Prospective study of clinical, neurophysiological and urodynamic findings in multiple sclerosis patients undergoing percutaneous transluminal venous angioplasty.

OBJECTIVE: Verify whether Percutaneous Transluminal Angioplasty (PTA) may affect neural conduction properties in Multiple Sclerosis (MS) patients, thereby modifying patients' disability, with prospective neurophysiological, urodynamic, clinical and subjective well-being evaluations. METHODS: In 55 out of 72 consecutively screened MS patients, the following procedures were carried out before (T0), at 2-6 months (T1) and at 6-15 months (T2) after a diagnostic phlebography, eventually followed by the PTA intervention if chronic cerebrospinal venous insufficiency (CCSVI) was diagnosed: clinical/objective evaluation (Expanded Disability Status Scale, EDSS), ratings of subjective well-being, evaluation of urodynamic functions and multimodal EPs (visual, acoustic, upper and lower limbs somatosensory and motor evoked potentials). RESULTS: The number of dropouts was relatively high, and a complete set of neurophysiological and clinical data remained available for 37 patients (19 for urological investigations). The subjective well-being score significantly increased at T1 and returned close to basal values at T2, but their degree of objective disability did not change. Nevertheless, global EP-scores (indexing the impairment in conductivity of central pathways in multiple functional domains) significantly increased from T0 (7.9 ±â€¯6.0) to T1 (9.2 ±â€¯6.3) and from T0 to T2 (9.8 ±â€¯6.3), but not from T1 and T2 (p > 0.05). Neurogenic urological lower tract dysfunctions slightly increased throughout the study. CONCLUSIONS: The PTA intervention did not induce significant changes in disability in the present cohort of MS patients, in line with recent evidence of clinical inefficacy of this procedure. SIGNIFICANCE: Absence of multimodal neurophysiological and functional testing changes in the first 15 months following PTA suggests that conduction properties of neural pathways are unaffected by PTA. Current findings suggest that the short-lived (2-6 months), post-PTA, beneficial effect on subjective well-being measures experienced by MS patients is likely related to a placebo effect.

Perineal schwannoma: an unusual tumor and clinical presentation - first case with erectile dysfunction associated with this neoplasm.

INTRODUCTION: Perineal schwannomas (PS) are very rare benign tumors with few cases reported in literature and none of these reports erectile dysfunction among clinical presentations. CASE DESCRIPTION: We report a case of PS with unusual clinical presentation showing erectile dysfunction associated with perineal pain and discomfort during defecation, and the postoperative residual pain and erectile dysfunction treatment. CONCLUSIONS: On the basis of a literature review of all cases reported and on our case reported, we have delineated a clinical, diagnostic, and therapeutic profile of PS, summarized in a useful table.

Incidence and evolution of aortic aneurysm in patients with bladder cancer.

OBJECTIVE: The incidence of aortic aneurysm is increasing, due to age, hypertension, hyperlipemia and voluptuary abuse like smoking, the last one of the most important cause of bladder cancer. Our study analyzes the incidence of aortic aneurysm in a group of patients who underwent radical cystectomy for bladder cancer and its evolution during follow-up in relationship with surgical procedure and adjuvant therapy. MATERIALS AND METHOD: During pre-operative staging of 173 patients, all affected by bladder cancer and then treated with radical cystectomy, we studied aorta and iliac artery diameters, as a part of our ultrasound scan evaluation. All patients underwent post-operative measurement of normal and abnormal aorta and common iliac artery during follow-up. RESULTS: At the pre-operative staging 19 patients (10.9%) had aneurysms in the aortic-iliac axis (A.A.). During follow-up in 5 patients the A.A. did not develop, whereas in 14 cases it increased within 12 months after surgery and then with an increase <0.5 mm per year, with no relationship with type of surgical procedure, urinary diversion, adjuvant therapy. No cases required a vascular surgical approach during the follow-up. Only 1 patient of basal 154 normal ones developed an aneurysm of the common right iliac artery, treated with endoprosthesis. CONCLUSIONS: The natural development or risk of aneurysm rupture in patients with bladder cancer depends on its dimensions but also on radical surgery, urinary diversion or adjuvant therapies. In our experience all these factors seem not to influence aneurysms if present nor determine de-novo development.

Renal papillary adenocarcinoma with unusual metastases: case report and review of the literature.

OBJECTIVE: This study focuses on a case report on a patient with renal carcinoma who developed metastases at unusual sites. We also reviewed the literature, including the theories proposed by various authors on the possible etiology of these odd localizations. CASE REPORT: A 48-year-old patient underwent conservative surgery for renal carcinoma (papillary adenocarcinoma). Twenty-two months later, he developed mediastinal metastases and underwent immunotherapy; two years after that he had metastases to unusual sites such as the urethra and the prostate. The mechanisms responsible for metastases to these unusual sites are not entirely clear yet. We feel it is important to note the highly aggressive and multifocal nature of papillary adenocarcinoma, and the need to perform closer follow-up on these patients, particularly if nephron-sparing surgery has been performed.

Assessment of bladder and urethral sphincter function before and after radical retropubic prostatectomy.

PURPOSE: In a prospective study we analyzed the effects of radical retropubic prostatectomy (RRP) on detrusor and urethral sphincter function by comparing urodynamic status preoperatively with that during longitudinal followup. MATERIALS AND METHODS: A total of 49 consecutive patients underwent urodynamics with pressure flow studies and Valsalva leak point pressure measurements 3 to 7 days before RRP (baseline), and then 1 and 8 months after surgery. We assessed bladder compliance, detrusor overactivity, detrusor contractility and intrinsic sphincter deficiency (ISD). RESULTS: There was no significant change in detrusor overactivity at 1 and 8 months of followup. Decreased bladder compliance was observed in 20.4% of patients at baseline, and in 38.7% and 30.6% at 1 and 8 months, respectively. De novo decreased compliance was detected in 18.4% and 10.2% of patients at the same points. Impaired bladder compliance was comparable to that before surgery in 20% of cases. Impaired detrusor contractility was detected in 42.8% of patients at baseline, and in 61.2% (p <0.05) and 42.8% at 1 and 8 months, respectively. De novo hypocontractility was observed in 28.6% and 10.2% of patients at 1 and 8 months, respectively. A strong association between detrusor overactivity and ISD was observed at 1 and 8 months (p <0.01). CONCLUSIONS: Following RRP detrusor hypocontractility and decreased bladder compliance represent de novo transient dysfunction probably due to bladder denervation and an established condition not influenced by the operation. The strong association between overactivity and ISD suggests that stress urinary incontinence increases urethral afferent nerve activity and induces involuntary detrusor contractions.