A single-operator experience using EchoLaser SoracteLiteTM for focal laser ablation of prostate cancer: One more arrow in the quiver for the conservative management of the disease.

BACKGROUND: The aim of this study was to evaluate the outcomes of patients suffering prostate cancer (PCa) treated conservatively using 1064 nm laser energy for focal laser ablation (FLA). The patients included in the study were unsuitable for surgery or unwilling to receive external beam radiotherapy because they were afraid of the possible side effects of whole-gland therapies. METHODS: This study included patients with a diagnosis of nonmetastatic PCa who underwent FLA using SoracteLiteTM system. Tissue ablation was performed at a fixed power of 5 W by the diode multichannel laser system EchoLaser X4 that uses laser light transmitted through optical fibres causing the target tissue to undergo irreversible thermal damage. Functional outcomes were evaluated with the International Prostatic Symptoms Score (IPSS) and 5-item version of the International Index of Erectile Function (IIEF-5) before the treatment and one year later. RESULTS: Ten patients suffering non-metastatic PCa were included. Four decided upon a conservative treatment because of reduced performance status and for six patients the procedure was chosen electively. All patients underwent multiparametric magnetic resonance imaging at 3 and 12 months and eight out of ten patients underwent prostate biopsy at 6 months. Persistent disease was detected in 3 patients who underwent a second ablation. In these patients at the biopsy following the second ablation none harbored residual disease. At follow-up, no patient suffered urinary incontinence requiring the use of pads. No significant worsening in sexual potency measured with IIEF-5 (p = 0.356) or prostatic symptoms measured at IPSS (p = 0.462) were recorded comparing pre-treatment condition vs one-year follow-up. Compared with baseline, prostate-specific antigen was significantly reduced at one-year follow-up (3.7 ± 1.1 vs 7.9 ± 4.1 ng/mL; p = 0.008). CONCLUSIONS: Although whole gland therapies remain the gold standard treatment for PCa, our results indicate that the SoracteLiteTM system for focal laser ablation, as a very preliminary step, appears to offer a short-term oncologic control of PCa with negligible side effects.

Cavernosal hematoma mimicking priapism.

We present a case of corpus cavernosum hematoma mimicking priapism. A 42-year-old man presented to the emergency room with penile pain and partial erection. Examination revealed partial erection and palpable space-occupying lesion of the corpus cavernosum without lymphadenopathy. Malignant workup was negative. Imaging assisted in diagnosis of unilateral hematoma of the corpus cavernosum. The lesion spontaneously resolved without the need for intervention.

Is there a place for nutritional supplements in the treatment of idiopathic male infertility?

OBJECTIVE: Infertility affects 15% of couples in fertile age. Male factor is a cause of infertility in almost half of cases, mainly due to oligoasthenoteratozoospermia (OAT). The purpose of this study is to review the effects of nutritional supplements as medical treatment for idiopathic male infertility. MATERIAL AND METHODS: A Pub Med and Medline review of the published studies utilizing nutritional supplements for the treatment of male infertility has been performed. RESULTS: Clinical trials on Vitamin E, Vitamin A, Vitamin C. Arginine, Carnitine, N-Acetyl-Carnitine, Glutathione, Coenzyme Q10, Selenium and Zinc were reviewed. Although there is a wide variability in selected population, dose regimen and final outcomes, nutritional supplements both alone and in combination seems to be able to improve semen parameters (sperm count, sperm motility and morphology) and pregnancy rate in infertile men. CONCLUSIONS: There are rising evidences from published randomized trials and systematic review suggesting that nutritional supplementation may improve semen parameters and the likelihood of pregnancy in men affected by OAT. This improvement, however, is not consistent and there is a wide variation in the treatment regimens used. Well designed and adequately powered RCTs are needed to better clarify the role of nutritional supplements as treatment for male infertility.

Low velocity gunshot wound to the penis.

A ricocheting 30-06 calibre bullet caused a low velocity penile injury in a 54-year-old man, shearing the right corpus cavernosum and crossing the ipsilateral thigh and gluteal muscles. Prompt surgical exploration with meticulous debridement and corporeal reconstruction through a degloving incision led to excellent cosmetic and functional results.

Long-term followup after elective testis sparing surgery for Leydig cell tumors: a single center experience.

PURPOSE: Although most Leydig cell tumors are benign, radical orchiectomy is currently considered the standard therapy. We retrospectively analyzed the long-term followup of a series of patients with Leydig cell tumors electively treated with testis sparing surgery. MATERIALS AND METHODS: Between November 1990 and December 2005, 17 consecutive patients with Leydig cell tumors underwent testis sparing surgery on an elective basis. Preoperative evaluation included physical examination, serum markers for germ cell tumors, scrotal ultrasound, abdominal computerized tomography, chest x-ray and hormonal profile if clinically required. Testis sparing surgery was performed via an inguinal approach with spermatic cord clamping. Frozen section examination was performed in all cases, revealing Leydig cell tumors. Followup consisted of physical examination, scrotal ultrasound, abdominal computerized tomography and chest x-ray every 6 months for the first 2 years, then annually. Tumor recurrence and survival were evaluated. RESULTS: Mean patient age was 41.6 years (range 28 to 55). Medical referral was prompted by symptoms/signs such as infertility, gynecomastia or self-palpation of scrotal mass in 11 patients (64.7%), while in the remaining 6 (35.3%) the lesions were incidentally diagnosed. Hormonal profile was performed in 9 patients, showing abnormalities in all. Mean tumor diameter was 13.4 mm (range 5 to 31). Definitive pathological examination confirmed benign Leydig cell tumor in all cases. After a mean followup of 91 months (range 12 to 192), neither local recurrence nor distant metastases have been detected and all patients are alive without evidence of disease. CONCLUSIONS: In patients with Leydig cell tumors testis sparing surgery with frozen section examination provides an excellent long-term oncological outcome.

The use of prostatic intravesical protrusion correlated with uroflowmetry: a new method to measure obstruction in patients with LUTS due to BOO without using P/F studies.

OBJECTIVES: To detect obstruction in patients with LUTS suggestive of BPH comparing the prostatic intravesical protrusion detected by abdominal ultrasounds with uroflowmetry testing results with urodynamic study to make evidence of obstruction. MATERIAL AND METHODS: A series of 25 patients (mean age 67.9 years) at the first visit for BPH problems, underwent to routine examination including: abdominal ultrasound examination, TRUS, uroflowmetry IPSS and QoL questionnaires and urodynamic evaluation. We evaluated the degree in mm of prostatic intravesical protrusion by ultrasounds with a bladder volume between 150-220 cc. The degree of protrusion was classified as mild (<5 mm), moderate (5-10 mm) and severe (>10 mm), Qmax was divided in obstructed (<10 ml/s), equivocal (10-15 ml/s) and unobstructed (>15 ml/s). Confirmation or not of obstruction was validated by urodynamic study. RESULTS: mean prostate volume was 41.4cc; IPSS 22.4; Quality of Life 4.0; post voided residual urine 97.8 cc; DAMPF 62.6; Schäfer 3.4; Qmax 9.9 ml/s. Almost all the patients with severe protrusion had obstructed flow confirmed by P/F study. Patients with severe protrusion and unobstructedflow have obstruction compensated by high pressure voiding. CONCLUSIONS: These results, despite of the numbers of patients, suggest that the degree of prostatic protrusion measured by abdominal ultrasounds is a data that, if correlated to obstructed Qmax, can be used in the evaluation of BPH patients and their grade of obstruction.

Doppler ultrasonography in a young patient with penile Mondor's disease.

OBJECTIVE: Mondor reported the first superficial venous thrombosis on the chest wall in 1939. This condition is usually a benign and self-limited process, requiring only symptomatic treatment. Mondor's disease of the penis is an uncommon condition, which usually involves the superficial dorsal veins, it was first described by Braun-Falco in 1955. Isolated superficial dorsal vein-thrombosis was reported in 1958 by Helm et al. Since then around fifty cases have been reported. Patients experience a cord or string-like induration along the penile superficial dorsal vein, which is often painful and accompanied by localized inflammatory changes. This condition is benign and self-limited in most patients with complete resolution after 6 to 8 weeks of conservative management although sometimes surgery is indicated when it is associated with chronic or severe local pain. MATERIAL AND METHODS: We report on a 23-year sold man with Mondor's disease of the penis following a normal sexual intercourse, who recently underwent microsurgical left varicocelectomy. RESULTS: Treatment consisted in NSAID Aulin (100 mg orally twice a day for 3 weeks) Ciproxin (500 mg orally twice a day for 10 days), Reparil 1 x 3 orally for 25 days and Lansox 30 mg orally 1 per day for 21 days. The patient was advised to abstain from sexual intercourse or masturbation until the thrombosis had completely resolved. In the follow-up visit there was the complete resolution of the disease with no evidence of superficial dorsal vein thrombosis or palpable penile plaque 30 days later. The patient was also able to have sexual intercourse without problems. CONCLUSION: Although penile Mondors' disease is rare, proper clinical diagnosis and consequent reassurance can help the patient to dissipate the anxiety and the following erectile dysfunction. Ultrasound and Doppler Ultrasonography examination was not useful for diagnosis but helped the clinician to show the patient that the disease is a benign condition.

Measurements of urinary bladder volume: comparison of five ultrasound calculation methods in volunteers.

OBJECTIVES: To assess the precision of five different calculation methods in real-time bladder volume measurement. MATERIAL AND METHODS: Bladders from 10 medical staff volunteers were examined. Two examinations of each subject were performed by one examiner using the same ultrasound scannet Five different calculation algorithms were used on the frozen ultrasound pictures: the prolate ellipsoid method based on the formula: volume = length x width x heigth x 0.52 on two dimensions; the double area method based on the formula: volume = ex [C1 + C2 x ln(A1) + C3 x ln(A2)] on two dimensions; The double ellipsoid method on two dimensions; the method of one dimension of the shape of the bladder outlined manually with the maximal longitudinal diameter; the method of one dimension of the shape of the bladder outlined by smooth ellipsoid with the maximal longitudinal diameter After registration of the voided volume the subjects were scanned again in order to assure complete emptying. RESULTS: Voided volumes ranged from 120 ml to 465 ml. The precision of each method was equal. Errors were not more than 25% of the voided volume. No significant improvement in accuracy for any of the methods was found. CONCLUSIONS: Ultrasound bladder volume calculation is an easy method for estimation of bladder volume. Errors can be reasonably accepted. Large variation, irrespective of methods, from the true bladder volume, indicates that the clinical evaluation of ultrasound bladder measurement must be interpreted with great care in some patients.