Comparison between thulium laser vapoenucleation and plasmakinetic resection of the prostate in men aged 75 years and older in a real-life setting: a propensity score analysis.

BACKGROUND: Urologists may hesitate to offer transurethral resection of the prostate (TURP) because of increased morbidity in elderly patients. AIMS: We aimed to compare data on postoperative outcomes of elderly men undergoing bipolar transurethral resection of the prostate (B-TURP) as compared to thulium laser vapoenucleation of the prostate (ThuVEP). METHODS: We retrospectively reviewed data of all patients aged ≥ 75 years who underwent benign prostatic hyperplasia surgery. Differences between interventions were estimated using propensity scores (PS) to adjust for different patients characteristics. RESULTS: Between 2017 and 2020, 275 men were included in the analysis. Propensity score retrieved 65 patients in each group. Median age was 78 (4) years in B-TURP group and 78 (6) in ThuVEP group. Median prostate volume was 63 (35) ml and 54 (24) ml in B-TURP group and ThuVEP group, respectively. Only American Society of Anesthesiologists score was significantly higher in ThuVEP group (p = 0.006). Median operation time, catheterization time, and hospital stay were similar in both groups (55 min, 2 and 3 days). Overall, 84.6% of men had no complications, with no significant differences between the groups (p = 0.234). Only one patient in B-TURP group experienced a Clavien grade IIIb complication. By 1 year, there were a statistically significant differences in International Prostate Symptom Score (p = 0.000) in favor of B-TURP group and in maximal urine flow rate (p = 0.000) in favor of ThuVEP group. DISCUSSION AND CONCLUSIONS: Both procedures showed excellent functional improvements one year after surgery with a low rate of major complications in men aged ≥ 75 years with small-to-medium sized prostates.

Low-Dose Intravaginal Estriol and Pelvic Floor Rehabilitation in Post-Menopausal Stress Urinary Incontinence.

INTRODUCTION: Pelvic floor muscle training (PFMT) and electrical stimulation (ES) are conservative models of therapy for treating female stress urinary incontinence (SUI). The presence of estradiol receptors in the lower urinary tract advances the case for estradiol therapy in SUI. The aim of our study was to investigate the effects of the combination of pelvic floor rehabilitation and intravaginal estriol (IE) on SUI treatment in postmenopausal women. MATERIAL AND METHODS: Sixty-two women with SUI were randomized to PFMT, ES and biofeedback (Group 1) or the same treatment plus 1 mg IE (Group 2) for 6 months. Patients were evaluated with medical history, pelvic examination, urodynamics, 24-hour pad test. Urinary incontinence was evaluated using the International Consultation on Incontinence questionnaire on urinary incontinence short form and quality of life using the Incontinence Impact Questionnaire-Short Form. RESULTS: Two patients were lost at follow-up and one discontinued the study. Mean urine leakage at the 24-hour pad test dropped from 42.3 ± 20.2 g/die to 31.5 ± 14.2 g/die in Group 1 and from 48.3 ± 19.8 g/die to 22.3 ± 10.1 g/die in Group 2. Symptoms scores and incontinence status were statistically significant better in Group 2 when compared to Group 1. CONCLUSION: IE added to PFMT, ES and BF is a safe and efficacious first-line therapy in postmenopausal women with SUI.

BPH/LUTS and ED: common pharmacological pathways for a common treatment.

INTRODUCTION AND AIM: This article reviews the current literature on common physiopathogenetic factors and pharmacological pathways of lower urinary tract symptoms (LUTS) and erectile dysfunction (ED) in men and their implications for diagnosis and treatment. MAIN OUTCOME MEASURES AND METHODS: A literature search was conducted to identify original articles, reviews, editorials, and international scientific congress abstracts by combining the following terms: lower urinary tract symptoms, erectile dysfunction and phosphodiesterase type 5 inhibitors (and their abbreviations LUTS, ED and PDE5-Is). RESULTS: We identified manuscripts presenting: (i) The existence of several newly discovered common pathophysiological mechanisms of LUTS and ED indicating that PDE5-Is might represent an alternative to current treatments of men with LUTS (e.g., α1-adrenergic blockers and 5α-reductase inhibitors); (ii) Randomized controlled clinical trials have shown that treatment with PDE5-Is is associated with improvements in both LUTS and ED in men with significant problems in both areas. CONCLUSION: The presence of common pathophysiological mechanisms between LUTS and ED seems well recognized and needs further exploration. Further comparisons between different PDE5-Is would be useful to determine the most appropriate regimen and their efficacy to safety ratio.

Plasmakinetic bipolar versus monopolar transurethral resection of non-muscle invasive bladder cancer: a single center randomized controlled trial.

OBJECTIVES: To compare the safety and the efficacy of plasmakinetic bipolar resectoscope versus conventional monopolar in the transurethral resection of primary non-muscle invasive bladder cancer. METHODS: From January 2007 to December 2009, 132 patients underwent endoscopic resection for primary non-muscle invasive bladder cancer. They were randomly assigned to two groups: 67 patients underwent a transurethral resection of the bladder with bipolar plasmakinetic energy transurethral resection of the bladder and 65 were treated with conventional monopolar transurethral resection. RESULTS: The mean operative time was 27 min for bipolar plasmakinetic energy transurethral resection of the bladder and 31 min for monopolar transurethral resection of the bladder. No significant differences in the mean change of hemoglobin and serum sodium level were observed. Mean catheterization time was 1.3 days and 2.3 days for bipolar plasmakinetic energy transurethral resection of the bladder and monopolar transurethral resection of the bladder, respectively. The mean hospital stay was shorter in the bipolar plasmakinetic energy transurethral resection of the bladder. Bladder perforation was reported in two cases for the monopolar transurethral resection of the bladder group and obturator nerve reflex occurred in a single case for both procedures. None of the patients experienced transurethral resection syndrome. The median time of bladder tumor recurrence after initial transurethral resection of the bladder was 12.4 months and 11.9 months for bipolar plasmakinetic energy transurethral resection of the bladder and monopolar transurethral resection of the bladder, respectively. No significant differences in the overall recurrence-free survival rate were observed comparing the two procedures. CONCLUSIONS: Plasmakinetic bipolar transurethral resection represents a safe and effective procedure in the management of non-muscle invasive bladder cancer.

Urgent ureteroscopy as first-line treatment for ureteral stones: a meta-analysis of 681 patients.

There are various recent studies on the use of ureteroscopy and debate on whether this should be the first-line treatment for patients with ureteral stones. The aim of this meta-analysis was to understand the role of this surgical procedure in the emergency setting as first-line treatment and to compare the immediate procedure with a delayed one in terms of stone-free rate and complications. A bibliographic search covering the period from January 1980 to March 2010 was conducted in PubMed, MEDLINE and EMBASE. This analysis is based on the six studies found that fulfilled the predefined inclusion criteria. A total of 681 participants were included. The number of participants in each of the studies considered ranged from 27 to 244 (mean 113). Stone-free rates were 81.9% (72.0-91.8) for the proximal ureter, 87.3% (82.6-92.0) for the mid-ureter, 94.9% (92.1-97.6) for the distal ureter and 89.5% (86.5-92.5) overall according to the logistic regression applied. These values are not statistically significantly different from those reported in the AUA and EAU guidelines. The stone diameter seems to affect the stone-free rate. An increase of the stone diameter of 1 mm beyond 8 mm corresponded to a reduction of stone-free rate of 5% (2.4-8.0) and 8.1% (3.8-12.1) for the distal and proximal ureters, respectively. There is a complete lack of information in international guidelines on the ureteroscopic management of ureteral stones in an emergency setting and the currently available results are dispersed in a few studies in the literature. The rationale for using emergency ureteroscopy is more rapid stone clearance and relief from colic pain. According to our meta-analysis, immediate ureteroscopy for ureteral stone colic seems to be a safe treatment with a high success rate. This evidence will be validated by further randomized studies, with larger series of patients.

Has the cost of anti-muscarinic a key role in the success rate of patients diagnosed with overactive bladder syndrome?

INTRODUCTION: Overactive bladder syndrome (OAB) is a chronic disease, the prevalence in the general population is reported to be 14-16%. Anti-muscarinic agents are considered the first-line pharmacological treatment for the management of OAB; although a long lasting therapy is indicated to reach a better control of OAB symptoms an high percentage of patients discontinue the cure after a brief period. Our attempt is to investigate whether the cost of solifenacin succinate may influence the long lasting regimen and patients' drug efficacy. MATERIALS AND METHODS: 70 consecutive women, with symptoms of OAB were enrolled in this randomized controlled study. In group A, all patients received solifenacin 5 mg by the urologist, without any cost; they were instructed to get the drug once daily for 4 months, differently, in group B, patients need to buy the drug which was administered as in the group A. Frequency, nocturia, incontinence, voided volume, were evaluated by a 3-day micturition diary. Overactive Bladder Questionnaire Short Form (OAB-qSF) was used to assess the impact of OAB symptoms on patients' quality of life (QoL). Urgency was assessed by patient's perception of intensity of urgency scale (PPIUS). Micturition-diary, OAB-qSF, PPIUS, were completed at baseline and after four months. RESULTS: A greater number of patients discontinued solifenacin in the group B who need to buy the drug. We observed significant differences in groups A and B in relation to frequency, nocturia, urge incontinence and voided volume comparing the pre and post treatment symptoms. The patients' perceptions of intensity of urgency and the PGI-I scale showed a significant improvement greater in group A in respect with group B. CONCLUSIONS: The cost of anticholinergic may be responsible for both early discontinuation of treatment and incomplete adherence to therapy with unsatisfactory results on symptoms and an incorrect assessment of the effectiveness of the drug by the urologist.

Which men with non-malignant pathology at magnetic resonance imaging-targeted prostate biopsy and persistent PI-RADS 3-5 lesions should repeat biopsy?

PURPOSE: To assess predictors of clinically significant (cs) prostate cancer (PCa) in men who had a non-malignant Multiparametric magnetic resonance imaging (mpMRI)-targeted biopsy and persistent Prostate Imaging-Reporting Data System (PI-RADS) 3 to 5 lesions in subsequent mpMRI. MATERIALS AND METHODS: We retrospectively analyzed MRI-targeted biopsy database in three centers. INCLUSION CRITERIA: persistence of at least one PI-RADS ≥3 lesion found negative for cancer in a previous MRI-targeted plus systemic biopsy (baseline biopsy). EXCLUSION CRITERIA: downgrading to PI-RADS 1-2. A logistic regression analysis was performed to estimate the predictors of csPCa. RESULTS: Fifty-seven patients were included. Median interval between biopsies was 12.9(2.43) months. Median age was 68.0(12) years. Median PSA was 7.0(5.45) ng/ml. At follow-up, 24.6%, 54.4%, and 21% of patients had a PI-RADS score 3, 4, and 5 index lesion (IL), respectively. At re-biopsy, 28/57(49.1%) men were found to harbor PCa. Among these, 22(78.6%) had csPCa. csPCa was found outside the IL in only 2 patients. Eleven, 13, and 5 patients with PI-RADS 3, 4, and 5, respectively, had no cancer. Three patients with a PI-RADS 3 lesion had cancer (2 with Gleason score 3+3, 1 with Gleason score 3+4). 14/43 men with a PI-RADS 4/5 lesion harbored Gleason score ≥3+4 PCa. Logistic regression analysis found that PSA (HR 1.281, 95% CI: 1.013-1.619, P = 0.039) and IL size (HR 1.146, 95% CI: 1.018-1.268, P = 0.041) were the predictors of csPCa at re-biopsy. CONCLUSIONS: Patients with non-malignant pathology from PI-RADS ≥3 lesions targeted biopsy should be follow-up with mpMRI, and those with persistent PI-RADS 4 to 5 lesions should repeat MRI-targeted and systematic biopsy.

PDE-5 and NOS II mRNA expression in menopausal women: a molecular biology study.

OBJECTIVE: Phosphodiesterase (PDE) and nitric oxide synthase (NOS), evaluated in male erectile dysfunction, are currently under study for their role in the female counterpart. We aim to assess PDE-5 and NOS II presence, at messenger Ribonucleic Acid (mRNA) level, in vaginal environment of menopausal women, by using molecular biology techniques. METHODS: Specimens of vaginal tissue were obtained from 16 menopausal women undergoing surgery for pelvic organ prolapse. The two samples obtained for each patient, one under the urethra (called U) and one on the rest of the vaginal wall (called V), were tested for PDE-5 and NOS II by RT-PCR and by a densitometric semiquantitative analysis. RESULTS: Of the V samples, 81.3% expressed PDE-5 and 100% NOS II. PDE-5 and NOS II expression were revealed in 87.5% of U specimens. A significant difference (P < 0.05) between V and U samples was found in the expression of NOS II (V vs. U: 24.14 vs. 7.25) and PDE-5 (V vs. U: 44.32 vs. 68.57). CONCLUSIONS: Our results demonstrated the presence of PDE-5 and NOS II mRNA in periurethral and vaginal tissue of menopausal women. The distribution of PDE-5 and NOD II may indicate a physiologic role in the regulatory function of human vagina.

Tadalafil versus solifenacin for persistent storage symptoms after prostate surgery in patients with erectile dysfunction: a prospective randomized study.

OBJECTIVES: The occurrence of residual storage symptoms after surgical relief of bladder outlet obstruction as a result of benign prostatic enlargement (BPE) underlines the intricate mechanism involved in lower urinary tract symptoms (LUTS). The aim of the present study was to compare tadalafil with solifenacin in modifying symptoms and uroflowmetric parameters in patients with erectile dysfunction (ED) and residual storage symptoms after prostate surgery. METHODS: From May 2007 to April 2009, we evaluated 68 patients who had undergone prostate surgery at least 6months earlier, and presented with ED and persistence of storage symptoms. A total of 56 patients were randomized to receive tadalafil 5mg (group 1) or solifenacin 5mg (group 2), both given daily for 12weeks. International Prostate Symptoms Score (IPSS), IPSS Quality of Life, International Index of Erectile Function-5 (IIEF-5) and uroflowmetry parameters were collected at baseline and after 12weeks of treatment. RESULTS: A total of 26 patients in group 1 and 25 patients in group 2 completed the study. Each group showed a significant and comparable improvement of urinary symptoms with a decrease of IPSS value. Only in group 1 did the treatment with tadalafil result in a significant increase of IIEF-5. No statistically significant variations were noted in uroflowmetric parameters in both groups. CONCLUSIONS: In patients suffering from ED and storage symptoms after surgical treatment for LUTS-BPE, tadalafil 5mg given once daily for 12weeks provided a comparable improvement in IPSS to solifenacin 5mg given for the same period of time.

Inflammation and endothelial activation in benign prostatic hyperplasia and prostate cancer.

PURPOSE: Emerging insights underline a link among chronic inflammation and endothelial activation with benign prostatic hyperplasia (BPH) and prostate cancer (PCa). We aim to investigate whether specific plasma markers of inflammation and endothelial activation allow to discriminate BPH and PCa. MATERIALS AND METHODS: Fifteen patients affected by BPH, 15 by PCa and 15 controls, were enrolled. Interleukin-6 (IL-6), CD40 ligand (CD40L), endothelial-selectin (E-selectin), platelet-selectin (P-selectin), vascular cell adhesion molecule-1 (VCAM-1) and intercellular adhesion molecule-1 (ICAM-1) were measured. RESULTS: In systemic blood samples, IL-6 has been found increased in patients affected by BPH (4.25 ± 0. pg/mL) and PCa (5.08 ± 0.24) respect to controls (2.62 ± 0.34; p < 0.05). CD40L was higher in BPH (4.25 ± 0.65 ng/mL; p < 0.05) than in control (2.31 ± 0.20) and PCa group (2.60 ± 0.56). E-selectin, P-selectin and VCAM-1 did not show any significant difference. Higher levels of ICAM-1 were detected in patients with PCa (573.04 ± 52.23) and BPH (564.40 ± 74.67) than in the controls (215.30 ± 11.53 ng/mL; p < 0.05). In local blood samples, IL-6 has been found significantly increased in PCa in comparison with patients with BPH; there was no difference in CD40L, E-selectin, P-selectin, VCAM-1 ed ICAM-1. CONCLUSIONS: Changes in inflammation and endothelial activation markers may be not considered to be of value in discriminating BPH and PCa.

Haemostatics in surgery and our experience in the enucleoresection of renal cell carcinoma.

BACKGROUND: 30 patients, with T1 renal cell carcinomas (RCC) who underwent open enucleoresection of the tumour, were randomized to the use of a topical haemostatic agent (Floseal) or to an infrared-sapphire coagulator (ISC), to compare their efficacy in achieving haemostasis. METHODS: Successful intra-operative haemostasis, intra- and post-operative bleeding, operative time, hospital discharge were evaluated. RESULTS: Statistically higher rates of successful haemostasis and shorter time-to-haemostasis (8,1 vs 12,9 min) were observed in the FloSeal group (p < 0.001 both). Patients operative time was not different between Group 1 vs 2 (58.7 +/- 12 vs 62.4 +/- 15; p > 0.05). The average blood loss during surgery was less (60 +/- 25.5 mL) for the FloSeal group than for the ISC group (85 +/- 40.5 mL) (p < 0.05). Postoperative blood loss was 25 +/- 5 mL and 40 +/- 45 mL for Floseal and ISC respectively, (p < 0.05). Length of the postoperative hospital discharge was 2.5 +/- 1.2 days for FloSeal group and 3.5 +/- 1.3 for the Group 2 (p < 0.05). No major immediate or delayed complications were observed in either Groups. CONCLUSIONS: The use of Floseal and ISC offer a safe and efficacy haemostasis in the enucleoresection of RCC. Moreover, our results show a less intra-operative and post-operative blood loss as well as a shorter time to haemostasis of Floseal in respect to ISC.

Oxidative stress in benign prostatic hyperplasia and prostate cancer.

OBJECTIVE: The aim was to verify whether oxidative stress could represent a common key factor of benign prostatic hyperplasia (BPH) and prostate cancer (PCa). SUBJECTS AND METHODS: 15 patients affected by BPH, 15 with PCa and 15 controls were enrolled. Blood samples were withdrawn systemically and locally during radical retropubic prostatectomy in patients with PCa and during transvesical retropubic adenomectomy in patients diagnosed with BPH. Plasma oxidized low-density lipoprotein, peroxides, and total equivalent antioxidant capacity (TEAC) including plasma superoxide dismutase (SOD) determination were analyzed as oxidative markers. RESULTS: With respect to the control group, high plasma peroxides and decreased TEAC levels were measured in patients affected by both PCa and BPH. Plasma peroxides were significantly higher in patients with PCa with respect to BPH. A positive correlation was found between peroxides and TEAC values in samples withdrawn locally in patients affected by PCa. An inverse correlation between peroxides and TEAC was observed in patients with BPH. No statistically significant modifications were observed as concerns SOD activity and LDL oxidability. CONCLUSIONS: Our findings confirm a significant unbalance of redox status in patients affected by BPH and PCa, and suggest a potential involvement of oxidative stress as a determinant in the pathogenesis of these diseases.

Penile rehabilitation therapy following radical prostatectomy.

PURPOSE: To compare erectile function (EF) recovery of patients treated by early penile rehabilitation therapy (PRT) with sildenafil and with control group. METHOD: Forty men treated by bilateral nerve sparing radical prostatectomy (NSRP) and with a normal pre-operative EF were enrolled. Fourteen days after surgery, they were randomised to a flexible-dose sildenafil group and to a control group. The International Index of Erectile Function (IIEF) questionnaire was completed before surgery and at 3, 6, 12 and 24 weeks after NSRP. RESULTS: In the group treated, the mean IIEF score before surgery was 26.2 and 14.1, 16.2, 22.5 and 25.2 at 3, 6, 12 and 24 weeks after NSRP, respectively. In the control group, the respective scores were 26.5 and 12.4, 15.8, 15.3 and 17.4. There was a significant difference in IIEF mean score (25+/-6 vs. 17+/-9, p<0.05) and in the potency rate (87% vs. 56%) between the groups at 24 weeks after NSRP. The percentage of patients who were capable of having medication-unassisted intercourse was 54% vs. 21%; 34% vs. 18% of patients had a normal EF with 72% vs. 32% of responders to sildenafil. CONCLUSIONS: PRT with PDE-5 inhibitors should be offered early after RP to allow the recovery of EF.

Sarcoma of prostate: case report and review of the literature.

OBJECTIVES: Prostate sarcomas are rare entity, the most common is leiomyosarcoma which account for 0.1% of all prostate malignancies. The presenting symptoms are mainly obstructive urinary symptoms. Surgery with chemo- or radiotherapy are the mainstay treatment options. The overall survival rate remains poor regardless of initial tumour size, grade or histological subtype. Immunohistochemistry reveals tumour cells diffusely positive for vimentin, smooth muscle actin, focally positive for progesterone receptor, whilst keratins are usually negative. MATERIALS AND METHODS: We describe a case of a patient affected by sarcoma of prostate. Furthermore, we reviewed the cases of prostate sarcomas available in literature to clarify the best therapeutic options to be applied. RESULTS: In the case described leiomyosarcoma diagnosed by an ultrasound guided biopsy was characterized by fascicles of spindle-shaped cells with a variable degree of nuclear atypia. The immunohistochemistry showed positive staining for smooth muscle actin, vimentin and focally for the S-100 protein. The patient was treated with radical retropubic prostatectomy and radiotherapy of the local recurrence, and chemotherapy at metastases onset. CONCLUSIONS: Prostate sarcomas are highly aggressive, with limited therapeutic options. An early diagnosis and complete surgical excision with negative margins offer patients the long-term disease free survival.

PSA supernormalisation: a surrogate of complete adenoma removal in men with benign prostatic hyperplasia.

It is known that serum prostate-specific antigen levels (PSA) decrease gradually following surgery for benign prostatic hyperplasia (BPH), but there is not an established cut-off value for normal PSA after relief of obstruction. We evaluated the impact of prostatic adenoma enucleation on PSA levels in 110 patients who underwent transvesical suprapubic adenomectomy for symptomatic BPH. We examined PSA levels before and after open surgery and weight of the prostatic adenoma as measured by the pathologist. Forty-eight percent of the patients had a preoperative PSA level between 0 and 4, 29% between 4 and 7, and 23% between 7 and 10 ng/ml. In patients with suspected abnormality on digital rectal examination or PSA > 4.0 ng/mL systematic multisite biopsies were performed preoperatively to rule out prostate cancer. The mean weight of enucleated adenoma was 87 gr (range 50-201). The mean serum PSA decreased from 4.8 ng/ml preoperatively to 0.5 ng/ml postoperatively. The mean decrease in PSA was 90% (range 70-99%). PSA was resetted at lower level in all patients irrespectively of baseline PSA levels or BPH weight. The transvesical suprapubic adenomectomy supernormalises serum PSA lower than 1 ng/ml in 96% of patients. 100% of patients have a postoperative PSA value < 1.5 ng/ml. PSA supernormalisation represents an objective measure of complete adenoma removal. The urologists should be aware of this resetted level and they should take account of it when different ablative therapies for BPH are confronted.

Periprostatic nerve block before ultrasound-guided prostate biopsy: a comparison of two local anesthetics.

The objective of the present study was to evaluate the efficacy of the periprostatic nerve block (PNB) of the prostate-vesicular junction with low volume and high concentration of anesthetics in relieving pain during prostate biopsy. Two hundred and twenty patients were enrolled and randomized to receive PNB with 5 ml 2% lidocaine (group 1110 pts) and PNB with 5 ml 2% mepivacaine (group 2, 110 pts). The anesthetic was administered through a single puncture on each side at the prostate-vesicular junction using a 22-gauge needle. All patients filled in a ten visual analogue pain score scale (VAS) from 0 = no discomfort to 10 = severe pain, for the assessment of pain experienced during biopsy. The two groups were homogeneous concerning the anthropometrical data. The mean pain score with lidocaine was 1.4 +/- 1.02 (CI 95% = 1.53 to 3.57) and with mepivacaine was 1.3 +/- 1.06 (CI 95% = 2.66 +/- 4.84) with no statistical significant difference between groups (p = 0.43). No general or local adverse effects were observed between the anaesthetics. The use of a low volume (2.5 ml on each side) and high concentration (2%) of local anesthetics (lidocaine/mepivacaine) almost completely suppresses pain and discomfort associated with prostate biopsy. The anatomy of neurovascular bundle regions appears favourable to the administration of small amounts of anesthetic.

Female sexual function evaluation of the tension-free vaginal tape (TVT) and transobturator suburethral tape (TOT) incontinence surgery: results of a prospective study.

INTRODUCTION: Significantly more women reporting stress urinary incontinence (SUI) or low urinary tract symptoms complained of sexual dysfunction than a general healthy female population. The use of a tension-free vaginal tape (TVT), placed transvaginally under the mid-urethra, ensures to reacquire continence but could affect sexual function. AIM: This study aimed to determine if a suburethral tape for the correction of SUI could interfere with sexual activity. METHODS: Of 108 patients, 37 underwent positioning of a tension free vaginal tape through a retropubic approach (TVT), and 71 through a transobturator approach from outside to inside (TOT). MAIN OUTCOME MEASURES: All patients enrolled had a complete urodynamic study and were invited to answer the Female Sexual Function Index questionnaire and our personal questionnaire, before surgery, after 1 month, and then at 3-month intervals. RESULTS: Of the 108 patients, 67% of the women experienced incontinence during intercourse, 96% during penetration, and 4% on orgasm. The cure rate for SUI was 97.1%. Sixty-two women (87%) with TOT placement and 31 (84%) with TVT were satisfied with the operation as regards sexual function, 68 (96%) and 29 (78%), respectively, with TOT and TVT had an improvement of urinary symptoms with resolution of urinary leakage during intercourse, after a 12.3-month follow-up. Just one patient treated with a TOT approach and two with the TVT complained of low grade of leakage. Of the 101 sexually active women, 90.1% reported a significant improvement in their sexual life, 9.9% referred a poor sexual activity not due to surgical intervention. CONCLUSIONS: In the surgical treatment of SUI, it is important to think about the patients' future sexual life and inform them that the great part of women can expect to improve their quality of life.

Bilateral megaureter: management strategy in a ninety years old woman.

OBJECTIVE: Megaureter is an uncommon presentation in the adult patients, we describe a case of a ninety years old woman asymptomatic for long part of her life, affected by bilateral MGU. MATERIAL AND METHOD: The clinical presentation, renal function, radiologic data, complications and treatment were studied. RESULT: The patient had a bilateral MGU radiologically revealed, asymptomatic for a long time. Just in the last two months she had bilateral loin pain and urinary infections, without other complications. We decided to act a watchful waiting strategy without any surgical interventation but proceeding with antibiotic suppression and close radiologic surveillance. CONCLUSION: Most adults patients with MGU are asymptomatic. Complications such as stone formation and altered function of the affected kidney are common and when associated to recurrent UTI require surgical interventation. Functional reserves of the kidney, transportation capacity of the upper urinary tract, histological changes of the ureter are other important criteria for surgery option of treatment. When renal failure is advanced interventation is not necessary. Otherwise if the patient is completely asymptomatic, conservative treatment may be employed effectively in adults in whom conditions are often stable and complications are absent.

The Mayer-Rokitansky-Küstner-Hauser syndrome.

OBJECTIVES: To describe the case of a woman affected by a rare syndrome, known as Mayer-Rokintansky-Küstner-Hauser syndrome (MRKH), characterized by congenital absence of uterus and upper vagina, often found associated with renal agenesia or other renal malformations, which in this case, presented as the prime feature of the disease, with left pelvic pain due to a hydronephrosis of the right cross ectopic kidney. MATERIAL AND METHODS: A kidneys ultrasound and an abdominal computerized tomography were executed to find the cause of the left pelvic pain referred by the woman and associated too, with a primary amenorrhea, with a normal 46, XX karyotypes and normal external genitalia. RESULTS: Examination and diagnostic images revealed an absence of the upper vagina, uterine agenesia, asymmetric hypoplasia of the buds associated with left kidney agenesia and cross-ectopia of the right kidney which was visualized in the left iliac fossa. CONCLUSIONS: Treatment is usually delayed until the patient is ready to start sexual activity. It is based on the surgical creation of a neovagina. In addition it is important to manage the psychological symptoms indeed in a young woman, the discovery of a malformation involving reproductive organs could be cause of anxiety about her femininity and her physical image. Everyday improvement in medical technology offers to such a woman, the possibility to satisfy her necessity to be mother through the use of the modern procreating assisted technology, bypassing the absence of the inner genital tract. In those cases it is also important to investigate the contemporary association not only of renal defects but also of cervico-thoracic and hearing, digital anomalies. When all those malformations are presented, the term MURCS (Müllerian Renal Cervical Somite) is used to define the most severe form of the disorder

Retroperitoneal cysts: a case report.

Retroperitoneal cysts are rare lesions, variable from asymptomatic cases with incidental discovery to case with acute or chronic abdominal discomfort. A 50-year-old female after a car crash refered chronic abdominal pain. An X-ray revealed the presence of sternal and multiple costal fractures. Abdominal ultrasonography (US) and computed tomography (CT) lead to the discovery of a retroperitoneal cyst too. As the patient was well after fractures solution, we decided to control the cyst in the time. In symptomatic cases surgery is the treatment of choice. The advent of laparoscopic surgery allows resection of these cysts to be achieved without full laparotomy.