[Endourologic treatment of benign uretero-intestinal stenosis in patients with definitive urinary diversion: 10-year experience]. / Trattamento endourologico delle stenosi uretero-intestinali benigne in pazienti con derivazione urinaria definitiva: esperienza di 10 anni.

OBJECTIVE: Ureterointestinal (U-I) anastomotic stricture is one of the most important complications after radical cystectomy, occurring in 4% to 8% of patients. We report our ten years experience in the endourological treatment of this condition. MATERIALS AND METHODS: 32 patients with U-I strictures were endourologically treated at our Institution. The endoscopic procedure provides for a percutaneous nephrostomy, the passage of the stenosis with a guide-wire, the incision and balloon dilation of the stricture and, finally, a ureteral double J stenting. Of the 28 successfully treated patients, 10 underwent balloon dilation alone and 18 both ureteral incision (with cold knife in 11 and hot knife in 7) and dilation. RESULTS: The endourological approach failed in 4/32 (12.5%) patients: 3 failures were due to the inability to pass a guide-wire across the stricture, whilst in the remaining patient a serious intraoperative hemorrhage occurred. In 28/32 (87.5%) patients the endoscopic treatment was successful (a ureteral stent was positioned across the stenosis). However, long term results are less promising: at 6-90 month follow up, only 16 patients (57.1%) are free of strictures without ureteral stent, 10 (35.7%) need a permanent ureteral stent, 2 (7.2%) a percutaneous nephrostomy. CONCLUSION: Due to the low morbidity of endoscopic procedures and to the high risks associated with open surgery, we believe that endourology should represent the first choice in the treatment of U-I strictures, reserving open surgery for endoscopic failures or complications. Moreover, endourological treatment with both incision and dilation is more effective than dilation alone (which should be performed only in very short and recent strictures).

Entrapment neuropathy of the internal pudendal nerve. Report of two cases.

Entrapment neuropathy of the internal pudendal nerve in the Alcock canal is a rare entity and literature on the subject is lacking. The pathogenesis of this disease is probably related to repeated microtraumatisms of the perineal region acting on the Alcock canal or dysmetabolic diseases favouring compression of the pudendal nerve inside the Alcock canal. In this article two new cases which have come to our attention are described and literature on the topic, with special regard to diagnosis and treatment, is reviewed.

Adult testicular pure yolk sac tumor.

Here we describe the clinical, ultrasonographic and histological features of a rare pure adult yolk sac tumor detected in the right testis of a 44-year-old male. Due to the rarity of this neoplasm (less than 10 cases have been reported), there is no unanimous consensus for therapy following inguinal orchiectomy. We believe that nerve-sparing retroperitoneal lymph node dissection could be potentially curative and useful for future interpretations of this tumor's potential evolution.

Scrotal extraperitoneal hernia of the ureter: case report and literature review.

Ureteral herniation is a rare, often misdiagnosed event and serious surgical complications are possible. Until 1992, 128 cases of ureteral herniation were reported and in 54 (42%) the inguino-scrotal region was involved. From an anatomical and pathogenic standpoint, two types of uretero-inguinal hernias can be identified: paraperitoneal (more frequent, acquired, always presenting a peritoneal hernia sac, frequently associated with other herniated abdominal structures) and extraperitoneal (very uncommon, congenital, never associated with a true peritoneal sac, always composed only of the ureter). We describe a new case of scrotal extraperitoneal ureteral hernia and review the current urological, surgical and radiological literature to analyze the main clinical characteristics of this pathology and its ideal treatment.

Hyperbaric oxygen therapy in the treatment of Fournier's disease in 11 male patients.

PURPOSE: Optimal tissue oxygenation, as obtained by hyperbaric oxygen therapy, potentiates or restores the host's bactericidal mechanisms and wound healing activity in patients afflicted by serious synergeic aerobic and anaerobic infections of the cutaneous and subcutaneous tissues. Furthermore, hyperbaric oxygen therapy has a direct toxic effect on anaerobic bacteria. We describe our experience with hyperbaric oxygen therapy in the treatment of 11 patients with Fournier's syndrome. MATERIALS AND METHODS: The average age of our patients was 59.5 years; the most common predisponsing condition was diabetes. All patients were treated with antibiotic therapy and hyperbaric oxygen therapy (minimum 5 and maximum 24 cycles, consisting of 90 minutes 2.5 atmosphere absolute pressure). Furthermore, 6 of these patients underwent surgical débridement of the wounds and 3 patients underwent delayed reconstructive surgery. RESULTS: The results we obtained with hyperbaric oxygen therapy as an adjunctive measure for the treatment of these infections were excellent; our mortality rate for Fournier's disease was 0. Moreover, no complications whatsoever were observed. Furthermore, the 3 patients who underwent delayed corrective surgery presented with well healed tissues and their operations were not complicated by infections or other pathological conditions. CONCLUSIONS: We believe that our findings, although limited in number, underline the excellent results that can be obtained with hyperbaric oxygen therapy as an adjunct treatment in Fournier's disease.

Biopsia guiada por ecografía: el diagnóstico clave del cáncer de próstata / Sonographically guided biopsy: the key diagnosis of prostate cancer

La biopsia sextante de la próstata guiada por ecograiía transrectal (ETR) representa la técnica más difundida en el diagnóstico del cáncer de próstata. La ETR aislada no es una herramienta adecuada para el diagnóstico de cánceres de próstata tempranos. Se discute el momento apropiado de practicar biopsia sextante en un paciente. Se discuten también los problemas asociados con la repetición de las biopsias, dándose también pautas para la realización de biopsias de repetición. Se discute con profundidad cuál es la técnica más idónea de practicar la biopsia y se compara la biopsia por sextantes clásica con las nuevas modalidades como la biopsia sistemática en 5 regiones, la biopsia prostática extendida de 11 muestras o la biopsia 'en abanico'. En la práctica clínica parece recomendable realizar siempre la biopsia sextante estándar y añadir progresivamente muestras en las zonas de mayor incidencia de cáncer: los cuernos laterales, la zona media y periférica, y la zona transicional. Todas ellas deben considerarse en las biopsias de repetición si se mantiene la sospecha clínica de cáncer (AU)