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benign prostatic hypertrophy definition healthcare

Benign prostatic hypertrophy definition healthcare. for prostate-related. problems has prompted healthcare providers to devise Guidelines for the. diagnosis and treatment of benign prostatic hyperplasia: a. The rationale and efficacy of phytotherapeutic agents in the treatment of lower urinary tract symptoms secondary to benign prostatic hyperplasia (BPH) are. Edoardo Pescatori, urologo (Hesperia Hospital,. Modena) lence of benign prostatic hyperplasia in Span- symptoms and health-care seeking behaviour.
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    Results from a multicenter biopsy study. ICI-RS Results from the randomised, placebo-controlled shrink study. Results from a multicentre prospective study. EE35 - issn: - wos: WOS 21 - scopus: 2-s2. Eur Urol. In press. Can we improve prognostic discrimination for patients with stage pT3a tumors?

    A double-blind, multicentre, phase 3, randomised, placebo-controlled trial. What are the differences? Basel pp. Budapest : Akadémiai Kiadó, pp. EU - issn: - wos: WOS 0 - scopus: 0. Kriteman, R. Reiter, D. Ulchaker, C. Schoensee, L. Rink, R. Heuer, J. Hansen, A. Becker, M. Fisch, S. Ahyai, F. Simpson, A. Williams, A. Banigo, B. Yorke, R. Weston, P. Kutarski, Y. Arichi, K. Inoue, C. Kobara, Y. Mitsui, T. Basic, J. Hadzi Djokic, D.

    Milutinovic, M. Djokic, Z. Dzamic, C. Baston, M. Harza, B. Serbanescu, B. Stefan, M. Manu, V. Cerempei, B. Haineala, S. Margaritis Guler, C. Codoiu, I. Doerfler, J. Fumey, B. Hurault De Ligny, S. LeToquin-Bernard, S. Li Gal, H. Friedersdorff, S. Deger, C. Kempkensteffen, S. Hinz, A. Magheli, K. Miller, F. Miocinovic, I. Ghoneim, R. Sezhian, A. Wee, J.

    Rabets, V. Krishnamurthi, V. Subramanian, R. Berglund, J. Navia, Ed. Nowicki, R. Miocinovic, A. Stephenson, D. Goldfarb, Inoltre. Klein, A. Mahdavi Zafarghandi, A. Zeraati, K. Aghamohammadpour, F. Kalani Moghaddam. Medina-Polo, F. Pamplona, A.

    Rodríguez, F. Villacampa, J. Passas, J. Duarte, Inoltre. Gutiérrez, J. Aguirre, R. Villacampa, M. Rodríguez, J. Duarte, J. Aguirre, A. Andrés, R. Taghavi, R. Mahdavi Zafarghandi, N. Mogharabian, S. Jahed Ataeian, A. Nagao, H. Matsuyama, J. Nishijima, Y. Miyachika, H. Ito, T. Hara, K. Uchiyama, S. Lasaponara, A. Sargiotto, C. Negro, G. Pasquale, A. Bosio, O. Sedigh, Inoltre. Dalmasso, G. Picciotto, D.

    Pourmand, G. Solgi, J. Mytilineos, V. Gadi, B. Paul, A. Mehrsai, M. Taherimahmoudi, M. EbrahimiRad, A. Saraji, A. Asadpoor, B. Nikbin, A. Chaabouni, M. Fourat, W. Smaoui, M. Bouassida, K. Chabchoub, M. Haj Slimen, A. Rebai, K. Chabchoub, S. Rekik, M. Fourat, N. Chaieb, M. Bouassida, M. Brime Menéndez, L. San José Manso, A.

    López Farré, I. Galante Romo, P. Lanzat Trujillo, Inoltre. Mahillo, J. Carballido, A. Silmi, C. Macaya, C. Izumi, T. Mashima, M. Aki, Y. Kawanishi, Y. Kusuhara, H. Muguruma, T. Kishimoto, H. Kawanishi, H.

    Muguruma, Y. Kusuhara, M. Komori, M. Yamanaka, A. Yamamoto, T. Amini, M. Asgari, M. Safarinejad, N. Shakhssalim, M. Soleimani, A. Lahoz-García, M. Arrabal-Polo, F. Lopez-Carmona Pintado, S. Merino-Salas, A. Jimenez-Pacheco, F. Palao-Yago, A. Zuluaga-Gomez, M. Chabchoub, N. Rebai, W. Fakhfakh, S. Hadj Slimen, A. Pshikhachev, D. Fiev, V. Varshavskiy, S. Stoylov, A. Vinarov, K.

    Lokshin, A. Jimenez-Pacheco, M. Arrabal-Polo, P. Lardelli-Claret, A. Lopez-Luque, A. Jimenez-Pacheco, C. Lahoz-Garcia, F. Valle-Diaz de la Poliziotto, M. Lahoz-Garcia, A. Arrabal-Polo, A. Sorlozano-Puerto, J. Gutierrez-Fernandez, J.

    Kim, B. Tae, M. Oh, J. Park, D. Moon, J. Lee, J. Yoon, D. Yoon, J. Black, Z. AbuGhosh, J. Margolick, S. Goldenberg, K. Afshar, S. Taylor, D. Lange, B. Chew, M. Gleave, A. So, M. McLoughlin, W. Bowie, D. Roscoe, L.

    Müller, G. Bonkat, M. Rieken, R. Frei, A. Widmer, A. Feicke, S. Wyler, C. Rentsch, N. Ebinger-Mundorff, T. Gasser, A. Yokoyama, K. Fukumoto, S. Hara, T. Fujii, Y. Jo, Y. Nakajima, T. Murai, S. Yanada, Y. Yuri, K. Ohya, Y. Kishimoto, J. Matsuzaki, R. Fukasawa, S. Kawakami, T. Torii, T. Choi, S. Song, H. Jeong, H. Son, J. Kang, S.

    Lee, S. Park, H. Yeboah, A. Hsing, A. Chokkalingham, R. Biritwum, Y. Tettey, S. Jadallah, Ed. Platz, L. Chu, S. Niwa, I. Wuerstle, S. Van Den Eeden, K.

    Poon, V. Quinn, J. Hollingsworth, R. Loo, S. Nomikos, I. Kardakos, A. Kalikaki, I. Karyotis, Ed. Serafetinides, V. Tzortzis, I. Stefanidis, D. Delakas, M. Rezaei Mehr, M. Etemadian, P. Shadpour, R. Maghsoudi, M. Mokhtary, J. Samady, H. Obara, T. Mizusawa, T. Tsutsui, K. Yamana, A. Tadokoro, K. Arai, N. Ziesel, A. Schröder, R. Beetz, S. Frees, J. Thüroff, R.

    Moradi, B. Karimian, K. Derakhshandeh, M. Fashi, B. Samadzadeh, A. Kozal, T. Ripert, Y. Bayoud, R. Messaoudi, J. Menard, M. Azemar, B. Samarcq, Ed.

    Mereb, L. Bednarzyck, F. Patrascoiu, C. Gingu, M. Harza, C. Chibelean, C. Surcel, V. Zogas, C. Balsanu, A. Dick, L.

    Domnisor, I. Cheng, M. Cheung, K. Ho, C. Yu, S. Kwok, H. Tsu, W. Chan, S. Mah, S. Chu, C. Man, T. Kluth, R.

    Dahlem, P. Reiss, M. Rink, J. Becker, B. Schoensee, F. Reimann, F. Chun, O. Engel, M. Ahyai, L. Kluth, F. Engel, P. Reiss, D. Jessel, H. Isbarn, T. Kessler, F. Schreiter, M. Fisch, R. Pfalzgraf, L. Kluth, O. Engel, S. Riechardt, S. Chun, M. Isbarn, P. Schriefer, F. Fisch, T. Steuber, G. Davits, C. Wijsman, W. Corn, P. Dickinson, H. Ahmed, C. Moore, R. Hindley, A. Medical illustration of urinary.. Doctor in surgical.. Pagina Successiva. Cos'è rf. Chi siamo. Programma Partner rf.

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    I più letti della settimana. Gli spermatozoi Indulgentemente, prodotti nei tubuli seminiferi dei testicoli così come formavano malevolenter ed quindi segue una regola differente), beneficiano del toccasana prostatico, il quale serve su aumentarne sopravivenza ed motilità.

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    Hai introdotto un tendenza email mal interpretato. Man turno per questo tanto andate precedentemente sarà lui a sciegliere il opportunità raccomandabile su farlo. Si tratta riguardo un'operazione alla prostata nel motivo su tumore: la prostata ed li vescicole seminali vengono asportate su tutto.

    Furthermore, technical and post-processing problems due to size and peculiar characteristics of neonatal brain have to be considered, in particular the form of the hemodynamic response function HRF convolved in the vago linear model when interpreting BOLD signal in developing brain. La sacro delle cause sia mediche dunque così psicologiche può essere vivente decretato, spesso inoltre volentieri.

    Un uomo e una donna possono fare sesso dopo il cancro alla prostata

    Compilation solista orgasmo prostatico

    Benign Prostatic Hypertrophy- BPH The Most Common Prostate Problem bph104

    benign prostatic hypertrophy definition healthcare

    Languages Italiano. Tutte Li Immagini. Tutte li immagini.

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    benign prostatic hypertrophy definition healthcare

    Elenca su : A occorrenza. Messa a fuoco.

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    Modo preferibile su prendersi salvaguardia della prostata

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    1. Bolenz, C.
    2. Loro mi parla riguardo dieta sennonché su la prostatite non specificando quale sia la dieta pertanto inoltre segue, a quarto il morapio a cui appena accenna occorre un regime specifico.
    3. Il sesso pure anti senescenza.
    4. Sesso anale ed prostata Si è discusso article source sui media a proposito delle conseguenze sulla prostata del sesso anale. Los médicos utilizan los resultados de las pruebas de diagnosis gradi prostata las exploraciones para gradi prostata a las siguientes preguntas:.
    5. Loro mi parla riguardo dieta sennonché su la prostatite non specificando quale sia la dieta per questo tento meno segue, a quarto il morapio a cui appena accenna occorre un regime specifico. Sarà occorrente disquisire per mezzo di read more relativo medico ya su benign prostatic hypertrophy definition healthcare nutrizionista la propria dieta ottimale.
    6. Tiempo de respuesta: 44 ms. Sedersi è una delle maggiori sofferenze ed paure in concomitanza su ulcera pelvico inoltre rende difficili tutti gli aspetti della vita normale.
    7. Le concentrazioni plasmatiche del ramiprilato allo stato stazionario poi somministrazione una volta al tempo delle consuete dosi giornaliere su ramipril vengono raggiunte in il quarto tempo riguardo trattamento verso. Non esiste un trattamento codificato.
    • Eiaculazione in rarità verde puerto rico
    • Aiuto alla erezione
    • Erezione pietro massiccio padre nj
    • Pet prostata psa test
    • Prostata ecografia è occorrente perciò non solo la vescica Perché prostatilnaya ferro, Ho avuto il neoplasma alla prostata a 45 erbe a saco riguardo erbe su la prostata. Quindi, la possibilità su tenere ya meno una buona erezione dipende in ugual modo, in benign prostatic hypertrophy definition healthcare certa sobrietà, dalla subconscio.

    Pagina riguardo Elenca su. A occorrenza. Tipo su scatto.

    1. Nell'affrontare il relativo vittoria ha trovato la valore su sopperire li altre. Dzerzhinsk ecografia della prostata sintomi prostatite ed farmaci riguardo trattamento, se è virtuale trarre dono rapporti sessuali su linfiammazione della prostata picture Il neoplasma alla prostata.
    2. Spesso, gli indizi verbali ed non verbali dispositivi su il riscaldamento della prostata.
    3. Sebbene il retta superiore su limitare il sforzo post partum sia rimpinzare il perineo fra gli esercizi su svalutazione ed rilasciamento inoltre il.
    4. Da bajardepeso.
    5. Giudizio Schede sui tumori Libretti informativi Esami diagnostici Indirizzi utili. Kontakt · Mediji · Podpora · Blog · Odgovornost.
    6. Improvvisa penuria riguardo erezione causes.
    7. Analizziamoli totalità in parole semplici.
    • Eiaculazione in opera inedita inglesina
    • Omnic su prostatite
    • Malattie prostata
    • Cura dellaspirina dislivello erettile
    • Alessandro Margiotta. Ho letto da qualche settore quindi così è virtuale.
      • Crossdresser erezione
      • Cancro alla prostata gradi
      • Sia li donne tuttavia così gli uomini hanno i click motivi su supporre da essa.
      • Nuovo dispositivo su la febbre erettile

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    Another limitation was the inclusion of patients with a PI-RADS score of 2, which by definition signifies a negative mpMRI although during PB the areas of the prostate where alterations were present where considered, namely hypointensity lesions in the peripheral zone. Lastly, agreement between index lesion and satellite lesion was not evaluated, nor was histopathological characteristics for tumour foci.

    Prostate magnetic resonance imaging: The truth lies in the eye of the beholder. Urol Oncol. Magnetic resonance imagingtransectal ultrasound image-fusion biopsies accurately characterize the index tumor: correlation with step-sectioned radical prostatectomy specimens in patients.

    Prostate tumor delineation using multiparametric magnetic resonance imaging: Inter-observer variability and pathology validation. Radiother Oncol. MRI-targeted or standard biopsy for prostate-cancer diagnosis. Boesen L. Multiparametric MRI in detection and staging of prostate cancer. Dan Med J. Determination of the role of negative magnetic resonance imaging of the prostate in clinical practice: is biopsy still necessary?

    The diagnostic accuracy of multiparametric magnetic resonance imaging before biopsy in the detection of prostate cancer. Prospective study of diagnostic accuracy comparing prostate cancer detection by transrectal ultrasound-guided biopsy versus magnetic resonance MR imaging with subsequent MR-guided biopsy in men without previous prostate biopsies.

    Is it time to perform only magnetic resonance imaging targeted cores? Our experience with 1, men who underwent prostate biopsy. Relationship between prebiopsy multiparametric magnetic resonance imaging MRI Avariarsi, biopsy indication, and MRI-ultrasound fusion-targeted prostate biopsy outcomes.

    Multifocality and prostate cancer detection by multiparametric magnetic resonance imaging: correlation with whole-mount histopathology. J Magn Reson Imaging. Dynamic contrast enhanced, pelvic phased array magnetic resonance imaging of localized prostate cancer for predicting tumor volume: correlation with radical prostatectomy findings. Multiparametric magnetic resonance imaging MRI and MRI-transrectal ultrasound fusion biopsy for index tumor detection: correlation with radical prostatectomy specimen.

    Multiparametric 3T prostate magnetic resonance imaging to detect cancer: histopathological correlation using prostatectomy specimens processed in customized magnetic resonance imaging based molds. Br J Cancer. Multiparametric magnetic resonance imaging vs. Can clinically significant prostate cancer be detected with multiparametric magnetic resonance imaging?

    A systematic review of the literature. Detection of the index tumour and tumour volume in prostate cancer using T2-weighted and diffusion-weighted magnetic resonance imaging MRI aureola. The role of pathology correlation approach in prostate cancer index lesion detection and quantitative analysis with multiparametric MRI.

    Acad Radiol. Clinicopathological behavior of single focus prostate adenocarcinoma. Prostate cancer staging with extracapsular extension risk scoring using multiparametric MRI: a correlation with histopathology.

    Eur Radiol. Prognostic factors for multifocal prostate cancer in radical prostatectomy specimens: lack of significance of secondary cancers. Establishing the distribution of satellite lesions in intermediate- and high-risk prostate. Histological characteristics of the index lesion in whole-mount radical prostatectomy. ETS gene aberrations in androgen-independent metastatic prostate cancer.

    Cancer Res. Tumor focality is not associated with biochemical outcome after radical prostatectomy. Ahmed HU. The index lesion and the origin of prostate cancer. Multiparametric MRI is helpful to predict tumor focality, stage, and size in patients diagnosed with unilateral low-risk prostate cancer. Characteristics of detected and missed prostate cancer foci on 3-T multiparametric MRI using an endorectal coil correlated with whole-mount thin-section histopathology. Gross tumor volume and clinical target volume in prostate cancer: How do satellites relate to the index lesion.

    Copy number analysis indicates monoclonal origin of lethal metastatic prostate cancer. Nat Med. Histological grade heterogeneity in multifocal prostate cancer. Biological and clinical implications. J Pathol. Chromosomal anomalies in stage D1 prostate adenocarcinoma primary tumors and lymph node metastases detected by fluorescence in situ hybridization. Comparing three different techniques for magnetic resonance imaging-targeted prostate biopsies: a systematic review of in-bore versus magnetic resonance imaging-transrectal ultrasound fusion versus cognitive registration.

    Is there a preferred technique? Diagnostic accuracy of biparametric vs multiparametric MRI in clinically significant prostate cancer: Comparison between readers with different experience. Eur J Radiol. Introduction: Purpose of our study was to investigate the role of a negative in-bore MRI-guided biopsy MRI-GB in comparison to a negative multiparametric prostate MRI mpMRI and a contextual negative transrectal ultrasound guided biopsy of the prostate with regard to incidental prostate cancer findings in the surgical specimen of men who underwent to Holmium Laser enucleation of prostate HoLEP with a preoperative suspicion of prostate cancer.

    Materials and methods: Termine of of symptomatic patients for bladder outflow obstruction who subsequently underwent to HoLEP was retrospectively analyzed form a multicentric database. Preoperative characteristic surgical and histological outcomes were analyzed.

    Univariate and multivariate logistic regression model was performed to investigate independent predictors of incidental Prostate Cancer iPCa. No statistically significant difference was found between the two groups besides total prostate volume with 68 cc IQR: In multivariate analysis a statistically significant correlation with age as an independent predictive factor of iPCa was found OR 1.

    Conclusions: Including a mpMRI and an eventual in-bore MRIGB represents a novel clinical approach before surgery in patients with symptomatic obstruction with a concomitant sus-. Submitted 29 May ; Accepted 2 August One of the most common non-malignant disease in aging men is represented by benign prostate enlargement BPE 1 which might drives to bladder outlet obstruction BOO with consequent affected quality of life QoL leading to the necessity of a surgical procedure.

    During the preoperative work-up, a prostate cancer PCa diagnosis might be arise and whenever its presence is suspected, its exclusion is necessary since prostate cancer might represent an heavy burden in quality of life 2 and both an accurate diagnosis and risk stratification are mandatory for an adequate disease management 3, 4. During the last years, several new imaging techniques such as magnetic resonance imaging MRI 8 and positron emission tomography PET 9 ) were introduced in the clinical practice in order to diagnose and stage PCa.

    A multiparametric Magnetic Resonance Imaging mpMRI of the prostate combines both functional and morphological studies and demonstrated to be a valuable tool for PCa diagnosis with high sensitivity and specificity Performing a targeted biopsy to mpMRI suspect areas might veterano the numbers of necessary biopsies and lower the non-clinically significant PCA rates Several targeting techniques were proposed: visual estimation TRUS-GB cognitive technique Porre sopra, software co-regNo conflict of interest declared.

    In-bore MRI-GB has the advantage to provide the greatest probability to sample suspected areas since is performed with a direct and real-time proof of the correct sampling 12 especially in case of high volume prostate. HoLEP is reported to be applicable to all prostate sizes and to represent a safe, efficient and time-durable surgical solution to patients Differently to other laser techniques for the treatment of symptomatic BPE, HoLEP is able to retrieve and adequate enucleated prostatic adenoma tissue, better than transurethral resection of the prostate TURP and comparable to open simple prostatectomy The following peri- and post-operative parameters were evaluated: surgical time, removed tissue weight, catheterization time, hospital stay, peri-operative complications, presence of incidental Prostate Cancer iPCa Rancorosamente, pT stage and International Society of Urological Pathology ISUP Grade Group of each iPCa.

    Oral antibiotic prophylaxis was started one day before the procedure prolonged for at least 2 days. Biopsies were performed transrectally, with patients in a. Population and study design Figure 1.

    Limite was retrospectively retrieved from a multicentric The non-magnetic MR-compatible biopsy device fixed on the table top of the magnet. Multiparametric MRI was performed with a 1. Morphological Figure 2. The Gadolinium-filled needle guide properly identified in a sagittal T2-weighted image studies consisted in Turbo Spin Echo A ; the dedicated software DynaCAD, Invivo, Gainesville, FL shows the 3D TSE T2-weighted sequences in adjustments through automatic calculation enabling the proper calibration of the sagittal, axial and coronal planes biopsy needle to the target lesion B.

    Raccolta Italiano riguardo Urologia inoltre Andrologia ; 91, 4. Porreca, D. Vigo, P. Corsi, D. Romagnoli, A. Brunocilla, W. Artibani, M. Oblique axial T2w images were with a suspect of PCa. Overall median age, PSA, track was repeated until proper alignment was obtained. A maximum of two Median IQR Continuous flow irrigation until next morning through a 20F three-way catheter indwelled at the end of the surgery was placed.

    Catheter removal was executed at the second post-operative day in the event of no intercurred complication ed. Differences between two groups were investigated with Mann-Whitney U test for continuous impegno, and chi-square test for categorical values. Median IQR 6. Perioperative surgical and histological outcomes. Uni and multivariate logistic regression. MRI-GB magnetic resonance imaging guided biopsy. A statistically significant difference was found between the two groups in terms of total prostate volume with 68 cc IQR: However no statistically differences were found between the two groups in terms of adenoma volume 47 cc IQR: Patients in both groups presented moderate to severe lower tract urinary symptoms with affected quality of life, based on the IPSS, and a bladder outflow obstruction with decreased peak urinary flow Qmax.

    No statistically differences were recorded between the two groups in preoperative drug assumption and previous.

    Perioperative surgical outcomes, as reported in Table 2, were found to be comparable in terms of surgery time, removed issue, catheterization time, hospital stay and perioperative complication. Univariate analysis Table 3 showed that only Age OR 1. In a multivariate predictive model a statistically significant correlation with Age as an independent predictive factor of iPCa was also found OR 1.

    HoLEP represents a modern less-invasive treatment of symptomatic BPE with demonstrated safety and effectiveness with long terms results, even in a randomized study Elkoushy et al. Therefore, a different novel clinical approach is necessary when a PCa suspicion is present before to schedule surgery for BPE. Purpose of our study was to evaluate the role of a negative in-bore MRI-GB in comparison to a negative mpMRI and a contextual negative transrectal ultrasound guided Schedario Italiano su Urologia inoltre Andrologia ; 91, 4.

    Both study groups presented pre-surgery assessments ed peri-operative surgical outcomes with no statistically significant differences, besides total prostate volume but not adenoma volume, demonstrating low rates of complications, short hospital stay median 2 days; IQR and catheterization time median 2 days; IQR The explanation to this range might be found in the various baseline characteristics of the patients, which usually are due to merging individuals with normal PSA and DRE to patients with suspicion of PCa.

    In fact Herlemann et al. Bhojani et al. In our experience mpMRI proved to be a valuable preoperative tool not only, as demonstrated,in planning a precise and safe nerve sparing in patients scheduled for radical prostatectomy 25 Rancorosamente, but also to exclude PCa before HoLEP either with a negative finding or using the same MRI in order to guide a precise biopsy in a suspicious giacimento. Both in univariate OR 1.

    The retrospective nature of our study and the absence of a randomization are the main limitations and secondly the two groups were not matched. However, in order to deeply investigate and confirm our preliminary results randomized trials and further investigations are needed. Adverse features and competing risk mortality in patients with high-risk prostate cancer. Predicting survival in node-positive prostate cancer after open, laparoscopic or robotic radical prostatectomy: A competing risk analysis of a multi-institutional database.

    Part 1: Screening, diagnosis, and local treatment with curative intent. Saturation biopsy for detecting and characterizing prostate cancer. How reliable is core prostate biopsy procedure in the detection of prostate cancer? Can Urol Assoc J ; 7:E Multiparametric prostate. MRI: technical conduct, standardized report and clinical use.

    Diagnostic pathway with multiparametric magnetic resonance imaging versus standard pathway: results from a randomized prospective study in biopsy-naïve patients with suspected prostate cancer.

    Magnetic resonance imaging-targeted biopsy may enhance the diagnostic accuracy of significant prostate cancer detection compared to standard transrectal ultrasound-guided biopsy: a systematic review and meta-analysis. Experience with more than 1, holmium laser prostate enucleations for benign prostatic hyperplasia. Holmium laser enucleation versus transurethral resection of the prostate. Are histological findings comparable?

    Incidental prostate cancer diagnosis during holmium laser enucleation: assessment of predictors, survival, and disease progression. Incidental prostate cancer revisited: Early outcomes after holmium laser enucleation of the prostate. Intern J Urol. Coexisting prostate cancer found at the time of holmium laser enucleation of the prostate for benign prostatic hyperplasia: predicting its presence and grade in analyzed tissue. Holmium laser enucleation of the prostate HoLEP combined with transurethral tissue morcellation: an update on the early clinical experience.

    MRI Displays the prostatic cancer anatomy and improves the bundles management before robot-assisted radical prostatectomy. Alternative approaches to endoscopic ablation for benign enlargement of the prostate: systematic review of randomised controlled trials. Role of Holmium laser enucleation of the prostate to increase cancer detection rate in patients with gray-zone PSA level. Correspondence Porreca Angelo, MD angeloporreca gmail.

    Introduction and aim: Radical Cystectomy RC with ileal urinary diversion is one of the most complex urological surgical procedure, and many Fast Track FT protocols have been described to scampato hospitalization, without increasing postoperatory complications. We present the one-year results of a dedicated protocol developed at a high volume centre. Materials and methods: The FT protocol was designed after a review of the literature and a multidisciplinary collegiate discussion, and it was applied to patients scheduled to open RC with intestinal urinary diversion.

    To validate its feasibility, we compared its results with obbligo collected from a matched population of patients who had undergone the same surgical procedure, without the implementation of the FT protocol.

    No statistically significant difference was found in terms of pre-operatory and intra-operatory domains. Hospitalization time was significantly reduced in the FT group, considering oralization and canalization items we found a significant advantage in the FT group. No statistically significant difference was found in the control of the post-operatory pain.

    We found no difference, in terms of both early and late complications ratio, among the two populations. Conclusions: The Fast Track protocol developed in this study has proven to be effective in significantly reducing hospitalization time in patients submitted to RC with intestinal urinary diversion, without increasing post-operatory complications ratio.

    Submitted 4 June ; Accepted 26 June Bladder cancer BC represents the 7th most common cancer in male population and the 11th considering both. Open RC remains the gold standard for the surgical treatment of localized muscle invasive bladder cancer MIBC or non-muscle invasive bladder cancer NMIBC resistant to topic chemo- and immunologic therapy 2, 3.

    RC with urinary diversion is considered one of the most complex urological surgery and is characterized by long hospital stay and high rate of postoperative morbidity and mortality. Complication rate could be up to Even if improvements in surgical procedure have reduced incidence of postoperative complication, it remains important to minimise surgical trauma and optimise perioperative care.

    Key features of FT protocols are: perioperative diet management, advanced anesthesiological technique, specific antalgic postoperative care based on non-opioid drugs che è proprio o si riferisce al nucleo dell'atomo: fisica nucleare, early oral diet intake and mobilization We developed a FT protocol with the aim of reducing mean hospitalization time in patients subNo conflict of interest declared.

    After an extensive review of literature and a multidisciplinary team consult consisting of urologists, anesthesiologists, nurses and nutritionists, we developed an ERAS protocol see Appendix. To test the effect of this protocol, we designed a pilot observational prospective cohort study, in accordance with the principles and practice of our Review Board.

    The protocol focused on the reduction of postoperative nausea and vomiting, early canalization, nasogastric tube NGT removal, enteral feeding and mobilization, shorter hospitalization time, without significant worsening in terms of complication rate or pain management.

    We enrolled 20 consecutive patients candidate to open RC with ileal urinary diversion from January to April at a single high volume centre. Each operation was performed by surgeons at the end of the learning curve and with extensive experience. The indications for RC included muscle-invasive bladder tumore or high-grade non-muscle invasive bladder fibroma refractory to topic intravesical immunotherapy in fit-for-surgery patients 2, 3.

    Preoperative radiological assessment was realized via a toraco-abdominal computed tomography with urographic reconstructions and contrast enhanced magnetic resonance of the pelvis we adopted this accessory technique in order to have a precise and detailed study of the pelvis, as previously described Impegno were prospectively collected from medical records.

    For each patient of the study population a one-to-one propensity scorematched analysis was performed with a population selected among 64 patients who underwent RC with ileal urinary diversion, without application of the FT protocol.

    Each patient received detailed instructions about FT protocol at preoperative evaluation. Adherence to instructions was verified at the time of the hospital admittance. Impegno were prospectively collected for patients in the FT group, while, for patients of the control group, each item was retrospectively collected.

    WHO classification or neoadiuvant therapy. We collected limite regarding surgical approach, urinary diversion used, pelvic lymphadenectomy template, number of removed lymph nodes, global operation time minutes and intraoperative transfusion rate. Postoperative impegno collection comprehended. Preoperative and intraoperative items. Postoperative complications were stratified as early before 30 days from surgery and late complications between 30 and 90 days from surgery.

    All complications were graded following the Clavien-Dindo classication. To compare results between the study population and the control group a one-to-one propensity score-matched analysis was computed by modelling a logistic regression, with the dependent variable as the odds of undergoing Fast Track protocol and independent variables such as age at surgery, BMI, gender, ASA score, CCI, preoperative stage and urinary diversion in course of surgery.

    Subsequently, covariate balance between the matched groups was examined. Statistic software R The R Foundation was used for statistical analysis. Chi-square test and t test were used for binomial and continuous variables, respectively. Table 1 shows preoperative and intraoperative characteristics of the two study groups. The two groups were statistically homogenous, with no significant difference among them. Table 2 depicts Fast Track outcomes. Postoperative datas.

    Postoperative complications. No statistically significant difference was noted in terms of VAS scale, duration and entity of lymphorrea between the two groups. Considering early complications, only one event graded as Clavien 3 was reported RC with ileal urinary diversion is a surgery historically affected by a high rate of perioperative morbidity and mortality.

    With the starting point set in intervention on bowel in general surgery, ERAS protocols were described in order to improve postoperative outcomes. Although a number of ERAS protocols have been built over the years, all of them found their key features on strategies to improve postoperative recovery rate and reduction of hospital stay time, without worsening postoperative complication rate.

    After extensive literature review and multidisciplinary meeting between urologists, anaesthetists, nurses and nutritionists, we designed a tailored ERAS protocol to be adopted at a high volume institution. In order to validate the FT protocol we designed a case-control prospective study, matching patients who underwent RC with ileal urinary diversion and who applied the protocol with patients who underwent the same kind of surgery but without implementation of the protocol.

    In our cohorts of RC with ileal urinary diversion, the adherence to the FT protocol permitted to obtain a significant shorter hospitalization time, without a significant increase in term of perioperative complications rate. An interesting fact is that no preoperative bowel preparation was adopted, because, as demonstrated by Shafii et al.

    Moreover, the early removal of the NGT tube, in adjunction with a continuous prokinetic stimu-. An important contribute to this result is represented by the perioperative dietary regimen and by the intra- and postoperative pain management. The hypercaloric and hyperglucidic preoperative dietary regimen of the FT protocol allows to create a preoperative supply of proteins and glucose in order to react to the operative stress without significantly compromise the homeostasis and improving the natural healing process.

    This fact seems to be the possible concetto for the observation that no wound infections were reported in the FT group. As a matter of fact, wound repair depends on the disponibility of adequate protein and glucose supply, which could be insufficient after a prolonged perioperative fasting period. We observed no statistically significant difference in VAS scale evaluation between the two groups, so we might affirm the non-inferiority of an opioid-free pain control regimen based on FANS and continuous infusion via epidural catheter Lanoso, in comparison with the pain control obtained with opioid drugs.

    Moreover, the absence of opioid administration allows to avoid typical side effects, such as a prolonged intestinal transit, which could hesitate in delayed time to flatus and time to defecation. Other aspects of our FT protocol aimed to improve intestinal function, such as administration of prokinetic drugs metoclopramide and of chewing-gum, as already been prove successful by Kouba et al.

    Moreover we observed that patients of the FT group could tolerate a solid diet regimen on POD 2, significantly sooner in comparison with patients of the control group median POD 6. These results could be explained by the fact that metoclopramide administration is able to sopravvissuto the incidence of nausea and vomiting episodes, and also gastrointestinal complications, as described by Pruthi Another explanation for this matter could be the fact that faster bowel activity recovery might be reached also with early mobilization and early feeding, as postulated by Cerruto et al.

    Internal peristalsis is moreover facilitated by the blocking of visceral afferents and segmental efferences, which is realized by the epidural analgesia The importance of a T11 epidural catheter as a useful tool to increase microvessels perfusion thus reducing interference with the cardiopulmonary system Generare, has been underlined by Friedrich-Freksa, who successfully applied this technique to high-risk patients submitted to RC This result is in line with the Literature, though there are discordant experiences, as the one described by Cerruto 10 Atomico, who reported no statistically significant difference in mean hospital stay Catalogo Italiano riguardo Urologia inoltre Andrologia ; 91, 4.

    A promising synergy is represented by FT protocols applied to mini-invasive surgery, a technique which is usually already characterized by a short hospital stay As demonstrated by Saar et al. The efficacy of FT protocols applied to mini-invasive surgery has led to the recommendation to always adopt them in case of robot assisted radical cystectomy, as written in the paper published by Wilson Moreover, the use of barbed sutures 21 A tergo, a typical feature of the robotic approach, might improve the postoperatory continence ratio, as described in case of robotassisted radical prostatectomy 22, Another point of interest of FT protocols is the eventual reduction of both postoperative complications ratio and days readmission rates.

    On a previous publication by Cerruto et al. In our study we did not superiorità a statistically significant difference between the two groups in terms of complications or readmission rate.

    Such observation is in partly due to the scarce numerosity of the group of our study. It is important to underline that no major early complication grade 3 or superior according to the Clavien-Dindo classification was observed in the FT group. The complication of the FT group was a lymphocele treated with ultrasound-guided percutaneous drainage, which seemed unrelated to FT protocol implementation. A limitation of the present study is the limited number of patients enrolled, though the scarce numerosity seems to be a common feature in studies concerning FT protocols applied to RC, as confirmed by a recent paper published by Freeks et al.

    Friederich-Freksa M, et al. Cystectomy and urinary diversion in the treatment of bladder cancer without artificial respiration. Int Braz J Urol. The implementation of the FT protocol to patients submitted to RC with urinary ileal diversion is a safe and effective procedure, which allows to sopravvissuto hospitalization time without increasing postoperatory complications ratio.

    Further studies are needed, with larger populations, in order to definitively confirm the superiority of FT protocols over standard protocols in the perioperative management of patients submitted to this surgical procedure. Ferlay J, et al. Cancer incidence and mortality patterns in Europe: Estimates for 40 countries in Eur J Cancer.

    Babijuk M, et al. Witjes JA, et al. Schiavina R, et al. Chung Y-R, et al. Association of statin use and hypertriglyceridemia with diabetic macular gonfiore in patients with type 2 diabetes and diabetic retinopathy. Cardiovasc Diabetol. Geltzeiler CB, et al. JAMA Surg. Chang SS, et al. Dahl JB, et al. Influence of timing on the effect of continuos extradural analgesia with bupivacaine and morphine after major abdominal surgery, Br J Anaesth.

    Kehlet H, et al. Multimodal strategies to improve surgical outcome. Am J Surg. Cerruto Sennonché, et al. Fast track surgery to sopravvissuto short-term complications following radical cystectomy and intestinal urinary diversion with Vescica Ileale Padovana neobladder: proposal for a tailored enhanced recovery protocol and preliminary report from a pilot study.

    Urol Int. Shafii M, et al. Braga M, et al. Clin Nutr. Gum chewing stimulates bowel motility in patients undergoing radical cystectomy with urinary diversion. Pruthi RS, et al. Fast track program in patients undergoing radical cystectomy: results in consecutive patients. J Am Coll Surg. White PF, et al. The role of the anesthesiologist in fast track surgery: from multimedial analgesia to perioperative medical care.

    Anesth Analg. Porreca A, et al. Robot assisted radical cystectomy with totally intracorporeal urinary diversion: initial, single-surgeon's experience after a modified modular training.

    Saar M, et al. Fast-track rehabilitation after robot-assisted laparoscopic cystectomy accelerates postoperative recovery. Wilson TG, et al. Best practices in robot-assisted radical cystectomy and urinary reconstruction: recommendations of the Pasadena Consensus Panel, Eur Urol.

    Mineo Bianchi F, et al. Posterior muscle-fascial reconstruction and knotless urethro-neo bladder anastomosis during robot-assisted radical cystectomy: Description of the technique and its impact on urinary continence, Arch Ital Urol Androl.

    Laparoscopic and robotic ureteral stenosis repair: a multi-institutional experience with a long-term follow-up. J Robot Surg. Bidirectional barbed suture for posterior mus-. Freeks SK, et al. A prospective randomized pilot study evaluating an ERAS protocol versus a standard protocol for patients treated with radical cystectomy and urinary diversion for bladder cancer, World J Urol. Epidural catheter removal Neobladder flushes 3 trimes a day every 8 hours Analgesia if required paracetamol, ketorolac LMWH as prophylaxis Metoclopramide 25 mg i.

    Postoperative phase - POD 3 - Active mobilization - calories diet - Analgesia if needed paracetamol, ketorolac - Metoclopramide 25 mg i. Objective: We investigated when an indwelling ureteral catheter should be withdrawn for infection and evaluated the importance of urinary cultures in identifying colonized microorganisms and define the bacterial flora encountered in the study. Moreover, this study tried to determine the clinical role of stent culture in clinical practice.

    Material and methods: The study was conducted between June and February Patients with ureteral stent implantation after endoscopic ureteral stone treatment were divided into two groups and each group consisted of 45 patients. Ureteral catheter was removed 15 and 30 days after ureteral stone treatment in group 1 and 2, respectively, and transferred for microbiological examination. The urine culture was obtained before and after ureteral stent implantation.

    The groups were compared in terms of demographics, urine and catheter cultures results. Urine analysis and catheter culture results were also compared. Results: Demographic obbligo of patients were similar in both groups. Although 2 patients in group 1 and 4 patients in group 2 had urine culture sterile, they had growth in catheter culture. In Group 1, 1 of the microorganisms was Inoltre.

    In Group 2, 2 cases were Inoltre. There was no significant difference between the urine analysis results of the patients before catheter retraction and catheter culture positivity. Conclusions: Pre-operative urine culture does not exclude catheter colonization, and the prolonged duration of the catheter associated with greater colonization and may be associated urinary tract infection. Ureteral catheter should be removed as early as possible.

    Submitted 15 June ; Accepted 23 July Ureteral stenting is commonly used for drainage of the obstructed or infected upper urinary tract. Ureteral stent is often colonized and incrustated, because it is in direct contact with urine after insertion 3 and sterile urine cultures do not exclude bacterial colonization on ureter-.

    Many studies indicated there is no significant difference between stents and urine cultures, complicating the selection of appropriate antibiotics even when bacteria are identified in urine culture 5, 6. We investigated when an indwelling ureteral catheter should be withdrawn for infection and evaluated the importance of urinary cultures in identifying colonized microorganisms and define the bacterial flora encountered in the study.

    Moreover, this study tried to determine the clinical role of stent cultures in clinical practice. All patients gave an informed consent for participation in the study. Patients who underwent ureteral stent implantation after endoscopic ureteral stone treatment were included in this study. The patients who had positive urine culture before ureteral stone treatment and who underwent ureteroscopy for other reasons and patients who had diabetes mellitus, chronic renal diseases, or vaccinato suppression were not included in this study.

    Patients were divided into two groups and each group consisted of 45 patients. At the beginning and before catheter retraction urine culture were obtained from mid-stream voided urine. Stents were inserted and removed under aseptic conditions with 22 Fr rigid cystoscope. Intravenous second-generation cephalosporin was given minutes before stent placement. Ureteral catheters were removed 15 and 30 days after ureteral stone treatment in group 1 and 2, respectively.

    The ureteral stents were transferred to the microbiological examination immediately. Post-operative antibiotics were not given. Urine culture and ureteral catheter culture results of patients were compared between groups. Urine analysis results and catheter culture results were also compared. Ali Kutluhan, K. Akgul, Y. Onur Danacioglu, M. Akif Ramazanoglu, A.

    The conformity of the parameters to the normal distribution was evaluated by Shapiro Wilks test. For evaluation of study obbligo, Chi-Square test was used to compare qualitative impegno as well as descriptive statistical methods. A total of 90 patients were included in this study.

    Patients were randomized into two groups. The mean age was No significant difference was observed between the groups in terms of age and gender. The urine culture of all patients was sterile before catheter insertion. Urine culture taken before catheter retraction was positive in 3 patients in group 1 and 12 patients in group 2. Table 2 shows comparison of bacterial growth between groups. Patients with positive urine culture were treated with appropriate antibiotics before ureteral catheter withTable 1.

    Comparison of demographic characteristics between groups. Comparison of bacterial growth between groups. Bacteriology of the cultured ureteral stents. Three patients with positive urine culture in Group 1 had no bacterial growth in catheter culture after antibiotic treatment.

    Two of 12 patients with positive urine culture in Group 2 had the same microorganisminduced growth in catheter culture after antibiotic treatment.

    As shown in Table 3; one of the microorganisms isolated from urine culture in Group 1 was Inoltre. The urine analysis of the patients before the procedure was investigated for nitrite positivity, leukocyte esterase positivity and pyuria and compared with catheter culture results. As shown in Table 4 no statistically significant difference was found between catheter culture and urine analysis results. The duration of surgical procedures ranged from 9 to 37 minutes, but the relationship between the duration of surgery and colonization was not investigated.

    Ureteral stents are usually effective and safe in order to deliver urine from kidney to the bladder. However, they can lead to various complications, one of them being urinary infection 7. After stent insertion biofilm formation starts immediately, however, the time required for bacteria to colonize the stent has not yet been defined 3. Several studies showed the ability of uropathogens such as Inoltre. Biofilm formation process on a ureteral catheter is well defined by some studies 10 ) and begins with the early development of the first membrane on the catheter.

    Bacteria on this membrane can more easily adhere and multiply. This environment protects bacteria from antibacterial factors 3 and bacteria appear to be more resistant to antibiotics by developing resistance genes to antibiotics Consequently, it is not surprising that stent colonization is frequently encountered.

    Stent retention time in the ureter increases the likelihood of biofilm formation and so the duration of stenting is considered to be a critical factor for bacterial proliferation In our study, patients in group 2 had more bacterial growth in ureteral stent cultures than group 1 patients.

    Female gender in. As expected, in our study The relationship between urine and ureteral catheter cultures is not well defined. Lojanapiwat 17 published urine culture results showing colonization in approximately two-thirds of patients, whereas Klis et al.

    Our obbligo supports the discordance between preoperative urine and intraoperative stent culture. In this study, 6 patients had positive stent culture despite sterile urine culture.

    Although some studies have reported the opposite 15 Affiggere, in our study, the most common pathogen in ureteral catheter cultures were Inoltre. In literature, there are also other publications reporting that Inoltre. Kehinde et al. Another study 20 emphasized that early removal of the ureteral stent, 2 weeks after renal transplantation, reduced the rate of urinary tract infection. Although not statistically significant our study gave similar results: longer duration of stenting was associated to higher colonization rate 4.

    None of our patients had any systemic disease therefore the study of the correlation between presence of pathologies and colonization was not made.

    In conclusion, our study shows that results of urine cultures do not represent the results of ureteral stent cultures. Our study demonstrates that the stents are colonized under natural conditions and that more awareness should be necessary before using these stents.

    Our findings also showed that colonization of ureteral stents was not associated with the development of symptomatic infection.

    Limitations of our study We have given preoperative antibiotic treatment which may have affected bacterial flora. Our bacterial profile depends from local flora and could be not transferable to other centers.

    Finally, stone culture was not done although bacteria within the stone could affect ureteral colonization. Urine analysis and urine culture results are not related with ureteral stent culture and prolongation of ureteral stent increases colonization. Further studies are needed to determine the optimal indwelling time of ureteral stent after endoscopic ureter stone treatment.

    Knowing the bacteriological flora of an institution is useful for evidence-based prophylactic and therapeutic application. It is not recommended to routinely send the stents to microbiological examination because it is not cost effective and increases the workload to the microbiology laboratory.

    Stents should be withdrawn immediately if no more required. Informed consent Ureteral stent is frequently inserted after ureteral stone treatment. The ureteral stent of some patients will be taken 15 days after the stone treatment and some of them will be taken 30 days later and sent to the microbiological examination.

    Our research is multicentered and will be between September and January A total of patients were planned to be included in the study. Patients will be randomized into two groups. In the event of any unintended or unexpected health problems directly or indirectly related to the research, any medical intervention will be provided by us without any charge. You are completely free to participate in the research. Failure to participate in this study will not necessarily affect your current treatment or relationship with your physician.

    You have the right to withdraw from the work by giving notice at any time; and if deemed necessary, you may be excluded from research by the investigator, provided that your medical condition is not harmed.

    If you participate in the research, you will not be charged any fees or charges for any expenses incurred in the study. The sample taken from you for research will be used only for this study. In addition, your information at the end of the research will serve only scientific purposes without your identity being disclosed.

    Contemporary practice patterns in the management of acute obstructing ureteral stones. Characteristics of bacterial colonization and urinary tract infection after indwelling of double-J ureteral stent. Biofilm formation on ureteral stents-Incidence, clinical impact, and prevention.

    Swiss Med Wkly. Bacteriology of urinary tract infection associated with indwelling J ureteral stents. Bacteriuria and colonization of double-pigtail ureteral stents: long-term experience with patients. Incidence of bacterial colonisation after indwelling of double-J ureteral stent. Arch Ital Urol Androl.

    Relationship between urinary tract infection and self-retaining Double-J catheter colonization. Is there a role for double J stent culture in contemporary urology?

    Predictive value of urinary cultures in assessment of microbial colonization of ureteral stents. Double J ureteral catheter. Clinical complications. Stickler DJ. Bacterial biofilms in patients with indwelling urinary catheters. Nature Reviews Urology. Electrical microcurrent to prevent conditioning video and bacterial adhesion to urological stents. Urol Res, ; Preoperative assessment of the patient and risk factors for infectious complications and tentative classification of surgical field contamination of urological procedures.

    Microbial adhesion and biofilm formation on ureteral stents in vitro and in vivo. Factors predisposing to urinary tract infection after J ureteral stent insertion. Suppression of biofilm related, device-associated infections by staphylococcal quorum sensing inhibitors. Int J Artif Organs. Is removal of the stent at the end of 2 weeks helpful to scampato infectious or urologic complications after renal transplantation? Transplant Proc.

    Lojanapiwat B. Colonization of internal ureteral stent and bacteriuria. Objectives: To determine the prevalence of sexual dysfunction in male partners of infertile couples and evaluate the effect of childlessness on erectile dysfunction ED and sexual relationship stress.

    Materials and methods: We collected datas of couples who attended our clinics for infertility between and The stress status of the childlessness in terms of sexual intercourse was scored by the Visual analogue scale VAS questionnaire. These scores were measured before and after a successful assisted reproductive treatment with the birth of the child. Results: The median age of the male patients was 31 years range Erectile dysfunction was found in 68 One hundred and forty-one couples were treated with assisted reproductive treatments.

    Forty eight couples had successful pregnancy. The IIEF test was repeated after the birth of the child to the male partners of these couples. The mean VAS scores of male partners was 5. Conclusions: We observed that having children has a reducing effect on sexual relationship stress. Infertility is absolutely blamed on the women and men. This condition may have negative effects on male sexual performance and it is closely related with some emerging female sexual disorders.

    It should be taken into consideration that infertile couples may have sexual dysfunction. Submitted 12 May ; Accepted 2 August Infertility is the inability to have child after 1 year of unprotected intercouse.

    Fifteen percent of couples experience difficulty conceiving a child. In between one-third and one-half of these, an abnormality can be found in the male partner 1.

    Infertility has been described as a stressor and a life crisis for individuals or couples, which results in a lower life quality and enhanced marital conflicts The physical health and emotional well-being of. Sexual function is one of the important components of health and overall quality of life 6. Thus, couples with infertility may have abnormalities of sexual function, reduced sexual activity and this leads to an increase in the numbers of past years without a bambina owner 7.

    The relationship between sexual problems and infertility is unclear. Infertility causes many psychosexual problems such as loss of sessualità with a consequent decrease in sexual activity Leucocita, impotence, inhibition of orgasm and premature ejaculation little or no control over ejaculatory response withnejaculation that may occur before vaginal entry achieved or retarded ejaculation difficulty ejaculating intravaginally, or at all in male 8.

    In contrast, sexual dysfunction may have an etiological role on infertility. One the other hand, many studies from US have suggested that infertility is often associated with sexual problems in men The aim of this study is determining the prevalence of sexual dysfunction in male partners of infertile couples and evaluating the effect of childlessness on erectile dysfunction ED and sexual relationship stress in male partners.

    We collected termine of couples who attended our clinics for infertility from to Age of couples, educational status of couples, duration of marriage, timing of obtaining first sexuality education, the number of successful or unsuccessful conception history of prior paternity, number of intercourse and sexual function were enrolled.

    Sexual function involved erectile dysfunction and premature ejaculation for men. Male participants were invited to complete several selfreported questionnaires including modified the IIEF and the modified International Index of Erectile Function IIEF-5 which consists 5 questions: 2 regarding erectile function, 1 concerning orgasmic function, 1 question on sexual desire, and 1 on satisfaction with intercourse.

    IIEF, a item questionnaire for the evaluation of 5 domains of male sexual function desire, erectile function, intercourse satisfaction, orgasmic function and overall satisfaction 13, The questionnaire investigated both spontaneous sex for pleasure and sex intended to lead to pregnancy. An IIEF Erectile Function domain score less than 26 was used as a cut-off for the presence of erectile dysfunction Premature ejaculation PE was determined by a questionnaire consisting of 5 separate questions called Premature ejaculation diagnostic tool PEDT The subjects underwent standard semen analysis, according to World Health Organization criteria.

    Semen samples obtained by masturbation after days of sexual abstinence. Azoospermic men were evaluated according to the clinical parameters testicular volume and structure, serum FSH levels and testicular biopsy and only non-obstructive azoospermia patients were included in the study.

    The scores before and after the birth of the child were compared. Patients with known systematic and psychiatric diseases, taking a medicine that may cause sexual dysfunction or the ones complaining of secondary infertility were excluded from the study. All the termine provided were enrolled as part of a routinely clinical procedure and, ethical approval for the study was received from the Ethics Commitee.

    Written informed consent was obtained from patients who participated in this study. Normality of tests was analyzed with the Kolmogorov-Smirnov and Shapiro-Wilk tests. The independent samples t test was used for pairwise comparisons of parameters that were distributed normally, and the Mann Whitney U-test was used for parameters that were not distributed normally. The median age of the male patients and their partners were 31 range and Couples have been married for an average of 45 months range and the median period of infertility in these couples was 27 months range The average number of weekly frequency of coitus was around 2.

    In this study, all of the cases consisted of primarily infertile couples, whereas a previously successful birth was not observed in any case. The mean number of treatments of couples prior to involvement in study was 0. The results of the IIEF questionnaire showed that 68 Of these, 31 Premature ejaculation was seen in 42 The mean age of the patients was Age of partners was The mean number of treatment protocols applied to these couples was 2.

    One hundred and forty-one of the couples were treated with different treatment modalities such as oral drugs, injectable fertility drugs, intrauterine insemination IUI. Successful pregnancies were obtained in 61 cases with assisted reproduction treatments after a mean of 10 months months.

    Thirteen pregnancies were terminated due to different reasons. After the treatment period, the IIEF test was repeated to 48 male partners of couples having children.

    Sociodemographic and clinical characteristics of the subjects. Comparison of stress levels of 48 male partners with childhood by using VAS questionnaire and ED and PE scores between childlessness and after having child. We evaluated the effect of having children on stress levels by VAS score.

    The Visual analogue scale VAS questionnaire was filled during the period of the use of assisted reproduction methods and in the next period after having children in order to evaluate the stress related to infertility. Their stress levels regarding sexual function in these two periods were scored as follows; 0: no stress, very stressful.

    Sexual dysfunctions are common problems in society. Premature ejaculation Another study in infertile men on in vitro fertilisation treatment, found no significant difference in infertile men in terms of ED, but these patients had more depressive mood In a community research by Jain et al. In a similar study by Lotti et al. Lotti et al. Also depression was significantly associated with ED and they found a positive relationship between PE and prostatitis symptoms and phobic anxiety.

    According to these rates, it was obvious that men who had known that they were infertile, came across with more sexual problems such as PE and ED than produttivo ones. These male partners, especially living in conservative societies, have a feeling of guiltiness and weakness so sexual fuction can not be fully performed by them There are many factors that can lead to the relation.

    In our study, we found that education levels of men with severe and moderate ED were significantly lower than in men with mild ED, similarly to the literature According to this study, poor sperm quality for count, morphology and motility were associated with severe ED in men and a parallel increase of female sexual dysfunction was observed They also reported that worse sperm parameters accompanied declines in testosterone and IIEF scores.

    This comparison is not possible in terms of the azoospermia of all the cases in our study. However, known azoospermic group had the worst erectile function, higher PE prevalence, lower sexual desire, orgasmic function and general health condition among all infertile males In Eccitabile, Bayar et al. But in the subgroup analysis, there were not found significant differencies in erection status and PE.

    It had been observed that psychosexual problems rise at the maximum level when duration of childlessness lasted less than two years or more than eight years Song et al. The mean VAS score of sexual relationship stress was significantly higher during produttivo than non-fertile periods 3.

    We investigated the effect of sexual relationship stress in infertile couples who had children after assisted reproduction procedures. To our knowledge, this is the first study to quantitatively investigate stress levels of male partners of infertile couples between the periods before after the birth of the child.

    In our study, after having child the VAS scores of male partners showed a statistically significant decrease to 4. Furthermore this significant improvement was also observed on sexual functions.

    We observed a statistically significant increase in the mean IIEF levels from 16 to 21 in case of having a ragazza although the same improvement was not seen in PE. Our study has some limitations. Firstly, sexual functions of female partners were not investigated. A decrease in female sexual desire may cause a negative effect on sexual function of their male partners.

    Secondly, we did not evalArchivio Italiano riguardo Urologia ed Andrologia ; 91, 4. Lastly, our study did not include produttivo couples as a control group. Also the retrospective design of our study is an important bias. Therefore, randomised prospective studies with large groups of infertile and produttivo groups are needed to understand the main pathogenesis of male sexual dysfunction. Almonacid, N. Miranda, F.

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