Stem Cell Therapy for Male Urinary Incontinence.

INTRODUCTION: Among the medical and surgical options which have been proposed in the last years for the management of male stress urinary incontinence (SUI), stem cell therapy represents a new frontier treatment. The aim of this paper is to update the current status of stem cell therapy in animal and human studies for the management of iatrogenic male SUI. MATERIAL AND METHODS: A PubMed review of the literature on stem cell therapy for the treatment of male SUI was performed. RESULTS: Regarding animal studies, bone marrow-, muscle- and adipose-derived stem cells have been widely studied, showing regeneration of the urethral sphincter and recovery of the damaged pelvic nerves. With regard to human studies, only four papers are available in the literature using muscle- and adipose-derived stem cells which reported a significant improvement in sphincteric function and incontinence with no severe side effects. CONCLUSIONS: In spite of these promising results, further studies are needed with longer follow-ups and larger numbers of patients in order to clarify the potential role of stem cell therapy for the treatment of male SUI.

Early results of urothelial carcinoma screening in a risk population of coke workers: urothelial carcinoma among coke workers.

OBJECTIVE: To present the protocol and the early results of a urothelial carcinoma (UC) screening analysis performed in a risk population of coke workers. METHODS: Between June 2006 and October 2008, 171 male workers (mean age 43 years), employed in a Ligurian coke plant (Italiana Coke S.r.l) and exposed to polycyclic aromatic hydrocarbons (PAHs) for a median period of 16 years, underwent screening for UC. Urological evaluation included medical history, physical examination, routine laboratory tests, urine analysis, urinary cytology and uCyt+ assay. In the event of signs and symptoms suggestive of UC or positive urinary tests, the workers were also subjected to urinary ultrasonography and cystoscopy with biopsy of any suspicious lesions. RESULTS: Regarding the laboratory tests, 19/171 (11%) uCyt+ samples were considered inadequate and were excluded from the outcomes assessment. Overall, urine analysis, cytology and uCyt+ were positive in 18/152 (12%) subjects who showed no evidence of UC at the scheduled check-ups. No significant association was identified between marker positivity and occupational activity. CONCLUSIONS: Our results fail to show an increased risk of UC among the coke workers evaluated. However, they will need to be confirmed in the future by a larger enrollment and a longer follow-up in order to assess the definitive risk for UC after exposure to coke.

Radical retropubic prostatectomy versus brachytherapy for low-risk prostatic cancer: a prospective study.

OBJECTIVES: To compare the oncological and functional outcomes reported after radical retropubic prostatectomy (RRP) versus brachytherapy (BT) in the treatment of low-risk prostatic cancer (CaP). METHODS: Between May 1999 and October 2002, 200 patients (mean age 65.3 +/- 8.7) were enrolled and randomized into two groups of 100 patients each to undergo RRP (group 1) or BT (group 2). Prior to and following treatment, all patients were evaluated by physical examination, PSA assay and compilation of IPSS, IIEF-5 and EORTC-QLQ-C30/PR25 questionnaires. Oncological results were reported at 5 years, while functional outcomes were reported at 6 months, and 1 and 5 years mean follow-up. RESULTS: Of the 200 patients studied, 174 completed the 5-year follow-up assessment. With regards to oncological outcomes, similar 5-year biochemical disease-free survival rates were reported for RRP (91.0%) or BT (91.7%). At 6 months and 1 year, both techniques produced a significant decrease in quality of life aspects, while group 2 patients reported a significantly higher and longer lasting rate of urinary irritative disorders and better erective function than group 1. No differences in functional outcomes were encountered after 5 years in either group. CONCLUSIONS: RRP and BT are two different options for the treatment of low-risk CaP, which produce different short-term sequelae in terms of urinary disorders and erective functions, but similar biochemical disease-free survival. Further studies with a higher number of patients and a longer follow-up are needed to evaluate their comparative effectiveness on overall disease-specific survival and metastatic disease.

The Giuliani muscle splitting and nerve-sparing anterolateral transabdominal approach to the kidney.

We report on an anterolateral transabdominal approach to the kidney, which is appropriate when vascular control is important (such as, radical nephrectomy, traumatic renal injury, and difficult nephrectomy). The technique splits muscles and spares nerves and that allows good exposure both downward as far as the aortic bifurcation and upward as far as the diaphragm. This approach has been used in 42 patients during the last 20 months (mean follow-up, 6.5). In all these patients the active control of the abdominal wall muscles has been completely preserved, while, during the period from 1974 to 1994, about half of 434 patients who underwent the same approach, but with muscle and nerve transection, showed abdominal wall relaxation.

Results of radical cystectomy for primary bladder cancer. Retrospective study of more than 200 cases.

During a seven-year period 202 patients with primary bladder cancer had radical cystectomy with bilateral pelvic lymphadenectomy and urinary diversion. Lymph node metastases were found in 28.7 per cent. No significant differences in overall survival owing to age were apparent. Only extension and grade of histopathologic differentiation of the tumor proved to be an important prognostic factor. The five-year survival rates for pT1, pT2, pT3, and pT4 tumors were 76, 56, 19, and 0 per cent, respectively. In patients with deep invasive (T3 and T4) tumors no significant differences of survival rate depending on N and M categories were found. Nevertheless in pT3 tumors the probability of remaining alive was significantly decreased in those patients with histologic grade 3 compared with grade 2 tumors (P less than 0.01). The prognosis for patients submitted to radical cystectomy for bladder cancer has been classified as good: tumors confined to superficial muscle (pT1 and pT2); intermediate: tumors mildly differentiated infiltrating the deep muscle (pT3/G2); fairly poor: tumors undifferentiated infiltrating deep muscle (pT3/G3); and poor: adjacent invasive bladder tumors (pT4).

Treatment of urinary tract infections with ciprofloxacin.

Urinary tract infections in 32 patients were treated with 250 mg of ciprofloxacin twice daily for seven to eight days. Clinical and laboratory examinations were performed before and after treatment. The infections were eradicated in 30 of the 32 patients. Ciprofloxacin was well tolerated by all patients.

Estramustine phosphate (estracyt) following androgens in men with refractory stage D2 prostate cancer.

Twenty-two orchiectomized men with progressive stage D2 prostate cancer were treated with a 3-week cycle of estramustine phosphate (EMP: from day 3 to day 21) and androgen priming (from day 1 to day 4). A partial response according to the NPCP-USA criteria was shown in 4 of 20 evaluable patients. Median progression-free survival of all patients was 24 weeks (range, 4-48) and median survival, 42 weeks (range, 4-112). Although in two cases treatment had to be stopped due to a marked increase in bone pain, no life-threatening side effects were observed. The androgen sensitivity of tumors was supported by the occurrence of increase in prostatic phosphatase and in bone pain in most patients. In this group of patients, androgen priming did not seem to potentiate the effectiveness of EMP, our results being comparable to those previously reported using EMP alone.

Long-acting (depot) D-TRP-6 LH-RH (Decapeptyl) in prostate cancer. An Italian multicentric trial.

Ninety-five patients with stage C (C1 + C2) or D (D1 + D2) prostatic carcinoma were treated with the long-acting formulation of D-TRP-6 LH-RH (Decapeptyl) for up to 39 months. Of 88 patients evaluable for response, about one-half showed an objective response. In most cases, subjective improvement with relief of bone pain and/or urinary symptoms was obtained. Five patients claimed a mild increase in bone pain and one patient a slight worsening of dysuria following the first injection. Median progression-free survival was 13.1 and 16.4 months in patients with stage D2 and D1, respectively. Median survival in stage D2 patients was 27.6 months. These results indicate that the depot formulation of D-TRP-6 LH-RH offers an effective therapeutic alternative for patients with advanced prostatic cancer.

[Renal adenocarcinoma with neoplastic thrombus in the inferior vena cava. Prognosis and operative risk]. / L'adenocarcinoma renale con trombo neoplastico nella vena cava inferiore. Prognosi e rischio operatorio.

10 cases of renal adenocarcinoma invading the lower vena cava and subjected at the Genoa urology clinic to radical nephrectomy and cavotomy, with thrombectomy or resection of the vena cava, are reviewed. Of 5 patients who did not present long-term metastasis, 2 are alive and in good condition at 30 and 64 months, one died from myocardial infarction after 34 months, and two died in the postoperative course from respectively renal insufficiency and myocardial infarction. In patients presenting long-term metastasis at the moment of surgery, results were poor: four patients died from 4 to 7 months later and only one patient, with bone metastasis, is alive after 33 months.

[Surgical treatment of renal adenocarcinoma with neoplastic thrombosis of the inferior vena cava]. / Il trattamento chirurgico dell'adenocarcinoma renale con trombosi neoplastica della vena cava inferiore.

Personal experience in the surgical management of 15 cases of renal adenocarcinoma with neoplastic thrombosis of the vena cava inferior is described, and an account is given of the procedures adopted in accordance with the degree of endocavitary extension of the tumour. Emphasis is also placed on the need to ensure, as in all cases of nephrectomy for tumours, "neoplastic asepsis" by means of a preliminary vascular stage with the compartment intact. For this purpose, it is felt that sufficient preoperative angiographic evaluation of the intracavitary tumour is essential, coupled with absolute intraoperative control of the vena cava and/or right atrium proximally to the thrombus, to prevent the intraoperative mobilisation of neoplastic embolisms.

[Translabial ultrasonography in the diagnosis of stress urinary incontinence in women]. / L'ecografia translabiale nella diagnosi della IUS femminile.

The target of this work is to evaluate the translabial ultrasonography (US) reliability as valid alternative to chain cystography in the pre and post operative assessment of patients with stress urinary incontinence (SUI). From June 1996 to May 1999, we studied 448 patients ranging in age from 35 to 90 years old with SUI from defect of anatomic support. Patients underwent translabial ultrasonography. The translabial US was performed with the patient in lithotomic position using a linear 7.5 MHz probe. The bladder was slightly filled, and the probe positioned longitudinally at the introitus to evaluate downwards and posterior rotation of bladder neck and urethra in basal conditions as well as during the abdominal strain. The evaluation of the anterior urethral angle of the 448 patients who underwent translabial US showed that, during the abdominal strain, all the patients with SUI had a very significative rotation of the urethral axis compared to continent women. Translabial US is a quick, simple, reliable non-invasive procedure. It may be used routinely for the pre and post-operative evaluation of anti-incontinence surgery.

[Giuliani's method of anterio-lateral transabdominal muscle splitting and nerve preservation for kidney tumors]. / Voie d'abord antéro-latérale trans-abdominale de Giuliani avec séparation musculaire et préservation nerveuse pour abord des tumeurs du rein.

OBJECTIVES: Anterolateral transabdominal incisions provide good exposure for supramesocolonic and inframescolonic surgery. However, these incisions section and denervate the rectus abdominis, oblique and transversus abdominis muscles with marked loss of active muscle control in a large number of patients. In 1974, Giuliani described an anterolateral transbdominal approach for renal tumours, which provides good visualization and good access to the renal pedicle, as well as good exposure caudally as far as the aortic bifurcation and cranially as far as the diaphragm. The authors report a new anatomical technique using this incision, which splits the muscles and preserves the nerves thereby avoiding the abdominal muscle hypotonia. MATERIAL AND METHODS: From March 1996 to March 1998, Giuliani's surgical incision was performed in 35 patients undergoing radical nephrectomy for renal cancer (24 on the left side and 11 on the right side). The mean age of the patients was 63.2 years (range: 42 to 80 years) and the mean follow-up was 11.6 months. RESULTS: Tone and active control of muscles of the abdominal wall were completely preserved in all of these 35 patients. However, all patients presented a slight sensory loss in the low portion of the transverse skin incision close to the umbilicus, which improved with time and resolved completely in about 50% of cases. CONCLUSION: The mahor advantage of this anatomical incision compared to the conventional technique is to eliminate permanent functional deficits and hypotonia of the abdominal wall. This anatomical approach also allows easy and perfectly safe wound closure in layers, by reconstructing the anterior abdominal wall.

Anomalies and absence of local equilibrium, and universality, in one-dimensional particles systems.

One-dimensional systems are under intense investigation, both from theoretical and experimental points of view, since they have rather peculiar characteristics which are of both conceptual and technological interest. We analyze the dependence of the behavior of one-dimensional, time-reversal invariant, nonequilibrium systems on the parameters defining their microscopic dynamics. In particular, we consider chains of identical oscillators interacting via hard-core elastic collisions and harmonic potentials, driven by boundary Nosé-Hoover thermostats. Their behavior mirrors qualitatively that of stochastically driven systems, showing that anomalous properties are typical of physics in one dimension. Chaos, by itself, does not lead to standard behavior, since it does not guarantee local thermodynamic equilibrium. A linear relation is found between density fluctuations and temperature profiles. This link and the temporal asymmetry of fluctuations of the main observables are robust against modifications of thermostat parameters and against perturbations of the dynamics.

Slings in iatrogenic male incontinence: Current status.

OBJECTIVES: The increasing number of prostatectomies entails an increasing number of patients suffering from iatrogenic incontinence despite improved surgical techniques. The severity of this problem often requires invasive treatments such as periurethral injection of bulking agents, artificial urinary sphincter (AUS) implantation, and sub-urethral sling positioning. The artificial urethral sphincter has represented, until today, the gold standard but, in the recent years, sling systems have been investigated as minimally invasive alternative options. Today, three different sling procedures are commonly performed: bone-anchored, readjustable, and trans-obturator slings systems. The aim of this review is to critically report the current status of sling systems in the treatment of iatrogenic male incontinence. MATERIALS AND METHODS: MEDLINE and PubMed databases were searched and all articles between 1974 and 2009 were evaluated. RESULTS: With regard to bone-anchored, readjustable, and trans-obturator slings systems, cure rates ranged between 58.0% and 86.0%, 55.5% and 73.0%, and 40.0% and 63.0%, respectively, while major complication rates ranged between 0 and 14.5%, 10.0 and 22.2%, and 0 and 10.0%, respectively. CONCLUSIONS: Suburethral slings are the only alternative techniques which can be favorably compared with the AUS, showing more advantages with respect to AUS implantations which are mainly represented by a quick and less invasive approach, low morbidity, and low costs. In spite of the difficulty in identifying the most effective sling procedure, overall, sling systems can be recommended for patients with persistent mild or moderate incontinence. However, the indication can also be extended to patients with severe incontinence, after appropriate counseling, allowing AUS implantation in the event of sling failure.

Transvaginal sacrospinous colpopexy by palpation-a new minimally invasive procedure using an anchoring system.

OBJECTIVES: To evaluate the preliminary results and complications of a new, minimally invasive, transvaginal sacrospinous colpopexy for vault and uterovaginal prolapse. METHODS: Twelve women, 41 to 79 years old, underwent sacrospinous fixation by palpation using the Raz Anchoring System (RAS) between October 1998 and September 1999. The vaginal vault prolapse was grade II and III in 4 and 6 patients, respectively. Two patients had grade III uterovaginal prolapse. Two patients underwent RAS alone, and 10 underwent RAS in conjunction with simultaneous related vaginal surgery. Eleven patients underwent vaginal vault and one uterovaginal fixation. RAS features two components: first, a 15-mm-long cylindrical titanium anchor and second, a disposable inserter. A penetration limiter tube allows one to penetrate the sacrospinous ligament up to the desired depth. The anchor is released into the ligament and then the vaginal apex is fixed in place. RESULTS: The minimum and mean follow-up was 12 and 16 months, respectively. The operative time to complete the colpopexy ranged from 8 to 15 minutes. We recorded only one recurrent vaginal vault prolapse due to pull-through of the suspension sutures through the vagina. No significant perioperative complications occurred. No de novo or recurrent cystocele, rectocele, enterocele, stress urinary incontinence, urgency, or frequency was seen. Defecation was normal in all patients. Coital function was normal in 8 patients who were still sexually active. No patient experienced perineal or buttock pain. CONCLUSIONS: RAS seems to be quick, easy, safe, and effective in the suspension of vaginal apex to the sacrospinous ligament, but our preliminary results must be confirmed by controlled prospective studies with a larger number of patients and wider follow-up.

Transvaginal bone-anchored synthetic sling for the treatment of stress urinary incontinence: an outcomes analysis.

OBJECTIVES: To evaluate the results and complications of a new transvaginal minimally invasive procedure for the treatment of stress urinary incontinence. METHODS: Sixty-seven women aged 37 to 77 years underwent a pervaginal bone-anchoring synthetic sling procedure between April 1997 and February 1999. Sixty-three patients had a defect of the anatomic support, and 4 had iatrogenic intrinsic sphincteric deficiency (ISD). Patients were assessed at least 1 year postoperatively, underwent physical examination, and filled in the self-assessment questionnaire with the help of a nonpartisan health care provider. The questionnaire inquired about urine leakage, obstructive and irritative symptoms, quality of life, and satisfaction with the treatment received. The physician and questioner had no knowledge of each other. RESULTS: Mean follow-up was 17 months. Perfect dryness was seen in 82% of patients with improvement in 9% and failure in 9%. Patients reporting a failed outcome were significantly older than those reporting improvement or cure (P = 0.01). All patients with ISD failed. Moderate obstructive symptom scores have been noticed in 31% of patients. Irritative voiding symptoms have been recorded in 22% of cured patients and 83% and 80% of improved and failed patients, respectively (P <0.001). Three percent of patients experienced pain during intercourse. Mild pelvic pain was found in 8% of patients. The only main complication of the operation was the vaginal erosion and sling removal in 16% of patients. Seventy-two percent of patients were completely satisfied with the treatment received. CONCLUSIONS: This procedure allows a high cure rate in patients with urinary incontinence due to a defect of anatomic support, and it is unsuitable when incontinence is due to ISD. The only main complication came from the use of the gelatin-coated Dacron sling that resulted in vaginal erosion, often necessitating the sling removal. The use of different synthetic or nonsynthetic materials may be advisable.