bluuebunny/crossref_metadata_2025_split huggingface dataset:
ProACT: A New Surgical Therapy for the Male Sui
Authors: Frea B. , Kocjancic E. , Zaramella S. , Crivellaro S. , Gontero P. , Favro M. , Ceratti G. , Sala M. , Monesi G. 
Published: June 2018

The incidence of reported male stress urinary incontinence (SUI) status prostate surgery varies widely between 2–40%. While the artificial urinary sphincter (AUS) reports good long-term efficacy, this procedure is associated with a high rate of reoperation. The aim of this study was to assess the results at 1 year of follow up of a new minimally invasive surgical technique called Pro ACT (Adjustable Continence Therapy). Material & Methods The ProACT is a new implant for post-prostatectomy incontinence. A balloon, a port and a tube of connection are the components of the Pro ACT. It is percutaneously implanted and is postoperatively adjustable. From September 2000 to December 2003 16 males underwent to the procedure. The mean age was 56.5 years (range 29–83). The SUI was due in 13 cases to radical retropubic prostatectomy, in one case to TURP, in one case to open prostatectomy for benign prostatic hypertrophy and one case to congenital incontinence associated with epispadia. The urodynamic exam revealed SUI due to intrinsic sphincteric deficiency in all patients. Efficacy was assessed by change in use of average number of pads used daily, and overall impression Results The average number of adjustments after the surgery was 1.6. The average number of pads used decreased from a mean 5.11 at baseline to 1.62 at 12 months. Overall 42.8% of the patients are now completely dry. 28% are improved and 30% are either not improved or only slightly improved. In three of these patients the adjustments are still on going. The only post-operative complication was a migration of both the balloons into the bladder in one patient, which necessitated the removal of both devices as a minor procedure under local anesthetic. Conclusions The ProACT is a new surgical therapy for the male SUI. This technique is easy, quick to learn and associated with a low rate of complications and a satisfactory rate of success. 70% patients were dry or improved at 1-year follow up. The device is well accepted from the patients because it doesn't require any manual skill to operate implanted components. Complications are easily managed because of the possibility to remove the Pro ACTs implants completely, or by simply deflating the balloons via percutaneous injection.
Uterine Preservation or Hysterectomy for the Uterovaginal Prolapse
Authors: Costantini E. , Saccomanni M. , Vianello A. , Ioannidou K. , Del Zingaro M. , Cecchetti G. , Zucchi A. 
Published: June 2018

For many years uterine prolapse has been an indication for hysterectomy, quite apart from the presence or the absence of any uterine disease and independently of the patients’ desire. Many studies on pelvic statics showed the central role of uterus on the pelvic static itself. Aim of the study is to prospectively compare sacropexy with and without hysterectomy in patients with uterovaginal prolapse. Surgical techniques, efficacy and overall results are described. Material and Methods Fifty-six consecutive patients affected by grade III-IV uterovaginal prolapse underwent colposacropexy: hysterectomy followed by sacropexy (SP) in 29 and hysterocolposacropexy (ISP) in 27. Before surgery all patients provided a detailed case history and replied to a questionnaire on urinary symptoms (Urogenital distress inventory). Patients underwent a clinical urogynaecological examination (HSW), a pelvic ultrasound scan and urodynamic test. Check-ups were scheduled at 3, 6, 12 months and then annually. Results No significant differences emerged in demographic and clinical characteristic in the SP and ISP groups. Mean operating times, intraoperative blood loss and hospital stay are significantly less after ISP (p<0.001). No patient required surgery for recurrent prolapse. Urodynamic results showed the pressure/flow parameters improved significantly (p< 0.001). 24/27 patients (88.9%) in the ISP group and 25/29 (86.2%) in the SP are satisfied and would repeat surgery again. 5/7 patients who would not repeat surgery were incontinent. Conclusions Sacrocolpopexy provides a secure anchorage restoring an anatomical vaginal axis and a good vaginal length. ISP can be safely offered to women who request uterine preservation. Long-term results in terms of prolapse resolution, urodynamic outcomes, improvements in voiding and sexual dysfunctions are excellent.
Gefitinib is Able to Sustain Metastatic Progression
Authors: Angelucci A. , Gravina G. L. , Festuccia C. , Muzi P. , Rucci N. , Galatioto G. Paradiso , Costa A.M. , Teti A. , Vicentini C. , Bologna M. 
Published: June 2018

The expression of epidermal growth factor receptor (EGFR) is a distinctive marker in the biologic progression of prostatic carcinoma (PCa). Gefitinib (‘Iressa’) is an orally active EGFR tyrosine kinase inhibitor, and in clinical trials has shown important antitumor activity in tumors expressing EGFR. Our aim was to demonstrate that Gefitinib was also effective in inhibiting the cellular capabilities leading to metastasis formation. Methods The inhibitory effect of Gefitinib on the invasive phenotype of PCa cells was tested in vivo by injecting PC3 cells subcutaneously (Xenograft) or into the left ventricle of nude mice and by daily administration of various doses of Gefitinib. Results The tumoral growth of xenograft was significantly inhibited by 150mg/kg Gefitinib with a reduction of 40% in tumor weight. Moreover mice receiving tumoral cells intracardially showed a significant reduction in bone metastases when treated with Gefitinib. Conclusions Our data demonstrate that EGF is able to sustain not only cellular growth, but also metastatic progression. For this reason the use of Gefitinib as a therapeutic agent may also be indicated in the control of tumor spreading in EGF responsive tumor cells.
Immunotherapy for Urologic Tumors
Authors: Ridolfi R. , Matera L. , Tizzani A. 
Published: June 2018

Cancer vaccines are intended to promote a long-lasting memory response against tumors. Rationale for cancer vaccines is based on two observations: a) many tumors express antigens (TA), which are recognized by specific cytotoxic T lymphocytes; b) these lymphocytes may protect the host against tumor growth in vivo. So far, cancer vaccines have been developed using soluble TA and, more recently, TA presented by dendritic cells (DC), the most powerful antigen presenting cells (APC). DCs play a key role in the process leading to antigen recognition and lymphocyte activation. Despite a deeper understanding of these processes, clinical efficacy of cancer vaccines is still hampered by the heterogeneity of the studies performed so far, and by the largely unknown mechanisms through which tumors escape immunosurveillance. Current DC-based cancer vaccines require the preparation of DCs from patient blood monocytes, as well as DC-loading with TA. Both whole tumor and TA peptides are used as source of TA. Similar schedules have been implemented in many clinical trials on melanoma, kidney and prostate cancer, with partial responses ranging from 7% to 30%. The study population was made up of non-respondent patients to any other therapy; the DC vaccination showed an extremely low toxicity. 22 patients with metastatic melanoma received a DC vaccine in Forlì (Italy) since August 2001. Good correlation between immunologic response, clinical response and overall survival was found. A clinical trial on pulsed APC administration to patients with recurring prostate cancer is ready to be started in Torino (Italy), pending the Ministerial approval from a local cell factory.
Quality of Life before and after Andro-Gynoid and Gynoandroid Conversion Surgery
Authors: Trombetta C. , Scati L. 
Published: June 2018

Our study intended to assess if surgery could be able to improve transsexuals’ QoL (quality of life); 16 subjects were asked to fill in a test form to verify quality of life before and after andro-gynoid conversion surgery. Other individuals were studied as follows: 18 MtoF (andro-gynoid) subjects awaiting surgery; 16 MtoF subjects who had been operated on more than one year before; 13 FtoM (gynoandroid) individuals waiting for surgery; 4 FtoM subjects after surgery. The “Quality of Life Enjoyment and Satisfaction Questionnaire - Q-LES-Q” (Endicott 1993) was drawn up: this is a self-report questionnaire which assesses the degree of enjoyment and satisfaction experienced by subjects in various areas of daily functioning. Outcomes confirmed the assumption of origin.
Enterovesical Fistulas Secondary to Crohn's Disease: Medical versus Surgical Therapies
Authors: Fischetti G. , Di CROSTA G. 
Published: June 2018

The purpose of this study is to evaluate the efficacy of medical therapies, especially infliximab, to induce remission of enteric fistulas in Crohn's disease (CD). Similarly to CD, chronic transmural inflammation of the bowel, diverticulitis and other pathologies may predispose to the development of fistulas. The risk of fistulization secondary to CD ranges from 17% to 80%. We focused on enterovesical fistulas, which statistically represent 10% of all fistulas secondary to CD. Material and Methods In this study we decided to implement a therapeutic program with infliximab 5 mg/kg associated with steroids, which proved to be the most effective method of treatment. From January 2003 to March 2005, we studied 4 patients with CD and enterovesical fistulas. All patients underwent NMR, colonoscopy and cystoscopy combined with fistulography; a therapeutic strategy with cortisone, mesalazine, nutritional therapy and infliximab was established. Results No regression was observed; therefore, all the four patients underwent surgery with complete remission of symptoms. Conclusions Data reported in literature and the evidence from our experience seem to be contradictory; we concluded therefore that it is mandatory to consider different therapeutic approaches, according to the fistulizing pathways, to such a complex disease, and to formulate some hypothesis that might explain why this treatment was unsuccessful in our patients.
TVT and TOT: a comparison between these two techniques based on our clinical experience
Authors: Tamai A. , Donazzan A. , Gallo V. , Durante S. 
Published: June 2018

Aim of the Study A retrospective evaluation and a comparison of results from two minimally invasive surgery techniques that we adopted for the treatment of SUI. Materials and Methods. In this study we evaluated 113 selected patients who underwent SUI minimally invasive surgery from 1–1-2000 to 31–12–2007. 87 patients underwent epidural anesthesia. 26 local anesthesia. In Group A (TVT) 61 patients were enrolled, mean age 57.6 (±22). 43 patients (70%) were on menopause. In Group B (TOT out-in) 52 patients were enrolled (for 34 of them we used the Obtape® sling while for 18 the Obtryx® one), their mean age was 58.5 (±20.5) and 39 patients (75%) were on menopause. Patients from both groups did not undergo any past previous urogynecological surgery and suffered from stress urinary incontinence with cervico-urethral hypermobility butno other associated pathology. The pre-operative work-up included an evaluation of patients based on ICS guidelines. Results. Group A (TVT) - mean follow-up 66.3 months, dry patients 53/61 (86.8%). Bladder perforations resolved by catheterization 3/61 (5%). Transient voiding dysfunction 14/61 (22.8%). “De novo” urgency 8/61 (13%). One patient on self-catheterization due to persistent urinary retention underwent a single-side section of the sling with spontaneous micturition and complete continence recovery. Group B (TOT out-in) - mean follow-up 35.5 months, dry patients 43/52 (82%). 4 patients (7.6%) complained oftransient voiding dysfunction, 5 patients (9.5%) for “de novo” urgency, 1 patient underwent a sling removal due to vaginal erosion 4 months after surgery (Obtape®).
Early vs Delayed Radical Cystectomy Compared in Highgrade Superficial Bladder Tumors
Authors: Varca V. , Simonato A. , Esposito M. , Curotto A. , Orlandini M. , Rikani E. , Carmignani G. 
Published: June 2018

Objectives The treatment of aggressive superficial TCC of the bladder remains controversial. In fact, although still classified as ‘superficial’, it has been shown that the biological characteristics of T1G3 bladder tumors are the same as those of the muscle-invasive group (T2 and above). Even with close monitoring and intensive intravesical therapy, the reported risk of muscle invasion in these patients is 53% and 1/3 die from this disease in the long-term. The aim of this study is to determine whether the timing of radical cystectomy affects the survival of patients with aggressive superficial bladder tumor. Methods We consider 74 patients who underwent radical cystectomy between November 1994 and October 2006 before a diagnosis of T1G3 bladder tumor. These patients were divided in 2 subgroups: group A (n=27, 25 M and 2 F) who underwent immediate radical cystectomy, and group B (n=47, 40 M and 7 F) who underwent other conservative treatments before radical cystectomy. Results The two subgroups were similar concerning age (66.29±8.37 yrs vs 66.87±8.6 yrs, respectively, p NS) and the timing of follow-up (respectively 77±45 vs 60±35 mths, p NS). Moreover, the progression-free survival was significantly higher in subgroup A (53.73±48.54 vs 31.94±35.19 mths, log-rank p<0.05) as well as the overall survival (59.73±45.37 vs 36.45±33.96 mths respectively, log-rank p<0.05). Comparing the histological examinations, the two subgroups were significantly different concerning the T stage (superficial tumors 14/27 vs 16/47, respectively, p<0.05; invasive tumors 13/27 vs 31/47, respectively, p<0.00005) and the lymphonodal dissemination (2N+/27 vs 11N+/47, respectively, p<<0.0005). Conclusions Delaying radical cystectomy for aggressive superficial bladder tumors leads to a worse progression-free survival; the overall survival is likely to be due also to an early lymphonodal dissemination, which occurs extending the timing between diagnosis and radical treatment.
Urethral Stricture: Complex Surgery
Authors: De Luca V. 
Published: June 2018

The optimal management strategy for urethral stricture remains controversial. The therapeutic indication and surgery technique are still as much an art as they are a science. It is often unclear which type of urethroplasty to perform under which particular circumstance, but some evidence basis for urethral surgery has been developed in the last 20 years at last. This article reports the options for urethroplasty at different sites in the urethra and for different types of stricture, indicating which procedure should be used in which circumstances according to best available publications on urethral stricture management.
Analysis of the Results Obtained with a new Phytotherapeutic Association for Benign Prostatic Hyperplasia versus Controls
Authors: Bercovich Eduard , Saccomanni Mauro 
Published: June 2018

Introduction Benign prostatic hypertrophy (BPH) is a common disease whose frequency has risen throughout the world in concomitance with the increase in life expectancy. BPH causes voiding distur-bances known by the acronym LUTS (lower urinary tract symptoms), which heavily influence the quality of life in the elderly. The treatment for LUTS is mainly divided into medical and surgical, the latter usually represented by prostate ablation. Medical therapy includes synthetic molecules that interfere with the hormonal control of BPH or act on the bladder neck tonus, as well as natural remedies based on plant extracts from Serenoa Repens and/or Urtica Dioica. Material and Methods TWO groups of patients who were candidates for surgery for BPH-induced LUTS, were randomly recruited in a six-month trial aimed at comparing outcome of treatment with a new combination of plants extracts (Pluvio®), which differs from the previous ones in that it also contains avocado and soya oil, as well as a high dose of Urtica Dioica, with no therapy. Age, IPSS score, maximal uroflow, prostate volume, PSA, free-to-total PSA ratio, post voiding residual urine and number of nocturia episodes were recorded and statistically evaluated using a NCSS 60® program. Result A marked benefit in terms of quality of life, measured by IPSS score, uroflow, residual urine and nocturia, was observed in the treated group compared to controls. PSA and prostate volume were not significantly affected. No noteworthy adverse events were observed. Conclusions The new phytotherapeutic combination evaluated in the present study would seem to be highly effective for the treatment of LUTS in BPH patients and does not have negative side effects. Its use could therefore be strongly advocated in this setting.
Informed Consent and Risk Management
Authors: Moreschi C. , Leone E. , Sabot A. 
Published: June 2018

In every relief run, both to the goals of medical performance quality and in the optics of a therapeutic alliance, it is fundamental to create a relationship of trust among the physician and the patient, in which communication assumes a fundamental role. The informed consent is set as an integral part of the sanitary action as conclusive moment of that “therapeutic alliance” fundamental to face in a correct way every illness, and it legitimates the same sanitary action, as it is the demonstration of the constitutionally guaranteed right of patient's autodetermination. The A.O.U.D. of Udine has undertaken a run of accreditation to the Joint Commission International that it foresees a revision of the informative runs and an updating of the forms of informed consent, with the purpose to overcome the traditional physician-patient relationship, recognizing to all the patients an active role in the exercise of the medical action and in the care process. In fact the information must be lived as integral part of the sanitary action, with the awareness that this, private of such a part, would result incomplete and inaccurate, independently from the result. In such optics, the consent form, created absorbing legislative, ethical and deontological principles and jurisprudential orientations, will be illustrated and particular considerations about the type of information that must be given to the patient for treatments effected in day-surgery will be formulated.
Which Factors allow to Anticipate the Diagnosis of Prostate Cancer in Pin Patients? A Study on 546 Patients
Authors: Antonelli Alessandro , Tardanico Regina , Giovanessi Luca , Pesenti Nicola , Gatti Lorenzo , Zambolin Tiziano , Zani Danilo , Simeone Claudio , Cunico Sergio Cosciani 
Published: June 2018

Aim of the study TO analyze which factors allow to assess the risk of finding a prostate cancer (PCa) at repeated biopsies in patients with diagnosis of prostatic intraepithelial neoplasia (PIN). Patients and Methods At our institute all patients with a diagnosis of PIN undergo a 6–monthly control biopsy until the achievement of a benign histology or up to a maximum of 4 consecutive biopsies. For this study a retrospective review of clinical and bioptic data of patients with a diagnosis of isolated PIN (i.e. without associated atypical small acinar proliferation or small cancer foci) was carried out. The correlation between these features and the probability to find PCa at the first re-biopsy or at a further re-biopsy was independently analyzed. Results The data of 546 patients subjected to a median number of 3 biopsies, (mean: 10.8 and 12.9 cores at initial biopsy and at first re-biopsy respectively), and with a mean “bioptic” follow-up time of 14.8 months, were analyzed. PCa was found in 174 cases (31.8%): for 116 of them it took place at the first re-biopsy with a mean latency of 7.8 months from PIN diagnosis, whereas for 58 at a further re-biopsy with a mean latency of 21.6 months. The risk of diagnosing PCa at the first re-biopsy was statistically correlated with the PSA value - for which a cut-off value of 7 ng/mL was identified - and with an anomalous rectal prostatic examination at the time of the initial biopsy. Differently, the risk of diagnosing PCa after the first re-biopsy correlated with the number of cores positive for PIN at the initial biopsy - for which a cut-off of 4 was identified - and to the ratio between these and the total number of cores, defined as PIN density - for which a cut-off of 50% was determined. Discussion and Conclusions It is possible to suggest a tailored protocol of controls in patients with a diagnosis of PIN on the basis of the data available at the initial biopsy: a) high PSA value and/or an anomalous prostatic rectal examination: the diagnosis of PCa is probably just unacknowledged by the initial sampling and it is advisable to carry out an early re-biopsy; b) number of cores with PIN equal to or higher than 4 and/or PIN density equal to or higher than 50%: a true transition from PIN to PCa is likely to happen with time and it is advisable to carry out a delayed re-biopsy; c) no risk factors: just clinical and PSA monitoring to establish the indication to re-biopsy.
Hepatorenal Bypass for Renal Salvage: A Forgotten Option in the Endovascular Era
Authors: Salahia M. Ghali , White Richard D. , Gordon Andrew C. , Williams Ian M. 
Published: June 2018

Introduction: In this era of rapidly expanding endovascular techniques, the use of hepatorenal bypass as treatment for a critically compromised renal perfusion has largely been forgotten. This article highlights the benefits of the technique both as a bailout strategy following complications from angioplasty and as a primary treatment in cases deemed unsuitable for endovascular intervention. Materials and Methods: Two patients are described whose renal viability was threatened by vascular compromise. One patient had a single functioning kidney with significant renal artery stenosis secondary to severe atherosclerotic disease and developed acute renal function deterioration following unsuccessful angioplasty. The second patient developed renal artery occlusion 3 years following open thoracoabdominal aortic aneurysm surgery. Both patients underwent successful hepatorenal bypass surgery and remain off dialysis 6 months after admission. Results: Both cases demonstrated the success of hepatorenal bypass with significant improvement in their renal function following open surgical repair. Conclusion: Hepatorenal bypass, although now seldom used because of available endovascular alternatives, remains an effective method of treating complicated cases of threatened kidney secondary to vascular insult.