Abnormal cytokine profile in patients with obstructive sleep apnea-hypopnea syndrome and erectile dysfunction.

Patients with obstructive sleep apnea-hypopnea syndrome (OSAHS) show a high prevalence of erectile dysfunction (ED). Although the underlying pathogenesis is still unknown, endothelial dysfunction, induced by inflammatory cytokines, chemokines, and adhesion molecules, has been proposed as a possible mechanism. The aim of this study was to assess whether OSAHS is associated with activation of the inflammatory cytokine system in patients with ED compared to the matched OSAHS patients with normal sexual function. Thirty-one patients with severe OSAHS and ED were included. Fifteen patients with severe OSAHS and without ED served as controls. Serum concentrations of high-sensitivity C-reactive protein (hsCRP), tumor necrosis factor-α (TNF-a), interleukin-6 (IL-6), interleukin-8 (IL-8), and adiponectin were measured after the diagnostic polysomnography. We found that hsCRP levels were significantly elevated in OSAHS patients with ED compared to controls. Similarly, TNF-a levels, IL-6, and IL-8 were elevated in OSAHS patients with ED compared to controls. Serum adiponectin levels were lower in OSAHS-ED patients, but the difference did not reach statistical significance. The presence of ED in patients with severe OSAHS is associated with elevated levels of inflammatory markers, underlining a possible involvement of endothelial dysfunction in the pathogenesis of ED.

What Factors Determine the Patients' Choice in Finding Their Office Urologist?

PURPOSE: The present study aimed to investigate how patients identify a quality urologist in primary health care and how they determine and evaluate their provider's qualities before their first examination. PATIENTS AND METHODS: A specific questionnaire (The ESUO Questionnaire) was prepared to describe the domains that influence the patient's evaluation and summarize the urologist related characteristics and behaviours that the patients estimate are more important. A total of 335 patients, over 18 years of age, presented in primary healthcare urology practice, completed the survey. The participants were divided into three age groups; 18-39 years of age (111 patients), 40-59 years of age (111 patients) and 113 patients 60 years of age and older. RESULTS: The majority of patients (68.4%) selected that the urologist must be efficient and well trained. This attitude was primarily expressed in patients ≥60 years of age. Individuals under 60 years old stated that they expect a detailed examination and that the patient should be the urologist's priority. The majority of the patients evaluates friends or family's proposals concerning the urologist's quality primarily and believes that there is at least good quality of urological health care. CONCLUSION: Most patients evaluate primarily the effectiveness of the care they receive instead of the urologist's personality traits or personal relationships.

Extracorporeal shock wave lithotripsy in the treatment of pediatric urolithiasis: a single institution experience.

PURPOSE: To compare the efficacy and safety of the electromagnetic lithotripter in the treatment of pediatric lithiasis to that of the earlier electrohydraulic model. MATERIALS AND METHODS: Two groups of children with lithiasis aged between 10 and 180 months who underwent extracorporeal shock wave lithotripsy (ESWL). In the first group (26 children), ESWL was performed by using the electrohydraulic MPL 9000X Dornier lithotripter between 1994 and 2003 while in the second group (19 children) the electromagnetic EMSE 220 F--XP Dornier lithotripter was used from April 2003 to May 2006. RESULTS: In the first group, 21/26 children (80.7%) were stone free at first ESWL session. Colic pain resolved by administration of an oral analgesic in 6 (23%), brief hematuria (<24 h) resolved with increased fluid intake in 5 (19.2%), while slightly elevated body temperature (<38°C) occurred in 4 (15.3%). Four children (15.3%) failed to respond to treatment and were treated with ureteroscopy. In the second group 18/19 children were completely stone free at first ESWL session (94.7%). Complications were infrequent and of minor importance: colic pain treated with oral analgesic occurred in 1 (5.26%), brief hematuria (<24 h), resolved with increased fluid intake in 4 (21%) and slightly elevated body temperature (<38° C) monitored for 48 hours occurred in 6 (31.5%). Statistical analysis showed that electromagnetic lithotripter is more efficacious and safer than the earlier electrohydraulic model. CONCLUSIONS: Technological development not only has increased efficacy and safety of lithotripter devices in treating pediatric lithiasis, but it also provided less painful lithotripsy by eliminating the need for general anesthesia.

The effectiveness of a scientific symposium to change urologists' attitude towards treatment of LUTS/BPH.

PURPOSE: The use of interactive voting systems in continuing education helps to evaluate the alteration in the audience's views after a presentation. This study was designed to evaluate whether urologists' attitude towards management of benign prostate hyperplasia can be changed, and to estimate objectively the achievement of educational goals by using an interactive voting system. METHODS: The audience attitude was repetitively estimated by responding to questions using wireless keypads. Educational goal achievement was calculated by adding the percentage of those changing their opinion from "wrong" to "right" and that of those insisting on their initial "right" opinion. RESULTS: Giving a "wrong" answer and the probability of opinion change were independent of age and board certification. Being initially on the "wrong" side resulted in a greater probability of opinion change. The educational goals were achieved in 20.8-86.2% of cases. CONCLUSION: Satellite symposia are helpful learning environments. The use of an interactive voting system may help to evaluate objectively the achievement of educational goals.

Rapid communication: first clinical experience with Doli S 220F-XP extracorporeal lithotripter for urinary lithiasis.

PURPOSE: To assess the initial results of the Dornier Doli S 220F-XP extracorporeal lithotripter for the management of solitary urinary calculi. PATIENTS AND METHODS: We prospectively examined the outcome of shockwave lithotripsy (SWL) in the first 140 patients with solitary renal and ureteral lithiasis treated by one urologist with the new power Doli S lithotripter. Ninety-one patients (group A) had renal stones, and 49 patients (group B) had ureteral stones. Data were collected with respect to stone size, location, and fragmentation. RESULTS: In group A, clinical success was documented in 77 patients (84%) at 1 month after lithotripsy. Three months after lithotripsy, 69 patients (75.2%) were stone free and 8 (8.8%) had fragments <4 mm. In group B, 41 patients (83%) achieved clinical success 1 month after lithotripsy. Thirty-eight patients (77%) were stone free 3 months after treatment, and 3 (6%) had fragments <4 mm. Seven patients (7%) in group A and three patients (6%) in group B required re-treatment. The overall efficiency quotient was 67%. No patient developed a perinephric hematoma. Ninety-four percent of the patients reported mild pain during lithotripsy. The majority (91%) mentioned that they were satisfied with this treatment modality for urinary lithiasis (mean visual analog scale satisfaction score 8). CONCLUSIONS: The Doli S 220 F-XP is a safe and effective device for managing calculi throughout the urinary tract.

Strategic lithotripsy using the Doli S EMSE 220 F-XP for the management of staghorn renal calculi.

AIM: The presentation of our results using the Dornier lithotripter (Doli) S electromagnetic shockwave emitter (EMSE) 220 F-XP for the strategic management of staghorn renal calculi. METHODS: Sixteen patients with renal staghorn stones of more than 35 mm in maximum length on plain X-rays were treated by shock wave lithotripsy (SWL) monotherapy with the Doli S EMSE 220 F-XP. Double-J ureteral stent was inserted to all prior to the first SWL treatment. Shock wave counts varied from 2,500 to 3,600 with a shock release frequency of 70-80 pulses per minute. The number of sessions varied from 2 to 6. The interval between the SWL sessions was around 1 month. Fragmentation rate of 20-25% of the stone load per session was considered a valid criterion for progressing to further SWL sessions. RESULTS: Nine patients became stone free at the end of SWL sessions and two patients had renal stone fragments smaller than 4 mm, which were eliminated 6 months later. Two patients developed streinstrasse that was managed with ureteroscopy. Auxiliary SWL was also performed on three patients with residual ureteral calculi. The mean follow up period was 12 months. The remaining five patients underwent open surgery for incomplete stone fragmentation. No major complications developed during the follow up period. The predominant composition of stones available for analysis was struvite. CONCLUSION: Doli S EMSE 220 F-XP can be a safe and effective treatment option for renal staghorn stones on an outpatient basis.

Endocervicosis of the bladder: report of a case and review of the current literature.

An important variety of metaplastic lesions of the urinary bladder have been reported in the medical literature up to date. Among those of Müllerian origin, endocervicosis is the most infrequent. We report a 67 years old woman who presented with a history of left flank pain and dysuria for the past 2 months. Imaging studies revealed a solid mass in the posterior bladder wall protruding into the lumen. Transurethral resection of the lesion was performed. Both pathologic examination and immunohistochemistry confirmed the diagnosis of endocervicosis. The patient was monitored with 6 months interval follow up and remains disease free 12 months post surgery.

Does educational printed material manage to change compliance with prostate cancer screening?

BACKGROUND/AIM: The effects of printed educational material on cancer screening in women (Pap test and mammography) are well documented and confirmed by several studies. The aim of our study was to evaluate the impact of similar printed educational material on prostate cancer screening by PSA and DRE. MATERIAL AND METHODS: Thousand five hundred men aged between 50 and 86 years of age, who attended our institutions for various medical conditions except prostate-related conditions, were randomly assigned to two study groups. Men in the informed group, received an educational leaflet with simple, general information on prostate cancer screening methods given by their physician along with treatment and other regular recommendations, while men in the non-informed group, were only informed by their physician in the examination room during an interview. RESULTS: After 24 months, there was no statistically significant difference between the two groups in terms of DRE screening. The percentages of men who were actually screened by DRE were 4 and 5% in the informed and non-informed groups, respectively, while the difference in the percentages of PSA screening was of statistical significance, with 31% of men screened in the non-informed group as compared to 93% of men screened in the informational leaflet group. CONCLUSIONS: A single, one-shift distribution of printed educational material on prostate cancer screening, changed their attitude regarding prostate cancer screening only in favour of PSA testing, while did not manage to change the DRE acceptance behavior. However, since the combination of the two tests is more sensitive for diagnosis than either one alone, there is a need of introducing intervention strategies, in the efforts of ameliorating the prostate cancer screening behavior.

Extracorporeal shock wave lithotripsy in the treatment of pediatric urolithiasis: a single institution experience

PURPOSE: To compare the efficacy and safety of the electromagnetic lithotripter in the treatment of pediatric lithiasis to that of the earlier electrohydraulic model. MATERIALS AND METHODS: Two groups of children with lithiasis aged between 10 and 180 months who underwent extracorporeal shock wave lithotripsy (ESWL). In the first group (26 children), ESWL was performed by using the electrohydraulic MPL 9000X Dornier lithotripter between 1994 and 2003 while in the second group (19 children) the electromagnetic EMSE 220 F-XP Dornier lithotripter was used from April 2003 to May 2006. RESULTS: In the first group, 21/26 children (80.7 percent) were stone free at first ESWL session. Colic pain resolved by administration of an oral analgesic in 6 (23 percent), brief hematuria (< 24 h) resolved with increased fluid intake in 5 (19.2 percent), while slightly elevated body temperature (< 38°C) occurred in 4 (15.3 percent). Four children (15.3 percent) failed to respond to treatment and were treated with ureteroscopy. In the second group 18/19 children were completely stone free at first ESWL session (94.7 percent). Complications were infrequent and of minor importance: colic pain treated with oral analgesic occurred in 1 (5.26 percent), brief hematuria (< 24 h), resolved with increased fluid intake in 4 (21 percent) and slightly elevated body temperature (< 38°C) monitored for 48 hours occurred in 6 (31.5 percent). Statistical analysis showed that electromagnetic lithotripter is more efficacious and safer than the earlier electrohydraulic model. CONCLUSIONS: Technological development not only has increased efficacy and safety of lithotripter devices in treating pediatric lithiasis, but it also provided less painful lithotripsy by eliminating the need for general anesthesia.