Petros Sountoulides | Aristotle University of Thessaloniki (original) (raw)

Papers by Petros Sountoulides

Current Drug Targets

Due to an editorial oversight, we would like to apologize for an error that occurred in the both ... more Due to an editorial oversight, we would like to apologize for an error that occurred in the both print and online version of an editorial entitled “Can Medical Therapy Fix Sexual Dysfunction after Major Pelvic and Prostate Surgery and does it Work for Kidney Stones? Chemotherapy before Cystectomy, New Schemes for which Patients?. It was published without the co-authors’ names in the journal “Current Drug Targets” 2021; 22(1): 2 [1]. The original editorial can be found online at https://doi.org/10.2174/138945012201201231123209 REFERENCE [1] Petros S, Ioannis M, Ioannis V, Luca C, Can medical therapy fix sexual dysfunction after major pelvic and prostate surgery and does it work for kidney stones? chemotherapy before cystectomy, new schemes for which patients? Curr Drug Targets 2021; 22(1): 1.

European Urology Focus, 2022

Surgical treatment for benign prostatic obstruction in patients wishing to preserve normal ejacul... more Surgical treatment for benign prostatic obstruction in patients wishing to preserve normal ejaculation remains a urological challenge. Standard surgical techniques are associated with high rates of postoperative ejaculatory dysfunction. Research is now concentrating on ejaculation-preserving modifications of standard surgical techniques and on alternative minimally invasive interventional techniques. Ejaculation-preserving modifications seem to be superior to standard techniques for preservation of ejaculation with comparable efficacy in terms of improvement in lower urinary tract symptoms (LUTS). Among the alternative minimally invasive interventional techniques, prostatic artery embolization and prostatic urethral lift provide high success rates for patients wishing to preserve ejaculation but are inferior to standard surgical techniques regarding improvement in LUTS. High-quality studies focusing on ejaculatory function as the primary outcome are still lacking. PATIENT SUMMARY: Benign prostate enlargement can cause obstruction of the lower urinary tract. We reviewed the evidence for techniques that preserve ejaculatory function in treatment of this condition. These ejaculation-preserving treatment techniques may have lower efficacy in improving bothersome urinary symptoms.

Metabolites

Insufficient physical activity (PA) may be a shared risk factor for the development of both metab... more Insufficient physical activity (PA) may be a shared risk factor for the development of both metabolic syndrome (MetS) and prostate cancer (PCa). To investigate this correlation and to develop a nomogram able to predict tumor diagnosis. Between 2016 and 2018, a consecutive series of men who underwent prostate biopsy at three institutions were prospectively enrolled. PA was self-assessed by patients through the Physical Activity Scale for the Elderly (PASE) questionnaire; MetS was assessed according to Adult Treatment Panel III criteria. A logistic regression analyses was used to identify predictors of PCa diagnosis and high-grade disease (defined as International Society of Uro-Pathology grade >2 tumors). A nomogram was then computed to estimate the risk of tumor diagnosis. A total of 291 patients were enrolled; 17.5% of them (n = 51) presented with MetS. PCa was diagnosed in 110 (38%) patients overall while 51 presented high-grade disease. At multivariable analysis, age (OR 1.04;...

Urology & Nephrology Open Access Journal, 2014

Malignancies of the genitourinary tract are currently diagnosed more frequently than ever in the ... more Malignancies of the genitourinary tract are currently diagnosed more frequently than ever in the past. While for some of them, like prostate cancer, available treatment options are likely to lead the majority of patients to cure from the disease, for others, like renal cancer, advanced disease will eventually lead to death within months. This coupled with the fact that the average life expectance in the Western World is increasing will result in a vast patient population with either advanced, non-curable disease or cancer survivors with problems related to the received therapeutic surgical or medical interventions. The care of patients with advanced urologic malignancies requires a multidisciplinary effort from physicians of many specialties under the guiding role of the treating urologist. We will discuss a less recognized cause of suffering for patients with advanced malignancies, the issue of paraneoplastic phenomena and their management.

Yonsei Medical Journal, 2008

The search for a minimally invasive approach to the treatment of Lower Urinary Tract Symptoms (LU... more The search for a minimally invasive approach to the treatment of Lower Urinary Tract Symptoms (LUTS) suggestive of Benign Prostatic Hyperplasia (BPH) is probably as old as Transurethral Resection of the Prostate (TURP). In an effort to overcome the limitations and morbidities of TURP, and in light of evidence suggesting that medical treatment for BPH has a limited lifespan , laser-based treatments have emerged during the last decade. Photoselective Vaporization of the Prostate (PVP) by the "GreenLight" KTP laser is considered one of the most promising options, one that is constantly evolving new technologies in prostate surgery. In this overview of KTP laser usage in BPH treatment, we will briefly discuss the evolution of this modality since it was first introduced and focus on the available evidence regarding safety, efficacy and cost parameters of its application.

Indian Journal of Urology, 2011

Expert Review of Medical Devices, 2012

The standard treatment options for organ-confined prostate cancer are radical prostatectomy and r... more The standard treatment options for organ-confined prostate cancer are radical prostatectomy and radiation therapy. A number of minimally invasive new technologies have also recently emerged. High-intensity focused ultrasound (HIFU) is considered to be one of the most promising alternative therapies for prostate cancer. The indications for HIFU have recently been expanded to include its use both as a primary therapy for organ-confined prostate cancer as well as for local recurrence of prostate cancer, following radiation therapy. Although experience with the use of HIFU in the salvage setting following failed radiation therapy is limited, there is evidence to support the concept that HIFU offers comparable oncological outcomes to other established salvage treatment options for radiation-recurrent prostate cancer, with potentially less side effects. HIFU should be regarded as a viable alternative, especially for low-to-intermediate-risk cases of radiation-recurrent prostate cancer.

LUTS: Lower Urinary Tract Symptoms, 2019

Archivio Italiano di Urologia e Andrologia, 2020

Hydrocele is the most common benign cause of painless scrotal enlargement and only very rarely ca... more Hydrocele is the most common benign cause of painless scrotal enlargement and only very rarely can be reactive to an underlying testicular tumor. We present the case of a healthy young man, complaining of mild left scrotal discomfort and swelling. Physical examination revealed a non-tender fluctuant left scrotum and serum tumor markers were normal. Scrotal ultrasonography (US) showed a normal right hemiscrotum and testicle and a fluid collection among thickened irregular septations in the left hemiscrotum, a finding which was considered as a complex hydrocele. Intraoperatively the presumed “complex hydrocele” was in fact a multicystic testicular tumor. We proceeded with orchiectomy through the scrotal incision and pathology revealed a mixed germ cell tumor of the testis consisting of cystic teratoma, in situ germ cell neoplasia unclassified (IGCNU) and Sertoli cell tumor. This is the first reported case of this type of testis tumor presenting as complex hydrocele. The aim of this ca...

Journal of Urology, 2021

Purpose: Ureteral stenting in patients with bladder cancer may become necessary in order to prote... more Purpose: Ureteral stenting in patients with bladder cancer may become necessary in order to protect the ureteral orifice during transurethral resection of the tumor or for relief of upper urinary tract obstruction. However, it is believed to increase metachronous upper tract urothelial carcinoma risk. Materials and Methods: We performed a systematic review and meta-analysis of studies comparing ureteral stenting versus nephrostomy or no drainage with regard to the risk of metachronous upper tract urothelial carcinoma. Records were identified through database searches and sources of grey literature up to October 2020 (PROSPERO: CRD42020178298). Results: Five studies (3,309 individuals) were included. Overall, 278 ureteral stents were placed and 20 (7.2%) patients developed metachronous upper tract urothelial carcinoma, while 131 patients were treated with nephrostomy and 3 (2.3%) cases of metachronous upper tract urothelial carcinoma occurred. Patients treated with ureteral stents had a higher likelihood of metachronous upper tract urothelial carcinoma compared to no stents (OR: 3.49, 95% CI: 1.43e8.48, I 2 [52%) and no upper urinary tract drainage (OR: 3.37, 95% CI: 1.49e7.63, I 2 [45%). No difference with regard to metachronous upper tract urothelial carcinoma was observed between stent and nephrostomy (OR: 3.07, 95% CI: 0.41e22.98, I 2 [54%). For the same outcomes, no difference was noted for patients with hydronephrosis. The level of evidence for all measures was evaluated as low. Conclusions: Stenting as a preventive measure after resection of tumors involving the orifice should be avoided, when possible, as it increases the risk of metachronous upper tract urothelial carcinoma. In cases of hydronephrosis, drainage with either nephrostomy or stent is recommended depending on individual patient cases as both interventions do not differ regarding metachronous upper tract urothelial carcinoma risk.

The Journal of Sexual Medicine, 2021

BACKGROUND In women with end-stage renal disease (ESRD), female sexual dysfunction (SD) remains u... more BACKGROUND In women with end-stage renal disease (ESRD), female sexual dysfunction (SD) remains underestimated. AIM To explore the prevalence, correlates, diagnostic approach and treatment modalities of sexual symptoms in females with ESRD. METHODS We performed a systematic review and meta-analysis to estimate both the prevalence of SD and the pooled Female Sexual Function Index (FSFI) scores in ESRD females. Similarly, for studies reporting the FSFI score before and after renal transplantation (RT), we estimated the effect of RT on sexual function. Further assessment of heterogeneity was conducted via subgroup and sensitivity analyses, cumulative meta-analysis and univariate meta-regression of important correlates. Records were identified through searching PubMed, Cochrane Library and Scopus databases as well as sources of grey literature until November 2020 (PROSPERO ID: CRD42020215178). OUTCOMES We included 47 studies with 61 patient group entries and 3490 ESRD female individuals (median age: 45.2 years, ΙQR: 40.4-50.6). RESULTS The SD prevalence in all females with ESRD was 74% (95%CI: 67%-80%, I2 = 92%) and the FSFI total score 16.1 points (95%CI: 14.3-17.8, I2 = 98%). The female SD prevalence was 63% (95%CI: 43%-81%, I2 = 92%) in renal transplant recipients, 80% (95%CI: 72%-87%, I2 = 91%) in hemodialysis patients and 67% (95%CI: 46%-84%, I2 = 90%) in peritoneal dialysis patients. The total FSFI score improved by 7.5 points (95%CI: 3.9-11.1, I2 = 92%) after RT. Older age and menopause were associated with higher SD prevalence. CLINICAL TRANSLATION Female SD is highly prevalent in all ESRD women, but renal transplant recipients reported improved sexual function. STRENGTHS & LIMITATIONS We provide the first study about SD in females and assessed the role of RT on sexual function. Contrary, none of the included studies evaluated the concomitant presence of distress with SD. The levels of heterogeneity were substantially high for all outcomes and we could not adjust for further correlates, which might have affected our measures. CONCLUSIONS Sexual symptoms negatively affect the quality of life and warrants appropriate clinical attention, as they are an underdetermined and undertreated clinical entity in females with ESRD. Studies on treatment modalities of female SD in patients with ESRD are mandatory, as currently no relevant studies or clinical recommendations exist. Pyrgidis N, Mykoniatis I, Tishukov M, et al. Sexual Dysfunction in Women With End-Stage Renal Disease: A Systematic Review and Meta-Analysis. Sex Med Rev 2021;xxx:xxx-xxx.

Minerva Urology and Nephrology, 2021

INTRODUCTION The aim of this review is to evaluate the effect of antibiotic prophylaxis (AP) on a... more INTRODUCTION The aim of this review is to evaluate the effect of antibiotic prophylaxis (AP) on asymptomatic bacteriuria (AB) and urinary tract infection (UTI) in patients with sterile urine undergoing ESWL. EVIDENCE ACQUISITION PubMed, Scopus, Web of Science and Cochrane Registry were searched systematically for randomized clinical trials assessing the effect of AP in patients with sterile urine undergoing SWL up to May 2020. Risk ratios were used to compare dichotomous outcomes. A stratified analysis was performed depending on the risk of bias assessment of the included studies. Subgroup analysis was performed in patients that underwent instrumentation of the urinary tract. EVIDENCE SYNTHESIS Sixteen studies were evaluated including 2442 patients. When evaluating all the included studies (regardless of the risk of bias assessment), the risk of AB was RR: 0.88, 95% CI: 0.64-1.21, P=0.42 and the risk of UTI was RR: 0.55, 95% CI: 0.22-1.36, P=0.19. When excluding the high risk of bias studies, the risk for AB was RR: 0.9, 95% CI: 0.63-1.28, P=0.55 and for UTI RR: 1.18, 95% CI: 0.38-3.72, P=0.77. When evaluating patients that underwent instrumentation of the urinary tract the risk for AB was RR: 0.92, 95% CI: 0.66-1.27, P=0.6 and for UTI was RR: 0.69, 95% CI: 0.22-2.22, P=0.54. CONCLUSIONS AP is not necessary for patients with sterile urine prior to ESWL for the prevention of UTI. Also, patients that undergo instrumentation of the urinary tract prior to or during ESWL do not benefit from antibiotic prophylaxis but further research is required.

Current Drug Targets, 2020

Lower urinary tract symptoms (LUTS) secondary to benign prostate obstruction (BPO) afflict a very... more Lower urinary tract symptoms (LUTS) secondary to benign prostate obstruction (BPO) afflict a very large part of the population on a global scale. Urologists confront patients with a diversity of BPH-related symptoms in their daily practice. For years, the cornerstone of obstructive BPH treatment consisted of mostly medical and to a lesser extent surgical therapies. However, while medical treatment has come to a standstill, over the last decade, new minimally invasive surgical therapies (MISTs) have emerged, conferring several possible advantages over conventional transurethral resection of the prostate (TURP). MISTs have also demonstrated the ability to better respect and preserve sexual function while providing safety and minimal morbidity. Their long-term efficacy and durability over drug therapy remain debatable, as is the need for secondary procedures. In the present paper, we aim to offer a narrative summary of the available literature, thus providing an indirect comparative as...

European Urology Supplements, 2018

Therapeutic Advances in Urology, 2019

Transurethral resection of the prostate (TURP) is considered the ‘gold standard’ for the surgical... more Transurethral resection of the prostate (TURP) is considered the ‘gold standard’ for the surgical management of lower urinary tract symptoms (LUTS) due to benign prostatic obstruction (BPO). However, during recent years TURP has been challenged by several minimally invasive therapies (MITs). The reasons for the development of these MITs are the need for anesthesia and the rather unchanged morbidity of TURP, including ejaculation disorders. Mechanical MITs may represent an attractive option for treating LUTS/BPO by using mechanical forces to maintain urethral patency without cutting, ablating, heating or removing prostatic tissue. The present paper provides an update on currently available mechanical devices for the treatment of LUTS/BPO including the prostatic urethral lift (PUL), the temporary implantable nitinol device, and new intraprostatic implants. It analyzes the evidence for their safety, tolerability, and efficacy in clinical practice and aims to define those subpopulations...

Therapeutic Advances in Urology, 2018

Background: To assess the efficacy and safety of treatment with abiraterone acetate (AA) in chemo... more Background: To assess the efficacy and safety of treatment with abiraterone acetate (AA) in chemotherapy-naïve men with metastatic castration-resistant prostate cancer (mCRPC) in the ‘real-life’ setting. Methods: Data acquisition on the outcomes of the use of AA in chemotherapy-naive patients with mCRPC was performed by a MEDLINE comprehensive systematic literature search using combinations of the following key words: ‘prostate cancer’, ‘metastatic’, ‘castration resistant’, ‘abiraterone’, ‘real life’, and excluding controlled clinical trials (phase II and III studies). Identification and selection of the studies was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) criteria. Outcomes of interest were overall survival (OS), progression-free survival (PFS), 12-week 50% reduction in prostate-specific antigen (PSA), and grade 3 and higher adverse events. Data were narratively synthesized in light of methodological and clinical heterog...

$Research paper thumbnail of Onabotulinumtoxin-A improves health status and urinary symptoms in subjects with refractory overactive bladder: Real-life experience$

Urologia Journal, 2018

Objective: Onabotulinumtoxin-A has been approved for wet overactive bladder refractory to anticho... more Objective: Onabotulinumtoxin-A has been approved for wet overactive bladder refractory to anticholinergics in randomised controlled trials; however, data from real-life practice are scarce. This study was designed to assess the efficacy of intravesical onabotulinumtoxin-A injections, focusing on health status, urinary symptoms and subjective satisfaction. Methods: Data from consecutive patients with overactive bladder-refractory to anticholinergics treated with onabotulinumtoxin-A were prospectively collected and analysed. Standard doses (100–150 U) were used, followed by repeat sessions when clinical benefits diminished. Efficacy and safety of repeat onabotulinumtoxin-A administrations were assessed at 12-week post-injection. Clinical parameters evaluated were: change in the magnitude and frequency of incontinence, urgency and nocturia episodes, change in the number of pads used and procedural complications. Quality of life was evaluated using the 36-Item Short-Form Health Survey, ...

Journal of endourology, 2018

Retropulsion, defined as unintended migration of a stone under the influence of the fragmentation... more Retropulsion, defined as unintended migration of a stone under the influence of the fragmentation device in ureteroscopy (URS) procedures, occurs in 2% to 60% of the cases. Antiretropulsive devices (ARDs) have been studied in experimental and small clinical studies. The current study aims at describing the worldwide usage of ARD and the outcomes related to their usage. The Clinical Research Office of the Endourological Society URS Global Study enrolled 11,885 patients who underwent URS and stone fragmentation for ureteral and/or renal stones. Of the 11,885 treated patients, 9877 were treated for ureteral stones, and data were available on stone migration and ARD use. Of all procedures, 14.5% were performed with the use of an ARD. Less stone migration (-2.0%; p = 0.050), higher stone-free rates (SFRs) (2.8%; p < 0.001), and shorter length of stay (-4.7%; p = 0.001) were observed in the antiretropulsive group. When an ARD is used during URS, less migration, higher SFRs, and shorter...

Public Health and Emergency, 2016

Urological malignancies are traditionally affecting people of older age, may not be upfront letha... more Urological malignancies are traditionally affecting people of older age, may not be upfront lethal, especially prostate cancer (PCa), and as a result urological patients often live many years with their disease. Recent advancement in the treatment of castration-resistant PCa have resulted in a prolongation of survival and an improvement in the quality of life even for of patients with advanced disease. The availability of new treatments that prolong life for cancer patients might result in an increase in the need for palliative care procedures as patients live longer and may suffer the side effects of treatment as well as the sequella of their underlying malignancy. This rather extensive review article will review the various palliative treatments available for the most common consequences and complications of genitourinary cancers. One of the most frequent everyday issues that will be discussed is the optimal management of upper urinary tract obstruction caused by malignancy. There has been considerable debate over whether stent placement or percutaneous nephrostomy (PCN) provides better patient care in terms of drainage, preservation of renal function and quality of life. Preservation of bone health and management of skeletal related events will be discussed along with the management of lower urinary tract obstruction by either indwelling or intermittent catheterization for patients with bladder outlet obstruction (BOO) will. The available options and the benefits and drawbacks of catheters versus urethral stents will be discussed in detail. The problems of recurrent intractable hematuria and paraneoplastic syndromes (PNSs) will be addressed as they greatly affect quality of life by requiring repeat hospital admissions.