Relationship of flow rate with symptoms, quality of life and other clinical parameters in patients with LUTS suggestive of BPH.

AIM: The uroflowmetry data of a selected number of patients who took part to the QUIBUS study (366 traces selected after quality control by a central panel of reviewer) were evaluated for their relationships with age, prostate volume, and IPSS and ICS-BPH scores. Waiting time, flow time, voided volume, maximum flow rate (Q(max)) and average flow rate (Q(ave)) were the flow variables considered for analysis. Only measurements with total voided volume exceeding 100 ml were included. RESULTS: An increasing percentage of subjects with voided volume <200 ml was observed over 65 years of age. Age did not affect neither Q(ave) nor Q(max )(p = n.s. at correlation analysis). In particular, Q(max)was <15 ml/s in about 70% of patients independently of age. Prostate enlargement was inversely associated with voided volume, Q(max) and Q(ave), showing a worsening of urinary function for increasing values of prostate volume Q(max) was negatively correlated with IPSS total score and with most single items with the exception of two storage symptoms such as repeated urination and nocturia). Accordingly, Q(max) was inversely associated with the total score ICS-BPH for voiding symptoms to a higher extent (r = -0.31, p < 0.01) than with the one for storage symptoms (r = -0.22, p < 0.01). Flow variables were inversely correlated with IPSS-QoL. CONCLUSION: Uroflowmetry and IPSS, although not allowing a definitive diagnosis of obstruction, may nonetheless satisfy the clinical need of a rapid, easy and accurate tool for the noninvasive screening of LUTS patients.

[Transurethral alprostadil (MUSE) in erectile dysfunction]. / Alprostadil transuretrale (MUSE) nella disfunzione erettile peniena.

The ideal therapy for erectile dysfunction should be easy, non invasive, painless, with a high success and a low side effects rate. Alternative methods of delivery drugs to the erectile body, instead of intracavernosal injection of vasoactive drugs such as prostaglandin, have been evaluated. Vasoactive agents can be administered topically into the urethral mucosa for absorption into the corpus spongiosum and transfer into the corpora cavernosa via small communicating veins. We report data from the literature and our experience with MUSE (Medicated Urethral System for Erection) for the treatment of erectile dysfunction. Penile pain or discomfort is the common adverse effect reported, while no priapism of fibrotic complication is reported. But local discomfort, limited efficacy, and cost are to be considered.

Standardization of assay for cytokeratin-related tumor marker CYFRA21.1 in urine samples.

The determination of tumor markers in urine samples has been proposed as an effective diagnostic tool in bladder cancer. The aim of the present investigation was to validate in urine samples the assay of the CYFRA21.1 cytokeratin-related marker, the serum concentrations of which showed promising diagnostic utility in patients with bladder cancer. First-voided urine samples were collected from patients with different malignancies. CYFRA21.1 was assayed with a commercially available enzyme immunoassay (Boehringer Mannheim). Different centrifugation patterns, the use of different buffers and nonionic detergents, and pH variations were evaluated. We demonstrated that: (a) cells and cell debris contain a large amount of CYFRA21.1 and must be eliminated by centrifugation; (b) storage at -20 degrees C causes amorphous precipitate, which may aspecifically bind CYFRA21.1; (c) the latter behavior may be prevented by diluting fresh urine samples with phosphate buffer with nonionic detergent added; (d) pH variations within the range 4.9-8.2 do not significantly affect CYFRA21.1 assay results. Provided that samples are diluted with buffer containing nonionic detergent, the CYFRA21.1 assay showed good precision and accuracy characteristic in urine samples. We therefore propose a standard protocol for the collection of urine samples for CYFRA21.1 assay. In a preliminary clinical evaluation, CYFRA21.1 concentrations in 16 patients with primary bladder cancer were higher than in healthy subjects. In the urine collected in the follow-up of patients treated for bladder cancer, CYFRA21.1 tended to be higher in relapsed patients than in those without evidence of disease. These preliminary data induced us to extend the clinical trial to establish the actual role of this assay in routine use.

[Role of BCG in T1G3 bladder transitional cell carcinoma (TCC): our experience]. / Ruolo del BCG nel carcinoma vescicale transizionale (TCC) T1 G3: nostra esperienza.

High grade superficial TCC of the bladder (T1 G3) has an important risk of recurrence and/or progression (40%) after TUR-B and a low survival rate (57% at 3 years, 50% at 10 years). Intravescical treatment with BCG seems to be able to reduce these rates. 64 patients with T1 G3 vescical TCC underwent a "second look" TUR-B. 9/64 patients presented locally advanced tumor (T2-3) or persistent high risk superficial TCC (T1 G3 + Tis) and underwent to early cistectomy. BCG intravescical therapy has been performed in the remaining 55 patients: 10 of them had not been evaluated because local or sistemic toxicity and consequent early interruption of treatment. BCG Pasteur was given weekly at the dose of 75 mg for two cycles of 6 weeks with a rest period of 6 weeks between the two cycles and then monthly for one year and every three months during next two years too. After the first 6 weeks 43/45 patients resulted tumor-free and 2/45 presented persistent Tis: after the second 6 weeks-cycle of BCG, two other patients had evidence of vescical TCC (one T2 G3 and the other T1 G3); all these four patients were submitted to radical cystectomy or radiotherapy. Of the reamining 41 patients, 28 presented had no recurrences, nowadays living and tumor-free; 3 presented local neoplastic progression and dead; relapsed in T1 G2 and are living NED after local chemotherapy. At a mean follow-up of 18 months, the total amount of recurrences is 17/45 (38%), progression rate is 4/45 (8.8%), exitus 5/45 (11%) and living NED are 28/45 (62%). In our opinion local BCG treatment for T1 G3 bladder cancer, after TUR--B, seems to be able to reduce the risk of recurrence and mortality.

[Role of urodynamics in implantation of prostatic stents]. / Ruolo dell'urodinamica nell'impianto degli stents prostatici.

Recent anxieties about the risk of prostate surgery in elderly and unfit patients have generated considerable interest in a number of new permanent prostatic stents. The prostatic Urolume Wallstent was positioned in 34 patients affected by BPH, all with acute or chronic retention of urine, most of whom were unfit for conventional prostatic surgery; the average follow-up is 14 months (range 9-24 months). The stents were inserted with the patients under local or regional anesthesia. 14 patients had prevalent irritative pre-retention symptoms, while in 18 patients obstructive symptoms were dominant; in the remaining 2 patients symptoms were minimal. Cystometry was performed in 29 patients before treatment for evaluation of detrusor activity. Following stent insertion, 31 patients were able to empty satisfactorily, while the remaining 3 patients presented chronic retention because of detrusor failure, evidenced before treatment. Most patients experienced frequency and urgency for several months (90% of 14 patients with pre-treatment irritative symptoms; 25% of the other 20 patients). No incrustation occurred, no serious urosepsis was registered. In 3 patients we need to put in a second stent. In the first weeks, 4 stents were removed for dislocation and then replaced endoscopically without difficulty or damage to the urethra. After 6 months, other 5 stents were definitively removed because of persistent unbearable irritative symptoms with poor quality of life (all these patients had severe pre-operative detrusor overactivity).(ABSTRACT TRUNCATED AT 250 WORDS)

[Study of intestinal absorption of calcium using 47Ca and whole body counter in renal calculosis with hypercalciuria]. / Studio dell'assorbimento intestinale del calcio mediante 47Ca e misure con whole body counter nella calcolosi renale con ipercalciuria.

Intestinal calcium absorption was studied using orally administered 47Ca and whole body counting. Using this method, we examined 82 patients suffering from recurrent calcium urolithiasis associated with idiopathic hypercalciuria, to evaluate the incidence of elevated intestinal absorption of this ion. An oral dose of 111 kBq (3 microCi) of 47Ca chloride, together with 250 mg of stable calcium as carrier, was given to each patient. Two hours and one week later, the total body radioactivity of each subject was measured. The retention of 47Ca, as percentage of the administered dose, was then calculated. The measurements were performed with a whole body counter consisting of a two-crystal moving system with shadow shield. Forty age-matched healthy volunteers were also examined. The whole body retention of 47Ca resulted significantly higher (p less than 0.0002) in the group of patients than in the control sample, whose m +/- SD was 22.0 +/- 6.0%. In particular, by defining the normality range as 10-34% (m +/- 2SD of control results), enhanced intestinal absorption of calcium was found in 28% of the examined patients. The use of this simple examination seems to be helpful in the physiopathologic assessment of subjects suffering from calcium urolithiasis and idiopathic hypercalciuria and consequently, in their appropriate management.

A case of renal oncocytoma.

A case of renal oncocytoma angiographically diagnosed and successfully treated by in situ tumorectomy under local hypothermia is presented.

Progestogens in renal cell carcinoma. A retrospective study.

A retrospective study of 88 cases of renal cell carcinoma is presented with emphasis on the follow-up and progestogens administration. Between the statistically homogeneous groups of patients treated with progesterone capronate and with other therapeutic regimens, no statistical difference in actuarial survival rate could be detected.