Association between clitoral tissue perfusion and female sexual dysfunction in healthy women of reproductive age: a pilot study.

The impact of abnormalities in the vascular bed of the external genitalia and vagina on female sexuality is not well defined because of some methodological difficulties in correctly assessing vascular changes of genitalia in women. Transmucosal oxygen tension (TmPO2) represents a precise measure of oxygen partial pressure at the clitoris surface and is expression of clitoral tissue perfusion. Aim of the study was to correlate TmPO2 with female sexual dysfunction (FSD) in healthy women in order to evaluate the impact of clitoral vascularization on female sexual health. Twenty-seven healthy, heterosexual, and sexually active women of reproductive age (mean age: 31.18 ± 4.71) were enrolled in the study. TmPO2 was assessed in every woman. In addition, all the women filled out the Female sexual function index (FSFI). After adjustment for some covariates (age, BMI, and smoking), TmPO2 significantly correlated with FSFI total score (r = 0.4261; p = 0.0379) and with arousal (r = 0.3239; p = 0.0390), lubrication (r = 0.4345; p = 0.0339), orgasm (r = 0.4092; p = 0.0471), and satisfaction (r = 0.4456; p = 0.0291) scores. In addition, TmPO2 was significantly lower in the FSD than in the NO FSD group (28.4 ± 14.5 versus 48.1 ± 25.1 mmHg; p = 0.0416). This study first shows that in healthy women of reproductive age clitoral tissue perfusion, as assessed by TmPO2, correlates very well with FSD and in particular with arousal, lubrication, orgasm, and satisfaction. Further studies should confirm our data and test TmPO2 as potential predictor for cardiovascular disease and metabolic conditions in women.

Modified radical retropubic prostatectomy: personal technical variation "tension free continuum-urethral anastomosis (T.F.C.U.A)" with optical magnification in the preservation of the bladder neck, and estimation of the urinary continence.

OBJECTIVE: To reassess the double continence technique for open retropubic radical prostatectomy, proposed by Malizia and employed by Pagano et al., with the "tension free continuum-urethral anastomosis" (T.F.C.U.A.) personal modification and the use of image magnification optical systems and appropriate and delicate surgical tools. MATERIALS AND METHODS: A total of 173 radical retropubic prostatectomies, performed by the same surgeon, were evaluated in terms of early and late continence. RESULTS: The presence of residual prostate cancer cells within the muscle layer was always excluded by the histopathological examination that also demonstrated that the muscle layer was well represented; satisfactory outcomes were obtained in terms of both early urinary continence (60%) and urinary continence at 6-12 month follow-up (92.4% for the whole series and 97.2% for the last series of patients). CONCLUSIONS: The "tension free" anastomosis obtained by the suspension of the anterior bladder wall to the the pubis along the median line allowed to achieve satisfactory outcomes in terms of urinary continence, even if these data obviously need to be confirmed by other series and comparative trials.

The role of the elastography in the diagnosis of prostate cancer: a retrospective study on 460 patients.

OBJECTIVE: Prostate cancer is one of the most common cancer among men in industrialized total Prostatic Specific Antigen (PSA) and PSA ratio, Trans Rectal Ultrasound Scan (TRUS) and prostate biopsy, which is the gold standard for tumoral diagnosis. The poor sensibility of TRUS, when DRE and/or PSA are abnormal, requires prostate biopsy for diagnostic confirmation. The aim of this study was to evaluate the sensibility and the specificity of real time elastography (SE) with and without the association of TRUS for cancer diagnosis. MATERIAL AND METHODS: We retrospectively evaluated 460 patients who underwent TRUS-guided prostate biopsy. The mean age of patients was 66.4 years, the mean PSA was 7.96 ng/ml and the mean PSA ratio was 17.19%. We compared histopathological findings of prostate biopsies with the results of TRUS and elastography. RESULTS: 32.17% of all patients were positive for prostate cancer.TRUS showed a sensitivity of 76.35% with a low specificity (43.59%), a Positive Predictive Value (PPV) of 39.1% and a Negative Predictive Value (NPV) of 79.53%. SE showed a lower sensitivity (61.49%), but better specificity (75%), PPV (53.85%) and NPV (80.41%). The association of TRUS + SE showed an increase in the sensitivity (79.79%) and in the NPV (86.71%). We separately evaluated the results of the two urologists with a greater experience in the use of these diagnostic methods who got an excellent sensitivity (91.42%) and an high NPV (92.68%). CONCLUSIONS: SE is certainly an useful diagnostic method for the detection of prostate cancer, especially in association with TRUS. A great experience of the sonographist and an adequate training are indispensable to make, in the future, elastography a "structural marker".

Impact of intravesical hyaluronic acid and chondroitin sulfate on bladder pain syndrome/interstitial cystitis.

INTRODUCTION AND HYPOTHESIS: Intravesical instillations of hyaluronic acid (HA) and chondroitin sulfate (CS) may lead to regeneration of the damaged glycosaminoglycan layer in interstitial cystitis/bladder pain syndrome (IC/BPS). METHODS: Twenty-two patients with IC/BPS received intravesical instillations (40 ml) of sodium HA 1.6% and CS 2.0% in 0.9% saline solution (IALURIL, IBSA) once weekly for 8 weeks, then once every 2 weeks for the next 6 months. RESULTS: The score for urgency was reduced from 6.5 to 3.6 (p = 0.0001), with a reduction in pain scores from an average of 5.6 to 3.2 (p = 0.0001). The average urine volume increased from 129.7 to 162 ml (p < 0.0001), with a reduction in the number of voids in 24 h, from 14 to 11.6 (p < 0.0001). The IC Symptom and Problem Index decreased from 25.7 to 20.3 (p < 0.0001), and the Pain Urgency Frequency score, from 18.7 to 12.8 (p < 0.0001). CONCLUSION: The treatment appeared to be effective and well tolerated in IC/BPS in this initial experience.