Objectives:To evaluate the therapeutic effects of tamsulosin on recurrent urinary tract infections in women with dysfunctional voiding. Methods: A total of 155 women with recurrent urinary tract infections and dysfunctional voiding were included and randomly assigned to the following groups: uroflowmetry biofeedback (group 1), α1-adrenoceptor antagonists (group 2), uroflowmetry biofeedback combined with α1-adrenoceptor antagonists (group 3) and no treatment (group 4). Patients were evaluated by the American Urological Association Symptom Index at 3, 6 and 12 months. Urodynamics was carried out in patients of groups 1, 2, and 3 at 3, 6 and 12 months, whereas urodynamics was only carried out at 12 months in group 4. All patients were followed up for 1 year with monthly urine cultures. Results: The incidence of storage and emptying symptoms decreased significantly at 3, 6 and 12 months. Mean flow rate, flow time and voiding volume increased significantly (with a better outcome in patients of group 3), whereas post-void residual urine decreased. Mean opening detrusor pressure and detrusor pressure at maximum flow decreased significantly (with a better outcome in patients of group 3). Mean urethral closure pressure and maximum urethral closure pressure decreased significantly with a more significant decrease for patients in group 3. The prevalence of urinary tract infection decreased significantly in all groups after treatment, and this decrease remained stable during the follow up. Conclusions: In women with dysfunctional voiding and recurrent urinary tract infection, tamsulosin associated with uroflowmetry biofeedback might be an effective and safe treatment option for improving urinary symptoms and quality of life.
Objective of our study was to define a diagnostic-therapeutic pathway for proper treatment of not-palpable testicular masses, that may be benign in 38% of cases. Since the intraoperative diagnosis is difficult to reach in particular in small lesion (< 8 mm) and the risk of tissue loss in frozen section analysis occurs frequently, we propose a diagnostic flow chart for the best management of small testis lesions. This proposed protocol has to be shown in details to physicians and patients, who must understand the clinical implications and the risk to undergo a second radical surgery. CLINICAL PROTOCOL TO NOT-PALPABLE TESTIS LESIONSWe present a diagnostic-therapeutic protocol for patients affected by not-palpable testicular masses, with maximum diameter lower than 15 mm and negative testicular markers. This approach follows our clinical practice. UltrasoundAll men underwent scrotal ultrasound in our hospital to confirm type, dimension and localization of the lesion. Ultrasound characteristics of the lesion were then verified at the confirmatory ultrasound by expert operator and last generation of ultrasound machine. If the lesion was not confirmed by confirmatory ultrasound or it is extra-testicular lesion, the patient was proposed for ultrasound follow-up. Once the small testicular mass was confirmed at our hospital, the therapeutic indication for all cases was testicular exploration with inguinal access. This technique can be associated to intraoperative ultrasound, equipped with linear probe, in order to obtain the relative certainty of the size of the nodule and negative surgical margins, which of course will be subsequently verified by the pathologist. In figures, we report ultrasound images of three cases of our who underwent surgery for epidermoid cyst (Figure 2), Leydig tumor (Figure 3), and seminoma (Figure 4). SurgerySurgical exploration, using intraoperative ultrasound was done without clamping the spermatic cord. The surgical technique involved the removal of the neoplastic nodule and 3 additional biopsies of the surrounding parenchyma (two distant and one next to the mass) sent for definitive histology. Smaller masses (< 8 mm) were usually sent for definitive histology, while larger masses (8-15 mm) were sent to the pathologist for intraoperative frozen sections. Pathologist confirmed size and completeness of surgical margins, by macroscopic view. If the nodule was large enough to be cut for frozen section, then a microscopic description of malignant pattern was reported.
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