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Background: Drugs may have a direct causative role in triggering hematuria. The range of medications which may be responsible for hematuria is wide, but little is known on those which are most frequently involved. The aim of our study was to identify and compare drugs mostly related with hematuria., Methods: The Food and Drug Administration (FDA) Adverse Event Reporting System (FAERS) database and the EudraVigilance (EV) database were queried to identify the drugs which were associated the most with hematuria individual reports till 30 September 2021. Rivaroxaban, aspirin, warfarin sodium, clopidogrel bisulfate, dabigatran etexilate mesylate, apixaban, warfarin, cyclophosphamide, lansoprazole, enoxaparin sodium, and ibuprofen were analyzed. Analysis per gender, age and severity was performed. Disproportional analysis was performed to compare drugs., Results: Overall, 15,687 reports of hematuria were recorded in the FDA database and 15 007 in the EV database. Rivaroxaban and Warfarin appear to be the most dangerous medications in terms of hematuria when compared to the other medications (PRR>1, P<0.05) while apixaban is the safest one (PRR<1, P<0.05) when compared to the other medications. In terms of severity only 162/15 007 (1.08%) were fatal. Between the drugs analyzed cyclophosphamide 7.2%, enoxaparin (3%) and dabigatran (2.5%) presented a higher number of fatal hematuria episodes when compared to the other drugs (<1%)., Conclusions: Anticoagulants and antiplatelets are more frequently related to hematuria episodes however some differences exist between them. Particularly warfarin and rivaroxaban should be prescribed with caution in patients at increased risk of hematuria. Prescribers should inform those treated with these medications about the risk of hematuria and its sequelae.

Background: The use of apical views focused on the left atrium (LA) has improved the accuracy of LA volume evaluation by two-dimensional (2D) echocardiography. However, routine cardiovascular magnetic resonance (CMR) evaluation of LA volumes still uses standard 2- and 4-chamber cine images focused on the left ventricle (LV). To investigate the potential of LA-focused CMR cine images, we compared LA maximuml (LAVmax) and minimum (LAVmin) volumes, and emptying fraction (LAEF), calculated on both standard and LA-focused long-axis cine images, with LA volumes and LAEF obtained by short-axis cine stacks covering the LA. LA strain was also calculated and compared between standard and LA-focused images., Methods: LA volumes and LAEF were obtained from 108 consecutive patients by applying the biplane area-length algorithm to both standard and LA-focused 2- and 4-chamber cine images. Manual segmentation of a short-axis cine stack covering the LA was used as the reference method. In addition, LA strain reservoir (εs), conduit (εe) and booster pump (εa) were calculated using CMR feature-tracking., Results: Compared to the reference method, the standard approach significantly underestimated LA volumes (LAVmax: bias - 13 ml; LOA =  + 11, - 37 ml; LAVmax i: bias - 7 ml/m 2 ; LOA =  + 7, - 21 ml/m 2 ; LAVmin; bias - 10 ml, LOA: + 9, - 28 ml; LAVmin i: bias - 5 ml/m 2 , LOA: + 5, - 16 ml/m 2 ), and overestimated LA-EF (bias 5%, LOA: + 23, - 14%). Conversely, LA volumes (LAVmax: bias 0 ml; LOA: + 10, - 10 ml; LAVmax i: bias 0 ml/m 2 ; LOA: + 5, - 6 ml/m 2 ; LAVmin: bias - 2 ml; LOA: + 7, - 10 ml; LAVmin i: bias - 1 ml/m 2 ; LOA: + 3, - 5 ml/m 2 ) and LAEF (bias 2%, LOA: + 11, - 7%) by LA-focused cine images were similar to those measured using the reference method. LA volumes by LA-focused images were obtained faster than using the reference method (1.2 vs 4.5 min, p < 0.001). LA strain (εs: bias 7%, LOA = 25, - 11%; εe: bias 4%, LOA = 15, - 8%; εa: bias 3%, LOA = 14, - 8%) was significantly higher in standard vs. LA-focused images (p < 0.001)., Conclusion: LA volumes and LAEF measured using dedicated LA-focused long-axis cine images are more accurate than using standard LV-focused cine images. Moreover, LA strain is significantly lower in LA-focused vs. standard images., (© 2023. The Author(s).)

Background: 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., Methods: 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., Results: 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%, P<0.01), solifenacin (2%, P<0.01), tolterodine (2%, P<0.01) and fesoterodine (1%, P<0.01); the rate of hypertension was higher in females (63%) than males (29%) (P<0.01). The risk of acute urinary retention was also significantly higher (15% vs. 10%, P<0.01) in older patients (>85 years)., Conclusions: 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.

In this paper the Authors present the preliminary results of an investigation of a series of a patients with BPH who have undergone TUIP by modified monolateral incision. Post-operative complications, hospital stay and short-term urine flow values have been assessed. From June '94 to April '96 at the Department of Urology of the Hospital of Matera, 56 patients with BPH-induced cervico-urethral obstruction undergone TUIP. Their average age was 66; the average follow up was 9.5 months. Thirty-one of them ha bladder catheters. The patients were selected by ultrasonographically measured prostatic volume (< or = 30 gr). The operation was almost in all cases conducted under spinal anaesthesia. A 5-10 mm-long monolateral incision was made medial to the right urinary meatus, starting just behind the trigonal bar and going up to the pre-spyncteric region, laterally to the veru montanum. The incision was made up to the section of the muscle fibres of the trigone and those of the prostate capsule, exposing the fat. Post-operative assessment included a urine culture after 15 days as well as a urine flow measurement every three months. The operative took an average of 10.3 minutes. The catheter was removed on average after 2 days. Post-operative hospitalization lasted on average 3.9 days. No post-operative complications were encountered. Only in 3 cases in which a catheter with no Coudè tip was used, was it difficult to insert. In no case was a blood transfusion necessary. Six patients with normal pre-operative sexual activity maintained their normal ejaculation. Of the 29 patients that had got through the 3-months' follow-up, seven who had been catheterized before the operation, showed, along with an average volume of urine of 236.7 cc, a maximum flow value of 10.8 ml/sec., an average flow of 6.8 ml/sec. and a bladder emptying time of 36.8 sec. The other 22 patients had an average maximum flow speed of 20.5 ml/sec. (+121.5%), an average flow of 10.3 (123.9%), an emptying time of 33 sec. (-8.8%) with an average volume of urine of approximately 300 cc (+58.9%). Thus, in view of the noteworthy post-operative improvement in the symptomatology, both in subjective and objective terms, as well as the low rate of complications and the considerably reduced costs, TUIP may be considered a valid surgical alternative for treatment of BPH with adenomas weighing < or = 30 gramis in selected patients.

Transrectal ultrasound of the prostate (TRUS) plays a major role in the follow-up of hormonally treated D2 prostate cancer patients because in these situations the digital rectal examination (DRE) cannot be reliable in the evaluation of local recurrence. 82 patients with advanced prostate cancer were evaluated. Mean follow-up was 33 months (range 3-103). TRUS was performed before starting hormonal therapy and every 3 months thereafter. A volume decrease of the prostate was obtained in 91% of the patients. The lowest mean volume of the prostate (nearly 55% decrease of the pretreatment volume) was reached after 6-9 months of therapy. 62.1% of the patients underwent disease progression after a mean follow-up of 25 months (range 3-80). No correlation between systemic progression and ultrasound findings were observed. In 9.6% of cases a local progression was observed. In 42 patients PSA was used in association with TRUS: the PSA nadir was reached after 6-9 months of therapy. PSA increased in every case a disease progression was observed. The data showed that TRUS is an objective and reliable method in the follow-up of D2 prostate cancer patients. However, considering the low incidence of local progression, the use of PSA appears to be the standard method to monitor the patients, leaving TRUS in case of suspicion of local progression.

Diltiazem is a dihydropyridinic calcium-antagonist which acts an arterial muscle, producing an increase in vascular capacity. We administered it intraoperatively in 2 patients subjected to kidney transplantation, to asses the maximal vascular reserve of the transplanted organ. After 2' and 10' from administration of Diltiazem, Color Doppler Ultrasound showed a 30% increase in mean flow in the renal artery and 13% reduction in the intraparenchymal resistance rates with respect to the basal parameters. Systemic arterious pressure remained unchanged. This result was associated with an improvement in the perfusion of the transplanted organ.

In the last eight years, 60 patients with carcinoma of the prostate in an advanced stage underwent transrectal ultrasound examinations of the prostate both before and after treatment with LHRH analogues, alone or associated with antiandrogens. Mean follow-up was 30 months (9-96 months) and mean survival 33 months (9-81). In all patients, the volume and echogeneicity of the prostate were assessed before treatment and once every three months thereafter. A significant reduction in volume was observed in 91% of the cases (54/60), while a variation in the echogeneicity was noted in 80% of the patients (48/60); these data do not seem to have been affected by the type of treatment administered. The greatest reduction in volume occurred during the first three months, after which a virtually constant volume was observed. Metastatic progression occurred in 29 of the 60 patients assessed, whereas no increase in prostate volume was demonstrated by ultrasound in 18 of these patients. These data, reported by other authors, too, may indicate that transrectal ultrasound examinations alone cannot constitute a complete follow-up in prostatic carcinoma: they can only show local progression and should therefore be associated with other diagnostic methods, in particular the specific prostate antigen.

Kidney transplantation can lead to a number of complications of a urological and/or vascular nature. Early diagnosis of these complications may determine the survival of the organ. While diagnosis of urological-type complications can be made by means of non-invasive techniques like ultrasound investigation, vascular-type complications often require invasive techniques using contrast medium, such as angiography. Recently, the possibility of using color doppler ultrasound, both intraoperatively and for follow-up, has been suggested, as a means not only of assessing anastomosis and renal perfusion but also of diagnosing any complications of a vascular nature. In the last two years, 51 kidney transplants have been performed at our centre; all patients underwent color doppler ultrasound. We report our experience paying particular attention to vascular complications.

104 patients with acute bacterial prostatitis were randomized to an antibiotic therapy group (group I) and an antibiotic plus laser therapy group (group II). Laser therapy was applied ever other day through a trans-rectally inserted fiberoptic probe. Resolution of the symptoms occurred in 87% of the patients in group I and 92% in group II (p < 0.001). Transrectal ultrasound resulted in resolution of the peri-prostatic venous plexus congestion in 43.7% of the patients in group I and 89.7% in group II. In conclusion, the combination of laser therapy and antibiotics in bacterial prostatitis provides both a better resolution of the symptoms and a reduction or disappearance of the peri-prostatic venous congestion.

Kidney transplants from infant donors are associated in the literature with poor results as regards both functionality and the survival of the transplant. Hence the increasing frequency, for kidneys obtained from donors under 5 years of age, of a surgical technique defined as "en bloc", involving the transplant of both kidneys into a single receiver and using the donor aorta and vena cava for vascular anastomosis. This technique seems to provide results comparable with those obtained using adult organs. Ultrasound and Doppler investigations are routinely performed in patients undergoing such a transplant. This study presents ultrasound and Doppler images of "en bloc" transplants, with particular reference to one case of pseudoaneurysm of the donor aorta and one of stenosis of the renal artery, revealed by Echo-Color-Doppler. The importance of ultrasound in this kind of transplant is emphasized, as it enables post-operative monitoring of the physiological growth in volume of the two transplanted infant kidneys.

An intravenous infusion of endotoxin into sheep results in accumulation of equal numbers of lymphocytes and granulocytes in the pulmonary microcirculation. The role of the sequestered lymphocytes in acute lung injury is not known. The present study examines whether lymphocyte migration through pulmonary endothelium contributes to endothelial damage and also examines the effect of lymphokines on granulocyte migration. Bovine pulmonary artery intimal explants were mounted in Boyden chambers and conditioned media, prepared from bovine peripheral blood lymphocytes, was used as the chemoattractant. The rate of 51Cr labelled bovine granulocyte lymphocyte migration into intimal explants was determined over a 3 hr incubation period. Permeability changes were assessed by adding trace amounts of 14C-sucrose and 3H-water to the upper well and following their rate of equilibration with the lower well. 6-Keto-PGF1 alpha was measured in the upper well. Lymphocyte conditioned media was found to be chemotactic for both lymphocytes and granulocytes (lymphocyte migration at 60 min: lymphocyte conditioned media = 18.5 +/- 2.3%, mean +/- s.e. RPMI control = 12.5 +/- 1.5; granulocyte migration at 120 min: conditioned media = 36.1 +/- 5.7, RPMI control = 18.2 +/- 3.0). Ultrastructural examination revealed leukocyte migration followed an orderly sequence during which the leukocytes maintained close contact with the adjacent endothelial cells. No structural evidence of endothelial cell damage was seen at any time examined. Granulocyte migration was associated with an increased rate of 14C-sucrose equilibration after 2 hr of incubation (lower well counts/upper well counts at 2 hr, RPMI control = 0.18 +/- 0.02; lymphocyte conditioned medium = 0.30 +/- 0.04) indicating alteration in the endothelial barrier function. Leukocyte migration, particularly lymphocyte migration, was accompanied by a marked increase in prostacyclin accumulation (3 hr: no leukocytes, 188 +/- 17 ng/ml; lymphocytes, 560 +/- 104). These in vitro findings suggest that lymphocytes and lymphokines may be involved in acute lung injury and also that permeability changes associated with granulocyte migration may depend on the chemoattractant.