bluuebunny/crossref_metadata_2025 huggingface dataset:
Fournier's gangrene: our experience of 10 cases
Authors: Rahmati M. , Sarti A. , Rubilotta E. , Chierigo P. , Lazzarotto M. , Franzolin N.
Published: June 2018

Fournier's gangrene, described for the first time by Alfred Jean Fournier in 1883, is a very uncommon disease.

It is characterized by an acute process of cellulites and necrotizing fasciitis of the external genitalia, perineum and abdominal wall; its mortality rate is about 30–50%.

We retrospectively reviewed 10 patients affected by Fournier's gangrene admitted to our Department of Urology from 1997 to 2006. At a mean follow-up of 37 months (range 0–108) 7 patients are alive and disease free, 1 patient is alive bearing the signs of the gangrene, and 2 patients died because of the disease complications.

We have noted that patients’ survival depends on early intervention and extremely aggressive approach. The combination of these factors with antibiotic therapy and supportive care have made this disease treatable and curable.
Scritti in ricordo del Professor Giorgio Ravasini nel quindicesimo anniversario della Sua scomparsa
Authors: Anselmo Giuseppe
Published: June 2018

Il 1 dicembre 2007 si è tenuto a Treviso il 61° Convegno dell'Associazione Triveneta di Urologia in onore del Professor Giorgio Ravasini nel XV anniversario della Sua scomparsa per iniziativa di un gruppo di allievi, fra cui i Direttori di questa Rivista fanno parte, e che si fanno portavoce nel ringraziare Guglielmo Breda, Presidente dell'Associazione Triveneta, per aver accettato la proposta di ospitare questa iniziativa nell'ambito dell'Associazione, e Luigi Maccatrozzo, Presidente e organizzatore del Convegno, per avervi aderito con entusiasmo e disponibilità, modificando un precedente programma scientifico.

Abbiamo pensato di pubblicare su Urologia i testi degli interventi fatti da alcuni relatori su “I diversi aspetti delle neoplasie vescicali”, tema caro al Professor Ravasini e per questo scelto come filo conduttore del Convegno.

Sergio Cosciani Cunico Antonino Lembo
Intravesical Electromotive Drug Administration® (EMDA) with Mitomycin-C for non-muscle invasive bladder cancer
Authors: Di Stasi S.M. , Dutto L. , Verri C.
Published: June 2018

Electromotive Drug Administration® (EMDA) offers a means of controlling and enhancing the tissue transport of certain drugs, when applied to a surface epithelium, where they have a local therapeutic effect, in order to increase their efficacy. One application option is the treatment of non-muscle invasive bladder cancer with intravesical mitomycin-C (MMC). Laboratory studies demonstrated that EMDA/MMC can reduce the variability and enhance the drug administration rate into all layers of the bladder wall, and that the applied electric current causes no histological damage to tissue and no chemical modification of MMC. A prospective randomized study, performed in patients with in situ carcinoma, validated the prediction that electromotive enhancement of MMC delivery would provide results superior to those achieved using passive MMC transport. A further randomized study in patients with pT1 bladder cancer demonstrated that a regimen combining intravesical BCG and EMDA/MMC increased the disease-free interval and reduced the recurrence rate, as well as the disease progression and mortality rate if compared with BCG alone. The possibility that BCG may enhance the efficacy of MMC against high-grade pT1 transitional cell carcinoma and in situ carcinoma represents an important new therapeutic perspective in the high-risk non-muscle invasive bladder cancer.
Contrast Media in Urogenital Radiology
Authors: Foschi N. , Totaro A. , Brescia A. , Gulino G. , Bassi P.F.
Published: June 2018

Background

Contrast media are widely used in urogenital radiology. The ideal contrast agent should be totally inert, causing no interactions with organism, and with a rapid and complete excretion. Adverse reactions could occur after using any type of contrast media. Contrast enhanced procedures are performed with increasing frequency and the patients population is progressively older and with multiple co-morbid conditions, thus contrast media toxicity is becoming a serious problem. Contrast media-induced nephropathy (CIN) is considered an important cause of hospital-acquired renal failure. The administration of gadolinium-based contrast agents has been recently associated with the development of a serious adverse reaction, potentially lethal in patients with renal insufficiency, named nephrogenic systemic fibrosis (NSF).

Methods

Literature review on contrast media in urogenital radiology, CIN, NSF.

Conclusions

Since 1996, the Contrast Media Safety Committee of the European Society of Urogenital Radiology (ESUR) has released its guidelines regarding safety about the use of contrast media. CIN, and the emerging NSF, are topics of increasing interest for urologists, radiologists, nephrologists, dermatologists and all the clinicians. Contrast media have progressively become safer in the last years. Even if rare, some adverse reactions still occurr up to now. CIN and its prevention remain an issue under debate. In the past, whenever a patient required a contrast-enhanced imaging study, the trend was to select magnetic resonance imaging with gadolinium-based contrast agents in order to avoid the well-known CIN of iodinated-based contrast agents. The awareness of NFS is changing the contrast–enhanced imaging in patients with renal failure. At present we have to investigate NSF etiopathogenesis, in order to prevent and eventually to cure it. The understanding of the risk factors for both CIN and NSF is an emerging need, the adoption of all preventive measures to reduce the risks remain a mandatory issue.
Management, and Prevention, of Intravesical Therapy Complications
Authors: Serretta V.
Published: June 2018

The urologist must prevent, identify and properly treat the complications of intravesical chemotherapy and immunotherapy. Both local and systemic toxicity of adjuvant intravesical therapy is herein analyzed. Topical toxicity is mainly due to the inflammation induced by the contact between the instilled agent and the bladder mucosa.

Material and Methods

The factors predisposing to topical toxicity must be identified and removed before starting the treatment. The choice of the agent, its dose, concentration and dosage must be tailored, whenever possible, to the presence of the above mentioned factors. Mitomycin and BCG can rarely provoke chronic cystitis, severely compromising bladder function.

Results

The most dangerous complication of early intravesical chemotherapy is the instillation in presence of an unrecognized bladder perforation. Flu-like syndrome, fever, chills, arthralgia are reported in almost 20% of patients receiving BCG. If fever persists for more than 48 hours or exceeds 38.5 °C, isoniazid must be administered and BCG stopped until complete remission. BCG sepsis is a rare but severe complication that must be promptly recognized and treated. If not, a life-threatening multi-organ failure syndrome can arise. Isoniazid and rifampicin, adding ethambutol when required, must be administered for a prolonged period until complete remission.

Conclusions

Granulomatous lesions represent the main other rare systemic complications of BCG therapy. Systemic toxicity of intravesical chemotherapy is rare, due to the high molecular weight of the drugs, limiting systemic absorption.
Living Donor Nephrectomy: Open versus Laparoscopic Technique
Authors: Franceschin M. , Capocasale E. , Valle DALLA R. , Mazzoni M.P. , Busi N. , Sianesi M.
Published: June 2018

Background

The living donor nephrectomy has to be safe and effective, allowing a good graft function in the recipient. In the past, donor nephrectomy was performed only by open technique; more recently this nephrectomy has also been performed by laparoscopic technique. The best technique has not been established in literature. The purpose of this study is to report the results of open and laparoscopic nephrectomy in living donors.

Materials and Methods

From January 1992 to August 2008, 37 living donor nephrectomies were performed. 23 nephrectomies were achieved by laparoscopic procedure (LDN) and 14 by open technique (ODN). The 2 groups were comparable regarding both donor and recipient characteristics.

Results

All laparoscopic nephrectomies were successfully performed without conversion to open procedure. No donor deaths were reported in either groups. 3 complications (13%) in the LDN group and 1 (7.1%) in the ODN group (p=0.6) were observed. Mean operative time was higher in the LDN group (p<0.036). Mean warm and cold ischemia time, resumption of oral intake and hospital stay were shorter in the LDN group (p<0.04)(p<0.03) (p<0.0001), whereas the return to normal occupational life was similar (p<0.52). We had no significant differences in the surgical complication rates, graft and patient survival.

Conclusions

Our experience suggests that both procedures can be used safely and efficiently, and assure a good renal function in the recipient. Laparoscopic nephrectomy, although more difficult, provides post-operative advantages. However, laparoscopic procedure must be performed by experienced centres only to prevent serious complications in the donor.
Bulking Agents: Anesthesia Techniques
Authors: Cerruto M.A. , Zattoni F.
Published: June 2018

Bulking therapy for the minimally invasive treatment of stress urinary incontinence (SUI) may be offered to women with urodynamic SUI, wishing to avoid the complications associated with more invasive surgery, on the basis of low operative morbidity and low long-term success rates. These bulking agents may be injected by a retrograde or antegrade technique in the periurethral tissue around the bladder neck and proximal urethra. This therapy is strongly dependent on the anesthetic technique of choice; moreover its application as an outpatient procedure implies the potential for a cost-effective treatment for selected patients with SUI. In the present paper all factors affecting the choice of different types of anesthetic techniques are discussed.
Conservation of Erectile Function following Brachytherapy for Low-Risk Prostate Cancer
Authors: Giberti C. , Rosso G. , Gallo F. , Chiono L. , Gastaldi E. , Ninotta G.
Published: June 2018

Brachytherapy (BT) is an effective option to treat low-risk prostate cancer (CaP). While oncological results are consistent with those reported following radical retropubic prostatectomy (RRP), attention may be given to the advantages in terms of functional results that a less invasive approach can ensure.

The aim of this study is to assess the impact of the conservation of erectile function (EF) in patients who underwent BT with a short and medium term follow-up.

Materials and Methods

Between May 1999 and January 2005, 170 patients underwent BT for low-risk CaP (intracapsular prostate cancer, PSA, 10 ng/mL, Gleason score, 6). Among them, 58 patients (average age 65.6) with good preoperative erectile function (IIEF>22) and a minimum follow-up of 5 years were selected. The results were evaluated by comparing the values of pre- and postoperative IIEF questionnaire at 3 months, 1 and 5 years of medium follow-up.

Results

At a mean 3-month follow-up, a spontaneous recovery of EF (IIEF> 17), strongly influenced by urinary irritative disorders, was reported by 34/58 patients (58%). At 1 and 5 years, good EF (IIEF >22) was reported by 45/58 (78%) and 39/58 (68%) patients, respectively.

Discussion and Conclusions

The recovery of EF was good one year after BT (78%). Urinary disorders are a significant limiting factor on this recovery. The deterioration of EF during the follow-up, which was already described in literature, is due not only to ageing but also to a delayed radioactive effect on pelvic structures.
Second-Line Intravesical Gemcitabine in High Risk Superficial Bladder Cancer: Our Experience
Authors: Aloisi A. , Ruggera L. , Beltrami P. , Cerruto M.A. , Zattoni F.
Published: June 2018

Purpose

Intravesical instillation of Gemcitabine may represent a useful second-line chemotherapy in case of non-muscle-invasive bladder cancer. Herein, we reported our experience with intravesical Gemcitabine in a group of patients affected by high-grade transitional cell carcinoma (TCC) of the bladder.

Materials and Methods

We retrospectively analyzed a total of 17 patients (15 males and 2 females), affected by high-risk superficial bladder cancer, who were refractory, intolerant or not eligible to intravesical BCG immunotherapy. Each patient received 2000 mg of Gemcitabine diluted in 100 mL of 0.9% saline solution, administered twice a week for 6 weeks. At start, TCC stage and grade were: CIS in 10 patients, TaG3 in 5 and T1G3 in the remaining 2 cases. Those with no macroscopic lesion and negative cytology and histology were considered as complete responders; those with only positive cytology as partial responders, and those with positive biopsy or evidence of macroscopic lesions as non-responders.

Results

Patients’ mean age was 71.5 yrs (± 7.3 yrs standard deviation). Overall, median follow-up was 12 months [interquartile range (IQR) 9–15 months]. A complete remission was achieved in 10 cases (58.8%), a partial response in 2 (11.8%), while 5 patients (29.4%) were considered as non-responders. Tumor stage and/or grade progression was observed in 26.7% of the cases. Overall, the 6-month recurrence-free survival was 33.3%. Drug toxicity was relatively low: 2 patients developed a grade II dysuria (NCI-CTC criteria); fever >38° was observed in 1 case.

Conclusions

Although our experience and follow-up are still rather limited to formulate any conclusive assessment, our study seems to confirm that Gemcitabine could be used as a safe and efficient intravesical chemotherapy agent even in high grade TCCs, representing a promising second-line option in those cases who failed, were intolerant or not eligible to BCG therapy. (Urologia 2009; 76: 178–84)
X-Ray Diffraction Study on Human Male Reproductive Tract and Semen
Authors: Skandhan K.P. , Amith S. , Avni K.P.S.
Published: June 2018

In the present study authors had separated testis, epididymis-caput, corpus, cauda, vas deferens, seminal vesicle, prostate gland and bulbourethral gland from human male reproductive tract, made it to ash form. Semen also underwent same procedure. All samples had undergone X-ray diffraction analysis.

Results

Results showed there where two distinct rings for each sample. We named it is “A” &” B”. Under “A” Barium silicate, Barium silicate hydrate and three metal complexes of copper, gold and zinc were seen. Under “B” Calcium silicate and calcium silicate hydrate were observed. Both “A” and “B” were seen throughout the length (expect for “A” is seminal vesicle) and in semen.

Conclusions

A tri metal complex of copper, gold and zinc is reported in this study, is first of its kind in Biology.
Positioning of a Malleable Penile Prosthesis. Solving an Intraoperative Complication
Authors: Pavone C. , Coraci G. , Karydi M. , Scarcella A. , Melloni C. , Melloni D.
Published: June 2018

We report a technique for the solution of an intraoperative complication occurred during penile prosthetic surgery.

Materials and Methods

A 70-year-old patient underwent open radical retropubic prostatectomy in 2004 due to a prostate cancer - Gleason 6 (3+3) pT2N0M0. The erectile dysfunction subsequently observed was not responsive to oral or intracavernosal drug administration, so a malleable penile implant surgery was recommended.

Results

During the positioning of the left penile cylinder, a septum perforation (cross-over) occurred. Instead of interrupting and postpone surgery in order to allow the septum to recover, we decided to proceed utilizing our technique for a safe positioning of the implants. As far as we know, this is the first detailed report on the technique.

Conclusions

Septum perforation during a penile prosthesis implant does not represent an absolute contraindication to terminating surgery. Our technique allows a safe placing of the cylinders after septum perforation with optimal functional and aesthetic results at long-term follow-up.
Painful Ejaculation: A Review
Authors: Pescatori E.S. , Farina F. Pirozzi
Published: June 2018

Background

Pain at ejaculation/orgasm perceived in perineum, urethra and/or urethral meatus, has a profound impact on the quality of life of the affected man. Although underestimated, this condition is reported to have a 1–9.7% prevalence over the general population.

Methods

Structured review of the relevant available literature.

Results

Among the main causes of pain experienced at ejaculation/orgasm are: prostatevesicular causes (LUTS/BPH, prostatitis, ejaculatory duct obstruction, vesicular stone), postsurgical causes (radical prostatectomy, inguinal hernioplasty), pharmacologic causes (antidepressants), psychogenic causes (psychosexual conflicts, sexual abuse), rare causes. For these pathologies, diagnostic and therapeutic strategies have been proposed.

Conclusions

Ejaculatory pain is associated with a high level of personal distress, and represents a possible request for help within the andrologic/urologic area. Each field specialist should be competent in correctly interpreting every single case, in order to manage it appropriately.
4 Hands/4 Ports Laparoscopic Radical Prostatectomy
Authors: Aliberti M. , Bianchetti G. , Ferraris C. , Raineri F. , Vottero M. , De Zan A.
Published: June 2018

Introduction

Radical laparoscopic prostatectomy is a challenging procedure, which requires a steep learning curve and involves normally three operators. Consequently this is an expensive procedure due both to the time spent for surgery in the operating theatre and the number of operators involved. But time consumption and consequently money costs can be reduced thanks to the learning curve enhancement and, moreover, by reducing the number of operators involved. This work is based on the idea of performing laparoscopic prostatectomy with two operators only.

Material and Methods

Our cases are 124 radical laparoscopic prostatectomies, performed from January 2004 until April 2009; of these, 13 non-consecutive, were carried out with 2 operators and 4 ports. The first attempt - not totally successful due to time spent in the operating theatre and to some operational difficulty - was carried out as 60th procedure (learning curve was not complete). Once the method was applied as 103rd procedure, it could then be constantly implemented.

Results

We demonstrate that this option is feasible once the team performing the laparoscopic radical prostatectomy has acquired a good level in the learning curve. The outcomes are very interesting with regard to time consumption (205’ minutes: one minute more than the 3 operators/5 ports procedure) and early oncological and functional results.
The LESS (Laparo-Endoscopic Single-Site) Procedure in Urology. Technical and Clinical Aspects
Authors: Neri F. , Cindolo L. , Gidaro S. , Schips L.
Published: June 2018

Background

Minimally invasive urology is rapidly advancing, and single-site laparoscopic surgery is being explored clinically. Such laparoscopic procedures are technically challenging and require an experienced laparoscopic surgeon due to the lack of port placement triangulation and instrument clashing.

Methods

In the last years several surgeons all over the world have explored the feasibility and safety of LESS using several and different ports, approaches and devices. Hundereds of procedures have been described with overall favorauble intraoperative and postoperative outcomes.

Results

Our experience consists of more than 30 procedures successifully completed for adrenal, kidney disease and varicocele.

Conclusions

To date, LESS could be considered feasible and effective using currently available devices, however it is to be considered as an initial status technique requiring further confirmatory studies and advanced laparoscopic skills.
Sexual Dysfunctions in Female with Neurological Disorders
Authors: Mazzariol C. , Di Tonno F. , Piazza N. , Pianon C.
Published: June 2018

Female sexuality is a controversial issue due to its embarrassment and to paucity of literature publications. The neuroanatomy and neuromediators involved in female sexuality are important but not so fundamental as in men. There are three sexual female dysfunctions (SFD): primary, secondary, tertiary. In the primary one, the sexual dysfunction (SD) is correlated to the neurological disease, in the secondary the SD derives from the symptoms of the neurological disease, in the tertiary the SD is the psychological reaction to the effects of the disease. We analyse the FSD in neurological diseases, as the outcome of medulla trauma, multiple sclerosis, epilepsy, Alzheimer, Parkinson, diabetes, outcome of pelvic surgery. Female sexuality (FS) is difficult and complex compared to male sexuality. Women with medulla lesion feel some discomfort when having to go and speak to their doctor: they are afraid of pregnancy, sexual intercourses, bladder and rectal functions. In women with newly diagnosed multiple sclerosis, there is a tertiary sexual dysfunction. Medical therapy worsens female sexuality as in case of epilepsy. Emotional and behavioural disorders involve sexual dysfunctions in women with Alzheimer. In Parkinson, reduction of sexual desire involves break of sexual intercourses. SD are more frequent in complicated diabetes. In pelvic surgery, pelvic autonomic dysfunction and depression correlated to the oncology disease, contribute to the FSD. Sexual counselling, especially in young women with medulla lesion or multiple sclerosis, is the best therapy, and learning erotic extragenital areas able to make sensations similar to the orgasms.
Retroperitoneal Surgery in the Treatment of Germ-Cell Tumors of the Testis: Retroperitoneal Lymph Node Dissection (RPLND)
Authors: Nicolai N. , Necchi A. , Piva L , Stagni S. , Catanzaro M.A. , Biasoni D. , Milani A. , Torelli T. , Salvioni R.
Published: June 2018

Germ-cell tumors of the testis (GCTT) are rare, but have a high social impact. In fact they represent no more than 1% of male tumors (about 700 new cases per year in Italy), but electively occur in young patients, 20 to 40 years old, during their fully mature social and working life. More than 80% of patients are cured and return to a normal social, sexual, and working life. Improvements achieved both in diagnosis, with the use of scans (CT, MRI, US and recently PET) and of serum tumor markers alpha-fetoprotein (AFP), beta-fraction of human chorionic gonadotropin (β-HCG) and lactate dehydrogenase (LDH), and mainly in treatment, through the amelioration of radiotherapy and surgical techniques and, especially, with the introduction of Cisplatin, Etoposide and Ifosfamide in Chemotherapic regimens, have made germ-cell tumor a model of “curable disease”. Retroperitoneal lymph node dissection (RPLND) has indications in patients with clinical stage I (CS1) as well as in advanced disease, where it is integrated in the multimodality treatment. Anatomical studies, as well as a long-term experience, have gradually but consistently modified the surgical techniques of RPLND. Currently, “nerve sparing” RPLND represents a safe management of CS1 nonseminomatous germ cell testicular tumor with minimal morbidity and excellent outcomes. Nonetheless, surveillance and adjuvant chemotherapy are as effective as RPLND, but, in our opinion, associated with some discomforts for the patients. Laparoscopic retroperitoneal lymph node dissection (Lap-RPLND) is gaining popularity as a minimally invasive staging procedure for clinical stage I nonseminomatous testicular carcinoma, but its therapeutic role is still under investigation.
Doping and Urologic Tumors
Authors: Pinto F. , Sacco E. , Volpe A. , Gardi M. , Totaro A. , Calamo A. , Racioppi M. , Gulino G. , D'Addessi A. , Bassi P.F.
Published: June 2018

Several substances such as growth hormone (GH), erythropoietin (Epo), and anabolic steroids (AS) are improperly utilized to increase the performance of athletes. Evaluating the potential cancer risk associated with doping agents is difficult since these drugs are often used at very high doses and in combination with other licit or illicit drugs.

The GH, via its mediator, the insulin-like growth factor 1 (IGF-1), is involved in the development and progression of cancer. Animal studies suggested that high levels of GH/IGF-1 increase progression of androgen-independent prostate cancer. Clinical data regarding prostate cancer are mostly based on epidemiological studies or indirect data such as IGF-1 high levels in patients with prostate cancer. Even if experimental studies showed a correlation between Epo and cancer, no clinical data are currently available on cancer development related to Epo as a doping agent. Androgens are involved in prostate carcinogenesis modulating genes that regulate cell proliferation, apoptosis and angiogenesis. Most information on AS is anecdotal (case reports on prostate, kidney and testicular cancers). Prospective epidemiologic studies failed to support the hypothesis that circulating androgens are positively associated with prostate cancer risk.

Currently, clinical and epidemiological studies supporting association between doping and urological neoplasias are not available. Nowadays, exposure to doping agents starts more prematurely with a consequent longer exposition period; drugs are often used at very high doses and in combination with other licit or illicit drugs. Due to all these elements it is impossible to predict all the side effects, including cancer; more detailed studies are therefore necessary.
Prostatitis Syndromes and Sporting Activities
Authors: Sacco E. , Totaro A. , Marangi F. , Pinto F. , Racioppi M. , Gulino G. , Volpe A. , Gardi M. , Bassi P.F.
Published: June 2018

Introduction

Prostatitis-like syndromes are high prevalent health problems and frequently considered by patients and physicians as strictly correlated to sports causing perineal compression. These syndromes and their relationships with sporting activities have been discussed in this report.

Methods

We reviewed peer-reviewed scientific articles published by May 2009 and searched according to the following term selection: prostatitis, pudendal nerve, sport, cycling.

Results

Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a major healthcare burden heavily affecting patients’ Quality of Life. No clear evidence of any direct etiologic relationship has been found in literature between prostatitis, either bacterial or non-bacterial, and sports activities. On the other hand, some types of sport causing perineal compression, such as cycling, can exacerbate symptoms of acute and chronic prostatitis; a temporary sport discontinuation is justified in these patients. CP/CPPS may be often caused by pudendal nerve entrapment (PNE). Prostatitis-like urogenital neuropathic pain together with voiding and sexual dysfunctions are the hallmark of PNE. A common feature is that flexion activities of the hip, such as climbing, squatting, cycling provoke or worsen urogenital pain or pelvic pain. Many of the patients with PNE are cyclists, played American football, lifted weights, or wrestled as teenagers and young adults. PNE represents the most common bicycling associated urogenital problems.

Conclusions

Overall, studies show that no causal relationship has been demonstrated between prostatitis and sporting activities. Conversely, urologists should be aware that sports involving vigorous hip flexion activities or prolonged perineal compression are a potential and not an infrequent cause of uroand rological symptoms caused by pudendal nerve entrapment.
Article
Authors: Di Tonno F. , Mazzariol C. , Piazza N. , Murer B.
Published: June 2018

A 25-year-old man from Bangla Desh with acute right scrotal pain was subjected to scrotal surgical exploration because of the suspicion of testicular torsion. The testicle appeared normally positioned; an epididymal nodule was removed, and pathology showed the presence of the filaria worm.

Filariasis is a tropical disease which has been estimated to affect 120 millions people throughout the world. Lymphadenitis and lymphangitis are the more common clinical settings; in men, there is a frequent scrotal involvement. In some cases, acute scrotal pain may lead to the suspicion of testicular torsion.

The observation of patients with genital filariasis is likely to become more frequent in an era of massive immigration from different countries; nowadays, the disease should always be taken into consideration in the differential diagnosis in patients with acute scrotal pain coming from tropical areas.
Correlation between pathologic features and perfusion CT of renal cancer: A feasibility study
Authors: Gigli Francesca , Zattoni Fabio , Zamboni Giulia , Valotto Claudio , Bernardin Livia , Mucelli Roberto Pozzi , Zattoni Filiberto
Published: June 2018

Objectives

The computerized tomography with perfusion technique (pCT) has proved to have some potentialities in the oncologic field as a possible tool to identify neoangiogenesis in vivo. The purpose of the present job is to test the correlations existing between perfusion data and pathologic features in the evaluation of vascularization in kidney cancer.

Methods

6 patients with clinical diagnosis of renal tumor awaiting surgical treatment underwent preoperatively pCT scans. Axial images encompassing the greatest diameter of the cancer were compared with the respective histological sections.

Results

A correlation between tumor histological subtype and perfusion index was observed and shown. Moreover, clear cell RCC of different Fuhrman grades showed statistically significant differences in perfusion values (T test). Specifically, high perfusion indexes were associated with high density of microvessels with abnormal architecture at the microscopic evaluation of tumor specimen. Conversely, lower perfusion index were detected in tumors with lower microvascular density.

Conclusions

pCT scans can provide significant data on tumor angiogenesis and, eventually, suggest tumor histological subtype. The possibility of identifying preoperatively tumor histotype can be of particular relevance in patients with small renal tumors, suitable for minimally-invasive surgery or active surveillance program.
Continuing evolution of statistical tests in medical research
Authors: Totaro Angelo , Volpe Andrea , Sacco Emilio , Pinto Francesco , Palma Monica , Bassi Pierfrancesco
Published: June 2018

The role of statistics in medical research starts at the planning stage of a clinical trial or laboratory experiment to establish the design and size of an experiment that will ensure a good prospect of detecting effects of clinical or scientific interest. Statistics is again used during data analysis (sample data) to make inferences valid in a wider population. In simple situations, computation of simple quantities such as P-values, confidence intervals, standard deviations, standard errors or application of some standard parametric or nonparametric tests may suffice. Moreover, despite the wide use of statistics in medical research, simple notions are sometimes misunderstood or misinterpreted by medical research workers, who have only a limited knowledge of statistics.

This article, written for non-statisticians, is to explain what are the most common statistical tests used today in the field of medical research, tracing the evolution of statistical tests over time, in particular the introduction of nonparametric methods and, more recently, the NonParametric Combination (NPC) methodology. At the same time, this work seeks to identify some of the errors associated with their use, that often lead to an incorrect assessment and interpretation of results of medical research.
VISPA's group (evaluation of the implementation Strategies of the Measurements Instruments Adopted in the Italian nursing Practice)
Authors: Palese A. , Mecugni S. , Barbieri M. , Bonocore M. , Buscaroli A. , Carpanoni M. , Colognese S. , Costi D. , Di Vaio S. , Lapi L. , Lionte G. , Nasi Am. , Pellicolari C. , Quartieri M. , Ricci R. , Saguatti K. , Saragoni M. , Tarantola S. , Torri E. , Vaccari S. , Volpi P , Vinceti M.
Published: June 2018

An innovative teaching strategy focused on problem based approach rather than theorical aiming to facilitate the learning of the research methodology in advanced nursing student has been introduced. Through out a qualitative evaluation of the diary kept by the student nurses involved, advantages and disadvantages of this innovative approach have been evaluated. This paper reports a synthesis of the teaching strategy and its impact on the competences in the research methodology as it has been perceived by the students participants.
Nefropessi Retroperitoneoscopica
Authors: Buffardi A. , Ceruti C. , Destetan P. , Ruffino M.A. , Bosio A. , Bisconti A. , De Maria C. , Negro C. , Carchedi M. , Fontana D.
Published: June 2018

Introduction

Nephroptosis has been defined as renal descent of 5 or more cm on orthostasis. This disease is more frequent in young and slim women. The patient complains pain in upright position, that regress lying down. The therapy consists of surgical treatment. We report the case of a woman treated with retroperitoneoscopic nephropexy.

Methods

We present the case of a 25–years old woman, affected by lumbar pain in upright position for about 1 year. Ultrasound scan of the abdomen and RX-KUB did not show hydronephrosis nor stones. Both an orthopedic examination and a spinal MRI excluded bone or muscular diseases. Intravenous pyelography and diuretic isotope renography in upright position revealed a renal descent of more than 5 cm, without obstruction of upper urinary tract. The patient underwent a renal color doppler imaging, that showed reduction of right kidney resistive index in upright position. The patient underwent a right retroperitoneoscopic nephropexy. After complete dissection of the perirenal fat from the kidney, three nonabsorbable sutures were placed between the posterior renal capsule and the psoas muscle.

Results

NO blood loss nor perioperative complications have been observed. One month after the procedure, the patient did not complain any pain. Renal color doppler, performed one month after the nephropexy, showed a normalization of resistive index.

Conclusions

Symptomatic nephroptosis is a disease that has been questioned in the past. Nowadays, the modern imaging and functional examination available allow to identify the “true” cases of symptomatic nephroptosis. The treatment with retroperitoneoscopic nephropexy is an easy and effective procedure.
I nuovi Materiali Nella Chirurgia del Prolasso e Dell'incontinenza
Authors: Tuffu G. , Fioretti F , Frumenzio E. , Bruno R. , Costantini E.
Published: June 2018

In line with the results of general surgeons, who revolutionised the surgical approach and the success rate of ventral hernia repair using synthetic mesh, urologists and gynaecologists recently moved towards the use of prosthesis to augment the native tissues.

The rationale was based on the relatively high failure rates of the traditional anterior vaginal compartment repair and the recognition that the native tissue may no longer assume the position, strength or functionality by simple re-approximation. Actually the plethora of mesh or graft material, ranging from absorbable (synthetic and biological) to non-absorbable materials, indicates how uncertain we are about the best management.

The surgical results are variable on the basis of 1) the material used (synthetic or biological, absorbable or not absorbable); 2) the position of the mesh (incorporated in the suture, overlay the suture, below or under the fascia); 3) the tension adopted.

Major problems concern the complications related to the use of the meshes in urogynaecological surgery and the final message is that surgeons may want to consider adopting use of graft techniques to improve surgical results with care given to carefully monitor complications.
Carcinoma dei Dotti Collettori del Bellini: Case Report con Metastasi Cutanea Come Iniziale Manifestazione Clinica
Authors: Grande M. , Facchini F. , La Rosa M. , Pozzoli G.L. , Leone M. , Piana S. , Monica B.
Published: June 2018

Introduction

Bellini's collecting ducts carcinoma represents a rare tumor with an aggressive behaviour with a poor prognosis and often metastatic at diagnosis. We report the first case documented of Bellini tumor with an initial clinic presentation represented by a cutaneous metastasis of scalp.

Materials and Methods

All pertinent clinical information were compiled, including patient age, sex, mode of presentation, preoperative laboratory data, radiologic findings, surgery type, macro and microscopic findings, survival data.

Results

After reporting an histopathologic finding of cutaneous metastasis of unknown origin adenocarcinoma with poorly differentiation, a voluminous 6 cm left mesorenal mass is diagnosed through uro-CT. Consequently, it is performed a left radical transperitoneal nephrectomy with consensual exeresis of scalp cutaneous lozenge at the level of previous excision. The histopathologic diagnosis reported was Bellini tumor at stage pT3a-N2-M1. It has not reported significative responsiveness to adjuvant chemotherapy and the patient was died seven months after diagnosis of cutaneous metastasis.

Conclusions

Most of Bellini's carcinoma are already metastatic at presentation. Analiyzing literature, it is never documented a cutaneous metastasis as first sign at clinical presentation. In this context, radical nephrectomy, differently from others subtypes of advanced renal cell carcinoma, does not seem to improve survival of the patient but rather, it can keep a role in palliation or in the context of new chemotherapeutic protocols.
The Role of Non-Invasive Urodynamics in Bladder Outlet Obstruction Diagnosis in Male Patients
Authors: Palazzetti A. , Tosco L , Crìvellaro S. , Guaitoli P. , Abbinante M. , Frea B.
Published: June 2018

Purpose

Many Methods have been suggested to assess bladder outlet obstruction, as defined by the gold standard of pressure flow studies. A comprehensive review of the literature on the different methods used to diagnose bladder outlet obstruction by non-invasive means was performed in order to compare those methods to invasive urodynamics in terms of sensitivity and specificity.

Materials and Methods

A MEDLINE search was done of the published literature covering from December 2003 on non-invasive methods, including only single measures to diagnose bladder outlet obstruction. We performed a comparison between all methods in terms of sensitivity and specificity for each test. For many techniques these values were calculated directly from the data presented in the article.

Results

There has been applied many methods to diagnose bladder outlet obstruction. Those methods were divided into uroflowmetry condom-catheter method, penile cuff method and Doppler ultrasonography urodynamics. Each method has been described and discussed in terms of its role in adding information to the diagnostic work-up for bladder outlet obstruction.

Conclusions

Pressure flow studies still remain the gold standard for assessing bladder outlet obstruction. However non-invasive urodynamics is a promising branch. Probably the most reliable information is given by the association of numerous methods together.
Endometriosis: Necessary and Sequential Therapeutic Procedures and Guidelines
Authors: Jasonni Valerio M.
Published: June 2018

Objectives

TO define the actual guidelines about the therapy of endometriosis. Methods. A brief review of the literature for the correct diagnosis of endometriosis and the medical and surgical approach.

Results

It is well accepted that the gold standard of endometriosis diagnosis is the direct vision of the disease with laparoscopy or the presence of endometriosis implants in vagina or cervix. Staging must be performed along with the distribution, and depth and bowel involvement must be noted. Symptoms intensity is not related to the degree of endometriosis. Therapy, medical or surgical, should be chosen in relation to symptoms and the disease degree, keeping in mind that surgery is the approach that may offer better results.

Conclusions

The direct vision of the disease is the only method to obtain the correct diagnosis and an accurate staging. However, ultrasound can be helpful in cases of pelvic localization and in the follow-up of the disease. Moreover, MRI can be employed, especially in cases with particular endometriosis implant, e.g. gluteus muscle. Surgery offers the best results but some medical therapy, especially hormonal therapy, is often employed for the relief of pains.
Indications and Limits to Endourologic Procedures for Endometriosis of the Urinary Tract
Authors: Marino G. , Piras D. , Pedalino M. , Di Primio O.G. , Velia R. , Vercesi E.
Published: June 2018

Introduction

The incidence of Urinary tract endometriosis (UTE) ranges from 1% to 3%; bladder is the most affected organ (85% of UTE), followed by ureter (12–14% of UTE), for which we distinguish an intrinsic very rare form and an extrinsic variety most frequently occurring in advanced pelvic endometriosis. Materials and Methods. From 1997 to 2010, 33 surgical procedures for urologic endometriosis were performed, involving the urinary tract, in 28 patients with mean age of 31 years (25–43). The localization of endometriosis were: 7 cases in the bladder, 2 cases in the vesicoureteral tract, and 19 cases of ureteral tract only. Of these, two cases were diagnosed with an intrinsic localization.

Results

Overall, we performed 3 TURB, 5 partial cystectomies (2 with open surgical approach and 3 by laparoscopy procedure), 12 laparoscopic ureterolysis and simultaneous protection of the upper urinary tract with stent, 9 cases of ureterocystoneostomy (UCNS) according to Lich-Gregoire procedure, and 3 according to Boari–Kuess procedure. Of the 12 patients who underwent ureterolysis with laparoscopic and stenting procedure, five cases required a UCNS according to Lich-Gregoire technique for persistent ureteral obstruction.

Conclusions

The limits of endoscopic procedures in endometriosis of the urinary tract are correlated both to the degree of extension and the localization of the disease. It is mandatory to achieve an interdisciplinary consensus in order to ensure the disease removal and the simultaneous functional results of the upper urinary tract.
Long-Term Results of Laparoscopic Retroperitoneal Lymph Node Dissection (RPLND) in Low-Stage Nonseminomatous Germ-Cell Testicular Tumors (NSGCTT) Performed by a Senior Surgeon: 1999–2003
Authors: Pizzocaro G. , Schiavo M. , Solima S. , Vitellaro M. , Blasoni D. , Nicolai N.
Published: June 2018

Background

Laparoscopic RPLND for low-stages NSGCTT is controversial: it is performed and recommended by excellent laparoscopic surgeons, but it is not widely used. The aim of this paper is to evaluate the results achieved by a senior surgeon, expert in open RPLND, who was introduced to laparoscopic surgery by excellent laparoscopists (LN, CU, GJ).

Patients and Methods

of the 48 operated patients, 36 had primary RPLND for clinical stage I disease (22 TINO, 7 TxNO, 5 T2–3 NO and 2 TIS1 NO) and 12 had post-chemotherapy surgery for IIA and IIB retroperitoneal nodes with normalized AFP and HCG. L-RPLND was performed with 4 ports and the en bloc removal of unilateral retroperitoneal nodes with the spermatic vessels. No post-operative adjuvant chemotherapy was planned for patients with documented nodal metastases as for open RPLND since 1985.

Results

Average operative time was 3.30'for the 36 clinical stage I patients and 4 hours for post-chemotherapy surgery. Blood loss was minimal in all cases, because of early conversion to open surgery in all patients with no immediate hemostasis at L-RPLND. Metastases were found in 6 (17%) out of the 36 clinical stage I patients: none in the 22 pTI, 1 in the 7 Tx, 3 in the 5 pT2–3 and in 2 of the 2 pT1S1 patients. Residual teratoma was found in 6 of the 12 patients who received neo-adjuvant chemotherapy for clinical stage IIA or IIB disease. The other 6 had fibrosis-necrosis. Further metastases developed in 2 of the 30 patients with negative nodes: 1 in the lung in a pT1, and 1 in a pT2 patient with increasing markers. Surprisingly, the first two pT2–3 patients with positive nodes developed liver metastases in a few months after L-RPLND. Consequently, all following patients with active metastases at L-RPLND received 2 courses of adjuvant PEB. All 4 patients who relapsed were cured, are alive and disease-free.

Conclusions

L-RPLND is a very demanding operation, which appears to be more a staging procedure than a curative operation. It is ideal for pT1 clinical stage I and for post-chemotherapy stages IIA& B with residual teratoma and normalized markers, but wait & see in good risk and open RPLND in high risk patients are very competing. Only few reports compared laparoscopic versus open RPLND, but not in a randomized study.
Multiple application of three-dimensional soft kidney models with localized kidney cancer: A pilot study
Authors: Glybochko Peter Vitalevich , Rapoport Leonid Mikhailovich , Alyaev Yuri Gennadevich , Sirota Eugene Sergeevich , Bezrukov Eugene Alexeevich , Fiev Dmitry Nikolaevich , Byadretdinov Ildar Shamilevich , Bukatov Mikhail Dmitrievich , Letunovskiy Alexander Vasilevich , Korolev Dmitry Olegovich
Published: June 2018

Aim:

To evaluate the effectiveness of three-dimensional printing application in urology for localized renal cancer treatment using three-dimensional printed soft models.

Materials and methods:

The study included five patients with kidney tumors. The patients were treated in the Urology Clinic of I.M. Sechenov First Moscow State Medical University from February 2016 to June 2017. Personalized three-dimensional printed models based on computed tomographic images were created. Five surgeons took part in a survey in which the utility of computed tomographic images versus three-dimensional printed models for presurgical planning was compared. A laparoscopic partial nephrectomy training using the developed three-dimensional printed models was performed by the same surgeons in a surgical training box.

Results:

The patients underwent endoscopic surgery using laparoscopic access. The average time of surgery was 187 min. All the operations were performed with complete renal artery clamping. The average warm ischemia time was 19.5 min and the average blood loss was 170 mL. No conversions to open surgery or radical nephrectomy, and no postoperative complications and deaths were observed. All the surgical margins were negative. The tumors were morphologically identified as renal cell carcinoma in four cases and as oncocytoma in one case.

Conclusion:

The developed three-dimensional printed models allow one to evaluate the pathological anatomy of tumors more effectively. High similarity between three-dimensional models and native kidneys contribute to improvement of surgical skills necessary for partial nephrectomy. Training on the three-dimensional models also allows surgeons to facilitate selection of an optimal surgical tactics for each patient.
Persistent Mullerian duct syndrome: Report of two cases with phenotypical immunohistochemical profiling
Authors: Ambrosi Francesca , Fiorentino Michelangelo , Chessa Francesco , Brunocilla Eugenio , D’Errico Antonietta , Bertuzzo Rosa Valentina , Giunchi Francesca
Published: June 2018

Introduction:

Persistent Mullerian duct syndrome is a rare disorder of male organ development characterized by internal male pseudohermaphroditism. Persistent Mullerian duct syndrome is usually an incidental finding in patients presenting cryptorchidism, inguinal hernia, or a previous story of undescended testes.

Case description:

We report on two cases of persistent Mullerian duct syndrome: an adult fertile male with uterus and ectopic prostate occurring as pelvic mass and a 75-year-old organ donor with uterus and two fallopian tubes, discovered in course of organ recruitment. We performed routine histological analysis and immunohistochemical profiling of the different tissue components. Examined tissues were all benign, and the living patient is well after surgery.

Conclusion:

In order to prevent further complications such as infertility and potential malignant change, surgeons and surgical pathologists must be aware of this condition and should consider excision of the Mullerian remnant where possible.