Asymptomatic bacteriuria in candidates for active treatment of renal stones: results from an international multicentric study on more than 2600 patients.

The occurrence of asymptomatic bacteriuria concomitant to urolithiasis is an issue for patients undergoing renal stone treatment. Disposing of a preoperative urine culture is essential to reduce the risk of septic events. The endpoint of the study is to report which characteristics of candidates for renal stone treatment are frequently associated with positive urine culture. 2605 patients were retrospectively enrolled from 14 centers; inclusion criteria were age > 18 and presence of a single renal stone 1-2 cm in size. The variables collected included age, gender, previous renal surgery, comorbidities, skin-to-stone distance, stone size, location, density, presence of hydronephrosis. After a descriptive analysis, the association between continuous and categorical variables and the presence of positive urine culture was assessed using a logistic regression model. Overall, 240/2605 patients (9%) had preoperative bacteriuria. Positive urine culture was more frequent in females, patients with previous renal interventions, chronic kidney disease, congenital anomalies, larger stones, increased density. Multivariate analysis demonstrated that previous renal interventions (OR 2.6; 95% CI 1.9-3.4; p < 0.001), renal-related comorbidities (OR 1.31; 95% CI 1.19-1.4; p < 0.001), higher stone size (OR 1.06; 95% CI 1.02-1.1; p = 0.01) and density (OR 1.00; 95% CI 1.0-1.00; p = 0.02) were associated with bacteriuria; male gender and lower caliceal location were inversely related to it. Beyond expected risk factors, such as female gender, other parameters are seemingly favoring the presence of positive urine culture. The awareness of variables associated with bacteriuria allows to assess which individuals are at increased risk of presenting bacteriuria and reduce the rate of septic complications.

Histopathological findings after radiofrequency (RITA) treatment for prostate cancer.

Radiofrequency interstitial tumor ablation (RITA) is a thermal ablation method that uses needles and low radiofrequency (RF) energy. The aim of our study was to evaluate the histopathology of thermal lesions induced by RF energy delivered interstitially in prostate cancer patients who subsequently underwent prostatectomy, and to determine the feasibility, effectiveness and safety of this new method in a pilot study.

Correlation of preoperative plasma IGF-I levels with pathologic parameters and progression in patients undergoing radical prostatectomy.

OBJECTIVES: To test whether preoperative insulin-like growth factor (IGF)-I levels could predict pathologic stage and prognosis of prostate cancer in patients undergoing radical prostatectomy. METHODS: The study group consisted of 120 consecutive patients who underwent radical prostatectomy for clinically localized prostate cancer. Preoperative plasma IGF-I levels were measured using the DSL-IGF-I Elisa assay. Surgically removed prostate specimens were analyzed pathologically, using a whole-mount step-section technique. Preoperative plasma IGF-I levels were compared with final pathologic parameters and with prostate-specific antigen (PSA) progression-free survival. Preoperative IGF-I levels in this cohort were also compared with IGF-I levels measured in 20 healthy men without any cancer and in 10 men with untreated, metastatic prostate cancer. RESULTS: Plasma IGF-I levels predicted neither organ-confined disease (P = 0.5611) nor the risk of PSA progression (P = 0.8125) at a median follow-up of 48.6 months after prostatectomy. Furthermore, IGF-I levels did not correlate with preoperative PSA level (P = 0. 2811) or final Gleason score (P = 0.4906). IGF-I levels in radical prostatectomy patients were not significantly higher than those in healthy subjects or in patients with metastatic disease (mean 156.7 +/- 66 ng/mL, 148.6 +/- 49 ng/mL, and 148.6 +/- 93 ng/mL, respectively; P = 0.8442). CONCLUSIONS: Circulating IGF-I levels may predict the future risk of developing prostate cancer, but our study found no association with other established markers of biologically aggressive disease or with disease progression in patients with clinically localized prostate cancer.

Transurethral needle ablation (TUNA) of the prostate: a clinical and urodynamic evaluation.

OBJECTIVES: This prospective study evaluated the clinical and urodynamic changes in patients with obstruction due to benign prostatic hyperplasia (BPH) treated with transurethral needle ablation (TUNA). METHODS: One hundred twenty patients with obstructive uropathy due to BPH were treated with the TUNA procedure between January 1994 and December 1995. All patients were selected according to the criteria established by the guidelines proposed by the International Consensus Committee (World Health Organization, Paris, 1993). The TUNA procedure was performed in an outpatient setting using topical intraurethral anesthesia (2% lidocaine gel). RESULTS: Patients showed a decrease in irritative symptoms as measured by the international Prostate Symptom Score (IPSS) and postprocedure urodynamic parameters. The mean (+/- SD) pretreatment IPSS was 20.8 +/- 4.5. At 3 months, the IPSS decreased to 9.7 +/- 3.0 (108 patients) (P < 0.001). At 6 months it decreased to 6.8 +/- 3.1 (86 patients) and remained at 6.2 +/- 2.9 (72 patients) and 6.7 +/- 3.8 (42 patients) at 12 and 18 months, respectively (P < 0.001). At 1 year after treatment, the peak flow rate (Qmax) increased from 8.2 +/- 3.4 mL/s to 15.9 +/- 2.1 mL/s and was 14.1 +/- 2.5 mL/s at 18 months of follow-up (P < 0.01). Urodynamic re-evaluation performed in 72 patients 12 months after TUNA demonstrated the absence of obstruction in 30 (41.7%). An additional 30 patients (41.7%) had equivocal results, whereas the remaining 12 (16.6%) still had obstruction, according to the Abrams-Griffith nomogram. Mean detrusor pressure at Qmax decreased from 85.3 +/- 18.5 cm H2O to 63.7 +/- 24.9 cm H2O at 12 months of follow-up. CONCLUSIONS: Our results confirm that the TUNA procedure is safe and effective when performed as an outpatient procedure. In addition, TUNA produced better results in patients presenting with moderate to severe irritative symptoms and minimal obstruction as determined by pressure/flow studies.

[Comparison of orthotopic neobladders: Studer vs modified Camey II]. / Neovesciche ortotopiche a confronto: Studer vs. Camey II modificata.

A comparative study between modified Camey II and Studer ileal orthotopic neobladder was performed. The Camey II was modified as follows: 1) The ureters were implanted, using wallace technique, in an undetubularized ileal loop, 15-18 cm. long, to prevent vesico-ureteral reflux; 2) The neobladder was made using staplers. In such a way, time is saved (about one hour) and results are quite similar, with a low rate of ureteral stenosis in both groups.

[Transurethral needle ablation (TUNA) of the prostate: preliminary results]. / Ablazione transuretrale di prostata con aghi (TUNA): risultati preliminari.

A multicentric prospective study was designed in Italy to verify the efficacy and the safety of TUNA-BPH patients treatment. The study is co-ordinate by Progress in Urology Association was started in January 1994. Thirty five patients were treated (Mean age 68.4 +/- 4.1 aa). All patients were selected and evaluated to respect the recommendations of the International Consensus Committee (Paris 1993). The procedure was performed with lidocaine 2.5% urethral gel, oral intake of 10 mg of diazepam and steroidal antiphlogistic drugs 1 hour before treatment. Maximal number of prostatic lesions were 6; in 2 BPH initial cases were done 2 lesions alone. The treatment was interrupted at the third lesion in 2 patients because uncomfortable. Hematuria was observed in all patients, but it was resolved within 12 hours. Irritative symptoms were referred by 10 patients (28.6%) and they spontaneously were insignificant within 24 hours. One patient had an acute prostatitis. In 15 patients (42.6%) was necessary to put a suprapubic cystostomy, but all except one voided within 36 hours. We noted narrow connection between prostatic lesions number and urinary acute retention after TUNA. The average follow-up is 3.2 months (range 0.5-6). At the follow-up urine culture was always negative and PSA values increased in the first month. The value of PSA was always higher than pre-treatment, but from 1 month to 3 months progressively reduced.(ABSTRACT TRUNCATED AT 250 WORDS)

Effectiveness and safety of laparoscopic adrenalectomy.

A laparoscopic approach was used to remove the adrenal gland in 7 patients with aldosterone-producing adenoma (Conn's disease), 2 with corticosteroid-producing adenoma (pituitary-independent Cushing's syndrome) and 2 with pheochromocytoma. The affected gland was on the right side in 3 patients and on the left side in 8. Mean operative time was 3 hours 10 minutes (range 140 to 370 minutes). The operation was uneventful in all patients and blood transfusions were never required. Mean postoperative hospitalization was 2.9 +/- 0.8 days (standard error). Only minimal doses of analgesics were used postoperatively. All patients returned to work within 10 days postoperatively (mean 8.4 +/- 1.2 days). Two months postoperatively no patient had clinical, biochemical or hormonal evidence of recurrent or persistent disease. We conclude that laparoscopic adrenalectomy is a safe and effective, minimally invasive approach for patients with benign adrenal neoplasms.

Prostatic UroLume Wallstent for urinary retention due to advanced prostate cancer: a 1-year followup study.

We attempt to clarify the long-term clinical reliability of the prostatic UroLume Wallstent in the treatment of urinary retention due to advanced prostate cancer. The stent was placed in 11 stage D prostate cancer patients at high surgical risk and with urinary retention unrelieved by total androgen blockade. At preoperative urethroscopy, the bladder neck and verumontanum were clearly visible and not massively infiltrated by tumor. All patients voided spontaneously at the end of the procedure. At 1 year maximum flow nomograms demonstrated the definite relief of bladder outlet obstruction and of related symptoms in the 10 cases evaluated. As expected, the stent had no evident effect on the natural history of prostate cancer. There were no major complications. Bladder outlet obstruction due to advanced prostate cancer and unrelieved by conventional medical therapy can be treated safely and effectively by the prostatic UroLume Wallstent.

Clinical reliability of multi-drug intracavernous vasoactive pharmacotherapy for diabetic impotence.

The aim of this study was to assess the effectiveness and safety of intracavernous injections of a four-drug vasoactive mixture in diabetic patients with organic impotence. A group of 60 diabetic patients with either pure neurogenic, pure vasculogenic or mixed neurovasculogenic impotence were treated with intracavernous injections of a combination of 12.1 mg/ml papaverine hydrochloride, 1.01 mg/ml phentolamine mesylate, 10.1 micrograms/ml prostaglandin E1 and 0.15 mg/ml atropine sulphate ('full-dose' mixture). A mixture of the same drugs but at one-third concentrations ('reduced-dose' mixture) was also used. The mean (+/- SEM) volumes of the full-dose and reduced-dose mixtures used were 0.21 +/- 0.03 ml and 0.31 +/- 0.02 ml, respectively. All the patients were able to sustain a rigid erection at the end of the titration phase of the study. At a mean follow-up of 18 months, 48 patients (80%) were successfully using the mixture, 6 patients (10%) were using the mixture at a dose lower than the initial dose and 6 patients (10%) had dropped out from the injection therapy. No major complications were seen. The association of multiple vasoactive drugs which use different mechanisms of action, thus exerting a pharmacological synergism, is an effective and safe procedure in intracavernous pharmacotherapy for diabetic patients with organic impotence.

Open surgical revision of laparoscopic pelvic lymphadenectomy for staging of prostate cancer: the impact of laparoscopic learning curve.

We attempt to clarify the impact of the learning curve on the first 30 laparoscopic pelvic lymphadenectomies performed at our institute. Open surgical revision of the area of laparoscopic dissection was performed at radical retropubic prostatectomy. The mean number of obturator and iliac lymph nodes removed laparoscopically was 8.7 and 8.8 from the right and left sides, respectively. The mean number of residual obturator and iliac lymph nodes removed at open operation was 3.2 and 3 from the right and left sides, respectively. The amount of residual lymph node tissue after laparoscopic lymphadenectomy progressively decreased with time, especially after the first 20 cases. A microscopic pelvic lymph node metastasis was found at open operation in patients 6, 14 and 15, who had false-negative results at laparoscopy. Due to the learning curve effect, the first 30 patients who undergo laparoscopic pelvic lymphadenectomy should be assessed again by an open operation at radical retropubic prostatectomy.

Laparoscopic unroofing of simple renal cysts.

OBJECTIVE: The aim of this study was to assess the clinical reliability of laparoscopic treatment for simple renal cysts. METHODS: Twenty patients with symptomatic simple renal cysts underwent laparoscopic unroofing of the cysts. Four of these patients also underwent concomitant laparoscopic cholecystectomy because of symptomatic gallbladder stones. RESULTS: In all cases the cyst wall was widely resected with no significant surgical complication. Cholecystectomy was easily performed without additional morbidity. Postoperative renal ultrasonography and intravenous urography demonstrated the absence of cyst recurrences and the integrity of the excretory tract. Symptoms were resolved by the operation in all cases. CONCLUSIONS: Laparoscopic unroofing is a safe, effective, and minimally invasive treatment for selected symptomatic simple renal cysts.

Vascular abnormalities in Peyronie's disease: the role of color Doppler sonography.

We attempted to clarify the role of color Doppler sonography in assessing the vascular function of untreated Peyronie's disease. A total of 50 patients with a mean 20-month history of penile curvature underwent color Doppler sonography with the penis in the flaccid state and after intracavernous injection of 20 micrograms. prostaglandin E1. Of the patients 41 (82%) complained of various degrees of erectile dysfunction, while 9 (18%) reported sustained rigid erections. Pathological peak systolic flow velocities (less than 30 cm. per second) of the cavernous arteries were found bilaterally in 10 patients (20%) and unilaterally in 10 (20%). Peak systolic flow velocity correlated positively with cavernous artery flow volume and with acceleration. Cavernous artery end diastolic velocity and resistance index, measured 15 and 30 minutes after vasoactive injection and genital manipulation, were indicative of corporeal veno-occlusive dysfunction (greater than 10 and less than 0.75 cm. per second, respectively) in 32 patients (65%). Of these patients, 11 (22%) had mixed arteriovenous dysfunction and 9 (18%) had normal cavernous artery flow velocities. Flow along the cavernous arteries is sometimes altered in cases of Peyronie's disease while corporeal veno-occlusive dysfunction seems to be the main hemodynamic abnormality. Color Doppler sonography should be considered as the initial step in the diagnostic evaluation of patients with Peyronie's disease who may be eligible for surgical treatment.

A comparison of transrectal hyperthermia, transurethral thermotherapy, urolume wallstent, and prostatic spiral for benign prostatic hyperplasia patients at poor operative risk.

Transrectal hyperthermia, transurethral thermotherapy, prostatic stent, and prostatic spiral were used to treat 120 poor operative risk patients with symptomatic benign prostatic hyperplasia. The preoperative subjective and objective conditions of the four groups (each of 30 patients) were comparable. None of the patients had an indwelling catheter, but according to flow nomograms, all were obstructed. The greatest increase in peak flow rate was observed after stent placement, while the greatest decrease of residual urine volume was seen after the insertion of the stent and transrectal hyperthermia. According to maximum flow nomograms, only the placement of the stent resolved bladder outlet obstruction. The greatest improvement in subjective symptoms was the result of stent insertion, but the heating procedures also caused a significant reduction of symptom scores. The spiral produced satisfactory results only in the short term.

Patient-partner satisfaction with semirigid penile prostheses for Peyronie's disease: a 5-year followup study.

The long-term acceptance of and satisfaction with penile prostheses were assessed in patients with Peyronie's disease and their partners. From 1985 to 1987, 50 men with advanced Peyronie's disease and associated erectile dysfunction were treated with a semirigid penile implant without additional plaque surgery. A total of 48 patients and 29 partners was reassessed at a followup of at least 60 months. Only 23 patients (48%) and 12 partners (40%) were totally satisfied with the long-term functional result and would repeat the same operation. Among the 25 dissatisfied patients (52%) loss of complementary erection resulting in a pencil-like penis, decrease in penile sensitivity, poor concealment and persistence of penile deviation were the major complaints. Of the partners 17 (60%) were dissatisfied due to poor penile girth, sensation of a cold glans penis, sensation of unnatural intercourse and dyspareunia. Eight patients (16%) chose to substitute the semirigid implant with a 3-component inflatable prosthesis. On a long-term basis, placement of a semirigid penile prosthesis for Peyronie's disease is associated with a significant patient-partner dissatisfaction rate.

Intracavernous vasoactive pharmacotherapy: the impact of a new self-injection device.

The clinical effects of a new self-injection pen were investigated in 160 impotent patients undergoing intracavernous vasoactive pharmacotherapy. Of the patients previously using insulin syringes for self-injection 90% switched to the pen, since it was considered easier to use and several injections could be performed with the same drug cartridge, thus avoiding the preparation necessary before every single injection with the syringe. Dropout rates were 36% and 12% for patients using the syringe and the pen, respectively (p < 0.05). This self-injection pen can be used for any drug, either singly or in combination with others. It is well accepted by patients, and greatly increases acceptance of and satisfaction with intracavernous pharmacotherapy.

Prostatic UroLume Wallstent for benign prostatic hyperplasia patients at poor operative risk: clinical, uroflowmetric and ultrasonographic patterns.

The prostatic UroLume Wallstent was positioned in 30 poor operative risk patients with bladder outlet obstruction due to benign prostatic hyperplasia. Preoperatively, 12 patients (40%) could still void spontaneously (group 1), while 18 (60%) had an indwelling catheter (group 2). Preoperative and postoperative assessment included scoring of subjective symptoms, physical examination, uroflowmetry with maximum flow nomogram, transrectal ultrasonography of the prostate, determination of residual urine volume and cystourethroscopy. All but 1 patient could void spontaneously after insertion of the stent. In group 1 preoperative and 1-year followup mean (plus or minus standard error) peak flow rates were 8.0 +/- 0.7 ml. per second and 15.8 +/- 1.8 ml. per second, respectively (p < 0.01), the mean residual urine volumes were 127 +/- 27 ml. and 38 +/- 11 ml. (p < 0.05), respectively, and the mean maximum flow nomograms (plus or minus standard deviation) were -2.6 +/- 0.1 and -1.4 +/- 0.4, respectively. In group 2 the 1-year followup mean peak flow rate, residual urine volume and maximum flow nomogram were 13.2 +/- 0.8 ml. per second (standard error), 32 +/- 14 ml. (standard error) and -1.5 +/- 0.1 (standard deviation), respectively. According to the maximum flow nomogram values all patients were nonobstructed postoperatively. At 1 year the stent was completely covered by prostatic epithelium in 90% of the patients, while in the remainder it was still partially visible at urethroscopy. Transrectal ultrasonography had an essential role in patient followup by accurately assessing the position of the stent. Placement of this prostatic stent is safe and effective for selected benign prostatic hyperplasia patients who cannot undergo surgical treatment due to poor operative risk.

Effectiveness and safety of multidrug intracavernous therapy for vasculogenic impotence.

A four-drug vasoactive mixture (papaverine hydrochloride, prostaglandin E1, phentolamine mesylate, atropine sulfate) was used for intracavernous injection therapy in 94 patients with vasculogenic impotence as diagnosed by color Doppler sonography and dynamic infusion cavernosometry-cavernosography. At a mean follow-up of twenty months, 66 patients (70%) are using the injections with the initial dose and are satisfied; 14 patients (15%) are using the injections with a smaller dose than initially given; and 14 patients (15%) dropped intracavernous treatment. Only 4 patients (4%) were unable to achieve a sustained rigid erection during the mixture titration phase. Selected cases of vasculogenic impotence can be safely and effectively treated by the association of drugs which rely on different mechanisms of action, producing a pharmacologic synergism which enhances the overall therapeutic effect.

[Laparoscopic adrenalectomy: a case report]. / Surrenalectomia laparoscopica: case report.

The authors report the first case of laparoscopic adrenalectomy for Conn's disease. The operative technique and clinical results are thoroughly discussed.

Four-drug intracavernous therapy for impotence due to corporeal veno-occlusive dysfunction.

Although veno-occlusive dysfunction is a frequent cause of impotence, a definitive therapeutic strategy has not yet been clearly defined. A total of 56 patients with corporeal veno-occlusive dysfunction diagnosed by dynamic infusion cavernosometry-cavernosography (flow to maintain erection greater than 10 ml. per minute and rate of corporeal pressure decrease after interruption of intracavernous infusion greater than 50 mm. Hg for 30 seconds) not considered suitable candidates for surgery underwent self-injection therapy. A vasoactive mixture composed of 12.1 mg./ml. papaverine hydrochloride, 10.1 micrograms./ml. prostaglandin E1, 1.01 mg./ml. phentolamine mesylate and 0.15 mg./ml. atropine sulfate was used. After dose titration of the drug mixture 54 patients (95%) were able to obtain sustained rigid erections that guaranteed satisfactory sexual activity. Mean (plus or minus standard error of mean) volume of injected mixture was 0.42 +/- 0.09 ml. (range 0.25 to 0.90 ml.). Four patients (7%) reported transient hypotension that did not recur after the application of a penile rubber band before injection. At a mean followup of 16 months 6 patients (11%) discontinued use of injections, 37 (69%) were satisfied and using the mixture, and 11 (20%) maintained rigid erections using a lower than initial dose. No major complications were encountered. The association of drugs with different mechanisms of action caused a synergism that potentiated the therapeutic activity and reduced side effects by decreasing the total drug dose.

[Doppler color echography in the diagnosis of impotence]. / Eco-color-Doppler nella diagnostica dell'impotenza.

This study reports the experience achieved with duplex and color Doppler ultrasonography in 120 impotent patients. The following morphodynamic parameters of the cavernosal arteries were studies before and after intracorporal injection of a mixture of vasoactive drugs: arterial diameter, wall pulsatility, morphology of the spectral waveform, peak systolic velocity, end diastolic velocity and flow volume. The veno-occlusive mechanism of the corpora cavernosa was studied directly by determination of flow along the deep dorsal vein of the penis and indirectly by serial evaluation of the diastolic flow of the cavernous arteries.