Antibiotic prophylaxis in invasive urodynamics, a Delphi consensus of the Italian Society of Urodynamics (SIUD).

INTRODUCTION: Although antibiotic prophylaxis (AB) demonstrated a statistically significant reduction in bacteriuria after invasive urodynamics (UDS), no significant decrease in the incidence of urinary tract infections (UTI) has been confirmed. No absolute recommendations on the use of AB in case of relevant potential risk of UTI have been reported, though some categories of patients at increased infective probability after UDS have been recognized. The aim of this study is to report the experts' consensus on the best practice for the use of AB before UDS in the main categories of patients at potential risk of developing UTI. MATERIALS AND METHODS: A systematic literature review was performed on AB before UDS in males and females. A panel of experts from the Italian Society of Urodynamics, Continence, Neuro-Urology, and Pelvic Floor (SIUD) assessed the review data and decided by a modified Delphi method on 16 statements proposed and discussed by the panel. The cut-off percentage for the consensus was a ≥70% of positive responses to the survey. The study was a Delphi consensus with experts' opinions, not a clinical trial involving directly patients. RESULTS: The panel group was composed of 57 experts in functional urology and UDS, mainly urologists, likewise gynaecologists, physiatrists, infectivologists, pediatric urologists, and nurses. A positive consensus was achieved on 9/16 (56.25%) of the statements, especially on the need for performing AB before UD in patients with neurogenic bladder and immunosuppression. Urine analysis and urine culture before UDS are mandatory, and in the event of their positivity, UDS should be postponed. A consensus was reached on avoiding AB in menopausal status, diabetes, age, gender, bladder outlet obstruction, high postvoid residual, chronic catheterization, previous urological surgery, lack of urological abnormalities, pelvic organ prolapse, and negative urine analysis. CONCLUSIONS: Antibiotic prophylaxis is not recommended for patients without notable risk factors and with a negative urine test due to the potential morbidities that may result from antibiotic administration. However, AB can be used for risk categories such as neurogenic bladder and immunosuppression. The evaluation of urine analysis and urine culture and postponing UDS in cases of positive tests were considered good practices, as well as performing AB in the neurogenic bladder and immunosuppression.

[Incontinence after retropubic radical prostatectomy: correlation between ultrasonographic morphological data and urodynamic parameters]. / Incontinenza dopo prostatectomia radicale retropubica: correlazione tra dati morfologici ecografici e parametri urodinamici.

OBJECTIVE: The aim of this study is to evaluate the relationships existing between transrectal ultrasound and urodynamics in patients undergone radical retropubic prostatectomy and affected by stress incontinence. MATERIALS AND METHODS: 78 patients were suitabe for the study. They have been divided in three groups: group A, 18 incontinent patients (at least 1 pad a day); group B, 30 patients with occasional dribbling (no incontinence device needed); group C, 30 continent patients. All the patients have undergone urethral pressure profile (UPP), abdominal leak point pressure (ALPP) and transrectal ultrasound (TRUS). ultrasound has been performed injecting saline solution in the spongious and bulbar urethra to dilate it and better visualize a collapsed tract corresponding to the distal sphincter, that was measured. Different doctors performed TRUS and urodynamics, and each ignored the results of the other tests. RESULTS: The mean value of TRUS length of the collapsed urethral segment was 5.47 mm (range 4.9-6.0) for group A, 11.5 mm (9.5-12.9) for group B, 13.8 mm (10.4-14.7) for group C. the mean value of rest FUL was 36.6 (range 23-52) for group A, 31.7 (range 21-37) for group B, 13.8 (range 10.4-14.7) for group C. The mean value of stress FUL was 20.3 (range 5-29) for group A, 20.7 (range 18-27) for group B, 25.0 (range 20-35) for group C. The mean value of VLPP was 61.9 cm H2O for group A, 83.6 cm H2O for group B, > 90 cm H2O for group C. CONCLUSIONS: The ranges of values of VLPP were narrower and showed less overlap among the groups than UPP. TRUS length showed a good correlation with VLPP and permitted to differentiate incontinent patients from continent patients and patients with occasional dribbling. These data correlate well with the possible role of the length of the urethral stump and of damage to genitourinary diaphragm in post-prostatectomy incontinence.

[Urethroplasty in hypoplastic-dysplastic corpus spongiosum and short urethra]. / Uretroplastica in paziente con grave incurvamento congenito e uretra corta secondari a corda ventrale e displasia del corpo spongioso.

Congenital penile curvature and chordee are a rare malformative condition most frequently associated with hypospadias, but varying degrees of penile curvature are observed with an orthotopic meatus. Disease becomes evident after puberty, when curvature becomes more apparent with erection. We present a case of a young man (16 years old), with ventral congenital penile curvature without hypospadias and with hypoplastic-dysplastic corpus spongiosum and short urethra, who could not have normal sexual intercourses. The patient underwent first-stage urethroplasty with urethral opening and graft of buccal mucosa and creation of a temporary hypospadic meatus. No post-operative complications were observed. There were no residual penile curvatures. Results are promising and satisfactory after the first surgical stage and provide a solid ground for the final reconstruction.