Uroflowmetry alterations in patients with autosomal dominant polycystic kidney disease.

OBJECTIVE: Autosomal Dominant Polycystic Kidney Disease (ADPKD) is a heterogeneous inherited disease characterized by renal and extrarenal manifestations with progressive fluid-filled cyst development leading to end-stage renal disease. Our aim was to evaluate the prevalence of obstructive urological disease in ADPKD patients and possible associations with endothelial dysfunction, nutritional, metabolic and inflammatory markers. PATIENTS AND METHODS: The study included ADPKD patients and control group, who carried out uroflowmetry, an assessment of renal function, metabolic and nutritional parameters and an evaluation of endothelial dysfunction and atherosclerotic markers, such as Renal Resistive Index (RRI), Intima-Media Thickness (IMT) and Flow-Mediated Dilation (FMD). RESULTS: We enrolled 37 ADPKD patients (20 males with 51.0 ± 14.3 years) and 34 control group (18 males with 60.7 ± 14.4 years). We showed a significant reduction in Max Flow Rate (Qmax) (p ≤ 0.001), age (p = 0.006), FMD (p = 0.023) and Voiding Volume (p = 0.053), in addition to a significant increase in Voiding Time and Diastolic Blood Pressure (p ≤ 0.001, p = 0.049; respectively) in ADPKD patients with respect to control group. Moreover, we found a negative correlation between Qmax and creatinine (r= -0.44, p = 0.007), RRI (r= -0.49, p ≤0.001) and intact Parathyroid Hormone (r = -0.329, p = 0.046), while we found a positive correlation between Qmax and MDRD (r = 0.327, p = 0.048) and between Voiding Time and serum uric acid (r= 0.34, p = 0.039) in ADPKD patients with respect to control group. CONCLUSIONS: In our study, we showed an elevated prevalence of urological functional diseases in ADPKD patients; therefore, we suggest to include uroflowmetry in the assessment of these patients, considering the non-invasiveness, repeatability and low cost of the exam. An early intervention could slow down the progression of renal damage and an early screening of the main cardiovascular risk factors could reduce the high morbidity and mortality in ADPKD patients.

Total intravenous anesthesia using remifentanil in extracorporeal shock wave lithotripsy (ESWL). Comparison of two dosages: a randomized clinical trial.

BACKGROUND: Extracorporeal Shock Wave Lithotripsy is usually performed in day surgery setting, consequently people who undergo to this procedure need a safe and fast recovery. Conscious sedation with remifentanil can relieve from pain and keep patients in touch with anaesthesiologists. Few publications tell about infusion rates administered to perform this procedure7. The aim of this study is to assess which is the most appropriate infusion rate. METHODS: Patients were randomly assigned to two groups. Two different infusion rates were compared: 0,05 mcg/kg/min, GROUP A (N.=114), vs. 0.1 µg/kg/min, GROUP B (N.=114). Patients' vital signs, additional analgesic requests, PONV (postoperative nausea and vomiting) and other side effects were registered. The deepness of sedation and patient's satisfaction were evaluated referring to Obsever's Assessment of Alertness and Sedation scale (O/ASS) and using a Likert's scale respectively. Pain intensity was assessed with a 11-points VAS (visual analogue scale). Differences between groups were analyzed using Student t test for independent variables. The χ2 test was used to analyze categorical variables. RESULTS: The study enrolled 228 patients and assigned them to two groups (N.=114). No significant differences were found regarding Likert's scale values (P=0.20), additional analgesic request (P=0.30) and mean VAS values (P>0.05) between the two groups. The difference between the two groups about PONV, hypotension, oxygen desaturation and respiratory depression was statistically significant (P<0.05), as a matter of fact in group A these side effects occurred less frequently. The fifth degree of O/ASS was estimated in about 1.61±0.19 min and 2.987±0.20 min in group A and in group B respectively (P<0.05). CONCLUSION: According with previous results remifentanil at the infusion rate of 0.05 µg/kg/min provides an effective analgesia, causing a lower incidence of side effect than 0.1 µg/kg/min, granting a fast and safe recovery.

Effect of water of Anticolana Valley on urinary sediment of renal stone formers.

An investigation was carried out to ascertain the effect of drinking Fiuggi water on the microcrystalline structure of the calcium oxalate monohydrate present in urinary sediments provided from patients suffering from recurrent idiopathic oxalic calculosis. The experimental group was administered tap and Fiuggi water for ten days. The control group was administered tap and Fiuggi water according to the same procedure as for the experimental group. The comparative data show that drinking Fiuggi water leads to a strong reduction, and sometimes even to the elimination, of the calcium oxalate monohydrate present in the urinary sediment reducing the risk of oxalic calculosis. Fiuggi water contains organic molecules belonging to the fulvic acid family. These acids are capable of complexing the calcium ions and interact preferentially with the crystal lattice of the calcium oxalate monohydrate via the formation of a film and behave as pumping systems by linking the calcium ion, demolishing the crystal lattice and dissolving calcium and oxalate ions. Mineral water treatments must therefore be viewed as a function of the specific composition of the water administered. The ecosystem influences the composition of water, as a complex matrix containing a number of organic molecules which are potentially biologically active.

Stone recurrence after lithotripsy in patients with recurrent idiopathic calcium urolithiasis: efficacy of treatment with fiuggi water.

A multicentric study was carried out on 384 patients (231 males, mean age 28.3 years; 153 females, mean age 40.8 years) previously treated with extracorporeal shock wave lithotripsy for recurrent idiopathic calcium urolithiasis. Patients were selected and submitted to different types of high fluid intake treatment (oligomineral water with a calcium content of 15 mg/l vs. tap water with a calcium content ranging between 55 and 130 mg/l) to evaluate stone recurrence and to identify any potential risk factors. During follow-up (range 14-34 months, mean 19 months) 44 (23%) of the 192 patients treated with tap water presented recurrence versus 32 (17%) of the 192 patients treated with Fiuggi mineral water, the difference in incidence between the two groups being 6%. Of the possible predictors of recurrence, evaluated at the beginning of follow-up and analyzed in a multivariate statistical study, the 24-hour diuresis and calciuria were seen to be directly related to the recurrence.

Solvent effect in vitro of Anticolana Valley water on renal stones: analytical-instrumental study.

The presence of humic and fulvic acids in the Anticolana Valley (Fiuggi) water has been established. On the basis of this evidence we investigated the capacity of Anticolana Valley (Fiuggi) water to dissolve renal calculi in vitro. Crystals of calcium oxalate monohydrate to simulate a kidney stone were prepared. Human renal stones of calcium oxalate monohydrate were obtained by courtesy of the Division of Urology of 'La Sapienza' University (Rome), the Division of Urology of the University of Havana (Cuba) and the ASTIF of Fiuggi. The study was performed using the Anticolana Valley (Fiuggi) water, distilled water and tap water (ACEA, Rome), in a specially designed Perspex apparatus. Each calculus was subjected to a water flow of 2 liters/24 h. The capacity of the Anticolana Valley (Fiuggi) water to dissolve human and synthetic calculi was found to be much higher than that of distilled water which in turn was significantly more effective than tap (ACEA) water.

[Twelve years of ureterorenoscopy: evolution of the technique]. / Dodici anni di ureterorenoscopia: evoluzione della tecnica.

In the last ten years the diagnostic and therapeutical approach to ureteral neoplasms and stones changed their feature, due to improvement of the ureteroscopy. The passage through flexible to rigid and finally semirigid ureteroscopes permitted reduction of invasiveness with higher results. The positive changes to the energy sources, in regard to cost-benefit, it was versus ballistic energy. Ureteroscopy should now be considered as a simple and safe technique, with minimal morbidity and invasiveness and also short operative times.

Long-term follow-up of low-dose methotrexate therapy in one case of idiopathic retroperitoneal fibrosis.

Idiopathic retroperitoneal fibrosis (RPF) is characterized by the development of a fibrotic mass surrounding the abdominal aorta and its branches, of unknown aetiology. Several immunological mechanisms can be operative in the pathogenesis of RPF. Based on this assumption we treated a patient affected by idiopathic RPF with low-dose methotrexate (MTX) therapy. To our knowledge this is the first example of the effectiveness and safety of a long-term low-dose MTX treatment in the post-surgical management of RPF.

[Neoplasms of the male urethra: diagnosis and therapy]. / Le neoplasie dell'uretra maschile: diagnosi e terapia.

Neoplasms of male urethra are particularly interesting for the diagnostic and therapeutical problems involved, urologist surgeons may be charged to resolve. The authors effected an anatomo-pathologic, diagnostical and especially therapeutical framing, by reviewing the data reported by the literature. The indications the Authors may draw therefrom are favourable to a radical surgery, even in consideration of the extensive nature of such tumours and the poor successes, in terms of survival, got by the conservative therapy.