Minimal Setting Stroke Unit in a Sub-Saharan African Public Hospital.

Introduction: Sub-Saharan Africa (SSA) has the highest stroke prevalence along with a case fatality that amounts to 40%. We aimed to assess the effect of a minimal setting stroke unit in SSA Public hospital on stroke mortality and main medical complications. Materials and Methods: The study was set in Conakry, Guinea, Ignace Deen public referral hospital. Clinical characteristics, hospital mortality and main medical stroke complications rates (pneumonia, urinary tract infections, sores and venous thromboembolism) of admitted stroke patients after the installation of a minimal stroke unit equipped with heart rate, blood pressure and blood oxygen saturation monitoring and portable oxygen concentrator (POST) were compared to a similar number of stroke patients admitted before the stroke unit creation (PRE). Results: PRE (n = 318) and POST (n = 361) stroke, patients were comparable in term of age (61 ± 14 vs. 60 ± 14.8 years, p = 0.24), sex (56 vs. 50% males, p = 0.09), High blood pressure rate (76.7 vs. 79%, p = 0.44), stroke subtype (ischemic in 72 vs. 78% of cases, p = 0.05) and NIHSS (11 ± 4 vs. 11 ± 4, p = 0.85). Diabetes was more frequent in the PRE group (19 vs. 9%, p < 0.001). Mortality was significantly lower in the POST group (7.2 vs. 22.3%, p < 0.0001) as well as medical complications (4.1 vs. 27.7%, p < 0.001) and lower pneumonia rate (3.3 vs. 14.5%, p < 0.001). Conclusions: Minimally equipped stroke units significantly reduce stroke mortality and main medical complications in SSA.

Renal tumor biopsies are associated with a low complication rate.

BACKGROUND: Due to the high incidence of benign lesions in renal masses, numerous studies have been performed to clarify the value of core needle biopsies. The aim of the present study was to describe the complication rate after renal tumor biopsies (RTB), in order to make recommendations on observation after the procedure. MATERIALS AND METHODS: Data from all patients who underwent percutaneous ultrasound-guided RTB between February 2013 and October 2016 due to CT verified solid renal masses were prospectively collected and kept in a well-maintained database. Complications were collected retrospectively and classified according to the Clavien-Dindo (CD) classification system. RESULTS: Data from 224 consecutive patients were retrieved. Thirteen patients underwent unilateral repeat biopsies and three patients underwent bilateral biopsies; thus, a total of 240 procedures were analyzed. A total of 124 patients (51.7%) were discharged within 4 hours after the RTB procedures and 110 patients (45.8%) were discharged within 24 hours. The remaining six patients (2.5%) were hospitalized for more than 1 day, all due to co-morbidities which were unrelated to the procedure. In total, five patients (2.1%) experienced post-biopsy complications: one case of iatrogenic pneumothorax, one case of spontaneously resolving hematuria and three cases of fever. All complications were CD ≤2 and all patients with complications were discharged within 24 hours, except for one patient who was hospitalized for 3 days due to management of bone pain. No correlation was found between the number of biopsies and complication rate. CONCLUSION: The overall complication rate following ultrasound-guided biopsies of renal tumors was low and all complications were mild. Given the current evidence, it is believed that ultrasound-guided RTB can be done as an outpatient procedure without the need for hospitalization.

El entorno digital en los trastornos sexuales masculinos: revisión sistemática / The digital environment in men's sexual disorders: A systematic review

Contexto: La revolución de las tecnologías digitales constituye un nuevo escenario para las relaciones médico-paciente y proporciona a los pacientes un espacio de privacidad y acceso universal al conocimiento. Sin embargo, existe poca información acerca del uso de los recursos digitales, así como de sus ventajas e inconvenientes. Objetivos: Explorar el ámbito de la investigación científica en cuanto al uso de recursos digitales relacionados con los trastornos sexuales masculinos y analizar las principales fuentes de información en estos campos. Adquisición de la evidencia: Búsquedas sistemáticas en la literatura científica, páginas web (10 primeros resultados en cada búsqueda de google) y aplicaciones móviles (apps). Las búsquedas combinaron las palabras clave "web" y "app" con "erectile dysfunction", "premature ejaculation", "Peyronie", "male hypogonadism", y "infertility". La calidad de las páginas web y apps fue analizada según indicadores predefinidos. Síntesis de la evidencia: El análisis cualitativo de la literatura científica incluyó 116 artículos, el 47% de los cuales eran estudios basados en encuestas online, el 9% abordaban los tratamientos digitales, el 11% la calidad/seguridad del entorno digital en salud, el 3% la actividad digital, el 21% el empoderamiento de los pacientes y el 9% las ventas de fármacos online. De las 50 páginas web evaluadas, 29 (58%) puntuaron 4 o 5 en una escala Likert de 5 puntos. La búsqueda de apps resultó en 40 apps; únicamente 3 de ellas (8%) aportaban la identidad de algún centro de salud o profesional implicado. Conclusiones: Tanto los pacientes como los profesionales sanitarios pueden beneficiarse de los recursos digitales relacionados con los trastornos sexuales masculinos. No obstante, es necesaria una mayor implicación de la comunidad médica para incrementar la calidad de dichos recursos

Context: The revolution of digital technologies constitutes a new setting for the patient-physician relationship and provides patients with a scenario of privacy and universal access to a vast amount of information. However, there is little information on how digital resources are used and what their advantages and disadvantages are. Objectives: To explore the scope of the scientific research on the use of digital technology related to men's sexual disorders and to analyze the primary sources of digital information related to this field. Acquisition of evidence: Systematic searches of the scientific literature, websites (10 first results in each google search) and mobile applications (apps). The searches combined the keywords "web" and "app" with "erectile dysfunction", "premature ejaculation", "Peyronie", "male hypogonadism", and "infertility". Websites and apps were assessed for quality according to predefined indicators. Synthesis of evidence: The qualitative analysis of the scientific literature included 116 manuscripts; 47% were clinical studies based on online survey, 9% dealt with digital treatments, 11% with quality/safety of digital healthcare environment, 3% with digital activity, 21% with patient empowerment, and 9% with online drug selling. Of 50 websites assessed for quality, 29 (58%) scored 4 or 5 on a 5-point Likert scale. The app search yielded 40 apps; only 3 of them (8%) reported the identity of a health center or healthcare professional involved. Conclusions: Patients and healthcare professionals may benefit from digital resources related to men's sexual disorders; however, a strong commitment by the scientific and healthcare community is essential to increase the quality of these resources

Core needle biopsy clarify the histology of the small renal masses and may prevent overtreatment.

PURPOSE: The purpose of the study was to evaluate the diagnostic accuracy of core biopsy in small renal masses ≤ 4 cm in response to the rising prevalence of renal masses. METHODS: Data from 129 consecutive patients who underwent biopsies of solid renal masses of ≤ 4 cm were prospectively collected between September 2014 and January 2017. In cases with inconclusive biopsies, a repeat biopsy was recommended. Histology from surgical specimens was used as gold standard to evaluate the accuracy of renal biopsies. RESULTS: The initial biopsies revealed malignancy in 77 patients (59.7%) and benign histology in 35 patients (27.1%), whereas 17 (13.2%) were inconclusive. Fifty-six patients with malignant histology underwent either partial or radical nephrectomy according to the physicians' recommendation, while two patients with benign histology requested surgery. In all cases, the biopsy diagnosis was confirmed upon final histopathology. Of the inconclusive cases, six underwent repeat biopsies all with benign histology. Further, three patients opted for immediate partial nephrectomy with benign oncocytoma in two and renal cell carcinoma in the third. The remaining eight patients opted for follow-up CT scans with no sign of progression with a minimum of 6-month follow-up. No biopsy related complications were reported in the first 30 days after RTB. Overall, the treatment strategy changed in 45 of 129 (35%) patients due to biopsy results. This was either due to benign findings or due to the discovery of non-renal cell cancers. CONCLUSION: Core needle biopsies of solid renal masses ≤ 4 cm have excellent accuracy and may be used to select the correct treatment. Importantly, they may serve to prevent overtreatment of benign tumors.

Is follow-up ultrasound necessary after acute epididymitis? A retrospective analysis from a large university hospital.

OBJECTIVES: To evaluate the role of scrotal ultrasound in the follow-up after epididymitis for underlying serious testicular pathologies, which could be overseen in the acute phase. METHODS: Retrospective chart reviews were performed for patients diagnosed with acute epididymitis at Herlev-Gentofte Hospital between 2006 and 2013. Patients were included if they had received the diagnosis after a clinical evaluation in the emergency department and had subsequently undergone antibiotic treatment and a follow-up scrotal ultrasound at a later date. RESULTS: Overall, 118 patients fulfilled the inclusion criteria. The median age was 45 years (range = 18-80). The follow-up ultrasound scans showed no signs of significant pathology in 92/118. Incidental findings of hydroceles, spermatoceles, and varicoceles were made in eight, five and five of the 118, respectively. One patient had testicular tuberculosis and one had neglected testicular torsion. Six patients were diagnosed with suspicious testicular lesions and underwent surgery. Cancer was confirmed in four men (27, 32, 40, and 45 years old). CONCLUSIONS: Epididymitis can be diagnosed and treated correctly without scrotal ultrasound in the majority of cases. However, the risk of underlying testicular cancer should be kept in mind. Patients below 50 years of age without bacteriuria and patients with persistent symptoms after antibiotic treatment should be referred to an urologist for a re-evaluation or for a follow-up ultrasound.

The digital environment in men's sexual disorders: A systematic review. / El entorno digital en los trastornos sexuales masculinos: revisión sistemática.

CONTEXT: The revolution of digital technologies constitutes a new setting for the patient-physician relationship and provides patients with a scenario of privacy and universal access to a vast amount of information. However, there is little information on how digital resources are used and what their advantages and disadvantages are. OBJECTIVES: To explore the scope of the scientific research on the use of digital technology related to men's sexual disorders and to analyze the primary sources of digital information related to this field. ACQUISITION OF EVIDENCE: Systematic searches of the scientific literature, websites (10 first results in each google search) and mobile applications (apps). The searches combined the keywords "web" and "app" with "erectile dysfunction", "premature ejaculation", "Peyronie", "male hypogonadism", and "infertility". Websites and apps were assessed for quality according to predefined indicators. SYNTHESIS OF EVIDENCE: The qualitative analysis of the scientific literature included 116 manuscripts; 47% were clinical studies based on online survey, 9% dealt with digital treatments, 11% with quality/safety of digital healthcare environment, 3% with digital activity, 21% with patient empowerment, and 9% with online drug selling. Of 50 websites assessed for quality, 29 (58%) scored 4 or 5 on a 5-point Likert scale. The app search yielded 40 apps; only 3 of them (8%) reported the identity of a health center or healthcare professional involved. CONCLUSIONS: Patients and healthcare professionals may benefit from digital resources related to men's sexual disorders; however, a strong commitment by the scientific and healthcare community is essential to increase the quality of these resources.

Nomogram based overall survival prediction in stereotactic body radiotherapy for oligo-metastatic lung disease.

BACKGROUND: Radical local treatment of pulmonary metastases is practiced with increasing frequency due to acknowledgment and better understanding of oligo-metastatic disease. This study aimed to develop a nomogram predicting overall survival (OS) after stereotactic body radiotherapy (SBRT) for pulmonary metastases. PATIENTS AND METHODS: A multi-institutional database of 670 patients treated with SBRT for pulmonary metastases was used as training cohort. Cox regression analysis with bidirectional variable elimination was performed to identify factors to be included into the nomogram model to predict 2-year OS. The calibration rate of the nomogram was assessed by plotting the actual Kaplan-Meier 2-year OS against the nomogram predicted survival. The nomogram was externally validated using two separate monocentric databases of 145 and 92 patients treated with SBRT for pulmonary metastases. RESULTS: The median follow up of the trainings cohort was 14.3months, the 2-year and 5-year OS was 52.6% and 23.7%, respectively. Karnofsky performance index, type of the primary tumor, control of the primary tumor, maximum diameter of the largest treated metastasis and number of metastases (1 versus >1) were significant prognostic factors in the Cox model (all p<0.05). The calculated concordance-index for the nomogram was 0.73 (concordance indexes of all prognostic factors between 0.54 and 0.6). Based on the nomogram the training cohort was divided into 4 groups and 2-year OS ranged between 24.2% and 76.1% (predicted OS between 30.2% and 78.4%). The nomogram discriminated between risk groups in the two validation cohorts (concordance index 0.68 and 0.67). CONCLUSIONS: A nomogram for prediction of OS after SBRT for pulmonary metastases was generated and externally validated. This tool might be helpful for interdisciplinary discussion and evaluation of local and systemic treatment options in the oligo-metastatic setting. KEY MESSAGE: A nomogram for prediction of overall survival after stereotactic body radiotherapy (SBRT) for pulmonary metastases was developed and externally validated. This tool might be helpful for interdisciplinary discussion and evaluation of local and systemic treatment options in the oligo-metastatic setting.

Multiple needle-pass percutaneous testicular sperm aspiration as first-line treatment in azoospermic men.

Percutaneous testicular sperm aspiration (TESA) has been known for decades as a simple, minimally invasive approach to sperm retrieval in azoospermic men. Because of lower reported sperm retrieval rates (SRR) when compared with microdissection testicular sperm extraction (mTESE), many centers now use mTESE as the first choice for retrieving spermatozoa in nonobstructive azoospermia (NOA). Objectives of this study were to evaluate the outcome and safety of TESA and mTESE in the treatment of azoospermia and to investigate the usefulness of a prognostic TESA to individualize protocols for couples and limit the use of invasive testicular procedures. IRB approval was obtained to retrospectively evaluate 208 patients undergoing multiple needle-pass TESA between 1999 and 2014. Prognostic TESA was performed on 125 men with NOA and 82 with obstructive azoospermia (OA). Nine NOA men and 31 OA men with previously demonstrated spermatozoa had a subsequent therapeutic TESA while nine NOA men with a failed TESA proceeded to mTESE. Main outcome measures were complication rates and SRR. SRR of the prognostic TESA was 30% (38/125) for NOA men and 100% (82/82) for OA men. Eight/nine NOA men and 31/31 OA men had spermatozoa found for intracytoplasmic sperm injection in a subsequent therapeutic TESA. In nine NOA men in whom a TESA produced no spermatozoa, only one had spermatozoa found with mTESE. Overall complication rates of TESA and mTESE were 3% (7/267) and 21% (3/14), respectively. TESA provides reasonable SRR and is a safe procedure. Successful prognostic TESA indicates future success with therapeutic TESA. Men with a failed TESA have a limited chance of sperm retrieval using mTESE. Approaching azoospermic men with an initial prognostic TESA followed by either therapeutic TESA and/or mTESE is an efficient algorithm in the management of azoospermia and limits the use of more invasive procedures.

Vibratory ejaculation in 140 spinal cord injured men and home insemination of their partners.

STUDY DESIGN: Retrospective cohort study. OBJECTIVES: Anejaculation is commonly found in spinal cord injured (SCI) men. Clinical treatments and assisted reproductive techniques allow SCI men to father children but few home pregnancies have been reported. The objective of this paper is to evaluate the results from the last 20 years' of treatment with penile vibratory stimulation (PVS) and vaginal self-insemination at home in SCI men and their partners. SETTING: The data originate from two European centers and one American center. METHODS: A total of 140 SCI men with anejaculation and their healthy partners were available for this analysis. Men who obtained antegrade ejaculation by PVS and had motile sperm in the ejaculate were offered the possibility of PVS combined with vaginal self-insemination at home. Couples were instructed to perform PVS and to instill the ejaculate intravaginally. Outcome measures were pregnancy rate per couple, number of live births, total motile sperm count and time to pregnancies. RESULTS: Median total motile sperm count was 29 million (range, 1-92 million). In all, 60 of the 140 couples (43% pregnancy rate) achieved 82 pregnancies. Seventy-two of the pregnancies resulted in live births with the delivery of 73 healthy babies. Median time to first pregnancy was 22.8 months (6.0-98.4). No complications were reported. CONCLUSION: PVS combined with vaginal self-insemination may be performed as a viable, inexpensive option for assisted conception in couples in whom the SCI male partner has an adequate total motile sperm count and the female partner is healthy.