bluuebunny/crossref_metadata_2025 huggingface dataset:
Oncological and Functional Results of Laparoscopic Radical Prostatectomy after 100 Procedures: Our Experience
Authors: Parma P. , Dall'Oglio B. , Samuelli A. , Guatelli S. , Bondavalli C.
Published: June 2018

Laparoscopic radical prostatectomy plays an emerging role in the surgical management of prostatic tumors. We present our experience of the first 100 cases of extraperitoneal laparoscopic radical prostatectomy. Our results about continence, erectile function and surgical margins are reported.

Materials and Methods

Between January 2005 and December 2007, 100 laparoscopic radical prostatectomies were performed by one surgeon. We retrospectively reviewed margins status, operative time, blood transfusion rates, time of catheterization, length of hospital stay, continence and potency rates.

Results

The operative time decreased during the learning curve. The mean duration of surgery was 240 minutes (in the first 25 procedures the median time was 320 minutes, while in the last 25 cases the mean duration was 200 minutes). Five conversions to open surgery were required owing to failure to progress. The overall rate of positive surgical margins was 15% in pT2 and 35% in pT3a tumors. We had 3 minor complications (two anastomotic leakage and one hemorrhage from the anastomosis) and 2 major complications (recto-urethral fistula). The mean intraoperative blood loss was 450 ml (range 200–1500). With regard to transfusion, 25 patients (25%) received their autologous units, while 2% of the patients required homologous units. The mean duration of catheterization was 7.8 days. The continence rate at 12 months was 85%; the potency rate was 55% at 12 months.

Conclusions

The results of the present study show that by using a rational approach to training, a general urologist with low experience in laparoscopy is able to safely perform laparoscopic radical prostatectomy, and with oncological and functional results comparable to those of other published series.
Coexistence of Different Histotypes of Renal Carcinoma: Our Experience and Literature Review
Authors: Esposito M. , Varca V. , Simonato A. , Toncini C. , Carmignani G. , Derchi L.
Published: June 2018

The coexistence of multiple, synchronous primary tumors of different histology within the same kidney is a rare condition. We report herein a series of five patients with two tumors of different histology involving synchronously the same kidney.

Materials and Methods

We reviewed the pathology reports of a series of 381 patients who underwent surgery for primary renal tumors at our institution from 2000 to 2007. In the files of all patients with synchronous tumors of different histology, special attention was given to the results of imaging studies.

Results

Five out of 381 patients (1.37%) had coexistence of two primary tumors of different histology within the same kidney. Four patients had ultrasonography as the first imaging procedure, one patient had ultrasonography as the second imaging procedure; all had preoperative CT of the abdomen. Both lesions were detected by preoperative CT in 4/5 of the cases; in the remaining one, the smaller lesion was not visible, even in retrospect.

Conclusions

The coexistence of multiple and synchronous primary tumors of different histology within the same kidney has been only rarely described. To the best of our knowledge, in literature there are only case reports with the exception of a case of renal oncocytoma with evolving papillary RCC. We believe that this condition could be more frequent if the radiologist and the anatomopathologist try to find it.
Evolution of Our Experience in Diagnosis and Therapy for Urinary Infections
Authors: Pizzorno R. , Simonato A. , Esposito M. , Montanaro T. , Mussap M. , Molinari M.P. , Gritti PR. , Carmignani G.
Published: June 2018

The therapy for urinary infections is advised according to the antibiogram; the symptoms request an empirical therapy based on urinary infections knowledge and drugs spectrum activity. We considered the urinoculture performed on 3834 patients, 3012 male and 822 female, hospitalized in our Institute in the period between 01/01/2005 and 31/10/2006; 444 of these were positive (12.7 % - 451 bacterial strains). Table 1: bacterial strains isolaed. We reported some evaluations obtained by antibiogram. E. coli strains Ciprofloxacin sensitive resulted in 60% of cases. Enterococcus species and Enterococcus faecalis strains Ampicillin sensitive resulted in 96.4% and 100% of cases, respectively.

In this study there is a Gram negative prevalence, whereas we had previously observed an equivalence between Gram negative and Gram positive (p 0.001). These data are useful for empirical therapy.
Severe Case of Male External Genitalia Injury in a Poly-Traumatized Patient
Authors: Venzano F. , Simonato A. , Ambruosi C. , Montanaro T. , Orlandini M. , Varca V. , Carmignani G.
Published: June 2018

We describe the case of a 34-year-old patient, polytraumatized during a motorcycle accident. The patient reported complete urethral rupture, bilateral avulsion of the testes by the scrotum, subtotal avulsion with complete amputation of the corpora cavernosa, and a deep open perineal wound. The reconstruction, performed by urologists, was postponed to the following day to ensure high standard of treatment with appropriate tools. This choice has yielded a good aesthetic and functional result.
Investigational Drug Therapies for Overactive Bladder Syndrome: The Potential Alternatives to Anticolinergics
Authors: Sacco E. , Pinto F. , Tienforti D. , Marangi F. , Destito A. , Racioppi M. , Gardi M. , Volpe A. , Bassi P.F.
Published: June 2018

Background

Overactive bladder is a high prevalent and quality of life affecting disease. The mainstay of the medical therapy is represented by antimuscarinic drugs, but their side effects markedly affect patient compliance and prompt studies on novel investigational drugs.

Methods

A systematic literature search of peer-reviewed papers and meeting abstracts published by December 2008 was performed. PubMed databank was searched for original English articles, by using the following search terms: “overactive bladder” or “detrusor overactivity” or “urinary incontinence” and “treatment”, alone and linked to any potential molecular target or novel drug cited in the literature.

Results

Effective alternative pharmacological treatments are currently scarce, but many new promising compounds are emerging which target key molecular pathways involved in micturition control. The most promising potential therapeutic targets include central nervous system GABAergic inhibitory pathway, dopaminergic and serotoninergic systems, b-adrenoceptors and cAMP metabolism, nonadrenergic-noncholinergic mechanisms such as purinergic and neuropeptidergic systems, vanilloid receptor, bladder sensory nervous terminals, nonneuronal bladder signalling systems including urothelium and interstitial cells, prostanoids, Rho-kinase and different subtypes of potassium and calcium channels.

Conclusions

Despite the enormous amount of new biologic insight, very few novel pharmacological therapies seems to have passed the proof-of-concept clinical stage. The ultimate clinical utility of new drugs will depend on the ability to exploit tissue-specific differences and disease-related changes in molecular expression/function and to improve storage phase dysfunctions without interfering with the emptying phase. Further preclinical investigations and controlled clinical trials are urgently needed in this challenging field.
The Activities of Risk Management
Authors: Marino G. , Di Primio O.G. , Cortese F.C. , Pedalino M. , Vella R. , Vercesi E.
Published: June 2018

Introduction

The activities of Risk Management at a department of urology involve specialist health workers, technical and administrative staff as the common denominator is communication, simplification of processes and the quality of health care provision. The Authors present their experience on the management of risk in urology and an attempted classification of adverse events with possible dysfunction in the clinical management in urology department.

Materials and Methods

Our analysis included those adverse events that occurred from January to December 2008. A total of 18 adverse events were identified from 638 urological procedures divided according to diagnosis, treatment and type of hospitalization.

Results

The following events were assessed: number of cases with wound infection: 5 (4.7%), diastasis of the surgical wound: 3 (0.47%), catheter obstructions that required therapeutic endoscopic or surgical haemostatic procedures: 5 (0.78%), delayed administration of treatment: 3 (0.47%) and accidental fall out of bed: 2 (0.31%).

Conclusions

The transition from a reactive to a preventive system remains the key to provide the citizen with the best health care in safety conditions. The involvement of different organizational and managerial levels in an optimal atmosphere in the absence of stress appears to be the most balanced and successful approach, especially putting aside the attitude of assigning error culpability. The transmission of individual experiences at a regional and national level will allow refining the project, which foresees the identification and classification of possible events and especially the ways and preventive procedures to achieve them.
Which Technical Aspects have an Impact on Perceived Pain during Transperineal Prostate Biopsy? A Prospective Study Involving 445 Cases
Authors: Antonelli A. , Simeone C. , Giovanessi L. , Zambolin T. , Zani D. , Cunico S. COSCIANI
Published: June 2018

To assess the technical aspects determining the perceived pain during prostate biopsy via transperineal access.

Materials and Methods

We conducted prostate biopsy with transperineal access in local anesthesia. Between January 2007 and January 2008, data on prostatic biopsies were prospectively surveyed. The patient was requested to assess perceived pain by means of a Visual Analogue Scale ranging from 0 (no pain) to 10 (unbearable pain). Complications were recorded by telephone interviews 30 days after the biopsy. The histological diagnosis was recorded.

Results

445 prostate biopsies were conducted. The average perceived pain score amounted to 2.60. At univariate analysis, a lower score was recorded in cases where the anesthetic agent was diluted with physiological saline, those in which a single cutaneous access was chosen along the middle line, those in the first bioptic series as compared to the following series and those in which no sampling involved the transition region. However, the multivariate analysis showed that only the single cutaneous access was statistically significant. In those cases, also the rates of delayed perineal pain were significantly lower. The cancer diagnosis rate showed no correlations with the type of cutaneous access.

Conclusions

A single median cutaneous access reduces the pain associated to transperineal prostatic biopsy.
Complete Duplication of Bladder, Urethra, Clitoris and Vagina Associated with Bilateral Ureteral Reflux in an Old Female Patient: Unique Case
Authors: Cai T. , Bausi F. , Mondaini N. , Nesi G. , Bartoletti R.
Published: June 2018

Complete duplication of the bladder, urethra, vaginal and clitoris is an extremely rare congenital anomaly that is usually diagnosed at pediatric age. We report an unusual case of a complete bladder, vaginal, clitoris and urethra duplication occurred in an old female patient (81 years old). This case highlighted the fact that an anatomical anomaly should be considered in all patients with persistent urinary tract problems, especially in old women, due to patients’ reluctance to consult physicians for this kind of problem.
Re-Biopsies of the Prostate after Endo-Magnetic Resonance Imaging (MRI) and Spectroscopy (MRS) in Patients with ASAP: Preliminary Results
Authors: Bosio A. , Destefanis P. , De Maria C. , Bisconti A. , Carchedi M. , Negro C. , Buffardi A. , Petracchini M. , Munoz F. , Cirillo S. , Fontana D.
Published: June 2018

Introduction e Objectives

There are some evidences that the combination of EndoMRI and MRS might be able to limit the number of iterative biopsies in patients with negative biopsies of the prostate and a still rising PSA. The aim of this study is to evaluate the possible role of EndoMRI/MRS in patients with ASAP.

Methods

From November 2005 to September 2008 we enrolled 28 consecutive patients diagnosed with ASAP at a TRUS-guided needle prostate biopsy. All patients underwent prostatic EndoMRI and MRS. A prostatic zone was classified as: suspicious for prostate cancer if low intensity signal was present on T2-weighted images and/or if the choline + creatine / citrate ratio was >0.86; equivocal or negative otherwise. A subsequent 12-core needle prostate biopsy was performed and supplementary biopsies were added in the suspicious zones. The results of MRI/MRS were then compared with histological findings.

Results

The combination of EndoMRI and MRS was suspicious for cancer in 70% of patients, equivocal in 23% and negative in 7%. Histological findings at re-biopsy included: prostate cancer in 35%, ASAP in 23%, BPH or prostatitis in 42%. In 78% of patients diagnosed with prostate cancer the combination MRI/MRS was suspicious and in 22% equivocal. In all patients the cancer was found in suspicious zones at MRI/MRS where targeted biopsies were performed.

Conclusions

The combination of EndoMRI and MRS proved to have a good sensitivity but a poor specificity in identifying a concurrent prostate cancer among patients with ASAP. The location of positive cores for prostate cancer was consistent with the suspicious zones at MRI/MRS.
ESWL and Triple Fire Lithotripter
Authors: Guiggi P. , Micheli C. , Nunzi E. , Bini V. , Porena M.
Published: June 2018

The ideal lithotripter which all companies hope to achieve in the near future, should be characterized by high efficacy, low impact on the patient's sensitivity to pain and least detrimental action on the surrounding tissues. Yet, even the most modern technology seems to be still very far from achieving these goals. For around 1 year our Department has been using the last generation lithotripter Piezolith 3000® (variable triple-focus). Compared to its predecessor, this machine has some changes such as: a) triple focus module that allows to adjust the focal distance to the size of the calculation, b) greater focal depth ranging from 15 cm in Piezolith 3000® fixed focus to 16.5 cm in the new lithotripter, allowing for an easier and more effective treatment of obese patients, c) increase in power by opening the SW variable focal length (F1: 0.20–3.26 mJ/mm2, F2: 0.08–1.64 mJ/mm2, F3: 0.030–0.41 mJ/mm2). The objective of our work is to assess whether the technical characteristics of the new Piezolith 3000® determine a real improvement in management of urinary calculi.

Methods

265 patients undergoing ESWL with variable triple-focus lithotripter from January 2008 to January 2009 (Group A) were compared to 265 patients treated with an equal lithotripter Piezolith 3000® fixed focus (Group B). The two groups were homogeneous as for the following variables: age, size and location of the calculi, which are distributed as follows: superior calyx (6), medium (20), inferior (32), renal pelvis (36), pyeloureteral junction (12), lumbar ureter (50), iliac (12), pelvis (6), iuxtavesical (70), bladder (7), multiple sites (14). The ESWL was performed in both groups with ultrasound exclusive point.

Results

In Group A the time of fragmentation is lower compared to Group B (p<0.01), with fewer days required for fragment expulsion and lower number of re-treatments (p<0.05). The latter result is probably due to increased average energy applied (2.35 mJ/mm2). However, the increase of this energy results in parallel increased perception of pain during ESWL.

Conclusions

Piezolith 3000® represents a real improvement in the effectiveness of fragmentation but there is, compared to the previous model, a significant reduction in the time of expulsion. This suggests that this variable is affected by other factors.
Urinary Stone Disease during Pregnancy: One Problem, Two Patients
Authors: Zanin M. , Vianello F. , Gigli F. , Beltrami P. , Zattoni F.
Published: June 2018

Urolithiasis in pregnant women is a quite uncommon event: about one in 1500 pregnancies is complicated by urinary calculi and it occurs in 80–90% of the patients during the second or third trimester of pregnancy.

Several factors may predispose stone formation in the upper urinary tract during pregnancy: the “physiological” hydronephrosis, the gestational hypercalciuria, and an elevation in both glomerular filtration rate and renal plasma flow, associated with an increase of creatinine clearance and higher renal filtration rate of sodium, calcium, and uric acid. Flank or abdominal pain is the most common symptom associated with evident or microscopic hematuria. Differential diagnosis of pain varies according to its location: it could be of gastrointestinal or gynecologic origin.

Diagnosis is previously based on ultrasound evaluation. The use of radiation must be avoided during pregnancy, even if the risk of fetal injures depends on gestational age and radiation dosage. Most of the symptomatic ureteral stones affecting pregnant women pass spontaneously: therefore therapy could be conservative (hydration, analgesia, antibiotics, antiemetics) in the most of cases, although in the 15–30% of the cases it is necessary to adopt an active treatment, like percutaneous nephrostomy drainage, ureteral stent insertion or ureterorenoscopy.
Penile Carcinoma: Treatment of Metastatic Disease after Previous Neoadjuvant Chemotherapy and Locoregional Therapy
Authors: Longo N. , Di Lorenzo G. , Verze P. , Arcaniolo D. , Creta M. , Buonopane R. , Riccio R. , Mirone V.
Published: June 2018

Introduction

Metastatic squamous cell carcinoma of the penis is a rare condition in European countries. Neoadjuvant chemotherapy improves local disease control in patients with lymph node metastases and/or inoperable disease. Limited data exist on the efficacy and safety of chemotherapy in the adjuvant setting for patients with metastatic disease after previous neoadjuvant chemotherapy and locoregional therapy.

Methods

Twelve patients with metastatic penile carcinoma previously treated with neoadjuvant chemotherapy and locoregional therapy were enrolled into the study. Treatment protocol consisted of paclitaxel 175mg/m2 at a 3-week interval. Objective response rate according to Response Evaluation Criteria in Solid Tumors, progression-free survival, overall survival and toxicity were evaluated.

Results

A partial objective response, a disease stability, and a disease progression were documented in 3, 3 and 6 patients, respectively. Median progression-free survival and median overall survival were 4 and 6 months, respectively. Treatment was well tolerated; only one case of grade 4 toxicity was reported.

Conclusions

Our initial data suggest that paclitaxel monotherapy is active and well tolerated in patients with metastatic squamous cell penile carcinoma previously treated with neoadjuvant systemic chemotherapy and local therapy. Further studies are therefore needed.
Results at 48 Months of a Randomized Trial on Maintenance after Early Adjuvant
Authors: Serretta V. , Morgia G. , Altieri V. , Passalacqua D. , Falsaperla M. , Cacciatore M. , Nicolosi F. , Siragusa A. , Borruso L. , Vaccarella G. , Vacirca F. , Napoli M. , Paola Q. , Gange E. , Falvo F. , Allegro R. , Melloni D.
Published: June 2018

Introduction and objectives

The role of maintenance regimen following early intravesical chemotherapy after TUR of intermediate risk non-muscle invasive bladder cancer (NMI-BC) is still debated. Only few studies have been published on this topic, rarely dealing with patients receiving an early treatment. The aim of the present study is to evaluate the efficacy of one-year maintenance after a 6-week cycle of early intravesical chemotherapy.

Methods

Between May 2002 and August 2003, 482 patients with intermediate risk NMI-BC after TUR and early intravesical chemotherapy (epirubicin, 80mg/50mL) were randomized between 6-week induction cycle and induction plus maintenance with 10 monthly instillations. A written informed consent was obtained. All patients underwent cytology and cystoscopy 3-monthly for 2 years and 6-monthly thereafter.

Results

Treatment interruption for toxicity was required in 39 patients. Median follow-up was 48 months. Ten patients (2.5%) progressed and 117 patients (29.6%) recurred. The tumor characteristics were equally distributed between the two arms. No statistically significant difference in recurrence free survival (RFS) was detected between the two arms (p=0.43). An advantage in terms of recurrence free rate (RFR) in favor of the maintenance arm was evident only until 18 months after TUR (p=0.03). A trend for a higher benefit from maintenance in primary and multiple tumors was detected.

Conclusions

The risk of tumor recurrence is significantly reduced by one-year maintenance only for 18 months after TUR in comparison with patients receiving a 6-week cycle of early intravesical chemotherapy. The disadvantages of prolonged intravesical chemotherapy should be taken into account.
Conservative Management and Survival of Patients Affected by T1G3 Bladder Tumours. When Shall we Indicate it and When the Cystectomy?
Authors: Ruggirello A. , Serretta V. , Passalacqua D. , Zaccone V. , Daricello M. , Aragona F. , Allegro R. , Melloni D.
Published: June 2018

Introduction

Conservative management is not applicable to all T1G3 tumors. The appropriate treatment should minimize mortality while assuring reduced morbidity and good quality of life. Several attempts have been done to identify categories of T1G3 patients at higher risk. The role of biologic markers is unclear and the prognostic risk factors are mainly clinical. The proper time to abandon the conservative approach in favor of cystectomy is still object of debate.

Objectives

The aim of the present study is to assess the clinical tumor features showing a detrimental effect on survival, identify the clinical risk factors impacting survival in patients undergoing conservative management of T1G3 bladder tumor, and to analyze the prognostic role of recurrence.

Methods

The present analysis is extended to 236 patients with T1G3 bladder tumors treated by TUR plus intravesical therapy between 1976 and 2005. Patients with previous T1G3, Tis, more than 3 tumors or greater than 3cm were excluded. Urinary cytology was obtained within 30 days after TUR. Since 2000 re-TUR has been performed. A sequential combination of mitomycin-C (30mg/30ml) and epirubicin (50mg/50ml) was adopted in 106 patients (44.9%). BCG or other agents were given intravesically in 85 (36.0%) and 38 (16.1%) patients, respectively. Seven (3%) patients refused intravescical therapy. In the case of Ta-T1 recurrence, TUR and one year of adjuvant intravesical therapy were repeated. Patients went off study if Tis, T1G3 or T-category tumor over T1 were detected. Age, previous history, number of tumors, re-TUR, adjuvant therapy, recurrence and progression were considered for survival analysis.

Results

Tumors were primary in 177 (75.3%) and single in 144 (61.5%) cases. At a mean follow-up of 52 months (range: 3–246 months), 116 patients (49.2%) relapsed. The recurring tumor was T1 in 47 (40.5%) cases and T1G3 in 33 (28.4%). In 11 additional patients (9.5%) a Tis was detected. Twenty-five patients (10.6%) progressed and 15 patients (6.4%) underwent cystectomy. Median overall survival was 167 months. The 5-year progression-free survival rate was 87.8%. Thirty-two patients (13.6%) died, 22 (9.3%) for bladder cancer. A higher mortality was detected in recurrent (p= 0.002) and multiple (p=0.009) tumors undergoing conservative management. Survival was decreased by NMI recurrence (p<0.0001) and by progression (p=0.009). No statistical significant difference in survival was evident in relation to the grade and stage of the recurrent tumor.

Conclusions

Previous positive history and multiplicity are relevant risk factors for survival in patients affected by T1G3 NMI TCCB conservatively treated. Survival is decreased if conservative management is not given up at the time of NMI recurrence, independently from its grade and stage.
Renal Artery Thrombosis
Authors: Pettenò A. , Dotti P. , Coluccio A. , Dallavalle F. , Gentilini C. , Tralce L.
Published: June 2018

The diagnosis of acute renal infarction is often delayed or failed due to the rarity of the disease and to its non-specific clinical presentation. Cigarette smoking, with its vasoconstrictive and prothrombotic effects, is a known and sure risk factor for the development of the atheroembolic artery disease.

Case study

This is the report of a case of acute renal infarction in a heavy-smoking patient, a 66-year-old man who arrived at our ward for right worsening backache with vomit and abdominal pain not reacting to the analgesic therapy. A urgent ultrasound showed excretory axes not dilated bilaterally. Therefore, we had to perform further diagnostic tests (CT and then angiography) which highlighted a case of a right massive renal infarction due to complete thrombotic obstruction of the renal artery with patent contralateral ramification. We performed a PTA and then a local infusion of thrombolytic (metalyse 2 mg in 10’). After this treatment the patient showed an immediate stop of the hurting symptomatology, an improvement of the flow and an opacification of the parenchyma. (lower and medium part) with persistence of vision concerning endoluminal thrombosis. A CT angiography 20 days later, after home therapy with LMWH at therapeutic doses, confirmed a restored and normalized vascularization of the lower and medium part of the right kidney.

Conclusions

In the light of these case results - good revascularization of the lower 2/3 of the right kidney, despite a prolonged time of ischemia from the beginning of the symptoms to the diagnosis and to the further thrombolytic therapy (about 14 hours) -, we assume that a wider use of the Doppler method can be of some usefulness, in case of recurring colics especially not reacting to analgesic therapy with negative ultrasonography check-up for the dilatation of the excretory routes, in order to considerably reduce the diagnosis time of renal diseases of vascular type.
Current Impact of Transrectal Ultrasonography in Prostate Cancer Diagnosis
Authors: Martella O. , Galatioto G. PARADISO , Pace G. , Bergamasco L. , Maselli G. , Vicentini C.
Published: June 2018

Aims

We evaluate the diagnostic accuracy of transrectal prostate ultrasonography (TRUS) in prostate cancer (PCa) diagnosis in a group of patients who underwent prostate biopsy in 2008.

Material and Methods

100 patients (mean age 65 years) underwent transrectal prostate biopsy at our center. Indications to biopsy were: suspected malignancy at rectal examination or increase of total PSA and/or PSA velocity and/or PSA density and/or low percentage of free PSA. 10–12 biopsies and additional ones in case of suspected ecographic images in every patient were carried out. We classified the ecographic aspects as: highly suggestive for heteroplasia (focal or widespread hypoechoic area in the peripheral zone), weakly suggestive (small hypoechoic focal alterations), and isohecoic areas.

Results

At ultrasound examination, highly suggestive images were found in 20 patients, weakly suggestive images in 39 patients, and isoechoic images in 41 patients. PCa was diagnosed in 45 patients. 40% of cancers (18 pts) appeared as highly suggestive hypoechoic images, 31% (14 pts) as weakly suggestive, and 29% (13 pts) as isoechoic. 32% was the positive predictive value of isoechoic areas biopsies, 90% of highly suggestive hypoechoic images, and 36% of weakly suggestive images. In the last ones, the diagnosis was often coincidental, i.e. in the opposite lobe, or in a different sextant of the same lobe (serendipity). Detection rate was 60% for prostate volumes ≤50 cc and 24% for volumes >50 cc.

Discussion

The result analysis allowed us to formulate the following considerations: - 60% of currently diagnosed PCa are not detectable by ultrasonography, or there are aspecific ecographic findings - 40% of cancers are detectable by ultrasonography with specific ecographic findings - The clinical value of the hypoechoic focal alterations is similar to isoechoic ones - Detection rate is positively influenced by prostate volume.

Conclusions

The study of hypoechoic and isoechoic bioptised areas shows a significant difference in TRUS accuracy in prostate cancer diagnosis. In this set of patients, prostate volume and transrectal ultrasonographic findings proved to be the most informative variables about PCa risk at the moment of first biopsy at any age.
Extracorporeal Shock Wave Therapy as First Line Treatment in Patients with Peyronie's Disease
Authors: Palmieri A. , Imbimbo C. , Longo N. , Creta M. , Buonopane R. , Dalena G. , Vivaldi O. , Riccio R. , Mirone V.
Published: June 2018

Introduction

Extracorporeal Shock Wave Therapy (ESWT) is a minimal invasive treatment for patients with Peyronie's Disease (PD). Currently, however, controversial data exist on the efficacy of ESWT as first-line treatment.

Methods

We performed a prospective, randomized, double blind, placebo-controlled trial to evaluate the efficacy of ESWT in a group of 100 patients with disease duration <12 months, naive to previous treatments, with a single plaque, erectile dysfunction and/or painful erections and/or penile recurvatum. Patients were randomized to undergo ESWT or Placebo. The Storz Duolith device was employed for treatments. A non-functioning probe was employed as placebo. Treatments were administered in four sessions at weekly intervals. The following evaluations were performed at baseline and at 12- and 24-week intervals from treatment: IIEF-5 (International Index of Erectile Function) questionnaire, VAS (Visual Analogue Scale), plaque size measurement, penile curvature measurement.

Results

Only patients treated with ESWT reported a significant improvement of mean VAS score and of mean IIEF-5 score at a 12-week follow-up. Mean plaque size and mean curvature degree did not improved significantly in patients treated with ESWT but showed a significant worsening at the 24-week follow up compared to baseline values in the placebo group.

Conclusions

ESWT can improve significantly painful erections and erectile functions in patients with PD naive to other treatments. Moreover, ESWT can stabilize plaque size and penile curvature thus preventing disease progression.
Associating Serenoa Repens, Urtica Dioica and Pinus Pinaster. Safety and Efficacy in the Treatment of Lower Urinary Tract Symptoms. Prospective Study on 320 Patients
Authors: Pavone C. , Abbadessa D. , Tarantino M.L. , Oxenius I. , Laganà A. , Lupo A. , Rinella M.
Published: June 2018

Introduction

Serenoa repens (saw palmetto) has been employed for the treatment of lower urinary tract symptoms (LUTS) for several years. Its mechanism of action is believed to be due to antiandrogenic, antiproliferative and antinflammatory properties. An association of Serenoa with the nettle “Urtica dioica” showing antiproliferative activity and the pine “Pinus pinaster” derivative, showing antinflammatory action, has been proposed in recent years. Such an action is hoped to act not only by reducing LUTS but also by preventing the development of prostate cancer.

Material and Methods

During the years 2007 and 2008, 320 patients suffering from LUTS were treated with an association of Serenoa repens 320 mg, Urtica dioica 120 mg and Pinus pinaster 5 mg, named IPBTRE. This treatment was administered to all patients for a minimal duration of 30 days to a maximum of a year, either alone or in association with antibiotics or alpha-blockers, if needed. Outcome analysis was based on evaluation of symptoms, prostate volume and maximum flow rate (Qmax).

Results

From a careful analysis of the data collected in our database, the following observations can be made: ages varied between 19 and 78 years. The patients were affected by BPH in 46% of cases, chronic prostatitis syndrome in 43%, chronic genital-pelvic pain in 7% and other conditions in 4%, the absolute numbers being 147, 138, 22 and 7 patients, respectively. No untoward side effect was reported in any case. Variations in symptom score could be fully evaluated only in 80 of 320 patients (25%), of whom 68 (85%) reported a significant benefit, with special reference to an improvement of pain, urgency, strangury and nocturia. Data on variations in prostate volume, as measured by digital rectal examination, were available in 84 (26.5%) patients. No significant change was observed. Qmax after treatment was measured in 83 (26%) patients. It did not show significant changes from the initial values.

Discussion

The association tested in our study appeared to be safe and well tolerated. No changes in flow rate and prostate volume were observed, but a marked reduction of LUTS was observed in 85% of evaluable cases, especially with regard to pain and irritative symptoms. Whether or not such an association may display a prevention of prostate cancer, may be investigated in additional studies.
Can Hyperbaric Oxygenation Therapy (HOT) Modify the Blood Testosterone Concentration?
Authors: Passavanti G. , Tanasi P. , Brauzzi M. , Pagni M.R. , Norgini E. , Aloisi A.M.
Published: June 2018

Introduction

Testosterone has a modulating effect on inflammatory and healing processes. In this study, we evaluate whether hyperbaric oxygenation therapy (HOT) modifies the blood concentration of total testosterone (TT) in patients treated for different pathologies.

Materials and Methods

Fourteen male patients (23–72 years old) were treated with 90-min HOT sessions (range 4 to 23 sessions) as an adjuvant to the following conditions: leg fractures, osteonecrosis, diabetic foot, firearm injuries, complicated arthroprosthesis and underwater diving embolism. As controls, six healthy male volunteers (37–51 years old) were subjected to 10 HOT sessions. Testosterone plasma levels were determined immediately before the first HOT session and the day after the last session.

Results

At the end of treatment, 12 patients fully recovered and 2 (diabetic foot patients) showed a marked improvement. Testosterone significantly increased after hyperbaric oxygenation therapy in both patients and controls (ANOVA, p<0.004).

Discussion

We conclude that hyperbaric oxygenation therapy increases the blood concentration of total testosterone in patients as well as in healthy men. This finding raises new questions and indicates the need to investigate the causes of this increase and its therapeutic significance. Since testosterone modulates inflammation and healing processes, it is possible that hormonal changes are the mechanisms affected by hyperbaric oxygenation therapy.
Laparoscopic Radicai Prostatectomy without Ligation of the Santorini's VenousPlexus
Authors: Ferrara V. , Giannubilo W. , Azizi B. , Scaldazza C. Vecchioli , Garritano A.
Published: June 2018

Background

The goal of our work is to demonstrate how, in the approach to laparoscopic radical prostatectomy, the ligation of Santorini's dorsal venous complex is not necessary. The retrospective evaluation of video-laparoscopich radical prostatectomy performed at UOC of Jesi with this technical device, showed an increased blood loss compared to a technique that provides for the ligation of Santorini's plexus and, overall, reduced blood loss compared with the average radical open prostatectomy.

Material and Methods

50 video-laparoscopic extraperitoneal radical prostatectomies were evaluated, which were performed with the same technique and by the same operator. The technique involves the non-ligation of Santorini's venous plexus. Surgical, oncological, functional outcomes were considered and in particular blood loss.

Results

The results are consistent with those reported in literature, and without ligation of the Santorini's venous plexus, there has been no increase in blood loss intra-and / or post-operatively or in the percentage of patients with hemotransfusion.

Conclusion

The video-laparoscopic radical prostatectomy, although a not yet codified and standardized technique for the treatment of organ-confined prostate cancer, did show oncological and functional results basically I similar to open-sky technique. But compared to this, it has certainly demonstrated a lower blood loss and a reduction of morbidity. The non ligation of Santorini's venous plexus, always necessary during open prostatectomy, in our experience is not necessary in video-laparoscopy
Androgen-Deprivation Therapy in Prostate Cancer: Clinical Evidence and Future Perspectives
Authors: Pinto F. , Calamo A. , Totaro A. , Sacco E. , Volpe A. , Racioppi M. , D'Addessi A. , Bassi P.F.
Published: June 2018

Androgens are involved in the development and progression of prostate cancer even if the mechanism is not well-recognized. For this reason androgen-deprivation therapy remains a milestone for the treatment of patients with advanced and metastatic disease and, in the last years, in conjunction with radiotherapy and surgery in locally advanced tumors. Alternative options, such as intermittent deprivation suppression, seem to be promising in terms of clinical benefits and toxicity profile. However, current therapies present side effects, such as testosterone surge with consequent clinical flare-up, metabolic syndrome and hormone-resistance, which develops after a variable number of years. Novel therapies such as LH-RH antagonists and prolonged depot LH-RH analogues have been developed in order to avoid clinical flare-up and testosterone microsurges. Novel androgen synthesis inhibitors, such as abiraterone acetate and MDV3100, have been recently discovered and tested as promising hormonal second-line agents in patients with castration-resistant prostate cancer. Finally, long-term side effects from androgen deprivation, such as osteoporosis, sarcopenic obesity and cardiovascular morbidity should be carefully monitored and properly treated.
Sport, Infertility and Erectile Dysfunction
Authors: Gulino G. , Sasso F. , D'Onofrio A. , Palermo G. , Luigi Di , Sacco E. , Pinto F. , Bassi P.F.
Published: June 2018

In the last decades a growing interest has been dedicated to prevention, diagnosis and therapy of male genital pathologies, such as varicocele, infertility and erectile dysfunction in the population involved in sport activities. High incidence (up to 30%) of varicocele has been reported in a population of athletes and up to 60–80% in the subgroup of body-builders. The incidence of varicocele specifically increases with hours of training, in a linear model. Controversial data come from literature about the effects of physical activity on fertility, with prevalence of trials demonstrating worsening of seminal parameters. Furthermore, it has been demonstrated that physical stress in healthy male athletes can interfere with LH levels. Bicycling is one of the major risk factors for erectile dysfunction, with incidence of 13–24%. This is due to the prolonged compression of perineal arteries leading to reduced chronic penile perfusion. Bioengineering studies have been the basis for industry to produce specifically shaped saddles that significantly reduce and minimize compressive effects. Finally, high frequency of lower urinary tract symptoms (LUTS) in cyclists has been related to increased incidence of erectile dysfunction in comparison with normal population.
Kidney and Sports
Authors: Luciani G. , Giungi S. , Di Mugno M.
Published: June 2018

Several renal function modifications can be related to sports activity, as pre-existing renal dysfunction can influence the assessment of sports practice capability. The multiplicity of aetiologies requires an accurate diagnosis to correctly define the treatment approach and feasible activities. Previous nephrectomy or chronic renal failure are conditions that complicate the sport exercise fitness assessment and every patient should be assessed individually by a multidisciplinary medical team.
Sports and Genitourinary Traumas
Authors: Sacco E. , Marangi F. , Pinto F. , D'Addessi A. , Racioppi M. , Gulino G. , Volpe A. , Gardi M. , Bassi P.F.
Published: June 2018

Introduction

Statistical data referring to sports-related traumas of the urinary tract are quite scarce; nevertheless, it is possible to draw general data on the relationship between sports and urological traumas.

Methods

Literature review of peer-reviewed articles published by May 2009.

Results

Urological traumas account for about 10% of all traumas, and about 13% of them is sports-related. Genitourinary traumas are among the most common cause of abdominal injuries in sports. Blunt injuries are more common than penetrating ones and renal injuries are by far the most common, followed by testicular injuries; ureters, bladder and penis injuries are much more infrequent. Considering chronic microtraumas, injuries of bulbar urethra are also common in sports that involve riding. Overall, the incidence of genitourinary trauma due to sports is low. Renal traumas in sports injuries usually consist of grade 1–11 lesions and usually do not require surgical treatment. Cycling is the sporting activity most commonly associated with genitourinary injuries, followed by winter sports, horse riding and contact/collision sports. Literature data suggest that significant injuries are rare also in athletes with only one testicle or kidney. General preventive measures against sport-related injuries, along with the use of protective cups for male external genitalia, are generally sufficient to reduce the incidence of urogenital trauma.

Conclusions

Overall, studies show that urogenital injuries are uncommon in team and individual sports, and that most of them are low-grade injuries. Participation in sports that involve the potential for contact or collision needs to be carefully assessed in the athletes with only one testicle or kidney, even though urogenital injuries should not preclude sports participation to an appropriately informed and counseled patient. Further research is needed to acquire more knowledge on genitourinary injuries according to age, sports type and technical skill.
Occurrence Rates and Predictors of Lower Urinary Tract Symptoms and Incontinence in Female Athletes
Authors: Simeone C. , Moroni A. , Pettenò A. , Antonelli A. , Zani D. , Orizio C. , Cunico S. Cosciani
Published: June 2018

Introduction and hypothesis

To assess the prevalence of lower urinary tract symptoms (LUTS) and incontinence in female athletes and to determine the etiological factors.

Methods

An anonymous self-questionnaire was collected from 623 casual female athletes aged 18 to 56 years, who were involved in 12 different sports. The surveys were distributed by hand to the athletes, during their sports fitness tests, in a sports center. We investigated the relationship between urinary disorders and factors such as age, body mass index (BMI), parity, duration of physical exercise, and type of sport.

Results

The prevalence of LUTS was 54.7%, and 30% for urinary incontinence. Changes in urinary frequency were detected in 91 (14.6%) women. Prevalence of dysuria was 13.3%, urinary straining was present in 173 (27.8%) athletes, whereas urinary urgency had an estimated prevalence of 37.2% with 232 athletes suffering from this disorder. Urgency was very common in volleyball players, as was dysuria among hockey and basketball players, whereas straining mainly affected aerobic participants and cyclists. Long training hours and competitive practices were correlated with the onset of LUTS. High-impact sports were more frequently associated with incontinence, while low-impact sports with LUTS. The sport with the main number of incontinent people was football. Urge incontinence affected a lot of athletes, mainly cyclists and football players. Stress incontinence was more frequent in hockey and volleyball players.

Conclusions

LUTS and incontinence are prevalent in female athletes. In many cases, the disorders were present only during sports activities. In this sample, the presence of urinary disorders did not seem to be a barrier during sports or exercise.
Percutaneous Nephrolithotomy (PCNL) in a 9-year-old Patient with Horseshoe Kidney
Authors: Ziglioli F. , Ferretti S. , Salsi P. , Dinaie F. , Ciuffreda M. , Campobasso D. , Frattini A.
Published: June 2018

Introduction

The horseshoe kidney is the most frequent renal anomaly, with a prevalence of 0.25% and amale to female ratio of 3:1. Although the pathogenesis remains controversial, the consequences of the impaired urinary drainage are well known: up to two third of patients present with urinary stasis, infection and urolithiasis. Percutaneous nephrolithotomy (PCNL) is a successful procedure for urolithiasis in horseshoe kidneys.

Materials and Methods

A 9-year-old patient with a 4-cm stone associated with horseshoe kidney underwent Percutaneous nephrolithotomy (PCNL). During the procedure, a flexible uretheroscopy was performed in order to obtain a complete vision and an optimal management of the procedure.

Results

At the end of the procedure, the patient was stone-free. We reported no hemorrhagic complications, no pain and no infection. The patient was discharged after 48 hours.

Conclusions

The procedure is safe and effective, as long as the surgeon pays attention to the recommendations below.
Wunderlich Syndrome. Clinical and Therapeutic Aspects of a Long-Term Experience
Authors: Marino Gaetano , Pedalino Marco , Di Primio Otello Giovanni , Piras Dorino , Vella Riccardo , Verces Enrico , Carbonatto Paolo
Published: June 2018

Introduction

Wunderlich's syndrome is defined as a clinical manifestation secondary to sudden spontaneous rupture of renal parenchyma in the absence of injury, resulting in hemoretroperitoneum. This syndrome may occur in patients with benign or malignant neoplasm of the kidney, arterial venous fistulae, immunovasculitis and other phlogosis of the kidney.

Materials and Methods

We present 19 cases of acute spontaneous hemoretroperitoneum or Wunderlich's syndrome diagnosed from 1996 to 2009, related to the following conditions: 7 renal carcinomas, 4 angiomyolipomas, 2 adrenal hemorrhages, 1 bleeding polycystic kidney, 2 hemorrhagic renal cysts and three cases of immunovasculitis. Overall, 6 patients were treated with acetylsalicylic acid and 4 with dicumarolics for cardiovascular disease, while 13 patients were suffering from hypertension

Results

In 19 cases there was no mortality and the following treatment was performed: 11 nephrectomy, 4 partial nephrectomy, 2 adrenalectomy, 2 selective embolization of intrarenal branches as single treatment, while in three other cases, the embolization was carried out from a surgical procedure, conservative (partial nephrectomy) in one case, ablative (nephrectomy) in two other cases.

Conclusions

The spontaneous hemoretroperitoneum is a rare syndrome associated with acute kidney disease often unknown to the patient and only in selected cases with small hematoma; it is possible to perform arteriography with selective embolization of branches avoiding renal access surgery. So far, it is unknown to which extent anti-platelet and anticoagulant drug treatment contributes to this syndrome but, in our experience, they have increased the morbidity of the clinical condition.