Removal of sacral neuromodulation quadripolar tined-lead using a straight stylet: description of a surgical technique.

BACKGROUND: Up to 7.5% of tined-lead removals in patients having sacral neuromodulation (SNM) therapy are associated with a lead breakage. It is still unclear what adverse effects can be caused by unretrieved fragments. The aim of our study was to describe the lead removal technique we have been using for the last 2 years in our centre. METHODS: We retrospectively enrolled patients who had lead removal between January 2018 and January 2020 using our standardized technique. The novelty of the technique is in the use of the straight stylet, which is available in the quadripolar tined-lead kit. The stylet gives the electrode greater stiffness, reducing interactions with surrounding tissues and probability of damage or breakage during removal. RESULTS: In 59 patients (42 women, mean age 57.2 years [range 40-79 years]) the lead was removed using our standardized technique. In 44 of 59 patients, the tined-lead was removed within 2 months from the SNM-test, due to lack of beneficial effects. In 15 patients the electrode was removed because of failure of definitive implantation. Meantime from definitive implantable pulse generator (IPG) implantation to lead removal was 67.9 months. We recorded only 1 case of lead-breakage during removal: a female patient with a non-tined lead fixed on sacral bone, placed 18 years previously using an open technique. CONCLUSIONS: Lead breakage during removal is not uncommon and adverse effects of retained fragments may occur. Our technique has been safely used for the last 2 years in our centre, with no episodes of lead breakage or retained fragments, except for one non-tined electrode.

[Leiomyosarcoma of the spermatic cord. Case report and revision of the literature]. / Leiomiosarcoma del funicolo spermatico. Presentazione di un caso clinico e revisione della letteratura.

A 76 year old man presented with an asymptomatic, very big left scrotal mass that was found to be a leiomyosarcoma of the spermatic cord. It was treated by radical orchiectomy with ligation of the spermatic cord at the internal inguinal ring. Convalescence was uneventful. 6 months postoperatively there was no evidence of local recurrence of the neoplasm or distant metastasis.

[Suspected spontaneous rupture of the ureter. Report of a clinical case]. / Sospetta rottura spontanea dell'uretere. Presentazione di un caso clinico.

A 57 year old man was admitted with left abdominal pain; radiological investigation showed a rupture of the left ureter. The authors discuss the diagnosis and the pathogenesis of ureteral rupture.

[The use of hemorrhage occluder pins in radical pelvic urologic surgery]. / L'uso degli Hemorrage Occluder Pins nella chirurgia pelvica urologica demolitiva.

The authors present the use of "Hemorrhage Occluder Pins" in pelvic urologic radical surgery, as a means of hemostasis for the retropubic venous plexus. The application technique and the bio-technological characteristics of the occluder pin are discussed.

Urinary levels of tumour associated antigens (CA 19-9, TPA and CEA) in patients with neoplastic and non-neoplastic urothelial abnormalities.

The urinary excretion of carbohydrate antigen 19-9 (CA 19-9), tissue polypeptide antigen (TPA) and carcinoembryonic antigen (CEA) was evaluated in 264 patients with bladder cancer. Cut-off levels were established using a pool of healthy blood donors. The combined determination of CA 19-9 and TPA had a sensitivity of 74% in pTa and 83% in pT1 tumours, and 62% in grade 1, well differentiated tumours. Absence of disease at follow-up was related to a significant decrease in CA 19-9 and TPA in 129 patients with superficial (pTa or pT1) bladder carcinoma, followed up for at least 3 years. Recurrences, defined as new tumours at the same site or elsewhere in the bladder, were associated with an increase in the mean values but this was not statistically significant. A poor prognosis was indicated in patients with infiltrating tumours and the following pre-operative levels: TPA > 1500 u/l or CA 19-9 > 300 u/ml or CEA > 50 ng/ml.

[A case of priapism of the proximal corpora cavernosa]. / Su un caso di priapismo dei corpi cavernosi prossimali.

A young man presented with a little perineal mass that was found to be secondary to partial priapism of the proximal corpora cavernosa. This is a very rare condition with only 3 previously recorded cases in the urology literature. The patient made a good recovery and was able to resume sexual activity.

[Immunohistochemical determination of antigen 19-9 (CA 19-9) in transitional carcinoma of the bladder]. / Determinazione immunoistochimica dell'antigene 19-9 (CA 19-9) nel carcinoma transizionale della vescica.

Carbohydrate Antigen 19-9 (CA 19-9) histological expression in transitional cell bladder carcinoma (TCBC) was studied by means of immunohistochemistry and its findings compared with those of Tissue Polypeptidic Antigen (TPA) and Carcino Embryonic Antigen (CEA). Twenty-one TCBC of various grade and stage were analyzed by using Avidin-Biotin complex method for CA 19-9 and TPA Peroxidase-Antiperoxidase method for CEA. Grade 3 and pT1, pT2/pT3 carcinomas showed a constant staining for CA 19-9 antigen, grade 2 showed a 50% positive immunoreaction while all grade 1 cases were negative. TPA showed an inverse correlation with well differentiated carcinomas which were better and more extensively stained than anaplastic ones. CEA expression was not correlated either with grade or stage. CA 19-9 could be considered as a dedifferentiation marker in TCBC.

[The Sarig test. A simple method to evaluate the inhibitory effect on urinary crystallization of calcium oxalate]. / Il test di Sarig. Un semplice metodo per valutare l'inibizione della cristallizzazione urinaria dell'ossalato di calcio.

In this study, the Authors evaluate a simple test proposed by Sarig for the discrimination of kidney stone-formers, based on the overall urine inhibitory effect. A solution of the tested urine is added with sodium-oxalate and the kinetics of calcium-oxalate precipitation is indirectly followed with ionometric selective measurement of the progressive reduction of free calcium ions. A Discriminating Index may be therefore calculated; higher values are obtained in lithiasic patients in comparison with normal controls.