Comparison of laparoscopic versus open simple nephrectomy in patients with xanthogranulomatous pyelonephritis:A singlecenter analysis of outcomes and predictors of surgical approaches and complications

Background:The aim ofthis study was to compare the outcomes of open simple nephrectomy and laparoscopic simple nephrectomy in patients with xanthogranulomatous pyelonephritis(XGP)in a single-institutional retrospective study and to identify predictive factors of surgical approaches and complications.Materials and methods:We retrospectively analyzed the data of 67 consecutive patients with a histopathological diagnosis of XGP who underwent either open simple nephrectomy(ON)or laparoscopic simple nephrectomy(LN)from January 2014 to April 2020.The primary endpoint was the evaluation of perioperative outcomes and complications.Secondary endpoints were to define factors influencing the surgical approach and the likelihood of postoperative complications.Results:Overall,44 out of 67 patients(65.67%)underwent ON,while 23(34.33%)underwent LN.Patients in the ON group experienced more postoperative pain according to the visual analogic scale(p=0.032).Moreover,time to deambulation and time to return to full daily activities,assessed according to the 12-ltem Short Form Survey physical and mental component summary scores questionnaires,were significantly shorter in the LN group(p=0.021,p<0.001,and p<0.001,respectively).Of note,there were no significant differences in intraoperative and postoperative complication rates among the groups(p=0.258 and p=0.317,respectively).No conversion to open surgery was described.Logistic regression analysis demonstrated that urgency(p=0.025)was the only predictor associated with a higher risk of intraoperative complications.However,no independent factors associated with postoperative complications or with the surgical approach of choice were found.Conclusions:Based on our results,laparoscopic treatment of XGP represents a feasible alternative to ON,resulting in less postoperative pain and faster recovery.In skilled hands,LN should be considered as the treatment of choice for XGP.

Efficacy and safety of low-intensity shockwave therapy plus tadalafil 5 mg once daily in men with type 2 diabetes mellitus and erectile dysfunction:a matched-pair comparison study

Low-intensity extracorporeal shockwave therapy(LiESWT)represents a promising treatment for patients with erectile dysfunction(ED).We investigated the efficacy of LiESWT combined with tadalafil 5 mg once daily in men with type 2 diabetes mellitus(T2DM)and ED and compared LiESWT protocols administering different number of shockwaves.We performed a retrospective matched-pair comparison using data from a prospectively maintained database.Seventy-eight patients who received tadalafil 5 mg once dai7ly for 12 weeks+LiESWT performed with an electrohydraulic source for 3 weeks(Group A)were matched 1:1 to patients who received tadalafil 5 mg once daily alone for 12 weeks(Group B).A subgroup analysis was performed according to the number of shockwaves delivered during each session(1500,1800,and 2400 in subgroup A1,A2,and A3,respectively).The mean International Index of Erectile Function-5(IIEF-5)score variations with respect to baseline recorded at 4,12,and 24 weeks after the end of the treatment were investigated as treatment outcomes.The mean IIEF-5 scores significantly improved in all groups and subgroups at 4-week follow-up without intergroup differences.At 12-and 24-week follow-up,the mean IIEF-5 improvement was significantly higher among patients in the A3 subgroup(+5.0±2.1[P<0.001]and+4.7±2.3[P<0.001],respectively).The combined approach with tadalafil 5 mg once daily and LiESWT with a protocol involving 2400 shockwaves provides significant advantages in terms of IIEF-5 improvement and durability compared to tadalafil 5 mg once daily alone in patients with T2DM and ED.