[Use of zoledronic acid in patients with prostate cancer bone metastases: control of pain and musculoskeletal complications]. / Utilizzo di acido zoledronico in pazienti con metastasi ossee da carcinoma prostatico: controllo del dolore e delle complicanze muscolo-scheletriche.

Background. Patients suffering from prostatic carcinoma are at high risk of having bone complications because of the metastatic progression of the disease to the skeleton and the consequences of androgenic deprivation. Zoledronic acid is a potent inhibitor of the bone resorption mediated by the osteoclasts, and is the only bisphosphonate whose capacity of reducing significantly the skeleton morbidity in patients with bone metastases is statistically proved. Methods. To attest tolerability and efficacy of zoledronic acid in preventing unfavorable skeletal events and in reducing osteomuscular pain, 25 patients - aged 75 years, suffering from hormone-responsive prostatic carcinoma under hormonal therapy with bone metastases, have been followed and subjected to IV monthly infusion of 4 mg zoledronic acid for 12 consecutive months, associated to daily intake of calcium and multivitamin supplementations. Results. At the end of the study, a sensible improvement in their clinical conditions and in their perception of the pain has been recorded in 23 patients and valued through a set of questions (Brief Pain Inventory). Conclusions. Zoledronic acid is therefore confirmed to be an effective medicine in preventing the skeleton complications and in controlling the painful symptoms in patients suffering from prostatic carcinoma with bone metastases.

[Reconstructive urethroplasty using porcine acellular matrix (SIS): evolution of the grafting technique and results of 10-year experience]. / Uretroplastica ricostruttiva con matrice acellularesuina (SIS): evoluzione della tecnica di impiantoe risultati di 10 anni di esperienza.

INTRODUCTION: Long tract urethral reconstruction still has no other resolution than two-stage techniques or graft and flap procedures, that are neither simple nor trouble-free. Tissue engineering simplifies this surgery using porcine acellular matrix, obtained from small intestine submucosa (SIS): thin but strong, ready for grafting, it is not immunogenic, being deprived of cells. It is a biological bridge for reconstruction, promoting the regeneration of surrounding tissue. We report our experience using SIS for urethroplasty. MATERIALS AND METHODS: After coronal or perineal-scrotal incision and penile degloving, the urethra is rotated of 180° and opened through the entire restricted tract. The graft is sutured dorsally and reinforced by the contact with the cavernous bodies to prevent pouching. From 1999 to 2005 we performed this grafting procedure in 36 men and 4 women. Afterwards, 16 more surgeries performed were with direct ventral graft procedure, without urethra isolation and rotation, with worthy simplification. RESULTS: A 10-year follow-up shows satisfactory urodynamic and subjective outcomes for both procedures, assessed by voiding urethrography, uroflowmetry, International Prostate Symptom Score, and Quality of Life perception. At urethroscopy the graft appears completely homogeneous to the native tissue, as confirmed by the histological examination. The ventral direct graft represents the more consistent innovation: we did not observe pouching and the results remained effective. For penile urethra, in a few patients, periodic dilatations were necessary. CONCLUSIONS: SIS can be considered as an alternative to more difficult grafting procedures, which are probably no more indispensable in urethral enlargement, even for critical strictures