Reproductive factors, family history, occupation and risk of urogenital prolapse.

OBJECTIVE: We conducted a case-control study to analyze risk factors for urogenital prolapse requiring surgery. METHODS: Cases were 108 women with a diagnosis of II or III degree uterovaginal prolapse and/or third degree cystocele. Controls were 100 women admitted to the same hospitals as the cases, for acute, non-gynecological, non-neoplastic conditions. RESULTS: Occupation showed an association with urogenital prolapse: in comparison with professional/managerial women, housewives had an odds ratios (OR) of urogenital prolapse of 3.1 (95% confidence interval (CI), 1.6-8.8). Compared with nulliparae, parous women tended to have a higher risk of genital prolapse (OR 2.6, 95% CI 0.9-7.8). In comparison with women reporting no vaginal delivery, the ORs were 3.0 for women reporting one vaginal delivery (95% CI 1.0-9.5), and 4.5 (95% CI 1.6-13.1) for women with two or more vaginal deliveries. Forceps delivery and birthweight were not associated with risk of prolapse after taking into account the effect of number of vaginal deliveries. The risk of urogenital prolapse was higher in women with mother or sisters reporting the condition: the ORs were, respectively, 3.2 (95% CI 1.1-7.6) and 2.4 (95% CI 1.0-5.6) in comparison with women whose mother or sisters reported no prolapse. CONCLUSIONS: Our data support the clinical suggestion that parous women are at a higher risk of prolapse and the risk increases with number of vaginal deliveries. First-degree family history of prolapse seems to increase the risk of prolapse.

Plasma steroid transport in subjects with tumors of hormonal target organs: a review.

Tumors derived from a hormonal target organ are assumed to be stimulated by the same hormone that stimulates the normal target tissue. In spite of attempts to acquire direct indications of a correlation between hormones and cancer, none have been definitive because studies of total and free hormone levels have given contradictory results. For this reason, attention has shifted to the study of plasma binding and transport of hormones, that is, of the proteins responsible for modulation of the hormone effect and thus of hormone bioavailability. The data reviewed indicate that in-depth study of the transport and binding system of sex steroids would give new information about the endocrine characteristics of cancer patients.

[Evaluation of the activity of the bladder detrusor muscle and analysis of bladder function in subjects with diabetes mellitus under insulin treatment]. / Valutazione dell'attività del muscolo detrusore della vescica ed analisi della funzione vescicale in soggetti affetti da diabete mellito in trattamento insulinico.

The present report concerns investigations of detrusor muscle adrenergic innervations in patients affected by bladder neuropathy secondary to diabetes without obstructive disturbances. Detrusor contractile activity evoked by NE is markedly reduced which can probably be attributed to receptor deficit. Urodynamic evaluation demonstrated a prevalence of sensory peripheral neuropathy than a motor conduction abnormality. In vitro study demonstrated that motor conduction abnormality of detrusor contractile activity is present early without bladder disturbances. Therefore early urodynamic measurements are necessary to evaluate bladder dysfunction and neuropathy in diabetic patients.

[Prospectives of the study of seminal fluid in the diagnosis of infertility]. / Prospettive di studio del plasma seminale nella diagnostica dell'infertilità.

Biochemical components usually evaluated in seminal plasma are lower than those in blood serum. In this study the concentration of different constituents in seminal plasma has been analyzed: creatinine, urea, glucose, uric acid, sodium, potassium, triglycerides, cholesterol, bilirubin, alkaline phosphatase, glutamic oxalacetic transaminase (SGOT), glutamic pyruvate transaminase (SGPT), cholinesterase, creatin phospho chinase (CPK), gamma glutamyl transpeptidase, lactic dehydrogenase (LDH), proteins, in comparison with the concentrations of the same constituents in blood. With the exception of uric acid, all the biochemical components in the seminal plasma were either significantly higher or lower than in blood serum, an index of the complexity of the mechanism regulating the presence and distribution of the single components in seminal plasma compared with blood serum. Isoelectro-focussing for proteins showed, in seminal plasma, a higher quantity of fragments and a different distribution of this in comparison with blood serum.

[Multicenter study on the effectiveness of Tension Vaginal Tape (TVT) in the treatment of stress urinary incontinence]. / Studio multicentrico sull'efficacia del Tension Free Vaginal Tape (TVT) nella terapia della incontinenza urinaria da sforzo.

BACKGROUND: The aim of the study was to evaluate the efficacy of Tension Free Vaginal Tape (TVT) for the surgical treatment of stress urinary incontinence. METHODS: The design was an open multicenter study including six Italian hospitals. Between January 1998 and November 1999, 429 stress incontinent women were enrolled in the study. Before surgery subjects had been studied through their history, urine culture, physical examination, cotton swab test, cough provocation test and urodynamic evaluation including: uroflowmetry, water cystometry and urethral profilometry. Incontinence inconvenience has been quantified through a 10-grade visual analogue scale (VAS). Postoperatively patients were assessed after 6, 12 and 24 months. RESULTS: The mean age of the patients considered was 57 years (range 31-83) and 78 of them had undergone a previous operation for the treatment of stress urinary incontinence or genital prolapse. Out of the 429 patients, 371 were followed for a minimum of 6 months, 11 were lost to follow-up and 47 had been operated recently. After surgery 355 subjects (96%) were subjectively cured and no leakage of urine was observed in 97% of the patients during the postoperative cough provocation test. CONCLUSIONS: This study carried out on a great number of patients demonstrates that TVT is a safe and effective procedure for the treatment of stress urinary incontinence.

[Urolithiasis in pregnancy]. / Urolitiasi in gravidanza.

Urolithiasis is a cause of abdominal pain occurring during pregnancy requiring hospitalization. Of 3793 deliveries in a 5-year period 11 were complicated by urinary calculi during pregnancy. The incidence was 0.29% and in 45% the calculi passed spontaneously. Conservative therapy was resolute in 100% of cases and didn't have any consequence on pregnancy and neonatal outcome. Pathogenesis, diagnostic and therapeutic approach are considered.

[Endometriosis of the large intestine. A report of 2 clinical cases]. / Endometriosi del grosso intestino. Descrizione di due casi clinici.

Intestinal involvement of endometriosis requiring treatment is 5%, but only 0.7% needs intestinal resection. The authors report two cases of colic endometriosis and illustrate problems in diagnosis and management of this disease. Usually intestinal endometriosis takes the form of asymptomatic superficial serosal implants, encountered incidentally at laparotomy for other diseases, but it can also result in obstruction and occasionally bleeding. Any premenopausal woman with episodic bowel symptoms associated with gynecologic complaints should be suspected of endometriosis of the colon. Diagnosis can be suspected by double-contrast enema examination and colonoscopy with biopsy, although neither is likely to establish the diagnosis with certainty. In fact there are no radiologic or diagnostic imaging findings that are specific for endometriosis and unequivocal diagnosis requires microscopic examination. Differential diagnosis includes primary carcinoma of the colon and other benign diseases (pelvic inflammatory disease, diverticulitis, inflammatory bowel disease, pelvic abscess, polyps, etc.). The treatment of patients with uncomplicated, but symptomatic gastrointestinal endometriosis depends on the age of the patient and her childbearing attitude. Resection of the affected bowel should be done in patient with pain, bleeding, changes in bowel habits and intestinal obstruction and it is necessary to avoid neglecting a malignant tumor. Total abdominal hysterectomy and bilateral oophorectomy is the treatment of choice in the perimenopausal and menopausal women. In symptomatic women desiring children the only resection of involved colon may be appropriate treatment. In these subjects hormonal therapy can be useful.

[The diagnosis and therapy of HPV-associated genital lesions: the role of systemic beta-interferon treatment]. / Diagnostica e terapia delle lesioni genitali associate ad HPV: ruolo del trattamento sistemico con beta-interferone.

OBJECTIVE: To evaluate the effective role of HPV DNA typing by commercial probes and of i.m. interferon therapy in the management of HPV-related female genital lesions. EXPERIMENTAL DESIGN: Perspective study in a second-level colposcopy service (Istituto Ostetrico-Ginecologico "L. Mangiagalli"--II Clinica Ostetrica-Ginecologica). 110 patients, age range 15-45 years, with cytologic and/or histologic diagnosis of HPV-related genital lesions: HPV DNA typing (commercial probes) of genital specimens was performed. Excluding CIN III or VIN III cases, patients were treated with i.m. interferon-beta therapy for 4 weeks and, in case of persistence, for other 4 weeks. A colposcopic, cytologic and histologic follow-up for 6 months after therapy was performed. HPV DNA typing was repeated only in case of positive hybridization before therapy. RESULTS: In 81 cases, diagnosis of low-grade intraepithelial genital lesion (LSIL) was done, while 29 were high-grade intraepithelial genital lesions (HSIL). 73 patients completed the study. 3 months after interferon-beta i.m. administration, we observed complete remission in 72.97% of LSILs and in 47.36% of HSILs, while, 6 months after, remissions were observed in 81.25% of LSILs and in 73.33% of HSILs. Anyhow, treatment was well tolerated. HPV DNA typing confirmed the clinical course of lesions. CONCLUSIONS: Because of difficulties to standardize techniques, we believe that HPV DNA typing cannot assume a clinical or prognostic value, but only an experimental one. Interferon-beta i.m. administration could be considered a valid alternative or support to physical therapy as treatment of HPV-related genital lesions.

[Arterialization of the deep dorsal vein in selected cases of vasculogenic impotence]. / Arterializzazione della vena dorsale profonda in casi selezionati di impotenza vasculogenica.

We report our study of surgical treatment of vasculogenic impotence using the technique of arterialization of the deep dorsal vein. The results of the operation performed in 13 selected cases are good although the follow-up is still short. The reasons why we consider this technique preferable to the others available for penile revascularization are discussed.

Plasma sex hormone binding globulin in patients with prostatic carcinoma.

The concentrations of sex hormone binding globulin (SHBG) were measured in the plasma of 56 men, who were 47 to 85 years of age, by time-resolved immunofluorometric assay with a monoclonal antibody. Twenty-five of the men had untreated carcinoma of the prostate and 17 had untreated prostatic hyperplasia. There were 14 healthy control subjects. SHBG levels were significantly higher in patients with prostatic carcinoma (37.6 +/- 8.4 nmol/l) than in those with prostatic hyperplasia (24.5 +/- 5.2 nmol/l; P less than 0.05) or control subjects (14.9 +/- 2.8 nmol/l; P less than 0.01). It is not known why SHBG levels are higher in patients with carcinoma or hyperplasia of the prostate. The contradictory results obtained in other studies may be due to heterogeneity of the binding globulin causing its values to vary in the different assays used.

[Experience with the determination of LDH-X in seminal plasma as diagnostic and prognostic factor in varicocele]. / Experiencias sobre la dosificación de la LDH-X en el plasma seminal como factor diagnóstico y pronóstico en el varicocele.

We studied the biochemical and functional properties of semen to evidence markers of diseases concerning fertility. We examined LDH especially isoenzyme LDHx in semen of patients with varicocele, diagnosed by clinical evaluation and doppler velocimetry. The existence of this enzyme is closely associated with active spermatogenesis. In conditions of testicular disease as in varicocele, a major diffusion of LDHx into the seminal plasma may occur as a reaction of the seminiferous epithelium. We evaluated 50 patients (10 normospermic patients, 20 affected by varicocele, 9 azoospermic patients, 11 oligo-astenospermic patients). We observed that the LDHx concentration in seminal plasma is proportional to the severity of the clinical damage. The follow up after spermatic vein ligation of the patients affected by varicocele demonstrated that these patients improved to the normal clinical parameters, associated to a decrease of the concentration of LDHx values.

Postpubertal cryptorchidism: review and evaluation of the fertility.

We assessed the fertility of 91 patients affected by unilateral cryptorchidism who were subjected to postpubertal orchidopexy in the last 15 years. All cases were clinically examined, evaluated by semen analysis and Doppler ultrasound of the spermatic artery. Twenty-two patients underwent testicular biopsy. The results indicate that orchidopexy is not the best treatment for postpubertal cryptorchid patients. After orchidopexy, 83.5% of patients were azoospermic or oligospermic, with or without asthenospermia.

Morphodynamic and biochemical assessment of seminal plasma in patients who underwent local prostatic hyperthermia.

Fourteen young and sexually active patients with chronic abacterial prostatitis who failed to respond to conventional medical therapy underwent four 60 minute sessions of local prostatic hyperthermia. Calculated prostatic temperature was 42 +/- 0.5 degrees C. Analysis of seminal plasma was performed pre- and postoperatively and included: number, motility, and morphology of spermatozoa; zinc, citric acid, D-fructose, and free testosterone content. Preoperative semen analysis was normal in five patients and abnormal in nine. Morphodynamic and biochemical patterns of seminal plasma were not significantly altered by thermotherapy. Local prostatic hyperthermia can be safely used in patients with chronic abacterial prostatis not responding to conventional medical therapy and desiring to preserve their reproductive potential.

Comparative effects of alfuzosin versus Serenoa repens in the treatment of symptomatic benign prostatic hyperplasia.

OBJECTIVES: Sixty-three patients suffering from benign prostatic hyperplasia (BPH) entered a double-blind, comparative, parallel-groups study lasting 3 weeks, carried out to compare the efficacy and safety of alfuzosin 2.5 mg tid (n = 32) vs serenoa repens 160 mg bid (n = 31) in BPH. METHODS: Efficacy was assessed both on clinical symptoms (Boyarsky's scale, visual analogue scale, clinical global impression), urinary flow rates (uroflowmetry) and residual urinary volume (transabdominal ultrasound). Events and reported signs were recorded throughout the entire study. RESULTS: Statistically significant and clinically relevant differences were found between the two treatments in favour of alfuzosin for Boyarsky's total score (decrease from 9.6 +/- 3.0 to 5.9 +/- 3.0, 38.8% for alfuzosin and from 9.3 +/- 2.5 to 6.8 +/- 2.8, 26.9% for serenoa repens) and obstructive score (decrease from 4.9 +/- 2.1 to 3.0 +/- 1.9, 37.8% for alfuzosin; from 4.4 +/- 1.7 to 3.4 +/- 1.8, 23.1% for Serenoa repens; p = 0.01 for both). Clinically relevant differences were found between the two treatments for visual analogue scale and overall clinical impression at the end of the study. Furthermore, the increase in quality of micturition was better with alfuzosin. The proportion of responders (increase on day 21 in peak flow rate of at least 25% relative to the baseline values) was in favour of alfuzosin (71.8% and 48.4% for alfuzosin and Serenoa repens, respectively; p = 0.057). Both treatments were well tolerated. No patient treated with alfuzosin complained of any adverse event at any time during the study. One patient in the Serenoa group complained of mild pruritus which cleared spontaneously. Systolic, diastolic blood pressure and heart rate did not show any clinically relevant change during treatment with alfuzosin. CONCLUSIONS: The findings confirm the efficacy and safety of alfuzosin in symptomatic BPH and indicate the superiority of alfuzosin over Serenoa repens in the treatment of urinary signs and symptoms of BPH.