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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.

Backgroud: Epilepsy is a chronic, recurrent disease, characterized by paroxysmal changes in intellectual, sensory, motor, autonomic or affective activity, with limited time. Objectives: To analyze cases of hospitalizations and deaths between 2010 and 2019 in Brazil. Methods: Descriptive epidemiologic study using data from the Department of Information of the Brazilian Health System (DATASUS). The variables researched were: hospital admissions, death, brazilian regions, age group, gender and race. Results: It was accounted 196,351 hospitalizations, 52% in the Southeast, 25% in the South, 14.7% in the Northeast, 5% in the Midwest and 3.1% in the North. In relation to profile, the male gender (59.9%) constituted the majority. In the case of deaths, 12.723 males and 6.557 females were reported, of which 46,4% were white and 41,8% were brown race. Major part of the deaths, 41,9% happened in the Southeast. The most affected age group was between 40 and 49, with 20.5% of cases. Conclusions: Therefore, most hospitalizations and deaths occurred in men, aged between 40 and 59 years, of white race, residents of the Southeast region.

Background: Parkinson’s is a neurodegenerative and progressive disease, with an unknown origin that can lead to functional incapacity and decreased quality of life. Objectives: Analyze the number of hospital admissions for Parkinson’s Disease in the Southeast of Brazil. Design and setting: Transversal, descriptive Epidemiologic study between the years of 2011 and 2020 in the Southeast of Brazil. Methods: Study realized using data from the Department of Information of the Brazilian Health System (DATASUS). The variables researched were hospital admissions, age, and year. Results: In the Southeast region, in the determined period, there was an average of 405 hospital admissions per year, an average growth of 4% between the years of 2011 and 2019. However, in 2020, there was a 30% decrease compared to the previous year. It was also observed that in the gap ages between 40 to 49 and 50 to 59 years old, there was a significant increase in the number of hospital admissions. In addition, the age gap between 50 to 80 or more represents an average of 90.88% of all the hospital admissions of the last decade. Conclusion: In the Southeast of Brazil, Parkinson’s Disease had a noticeable absolute reduction of the total admissions analyzed in the last year and a deviation in the average growth of the other years, meaning a possible relation with the COVID-19 pandemic.

Background: Stroke is the second leading cause of death in the world and in Brazil. During the Corona Virus pandemic, patients may have been neglecting stroke symptoms, inducing a drop in the search for medical assistance. Objectives: Analyze the prevalence of hospitalizations and deaths due to stroke in Brazil during the COVID-19 pandemic compared to the previous year. Design and setting: Transversal, descriptive Epidemiologic study between the years of 2019 and 2020 in Brazil. Methods: Study realized using data from the Department of Information of the Brazilian Health System (DATASUS). Results: There were 163.120 hospitalizations for stroke in the year of 2019, and in the year of 2020 this number had a decrease of approximately 6%. In 2019, Household deaths due to unspecified Cardiovascular Diseases had 85 records. In 2020, there was an increase of 7% in home deaths due to unspecified Cardiovascular Diseases. Conclusion: There is a decrease in notifications of hospitalizations and deaths in Brazil due to unspecified stroke during the year of the pandemic. It is also noticed, during this period, an increase in home deaths due to unspecified Cardiovascular Diseases, of which stroke is a prominent cause. This fact suggests interference of the pandemic in the search for medical care.

Background: Viral meningitis is a neuroinfection that presents neurological alterations that usually evolve benignly. In Brazil, during the last decade, the disease caused 30,731 admissions and 1,048 deaths. Objectives: Analyze the number of hospital admissions for Viral Meningitis, between from 2011 to 2021 in all the regions of Brazil. Design and setting: Study realized using data from the Department of Information of the Brazilian Health System (DATASUS). The variables researched were hospitalizations, deaths, age, gender, race e Brazilian regions. Results: The regions with the highest number of admissions for viral meningitis are the Southeast (42.51%), followed by the Northeast (24.07%) and the South region (22.10%).It was observed that, in all age groups analyzed, males constitute the majority of admissions (58%). In terms of race, 37.51% were white and 28.41% were brown. In the case of deaths (1,048 in total), men were the majority. The mean length of hospital stay was 7.4 days and the average cost was R $1,119.07. Conclusion: Male, white, and aged between 1 and 4 years old are the characteristics that form the profile of the patient frequently hospitalized for Viral Meningitis. The region of Brazil with the highest number of admissions was in the Southeast and the one with the lowest was the North region. Regarding the number of deaths, it is higher in males.

Background: Spina bifida is a birth defect not fully understood, which suggests the association of genetic factors with environmental factors as possible causes. Objectives: To analyze the epidemiological data of Spina Bifida in the period from 2010 to 2019 in Brazil. Design and setting: Descriptive cross-sectional epidemiological study with patients with Spina Bifida in Brazil between 2010 and 2019. Methods: Study realized using data from the Department of Information of the Brazilian Health System (DATASUS). The data used were classification, sex, ethnicity, Regions of Brazil, mother’s age and adequacy to prenatal care. Results: In this period, there were 10,309 cases of spina bifida and a record of 229 deaths. In classification criteria, a non-specific spina bifida predominated, corresponding to 74.3%. The greatest number of hospitalizations occurs in children under 1 year of age. At maternal age, cases of spina bifida prevailed in mothers aged 15 to 29 years. Regarding prenatal, 36.91% were considered more than adequate. The Northeast is the region with the most reports of spina bifida cases in the country. In relation to sex, girls are followed up similarly to boys. The black race and the white count the majority of cases. Conclusion: The profile of anomalous patients is brown skin and less than 1 year old of both sexes and children of mothers aged between 15 and 29 years. Spina Bifida unspecified is the most frequent.

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.

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.

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.

Desmopressin is a synthetic analogue of arginine vasopressin, commercially available since 1974. Desmopressin is proven effective for the treatment primary nocturnal enuresis and polyuria. It has been considered by several investigators for the treatment of nocturia with positive results and is now an established treatment for this indication. In this review, we assessed the available clinical data on desmopressin in adult urological disease.

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.