Keywords: Nephrolithotomy; Percutaneous; Prone Position; Kidney Calculi

Surgical correction of the deformity and plaque caused by Peyronie's disease has some important disadvantages and extracorporeal shockwave therapy (ESWT) emerged as a new promising therapy. We evaluated prospectively the efficacy and safety of the association of high dose vitamin E and ESWT as a non-invasive treatment for the disease. Twenty-five patients 42 to 68 years old (mean = 54) presenting penile deviation and sexual distress caused by Peyronie's disease were treated in a non-invasive manner. The time of penile deviation ranged from 16 to 52 months (mean = 30). All patients had previous unsuccessful treatment for Peyronie's disease. The angulation's deformity of the penis was assessed by photography at home. The patients received vitamin E (l.200 mg daily) during 3 months and underwent 3 to 6 sessions (mean = 3) of ESWT (3,000 to 4,000 shockwaves) at a power level of l to 2 at 1-week intervals. From 25 patients treated, 16 (64%) reported an improvement in penile angulation, with a mean reduction of 21 degrees (10 to 40). Eight patients reported improvement in their spontaneous erections. Overall, the patients presented only minimal bruising at the site of treatment and skin hematoma. Four patients presented urethral bleeding. The mean angulation after treatment in the control group was 48.67 degrees (30 - 70) and in the study group was 24.42 degrees (0 - 70), statistically significant. Considering the common complications and the unsatisfactory outcome of the surgical correction for Peyronie's disease, the association of high dose vitamin E and ESWT represents a good option for a non-invasive, effective and safe treatment of the penile deformity.

CONTEXT: Despite the recent improvements in performing radical retropubic prostatectomy that have led to a considerable decrease in the complication rate, erectile dysfunction still represents a major problem. Moreover, less invasive treatment options that are emerging for erectile dysfunction have not shown satisfactory results in managing these patients. OBJECTIVE: To study the efficacy and side effects of self-injection therapy in the treatment of men who had become impotent after undergoing radical prostatectomy due to prostate cancer, over a study period of 96 months. DESIGN: Observational study. SETTING: University Referral Center. PARTICIPANTS: 168 patients with erectile dysfunction, aged 43 to 78 years old, who underwent radical retropubic prostatectomy due to localized prostate cancer. PROCEDURES: The patients were treated with self-injection therapy using papaverine, phentolamine and prostaglandin E1, at home. RESULTS: This study showed an acceptable 94.6% success rate, with no life-threatening complications. In addition to this, our series presented a 13.1% cure rate with this therapy. CONCLUSION: Self-injection therapy with papaverine, phentolamine and prostaglandin E1 is effective and safe in the treatment of erectile dysfunction after radical prostatectomy.

Purpose: Prostate biopsy is mostly performed through the transrectal route worldwide and infectious complications (ICs) may occur in up to 7% of cases. Therefore, alternative strategies to decrease ICs are needed. Our aim was to evaluate the effectiveness of intrarectal povidone-iodine cleansing plus formalin disinfection of the needle tip in decreasing ICs after transrectal ultrasound guided prostate biopsy. Materials and Methods: We conducted a prospective, single-center, phase-III trial in patients undergoing TRUS-Bx randomized 1:1 to rectal mucosa cleansing with gauze soaked in 10% povidone-iodine solution wrapped around the gloved index finger and needle tip disinfection by immersion in a 10% formalin solution before each puncture versus control group. The primary endpoint was the rate of ICs defined as one or more of the following events: fever, urinary tract infection (UTI) or sepsis. Results: Overall, 633 patients were randomized to the intervention group and 623 to the control group. The IC rate was 3.9% in the intervention group and 6.4% in the control group (RR 0.61; 95% [CI] 0.36–0.99; p=0.049). The rates of sepsis, UTI, and fever were 0.3% vs. 0.5% (p=0.646), 2.3% vs. 4.1% (p=0.071), and 1.3% vs. 1.9% (p=0.443), respectively. The positive urine culture rate was 5.2% in the intervention group and 9% in the control group (RR 0.57; p=0.015). There was no statistically significant difference between the groups regarding the occurrence of non-infectious adverse events. Conclusions: Intrarectal povidone-iodine cleansing plus formalin disinfection of the biopsy needle tip was associated with a reduction in ICs after transrectal prostate biopsy.

Objectives: To determine whether obesity has an impact on the outcomes of supine percutaneous nephrolithotomy (PCNL). Patients and Methods: We retrospectively evaluated a prospectively created database of patients who underwent PCNL in the supine position from June 2009 to June 2014. The patients were divided into two groups according to their body mass index (BMI): <30 kg/m ² (group 1, nonobese) and ≥30 kg/m ² (group 2, obese). Pre, peri, and postoperative data were analyzed. Stone complexity was classified according to Guy's stone score. The primary endpoint was the absence of stone fragments of ≥4 mm on CT scans at postoperative day 1. Complications were graded according to the modified Clavien classification. Results: Of the 401 patients, 307 (76.6%) were nonobese and 94 (23.4%) were obese. Regarding demographic and stone characteristics, group 2 (BMI ≥30 kg/m ² ) had a higher percentage of female patients (67.3% vs 50.4%, p = 0.002) and a higher mean BMI (34.8 vs 24.5 kg/m ² , p < 0.001) than group 1. Success rates were not statistically different between the groups (group 1 = 61.8%, group 2 = 51%, p = 0.08). There were no differences in the transfusion rate (group 1 = 2.9%, group 2 = 4.2%, p = NS) or total number of complications greater than Clavien grade 1 (group 1 = 13.6%, group 2 = 13.8%, p = NS). Conclusion: In a retrospective study of 400 patients undergoing PCNL, the outcomes were not different between nonobese and obese patients. To our knowledge, this is the first study evaluating these outcomes for PCNL performed in the supine position. Further multicenter and prospective studies are necessary to verify these findings.