Impact of COVID-19 on birth rate trends in the Italian Metropolitan Cities of Milan, Genoa and Turin.

OBJECTIVES: The COVID-19 pandemic has led to major changes in the lives of people worldwide, including changes in personal and social habits. Faced with this global health emergency, governments have imposed strict mitigation measures. Within this context, and considering data from previous epidemics, it has been proposed that birth rates may have been negatively impacted. This study aimed to assess the trends in birth rates in three main industrial cities in Northern Italy during the COVID-19 pandemic. STUDY DESIGN: This was a retrospective and observational study. METHODS: Data on birth rates were collected and compared for the cities of Milan, Genoa and Turin from November 2019 to January 2020 (i.e. before the COVID-19 pandemic) and during the same period of the following year (i.e. during the COVID-19 pandemic). RESULTS: Birth rates in the cities of Milan, Genoa and Turin decreased by 55%, 12% and 33%, respectively. CONCLUSIONS: The decrease in birth rates during the COVID-19 pandemic in these three industrialised cities is in line with the demographic effects of previous pandemics. The negative impact of COVID-19 on conception may be a result of various underlying factors. Further studies are required to verify how social and demographic factors may influence birth rates during pandemics.

Prulifloxacin versus ciprofloxacin in the treatment of adults with complicated urinary tract infections.

INTRODUCTION: The present study was performed to evaluate the efficacy and safety of a 10-day regimen of prulifloxacin 600 mg once daily as compared to ciprofloxacin 500 mg twice daily in the treatment of patients with complicated urinary tract infections (UTIs). MATERIALS AND METHODS: 257 patients (mean age +/- SD 62.3 +/- 16.5) were enrolled and orally treated with prulifloxacin (127 patients) or ciprofloxacin (130 patients). The study was designed as a randomized, double-blind, double-dummy, controlled clinical trial. The primary efficacy parameter was the eradication of infecting strains (<10(3) cfu/ml). The clinical outcome and tolerability were also assessed. RESULTS: At baseline, the most common infecting strains were Escherichia coli (62.8%), Proteus mirabilis (7.1%) and Klebsiella pneumoniae (4.1%). At the early follow-up, the rate of patients showing successful treatment was 90.8% in the prulifloxacin group, and 77.8% in the ciprofloxacin group (p = 0.008). A positive clinical outcome was observed in 94.8 and 93.3% of prulifloxacin- and ciprofloxacin-treated patients. Both drugs were well tolerated. Two patients dropped out for treatment-related adverse events. CONCLUSIONS: The high urinary concentrations of prulifloxacin, combined with a broad-spectrum antimicrobial activity, allow its use in the empiric therapy of UTIs.

Evaluation of sexual activity in patients treated with tadalafil: a randomized prospective placebo-controlled trial.

The chronological distribution of sexual intercourses in a group of patients treated with tadalafil versus placebo for 3 months was evaluated. In total, 120 patients with ED were randomized in two groups and treated, respectively, with one pill of tadalafil 20 mg or placebo on Tuesday and on Friday. After 3 months, we collected data using IIEF and SEP diaries. After 3 months, IIEF score and percentages of success SEP diaries increased in the tadalafil group (<0.01) versus placebo group. Considering all the successful intercourses of the 3 months of tadalafil assumption, the highest percentages were reported within 6-12 h range (35%) and 12-24 h range (28%). In tadalafil group, 41% of patients reported their first successful intercourse between 1 and 6 h and 78% of patients reported the recovery of spontaneous erections. In conclusion, after carrying out the first sexual attempt between 1 and 6 h, patients engaged in sexual activity between 6 and 24 h.

Combined oral therapy with sildenafil and doxazosin for the treatment of non-organic erectile dysfunction refractory to sildenafil monotherapy.

The purpose of this work was to investigate the efficacy and safety of sildenafil in combination with doxazosin for the treatment of non-organic erectile dysfunction in patients who did not respond to sildenafil. We enrolled 28 patients with non-organic erectile dysfunction, for whom 3 months of sildenafil monotherapy had failed. They were divided in two random and homogeneous groups: 14 were treated with doxazosin (4 mg daily) and sildenafil (100 mg 1 h before sexual intercourse); the other 14 patients received sildenafil and placebo. The results were assessed by means of the IIEF questionnaire before the beginning of the study, after 30 days of therapy and after 60 days. Of the 14 patients treated with doxazosin and sildenafil, 11 (78.6%) showed a statistically significant increase of IIEF; in the placebo group, only one patient (7.1%) recorded a significant IIEF increase. The differences observed in the two groups were statistically very significant (P=0.0016). Blood pressure did not show significant alterations. Side effects were minimal and even present during sildenafil monotherapy. The combination therapy with sildenafil and doxazosin resulted in the safe and effective treatment of men with non-organic erectile dysfunction for whom sildenafil alone had failed.

Arterial priapism and cycling: a new worrisome reality?

Arterial priapism is a rare condition caused by the traumatic formation of an arteriolacunar fistula. We report 2 cases of arterial priapism after cycling injuries. Both patients sustained a violent perineal trauma against the top tube on the bicycle. In both cases, penile detumescence was obtained by superselective arteriographic embolization of the fistula with gelatin sponge or microcoil. The fistula was monolateral in the first case and bilateral in the second. Cycling should be considered a possible risk factor for arterial priapism as it is for urethritis, prostatitis, hematuria, testicular torsion, scrotal and penile numbness, and erectile dysfunction.

[Priapism: decisional algorithm, our experience, and role of sildenafil in sexual rehabilitation]. / Priapismo: algoritmo decisionale, nostra esperienza e ruolo del sildenafil nella riabilitazione sessuale.

OBJECTIVE: We report our experience in the management of priapism. MATERIALS AND METHODS: In a 2-year period we observed 7 patients of whom 4 presented with low flow and 3 with high flow priapism. RESULTS: In 2 of the patients with ischemic priapism, simple blood aspiration from the corpora allowed for a quick detumescence, while in the other 2 cases a derivative intervention (1 spongio cavernous and 1 glans cavernous) had to be performed. In all the 3 patients with high flow priapism we performed a superselective arteriography that obtained the visualisation of the arteriovenous fistula. These patients restarted their sexual activity after about three months. At six months a patient with low flow priapism restored sexual activity due to sildenafil 50 mg. CONCLUSION: The importance of distinguishing low and high flow priapism was confirmed.

Traumatic rupture of the corpora cavernosa: new physiopathologic acquisitions.

OBJECTIVES: To investigate the physiopathologic mechanisms of the rupture of the corpora cavernosa by means of a histologic study of the tunica albuginea. METHODS: In 6 patients (age range 28 to 49 years, mean 38) with traumatic penile rupture, samples of the tunica albuginea were taken during corrective surgery far from the site of the lesion. These specimens were analyzed with light microscopy by the same pathologist and compared with other samples of tunica albuginea taken from 7 patients who underwent penile surgery for other reasons. RESULTS: Five of the 6 patients with traumatic penile rupture had histologic anomalies of the tunica albuginea (fibrosclerosis in all 5 patients [83%] and phlogistic cellular infiltrations composed of lymphocytes or histiocytes in 3 patients [50%]). Only 1 patient (17%) with traumatic rupture of the corpus cavernosum had a completely healthy tunica albuginea. None of the control specimens revealed any histologic alterations. CONCLUSIONS: Structural anomalies could alter the mechanical properties of the tunica albuginea, representing a weakening factor of the corpora cavernosa and thus a predisposing factor for traumatic rupture of the penis. Therefore, patients with anomalous albuginea could undergo penile rupture even at intracavernous pressures inferior to pressures usually necessary to cause rupture in patients with healthy albuginea.

[Evaluation of the association between benign prostatic hyperplasia and sexual disorders]. / Valutazione dell'associazione tra iperplasia prostatica benigna e disturbi sessuali.

OBJECTIVE: The aim of this study was to determine the incidence of sexual dysfunction in patients with benign prostatic hyperplasia (BPH). METHODS: During the last 6 months 88 patients (mean age 65 years, range 55-78) suffering from BPH, without other chronic disease, were studied. RESULTS: Andrological evaluation enabled us to find erectile dysfunction in 52% of patients, ejaculation problems in 41% and decrease of libido in 54%. CONCLUSION: Due to the great impact of these disturbances in patients' quality of life, we believe that clinical and therapeutic approach in BPH patients should be global, with both urological and andrological assessment.

[Priapism: decisional algorithm. Our experience and role of sildenafil in sexual rehabilitation]. / Priapismo: algoritmo decisionale. Nostra esperienza e ruolo del sildenafil nella riabilitazione sessuale.

In this period we observed seven patients of whom four presented with low flow and three with high flow priapism. In two of the patients with ischemic priapism, simple blood aspiration from the corpora allowed for a quick detumescence, while in the other two cases a derivative intervention (one spongio cavernous and one glans cavernous) had to be performed. In all the three patients with high flow priapism we performed a superselective arteriography that obtained the visualisation of the arteriovenous fistula. These patients restarted their sexual activity after about three months. A six months a patient with low flow priapism restored sexual activity due to sildenafil 50 mg.

[Surgical approach in Peyronie's disease]. / Strategia chirurgica dell'induratio penis plastica.

The goal of surgical treatment of Induratio Penis Plastica should be the achievement of the best aesthetic and functional result with the lowest side-effects. During the last two years different techniques have been proposed for the cases with conserved erectile function, such as Nesbit's technique, excision or incision of the plaque followed by implants of autologous (dermal, saphena vein) or heterologous (dura madre, gore-tex) patches. The criteria for the choice of the most appropriated surgical technique include the curvature degree, the plaque dimension and the penis length. In our experience 6 months after the surgical correction a remaining curvature was observed in 4/38 patients (10%), only 1 of whom needed a new surgical treatment. One case of erectile disfunction occurred, treated by intra-cavernous injection of PgE1.

[Local complications of papaverine-induced erection: follow-up at 7 years]. / Complicanze locali della farmacoerezione con papaverina: follow-up a 7 anni.

127 patients whose age was from 36 to 68 years old, affected by coeundi impotence, have been started to pharmaco-injection. 44 of these patients practised self-injection for 3 years: 25% once a week, 60% fortnightly and 15% once a month. The 60% of first group patients showed a certain fibrotic plaque between the 11th and the 13th month. At the end of the first year two patients with significative penile deviation underwent to corporoplasty. The 40% (6 patients) that made injection every 15-20 days showed fibrotic plaque between the 22nd and the 32nd month. At the third year two more patients underwent to corporoplasty. The 9 patients that made pharmacoerection monthly, showed plaque after almost 38 months. Only 11 patients have been using self-injection from about 7 years. At the half of the fifth year all patients presented multiple plaques and the 95% showed significant bends. At the end of the sixth year, 3 patients with serious bend, not to permit sexual intercourses, underwent to corporoplasty, having refused prosthesis. The anatomo-pathologic situation of the cavernous bodies has showed an heavy fibrosis, hipertrophy of smooth muscle and many perivascular phlogistic infiltrates.

The surgical correction of varicocele: multidisciplinary study on semen evaluation and prognostic factors for fertility.

The seminal pattern was studied in a group of 52 patients before and six months after sclerotherapy of varicocele. In this series, we studied the differences in clinical and seminal characteristics between the group that succeeded in obtaining a pregnancy and the group that remained infertile after 1 year follow-up. The difference in pregnancy rate is discussed between the operated group and a control group of pz, who refused any form of surgery, after 1 year follow-up.

[Evaluation of the seminal fluid in patients treated with ESWL of pelvic ureteral calculi]. / Valutazione del liquido seminale nei pazienti trattati con ESWL per calcolosi dell'uretere pelvico.

We have studied the possible alterations or damage of spermatozoa in patients treated by ESWL for pelvic ureteral stones. Six patients with right and four with left pelvic ureteral stone underwent semen analysis before and after ESWL with Dornier MH3. The semen analysis was repeated 2-3 and 90 days later. No significative alteration was observed.

[Aztreonam vs norfloxacin: a comparative study of the treatment of urinary tract infections in ambulatory and hospitalized patients]. / Aztreonam vs norfloxacina: studio comparativo nel trattamento delle infezioni delle vie urinarie in pazienti ambulatoriali ed ospedalizzati.

Eighty-two evaluable patients suffering from UTI were randomly treated with parenteral Aztreonam (1 g OD in cystitis and 1 g BID in pyelonephritis) or oral Norfloxacin (400 mg BID). Predisposing urological conditions were present in 75% and 78.5% respectively. Microbiological cultures at the end of treatment and at a follow-up visit after 4 weeks showed significantly better results among Aztreonam treated patients (microbiological cure: 97.5% vs 71.4%-p less than or equal to 0.005). Clinical cure was achieved in 97.5% and 71.4% respectively (p less than or equal to 0.001). A statistically significant difference was present only in patients treated for pyelonephritis (microbiological cure-AZT: 100%; NOR: 50%-p less than or equal to 0.0005) and not in those with cystitis (AZT: 95.0%; NOR: 83.3%). Side effects were rare in both treatments. Aztreonam seems to offer major advantages, when compared to Norfloxacin, in the treatment of UTI, especially when upper urinary tract is involved.

Diagnosis of male impotence after intracavernous papaverine test.

The diagnosis and treatment of male impotence have been radically modified by the introduction of intracavernous injections of papaverine. Papaverine treatment can solve more than 70% of male impotence cases, so that the real clue to the diagnosis of impotence is to discriminate between patients who can be treated by papaverine alone and patients deserving thorough investigation. The association of papaverine injection plus video sexual stimulation for this purpose was adopted in our last 250 unselected patients and represents a valuable tool. 115 of 250 achieved successful treatment for their impotence according the following percentages: intracavernous papaverine injections at the practice or at home 75.8%; prosthesis, 19.1%; venous surgery, 3.4%, and arterial surgery, 1.7%.

Penile-brachial pressure index as a guide for the dosage of intracavernous injection of papaverine.

From October 1985 to June 1986 we have treated 82 impotent patients. We related their penis-brachial pressure index (PBPI) with the dosage of papaverine necessary to obtain a full erection as measured by tumistore. We describe the technique and the relationship between the PBPI and the dose of papaverine necessary for the erection; in this way PBPI should be used as guide for the dosage of intracavernous papaverine injection.