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Aims: Male stress urinary incontinence (SUI) represents a complication after radical prostatectomy or benign prostatic obstruction surgery. The artificial urinary sphincter is considered the standard treatment but interest on minimally invasive devices, such as adjustable balloons, has recently increased. Aim of this study is to evaluate the efficacy and safety of the ProACT system., Methods: In this multicentric retrospective study, we reported the data from nine centers. Patients with SUI who underwent a ProACT device implantation for postoperative SUI and had a minimum follow-up of 24 months were included. Efficacy was evaluated at the maximum available follow-up and was assessed utilizing a 24-hour pad test. Patients were considered: "Dry" if presenting a urine leak weight lower than 8 g at the 24-hour pad test; "Improved" if presenting a reduction of urine leak higher than 50% (but >8 g/24 hours); "Failure" if presenting a reduction in urine leak lower than 50%. The evaluation included a record of intraoperative and long-term complications., Results: Safety and efficacy results are reported on 240 patients. 29.6% of patients were dry at 24 months, 37.5% were improved and 32.9% of patients were considered failures. The baseline mean pad weight of 367 g was reduced to 123 g at 24 months. Five-year follow-up on 152 patients showed similar efficacy. The complication rate was 22.5%, with the top complication being long-term balloon failure., Conclusions: ProACT implantation represents a safe and efficacious treatment for male postoperative SUI at both medium and long-term follow up. 67.1% of patients were dry or improved at 24 months. The majority of complications are low grade., (© 2019 Wiley Periodicals, Inc.)

Aims: To assess efficacy and safety as well as predictive factors of dry rate and freedom from surgical revision in patients underwent AUS placement. The artificial urinary sphincter (AUS) is still considered the standard for the treatment of moderate to severe post-prostatectomy stress urinary incontinence (SUI). However, data reporting efficacy and safety from large series are lacking., Methods: A multicenter, retrospective study was conducted in 16 centers in Europe and USA. Only primary cases of AUS implantation in non-neurogenic SUI after prostate surgery, with a follow-up of at least 1 year were included. Efficacy data (continence rate, based on pad usage) and safety data (revision rate in case of infection and erosion, as well as atrophy or mechanical failure) were collected. Multivariable analyses were performed in order to investigate possible predictors of the aforementioned outcomes., Results: Eight hundred ninety-two men had primary AUS implantation. At 32 months mean follow-up overall dry rate and surgical revision were 58% and 30.7%, respectively. Logistic regression analysis showed that patients without previous incontinence surgery had a higher probability to be dry after AUS implantation (OR: 0.51, P = 0.03). Moreover institutional case-load was positively associated with dry rate (OR: 1.18; P = 0.005) and freedom from revision (OR: 1.51; P = 0.00)., Conclusions: The results of this study showed that AUS is an effective option for the treatment of SUI after prostate surgery. Moreover previous incontinence surgery and low institutional case-load are negatively associated to efficacy and safety outcomes., (© 2018 Wiley Periodicals, Inc.)

Objective: To evaluate the short-term results with Argus-T sling in patients with post-prostatectomy incontinence (PPI)., Materials and Methods: A total of 182 patients with PPI were treated with Argus-T sling at 5 urologic centers from June 2008 to March 2013. The preoperative evaluation included medical history, pad count (1-2 pads: mild PPI; 3-5 pads: moderate PPI; >5 pads: severe PPI), visual analog scale on continence, quality of life score scale, physical examination, cystoscopy, and urodynamic evaluation. Postoperative evaluation was performed 6 weeks postoperatively, and late follow-up was achieved in April 2013. We considered a successful result when patients were cured (0-1 pads/24 hours) and or improved (1-2 pads/24 hours or a reduction in pad per day usage greater than 50%)., Results: Twenty-one (11.8%), 96 (52.7%), and 65 (35.7%) patients have mild, moderate, and severe incontinence, respectively. At the median follow-up of 22 months, the overall success rate was 86.2%. We obtained successful results of 95% in mild incontinence, 78% in moderate incontinence and 70% in severe incontinence. In cured and improved patients, we observed a statistically significant amelioration of quality of life (P <.0001). Sling regulation was carried out in 42.9% of cases, whereas its removal occurred in 9.3% of cases. Postoperative complications were reported in 14.3% of patients. In patients with previous radiotherapy, we observed a successful result in 61.2% of cases., Conclusion: This study represents the first report that shows short-term results of Argus-T positioning in a large population. Argus-T seems to offer good outcomes in patients with mild and moderate PPI., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Objectives: To assess morbidity, effectiveness and quality of life (QoL) of implant of Silimed periurethral constrictor (PC) in a consecutive series of patients who had stress urinary incontinence following radical prostatectomy., Material and Methods: A prospective non-randomized study designed on patients who underwent implant of Silimed PC. Primary end point was postoperative morbidity and secondary end points were effectiveness of implant and QoL. We performed a sub-analysis of men who received previous radiation and we compared the subpopulation with radiation-naïve patients., Results: Nineteen patients (31.6%) received pelvic radiation therapy prior implant. All procedures were completed successfully with median operative time of 55 (IQR 50-62.5) min. We recorded 47 (78.3%) postoperative complications in 30 men. Twenty-three men (38.3%) developed urethral erosion at median follow-up of 27.5 (IQR 21-35) months, and 1 man (1.9%) had rectourethral fistula at 2 months. Risk of urethral erosion increased significantly among patients who received radiation (63.1 vs. 26.8%; p < 0.001). In 12 cases (20%), we recorded malfunctioning of the reservoir requiring replacement., Conclusion: The implant of Silimed device is not safe due to a high risk of urethral erosion. Careful patient selection and detailed counseling are mandatory when considering the implant of PC in adult patients., (© 2016 S. Karger AG, Basel.)

Bladder outlet obstruction can negatively affect renal function in the kidney transplant population. Functional obstruction represents a clinical challenge as conventional treatments are either ineffective or not recommended. Sacral neuromodulation was successfully used in functional voiding dysfunction in a kidney transplant patient. This is the first case to be reported in the literature., (Copyright (c) 2005 S. Karger AG, Basel.)

Purpose: Leak point pressure (LPP) measurement has become standard in the diagnosis of stress urinary incontinence. Leak point pressure is determined by increasing abdominal pressure, which can be done with a Valsalva maneuver or coughing, that is Valsalva LPP and cough LPP (CLPP). It may be influenced by catheter size, bladder volume and interobserver variability. A new, computerized LPP measuring technique for routine use in daily urodynamic practice was tested at a female unit urodynamic practice to evaluate female urinary incontinence., Materials and Methods: A total of 28 female patients with a mean age of 54.07 years (range 23 to 82) and urinary incontinence underwent a new, minimally invasive measurement of the cough leak point. Measurements are made with the patient standing and repeated 3 times per patient. Additionally, parameters of the corresponding leak were recorded simultaneously. All patients underwent new CLPP measurement and a standard, complete urodynamic investigation, including filling cystometry with abdominal LPP and urethral pressure profile at rest. Statistical evaluation was done by linear regression analysis and the correlation coefficients among CLPP, age, standard abdominal LPP and maximum urethral pressure, and among the 3 measurements for each patient., Results: : The assignment of leakage to the pressure signal presented no problem. All CLPP data were reproducible in the 3 repeated measurements per patient. No correlation was seen between CLPP and abdominal LPP or the urethral pressure profile., Conclusions: The study confirm that the CLPP is a practicable, consistent and minimally invasive method in routine use. Clinical use is easy and reproducible, and only 1 catheter is required for measurement.

Background: The "Valle Belbo Project" is a primary prevention study on ischemic heart disease, aiming at identifying cardiovascular risk factors. Detailed data about the amount and kind of alcohol beverages used were assessed, too. The aims of the present study were to evaluate the prevalence of cardiovascular risk factors, and the relationships between alcohol and these factors., Methods: The study enrolled 3123 subjects, aged 20-65 years. Data about consumption of alcoholic drinks (amount and kind of beverages), smoking habits, physical activity during work, clinical and drug history were collected; height, weight, arterial blood pressure, fasting glycemia, and total cholesterol were also measured., Results: About 57% of the subjects consumed alcoholic drinks, mostly < 30 g/day (84%) and red wine only (80%). Prevalence of overweight/obesity, hypertension, hyperglycemia, hypercholesterolemia increased with higher amounts of alcohol consumed. A > 30 g/day alcohol use was independently associated with hypertension (odds ratio-OR 1.48, p = 0.03), hyperglycemia (OR 1.62, p = 0.02) overweight/obesity (OR 1.64, p = 0.003), and hypercholesterolemia (OR 1.69, p = 0.001) in a multiple logistic regression model, after multiple adjustments. A < 30 g/day red wine use was negatively correlated with hyperglycemia (OR 0.54, p < 0.0001) and overweight/obesity (OR 0.71, p = 0.002) with respect to consumption of higher or other kinds of alcoholic beverages in the same model., Conclusions: Differently from heavy drinkers, < 30 g/day red wine drinkers are less frequently affected by overweight/obesity and hyperglycemia. Follow-up of these subjects may determine the role of alcohol effects in the incidence of ischemic heart disease.

Patients with bleeding disorders frequently need medical or surgical care. The case is reported of a man with von Willebrand's disease type I undergoing radical cystectomy with urethrectomy for multicentric bladder cancer with neoplastic involvement of prostatic urethra, who developed serious bleeding complications which can not be predicted with conventional coagulation in laboratory. The use of the thromboelastograph (TEG) in the critical postoperative period was decisive. The tracing alterations allowed to assess the clotting disorder, constantly counterbalancing the baseline deficit and the blood loss.

The authors report their experience with 11 patients, surgically treated since 1990, affected with superior vena cava syndrome. A peculiar case of neoplastic thrombosis in hepatocarcinoma is stressed. In fact a similar case hadn't been reported in the last ten-year literature, although hepatocarcinoma may spread in different organs. A subject review and a discussion are presented.

Conservative surgery was initially limited to patients with localized RCC present bilaterally or in a solitary kidney, in whom radical nephrectomy would necessitate immediate renal replacement therapy. Today, the widespread use of abdominal ultrasound as screening modality in patients with nonspecific or unrelated symptoms allows the detection of renal parenchymal tumors rarely seen before: asymptomatic, small and unilateral neoplasms, often surrounded by a thick and complete pseudocapsule. Global renal function and contralateral kidney are usually normal and the patients show good performance status. For these reasons and because of the generally good results of the first experiences, several authors advocate conservative surgery as an elective indication. Recently, some studies have reported promising results with this approach. On the other hand, some controversial issues persist (multifocality of RCC, low risk of local relapse and renal failure after radical surgery, low incidence of tumor in the contralateral kidney) reducing the opportunity to perform nephron-sparing surgery when the contralateral kidney is normal. In the present study, we report our experience of nephron-sparing surgery for RCC and we review the current and international opinion concerning this treatment.

Recent reports suggest that radionuclide bone scan (BS) may not be necessary in the standard staging evaluation of patients with prostate cancer when serum prostate-specific antigen (PSA) levels are normal. To evaluate the ability of PSA to predict BS findings, we retrospectively reviewed the case records of 118 consecutive patients (median age 73 years, range 50-90 years) with newly diagnosed, untreated, pathologically proven prostate cancer who underwent BS and serum PSA sampling within a period of no more than 3 months. Fifty-four out of 118 BSs demonstrated metastatic bone disease. A PSA value of less than 10 ng/ml excluded bone metastasis; of 35 patients with a serum PSA level of 20 ng/ml or less, seven had a positive BS (negative predictive value of 80%). These findings provide additional confirmation of the value of low serum PSA concentrations in excluding the need for a staging BS, although the threshold for a high value of negative predictive accuracy is lower than previously reported.