bluuebunny/crossref_metadata_2025 huggingface dataset:
Evidence for the Presence of α1 Adrenoceptor Subtypes in the Human Ureter
Authors: Palazzolo F. , Sigala S. , Dellabella M. , Milanese G. , Faccoli S. , Peroni A. , Mirabella G. , Cunico S. Cosciani , Spano P.F. , Muzzonigro G.
Published: June 2018

Several studies proposed a role for α1 adrenoceptors (α1 ARs) in the ureteral physiology, indicating that they are present in the ureter; however, few studies have been made to identify α1 AR subtypes present in this area. Thus, this study was carried out to characterize the α1 AR subtype gene and protein expression in proximal, medial and distal region of the human ureter.

Methods

Molecular characterization of α1 AR subtypes was done by semi-quantitative RT-PCR. The α1 AR protein expression was studied by saturation binding curves using the α1 AR antagonist 125I-HEAT. Analysis of data was performed using the GraphPad PRISM 4 software.

Results

Analysis of saturation binding curves revealed an heterogeneous distribution of α1 AR binding sites; the Bmax for the distal ureter was indeed 52.5 ±5.4 fmol/mg prot, while a lower similar density of α1 ARs was demonstrated in the medial (25.2 ±1.7 fmol/mg prot) and proximal (23.4 ±0.4 fmol/mg prot) ureters. Molecular characterization of α1 AR subtypes indicated that each receptor was present, although with differences in term of the amount expressed.

Conclusions

Human ureter was endowed with each α1 AR subtype, although α1D and α1A ARs were prevalent over α1B ARs. Radioligand binding results revealed that there were no significant differences in the Kd between ureteral regions, while an heterogeneous distribution of α1 AR binding sites was detected, with the highest density of α1 ARs in the distal ureter and a lower similar density in the medial and proximal ureter.
Involvement of β3-Adrenergic Receptor Activation in Human Corpus Cavernosum Function
Authors: Verze P. , Cirino G. , Imbimbo C. , Di Villa Bianca R. D'Emmanuele , Buonopane R. , Ignarro L.J. , Mirone V.
Published: June 2018

β3 adrenergic receptors are extensively studied, and in animal model it was demostrated their involvement in the vasorelaxation of smooth muscle cells. However the precise role and their exact distribution in human body is almost unknown. We studied the presence of β3 adrenergic receptors in human corpus cavernosum and the pathways involved in their activation:

Materials and Methods

Using strips isolated from human corpus cavernosum obtained from transsexual surgical procedures, we tested this receptors with a specific agonist BRL-37344 (10–5 −10–8) to understand their precise role. Removing endothelium and using L-NAME (100 μM), we tested the involvement of NO in the pathways of activation of this receptors.

Results

We demostrated the presence of β3 adrenergic receptors in the human corpora cavernosa and their mainly localization in the smooth muscle cells of vascular vessels. Our results dimostrated, making a stimulation with BRL-37344, that exists a mechanism of smooth muscle relaxation concentration-dependent. This relaxation is endothelium-indipendent too, like we showed removing it or using L-NAME. The vasorelaxation induced by BRL-37344 is realized by the increase of cGMP level of 7-fold like it was dimostrated by ELISA. Moreover the use of SR-59230A, an antagonist of β3 adrenergic receptors, removes the relaxant effect.

Conclusions

The vascular smooth muscle in human corpus cavernosum possesses tonic or continuous β3-adrenergic receptor activity (mediating relaxation), as suggested by the vasoconstrictor effect that results from selectively antagonizing the β3-adrenergic receptors. The presence of β3-adrenergic receptors in human corpus cavernosum and their possible involvement in promoting erectile function via cGMP but NO-indipendent, may open new approaches to develop new treatment of E.D.
Retrograde Ureteroscopy for Distal Ureteral Stones Removal in Childhood
Authors: De Dominicis M. , Matarazzo E. , Defidio L. , Collura G. , Caione P.
Published: June 2018

Distal ureteral stones are commonly treated by extracorporeal shock wave lithotripsy (ESWL) as first option in adult age patients, but no agreement is achieved about the treatment in children. Efficacy and safety of ureteroscopy with ureterolithotripsy (ULT) was compared with ESWL results for distal ureteral calculi treatment in childhood.

Materials e Methods

From July 2002 to July 2003, paediatric patients presenting ureteral stones were consecutively randomized for treatment, using ULT or ESWL. The success rate, effectiveness quotient, complication rate and hospitalization length were evaluated. T-Student test (chi-square) was adopted for statistical analysis.

Results

A total of 31 patients, aged 2 to 17 years (mean age 7.2 years) were recruited. ULT was performed in 17 children. All the females (100%) and 4 males (80%) were stone-free in a single endoscopic procedure. ESWL was performed as a primary procedure in 14 cases, 5 males and 9 females. Four females (44.4%) and 2 males (40%) resulted stone-free at first treatment. The total stone-free rate was 94.1% for ULT and 42.8% for ESWL (p=0.004). Eight patients (57%) underwent a second ESWL and 3 of them (37.5%) became stone-free súbsequently. The 5 patients (62.5%) with failed double ESWL underwent ULT successfully. The calculated efficiency quotient for treating distal ureteral calculi was significantly lower in the ESWL than in the ULT group (p=0.05).

Conclusions

ULT should be recommended as treatment of choice for distal ureteral calculi in childhood. Using small ureteroscopes the target stone was treated safety and effectively in our patients.
Trans Obturator Tape for Female SUI
Authors: Kocjancic E. , Costa P. , Crivellaro L.S. , Gontero P. , Favro M. , Ceratti G. , Zaramella S. , Maso G. , Tarrano E. , Gherzi R. , Frea B.
Published: June 2018

The Trans Obturator Tape (TOT) is a new technique, based on positioning of a tape under the middle urethra through the obturator foramina. The outcomes and complications of the TOT at 1 year follow up were evaluated.

Materials and Methods

50 patients underwent to TOT for stress urinary incontinence (SUI) have been prospectively evaluated. In the first 6 patients was used the Uratape, a polypropylene tape covered by silicon in the middle part. Eventually, because of 1 case of extrusion due to the silicon part, it was created and used the Obtape, the same tape without the silicon part. The patient was positioned in lithotomy position and a Foley catheter was inserted. A small (2 cm) incision was performed 1 cm below the external meatus in order to allow the digital dissection of the paraurethral. Through the skin the obturator foramen was identified and a small incision was done in the medial part just above the level of the urethral meatus bilaterally. Eventually a hooked tunneler was inserted through the incision at the level of the obturator foramen and the obturator fascia is perforated anteroposteriorly. The tunneler is than directed medially in the paraurethral space previously prepared and under direct digital control. The tape is inserted into the eye of the tunneler to retract the tape through the obturator foramina. The procedure is repeated on the other side. Patients were evaluated preoperatively, at 1, 6, 12 months of follow up with a physical examination, validated questionnaire (AUA score) and reported percentage of improvement, and uroflowmetry.

Results

The mean age was 57 (range 36 – 76). 70% of the patients had urodynamic stress incontinence, 30% had stress incontinence associated with urgency. The median follow up was 12 months (range 1–24 months). - The average of the AUA score has been decreased of 13 points (form 16 to 3) and the average percentage of improvement was 81 % up to a maximum follow up of 18 months. - 88% (44/50) patients were dry one year after the surgery and 12% (6/50) were improved.- No significant changes in uroflowmetry parameters. One case of extrusion have been reported, using the Uratape, no cases of extrusion have been reported using the Obtape. One patient had developed new urgency.

Conclusions

The Trans Obturator Tape is a simple, direct and quick procedure. It is associated with good outcomes and high patient satisfaction up to an average follow up of 12 months. Additionally the Obtape does not seem associate to erosion, extrusion or alteration of the normal voiding.
Urethroplasty with a Buccal Mucosa for Treatment of Anterior Urethral Strictures
Authors: Gaffi M. , Anceschi C. , D'Amico F. , Lentini M.
Published: June 2018

We report the early results of urethroplasty with a buccal mucosa free graft as a dorsal onlay for treatment of anterior urethral strictures.

Materials and Methods

Since February 1997 to December 2003, 22 patients with recurrent anterior urethral strictures have been treated with buccal mucosa urethroplasty. Mean age of patients was 48.7 years (range 20 – 71). The etiology of strictures was inflammatory (7), iatrogenic (6), traumatic (3), idiopathic (6). Urethroplasty was performed with a free graft of buccal mucosa using dorsal onlay. The buccal mucosa onlay was sutured to the urethra and corpora cavernosa.

Results

At 37 month mean follow-up (range 5 to 83) the success rate was 95.5%.

Conclusions

Buccal mucosa free graft represents a simple surgical option and although longer follow up is needed preliminary results are excellent.
Urinary Tract Infections after Extracorporeal Shock Wave Lithotripsy
Authors: Carlino F. , Pichierri G. , Pomara G. , Foti G. , Tanzilli P. , Costarelli S. , Selli C. , Bonadio M.
Published: June 2018

Extracorporeal shock wave lithotripsy (ESWL) has been using since a long time in the treatment of urolithiasis; until now it is not universally stated if such a procedure represents a risk factor for the development of complications (such as pyelonephritis) and if the same procedure needs an antimicrobial prophylaxis. We began a prospective study in order to evaluate the clinical and microbiological follow-up of all the patients undergoing ESWL at the Centre of urologic lithotripsy of the University of Pisa into a two months period.

Methods

Fifty-four consecutive patients were enrolled (38 males and 16 females). All the patients were studied, examining their urine samples before ESWL and after one week and evaluating their risk factors for urinary tract infections.

Results

12 (22.2 %) out of 54 patients had a significant bacteriuria (≥ 104 CFU/mL) before undergoing ESWL; such bacteriuria persisted in eight of the twelve patients even though they received an appropriate antimicrobial therapy. 41 (75.9%) patients without a significant bacteriuria at the enrollment remained asymptomatic –with sterile urine- after ESWL and they did not receive therapy. One patient with multiple stones, who had a clinical history of previous urinary infections, developed an acute pyelonephritis after ESWL when she stopped the antibiotic terapy.

Conclusions

Such preliminary data seem to show that the risk of developing urinary infections after ESWL is represented primarily by a history of previous urinary infections and by the presence of an asymptomatic urinary tract infection before ESWL. The decision about the need of an antimicrobial prophylaxis should be taken in every single case basing on the peculiar clinic history of the patient.
Perineal Magnetic Stimulation for Female Urinary Incontinence
Authors: Sandri S.D. , De Francesco O. , Sommariva M. , Confalonieri S. , Nervi S. , Zanollo L.
Published: June 2018

Perineal Magnetic Stimulation (PMS) is a new technique in pelvic floor rehabilitation which produces magnetic fields that induce involuntary perineal muscles contraction. Our aims were to evaluate efficacy and tolerability in different types of female urinary incontinence.

Material and Methods

104 consecutive female outpatients complaining of urinary incontinence were enrolled, 53 suffered of stress urinary incontinence (SUI), 37 of mixed urinary incontinence (MUI) and 14 of urge incontinence (UI). The whole treatment consists of two sessions a week of PMS for a total of six weeks.

Results

After one course of treatment 8 patients (8%) were cured, 53 (51%) felt improved and 43 (41%) were unchanged. Better results were obtained in pure stress urinary incontinence, while the presence of bladder overactivity reduced the cure dramatically. If the subjective results were related to the entity of the incontinence, evaluated with the one hour weighting pad test, we could see that only a urinary leakage superior to 50 g makes resulted very poor.

Conclusions

PMS is a new simple perineal rehabilitative technique with instrumental higher costs but less nurse time involvement, with similar results to the usual pelvic floor fisiotherapy and without side effects.
Detection of Circulating Prostate Cancer Cells Using Real Time Rt – Pcr: Our Experience
Authors: Fontana D. , Ceruti C. , Destefanis P. , Rosso R. , Fiori C. , Bisconti A. , Demaria C. , Barbero G. , Giribaldi G. , Turrini F. , Arese P.
Published: June 2018

PCR (Polymerase Chain Reaction) has revolutionized molecular genetics and continues to be applied to many fields of medicine and biology. We used nested real time RT – PCR to detect circulating prostate cells in patients affected by prostate cancer, in order to evaluate a possible clinical role of this technique. We present our initial experience.
Alpha-Lithic Drugs and Renal Colic
Authors: Porena M. , Guiggi P. , Balestra A. , Micheli C.
Published: June 2018

All alpha-lithic drugs provide encouraging results in terms of stone expulsion from the intramural lower ureteral tract. However Tamsulosin seems the most promising because of its high selectivity for alpha 1-D receptors which are well distributed in this area.
Evaluation of Psa Kinetic after Radical Prostatectomy
Authors: Benecchi L. , Cantoni F. , Prati A. , Arnaudi R. , Pastizzaro C. Destro , Savino A. , Uliano N. , Pieri A. M. , Martens D. , Potenzoni D.
Published: June 2018

The aim of our study is evaluate PSA kinetics after radical prostatectomy for localized prostate cancer.

Materials and Methods

We evaluated PSA kinetic in 101 patients who underwent radical prostatectomy for localized prostate cancer. Only patients in whom one or more measurable PSA values available postoperatively (from day 2 to day 10) were included in our study group. We calculated the PSA half-life after radical prostatectomy.

Results

The median PSA half-life after radical prostatectomy was 2.2 days (range 0.97 to 6.73 days). We found a statistical difference in PSA half-life between patients with and without positive surgical margins; the group with positive surgical margins showed a slower reduction of PSA than the other, probably due the presence of residual cancer tumor. Conclusions. PSA half-life differs during the beta-phase after radical prostatectomy, it is longer in patients with positive surgical margins than those with negative surgical margins. This difference is probably due to the presence of residual prostate cancer after surgery.
Psa Elevation during Intravesical Therapy for Superficial Bladder Carcinoma
Authors: Beltrami P. , Ruggera L. , Cazzoletti L. , Schiavone D. , Artibani W.
Published: June 2018

PSA is commonly accepted as an indication for prostate biopsy. We determined PSA value in 81 consecutive patients treated with intravesical immuno- (59 cases) or chemotherapy (22 cases) for superficial bladder cancer. Blood samples were obtained before and after the induction course of instillation therapy and at 3, 6 and 12 months. We observed a clinical significant elevation of average PSA in 27 cases (45%) during BCG therapy and a return at the baseline levels within 12 months. Histological findings obtained in 10 patients shown inflammatory pictures in 9 cases. Prostate carcinoma was found only in one case with elevated PSA at 12 months. No significant differences of PSA levels were noted in patients treated with chemotherapy.

Our findings confirm that PSA increase in patients during intravesical BCG therapy is self-limited. Prostate biopsies in these patients are not mandatory and could be delayed while monitoring PSA.
Another Route for Retrieval of a Foley Catheter When the Balloon Does Not Deflate
Authors: Gregori A. , Simonato A. , Lissiani A. , Galli S. , Acquati P. , Gaboardi F.
Published: June 2018

Failure of a Foley balloon to deflate is a rare complication that can be initially managed with various non invasive procedures. If the balloon remains inflated, direct puncture of the balloon may be required. We describe a minimally invasive percutaneous transperineal transprostatic balloon puncture.
Diffused Pelvic Endometriosis to the Ureter and Rectal: Multidisciplinary Approach
Authors: Iannucci M. , Nicolai M. , Tenaglia R.L.
Published: June 2018

Endometriosis functionally causes lesions, nodules or active bulges to numerous organs. Is the second most common pelvic pathology in woman and strikes the 10–20% of the women in the pre-menopausal epoch (40–45 years) and the interest of the urinary apparatus is 1–11%. Rare to renal level, it mostly strikes the bladder and in smaller measure the ureters and the uretera with a relationship 40/5/1. Ureteral location is common extrinsic, deriving for contiguity of the ovarian endometriosis adherent or of the peritoneum or of the uterus-sacred ligament; rare the ureteral intrinsic endometriosis, primitively located in the organ wall. Our therapeutic orientation is surgical, especially in the cases of wide endometriosis or when the tissue has had a cicatrizial involution with absence of answer to the hormonal therapy.
Myxoid Liposarcoma of the Spermatic Cord
Authors: Liberti M. , Perugia G. , Masala D. , Teodonio S. , Di Viccaro D. , Iaboni L.
Published: June 2018

The myxoid liposarcoma, a rare form of spermatic cord liposarcoma, is a neoplasia of adult men which arise from adipose tissue, with a slow and subdolous growth, showing good prognosis and low incidence of local or distant recurrence. The case came at our attention is the sixteenth described in literature. Orchifunicolectomy is the gold standard therapy, although in some cases in which this kind of surgery is not radical, adjuvant inguinal or retroperithoneal and pelvic nodes radiotherapy should be taken in consideration.
Angiomyolipoma in a Patient with Tuberous Sclerosis
Authors: Antonelli A. , Zani D. , Portesi E. , Cozzoli A. , Maroldi R. , Battaglia G. , Chiesa A. , Cunico S. Cosciani
Published: June 2018

Angiomyolipoma (AML) is a benign hamartoma with two distinct clinical settings, one sporadic with no underlying predisposing conditions, and another linked to the tuberous sclerosis complex in which lesions tend to be larger, multifocal and bilateral and more likely to cause spontaneous hemorrhage.

Due to the benign nature of the disease the elective treatment of AML, which is conventionally required for neoplasms with diameter greater that 4 centimeters, should have the aim of lowering the risk of bleeding without sacrifice of the normal renal parenchyma and with the minimum of invasiveness. The bleeding from AML, the lack of a pseudocapsule and the collocation of the tumour can be a limit to a correct nephron sparing surgery.

For these reasons a selective angiographic embolization, which allows the vascular exclusion and the lowering of the risk of bleeding with reduced invasiveness, is actually indicated to treat AML. A case of successful embolization of AML in a patient with tuberous sclerosis is presented.
Renal and Lymph-Node Inflammatory Pseudotumor
Authors: Ronci L. , Viola D. , Comerci F. , De Stefano R. , Emili E. , Sanguedolce F. , Franceschelli A. , Marlia E. , Martorana G.
Published: June 2018

Inflammatory pseudotumor (IP) is a benign uncommon tumour with uncertainly aetiology. Aetiology may be an inflammatory process due to small traumas, surgery, or malignancy. Some studies showed that patients affected by IP were also affected by wide vasculities and genetics abnormalities, strengthening the hypothesis of an aetiology of this disease from an autoimmune pathology or a true tumour respectively. The bladder localization is the most frequently localisation in the genital-urinary apparatus, while the kidney localization is very uncommon. The IP consist of inflammatory and myofibroblastic cells.

Material and Methods

A 69 years old affected with inhomogeneous mass in the right kidney of about 8 cm, calcify lymph-node of the mesentery of about 28 mm.

Results

The patient was undergone to right nephrectomy and removal of mesenteric lymph-node. Histological issue showed a renal cells carcinoma G2 associated to IP. Mesenteric lymph-node with ossification and associated to IP.

Conclusions

This case is interesting for the simultaneous finding of the IP placed to right kidney and mesenteric lymph-node. Similar wide IP have already described in other studies like true tumour with more biological aggressivity. The differential diagnosis of IP with other neoformations is still difficult. We consider an optimal indication to perform a radical surgery therapy in any case, because IP may be associated with a malignancy and because sometime IP may increases progressively its aggressiveness. The histological diagnosis achieved by bioptical sample may be risky because biopsy cannot exclude all doubt about the existence of a mixed neoformations with IP and malignancy like our case.
Seminal Vesicle Biopsy
Authors: Mari M. , Ambu A. , Bollito E. , Bellina M.
Published: June 2018

Nowadays, because of early diagnosis of prostate cancer (PC) and the widespread use of nomograms to predict pathological stage of the tumour, seminal vesicle biopsy is considered as a useful tool only in case of clinical suspicion of seminal vesicle invasion. On the other hand, in last years some authors described their experience in less demolitive surgical procedures for PC, such as seminal sparing radical prostatectomy, in an attempt to improve both postoperative urinary continence and sexual function, as reported by Hauri and Montie, respectively. Patients, who may undergo to such procedure, could benefit from preoperative seminal vesicle biopsy, instead of rely on probability of seminal vesicle invasion indicated by nomograms only.

From November 2001 to June 2003, 135 patients with negative rectal examination and PSA ≤10, with no contraindications to radical prostatectomy, underwent transrectal ultrasound guided seminal vesicle biopsy at our Institution. We performed seminal-monolateral nerve sparing radical prostatectomy in patients with monolateral PC, Gleason score <7 and <4 positive biopsy cores, without seminal vesicles involvement. Patients with seminal vesicle invasion were addressed to radiotherapy.

Seminal vesicles biopsy showed in our hands good feasibility and low morbility; it was in general well tolerated by the patients.

All biopsy cores were adequate for histological examination.

Among patients with PC diagnosis, only one patient (4%), with serum PSA = 5 ng/mL and Gleason score = 6, had seminal vesicles involvement.

We performed seminal-nerve sparing radical prostatectomy in 21 patients, neither histological examination on frozen section nor final pathology showed seminal vesicle invasion in any case. Real usefulness of seminal vesicle biopsy remains controversial, but due to its good feasibility and low morbility it may play a role in the staging of selected patients.
The Role of an Extended 24 Cores Biopsy in Patients with Clinically Suspected Prostate Cancer and Prior Negative Biopsy
Authors: Ciaccia M. , Prayer-Galetti T. , Dal Moro F. , Pinto F. , Gardiman M. , Sacco E. , Fracalanza S. , Betto G. , Pagano F.
Published: June 2018

The aim of this study is to evaluate the role of an extensive “saturation biopsy” in patients at increased risk for prostate cancer with previously negative biopsies, HGPIN or ASAP diagnosis.

Materials and Methods

We performed an extensive 24 cores biopsy with spinal anaesthesia in 168 patients with at least 1 prior negative biopsy and persistently high PSA and/or abnormal digital rectal examination or with a ASAP or HGPIN diagnosis at previous biopsy.

Results

A total of 55 patients were diagnosed having prostate cancer for an overall diagnostic yeld of 33 %. Specifically, cancer was detected in 79% of ASAP, 32% of HGPIN and 28% of prior negative biopsies. 31 patients underwent radical retropubic prostatectomy. There was no correlation between number of positive biopsy cores and pathological stage or pathological Gleason score. A high concordance was found between clinical and pathological Gleason score.

Conclusions

Extensive biopsy can be considered a safe and effective diagnostic tool in men at risk for prostate cancer with previous negative biopsies. This procedure comes out to be particularly useful also in patients with a prior ASAP or HGPIN.
Laparoscopic Extraperitoneal Radical Prostatectomy: The First 120 Cases Performed
Authors: Martina G. , Scuzzarella S. , Giumelli PL. , Remoti M. , Caruso G.
Published: June 2018

The present study describes the training approach that a laparoscopy naive general urologist working in a non teaching hospital employed to successfully learn to perform laparoscopic extraperitoneal radical prostatectomy and describes the results obtained in the first 120 cases performed.

Methods

The urologist assisted an experienced laparoscopic surgeon for a total of 20 extraperitoneal radical prostatectomies. During this time he modified his technic of performing open radical retropubic prostatectomy to facilitate the acquisition of the laparoscopic technics. Intracorporeal suturing was learned with the aid of a pelvic trainer.

Results

The operating time progressively decreased during the learning curve. The mean duration of surgery was 160 minutes. There were 2 conversions to open surgery due to failure to progress.

Conclusions

Laparoscopic extraperitoneal radical prostatectomy can be successfully learned by a general urologist with no prior laparoscopic experience.
Effects on Sexual Function by the Drugs used in the Treatment of Benign Prostatic Hyperplasia and Prostate Cancer. A Practical Guide for the Urologist
Authors: Di Tonno F. , Mazzariol C. , Piazza N. , Omacini S. , Malossini G. , Contemori G.
Published: June 2018

The effects on sexual function (SF) by the drugs commonly used in the treatment of benign prostatic hyperplasia (BPH) and prostate cancer (PC) have been analyzed. BPH therapy: alpha-blockers have no adverse effects on SF; the only one without significant hypotensive effect, Tamsulosin, can cause retrograde ejaculation in 4–8% of cases. 5-Alpha-reductase (Finasteride and Dutasteride) inhibitors could have detrimental effects on erectile function, libido and ejaculation in a small percentage of cases rarely exceeding 10%; these effects are reversible and their incidence reduces after 1 yr. Phytotherapy (extracts from pygeum africanum and serenoa repens) and mepartricin have no unfavorable action on SF. PC therapy: Loss of erectile function and libido are the norm with the use of LH-RH analogues, estrogens and steroidal antiandrogens (cyproterone acetate). Non-steroidal antiandrogens (Flutamide, Bicalutamide and Nilutamide) allow the preservation of SF in two-thirds of cases.
Laparoscopic Radical Nephrectomy: A Single Center Experience
Authors: Sicuro O. , Veneziano P. , Sidari V. , Arcudi L. , Carbone L. , Ierace M. , Malara G. , Sgrò E. , Veneziano D. , Cozzupoli P.
Published: June 2018

Renal cell carcinoma has become one of the most important indications for urological laparoscopic surgery. The laparoscopic technique combines the benefits of a minimal invasive approach with basic surgical principles. We report our experience with 52 procedures.

Materials and methods

Between June 2000 and December 2003 we performed 52 transperitoneal laparoscopic radical nephrectomies for clinical stage T1-T2 renal cell carcinoma. Median age of patients was 59 yrs (range 31–77 yrs). The mean tumor size was 5.4 cm (range 3–12 cm).

Results

In three patients (5.7%) conversion to open surgery was necessary. The mean operating time was 215 min (150–305 min). Post-operative hospitalization was 5.1 days (3–11 days). Median follow-up was 19.5 months (3–36 months). No cases of local recurrence or port metastasis occurred during observation.

Conclusions

In our center, a transperitoneal laparoscopic approach with the removal of intact specimens in endobags has become the standard treatment for stage T1-T2 N0 M0 renal cell carcinoma.
The Prognostic Importance of Prostate-Specific Antigen in Monitoring Patients Undergoing Maximum Androgen Blockade for Metastatic Prostate Cancer
Authors: Kiper A. , Yigitbasi O. , Imamoglu A. , Tuygun C. , Turan C.
Published: June 2018

The changes in serum prostate-specific antigen (PSA) concentrations can be used as a prognostic factor in patients undergoing maximum androgen blockade for metastatic prostate cancer.

Materials and methods

One hundred and forty-nine patients followed-up in our department were classified into four groups based on PSA changes. Group 1, those with a normalization of PSA levels within the 1st 3 months; group 2, those with a normalization of PSA levels between months 3 and 6; group 3, those with a reduction in PSA levels, but not reaching the normal range; group 4, those with no reduction in PSA levels. The gleason scores and the number of bone metastases were also compared between the groups.

Results

The time to progression was significantly delayed in group 1 (mean: 23.3 months) compared to that of group 2 (mean: 16.9 months) (p<0.02). The time to progression in group 3 (mean: 8.45 months) was significantly shorter compared to groups 1 and 2 (p<0.001). In addition, in patients with gleason scores 5–7 (grade 2) and gleason scores >7 (grade 3) and in group 1, the time to progression (mean: 21.2 months) was significantly delayed compared to those with the same gleason scores but in group 2 (mean: 13.4 months) (p<0.001).

Conclusion

The reduction in PSA levels is more important than gleason scores in determining the time to progression. Early normalization of PSA levels delays the time to progression, and when combined with gleason scores, PSA is an important prognostic factor in predicting the success of the therapy.
Transperineal Salvage Cryosurgery (SC) for Prostate Adenocarcinoma
Authors: Galosi A.B. , Corsini C. , Fabiani A. , Pentimone S. , Muzzonigro G.
Published: June 2018

Criteria used for the diagnosis and treatment of recurrent prostate adenocarcinoma after radiotherapy are examined according to recently published studies in the literature. The diagnosis of recurrence is confirmed by the histological test of a biopsy performed due to the gradual increase in prostate-specific antigen (PSA). Proper sampling, nomenclature and analysis of prostate biopsies allow an early diagnosis to identify some important prognostic parameters and to plan the most appropriate therapeutic strategy for every single case. Androgen suppressive therapy only induces a temporary benefit in these patients. Transperineal salvage cryosurgery (SC) represents a recognized effective treatment option. Technological advances, including computerized treatment planning and miniaturized cryoprobes, allow further potential therapeutic advantages and reduce complications. Results of SC are promising even in patients with other comorbidities; therefore, it is useful to include it among therapeutic instruments for failures following radiotherapy.
Fatal Hemorrhage during Nephrolithotomy in a Patient with Unknown Vascular Ehlers-Danlos Syndrome Type IV
Authors: Zaramella S. , Rossetti S. Rocca , Tizzani A. , Frea B.
Published: June 2018

Ehlers-Danlos syndrome type IV (vascular EDS), is a life-threatening inherited connective tissue disorder resulting from mutations in the COL3A1 gene coding for type III procollagen. Vascular EDS causes severe fragility of connective tissues. We report a case of a 26-year-old male with bilateral staghorn renal calculi, the patient underwent a left nephrolithotomy, during the suspension of the renal artery incredibly, it was lacerated by the vessel loop, without any actraction. Subsequently, all hemostatic attempts, although gentle, resulted in important and catastrophic aortic and caval injures; the patient died due to an uncontrollable abdominal and thoracic hemorrhage. The early diagnosis of the vascular EDS is difficult if there are no known cases. Every surgical procedure in patients with Enlers-Danlos syndrome has a high risk of fatal vascular injuries.
Variations PSA Value in Patients Candidate to Biopsy of the Prostate
Authors: Galuffo A. , Serretta V. , Di Gregorio L. , Scuto F. , Bertolino V. , Ruggirello A. , Allegro R. , Ascoli R. , Pavone-Macaluso M.
Published: June 2018

Subclinical infections of the prostate can increase the prostate-specific antigen (PSA) values in patients with normal digital rectal examination. This study aimed to evaluate the role of short-term antimicrobial therapy in reducing the PSA value in patients as candidates for transrectal biopsy. Fifty-eight patients with negative digital rectal examination and PSA values between 4 and 20 ng/mL were included in the study. Antibiotics were administered to all patients for 3 weeks, and the PSA was reassessed 10 days after the end of the treatment. Patients were subsequently submitted to prostate biopsy.

A reduction in PSA was detected in 34 patients (59%). Mean percentage reduction was 32%. In only six patients (10%) did the PSA return to normal levels. Prostate biopsy revealed prostate cancer in 26 patients (45%). Prostate cancer was not detected in patients with PSA levels above 4 ng/mL. Prostate biopsy can be avoided only in a small number of patients showing the normalization of PSA levels after short-term antimicrobial therapy. These patients should be strictly monitored with frequent PSA determinations.
Uroangiographic Contrast Media-Induced Nephropathy: Correlations between Their Physicochemical Properties and Renal Damage
Authors: Alberti C. , Piovano M. , Tizzani A.
Published: June 2018

Contrast media-induced nephropathy (CN) is an important cause of hospital-acquired acute renal failure. Patients with both diabetes mellitus and renal impairment are at high risk. CN pathophysiology involves activation of the tubulo-glomerular feedback and vasoactive mediators such as renin-angiotensin 2, endothelin, adenosine, ADH, etc. The risk of CN can be minimized by the use of non-ionic, low or isoosmolar, contrast material, adequate hydration and prophylactic pharmacological measures. In patients with chronic renal failure who are undergoing arteriography (e.g. coronary angiography and angioplasty), periprocedural hemofiltration appears effective in preventing further renal damage due to contrast agents.
Role of Shock wave Therapy in Peyronie's Disease
Authors: Aresu L. , Ballario R. , Beltrami P. , Ruggera L. , Schiavone D. , Artibani W.
Published: June 2018

Shock wave therapy (ESWT) for the treatment of Peyronie's Disease (PD) is still controversial. The aim of this study is to evaluate the efficacy of shock wave therapy in patients candidates for surgical treatment of stable PD for at least 12 months.

238 patients affected by PD were treated with ESWT since January 2000. We selected those patients (65 cases) who were having a stable disease for at least 12 months, previously treated unsuccessfully with different therapy (pharmacological, ionophoresis or infiltrations), and with an adequate follow-up. The parameters considered were the size modification of the lesion, the reduction of the penile deviation and the overall satisfaction for reaching an adequate sexual activity after the ESWT treatment. All patients received a 3000 shock waves treatment in 4 occasions during 2 weeks according to the institutional protocol.

All the study patients reported to have an inadequate sexual function before the ESWT treatment. The mean age was 57 years, the penile deviation varied between 30° and 90° and the average follow-up was 18 months. In 43 cases (66%) the ultrasounds revealed a significant reduction of the penile deviation and 39 patients (60%) reported to have reached an adequate sexual activity after the ESWT treatment.

ESWT represents a valid option in the treatment of PD considering that the patients’ main goal is to regain a satisfactory sexual activity. Therefore this non-invasive treatment should be included in the therapeutic guidelines of PD together with other non-surgical treatments.
Incidental Retrovesical “Proximal-Type” Epithelioid Sarcoma: Pitfall of Diagnosis
Authors: Gentilucci A. , Iannotta L. , Parente U. , Sciarra A. , Cardillo M.R. , Di Silverio F.
Published: June 2018

The article aims at presenting an uncommon case of retrovesically located “proximal-type” epithelioid sarcoma, incidentally found as a retrovesical mass during prostatectomy for benign prostatic hyperplasia. Clinical, pathological and immunohistochemical data are presented. More specifically, two transrectal ultrasounds (TRUS) revealed a prostate gland enhancement and no evidence of other pelvic masses. This case report underlines that the retrovesical location of this neoplasm may mislead from a correct clinical diagnosis.
Spontaneous Rupture of the Kidney
Authors: Pecoraro G. , Olivo G. , Motta L. , Frigo M.
Published: June 2018

The rupture of the kidney with the formation of an extracapsular hematoma in the renal cavity but no evidence of external trauma or other obvious renal cause, is an uncommon finding, most often requiring urgent surgery.

An underlying renal pathology, often a renal tumor, should always be suspected.

This article describes the case of a 57-year-old male patient who was admitted for severe left flank pain and presented with signs of peritonism, microscopic hematuria and low hemoglobin levels; an emergency left subcostal laparotomy was performed, with removal of the hematoma and enucleation of a partially open mid-renal mass; the kidney was spared.

Histology showed a WHO type I, Fuhrman grade 2, papillary renal cell carcinoma.

The article deals further with frequency, presentation, type and treatment of the pathology underlying the spontaneous rupture of the kidney, particularly with regard to renal carcinoma.
Benign Prostatic Hypertrophy: A Progressive Pathology. Hypothesis for a Preventive Therapy
Authors: Sciarra A. , Cristini C. , Gentilucci A. , Iannotta L. , Parente U. , Di Pierro G.B. , Antonini F. , Alfarone A. , Di Silverio F.
Published: June 2018

The purpose of this review is to enhance prevention as a new key aspect in the treatment of BPH. The concept of BPH as a progressive disease helps to adopt new approaches to patient evaluation and treatment. The disease progression, with respect to the risk of bladder function complications and alterations, to the progression of symptoms, and to the deterioration of the quality of life, leads to new ways of treating patients through a preventive as well as a symptomatic approach, thanks also to the identification of some parameters associated with the risk of BPH progression, i. e. the prostate volume and the serum PSA.

Furthermore, the concept of progression helps the clinician to identify different classes of BPH patients with different indications of medical treatment. The PLESS, ARIA and MTOPS multicentric studies point out the preventive potential of the therapy based on 5 alpha-reductase inhibitors (finasteride and dutasteride) or their combination with alpha-1 adrenergic blockers. Only a long term evaluation (4 years or more) can lead to the identification of statistically and clinically significant outcomes for the BPH preventive therapy.
Quinazoline α1-Blockers: Are there any News about their Efficacy in Inhibiting Prostate Tumor Growth?
Authors: Alberti C. , Chiapello G. , Bernardi D. , Mediago M. , Arena G.
Published: June 2018

α1-adrenoceptor agonists have recently been recognized as growth factors for several cell types, including both stromal smooth muscle- and epithelial cells of the prostate gland, by triggering off a cascade of intracellular signal transduction pathway that controls cell proliferation. On the contrary, quinazoline α1 -blockers (doxazosin, terazosin, prazosin) inhibit cell kinetics and induce, above all, anoikis and apoptotic death of both stromal smooth muscle- and epithelial cells, through α1 -adrenoceptor-indipendent mechanisms, thus preventing or delaying prostate tumor growth.
L-Propionil Carnitine (LPC) is a Propionic Outcome of Carnitine
Authors: Mantovani F. , Castelnuovo C. , Paparella S. , Inneo V.
Published: June 2018

L-Propionil Carnitine (LPC) is a propionic derivative of Carnitine. It enhances mitochondrial activity, fat acids and free radical metabolism; it could therefore prove effective in preventing chronic oxidative diseases such as Cavernous fibrosis, which results essentially from an increase in endothelin, and a decrease in nitric oxide (NO) and prostaglandins (PGEi), as it occurs with hypoxia.

An incidence of about 15% of segmentary cavernous fibrosis is reported as a consequence of, at least, a 72-hour catheterization. The physiopathology of the syndrome is still uncertain, but strongly related to vasculitis.

We carried out a 15-month double-blind, prospective, randomized placebo-control study on 240 patients (age range: 42–68 years) on the possibility of preventing fìbrosis through LPC; study follow-up at 6 months, drug dose: 2g/day p.o.

Cavernous fibrosis was reported in 11% of LPC treated patients, and 14% of the placebo group (p = l).

Any kind of prevention, even if with poor outcomes as in our experience, should be usefully considered and improved.
Transperineal TRUS-Guided Prostate Biopsy
Authors: Ficarra V. , Novella G. , Galfano A. , Artibani W.
Published: June 2018

Prostate biopsy can be performed through different approaches, with several differences in patient preparation, procedural technique and post-biopsy patient management. On the basis of our personal experience, and comparing it with literature data, this paper presents our data reviews regarding enema and antibiotic prophylaxis administration, biopsy technique, prostate sampling, core pathological management and post-operative management. We also provide a possible standardization of these procedures in patients undergoing transperineal TRUS-guided prostate biopsy. We accordingly classify antibiotic prophylaxis and bowel preparation as optional/advisable, ultrasound prostate examination before biopsy and local anaesthesia as recommended. Prostate sampling should be performed with at least 8 cores, to be increased proportionally to prostate volume. Each sample should be sent to the pathologist in single containers, according to the pre-embedding sandwich method. Finally, the patient should be evaluated for early complications before discharging, and for delayed complications within one month after the procedure. (Urologia 2007; 74: 1–7)
Testicular Cancer. Open Questions: Prevention, Early Diagnosis and Infertility
Authors: Menditto V.G. , Polito M. , Muzzonigro F. , Minardi D. , Muzzonigro G.
Published: June 2018

Testicular cancer is the most common malignancy in men aged 15–35 years. Histologically testicular germ-cell tumors have two main subtypes: pure seminoma and non-seminoma. Knowing the histopathological tumor type and detecting the relevant prognostic factors helps to guide the subsequent therapeutic course.

At present there are no recommendations for testicular cancer screening in healthy young men, even among men showing high risk; however, a testicular cancer should be diagnosed as soon as a young man presents with suggestive signs and symptoms. Furthermore, thanks to highly effective treatments including surgery, chemotherapy, and radiation therapy, it is very important to effectively manage secondary prevention and improve these patients’ quality of life. Secondary prevention of relapses or secondary malignancy onsets should be carried out through a regular follow-up of the patient; in selected cases of positive family history, it is possible to perform genome-wide analyses aiming at searching the genes possibly causing testicular germ-cell tumor in affected first-degree male relatives. Long-term therapies can yield infertility and sexual dysfunction, issues gaining more and more importance from a clinical point of view.

Sperm cryopreservation should be systematically offered to all requiring patients; moreover, screening for gonadal dysfunction should be considered in the follow-up of testicular cancer survivors, with the aim of hormone supplementation in symptomatic patients. (Urologia 2007; 74: 8–14)
Transitional Cell Carcinoma of the Prostate
Authors: Bassi PF , Falabella R. , Pinto F. , Sacco E. , Racioppi M.
Published: June 2018

Transitional cell carcinoma of the prostate (TCCP) has become a well recognized entity, showing an increasing incidence due to the growing research awareness. TCCP is part of the well known pan-urothelial disease: the urologist, therefore, is strongly recommended to consider the prostate at any time in the management of superficial and invasive bladder cancer. Several cases are diagnosed in association with bladder cancer (secondary TCCP): primary prostatic transitional cell carcinoma arises ‘de novo’ as first tumour of the prostate urothelium and is rare. Prognosis depends on the prostate invasion degree. No reliable staging systems are presently available. Non-invasive TCCP can be successfully treated with conservative means (TUR +/- BCG), whereas stromal invasive TCCP must be aggressively treated with radical cystectomy. TCCP can interphere with surgeon's decisions about urinary diversion in patients undergoing radical cystectomy for urothelial cancer. (Urologia 2007; 74: 15–21)
Sclerosing Sertoli Cell Tumor of the Testis
Authors: Calcagno C.
Published: June 2018

Sclerosing Sertoli cell tumor of the testis is a very rare neoplasm. To date only 19 cases have been reported in the literature. We present the twentieth case in a 39 year-old man treated with conservative surgery with a review of the pathological and urological literature. (Urologia 2007; 74: 37–9)
The Clinical and Pathological Comments from a Case of Sarcomatoid Renal Carcinoma
Authors: Marzi M. , Piras P. , D'Alpaos M. , Paiusco A. , Marchesotti F. , Minervini M.S.
Published: June 2018

Sarcomatoid renal carcinoma represents 1–5% of primitive tumours of the kidney. Materials and Methods. A young man aged 34 presented with left side colic pain, preceded two days earlier by hematuria without pain; no previous complaints. Echotomography was performed revealing a tumour lesion of the upper left renal pole, which was subsequently confirmed by computerized tomography scanning, with a maximum diameter of approximately 6cm, and evidence of multiple lymph nodes with increased volume. A left-side nephroadrenalectomy was performed with locoregional lymphadenectomy; a sarcomatoid renal carcinoma with massive metastases in 4/19 excised lymph nodes was shown through histological examination. IL-2 therapy was commenced but interrupted due to intolerance. After only three months the disease resumed locally with diffuse lymph nodes metastases and multiple encephalic metastases. A carboplatinum and vinorelbine therapy was started; the possibility of an allogeneic transplant with non-myeloablative conditioning (“miniallogeneic”) was suggested, though being impossible to be performed due to the further rapid disease progression. The patient died after approximately 10 months. Conclusions. Sarcomatoid renal carcinoma is characterised histologically by closely interconnected epithelial and connective tissue elements; sarcomatous cells seem to originate from a phenotype conversion to carcinomatous cells, as they both belong to the same DNA clone. Their behaviour is very aggressive and the prognosis is unfavourable: 6-month average survival after diagnosis. Radical nephrectomy is still the main therapeutic approach, although it is has no significant influence on prognosis and survival rate. This case showed an approximately 10-month patient's survival, with some different chemotherapeutic approaches being followed (first IL-2 and then carboplatinum) after surgery. (Urologia 2007; 74: 40–2)