Michael D Melekos

University of Thessaly, Iolcus, Thessaly, Greece

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Publications (70)196.87 Total impact

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    ABSTRACT: The purpose of this study was to assess the correlation of previous bladder cancer history with the recurrence and progression of patients with high-risk non-muscle-invasive bladder cancer treated with adjuvant Bacillus Calmette-Guérin (BCG) and to evaluate their natural history. Patients were divided into two groups based on the existence of previous bladder cancer (primary, non-primary). A logistic regression analysis was used to identify the possible differences in the probabilities of recurrence and progression with respect to tumor history, while potential differences due to gender, tumor size (> 3 cm, < 3 cm), stage (pTa, T1), concomitant carcinoma in situ (pTis) and number of tumors (single, multiple) were also assessed. Univariate and multivariate models were employed. In addition, Kaplan-Meier survival analysis was used to compare recurrence- and progression-free survival between the groups. A total of 192 patients were included (144 with primary and 48 with non-primary tumors). The rates of recurrence and progression for patients with primary tumors were 27.8% and 12.5%, respectively. The corresponding percentages for patients with non-primary tumors were 77.1% and 33.3%, respectively. The latter group of patients displayed significantly higher probabilities of recurrence (p=0.000; 95% confidence interval [CI], 4.067 to 18.804) and progression (p=0.002; 95% CI, 1.609 to 7.614) in a univariate logistic regression analysis. Previous bladder cancer history remained significant in the multivariate model accounting for history, age, gender, tumor size , number of tumors, stage and concomitant pTis (p=0.000; 95% CI, 4.367 to 21.924 and p=0.002; 95% CI, 1.611 to 8.182 for recurrence and progression respectively). Kaplan-Meier curves revealed that the non-primary group hadreduced progression- and recurrence-free survival. Previous non-muscle-invasive bladder cancer history correlates significantly with recurrence and progression in patients with high-risk non-muscle-invasive disease treated with adjuvant BCG.
    Cancer Research and Treatment 09/2014; · 2.98 Impact Factor
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    ABSTRACT: To investigate the impact of shock wave lithotripsy (SWL) on renal tissues using neutrophil gelatinase-associated lipocalin (NGAL), cystatin C, and interleukin 18 (IL-18) levels in serum and urine and to examine the relationship of these biomarkers with patient and calculus characteristics as well as SWL treatment parameters.
    Urology 08/2014; · 2.13 Impact Factor
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    ABSTRACT: Although partnership issues are thought to be implicated in female psychology and sexual life, no data exist on the relationship between dissatisfaction with male sexual performance and female sexual dysfunction (FSD) in women with type 1 diabetes mellitus (DM-1). We studied 70 women with uncomplicated DM-1 and 100 nondiabetic women using Female Sexual Function Index (FSFI), Female Sexual Distress Scale (FSDS) and a Likert Scale to evaluate sexual function, sexual distress and the degree of satisfaction derived from the male partner's sexual performance. Compared with healthy controls, DM-1 women had significantly worse sexual function, higher sexual distress and higher FSD frequency. No significant difference in dissatisfaction with partner's sexual performance was found between diabetic and control group (CG). Moreover, dissatisfied diabetic and control women were comparable in sexual functioning, sexual distress and FSD frequency. In the CG, dissatisfied women had significantly worse total FSFI score compared with the satisfied ones. In addition, dissatisfaction with male sexual performance led to significantly worse FSDS score and higher FSD frequency in both diabetic and CGs. Therefore, our findings reveal a negative association between dissatisfaction with male partner's sexual performance and female sexual functioning, regardless of the presence of diabetes.International Journal of Impotence Research advance online publication, 10 July 2014; doi:10.1038/ijir.2014.21.
    International Journal of Impotence Research 07/2014; · 1.37 Impact Factor
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    ABSTRACT: The aim of this retrospective study was to evaluate the impact of stapling devices use on overweight and obese bladder cancer patients treated with radical cystectomy (RC). Fifty-two overweight and 24 obese patients underwent open RC for muscle invasive bladder cancer. Bladder removal was performed using standard suture technique (SST) or multifire autosuture articulated vascular Endo-GIA (eG). Twenty-three overweight and 11 obese patients formed the SST arms and the remaining 29 overweight and 13 obese patients formed the eG arms. Intra and postoperative parameters and early postoperative complications (30 days) using the Clavien-Dindo classification were recorded. SST and eG arms of overweight and obese patients were comparable in intra and postoperative parameters. Both overweight and obese eG arms had significantly lower estimated blood loss, lower number of transfused packed red blood cells units (PRBC) and lower cystectomy intraoperative time compared with the SST ones (p < 0.05). In obese patients, staplers use led to significantly lower total length of stay compared with SST (p = 0.041). Complications rate was significantly higher in the obese group compared with the overweight group (58.33% versus 30.77%, p = 0.042). No difference in complications was found between the SST and eG arms of the overweight and obese patients. No deaths occurred. Staplers use in RC in overweight/obese patients is accompanied by significantly shorter intraoperative time, lower blood loss and lower number of transfused PRBC units, compared with SST. In obese patients, eG use led to shorter length of stay.
    The Canadian Journal of Urology 02/2014; 21(1):7114-9. · 0.91 Impact Factor
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    ABSTRACT: We conducted a retrospective study to determine the prognostic significance of age, gender, associated carcinoma in situ, stage, number of tumors, and tumor size for patients with high-risk non-muscle-invasive bladder tumors treated with bacillus Calmette-Guérin (BCG). Data were evaluated on 144 high-risk patients with non-muscle-invasive bladder cancer treated with BCG immunotherapy after the initial treatment with transurethral resection. According to their response to BCG, patients were divided into groups, and the differences in factors, associated with recurrence and progression, were evaluated. Patients were categorized into two groups: group A, complete responders without recurrence and without progression, and group B, patients with recurrence and with progression. Furthermore, group B was divided into two subgroups: group B1, patients with recurrence, and group B2, patients with progression. Univariate analysis of group B showed that only tumor size of >3 cm diameter (hazard ratio (HR) 11.99; 95 % confidence interval (CI) range 5.69-25.3; p < 0.001) is associated with recurrence. After multivariate analysis, the same factor appeared to be prognostic for recurrence as well. In addition, group B2 was statistically correlated with group B1. Univariate analysis proved that tumor stage (Ta or T1) is the unique factor associated with progression (HR 6.4; 95 % CI 1.29-31.9; p = 0.02). Tumor stage seems to be associated with disease's progression after the multivariate analysis too. Tumor size and stage may serve as prognostic factors, because of its independent correlation with recurrence and progression for patients with high-risk non-muscle-invasive bladder tumors treated with BCG.
    Tumor Biology 12/2013; · 2.84 Impact Factor
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    ABSTRACT: Glucuronidation, mediated by the UDP-glucuronosyltransferase 1A1 (UGT1A1) enzyme, is an important metabolic process during which steroids are converted to more easily excreted compounds in steroid target tissues, such as the prostate. The aim of our study was to investigate the possible correlation between UGT1A1 promoter gene polymorphism and benign prostatic hyperplasia. 421 blood samples were obtained from 138 consecutive patients diagnosed with benign prostatic hypeplasia (BPH group) and 283 healthy volunteers (control group). A(TA)6TAA promoter polymorphism of UGT1A1 gene was studied using the Fragment Analysis Software of an automated DNA sequencer and three genotypes (homozygous 7/7, heterozygous 6/7 and normal homozygous 6/6) were identified. No significant differences were observed between the BPH group and controls regarding the genotyping distribution of the three UGT1A1 promoter genotypes (P = 0.39). Also, no association was found between overall disease risk and the presence of the polymorphic homozygous genotype (TA(7)/TA)7) vs. TA(6)/TA(7) + TA(6)/TA(6)) (P = 0.31). Our data suggest that the TA repeat polymorphism of UGT1A1 is not associated with increased BPH risk susceptibility in Caucasian men.
    Molecular Biology Reports 09/2013; · 1.96 Impact Factor
  • Article: Reply.
    Urology 03/2013; · 2.13 Impact Factor
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    ABSTRACT: OBJECTIVE: To suggest minipercutaneous ureterolithotripsy using the mininephroscope as an alternative process for impacted stones of the upper ureter because these stones can be challenging to treat and can produce severe symptoms. MATERIALS AND METHODS: We report our results of cases in which the percutaneous approach using 2-step minipercutaneous ureteroscopy with the mininephroscope was used to achieve relief from the stone, with minimal anesthesia risks. A total of 54 patients (33 men and 21 women) presented with impacted stones in the proximal ureter. The mean stone size was 16.2 mm (range 10-21). All patients were treated with 2-step minipercutaneous antegrade ureterolithotripsy under multimodal analgesia. RESULTS: The mean operative time was 49 minutes (range 40-110). Placement of the percutaneous drainage tube was quick and was performed with the patient under local anesthesia. The minipercutaneous session followed several days later, with the patient under multimodal anesthesia. The initial stone-free rate was 94%. The stone-free rate 2 months after the procedure was 100%. All procedures were well tolerated by the patients (group mean visual analog scale score 3.1 ± 0.7 standard deviation). No severe adverse events were noted. The mean hospital stay was 5.3 days (range 3-12). CONCLUSION: In selected emergency cases of impacted proximal ureteral stones, the approach of the initial insertion of a nephrostomy tube followed by a second session of antegrade ureterolithotripsy using the mininephroscope is a safe and effective alternative treatment, especially, because it can be accomplished with minimal anesthesia requirements.
    Urology 03/2013; · 2.13 Impact Factor
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    ABSTRACT: Giant inguinoscrotal bladder hernias are very rare and require surgical intervention. They usually do not cause any specific symptoms and thus, they are often misdiagnosed. If left untreated though, they might lead to severe medical conditions, such as renal failure. We present the case of a 71-year-old male patient suffering from a giant inguinoscrotal mass, accompanied by symptoms of the lower urinary track (LUTS) and chronic renal failure. In our case, the patient presented with bladder hernia causing non specific symptoms of renal failure. In contrast to acute renal failure, a chronic renal impairment most often comes with no specific symptoms and thus, it can be present for many years before the diagnosis is made. It is evident that such serious conditions should be suspected and treated. Inguinoscrotal bladder hernias may be associated with severe medical conditions, such as renal deterioration, and should be considered in the differential diagnosis of renal failure, when accompanied by any inguinal, scrotal, or low abdominal wall hernia.
    International journal of surgery case reports. 01/2013; 4(3):345-7.
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    ABSTRACT: Introduction.  Psychosomatic and social issues have been found to be determinants of sexual distress in diabetic and non-diabetic populations. However, the role of parental bonding as a determinant for sexual distress has not been studied in women with type 1 diabetes mellitus (DM-1). Aim.  To study the role of parental care and overprotection, in the pathogenesis of sexual distress in women with DM-1. Methods.  Seventy-seven women with uncomplicated DM-1 and 77 healthy controls were enrolled in the study. The Female Sexual Distress Scale (FSDS), the General Health Questionnaire-28, and the Parental Bonding Instrument were used to evaluate sexual distress, general health and bonding with parents, respectively. Main Outcome Measures.  To assess the role of parental bonding as risk factor for sexual distress, in women with DM-1. Results.  Women with DM-1 had significantly higher FSDS scores compared with controls. Furthermore, women with DM-1 had significantly higher maternal and paternal care, and lower maternal overprotection in comparison with the healthy ones. Paternal overprotection and general health were similar in both groups (P > 0.05). Sexual distress was more frequent in women with DM-1 (31.43% vs. 8.57% of controls, P < 0.05). Diabetic women with sexual distress had lower maternal care, higher maternal overprotection and lower paternal overprotection compared to diabetics without sexual distress (P < 0.05). No difference was found in the paternal care between the two groups (P > 0.05). Moreover, sexually distressed DM-1 women had worse general health parameters in comparison with the non-sexually distressed diabetics (P < 0.05). In the DM-1 group, low maternal care and low paternal overprotection were significant risk factors for sexual distress (P < 0.05). Conclusions.  Parental care and overprotection can lead to sexual distress and, therefore, to Female Sexual Dysfunction in DM-1 women. Evaluation of parental bonding is necessary in DM-1 women with distressing sexual problems. Bargiota A, Dimitropoulos K, Mouzas O, Melekos M, Tzortzis V, and Koukoulis G. The impact of parental bonding on sexual distress in women with type 1 diabetes mellitus. J Sex Med **;**:**-**.
    Journal of Sexual Medicine 10/2012; · 3.15 Impact Factor
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    ABSTRACT: The objective of this study was to evaluate the female sexual function in relation to hormonal status in pre- and postmenopausal women with obstructive sleep apnea (OSA). A total of 43 premenopausal (mean age 42.1±4.9) and 58 postmenopausal (mean age 59.9±4.8) women were included in the study. All women filled out the Epworth sleepiness scale (ESS), the Beck Depression Inventory (BDI) and the Female Sexual Function Index (FSFI). Testosterone, estradiol and progesterone were measured. After polysomnography, women were allocated to a not-severe OSA group (Apnea-Hypopnea Index (AHI) 10-30) and a severe OSA group (AHI >30). Healthy subjects comprised the control group. Severe OSA women in both pre- and post-menopausal group were found to have significantly lower mean FSFI score (16.5±4.0 and 16.9±4.7, respectively) compared with not-severe OSA (23.4±5.5, P<0.01 and 21.8±7.5, P<0.05) and control subjects (27.0±5.5, P<0.01 and 24.0±6.7, P<0.01). Progesterone, which was significantly lower in severe OSA premenopausal women (0.26±0.2) compared with not-severe OSA (0.55±0.14, P<0.01) and control group (0.62±0.16, P<0.01), correlated significantly with FSFI (r=0.39, P<0.01). Our study demonstrated that OSA is associated with sexual dysfunction in both premenopausal and postmenopausal women in a dose-related fashion. Regarding premenopausal women, our results indicated that progesterone may play a role in the association between OSA and female sexual dysfunction.International Journal of Impotence Research advance online publication, 7 June 2012; doi:10.1038/ijir.2012.20.
    International journal of impotence research 06/2012; · 2.73 Impact Factor
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    ABSTRACT: To assess the learning curve for fluorescence cystoscopy using hexaminolevulinate hydrochloride (HAL) in patients with bladder cancer. Fifty patients underwent bladder instillation with HAL. Two senior residents inspected separately the bladder using white light cystoscopy, followed by fluorescence cystoscopy and mapped the lesions. An experienced with photodynamic diagnosis (PDD) urologist also performed both cystoscopies, mapped, resected or cold biopsied suspect lesions under the supervision of another experienced urologist. To evaluate the learning curve, patients were divided into five subgroups, including group 1 (patients 1-10), group 2 (11-20), group 3 (21-30), group 4 (31-40) and group 5 (41-50). The kappa statistics was calculated to assess interobserver agreement between the physicians and the false positive rates of urologists and residents were also compared. Histologically verified tumors were diagnosed in 103 of 142 lesions identified by PDD. The interobserver agreement between urologists and residents was moderate, moderate, good, excellent, and excellent for group 1, 2, 3, 4, and 5, respectively. Both residents had increased false positive rates compared to urologists in all subgroups of patients but this difference did not reach statistical significance. In addition, false positive rate of residents was declining as the number of procedures was increasing. Our data suggest that 20 cases of HAL PDD are required to achieve a good interobserver agreement between inexperienced and experienced operator, and excellent agreement is achieved after 30 cases. The false positive rate of inexperienced operators was comparable to the experts and showed a gradual decrease.
    The Canadian Journal of Urology 06/2012; 19(3):6269-73. · 0.91 Impact Factor
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    ABSTRACT: Current studies indicate that women with type 1 diabetes (T1DM) have a high prevalence of sexual disorders although data on the prevalence of sexual dysfunction are limited when sexual distress is included. The frequency and the possible correlates of distressful sexual disorders in a highly selected group of type 1 diabetic women. The sexual function, sexual distress, and general health status were assessed in 44 premenopausal women with uncomplicated T1DM and 47 healthy controls, using the Female Sexual Function Index (FSFI), the Female Sexual Distress Scale (FSDS), and the General Health Questionnaire-28 (GHQ-28). The impact of sexual distress on the frequency of female sexual dysfunction (FSD). The frequency of sexual disorders according to the FSFI was significantly higher in diabetic compared to control women (25% vs. 8.5%, respectively, P < 0.05). Diabetic women had significantly lower median (first to third quartile) total FSFI score compared to control group (30.55 [26.08-33.08] vs. 33.50 [30.70-34.30], P = 0.001). Desire, arousal, and satisfaction were the sexual domains significantly affected in the diabetic group. Diabetic women had significantly higher median (first to third quartile) FSDS score compared to control group (6.5 [2.3-15.8] vs. 4.0 [1.0-10.5] P = 0.043). FSD (combined pathological FSFI and FSDS scores) was present in higher proportion of diabetic women (15.9%) compared to controls (2.1%) (P = 0.020). GHQ-28 score was comparable between the groups. However, in the diabetic group, FSD was related with anxiety, depression, and low educational level. Diabetes-related factors were not associated with FSD. Pre-menopausal women with uncomplicated T1DM have significantly higher frequency of FSD compared to healthy controls, when the criterion of sexual distress is included. Psychosomatic and contextual factors implicated in sexual distress are correlates of FSD.
    Journal of Sexual Medicine 02/2012; 9(5):1374-81. · 3.15 Impact Factor
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    ABSTRACT: The cell surface endopeptidase CD10 (neutral endopeptidase) and nuclear factor-κB (NF-κB) have been independently associated with prostate cancer (PC) progression. We investigated the correlations between these two factors and their prognostic relevance in terms of biochemical (prostate-specific antigen, PSA) relapse after radical prostatectomy (RP) for localized PC. The immunohistochemical expression of CD10 and NF-κB in samples from 70 patients who underwent RP for localized PC was correlated with the preoperative PSA level, Gleason score, pathological stage and time to PSA failure. CD10 expression was inversely associated with NF-κB expression (p < 0.001), stage (p = 0.03) and grade (p = 0.003), whereas NF-κB was directly related with stage (p = 0.006) and grade (p = 0.002). The median time to PSA failure was 56 months. CD10 and NF-κB were directly (p < 0.001) and inversely (p < 0.001) correlated with biochemical recurrence-free survival, respectively. CD10 expression (p = 0.022) and stage (p = 0.018) were independently associated with time to biochemical recurrence. Low CD10 expression is an adverse prognostic factor for biochemical relapse after RP in localized PC, which is also associated with high NF-κB expression. Decreased CD10 expression which would lead to increased neuropeptide signaling and NF-κB activity may be present in a subset of early PCs.
    Urologia Internationalis 01/2012; 88(2):158-64. · 1.15 Impact Factor
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    ABSTRACT: Objective. To study the impact of the neutral endopeptidase (NEP)/neuropeptides (NPs) axis and nuclear factor kappa B (NFκB) as predictors of prostate-specific antigen (PSA) recurrence after radical prostatectomy (RP). Patients and Methods. 70 patients with early-stage PC were treated with RP and their tumor samples were evaluated for expression of NEP, endothelin-1 (ET-1) and NFκB (p65). Time to PSA recurrence was correlated with the examined parameters and combined with preoperative PSA level, Gleason score, pathological TNM (pT) stage, and surgical margin (SM) assessment. Results and Limitations. Membranous expression of NEP (P < 0.001), cytoplasmic ET-1 (P = 0.002), and cytoplasmic NFκB (P < 0.001) were correlated with time to PSA relapse. NEP was associated with ET-1 (P < 0.001) and NFκB (P < 0.001). ET-1 was also correlated with NFκB (P < 0.001). NEP expression (P = 0.017), pT stage (P = 0.013), and SMs (P = 0.036) were independent predictors of time to PSA recurrence. Conclusions. There seems to be a clinical model of NEP/NPs and NFκB pathways interconnection, with their constituents following inverse patterns of expression in accordance with their biological roles and molecular interrelations.
    Prostate cancer. 01/2012; 2012:452795.
  • Journal of Obstetrics and Gynaecology 10/2011; 31(7):670-1. · 0.60 Impact Factor
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    ABSTRACT: Approximately 70% to 80% of patients with urothelial carcinomas of the bladder are initially diagnosed with non-muscle invasive disease. Superficial, non-muscle invasive bladder cancers (NMIBCs) are managed with cystoscopic transurethral resection of all visible lesions followed by intravesical chemotherapy and/or immunotherapy. Despite this treatment, up to 70% of these tumors will recur within five years and 15% will ultimately progress to muscle-invasive disease, suggesting that novel therapeutic strategies are necessary. Recent studies have greatly advanced our understanding of urothelial carcinogenesis and have highlighted the distinct molecular pathogenesis of NMIBCs versus muscle-invasive bladder tumors. It is now clear that diverse genetic and epigenetic events are driving the oncogenesis of NMIBCs, thereby attesting to their potential as therapeutic targets for these tumors. This article reviews the molecular pathogenesis of NMIBCs, discusses recently completed and ongoing clinical trials and anticipates the future direction of molecular targeted agents in this disease.
    Current Molecular Medicine 09/2011; 11(8):623-32. · 3.61 Impact Factor
  • Urology 09/2011; 78(3). · 2.13 Impact Factor
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    ABSTRACT: Introduction and Objective: Surgical ligation of the internal spermatic veins in infertile men with a palpable varicocele has been associated with a significant improvement in sperm parameters. On the contrary there is no consensus on the role of varicocelectomy for the treatment of infertile men with non palpable, ultrasound-detected, subclinical varicoceles. The aim of this study is to evaluate the effect of the surgical ligation of the internal spermatic vein for the treatment of infertile men with subclinical varicoceles and no other causes of spermatogenetic impairment. Materials and Methods: In this multiinstitutional prospective study, a total of 34 infertile men with subclinical varicocele diagnosed with high resolution Color Doppler ultrasonography and no other demonstrable causes of infertility were enrolled. The patients were allowed to choose between surgical ligation of the internal spermatic veins and observation. 18 men consented to undergo microsurgical ligation of the spermatic veins (group A) while 16 men opted for observation and constituted the control group (group B). Baseline sperm parameters (sperm count, motility and morphology) were compared to values obtained after a period of 6-9 months for the patients in both groups (postoperative values for group A). Results: In the group of patients that underwent surgical ligation of the internal spermatic veins there was no statistically significant differences between preoperative and postoperative values for all sperm parameters, although postoperatively there was a small increase in all sperm parameters. On the contrary, for the patients in the control group there was a statistically significant decrease in the percentage of morphologically normal spermatozoa. There was a non-statistically significant decrease in the sperm count and motility in the control group. Conclusions: There is no evidence from the present study suggesting that infertile men with subclinical varicoceles and other causes of infertility would benefit from surgical ligation of the internal spermatic veins.
    Urology 09/2011; 78(3). · 2.13 Impact Factor
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    ABSTRACT: The aim of our study was to evaluate the efficacy and safety of ESWL using a modified lateral position in obese patients with renal stones. Nineteen obese patients with renal stones were enrolled (group A). The mean stone diameter was 1.3 cm (0.7-1.9 cm). The mean BMI was 35.1 kg/m² (31-41 kg/m²). Patients were placed in the lateral position, with the energy source facing their body posteriorly and the site where the stone was located in direct contact with the water cushion. Success rate (defined as the percentage of patients who were stone-free or with insignificant fragments after 3 months), mean number of ESWL sessions, mean duration of ESWL session and complications were recorded. The results were compared with those of 17 obese patients (Group B) with similar baseline characteristics treated in the standard supine position. All ESWLs were performed using the Dornier lithotripter SII. Both success rate (68.4 vs. 64.7% for groups A and B, respectively) and mean number of sessions (2.2 vs. 2.6) did not differ significantly between the two groups (p = 0.5). Interestingly, the time required to complete ESWL was significantly shorter for group A patients (56 min) compared to group B (73 min) (p = 0.001). No severe complications (including hematoma, pyelonephritis) were recorded. Our data indicate that ESWL in the modified lateral position for renal calculi in obese patients seems to be feasible and safe. In addition, it is faster than in the supine position since it overcomes technical difficulties. Further studies with a large number of patients are required to support our findings.
    Urological Research 08/2011; 40(4):355-9. · 1.31 Impact Factor

Publication Stats

404 Citations
196.87 Total Impact Points


  • 2003–2014
    • University of Thessaly
      • Ουρολογική Κλινική
      Iolcus, Thessaly, Greece
  • 2006–2012
    • General University Hospital of Larissa
      Lárissa, Thessaly, Greece