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1.
Cureus ; 14(11): e31498, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36532939

RESUMO

Fournier's gangrene is a urologic emergency manifested as an aggressive form of necrotizing fasciitis. Co-infection of Fournier's gangrene with COVID-19 might have catastrophic sequelae. We report a case of a 69-year-old male patient, unvaccinated against coronavirus, was obese, and with type 2 diabetes diagnosed with Fournier's gangrene. Apart from administration of piperacillin/tazobactam and clindamycin, the patient underwent surgical debridement four hours after his presentation. Postoperatively, the PCR test for COVID-19 was proved to be positive. The patients develop septic shock necessitating the delivery of dopamine, supplemental oxygen, and thromboprophylaxis. On the seventh postoperative day, left testicular ischemia was developed and ipsilateral orchiectomy was performed. After his full recovery from an in-hospital infection by Acinetobacter baumannii, the patient was transferred to the plastic surgery department. The prompt surgical debridement has likely counterbalanced the health risk originated from COVID-19 infection, contributing to the patient's full recovery. Testicular ischemia is a very rare condition in necrotizing fasciitis of the genital and perineal space and it could be attributed primarily to the thrombotic nature of coronavirus. Due to the assault of multiple organs and systems, a medical board consisting of urologists and other medical specialties substantially contributed to the favorable outcome.

2.
J Endourol ; 34(4): 516-522, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32000528

RESUMO

Objective: To investigate prognostic factors of outcome of acute obstructive pyelonephritis (AOP). Materials and Methods: Patients with AOP were prospectively evaluated and logistic regression analysis was applied to identify factors associated with the duration of hospital stay and occurrence of sepsis and septic shock. Results: Based on CT scan findings, 62 patients were found to have AOP and subjected to emergency drainage. The main etiology of obstruction was lithiasis (70.9%). Double-J stent and percutaneous nephrostomy were introduced in 48 and 14 patients, respectively. Urosepsis and septic shock were diagnosed in 20 (32%) and 6 (9.7%) patients, respectively. None of the patients died of sepsis. In univariative analysis, older age, high neutrophils, increased serum creatinine, higher Charlson comorbidity index (CCI) score, any CCI score ≥1, diabetes mellitus (DM) longer operation time (OT), and multiresistant stains were risk factors of sepsis. Gender, type of drainage, laterality, white blood cell count, neutrophils rate >80%, C-reactive protein, and the presence of malignancy or lithiasis were not. Age, DM, and CCI score ≥1 were associated with prolonged hospitalization. None of the factors was associated with shock. In multivariative models, age (odds ratio [OR]: 1.09, 95% confidence interval [CI]: 1.02-1.16, p = 0.010), multiresistant strains (OR: 16.36, 95% CI: 1.97-135.71, p = 0.006), OT >20 minutes (OR: 1.03, 95% CI: 1.00-1.07, p = 0.048), and elevated creatinine (OR: 1.68, 95% CI: 1.001-2.84, p = 0.049) were independent prognostic factors of sepsis, and DM (OR: 30.8%, CI: 8.86%-52.8%, p = 0.007) was a prognostic factor of longer hospitalization. Conclusions: One-third of AOP patients will develop sepsis. Older age, elevated serum creatinine, longer OT presence of multiresistant strains, and DM are independent factors of worse outcome.


Assuntos
Pielonefrite , Sepse , Choque Séptico , Idoso , Hospitalização , Humanos , Prognóstico , Pielonefrite/complicações , Estudos Retrospectivos , Sepse/complicações , Choque Séptico/complicações
3.
Arch Ital Urol Androl ; 91(2)2019 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-31266285

RESUMO

Solitary Fibrous Tumors (SFTs) are mesenchymal tumors occurring in several sites. Urinary bladder SFTs are quite rare. Eighteen cases are described in the literature and only two of them had malignant features. SFTs comprise a histologic spectrum of mesenchymal neoplasms that show fibroblastic differentiation. The signs and symptoms are non specific. Immunohistochemistry plays a pivotal role in the diagnosis, differentiating SFTs from other spindle cell mesenchymal tumors. Malignant criteria are considered the large size, increased mitotic activity, focal necrosis or hemorrhage, nuclear atypia, hypercellularity and infiltrative margins. Clinical and biological behavior of bladder SFTs is usually not aggressive but cannot be safely predicted based on the pathologic features. Complete surgical resection is the cornerstone of treatment. We present the third bladder SFT case with malignant features and a mini literature review.


Assuntos
Tumores Fibrosos Solitários/diagnóstico , Neoplasias da Bexiga Urinária/diagnóstico , Adulto , Diagnóstico Diferencial , Humanos , Imuno-Histoquímica , Masculino , Tumores Fibrosos Solitários/patologia , Tumores Fibrosos Solitários/cirurgia , Neoplasias da Bexiga Urinária/patologia , Neoplasias da Bexiga Urinária/cirurgia
4.
Urol Int ; 103(1): 74-80, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30999318

RESUMO

PURPOSE: To present the results and complications of retrograde ureteroscopic lithotripsy for treatment of large ureteral stones. METHODS: Nineteen patients were treated for ureteral stones ≥15 mm detected in CT or plain KUB film. Endoscopy was performed with either a semirigid or flexible ureteroscope. Stone fragmentation was performed using a 30 W Holmium laser. RESULTS: The mean stone size was 20.7 mm (range 15-30). The mean duration of the operation was 82 min (45-140). Measures to prevent retropulsion of fragments into the kidney were not routinely applied. A subsequent RIRS during the same session was necessary in 2 cases. After a single procedure a stone free state was achieved in 15 cases (78.9%), while 4 others required a second session (ESWL or second ureterolithotripsy, 2 cases each). In only 1 patient, the stone-free state was not achieved after a 1.2 procedure per patient (overall success rate 94.7%). The mean duration of hospitalization was 1.9 days (range 1-5). Three patients experienced postoperative pyelonephritis and 2 others prolonged hematuria. CONCLUSION: Endoscopic lithotripsy is safe and effective in treating large ureteral stones. After a single endoscopic procedure, approximately 4 out of 5 patients are expected to become stone free. This rate increases to 95% with a second session of lithotripsy.


Assuntos
Litotripsia a Laser/métodos , Cálculos Ureterais/fisiopatologia , Cálculos Ureterais/terapia , Ureteroscópios , Ureteroscopia/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Hematúria/complicações , Humanos , Lasers de Estado Sólido , Litotripsia a Laser/instrumentação , Masculino , Pessoa de Meia-Idade , Segurança do Paciente , Pielonefrite/complicações , Estudos Retrospectivos , Resultado do Tratamento , Ureteroscopia/instrumentação
5.
Urol Int ; 100(2): 203-208, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29421810

RESUMO

INTRODUCTION: To present the incidence of bacterial colonization on ureteral double J stents (DJS); isolate the uropathogens; define the rate of multi-resistant bacteria strains (MRBS) and present their clinical importance. MATERIALS AND METHODS: The whole body of 105 DJSs was examined for the presence of uropathogens. RESULTS: The main etiology for stent placement was lithiasis (57.1%). The most frequently cultured microorganisms were staphylococcus (28.6%). Forty-four stents hosted MRBS. 25 (23.8%), 10 (9.5%) and 8 (7.6%) of the patients were affected by malignancy, diabetes mellitus and chronic renal failure respectively. Apart from the female gender, none of the examined factors (age, duration of stenting and chronic diseases) was correlated with the colonization or the presence of MRBS. Eleven of the 61 stented patients (18%) who were operated upon developed a febrile urinary tract infections (UTI). In 7 of them the stent hosted MRBS (63.6%). After taking into consideration the sensitivity report, we altered our initial empirical antibacterial prophylaxis to targeted antibacterial treatment in the patients with MRBS with rapid remission of their infection and no urosepsis event. CONCLUSION: The knowledge of bacteriologic flora of DJS can be very helpful in an evidence-based prophylactic and therapeutic practice. Stent examination could be recommended in high-risk cases of developing UTI and sepsis after a urologic operation.


Assuntos
Bactérias/isolamento & purificação , Infecções Relacionadas à Prótese/microbiologia , Stents/efeitos adversos , Obstrução Ureteral/terapia , Infecções Urinárias/microbiologia , Urologia/instrumentação , Idoso , Antibacterianos/uso terapêutico , Bactérias/efeitos dos fármacos , Bactérias/patogenicidade , Farmacorresistência Bacteriana Múltipla , Grécia/epidemiologia , Humanos , Incidência , Pessoa de Meia-Idade , Estudos Prospectivos , Desenho de Prótese , Infecções Relacionadas à Prótese/diagnóstico , Infecções Relacionadas à Prótese/tratamento farmacológico , Infecções Relacionadas à Prótese/epidemiologia , Fatores de Risco , Resultado do Tratamento , Obstrução Ureteral/diagnóstico , Infecções Urinárias/diagnóstico , Infecções Urinárias/tratamento farmacológico , Infecções Urinárias/epidemiologia , Urologia/métodos , Virulência
6.
Adv Urol ; 2018: 1525832, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30687403

RESUMO

PURPOSE: Prostate cancer (PCa) is one of the most frequently diagnosed malignancies worldwide. Hormonal deprivation therapy is a well-established treatment for locally advanced or metastatic diseases but exposes patients to the risk of osteoporosis and fragility fractures. Furthermore, the tropism of the PCa cells to osseous metastases increases the incidence of skeletal-related events (SREs). METHODS: A nonsystematic review of the international literature was performed in respect to the use of osteoclast inhibitors zoledronic acid (ZA) and denosumab (DEN) in PCa patients. RESULTS: DEN and ZA have proved their efficacy in preventing osteoporosis and bone mass loss in patients treated with hormonal therapy with no proven superiority of one agent over the other. However, the effectiveness in reducing fragility fractures has been proved only for DEN so far. In metastatic-free castrate-sensitive high-risk PCa patients, ZA has not shown any efficacy in preventing osseous metastasis, and evidence is lacking in favor or against the use of DEN. The use of osteoclasts inhibitors had no evident positive effect in overall and disease-specific survival in this group of patients. In advanced castrate-refractory malignancy, DEN has shown clinical superiority over ZA in preventing new SRE but not in overall survival. CONCLUSION: Superiority of DEN over ZA has been proved only in advanced castrate refractory disease in terms of preventing new SRE. In the rest of the cases, the selection of either agent should be based on the clinical condition of each patient and the cost of the treatment.

7.
Adv Urol ; 2015: 251879, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26770192

RESUMO

Bipolar technology offers a new perspective in the treatment of BPH. Purpose. To present our experience with the TURis system (Olympus, Tokyo, Japan). Materials and Methods. From February 2011 till December 2013 in a prospective study, 93 patients were treated for BPH. They were evaluated with IPSS, QoL, uroflow (Q max), and residual urine (RU), preoperatively as well as 6 and 9 months postoperatively. Based on the prostate volume, the patients were divided into two groups: group A (n = 48) with prostates ≥ 75 cc and group B (n = 45) with smaller prostate glands. All patients underwent bipolar TURP or/and plasma vaporization. Results. The postoperative improvement for IPSS, QoL, Q max, and RU was statistically significant. The operation time was longer in group A in comparison with group B (P < 0.001). The former group also had higher infection and stricture formation rates; however, there was no statistical difference between the two groups. Conclusions. Treatment with the TURis constitutes an effective technique and can be offered to large prostates with results equivalent to those in small ones. Regarding safety, large adenomas treated with TURis are not at a higher risk for urethral stricture but their odds to develop urogenital infections are relatively higher compared to the smaller adenomas.

8.
Asian J Androl ; 15(6): 819-23, 2013 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-23792340

RESUMO

Our objective is to describe a novel ligamentolysis approach using a subcoronal incision technique and to determine its safety and efficacy. During the last 7 years, 82 consecutive patients had penile augmentation surgery. Ligamentolysis, through a lower abdominal incision (V-Y plasty) in the first 35 males, was performed (Group A), followed by circumcision ligamentolysis in the next 47 males (Group B). The operation time, complications, and the preoperative and postoperative values of penile length and girth along with the self-esteem and relations questionnaire score as well as satisfaction score was calculated before and after the surgery, and a comparison was conducted between the groups. The mean age at presentation was 32 years (range: 18-56 years). Seventy-nine patients suffered from penile dysmorphophobia, and three patients had micropenises (length <7.5 cm). The mean surgical times were 150.7 and 125.2 min for Groups A and B, respectively (P=0.005). Postoperatively, four Group A patients and three Group B patients (11% versus 6%, respectively) experienced penile retraction (P=0.453). Hypertrophic scars were observed in 18 men (51%) in the former [corrected] group. In the circumcision group, no major wound complications were recorded. The length and girth improvements between the groups were similar. In terms of satisfaction and SEAR improvement, the resulting difference for both variables favored the circumcision group (P=0.007 and <0.001, respectively). With strict selection criteria, the circumcision ligamentolysis procedure compared to the V-Y plasty demonstrated improved results in terms of safety, operation time, retraction rate and cosmetic appearance without any compromise in the gained penile size.


Assuntos
Circuncisão Masculina , Pênis/anatomia & histologia , Adolescente , Adulto , Humanos , Masculino , Pessoa de Meia-Idade , Pênis/cirurgia
10.
Can Urol Assoc J ; 6(6): E274-6, 2012 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-23283103

RESUMO

A 62-year old male patient presented complaining of intermittent macroscopic hematuria. The ultrasonographic investigation revealed a hydronephrosis of remarkable degree with indiscrete renal parenchyma. The abdominal computed tomography scan identified a ureteral lesion with proximal dilatation, hydronephrosis and a functionless ipsilateral renal unit. The retrograde urography showed a 4-cm lesion with multiple filling defects and a smooth contour. The endoscopic examination showed an exophytic lesion, highly suspicious for malignancy. Urine cytology revealed atypia. Right nephroureterectomy was performed and the pathology revealed a ureteral inverted papilloma (UIP). Polymerase chain reaction examination for the presence of human papilloma virus, using GP5+/6+ consensus primers, was negative. The presence UIP should be considered in patients with urotheleal lesions in the ureter when the diagnostic workup for malignancy is inconclusive. The clinical course of the disease seems to be favorable.

11.
Int J Urol ; 18(10): 731-4, 2011 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-21815938

RESUMO

Herein, we report on our experience with six patients (0.3%) diagnosed with lymphoepithelioma-like bladder carcinoma (LELBC) over the past 15 years at our department. The mean age of the patients with LELBC was 73 years (range 69-80 years). All patients had at least pT2 disease. The primary treatment was transurethral resection of the bladder tumor, radical cystectomy (RC), and radiotherapy (RT) in one, two, and three patients, respectively. After a mean follow-up of 31 months (range 13-72 months), three patients are still alive. The predominant subtype was diagnosed in four patients, three of whom are alive at the time of writing, compared with the two patients in whom the focal subtype was diagnosed, both of whom are dead. Two of the living patients were treated with a bladder-preservation strategy. Our experiences suggest that RC may not be necessary in muscle invasive disease and that RT and chemotherapy may be reliable treatment options. The pathology report may be useful in selecting patients suitable for bladder-preservation treatment.


Assuntos
Carcinoma/patologia , Linfócitos do Interstício Tumoral , Neoplasias da Bexiga Urinária/patologia , Idoso , Feminino , Humanos , Masculino , Estudos Retrospectivos
12.
Cases J ; 2: 7743, 2009 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-19830006

RESUMO

Neuroendocrine small cell carcinoma of the urinary tract is rarely encountered and very few cases have been reported in the literature. Herein we describe a case of small cell malignancy located contemporarily in the ureter and the bladder.

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