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To confirm the correlation between post-void residual urine ratio (PVR-R) and BOO diagnosed by pressure-flow studies (PFS) in males with lower urinary tract symptoms (LUTS) and to develop a clinical nomogram.A consecutive series of patients aged 45 years or older with non-neurogenic LUTS were prospectively enrolled. Patients underwent standard diagnostic assessment for BOO including International Prostatic Symptoms Score, uroflowmetry, urodynamic studies, suprapubic ultrasound of the prostate, and ultrasound measurements of the bladder wall thickness (BTW). PVR-R was defined as follows: PVR-R = (PVR/total Bladder Volume [BV]) × 100). Logistic regression analysis was used to investigate predictors of pathological bladder emptying (BOO) defined as Schafer II. A nomogram to predict BOO based on the multivariable logistic regression model was then developed.Overall 335 patients were enrolled. Overall, 131/335 (40%) presented BOO on PFS. In a multivariable logistic age-adjusted regression model BWT (odds ratio [OR]: 2.21 per mm; 95% confidence interval [CI], 1.57-3.09; p = 0.001), PVR-R (OR: 1.02 per %; 95% CI, 1.01-1.03; p = 0.034) and prostate volume (OR: 0.97 per mL; 95% CI, 0.95-0.98; p = 0.001) were significant predictors for BOO. The model presented an accuracy of 0.82 and a clinical net benefit in the range of 10-90%.The present study confirms the important role of PVR-ratio in the prediction of BOO. For the first time, we present a clinical nomogram including PVR-ratio for the prediction of BOO.

Background: Stent Encrustation is an uncommon event (13%) with a significant impact in patients' management. Aim of our study was to evaluate the available grading systems for encrusted stents. Methods: A retrospective analysis of encrusted stents was performed in four Italian centers between 2006 and 2020. Encrusted stents were classified according to four classifications: the Forgotten Encrusted Calcificated (FECal) score, the Kidney Ureter Bladder (KUB) score, the Visual Grading for Ureteral Encrusted Stent Classification and the Encrustation Burden Score (EBS). Classifications were evaluated to predict complex surgery defined as: long operative time (>60min); need of more than one surgery; need of a percutaneous approach. The scores were compared with Receiver Operating Characteristic (ROC) analysis as predictors of complex surgery. Results: 77 patients were evaluated with a median age of 62 years (65/70). Overall FECal score >2 was present in 45/77 (58%) patients, median KUB score was 9 (6/14) and severe EBS was found in 47/77 (63%) patients. Patients were managed with cystolithotripsy in 13/77 (17%), with ureteroscopy in 58/77 (75%) and with Percutaneous Nephrolithotomy (PCNL) in 6/77 (8%). Overall, 6/77 (8%) patients required a second intervention to remove the encrusted stent. All classifications predicted the need of complex surgery. On ROC analysis KUB score presented a better accuracy in predicting complex surgery compared to FECal, V-GUES and encrusted burden. Conclusions: KUB score, FECal score, V-GUES score and encrustation burden accurately predict the need of a complex surgery. KUB showed to be superior to other classifications according to our results.

To evaluate the technical efficacy, safety, and reproducibility of automated percutaneous lumbar discectomy (APLD) under CT and fluoroscopic guidance, for treating radiculopathy caused by lumbar disc herniation in patients impervious to conservative treatment. A total of 77 patients with symptomatic lumbar disc herniation were treated with APLD in a prospective multicentric study performed in four centers across three countries. Magnetic resonance imaging and/or computed tomography was used to evaluate the disc herniation before and after the procedure. Only local anesthesia was used during these procedures. Clinical outcomes were measured with the visual analog scale (VAS) for pain at one and 6 months after the procedure. Technical success rate was 100% with a mean intervention duration of 30 min (15–45 min). No complications occurred during the procedure. Post-lumbar puncture syndrome occurred in three patients who were successfully treated with blood patches. VAS decreased from a mean of 8 before the intervention to 3 1 month after (p value = 0.001). The requirement for analgesia decreased from 100 to 27%. No statistically significant differences in outcomes were found between the centers. APLD with dual imaging guidance under local anesthesia is a safe, feasible, and reproducible technique to treat symptomatic lumbar disc herniation.

To develop an easy tool to predict cancer specific (CSS) and disease-free survival (DFS) in patients with bladder cancer treated with radical cystectomy.Data from a consecutive series of 2395 patients with primitive or progression to muscle invasive bladder cancer (MIBC) undergone to radical cystectomy and lymph nodes dissection in 5 centers were evaluated. Using Cox proportional hazards analyses, the Cancer of the bladder risk assessment (CRAB) nomogram was generated. Accuracy of the nomogram was evaluated by Harrell's C test. Internal validation of the model was performed using 200 bootstraps.Median age was 66 (IQR 58/73) years; 612/2395 (26%) patients presented an advanced pathological stage (≥pT3a); 478/2395 (20%) presented positive lymph nodes. Overall, 729/2395 (30%) presented local or distant recurrence with a median DFS of 42 (IQR 14/89) months. Overall, 642/2395 (27%) died of bladder cancer with a median follow up of 48 (IQR 22/92) months. On univariate Cox proportional hazards analyses, age, stage, and lymph nodes density were a significant predictor of 3 and5 years CSS and DFS. Accuracy of the CRAB nomogram was 0.73 and 0.71 respectively.CRAB nomogram can be a practical and easily applicable tool that may help urologists to classify the long-term CSS and DFS of patients treated with radical cystectomy and to predict the oncological outcome.

Recent data suggest that greater ureteral density distal to ureteral stones or increased ureteral wall thickness (UWT) can predict impacted stones. The aim of our study was to evaluate if patients with residual fragments present with greater ureteral density and larger UWT when compared to stone-free patients. From January onward, a consecutive series of patients undergoing semi rigid Ho:YAG laser ureterolithotripsy (ULT) for ureteral stones were enrolled. A non-contrast enhanced computed tomography (CT) scan was performed before the procedure to evaluate distal ureteral density (DUD) and wall ureteral thickness (UWT) at the site of ureteral stones. Patients with residual fragments were compared to stone-free patients using a matched-pair analysis (1:1 scenario). Cases were matched sequentially using the following criteria: age, gender, body mass index (BMI), stone length, hydronephrosis, location of stones, and mean Hounsfield unit (HU) of the stone. Overall, 160 patients were enrolled, mean age was 57.9 ± 14 years, mean BMI was 25.8 ± 4 kg/m

Antimuscarinic (AM) and beta-3-agonist (B3A) treatment are the standard first line pharmacological treatment used to manage overactive bladder (OAB) patients. Aim of our study was to analyze real-life data of adverse events related to AMs and B3A reported on Eudra-Vigilance (EV) database.EV database is the system for managing and analyzing information on suspected adverse reactions to medicines which have been authorized or being studied in clinical trials in the European Economic Area (EEA). We recorded the number of AEs for antimuscarinic and beta-3-agonist per category and severity until January 2021.Overall, 2313 AEs were reported for Oxybutinin, 5129 for Solifenacin, 2483 for Tolterodine, 3523 for Fesoterodine, 787 for Trospium, 621 for Propiverine and 7213 for Mirabegron. Urinary retention was higher for Fesoterodine (43%) and Tolterodine (23%) when compared to Solifenacin (10%), Mirabegron (11%) and Oxybutinin (4%). Cognitive disorder was uncommon for all the analyzed drugs analyzed. Regarding anticolinergic AEs: vision blurred, dry mouth and constipation were higher for AMs when compared to Mirabegron. Their prevalence was higher in female patients. Mirabegron presented a higher risk of hypertension (7%) when compared to Oxybutinin (2%, p0,01), Solifenacin (2%, p0,01), Tolterodine (2%, p0,01) and Fesoterodine (1%, p0,01); the rate of hypertension was higher in females (63%) than males (29%) (p0,01). The risk of acute urinary retention was also significantly higher (15% vs 10%, p0,01)) in older patients (85 years).Real life data is consistent with registry studies regarding the rate of AEs related to antimuscarinic and beta-3-agonist. However some differences were observed. Female patients present higher rates of AEs when compared to male patients. The risk of acute urinary retention was particularly evident in the octogenarians.

To evaluate the technical efficacy, safety, and reproducibility of automated percutaneous lumbar discectomy (APLD) under CT and fluoroscopic guidance, for treating radiculopathy caused by lumbar disc herniation in patients impervious to conservative treatment.A total of 77 patients with symptomatic lumbar disc herniation were treated with APLD in a prospective multicentric study performed in four centers across three countries. Magnetic resonance imaging and/or computed tomography was used to evaluate the disc herniation before and after the procedure. Only local anesthesia was used during these procedures. Clinical outcomes were measured with the visual analog scale (VAS) for pain at one and 6 months after the procedure.Technical success rate was 100% with a mean intervention duration of 30 min (15-45 min). No complications occurred during the procedure. Post-lumbar puncture syndrome occurred in three patients who were successfully treated with blood patches. VAS decreased from a mean of 8 before the intervention to 3 1 month after (p value = 0.001). The requirement for analgesia decreased from 100 to 27%. No statistically significant differences in outcomes were found between the centers.APLD with dual imaging guidance under local anesthesia is a safe, feasible, and reproducible technique to treat symptomatic lumbar disc herniation.

The combination of a new device and dual guidance (computed tomography [CT] and fluoroscopy) is similar to other percutaneous devices in achieving a mechanical decompression of the disc. The difference, however, is that the target of the decompression with the current technique is the herniated disc itself. The goal of this combined technique is to create a space, an “olive” around the probe, allowing a decrease in pressure inside the hernia. Percutaneous discectomy under combined CT and fluoroscopic guidance is a minimally invasive spine surgery that should be considered as an alternative to surgery in properly selected patients.

We present a case of percutaneous treatment of symptomatic recurrent lumbar facet joint cyst resistant to all medical treatments including facet joint steroid injection. Percutaneous transfacet fixation was then performed at L4-L5 level with a cannulated screw using CT and fluoroscopy guidance. The procedure time was 30 min. Using the visual analog scale (VAS), pain decreased from 9.5, preoperatively, to 0 after the procedure. At 6-month follow-up, an asymptomatic cystic recurrence was observed, which further reduced at the 1-year follow-up. Pain remained stable (VAS at 0) during all follow-ups. CT- and fluoroscopy-guided percutaneous cyst rupture associated with facet screw fixation could be an alternative to surgery in patients suffering from a symptomatic recurrent lumbar facet joint cyst.

Surgical repair of pertrochanteric and subtrochanteric fractures in the elderly is usually achieved using an endomedullary nail. Unfortunately, even today, some of the patients who undergo this intervention develop periprosthetic bone absorption over time that can lead to loosening of the prosthesis, resulting in pain, joint instability and the need for revision surgery. Surgical revision is hindered by potential complications related to patients’ existing underlying medical conditions. It is often the case that these patients are weak and present comorbidities, which can lead to an absolute contraindication to surgery. An interesting alternative could be the stabilisation by percutaneous injection of cement (cementoplasty) in the periprosthetic space under CT and fluoroscopic guidance. In patients with absolute contraindication we performed percutaneous cementoplasty as treatment for femoral prosthesis loosening. Our procedure was technically a success following the end of the intervention period (follow-up: 6 months). The patient no longer experienced significant pain and showed stability of the prosthesis, as demonstrated by CT.

The objective was to evaluate percutaneous computed tomography (CT) and fluoroscopy-guided injection of bone cement for consolidation of loosened posterior arthrodesis performed by radiologists. A single-centre prospective study involving four consecutive patients (three women, one man) suffering from screw loosening (three at the vertebral level, one at the iliac wing level) after Posterior Lumbar Interbody Fusion (PLIF) treatment was done. The average age was 80 years. Surgical treatment was not indicated or not wished for by the patients. Institutional review board approval and informed consent were obtained. Percutaneous consolidation was performed by an interventional radiologist under CT and fluoroscopy guidance. The path of the trocars was made outside loosened screws bilaterally. Follow-up was assessed using the Visual Analog Scale (VAS). In all cases, bone cement was successfully placed around the loosened screw. The mean volume of cement that was injected was 3 ml. No cement leakage was observed. No neurological complication occurred. Using VAS, pain decreased from more than 9/10 preoperatively to less than 2/10 the day after the procedure for all patients (p

A presente dissertação analisa os processos participativos como alternativa para o planeamento face às circunstâncias de crise atuais. A pesquisa, desenvolvida a partir do estudo de um caso concreto, a zona industrial de Santa Cruz do Bispo, Matosinhos, está estruturada em quatro partes:1. O enquadramento do problema, em que se desenvolve uma leitura das dinâmicas territoriais, socioeconómicas e urbanísticas que concorrem para a produção do contexto de impasse e incerteza contemporâneo. Nomeadamente, destaca-se o carácter "transgénico" e fragmentário da porção de território considerada, a importância e a irreversibilidade da recessão económica em ato e a incapacidade pelos instrumentos de gestão territorial de lidar com a presente situação. Os efeitos dessa combinação de fatores reproduzem-se a nível territorial na forma de um significativo desperdício de recursos espaciais e económicos, alvos de uma possível intervenção de regeneração urbana.2. A formulação da hipótese da implementação da participação pública, qual possível solução para tornar as práticas de planeamento atuais em processos flexíveis e capazes de aproveitar as oportunidades latentes no território. Nomeadamente, propõe-se a inclusão nos processos de planeamento à escala municipal de dinâmicas bottom-up descentralizadas. Desta forma pretende-se integrar com a contribuição ativa e estruturada dos cidadãos a produção do conhecimento sobre o território indispensável para intervir no espaço urbano.3. A resposta teórica, que constitui uma análise das diferentes alternativas para a montagem de um processo de planeamento participativo, em relação aos objetivos que se pretende alcançar, aos momentos em que incluir os principais stakeholders, ao papel por eles desempenhado e às técnicas utilizadas na implementação do processo. O discurso é dirigido em particular às administrações públicas, entidades responsáveis pela promoção, pela gestão e, em certa medida, pela execução do processo, juntamente com os atores locais, que neste contexto se tornam nos verdadeiros protagonistas da ação regeneradora do espaço de uso coletivo.4. O estudo de caso, em que se procura regressar à área de Santa Cruz do Bispo para testar em objetivos concretos as contribuições teóricas anteriormente propostas e confirmar a hipótese inicial. A partir da análise das características peculiares da freguesia e do potencial representado por elementos que atualmente se encontram desqualificados, propõe-se uma ação de regeneração urbana participada focando em três casos específicos: a reativação de terrenos disfuncionais para uso agrícola; o melhoramento da fruição das margens do rio Leça; a integração urbana do parque escolar da Portela.Através destes exemplos, pretende-se despertar o interesse para um tema ainda pouco investigado em Portugal, mas que acredita-se essencial para operar no espaço urbano de forma democrática e abrangente, nomeadamente nas conjunturas de precariedade atuais, onde a falta de recursos para o planeamento do território pode ser integrada com a contribuição ativa de um conjunto de atores locais. Na procura de uma resposta concretamente viável, é analisada a possibilidade de implementar a participação pública nos processos de planeamento municipais, sem entrar em conflito com a estratégia geral, mas desenvolvendo um trabalho em paralelo a contacto com a realidade local e aumentar desta forma a eficácia dos instrumentos de gestão do território. This dissertation analyses participative processes as an alternative for planning in present circumstances of crisis. The research, developed from the case study of the industrial area of Santa Cruz do Bispo, Matosinhos, is structured in four parts:1. The framing of the problem: a description of territorial, socioeconomic and planning dynamics that contribute to the development of the stagnant and uncertain present-day context. In particular, we highlight the "transgenic" outline of the territory examined, the importance and irreversibility of the current economic recession and the incapacity by urban planning tools to deal with this situation. The effects of this combination of factors is visible on the territory as a significant waste of spacial and economic resources, targets for a possible intervention of urban regeneration.2. The formulation of the hypothesis: the implementation of public participation, as a solution to convert current planning practices in flexible processes, capable to seize the opportunities latent in the territory. In particular, we propose the inclusion in municipal planning processes of bottom-up, decentralized dynamic. In such way, we intend to integrate with the active and structured contribution of citizens the production of the local knowledge, essential to intervene on urban space.3. The theoretical response: an analysis of various alternatives for setting up a participative planning process, according to the goals to be achieved, the time to involve key stakeholders, the role they play and the techniques used in the implementation of the process. This question is mostly addressed to public administrations, responsible for the promotion, management and, to a certain extent, execution of the process, alongside local players, which in this context become the actual protagonists of the regeneration of public space.4. The case study: going back once again to the area of Santa Cruz do Bispo to test on concrete objects the previously proposed theoretical contributions and confirm the starting hypothesis. From the analysis of local features and the potential of elements which are currently disqualified, we propose a participative urban regeneration process, focusing on three specific cases: the reactivation of dysfunctional land for agricultural use; the improvement of the Leça river banks; the urban reintegration of Portela school park.Through these examples we intend to arouse interest for a topic not yet sufficiently investigated in Portugal, but that we believe is essential to operate on urban space in a democratic and comprehensive way, particularly in the present instable context, where the lack of resources for spatial planning can be integrated with the active contribution of a set of local actors. In seeking a concrete response, we analyse the possibility of implementing public participation in municipal planning processes, without diverging from the overall strategy, but developing a parallel work, in contact with the local reality and thus increasing the effectiveness of territorial management tools.

e20562 Background: We evaluated feasibility, safety and efficacy of IAIRIM on a compassionate use basisto treat locally UCRC and investigated a volume reduction of the target lesion. Methods: We considered patients with UCRC not eligible for any conventional treatment presenting severe anemia from rectal bleeding, colon obstruction and severe pain. A multidisciplinary evaluation was performed by surgeon, radiologist and oncologist. Patients underwent abdominal quadriphasic CT scan, in order to obtain a preliminary arterial mapping of the tumour; colostomy was performed in all patients. Angiography of superior and inferior mesenteric arteries was obtained to define the lesion vascularization and perform IAIRIM. A month later a new CT scan evaluation was performed to evaluate the volume of the target on Aw Volume share 2 (slice thickness 5mm). We defined the results adopting MASS, RECIST and mChoi response criteria. QoL was reported adopting Edmonton scale and EORTC QLQ-C30. Results: Ten patients were enrolled, IAIRIM was successfully performed in all without major complications. Ten patients experienced a clinical improvement with disappearance of bleeding and reduction of pain in a week. Fever lasting 36 hours (24-48) and minimal discomfort procedure related in were observed in all . Reduced but persisting muchorrea and tenesm were reported in 4 patient. After four months all patients were alive without pain or bleeding. 8/10 patients experienced mass reduction ( -39%; range -96% / +7%) and 2/10 no evidence of progression. QoL: Edmonton scale (considering only pain, fatigue, well-being and depression items) was around 7 in 8/10 patients before treatment and 6 in 2/10 patients. After treatment 6/10 patients reported mean score 3; 3/10 reported 4, 1/10 reported 2. Using EORTC QLQ-C30, mean score decreased from 3 to 2. Conclusions: IAIRIM seems feasible, with low side effects in patients bearing UCRC considered out of usual approaches. A reduction of symptomatic treatments and an increase of QoL (Edmonton and EORT QLQ-C30 scale) has been recorded in all patients. Volume reduction of the tumour has been observed in nine patients. Further experiences are warranted.