Archivio italiano di urologia, andrologia : organo ufficiale [di] Società italiana di ecografia urologica e nefrologica / Associazione ricerche in urologia
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Arch Ital Urol Androl · Sep 2009
ReviewUrinary citrate and renal stone disease: the preventive role of alkali citrate treatment.
Hypocitraturia or low urinary citrate excretion is a common feature in patients with nephrolithiasis, particularly in those with calcium stone disease. Citrate is a weak acid that is synthesized inside Krebs' cycle. It can also enter the body through dietary intake. ⋯ Moreover, alkali treatment reduces the rate of stone recurrence and increases the clearance rates and dissolution of stone fragments. Last but not the least, an increasing number of papers pointed out the protective role of alkali citrate in preserving bone mass in stone formers as well as in healthy subjects with bone loss. Nevertheless, the evaluation of urinary citrate in patients with kidney stones and the treatment of these patients with alkali salts namely with potassium citrate are still scarce.
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Arch Ital Urol Androl · Mar 2009
Prospective assessment of the efficacy of the EAU guidelines for the prevention of nosocomial acquired infections after genitourinary surgery in a district hospital.
To evaluate incidence and risk factors for nosocomial acquired infections in an urology ward after the application of the European Association of Urology (EAU) guidelines for surgical prophylaxis after genitourinary surgery in a district hospital. ⋯ Antimicrobial prophylaxis according to EAU guidelines together with an active surveillance seems to be adequate to prevent symptomatic/febrile genito-urinary infections as well as serious wound infections in the majority of patients. A further effort should be made in order to identify sub-populations of patients for which the actual prophylactic regimen proved to be less efficacious.
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Arch Ital Urol Androl · Mar 2009
Transrectal-HIFU as primary minimally-invasive option for localized prostate cancer. Is spinal anaesthesia cost-effective? A single centre experience in over 100 patients.
The management of Prostate cancer (PC), since PSA testing has been introduced in the clinical practice, has been significantly spoiled by a "leading-time bias" effect. As a consequence, this has brought to a dramatic diagnosis anticipation at the 4th-5th decade of life in sexually active and otherwise asymptomatic men. Standard options as radical prostatectomy or EBRT are hampered by a significant negative impact on patient's QoL. More recently several alternative minimally-invasive ablative treatment modalities have been proposed with promising results. Among these, TR-HIFU (Trans-Rectal High Intensity Focused Ultrasound) is playing a growing role in the treatment of localized low-intermediate risk PC, although long-term oncologic outcome are still awaited. In order to achieve an optimal result, a specific TR-HIFU's requirement is given by an unchanging target throughout the whole procedure. Therefore, the ideal anaesthesia should be either minimally-invasive and allow to get a motionless target up to 3-4 hours. A retrospective evaluation of efficacy and safety of a spinal anaesthesia in this patient's setting was done. ⋯ Using a low-dose intrathecal sufentanil an effective spinal block either on the sensitive and motor pathways was provided. Patients' tolerance to the procedure was good and the side-effect rate low. No adverse reactions to intrathecal sufentanil 5 microg were observed. In our experience TR-HIFU can be performed with neuraxial block in most of the cases and it's associated to a favorable cost-benefit rate.
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Arch Ital Urol Androl · Mar 2008
Case ReportsRecurrent renal colic in young people: abdominal Munchausen syndrome--a diagnosis not to forget.
The Munchausen's syndrome (MHS) is a rare psychiatric disorder classified among the self-manipulated diseases. Incidence of Munchausen syndrome peaks in young-to-middle-aged adults, but it has been reported in patients of all ages (ie, childhood through advanced age). Diagnosing Munchausen syndrome is very difficult, but early diagnosis could to a considerable extent prevent the iatrogenic risks. ⋯ At this stage, suspicion was raised regarding the possible factitious nature of her problem and a psychiatric consultation was made. On the basis of psychiatric consultation and the symptoms resolution with simple intravenous saline solution infusions, the diagnosis of factitious illness (Munchausen syndrome) was confirmed. In the present case report, we stress the fact that the MHS is an underestimated medical problem and the necessity to evaluate the possible role of psychiatric disorders in the absence of pathological findings.
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Arch Ital Urol Androl · Dec 2007
Case ReportsNumb chin syndrome: the presenting symptom of a metastatic prostate carcinoma.
Numb chin syndrome is a sensory neuropathy characterized by numbness involving the distribution of the mental nerve that could be an uncommon manifestation of metastatic malignancy. Bony metastases are common in patients with advanced prostate carcinoma and involving preferentially vertebrae, sternum, pelvic bones, ribs and femurs. We report a case in an 82-year-old man presenting a history of mental neuropathy as the isolated presenting symptom of a widespread metastatic prostate cancer Numb chin syndrome was describe in some reviews as a late component of a previously diagnosed disease but this report underline the importance of this neuropathy as the isolated presenting symptom of a widespread metastatic prostate cancer. This event is very rare and enumerates four cases in the world literature.