective analysis.

OBJECTIVE: Endometriosis is an estrogendependent disease. The incidence of urinary tract endometriosis (UE) increased during the last few years and, nowadays, it ranges from 0.3 to 12% of all women affected by the disease. The ureter is the second most common site affected. The ureteral endometriosis is classified in extrinsic and intrinsic. The aim of this study is to individuate the best treatments for each subset of ureteral endometriosis. MATERIALS AND METHODS: 32 patients diagnosed with surgically treated UE were retrospectively reviewed. The patients were divided into 3 subsets (intrinsic UE, extrinsic UE with and without obstruction). The patients with intrinsic UE (n = 10) were treated with laser endoureterotomy. The patients with extrinsic UE (n = 22) were divided in two subsets with (n = 16) and without (n = 6) hydronephrosis. All the patients underwent ureteral stenting, and resection and reimplantation was performed in the first group, and when the mass was > 2.5 cm (n = 3) Boari flap was performed. Laparoscopic ureterolysis (shaving) was performed in the second group. RESULTS: In the extrinsic subset of UE, we obtained an high therapeutic success (84%). Conversely, in the intrinsic subset there was a recurrence rate of the disease in 6/10 of the patients (60%). CONCLUSIONS: Ureterolysis seems to be a good treatment in extrinsic UE without obstruction. Resection and reimplantation allows excellent results in the extrinsic UE with obstruction. In the intrinsic subset, the endoureterotomy approach is inadequate.

Transrectal ultrasound (TRUS) guided prostate biopsy: Three different types of local anesthesia.

Transrectal Ultrasound (TRUS) guided prostate biopsy is regarded as the gold standard for prostate cancer diagnosis. The majority of patients perceive TRUS-guided prostate biopsy as a physically and psychologically traumatic experience. We aimed to compare in this paper the efficacy of three different anesthesia techniques to control the pain during the procedure. MATERIALS AND METHODS: 150 patients who underwent transrectal ultrasound (TRUS) guided prostate biopsy were randomly divided into three groups. Group A included 50 patients who received one hour before the procedure a mixture of 2.5% lidocaine and 2.5% prilocaine, Group B: 50 patients who received intrarectal local anesthetic administration (lidocaine 5 ml 10%) and lidocaine local spray 15 % and Group C included 50 patients who received periprostatic block anesthesia (lidocaine 10 ml 10%). Visual analogue scale (VAS) of patients in different groups was evaluated at the end of the biopsy and 30 minutes after the procedure. RESULTS: The VAS of patients in Group A was 1.32 ± 0.65 (VAS I) and 2.47 ± 0.80 (VAS II). In group B the VAS of patients was 1.09 ± 0.47 (VAS I) and 1.65 ± 0.61 (VAS II). In group C the VAS of patients was 2.63 ± 0.78 (VAS I) and 1.70 ± 0.85 (VAS II). There was no statistically significant difference in term of VAS I between group A and B. A statistically significant difference was determined in terms of VAS II between group A and B. There was no statistically significant difference in term of VAS between group B and C. CONCLUSIONS: The most effective of the three methods for pain control we used was intrarectal local anesthetic administration and lidocaine local spray 15% that enables an ideal patient comfort.

Does epidural analgesia play a role in postpartum urinary incontinence? Medium-term results from a case-control study.

OBJECTIVE: To evaluate the medium-term effect of epidural analgesia (EA) on the possible onset of postpartum urinary incontinence (PUI). METHODS: We performed a single-centre, retrospective case-control study. At 8-week postpartum, we recruited a cohort of women who had term singleton pregnancy and foetus in cephalic presentation, and divided in six groups: (1) vaginal delivery without episiotomy, without EA; (2) vaginal delivery without episiotomy, with EA; (3) vaginal delivery with episiotomy, without EA; (4) vaginal delivery with episiotomy, with EA; (5) emergency caesarean section without previous EA during labour and (6) emergency caesarean section with previous EA during labour. For each woman, we recorded age, Body Mass Index (BMI) and the result of the following questionnaire for urinary incontinence: International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF), Incontinence Impact Questionnaire-7 (IIQ-7) and Urogenital Distress Inventory-6 (UDI-6). Subsequently, we compared group 1 versus group 2, group 3 versus group 4 and group 5 versus group 6. RESULTS: We did not evidence any significant difference for age, BMI and incontinence scores between groups 1 and 2, 3 and 4, and 5 and 6. CONCLUSIONS: EA did not affect the onset of PUI in medium-term, regardless the mode of delivery.