Treating varicocele in 2018: current knowledge and treatment options.

PURPOSE: Varicocele is defined as a state of varicosity and tortuosity of the pampiniform plexus around the testis caused by retrograde blood flow through the internal spermatic vein. The prevalence of clinically relevant varicocele ranges from 5 to 20% in the male population and is often associated with infertility and reduction of sperm quality. In this review, the pathophysiology and clinical aspects of varicocele are reviewed along with therapeutic options and treatment effects on sperm parameters and fertility both in adult and in pediatric/adolescent subjects. METHODS: We conducted a Medline and a PubMed search from 1965 to 2018 to identify publications related to varicocele clinical aspects, treatment procedures and treatment outcomes. Keywords used for the search were: "varicocele", "varicocelectomy", "sclerotherapy", "male infertility", "subfertility", and "semen abnormalities". RESULTS: Data from a large number of studies in adolescent and adult males indicate that varicocele correction improves semen parameters in the majority of patients, reducing oxidative stress and improving sperm nuclear DNA integrity either with surgical or percutaneous approach. CONCLUSIONS: Varicocele repair seems to represent a cost-effective therapeutic option for all males (both adolescent and adults) with a clinical varicocele in the presence of testicular hypotrophy, worsening sperm alterations or infertility. On the other hand, some investigators questioned the role of varicocelectomy in the era of assisted reproduction. Thus, a better understanding of the pathophysiology of varicocele-associated male subfertility is of paramount importance to elucidating the deleterious effects of varicocele on spermatogenesis and possibly formulating new treatment strategies.

Chemical and sensorial investigation of in-mouth sensory properties of grape anthocyanins.

Anthocyanins are water-soluble pigments found in the cell vacuoles of fruits and flowers, performing several roles from insects attraction to stress protection. Their antioxidant activity contributes to human health, and consuming plant-derived products provides their higher source in the diet. Although their colour and nutritional features, their contribution to sensory properties of foods has not been widely investigated. In wine, preferences are connected with sensory attributes of colour, aroma, taste, and mouthfeel. In this study, grape anthocyanin extracts (TAE) were fractionated using centrifugal partition chromatography (CPC) and preparative HPLC in three fractions, i.e glucoside (GF), acetylated (AF) and cinnamoylated (CF) anthocyanins. Sensory properties were investigated by chemical analysis, as reactivity towards bovin serum albumin (BSA) and salivary proteins, and in tasting sessions to assess anthocyanins best estimated thresholds (BET) in wine-like solution. Anthocyanins reacted with both BSA and salivary proteins, but to different extents, because higher interaction between salivary proteins and anthocyanins were found. Cinnamoylated anthocyanins are the most reactive to salivary proteins. Tasting sessions suggested an involvement of anthocyanins as in-mouth contributors in wine, since their BETs were 255, 297, 68, and 58 mg/L for TAE, GF, AF, and CF, respectively, and the descriptors reported were astringency and bitterness.

Application of enzyme preparations for extraction of berry skin phenolics in withered winegrapes.

Postharvest withering of grapes strongly affects the content and extractability of phenolic compounds in the production of sfursat, fortified and passito wines. This work evaluated the effectiveness of enzymes applied individually and/or in multi-enzyme blends, on the extraction of anthocyanins, oligomeric flavanols and polymeric flavanols from withered grape skins during simulated maceration. The study was performed on Vitis vinifera L. cv. Nebbiolo and Barbera because of their different skin phenolic profile and cell wall composition. Our findings highlight that the relationship between skin mechanical properties (berry skin break force and energy) and extraction yield of phenolic compounds is variety dependent. Significant correlations were found between the skin softening associated with cell wall degradation and the extraction of anthocyanins and flavanols in Nebbiolo, for which polygalacturonase, individually or in multi-enzyme blends, plays an important role. In Barbera, the extractability of phenolic compounds was not affected by the presence of exogenous enzymes.

[Orgotein iontophoresis in the therapy of induratio penis plastica]. / La ionoforesi medicata con Orgoteina nella terapia dell'induratio penis plastica.

In objective terms the results of medical and physical treatment of Peyronie's disease are still indubitably disappointing. However personal experience has shown that medicated ionophoresis using orgotein does at least eliminate or reduce the pain in Peyronie's disease.

[Intervention models in andrology in adult-elderly patients with psychogenic erectile dysfunction]. / Modelli di intervento in andrologia su pazienti adulto-anziani affetti da disfunzione erettile psicogena.

The Authors deals of the principal models of management in andrologic ambit on patients adult-elder affected by psychogenic impotence. Yet they made a critic remark of these models and show a different management model named "within treatment". The authors presents the results achieved using this model in the S. Luigi Gonzaga Hospital surgery for male sexual diseases.

[Italian centers that deliver treatment for male sexual dysfunction]. / Indagine sui Centri Italiani che si occupano della Terapia delle disfunzioni sessuali maschili.

In agree with President and Committee of Andrological Italian Society (S.I.A.), authors have carried on a research to know: 1) main features of Italian Structures interested in male sexual dysfunction 2) actual trend in diagnosis and therapies of male sexual dysfunction, Authors report results and data about this research, particularly regarding new trends in therapia (therapy).

[The pharmaco-erection test]. / Il test di farmacoerezione.

Intracavernous administration of vasoactive drugs induces an erection in absence of erotic stimuli; we can use this property in the study of impotent patients, inducing the appearance on an erection to examine it in all its phases (FIC Test). In case of the appearance of a good erection, the test should rule out the presence of a penile arterial disease or of a corpora-veno-occlusive deficiency. When the administration of the drug does not cause complete tumescence, it is very probable that the erectile dysfunction is caused by arterial vascular alterations or by organic disorders of veno-occlusion mechanism, but we cannot exclude for a certainty a psychogenic dysfunction. In fact an excessive noradrenergic autonomic control, as during stress condition, may limit FIC Test response. Therefore we hope that more efficacious molecules will be available in a near future. Nevertheless, we consider the opportunity of enclosing tests in the diagnostic algorithm of impotent patients to reveal an excessive adrenergic tone, such as, for example, psychological tests, study of cavernous potential, or intracavernous catecholamine dosage.

[Psychological problems related to the sexual stimulation video (SSV) test in the diagnosis of erectile disorders]. / Problemi psicologici relativi al test di video stimolazione sessuale (VSS) nella diagnostica dei disturbi erettili.

The Authors analyze scientific community's attitude towards VSS test. Related psychological problems are examined: the doctor's fear to be accused of voyeurism, the doctor's inadequacy in "invading" patient's field of intimacy, the doctor's relationship with his own erotic fantasies and with pornography, the "castrating" aspects in hospital environment and so on.

[Anatomo-functional changes in the cavernous body in the elderly]. / Modificazioni anatomo-funzionali dei corpi cavernosi nell'anziano.

The main histological alteration that happens to the structure of the corpora cavernosa as years go by, is the progressive increase of collagen fibers compared to the decrease of both smooth muscle and elastic fibers. This phenomenon is held responsible of consequences on the hemodynamic events occurring during the erection.

[Psychosexual interventions combined with biologic therapy of erectile dysfunction]. / Considerazioni sull'intervento psicosessuologico in associazione alle terapie biologiche della disfunzione erettile.

The authors, beginning from che concept of erectile disorder with mixed pathogenesis, describe its clinical dimension. The psychic variables which prevent the use of biologic-andrologic therapy (FIC, penis prosthesis) are then considered: 1) psycho-sexual difficulties before the onset of the organic lesion; 2) the partner's relationship with the biologic-andrologic therapy; 3) the patients' relationship with the biologic therapy. A model of intervention (Group Psycho-sexologic Intervention) on the psychic variables interfering with the use of the biologic-andrologic therapy is then described. The authors end by considering the psychological impact and the possible psychoiatrogenicity of biologic-andrologic therapies.

[False penile shortness]. / La falsa brevità del pene.

The rising interest on male genital aesthetics increased the number of patients complaining of short penis. therefore, the andrologist must be able to perform a correct diagnostic assessment and to make the correct therapeutical choice as well, even if there's no standard yet. The aim of this paper is to discuss some diagnostic troubles about penile shortness and, in particular, to explain the basic surgical strategies suitable for the treatment of "hidden penis".

[Penile prosthesis]. / Gli impianti protesici.

In this article the Authors, after describing the history of the penile prosthesis surgery and analyzing the technical progresses made in the last twenty years, offer their personal experience and data from the most recent literature about treatment of erectile dysfunction through the application af penile prosthesis, about the indications for the operation and the choice of the type of prosthesis. They also explain all the possible complications and eventual mechanical failures, which have considerably decreased in the last few years.

Early insertion of inflatable prosthesis for intractable ischemic priapism: our experience and review of the literature.

A cohort of 20 patients with delayed priapism who underwent treatment at the Emergency Department of our academic referral centers between January 2002 and April 2010 was studied. Of these, 16 cases suffered from a low-flow priapism. A total of 6 cases were managed non-surgically, 10 required shunt surgery, and of these 5 were treated by early penile prosthesis surgery. Prostheses were easily implanted in all patients with a mean operative time of 94 min. No intraoperative complications and no infection were registered. All patients with an inflatable prosthesis complained a reduction in penile sensibility that lasted 3 months. All patients were satisfied with the results of surgery (International Index of Erectile Function Questionnaire-5, Q5 mean value 4), and all were successfully engaging in satisfactory sexual intercourses. No significant loss of penile length, neither apical erosion nor extrusion was recorded. Early insertion of a penile prosthesis is a simple and safe procedure in patients with ischemic priapism, which failed to respond to conservative management. Early insertion of a prosthesis helps to maintain adequate penile length, resolve priapism and, in the long term, it results in high satisfaction rates.

[Avulsion of the penile skin: a conservative approach]. / Avulsione della cute peniena: un approccio conservativo.

INTRODUCTION: Skin avulsion of male genital is a rare urological emergency. Although not life-threatening such lesions are both physically and psychologically traumatic. If poorly managed in the acute setting, these injuries may result in long-term problems or permanent disabilities. METHODS: A 58 year-old male patient was admitted to the Emergency Department of our hospital with a traumatic injury of the penis, caused by a bike trauma. At the inspection, a rather complete degloving of penis and a tear in scrotal skin with no involvement of testes were observed. The skin was completely detached, out of the penis, but for a small flap at the peno-scrotal angle. After a careful cleaning, the penis was covered again with the skin attached to peno-scrotal angle through multiple circumferential sutures. RESULTS: A complete cover of the defects was obtained with one-step surgery. The patient was treated with broad spectrum of antibiotics for 1 month. No infections occurred. The patient was discharged from hospital after 5 days. After 3 months from trauma, the patient is able to achieve sexual intercourse, with normal erectile function, no painful erections and no penile recurvatum. CONCLUSIONS: Traumatic skin avulsion of penis is a rare condition; the best aesthetic and functional results depends on the choice of the proper treatment. Conservative approach in selected cases can provide good results both aesthetically and functionally.

[Transvaginal repair of neobladder vaginal fistula]. / Riparazione trans-vaginale di fistola neovescico-vaginale.

INTRODUCTION: Neobladder vaginal fistula is a known complication after cystectomy and orthotopic neobladder in women. The exact incidence is still unknown, even if in some of the largest series is reported in about 5% of female patients. We present our personal experience with a case of neobladder vaginal fistula. METHODS: A fifty-year old woman affected by T2G3 bladder cancer underwent radical cystectomy and orthotopic neobladder in December 2007. Definitive pathological examination revealed pT3aN0G3 urothelial cancer with squamous aspects. Two cycles of neoadjuvant chemotherapy were administered before cystectomy. Three weeks after cystectomy, a retrograde cystography revealed a fistula between vagina and neobladder. At first, the patient was treated conservatively, keeping the urethral catheter for two months. Cystographies, repeated every month, recorded a reduction in size of the fistula but not the complete closure. A surgical correction was planned. Preoperative cystoscopy showed the neobladder opening of the fistula on the posterior wall. Then a transvaginal approach with fistula excision and a two layer cross suture were performed. RESULTS: At the cystography performed 1 month after surgical repair no fistula was detected, and the patient was completely dry. At 3 months follow-up the patient was completely dry. CONCLUSION: The development of a neobladder-vaginal fistula is a significant, even if infrequent, complication after cystectomy. In our case, we performed a transvaginal approach without tissue interposition, with good results. Such procedure is easy and effective and, in our opinion, can be tempted as first line surgical treatment.