Is there a place for indwelling transurethral catheterization in women with febrile urinary tract infection? A prospective randomized trial.

PURPOSE: To assess the common practice to transiently place an indwelling transurethral catheter in case of hospitalization of women with febrile urinary tract infections. So far, this intervention has not been scientifically investigated. METHODS: Inclusion criteria were female gender, a leucocyte esterase-positive urine dipstick analysis (≥ 250) from urine obtained with a catheter and fever > 38 °C. Patients were randomized 1:1 to either receive an indwelling catheter French 16 or not. The catheter was removed after 24 h without fever (< 37.5 °C). Principal exclusion criteria were a post void residual volume exceeding 50 mL or abnormalities of the urinary tract. Hospital stay and fever in days, the amount of analgetic medication needed and the laboratory parameters WBC and CRP-measured on the day of admission and in predefined intervals thereafter-were study endpoints. RESULTS: 75 patients were included in the final analysis, 36 in the catheter group and 39 in the no-catheter group. Mean age was 39.4 ± 17.7 years and 39.8 ± 15.5 years, respectively (p > 0.05). The mean length of catheterisation was 3.6 ± 1.6 days in the catheter group. There were no differences between the two groups regarding duration of hospitalization and fever, or the amount of analgetic medication needed (all p > 0.05). Additionally, there was no difference in time to WBC < 10 G/L or CRP < 100 mg/L (all p > 0.05). CONCLUSIONS: This prospective, randomized trial provides no evidence to support routine insertion of an indwelling catheter in women with febrile urinary tract infection requiring hospital admission.

Prostate cancers detected by saturation repeat biopsy impairs the Partin tables' accuracy to predict final pathological stage.

OBJECTIVE: • To analyse the overall accuracy of Partin tables, with special emphasis to potential limitations resulting from differences between prostate cancers detected by different biopsy schedules. PATIENTS AND METHODS: • Clinical characteristics from 599 patients treated with radical prostatectomy defined the 2007 Partin probabilities of organ confinement (OC), seminal vesicle invasion (SVI) and extracapsular extension (ECE). Prostate cancers were detected by initial biopsy (IBx) with ≤12 cores in 405 patients (67.6%), by conventional repeat biopsy (CRBx) with ≤12 cores in 99 (16.5%) and by saturation repeat biopsy (SRBx) with ≥20 cores in 95 patients (15.9%). • The area under the curve (AUC) estimated by the receiver operating characteristic curve, assessed the predictive accuracy of the 2007 Partin tables. RESULTS: • The Partin tables AUC of the IBx, CRBx and the SRBx groups were 0.730 vs 0.701 vs 0.585 for OC, 0.631 vs 0.689 vs 0.547 for ECE, and 0.775 vs 0.755 vs 0.641 for SVI, respectively. CONCLUSIONS: • The overall accuracy of the 2007 Partin tables was clearly inferior in patients with prostate cancers detected by SRBx. • Prostate cancers detected by SRBx undermine the Partin tables' overall accuracy, and this group of patients may be miscounselled by vague predictions.

Abiraterone acetate, enzalutamide and their sequence for castration-resistant prostate cancer : Adherence, survival and hospitalization analysis of a medical claims database.

OBJECTIVE: To analyze drug adherence, overall survival (OS) and hospitalization rates of patients with castration-resistant prostate cancer (CRPC) treated with arbiraterone acetate (AA), enzalutamide (ENZ) and their sequence in a real-life setting. METHODS: The database of the largest public insurance company in Austria was analyzed. All CRPC patients with at least one prescription of AA and/or ENZ between September 2013 and August 2016 in the pre-chemotherapy and post-chemotherapy setting were extracted and matched to the Austrian death and hospital admission statistics. Drug adherence was estimated by the medication possession ratio (MPR). RESULTS: Data of 457 patients (mean age: 74.4 ± 8.5 years) were analyzed. The mean MPR was 90% for AA, 85% for ENZ and 88% for the sequence therapy cohort. The median overall survival (OS) of the entire cohort was 21 months: 15 months for AA, 24 months for ENZ, 26 months for the sequence group, and 10 months for the sequence group after switching. In the post-chemotherapy setting, the median OS was 14 months in AA treatment (mean: 15.8 ± 0.9 months), 19 months in the ENZ treatment (mean: 17.2 ± 1.4 months) and 25 months in the sequence group (mean: 22.7 ± 0.8 months). Median OS in the pre-chemotherapy setting was 25 months (mean: 21.5 ± 1.1 months), 18 months in AA treatment group (mean: 18.9 ± 1.5 months) and 17 months in ENZ treatment group (mean: 18.2 ± 1.9 months). Only 43 (9.4%) patients were not hospitalized during the course of the study. On average patients spent 13% of their remaining life span in hospital care (median 8%, range: 1-34%). CONCLUSION: This Austrian prescription database allows some insights into the outcome of CRPC patients treated with AA and ENZ and their sequence in a real-life setting. Drug adherence was satisfactory, OS was shorter for AA and ENZ as compared to the pivotal phase III trials.

Impact of urinary stone volume on computed tomography stone attenuations measured in Hounsfield units in a large group of Austrian patients with urolithiasis.

INTRODUCTION: To investigate retrospectively the impact of urinary stone volume on computed tomography stone attenuations measured in Hounsfield units in 253 patients with urolithiasis. MATERIAL AND METHODS: CT scans were performed in 253 patients with suspected urinary stone disease from 2008 to 2010 using CT-Scanner Siemens, SOMATOM, Sensation 64. One experienced radiologist (A.L) who was blinded to the chemical composition of the stones retrospectively reviewed images and analyzed data to determine the composition of the stones. The results were compared with the biochemical analysis results obtained by infrared spectroscopy (100 FTIR, PerkinElmer). RESULTS: 253 consecutive patients from 2008 to 2010 were included into analysis: 189 males, and 64 females. Mean age was 51.2. According to stone volume, stones were divided into 2 groups: 126 stones with volume of 4.3 mm or more, 127 stones with volume less than 4.3 mm. There was a significant relationship between stone volume and its CT attenuation only in stones with a volume 4.3 mm or more (p <0.05). CONCLUSIONS: We failed to show a significant relationship between stone volume and its attenuations in Hounsfield units. We could not distinguish uric acid stones from non uric acid stones.

Clinical and laboratory profiles of a large cohort of patients with different grades of varicocele.

OBJECTIVE: In this retrospective study we attempted to report our own data on the different clinical parameters in association with the presence and severity of varicocele in a large group of Austrian men. METHODS: The records of 1,111 consecutive patients with clinical varicocele from 1993 to 2010 were evaluated. The presence, grade, and side of any varicocele were recorded. Semen samples, serum FSH, LH, and testosterone levels, and testicular volume were assessed. RESULTS: The mean age was 28.8 (±7.3) years. Three hundred seventeen (28.5%) patients presented with grade I varicocele, 427 (38.4%) with grade II varicocele, and 367 (33%) with grade III varicocele. Correlation between different grades of varicocele and semen quality indicated an over-representation of oligospermia and asthenoteratospermia in the group of grade III varicocele (p <0.05), whereas other parameters of semen quality showed no significant difference between the three groups. Serum testosterone levels and BMI were significantly associated (p <0.05) with the grade of varicocele, but no association was found with the other parameters analyzed. CONCLUSIONS: Our analysis showed a significant relationship between the grade of varicocele and semen analysis. Moreover, higher testosterone levels and lower body mass index were associated with the higher grade of varicocele and decreased semen quality. More prospective studies are recommended.

Cell phone usage and erectile function.

INTRODUCTION: The objective of this pilot study was to report our experience concerning the effects of cell phone usage on erectile function (EF) in men. MATERIAL AND METHODS: We recruited 20 consecutive men complaining of erectile dysfunction (ED) for at least six months (Group A), and another group of 10 healthy men with no complaints of ED (Group B). Anamnesis, basic laboratory investigations, and clinical examinations were performed. All men completed the German version of the Sexual Health Inventory for Men (SHIM) for evaluation of the International Index of Erectile Function (IIEF), as well as another questionnaire designed by our clinicians that assessed cell phone usage habits. RESULTS: There was no significant difference between both groups regarding age, weight, height, and total testosterone (Table 1). The SHIM scores of Group A were significantly lower than that of Group B, 11.2 ±5 and 24.2 ±2.3, respectively. Total time spent talking on the cell phone per week was not significantly higher in Group A over B, 17.6 ±11.1 vs. 12.5 ±7 hours. Men with ED were found to carry their 'switched on' cell phones for a significantly longer time than those without ED, 4.4 ±3.6 vs. 1.8 ±1 hours per day. CONCLUSIONS: We found a potential correlation with cell phone usage and a negative impact on EF. Further large-scale studies confirming our initial data and exploring the mechanisms involved in this phenomenon are recommended.

Sexual function in women with stress urinary incontinence treated with the SPARC sling system.

AIM: To evaluate the impact of SPARC on female sexual function. METHODS: 151 women with a mean age of 60 ± 11.90 and SUI had a complete urodynamic investigation and underwent SPARC operation. 98 women completed the validated female sexual function index questionnaire (FSFI) at baseline and 94 women at follow-up. A minimum follow-up of 12 months was required for study inclusion. RESULTS: 52/98 women were sexually active at baseline. Postoperatively only 33 patients were sexually active. The FSFI score of all 33 pre- and postoperative sexually active women increased from 25.3 ± 5.7 at baseline to 27.4 ± 4.8 at follow-up (P = 0.1). Scores of women with reduced sexual function at baseline increased significantly in the domains desire, arousal, and lubrication as well as orgasm and satisfaction and total FSFI-score (P = 0.002) postoperatively. CONCLUSIONS: Our results suggest that the SPARC-sling procedure for SUI did not negatively interfere with female sexual function.

A case of Fournier's gangrene after hydrocelectomy.

An uncommon case of Fournier's gangrene following hydrocelectomy is described. A 78-year-old male with no remarkable previous history, who underwent hydrocelectomy in another hospital, developed Fournier's gangrene 15 days later. The patient required wide aggressive surgical debridement, hyperbaric oxygen chamber and broad-spectrum antibiotic coverage. Afterwards the patient was referred for plastic surgery. Fournier's gangrene is a polymicrobial infection of perineoscrotal region that manifests as a rapidly progressive necrotizing fasciitis. Fournier's gangrene following hydrocelectomy is uncommon. The morbidity and mortality in this severe complication depend on early diagnosis and aggressive surgical management.

A case of descending colon carcinoma metastasized to left spermatic cord, testis, and epididymis.

We report a case of descending colon carcinoma metastasized to the left spermatic cord, testis, and epididymis. A 77-year old male patient underwent a left hemicolectomy for a descending colon cancer. He was referred to our department because of swelling and pain of the left scrotum two years and six months after surgery. High left orchiectomy was performed. Histological examination revealed a metastasis of the colon carcinoma within the spermatic cord and epididymis approaching the testicle. Reports on metastatic cancer of the testis are scarce, because this metastatic cancer is extremely rare. In general, testicular pain is rare in the elderly. We suggest that any elder presenting with testicular pain deserves a complete clinical and diagnostic evaluation.

Acute pancreatitis as rare complication of the right radical transperitoneal open nephrectomy.

Radical open nephrectomy is considered the standard treatment for kidney tumors or masses greater than 10 cm. We present a rare case of acute pancreatitis that occurred after right radical transperitoneal nephrectomy, which was treated by nonsurgical conservative interventions. The incidence of acute pancreatitis after renal surgery is not known in the literature. A 56-year-old man developed acute pancreatitis postoperatively after radical transperitoneal nephrectomy. An initial CT scan showed an enlarged pancreas with hypodense, heterogeneous consistency and with peripancreatic, perihepatic, mesenteric, and pelvic fluid collections. This complication was managed conservatively.

Laparoscopic partial nephrectomy: a matched-pair comparison of the transperitoneal versus the retroperitoneal approach.

OBJECTIVES: To compare surgical and functional results of both surgical approaches to endoscopic partial nephrectomy. It is currently performed either by the transperitoneal (t) or the retroperitoneal (r) approach. METHODS: This was a retrospective, matched-pair comparison of 105 patients who underwent either transperitoneal laparoscopic (Graz) or retroperitoneoscopic (Klagenfurt) partial nephrectomy for clinical T1a renal masses. RESULTS: A total of 35 patients after transperitoneal laparoscopic and 70 patients after retroperitoneoscopic partial nephrectomy were included to this analysis after matching for age (T: 59.3 vs R: 60.1 a), preoperative glomerular filtration rate (GFR) (T: 93.2 vs R: 96.1 mL/min) and tumor size (T: 2.4 vs R: 2.5 cm). Nephrometry scores were comparable between groups and were low, medium, and high in 54.3%, 45.7%, and 0% (t) and 55.7%, 42.9%, and 1.4% (r) of patients (P = .9). Operative time (T: 139.3 minutes vs. R: 83.9 minutes; P < .001) and hospitalization (T: 7 days, R: 5 days; P < .001) were shorter in the retroperitoneoscopic group. Ischemia time (T: 24.3 minutes, R: 22.6 minutes) and postsurgical GFR (T: 86.6 vs R: 90.0 mL/min), postsurgical GFR-decrease (T: 7.1%, R: 6.2%, P = .9) and decline of hemoglobin (T: 17.1%, R: 16.6%) were comparable. Complications were 4 nephrectomies (T: n = 1, R: n = 3), 2 revisions for hemorrhage (R: n = 2), 4 pneumothorax (R: n = 4), and 2 urinary fistulas (T: n = 2). The positive surgical margin rate was comparable between groups (T: n = 3, R: n = 5). CONCLUSIONS: Transperitoneal laparoscopic and retroperitoneoscopic partial nephrectomy provide comparable surgical and functional results. One advantage of the retroperitoneoscopic access seems to be a shorter total surgical time.

Clinical parameters and semen analysis in 716 Austrian patients with varicocele.

OBJECTIVES: To evaluate different clinical parameters in association with the presence and severity of varicocele in a large group of Austrian men. METHODS: Records of 716 consecutive patients with clinical varicocele and infertility, who visited our andrology unit from 2001 to 2007, were retrospectively evaluated. The presence, grade, and side of any varicocele were recorded; varicoceles were confirmed by Doppler sonography. Semen samples, serum follicle-stimulating hormone, luteinizing hormone, estradiol, and testosterone levels were also assessed in all patients. RESULTS: Mean age was 29.6 +/- 0.3 years; 30% of patients presented with grade I varicocele, 39.0% with grade II, and 30.3% with grade III varicocele. About 33.3% of patients presented with normozoospermia, followed by asthenozoospermia (17.9%), oligoasthenoteratozoospermia syndrome (14.2%), and oligozoospermia (13.2%). Sperm density significantly decreased with increasing grade of varicocele. Body mass index was inversely proportional to varicocele. Serum testosterone levels were higher in grade III varicoceles (5.7 +/- 0.2 nmol/L) compared with grade I (4.9 +/- 0.2 nmol/L) and grade II (5.0 +/- 0.1 nmol/L) varicoceles (P <.001; range, 0.4-16.6 nmol/L). CONCLUSIONS: To our knowledge the current report is the first to describe a direct relationship between grade of varicocele and semen quality. Grade III varicocele was associated with decreased semen quality and, interestingly, with higher testosterone levels. Our study confirmed previous reports regarding the relationship between varicoceles and body mass index.