Asymptomatic bacteriuria in candidates for active treatment of renal stones: results from an international multicentric study on more than 2600 patients

The occurrence of asymptomatic bacteriuria concomitant to urolithiasis is an issue for patients undergoing renal stone treatment. Disposing of a preoperative urine culture is essential to reduce the risk of septic events. The endpoint of the study is to report which characteristics of candidates for renal stone treatment are frequently associated with positive urine culture. 2605 patients were retrospectively enrolled from 14 centers; inclusion criteria were age > 18 and presence of a single renal stone 1-2 cm in size. The variables collected included age, gender, previous renal surgery, comorbidities, skin-to-stone distance, stone size, location, density, presence of hydronephrosis. After a descriptive analysis, the association between continuous and categorical variables and the presence of positive urine culture was assessed using a logistic regression model. Overall, 240/2605 patients (9%) had preoperative bacteriuria. Positive urine culture was more frequent in females, patients with previous renal interventions, chronic kidney disease, congenital anomalies, larger stones, increased density. Multivariate analysis demonstrated that previous renal interventions (OR 2.6; 95% CI 1.9-3.4; p < 0.001), renal-related comorbidities (OR 1.31; 95% CI 1.19-1.4; p < 0.001), higher stone size (OR 1.06; 95% CI 1.02-1.1; p = 0.01) and density (OR 1.00; 95% CI 1.0-1.00; p = 0.02) were associated with bacteriuria; male gender and lower caliceal location were inversely related to it. Beyond expected risk factors, such as female gender, other parameters are seemingly favoring the presence of positive urine culture. The awareness of variables associated with bacteriuria allows to assess which individuals are at increased risk of presenting bacteriuria and reduce the rate of septic complications.

Modulatory effects of alpha-lipoic acid (ALA) administration on insulin sensitivity in obese PCOS patients

PURPOSE

To evaluate the efficacy of alpha-lipoic acid (ALA) administration on hormonal and metabolic parameters of obese PCOS patients.

METHODS

A group of 32 obese PCOS patients were selected after informed consent. 20 patients referred to have first grade relatives with diabetes type I or II. Hormonal and metabolic parameters as well as OGTT were evaluated before and after 12 weeks of ALA integrative administration (400 mg per os every day).

RESULTS

ALA administration significantly decreased insulin, glucose, BMI and HOMA index. Hyperinsulinemia and insulin response to OGTT decreased both as maximal response (Δmax) and as AUC. PCOS with diabetes relatives showed the decrease also of triglyceride and GOT. Interestingly in all PCOS no changes occurred on all hormonal parameters involved in reproduction such as LH, FSH, and androstenedione.

CONCLUSIONS

ALA integrative administration at a low dosage as 400 mg daily improved the metabolic impairment of all PCOS patients especially in those PCOS with familiar diabetes who have a higher grade of risk of NAFLD and predisposition to diabetes.

[The putative role and use of DHEA and its association with the hormone replacement therapy]

The putative role and use of dehydroepiandrosterone (DHEA) as replacement therapy for menopausal women has been under consideration during the latest years. DHEA is one of the main adrenal hormones that progressively reduces its plasmatic levels from the beginning of ageing. This phenomenon implies not only the reduction of the plasmatic androgens but also the decrease of a peculiar category of hormones, named neurosteroids, in particular one: allopregnanolone. This review aims to elucidate the peculiar aspects of DHEA administration and its putative use as substitutive/integrative hormonal treatment alone or in combination with the traditional hormone replacement therapy.

Evaluation of Psa Kinetic after Radical Prostatectomy

The aim of our study is evaluate PSA kinetics after radical prostatectomy for localized prostate cancer.

Materials and Methods

We evaluated PSA kinetic in 101 patients who underwent radical prostatectomy for localized prostate cancer. Only patients in whom one or more measurable PSA values available postoperatively (from day 2 to day 10) were included in our study group. We calculated the PSA half-life after radical prostatectomy.

Results

The median PSA half-life after radical prostatectomy was 2.2 days (range 0.97 to 6.73 days). We found a statistical difference in PSA half-life between patients with and without positive surgical margins; the group with positive surgical margins showed a slower reduction of PSA than the other, probably due the presence of residual cancer tumor. Conclusions. PSA half-life differs during the beta-phase after radical prostatectomy, it is longer in patients with positive surgical margins than those with negative surgical margins. This difference is probably due to the presence of residual prostate cancer after surgery.

Use of mechanical devices for the intermaxillary registration in edentulous patients treated with implants

This article describes the use of three devices that replace the wax rims in the registration of the intermaxillary position and of the vertical dimension of occlusion in completely edentulous patients who have been treated with Brånemark implants. The devices consist of a mechanical "tooth" that can be adjusted in all three dimensions of space and of two plates that support the registration material. The mechanical tooth is connected to an abutment in the anterior region and a contact is established with a tooth in the opposite jaw at the vertical dimension in which the patient will be restored. This allows the operator to position the mandible in the centric relation in a condition of neuromuscular deprogramming and in the absence of posterior interferences. The two metal plates are then fixed to the posterior abutments, one on each side, and support the wax and zinc oxide eugenol paste used to register the intermaxillary position just established.

Trattamento chirurgico nell'impotenza vasculogenica da fuga venosa: Esperienza e risultati

Venous leakage is one of the most important causes of erectile dysfunction. The ligation and resection of the deep dorsal vein of the penis and all anastomoses from this vein allow considerable improvement in the rigidity of the penis and erection.

Incidental renal masses: Therapeutic management

Evaluation and treatment of incidental renal masses is a problem facing urologists with increasing frequency since radiologic imaging (Echotomography and CT) has become routine. Traditional treatment by total nephrectomy may be unnecessary for small renal cell carcinoma and is often inappropriate for benign, lesions: whereas only observation by periodic follow-up with imaging studies and/or percutaneous biopsy is not always sufficient. So the problem of management alternatives is very important and no universal strategy can be employed. We report our experience with 15 pts with incidental renal mass treated in different ways.

Epidemiological study of urinary tract stones in a Northern Italian city

An epidemiological study about stone disease was carried out by mailing a postal questionnaire to 6000 persons; it concerned a sample of the population of the USL n. 5 (Fidenza - PR). This population sample was divided into two groups: those who live on the hills and those who live on the plain. No differences of any kind were found between the two groups. It came out that the incidence of stone disease in the general population is 8%. There was a relationship between stone disease and hypertension and other renal diseases. Stone-formers showed no alimentary difference from non-stone formers. Stone-formers drank more still mineral water than non-stone formers, but only 37% of them drank at least 2 litres a day.

Mass screening for prostatic carcinoma and therapeutic options

In western countries, prostatic carcinoma is the most frequent neoplasia in the male sex after pulmonary neoplasia. Its early diagnosis is very important. The authors report the results of a screening for prostatic carcinoma effected in some municipalities of the district of Parma (Italy); 28 prostatic carcinomas were diagnosed (1.2% of the examined patients). Twelve patients were submitted to radical nerve-sparing prostatectomy according to Walsh. In all of them, PSA values decreased to values < 1 ngr/ml, confirming the radicality of the operation and few complications occurred. The conclusion of the authors is that nowadays timely radical prostatectomy is the only “definitive” treatment of prostatic carcinoma, allowing a better quality of life, however long it is.