Petros Perimenis - Academia.edu (original) (raw)

Papers by Petros Perimenis

Urology journal, 2013

To evaluate the epidemiological, clinical and pathological parameters that may predict the presen... more To evaluate the epidemiological, clinical and pathological parameters that may predict the presence of positive surgical margins and extraprostatic disease in patients with low risk [prostate specific antigen (PSA) < 10, and Gleason score ≤ 6, stage T1c)] prostate cancer. We retrospectively analyzed the medical records of patients who had undergone radical prostatectomy from January 2005 until January 2011. The analysis comprised patients age, preoperative serum prostate specific antigen (PSA) level, prostate volume, PSA density, biopsy Gleason score, the presence of bilateral disease according to the results of biopsy cores analysis, the percentage of cancer in biopsy material and the presence of high grade prostatic intraepithelial neoplasia. A total of 117 patients were included in the study. Positive surgical margins were found in 37 (31.6%) patients and 23 (19.7%) had advanced disease. The results of the multivariate analysis showed that bilateral disease was the single sign...

International urology and nephrology, 2002

We report our experience with two cases of late migration of the suture and bolster occurring 2 y... more We report our experience with two cases of late migration of the suture and bolster occurring 2 years after a modified Stamey endoscopic bladder neck suspension. Delayed migration of the suture and bolster after an endoscopic bladder neck suspension across tissue planes, with subsequent erosion into the bladder, is uncommon. Recurrent urinary tract infection and mild suprapubic discomfort were the only symptoms. Cystoscopy was the only helpful diagnostic tool and should be considered early in the evaluation of this kind of patients. The mechanism of migration of the cuff and the operative technique are discussed.

Urology, 2002

To evaluate the influence of two differently acting antiandrogens, finasteride (FIN) and cyproter... more To evaluate the influence of two differently acting antiandrogens, finasteride (FIN) and cyproterone acetate (CPA), on the natural history of hematuria associated with benign prostatic hyperplasia (BPH) in a prospective, randomized, controlled study. Forty-two patients with hematuria episodes due to BPH were randomly allocated to three subgroups of 14 patients each and treated daily with either 5 mg FIN or 100 mg CPA or were placed in a watchful waiting arm. Patients were evaluated at 3-month intervals, and 40 patients had at least 1 year of follow-up. Four patients in the FIN group (30%) and three in the CPA group (23%) presented with recurrent hematuria. In both groups, the bleeding episodes were treated conservatively and required no hospitalization. In the control group, 8 patients (57%) presented with recurrent bleeding; in 4, the bleeding was severe and required some form of intervention (catheterization or transurethral prostatectomy). When the frequency and severity of the h...

Expert Opinion on Medical Diagnostics, 2008

Early diagnosis of bladder cancer is mandatory, as a delay in treatment has been shown to affect ... more Early diagnosis of bladder cancer is mandatory, as a delay in treatment has been shown to affect prognosis. The current diagnostic standard of cystoscopy and cytology is costly, invasive and inconvenient, whereas advances in molecular biology have resulted in the evolvement of several markers. To review diagnostic considerations in the use of old and new technical modalities and tests for the detection of bladder cancer. A PubMed search of the literature concerning bladder cancer diagnosis was performed. Reviews are included on certain topics to avoid extensive reference to separate studies. Recent technical advances have an impact on the management of patients with suspected bladder cancer. Cytology is still an important adjunct in the diagnostic work-up, whereas urine-bound tests may have a role in screening and surveillance. However, cystoscopy is the standard of care for the detection of bladder cancer. Fluorescence cystoscopy is an adjunctive tool, especially for the prompt identification of carcinoma in situ.

Urology, 2014

To evaluate the impact of early hospital admission and onset of medical expulsive therapy (MET) i... more To evaluate the impact of early hospital admission and onset of medical expulsive therapy (MET) in spontaneous passage of ureteral stones causing renal colic. We recruited 392 patients referred to the emergency room with symptoms of renal colic. All patients received standard MET of oral tamsulosin 0.4 mg at the time of diagnosis. In group A, patients who received MET in &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;2 hours from the symptom onset were included, whereas group B consisted of patients treated in &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;2 hours. The association of MET onset and stone-free rates after 6 weeks of follow-up was evaluated. Early MET onset predictive impact on spontaneous stone passage was evaluated as well. The stone-free rate in group A and B patients was 71.2% and 59.7% (P=.018), respectively. A significant association was observed between spontaneous calculus elimination and stone size (P≤.001), location within the ureter (P=.007), and the interval between pain onset and pharmaceutical management (P=.018). Patients who received a late-onset MET had an increased risk to develop febrile upper urinary tract infection during the follow-up period (P=.040). In the multivariate analysis, size (P≤.001) and early therapy onset (P=.019) were statistically important predictors for stone-free status after the surveillance period. Patients with renal colic who admitted to the emergency department earlier since symptom onset may have increased potential to be stone free during the surveillance period.

The Journal of Urology, 2007

We report our long-term experience with the management of benign ureteroileal anastomotic strictu... more We report our long-term experience with the management of benign ureteroileal anastomotic strictures using self-expandable metal stents. Materials and Methods: A total of 16 male and 2 female patients with a mean Ϯ SD age of 72 Ϯ 7 years (range 66 to 78) with benign fibrotic strictures at the site of ureteroileal anastomosis underwent implantation of self-expandable metal stents with a nominal diameter of 6 to 8 mm. A total of 24 ureteroileal conduits were treated. The external nephrostomy tubes were removed after fluoroscopic validation of ureteral patency. Patients were followed with blood biochemistry, ultrasonography, urography and/or virtual endoscopy. Retrograde external-internal catheter insertion through the cutaneous stoma was performed in cases of recalcitrant stricture. Results: The technical success rate of ureteroileal stricture crossing and stenting was 100% (24 of 24 cases). Mean followup was 21 months (range 7 to 50). The clinical success rate during the immediate post-stenting period was 70.8% (17 of 24 cases). The 1 and 4-year primary patency rates were 37.8% and 22.7%, respectively. Secondary interventions included repeat balloon dilation in 15 ureters, of which 8 also underwent subsequent coaxial stent placement. The 1 and 4-year secondary patency rates were 64.8% and 56.7%, respectively. Except in 2 patients who died external-internal Double-J® catheters continued to be inserted retrograde in 6 ureteroileal conduits. They are periodically exchanged to prevent mucous inspissation and stent encrustation. Conclusions: Metal stents served as the definitive treatment for stricture in more than half of the cases, whereas in the remainder the stents allowed the uncomplicated and regular exchange of Double-J catheters in retrograde fashion. This combined, less invasive treatment for ureteroileal anastomotic strictures may help patients avoid surgical revision and preserve quality of life.

Journal of Endourology, 2006

We report a case of laparoscopic management of a primary malignant melanoma of the left adrenal g... more We report a case of laparoscopic management of a primary malignant melanoma of the left adrenal gland. A 42-year-old male presented a 55 x 60-mm round, inhomogeneous, noninvasive mass of the left adrenal gland. Hormone-activity values were within normal range. The mass was removed laparoscopically en bloc along with the left adrenal gland, and its histopathologic evaluation was consistent with the features of a malignant melanocytic tumor. Postoperatively, the patient presented no signs of fever or remarkable blood loss and was discharged on the third day in good clinical condition. He is free of disease 1 year later.

International Urology and Nephrology, 2000

To examine histological nature and clinical process of ureteral carcinosarcomas. We report on a n... more To examine histological nature and clinical process of ureteral carcinosarcomas. We report on a new case of carcinosarcoma of the ureter. The literature was reviewed and histological and clinical features were elucidated. Fourteen cases of ureteral carcinosarcomas have been reported. The nomenclature used for these tumors either in the pathology reports or in literature is confusing. In contrary to obscure tumor biology, prognosis was clearly bad as the majority of the patients died within 2 years after diagnosis. Terminology confusion is due to the rarity of this entity and lack of its biology knowledge. Patients present after the age of 60 with hematuria and obstruction. Nephroureterectomy is the only hope of cure but, due to tumor aggressiveness, recurrences occur almost always and prognosis is poor.

International Urology and Nephrology, 2006

We present a new case of leiomyosarcoma, a very rare clinical entity, arising from the renal pelv... more We present a new case of leiomyosarcoma, a very rare clinical entity, arising from the renal pelvis. The primary diagnosis, based on asymptomatic gross hematuria and imaging findings, was tumor of the left kidney. After a left radical nephro-ureterectomy, histology confirmed a leiomyosarcoma of the renal pelvis. No adjuvant treatment was provided and the patient remains healthy 3 years after surgery. Figure 3. Tumor cells in well-differentiated areas were strongly positive for desmin and smooth muscle actin (200Â).

International Urology and Nephrology, 2007

International Journal of Impotence Research, 2004

The aim of this study was to compare the efficacy of sildenafil and continuous positive airway pr... more The aim of this study was to compare the efficacy of sildenafil and continuous positive airway pressure (CPAP) in men with erectile dysfunction (ED) and obstructive sleep apnea syndrome (OSAS). In all, 30 men were randomly treated for 12 weeks either with sildenafil 100 mg before intercourse (15 men) or CPAP during night time sleep (15 men). Under sildenafil, 97/180 (53.9%) of attempted intercourses were successful compared to 33/138 (23.9%) under CPAP. The mean IIEF (erectile function domain score) was 12.9 and 9.3 after sildenafil and CPAP treatment, respectively (P=0.007), compared to 7.9 and 7 at baseline. In all, 53.3% of patients were satisfied with sildenafil and 20% with CPAP for ED treatment (P=0.058). Although sildenafil was superior to CPAP, comorbidities and OSAS per se possibly resulted in a lower effectiveness of sildenafil compared to that in the general population of ED men. While about half of the patients were not satisfied even with the more effective treatment, we conclude that a combination of the two therapeutic tools or a different therapeutic mode should be studied further.

European Urology, 2002

Objective: The purpose of the present study was to evaluate the use of externally coated stents i... more Objective: The purpose of the present study was to evaluate the use of externally coated stents in patients with malignant ureteral obstruction. Materials and Methods: We have prospectively evaluated 16 patients, 10 men and 6 women, with malignant ureteral obstruction treated successfully by placement of Passager metal stents (Boston Scienti®c, Natick, MA, USA) bypassing the stricture. Mean patient age was 65.6 years (range 62±78 years). Ureteral patency was con®rmed 24 and 48 hours by injection of contrast material through the nephrostomy tube, and after patency con®rmation the nephrostomy catheter was removed. Results: All stents were positioned successfully, and the postoperative course was uneventful. In 13 cases (81.2%) the prostheses ®nally migrated into the bladder hindering overall ureteral patency (mean time of migration: 1.5 months). Patency was achieved in the remaining ureters (n 3), during the follow-up period (mean: 8 months, range 6±16 months), without any need for further intervention. Conclusion: The inappropriate anchorage and the increased ureteral peristalsis are the main causes of migration towards the bladder, thus, minimizing the usefulness of this stent for the treatment of ureteral strictures. #