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Firenze, Italy

Trinchieri A.,Urology Unit
Archivio Italiano di Urologia e Andrologia | Year: 2012

Aim of the study: The potential renal acid load of foods (PRAL) has been proposed as a causative factor of renal stone formation in patients with calcium stones. Evaluation of the dietary PRAL seems to be advisable to evaluate the lithogenic potential of the diet of the individual patient. Materials and Methods: On the basis of a dietary questionnaire administered to a sample of 75 renal stone formers living in the urban area of Milan (Northern Italy), we selected the most frequently reported foods for each of 11 categories: grains, meats, cured meats, eggs, cheeses, legumes, potatoes, vegetables, fruit and juices, milk and dairies and bread. The PRAL per 100 g of each food was calculated considering its mineral and protein composition, the mean intestinal absorption rate for each nutrient and the metabolism of sulfur-containing amino acids. The PRAL/100 g of each main food category was then calculated considering the frequency of the most represented (up to six) foods in the respective food group and the PRAL/100 g of each food. Subsequently the PRAL/100 g value for each main food category was adjusted for the standard serving size. Finally, according to the value of the adjusted PRAL value a score was assigned to each group of foods and named as LAKE (Load of Acid to Kidney Evaluation) score. Results: The scores computed for grains, meats, cured meats, eggs, cheeses, legumes, potatoes, vegetables, fruit & juices, milk & dairies and bread were +2, +10, +6, +4, +10, -2, -10, -10, -10, +1 and +1, respectively. Two report forms were designed to allow a rapid collection of data about the intake of each food group. Time requested for filling the forms and to compute scores ranges from 2 to 4 minutes (report forms can be requested to a.trinchieri@ospedale.lecco.it). Conclusion: LAKE score can be an useful and simple tool in order to evaluate the dietary PRAL and to suggest modifications to achieve its reduction for the prevention of calcium nephrolithiasis and other diseases.

Martinez-Pineiro L.,Urology Unit
European urology | Year: 2010

These guidelines were prepared on behalf of the European Association of Urology (EAU) to assist urologists in the management of traumatic urethral injuries. To determine the optimal evaluation and management of urethral injuries by review of the world's literature on the subject. A working group of experts on Urological Trauma was convened to review and summarize the literature concerning the diagnosis and treatment of genitourinary trauma, including urethral trauma. The Urological Trauma guidelines have been based on a review of the literature identified using on-line searches of MEDLINE and other source documents published before 2009. A critical assessment of the findings was made, not involving a formal appraisal of the data. There were few high-powered, randomized, controlled trials in this area and considerable available data was provided by retrospective studies. The Working Group recognizes this limitation. The full text of these guidelines is available through the EAU Central Office and the EAU website (www.uroweb.org). This article comprises the abridged version of a section of the Urological Trauma guidelines. Updated and critically reviewed Guidelines on Urethral Trauma are presented. The aim of these guidelines is to provide support to the practicing urologist since urethral injuries carry substantial morbidity. The diversity of urethral injuries, associated injuries, the timing and availability of treatment options as well as their relative rarity contribute to the controversies in the management of urethral trauma. Copyright © 2010 European Association of Urology. Published by Elsevier B.V. All rights reserved.

Trinchieri A.,Urology Unit
Minerva Medica | Year: 2013

The relationship between diet and the formation of renal stones is demonstrated, but restrictive diets do not take into account the complexity of metabolism and the complex mechanisms that regulate the saturation and crystallization processes in the urine. The restriction of dietary calcium can reduce the urinary excretion of calcium but severe dietary restriction of calcium causes hyperoxaluria and a progressive loss of bone mineral component. Furthermore urinary calcium excretion is influenced by other nutrients than calcium as sodium, potassium, protein and refined carbohydrates. Up to 40% of the daily excretion of oxalate in the urine is from dietary source, but oxalate absorption in the intestine depends linearly on the concomitant dietary intake of calcium and is influenced by the bacterial degradation by several bacterial species of intestinal flora. A more rational approach should be based on the cumulative effects of foods and different dietary patterns on urinary saturation rather than on the effect of single nutrients. A diet based on a adequate intake of calcium (1000-1200 mg per day) and containment of animal protein and salt can decrease significantly urinary super-saturation for calcium oxalate and reduce the relative risk of stone recurrence in hypercalciuric renal stone formers. The DASH-style diet that is high in fruits and vegetables, moderate in low-fat dairy products and low in animal proteins and salt is associated with a lower relative supersaturation for calcium oxalate and a marked decrease in risk of incident stone formation. All the diets above mentioned have as a common characteristic the reduction of the potential acid load of the diet that can be correlated with a higher risk of recurrent nephrolithiasis, because the acid load of diet is inversely related to urinary citrate excretion. The restriction of protein and salt with an adequate calcium intake seem to be advisable but should be implemented with the advice to increase the intake of vegetables that can carry a plentiful supply of alkali that counteract the acid load coming from animal protein. New prospective studies to evaluate the effectiveness of the diet for the prevention of renal stones should be oriented to simple dietary advices that should be focused on a few specific goals easily controlled by means of self-evaluation tools, such as the LAKE food screener.

Petrelli F.,Medical Oncology Unit | Coinu A.,Medical Oncology Unit | Cabiddu M.,Medical Oncology Unit | Ghilardi M.,Medical Oncology Unit | And 2 more authors.
European Urology | Year: 2014

Context Neoadjuvant chemotherapy before radical cystectomy (RC) is the preferred initial option for muscle-invasive bladder cancer (BCa). As in rectal and breast cancer, pathologic downstaging is associated with increased overall survival (OS). Objective We conducted a meta-analysis to determine whether pathologic complete response (pCR) (pT0N0M0) after neoadjuvant chemotherapy is associated with a better outcome in muscle-invasive BCa. Evidence acquisition A systematic search was conducted in PubMed, Web of Science, Cochrane Collaboration's Central register of controlled trials, and Embase for publications reporting outcomes of patients with and without pCR. All patients underwent neoadjuvant cisplatin-based polychemotherapy and RC. The primary outcome reported as relative risk (RR) was OS. Secondary end points were recurrence-free survival (RFS) and cancer-specific survival other than distant and locoregional RFS. A meta-analysis was performed using the fixed effects model or random effects model. Overall heterogeneity for RFS and OS was assessed with forest plots and the Q test. Evidence synthesis A total of 13 trials were included, for a total of 886 patients analysed after neoadjuvant chemotherapy and RC, without any postoperative treatment. The pCR rate was 28.6%. Patients who achieved pCR in the primary tumour and the lymph nodes presented an RR for OS of 0.45 (95% confidence interval [CI], 0.36-0.56; p < 0.00001). The number needed to treat to prevent 1 death was 3.7 (absolute risk difference: -26%). The summary RR for RFS was 0.19 (95% CI, 0.09-0.39; p < 0.00001). Conclusions Patients with BCa who achieved pCR (pT0N0M0 stage) after neoadjuvant chemotherapy have a better OS and RFS than do patients without pCR. © 2013 European Association of Urology.

Dell'atti L.,Urology Unit
Archivio Italiano di Urologia e Andrologia | Year: 2013

The adenomatoid tumor of the epididymis (EAT) is a neoplasm located in the paratesticular region. Mesothelial origin has been mentioned and inflammation has played some role in the development of these tumors. Physical examination and testicular ultrasound constituted important tools in the diagnosis. Some reports have mentioned malignant behavior, but it is very rare. Surgical treatment is the procedure of choice. We present the case of a 46-year-old patient with an adenomatoid tumour located in the head of the left epididymis that referred to our department with gradually enlarged intrascrotal mass.

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