Management of testicular seminoma. Our experience.

BACKGROUND: The authors report their experience in the management of seminomas. MATERIALS: They examine 12 cases of seminoma among a series of 19 patients with testicular germ cell tumours observed at the Second Surgical Department of the Second University of Naples. RESULTS: Their results showed a better prognosis for patients in early stage of the disease who underwent surgery and adjuvant prophylactic radiotherapy; good survival rates for patients in advanced stages of the disease were achieved by the combined use of surgery, adjuvant radiotherapy and chemotherapy. DISCUSSION: The authors discuss risk factors, clinical and diagnostic features of seminomas, relating their prognosis with the combined use of both surgery and adjuvant therapies. They consider total orchiectomy, followed by prophylactic radiotherapy, the treatment of choice, especially in stages IA and IIA. They don't perform the routine retroperitoneal lymphadenectomy, differently from American authors, who always achieve it to stage the disease. CONCLUSIONS: The authors stress the improvement in the prognosis of seminoma, which has actually reached the 98% of five-year survival rate, for stages I and II.

[Idiopathic varicocele. Ligature of the reflexive vessels to the internal inguinal ring]. / Il varicocele essenziale. Legatura all'anello inguinale interno dei vasi reflussivi.

The idiopathic varicocele is involved in 40-50% of the male sterility. The angiographic studies undertaken by Coolsaet in the 1980 have showed the different anatomic conditions that are at origin of the varicocele, explaining the recurrence or persistence of the illness after surgical operations. The high ligature of spermatic vein (Ivanissevich), eventually with ligature of spermatic artery also (Palomo), and the micro-surgical anastomoses result in high percentage of varicocele persistence. On the basis of such considerations, the Authors reviewed their experience on 371 patient surgically treated for idiopathic varicocele by inguinal ligature of the refluxive venous vessels. They emphasize the role of the intraoperative Doppler, that consents preserving spermatic artery and not-refluxive venous vessels, and need to respect the lymphatics.