Dissatisfaction with male sexual performance and female sexual dysfunction in women with type 1 diabetes.

Although partnership issues are thought to be implicated in female psychology and sexual life, no data exist on the relationship between dissatisfaction with male sexual performance and female sexual dysfunction (FSD) in women with type 1 diabetes mellitus (DM-1). We studied 70 women with uncomplicated DM-1 and 100 nondiabetic women using Female Sexual Function Index (FSFI), Female Sexual Distress Scale (FSDS) and a Likert Scale to evaluate sexual function, sexual distress and the degree of satisfaction derived from the male partner's sexual performance. Compared with healthy controls, DM-1 women had significantly worse sexual function, higher sexual distress and higher FSD frequency. No significant difference in dissatisfaction with partner's sexual performance was found between diabetic and control group (CG). Moreover, dissatisfied diabetic and control women were comparable in sexual functioning, sexual distress and FSD frequency. In the CG, dissatisfied women had significantly worse total FSFI score compared with the satisfied ones. In addition, dissatisfaction with male sexual performance led to significantly worse FSDS score and higher FSD frequency in both diabetic and CGs. Therefore, our findings reveal a negative association between dissatisfaction with male partner's sexual performance and female sexual functioning, regardless of the presence of diabetes.

Intravesical therapy of superficial bladder cancer.

Transurethral resection (TUR) of the superficial transitional cell carcinoma (TCC) of the bladder is known to be insufficient in controlling the disease because of the unacceptable rates of recurrence, progression and ultimate cystectomy. Adjuvant intravesical chemo-and/or immunotherapy is administered in an effort to enhance the efficacy of surgery alone. The initial tumor stage and grade, the multifocality of this cancer and the history of previous recurrences remain the determinant factors in survival. It is important to decide exactly which patients are at risk, and, therefore, do need treatment. Knowledge of the natural history of the disease will facilitate this decision making, although the natural history of TCC is largely unpredictable owing to tumor heterogeneity. Several cytotoxic and immune modifying agents have been used intravesically in different treatment schedules. However, despite their effectiveness, no consensus exists about the optimal antineoplastic regimen. The selection of the latter is a subject of continuous investigation. Intravesical treatment with cytotoxic drugs has been demonstrated to achieve an acceptable reduction in short- and intermediate-term recurrence rates, but has no proven ability in preventing disease progression to muscle-invasive cancer or prolonging survival. On the other hand, bacillus Calmette-Guerin (BCG) currently appears to be the most effective agent for intravesical use, especially in patients with high grade and stage neoplasms but the optimum strain, dosage and duration schedule have not been determined. Clinical trials have shown that BCG provides long-term protection from tumor recurrence, while there is evidence that it may favorably alter the progression rate of the disease with prolongation of survival. Toxicity of intravesical chemo- and immunotherapy still remains a major problem and attempts at reducing the dosage, and, thus, toxicity without affecting efficacy are underway. This review endeavors to present updated information on intravesical chemotherapy in treating superficial bladder cancer, the expanding role of intravesical immunotherapy, the recent work comparing various immunotherapeutic regimens with chemotherapeutic intravesical therapies, and the progress made towards achieving optimal treatment regimens.

Clinical evaluation of temocillin in urinary tract infections.

A group of 27 female and 2 male urological patients, aged 19 to 80 years (mean 44 years), were treated with intravenous temocillin 500 mg twice daily for 5 to 7 days. The diagnoses were acute pyelonephritis (n = 20), acute cystitis (n = 6), and acute cystitis and pyelonephritis combined (3). The causative organisms were Escherichia coli (n = 20). Proteus species (n = 9). Klebsiella species (n = 4). Streptococcus faecalis (n = 2). Staphylococcus epidermidis (n = 1), and Providencia stuartii (n = 1). 27 of the 29 patients (93%) were clinically and bacteriologically cured; bacteriuria persisted in 2 patients with prolonged obstructive uropathy. In acute non-obstructive pyelonephritis, the urinary excretion of beta-2-microglobulin rapidly decreased, documenting a prompt renal tubular restitution during therapy. The drug was well tolerated and proved very safe with regard to haematological, hepatic and renal parameters. Also, Candida haemagglutination titres did not increase significantly during therapy. Temocillin therapy should preferably be commenced after the results of the urine culture are available.

Rubinstein-Taybi syndrome.

Rubinstein-Taybi (broad thumb and big toe) syndrome, is characterized by mental and motor retardation and skeletal deformities of which broad thumb and large first toe are the most obvious. In addition, defects of the cardiovascular system and the urinary tract may be present. A case of Rubinstein-Taybi syndrome in a boy is presented.

Penile duplication.

We report on a case of penile duplication in an eight-year-old boy. While diphallia was incomplete, there was a common root of the penis which divided into two shafts of different size, doubling in frontal plane. Only one urethra left the bladder along the lower and smaller penile shaft and ended with a hypospadiac meatus. After surgical plastic repair, the patient had a good functional and cosmetic result. In addition, this patient had a horseshoe kidney.

Primary endourologic re-establishment of urethral continuity after disruption of prostatomembranous urethra.

A new technique for the early management of traumatic disruption of the prostatomembranous urethra has been used in 4 consecutive young patients. Urethral realignment by stenting the injured urethra with a catheter was achieved by combined urethroscopy and suprapubic instrumentation one to three days after the injury. We describe herein our experience with this technique and we suggest that it could be a valuable alternative in posterior urethral repair.

Vesical diverticula: etiology, diagnosis, tumorigenesis, and treatment. Analysis of 74 cases.

A thirteen-year review of bladder diverticula was undertaken and 74 cases were identified. In 8 patients primary neoplasms arose in the diverticula, and their treatment included diverticulectomy or partial cystectomy with or without postoperative irradiation, irradiation only, and transurethral resection of the tumor combined with fulguration of the diverticular wall and postoperative bladder instillations with doxorubicin or thiotepa solutions. Early diagnosis with additional visualization of the interior of vesical diverticulum is mandatory, since carcinoma arising in it has a poor prognosis.

Complicated urinary tract infections.

The term complicated urinary tract infection is usually used to convey an infection that occurs in a patient with a structural or functional abnormality impeding urine flow, or in a host with altered defences. The distinction between complicated and uncomplicated infections is important because, when complicating factors are present, antimicrobial resistance is more common and the response to therapy is often disappointing, even with agents active against the causative microbial pathogen. In addition, severe complications frequently occur which may lead to urosepsis, renal scarring or even end-stage disease. Drug treatment of complicated urinary tract infections often must be complemented with endoscopic and/or surgical intervention. Only a few well designed treatment studies have been published and therefore sources for definitive therapeutic guidelines remain inadequate.

Retrograde acucise endopyelotomy: is it worth its cost?

PURPOSE: To identify patients with ureteropelvic junction (UPJ) obstruction who will benefit from endoscopic Acucise incision of the stenosis and to compare the open Hynes-Anderson pyeloplasty with this minimally invasive technique. PATIENTS AND METHODS: In a prospective trial, 22 patients with primary and secondary UPJ obstruction were treated by Acucise endopyelotomy, and 18 patients were treated by Hynes-Anderson pyeloplasty. Preoperative and postoperative renal scans were used to determine the degree of obstruction and intravenous urography, ultrasound scanning, or both to assess the degree of dilation. RESULTS: There was a vast difference in the cure rate of the two groups: Hynes-Anderson pyeloplasty cured 94.5% of the patients, while in the Acucise group, the cure rate was only 32%. There was some improvement in another 22% of the patients, but the renal scan curve remained obstructed. The remaining 45% of patients failed to show any improvement. CONCLUSION: Acucise endopyelotomy will improve or cure only patients with good renal function and mild dilation of the pelvicaliceal system. Patients with severe dilation should be treated by Hynes-Anderson pyeloplasty.

Milk of calcium cysts masquerading as renal calculi.

Milk of calcium renal cysts contain a colloidal suspension of calcium crystals. By routine radiography and sonography in supine position this rare condition may be misinterpreted as renal lithiasis for which an unnecessary surgical intervention may be performed as it happened in our two cases that are presented here. Postoperatively, the characteristic finding of half-moon contour on upright abdominal plain views was lacking in one case, but in both cases computed tomography revealed the typical calcific suspension layering. However, upright plain views and computed tomography are not routinely performed in patients in whom a renal stone has initially been considered. This entity should be considered in the differential diagnosis of renal paracalyceal calcifications of obscured origin.

A comparative study on aztreonam, ceftazidime and amikacin in the treatment of complicated urinary tract infections.

In a prospective, randomized trial, aztreonam (1 g intravenously or intramuscularly, twice daily) was compared with ceftazidime (1 g intravenously or intramuscularly, twice daily) and amikacin (500 mg intravenously or intramuscularly, twice daily) in 76 patients aged 24 to 84 years (mean, 59.7 years) with complicated urinary tract infections. Initial pathogens included Escherichia coli (47.5%), Pseudomonas aeruginosa (22.5%), Klebsiella spp. (9%), Proteus spp. (7.5%) and Enterobacter spp (6%). In four patients initial urine cultures yielded more than one organism. All pathogens were sensitive to the three study drugs. Including performance of 4- to 6-week follow-up cultures, eradication of the pathogens occurred in 72% of patients treated with aztreonam, in 74% of those treated with ceftazidime and in 71% treated with amikacin (p greater than 0.05). Clinical success was observed in 84% of patients treated with aztreonam, in 82% of those treated with ceftazidime and in 85% treated with amikacin (p greater than 0.05). All drugs were well tolerated. It is concluded that aztreonam, ceftazidime and amikacin are equally effective and safe for the treatment of complicated urinary tract infections due to susceptible organisms.

Efficacy of prophylactic antimicrobial regimens in preventing infectious complications after transrectal biopsy of the prostate.

In a prospective study on 81 patients undergoing transrectal needle biopsy of the prostate, the efficacy of prophylaxis in preventing postbiopsy infectious complications was determined. The patients were divided randomly into four groups, and a comparison of the rate of postbiopsy complications in each group was made. In 11 and 17% of the patients in Group A (n = 18) who received povidone-iodine enema alone, bacteriuria and bacteraemia, respectively, occurred. When parenteral piperacillin alone in Group B (n = 22) was administered, the rates of the same complications were 9 and 14%, respectively, while both rates were as low as 4% in Group C (n = 25) when piperacillin in combination with povidone-iodine enema was given. On the other hand, in 31 and 37.5% of the patients in Group D (n = 16), who served as controls, bacteriuria and bacteraemia developed. The study has thus shown that parenteral piperacillin in combination with povidone-iodine enema significantly reduces the incidence of infectious complications associated with transrectal prostatic biopsy.

The role of chlamydiae in epididymitis.

In 21 men suffering from acute or chronic epididymitis who underwent scrotal surgical exploration, diagnostic microbiological studies consisting in cultures of the epididymal tissues and mid-stream urine specimens, as well as examination of the urethral swabs--before and after prostatic massage--were performed. Laboratory tests revealed that 55 per cent of the patients younger than 40 years were infected by Chlamydia trachomatis, and 36 per cent by urinary tract bacteria. On the other hand, in only 10 per cent of the patients older than 40 years the causative organisms were Chlamydiae, whereas in 70 per cent the common urinary tract bacteriae were the agents of epididymal infection. The aforementioned microbiological examinations were proved to be reliable in demonstrating the causative bacteria for epididymitis.

Prostatectomy in the very aged.

The number of very aged men who demand prostatectomy for benign disease is increasing. We have assessed surgery results in 79 patients operated during the last four years. Sixty-two underwent endoscopic and 17 open procedure. Mortality rate was 3.7%. Two patients died in the first week and one patient three weeks after surgery. Morbidity rate was 61% but did not significantly affect the final operative outcome. Operative success rate six weeks postoperatively was 87%, satisfactory for this age group. After detailed preoperative evaluation and postoperative care by specialized age care team, prostatectomy is safe, effective and involves low-cost treatment.

Prognostic factors for the operative correction of stress urinary incontinence.

Investigating the reliability of using some clinical and laboratory parameters as long-term prognostic factors in properly selected patients for stress urinary surgery could help in the prediction of the long-term result in each case. Toward this goal 51 women were examined prospectively, after they were assessed by clinical and laboratory exams with particular emphasis on urodynamic studies. Out of this group, 41 patients had genuine stress incontinence, and 10 had mixed stress incontinence. Twenty-seven women underwent Burch colposuspension while 24 had Stamey endoscopic bladder neck suspension. In all patients clinical and urodynamic evaluation was done with the same methodology before the operation, and after one month and six months, respectively. The study indicated that 73% of the incontinent women were cured. According to the "analysis of variance" and "correlation analysis" methods the factors which were found to influence the operative result were as follows: (1) Clinical factors including preoperative urgency, U.T.I. and previous gynaecological operations. These factors had negative prognostic value, while the grade of incontinence did not influence at all the outcome of surgery. (2) Urodynamic factors including preoperative residual urine, immediate operative first sensation of micturition, maximum urine flow rate, pre- and immediate postoperative bladder capacity and functional length. These factors influence the operative result negatively or positively according to the deviation from the normal values. Furthermore, the important immediate postoperative change of the urodynamic values was found to determine the result of the operation.

Idiopathic gangrene (Fournier) of the male external genitalia, with report of a case and review of the literature.

Fournier's gangrene, originally described by Fournier in 1883, is a rare and unusual ischaemic necrosis of the male external genitalia. Reports on the idiopathic penile and/or scrotal gangrene are relatively rare in newer publications. The aetiology of the disease which is characterized by a sudden onset, most commonly without prodromal symptoms, is still not fully understood. There is strong evidence, however, that Fournier's gangrene is a specific infection due to Streptococcus haemolyticus, group A, and/or anaerobic Streptococci. Presenting a case of our own, we take the opportunity to discuss the pathogenesis, pathomorphology, bacteriology and treatment of the disease.

Aspects concerning posterior urethral valves.

Twenty-six boys were evaluated and treated for posterior urethral valves. At the time the valves were diagnosed unilateral or bilateral vesicoureteral reflux was present in 58% of the ureters and 69% of the children, while dilatation of the upper urinary tract was present in 88% and 92%, respectively. There was a variety of symptoms and signs, but the most prominent in neonates and infants were vesical urine retention, palpable kidneys and failure to thrive, whereas in the older children voiding dysfunction, incontinence and urinary infection were the most common. Twenty-four out of 26 boys were managed by primary valve ablation and in 62.5% of them this type of treatment was adequate in resolving or sufficiently improving clinical manifestations and roentgenologic findings, requiring no further management. Urinary diversion in the form of vesicostomy and cutaneous ureterostomy was preserved for those patients who did not improve with valve ablation alone. The current aspects concerning posterior urethral valves are also discussed.

Stamey endoscopic vesical neck suspension in female urinary stress incontinence: results and changes in various urodynamic parameters.

A total of 32 female patients with urinary stress incontinence who underwent a Stamey endoscopic bladder neck suspension were clinically and urodynamically studied pre- and postoperatively. Complete cure was obtained in 78% of the patients and improvement in 6%, the overall success rate being 84% for a mean follow-up of 11.1 months (range 6-19). Complications occurred in 22% of the patients. Comparison of the pre- and postoperative urodynamic data revealed that the maximum urine flow rate, functional urethral length and maximum urethral closure pressure were changed significantly after operation. In addition, when studying the abdominal pressure transmission to the entire urethra during stress, there was a significant conversion of negative to positive pressure transmission after surgical repositioning of the urethra.

Intravesical bacillus Calmette-Guérin administration in the prophylaxis of superficial bladder cancer.

A total of 68 patients received prophylactic/adjuvant intravesical Pasteur strain bacillus Calmette-Guérin (BCG) instillations following transurethral resection for superficial bladder carcinoma. An induction phase consisting of 6 weekly instillations was followed by a maintenance phase consisting of 1 instillation given every 3 months. A second 6-week course of BCG was administered to initial failure followed again by a quarterly maintenance therapy. The response rate for patients treated with one 6-week course was 56%, while complete response was achieved in 72% when both treatment courses were considered. Follow-up period lasted at least 2 years after each course of BCG. These results suggest that additional courses of BCG increase the prophylactic efficacy of intracavitary BCG. Regarding the purified protein derivative (PPD) skin test and granulomatous response in the bladder, it has been shown in the present study that, although favourable results occurred more frequently among patients with either PPD conversion from negative to positive or vesical granuloma formation, neither of these indices should be considered reliable prognostic indicators.