Quick note on tissue engineering-based surgical measures to treat patients with neurogenic bladder-due detrusor/sphincter dyssynergia.

To treat the neurogenic bladder-due detrusor/urethral rhabdosphincter dyssynergia, early combined clean intermittent catheterization/ pharmacotherapy (anticholinergic-, ß3-adrenoceptor agonist drugs) management may be at times crowned with success of preserving an adequate bladder compliance and renal safe conditions.The persistence, instead, of elevated bladder filling pressure levels with high voiding pressure/uroflow values, together with aberrant urethral rhabdosphincter electromyographic findings, make necessary the resort to surgery strategies, among which - a part from rhabdosphincterotomy or alternatively intrasphincteric botulinum A toxin injection or urethral stent insertion - the bladder augmentation cystoplasty, with either reconfigurated bowel- or gastric segment, is today the most efficacious surgical measure to increase the bladder urinary storage meanwhile lowering bladder filling pressure. Given the enterocistoplasty-dependent both potential systemic metabolic imbalances - such as hyperchloremic acidosis/hypokaliemia, hyperoxaluria, bone demineralization, chologenic diarrhoea/steatorrhoea, vit B12 deficiency - together with bowel prosthetic mucus overproduction-due recurrent stone formation, and, sometimes, malignant complications particularly at the intestinal-urinary tract suture line, tissue engineering techniques have been taken into consideration, more than twenty years ago, as alternative measure for bladder augmentation cystoplasty, until to reach successful clinical validation just in patients suffering from either congenital dysraphism- or acquired spinal cord injury-dependent neurogenic bladder. Nevertheless, also the tissue engineering-made augmentation cistoplasty, as well as that bowel-based one, unfortunately remains influenced by spinal cord neuropathydue dysfunctional effects, hence the tissue engineering research could be today directed to suitably overcome such disadvantageous conditions.

About recent developments of synthetic polymers for a suitable cell adhesion/growth support in tissue engineering-based either augmentation cystoplasty or neobladder.

Among the regenerative medicine technologies, the tissue engineering has emerged, in recent years, as a prominent tool, particularly given the tremendous developments in the field of synthetic polymer-based scaffolds. Scaffold surface coatings with either extracellular matrix (ECM) proteins or integrin-binding bioactive peptide sequences, such as RDG, proved to be extremely useful to enhance cell adhesion and growth. Nevertheless, about it, excellent effects may be reached by electrospinning-obtained nanofiber-structured synthetic polymer scaffold ­ such as polyurethane or polyethylene-terephthalate electrospun nanofibers ­ without resorting to surface- coated adhesion proteins. As for bladder tissue engineering, properly cell-seeded synthetic biomaterial-based scaffolds allow today timely chances to obtain constructs provided with specific bladder native tissue-like both histological-immunohistochemical and functional-dynamic features. Recent bright advances in the tissue engineering research, particularly in the area of materials science ­ together with increasing availability of suitable bioreactors ­ and stem cell biology, make foreseeable, in the near future, further technological improvements that might widen the clinical applications of bladder tissue engineering up to whole bladder replacement in radical tumor surgery.

[Some etiopathogenetic and diagnostic considerations in neuroendocrine tumors, with particular attention to those in urology]. / Alcune considerazioni etiopatogenetiche e diagnostiche sui tumori neuroendocrini, con particolare attenzione a quelli in ambito urologico.

Some aetiopathogenetic and diagnostic considerations about the neuro-endocrine tumours, with particular attention to those pertinent of urology.Some neuroendocrine tumours (NET) occur in hereditary-familial neoplastic syndromes such as MEN (multiple endocrine neoplasias) or neuroectodermic dysplasias (neurofibromatosis-NF1, von Hippel Lindau disease, pheochromocytoma-chemodectoma familial syndrome, etc.) while others arise as solitary-isolated tumours such as those of gastrointestinal tract, pancreas, lung, skin, genitourinary system. The diagnostics of NET implies plasmatic assay of common neuroendocrine markers and specific peptide hormones, and more properly, their immuno-histochemical characterisation, together with molecular-genetic studies. Several gene alterations (MEN1, RET, NF1, VDL, SDH-B and -D) are associated with pheochromocytoma, showing that almost 25% of subjects with apparent-sporadic pheochromocytoma at the sheer clinical examination, are actually syndromic-familial pheochromocytoma patients at the genetic testing. The functional imaging provides intriguing data regarding not only the diagnostics but also the assessment of tumour response to the therapy. This paper aims to review the literature on morphological, functional as well as biological features of NET and to briefly summarize the recent advances in their diagnosis, with particular attention to those pertinent the urology.