Triorchidism: genetic and imaging evaluation in an adult male.

We report the results of imaging and cytogenetic studies in a case of triorchidism in a 54 years old male without any associated anomaly. A scrotal ultrasonography revealed the presence of two testes within the left hemiscrotum with complete septation and echotexture and vascular flow pattern similar to the vascular flow of the normal right testis. There was no focal abnormal echogenicity suggesting malignancy. Scrotal MRI confirmed two soft-tissue structures in the left hemiscrotum with normal signal intensity at T1w and T2w images. Both testes had a tunica albuginea with low-signal intensity. Cytogenetic analysis resulted in normal male karyotype 46XY. Array-CGH analysis detected the presence of two interstitial rearrangements: a ~120 Kb deletion of chromosome 1 and a ~140 Kb deletion of chromosome 16. Currently there are little details on the functions of both genes.

Penile prosthesis surgery in out-patient setting: Effectiveness and costs in the "spending review" era.

INTRODUCTION: Penile implant patients are required to remain in the hospital after the operation for monitoring, antibiotic and analgesia administration. Cost containment, however, has resulted in the increased use of ambulatory surgery settings for many surgical procedures. Few studies have studied the feasibility of performing penile prosthesis insertion in an outpatient setting. The results are controversial and nowadays, in the most of centers that deal with prosthetic surgery, patients are still hospitalized. AIM: The aim of our investigation was to compare the feasibility of the performance as well as the complication profiles of penile implant surgery performed in an in-patient and an outpatient setting at a single center by a single surgeon. METHODS: From January 2009 to June 2014, 50 patients of the same uro-andrological unit underwent penile prosthesis implantation performed by a single surgeon (N.M.). Twenty implantations were performed in an ambulatory day surgery setting. MAIN OUTCOME MEASURES: Effectiveness and costs of outpatient setting versus the in-patient setting of the penile prosthesis surgery. RESULTS: There were some differences between the two groups in the intra-operative parameters, such as, operating time. Time lost from work was similar in both groups approximating 14 days. The mean number of analgesic pills ingested by the patients post-operatively was similar in both groups, averaging just under 25 pills per patient. There weren't post-operative complications in the outpatient group. Cost were 17% less in outpatient clinic. CONCLUSIONS: The outpatient setting for this surgery is safe and effective even in patients with comorbidities or in case of secondary procedures. Costs are reduced by 17%.

Realtime-elastosonography of the penis in patients with Peyronie's disease.

OBJECTIVE: To evaluate the performance of real time elastosonography (RTE) in the identification of different types of penile lesions in patients with Peyronie's disease. MATERIALS AND METHODS: Seventy four consecutive patients with complaints of Peyronie's disease underwent B-Mode ultrasonography (US) and RTE of the penis in the same sitting. In each patient all sequences of elastosonography and B-Mode US were recorded and compared to evaluate the diagnostic performance of the new imaging technique. RESULTS: B-Mode US detected penile plaques in 64 patients (86.41%) and elastosonography confirmed these data. In the remaining 10 patients elastosonography documented, in five of them, areas of reducing elasticity suggesting the presence of initialfibrosis. Cohen's K was used to evaluate the discordances between B-Mode US and Elastosonography scan. A p value < 0.05 (two tailed) was considered statistically significant. The penile curvature (K = 0.353; p = 0.125) and the painful erection (K = 0.500; p = 0.248) evaluations were discordant: the B-mode US underestimated the positive cases. Instead the penile plaque and curvature > 30 degrees, and the penile plaque evaluations were completely concordant. CONCLUSIONS: RTE is a simple, non invasive, rapid complementary imaging technique that may improve the accuracy of B-Mode US in detecting penile lesions in patients with Peyronie's disease.

Obesity rates in renal stone formers from various countries.

OBJECTIVE: To collect evidence on the rate of obesity in renal stone formers (RSFs) living in different climatic areas and consuming different diets. MATERIALS AND METHODS: Data of adult renal stone formers were retrospectively collected by members of U-merge from 13 participant centers in Argentina, Brazil, Bulgaria (2), China, India, Iraq (2), Italy (2), Nigeria, Pakistan and Poland. The following data were collected: age, gender, weight, height, stone analysis and procedure of stone removal. RESULTS: In total, 1689 renal stone formers (1032 males, 657 females) from 10 countries were considered. Average age was 48 (±14) years, male to female ratio was 1.57 (M/F 1032/657), the average body mass index (BMI) was 26.5 (±4.8) kg/m2. The obesity rates of RSFs in different countries were significantly different from each other. The highest rates were observed in Pakistan (50%), Iraq (32%), and Brazil (32%), while the lowest rates were observed in China (2%), Nigeria (3%) and Italy (10%). Intermediate rates were observed in Argentina (17%), Bulgaria (17%), India (15%) and Poland (22%). The age-adjusted obesity rate of RSFs was higher than the age-adjusted obesity rate in the general population in Brazil, India, and Pakistan, whereas it was lower in Argentina, Bulgaria, China, Italy, and Nigeria, and similar in Iraq and Poland. CONCLUSIONS: The age-adjusted obesity rate of RSFs was not higher than the age-adjusted obesity rate of the general population in most countries. The relationship between obesity and the risk of kidney stone formation should be reconsidered by further studies carried out in different populations.

Phase I study of a new tablet-based image guided surgical system in robot-assisted radical prostatectomy.

Robot-assisted radical prostatectomy is, currently, the most commonly utilized procedure for the treatment of localized prostate cancer. Image-guided surgical systems have been proposed in the literature as a valuable tool for the better utilization of the preoperative data in theatre. In this Phase 1 trial, we tested the feasibility and safety of a new, cutting-edge tablet-based surgical imaging system designed for robot-assisted radical prostatectomy (RARP). It utilizes the preoperative MRI images of the prostate, mapping them intra-operatively, real time to the patient by magnetic tracking to fixed points of the pelvis. The system is comprised of a tablet computer with a touch screen display; a tracking system housed in a portable cart, a magnetic field generator and position sensors. It updates image data over 20 times per second to compensate with anatomical alterations during the operation. Four patients diagnosed with prostate adenocarcinoma were enrolled in this study. All four had negative surgical margins along with satisfactory functional recovery regarding continence and potency. The navigational accuracy and the real time information provided by the imaging system was mainly utilized in the more challenging parts of the operation including the apical dissection, the nerve sparing procedure and the bladder neck dissection. The system proved to be safe and its clinical efficacy is due to be assessed with a Phase II clinical study.

Erectile dysfunction and diabetes: Association with the impairment of lipid metabolism and oxidative stress.

OBJECTIVES: To test the hypothesis that exists an association of non-diabetic and diabetic patients suffering from erectile dysfunction (ED) with lipid metabolism and oxidative stress. DESIGN AND METHODS: Clinical and laboratory characteristics in non-diabetic (n = 30, middle age range: 41­55.5 years; n = 25, old age range: 55.5­73), diabetic ED patients (n = 30, age range: 55.5­75 years) and diabetic patients (n = 25, age range: 56­73.25), were investigated. Proteomic analysis was performed to identify differentially expressed plasma proteins and to evaluate their oxidative posttranslational modifications. RESULTS: A decreased level of high-density lipoproteins in all ED patients (P < 0.001, C.I. 0.046­0.10), was detected by routine laboratory tests. Proteomic analysis showed a significant decreased expression (P < 0.05) of 5 apolipoproteins (i.e. apolipoprotein H, apolipoprotein A4, apolipoprotein J, apolipoprotein E and apolipoprotein A1) and zinc-alpha-2-glycoprotein, 50% of which are more oxidized proteins. Exclusively for diabetic ED patients, oxidative posttranslational modifications for prealbumin, serum albumin, serum transferrin and haptoglobin markedly increased. CONCLUSIONS: Showing evidence for decreased expression of apolipoproteins in ED and the remarkable enhancement of oxidative posttranslational modifications in diabetes-associated ED, considering type 2 diabetes mellitus and age as independent risk factors involved in the ED pathogenesis, lipid metabolism and oxidative stress appear to exert a complex interplay in the disease.