bluuebunny/crossref_metadata_2025 huggingface dataset:
Intravesical Instillation of Gemcitabine in Patients with SBC
Authors: De Berardinis E. , Antonini G. , Di Monaco F. , Pisanelli G. Codacci , Di Silverio F.
Published: June 2018

To determine, in phase I trial, the local and systemic toxicity and pharmacodynamics of intravesical Gemcitabine in patients with superficial bladder cancer. To evaluate, in phase II trial, the activity of this treatment against superficial bladder cancer, measuring the response of a marker lesion.

Patients and methods

In phase I trial, twelve patients with histologically confirmed carcinoma to the bladder wall (stage Ta-T1) resistant to previous administration of anti-cancer drugs or BCG were enrolled. They received intravesical Gemcitabine starting at 500 mg and increased in 500 mg increments to 2000 mg. Three patients were treated at each dose level. In phase II trial twenty four patients with superficial bladder cancer resistant to previous treatments were treated by endoscopic resection, but a single lesion less than 1 cm was left in site. Patients then received Gemcitabine 2000 mg weekly for six weeks. The marker lesion was re-analyzed by cistoscopy and patients were re-evaluated every month.

Results

The phase I trial showed no evidence of systemic toxicity and minimal local toxicity. Gemcitabine was undetectable in plasma and its inactive metabolite (2’,2’-Difluorodeoxiuridine) was present at a mean concentration of 1.39 (1.05) μmol/L. In phase II trial, a complete response was obtained in 50% and a partial response in 29%. No response was seen in 5 patients (21%). No patient showed signs of progression of the marker lesion nor the appearance of new lesions.

Conclusions

Intravesical Gemcitabine appears to be well tolerated with no systemic and minimal local toxicity, even at the highest dose (2000 mg). At this dose, it also shows a good ablative action on marker lesions.
The Use of Human Dermal Allograft Material for Transvaginal Slings
Authors: Crivellano S. , Smith J.J. , Kocjancic E. , Bresette J.
Published: June 2018

We evaluated the safety and efficacy of using human dermal allograft material for transvaginal slings to treat female stress urinary incontinence (SUI).

Materials and Methods

We present a prospective series of 253 patients with SUI treated with a transvaginal sling using a Repliform cadaveric human dermal allograft (LifeCell Corp., The Woodlands, Texas) and a bone anchor fixation kit. Clinical history, urogynecologic examination and videourodynamics were performed preoperatively. Results were assessed by a third party through validated quality of life questionnaires (Incontinence Impact Questionnaire and Urogenital Distress Inventory), overall impression and percent of improvement as perceived by the patients, and pad use. Scheduled follow-up examination were performed to rule out erosion, infection, obstruction, pain or recurrent incontinence.

Results

Complete follow-up was available on 234 of 253 patients. Average follow-up was 18 months. Of the patients 78% were cured or improved according to the questionnaires. The average improvement was 80%. At 18 months of follow-up incontinence average distress and scores decreased 10 and 7 points, respectively. Complications were de novo urgency in 5% of cases, recurrent SUI in 15% with no cases of persistent SUI, retention in 2% and slow vaginal wall healing in 1.7%. Of 156 patients 51 (22%) had persistent urgency. There were no cases of vaginal or urethral erosion, osteitis pubis or osteomyelitis.

Conclusions

Our data indicate that use of human dermal allograft for transvaginal slings is associated with low complication rates and favorable outcomes at an average of 18 months of follow-up.
Prophylaxis in Female Urinary Infections in Women
Authors: Costantini E. , Vianello A. , Saccomanni M. , Tascini M.C. , Ioannidou K. , Guercini F.
Published: June 2018

Recurrent urinary tract infections (UTI) in women cost billions of euro annually. E. Coli causes 70–95% of these infections and it has been observed, in vitro and in vivo, to have the capability to develop bacterial biofilms in the bladder: polysaccharide-rich matrix. At the present, the only way to overcome this mucopolysaccaride barrier is to administer long repeated cycles of chemotherapy. We submit prophylaxis to patients with recurrent UTI to sterilize urine for at least 6 consecutive months.

Materials and Methods

42 women with recurrent UTI have been selected according to: urine culture, vaginal swabs, and DNA-probe for Chlamydia, Gonococcus, Mycoplasma. After giving informed consent patients were assigned to treatment group A and B. For the first 10 days both groups received ciprofloxacin 500 mg bid, and then group A received ciprofloxacin 250 mg on alternate days and 1 cpr before every sexual intercourse. The group B received placebo in the same modality. Every sexual intercourse had to be safe. All the patients, after the initial screening, repeated an urine culture every 10 days for the first 6 months and every 20 days for the next 6 months. The statistical analysis was performed by chi-square test.

Results

44 patients finished the study. 23 pt of group A had sterile urine for the first 6 months of the study and 81% for the next 6 months; 1/23 had 2 episodes of symptomatic UTI. 71% of the 21 patients of group B had symptomatic bacteriuria 20 days after the first treatment (p<0.001). 16/21 patients had symptomatic UTI in the first 6 months of the study and the 90% in the 12 months of the study (p<0.001), in spite of every poussèe was treated with the same antibiotic scheme.

Conclusions

This kind of prophylaxis has few collateral effects, and it appears to be effective in the treatment of recurrent UTI in women.
Transition Zone Carcinoma of the Prostate Gland: Evaluation of the Incidence and Biological Behaviour
Authors: De Luca S. , Caccia P. , Giargia E. , Randone D.E.
Published: June 2018

About 25% of all prostate cancers occur in the transition zone (TZ). TZ carcinoma are often well differenziateci and considered clinically unimportant. On the other site a subset of these tumours characterized by high tumour grade has a significant risk of extraprostatic spread, margin positivity and possible biochemical failure. Routine TZ biopsy does not substantially increase the prostate cancer detection rate; however, it can be useful in patients that require repeat biopsy.

We retrospectively analyzed 13 patients with TZ prostate carcinoma in order to evaluate the incidence and the biological behaviour of these types of neoplasm.
Risk Factors for Female Urinary Incontinence and Pad-Test: Our Experience
Authors: Pizzorno R. , Arancio M. , Ninotta G. , Risso D. , Carmignani G.
Published: June 2018

If urinary incontinence in females is present upon effort or exertion, or on sneezing or coughing it is called stress urinary incontinence. If it is accompanied or immediately preceded by urgency it is called urge urinary incontinence. Many studies have shown that risk factors (age, parity, obstetric traumas, body mass index and others) are associated with the prevalence and severity of female urinary incontinence (any type), while other studies do not support this correlation. We reviewed the records at our institution to investigate the relationship between risk factors and severity of stress urinary incontinence.

Patients and methods

In the year 2002, we examined 118 consecutive patients - mean age 59 years SD ± 10.6 years (range 29 – 80 years) with urodynamic stress incontinence, at the Urodynamic Unit of our institution. The severity of stress incontinence was evaluated by Pad-test performed after cystometry (350 ml or maximum cystometric filling). Only results > 3 g were considered positive - mean 37.8 g SD ± 55.7 g (range 3 –281 g, Median ± MAD 17.0 g ± 10.0 g).

Results

We did not find any correlation between severity of incontinence and parity, obstetric traumas, or body mass index. However, we did find a statistically significant correlation between age and severity of urinary incontinence (Spearman Rank Correlation = 0.401, P=0.0014), whereas no association was found among women over 70 years of age.

Conclusions

Our study supports the association between age and severity of urodynamic stress incontinence, while we cannot confirm the correlation between severity of urinary incontinence and other risk factors.
The Role of 5αR Inhibitors in the Early Growth of Pca Cells
Authors: Gravina G.L. , Festuccia C. , Angelucci A. , Muzi P. , Galatioto G. Paradiso , Costa A.M. , Pace G. , Vicentini C. , Bologna M.
Published: June 2018

Aim of this study is to investigate the efficacy of Finasteride (MK906), a selective 5α reductase type 2(5αR2) inhibitor, and of MK386, a selective 5α reductase type 1 (5αR1), on the cellular proliferation of primary cell cultures derived from patients with prostatic diseases.

Methods

We evaluated the effects of Finasteride and MK386 in 30 primary cultures obtained from prostatic carcinoma (PCa), 6 from high grade intraepithelial neoplasia (HGPIN) and 10 from benign prostatic hyperplasia (BPH).

Results

Primary cultures require testosterone (T) for optimal growth and both 5αR inhibitors decreased cell proliferation of primary cultures of PCa cells. IC50 values of Finasteride were lower when compared to those of MK386. In particular, Finasteride was more active in cultures derived from Gleason 2–6 PCa, compared to those derived from Gleason 7–10 PCa. On the contrary, we observed higher effectiveness of MK386 in Gleason 7–10 PCa derived cultures compared to those derived from Gleason 2–6 PCa tissues. The growth of PCa primary cultures was down-modulated by MK386 through a direct inhibition of the epithelial 5αR1, whereas the anti-proliferative activity of Finasteride seems to be mediated by stromal cells present in the primary cultures.

Conclusions

We found biological evidence for an important role of 5αR inhibitors in the early growth of PCa cells and for the necessity of combining anti-hormonal treatment for a sustained inhibition of PCa through the inhibition of stromal cell function even in advanced and androgen-resistant tumor progression phases.
New Metastatic Models in Vivo of Prostate Cancer
Authors: Angelucci A. , Gravina G.L. , Rucci N. , Festuccia C. , Muzi P. , Gaiatioto G. Paradiso , Costa A.M. , Ronchi P. , Fabiani F. , Teti A. , Vicentini C. , Bologna M.
Published: June 2018

Experimental prostate cancer bone metastases are difficult to form in vivo, and some typical clinical patterns remain irreproducible. In our work we describe new metastatic models in vivo using different experimental approaches.

Methods

We injected prostate cancer cells in the left cardiac ventricle or in the medullar cavity of tibia of male nude mice.

Results

Mice were monitored by x-ray analysis and 70% of them revealed osteolytic lesions 40 days after heart injection. By scintigraphy and alu-PCR we were able to identify early a higher number of metastatic loci than by x-ray.

Conclusions

Heart and intratibial injection of prostate cancer cells in nude mice may represent a good experimental model to investigate the pathophysiology of bone and bone marrow metastases in vivo.
Percutaneous Lithotripsy: Indications
Authors: D'Armiento M. , Autorino R. , Cosentino L. , Pane U. , Di Giacomo F. , Quarto G. , Mordente S. , De Sio M.
Published: June 2018

Although percutaneous nephrolithotomy (PCNL) is more invasive than extracorporeal lithotripsy (ESWL) it still plays an important role in the treatment of renal stones and indications to PCNL are mainly the cases where ESWL gives poor outcome results. When considering the indications to treat a patient affected by a renal stone, we have to evaluate factors related to: the stone, the kidney, the patient, the instruments and finally the urologist. We believe that elective indications to PCNL are: a stone burden >2cm; staghorn and complex stones; stones in hydronephrotic kidneys or associated to UPJ obstruction; lower calyceal stones when >10 mm or in a calyx with an unfavorable anatomy; ureteral stones impacted in the UPJ with severe hydronephrosys; stones in caliceal diverticula.
Rehabilitation Therapy and Urinary Incontinence Post Radical Prostatectomy
Authors: Viola D. , Comerci F. , Franceschelli A. , Sanguedolce F. , Ronci L. , Brunocilla E. , Concetti S. , Bertaccini A. , Martorana G.
Published: June 2018

Urinary incontinence rates after radical retropubic prostatectomy vary widely among the different series and depending on the different scoring systems, from 2–10% up to 87%. Rehabilitation therapy is the safest and simplest treatment available so far, although a wide consensus on the efficacy of its results is still lacking.

In our experience, treating post radical prostatectomy incontinent patients with rehabilitation therapy has been safe, reproducible and without side effects; nevertheless, our results suggest its use only in mild to moderate cases of post radical prostatectomy urinary incontinence.
Complete Intermittent Androgenic Deprivation in Prostate Cancer: Our Experience
Authors: De Dominicis C. , Michetti P.M. , Musy M. , Orsolini G. , De Mayo E.E. , Fraioli A.
Published: June 2018

Our study aimed at a retrospective evaluation of clinicAL/biochemical progression in prostate cancer patients treated with intermittent androgenic deprivation (IAD) after a period of continuous cut off (CAD).

Methods

From 1996 to 2003 40 patients have been screened. 8 (gr.A) with increased PSA after radical prostatectomy (pT2N0M0); 32 (gr.B) had no surgical treatment due to age or other pathologies (Gleason ≤ 8). Patients have been monitored dosing out PSA every 3 months. CAD has been applied for an average period of 40 ± 10 months (med. 36). IAD has been performed by an “off” stage of interruption, alternately with an “on” stage of treatment. The cut-off for the suspension/resumption of therapy has been 0.4 ng/mL of PSA for group A and 3 ng/mL for group B. All patients have been received at least 3 cycles of therapy, each including “on” and “off” stages.

Results

After an average follow-up of 48 ± 12 months (med. 42) since the beginning of IAD, the progression-free survival has been 100% for group A and 96.8% for group B. The intermediate time of stage “off” during IAD pointed out a progression increment from the first cycle (51.6% gr. A, 46.6% gr. B) to the third cycle (73.5% gr. A, 76% gr. B).

Conclusions

The study pointed out that the actual average time of pharmacological treatment has been 47% for the period CAD+IAD and 31.5% for IAD only, keeping the PSA always near the nadir. Besides keeping the progression close to 0, we obtained an appreciable saving on the pharmacological costs and an improvement in the quality of life of patients due to the regression of the side-effects of therapy during stage “off”. Nevertheless it is still controversial in the Litterature on the pharmacological procedure to adopt, on the more suitable values of cut-off in PSA and on the timing of monitoring of patients.
A Rare Case Report about an Extrinsic Ureteral Endometriosis
Authors: Piccolotti D. , Viggiano A. M. , Piccolotti G.
Published: June 2018

Endometriosis represents extrauterine nonneoplastic endometrial tissue. Involvement of the genitourinary tract has been reported at an incidence of about 1.2% and ureteral endometriosis is a rare entity. There are two major pathological types of ureteral endometriosis extrinsic and intrinsic. Here, we describe a case report about an ureteral endometriosis extrinsic with double collecting system and complete ureteral duplication.
The Prognostic Value of P53 in Predicting of Bladder Carcinoma
Authors: Pavone C. , Serretta V. , Galuffo A. , Vella M. , Allegro R. , Morello V. , Porcasi R. , Tomasino R.M. , Pavone-Macaluso M.
Published: June 2018

The prognostic value of p53 in predicting recurrence and progression of superficial transitional cell carcinoma of the bladder (TCCB) is still uncertain.

Materials and methods

P53 expression was retrospectively assessed in 160 patients. At a median follow-up of 45 months, (up to years) 84 patients (53%) recurred and 13 (8%) progressed. Adjuvant intravesical chemotherapy after TUR was adopted in 51 patients (32%). The correlations between p53 and G-grade, T-category, risk of recurrence and progression, and intravesical chemotherapy were investigated. Similarly, the correlations between variations in grade and stage at recurrence and modifications in p53 expression were also studied.

Results

Seventy-nine patients (49%) were negative for p53. P53 was expressed in 84% of G3 tumors and in 65% of T1 lesions. A significant correlation between p53 expression and G-grade (p<0.0001) and T-category (p<0.0001) of the tumor was found. Eight-four patients (53%) recurred and 13 (8%) progressed. No correlation was found with recurrence and response to intravesical chemotherapy. P53 expression resulted correlated to progression in T1 tumors (although was not independent from G-grade).

Conclusion

According to our experience, p53 expression is not independent from grade and stage of superficial TCCB. A significant correlation between p53 expression and progression, not independent from G-grade, was detected only in T1 tumors.
Bilateral Pyelocutaneous Ileal Conduit in a Diffuse Neoplasia of Urinary Tract
Authors: Leoni S. , Loreto A. , Zuliani C. Guatti , Mora A. , Rossi R. , Bedogni G. , Spatafora S.
Published: June 2018

We present a surgic solution that we adopted in a case of diffuse neoplasia from the upper urinary tract to the bladder and the prostatic urethra.

Case

67 year-old male, has been submitted to bladder mapping with results of diffuse CIS and sequential immunotherapy with BCG. The three month control had pathological findings of CIS in the bladder and in the prostatic urethra. The staging has shown neoplasia in both kidneys. We had performed a cystoprostatectomy with a bilateral ureterectomy and cleaning of the intrarenal tissue. We had performed a bilateral pyelocutaneous ileal conduit in accord with Holland.

Results

The kidney parameters at 6 months were normal and the patient was well. The control, in general anesthesia with a pediatric gastroscope, in the pelvis and calyx with x-ray facility, didn't show a recidive in the kidney. Otherwise in annual control a little neoplasia in the right kidney was found. In the successive control at 18 and at 24 months we had found no signs of neoplasia.

Conclusions

Despite this extreme case, in which the neoplasia is in all of the urinary tract, it is possible to preserve the kidneys, to have a good oncological result and to preserve the renal function with a good quality of life, to avoid or to delay the bilateral nefrectomy.
Combined Buccal and Bladder Mucosa for Staged Urethral Reconstruction
Authors: Palminteri E. , Barbagli G. , Vallasciani S. , Marrocco G. , Manzoni G.A. , Bracka A.
Published: June 2018

Combined buccal and bladder mucosa represents the only reconstructive solution for panurethral strictures by Lichen Sclerosus (LS) in which the need to remove the diseased urethral mucosa and to reconstruct a long and circumferential urethral tract, collides with the limit of buccal mucosa harvesting and with the lack of others substitutive tissues not lichen involved. The use of buccal mucosa for glandular urethral reconstruction avoids the direct contact of the bladder mucosa with the air and, therefore its drying-retraction-stenosis. The bladder mucosa tube is covered and supported by residual urethral spongiosum that has been saved during the phase of diseased urethral mucosa removal. The described technique is the only reconstructive chance in severe panurethral strictures by LS. In these cases the alternative would be the definitive urethral perineal stomy.
Relapsing Recto Vescical Fistula Treated According to the York Mason Technique
Authors: Zani D. , Antonelli A. , Teppa A. , Moroni A. , Simeone C. , Cunico S. Cosciani
Published: June 2018

Recto-urinary fistulas are a rare event and their therapeutic management can be different. We present the case of a relapsing recto-vesical fistula, non-responsive to multiple therapeutic approaches, which was finally treated according to the York Mason technique to have immediate access to the fistula.
Flexible Endoscopic Extraction of Clinically Significant Fragments after Eswl
Authors: Defidio L. , Piccolotti D. , De Dominicis M. , Santini V. , Nesci L.
Published: June 2018

Residual fragments after ESWL which are clinically significant are a clear indication to their removal. The flexible endoscopic extraction represents the method of choice for its minimal invasion. We report a case of residual fragments after ESWL with recurrent colics and hydronephrosis treated with a double J stenting. Ten fragments were removed retrograde with a flexible ureteroscope and a nitinol basket. We used a ureteral sheath to facilitate the many reintroduction of the instrument.

We believe this technique is to be considered as the first choice treatment for this kind of pathology.
Percutaneous Treatment of Uretero-Intestinal Stenosis with Acucise®: Preliminary Experience
Authors: Orsi F. , Penco S. , Matei V. , Bonomo G. , Monfardini L. , De Cobelli O.
Published: June 2018

The incidence of stenosis of uretero-intestinal anastomoses is about 5–10%. The most relevant effect of this post-surgical complication is the progressive renal function deterioration. Infections, ureteric ischemia, perianastomotic urinary extravasation and apposition of two different types of mucosa are the main causes of this complication. Several options are available for the treatment of these strictures: surgery, ureteral stenting, balloon dilation, endoscopic electrocautery or laser incision. The Acucise® catheter system combines diatermic incision with balloon dilation.

Material and methods

9 stenosis of uretero-intestinal anastomoses have been treated with Acusise® endoureterotomy in 7 patients. All the patients underwent to radical cistectomy with urinary diversion for oncological disease. The diagnosis has been obtained with US and/or CT examination. Residual renal function has been assessed with sequential renal scintigraphy. The procedure includes two parts: percutaneous pleacement of nephrostomic catheter with distal part inside the neo-bladder and, after 15 days, treatment with Acucise®. The incision was performed with 75W activation of the cutting wire during inflation of the balloon at the level of stenosis.

Results

Mean follow-up is about 5 months so we can't consider the long term effects of the treatment but our preliminary results are interesting, with an adequate patency of the anastomoses in 8/9 cases at CT scan. The procedure, performed under fluoroscopic control and local anaesthesia, resulted ease and safe with low procedural complications.

Conclusions

If long term results will be confirm, Acucise® could be suggested as first-line treatment in these situations; surgery should be indicated in case of minimally invasive procedure approach.
Hereditary Predisposition and Prostate Cancer
Authors: Sacco E. , Prayer-Galetti T. , Pinto F. , Ciaccia M. , Fracalanza S. , Betto G. , Pagano F.
Published: June 2018

A genetic component in prostate cancer (PCa) has been recognized for decades, and much evidence has been accumulated in favor of a significant, but heterogeneous hereditary component in PCa.

Purpose

We studied the incidence of the familial and hereditary forms of PCa in our population of patients with a diagnosis of PCa clinically localized and age at diagnosis <65 yrs. Materials and methods: We administered a questionnaire to 667 patients submitted to radical prostatectomy from July 1978 to December 2002, obtaining a complete familial oncological anamnesis in 499 patients. The patients were followed-up until death or until 30 June 2004. Patients were classified into three categories according to Carter: familial, hereditary and sporadic PCa.

Results

A positive family history for PCa was found in 72 patients (14.4%). In 15 patients (3%), we observed a hereditary form of PCa and in 57 patients (11.4%) a familial form. Patients with hereditary PCa had a lower age at diagnosis (55 yrs). Genealogical pedigrees ruled out mendelian dominant autosomical transmission. No difference was found in the preoperatory, clinical and pathological features among the three PCa groups. A statistically significant familial association was found between PCa and cancer of breast and uterus.

Conclusions

This study supports evidence of a hereditary predisposition to PCa and the suggestion that an excess familial risk of PCa is due to the inheritance of multiple moderate-risk genetic variants.
The 2004 WHO Classification of Non-Invasive Papillary Neoplasms of the Urinary Bladder (Also Referred to as WHO(2004)/ISUP)
Authors: Mazzucchelli R. , Montironi R. , Beltran A. López , Bono A.V.
Published: June 2018

The consistent use of the 2004 World Health Organization (WHO) classification of non-invasive urothelial papillary tumors should result in the uniform diagnosis of tumors diagnosis, stratified according to risk potential, and will facilitate comparative clinical studies, the incorporation of molecular data and the identification of aggressive, genetically unstable neoplasms. Until the 2004 WHO system is fully validated from the clinically and prognostically, point of view, tumors should be graded according to both the 2004 WHO scheme and the 1973 WHO system.
Superficial Bladder Cancer Therapy: A Review
Authors: Bassi P.F. , Serretta V. , Pinto F. , Calpista A. , Galuffo A. , Dispensa N.
Published: June 2018

Most bladder cancers present as a superficial disease, confined to the bladder mucosa or submucosal layer, without muscle invasion. Most superficial tumors have a propensity for recurrence after transurethral resection; some have a high risk for progression to muscle invasion. The treatment aim in superficial bladder cancer with intravesical therapy is three-fold: (1) eradicate existing disease, (2) prevention of recurrence, (3) prevention of tumor progression. The prognostic factors (tumor stage, grade, size, number and recurrence pattern) allow the stratification of tumors in different risk groups to plan treatment. Studies on pharmacokinetics have proved the efficacy of optimized drug delivery. Comparing resection with and without intravesical chemotherapy, a short-term reduction, approximately 15%, in tumor recurrence with chemotherapy can be obtained, but no effect on progression was proven. No agent has proved to be more effective than the others. A single instillation of chemotherapy immediately after transurethral resection has proven to be effective, but the role of maintenance therapy is controversial. Immunotherapy, in the form of Bacillus Calmette-Guerin, is generally shown to be more effective than chemotherapy, even if the results in comparison to mitomycin C do not result conclusive. Several new approaches are being explored to improve the efficacy of this therapy.
Results of a Phase I-II Pilot Study with Intravescical Gemcitabine in Superficial Bladder Cancer (Ta-T1)
Authors: Serretta V. , Galuffo A. , Parrinello M. , Ruggirello A. , Daricello G , Pavone C. , Pavone-Macaluso M.
Published: June 2018

To study the ablative activity of intravescical gemcitabine against superficial transitional cell carcinoma of the bladder at different doses and concentrations.

Methods

Twenty-seven patients were treated with intravescical gemcitabine after transurethral resection, during which one to three papillary marker lesions were left unresected. Starting 14 days after transurethral resection, six gemcitabine instillations were given at weekly intervals. Gemcitabine, diluted in 50 mL of saline solution and maintained for 2 hr, was given at a dose of 500, 1000 and 2000 mg in groups of nine patients each. A complete response (CR) was defined as negative cutologycystoscopy and biopsy findings.

Results

Of the 27 patients, one was lost to follow-up, and of the remaining 26 patients, six (23%) achieved a CR. A CR was achieved in one patient (12.5%), in two patients (22.2%) and in three patients (33.3%) at dose of 500, 1000 and 2000 mg, respectively. A partial response was obtained in two additional patients (22%) at a dose of 500 and 1000 mg. Bladder Tis was diagnosed in two patients with a CR at 8 and 3 months, respectively. Systemic and local tolerability was excellent, and the interruption of treatment was not required.

Conclusions

Our experience has shown the good tolerability and the potential efficacy of intravescical gemcitabine against recurrent transitional cell carcinoma of the bladder. Gemcitabine could be proposed, if our results are confirmed by larger studies, as a second-line therapy in patients who cannot tolerate more aggressive intravescical therapy.
Relationship of Hormonal Parameters to Sperm Production in Patients with Varicocele
Authors: Tzvetkova P. , Tzvetkov D. , Kacarov M.
Published: June 2018

Idiopathic varicocele is a one of the all too often organic causes of male infertility and may can affect hormonal and spermatogenic function of the testis. We demonstrated relationships of hormonal parameters to sperm production on follicle-stimulating hormone (FSH), (LH) and testosterone blood concentrations to sperm production. The investigations involved a total of 329 patients with varicocele, at aged from 20 to 48 years, mean age 28.76 ± 0.66 years, divided into three groups: group I – patients with varicocele dextra; group II – patients with varicocele sinistra; and group III – patients with varicocele bilateralis. We established in our investigations that in 65.35% of cases the varicocele was attended coupled by with some disorders in the fertilizing ability, included including oligospermia Gr I-II (groups I and II) in 41.33% of cases, oligospermia (Gr.II-IIIgroups II and III) in 15.5% of cases and azoospermia in 8.52% of cases. In 56.83% of cases, the low sperm concentration was attended by decreasedcoupled with reduced sperm motility and velocity. Our data did not demonstrated a statistically significant increase in blood plasma T testosterone and we noted no significant correlation between the magnitude of the change in serum androgen and improvements in sperm concentration or total sperm motility per ejaculate in patients with varicocele. No significant correlations were noted in mean blood LH and FSH concentrations in patients with varicocele and in controls group.
Levels of Cadmium, Chromium, Nickel, Manganese and Lead in Normal and Pathological Human Seminal Plasma
Authors: Skandhan K. P. , Makada M. T. , Amith S.
Published: June 2018

In this study, we established the values for cadmium, chromium, nickel, manganese and lead in seminal plasma of normal and in different infertile conditions. Except for manganese, the other elements were not present in all normal samples. The value of nickel differed significantly from normal in all pathological conditions except azoospermia. Chromium showed a statistical difference in azoospermia when compared to that of normozoospermia. The presence of these elements in semen could have different roles to play in the survival and function of spermatozoa.
Retroperitoneal Splenosis Simulating a Relapsing Renal Carcinoma
Authors: Landi G. , Baietto S. , Delsignore A. , Arancio M. , Mina A. , Marcato M. , Martinengo C.
Published: June 2018

We present a case of retroperitoneal splenosis simulating a relapsing renal carcinoma. A 75-year-old male had undergone a left radical nephrectomy for a clear cell neoplasm, pT4 N0; during the operation a splenectomy for an unreparable spleen laceration had been performed. After 1 yr, the patient was asymptomatic; an abdominal CT evidenced a solid 24 mm diameter nodular formation of the left lumbar region, a suspected recurrence of renal carcinoma. This nodule was removed, it was capsulated and violaceous; the histologic examination demonstrated that it was typical splenic tissue. Splenosis nodules are generally due to “insemination” of splenic pulp after trauma or splenectomy, probably more frequent with laparoscopic surgery. The splenosis localizations can be either single or multiple, round in form, a few centimeters at its greatest diameter; the favorite seats are the peripancreatic region, the gastrocolic ligament and the great omentum. The splenosis is generally asymptomatic, but it can simulate tumors of various organs. The echotomographic and CT scan remarks can be aspecific. MRI can be more precise, with the ferumoxide-enhancement effect. The most reliable examination is the “heat damaged” Tc-99 labeled erythrocyte scintigraphy: 1 cm nodules appear evident. We recommend that the diagnosis of suspected neoplasm in splenectomized patients should include the heat damaged red cell scintigraphy.
Retroperitoneal Fibrosis, Today: An Updating of Knowledges on this Subjet
Authors: Alberti C. , Mediago M. , Chiapello G. , Bernardi D. , Arena G.
Published: June 2018

Retroperitoneal fibrosis (RPF) is characterized, at first, by a replacement of the normal retroperitoneal tissue by an active granulomatosis inflammation (cellular phase), and at a later stage by a fibrous scar tissue (established fibrotic phase). The aetiology of secondary RPFs includes several drugs (notably methysergide, ergotamine, pergolide, hydralazine), both chronic atherosclerotic aortitis-periaortitis and inflammatory aortic aneurisms, autoimmune diseases such as different forms of systemic vasculitis and collagen diseases, histiocytosis such as Erdheim-Chester syndrome, desmoplastic reactions to retroperitoneal malignancy carcinoid syndrome, retroperitoneal accidentally and surgically occurred traumas, abdominal radiation therapy.

On the contrary, the causes of idiopathic RPF remain uncertain; its pathogenesis is associated to immuno-mediated mechanisms. The inflammatory process can involve retroperitoneal vessels, ureters, peri- and pararenal spaces, mesenteric small intestine, duodenum, psoas muscles, and can spread to mediastinal space. Diagnosis and characterization of the polyphase inflammatory evolution require integrated approaches including laboratory tests, morpho-functional imaging and, sometimes, histopathologic assessment. In the early stages, the management of RPF ranges from the removal of identifiable etiologic agents to the interfering with the inflammatory immuno-mediated process by means of several drugs. Unfortunately, many effective immunosuppressive drugs induce adverse reactions unrelated to their specific immunosuppressive action; this is the reason why the biopharmacology research today is struggling towards the identification of molecular targets having their expression restricted to immune cells and/or cytokines. Moreover, the progression of atheromatous aortitis to RPF could be prevented by statins which are able to interfere with the inflammatory pathway as well as to induce the well-known reduction in the levels of atherogenic lipoproteins. In the late established fibrotic stage, either open surgery or endourologic, laparoscopic procedures are performed; nevertheless neoadiuvant and adiuvant corticosteroid-immunosuppressive treatments are mandatory in order to avoid any relapse of the disease.
Paraneoplastic Syndromes: Elements of Interest for the Urologist
Authors: Alberti C. , Piovano M. , Zitella A. , Tizzani A.
Published: June 2018

A paraneoplastic syndrome is a clinical condition in a patient affected by tumor which occurs distally from the primary neoplasia or its metastases, and is assessed via the humoral mediators. The uncommon secretion of peptide hormones is the most frequent cause of paraneoplastic syndromes. Although the symptoms are strongly varied, paraneoplastic endocrine syndromes are characterized by several functional features that differentiate them from the endocrine glands hyper-function related disorders. Based on the field's literature, the article presents the pathogenetic mechanisms, the laboratory and imaging features, and the essential therapeutic measures for humoral hypercalcemia of malignancy, hypercortisolism from ectopic ACTH/CRH production and water intoxication syndrome due to inadequate ADH secretion. Moreover, neuroendocrine differentiation in some urogenital cancers (prostate, bladder, kidney etc.), occurring as pure endocrine malignancy or as focal lesion, can develop a paraneoplastic carcinoid-like syndrome. On the other hand, some patients with urogenital tumors have increased serum levels of IGF-2 resulting in paraneoplastic hypoglycemia.
Clinical Insignificant Residual Fragments (CIRF) after Extracorporeal Lithotripsy: Implications and Treatment
Authors: Merlo F. , Cicerello E. , Anselmo G.
Published: June 2018

The stone-free status depends on the appropriate selection of the urologic treatment according to the stone and excretory tract characteristics, and/or to the patient parameters.

Although the gold standard for the treatment is the stone-free status, the authors believe that the presence of non-infected, nonobstructive, asymptomatic residual fragments, smaller than 4–5 mm, can be treated with an adequate medical therapy in order to prevent stone growth. Further urological treatment is recommended if the clinical indications for stone removal persist.
Testis Sparing Microsurgery
Authors: Rolle L. , Timpano M. , Destefanis P. , Bosio A. , Fiori C. , Tamagnone A. , Demaria C. , Vigna D. , Ceruti C. , Negro C. , Burlo P. , Fontana D.
Published: June 2018

The unexpected detection of non palpable hypoechoic testicular lesions has become more frequent thanks to the increased use of trans-scrotal ultrasound (US): patients are often asymptomatic and the objective examination reveals no palpable masses. The different diagnostic, therapeutic approaches vary from radical orchifunicolectomy to simple US follow-up, although the guidelines on the management of these lesions are not defined, yet. The article shows our series of patients with hypoechoic testicular lesions who underwent surgical exploration, with the aid of the operating microscope and histologic test.

Materials and Methods

6 patients in total underwent microsurgical exploration of non palpable hypoechoic testicular lesions, from April 2003 to December 2004.

Results

4 out of the 6 cases were a left-sided testicular lesion, whereas the 2 remaining cases revealed a right-sided lesion [hypoechoic areas mean size = 3.9 mm (range 2.5 – 16)]. The lesions in all patients could be easily identified and successfully excised thanks to the microsurgical technique. The intraoperative frozen section examination (FSE) showed a benign lesion in 5 cases and an intratubular germ cell neoplasia (ITGCN) in one. Patient with ITGCN underwent radical orchiectomy. The final histological analysis confirmed the frozen section examination report for all the 6 cases. Patients were clinically and ultrasonographically evaluated with a mean follow-up of 15 months. No complication occurred.

Conclusion

Microsurgical exploration of the testis combined with FSE represents a safe, effective and reliable technique in case of non palpable hypoechoic testicular lesions. This approach leads to significant advantages and should be considered especially in patients with a solitary testis or presenting bilateral lesions, and wishing to father a child.
Penile Carcinoma
Authors: Zumbo G. , Saraceno D.
Published: June 2018

The carcinoma of the penis is a rare neoplasia which tends to remain localized for long because of the patient's embarrassment; thus the diagnosis is often late. The treatment modality is a critical issue due to the controversies existing with regard to the role of linfoadenectomy. However, in cases of no lymphonodal involvement, the surgical treatment with the penis amputation proves certainly to be curative and leads to a favourable outcome.
Modified Nesbit Procedure: An Easy and Effective Technique
Authors: Rolle L. , Timpano M. , Ceruti C. , Tamagnone A. , Destefanis P. , Fiori C. , Demaria C. , Vigna D. , Negro C. , Fontana D.
Published: June 2018

This paper reports the results of a modified Nesbit procedure, designed to increase precision and to simplify the correction of penile congenital or acquired curvatures.

Materials and Methods

58 patients in total were considered candidates for surgical treatment of penile curvature, and underwent a modified corporoplasty procedure involving plication suture on the convex aspect of the penis before tunica albuginea resection. Hospital records and follow-up data were retrospectively reviewed.

Results

37 patients were affected by congenital penile curvature (mean angle: 48 degrees - range 40 to 90); they reported difficult vaginal penetration. Another 21 patients suffered from Peyronie's disease, with mean angle penile deformity of 48 degrees (range 40 to 60), but no hourglass deformity or hinge effects. All patients had spontaneous and full erections. Mean operative time ±SD was 62±15 minutes. No intra-operative complications were reported. Penile curvature was completely corrected in all cases. Neither residual curvatures nor hypercorrections were recorded. Regarding erectile function, which was evaluated in the Peyronie's disease group, pre-operative average International Index of Erectile Function-5 score was 17.83±4.17, whereas post-operatively it was 19±4.63 (p >0.036). With regard to overall satisfaction, 3 patients (5%) with Peyronie's disease were unsatisfied.

Conclusions

This modified corporoplasty procedure has resulted in an improved straightening outcome thanks to the possibility of performing tunica albuginea excision only after the surgeon has made and verified the exact correction in real time. A slight but statistically significant improvement in erectile function was observed in patients with Peyronie's disease.
Epidural Post-Operative Analgesia in Major Urologic Surgery: Our Experiences
Authors: Fasciolo A. , Parodi E. , Zanghi A. , Buscaglia V.
Published: June 2018

Pulmonary, cardiovascular, gastrointestinal and urinary dysfunctions are among the physiologic outcomes of surgical lesions and stress, as well as metabolic, muscular and neuroendocrine disorders.

Our purpose is to prevent such complications in order to optimize the healing process and improve the patient's satisfaction through the application of a post-operative codified analgesia protocol allowing the combined use of local anaesthetics and morphine by both epidural bolus injection and elastomeric pump.

All the patients enrolled underwent the same anaesthetic program: the data processing emphasizes the satisfactory analgesic results of the treatment. More than 80% of the patients did not feel pain at awakening, up to 98.5% during the following hours; one patient only was still complaining 96 hours after surgery.

This excellent analgesic function results in an extremely low rate of severe post-operative complications, despite the fact that patients underwent radical and often prolonged surgery (31% was affected by severe systemic pathology).

We encountered a negligible and easy-to-treat complication rate secondary to the analgesic technique or to the infused drugs; the epidural analgesia proved effective in the healing process, with high satisfaction of clinicians and patients.

This represents for sure a fundamental alternative to the various methods described in literature.
Percutaneous Treatment of the Obstructive Uropathy
Authors: Orlacchio A. , Laviani F. , Simonetti G.
Published: June 2018

Purpose

to analyse the technical aspects, the patient's selection criteria, and some useful tactics to reduce the complications of percutaneous nephrostomy and of other interventional procedures to temporarily treat obstructive uropathy (OU), such as double J stent insertion, dilatation of the stricture using high-pressure balloon catheters, removal of renal or ureteral calculi, fistulas treatment.

Materials and Methods

a fluoroscopy table and an ultrasonographic guidance are key elements. Two techniques are employed, either the Seldinger type (wire-guided catheters) or the trocar needle type. Sole contraindication: uncorrectable severe coagulopathy. Most important risk factors are: dendritic calculus, non corrected high blood pressure, obesity, small size kidney, severe scoliosis.

Results

high technical success of the procedure in case of dilated collecting systems (98%); it is minor without dilatation (85%).

Conclusion

percutaneous nephrostomy is indicated in 87% of obstructive uropathy cases. It represents the basic technique allowing other interventional procedures to treat obstructive uropathy; it should be performed by most radiologists following an adequate training with technique and materials.
An Alternative dosing Regimen with Tadalafil 3 Times/Week in the Treatment of Erectile Dysfunction: Italian Data from the SURE Study
Authors: Mirone V. , Imbimbo C. , Rossi A. , Sicuteri R. , Valle D. , Fusco N. Longo EF.
Published: June 2018

Aim.

To evaluate the preference for 2 dosing regimens of tadalafil 20 mg, on demand or 3 times/week, in Italian men affected by erectile dysfunction (ED).

Materials and Methods.

SURE is a multicenter, crossover, open-label study, involving 94 urology centers in Italy. Patients aged 18 or more, affected by ED for at least 3 months were enrolled into the study and randomized to a tadalafil 20 mg treatment on demand or 3 times/week for 5–6 weeks. After a 1-week washout period, patients were crossed over to the alternate regimen for 5–6 weeks. A treatment preference question (TPQ) was used to determine the preferred treatment regimen. IIEF and SEP questionnaires were used as efficacy measures.

Results.

1058 men, mean age 54.8 years, were randomized to treatment. Overall, 59.1% of patients preferred the on-demand regimen and 41.9% preferred the 3 times/week dosing regimen. Both regimens were efficacious and well tolerated.

Conclusions.

Tadalafil is effective and well tolerated whether used both on demand and three times/week. Patients should be given the possibility to choose the best treatment regimen according to personal needs and preferences. (Urologia 2007; 74: 30–6)
Evolution and progress in bladder replacement
Authors: Fontana D. , Destefanis P. , Cugiani A.
Published: June 2018

Nowadays, the first choice after radical cystectomy both in male and in female patients is no more urinary diversion, but bladder replacement surgery through orthotopic reconstruction.

In 2006 we carried out a mail interview among Italian Urology Departments about urinary diversions and orthotopic neobladders; the choice for orthotopic neobladder had increased compared to a previous interview administered five years before.

As far as the type of orthotopic neobladders are concerned, it was evident that Italian urologists prefer to use the ileal reservoir, preferably the Studer's neobladder, followed by VIP; the use of Camey II is decreasing while Y-neobladder has gained many consents, being preferred to Hautmann's reservoir.

The findings of this interview suggest that the ideal orthotopic neobladder hasn't been proposed, yet, and that Italian urologists are still looking for easier and more reliable solutions.