Quality of Life and Patient Engagement: What News in Urology and Andrology?

A special issue of Uro (ISSN 2673-4397).

Deadline for manuscript submissions: closed (31 October 2022) | Viewed by 42599

Special Issue Editor


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Guest Editor
Department of Urology, Santa Chiara Regional and Teaching Hospital, 38123 Trento, Italy
Interests: andrology; biofilm; bladder cancer; bph; functional urology; nutraceuticals and phytotherapy; prostate cancer; penile cancer; urinary tract infections; mini-invasive surgery
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Special Issue Information

Dear Colleagues,

Because of improvements in medical care, the average life expectancy of patients affected by urological diseases has increased considerably in recent decades: technical innovations, new drugs, and new insights into the pathophysiology of urological diseases are the reasons of this improvement. On the other hand, all physicians taking care urological patients are asked to pay attention to patients’ quality of life (QoL); this is due to the fact that improvement in life expectancy is not always linked with an improvement of QoL. The World Health Organization, in 1947, defined QoL as a “state of complete physical, mental and social well-being, and not merely the absence of disease and infirmity”. In the same way, Elkington in an editorial in the Annals of Internal Medicine, stated that: “What every physician wants for every one of his patients old or young, is not just the absence of death but life with a vibrant quality that we associate with a vigorous youth. This is nothing less than a humanistic biology that is concerned, not with material mechanisms alone, but with the wholeness of human life, with the spiritual quality of life that is unique to man”. In this sense, urological and andrological diseases are two interesting fields that address these new ethical and professional perspectives. In this Special Issue about QoL in urological and andrological settings, we want start from the history of QoL concept in medicine and discuss the newest findings concerning QoL in the most common urological and andrological diseases. All discussed fields should analyze considering the features of patient-centered medicine and patient engagement practice, in order to provide readers with a useful tool for everyday clinical practice.

Key areas of this Special Issue include but are not limited to Quality of life, BPH, erectile dysfunction, bladder cancer, urinary diversion, testicular cancer, prostate cancer, premature ejaculation, infertility, urinary stones, and recurrent urinary tract infections.

We hope to provide readers with an interesting tool for use in everyday clinical practice and invite many colleagues to focus part of their clinical research in the QoL field. 

Prof. Dr. Tommaso Cai
Guest Editor

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Published Papers (8 papers)

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8 pages, 204 KiB  
Article
Hospitalist Co-Management of Urethroplasty Patients in an Academic Center: Implementation of a Standardized Postoperative Care Model
by Pegah Taheri, Adan Tijerina, Sofia Gereta, Safiya-Hana Belbina and E Charles Osterberg
Uro 2023, 3(1), 74-81; https://doi.org/10.3390/uro3010010 - 2 Mar 2023
Viewed by 1315
Abstract
Objectives: to evaluate whether hospitalist co-management would lead to improved outcomes and value in patients undergoing urethroplasty (UPL) with a single surgeon for urethral stricture disease (USD). Material: A co-management model with hospitalists was introduced in August 2019 for all patients undergoing UPL [...] Read more.
Objectives: to evaluate whether hospitalist co-management would lead to improved outcomes and value in patients undergoing urethroplasty (UPL) with a single surgeon for urethral stricture disease (USD). Material: A co-management model with hospitalists was introduced in August 2019 for all patients undergoing UPL for USD with a single surgeon in a United States teaching center. The hospitalist worked closely with the urologic surgeon and the support staff. The hospitalist managed post-operative concerns, such as pain and comorbidities, as well as conducted rounds with the urological team for disposition planning and addressing interdisciplinary needs. Retrospective analysis compared a 42-month period before initiation of co-management (Jan 2016–July 2019) with a 32-month period after initiation (Aug 2019–March 2022). Outcomes assessed were recurrence of stricture, complications, length of stay, readmission, and emergency room visits. Results: A total of 135 patients (71 surgeon-managed, 64 co-managed) underwent urethroplasty from January 2016 to March 2022. Hospitalist co-management did not affect complications, length of stay, readmission, and emergency room visits. Accounting for confounding variables using multivariable analysis, no factors were independently associated with recurrence. There were no demographic, comorbidity, or American Society of Anesthesiologists (ASA) score differences between the two groups. Conclusions: This study suggests that hospitalist care for patients undergoing urethroplasty may be non-inferior to surgeon care, based on similar outcomes between the two groups. There were no significant differences in the total length of stay or blood pressure readings, and the complication rates and hospital readmission rates were also similar. Full article
12 pages, 278 KiB  
Article
The Role of a Multidisciplinary Approach in Gender Affirmation Surgery: What to Expect and Where Are We Currently?
by Alessia Celeste Bocchino, Andrea Cocci, Alessandro Zucchi, Riccardo Bartoletti, Antonello De Lisa and Girolamo Morelli
Uro 2022, 2(3), 179-190; https://doi.org/10.3390/uro2030022 - 23 Aug 2022
Viewed by 2471
Abstract
Gender Affirmation Surgeries (GASs), erstwhile called Sex Reassignment Surgeries (SRSs), may be necessary for transgender individuals to change their bodily sexual characteristics and thereby affirm their gender identity. GASs encompass all medically necessary interventions to relieve gender dysphoria and should be available to [...] Read more.
Gender Affirmation Surgeries (GASs), erstwhile called Sex Reassignment Surgeries (SRSs), may be necessary for transgender individuals to change their bodily sexual characteristics and thereby affirm their gender identity. GASs encompass all medically necessary interventions to relieve gender dysphoria and should be available to patients who wish to, and who meet the surgical criteria of the World Professional Association for Transgender Health (WPATH) and Standards of Care (SOC). The comprehensive clinical assessment involves many health specialists, including general practitioners, psychologists, psychiatrists, speech therapists, endocrinologists, surgeons, anesthesiologists, nurses, and other healthcare professionals. To define the patients’ complex care needs and their objectives, high-volume specialized centers, accredited training programs, skilled surgeons and health professionals specializing in transgender care within a multidisciplinary team are essential. Currently, the most prominent challenges are related to ethical issues such as the treatment of underage individuals, fertility, parenting and the potential for regret after GAS. Finally, although GAS has been practiced for more than half a century, data on long-term follow-up represents a further topic for investigation. Full article
7 pages, 440 KiB  
Article
The Use of Ellagic Acid and Annona muricata Complex in Male Subjects with Oligospermia and HPV-Related Infections: Results from a Pilot Study
by Tommaso Cai, Daniele Tiscione, Marco Puglisi, Luca Gallelli, Manuela Colosimo, Michele Rizzo, Giovanni Liguori, Sandra Mazzoli and Alessandro Palmieri
Uro 2022, 2(3), 166-172; https://doi.org/10.3390/uro2030020 - 8 Jul 2022
Cited by 1 | Viewed by 1735
Abstract
Background: Human papilloma virus (HPV) has been recognized as one of the most common sexually transmitted infections and has been correlated with poor semen quality and male hypofertility. Ellagic acid and Annona muricate have been considered as fascinating compounds in the chemoprevention [...] Read more.
Background: Human papilloma virus (HPV) has been recognized as one of the most common sexually transmitted infections and has been correlated with poor semen quality and male hypofertility. Ellagic acid and Annona muricate have been considered as fascinating compounds in the chemoprevention of HPV-related lesions of the cervix. Here, we aimed to evaluate the role of ellagic acid and Annona muricata (OASIT-k®) in managing male subjects with oligospermia and HPV-related infections. Methods: From January 2017 to January 2019, all patients attending our center for oligospermia were evaluated for HPV-DNA. All HPV-DNA positive patients underwent orally administered OASIT-k 1 tablet/day for 3 months. After 6 months, all patients underwent spermiogram, HPV-DNA analysis on seminal plasma and urological visit. The main outcome measures were HPV-DNA clearance rate and improvement of semen parameters. Results: Forty-three patients (aged 22–43 years) were enrolled and treated. At the end of the treatment, the clearance of HPV-DNA infections was 62.7% (27/43). Seminal parameters were improved by treatment in terms of the number of spermatozoa (10.6 vs. 15.8) and mobility (27.5% vs. 36.1%). Conclusions: The therapy with OASIT-K was efficient in improving the HPV-DNA clearance and seminal parameters. These promising data emphasize the importance of redirecting the immune responses in viral infections. Full article
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7 pages, 531 KiB  
Review
The Role of Ellagic Acid and Annona muricata in the Management of Human Papillomavirus (HPV)-Related Genital Lesions: A Systematic Review
by Tommaso Cai, Michele Rizzo, Giovanni Liguori, Michele Palumbo, Alessandro Palmieri and Luca Gallelli
Uro 2023, 3(1), 54-60; https://doi.org/10.3390/uro3010008 - 5 Feb 2023
Cited by 2 | Viewed by 2120
Abstract
Background: Several reports highlighted the role of nutraceutical compounds in the prevention and management of HPV-related genital lesions both in men and women, with interesting results. Here, we reviewed the effect of ellagic acid and Annona muricata for managing HPV-related genital lesions. [...] Read more.
Background: Several reports highlighted the role of nutraceutical compounds in the prevention and management of HPV-related genital lesions both in men and women, with interesting results. Here, we reviewed the effect of ellagic acid and Annona muricata for managing HPV-related genital lesions. Methods: Relevant databases were searched by using methods recommended by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. The primary endpoint was the clinical cure, defined as the clinical and/or laboratory and/or histopatologically demonstrated absence of HPV-related lesions at the end of the treatment. Results: We enclosed two retrospective studies, two prospective studies and one randomized controlled trial. In men, ellagic acid and Annona muricata complex improves seminal parameters and HPV-DNA clearance. In women, it has a chemopreventive action in cervical cancer and increases the HPV viral clearance. No clinically significant adverse effects have been reported. Conclusions: In conclusion, the combination of ellagic acid and Annona muricata shows interesting and promising results in terms of HPV viral clearance and HPV related genital lesions. However, more data are necessary to confirm these results. Full article
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9 pages, 809 KiB  
Review
Penile Implants: A Lesson from the First 50 Years
by Alessandro Giordano, Marco Capece, Carlo D’Alterio, Angelo di Giovanni, Assunta Zimarra, Luigi Napolitano, Claudio Marino, Roberto La Rocca, Massimiliano Creta, Tommaso Cai and Alessandro Palmieri
Uro 2023, 3(1), 1-9; https://doi.org/10.3390/uro3010001 - 27 Dec 2022
Cited by 1 | Viewed by 6556
Abstract
This year marks the fiftieth anniversary of the first implant of an inflatable penile prosthesis (IPP). The authors of this paper want to celebrate the event with a narrative review of the current literature. The main scopes are antibiotic prophylaxis, patient satisfaction, and [...] Read more.
This year marks the fiftieth anniversary of the first implant of an inflatable penile prosthesis (IPP). The authors of this paper want to celebrate the event with a narrative review of the current literature. The main scopes are antibiotic prophylaxis, patient satisfaction, and future developments. The implant of the first IPP in 1973, performed by Branteley Scott was a turning point in the history of penile prosthesis, revolutionizing the treatment of erectile dysfunction (ED). Since then, the idea of an inflatable device has not changed much. However, the innovations in design, materials, surgical techniques, and perioperative management led to a more natural, durable, and reliable device featuring fewer complications and greater patient satisfaction. Currently, IPP is associated with high patient satisfaction and excellent long-term outcomes, remaining the gold standard for men with refractory ED. Several strategies are under investigation to improve the technology of penile prosthesis, and we expect in the next future the introduction of new devices that are easier to activate, discreet, comfortable when deflated, and durable in time, mimicking a more physiological erection. Full article
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8 pages, 254 KiB  
Review
Recurrent UTI: Questions and Answers on Clinical Practice
by Tommaso Cai, Massimiliano Lanzafame and Carlo Tascini
Uro 2022, 2(4), 262-269; https://doi.org/10.3390/uro2040029 - 21 Nov 2022
Cited by 2 | Viewed by 2225
Abstract
Recurrent urinary tract infection (rUTI) management is still a challenge due to the lack of a standard approach and due to the burden of diseases both on personal and societal aspects. Consultations for rUTIs in everyday clinical practice range from 1% to 6% [...] Read more.
Recurrent urinary tract infection (rUTI) management is still a challenge due to the lack of a standard approach and due to the burden of diseases both on personal and societal aspects. Consultations for rUTIs in everyday clinical practice range from 1% to 6% of all medical visits with high social and personal associated costs, such as prescriptions, hospital expenses, days of sick leave due to the disease, and the treatment of related comorbidities. Recurrent UTIs are, then, associated with anxiety and depression due to treatment failures and symptomatic recurrences. Often urologists are asked to give practical recommendations to patients regarding the everyday management of recurrent UTIs. Here, we aim to give to the physicians managing UTI some helpful suggestions for their everyday clinical practice, on the basis of the recent evidence. Full article
17 pages, 460 KiB  
Review
Sexual Dysfunctions Related to Drugs Used in the Management of Lower Urinary Tract Symptoms Due to Benign Prostatic Hyperplasia: A Narrative Review on α-Blockers and 5-Alpha Reductase Inhibitors
by Antonio La Torre, Caterina Palleria, Irene Tamanini, Andrea Scardigli, Tommaso Cai, Manuela Colosimo, Lucia Muraca, Vincenzo Rania, Davida Mirra, Alessandro Casarella, Gianmarco Marcianò, Giovambattista De Sarro and Luca Gallelli
Uro 2021, 1(3), 82-98; https://doi.org/10.3390/uro1030012 - 5 Jul 2021
Cited by 2 | Viewed by 14161
Abstract
This is a critical review of the current literature data about sexual dysfunction as a potential side effect related to drugs commonly used for the treatment of Benign Prostatic Hyperplasia and Lower Urinary Tract Symptoms. In this narrative review, we analyzed data from [...] Read more.
This is a critical review of the current literature data about sexual dysfunction as a potential side effect related to drugs commonly used for the treatment of Benign Prostatic Hyperplasia and Lower Urinary Tract Symptoms. In this narrative review, we analyzed data from the literature related to the development of sexual dysfunctions during the treatment of BPH or LUTS. Both α-blockers and 5-alpha reductase inhibitors (5-ARIs) can induce erectile dysfunction, ejaculatory disorders and a reduction in sexual desire. The sexual side effect profile of these drugs is different. Among the α-blockers, silodosin appears to have the highest incidence of ejaculatory disorders. Persistent sexual side effects after the discontinuation of finasteride have been recently reported; however, further studies are needed to clarify the true incidence and the significance of this finding. However, most of the published studies are affected by a weak methodology and other important limitations, with only a few RCTs available. Therefore, it is desirable that future studies will include validated tools to assess and diagnose the sexual dysfunction induced by these medications, especially for ejaculation and sexual desire disorders. Full article
9 pages, 1282 KiB  
Review
The Quality of Life Definition: Where Are We Going?
by Tommaso Cai, Paolo Verze and Truls E. Bjerklund Johansen
Uro 2021, 1(1), 14-22; https://doi.org/10.3390/uro1010003 - 25 Feb 2021
Cited by 25 | Viewed by 10677
Abstract
The quality of life (QoL) concept now includes new aspects related to patients’ well-being because QoL has become more of a personal perception than an an objective and measurable entity. Here, we discuss the principal aspects of QoL-related aspects in urology and andrology [...] Read more.
The quality of life (QoL) concept now includes new aspects related to patients’ well-being because QoL has become more of a personal perception than an an objective and measurable entity. Here, we discuss the principal aspects of QoL-related aspects in urology and andrology by using a narrative review. Some aspects concerning the QoL are essential when managing uro-andrological patients. The aim of treatments should not only include the absence of disease or symptoms relief but also the improvement of a patient’s QoL with regard to his/her internal status and relationship with others. In this sense, any therapeutic approach should be based on the patient’s perspectives and not only on the instrumental and laboratory findings. Finally, we discussed the role of a patient’s sexual partner adding an extra dimension to the patient-centerd approach as part of the QoL concept in andrology. Full article
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