Buccal mucosa graft in surgical management of Peyronie's disease: Ultrasound features and clinical outcomes.

INTRODUCTION: Plaque incision and grafting represent the best surgical approach to the Peyronie's Disease (PD). The grafting procedures must be restricted to patients with normal preoperative status, excessive curvature and/or deformities. However, the ideal graft has not been identified yet. Buccal mucosa grafts (BMG) provided excellent short-term results, ensuring the fast return of spontaneous erections and preventing shrinkage, which is the main cause of graft failure. Another fearsome surgical complication is de novo erectile dysfunction (ED). We report our results with BMG focusing on the analysis of ultrasonographic and clinical data demonstrating buccal mucosa as determinant factor that allow to avoid complications. MATERIALS AND METHODS: From 2013 to 2019 we performed at our Urology Unit 27 corporoplasties with BMG to correct complex penile curvature due to PD. Clinical, post-surgical and ultrasound follow up data were evaluated. All patients were no responders to medical treatment or previous surgical procedures. The evaluation period was 72 months. Data regarding pre-operative work-up, including IIEF (IIEF-5) questionnaire administration, detailed clinical history and penile dynamic ultrasound (PGE1-induced erection) were collected. The time of spontaneous erection resumption was recorded for each patient. To improve blood supply to the graft, a low-dose PDE5-i was prescribed for all patients for a period of two months, starting immediately after discharge. Check-ups were scheduled every 3 months, starting from 1 month after surgery. In each visit, patients underwent a penile ultrasound evaluation of graft features. After 6 and 12 months, all patients underwent a penile dynamic ultrasound for Erection Hardness Score determination, then standard ultrasound and clinical evaluation yearly. Our analyses were focused on BMG as a major determinant of the surgical success. RESULTS: Mean age of 27 patients was 57 years (42-71) with a maximum follow up time of 72 months and minimum of 3. Site of penile curvature was dorsal in 18 (67%) patients, ventral in 2 (7%), complex in 7 (26%). The degree of the curvature was < 60° in 11 (41%) patients, > 60° in 16 (59%). Straightening of penis was reached in 100% of cases. Penile shortening resulted in 7.4% (2/27). De novo ED appeared in 2/27 cases with a post-operative rate of PDE5i users increasing from 12 to 14 patients (45% vs 52%). Ultrasound aspects of BMG, recorded at every follow up visit, results in a hypoechoic plaque with an iperechoic rim that become isoechoic over the time in all cases. No case of scars or seroma was registered. Small intra-graft cystic lesions were highlighted in 3 cases (11%). CONCLUSIONS: BMG may represent a good choice in grafts procedures for PD surgical management. The functional results obtained by BMG procedures were related to the good anatomical characteristics of the patch and were highlighted in our series by use of penile ultrasound, during the follow up period.

Effect on prostatic specific antigen by a short time treatment with a Curcuma extract: A real life experience and implications for prostate biopsy.

INTRODUCTION AND OBJECTIVES: PSA elevation is associated with prostate cancer and it is used in screening programs for its diagnosis. It is one of the most common indications for referral to an urologist. There's no consensus about what to do in PSA elevation management. Antibiotics, nutraceuticals or anti-inflammatories are commonly prescribed in daily practice. Our objective was to verify the effect on the PSA value of a short 30-day trial of a curcuma extract, than to discuss the implications in terms of reducing the number of prostate biopsies performed. PATIENTS AND METHODS: We enrolled 50 consecutive patients admitted at our attention for a first PSA over the level of 4 ng/ml or for a suspected PSA rising defined as PSA velocity (PSAv) > 0.75 ng/ml/years. They received treatment with curcuma extract, 2 tablets per day for 30 day. All patients received a second PSA measurement and TRUS within 6 days from the end of the therapy. In case of PSA reduction below 4 ng/ml, patients were reassured and invited to repeat a PSA control over the time. When PSA level were persistently high over 4 ng/ml or in case of any rising, patients underwent a transrectal ultrasound guided 12-core prostatic biopsy (TRUSbx). RESULTS: Mean age of the patients was 64.56 ± 8.88 (range, 42- 81 years). Prostate volume was 48.34 ± 15,77 ml (range, 18-80 ml). At visit 1, PSA value was in mean 6,84 ± 3.79 ng/ml (range 2.93-21ng/ml). Consequently, mean PSA density value was 0.16 ± 0.16 (range 0.05-1.11). PSA free and PSA total ratio at baseline was 16.85 ± 3.9% (range 8-26%). At visit 2, the prostate volume did not change. Total PSA was 4.65 ± 2,67 ng/ml (range 1-16.82 ng/ml). PSA free and PSA total ratio (PSAF/T) after treatment was 19.68 ± 5.35 % (range 7.8-29%). The differences of total PSA and PSAF/T between visit 1 and visit 2 were < 0.0001 and p < 0.0036, respectively. We performed 26 TRUSbx. Prostate cancer was diagnosed in 6 cases, PIN HG in 2 cases and non neoplastic findings in the remnants 18 patients. CONCLUSIONS: Use of the Curcuma extract is able to lower the PSA value after a 30-day intake period. We are not able to state that the reduction of PSA after intake of this Curcuma extract may exclude a prostate cancer. We need further studies to evaluate that.

Explorative surgery for acute scrotal pain: The importance of patient age, side affected, time to surgery and surgeon.

INTRODUCTION AND OBJECTIVE: Testicular torsion must be diagnosed quickly and accurately. The delay of the diagnosis and the subsequent delay of surgery may lead to loss testicular viability and orchidectomy. Aim of our retrospective evaluation was to define which element should be considered as major support to the clinician in distinguishing spermatic cord torsion from the other diseases mimicking this clinical emergency requiring surgical exploration. MATERIAL AND METHODS: We retrospectively reviewed all clinical and instrumental data of emergency scrotal exploration performed for acute scrotal pain at two different Urological Department in a 10 year period. Results of surgical exploration represented the four diagnostic categories in which patients were divided for statistical evaluation. We evaluated the relationship between diagnosis performed by testicular surgical exploration and the all clinical data available including surgeon involved in the procedures. RESULTS: A total of 220 explorative scrotal surgery were considered. We divided the cases in 4 categories according to the diagnostic results of each surgical procedure. Of all, spermatic cord torsion was diagnosed in 45% (99/220). The total testis salvage rate was of 78.8%. The patients with a diagnosis of spermatic cord torsion were older than patients with appendix torsion (15 vs 11 years in mean). When the affected side was the left, the probability to have a diagnosis of spermatic cord torsion was higher than the right side [χ2 (2, N = 218) = 11.77, p < 0.01]. Time elapsing between onset of symptoms and testicular salvagewas significantly lower even than in case of appendix torsion/necrosis (p < .0001), and of others pathologies diagnosed (p = .0383). CONCLUSION: In case of spermatic cord torsion, in addition to the clinical data, patient age and left side affected may represent an independent diagnostic predicting factor. The time elapsing between onset of symptoms and explorative surgery remain the only still prognostic factor for testicular viability.

May ultrasound probe size influence pain perception of needle piercing during transrectal prostate biopsy? A prospective evaluation.

INTRODUCTION AND OBJECTIVE: Transrectal ultrasound guided prostate biopsy (TRUS-Bx) is the definitive step in the diagnosis of prostate cancer (CaP). Patients (pts) generally experience significant pain during the procedure at the point that biopsy should be accompanied by some form of anesthesia. Several different factors influence pain perception (PP) during TRUS-Bx. In our study we want to assess that the use of an ergonomic smaller sized probe reduces PP during the procedure independently from the administration of local anesthesia or pain relieving drugs. MATERIALS AND METHODS: This was a prospective, randomized study in which 114 pts who underwent TRUS-Bx due to abnormal PSA and/or to digital rectal examination (DRE) suspicious findings were considered eligible. Pts were split in two TRUS-Bx groups into which we used two different sized ultrasound probes. In group 1, 61 pts underwent TRUS-Bx with ALOKA end fire probe (size 74 mm). In group 2, 53 pts underwent TRUS-Bx with B-K Type 8818 probe (size 58 mm). Both groups were treated with no local anesthesia or pain relieving drugs. Pain was evaluated three times using a 10-point visual analogue scale (VAS), during the DRE (VAS 1), during the insertion of the probe (VAS 2) and during the needle piercing (VAS 3). RESULTS: Mean age of pts was 68.03 (SD 8.51); mean tPSA and mean prostate volume was 7.75 (SD 4.83) and 45.17cc (SD 17.7), respectively. The two groups were homogeneous respect to tPSA (p = 0.675) and to prostate volume (p = 0.296); age was significantly different (p = 0.04) between Group 1 (65.93) and Group 2 (70.43), whereas no statistically significant correlation between VAS 3 and age was observed (p = 0.179). Analyzing pain perception, we found no statistically significant difference between the two groups in DRE (VAS 1; p = 0.839); on the contrary, patients in Group 1 experienced on average more pain than other in Group 2 both during the insertion of the probe (VAS 2 3.49 vs 1.09; p < 0.001) and during the needle piercing VAS 3 (2.8 vs 2.00; p < 0.05). The discomfort during probe insertion and manipulation was perceived as very high (VAS 2 > 5) in 42.6% of patients in Group 1 and in 9.4% in Group 2. Globally, the procedure was well tolerated (mean VAS score < 3) in 77% of patients in Group 1 and in 90% in Group 2. The proportion of patients who experienced more than moderate pain (VAS > 5) during needle piercing ranged 24.6 % in Group 1 to 18.9 % in Group 2. CONCLUSIONS: Patients who underwent a TRUS-Bx with the 58-mm circumference probe were found to experience lower degree of pain not only during the insertion of the probe through the anal sphincter, but also in the moment of needle piercing.

Buccal mucosa is a promising graft in Peyronie's disease surgery. Our experience and a brief literature review on autologous grafting materials.

AIM: Peyronie's Disease (PD) is an under reported acquired benign condition that, at the moment, is not curable with medical therapy. Surgery represent the gold standard of treatment. Surgical approaches are several and they consist in "plication techniques" or plaque incision/excision with grafting of resulting albuginea defect. Among grafting procedures, albuginea defect substitution with autologous materials demonstrated over the years not inferior results respect to heterologous grafts. Buccal mucosa graft (BMG) is not usually emphasized in many review articles and clinical series are yet limited. METHODS: We present our experience with seventeen plaque incision procedures and BMG in surgical correction of complex penile curvatures due to PD performed in a period of 30 months. Our analyses was focused on buccal mucosa graft characteristics as major determinant of the surgical success. We also conducted a brief literature review on autologous grafting materials used in reconstructive penile surgery for PD. RESULTS: Our cosmetics and functional results consists in a 100% of functional penile straightening with no relapses and 5,8% of de novo erectile dysfunction. Mean age was 56.4 years, mean follow-up of 22.5 (6-36) months. No complications graft related were observed. Operative time was 115.3 minutes in mean. Over 94% of patients referred they were "really much better" and "much better" satisfied based on PGI-I questionnaire administrated at the last follow- up visit. CONCLUSION: BMG is revealing as an optimal choice for reconstructive surgery in PD. Anatomical characteristics consisting in the great elasticity, the quick integration time and the easy harvesting technique lead to high cosmetics and functional success rate, without omitting economical and invasiveness aspects.

Painful ultrasound detected lesion in the proximal part of the corpus cavernosum: A case of so called "partial priapism"?

Partial priapism is a rare disorder generally described in literature as related to an idiopathic etiology leading to the thrombosis of the corpus cavernosum. Despite his rarity, this condition has been described in the last years with an increased frequency. It is characterized by thrombosis of the proximal segment of one corpus cavernosum with perineal pain as the more frequent clinical manifestation. Few cases were associated with perineal trauma. Instrumental appearance suggests for an hematoma in the interstitium of the proximal part of corpus cavernosum. Therapy is still controversial. We report a case of a 52-years old man referred to our Section of Urology suffering from a perineal pain occurred without trauma, sexual arousal or sexual intercourse, during the working office time. Laboratory revealed a slightly elevated white blood cells count. The full blood count, protein C reactive, electrolytes, international normalized ratio, activated partial thromboplastin time and urinalysis were within normal range. Tunica albuginea was normal. The partial thrombosis of the right corpus cavernosum was hypothesized. Treatment was conservative with non steroidal anti-inflammatory drug. Only the clinical presentation of symptoms and perineal ultrasound scan performed with color sonography leaded to the diagnosis. Eleven days later, at the clinical and ultrasonographic follow-up visit, the patient was asymptomatic with a total clinical and instrumental disappearance of signs of the corpus cavernosum involvement previously described. Considering the rarity of the condition, we performed a literature review.

An unusual case of primary intrascrotal lipoma.

In daily clinical practice, intrascrotal lesion are commonly detected, both by clinical examination either by ultrasound scan. While 95% of testicular lesions are malignant, most paratesticular lesions are benign. Among these, intrascrotal lipomas must be take into account in differential diagnosis. When they originate from scrotal wall, they named "primary scrotal lipoma". We describe a case of a primary intrascrotal lipoma diagnosed after surgical excision in a young man presented at our Urological Department complaining a painful left scrotal mass.

Ultrasound features of a metastatic seminal vesicle melanoma: A case report.

In this report we describe what we consider to be the second case of seminal vescicle (SV) metastasis from an unknown primary melanoma. only presenting symptom was a palpable firm nodule of the right prostate base on digital rectal examination (DRE). The diagnosis, after prostatic transrectal ultrasound examination (TRUS), was performed by ultrasound guided biopsy. We underline that prostatic TRUS evaluation is mandatory in case of abnormal digital rectal examination. Seminal vesicle must be always evaluated.

Penile plaque as predictor of an advanced anorectal carcinoma: A case report.

The secondary involvement of the penis by tumors from others organs is a rare event representing only 0.8% of overall metastasis in the genitourinary tract. The most frequent clinical findings is priapism, but occasionally, solitary metastases to the penile skin, mucosa of the glans, corpus spongiosum or lesions of the albuginea mimicking an induratio penis have been reported. We report a case of penile plaque predicting the relapse of an anorectal carcinoma. The precise etiology of this particular manifestation is not well understood and the prognosis is poor. There are no individual treatments with curative intent.

Patch bulging after plaque incision and grafting procedure for Peyronie's disease. Surgical repair with a collagen fleece.

The incision/excision and grafting techniques (PIG) for surgical therapy of Peyronie's disease (PD) have gained popularity in recent years. Several different graft materials have been used but the ideal graft has yet to be established. The use of grafting materials could cause complications. In the daily clinical practice it will always be more frequent to manage complications arising from their use. We present herein the case of a patch bulging repaired with a ready-to-use collagen fleece (Tachosil®, Takeda, Linz, Austria, Europe) in a 61 years old man subjected to intervention of geometric corporoplasty with Paulo Egydio technique using an acellular collagen material (Xenform® patch, Boston Scientific, Natick, MA, USA) as graft. We also discuss the possible implications of PIG procedure.

Corporoplasty using buccal mucosa graft in Peyronie disease: is it a first choice?

OBJECTIVE: To assesses the surgical and functional efficacy of corporoplasty with buccal mucosa graft, patients and partner's satisfaction, and the low cost of this operation. Biocompatible tissues are frequently used during corporoplasty, but they are expensive and often do not match the thickness and elasticity of the tunica albuginea, leading to fibrosis and scar retraction. Buccal mucosa graft is not usually emphasized in many review articles and clinical studies are limited. METHODS: Thirty-two patients with stable disease and normal erections were included in this retrospective study. All patients underwent corporoplasty with plaque incision and buccal mucosa graft. Preoperative International Index of Erectile Function (IIEF) questionnaire and penile duplex ultrasonographies with measurement of curvature were conducted. At 6 and 12 months postoperatively, patients answered the IIEF and the Patient Global Impression of Improvement questionnaires. Patient and partner satisfaction were recorded at all subsequent visits. RESULTS: Thirty-two patients underwent corporoplasty between 2006 and 2013, and no major complications developed in any patient. After 1 year, curvature relapse was present in 1 patient (3.5%), and 1 patient had slight erectile dysfunction. IIEF values had significantly improved 1 year after surgery (P = .031). Patient satisfaction was 85% on the Patient Global Impression of Improvement questionnaire. Twenty-five of 28 partners were satisfied (90%). Data analysis confirmed the stability of the IIEF score in 16 patients after 2 years (mean IIEF score, 21.3). CONCLUSION: Corporoplasty with buccal mucosa graft is easy to perform and represents a good treatment choice for most forms of Peyronie disease with curvature preventing penetration and sexual intercourse.

Diagnostic and therapeutic utility of transrectal ultrasound in urological office prostatic abscess management: a short report from a single urologic center.

OBJECTIVES: Prostatic abscess (PA) is an infrequent condition in the modern antibiotic era. The everyday use of transrectal ultrasound (TRUS) during diagnostic work-up and the widespread recurrence to prostatic biopsies may lead to an increase of PA diagnosis. In this short report we analyze the patients characteristics and the management of seven recent cases of PA diagnosed in our institution. MATERIALS AND METHODS: The records of 7 patients admitted to our Center for LUTS associated to septic fever or acute urinary retention, was prospectively collected. Suspect of PA was done on digital rectal examination (DRE) and confirmed by TRUS performed after urinary system ultrasound (UUS) evaluation. Patients were admitted to hospital only in case of septic signs. A sovrapubic (SPC) or urethral catheter (UC) was placed depending on symptoms. A TRUS-guided aspiration of PA was performed with patient in lithotomic position, using a 18 gauge two-part needle, side/end fire needle access. Patient was discharged with antibiotic therapy and followed up until complete resolution of the PA and symptoms. RESULTS: Mean age was 62 years (range 24-82). Two patients were diabetics and one was affected by the immunodeficiency acquired syndrome (HIV). In one case, PA was detected after a persistent fever post TRUS guided prostate biopsy. Average prostate volume was 69 ml (range 19-118 ml). DRE was able to diagnose PA only in 2 cases (29%), UUS evaluation in 1 case (14%). All cases were confirmed by TRUS as hypo-anechoic areas with or without internal echoes in all patients. Mean PA dimension was 3.64 cm (range 1.5-8). SPC was placed in 3 cases (43%), UC in 3 patients (43%). Only 1 patient refused catheterization. Side fire needle aspiration was performed in all cases and in combination with end fire access in case of particular location of abscess cavities. Second look was needed in 2 cases (29%). Antibiotics were administered in all cases. The aspirated pus showed a positive culture for Escherichia coli (43%), Klebsiella pneumoniae (29%), Pseudomonas aeruginosa (14%) and Enterococcus faecalis (14%). PA resolution time mean was 9 days (range 3-24). CONCLUSIONS: TRUS evaluation in case of persistent LUTS associated with fever or acute urinary retention is determinant in the diagnosis of PA. Office or institutional management with TRUS needle aspiration is a good option in these cases.

Diagnostic ultrasound-guided excisional testicular biopsy for small (< 1 cm) incidental nodules. A single institution experience.

INTRODUCTION AND OBJECTIVES: The widespread use of scrotal ultrasound (SUS) has led to a marked increase in the number of incidentally detected testicular lesions. A small incidental nodule (STN) has defined as a non palpable (< 10 mm), asymptomatic solid lesion with normal levels of oncological testicular markers. Nowadays the lack of agreement on the topic causes managing problems to andrologists. We present our experience consisting in 8 cases of STN discovered by SUS performed for different clinical indications. MATHERIAL AND METHODS: We retrieved from our ultrasonographic files the clinical information about 717 patients evaluated for andrological problems. Patients with STN underwent to a complete clinical history and physical examination as well as oncological testicular markers measurement and ormonal assessment and then received a diagnostic ultrasound guided excisional biopsy (DEB). Surgical approach was performed through an inguinal incision. Using the coordinates previously obtained from preoperative SUS, STN was localized by intraoperative SUS. The lesion was enucleated and sent to the Pathology department for frozen section examination (FSE). Biopsies of affected testis (TB) were also performed. Post-excision ultrasound has been used to confirm the complete removal of the nodule. Whether pathological findings were benign, testis sparing surgery (TSS) was performed. Immediate radical orchidectomy (IRO) was performed if FSE and TB findings suggested a malignant lesion. RESULTS: STNs were discovered in 8 patients (1,1%). Very small lesions (< 5 mm) were detected in 50% of cases. We performed four IRO and four DEB with consequent TSS. In one case we performed a delayed radical orchidectomy (DRO). At FSE pathologist reported 3 Leydig cell tumor and 3 seminoma and an inflammatory regressive lesion in one case. FSE on TB reported intratesticular neoplasia (TIN) in three cases. In one case nodule wasn't sent to FSE. We observed a concordance between FSE and definitive pathologic report in six cases (75%). CONCLUSIONS: The management of STN is still a challenge for the surgical andrologist. A correct diagnosis has a crucial role in making the best treatment and patients outcome. Ultrasound guided excisional biopsy and the close collaboration with a dedicated pathologist are very useful in reducing errors.

Open-label, longitudinal study of tamsulosin for functional bladder outlet obstruction in women.

OBJECTIVES: To investigate the clinical effect of tamsulosin for the treatment of functional bladder outlet obstruction (BOO) in adult women. METHODS: In a prospective, longitudinal open-label study, 63 women affected by functional BOO were treated with tamsulosin. Inclusion criteria were: age >18 years, reporting voiding symptoms (intermittent stream, hesitancy, straining and/or a feeling of incomplete emptying), uroflowmetry maximum flow rate (Q(max)) under 12 ml and/or presence of postvoid residual greater than 50% of the voiding volume. Exclusion criteria were: patients suffering from any other anatomical or functional disorder such as urethral stenosis, pelvic organ prolapse, neurological disturbances, or systemic diseases that could impact upon bladder voiding. Tamsulosin was administered in a single daily dose of 0.4 mg for at least 30 days. Primary outcomes were clinical efficacy and Q(max) improvement; secondary outcomes were tolerability and safety. Voiding and storage symptoms and uroflowmetry results were assessed before and at the end of the alpha-blocker therapy. RESULTS: Tamsulosin therapy was well tolerated. After therapy voiding symptoms improved in 71.4% of patients (45/63; p < 0.0001), and if associated with storage symptoms in 66.67% (26/39; p < 0.00001). Recurrent infections were reduced by 50% in 81% (21/26) of patients. Uroflowmetry parameters improved in 36/63 patients (57.1%). Postvoiding residue improved in 62.5% (10/16) and disappeared in 25% (4/16) with no significant changes in voided volume. An improvement was observed in 66% (16/24) of patients with isolated voiding symptoms, in 51.2% (20/39) with associated storage symptoms and in 65% (17/26) of women with associated recurrent urinary infections. CONCLUSIONS: These results suggest that alpha-blocker may be an effective treatment option in women with voiding dysfunction due to functional BOO.

Surgical treatment of Peyronie's disease by plaque incision and grafting with buccal mucosa.

BACKGROUND: Plaque incision and tunical grafting is widely used to correct penile curvatures secondary to Peyronie's disease (PD), but there is no consensus on the ideal graft to be used. OBJECTIVE: To evaluate the efficacy, safety, and reproducibility of plaque incision and buccal mucosa grafting (BMG) in the correction of severe penile curvatures secondary to PD. DESIGN, SETTING, AND PARTICIPANTS: Fifteen patients reporting normal erections and stable curvature (>12-mo duration) entered this prospective study carried out at two university hospitals. INTERVENTION: All patients underwent plaque incision and BMG. MEASUREMENTS: Preoperative evaluation included the International Index of Erectile Function (IIEF-5) and penile duplex ultrasounds with measurement of curvature and length of affected side. Follow-up visits were scheduled at 1, 3, 6, and 12 mo postoperatively, then yearly. Three-mo postoperative evaluation included IIEF-5, patient and partner satisfaction, and intracavernous injection test with evaluation of penile rigidity, straightness, and length; patient and partner satisfaction was recorded at all subsequent visits. RESULTS AND LIMITATIONS: Mean patient age was 56.3 yr and mean penile curvature 72 degrees ; five patients had a two-sided curvature with mean second curvature of 37 degrees . There were no complications. All patients resumed unassisted intercourse 1 mo after surgery. Three-mo postoperative evaluation showed 100% penile straightening, 1.8-cm mean increase in length of affected side, no curvature recurrence or de novo erectile dysfunction, 1.6 mean increase in IIEF-5 score, and patient and partner satisfaction of 93.3% and 100%, respectively. Although results remained stable at subsequent follow-up (mean 13.1 mo), a greater number of patients and longer follow-up are needed before drawing any definite conclusions. CONCLUSIONS: BMG provided excellent short-term results, probably because its prompt revascularisation, suggested by the fast return of spontaneous erections, prevented shrinkage, which is the main cause of graft failure. It also proved to be safe and reproducible, thus representing a valuable treatment option for PD.

Female sexual dysfunction in urogenital prolapse surgery: colposacropexy vs. hysterocolposacropexy.

INTRODUCTION: Colposacropexy (CSP), with or without hysterectomy, is a valid technique for the repair of severe urogenital prolapse. For many years, uterine prolapse has represented an indication for hysterectomy, apart from the presence or absence of uterine disease and the patient's desires. Nevertheless, sparing the uterus is essential to women not only to have normal sexual functioning but to maintain physical and anatomical integrity as well. AIM: To assess sexual function in a group of patients who underwent CSP or hysterocolposacropexy (HSP). MATERIALS AND METHODS: We enrolled 37 patients who underwent surgery for urogenital prolapse (15 HSP, mean age 53 years; 22 CSP, mean age 56 years). Based on a preliminary sexual history and sexual questionnaire, all patients were sexually active before surgery. At a mean follow-up of 39 months, we reassessed the patients using the Female Sexual Function Index (FSFI). MAIN OUTCOME MEASURE: We considered sexual activity with a score of 30 = good, 23-29 = intermediate, and <23 = poor. RESULTS: In patients who underwent CSP and HSP, sexual activity was good in 13% and 26%, intermediate in 33% and 21%, and poor in 54% and 53%, respectively; considering also five patients who no longer had sexual activity postoperatively. Nevertheless, the statistical analysis, performed based on the data obtained from the FSFI questionnaire, showed that there were no significant differences between the two groups of points in terms of total score-CSP 21.1 (1.2-33.5) vs. HSP 22.8 (3.6-34.5)-and single domains (desire, arousal, lubrication, orgasm, satisfaction, and pain) (P = not significant). CONCLUSIONS: Our data demonstrated no substantial differences regarding sexual activity in patients in which the uterus has been spared as opposed to those in whom it has been removed. Furthermore, in a small percentage of cases, surgery actually reduced regular sexual activity.

Varicocele and fertility: relationship between testicular volume and seminal parameters before and after treatment.

Varicocele is a condition of varicosity and tortuosity of the pampiniform plexus that is often associated with a reduction in the volume of the affected testicle. Today there is much debate about how much the varicocele actually damages the reproductive system and the mechanism through which this occurs. Furthermore, it has not yet clearly been established if treatment is truly useful to restore testicular function. The goal of this study was to evaluate changes in the volume of the affected testis after treatment and to examine any correlations between volume and seminal parameters. We evaluated 43 patients with left idiopathic varicocele with ultrasound scan of the testis before and after surgery; testicular volume was obtained using the ellipsoid formula. We also examined semen parameters before and at an average time of 1 year after the procedure, using the WHO indications. We performed 2 statistical analyses, comparing changes in testicular volume before and after surgery, and volume with seminal parameters. Statistical analysis shows a significant increase of testicular volume after varicocele treatment (P < .05). Furthermore, the total number of spermatozoa and fast progressive spermatozoa rates significantly increased after surgery (respectively P < .05 and P < .01) (Figure 1). The Spearman correlation coefficient shows a good relationship between testicular volume and total number of spermatozoa (r = .445; P = .01). Our data point to the possibility that the affected testicle could benefit in terms of trophism and function after varicocele treatment. Ultrasound scan at follow-up permits assessment of not only the presence of recurrence, but it is also useful for evaluating trophism.