Publications by authors named "Finazzi-Agro"
Introduction: Defining "high-risk bladder" or "high-pressure bladder" involves recognizing the potential for an unsafe lower urinary tract, where dysfunction in storage and micturition can threaten upper urinary tract health, leading to unfavorable outcomes like dialysis, recurrent infections, systemic impact, or mortality.
Methods: ICI-RS was held in Bristol in June 2024, and Think Tank 2 aimed to define research priorities including identifying clinical predictors and developing prevention and monitoring strategies.
Results: Risk factors encompass both congenital and neurogenic lower urinary tract dysfunction, bladder outlet obstruction, vascular diseases, and inflammatory disorders, but a validated stratification risk is lacking.
Background: Prostate cancer (PCa) is the second most commonly diagnosed cancer in men worldwide, with metastasis, particularly to bone, being the primary cause of mortality. Currently, prognostic markers like PSA levels and Gleason classification are limited in predicting metastasis, emphasizing the need for novel clinical biomarkers. New molecules predicting tumor progression have been identified over time.
View Article and Find Full Text PDFAims: The integration of artificial intelligence (AI) into functional urology management must be assessed for its clinical utility, but hopefully will change, perhaps to revolutionize the way LUTD and other conditions are assessed, the aim being to offer patients more rapid and effective management which enhances patient outcomes. The aim of this proposal, discussed at the ICI-RS annual meeting, is to evaluate the available evidence on AI and the way it might change the approach to urodynamic (UDS) diagnoses, including overactive bladder syndrome (OAB), and perhaps other LUTDs such as bladder outflow obstruction.
Methods: A compendium of discussion based on the current evidence related to AI and its potential applications in UDS and OAB.
Article Synopsis
- Sacral neuromodulation (SNM) and percutaneous tibial nerve stimulation (PTNS) are recommended treatments for complex lower urinary tract issues, but they often face challenges like treatment failure and limited long-term effectiveness, necessitating better follow-up strategies.
- A recent consensus report from a 2024 meeting highlighted the importance of "rescue programming" to enhance patient outcomes and device use, alongside exploring alternative stimulation sites for better results.
- Current SNM techniques have not evolved significantly, and while there's little evidence for PTNS rescue programming, advancements in implantable devices and neurostimulation targeting the pudendal nerve show promise for improving treatment adherence and effectiveness.
Introduction: The orthotopic neobladder is the type of urinary diversion (UD) that most closely resembles the original bladder. However, in the literature the urodynamic aspects are scarcely analysed.
Objective: To provide the first systematic review (SR) on the urodynamic (UDS) outcomes of the ileal orthotopic neobladders (ONB).
Article Synopsis
- Antibiotic prophylaxis (AB) reduces bacteriuria after invasive urodynamics (UDS) but does not significantly lower urinary tract infection (UTI) rates; guidelines for AB use in high-risk patients remain unclear.
- A systematic review and expert consensus via a modified Delphi method identified key patient categories at risk for UTIs and proposed 16 statements regarding AB use.
- The panel of 57 experts largely agreed (56.25%) on the necessity of AB for patients with neurogenic bladder and immunosuppression, while advising against AB for several other factors such as menopausal status and diabetes.
Article Synopsis
- This study used the Delphi method to gather expert opinions on unresolved issues in lower urinary tract infections (UTIs), focusing on recurrent UTIs, asymptomatic bacteriuria in pregnant women, and catheter-associated UTIs in adults.
- A panel of 37 experts participated in multiple consensus phases, achieving agreement on 12 out of 13 key topics related to the diagnosis and prevention of these UTIs.
- The findings highlight the need for more research on non-antibiotic preventive measures for UTIs, as antibiotic resistance continues to be a significant concern in treatment strategies.
Introduction: Overactive bladder (OAB) and underactive bladder (UAB) could be associated with metabolic syndrome, affective disorders, sex hormone deficiency, changes in urinary microbiota, functional gastrointestinal disorders, or autonomic nervous system dysfunction.
Objectives: The aim of this Think Tank was to provide a guide on how to investigate OAB and/or detrusor underactivity (DU) patients to better clarify the underlying pathophysiology and possibly personalize the treatment.
Methods: A compendium of discussion based on the current evidence related to phenotyping patients with OAB or DU using urodynamic tests, functional neuro-imaging, urinary markers, and microbiome.
Introduction: Overactive bladder (OAB) and Underactive bladder (UAB) could be associated with metabolic syndrome, affective disorders, sex hormone deficiency, changes in urinary microbiota, functional gastrointestinal disorders, or autonomic nervous system dysfunction.
Objectives: The aim of this Think Tank was to provide a guide on how to investigate OAB and/or detrusor underactivity (DU) patients to better clarify the underlying pathophysiology and possibly personalize the treatment.
Methods: A compendium of discussion based on the current evidence related to phenotyping patients with OAB or DU investigating metabolic, neurogical, psychological and gastrointestinal aspects with the aim to personalize the treatment.
Article Synopsis
- The study wanted to find evidence on how useful urodynamic studies (UDS) are for women with pee problems.
- A group of experts talked about how to create strong research designs, including who to study and how to measure results.
- They concluded that while no perfect research method exists, following their suggestions can help improve future studies.
Background: This study evaluated the effectiveness, safety, and possible changes in bowel symptoms after multicompartment prolapse surgery by comparing two different surgical approaches, transvaginal mesh surgery with levatorplasty (TVMLP) and robot-assisted sacrocolpopexy (RSC).
Methods: All patients underwent pelvic (POP-Q staging system) and rectal examination to evaluate anal sphincter tone in the lithotomy position with the appropriate Valsalva test. The preoperative evaluation included urodynamics and pelvic magnetic resonance defecography.
Numerous continence-sparing radical prostatectomy techniques have been developed to enhance postoperative early continence (EC) recovery; however, evidence regarding the best approach remains controversial. The objectives are to provide a critical appraisal of various prostatectomy techniques, based on the evidence of quality-assessed randomized control trials (RCTs); to summarize the immediate continence and the EC reported; and to propose a new standardization for continence outcomes reporting. Data acquired from five medical registries were reported to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards.
View Article and Find Full Text PDFBackground: Percutaneous tibial nerve stimulation (PTNS) is widely used in the treatment of neurogenic detrusor overactivity (NDO) in multiple sclerosis (MS); however, controlled studies are still lacking. To assess effectiveness of PTNS in MS patients with NDO unresponsive to pharmacological and behavioural therapies.
Methods: MS patients with NDO were enrolled.
Prostate cancer is the most frequently diagnosed cancer and the fifth leading cause of cancer death among men in 2020. The clinical decision making for prostate cancer patients is based on the stratification of the patients according to both clinical and pathological parameters such as Gleason score and prostate-specific antigen levels. However, these tools still do not adequately predict patient outcome.
View Article and Find Full Text PDFArticle Synopsis
- A study investigated new training methods for retrograde intrarenal surgery (RIRS) using 3D printed models of the upper urinary tract and stones, introduced in 2021.
- Twenty urologists with varying expertise participated in a simulation event to assess the models' effectiveness in developing surgical skills, with their performance evaluated using the OSATS scale.
- Results showed that novice surgeons improved their skills through repeated simulations, evidenced by shorter operative times and higher OSATS scores, confirming the models' validity and suggesting their use in training programs.
Aims: This Delphi study was planned to examine global expert consensus with regard to utility, accuracy, and categorization of Bladder Contractility Index (BCI), Bladder Outlet Obstruction Index (BOOI), and the related evidence. This manuscript deals with children and follows previous manuscripts reporting on adult men and women.
Methods: Eighteen experts were invited to answer the two-round survey including three foundation questions and four survey questions.
Aims: This Delphi study was planned to examine global expert consensus with regard to utility, accuracy, and categorization of the bladder contractility index (BCI), bladder outlet obstruction index (BOOI), and the related evidence. This manuscript deals with adult women and follows a previous manuscript reporting on adult men.
Methods: Twenty-nine experts were invited to answer the two-round survey including three foundation questions and 12 survey questions.
Almost 20% of patients with congenital posterior urethral valves (PUV) reach end-stage kidney disease requiring kidney transplantation (KT). An augmentation cystoplasty (AC) is performed to treat significant lower urinary tract dysfunction (LUTD) which can persist afterwards due to residual valve bladder and lead to recurrent urinary tract infections (UTIs) and a worse graft survival. Percutaneous tibial nerve stimulation (PTNS) is a minimally invasive second-line neuromodulation therapy approved for the treatment of non-neurogenic LUTD performed in the outpatient setting.
View Article and Find Full Text PDFAims: This Delphi study was planned to examine global expert consensus with regard to utility, accuracy, and categorization of Bladder Contractility Index (BCI) and Bladder Outlet Obstruction Index (BOOI) and the related evidence.
Methods: Twenty-eight experts were invited to answer the two-round survey including three foundation questions and 15 survey questions. Consensus was defined as ≥75% agreement.
Article Synopsis
- Antimuscarinics (AMs) are commonly used to treat storage lower urinary tract symptoms (LUTS) in multiple sclerosis (MS) patients, but limited data exists on their effectiveness and tolerability in this group.
- A study involving 60 MS patients found that AMs significantly reduced urgency and the number of daily pads used, while increasing post-void residual urine after 6 months of treatment.
- Despite their effectiveness, over half of the patients experienced adverse events, with a notable number having to stop treatment due to issues like dry mouth and other neurological symptoms.
Context: The role of urodynamic studies (UDSs) in the diagnosis of lower urinary tract symptoms (LUTS) is crucial. Although expert statements and guidelines underline their value for clinical decision-making in various clinical settings, the academic debate as to their impact on patient outcomes continues.
Objective: To summarise the evidence from all randomised controlled trials assessing the clinical usefulness of UDS in the management of LUTS.