Aim The efficacy of prostaglandin E1 (PGE1)-intracavernous injection (ICI) therapy for erectile dysfunction (ED) after non-nerve-sparing (NNS) radical pelvic surgery depends on patient compliance. The purpose of this study was to verify the utility of sexual counseling in ICI in terms of treatment efficacy, compliance, and dropout rate. Methods In this prospective randomized study, 57 patients with ED after NNS radical prostatectomy or cystectomy were divided: 29 patients (group SC+) were treated with sexual counseling and PGE1-ICI therapy; the others 28 (group SC–) were treated with only ICI. At the start of the study all patients were administered the International Index of Erectile Function (IIEF) questionnaire and ICI training test; follow-up (at 3, 6, 9, 12, 18 months) was achieved by home Sildenafil test and ambulatory IIEF test; sexual counseling was provided only to group SC+. Results The mean IIEF score at the end of study was 26.5 (SC+) vs. 24.3 (SC–) (P < 0.05); eight patients (SC+, 27.5%) became responders to home Sildenafil vs. five (SC–, 17.8%) (P < 0.05); no dropout cases occurred (SC+) vs. eight (SC–, 28.5%) (P < 0.05). Moreover, we recorded best IIEF scores in group SC+ in sexual satisfaction (P < 0.05), sexual desire (P < 0.05), orgasmic function, and general satisfaction. Mean PGE1 doses were better in group SC+ (P < 0.05). ICI-oriented sexual counseling was utilized to motivate couples, to improve sexual intercourses, to correct mistakes in ICI administration. At the end of follow-up 21 patients (SC+) declared themselves satisfied vs. 12 (SC–). Conclusions ICI-oriented sexual counseling in ICI increased the efficacy of treatment, the compliance, and Sildenafil responders rate, decreased the dropout rate.

In this study, the effect of CO 2 concentration and ambient relative humidity (RH) on accelerated and natural carbonation of 18 concrete mixtures produced with nine different cement types is investigated. Increasing the CO 2 concentration from 0.045 to 1 and 4 % at 57 % RH does not alter the relative carbonation resistance between the concrete mixtures. The increase of RH from 57 to 70 and 80 % RH at 4 % CO 2 shows a water-to-cement ratio and cementspecific effect that affects the relative carbonation resistance between the concrete mixtures. The carbonation resistance at 4 % CO 2 and 57 % RH allows assessing the carbonation resistance of concrete in sheltered and with restrictions in unsheltered outdoor exposure. The carbonation resistance below 70 % RH is mainly governed by the CO 2 buffer capacity. However, in the accelerated tests at 80 % RH and in the unsheltered outdoor exposure capillary condensation is of increased importance.

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Background/Aim: To investigate the seasonal variations of the incidence of renal colic by a computerized analysis of cyclic climatic features. Methods: 1,163 consecutive patients with acute renal colic were studied. Eigendecomposition and signal reconstruction of district temperature and humidity were performed to establish any cyclic variation. Average temperatures and humidity values were calculated at time periods of 15, 30, 45 and 60 days preceding each renal colic. Results: Patients were allocated to groups every 30 days, since eigendeanalysis suggested that intervals of this duration have homogeneous climatic features. With an average time period of 15 days preceding each renal colic, a positive correlation coefficient of temperature (r = +0.75 with CI 0.31–0.93, p < 0.005) and a cubic relationship at the regression analysis (R = 82.4%, p = 0.015) were found with the onset of colics. We observed a negative correlation between humidity and renal colic (rho = –0.70 with CI –0.92 to –0.21, p < 0.01), with an inverse relation as regression model (R = 57.9%, p < 0.05). Conclusions: We demonstrated an association between the onset of renal colics and exposure to hot and dry weather, particularly when temperatures rose above 27°C and relative humidity fell below 45%.

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Several works stress the importance of ultrasound-guided transversus abdominis plane block (TAPb) for post-operative analgesia and its versatility in all types of abdominal surgery, thanks to laparotomy and laparoscopy. The aim of this study was to evaluate the impact of TAPb on intra- and post-operative analgesia in the first 24 h after robot-assisted radical prostatectomy (RARP). TAPb is a new local anesthetic technique which provides analgesia after abdominal surgery. It involves injection of local anesthetic into the plane between the transversus abdominis and the internal oblique muscles. TAPb can be performed according to a landmark technique, either through the lumbar triangle or with ultrasound guidance. We evaluated the intra- and post-operative analgesic efficacy of TAPb in 100 ASA I-III patients undergoing RARP under general anesthesia without (group A, 50 patients) or with US-TAPb (group B, 50 patients), in the first 24 post-operative hours. After induction of general anesthesia, US-TAPb was performed in 50 selected patients. All patients received post-operative analgesia (Paracetamol 1 g) three times a day. Tramadol and Ketoprofen were used as rescue drugs if the Numerical Rating Scale test was > 3. No complications were recorded during block performance. A significant reduction was seen in the need to administer intraoperative opioids, and in the occurrence of post-operative pain or post-operative drug consumption in patients receiving US-TAPb. Seven patients, all in group A, received 100 mg of Tramadol. In group B, only one patient received 100 mg Tramadol (first and second post-operative days) due to surgical complications. In conclusion, US-TAPb provided highly effective intra- and post-operative analgesia in the first 24 h after RARP. A further prospective study is necessary to assess the best protocol for all patients.

Background and purposeRectal toxicity presents a significant limiting factor in prostate radiotherapy regimens. This study evaluated the safety and efficacy of an implantable and biodegradable balloon specifically designed to protect rectal tissue during radiotherapy by increasing the prostate–rectum interspace.Patients and methodsBalloons were transperineally implanted, under transrectal ultrasound guidance, into the prostate–rectum interspace in 27 patients with localized prostate cancer scheduled to undergo radiotherapy. Patients underwent two simulations for radiotherapy planning--the first simulation before implant, and the second simulation seven days post implant. The balloon position, the dimensions of the prostate, and the distance between the prostate and rectum were evaluated by CT/US examinations 1 week after the implant, weekly during the radiotherapy period, and at 3 and 6 months post implant. Dose-volume histograms of pre and post implantation were compared. Adverse events were recorded throughout the study period.ResultsFour of 27 patients were excluded from the evaluation. One was excluded due to a technical failure during implant, and three patients were excluded because the balloon prematurely deflated. The balloon status was evaluated for the duration of the radiotherapy period in 23 patients. With the balloon implant, the distance between the prostate and rectum increased 10-fold, from a mean 0.22 ± 0.2 cm to 2.47 ± 0.47 cm. During the radiotherapy period the balloon length changed from 4.25 ± 0.49 cm to 3.81 ± 0.84 cm and the balloon height from 1.86 ± 0.24 cm to 1.67 ± 0.22 cm. But the prostate-rectum interspace distance remained constant from beginning to end of radiotherapy: 2.47 ± 0.47 cm and 2.41 ± 0.43 cm, respectively. A significant mean reduction in calculated rectal radiation exposure was achieved. The implant procedure was well tolerated. The adverse events included mild pain at the perineal skin and in the anus. Three patients experienced acute urinary retention which resolved in a few hours following conservative treatment. No infections or thromboembolic events occurred during the implant procedure or during the radiotherapy period.ConclusionThe transperineal implantation of the biodegradable balloon in patients scheduled to receive radiotherapy was safe and achieved a significant and constant gap between the prostate and rectum. This separation resulted in an important reduction in the rectal radiation dose. A prospective study to evaluate the acute and late rectal toxicity is needed.

Bladder cancer (BC) represents the fourth most common neoplasia in men and the ninth most common cancer in women, with a significant morbidity and mortality. Cystoscopy and voided urine cytology (involving the examination of cells in voided urine to detect the presence of cancerous cells) are currently the routine initial investigations in patients with hematuria or other symptoms suggestive of BC. Around 75-85% of the patients are diagnosed as having non-muscle-invasive bladder cancer (NMIBC). Despite the treatment, these patients have a probability of recurrence at 5 years ranging from 50 to 70% and of progression to muscle invasive disease of 10-15%. Patients with NMIBC must undergo life-long surveillance, consisting of serial cystoscopies, possibly urine cytology and ultrasonography. Cystoscopy is unsuitable for screening because of its invasiveness and costs; serial cystoscopies may cause discomfort and distress to patients. Furthermore, cystoscopy may be inconclusive, falsely positive or negative. Although urine cytology has a reasonable sensitivity for the detection of high-grade BC, it lacks sensitivity to detect low-grade tumors (sensitivity ranging from 4 to 31%). The overall sensitivity and specificity of urine cytology range from 7 to 100 and from 30 to 70%, respectively. There is a need for new urine biomarkers that may help in BC diagnosis and surveillance. A lot of urinary biomarkers with high sensitivity and/or specificity have been investigated. Although none of these markers have proven to be powerful enough to replace standard cystoscopy, some of them may represent accurate predictors of BC. A review of recent studies is presented.