Role of mepartricin in category III chronic nonbacterial prostatitis/chronic pelvic pain syndrome: a randomized prospective placebo-controlled trial.

OBJECTIVES: To verify the efficacy of mepartricin versus placebo with regard to symptom improvement in patients with chronic nonbacterial prostatitis/chronic pelvic pain syndrome (CPPS) and to verify a relation between hormonal levels and clinical improvement in these patients. METHODS: Twenty-six patients with CPPS were included in our study and randomized into two groups of 13 subjects each. Group 1 patients were treated with mepartricin (40 mg daily) and group 2 patients with placebo. All patients underwent treatment for 60 days. At the beginning and end of therapy, all patients underwent evaluation, including a standardized history, physical examination, luteinizing hormone, follicle-stimulating hormone, testosterone, and beta-estradiol measurements, and a National Institutes of Health-Chronic Prostatitis Symptom Index (NIH-CPSI) questionnaire. RESULTS: We observed a decrease in the total NIH-CPSI score from 25.0 to 10.0 in group 1 and from 25.0 to 20.0 in group 2, revealing a 60% and 20% improvement in groups 1 and 2, respectively. A statistically significant decrease was observed with regard to pain (from 11.0 to 4.0 and from 10.0 to 8.0, respectively) and quality of life (from 10.0 to 5.0 and 10.0 to 9.0, respectively). No statistically significant difference was observed in urinary dysfunctions. The luteinizing hormone, follicle-stimulating hormone, and testosterone values were similar in both groups before and after treatment; the 17-beta-estradiol levels were significantly lower in group 1 compared with group 2 at the end of the study. CONCLUSIONS: Mepartricin provides significant symptomatic improvement in men with CPPS compared with placebo. The role of mepartricin in decreasing estrogen plasmatic levels and their concentration in the prostate may account for this clinical improvement.

[Early use of menotropin in the treatment of varicocele]. / Early use of menotropin in the treatment of varicocele.

INTRODUCTION AND OBJECTIVES: Varicocele is the most common disease in infertile men and varicocelectomy remains the main treatment. During the last years a lot of drugs have been proposed in association with surgery. The aim of this study is verify the effects of the association between menotropin and subinguinal varicocelectomy on sperm parameters and pregnancy rate. METHODS: 60 patients with left varicocele were randomized in three groups of 20 patients: patients of group A were treated with menotropin since diagnosis for three months; patients of group B were treated with menotropin but started the treatment three months after surgical treatment; patients of group C were treated only with varicocelectomy. We have tested sperm parameters before and after three, six and twelve months from surgical treatment. After six and twelve months from varicocelectomy we have verified the pregnancy rates in the three groups. RESULTS: After three months from surgical treatment, sperm parameters were significantly improved only in the group A (p < 0.05). After six months we have recorded a similar improvement even in the group B. After twelve months we have confirmed a significant improvement in groups A and B; the values were significantly higher than in the group C (p < 0.05). After six months the pregnancy rate was 42%, 25% and 22.2% respectively in the three groups. After twelve months we have recorded an important improvement of pregnancy rate in groups A and B (47% and 45% respectively) and a little improvement (27.7%) in group C. CONCLUSIONS: Our data show a significant improvement of sperm parameters in the two groups treated with menotropin respect to the group treated with only varicocelectomy. It could be responsible for a similar improvement of the pregnancy rate. The association between varicocelectomy and early use of menotropin seem to improve testis functional rehabilitation.

Testicular sertoli cell tumours and relative sub-types. Analysis of clinical and prognostic features.

INTRODUCTION: Sertoli cell tumours have a rare (0.4-1.5% of all testicular neoplasms) and heterogeneous pathology. The aim of this paper is to analyse the histological classification of Sertoli cell tumours, in order to assess if the three different histotypes--classic type, large cell calcifying Sertoli cell tumour (LCCSCT) and sclerosing Sertoli cell tumour (SSCT)--really present distinctive clinical and prognostic features. MATERIALS AND METHODS: The current literature was reviewed; Sertoli cell tumour clinical series and single case reports were searched and analysed. Hence, more than 200 classic Sertoli cell tumours, 48 LCCSCTs and only 12 SSCTs were found. The thirteenth SSCT has been found by us in a 34-year-old man. RESULTS: Every single sub-type presents clinical specific characteristics regarding age of onset, bilaterality, focality, abnormal hormone production, correlated systemic symptoms. Ultrasonographic findings, size and--above all--malignant potential. CONCLUSIONS: The precise classification of these tumours is not important only histologically: the currently recognised variants really differ in clinical presentation and course. Moreover, LCCSCTs can be further divided in two subgroups with very different clinical behaviour, those in older patients and those associated with well-known syndromes. These clinical and prognostic variables are of great importance when deciding on the therapeutical approach.

Congenital bilateral absence of the vasa deferentia and related respiratory disease.

In a meaningful proportion of cases, CBAVD has been recognised as a probable consequence of cftr gene mutations. This lead to a further enlargement of the spectrum of clinical pictures due to "cftr deficiency". More recently, the identification of a polymorphism in intron 8 regulating the level of correct cftr transcription, shed new light on the genotype-fenotype correlation of cftr mutations. Unfortunately, little information is still available on the clinical manifestations of CBAVD other than infertility. History, clinical picture, sweat test and genotype were carefully evaluated in a series of 21 patients affected by CBAVD, selected on the basis of otherwise unexplained obstructive azoospermia. History collection was especially addressed to respiratory symptoms. Family history was always negative for CF. Nevertheless, personal history showed respiratory symptoms in 18 cases (86%) 9/21 (43%) patients suffered from chronic sinusitis and one of these had had a pneumothorax. Other 9 (43%) patients had chronic nasal obstruction, due to recurrent nasal poliposis in two cases. Sweat test was clearly abnormal in 15/21 (71%) and borderline in the remaining 6 patients (29%). Genetic analysis allowed detection of one mutation in 15/21 patients (71%). Our data show that respiratory symptoms may be present in CBAVD patients, so that CBAVD cannot be merely considered a "genital form" of CF.

Case report: testicular secondary localization of a multiple myeloma.

A 61-year-old man who had 40 months history of recurrent multiple myeloma presented a right testicular mass, which was diagnosed incidentally by scrotal sonography examination. Alpha-feto-protein and beta-human-chorionic-gonadotropin were normal. A right radical orchiectomy was performed. The histological examination showed an intermediate grade plasmacytoma.

Preperitoneal inguinal hernia repair during pelvic surgery.

OBJECTIVES: We report our experience with posterior preperitoneal prosthetic herniorrhaphy for inguinal hernia in patients undergoing concomitant pelvic surgery for both benign and malignant urological pathologies. METHODS: 116 patients with either unilateral or bilateral inguinal hernia underwent posterior preperitoneal prosthetic herniorrhaphy during a pelvic operation for various urological pathologies. The technique described by Mahorner and Goss was used for unilateral hernia, while the modified Stoppa technique was used for bilateral hernia. RESULTS: All patients had a complication-free peri- and post-operative course, except for one patient who developed a spontaneously resolving small peri-prosthetic hematoma. In the follow-up of all patients (mean 35.7 months, range 4-72) we did not observe any hernia recurrence. CONCLUSIONS: Posterior preperitoneal prosthetic inguinal herniorrhaphy during pelvic surgery for urological pathologies is a relatively simple and safe procedure to perform and a recurrence rate of zero, or very close to zero, is to be expected.

Renal dysplasia associated with ureteral ectopia and ipsilateral seminal vesicle cyst.

The simultaneous presence of renal aplasia/dysplasia, ureteral ectopia and seminal vesicle cyst represents an exceptionally rare malformation. The literature is reviewed here and a new case of such malformation, concerning a 45-year-old man affected by recurrent epididymitis, is reported.

Cirugía de corrección de hernia preperitoneal inguinal concomitante con cirugía pelviana / Preperitoneal inguinal hernia repair during pelvic surgery

OBJETIVOS: Comunicamos nuestra experiencia con este tipo de corrección herniaria con material protésico concomitante con cirugía pelviana tanto en patologías malignas o benignas urológicas. MÉTODOS: Hemos tratado 116 pacientes con hernia uni o bilaterales, durante una cirugía pélvica por variada patología urológica. La técnica descrita por Mahorner y Goss se usó para las hernias unilaterales y la de Stoppa para las bilaterales. RESULTADOS: Todos los pacientes tuvieron un postoperatorio libre de complicaciones, excepto uno que desarrolló un pequeño hematoma periprotésico, que se resolvió espontáneamente. En el seguimiento (media 35,7 meses, rango 4-72 meses) no objetivamos ninguna recidiva herniana. CONCLUSIONES: Este tipo de corrección herniaria aplicada por nosotros, durante la cirugía pélvica urológica nos parece un procedimiento seguro y fácil de realizar con tasa de recurrencia igual o muy cercana a cero (AU)

Observational multicentric trial performed with doxazosin: evaluation of sexual effects on patients with diagnosed benign prostatic hyperplasia.

INTRODUCTION: The aim of our study is to verify the effects of doxazosin on sexual function in patients with benign prostatic hyperplasia (BPH). MATERIALS AND METHODS: We enrolled 102 patients with BPH, selected by nine Italian Urology Departments. Patients were evaluated with the International Prostatic Symptom Score (I-PSS) and divided into two groups: those with intact sexual activity and those with erectile dysfunction. According to the International Index of Erectile Function (IIEF), the second cohort was divided into three subgroups on the basis of the degree of erectile dysfunction degree (severe, moderate or mild). All patients underwent 3 months of therapy with doxazosin. The effects of doxazosin on sexual activity and on voiding symptoms were monitored at 1, 2 and 3 months with IIEF and I-PSS scales. RESULTS: Eighty-six of the 102 initial patients (84%) were monitored until follow-up was completed. The follow-up at 1 month showed a significant decrease in the I-PSS (p < 0.0001) from 20.2 +/- 2.01 (base visit) to 13.1 +/- 2.21. The mean IIEF was 19.24 +/- 6.59 at baseline and 1 month later the score reached 21.44 +/- 5.40, thus showing a statistically significant increase (p = 0.0177). This is more evident in the group presenting with severe to moderate erectile dysfunction. I-PSS and IIEF do not significantly change at the 2- and 3-month follow-ups. CONCLUSIONS: The use of doxazosin improved sexual function in patients with BPH.

[Ultrasonography-guided transperineal prostatic biopsy: optimization of sampling protocol after 1,352 biopsies]. / Biopsia prostatica transperineale ecoguidata: ottimizzazione del protocollo di campionamento dopo 1.352 biopsie.

We report our experience-based approach in transperineal ultrasound guided biopsy to detect early prostate cancer. We selected patients on the basis of clinical characteristics. We tried to determine correct number and sites of biopsy to reduce patient discomfort and complications without loosing sensibility. Routine TZ biopsy increases detection rate of prostate cancer in T1 patients. Lateral peripheral biopsy resulted in a loss of sensibility of 5% and thus we considered it useless. Literature reported gain of sensibility with lateral peripheral biopsy referred to transrectal technique. Needle angle of incidence is different and therefore the area biopsied differs. Thus, results are not comparable.