bluuebunny/crossref_metadata_2025_split huggingface dataset:
Psycho-relational aspects of urinary incontinence in female sexuality
Authors: Simonelli C. , Tripodi F. , Vizzari V. , Rossi R. 
Published: June 2018

Urinary incontinence (UI) is a very common disorder in women, involving severe consequences on the patients’ perception of quality of life and sexuality. The aim of this contribution is to analyze the psycho-relational aspects linked to UI, focusing on sexual activity, self-perception of sexual competence and self-esteem. Urinary incontinence causes feelings of shame and inadequacy as well as low self-esteem; it may affect sexual activity, reducing sexual intercourse frequency. Many authors highlight a strong comorbidity between urinary incontinence and sexual dysfunctions, such as dyspareunia, vaginismus, hypo-active sexual desire, arousal and orgasm disorders. Literature analysis shows that changes in sexual activity are influenced not only by urinary incontinence symptoms but also by the disorder self-perception, by previous sexuality, menopause, social status and the partner's attitude. The etiological study of urinary incontinence shows that several different factors play a role in this disorder. Therefore, an integrated therapeutic approach is suggested, considering, besides the organic issues, the experience and feelings of patients as well as the consequences on their sexual and social life.
Urologic surgical procedures in patients with uterus neoplasm and colon-rectal cancer
Authors: Marino G. , Laudi M. , Capussotti L. , Zola P. 
Published: June 2018

Introduction. During the last 30 years, the multidisciplinary treatments of colon and uterus neoplasm have yielded an increase in total survival rates, fostering therefore the increase of cases with regional relapse involving the urinary tract. In these cases the iterative surgery can be performed, if no disease secondary to pelvic pain, haemostatic or debulking procedure is present, and must be considered and discussed with the patient, according to his/her general status. Materials and Methods. From 1997 to August 2007 we performed altogether 43 pelvic iterative surgeries, with simultaneous urologic surgical procedure because of pelvic tumor relapse in patients with uterus neoplasm and colon and rectal cancer. In 4 cases of anal cancer, the urological procedure were: one radical prostatectomy with continent vesicostomy in the first case, while in the other 3 cases radical pelvectomy with double-barrelled uretero-cutaneostomy In 23 cases of colon cancer, the urologic procedures were: 9 cases of radical cystectomy with double-barrelled uretero-cutaneostomy, 4 cases of radical cystectomy with uretero-ileo-cutaneostomy according to Bricker-Wallace II procedure, and 9 cases of partial cystectomy with pelvic ureterectomy and ureterocystoneostomy according to Lich-Gregoire technique (7 cases) and Lembo-Boari (2 cases) procedure. In 16 cases of uterus cancer, the urological procedure were: 7 cases of partial cystectomy with pelvic ureterectomy and uretero-cystoneostomy according to Lich-Gregoire procedure; in 3 cases, a radical cystectomy with urinary continent cutaneous diversion according to the Ileal T-pouch procedure; 2 cases of total pelvectomy and double uretero-cutaneostomy, and 4 cases of bilateral uretero-cutaneostomy. Results. No patients died in the perioperative time; early systemic complications were: 2 esophageal candidiasis, 1 case of venous thrombosis. Conclusions. The iterative pelvic surgery in the case of oncological relapse involving the urinary tract aims to achieve the best quality of life with the utmost oncological radicality. The equation: eradication of pelvic neoplasm and urinary tract reconstruction, with acceptable quality of life, will be the future target; nevertheless, it is not possible to establish guidelines beforehand, and the therapy must be adapted to each single case.
Use of human fibrinogen and human thrombin for urethral reconstructive surgery
Authors: Romano G. , De Angelis M. , Barbagli G. 
Published: June 2018

The objective of the present study is to test the use of a haemostatic sponge for urethral reconstructive surgery and to assess the relevant benefits. Methods. The haemostatic sponge is made up of collagen with human fibrinogen and human thrombin. When the sponge gets in contact with fluids, such as blood, lymph or saline solution, the fibrinogen and thrombin are activated and form a fibrin net able to achieve local haemostasis and tissue regeneration. This kind of product was used in 30 selected patients (pts.), aged 19 - 70 (mean age: 35), who underwent single-stage anastomotic urethroplasty from January 2006 to March 2007: 22 bulbar end-to-end anastomoses and 8 bulbo-prostatic anastomoses. All operations were performed due to post-traumatic stricture of bulbar and posterior urethra. The main selection criterion for the use of the haemostatic sponge has always been the tendency to and/or the presence of bleeding in the different surgical stages. The sponge imbibed in saline solution and suitably modeled for all specific requirements was differently placed: sleeve-shaped in the case of bulbar anastomoses (16 pts.); as a “patch” in the centre of spongioplasty in bulbo-prostatic anastomoses (8 pts.), and within the widening incisions of the urethral roof performed between the two cavernous bodies at level of the intercrural septum (5 pts.). In 1 case (obese patient) a single sponge was placed after the deep perineal reconstruction on the bulbo-cavernous muscle-subcutaneous layers because of massive bleeding. Results. In all cases a perfect control of haemostasis could be achieved, with immediate end of bleeding in the points where the haemostatic sponges were used. The dressings performed on day 3 upon removal of the compressive scrotum-perineal bandages did not show any late post-operative bleeding. The follow-up visits at month 1 and 3 yielded positive outcomes for all 30 patients, who achieved complete wound healing by first intention, and a perfect anastomosis especially in the bulbar end-to-end urethroplasty, confirmed by urethrografy at one month. Conclusions. The association of human fibrinogen and human thrombin in haemostatic sponges represents a manageable, useful product, apparently sure, not negatively interfering in repairing and regenerating tissue processes, and allowing a simple and direct control of important bleeding events occurring during urethral reconstructive surgery as well as other operations. It is therefore advisable to more widely use the product after a suitable follow-up period.
Testis tumors: what is new?
Authors: Necchi A. , Nicolai N. , Salvioni R. 
Published: June 2018

Germ-cell tumors (GCTs) are extraordinary chemosensitive neoplasms that resemble the model for the cure of cancer even in metastatic disease. Nonetheless, a small portion of patients does not achieve a long-lasting complete response and new efforts are then required in order to further improve their healing rate. This paper summarizes what is new about the management of these tumors through dedicated sections about biology, prognosis and treatment. Special interest is then focused on the Italian reality and how it participates to the advances made by the International community.
Is antibiotic prophylaxis in invasive urodynamics a useful procedure in postmenopausal subjects?
Authors: Siracusano S. , Knez R. , Tiberio A. , Simonazzi M. , Alfano V. , Giannantoni A. , Ciciliato S. , Belgrano E. 
Published: June 2018

Objectives. To define the incidence rate of urinary tract infections (UTI) and the usefulness of antibiotic prophylaxis in postmenopausal female undergoing invasive urodynamics (IU). Methods. 262 postmenopausal females underwent IU, being previously double-blindly randomized in 2 homogenous age-matched groups. Group 1 (130 patients) received oral antibiotic prophylaxis with a single 400 mg dose of norfloxacin. Group 2 (132 patients) was given placebo. The statistical analysis was performed using a Chi-Square test, in order to evaluate any difference between groups for UTI incidence rate. Results. 54 patients out of 262 (20.6%) developed a UTI [24 out of 130 subjects who received antibiotic prophylaxis (18.4%), and 30 out of 132 subjects who received placebo (22.7%)]. As per the UTI incidence rate, no statically significant difference (p>.05) was shown between patients receiving and those not receiving the antibiotic prophylaxis. Conclusions. The UTI incidence rate in postmenopausal women undergoing urodynamics is not affected by the administration of antibiotic prophylax.
Efficacy of Dutasteride, Alfuzosin or both on Quality of Life in Patients with Prostatic Hyperplasia and BOO. A Two-Year Spontaneous, Observational, Self-Controlled Study
Authors: Ventimiglia B. , Consoli S. , Serrao M. , Serrao A. , Tsirgiotis A. 
Published: June 2018

Three homogeneous groups of patients suffering from benign prostatic hypertrophy (BPH) were evaluated by means of a two-year observational study, in order to assess and compare their Quality of Life (QoL) under the following different medical treatments. Group 1: alfuzosin alone, Group 2: alfuzosin and dutasteride, Group 3: dutasteride alone. QoL was evaluated by validated indexes, such as the IPSS and the QoL-Vas. Although different in entity and timing, as expected, all the three groups showed an improvement. The best and quickest results were detected in the drug association of Group 2. Significant decrease in volume was detected in the dutasteride groups (2 and 3) but not in group 1 (alfuzosin alone), where a quick relief of LUTS was detected, due to its well-known alphalytic action. Our results suggest that dutasteride alone does not result in a rapid decrease in LUTS, whereas it can help to manage the reduction of the prostate volume. A combination therapy seems therefore to be recommended to obtain LUTS relief both in the short and long term results.
Erectile dysfunction and alcohol intake
Authors: Dachille G. , Lamuraglia M. , Leone M. , Pagliarulo A. , Palasciano G. , Salerno M.T. , Ludovico G.M. 
Published: June 2018

The objective of this work is to evaluate in a selection of patients with erectile dysfunction the influence of alcohol consumption and the response to alcohol abstinence with and without sildenafil association. Materials and Methods. In a population of 150 consecutive patients with erectile dysfunction we studied 50 patients aged between 22 and 77 years (mean 56±14 SD). These 50 patients were divided into three different treatment groups and were screened for three different levels of alcohol risk with two questionnaires. All patients were evaluated with an International Index Erectile Dysfunction (IIEF) questionnaire before and after one month of treatment. Results. The 50 patients included 14 patients with high alcohol risk, 34 patients with low alcohol risk and only 2 patients with no alcohol risk. After one month, 29 patients responded to the therapy, and 21 did not respond. The IIEF questionnaire presented a statistically significant difference between the different risk groups before and after treatment (p≤0.05). All the patients were examined with a penile Doppler Ultrasound. Only 10 of them had an abnormal diastolic peak velocity (PDV) and only 1 presented both pathologic systolic peak velocity (PSV) and PDV. These 11 patients did not respond to therapies and 10 of them were at high alcohol risk. The alcohol consumption risk was directly correlated with PDV (p=0.00001; R=0.4). Conclusions. The results of this study demonstrated a significant relationship between alcohol consumption and erectile dysfunction. This underlines the important therapeutic issue of alcohol abstinence in treating patients with erectile dysfunction.
Acute thrombosis of the renal artery secondary to closed abdominal trauma: our experience and literature revision
Authors: Benedetto G. , Nigro F. , Bratti E. , Ferrarese P. , Abatangelo G. , Scremin E. , Cavarretta L. , Tasca A. 
Published: June 2018

Aim Thrombosis secondary to renal closed abdominal trauma is a rare event, most of the time it is clinically silent. We report here our experience. Materials and Methods. This is the case of a boy came to our observation after a road trauma with motorbike fall-out. The boy arrived in ED for head injury. The patient, stable for haemodynamics, had lacerated and contused injuries at pelvis and right buttock level. He underwent chest x-rays, brain CT and neurosurgery examination: all resulted negative. There was no macrohematuria, nor lumbar pain. Objectively abdomen was treatable. The patient was referred to temporary observation for 12 hours when he was asked to undergo abdomen ultrasound, which showed no documented lesions except for fluid collection at the pelvic level. To rule out all doubts, the patient had an abdominal CT scan, which showed a silent left kidney with suspected thrombosis at left renal level. The patient was sent to our attention after 15 hours: we decided to perform immediately selective arteriography with thrombus lysis. The arteriography documented a massive thrombosis. The thrombus lysis was impossible to be performed. To maintain the perfect functionality of the contralateral kidney we decided not to proceed further, but to perform only left nephrectomy. During surgery mesocolon laceration occurred, so the patient underwent also colic resection. Discussion. Thrombosis secondary to a closed renal abdominal trauma is an uncommon event, with little clinical expression. It is the consequence of an injury. Deceleration produces arterial dissection, which alters the blood flow to the kidney, which is then twisted and complicated with renal thrombosis. Quite common is the association with diaphragmatic rupture or urethral detachment. The alterations of renal parenchyma in the early hours are detectable only through CT scan, which represents the method of election, and which can highlight a functionally silent kidney. Conclusions. Renal thrombosis requires that diagnosis is done within the first 12 hours; a rapid revascularization should be promptly attempted.
Transvesical prostatic adenomectomy: general or local anesthesia
Authors: Fasciolo A. , Baldini C. 
Published: June 2018

A transvesical prostatic adenomectomy is defined as an “open-sky” surgical procedure performed to remove a benign prostatic nodule that, growing up, could represent an obstacle to the normal emptying of the bladder. This operation can be carried out under general or loco-regional anesthesia conditions: the second option, however, does not provide the curarization of the patient, and could result in a higher endoabdominal pressure, which could significantly reduce the surgeon's visual field. Nevertheless, this technique allows for a complete analgesia and anesthesia during the first postoperative hours, avoiding the occurrence of abdominopelvic contractions and pain-linked hypertension, which can cause dangerous postoperative bleedings. As opposed to this, during surgery under general anesthesia conditions, the curarization ensures a wider operating field, free from abdominopelvic contractions, but with important postoperative pain, the main cause of which is the continuous bladder washing; this kind of pain is very difficult to treat even with oppioids: it is certainly the most important cause of bleedings, resulting in patient's discomfort, risk of blood transfusion or even reoperation. The two techniques have been compared in a randomized study on 40 patients: the subarachnoid technique seems definitely to be more favorable, with its optimal antalgic effect even during the first postoperative hours, with no need to use high doses of antalgic iv drugs, and, most important, with no subsequent postoperative hypertension and bleedings.
α-Blockers in Benign Prostatic Hyperplasia: The Problem of “Floppy Iris Syndrome”. Results of a Case-Control Study to Evaluate the Surgical Risk through the Meausurement of Pupil Diameter
Authors: Pavone C. , Abbadessa D. , Serretta V. , Cillino V. , Maggioni A. , Rahman D. ABED EL 
Published: June 2018

Objectives α-blockers are a group of α-adrenoceptor antagonists used by urologists to treat lower urinary tract symptoms suggestive of benign prostatic hyperplasia. Recent studies have suggested that these drugs – tamsulosin in particular – are involved in the development of iris complications during phacoemulsification. The objective of this study is to investigate the effects of α-blockers – especially tamsulosin – on pupil diameter. Materials and Methods We measured the photopic, mesopic and post-dilatation pupil diameters in both eyes of 24 patients (46 eyes in total), 16 of them treated with α-blockers and 8 of them (16 eyes in total) not treated with any drugs (controls). Results All patients treated with tamsulosin showed minor photopic, mesopic and post-dilatation diameters compared to controls. Patients treated with other α-blockers did not show any difference compared to controls. Conclusions Even if a small number of eyes was evaluated, our study shows that tamsulosin - through its selective effect on α1A receptors - is the most involved drug in the Intraoperative Floppy Iris Syndrome.
Bladder Augmentation and Urinary Diversions in Kidney Transplants
Authors: Lasaponara F. , Pasquale G. , Cucchiarale G. , Ferrando U. 
Published: June 2018

There is some controversy about the safety of kidney transplant in patients with augmented or diverted urinary system: they are considered higher risk recipients in view of increased technical problems and infective complications leading to pyelonephritis and graft loss. The ureter of a transplanted kidney should be anastomosed into a reservoir with an adequate capacity, with low bladder pressure, with good compliance, and efficient voluntary empting. Ileal and sigmoid bladder augmentation, usually associated with clean intermittent catheterization, has become a well-accepted part of the urological practice and has been used for implantation of the transplant ureter. During the last years, the interest in new biomaterials for reconstructive surgery has increased. Experimental studies showed how these requests can be satisfied by porcine small intestinal submucosa SIS (Stratasis”): this can be degraded by the host and substituted by “new tissue”. In four recent cases we have used SIS to obtain an augmented, normal-pressure and good compliance bladder reservoir, with three (epithelial, muscular and adventitial) layers normally represented.
Oncological and Functional Results of Laparoscopic Radical Prostatectomy after 100 Procedures: Our Experience
Authors: Parma P. , Dall'Oglio B. , Samuelli A. , Guatelli S. , Bondavalli C. 
Published: June 2018

Laparoscopic radical prostatectomy plays an emerging role in the surgical management of prostatic tumors. We present our experience of the first 100 cases of extraperitoneal laparoscopic radical prostatectomy. Our results about continence, erectile function and surgical margins are reported. Materials and Methods Between January 2005 and December 2007, 100 laparoscopic radical prostatectomies were performed by one surgeon. We retrospectively reviewed margins status, operative time, blood transfusion rates, time of catheterization, length of hospital stay, continence and potency rates. Results The operative time decreased during the learning curve. The mean duration of surgery was 240 minutes (in the first 25 procedures the median time was 320 minutes, while in the last 25 cases the mean duration was 200 minutes). Five conversions to open surgery were required owing to failure to progress. The overall rate of positive surgical margins was 15% in pT2 and 35% in pT3a tumors. We had 3 minor complications (two anastomotic leakage and one hemorrhage from the anastomosis) and 2 major complications (recto-urethral fistula). The mean intraoperative blood loss was 450 ml (range 200–1500). With regard to transfusion, 25 patients (25%) received their autologous units, while 2% of the patients required homologous units. The mean duration of catheterization was 7.8 days. The continence rate at 12 months was 85%; the potency rate was 55% at 12 months. Conclusions The results of the present study show that by using a rational approach to training, a general urologist with low experience in laparoscopy is able to safely perform laparoscopic radical prostatectomy, and with oncological and functional results comparable to those of other published series.
Coexistence of Different Histotypes of Renal Carcinoma: Our Experience and Literature Review
Authors: Esposito M. , Varca V. , Simonato A. , Toncini C. , Carmignani G. , Derchi L. 
Published: June 2018

The coexistence of multiple, synchronous primary tumors of different histology within the same kidney is a rare condition. We report herein a series of five patients with two tumors of different histology involving synchronously the same kidney. Materials and Methods We reviewed the pathology reports of a series of 381 patients who underwent surgery for primary renal tumors at our institution from 2000 to 2007. In the files of all patients with synchronous tumors of different histology, special attention was given to the results of imaging studies. Results Five out of 381 patients (1.37%) had coexistence of two primary tumors of different histology within the same kidney. Four patients had ultrasonography as the first imaging procedure, one patient had ultrasonography as the second imaging procedure; all had preoperative CT of the abdomen. Both lesions were detected by preoperative CT in 4/5 of the cases; in the remaining one, the smaller lesion was not visible, even in retrospect. Conclusions The coexistence of multiple and synchronous primary tumors of different histology within the same kidney has been only rarely described. To the best of our knowledge, in literature there are only case reports with the exception of a case of renal oncocytoma with evolving papillary RCC. We believe that this condition could be more frequent if the radiologist and the anatomopathologist try to find it.
Evolution of Our Experience in Diagnosis and Therapy for Urinary Infections
Authors: Pizzorno R. , Simonato A. , Esposito M. , Montanaro T. , Mussap M. , Molinari M.P. , Gritti PR. , Carmignani G. 
Published: June 2018

The therapy for urinary infections is advised according to the antibiogram; the symptoms request an empirical therapy based on urinary infections knowledge and drugs spectrum activity. We considered the urinoculture performed on 3834 patients, 3012 male and 822 female, hospitalized in our Institute in the period between 01/01/2005 and 31/10/2006; 444 of these were positive (12.7 % - 451 bacterial strains). Table 1: bacterial strains isolaed. We reported some evaluations obtained by antibiogram. E. coli strains Ciprofloxacin sensitive resulted in 60% of cases. Enterococcus species and Enterococcus faecalis strains Ampicillin sensitive resulted in 96.4% and 100% of cases, respectively. In this study there is a Gram negative prevalence, whereas we had previously observed an equivalence between Gram negative and Gram positive (p 0.001). These data are useful for empirical therapy.