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Introduction and Objectives. Prostate cancer is the 2nd most common cancer in men worldwide. Latest prostate cancer data also shows that this pathology is the 4th most common cancer overall. There were more than 1.4 million new cases of prostate cancer in 2020. Guadeloupe had the highest incidence for prostate cancer in 2020, with 722 new cases, 183.6/100000 inhabitants. In Europe, Ireland, Estonia, Sweden and France are the countries with the highest incidence rate for prostate cancer. Materials and Methods. We present the case of a 65 years old patient, which was diagnosed in July 2020 with a high risk prostate cancer. Firstly, he was referred to a Urology Clinic for a clinical examination and possibly to have a diagnosis formulated after an elevated prostate specific antigen (PSA) was observed in another medical setting. After a more precise measurement, the PSA was surprisingly high, a finding that was the trigger for a multidisciplinary approach, using the latest information and treatments described in important clinical trials. Results. The evolution of the patient during the 32 months long surveillance period varied, as the PSA level fell and rose, prompting many changes in the treatment of the prostate cancer. Various clinical trials were reviewed in order to present the rationale for treatment changes occurring at certain moments. Conclusions. Even though the metastatic high risk prostate cancer proves to be very difficult to treat, and the patients are still suffering from this pathology, the progress made in the last decade seem to improve the chances for a longer survival and a better quality of life. [ABSTRACT FROM AUTHOR]

Post prostatectomy urinary incontinence is a bothersome condition, marked by severe leakage in most cases, with poor response to most treatments. Our paper aims to review the history, current indications and future perspectives of the artificial urinary sphincter (AUS), a device which imposed itself as the gold standard therapy for post prostatectomy urinary incontinence. We describe the AMS 800, the Rigicon ContiClassic and the newer Rigicon ContiReflex devices, with data from the international literature and practice guidelines, underlining pros and cons of each sphincter. Our paper concludes that there is a significant improvement in the field of AUS and that future projects are promising in terms of better efficacy and safety. [ABSTRACT FROM AUTHOR]

Introduction and Objectives. Lichen sclerosus is a chronic inflammatory condition that usually affects the genital and anal areas. It causes irritation, skin changes, itching, and pain, often the foreskin gets tighter and more difficult to retract, leading to painful erections and bleeding during intercourse. The etiology is still unknown, is not caused by an infection, and cannot be passed to a sexual partner. Materials and Methods. During the period January 1st, 2016-to January 1st, 2017 we selected 137 patients with the diagnosis of urethral stricture disease and were candidates for urethroplasty. Patients were followed rigorously for 2 years after the surgery with uroflowmetry, measurement of post-void residual urine volume, IPSS, and IPSS QoL. For stricture recurrence confirmation the patients underwent retrograde urethrography. Other data used were weight, height, body mass index and established etiology of the urethral stricture, and age of patients at enrolment. Results. Only 18 patients had definitive criteria for clinical diagnosis of LS, and out of these, 17 were circumcised. The relationship between BMI and LS was not statistically sustainable in our study results. Studies suggest that the lichen sclerosus has a more severe evolution in older patients, and we managed to demonstrate a statistically significant relationship between the age of the patient and the LS. Conclusions. The treatment of urethral strictures in patients with confirmed lichen sclerosus is two-stage buccal mucosa graft urethroplasty. Urethral stricture disease in combination with LS appears to be a much more common and challenging disease and requires particular care. [ABSTRACT FROM AUTHOR]

Introduction and Objectives. Benign prostatic hyperplasia (BPH) is one of the main causes of low urinary tract symptoms (LUTS) and the surgical standard of treatment for of symptomatic BPH up to 80 mL is the trans- urethral resection (TUR-P). One of the non-ablative techniques is the second-generation Temporary Implantable Nitinol Device (ITIND), a safe technology with promising results that does not seem to affect the patient's sexual or ejaculatory functions and treats effectively the BPH-related LUTS in the short and medium terms, further studies being required to confirm the results. The aim of this work is to describe its characteristics, the surgical technique and to provide a systematic review of the available literature. Materials and Methods. The PubMed, SCOPUS and Google Scholar databases were utilized for a comprehensive literature research of original English-language articles on the subject, focusing on the functional results and perioperative morbidity. Results. The few prospective available studies from the published literature reveal promising short-term results at 6 and 12 months, regarding symptom control, maximum urinary flow, sexual and ejaculatory function and complication rates. Conclusions. The iTIND procedure seems to be a safe, minimally invasive alternative to the usual techniques proposed for the surgical treatment of the clinical BPH but it is still under evaluation. Further randomized controlled studies are required to assess the selection criteria and the utility of this procedure over a longer period of time also compared to the available techniques. [ABSTRACT FROM AUTHOR]

Introduction and Objectives. Flexible ureterorenoscopy (f-URS) gained a lot of field in treating reno-ureteral lithiasis, with a clear indication for kidney stones smaller than 20 mm with an acceptable stone free rate (SFR) compared to its complications, but also with a specific learning curve. The goal of this study is to investigate the learning curve in f-URS and its impact on success and complication rates. Materials and Methods. 60 patients from a tertiary care urology clinic who underwent f-URS were enrolled in this prospective study and divided into two study groups of 30 patients each based on the period of time the surgery was performed. Patients' and lithiasis characteristics, f-URS-related parameters, hospital stay time, SFR and complications were gathered into a database for comparison and statistical assessment of the differences. Results. The two study groups were comparable, regarding the age, sex, BMI, stone location, stone density and stone sizes. Time passed till the introduction of the flexible ureteroscope was 18.5 minutes in group 1 versus 12.4 minutes in group 2 (p = 0.001). The fluoroscopy time was shorter in group 2 40.8 versus 83 seconds (p = 0.001). The operative time decreased significantly from 49.2 minutes to 32 minutes in the second group (p = 0.001). Complication rate and hospital stay showed no major difference between the two patient groups, but the SFR was significantly improved in the latest study group-86.66% versus 66%. Conclusions. Flexible ureteroscopy is a minimally invasive surgical intervention that requires experience and surgical skills gained after overpassing a specific learning curve. Our study shows that a good level of proficiency might be obtained after the completion of at least 30 cases in terms of operative time, fluoroscopy time, complication, and stone free rates. Further standardized prospective trials ought to be conducted to better characterize assess the precise learning curve. [ABSTRACT FROM AUTHOR]

Introduction and Objectives. When it comes to the best treatment option for small (<10 mm) and intermediate (10- 20 mm) kidney stones, the EAU offers the possibility to choose between ESWL and f-URS. Given the fact that the management of kidney stones smaller than 2 cm in diameter is still controversial, we aimed to retrospectively compare the efficacy of these two techniques in our clinical department. Materials and Methods. A retrospective evaluation between January and December 2022 was conducted at our clinic including 231 patients with a single renal opaque stone ≤2 cm who underwent ESWL or f-URS. In order to assess the efficacy of each treatment, we set the stone-free rate as our main objective and complications, operating time and hospital stay as our secondary outcomes. As a way to a more precise comparison, we divided the patients in two subgroups regarding the stone size: One subgroup with small renal stone (<10 mm) and one with intermediate renal stone (10-20 mm). Results. Overall, a better stone free rate was found in f-URS group (f-URS 87.5% vs. 70.58% ESWL), although both the operative (63.2 min vs. 44.5 min) and hospitalization (3.65 days vs. 1.43 days) time were longer for f-URS than ESWL. Regarding small sized stones (Subgroup 1), the stone-free rate was similar between each procedure (ESWL 87.5% vs. 94.2% f-URS). When it comes to intermediate sized stones (Subgroup 2), more f-URS patients achieved a stone-free status (81.6% vs. 44.6%). In both subgroups, the ESWL procedure achieved a better operative time, as well as a shorter hospital stay. Less complications were encountered when ESWL was the treatment option. Conclusions. We advocate for using ESWL as primary treatment option for kidney stones smaller than 10 mm and to strongly consider it regarding intermediate renal stones. [ABSTRACT FROM AUTHOR]

Introduction and Objectives. The most common cause for Congenital adrenal hyperplasia (CAH) is due to 21- hydroxylase deficiency which can produce disorders of sex development. 46,XX maleness is a rare syndrome with an incidence of 1 in 20000-25000 males, and they are defined by ambiguous genitalia or partially to fully mature male genitalia. Materials and Methods. We present the case of a 49-year-old patient (46,XX) with CAH resulting from 21-hydroxylase deficiency, diagnosed with penoscrotal hypospadias at the age of 3 and a half years for whom multiple corrective surgeries were performed and was referred to our hospital for evaluation of urethrocutaneous fistulas. Results. In 2021, the patient was diagnosed by the endocrinology department with 46,XX Karyotype, male phenotype and congenital adrenal hyperplasia due to 21 hydroxylase deficiency. The urological diagnosis established at "Prof. Dr. Theodor Burghele" Clinical Hospital was of multiple urethrocutaneous fistulas that occurred after penoscrotal hypospadias repair in childhood. The surgical indication consisted of urethroplasty with oral mucosa graft in two steps, the time between interventions being about four months. The surgical evolution was good, without complications. Complications after multiple times operated hypospadias are redoubtable, including strictures of the anterior urethra, urethral fistulas, urethritis, and recurrent urinary tract infections. The treatment of such cases is particularly difficult. Conclusions. The use of extragenital tissues for urethral reconstruction (oral mucosa graft) provides superior functional and aesthetic results compared to the techniques using skin flaps. [ABSTRACT FROM AUTHOR]

Introduction and objectives: The staging system of prostate adenocarcinoma, represented by the sum of the two most frequent tumoral patterns and developed by Gleason, is extremely valuable from a prognostic point of view. The purpose of this paper is to establish the concordance between the Gleason Score (GS) obtained from needle biopsy specimens of prostatic tissue compared to the Gleason Score on the following radical prostatectomy. Materials and methods: Data from 123 patients diagnosed with prostate adenocarcinoma after prostatic needle biopsy (PNB), who subsequently underwent radical prostatectomy was analyzed. Patients whose diagnosis was established by a different urological service and those whose diagnosis was established by immunohistochemistry were excluded from the study. The concordance degree was calculated by determining the correlation coefficient. Results: The highest concordance between needle biopsy and radical prostatectomy samples was found in the case of Gleason Score 7, where the results were similar for 59 patients (80.8%). The understaging tendency was observed for reduced tumoral grading (Gleason 6), while the high-grade tumors (Gleason 8-9) were constantly overstaged. The Pearson's R correlation coefficient was also calculated at a value of 0.285, which was statistically significant (P< 0.001), corresponding to a low level of correlation above chance and the direct relative correlation. Conclusion: There is an obvious tendency of understaging using needle biopsy in the case of reduced Gleason Scores and a tendency of overstaging in the case of increased values, which should be taken into consideration by the urologist when the "active surveillance" protocol is decided or when the adjuvant therapy initiation and the surgical therapeutic window loss are decided. [ABSTRACT FROM AUTHOR]

Introduction and Objectives. Results after external beam radiotherapy have significantly improved through dose escalation and the use of androgen deprivation therapy (ADT). The purpose of this study was to assess the long-term urinary, bowel, and sexual functions after image guided radiotherapy (IGRT). Materials and Methods. Our study group included 85 men with localized prostate cancer (clinical classification T1-3 N0 (pN0) M0) treated with external beam radiotherapy guided on intraprostatic fiducial gold markers, between 2012 and 2017. The radiation dose ranged from 74 to 78 Gy (mean dose of 77,9 Gy); 72 men had received ADT for 6 to 36 months. Functional status was assessed at baseline every three months in the first year, and every six months from two to five years. Results. After five years of follow up, 83% of patients presented with no symptoms of late rectal toxicity. Grade 2 gastrointesitanl (GI) toxicity was present in 12 patients (14,11%). Grade 3 proctitis was reported for two patients (2.4%). Comparing the urinary status before radiotherapy and two and five years after completing radiotherapy, 68%, respectively 61% of patients reported improvement of symptoms. One patient developed urethral stricture seven months after completion of radiotherapy. Erectile function defined as the ability to achieve an erection adequate for intromission was present in 62 patients (73%) before treatment. Out of these, 33 (53%) presented with erectile dysfunction 4 years after the treatment. There were no Grade 4 or fatal toxicity encountered. Conclusion. In the modern era, treatment consisting of high-dose radiotherapy delivered with advanced radiotherapy techniques (intensity-modulated radiation therapy and image-guided radiation therapy) which significantly improve tumor control, can contribute to reduction of late toxicity. [ABSTRACT FROM AUTHOR]

Introduction and objectives. Renal cell carcinoma (RCC) is one of the most important urological pathologies, being correlated with high morbidity, poor prognosis and outcome. Kidney tumors can be heterogeneous comprehending several histological types. Diagnosis of RCC usually results in most cases from incidental findings, although in some cases, due to paraneoplastic syndromes, patients present with symptoms caused by hormones or cytokines excreted by the tumor cells or by a systemic immune response against the tumor. The treatment of choice for RCC is mainly surgical, involving partial or radical nephrectomy, either open or laparoscopic, while the oncological results depend on a series of prognostic factors among which the tumor pathological stage, the presence of lymphovascular or perineural invasion, presence of tumor necrosis or sarcomatoid and rhabdoid changes. The objective of our study was to try and determine correlations between the clinical and the histopathological aspects of renal cell carcinoma patients that might be used as prognostic factors for the evolution of the disease. Materials and Methods. We conducted a retrospective study involving 50 patients treated for renal cell carcinoma, who underwent radical or partial nephrectomy in 2019 in a urology tertiary care center. The demographic data, clinical and histopathological data were gathered into a database for the study group. Our goal was to determine key prognostic factors that could be related to the oncological outcomes and the surgical results for patients with renal cell carcinoma who underwent curative intent treatment. Results. The mean patient's age was 65 years, ranging from 46 to 81 years. In the study groups, there were 32 laparoscopic nephrectomies and 18 through an open approach. In most of the cases the tumor size varied between 4 and 7 cm. In terms of pathological prognosis factors, tumor necrosis was found in 21 cases, 14 of them had Fuhrman grade 3 and 5 cases presented with Fuhrman grade 4. Only 2 cases found to have low Fuhrman grade (2) associated with tumoral necrosis. Patients with larger tumors tended to present with a higher Fuhrman grade. Fatty tissue involvement was found in 15 cases, from which 12 presented with Fuhrman grade 3 and 3 cases with grade 4. Capsular invasion was found in 9 cases and 7 cases had positive lymph nodes. Only one case presented sarcomatoid changes. In terms of intraoperative surgical decision making out of 24 cases of tumors measuring 7 cm or less, 15 of them had the tumor situated at one of the poles, 12 of them without touching the renal collecting system feasible for partial nephrectomy. Due to intraoperative complications and aspects, regarding the surgical dissection and the increased bleeding, in seven of these cases, the surgeon's decision was towards radical nephrectomy. Out of these seven cases the histopathological report following radical nephrectomy revealed a Fuhrman grade 3, with five tumors with a diameter of less than 5.5 cm and two cases with tumor dimensions below 4 cm, all situated at one of the poles. Conclusion. Patients with larger tumors presented with higher Fuhrman grades and more tumor necrosis, most of them invading the collecting system (p<0,05). Small tumors, less than 4 cm, were more likely to be feasible for nephron sparing surgery. Although 15 cases in our study were suitable for partial nephrectomy, in 7 cases the decision of radical nephrectomy was made intra-operatively and found to have Fuhrman grade 3 and tumor necrosis, in three cases the renal collective system was involved. Modern approach regarding surgical treatment of RCC depends on the tumor location, size, the relationship with urinary tract, blood vessels and the surrounding organs. Although novel oncologic markers emerge every year and become available for RCC patients, the use of predictive biomarkers for clinical stratification and management still awaits validation studies. [ABSTRACT FROM AUTHOR]

Introduction and Objectives. The aim of the study was to evaluate the way the PSA decrease and PSA nadir influence the biochemical recurrence (BR) in localized prostate cancer patients treated with IGRT-VMAT. Materials and Methods. Between 2012 and 2017, 252 patients with clinically localized adenocarcinoma of the prostate, staged as T1-3bN0M0 according to the American Joint Committee on Cancer 2002, received image guided radiotherapy with volumetric modulated intensity (IGRT-VMAT) up to a total dose of 78Gy with or without short course androgen deprivation therapy (SC-ADT) or long term androgen deprivation therapy (LT-ADT); (IGRT-VMAT; n=58, IGRT- VMAT + SCADT; n=73, IGRT-VMAT + LTADT; n=121). Results. For the 252 analysed patients, we measured prostate specific antigen (PSA) nadir levels between lower than 0.001 and 12.6ng/ml. Estimated 5-years biochemical relapse-free survival (BRS) for 218 patients with PSA nadir lower than 0.5ng/ml was 85% (n=186) vs. 59% (n=20) for 34 patients with PSA nadir higher than 0.5ng/ml. Forty seven patients presented with at least one PSA rise of =0.2 ng/ml followed by spontaneous return to pre-bounce level or lower. Biochemical recurrence rate (BRR) was 4.2% (n=2) for patients with PSA bounce compared to 19.5% (n=40) for patients without PSA bounce. Conclusion. In our analysis, we found strong correlations between BRS and level of PSA nadir (patients with PSA nadir lower than 0.5 ng/ml had a higher BRS compared to patients in whom this value was not reached) and PSA bounce BRR 4.2%; n=2 for patients with PSA bounce compared to 19.5%; n=40 for patients without PSA bounce. There was no correlation between PSA bounce and the level of nadir reached or the time to nadir. [ABSTRACT FROM AUTHOR]

Introduction and Objectives. Percutaneous nephrolithotomy (PCNL) successfully replaced open surgery more than 30 years ago, and it still represents the gold standard in the treatment of large renal stones. Although nowadays, with advancing technology improving many technical aspects, it is considered a safe procedure with a low complication rate, close postoperative management is mandatory. Colon perforation is a rare but severe complication that can occur in specific cases. Materials and Methods. We analyzed 1146 cases, from June 2015 to May 2017, admitted in "Prof. Dr. Th. Burghele" Clinical Hospital based on medical records identified when searching procedure code. Data referring to risk factors such as age, sex, stone location and type, associated diseases, previous surgical history, and also intra and postoperative details were carefully analysed. All of the cases were primarily assessed with complete blood and urine tests. When diagnosed, urinary tract infections were treated with specific antibiotic agents. All available imagistic details were studied before and after the PCNL session for selected cases. Results. 7 cases met our criteria and were diagnosed with colonic injury after PCNL. All suspected cases were assessed imagistically with an abdominal CT scan and managed conservatively as the first intention. Sex distribution revealed five males and two females with a mean age of 52.3 years old. Colonic injuries were diagnosed intra or postoperatively and were most prevalent on the left side. Accessing the pylocaliceal system was performed by puncturing the lower calyx in 6 cases and the middle calyx for technical reasons in one case. When referring to risk factors, a retrorenal colon was diagnosed in two cases. In one case with previous open renal surgery, the right colon was injured. It was only one case of intraperitoneal lesion in which surgical management with temporary colostomy for three months was preferred. Conclusions. Colon perforation is a rare complication related to PCNL with management key being based on early diagnosis. According to other studies, our results reveal that extraperitoneal colon perforations can be successfully managed conservatively, but surgery with a temporary colostomy is the election treatment for intraperitoneal lesions. [ABSTRACT FROM AUTHOR]

Introduction. Urethral strictures in adults male are defined as a reduction of the urethral caliber due to scar formation Treatment modalities of urethral strictures are dilation, direct vision internal urethrotomy and urethral reconstructive surgery. Endoscopic treatment options, such as direct vision internal urethrotomy and dilations, are associated with high recurrence rates and low long-term results, especially for strictures exceeding 1 cm in length. Patients who undergo buccal mucosa graft urethroplasty (BMGU) have a stricture recurrence rate of about 15%, whereas recurrence rates following direct vision internal urethrotomy(DVIU) ranges between 27 to 92%. Regarding the fact that up to 50% of stricture recurrences presents anastomotic fibrous rings of short length, or veil-like short strictures, that form distal and/or proximal to the urethroplasty zone, we hypothesize that DVIU might be a treatment option for short recurrent strictures after bulbar urethroplasty in adults. Materials and methods. In our center, we perform about 100 urethroplasties surgery's per year from a single surgical team. Approximately 75% of these operations are represented by buccal mucosa graft urethroplasties. Preferred techniques are ventral graft onlay and ventral and dorsal graft onlay for bulbar urethral strictures, and two stage buccal mucosa graft procedure or dorsal inlay graft procedure for penile urethra. In case of stricture recurrence after buccal mucosa graft for bulbar urethroplasty, we propose a direct vision internal urethrotomy, that is done in standard manner, with a cold knife incision at 12 o'clock position, as described by Sachse in 1972. Postoperatively, patients receive a urethrovesical catheter for approximately 24 hours. We retrospectively identified 15 patients that had a bulbar urethroplasty and presented in our service due to an unsatisfactory result. We performed uroflowmetry, retrograde and voiding cystourethrography, followed up by endoscopic confirmation of stricture presents. In patients with veil-like urethral strictures(<1cm), either at the distal or the proximal end of the augmented urethra, we performed direct vision internal urethrotomy(DVIU). After endoscopic management of these patients, a prospective follow-up was performed with regular visits to the clinic for uroflowmetry and postvoid residual volume measurement and IPSS QoL questionnaire. We registered variables such as age at urethroplasty, age at DVIU, time until last follow-up, Qmax values, postvoid residual urine volume, primary stricture etiology and type of surgical procedure. Results. The mean age of our 15 patients at the moment of urethroplasty was 54,86±17,19 years and stricture etiology was identified in 8 patients as iatrogenic after multiple endoscopic surgeries, 2 cases of posttraumatic urethral strictures and 5 cases with no identifiable etiology. Mean length of urethral stricture prior to urethroplasty was of 3,17 centimeters. 15 cases underwent two types of surgical procedures, ventral graft urethral onlay in 13 cases(86,7%), and 2 patients (13,3%) with excision and primary end-to-end anastomosis. Time elapsed from bulbar or membranous urethroplasty until patient reported unsatisfactory result and DVIU management of these veil-like strictures was 34,13 ± 20.08 months, with a minimum of 11 months and a maximum of 72 months. Median time failure of urethroplasty was 29 months. Mandatory follow up was done at 3 months, 6 months, 12 months respectively after DVIU. The parameters assessed were of patients satisfaction using the IPSS QoL question 8, to which 8(53,3%) patients selected score 1(pleased) and 7(46,6%) patients selected score 0(delighted). At every mandatory follow up visit uroflowmetry study was done to see the maximum flow(Qmax), and also, transabdominal ultrasound to measure post void urine volume. Qmax at 3 months after DVIU had a mean value of 18,74 ± 2,24 ml/s with a mean post void residual urine volume of 34,24 ml. At the 6 months follow up visit the study population had a mean maximum flow of 19,37 ± 1,88 ml/s and a mean post void urine volume of 28,22 ml. Last scheduled follow up visit was at 12 months after DVIU procedure, the values we found in terms of mean maximum flow of 17,99 ± 1,41 ml/s and a mean post void urine volume of 24,55 ml. Descriptive statistics that include median values, minimum and maximum values, interquartile ranges. Conclusion. Stricture recurrence after urethroplasty using buccal mucosa graft is approximately 10 to 15%, without regard for accurate technique and substitution material. Taking into consideration the fact that approximately half of these recurrences are short fibrous rings, or what is termed "veil-like" strictures, with a length of less then on centimeter that are mostly found at the distal and/or proximal ends of the reconstructed urethra. In this clinical scenario offering direct vision internal urethrotomy to this selected group of patients might have long-term success. However, literature on this subject is scarce with only one other study being published by Rosenbaum et al. In their study they included all patients with stricture recurrence after buccal mucosa graft urethroplasty in the penile, bulbar and membranous urethra. In our series, the 15 patients we prospectively followed up are carefully selected patients that meet criteria such as very short, less then 1 cm, bulbar urethra or membranous urethra due to the fact that the theoretical healing potential of these urethral segments are more significant than that of the penile urethra. We had 15 patients that after bulbar urethroplasty, were followed-up to 1 year after undergoing DVIU. Mean maximum flow at three, six and twelve months, respectively are as reported in table 2. The goal of this study is to change a clinical paradigm in which all failed urethroplasty surgeries are automatically treated by performing a redo-urethroplasty. Although this is a very short series of patients and the prospective follow up is limited to only 12 months, the results show that its worth to perform a direct vision internal urethrotomy procedure in selected cases that present with these so called veil-like strictures, even more so if we consider the objective difference of cost and risk between direct vision internal urethrotomy and urethroplasty. Direct vision internal urethrotomy is less traumatizing for the patient, presents less perioperative risk and lower hospital admission requirement. In conclusion, it is the authors belief that in these, carefully selected cases, performing direct vision internal urethrotomy to correct a minor, veil-like stricture after bulbo- membranous urethroplasty should be the primary step in surgically managing these patients. [ABSTRACT FROM AUTHOR]

Introduction and Objectives. Lithiasis is a name given to the pathology that brings together under its umbrella the bioumoral and local factors that lead to the appearance of urinary lithiasis. Regarding the applications of genetics in the field of nephrolithiasis, we can say that things have been set in motion a great deal after the introduction of the GWAS (genome-wide association studies). Material and methods. This study consists of 1988 hospital patients; 127 unrelated, confirmed nephrolithiasis cases, and 1861 controls, consisting of patients admitted for urological and surgical conditions other than nephrolithiasis. DNA was extracted from whole blood at deCODE Genetics (Reykjavik, Iceland) and genotyped using Infinium Omni- Express-24 bead chips. An association test was performed between the 8.5 million markers and a phenotype represented by the confirmed nephrolithiasis diagnostic. Results. To search for new susceptibility loci associated with nephrolithiasis, we tested a total of 8.5 million genetic variants in a Romanian cohort. No variants tested in the Romanian GWAS reached genome-wide significance (P-value lower than 5 × 10-8), while 14 markers showed association P-values <1 × 10-6. Conclusions. Despite the lack of replication, we strongly consider our results an important stepping-stone for the future development of genetic screening of renal lithiasis in the Romanian population. [ABSTRACT FROM AUTHOR]

Introduction and Objectives. Multidrug resistant bacteria are a threat to healthcare both because of increased morbidity and mortality. Local epidemiology is important because it may guide interventions aimed at reducing the frequency of such infections. Materials and Methods. A prospective study was done over the course of one month, evaluating all strains isolated that had a decreased susceptibility to at least one carbapenem. Strains were evaluated for the presence of a carbapenemase through the rapid Carbapenem Inactivation Method (rCIM). Strains that tested positive and controls were then evaluated through a broad spectrum commercial PCR system. In the time period 50 Gram negative bacilli were isolated. After MALDI-TOF-MS identification, the 10 strains tested rCIM positive - showing the presence of a carbapenemase. Molecular characterisation showed the presence of blaNDM in 5 isolates, blaOXA-48-like in 2 isolates and blaOXA-24 in 1 isolate. One isolate did not yield a readable result. Results and Concluions. Thus, we show that blaNDM is the dominant gene present in this pilot study. These preliminary results, which require confirmation through a larger study, shows that different medical institutions may have different genetic subtrates for carbapenem resistance, which may be due to an outbreak or the evolving landscape of resistance. [ABSTRACT FROM AUTHOR]

Introduction and Objectives. Prostate cancer shows evidence for genetic predisposition, more than 70 prostate cancer (PCa) susceptibility loci have been found, explaining 30% of the familial risk for this disease. Each locus can have a different number of single nucleotide polymorphism. In the 70 PCa susceptibility loci, more than 100 prostate cancer (PCa) risk-associated single nucleotide polymorphisms (SNPs) have been identified by genome wide association studies (GWAS). Materials and Methods. The study consisted of 1064 hospital patients genotyped, 166 unrelated PCa cases histopathologically confirmed, with abnormal PSA levels and age of onset lower than 60 years, and 1104 controls consisting of patients admitted for urological and surgical conditions, excluding cancer. Results. The top two results were for uncommon variants (minor allele frequency estimated to be 2% in case sample and 9% in control sample) from chromosomes 22 and 12 SNP, RS9621053 and RS11059458. We believe the result for this SNP should be considered with caution. One other novel variant (RS42929) also reached genome-wide significance. We found significant evidence (p < 0.05) supporting the association between early onset prostate cancer and 13 of 14 SNPs studied, with the same direction of effects as in previous reports. We showed that the frequency of risk alleles, for both individual SNPs and in aggregate across SNPs, is significantly greater in EO PCa cases than in CGEMs cases that were diagnosed at > 55 years. Conclusions. In summary, our results provide strong evidence that SNPs associated with overall PCa are also likely to be associated with EO PCa and that studies focused on EO PCa could be a particularly powerful resource for future association studies focusing on PCa. [ABSTRACT FROM AUTHOR]

Introduction and Objectives. A wide range of lower urinary tract dysfunctions from detrusor hipo- or acontractility to overactive detrusor can be comprised under the term "neurogenic bladder". The first-line treatment for the neurogenic detrusor overactivity is represented by the anticholinergic medication, but there is a percentage of patients who do not respond to this type of therapy and for this category of subjects, the treatment of choice, as stated by the European Association of Urology Guidelines [1], is the intravesical administration of Botulinum Toxin A. There are various types of botulinum toxin A available on the pharmaceutical market, but only onabotulinumtoxin A is approved for treating NDO [2]. The aim of this study was to compare the efficacy of onabotulinumtoxin A to abobotulinumtoxin A in the management of NDO. Materials and Methods. A single center prospective study that included 47 patients was conducted between 2014 and 2017. The patients presented with NDO secondary to a neurological documented disorder and they were divided into two groups of 26 and 21 patients, respectively. The first group of patients received 200U of onabotulinumtoxin A and the second group 750U of abobotulinumtoxin A. Both substances were reconstituted in 30 ml of sterile saline and they were administered by intradetrusor injections. The urodynamic, clinical parameters as well as the safety profile were assessed. Results. The reflex volume (RV), maximum cystometric capacity (MCC), maximum detrusor pressure during the first involuntary contraction (Pdet max), bladder compliance, vesical residue and the incontinence episodes were assessed at baseline and 12 weeks after the procedure. The collected data showed a notable improvement in both urodynamic and clinical parameters, with no statistical significant difference between the two types of toxins. Conclusions. The 200U dosage of onabotulinumtoxin A proved to have similar efficacy with the 750U dose of abobotulinumtoxin A for the treatment of NDO refractory to anticholinergic medication in the present study. [ABSTRACT FROM AUTHOR]

Introduction and Objectives. Hypospadias is one of the most common penile anomalies in the pediatric population. The repair of hypospadias should be performed in childhood, however there is no consensus regarding the best surgical technique. Postoperative complications can include stricture, wound dehiscence, persistent chordee and fistula, meatal stenosis, lower urinary tract symptoms, urethral diverticulum and urinary tract infections. Every case of urethral complication should be thoroughly investigated prior to surgery in order to identify possible causes of recurrence. The aim of this study is to show our initial experience in using cystoscopy for complicated cases of hypospadias. Materials and Methods. We reviewed the records of all the patients with hypospadias treated in our hospital between 2010 and 2018. 16 patients were referred with lower urinary tract dysfunctions such as: urinary tract infections (UTI), difficulties in passing urine, nocturnal enuresis and recurrent orchiepididymitis. All 16 patients presented with post-operative complications which required re-do surgery: 5 patients presented with glans dehiscence, 4 with fistulas and 7 patients presented with urethral stenosis. These patients underwent exploratory cystoscopy in order to establish the existence of possible causes for recurrence. Results. The chief complaint in this case series was the difficulty in passing urine, with 13 out of 16 patients having been referred to our service for this reason. Out of the five patients with normal cystoscopy, three had previous surgery for urethral fistula repair, while in two cases the cosmetic postoperative results were unfavorable and required further surgery. In 11 cases exploratory cystoscopy showed urethral anomalies. Three patients had a urethral diverticulum, one patient had a meatal stenosis and seven patients presented with urethral stenosis. All the patients who presented with urethral stenosis presented with difficulties in passing urine. In one case the stenosis was due to a urethral polyp which was excised. In four patients with urethral stenosis we performed laser ablation during exploratory cystoscopy and in the rest of the cases with stenosis we performed urethral dilatation. One patient required re-do SLAM procedure. In two of the cases with urethral stenosis we also encountered “golf-hole” ureteral orifice with low-grade hydro distention. All patients with urethral diverticulum underwent surgical repair; they all presented with difficulties in passing urine and one patient also presented with recurrent urinary tract infections. The patient with meatal stenosis presented with difficulties in passing urine and subsequently underwent a redo glansplasty. Endoscopic treatment offers almost no cure for hypospadias patients. Voiding difficulties observed by parents or a meatal stenosis observed by the surgeon can indicate the need for an endoscopic procedure. Urinary tract infections have a low incidence rate in patients with hypospadias repair, but there is a paucity of data in the literature. UTI rates in patients with hypospadias vary from 1.91% to 20-38%. Stones that grow gradually around the hair, are firmly embedded with them and are often asymptomatic. The treatment of urethral stones depends on the shape, location, and mobility of the stones. Long term complications of hypospadias repair may include difficulties in voiding, sexual dysfunction, psychosexual adjustment and self-appraisal. These difficulties can usually worsen when the patient goes into adulthood. Conclusions. Using cystoscopy in complicated cases of hypospadias with symptomatic patients can be beneficial in order to establish the existence of possible causes for recurrence. However, further studies need to be conducted on larger groups. [ABSTRACT FROM AUTHOR]

Introduction and Objectives. Vesicoureteral reflux (VUR) is one of the most common urological abnormalities in children, with a prevalence as high as 30-40% in patients suffering from urinary tract infections (UTIs). The present study aims to provide data regarding the epidemiology of this condition in a cohort of paediatric patients treated in the Surgical Clinic of the “Grigore Alexandrescu” Clinical Emergency Hospital for Children in Bucharest. Materials and Methods. The study, taking place from January 2009 to May 2018, is of the retrospective, observational type. Data has been collected for each patient, regarding demographics, age at the time of diagnosis, the presence of associated birth defects, and the severity of VUR (uni- or bilateral, degree of reflux). The international classification of VUR has been used, consisting of five different degrees. Results. 345 patients have been included in the final study cohort (58.6% female and 41.4% male), with the mean age of 47.03±2.03 months. Females were diagnosed at a significantly higher age than males (46.5±2.8 months for females, versus 33.9±2.9 months in males, p=0.002). The patients in which the possibility of renal defects had been taken into account prenatally had the lowest age at the moment of VUR diagnosis. In addition, patients that associated both hydronephrosis, as well as UTIs as initial findings had a significantly lower age at diagnosis than patients exhibiting solely UTIs (p=0.05). The distribution regarding the placement of the lesion is similar (52.8% of patients with unilateral VUR versus 47.2% patients with bilateral VUR). Associated structural defects were observed in 42.6% of cases. Conclusions. In spite of it being more common in females, VUR is diagnosed in males at an earlier age. The association of hydronephrosis and UTI should point towards the possibility of VUR. Moreover, the prenatal finding of structural urological abnormalities greatly reduces the age of diagnosis, thus greatly reducing the rate of complications such as renal scarring. [ABSTRACT FROM AUTHOR]

Introduction and Objectives. No cause has yet been discovered for hypospadias, although multiple hypotheses have been considered, such as: family history, maternal age of over 35 years, exposure to certain drugs and chemicals during pregnancy and genetic anomalies. Many surgical techniques have been postulated as a treatment for this condition, aiming to have a small percentage of complications, but there is still no consensus upon the best type of procedure. The aim of this study is to underline the importance and necessity of a centre of excellence in the diagnosis and management of hypospadias, by comparing from multiple points of view the patients admitted initially in our centre and the patients who have been operated in other hospitals, referred to our department for the treatment of complications. Materials and Methods. The study includes 848 patients, divided into two groups: group A - 677 patients admitted and managed exclusively in our centre and group B - 171 patients referred for the treatment of complications. The statistical analysis has been made using GraphPad Prism 7. Results. The children belonging to group A were operated on at a much younger age (32.65 months, n=677 vs 83.05 months, n=171, p<0.0001). In addition, the patients in group B had undertaken the surgery at a much higher grade of hypospadias, generally 2, compared to the patients in group A, where we chose to operate starting with grade 1 (p<0.0001). It is worth mentioning that the patients who had been previously operated on had undertaken between 1 and 20 procedures, with a mean of 2 to 3 operations. The patients admitted and managed solely in our hospital underwent between 1 to 6 procedures, with 79.46% having just one surgery. After the first intervention in our ward, group A had a much lower rate of postoperative complications, compared to the other group (19.44% vs 27.2%). The frequency of distribution of the complications in the two groups was significantly higher in the group of patients having re-interventions (p=0.0003, RR=0.59). One can interpret this value as being highly protective, shielding future patients from complications, if it is decided they should receive surgical treatment in a centre with experience in the management of hypospadias. In both cases, the most frequent complications were fistulae and stenoses, but their frequency of distribution seems to be equally divided (p>0.05). Conclusion. The simple gesture of deciding to seek treatment in a centre with great experience in the management of a condition so heterogeneous, both clinical and outcome-wise, as hypospadias, is a way of preventing a significant percentage of both major and minor complications. [ABSTRACT FROM AUTHOR]

Introduction and Objectives. The management of children possessing birth defects is oftentimes a strenuous task for every hospital, due to the severity of the associated diseases, but also due to the heterogeneity of potential complications. Thus, they are generally referred to hospitals with great experience in this field. The objective of this study is to verify whether, in the “Grigore Alexandrescu” Clinical Emergency Hospital for Children (CEHC), the costs regarding the treatment of vesicoureteral reflux (VUR) are higher for children with birth defects, than in the case of children born without defects of any kind. Materials and Methods. We performed a randomized case-control, prospective study, which included 346 patients treated in the Pediatric Surgery Department of the CEHC. The patients were divided into two groups regarding the main decision criterion - the presence of birth defects, the groups consisting of: 146 children with birth defects and 197 children without. MedCalc 14.1 was used for statistical analysis. Results. The group of children without birth defects contains more females than males (n=139 vs n=58), the females diagnosed with VUR an average of nine months earlier (p=0.0945). In the group of children born with defects the sex ratio is reversed, with males diagnosed approximately 12 months earlier (n=86 vs 62; p=0.0765). In total, children with birth defects are diagnosed with VUR at a younger age (36.37 months, n=148 vs 44.24 months, n=195; p=0.062). In average, both groups were hospitalized for six days (6.2 vs 6.9; p=0.27), but the cost of hospitalization is significantly higher in children with birth defects (1440 EUR vs. 1320 EUR; p=0.04). It is worth mentioning that the standard deviation is greater in children with birth defects (656 EUR vs 320 EUR). The rate of postoperative complications has been higher in children with birth defects (28.75% vs 17.1%). Using the Chi-Square test, we also see a statistically significant difference in the frequency of distribution (p=0.0438), with an RR=1.727 (95%CI=1.01-2.97), underlining the presence of birth defects as a risk factor for postoperative complications. However, upon conducting a ROC analysis on the patients not presenting complications, using the cost of hospitalization as a variable and the presence of malformations as the classification criterion, a cut-off point of 1560 EUR is revealed (AUC=0.51, sensitivity=43.7%, specificity=67.3%; p=0.6). Thus, in order to obtain a favorable result in 67% of cases, at least 1560 EUR had been spent. Conclusions. In spite of the small financial difference between the two groups, a physician admitting a child with both birth defects and VUR should not start off by thinking more money will have to be spent, but rather take into account the higher rate of postoperative complications, which can amount to a true economic black hole, this fact being supported both by the higher standard deviation, as well as the ROC analysis. [ABSTRACT FROM AUTHOR]

Introduction and Objectives. Persistent Müllerian duct syndrome is a relatively rare form of male pseudohermaphroditism in which Müllerian duct derivatives (uterus, fallopian tubes and upper vagina) are seen in an otherwise differentiated male patient with a normal 46XY karyotype. Materials and Methods. We report the case of one patient that was evaluated in our clinic using physical examination, imaging, measurement of tumor markers and surgical exploration. Results. The patient had an atrophic right testicle and a hypoplasic left testicle and presented primary infertility. Taking into account the existent risk of malignancy of the müllerian derivatives, laparoscopic hysterectomy was performed. Conclusion. Controversy remains as to the ideal surgical treatment regarding the müllerian structures, but orchidopexy should be performed in all cases. Laparoscopic exploration associated with excision on the derivatives is safe and should be taken into account. [ABSTRACT FROM AUTHOR]

Introduction and Objectives. Flexible ureteroscopy (fURS) can be a difficult intervention. It takes practice and it has a rather difficult learning curve. But, does standardizing the intervention create the premises for a better outcome, for reduced intervention time and reduced incidence of complications? A study from 2012 from Freiburg, detailed the use of what they called “The Freiburg fURS Technique”, but is the technique still coherent today, with the new advances in the technology used and with the increased experience of urologists? Our aim is to assess if the outcomes in our hospital, with our technique for fURS, are comparable with others reported. Materials and Methods. We included in the study, 101 patients with lower pole caliceal stones, with sizes ranging from 0.5 to 3 cm, for whom fURS (retrograde intrarenal surgery - RIRS) was performed. For the intervention, an Olympus digital flexible ureteroscope and single use Lithovue, 9.5 Fr, Boston Scientific flexible ureteroscopes were used. The lithotripsy was achieved using Holmium Laser (Olympus Empower H65 and Swiss LaserClast EMS). Laser fibres used – 200-270 microns. Retrieving devices – Boston Scientific Dakota. Results. Treating (dilating) the ureteral orifice was needed in 9 cases and we inserted a double-J stent preoperatively in 14 cases and performed the intervention 10-14 days after in those cases. In all cases a single guidewire which was passed all the way in to the renal pelvis and preferably in the upper pole calyx was used, instead of two as recommended in the Freiburg Technique. The semirigid ureteroscope was not used before the flexible one, although that would have been the case for a concomitant ipsilateral ureteral stone. A Ureteral Access Sheath was used in every case. Relocation of the stone to the renal pelvis or un upper pole calyx was performed in 62 patients (61.4%). We agree with the Freiburg team, that the use of a 2-access way scope would be better and also that a device for increasing water pressure is needed, but these are not mandatory. Complications were assessed using an MCCS – modified Clavien Classification System and we noted 10 patients (9.9%) with Clavien I complications, 8 patients (7.9%) with Clavien II and 1 patient with Clavien III complications (0.9%). Clavien IV complications were not encountered. The success rate was 94.1%. Conclusions. Our study intended to show that outcome is better and complications are low, indeed, using a standardized technique, but one which is continuously renewed. Of course, having a standardized technique improves the outcome and decreases the length of any operation. But we need to keep these standards up-to-date and synchronized with the new advances in technology. [ABSTRACT FROM AUTHOR]

Introduction and Objectives. OAB is bothersome for the patient, affecting the quality of life, but is also a burden to the public health systems. The primary aim of the treatment in neurogenic lower urinary tract dysfunctions is to protect the upper urinary tract. Secondary goals are to achieve urinary continence, to restore functions of the lower urinary tract and to improve the patient’s quality of life. Intradetrusor botulinum toxin injections are recommended by the EAU as “the most effective minimally invasive treatment to reduce neurogenic detrusor overactivity”, but as a third-line therapy for patients refractory to anticholinergic therapy. This treatment requires a prior urodynamic diagnosis of detrusor overactivity. Botulinum toxin, produced by Clostridium botulinum, works by blocking the efference of the reflex arc. Materials and Methods. We performed a retrospective study which evaluated all NDO patients treated with Dysport in 2016 and 2017. A total of 47 patients were included in our study, aged between 24 and 67 years old, with either SCI or MS, 31 males and 16 females. Results. The longest follow up available was 21 months. The significant reduction of incontinence episodes, which even disappeared in some cases is a great element of satisfaction for those involved and might lead to treatment compliance over time, with benefic results over other less evident parameters. Conclusions. Abobotulinum toxin (Dysport®) is both safe and effective, and the results of our retrospective study are in line with data from the literature. Keeping in mind that botulinum toxin is not and should not become first line therapy, we should consider Dysport every time our initial treatment is not effective or well tolerated by the patient. [ABSTRACT FROM AUTHOR]

Introduction and Objectives. Renal cell carcinoma represents an important surgical disease. In the present times, in case of an imagistic suspicion of a renal cell carcinoma, a total nephrectomy or a radical nephrectomy should be performed when the tumor formation is not suitable for partial nephrectomy. Renal cell carcinoma is the third most common type of cancer after prostate and bladder cancer in the field of uro-oncology. Its incidence has known a rapid increase in the last years, thanks to the well spread use of the new imagining techniques, that also improved the mortality and morbidity rate caused by this malignancy. We performed a comparison between open versus laparoscopic nephrectomy, regarding the treatment of renal cell carcinoma, in order to assess if the laparoscopic nephrectomy for renal tumors is by any means superior to the "old-school" open approach, and if it can, indeed, replace the open surgical intervention. Materials and Methods. 63 cases of patients with renal cell carcinoma who underwent nephrectomy were studied in a retrospective manner. The surgeries were performed in the Urology Clinic of "Prof. Dr. Theodor Burghele" Clinical Hospital, between January 2011 and September 2013. The subjects were divided into two study groups by means of the surgical approach used, open or laparoscopic nephrectomy and several parameters were analyzed. Results. Of the total 63 patients with RCC, 28 underwent laparoscopic nephrectomy, while the rest of 35 underwent open nephrectomy. The mean age of patients with laparoscopic nephrectomy was 59.39±12 years, compared to 63.31±11 years for the open approach. The male patients were statistically significantly older than the female patients in our population (p=0.017). Clear-cell carcinoma accounted for approximately 70% of all adult epithelial kidney tumors, in the nephrectomy series. Papillary renal cell carcinoma was the second most common type of renal cell carcinoma and it accounted for 10-15% of all types of renal cell carcinomas. Mean length of hospitalization was significantly higher for patients receiving open surgery than for those receiving laparoscopy (8.26 days versus 5.81 days, respectively) (p=0.0001). Blood loss has been lower for the laparoscopically operated patients, compared to the other group of open nephrectomies: average blood loss was 93 ml versus 202 ml in the open nephrectomy group (p=0.002). Complications were more frequent after open surgery compared to laparoscopic surgery (p=0.015). Conclusions. The laparoscopic approach in the surgical treatment of the renal cell carcinoma has the advantage of a reduced rate of complications, decreased postoperative pain, shorter hospital- stay and therefore more rapid socio-professional reintegration. In terms of success rates and oncological results, both techniques presented with similar results, only minor differences were observed, with no statistical significantly difference. [ABSTRACT FROM AUTHOR]

Introduction and Objectives. Recent studies suggest that obesity may be associated with a higher risk of aggressive or fatal prostate cancer. One explanation could be the effect of BMI on serum levels of PSA. The aim of this paper is to investigate and better understand the correlation between BMI and PSA value in a population diagnosed with prostate cancer. Materials and Methods. Between January 2013 and March 2017, 550 patients with prostate cancer, diagnosed either through a prostate biopsy due to elevated PSA or through TUR-P for prostatic enlargement, were included in the study group. A questionnaire regarding age, height, weight, anthropometric measures and biological samples (PSA) has been submitted to all the patients and the results were constituted in a database. In order to establish a correlation between the obtained variables, the q Spearman correlation coefficient has been calculated. Results. The mean age of patients was 69.17 years (SD 7.7) and the mean PSA value was 31.97 ng/ml (SD 43.1). BMI (weight in kg / height in m2) was categorized as follows: normal and underweight (BMI < 24.9) - 175 (31.8%), patients overweight (BMI = 25.0-29.9) - 249 (45.3%) patients, Class I obesity (BMI = 30.0-34.9) - 96 (17.5%) patients, Class II obesity (BMI = 35.0-39.9) - 26 (4.6%) patients and Class III obesity (BMI > 40) - 4 (0.7%) patients. Data analysis revealed a negative and moderate correlation between PSA values and BMI for patients with PSA levels between 10-20 ng/ml and higher than 20 ng/ml. Changing the distribution of patients based on BMI classification, we obtained a strong and negative correlation between PSA and BMI in underweight and normal weight patients (p=0.016) and a low negative correlation between PSA and BMI in patients with Class II obesity. Regarding age and PSA values, we found a moderate and positive correlation (p=0.008). Conclusions. This study confirms the inverse relationship between PSA values and BMI in patients with prostate cancer. Low levels of PSA in overweight and obese patients could delay early detection of prostate cancer (only 22.9% of studied patients had a BMI > 29.9 kg/m2) and underestimate the disease severity. Obesity can help the clinical staff to a better interpretation of PSA values while screening for prostate cancer. [ABSTRACT FROM AUTHOR]

Introduction and Objectives. The continuous and excessive increase in antibiotic use in Romania has led to the occurrence of enterocolitis by Clostridium Difficile. The aim of the paper is to analyze the association of the development of infections with enterocolitis trigger germs and exposure to broad spectrum antibiotics. Materials and Methods. Between January 2015 and March 2017, we conducted a retrospective study to assess the incidence and prevalence of patients with Clostridium Difficile. Patients who have experienced symptoms have been tested for C.Difficile infections by immunological tests - toxin A, B and GDH. A number of factors such as age, gender, basic urological pathology, antibiotic treatment administered, and number of days until diagnosis of C. difficile infection were followed. Results. We enrolled 134 patients who developed C.Difficile infections. The mean age was 66.85 ± 12.187 years. The gender distribution was 100 males (74.6%) and 34 women (25.4%). The highest prevalence was in the case of HBP, 26 cases (19.4%), followed by lithiasis pathology - 23 cases (17.2%), and infiltrative vesicular tumors 23 cases (17.2%). The most frequent class of antibiotic prescribed to trigger symptomatology (4-6 diarrheal, explosive, watery stools) was the third generation cephalosporins, 77 cases (57.5%), followed by carbapenems, 21 cases (15.7%). The median duration of administration until the onset of manifestations was 4.77 ± 3.02 days. Positivity of all immunological markers was found in 84 cases (62.7%), 24 patients (17.9%) had only positive GDH associated with the clinical profile. There is no strong correlation (Pearson's R = 0.235) between the number of days of antibiotic treatment and the positivity of toxins (p <0.001). Conclusions. Applying rational use of antibiotics and controlling nosocomial infections nationwide is one of the ways to limit the above process. [ABSTRACT FROM AUTHOR]

Introduction and Objectives. Varicocele affects one in ten adult men and one in four men with infertility. The exact mechanism through which it reduces male fertility is not known but surgical correction usually improves semen parameters. We consider the study of varicocele repair in single testis patients to be less biased by the presence of a healthy contralateral testicle and thus providing accurate results regarding the benefits of the procedure. Materials and Methods. This is a retrospective, descriptive, single-center study, where we analyzed data from the clinical records of patients diagnosed with varicocele and a history of contralateral orchiectomy during a period of 4 years. All patients had varicocele surgery done by the same surgeon and the same surgical procedure of microsurgical subinguinal varicocelectomy was used. We follow their pathological history, clinical findings, hormonal work-up and semen analysis from before the surgery until the present day. Results. There were six patients that corresponded to our criteria during the studied period. The patients were between 25 and 39 years old. All of them had right-sided orchiectomy for either benign or malignant disease and a left sided varicocele. Four of these patients presented for infertility of various lengths and two for clinical symptoms associated with the varicocele. Two patients that presented for infertility and were candidates for in-vitro-fertilization before varicocele repair managed to obtain natural pregnancies. All four patients that presented for infertility managed to obtain a pregnancy. The other two patients had their symptoms settled. Conclusions. Microsurgical subinguinal varicocelectomy is a straightforward way to relieve clinical symptoms and upgrade the fertility status of single testis patients. Microsurgical treatment of a varicocele in single testis patients could result in the use of a safer, less invasive and less expensive artificial reproductive technique and a higher natural pregnancy rate. [ABSTRACT FROM AUTHOR]

Introduction and Objectives. The neurogenic detrusor overactivity (NDO) represents the pathology in which the bladder detrusor overactivity can be caused by a series of neurological conditions. The burden of NDO is not all neglectable, impairing the patients' quality of life. Currently there is no optimal medical therapy to relieve all the neuro-urological symptoms available. even if antimuscarinic agents have been used for many years with good clinical and urodynamic response, there is still limited data for tailoring the perfect antimuscarinic treatment for individual patients with NDO. High doses or combination of anticholinergics are recommended for maximizing the outcome in neurological patients, still, the incidence of adverse events is the major factor for therapy discontinuation. For patients who abort anticholinergic drugs or for unresponsive patients or for patients unwilling to assume the side effects, other types of treatments should be regarded. In recent years, Onabotulinumtoxin A has emerged as the most effective minimally invasive treatment to reduce NDO, therefore an efficient treatment alternative. Materials and Methods. The aim of this prospective study performed on 15 patients was to assess the efficacy of botulinum toxin A intradetrusor injections for the treatment of NDO. Intradetrusor injections with Onabotulinumtoxin A 200 U were performed through a minimally invasive flexible cystoscopy technique, under general intravenous anesthesia. Urodynamic studies were performed at baseline and 3 months after injecting the botulinum toxin. Urodynamic parameters like reflex volume (RV), maximum cystometric capacity (MCC) and maximum detrusor pressure (MDP) were assessed. The number of incontinence episodes and the score of quality of life questionnaires were also analyzed at baseline and 3 months after the injection. Results. Mean age for the study group was 48,73 years old, most of the patients presented with spinal cord injury or multiple sclerosis. RV increased in most of the cases with an average of 49.26 ml (42.84%). MCC presented an overall average increase of 69.93 ml (57.32%). MDP showed an average decrease of 12.15 cm H2O, accounting for 22.93%. Incontinence episodes were reduced with 66.66% compared to baseline. On the Overactive Bladder Perception Score an average decrease of 0.73 (12.5%) was recorded, while on The VAS QoL an average decrease of 1.93 points (22.52%) was noted. No major adverse events were recorded. Conclusions. Botulinum toxin A intradetrusor injection can be a feasible minimally invasive treatment for patients with neurogenic detrusor overactivity not only for patients who are non-responsive or who fail to tolerate anticholinergic medication, with possible low rates of adverse events that lead to discontinuation. [ABSTRACT FROM AUTHOR]

Introduction and Objectives. There is no scientific consensus to date regarding the approach to a clinically significant left varicocele associated with a right varicocele (frequently of a smaller size). We could not find studies concerning the efficacy of bilateral microsurgical subinguinal approach for the treatment of bilateral varicoceles. Materials and Methods. A retrospective study was performed with patients presenting with infertility and diagnosed with bilateral varicocele. 46 patients that have been admitted to the Center for Uronephrology and Renal Transplantation of Fundeni Clinical Institute and underwent microsurgical subinguinal varicocelectomy between June 2009 and November 2014 were selected. Patients were divided into two groups, group I - that underwent unilateral left varicocelectomy, and group II - that underwent bilateral varicocelectomy. Results. There was a significant rise in post-op sperm concentration for both groups (34.4 mil - group I vs 31.18 - group II). There was a higher rise in progressive motility percentage in group II (from 23% to 30%) than in group I (27% to 30%), but overall results were identical. (p=0.932). At the 3-months check-up we noticed a 20% higher rise (p=0.765) in TMSC for the bilateral surgery group (34.89 mil for group I vs 40.04 for group II). Conclusions. There weren't important postoperative differences in classical semen parameters (sperm concentration, motility, morphology, viability) but TMSC value was better in the bilateral surgery group. [ABSTRACT FROM AUTHOR]

Introduction and Objectives. In Romania, prostate cancer has a rising incidence, it occupies the third place after lung and colorectal cancer, representing the fourth cause of cancer death among men in 2012. Depending on the diagnosis stage, prostate cancer benefits from curative treatment methods, radical prostatectomy having its' well-deserved place. Materials and Methods. Starting from this premise, the last 20-month experience performing retropubic radical prostatectomy in our clinic was reviewed, comparing the obtained results with our previous study from 2012. The study included 201 patients, who underwent retropubic radical prostatectomy between November 2012 and June 2014, analyzing a series of parameters in order to assess the complication's degree and the oncological results at 12 Month post-surgery. Results. Patients' age was between 49-77 years (versus 53-75), preoperative PSA levels between 2,2 - 24,9 ng/ml, Gleason score on preoperative biopsy - 6-9. In terms of clinical staging, 40% of patientspresented with T1 disease, 50% with T2 and 10% with T3 (versus 37%, 53% and 10%). The pT staging reveled 115 cases in pT2 stage (57,2%), 84 cases in pT3 (41,8%) and 2 cases of pT4 (1%) (Versus 55,6%, 43% and 1,4%). Neither intraoperative deaths nor major complications occurred, minor complications were estimated at about 15%. Mean operating time was 210 minutes (versus 240 minutes). Average blood loss was 370 ml (versus 385 ml), with an average blood transfusion rate was 1.2 units. Length of hospitalization was 7-13 days (versus 7-14 days). Continence and erectile function were assessed at one year post-surgery, revealing encouraging results. Conclusions. The obtained results were improved, depicting satisfying oncological outcome with minor complications. Retropubic radical prostatectomy deserves its' highly important position in curing prostate cancer, remaining the "gold standard" in the treatment of localized prostatic adenocarcinoma. [ABSTRACT FROM AUTHOR]

Introduction and Objectives. Neurogenic detrusor overactivity (NDO) is the condition where the detrusor overactivity is caused by a disturbance of nervous control mechanism with evidence of a relevant neurological disorder. For patients who abort the anticholinergic drugs, the recommended first line therapy, other type of treatments should be considered. The use of botulinum toxin A administered as intradetrusor injections has emerged as an effective alternative. Materials and Methods. The goalwas to assess the efficacy of botulinum toxin A for the treatment of NDO from the published literature in the last five years, starting 2010. The search was performed in the PubMed database, using the following terms: botulinum toxin A, onabotulinumtoxin A, abobotulinumtoxin A, incobotulinumtoxinA, neurogenic detrusor overactivity, overactive bladder, NDO. The search was limited to articles presenting clinical trials with adult human subjects and written in the English language.Published reviews on the topic were excluded. Results. Eight studies were reviewed. All of them reported a major improvement in the urodynamic parameters - MCC, MDP. There was also a significantly decrease in the urinary incontinence episodes, frequency and urgency episodes. All authors reported an increase on patients' quality of life, regardless of the underlying neurological condition. There were no major registered adverse events. Furthermore, BoNT/A injections proved to have a good long term efficacy and tolerability. Conclusions. Botulinum toxin A appears to be a feasible second line treatment for patients with neurogenic detrusor overactivity non responsive or who fail to tolerate anticholinergic medication. [ABSTRACT FROM AUTHOR]

Introduction and Objectives. With new antiretroviral treatment regimens, HIV infection has become a chronic disease and patients with high compliance who follow the instructions of the treating physician have a global survival similar to those without HIV infection. Among the pathologies associated with this infection, sexual disorders are increasingly accused by HIV-infected men who are being treated with antiretrovirals. Our study aimed to evaluate the prevalence of sexual dysfunction in a group of HIV-positive men being in antiretroviral therapy. Materials and Methods. In the study, a group of HIV-positive men under antiretroviral therapy completed the International Index of Erectile Function (IIEF) questionnaire with 15 questions, evaluating the erectile function, orgasmic function, sexual desire, intercourse satisfaction and overall sexual satisfaction. Results. We evaluated a number of 30 HIV-positive patients, aged between 23 and 69 who completed the IIEF questionnaire. The mean age was 36.8 ± 11.1 years. A total of 13 patients experienced erectile dysfunction (IIEF-erectile function score < 26), with the prevalence of erectile dysfunction of 43.3%. A total of 9 patients had orgasmic dysfunction (IIEF-orgasmic function score < 9), the prevalence of orgasmic dysfunction being 30%. A total of 17 patients experienced impaired sexual desire (IIEF-sexual desire score < 9), the prevalence of 56.6% sexual desire being affected. A total of 13 patients experienced impaired sexual intercourse satisfaction (IIEF-satisfaction of intercourse score < 13), intercourse satisfaction impairment prevalence is 43.3%. A total of 20 patients experienced impairment of general sexual satisfaction (IIEF-general sexual satisfaction score < 9), overall sexual satisfaction impairment prevalence being 66.6%. Conclusions. This study evaluated the prevalence of sexual disorders in HIV-positive men who were in antiretroviral therapy, identifying erectile dysfunction at 43.3%, orgasmic dysfunction at 30%, sexual desire impairment at 56.6%, impairment of sexual intercourse to 43.3% and impairment of general sexual satisfaction to 66.6% of them. [ABSTRACT FROM AUTHOR]

Introduction and Objectives. Retroperitoneal mullerian cysts are very rare, usually asymptomatic and are considered to be a subtype of urogenital cysts. We present the clinical and pathological findings in a case of benign retroperitoneal cyst of mullerian type. Materials and Methods. A 50 years old female presented in our department left side abdominal pain and a left side abdominal mass discovered on clinical examination. Physical examination detected a 20x15 cm left side abdominal mass. The CT scan showed a large cyst like structure, 163/160/138 mm in dimensions situated in the left abdominal flank, with its upper pole under the caudal pancreatic region, unilocular with homogenous fluid density. It appears to be separated from the left kidney. Results. Surgery was performed – open laparotomy. We found a large cyst of 17/15 cm situated in the left retroperitoneum. Final histopathological exam described mullerian unilocular cyst, 17/17/13 cm in dimensions, with a thin firm wall, with serosal clear fluid, and the inner surface was without papillary projections. Conclusions. Retroperitoneal mullerian cysts are rare diseases, with a long period of asymptomatic evolution. [ABSTRACT FROM AUTHOR]

Introduction and objectives. ESWL is still the first line approach for renal calculi even after 35 years, provided the new guidelines and indications are followed. Our objective was to find out if there was a correlation between the length or width of the calyx, the infundibulo-pelvic angle, or the infundibulo-transverse angle and the stone free rate/ and clearance rate after ESWL for lower calyceal calculi. Materials and methods. A retrospective analysis was performed on 80 randomly chosen patients with radioopaque lower calyceal stones who were treated in our clinic between February 2014 and July 2015. Data was collected about the number of procedures needed to achieve CIRF (clinically insignificant residual fragments) or stone-free status. IVU was performed in order to measure the length and width of the inferior calyx, the infundibulo-pelvic and the infundibulo-transverse angles. Ultrasound and plain KUB X-rays were used to assess stone clearance and the size of residual fragments. Results. 52 patients (65%) needed only 1 procedure, 24 (30%) needed 2 procedures and 4 (5%) needed 3 procedures. In our study population, the mean infundibular length was 18.2 mm (minimum 7 mm and a maximum of 38 mm), the mean infundibular width was 8.5 mm (with a minimum of 2 mm and a maximum of 18 mm). The lower pole infundibulo-pelvic angles were between 31° and 134° with a mean of 61° and the lower pole infundibulo-transverse angles between 28° and 69°, with a mean of 50.8°. Conclusions. We found no statistically significant correlation between the number of procedures needed to achieve stone-free status and either of the anatomical measurements made. [ABSTRACT FROM AUTHOR]

Introduction and objectives. To identify the value of contrast-enhanced ultrasound (CEUS) assessment for renal microvascular perfusion damage in patients with essential arterial hypertension (AHT) and associated comorbidities, diabetes and chronic kidney disease (CKD). Materials and Methods. 85 patients with AHT grade I-III (29 with diabetes and 12 with CKD), age=60+/-12, Males=45.8% and 10 healthy adults were investigated by CEUS. After intravenous administration of 1.2ml contrast agent the images were recorded for 3 minutes. Renal micro-vascular perfusion was evaluated in early cortical phase (N-10-14sec), late cortical phase (N=15/20-40sec) and medullar phase (N=45-120sec). Tine-intensity curves (TIC) were analyzed by Contrast Dynamics software using: arriving time (AT), time to peak (TP), peak intensity (PI), area under the curve (AUC) and mean transit time (MTT). Results. The enhancement times were progressively prolonged in the study group according to the grade of the hypertension and more in diabetes and CKD. TIC analyze were similar: AT in AHT group was 18sec, in diabetes 21sec and in CKD 25 sec vs. healthy 10 sec. TP, PI, AUC are also well correlated with the grade of the hypertension and associated comorbidities. No adverse effect was noted during the study. No changes in biological status were noted in the study group after CEUS. Conclusions. CEUS is a reliable, non-invasive, simple and safe method to evaluate in real-time the renal microvascular perfusion damage in all grades of hypertension and associated comorbidities. TIC parameters (TP, PI and AUC) accurately assess the renal microvascular impairment in different stages. [ABSTRACT FROM AUTHOR]

Introduction and Objectives. Testicular cancer is one of the most curable malignancies due to the last advances in diagnosis and treatment, but late diagnosis remains a serious problem. Materials and Methods. We present a case of a 44-year-old man who presented in our clinic with a giant testicular tumor, measuring about 40 cm in diameter, extended to the scrotum. Preoperative investigations revealed tumor markers highly elevated and an enormous tumor mass extended from the right testicle, enlarged pelvic and inguinal lymphatic nodes, bilateral femoral bone metastases and also bilateral pulmonary metastases. Results. Bilateral inguinal orchiectomy and local resection with a wide margin was performed followed by chemotherapy courses and after three months tumor markers decreased to normal and the CT exam revealed a reduction in size of secondary tumors. A review of the literature showed that this form of presentation is rare, the case being impressive by the size of the tumor. [ABSTRACT FROM AUTHOR]

Patients with skeletal deformities represent a challenge during surgical management of renoureteral lithiasis. We present a case of supine percutaneous treatment in a 24-year-old female with spastic tetraparesis and complex skeletal deformity. A diagnosis of left ureterohydronephrosis caused by a 7mm distal ureteral calculus and 18mm left renal pelvis lithiasis was established. A lower pole ultrasound-fluoroscopy-guided percutaneous nephrostomy tube was inserted into the dilated pyelocaliceal system for the immediate relief of the obstructive nephropathy. Afterwards, a definitive approached with a mid pole puncture was performed. The pyelic stone was removed using a rigid nephroscop and a Swiss lithoclast for stone fragmentation. Then, anterograde flexible ureteroscopy combined with holmium: YAG laser was used in order to approach the ureteral stone for intracorporeal lithotripsy. The fragmented stones were passed down to the bladder by irrigation and a 6 nephroureteral catheter was left in place at the end of the procedure. [ABSTRACT FROM AUTHOR]

Introduction and Objectives: Prostate cancer is the most common cancer affecting males in developed countries. It shows consistent evidence of familial aggregation, but the causes of this aggregation are mostly unknown. Early diagnosis and treatment are key factors in determining the survival of certain sets of prostate cancer patients. Hence, a major effort has been put into trying to identify biomarkers that could be used for screening for the disease. The aim of the study is to find if previously identified genetic variants on 8q24 chromosome affect susceptibility to prostate cancer in the Romanian population and to attempt to translate recent breakthrough findings in prostate cancer genetics into biomarkers of clinical utility. Material and Methods: Recent advances in SNP genotyping have revolutionized genetic association studies of prostate cancer. We participated in a genome-wide association study (GWAS) using a bio bank with blood DNA samples from 990 cases (histologically confirmed prostate cancer) and 1034 controls. Detailed lifestyle and medical information was collected. Biological material was tested for 34 previously identified genetic variants using IlluminaInfinium Platform in the deCODE laboratory to observe if these variants affect susceptibility to prostate cancer in the Romanian population. The presence of genetic risk variants was correlated with clinical parameters associated with disease severity and outcome. The data was analysed separately for the Romanian population and it will be analysed in conjunction with comparable data from the Icelandic, Dutch and UK populations. Finally, we will evaluate whether the identified genetic variants are associated with known or suspected lifestyle and anthropometric risk factors. Results: The C allele of SNP marker rs1447295 is strongly associated with prostate cancer risk with both forms: heterozygote (OR: 1, 52, p: 0,002) and homozygote (OR: 1, 49, p: 0,003) on Romanian male population. This marker was most strongly correlated with high values of PSA levels, advanced TNM stages and Gleason's score between 8 and 10. Conclusions: The genetic studies conducted using Romanian bio bank from ProMark study confirmed that 8q24 is one of the most important region in the attempt to identify genetic variants underlying risk of prostate cancer. For the Romanian patients with prostate cancer, allele C of rs1447295 was found to be strongly associated with high values of PSA levels, advanced TNM stages and Gleason's score between 8 and 10. Further investigation is warranted to determine the molecular basis of each of the prostate susceptibility loci at 8q24 and the possible interaction between these loci. [ABSTRACT FROM AUTHOR]

Introduction: There is still no consensus on how to define and grade postoperative complications, and this hampers comparison of outcome data among different centers. A classification (modified Clavien system) has recently been proposed for this purpose, and we reviewed our experience with percutaneous nephrolithotomy (PCNL), grading perioperative complications according to this new classification. Materials and methods: A total of 976 PCNLs were performed for reno-ureteral lithiasis between January 2012 and July 2013 in our clinic, and charts were retrospectively reviewed focusing on complications observed. Complications were evaluated and stratified into five grades by the modified Clavien classification system. Results: PCNL was performed in 141 cases (14.44%), ureteroscopy followed by PCNL in 23 cases (2.35%) and tubeless PCNL (double J stent) in 812 cases (83.19%). The average stone volume was 7.9 ± 3.9 cm2. A total of 322 complications were documented in 291 patients (29.81%). According to the modified Clavien classification, grade 1, 2, 3a, 3b, 4a, 4b, and 5 complications were observed in 92 (9.42%), 137 (14.03%), 51 (5.22%), 31 (3.17%), 6 (0.61%), 5 (0.51%), and 0 patients, respectively. The majority of complications were related to bleeding, urine leakage and infections. The stone free rate achieved at 3 months postoperative was 87.8% - 857 patients. Conclusions: The majority of complications after PCNL are minor. The modified Clavien classification provides a standardized grading system for complications of PCNL, although consensus on specific complications would prompt better comparison between centers. We recommend this graded classification scheme to apply to other surgical procedure. [ABSTRACT FROM AUTHOR]

Copyright of Romanian Journal of Urology is the property of Romanian Journal of Urology and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Romanian Journal of Urology is the property of Romanian Journal of Urology and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Romanian Journal of Urology is the property of Romanian Journal of Urology and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: The O'Leary Sant Symptom Index (OLS) is one of the tools used to help the diagnosis of the Bladder Pain Syndrome/Painful Bladder Syndrome/ Interstitial Cystitis (BPS/PBS/IC) and also used to evaluate the outcome of the treatment. Objective: To obtain a culturally validated form of OLS for Romanian language and to verify the psychometric properties of this symptom index in the Romanian format. Objective: To obtain a culturally validated form of OLS for Romanian language and to verify the psychometric properties of this symptom index in the Romanian format. Method: After obtaining the authors agreement the OLS was translated to Romanian by two authorized English Romanian translators. The differences between the two translations were discussed and a first draft was finalized. A different authorized translator did the back translation into English and the authors were asked to evaluate if there is any change of meanings and discrepancies. Modifications were done accordingly. Testing for acceptability was done on a sample of 6 patients (5 female, 1 male) known to have BPS/PBS/IC. Minor adaptations were done and the final Romanian version of the OLS was culturally validated. The symptom items demonstrated excellent stability (the reliability of the questionnaire), with 95.6% reporting identical ratings or moving a maximum of one response category between two week test-retest analysis of 23 patients (21 females, 2 males) attending the urology clinic for symptoms suggestive of BPS/PBS/IC. Sensitivity to change - the responsiveness of the questionnaire was assessed on the same sample of individuals after undergoing pharmacotherapy and/or bladder instillations. The difference between mean symptom scores at baseline and follow-up was examined using the one-sample paired t-test. Symptom scores were significantly improved following treatment (mean score 22.6 and 11.8 before and after treatment, P<0.0001). Conclusions: The properties of the questionnaire were retained, its Romanian version being reliable and responsive to change. [ABSTRACT FROM AUTHOR]

Copyright of Romanian Journal of Urology is the property of Romanian Journal of Urology and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Romanian Journal of Urology is the property of Romanian Journal of Urology and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: Our aim was to evaluate the prevalence and risk factors of erectile dysfunction (ED) in a cohort of HIV-infected male patients, and to test the testosterone levels for those with ED. Materials & methods: We evaluated a cohort of HIV infected men. They completed a questionnaire based on IIEF (maximum score 30 for questions 1,2,3,4,5,15) and for those with ED (IIEF-score less than 25) testosterone level was determined. Participants gave information related to smoking and drug consumption and current antiretroviral therapy. Results: Forty-four HIV-infected men were enrolled, all of them completed the questionnaire, mean age was 35.9 ± 10.5 (range 23 - 69). 23 patients complained of ED (52.2% of total). 14 patients had mild erectile dysfunction (score between 22-25), six patients had mild to moderate erectile dysfunction (score between 17-21), three patients had moderate erectile dysfunction (score between 11-16). Total testosterone level was tested for three patients, all having normal values (>10nmol/L). Six patients refused the test. We found no correlation (Pearson Correlation Coefficient) between ED and tobacco smoking (R=0.1011, p=0.51), drug consumption (R=0.1664, p=28) and therapy with protease inhibitors (R=0.0244, p=0.89). Conclusions: Our study showed a prevalence of erectile dysfunction of 52.2% in the HIV-infected men evaluated, with mean age 35.9 ± 10.5. We found no correlation between tobacco use, drug consumption or protease inhibitors (PI) therapy and ED. [ABSTRACT FROM AUTHOR]

Copyright of Romanian Journal of Urology is the property of Romanian Journal of Urology and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: Observational study to record the effect of Cystistat instillations on the pain felt by patients with Painful Bladder Syndrome/ Intestitial Cystitis, measured via Visual Analogue Scale (VAS) (main scope) and measuring urinary volumes and urination frequency prior to the end after the treatment (secondary scope). Material and method: 12 weeks study, with 8 weeks of treatment with weekly Cystistat instillations; were evaluated (11 females and 1 male ). Patient tracking was executed using VAS and an voiding diary at every 4-8-12 weeks. Statistical analysis of the mean VAS value trends - Wilcoxon test. VAS at inclusion was between 7 and 9 (mean= 8,2). Results: Mean value of VAS was 5 after one month and 2,5 after two months (p<0,0001). The voiding diary showed a decrease in urination frequency by 1-4 urination per day - mean values have no statistical significance. Mean volumes per urination varied slightly, mean values have no statistical significance. No adverse events were recorded; no UTI's recorded. Conclusions: Cystistat treatment reduced the pain in patients with PBS/IC; administration is simple and accepted by the patients. Study limitations : the reduced number of patients, short tracking period, the lack of control sample, seeing as 30 % of PBS/IC cases can have spontaneous remissions. [ABSTRACT FROM AUTHOR]