Role of pre-operative ureteral stent on outcomes of retrograde intra-renal surgery (RIRS): systematic review and meta-analysis of 3831 patients and comparison of Asian and non-Asian cohorts.

PURPOSE: To evaluate the outcomes of pre-stented (PS) versus non-pre-stented (NPS) patients who have undergone retrograde intrarenal surgery (RIRS) for renal calculi with subgroup analysis of Asian and non-Asian cohorts. METHODS: Protocol is registered in PROSPERO, CRD42021261123. Eligible studies identified from four electronic databases. Meta-analysis was done to enumerate the outcomes of RIRS in between PS and NPS. Secondary sub-analysis was done to look for differences in outcomes in Asian and non-Asian cohorts. RESULTS: Fourteen studies involving 3831 patients (4 prospective, 10 retrospective studies) were included. PS patients experienced higher success rates of ureteral access sheath (UAS) insertion than NPS (RR 1.09, 95% CI 1.05-1.13, p < 0.00001). PS patients had lower risk of ureteral injuries from UAS placement (RR 0.69, 95% CI 0.50-0.96, p = 0.03). No significant differences in intra- and postoperative complications between two groups were found. Stone-free rate (SFR) outcomes for residual fragment (RF) cut-off of < 1 mm and < 4 mm favoured the PS patients (RR 1.10, 95% CI 1.04-1.17, p = 0.002 for < 4 mm, RR1.10, 95% CI 1.02-1.19, p = 0.02 for < 1 mm). In the subgroup analysis, PS Asian patients had similar SFR as NPS patients for SFR(< 4 mm) but non-Asian population showed better outcomes in the PS patients for SFR(< 4 mm) (RR 1.31, 95% CI 1.13-1.52, p = 0.0005). CONCLUSIONS: This meta-analysis suggests that pre-stenting results in a higher success for UAS placement, minimising intraoperative ureteric injury, with higher overall SFR for any RF cut-off in PS cohorts. In non-Asian cohort, significant differences occurred at SFR < 4 mm but not for SFR < 1 mm. No difference was seen in our Asian cohort for any SFR cut-off in both PS and NPS patients.

A unique case of late complication of rectum mesh erosion after laparoscopic sacrocolpopexy.

Sacrocolpopexy, a surgical technique with a low morbidity rate, is a valid procedure for repairing vaginal vault prolapse. To our knowledge, only 1 case of rectum erosion after open sacrocolpopexy has been reported in the literature, and there is no record of any such incident after laparoscopic sacrocolpopexy. We report the first case of mesh erosion involving the rectum instead of the vagina assessed 8 years after laparoscopic sacrocolpopexy.

Human papillomavirus infection and vaginal tape exposure after midurethral sling: a case report.

Midurethral tape placement is the gold standard procedure for stress urinary incontinence (SUI). Among reported complications, tape erosion is uncommon. Several risk factors have been postulated as causes of vaginal erosion, but none have been demonstrated. Cases of vaginal erosion caused by tape infections have been described, but none has been associated with human papillomavirus (HPV) infection. We report the first case of vaginal exposure in a woman who underwent a midurethral sling procedure for SUI after HPV colonization.

[Fournier's gangrene: our experience of 10 cases].

Fournier's gangrene, described for the first time by Alfred Jean Fournier in 1883, is a very uncommon disease. It is characterized by an acute process of cellulites and necrotizing fasciitis of the external genitalia, perineum and abdominal wall; its mortality rate is about 30-50%. We retrospectively reviewed 10 patients affected by Fournier's gangrene admitted to our Department of Urology from 1997 to 2006. At a mean follow-up of 37 months (range 0-108) 7 patients are alive and disease free, 1 patient is alive bearing the signs of the gangrene, and 2 patients died because of the disease complications. We have noted that patients' survival depends on early intervention and extremely aggressive approach. The combination of these factors with antibiotic therapy and supportive care have made this disease treatable and curable.

Repetitive magnetic stimulation of the sacral roots for the treatment of stress incontinence: a brief report.

AIM: The aim of this study was to investigate the short and long-term effects of repetitive magnetic stimulation on the sacral roots in a homogeneous group of patients affected by stress incontinence. METHODS: Twenty women with urinary stress incontinence were randomly assigned to an active or a sham stimulation group. Fifteen-Hz repetitive magnetic stimulation of the sacral roots (S2-S4) was applied for 15 min. Patients were treated with magnetic stimulation for 3 days a week for 2 weeks (6 times in all). The clinical outcome was assessed before (T1) and 1 week (T2) and 1 month (T3) after stimulation. Main outcome measures were: the King's Health Questionnaire, the SEAPI-QMM scale and the amount of urinary loss in a 1-h pad test and stress test. RESULTS: At T2 patients in the active stimulation group showed improvement in health perception (P<0.001), social limitation (P<0.01), sleep/energy performance (P<0.05) and severity measure score (P<0.05) not observed in the sham stimulation group; a significant decrease in SEAPI-QMM score was noted only in the active group at T2 (P<0.05). These results were no longer observed at T3. We also observed a decrease in the amount of urine loss quantified with the pad test and stress test in the active stimulation group. CONCLUSION: Repetitive magnetic stimulation of the sacral roots has a short-term effect on some aspects of the quality of life of the patients, but it did not prove effective using quantified measurement.

Prognostic value of renal cell carcinoma nuclear grading: multivariate analysis of 333 cases.

OBJECTIVE: To evaluate the independent predictive value of the nuclear grading system according to Fuhrman in relation to the disease-specific survival of patients with renal clear cell carcinoma. MATERIAL AND METHODS: 333 patients who underwent radical nephrectomy for renal clear cell carcinoma between 1983 and 1999 were evaluated. In all patients we retrospectively studied nuclear grading, average tumor size, multifocality, pathologic stage of primary tumor, vein invasion, lymph node involvement and distant metastases. The Kaplan-Meier method was applied to evaluate disease-specific survival rates. The log rank test was used to compare survival curves and for univariate analysis. The Cox proportional hazards model was used for the multivariate analysis. RESULTS: Histologic grade was G1 in 83 cases (25%), G2 in 117 cases (35%), G3 in 110 cases (33%) and G4 in 23 cases (7%). Our data showed that nuclear grading according to Fuhrman is related to medium tumor size (p < 0.0001), pathologic stage of cancer (p < 0.001), venous system invasion (p < 0.001), lymph node involvement (p < 0.001) and distant metastases (p < 0.001). The disease-specific survival after 5 and 10 years was 94 and 88%, respectively, in patients with G1, 86 and 75% in patients with G2, 59 and 40% in patients with G3 and 31% in patients with G4 (log rank p value < 0.0001). Multivariate analysis showed that nuclear grading by Fuhrman has a prognostic independent predictive value (hazard ratio = 1.8461, p = 0.002). CONCLUSIONS: Nuclear grading is an important independent predictive factor of disease-specific survival in patients with renal cell carcinoma.

Renal vein and vena cava involvement does not affect prognosis in patients with renal cell carcinoma.

OBJECTIVES: The prognostic value of tumor extension into the renal vein or vena cava is still a controversial issue. The aim of this study is to report our experience with radical surgery in patients with renal cell carcinoma (RCC) extending into the renal vein or subdiaphragmatic vena cava. METHODS: We evaluated 142 patients with RCC involving the renal vein or inferior subdiaphragmatic vena cava. RCC had extended into the renal vein in 118 patients and into the inferior vena cava in the remaining 24. Radical nephrectomy was performed in all cases with renal vein invasion. Radical nephrectomy with cavotomy and tumor thrombus removal was carried out in all cases with inferior subdiaphragmatic vena caval invasion. Cause-specific survival was calculated by means of the Kaplan-Meier method. The log rank test was used for survival comparisons and univariate analysis. RESULTS: The 5- and 10-year cause-specific survival rates were 51.5 and 39%, respectively, in the group of patients with tumor extension into the renal vein and 33.4% in those with inferior vena caval involvement. In 52 patients (44%), RCC extended only into the renal vein. In the remaining 66 patients, renal vein invasion was associated with other adverse prognostic factors. Life expectancy was lower for patients with other concurrent adverse prognostic factors than for those affected by renal vein involvement alone (p < 0.0001). In the latter group, survival expectancy was similar to those with stage T2N0M0 tumor. In 7 cases (29%), inferior vena caval invasion was not associated with other adverse prognostic factors. In the remaining 15 patients (71%), vena caval involvement was associated with other adverse prognostic factors. Concurrence of other adverse prognostic factors with vena caval invasion significantly decreased the disease-specific survival expectancy in comparison with the patients in whom vena caval involvement was the main prognostic factor (p = 0.008). In these patients, disease-specific survival was similar to those with stage T2N0M0 tumor. CONCLUSION: Renal vein or inferior subdiaphragmatic vena caval involvement does not significantly affect prognosis in patients with RCC.

High flow priapism due to a bilateral arteriosinusoidal fistula--an unusual conservative treatment.

The authors report a rare case of high flow priapism due to a bilateral arteriosinusoidal fistula conservatively treated. Twenty months after the treatment the patient claimed to have a normal sexual activity.