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   Table of Contents - Current issue
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October-December 2020
Volume 32 | Issue 4
Page Nos. 135-169

Online since Friday, August 13, 2021

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ORIGINAL ARTICLES  

Improvement of health-related quality of life in patients with overactive bladder syndrome: A subanalysis of the prospective, noninterventional study BELIEVE in the Greek population p. 135
Apostolos Apostolidis, Garyfalia Petoumenou, Manto Tzanetakou
DOI:10.4103/HUAJ.HUAJ_17_21  
Objective: The BELIEVE study is a prospective, noninterventional study which was conducted in a real-world setting in Europe and assessed quality of life, treatment satisfaction, healthcare resource utilization, and persistence with treatment in patients with overactive bladder (OAB) syndrome prescribed mirabegron as part of routine clinical practice. We present the results of a subanalysis of the BELIEVE study in the Greek population. Materials and Methods: The primary endpoint was change from baseline in quality of life (QoL) based on the OAB-questionnaire (OAB-q), consisting of the Symptom Bother Scale and health-related QoL (HRQoL). Change from baseline in QoL based on the EQ-5D-5 L health survey, treatment patterns and persistence with treatment, as well as adverse events during the study were also assessed. The duration of the observation period was 12 months. Results: A total of 97 OAB patients from 10 sites in Greece participated in the substudy; 89 completed the OAB-q at baseline and at least at one follow-up visit (Full Analysis Set, mean age 62.7 ± 10.9 years, 86.5% female). At baseline, 73% of patients were “new,” 14.6% were “lapsed,” 9% switched treatment, and 3.4% were on combination treatment. The scores in the Symptom Bother Scale and HRQoL Scale improved significantly from baseline at 10–12 months (−32.4 ± 2.54 and 30.2 ± 2.49, respectively). The EQ-5D subscales confirmed that mirabegron led to an improvement in the HRQoL of patients. At 10–12 months, 72% of patients were continuing on mirabegron treatment for OAB, either as single treatment (60%) or as combination treatment (12%). Mirabegron was well-tolerated, as no serious drug-related adverse events (AEs) were observed, whereas only a small percentage (6.2%) of drug-related AEs resulted in treatment discontinuation. Conclusions: The Greek population subanalysis confirmed the European results of the BELIEVE study. Patients who received mirabegron in a real-world setting showed clinically meaningful improvements in HRQoL. Mirabegron demonstrated a high persistence rate (72% at 12 months), and good tolerability. The overall improvement in HRQoL, particularly in the population continuing to receive mirabegron at 10–12 months, and the low incidence of AEs may have contributed to the high persistence rate.
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Idiopathic urethritis in childhood: Presentation of five cases p. 145
Chrysie Koutsaftiki, Alexia Papatheodoropoulou, Diomidis Kozyrakis
DOI:10.4103/HUAJ.HUAJ_13_21  
Introduction: Idiopathic urethritis (IU) in childhood is a rare disease with very few cases reported so far. Methods: During the past 3 years, the medical records of young boys diagnosed with and treated for IU in our department were retrieved and analyzed. Herein, their clinical course is presented, and a brief review of the literature is performed. Results: Five young male patients (mean age: 8.2 years) presented to the pediatric office with blood spotting of the underwear or urethral discharge, with or without dysuria. All the patients were treated in an outpatient basis and the corresponding clinical courses after a mean follow-up was 15.8 months were favorable. Conclusions: IU is a rare disease with a generally benign clinical course. Treatment must be tailored to symptomatic relief with avoidance of antibiotics. An aggressive diagnostic workup should be reserved to those with persistent symptoms or frequent recurrences.
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Upper-pole infra-costal access for supine percutaneous nephrolithotomy: Advantage or risk? p. 148
Stylianos Kontos, Niamh Smyth, Athanasios Papatsoris, Sarath Krishna Nalagatla
DOI:10.4103/HUAJ.HUAJ_11_20  
Objective: There are still disagreements in choosing a better approach to establish a percutaneous tract for percutaneous nephrolithotomy (PCNL), between supine and prone positions. The aim of this study is to investigate the safety, efficacy, and practicability of treating upper-pole renal stones, using an infra-costal puncture in both prone and supine positions. Materials and Methods: Fifteen patients underwent infra-costal puncture for the percutaneous treatment of upper-pole stones at our institution over a 3-year period. Seven patients underwent a prone procedure and six had a supine PCNL. All punctures were undertaken by two consultant urologists. Stone clearance was assessed with a plain X-ray kidney-ureter-bladder on postoperative day 1. We retrospectively analyzed our prospectively maintained database to assess stone clearance, complications, and length of stay of these patients. Results: The overall stone-free rate was 93.3% (all but one patient). One hundred percentage of the prone group were stone free following the procedure. Nearly 87.5% of the supine group had a complete clearance. Complications and length of stay were comparable for both groups. Almost 25% of the supine group and 14% of the prone group required transfusion. The postoperative pyrexia rates were similar for both groups. The overall complication rate was 26.7% (n = 4) – one case of sepsis and three patients required blood transfusion. There were no thoracic complications. Conclusions: Upper-pole renal stones can be safely and effectively treated percutaneously using direct upper-pole puncture via an infra-costal approach in supine position, as well as in prone position.
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REVIEW ARTICLES Top

Prostate cancer therapies and fertility: What do we really know? p. 153
Panagiotis Mourmouris, Lazaros Tzelves, Titos Deverakis, Lazaros Lazarou, Kimon Tsirkas, Anastasia Fotsali, Christiana Roidi, Ioannis Varkarakis
DOI:10.4103/HUAJ.HUAJ_9_21  
We reviewed the literature for articles in English in the Medline database from 1970 until today. The keywords used were “prostate cancer,” “fertility,” “radical prostatectomy,” “external beam radiotherapy,” “androgen deprivation therapy,” and “chemotherapy.” Only the studies with full paper were included in our review. The knowledge for this important issue is minimal and more minimal tends to be the consent of the patients. Prostate cancer does not seem to directly influence fertility, but all its therapies directly or indirectly seem to do so. In many of them, the impact may be reversible, but the mechanisms of this impact are still under consideration. Prostate cancer treatments, predominantly radiation, can cause long-term azoospermia; however, the data in the literature are sparse, mainly derived from small series, and based on these, no safe conclusions can be drawn.
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Antioxidants and oligoasthenoteratozoospermia: A review of the literature p. 157
Christos Roidos, Stilianos Giannakopoulos
DOI:10.4103/HUAJ.HUAJ_22_21  
The present review examines whether and to which extent the antioxidant drugs have a role in the management of patients with oligoasthenoteratozoospermia (OAT). Subfertility and especially semen parameters disorders presented as OAT have been associated with increased oxidative stress and on this basis, several studies of antioxidants administration toward its treatment have been carried out. In the limits of this literature review and by using scientific publications search engines (PubMed, Medscape, Cochrane Library, Google Scholar), 285 related studies were found in total. Among them, the 34 more relevant to the investigated topic, with a complete statistical analysis, were isolated and included in the present review. It seems that there is a significant positive impact of antioxidants on semen parameters' improvement and childbearing. However, these studies are quite heterogeneous and more studies are required, for safe conclusions to be extracted. Administration of antioxidants to those men should be a matter of individualized approach.
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CASE REPORTS Top

A 36-year-old patient with acute urinary retention due to an anterior midline prostatic cyst: A case report and review of the literature p. 163
Dimitrios Deligiannis, Konstantinos Adamos, Angelos Tselos, Stamatios Mavrikos
DOI:10.4103/HUAJ.HUAJ_21_21  
During the years, there have been no more than a few reports (with ours being so far the sixth) of prostatic cysts prolapsing into the bladder and thus causing urinary obstruction. Most of those cystic formations are generally asymptomatic and are found during random controls. In our case, the cyst was located in the anterior midline of the prostate in a 36-years-old patient presenting at the E. R with severe suprapubic pain and urinary retention after 3 months of constantly deteriorating lower urinary tract symptoms. Transabdominal ultrasonography and magnetic resonance imaging revealed a projecting prostatic cyst that like a valve was blocking the bladder neck at 12 o'clock position. It was successfully removed by transurethral resection leaving the patient free of symptoms.
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Conservative management of hemodynamically stable patient with grade V renal trauma: Case presentation and review of the literature p. 167
Charalampos Fragkoulis, Ioannis Glykas, Dimitrios Moschotzopoulos, Odysseas Aristas, Georgios Papadopoulos, Georgios Stathouros, Konstantinos Ntoumas
DOI:10.4103/HUAJ.HUAJ_26_21  
Renal trauma is a major health problem involving mostly young patients. It is estimated that renal trauma is diagnosed in almost 5% of all trauma patients. Patients diagnosed with Grade V renal trauma require surgical intervention and usually nephrectomy. The aim of this study is to present a case of Grade V renal trauma in a hemodynamically stable patient treated conservatively in our department. A 24-year-old male was admitted to the urology department due to Grade V left renal trauma after a motor accident. The patient presented with hematuria and was hemodynamically stable. A conservative approach was performed with close monitoring of hemodynamic status. Two red blood cells units was transfused. The patient remained hemodynamically stable and renal hematoma reduced in size in follow-up computed tomography. The patient was discharged in excellent clinical status after 17 days of hospitalization. Although Grade V renal trauma involving vascular injury requires immediate surgical intervention, in selected patients diagnosed with shattered kidney, a conservative approach may be successful provided that the patient remains hemodynamically stable and under close monitoring. Hemodynamic instability is an absolute indication for surgical exploration and possible nephrectomy.
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