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Introduction Women undergoing radical cystectomy (RC) followed by urinary diversion (UD) for bladder cancer experience a substantial reduction in health-related quality of life (HRQOL). At present, studies comparing long-term QOL outcomes for different UD methods, needed to inform evidence-based choices of bladder reconstruction for female patients, are sparse. Our objective was to compare two common UD methods in terms of their HRQOL outcomes in women. Materials and methods We retrospectively analysed HRQOL in 73 consecutive female bladder cancer patients having undergone orthotopic ileal neobladder (IONB, N = 24) or ileal conduit (IC, N = 49) following RC between 2007 and 2013 in six Italian academic urological centres. Patients had no evidence of tumour recurrence and were actively followed up. Validated Italian versions of the European Organisation for Research and Treatment of Cancer (EORTC) generic (QLQ-C30) and bladder-cancer-specific (QLQ-BLM30) questionnaires were used to evaluate HRQOL. Results Patients in the IONB group were significantly younger than those in the IC group (median age: 67 and 73 years, respectively, p = 0.02). Barring that, the two groups did not present statistically significant differences in median length of follow-up (43 vs 54 months), pathological stage, grading of the neoplasm, or adjuvant chemo - or radiotherapy. No significant differences in QOL were found between the groups, with the exception of financial difficulties, affecting IONB patients significantly more than IC patients (mean score on a scale of 0–100: 33.3 ± 29.5 vs 18.4 ± 19.3, respectively; p = 0.05). Conclusion Financial difficulties was the only HRQOL item to differ between the two UD groups.

Users’ opinions can be greatly beneficial in developing and providing products and services and improving marketing techniques for customer recommendation and retention. For this reason, sentiment analysis algorithms that automatically extract sentiment information from customers’ reviews are receiving growing attention from the computer science community. Aspect-based sentiment analysis (ABSA) allows for a more detailed understanding of customer opinions because it enables extracting sentiment polarities along with the sentiment target from sentences. ABSA consists of two steps: Aspect Extraction (AE) that allows recognizing the target sentiment; Aspect Sentiment Classification (ASC) that enables to classify the sentiment polarity. Currently, most diffused sentiment analysis algorithms are based on deep learning. Such algorithms require large labeled datasets that are extremely expensive and time consuming to build. In this paper, we present two approaches based on transfer learning and weak supervision, respectively. Both have the goal of reducing the manual effort needed to build annotated datasets for the ASC problem. In the paper, we describe the two approaches and experimentally compare them.

We present and discuss results of the application of a deep convolutional network model developed for the automatic recognition of images of insects. The network was trained using transfer learning on an architecture called MobileNet, specifically developed for mobile applications. To fine tune the model, a grid-search on hyperparameters space was carried out reaching a final accuracy of 98.39% on 11 classes. Fine-tuned models were validated using 10-fold cross validation and the best model was integrated into an Android application for practical use. We propose solving the “open set” problem through feed-back collected with the application itself. This work also led to the creation of a well-structured image dataset of some important species/genera of insects.

Aims To retrospectively report our mid- to long-term results following suburethral tension adjustable sling (Remeex system) implantation for stress urinary incontinence (SUI) due to intrinsic sphincter deficiency (ISD). Methods Fifty female patients with severe SUI due to ISD underwent Remeex system positioning between May 2002 and March 2013 (mean follow-up 83.8 months, median follow-up 85.4 months). Before surgery, patients were evaluated by physical examination, translabial ultrasonography, cystoscopy, urodynamics, 1 hr pad test and compilation of quality-of-life questionnaire. Postoperatively, based on the physical examination and pad test, patients were stratified into three groups: (i) Cured: perfectly dry patients at stress test, pad weight 0–1 g; (ii) Improved: patients with mild to moderate incontinence, pad weight 2–50 g; and (iii) Failed: unchanged or worsened patients, pad weight >50 g. Results At 7-years mean follow-up, 45 (90.0%) patients were cured, three (6.0%) were improved, and two (4.0%) had failed. Concerning the mean total score of the quality-of-life questionnaire, it increased significantly up to 87.1 ± 5.9 with an improvement of 76.9%. Sling tension readjustment was needed in three patients (6%). The incontinence-free survival curve showed that, after sling positioning and tension readjustments, all the cured patients remained continent during all the follow-up. Complications were represented by bacterial cystitis (6%), de novo urgency (10%), persistent urinary retention (6%), and seroma formation (2%). Conclusions Our 7-year results showed the efficacy of the Remeex procedure in the treatment of SUI due to ISD. These outcomes tended to be confirmed in the mid- to long-term follow-up which would highlight the durability of this technique. Neurourol. Urodynam. © 2016 Wiley Periodicals, Inc.

Objectives To provide an analysis of the outcomes in patients who have a suburethral sling placed using the transobturator approach for the treatment of stress urinary incontinence after radical prostatectomy, because data in this specific area remain limited, and recent changes in male sling surgery might improve the efficacy in men with moderate or mild incontinence. Methods We evaluated the results of transobturator non-adjustable and re-adjustable sling systems after reviewing previous reports identified using the Medline and PubMed databases for original articles, from 2002 to 2012, using the terms ‘postoperative male incontinence’, ‘transobturator’ and ‘male sling’. Of a total of 31 articles, we reviewed the 22 related to the outcomes of the suburethral sling with positioning by the transobturator approach. Results Currently the only results of the transobturator approach are those relating to the AdVance™ device (American Medical Systems, Minnetonka, MN, USA), for which the cure rate is ≈ 60% at 20 months. The remaining devices, although innovative, were assessed in studies for which the follow-up was too short to make a judgement. Conclusions It would be advisable to reserve the transobturator approach for patients with mild and moderate incontinence, and refer those with severe incontinence, with or without adjuvant radiotherapy after radical prostatectomy, for treatment with an artificial urinary sphincter. More results and a long-term follow-up are needed to evaluate the effectiveness of these devices.

Background/Aim: Studies comparing health-related quality of life (HR-QoL) between patients who underwent radical cystectomy (RC) and those who underwent a different form of urinary diversion has not reached yet univocal and reliable conclusions. The aim of our study was to evaluate bladder-specific long-term HR-QoL after radical cystectomy and ileal conduit. Patients and Methods: A multicenter study was carried out on 145 consecutive patients (112 males and 33 females) undergoing RC and ileal conduit (IC). HR-QoL assessment was conducted using Italian versions of European Organisation for Research and Treatment of Cancer QLQ-C30 and EORTC BLM-30 questionnaires. Results: Our data showed that women who underwent IC presented greater problems than men in cognitive functioning (mean score±SD: 77.3±27.9 vs. 87.8±18.6) as well in future perspective (score: 42.4±34.4 vs. 21.9±24.6). Nevertheless, men undergoing IC had more problems in sexual functioning than women (score: 23.3±24.5 vs. 7.0±20.3) (all p

Introduction: From the most recent systematic revision of the literature, an orthotopic neobladder would seem to show marginally better health related quality of life (HR-QoL) scores compared with an ileal conduit. The aim of this study was to review all relevant published studies about the comparison between ileal orthotopic neobladder (IONB) and ileal conduit using validated HR-QoL questionnaires. Materials and Methods: Studies were identified by searching multiple literature databases. Data were synthesized using meta-analytic methods conformed to the PRISMA statement. Results: The literature search identified 10 papers; pooled effect sizes of combined quality of life outcomes for ileal conduit versus IONB showed a significantly better HR-QoL in patients with IONB (Hedges' g = 0.278; p = 0.000);. The present study has an important limitation due to the type of the analyzed comparative studies, all retrospective and not randomized. Conclusion: This meta-analysis of not-randomized, retrospective comparative studies on the impact of ileal conduit versus IONB on HR-QoL showed a significant advantage of IONB subgroups.

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 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.

BACKGROUND: There is a lack of good data in the literature evaluating the Health-Related Quality of Life (HR- QoL) in patients with urinary diversions. The aim of this study was to examine the changes in expectation and needs in terms of human adaptation and behavioural profiles in patients with ileal conduit (IC) after radical cystectomy (RC) for bladder cancer (BC). MATERIALS AND METHODS: A qualitative, multicenter cross-sectional study using a "narrative based" approach was planned. We proceed with a sampling reasoned choice (purposive), selecting groups of patients with follow-up from one up to more than 7 years after surgery. Data were collected through individual interviews. RESULTS: Thirty patients participated in the study. The processing of the interviews allowed us to identify 2 major profiles: positive and negative. Patients with a positive profile resumed normal daily activities with no or limited restrictions both on the personal and the social level. This profile reflects a good HR-QoL. The negative profile reflects the patients for whom the ostomy has meant a worsening of HR-QoL. A positive profile was statistically more frequent in older patients (p = 0.023), with a longer follow-up (p = 0.042) and less complications rates (p = 0.0002). According to the length of follow-up and the occurrence of complitations, we identified further 5 intermediate profiles. CONCLUSIONS: Patients' satisfaction is related to the degree of adaptation to their new life with an urinary stoma and its correct management. Live "with urinary diversion" represents a new phase of life and not a deterioration.

To retrospectively report our mid- to long-term results following suburethral tension adjustable sling (Remeex system) implantation for stress urinary incontinence (SUI) due to intrinsic sphincter deficiency (ISD).Fifty female patients with severe SUI due to ISD underwent Remeex system positioning between May 2002 and March 2013 (mean follow-up 83.8 months, median follow-up 85.4 months). Before surgery, patients were evaluated by physical examination, translabial ultrasonography, cystoscopy, urodynamics, 1 hr pad test and compilation of quality-of-life questionnaire. Postoperatively, based on the physical examination and pad test, patients were stratified into three groups: (i) Cured: perfectly dry patients at stress test, pad weight 0-1 g; (ii) Improved: patients with mild to moderate incontinence, pad weight 2-50 g; and (iii) Failed: unchanged or worsened patients, pad weight50 g.At 7-years mean follow-up, 45 (90.0%) patients were cured, three (6.0%) were improved, and two (4.0%) had failed. Concerning the mean total score of the quality-of-life questionnaire, it increased significantly up to 87.1 ± 5.9 with an improvement of 76.9%. Sling tension readjustment was needed in three patients (6%). The incontinence-free survival curve showed that, after sling positioning and tension readjustments, all the cured patients remained continent during all the follow-up. Complications were represented by bacterial cystitis (6%), de novo urgency (10%), persistent urinary retention (6%), and seroma formation (2%).Our 7-year results showed the efficacy of the Remeex procedure in the treatment of SUI due to ISD. These outcomes tended to be confirmed in the mid- to long-term follow-up which would highlight the durability of this technique. Neurourol. Urodynam. 36:770-773, 2017. © 2016 Wiley Periodicals, Inc.

INTRODUCTION AND OBJECTIVES: The QoL in presence of urinary incontinence is significantly decreased after radical prostatectomy. ARGUS-T sling are currently employed for the treatment of SUI after radical prostatectomy but data on this device remain still limited. We report the short-term results of SUI treatment after radical prostatectomy with ARGUS-T. METHODS: From June 2008 since March 2013 161 patients affected by post-prostatectomy SUI and 21 patients affected by postTURP SUI were treated with ARGUS-T. The population was divided in 3 groups according to the incontinence degree: mild (1-2 pads/die), moderate (3-5 pads/die) and severe (>5 pads/die). The result was considered as satisfactory when the SUI was cured or improved. 21/182 patients (11.5%) were affected by mild SUI, 96/182 patients (52.7%) were affected by moderate SUI and 65/182 patients (35.7%) were affected by severe SUI. 49/182 patients (26.9%) were previously treated with adjuvant radiotherapy. In our study the QoL was evaluated using specific questionnaires (VAS score scale/QoL score scale) and the daily pad number was compared before and after ARGUS positioning. RESULTS: Median age of patients was 71 years old (range 5086 years) and median follow-up was 22 months (1-59 months). In our study the results were satisfactory in 157/182 patients (86.2%), 60/182 patients (33%) were cured and 97/182 patients (53.2%) were improved respectively. 37/49 patients (75.5%) previously treated with adjuvant radiotherapy showed satisfactory results. None complication was occurred during the intra-operative period while we observed in 26/182 patients (14.3%) a post-operative complication, such as infection (9/182), urethral erosion (1/182) and hypercontinence (16/182). The statistical analysis showed a significant reduction in the use of the number of daily pads and a substantial improvement in QoL after ARGUS-T implant (p

The function of the lower urinary tract is to store and release urine and is dependent on the activity of smooth and striated muscles in the bladder, urethra, and pelvic floor. These structures are controlled by a complex interplay between the central and the peripheral nervous system and local regulatory factors. Malfunction of various levels may result in bladder control disorders. The evaluation of the LUT after the surgical approach of male-to-female transsexuals is similar to other areas of incontinence and includes a clinical approach with history, bladder diary, self-completed questionnaire, urodynamic studies, and radiographic imaging of the lower urinary tract which may provide important information for the treating clinician. Actually, the evaluation of the LUT function after surgery in MTF patients is still undefined, and in this chapter, we propose a model of recommendation based on evidence from the literature.

Objective To assess health-related quality of life (HRQoL) parameters in patients who received radical cystectomy (RC) with ileal orthotopic neobladder (IONB) reconstruction and to identify clinic-pathologic predictors of HRQoL. Patients and Methods From January 2010 to December 2013, a multicenter, retrospective on 174 RC-IONB patients was carried out. All patients completed the following questionnaires: the European Organization for Research and Treatment of Cancer (EORTC) generic (QLQ-C30) and bladder cancer–specific instruments (QLQ-BLM30) and the IONB-Patient Reported Outcome (IONB-PRO). Univariate and multivariate analyses were computed to identify clinic-pathologic predictors of HRQoL. Results Median age was 66 years (range, 31-83), and 91.4% of patients were men. Median follow-up period was 37 months (range, 3-247). The EORTC QLQ-C30 revealed that age >65 years, absence of urinary incontinence, and absence of peripheral vascular disease were independent predictors of deteriorated body image. A follow-up > 36 months and the presence of urinary incontinence were independent predictors of worsened urinary symptoms, whereas the absence of urinary incontinence was an independent predictor of a worsened body image according to EORTC QLQ-BLM30 results. A follow-up >36 months and the absence of urinary incontinence were independent predictors of better functioning in terms of relational life, emotional life, and fatigue as revealed by the IONB-PRO. Conclusion Age, presence of urinary incontinence, length of follow-up, and comorbidity status may influence postoperative HRQoL and should all be taken into account when counseling RC-IONB patients.

Introduction: The intestinal mucosa undergoes significant atrophic changes when it is used to reconstruct the urinary tract. We analyzed the ultrastructural changes of intestinal mucosa in the orthotopic neobladder on the basis of our clinical experience. Patients and Methods: Fifteen male patients with an ileal neobladder underwent endoscopic biopsy at different postoperative intervals. Results: No significant changes were observed 3 months after surgery. After 6 and 12 months, the structure of the microvilli was modified significantly. No other substantial changes after 24 months were observed. Conclusions: Progressive modifications occur in the cytoplasmic structures involved in the absorptive process. They do not seem to begin before 3 months and are almost totally completed after 1 year.

Catheters are used for effective drainage of the bladder, either temporally or permanently, in the presence of physiological and anatomical defects or obstruction of the lower urinary tract. Catheters are used for a variety of reasons, as follows, to maintain bladder drainage during and following surgery or epidurals anesthesia for minimizing and prevention of the risk of distension injuries; investigations, for accurate urine output measurement, and measurement of post-micturition residuals; treatments, to relieve urinary retention or for chemotherapy instillation; intractable incontinence, as the final option for containment.

By using a microbubble contrast agent and contrast-specific imaging software, the contrast-enhanced ultrasound (CEUS) is able to depict the micro and macrocirculation of the target organ.A review of the peer reviewed literature was done regarding the current role of ultrasound CEUS imaging in the evaluation of renal pathology with reference to the diagnosis of renal ischaemia, in the characterization of complex cystic lesions and in those with equivocal enhancement at CT.CEUS provides information on tissue perfusion and may play a role in kidney mass characterization similar to the role of contrast-enhanced CT and MRI. In this context, the characterization of cystic lesions is probably the most consolidated field of application of contrast agents on kidney ultrasound imaging. Finally, CEUS provides a good alternative to CT, especially in patients with contraindications to iodinated contrast agents.The usefulness of CEUS in these applications is confirmed by extensive literature production and this article focuses on the potential clinical applications of recent advances in CEUS technology in urology.

Objective: The long-term efficacy of pubovaginal sling (PVS) procedure with porcine small intestinal submucosa (SIS) implant was retrospectively assessed. Study design: Forty-eight patients with SUI underwent a pubovaginal sling with SIS. Patient evaluation included history, physical examination with stress test and prolapse assessment by Baden-Walker classification, routine laboratory tests, 24 h-pad test, and multichannel urodynamic measurement. Postoperatively the patients were classified as cured, improved and unchanged or failed. A King's Health Questionnaire (KHQ) was performed to verify post-operatively the quality of life of these patients. Results: At median follow-up of 76 months 33/48 (69%) were cured, 6/48 (12%) were improved while 9/. 48 (19%) were failed or unchanged. No urinary retention or dyspareunia was reported and no vaginal erosion or adverse tissue reaction was detected. The descriptive statistics of KHQ scores by dimensions was done in 32/48 patients (67%). Failed or unchanged patients showed worse scores than cured and improved patients in all KHQ dimensions showing an overall overlapping between objective and subjective results although these findings are weakened due to the lack of a preoperative evaluation of QoL. Conclusions: PVS procedure using SIS cannot offer a durable option for the treatment of SUI as reported by the current mininvasive techniques. (C) 2011 Elsevier Ireland Ltd. All rights reserved.

Background The ileal orthotopic neobladder (IONB) is often used in patients undergoing radical cystectomy. The IONB allows to void avoiding the disadvantages of the external urinary diversion. In IONB patients the quality of life (QoL) appears compromised by the need to urinate voluntarily. The patients need to wake up at night interrupting the sleep-wake rhythm with consequences on social and emotional life. At present the QoL in IONB patients is evaluated by generic questionnaires. These are useful when IONB patients are compared with patients with different urinary diversions but they are less effective when only IONB patients are evaluated. To address this problem a specific questionnaire—the IONB-PRO—was developed. Methods A) Based on a conceptual framework, narrative-based interviews were conducted on 35 IONB patients. A basic pool of 43 items was produced and organized throughout two clinical and four QoL dimensions. An additional 15 IONB patients were interviewed for face validity testing. B) Psychometric testing was conducted on 145 IONB patients. Both classic test strategy and Rasch analysis were applied. Psychometric properties of the resulting scales were comparatively tested against other QoL-validated scales. Results The IONB-PRO questionnaire includes two sections: one on the QoL and a second section on the capability of the patient to manage the IONB. For evaluation of the QoL, three versions were delivered: 1) a basic 23-item QoL version (3 domains 23-items; alpha 0.86÷ 9.69), 2) a short-form 12-item QoL scale (alpha = 0.947), and 3) a short-form 15-item Rasch QoL scale (alpha = 0.967). Correlations of the long version scales with the corresponding dimensions of the EORTC-QLQ C30 and the EORTC-BLM30 were significant. The short forms exhibited significant correlations with the global health dimension of the EORTC-QLQ and with the urinary subscales of the EORTC-BLM30. The effect size was approximately 1.00 between patients at the 1-year follow-up period and those with 3, 5, and > 5-year follow-up periods for all scales. No relevant differences were observed between the 12-item short-form and the Rasch scale. Conclusions The IONB-PRO long and short-forms demonstrated a high level of internal consistency and reliability with an excellent discriminanting validity.