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Objective In a previous study, we found an apparent protective effect of neck pain on all-cause mortality in subjects older than age 85 years. The present longitudinal investigation was performed to verify this unexpected finding in a larger sample and to establish its significance. Design Population follow-up study. Setting Three towns of Northern Italy. Subjects We examined 5,253 community-dwelling residents age 65–102 years (55% female). Methods Through a postal questionnaire, baseline information was obtained concerning cardiovascular risk factors, self-rated health, physical activity, cardiovascular events, medical therapy, and presence of pain in the main joints. Seven-year all-cause mortality was the end point. Results During follow-up, 1,250 people died. After adjustment for age, sex, anti-inflammatory drugs, physical activity, and main risk factors, neck pain was inversely associated with mortality (hazard ratio = 0.74, 95% confidence interval = 0.64–0.86, P  < 0.001). This association was present, with high significance, in each of the eight following subgroups: men, women, age 65–74 years, age 75–84 years, age ≥85 years and residents of each of the three towns. The subjects without neck pain (N = 3,158) were older, more often men, less often hypercholesterolemic, less physically active, and had more frequently had a stroke than the subjects with neck pain (N = 2,095). There were no differences in the causes of death between subjects with or without neck pain. Conclusion This study has confirmed the existence of an independent inverse association between neck pain and mortality in the elderly, suggesting that reduced sensitivity to neck pain may be a new marker of frailty. [ABSTRACT FROM AUTHOR]

Objectives To determine the role of physical activity as a possible survival determinant in the oldest adults. Design Prospective, longitudinal, population-based cohort. Setting The Pianoro Study of community-dwelling older adults in three towns in northern Italy. Participants Noninstitutionalized individuals aged 85 and older (n = 500; mean age 89.6 ± 3.1, 65% female). Measurements Participants provided information on marital status, educational level, previous work activity, cardiovascular risk factors, previous cardiovascular events, self-rated health, joint pain, and functional status. Physical activity was quantified using the Physical Activity Scale for the Elderly. Seven-year mortality was known for all subjects. Results During the 7 years of follow-up, 365 subjects died. According to Cox proportional hazards regression, the following factors were found to be independently associated with mortality: PASE score (hazard ratio ( HR) = 0.987, 95% confidence interval ( CI) = 0.981-0.993, P < .001), male sex ( HR = 1.642, 95% CI = 1.411-2.068, P < .001), age in years ( HR = 1.077, 95% CI = 1.040-1.116, P < .001), previous stroke ( HR = 1.908, 95% CI = 1.362-2.673, P < .001), poor self care ( HR = 1.662, 95% CI = 1.231-2.246, P < .001), neck pain ( HR = 0.649, 95% CI = 0.497-0.849, P = .002), self rated health ( HR = 0.991, 95% CI = 0.985-0.997, P = .002). Conclusion In the oldest adults, accurate quantification of physical activity may provide important prognostic information. The predictive value of cardiovascular risk factors, except age, male sex, and prior stroke, was confirmed to be negligible. An unexpected inverse association between neck pain and mortality may require further investigation. [ABSTRACT FROM AUTHOR]

Objective: To describe a modified technique for orthotopic ileal neobladder preparation. The Studer technique is the method most frequently used worldwide and seems to be an ideal reconstructive solution after radical cystectomy.Methods: After radical cystectomy, urinary diversion is attained by means of a detubulized ileal segment. About 40 cm are used to create the reservoir and 15 cm for a tubular afferent limb. A spheroidal-shaped reservoir is then obtained with a conic distal part that will be anastomized to the urethral stump. After the reconstructive part, the neobladder and the afferent limb are attached to the levator ani and psoas muscles, respectively. Postoperative results on a series of 36 patients are reported.Results: The final shape of the reservoir was roughly spherical. A small amount of anastomotic strictures was registered. Renal function was not impaired after surgery, even at late follow-up.Conclusion: Even if the Studer technique is already well described, we believe that our technical changes may improve urinary tract restoration, and potentially decrease complications typical of urinary orthotopic diversion. Further cases are required to confirm possible advantages of the modified technique. [ABSTRACT FROM AUTHOR]

Objectives To assess the relationship between light to moderate alcohol consumption and mortality, particularly accounting for baseline health status and physical activity. Design Prospective, longitudinal, population-based study. Setting The Pianoro Study, which consisted of community-dwelling older adults in three towns in northern Italy. Participants Noninstitutionalized individuals of both sexes aged 65 and older (N = 5,256; 2,318 abstainers, 2,309 light to moderate drinkers (≤2 alcoholic units/d)). Measurements Baseline information about demographic characteristics, lifestyle factors, physical activity (Physical Activity Scale for the Elderly ( PASE)), perceived health status (visual analog scale ( VAS)), dependency level, risk factors, and previous cardiovascular events was obtained using a structured questionnaire. Follow-up information was obtained 6 years later from 2,752 survivors, and mortality information was obtained from death certificates. Results Male sex, being physically active, and good health status were independently associated with light to moderate drinking ( P < .001). An apparent protective effect of light to moderate drinking on mortality was evident in the unadjusted analysis and after adjusting for age, sex, risk factors, and cardiovascular events (adjusted hazard ratio ( aHR) = 0.77, 95% confidence interval ( CI) = 0.68-0.88, P < .001), but after also adjusting for PASE and VAS, the relationship was no longer significant ( aHR = 0.92, 95% CI = 0.80-1.05, P = .19). Follow-up physical activity was associated with baseline alcohol consumption; baseline physical activity did not predict alcohol consumption during follow-up. Conclusion After accounting for health status and physical activity, light to moderate alcohol drinking had no direct protective effect on mortality. [ABSTRACT FROM AUTHOR]

The progressive increase in the prevalence of obesity and aging in the population is resulting in increased healthcare and disability spending. The burden of obesity is particularly relevant in old age, due to accumulating co-morbidities and changes in body composition. Sarcopenic obesity, a mix of over- and under-nutrition, causes frailty, disability, and problems in social and psychological areas, impacting overall health-related quality of life (HR-QOL). The relationship between obesity, aging, and HR-QOL is, however, much more complex than generally acknowledged and is difficult to disentangle. The impact of obesity on HR-QOL is particularly strong in young people, who are free of co-morbidities. It progressively attenuates, compared with the general population, with advancing age, when co-morbid conditions are diffusely present and reduce the perceived health status, independent of obesity. However, even this apparent 'obesity paradox' should not minimize the importance of obesity on HR-QOL, as other obesity-associated limitations and disabilities do impact HR-QOL in older age. A patient-centered approach aimed at reducing the disability and social isolation of advancing age is mandatory to improve HR-QOL in any class of obesity. [ABSTRACT FROM AUTHOR]

Osteoid osteoma (OO) is one of the most common benign bone tumors with specific clinical and radiological characteristics. Analgesic therapy and surgical treatment have been considered the only therapy for a long time. Recently, safe and effective new therapeutic options have been introduced, among which percutaneous thermal ablation techniques. This review aims to describe the recent updates in the field of percutaneous thermal ablation techniques in the treatment of OO, assessing the outcomes in terms of efficacy, complications, and recurrence rate. [ABSTRACT FROM AUTHOR]

Percutaneous nephrolithotomy (PCNL) is an endourological technique for the treatment of kidney stones. Its goal is their complete clearance via percutaneous access. The technique as we know it today was developed by Johansson and Fernstrom in 1976. They used the technological advances in percutaneous fluoroscopy of the time to obtain percutaneous access. Following the application of various sources of energy (including ultrasound) for the fragmentation of calculi, PCNL gained worldwide acclaim thanks to Alken and Marbergen in Europe and Segura and Clayman in the US. Although in the early 1980s PCNL lost the initial momentum in favor of shock wave lithotripsy, it had a revival in the 1990s as a result of the application of emerging technologies such as computed tomography, new percutaneous access techniques, flexible instrumentation, laser energy and, more recently, robotic surgery and virtual reality. All of these have contributed to steering PCNL towards mini-invasiveness, culminating in the development of microperc. Microperc allows the treatment of calculi as large as 2 cm, obtaining access under ultrasound, fluoroscopy and direct vision guidance. A complete system comprising micro-optics, laser fiber and irrigation is then inserted into a needle with a diameter of 4.85, 8 or 10 Fr . The Clinical Research Office of the Endourological Society (CROES) has made use of the logistic developments to create a global network and a multicenter database. The PCNL study, which was concluded in 2009, has led to the publication of as many as 27 scientific papers on the subject. [ABSTRACT FROM AUTHOR]

The liver plays a central role in the regulation of nutrition by trafficking the metabolism of nutrients, their distribution and appropriate use. Accordingly, protein-energy malnutrition is common in patients with advanced liver disease, and it is a significant prognostic factor, affecting survival, the success of liver transplantation and quality of life. Clinical guidelines for the assessment and treatment of malnutrition have been issued by International societies, suggesting that nutritional therapy should be instituted in all patients where requirements are not adequately met by diet. The supplementation of the diet with amino acids (mainly branched-chain amino acids) and trace elements may improve nutritional status, liver function and hepatic encephalopathy. Nutritional issues should be carefully considered in Liver Units treating patients with advanced cirrhosis, and long-term, carefully controlled studies are needed to better define the type of nutritional support and the amount and timing of administration. [ABSTRACT FROM AUTHOR]

Background: The acute infusion of a Prostaglandin of E series 1 (PGE1) analogue results in nitrogen sparing in cirrhosis.Aims: To test the effects of long-term oral PGE1 on hepatic and whole-body nitrogen metabolism.Patients and methods: Ten patients with advanced cirrhosis were studied in paired experiments, before and 30–50 days after oral misoprostol therapy. α-Amino-nitrogen levels and urea-nitrogen synthesis rate were measured in the post-absorptive state and in response to continuous alanine infusion (2 mmol/kg per hour for 4.5 h). Data were used to compute the functional hepatic nitrogen clearance, i.e. the slope of the regression of α-amino-N levels to urea-N synthesis rate, and the apparent nitrogen exchange.Results: Misoprostol reduced urea-N synthesis rate (during fasting and in response to alanine), resulting in a positive nitrogen exchange. The functional hepatic nitrogen clearance slightly increased, and the regression line was rightwards shifted, indicating a reduced urea synthesis rate at any α-amino-N concentration. Amino acid- and ammonia-N did not accumulate in plasma. No systematic effects on insulin and glucagon were observed.Conclusions: Data are consistent with a nitrogen sparing mechanism of misoprostol, not mediated by hormone levels. These effects may be beneficial in clinical hepatology, and need to be tested in controlled trials. [Copyright &y& Elsevier]

During the last 20 years there has been much interest in nutritional treatment for patients with advanced cirrhosis. Most studies have measured the potential benefit of nutritional supplements of dietary proteins, generic protein hydrolysates, or specific branched-chain amino acid (BCAA)-enriched formulas in regard to nutritional parameters and hepatic encephalopathy. The issue is not definitively settled; data are conflicting and meta-analyses have failed to produce unequivocal results. A consensus review, recently produced under the auspices of the European Society for Parenteral and Enteral Nutrition, concluded that: (1) patients with cirrhosis tend to be hypermetabolic, and a higher-than-normal supply of dietary proteins is needed to achieve nitrogen balance; (2) most patients tolerate a normal or even increased dietary protein intake, without risk of hepatic encephalopathy; (3) a modified eating pattern, based on several meals and a late evening snack, is useful; (4) in severely malnourished patients, amino acid supplements may be considered to provide the necessary amount of proteins to meet protein requirements; (5) in a few patients intolerant to the required protein intake, BCAA supplements may be considered to provide the necessary nitrogen intake without detrimental effects on the mental state, perhaps even improving it. Future studies are needed to quantify the advantage of nutritional support with amino acids or BCAA supplements on overall well-being, complications, and ultimately survival with a long-lasting disease where self-perceived health-related quality of life is a major outcome. [ABSTRACT FROM AUTHOR]

The prevalence of renal cell carcinoma (RCC) is increasing due to advanced imaging techniques. Surgical resection is the standard treatment, involving complex radical and partial nephrectomy procedures that demand extensive training and planning. Furthermore, artificial intelligence (AI) can potentially aid the training process in the field of kidney cancer. This review explores how artificial intelligence (AI) can create a framework for kidney cancer surgery to address training difficulties. Following PRISMA 2020 criteria, an exhaustive search of PubMed and SCOPUS databases was conducted without any filters or restrictions. Inclusion criteria encompassed original English articles focusing on AI's role in kidney cancer surgical training. On the other hand, all non-original articles and articles published in any language other than English were excluded. Two independent reviewers assessed the articles, with a third party settling any disagreement. Study specifics, AI tools, methodologies, endpoints, and outcomes were extracted by the same authors. The Oxford Center for Evidence-Based Medicine's evidence levels were employed to assess the studies. Out of 468 identified records, 14 eligible studies were selected. Potential AI applications in kidney cancer surgical training include analyzing surgical workflow, annotating instruments, identifying tissues, and 3D reconstruction. AI is capable of appraising surgical skills, including the identification of procedural steps and instrument tracking. While AI and augmented reality (AR) enhance training, challenges persist in real-time tracking and registration. The utilization of AI-driven 3D reconstruction proves beneficial for intraoperative guidance and preoperative preparation. Artificial intelligence (AI) shows potential for advancing surgical training by providing unbiased evaluations, personalized feedback, and enhanced learning processes. Yet challenges such as consistent metric measurement, ethical concerns, and data privacy must be addressed. The integration of AI into kidney cancer surgical training offers solutions to training difficulties and a boost to surgical education. However, to fully harness its potential, additional studies are imperative. [ABSTRACT FROM AUTHOR]

The article discusses research about the relevance of metabolic syndrome to chronic liver diseases. Topics mentioned include the role of components of the metabolic syndrome on liver-related mortality in chronic liver disease, the association of diabetes with mortality in patients with cirrhosis, and behavior therapy in non-alcoholic fatty liver disease.

Background Several predictors of cognitive impairment assessed by Mini Mental State Examination (MMSE) have previously been identified. However, which predictors are the most relevant and what is their effect on MMSE categories remains unclear. Methods Cross-sectional and longitudinal study using data from 1116 older adults (72.6 ± 5.6 years, 579 female), 350 of whom were followed for 7 years. At baseline, the following variables were collected: personal data, marital status, occupation, anthropometric measures, risk factors, previous cardiovascular events, self-rated health and physical activity during the last week. Furthermore, routine laboratory tests, abdominal echography and a step test (with measurement of the time needed to ascend and descend two steps 20 times) were performed. The associations of these variables with cross-sectional cognitive deficit (MMSE < 24) and longitudinal cognitive decline (decrease of MMSE score over 7 years of follow-up) were investigated using logistic regression models. Results Cross-sectional cognitive deficit was independently associated with school education ≤ 5 years, prolonged step test duration, having been blue collar or housewife ( P  ≤ 0.0001 for all) and, with lower significance, with advanced age, previous stroke and poor recent physical activity ( P  < 0.05). Longitudinal cognitive decline was mainly associated with step test duration ( P  = 0.0001) and diastolic blood pressure ( P  = 0.0002). The MMSE categories mostly associated with step test duration were orientation, attention, calculation and language, while memory appeared to be poorly or not affected. Conclusions In our cohort of older adults, step test duration was the most relevant predictor of cognitive impairment. [ABSTRACT FROM AUTHOR]

Background: Prostate cancer is the most commonly diagnosed neoplasm in men. From the introduction of PSA testing, an increasing number of men undergoes prostate biopsy (PBX). While the physical side effects of PBx have been well investigated, its psychological impact has been under-evaluated. Aim: The aim of our study is to investigate the presence of psychological distress (anxiety and depression) in patients waiting for histopathological results after prostate biopsy (PBx). Methods: From February to April 2019, 51 consecutive patients undergoing prostate biopsies at our institution were included. Age, PSA, DRE, familiarity for prostate cancer, number of previous biopsies, type of anesthesia, number of cores were recorded. All patients filled the Hospital Anxiety and Depression Scale (HADS), a psychometric Likert-scale questionnaire, before receiving the histopathological results of their PBx. Results: The prevalence of psychological distress among patients awaiting histopathologic results is 41% (21/51 patients), with anxiety being the main component of their distress. On multivariate analysis, PSA, family history, and repeat biopsy were significantly associated with anxiety and depression. Conclusion: Patients undergoing PBx experience a burden of psychological distress waiting for histopathologic results, especially anxiety. Appropriate counseling should be offered to patients at high risk of developing psychological distress after PBx. Future goals would include technological improvements to shorten the time between biopsy and definitive results. [ABSTRACT FROM AUTHOR]

Epidemiologic studies indicate that millions of people suffer from recurrent cystitis, a pathology requiring antibiotic prophylaxis and entailing high social costs. Cranberry is a traditional folk remedy for cystitis and, which, in the form of a variety of products and formulations has over several decades undergone extensive evaluation for the management of urinary tract infections (UTI). The aim of this retrospective study is to summarize and review the most relevant and recent preclinical and clinical studies on cranberries for the treatment of UTIs. The scientific literature selected for this review was identified by searches of Medline via PubMed. A variety of recent experimental evidence has shed light on the mechanism underlying the anti-adhesive properties of proanthrocyanidins, their structure–activity relationships, and pharmacokinetics. Analysis of clinical studies and evaluation of the cranberry efficacy/safety ratio in the prevention of UTIs strongly support the use of cranberry in the prophylaxis of recurrent UTIs in young and middle-aged women. However, evidence of its clinical use among other patients remains controversial. [ABSTRACT FROM PUBLISHER]

Abstract: Non-alcoholic fatty liver disease (NAFLD) is frequently associated with metabolic syndrome (MS) and may represent a cardiovascular (CV) risk factor. Functional cardiac abnormalities have been reported in patients with NAFLD. The aim of this paper is to investigate whether these findings are present also in elderly people. We tested 171 subjects aging more than 65 years, enrolled in a prospective study on CV risk reduction, for laboratory examination, abdominal ultrasound for evaluation of hepatic steatosis and standard echocardiography for determining morphological and functional cardiac parameters. Higher BMI, serum levels of glucose, triglycerides, cholesterol, insulin and visceral adipose tissue and lower serum levels of HDL-cholesterol were significantly associated with NAFLD. Furthermore, subjects with NAFLD had higher prevalence of diabetes, pathological waist-circumference, insulin-resistance and positive ATP-III criteria. While NAFLD had only a borderline significant association with higher end-diastolic thicknesses of left-ventricle posterior wall (edPW) and right-ventricle wall, higher values of edPW and end-diastolic thickness of interventricular septum were significantly correlated with glucose levels above 100mg/dl, hypertension, MS and insulin-resistance. Moreover, subjects with MS and/or pathological waist-circumference had a lower early-diastolic mitral annular motion, whereas those with insulin-resistance had lower E/A ratio and early-diastolic filling peak velocity. Regression analyses identify hypertension and pathological waist-circumference as factors independently associated to pathological edPW, and hypertriglyceridemia to pathological left-ventricle mass. In conclusion, an ultrasonographic diagnosis of NAFLD in old subjects may be an “alert” on the coexistence of multiple CV risk factors and on the presence of possible alterations of cardiac morphology and diastolic function. [Copyright &y& Elsevier]

Introduction: Hyperglycemia is common in patients admitted to Italian medical/geriatric units and is associated with a poorer outcome. We tested the significance of diabetes and stress-induced hyperglycemia in clinical outcome. Materials and Methods: Three hundred seventy-eight consecutive patients with hyperglycemia at entry (≥ 126 mg/dl) (206 without known diabetes) were included, with a wide range of underlying diseases requiring hospital admission and independent of the presence of diabetes. Relative hyperglycemia was calculated as admission glucose divided by average glucose, estimated based of glycosylated hemoglobin. Values ≥ 1.20 were considered indicative of stress hyperglycemia (SHR). The association of SHR with outcome variables (all-cause complications, infections, non-infectious events, deaths) was tested by logistic regression analysis, adjusted for sex, BMI, age-adjusted comorbidities (Charlson index) and known diabetes. Results: During hospital stay, one or more events were registered in 96 patients (25.4%); 44 patients died in hospital, and fatality rate was borderline higher in patients without diabetes (14.6% vs. 8.1% in diabetes; P = 0.052) and nearly three times higher in patients with stress hyperglycemia (15.0%) vs. those with SHR < 1.2 (P = 0.005). Stress hyperglycemia—more common in the absence of diabetes (71% vs. 58%)—and age were the only independent prognostic factors for death. At multivariable analysis, the risks of death (OR 4.31, 95% CI 1.25–14.81), of all complications (OR 5.90, 95% CI 2.22–15.71) and of newly developed systemic infections (OR 5.67, 95% CI 1.61–19.92) were associated with stress hyperglycemia in subjects without diabetes, as was the risk in non-insulin-treated cases (OR 4.02, 95% CI 1.16–13.92; OR 5.47, 95% CI 2.21–13.52; OR 5.15, 95% CI 1.70–15.62, respectively). Conclusion: The study confirms the prognostic value of stress-related hyperglycemia in patients requiring hospital admission to a geriatric/medical unit for a variety of acute medical conditions, contributing to adverse outcomes not limited to events commonly associated with hyperglycemia (e.g., infections). [ABSTRACT FROM AUTHOR]

Robot-assisted radical prostatectomy (RARP) involves a tradeoff between oncological control and functional outcomes. Intraoperative control of surgical margins (SMs) may help in ensuring the safety of the dissection. Fluorescence confocal microscopy (FCM) is an effective method for interpretation of prostate tissue and provides digital images with an appearance similar to hematoxylin-eosin staining. To describe an alternative technique to NeuroSAFE for intraoperative evaluation of neurovascular-adjacent margins shaved from ex vivo specimens using FCM analysis. This was a prospective study of 24 patients undergoing RARP with intraoperative FCM control of margin status. After surgical dissection, SMs are sectioned from the fresh prostate using the Mohs technique (shaving): three slices from the apex and the right and left posterolateral aspects are obtained. Digital images of the shavings are immediately acquired via FCM and shared with a remote pathologist. In the case of a positive SM, a focal secondary resection of the bundle can be performed owing to the ability of FCM to locate a region of interest on the flat sample. The primary outcome measure was the rate of negative margins at neurovascular-adjacent sites. Oncological and functional outcomes for patients with 1 yr of follow-up are also reported. All patients had negative SMs in shavings from neurovascular-adjacent areas at final histopathology; four underwent a secondary resection with final conversion to negative SM status. Nine of ten patients with 1-yr follow-up are free of biochemical recurrence (prostate-specific antigen persistence in one pN1 case), nine are fully continent, and four of the five with preoperative potency have recovered their sexual function. Digital frozen sections with FCM during RARP may represent an alternative to NeuroSAFE for possible optimization of functional outcomes without compromising oncological safety. We developed a technique to ensure complete removal of cancer tissue during surgical removal of the prostate. Tissue specimens are examined via digital microscopy in real time during the operation. This allows the surgeon to remove more tissue if cancer is detected at the margins of a specimen, while avoiding unnecessary removal of healthy tissue. Fluorescence confocal microscopy analysis of areas adjacent to neurovascular bundles in freshly shaved prostate specimens represents a feasible and easy procedure to control surgical margin status during prostatectomy. The ability to create digital images without conventional processing and to allow remote reporting is a major strength. In the future, the technique could be used to guide functional tissue sparing and reduce positive margins at final histopathology. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the impact of an e-learning online event, created for supporting resident's training during the slowdown of surgical and clinical activities caused by COVID-19 pandemic. An overview of PubMed literature depicting the state of the art of urology residency in the COVID-19 era was performed as well, to contextualize the issue. Methods: An online learning event for residents was set up at the beginning of the pandemic; the faculty consisted of experts in urology who provided on-line lectures and videos on surgical anatomy, procedures, updates in guidelines, technology, training. The audience was composed of 30–500 attendees from Italy, USA, India and Belgium. A questionnaire to analyze relevance, satisfaction and popularity of the lessons was mailed to 30 local residents. Results and limitations: Almost all residents defined the web environment suitable to achieve the learning outcomes; the method, the number and the competence of the faculty were appropriate/excellent. Most of the younger residents (81.8%) stated their surgical knowledge would improve after the course; 72.7% declared they would take advantage into routine inpatients clinical activity. Nineteen more expert residents agreed that the course would improve their surgical knowledge and enhance their practical skills; almost all stated that the initiative would change their outpatients and inpatients practice. Overall, 44 articles available in PubMed have addressed the concern of urological learning and training during the pandemic from different standpoints; four of them considered residents' general perception towards web-based learning programs. Conclusions: The paper confirms residents' satisfaction with e-learning methods and, to our knowledge, is the first one focusing on a specific event promptly settled up at the beginning of the outbreak. Web-based educational experience developed during the pandemic may represent the very basis for the implementation of prospective on-site training and overall scientific update of future urologists. [ABSTRACT FROM AUTHOR]

Live surgery events (LSEs) have been used in all surgical fields for education and training and to demonstrate new techniques. The European Association of Urology (EAU) live surgery guidelines were established in 2014. To review the compliance of outcomes for procedures performed at EAU-affiliated LSEs with the 2014 guidelines and to establish updated guidelines for LSEs and semi-LSEs. Patients from EAU-affiliated LSEs were included for all surgical procedures carried out between January 2015 and January 2020. All these events were pre-evaluated by the EAU Live Surgery Committee and met the criteria for an EAU LSE, with outcomes recorded and submitted to the registry. Data were collected for the type of procedure and for intraoperative and short- and long-term complications. A total of 246 procedures were performed across 18 LSEs, with an annual volume ranging from 19 to 74 procedures. These included 109 (44.3%) robot-assisted procedures, 21 (8.5%) laparoscopic procedures, 10 (4%) transurethral bladder procedures, 11 (4.4%) prostate enucleation procedures, 72 (29.2%) endourological procedures, and 23 (9.3%) andrology or reconstruction procedures. A total of 77 different surgical techniques and variations for 55 different types of surgery were performed as LSEs over the past 5 yr. There were 44 (17.8%) short-term complications and 11.3% (nine/79) long-term complications observed, with Clavien grade III/IV complications seen in 5.2% and 7.5% of cases over short- and long-term follow-up, respectively. The 5-yr outcomes for EAU LSEs show that they are safe and follow previous guidelines set by the panel. It seems likely that the fine balance between patient safety and educational value might be best achieved if LSEs are performed by local surgeons in their parent hospital with patients and staff they know, and that technological advances will make live streaming a seamless process. The current EAU Live Surgery Committee has updated the guidelines on LSEs and provided new guidelines for semi-live events. We reviewed 5-year outcomes for live surgery events endorsed by the European Association of Urology. We found that the operations carried out at these events were safe and followed the guidelines previously set. We have updated the guidelines and provided new guidelines for semi-live events. The 5-year outcomes for European Association of Urology (EAU) live surgery events (LSEs) show that they are safe and follow previous EAU guidelines. It seems likely that a fine balance between patient safety and educational value might be best achieved if LSEs are performed by local surgeons in their parent hospital with patients and staff they know. The current EAU Live Surgery Committee has updated the LSE guidelines and provided new guidelines for semi-live events. [ABSTRACT FROM AUTHOR]

OBJECTIVE -- This study was performed to ascertain the relative relevance of some inflammatory markers in insulin resistance. RESEARCH DESIGN AND METHODS-- Four inflammatory markers (leukocyte count, erythrocyte sedimentation rate [ESR], high-sensitivity C-reactive protein [CRP], and C3 complement) were assessed as possible determinants of the homeostasis model assessment (HOMA) index, together with the five elements of the metabolic syndrome (National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults [Adult Treatment Panel III] definition), total cholesterol, physical activity, and four indicators of adiposity (BMI, waist circumference, percent body fat, and hepatic steatosis) in an unselected population of 990 subjects aged 65-91 years (the Pianoro Study). RESULTS-- In univariable analysis, C3, CRP, and leukocyte count, but not ESR, were significantly correlated with HOMA index. In multivariable analysis, C3 remained associated with insulin resistance with the highest partial R² value (0.049), independently of all other covariates. The other most significant (P < 0.0001) determinants of HOMA index were total cholesterol (inverse association, R² = 0.026), waist circumference (R² = 0.023), triglycerides (R² = 0.022), and hepatic steatosis (R² = 0.021) (R² = 0.450 for the whole model). The adjusted relative risks of having the metabolic syndrome for the subjects with inflammatory markers in the high tertile, with respect to those with lower values, were (prevalence ratio [95% CI]): 1.77 (1.41-2.22) for C3, 1.38 (1.12-1.70) for leukocyte count, 1.17 (0.94-1.46) for CRP, and 1.13 (0.91-1.40) for ESR. CONCLUSIONS-- Of the four inflammatory markers simultaneously assessed in our elderly population, only C3 was strongly associated with insulin resistance, independently of the components of the metabolic syndrome and the main indexes of abdominal and general obesity. [ABSTRACT FROM AUTHOR]

Abstract: Background: The levels of B-type natriuretic peptide (BNP), a marker of heart failure, are higher in women and anaemic subjects, and tend to be lower in obese people. These relationships are still largely unexplained and it is unclear whether they also apply to the N-terminal portion of BNP precursor (NT-proBNP). Aims: This cross-sectional study was performed to assess general and abdominal obesity, sex and other variables as possible extra-cardiac determinants of NT-proBNP. Methods and results: A random sample of 713 subjects aged 65–74 years resident of Pianoro (Northern Italy) underwent assessment of NT-proBNP, several haemato-chemical variables, body mass index (BMI), body fat estimation (through skinfold measurement), waist circumference, intra-abdominal thickness and possible presence of hepatic steatosis (by ultrasound examination). An echocardiogram was performed in a subset of 125 subjects. In multivariable analysis NT-proBNP was inversely associated with haematocrit (r =0.22, P <0.0001) and hepatic steatosis (r =0.13, P =0.0001), while no association was found with BMI and body fat estimation. NT-proBNP was higher in women, but this relationship disappeared when haematocrit was included in the multivariable model. The associations with haematocrit and hepatic steatosis were independent from echocardiographic measurements. Conclusion: NT-proBNP is increased in subjects with low haematocrit, which explains the higher values in women. Although NT-proBNP is not affected by general adiposity, low levels of NT-proBNP are associated with hepatic steatosis. [Copyright &y& Elsevier]

Introduction: Telementoring is one of the applications of telemedicine capable of bringing highly experienced surgeons to areas lacking expertise. In the current study, we aimed to assess a novel telementoring application during the learning curve of transurethral enucleation of the prostate using bipolar energy (TUEB). Material and methods: A telementoring system was developed by our engineering department. This application was used to mentor ten prospective cases of TUEB performed by an expert endourologist (novice to the TUEB). A questionnaire was filled by the operating surgeon and the mentor to provide subjective evaluation of the telementoring system. Finally, the outcomes of these patients were compared to a control group consisting of ten consecutive patients performed by the mentor. Results: Ten consecutive TUEB were performed using this telementoring application. Delayed and interrupted connection were experienced in two and one patients, respectively; however, their effect was minor, and they did not compromise the safety of the procedure. None of the patients required conversion to conventional transurethral resection of the prostate. Only one patient in our series experienced grade IIIb complication. Conclusion: The telementoring application for TUEB is promising. It is a simple and low-cost tool that could be a feasible option to ensure patients' safety during the initial phase of the learning curve without time and locations constraints for both the mentor and the trainee; However, it should be mentioned that telementoring cannot yet replace the traditional surgical training with the mentor and trainee being in the operative room. Further studies are required to confirm the current results [ABSTRACT FROM AUTHOR]

Introduction: The Coronavirus disease-2019 (COVID-19) has been declared as a pandemic in March 2020 by the World Health Organization (WHO). Since then, this pandemic has dramatically affected the entire world, even radically influencing the way patients are framed at triage. Symptoms and tests in most cases lead to a correct diagnosis; however, error may be around the corner. Case report: A 60 years old patient was referred with weight loss, fatigue and mild fever for 3 weeks as he was working in a COVID-19 ward. After a positive swab and chest CT scan, he was admitted in the hospital and treated as mild COVID-19 patient. A CT scan performed after the patient was discharged revealed a renal lesion misidentified as a tumor then clarified to be an abscess which retrospectively appears to be the main cause of his symptoms. Conclusion: Clinicians should consider other life-threatening disease in the differential diagnosis of patients presenting with similar symptoms to minimize mistakes and avoid further unnecessary investigations. [ABSTRACT FROM AUTHOR]

Objective: Total serum homocysteine is a risk factor for cardiovascular disease in the general population. Further, homocysteine might be the link between psychological traits (namely anger and hostility) and cardiovascular disease, mediated by stressful events and sympathetic nervous tone.Methods: We measured total plasma homocysteine levels and psychological traits in 205 obese individuals entering a weight-reduction program (162 females; age range, 17–64 years; body mass index, 37.7 ± 6.2 kg/m2, mean ± standard deviation). Psychometric assessment was performed with three self-administered questionnaires (Symptom Checklist 90, composed of nine subscales including Hostility/Anger and Depression scales; Beck Depression Inventory; and Binge Eating Scale).Results: Homocysteine levels were moderately increased in obese individuals when compared with the normal population and higher in males (median, 12.9 μmol/L; range, 6.9–26.3) than in females (9.8; 4.6–24.6; P < 0.0002), but not different in relation to the severity of obesity. Serum folate and vitamin B12 were normal. Psychometric testing showed pathologic data in up to 50% of patients and the Anger/Hostility scale was positive in 24%, mainly female, subjects. There were no differences in psychological traits in relation to the severity of obesity. Homocysteine did not correlate with Symptom Checklist 90 values or other values of psychometric testing.Conclusions: In obese persons, psychological traits are not major determinants of total homocysteine. A different response to stressful events, not simply mediated by sympathetic nervous tone, might be present in obesity. [ABSTRACT FROM AUTHOR]

Examines the insulin sensitivity of patients with nonalcoholic fatty liver disease. Analysis of the normal glucose tolerance; Reduction of glucose disposal during euglycemic clamping; Decrease in postabsorptive hepatic glucose production.

Aims: A sliding-scale (SS) regimen is discouraged to correct hyperglycemia in hospital patients, but there is resistance to adoption of basal–bolus (BB) treatment in surgical units. We tested the feasibility and the effects of a nurse-based BB regimen in orthopedic surgery. Methods: Following an intense training to implement a protocol amenable by nurses, a group of patients admitted with hyperglycemia in an orthopedic institute were prospectively followed according to a basal–bolus insulin regimen (BB, n = 80). They were compared with a hyperglycemic group eventually treated by sliding-scale insulin on demand (SS, n = 122). Diabetes was present in 196 cases. Metabolic control was assessed during the first 3 days of surgery; outcome data were tested by logistic regression, after adjusting for propensity score. Result: Average blood glucose and glucose variability were lower in BB versus SS (P < 0.001), in the presence of similar 3-day insulin doses. Complications were recorded in 68 cases (16.2% vs. 45.1% in BB and SS, respectively). BB regimen was associated with propensity-adjusted reduction in all adverse events [odds ratio (OR) 0.36; 95% confidence interval (CI) 0.17–0.76] and of systemic infections (OR 0.18; 95% CI 0.07–0.50) and with shorter hospital stay (8.8 ± SD 5.2 days vs. 12.5 ± 7.4; P < 0.01). The superiority of BB regimen was confirmed in the pair-matched analysis. Conclusions: The study proves the feasibility and the superiority of nurse-based BB versus SS treatment in metabolic control and on the risk of adverse events in orthopedic surgery patients with hyperglycemia. [ABSTRACT FROM AUTHOR]

Objective: To discuss the impact of COVID‐19 on global health, particularly on urological practice and to review some of the available recommendations reported in the literature. Material and Methods: In the current narrative review the PubMed database was searched to identify all the related reports discussing the impact of COVID‐19 on the urological field. Results: The COVID‐19 pandemic is the latest and biggest global health threat. Medical and surgical priorities have changed dramatically to cope with the current challenge. These changes include postponements of all elective outpatient visits and surgical procedures to save facilities and resources for urgent cases and patients with COVID‐19 patients. This review discuss some of the related changes in urology. Conclusions: Over the coming weeks, healthcare workers including urologists will be facing increasingly difficult challenges, and consequently, they should adopt triage strategy to avoid wasting of medical resources and they should endorse sufficient protection policies to guard against infection when dealing with COVID‐19 patients. [ABSTRACT FROM AUTHOR]

Objective: The aim of the paper is to provide an overview of intraoperative sampling methods for frozen section (FS) analysis and of surgical techniques for a secondary neurovascular bundle (NVB) resection, as the method of surgical margin (SM) sampling and the management of a positive SM (PSM) at the nerve‐sparing (NS) area are under evaluated issues. FS analysis during radical prostatectomy (RP) can help to tailor the plane of dissection based on cancer extension and thus extend the indications for NS surgery. Evidence Acquisition: We performed a PubMed/Medical Literature Analysis and Retrieval System Online (MEDLINE), Web of Science, Cochrane Library, and Elton B. Stephens Co. (EBSCO)host search to include articles published in the last decade, evaluating FS analysis in the NS area and surgical attempts to convert a PSM to a negative status. Evidence Synthesis: Overall, 19 papers met our inclusion criteria. The ways to collect samples for FS analysis included: systematic (analysing the whole posterolateral aspect of the prostate specimen, i.e., neurovascular structure‐adjacent frozen‐section examination [NeuroSAFE]); magnetic resonance imaging (MRI)‐guided (biopsies from MRI‐suspicious areas, retrieved by the surgeon in a cognitive way); and random biopsies from the soft periprostatic tissues. Techniques to address a PSM in the NS area included: full resection of the spared NVB, from its caudal to cranial aspect, often including the rectolateral part of the Denonvilliers' fascia; partial resection of the NVB, in cases where sampling attempts to localise a PSM; incremental approach, meaning a partial or full resection that extends until no prostate tissue is found in the soft periprostatic environment. Conclusions: There is no homogeneity in prostate sampling for FS analysis, although most recent evidence is moving toward a systematic sampling of the entire NS area. The management of a PSM is variable and can be affected by the sampling strategy (difficult localisation of the persisting tumour at the NVB). The difficult identification of the exact soft tissue location contiguous to a PSM could be considered as the critical point of FS analysis and of spared‐NVB management. [ABSTRACT FROM AUTHOR]

Purpose: To assess the MRI modifications of the intervertebral disc (IVD) treated by chemiodiscolysis using T2 mapping sequences. Methods: Thirty sciatica patients (17 males, 13 females, mean age 47.52 years) were enrolled for percutaneous CT-guided O2–O3 chemiodiscolysis treatment. As a control group, we enrolled 30 patients who were treated by CT-guided periradicular injections. All patients were submitted to clinical (using VAS and Oswestry Disability index (ODI)) and imaging studies to evaluate the intervertebral disc area (IDA) and T2 mapping values of the IVD before and at 1-month follow-up. Results: In the study group, pre-treatment IDA mean values were 20.47 ± 1.62 cm2, with significant reduction at the follow-up (P < 0.05). Mean pre-treatment T2 relaxation time values were 38.80 ± 4.51 ms, 44.05 ± 0.91 ms, and 45.45 ± 14.11 ms for anterior annulus fibrosus, nucleus pulposus (NP), and posterior annulus fibrosus, respectively, with significant increase at the level of the NP (P < 0.05) at the follow-up. Mean pre-treatment ODI and VAS scores were 21.5 ± 10.6 and 8.5 ± 0.57, with significant improvement at the post-treatment follow-up (P < 0.05). In the control group, despite clinical improvement, we did not find significant IVA reduction nor significant T2 values change after treatment. Correlation analysis of T2 mapping relaxation time values showed significant correlation of NP T2 mapping value with both the reduction of IDA (0.81, P < 0.001) and the improvement of VAS and ODI scores (0.86, P < 0.001) at 1 month. In the control group, we did not find any statistically significant correlation. Conclusions: T2 mapping may be a useful indicator to predict disc shrinkage and the clinical response to CT-guided O2–O3 injection. [ABSTRACT FROM AUTHOR]

Drug-induced nephrolithiasis is a rare condition in children. The involved drugs may be divided into two different categories according to the mechanism involved in calculi formation. The first one includes poorly soluble drugs that favor the crystallization and calculi formation. The second category includes drugs that enhance calculi formation through their metabolic effects. The diagnosis of these specific calculi depends on a detailed medical history, associated comorbidities and the patient's history of drug consumption. There are several risk factors associated with drug-induced stones, such as high dose of consumed drugs and long duration of treatment. Moreover, there are some specific risk factors, including urinary pH and the amount of fluid consumed by children. There are limited data regarding pediatric lithogenic drugs, and hence, our aim was to perform a comprehensive review of the literature to summarize these drugs and identify the possible mechanisms involved in calculi formation and discuss the management and preventive measures for these calculi. [ABSTRACT FROM AUTHOR]

Objective: To report the first application of ex vivo fluorescence confocal microscopy (FCM) ‐ a novel optical technology that is capable of providing fast microscopic imaging of unfixed tissue specimens‐ in the urological field assessing its diagnostic accuracy for non neoplastic and cancerous prostate tissue (prostatic adenocarcinoma) compared to the 'gold standard' histopathological diagnoses. Patients and methods: In all, 89 specimens from 13 patients with clinically localised prostate cancer were enrolled into the study. All patients underwent robot‐assisted laparoscopic radical prostatectomy with fresh prostatic tissue biopsies taken at the end of each intervention using an 18‐G biopsy punch. Specimens were randomly assigned to the three collaborating pathologists for evaluation. Intra‐ and inter‐observer agreement was tested by the means of Cohen's κ. The diagnostic performance was evaluated on receiver operating characteristic curve analysis. Results: The overall diagnostic agreement between FCM and histopathological diagnoses was substantial with a 91% correct diagnosis (κ = 0.75) and an area under the curve of 0.884 (95% confidence interval 0.840–0.920), 83.33% sensitivity, and 93.53% specificity. Conclusion: FCM seems to be a promising tool for enhanced specimens' reporting performance, given its simple application and very rapid microscopic image generation (<5 min/specimen). This technique may potentially be used for intraoperative pathological specimens' analysis. [ABSTRACT FROM AUTHOR]

Introduction and aim: The urodynamic study is an invasive examination that allows a thorough evaluation of the functional activity of the lower urinary tract (bladder, urethra). The execution of urodynamic study exposes the patient to the risk of contracting infections of the lower urinary tract. Prevention of urinary tract infections consists in the avoidance of risk factors and prophylaxis with antimicrobial and non-antimicrobial measures. In this article, we aimed to evaluate the effectiveness of a phytotherapeutic product composed of D-mannose, Hibiscus sabdariffa, and Lactobacillus plantarum in the prevention of infectious events following invasive urodynamic examination. Materials and methods: We selected 100 female consecutive patients (age 19–87 years) that underwent urodynamic invasive procedure. We prescribed 14-day therapy with D-mannose, H. sabdariffa, and L. plantarum to these 100 patients after urodynamic invasive test. After that, we have examined urine cultures and urinary symptoms through telephone interviews and hospital outpatient visits to evaluate the possible presence of urinary tract infections. Results: Urinary tract infections were observed through urine culture in 13% of the selected patients; of the 13 urinary tract infections, 9 were observed in patients with urinary tract recurrent infections in the last year and the other 4 cases were associated with patients with no urinary infection in the last year. Three women reported some urinary symptoms and underwent antibiotic therapy. The other 10 cases were classified as asymptomatic bacteriuria. Three cases were related to patients presenting with pelvic organ prolapse. Eight cases were instead related to significant post-voiding residue (>100). Six patients with urinary tract infection reported constipation in the last year. All patients completed the prescribed therapy due to the affordable price of the product and no side effects have been reported. Conclusion: Our study about the administration of D-mannose, H. sabdariffa, and L. plantarum after invasive urodynamic examination underlined how this phytotherapeutic product can reduce the risk of bacteriuria and urinary tract infection in women. [ABSTRACT FROM AUTHOR]

Our aim was to review and externally validate all the available predictive tools (PTs) predicting extraprostatic extension (EPE) using the area under the curve, calibration plots, and scaled Brier score. A literature search was performed showing 19 models predicting EPE. External validation was carried out on 6360 prostate cancer patients submitted to RP. Most of the PTs showed poor discrimination and unsatisfactory calibration. The majority of the available PTs are not reliable for the prediction of EPE in populations other than the development one; thus, they may not be completely appropriate for patients' counselling or for surgical strategy preplanning. [ABSTRACT FROM AUTHOR]

Purpose: To provide latest evidence on the use of suprapubic catheter (SPC) versus urethral catheter (UC) after robot-assisted laparoscopic radical prostatectomy (RARP).Materials and methods: A systematic revision of literature was performed up to September 2017 using different search engines (Pubmed, Ovid, Scopus) to identified studies comparing the use of SPC versus standard UC after RARP. Identification and selection of the studies were conducted according to the preferred reporting items for systematic reviews and meta-analysis criteria. For continuous outcomes, the weighted mean difference (WMD) was used as a summary measure, whereas the odds ratio (OR) or risk ratio (RR) with 95% confidence interval (CI) was calculated for binary variables. RR was preferred in cases of a high number of events to avoid overestimation. Pooled estimates were calculated using the random-effect model to account for clinical heterogeneity. All statistical analyses were performed using Review manager 5 (Cochrane Collaboration, Oxford, UK).Results: Eight studies were identified and included in this systematic review, namely 3 RCTs, 4 non-randomized prospective studies, and one retrospective study. A total of 966 RARP cases were collected for the cumulative analysis. Among them, 492 patients received standard UC and 474 SPC placement after RARP. UC patients had higher baseline PSA (WMD 0.44 ng/ml; p = 0.02). Visual Analog Scale (VAS) score was found to be significantly lower in patients with SPC at postoperative day 7 (WMD 0.53; 95% CI 0.13-0.93; p = 0.009). Regarding penile pain, a significant difference in favor of the SPC group was found at postoperative day 7 assessment (WMD 1.2; 95% CI 0.82-1.6; p < 0.001). More patients in the SPC group reported “not at all” or “minimal pain” at this time point (OR 0.17, 95% CI 0.06, 0.44; p < 0.001). No significant differences were found in terms of continence recovery rate at 6-12 weeks between the groups (UC 78.7%, 88.2%; RR 0.92, 95% CI 0.84, 1.01; p = 0.09). Similarly, no differences were found in terms of catheter-related issues (p = 0.17). However, UC patients had lower likelihood of overall complications (OR 0.44, 95% CI 0.21-0.89, p = 0.02).Conclusions: Available evidence suggests that the use of SPC can be a viable option for postoperative urine drainage after RARP, as it can translate into decreased postoperative pain without carrying a significant higher risk of catheter-related complications. Further investigation seems to be warranted, ideally within the framework of a multicentre randomized study with standardized analysis of outcomes. [ABSTRACT FROM AUTHOR]

Real-time assessment of surgical margins during radical prostatectomy: a novel approach that uses fluorescence confocal microscopy for the evaluation of peri-prostatic soft tissue PCa was detected in one patient (the patient with macroscopical pT3a disease), prostatic benign glands were detected in one patient, and for the remaining patients only soft tissue was present. FCM diagnostic performance in distinguishing between non-prostatic tissue, benign prostatic tissue and PCa was high; FCM demonstrated almost perfect agreement with H&E in its depiction of all tissue types. [Extracted from the article]

Objectives: To create a statistical tool for the estimation of extracapsular extension (ECE) level of prostate cancer and determine the nerve‐sparing (NS) approach that can be safely performed during radical prostatectomy (RP). Patients and Methods: A total of 11 794 lobes, from 6 360 patients who underwent robot‐assisted RP between 2008 and 2016 were evaluated. Clinicopathological features were included in a statistical algorithm for the prediction of the maximum ECE width. Five multivariable logistic models were estimated for: presence of ECE and ECE width of >1, >2, >3, and >4 mm. A five‐zone decision rule based on a lower and upper threshold is proposed. Using a graphical interface, surgeons can view patient's pre‐treatment characteristics and a curve showing the estimated probabilities for ECE amount together with the areas identified by the decision rule. Results: Of the 6 360 patients, 1 803 (28.4%) were affected by non‐organ‐confined disease. ECE was present in 1 351 lobes (11.4%) and extended beyond the capsule for >1, >2, >3, and >4 mm in 498 (4.2%), 261 (2.2%), 148 (1.3%), 99 (0.8%) cases, respectively. ECE width was up to 15 mm (interquartile range 1.00–2.00). The five logistic models showed good predictive performance, the area under the receiver operating characteristic curve was: 0.81 for ECE, and 0.84, 0.85, 0.88, and 0.90 for ECE width of >1, >2, >3, and >4 mm, respectively. Conclusion: This novel tool predicts with good accuracy the presence and amount of ECE. Furthermore, the graphical interface available at www.prece.it can support surgeons in patient counselling and preoperative planning. [ABSTRACT FROM AUTHOR]

Biparametric Magnetic Resonance Imaging (bpMRI) of the prostate combining both morphologic T2-weighted imaging (T2WI) and diffusion-weighted imaging (DWI) is emerging as an alternative to multiparametric MRI (mpMRI) to detect, to localize and to guide prostatic targeted biopsy in patients with suspicious prostate cancer (PCa). BpMRI overcomes some limitations of mpMRI such as the costs, the time required to perform the study, the use of gadolinium-based contrast agents and the lack of a guidance for management of score 3 lesions equivocal for significant PCa. In our experience the optimal and similar clinical results of the bpMRI in comparison to mpMRI are essentially related to the DWI that we consider the dominant sequence for detection suspicious PCa both in transition and in peripheral zone. In clinical practice, the adoption of bpMRI standardized scoring system, indicating the likelihood to diagnose a clinically significant PCa and establishing the management of each suspicious category (from 1 to 4), could represent the rationale to simplify and to improve the current interpretation of mpMRI based on Prostate Imaging and Reporting Archiving Data System version 2 (PI-RADS v2). In this review article we report and describe the current knowledge about bpMRI in the detection of suspicious PCa and a simplified PI-RADS based on bpMRI for management of each suspicious PCa categories to facilitate the communication between radiologists and urologists. Keywords: Biparame [ABSTRACT FROM AUTHOR]

Background: To evaluate the safety and efficacy of abiraterone acetate (AA) in the "real life" clinical practice for men with chemotherapy-naïve metastatic castration-resistant prostate.Methods: A consecutive series of patients with mCRPC in 9 Italian tertiary centres treated with AA was collected. Demographics, clinical parameters, treatment outcomes and toxicity were recorded. The Brief Pain Inventory scale Q3 was tracked and patient treatment satisfaction was evaluated. Survival curves were estimated by the method of Kaplan-Meier and Cox regression and compared by the log-rank test statistic.Results: We included 145 patients (mean age 76.5y). All patients were on androgen deprivation therapy. Patients had prior radiotherapy, radical prostatectomy, both treatments or exclusive androgen deprivation therapy in 17%, 33%, 9% and 40%, respectively. 57% of the patients had a Gleason score higher more than 7 at diagnosis. 62% were asymptomatic patients. The median serum total PSA at AA start was 17 ng/mL (range 0,4-2100). The median exposure to AA was 10 months (range 1-35). The proportion of patients achieving a PSA decline ≥50% at 12 weeks was 49%. Distribution of patient satisfaction was 32% "greatly improved", 38% "improved", 24% "not changed", 5.5% "worsened". Grade 3 and 4 toxicity was recorded in 17/145 patients 11.7% (70% cardiovascular events, 30% critical elevation of AST/ALT levels). At the last follow-up, median progression free and overall survival were 17 and 26.5 months, respectively. Both outcomes significantly correlated with the presence of pain, patient satisfaction, PSA baseline and PSA decline.Conclusions: The AA is effective and well tolerated in asymptomatic or slightly symptomatic mCRPC in a "real life" setting. The survival outcomes are influenced by the presence of pain, patient satisfaction, baseline PSA and PSA decline.Trial Registration: The study was retrospectively registered at ISRCTN as DOI: 10.1186/ISRCTN 52513758 in date April the 30th 2016. [ABSTRACT FROM AUTHOR]

Introduction: Although differentiation between benign and malignant small renal tumors (≤4 cm) is still difficult, it is a demand for decision making and determining the treatment strategy. Our aim is to evaluate the role of multidetector row computed tomography (MDCT) in the differentiation of small renal clear cell carcinoma (RCC) and renal oncocytoma (RO). Methods: We reviewed triphasic computed tomographic (CT) scans performed in 43 patients diagnosed with RCC (n = 23) and RO (n = 21). After an unenhanced CT phase of the upper abdomen, triple-phase acquisition included a cortico-medullary phase (CMP), a nephrographic phase (NP), and a pyelographic phase (PP), and lesions were evaluated both qualitatively and quantitatively. Results: RCCs were hypervascular in 13 cases and hypovascular in 10 cases, while ROs were hypervascular in nine cases and hypovascular in 12 cases. Mean attenuation values (MAVs) for hypervascular RCCs and hypervascular ROs on unenhanced examination were 34.0 ± 7.1 and 31.3 ± 8.1 HU, respectively. Enhancement in CMP was 173.1 ± 45.2 HU for RCCs and 151.1 ± 36.0 HU for ROs and a gradual wash-out in NP (148.8 ± 34.3 and 137.1 ± 33.9 HU for RCCs and ROs, respectively) and in PP (98.2 ± 36.0 HU for RCCs and 79.4 ± 21.5 HU for ROs) was observed. MAV for hypovascular RCCs and hypovascular ROs on unenhanced examination were 32.4 ± 12.0 and 28.9 ± 8.0 HU, respectively. Both hypovascular RCCs and ROs showed a statistically significant difference in each post contrastographic phase. Conclusions: Absolute attenuation and the quantitative amount of the enhancement were not strong predictors for RO and RCC differentiation. [ABSTRACT FROM AUTHOR]

Prostate Imaging Reporting and Data System version 2 (PI-RADS v2) does not offer a precise guidance on the clinical management (biopsy or not biopsy) for PI-RADS v2 score 3 lesions. Lesion volume calculated on biparametric MRI (bpMRI) [T2-weighted imaging (T2WI) and diffusion-weighted imaging (DWI)] by introducing a cut-off of 0.5 mL, allows to distinguish the lesions assigned by the multiparametric MRI (mpMRI) to the category PI-RADS v2 score 3 in two subgroups: a) Indolent or low risk lesions with volume <0.5 mL, and b) Significant or high risk lesions with volume ≥0.5 mL. For mpMRI lesions assigned to PI-RADS v2 score 3, we suggest the following management: 1) Subgroup a (low-risk lesion): Clinical surveillance (accurate evaluation of age and clinical informations, periodic monitoring of prostate specific antigen value and repeated bpMRI 1 year later); 2) Subgroup b (high-risk lesion): Targeted biopsy. The proposed management would reduce the use of unnecessary biopsies and increase the diagostic yield of significant prostate cancer of approximately 50% and 30% respectively. These approaches encourage the radiologist to adopt MRI lesion volume to improve PIRADS v2 and to optimize the management of PI-RADS v2 score 3 lesions. [ABSTRACT FROM AUTHOR]

Discriminating between causes of dyspnea may be difficult, particularly in the elderly. The aim of this retrospective study of 83 inpatients with acute dyspnea was to assess the influence of age, multimorbidity and cognitive or motor impairment on the diagnostic accuracy of lung ultrasound (LUS) in discriminating acute heart failure (AHF) from noncardiogenic dyspnea (NCD). Univariate analysis indicates that LUS misdiagnosis was associated with the following parameters: history of stroke (p = 0.037), lower activity of daily living (p = 0.039), higher modified-Rankin scale (mRS) (p = 0.027) and need of two operators to complete LUS because of reduced patient compliance (p = 0.030). Regression analysis identified only history of stroke (p = 0.048) as an independent predictor of LUS misdiagnosis. This study supports LUS usefulness to differentiate AHF from NCD. Our data suggest that diagnostic accuracy of LUS is affected by history of stroke as a proxy for severe motor impairment but not by age, cognitive impairment and multimorbidity. [ABSTRACT FROM AUTHOR]

Objective To demonstrate the association between magnetic resonance imaging ( MRI) estimated lesion volume ( LV), prostate cancer detection and tumour clinical significance, evaluating this variable alone and matched with Prostate Imaging Reporting and Data System version 2 ( PI- RADS v2) score. Patients and methods We retrospectively analysed 157 consecutive patients, with at least one prior negative systematic prostatic biopsy, who underwent transperineal prostate MRI/ultrasonography fusion-targeted biopsy between January 2014 and February 2016. Suspicious lesions were delineated using a 'region of interest' and the system calculated prostate volume and LV. Patients were divided in groups considering LV (≤0.5, 0.5-1, ≥1 mL) and PI- RADS score (1-5). We considered clinically significant prostate cancer as all cancers with a Gleason score of ≥3 + 4 as suggested by PI- RADS v2. A direct comparison between MRI estimated LV ( MRI LV) and histological tumour volume ( HTV) was done in 23 patients who underwent radical prostatectomy during the study period. Differences between MRI LV and HTV were assessed using the paired sample t-test. MRI LV and HTV concordance was verified using a Bland-Altman plot. The chi-squared test and logistic and ordinal regression models were used to evaluate difference in frequencies. Results The MRI LV and PI- RADS score were associated both with prostate cancer detection (both P < 0.001) and with significant prostate cancer detection ( P < 0.001 and P = 0.008, respectively). When the two variables were matched, increasing LV increased the risk within each PI- RADS group. Prostate cancer detection was 1.4-times higher for LVs of 0.5-1 mL and 1.8-times higher for LVs of ≥1 mL; significant prostate cancer detection was 2.6-times for LVs of 0.5-1 mL and 4-times for LVs of ≥1 mL. There was a positive correlation between MRI LV and HTV ( r = 0.9876, P < 0.001). Finally, Bland-Altman analysis showed that MRI LV was underestimated by 4.2% compared to HTV. Study limitations include its monocentric and retrospective design and the limited cohort. Conclusions This study demonstrates that PI- RADS score and the MRI LV, independently and in combination, are associated with prostate cancer detection and with tumour clinical significance. [ABSTRACT FROM AUTHOR]

Background and study objective: Several studies suggest a protective role of green tea catechins against prostate cancer (PCa). In order to evaluate the efficacy of green tea catechins for chemoprevention of PCa in patients with high-grade prostate intraepithelial neoplasia (HG-PIN) we performed a phase II clinical trial. Methods: Sixty volunteers with HG-PIN were enrolled to carry out a double-blind randomized placebo-controlled phase II clinical trial. Treated group took daily 600 mg of green tea catechins (Categ Plus®) for 1 year. Patients were screened at 6 and 12 months through prostatic biopsy and measurements of prostate-specific antigen (PSA). Results: Despite the statistically significant reduction of PSA observed in subjects who received green tea catechins for 6 and 12 months, we did not find any statistical difference in PCa incidence between the experimental groups neither after 6 nor after 12 months. However, throughout the one-year follow-up we observed very limited adverse effects induced by green tea catechins and a not significant improvement in lower urinary tract symptoms and quality of life. Conclusions: Although the small number of patients enrolled in our study and the relatively short duration of intervention, our findings seems to deny the efficacy of green tea catechins. However, results of our clinical study, mainly for its low statistical strength, suggest that the effectiveness of green tea catechins should be evaluated in both a larger cohort of men and longer trial. [ABSTRACT FROM AUTHOR]

Introduction and aim of the study: Chronic prostatitis/chronic pelvic pain syndrome (CP/CPSS) is a pathology of high prevalence in Italian male population, difficult to diagnose and to treat and with poor response to conventional therapy. Aim of this study was to review the evidence of the literature about the therapeutic effects of a plant product containing flower pollen extracts and group B vitamins on symptoms resolution and amelioration of CP/CPPS patients' quality of life and to investigate the knowledge among practicing urologists about the clinical application of this product. Materials and methods: A group of 38 urologists was submitted to an investigational survey of the knowledge of the clinical applications of a plant product containing flower pollen extracts and group B vitamins. Results: 71% of the urologists interviewed prescribed the plant product for CBP and CP/CPPS at least one time in a month and 11% prescribed it more than 5 times; 67% had evidence of clear ameliorations in pain relief and on patient's quality of life and 47% reported that the effectiveness is comparable to NSAIDs; 39% also reported a significant effect for the improvement of the urinary symptoms of patients. No gastric or general side effects have been noticed during the administration period of this plant product. Finally, the cost of the product has always reported to be sustainable for the patients. Conclusions: From the results of this investigational survey, we can state that the plant product containing flower pollen extracts and group B vitamins is well-known and demonstrated beneficial effects on symptoms resolution and amelioration of quality of life in patients with chronic prostatitis/chronic pelvic pain syndrome. [ABSTRACT FROM AUTHOR]