Implant of ATOMS® system for the treatment of postoperative male stress urinary incontinence: an Italian multicentric study.

BACKGROUND: The aim of this study was to evaluate efficacy and safety of the ATOMS system for the treatment of postoperative stress urinary incontinence (SUI). METHODS: We included all consecutive male patients referring for postoperative SUI and treated with ATOMS system from June 2013 to July 2017. Patients received anamnesis, 24 h Pad Test, Pad count, physical examination, urodynamic evaluation, ICIQ-UI SF questionnaire. We excluded patients with low bladder capacity and compliance, uncontrolled detrusor overactivity. RESULTS: We treated 98 patients with median age of 70.21±10.02 years. The most common cause of SUI was open radical prostatectomy in 79 patients. Ten patients had undergone urethrotomy, 7 bladder neck incision, 14 adjuvant radiotherapy. Thirty-nine patients suffered of mild incontinence (24 h Pad Test <200 g), 49 moderate incontinence (200-400 g), 10 severe incontinence (≥400 g). Thirty-one patients underwent previous incontinence surgery: 29 ProACT, 3 artificial urinary sphincters (in 2 cases both devices), 1 bulking agents and subsequent male sling. Median follow-up was 21.5 months. We had a significant reduction of mean 24 h Pads Test, pad count and ICIQ-UI SF questionnaire (P<0.01). At last follow-up 47.96% of patients were dry and 79.59% reached social continence. A high incontinence grade, adjuvant radiotherapy, previous urethral surgery and incontinence surgery have been associated with lower continence results. We had complications in 33 patients (33.7%). The device was removed in 4 cases due to scrotal port erosion and in one case due to persistent pain. CONCLUSIONS: The ATOMS system seems to be an effective and safe surgical treatment for postoperative male SUI.

64CuCl2 PET/CT in Prostate Cancer Relapse.

Our objective was to evaluate the biodistribution, kinetics, and radiation dosimetry of 64CuCl2 in humans and to assess the ability of 64CuCl2 PET/CT to detect prostate cancer (PCa) recurrence in patients with biochemical relapse. Methods: We prospectively evaluated 50 PCa patients with biochemical relapse after surgery or external-beam radiation therapy. All patients underwent 64CuCl2 PET/CT, 18F-choline PET/CT, and multiparametric MRI within 15 d of each other. Experienced readers interpreted the images, and the detection rate (DR) of each imaging modality was calculated. Histopathology, when available; clinical or laboratory response; and multidisciplinary follow-up were used to confirm the site of disease. In parallel, biodistribution, kinetics of the lesions, and radiation dosimetry of 64CuCl2 were evaluated. Results: From a dosimetric point of view, an administered dose of 200 MBq for 64CuCl2 translated into a 5.7-mSv effective dose. Unlike 18F-choline, 64CuCl2 was not excreted or accumulated in the urinary tract, thus allowing thorough pelvic exploration. The maximum 64CuCl2 uptake at the sites of PCa relapse was observed 1 h after tracer injection. In our cohort, 64CuCl2 PET/CT proved positive in 41 of 50 patients, with an overall DR of 82%. The DRs of 18F-choline PET/CT and multiparametric MRI were 56% and 74%, respectively. The difference between the DRs of 64CuCl2 PET/CT and 18F-choline PET/CT was statistically significant (P < 0.001). Interestingly, on considering prostate-specific antigen (PSA) value, 64CuCl2 PET/CT had a higher DR than 18F-choline PET/CT in patients with a PSA of less than 1 ng/mL. Conclusion: The biodistribution of 64CuCl2 is more suitable than that of 18F-choline for exploring the pelvis and prostatic bed. The 64CuCl2 effective dose is like those of other established PET tracers. In patients with biochemical relapse and a low PSA level, 64CuCl2 PET/CT shows a significantly higher DR than 18F-choline PET/CT.

The influence of Genoa G8 events on people sexuality.

OBJECTIVES: Aim of the study is to verify if a stress reaction due to G8 meeting, held in Genoa on July 2001, can produce a mass stress reaction and influence negatively people sexuality and so the birth rate. MATERIALS AND METHODS: 402 citizens (221 men and 181 women ranging in age from 25 to 52 years, mean 39) have been invited to answer two questionnaires concerning their sexual activity and their feelings before, during and after the G8 meeting. After 9,10 and 11 months we have valued the birth rate in Genoa. RESULTS: 30 people (7%) did not answer the two questionnaires. 12 people (3%) answered the questionnaire wrongly and were excluded from the study. 228 people (63%) didn't report changes about their sexual activity, during G8 meeting. 120 people (33%) reported a decrease of sexual intercourses and of sexual desire; 12 people (4%) reported an increase of these parameters. 54% of our population reported a definite anxiety. We want to emphasize the high number of people that had anxiety even in the group that didn't report changes in sexual activity (105/228 = 46%). After 9, 10 and 11 months we have recorded a significant decrease of the birth rate respectively of 29%, 23%, 20%. (P < 0.05). CONCLUSIONS: Violent demonstrations during G8 meeting have negatively influenced people sexual activity and people behaviour. Besides, we have recorded a decrease of birth rate in Genoa, nine, ten and eleven months after G8. This decrease rate was respectively 29%-23%-20% as regards the same months during the three years before (P < 0.05). We cannot determine the real cause of this decrease. Violent G8 demonstrations could be responsible for a stress reaction with negative consequences on human reproductive functions.

[Ultrasonography-guided transperineal prostatic biopsy: optimization of sampling protocol after 1,352 biopsies]. / Biopsia prostatica transperineale ecoguidata: ottimizzazione del protocollo di campionamento dopo 1.352 biopsie.

We report our experience-based approach in transperineal ultrasound guided biopsy to detect early prostate cancer. We selected patients on the basis of clinical characteristics. We tried to determine correct number and sites of biopsy to reduce patient discomfort and complications without loosing sensibility. Routine TZ biopsy increases detection rate of prostate cancer in T1 patients. Lateral peripheral biopsy resulted in a loss of sensibility of 5% and thus we considered it useless. Literature reported gain of sensibility with lateral peripheral biopsy referred to transrectal technique. Needle angle of incidence is different and therefore the area biopsied differs. Thus, results are not comparable.

A randomized prospective trial to assess the impact of transurethral resection in narrow band imaging modality on non-muscle-invasive bladder cancer recurrence.

BACKGROUND: Narrow band imaging (NBI) is an optical enhancement technology that filters white light into two bandwidths of illumination centered on 415nm (blue) and 540nm (green). NBI cystoscopy can increase bladder cancer (BCa) visualization and detection at the time of transurethral resection (TUR). NBI may therefore reduce subsequent relapse following TUR. OBJECTIVE: Assess the impact of NBI modality on 1-yr non-muscle-invasive BCa (NMIBC) recurrence risk. DESIGN, SETTING, AND PARTICIPANTS: Consecutive patients with overt or suspected BCa were included in a prospective study powered to test a 10% difference in 1-yr recurrence risk in favor of cases submitted to NBI TUR. Excluding patients with muscle-invasive BCa, negative pathologic examination, or without follow-up, the study population was composed of 148 subjects randomized from August 2009 to September 2010 to NBI TUR (76 cases) or white light (WL) TUR (72 cases). INTERVENTION: TUR was performed in NBI or standard WL modality. MEASUREMENTS: The 1-yr recurrence risks in NBI or WL TUR groups were compared using odds ratio (OR) point and interval estimates derived from logistic regression modeling. RESULTS AND LIMITATIONS: The 1-yr recurrence-risk was 25 of 76 patients (32.9%) in the NBI and 37 of 72 patients (51.4%) in the WL group (OR=0.62; p=0.0141). Simple and multiple logistic regression analyses provided similar OR points and interval estimates. CONCLUSIONS: TUR performed in the NBI modality reduces the recurrence risk of NMIBC by at least 10% at 1 yr.

Safety and efficacy of periurethral constrictor implantation for the treatment of post-radical prostatectomy incontinence.

OBJECTIVE: To assess safety and efficacy of the periurethral constrictor for the treatment of postprostatectomy urinary incontinence. METHODS: Periurethral constrictor is a minimally invasive, low-cost (€ 2000) device based on an adjustable occlusive mechanism. From December 2004 to March 2010 the device was implanted in 66 patients with mild to severe incontinence (3 or more pads per day) through a 3- to 5-cm perineal incision. Median surgical time was 35 minutes (range 25-60). Discharge occurred on day 1 after removing the indwelling urethral catheter. RESULTS: In 4 cases (6%), the device was removed because of infection/periurethral erosion. At 18 months, 62 patients were valuable; continence was recovered totally in 49 cases (79%), partially in 9 (15%) cases, and remained unchanged in 4 (6%). No one needed self-catheterization to empty the bladder. CONCLUSION: Periurethral constrictor improved continence in most of the patients. Nevertheless, a larger series and longer follow-up are needed to confirm safety and to test durability.

Bipolar transurethral resection in saline (TURis): outcome and complication rates after the first 1000 cases.

OBJECTIVE: TURis((R)) is an emerging technique that shows the same efficacy of monopolar resection. However, there is currently little available data on the safety of bipolar devices. We assessed outcome and safety of TURis on a large cohort of patients with at least 6 months' follow-up. PATIENTS AND METHODS: Between January 2006 and October 2007, 1000 consecutive transurethral resection (TUR), 376 transurethral resection of prostate, 480 transurethral resection of bladder neoplasm, and 144 transurethral incision of prostate were performed. All procedures were carried out with a bipolar device in physiologic saline (TURis). The resectoscope used was an Olympus 26F in continuous flow-type Iglesias with continuous aspiration. The loops were all disposable/single use. The incidence of unwanted stimulation of the obturator reflex, TUR syndrome, thermal skin lesion, blood transfusion, urethral strictures, and bladder neck contractures were recorded. RESULTS: None of the patients operated experienced a TUR syndrome or a thermal skin lesion. The median follow-up of the entire cohort was 12 months (range, 6-24 months); 663 patients had at least 1-year follow-up (66.3%). Urethral stricture occurred in 27 patients (2.7%). Four patients developed a bladder neck contracture after transurethral resection of prostate (1%). Early postoperative clot retention occurred in 21 patients (2.1%), and 11 patients needed one or more transfusion (1.1%). Only six patients (2%) submitted to TUR of a neoplastic lesions at the lateral bladder wall experienced an unwanted trigger of the obturator reflex. CONCLUSIONS: TURis offers the patient the same results as monopolar technology guaranteeing maximum safety without increasing the incidence of urethral strictures.