Subjective effects of Lepidium meyenii (Maca) extract on well-being and sexual performances in patients with mild erectile dysfunction: a randomised, double-blind clinical trial.

Lepidium meyenii (Maca) is a cultivated root belonging to the brassica family used in the Andean region for its supposed aphrodisiac properties. We carried out a double-blind clinical trial on 50 Caucasian men affected by mild erectile dysfunction (ED), randomised to treatment with Maca dry extract, 2400 mg, or placebo. The treatment effect on ED and subjective well-being was tested administrating before and after 12 weeks the International Index of Erectile Function (IIEF-5) and the Satisfaction Profile (SAT-P). After 12 weeks of treatment, both Maca- and placebo-treated patients experienced a significant increase in IIEF-5 score (P < 0.05 for both). However, patients taking Maca experienced a more significant increase than those taking placebo (1.6 +/- 1.1 versus 0.5 +/- 0.6, P < 0.001). Both Maca- and placebo-treated subjects experienced a significant improvement in psychological performance-related SAT-P score, but the Maca group higher than that of placebo group (+9 +/- 6 versus +6 +/- 5, P < 0.05). However, only Maca-treated patients experienced a significant improvement in physical and social performance-related SAT-P score compared with the baseline (+7 +/- 6 and +7 +/- 6, both P < 0.05). In conclusion, our data support a small but significant effect of Maca supplementation on subjective perception of general and sexual well-being in adult patients with mild ED.

Activity of endovesical gemcitabine in BCG-refractory bladder cancer patients: a translational study.

Intravesical gemcitabine (Gem) has shown promising activity against transitional cell carcinomas (TCC) of the bladder, with moderate urinary toxicity and low systemic absorption. The present phase II study evaluated the activity of biweekly intravesical treatment with Gem using a scheme directly derived from in vitro preclinical studies. Patients with Bacille Calmette-Guérin (BCG) -refractory Ta G3, T1 G1-3 TCC underwent transurethral bladder resection and then intravesical instillation with 2000 mg Gem diluted in 50 ml saline solution on days 1 and 3 for 6 consecutive weeks. Thirty-eight (95%) of the 40 patients showed persistent negative post-treatment cystoscopy and cytology 6 months after Gem treatment, while the remaining 2 patients relapsed at 5 and 6 months. At a median follow-up of 28 months, recurrences had occurred in 14 patients. Among these, four had downstaged (T) disease, three had a lower grade (G) lesion and three had a reduction in both T and G. Urinary and systemic toxicity was very low, with no alterations in biochemical profiles. In conclusion, biweekly instillation of Gem proved active in BCG-refractory Ta G3, T1 G1-3 TCC. Our results highlight the importance of preclinical studies using in vitro systems that adequately reproduce the conditions of intravesical clinical treatment to define the best therapeutic schedule.

Tension-free vaginal tape and female stress incontinence: further evidence of effectiveness.

OBJECTIVES: Female stress incontinence is a frequent and distressing event with subsequent impact on quality of life. The tension-free vaginal tape (TVT) technique is considered to fulfill the criteria for an ideal surgical procedure and we therefore reviewed our cases to further analyze its effectiveness. MATERIALS AND METHODS: 57 patients suffering from stress incontinence with grade 1-2 cystocele underwent the TVT operation. During follow-up (mean 22.2 months), the short- and long-term results were investigated. RESULTS: 91.3% of patients achieved complete resolution of previous stress incontinence in the early postoperative period. Early complications occurred in 8.7% of patients. Follow-up (mean 22.2 months) highlighted the stabilization of positive outcomes in 87.7% of cases. No postoperative modification of sexual habits and a significant improvement in quality of life were reported by all patients. CONCLUSION: The results of our study confirm that the TVT technique for stress incontinence is an easy to perform procedure which is safe, effective and long-lasting.

A multivariate analysis of lower urinary tract ageing and urinary symptoms: the role of fibrosis.

An investigative trial including 72 patients who underwent open surgery for benign prostatic hypertrophy (BPH) induced urinary symptoms was carried out with the purpose to obtain a deeper insight in the pathophysiology of this clinical picture. Prostate weight, stroma to parenchyma ratio, bladder wall fibrosis, I-PSS score, residual urine and uroflow obtained from these patients were processed by statistical multivariate analysis. The results point out the pivotal impact of prostate and bladder wall fibrosis in conditioning biological and chronological ageing of the lower urinary tract and relative symptoms.

Orthotopic bladder substitution in a presacral ectopic kidney bearer.

Orthotopic bladder substitution after radical cystectomy may require original surgical procedures when urinary tract malformations are present. A case of presacral left ectopic kidney with hypoplastic ureters is described, and the main issues faced in lower urinary tract reconstruction are pointed out.

[Developments in the last 10 years in diagnostic imaging discovery of renal carcinoma]. / Evoluzione negli ultimi dieci anni della diagnostica per immagini nel riscontro del carcinoma renale.

We have reviewed the files of 69 patients who had presented with cancer of the renal parenchyma between 1985 and 1994. In 20% of cases in 1985-1989 and in 40% of cases in 1990-1994 these tumours were discovered incidentally, in example before the occurrence of any suggestive symptoms. In 20% (1985-1989) of cases and 40% (1990-1994) of cases, the credit for this early detection was due to ultrasound study prescribed by the attending physician waiting a general health assessment or the follow-up of some other disease. The early diagnosis treating cancers at less advanced staged, which will probably improve the prognosis.

[BCG vs. BCG plus recombinant alpha-interferon 2b in superficial tumors of the bladder]. / BCG vs. BCG plus alpha-interferon 2b ricombinante nei tumori superficiali della vescica.

BCG intravesical instillation is a well established therapy for superficial bladder carcinoma as adjuvant and/or prophylactic treatment. However side-effects are frequent when full doses are employed and therefore low dose alternative schedules were proposed. Interferon intraluminal therapy for bladder TCC has been used with similar indication but the results did not encourage further single drug trials. A double arm random study, BCG full dose vs. BCG low dose, is presented. The results point out that the combination treatment is superior to BCG full dose therapy in terms of side effects and similar to BCG full dose as regards efficiency (5/18 vs 4/18 recurrences) after a follow-up of 24.11 +/- 8.15 for BCG and 16.72 +/- 8.7 for BCG + IFN.

[Bourneville's syndrome: diagnostic and urologic implications]. / La sindrome di Bournerville: implicazioni diagnostiche ed urologiche.

Angiomyolipoma is a rare tumor frequently associated with tuberous sclerosis and it has a higher incidence of bilateral renal involvement in this case. Patients effected by Bourneville's Syndrome are often more symptomatic than patients with angiomyolipoma only, however it is necessary to examine the renal conditions in all of them because of the high risk for severe hemorrhage. Diagnostic evaluation is based on radiological findings as Ultrasonography and Computed Tomography. We present a case of bilateral and symptomatic angiomyolipoma is a young woman with Bourneville's Syndrome.

A new device for self-adjustment of colposuspension.

One of the major problems with the colposuspension technique is the tension applied to the stitches which is usually adjusted on the basis of experience or by means of endoscopic observation of the bladder neck with the patients immobile and under anesthesia. The outcome of the procedures may be different during active life and in an upright position resulting in under- or overcorrection. Therefore, the authors developed a device to be applied on the 4th to 5th postoperative day after standard Gittes or Raz-Pereyra procedures and checked continence during walking and voiding. Up to November 1993, 13 females with recurrent incontinence had been treated with this method; good results were obtained in 12 cases. The authors advocate the use of this device as a solution in cases with imperfect outcome due to assessment of colposuspension during surgery.

Chemotherapy with cisplatin, epirubicin, methotrexate in the treatment of locally advanced or metastatic transitional cell cancer of the bladder (TCC).

Forty patients with advanced transitional cell cancer (TCC) of the bladder were treated with cisplatin, epirubicin, methotrexate (PEM, every 3-4 weeks). If creatinine clearance was reduced to 40 ml/min, the usual full doses of cisplatin and methotrexate, 50 mg/m2, were proportionally reduced. 23 patients had full-dose (FD) therapy, 17 had reduced dose (RD) (40-20 mg/m2). Two patients achieved complete response and 17 partial response. The overall response rate was 19/40 (47.5%), 11/23 (48%) for FD and 8/17 (47%) for RD (p = 1.000). 17/40 pts (42.5%) had no-change and 4/40 (10%) had disease progression. The median duration of CR and PR was 32 weeks, range 4-82 (22 weeks, range 12-52 for FD; 32 weeks, range 4-82 for RD, cisplatin p = .7362). The main side effect was vomiting (35/40 pts, 87.5%, 20/23 = 87% for FD, 15/17 = 90% for RD, p = 1.000). Leukopenia was observed in 12 patients (30%, nadir 3,240 range 900-3,800, 6/23 = 26% for FD, 6/17 = 35% for RD, p = .7285), alopecia in 18 patients (45%, 15/23 = 65% for FD, 3/17 = 18% for RD, p = .004). The results of this study show that a dose escalation to 50 mg/m2 for cisplatin, epirubicin and methotrexate in the PEM regimen results in an increase in overall response (OR) (19/40 = 47.5%) with respect to a historical control using the same drugs at doses of 40 mg/m2 (12/35 = 34%). In patients with normal renal function the escalated dose was tolerated without a corresponding increase in toxicity.(ABSTRACT TRUNCATED AT 250 WORDS)

Class I and class II HLA antigen expression by transitional cell carcinoma of the bladder: correlation with T-cell infiltration and BCG treatment.

HLA class I and II glycoproteins from transitional cell carcinoma (TCC) and from perineoplastic and healthy vesical mucosa were characterized together with infiltrating cells by means of immunochemistry using specific monoclonal antibodies on frozen sections obtained during resection or radical cystectomy. Specimens were taken from 11 patients with TCC and five with healthy bladder mucosa. Four patients with TCC and four with healthy mucosa had been previously treated with a course of intravesical bacillus Calmette-Guerin (BCG). Ten out of 11 TCC samples expressed class I glycoproteins with a membrane pattern (diffuse in seven, focal in three) as normal epithelial cells from either controls or perineoplastic bladder. Interestingly, eight out of 11 TCC samples expressed class II antigens on their membrane that were also present in six cases in the perineoplastic tissue while the epithelial cells from four out of five normal bladders were completely negative. The epithelial display of class II antigens in the non-neoplastic areas and in the normal bladder correlates (p less than 0.001) with the degree of cellular infiltrate while such a relationship was not found between the HLA II expression of neoplastic cells and the infiltrate. BCG treatment was associated with a higher amount of inflammatory cells, prevalently T "activated" cells (CD5+,DR+), with a CD4/CD8 ratio always greater than 1. In the light of the role played by HLA glycoproteins in immune mechanisms, these results could help explain the positive action of BCG and the relative immunosensitivity of TCC.

[Prostate-specific antigen (PSA): diagnostic and prognostic implications in the evaluation of carcinoma of the prostate]. / Antigene prostatico specifico (PSA): implicazioni diagnostiche e prognostiche nella valutazione del carcinoma della prostata.

Prostatic specific antigen (PSA), glycoprotein with molecular weight of 34000, was first identified by Wang and Coll. in prostatic tissue initially; then Papsidero and Wang purified PSA in the sera of patients with prostatic cancer. We determined PSA concentration in 132 serum samples obtained from 111 patients affected by prostatic carcinoma: of these 61 had untreated prostatic cancer (6 had a stage A disease, 10 stage B, 19 stage C and 26 stage D) and 50 were variously treated (17 with cyproterone acetate, 11 with estramustine phosphate, 10 with LH-RH analogues, 9 underwent radical prostatectomy and 3 radiation therapy alone). Each patients was assigned a histological grade according to Gaeta, by means of a perineal transrectally guided prostatic biopsy. At periodical follow-ups of treated subjects, patients' state and neoplastic evolution were considered. Serum PSA has been measured by a competitive radioimmunoassay (PSA-Double antibody, Diagnostic Product Corporation) in which 125-I-labeled PSA competes with PSA in the samples for antibody sites. The antibody-bound fraction is then precipitated and counted. Since manipulation of the prostate gland may lead to elevated PSA levels, patients' samples were obtained prior to rectal examination, biopsy or surgical procedures. On the basis of a preliminary study of samples from healthy blood donors, we fixed the cut-off value at 2.9 ng/ml. In patients with untreated prostatic carcinoma PSA serum mean value was 26.33 ng/ml (range 0.5-100), resulting elevated in 56/61 (90,16%) patients.(ABSTRACT TRUNCATED AT 250 WORDS)