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Introduction and Objectives. The large BPH treatment alternative consisting of bipolar plasma enucleation of the prostate (BPEP) was retrospectively matched against standard open transvesical prostatectomy (OP). Materials and Methods. In the BPEP study arm, 24 BPH patients were enrolled based on the selection criteria of prostate volume over 80 mL, Qmax below 10 mL/s and IPSS over 19. In the control group, a similar number of cases matching the respective features underwent OP. Patients were assessed at 1, 3 and 6 after the initial intervention by IPSS and QoL scores, Qmax and PVR. Results. Resembling mean operating times (94.1 versus 85.6 minutes) and resected adenoma tissue weights (102.9 versus 113.7 grams) characterized BPEP and OP. Significantly decreased mean hemoglobin level drop (1.5 versus 3.2 g/dL), catheterization period (2.5 versus 6 days) and hospital stay (3 versus 7 days) were described among BPEP patients when compared to OP. During the 1, 3 and 6 months' follow-up check-ups, no significant variations were determined concerning the mean IPSS, Qmax, QoL and PVR values displayed in the 2 series. Conclusions. By comparison to OP, BPEP emphasized equivalent surgical efficiency and prostatic bulk ablation capacity, reduced perioperatvie bleeding and shorter recovery period. Similar short term follow-up parameters were established. [ABSTRACT FROM AUTHOR]

In studies performed until now it was proved that about 80% of bladder tumors discovered as first diagnostic are in a non-infiltrative stage (pTa, pT1, CIS). White light cystoscopy (WLC) is a cornerstone in the diagnosis of bladder diseases in general and especially of tumor pathology. Narrow-band imaging (NBI) cystoscopy represents a complementary endoscopic method based on the principle of visualization in narrow band due to the white light filtration. Thus, is generated an ameliorated contrast between the normal urothelium and tumor hypervascularized tisssue, increasing the rate of detection of urothelial tumors. Comparatively with standard cystoscopy, NBI provides a clearer view of papillary tumors on the one hand, and especially of specific capillary architecture, better defining the edges of plate lession of in situ carcinoma. Studies published until now evidenced a significantly ameliorated tumor detection rate, specific to NBI visualization mode, thus confirming a substantial rate of additional tumors detected exclusively from this method. The specialty literature confirmed a certain category of patients diagnosed with non-invasive bladder cancer only using the NBI endoscopic evaluation. On the other side, this alternative was marked by a reduced specificity compared with conventional cystoscopy, manifested by an increased rate of false-positive outcomes. In conclusion, the changing of the anatomic endoscopic architecture of urinary bladder in tumor pathology was marked by a further quality after the introduction of NBI as additional routinely investigation, without suplementary costs. [ABSTRACT FROM AUTHOR]

Introduction: The present study was aimed to assess in a retrospective manner the impact of narrow band imaging (NBI) cystoscopy concerning the detection of recurrent tumors during the follow-up protocol for previously confirmed non-muscle invasive bladder cancer (NMIBC) patients. Materials and Methods: Between June 2014 and January 2015, a total of 45 known NMIBC cases (based on the initial pathology findings subsequent to standard transurethral resection of bladder tumors - TURBT) were confirmed as presenting tumor recurrence. All cases underwent both standard white light (WLC) and NBI cystoscopy, followed by the classical resection of all WLC detected tumors and NBI guided TURBT for lesions solely observed in NBI vision. Results: In light of the pathological exam, 43 cases were diagnosed with NMIBC recurrence (2 patients had muscle invasive tumors and were excluded from the analysis). The NBI mode was characterized by a higher patients' detection rate when compared to conventional cystoscopy (95.3% versus 83.7%). On a lesions' related basis, the NBI evaluation also displayed an improved diagnostic accuracy by comparison to white light (91.5% versus 79.7%). On the other hand, NBI cystoscopy was marked by an increased rate of false positive results (19.2% versus 13.2%). Conclusions: The use of NBI assessment during the periodical cystoscopic NMIBC follow-up was confirmed to benefit from superior sensitivity leading to more recurrent tumors being identified and resected. [ABSTRACT FROM AUTHOR]

The hepatorenal syndrome is a syndrome of functional renal failure due to end stage liver disease. The ideal cure currently available for treating HRS is liver transplantation. Other therapeutic options appear to be those that reverse portal hypertension, splanchnic vasodilation, and/or renal vasoconstriction and renal replacement therapy. All the above mentioned represent a bridge towards liver transplantation. [ABSTRACT FROM AUTHOR]

We measured trabecular bone score (TBS) in 98 patients on permanent hemodialysis (HD) and 98 subjects with similar bone mineral density and normal kidney function. TBS was significantly lower in HD patients, indicating deteriorated bone microarchitecture, independent of bone mass. This might partially explain the increased fracture risk in HD., Purpose: In the general population, trabecular bone score (TBS) was shown to predict fracture independent of bone mineral density (BMD). In end-stage renal disease patients on hemodialysis (HD), the value of TBS is beyond that of BMD in currently unclear. Our aim was to assess lumbar spine (LS) TBS in HD patients compared with subjects with normal kidney function matched for age, sex, and LS BMD., Methods: We assessed TBS and LS and femoral neck (FN) BMD in 98 patient on permanent HD (42.8% males; mean age 57.5 ± 11.3 years; dialysis vintage 5.5 ± 3.8 years) and 98 control subjects (glomerular filtration rate > 60 mL/min) using DXA. We simultaneously controlled for sex, age (± 3 years), and LS BMD (± 0.03 g/cm 2 )., Results: HD patients had significantly lower LS TBS (0.07 [95% CI 0.03-0.1]; p = 0.0004), TBS T-score (0.83 SD [95% CI 0.42-1.24]; p = 0.0001)) and TBS Z-score (0.81 SD [95% CI 0.41-1.20]; p = 0.0001) than matched controls. TBS significantly correlated with LS BMD in both HD patients (r = 0.382; p = 0.001) and controls (r = 0.36; p = 0.002). The two regression lines had similar slopes (0.3 vs. 0.28; p = 0.84) with different intercepts (0.88 vs. 0.98). TBS adjustment significantly increased the 10-year fracture risk from 3.7 to 5.3 for major osteoporotic fracture and from 0.9 to 1.5 for hip fracture., Conclusions: HD patients have lower TBS than controls matched for LS BMD, indicating altered bone microarchitecture. Also, the magnitude of TBS reduction in HD patients is constant at any LS BMD. Adjustment for TBS partially corrects the absolute 10-year fracture risk.

Objectives: The study compared the transurethral resection in saline (TURis), transurethral vaporization in saline (TUVis), bipolar plasma enucleation of the prostate (BPEP), and open prostatectomy (OP) in a single-center, prospective, randomized controlled clinical setting exclusively involving large prostate patients., Patients and Methods: During a 4½ year enrollment period, 320 cases of prostate volume over 80 mL, maximum flow rate (Qmax) below 10 mL/second, International Prostate Symptom Score (IPSS) over 19, or urinary retention were included in the trial and equally randomized in the four study arms. Patients were assessed preoperatively as well as at the 1-, 3-, 6-, and 12-month follow-up checkups using the IPSS, quality of life (QoL) score, Qmax, postvoiding residual urinary volume (PVR), and prostate-specific antigen (PSA)., Results: Similar preoperative parameters were established in the four series. OP and BPEP were characterized by resembling operating times, while TURis and TUVis displayed prolonged surgical durations. TURis emphasized a substantially decreased mean resected tissue weight. TUVis showed the lowest mean hemoglobin level drop, followed by TURis and BPEP (equivalent results) and finally OP (highest bleeding). OP described the longest mean catheterization period and hospital stay, followed by TURis, and afterward by TUVis and BPEP (similar data). During the follow-up period, statistically equivalent IPSS, QoL, Qmax, and PVR outcomes were established for OP, BPEP, and TURis. TUVis displayed significantly smaller Qmax improvements, but similar other functional features. Significantly lower mean PSA levels were determined secondary to OP and BPEP when compared to bipolar resection and subsequently to vaporization., Conclusions: OP and BPEP emphasized the highest surgical efficiency (prolonged postoperative recovery for OP), while TUVis displayed the lowest hemorrhagic risks. On the medium term, generally resembling functional outcomes were determined for the four techniques, with significantly decreased mean PSA values secondary to OP and BPEP.

Background: A retrospective study was aimed to establish the eventual impact of narrow band imaging (NBI) cystos copy over the short term residual tumors’ rate determined during the first follow-up endoscopic control in newly determined non-muscle invasive bladder cancer (NMIBC) cases., Methods: 68 patients were found with NMIBC by means of both white light cystoscopy (WLC) and NBI. A follow-up using both investigation modalities was performed at 3 months from the initial procedure in 67 cases (one was lost from follow-up). RESULTS concerning the short termer currences were retrospectively compared to those obtain ending a similar series of 67 patients previously diagnosed and treated by means of classical WLC and resection only., Results: The short term residual tumors’ rate established during the first follow-up cystoscopy was lower in the study group initially benefiting from the NBI mode by comparison to the WLC control series (4.5% versus 11.9%). When drawing a parallel with the tumor map location outlined during the initial procedure, the most important differences were emphasized concerning other site recurrences (3%versus 8.95%)., Conclusions: NBI cystoscopy and resection displayed a substantially favorable influence over the short termoncologic outcome in newly diagnosed NMIBC cases when compared to the standard protocol., Abbreviations: NBI â€" narrow band imaging; NMIBC â€"non-muscle invasive bladder cancer; WLC â€" white light cystoscopy; TURBT â€" transurethral resection of bladdertumors; CIS â€" carcinoma in situ., (Celsius.)