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Biomedical subjects

Andrea Tubaro

Publications and source records attributed to Andrea Tubaro.

At least 19 recordsLinked to original sources
PubMed2007

Transurethral needle ablation of the prostate.

PURPOSE OF REVIEW: The review aims at reviewing the evidence published in the peer review literature or otherwise available with particular focus on articles published over the last 2 years on the transurethral needle ablation of the prostate in the treatment of benign prostatic hyperplasia. Prospective noncomparative and comparative studies as well as meta-analyses were considered. Information from the European Real Life database on transurethral needle ablation was also included. RECENT FINDINGS: The evidence currently available confirms a clinically relevant improvement of lower urinary tract symptoms and quality of life. Impact on voiding dynamics including flow rates, detrusor pressure at maximum flow and postvoid residual, as well on prostate volume, remains marginal. SUMMARY: All major guidelines in the management of lower urinary tract symptoms in patients with benign prostatic enlargement include transurethral needle ablation of the prostate as a valuable treatment option in patients with severe symptoms and low degree of bladder outlet obstruction, patients at high risk for surgery and patients who wish to avoid surgery or regional/general anaesthesia.

Humans↗
PubMed2006

Clinically overt venous thromboembolism after urologic cancer surgery: results from the @RISTOS Study.

OBJECTIVE: Incidence of venous thromboembolism (VTE) and need for thromboprophylaxis in urologic surgery have received little attention since only one randomised study has addressed this issue in the last 20 yr. The present prospective observational study evaluated incidence and risk factors for clinically overt VTE in a wide spectrum of consecutive patients undergoing surgery for cancer and compared findings in urologic patients with those in patients undergoing general or gynaecologic surgery. METHODS: Patients having cancer surgery (general surgery, gynaecology, urology) were assessed for clinically overt VTE occurring up to 30+/-5 d after intervention or more if the hospital stay was longer. All suspected VTE events were evaluated by an external independent Adjudication Committee. RESULTS: A total of 2373 patients, 1238 (52%) undergoing general surgery, 685 (29%) urologic, and 450 (19%) gynaecologic surgery were evaluated. In urologic patients, most procedures (61%) were endoscopic, with bladder and prostate cancer being the most frequent tumours. In-hospital thromboprophylaxis was given to 71.7% of patients, whereas 32.5% received prophylaxis after discharge. The incidence of VTE in urologic patients was lower (0.87%) than that in general surgery and gynaecologic patients (2.8% and 2.0%, respectively). VTE consisted of three cases of nonfatal and three cases of fatal pulmonary embolism (PE). In four of the six cases, VTE occurred during prophylaxis. CONCLUSIONS: VTE still represents a severe complication and remains the most common cause of death after urologic cancer surgery. Efforts should be made to optimise prophylactic measures to further reduce such risk.

Aged↗
PubMed2006

Italian validation of the urogenital distress inventory and its application in LUTS patients.

OBJECTIVES: The objective of this study was to validate the Italian version of the Urogenital Distress Inventory (UDI) in a sample of women with lower urinary tract symptoms (LUTS). METHODS: The linguistic validation of the questionnaire was performed through a multistep process: backward and forward translations coordinated by clinical investigators, followed by a pretest. The final version was administered to a larger sample of female patients, aged 18 years or older who had been having LUTS for at least 3 months, numbering 53 subjects. To evaluate test-retest reliability, patients were re-rated after 1 week. To test the questionnaire's capacity to discriminate women with or without LUTS (cases and controls, respectively), a sample of 53 healthy women was enrolled. A 72-h voiding diary was used as a gold standard and compared with the UDI. RESULTS: The correlation coefficient between ratings was >or=0.80, and the discriminant power between cases and controls was confirmed. The UDI showed good internal consistency for all domains, except irritative symptoms (total score's Cronbach alpha=0.86). Factor analytic structure revealed urinary incontinence to be opposite to the other urologic symptoms, with bed wetting being loaded separately. The average daily number of urgent micturitions was higher in patients who reported they "experience a strong feeling of urgency to empty bladder" in the UDI than those ones who did not (p<0.01). CONCLUSIONS: The Italian version of the UDI is a valid and robust instrument, which can now be used reliably in daily practice and clinical research.

Female↗
PubMed2006

Translating overactive bladder questionnaires in 14 languages.

OBJECTIVES: Overactive bladder (OAB) affects millions of people worldwide. Identifying patients and measuring OAB's impact on symptom severity and patients' health-related quality-of-life is necessary to ensure proper treatment and facilitate communication among patients, clinicians, and caregivers. To accomplish this, the Overactive Bladder questionnaire (OAB-q) and its subsets instruments, the OAB-q Short-Form and the OAB-V8, were developed in U.S. English. To measure the impact of OAB cross-culturally, we performed the linguistic validation of these instruments in Danish, English (Canada), French (Canada and France), Italian (Switzerland), German (Switzerland), Korean, Norwegian, Polish, Portuguese (Brazil), Romanian, Swedish, and Turkish. The linguistic validation was conducted following a rigorous method to ensure conceptual equivalence between the original and its translations. METHODS: In each country, a specialist monitored the process, which included six steps: (1) two forward translations; (2) comparison and reconciliation of the translations; (3) back-translation; (4) comparison of the source and back-translation; (5) review by one urologist or gynecologist; and (6) a comprehension test using patients. RESULTS: The translation of symptom-related adjectives such as "uncomfortable," "sudden," "accidental," "uncontrollable" proved challenging. The subtle differences in the meaning of symptomatic items increased the difficulties to find equivalents. Issues regarding the appropriateness of certain concepts and idiomatic terms emerged during cognitive debriefing. The terms "urge," "desire," "urination," "commute," "drowsy," and "escape routes" were not retained literally and were replaced by colloquial expressions. CONCLUSIONS: The 14 versions of the OAB-q, OAB-q Short-Form, and OAB-V8 were successfully validated linguistically to facilitate data collection cross-culturally and the international comparison of symptom bother and health-related quality of life in patients with OAB.

Language↗
PubMed2006

Development and validation of patient-reported outcomes measures for overactive bladder: a review of concepts.

Patient-reported outcome (PRO) measures are a valuable means for determining how a disease and its treatment affect patients, including effects on health-related quality of life (HRQL). To ensure that the results obtained with PROs are clinically useful, data must be gathered using valid and reliable instruments. Developing such instruments requires a multistep, structured process that incorporates cognitive psychology, psychometric theory, and patient and clinician input. The process begins by determining the intent and purpose of the PRO and culminates in studies that demonstrate the measure's validity, reliability, and responsiveness. Several valid and reliable PROs are available for assessing the effects of treatment on symptom severity, symptom bother, and HRQL in patients with overactive bladder.

Cultural Characteristics↗
PubMed2006

Reliability of bladder volume measurement with BladderScan in paediatric patients.

OBJECTIVE: To evaluate the reliability of estimates of bladder volume (BV) in children made with the BladderScan BVI 2500 (BS) and their agreement with standard ultrasound (US) measurements. MATERIAL AND METHODS: BV was measured using both US and BS in 92 children (41 females, 51 males; age range 3 months to 16 years) who underwent standard US measurements for various reasons. Patients were stratified into three groups according to age (3-35, 36-83 and > 83 months) and BV (< 20%, 20-50% and > 50% of expected bladder capacity for age). US and BS measurements were compared by means of the percentage difference and Pearson's correlation coefficient (r); limits of clinical agreement were evaluated by means of Bland-Altman analysis. RESULTS: Overall, a difference of -12.9% and a correlation coefficient of r = 0.98 were found between US and BS. The percentage difference was higher in younger patients (-27.8%) and for low volumes (-24.8%). Correlation analysis confirmed this trend in different age (3-35 months, r = 0.74; 36-83 months, r = 0.93; > 83 months, r = 0.97) and BV (< 20%, r = 0.70; 20-50%, r = 0.94; >50%, r = 0.97) groups. Bland-Altman analysis showed large limits of clinical agreement between the two methods in terms of overall measurements (-45 to 29.3 ml) and in both age (-25.3 to 56.9 ml) and BV (-27.5 to 52.5 ml) groups. CONCLUSIONS: A good correlation between US and BS measurements of BV was found in children aged > 7 years and in those with a BV > 20% of expected bladder capacity. Thus, BS avoids the need for standard US equipment to assess BV for schoolchildren with voiding dysfunction. Nevertheless, a dedicated BS instrument should be used in younger children.

Adolescent↗
PubMed2006

Italian validation of the International Consultation on Incontinence Questionnaires.

OBJECTIVE: To validate the Italian version of two questionnaires for lower urinary tract symptoms (LUTS), i.e. the long (LF) and the short form (SF) of the International Consultation on Incontinence Questionnaire (ICIQ). METHODS: Two native Italian speakers and a native English speaker collaborated with clinical investigators through a multistep process to obtain a consensus version of the questionnaires. The resulting Italian versions were then pre-tested during a pilot study on 16 women for the LF and 10 for the SF. The final versions of the ICIQ-LF and ICIQ-SF were administered to two samples of consecutive female patients, aged > or = 18 years, who had been having LUTS for > or = 3 months, with respectively 82 and 50 women. Internal consistency and test-retest reliability were then assessed; to evaluate the latter, a subset of patients (25 for the ICIQ-LF and 42 for ICIQ-SF) was re-rated. To test the capacity of the questionnaires to discriminate women with or without LUTS (respectively cases and controls), a sample of healthy women was also enrolled and assessed. RESULTS: Both scales showed good psychometric properties overall. The correlation coefficient between ratings was > 0.75 in both questionnaires, and the discriminant power between cases and controls was confirmed for both scales. The ICIQ-SF showed good internal consistency for the total score (Cronbach's alpha 0.90). The sections of the ICIQ-LF 'impact of incontinence on everyday life', 'emotional aspects', 'urinary symptoms' and the degree of bother seemed to be internally consistent (Cronbach's alpha > 0.70); there was a weak relationship for items related to 'sexual matters' (Cronbach's alpha 0.38). CONCLUSION: The Italian version of both questionnaires is a valid and robust instrument which can now be used reliably both in daily practice and in clinical research.

Adolescent↗
PubMed2006

The role of bisphosphonates in the treatment of prostate cancer: recommendations from an expert panel.

In this study, we provide consensus guidelines for the use of bisphosphonates in men with prostate cancer. To this end, an expert panel composed of urologists, medical oncologists, radiation oncologists, and endocrinologists met to review current clinical evidence for the use of bisphosphonates in patients with different stages of prostate cancer to derive consensus recommendations. Physicians should be proactive in monitoring bone loss in patients receiving long-term androgen-deprivation therapy for prostate cancer. Further study is needed before recommending the routine use of bisphosphonates in men with nonmetastatic prostate cancer. However, if a patient has clinically significant bone loss, use of a bisphosphonate to prevent further compromise of bone integrity should be strongly considered, regardless of hormonal and metastatic status. Bone scans are the preferred method for the identification of bone metastases. In patients with hormone-refractory prostate cancer and bone metastases, zoledronic acid is the only bisphosphonate indicated for the prevention of skeletal complications. In conclusion, patients with prostate cancer are at high risk for skeletal morbidity. Bisphosphonates have been shown to prevent cancer treatment-induced bone loss in men receiving androgen-deprivation therapy as well as skeletal complications in men with bone metastases. However, further study of the use of bisphosphonates across the clinical spectrum of prostate cancer is needed.

Bone Density Conservation Agents↗
PubMed2005

Non-invasive detection of prostate cancer by electromagnetic interaction.

OBJECTIVES: Malignant and normal tissues are known to have different electromagnetic properties, and various attempts have been made to use these information for diagnostic purposes. A nonlinear tuneable oscillator (Trimprob) generating extremely low energy multiple electromagnetic fields has been developed for non-invasive analysis of electromagnetic anisotropy in humans. Objective of this study was to evaluate the feasibility of prostate cancer detection using the TRIMprob and to evaluate its diagnostic accuracy. METHODS: 757 men were evaluated with the TRIMprob between July 2002 and May 2003 in a prostate unit. The TRIMprob was moved over the surface of the patient's perineum while standing, normally dressed, in front of the system receiver. A single operator, blinded to the patient status, conducted the tests. Nonlinear resonance was analysed at 465, 930 and 1395 MHz. RESULTS: Analysis of resonance values at 465 MHz showed a significant difference between controls, patients with benign prostatic hyperplasia and patients with prostate cancer. In our study population, a sensitivity of 95.5% and specificity of 42.7% for the diagnosis of prostate cancer with a positive and negative predictive value of 63.6% and 89.8% was found. CONCLUSIONS: The results of this study confirm the possibility of electromagnetic detection of cancer. An extracorporeal scan by the TRIMprob can identify patients at risk for prostate cancer, and recognise those in whom the risk is extremely low. The results of the present study represent a proof-of-concept, which may open a new field of medicine.

Electromagnetic Phenomena↗
PubMed2005

Overactive bladder: epidemiology and social impact.

PURPOSE OF REVIEW: Overactive bladder epidemiology is a rapidly evolving field. The new terminology of lower urinary tract function, introduced in 2002, modified the definitions of all four components of overactive bladder. In the same year, the lack of specific information on overactive bladder prevalence was identified and consequently new studies were launched and recently published. RECENT FINDINGS: Following the new terminology, overactive bladder now includes both a purely sensory disorder and a condition related to an altered bladder behaviour. Studies conducted in selected countries and populations suggested comparable prevalence data worldwide, although the syndrome is considered to be underreported. 'Urge' is now considered the cornerstone symptom of overactive bladder. Recent epidemiological data confirm the increase in overactive bladder prevalence with age and suggest that most diet and lifestyle factors are not associated with the condition, with the exception of body mass index. Among the symptoms, urge and urinary incontinence were considered to be more significantly related to patients' quality of life compared with frequency and nocturia. The socioeconomic consequences of the overactive bladder syndrome were recently estimated in a large US study and a total cost of 12.6 billion US dollars was calculated. SUMMARY: Specific data on overactive bladder epidemiology are now available, providing new evidence about its relevance as a clinical issue. Both wet and dry overactive bladder cause a significant reduction in quality of life. In our daily practice we have to consider that overactive bladder is frequently underreported as patients believe that no treatment is available and urinary incontinence is considered a natural consequence of aging.

Female↗
PubMed2005

Variability of detrusor overactivity on repeated filling cystometry in men with urge symptoms: comparison with spinal cord injury patients.

OBJECTIVE: To investigate the variation in urodynamic variables during repeated filling cystometry and the impact that the variability had on the observed incidence of detrusor overactivity, to evaluate the correlation of detrusor overactivity with the symptoms of urge in men with lower urinary tract symptoms (LUTS), and to compare the variability of detrusor overactivity in men with LUTS to that in men with spinal cord injury (SCI). PATIENTS AND METHODS: Sixty men with LUTS and 35 with neurogenic bladders after SCI were assessed. Investigations included the International Prostate Symptom Score (IPSS), Madsen-Iversen Symptom Score (MSS), uroflowmetry, filling cystometry and pressure-flow, in three successive studies. RESULTS: In men with LUTS, a significant decrease in the number and pressure of involuntary detrusor contractions (IDCs) in consecutive cystometries resulted in a reduction of observed detrusor overactivity from 72% to 63% and 48%, in the three studies. Urgency scores were significantly lower in men who became 'stable' than in those who remained 'unstable' throughout the three studies. In men with SCI, cystometric variables and detrusor overactivity remained consistent over sequential studies. CONCLUSION: Urodynamic detrusor overactivity is affected by repeated cystometry. In men with LUTS, two populations with detrusor overactivity were identified; one group adapted to repeated filling while another had persistent IDCs and greater urgency scores. The latter group had bladder behaviour similar to that of men with neurogenic bladders secondary to SCI. These findings might be important in explaining the cause of symptoms, initiating further investigation, and predicting the outcome of therapy.

Adolescent↗
PubMed2005

Local anesthesia reduces pain associated with transrectal prostatic biopsy. A prospective randomized study.

INTRODUCTION: To test the hypothesis that periprostatic block could completely relief prostatic biopsy-associated pain. MATERIALS AND METHODS: Patients scheduled for transrectal ultrasound guided prostate biopsy were randomized (1:1:1 ratio) to no analgesia (group A), endorectal enema of 1% lidocaine gel (group B) or transrectal periprostatic block (group C). All patients underwent 10 core TRUS-guided biopsy. After the procedure, a ten visual analogue pain score (VAS) from 0 = no discomfort to 10 = severe pain was administered to the biopsied patients and a global estimation of pain associated with the procedure was obtained. The study design included interim analysis of pain score after the first 60 patients were enrolled. Kruskal-Wallis test for unpaired data was used for statistical analysis. Data are presented as mean, median (range). RESULTS: Sixty patients were enrolled between May 2003 and December 2003 and all patients were evaluable. Mean and median age was 68.5 and 69 (range 53-82) years, respectively. Mean and median PSA was 86.8 and 9 ng/ml (range 0.58-4.111), respectively. No major side effects were observed. Patients in group A scored at VAS a median 4, mean 5.5 +/- 2.3 (range 3-10). Patients in group B scored a median 4, mean 5.5 +/- 2.7 (range 3-10) (p = 0.237). Patients receiving periprostatic injections of carbocaine (group C) scored a median 0, mean 0.5 +/- 0.8 (range 0-2). The level of pain reported by this group of patients was significantly different from those reported by patients who performed prostatic biopsy without anesthesia or with intrarectal anesthetic jelly (p = 0.00001). In the periprostatic block group 65% of patients referred no pain after the procedure (VAS = 0) while all patients in the other groups experience some degree of pain. CONCLUSION: The use of bilateral periprostatic block is a very effective and useful technique, well tolerated by the patient, which almost completely abolishes the pain and discomfort associated with the prostatic biopsy procedure.

Aged↗
PubMed2005

The effect of bladder outlet obstruction treatment on ultrasound-determined bladder wall thickness.

Detrusor hypertrophy associated with bladder outlet obstruction can be imaged on suprapubic ultrasound, and bladder mass can be quantified from the evaluation of bladder wall thickness and bladder volume. Bladder wall hypertrophy has been found to be correlated with detrusor function. Independent studies have shown that surgical treatment of benign prostatic obstruction results in a significant decrease of bladder mass. Preliminary data suggest the possibility that medical treatment with alpha-adrenergic antagonists might also produce a reduction of bladder wall hypertrophy, although confirmation is still awaited. The development of dedicated automated ultrasound systems for the evaluation of bladder mass might result in the use of such parameters in clinical trials of treatment for benign prostatic hyperplasia and ultimately in daily urologic practice.

Journal Article↗
PubMed2004

Detection of telomerase activity in prostate massage samples improves differentiating prostate cancer from benign prostatic hyperplasia.

PURPOSE: We performed a case-control study in which we tested the ability of a non-invasive assay to detect telomerase activity and to distinguish between prostatic cancer (Pca) and benign prostatic hyperplasia (BPH) on samples of epithelial cells obtained after prostatic massage. METHODS: Telomerase activity was determined by a telomeric repeat amplification protocol (TRAP) assay. We selected 60 patients with histologically proven Pca (30 cases) or BPH (30 cases). Specimens included in this study were from patients who had no suspicious findings on digital rectal examination for cancer, had clinical evidence of lower urinary tract symptoms, had no sonographic signs of Pca at the transrectal ultrasound evaluation, had total PSA values moderately elevated (2.6-15 ng/ml), and had no evidence of other urological cancers. The whole procedure was conducted in double blind between pathologists and molecular biology operators. RESULTS: Telomerase activity was detected in 90% of Pca cases and in 13% of BPH cases. The sensitivity (90%) and specificity (76%) of this method were calculated. The positive predictive value, negative predictive value, and diagnostic efficiency were 87%, 90%, and 88% respectively. CONCLUSION: Our data indicate that telomerase activity detected by TRAP assay on prostate epithelial cells collected by prostate massage can substantially improve the distinction between Pca and BPH conditions. One of the clinical benefits resulting from the use of this new assay would be to refine the biopsy indication and to avoid for several patients without Pca the unnecessary cost and the complications of prostate biopsy.

Aged↗