The effect of hexanic extract of Serenoa repens on prostatic inflammation: results from a randomized biopsy study.

PURPOSE: To evaluate the effect of hexanic extract of Serenoa repens (HESr) on prostatic inflammation in patients with diagnosed prostatic inflammation. METHODS: Patients with prostatic inflammation histologically confirmed by TRUS prostatic biopsy were randomized either to receive HESr (320 mg/day) or no treatment. A second biopsy was performed 6 months later according to standard clinical practice. Inflammation was assessed by the Irani's score and immunohistochemical staining using the CD3, CD4 and CD8 (for T-leucocytes), CD20 (for B-leucocytes) and CD163 (for macrophages) antibodies. RESULTS: Overall 97 patients were eligible for analysis. In the HESr group the mean inflammation grading and aggressiveness grading score significantly decreased from 1.55 and 1.55 at baseline to 0.79 (p = 0.001) and 0.87 (p = 0.001) at the second biopsy, respectively. In the control group the mean inflammation grading score was 1.44 at first biopsy and 1.23 at the second biopsy. The mean aggressiveness gradings core was 1.09 and 0.89, respectively. No statistical significance was found (p = 0.09 and p = 0.74).The mean decrease in all inflammation scores was statistically higher in the HESr patients compared to controls. The immunohistochemical staining showed a significant change in the expression of the analyzed antibodies for the HESr patients compared to the first biopsy. In the nontreatment group, no significant difference was found at the second biopsy. The change in expression of each antibody in the HESr group was statistical significant compared to control. CONCLUSIONS: HESr seems to reduce prostatic inflammation in terms of histological and immunohistochemical parameters in this specific patients population.

Two-step minipercutaneous ureterolithotripsy under multimodal analgesia for complicated impacted calculi in proximal ureter.

OBJECTIVE: To suggest minipercutaneous ureterolithotripsy using the mininephroscope as an alternative process for impacted stones of the upper ureter because these stones can be challenging to treat and can produce severe symptoms. MATERIALS AND METHODS: We report our results of cases in which the percutaneous approach using 2-step minipercutaneous ureteroscopy with the mininephroscope was used to achieve relief from the stone, with minimal anesthesia risks. A total of 54 patients (33 men and 21 women) presented with impacted stones in the proximal ureter. The mean stone size was 16.2 mm (range 10-21). All patients were treated with 2-step minipercutaneous antegrade ureterolithotripsy under multimodal analgesia. RESULTS: The mean operative time was 49 minutes (range 40-110). Placement of the percutaneous drainage tube was quick and was performed with the patient under local anesthesia. The minipercutaneous session followed several days later, with the patient under multimodal anesthesia. The initial stone-free rate was 94%. The stone-free rate 2 months after the procedure was 100%. All procedures were well tolerated by the patients (group mean visual analog scale score 3.1 ± 0.7 standard deviation). No severe adverse events were noted. The mean hospital stay was 5.3 days (range 3-12). CONCLUSION: In selected emergency cases of impacted proximal ureteral stones, the approach of the initial insertion of a nephrostomy tube followed by a second session of antegrade ureterolithotripsy using the mininephroscope is a safe and effective alternative treatment, especially, because it can be accomplished with minimal anesthesia requirements.

Extracorporeal shock-wave lithotripsy and garlic consumption: a lesson to learn.

The first case of a kidney haematoma after extracorporeal shock-wave lithotripsy (SWL) in a patient with nephrolithiasis who was taking aged garlic extraction is reported. Patient was treated conservatively without the need of any intervention. Urologists should be aware that herbal products including garlic, ginkgo, and ginseng have been associated with potential increased bleeding. The present case emphasises the need to specifically seek out a history of herbal use in presurgical patients. It is suggested that herbal medications should be discontinued up to 15 days prior to urologic surgery or SWL to minimise the risk of complications.

Transurethral microwave thermotherapy: from evidence-based medicine to clinical practice.

PURPOSE OF REVIEW: The aim of this article is to provide new clinical data on transurethral microwave thermotherapy, evaluate it in the perspective of evidence-based guidelines and daily practice and investigate the driving forces that determine the current position of thermotherapy for the management of benign prostatic obstruction. RECENT FINDINGS: Recent studies have provided significant evidence regarding the efficacy, safety and durability of thermotherapy. Updated evidence-based clinical guidelines on the management of patients with benign prostatic obstruction have been made available. Surveys have evaluated the acceptance of transurethral microwave thermotherapy from the urological community. In addition, several studies have made major contributions to our knowledge of the translation of evidence to daily practice. SUMMARY: The range of therapeutic options for benign prostatic obstruction continues to widen creating the need for clarity in selection and application of these treatments. High-quality data on transurethral microwave thermotherapy have been published and integrated into clinical guidelines. Considerations on the implementation of guidelines to clinical practice, emergence of new treatments, shift of benign prostatic obstruction therapy, economics and the increasing need to treat patients with different clinical profile during the last decade seem to affect the position of transurethral microwave thermotherapy in the armamentarium of a urological centre. Into this frame, transurethral microwave thermotherapy tailored to selective cases seems to remain an attractive option.

Feasibility of percutaneous nephrolithotomy under assisted local anaesthesia: a prospective study on selected patients with upper urinary tract obstruction.

OBJECTIVE: To evaluate the feasibility of performing percutaneous nephrolithotomy (PCNL) under local anaesthesia in selected patients. METHODS: Twenty-four patients with unilateral renal obstruction due to pelvic stones > or =2.0 cm were enrolled in our study. First a percutaneous nephrostomy to decompress the obstructed kidney was performed using local anaesthesia (lignocaine). A 16-Fr nephrostomy tube was left in place for 1 wk, and then the second stage was carried out. After having infiltrated the tract and the renal parenchyma with lignocaine, dilatation of the nephrostomy tract was performed. Subsequently, PCNL was done using a 24-Fr rigid nephroscope and a ballistic lithotripter. All patients were premedicated with pethidine HCl intramuscularly 30 min before the beginning of both stages. Diazepam was given (0.1mg/kg orally) to patients before the second stage. Pain scores were collected using 10-cm linear visual analogue scale (VAS) after the completion of both procedures. RESULTS: The procedure was well tolerated. One patient needed further treatment with midazolam during PCNL. The mean VAS score was 38 mm (range: 17-60 mm) for the first stage and 36 mm (13-69 mm) for the second stage. The mean operative time, including both stages, was 127 min (85-155 min). No anaesthesia-related complications occurred. CONCLUSION: Our study indicates that PCNL under assisted local anaesthesia is safe and effective in selected patients.

Percutaneous suprapubic cystolithotripsy under local anesthesia.

OBJECTIVES: To assessed the feasibility and effectiveness of percutaneous cystolithotripsy under local anesthesia in selected patients. METHODS: Thirty-one patients with bladder stones of different etiologies underwent percutaneous cystolithotripsy under local anesthesia. Suprapubic access was obtained with ultrasound guidance, and fragmentation of the stone was performed using the Swiss lithoclast. Suprapubic and transurethral catheters were placed postoperatively. RESULTS: No major intraoperative complications occurred. The whole procedure was well tolerated, and no significant differences were found in the mean pain score between the percutaneous suprapubic cystolithotripsy group and a group of male patients who underwent rigid cystoscopy under local anesthesia (P = 0.35). Complete stone clearance was achieved in all but 1 patient (96.78%). Bladder irrigation because of gross hematuria was needed in 5 patients, but no blood transfusion was required. Fever developed in 1 patient and was treated with intravenous antibiotics. The average hospitalization was 2.3 days (range 2 to 5). After a mean follow-up of 10 months, no recurrent stone developed. CONCLUSIONS: Percutaneous suprapubic cystolithotripsy under local anesthesia is a safe and effective technique to remove bladder calculi. Thus, it may be used as an alternative treatment option in selected patients.