Low-Dose Intravaginal Estriol and Pelvic Floor Rehabilitation in Post-Menopausal Stress Urinary Incontinence.

INTRODUCTION: Pelvic floor muscle training (PFMT) and electrical stimulation (ES) are conservative models of therapy for treating female stress urinary incontinence (SUI). The presence of estradiol receptors in the lower urinary tract advances the case for estradiol therapy in SUI. The aim of our study was to investigate the effects of the combination of pelvic floor rehabilitation and intravaginal estriol (IE) on SUI treatment in postmenopausal women. MATERIAL AND METHODS: Sixty-two women with SUI were randomized to PFMT, ES and biofeedback (Group 1) or the same treatment plus 1 mg IE (Group 2) for 6 months. Patients were evaluated with medical history, pelvic examination, urodynamics, 24-hour pad test. Urinary incontinence was evaluated using the International Consultation on Incontinence questionnaire on urinary incontinence short form and quality of life using the Incontinence Impact Questionnaire-Short Form. RESULTS: Two patients were lost at follow-up and one discontinued the study. Mean urine leakage at the 24-hour pad test dropped from 42.3 ± 20.2 g/die to 31.5 ± 14.2 g/die in Group 1 and from 48.3 ± 19.8 g/die to 22.3 ± 10.1 g/die in Group 2. Symptoms scores and incontinence status were statistically significant better in Group 2 when compared to Group 1. CONCLUSION: IE added to PFMT, ES and BF is a safe and efficacious first-line therapy in postmenopausal women with SUI.

TURP in the young man: is it possible to preserve the anterograde ejaculation?

INTRODUCTION: LUTS are fairly common in young men. BPO and intra-prostatic cyst localized near the bladder neck can determine a BOO in men younger than 50 years too. TURP remains the gold standard treatment, but the retrograde ejaculation or the decreased ejaculate volume after TURP was associated with considerable bother. In our study we have evaluated the possibility of obtaining a prostatic disobstruction without affecting the patient's sexual function and, specifically, the retrograde ejaculation, evaluating the sexual function after a 1-year follow-up. MATERIALS AND METHODS: 18 patients were enrolled in the study. Mean age of the patients at time of surgery was 41 years. Erectile and sexual functions have been evaluated according to the self-administered IIEF and MSHQ. Endoscopic procedure was performed with a resection of the bladder neck at 6 o'clock position followed by a resection at the 12 o'clock position. The same questionnaires were administered at 6 months and 1 year after endoscopic surgery. RESULTS: The mean baseline prostate volume was 36 mL, with a mean operative time of 22 minutes. No statistical differences were reported in IIEF and MSHQ domains at baseline and after 1 year. Qmax increased from 7.4 mL/s preoperatively to 23.6 mL/s at 1-year follow-up. CONCLUSION: In young and selected patients with prostatic obstruction, it is possible to perform a mini-invasive surgery: "Minimally Invasive Nonexpensive TURP", an effective and safe procedure, not affecting sexual function, and particularly, retrograde ejaculation.

Plasmakinetic bipolar versus monopolar transurethral resection of non-muscle invasive bladder cancer: a single center randomized controlled trial.

OBJECTIVES: To compare the safety and the efficacy of plasmakinetic bipolar resectoscope versus conventional monopolar in the transurethral resection of primary non-muscle invasive bladder cancer. METHODS: From January 2007 to December 2009, 132 patients underwent endoscopic resection for primary non-muscle invasive bladder cancer. They were randomly assigned to two groups: 67 patients underwent a transurethral resection of the bladder with bipolar plasmakinetic energy transurethral resection of the bladder and 65 were treated with conventional monopolar transurethral resection. RESULTS: The mean operative time was 27 min for bipolar plasmakinetic energy transurethral resection of the bladder and 31 min for monopolar transurethral resection of the bladder. No significant differences in the mean change of hemoglobin and serum sodium level were observed. Mean catheterization time was 1.3 days and 2.3 days for bipolar plasmakinetic energy transurethral resection of the bladder and monopolar transurethral resection of the bladder, respectively. The mean hospital stay was shorter in the bipolar plasmakinetic energy transurethral resection of the bladder. Bladder perforation was reported in two cases for the monopolar transurethral resection of the bladder group and obturator nerve reflex occurred in a single case for both procedures. None of the patients experienced transurethral resection syndrome. The median time of bladder tumor recurrence after initial transurethral resection of the bladder was 12.4 months and 11.9 months for bipolar plasmakinetic energy transurethral resection of the bladder and monopolar transurethral resection of the bladder, respectively. No significant differences in the overall recurrence-free survival rate were observed comparing the two procedures. CONCLUSIONS: Plasmakinetic bipolar transurethral resection represents a safe and effective procedure in the management of non-muscle invasive bladder cancer.