Georgios Avgenakis

Introduction. There is not much evidence regarding clinical behavior of bladder cancer in younger patients. We evaluated clinical characteristics, tumor recurrence and progression in patients younger than 40 years old with urothelial bladder carcinoma. Methods. We retrospectively reviewed the medical records of 31 patients less than 40 years old who were firstly managed with bladder urothelial carcinoma in our department. Data were analysed with the Chi-square test. Results. Mean age was 31.7 years. Mean followup was 38.52 months (11-72 months). Nineteen (61%) patients were diagnosed with GII and 2 (6%) patients with GIII disease. Five (16%) patients presented with T1 disease. Three (9%) patients with invasive disease underwent cystectomy and adjuvant chemotherapy and one developed metastatic disease. Ten (32%) patients recurred during followup with a disease free recurrence rate of 65% the first 2 years after surgery. From those, 1 patient progressed to higher stage and three to higher grade disease. No patient died during followup. Conclusions. Bladder urothelial carcinoma in patients younger than 40 years is usually low stage and low grade. Management of these patients should be according to clinical characteristics and no different from older patients with the same disease.

The aim of the present study was to examine the seasonality of hypospadias in Greece in an attempt to elucidate the aetiology. All boys born between 1991-1998, who underwent hypospadias repair at 'Aghia Sophia' Children's Hospital, Athens (n=542) were analysed. All Greek live-born males during the same period (population at risk; m=421,175) served as the controls. Seasonality by month of birth was evaluated with specific statistical tools. Meteorological parameters were also analysed. All tests yielded significant results, suggesting a simple harmonic prevalence pattern (highest/lowest: autumn, peak in October/spring, trough in April). Therefore, the first trimester of hypospadiac gestations coincides more frequently with winter. Meteorological parameters varied seasonally (maximal sunlight; air temperature in summer/minimal in winter, maximal rainfall in winter/minimal in summer) and were strongly associated pairwise. Hypospadiac birth prevalence follows a simple harmonic seasonal pattern and is associated with that of cryptorchidism in Greece. The coincidence of the first or third trimester of a potentially genetically influenced gestation with winter could lead to the phenotypic expression of hypospadias or cryptorchidism, respectively. The potential role of a cyclic-varied androgen-production stimulator, such as human chorionic gonadotrophin may be speculated. The seasonality of a common environmental factor acting directly/indirectly may contribute to these patterns, and possibly to the common pathogenesis of these congenital malformations.

We present the case of a patient who suffered from Takotsubo cardiomyopathy (TCM) immediately after the initiation of subarachnoid anesthesia for a minimally invasive urologic procedure (tension-free vaginal tape (TVT) surgery for stress urine incontinence). TCM mimics acute coronary syndrome and is caused by an exaggerated sympathetic reaction to significant emotional or physical stress. Our patient suffered from chest pain, palpitations, dyspnea, and hemodynamic instability immediately following subarachnoid anesthesia and later in the postanesthesia care unit. Blood troponin was elevated and new electrocardiographic changes appeared indicative of cardiac ischemia. Cardiac ultrasound indicated left ventricular apical akinesia and ballooning with severely affected contractility. The patient was admitted to coronary intensive care for the proper care and finally was discharged. TCM was attributed to high emotional preoperative stress for which no premedication had been administered to the patient. In conclusion, adequate premedication and anxiety management are not only a measure to alleviate psychological stress of surgical patients, but, more importantly, an imperative mean to suppress sympathetic nerve system response and its cardiovascular consequences.

Introduction-Objective: Assessing the quality of health service provision at a Department level is difficult and needs to be documented. Documentation is achieved by certification. In spite of the increasing trend for more specialized quality standards, ISO 9001:2015 is the most widespread one. The Directorate of the Department of Urology of the University General Hospital of Heraklion, in cooperation with the Hospital Administration proceeded to study/ install the quality management system (QMS) according to ISO 9001:2015 for the provision by the Department of Urology and its Special Units (Non-Invasive Urology-Lithotripsy & Cystoscopy-Urodynamics) of diagnostic, therapeutic and nursing services as well as for the production of scientific work, research activity and provision of educational services. The procedure was implemented in July 2017 through the Special Account for Research of the University of Crete; using funds from a specific program set up for the development of the Department of Urology. To the best of our knowledge, this is the first case of certification of a Urological Department in a Public Hospital in Greece. The purpose of this study is to present the initial experience/results from the implementation of a QMS according to ISO 9001:2015 at our Department. Material and Methods: The procedure was initiated by providing medical-nursing and administrative staff with self-assessment questionnaires and special forms for problem-filling and improvement suggestions. All forms were filled in anonymously. All data gathered were processed by our quality management consultant. The results were presented to the parties involved in an open meeting at the Department and formed the basis for the QMS design. Through a 12-month strenuous workout with meetings about every 15 days, a QMS consisting of 14 procedures, two working instructions, 17 forms, and 13 administrative nursing protocols was set up. The system included 24 forms provided by the Ministry of Health and 29 clinical nursing protocols issued by the local Health Region. The staff was systematically trained in keeping them up and, with suggestions/ corrective actions the QMS was improved. Results: Through patient satisfaction questionnaires, the Department was rated with 9.1/10 (reception/stay), 9.8/10 (medical follow up), 9.3/10 (nursing care) and 9.2/10 (general service). With the implementation of the QMS, quality indicators related to medical-nursing care (drop-fall rates, fever rates, admission severity-related mortality, etc.) are monitored. Through staff meetings the progress of indicators is presented and actions are being taken aiming at improvements. The operation of the Department has been parameterized and co-perception has been conquered. By implementing a QMS, future goals have also been set: a) Higher staff participation rate problems/suggestions for improvement recording, b) Monitoring achievement of research objectives through standardized procedures, c) Higher satisfaction score achievement, d) Certification according to EN 15224, in order to introduce the of clinical risk concept by adopting scientifically registered protocols in daily diagnostic/ therapeutic practice. Conclusions: Certification of the QMS of a Urological Department in a Public Hospital is difficult but feasible. It can be successful despite organizational-technical difficulties/lack of resources. The benefits are many, such as enhancing organizational structure efficiency and improving communication within/outside the hospital.