bluuebunny/crossref_metadata_2025 huggingface dataset:
Alpha1 Adrenoceptors in Human Urinary Tract: Expression, Distribution and Clinical Implications
Authors: Arrighi N. , Bodei S. , Zani D. , Mirabella G. , Peroni A. , Simeone C. , Sigala S.
Published: June 2018

Adrenergic receptors (ARs) are a class of proteins belonging to the G protein-coupled receptor family. Pharmacological and molecular studies allowed dividing ARs into three different categories: α1, α2 and β. In this review, we focused on α1 ARs and α1 AR antagonists, since α 1 ARs play an important role in the pathophysiology of a number of urinary tract (UT) dysfunctions. α1 ARs are widely expressed in human UT; in particular, the three ureter areas (distal, medial and proximal) show different patterns of receptor expression (i.e. distal > medial = proximal), giving the molecular basis for the use of α1 ARs antagonist in the expulsive therapy of distal ureter calculi. Bladder areas are characterized by important differences among trigone, detrusor and neck, the first showing a different pattern of expression compared to the other parts. Further, there are evidences of both density and subtype gender-dependent expressions. α1 ARs expression in prostate and detrusor is a widely investigated area of research, mainly due to the clinical impact of benign prostatic hyperplasia (BPH). Urethra has not been well studied in human, although it plays a role in the control of continence.

Studies carried out on α1 AR subtype expression in the UT indicate that, although the presence of each subtype is observed, α1A firstly and then α1D ARs seem to be more expressed than α1B ARs. Thus, drugs that demonstrate high α1A/D AR selectivity have drawn the researchers’ attention. As it relates specifically to the α1 AR antagonists used in the treatment of lower UT symptoms, the concept of uroselectivity has been operationally defined; indeed, in a number of recent publications uroselectivity has been defined as the degree to which a given compound inhibits norepinephrine-induced increase in urinary muscle contractions and/or its propensity to generate unwanted cardiovascular effects, such as decreases in blood pressure.
Circumcision: What do we cut when we are Cutting?
Authors: Calcagno Carlo
Published: June 2018

The term circumcision refers to partial or complete excision of the foreskin. There are three types of circumcision: ritual circumcision, performed for religious practice, as a rite of passage, usually during neonatal or transpubertal age; prophylactic circumcision, as preventive measure against future potential diseases; therapeutic circumcision, performed because of an evident pathology of the foreskin with clear medical indications. The investigation on the meaning of the ritual circumcision goes beyond the boundaries of the present paper; we are referring to anthropological literature to better understand its origin and reasons. Prophylactic circumcision spread among English-speaking peoples in the nineteenth century as a means against masturbation. In the twentieth century prevention against cancer, urinary infections, sexually transmitted diseases and, eventually, AIDS took over. The controversy about prophylactic circumcision is increasing nowadays in the United States whereas in the other English-speaking countries the procedure has almost disappeared and this represents what Edward Wallerstein calls “the uniquely American medical enigma”. There are many interpretations for prophylactic circumcision and its lasting success in the United States. Each explanation probably hits the target only partially because this procedure takes its roots in the cultural history of the above mentioned country and in the relation with its puritan origins. Therapeutic circumcision is performed because of a clear and evident pathology of the prepuce. The embryological development of the prepuce is completed at the sixteenth week of pregnancy. At birth, this tissue covers the glans without an apparent plane of cleavage and should be defined as ‘non-retractile prepuce’ instead of ‘phymosis’. The prepuce in its free development becomes completely retractile at puberty. These evolutionary concepts about prepuce have been described by Douglas Gairdner in 1948 and Jacob Oster in 1968. The prepuce is an integrant part of the male genital system. It has three functions: protective, immunological and sexual. The extremely complex innervation of the prepuce explains its sensibility and makes it an extraordinary erogenous zone. In view of these features, the excision of the prepuce necessarily interferes with the patient's sexual function, and possibly involves serious psychological concerns. Circumcision represents a minor surgical procedure but, like any other surgical techniques, can result in complications: A) operative: hemorrhage, removal of too much skin from the penile shaft infection; B) post-operative: sepsis, urethrocutaneous fistula, gangrene of the penis; C) long-term complications: meatal stenosis, skin bridge between the glans and the penile shaft. Sometimes complications are severe and can cause death of the patient, especially during ritual circumcision.

Given these aspects, a well informed consent is mandatory both in terms of potential complications linked to surgical procedures, and in terms of sexual and psychological consequences.
Efficacy and safety of endoscopic treatment of ureteral stones in pediatric age
Authors: Mariani S. , Matarazzo E. , De Dominicis M. , Capozza N. , Caione P.
Published: June 2018

Ureteroscopy procedures in pediatric age are becoming more and more common thanks to the availability of smaller caliber instruments, and of improved endoscopic techniques. The efficacy of this procedure in pediatric age is still discussed nowadays. This paper aims at reviewing all cases of ureteral lithiasis treated by ureteroscopy plus intracorporeal lithotripsy (ULT), as well as verifying efficacy and safety of this procedure in pediatric age.

Materials and Methods

From July 2002 to May 2006, 37 patients (26 female, 11 male; mean age 7.4 years; range 2–17) were treated by ULT for ureteral stones: 30 in distal, 4 in middle and 3 in proximal ureter. Median size of stones was 7mm (range 3–13mm). Dilation of the ureteral meatus was necessary in 2 patients only. Endoscopic procedure was similar to adult patients. Outcomes were statistically compared with current literature data.

Results

In 36 (97.3%) out of 37 patients ULT proved successful. All patients having stones in distal (30) and middle (4) ureter were stone-free at the end of treatment. Stone migration into the kidney pelvis occurred in 1 patient with proximal ureter stones (66.7% stone-free rate): an ESWL treatment was therefore performed. 1 case only (2.7%) developed a perioperative complication (stone migration). Hematuria and flank pain in 4 patients (10.8%) were the most common reported post-operative complications. A stone-free state was confirmed at 1 and 3 months for all 36 patients. There was no evidence of ureteral strictures and/or ureteral refluxes.

Conclusions

Smaller caliber ureteroscopes confirmed ULT as the first-choice treatment procedure in children affected by ureteral lithiasis, thanks to its efficacy and safety.
Intravenous Treatment of Postoperative Pain in Urologic Surgery: Comparison between Analgesics
Authors: Fasciolo A. , Belcio W.
Published: June 2018

The need for efficaciously treating acute postoperative pain arises primarily from the observation that pain is associated with modifications of organs and systems that can become extremely detrimental to the patients; the antalgic treatment, besides its ethic aspect, plays therefore an essential role since it can enormously improve the patient's outcomes, significantly reducing mortality, morbidity and discomfort.

In the postoperative antalgic therapy, it is possible to associate molecules of different pharmacological classes: the aim of our study is to compare different combinations between opioids, Ketorolac and Paracetamol in 75 operations of urologic surgery; to assess any side effects and the postoperative pain (through the VNS scale) and, if necessary, to administer supplementary doses of Tramadol in order to complete the pre-arranged pain therapy. The statistical analysis of data demonstrates first how different antalgic medicaments can enhance each other, highlighting the greater effectiveness of Ketorolac compared to Paracetamol during the awakening period, at the pre-established dosages.

Moreover, the study presents the slight occurrence of side effects during the postoperative period, of no importance in most cases: we can therefore come to the conclusion that the association between different drugs could result in a reduction in the single given dosages, and would probably be co-responsible of the low incidence of iatrogenic sequelae.
Three-Dimensional Conformal Radiotherapy in Localized Carcinoma of Prostate: Preliminary Reports of Toxicity in Dose-Escalation Treatment
Authors: Tumminello E. , La Paglia L. , Montemaggi P.
Published: June 2018

Purpose

Many studies confirmed the evidence of a dose-response relationship in prostate cancer. Escalation of dose using conventional techniques is however limited by rectal tolerance. IMRT and 3D-CRT have been designed to allow dose escalation while not exceeding rectal tolerance. We evaluated the acute and early late tolerance to surrounding organs upon dose escalation from 70 to 78 Gy in 3D-CRT setting, in order to introduce the IMRT process as a routine practice in prostate cancer treatment.

Materials and Methods

We compared clinical data from 35 patients with localized adenocarcinoma of the prostate, who received 70 Gy within a traditional reconstructed three-dimensional treatment planning, and data from 72 patients who received 78 Gy within a three-dimensional conformal setting. In order to respect rectal tolerance in the higher dose group, limits were set for rectum doses, and simulation procedures were standardized. We evaluated radiation morbidity (acute and late gastrointestinal and genitourinary toxicity) using the Radiation Therapy Oncology Group scoring criteria (RTOG scale).

Results

Increasing doses from 70 Gy to 78 Gy resulted in no significant difference for acute and late effects.

Conclusion

A procedural standardization aiming at minimizing day-by-day variation, as well as a more consistent dose distribution to critical organs may significantly reduce the risk of increased toxicity in dose-escalation setting.
A case of particular diffusion of prostate cancer
Authors: Marzi M. , Piras P , D'Alpaos M. , Paiusco A. , Marchesotti F. , Minervini M.S.
Published: June 2018

Neoplastic diffusion can occur due to dissemination, continuity, through lymphatic or haematic vessels, or, more rarely originate from surgical instruments. We report a particular case of prostate cancer spread.

A 64-year-old man was diagnosed with undifferentiated prostate cancer through prostate biopsy. The patient was treated with a total androgenic block allowing a decrease in PSA blood level. The patient, wishing to regain his sexual activity compromised by hormonal therapy, interrupted the treatment spontaneously and unchecked. 19 months later he contacted us again: we had to hospitalize him due to a 12-hour anuresis. A urgent right transcutaneous nephrostomy was carried out, yielding an improvement in the patient's condition. A descending pyelography carried out by means of nephrostomy revealed a completely reduced urethral lumen. During the following surgery for transcutaneous urinary derivation we observed the two ureters entangled in whitish tissue, spreading bilaterally up to the renal pelvis. The histological examination of tissue samples showed the presence of neoplastic metastasis of prostatic origin.

We assume that this neoplastic diffusion has occurred due to permeability through the lymphatic vessels of the urethral wall, producing a subsequent neoplasm growth: this has been limited by the urethral connective sheath, thus preventing its wide diffusion to the surrounding tissues, but fostering its spreading upwards along the ureter pathway.
A Four-Year Experience with Holmium-YAG Laser: Parameters of use
Authors: Cecchetti W. , Cerruto M.A. , Bianco M. Dal , Milani C. , Zattoni F.
Published: June 2018

In the last years, laser has gained increasingly high popularity in Endourology The newer generation Ho-YAG lasers represent the most updated laser used in Urology, being able to successfully treat both urinary stones and soft tissue lesions. The aim of this work was to report a multicentre 4-year experience using the Ho-YAG laser in the treatment of stones and soft tissue lesions, in order to offer parameters and modalities of use in several different situations.

Materials and Methods

Two urological Centers were asked between 2002 and 2005 to use Coherent Versa Pulse 20 Ho-YAG laser source in the treatment of urinary stones in 212 patients, and urinary soft tissue lesions (urethra, ureter or bladder neck strictures or urinary tract tumors) in 56 patients. According to the various situations (either stone fragmentation or treatment of soft tissue lesions), pulse frequency and energy per impulse were differently dosed and set.

Results

The following parameters were identified as the starting points for the correct use of the Ho-YAG laser: a) lithotripsy with rigid endoscope: 365 μm fiber, 0.8 - 1.2 Joule (J) energy and 6–8 Hz frequency; 365 μm fiber, 0.8–1.2 J energy and 10–12 Hz frequency; 550 μm fiber, 1.0–1.5 J energy and 10–12 Hz frequency. b) lithotripsy with flexible endoscope: 270 μm fiber, 0.6–1.0 J energy and 6–10 Hz frequency. c) soft tissue resection in case of: c1) ureteral stricture, 365 μm fiber, 0.6 J energy and 14–16 Hz frequency; c2) urethral stricture, 365 μm fiber, 0.7 J energy and 16–18 Hz frequency; c3) upper urinary tract tumors, 365 μm fiber, 0.7 J energy and 16 Hz frequency; c4) bladder tumors 365 μm fiber, 0.8 J energy and 16–20 Hz frequency; c5) bladder neck strictures, 365 μm fiber, 1.0 J energy and 16–18 Hz frequency.

Conclusions

In the light of these parameters, Ho-YAG laser is a very handy instrument for the treatment of both urinary stones and soft tissue lesions, which allows to put aside the current tools used for the same purposes.
Male to Female Transsexualism
Authors: Imbimbo C. , Verze P. , Arcaniolo D. , Mirone V.
Published: June 2018

The transsexual is a person who suffers from a deep identity disturbance caused by physical characteristics which do not correspond to mental traits and tendencies. The persistent sense of contradiction between his or her deceptive sexual appearance and his or her inner perception, causes a strong desire to achieve harmonization of the two. This aspiration, even if modification of chromosomal sex is impossible, can be fulfilled by undergoing SRS (Sex Reassignment Surgery). SRS represents the last major step of a clinical, therapeutic and diagnostic program involving skilled professionals in the physical and psychological sciences. Their assistance and counseling helps the patient to calmly and consciously decide to undergo SRS. A surgeon has the obligation not only to validate the operation outcome, but to also to maintain a long-term follow-up. A transsexual is not just like any other person; he or she should therefore be treated with sympathy and understanding. The surgeon should try his best to establish a relationship of mutual trust, taking into account the causes of anxiety and stress felt by the patient, and keeping in mind the ultimate objective, which is an improvement in the quality of life.

At present, the most widely used surgical techniques are the Simple Penile Skin Inversion, the Penile-scrotal flap Inversion and the enterovaginoplasty. Each surgical technique has its own advantages and disadvantages, and it is up to the surgeon, in discussion with the patient, to make the appropriate choice.

The surgical technique performing the Simple Penile Skin Inversion seems to ensure a better cosmetic appearance and an adequate lubrication, but a lower rate of satisfaction, in relation to the neocavity depth. On the contrary, the Penile-Scrotal Flap Inversion guarantees an adequate vaginal depth and lubrication, even though the cosmetic appearance is not always completely satisfactory.

In our experience, a significant number of patients were satisfied with the chosen surgery and felt comfortable with their new post-operative gender. Taking into account all the complications involved, none of the patients did regret; actually, they would recommend the same operation to others. The overall results of some studies carried out on patient satisfaction before and after SRS show a marked post-surgery improvement of sexual life.
Endourological Management of Ureteral Stenosis and Vesicoureteral Reflux after Renal Transplantation
Authors: Frattini A. , Capocasale E. , Granelli P , Mazzoni M.P. , Maestroni U. , Valle R. Dalla , Salsi P , Busi N. , Ferreri G. , Cortellini P , Sianesi M.
Published: June 2018

Introduction and Objectives

Ureteral stenosis and vesicocoureteral reflux after renal transplantation represent a key concern because of their incidence and the associated morbidity. Prompt diagnosis and minimally invasive treatment are mandatory in immunosuppressed patients with single kidney. The aim of this study is to evaluate the success rate of the endourological techniques in the management of such complications.

Materials and Methods

Between January 1996 and December 2006, 647 kidney transplants were performed. Urinary tract continuity was re-established by ureteroneocystostomy according to Gregoir-Lich technique. We observed 13 cases of ureteral stenosis (2%) and 11 cases of symptomatic vesicoureteric reflux (1.7%). The endourogical procedure was performed in 13 patients: 5 cases of II-III grade vesicoureteric reflux, 4 early ureteral stenosis and 4 late ureteral stenosis. Patients with vesicoureteric reflux underwent endoscopic injection of macroplastique in 4 cases and Durasphere in 1. Early ureteral stenoses were treated using balloon dilation in 2 cases, balloon dilation and laser endoureterotomy in 3, ureteral stent placement in the other. Recipients with late stenosis underwent laser incision and balloon dilation in 2 cases, balloon dilation in 1 and a laser incision only in the last case. Combined antegrade and retrograde endoscopic approach was performed in 7 patients, whereas retrograde access in 1.

Results

Endourologic treatment was successful in 9 cases (69.2%); 2 patients required open reconstructive surgery due to endourological technique failure (early ureteropelvic junction stricture, late ureterovesical anastomotic stricture). Vesicoureteric reflux was corrected in 3 patients (60%), 2 patients underwent uretero-ureterostomy for recurrent reflux. No technique-related morbidity was observed. With a mean follow-up of 81.6 months, 8 patients show normal renal function, 5 patients have returned to haemodialysis (4 for chronic rejection, 1 for carcinoma in the graft).

Conclusions

Considering their low morbidity and the satisfactory success rate, we claim that endourological procedures should be considered the preferred treatment for ureteral stenosis and vesicoureteric reflux in selected patients.
Evaluation of the Female Sexual Function after Vaginal Surgery Using the FSFI (Female Sexual Function Index)
Authors: Di TONNO F. , Mazzariol C. , Optale G. , Piazza N. , Ciaccia M. , Pianon C.
Published: June 2018

Urinary Incontinence (UI) and Pelvic Organ Prolapse (POP) have a detrimental effect on Female Sexual Function (FSF). We decided to focus on the effect of vaginal surgery for UI and/or POP on FSF.

Materials and Methods

72 women (aged 42–80, mean age: 62) were given the FSFI questionnaire after undergoing the following operations: 54 Tension-Free Vaginal Slings (TFVS), 12 Kelly plications, 3 hysterectomies+Kelly 2 Tension-Free Vaginal Slings+Kelly 1 hysterectomy+Kelly+posterior IVS.

Results

35 women did not answer the questionnaire, 6 women were sexually inactive and answered only partially; 31 patients answered completely. Mean pre- and postoperative scores were, respectively, 25.26 and 25.22 (normal >26.55). 9 patients had a normal preoperative score, whereas 22 a pathological score. The FSFI score did not change postoperatively in 26 women; it worsened in 3 and improved in 2 women treated because of coital incontinence.

Conclusions

Vaginal surgery for UI and/or POP does not seem to affect FSF in the great majority of cases; conditions may worsen or improve, the latter definitely resulting from the treatment of Coital Incontinence. The high number of patients not answering the questionnaire deserves further studies and it could be - at least partially - explained on the basis of psychological and/or cultural problems regarding the highly emotional issues of sex, incontinence and prolapse.
Periorbital Emphysema after Laparoscopic Nephrectomy: Case Report and Literature Review
Authors: Cerruto M.A. , Ruggera L. , Beltrami P. , Tiscione D. , Zattoni F.
Published: June 2018

A 40-year-old lady presented with marked swelling and inability to open her left eye immediately after laparoscopic nephrectomy for a left pyelonephritic kidney. A diagnosis of periorbital emphysema was made and within 7 days the emphysema spontaneously disappeared. Periorbital emphysema is a rare benign condition that may complicate a laparoscopic nephrectomy.
Surgery for renal carcinoma metastases
Authors: Antonelli A. , Cunico S. Cosciani
Published: June 2018

During the last few years, the increasing use of diagnostic imaging (especially ultrasound) has allowed a remarkable rise in the detection of asymptomatic, early-stage renal neoplasms, possibly treatable by radical surgery. Renal cell carcinoma, however, is still the renal neoplastic condition with the highest mortality rate, due in most cases to the presence of distal metastases.

Because of a lack of agreement on an efficient systemic therapeutic approach, surgery is generally considered to be the most suitable option to remove metastases: it is technically easy to perform, it can increase survival and the patient's psychological compliance, though metastasectomy is unlikely to cure the metastatic patient.

In our experience, we studied 1475 patients who underwent surgery for renal cell carcinoma from 1983 on. 304 (20%) developed a metastasis; 4 subjects only (5.4%) out of the 74 having multiple metastatic anatomical sites were long-surviving. 39 subjects (16.9%) out of the 230 having single-site metastases are currently disease-free (mean follow-up: 80 months from diagnosis): 33 out of the 111 patients who underwent metastasectomy, 4 out of the 57 who received a medical therapy, 1 out of the 14 being administered radiotherapy, and 1 out of the 48 who were cared under palliative purposes only.

Therefore we concluded that, in case of single-site (lung or adrenal) metastases, surgery is the most suitable and advisable therapeutic approach, being the only option able to achieve survival even for a small amount of patients.

New biologic drugs are currently under investigation, which can interfere with tumor proliferation and angiogenesis: the study results are still preliminary, nevertheless these drugs open the way to a multimodal medical option of treatment for metastatic renal cell carcinoma.
Botulinum toxin in the treatment of overactive bladder
Authors: Sacco E. , Paolillo M. , Totaro A. , Pinto F. , Volpe A. , Gardi M. , Bassi P.F.
Published: June 2018

Clinical effectiveness of botulinum toxin (BTX) in the treatment of both neurogenic and idiopathic detrusor overactivity has been demonstrated in several studies. However, different protocols and techniques have been used by authors.

Methods.

Literature review on intradetrusor injection of BTX for detrusor overactivity.

Results.

The greatest clinical experience reports the use of 200 and 300 U Botox®. Available data suggest that clinical efficacy, duration, and the side effect profile is similar at these doses. Very few data, on the other hand, are available regarding the clinical outcomes using the Dysport® preparation; isolated reports support that efficacy is similar when using a dosing range of 500 to 1000 SU with increased risk of systemic side effects using 1000 SU. A variety of injection volumes was used, demonstrating similar efficacy and tolerability profile. Clinical effect duration extends six to ten months in the majority of studies. Data suggest that a repeated injection scheme proves successful in the vast majority of initial responders.

Conclusions.

Safety, effectiveness, specificity and reversibility make BTX a new attractive treatment modality for overactive bladder syndrome. However, more experience is needed to standardize the injection protocol with respect to therapeutic outcomes and adverse effects.
Psycho-relational aspects of urinary incontinence in female sexuality
Authors: Simonelli C. , Tripodi F. , Vizzari V. , Rossi R.
Published: June 2018

Urinary incontinence (UI) is a very common disorder in women, involving severe consequences on the patients’ perception of quality of life and sexuality. The aim of this contribution is to analyze the psycho-relational aspects linked to UI, focusing on sexual activity, self-perception of sexual competence and self-esteem.

Urinary incontinence causes feelings of shame and inadequacy as well as low self-esteem; it may affect sexual activity, reducing sexual intercourse frequency. Many authors highlight a strong comorbidity between urinary incontinence and sexual dysfunctions, such as dyspareunia, vaginismus, hypo-active sexual desire, arousal and orgasm disorders. Literature analysis shows that changes in sexual activity are influenced not only by urinary incontinence symptoms but also by the disorder self-perception, by previous sexuality, menopause, social status and the partner's attitude.

The etiological study of urinary incontinence shows that several different factors play a role in this disorder. Therefore, an integrated therapeutic approach is suggested, considering, besides the organic issues, the experience and feelings of patients as well as the consequences on their sexual and social life.
Urologic surgical procedures in patients with uterus neoplasm and colon-rectal cancer
Authors: Marino G. , Laudi M. , Capussotti L. , Zola P.
Published: June 2018

Introduction.

During the last 30 years, the multidisciplinary treatments of colon and uterus neoplasm have yielded an increase in total survival rates, fostering therefore the increase of cases with regional relapse involving the urinary tract. In these cases the iterative surgery can be performed, if no disease secondary to pelvic pain, haemostatic or debulking procedure is present, and must be considered and discussed with the patient, according to his/her general status.

Materials and Methods.

From 1997 to August 2007 we performed altogether 43 pelvic iterative surgeries, with simultaneous urologic surgical procedure because of pelvic tumor relapse in patients with uterus neoplasm and colon and rectal cancer. In 4 cases of anal cancer, the urological procedure were: one radical prostatectomy with continent vesicostomy in the first case, while in the other 3 cases radical pelvectomy with double-barrelled uretero-cutaneostomy In 23 cases of colon cancer, the urologic procedures were: 9 cases of radical cystectomy with double-barrelled uretero-cutaneostomy, 4 cases of radical cystectomy with uretero-ileo-cutaneostomy according to Bricker-Wallace II procedure, and 9 cases of partial cystectomy with pelvic ureterectomy and ureterocystoneostomy according to Lich-Gregoire technique (7 cases) and Lembo-Boari (2 cases) procedure. In 16 cases of uterus cancer, the urological procedure were: 7 cases of partial cystectomy with pelvic ureterectomy and uretero-cystoneostomy according to Lich-Gregoire procedure; in 3 cases, a radical cystectomy with urinary continent cutaneous diversion according to the Ileal T-pouch procedure; 2 cases of total pelvectomy and double uretero-cutaneostomy, and 4 cases of bilateral uretero-cutaneostomy.

Results.

No patients died in the perioperative time; early systemic complications were: 2 esophageal candidiasis, 1 case of venous thrombosis.

Conclusions.

The iterative pelvic surgery in the case of oncological relapse involving the urinary tract aims to achieve the best quality of life with the utmost oncological radicality. The equation: eradication of pelvic neoplasm and urinary tract reconstruction, with acceptable quality of life, will be the future target; nevertheless, it is not possible to establish guidelines beforehand, and the therapy must be adapted to each single case.
Use of human fibrinogen and human thrombin for urethral reconstructive surgery
Authors: Romano G. , De Angelis M. , Barbagli G.
Published: June 2018

The objective of the present study is to test the use of a haemostatic sponge for urethral reconstructive surgery and to assess the relevant benefits.

Methods.

The haemostatic sponge is made up of collagen with human fibrinogen and human thrombin. When the sponge gets in contact with fluids, such as blood, lymph or saline solution, the fibrinogen and thrombin are activated and form a fibrin net able to achieve local haemostasis and tissue regeneration. This kind of product was used in 30 selected patients (pts.), aged 19 - 70 (mean age: 35), who underwent single-stage anastomotic urethroplasty from January 2006 to March 2007: 22 bulbar end-to-end anastomoses and 8 bulbo-prostatic anastomoses. All operations were performed due to post-traumatic stricture of bulbar and posterior urethra. The main selection criterion for the use of the haemostatic sponge has always been the tendency to and/or the presence of bleeding in the different surgical stages. The sponge imbibed in saline solution and suitably modeled for all specific requirements was differently placed: sleeve-shaped in the case of bulbar anastomoses (16 pts.); as a “patch” in the centre of spongioplasty in bulbo-prostatic anastomoses (8 pts.), and within the widening incisions of the urethral roof performed between the two cavernous bodies at level of the intercrural septum (5 pts.). In 1 case (obese patient) a single sponge was placed after the deep perineal reconstruction on the bulbo-cavernous muscle-subcutaneous layers because of massive bleeding.

Results.

In all cases a perfect control of haemostasis could be achieved, with immediate end of bleeding in the points where the haemostatic sponges were used. The dressings performed on day 3 upon removal of the compressive scrotum-perineal bandages did not show any late post-operative bleeding. The follow-up visits at month 1 and 3 yielded positive outcomes for all 30 patients, who achieved complete wound healing by first intention, and a perfect anastomosis especially in the bulbar end-to-end urethroplasty, confirmed by urethrografy at one month.

Conclusions.

The association of human fibrinogen and human thrombin in haemostatic sponges represents a manageable, useful product, apparently sure, not negatively interfering in repairing and regenerating tissue processes, and allowing a simple and direct control of important bleeding events occurring during urethral reconstructive surgery as well as other operations. It is therefore advisable to more widely use the product after a suitable follow-up period.
Testis tumors: what is new?
Authors: Necchi A. , Nicolai N. , Salvioni R.
Published: June 2018

Germ-cell tumors (GCTs) are extraordinary chemosensitive neoplasms that resemble the model for the cure of cancer even in metastatic disease. Nonetheless, a small portion of patients does not achieve a long-lasting complete response and new efforts are then required in order to further improve their healing rate.

This paper summarizes what is new about the management of these tumors through dedicated sections about biology, prognosis and treatment. Special interest is then focused on the Italian reality and how it participates to the advances made by the International community.
Is antibiotic prophylaxis in invasive urodynamics a useful procedure in postmenopausal subjects?
Authors: Siracusano S. , Knez R. , Tiberio A. , Simonazzi M. , Alfano V. , Giannantoni A. , Ciciliato S. , Belgrano E.
Published: June 2018

Objectives.

To define the incidence rate of urinary tract infections (UTI) and the usefulness of antibiotic prophylaxis in postmenopausal female undergoing invasive urodynamics (IU).

Methods.

262 postmenopausal females underwent IU, being previously double-blindly randomized in 2 homogenous age-matched groups. Group 1 (130 patients) received oral antibiotic prophylaxis with a single 400 mg dose of norfloxacin. Group 2 (132 patients) was given placebo. The statistical analysis was performed using a Chi-Square test, in order to evaluate any difference between groups for UTI incidence rate.

Results.

54 patients out of 262 (20.6%) developed a UTI [24 out of 130 subjects who received antibiotic prophylaxis (18.4%), and 30 out of 132 subjects who received placebo (22.7%)]. As per the UTI incidence rate, no statically significant difference (p>.05) was shown between patients receiving and those not receiving the antibiotic prophylaxis.

Conclusions.

The UTI incidence rate in postmenopausal women undergoing urodynamics is not affected by the administration of antibiotic prophylax.
Efficacy of Dutasteride, Alfuzosin or both on Quality of Life in Patients with Prostatic Hyperplasia and BOO. A Two-Year Spontaneous, Observational, Self-Controlled Study
Authors: Ventimiglia B. , Consoli S. , Serrao M. , Serrao A. , Tsirgiotis A.
Published: June 2018

Three homogeneous groups of patients suffering from benign prostatic hypertrophy (BPH) were evaluated by means of a two-year observational study, in order to assess and compare their Quality of Life (QoL) under the following different medical treatments. Group 1: alfuzosin alone, Group 2: alfuzosin and dutasteride, Group 3: dutasteride alone. QoL was evaluated by validated indexes, such as the IPSS and the QoL-Vas.

Although different in entity and timing, as expected, all the three groups showed an improvement. The best and quickest results were detected in the drug association of Group 2. Significant decrease in volume was detected in the dutasteride groups (2 and 3) but not in group 1 (alfuzosin alone), where a quick relief of LUTS was detected, due to its well-known alphalytic action. Our results suggest that dutasteride alone does not result in a rapid decrease in LUTS, whereas it can help to manage the reduction of the prostate volume. A combination therapy seems therefore to be recommended to obtain LUTS relief both in the short and long term results.
Update on epidemiology and risk factors of prostate cancer
Authors: Oderda M. , Mondino P. , Zitella A. , Gontero P. , Tizzani A.
Published: June 2018

Prostate cancer is one of the most common malignancies in the world; more and more men are being diagnosed with prostate cancer worldwide. According to epidemiological studies, prostate cancer will become the most common male cancer by 2010, with 900,000 cases per year. Nevertheless, although the constant increase in incidence, knowledge about the aetiology and risk factors of this tumour is still poor. Several important issues could foster the understanding and prevention of this disease, such as the variation in incidence of prostate cancer between ethnic populations, studies on migrants, dietary and genetic factors. Here we provide an update on epidemiology and risk factors of prostate cancer.
Erectile dysfunction and alcohol intake
Authors: Dachille G. , Lamuraglia M. , Leone M. , Pagliarulo A. , Palasciano G. , Salerno M.T. , Ludovico G.M.
Published: June 2018

The objective of this work is to evaluate in a selection of patients with erectile dysfunction the influence of alcohol consumption and the response to alcohol abstinence with and without sildenafil association.

Materials and Methods.

In a population of 150 consecutive patients with erectile dysfunction we studied 50 patients aged between 22 and 77 years (mean 56±14 SD). These 50 patients were divided into three different treatment groups and were screened for three different levels of alcohol risk with two questionnaires. All patients were evaluated with an International Index Erectile Dysfunction (IIEF) questionnaire before and after one month of treatment.

Results.

The 50 patients included 14 patients with high alcohol risk, 34 patients with low alcohol risk and only 2 patients with no alcohol risk. After one month, 29 patients responded to the therapy, and 21 did not respond. The IIEF questionnaire presented a statistically significant difference between the different risk groups before and after treatment (p≤0.05). All the patients were examined with a penile Doppler Ultrasound. Only 10 of them had an abnormal diastolic peak velocity (PDV) and only 1 presented both pathologic systolic peak velocity (PSV) and PDV. These 11 patients did not respond to therapies and 10 of them were at high alcohol risk. The alcohol consumption risk was directly correlated with PDV (p=0.00001; R=0.4).

Conclusions.

The results of this study demonstrated a significant relationship between alcohol consumption and erectile dysfunction. This underlines the important therapeutic issue of alcohol abstinence in treating patients with erectile dysfunction.
Acute thrombosis of the renal artery secondary to closed abdominal trauma: our experience and literature revision
Authors: Benedetto G. , Nigro F. , Bratti E. , Ferrarese P. , Abatangelo G. , Scremin E. , Cavarretta L. , Tasca A.
Published: June 2018

Aim

Thrombosis secondary to renal closed abdominal trauma is a rare event, most of the time it is clinically silent. We report here our experience.

Materials and Methods.

This is the case of a boy came to our observation after a road trauma with motorbike fall-out. The boy arrived in ED for head injury. The patient, stable for haemodynamics, had lacerated and contused injuries at pelvis and right buttock level. He underwent chest x-rays, brain CT and neurosurgery examination: all resulted negative. There was no macrohematuria, nor lumbar pain. Objectively abdomen was treatable. The patient was referred to temporary observation for 12 hours when he was asked to undergo abdomen ultrasound, which showed no documented lesions except for fluid collection at the pelvic level. To rule out all doubts, the patient had an abdominal CT scan, which showed a silent left kidney with suspected thrombosis at left renal level. The patient was sent to our attention after 15 hours: we decided to perform immediately selective arteriography with thrombus lysis. The arteriography documented a massive thrombosis. The thrombus lysis was impossible to be performed. To maintain the perfect functionality of the contralateral kidney we decided not to proceed further, but to perform only left nephrectomy. During surgery mesocolon laceration occurred, so the patient underwent also colic resection.

Discussion.

Thrombosis secondary to a closed renal abdominal trauma is an uncommon event, with little clinical expression. It is the consequence of an injury. Deceleration produces arterial dissection, which alters the blood flow to the kidney, which is then twisted and complicated with renal thrombosis. Quite common is the association with diaphragmatic rupture or urethral detachment. The alterations of renal parenchyma in the early hours are detectable only through CT scan, which represents the method of election, and which can highlight a functionally silent kidney.

Conclusions.

Renal thrombosis requires that diagnosis is done within the first 12 hours; a rapid revascularization should be promptly attempted.
Transvesical prostatic adenomectomy: general or local anesthesia
Authors: Fasciolo A. , Baldini C.
Published: June 2018

A transvesical prostatic adenomectomy is defined as an “open-sky” surgical procedure performed to remove a benign prostatic nodule that, growing up, could represent an obstacle to the normal emptying of the bladder. This operation can be carried out under general or loco-regional anesthesia conditions: the second option, however, does not provide the curarization of the patient, and could result in a higher endoabdominal pressure, which could significantly reduce the surgeon's visual field. Nevertheless, this technique allows for a complete analgesia and anesthesia during the first postoperative hours, avoiding the occurrence of abdominopelvic contractions and pain-linked hypertension, which can cause dangerous postoperative bleedings.

As opposed to this, during surgery under general anesthesia conditions, the curarization ensures a wider operating field, free from abdominopelvic contractions, but with important postoperative pain, the main cause of which is the continuous bladder washing; this kind of pain is very difficult to treat even with oppioids: it is certainly the most important cause of bleedings, resulting in patient's discomfort, risk of blood transfusion or even reoperation. The two techniques have been compared in a randomized study on 40 patients: the subarachnoid technique seems definitely to be more favorable, with its optimal antalgic effect even during the first postoperative hours, with no need to use high doses of antalgic iv drugs, and, most important, with no subsequent postoperative hypertension and bleedings.
Anatomy and nerve supply of the pelvic floor
Authors: Cerruto M.A. , Zattoni F.
Published: June 2018

In order to guarantee urinary and fecal continence as well as correct pelvic statics, the perfect neuroanatomical integrity of the pelvic floor muscles is mandatory. As Dickinson stated: “There is no considerable muscle in the body whose form and function are more difficult to understand than those of the levator ani, and about which such nebulous impressions prevail”. Clinical implications of pelvic floor anatomy and nerve supply are evident: a denervation of this muscle group and the consequent muscle dysfunction could result in urinary and/or fecal incontinence, as well as pelvic organ prolapse.
α-Blockers in Benign Prostatic Hyperplasia: The Problem of “Floppy Iris Syndrome”. Results of a Case-Control Study to Evaluate the Surgical Risk through the Meausurement of Pupil Diameter
Authors: Pavone C. , Abbadessa D. , Serretta V. , Cillino V. , Maggioni A. , Rahman D. ABED EL
Published: June 2018

Objectives

α-blockers are a group of α-adrenoceptor antagonists used by urologists to treat lower urinary tract symptoms suggestive of benign prostatic hyperplasia. Recent studies have suggested that these drugs – tamsulosin in particular – are involved in the development of iris complications during phacoemulsification. The objective of this study is to investigate the effects of α-blockers – especially tamsulosin – on pupil diameter.

Materials and Methods

We measured the photopic, mesopic and post-dilatation pupil diameters in both eyes of 24 patients (46 eyes in total), 16 of them treated with α-blockers and 8 of them (16 eyes in total) not treated with any drugs (controls).

Results

All patients treated with tamsulosin showed minor photopic, mesopic and post-dilatation diameters compared to controls. Patients treated with other α-blockers did not show any difference compared to controls.

Conclusions

Even if a small number of eyes was evaluated, our study shows that tamsulosin - through its selective effect on α1A receptors - is the most involved drug in the Intraoperative Floppy Iris Syndrome.
Iliac Artery-Ureteral Fistula: A Fatal Hemorrhage in a Man with Ureterocutaneostomy
Authors: Morelli B. , Berta G. , Cattaneo E. , Lucca I. , Fiorito C. , Oderda M. , Mondino P. , Valentino F.
Published: June 2018

Primary and secondary artery-ureteral fistulas are a rare condition. In this case report we describe a case of misunderstood iliac artery-ureteral fistula, with negative radiological preoperative imaging, which occurred in a man as late complication of ureterocutaneostomy.
Anterior Urethral Therapy
Authors: Parma P. , Samuelli A. , Cappellaro L. , Dall'Oglio B. , Bondavalli C.
Published: June 2018

Surgical treatment of anterior urethral stenosis encompasses a large number of techniques. In literature there are few prospective studies that could compare the efficacy of different techniques. Most of these studies are retrospective and not multicentric. We present a review of the literature on the treatment of penile and bulbar strictures, focusing the attention on different kinds and numbers of complication, and showing short- and long-term results of each technique.
Bladder Augmentation and Urinary Diversions in Kidney Transplants
Authors: Lasaponara F. , Pasquale G. , Cucchiarale G. , Ferrando U.
Published: June 2018

There is some controversy about the safety of kidney transplant in patients with augmented or diverted urinary system: they are considered higher risk recipients in view of increased technical problems and infective complications leading to pyelonephritis and graft loss.

The ureter of a transplanted kidney should be anastomosed into a reservoir with an adequate capacity, with low bladder pressure, with good compliance, and efficient voluntary empting. Ileal and sigmoid bladder augmentation, usually associated with clean intermittent catheterization, has become a well-accepted part of the urological practice and has been used for implantation of the transplant ureter.

During the last years, the interest in new biomaterials for reconstructive surgery has increased. Experimental studies showed how these requests can be satisfied by porcine small intestinal submucosa SIS (Stratasis”): this can be degraded by the host and substituted by “new tissue”. In four recent cases we have used SIS to obtain an augmented, normal-pressure and good compliance bladder reservoir, with three (epithelial, muscular and adventitial) layers normally represented.
Penile Prosthesis Implantation in Kidney-Transplanted Patients
Authors: Lasaponara F. , Paradiso M. , Abbona A. , Sedigh O. , Ferrando U.
Published: June 2018

Most kidney transplantations are performed on middle-aged men for whom problems of sexual potency are still of great importance. Although a functional renal graft improves the problem in some patients and others resolve with oral or intracavernous therapy, about 20% of patients do not have a good response. In non-responders, tricomponent penile prosthesis implantation is possible. In the last 10 years we have implanted with no complications 7 tricomponent AMS 700 prostheses in patients not otherwise responding. Our good results confirm that patients with kidney transplantation should be considered good candidates to the penile prosthesis if the erectile dysfunction persists after different therapies.