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ABSTRACT: To evaluate the effects of the transdermal electromotive administration of verapamil and dexamethasone on plaque size, penile deviation, pain, erectile function and capacity for vaginal penetration in patients with Peyronie's disease.
Forty-nine patients were treated four times weekly for six consecutive weeks. During each session the drug mixture was administered from a receptacle fixed to the skin overlying the plaques, using 2.4 mA pulsed current for 20 min. Plaque size and penile deviation were evaluated by dynamic penile duplex ultrasonography, X-ray and photographs; pain, erectile function and capacity for vaginal penetration were assessed using a questionnaire. Vital signs and side-effects were recorded. Differences before and after treatment were assessed.
The plaque disappeared in 8% of patients, with a measurable reduction in volume in 74% and no change in 18% (P < 0.001). Penile deviation resolved in 10% of the men, decreased in 74% and remained unchanged in 16% (P < 0.001). The plaque volume was halved in two-thirds of the men, to a mean (sd) of 515 (301) mm3, and the penile deviation halved in 45% of patients, to 24 (5) degrees; pain was completely eliminated in 88% (P < 0.001). Erectile function was completely restored in 42% of patients with initial erectile dysfunction and improved in 17% (P < 0.001); vaginal penetration improved in 73%. No toxicity was noted, except for a transient skin erythema at the site of the penile and dispersive electrodes.
The transdermal electromotive administration of verapamil and dexamethasone is clinically safe and appears to be an effective treatment in patients with Peyronie's disease.
BJU International 07/2003; 91(9):825-9. · 2.84 Impact Factor
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ABSTRACT: Peyronie's disease continues to be a fascinating topic for urologists, and two papers in this section, one from Rome and one from Los Angeles, describe new insights into this disease.Authors from the UK write about the current practice of vasectomy reversal and the management of unobstructive azoospermia in a region of that country. Although this is a questionnaire-based survey, a 74% response rate justifies the authors’ conclusions and their comments, which will be of value to the reader.OBJECTIVE
To evaluate the effects of the transdermal electromotive administration of verapamil and dexamethasone on plaque size, penile deviation, pain, erectile function and capacity for vaginal penetration in patients with Peyronie's disease.PATIENTS AND METHODS
Forty-nine patients were treated four times weekly for six consecutive weeks. During each session the drug mixture was administered from a receptacle fixed to the skin overlying the plaques, using 2.4 mA pulsed current for 20 min. Plaque size and penile deviation were evaluated by dynamic penile duplex ultrasonography, X-ray and photographs; pain, erectile function and capacity for vaginal penetration were assessed using a questionnaire. Vital signs and side-effects were recorded. Differences before and after treatment were assessed.RESULTSThe plaque disappeared in 8% of patients, with a measurable reduction in volume in 74% and no change in 18% (P < 0.001). Penile deviation resolved in 10% of the men, decreased in 74% and remained unchanged in 16% (P < 0.001). The plaque volume was halved in two-thirds of the men, to a mean (sd) of 515 (301) mm3, and the penile deviation halved in 45% of patients, to 24 (5)°; pain was completely eliminated in 88% (P < 0.001). Erectile function was completely restored in 42% of patients with initial erectile dysfunction and improved in 17% (P < 0.001); vaginal penetration improved in 73%. No toxicity was noted, except for a transient skin erythema at the site of the penile and dispersive electrodes.CONCLUSION
The transdermal electromotive administration of verapamil and dexamethasone is clinically safe and appears to be an effective treatment in patients with Peyronie's disease.
BJU International 05/2003; 91(9):825 - 829. · 2.84 Impact Factor
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ABSTRACT: Retroperitoneal lipomas are a heterogeneous group of mesenchymal tumors. They are usually large and occur most frequently in the retroperitoneal, perineal and pelvic regions. Lipomas grow slowly surrounding the retroperitoneal and pelvic organs, with a displacement of bowel and vascular axis. A case of a 61-year-old male patient which referred urinary frequency, urgency and nocturia is presented. Urodynamics evidenced a detrusor instability in a low capacity bladder. CT scan demonstrated a bladder dome compression due to a huge retroperitoneal mass extending from the right hepatic lobe to the hypogastric region and the right thigh. Surgical complete resection was performed: histology demonstrated a lipoma with areas of well differentiated myxoid degeneration. After surgery the irritative urinary symptoms disappeared. This is the first case described in literature of detrusor instability due to bladder compression by retroperitoneal lipoma.
Minerva urologica e nefrologica = The Italian journal of urology and nephrology 07/2002; 54(2):131-3.
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ABSTRACT: During the dissection of a female human cadaver a case of a duplex ovarian vein was observed. It was unique in its upper course where it anastomosed with an inferior polar renal vein, which in turn was linked to an upper polar renal vein by means of a joining branch. It is hypothesised that this represent a persistent link between the left subcardinal vein and the left sacrocardinal vein, together with some branches of a venous net, which represent the embryological intersubcardinal anastomosis. The gonadal vein arises from the distal (or postrenal) left subcardinal vein portion; the left renal vein develops from the intersubcardinal anastomosis. The venous net derived from the intersubcardinal anastomosis may represent a bypass system in cases of left renal vein occlusion. Left gonadal vein duplicity may also play an important role in the anatomical basis of idiopathic left ovarian vein syndrome or left varicocele, and can lead to mistakes being made during venous sclerotherapy.
Surgical and Radiologic Anatomy 03/2002; 24(1):64-7. · 1.06 Impact Factor
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ABSTRACT: We compared the safety and patient acceptance of a conventional Nélaton and a prelubricated nonhydrophilic catheter in 18 spinal cord injured patients on intermittent catheterization.
In a prospective crossover study each catheter was used for 7 weeks and the initial course was randomized. Urinalysis and urine culture were performed at 2, 4 and 7 weeks. Urethral trauma was evaluated by urethral cell count on the surface of each catheter used on the last day of each study period. Patient satisfaction was assessed at the end of the study by a questionnaire using multiple visual analog scales.
Urinary tract infection was identified in 12 and 4 patients on a Nélaton and a prelubricated nonhydrophilic catheter (p = 0.03), while asymptomatic bacteruria was identified in 18 and 8 (p = 0.0244), respectively. The mean urethral cell count plus or minus standard deviation on the catheter surface was 6.7 +/- 2.8 x 10(4) and 15.1 +/- 8.9 x 10(4) for the prelubricated nonhydrophilic and the Néelaton catheter, respectively (p = 0.01). The prelubricated nonhydrophilic catheter resulted in a better mean satisfaction score than the Nélaton catheter (2.33 +/- 1.06 versus 4.72 +/- 2.13, p = 0.022). Urethral bleeding was reported in 2 patients during the study period while using the Nélaton catheter.
The prelubricated nonhydrophilic catheter is a safe, effective and comfortable option in spinal cord injured patients on intermittent self-catheterization.
The Journal of Urology 08/2001; 166(1):130-3. · 3.75 Impact Factor
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ABSTRACT: Retroperitoneal procedures were initiated in 1992 by balloon dissection of the retroperitoneum. More recently a new type of retroperitoneal access has been obtained by directly entering the retroperitoneum using the Visiport visual trocar. We present our initial experience with direct visual access to the retroperitoneum in the pediatric population.
A total of 31 children underwent retroperitoneal laparoscopy, including renal biopsy in 22, varicocelectomy in 5, renal cyst ablation in 3 and pyelolithotomy for a staghorn stone in 1. Patients were placed in the full flank position. A maximum of 3 ports was used and the initial trocar was placed under direct vision. The laparoscope was then used to dissect bluntly a working space in the retroperitoneum.
All procedures were successful. Blood loss was minimal. Operative time was 4 hours for pyelolithotomy and less than 1 for the other procedures. Mean hospital stay was 1.5 days and all patients returned to normal activity at a mean of 6 days. Two minor complications developed. The peritoneum was inadvertently entered in 1 case, in which no further treatment was necessary and convalescence was uneventful and short. In another case severe arrhythmia developed, resulting in an aborted procedure.
This technique is simple, safe and does not require extensive laparoscopic experience.
The Journal of Urology 05/2001; 165(4):1229-32. · 3.75 Impact Factor
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ABSTRACT: Left testicular vein anatomy has received more attention due to the presence of competent or incompetent venous valves and bypassing anastomoses, which are involved in venographic diagnosis and embolisation of varicocele. The left gonadal vein develops, in both males and females, between the 5th and 7th intrauterine weeks, being derived from the distal or postrenal portion of the left subcardinal vein. The varicocele aetiologic hypothesis leads to ontogenetic disturbances in the development of the secondary venous system. Retrograde testicular venography shows the precise anatomy of the left pampiniform plexus, while anterograde testicular venography identifies the presence of the valve and possible continence. In the present case sclerotherapy could not be achieved due to testicular vein anomalies. Sclerotherapy versus surgical high ligature of the left testicular vein in cases of left idiopathic varicocele with testicular vein anomalies is discussed.
Surgical and Radiologic Anatomy 02/2001; 23(6):427-31. · 1.06 Impact Factor
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ABSTRACT: A lesion of the upper urinary tract (UUT) is a possible outcome of the bladder dysfunction following a spinal cord injury (SCI). The most common findings are hydronephrosis, bladder-ureteral reflux and pyelonephritis. Aim of the study was to evaluate the prevalence of UUT abnormalities, evaluable by ultrasound (US), in a population of SCI patients; furthermore we correlated the presence of such abnormalities to clinical findings. We evaluated 115 consecutive patients who underwent US scan of UUT. Mean time between injury and our evaluation was 81.5 +/- 100.2 months. Lesion level was cervical (38/115), dorsal (59/115) and lumbar (18/115). Eight patients emptied their bladder spontaneously, 105 by means of intermittent catheterization, while 2 were wearing indwelling catheter. Seventy-four patients used anticholinergics drugs. It was evaluated the presence of: hydronephrosis, renal stones and chronic pyelonephritis using US. Afterward the presence of such alterations was correlated to sex and age of patients, time between injury and our evaluation, method of bladder emptying and use of anticholinergics drugs. In 25/115 patients (21.7%) were found abnormalities of UUT. A significative correlation was found between presence of UUT lesions and older age. In our series, prevalence of UUT abnormalities observed by means of US in SCI patients is 21.7%. This finding could be due to correct management and strict follow up of the patients.
Archivio italiano di urologia, andrologia: organo ufficiale [di] Società italiana di ecografia urologica e nefrologica / Associazione ricerche in urologia 01/2001; 72(4):225-7.
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ABSTRACT: Telemedicine is the use of telecommunication technology to deliver healthcare. Telementoring has been developed to allow a surgeon at a remote site to offer guidance and assistance to a less-experienced surgeon. We report on our experience during laparoscopic urologic procedures with mentoring between Rome, Italy, and Baltimore, USA.
Over a period of 3 months, two laparoscopic left spermatic vein ligations, one retroperitoneal renal biopsy, one laparoscopic nephrectomy, and one percutaneous access to the kidney were telementored. Transperitoneal laparoscopic cases were performed with the use of AESOP, a robotic for remote manipulation of the endoscopic camera. A second robot, PAKY, was used to perform radiologically guided needle orientation and insertion for percutaneous renal access. In addition to controlling the robotic devices, the system provided real-time video display for either the laparoscope or an externally mounted camera located in the operating room, full duplex audio, telestration over live video, and access to electrocautery for tissue cutting or hemostasis.
All procedures were accomplished with an uneventful postoperative course. One technical failure occurred because the robotic device was not properly positioned on the operating table. The round-trip delay of image transmission was less than 1 second.
International telementoring is a feasible technique that can enhance surgeon education and decrease the likelihood of complications attributable to inexperience with new operative techniques.
Journal of Endourology 09/2000; 14(6):493-6. · 1.85 Impact Factor
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ABSTRACT: We report a rare case of a retroperitoneal inflammatory variant of malignant fibrous histiocytoma (MFH) involving both kidneys. The best treatment for MFHs is surgery with radical excision of the tumor. In this case the need to save at least one kidney meant tumorectomy was incomplete. The patient underwent adjuvant chemotherapy and 4 years later survives in a fairly good condition.
Scandinavian Journal of Urology and Nephrology 07/2000; 34(3):208-10. · 0.99 Impact Factor
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ABSTRACT: Laparoscopic procedures are performed using general anesthesia due to the perceived limitations of regional anesthesia in the upper abdomen and retroperitoneum. We present our initial experience with epidural anesthesia for retroperitoneal laparoscopic renal biopsy.
Urology 05/2000; 55(4):590. · 2.43 Impact Factor
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ABSTRACT: The role of extracorporeal shockwave lithotripsy (SWL) for ureteral calculi is still being debated. We evaluated our results in a large series to clarify the role of this modality.
A total of 478 patients with solitary ureteral stones were treated by in situ piezoelectric extracorporeal shockwave lithotripsy (SWL) using a Wolf Piezolith 2300 ultrasound-guided lithotripter. Two hundred fifty stones (52.3%) were located in the upper ureter and 228 (47.7%) in the distal ureter. Seventy of the upper ureteral stones were located in the ureteropelvic junction and 180 in the lumbar ureter. The diameter of the stones ranged from 5 to 30 mm. Four hundred sixty-seven patients were followed up for a mean of 4 months.
Four hundred forty patients (94.2%) were stone free after in situ SWL alone. Complete removal of all stone fragments was achieved in 95.4% of the 216 patients with calculi of 5 to 10 mm in diameter, in 94.3% of the 229 with stones of 11 to 20 mm, and in 81.8% of the 22 with calculi of 21 to 30 mm. In situ treatment completely removed 61 of 69 ureteropelvic junction stones (88.4%), 166 of 175 lumbar stones (94.8%), and 213 of 223 distal ureteral stones (95.5%). In situ treatment failed in 27 stones (5.8%). After 4 months, 12 stone fragments and 15 unfragmented stones persisted despite retreatments and required endoscopic procedures. The mean number of sessions and shockwaves per patient was 1.8 and 4884, respectively. Morbidity was low. Renal colic in 57 patients (11.9%) was managed successfully by analgesics. In 36 patients, stone fragments obstructed the ureter; in 28 of these 36 (78%), the obstruction was resolved and the patients were stone free after in situ retreatments alone. All these results were achieved on an outpatient basis without sedation or local or general anesthesia.
Piezoelectric SWL is an effective and noninvasive method for eliminating ureteral stones. Second-generation ultrasound-guided lithotripters are not yet obsolete.
Journal of Endourology 11/1999; 13(8):543-7. · 1.85 Impact Factor
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ABSTRACT: With a varied presentation and a difficult preoperative diagnosis, schwannoma accounts for only a small percentage of retroperitoneal tumors. Moreover, malignant schwannoma of the adrenal gland, kidney and renal pelvis has previously been described. We report the first case of benign schwannoma causing obstruction by external compression of the ureteropelvic junction. A case report of a male patient who complained of a 3-month history of dull lumbar pain on the right side is reported. Using intravenous pyelogram, sonography and computed tomography a benign tumor of the retroperitoneum was suspected. Upon exploration, the suspected diagnosis of the tumor's retroperitoneal origin was confirmed. After the histological and immunohistochemical studies the diagnosis was verified. The diagnosis, treatment and histological features of benign schwannoma are discussed. A brief review of the literature is also included.
European Urology 02/1997; 32(1):121-3. · 8.49 Impact Factor
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ABSTRACT: "Milk of calcium renal stone" (liquid renal calculosis) is a quite uncommon lithiasis distinguished by the presence of a semiliquid suspension of calcium salts or a "seed-like" sediment in a caliceal diverticulum or an ectasia segment of the collecting system. We reviewed 5 patients (1 male and 4 females, mean age 48.6 years), with a history of urinary tract infection, renal pain or haematuria. All patients underwent renal ultrasonographic assessment in both clinostatic and orthostatic position. Three patients underwent intravenous pyelography before ultrasound. Ultrasonography showed a sonolucent "levelled" image with a posterior acoustic shadow inside a hydro-caliceal dilation (2 pts.) or caliceal diverticulum (3 pts.); the persistence of the "level" in both clinostatic and orthostatic position allowed an immediate diagnosis in all patients. Intravenous pyelography performed before renal ultrasound showed no abnormality in 1 patient and was misleading in two; it otherwise confirmed the diagnosis when performed after renal ultrasonography. Three patients underwent surgery, two patients refused therapy; sonographic follow-up showed no evolution of the morphologic picture. Once considered as exceptional, liquid renal calculosis still remains rare pathology and accounts for 0.6% of all the urinary lithiasis diagnosed by ultrasound in our series. An accurate sonographic assessment allows a reliable diagnosis of this particular lithiasis and an easy discrimination from solid lithiasis, nephrocalcinosis, medullary sponge kidney and hydropyonephrosis. Hence, a correct diagnosis of this rare condition lets uneffective and improper treatments be avoided.
Archivio italiano di urologia, andrologia: organo ufficiale [di] Società italiana di ecografia urologica e nefrologica / Associazione ricerche in urologia 01/1997; 68(5 Suppl):111-5.
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ABSTRACT: Non-specific granulomatous prostatitis (NSGP) is a rare but important pathology of the prostate because it often is confused with prostatic cancer. In fact, NSGP, presents at digital rectal examination as an area of increased consistency and painful, and at endorectal ultrasonography as an hypoechoic area with inhomogeneous echo structure. The frequent elevation of Prostatic-Specific Antigen (PSA) serum level vanish, moreover, its role of a differential factor. Since 1994 we used Echo-color doppler (ECD) in the evaluation of prostate cancer with satisfying results. The aim of our work is to value the route of ECD in the diagnosis of NSGP, and in the differential diagnosis with prostate cancer, actually only bioptic . Since January 1994 we observed 9 cases of NSGP; 7 patients with prostatic symptomatology and 2 with PSA serum level between 4 and 10 ng/ml. In all patients we performed endorectal US who showed, in 7 cases, nodular hypoechoic areas in the peripheral or central zone of the prostate, and in 2 cases the presence of evident BPH. In 5/7 cases with hypoechoic areas, ECD-US showed an increase of color intensity intra-perinodular. In 2 patients with BPH no marked color enhancement was observed. The diagnosis of NSGP has been done after needle biopsy in the 7 patients with suspect nodular areas, and in the 2 patients with BPH, after histological examination secondary to open prostatectomy. Our experience shows that ECD-US scanning picture in NSGP is superimposable with the prostatic cancer one. In fact the anatomical presupposition on the grounds of the "positivity" in ECD-US, focal hypervascularization, is present in ECD scanning pictures of both pathologies. In conclusion, ECD doesn't give an advantage in the differential diagnosis between NSGP and prostate cancer that actually remains only bioptic .
Archivio italiano di urologia, andrologia: organo ufficiale [di] Società italiana di ecografia urologica e nefrologica / Associazione ricerche in urologia 01/1997; 68(5 Suppl):57-60.
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ABSTRACT: Ultrasonography take a predominant place in the evaluation of urologic complications in SM patients. SM can cause urinary disorders according to entity and level of the primary lesion with important repercussion on the upper urinary tract. Aim of this work is to value the sensibility of ultrasonography in the identification of bladder wall abnormalities indicative of involvement of upper urinary tract, correlated with urodynamic evaluation. Since 1993 we performed 116 urological ultra sound in patients with Multiple Sclerosis. We considered pathologic bladders with wall abnormalities or with stones, considering those abnormalities as secondary to altered emptying of the bladder. 65 patients showed wall abnormalities while 51 patients had any alteration evaluated with ultrasonography. In the first group the amplitude of uninhibited detrusor contractions was 74 cmH2O, while in the second group it was 61 cm H2O: the difference was statistically significant. Furthermore the incidence of upper tract alterations was significantly higher in the first group (p = 0.005), even in absence of signs of renal failure. Thus, ultrasonography demonstrated a high sensibility in detecting bladder conditions possibly conducive to upper urinary tract deterioration.
Archivio italiano di urologia, andrologia: organo ufficiale [di] Società italiana di ecografia urologica e nefrologica / Associazione ricerche in urologia 01/1997; 68(5 Suppl):71-4.
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ABSTRACT: Bladder stones represent a troublesome complication in patients suffering from neurogenic voiding dysfunction, in whom prompt and effective therapy is required. A variety of endoscopic lithotripsy methods are available; however, current devices can be tedious to use. We have treated 17 patients affected by bladder calculi and spinal cord injury or multiple sclerosis by means of the ballistic lithotripter EMS Swiss Lithoclast. The mean diameter of the stones was 2.7 cm. The mean operative time was 27 minutes. There were five intraoperative complications, including crises of autonomic dysreflexia (three patients) and light hematuria (two patients). There was no malfunction of the lithotripter and no long-term complications. All the patients were stone free at 6 months postoperatively. In conclusion, endoscopic lithotripsy with the ballistic lithotripter proved to be a very effective, rapid, and safe method for treating bladder calculi in patients with neurogenic bladders.
Journal of Endourology 01/1997; 10(6):551-4. · 1.85 Impact Factor
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ABSTRACT: In many infertile patients abnormalities in sperm are due to prostatic inflammatory disease. In the male reproductive system temporary episodes of inflammation, caused by newly discovered micro-organisms such as Chlamydia Trachomatis and Ureaplasma Urealyticum, may occur frequently and cause sub-clinical inflammation. This rapidly became chronic and induce the development of anti-spermatozoon antibodies. This latent clinical pattern and lack of symptoms often means diagnosis is late and medical treatment inadequate. In recent years attention has been focused on transrectal ultrasonography as a possible gold standard for diagnosing prostatic inflammatory disease. Widespread use of technologically advanced instruments has significantly improved the quality and definition of prostatic images. This paper discusses the current role of transrectal ultrasonography in the diagnosis of prostatic inflammatory disease. Abnormalities in the ultrasound pattern, caused by infection, are analyzed in detail and discussed critically in order to assess their role as markers of prostatic inflammation.
Archivio italiano di urologia, andrologia: organo ufficiale [di] Società italiana di ecografia urologica e nefrologica / Associazione ricerche in urologia 10/1994; 66(4 Suppl):37-40.
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ABSTRACT: Urethral diverticula, a not infrequent complication in patients with spinal cord injuries, usually involve the bulbous urethra which is particularly exposed to the trauma of catheterism. Indeed, the frequent association of urethral trauma and infection is often the cause of diverticula in these patients. Diagnosis is made by ascending urethrogram, voiding cystourethrogram and urethroscopy. Eight patients between 20 and 45 years of age with spinal cord injuries who had used an indwelling catheter for periods ranging from 1 to 18 months and who presented urethral diverticula at conventional investigation, underwent transperineal and penile contact ultrasonography using 3.5 and 7.5 MhZ real-time scanners. Ultrasonography was performed during intraurethral injection of saline solution through a catheter positioned near the external urethral meatus. Before the scan all patients had undergone a neuro-urological physical examination, urine analysis and culture, renal and bladder ultrasonography, ascending urethrogram and voiding cystourethrogram, urethroscopy and urodynamic investigation. Ultrasonography identified all urethral diverticula, defined them morphologically, visualized the diverticula filling and emptying phases and evaluated urethral wall and periurethral tissue characteristics, without exposing patients to any dangerous gonadal irradiation. Ultrasonography cannot replace radiological investigation but is a valid alternative in cases of contrast medium allergy, when monitoring inoperable diverticula and in postoperative follow-ups.
Archivio italiano di urologia, andrologia: organo ufficiale [di] Società italiana di ecografia urologica e nefrologica / Associazione ricerche in urologia 10/1994; 66(4 Suppl):187-91.
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ABSTRACT: Ultrasonography has a great interest in diagnosis of cystic kidney disorders for typical eco-pattern of this pathology. In this work we show the eco-pattern of the most common cystic kidney disorders. Particularly we examine simple cysts (typical, atypical, complicated), multicystic kidney dysplasia, autosomal recessive polycystic kidney disease (infantile) autosomal dominant polycystic kidney disease (adult age). The so-called neoplastic cysts (multiloculated cysts, multiloculated cysts nephroma, cystic nephroblastoma), medullar cysts (medullary sponge kidney, medullary cystic disease), parapyelic cysts, acquired cystic kidney disease in renal failure patients, parasitic cysts, epidermoid cysts. About this disorders we present the more typical and expressive ultrasonographic appearance and we define the role and the opportunity of diagnostic setting by echography, moreover ultrasonography allows us to make a differential diagnosis between cystic kidney disorders and other kidney disease.
Archivio italiano di urologia, andrologia: organo ufficiale [di] Società italiana di ecografia urologica e nefrologica / Associazione ricerche in urologia 09/1993; 65(4):341-50.
