bluuebunny/crossref_metadata_2025 huggingface dataset:
Surgical Correction of Pyelo-Ureteral Junction Desease on Graft before Kidney Transplantation
Authors: Lasaponara F. , Graziano M.E. , Rossi R. , Morabito F. , Paradiso M. , Cucchiarale G. , Ferrando U.
Published: June 2018

Before kidney transplantation, even without ultrasound alterations of donor urinary tract, we usually and carefully study kidney to be transplanted. We fill urinary tract retrogradly with physiological solution from distal ureter. With this method we can recognise stenosis, ectasis and, during a spontaneous emptying, an altered urinary flow due to a “pyelo-ureteral junction attitude”. After kidney transplantation, in fact, hyperdiuresis can unmask a pyelo-ureteral junction attitude with heavy functional rebounds. When, during graft's preparation, we recognize an altered flow, we operate it “on the bank” in order to a easier surgery than on a transplanted kidney, because of its site in iliac fossa, vascular anastomosis and fibrosis that will establish early.

We don't use traditional pyeloplastic technique (Anderson Hynes). We use easier pyeloplastic techniques Y-V sec. Foley. Than we apply a ureteral catheter JJ Ch 6 to protect suture and finally we vitrify the suture with fibrin glue. Recently we operated on bank with pyeloplastic technique Y-V sec. Foley a kidney without pyelo-ureteral flow. After ureteral catheter removal, kidney scintigrafy show normal morphology and functionality of graft. Follow-up show a normal urinary flow and kidney function.
Thin-Prep Urinary Cytology: New Method and Preliminary Results
Authors: Reich A. , Polla E.
Published: June 2018

Cytology of voided urine is a reliable and important tool in the diagnosis and follow-up of patients with epithelial tumors of the urinary bladder. In order to improve its sensitivity Thin-Prep monolayer technique has been used. This method seems to be suitable for the diagnosis of low grade papillary tumors too.
A Knotted Multilenght Ureteral Stent: A Rare Complication
Authors: Sighinolfi M.C. , DE Stefani S. , Mofferdin A. , Baisi B. , DI Pietro C. , Celia A. , Pollastri C.A. , Bianchi G.
Published: June 2018

Indwelling Ureteral stents are fundamental instruments for modern urologist. They are commonly used in the management of upper urinary tract obstruction. Complications are rare. Knotting of the stent at its proximal coiled end is a very rare event but it can be resolved easily by an endoscopic approach if promptly recognized.
Environmental Risk Factors in Superficial Bladder Cancer
Authors: Serretta V. , Altieri V. , Morgia G. , Rinella M. , Abbadessa D. , DI Lallo A. , Testa G , Gallo A. , Melloni D. , Magno C. , Motta M. , Pavone-Macaluso M. , Selvaggi F.P. , Bartolotta A. , Sblendorio D. , Annese P. , Allegro R. ,   EI MEMBRI DEL GRUPPO STUDIO TUMORI UROLOGICI (GSTU) E DEL GRUPPO URO-ONCOLOGICO CAMPANO (GUOC), Vaccarella G. , Salzano L. , Ruggero G. , Zito A. , Borruso L. , Chincoli S. , Vacirca F. , Cammarata C. , Armenio A. , Simone N.S. , Falvo F. , Gentile M. , Nicolosi D. , Masala A. , Napoli M , Bizzini A. , D'Elia A. , Aragona F. , Gange E. , Barbini V. Ricci , Spampinato A. , Curto G. , Raguso G. , Paola Q. , Crimi A. , Cicalese V.
Published: June 2018

As a preliminary approach to define the object of larger case-control studies, the distribution of potential risk factors coming from environmental pollution among patients affected by superficial bladder cancer (TCCB) has been analyzed.

Material e Methods.

The analysis included only patients affected by medium risk superficial TCCB. Forty Italian urological centres joined the study. Detailed information about age, sex, residency, employment, active and passive cigarette smoking, water resource, hair-dye use were centralized. All patients underwent TUR and early intravesical chemotherapy. The distribution of the above mentioned environmental factors was related to tumor characteristics such as multiplicity and previous natural history.

Results.

Until today 474 patients have been recruited, 182 (38.4%) with primary tumors and 293 (61.8%) with multiple lesions. Over 80% of the patients lived in urban areas, 20% were employed in industry at risk for bladder cancer and 8% used hair dye. Forty percent of the patients were smokers, with a median smoking period of 30 years. Bottled water was the only water resource in 42% of cases. At multivariate statistical analysis a significant correlation between tumor multiplicity and employment in industry (p<0.01) and between past natural history and period of cigarette smoking (p<0.05) was found. Preliminar/y, an interesting trend was detected for a correlation between water resource and bladder cancer in non-smoking patients. The municipal water system was the main water resource more frequently in non-smokers (75% vs 53%). This might imply a pathogenic role of water pollution and chlorination.
High Risk Superficial Bladder Tumours: Is a Second Transurethral Resection after Intravesical Bcg Necessary?
Authors: Mari M. , Ambu A. , Bellina M.
Published: June 2018

According to some authors, residual tumour rate after superficial bladder cancer transurethral resection varies from 4–78%; among high risk superficial tumours (TaG3, T1G3, Tis) managed by transurethral resection of the bladder (TURB) and adjuvant immunotherapy, residual tumour rate varies from 57–76%.

This study was aimed to evaluate residual tumour and/or tumour recurrence in 56 patients diagnosed with high risk superficial bladder tumour, who underwent transurethral resection, adjuvant 6-weekly course of intravesical bacille Calmette-Guérin (BCG) and second TURB on the first resection sites, and in other sites suspicious for recurrence. Overall, 7/56 patients (12.5%) had residual tumour and/or recurrent disease at second TURB; no histological progression was recorded. Disease persistence or recurrence was not related to tumour multifocality at first diagnosis.

Our results appear to be consistent with other recent experiences, reporting low rates of residual tumour and disease progression in superficial bladder tumours after a first adequate resection and adjuvant immunotherapy.

Thus, our current practice in management of high risk superficial bladder tumour is oriented towards routine cystoscopy within 3 months after first bladder tumour resection, completed by cold biopsies on previous resection sites.

To our opinion, this approach provides adequate diagnostic reliability besides sparing the costs of a new resection and improving patients quality of life.
Morbility and Outcomes of Radical Prostatectomy in Patients with Clinically Advanced Prostatic Cancer
Authors: Zaramella S. , Monesi G. , Sala M. , Favro M. , Marchioro G. , Gontero P. , Kocjancic E. , Ceratti G. , Pisani R. , Maso G. , Frea B.
Published: June 2018

In this study we have reviewed patients with prostate cancer clinically advanced at the diagnosis, and subjected at radical prostatectomy, to evaluate the morbility, mortality, and results of the surgery. We have subjected 38 patients with sure clinically advanced disease to radical prostectomy (PSA average 80 ng/mL). An ureteral injury and no rectal lesion have been observed. The rate of urinary incontinence have not been increased in comparison with the literature data, while more frequently are been developed stenosis of bladder neck (26%).

At 2 years the 15% of the patients is disease free survival. Our opinion is that radical prostectomy in patients with locally advanced prostate cancer is feasible and the rate of the complications is acceptable.
Oxygenation Status of the Cavernosal Tissue after the Direct Action of the Vacuum Device
Authors: Austoni E. , Guarneri A. , Colombo F. , Cazzaniga A. , Goumas J.
Published: June 2018

This study aims at comparing the oxygenation status of the cavernosal tissue after the direct action of the Vacuum device (VD) preceded or not by administration of Sildenafil. Patients and methods. We enrolled thirty patients who had undergone perineal radical prostatectomy. After four weeks from surgery we evaluated oxygen pressure (pO2), carbon dioxide pressure (pCO2) and O2 saturation in cavernosal blood. The pts were divided in 2 groups: 15 pts used only Vacuum device (first group), while the other 15 took Sildenafil 50 mg one hour before the exercise with VD (second group) for approximately 30 minutes without constriction band. Cavernous blood gas analyses pre- e post-exercising with the VD were repeated at the end of the complete 3-month rehabilitation program. The data obtained were processed by statistical analysis using the Student t test.

Results

During flaccidity at baseline, average levels of pO2, pCO2 and O2% saturation rates were respectively 30.07+/-2.91, 39.60+/-6.47, and 65.93+/-2.15 in the first group and 31.20+/-8.1, 42.64+/-7.64 and 52.87+/-8.95 in the second group. Mean values of pO2 rates increased after both treatments with higher oxygenation levels in the second group. At the end of the study pO2 and O2 saturation levels in the second group were found to be 68.5+/-6.87 (p>0.05) and 92.8+/- 2.66 (n.s.) versus levels of 63.8+/- 4.61 and 91.6+/-2.79 in the first group. No significant variations were found in partial CO2 pressure between the two groups (38.13+/-3.52 vs 38. 13+/-6.62).

Conclusions

In patients presenting with ED after radical prostatectomy, treatment with exercising of erectile tissue by means of an intermittent Vacuum device without constriction band can locally improve oxygenation levels. The addition of Sildenafil offers a further increase of oxygenation levels in the cavernosal tissue.
Reconstructive Technique for Partial Penile Amputation
Authors: Austoni E. , Guarneri A. , Colombo F. , Cazzaniga A. , Kartalas J. Goumas
Published: June 2018

Partial or total penile amputation with resection of the corpora cavernosa and the urethra is a common and effective surgical procedure used to treat squamous cell cancer infiltrating the deep tissues of the penis. We describe an original method that allows for an aesthetic and functional restoration of the partially or total amputated penis.

Surgical technique

We performe a reconstructive technique for partial penile amputation by releasing the scarring tissue adhesions with cavernosal lysis and by advancing the penile stump with dissection of the suspensory ligament; implantation of soft but axially firm endocavernosal elastomer prostheses to maintain the corpora cavernosa extended; placement of split-thickness skin grafts to cover the shaft skin defects and glanduloplasty with oral mucosa grafting. In cases of total penile amputation, the method begins with the reconstruction of a new phallus using a rectoabdominalis flap; the new penis is then covered with split-thickness skin grafts and finally, at a later date, soft but axially firm endocavernosal elastomer prostheses are implanted.

Results

The success rate as be excellent compared with other complex reconstructive and remodelling procedures for the penis and the glans after partial or total penectomy described by several authors.

Conclusions

In cases of total or subtotal penile amputation, the use of our techniques provides satisfactory aesthetic and functional results, thus we consider it to be a simple solution since it is not too invasive, it is quick and can be carried out by urologists without recourse to sophisticated microsurgery techniques.
Treatment of Urolithiasis with Ureterocele: 5 Years of Experience (1998–2003)
Authors: Imbimbo C. , Cancelmo G. , Manno G. , Ranavolo R. , Piscopo A. , Ammendola C.
Published: June 2018

To assess efficacy of Extracorporeal Shock Wave Lithotripsy (ESWL) about treatment of urolithiasis with ureterocele.

Materials and Methods

From January 1998 to July 2003, we have treated 6 adult patients (4 women and 2 men) with urolithiasis linked to ureterocele with mean age 35.8 years (range between 24–49 years). The patients showed dysuria, and pain during advanced stage of miction. The diagnosis of ureterocele was based by ultrasound and intravenous urography. The ureterocele appeared monolateral in 5 patients and bilateral in 1 patient. The stone is been treated with Extracorporeal Shock Wave Lithotripsy (4000 shocks; 9Kj), in mean 2 applications for patient.

Results

In 4 patients we have assessed breaking stone with expulsion of chips. In 2 patients, after treatment with ESWL, we have proceeded to extract the stone by endoscopic view, by small cut (“smile cut”) on ureterocele wall. Reflux was not present in these 2 patients after smile cut.

Conclusions

In patients with urolithiasis and ureterocele is recommended to perform a treatment of ESWL, that proved to be effectiveness, allowed by patients and without collateral effects.
Power Doppler Ultrasonografy (Pdu) as an Additional Tool to Increase Reliability of Systematic Biopsy of the Prostate
Authors: Passavanti G. , Pizzuti V. , Paolini R.
Published: June 2018

Diagnosis of prostate cancer has until recently relied primarily on eight core TR biopsy.

Tests are being carried out to verify whether PDU can effectively aid such diagnosis thereby reducing the number of biopsies and tissue samplings.

This has also been our attempt.

Two groups of patients were examined for increased PSA with or without a palpable prostatic nodule. The first group was composed by 52 patients between 55 and 83 years of age (av. 69.57) with PSA values between 0.87 and 94.91 ng/mL (r.8.085) of which 29 (55.75%) showed a palpable nodule. All patients underwent prostatic eight core TR ecobiopsy.

The second group was composed by 56 patients between 49 and 84 years of age (av.69.19) with PSA values between 1.14 and 59.7ng/mL (r.8.74) of which 33 (58.97%) showed a palpable nodule. This group of patients underwent a PDU just before TR biopsy in order to assess prostatic blood supply and locate possible alterations. Prostatic volume in both groups was never higher than 50 cc. Of the first group 25 patients (48.08%) were prostate cancer positive. Of the second group 31 patients (55.36%) were positive to a biopsy for prostate cancer. In addition 22 out of the 31 showed a vascular irregularity.

From the evidence above (tests carried out by the same operator with two homogeneous groups of patients-Wilcoxon test-) it is clear that PDU usefully worked in diagnosing a higher number of prostate cancers.

Diagnostic sensitivity and specificity was markedly increased by the association of PDU and TR biopsy.
The Artificial Neural Network Utilization for the Diagnosis of Prostate Cancer
Authors: Benecchi L. , Pieri A.M.
Published: June 2018

The Artificial Neural Network utilization is limited to its complexity. Aim of our study is to organize a simple ANN for a practical utilization.

Methods

We retrospectively reviewed from our database male patients (both outpatients and hospitalized patients) who underwent PSA and free PSA assay. Inclusion criteria was as follows: male older than 45, without a history of prostate cancer. Patients who rejected a proposed prostatic biopsy were excluded. 520 men were included in the study. There were 431 (83%) controls and 89 (17%) had prostate cancer. An ANN was constructed on the basis of data on PSA, fPSA, percentage of free PSA and age.

Results

Of the samples 200 random cases (38.5%) were used to train the system, 100 random cases (19.2%) were used for the test phase and the remains 220 (42.3%) were used for validation. At the ROC analysis the higher area under the curve was for ANN with a significant difference with that of PSA (p=0.022).

Conclusions

We developed a diagnostic algorithm based on both serum data (tPSA, fPSA and %fPSA) and clinical data (age) to enhance the performance of tPSA to discriminate prostate cancer patients. The predictive accuracy of the ANN was superior to that of tPSA. Limiting input neurons, the complexity is reduced so this ANN can be used for daily urological practice.
Adjustable Continence Therapy for Female Sui
Authors: Kocjancic E. , Carone R , Crivellaro S. , Gontero P. , Favro M. , Ceratti G. , Sala M. , Bodo G. , Giammò A. , Zaramella S. , Frea B.
Published: June 2018

Since December 1999 a new adjustable device for female stress urinary incontinence called the ACT (Adjustable Continence Therapy) has been used in a multicentre study. The two year follow-up of the Italian multicentre study is presented.

Material & Methods

A group of 37 female patients, affected by SUI was evaluated before and after the positioning of the ACT with physical examination, urodynamic study and quality of life questionnaires (I-QOL) Mean age was 58,5 (range 21.9 – 84.6). 59% (22/37) had type II SUI while 42% (15/37) had type III SUI. 57% (21/37) had had prior urogenital surgery. The ACT device consists of an adjustable silicon balloon, a subcutaneously positioned titanium port and a two lumen tube in between. The devices are positioned via a percutaneous perineal approach, using either local or regional anaesthesia. A 2 cm skin incision is made on each labia majora and through these incisions a delivery trocar is directed toward the bladder neck. The trocar is manoeuvred into the desired position using tactile guidance and an image intensifier (III). Each ACT device is then inserted via the delivery tool. Each balloon is positioned lateral to the bladder neck, proximal to the vesico-vaginal space, below the endopelvic fascia. Each balloon is then filled with one to two millilitres of the isotonic contrast/sterile water mixture with X rays confirmation of the correct location. The injection ports attached to each balloon are then positioned subcutaneously in each labia majora; the balloons are subsequently adjusted, if this is required.

Results

15 patients reached 24 months of follow-up. 46% of them were dry at physical examination and wear no pads. Additional 26% were significantly improved. This group of patients had to wear 1 pad/daily. 56% of the patients required one adjustment to achieve continence, 10% two adjustments, 10% three adjustments 24% need no adjustments. No cases of urinary retention were reported out of 37 cases. One patient had a transient dyspareunia.

Conclusions

70 % of our patients where dry or substantially improved and the patients quality of life increases significantly, this results includes mainly the patient with sever intrinsic sphincter deficiency and failed previous incontinence surgery. The ability to post-operatively adjust the ACT permits to reach the appropriate volume to each patient. However a longer follow up and a bigger number of procedures are required for definitive conclusions.
Complications of Irrigations Solutions during Transurethral Resection of the Prostate in Spinal Anesthesia
Authors: Biamino C. , Gratarola A. , Gontero P. , Kocjancic E. , Frea B. , Corte F. Della
Published: June 2018

Perspective study in order to estimate the incidence of TURP-Syndrome, in spinal anesthesia (SA) with volemic expansion with sodium chloride solution 0.9 % vs 3%.

Materials and Methods

Two groups (gr) of patients (pt) A (n=20) and B (n=20) in SA have received like respective 500 ml of NaCl 0.9% and 250 ml. of NaCl 3%. The bladder was irrigated with a solution containing 1.5% glycine (1). We estimated: weight of prostate adenoma and weight of removed tessue, Sodium (Na) preop - intraop - postop. and after 24 hours, Ammonium (NH4+) pre - postop, volumes (V) of dropped solutions, V of dropped glycine (gl), operation time, core body temperature intraop and postop, mental state intra and postop., osmolarity.

Results

We found no significant difference in weight of adenoma and removed tessue. We have not observed any differences in the V of infusive solutions in the periop. We have not observed any difference in the values of Na preop. and postop, in those of NH4+ preop and postop, in operation time and in the V of gl. During procedure 5 pz. (S group) showed: visual disturbances, mental confusion (TURP-Syndrome) and hypertention (2). No pz. have any Na and NH4+ intraop.values altered. Time of TURP appeared bigger in non symptomatic patients (69 mn gr S. vs 48.43 gr.A and 47.26 gr. B). The V of instilled gl. has appeared meaningfully more elevated in gr. S (21.4 / vs 12 in gr.A and 12.31 in gr. B). The Na and NH4+ postop., Na after 24 hours and core body temperature have turned out statistically omogenee in all pt. In the 5 symptomatic pt the osmolarity values entered in normality ranges and they did not show differences between the groups considered.

Conclusions

We have not noticed any differences in using of the NaCl solution 0.9% versus NaCl 3% like volemic prefilling; the symptomatic patients have endured one longer procedure and greater amount of irrigating solution; their values of Na and NH4+ were in the limits of the normality; for this reasons perhaps the cause of symptoms in our patients would be searched in direct toxicity of glycine as inhibitory neurotrasmitter in CNS.
Transurethral Resection of Bladder Tumor and Benign Prostatic Hyperplasia: Simultaneous Approach
Authors: Iannucci M. , Nicolai M. , Tenaglia R.L.
Published: June 2018

Approximately 70% of the bladder tumors are superficial, and 10%-20% of these progresses as muscle-invasive. For implant problems is common the practice to immediately instill chemotherapeutic agents after TURBT that a decrease of the recurrence has provoked. Many urologists didn't observe any deleterious effect of simultaneous TURBT-TURP. But really the simultaneous approach provokes an increase of the recurrence of the tumor to the bladder neck or prostatic urethra? We have performed a perspective study after simultaneous approach. In our Clinic any case of solitary recidivist is not occurred in the prostatic site, but in all the patients concomitant multiple locations are been observed.
Evaluation of Sexual Activity in Patients Treated with Tadalafil: A Randomized Prospective Placebo-Controlled Trial
Authors: De Rose A. F. , Gallo F. , Ninotta G. , Carmignani G.
Published: June 2018

Evaluate the chronological distribution of sexual intercourses in a group of patients treated with Tadalafil versus placebo for three months.

Methods

120 patients with ED were randomized in two groups and treated respectively with one pill of Tadalafil 20mg or placebo on Tuesday and on Friday. After three months we collected data using IIEF and SEP diaries.

Results

After three months, IIEF score and percentages of success SEP diaries increased in Tadalafil group (< 0.01) versus Placebo group. Considering all the successful intercourses of the three months of Tadalafil assumption, the highest percentages were reported within 6–12 hours range (35%) and 12–24 hours range (28%). In Tadalafil group, 41% of patients reported their first successful intercourse between 1–6 hours and 78% of patients reported the recovery of spontaneous erections.

Conclusions

After doing the first sexual attempt between 1–6 hours, patients engaged in sexual activity between 6–24 hours.
The Role of Partial Cystectomy in the Treatment of Muscle-Invasive Bladder Cancer
Authors: Tombolini P. , Ruoppolo M. , Dormia G. , Dormia E.
Published: June 2018

Partial cystectomy has been widely performed in the treatment of muscle-invasive bladder cancer in the 1960s and 70s. During the 1970s and 80s a more aggressive surgical approach was advocated by urologists. However, major complications occurred in 4–25% of patients undergoing radical cystectomy and urinary diversion. The overall survival in patients managed by radical cystectomy has increased during the last decades, but disease-free survival remains the same. This procedure allows excellent loco-regional tumor control, but not changes in the timing of distant metastases and in the failure to control the disease. Recently, multimodal strategies in sparing bladder surgery have been proposed. Neoadjuvant chemotherapy, with or without irradiation, allows bladder sparing surgery in selected patients. A literature review demonstrates a later recurrence in the preserved bladder ranging from 40–75%. One-third of these recurrences required cystectomy and 15–20% of cases with bladder preservation experienced disease progression and died of cancer within 2 yrs. Only 40 and 20% of T2-T3 bladder cancer patients are alive and disease-free at 5 and 10 yrs of follow-up, respectively. In our experience, in selected patients, disease-free survival, overall survival, time to progression and final bladder preservation rate was higher compared to other patients. Bladder sparing in selected patients, i.e. single non-recurrent neoplasm, favorable site, no prostatic or urethral involvement, complete response to neoadjuvant chemotherapy, no P53 overexpression, no previous BCG-failure, is a feasible approach. Cystectomy, possibly with neobladder tailoring, is currently, the standard therapy for muscle-invasive bladder cancer. A better understanding of bladder tumor disease is necessary to choose the optimal treatment and to control each individual patient.
Does Urine Cytology Still have a Role?
Authors: Ciaccia M. , Bertoloni R. , Pinto F. , Calpista A. , Bassi P.F.
Published: June 2018

Urine cytology is a reliable and well known tool in the diagnosis and follow-up of patients with transitional cell carcinoma even if it has high sensitivity only in high grade tumors and carcinoma in situ. In order to improve sensitivity of this test in patients with low grade tumors, new methods such as cytometry, microsatellite assays, Immunocyt®, fuorescence in-situ hybridization and Thin-Prep monolayer have been developed. These new assays will be able to increase the cytology detection rate and to predict the outcome of transitional cell carcinoma.
Tissue Engineering in Urology: Between Basic Research and Clinical Applications
Authors: Alberti C. , Mediago M. , Chiapello G. , Arena G
Published: June 2018

Tissue engineering follows the principles of cell and tissue culture, cloning and stem cell production, and materials science to develop biological substitutes, which could repair and maintain normal function. The biomaterials must be able to control the structure and function of engineered tissue by interacting with both transplanted and host cells. Either natural or synthetic biodegradable materials have been used as cell delivery scaffolds. The stem cell field is also advancing rapidly, opening new options for regenerative medicine. In the genitourinary system, tissue engineering has been applied experimentally for the reconstitution of pelvis, ureter, bladder, urethra, penile corpora cavernosa and testis. This literature review underlines recent advances that have occurred in tissue engineering and describes their clinical repercussions, particularly in offering novel therapies in urogenital pathology.
Microwave-Induced Hyperthermia and Cytostatic Agent for Superficial Bladder Cancer
Authors: Ruggirello A. , Serretta V. , Galuffo A. , Vella M. , Pavone C. , Macaluso M. Pavone
Published: June 2018

The efficacy and local toxicity of the intravesical combination of microwave-induced hyperthermia with a cytostatic agent in patients affected by superficial bladder cancer is presented. Between 1994 and 2002, two studies were performed on ablative and adjuvant intravesical thermo-chemotherapy. The ablative study demonstrated complete tumor eradication in 88% of patients who should have undergone cystectomy due to diffuse multiple papillary tumors non-responsive TUR and intravescical adjuvant therapy. In a randomized study, comparing adjuvant thermo-chemotherapy vs. standard chemotherapy with mitomycin C, recurrence-free survival analysis at 24 months revealed a significant difference in favor of thermo-chemotherapy. Our preliminary experience confirmed that local side effects, mainly cystitis, suprapubic pain and thermal reaction of the posterior bladder wall, were transitory and did not require treatment interruption.
The Rationale of Dual Serotonin/Noradrenaline Reuptake Inhibitors in the Management of Stress Urinary Incontinence
Authors: Alberti C. , Mediago M. , Chiapello G. , Arena G.
Published: June 2018

This paper aims at evaluating the role of serotonin (5-HT) and noradrenaline in the nervous control of urinary continence. Both α1-adrenergic and 5-HT2 receptors in the Onuf's nucleus help the guarding reflex; therefore the pharmacologic agents enhancing the effects of 5-HT and noradrenaline represent a promising choice in treating stress urinary incontinence. Duloxetine, a dual 5-HT/noradrenaline reuptake inhibitor, improves the external urethral sphincter contractility while increasing the activation of 5-HT2 and α1-adrenergic receptors thanks to the high concentrations of these monoamines in the Onuf's nucleus; it also plays a significant role in the management of stress urinary incontinence.
Adult Type Testicular Granulosa Cell Tumor: Case Report and Review of the Literature
Authors: Lucarelli G. , Mancini V. , Annunziata G. , Trabucco S. , Palazzo S. , Ditonno P. , Battaglia M. , Selvaggi F.P.
Published: June 2018

Granulosa cell tumors represent a special group of the so-called sex cord-stromal tumors of the gonads, and are divided into 2 histological types: adult and juvenile. Adult type testicular granulosa cell tumor is a rare neoplasia: 22 cases of this testicular tumor only have been described in literature so far. They are often discovered accidentally and exhibit no endocrine-related symptoms.

We report a case of adult type granulosa cell tumor in a 45-year-old man likely affected by a 15-year-old painless tumor with increased right testicular size; he underwent radical orchiectomy.

This case and a review of the literature indicate that this kind of tumor is a rare, slow-growing neoplasm. Since distant metastases may occur late in the clinical course, long term follow-up of these patients is recommended.
The Long-Term Hormone Levels and Sexual Function of Monorchid Patients
Authors: Carmignani L. , Galasso G , Acquati P. , Gadda F. , Zambito S. , Salvioni R. , Nicolai N. , Rocco F.
Published: June 2018

The purpose of this study was to evaluate monorchid patients’ long-term hormone levels and sexual function.

Materials and Methods

Between September and December 2005, 20 patients were reassessed, having undergone orchiectomy for testicular tumors at the Policlinico and at the National Tumor Institute in Milan between 1986 and 1996. Four patients had seminoma, three of them underwent radiotherapy; 15 patients with embryonal carcinoma subsequently underwent retroperitoneal lymphadenectomy, and one of them underwent chemotherapy; one patient had a Leydig cell tumour. The patients’ case histories were analysed; they underwent urological examination, endocrine test, scrotal ultrasound, and blood samples were taken for testosterone, FSH, LH, prolactin, E2, total cholesterol, triglyceride, beta-HCG, alpha-FP and LDH assays. Body mass index was calculated. Patients were also asked to fill in the IIEF questionnaire.

Results

Patients’ mean age was 30.7 years at the time of orchiectomy, and 44.7 at the time of endocrine/sexology follow up. Case histories showed that 2 patients suffered from arterial hypertension, for which they were receiving treatment, 2 patients were obese, none of the patients suffered from endocrine disorders. Upon ultrasound evaluation, the remaining testicle mean volume was 22.04 mL. All patients presented testosterone levels at the lower limits of the normal range (mean value 3.3 ng/ml). In 5 patients values were below the lower limit, indicating marked hypogonadism. Only one patient suffered from moderate erectile dysfunction.

Conclusions

Twenty-five per cent of patients showed low testosterone levels. In view of the long life expectancy of patients suffering from testicular tumors, it is fundamental to consider the long-term problems that a mutilation such as orchiectomy can involve. Patients undergoing orchidectomy in general should be considered to be at higher risk of andropause.
Radical Prostatectomy: Which Quality of Life?
Authors: Mercuriali M. , Lilli P. , Saltutti C. , Vivacqua C. , Zenico T. , Bercovich E.
Published: June 2018

The aim of the present study was to evaluate quality of life in patients submitted to radical prostatectomy, by correlating the results of the post-operative condition with follow-up data at 6 and 12 months.

Materials and Methods.

Between october 2004 and december 2005, 68 patients - mean age 68 (range 49–76) - treated with radical retropubic prostatectomy for localized prostate cancer (T2a, T2b, No, Mo) were consecutively enrolled onto the study. All patients underwent sexual as well as urinary incontinence rehabilitation, showing good compliance. We evaluated quality of life before prostatectomy (T0), 6 (T1) and 12 (T2) months after surgery through the Short Form 36 questionnaire, for which an analysis of variance for repeated measures was carried out. Patients were interviewed by our department psychologist regarding urinary incontinence and erectile dysfunction. All patients were disease-free at the time of evaluation.

Results.

No significant differences were observed between physical and mental health indices. Conversely, a significant improvement (p<0.001) was seen in all SF-36-questionnaire 8 scales, comparing preoperative T0 values with T1 and T2 values. Of the 68 patients, 53 (78%) no longer needed pads at the T2 follow-up, while 15 (22%) reported using 3–4 pads/day A significant worsening of the sexual function (maintenance of erection) was observed in 51 (75%) patients, who had reported having normal sexual activity preoperatively (T0). On the other hand, 17 (25%) patients reported having an adequate erection to engage in sexual intercourse.

Conclusions.

Despite the differences observed in physical and mental health scores during the three periods evaluated (T0, T1 and T2), overall quality of life does not appear to have been greatly compromised by surgery. At T2 follow-up, in fact, all 68 patients reported to be satisfied with having undergone radical prostatectomy because of its benefits in terms of survival and its limited effects on their quality of life. (Urologia 2007; 74: 22–9)
Sexual rehabilitation with intracavernous PGE1 injections and oral drug administration in diabetic patients non-responder to oral therapy alone
Authors: Passavanti G. , Pizzuti V. , Carlucci M. , Aloisi A.M. , Costantini F.M. , Lia A. Bragag , Lini R. PAO
Published: June 2018

Diabetes is an important risk factor in erectile dysfunction (ED), acting via several mechanisms. We assessed the efficacy of intracavernous injections (ICI) rehabilitation and oral systematic therapy in diabetic patients, as well as the response of controls to oral therapy ‘on demand’.

Materials and Methods

Sixteen diabetic patients with ED were treated with vasoactive drugs orally when needed, without satisfactory erections. The patients underwent then ICI rehabilitation with PGE1 20 mcg twice weekly for 4 weeks, followed by the administration of oral drugs twice weekly for 4 weeks. Before and after rehabilitation, the patients completed a detailed anamnestic protocol to study their libido (always present); they answered questions Q3 and Q4 of the IIEF questionnaire. During ICI, a study with dynamic echocolordoppler (ECCD) was carried out. All patients had Type 2 diabetes: 10 were treated with oral antidiabetics, 4 were treated with insulin, and in the other 2 patients, treated with insulin, a sensitive neuropathy of the lower limbs was diagnosed. Fourteen patients were treated with antihypertensive drugs.

Results

Before rehabilitation, the mean responses to questions 3 and 4 of the IIEF (International Index of Erectile Function) questionnaire were 1.6 and 1.5 respectively; after rehabilitation, the mean responses were 2.68 and 2.5, respectively. The ECCD test showed an arterial component in 4 cases and a high end-diastolic velocity (EDV) in 14 cases. Four patients (25%), 2 of which had neuropathy, and 2 were in advanced age, did not respond to PGE1 or to oral therapy, 4 patients (25%) (2 treated with insulin and 2 by oral therapy) responded to ICI but not to oral therapy, while 8 patients (50%) showed a good response to both injectable and oral therapy, with good Q3 and Q4 scores.

Conclusions

Good endothelial function appears to be essential for the maintenance of acceptable erectile function. Diabetes has a negative effect on this function, as does hypoxia and low perfusion. Based on the principle that a good erection improves endothelial function, we tried to determine if oral systematic and intracavernous rehabilitation would improve erectile function in diabetic patients. The results indicate that diabetes interferes with erectile function, compromising the effects of the vasoactive drugs. However, integrated systematic rehabilitation appears to allow a good erectile response to both intracavernous and oral therapy in a large number of cases. Therefore, we support this kind of rehabilitative protocol in the treatment of ED in diabetic patients.
Sensitivity and specificity evaluation of endorectal magnetic resonance imaging and transrectal sonography in the staging of prostate cancer
Authors: Mangiapia F. , Liotta RF , Palmieri A. , Imbimbo C. , Pavone C. , Melloni D. , Mirone V.
Published: June 2018

Objectives

Nowadays endorectal probes for Magnetic Resonance Imaging (MRI) have better resolutions, which allows to acquire high-level images of prostate and to improve the MRI sensitivity and specificity to determine the cancer volume and the extraprostatic extension. The objective of the present study is to evaluate the sensitivity and diagnostic accuracy of endorectal MRI for identifying the local extension of prostate carcinoma compared to transrectal sonography (TRUS) of prostate.

Materials and Methods

The study included 81 patients with clinical suspect of cancer and/or elevated values of serum prostate specific antigen (PSA), who underwent endorectal MRI with 1.5 T endorectal probe before transrectal biopsy. Patients with localized prostate cancer underwent radical surgery. The results of endorectal MRI were compared to those of TRUS and histopathological examination outcomes.

Results

15 of the 81 enrolled patients had extraprostatic localization of cancer, which was assessed through TRUS in 4 cases only (26%), and through MRI in 7 cases (46%). A seminal vesicle involvement was present in 10 patients, detected by MRI in 5 cases and in no cases by TRUS.

Discussion and Conclusions

Data are similar to the findings collected by several Authors. The endorectal MRI has a better accuracy in staging prostate cancer compared to TRUS. Nevertheless, this procedure has some limits: little availability of equipment in hospitals, physicians’ little experience, and higher costs compared to TRUS.
Ureterorenoscopy with a flexible instrument
Authors: Zanin M. , Ruggera L. , Beltrami P. , Zattoni F.
Published: June 2018

Flexible ureterorenoscopy should be routinely used at the Urological Centers that deal with urinary stones. Flexible instruments should be used for both diagnostic and therapeutic purposes, allowing a safe exploration of the whole upper urinary tract. Thanks to their flexibility and to the active and passive deflection of their distal part, these instruments allowed to successfully treat several difficult situations, such as renal caliceal calculi in the lower calices or even in some middle/upper calices or in horseshoe kidneys. The therapeutic potential of this approach is enhanced by the large availability of ancillary instrumentation, such as baskets, grasps, holmium laser fibers, etc, which is continuously growing. On the other side, a steep learning curve of the technique is usually required for the surgeon. Furthermore, the intrinsic fragility of the instrument components and a potentially lower quality, when compared to that of the rigid and semi-rigid ureteroscopes, should be considered.
The use of bipolar PlasmaKinetic resectoscope in endoscopic resection of the prostate: our experience
Authors: Passavanti G. , Pizzuti V. , Bragaglia A. , Mengoni F. , Costantini F.M. , Paolini R.
Published: June 2018

Prostatic endoscopic resection (TURP) is a reference method in the treatment of prostatic obstruction.

In the past decades, the method used a monopolar resectoscope. In the last years, various technologies have been studied to improve the efficacy of endoscopic resection. As per our experience, we have thence ascertained the variations of the hematic crasis and of the mictional asset in TURP patients treated with bipolar knives.

20 patients underwent bipolar plasmakinetic resection of the prostate. Their age ranged between 58 yrs and 82 yrs (av: 70.2 yrs), the adenoma volume, checked with TR ultrasound scanning, was between 33 and 44 cc (av: 37.6), the Qmax was between 6.4 and 9.0 mL/min (av.: 7.42 mL/min). A 24Ch resectoscope and spinal anesthesia were used. Bleeding during resection was never relevant; therefore resection never had to be stopped. After about 36 hours from surgery, the patients’ sanguification was checked again: a 6.53% reduction of the number of erythrocytes, compared to pre-surgery data, was observed, together with a 6.73% decrease of hemoglobin concentration, and a 6.3% decrease of hematocrit. Continuous irrigation was suspended during the first day, catheter was removed on the 48th hour in 15 cases, and on the 72nd in 5 cases: the patients were discharged on day 3 in 16 cases, and on day 4 in 4 cases. A flux evaluation was performed after 3 months, which showed a Qmax between 16.6 and 24 mL/min (av.: 19.11), with a significant increase in the maximum flow rate.

The use of the new technologies in prostatic endoscopic resection has allowed us to improve the efficacy of such a method. Above all, the use of a bipolar electrosurgical knife enables us to associate a basal hemostasis with the resection of the prostatic tissue. Thus, the hematic loss is low, as we have been able to ascertain also in our own experience. This gave us the possibility to quickly stop continuous irrigation and to early remove the catheter. This way, hospitalization was sensibly reduced (av. 76.8 hours). The maximum flow rate, in the short term, has been good. We have been able, in our experience, to assess that this technology represents a useful guarantee to improve the results of prostatic endoscopic resection.
Laparoscopic Transperitoneal Radical Prostatectomy: Surgical Technique. A Personal Experience
Authors: Liotta R.F. , Tarantino M.L. , Melloni D.
Published: June 2018

At present, radical prostatectomy is the standard of care for localized prostate cancer.

Several mini-invasive urological procedures have been developed during the last years, such as the laparoscopic radical prostatectomy, which is nowadays an innovative technique for urologists. This procedure shows many benefits in terms of anatomic accuracy, reduction of hospitalization and transurethral catheterization, recovery of urinary continence and sexual potency.

In this study we have described the laparoscopic radical prostatectomy technique which is carried out by urologists at the “Hôpital Henry Mondor” - Creteil, Paris, where the first author has worked for six months.
Fraley's Syndrome. A Nephron-Sparing Laparoscopic Surgical Procedure. Case Report
Authors: Aresu L. , Amenta M. , Maritati F. , Occhipinti M. , Grosso G.
Published: June 2018

16-year-old girl with Fraley's syndrome, which caused right flank pain and urinary infection. The radiologic exam showed a distended calyx and an infundibular obstruction caused by compression of normal renal vessels. Retroperitoneal laparoscopic calycectomy and closure of infundibulum with calyx exclusion were performed.
Regenerative Medicine: Applications and Development in Urology
Authors: Pinto F. , Calarco A. , Brescia A. , Sacco E. , D'addessi A. , Racioppi M. , Bassi P.F.
Published: June 2018

Purpose

Congenital abnormalities and acquired disorders can lead to organ damage and loss. Nowadays, transplantation represents the only effective treatment option. However, there is a marked decrease in the number of organ donors, which is even yearly worsening due to the population aging. The regenerative medicine represents a realistic option that allows to restore and maintain the normal functions of tissues and organs. This article reviews the principles of regenerative medicine and the recent advances with regard to its application to the genitourinary tract.

Recent findings

The field of regenerative medicine involves different areas of technology, such as tissue engineering, stem cells and cloning. Tissue engineering involves the field of cell transplantation, materials science and engineering in order to create functional replacement tissues. Stem cells and cloning permit the extraction of pluripotent, embryonic stem cells offering a potentially limitless source of cells for tissue engineering applications. Most current strategies for tissue engineering depend upon a sample of autologous cells from the patient's diseased organ. Biopsies from patients with extensive end-stage organ failure, however, may not yield enough normal cells. In these situations, stem cells are envisaged as being an alternative source. Stem cells can be derived from discarded human embryos (human embryonic stem cells), from fetal tissue or from adult sources (bone marrow, fat, skin). Therapeutic cloning offers a potentially limitless source of cells for tissue engineering applications. Regenerative medicine and tissue engineering scientists have increasingly applied the principles of cell transplantation, materials science and bioengineering to construct biological substitutes that will restore and maintain normal function in urological diseased and injured tissues such as kidney, ureter, bladder, urethra and penis.

Conclusions

Regenerative medicine offers several applications in acquired and congenital genitourinary diseases. Tissue engineering, stem cells and, mostly, cloning have been applied in experimental studies with excellent results. Few preliminary human applications have been developed with promising results.
Phytotherapy and Diet for And Rological Pathologies
Authors: Patelli E. , Nicola M. , Maggioni M. , Tombolini P.
Published: June 2018

For long time the role of phytotherapy and diet has been known to be useful in managing and rological pathologies. Nowadays, phytotherapy knowledge among urologists is quite restricted; though, they are gaining more and more practice in relation to many different urological diseases, even though the mechanism of action and pharmacokinetics characteristics remain unknown.

The mechanism of action is often represented by vasodilatation of genital area and stimulation of lumbar plexus. Many reports suggest that diet can reduce the incidence of prostate pathologies and improve sexual and reproductive activity. In this article the most common phytotherapy agents are presented, together with their mechanism of action, side-effects and toxicity characteristics.
Neuroendocrine bladder cancer: oncological emergency?
Authors: Fiorito C. , Lucca I. , Oderda M. , Mondino P. , Berta G. , Cattaneo E.A. , Valentino F. , Zitella A. , Pacchioni D. , Tizzani A.
Published: June 2018

Neuroendocrine bladder cancer is extremely rare, with an estimated incidence of 0.5%- 0.7%. In bladder cancers there is no evident connection between the neuroendocrine phenotypic expression and the clinical history. However, prognosis is usually poor and the survival rate at 5 years does not exceed 8%, if untreated.

Methods.

We are here describing three case reports of bladder carcinoma with neuroendocrine differentiation, which is extremely aggressive and leads rapidly to death. At the present time, the local control of these tumors is achieved by radical cystectomy and radiotherapy; they can be both associated to chemotherapy. However, since these lesions are fairly rare, there is no gold standard therapy and there are no prospective studies on the management of these tumors.

Conclusions.

Considering the quick evolution and progression of any variant of the neuroendocrine tumors of the bladder, urologists and anesthetists should see them as real oncological emergencies. A prompt intervention through radical surgery with cystectomy and linfadenectomia, and the anathomo-pathologist's systematic investigation of the scraps could make the approach therapeutic and not only palliative. Prospective studies on neo-adjuvant chemotherapy as well as experimental studies about target therapies may yield new guidelines on the tumor management.