Archivio Italiano di Urologia e Andrologia
About: Archivio Italiano di Urologia e Andrologia is an academic journal. The journal publishes majorly in the area(s): Prostate cancer & Prostate biopsy. It has an ISSN identifier of 1124-3562. It is also open access. Over the lifetime, 678 publications have been published receiving 3702 citations.
Topics: Prostate cancer, Prostate biopsy, Prostate, Erectile dysfunction, Lower urinary tract symptoms
Papers published on a yearly basis
TL;DR: Diet interventions may reduce the risk of urinary stone formation and its recurrence, but there is no conclusive consensus in the literature regarding the effectiveness of dietary interventions and recommendations about specific diets for patients with urinary calculi.
Abstract: Objective: Diet interventions may reduce the risk of urinary stone formation and its recurrence, but there is no conclusive consensus in the literature regarding the effectiveness of dietary interventions and recommendations about specific diets for patients with urinary calculi. The aim of this study was to review the studies reporting the effects of different dietary interventions for the modification of urinary risk factors in patients with urinary stone disease. Materials and Methods: A systematic search of the Pubmed database literature up to July 1, 2014 for studies on dietary treatment of urinary risk factors for urinary stone formation was conducted according to a methodology developed a priori. Studies were screened by titles and abstracts for eligibility. Data were extracted using a standardized form and the quality of evidence was assessed. Results: Evidence from the selected studies were used to form evidencebased guideline statements. In the absence of sufficient evidence, additional statements were developed as expert opinions. Conclusions: General measures: Each patient with nephrolithiasis should undertake appropriate evaluation according to the knowledge of the calculus composition. Regardless of the underlying cause of the stone disease, a mainstay of conservative management is the forced increase in fluid intake to achieve a daily urine output of 2 liters. Hypercalciuria: Dietary calcium restriction is not recommended for stone formers with nephrolithiasis. Diets with a calcium content ≥ 1 g/day (and low protein-low sodium) could be protective against the risk of stone formation in hypercalciuric stone forming adults. Moderate dietary salt restriction is useful in limiting urinary calcium excretion and thus may be helpful for primary and secondary prevention of nephrolithiasis. A low-normal protein intake decrease calciuria and could be useful in stone prevention and preservation of bone mass. Omega-3 fatty acids and bran of different origin decreases calciuria, but their impact on the urinary stone risk profile is uncertain. Sports beverage do not affect the urinary stone risk profile. Hyperoxaluria: A diet low in oxalate and/or a calcium intake normal to high (800-1200 mg/day for adults) reduce the urinary excretion of oxalate, conversely a diet rich in oxalates and/or a diet low in calcium increase urinary oxalate. A restriction in protein intake may reduce the urinary excretion of oxalate although a vegetarian diet may lead to an increase in urinary oxalate. Adding bran to a diet low in oxalate cancels its effect of reducing urinary oxalate. Conversely, the addition of supplements of fruit and vegetables to a mixed diet does not involve an increased excretion of oxalate in the urine. The intake of pyridoxine reduces the excretion of oxalate. Hyperuricosuria: In patients with renal calcium stones the decrease of the urinary excretion of uric acid after restriction of dietary protein and purine is suggested although not clearly demonstrated. Hypocitraturia: The administration of alkaline-citrates salts is recommended for the medical treatment of renal stone-formers with hypocitraturia, although compliance to this treatment is limited by gastrointestinal side effects and costs. Increased intake of fruit and vegetables (excluding those with high oxalate content) increases citrate excretion and involves a significant protection against the risk of stone formation. Citrus (lemons, oranges, grapefruit, and lime) and non citrus fruits (melon) are natural sources of dietary citrate, and several studies have shown the potential of these fruits and/or their juices in raising urine citrate levels. Children: There are enought basis to advice an adequate fluid intake also in children. Moderate dietary salt restriction and implementation of potassium intake are useful in limiting urinary calcium excretion whereas dietary calcium restriction is not recommended for children with nephrolithiasis. It seems reasonable to advice a balanced consumption of fruit and vegetables and a low consumption of chocolate and cola according to general nutritional guidelines, although no studies have assessed in pediatric stone formers the effect of fruit and vegetables supplementation on urinary citrate and the effects of chocolate and cola restriction on urinary oxalate in pediatric stone formers. Despite the low level of scientific evidence, a low-protein ( 3 liters/day) is strongly advised in children with cystinuria. Elderly: In older patients dietary counseling for renal stone prevention has to consider some particular aspects of aging. A restriction of sodium intake in association with a higher intake of potassium, magnesium and citrate is advisable in order to reduce urinary risk factors for stone formation but also to prevent the loss of bone mass and the incidence of hypertension, although more hemodynamic sensitivity to sodium intake and decreased renal function of the elderly have to be considered. A diet rich in calcium (1200 mg/day) is useful to maintain skeletal wellness and to prevent kidney stones although an higher supplementation could involve an increase of risk for both the formation of kidney stones and cardiovascular diseases. A lower content of animal protein in association to an higher intake of plant products decrease the acid load and the excretion of uric acid has no particular contraindications in the elderly patients, although overall nutritional status has to be preserved.
TL;DR: Fournier's gangrene is a urological emergency with a high mortality rate despite advances in the medical and surgical fields, and based on current guidelines a management pathway is suggested.
Abstract: Introduction and Hypothesis: Fournier’s gangrene is a rare, necrotising fasciitis of the external genitalia, perineal or perianal regions. The disease has a higher incidence in males and risk factors for development include diabetes, HIV, alcoholism and other immune-compromised states. The aggressive disease process is associated with a high mortality rate of 20-30%. In addition, the increasing age and prevalence of diabetes in the population, begs the need for increased clinical awareness of Fournier’s gangrene with emphasis on early diagnosis and management. This review aims to highlight the relevant research surrounding Fournier’s gangrene, in particular the various prognostic indicators and management strategies. Methods: A search was conducted on the MEDLINE database for all applicable research; clinical reviews, retrospective studies and case reports. In addition to which a search of the European Association of Urology, the British Association for Urological Surgeons and the British Medical Journal was conducted for the most recent recommendations. Results: Immediate broad-spectrum antibiotic therapy and urgent surgical debridement are the core managerial principles of Fournier’s gangrene. The use of adjunctive therapies such as hyperbaric oxygen and vacuum assisted closure are supported in some aspects of the literature and disputed in others. The lack of randomized controlled studies limits the use of these potential additional therapies to patients unresponsive to conventional management. The value of unprocessed honey as a topical antimicrobial agent has been highlighted in the literature for small lesions in uncomplicated patients. Conclusion: Fournier’s gangrene is a urological emergency with a high mortality rate despite advances in the medical and surgical fields. The aggressive nature of the infection advocates the need for early recognition allowing immediate surgical intervention. The opposing results of available research as well as the lack of high quality evidence surrounding emergent therapies prevents their routine use in the management of Fournier’s gangrene. The absence of a specific care pathway may hinder efficient management of Fournier’s gangrene, thus based on current guidelines a management pathway is suggested.
TL;DR: Although mental distress and impaired quality of life related to illness could contribute to sexual dysfunction observed in patients with CP/CPPS, the presence of erectile and ejaculatory disorders is more frequently related to symptoms and imaging suggestive of a more severe inflammatory condition.
Abstract: Objective The aim of this study was to assess the prevalence of sexual dysfunction in men with chronic prostatitis/chronic pelvic pain syndrome. Materials and methods A group of 399 patients with symptoms suggesting prostatitis without urethral discharge attending an outpatient Prostatitis Clinic was considered. All were evaluated by the same urologist according to a protocol comprising medical history, physical and transrectal ultrasound examination. Patients had a urethral swab, a four-specimen study and culture of the seminal fluid. Patients were classified according to NIDDK/NIH on the basis of the results of the microbiologic and microscopic four-specimen study and of the culture of the seminal fluid. Subjective symptoms were scored by CPSI questionnaire and by non validated general assessment questions inquiring loss of libido, quality of erection, premature loss of erection, pain on ejaculation, hemo-spermia, pyo-spermia, premature ejaculation, and presence of semen abnormalities. Results Of all the patients evaluated, 138 (34%) had erectile and 220 ejaculatory dysfunctions (55%). Loss of libido, premature ejaculation and presence of semen abnormalities were more frequent in subjects younger than 50 years. Rates of impaired erection and of semen abnormalities were significantly higher in patients with bacterial chronic prostatitis with respect to patients with chronic pelvic pain syndrome. Premature ejaculation was more frequent (p = 0.02) in patients with 10-30 leukocytes (36%) or > 30 leukocytes (32%) in VB3 urine than in those with 10 or less leukocytes (22%). Painful ejaculation was significantly associated to the sonographic demonstration of enlargement (p = 0.000), asymmetry (p = 0.001) or inflammatory changes (p = 0.038) of the seminal vesicles, whereas hemo-spermia was significantly associated to asymmetry (p = 0.000) or inflammatory changes (p = 0.013, respectively) of the seminal vesicles. Men with erectile (p = 0.001) and ejaculation dysfunction (p = 0.001) had more severe CPSI scores than men without such complaints. The presence of erectile and ejaculation dysfunction was related to significantly higher scores for domains of pain and quality of life. Conclusions Although mental distress and impaired quality of life related to illness could contribute to sexual dysfunction observed in patients with CP/CPPS, the presence of erectile and ejaculatory disorders is more frequently related to symptoms and imaging suggestive of a more severe inflammatory condition.
TL;DR: The most recent literature has shown excellent results with fluoroquinolones both in prophylaxis and therapy, concerning post-operative infection control after percutaneous as well as ureteroscopic removal of stones.
Abstract: Urinary tract infections and urosepsis are complications which can precede or follow a kidney stone treatment. Often the stones themselves are the source of infection, whether they are infection stones or not. Systemic infections are difficult to foresee, and neither a pre-operative negative urine culture nor an antibiotic prophylaxis avoid infectious complications for certain. The primary predictive risk factors of urosepsis are: patient conditions, urinary tract infection or a history of recurrent infections, characteristics of the stone, and anatomy of the urinary tract. Infection stones are still a matter of debate, concerning both the aetiology of the disease and its treatment. Positive cultures are not only found with struvite stones, but also with apatite and calcium oxalate stones. Currently, a long-term antibiotic therapy is advised in patients affected by infection stones. Antibiotic therapy should prevent not only septic complications but also recurrence or re-growth of stones after treatment. Different antibiotic modalities are recommended, sometimes together with urease inhibitors. Mid-stream urine culture is the easiest available pre-treatment parameter notwithstanding its poor predictive value. In case of suspected or proven urinary infection, an appropriate antibiotic therapy should always be administered prior to surgical procedure. There is, however, controversy regarding the antibiotic use, its role, expediency, and duration of prophylaxis in relation to the various surgical procedures, and the way infectious complications are considered and classified. When antibiotic prophylaxis is considered, its duration should be clearly established prior to surgery; duration may vary depending on the type of surgery or the type of antibiotic. Furthermore, prophylaxis should be administered only for a limited amount of time. In infection stones, in immuno-compromised patients or in patients with anatomical anomalies or diabetes, the risk of post-treatment infection and sepsis is higher Hence there is agreement on the need for prophylaxis and antibiotic therapy The most recent literature has shown excellent results with fluoroquinolones both in prophylaxis and therapy, concerning post-operative infection control after percutaneous as well as ureteroscopic removal of stones. No agreement has yet been reached on antibiotic prophylaxis modalities prior to percutaneous or ureteroscopic removal and its usefulness for SWL.
TL;DR: Findings from the Prostate Cancer Prevention Trial (PCPT) concerning the operating characteristics of PSA for biopsy-detectable prostate cancer are explained, with special emphasis on a subpopulation of men with PSA less than 4 ng/ml, what is often regarded as the "normal" level of PSC in healthy men.
Abstract: In this article we explain findings from the Prostate Cancer Prevention Trial (PCPT) concerning the operating characteristics of PSA for biopsy-detectable prostate cancer, with special emphasis on a subpopulation of men with PSA less than 4 ng/ml, what is often regarded as the "normal" level of PSA in healthy men. The PCPT enrolled 18,882 healthy men 55 years of age or older, with a PSA value less than 3 ng/mL and a normal digital rectal exam (DRE); 9,459 of these men were randomized to the placebo arm and 9,423 to the finasteride arm In this report we summarize the operating characteristics of PSA only for the placebo arm of the PCPT; operating characteristics of PSA on the finasteride arm are more complicated to assess since finasteride approximately halves the PSA value and will be reported only briefly. In our first analysis, we focused on a group of 2,950 men on the placebo arm who had had an end-of-study biopsy and a normal DRE and PSA < 4 ng/mL for all 7 years of the study. For prostate cancer, the standard PSA cut-off of 4 ng/mL has low sensitivity: with this cut-off only 20.5% of the prostate cancer cases test positive-nearly 80% of prostate cancer cases are missed. The specificity at this cut-off is high (93.6%) meaning only 6.2% of men who do not have prostate cancer falsely test positive. Lowering the PSA threshold for screening increases detection of aggressive cancer at an earlier stage, but has the unavoidable tradeoff of increased detection of the biologically irrelevant cancers.
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