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ABSTRACT: he onset of a ureterovaginal fistula is a not frequent, though it represents a dreaded and disabling complication of the pelvic surgery. The literature suggests to perform ureteroneocystostomy associated, if necessary, with a bladder suspension technique to Psoas muscle, or endoscopic procedures of ureteral stenting as the "gold standard" to repair this condition. We describe an innovative combined anterograde trans-nephrostomic and retrograde trans-ureteral surgical approach successfully carried out for the treatment of a rare ureterovaginal fistula associated with ipsilateral hydroureteronephrosis secondary to a complete obliteration of the ureteral orifice. We believe that this approach could be considered as a minimally invasive surgical option, an alternative to the traditional ones, for the repair of ureterovaginal fistulae complicated by a complete obliteration of the ipsilateral ureteral meatus.
Urologia 02/2013;
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ABSTRACT: Introduction: LUTS are fairly common in young men. BPO and intra-prostatic cyst localized near the bladder neck can determine a BOO in men younger than 50 years too. TURP remains the gold standard treatment, but the retrograde ejaculation or the decreased ejaculate volume after TURP was associated with considerable bother. In our study we have evaluated the possibility of obtaining a prostatic disobstruction without affecting the patient's sexual function and, specifically, the retrograde ejaculation, evaluating the sexual function after a 1-year follow-up. Materials and methods: 18 patients were enrolled in the study. Mean age of the patients at time of surgery was 41 years. Erectile and sexual functions have been evaluated according to the self- administered IIEF and MSHQ. Endoscopic procedure was performed with a resection of the bladder neck at 6 o'clock position followed by a resection at the 12 o'clock position. The same questionnaires were administered at 6 months and 1 year after endoscopic surgery. Results: The mean baseline prostate volume was 36 mL, with a mean operative time of 22 minutes. No statistical differences were reported in IIEF and MSHQ domains at baseline and after 1 year. Qmax increased from 7.4 mL/s preoperatively to 23.6 mL/s at 1-year follow-up. Conclusion: In young and selected patients with prostatic obstruction, it is possible to perform a mini-invasive surgery: "Minimally Invasive Nonexpensive TURP", an effective and safe procedure, not affecting sexual function, and particularly, retrograde ejaculation.
Urologia 02/2013;
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ABSTRACT: Introduction. The management of "grey zone" elevated Prostate Specific Antigen (PSA) is uncertain. After prostate cancer, benign prostatic hyperplasia and prostatitis may induce PSA increase. PSA reduction, after medical therapy, might identify those patients in whom biopsy can be avoided. The aim of this study was to determine if antibiotic and anti-inflammatory allow avoiding prostate biopsies in patients showing PSA decrease or normalization after medical therapy. Materials and Methods. Between January 2009 and May 2011, a total of 31 men with total PSA between 4 and 10 ng/ml were enrolled in this study. Patients with pathological digital rectal examination and clinical symptoms of prostatitis or lower urinary tract infection were excluded from the study. Total PSA, free PSA and free/total PSA were evaluated for all of them. Patients received 1000 mg ciprofloxacin daily for 15 days in combination with 100 mg ketoprofen administered rectally. PSA determinations were repeated two weeks after treatment. SPSS for Windows (version 10.0.7) computer package was used for statistical analysis of the data; a p value <0.05 was considered as level of statistical significance. Results. 19 patients (61%) showed a reduction of PSA level after therapy. Initial total PSA and free-PSA levels were 7.41 and 1.24 ng/ml, respectively. After medical therapy total and free PSA decreased to 5.72 and 1.19 ng/ml. Free/total PSA changed from 15.2% to 14.3%. PSA reached a normal range value in 5 patients (16%), while in 26 patients it was persistently >4 ng/ml, it decreased in 14 patients (45%), and increased in 12 (39%). Patients with PSA up to 4 ng/ml reported a prostatic cancer in 28.5% and 41.6% of cases if PSA was respectively decreased or increased from the initial value. Conclusions. A combination of antibiotic and anti-inflammatory therapy seems to be a useful way to avoid unnecessary biopsies in patients with PSA range from 4 to 10 ng/ml.
Urologia 06/2012;
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ABSTRACT: In selected cases of endoscopic surgery of bladder cancer, in order to reach an oncologic radicality, the resection of the ureteral ostium affected by the disease is required. Although infrequent, a possible complication of this manoeuvre is represented by the complete obliteration of theresected ostium. Literature suggests that the traditional "open" surgery and the latest "laparoscopic" surgery are effective in the resolution of this complication, in contrast with the techniques of endourological and uro-interventional radiology which, although minimally invasive, do not appear to be completely appropriate in the treatment of this condition. We believe that an innovative, minimally invasive anterograde trans-nephrostomic and retrograde endoscopic combined approach can be decisive in restoring complete patency of the neo-ostium.
Archivio italiano di urologia, andrologia: organo ufficiale [di] Società italiana di ecografia urologica e nefrologica / Associazione ricerche in urologia 03/2012; 84(1):39-41.
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ABSTRACT: To prospectively evaluate whether TRUS guided biopsy associated with Color Doppler (CD) imaging improves the detection of PCa.
From January 2008 to December 2010, 144 subjects, with an increased PSA value or with a suspect digital rectal examination, were enrolled. Transrectal grey-scale Ultrasound (US) and CD examination were performed in all patients. CD US was considered positive or negative on the basis of the presence or absence of vascular abnormality. Prostate biopsy was performed immediately after grey-scale and Doppler evaluation, with a mean of 10 core-biopsy for each patient as well as a selective biopsy of all US abnormal areas (hypoechoic lesion or CD abnormality areas).
PCa has been detected in 71 (49.3%) patients. 58 of the 71 patients had a hypoechoic area at US scan and 27 had a CD abnormality. The PSA value was < 4 ng/ml in 11 patients (Group 1), in 63 patients PSA ranged between 4 and 10 ng/ml (Group 2) and in 70 patients PSA was greater than 10 ng/ml (Group 3). The detection rate was 36.7, 36.5 and 62.8% respectively. In Group 1 we detected 5 hypoechoic areas and 4 CD abnormal areas. Moreover 6 of 11 patients had a positive DRE. In the Group 2, 20 patients were positive to DRE; we visualized 21 hypoechoic areas and 7 CD abnormality. In the Group 3, 38 patients had a positive DRE, with 32 hypoechoic areas and 16 CD abnormalities found. We obtained 1537 total bioptic cores, 1440 randomly from peripheral gland, 70 from hypoechoic areas and 27 from abnormal CD flow areas. The detection rate was 17.1, 65.7 and 22.2% respectively.
CD US showed to be a complement to grey-scale imaging of prostate unless insufficiently sensitive to replace the standard systematic 8-12 core random peripherally biopsy. Furthermore it should be associated routinely to TRUS to easily focus suspect areas.
Archivio italiano di urologia, andrologia: organo ufficiale [di] Società italiana di ecografia urologica e nefrologica / Associazione ricerche in urologia 03/2012; 84(1):22-5.
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ABSTRACT: Introduction. The Propionibacterium acnes and the Staphylococcus cohnii ssp. cohnii are occasional pathogenic bacteria. The intrascrotal localization of the Propionibacterium acnes is exceptional. The Staphylococcus cohnii ssp. cohnii is not able to colonize the urogenital apparatus but it is the most frequently responsible for blood culture contamination even if it can sustain, in particular conditions, systemic infections. Case Presentation. We report the case of a 72-year-old man who is under observation for pain and swelling of the left hemiscrotum associated to high fever. The scrotal ultrasound shows the presence of a left intra-scrotal abscess with didymus, epididymis, and intact didymus-epididymis tunicae. The blood culture executed for evening fever during antibiotic therapy has underlined an infection with Propionibacterium acnes. A following blood culture has shown an increase in Staphylococcus cohnii ssp. cohnii. Due to fever the patient has undergone left orchifunicolectomy with inguino-scrotal toilet. The anatomical pathological examination has also shown the presence of nonspecific granulomatous inflammation compatible with Propionibacterium acnes infection. Conclusion. The onset of an intrascrotal abscess likely sustained by Propionibacterium acnes complicated by a possible systemic Staphylococcus cohnii ssp. cohnii suprainfection is an exceptional event that, in our case, has been resolved with surgical toilet.
Case reports in urology. 01/2012; 2012:313694.
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ABSTRACT: Overactive Bladder (OAB) and Urge Urinary Incontinence (UUI) are both debilitating and bothersome conditions. OAB negatively impact on women’s quality of life affecting their own ability and personal relationships. Our aim has been to evaluate how OAB and UUI affect women’s sexual function and the possible role of antimuscarinic drugs in improving their sexual condition.
From January 2009 to May 2010, 58 women diagnosed with OAB filled in the self-administered questionnaires: Female Sexual Function Index (FSFI), the short form of Urogenital Distress Inventory (UDI-6) and the Incontinence Impact Questionnaire (IIQ-7). 33 of them (57%) reported a FSFI score<26,55 and were treated with Solifenacin 5mg. they were re-evaluated with the same questionnaires after three months of therapy.
The mean FSFI score of 33 patients affected by Female Sexual Disfunction (FSD) was 21,8 (range: 18,6-25,7). The six domains designed to address different aspects of female sexual dysfunctions, sexual desire, satisfaction, orgasm, arousal, lubrication and related pain symptoms, were altered in 48, 33, 21, 15, 12 and 8% of the patients respectively. In 70% of the patients, FSFI score improved of a mean of 5,4 after three months of therapy; UDI-6 and IIQ-7 decreased from 56,3 and 59,9 to 47,6 and 50,2, respectively. Considering women with UUI + OAB or OAB alone, we reported a significant improvement of urinary symptoms and women sexual condition after three months of therapy.
OAB syndrome was found to cause greater deterioration in women sexual function. Antimuscarinic drugs are the mainstay of pharmacologic treatment of OAB able to improve urinary symptoms, enhance quality of life and female sexual condition.
Urologia 07/2011; 78(3):200-2.
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ABSTRACT: To compare erectile function (EF) recovery of patients treated by early penile rehabilitation therapy (PRT) with sildenafil and with control group.
Forty men treated by bilateral nerve sparing radical prostatectomy (NSRP) and with a normal pre-operative EF were enrolled. Fourteen days after surgery, they were randomised to a flexible-dose sildenafil group and to a control group. The International Index of Erectile Function (IIEF) questionnaire was completed before surgery and at 3, 6, 12 and 24 weeks after NSRP.
In the group treated, the mean IIEF score before surgery was 26.2 and 14.1, 16.2, 22.5 and 25.2 at 3, 6, 12 and 24 weeks after NSRP, respectively. In the control group, the respective scores were 26.5 and 12.4, 15.8, 15.3 and 17.4. There was a significant difference in IIEF mean score (25+/-6 vs. 17+/-9, p<0.05) and in the potency rate (87% vs. 56%) between the groups at 24 weeks after NSRP. The percentage of patients who were capable of having medication-unassisted intercourse was 54% vs. 21%; 34% vs. 18% of patients had a normal EF with 72% vs. 32% of responders to sildenafil.
PRT with PDE-5 inhibitors should be offered early after RP to allow the recovery of EF.
Disability and Rehabilitation 02/2010; 32(14):1204-8. · 1.50 Impact Factor
