Efficacy of pollen extract in association with group B vitamins for pain relief in chronic prostatitis/chronic pelvic pain syndrome: A survey of urologists' knowledge about its clinical application.

INTRODUCTION AND AIM OF THE STUDY: Chronic prostatitis/chronic pelvic pain syndrome (CP/CPSS) is a pathology of high prevalence in Italian male population, difficult to diagnose and to treat and with poor response to conventional therapy. Aim of this study was to review the evidence of the literature about the therapeutic effects of a plant product containing flower pollen extracts and group B vitamins on symptoms resolution and amelioration of CP/CPPS patients' quality of life and to investigate the knowledge among practicing urologists about the clinical application of this product. MATERIALS AND METHODS: A group of 38 urologists was submitted to an investigational survey of the knowledge of the clinical applications of a plant product containing flower pollen extracts and group B vitamins Results: 71% of the urologists interviewed prescribed the plant product for CBP and CP/CPPS at least one time in a month and 11% prescribed it more than 5 times; 67% had evidence of clear ameliorations in pain relief and on patient's quality of life and 47% reported that the effectiveness is comparable to NSAIDs; 39% also reported a significant effect for the improvement of the urinary symptoms of patients. No gastric or general side effects have been noticed during the administration period of this plant product. Finally, the cost of the product has always reported to be sustainable for the patients. CONCLUSIONS: From the results of this investigational survey, we can state that the plant product containing flower pollen extracts and group B vitamins is well-known and demonstrated beneficial effects on symptoms resolution and amelioration of quality of life in patients with chronic prostatitis/chronic pelvic pain syndrome.

Robotic transposition and ureteroureterostomy of type 1 retrocaval ureter.

Retrocaval ureter (RCU) is a rare malformation of the inferior vena cava. We report a case of a 60-years-old female presented with right flank pain and computed tomography scan diagnosis of (RCU). She underwent robotic transposition and ureteroureterostomy of RCU. No complications were recorded. After 1 year of follow-up the patient remains asymptomatic and without signs of obstruction. Robotic repair of RCU with preservation of the retrocaval segment is a safe procedure with the advantages of the vision and dexterity in dissection and suturing.

Safety profile of treatment with greenlight versus Thulium Laser for benign prostatic hyperplasia.

OBJECTIVE: The major strengths of surgical treatment of benign prostatic hyperplasia with laser are reduced morbidity compared to endoscopic resection. No studies analysed the different risk of intra/peri-operative events between patients undergoing Thulium and GreenLight procedures. MATERIALS AND METHODS: We retrospectively reviewed 100 consecutive cases undergoing GreenLight vaporization and Thulium procedures performed during the learning curve of two expert endoscopic surgeons. Pre-operative data, intra and post-operative events at 90 days were analysed. RESULTS: Patients on antiplatelet/anticoagulant therapy were pre-dominant in the Green group (p < 0.0001). Rates of blood transfusion (p < 0.0038), use of resectoscope (p < 0.0086), and transient stress urinary incontinence were statistically higher in the Thulium group. On the contrary conversions to TURP (p < 0.023) were more frequent in GreenLight patients. Readmissions were more frequently necessary in GreenLight group (24%) vs. Thulium group (26.6%). The overall complication rate in GreenLight and Thulium groups were 31% and 53% respectively; Clavien 3b complications were 13% in Thulium patients versus 1% in GreenLight patients. CONCLUSIONS: GreenLight and Thulium treatments show similar safety profiles. Randomized controlled trial are needed to better clarify the rate of major complications in Thulium group, and the incidence of post-operative storage symptoms in these patients' populations.

Comparison between prone and supine nephrolithotomy in pediatric population: a double center experience.

PURPOSE: Stone disease in the pediatric age is an increasing issue. Percutaneous Nephrolithotomy (PNL) can be used for larger and complex stones. As in adults it can be performed in the supine or prone position. METHODS: We retrospectively reviewed two centers' experience in prone and supine PNL in children to analyze its results and complications. RESULTS: 33 patients underwent prone and 19 supine procedures. Patients in the prone group were younger than in the supine, while no significant differences were found in stone burden, access size, operative time or complications. Complications were: 8 and 4 Clavien 1 for the prone and supine group, respectively, one case of urosepsis (4b) in the prone and 2 cases of Clavien 3 in the supine group (double J stent placement for renal colic and ureteroscopy for steinstrasse). Tubeless procedures and mean nephrostomy time were in favor of the supine group, whereas fluoroscopy time and ureteral drainage stay were in support of the prone group. Stone free rate was better in the supine group (83.3 vs 66.6%), possibly reflecting the capability to perform a combined approach in 12 patients (allowing to reach all the calyx with simultaneous anterograde and retrograde access) or younger age in the prone group (13 vs 2 patients ≤5 years), with no differences in stone burden. CONCLUSIONS: Supine approach seems to guarantee higher stone-free rates. Larger series are necessary to determine what the best technique is in terms of X-ray exposure, operative time and complications.

Müllerianosis of the urinary bladder may simulate a bladder cancer: a case report.

Müllerianosis is an extremely rare entity consisting of an admixture of 2 or more müllerian tissues. We report the case of a 61 years old woman who came to our attention with hypogastric pain and dysuria. She was in menopause and had a previous history of cesarean section. Ultrasound and CT-scan of the abdomen showed a proliferative bladder lesion close to the left ureteric orifice. Transurethral resection of the bladder (TUR-B) was performed. Histopathological examination of the specimens was negative for bladder cancer and revealed the presence of endosalpingeal tissue. Postoperative course was unremarkable as well as follow up at 12 months. A proper knowledge and awareness of this disease, even if rare, is necessary for an accurate differential diagnosis and to perform an appropriate treatment.

Rigid and flexible ureteroscopy (URS/RIRS) management of paediatric urolithiasis in a not endemic country.

INTRODUCTION: In the last years due to miniaturization of endoscopic instruments and percutaneous surgery, endourology has become very popular in paediatric urinary stone managment. We reported our single-centre experience in retrograde endoscopic procedures in children. Results and complications of URS/RIRS are discussed. MATERIALS AND METHODS: We retrospectively reviewed our experience in patients ≤ 16 years old affected by urinary stones who underwent URS/RIRS procedures performed by two surgeons with expertise in endourology. A total of 30 renal Units (RUs) underwent endoscopic procedures (URS, RIRS or both). Surgical complications according to the ClavienDindo's classification and stone-free rate were evaluated at 3 months follow-up. Success of URS was defined as stone-free status after single procedure while RIRS success rate was considered as presence of residual stone fragments smaller than 4 mm at first procedure. RESULTS: The mean age of our patients was 8 years, range 2- 16 years. A total of 30 renal units (RUs) underwent 40 endourological procedures (23 URS and 17 RIRS; 10 children underwent both procedures at the same time). 17/30 (56.6%) RUs were pre-stented before surgery. The stone-free status was achieved in 23/30 renal units treated, with a 76.6% success rate. The remaining 7 patients had residual stones greater than 4 mm and underwent further treatments. After a second surgery the stone-free rate turned out to be 93.3% (28/30 renal units). CONCLUSIONS: Rigid and flexible ureteroscopy (URS/RIRS) is a reliable technique for treatment of < 2 cm urinary stones in paediatric age group. It shows low rate of major complications and promising results in terms of stone-free rate.

Validation of the effectiveness of a modified Studer orthotopic neobladder in a single center after 3 years of its application.

INTRODUCTION AND OBJECTIVE: In this study, we reported the 2 years outcomes of orthotopic neobladder diversion according to the Studer modified technique described by Bianchi G. et al. This technique improves the stability of the reservoir and the urine-storage capacity. After radical cystectomy, urinary diversion is created with a spheroidal-shaped reservoir with a conic distal-part, obtained with 40 cm detubulized ileal segment, and a 15 cm of tubular afferent limb, where a Wallace ureteral anastomoses is made. The conic distal part of the neobladder that is anastomized to the urethral stump. After the reconstructive part, the neobladder and the afferent limb are attached to the elevator ani and psoas muscles, respectively. MATERIALS AND METHODS: In all, 18 patients underwent radical cystectomy with the reconstruction of urinary diversion with the Modified-Studer Orthotopic technique, at S. Giuseppe Hospital. We studied the post-operative years of follow-up, especially with anamnesis of lower urinary tract, axial computerized tomography, and blood tests, according to the EAU guidelines. RESULTS: We discover with TC 2 cases of low-grade bilateral hydronephrosis, associated with a slight increase in creatinine levels (1.4-1.8 mg/dL). No stricture at the neobladder-urethral anastomosis was detected. Three patients complain daytime urinary incontinence; only two patients report nocturnal urinary incontinence. One patient underwent ureteroscopy for lithiasis and 1 patient died for non-onco-urological disease. CONCLUSION: The modifications we applied to the Studer-Neobladder seems to improve urinary tract restoration, potentially decreasing long-term complications like hydronephrosis connected to ureteral anastomotic stenosis (11.1% vs 16.9% reported in literature) and urinary retention (0% vs 12% reported in literature). However, we discovered the same risk of diurnal and nocturnal incontinence reported in literature for the classic Studer Neobladder.

Oncologic outcome, side effects and comorbidity of high-intensity focused ultrasound (HIFU) for localized prostate cancer. A review.

INTRODUCTION: Prostate cancer is considered one of the most important health problems. Due to the increased number of diagnosed patients and the inability to distinguish aggressive tumors, minimally-invasive procedures have become increasingly interesting. High-intensity focused ultrasound (HIFU) is an alternative option to radical surgery to treat prostate cancer. To date, however, data on side effects and comorbidities of this technique are still not conclusive. METHODS AND RESULTS: We reviewed the literature to concentrate on side effects and comorbidities of HIFU treatment of prostate cancer with the following key words: hifu, high intensity focused ultrasound, ultrasonic therapy, transrectal hifu, prostate ablation, side effects, comorbidities. MedLine and Embase via Ovid database were searched. Selection criteria were: English language, articles published between 2001 and 2015, case series including at least 100 participants and reported data on side effects and comorbidities. Sixteen uncontrolled studies were identified. No randomized controlled trials (RCT) were found in the literature comparing side effects and comorbidities of HIFU to other routine approaches to prostate cancer treatment. CONCLUSION: HIFU seems to be a promising minimally-invasive treatment for low- and intermediate-risk prostate cancer, especially for patients who are unfit for radical surgery. Prospective studies with longer follow-up periods and RCT are required to properly assess the impact of side effects and comobidities related to the HIFU technique in comparison with other therapies to treat prostate cancer.

Second-look TURBT: evaluation of anatomopatological and oncologic results in a single center.

INTRODUCTION: T1 bladder cancer is associated with a high risk of recurrence and progression; concomitant carcinoma in situ and/or multifocality are negative prognostic factors. Persistent disease after resection of T1 tumours has been observed in 33-55% of patients, and after resection of High-grade (HG) Ta tumour in 41,4%. It has been demonstrated that a second TURB can increase recurrence-free survival and it can make a restaging of the cancer. PATIENTS AND METHODS: From January 2011 to December 2016, 87 patients with superficial bladder tumor (Ta-T1), undergoing TURB and routine repeat TURB (Re-TURB) 4-6 weeks after the initial resection, were included in the study. Re-TURB was applied to the scar of the first resection and other suspicious lesions in the bladder. After the second-look, we studied the follow-up of each patient. RESULTS: Specimens obtained during the second TURBT showed no tumor in 47 (54,02%) patients; 40 (45,98%) patients had residual cancer: 34 of them had cancer of the same stage, 6 patients of pT1 had a lower stage, and 3 had a higher stage. 5 patient underwent radical cistectomy immediatly after re-TURBT. During the first year of follow up, 15 patients had a recurrent bladder cancer; 2 of them underwent radical cistectomy. CONCLUSIONS: T1 bladder cancer is an high risk tumor, so that second-look TURBT is a valuable procedure for accurate staging of nonmuscle-invasive bladder cancer and it can guarantee a better eradication of the neoplasm.

Effects of D-Mannose, ElliroseTM and Lactobacillus Plantarum in treatment of urinary tract recurrent infections (rUTIs): A survey of urologists knowledge about its clinical application.

BACKGROUND AND AIM OF THE WORK: Urinary tract infections (UTIs) and recurrent urinary tract infections (rUTIs) are widespread disease and almost half of all women will experience at least one episode of cystitis during their life. Aim of this study was to review the evidence of literature about the therapeutic and preventive effects of a product containing D-Mannose, ElliroseTM and Lactobacollus Plantarum on patients' symptoms, quality of life and recurrence of UTIs and to investigate the practicing urologists' knowledge about the clinical application of this product. MATERIALS: We administrated an investigational survey about clinical use of a phytotherapeutic product made of D-Mannose, ElliroseTM and Lactobacollus Plantarum to 12 residents in Urology at the University of Modena and Reggio Emilia and to 32 urologists working in the provinces of Modena, Reggio Emilia and Parma. RESULTS: 61% of physicians have diagnosed rUTIs in 3-6 patients during a month, and 7% of them in more than 6 patients during the same period of time. By these results rUTIs appear as common pathological conditions. 59% prescribed the product at least 1 time a month and 14% prescribed it more than 5 times. 43% administrated the product after out-patient invasive examinations as cistoscopy and urodynamic exam for UTIs prevention. 55% noticed a significant improvement in patient's QoL (Quality of Life) suffering from rUTIs. Furthermore 48% also reported a significant effect for the improvement of urinary symptoms of patients. No gastric or general side effects have been noticed during the administration period. Finally the cost of integrator has been reported affordable for the great majority of patients. CONCLUSIONS: Many studies in Literature have shown that D-Mannose and H. sabdariffa (ElliroseTM) reduce the risk of development of rUTIs opposing colonization and proliferation of uropathogenic bacteria in urinary tract. Our investigational survey about the administration of a phytotherapeutic product showed that this product is well-known and has a proved positive impact.

What chance do we have to decrease prostate cancer overdiagnosis and overtreatment? A narrative review.

In the era of biochemical tests and algorithms, the management of prostate cancer from prevention to treatment is still controversial. The debate is focused on clinically-significant and clinically-insignificant prostate cancer. As it is well known, the diagnostic tools available are not able to distinguish between the two, thus leading to men treated for prostate cancer even if not strictly necessary. Unfortunately, as of today, there is no test available able to predict the clinical aggressiveness of prostate cancer at the time of the diagnosis. However, some indexes, PSA derivatives, immunocomplexes, and diagnostic methods have been proposed. If properly used in the daily clinical practice, these tools may be of support in the decision making process, in the effort to reduce the overdiagnosis and the overtreatment of prostate cancer.For this reason, we believe that a clear knowledge of this tools, indexes and diagnostic methods is of the utmost importance in preventing the morbidities related to unnecessary treatment as weel as preventing the detrimental effect of missing the diagnosis of a clinically significant prostate cancer.This reviews encompasses the most studied tests and diagnostic methods to predict the aggressiveness of prostate cancer, to avoid to miss a diagnosis of clinically significant cancers and to optimize the overall pre-treatment work-up. (www.actabiomedica.it).

Effectiveness of D-mannose, Hibiscus sabdariffa and Lactobacillus plantarum therapy in prevention of infectious events following urodynamic study.

INTRODUCTION AND AIM: The urodynamic study is an invasive examination that allows a thorough evaluation of the functional activity of the lower urinary tract (bladder, urethra). The execution of urodynamic study exposes the patient to the risk of contracting infections of the lower urinary tract. Prevention of urinary tract infections consists in the avoidance of risk factors and prophylaxis with antimicrobial and non-antimicrobial measures. In this article, we aimed to evaluate the effectiveness of a phytotherapeutic product composed of D-mannose, Hibiscus sabdariffa, and Lactobacillus plantarum in the prevention of infectious events following invasive urodynamic examination. MATERIALS AND METHODS: We selected 100 female consecutive patients (age 19-87 years) that underwent urodynamic invasive procedure. We prescribed 14-day therapy with D-mannose, H. sabdariffa, and L. plantarum to these 100 patients after urodynamic invasive test. After that, we have examined urine cultures and urinary symptoms through telephone interviews and hospital outpatient visits to evaluate the possible presence of urinary tract infections. RESULTS: Urinary tract infections were observed through urine culture in 13% of the selected patients; of the 13 urinary tract infections, 9 were observed in patients with urinary tract recurrent infections in the last year and the other 4 cases were associated with patients with no urinary infection in the last year. Three women reported some urinary symptoms and underwent antibiotic therapy. The other 10 cases were classified as asymptomatic bacteriuria. Three cases were related to patients presenting with pelvic organ prolapse. Eight cases were instead related to significant post-voiding residue (>100). Six patients with urinary tract infection reported constipation in the last year. All patients completed the prescribed therapy due to the affordable price of the product and no side effects have been reported. CONCLUSION: Our study about the administration of D-mannose, H. sabdariffa, and L. plantarum after invasive urodynamic examination underlined how this phytotherapeutic product can reduce the risk of bacteriuria and urinary tract infection in women.