[Iontophoresis in the conservative treatment of Peyronie's disease: preliminary experience]. / La iontoforesi nel trattamento conservativo della malattia di La Peyronie: esperienza preliminare.

In Peyronie's disease an early "peri-vasculitic" phase and a late "sclerogenic" one are described. In the former, conservative management is believed useful; unfortunately it is empirical concerning treatment modalities, drugs and administration routes, due to the poor pathogenetic knowledge of the disease itself. The Authors report on a preliminary experience based on iontophoresis, that is the drugs' ions direct transport from a solution into the tissues by means of a local electric field. 15 patients (47 to 64 years old, mean 55) all with penile recurvatum due to a well (physically and U.S.) documented Peyronie's plaque, and all but one with normal stiffness during erection, were submitted to the following therapeutic schedule: 3 sessions a week for three weeks; in each session (20 minutes) 10 mg verapamil and 4 mg dexamethasone are administered; the iontophoretic equipment delivers a 3 mA current; the active electrode, shaped as a small cup is placed on the penile skin above the plaque; the other electrode is set on one thigh. At a mean 5 months follow up (3-10 months) penile pain during erection disappeared in 66% patients, recurvatum diminished in 53%, and the plaque was reduced in size and/or was softened in 40% of the cases. No patient worsened nor became impotent during the treatment. The contextual improvement of all three above mentioned parameters (pain-recurvatum-physical examination) was observed in 26% of patients (versus 13% in a previous series treated by the Authors by drug peri-plaque injections). Although a longer follow up is necessary before drawing conclusions about the iontophoretic approach to the Peyronie's disease, the Authors wish to stress two main advantages of this therapeutic modality: absence of pain; absence of local trauma, in order to avoid local sclerogenic stimuli, which could perpetuate the hardening process.

[Management of sexual disorders in the diabetic patient. Considerations on diagnosis and therapy based on current pathogenetic and physiopathologic knowledge]. / La gestione dei disturbi sessuali nel diabetico. Considerazioni in tema di diagnosi e terapia alla luce delle attuali conoscenze patogenetiche e fisiopatologiche.

The sexual disorders in the diabetic males are quite frequent, particularly the erectil failures, which involve about 50% of these subjects. After a brief epidemiological note, the Authors review the recent advances about the pathogenesis of such a disturbance in the International Literature: values and limitations of up-to-date diagnostic examinations as well as therapeutic options are critically considered. From the diagnostic point of view the progress of the techniques involved both in the study of penile microcirculation and in the neurophysiopathology of the pelvic autonomic nervous system must be emphasized. Furthermore the great efficacy (up to 90% of satisfactory results) of vasoactive intracorporeal injections has to be stressed.

[Usefulness of PSA density (PSAD) in the differential diagnosis between prostatic adenocarcinoma and benign ++ prostatic hypertrophy]. / Utilità della PSA density (PSAD) nella diagnosi differenziale tra adenocarcinoma prostatico ed ipertrofia prostatica benigna.

The purpose of this study was to evaluate the usefulness of PSAD in distinguishing benign prostatic hyperplasia (BPH) from prostate cancer. The Authors studied 50 patients, 30 affected with BPH and 20 with prostate cancer. All patients were submitted to: digital rectal examination, trans-rectal ultrasonography and evaluation of serum PSA, before performing any prostatic manipulation. All clinical data were confirmed by histological diagnosis. Although the mean PSAD value was greater significantly in the patients' group affected with prostate cancer, it was impossible to define a PSAD cut off value useful to distinguish malignant from benign prostatic diseases. Similar findings have been observed in a sub-group patients with serum PSA concentration of 3.5-15 ng/ml. The PSAD cut off value of 0.10, proposed from some Authors, showed low specificity. On the contrary a cut off value of 0.15 is not sufficiently sensitive: an elevated number of cancer would have missed using this parameter alone. Therefore, the combined use of clinical findings and serum PSA is recommended to improve the early diagnosis of prostate cancer.

[Doppler velocimetry]. / La velocimetria Doppler.

After a brief historical introduction, the Authors describe the methodology of the continuous wave basic and dynamic Doppler examination of the penile arteries as well as the main normal and pathologic patterns. Some special tensiometric tests are reported. Advantages and limits of the afore mentioned examinations are discussed.

[Vesico-urethral and entero-urethral anastomosis: anatomo-surgical considerations and technical note]. / Anastomosi vescico-uretrali ed entero-uretrali: considerazioni anatomo-chirurgiche e note di tecnica.

Following radical prostatectomy or radical cystectomy with orthotopic ileal bladder (in male patients), the cervico-urethral or entero-urethral anastomosis are at high risk for urinary stress incontinence, due to the shortening of the urethral functional length as well as "unavoidable downward fall" of the perineum after sectioning of the anterior portion of the sacro-pubic ligaments. That descensus of the perineum, if uncorrected, might cause a functional extraabdominal positioning of the residual functional urethra; this feature is close similar to one of the most important pathogenetic factors of genuine stress incontinence in the female. In order to correct that perineal fall is advisable to perform the so-called "secondary sphincter" (after Rocca Rossetti, 1982) by suturing with the same stitches not only the anastomotic edges but the medial part of the levator ani (i.d. pubo-rectal muscles) and the retro-urethral striated musculature as well; this technique ensure a good intraabdominal position of the residual functional urethra and prevents dangerous tensions on the anastomosis. The Authors stress the importance of a delicate dissection of the prostatic apex with no or minimal manipulation of the membranous urethra avoiding to evaginate it from the surrounding pelvic floor, that could damage its vascular supply. Following the before mentioned criteria the Authors performed 17 radical prostatectomies and 7 ileal bladder after radical cystectomy with satisfactory results (4.1% of postoperative urinary incontinence).

[Radical prostatectomy: role of ultrasonography in the follow-up]. / Prostatovesciculectomia radicale: ruolo dell'ecografia nel follow-up.

After a brief summary about surgical technique of radical prostatectomy and its indications in the different stages of prostatic cancer, the Authors describe complications and surgical sequelae of this operation. The Authors report a brief series. It is composed with 13 patients. Their have been submitted to radical prostatectomy for prostatic cancer between January 1989 and September 1991. Pathological stage was B1 in 6 patients, B2 in 2 patients, C1 in 4 cases and C2 in 1. Particularly the role of ultrasonography in detection and follow-up of early complications such as lymphocele, pelvic hematoma and anastomotic urine leakage is stressed. Transrectal ultrasound is especially useful in the detection of urine leakage from vesico-urethral anastomosis. This technique is compared with traditional cystourethrography and advantages and disadvantages of the two techniques are discussed. Later complications of radical prostatectomy are anastomotic stenosis, pelvic recurrences, nodal or parenchymal metastasis, urinary incontinence. The role of transrectal ultrasound in the detection of anastomotic strictures is stressed, especially when the study is done during micturition. Transrectal ultrasound is not so satisfying in the detection of pelvic recurrences, especially if they are smaller than 1 cm. In case of large masses digital examination is diagnostic itself. At last the Authors describe urinary incontinence and its etiology as a complication of radical prostatectomy. Particularly a surgical technique for vesico-urethral anastomosis proposed by Rocca Rossetti and its value in post-operative continence is described. The Authors show the results of transrectal ultrasound in the detection of striated urethral sphincter and its function after radical prostatectomy.

Immunophenotypic characterization of the bladder mucosa infiltrating lymphocytes after intravesical BCG treatment for superficial bladder carcinoma.

The lymphocytes infiltrating the bladder mucosa of 28 patients treated with bacillus Calmette-Guérin (BCG) for superficial bladder carcinoma were characterized using an immunohistochemical technique on frozen sections of biopsy specimens obtained during cystoscopy. The inflammatory response induced by BCG consisted mainly of T lymphocytes (CD3+), most of which had the helper/inducer phenotype (CD4+), with a CD4/CD8 ratio greater than 1. A minor subset of lymphocytes were of B phenotype (CD22+). These findings persisted for the whole follow-up period (6-12 months) in spite of a progressive decrease of the inflammatory infiltrate. No difference in the lymphocyte phenotype was observed between nonresponding patients and those who responded to BCG in the short term. It is concluded that, although intravesical BCG therapy does affect the immunocompetent cells of the bladder wall, the BCG-induced antitumor activity is unlikely to depend exclusively on a local immune mechanism.

[Mono-symptomatic hematuria: first symptom of metastatic pulmonary carcinoma]. / Ematuria monosintomatica: primo sintomo di carcinoma polmonare metastatico.

The occurrence of secondary bladder neoplasms is very uncommon, especially when the bladder is the only site of metastasis. The Authors report on one case of bladder metastasis from primary small cell carcinoma of the lung.

[Cystic nephroma: report of two cases and review of literature]. / Nefroma cistico: nostra esperienza su due casi e revisione della letteratura.

Cystic nephroma is an uncommon lesion, whose etiology and pathogenesis is still debated: some Authors designate it as being of neoplastic origin, other ones of dysplastic or hamartomous origin. Also epidemiology makes difficult its pathogenetic interpretation, as being especially affected children under age of fourth year and adults within the 5th and 6th decade. The Authors report two cases of cystic nephroma examined in two female patients 30 and 74 aged. The most interesting matters are: 1) Possibility of a pre-operative diagnosis of founded suspicion, based on pathologic criteria, codified in literature (unilateral and multilocular cyst which doesn't communicate with the renal collecting system, separated by delicate septae without mature renal tissue) and on respective ultrasonographic, CT and angiographic patterns; 2) Possibility of programming a surgical-conservative strategy; 3) Knowledge about possibility of foci association of adeno-carcinoma or nephroblastoma in the lesion, that, nevertheless, if not widespread, it should not modified neither therapeutical proceeding nor prognosis, generally favourable.

[Inverted papilloma associated with transitional cell carcinoma in the upper urinary tract: report of one case and review of the literature]. / Associazione di papilloma invertito e carcinoma uroteliale nell'alta via escretrice: presentazione di un caso e revisione della letteratura.

Inverted papilloma of the pelvis and the ureter is a rather uncommon (only 40 cases in the relevant literature) benign epithelial tumor, occasionally harboring foci of malignancy. Since it does not metastasize, a conservative treatment is advisable, but a strict follow up is always required. The Authors report a case of inverted papilloma of the ureter near which an area of transitional carcinoma was discovered.

[Extrinsic ureteral endometriosis: description of a case]. / Endometriosi ureterale estrinseca: descrizione di un caso.

After a brief review about pathogenetic hypothesis of the endometriosis of the ureter, the Authors describe a case occurred to their observation. Diagnostic problems and choice in treatment (especially partial ureterectomy, end-to-end ureteral anastomosis and omentoplasty) are discussed.

[The urethral canal in the prostatectomy patient. Echographic aspects]. / Il canale uretrale nel prostatectomizzato. Aspetti ecografici.

An evaluation of the urethra has been made in patients who underwent open surgery or endoscopic resection of the prostate, by means of transrectal echography (EG). The technique used is described; studies have been performed both in basal conditions and in various functional phases, including micturation. Echographic findings are compared to those achieved with micturating cystourethrography (MCU). In case of total prostatectomy EG and MCU findings are similar, showing the surgical bladder neck and the urethral aspect even during micturation. EG shows furthermore possible liquid fluid collections. In partial prostatectomies EG and CUM findings differ, showing the first, besides the site of the surgical intervention, the possible presence of calculi, while CUM findings do not differ from those visible in total prostatectomies. Conclusions are that for the whole study of the urethra CUM is necessary, while for the study of the prostatic region EG gives more information. Therefore EG is proposed as method complementary to CUM in the evaluation of the proximal urethra.

Correlation between liver cirrhosis and benign prostatic hyperplasia: a morphological study.

In elderly males hormonal changes occur, that are believed to cause benign prostatic hyperplasia (BPH). These are decreased testosterone production, an increased testosterone SHBG and a slightly increased estradiol production. Liver cirrhosis in males causes similar endocrine changes. We carried out a post mortem study evaluating the prostates of 51 men who died with liver cirrhosis compared with a similar group without any hepatic disease. The occurrence of BPH in cirrhotic subjects was diminished and delayed compared to total population. Furthermore in cirrhotic men BPH is more common as early nodular hyperplasia (early stage) or stromal hyperplasia (suggesting estrogenic prevalence), while in the general population stromal and epithelial hyperplasia (androgenic stimulation), were almost equally present.